Home > 106th Congressional Bills > S. 972 (is) To amend the Wild and Scenic Rivers Act to improve the administration of the Lamprey River in the State of New Hampshire. [Introduced in Senate] ...

S. 972 (is) To amend the Wild and Scenic Rivers Act to improve the administration of the Lamprey River in the State of New Hampshire. [Introduced in Senate] ...


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108th CONGRESS
  1st Session
                                 S. 971

 To amend title XIX of the Social Security Act to provide individuals 
 with disabilities and older Americans with equal access to community-
     based attendant services and supports, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 1, 2003

  Mr. Harkin (for himself, Mr. Specter, Mr. Kennedy, Mr. Cochran, Mr. 
Biden, Ms. Landrieu, Mr. Kerry, Mr. Corzine, Mr. Schumer, Mrs. Clinton, 
and Mr. Dayton) introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend title XIX of the Social Security Act to provide individuals 
 with disabilities and older Americans with equal access to community-
     based attendant services and supports, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicaid 
Community-Based Attendant Services and Supports Act of 2003''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings and purposes.
            TITLE I--ESTABLISHMENT OF MEDICAID PLAN BENEFIT

Sec. 101. Coverage of community-based attendant services and supports 
                            under the medicaid program.
Sec. 102. Enhanced FMAP for ongoing activities of early coverage States 
                            that enhance and promote the use of 
                            community-based attendant services and 
                            supports.
Sec. 103. Increased Federal financial participation for certain 
                            expenditures.
      TITLE II--PROMOTION OF SYSTEMS CHANGE AND CAPACITY BUILDING

Sec. 201. Grants to promote systems change and capacity building.
Sec. 202. Demonstration project to enhance coordination of care under 
                            the medicare and medicaid programs for non-
                            elderly dual eligible individuals.

SEC. 2. FINDINGS AND PURPOSES.

    (a) Findings.--Congress makes the following findings:
            (1) Long-term services and supports provided under the 
        medicaid program established under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.) must meet the ability and 
        life choices of individuals with disabilities and older 
        Americans, including the choice to live in one's own home or 
        with one's own family and to become a productive member of the 
        community.
            (2) Research on the provision of long-term services and 
        supports under the medicaid program (conducted by and on behalf 
        of the Department of Health and Human Services) has revealed a 
        significant funding bias toward institutional care. Only about 
        27 percent of long term care funds expended under the medicaid 
        program, and only about 9 percent of all funds expended under 
        that program, pay for services and supports in home and 
        community-based settings.
            (3) In the case of medicaid beneficiaries who need long 
        term care, the only long-term care service currently guaranteed 
        by Federal law in every State is nursing home care. Only 27 
        States have adopted the benefit option of providing personal 
        care services under the medicaid program. Although every State 
        has chosen to provide certain services under home and 
        community-based waivers, these services are unevenly available 
        within and across States, and reach a small percentage of 
        eligible individuals. In fiscal year 2000, only 3 States spent 
        50 percent or more of their medicaid long term care funds under 
        the medicaid program on home and community-based care.
            (4) Despite the funding bias and the uneven distribution of 
        home and community-based services, 2\1/2\ times more people are 
        served in home and community-based settings than in 
        institutional settings.
            (5) The goals of the Nation properly include providing 
        families of children with disabilities, working-age adults with 
        disabilities, and older Americans with--
                    (A) a meaningful choice of receiving long-term 
                services and supports in the most integrated setting 
                appropriate to their needs;
                    (B) the greatest possible control over the services 
                received and, therefore, their own lives and futures; 
                and
                    (C) quality services that maximize independence in 
                the home and community, including in the workplace.
    (b) Purposes.--The purposes of this Act are the following:
            (1) To reform the medicaid program established under title 
        XIX of the Social Security Act (42 U.S.C. 1396 et seq.) to 
        provide equal access to community-based attendant services and 
        supports.
            (2) To provide financial assistance to States as they 
        reform their long-term care systems to provide comprehensive 
        statewide long-term services and supports, including community-
        based attendant services and supports that provide consumer 
        choice and direction, in the most integrated setting 
        appropriate.

            TITLE I--ESTABLISHMENT OF MEDICAID PLAN BENEFIT

SEC. 101. COVERAGE OF COMMUNITY-BASED ATTENDANT SERVICES AND SUPPORTS 
              UNDER THE MEDICAID PROGRAM.

    (a) Mandatory Coverage.--Section 1902(a)(10)(D) of the Social 
Security Act (42 U.S.C. 1396a(a)(10)(D)) is amended--
            (1) by inserting ``(i)'' after ``(D)'';
            (2) by adding ``and'' after the semicolon; and
            (3) by adding at the end the following new clause:
                    ``(ii) subject to section 1935, for the inclusion 
                of community-based attendant services and supports for 
                any individual who--
                            ``(I) is eligible for medical assistance 
                        under the State plan;
                            ``(II) with respect to whom there has been 
                        a determination that the individual requires 
                        the level of care provided in a nursing 
                        facility or an intermediate care facility for 
                        the mentally retarded (whether or not coverage 
                        of such intermediate care facility is provided 
                        under the State plan); and
                            ``(III) who chooses to receive such 
                        services and supports;''.
    (b) Community-Based Attendant Services and Supports.--
            (1) In general.--Title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.) is amended--
                    (A) by redesignating section 1935 as section 1936; 
                and
                    (B) by inserting after section 1934 the following:

           ``community-based attendant services and supports

    ``Sec. 1935. (a) Required Coverage.--
            ``(1) In general.--Not later than October 1, 2007, a State 
        shall provide through a plan amendment for the inclusion of 
        community-based attendant services and supports (as defined in 
        subsection (g)(1)) for individuals described in section 
        1902(a)(10)(D)(ii) in accordance with this section.
            ``(2) Enhanced fmap and additional federal financial 
        support for earlier coverage.--Notwithstanding section 1905(b), 
        during the period that begins on or after October 1, 2003, and 
        ends on September 30, 2007, in the case of a State with an 
        approved plan amendment under this section during that period 
        that also satisfies the requirements of subsection (c) the 
        Federal medical assistance percentage shall be equal to the 
        enhanced FMAP described in section 2105(b) with respect to 
        medical assistance in the form of community-based attendant 
        services and supports provided to individuals described in 
        section 1902(a)(10)(D)(ii) in accordance with this section.
    ``(b) Development and Implementation of Benefit.--In order for a 
State plan amendment to be approved under this section, a State shall 
provide the Secretary with the following assurances:
            ``(1) Assurance of development and implementation 
        collaboration.--That the State has developed and shall 
        implement the provision of community-based attendant services 
        and supports under the State plan through active collaboration 
        with--
                    ``(A) individuals with disabilities;
                    ``(B) elderly individuals;
                    ``(C) representatives of such individuals; and
                    ``(D) providers of, and advocates for, services and 
                supports for such individuals.
            ``(2) Assurance of provision on a statewide basis and in 
        most integrated setting.--That community-based attendant 
        services and supports will be provided under the State plan to 
        individuals described in section 1902(a)(10)(D)(ii) on a 
        statewide basis and in a manner that provides such services and 
        supports in the most integrated setting appropriate for each 
        individual eligible for such services and supports.
            ``(3) Assurance of nondiscrimination.--That the State will 
        provide community-based attendant services and supports to an 
        individual described in section 1902(a)(10)(D)(ii) without 
        regard to the individual's age, type of disability, or the form 
        of community-based attendant services and supports that the 
        individual requires in order to lead an independent life.
            ``(4) Assurance of maintenance of effort.--That the level 
        of State expenditures for optional medical assistance that--
                    ``(A) is described in a paragraph other than 
                paragraphs (1) through (5), (17) and (21) of section 
                1905(a) or that is provided under a waiver under 
                section 1915, section 1115, or otherwise; and
                    ``(B) is provided to individuals with disabilities 
                or elderly individuals for a fiscal year,
        shall not be less than the level of such expenditures for the 
        fiscal year preceding the fiscal year in which the State plan 
        amendment to provide community-based attendant services and 
        supports in accordance with this section is approved.
    ``(c) Requirements for Enhanced FMAP for Early Coverage.--In 
addition to satisfying the other requirements for an approved plan 
amendment under this section, in order for a State to be eligible under 
subsection (a)(2) during the period described in that subsection for 
the enhanced FMAP for early coverage under subsection (a)(2), the State 
shall satisfy the following requirements:
            ``(1) Specifications.--With respect to a fiscal year, the 
        State shall provide the Secretary with the following 
        specifications regarding the provision of community-based 
        attendant services and supports under the plan for that fiscal 
        year:
                    ``(A)(i) The number of individuals who are 
                estimated to receive community-based attendant services 
                and supports under the plan during the fiscal year.
                    ``(ii) The number of individuals that received such 
                services and supports during the preceding fiscal year.
                    ``(B) The maximum number of individuals who will 
                receive such services and supports under the plan 
                during that fiscal year.
                    ``(C) The procedures the State will implement to 
                ensure that the models for delivery of such services 
                and supports are consumer controlled (as defined in 
                subsection (g)(2)(B)).
                    ``(D) The procedures the State will implement to 
                inform all potentially eligible individuals and 
                relevant other individuals of the availability of such 
                services and supports under this title, and of other 
                items and services that may be provided to the 
                individual under this title or title XVIII.
                    ``(E) The procedures the State will implement to 
                ensure that such services and supports are provided in 
                accordance with the requirements of subsection (b)(1).
                    ``(F) The procedures the State will implement to 
                actively involve individuals with disabilities, elderly 
                individuals, and representatives of such individuals in 
                the design, delivery, administration, and evaluation of 
                the provision of such services and supports under this 
                title.
            ``(2) Participation in evaluations.--The State shall 
        provide the Secretary with such substantive input into, and 
        participation in, the design and conduct of data collection, 
        analyses, and other qualitative or quantitative evaluations of 
        the provision of community-based attendant services and 
        supports under this section as the Secretary deems necessary in 
        order to determine the effectiveness of the provision of such 
        services and supports in allowing the individuals receiving 
        such services and supports to lead an independent life to the 
        maximum extent possible.
    ``(d) Quality Assurance Program.--
            ``(1) State responsibilities.--In order for a State plan 
        amendment to be approved under this section, a State shall 
        establish and maintain a quality assurance program with respect 
        to community-based attendant services and supports that 
        provides for the following:
                    ``(A) The State shall establish requirements, as 
                appropriate, for agency-based and other delivery models 
                that include--
                            ``(i) minimum qualifications and training 
                        requirements for agency-based and other models;
                            ``(ii) financial operating standards; and
                            ``(iii) an appeals procedure for 
                        eligibility denials and a procedure for 
                        resolving disagreements over the terms of an 
                        individualized plan.
                    ``(B) The State shall modify the quality assurance 
                program, as appropriate, to maximize consumer 
                independence and consumer control in both agency-
                provided and other delivery models.
                    ``(C) The State shall provide a system that allows 
                for the external monitoring of the quality of services 
                and supports by entities consisting of consumers and 
                their representatives, disability organizations, 
                providers, families of disabled or elderly individuals, 
                members of the community, and others.
                    ``(D) The State shall provide for ongoing 
                monitoring of the health and well-being of each 
                individual who receives community-based attendant 
                services and supports.
                    ``(E) The State shall require that quality 
                assurance mechanisms appropriate for the individual be 
                included in the individual's written plan.
                    ``(F) The State shall establish a process for the 
                mandatory reporting, investigation, and resolution of 
                allegations of neglect, abuse, or exploitation in 
                connection with the provision of such services and 
                supports.
                    ``(G) The State shall obtain meaningful consumer 
                input, including consumer surveys, that measure the 
                extent to which an individual receives the services and 

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