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<!DOCTYPE bill PUBLIC "-//US Congress//DTDs/bill.dtd//EN" "bill.dtd"> |
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<bill bill-stage="Introduced-in-Senate" dms-id="A1" public-private="public" slc-id="S1-LYN23043-SNR-SK-GCF"> |
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<metadata xmlns:dc="http://purl.org/dc/elements/1.1/"> |
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<dublinCore> |
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<dc:title>118 S100 IS: Better Care Better Jobs Act</dc:title> |
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<dc:publisher>U.S. Senate</dc:publisher> |
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<dc:date>2023-01-26</dc:date> |
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<dc:format>text/xml</dc:format> |
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<dc:language>EN</dc:language> |
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<dc:rights>Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.</dc:rights> |
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</dublinCore> |
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</metadata> |
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<form> |
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<distribution-code display="yes">II</distribution-code> |
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<congress>118th CONGRESS</congress><session>1st Session</session> |
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<legis-num>S. 100</legis-num> |
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<current-chamber>IN THE SENATE OF THE UNITED STATES</current-chamber> |
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<action> |
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<action-date date="20230126">January 26, 2023</action-date> |
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<action-desc><sponsor name-id="S309">Mr. Casey</sponsor> (for himself, <cosponsor name-id="S270">Mr. Schumer</cosponsor>, <cosponsor name-id="S247">Mr. Wyden</cosponsor>, <cosponsor name-id="S229">Mrs. Murray</cosponsor>, <cosponsor name-id="S386">Ms. Duckworth</cosponsor>, <cosponsor name-id="S307">Mr. Brown</cosponsor>, <cosponsor name-id="S388">Ms. Hassan</cosponsor>, <cosponsor name-id="S313">Mr. Sanders</cosponsor>, <cosponsor name-id="S415">Mr. Warnock</cosponsor>, <cosponsor name-id="S322">Mr. Merkley</cosponsor>, <cosponsor name-id="S390">Mr. Van Hollen</cosponsor>, <cosponsor name-id="S331">Mrs. Gillibrand</cosponsor>, <cosponsor name-id="S316">Mr. Whitehouse</cosponsor>, <cosponsor name-id="S341">Mr. Blumenthal</cosponsor>, <cosponsor name-id="S418">Mr. Fetterman</cosponsor>, <cosponsor name-id="S413">Mr. Padilla</cosponsor>, <cosponsor name-id="S362">Mr. Kaine</cosponsor>, <cosponsor name-id="S253">Mr. Durbin</cosponsor>, <cosponsor name-id="S354">Ms. Baldwin</cosponsor>, <cosponsor name-id="S394">Ms. Smith</cosponsor>, <cosponsor name-id="S369">Mr. Markey</cosponsor>, <cosponsor name-id="S311">Ms. Klobuchar</cosponsor>, <cosponsor name-id="S259">Mr. Reed</cosponsor>, <cosponsor name-id="S366">Ms. Warren</cosponsor>, <cosponsor name-id="S284">Ms. Stabenow</cosponsor>, <cosponsor name-id="S275">Ms. Cantwell</cosponsor>, <cosponsor name-id="S308">Mr. Cardin</cosponsor>, <cosponsor name-id="S370">Mr. Booker</cosponsor>, <cosponsor name-id="S353">Mr. Schatz</cosponsor>, <cosponsor name-id="S363">Mr. King</cosponsor>, <cosponsor name-id="S359">Mr. Heinrich</cosponsor>, <cosponsor name-id="S361">Ms. Hirono</cosponsor>, <cosponsor name-id="S324">Mrs. Shaheen</cosponsor>, <cosponsor name-id="S422">Mr. Welch</cosponsor>, <cosponsor name-id="S364">Mr. Murphy</cosponsor>, <cosponsor name-id="S306">Mr. Menendez</cosponsor>, <cosponsor name-id="S409">Mr. Luján</cosponsor>, <cosponsor name-id="S221">Mrs. Feinstein</cosponsor>, <cosponsor name-id="S385">Ms. Cortez Masto</cosponsor>, and <cosponsor name-id="S380">Mr. Peters</cosponsor>) introduced the following bill; which was read twice and referred to the <committee-name committee-id="SSFI00">Committee on Finance</committee-name></action-desc> |
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</action> |
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<legis-type>A BILL</legis-type> |
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<official-title>To amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid, and for other purposes.</official-title> |
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</form> |
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<legis-body display-enacting-clause="yes-display-enacting-clause" id="HFBAB706230294032A5FDD0021791BBC3"> |
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<section section-type="section-one" id="S1"><enum>1.</enum><header>Short title; table of contents</header> |
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<subsection id="id539F68434EB74376ADDC561FCFBE4C5C"><enum>(a)</enum><header>Short title</header><text display-inline="yes-display-inline">This Act may be cited as the <quote><short-title>Better Care Better Jobs Act</short-title></quote>.</text></subsection> <subsection id="idD38CA4136C50428CB68A636106231CCF"><enum>(b)</enum><header>Table of contents</header><text display-inline="yes-display-inline">The table of contents for this Act is as follows:</text> |
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<toc> |
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<toc-entry level="section" idref="S1">Sec. 1. Short title; table of contents.</toc-entry> |
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<toc-entry level="section" idref="idA43C613BAB03469AB04F5C2FD4EE1F8E">Sec. 2. Definitions.</toc-entry> |
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<toc-entry level="title" idref="idB781DDF246F64C7BBE2CE1B68FD14A1A">TITLE I—Expanding Access to Medicaid Home and Community-Based Services</toc-entry> |
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<toc-entry level="section" idref="idFCAED319606F4B9E80A60C2190CB0691">Sec. 101. HCBS infrastructure improvement planning grants.</toc-entry> |
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<toc-entry level="section" idref="idD632CFA40D1C4A1796AC5208E84F468A">Sec. 102. HCBS Infrastructure Improvement Program.</toc-entry> |
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<toc-entry level="section" idref="id1D5877B3391D463C9499D00AD180EB53">Sec. 103. Reports; technical assistance; other administrative requirements.</toc-entry> |
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<toc-entry level="section" idref="id5CD0AF11A3B74A50A765B7B3F74742BE">Sec. 104. Quality measurement and improvement.</toc-entry> |
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<toc-entry level="title" idref="id04C21968F9A94BF2AAE33631839B1EC3">TITLE II—Other Provisions</toc-entry> |
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<toc-entry level="section" idref="id03D0418F1BE14047802509A258A6DFA3">Sec. 201. MACPAC study and report on Appendix K emergency home and community-based services (HCBS) 1915(c) waivers.</toc-entry> |
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<toc-entry level="section" idref="HD4708FE03F7E4E689AAE148E339F36E6">Sec. 202. Making permanent the State option to extend protection under Medicaid for recipients of home and community-based services against spousal impoverishment.</toc-entry> |
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<toc-entry level="section" idref="idCD37D3E6975F4778BB30E2A126037ACE">Sec. 203. Permanent extension of Money Follows the Person Rebalancing demonstration.</toc-entry></toc></subsection></section> |
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<section id="idA43C613BAB03469AB04F5C2FD4EE1F8E"><enum>2.</enum><header>Definitions</header><text display-inline="no-display-inline">In this Act:</text> <paragraph commented="no" display-inline="no-display-inline" id="id50476B47FB924B54A5E773B5428F53C3"><enum>(1)</enum><header display-inline="yes-display-inline">Appropriate committees of congress</header><text display-inline="yes-display-inline">The term <term>appropriate committees of Congress</term> means the Committee on Energy and Commerce of the House of Representatives, the Committee on Education and the Workforce of the House of Representatives, the Committee on Finance of the Senate, the Committee on Health, Education, Labor, and Pensions of the Senate, and the Special Committee on Aging of the Senate. </text></paragraph> |
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<paragraph id="id80A951CFB4034B71A5600DE937EA34A4"><enum>(2)</enum><header>Direct care worker; direct care workforce</header><text>The terms <term>direct care worker</term> and <term>direct care workforce</term> mean—</text> <subparagraph id="idfaf600ae84184d8ca1be8cc092329424"><enum>(A)</enum><text>a direct support professional;</text></subparagraph> |
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<subparagraph id="id613843a9001f40d3a57c474fcad984a5"><enum>(B)</enum><text>a personal care attendant;</text></subparagraph> <subparagraph id="idf33ae3e8c5784365b48b5864733da291"><enum>(C)</enum><text>a direct care worker;</text></subparagraph> |
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<subparagraph id="id91badfba2afa470eb80da418283d6d6f"><enum>(D)</enum><text>a home health aide; and</text></subparagraph> <subparagraph id="id49b6d3bd5e794d33935ea80f87220be5"><enum>(E)</enum><text>any other relevant worker, as determined by the Secretary.</text></subparagraph></paragraph> |
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<paragraph commented="no" id="H889DAFEBC61D47A18DC66C453F74642C"><enum>(3)</enum><header>Eligible individual</header><text>The term <term>eligible individual</term> means an individual who is eligible for and enrolled for medical assistance under a State Medicaid program and includes an individual who becomes eligible for medical assistance under a State Medicaid program when removed from a waiting list. </text></paragraph> <paragraph commented="no" id="id13D1307AF6C14ACC8B7D1B084CE49880"><enum>(4)</enum><header>Health plan</header><text>The term <term>health plan</term> means a group health plan or health insurance issuer (as such terms are defined in section 2791 of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg-91">42 U.S.C. 300gg–91</external-xref>)).</text></paragraph> |
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<paragraph commented="no" display-inline="no-display-inline" id="H5298B7050E04499DA18263A3E113F102"><enum>(5)</enum><header>HCBS program improvement State</header><text display-inline="yes-display-inline">The term <term>HCBS program improvement State</term> means a State with an HCBS infrastructure improvement plan approved by the Secretary under section 101(d). </text></paragraph> <paragraph id="HC5255EC3F2404865BD824EAB1C323302"><enum>(6)</enum><header>Home and community-based services</header><text display-inline="yes-display-inline">The term <term>home and community-based services</term> means any of the following (whether provided on a fee-for-service, risk, or other basis): </text> |
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<subparagraph id="HDA7C1DA5278A431EB5BA94F2D197D32D"><enum>(A)</enum><text display-inline="yes-display-inline">Home health care services authorized under paragraph (7) of section 1905(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(a)</external-xref>). </text></subparagraph> <subparagraph id="H91C5BF3A084546E2880DE39CE317582A"><enum>(B)</enum><text display-inline="yes-display-inline">Personal care services authorized under paragraph (24) of such section. </text></subparagraph> |
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<subparagraph id="HC3BCD6951919467782658CC61B082AA0"><enum>(C)</enum><text display-inline="yes-display-inline">PACE services authorized under paragraph (26) of such section. </text></subparagraph> <subparagraph id="H49B7C84628DF41EFA48D2DC706A070EC"><enum>(D)</enum><text display-inline="yes-display-inline">Home and community-based services authorized under subsections (b), (c), (i), (j), and (k) of section 1915 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396n">42 U.S.C. 1396n</external-xref>), such services authorized under a waiver under section 1115 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1315">42 U.S.C. 1315</external-xref>), and such services provided through coverage authorized under section 1937 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396u-7">42 U.S.C. 1396u–7</external-xref>). </text></subparagraph> |
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<subparagraph id="H3156A40224164F0BB749449154BE7261"><enum>(E)</enum><text display-inline="yes-display-inline">Case management services authorized under section 1905(a)(19) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(a)(19)</external-xref>) and section 1915(g) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396n">42 U.S.C. 1396n(g)</external-xref>). </text></subparagraph> <subparagraph id="HC175E3946C4D43C9BA29C556BDFDFBF2"><enum>(F)</enum><text display-inline="yes-display-inline">Rehabilitative services, including those related to behavioral health, described in section 1905(a)(13) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(a)(13)</external-xref>).</text></subparagraph> |
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<subparagraph commented="no" display-inline="no-display-inline" id="HDF9B9D2446FF406AA4A008FF351A79BF"><enum>(G)</enum><text display-inline="yes-display-inline">Such other services specified by the Secretary. </text></subparagraph></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="idA407A2C1B4E2468299BBD2704C59627D"><enum>(7)</enum><header>Institutional setting</header><text>The term <term>institutional setting</term> means—</text> |
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<subparagraph id="ID87A104B3C8EE4EE8BBCFDC2C54B347EB"><enum>(A)</enum><text>a skilled nursing facility (as defined in section 1819(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i-3">42 U.S.C. 1395i–3(a)</external-xref>));</text></subparagraph> <subparagraph id="IDAB42DBFBF2DA423ABD397CFBB60D2007"><enum>(B)</enum><text>a nursing facility (as defined in section 1919(a) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r">42 U.S.C. 1396r(a)</external-xref>));</text></subparagraph> |
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<subparagraph id="IDD5FBC2A7F7394AF18B91FE47474CAAF7"><enum>(C)</enum><text>a long-term care hospital (as described in section 1886(d)(1)(B)(iv) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(d)(1)(B)(iv)</external-xref>));</text></subparagraph> <subparagraph id="ID2A9984766D0F4FA9A622A08D3DC44E1E"><enum>(D)</enum><text>an institution (or distinct part thereof) described in section 1905(d) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(d)</external-xref>));</text></subparagraph> |
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<subparagraph id="id12078735F32544C680566170A0DBA383"><enum>(E)</enum><text>an institution (or distinct part thereof) which is a psychiatric hospital (as defined in section 1861(f) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(f)</external-xref>)) or that provides inpatient psychiatric services in another residential setting specified by the Secretary;</text></subparagraph> <subparagraph id="id69F97D47C1D44D1099ECBFEF39213A54"><enum>(F)</enum><text>an institution (or distinct part thereof) described in section 1905(i) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(i)</external-xref>); and</text></subparagraph> |
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<subparagraph id="ID4C5E9B175DDA4858891BD2C37FA3A815"><enum>(G)</enum><text>any other relevant facility, as determined by the Secretary.</text></subparagraph></paragraph> <paragraph id="H43CEBB64377E4E54856E07869C37399F"><enum>(8)</enum><header>Medicaid program</header><text>The term <term>Medicaid program</term> means, with respect to a State, the State program under title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>) (including any waiver or demonstration under such title or under section 1115 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1315">42 U.S.C. 1315</external-xref>) relating to such title). </text></paragraph> |
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<paragraph id="id0F4E67A144BF4E0187F414D1A167A37E"><enum>(9)</enum><header>Secretary</header><text>The term <term>Secretary</term> means the Secretary of Health and Human Services.</text></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="H510E5E5BA0224605B8BF73543A2EB255"><enum>(10)</enum><header>State</header><text display-inline="yes-display-inline">The term <term>State</term> has the meaning given such term for purposes of title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>). </text></paragraph></section> |
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<title id="idB781DDF246F64C7BBE2CE1B68FD14A1A" style="OLC"><enum>I</enum><header>Expanding Access to Medicaid Home and Community-Based Services</header> |
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<section id="idFCAED319606F4B9E80A60C2190CB0691"><enum>101.</enum><header>HCBS infrastructure improvement planning grants</header> |
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<subsection id="ide335828fd62642d48bfb2de564c40933"><enum>(a)</enum><header>In general</header><text>Not later than 12 months after the date of enactment of this Act, the Secretary shall award planning grants to States for the purpose of expanding access to home and community-based services and strengthening the direct care workforce that provides such services by developing HCBS infrastructure improvement plans that meet the requirements of subsections (b) and (c). </text></subsection> <subsection id="id243D84E9E4834C2A9AC7B8D211190D54"><enum>(b)</enum><header>Content requirements</header><text>In order to meet the requirements of this subsection, an HCBS infrastructure improvement plan shall include, with respect to a State, the following:</text> |
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<paragraph id="id7E2E143DBC61464A8BAE9AD6422BC9E1"><enum>(1)</enum><header>Existing Medicaid HCBS landscape</header> |
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<subparagraph id="id53B3E03F6525416CACE00FF0FB1C3787"><enum>(A)</enum><header>Eligibility and benefits</header><text>A description of—</text> <clause id="idAF7A5A282BD54D7E8BCE7EEC5485BE2C"><enum>(i)</enum><text>the existing standards, pathways, and methodologies for eligibility for home and community-based services, including limits on assets and income;</text></clause> |
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<clause id="id2BB8278A37964D159F262820EF165938"><enum>(ii)</enum><text>the home and community-based services available under the State Medicaid program; and</text></clause> <clause id="idC229359917F44BCAB31FA36059A113DD"><enum>(iii)</enum><text>utilization management standards for such services.</text></clause></subparagraph> |
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<subparagraph id="id2B8D95FF4B2441A29725833F0446D3B8"><enum>(B)</enum><header>Access</header><text>An assessment of the extent to which home and community-based services are available to eligible individuals in the State, including—</text> <clause id="id87a9784120874932b22aafe7f4812c8f"><enum>(i)</enum><text>estimates of the number of eligible individuals who are on a waitlist for such services;</text></clause> |
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<clause id="id745ccd8d413349658cef471e6e58a599"><enum>(ii)</enum><text>estimates of the number of individuals who would be eligible individuals but are not enrolled in the State Medicaid program or on a waitlist for such services; </text></clause> <clause id="idF9BF7A8E28FB494A9718E9C995177CE6"><enum>(iii)</enum><text>a description of the home and community-based services not available under the State Medicaid program;</text></clause> |
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<clause id="id178AE23DF6F04ABB9EAFFE91B49E4835"><enum>(iv)</enum><text>a description of the populations for which the State is unable to provide home and community-based services under the State Medicaid program that are provided under the Medicaid programs of other States; and</text></clause> <clause id="id7AAF25CD241A4EB2AA8C0A125BD39523"><enum>(v)</enum><text>a description of barriers to accessing home and community-based services identified by eligible individuals and families of such individuals.</text></clause></subparagraph> |
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<subparagraph id="ide644ac9e19844eed9d3fb9cac16a7855"><enum>(C)</enum><header>Utilization</header><text>An assessment of the utilization of home and community-based services in the State. </text></subparagraph> <subparagraph id="ide5eac62f36c3437280dad78d141955a9"><enum>(D)</enum><header>Service delivery structures</header><text>A description of the service delivery structures for providing home and community-based services in the State, including with respect to the use and models of self-direction, the provision of services by agencies, the ownership of service provider agencies, the use of managed care versus fee-for-service to provide such services, and the supports provided for family caregivers. </text></subparagraph> |
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<subparagraph id="idf34a58d5b2bd4156b8fe28f5efef1b66"><enum>(E)</enum><header>Workforce</header><text>A description of the characteristics of the direct care workforce that provides home and community-based services, including the number of full- and part-time direct care workers, the average and range of direct care worker wages, the benefits provided to direct care workers, the turnover and vacancy rates of direct care worker positions, the membership of direct care workers in labor organizations or professional organizations, and the race, ethnicity, and gender of such workforce.</text></subparagraph> <subparagraph id="id88b04f567b9a46e9842fc2019587144c"><enum>(F)</enum><header>Payment rates</header><text>A description of the payment rates for home and community-based services, including when such rates were last updated, an assessment of the extent to which authorized services are not delivered as a result of such rates being insufficient, and the extent to which payment rates are passed through to direct care worker wages.</text></subparagraph> |
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<subparagraph id="id2849036367884c9288e371c8e144988d"><enum>(G)</enum><header>Quality</header><text>A description of how the quality of home and community-based services is measured and monitored, including how the State uses beneficiary and family caregiver experience of care surveys to assess the quality of home and community-based services provided by the State. </text></subparagraph> <subparagraph id="id92117CA49EC846E78FF3A049ADA72668"><enum>(H)</enum><header>Long-term services and supports provided in institutional settings</header><text>A description of—</text> |
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<clause id="id0b8871bfa8684c99a532aa219d992bc2"><enum>(i)</enum><text>the extent to which eligible individuals receive long-term services and supports in institutional settings in the State; and </text></clause> <clause id="id54673485A73F4CF6B7896B13CCE46771"><enum>(ii)</enum><text>the populations provided such services and supports.</text></clause></subparagraph> |
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<subparagraph id="id55F45AECBF7847A0AB4EEA927225AAD8"><enum>(I)</enum><header>HCBS share of overall Medicaid LTSS spending</header><text>For the most recent fiscal year for which data is available, the percentage of expenditures made by the State under the State Medicaid program for long-term services and supports that are for home and community-based services.</text></subparagraph> <subparagraph id="id346ED474338040D18CDF305EE4FAE35F"><enum>(J)</enum><header>Demographic data</header><text>Each assessment required under subparagraphs (B) and (C), and the description required under subparagraph (H)(ii) shall include, to the extent available, data disaggregated by disability status, age, income, gender, race, ethnicity, geography, primary language, sexual orientation, gender identity, and type of service setting. </text></subparagraph></paragraph> |
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<paragraph id="ide39fdc0d6ab24f14ad0764788a3d805a"><enum>(2)</enum><header>Annual measures and reports</header><text>A description of the State plan for—</text> <subparagraph id="id31DFDA301B8642BDA5D31F9D2E01A011"><enum>(A)</enum><text>annually measuring and reporting on—</text> |
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<clause id="ide81d57ff25b34f828403873a7098f493"><enum>(i)</enum><text> the availability and utilization of home and community-based services;</text></clause> <clause id="idDCEB2EDDF84F4E5597E367BE3E440848"><enum>(ii)</enum><text>the characteristics of the direct care workforce that provides home and community-based services and the race, ethnicity, and gender of such workforce;</text></clause> |
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<clause id="id90629889b18c40ca991b5d5e285f2ddc"><enum>(iii)</enum><text>changes in payment rates for home and community-based services; and</text></clause> <clause id="id093e403891b949a286eac3c8337af494"><enum>(iv)</enum><text>progress with respect to implementation of the activities, benchmarks, and improvement activities provided under subsection (jj) of section 1905 of the Social Security Act (as added under section 102); and</text></clause></subparagraph> |
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<subparagraph id="id8F734F8BB4244A3092558F4D613FFAB9"><enum>(B)</enum><text>collecting and reporting disaggregated data by disability status, age, income, gender, race, ethnicity, geography, primary language, sexual orientation, gender identity, and type of service setting for the information required by clause (i) of subparagraph (A).</text></subparagraph></paragraph> <paragraph id="id6610b153632f43fb81712a897fac5d4f"><enum>(3)</enum><header>Implementation and goals for HCBS improvements</header><text>A description of how the State will—</text> |
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<subparagraph id="id8d5a1ebeed754d5697a5e777984a6084"><enum>(A)</enum><text>conduct the activities, benchmarks, and improvement activities provided under subsection (jj) of section 1905 of the Social Security Act (as added under section 102), including how the State plans to meet the benchmarks described in paragraph (5) of such subsection and, if applicable, the additional HCBS improvement efforts described in paragraph (3) of such subsection;</text></subparagraph> <subparagraph id="id3df2155916584f518ee856011bdfb3a4"><enum>(B)</enum><text>identify and reduce barriers to accessing home and community-based services, including for individuals in institutional settings, individuals experiencing homelessness or housing instability, and individuals in regions with low or no access to such services;</text></subparagraph> |
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<subparagraph id="id87DD0A77705243999E1AA1FCD0EDC5C9"><enum>(C)</enum><text>identify and reduce disparities in access to, and utilization of, home and community-based services by disability status, age, income, gender, race, ethnicity, geography, primary language, sexual orientation, gender identity, and type of service setting;</text></subparagraph> <subparagraph id="id477cfe2e12ae4ad18257696b6a35253d"><enum>(D)</enum><text>coordinate implementation of the HCBS infrastructure improvement plan among the State Medicaid agency, agencies serving individuals with disabilities, the elderly, and other relevant State and local agencies; and</text></subparagraph> |
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<subparagraph id="idb2dd16f4e848419e9ca882f79bbc92ed"><enum>(E)</enum><text>facilitate access to related supports by coordinating with State and local agencies and organizations that provide housing, transportation, employment, nutrition, and other services and supports.</text></subparagraph></paragraph></subsection> <subsection id="id0bce4c8797144e268aa9d8895790c1db"><enum>(c)</enum><header>Development and submission requirements</header><text>In order to meet the requirements of this subsection, an HCBS infrastructure improvement plan shall—</text> |
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<paragraph id="id37ff12d47a0047ec9c8df6432d7bb056"><enum>(1)</enum><text>be developed with input from stakeholders through a public notice and comment process that includes consultation with eligible individuals who are recipients of home and community-based services, family caregivers of such recipients, providers, health plans, direct care workers, chosen representatives of direct care workers, and aging, disability, and workforce advocates;</text></paragraph> <paragraph id="id820139f3b07341b284839a04fa0f9d25"><enum>(2)</enum><text>be submitted for approval by the Secretary not later than 24 months after the date on which the State was awarded the planning grant under this section; and </text></paragraph> |
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<paragraph id="idF7D7BC859219438EABFAE4412F790B96"><enum>(3)</enum><text>be publicly available in the final version submitted to the Secretary on a State internet website. </text></paragraph></subsection> <subsection id="idB752A1BCC54D47618ED54D9D7753D820"><enum>(d)</enum><header>Approval; publication</header> <paragraph id="id4726EB3B18B443B4AC5FAC693F6FDCE7"><enum>(1)</enum><header>In general</header><text>The Secretary shall approve an HCBS infrastructure improvement plan if the plan—</text> |
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<subparagraph commented="no" id="idE4639ACE155C45A8B7B62DECD186D453"><enum>(A)</enum><text display-inline="yes-display-inline">is complete; and</text></subparagraph> <subparagraph commented="no" id="id17BA10FB6086400C9EAA49F9E99363E8"><enum>(B)</enum><text>provides assurances to the satisfaction of the Secretary that the State will meet the requirements of the HCBS Infrastructure Improvement Program established under subsection (jj) of section 1905 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d</external-xref>), as added by section 102, and achieve the benchmarks for improvement established by such program.</text></subparagraph></paragraph> |
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<paragraph commented="no" id="id191855AD197543C79C156600D65507FD"><enum>(2)</enum><header>Publication</header><text>The Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services, shall make publicly available on an internet website—</text> <subparagraph commented="no" id="id33D77722380B4DF29B708E262D37B192"><enum>(A)</enum><text>the final version of each approved HCBS infrastructure improvement plan; and</text></subparagraph> |
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<subparagraph commented="no" id="id1FC0911F38FB4A91A1F4A81F7F6298CA"><enum>(B)</enum><text>in the case of any HCBS infrastructure improvement plan submitted for approval that is not approved—</text> <clause commented="no" id="id0F9BBAFDC24A4EB8BB2F15AAE25C6128"><enum>(i)</enum><text>the submitted plan;</text></clause> |
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<clause commented="no" id="id1D82B3F5DF6D4B2EAABB9245800C8CBF"><enum>(ii)</enum><text>the decision not approving such plan; and </text></clause> <clause commented="no" id="idF134395BFD464EA4A2F00367DC1E4B8D"><enum>(iii)</enum><text>information relating to why the plan was not approved.</text></clause></subparagraph></paragraph></subsection> |
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<subsection commented="no" id="idD385841333F74A328D75A3ABD0E75684"><enum>(e)</enum><header>Continuation of American Rescue Plan Act increased FMAP for HCBS for States awarded a planning grant</header> |
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<paragraph commented="no" id="idF2736B8E2B744E898000F25EDB845EE1"><enum>(1)</enum><header>FMAP</header> |
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<subparagraph commented="no" id="id0F06514A205D4A2BAF3F377B19F922F2"><enum>(A)</enum><header>In general</header><text>Notwithstanding subsection (b) or (ff) of section 1905 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d</external-xref>), in the case of a State that is awarded a planning grant under this section and meets the maintenance of effort requirements under paragraph (2), the Federal medical assistance percentage determined for the State under such subsection (b) (or such subsection (ff), if applicable) and, if applicable, as increased under subsection (y), (z), (aa), or (ii) of such section, section 1915(k) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396n">42 U.S.C. 1396n(k)</external-xref>), or section 6008 of the Families First Coronavirus Response Act (<external-xref legal-doc="public-law" parsable-cite="pl/116/127">Public Law 116–127</external-xref>), shall be increased by 10 percentage points (but not to exceed 95 percent) with respect to amounts expended by the State Medicaid program for medical assistance for home and community-based services that are provided during the HCBS planning period (as defined in subparagraph (B)). </text></subparagraph> <subparagraph commented="no" id="id5ED5C3B5F1E04374BA642B78F342890C"><enum>(B)</enum><header>HCBS planning period</header><text>In this paragraph, the term <term>HCBS planning period</term> means, with respect to a State, the period—</text> |
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<clause commented="no" id="idDDBDE06EB904466194CEC03598678C98"><enum>(i)</enum><text>beginning on the date on which the State is awarded a planning grant under this section; and</text></clause> <clause commented="no" id="id469B1A4F3E184C1F90A9ADEAB489D48B"><enum>(ii)</enum><text>ending on the earlier of—</text> |
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<subclause commented="no" id="idEA125C43A0B94702B7C68E0EA25514B1"><enum>(I)</enum><text>the first day of the first fiscal quarter for which the State is an HCBS program improvement State; and</text></subclause> <subclause commented="no" id="idE7DD208D441D4F26954D7DEE705AB37A"><enum>(II)</enum><text>the date that is 3 years after the date on which the State is awarded such a grant.</text></subclause></clause></subparagraph> |
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<subparagraph commented="no" id="id9CD2966D29264C62A5D0341CD6221BC0"><enum>(C)</enum><header>Nonapplication of territorial funding caps</header><text>Any payment made to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa for expenditures on medical assistance that are subject to the Federal medical assistance percentage increase specified under subparagraph (A) shall not be taken into account for purposes of applying payment limits under subsections (f) and (g) of section 1108 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1308">42 U.S.C. 1308</external-xref>).</text></subparagraph></paragraph> <paragraph commented="no" id="id2A25B43230554F549F5BD0EB1F8CE64B"><enum>(2)</enum><header>Maintenance of effort requirements</header><text>For purposes of paragraph (1)(A), the requirements of this paragraph are, with respect to the period for which a State is awarded a planning grant under this section, the State shall not— </text> |
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<subparagraph commented="no" id="id39B01B7969DC47BDADC364045EBF56A2"><enum>(A)</enum><text>lower the amount, duration, or scope of home and community-based services available under the State Medicaid program (relative to the services available under the program as of the date on which the State was awarded such grant); or</text></subparagraph> <subparagraph commented="no" id="id8E83944F4075487FB2E09792798F4774"><enum>(B)</enum><text>adopt more restrictive standards, methodologies, or procedures for determining eligibility, benefits, or services for receipt of home and community-based services under the State Medicaid program, including with respect to utilization management or cost-sharing, than the standards, methodologies, or procedures applicable as of the date on which the State was awarded such grant.</text></subparagraph></paragraph></subsection> |
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<subsection id="id02f5069ff91546578861b54849f750a4"><enum>(f)</enum><header>Funding</header> |
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<paragraph id="idAB889AB1F0AC43F086776FF5FF0BD926"><enum>(1)</enum><header>In general</header><text>Out of any funds in the Treasury not otherwise appropriated, there is appropriated to the Secretary for purposes of awarding planning grants under this section, $100,000,000 for fiscal year 2024, to remain available until expended.</text></paragraph> <paragraph id="id07C033D2AB4E4AA8AA8D85B155B6BB33"><enum>(2)</enum><header>Technical assistance and guidance</header><text>The Secretary shall reserve $5,000,000 of the amount appropriated under paragraph (1) for purposes of issuing guidance and providing technical assistance to States seeking or awarded a planning grant under this section.</text></paragraph></subsection></section> |
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<section id="idD632CFA40D1C4A1796AC5208E84F468A"><enum>102.</enum><header>HCBS Infrastructure Improvement Program</header> |
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<subsection id="id4B365F1428F94D34847779AD56041B04"><enum>(a)</enum><header>Enhanced FMAP for HCBS program improvement States</header><text>Section 1905 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d</external-xref>) is amended—</text> <paragraph id="id148C1546924C4708B43798314B666DC1"><enum>(1)</enum><text>in subsection (b), by striking <quote>and (ii)</quote> and inserting <quote>(ii), and (jj)</quote>; and</text></paragraph> |
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<paragraph commented="no" display-inline="no-display-inline" id="idEF47BB709FE34CE3B53668A5B1996FD1"><enum>(2)</enum><text>by adding at the end the following new subsection: </text> <quoted-block style="OLC" display-inline="no-display-inline" id="idE5C32163161340B5B08383B0DA7B1D55"> <subsection id="idFB96A1069F3C4BEFBA016627229B36CE"><enum>(jj)</enum><header>Enhanced Federal medical assistance percentage for HCBS program improvement States</header> <paragraph id="id0A44DC960FE549FFBE5711B01534091E"><enum>(1)</enum><header>In general</header> <subparagraph id="id51A596F1315041BE9E3B2EB913BF8869"><enum>(A)</enum><header>Increased federal financial participation</header><text>Subject to paragraph (5), in the case of a State that is an HCBS program improvement State and meets the requirements described in paragraphs (2) and (4), for each fiscal year quarter that begins on or after the first date on which a State is an HCBS program improvement State—</text> |
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<clause id="idB385495F65E7468F96DD83430E0FF169"><enum>(i)</enum><text>notwithstanding subsection (b) or (ff), subject to subparagraph (B), with respect to amounts expended during the quarter by such State for medical assistance for home and community-based services, the Federal medical assistance percentage for such State and quarter (as determined for the State under subsection (b) and, if applicable, increased under subsection (y), (z), (aa), or (ii), or section 6008(a) of the Families First Coronavirus Response Act) shall be increased by 10 percentage points (but not to exceed 95 percent); and</text></clause> <clause id="id70BA7B539BC14E179E30B00D76D96512"><enum>(ii)</enum><text>notwithstanding the per centum specified in section 1903(a)(7), with respect to amounts expended during the quarter and before October 1, 2033, for administrative costs for expanding and enhancing home and community-based services, including for enhancing the Medicaid data and technology infrastructure, modifying rate setting processes, adopting, using, and reporting quality measures and beneficiary and family caregiver experience surveys, adopting or improving training programs for direct care workers and family caregivers, and adopting, carrying out, or enhancing programs that register qualified direct care workers or connect beneficiaries to qualified direct care workers, such per centum shall be increased to 80 percent.</text></clause></subparagraph> |
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<subparagraph id="idA64AA8EEBE68498C8FDBBD63C7F90477"><enum>(B)</enum><header>Additional HCBS improvement efforts</header><text>Subject to paragraph (5), in addition to the increase to the Federal medical assistance percentage under subparagraph (A)(i), with respect to amounts expended for medical assistance during the first 4 fiscal quarters throughout which an HCBS program improvement State has implemented a program to support self-directed care that meets the requirements of paragraph (3) (in addition to meeting the requirements described in paragraph (2)), the Federal medical assistance percentage for such State and each such quarter with respect to such amounts shall be further increased by 2 percentage points (but not to exceed 95 percent).</text></subparagraph> <subparagraph commented="no" id="id126DF4845C584C06851B6764037613B8"><enum>(C)</enum><header>Nonapplication of territorial funding caps</header><text>Any payment made to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa for expenditures that are subject to an increase in the Federal medical assistance percentage under subparagraph (A)(i) or (B), or an increase in an applicable Federal matching percentage under subparagraph (A)(ii), shall not be taken into account for purposes of applying payment limits under subsections (f) and (g) of section 1108. </text></subparagraph></paragraph> |
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<paragraph id="idDFC600961F9B4332B2B6AA8B85F64E42"><enum>(2)</enum><header>Requirements</header><text>The requirements described in this paragraph, with respect to a State and a fiscal year quarter, are the following:</text> <subparagraph commented="no" id="idEFE5114380A542769FA350C37678C8C7"><enum>(A)</enum><header>Maintenance of effort</header> <clause commented="no" id="idD8A3D13D23A3469F99A7066F6DE98E97"><enum>(i)</enum><header>In general</header><text>Except as provided under clause (ii), the State does not— </text> |
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<subclause commented="no" id="idB783E162C460478CBF4FBB7E13F0ABE0"><enum>(I)</enum><text>lower the amount, duration, or scope of home and community-based services available under the State plan or waiver (relative to the home and community-based services available under the plan or waiver as of the date on which the State was awarded a planning grant under section 101 of the <short-title>Better Care Better Jobs Act</short-title>); or </text></subclause> <subclause commented="no" id="idC91AE874A056480C9A19A209215330BD"><enum>(II)</enum><text>adopt more restrictive standards, methodologies, or procedures for determining eligibility, benefits, or services for receipt of home and community-based services, including with respect to utilization management or cost-sharing and the amount, duration, and scope of available home and community-based services, than the standards, methodologies, or procedures applicable as of such date. </text></subclause></clause> |
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<clause commented="no" id="id8E75D4D685E74BF68AADA897786D170D"><enum>(ii)</enum><header>Exception</header><text>On or after October 1, 2030, a State may modify such standards, methodologies, or procedures if the State demonstrates that such modifications shall not result in—</text> <subclause commented="no" id="idD26007AF493D49C4A49E634E44D862F4"><enum>(I)</enum><text>home and community-based services that are less comprehensive or lower in amount, duration, or scope;</text></subclause> |
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<subclause commented="no" id="id3F23E0E58A934A9B8D9EA5804561C6BF"><enum>(II)</enum><text>fewer individuals (overall and within particular beneficiary populations) receiving home and community-based services; or</text></subclause> <subclause commented="no" id="id17D5475564F346A8AE0BC10D6334A8E7"><enum>(III)</enum><text>increased cost-sharing for home and community-based services.</text></subclause></clause></subparagraph> |
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<subparagraph commented="no" id="idF2114CF574D24A10AB6200F9162FD2E9"><enum>(B)</enum><header>Access to services</header><text>The State enhances, expands, or strengthens home and community-based services by doing all of the following:</text> <clause commented="no" id="idFD1D6A35FC164976A192A256B8BD6733"><enum>(i)</enum><text>Addressing access barriers and disparities in access or utilization identified in the State HCBS infrastructure improvement plan.</text></clause> |
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<clause commented="no" id="idC11FB8A8C5284D22B390B5470FC59B1A"><enum>(ii)</enum><text>Expanding financial eligibility criteria for home and community-based services up to Federal limits.</text></clause> <clause commented="no" id="id17E1457E5DB043B5B96CEEAA47E9DA34"><enum>(iii)</enum><text>Requiring coverage of personal care services for all eligible populations receiving home and community-based services in the State.</text></clause> |
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<clause commented="no" id="idFC9F12D76D5B480D90F9E15045C344D0"><enum>(iv)</enum><text>Using <quote>no wrong door</quote> programs, providing presumptive eligibility for home and community-based services, and improving home and community-based services counseling and education programs.</text></clause> <clause commented="no" id="id8EF0860FD24745668ED58E349115FC8F"><enum>(v)</enum><text>Expanding access to behavioral health services and coordination with employment, housing, and transportation supports. </text></clause> |
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<clause commented="no" id="idC1D1AEA5331547828709DFA3B9132158"><enum>(vi)</enum><text>Providing supports to family caregivers, which shall include providing respite care, and may include providing such services as caregiver assessments, peer supports, or paid family caregiving.</text></clause> <clause commented="no" id="id1FAE98D3AB74417D875AFA37C6F902A7"><enum>(vii)</enum><text>Adopting, expanding eligibility for, or improving coverage provided under a Medicaid buy-in program authorized under subclause (XIII), (XV), or (XVI) of section 1902(a)(10)(A)(ii).</text></clause></subparagraph> |
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<subparagraph commented="no" id="idE06ED6898D3743789427ABDF2A7ED20C"><enum>(C)</enum><header>Strengthened and expanded workforce</header> |
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<clause commented="no" id="idD0A547D1C603431CA58D71E6D8ADFC77"><enum>(i)</enum><header>In general</header><text>The State strengthens and expands the direct care workforce that provides home and community-based services by—</text> <subclause id="id5fcfe340b0464c6cbc8f003ef7eba42e"><enum>(I)</enum><text>adopting processes to ensure that payments for home and community-based services are sufficient to ensure that care and services are available to the extent described in the State HCBS infrastructure improvement plan; and</text></subclause> |
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<subclause id="id9CA7C8225B0740C2989D970DD518A6F1"><enum>(II)</enum><text>updating, developing, and adopting qualification standards and training opportunities for the continuum of providers of home and community-based services, including programs for independent providers of such services and agency direct care workers, as well as unique programs and resources for family caregivers.</text></subclause></clause> <clause id="idC1043AA52F1A4E14A94A217B96E87C88"><enum>(ii)</enum><header>Payment rates</header><text>In carrying out clause (i)(I), the State shall—</text> |
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<subclause id="id1FC5B5D0A1B94AE795A09BB98D165406"><enum>(I)</enum><text>address insufficient payment rates for delivery of home and community-based services, with an emphasis on supporting the recruitment and retention of the direct care workforce, as identified during the period in which the State HCBS infrastructure improvement plan was developed and during subsequent years;</text></subclause> <subclause id="idE5789F5C04E34818884B46BA6A0404EC"><enum>(II)</enum><text>update payment rates for home and community-based services at least every 2 years through a transparent process involving meaningful input from stakeholders, including recipients of home and community-based services, family caregivers of such recipients, providers, health plans, direct care workers, chosen representatives of direct care workers, and aging, disability, and workforce advocates; and</text></subclause> |
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<subclause id="idF1CB7CC2BCA840899FC844C210B1E4DE"><enum>(III)</enum><text>ensure that increases in the payment rates for home and community-based services are—</text> <item id="idEC8DB947C8094D8CADC6DDB99B71B192"><enum>(aa)</enum><text>at a minimum, proportionately passed through to direct care workers and in a manner that is determined with input from the stakeholders described in subclause (II); and</text></item> |
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<item id="id5F67EE1989F744978AB2AF2161AEBB66"><enum>(bb)</enum><text>incorporated into payment rates for home and community-based services provided under this title by a managed care entity (as defined in section 1932(a)(1)(B)) or a prepaid inpatient health plan or prepaid ambulatory health plan, as defined in section 438.2 of title 42, Code of Federal Regulations (or any successor regulation), under a contract with the State.</text></item></subclause></clause></subparagraph></paragraph> <paragraph id="idF5C9785BC484443394417F022FB65221"><enum>(3)</enum><header>HCBS improvement to support self-directed models for the delivery of services</header><text>For purposes of paragraph (1)(B), the requirements of this paragraph, with respect to a State and a fiscal year quarter, are that the State establishes directly or by contract with 1 or more non-profit entities, a program for the performance of all of the following functions: </text> |
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<subparagraph id="idFE91FB05F7B9453EAAFF0081FB1C3A29"><enum>(A)</enum><text>Registering qualified direct care workers and assisting beneficiaries in finding direct care workers.</text></subparagraph> <subparagraph id="id0CB3D0C689D74ABF890B8EDCBDB19C26"><enum>(B)</enum><text>Undertaking activities to recruit and train independent providers to enable beneficiaries to direct their own care, including by providing or coordinating training for beneficiaries on self-directed care.</text></subparagraph> |
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<subparagraph id="id0c124f19bc074397ac9dd60176dbdb83"><enum>(C)</enum><text>Ensuring the safety of, and supporting the quality of, care provided to beneficiaries, such as by conducting background checks and addressing complaints reported by recipients of home and community-based services.</text></subparagraph> <subparagraph id="id27e7ba5fe07b45a281631b50baa52a45"><enum>(D)</enum><text>Facilitating coordination between State and local agencies and direct care workers for matters of public health, training opportunities, changes in program requirements, workplace health and safety, or related matters.</text></subparagraph> |
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<subparagraph id="id44AF2EB0E56A4010A7B9C4AE8571D2F3"><enum>(E)</enum><text>Supporting beneficiary hiring of independent providers of home and community-based services through an agency with choice or similar model, including by processing applicable tax information, collecting and processing timesheets, submitting claims and processing payments to such providers. </text></subparagraph> <subparagraph id="idabe49db54ba9485ab24e549e4f29dbaf"><enum>(F)</enum><text>To the extent a State permits beneficiaries to hire a family member or individual with whom they have an existing relationship to provide home and community-based services, providing support to beneficiaries who wish to hire a caregiver who is a family member or individual with whom they have an existing relationship, such as by facilitating enrollment of such family member or individual as a provider of home and community-based services under the State plan or a waiver of such plan. </text></subparagraph> |
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<subparagraph id="id42ccfedd182d4f7eb4a4dedd54c473a7"><enum>(G)</enum><text>Ensuring that program policies and procedures allow for cooperation with labor organizations that bargain on behalf of direct care workers in the case of a State in which the direct care workers in the State have elected to join, or form, such a labor organization, or, in the case of a State in which such workers have not joined or formed such a labor organization, are neutral with regard to such workers joining or forming such a labor organization.</text></subparagraph></paragraph> <paragraph id="id0257212c488b4fb5b9cca56446fa2728"><enum>(4)</enum><header>Quality, reporting, and oversight</header><text>The requirements described in this paragraph, with respect to a State and a fiscal year quarter, are the following:</text> |
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<subparagraph id="id9c364c694a1e4690b81f541cdce21db0"><enum>(A)</enum><text>The State adopts the core quality measures for home and community-based services developed by the Secretary under section 104 of the <short-title>Better Care Better Jobs Act</short-title>, or an alternate set of quality measures approved by the Secretary, and, at the option of the State, expands the use of beneficiary and family caregiver experience surveys.</text></subparagraph> <subparagraph id="idc9b5918c199f4c90aeda84f07ab060e8"><enum>(B)</enum><text>The State designates an HCBS ombudsman office that—</text> |
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<clause id="idCD39037F4C25497BBB5A030C1FFAC320"><enum>(i)</enum><text>operates independently from the State Medicaid agency and managed care entities;</text></clause> <clause id="id80EFE68248DB499EB9F01607AF617DA0"><enum>(ii)</enum><text>provides direct assistance to beneficiaries and their families; and</text></clause> |
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<clause id="id91A409BF2AC3433FB63166C904DC477C"><enum>(iii)</enum><text>identifies and reports systemic problems to State officials, the public, and the Secretary.</text></clause></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="id2d4144f94762403a868f242927973147"><enum>(C)</enum><text>Beginning with the 5th fiscal year quarter for which the State is an HCBS program improvement State, and annually thereafter, the State reports on the components of the existing home and community-based services landscape reported in the State HCBS infrastructure improvement plan, including with respect to—</text> |
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<clause id="id6cabc843f260455fa7fbe6ecee5a10bd"><enum>(i)</enum><text>the availability and utilization of home and community-based services, disaggregated by disability status, age, income, gender, race, ethnicity, geography, primary language, sexual orientation, gender identity, and type of service setting; </text></clause> <clause id="id918C7F407E1F4AF3ACD43045649BDC8E"><enum>(ii)</enum><text>the characteristics of the direct care workforce that provides home and community-based services and the race, ethnicity, and gender of such workforce;</text></clause> |
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<clause id="id889563CA822044BF9891F92086ACC2A8"><enum>(iii)</enum><text>changes in payment rates for home and community-based services;</text></clause> <clause id="idE3C5966920414410A1660EAFBDBC5DED"><enum>(iv)</enum><text>implementation of the activities to strengthen and expand access to home and community-based services and the direct care workforce that provides such services in accordance with the requirements of subparagraphs (B) and (C) of paragraph (2); </text></clause> |
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<clause commented="no" display-inline="no-display-inline" id="id874A212697A64C7DB1E88301C56291ED"><enum>(v)</enum><text> if applicable, implementation of the activities described in paragraph (3); and</text></clause> <clause commented="no" display-inline="no-display-inline" id="idA117E69FB3B44426B87034B1FC50CE51"><enum>(vi)</enum><text>the progress made with respect to meeting the benchmarks for demonstrating improvements required in paragraph (5). </text></clause></subparagraph></paragraph> |
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<paragraph id="id751a2a06e7bf43e1a10f3c4d4889826d"><enum>(5)</enum><header>Benchmarks for demonstrating improvements</header><text>An HCBS program improvement State shall cease to be eligible for an increase in the Federal medical assistance percentage under paragraph (1)(A)(i) or (1)(B) or an increase in an applicable Federal matching percentage under paragraph (1)(A)(ii) beginning with the 29th fiscal year quarter that begins on or after the first date on which a State is an HCBS program improvement State, unless, not later than 90 days before the first day of such fiscal year quarter, the State submits to the Secretary a report demonstrating the following improvements:</text> <subparagraph id="id30c53d15581a4e3bb1854489c910128b"><enum>(A)</enum><text>Increased availability of home and community-based services in the State relative to such availability as reported in the State HCBS infrastructure improvement plan and adjusted for demographic changes in the State since the submission of such plan.</text></subparagraph> |
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<subparagraph id="id47169EA54C4B420CB694A887F46D7125"><enum>(B)</enum><text>Increased utilization and availability of home and community-based services by populations with the lowest utilization and availability of such services (as reported in the State HCBS infrastructure improvement plan) relative to the utilization of such services by such populations as reported in such plan and adjusted for demographic changes in the State since the submission of such plan. </text></subparagraph> <subparagraph id="id4a7d28916dba49e8ad3e3b9bc0663fbb"><enum>(C)</enum><text>Evidence that a majority of direct care workers receive competitive wages and benefits.</text></subparagraph> |
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<subparagraph id="id05e1bb8574b64eaba6bea8e6b99d3382"><enum>(D)</enum><text>With respect to the percentage of expenditures made by the State for long-term services and supports that are for home and community-based services, in the case of an HCBS program improvement State for which such percentage (as reported in the State HCBS infrastructure improvement plan) was—</text> <clause id="idEC2021CBC714472C9BF32B035C013A62"><enum>(i)</enum><text>less than 50 percent, the State demonstrates that the percentage of such expenditures has increased to at least 50 percent since the plan was approved; and</text></clause> |
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<clause id="id7908D3E36B9E4DA1B371001DEA27CC13"><enum>(ii)</enum><text>at least 50 percent, the State demonstrates that such percentage has not decreased since the plan was approved.</text></clause></subparagraph></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="idBE28402C7E9F4678925684E0A9A0F93E"><enum>(6)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this subsection, the terms <term>direct care worker</term>, <term>direct care workforce</term>, <term>HCBS program improvement State</term>, and <term>home and community-based services</term> have the meanings given those terms in section 2 of the <short-title>Better Care Better Jobs Act</short-title>.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection></section> |
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<section id="id1D5877B3391D463C9499D00AD180EB53"><enum>103.</enum><header>Reports; technical assistance; other administrative requirements</header> |
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<subsection id="id5DCF581D59904AF09C5CC099A302D560"><enum>(a)</enum><header>Reports</header><text>The Secretary shall submit to the appropriate committees of Congress the following reports relating to the HCBS Infrastructure Improvement Program established under this title:</text> <paragraph id="idA860D8ADEFC54521A58AD80EA460A45B"><enum>(1)</enum><header>Initial report</header><text>Not later than 4 years after the date of enactment of this Act, a report that includes the following:</text> |
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<subparagraph id="id77627755E86C451D901BA3511B14E471"><enum>(A)</enum><text>A description of the HCBS infrastructure improvement plans approved by the Secretary under section 101(d).</text></subparagraph> <subparagraph id="id272b8ce80b7148f19689b037a64e101d"><enum>(B)</enum><text>A description of the national landscape with respect to gaps in coverage of home and community-based services, disparities in access to, and utilization of, such services, and barriers to accessing such services. </text></subparagraph> |
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<subparagraph id="id0FFA0177C5724EF28CD6AD3EABD2CBAF"><enum>(C)</enum><text>A description of the national landscape with respect to the direct care workforce that provides home and community-based services, including with respect to compensation, benefits, and challenges to the availability of such workers. </text></subparagraph></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="idCB90026650AB4B16BCDDA4E8F3DD2FD6"><enum>(2)</enum><header>Subsequent reports</header><text>Not later than 7 years after the date of enactment of this Act, and every 3 years thereafter, a report that includes the following:</text> |
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<subparagraph id="id53da54ba2da340c481f2d012aa6d3c4c"><enum>(A)</enum><text>The number of HCBS program improvement States. </text></subparagraph> <subparagraph id="idd32a4030cf5040cbb0a77801f2ba3e20"><enum>(B)</enum><text>A summary of the progress being made by such States with respect to strengthening and expanding access to home and community-based services and the direct care workforce that provides such services and meeting the benchmarks for demonstrating improvements required under section 1905(jj)(5) of the Social Security Act (as added by section 102). </text></subparagraph> |
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<subparagraph id="idcbde0b3c078a43bdbddb86d72630e1f0"><enum>(C)</enum><text>A summary of outcomes related to home and community-based services core quality measures and beneficiary and family caregiver surveys.</text></subparagraph> <subparagraph id="idD451DF615F0448328DC151D79B869F55"><enum>(D)</enum><text>A summary of the challenges and best practices reported by States in expanding access to home and community-based services and supporting and expanding the direct care workforce that provides such services.</text></subparagraph></paragraph></subsection> |
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<subsection commented="no" display-inline="no-display-inline" id="id16595F9087924AA0800B201003EDCEFF"><enum>(b)</enum><header>Technical assistance; guidance; regulations</header><text>The Secretary shall provide HCBS program improvement States with technical assistance related to carrying out the HCBS infrastructure improvement plans approved by the Secretary under section 101(d) and meeting the requirements and benchmarks for demonstrating improvements required under section 1905(jj) of the Social Security Act (as added by section 102) and shall issue such guidance or regulations as necessary to carry out this title and the amendments made by this title, including guidance specifying how States shall assess and track the availability of home and community-based services over time.</text></subsection> <subsection id="id0d8e948fa303478ab708a3a1ff2afd25"><enum>(c)</enum><header>Recommendations To guide infrastructure improvement</header> <paragraph id="idBB86F2EF2C4E45AAB01EEA6B5863E6E2"><enum>(1)</enum><header>In general</header><text>Not later than 18 months after the date of enactment of this Act, the Secretary shall coordinate with the Secretary of Labor and the Administrator of the Centers for Medicare & Medicaid Services for purposes of issuing recommendations for the Federal Government and for States to strengthen the direct care workforce that provides home and community-based services, including with respect to how the Federal Government should classify the direct care workforce, how such Administrator and State Medicaid programs can enforce and support the provision of competitive wages and benefits across the direct care workforce, including for workers with particular skills or expertise, and how State Medicaid programs can support training opportunities and other related efforts that support the provision of quality home and community-based services care.</text></paragraph> |
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<paragraph id="id764ee26bd0eb4f4496c540efee5cc336"><enum>(2)</enum><header>Stakeholder consultation</header><text>In developing the recommendations required under paragraph (1), the Secretary shall ensure that such recommendations are informed by consultation with recipients of home and community-based services, family caregivers of such recipients, providers, health plans, direct care workers, chosen representatives of direct care workers, and aging, disability, and workforce advocates.</text></paragraph></subsection> <subsection id="id577698C329264F6A8F04F2061BCE26BB"><enum>(d)</enum><header>Funding</header><text display-inline="yes-display-inline">Out of any funds in the Treasury not otherwise appropriated, there is appropriated to the Secretary for purposes of carrying out this section, $10,000,000 for fiscal year 2024, to remain available until expended.</text></subsection></section> |
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<section id="id5CD0AF11A3B74A50A765B7B3F74742BE"><enum>104.</enum><header>Quality measurement and improvement</header> |
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<subsection id="id5DBFBE1D087C45778A50D31DC8F74124"><enum>(a)</enum><header>Development and publication of core and supplemental sets of HCBS quality measures</header> |
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<paragraph commented="no" display-inline="no-display-inline" id="IDA57CAD6CCE5947B596999445B673796E"><enum>(1)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Not later than 2 years after the date of enactment of this Act, the Secretary shall identify and publish for general comment a recommended core set and supplemental set of home and community-based services quality measures for use by State Medicaid programs, health plan and managed care entities that enter into contracts with such programs, and providers of items and services under such programs.</text></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="idCD0B04E244EB4E74B4CFD4AAA9D81DF8"><enum>(2)</enum><header>Regular reviews and updates</header><text>The Secretary shall review and update the recommended core set and supplemental set of home and community-based services quality measures published under paragraph (1) not less frequently than once every year. </text></paragraph> |
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<paragraph id="id45a709018be642208ccd27f64d01d995"><enum>(3)</enum><header>Requirements</header> |
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<subparagraph id="id2489970362694DCDB6E22A17B924054F"><enum>(A)</enum><header>Interagency collaboration; stakeholder input</header><text>In developing the recommended core set and supplemental set of home and community-based services quality measures under paragraph (1), and subsequently reviewing and updating such core and supplemental sets, the Secretary shall—</text> <clause id="idA41FD8014B354B83B5C6C12508E12DD3"><enum>(i)</enum><text>collaborate with the Administrator of the Centers for Medicare & Medicaid Services, the Administrator of the Administration for Community Living, the Director of the Agency for Healthcare Research and Quality, and the Administrator of the Substance Abuse and Mental Health Services Administration; and</text></clause> |
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<clause id="idD4C9814899334D3FBDD788078FECF492"><enum>(ii)</enum><text>ensure that such core and supplemental sets are informed by input from stakeholders, including recipients of home and community-based services, family caregivers of such recipients, providers, health plans, direct care workers, chosen representatives of direct care workers, and aging, disability, and workforce advocates.</text></clause></subparagraph> <subparagraph id="id3629d079e6074730bfb666db024cbe1f"><enum>(B)</enum><header>Reflective of full array of services</header><text>Such recommended core set and supplemental set of home and community-based services quality measures shall—</text> |
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<clause id="idBCD604A753BE44EF8AA096BB8BCE223A"><enum>(i)</enum><text>reflect the full array of home and community-based services and recipients of such services, including adults and children; and</text></clause> <clause id="id95BF29FF051147F08006E97877330EE5"><enum>(ii)</enum><text>include—</text> |
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<subclause id="id2F4AFA9A145244EBAF2440C3D0CA37A3"><enum>(I)</enum><text>outcomes-based measures;</text></subclause> <subclause id="id1847A250994D4CF5958E3894724D1ACF"><enum>(II)</enum><text>measures of availability of services;</text></subclause> |
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<subclause id="idD2FD86D873A04AE985F639A9C98B0364"><enum>(III)</enum><text>measures of provider capacity and availability;</text></subclause> <subclause id="id0F669076124146A69606BEC16C3B5D3B"><enum>(IV)</enum><text>measures related to person-centered care;</text></subclause> |
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<subclause commented="no" id="idDA7F12E836E34431BA853C0ABB4F6D20"><enum>(V)</enum><text>measures specific to self-directed care;</text></subclause> <subclause id="idCADC9A67FB3941A49E70F2419A220CF1"><enum>(VI)</enum><text>measures related to transitions to and from institutional care; and</text></subclause> |
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<subclause id="idCCB841FDD6ED45D59214D7B38808C7AB"><enum>(VII)</enum><text>beneficiary and family caregiver surveys.</text></subclause></clause></subparagraph> <subparagraph id="ida48e1addb9fc4d41810d36af44e42f12"><enum>(C)</enum><header>Demographics</header><text>Such recommended core set and supplemental set of home and community-based services quality measures shall allow for the collection of data that is disaggregated by disability status, age, income, gender, race, ethnicity, geography, primary language, sexual orientation, gender identity, and type of service setting.</text></subparagraph></paragraph> |
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<paragraph id="id99D7505DBECD4C7D89EC35AAA4F7F997"><enum>(4)</enum><header>Funding</header><text display-inline="yes-display-inline">Out of any funds in the Treasury not otherwise appropriated, there is appropriated to the Secretary for purposes of carrying out this subsection, $5,000,000 for fiscal year 2024, to remain available until expended.</text></paragraph></subsection> <subsection id="idfaa03b06fd864d699fa80669bc7215bf"><enum>(b)</enum><header>State adoption and reports</header> <paragraph id="id5712B749CE634D44AE1B67108BC2E7EC"><enum>(1)</enum><header>In general</header><text>Not later than 2 years after the date on which the Secretary publishes the recommended core set and supplemental set of home and community-based services quality measures under subsection (a)(1), and annually thereafter, each State Medicaid program shall use such core and supplemental sets (or an alternative set of quality measures approved by the Secretary) to report information to the Secretary regarding the quality of home and community-based services provided under such program. </text></paragraph> |
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<paragraph id="id5AC352FA10F142F6AFF6CF9E0E9F7AE0"><enum>(2)</enum><header>Process</header><text>The information required under paragraph (1) shall be reported using a standardized format and procedures established by the Secretary. Such procedures shall allow a State Medicaid program to report such information separately or as part of the annual reports required under sections 1139A(c) and 1139B(d) of the Social Security Act (42 U.S.C. 1320b–9a, 1320b–9b).</text></paragraph> <paragraph id="iddb1db8606cc04c85bccb2d1e613c355f"><enum>(3)</enum><header>Publication of quality measures</header><text>Each State Medicaid program shall periodically make the information reported to the Secretary under paragraph (1) available to the public.</text></paragraph> |
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<paragraph id="id2FB2639D80DC4C9CB3BC47AE151448C2"><enum>(4)</enum><header>Increased Federal matching rate for adoption and reporting</header><text>Section 1903(a)(3) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396b">42 U.S.C. 1396b(a)(3)</external-xref>) is amended—</text> <subparagraph id="id64A40DE35F35439DB1100CB3B6C5A1ED"><enum>(A)</enum><text>in subparagraph (F)(ii), by striking <quote>plus</quote> after the semicolon and inserting <quote>and</quote>; and</text></subparagraph> |
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<subparagraph id="idF7CF5CB891604D578CF17DC79AE1772F"><enum>(B)</enum><text>by inserting after subparagraph (F), the following:</text> <quoted-block style="OLC" display-inline="no-display-inline" id="id8D68296FADEC483CB0AC26C79F0D683C"> <subparagraph id="idAD072BC6C7A2458A9122D8434EACBB6F"><enum>(G)</enum><text>80 percent of so much of the sums expended during such quarter as are attributable to the reporting of information regarding the quality of home and community-based services in accordance with section 104(b) of the <short-title>Better Care Better Jobs Act</short-title>; and</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph></subsection></section></title> |
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<title id="id04C21968F9A94BF2AAE33631839B1EC3" style="OLC"><enum>II</enum><header>Other Provisions</header> |
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<section commented="no" display-inline="no-display-inline" id="id03D0418F1BE14047802509A258A6DFA3"><enum>201.</enum><header>MACPAC study and report on Appendix K emergency home and community-based services (HCBS) 1915(c) waivers</header> |
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<subsection commented="no" display-inline="no-display-inline" id="id3259478C562D425F95206B05639A02AB"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Medicaid and CHIP Payment and Access Commission (referred to in this section as <quote>MACPAC</quote>) shall conduct a study and submit to Congress a report on the accelerated changes and emergency amendments to home and community-based services waivers under section 1915(c) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396n">42 U.S.C. 1396n(c)</external-xref>) approved for States during the COVID–19 pandemic using the Appendix K template issued by the Centers for Medicare & Medicaid Services on March 22, 2020.</text></subsection> <subsection id="id6f0ddf9259f84f29bbb821f60de05d26"><enum>(b)</enum><header>Report</header><text>The report submitted under subsection (a) shall—</text> |
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<paragraph id="idD8EE1C5ECCFE42B7AD4BF22F555E797F"><enum>(1)</enum><text>describe the specific types of flexibilities or other program changes adopted by States using the Appendix K template;</text></paragraph> <paragraph id="id365751FD50C44BD79EA8F0328B8BC585"><enum>(2)</enum><text>evaluate the efficiency, management, and success and failures of such flexibilities and program changes; and</text></paragraph> |
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<paragraph id="idBDF5E2C699FD48C98C9A075017BA1F6A"><enum>(3)</enum><text>include recommendations for legislative and administrative actions to continue specific flexibilities, program changes, and innovative service delivery models that increase access to care in home and community settings.</text></paragraph></subsection></section> <section id="HD4708FE03F7E4E689AAE148E339F36E6"><enum>202.</enum><header>Making permanent the State option to extend protection under Medicaid for recipients of home and community-based services against spousal impoverishment</header> <subsection id="HB41C489811C0438BB69B26C2BAED9185"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1924(h)(1)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-5">42 U.S.C. 1396r–5(h)(1)(A)</external-xref>) is amended by striking <quote>is described in section 1902(a)(10)(A)(ii)(VI)</quote> and inserting the following: <quote>is eligible for medical assistance for home and community-based services provided under subsection (c), (d), or (i) of section 1915, under a waiver approved under section 1115, or who is eligible for such medical assistance by reason of being determined eligible under section 1902(a)(10)(C) or by reason of section 1902(f) or otherwise on the basis of a reduction of income based on costs incurred for medical or other remedial care, or who is eligible for medical assistance for home and community-based attendant services and supports under section 1915(k)</quote>.</text></subsection> |
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<subsection commented="no" display-inline="no-display-inline" id="HF83B38558BAB4B5E8A5C66BC121B6502"><enum>(b)</enum><header>Conforming amendment</header><text>Section 2404 of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-5">42 U.S.C. 1396r–5</external-xref> note) is amended by striking <quote>September 30, 2027</quote> and inserting <quote>the date of enactment of the <short-title>Better Care Better Jobs Act</short-title></quote>. </text></subsection></section> <section id="idCD37D3E6975F4778BB30E2A126037ACE"><enum>203.</enum><header>Permanent extension of Money Follows the Person Rebalancing demonstration</header><text display-inline="no-display-inline">Subparagraph (L) of section 6071(h)(1) of the Deficit Reduction Act of 2005 (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a</external-xref> note), as added by section 5114 of the Health Extenders, Improving Access to Medicare, Medicaid, and CHIP, and Strengthening Public Health Act of 2022, is amended by striking <quote>for each of fiscal years 2024 through 2027</quote> and inserting <quote>for each fiscal year after fiscal year 2023</quote>.</text></section></title> |
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</legis-body> |
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</bill> |
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