S.Amdt. 3086

SA 3086. Ms. CANTWELL (for herself and Mr. Kohl) submitted an
amendment intended to be proposed to amendment SA 2786 proposed by Mr.
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the
first-time homebuyers credit in the case of members of the Armed Forces
and certain other Federal employees, and for other purposes; which was
ordered to lie on the table; as follows:

On page 492, between lines 15 and 16, insert the following:

SEC. 2407. INCENTIVES FOR STATES TO OFFER HOME AND COMMUNITY-
BASED SERVICES AS A LONG-TERM CARE ALTERNATIVE
TO NURSING HOMES.

(a) State Balancing Incentive Payments Program.--
Notwithstanding section 1905(b) of the Social Security Act
(42 U.S.C. 1396d(b)), in the case of a balancing incentive
payment State, as defined in subsection (b), that meets the
conditions described in subsection (c), during the balancing
incentive period, the Federal medical assistance percentage
determined for the State under section 1905(b) of such Act
and increased under section 1902(gg)(5) shall be increased by
the applicable percentage points determined under subsection
(d) with respect to eligible medical assistance expenditures
described in subsection (e).
(b) Balancing Incentive Payment State.--A balancing
incentive payment State is a State--
(1) in which less than 50 percent of the total expenditures
for medical assistance under the State Medicaid program for a
fiscal year for long-term services and supports (as defined
by the Secretary under subsection (f))(1)) are for non-
institutionally-based long-term services and supports
described in subsection (f)(1)(B);
(2) that submits an application and meets the conditions
described in subsection (c); and
(3) that is selected by the Secretary to participate in the
State balancing incentive payment program established under
this section.
(c) Conditions.--The conditions described in this
subsection are the following:
(1) Application.--The State submits an application to the
Secretary that includes, in addition to such other
information as the Secretary shall require--
(A) a proposed budget that details the State's plan to
expand and diversify medical assistance for non-
institutionally-based long-term services and supports
described in subsection (f)(1)(B) under the State Medicaid
program during the balancing incentive period and achieve the
target spending percentage applicable to the State under
paragraph

[[Page S12821]]

(2), including through structural changes to how the State
furnishes such assistance, such as through the establishment
of a ``no wrong door - single entry point system'', optional
presumptive eligibility, case management services, and the
use of core standardized assessment instruments, and that
includes a description of the new or expanded offerings of
such services that the State will provide and the projected
costs of such services; and
(B) in the case of a State that proposes to expand the
provision of home and community-based services under its
State Medicaid program through a State plan amendment under
section 1915(i) of the Social Security Act, at the option of
the State, an election to increase the income eligibility for
such services from 150 percent of the poverty line to such
higher percentage as the State may establish for such
purpose, not to exceed 300 percent of the supplemental
security income benefit rate established by section
1611(b)(1) of the Social Security Act (42 U.S.C. 1382(b)(1)).
(2) Target spending percentages.--
(A) In the case of a balancing incentive payment State in
which less than 25 percent of the total expenditures for home
and community-based services under the State Medicaid program
for fiscal year 2009 are for such services, the target
spending percentage for the State to achieve by not later
than October 1, 2015, is that 25 percent of the total
expenditures for home and community-based services under the
State Medicaid program are for such services.
(B) In the case of any other balancing incentive payment
State, the target spending percentage for the State to
achieve by not later than October 1, 2015, is that 50 percent
of the total expenditures for home and community-based
services under the State Medicaid program are for such
services.
(3) Maintenance of eligibility requirements.--The State
does not apply eligibility standards, methodologies, or
procedures for determining eligibility for medical assistance
for non-institutionally-based long-term services and supports
described in subsection (f)(1)(B) under the State Medicaid
program that are more restrictive than the eligibility
standards, methodologies, or procedures in effect for such
purposes on December 31, 2010.
(4) Use of additional funds.--The State agrees to use the
additional Federal funds paid to the State as a result of
this section only for purposes of providing new or expanded
offerings of non-institutionally-based long-term services and
supports described in subsection (f)(1)(B) under the State
Medicaid program.
(5) Structural changes.--The State agrees to make, not
later than the end of the 6-month period that begins on the
date the State submits an application under this section, the
following changes:
(A) ``No wrong door''--single entry point system.--
Development of a statewide system to enable consumers to
access all long-term services and supports through an agency,
organization, coordinated network, or portal, in accordance
with such standards as the State shall establish and that
shall provide information regarding the availability of such
services, how to apply for such services, and referral
services for services and supports otherwise available in the
community ; and determinations of financial and functional
eligibility for such services and supports, or assistance
with assessment processes for financial and functional
eligibility.
(B) Conflict-free case management services.--Conflict-free
case management services to develop a service plan, arrange
for services and supports, support the beneficiary (and, if
appropriate, the beneficiary's caregivers) in directing the
provision of services and supports, for the beneficiary, and
conduct ongoing monitoring to assure that services and
supports are delivered to meet the beneficiary's needs and
achieve intended outcomes.
(C) Core standardized assessment instruments.--Development
of core standardized assessment instruments for determining
eligibility for non-institutionally-based long-term services
and supports described in subsection (f)(1)(B), which shall
be used in a uniform manner throughout the State, to
determine a beneficiary's needs for training, support
services, medical care, transportation, and other services,
and develop an individual service plan to address such needs.
(6) Data collection.--The State agrees to collect from
providers of services and through such other means as the
State determines appropriate the following data:
(A) Services data.--Services data from providers of non-
institutionally-based long-term services and supports
described in subsection (f)(1)(B) on a per-beneficiary basis
and in accordance with such standardized coding procedures as
the State shall establish in consultation with the Secretary.
(B) Quality data.--Quality data on a selected set of core
quality measures agreed upon by the Secretary and the State
that are linked to population-specific outcomes measures and
accessible to providers.
(C) Outcomes measures.--Outcomes measures data on a
selected set of core population-specific outcomes measures
agreed upon by the Secretary and the State that are
accessible to providers and include--
(i) measures of beneficiary and family caregiver experience
with providers;
(ii) measures of beneficiary and family caregiver
satisfaction with services; and
(iii) measures for achieving desired outcomes appropriate
to a specific beneficiary, including employment,
participation in community life, health stability, and
prevention of loss in function.
(d) Applicable Percentage Points Increase in FMAP.--The
applicable percentage points increase is--
(1) in the case of a balancing incentive payment State
subject to the target spending percentage described in
subsection (c)(2)(A), 5 percentage points; and
(2) in the case of any other balancing incentive payment
State, 2 percentage points.
(e) Eligible Medical Assistance Expenditures.--
(1) In general.--Subject to paragraph (2), medical
assistance described in this subsection is medical assistance
for non-institutionally-based long-term services and supports
described in subsection (f)(1)(B) that is provided by a
balancing incentive payment State under its State Medicaid
program during the balancing incentive payment period.
(2) Limitation on payments.--In no case may the aggregate
amount of payments made by the Secretary to balancing
incentive payment States under this section during the
balancing incentive period exceed $3,000,000,000.
(f) Definitions.--In this section:
(1) Long-term services and supports defined.--The term
``long-term services and supports'' has the meaning given
that term by Secretary and may include any of the following
(as defined with for purposes of State Medicaid programs
under title XIX of the Social Security Act):
(A) Institutionally-based long-term services and
supports.--Services provided in an institution, including the
following:
(i) Nursing facility services.
(ii) Services in an intermediate care facility for the
mentally retarded described in subsection (a)(15) of section
1905 of such Act.
(B) Non-institutionally-based long-term services and
supports.--Services not provided in an institution, including
the following:
(i) Home and community-based services provided under
subsection (c), (d), or (i), of section 1915 of such Act or
under a waiver under section 1115 of such Act.
(ii) Home health care services.
(iii) Personal care services.
(iv) Services described in subsection (a)(26) of section
1905 of such Act (relating to PACE program services).
(v) Self-directed personal assistance services described in
section 1915(j) of such Act.
(2) Balancing incentive period.--The term ``balancing
incentive period'' means the period that begins on October 1,
2011, and ends on September 30, 2015.
(3) Poverty line.--The term ``poverty line'' has the
meaning given that term in section 2110(c)(5) of the Social
Security Act (42 U.S.C. 1397jj(c)(5)).
(4) State medicaid program.--The term ``State Medicaid
program'' means the State program for medical assistance
provided under a State plan under title XIX of the Social
Security Act and under any waiver approved with respect to
such State plan.
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