[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1394 Introduced in Senate (IS)]
108th CONGRESS
1st Session
S. 1394
To establish a demonstration project under the medicaid program to
encourage the provision of community-based services to individuals with
disabilities.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 11, 2003
Mr. Harkin (for himself, Mr. Smith, Mr. Kennedy, Mr. Lautenberg, and
Mr. Kerry) introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To establish a demonstration project under the medicaid program to
encourage the provision of community-based services to individuals with
disabilities.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Money Follows the Person Act of
2003''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) In his budget for fiscal year 2004, President George W.
Bush proposes a ``Money Follows the Person'' rebalancing
initiative under the medicaid program to help States rebalance
their long-term services support systems more evenly between
institutional and community-based services.
(2) The President, by proposing this initiative, and
Congress, recognize that States have not fully developed the
systems needed to create a more equitable balance between
institutional and community-based services spending under the
medicaid program.
(3) While a few States have been successful at achieving
this balance, nationally, approximately 70 percent of the
medicaid funding spent for long-term services is devoted to
nursing facilities and intermediate care facilities for the
mentally retarded. Only 30 percent of such funding is spent for
community-based services.
(4) As a result, there are often long waiting lists for
community-based services and supports.
(5) In the Americans with Disabilities Act of 1990,
Congress found that individuals with disabilities continue to
encounter various forms of discrimination, including
segregation, and that discrimination persists in such critical
areas as institutionalization.
(6) In 1999, the Supreme Court held in Olmstead v. LC (527
U.S. 581 (1999)) that needless institutionalization is
discrimination under the Americans with Disabilities Act of
1990, noting that institutional placement of people who can be
served in the community ``perpetuates unwarranted assumptions
that persons so isolated are unworthy of participating in
community life.'' (Id. at 600). The Court further found that
``confinement in an institution severely diminishes the
everyday life activities of individuals, including family
relations, social contacts, work options, economic
independence, educational advancement, and cultural
enrichment.'' (Id. at 601).
(7) Additional resources would be helpful for assisting
States in rebalancing their long-term services support system
and complying with the Olmstead decision.
SEC. 3. AUTHORITY TO CONDUCT MEDICAID DEMONSTRATION PROJECTS.
(a) Definitions.--In this section:
(1) Community-based services and supports.--The term
``community-based services and supports'' means, with respect
to a State, any items or services that are an allowable
expenditure for medical assistance under the State medicaid
program, or under a waiver of such program and that the State
determines would allow an individual to live in the community.
(2) Individual's representative; representative.--The terms
``individual's representative'' and ``representative'' mean a
parent, family member, guardian, advocate, or authorized
representative of an individual.
(3) Medicaid long-term care facility.--The term ``medicaid
long-term care facility'' means a hospital, nursing facility,
or intermediate care facility for the mentally retarded, as
such terms are defined for purposes of the medicaid program.
(4) Medicaid program.--The term ``medicaid program'' means
the State medical assistance program established under title
XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
(5) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(6) State.--The term ``State'' has the meaning given such
term for purposes of the medicaid program.
(b) State Application.--A State may apply to the Secretary for
approval to conduct a demonstration project under which the State shall
provide community-based services and supports to individuals--
(1) who are eligible for medical assistance under the
medicaid program;
(2) who are residing in a medicaid long-term care facility
and who have resided in such facility for at least 90 days; and
(3) with respect to whom there has been a determination
that but for the provision of community-based services and
supports, the individuals would continue to require the level
of care provided in a medicaid long-term care facility.
(c) Requirements.--A State is not eligible to conduct a
demonstration project under this section unless the State certifies the
following:
(1) With respect to any individual provided community-based
services and supports under the demonstration project, the
State shall continue to provide community-based services and
supports to the individual under the medicaid program (and at
the State's Federal medical assistance percentage (as defined
in section 1905(b) of the Social Security Act) reimbursement
rate), for as long as the individual remains eligible for
medical assistance under the State medicaid program and
continues to require such services and supports, beginning with
the month that begins after the 12-month period in which the
individual is provided such services and supports under the
demonstration project.
(2) The State shall allow an individual participating in
the demonstration project (or, as appropriate, the individual's
representative) to choose the setting in which the individual
desires to receives the community-based services and supports
provided under the project.
(3) The State shall identify and educate individuals
residing in a medicaid long-term care facility who are eligible
to participate in the demonstration project (and, as
appropriate the individual's representative) about the
opportunity for the individual to receive community-based
services and supports under the demonstration project.
(4) The State shall ensure that each individual identified
in accordance with paragraph (3) (and, as appropriate, the
individual's representative), has the opportunity, information,
and tools to make an informed choice regarding whether to
transition to the community through participation in the
demonstration project or to remain in the medicaid long-term
care facility.
(5) The State shall maintain an adequate quality
improvement system so that individuals participating in the
demonstration project receive adequate services and supports.
(6) The State shall conduct a process for public
participation in the design and development of the
demonstration project and such process shall include the
participation of individuals with disabilities, elderly
individuals, or individuals with chronic conditions who are
part of the target populations to be served by the
demonstration project, and the representatives of such
individuals.
(7) The Federal funds paid to a State pursuant to this
section shall only supplement, and shall not supplant, the
level of State funds expended for providing community-based
services and supports for individuals under the State medicaid
program as of the date the State application to conduct a
demonstration project under this section is approved.
(d) Approval of Demonstration Projects.--
(1) In general.--Subject to paragraph (2), the Secretary
shall conduct a competitive application process with respect to
applications submitted under subsection (b) (taking into
consideration the preferences provided under paragraph (2))
that meet the requirements of subsection (c). In determining
whether to approve such an application, the Secretary may waive
the requirement of--
(A) section 1902(a)(1) of the Social Security Act
(42 U.S.C. 1396a(a)(1)) to allow for sub-State
demonstrations;
(B) section 1902(a)(10)(B) of such Act (42 U.S.C.
1396a(a)(10)(B)) with respect to comparability; and
(C) section 1902(a)(10)(C)(i)(III) of such Act (42
U.S.C. 1396a(a)(10)(C)(i)(III)) with respect to income
and resource limitations.
(2) Preference for certain applications.--In approving
applications to conduct demonstration projects under this
section, the Secretary shall give preference to approving
applications that indicate that the State shall do the
following:
(A) Design and implement enduring improvements in
community-based long-term services support systems
within the State to enable individuals with
disabilities to live and participate in community life,
particularly with respect to those practices that will
ensure the successful transition of such individuals
from medicaid long-term care facilities into the
community.
(B) Design and implement a long-term services
support system in the State that prevents individuals
from entering medicaid long-term care facilities in
order to gain access to community-based services and
supports.
(C) Engage in systemic reform activities within the
State to rebalance expenditures for long-term services
under the State medicaid program through administrative
actions that reduce reliance on institutional forms of
service and build up more community capacity.
(D) Address the needs of populations that have been
underserved with respect to the availability of
community services or involve individuals or entities
that have not previously participated in the efforts of
the State to increase access to community-based
services.
(E) Actively engage in collaboration between public
housing agencies, the State medicaid agency,
independent living centers, and other agencies and
entities in order to coordinate strategies for
obtaining community integrated housing and supportive
services for an individual who participates in the
demonstration project, both with respect to the period
during which such individual participates in the
project and after the individual's participation in the
project concludes, in order to enable the individual to
continue to reside in the community.
(F) Develop and implement policies and procedures
that allow the State medicaid agency to
administratively transfer or integrate funds from the
State budget accounts that are obligated for
expenditures for medicaid long-term care facilities to
other accounts for obligation for the provision of
community-based services and supports (including
accounts related to the provision of such services
under a waiver approved under section 1915 of the
Social Security Act (42 U.S.C. 1396n)) when an
individual transitions from residing in such a facility
to residing in the community.
(e) Payments to States.--
(1) In general.--The Secretary shall pay to each State with
a demonstration project approved under this section an amount
for each quarter occurring during the period described in
paragraph (2) equal to 100 percent of the State's expenditures
in the quarter for providing community-based services and
supports to individuals participating in the demonstration
project.
(2) Period described.--The period described in this
paragraph is the 12-month period that begins on the date on
which an individual first receives community-based services and
supports under the demonstration project in a setting that is
not a medicaid long-term care facility and is selected by the
individual.
(f) Reports.--
(1) In general.--Each State conducting a demonstration
project under this section shall submit a report to the
Secretary that, in addition to such other requirements as the
Secretary may require, includes information regarding--
(A) the types of community-based services and
supports provided under the demonstration project;
(B) the number of individuals served under the
project;
(C) the expenditures for, and savings resulting
from, conducting the project; and
(D) to the extent applicable, the changes in
State's long-term services system developed in
accordance with the provisions of subsection (d)(2).
(2) Uniform data format.--In requiring information under
this subsection, the Secretary shall develop a uniform data
format to be used by States in the collection and submission of
data in the State report required under paragraph (1).
(g) Evaluations.--The Secretary shall use an amount, not to exceed
one-half of 1 percent of the amount appropriated under subsection (h)
for each fiscal year, to provide, directly or through contract--
(1) for the evaluation of the demonstration projects
conducted under this section;
(2) technical assistance to States concerning the
development or implementation of such projects; and
(3) for the collection of the data described in subsection
(f)(1).
(h) Funding.--
(1) In general.--There is appropriated to carry out this
section $350,000,000 for each of fiscal years 2004 through
2008.
(2) Availability.--Funds appropriated under paragraph (1)
for a fiscal year shall remain available until expended, but
not later than September 30, 2008.
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