[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 528 Introduced in Senate (IS)]
109th CONGRESS
1st Session
S. 528
To authorize the Secretary of Health and Human Services to provide
grants to States to conduct demonstration projects that are designed to
enable medicaid-eligible individuals to receive support for appropriate
and necessary long-term services in the settings of their choice.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 3, 2005
Mr. Harkin (for himself and Mr. Smith) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To authorize the Secretary of Health and Human Services to provide
grants to States to conduct demonstration projects that are designed to
enable medicaid-eligible individuals to receive support for appropriate
and necessary long-term services in the settings of their choice.
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
2005''.
SEC. 2. MONEY FOLLOWS THE PERSON REBALANCING DEMONSTRATION.
(a) Program Purpose and Authority.--The Secretary of Health and
Human Services (in this section referred to as the ``Secretary'') is
authorized to award, on a competitive basis, grants to States in
accordance with this section for demonstration projects (each in this
section referred to as an ``MFP demonstration project'') designed to
achieve the following objectives with respect to institutional and home
and community-based long-term care services under State medicaid
programs:
(1) Rebalancing.--Increase the use of home and community-
based, rather than institutional, long-term care services.
(2) Money follows the person.--Eliminate barriers or
mechanisms, whether in the State law, the State medicaid plan,
the State budget, or otherwise, that prevent or restrict the
flexible use of medicaid funds to enable medicaid-eligible
individuals to receive support for appropriate and necessary
long-term services in the settings of their choice.
(3) Continuity of service.--Increase the ability of the
State medicaid program to assure continued provision of home
and community-based long-term care services to eligible
individuals who choose to transition from an institutional to a
community setting.
(4) Quality assurance and quality improvement.--Ensure that
procedures are in place (at least comparable to those required
under the qualified HCB program) to provide quality assurance
for eligible individuals receiving medicaid home and community-
based long-term care services and to provide for continuous
quality improvement in such services.
(b) Definitions.--For purposes of this section:
(1) Home and community-based long-term care services.--The
term ``home and community-based long-term care services''
means, with respect to a State medicaid program, home and
community-based services (including home health and personal
care services) that are provided under the State's qualified
HCB program or that could be provided under such a program but
are otherwise provided under the medicaid program.
(2) Eligible individual.--The term ``eligible individual''
means, with respect to an MFP demonstration project of a State,
an individual in the State--
(A) who, immediately before beginning participation
in the MFP demonstration project--
(i) resides (and has resided, for a period
of not less than six months or for such longer
minimum period, not to exceed 2 years, as may
be specified by the State) in an inpatient
facility;
(ii) is receiving medicaid benefits for
inpatient services furnished by such inpatient
facility; and
(iii) with respect to whom a determination
has been made that, but for the provision of
home and community-based long-term care
services, the individual would continue to
require the level of care provided in an
inpatient facility; and
(B) who resides in a qualified residence beginning
on the initial date of participation in the
demonstration project.
(3) Inpatient facility.--The term ``inpatient facility''
means a hospital, nursing facility, or intermediate care
facility for the mentally retarded. Such term includes an
institution for mental diseases, but only, with respect to a
State, to the extent medical assistance is available under the
State medicaid plan for services provided by such institution.
(4) Individual's authorized representative.--The term
`individual's authorized representative' means, with respect to
an eligible individual, the individual's parent, family member,
guardian, advocate, or other authorized representative of the
individual.
(5) Medicaid.--The term ``medicaid'' means, with respect to
a State, the State program under title XIX of the Social
Security Act (including any waiver or demonstration under such
title or under section 1115 of such Act relating to such
title).
(6) Qualified hcb program.--The term ``qualified HCB
program'' means a program providing home and community-based
long-term care services operating under medicaid, whether or
not operating under waiver authority.
(7) Qualified residence.--The term ``qualified residence''
means, with respect to an eligible individual--
(A) a home owned or leased by the individual or the
individual's family member;
(B) an apartment with an individual lease, with
lockable access and egress, and which includes living,
sleeping, bathing, and cooking areas over which the
individual or the individual's family has domain and
control; and
(C) a residence, in a community-based residential
setting, in which no more than 4 unrelated individuals
reside.
(8) Qualified expenditures.--The term ``qualified
expenditures'' means expenditures by the State under its MFP
demonstration project for home and community-based long-term
care services for an eligible individual participating in the
MFP demonstration project, but only with respect to services
furnished during the 12-month period beginning on the date the
individual is discharged from an inpatient facility referred to
in paragraph (2)(A)(i).
(9) Self-directed services.--The term ``self-directed''
means, with respect to, home and community-based long-term care
services for an eligible individual, such services for the
individual which are planned and purchased under the direction
and control of such individual or the individual's authorized
representative, including the amount, duration, scope,
provider, and location of such services, under the State
medicaid program consistent with the following requirements:
(A) Assessment.--There is an assessment of the
needs, capabilities, and preferences of the individual
with respect to such services.
(B) Service plan.--Based on such assessment, there
is developed jointly with such individual or the
individual's authorized representative a plan for such
services for such individual that is approved by the
State and that--
(i) specifies those services which the
individual or the individual's authorized
representative would be responsible for
directing;
(ii) identifies the methods by which the
individual or the individual's authorized
representative will select, manage, and dismiss
providers of such services;
(iii) specifies the role of family members
and others whose participation is sought by the
individual or the individual's authorized
representative with respect to such services;
(iv) is developed through a person-centered
process that--
(I) is directed by the individual
or the individual's authorized
representative;
(II) builds upon the individual's
capacity to engage in activities that
promote community life and that
respects the individual's preferences,
choices, and abilities; and
(III) involves families, friends,
and professionals as desired or
required by the individual or the
individual's authorized representative;
(v) includes appropriate risk management
techniques that recognize the roles and sharing
of responsibilities in obtaining services in a
self-directed manner and assure the
appropriateness of such plan based upon the
resources and capabilities of the individual or
the individual's authorized representative; and
(vi) may include an individualized budget
which identifies the dollar value of the
services and supports under the control and
direction of the individual or the individual's
authorized representative.
(C) Budget Process.--With respect to individualized
budgets described in subparagraph (B)(vi), the State
application under subsection (c)--
(i) describes the method for calculating
the dollar values in such budgets based on
reliable costs and service utilization;
(ii) defines a process for making
adjustments in such dollar values to reflect
changes in individual assessments and service
plans; and
(iii) provides a procedure to evaluate
expenditures under such budgets.
(10) State.--The term ``State'' has the meaning given such
term for purposes of title XIX of the Social Security Act.
(c) State Application.--A State seeking approval of an MFP
demonstration project shall submit to the Secretary, at such time and
in such format as the Secretary requires, an application meeting the
following requirements and containing such additional information,
provisions, and assurances, as the Secretary may require:
(1) Assurance of a public development process.--The
application contains an assurance that the State has engaged,
and will continue to engage, in a public process for the design,
development, and evaluation of the MFP demonstration project that
allows for input from eligible individuals, the families of such
individuals, authorized representatives of such individuals, providers,
and other interested parties.
(2) Operation in connection with qualified hcb program to
assure continuity of services.--The State will conduct the MFP
demonstration project for eligible individuals in conjunction
with the operation of a qualified HCB program that is in
operation (or approved) in the State for such individuals in a
manner that assures continuity of medicaid coverage for such
individuals so long as such individuals continue to be eligible
for medical assistance.
(3) Demonstration project period.--The application shall
specify the period of the MFP demonstration project, which
shall include at least two consecutive fiscal years in the 5-
fiscal-year period beginning with fiscal year 2006.
(4) Service area.--The application shall specify the
service area or areas of the MFP demonstration project, which
may be a Statewide area or one or more geographic areas of the
State.
(5) Targeted groups and numbers of individuals served.--The
application shall specify--
(A) the target groups of eligible individuals to be
assisted to transition from an inpatient facility to a
qualified residence during each fiscal year of the MFP
demonstration project;
(B) the projected numbers of eligible individuals
in each targeted group of eligible individuals to be so
assisted during each such year; and
(C) the estimated total annual qualified
expenditures for each fiscal year of the MFP
demonstration project.
(6) Individual choice, continuity of care.--The application
shall contain assurances that--
(A) each eligible individual or the individual's
authorized representative will be provided the
opportunity to make an informed choice regarding
whether to participate in the MFP demonstration
project;
(B) each eligible individual or the individual's
authorized representative will choose the qualified
residence in which the individual will reside and the
setting in which the individual will receive home and
community-based long-term care services;
(C) the State will continue to make available, so
long as the State operates its qualified HCB program
consistent with applicable requirements, home and
community-based long-term care services to each
individual who completes participation in the MFP
demonstration project for as long as the individual
remains eligible for medical assistance for such
services under such qualified HCB program (including
meeting a requirement relating to requiring a level of
care provided in an inpatient facility and continuing
to require such services).
(7) Rebalancing.--The application shall--
(A) provide such information as the Secretary may
require concerning the dollar amounts of State medicaid
expenditures for the fiscal year, immediately preceding
the first fiscal year of the State's MFP demonstration
project, for long-term care services and the percentage
of such expenditures that were for institutional long-
term care services or were for home and community-based
long-term care services;
(B)(i) specify the methods to be used by the State
to increase, for each fiscal year during the MFP
demonstration project, the dollar amount of such total
expenditures for home and community-based long-term
care services and the percentage of such total
expenditures for long-term care services that are for
home and community-based long-term care services; and
(ii) describe the extent to which the MFP
demonstration project will contribute to accomplishment
of objectives described in subsection (a).
(8) Money follows the person.--The application shall
describe the methods to be used by the State to eliminate any
legal, budgetary, or other barriers to flexibility in the
availability of medicaid funds to pay for long-term care
services for eligible individuals participating in the project
in the appropriate settings of their choice, including costs to
transition from an institutional setting to a qualified
residence.
(9) Maintenance of effort and cost-effectiveness.--The
application shall contain or be accompanied by such information
and assurances as may be required to satisfy the Secretary
that--
(A) total expenditures under the State medicaid
program for home and community-based long-term care
services will not be less for any fiscal year during
the MFP demonstration project than for the greater of
such expenditures for--
(i) fiscal year 2004; or
(ii) any succeeding fiscal year before the
first year of the MFP demonstration project;
and
(B) in the case of a qualified HCB program
operating under a waiver under subsection (c) or (d) of
section 1915 of the Social Security Act (42 U.S.C.
1396n), but for the amount awarded under a grant under
this section, the State program would continue to meet
the cost-effectiveness requirements of subsection
(c)(2)(D) of such section or comparable requirements
under subsection (d)(5) of such section, respectively.
(10) Waiver requests.--The application shall contain or be
accompanied by requests for any modification or adjustment of
waivers of medicaid requirements described in subsection
(d)(3), including adjustments to maximum numbers of individuals
included and package of benefits, including one-time
transitional services, provided.
(11) Quality assurance and quality improvement.--The
application shall include--
(A) a plan satisfactory to the Secretary for
quality assurance and quality improvement for home and
community-based long-term care services under the State
medicaid program, including a plan to assure the health
and welfare of individuals participating in the MFP
demonstration project; and
(B) an assurance that the State will cooperate in
carrying out activities under subsection (f) to develop
and implement continuous quality assurance and quality
improvement systems for home and community-based long-
term care services.
(12) Optional program for self-directed services.--If the
State elects to provide for any home and community-based long-
term care services as self-directed services (as defined in
subsection (b)(9)) under the MFP demonstration project, the
application shall provide the following:
(A) Meeting requirements.--A description of how the
project will meet the applicable requirements of such
subsection for the provision of self-directed services.
(B) Voluntary election.--A description of how
eligible individuals will be provided with the
opportunity to make an informed election to receive
self-directed services under the project and after the
end of the project.
(C) State support in service plan development.--
Satisfactory assurances that the State will provide
support to eligible individuals who self-direct in
developing and implementing their service plans.
(D) Oversight of receipt of services.--Satisfactory
assurances that the State will provide oversight of
eligible individuals' receipt of such self-directed
services, including steps to assure the quality of
services provided and that the provision of such
services are consistent with the service plan under
such subsection.
Nothing in this section shall be construed as requiring a State
to make an election under the project to provide for home and
community-based long-term care services as self-directed
services, or as requiring an individual to elect to receive
self-directed services under the project.
(13) Reports and evaluation.--The application shall provide
that--
(A) the State will furnish to the Secretary such
reports concerning the MFP demonstration project, on
such timetable, in such uniform format, and containing
such information as the Secretary may require, as will
allow for reliable comparisons of MFP demonstration
projects across States; and
(B) the State will participate in and cooperate
with the evaluation of the MFP demonstration project.
(d) Secretary's Award of Competitive Grants.--
(1) In general.--The Secretary shall award grants under
this section on a competitive basis to States selected from
among those with applications meeting the requirements of
subsection (c), in accordance with the provisions of this
subsection.
(2) Selection and modification of state applications.--In
selecting State applications for the awarding of such a grant,
the Secretary--
(A) shall take into consideration the manner in
which and extent to which the State proposes to achieve
the objectives specified in subsection (a);
(B) shall seek to achieve an appropriate national
balance in the numbers of eligible individuals, within
different target groups of eligible individuals, who
are assisted to transition to qualified residences
under MFP demonstration projects, and in the geographic
distribution of States operating MFP demonstration
projects;
(C) shall give preference to State applications
proposing--
(i) to provide transition assistance to
eligible individuals within multiple target
groups; and
(ii) to provide eligible individuals with
the opportunity to receive home and community-
based long-term care services as self-directed
services, as defined in subsection (b)(9); and
(D) shall take such objectives into consideration
in setting the annual amounts of State grant awards
under this section.
(3) Waiver authority.--The Secretary is authorized to waive
the following provisions of title XIX of the Social Security
Act, to the extent necessary to enable a State initiative to
meet the requirements and accomplish the purposes of this
section:
(A) Statewideness.--Section 1902(a)(1), in order to
permit implementation of a State initiative in a
selected area or areas of the State.
(B) Comparability.--Section 1902(a)(10)(B), in
order to permit a State initiative to assist a selected
category or categories of individuals described in
subsection (b)(2)(A).
(C) Income and resources eligibility.--Section
1902(a)(10)(C)(i)(III), in order to permit a State to
apply institutional eligibility rules to individuals
transitioning to community-based care.
(D) Provider agreements.--Section 1902(a)(27), in
order to permit a State to implement self-directed
services in a cost-effective manner.
(4) Conditional approval of outyear grant.--In awarding
grants under this section, the Secretary shall condition the
grant for the second and any subsequent fiscal years of the
grant period on the following:
(A) Numerical benchmarks.--The State must
demonstrate to the satisfaction of the Secretary that
it is meeting numerical benchmarks specified in the
grant agreement for--
(i) increasing State medicaid support for
home and community-based long-term care
services under subsection (c)(5); and
(ii) numbers of eligible individuals
assisted to transition to qualified residences.
(B) Quality of care.--The State must demonstrate to
the satisfaction of the Secretary that it is meeting
the requirements under subsection (c)(9) to assure the
health and welfare of MFP demonstration project
participants.
(e) Payments to States; Carryover of Unused Grant Amounts.--
(1) Payments.--For each calendar quarter in a fiscal year
during the period a State is awarded a grant under subsection
(d), the Secretary shall pay to the State from its grant award
for such fiscal year an amount equal to the lesser of--
(A) 100 percent of the amount of qualified
expenditures made during such quarter; or
(B) the total amount remaining in such grant award
for such fiscal year (taking into account the
application of paragraph (2)).
(2) Carryover of unused amounts.--Any portion of a State
grant award for a fiscal year under this section remaining at
the end of such fiscal year shall remain available to the State
for the next four fiscal years, subject to paragraph (3).
(3) Re-awarding of certain unused amounts.--In the case of
a State that the Secretary determines pursuant to subsection
(d)(4) has failed to meet the conditions for continuation of a
MFP demonstration project under this section in a succeeding
year or years, the Secretary shall rescind the grant awards for
such succeeding year or years, together with any unspent
portion of an award for prior years, and shall add such amounts
to the appropriation for the immediately succeeding fiscal year
for grants under this section.
(4) Preventing duplication of payment.--The payment under
an MFP demonstration project with respect to qualified
expenditures shall be in lieu of any payment with respect to
such expenditures that could otherwise be paid under medicaid,
including under section 1903(a) of the Social Security Act.
Nothing in the previous sentence shall be construed as
preventing the payment under medicaid for such expenditures in
a grant year after amounts available to pay for such
expenditures under the MFP demonstration project have been
exhausted.
(f) Quality Assurance and Improvement; Technical Assistance;
Oversight.--
(1) In general.--The Secretary, either directly or by grant
or contract, shall provide for technical assistance to and
oversight of States for purposes of upgrading quality assurance
and quality improvement systems under medicaid home and
community-based waivers, including--
(A) dissemination of information on promising
practices;
(B) guidance on system design elements addressing
the unique needs of participating beneficiaries;
(C) ongoing consultation on quality, including
assistance in developing necessary tools, resources,
and monitoring systems; and
(D) guidance on remedying programmatic and systemic
problems.
(2) Funding.--From the amounts appropriated under
subsection (h) for each of fiscal years 2006 through 2010, not
more than $2,400,000 shall be available to the Secretary to
carry out this subsection.
(g) Research and Evaluation.--
(1) In general.--The Secretary, directly or through grant
or contract, shall provide for research on and a national
evaluation of the program under this section, including
assistance to the Secretary in preparing the final report
required under paragraph (2). The evaluation shall include an
analysis of projected and actual savings related to the
transition of individuals to qualified residences in each State
conducting an MFP demonstration project.
(2) Final report.--The Secretary shall make a final report
to the President and the Congress, not later than September 30,
2011, reflecting the evaluation described in paragraph (1) and
providing findings and conclusions on the conduct and
effectiveness of MFP demonstration projects.
(3) Funding.--From the amounts appropriated under
subsection (h) for each of fiscal years 2006 through 2010, not
more than $1,100,000 per year shall be available to the
Secretary to carry out this subsection.
(h) Appropriations.--
(1) In general.--There are appropriated, from any funds in
the Treasury not otherwise appropriated, for grants to carry
out this section--
(A) $250,000,000 for fiscal year 2006;
(B) $300,000,000 for fiscal year 2007;
(C) $350,000,000 for fiscal year 2008;
(D) $400,000,000 for fiscal year 2009; and
(E) $450,000,000 for fiscal year 2010.
(2) Availability.--Amounts made available under paragraph
(1) for a fiscal year shall remain available for the awarding
of grants to States by not later than September 30, 2010.
(i) Rule of Construction.--Nothing in this Act shall be construed
as requiring a State to agree to a capped allotment for expenditures
for long-term care services under medicaid.
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