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Code · BILL · 113th Congress · H.R. 1200 (Introduced in House) — To provide for health care for every American and to control the cost and enhance the quality of the health care system. · Sec. 203

Sec. 203. Special rules for home and community-based long-term care services

302 words·~1 min read·/bill/113/hr/1200/ih/section-203·

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For purposes of section 201(a)(5)(C), individuals described in this subsection are the following individuals: Individuals 18 years of age or older determined (in a manner specified by the Board)— to be unable to perform, without the assistance of an individual, at least 2 of the following 5 activities of daily living (or who has a similar level of disability due to cognitive impairment)— bathing; eating; dressing; toileting; and transferring in and out of a bed or in and out of a chair; due to cognitive or mental impairments, to require supervision because the individual behaves in a manner that poses health or safety hazards to himself or herself or others; or due to cognitive or mental impairments, to require queuing to perform activities of daily living.
Individuals under 18 years of age determined (in a manner specified by the Board) to meet such alternative standard of disability for children as the Board develops. Such alternative standard shall be comparable to the standard for adults and appropriate for children. The aggregate expenditures by a State health security program with respect to home and community-based long-term care services in a period (specified by the Board) may not exceed 65 percent (or such alternative ratio as the Board establishes under paragraph (2)) of the average of the amount of payment that would have been made under the program during the period if all the home-based long-term care beneficiaries had been residents of nursing facilities in the same area in which the services were provided.
The Board may establish for purposes of paragraph
(1)an alternative ratio (of payments for home and community-based long-term care services to payments for nursing facility services) as the Board determines to be more consistent with the goal of providing cost-effective long-term care in the most appropriate and least restrictive setting.
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