Sec. 802. HCBS Improvement Program
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Section 1905 of the Social Security Act ( 42 U.S.C. 1396d ) is amended— in subsection (b), by striking and
(ii)and inserting (ii), and
(ll); and by adding at the end the following new subsection: Subject to paragraph (5), in the case of a State that is an HCBS Improvement Program State, for each fiscal quarter that begins on or after the first date on which the State is an HCBS Improvement Program State— and for which the State meets the requirements described in paragraphs
(2)and (4), 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)or
(ff)and, if applicable, increased under subsection (y), (z), (aa), or (ii), or section 1915(k)(2)) shall be increased by 8 percentage points; and with respect to the State meeting the requirements described in paragraphs
(2)and
(4)and with respect to amounts expended during the quarter and before October 1, 2036, administrative costs for expanding and enhancing home and community-based services, including for enhancing Medicaid data and technology infrastructure, modifying rate setting processes, adopting or improving training programs for direct care workers and family caregivers, home and community-based services ombudsman office activities, developing processes to identify direct care workers and assign such workers unique identifiers, and adopting, carrying out, or enhancing programs that register direct care workers or connect beneficiaries to direct care workers, shall be eligible for Federal financial participation in the same manner as other administrative expenditures under section 1903(a), except that, for purposes of this clause, the per centum applicable to such expenditures shall be the greater of 80 percent or the per centum that would otherwise apply. In no case may the application of clause
(i)result in the Federal medical assistance percentage determined for a State being more than 95 percent with respect to such expenditures. Any increase pursuant to clause
(ii)shall be available to a State before the State meets the requirements of paragraphs
(2)and (4). Subject to paragraph (5), in addition to the increase to the Federal medical assistance percentage under subparagraph (A)(i) for amounts expended during a quarter for medical assistance for home and community-based services by an HCBS Improvement Program State that meets the requirements of paragraphs
(2)and
(4)for the quarter, the Federal medical assistance percentage for amounts expended by the State during the quarter for medical assistance for home and community-based services shall be further increased by 2 percentage points (but not to exceed 95 percent) during the first 6 fiscal quarters throughout which the State has implemented and has in effect a program that meets the requirements of paragraph (3). Any increase to the Federal medical assistance percentage of a State under subparagraph (A)(i) or
(B)or an increase to an applicable Federal matching percentage under subparagraph (A)(ii) shall not be taken into account in calculating the enhanced FMAP of a State under section 2105. As conditions for receipt of the increase under paragraph (1)(A)(i) to the Federal medical assistance percentage determined for a State, with respect to a fiscal year quarter, the State shall meet each of the following requirements: The State uses an amount in State funds equivalent to the additional Federal funds received by the State that are attributable to the increase to the Federal medical assistance percentage for amounts expended during a quarter for medical assistance for home and community-based services under paragraph (1)(A) and paragraph (1)(B) (if applicable) to supplement, and not supplant, the level of State funds expended for home and community-based services for eligible individuals through programs in effect as of the date the State is awarded a planning grant under section 801 of the Make Billionaires Pay Their Fair Share Act . In applying this subparagraph, the Secretary shall provide that a State shall have a 3-year period, as specified by the Secretary, to spend any accumulated unspent State funds attributable to such increase to the Federal medical assistance percentage. The State does not— reduce the amount, duration, or scope of home and community-based services available under the State plan (or waiver of such plan) relative to the home and community-based services available under the plan or a waiver of such plan as of the date on which the State was awarded a planning grant under section 801 of the Make Billionaires Pay Their Fair Share Act ; reduce payment rates for home and community-based services lower than such rates that were in place as of the date described in subclause (I), including, to the extent applicable, assumed payment rates for such services that are included in managed care capitation rates as such rates are being prospectively built; or except to the extent permitted under clause (ii), adopt more restrictive standards, methodologies, or procedures for determining eligibility for, or the scope of, medical assistance for home and community-based services, including with respect to cost-sharing, than the standards, methodologies, or procedures applicable as of the date described in subclause (I). A State may make modifications that would otherwise violate the maintenance of effort described in clause
(i)if the State demonstrates to the satisfaction of the Secretary that such modifications shall not result in— home and community-based services that are less comprehensive or lower in amount, duration, or scope; fewer individuals (overall and within particular eligibility groups) receiving home and community-based services, adjusted for demographic changes since the date described in clause (i)(I); or increased cost-sharing (other than resulting from the rate of inflation) for home and community-based services. The State undertakes efforts to improve access to home and community-based services by doing all of the following not later than an implementation date specified by the Secretary (which may vary for each of the following clauses) after the first day of the first fiscal quarter for which a State receives an increase to the Federal medical assistance percentage or other applicable Federal matching percentage under paragraph (1): Reduces access barriers and disparities in access or utilization of home and community-based services. Provides coverage of personal care services authorized under subsection (a)(24) for all individuals eligible for and enrolled in medical assistance in the State. Provides for navigation of home and community-based services through no wrong door programs, provides expedited eligibility for home and community-based services, and improves home and community-based services counseling and education programs. Expands access to behavioral health services furnished in home and community-based settings. Improves coordination of home and community-based services with employment, housing, and transportation supports. Provides supports to family caregivers. Newly provides coverage under, or expands existing eligibility criteria for, 1 or more of the eligibility categories authorized under subclause (XIII), (XV), or
(XVI)of section 1902(a)(10)(A)(ii). The State strengthens and expands the workforce of direct care workers that provides home and community-based services by— adopting processes to ensure that payment rates for home and community-based services are sufficient (as defined by the Secretary) to ensure that services are available, including by, not later than 2 years after approval of the HCBS improvement plan and, at least every 3 years thereafter, updating and, as appropriate, increasing payment rates for home and community-based services to support recruitment and retention of direct care workers using, through existing or other processes to determine provider payments, a transparent process involving input from nongovernmental stakeholders; ensuring that increases in the payment rates for home and community-based services result in at least a proportionate increase to payments for direct care workers; and updating qualification standards as appropriate, and developing and adopting training opportunities, for direct care workers and family caregivers, at such times as the Secretary shall prescribe. As conditions for receipt of the increase under paragraph (1)(B) to the Federal medical assistance percentage determined for a State, with respect to a fiscal year quarter, the State shall establish directly, or by contract with 1 or more entities, including an agency with choice or a similar service delivery model, a program for the performance of all of the following functions, consistent with guidance issued by the Secretary, to facilitate beneficiary use of self-directed care in the case the State covers home and community-based services under authorities that permit self-direction: Recruiting and registering qualified direct care workers and assisting beneficiaries in finding qualified direct care workers. Supporting beneficiary hiring, if selected by the beneficiary, of independent providers of home and community-based services, including through the provision of financial management services. 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. Ensuring that the program under this paragraph does not promote or deter the ability of workers to form a labor organization or discriminate against workers who may join or decline to join such an organization. As a condition for receipt of an increase under subparagraphs (A)(i) or
(B)of paragraph
(1)to the Federal medical assistance percentage determined for a State, with respect to a fiscal year quarter, the State shall, beginning with the last day of the 5th fiscal quarter for which the State is an HCBS Improvement Program State, and annually thereafter, report to the Secretary, in a manner the Secretary shall prescribe, on— the State's progress in implementing the activities described in subparagraphs
(C)and
(D)of paragraph
(2)and (if applicable) paragraph
(3)in accordance with the State HCBS improvement plan; and the use of the increased funding provided under this subsection. An HCBS Improvement Program State shall cease to be eligible for an increase to the Federal medical assistance percentage under paragraph (1)(A)(i) or (1)(B) or an increase to an applicable Federal matching percentage under paragraph (1)(A)(ii) for each fiscal quarter after the 29th fiscal quarter that begins on or after the first date on which the State is an HCBS Improvement Program State unless, at the end of such 29th fiscal quarter, the State demonstrates the following in the annual report required in paragraph
(4)for such quarter: Increased availability (above a marginal increase) of home and community-based services in the State relative to such availability as reported in the State HCBS improvement plan and adjusted for demographic changes in the State since the submission of such plan. 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 Improvement Program State for which such percentage (as reported in the State HCBS improvement plan) was— 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 at least 50 percent, the State demonstrates that such percentage has not decreased since the plan was approved. In this subsection, the terms direct care worker , HCBS Improvement Program State , and home and community-based services have the meaning given those terms in section 801(d) of the Make Billionaires Pay Their Fair Share Act . .
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Sec. 802
HCBS Improvement Program
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