Sec. 101. Additional support for Medicaid long-term care services provided by direct care professionals
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/bill/119/hr/8541/ih/section-101·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
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
(kk); and by adding at the end the following new subsection: Notwithstanding subsections
(b)and (ff), in the case of a State that satisfies the conditions described in paragraph (2), for each fiscal quarter during the period of fiscal years 2026 through 2035, the Federal medical assistance percentage otherwise determined for such State under such subsection
(b)or
(ff)shall, after the application of any other increase to the Federal medical assistance percentage for the State and quarter applicable under any other provision of law, be increased by 10 percentage points (but not to exceed 95 percent) with respect to amounts expended by the State for medical assistance for long-term care services that are provided by direct care professionals during such quarter. As a condition for receipt of the increase under paragraph
(1)to the Federal medical assistance percentage determined for a State, the State shall submit to the Secretary, at such time and in such manner as specified by the Secretary, an application that includes, in addition to such other information as the Secretary shall require— a description of which activities described in paragraph
(4)that a State plans to implement and a description of how it plans to implement such activities; assurances that all Federal funds attributable to the increase under paragraph
(1)will be— expended by the State in accordance with this subsection not later than September 30, 2037; and used— to implement the activities described in paragraph (4); to supplement, and not supplant, the level of State funds expended for long-term care services provided by direct care professionals under the State plan (or under a waiver of such plan) as of the date of enactment of this subsection; and to increase reimbursement rates for long-term care services provided by direct care professionals under the State plan (or under a waiver of such plan) to a level that will support recruitment and retention of a sufficient workforce to provide such services under the State plan (or waiver); assurances that the State will use a portion of the Federal funds attributable to the increase under paragraph
(1)to ensure greater service capacity, including reducing waiting lists and improving compensation, benefits, working conditions, and training for direct care professionals and direct care managers; and assurances that the State will conduct adequate oversight and ensure the validity of such data as may be required by the Secretary. Not later than 90 days after the date of submission of an application of a State under paragraph (2), the Secretary shall certify if the application is complete. Upon certification that an application of a State is complete, the application shall be deemed to be approved for purposes of this section. A State shall work with community partners such as Area Agencies on Aging, centers for independent living, as described in part C of title VII of the Rehabilitation Act of 1973, nonprofit long-term care services providers, and other entities to implement some or all of the purposes described in subparagraph (B). The purposes described in this paragraph, with respect to a State, are the following: To increase rates for service provider agencies that employ direct care professionals (including independent providers in a self-directed or consumer-directed model) to provide long-term care services under the State plan (or under a waiver of such plan), provided that any service provider agency or individual that receives payment under such an increased rate increases the compensation it pay its direct care professionals. To provide paid sick leave, paid family leave, and paid medical leave for direct care professionals. To provide hazard pay, overtime pay, and shift differential pay for direct care professionals. To improve stability of direct care professional jobs, including consistent hours, scheduling, pay, and benefit eligibility. To provide home and community-based services to individuals who are on waiting lists for programs approved under sections 1115 or 1915. To purchase emergency supplies and equipment, which may include items not typically covered under the State plan (or under a waiver of such plan), such as personal protective equipment, necessary to enhance access to services and to protect the health and well-being of direct care professionals. To pay for the travel of direct care professionals to conduct their job responsibilities. To recruit new direct care professionals. To pay for training for direct care professionals, including apprenticeship programs. To pay for assistive technologies, staffing, and training to facilitate eligible individuals’ communication, and other costs incurred in order to facilitate community integration and ensure an individual’s person-centered service plan is fully implemented. To prepare information and public health and educational materials in accessible formats (including formats accessible to people with low literacy or intellectual disabilities about prevention, treatment, recovery, and other aspects of communicable diseases and threats to the health of individuals who are enrolled for medical assistance under the State plan (or under a waiver of such plan)), their families, and the general community served by agencies described in clause (i). To protect the health and safety of direct care professionals during public health emergencies and natural disasters. To pay for interpreters to assist in providing long-term care services to individuals under the State plan (or under a waiver of such plan) and to inform the general public about communicable diseases and other public health threats. To pay for other expenses deemed appropriate by the Secretary to enhance, expand, or strengthen long-term care services under the State plan (or under a waiver of such plan). Not later than December 31, 2028, and every 2 years thereafter until December 31, 2040, any State with respect to which an application is approved by the Secretary pursuant to paragraph
(3)shall submit a report to the Secretary that contains the following information: Activities and programs that were funded using Federal funds attributable to the increase to the Federal medical assistance percentage of the State under paragraph (1). The number of individuals enrolled under the State plan (or under a waiver of such plan) who were served by such activities and programs. A detailed accounting of all spending of funds attributable to the increase to the Federal medical assistance percentage of the State under paragraph
(1)by the State and by any providers with whom the State entered into contracts or agreements to fulfill the requirements of this subsection. Chapter 35 of title 44, United States Code (commonly referred to as the Paperwork Reduction Act of 1995 ), shall not apply to the provisions of this subsection. If the Secretary determines that a State with respect to which an application is approved pursuant to paragraph
(3)has failed to comply with the requirements of this subsection (including the requirement that all Federal funds attributable to the increase to the Federal medical assistance percentage of the State under paragraph
(1)be spent in accordance with paragraph (4)) for any quarter during the period of fiscal years described in paragraph (1), the Secretary may reduce the number of percentage points by which the Federal medical assistance percentage for the State and quarter would otherwise be increased under paragraph
(1)for such quarter. The Secretary shall impose reductions under this paragraph based on the degree to which a State has failed to comply with the requirements of this subsection. Not later than 2028 and annually until 2037, the Secretary, in conjunction with the Secretary of Labor, shall evaluate the implementation and outcomes of this subsection on the availability of staff to cover shifts in all long-term care settings serving, worker credentials and skills, and worker compensation through a contract with an external evaluator who has experience with evaluation related to people with disabilities and older individuals. In this subsection: The term direct care professional has the meaning given such term in section 3 of the Long-Term Care Workforce Support Act. The term home and community-based services means any of the following: Home health care services authorized under paragraph
(7)of subsection (a). Personal care services authorized under paragraph
(24)of such subsection. PACE services authorized under paragraph
(26)of such subsection. Home and community-based services authorized under subsections (b), (c), (i), (j), and
(k)of section 1915, such services authorized under a waiver under section 1115, and such services through coverage authorized under section 1937. Case management services authorized under subsection (a)(19) of this section and section 1915(g). Rehabilitative services, including those related to behavioral health, described in subsection (a)(13) of this section. Such other services specified by the Secretary. .
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Sec. 101
Additional support for Medicaid long-term care services provided by direct care professionals
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