[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3277 Introduced in Senate (IS)]
<DOC>
116th CONGRESS
2d Session
S. 3277
To amend title XIX of the Social Security Act to strengthen the
infrastructure of, access to, and reporting of Medicaid home and
community-based services, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 12, 2020
Mr. Casey introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to strengthen the
infrastructure of, access to, and reporting of Medicaid home and
community-based services, and for other purposes.
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 ``HCBS Infrastructure Improvement
Act''.
SEC. 2. FINDINGS AND PURPOSE.
(a) Findings.--Congress finds the following:
(1) States are prioritizing funding of their Medicaid
programs for long-term services and supports (referred to in
this section as ``LTSS'') to offer a wider range of options for
home and community-based services (referred to in this section
as ``HCBS''), but gaps in HCBS remain.
(2) In fiscal year 2016, States were spending only 57
percent of their total LTSS budgets on HCBS, well short of the
national goal of 69 percent set by the Centers for Medicare &
Medicaid Services.
(3) In 2017, more than 700,000 people with disabilities,
older adults, and children were on waiting lists to receive
HCBS through existing Medicaid waver programs.
(4) According to projections by the Bureau of the Census,
the number of adults over age 65 will reach 84,000,000 by mid-
century, and the population of people 85 and older will be
nearly 15 million by 2040.
(5) Absent strategic planning and investment, States will
experience greater difficulties as the needs of older adults
increase demands on State home and community-based services
HCBS capacity.
(6) A one-time, targeted investment to strengthen State
capacity to build out Medicaid infrastructure that supports
multiple HCBS programs and connects to other Federal and State
programs, including Medicare and the Older Americans Act, will
improve the quality of health and daily living for the millions
of older adults, people with disabilities and their families.
(7) Home and community-based services HCBS play an outsized
role in addressing the social determinants of health among
older adults and people with disabilities, who require
accessible housing and accessible transportation and access to
reliable personal care to avert costly medical crises.
(b) Purpose.--The purpose of this Act is to establish to a one-time
infrastructure improvement initiative for States to strengthen their
HCBS capacity in selected target areas, including housing and
transportation, workforce, and employment supports, in order to improve
the cost-effectiveness of long-term service and support (LTSS) Medicaid
programs and coordination with other programs that provide supportive
services to older adults and people with disabilities.
SEC. 3. MEDICAID HOME AND COMMUNITY-BASED SERVICES INFRASTRUCTURE
IMPROVEMENT.
Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is
amended by adding at the end the following:
``SEC. 1947. HOME AND COMMUNITY-BASED SERVICES INFRASTRUCTURE
IMPROVEMENT.
``(a) Definitions.--In this section:
``(1) Direct support professional.--The term `direct
support professional' means a person who, in exchange for
compensation, provides services to a person with a disability
(as defined in section 3 of the Americans With Disabilities Act
of 1990) that promote such person's independence, including--
``(A) services that enhance independence and
community inclusion for such person, including
traveling with such person, attending and assisting
such persons while visiting friends and family,
shopping, or socializing;
``(B) services such as coaching and supporting such
person in communicating needs, achieving self-
expression, pursuing personal goals, living
independently, and participating actively in employment
or voluntary roles in the community;
``(C) services such as providing assistance with
activities of daily living (such as feeding, bathing,
toileting, and ambulation) and with tasks such as meal
preparation, shopping, light housekeeping, and laundry;
or
``(D) services that support such person at home,
work, school, church, or other community settings.
``(2) Eligible hcbs expenditures.--The term `eligible HCBS
expenditures' means expenditures by an HCBS infrastructure
State on medical assistance for home and community-based
services that are provided under the State plan or waiver
during the State's HCBS infrastructure period and which aim to
collaborate with other programs offering support for home and
community-based services.
``(3) First mile/last mile transportation.--The term `first
mile/last mile transportation' means the transportation
necessary to--
``(A) transport a person to a fixed route transit
system that the person could not otherwise conveniently
access by walking, wheelchair, walker, or other self-
propelled mobility method; and
``(B) transport a person from a fixed route transit
system to the person's final destination when the final
destination is not within a distance that the person
could conveniently access by walking, wheelchair,
walker, or other self-propelled mobility method.
``(4) HCBS infrastructure period.--The term `HCBS
infrastructure period' means, with respect to an HCBS
infrastructure State, the 7-fiscal year period that begins with
the first fiscal year that begins after the date on which the
State is granted approval by the Secretary under subsection (c)
to conduct an HCBS infrastructure program.
``(5) HCBS infrastructure program.--The term `HCBS
infrastructure program' means a demonstration program conducted
under this section.
``(6) HCBS infrastructure state.--The term `HCBS
infrastructure State' means a State that has been granted
approval by the Secretary under subsection (c) to conduct an
HCBS infrastructure program.
``(7) Home and community-based services.--The term `home
and community-based services' means long-term, person-centered
services and supports that are not provided in an institutional
setting, including--
``(A) a home and community-based service provided
under subsection (c), (d), or (i) of section 1915 or
under a waiver under section 1115;
``(B) home and community-based long-term services
and supports (provided in accordance with the
requirements for home and community-based settings
under sections 441.530 and 441.710 of title 42, Code of
Federal Regulations), including--
``(i) services described in paragraphs (7),
(8), (13), (19), and (24) of section 1905(a);
``(ii) home and community-based services
described in subsection (c)(4)(B) of section
1915;
``(iii) self-directed home and community-
based services described in subsection (i) of
section 1915;
``(iv) self-directed personal assistance
services (as defined in subsection (j)(4)(A) of
section 1915); and
``(v) home and community-based attendant
services and supports described in subsection
(k) of section 1915;
``(C) a home health care service; and
``(D) a personal care service.
``(8) Long-term services and supports.--The term `long-term
services and supports' has the meaning given that term in
section 438.2 of title 42, Code of Federal Regulations (as of
the date of enactment of this section).
``(9) Shared living.--The term `shared living' means a
living arrangement involving--
``(A) not more than 2 people with disabilities or
an older adult with a disability, except if 1 or more
of the people are related to each other (by blood or a
close association that is equivalent to a family
relationship);
``(B) a person who--
``(i) provides long-term services and
supports in exchange for compensation;
``(ii) lives together in a private home
with the recipient of such services; and
``(iii) receives a stipend or room and
board as the primary form of payment for
providing such services;
``(C) a person receiving funding through a State
Medicaid program under this title or another publically
funded program; and
``(D) the person receiving such services having the
final decision regarding who is the provider of such
services living with the person, through a consumer-
driven matching process that includes relationship
building, person-centered planning as defined by the
Administrator of the Centers for Medicare & Medicaid
Services, and an assessment of individual
compatibility.
``(10) State.--The term `State' means each of the 50
States, the District of Columbia, the Commonwealth of Puerto
Rico, the United States Virgin Islands, Guam, American Samoa,
and the Northern Mariana Islands.
``(11) Universal mobility service.--The term `universal
mobility service' means a single platform through which people
with disabilities or older adults are able to--
``(A) access a variety of public and private demand
responsive and fixed-route transportation services
which have the necessary vehicles and facilities to
meet the needs of all users, regardless of income,
geographic location, disability, or age;
``(B) and identify their travel options and compare
the cost and length of trips using each such option;
and
``(C) schedule a ride, monitor progress, and pay
for the trip, regardless of the number of transfers and
independent providers used.
``(b) Planning Grants.--
``(1) In general.--Not later than January 1 of each of
calendar years 2021 through 2024, from the amount appropriated
under paragraph (5), the Secretary shall, subject to paragraph
(2), award planning grants to any State that applies for such a
grant for the purpose of developing proposals for an HCBS
infrastructure program.
``(2) Selection, duration, and number of states.--
``(A) Selection criteria.--In awarding grants for a
year under this subsection the Secretary shall--
``(i) consider the technical merits the
proposed HCBS infrastructure program of each
State that is applying for a grant in such
year; and
``(ii) select a group of States that is
diverse in terms of--
``(I) the geographic areas the
group represents;
``(II) the population sizes of the
States comprising the group; and
``(III) the subparagraphs of
subsection (e)(2) in which each such
State is described (based on data from
the 2 most recent years for which data
is available).
``(B) Duration.--Grants awarded under this
subsection shall be available to States for a period of
1 year.
``(C) Number of states.--The Secretary shall not
award planning grants under this subsection to more
than 17 States in any year, and no State may receive
more than 1 grant under this subsection.
``(3) Use of funds.--A State awarded a planning grant under
this subsection shall--
``(A) establish a Development and Implementation
Council that meets the requirements described in
paragraph (4) to provide input into the development of
the proposal and, if the State receives approval to
conduct a demonstration program under this section, to
monitor the ongoing implementation of the program;
``(B) with guidance from the Centers for Medicare &
Medicaid Services, identify populations in the State
for which the per capita annual expenditures under the
State plan or waiver of such plan on home and
community-based services is less than the national
average for that population;
``(C) establish a set of standards and procedures
to ensure the State makes measurable progress in
expanding the availability of self-direction to people
served by home and community-based service providers;
``(D) develop a plan to increase home and
community-based services, increase the availability of
providers of such service throughout the State, and
address at least 3 of the HCBS infrastructure priority
areas described in subsection (c)(3);
``(E) solicit public comment to help determine what
the priorities of the proposed demonstration program
should be; and
``(F) execute memoranda of understanding between
any State agencies that will be responsible for
activities under the proposed demonstration program
under which each such agency agrees to conduct the
activities for which it will be responsible and to
cooperate with other agencies as necessary.
``(4) Development and implementation council
requirements.--The requirements described in this paragraph
with respect to a Development and Implementation Council
established by a State (referred to in this section as a
`Council') are the following:
``(A) The members of the Council (the majority of
whom shall be people with disabilities or older adults
who need home and community-based services) shall
consist of--
``(i) people with disabilities or older
adults who receive home and community-based
services;
``(ii) people with disabilities, including
older adults with disabilities, who meet
criteria for home and community-based services
but are not receiving such services;
``(iii) family caregivers;
``(iv) direct support professionals;
``(v) providers of home and community-based
services;
``(vi) one representative each from--
``(I) an organization that
represents people with disabilities;
``(II) an organization that
represents older adults; and
``(III) an organization that
represents direct support
professionals; and
``(vii) representatives from State agencies
that provide aging, disability, transportation,
housing, employment, vocational rehabilitation,
mental health, and substance use services and
representatives, as appropriate, from programs
providing transportation supports, housing
supports, home and community-based services
workforce development, family caregiver
supports, and education and vocational
rehabilitation services.
``(B) The Council is coordinated by the Governor,
and any proposal of the Council shall be submitted to,
and reviewed by, by the Governor before it is submitted
to the Secretary.
``(C) The Council shall conduct a public comment
process to collect information to inform the priorities
and activities identified in the grant application.
``(5) Funding.--
``(A) In general.--Out of any funds in the Treasury
not otherwise appropriated, there is appropriated to
the Secretary for each of fiscal years 2021 through
2024 $100,000,000 for purposes of awarding grants under
this subsection.
``(B) Availability.--Funds appropriated under
subparagraph (A) shall remain available until expended.
``(C) Technical assistance.--
``(i) In general.--For each of fiscal years
2021 through 2024, out of the funds
appropriated for such year under subparagraph
(A), $3,000,000 shall be reserved for the
purpose of providing technical assistance
(through the Administrator of the Centers for
Medicare & Medicaid Services) to States in
meeting the requirements of paragraph (2).
``(ii) Coordination with relevant
agencies.--In providing technical assistance to
States in developing plans to improve HCBS
infrastructure priority areas described in
subsection (c)(3), the Administrator of the
Centers for Medicare & Medicaid Services shall
consult with other agencies with relevant
expertise in such areas, such as the Department
of Transportation, the Department of Housing
and Urban Development, and the Interagency
Transportation Coordinating Council on Access
and Mobility established under Executive Order
No. 13330.
``(c) HCBS Infrastructure Implementation Grants.--
``(1) Approval of states.--Not later than 1 year after
awarding a planning grant to a State under subsection (b), the
Secretary shall, subject to paragraph (4), award to the State
an HCBS infrastructure implementation grant under this section
if the application--
``(A) is developed through such planning grant; and
``(B) meets the requirements of paragraph (2).
``(2) Grant requirements.--The requirements of this
paragraph with respect to a State implementation grant are the
following:
``(A) Application.--The State submits an
application, using the most recent data available at
the time the State was awarded a planning grant under
subsection (b), to conduct an HCBS infrastructure
implementation grant to the Secretary that includes, in
addition to such other information as the Secretary may
require--
``(i) targets for spending under the State
plan or waiver for home and community-based
services under the State plan or waiver as a
percentage of all spending under the plan or
waiver on long-term services and supports, and
yearly milestones for such targets that--
``(I) provide States with the
flexibility to focus on providing home
and community-based services to certain
populations; and
``(II) require the State--
``(aa) to achieve spending
targets for those populations;
``(bb) to identify
populations in the State for
which the per capita annual
expenditures under the State
plan or waiver on home and
community-based services is
less than the national average
for that population; and
``(cc) to increase the
level of expenditures on home
and community-based services
for each population described
in clause (v)(II) to a target
level proposed by the State;
``(ii) a description of how the State
will--
``(I) expand medical assistance for
home and community-based services under
the plan or waiver during the HCBS
infrastructure period;
``(II) achieve the spending targets
and milestones described in clause (i);
and
``(III) initiate or expand self-
directed services, with measurable
targets and milestones;
``(iii) if the State limits the provision
of home and community-based services to people
under the plan or waiver or imposes any
numerical limitation, waiting list, or similar
limitation on the eligibility of people for
such services, a detailed plan for how the
State will reduce such limitations;
``(iv) a detailed plan with measurable
objectives and annual milestones for at least 3
of the HCBS infrastructure priority areas
described in paragraph (3); and
``(v) data on the extent to which the State
has already balanced the long-term services and
supports system of the State, including--
``(I) the percentage of total
annual expenditures under the State
plan or waiver for long-term services
and supports expenditures that are for
home and community-based services; and
``(II) the percentage of total
annual expenditures under the State
plan or waiver for long-term services
and supports expenditures that are for
home and community-based services by
population group, including--
``(aa) people with
intellectual and developmental
disabilities;
``(bb) people aged 65 and
older;
``(cc) people with physical
disabilities; and
``(dd) people with mental
health and substance use
disorders.
``(B) Maintenance of eligibility requirements.--
During the HCBS infrastructure period, the State does
not apply eligibility standards, methodologies, or
procedures for determining eligibility for medical
assistance for home and community-based services under
the plan or waiver that are more restrictive than the
eligibility standards, methodologies, or procedures in
effect for such purposes on December 31, 2019.
``(C) Implementation and compliance with hcbs
settings rule.--The State has a final approved plan
to--
``(i) fully comply with the Home and
Community-Based Services Final Rule published
by the Centers for Medicare & Medicaid Services
on January 16, 2014 (79 Fed. Reg. 2947)
(referred to in this section as the `HCBS
Settings Rule'); and
``(ii) construct the activities of the
grant such that the results will be to
stabilize and expand the service delivery
network available in the State to provide
services and supports under the State plan or
waiver of such plan in a manner that complies
with the HCBS Settings Rule.
``(D) Use of additional funds.--The State uses any
additional Federal funds paid to the State as a result
of this section only for purposes of increasing the
availability and improving the quality of home and
community-based services in the State.
``(E) Data collection.--The State collects
standardized data as determined by the Secretary,
including--
``(i) services data on a per-capita or
family caregiver basis and, to the extent
possible, in accordance with the Transformed
Medicaid Statistical Information System (T-
MSIS) (or a successor system);
``(ii) quality data on a selected set of
core home and community-based services measures
determined by the Secretary, including--
``(I) measures of beneficiary and
family caregiver experience;
``(II) measures for the achievement
of desired outcomes appropriate to a
specific beneficiary or family
caregiver, including--
``(aa) community inclusion;
``(bb) choice and personal
control, including through
self-directed services; and
``(cc) person-centered
planning; and
``(III) measures for the
achievement of home and community-based
services infrastructure improvements,
including--
``(aa) competitive,
integrated employment for
people with disabilities and
older adults;
``(bb) direct support
professional workforce
improvements, including
increased wages;
``(cc) caregiver supports;
``(dd) accessible housing
and accessible transportation
improvements; and
``(ee) non-disability-
specific settings;
``(iii) services data from providers of
home and community-based services on a per-
beneficiary or family caregiver basis and in
accordance with such standardized coding
procedures as the State shall establish in
consultation with the Secretary;
``(iv) quality data on a selected set of
core quality measures agreed upon by the
Secretary and the State that are--
``(I) linked to population-specific
outcomes measures; and
``(II) available to the public,
including consumers and providers of
home and community-based services; and
``(v) outcomes measures data on a selected
set of core population-specific outcomes
measures agreed upon by the Secretary and the
State that are accessible to providers and
include--
``(I) measures of beneficiary and
family caregiver experience with
providers; and
``(II) measures for achieving
desired outcomes appropriate to a
specific beneficiary or family
caregiver, including--
``(aa) competitive
integrated employment (as
defined in section 3(11) of the
Workforce Innovation and
Opportunity Act);
``(bb) participation in
community life;
``(cc) health stability;
``(dd) prevention of loss
in function; and
``(ee) improved family
caregiver health and wellness.
``(3) HCBS infrastructure priority areas.--The HCBS
infrastructure priority areas described in this paragraph are
the following:
``(A) Workforce and unpaid caregiver supports.--The
State develops and implements, in consultation with
representatives of people with disabilities,
representatives of older adults, and representatives of
direct support workers--
``(i) infrastructure to enhance supply and
retention of the direct support workforce,
including through--
``(I) enhancement of payment rates,
contingent on wage increases for direct
support professionals; and
``(II) training and career
advancement programs for direct support
professionals, including programs that
facilitate the participation of direct
support professionals in organizations
that foster their professional
development and stakeholder engagement;
``(ii) infrastructure to support self-
direction, including--
``(I) matching service registries;
and
``(II) training for consumers who
want to self-direct; and
``(iii) supports for family caregivers,
including--
``(I) use of family caregiver
assessments;
``(II) service offerings that
support caregivers and may delay or
ameliorate the need for more
comprehensive non-institutional long-
term services and supports; and
``(III) implementation of evidence-
based caregiver supportive services,
increased access to and improvements in
respite care, and financial assistance
to help with out-of-pocket costs
incurred by family caregivers.
``(B) Employment supports.--The State develops and
implements statewide infrastructure, subject to the
merit-based personnel standards and conflict of
interest safeguards established and maintained by the
State pursuant to section 1902(a)(4), to support
opportunities for competitive integrated employment (as
defined in section 3(11) of the Workforce Innovation
and Opportunity Act) for people with disabilities and
older adults, which may include--
``(i) service delivery modifications and
expansion; and
``(ii) establishing and expanding linkages
with other programs that support workers with
disabilities, such as--
``(I) vocational rehabilitation;
``(II) one-stop centers described
in section 121 of the Workforce
Innovation and Opportunity Act; and
``(III) State departments of
education.
``(C) Housing supports.--The State develops and
implements infrastructure to increase the availability
of affordable, accessible housing in non-disability-
specific settings for people with disabilities and
older adults receiving home and community-based
services, which may include--
``(i) assessing the supply and availability
of such housing in communities across the
State;
``(ii) creating or scaling incentives for
State and local housing partners and developers
to create more accessible housing;
``(iii) developing and implementing
strategies to target people with the most
significant developmental and other
disabilities, including people with challenging
behavior, complex medical needs, people
requiring round-the-clock, one-on-one support
from a direct support professional, and people
with very high-service needs, for housing in
non-disability-specific settings;
``(iv) scaling shared living within the
State;
``(v) home modifications and repairs that
make it possible for a person to remain in the
person's home or building modifications that
make it possible for a person with a disability
or an older adult to reside in a house or
apartment; and
``(vi) developing administrative
infrastructure to match people with housing and
provide meaningful choices among non-
disability-specific settings via the person-
centered planning process.
``(D) Transportation supports.--
``(i) In general.--The State develops and
implements strategies to improve access for all
people with disabilities and older adults
(including people who are blind or visually
impaired, deaf or hard of hearing, have other
physical disabilities, use a wheelchair or
other mobility device, use a guide animal, or
have an intellectual disability) to accessible
transportation options, including first mile/
last mile transportation, with the goal of
improved community integration, in accordance
with the HCBS Setting Rule, which may include--
``(I) the provision of universal
mobility services (as defined in
subsection (a)(11));
``(II) partnering with existing
non-emergency medical transportation
brokers and their networks;
``(III) partnering with demand-
responsive providers, non-disability-
specific non-profit providers, and
other transportation providers;
``(IV) the targeted development of
a community integration transportation
system that leverages traditional and
innovative transportation networks
(such as on-demand application-based
transportation); and
``(V) expanding the non-emergency
medical transportation services offered
under the State plan to include
transportation to--
``(aa) employment training
and jobs;
``(bb) community-based
supportive services such as
congregate meals or independent
living centers; and
``(cc) pharmacies, grocery
stores, and other retail
establishments to assist older
adults and people with
disabilities to remain in their
homes and participate fully in
their communities.
``(ii) Training requirement.--Any strategy
to improve access to transportation under this
subparagraph shall include the implementation
of a State requirement that providers of
transportation receive training on how to
support people with disabilities and older
adults.
``(iii) Exclusion.--To the extent that any
expansion, development, or financing of
paratransit is required under the Americans
with Disabilities Act for fixed route service,
such expansion, development, or financing shall
not be considered to be a strategy to improve
access to transportation for purposes of this
subparagraph.
``(iv) Consideration of national aging and
disability transportation center proposals.--A
proposal for improvements described in this
subparagraph shall consider and discuss the
work of the National Aging and Disability
Transportation Center, the `Transactional Data
Specification for Demand Responsive
Transportation' published by the Transportation
Research Board, and best practices for the
delivery of Medicaid non-emergency medical
transportation services.
``(E) `No wrong door single' entry point system.--
The State develops and implements a statewide system
(which may include preadmission screening by nurses,
peer assessors, and other necessary providers to ensure
that the appropriate assessments with respect to any
person with a disability or older adult are done as
soon as required), subject to the merit-based personnel
standards and conflict of interest safeguards
established and maintained by the State pursuant to
section 1902(a)(4), to enable people enrolled in the
State plan or waiver to access, on a timely basis, all
long-term services and supports through an agency,
organization, coordinated network, or portal, in
accordance with such standards as the State shall
establish and that shall provide information
regarding--
``(i) the availability of such services;
``(ii) how to apply for such services;
``(iii) disability benefits counseling;
``(iv) referral services for services and
supports otherwise available in the community;
and
``(v) determinations of financial and
functional eligibility for such services and
supports, or assistance with assessment
processes for financial and functional
eligibility.
``(4) Number of states.--The Secretary shall not grant
approval to more than 17 States to conduct an HCBS
infrastructure demonstration program under this section in any
year.
``(d) Evaluation, Oversight, and Quality.--
``(1) Surveys and report on direct support professional
compensation.--
``(A) In general.--Each HCBS infrastructure State
shall, for each fiscal year of the State's HCBS
infrastructure period, conduct surveys of providers
that received increased rates under the HCBS
infrastructure program conducted by the State on the
compensation paid by such providers to direct support
professionals.
``(B) Report.--Not later than 2 years after the
date that an HCBS infrastructure State begins to
conduct an HCBS infrastructure program, the State
submits a report to the Administrator of the Centers
for Medicare & Medicaid Services on the impact of the
rate increases on the compensation, benefits, and
training received by direct support professionals.
``(2) Evaluation.--
``(A) In general.--The Secretary shall evaluate the
implementation and outcomes of the HCBS infrastructure
programs conducted by the States in the aggregate using
an external evaluator with experience evaluating home
and community-based services, disability programs, and
older adult programs using the criteria described in
each HCBS infrastructure State's application and
evaluating any change in HCBS service availability and
quality for each HCBS infrastructure State.
``(B) Evaluation criteria.--The external evaluator
shall document and evaluate changes in access,
availability, and quality of HCBS services in each of
the priority areas described in subsection (c)(3)
chosen by each HCBS infrastructure State. The external
evaluator shall also evaluate the aggregate change
changes in access, availability, and quality of HCBS
services in each of the priorities areas described in
subsection (c)(3) across the HCBS infrastructure
States. The external evaluator shall also evaluate the
HCBS infrastructure programs based on (i) the impact of
the programs on increasing funding for home and
community-based services, (ii) the impact of the
programs on achieving targeted access, availability,
and quality of home and community-based services, and
(iii) promising practices identified by the programs
that increase access to, availability of, and quality
of home and community based services.
``(C) Dissemination of evaluation findings.--The
Secretary shall--
``(i) disseminate the findings from the
evaluations of HCBS infrastructure programs
conducted under this paragraph to--
``(I) all State Medicaid directors;
and
``(II) the Committees on Ways and
Means and Energy and Commerce of the
House of Representatives, the Committee
on Finance of the Senate, and the
Special Committee on Aging of the
Senate; and
``(ii) make all evaluation findings
publicly available in an accessible electronic
format and any other accessible format
determined appropriate by the Secretary.
``(D) Oversight.--Each State awarded a grant under
subsection (c) shall ensure adequate oversight of the
expenditure of HCBS infrastructure program grant funds
in accordance with the Medicaid regulations, including
waiver 1115 and 1915 waiver regulations.
``(e) Financing Incentives.--
``(1) In general.--Notwithstanding section 1905(b), with
respect to each fiscal year in an HCBS infrastructure State's
HCBS infrastructure period, if such State meets the conditions
described in subsection (c)(2) for the year, the Federal
medical assistance percentage that would otherwise apply with
respect to eligible HCBS expenditures made by the State during
the year shall be increased (but in no case to exceed 100
percent) by the applicable percentage points increase
determined for the State and year under paragraph (2) (and as
increased, if applicable, under paragraph (3)).
``(2) Applicable percentage points increase.--The
applicable percentage points increase for an HCBS
infrastructure State and year is--
``(A) in the case of a State in which, for the 2
years preceding the year involved, less than 35 percent
of the total expenditures for long-term services and
supports were for home and community-based services, 5
percentage points;
``(B) in the case of a State in which, for the 2
years preceding the year involved, between 35 percent
and 50 percent of the total expenditures for long-term
services and supports were for home and community-based
services, 2 percentage points;
``(C) in the case of a State in which, for the 2
years preceding the year involved, between 50 percent
and 65 percent of the total expenditures for long-term
services and supports were for home and community-based
services, 0.50 percentage points; and
``(D) in the case of a State in which, for the 2
years preceding the year involved, 65 percent or more
of the total expenditures for long-term services and
supports were for home and community-based services,
0.25 percentage points.
``(3) Additional increase to incentivize targeting
underserved populations.--Beginning with the first full fiscal
year for which the Transformed Medicaid Statistical Information
System (T-MSIS) is fully operational, the applicable percentage
points increase determined for an HCBS infrastructure State and
year under paragraph (2) shall be increased by an additional--
``(A) in the case of a State that is providing home
and community based services to 85 percent or more of
the people that make up the populations identified by
the State under subsection (b)(3)(B), 5 percentage
points;
``(B) in the case of a State that is providing home
and community based services to between 75 percent and
85 percent of the people that make up the populations
identified by the State under subsection (b)(3)(B), 2
percentage points;
``(C) in the case of a State that is providing home
and community based services to between 65 percent and
75 percent of the people that make up the populations
identified by the State under subsection (b)(3)(B), 0.5
percentage points; and
``(D) in the case of a State that is providing home
and community based services to less than 65 percent of
the people that make up the populations identified by
the State under subsection (b)(3)(B), 0.25 percentage
points.
``(4) Exemption from limits on payments to territories.--
The limitations on payment under subsections (f) and (g) of
section 1108 shall not apply to Federal payments under this
title that are based on the Federal medical assistance
percentage as increased under this subsection, and such
payments shall not be taken into account in applying such
subsections.''.
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