[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6296 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 6296
To provide for an emergency increase in Federal funding to State
Medicaid programs for expenditures on home and community-based
services.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
November 8, 2023
Mrs. Dingell introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To provide for an emergency increase in Federal funding to State
Medicaid programs for expenditures on home and community-based
services.
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 Relief Act of 2023''.
SEC. 2. ADDITIONAL SUPPORT FOR MEDICAID HOME AND COMMUNITY-BASED
SERVICES.
(a) Increased FMAP.--
(1) In general.--Notwithstanding section 1905(b) of the
Social Security Act (42 U.S.C. 1396d(b)), in the case of an
HCBS program State, the Federal medical assistance percentage
determined for the State under section 1905(b) of such Act and,
if applicable, increased under subsection (y), (z), or (aa) of
section 1905 of such Act (42 U.S.C. 1396d), or section 1915(k)
of such Act (42 U.S.C. 1396n(k)), shall be increased by 10
percentage points with respect to expenditures of the State
under the State Medicaid program for home and community-based
services that are provided during fiscal years 2024 and 2025.
In no case may the application of the previous sentence result
in the Federal medical assistance percentage determined for a
State being more than 95 percent.
(2) Definitions.--In this section:
(A) HCBS program state.--The term ``HCBS program
State'' means a State that meets the condition
described in subsection (b) by submitting an
application described in such subsection, which is
approved by the Secretary pursuant to subsection (c).
(B) Home and community-based services.--The term
``home and community-based services'' means home health
care services authorized under paragraph (7) of section
1905(a) of the Social Security Act (42 U.S.C.
1396d(a)), behavioral health services authorized under
paragraph (13) of such section, personal care services
authorized under paragraph (24) of such section, PACE
services authorized under paragraph (26) of such
section, services authorized under subsections (b),
(c), (i), (j), and (k) of section 1915 of such Act (42
U.S.C. 1396n), such services authorized under a waiver
under section 1115 of such Act (42 U.S.C. 1315), and
such other services specified by the Secretary.
(b) Condition.--The condition described in this subsection, with
respect to a State, is that the State submits an application to the
Secretary, at such time and in such manner as specified by the
Secretary, that includes, in addition to such other information as the
Secretary shall require--
(1) a description of which activities described in
subsection (d) that a State plans to implement and a
description of how it plans to implement such activities;
(2) assurances that all Federal funds attributable to the
increase under subsection (a) will be--
(A) expended by the State in accordance with this
section not later than September 30, 2027; and
(B) used--
(i) to implement the activities described
in subsection (d);
(ii) 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 of the enactment of this section; and
(iii) to increase reimbursement rates for
home and community-based services to a level
that will support recruitment and retention of
a sufficient workforce to provide home and
community-based services to eligible
individuals; and
(3) assurances that the State will conduct adequate
oversight and ensure the validity of such data as may be
required by the Secretary.
(c) Approval of Application.--Not later than 90 days after the date
of submission of an application of a State under subsection (b), 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.
(d) Activities To Improve the Delivery of HCBS.--
(1) In general.--A State shall work with community
partners, such as Area Agencies on Aging, Centers for
Independent Living, non-profit home and community-based
services providers, and other entities providing home and
community-based services, to implement the purposes described
in paragraph (2).
(2) Focused areas of hcbs improvement.--The purposes
described in this paragraph, with respect to a State, are the
following:
(A) To increase rates for home health agencies and
agencies that employ direct support professionals
(including independent providers in a self-directed or
consumer-directed model) to provide home and community-
based services under the State Medicaid program,
provided that any agency or individual that receives
payment under such an increased rate increases the
compensation it pays its home health workers or direct
support professionals.
(B) To provide paid sick leave, paid family leave,
and paid medical leave for home health workers and
direct support professionals.
(C) To provide hazard pay, overtime pay, and shift
differential pay for home health workers and direct
support professionals.
(D) To improve stability of home health worker and
direct support professional jobs, including consistent
hours, scheduling, pay, and benefit eligibility.
(E) To provide home and community-based services to
eligible individuals who are on waiting lists for
programs approved under section 1115 or 1915 of the
Social Security Act (42 U.S.C. 1315, 1396n).
(F) To purchase emergency supplies and equipment,
which may include items not typically covered under the
Medicaid program, such as personal protective
equipment, necessary to enhance access to services and
to protect the health and well-being of home health
workers and direct support professionals.
(G) To pay for the travel of home health workers
and direct support professionals to conduct home and
community-based services.
(H) To recruit new home health workers and direct
support professionals.
(I) To support family care providers of eligible
individuals with needed supplies, equipment, and
services, which may include items such as family
caregiver pay and respite services.
(J) To pay for training for home health workers and
direct support professionals.
(K) To pay for assistive technologies, staffing,
training to facilitate an eligible individual's
communication, and other costs incurred in order to
facilitate community integration and ensure an
individual's person-centered service plan continues to
be fully implemented.
(L) 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 eligible individuals, their
families, and the general community served by agencies
described in subparagraph (A).
(M) To protect the health and safety of home health
workers and direct support professionals during public
health emergencies and natural disasters.
(N) To pay for interpreters to assist in providing
home and community-based services to eligible
individuals and to inform the general public about
communicable diseases and other public health threats.
(O) To allow day services providers to provide home
and community-based services.
(P) To pay for other expenses deemed appropriate by
the Secretary to enhance, expand, or strengthen Home
and Community-Based Services, including retainer
payments, and expenses which meet the criteria of the
home and community-based settings rule published on
January 16, 2014.
(Q) To assist eligible individuals who had to
relocate to a nursing facility or institutional setting
from their homes in--
(i) moving back to their homes (including
by paying for moving costs, first month's rent,
and other one-time expenses and start-up
costs);
(ii) resuming home and community-based
services;
(iii) receiving mental health services and
necessary rehabilitative service to regain
skills lost while relocated; and
(iv) while funds attributable to the
increased FMAP under this section remain
available, continuing home and community-based
services for eligible individuals who were
served from a waiting list for such services
during the emergency period described in
section 1135(g)(1)(B) of the Social Security
Act (42 U.S.C. 1320b-5(g)(1)(B)).
(e) Reporting Requirements.--
(1) State reporting requirements.--Not later than December
31, 2027, any State with respect to which an application is
approved by the Secretary pursuant to subsection (c) shall
submit a report to the Secretary that contains the following
information:
(A) Activities and programs that were funded using
Federal funds attributable to such increase.
(B) The number of eligible individuals who were
served by such activities and programs.
(C) The number of eligible individuals who were
able to resume home and community-based services as a
result of such activities and programs.
(2) HHS evaluation.--
(A) In general.--The Secretary shall evaluate the
implementation and outcomes of this section in the
aggregate using an external evaluator with experience
evaluating home and community-based services,
disability programs, and older adult programs.
(B) Evaluation criteria.--For purposes of
subparagraph (A), the external evaluator shall--
(i) document and evaluate changes in
access, availability, and quality of home and
community-based services in each HCBS program
State;
(ii) document and evaluate aggregate
changes in access, availability, and quality of
home and community-based services across all
such States; and
(iii) evaluate the implementation and
outcomes of this section based on--
(I) the impact of this section on
increasing funding for home and
community-based services;
(II) the impact of this section on
achieving targeted access,
availability, and quality of home and
community-based services; and
(III) promising practices
identified by activities conducted
pursuant to subsection (d) 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 conducted under this paragraph to--
(I) all State Medicaid directors;
and
(II) the Committee on 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 with respect to which an
application is approved by the Secretary pursuant to
subsection (c) shall ensure adequate oversight of the
expenditure of Federal funds pursuant to such increase
in accordance with the Medicaid regulations, including
sections 1115 and 1915 waiver regulations and special
terms and conditions for any relevant waiver or grant
program.
(3) Non-application of the paperwork reduction act.--
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.
(f) Additional Definitions.--In this section:
(1) Eligible individual.--The term ``eligible individual''
means an individual who is eligible for or enrolled for medical
assistance under a State Medicaid program.
(2) Medicaid program.--The term ``Medicaid program'' means,
with respect to a State, the State program under title XIX of
the Social Security Act (42 U.S.C. 1396 et seq.) (including any
waiver or demonstration under such title or under section 1115
of such Act (42 U.S.C. 1315) relating to such title).
(3) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(4) State.--The term ``State'' has the meaning given such
term for purposes of title XIX of the Social Security Act (42
U.S.C. 1396 et seq.).
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