Federal

HCBS Access Act

Source: Congress.gov · 16,586 words in original text

What This Bill Does

This bill requires states to provide home and community-based services (services that help people with disabilities and older adults live in their own homes and communities instead of institutions) through Medicaid. The bill also provides grants to hire, train, and support direct care workers (people who help individuals with disabilities and older adults) and family caregivers who provide unpaid care. ##

Who It Affects

- People with disabilities and older adults who need long-term care services - States that run Medicaid programs - Direct care workers and supervisors who work in homes and communities - Family members who provide unpaid care to relatives - Community colleges and other training organizations - Healthcare providers and nursing facilities - Employers of direct care workers - Federal agencies including the Department of Health and Human Services ##

Key Provisions

- States must cover home and community-based services for people with disabilities and older adults who meet eligibility requirements, including services like personal care assistance, support for community activities, job training, and help with housing (Sec. 102) - The federal government will pay 100 percent of the costs for home and community-based services (instead of the usual split between federal and state funding) as long as states improve access to these services and address gaps in who can get them (Sec. 102) - States must submit an implementation plan to the federal government explaining how they will provide these services, including how they will hire and pay direct care workers fairly and ensure services reach people who currently have barriers to access (Sec. 104) - The federal government will establish a national training center to help create education programs for direct care workers and support family caregivers, and will award grants to states, nonprofits, and colleges to recruit, train, and keep direct care workers in their jobs (Sec. 302-303) - The federal government will develop quality measures (standards for what counts as good service) for home and community-based services that states must use to report on how well they are serving people (Sec. 107) ##

What Changes

If this bill becomes law, states will be required to cover home and community-based services for all eligible people with disabilities and older adults through regular Medicaid instead of needing special waivers (exceptions to normal Medicaid rules). The federal government will pay the full cost of these services. States will no longer be able to keep waiting lists of people who need services but cannot access them. States will need to hire and train many more direct care workers and will receive federal help and money to do this. Family caregivers will have access to support services like respite care (temporary help so the family member can take a break). Education and training programs for direct care workers will be created and expanded at community colleges and other institutions. Direct support professionals will be recognized as a distinct job category in the government's official occupational classification system. ##

Important Definitions

- **Home and community-based services** means services that help people with disabilities and older adults stay in their homes and communities, including personal care help, support for community activities, job training, help moving from institutions to community settings, and other services specified in the bill (Sec. 102) - **Direct care professional** means a person paid to provide services to someone with a disability or an older adult that help them stay independent, including help with daily activities, community involvement, job support, and health care coordination (Sec. 301) - **Direct support professional** means a person paid to provide services to someone with a disability, including help with independence and community inclusion, assistance with daily activities, and support in any community setting (Sec. 202) - **Functional impairment** means the inability of a person to perform without help either two or more daily activities (like bathing or dressing) or two or more instrumental activities (like shopping or managing money) or one of each (Sec. 102) - **Eligible individual** means a person with a functional impairment expected to last at least 90 days, or a person currently receiving these services under existing Medicaid rules, or someone under age 21 who meets the requirements (Sec. 102) - **Family caregiver** includes both paid and unpaid family members who provide care to older adults or people with disabilities (Sec. 301) - **Demographics** means information about a person's race, ethnicity, gender, sexual orientation, gender identity, location, income, language, type of service setting, and disability type (Sec. 2) ##

Effective Date

Most requirements take effect on the first day of the first calendar quarter that begins on or after five years after the bill is signed into law (roughly 2028), though states may choose to start earlier (Sec. 102). Some provisions like establishing the technical assistance center and awarding grants begin within 12 months of the bill becoming law (Sec. 303).

I 118TH CONGRESS 1ST SESSION H. R. 1493 To amend title XIX of the Social Security Act to require coverage of, and expand access to, home and community-based services under the Medicaid program; to award grants for the creation, recruitment, training and education, retention, and advancement of the direct care workforce and to award grants to support family caregivers; and for other purposes. IN THE HOUSE OF REPRESENTATIVES MARCH 9, 2023 Mrs. DINGELL (for herself and Mr. BOWMAN) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Over- sight and Accountability, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall with- in the jurisdiction of the committee concerned A BILL To amend title XIX of the Social Security Act to require coverage of, and expand access to, home and community- based services under the Medicaid program; to award grants for the creation, recruitment, training and edu- cation, retention, and advancement of the direct care workforce and to award grants to support family care- givers; and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 05:50 Mar 29, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1493.IH H1493 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 1493 IH SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 1 (a) SHORT TITLE.—This Act may be cited as the 2 ‘‘HCBS Access Act’’. 3 (b) TABLE OF CONTENTS.—The table of contents of 4 this Act is as follows: 5 Sec. 1. Short title; table of contents. Sec. 2. Definitions. TITLE I—REQUIRING AND EXPANDING ACCESS TO HCBS COVERAGE UNDER MEDICAID Sec. 101. Purpose. Sec. 102. Requiring coverage of home and community-based services under the Medicaid program. Sec. 103. Medicaid eligibility modifications. Sec. 104. Home and community-based services implementation plan grant pro- gram. Sec. 105. Quality of services. Sec. 106. Reports; technical assistance; other administrative requirements. Sec. 107. Quality measurement and improvement. Sec. 108. Making permanent the State option to extend protection under Med- icaid for recipients of home and community-based services against spousal impoverishment. Sec. 109. Permanent extension of Money Follows the Person Rebalancing dem- onstration. TITLE II—RECOGNIZING THE ROLE OF DIRECT SUPPORT PROFESSIONALS Sec. 201. Findings. Sec. 202. Definition of direct support professional. Sec. 203. Revision of Standard Occupational Classification System. TITLE III—SUPPORT FOR THE DIRECT CARE WORKFORCE Sec. 301. Definitions. Sec. 302. Authority to establish a technical assistance center for building the direct care workforce. Sec. 303. Authority to award grants. Sec. 304. Project plans. Sec. 305. Evaluations and reports; technical assistance. Sec. 306. Authorization of appropriations. TITLE IV—EVALUATION Sec. 401. Evaluation of impact on access to HCBS. SEC. 2. DEFINITIONS. 6 In this Act: 7 VerDate Sep 11 2014 05:50 Mar 29, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1493.IH H1493 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 1493 IH (1) DEMOGRAPHICS.—The term ‘‘demo- 1 graphics’’ means information relating to the races, 2 ethnicities, genders, sexual orientations, gender iden- 3 tities, geographic locations, incomes, primary lan- 4 guages, types of service setting, and disability types 5 represented within a particular group of individuals. 6 (2) PRIVATE DUTY NURSING.—The term ‘‘pri- 7 vate duty nursing’’ means nursing services that are 8 sufficient to meet the needs of an individual who re- 9 quires more individualized and continuous care than 10 is available from a visiting nurse or routinely pro- 11 vided by the nursing staff of a hospital or skilled 12 nursing facility, and includes services provided to an 13 individual in the individual’s own home by a reg- 14 istered nurse or licensed practical nurse under the 15 direction of a physician. 16 (3) SECRETARY.—Except as otherwise provided, 17 the term ‘‘Secretary’’ means the Secretary of Health 18 and Human Services. 19 TITLE I—REQUIRING AND EX- 20 PANDING ACCESS TO HCBS 21 COVERAGE UNDER MEDICAID 22 SEC. 101. PURPOSE. 23 It is the purpose of this title to require coverage of 24 home and community-based services (in this section re- 25 VerDate Sep 11 2014 05:50 Mar 29, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1493.IH H1493 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 1493 IH ferred to as ‘‘HCBS’’) under a State plan (or waiver of 1 such plan) under title XIX of the Social Security Act (42 2 U.S.C. 1396 et seq.) for the following reasons: 3 (1) To eliminate waiting lists for HCBS, which 4 delay access to necessary services and civil rights for 5 people with disabilities and older adults. 6 (2) To build on decades of progress in serving 7 people with disabilities and older adults via HCBS. 8 (3) To fulfill the purposes of the Medicaid pro- 9 gram to provide medical assistance for those whose 10 income and resources are insufficient to meet the 11 costs of necessary medical services, and to provide 12 rehabilitation, long-term services and supports, and 13 other services to help such families and individuals 14 attain or retain capability for independence or self- 15 care. 16 (4) To ensure that people with all kinds of dis- 17 abilities and with multiple disabilities, including in- 18 tellectual disability, cognitive disabilities, develop- 19 mental disabilities, behavioral health disabilities, 20 physical disabilities, and substance use disorders, 21 and older adults, receive the services they need to 22 live in their communities. 23 VerDate Sep 11 2014 05:50 Mar 29, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1493.IH H1493 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 1493 IH (5) To streamline access to HCBS by elimi- 1 nating the need for States to repeatedly apply for 2 waivers. 3 (6) To continue to increase the capacity of com- 4 munity services to ensure people with disabilities and 5 older adults have safe and meaningful options in the 6 community and are not at risk of unnecessary insti- 7 tutionalization. 8 (7) To act on the decades of research and prac- 9 tice that show everyone, including people with the 10 most severe disabilities, can live in the community 11 with the right services and supports. 12 (8) To support over 53,000,000 unpaid family 13 caregivers who are often providing complex services 14 and supports to older adults and people with disabil- 15 ities because of a lack of affordable services, work- 16 force shortages, and other inefficiencies. 17 (9) To improve direct care quality and address 18 the decades long workforce barriers, which have been 19 exacerbated by the COVID–19 pandemic, for nearly 20 2,600,000 direct care professionals providing sup- 21 port to people with disabilities and older adults in 22 their homes and communities. 23 (10) To eliminate the race, gender, sexual ori- 24 entation, and gender identity disparities that exist in 25 VerDate Sep 11 2014 05:50 Mar 29, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1493.IH H1493 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 1493 IH accessing information and HCBS and to prevent the 1 unnecessary impoverishment and institutionalization 2 of black and brown individuals with disabilities and 3 older adults. 4 SEC. 102. REQUIRING COVERAGE OF HOME AND COMMU- 5 NITY-BASED SERVICES UNDER THE MED- 6 ICAID PROGRAM. 7 (a) DEFINITION OF HOME AND COMMUNITY-BASED 8 SERVICES.— 9 (1) IN GENERAL.—Section 1905 of the Social 10 Security Act (42 U.S.C. 1396d) is amended by add- 11 ing at the end the following new subsection: 12 ‘‘(jj) HOME AND COMMUNITY-BASED SERVICES.— 13 ‘‘(1) IN GENERAL.—For purposes of this title, 14 the term ‘home and community-based services’ 15 means those services specified in paragraph (2) fur- 16 nished to an eligible individual (as defined in para- 17 graph (3)), based on an individualized assessment 18 (as described in paragraph (4)) of such individual, 19 in a setting that— 20 ‘‘(A) meets the qualities specified in para- 21 graph (1) of section 441.710(a) of title 42, 22 Code of Federal Regulations (or a successor 23 regulation); 24 VerDate Sep 11 2014 05:50 Mar 29, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1493.IH H1493 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 1493 IH ‘‘(B) is not described in paragraph (2) of 1 such section (or successor regulation); and 2 ‘‘(C) meets such other qualities as the Sec- 3 retary determines appropriate. 4 ‘‘(2) SERVICES SPECIFIED.— 5 ‘‘(A) IN GENERAL.—For purposes of para- 6 graph (1), the services specified in this para- 7 graph are services described in any of para- 8 graphs (7), (8), (13)(C), (19), (20), (24), and 9 (29) (as applied without regard to the reference 10 to ‘September 30, 2025’) of subsection (a) or in 11 any of subsections (c)(4)(B), (c)(5), (k)(1)(A), 12 (k)(1)(B), or (k)(1)(D) of section 1915, includ- 13 ing the following: 14 ‘‘(i) Supported employment and inte- 15 grated day services. 16 ‘‘(ii) Personal assistance, including 17 personal care attendants, direct support 18 professionals, home health aides, private 19 duty nursing, homemakers and chore as- 20 sistance, and companionship services. 21 ‘‘(iii) Services that enhance independ- 22 ence, inclusion, and full participation in 23 the broader community. 24 VerDate Sep 11 2014 05:50 Mar 29, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1493.IH H1493 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 1493 IH ‘‘(iv) Non-emergency, non-medical 1 transportation services to facilitate commu- 2 nity integration. 3 ‘‘(v) Respite services provided in the 4 individual’s home or broader community. 5 ‘‘(vi) Caregiver and family support 6 services. 7 ‘‘(vii) Case management, including in- 8 tensive case management, fiscal inter- 9 mediary, and support brokerage services. 10 ‘‘(viii) Services which support person- 11 centered planning and self-direction. 12 ‘‘(ix) Direct support services during 13 acute hospitalizations. 14 ‘‘(x) Necessary medical and nursing 15 services not otherwise covered which are 16 necessary in order for the individual to re- 17 main in their home and community, includ- 18 ing hospice services. 19 ‘‘(xi) Home and community-based in- 20 tensive behavioral health and crisis inter- 21 vention services. 22 ‘‘(xii) Peer support services. 23 ‘‘(xiii) Housing support, including 24 transitional housing or transitional support 25 VerDate Sep 11 2014 05:50 Mar 29, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1493.IH H1493 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •HR 1493 IH services for individuals who are unhoused, 1 and wrap-around services. 2 ‘‘(xiv) Necessary home modifications 3 and assistive technology, including those 4 which substitute for human assistance. 5 ‘‘(xv) Transition services to support 6 an individual who is transitioning from an 7 institutional setting to the community, in- 8 cluding appropriate services for individuals 9 who are unhoused or at risk of becoming 10 unhoused, and including such transition 11 services provided while the individual re- 12 sides in an institution. 13 ‘‘(xvi) Any other service recommended 14 by the panel convened pursuant to sub- 15 paragraph (B). 16 ‘‘(B) SPECIFICATION OF RECOMMENDED 17 SERVICES.— 18 ‘‘(i) IN GENERAL.—Not later than 6 19 months after the date of the enactment of 20 this subparagraph, and not less frequently 21 than once every 5 years thereafter, the 22 Secretary shall convene an advisory panel 23 (in this subparagraph referred to as the 24 ‘panel’) for purposes of recommending ad- 25 VerDate Sep 11 2014 05:50 Mar 29, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1493.IH H1493 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •HR 1493 IH ditional services which shall be included as 1 home and community-based services under 2 this paragraph. 3 ‘‘(ii) COMPOSITION.— 4 ‘‘(I) SELECTION.—The panel 5 shall be composed of at least one rep- 6 resentative (to be selected by the Sec- 7 retary) from each of the following: 8 ‘‘(aa) Individuals with dis- 9 abilities receiving home and com- 10 munity-based services under this 11 title and individuals with disabil- 12 ities in need of such services, in- 13 cluding those with physical dis- 14 abilities, behavioral health dis- 15 abilities, or intellectual or devel- 16 opmental disabilities, and includ- 17 ing older adults. 18 ‘‘(bb) Beneficiary-led dis- 19 ability rights organizations. 20 ‘‘(cc) Disability-led organiza- 21 tions. 22 ‘‘(dd) Disabled veterans or- 23 ganizations. 24 VerDate Sep 11 2014 05:50 Mar 29, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1493.IH H1493 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •HR 1493 IH ‘‘(ee) Disability organiza- 1 tions representing families. 2 ‘‘(ff) Community-based pro- 3 vider organizations. 4 ‘‘(gg) Organizations serving 5 older adults. 6 ‘‘(hh) The Protection and 7 Advocacy system, the Centers for 8 Independent Living. 9 ‘‘(ii) Health care providers. 10 ‘‘(jj) The National Associa- 11 tion of Medicaid Directors. 12 ‘‘(kk) The National Associa- 13 tion of State Directors of Devel- 14 opmental Disabilities Services. 15 ‘‘(ll) The National Associa- 16 tion of State Mental Health Pro- 17 gram Directors. 18 ‘‘(mm) ADvancing States. 19 ‘‘(nn) The Centers for Medi- 20 care & Medicaid Services. 21 ‘‘(oo) The Administration 22 for Community Living of the De- 23 partment of Health and Human 24 Services. 25 VerDate Sep 11 2014 05:50 Mar 29, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1493.IH H1493 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •HR 1493 IH ‘‘(pp) Other relevant local, 1 State, and Federal home and 2 community-based service systems, 3 as determined by the Secretary. 4 ‘‘(II) REQUIREMENT FOR EQUAL 5 REPRESENTATION.—The Secretary 6 shall select an equal number of rep- 7 resentatives from each category de- 8 scribed in items (aa) through (oo) of 9 subclause (I) in convening the panel. 10 ‘‘(iii) DUTIES.—Not later than 6 11 months after a panel is convened under 12 clause (i), the panel shall submit to the 13 Secretary and to Congress a report recom- 14 mending additional services which shall be 15 included as home and community-based 16 services under this paragraph. Such rec- 17 ommended services shall be so specified 18 with the goal of increasing community in- 19 tegration and self-determination for indi- 20 viduals with disabilities receiving such 21 services. 22 ‘‘(iv) IMPLEMENTATION OF REC- 23 OMMENDED SERVICES.— 24 VerDate Sep 11 2014 [Text truncated for display. Full text available on Congress.gov.]

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