HCBS Infrastructure Improvement Act

II 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 Med- icaid home and community-based services, 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 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘HCBS Infrastructure 4 Improvement Act’’. 5 SEC. 2. FINDINGS AND PURPOSE. 6 (a) FINDINGS.—Congress finds the following: 7 VerDate Sep 11 2014 04:25 Feb 14, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S3277.IS S3277 kjohnson on DSK79L0C42PROD with BILLS 2 •S 3277 IS (1) States are prioritizing funding of their Med- 1 icaid programs for long-term services and supports 2 (referred to in this section as ‘‘LTSS’’) to offer a 3 wider range of options for home and community- 4 based services (referred to in this section as 5 ‘‘HCBS’’), but gaps in HCBS remain. 6 (2) In fiscal year 2016, States were spending 7 only 57 percent of their total LTSS budgets on 8 HCBS, well short of the national goal of 69 percent 9 set by the Centers for Medicare & Medicaid Services. 10 (3) In 2017, more than 700,000 people with 11 disabilities, older adults, and children were on wait- 12 ing lists to receive HCBS through existing Medicaid 13 waver programs. 14 (4) According to projections by the Bureau of 15 the Census, the number of adults over age 65 will 16 reach 84,000,000 by mid-century, and the popu- 17 lation of people 85 and older will be nearly 15 mil- 18 lion by 2040. 19 (5) Absent strategic planning and investment, 20 States will experience greater difficulties as the 21 needs of older adults increase demands on State 22 home and community-based services HCBS capacity. 23 (6) A one-time, targeted investment to 24 strengthen State capacity to build out Medicaid in- 25 VerDate Sep 11 2014 04:25 Feb 14, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3277.IS S3277 kjohnson on DSK79L0C42PROD with BILLS 3 •S 3277 IS frastructure that supports multiple HCBS programs 1 and connects to other Federal and State programs, 2 including Medicare and the Older Americans Act, 3 will improve the quality of health and daily living for 4 the millions of older adults, people with disabilities 5 and their families. 6 (7) Home and community-based services HCBS 7 play an outsized role in addressing the social deter- 8 minants of health among older adults and people 9 with disabilities, who require accessible housing and 10 accessible transportation and access to reliable per- 11 sonal care to avert costly medical crises. 12 (b) PURPOSE.—The purpose of this Act is to estab- 13 lish to a one-time infrastructure improvement initiative for 14 States to strengthen their HCBS capacity in selected tar- 15 get areas, including housing and transportation, work- 16 force, and employment supports, in order to improve the 17 cost-effectiveness of long-term service and support (LTSS) 18 Medicaid programs and coordination with other programs 19 that provide supportive services to older adults and people 20 with disabilities. 21 SEC. 3. MEDICAID HOME AND COMMUNITY-BASED SERV- 22 ICES INFRASTRUCTURE IMPROVEMENT. 23 Title XIX of the Social Security Act (42 U.S.C. 1396 24 et seq.) is amended by adding at the end the following: 25 VerDate Sep 11 2014 04:25 Feb 14, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3277.IS S3277 kjohnson on DSK79L0C42PROD with BILLS 4 •S 3277 IS ‘‘SEC. 1947. HOME AND COMMUNITY-BASED SERVICES IN- 1 FRASTRUCTURE IMPROVEMENT. 2 ‘‘(a) DEFINITIONS.—In this section: 3 ‘‘(1) DIRECT SUPPORT PROFESSIONAL.—The 4 term ‘direct support professional’ means a person 5 who, in exchange for compensation, provides services 6 to a person with a disability (as defined in section 7 3 of the Americans With Disabilities Act of 1990) 8 that promote such person’s independence, includ- 9 ing— 10 ‘‘(A) services that enhance independence 11 and community inclusion for such person, in- 12 cluding traveling with such person, attending 13 and assisting such persons while visiting friends 14 and family, shopping, or socializing; 15 ‘‘(B) services such as coaching and sup- 16 porting such person in communicating needs, 17 achieving self-expression, pursuing personal 18 goals, living independently, and participating 19 actively in employment or voluntary roles in the 20 community; 21 ‘‘(C) services such as providing assistance 22 with activities of daily living (such as feeding, 23 bathing, toileting, and ambulation) and with 24 tasks such as meal preparation, shopping, light 25 housekeeping, and laundry; or 26 VerDate Sep 11 2014 04:25 Feb 14, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3277.IS S3277 kjohnson on DSK79L0C42PROD with BILLS 5 •S 3277 IS ‘‘(D) services that support such person at 1 home, work, school, church, or other community 2 settings. 3 ‘‘(2) ELIGIBLE HCBS EXPENDITURES.—The 4 term ‘eligible HCBS expenditures’ means expendi- 5 tures by an HCBS infrastructure State on medical 6 assistance for home and community-based services 7 that are provided under the State plan or waiver 8 during the State’s HCBS infrastructure period and 9 which aim to collaborate with other programs offer- 10 ing support for home and community-based services. 11 ‘‘(3) FIRST MILE/LAST MILE TRANSPOR- 12 TATION.—The term ‘first mile/last mile transpor- 13 tation’ means the transportation necessary to— 14 ‘‘(A) transport a person to a fixed route 15 transit system that the person could not other- 16 wise conveniently access by walking, wheelchair, 17 walker, or other self-propelled mobility method; 18 and 19 ‘‘(B) transport a person from a fixed route 20 transit system to the person’s final destination 21 when the final destination is not within a dis- 22 tance that the person could conveniently access 23 by walking, wheelchair, walker, or other self- 24 propelled mobility method. 25 VerDate Sep 11 2014 04:25 Feb 14, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S3277.IS S3277 kjohnson on DSK79L0C42PROD with BILLS 6 •S 3277 IS ‘‘(4) HCBS INFRASTRUCTURE PERIOD.—The 1 term ‘HCBS infrastructure period’ means, with re- 2 spect to an HCBS infrastructure State, the 7-fiscal 3 year period that begins with the first fiscal year that 4 begins after the date on which the State is granted 5 approval by the Secretary under subsection (c) to 6 conduct an HCBS infrastructure program. 7 ‘‘(5) HCBS INFRASTRUCTURE PROGRAM.—The 8 term ‘HCBS infrastructure program’ means a dem- 9 onstration program conducted under this section. 10 ‘‘(6) HCBS INFRASTRUCTURE STATE.—The 11 term ‘HCBS infrastructure State’ means a State 12 that has been granted approval by the Secretary 13 under subsection (c) to conduct an HCBS infra- 14 structure program. 15 ‘‘(7) HOME AND COMMUNITY-BASED SERV- 16 ICES.—The term ‘home and community-based serv- 17 ices’ means long-term, person-centered services and 18 supports that are not provided in an institutional 19 setting, including— 20 ‘‘(A) a home and community-based service 21 provided under subsection (c), (d), or (i) of sec- 22 tion 1915 or under a waiver under section 23 1115; 24 VerDate Sep 11 2014 04:25 Feb 14, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S3277.IS S3277 kjohnson on DSK79L0C42PROD with BILLS 7 •S 3277 IS ‘‘(B) home and community-based long- 1 term services and supports (provided in accord- 2 ance with the requirements for home and com- 3 munity-based settings under sections 441.530 4 and 441.710 of title 42, Code of Federal Regu- 5 lations), including— 6 ‘‘(i) services described in paragraphs 7 (7), (8), (13), (19), and (24) of section 8 1905(a); 9 ‘‘(ii) home and community-based serv- 10 ices described in subsection (c)(4)(B) of 11 section 1915; 12 ‘‘(iii) self-directed home and commu- 13 nity-based services described in subsection 14 (i) of section 1915; 15 ‘‘(iv) self-directed personal assistance 16 services (as defined in subsection (j)(4)(A) 17 of section 1915); and 18 ‘‘(v) home and community-based at- 19 tendant services and supports described in 20 subsection (k) of section 1915; 21 ‘‘(C) a home health care service; and 22 ‘‘(D) a personal care service. 23 ‘‘(8) LONG-TERM SERVICES AND SUPPORTS.— 24 The term ‘long-term services and supports’ has the 25 VerDate Sep 11 2014 04:25 Feb 14, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S3277.IS S3277 kjohnson on DSK79L0C42PROD with BILLS 8 •S 3277 IS meaning given that term in section 438.2 of title 42, 1 Code of Federal Regulations (as of the date of en- 2 actment of this section). 3 ‘‘(9) SHARED LIVING.—The term ‘shared living’ 4 means a living arrangement involving— 5 ‘‘(A) not more than 2 people with disabil- 6 ities or an older adult with a disability, except 7 if 1 or more of the people are related to each 8 other (by blood or a close association that is 9 equivalent to a family relationship); 10 ‘‘(B) a person who— 11 ‘‘(i) provides long-term services and 12 supports in exchange for compensation; 13 ‘‘(ii) lives together in a private home 14 with the recipient of such services; and 15 ‘‘(iii) receives a stipend or room and 16 board as the primary form of payment for 17 providing such services; 18 ‘‘(C) a person receiving funding through a 19 State Medicaid program under this title or an- 20 other publically funded program; and 21 ‘‘(D) the person receiving such services 22 having the final decision regarding who is the 23 provider of such services living with the person, 24 through a consumer-driven matching process 25 VerDate Sep 11 2014 04:25 Feb 14, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S3277.IS S3277 kjohnson on DSK79L0C42PROD with BILLS 9 •S 3277 IS that includes relationship building, person-cen- 1 tered planning as defined by the Administrator 2 of the Centers for Medicare & Medicaid Serv- 3 ices, and an assessment of individual compat- 4 ibility. 5 ‘‘(10) STATE.—The term ‘State’ means each of 6 the 50 States, the District of Columbia, the Com- 7 monwealth of Puerto Rico, the United States Virgin 8 Islands, Guam, American Samoa, and the Northern 9 Mariana Islands. 10 ‘‘(11) UNIVERSAL MOBILITY SERVICE.—The 11 term ‘universal mobility service’ means a single plat- 12 form through which people with disabilities or older 13 adults are able to— 14 ‘‘(A) access a variety of public and private 15 demand responsive and fixed-route transpor- 16 tation services which have the necessary vehi- 17 cles and facilities to meet the needs of all users, 18 regardless of income, geographic location, dis- 19 ability, or age; 20 ‘‘(B) and identify their travel options and 21 compare the cost and length of trips using each 22 such option; and 23 VerDate Sep 11 2014 04:25 Feb 14, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S3277.IS S3277 kjohnson on DSK79L0C42PROD with BILLS 10 •S 3277 IS ‘‘(C) schedule a ride, monitor progress, 1 and pay for the trip, regardless of the number 2 of transfers and independent providers used. 3 ‘‘(b) PLANNING GRANTS.— 4 ‘‘(1) IN GENERAL.—Not later than January 1 5 of each of calendar years 2021 through 2024, from 6 the amount appropriated under paragraph (5), the 7 Secretary shall, subject to paragraph (2), award 8 planning grants to any State that applies for such 9 a grant for the purpose of developing proposals for 10 an HCBS infrastructure program. 11 ‘‘(2) SELECTION, DURATION, AND NUMBER OF 12 STATES.— 13 ‘‘(A) SELECTION CRITERIA.—In awarding 14 grants for a year under this subsection the Sec- 15 retary shall— 16 ‘‘(i) consider the technical merits the 17 proposed HCBS infrastructure program of 18 each State that is applying for a grant in 19 such year; and 20 ‘‘(ii) select a group of States that is 21 diverse in terms of— 22 ‘‘(I) the geographic areas the 23 group represents; 24 VerDate Sep 11 2014 04:25 Feb 14, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S3277.IS S3277 kjohnson on DSK79L0C42PROD with BILLS 11 •S 3277 IS ‘‘(II) the population sizes of the 1 States comprising the group; and 2 ‘‘(III) the subparagraphs of sub- 3 section (e)(2) in which each such 4 State is described (based on data from 5 the 2 most recent years for which 6 data is available). 7 ‘‘(B) DURATION.—Grants awarded under 8 this subsection shall be available to States for 9 a period of 1 year. 10 ‘‘(C) NUMBER OF STATES.—The Secretary 11 shall not award planning grants under this sub- 12 section to more than 17 States in any year, and 13 no State may receive more than 1 grant under 14 this subsection. 15 ‘‘(3) USE OF FUNDS.—A State awarded a plan- 16 ning grant under this subsection shall— 17 ‘‘(A) establish a Development and Imple- 18 mentation Council that meets the requirements 19 described in paragraph (4) to provide input into 20 the development of the proposal and, if the 21 State receives approval to conduct a demonstra- 22 tion program under this section, to monitor the 23 ongoing implementation of the program; 24 VerDate Sep 11 2014 04:25 Feb 14, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S3277.IS S3277 kjohnson on DSK79L0C42PROD with BILLS 12 •S 3277 IS ‘‘(B) with guidance from the Centers for 1 Medicare & Medicaid Services, identify popu- 2 lations in the State for which the per capita an- 3 nual expenditures under the State plan or waiv- 4 er of such plan on home and community-based 5 services is less than the national average for 6 that population; 7 ‘‘(C) establish a set of standards and pro- 8 cedures to ensure the State makes measurable 9 progress in expanding the availability of self-di- 10 rection to people served by home and commu- 11 nity-based service providers; 12 ‘‘(D) develop a plan to increase home and 13 community-based services, increase the avail- 14 ability of providers of such service throughout 15 the State, and address at least 3 of the HCBS 16 infrastructure priority areas described in sub- 17 section (c)(3); 18 ‘‘(E) solicit public comment to help deter- 19 mine what the priorities of the proposed dem- 20 onstration program should be; and 21 ‘‘(F) execute memoranda of understanding 22 between any State agencies that will be respon- 23 sible for activities under the proposed dem- 24 onstration program under which each such 25 VerDate Sep 11 2014 04:25 Feb 14, 2020 Jkt 099200 PO 00000 Frm 00012 Fmt 66 [Text truncated for display. 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