COVID HCBS Relief Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 8871 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 DECEMBER 4, 2020 Mrs. DINGELL (for herself, Mr. LANGEVIN, Mr. LARSON of Connecticut, Mr. MICHAEL F. DOYLE of Pennsylvania, Ms. PRESSLEY, Ms. HAALAND, Ms. MATSUI, Ms. KUSTER of New Hampshire, Ms. SCHAKOWSKY, Mr. DEUTCH, Ms. BLUNT ROCHESTER, Mr. TONKO, Ms. PORTER, Miss RICE of New York, and Ms. DELAURO) 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 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 ‘‘COVID HCBS Relief 4 Act of 2020’’. 5 VerDate Sep 11 2014 20:23 Dec 15, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H8871.IH H8871 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 8871 IH SEC. 2. ADDITIONAL SUPPORT FOR MEDICAID HOME AND 1 COMMUNITY-BASED SERVICES DURING THE 2 COVID–19 EMERGENCY PERIOD. 3 (a) INCREASED FMAP.— 4 (1) IN GENERAL.—Notwithstanding section 5 1905(b) of the Social Security Act (42 U.S.C. 6 1396d(b)), in the case of an HCBS program State, 7 the Federal medical assistance percentage deter- 8 mined for the State under section 1905(b) of such 9 Act and, if applicable, increased under subsection 10 (y), (z), or (aa) of section 1905 of such Act (42 11 U.S.C. 1396d), section 1915(k) of such Act (42 12 U.S.C. 1396n(k)), or section 6008(a) of the Fami- 13 lies First Coronavirus Response Act (Public Law 14 116–127), shall be increased by 10 percentage 15 points with respect to expenditures of the State 16 under the State Medicaid program for home and 17 community-based services that are provided during 18 the HCBS program improvement period. In no case 19 may the application of the previous sentence result 20 in the Federal medical assistance percentage deter- 21 mined for a State being more than 95 percent. 22 (2) DEFINITIONS.—In this section: 23 (A) HCBS PROGRAM IMPROVEMENT PE- 24 RIOD.—The term ‘‘HCBS program improve- 25 VerDate Sep 11 2014 20:23 Dec 15, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H8871.IH H8871 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 8871 IH ment period’’ means, with respect to a State, 1 the period— 2 (i) beginning on October 1, 2020; and 3 (ii) ending on September 30, 2022. 4 (B) HCBS PROGRAM STATE.—The term 5 ‘‘HCBS program State’’ means a State that 6 meets the condition described in subsection (b) 7 by submitting an application described in such 8 subsection, which is approved by the Secretary 9 pursuant to subsection (c). 10 (C) HOME AND COMMUNITY-BASED SERV- 11 ICES.—The term ‘‘home and community-based 12 services’’ means home health care services au- 13 thorized under paragraph (7) of section 1905(a) 14 of the Social Security Act (42 U.S.C. 15 1396d(a)), personal care services authorized 16 under paragraph (24) of such section, behav- 17 ioral health services authorized under para- 18 graph (13) of such section, PACE services au- 19 thorized under paragraph (26) of such section, 20 services authorized under subsections (b), (c), 21 (i), (j), and (k) of section 1915 of such Act (42 22 U.S.C. 1396n), such services authorized under 23 a waiver under section 1115 of such Act (42 24 VerDate Sep 11 2014 20:23 Dec 15, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H8871.IH H8871 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 8871 IH U.S.C. 1315), and such other services specified 1 by the Secretary. 2 (b) CONDITION.—The condition described in this sub- 3 section, with respect to a State, is that the State submits 4 an application to the Secretary, at such time and in such 5 manner as specified by the Secretary, that includes, in ad- 6 dition to such other information as the Secretary shall re- 7 quire— 8 (1) a description of which activities described in 9 subsection (d) that a State plans to implement and 10 a description of how it plans to implement such ac- 11 tivities; 12 (2) assurances that the Federal funds attrib- 13 utable to the increase under subsection (a) will be 14 used— 15 (A) to implement the activities described in 16 subsection (d); and 17 (B) to supplement, and not supplant, the 18 level of State funds expended for home and 19 community-based services for eligible individ- 20 uals through programs in effect as of the date 21 of the enactment of this section; and 22 (3) assurances that the State will conduct ade- 23 quate oversight and ensure the validity of such data 24 as may be required by the Secretary. 25 VerDate Sep 11 2014 23:44 Dec 18, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H8871.IH H8871 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 8871 IH (c) APPROVAL OF APPLICATION.—Not later than 90 1 days after the date of submission of an application of a 2 State under subsection (b), the Secretary shall certify if 3 the application is complete. Upon certification that an ap- 4 plication of a State is complete, the application shall be 5 deemed to be approved for purposes of this section. 6 (d) ACTIVITIES TO IMPROVE THE DELIVERY OF 7 HCBS.— 8 (1) IN GENERAL.—A State shall work with 9 community partners, such as Area Agencies on 10 Aging, Centers for Independent Living, nonprofit 11 home and community-based services providers, and 12 other entities providing home and community-based 13 services, to implement— 14 (A) the purposes described in paragraph 15 (2) during the COVID–19 public health emer- 16 gency period; and 17 (B) the purposes described in paragraph 18 (3) after the end of such emergency period. 19 (2) FOCUSED AREAS OF HCBS IMPROVE- 20 MENT.—The purposes described in this paragraph, 21 with respect to a State, are the following: 22 (A) To increase rates for home health 23 agencies and agencies that employ direct sup- 24 port professionals (including independent pro- 25 VerDate Sep 11 2014 23:44 Dec 18, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H8871.IH H8871 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 8871 IH viders in a self-directed or consumer-directed 1 model) to provide home and community-based 2 services under the State Medicaid program, 3 provided that any agency or individual that re- 4 ceives payment under such an increased rate in- 5 creases the compensation it pays its home 6 health workers or direct support professionals. 7 (B) To provide paid sick leave, paid family 8 leave, and paid medical leave for home health 9 workers and direct support professionals. 10 (C) To provide hazard pay, overtime pay, 11 and shift differential pay for home health work- 12 ers and direct support professionals. 13 (D) To provide home and community- 14 based services to eligible individuals who are on 15 waiting lists for programs approved under sec- 16 tions 1115 or 1915 of the Social Security Act 17 (42 U.S.C. 1315, 1396n). 18 (E) To expand home and community-based 19 services to facilitate reducing the census of 20 nursing facilities, intermediate care facilities, 21 psychiatric facilities, and other institutional or 22 congregate settings so that safety measures can 23 be effectively implemented within these settings. 24 VerDate Sep 11 2014 20:23 Dec 15, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H8871.IH H8871 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 8871 IH (F) To purchase emergency supplies and 1 equipment, which may include items not typi- 2 cally covered under the Medicaid program, such 3 as personal protective equipment, necessary to 4 enhance access to services and to protect the 5 health and well-being of home health workers 6 and direct support professionals. 7 (G) To pay for the travel of home health 8 workers and direct support professionals to con- 9 duct home and community-based services. 10 (H) To recruit new home health workers 11 and direct support professionals. 12 (I) To support family care providers of eli- 13 gible individuals with needed supplies and 14 equipment, which may include items not typi- 15 cally covered under the Medicaid program, such 16 as personal protective equipment, and pay. 17 (J) To pay for training for home health 18 workers and direct support professionals that is 19 specific to the COVID–19 public health emer- 20 gency. 21 (K) To pay for assistive technologies, staff- 22 ing, and other costs incurred during the 23 COVID–19 public health emergency period in 24 order to facilitate community integration and 25 VerDate Sep 11 2014 20:23 Dec 15, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H8871.IH H8871 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 8871 IH ensure an individual’s person-centered service 1 plan continues to be fully implemented. 2 (L) To prepare information and public 3 health and educational materials in accessible 4 formats (including formats accessible to people 5 with low literacy or intellectual disabilities) 6 about prevention, treatment, recovery and other 7 aspects of COVID–19 for eligible individuals, 8 their families, and the general community 9 served by agencies described in subparagraph 10 (A). 11 (M) To pay for interpreters to assist in 12 providing home and community-based services 13 to eligible individuals and to inform the general 14 public about COVID–19. 15 (N) To allow day services providers to pro- 16 vide home and community-based services. 17 (O) To pay for other expenses deemed ap- 18 propriate by the Secretary to enhance, expand, 19 or strengthen Home and Community-Based 20 Services, including retainer payments, and ex- 21 penses which meet the criteria of the home and 22 community-based settings rule published on 23 January 16, 2014. 24 VerDate Sep 11 2014 20:23 Dec 15, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H8871.IH H8871 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 8871 IH (3) PERMISSIBLE USES AFTER THE EMER- 1 GENCY PERIOD.—The purpose described in this 2 paragraph, with respect to a State, is to assist eligi- 3 ble individuals who had to relocate to a nursing fa- 4 cility or institutional setting from their homes dur- 5 ing the COVID–19 public health emergency period 6 in— 7 (A) moving back to their homes (including 8 by paying for moving costs, first month’s rent, 9 and other one-time expenses and start-up 10 costs); 11 (B) resuming home and community-based 12 services; 13 (C) receiving mental health services and 14 necessary rehabilitative service to regain skills 15 lost while relocated during the public health 16 emergency period; and 17 (D) while funds attributable to the in- 18 creased FMAP under this section remain avail- 19 able, continuing home and community-based 20 services for eligible individuals who were served 21 from a waiting list for such services during the 22 public health emergency period. 23 (e) REPORTING REQUIREMENTS.— 24 VerDate Sep 11 2014 20:23 Dec 15, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H8871.IH H8871 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 8871 IH (1) STATE REPORTING REQUIREMENTS.—Not 1 later than December 31, 2023, any State with re- 2 spect to which an application is approved by the Sec- 3 retary pursuant to subsection (c) shall submit a re- 4 port to the Secretary that contains the following in- 5 formation: 6 (A) Activities and programs that were 7 funded using Federal funds attributable to such 8 increase. 9 (B) The number of eligible individuals who 10 were served by such activities and programs. 11 (C) The number of eligible individuals who 12 were able to resume home and community- 13 based services as a result of such activities and 14 programs. 15 (2) HHS EVALUATION.— 16 (A) IN GENERAL.—The Secretary shall 17 evaluate the implementation and outcomes of 18 this section in the aggregate using an external 19 evaluator with experience evaluating home and 20 community-based services, disability programs, 21 and older adult programs. 22 (B) EVALUATION CRITERIA.—For pur- 23 poses of subparagraph (A), the external eval- 24 uator shall— 25 VerDate Sep 11 2014 20:23 Dec 15, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H8871.IH H8871 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 8871 IH (i) document and evaluate changes in 1 access, availability, and quality of home 2 and community-based services in each 3 HCBS program State; 4 (ii) document and evaluate aggregate 5 changes in access, availability, and quality 6 of home and community-based services 7 across all such States; and 8 (iii) evaluate the implementation and 9 outcomes of this section based on— 10 (I) the impact of this section on 11 increasing funding for home and com- 12 munity-based services; 13 (II) the impact of this section on 14 achieving targeted access, availability, 15 and quality of home and community- 16 based services; and 17 (III) promising practices identi- 18 fied by activities conducted pursuant 19 to subsection (d) that increase access 20 to, availability of, and quality of home 21 and community-based services. 22 (C) DISSEMINATION OF EVALUATION FIND- 23 INGS.—The Secretary shall— 24 VerDate Sep 11 2014 20:23 Dec 15, 2020 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H8871.IH H8871 pamtmann on DSKBC07HB2PROD with BILLS 12 •HR 8871 IH (i) disseminate the findings from the 1 evaluations conducted under this para- 2 graph to— 3 (I) all State Medicaid directors; 4 and 5 (II) the Committee on Energy 6 and Commerce of the House of Rep- 7 resentatives, the Committee on Fi- 8 nance of the Senate, and the Special 9 Committee on Aging of the Senate; 10 and 11 (ii) make all evaluation findings pub- 12 licly available in an accessible electronic 13 format and any other accessible format de- 14 termined appropriate by the Secretary. 15 (D) OVERSIGHT.—Each State with respect 16 to which an application is approved by the Sec- 17 retary pursuant to subsection (c) shall ensure 18 adequate oversight of the expenditure of Fed- 19 eral funds pursuant to such increase in accord- 20 ance with the Medicaid regulations, including 21 section 1115 and 1915 waiver regulations and 22 special terms and conditions for any relevant 23 waiver or grant program. 24 VerDate Sep 11 2014 20:23 Dec 15, 2020 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H8871.IH H8871 pamtmann on DSKBC07HB2PROD with BILLS 13 •HR 8871 IH (3) NON-APPLICATION OF THE PAPERWORK RE- 1 DUCTION ACT.—Chapter 35 of title 44, United 2 States Code (commonly referred to as the ‘‘Paper- 3 work Reduction Act of 1995’’), shall not apply to the 4 provisi [Text truncated for display. Full text available on Congress.gov.]