Community Integration Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 8934 To ensure that Medicaid beneficiaries have the opportunity to receive care in a home and community-based setting. IN THE HOUSE OF REPRESENTATIVES DECEMBER 10, 2020 Mr. CARTWRIGHT introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To ensure that Medicaid beneficiaries have the opportunity to receive care in a home and community-based setting. 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 ‘‘Community Integra- 4 tion Act of 2020’’. 5 SEC. 2. FINDINGS. 6 Congress finds the following: 7 (1) The Supreme Court’s 1999 decision in 8 Olmstead v. L.C., 527 U.S. 581 (1999), held that 9 the unnecessary segregation of individuals with dis- 10 VerDate Sep 11 2014 06:38 Dec 24, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H8934.IH H8934 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 8934 IH abilities is a violation of the Americans with Disabil- 1 ities Act of 1990 (42 U.S.C. 12101 et seq.). 2 (2) Under Olmstead, individuals generally have 3 the right to receive their supports and services in 4 home and community-based settings, rather than in 5 institutional settings, if they so choose. 6 (3) Olmstead envisioned that States would pro- 7 vide appropriate long-term services and supports to 8 individuals with disabilities through home and com- 9 munity-based services and end forced segregation in 10 nursing homes and other institutions. 11 (4) While there has been progress in rebal- 12 ancing State spending on individuals with disabilities 13 in institutions as compared to home and community- 14 based settings, more than 75 percent of States con- 15 tinue to spend the majority of their long-term care 16 dollars on nursing homes and other institutional set- 17 tings, and the number of individuals with disabilities 18 under age 65 in nursing homes increased between 19 2008 and 2012. 20 (5) As of June 2013, there were more than 21 200,000 individuals younger than age 65 in nursing 22 homes—almost 16 percent of the total nursing home 23 population. 24 VerDate Sep 11 2014 06:38 Dec 24, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H8934.IH H8934 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 8934 IH (6) Thirty-eight studies published from 2005 to 1 2012 concluded that providing services in home and 2 community-based settings is less costly than pro- 3 viding care in a nursing home or other institutional 4 setting. 5 (7) No clear or centralized reporting system ex- 6 ists to compare how effectively States are meeting 7 the Olmstead mandate. 8 SEC. 3. ENSURING MEDICAID BENEFICIARIES MAY ELECT 9 TO RECEIVE CARE IN A HOME AND COMMU- 10 NITY-BASED SETTING. 11 (a) IN GENERAL.—Section 1902(a) of the Social Se- 12 curity Act (42 U.S.C. 1396a(a)) is amended— 13 (1) in paragraph (85), by striking ‘‘and’’ at the 14 end; 15 (2) in paragraph (86), by striking the period 16 and inserting ‘‘; and’’; and 17 (3) by inserting after paragraph (86) the fol- 18 lowing new paragraph: 19 ‘‘(87) in the case of any individual with respect 20 to whom there has been a determination that the in- 21 dividual requires the level of care provided in a nurs- 22 ing facility, an intermediate care facility for the 23 mentally retarded, an institution for mental diseases, 24 VerDate Sep 11 2014 06:38 Dec 24, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H8934.IH H8934 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 8934 IH or any other similarly restrictive or institutional set- 1 ting— 2 ‘‘(A) provide the individual with the choice 3 and opportunity to receive such care in a home 4 and community-based setting, including reha- 5 bilitative services, assistance and support in ac- 6 complishing activities of daily living, instru- 7 mental activities of daily living, and health-re- 8 lated tasks, and assistance in acquiring, main- 9 taining, or enhancing skills necessary to accom- 10 plish such activities, tasks, or services; 11 ‘‘(B) ensure that each such individual has 12 an equal opportunity (when compared to the re- 13 ceipt and availability of nursing facility serv- 14 ices) to receive care in a home and community- 15 based setting, if the individual so chooses, by 16 ensuring that the provision of such care in a 17 home and community-based setting is widely 18 available on a statewide basis for all such indi- 19 viduals within the State; and 20 ‘‘(C) meet the requirements of section 21 1904A (relating to the provision of care in a 22 home and community-based setting).’’. 23 (b) REQUIREMENTS FOR COMMUNITY CARE OP- 24 TIONS.—Title XIX of the Social Security Act is amended 25 VerDate Sep 11 2014 06:38 Dec 24, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H8934.IH H8934 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 8934 IH by inserting after section 1904 (42 U.S.C. 1396c) the fol- 1 lowing new section: 2 ‘‘PROVISIONS RELATED TO HOME AND COMMUNITY- 3 BASED CARE 4 ‘‘SEC. 1904A. (a) DEFINITIONS.—For purposes of 5 this section, section 1902(a)(87), and section 6 1905(a)(4)(A): 7 ‘‘(1) ACTIVITIES OF DAILY LIVING.—The term 8 ‘activities of daily living’ includes, but is not limited 9 to, tasks such as eating, toileting, grooming, dress- 10 ing, bathing, and transferring. 11 ‘‘(2) HEALTH-RELATED TASKS.—The term 12 ‘health-related tasks’ means specific tasks related to 13 the needs of an individual, including, but not limited 14 to, bowel or bladder care, wound care, use and care 15 of ventilators and feeding tubes, and the administra- 16 tion of medications and injections, which, in the 17 opinion of the individual’s physician, can be dele- 18 gated to be performed by an attendant. 19 ‘‘(3) HOME AND COMMUNITY-BASED SET- 20 TING.—The term ‘home and community-based set- 21 ting’ means, with respect to an individual who re- 22 quires a level of care provided in a nursing facility, 23 an intermediate care facility for the mentally re- 24 tarded, an institution for mental diseases, or any 25 VerDate Sep 11 2014 06:38 Dec 24, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H8934.IH H8934 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 8934 IH other similarly restrictive or institutional setting, a 1 setting that— 2 ‘‘(A) includes a house, an apartment, a 3 townhouse, a condominium, or any similar pub- 4 lic or private housing where the individual re- 5 sides that— 6 ‘‘(i) is owned or leased by the indi- 7 vidual or a member of the individual’s fam- 8 ily; 9 ‘‘(ii) ensures the individual’s privacy, 10 dignity, respect, and freedom from coer- 11 cion; and 12 ‘‘(iii) maximizes the individual’s au- 13 tonomy and independence; 14 ‘‘(B) is integrated in, and provides access 15 to, the general community in which the setting 16 is located so that the individual has access to 17 the community and opportunities to seek em- 18 ployment and work in competitive integrated 19 settings, participate in community life, control 20 and utilize personal resources, benefit from 21 community services, and participate in the com- 22 munity in an overall manner that is comparable 23 to that available to individuals who are not indi- 24 viduals with disabilities; and 25 VerDate Sep 11 2014 06:38 Dec 24, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H8934.IH H8934 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 8934 IH ‘‘(C) has the services and supports that the 1 individual needs in order to live as independ- 2 ently as possible. 3 ‘‘(4) INSTRUMENTAL ACTIVITIES OF DAILY LIV- 4 ING.—The term ‘instrumental activities of daily liv- 5 ing’ means activities related to living independently 6 in the community and includes, but is not limited to, 7 meal planning and preparation, managing finances, 8 shopping for food, clothing, and other items, per- 9 forming household chores, communicating by phone 10 or other media, and traveling around and partici- 11 pating in the community. 12 ‘‘(5) PUBLIC ENTITY.—The term ‘public entity’ 13 means a public entity as defined in subparagraphs 14 (A) and (B) of section 201(1) of the Americans with 15 Disabilities Act of 1990. 16 ‘‘(b) REQUIREMENTS FOR PROVIDING SERVICES IN 17 HOME AND COMMUNITY-BASED SETTINGS.—With respect 18 to the availability and provision of services under the State 19 plan under this title, or under any waiver of State plan 20 requirements (subject to section 3(d) of the Community 21 Integration Act of 2020), in a home and community-based 22 setting to any individual who requires a level of care pro- 23 vided in a nursing facility, an intermediate care facility 24 for the mentally retarded, an institution for mental dis- 25 VerDate Sep 11 2014 06:38 Dec 24, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H8934.IH H8934 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 8934 IH eases, or any other similarly restrictive or institutional set- 1 ting, any public entity that receives payment under the 2 State plan or waiver for providing services to such an indi- 3 vidual shall not— 4 ‘‘(1) impose or utilize policies, practices, or pro- 5 cedures, such as unnecessary requirements or arbi- 6 trary service or cost caps, that limit the availability 7 of services in home and community-based settings to 8 an individual with a disability (including individuals 9 with the most significant disabilities) who need such 10 services; 11 ‘‘(2) impose or utilize policies, practices, or pro- 12 cedures that limit the availability of services in a 13 home and community-based setting (including assist- 14 ance and support in accomplishing activities of daily 15 living, instrumental activities of daily living, health- 16 related tasks, and rehabilitative services) based on 17 the specific disability of an otherwise eligible indi- 18 vidual; 19 ‘‘(3) impose or utilize policies, practices, or pro- 20 cedures that arbitrarily restrict an individual with a 21 disability from full and meaningful participation in 22 community life; 23 ‘‘(4) impose or utilize policies, practices, or pro- 24 cedures that unnecessarily delay or restrict the pro- 25 VerDate Sep 11 2014 06:38 Dec 24, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H8934.IH H8934 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 8934 IH vision of services in a home and community-based 1 setting to any individual who requires such services; 2 ‘‘(5) fail to establish and utilize adequate pay- 3 ment structures to maintain a sufficient workforce 4 to provide services in home and community-based 5 settings to any individual who requires such services; 6 ‘‘(6) fail to provide information, on an ongoing 7 basis, to help any individual who receives care in a 8 nursing facility, an intermediate care facility for the 9 mentally retarded, an institution for mental diseases, 10 or any other similarly restrictive or institutional set- 11 ting, understand the individual’s right to choose to 12 receive such care in a home and community-based 13 setting; or 14 ‘‘(7) fail to provide information to help any in- 15 dividual that requires the level of care provided in a 16 nursing facility, an intermediate care facility for the 17 mentally retarded, an institution for mental diseases, 18 or any other similarly restrictive or institutional set- 19 ting, prior to the individual’s placement in such a fa- 20 cility or an institution, understand the individual’s 21 right to choose to receive such care in a home and 22 community-based setting. 23 ‘‘(c) PLAN TO INCREASE AFFORDABLE AND ACCES- 24 SIBLE HOUSING.—Not later than 180 days after the en- 25 VerDate Sep 11 2014 06:38 Dec 24, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H8934.IH H8934 pbinns on DSKJLVW7X2PROD with BILLS 10 •HR 8934 IH actment of this section, each State shall develop a state- 1 wide plan to increase the availability of affordable and ac- 2 cessible private and public housing stock for individuals 3 with disabilities (including accessible housing for individ- 4 uals with physical disabilities and those using mobility de- 5 vices). 6 ‘‘(d) AVAILABILITY OF REMEDIES AND PROCE- 7 DURES.— 8 ‘‘(1) IN GENERAL.—The remedies and proce- 9 dures set forth in sections 203 and 505 of the Amer- 10 icans with Disabilities Act of 1990 shall be available 11 to any person aggrieved by the failure of— 12 ‘‘(A) a State to comply with this section or 13 section 1902(a)(87); or 14 ‘‘(B) a public entity (including a State) to 15 comply with the requirements of subsection (b). 16 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 17 paragraph (1) shall be construed to limit any rem- 18 edy or right of action that otherwise is available to 19 an aggrieved person under this title. 20 ‘‘(e) ENFORCEMENT BY THE SECRETARY.— 21 ‘‘(1) IN GENERAL.—The Secretary may reduce 22 the Federal medical assistance percentage applicable 23 to the State (as determined under section 1905(b)) 24 VerDate Sep 11 2014 06:38 Dec 24, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H8934.IH H8934 pbinns on DSKJLVW7X2PROD with BILLS 11 •HR 8934 IH if the Secretary determines that the State has vio- 1 lated the requirements of subsection (b). 2 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 3 paragraph (1) shall be construed to limit any rem- 4 edy or right of action that is otherwise available to 5 the Secretary. 6 ‘‘(f) REPORTING REQUIREMENTS.—With respect to 7 fiscal year 2020, and for each fiscal year thereafter, each 8 State shall submit to the Administrator of the Administra- 9 tion for Community Living of the Department of Health 10 and Human Services, not later than April 1 of the suc- 11 ceeding fiscal year, a report, in such form and manner 12 as the Secretary shall require, that includes— 13 ‘‘(1) the total number of individuals enrolled in 14 the State plan or under a waiver of the plan during 15 such fiscal year that required the level of care pro- 16 vided in a nursing facility, an intermediate care fa- 17 cility for the mentally retarded, an institution for 18 mental diseases, or any other similarly restrictive or 19 institutional setting, disaggregated by the type of fa- 20 cility or setting; 21 ‘‘(2) with respect to the total number described 22 in paragraph (1), the total number of individuals de- 23 scribed in that paragraph who received care in a 24 nursing facility, an intermediate care facility for the 25 VerDate Sep 11 2014 06:38 Dec 24, 2020 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H8934.IH H8934 pbinns on DSKJLVW7X2PROD with BILLS 12 •HR 8934 IH mentally retarded, an institution for mental diseases, 1 or any other similarly restrictive or institutional set- 2 ting, disaggregated by the type of facility or setting; 3 and 4 ‘‘(3) with respect to the total number described 5 in [Text truncated for display. 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