[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4250 Introduced in House (IH)]







104th CONGRESS
  2d Session
                                H. R. 4250

  To amend title XIX of the Social Security Act to permit a State the 
    option of covering community-based attendant services under the 
                           Medicaid program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 27, 1996

 Mr. Gunderson (for himself and Mr. Gingrich) introduced the following 
         bill; which was referred to the Committee on Commerce

_______________________________________________________________________

                                 A BILL


 
  To amend title XIX of the Social Security Act to permit a State the 
    option of covering community-based attendant services under the 
                           Medicaid program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. OPTIONAL COVERAGE OF COMMUNITY-BASED ATTENDANT SERVICES 
              UNDER THE MEDICAID PROGRAM.

    (a) Coverage.--
            (1) In general.--Section 1905 of the Social Security Act 
        (42 U.S.C. 1396d) is amended--
                    (A) in subsection (a)--
                            (i) by striking ``and'' at the end of 
                        paragraph (24),
                            (ii) by redesignating paragraph (25) as 
                        paragraph (26), and
                            (iii) by inserting after paragraph (24) the 
                        following new paragraph:
            ``(25) subject to subsection (t)(3), qualified community-
        based attendant services (as defined in subsection (t)(1)); 
        and''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(t)(1) The term `qualified community-based attendant services' 
means community-based attendant services furnished to individuals under 
a plan of care if all the following conditions are met:
            ``(A) The individuals to whom the services are furnished 
        select, manage, and control the attendant services to be 
        provided.
            ``(B) Attendant services would be covered only if they are 
        home or community-based and are not provided in a nursing 
        facility or other institutional facility.
            ``(C) Eligibility for such coverage would be limited to 
        those who required such services based on functional need.
            ``(D) Such services would be available in home and in other 
        locations, including school, work, recreation and church.
            ``(E) Such services would be available on an as-needed 
        basis.
            ``(F) Backup and emergency attendant services would be 
        available.
            ``(G) Notwithstanding section 1916, a State may impose 
        copayments and cost-sharing for individuals for attendant 
        services based on the income of individuals involved and in a 
        manner so as not to be a disincentive for employment.
            ``(H) Coverage of services could be effected through any 
        appropriate means, which may include through provision of 
        vouchers to eligible individuals, through direct cash payment, 
        through an individual provider model, or through a consumer-
        directed agency model.
            ``(I) Voluntary training should be available to recipients 
        on how to select, manage, and dismiss attendants.
            ``(J) The particular attendant services to be covered for 
        an eligible individual would be based on a service delivery 
        plan that is agreed upon by the individual and the attendants.
            ``(K) Health-related tasks included within such services 
        could be delegated to (or performed by) unlicensed personal 
        attendants.
            ``(L) The State provides for the periodic submission to the 
        Secretary of reports on the coverage of such services under 
        this subsection.
    ``(2) Medical assistance for qualified community-based attendant 
services need not be made available in all geographic areas of a State 
or to all beneficiaries, notwithstanding anything to the contrary in 
section 1902(a)(1) or section 1902(a)(10)(B).
    ``(3) Medical assistance for qualified community-based attendant 
services may not be made available by a State under section 1905(a)(25) 
unless the State establishes that the provision of medical assistance 
with respect to such services will not increase the Federal payments 
made under this title above the level of such payments if such medical 
assistance under such section had not been provided.''.
            (2) Conforming amendments.--(A) Section 1902(j) (42 U.S.C. 
        1396a(j)) is amended by striking ``(25)'' and inserting 
        ``26)''.
            (B) Section 1902(a)(10)(C)(iv) (42 U.S.C. 
        1396a(a)(10)(C)(iv)) is amended by striking ``(24)'' and 
        inserting ``(25)''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to services furnished on or after the date of the enactment of 
this Act.
    (c) Reports to Congress.--The Secretary of Secretary of Health and 
Human Services shall submit to Congress periodic reports on the impact 
of the amendments made by this section on medicaid beneficiaries, 
States, and the Federal Government.
                                 <all>