1.This Act may be cited as the
Community-Based Choices for Older
Americans Act of 2006
.
2.The purpose of this Act is to provide grants
to States in order to achieve the following:
(1)To enable eligible individuals to make
informed choices about the long-term care services and supplies that best meet
their needs and preferences.
(2)To provide financial assistance to older
individuals to purchase a flexible range of long-term care services or supplies
in a manner that respects the individuals’ cultural, ethnic, and lifestyle
preferences in the least restrictive settings possible.
(3)To make the purchase of long-term care
services and supplies delivered in a home or community-based setting, such as a
naturally occurring retirement community, more affordable for individuals with
financial need.
(4)To help families continue to care for their
older relatives with long-term care needs, including older individuals with
physical and cognitive impairments, and to help reduce the number of older
individuals who are forced to impoverish themselves in order to pay for the
long-term care services and supplies they need.
(5)To help relieve financial pressure on the
medicaid program by delaying or preventing older individuals from spending down
their income and assets to medicaid eligibility thresholds.
(6)To concentrate the resources made available
under this Act to those individuals with the greatest economic need for
long-term care services and supplies.
3.Establishment of the
National Long-Term Care Choice ProgramThe Older Americans Act of 1965 (42 U.S.C.
3001 et seq.) is amended by adding at the end the following:
<enum>VIII</enum><header>National Long-term Care Choice Program
</header>
<section commented="no" display-inline="no-display-inline" id="idD6EAD2F528124F26871752946654A490" section-type="subsequent-section"><enum>801.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title:</text>
<paragraph commented="no" display-inline="no-display-inline" id="ID8F89CCAC10294BCDBD051476B5EF1889"><enum>(1)</enum><header>Caregiver</header><text display-inline="yes-display-inline">The term <term>caregiver</term> means an
adult family member, or another individual, who is a paid or unpaid provider of
home or community-based care to an eligible individual.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id4CDE4147EFC14AE499CC45DE8EBCE7D8"><enum>(2)</enum><header>Consumer
choice</header><text display-inline="yes-display-inline">The term
<term>consumer choice</term> means the opportunity for an eligible
individual—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="id3F712FED9843427EA36F8EAD37AE9A46"><enum>(A)</enum><text display-inline="yes-display-inline">to have greater control over the covered
long-term care services and supplies the individual receives; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idCC884332C527486E98D2D899F3F903DB"><enum>(B)</enum><text display-inline="yes-display-inline">to elect—</text>
<clause commented="no" display-inline="no-display-inline" id="id6EF946E75CB64191B237EEB2429D08B1"><enum>(i)</enum><text display-inline="yes-display-inline">to receive a payment under this title
through a fiscal intermediary as described in section 806(b)(2)(B) for the
purpose of purchasing covered long-term care services or supplies; or</text>
</clause><clause commented="no" display-inline="no-display-inline" id="idB3E8B6BB4AFC47CCAE1D60D40B602D98"><enum>(ii)</enum><text display-inline="yes-display-inline">to receive such services or supplies from a
provider paid by the State involved (or its designee) as described in section
806(b)(2)(A).</text>
</clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDFC168DE574594F419C3E2091393802A0"><enum>(3)</enum><header>Covered
long-term care services or supplies</header>
<subparagraph commented="no" display-inline="no-display-inline" id="IDCF0C15700B7946FDAE23DB04CEF4BC8D"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">Subject to
subparagraph (B), the term <term>covered long-term care services or
supplies</term> means any of the following services or supplies, but only if,
with respect to an eligible individual, such services or supplies are not
available or not eligible for payment by any entity carrying out a program
described in section 804(b)(8) or a similar third party:</text>
<clause commented="no" display-inline="no-display-inline" id="IDBC6D9DC89D8644E48249D2F0AE209E5B"><enum>(i)</enum><text display-inline="yes-display-inline">Adult day services (including health and
social day care services).</text>
</clause><clause commented="no" display-inline="no-display-inline" id="IDC3E80591AFBA409C830495377B43445A"><enum>(ii)</enum><text display-inline="yes-display-inline">Bill paying.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="IDF3F33498D3E84CE799185B54BCD0A861"><enum>(iii)</enum><text display-inline="yes-display-inline">Care-related supplies and equipment.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="ID07EF17193D6B446B90E1B91C331A225A"><enum>(iv)</enum><text display-inline="yes-display-inline">Companion services.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="ID4D1AC843DDCE40E68E0091C787C1347E"><enum>(v)</enum><text display-inline="yes-display-inline">Congregate meals.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="ID8954189FF43D4B649E112DDBA48D7A00"><enum>(vi)</enum><text display-inline="yes-display-inline">Environmental modifications.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id8D2883E5D0584A6BAB8E6967BED549FF"><enum>(vii)</enum><text display-inline="yes-display-inline">Fiscal intermediary services.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="IDA35277EEE275447D8780E5CDA0777056"><enum>(viii)</enum><text display-inline="yes-display-inline">Home-delivered meals.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="IDB1D0C512B2504B35B65FD5DCE80EB2DA"><enum>(ix)</enum><text display-inline="yes-display-inline">Home health services.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="ID2F23DBDC9AEE460A85B13AA8093571BC"><enum>(x)</enum><text display-inline="yes-display-inline">Homemaker services (including chore
services).</text>
</clause><clause commented="no" display-inline="no-display-inline" id="ID599AB3F834864366A28FA102D64918F0"><enum>(xi)</enum><text display-inline="yes-display-inline">Mental and behavioral health
services.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="ID9F217E9A5D0642AAAECA0B717C6D0C08"><enum>(xii)</enum><text display-inline="yes-display-inline">Nutritional counseling.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="ID0209885C71C1413187C712918D6C1465"><enum>(xiii)</enum><text display-inline="yes-display-inline">Personal care services.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="ID2D3BE91266CA4C89ADB10267FB7D191E"><enum>(xiv)</enum><text display-inline="yes-display-inline">Personal emergency response systems.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="IDF92E583C3E6C4E37839E93A675BE93C8"><enum>(xv)</enum><text display-inline="yes-display-inline">Respite care.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="IDC73AD4C9449146A3AC3DC9E09C42A33F"><enum>(xvi)</enum><text display-inline="yes-display-inline">Telemedicine devices.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="IDD7E9171D3B40425D9FA4A46CEA9E4128"><enum>(xvii)</enum><text display-inline="yes-display-inline">Transition services for individuals who
have a plan that meets such requirements as a State shall establish, to
relocate from a nursing home to a home or community-based setting within 60
days.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="IDF01ABF07AE4E444482C77610BB4E09FE"><enum>(xviii)</enum><text display-inline="yes-display-inline">Transportation.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="ID533F7174BEC841A6BAA121F9CB734798"><enum>(xix)</enum><text display-inline="yes-display-inline">Any service or supply that a State
describes in its State plan and is approved by the Assistant Secretary.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="ID60CCF5CDB06A476FAEED0A1FB1D91B3D"><enum>(xx)</enum><text display-inline="yes-display-inline">Any service or supply that is requested by
an eligible individual (in coordination with the individual's service
coordinator) and that is approved by the State.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="IDF565829C1AEB40C3BB12EDA6A7D18D34"><enum>(B)</enum><header>Exclusions</header>
<clause commented="no" display-inline="no-display-inline" id="id0597AD9A2B1443CEBF5A83F6E955D2B0"><enum>(i)</enum><header>Service
coordination</header><text display-inline="yes-display-inline">Such term does
not include a service directly provided by the service coordinator for an
eligible individual as part of service coordination under this title.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="idF895105FC3CE42F5B82429FB842454FA"><enum>(ii)</enum><header>Services for
nursing home residents</header><text display-inline="yes-display-inline">Such
term does not include any service for a resident of a nursing home, except a
service described in subparagraph (A)(xvii).</text>
</clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID0C03F7E3D9CE4DE8956E9219773F1E3F"><enum>(4)</enum><header>Eligible
individual</header><text display-inline="yes-display-inline">The term
<term>eligible individual</term> means an individual—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="IDD5D0CE7C36114685AA5193FC8C42EC78"><enum>(A)</enum><text display-inline="yes-display-inline">who is age 60 or older;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID85E59806311F4695A4F2A52DF0F07561"><enum>(B)</enum><text display-inline="yes-display-inline">who is not eligible for medical assistance
under the medicaid program established under title XIX of the Social Security
(<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C.
1396</external-xref> et seq.);</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID2EBA143185ED47B4A8F03B9CEE5BD0B3"><enum>(C)</enum><text display-inline="yes-display-inline">who meets such income eligibility and total
asset criteria as a State may establish;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID46587815EA2543219BB46433FF65EA4C"><enum>(D)</enum><text display-inline="yes-display-inline">who—</text>
<clause commented="no" display-inline="no-display-inline" id="ID810265223FEA463D98943F76874E2D50"><enum>(i)</enum><subclause commented="no" display-inline="yes-display-inline" id="id5A5346E397A0431495CA724F75FBF2AF"><enum>(I)</enum><text display-inline="yes-display-inline">is unable to perform (without substantial
assistance from another individual) at least 2 activities of daily living (such
as eating, toileting, transferring, bathing, dressing, and continence);
or</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="idD4278495D8BB4BF2A099FE668DF1E295" indent="up1"><enum>(II)</enum><text display-inline="yes-display-inline">at the option of the State, is unable to
perform at least 3 such activities without such assistance;</text>
</subclause></clause><clause commented="no" display-inline="no-display-inline" id="ID5CA9B5FFD57948C187C4F9C22C04D04F"><enum>(ii)</enum><text display-inline="yes-display-inline">has a level of disability similar (as
determined by the State) to the level of disability described in clause (i);
or</text>
</clause><clause commented="no" display-inline="no-display-inline" id="ID3CC55F3797C8444FAF8C2594C359E108"><enum>(iii)</enum><text display-inline="yes-display-inline">requires substantial supervision due to
cognitive or mental impairment; and</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID4EA2C8D5FA514A6288E5403FB8BD1986"><enum>(E)</enum><text display-inline="yes-display-inline">who satisfies such other eligibility
criteria as the State may establish in accordance with such guidance as the
Assistant Secretary may provide.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDF54A73E20B904AB191DBCC78D44DCD0B"><enum>(5)</enum><header>Eligible
State</header><text display-inline="yes-display-inline">The term <term>eligible
State</term> means a State with an approved State plan under section
804.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id7B4471A4BE3549619BB26B3F8BB09521"><enum>(6)</enum><header>Fiscal
intermediary</header><text display-inline="yes-display-inline">The term
<term>fiscal intermediary</term> means an entity that—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="id94013BDF8FDF49B3A567987514A929A6"><enum>(A)</enum><text display-inline="yes-display-inline">assists individuals who choose to employ
providers of covered long-term care services or supplies directly, to—</text>
<clause commented="no" display-inline="no-display-inline" id="idCFEF008B63C346EA8417BB696DAB5E62"><enum>(i)</enum><text display-inline="yes-display-inline">carry out employer-related
responsibilities, as designated by a State with the approval of the Assistant
Secretary;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id330C8C6DED214D4582F57D41DA49F27A"><enum>(ii)</enum><text display-inline="yes-display-inline">assure compliance with Federal, State, and
local law; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id0C6F2791DC164FB498DBF234C4D2B24B"><enum>(iii)</enum><text display-inline="yes-display-inline">assure compliance with other requirements
designated by the State; and</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id091E14192C094C1A9B810736FDD7980D"><enum>(B)</enum><text display-inline="yes-display-inline">receives and disburses, as described in
section 806(b)(2)(B), payments described in section 806(b).</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id0908678037724BD195CF2B787EF84914"><enum>(7)</enum><header>Fiscal
intermediary service</header><text display-inline="yes-display-inline">The term
<term>fiscal intermediary service</term> means a service to enable an eligible
individual to carry out a responsibility described in subparagraph (A)(i) or
(B) of paragraph (6) or assure compliance with Federal, State, or local law, or
another requirement designated by the State.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID3EFCED09501F4627B88C9B33B6916818"><enum>(8)</enum><header>Long-term
care</header><text display-inline="yes-display-inline">The term <term>long-term
care</term> means a wide range of supportive social, health, and mental health
services for individuals who do not have the capacity for self-care due to
illness or frailty.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idB953409D98EB4A12B9EBFCC1CF953860"><enum>(9)</enum><header>Naturally
occurring retirement community</header><text display-inline="yes-display-inline">The term <term>naturally occurring
retirement community</term> means a residential area (such as an apartment
building, housing complex or development, or neighborhood) not originally built
for older individuals but in which a substantial number of individuals have
aged in place and become older individuals.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID1E297E175A0D4ECF876D4BEAD416CE26"><enum>(10)</enum><header>Nursing
home</header><text display-inline="yes-display-inline">The term <term>nursing
home</term> means—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="IDDF36E456CD0045F682FBB8515A9A9A25"><enum>(A)</enum><text display-inline="yes-display-inline">a nursing facility, as defined in
<external-xref legal-doc="act" parsable-cite="SSA/1919(a)">section
1919(a)</external-xref> of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r(a)">42 U.S.C. 1396r(a)</external-xref>);</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="IDD5912130461744E7AEAFCADA8CFCB005"><enum>(B)</enum><text display-inline="yes-display-inline">a skilled nursing facility, as defined in
section 1819(a) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i-3(a)">42 U.S.C. 1395i–3(a)</external-xref>);
and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="IDC0B15BB3A9254C67BE9F2293060C1A8B"><enum>(C)</enum><text display-inline="yes-display-inline">a residential care facility that directly
provides care or services described in paragraph (1) of
<external-xref legal-doc="act" parsable-cite="SSA/1919(a)">section
1919(a)</external-xref> of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r(a)">42 U.S.C. 1396r(a)</external-xref>) but does
not receive payment for such care or services under the medicare or medicaid
programs established under titles XVIII and XIX, respectively, of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395</external-xref> et
seq., 1396 et seq.).</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID885E937B2FAE4187B296E033B7C95E05"><enum>(11)</enum><header>Qualified
provider</header><text display-inline="yes-display-inline">The term
<term>qualified provider</term> means a provider of covered long-term care
services or supplies who meets such licensing, quality, and other standards as
the State may establish.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID848388DFF0B14D8BAA7D8FE74ABF7756"><enum>(12)</enum><header>Representative</header><text display-inline="yes-display-inline">The term <quote>representative</quote>
means a person appointed by the eligible individual, or legally acting on the
individual's behalf, to represent or advise the individual in financial or
service coordination matters.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDFEF917693AAB40E881BD9F3A98A31957"><enum>(13)</enum><header>Service
coordination</header><text display-inline="yes-display-inline">The term
<term>service coordination</term> means a service that—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="id35ED40EA171D46348907E92F2FD57923"><enum>(A)</enum><text display-inline="yes-display-inline">is provided to an eligible individual, at
the direction of the eligible individual or a representative of the eligible
individual (as appropriate); and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idE35E56165CA444829A3CA55D9C621255"><enum>(B)</enum><text display-inline="yes-display-inline">consists of facilitating consumer choice or
carrying out—</text>
<clause commented="no" display-inline="no-display-inline" id="id24A8D74F7B2F497AACA6F2EA8E10AED8"><enum>(i)</enum><text display-inline="yes-display-inline">a function described in section 805;
or</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id255AF6B9C3CB4134A443D7D3F84C25F8"><enum>(ii)</enum><text display-inline="yes-display-inline">a function described in section 804(9), as
determined appropriate by the State involved.</text>
</clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idA0A4354535D14EC3A3A3EE444591945B"><enum>(14)</enum><header>Service
coordinator</header><text display-inline="yes-display-inline">The term
<term>service coordinator</term> means an individual who—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="idAA27E0989F9F480B9D020ED1B1A4888E"><enum>(A)</enum><text display-inline="yes-display-inline">provides service coordination for an
eligible individual; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id06668147CA23477FA98995652B26A59E"><enum>(B)</enum><text display-inline="yes-display-inline">is trained or experienced in the skills
that are required to facilitate consumer choice and carry out the functions
described in paragraph (13)(B).</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDBF67C85D48E6458C970B6B80BBA6B6CF"><enum>(15)</enum><header>State</header><text display-inline="yes-display-inline">The term <term>State</term> means each of
the 50 States, the District of Columbia, the Commonwealth of Puerto Rico, Guam,
the United States Virgin Islands, American Samoa, and the Commonwealth of the
Northern Mariana Islands.</text>
</paragraph></section><section commented="no" display-inline="no-display-inline" id="idBD702B161F144E21AB2DD34C2F8A50B4" section-type="subsequent-section"><enum>802.</enum><header>Allotments to
eligible States</header>
<subsection commented="no" display-inline="no-display-inline" id="idFBBBEA5207A44C0A9859056FCA7D83F1"><enum>(a)</enum><header>Allotments</header>
<paragraph commented="no" display-inline="no-display-inline" id="id84146A55DEAA40BF8AF51DA50CBADA12"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">The Assistant
Secretary shall make an allotment to each eligible State for a fiscal year, to
enable the State to carry out a program that pays for the Federal share of the
cost of providing covered long-term care services and supplies for eligible
individuals under this title. The Assistant Secretary shall make the allotment
in an amount determined under section 803.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id4A80FAAD9DA443C0A7846EACC8627173"><enum>(2)</enum><header>Limitations</header><text display-inline="yes-display-inline">From an allotment made under paragraph (1)
for a program carried out in a State under this title for a fiscal year, not
more than 15 percent may be used to pay for administrative costs (other than
service coordination) of the program.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idF866525C1E8247B9AAC91003CAA0F7A5"><enum>(b)</enum><header>Federal
share</header><text display-inline="yes-display-inline">From that allotment for
that fiscal year—</text>
<paragraph commented="no" display-inline="no-display-inline" id="id552A407FF7D041809723EB281280A628"><enum>(1)</enum><text display-inline="yes-display-inline">funds from the allotment shall be available
to such State for paying a Federal share equal to such percentage as the State
determines to be appropriate, but not more than 75 percent, of the cost of
administration of the program carried out in the State under this title;
and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id426FCF937BD44F8AB34C47CA56B18A47"><enum>(2)</enum><text display-inline="yes-display-inline">the remainder of such allotment shall be
available to such State only for paying a Federal share equal to such
percentage as the State determines to be appropriate, but not more than 85
percent, of the cost of providing covered long-term care services and supplies
through the program.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id47E1F8E91253490EAF1B7E71FC455B15"><enum>(c)</enum><header>Supplement, not
supplant</header><text display-inline="yes-display-inline">Allotments made to a
State under this section shall supplement and not supplant other Federal or
State payments that are made for the provision of long-term care services or
supports under—</text>
<paragraph commented="no" display-inline="no-display-inline" id="idC88872F6873E4CA090CEA2F15E5170E8"><enum>(1)</enum><text display-inline="yes-display-inline">the medicaid program carried out under
title XIX of the Social Security Act (42 U.S.C. 1396 et seq.);</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idAB03A624901B47B4A597A36E7018D583"><enum>(2)</enum><text display-inline="yes-display-inline">a program funded under title XX of such Act
(42 U.S.C. 1397 et seq.);</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id79BE2436F3204783873347CF3027C338"><enum>(3)</enum><text display-inline="yes-display-inline">a program funded under title III of this
Act; or</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id3F314F00BB7C44FF8109A9996DE053DB"><enum>(4)</enum><text display-inline="yes-display-inline">any other Federal or State program.</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="id0B89DCFA99874ED19B2346580F1C9F89" section-type="subsequent-section"><enum>803.</enum><header>Allotments</header>
<subsection commented="no" display-inline="no-display-inline" id="id0B81861DD42B444BB8F10FD4E72A2C8C"><enum>(a)</enum><header>Allotments</header>
<paragraph commented="no" display-inline="no-display-inline" id="id65288DAF11F3445C95AA480B6AE97E42"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Subject to subsection
(b), from sums appropriated for a fiscal year to carry out this title, the
Assistant Secretary shall allot to each eligible State an amount that bears the
same relationship to such sums as the number of individuals who are age 60 or
older and whose income does not exceed 100 percent of the poverty line who
reside in the State bears to the total number of such individuals who reside in
all States.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id28FC9212E1F545D88250DF0C0D6139F7"><enum>(2)</enum><header>Data</header><text display-inline="yes-display-inline">For purposes of paragraph (1), the number
of individuals described in that paragraph shall be determined on the basis of
the most recent available data from the Bureau of the Census.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id698A9E2646434DEE88F5789C59512FF0"><enum>(3)</enum><header>Definition</header><text display-inline="yes-display-inline">In paragraph (1), the term
<term>State</term> does not include a State specified in subsection (b).</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id33729B5731064CAD95B6DACA5F1C39A0"><enum>(b)</enum><header>Allotments to
territories</header><text display-inline="yes-display-inline">Of the sums
appropriated for a fiscal year to carry out this title, the Assistant Secretary
shall allot an amount equal to 0.25 percent of such sums among the following
commonwealths and territories according to the percentage specified for each
such commonwealth or territory:</text>
<paragraph commented="no" display-inline="no-display-inline" id="id2C483796342E468DA1A45C7F87AE18FE"><enum>(1)</enum><text display-inline="yes-display-inline">The Commonwealth of Puerto Rico, 91.6
percent.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id42D01A1770584529A73933831D2DF429"><enum>(2)</enum><text display-inline="yes-display-inline">Guam, 3.5 percent.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id3C5712D90BA348BDB9FF25785D2E77B8"><enum>(3)</enum><text display-inline="yes-display-inline">The United States Virgin Islands, 2.6
percent.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idD9F1027CF45347B2B9B91B9AA82FB075"><enum>(4)</enum><text display-inline="yes-display-inline">American Samoa, 1.2 percent.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id08DFC88DC1C940DB909A2FD2FBCD2C51"><enum>(5)</enum><text display-inline="yes-display-inline">The Commonwealth of the Northern Mariana
Islands, 1.1 percent.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idE0CFA2BD58034032BF80119D7CD26548"><enum>(c)</enum><header>Availability of
amounts allotted</header>
<paragraph commented="no" display-inline="no-display-inline" id="id628E22F703F945E387F68108A4819054"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Except as provided in
paragraph (2), an amount allotted to an eligible State for a fiscal year shall
remain available for expenditure by the State for the 2 succeeding fiscal
years.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id0B9445C398644CAAB7BD3979EAB42007"><enum>(2)</enum><header>Availability of
redistributed amounts</header><text display-inline="yes-display-inline">An
amount redistributed to an eligible State under subsection (d) in a fiscal year
shall be available for expenditure by the State for the succeeding fiscal
year.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="ID7EE8EA00A1B845F3BD5F91590E9BC769"><enum>(d)</enum><header>Redistribution
of unspent funds</header><text display-inline="yes-display-inline">An amount
that is not expended by an eligible State during the period in which such
amount is available under subsection (c) shall be redistributed by the
Assistant Secretary according to a formula determined by the Assistant
Secretary that takes into account the extent to which an eligible State has
exhausted, or is likely to exhaust, its allotment for that fiscal year.</text>
</subsection></section><section commented="no" display-inline="no-display-inline" id="IDAA1964BBBCE541A79792755D7B6FB692" section-type="subsequent-section"><enum>804.</enum><header>State plans</header>
<subsection commented="no" display-inline="no-display-inline" id="id9631E4B4CDC1499CAA9F7BA3805CF7F1"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">In order to receive
an allotment made under section 802 for an eligible State for a fiscal year,
the State shall submit to the Assistant Secretary for approval a State plan
that includes the information and assurances described in subsection
(b).</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="id6307EF3B51F645C5836FB2E137488DF7"><enum>(b)</enum><header>Contents</header>
<paragraph commented="no" display-inline="no-display-inline" id="IDCDAAEEA04C9E412F8043884ECD83F4A0"><enum>(1)</enum><header>Eligibility</header><text display-inline="yes-display-inline">The plan shall include descriptions of the
eligibility criteria and methodologies that the State will apply, consistent
with section 801(4), to determine whether an individual is an eligible
individual for the program carried out in the State under this title.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idF9E10819B5204B2FB5CDD321927BB420"><enum>(2)</enum><header>Priority for
eligible individuals with greatest economic need</header><text display-inline="yes-display-inline">The plan shall include an assurance that,
in establishing and applying the eligibility criteria and methodologies
described in paragraph (1), the State will give priority to providing
assistance to those eligible individuals who have the greatest economic need,
as defined by the State.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDFEA7C81B47FE493EAB9720865E2B0A21"><enum>(3)</enum><header>Needs and
preferences of eligible individuals</header><text display-inline="yes-display-inline">The plan shall include a description of how
the State will ensure that the needs and preferences of an eligible individual
are addressed in all aspects of the program.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idD5925C761A1C4451824D626A13CF67C7"><enum>(4)</enum><header>Payments for
services</header><text display-inline="yes-display-inline">The plan shall
include an assurance that the State will make payments, at the election of an
eligible individual, in accordance with section 806(b)(2), and will provide a
fiscal intermediary for each eligible individual electing to receive a payment
as described in section 806(b)(2)(B).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id0EE011A64BD6425895BC4C0FA3F7872E"><enum>(5)</enum><header>Services and
supplies</header><text display-inline="yes-display-inline">The plan shall
describe the services and supplies that the State will make available to an
eligible individual, consistent with the definition of covered long-term
services or supplies specified in section 801(3).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID20E9EF2546654B03A9D425A0D720863E"><enum>(6)</enum><header>Cost-sharing</header><text display-inline="yes-display-inline">The plan shall include a description of the
methodologies to be used—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="ID0A738323551D476B8ED70C0EF2EE2948"><enum>(A)</enum><text display-inline="yes-display-inline">to calculate the ability of an eligible
individual to pay for covered long-term care services or supplies without
assistance under the program carried out under this title;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID7DF04B8C753E4137B149C4A25782482B"><enum>(B)</enum><text display-inline="yes-display-inline">based on the calculation of ability to pay,
to determine the amount of cost-sharing that the eligible individual will be
responsible for under the program, set on a sliding scale based on
income;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id065D5CDE959146C1B2304944DAE9085C"><enum>(C)</enum><text display-inline="yes-display-inline">to collect cost-sharing amounts, both in
cases in which the State makes payments directly to a qualified provider as
described in section 806(b)(2)(A), and in cases in which the State makes
payments to a fiscal intermediary on behalf of an eligible individual, as
described in section 806(b)(2)(B); and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idE18EE22D85D948AFA465C3D1FDE9EA98"><enum>(D)</enum><text display-inline="yes-display-inline">to track expenditures by eligible
individuals for the purchase of covered long-term care services or
supplies.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id2E265E388F584FCEA3AE2FAD55E0DDD9"><enum>(7)</enum><header>Cost-sharing
requirements for providers</header><text display-inline="yes-display-inline">The plan shall provide an assurance that
the State will require each provider involved in the program carried out in the
State under this title—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="IDc38edb9c2f69496dbe98e26e61489050"><enum>(A)</enum><text display-inline="yes-display-inline">to protect the privacy and confidentiality
of each eligible individual with respect to the income, and any cost-sharing
amount determined under paragraph (6), of an eligible individual;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID6798732763384dc8b06877586201e831"><enum>(B)</enum><text display-inline="yes-display-inline">to establish appropriate procedures to
account for cost-sharing amounts; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="IDaf5a672c97984d54b17bfbf5611af9e5"><enum>(C)</enum><text display-inline="yes-display-inline">to widely distribute State-created written
materials in languages reflecting the reading abilities of eligible individuals
that describe the criteria for cost-sharing, and the State's sliding scale
described in paragraph (6)(B).</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDE1BF3803951B41A799C6986C6D307026"><enum>(8)</enum><header>Coordination
with other programs</header><text display-inline="yes-display-inline">The plan
shall include a description of the methods by which the State will, as
appropriate, refer individuals who apply for assistance under a program carried
out under this title for eligibility determinations under—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="id85B6A9CCCE7443D2931A1F7F8EDCC730"><enum>(A)</enum><text display-inline="yes-display-inline">the State medicaid program carried out
under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.);</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idB0162AF8ECC74FED9E204E9864B49F88"><enum>(B)</enum><text display-inline="yes-display-inline">the medicare program carried out under
title XVIII of such Act (42 U.S.C. 1395 et seq.);</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idDD1607134AF044E6B340706DAD50ACDD"><enum>(C)</enum><text display-inline="yes-display-inline">a program funded under title XX of such Act
(42 U.S.C. 1397 et seq.);</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id058B8CDCF70B4630B129B049B1266BCA"><enum>(D)</enum><text display-inline="yes-display-inline">other programs funded under this Act;
and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idCE4C4D82B0CB4BAD9FCDF137D587B48A"><enum>(E)</enum><text display-inline="yes-display-inline">other Federal or State programs that
provide long-term care.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID5EC0125B348C4CF1BDB8EC00916394C7"><enum>(9)</enum><header>Entities and
procedures</header><text display-inline="yes-display-inline">The plan shall
include a description of the entities and procedures that the State will use to
carry out the following functions:</text>
<subparagraph commented="no" display-inline="no-display-inline" id="ID404EA6F6A00E4F1DAC8FC90D8227BF55"><enum>(A)</enum><text display-inline="yes-display-inline">Establishing eligibility for the program
carried out under this title.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID387E8078B80240E489BE45A015FB93A6"><enum>(B)</enum><text display-inline="yes-display-inline">Assessing the need of an eligible
individual for covered long-term care services or supplies.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idF74F270669254DE6B1B7A867CEA1AE83"><enum>(C)</enum><text display-inline="yes-display-inline">Determining the amount of payments
described in section 806(b) to be made for the eligible individual under the
program.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idA15CF71752804B0D83FA1F3498182532"><enum>(D)</enum><text display-inline="yes-display-inline">Evaluating the cost-sharing by the eligible
individual under the program.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID87AF5C3C0F084A79A5D64AACFA0A89C5"><enum>(E)</enum><text display-inline="yes-display-inline">In the case of an eligible individual who
elects to receive payments as described in section 806(b)(2)(B), helping the
eligible individual or the eligible individual’s representative (as
appropriate) identify, retain, and negotiate and terminate agreements with,
qualified providers of covered long-term services or supplies.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID5777C5A0B6AD4098A7786C6E16813E0B"><enum>(F)</enum><text display-inline="yes-display-inline">Monitoring payments made for an eligible
individual to ensure that—</text>
<clause commented="no" display-inline="no-display-inline" id="ID0E435570B0CB439586C776AE10202A06"><enum>(i)</enum><text display-inline="yes-display-inline">the cost-sharing amounts that the eligible
individual is responsible for under the State plan are paid;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="ID8F23854AEDD948F7961D27D7CD92A9FC"><enum>(ii)</enum><text display-inline="yes-display-inline">the payments made by the State for the
eligible individual—</text>
<subclause commented="no" display-inline="no-display-inline" id="IDC562A277747A4B1B9E1D4801FE453199"><enum>(I)</enum><text display-inline="yes-display-inline">are made in a timely fashion; and</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="ID5884325C025542CA8A939C996F66C393"><enum>(II)</enum><text display-inline="yes-display-inline">do not exceed the annual assistance amount
established for the eligible individual under section 806(a); and</text>
</subclause></clause><clause commented="no" display-inline="no-display-inline" id="ID76093C84F400404CB711C721E518E2DA"><enum>(iii)</enum><text display-inline="yes-display-inline">when appropriate, the payments are made by
the State in an expedited manner to account for health status changes of an
eligible individual that require rapid responses.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID90C775F399294795A15AC779FE390A4C"><enum>(G)</enum><text display-inline="yes-display-inline">Establishing a quality assurance system
that assesses the covered long-term services or supplies provided for the
eligible individual to ensure that the qualified provider of such services or
supplies meets such licensing, quality, or other standards as the State may
establish in accordance with paragraph (11).</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idA56BD2A486884CA3B916B6D5E247E2E6"><enum>(H)</enum><text display-inline="yes-display-inline">Providing information to eligible
individuals about average market rates for covered long-term care services or
supplies.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id28E365AA58D442289F125F98AA96F53D"><enum>(I)</enum><text display-inline="yes-display-inline">Administering payments in a timely fashion
and in accordance with a written care plan described in section 805(1) for an
eligible individual (that takes into account payment rates established by the
eligible individual or a representative of the eligible individual (as
appropriate)), including the methods for—</text>
<clause commented="no" display-inline="no-display-inline" id="idE688BFCDC3C74FB492DC519DAF869B19"><enum>(i)</enum><text display-inline="yes-display-inline">making payments directly to a qualified
provider as described in section 806(b)(2)(A);</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id281442CC79C54390962DFDD8694EF316"><enum>(ii)</enum><text display-inline="yes-display-inline">making payments to a fiscal intermediary on
behalf of an eligible individual, as described in section 806(b)(2)(B), for the
purchase of such services or supplies; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="idE8749649EA694E2F99AAD84AE924D3E0"><enum>(iii)</enum><text display-inline="yes-display-inline">making payments (when appropriate) in an
expedited manner to account for health status changes of the eligible
individual that require rapid responses.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID97A8D46FC9E94C92A475FCECFC05B56C"><enum>(J)</enum><text display-inline="yes-display-inline">Carrying out such other activities as the
eligible State determines are appropriate with respect to the eligible
individual or the program carried out under this title.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID8342CF7F29FD4A9482427A1A9805F253"><enum>(10)</enum><header>Service
coordinators</header><text display-inline="yes-display-inline">The plan shall
include a description of how the State will—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="ID23665CBBA7FF4D64846D698EA7BA3A1E"><enum>(A)</enum><text display-inline="yes-display-inline">provide a service coordinator (directly or
by contract) for each eligible individual receiving assistance under the
program carried out under this title; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID29E554561CEF4254B02E6ABA01EE1D73"><enum>(B)</enum><text display-inline="yes-display-inline">ensure that the service coordinator carries
out the responsibilities described in section 805, including any
responsibilities assigned by the State under section 805(5).</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDAB004566CC5345AEA80C6B7F0B10D12E"><enum>(11)</enum><header>Qualified
providers</header><text display-inline="yes-display-inline">The plan shall
include a description of any licensing, quality, or other standards for
qualified providers (including both providers paid directly by the State as
described in section 806(b)(2)(A) or through payments made to a fiscal
intermediary on behalf of an eligible individual, as described in section
806(b)(2)(B).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDF742EFE621E14E039BAE4E16A8835D2E"><enum>(12)</enum><header>Quality
assurance</header><text display-inline="yes-display-inline">The plan shall
include a description of the procedures to be used to ensure the quality and
appropriateness of the covered long-term care services or supplies provided to
an eligible individual and the program carried out under this title, which
shall include—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="IDEF46A126E36D43F98A59931D381EE794"><enum>(A)</enum><text display-inline="yes-display-inline">a quality assessment and improvement
strategy that establishes—</text>
<clause commented="no" display-inline="no-display-inline" id="IDF47FE553F779471DABA47D1762765A8E"><enum>(i)</enum><text display-inline="yes-display-inline">standards that provide for access to
covered long-term care services or supplies within reasonable time frames and
that are designed to ensure the continuity and adequacy of such services or
supplies; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="ID14287D16F85E47A3AFF529171C54A560"><enum>(ii)</enum><text display-inline="yes-display-inline">procedures for monitoring and evaluating
the quality and appropriateness of the covered long-term care services or
supplies provided to eligible individuals under the program carried out under
this title; and</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id3E4CF223CD3742F8AF3E1A25B99244B0"><enum>(B)</enum><text display-inline="yes-display-inline">a mechanism for obtaining feedback from
eligible individuals and others regarding their experiences with, and
recommendations for improvement of, the program carried out under this
title.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID46560ABF30B54F9CBDCAB6F040D3B484"><enum>(13)</enum><header>Outreach</header><text display-inline="yes-display-inline">The plan shall include a description of the
procedures by which the State will conduct outreach for enrollment (including
outreach to persons residing in naturally occurring retirement communities) in
the program carried out under this title.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDDEB0BDF73A6C4FAA96D3FBE3AB3BF0C0"><enum>(14)</enum><header>Indians</header><text display-inline="yes-display-inline">The plan shall include a description of the
procedures by which the State will ensure the provision of assistance under the
program carried out under this title to eligible individuals who are Indians
(as defined in section 4(c) of the <act-name parsable-cite="IHCIA">Indian
Health Care Improvement Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/25/1603(c)">25 U.S.C. 1603(c))</external-xref>) or Native
Hawaiians, as defined in section 625.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDBBF0A443F4624941B1DA03C46AB4BC9B"><enum>(15)</enum><header>Data
collection</header><text display-inline="yes-display-inline">The plan shall
include an assurance that the State will annually collect and report to the
Assistant Secretary such data and information related to the program carried
out under this title as the Assistant Secretary may require, including the
information required under section 807(a)(1)(B).</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="ID3A34897BB0DC46E6AFF15608DD5B2D2C" section-type="subsequent-section"><enum>805.</enum><header>Responsibilities of
service coordinators</header><text display-inline="no-display-inline">Each
eligible State shall ensure that the service coordinator for an eligible
individual receiving assistance under the program carried out under this title,
at a minimum, carries out the following responsibilities:</text>
<paragraph commented="no" display-inline="no-display-inline" id="id1097F80D46BD421C96ADE0D339A5E682"><enum>(1)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id9F61293BB7F74CCB803B287C34054CC1"><enum>(A)</enum><text display-inline="yes-display-inline">Assisting an eligible individual and the
eligible individual’s representative (as appropriate) with the development of a
written care plan for the eligible individual that—</text>
<clause commented="no" display-inline="no-display-inline" id="ID0CEAEBF7DDE248BCA5A938EB1EC5CB5F" indent="up1"><enum>(i)</enum><text display-inline="yes-display-inline">specifies the covered long-term care
services or supplies that best meet the needs and preferences of the eligible
individual; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="ID014466DD8379494FA46BF854B4DF8F65" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">takes into account the ability of
caregivers to provide adequate and safe care.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id8C7874EFBB32454CA85C25E0D20BCA19" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">Assuring that the care plan is coordinated
with other care plans that may be developed for the eligible individual under
other Federal or State programs (including care plans applicable to naturally
occurring retirement communities).</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID8B1403C1B24D4A828BB9DC88BE22A76A"><enum>(2)</enum><text display-inline="yes-display-inline">Reassessing and, as appropriate, assisting
with revising the care plan for the eligible individual—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="ID919C8DDB9A4D45F4A145EFE3E842A376"><enum>(A)</enum><text display-inline="yes-display-inline">not less than annually; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID5F8C0B35D4784FEEAB01BC270B8C468D"><enum>(B)</enum><text display-inline="yes-display-inline">whenever there is a change of health status
or other event that requires a reassessment of the care plan.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID215BA72955D3472B9D662D9E4799ADC9"><enum>(3)</enum><text display-inline="yes-display-inline">Educating—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="idF3976F20902A491C9154C062D12D718F"><enum>(A)</enum><text display-inline="yes-display-inline">an eligible individual who elects to
receive payments as described in section 806(b)(2)(B) about available qualified
providers of covered long-term care services or supplies; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id62EE7A35AEE74208ABF4AE3516F9F3D5"><enum>(B)</enum><text display-inline="yes-display-inline">an eligible individual about specific
covered long-term care services or supplies.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDD611C3BC9BFA49C1894DB3AC877068A5"><enum>(4)</enum><text display-inline="yes-display-inline">Recommending, as appropriate, methods for
community integration for an eligible individual who resides in a nursing home
and who is relocating to a home or community-based setting.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id99AE5FBD3470469CB0502BDB6392A37E"><enum>(5)</enum><text display-inline="yes-display-inline">Carrying out any other responsibilities
assigned to the service coordinator by the State.</text>
</paragraph></section><section commented="no" display-inline="no-display-inline" id="IDA287AC0F95B040ACB0C21CD6DF454530" section-type="subsequent-section"><enum>806.</enum><header>Payments for covered
long-term care services or supplies</header>
<subsection commented="no" display-inline="no-display-inline" id="ID0A0A2D9D99D241B580F0D0A56D09F7C0"><enum>(a)</enum><header>Annual
assistance amount</header>
<paragraph commented="no" display-inline="no-display-inline" id="ID27AAD681B9E342439F7078E955F0C926"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Subject to paragraph
(2), an eligible State shall establish an annual assistance amount for each
eligible individual enrolled in the program carried out under this title based
on an assessment of the eligible individual.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idB03ABD3890324BB0B6A0BC4385197B19"><enum>(2)</enum><header>Cost-sharing
amount</header><text display-inline="yes-display-inline">The State shall
subtract from the annual assistance amount the individual's cost-sharing amount
determined under section 804(b)(6) to obtain the amount of the payments
described in subsection (b).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID3DDC56358FE14AD4B22C5F2F9FEF105B"><enum>(3)</enum><header>Limitation</header><text display-inline="yes-display-inline">The annual assistance amount made for an
eligible individual under a program carried out under this title may not
exceed—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="ID63EFDD1EB37A47C3B736418812A4E0D4"><enum>(A)</enum><text display-inline="yes-display-inline">in the case of fiscal year 2007, $8,000;
and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID23BDDB4DBA064435823E0EAB5F1022FE"><enum>(B)</enum><text display-inline="yes-display-inline">in the case of any subsequent fiscal year,
the amount described in this paragraph for the preceding fiscal year increased
by the percentage increase in the Consumer Price Index for all urban consumers
(all items: U.S. city average) for the preceding fiscal year.</text>
</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="IDB87C46B3B18A4892A95E219944904CB6"><enum>(b)</enum><header>Payments</header>
<paragraph commented="no" display-inline="no-display-inline" id="id9B100224E7E14F1B84D3AD78E7F62052"><enum>(1)</enum><header>Written care
plans</header><text display-inline="yes-display-inline">Under a program carried
out under this title, an eligible State (or its designee) shall make payments
for the provision or purchase of covered long-term care services or supplies
for eligible individuals in accordance with the written care plans established
for such individuals.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id754353ADC72A4A17ABD416A091EDCAD6"><enum>(2)</enum><header>Elections</header><text display-inline="yes-display-inline">At the election of an eligible individual,
the payments shall be made by the State (or its designee)—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="id38E42C67B9774AD7AE5B8A041CBCA372"><enum>(A)</enum><text display-inline="yes-display-inline">directly to a qualified provider of covered
long-term care services or supplies; or</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id334C290A3926413D85C1B3078C9231F9"><enum>(B)</enum><text display-inline="yes-display-inline">to a fiscal intermediary on behalf of the
eligible individual, to enable the fiscal intermediary to disburse the payments
for the purchase of such services or supplies—</text>
<clause commented="no" display-inline="no-display-inline" id="id6108379DD89B4A88A057BE58A51A937B"><enum>(i)</enum><text display-inline="yes-display-inline">in advance to the provider or the eligible
individual; or</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id436238ED9DA741AAA6240BBF08032A9B"><enum>(ii)</enum><text display-inline="yes-display-inline">as reimbursement for the eligible
individual.</text>
</clause></subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idD9CA923C9C8A49E6808DAB87BD8F47A8"><enum>(c)</enum><header>Limitations</header><text display-inline="yes-display-inline">In making payments under this section, a
State shall ensure that not more than 10 percent of the funds made available to
the State under section 802(a) shall be used to pay for service
coordination.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="ID77DEAA19116D4F34BAC62D0A4F757696"><enum>(d)</enum><header>Exclusion from
income</header><text display-inline="yes-display-inline">Payments made for an
eligible individual under this section for a program carried out under this
title shall not be—</text>
<paragraph commented="no" display-inline="no-display-inline" id="ID07CF4AEFEDE046EFB5721B084A44CF6B"><enum>(1)</enum><text display-inline="yes-display-inline">included in the gross income of the
eligible individual for purposes of the Internal Revenue Code of 1986;
or</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID11B05753DA7546A9A4A33AAD14AE05B2"><enum>(2)</enum><text display-inline="yes-display-inline">treated as income, assets, or benefits, or
otherwise be taken into account, for purposes of determining the individual’s
eligibility for, the amount of benefits under, or the amount of cost-sharing
required by, any other Federal or State program.</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="ID33E01E1170FE44C1A1F819B79380B447" section-type="subsequent-section"><enum>807.</enum><header>Annual
reports</header>
<subsection commented="no" display-inline="no-display-inline" id="IDC8B722A9DA8F4CD58C26CC6F15D8E273"><enum>(a)</enum><header>State
reports</header>
<paragraph commented="no" display-inline="no-display-inline" id="ID88DC16DAF171439298D3F09B5AECBCC6"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Each eligible State
shall—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="IDFE8F0C4500FD45868DCDF425B1FD2461"><enum>(A)</enum><text display-inline="yes-display-inline">evaluate the establishment and operation of
the State plan under this title in each fiscal year for which the State
receives allotments under section 802; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID99607BA054194B9E9B61C3BD2DC7BD19"><enum>(B)</enum><text display-inline="yes-display-inline">prepare and submit to the Assistant
Secretary, not later than January 1 of the succeeding fiscal year, a report
that includes the following:</text>
<clause commented="no" display-inline="no-display-inline" id="IDF1B640403E6D4BFB88DBBEAE37B9E360"><enum>(i)</enum><text display-inline="yes-display-inline">The number of total unduplicated eligible
individuals and the amount of expenditures made for the individuals, analyzed
by type of payment specified in subparagraph (A) or (B) of section 806(b)(2) in
the program carried out under this title in the State.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="ID6622C14FFA30404EA2CB9C3C0A6A0C00"><enum>(ii)</enum><text display-inline="yes-display-inline">The number of eligible individuals in the
program that received each of the categories of covered long-term care services
or supplies described in clauses (i) through (xx) of section 801(3)(A),
analyzed, for each category by type of payment specified in subparagraph (A) or
(B) of section 806(b)(2).</text>
</clause><clause commented="no" display-inline="no-display-inline" id="ID8A308387DF1246229F58E6868EEE1596"><enum>(iii)</enum><text display-inline="yes-display-inline">The total amount of cost-sharing amounts
that the State received from eligible individuals in the program.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="IDA988DF8B37AB4BF8A421E4C52AA11653"><enum>(iv)</enum><text display-inline="yes-display-inline">Information on the age and income of the
eligible individuals.</text>
</clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID54EACD4DED6E48A8ADA4E42316C24D60"><enum>(2)</enum><header>Format</header><text display-inline="yes-display-inline">The Assistant Secretary shall provide
guidance to eligible States regarding the format for the information included
in the report required under paragraph (1) in such manner as to allow for
comparison of the information provided across such States.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDD295421D9A6C4F8FBB4E1B4DE379D7ED"><enum>(3)</enum><header>Public
availability</header><text display-inline="yes-display-inline">The Assistant
Secretary shall make the State reports submitted under paragraph (1) available
to the public.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id3A98D2CCCC184224B2FC3A2B6A548D1E"><enum>(b)</enum><header>Reports by
fiscal intermediaries and qualified providers</header><text display-inline="yes-display-inline">The State shall require fiscal
intermediaries and qualified providers participating in the program carried out
in the State under this title to prepare and submit to the State, not less
often than twice a year, reports containing such information as is necessary
for the State to meet the reporting requirements described in subsection (a)
and as is necessary for the administration of the program.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="idD316A522030546F1954F6D39000C7E81"><enum>(c)</enum><header>Report to
Congress</header><text display-inline="yes-display-inline">At the end of each
fiscal year, the Assistant Secretary shall prepare and submit to the Committee
on Education and the Workforce of the House of Representatives and the
Committee of Health, Education, Labor, and Pensions of the Senate a report that
contains a summary of the data submitted under subsection (a)(1)(B) and a
description of any implementations issues with the programs carried out under
this title.</text>
</subsection></section><section commented="no" display-inline="no-display-inline" id="IDDED894B3F3E6469FA9D08B7D3C5FF44E" section-type="subsequent-section"><enum>808.</enum><header>Authorization of
appropriations</header><text display-inline="no-display-inline">There are
authorized to be appropriated to the Secretary to carry out this title, such
sums as may be necessary for each of fiscal years 2007 through
2012.</text>
</section>.