II 109th CONGRESS 1st Session S. 401 IN THE SENATE OF THE UNITED STATES February 16, 2005 Mr. Harkin (for himself, Mr. Specter, Mr. Kennedy, Mr. Kerry, Mr. Biden, Mr. Dayton, Ms. Landrieu, Mr. Schumer, Mr. Corzine, Mr. Lautenberg, Mr. Lieberman, and Mr. Dodd) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes.

1.

Short title; table of contents

(a)

Short title

This Act may be cited as the Medicaid Community-Based Attendant Services and Supports Act of 2005. (b)

Table of contents

The table of contents for this Act is as follows: Sec. 1. Short title; table of contents. Sec. 2. Findings and purposes. Title I—Establishment of medicaid plan benefit Sec. 101. Coverage of community-based attendant services and supports under the medicaid program. Sec. 102. Enhanced FMAP for ongoing activities of early coverage States that enhance and promote the use of community-based attendant services and supports. Sec. 103. Increased Federal financial participation for certain expenditures. Title II—Promotion of systems change and capacity building Sec. 201. Grants to promote systems change and capacity building. Sec. 202. Demonstration project to enhance coordination of care under the medicare and medicaid programs for non-elderly dual eligible individuals.

2.

Findings and purposes

(a)

Findings

Congress makes the following findings: (1) Long-term services and supports provided under the medicaid program established under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) must meet the ability and life choices of individuals with disabilities and older Americans, including the choice to live in one’s own home or with one’s own family and to become a productive member of the community. (2) Research on the provision of long-term services and supports under the medicaid program (conducted by and on behalf of the Department of Health and Human Services) has revealed a significant funding bias toward institutional care. Only about 33 percent of long term care funds expended under the medicaid program, and only about 11 percent of all funds expended under that program, pay for services and supports in home and community-based settings. (3) In the case of medicaid beneficiaries who need long term care, the only long-term care service currently guaranteed by Federal law in every State is nursing home care. Only 30 States have adopted the benefit option of providing personal care services under the medicaid program. Although every State has chosen to provide certain services under home and community-based waivers, these services are unevenly available within and across States, and reach a small percentage of eligible individuals. In fiscal year 2003, only 7 States spent 50 percent or more of their medicaid long term care funds under the medicaid program on home and community-based care. (4) The goals of the Nation properly include providing families of children with disabilities, working-age adults with disabilities, and older Americans with— (A) a meaningful choice of receiving long-term services and supports in the most integrated setting appropriate to their needs; (B) the greatest possible control over the services received and, therefore, their own lives and futures; and (C) quality services that maximize independence in the home and community, including in the workplace. (b)

Purposes

The purposes of this Act are the following: (1) To reform the medicaid program established under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) to provide equal access to community-based attendant services and supports. (2) To provide financial assistance to States as they reform their long-term care systems to provide comprehensive statewide long-term services and supports, including community-based attendant services and supports that provide consumer choice and direction, in the most integrated setting appropriate.