1.Short
title; table of contents
(a)This Act may be cited
as the Community Choice Act of
2007
.
(b)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 dual eligible
individuals.
2.
(a)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 and programmatic bias toward institutional care.
Only about 37 percent of long-term care funds expended under the Medicaid
program, and only about 12.5 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 are services related to
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. Individuals with the most
significant disabilities are usually afforded the least amount of choice,
despite advances in medical and assistive technologies and related
areas.
(4)Despite the more
limited funding for community services, the majority of individuals who use
Medicaid long-term services and supports are in the community, indicating that
community services is a more cost effective alternative to institutional
care.
(5)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 the individual's 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)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 services in the most integrated setting
appropriate to the individual's needs, and to provide equal access to
community-based attendant services and supports in order to assist individuals
in achieving equal opportunity, full participation, independent living, and
economic self-sufficiency.
(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.
(3)To assist States
in meeting the growing demand for community-based attendant services and
supports, as the Nation's population ages and individuals with disabilities
live longer.
(4)To assist States
in addressing the decision of the Supreme Court in Olmstead v. L.C., (527 U.S.
581 (1999)), and implementing the integration mandate of the Americans with
Disabilities Act.
<enum>I</enum><header>Establishment of
Medicaid plan benefit</header>
<section id="IDecde1f57eccd43ac9fbbf8473886ada6"><enum>101.</enum><header>Coverage of
community-based attendant services and supports under the Medicaid
program</header>
<subsection id="IDb815b5a81f294cd8b7a9be31ebcb1221"><enum>(a)</enum><header>Mandatory
coverage</header><text>Section 1902(a)(10)(D) of the Social Security Act (42
U.S.C. 1396a(a)(10)(D)) is amended—</text>
<paragraph id="ID4c14d19e9dd440fc98872121763759a2"><enum>(1)</enum><text>by inserting
<quote>(i)</quote> after <quote>(D)</quote>;</text>
</paragraph><paragraph id="ID9ba9344fd1ee4c9482fd1fded0d77430"><enum>(2)</enum><text>by adding
<quote>and</quote> after the semicolon; and</text>
</paragraph><paragraph id="IDb71508300b5946efb09883c7ec92f986"><enum>(3)</enum><text>by adding at the
end the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="id339C6C3B4F8745B1A02A1E41C7DF4C15" style="OLC">
<clause id="ID4c47047e87c44428baf4d4dcc0dcd676"><enum>(ii)</enum><text>subject to
section 1939, for the inclusion of community-based attendant services and
supports for any individual who—</text>
<subclause id="IDa2c9324411484322bd025e249592dcc8"><enum>(I)</enum><text>is eligible for
medical assistance under the State plan;</text>
</subclause><subclause id="IDa34ba2f7f3f14cad8034f6eb2e3cfe87"><enum>(II)</enum><text>with respect to
whom there has been a determination that the individual requires the level of
care provided in a nursing facility, institution for mental diseases, or an
intermediate care facility for the mentally retarded (whether or not coverage
of such institution or intermediate care facility is provided under the State
plan); and</text>
</subclause><subclause id="IDb407ff0a930d4e259b32ce9299613dc5"><enum>(III)</enum><text>chooses to
receive such services and
supports;</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="ID5fc02fc2b4644792954aca06907d497a"><enum>(b)</enum><header>Community-based
attendant services and supports</header>
<paragraph id="IDa6c24a12301847829042be06e2cd925c"><enum>(1)</enum><header>In
general</header><text>Title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.) is amended—</text>
<subparagraph id="ID9bf0533d8e8b431d98363108f6e006c5"><enum>(A)</enum><text>by redesignating
section 1939 as section 1940; and</text>
</subparagraph><subparagraph id="ID775334b733134ff4b0e68b43b00d8410"><enum>(B)</enum><text>by inserting
after section 1938 the following:</text>
<quoted-block display-inline="no-display-inline" id="id8D331ADCBE974105B61617FD0C3E5833" style="traditional">
<section id="IDbf473f54774247b29f79af0cd465cc70"><enum>1939.</enum><header>Community-based attendant services and
supports</header><subsection commented="no" display-inline="yes-display-inline" id="idE51479FCF9D440B099CD914CB10E3150"><enum>(a)</enum><header>Required
coverage</header>
<paragraph id="IDde261b2ae8304ae593faf488c4c6e2db"><enum>(1)</enum><header>In
general</header><text>Not later than October 1, 2012, a State shall provide
through a plan amendment for the inclusion of community-based attendant
services and supports (as defined in subsection (g)(1)) for individuals
described in section 1902(a)(10)(D)(ii) in accordance with this section.</text>
</paragraph><paragraph id="ID59fda582229a4ab6907ef825bb446f48"><enum>(2)</enum><header>Enhanced FMAP
and additional Federal financial support for earlier
coverage</header><text>Notwithstanding section 1905(b), during the period that
begins on October 1, 2007, and ends on September 30, 2012, in the case of a
State with an approved plan amendment under this section during that period
that also satisfies the requirements of subsection (c) the Federal medical
assistance percentage shall be equal to the enhanced FMAP described in section
2105(b) with respect to medical assistance in the form of community-based
attendant services and supports provided to individuals described in section
1902(a)(10)(D)(ii) in accordance with this section on or after the date of the
approval of such plan amendment.</text>
</paragraph></subsection><subsection id="IDb313ecc3918a4e2aab06c5f50c3bd04b"><enum>(b)</enum><header>Development and
implementation of benefit</header><text>In order for a State plan amendment to
be approved under this section, a State shall provide the Secretary with the
following assurances:</text>
<paragraph id="ID5480c8c23f9142fcb99eef921e519b38"><enum>(1)</enum><header>Assurance of
development and implementation collaboration</header>
<subparagraph id="idF84ADB861A714179BEB2B91FA7DE99C1"><enum>(A)</enum><header>In
general</header><text>That State plan amendment—</text>
<clause id="id00596B1101494EA790C5114FD43793CE"><enum>(i)</enum><text>has been
developed in collaboration with, and with the approval of, a Development and
Implementation Council established by the State that satisfies the requirements
of subparagraph (B); and</text>
</clause><clause id="id240A3E3B62434DC1970D91CD89CDE252"><enum>(ii)</enum><text>will be
implemented in collaboration with such Council and on the basis of public input
solicited by the State and the Council.</text>
</clause></subparagraph><subparagraph id="id99875457D15E4D5CB9DDFE9BEF074123"><enum>(B)</enum><header>Development and
implementation council requirements</header><text>For purposes of subparagraph
(A), the requirements of this subparagraph are that—</text>
<clause id="id77A631785052497184C1B569C47FF111"><enum>(i)</enum><text>the majority of
the members of the Development and Implementation Council are individuals with
disabilities, elderly individuals, and their representatives; and</text>
</clause><clause id="idC15FFFB989854C8EBA3901E9C18D6A2C"><enum>(ii)</enum><text>in carrying out
its responsibilities, the Council actively collaborates with—</text>
<subclause commented="no" id="ID6b4e9a6fdabd44fe98697c0820e33f76"><enum>(I)</enum><text>individuals with
disabilities;</text>
</subclause><subclause commented="no" id="IDe73d86978f634f48b9371a9a22e3fabe"><enum>(II)</enum><text>elderly
individuals;</text>
</subclause><subclause commented="no" id="ID315ff374d1ab47a886dcc1569a11d50a"><enum>(III)</enum><text>representatives
of such individuals; and</text>
</subclause><subclause commented="no" id="IDbe2d5d94a09948eab9b9d0a93708281f"><enum>(IV)</enum><text>providers of,
and advocates for, services and supports for such individuals.</text>
</subclause></clause></subparagraph></paragraph><paragraph id="ID0cdf95494614410aa235cab3e87fcf09"><enum>(2)</enum><header>Assurance of
provision on a statewide basis and in most integrated
setting</header><text>That consumer controlled community-based attendant
services and supports will be provided under the State plan to individuals
described in section 1902(a)(10)(D)(ii) on a statewide basis and in a manner
that provides such services and supports in the most integrated setting
appropriate to the individual's needs.</text>
</paragraph><paragraph id="IDb80b7a98194749ab9b99c8f07231766b"><enum>(3)</enum><header>Assurance of
nondiscrimination</header><text>That the State will provide community-based
attendant services and supports to an individual described in section
1902(a)(10)(D)(ii) without regard to the individual's age, type or nature of
disability, severity of disability, or the form of community-based attendant
services and supports that the individual requires in order to lead an
independent life.</text>
</paragraph><paragraph id="ID27843e95c7d7444ea88315ce7bcbbd81"><enum>(4)</enum><header>Assurance of
maintenance of effort</header><text>That the level of State expenditures for
medical assistance that is provided under section 1905(a), section 1915,
section 1115, or otherwise to individuals with disabilities or elderly
individuals for a fiscal year shall not be less than the level of such
expenditures for the fiscal year preceding the first full fiscal year in which
the State plan amendment to provide community-based attendant services and
supports in accordance with this section is implemented.</text>
</paragraph></subsection><subsection id="ID5216dfa0b5ce43ae8f7c01074a6b134d"><enum>(c)</enum><header>Requirements
for enhanced FMAP for early coverage</header><text>In addition to satisfying
the other requirements for an approved plan amendment under this section, in
order for a State to be eligible under subsection (a)(2) during the period
described in that subsection for the enhanced FMAP for early coverage under
subsection (a)(2), the State shall satisfy the following requirements:</text>
<paragraph id="ID8936e656313b4c8a9d745ed82ce27cc7"><enum>(1)</enum><header>Specifications</header><text>With
respect to a fiscal year, the State shall provide the Secretary with the
following specifications regarding the provision of community-based attendant
services and supports under the plan for that fiscal year:</text>
<subparagraph id="ID765f780d2c40400f8c6b2cf163839192"><enum>(A)</enum><clause commented="no" display-inline="yes-display-inline" id="id5F6BF3A847E1439786B5A41A67B0AFBA"><enum>(i)</enum><text>The number of
individuals who are estimated to receive community-based attendant services and
supports under the plan during the fiscal year.</text>
</clause><clause id="IDae0055b2f1d74813b28810687beaabce" indent="up1"><enum>(ii)</enum><text>The number of individuals that
received such services and supports during the preceding fiscal year.</text>
</clause></subparagraph><subparagraph id="ID8c7c2ce18b094e6cbc70d10afb637350"><enum>(B)</enum><text>The maximum
number of individuals who will receive such services and supports under the
plan during that fiscal year.</text>
</subparagraph><subparagraph id="IDd1d9b703725e4c6a8012a43c0bff612a"><enum>(C)</enum><text>The procedures
the State will implement to ensure that the models for delivery of such
services and supports are consumer controlled (as defined in subsection
(g)(2)(B)).</text>
</subparagraph><subparagraph id="IDc56973a40f294c009103d39da3ad073a"><enum>(D)</enum><text>The procedures
the State will implement to inform all potentially eligible individuals and
relevant other individuals of the availability of such services and supports
under this title, and of other items and services that may be provided to the
individual under this title or title XVIII and other Federal or State long-term
service and support programs.</text>
</subparagraph><subparagraph id="ID925360f33cc2492aae5b6cdee4077cf6"><enum>(E)</enum><text>The procedures
the State will implement to ensure that such services and supports are provided
in accordance with the requirements of subsection (b)(1).</text>
</subparagraph><subparagraph id="ID34bbb67c122b408c9722ed0163cc1a32"><enum>(F)</enum><text>The procedures
the State will implement to actively involve in a systematic, comprehensive,
and ongoing basis, the Development and Implementation Council established in
accordance with subsection (b)(1)(A)(ii), individuals with disabilities,
elderly individuals, and representatives of such individuals in the design,
delivery, administration, implementation, and evaluation of the provision of
such services and supports under this title.</text>
</subparagraph></paragraph><paragraph id="ID0c6ea52bd7ea41d2a691f4b1f97ae1cc"><enum>(2)</enum><header>Participation
in evaluations</header><text>The State shall provide the Secretary with such
substantive input into, and participation in, the design and conduct of data
collection, analyses, and other qualitative or quantitative evaluations of the
provision of community-based attendant services and supports under this section
as the Secretary deems necessary in order to determine the effectiveness of the
provision of such services and supports in allowing the individuals receiving
such services and supports to lead an independent life to the maximum extent
possible.</text>
</paragraph></subsection><subsection id="ID4c71f90eca8045ccb9d5aefa46fc5c2a"><enum>(d)</enum><header>Quality
assurance</header>
<paragraph id="IDc6b36c43d2574cbcb09d28077dc13b3f"><enum>(1)</enum><header>State
responsibilities</header><text>In order for a State plan amendment to be
approved under this section, a State shall establish and maintain a
comprehensive, continuous quality assurance system with respect to
community-based attendant services and supports that provides for the
following:</text>
<subparagraph id="IDb3b272786a6b49a79e721b0ffd4ed7d5"><enum>(A)</enum><text>The State shall
establish requirements, as appropriate, for agency-based and other delivery
models that include—</text>
<clause id="ID46371383456943158fcb1b3f4c203cc9"><enum>(i)</enum><text>minimum
qualifications and training requirements for agency-based and other
models;</text>
</clause><clause id="ID76feac5298dc47b581d18461ab19f612"><enum>(ii)</enum><text>financial
operating standards; and</text>
</clause><clause id="IDa598900a8c5d41d38ed2add21f36e5aa"><enum>(iii)</enum><text>an appeals
procedure for eligibility denials and a procedure for resolving disagreements
over the terms of an individualized plan.</text>
</clause></subparagraph><subparagraph id="ID4a4cfae835fa4944a4dba4cb1ee2d6ff"><enum>(B)</enum><text>The State shall
modify the quality assurance system, as appropriate, to maximize consumer
independence and consumer control in both agency-provided and other delivery
models.</text>
</subparagraph><subparagraph id="ID92e376da4fcf4604b0294153c3e948fc"><enum>(C)</enum><text>The State shall
provide a system that allows for the external monitoring of the quality of
services and supports by entities consisting of consumers and their
representatives, disability organizations, providers, families of disabled or
elderly individuals, members of the community, and others.</text>
</subparagraph><subparagraph id="IDb82f014d3e114b3fb770e794be82006d"><enum>(D)</enum><text>The State shall
provide for ongoing monitoring of the health and well-being of each individual
who receives community-based attendant services and supports.</text>
</subparagraph><subparagraph id="IDf86404114a5e40c2a72dcaa802f7edac"><enum>(E)</enum><text>The State shall
require that quality assurance mechanisms pertaining to the individual be
included in the individual's written plan.</text>
</subparagraph><subparagraph id="ID4a3598e3f2f54192a83dde04ca340526"><enum>(F)</enum><text>The State shall
establish a process for the mandatory reporting, investigation, and resolution
of allegations of neglect, abuse, or exploitation in connection with the
provision of such services and supports.</text>
</subparagraph><subparagraph id="ID2ebcaaca4696493ea2abdba97756a75c"><enum>(G)</enum><text>The State shall
obtain meaningful consumer input, including consumer surveys, that measure the
extent to which an individual receives the services and supports described in
the individual's plan and the individual's satisfaction with such services and
supports.</text>
</subparagraph><subparagraph id="ID134adb3eba7842b38575f81c0cec7421"><enum>(H)</enum><text>The State shall
make available to the public the findings of the quality assurance
system.</text>
</subparagraph><subparagraph id="IDff9396722c3e483db4074143404b129c"><enum>(I)</enum><text>The State shall
establish an ongoing public process for the development, implementation, and
review of the State's quality assurance system.</text>
</subparagraph><subparagraph id="IDac4a79afad6c46b9ba4d8b0629bca85f"><enum>(J)</enum><text>The State shall
develop and implement a program of sanctions for providers of community-based
services and supports that violate the terms or conditions for the provision of
such services and supports.</text>
</subparagraph></paragraph><paragraph id="IDe95dfc527aeb492180ee1fcb325db1f0"><enum>(2)</enum><header>Federal
responsibilities</header>
<subparagraph id="ID18f4c2d2ba5940668f4d84194689bdb3"><enum>(A)</enum><header>Periodic
evaluations</header><text>The Secretary shall conduct a periodic sample review
of outcomes for individuals who receive community-based attendant services and
supports under this title.</text>
</subparagraph><subparagraph id="ID828966b607f54c8bbaa0f5136c20c960"><enum>(B)</enum><header>Investigations</header><text>The
Secretary may conduct targeted reviews and investigations upon receipt of an
allegation of neglect, abuse, or exploitation of an individual receiving
community-based attendant services and supports under this section.</text>
</subparagraph><subparagraph id="IDffbe47b5b88a43fe9dd05b42c62bbd34"><enum>(C)</enum><header>Development of
provider sanction guidelines</header><text>The Secretary shall develop
guidelines for States to use in developing the sanctions required under
paragraph (1)(J).</text>
</subparagraph></paragraph></subsection><subsection id="IDccc355005d66407b818d0476c6d25367"><enum>(e)</enum><header>Reports</header><text>The
Secretary shall submit to Congress periodic reports on the provision of
community-based attendant services and supports under this section,
particularly with respect to the impact of the provision of such services and
supports on—</text>
<paragraph id="IDe3dff24a76314612ab2a9b9acfd0eebc"><enum>(1)</enum><text>individuals
eligible for medical assistance under this title;</text>
</paragraph><paragraph id="ID9c7ff744c35542dd8a000eb741afaa23"><enum>(2)</enum><text>States;
and</text>
</paragraph><paragraph id="ID033b37483d344b45a8c4454979057d22"><enum>(3)</enum><text>the Federal
Government.</text>
</paragraph></subsection><subsection id="ID99d6545f87de4a9aaa7fdbd501e8aef1"><enum>(f)</enum><header>No effect on
ability to provide coverage</header>
<paragraph id="ID5981f0624d054ba68531de52b9735899"><enum>(1)</enum><header>In
general</header><text>Nothing in this section shall be construed as affecting
the ability of a State to provide coverage under the State plan for
community-based attendant services and supports (or similar coverage) under
section 1905(a), section 1915, section 1115, or otherwise.</text>
</paragraph><paragraph id="IDfe643a9b63814fc6bfc16ec4a31292b1"><enum>(2)</enum><header>Eligibility for
enhanced match</header><text>In the case of a State that provides coverage for
such services and supports under a waiver, the State shall not be eligible
under subsection (a)(2) for the enhanced FMAP for the early provision of such
coverage unless the State submits a plan amendment to the Secretary that meets
the requirements of this section and demonstrates that the State is able to
fully comply with and implement the requirements of this section.</text>
</paragraph></subsection><subsection id="IDe2f1089860b349b5b4bd6fc12596773e"><enum>(g)</enum><header>Definitions</header><text>In
this title:</text>
<paragraph id="ID9c6211cc45044213bc175b70a2f85e98"><enum>(1)</enum><header>Community-based
attendant services and supports</header>
<subparagraph id="ID7bc086bfe65a47dc833c2730d980919a"><enum>(A)</enum><header>In
general</header><text>The term <term>community-based attendant services and
supports</term> means attendant services and supports furnished to an
individual, as needed, to assist in accomplishing activities of daily living,
instrumental activities of daily living, and health-related tasks through
hands-on assistance, supervision, or cueing—</text>
<clause id="ID716237b5d04e47519d85a738101d5f0c"><enum>(i)</enum><text>under a plan of
services and supports that is based on an assessment of functional need and
that is agreed to in writing by the individual or, as appropriate, the
individual's representative;</text>
</clause><clause id="ID827ef423e5ec4d69acbdef0e2d3016e0"><enum>(ii)</enum><text>in a home or
community setting, which shall include but not be limited to a school,
workplace, or recreation or religious facility, but does not include a nursing
facility, institution for mental diseases, or an intermediate care facility for
the mentally retarded;</text>
</clause><clause id="IDa491c986c1a44bbd90cf3fb4d6efaed3"><enum>(iii)</enum><text>under an
agency-provider model or other model (as defined in paragraph (2)(C));</text>
</clause><clause id="IDdc06526cadd545dbb933b17e4916404f"><enum>(iv)</enum><text>the furnishing
of which—</text>
<subclause id="idBEAC7158926F409992904A34B4E11E5D"><enum>(I)</enum><text>is selected,
managed, and dismissed by the individual, or, as appropriate, with assistance
from the individual's representative; and</text>
</subclause><subclause id="ID91ef6cbf358a4df6a6135bc9f7c6ddd1"><enum>(II)</enum><text>provided by an
individual who is qualified to provide such services, including family members
(as defined by the Secretary).</text>
</subclause></clause></subparagraph><subparagraph id="IDa601ed2ac66d4e71adf6a01d101b8f4f"><enum>(B)</enum><header>Included
services and supports</header><text>Such term includes—</text>
<clause id="ID7a487ce55a5548c1ab473569896d4938"><enum>(i)</enum><text>tasks necessary
to assist an individual in accomplishing activities of daily living,
instrumental activities of daily living, and health-related tasks;</text>
</clause><clause id="IDb77cfb56cb784e90b4fc9c888e259730"><enum>(ii)</enum><text>the acquisition,
maintenance, and enhancement of skills necessary for the individual to
accomplish activities of daily living, instrumental activities of daily living,
and health-related tasks;</text>
</clause><clause id="ID39d848f940264b578f298a6366ce6471"><enum>(iii)</enum><text>backup systems
or mechanisms (such as the use of beepers) to ensure continuity of services and
supports; and</text>
</clause><clause id="ID972cdea87ddf41bcb79478bfeb082d9e"><enum>(iv)</enum><text>voluntary
training on how to select, manage, and dismiss attendants.</text>
</clause></subparagraph><subparagraph id="IDe03ceb54f87d400db128e599b4c4f91e"><enum>(C)</enum><header>Excluded
services and supports</header><text>Subject to subparagraph (D), such term does
not include—</text>
<clause id="IDbe08ff421e194f59af7ea65443f6d19c"><enum>(i)</enum><text>the provision of
room and board for the individual;</text>
</clause><clause id="ID016a428075d1499d8c597982c3b131ca"><enum>(ii)</enum><text>special
education and related services provided under the Individuals with Disabilities
Education Act and vocational rehabilitation services provided under the
Rehabilitation Act of 1973;</text>
</clause><clause id="ID2b7833881e6440c9991d3db58b8f7797"><enum>(iii)</enum><text>assistive
technology devices and assistive technology services;</text>
</clause><clause id="ID50f0b07a00514391b6784cdceb498d88"><enum>(iv)</enum><text>durable medical
equipment; or</text>
</clause><clause id="ID7f49a4384a26420abf5754c3030f659b"><enum>(v)</enum><text>home
modifications.</text>
</clause></subparagraph><subparagraph id="IDb2ca0157c01a4abd8844c32ff7d15837"><enum>(D)</enum><header>Flexibility in
transition to community-based home setting</header><text>Such term may include
expenditures for transitional costs, such as rent and utility deposits, first
month's rent and utilities, bedding, basic kitchen supplies, and other
necessities required for an individual to make the transition from a nursing
facility, institution for mental diseases, or intermediate care facility for
the mentally retarded to a community-based home setting where the individual
resides.</text>
</subparagraph></paragraph><paragraph id="ID8f15ced162e448ceae555927918ffaad"><enum>(2)</enum><header>Additional
definitions</header>
<subparagraph id="ID99efb5343e2948b58fdf9261f864e7d9"><enum>(A)</enum><header>Activities of
daily living</header><text>The term <term>activities of daily living</term>
includes eating, toileting, grooming, dressing, bathing, and
transferring.</text>
</subparagraph><subparagraph id="IDeb52c08959634d4eadd9ef69ad4d8a17"><enum>(B)</enum><header>Consumer
controlled</header><text>The term <term>consumer controlled</term> means a
method of selecting and providing services and supports that allow the
individual, or where appropriate, the individual's representative, maximum
control of the community-based attendant services and supports, regardless of
who acts as the employer of record.</text>
</subparagraph><subparagraph id="ID87c0740386f04f85b6aaaa12aad87506"><enum>(C)</enum><header>Delivery
models</header>
<clause id="ID1e64de74583147d8bde65f2ce59edcdf"><enum>(i)</enum><header>Agency-provider
model</header><text>The term <term>agency-provider model</term> means, with
respect to the provision of community-based attendant services and supports for
an individual, subject to clause (iii), a method of providing consumer
controlled services and supports under which entities contract for the
provision of such services and supports.</text>
</clause><clause id="ID32753bd4cda04605bbcb9a9d5ca078b5"><enum>(ii)</enum><header>Other
models</header><text>The term <term>other models</term> means, subject to
clause (iii), methods, other than an agency-provider model, for the provision
of consumer controlled services and supports. Such models may include the
provision of vouchers, direct cash payments, or use of a fiscal agent to assist
in obtaining services.</text>
</clause><clause id="ID247417379c7e406085ac5314bc7fc2e9"><enum>(iii)</enum><header>Compliance
with certain laws</header><text>A State shall ensure that, regardless of
whether the State uses an agency-provider model or other models to provide
services and supports under a State plan amendment under this section, such
services and supports are provided in accordance with the requirements of the
Fair Labor Standards Act of 1938 and applicable Federal and State laws
regarding—</text>
<subclause id="ID2081605a7f4242c8b8312f247dbfddde"><enum>(I)</enum><text>withholding and
payment of Federal and State income and payroll taxes;</text>
</subclause><subclause id="IDbcf233ebcec34a1db807c7a42828733d"><enum>(II)</enum><text>the provision of
unemployment and workers compensation insurance;</text>
</subclause><subclause id="ID3326bc6b24864ea58e40da324d46734c"><enum>(III)</enum><text>maintenance of
general liability insurance; and</text>
</subclause><subclause id="ID258798276ae04b429ef470ede322121a"><enum>(IV)</enum><text>occupational
health and safety.</text>
</subclause></clause></subparagraph><subparagraph id="ID67eb143ad3cd49a39355e00c0d902932"><enum>(D)</enum><header>Health-related
tasks</header><text>The term <term>health-related tasks</term> means specific
tasks that can be delegated or assigned by licensed health-care professionals
under State law to be performed by an attendant.</text>
</subparagraph><subparagraph id="IDc957cdedffcf4fefba72a9f5f356ed1f"><enum>(E)</enum><header>Instrumental
activities of daily living</header><text>The term <term>instrumental activities
of daily living</term> includes, but is not limited to, meal planning and
preparation, managing finances, shopping for food, clothing, and other
essential items, performing essential household chores, communicating by phone
and other media, and traveling around and participating in the
community.</text>
</subparagraph><subparagraph id="IDdf30b0a2ab994824bfd88d796e40b13e"><enum>(F)</enum><header>Individuals
representative</header><text>The term <term>individual's representative</term>
means a parent, a family member, a guardian, an advocate, or other authorized
representative of an
individual.</text>
</subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></subsection><subsection id="ID123744e024da40df8a5175d90d457a58"><enum>(c)</enum><header>Conforming
amendments</header>
<paragraph id="ID58f4ba7aed6d42f6a98e3aa89aa8633d"><enum>(1)</enum><header>Mandatory
benefit</header><text>Section 1902(a)(10)(A) of the Social Security Act (42
U.S.C. 1396a(a)(10)(A)) is amended, in the matter preceding clause (i), by
striking <quote>(17) and (21)</quote> and inserting <quote>(17), (21), and
(28)</quote>.</text>
</paragraph><paragraph id="IDbb2f87560d07484383338c8847ed7432"><enum>(2)</enum><header>Definition of
medical assistance</header><text>Section 1905(a) of the Social Security Act (42
U.S.C. 1396d) is amended—</text>
<subparagraph id="ID4d5ecd7499f2414ca89d5e916137bb7a"><enum>(A)</enum><text>by striking
<quote>and</quote> at the end of paragraph (27);</text>
</subparagraph><subparagraph id="ID31736b58364b4854b6e56145bf1f7ecd"><enum>(B)</enum><text>by redesignating
paragraph (28) as paragraph (29); and</text>
</subparagraph><subparagraph id="ID7f0978a262e64e93ab4ea17c8d6f8d02"><enum>(C)</enum><text>by inserting
after paragraph (27) the following:</text>
<quoted-block display-inline="no-display-inline" id="id7480A7C3313B41318B2B6FAA0D2BC190" style="OLC">
<paragraph id="IDf13d4db4409346e8bccc236d7b2334fa"><enum>(28)</enum><text>community-based
attendant services and supports (to the extent allowed and as defined in
section 1939);
and</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="IDacca04a9c7bc49a8b0cee6e510b503b0"><enum>(3)</enum><header>IMD/ICFMR
requirements</header><text>Section 1902(a)(10)(C)(iv) of the Social Security
Act (42 U.S.C. 1396a(a)(10)(C)(iv)) is amended by inserting “and (28)” after
“(24)”.</text>
</paragraph></subsection><subsection id="ID0a60b9135e174ecfba78b608ea81f64b"><enum>(d)</enum><header>Effective
dates</header>
<paragraph id="ID4535b3acad4f4150bc37d9715e71527f"><enum>(1)</enum><header>In
general</header><text>Except as provided in paragraph (2), the amendments made
by this section (other than the amendment made by subsection (c)(1)) take
effect on October 1, 2007, and apply to medical assistance provided for
community-based attendant services and supports described in section 1939 of
the Social Security Act furnished on or after that date.</text>
</paragraph><paragraph id="ID0d332f66624a4cdd8d6dd8c59cc2d3e0"><enum>(2)</enum><header>Mandatory
benefit</header><text>The amendment made by subsection (c)(1) takes effect on
October 1, 2012.</text>
</paragraph></subsection></section><section id="ID6fc5d5eaf4ad4760a6a352cb9aabea17"><enum>102.</enum><header>Enhanced FMAP
for ongoing activities of early coverage States that enhance and promote the
use of community-based attendant services and supports</header>
<subsection id="ID0feec77c2cca41ea96d65c806c117269"><enum>(a)</enum><header>In
general</header><text>Section 1939 of the Social Security Act, as added by
section 101(b), is amended—</text>
<paragraph id="ID2f7b9fee869a47569584a23a4f52019f"><enum>(1)</enum><text>by redesignating
subsections (d) through (g) as subsections (f) through (i),
respectively;</text>
</paragraph><paragraph id="ID23fb7c04c29443ac9064b8eb9cdab0e3"><enum>(2)</enum><text>in subsection
(a)(1), by striking <quote>subsection (g)(1)</quote> and inserting
<quote>subsection (i)(1)</quote>;</text>
</paragraph><paragraph id="IDf7840695dcca48bba30cdcea7229ca8b"><enum>(3)</enum><text>in subsection
(a)(2), by inserting <quote>, and with respect to expenditures described in
subsection (d), the Secretary shall pay the State the amount described in
subsection (d)(1)</quote> before the period;</text>
</paragraph><paragraph id="ID1a85dd7efd914e548f0ca714ab317305"><enum>(4)</enum><text>in subsection
(c)(1)(C), by striking <quote>subsection (g)(2)(B)</quote> and inserting
<quote>subsection (i)(2)(B)</quote>; and</text>
</paragraph><paragraph id="IDaee6ad46ab3543258a164ac3afc51b76"><enum>(5)</enum><text>by inserting
after subsection (c), the following:</text>
<quoted-block display-inline="no-display-inline" id="id8405B267828542A48B623DBF2BC26256" style="OLC">
<subsection id="ID2c963bd066874a0593a975d361d04c1e"><enum>(d)</enum><header>Increased
Federal financial participation for early coverage States that meet certain
benchmarks</header>
<paragraph id="IDc674a31d9b50494f813978558292ce32"><enum>(1)</enum><header>In
general</header><text>Subject to paragraph (2), for purposes of subsection
(a)(2), the amount and expenditures described in this subsection are an amount
equal to the Federal medical assistance percentage, increased by 10 percentage
points, of the expenditures incurred by the State for the provision or conduct
of the services or activities described in paragraph (3).</text>
</paragraph><paragraph id="ID0aa384ac9c264192a8283dc04a1fe041"><enum>(2)</enum><header>Expenditure
criteria</header><text>A State shall—</text>
<subparagraph id="IDc539bdee5c014c49a4c9074abe31ba29"><enum>(A)</enum><text>develop criteria
for determining the expenditures described in paragraph (1) in collaboration
with the individuals and representatives described in subsection (b)(1);
and</text>
</subparagraph><subparagraph id="IDd2dc5f337b834418a933acea325f83ec"><enum>(B)</enum><text>submit such
criteria for approval by the Secretary.</text>
</subparagraph></paragraph><paragraph id="ID0af90afa96804637af3313e503723607"><enum>(3)</enum><header>Services,
supports and activities described</header><text>For purposes of paragraph (1),
the services, supports and activities described in this subparagraph are the
following:</text>
<subparagraph id="IDf5199351fca24adc92dffdd76bf62a6b"><enum>(A)</enum><text>1-stop intake,
referral, and institutional diversion services.</text>
</subparagraph><subparagraph id="ID68a96910c9fb4227a965dbe2213d8167"><enum>(B)</enum><text>Identifying and
remedying gaps and inequities in the State's current provision of long-term
services and supports, particularly those services and supports that are
provided based on such factors as age, severity of disability, type of
disability, ethnicity, income, institutional bias, or other similar
factors.</text>
</subparagraph><subparagraph id="ID925d8efeb56f40ccbc5aa9b55bc009c1"><enum>(C)</enum><text>Establishment of
consumer participation and consumer governance mechanisms, such as cooperatives
and regional service authorities, that are managed and controlled by
individuals with significant disabilities who use community-based services and
supports or their representatives.</text>
</subparagraph><subparagraph id="ID4d6ef64796a24f34b335d30ab6de4a5b"><enum>(D)</enum><text>Activities
designed to enhance the skills, earnings, benefits, supply, career, and future
prospects of workers who provide community-based attendant services and
supports.</text>
</subparagraph><subparagraph id="IDca9d72d8012e449eb7249ccca0a7234d"><enum>(E)</enum><text>Continuous,
comprehensive quality improvement activities that are designed to ensure and
enhance the health and well-being of individuals who rely on community-based
attendant services and supports, particularly activities involving or initiated
by consumers of such services and supports or their representatives.</text>
</subparagraph><subparagraph id="IDfb43b265f3084ffe82ac44abd1b6bd91"><enum>(F)</enum><text>Family support
services to augment the efforts of families and friends to enable individuals
with disabilities of all ages to live in their own homes and
communities.</text>
</subparagraph><subparagraph id="ID64c6f56e5eab44d9818460d47b2be6ec"><enum>(G)</enum><text>Health promotion
and wellness services and activities.</text>
</subparagraph><subparagraph id="ID6b97825315d04daea97f5ebb47b86b3d"><enum>(H)</enum><text>Provider
recruitment and enhancement activities, particularly such activities that
encourage the development and maintenance of consumer controlled cooperatives
or other small businesses or micro-enterprises that provide community-based
attendant services and supports or related services.</text>
</subparagraph><subparagraph id="IDe324bc5cf1004ece9efbe68a17e02b58"><enum>(I)</enum><text>Activities
designed to ensure service and systems coordination.</text>
</subparagraph><subparagraph id="IDb9f340738e644ee2a7f64246a2b4ae9e"><enum>(J)</enum><text>Any other
services or activities that the Secretary deems
appropriate.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="ID1b7bac08ea8f46c384dc5723515d691d"><enum>(b)</enum><header>Effective
date</header><text>The amendments made by subsection (a) take effect on October
1, 2007.</text>
</subsection></section><section id="ID747345c5624b471e84f2fec5a7eec2b2"><enum>103.</enum><header>Increased
Federal financial participation for certain expenditures</header>
<subsection id="ID01f09a15f175463b8eb6d945a98d7734"><enum>(a)</enum><header>In
general</header><text>Section 1939 of the Social Security Act, as added by
section 101(b) and amended by section 102, is amended by inserting after
subsection (d) the following:</text>
<quoted-block display-inline="no-display-inline" id="id573C27FAFA1C46368AB8EBBC4AE05E22" style="OLC">
<subsection id="ID7f53019d269d486ab45fb7f3ef41d734"><enum>(e)</enum><header>Increased
Federal financial participation for certain expenditures</header>
<paragraph id="ID87ff176b808b4da3b47f5cb3b86e1ca2"><enum>(1)</enum><header>Eligibility for
payment</header>
<subparagraph id="ID3fc3d06df4494a49a3b2d1c10aef0117"><enum>(A)</enum><header>In
general</header><text>In the case of a State that the Secretary determines
satisfies the requirements of subparagraph (B), the Secretary shall pay the
State the amounts described in paragraph (2) in addition to any other payments
provided for under section 1903 or this section for the provision of
community-based attendant services and supports.</text>
</subparagraph><subparagraph id="IDb6f32db1688d48299009a34337b115dd"><enum>(B)</enum><header>Requirements</header><text>The
requirements of this subparagraph are the following:</text>
<clause id="ID5e22721c534146108d281b10e033fba4"><enum>(i)</enum><text>The State has an
approved plan amendment under this section.</text>
</clause><clause id="IDa8ecf14d790e470bb76fd3a9169b5362"><enum>(ii)</enum><text>The State has
incurred expenditures described in paragraph (2).</text>
</clause><clause id="ID07a8529a84014701a1f242d41e2116fd"><enum>(iii)</enum><text>The State
develops and submits to the Secretary criteria to identify and select such
expenditures in accordance with the requirements of paragraph (3).</text>
</clause><clause id="ID777a46fee29d4182a92c8e31fb18eea3"><enum>(iv)</enum><text>The Secretary
determines that payment of the applicable percentage of such expenditures (as
determined under paragraph (2)(B)) would enable the State to provide a
meaningful choice of receiving community-based services and supports to
individuals with disabilities and elderly individuals who would otherwise only
have the option of receiving institutional care.</text>
</clause></subparagraph></paragraph><paragraph id="ID56ba3241f8cd44bc88e1cfb8ad77a2d1"><enum>(2)</enum><header>Amounts and
expenditures described</header>
<subparagraph id="IDeb8f2a850d3f43db85579c45ebf635c4"><enum>(A)</enum><header>Expenditures in
excess of 150 percent of baseline amount</header><text>The amounts and
expenditures described in this paragraph are an amount equal to the applicable
percentage, as determined by the Secretary in accordance with subparagraph (B),
of the expenditures incurred by the State for the provision of community-based
attendant services and supports to an individual that exceed 150 percent of the
average cost of providing nursing facility services to an individual who
resides in the State and is eligible for such services under this title, as
determined in accordance with criteria established by the Secretary.</text>
</subparagraph><subparagraph id="ID063b37d9b54840298e9aa69f0c5124f6"><enum>(B)</enum><header>Applicable
percentage</header><text>The Secretary shall establish a payment scale for the
expenditures described in subparagraph (A) so that the Federal financial
participation for such expenditures gradually increases from 70 percent to 90
percent as such expenditures increase.</text>
</subparagraph></paragraph><paragraph id="ID86750ccff62b4d609aadb716aedbfa6d"><enum>(3)</enum><header>Specification
of order of selection for expenditures</header><text>In order to receive the
amounts described in paragraph (2), a State shall—</text>
<subparagraph id="ID702a4245abb04f68bbcc0a456afe7387"><enum>(A)</enum><text>develop, in
collaboration with the individuals and representatives described in subsection
(b)(1) and pursuant to guidelines established by the Secretary, criteria to
identify and select the expenditures submitted under that paragraph; and</text>
</subparagraph><subparagraph id="IDf159ea178706405d84d3db5c46cf5a9e"><enum>(B)</enum><text>submit such
criteria to the
Secretary.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="IDc6d9b2328c3143c09cec605252430e43"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) takes effect on October
1, 2007.</text>
</subsection></section><enum>II</enum><header>Promotion of
systems change and capacity building</header>
<section id="ID1c0dca588b784848b2b5eff85d034f3d"><enum>201.</enum><header>Grants to
promote systems change and capacity building</header>
<subsection id="IDe8668e7c3c51420b8c3e4620b6f02cc2"><enum>(a)</enum><header>Authority to
award grants</header>
<paragraph id="IDa2f4e1f8af1a45f18194fe0d332a67a7"><enum>(1)</enum><header>In
general</header><text>The Secretary of Health and Human Services (in this
section referred to as the <quote>Secretary</quote>) shall award grants to
eligible States to carry out the activities described in subsection (b).</text>
</paragraph><paragraph id="ID24edcddeb5c54aea97d88e04f77aeb59"><enum>(2)</enum><header>Application</header><text>In
order to be eligible for a grant under this section, a State shall submit to
the Secretary an application in such form and manner, and that contains such
information, as the Secretary may require.</text>
</paragraph></subsection><subsection id="ID37cd6e0704a546f3b5aff67e058113e9"><enum>(b)</enum><header>Permissible
activities</header><text>A State that receives a grant under this section may
use funds provided under the grant for any of the following activities,
focusing on areas of need identified by the State and the Consumer Task Force
established under subsection (c):</text>
<paragraph id="ID2345690ee726430f9c8c81b6791b61cc"><enum>(1)</enum><text>The development
and implementation of the provision of community-based attendant services and
supports under section 1939 of the Social Security Act (as added by section
101(b) and amended by sections 102 and 103) through active collaboration
with—</text>
<subparagraph id="ID2b88e809399049318863ad14503c0a4f"><enum>(A)</enum><text>individuals with
disabilities;</text>
</subparagraph><subparagraph id="IDfdc4c13945d64159a3d3f85ba34ef8ba"><enum>(B)</enum><text>elderly
individuals;</text>
</subparagraph><subparagraph id="IDa1f768367ef340cc91fbe4f60e4aa52b"><enum>(C)</enum><text>representatives
of such individuals; and</text>
</subparagraph><subparagraph id="ID8eec953350c3437181a246ecd16a4348"><enum>(D)</enum><text>providers of, and
advocates for, services and supports for such individuals.</text>
</subparagraph></paragraph><paragraph id="ID86a9a9aa3b234404807f1e98a9537b4a"><enum>(2)</enum><text>Substantially
involving individuals with significant disabilities and representatives of such
individuals in jointly developing, implementing, and continually improving a
mutually acceptable comprehensive, effectively working statewide plan for
preventing and alleviating unnecessary institutionalization of such
individuals.</text>
</paragraph><paragraph id="ID24d19d08dfa14a2b8b3e8b4f803efa4a"><enum>(3)</enum><text>Engaging in
system change and other activities deemed necessary to achieve any or all of
the goals of such statewide plan.</text>
</paragraph><paragraph id="ID07ad5219366342fdbcf15f90233337c7"><enum>(4)</enum><text>Identifying and
remedying disparities and gaps in services to classes of individuals with
disabilities and elderly individuals who are currently experiencing or who face
substantial risk of unnecessary institutionalization.</text>
</paragraph><paragraph id="IDec809a9130184f8ca7958a4c30efc055"><enum>(5)</enum><text>Building and
expanding system capacity to offer quality consumer controlled community-based
services and supports to individuals with disabilities and elderly individuals,
including by—</text>
<subparagraph id="ID4996e1c86f294bf685eab6b8ba7321af"><enum>(A)</enum><text>seeding the
development and effective use of community-based attendant services and
supports cooperatives, Independent Living Centers, small businesses,
micro-enterprises, micro-boards, and similar joint ventures owned and
controlled by individuals with disabilities or representatives of such
individuals and community-based attendant services and supports workers;</text>
</subparagraph><subparagraph id="IDdeabad27f618457fb1da192df0e17e29"><enum>(B)</enum><text>enhancing the
choice and control individuals with disabilities and elderly individuals
exercise, including through their representatives, with respect to the personal
assistance and supports they rely upon to lead independent, self-directed
lives;</text>
</subparagraph><subparagraph id="ID60f97a1c1e4f49f6a2f78ff4595259c9"><enum>(C)</enum><text>enhancing the
skills, earnings, benefits, supply, career, and future prospects of workers who
provide community-based attendant services and supports;</text>
</subparagraph><subparagraph id="IDc24a1849336b4f20a047e6d4446e4203"><enum>(D)</enum><text>engaging in a
variety of needs assessment and data gathering;</text>
</subparagraph><subparagraph id="IDe1445363ae3e4ebfb0aa28b008a20372"><enum>(E)</enum><text>developing
strategies for modifying policies, practices, and procedures that result in
unnecessary institutional bias or the over-medicalization of long-term services
and supports;</text>
</subparagraph><subparagraph id="IDfbd8e5b2b1224bf7b03c5f0947557c99"><enum>(F)</enum><text>engaging in
interagency coordination and single point of entry activities;</text>
</subparagraph><subparagraph id="IDf9179ba416314f628516255920f8321c"><enum>(G)</enum><text>providing
training and technical assistance with respect to the provision of
community-based attendant services and supports;</text>
</subparagraph><subparagraph id="IDc722069895244263b42e3fa03bc7c711"><enum>(H)</enum><text>engaging
in—</text>
<clause id="ID38ebedbc422648c0bd6790b367e7f05b"><enum>(i)</enum><text>public awareness
campaigns;</text>
</clause><clause id="ID1ffc6b65e0d247828882038fdfa9b91c"><enum>(ii)</enum><text>facility-to-community
transitional activities; and</text>
</clause><clause id="ID3ac00d05f1914458805318667d26425c"><enum>(iii)</enum><text>demonstrations
of new approaches; and</text>
</clause></subparagraph><subparagraph id="ID89984a3fa6d9477d815120287890d034"><enum>(I)</enum><text>engaging in other
systems change activities necessary for developing, implementing, or evaluating
a comprehensive statewide system of community-based attendant services and
supports.</text>
</subparagraph></paragraph><paragraph id="IDfd1a2beea054434cbec9ad18c45f687e"><enum>(6)</enum><text>Ensuring that the
activities funded by the grant are coordinated with other efforts to increase
personal attendant services and supports, including—</text>
<subparagraph id="ID43254e8d0d9a4bf5b1295dbfb290566d"><enum>(A)</enum><text>programs funded
under or amended by the Ticket to Work and Work Incentives Improvement Act of
1999 (Public Law 106–170; 113 Stat. 1860);</text>
</subparagraph><subparagraph id="ID9aacefe3ee824e34bd0e08928a48794e"><enum>(B)</enum><text>grants funded
under the Families of Children With Disabilities Support Act of 2000 (42 U.S.C.
15091 et seq.); and</text>
</subparagraph><subparagraph id="ID5d6766e55fe647218653869dd8e63d6c"><enum>(C)</enum><text>other initiatives
designed to enhance the delivery of community-based services and supports to
individuals with disabilities and elderly individuals.</text>
</subparagraph></paragraph><paragraph id="ID792104cc77954b42a96b9da9f00ee0f8"><enum>(7)</enum><text>Engaging in
transition partnership activities with nursing facilities and intermediate care
facilities for the mentally retarded that utilize and build upon items and
services provided to individuals with disabilities or elderly individuals under
the Medicaid program under title XIX of the Social Security Act, or by Federal,
State, or local housing agencies, Independent Living Centers, and other
organizations controlled by consumers or their representatives.</text>
</paragraph></subsection><subsection id="ID7ee7fc9d43ea4d6a8962349004a0c71f"><enum>(c)</enum><header>Consumer task
force</header>
<paragraph id="IDc9df1a02abcf47268df89df5e2905289"><enum>(1)</enum><header>Establishment
and duties</header><text>To be eligible to receive a grant under this section,
each State shall establish a Consumer Task Force (referred to in this
subsection as the <quote>Task Force</quote>) to assist the State in the
development, implementation, and evaluation of real choice systems change
initiatives.</text>
</paragraph><paragraph id="ID0c4034d499fd4f02918c8260129a6f38"><enum>(2)</enum><header>Appointment</header><text>Members
of the Task Force shall be appointed by the Chief Executive Officer of the
State in accordance with the requirements of paragraph (3), after the
solicitation of recommendations from representatives of organizations
representing a broad range of individuals with disabilities, elderly
individuals, representatives of such individuals, and organizations interested
in individuals with disabilities and elderly individuals.</text>
</paragraph><paragraph id="ID16c33938e7f648988d6f70895b4bfe55"><enum>(3)</enum><header>Composition</header>
<subparagraph id="ID35d1d2c24b6a462997edc8b7bf308d10"><enum>(A)</enum><header>In
general</header><text>The Task Force shall represent a broad range of
individuals with disabilities from diverse backgrounds and shall include
representatives from Developmental Disabilities Councils, Mental Health
Councils, State Independent Living Centers and Councils, Commissions on Aging,
organizations that provide services to individuals with disabilities and
consumers of long-term services and supports.</text>
</subparagraph><subparagraph id="ID5e9adb532e104ad199716fc7fe562c26"><enum>(B)</enum><header>Individuals
with disabilities</header><text>A majority of the members of the Task Force
shall be individuals with disabilities or representatives of such
individuals.</text>
</subparagraph><subparagraph id="IDf57a1f7966df48adbf9a62e8213193df"><enum>(C)</enum><header>Limitation</header><text>The
Task Force shall not include employees of any State agency providing services
to individuals with disabilities other than employees of entities described in
the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (42
U.S.C. 15001 et seq.).</text>
</subparagraph></paragraph></subsection><subsection id="ID7ca192136ce7451b912dd0d908eb4310"><enum>(d)</enum><header>Annual
report</header>
<paragraph id="ID61852007d4b44f42bcd92f64d49d582c"><enum>(1)</enum><header>States</header><text>A
State that receives a grant under this section shall submit an annual report to
the Secretary on the use of funds provided under the grant in such form and
manner as the Secretary may require.</text>
</paragraph><paragraph id="ID749110a1fada46a6b4c89d04ddb19644"><enum>(2)</enum><header>Secretary</header><text>The
Secretary shall submit to Congress an annual report on the grants made under
this section.</text>
</paragraph></subsection><subsection id="ID0078a114fbe04bee8ff6d4a764123de0"><enum>(e)</enum><header>Authorization
of appropriations</header>
<paragraph id="ID61d0c15f254445a5b6bec10a8c82e5a7"><enum>(1)</enum><header>In
general</header><text>There is authorized to be appropriated to carry out this
section, $50,000,000 for each of fiscal years 2008 through 2010.</text>
</paragraph><paragraph id="IDb09b92035c7046ae8c5df7744acdc32e"><enum>(2)</enum><header>Availability</header><text>Amounts
appropriated to carry out this section shall remain available without fiscal
year limitation.</text>
</paragraph></subsection></section><section id="IDed159d87317f4713a8e646f5e9e51e6e"><enum>202.</enum><header>Demonstration
project to enhance coordination of care under the Medicare and Medicaid
programs for dual eligible individuals</header>
<subsection id="IDc75827d2db6b4db990068be686c2d5aa"><enum>(a)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="ID7d568e218d03492185ec2a0359bd09ab"><enum>(1)</enum><header>Dually eligible
individual</header><text>The term <term>dually eligible individual</term> means
an individual who is enrolled in the Medicare and Medicaid programs established
under Titles XVIII and XIX, respectively, of the Social Security Act (42 U.S.C.
1395 et seq., 1396 et seq.).</text>
</paragraph><paragraph id="ID32be3f1f7bd64afb8f537f2167bb5693"><enum>(2)</enum><header>Project</header><text>The
term <quote>project</quote> means the demonstration project authorized to be
conducted under this section.</text>
</paragraph><paragraph id="ID87316c33d07a4063aab72ad7d7889544"><enum>(3)</enum><header>Secretary</header><text>The
term <quote>Secretary</quote> means the Secretary of Health and Human
Services.</text>
</paragraph></subsection><subsection id="ID544f792e96a34105844a4d6e5b805f6c"><enum>(b)</enum><header>Authority to
conduct project</header><text>The Secretary shall conduct a project under this
section for the purpose of evaluating service coordination and cost-sharing
approaches with respect to the provision of community-based services and
supports to dually eligible individuals.</text>
</subsection><subsection id="ID2b29f40e1abf4ebebfec61ebcfd247b7"><enum>(c)</enum><header>Requirements</header>
<paragraph id="ID2046726e97e9474eaccf53992af77d3f"><enum>(1)</enum><header>Number of
participants</header><text>Not more than 5 States may participate in the
project.</text>
</paragraph><paragraph id="ID7c67ce0ff49d4f7aaf1ec6eb48bced27"><enum>(2)</enum><header>Application</header><text>A
State that desires to participate in the project shall submit an application to
the Secretary, at such time and in such form and manner as the Secretary shall
specify.</text>
</paragraph><paragraph id="ID950172bd76f04abe9d5b4e1fdf85bd3f"><enum>(3)</enum><header>Duration</header><text>The
project shall be conducted for at least 5, but not more than 10 years.</text>
</paragraph></subsection><subsection id="ID2d0085d4c3b745148512ea790f5a866c"><enum>(d)</enum><header>Evaluation and
report</header>
<paragraph id="ID1e1d664710d84cf98f320e04fd980729"><enum>(1)</enum><header>Evaluation</header><text>Not
later than 1 year prior to the termination date of the project, the Secretary,
in consultation with States participating in the project, representatives of
dually eligible individuals, and others, shall evaluate the impact and
effectiveness of the project.</text>
</paragraph><paragraph id="IDc72d32515444467dab69c27094c9f5e6"><enum>(2)</enum><header>Report</header><text>The
Secretary shall submit a report to Congress that contains the findings of the
evaluation conducted under paragraph (1) along with recommendations regarding
whether the project should be extended or expanded, and any other legislative
or administrative actions that the Secretary considers appropriate as a result
of the project.</text>
</paragraph></subsection><subsection id="IDa4221a32c9df40b19fc56f454fda5bec"><enum>(e)</enum><header>Authorization
of appropriations</header><text>There are authorized to be appropriated such
sums as are necessary to carry out this section.</text>
</subsection></section>