[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6305 Introduced in House (IH)]

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116th CONGRESS
  2d Session
                                H. R. 6305

  To assist older Americans and people with disabilities affected by 
                               COVID-19.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 19, 2020

 Mrs. Dingell (for herself, Ms. Schakowsky, Ms. Matsui, Ms. Pressley, 
 Mr. Deutch, Ms. Roybal-Allard, and Mr. Lamb) introduced the following 
  bill; which was referred to the Committee on Appropriations, and in 
addition to the Committees on the Budget, and Energy and Commerce, for 
a period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
  To assist older Americans and people with disabilities affected by 
                               COVID-19.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) In General.--This Act may be cited as the ``Coronavirus Relief 
for Seniors and People with Disabilities Act of 2020''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
                  TITLE I--SUPPLEMENTAL APPROPRIATIONS

Sec. 101. Supplemental appropriations.
                           TITLE II--MEDICAID

Sec. 201. Expanded access to medical assistance for Medicare costs 
                            during the COVID-19 public health 
                            emergency.
Sec. 202. Authority to award Medicaid HCBS grants to respond to the 
                            COVID-19 public health emergency.

                  TITLE I--SUPPLEMENTAL APPROPRIATIONS

SEC. 101. SUPPLEMENTAL APPROPRIATIONS.

    The following sums are hereby appropriated, out of any money in the 
Treasury not otherwise appropriated, for the fiscal year ending 
September 30, 2020, and for other purposes, namely:

                DEPARTMENT OF HEALTH AND HUMAN SERVICES

                Centers for Medicare & Medicaid Services

                  survey and certification activities

    For an additional amount for survey and certification activities 
authorized under sections 1862(g) and 1864 of the Social Security Act 
(42 U.S.C. 1395y(g), 1395aa) and section 353 of the Public Health 
Service Act (42 U.S.C. 263a), $154,400,000, to remain available through 
September 30, 2021:  Provided, That such amount is designated by the 
Congress as being for an emergency requirement pursuant to section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Control 
Act of 1985.

                           TITLE II--MEDICAID

SEC. 201. EXPANDED ACCESS TO MEDICAL ASSISTANCE FOR MEDICARE COSTS 
              DURING THE COVID-19 PUBLIC HEALTH EMERGENCY.

    (a) In General.--Section 1902 of the Social Security Act (42 U.S.C. 
1396a) is amended--
            (1) in subsection (a)(10)(E)--
                    (A) in clause (iii), by striking ``; and'' and 
                inserting a semicolon;
                    (B) in clause (iv), by striking the semicolon and 
                inserting ``; and''; and
                    (C) by adding at the end the following new clause:
                    ``(v) during the period described in subsection 
                (ss), for making medical assistance available for 
                medicare cost-sharing (as defined in section 
                1905(p)(3)) for--
                            ``(I) individuals who are described in 
                        clause (ii), (iii), or (iv); and
                            ``(II) individuals--
                                    ``(aa) who are not described in 
                                clauses (i) through (iv) but who are 
                                eligible for, or enrolled in, the low-
                                income subsidy program under section 
                                1860D-14; and
                                    ``(bb) whose application for such 
                                medical assistance is received by the 
                                State (or automatically initiated 
                                pursuant to the transmittal of data 
                                under section 1144(c)(3)(B)) before the 
                                end of the emergency period defined in 
                                section 1135(g)(1)(B).''; and
            (2) by adding at the end the following new subsection:
    ``(ss) COVID-19 Emergency Assistance Period.--For purposes of 
subsection (a)(10)(E)(v), the period described in this subsection is 
the period--
            ``(1) beginning with the date of enactment of this 
        subsection; and
            ``(2) ending with the last day of the 12th month that 
        begins after the emergency period defined in section 
        1135(g)(1)(B).''.
    (b) Transmittal of Data to States and Automatic Enrollment of 
Individuals.--Section 1144(c)(3) of the Social Security Act (42 U.S.C. 
1320b-14(c)(3)) is amended--
            (1) by striking ``Beginning on January 1, 2010'' and 
        inserting the following:
                    ``(A) Transmittal of lis applications to states.--
                Beginning on January 1, 2010''; and
            (2) by adding at the end the following new subparagraph:
                    ``(B) Transmittal of lis enrollment information to 
                states during the covid-19 public health emergency.--
                During the period described in section 1902(ss), the 
                Secretary, in coordination with the Commissioner of 
                Social Security, shall electronically transmit to the 
                appropriate State Medicaid agency data related to each 
                individual who is enrolled in the low-income subsidy 
                program under section 1860D-14, and such transmittal 
                shall initiate an application of the individual for 
                benefits under the Medicare Savings Program with the 
                State Medicaid agency. In order to ensure that such 
                data transmittal provides effective assistance for 
                purposes of State adjudication of applications for 
                benefits under the Medicare Savings Program, the 
                Secretary shall consult with the States regarding the 
                content, form, frequency, and manner in which data (on 
                a uniform basis for all States) shall be transmitted 
                under this subparagraph.''.
    (c) Additional Appropriation for Administrative Costs for the 
Department of Health and Human Services and the Social Security 
Administration.--
            (1) In general.--There are hereby appropriated to carry out 
        the requirement of subparagraph (B) of section 1144(c)(3) of 
        the Social Security Act (42 U.S.C. 1320b-14(c)(3)), as added by 
        subsection (b), out of any funds in the Treasury not otherwise 
        appropriated--
                    (A) $1,000,000 to the Secretary of Health and Human 
                Services, to remain available until expended; and
                    (B) $1,000,000 to the Commissioner of Social 
                Security, to remain available until expended.
            (2) Supplement not supplant.--Any amounts appropriated 
        pursuant to this subsection shall be in addition to any other 
        amounts otherwise appropriated pursuant to any other provision 
        of law.
    (d) Budget Neutrality With Respect to Medicare Advantage 
Payments.--The Secretary of Health and Human Services shall assess the 
effect of the amendments made by subsection (a) on payments to Medicare 
Advantage plans under part C of title XVIII of the Social Security Act 
(42 U.S.C. 1395w-21 et seq.) and make necessary adjustments to ensure 
that, during the COVID-19 emergency assistance period described in 
subsection (ss) of section 1902 of the Social Security Act (42 U.S.C. 
1396a) (as added by subsection (a)), risk-adjusted payments under such 
part with respect to individuals newly enrolled in the Medicare Savings 
Program (as defined in section 1144 of the Social Security Act (42 
U.S.C. 1320b-14)) pursuant to such amendments do not exceed such 
payments that would have been made under such part with respect to such 
individuals if such subsection had not been enacted.
    (e) Federal Medical Assistance Percentage.--Section 1905 of the 
Social Security Act (42 U.S.C. 1396d) is amended--
            (1) in subsection (b), by striking ``and (ff)'' and 
        inserting ``(ff), and (gg)''; and
            (2) by adding at the end the following:
    ``(gg) Increased FMAP for Additional Expenditures for Medicare 
Cost-Sharing Provided During the COVID-19 Public Health Emergency.--
Notwithstanding subsection (b), the Federal medical assistance 
percentage for a State shall be 100 percent--
            ``(1) with respect to the additional amounts expended by 
        the State for medical assistance provided during the period 
        described in section 1902(ss) under the State plan under this 
        title or a waiver of such plan that are attributable to the 
        requirements imposed by section 1902(a)(10)(E)(v);
            ``(2) with respect to expenditures described in section 
        1903(a)(7) that--
                    ``(A) are made by the State during the period 
                described in section 1902(ss); and
                    ``(B) the State demonstrates to the satisfaction of 
                the Secretary are attributable to administrative costs 
                related to meeting such requirements; and
            ``(3) with respect to expenditures that are made by the 
        State to determine whether individuals who are provided medical 
        assistance for medicare cost-sharing under section 
        1902(a)(10)(E)(v)(II) remain eligible for such assistance after 
        the period described in section 1902(ss).''.

SEC. 202. AUTHORITY TO AWARD MEDICAID HCBS GRANTS TO RESPOND TO THE 
              COVID-19 PUBLIC HEALTH EMERGENCY.

    (a) In General.--The Secretary is authorized to award grants to 
States in accordance with this section to enhance access to home and 
community-based services during the COVID-19 public health emergency 
period.
    (b) Definitions.--In this section:
            (1) COVID-19 public health emergency period.--The term 
        ``COVID-19 public health emergency period'' means the portion 
        of the emergency period defined in paragraph (1)(B) of section 
        1135(g) of the Social Security Act (42 U.S.C. 1320b-5(g)) 
        beginning on or after the date of the enactment of this Act.
            (2) Eligible individual.--The term ``eligible individual'' 
        means an individual who is eligible for or enrolled for medical 
        assistance under a State Medicaid program.
            (3) Home and community-based services.--The term ``home and 
        community-based services'' means, with respect to a State 
        Medicaid program, home and community-based services (including 
        home health and personal care services) that are provided under 
        the State's qualified HCBS program or that could be provided 
        under such a program but are otherwise provided under the 
        Medicaid program.
            (4) Indian tribe.--The term ``Indian tribe'' means an 
        Indian tribe, a tribal organization, or an urban Indian 
        organization (as such terms are defined in section 4 of the 
        Indian Health Care Improvement Act (25 U.S.C. 1603)), and 
        includes a tribal consortium of Indian tribes or tribal 
        organizations (as so defined).
            (5) Medicaid program.--The term ``Medicaid program'' means, 
        with respect to a State, the State program under title XIX of 
        the Social Security Act (42 U.S.C. 1396 et seq.) (including any 
        waiver or demonstration under such title or under section 1115 
        of such Act (42 U.S.C. 1315) relating to such title).
            (6) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (7) State.--The term ``State'' has the meaning given such 
        term for purposes of title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.).
            (8) Qualified hcbs program.--The term ``qualified HCBS 
        program'' means a program providing home and community-based 
        services operating under a State Medicaid program, whether or 
        not operating under waiver authority.
    (c) Grants to States.--
            (1) In general.--During the COVID-19 public health 
        emergency period, the Secretary may award grants to States with 
        applications meeting the requirements of paragraph (2).
            (2) Application requirements.--A State seeking a grant 
        under this section shall submit an application to the Secretary 
        at such time, in such form and manner, and containing such 
        information as the Secretary shall require.
            (3) Limitations.--
                    (A) Termination of authority.--The Secretary shall 
                not award any grants under this section with respect to 
                a State that submits an application after the date that 
                is 60 days after the end of the COVID-19 public health 
                emergency period.
                    (B) Use of funds.--A State to which a grant is made 
                under this section shall only use grant funds in 
                accordance with subsection (d).
                    (C) Maintenance of state effort.--Federal funds 
                paid to a State pursuant to this section must be used 
                to supplement, but not supplant, the level of State 
                funds expended for home and community-based services 
                for eligible individuals programs in effect for such 
                individuals at the time the grant is awarded under this 
                section.
            (4) Monthly grant payment amounts.--
                    (A) In general.--Subject to paragraph (5), the 
                Secretary shall pay to each State that is awarded a 
                grant under this section, for each month during the 
                State's grant period (as defined in subparagraph (C)), 
                an amount equal to 15 percent of the amount determined 
                for the State under subparagraph (B).
                    (B) Average monthly hcbs expenditures.--The amount 
                determined for a State under this subparagraph is the 
                amount equal to--
                            (i) the sum of--
                                    (I) the average annual amount of 
                                State expenditures under title XIX of 
                                the Social Security Act (42 U.S.C. 1396 
                                et seq.) that are attributable to 
                                providing medical assistance for home 
                                and community-based services for the 3 
                                most recent fiscal years for which data 
                                is available; and
                                    (II) the average annual amount, if 
                                any, received by the State pursuant to 
                                an MFP demonstration project conducted 
                                under section 6071 of the Deficit 
                                Reduction Act of 2005 (42 U.S.C. 1396a 
                                note) for the 3 most recent fiscal 
                                years for which data is available; 
                                divided by
                            (ii) 12.
                    (C) Grant period defined.--In this paragraph, the 
                term ``grant period'' means, with respect to a State, 
                the period of months--
                            (i) beginning with the month in which the 
                        Secretary approves the State's application for 
                        a grant under this section; and
                            (ii) ending with the 12th month that begins 
                        after the end of the COVID-19 public health 
                        emergency period.
            (5) Grants to indian tribes.--
                    (A) In general.--During the COVID-19 public health 
                emergency period, the Secretary may award grants to an 
                Indian tribe in the same manner, and subject to the 
                same requirements, as apply to a State, except as 
                otherwise provided in this paragraph.
                    (B) Application.--Any Indian tribe seeking a grant 
                under this section shall submit to the Secretary an 
                application that includes (in addition to any other 
                information the Secretary shall require) an 
                identification of the population and service area or 
                areas to be served by the activities and programs that 
                will be funded by the grant.
                    (C) Monthly grant payment amounts.--
                            (i) In general.--The Secretary shall pay to 
                        each Indian tribe that is awarded a grant under 
                        this section, for each month during the tribe's 
                        grant period (as defined in clause (iii)), an 
                        amount equal to 15 percent of the amount 
                        determined for the tribe under clause (ii).
                            (ii) Tribal share of monthly hcbs 
                        expenditures.--The amount determined for an 
                        Indian tribe under this clause is equal to 
                        the--
                                    (I) the total of the average annual 
                                amount of State expenditures made by a 
                                State or States under title XIX of the 
                                Social Security Act (42 U.S.C. 1396 et 
                                seq.) that are attributable to 
                                providing medical assistance for home 
                                and community-based services to 
                                eligible individuals who reside in the 
                                service area or areas identified by the 
                                tribe pursuant to subparagraph (B) for 
                                the 3 most recent fiscal years for 
                                which data is available; divided by
                                    (II) 12.
                            (iii) Grant period.--The term ``grant 
                        period'' has the same meaning with respect to 
                        an Indian tribe as the term has with respect to 
                        a State under paragraph (4)(C).
                    (D) Reduction of state grant amounts.--If any State 
                in which lies a service area or areas identified by an 
                Indian tribe in a successful grant application pursuant 
                to subparagraph (B) is also awarded a grant under this 
                section, the Secretary shall reduce the amount payable 
                to such State each month under paragraph (4) by the 
                portion of the amount payable to the Indian tribe under 
                this paragraph that is attributable to expenditures by 
                the State.
    (d) Permissible Uses of Funds.--
            (1) In general.--A State to which a grant is made under 
        this section may use grant funds--
                    (A) to work with community partners such as Area 
                Agencies on Aging, Independent Living Centers, non-
                profit home and community-based service providers, and 
                other entities providing home and community-based 
                services;
                    (B) during the COVID-19 public health emergency 
                period, for the purposes described in paragraph (2); 
                and
                    (C) after the end of such period, for the purposes 
                described in paragraph (3).
            (2) Permissible uses during the emergency period.--The 
        purposes described in this paragraph for which a State may use 
        grant funds awarded under this section are the following:
                    (A) To increase rates for home health and direct 
                service worker agencies to provide home and community-
                based services under the State Medicaid program, 
                provided that any agency or individual that receives 
                payment under such an increased rate increases the 
                compensation it pays its home health or direct service 
                workers.
                    (B) To provide paid sick leave, paid family leave, 
                and paid medical leave for home health workers and 
                direct service workers.
                    (C) To provide hazard pay, overtime pay, and shift 
                differential pay for home health workers and direct 
                service workers.
                    (D) To provide home and community-based services to 
                eligible individuals who are on waiting lists for 
                programs approved under sections 1115 or 1915 of the 
                Social Security Act (42 U.S.C. 1315, 1396n).
                    (E) To purchase emergency supplies and equipment 
                necessary to enhance access to services and to protect 
                the health and well-being of home health workers and 
                direct service workers.
                    (F) To pay for home health worker and direct 
                service worker travel to conduct home and community-
                based services.
                    (G) To recruit new direct service workers and home 
                health workers.
                    (H) To support family care providers of eligible 
                individuals with needed supplies and equipment and pay.
                    (I) To pay for training for direct service workers 
                and home health workers that is specific to the COVID-
                19 public health emergency.
                    (J) To pay for assistive technologies, staffing, 
                and other costs incurred during the public health 
                emergency in order to facility community integration 
                and ensure an individual's person-centered service plan 
                continue to be fully implemented.
                    (K) To support direct service workers and home 
                health workers going to nursing facilities, hospitals, 
                institutions, and quarantine settings to provide 
                services to eligible individuals who usually receive 
                home and community-based services and have chosen to 
                temporarily move to a more restrictive setting.
                    (L) To prepare information and public health and 
                educational materials in accessible formats about 
                prevention, treatment, recovery and other aspects of 
                COVID-19 for eligible individuals, their families, and 
                the general community served by home health and direct 
                service agencies, including formats accessible to 
                people with low literacy or intellectual disabilities.
                    (M) To pay for American sign language interpreters 
                to assist in providing home and community-based 
                services to eligible individuals and to inform the 
                general public about COVID-19.
                    (N) To allow for day service providers to shift to 
                providing home-based services.
                    (O) To pay for COVID-19 testing in home settings.
                    (P) To pay for other expenses deemed appropriate by 
                the Secretary and which meet the criteria of the home 
                and community-based settings rule.
            (3) Permissible uses after the emergency period.--The 
        purpose described in this paragraph for which a State may use 
        grant funds awarded under this section is to assist eligible 
        individuals who had to relocate to a nursing facility or 
        institutional setting from their homes during the COVID-19 
        public health emergency period in--
                    (A) moving back to their homes (including by paying 
                for moving costs);
                    (B) resuming home and community-based services;
                    (C) receiving mental health services and necessary 
                rehabilitative service to regain skills lost while 
                relocated during the public health emergency period; 
                and
                    (D) continuing home and community-based services 
                for eligible individuals who were served from a waiting 
                list for such services during the public health 
                emergency period.
    (e) Reporting Requirements.--
            (1) State reporting requirements.--Not later than 18 months 
        after the end of the COVID-19 public health emergency period, 
        any State that received a grant under this section shall submit 
        a report to the Secretary that contains the following 
        information:
                    (A) Activities and programs that were funded using 
                grant amounts.
                    (B) The number of eligible individuals who were 
                served by such activities and programs.
                    (C) The number of eligible individuals who were 
                able to resume home and community-based services as a 
                result of such activities and programs.
            (2) HHS report.--Not later than 18 months after the end of 
        the COVID-19 public health emergency period, the Secretary 
        shall issue a public summary of the grants awarded under this 
        section.
    (f) Appropriation.--
            (1) In general.--Subject to paragraph (2), there are 
        appropriated for fiscal year 2020 from any funds in the 
        Treasury not otherwise appropriated such sums as are necessary 
        to carry out this section, to remain available until expended.
            (2) Availability of appropriations.--Amounts made available 
        under paragraph (1) shall not be available for the awarding of 
        grants to States that do not submit an application for such a 
        grant before the date described in subsection (c)(3)(A).
            (3) Unused grant funds.--A State that receives a grant 
        under this section shall return to the Secretary any portion of 
        such grant that is unused as of the date that is 1 year after 
        the last day of the COVID-19 public health emergency period, 
        and such returned portion shall revert to the Treasury.
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