[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6296 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 6296

   To provide for an emergency increase in Federal funding to State 
    Medicaid programs for expenditures on home and community-based 
                               services.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            November 8, 2023

 Mrs. Dingell introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
   To provide for an emergency increase in Federal funding to State 
    Medicaid programs for expenditures on home and community-based 
                               services.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``HCBS Relief Act of 2023''.

SEC. 2. ADDITIONAL SUPPORT FOR MEDICAID HOME AND COMMUNITY-BASED 
              SERVICES.

    (a) Increased FMAP.--
            (1) In general.--Notwithstanding section 1905(b) of the 
        Social Security Act (42 U.S.C. 1396d(b)), in the case of an 
        HCBS program State, the Federal medical assistance percentage 
        determined for the State under section 1905(b) of such Act and, 
        if applicable, increased under subsection (y), (z), or (aa) of 
        section 1905 of such Act (42 U.S.C. 1396d), or section 1915(k) 
        of such Act (42 U.S.C. 1396n(k)), shall be increased by 10 
        percentage points with respect to expenditures of the State 
        under the State Medicaid program for home and community-based 
        services that are provided during fiscal years 2024 and 2025. 
        In no case may the application of the previous sentence result 
        in the Federal medical assistance percentage determined for a 
        State being more than 95 percent.
            (2) Definitions.--In this section:
                    (A) HCBS program state.--The term ``HCBS program 
                State'' means a State that meets the condition 
                described in subsection (b) by submitting an 
                application described in such subsection, which is 
                approved by the Secretary pursuant to subsection (c).
                    (B) Home and community-based services.--The term 
                ``home and community-based services'' means home health 
                care services authorized under paragraph (7) of section 
                1905(a) of the Social Security Act (42 U.S.C. 
                1396d(a)), behavioral health services authorized under 
                paragraph (13) of such section, personal care services 
                authorized under paragraph (24) of such section, PACE 
                services authorized under paragraph (26) of such 
                section, services authorized under subsections (b), 
                (c), (i), (j), and (k) of section 1915 of such Act (42 
                U.S.C. 1396n), such services authorized under a waiver 
                under section 1115 of such Act (42 U.S.C. 1315), and 
                such other services specified by the Secretary.
    (b) Condition.--The condition described in this subsection, with 
respect to a State, is that the State submits an application to the 
Secretary, at such time and in such manner as specified by the 
Secretary, that includes, in addition to such other information as the 
Secretary shall require--
            (1) a description of which activities described in 
        subsection (d) that a State plans to implement and a 
        description of how it plans to implement such activities;
            (2) assurances that all Federal funds attributable to the 
        increase under subsection (a) will be--
                    (A) expended by the State in accordance with this 
                section not later than September 30, 2027; and
                    (B) used--
                            (i) to implement the activities described 
                        in subsection (d);
                            (ii) to supplement, and not supplant, the 
                        level of State funds expended for home and 
                        community-based services for eligible 
                        individuals through programs in effect as of 
                        the date of the enactment of this section; and
                            (iii) to increase reimbursement rates for 
                        home and community-based services to a level 
                        that will support recruitment and retention of 
                        a sufficient workforce to provide home and 
                        community-based services to eligible 
                        individuals; and
            (3) assurances that the State will conduct adequate 
        oversight and ensure the validity of such data as may be 
        required by the Secretary.
    (c) Approval of Application.--Not later than 90 days after the date 
of submission of an application of a State under subsection (b), the 
Secretary shall certify if the application is complete. Upon 
certification that an application of a State is complete, the 
application shall be deemed to be approved for purposes of this 
section.
    (d) Activities To Improve the Delivery of HCBS.--
            (1) In general.--A State shall work with community 
        partners, such as Area Agencies on Aging, Centers for 
        Independent Living, non-profit home and community-based 
        services providers, and other entities providing home and 
        community-based services, to implement the purposes described 
        in paragraph (2).
            (2) Focused areas of hcbs improvement.--The purposes 
        described in this paragraph, with respect to a State, are the 
        following:
                    (A) To increase rates for home health agencies and 
                agencies that employ direct support professionals 
                (including independent providers in a self-directed or 
                consumer-directed model) 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 workers or direct 
                support professionals.
                    (B) To provide paid sick leave, paid family leave, 
                and paid medical leave for home health workers and 
                direct support professionals.
                    (C) To provide hazard pay, overtime pay, and shift 
                differential pay for home health workers and direct 
                support professionals.
                    (D) To improve stability of home health worker and 
                direct support professional jobs, including consistent 
                hours, scheduling, pay, and benefit eligibility.
                    (E) To provide home and community-based services to 
                eligible individuals who are on waiting lists for 
                programs approved under section 1115 or 1915 of the 
                Social Security Act (42 U.S.C. 1315, 1396n).
                    (F) To purchase emergency supplies and equipment, 
                which may include items not typically covered under the 
                Medicaid program, such as personal protective 
                equipment, necessary to enhance access to services and 
                to protect the health and well-being of home health 
                workers and direct support professionals.
                    (G) To pay for the travel of home health workers 
                and direct support professionals to conduct home and 
                community-based services.
                    (H) To recruit new home health workers and direct 
                support professionals.
                    (I) To support family care providers of eligible 
                individuals with needed supplies, equipment, and 
                services, which may include items such as family 
                caregiver pay and respite services.
                    (J) To pay for training for home health workers and 
                direct support professionals.
                    (K) To pay for assistive technologies, staffing, 
                training to facilitate an eligible individual's 
                communication, and other costs incurred in order to 
                facilitate community integration and ensure an 
                individual's person-centered service plan continues to 
                be fully implemented.
                    (L) To prepare information and public health and 
                educational materials in accessible formats (including 
                formats accessible to people with low literacy or 
                intellectual disabilities) about prevention, treatment, 
                recovery and other aspects of communicable diseases and 
                threats to the health of eligible individuals, their 
                families, and the general community served by agencies 
                described in subparagraph (A).
                    (M) To protect the health and safety of home health 
                workers and direct support professionals during public 
                health emergencies and natural disasters.
                    (N) To pay for interpreters to assist in providing 
                home and community-based services to eligible 
                individuals and to inform the general public about 
                communicable diseases and other public health threats.
                    (O) To allow day services providers to provide home 
                and community-based services.
                    (P) To pay for other expenses deemed appropriate by 
                the Secretary to enhance, expand, or strengthen Home 
                and Community-Based Services, including retainer 
                payments, and expenses which meet the criteria of the 
                home and community-based settings rule published on 
                January 16, 2014.
                    (Q) To assist eligible individuals who had to 
                relocate to a nursing facility or institutional setting 
                from their homes in--
                            (i) moving back to their homes (including 
                        by paying for moving costs, first month's rent, 
                        and other one-time expenses and start-up 
                        costs);
                            (ii) resuming home and community-based 
                        services;
                            (iii) receiving mental health services and 
                        necessary rehabilitative service to regain 
                        skills lost while relocated; and
                            (iv) while funds attributable to the 
                        increased FMAP under this section remain 
                        available, continuing home and community-based 
                        services for eligible individuals who were 
                        served from a waiting list for such services 
                        during the emergency period described in 
                        section 1135(g)(1)(B) of the Social Security 
                        Act (42 U.S.C. 1320b-5(g)(1)(B)).
    (e) Reporting Requirements.--
            (1) State reporting requirements.--Not later than December 
        31, 2027, any State with respect to which an application is 
        approved by the Secretary pursuant to subsection (c) shall 
        submit a report to the Secretary that contains the following 
        information:
                    (A) Activities and programs that were funded using 
                Federal funds attributable to such increase.
                    (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 evaluation.--
                    (A) In general.--The Secretary shall evaluate the 
                implementation and outcomes of this section in the 
                aggregate using an external evaluator with experience 
                evaluating home and community-based services, 
                disability programs, and older adult programs.
                    (B) Evaluation criteria.--For purposes of 
                subparagraph (A), the external evaluator shall--
                            (i) document and evaluate changes in 
                        access, availability, and quality of home and 
                        community-based services in each HCBS program 
                        State;
                            (ii) document and evaluate aggregate 
                        changes in access, availability, and quality of 
                        home and community-based services across all 
                        such States; and
                            (iii) evaluate the implementation and 
                        outcomes of this section based on--
                                    (I) the impact of this section on 
                                increasing funding for home and 
                                community-based services;
                                    (II) the impact of this section on 
                                achieving targeted access, 
                                availability, and quality of home and 
                                community-based services; and
                                    (III) promising practices 
                                identified by activities conducted 
                                pursuant to subsection (d) that 
                                increase access to, availability of, 
                                and quality of home and community-based 
                                services.
                    (C) Dissemination of evaluation findings.--The 
                Secretary shall--
                            (i) disseminate the findings from the 
                        evaluations conducted under this paragraph to--
                                    (I) all State Medicaid directors; 
                                and
                                    (II) the Committee on Energy and 
                                Commerce of the House of 
                                Representatives, the Committee on 
                                Finance of the Senate, and the Special 
                                Committee on Aging of the Senate; and
                            (ii) make all evaluation findings publicly 
                        available in an accessible electronic format 
                        and any other accessible format determined 
                        appropriate by the Secretary.
                    (D) Oversight.--Each State with respect to which an 
                application is approved by the Secretary pursuant to 
                subsection (c) shall ensure adequate oversight of the 
                expenditure of Federal funds pursuant to such increase 
                in accordance with the Medicaid regulations, including 
                sections 1115 and 1915 waiver regulations and special 
                terms and conditions for any relevant waiver or grant 
                program.
            (3) Non-application of the paperwork reduction act.--
        Chapter 35 of title 44, United States Code (commonly referred 
        to as the ``Paperwork Reduction Act of 1995''), shall not apply 
        to the provisions of this subsection.
    (f) Additional Definitions.--In this section:
            (1) Eligible individual.--The term ``eligible individual'' 
        means an individual who is eligible for or enrolled for medical 
        assistance under a State Medicaid program.
            (2) 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).
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (4) 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.).
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