[Congressional Record Volume 160, Number 99 (Tuesday, June 24, 2014)]
[Senate]
[Pages S3940-S3941]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
By Mr. HARKIN:
S. 2515. A bill to ensure that Medicaid beneficiaries have the
opportunity to receive care in a home and community-based setting; to
the Committee on Finance.
Mr. HARKIN. Mr. President, I ask unanimous consent that the text of
the bill be printed in the Record.
There being on objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 2515
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 ``Community Integration Act of
2014''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) The Supreme Court's 1999 decision in Olmstead v. L.C.,
527 U.S. 581 (1999), held that the unnecessary segregation of
individuals with disabilities is a violation of the Americans
with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.).
(2) Under Olmstead, individuals generally have the right to
receive their supports and services in home and community-
based settings, rather than in institutional settings, if
they so choose.
(3) Olmstead envisioned that States would provide
appropriate long-term services and supports to individuals
with disabilities through home and community-based services
and end forced segregation in nursing homes and other
institutions.
(4) While there has been progress in rebalancing State
spending on individuals with disabilities in institutions as
compared to home and community-based settings, more than 75
percent of States continue to spend the majority of their
long-term care dollars on nursing homes and other
institutional settings, and the number of individuals with
disabilities under age 65 in nursing homes increased between
2008 and 2012.
(5) As of June 2013, there were more than 200,000
individuals younger than age 65 in nursing homes - almost 16
percent of the total nursing home population.
(6) Thirty-eight studies published from 2005 to 2012
concluded that providing services in home and community-based
settings is less costly than providing care in a nursing home
or other institutional setting.
(7) No clear or centralized reporting system exists to
compare how effectively States are meeting the Olmstead
mandate.
SEC. 3. ENSURING MEDICAID BENEFICIARIES MAY ELECT TO RECEIVE
CARE IN A HOME AND COMMUNITY-BASED SETTING.
(a) In General.--Section 1902(a) of the Social Security Act
(42 U.S.C. 1396a(a)) is amended--
(1) in paragraph (80), by striking ``and'' at the end;
(2) in paragraph (81), by striking the period and inserting
``; and''; and
(3) by inserting after paragraph (81) the following new
paragraph:
``(82) in the case of any individual with respect to whom
there has been a determination that the individual requires
the level of care provided in a nursing facility,
intermediate care facility for the mentally retarded,
institution for mental disease, or other similarly
restrictive or institutional setting--
``(A) provide the individual with the choice and
opportunity to receive such care in a home and community-
based setting, including rehabilitative services, assistance
and support in accomplishing activities of daily living,
instrumental activities of daily living, and health-related
tasks, and assistance in acquiring, maintaining, or enhancing
skills necessary to accomplish such activities, tasks, or
services;
``(B) ensure that each such individual has an equal
opportunity (when compared to the receipt and availability of
nursing facility services) to receive care in a home and
community-based setting, if the individual so chooses, by
ensuring that the provision of such care in a home and
community-based setting is widely available on a statewide
basis for all such individuals within the State; and
``(C) meet the requirements of section 1904A (relating to
the provision of care in a home and community-based
setting).''.
(b) Requirements for Community Care Options.--Title XIX of
the Social Security Act (42 U.S.C. 1396 et seq.) is amended
by inserting after section 1904 the following new section:
``provisions related to home and community-based care
``Sec. 1904A. (a) Definitions.--For purposes of this
section, section 1902(a)(82), and section 1905(a)(4)(A):
``(1) Activities of daily living.--The term `activities of
daily living' includes, but is not limited to, tasks such as
eating, toileting, grooming, dressing, bathing, and
transferring.
``(2) Health-related tasks.--The term `health-related
tasks' means specific tasks related to the needs of an
individual, including, but not limited to, bowel or bladder
care, wound care, use and care of ventilators and feeding
tubes, and the administration of medications and injections,
which, in the opinion of the individual's physician, can be
delegated to be performed by an attendant.
``(3) Home and community-based setting.--The term `home and
community-based setting' means, with respect to an individual
who requires a level of care provided in a nursing facility,
intermediate care facility for the mentally retarded,
institution for mental disease, or other similarly
restrictive or institutional setting, a setting that--
``(A) includes a house, apartment, townhouse, condominium,
or similar public or private housing where the individual
resides that--
``(i) is owned or leased by the individual or a member of
the individual's family;
``(ii) ensures the individual's privacy, dignity, respect,
and freedom from coercion; and
``(iii) maximizes the individual's autonomy and
independence;
``(B) is integrated in, and provides access to, the general
community in which the setting is located so that the
individual has access to the community and opportunities to
seek employment and work in competitive integrated settings,
participate in community life, control and utilize personal
resources, benefit from community services, and participate
in the community in an overall manner that is comparable to
that available to individuals who are not individuals with
disabilities; and
``(C) has the services and supports that the individual
needs in order to live as independently as possible.
``(4) Instrumental activities of daily living.--The term
`instrumental activities of daily living' means activities
related to living independently in the community and
includes, but is not limited to, meal planning and
preparation, managing finances, shopping for food, clothing,
and other items, performing household chores, communicating
by phone or other media, and traveling around and
participating in the community.
``(5) Public entity.--The term `public entity' means a
public entity as defined in subparagraphs (A) and (B) of
section 201(1) of the Americans with Disabilities Act of
1990.
``(b) Requirements for Providing Services in Home and
Community-based Settings.--With respect to the availability
and provision of services under the State plan under this
title, or under any waiver of State plan requirements
(subject to section 3(d) of the Community Integration Act of
2014), in a home and community-based setting to any
individual who requires a level of care provided in a nursing
facility, intermediate care facility for the mentally
retarded, institution for mental disease, or other similarly
restrictive or institutional setting, any public entity that
receives payment under the State plan or waiver for providing
services to such an individual shall not--
``(1) impose or utilize policies, practices, or procedures,
such as unnecessary requirements or arbitrary service or cost
caps, that limit the availability of services in home and
community-based settings to an individual with a disability
(including individuals with the most significant
disabilities) who need such services;
``(2) impose or utilize policies, practices, or procedures
that limit the availability of services in a home and
community-based setting (including assistance and support in
accomplishing activities of daily living, instrumental
activities of daily living, health-related tasks, and
rehabilitative services) based on the specific disability of
an otherwise eligible individual;
``(3) impose or utilize policies, practices, or procedures
that arbitrarily restrict an individual with a disability
from full and meaningful participation in community life;
``(4) impose or utilize policies, practices, or procedures
that unnecessarily delay or restrict the provision of
services in a home and community-based setting to any
individual who requires such services;
``(5) fail to establish and utilize adequate payment
structures to maintain a sufficient workforce to provide
services in home and community-based settings to any
individual who requires such services;
``(6) fail to provide information, on an ongoing basis, to
help any individual who receives care in a nursing facility,
intermediate care facility for the mentally retarded,
institution for mental disease, or
[[Page S3941]]
other similarly restrictive or institutional setting,
understand the individual's right to choose to receive such
care in a home and community-based setting; or
``(7) fail to provide information to help any individual
that requires the level of care provided in a nursing
facility, intermediate care facility for the mentally
retarded, institution for mental disease, or other similarly
restrictive or institutional setting, prior to the
individual's placement in such a facility or institution,
understand the individual's right to choose to receive such
care in a home and community-based setting.
``(c) Plan to Increase Affordable and Accessible Housing.--
Not later than 180 days after the enactment of this section,
each State shall develop a statewide plan to increase the
availability of affordable and accessible private and public
housing stock for individuals with disabilities (including
accessible housing for individuals with physical disabilities
and those using mobility devices).
``(d) Availability of Remedies and Procedures.--
``(1) In general.--The remedies and procedures set forth in
sections 203 and 505 of the Americans with Disabilities Act
of 1990 shall be available to any person aggrieved by the
failure of--
``(A) a State to comply with this section or section
1902(a)(82); or
``(B) a public entity (including a State) to comply with
the requirements of subsection (b).
``(2) Rule of construction.--Nothing in paragraph (1) shall
be construed to limit any remedy or right of action that
otherwise is available to an aggrieved person under this
title.
``(e) Enforcement by the Secretary.--
``(1) In general.--The Secretary may reduce the Federal
matching assistance percentage applicable to the State (as
determined under section 1905(b)) if the Secretary determines
that the State has violated the requirements of subsection
(b).
``(2) Rule of construction.--Nothing in paragraph (1) shall
be construed to limit any remedy or right of action that is
otherwise available to the Secretary.
``(f) Reporting Requirements.--With respect to fiscal year
2016, and for each fiscal year thereafter, each State shall
submit to the Administrator of the Administration for
Community Living of the Department of Health and Human
Services, not later than April 1 of the succeeding fiscal
year, a report, in such form and manner as the Secretary
shall require, that includes--
``(1) the total number of individuals enrolled in the State
plan or under a waiver of the plan during such fiscal year
that required the level of care provided in a nursing
facility, intermediate care facility for the mentally
retarded, institution for mental disease, or other similarly
restrictive or institutional setting, disaggregated by the
type of facility or setting;
``(2) with respect to the total number described in
paragraph (1), the total number of individuals described in
that paragraph who received care in a nursing facility,
intermediate care facility for the mentally retarded,
institution for mental disease, or other similarly
restrictive or institutional setting, disaggregated by the
type of facility or setting; and
``(3) with respect to the total number described in
paragraph (2), the total number of individuals described in
that paragraph who were transitioned from a nursing facility,
intermediate care facility for the mentally retarded,
institution for mental disease, or other similarly
restrictive or institutional setting to a home and community-
based setting, disaggregated by the type of home and
community-based setting.''.
(c) Inclusion as a Mandatory Service.--Section
1905(a)(4)(A) of the Social Security Act (42 U.S.C.
1396d(a)(4)(A)) is amended by striking ``other than'' and
inserting ``including similar services such as rehabilitative
services and assistance and support in accomplishing
activities of daily living, instrumental activities of daily
living, and health-related tasks, that are provided, at the
individual's option, in a home and community-based setting
(as defined in section 1904A(a)(3)), but not including''.
(d) Application to Waivers.--Notwithstanding section 1904A
of the Social Security Act (as added by subsection (b)), such
section, and sections 1902(a)(82), and 1905(a)(4)(A) of the
Social Security Act (42 U.S.C. 1396 et seq.), as amended by
subsections (a) and (c), respectively, shall not apply to any
individuals who are eligible for medical assistance for home
and community-based services under a waiver under section
1115 or 1915 of the Social Security Act (42 U.S.C. 1315,
1396n) and who are receiving such services, to the extent
such sections (as so added or amended) are inconsistent with
any such waiver.
(e) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by this section shall take effect on October
1, 2014.
(2) Delay permitted if state legislation required.--In the
case of a State plan under section 1902 of the Social
Security Act (42 U.S.C. 1396a) which the Secretary of Health
and Human Services determines requires State legislation
(other than legislation appropriating funds) in order for the
plan to meet the additional requirements imposed by the
amendments made by this section, the State plan shall not be
regarded as failing to comply with the requirements of such
section 1902 solely on the basis of the failure of the plan
to meet such additional requirements before the 1st day of
the 1st calendar quarter beginning after the close of the 1st
regular session of the State legislature that begins after
the date of enactment of this Act. For purposes of the
previous sentence, in the case of a State that has a 2-year
legislative session, each year of such session shall be
deemed to be a separate regular session of the State
legislature.
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