Statement on Introduced Bill (House of Representatives - June 24, 1997)

By Mr. GINGRICH:
H.R. 2020. A bill to amend title XIX of the Social Security Act to provide for coverage of community attendant services under the Medicaid Program; to the Committee on Commerce.

Mr. GINGRICH: Mr. Speaker, I want to introduce today the Medicaid Community Attendant Services Act of 1997 as part of my commitment to empowering all Americans and to the principles of community-based care. This bill allows for choices for persons with disabilities so that individuals can receive the care that is more appropriate for them. Everyone deserves the opportunity to lead a full and independent life and people with disabilities are no exception.

I believe that personal empowerment is essential to the pursuit of happiness and believe that this bill will begin a very important debate about long-term care in the Nation. During the 104th Congress, I submitted for the Congressional Record a statement in support of community-based care based upon the recommendations of a disabilities task force on disabilities which I appointed in Georgia and the work of advocates for community-based care from around the Nation.

The bill I am introducing today is the starting point for the dialog about the best way to empower persons with disabilities. I am aware that this proposal may have significant cost implications, so I encourage careful consideration and additional input to help ensure a sound policy decision.

Mr. GINGRICH: Mr. Speaker, I would like to encourage my colleagues to support the principles of home -and community-based services for the disabled and to urge States to consider these services as part of State initiatives to reform Medicaid through the MediGrant proposal.

I have had a longstanding admiration for the ability of our Nation's disabled to bear the burdens imposed on their day-to-day lives and the difficulties they face. It is no wonder that individuals affected by disabilities, as well as their families and friends, have sought greater access to long-awaited advancements in providing care for the disabled. Although this process has been slow at times, we are beginning to see a mindset emerge that encourages personal liberties, not discourages them.

I practice a management technique based on listen, learn, help, and lead. Well, I have listened to the disabled around the Nation and in the 6th Congressional District of Georgia where I have appointed a task force on disabilities. This task force has developed ideas that I think are thoughtful in addressing the needs of the disabled and which add a tremendously positive aspect to the MediGrant discussion.

The task force believes that there currently exists a bias in Medicaid toward institutionalization and away from home- and community-based services. While there are circumstances where institutionalization is the only viable choice, the task force believes that home- and community-based services should be the first option when appropriate for people with disabilities. I share in their assertion that no person should be forced into an institution to receive services that can be more effectively and more economically delivered in the home or community.

The task force points to the fact that 31 percent of the current Medicaid budget goes to institutional long-term care and only 6 percent goes to community-based long-term care. Furthermore, they assert that the average cost of nursing home care per person is $38,000 annually and that allowing persons to remain in their homes and communities is more economical, as well as more humane.

I hope that my colleagues will carefully consider these ideas on behalf of their constituents and help to empower individuals to realize their maximum freedoms and potentials.

Mr. GINGRICH: Mr. Speaker, as a cosponsor of important legislation introduced by my friend, colleague, and member of the Task Force on Disabilities, Steve Gunderson, I wish to express my support for home- and community-based care. This initiative was advocated by people with a personal interest in attendant services--the disabled--and I believe that this bill is a step in the right direction toward personal empowerment.

I appointed Mr. Gunderson to the Task Force on Disabilities back in July 1995 because of his commitment to personal empowerment. He has demonstrated his ability to lead, and I applaud his leadership on this issue. During the debate over Medicaid reform during the 104th Congress, I submitted a statement in the Congressional Record in support of home- and community-based case for the disabled based on recommendations from the Sixth District Disabilities Task Force which I appointed in Georgia, and urged States to develop programs that provide these services. It is only by giving States more flexibility to develop these innovative programs that the Government can efficiently and effectively meet the health care needs of Medicaid recipients. I am aware that this proposal may have significant cost implications, and I believe that careful consideration and additional input will help ensure a sound policy decision.

I am hopeful that we can move away from the current bias toward institutionalization in favor of home- and community-based services, whenever appropriate. This is an important bill for helping the disabled to lead a fully integrated life.

105th CONGRESS
  1st Session
                                H. R. 2020

 To amend title XIX of the Social Security Act to provide for coverage 
      of community attendant services under the Medicaid program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 24, 1997

 Mr. Gingrich introduced the following bill; which was referred to the 
                         Committee on Commerce

_______________________________________________________________________

                                 A BILL


 
 To amend title XIX of the Social Security Act to provide for coverage 
      of community attendant services under the Medicaid program.

    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 ``Medicaid Community Attendant 
Services Act of 1997''.

SEC. 2. COVERAGE OF COMMUNITY-BASED ATTENDANT SERVICES UNDER THE 
              MEDICAID PROGRAM.

    (a) Requiring Coverage for Individuals Entitled to Nursing Facility 
Services or Intermediate Care Facility Services for the Mentally 
Retarded.--Section 1902(a)(10)(D) of the Social Security Act (42 U.S.C. 
1396a(a)(10)(D)) is amended--
            (1) by inserting ``(i)'' after ``(D)'', and
            (2) by adding at the end the following:
                    ``(ii) subject to section 1932(b), for the 
                inclusion of qualified community-based attendant 
                services for any individual who, under the State plan, 
                is entitled to nursing facility services or 
                intermediate care facility services for the mentally 
                retarded and who requires such services based on 
                functional need (and without regard to age or 
                disability);''.
    (b) Medicaid Coverage of Community-Based Attendant Services.--
            (1) In general.--Title XIX of the Social Security Act, as 
        amended by section 114(a) of the Personal Responsibility and 
        Work Opportunity Reconciliation Act of 1996, is amended--
                    (A) by redesignating section 1932 as section 1933, 
                and
                    (B) by inserting after section 1931 the following 
                new section:

       ``coverage of qualified community-based attendant services

    ``Sec. 1932. (a) Qualified Community-Based Attendant Services 
Defined.--
            ``(1) In general.--In this title, the term `qualified 
        community-based attendant services' means attendant services 
        (as defined by the Secretary) furnished to an individual--
                    ``(A) on an as-needed basis under a plan of service 
                that is based on an assessment of functional need and 
                that is agreed to by the individual;
                    ``(B) in a home or community-based setting, which 
                may include a school, workplace, or recreation or 
                religious facility, but does not include a nursing 
                facility, an intermediate care facility for the 
                mentally retarded, or other institutional facility;
                    ``(C) under either an agency-provider model or 
                other model (as defined in subsection (c)); and
                    ``(D) the furnishing of which is selected, managed, 
                controlled by the individual (as defined by the 
                Secretary).
            ``(2) Services included.--Such term includes--
                    ``(A) backup and emergency attendant services;
                    ``(B) voluntary training on how to select, manage, 
                and dismiss attendants; and
                    ``(C) health-related tasks (as defined by the 
                Secretary) that are assigned to, delegated to, or 
                performed by, unlicensed personal attendants.
            ``(3) Excluded services.--Subject to paragraph (4), such 
        term does not include--
                    ``(A) provision of room and board, and
                    ``(B) prevocational, vocational, and supported 
                employment.
            ``(4) Flexibility in transition to home setting.--Under 
        regulations of the Secretary, such term may include 
        expenditures for transitional costs, such as rent and utility 
        deposits, first months's rent and utilities, bedding, basic 
        kitchen supplies, and other necessities required for an 
        individual to make the transition from a nursing facility or 
        intermediate care facility for the mentally retarded to a home 
        setting.
    ``(b) Limitation on Amounts of Expenditures as Medical 
Assistance.--
            ``(1) In general.--In carrying out section 
        1902(a)(10)(D)(ii), a State shall permit an individual who is 
        entitled to medical assistance with respect to nursing facility 
        services or intermediate care facility services for the 
        mentally retarded and who qualifies for the receipt of such 
        services to choose to receive medical assistance for qualified 
        community-based attendant services (rather than medical 
        assistance for such institutional services), in the most 
        integrated setting appropriate to the needs of the individual, 
        so long as the aggregate amount of the Federal expenditures for 
        such individuals in a fiscal year does not exceed the total 
        that would have been expended for such individuals to receive 
        such institutional services in the year plus, subject to 
        subsection (e), the transitional allotment to the State for the 
        fiscal year involved, as determined under paragraph (2)(B).
            ``(2) Transitional allotments.--
                    ``(A) Total amount.--The total amount of the 
                transitional allotments under this paragraph for--
                            ``(i) fiscal year 1998 is $580,000,000,
                            ``(ii) fiscal year 1999 is $480,000,000,
                            ``(iii) fiscal year 2000 is $380,000,000,
                            ``(iv) fiscal year 2001 is $280,000,000,
                            ``(v) fiscal year 2002 is $180,000,000 and
                            ``(vi) fiscal year 2003 is $100,000,000.
                    ``(B) State allotments.--The Secretary shall 
                provide a formula for the distribution of the total 
                amount of the transitional allotments provided in each 
                fiscal year under subparagraph (A) among States. Such 
                formula shall give preference to States that have a 
                relatively higher proportion of long-term care services 
                furnished to individuals in an institutional setting 
                but who have a plan under subsection (e) to 
                significantly reduce such proportion.
                    ``(C) Use of funds.--Such funds allotted to, but 
                not expended in, a fiscal year to a State are available 
                for expenditure in the succeeding fiscal year.
    ``(c) Delivery Models.--For purposes of this section:
            ``(1) Agency-provider model.--The term `agency-provider 
        model' means, with respect to the provision of community-based 
        attendant services for an individual, a method of providing 
        such services under which a single entity contracts for the 
        provision of such services.
            ``(2) Other model.--The term `other model' means a method, 
        other than an agency-provider model, for provision of services. 
        Such a model may include the provision of vouchers, direct cash 
        payments, or use of a fiscal agent to assist in obtaining 
        services.
    ``(d) Quality Assurance.--
            ``(1) In general.--No Federal financial participation shall 
        be available with respect to qualified community-based 
        attendant services furnished under an agency-provider model or 
        other model unless the State establishes and maintains a 
        quality assurance program that is developed after public 
        hearings, that is based on consumer satisfaction, and that, in 
        the case of services furnished under the agency-provider model, 
        meets the following requirements:
                    ``(A) Survey and certification.--The State 
                periodically certifies and surveys such provider-
                agencies. Such surveys are conducted on an unannounced 
                basis and average at least 1 a year for each agency-
                provider.
                    ``(B) Standards.--The State adopts standards for 
                survey and certification that include--
                            ``(i) minimum qualifications and training 
                        requirements for provider staff;
                            ``(ii) financial operating standards; and
                            ``(iii) a consumer grievance process.
                    ``(C) Monitoring boards.--The State provides a 
                system that allows for monitoring boards consisting of 
                providers, family members, consumers, and neighbors to 
                advise and assist the State.
                    ``(D) Public reporting.--The State establishes 
                reporting procedures to make available information to 
                the public.
                    ``(E) Ongoing monitoring.--The State provides 
                ongoing monitoring of the delivery of attendant 
                services and the effect of those services on the health 
                and well-being of each recipient.
            ``(2) Protection of beneficiaries.--
                    ``(A) In general.--The regulations promulgated 
                under section 1930(h)(1) shall apply with respect to 
                the protection of the health, safety, and welfare of 
                individuals receiving qualified community-based 
                attendant services in the same manner as they apply to 
                individuals receiving community supported living 
                arrangements services.
                    ``(B) Development of additional regulations.--The 
                Secretary shall develop additional regulations to 
                protect the health, safety, and welfare for individuals 
                receiving qualified community-based attendant services 
                other than under an agency-provider model. Such 
                regulations shall be designed to maximize the 
                consumers' independence and control.
                    ``(C) Sanctions.--The provisions of section 
                1930(h)(2) shall apply to violations of regulations 
                described in subparagraph (A) or (B) in the same manner 
                as they apply to violations of regulations described in 
                section 1930(h)(1).
    ``(e) Transition Plan.--
            ``(1) In general.--As a condition for receipt of a 
        transitional allotment under subsection (b)(2), a State shall 
        develop a long-term care services transition plan that 
        establishes specific action steps and specific timetables to 
        increase the proportion of long-term care services provided 
        under the plan under this title in home and community-based 
        settings, rather than institutional settings.
            ``(2) Participation.--The plan under paragraph (1) shall be 
        developed with major participation by both the State 
        Independent Living Council and the State Developmental 
        Disabilities Council, as well as input from the Councils on 
        Aging.
    ``(f) Eligibility.--Effective January 1, 1999, a State may not 
exercise the option of coverage of individuals under section 
1902(a)(10)(A)(ii)(V) without providing coverage under section 
1902(a)(10)(A)(ii)(VI).
    ``(g) Report on Impact of Section.--The Secretary shall submit to 
Congress periodic reports on the impact of this section on 
beneficiaries, States, and the Federal Government.''.
    (c) Coverage as Medical Assistance.--
            (1) In general.--Section 1905(a) of such Act (42 U.S.C. 
        1396d) is amended--
                    (A) by striking ``and'' at the end of paragraph 
                (24),
                    (B) by redesignating paragraph (25) as paragraph 
                (26), and
                    (C) by inserting after paragraph (24) the following 
                new paragraph:
            ``(25) qualified community-based attendant services (to the 
        extent allowed and as defined in section 1932); and''.
            (2) Eligibility classifications.--Section 
        1902(a)(10)(A)(ii)(VI) (42 U.S.C. 1396a(a)(10)(A)(ii)(VI)) is 
        amended by inserting ``or qualified community-based attendant 
        services'' after ``section 1915'' each it appears.
            (3) Conforming amendments.--(A) Section 1902(j) of such Act 
        (42 U.S.C. 1396a(j)) is amended by striking ``(25)'' and 
        inserting ``(26)''.
            (B) Section 1902(a)(10)(C)(iv) of such Act (42 U.S.C. 
        1396a(a)(10)(C)(iv)) is amended by striking ``(24)'' and 
        inserting ``(25)''.
    (d) Review of, and Report on, Regulations.--The Secretary of Health 
and Human Services shall review existing regulations under title XIX of 
the Social Security Act insofar as they regulate the provision of home 
health services and other services in home and community-based 
settings. The Secretary shall submit to Congress a report on how 
excessive utilization of medical services can be reduced under such 
title by using qualified community-based attendant services.
    (e) Development of Functional Needs Assessment Instrument.--The 
Secretary shall develop a functional needs assessment instrument that 
assesses an individual's need for qualified community-based attendant 
services and that may be used in carrying out sections 
1902(a)(10)(D)(ii) and 1932 of the Social Security Act.
    (f) Task Force on Financing of Long-Term Care Services.--The 
Secretary shall establish a task force to examine appropriate methods 
for financing long-term care services. Such task force shall include 
significant representation of individuals (and representatives of 
individuals) who receive such services.

SEC. 3. STATE OPTION FOR ELIGIBILITY FOR INDIVIDUALS.

    (a) In General.--Section 1903(f) of the Social Security Act (42 
U.S.C. 1396b(f)) is amended--
            (1) in paragraph (4)(C), by inserting ``subject to 
        paragraph (5),'' after ``does not exceed'', and
            (2) by adding at the end the following:
    ``(5)(A) A State may waive the income limitation described in 
paragraph (4)(C) in such cases as the State finds the potential for 
employment opportunities would be enhanced through the provision of 
such services.
    ``(B) In the case of an individual who is made eligible for medical 
assistance because of subparagraph (A), notwithstanding section 
1916(b), the State may impose a premium based on a sliding scale 
relating to income.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to medical assistance provided for items and services furnished 
on or after January 1, 1998.
                                 <all>