Statement on Introduced Bill (House of Representatives - June 24, 1997)
H.R. 2020 "Medicaid Community Attendant Services Act of 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.
INTRODUCTION OF THE MEDICAID COMMUNITY ATTENDANT SERVICES ACT OF 1997
______
HON. NEWT GINGRICH
of georgia
in the house of representatives
Tuesday, June 24, 1997
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.
A POSITIVE ASPECT TO THE MEDIGRANT DISCUSSION
______
HON. NEWT GINGRICH
of georgia
in the house of representatives
Wednesday, November 15, 1995
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.
EXPRESSING SUPPORT FOR HOME-AND COMMUNITY-BASED CARE
______
HON. NEWT GINGRICH
of georgia
in the house of representatives
Friday, September 27, 1996
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.
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