42 U.S.C. § 1396t : US Code - Section 1396T: Home and community care for functionally disabled elderly individuals

Search 42 U.S.C. § 1396t : US Code - Section 1396T: Home and community care for functionally disabled elderly individuals

(a) "Home and community care" defined
In this subchapter, the term "home and community care" means one
or more of the following services furnished to an individual who
has been determined, after an assessment under subsection (c) of
this section, to be a functionally disabled elderly individual,
furnished in accordance with an individual community care plan
(established and periodically reviewed and revised by a qualified
community care case manager under subsection (d) of this section):
(1) Homemaker/home health aide services.
(2) Chore services.
(3) Personal care services.
(4) Nursing care services provided by, or under the supervision
of, a registered nurse.
(5) Respite care.
(6) Training for family members in managing the individual.
(7) Adult day care.
(8) In the case of an individual with chronic mental illness,
day treatment or other partial hospitalization, psychosocial
rehabilitation services, and clinic services (whether or not
furnished in a facility).
(9) Such other home and community-based services (other than
room and board) as the Secretary may approve.
(b) "Functionally disabled elderly individual" defined
(1) In general
In this subchapter, the term "functionally disabled elderly
individual" means an individual who -
(A) is 65 years of age or older,
(B) is determined to be a functionally disabled individual
under subsection (c) of this section, and
(C) subject to section 1396a(f) of this title (as applied
consistent with section 1396a(r)(2) of this title), is
receiving supplemental security income benefits under
subchapter XVI of this chapter (or under a State plan approved
under subchapter XVI of this chapter) or, at the option of the
State, is described in section 1396a(a)(10)(C) of this title.
(2) Treatment of certain individuals previously covered under a
waiver
(A) In the case of a State which -
(i) at the time of its election to provide coverage for home
and community care under this section has a waiver approved
under section 1396n(c) or 1396n(d) of this title with respect
to individuals 65 years of age or older, and
(ii) subsequently discontinues such waiver, individuals who
were eligible for benefits under the waiver as of the date of
its discontinuance and who would, but for income or resources,
be eligible for medical assistance for home and community care
under the plan shall, notwithstanding any other provision of
this subchapter, be deemed a functionally disabled elderly
individual for so long as the individual would have remained
eligible for medical assistance under such waiver.
(B) In the case of a State which used a health insuring
organization before January 1, 1986, and which, as of December
31, 1990, had in effect a waiver under section 1315 of this title
that provides under the State plan under this subchapter for
personal care services for functionally disabled individuals, the
term "functionally disabled elderly individual" may include, at
the option of the State, an individual who -
(i) is 65 years of age or older or is disabled (as determined
under the supplemental security income program under subchapter
XVI of this chapter);
(ii) is determined to meet the test of functional disability
applied under the waiver as of such date; and
(iii) meets the resource requirement and income standard that
apply in the State to individuals described in section
1396a(a)(10)(A)(ii)(V) of this title.
(3) Use of projected income
In applying section 1396b(f)(1) of this title in determining
the eligibility of an individual (described in section
1396a(a)(10)(C) of this title) for medical assistance for home
and community care, a State may, at its option, provide for the
determination of the individual's anticipated medical expenses
(to be deducted from income) over a period of up to 6 months.
(c) Determinations of functional disability
(1) In general
In this section, an individual is "functionally disabled" if
the individual -
(A) is unable to perform without substantial assistance from
another individual at least 2 of the following 3 activities of
daily living: toileting, transferring, and eating; or
(B) has a primary or secondary diagnosis of Alzheimer's
disease and is (i) unable to perform without substantial human
assistance (including verbal reminding or physical cueing) or
supervision at least 2 of the following 5 activities of daily
living: bathing, dressing, toileting, transferring, and eating;
or (ii) cognitively impaired so as to require substantial
supervision from another individual because he or she engages
in inappropriate behaviors that pose serious health or safety
hazards to himself or herself or others.
(2) Assessments of functional disability
(A) Requests for assessments
If a State has elected to provide home and community care
under this section, upon the request of an individual who is 65
years of age or older and who meets the requirements of
subsection (b)(1)(C) of this section (or another person on such
individual's behalf), the State shall provide for a
comprehensive functional assessment under this subparagraph
which -
(i) is used to determine whether or not the individual is
functionally disabled,
(ii) is based on a uniform minimum data set specified by
the Secretary under subparagraph (C)(i), and
(iii) uses an instrument which has been specified by the
State under subparagraph (B).
No fee may be charged for such an assessment.
(B) Specification of assessment instrument
The State shall specify the instrument to be used in the
State in complying with the requirement of subparagraph
(A)(iii) which instrument shall be -
(i) one of the instruments designated under subparagraph
(C)(ii); or
(ii) an instrument which the Secretary has approved as
being consistent with the minimum data set of core elements,
common definitions, and utilization guidelines specified by
the Secretary in subparagraph (C)(i).
(C) Specification of assessment data set and instruments
The Secretary shall -
(i) not later than July 1, 1991 -
(I) specify a minimum data set of core elements and
common definitions for use in conducting the assessments
required under subparagraph (A); and
(II) establish guidelines for use of the data set; and
(ii) by not later than July 1, 1991, designate one or more
instruments which are consistent with the specification made
under subparagraph (A) and which a State may specify under
subparagraph (B) for use in complying with the requirements
of subparagraph (A).
(D) Periodic review
Each individual who qualifies as a functionally disabled
elderly individual shall have the individual's assessment
periodically reviewed and revised not less often than once
every 12 months.
(E) Conduct of assessment by interdisciplinary teams
An assessment under subparagraph (A) and a review under
subparagraph (D) must be conducted by an interdisciplinary team
designated by the State. The Secretary shall permit a State to
provide for assessments and reviews through teams under
contracts -
(i) with public organizations; or
(ii) with nonpublic organizations which do not provide home
and community care or nursing facility services and do not
have a direct or indirect ownership or control interest in,
or direct or indirect affiliation or relationship with, an
entity that provides, community care or nursing facility
services.
(F) Contents of assessment
The interdisciplinary team must -
(i) identify in each such assessment or review each
individual's functional disabilities and need for home and
community care, including information about the individual's
health status, home and community environment, and informal
support system; and
(ii) based on such assessment or review, determine whether
the individual is (or continues to be) functionally disabled.
The results of such an assessment or review shall be used in
establishing, reviewing, and revising the individual's ICCP
under subsection (d)(1) of this section.
(G) Appeal procedures
Each State which elects to provide home and community care
under this section must have in effect an appeals process for
individuals adversely affected by determinations under
subparagraph (F).
(d) Individual community care plan (ICCP)
(1) "Individual community care plan" defined
In this section, the terms "individual community care plan" and
"ICCP" mean, with respect to a functionally disabled elderly
individual, a written plan which -
(A) is established, and is periodically reviewed and revised,
by a qualified case manager after a face-to-face interview with
the individual or primary caregiver and based upon the most
recent comprehensive functional assessment of such individual
conducted under subsection (c)(2) of this section;
(B) specifies, within any amount, duration, and scope
limitations imposed on home and community care provided under
the State plan, the home and community care to be provided to
such individual under the plan, and indicates the individual's
preferences for the types and providers of services; and
(C) may specify other services required by such individual.
An ICCP may also designate the specific providers (qualified to
provide home and community care under the State plan) which will
provide the home and community care described in subparagraph
(B). Nothing in this section shall be construed as authorizing an
ICCP or the State to restrict the specific persons or individuals
(who are competent to provide home and community care under the
State plan) who will provide the home and community care
described in subparagraph (B).
(2) "Qualified community care case manager" defined
In this section, the term "qualified community care case
manager" means a nonprofit or public agency or organization which
-
(A) has experience or has been trained in establishing, and
in periodically reviewing and revising, individual community
care plans and in the provision of case management services to
the elderly;
(B) is responsible for (i) assuring that home and community
care covered under the State plan and specified in the ICCP is
being provided, (ii) visiting each individual's home or
community setting where care is being provided not less often
than once every 90 days, and (iii) informing the elderly
individual or primary caregiver on how to contact the case
manager if service providers fail to properly provide services
or other similar problems occur;
(C) in the case of a nonpublic agency, does not provide home
and community care or nursing facility services and does not
have a direct or indirect ownership or control interest in, or
direct or indirect affiliation or relationship with, an entity
that provides, home and community care or nursing facility
services;
(D) has procedures for assuring the quality of case
management services that includes a peer review process;
(E) completes the ICCP in a timely manner and reviews and
discusses new and revised ICCPs with elderly individuals or
primary caregivers; and
(F) meets such other standards, established by the Secretary,
as to assure that -
(i) such a manager is competent to perform case management
functions;
(ii) individuals whose home and community care they manage
are not at risk of financial exploitation due to such a
manager; and
(iii) meets such other standards as the State may
establish.
The Secretary may waive the requirement of subparagraph (C) in
the case of a nonprofit agency located in a rural area.
(3) Appeals process
Each State which elects to provide home and community care
under this section must have in effect an appeals process for
individuals who disagree with the ICCP established.
(e) Ceiling on payment amounts and maintenance of effort
(1) Ceiling on payment amounts
Payments may not be made under section 1396b(a) of this title
to a State for home and community care provided under this
section in a quarter to the extent that the medical assistance
for such care in the quarter exceeds 50 percent of the product of
-
(A) the average number of individuals in the quarter
receiving such care under this section;
(B) the average per diem rate of payment which the Secretary
has determined (before the beginning of the quarter) will be
payable under subchapter XVIII of this chapter (without regard
to coinsurance) for extended care services to be provided in
the State during such quarter; and
(C) the number of days in such quarter.
(2) Maintenance of effort
(A) Annual reports
As a condition for the receipt of payment under section
1396b(a) of this title with respect to medical assistance
provided by a State for home and community care (other than a
waiver under section 1396n(c) of this title and other than home
health care services described in section 1396d(a)(7) of this
title and personal care services specified under regulations
under section 1396d(a)(23) of this title), the State shall
report to the Secretary, with respect to each Federal fiscal
year (beginning with fiscal year 1990) and in a format
developed or approved by the Secretary, the amount of funds
obligated by the State with respect to the provision of home
and community care to the functionally disabled elderly in that
fiscal year.
(B) Reduction in payment if failure to maintain effort
If the amount reported under subparagraph (A) by a State with
respect to a fiscal year is less than the amount reported under
subparagraph (A) with respect to fiscal year 1989, the
Secretary shall provide for a reduction in payments to the
State under section 1396b(a) of this title in an amount equal
to the difference between the amounts so reported.
(f) Minimum requirements for home and community care
(1) Requirements
Home and Community (!1) care provided under this section must
meet such requirements for individuals' rights and quality as are
published or developed by the Secretary under subsection (k) of
this section. Such requirements shall include -
(A) the requirement that individuals providing care are
competent to provide such care; and
(B) the rights specified in paragraph (2).
(2) Specified rights
The rights specified in this paragraph are as follows:
(A) The right to be fully informed in advance, orally and in
writing, of the care to be provided, to be fully informed in
advance of any changes in care to be provided, and (except with
respect to an individual determined incompetent) to participate
in planning care or changes in care.
(B) The right to voice grievances with respect to services
that are (or fail to be) furnished without discrimination or
reprisal for voicing grievances, and to be told how to complain
to State and local authorities.
(C) The right to confidentiality of personal and clinical
records.
(D) The right to privacy and to have one's property treated
with respect.
(E) The right to refuse all or part of any care and to be
informed of the likely consequences of such refusal.
(F) The right to education or training for oneself and for
members of one's family or household on the management of care.
(G) The right to be free from physical or mental abuse,
corporal punishment, and any physical or chemical restraints
imposed for purposes of discipline or convenience and not
included in an individual's ICCP.
(H) The right to be fully informed orally and in writing of
the individual's rights.
(I) Guidelines for such minimum compensation for individuals
providing such care as will assure the availability and
continuity of competent individuals to provide such care for
functionally disabled individuals who have functional
disabilities of varying levels of severity.
(J) Any other rights established by the Secretary.
(g) Minimum requirements for small community care settings
(1) "Small community care setting" defined
In this section, the term "small community care setting" means -

(A) a nonresidential setting that serves more than 2 and less
than 8 individuals; or
(B) a residential setting in which more than 2 and less than
8 unrelated adults reside and in which personal services (other
than merely board) are provided in conjunction with residing in
the setting.
(2) Minimum requirements
A small community care setting in which community care is
provided under this section must -
(A) meet such requirements as are published or developed by
the Secretary under subsection (k) of this section;
(B) meet the requirements of paragraphs (1)(A), (1)(C),
(1)(D), (3), and (6) of section 1396r(c) of this title, to the
extent applicable to such a setting;
(C) inform each individual receiving community care under
this section in the setting, orally and in writing at the time
the individual first receives community care in the setting, of
the individual's legal rights with respect to such a setting
and the care provided in the setting;
(D) meet any applicable State or local requirements regarding
certification or licensure;
(E) meet any applicable State and local zoning, building, and
housing codes, and State and local fire and safety regulations;
and
(F) be designed, constructed, equipped, and maintained in a
manner to protect the health and safety of residents.
(h) Minimum requirements for large community care settings
(1) "Large community care setting" defined
In this section, the term "large community care setting" means -

(A) a nonresidential setting in which more than 8 individuals
are served; or
(B) a residential setting in which more than 8 unrelated
adults reside and in which personal services are provided in
conjunction with residing in the setting in which home and
community care under this section is provided.
(2) Minimum requirements
A large community care setting in which community care is
provided under this section must -
(A) meet such requirements as are published or developed by
the Secretary under subsection (k) of this section;
(B) meet the requirements of paragraphs (1)(A), (1)(C),
(1)(D), (3), and (6) of section 1396r(c) of this title, to the
extent applicable to such a setting;
(C) inform each individual receiving community care under
this section in the setting, orally and in writing at the time
the individual first receives home and community care in the
setting, of the individual's legal rights with respect to such
a setting and the care provided in the setting; and
(D) meet the requirements of paragraphs (2) and (3) of
section 1396r(d) of this title (relating to administration and
other matters) in the same manner as such requirements apply to
nursing facilities under such section; except that, in applying
the requirement of section 1396r(d)(2) of this title (relating
to life safety code), the Secretary shall provide for the
application of such life safety requirements (if any) that are
appropriate to the setting.
(3) Disclosure of ownership and control interests and exclusion
of repeated violators
A community care setting -
(A) must disclose persons with an ownership or control
interest (including such persons as defined in section 1320a-
3(a)(3) of this title) in the setting; and
(B) may not have, as a person with an ownership or control
interest in the setting, any individual or person who has been
excluded from participation in the program under this
subchapter or who has had such an ownership or control interest
in one or more community care settings which have been found
repeatedly to be substandard or to have failed to meet the
requirements of paragraph (2).
(i) Survey and certification process
(1) Certifications
(A) Responsibilities of the State
Under each State plan under this subchapter, the State shall
be responsible for certifying the compliance of providers of
home and community care and community care settings with the
applicable requirements of subsections (f), (g) and (h) of this
section. The failure of the Secretary to issue regulations to
carry out this subsection shall not relieve a State of its
responsibility under this subsection.
(B) Responsibilities of the Secretary
The Secretary shall be responsible for certifying the
compliance of State providers of home and community care, and
of State community care settings in which such care is
provided, with the requirements of subsections (f), (g) and (h)
of this section.
(C) Frequency of certifications
Certification of providers and settings under this subsection
shall occur no less frequently than once every 12 months.
(2) Reviews of providers
(A) In general
The certification under this subsection with respect to a
provider of home or community care must be based on a periodic
review of the provider's performance in providing the care
required under ICCP's in accordance with the requirements of
subsection (f) of this section.
(B) Special reviews of compliance
Where the Secretary has reason to question the compliance of
a provider of home or community care with any of the
requirements of subsection (f) of this section, the Secretary
may conduct a review of the provider and, on the basis of that
review, make independent and binding determinations concerning
the extent to which the provider meets such requirements.
(3) Surveys of community care settings
(A) In general
The certification under this subsection with respect to
community care settings must be based on a survey. Such survey
for such a setting must be conducted without prior notice to
the setting. Any individual who notifies (or causes to be
notified) a community care setting of the time or date on which
such a survey is scheduled to be conducted is subject to a
civil money penalty of not to exceed $2,000. The provisions of
section 1320a-7a of this title (other than subsections (a) and
(b)) shall apply to a civil money penalty under the previous
sentence in the same manner as such provisions apply to a
penalty or proceeding under section 1320a-7a(a) of this title.
The Secretary shall review each State's procedures for
scheduling and conducting such surveys to assure that the State
has taken all reasonable steps to avoid giving notice of such a
survey through the scheduling procedures and the conduct of the
surveys themselves.
(B) Survey protocol
Surveys under this paragraph shall be conducted based upon a
protocol which the Secretary has provided for under subsection
(k) of this section.
(C) Prohibition of conflict of interest in survey team
membership
A State and the Secretary may not use as a member of a survey
team under this paragraph an individual who is serving (or has
served within the previous 2 years) as a member of the staff
of, or as a consultant to, the community care setting being
surveyed (or the person responsible for such setting)
respecting compliance with the requirements of subsection (g)
or (h) of this section or who has a personal or familial
financial interest in the setting being surveyed.
(D) Validation surveys of community care settings
The Secretary shall conduct onsite surveys of a
representative sample of community care settings in each State,
within 2 months of the date of surveys conducted under
subparagraph (A) by the State, in a sufficient number to allow
inferences about the adequacies of each State's surveys
conducted under subparagraph (A). In conducting such surveys,
the Secretary shall use the same survey protocols as the State
is required to use under subparagraph (B). If the State has
determined that an individual setting meets the requirements of
subsection (g) of this section, but the Secretary determines
that the setting does not meet such requirements, the
Secretary's determination as to the setting's noncompliance
with such requirements is binding and supersedes that of the
State survey.
(E) Special surveys of compliance
Where the Secretary has reason to question the compliance of
a community care setting with any of the requirements of
subsection (g) or (h) of this section, the Secretary may
conduct a survey of the setting and, on the basis of that
survey, make independent and binding determinations concerning
the extent to which the setting meets such requirements.
(4) Investigation of complaints and monitoring of providers and
settings
Each State and the Secretary shall maintain procedures and
adequate staff to investigate complaints of violations of
applicable requirements imposed on providers of community care or
on community care settings under subsections (f), (g) and (h) of
this section.
(5) Investigation of allegations of individual neglect and abuse
and misappropriation of individual property
The State shall provide, through the agency responsible for
surveys and certification of providers of home or community care
and community care settings under this subsection, for a process
for the receipt, review, and investigation of allegations of
individual neglect and abuse (including injuries of unknown
source) by individuals providing such care or in such setting and
of misappropriation of individual property by such individuals.
The State shall, after notice to the individual involved and a
reasonable opportunity for hearing for the individual to rebut
allegations, make a finding as to the accuracy of the
allegations. If the State finds that an individual has neglected
or abused an individual receiving community care or
misappropriated such individual's property, the State shall
notify the individual against whom the finding is made. A State
shall not make a finding that a person has neglected an
individual receiving community care if the person demonstrates
that such neglect was caused by factors beyond the control of the
person. The State shall provide for public disclosure of findings
under this paragraph upon request and for inclusion, in any such
disclosure of such findings, of any brief statement (or of a
clear and accurate summary thereof) of the individual disputing
such findings.
(6) Disclosure of results of inspections and activities
(A) Public information
Each State, and the Secretary, shall make available to the
public -
(i) information respecting all surveys, reviews, and
certifications made under this subsection respecting
providers of home or community care and community care
settings, including statements of deficiencies,
(ii) copies of cost reports (if any) of such providers and
settings filed under this subchapter,
(iii) copies of statements of ownership under section 1320a-
3 of this title, and
(iv) information disclosed under section 1320a-5 of this
title.
(B) Notices of substandard care
If a State finds that -
(i) a provider of home or community care has provided care
of substandard quality with respect to an individual, the
State shall make a reasonable effort to notify promptly (I)
an immediate family member of each such individual and (II)
individuals receiving home or community care from that
provider under this subchapter, or
(ii) a community care setting is substandard, the State
shall make a reasonable effort to notify promptly (I)
individuals receiving community care in that setting, and
(II) immediate family members of such individuals.
(C) Access to fraud control units
Each State shall provide its State medicaid fraud and abuse
control unit (established under section 1396b(q) of this title)
with access to all information of the State agency responsible
for surveys, reviews, and certifications under this subsection.
(j) Enforcement process for providers of community care
(1) State authority
(A) In general
If a State finds, on the basis of a review under subsection
(i)(2) of this section or otherwise, that a provider of home or
community care no longer meets the requirements of this
section, the State may terminate the provider's participation
under the State plan and may provide in addition for a civil
money penalty. Nothing in this subparagraph shall be construed
as restricting the remedies available to a State to remedy a
provider's deficiencies. If the State finds that a provider
meets such requirements but, as of a previous period, did not
meet such requirements, the State may provide for a civil money
penalty under paragraph (2)(A) for the period during which it
finds that the provider was not in compliance with such
requirements.
(B) Civil money penalty
(i) In general
Each State shall establish by law (whether statute or
regulation) at least the following remedy: A civil money
penalty assessed and collected, with interest, for each day
in which the provider is or was out of compliance with a
requirement of this section. Funds collected by a State as a
result of imposition of such a penalty (or as a result of the
imposition by the State of a civil money penalty under
subsection (i)(3)(A) of this section) may be applied to
reimbursement of individuals for personal funds lost due to a
failure of home or community care providers to meet the
requirements of this section. The State also shall specify
criteria, as to when and how this remedy is to be applied and
the amounts of any penalties. Such criteria shall be designed
so as to minimize the time between the identification of
violations and final imposition of the penalties and shall
provide for the imposition of incrementally more severe
penalties for repeated or uncorrected deficiencies.
(ii) Deadline and guidance
Each State which elects to provide home and community care
under this section must establish the civil money penalty
remedy described in clause (i) applicable to all providers of
community care covered under this section. The Secretary
shall provide, through regulations or otherwise by not later
than July 1, 1990, guidance to States in establishing such
remedy; but the failure of the Secretary to provide such
guidance shall not relieve a State of the responsibility for
establishing such remedy.
(2) Secretarial authority
(A) For State providers
With respect to a State provider of home or community care,
the Secretary shall have the authority and duties of a State
under this subsection, except that the civil money penalty
remedy described in subparagraph (C) shall be substituted for
the civil money remedy described in paragraph (1)(B)(i).
(B) Other providers
With respect to any other provider of home or community care
in a State, if the Secretary finds that a provider no longer
meets a requirement of this section, the Secretary may
terminate the provider's participation under the State plan and
may provide, in addition, for a civil money penalty under
subparagraph (C). If the Secretary finds that a provider meets
such requirements but, as of a previous period, did not meet
such requirements, the Secretary may provide for a civil money
penalty under subparagraph (C) for the period during which the
Secretary finds that the provider was not in compliance with
such requirements.
(C) Civil money penalty
If the Secretary finds on the basis of a review under
subsection (i)(2) of this section or otherwise that a home or
community care provider no longer meets the requirements of
this section, the Secretary shall impose a civil money penalty
in an amount not to exceed $10,000 for each day of
noncompliance. The provisions of section 1320a-7a of this title
(other than subsections (a) and (b)) shall apply to a civil
money penalty under the previous sentence in the same manner as
such provisions apply to a penalty or proceeding under section
1320a-7a(a) of this title. The Secretary shall specify
criteria, as to when and how this remedy is to be applied and
the amounts of any penalties. Such criteria shall be designed
so as to minimize the time between the identification of
violations and final imposition of the penalties and shall
provide for the imposition of incrementally more severe
penalties for repeated or uncorrected deficiencies.
(k) Secretarial responsibilities
(1) Publication of interim requirements
(A) In general
The Secretary shall publish, by December 1, 1991, a proposed
regulation that sets forth interim requirements, consistent
with subparagraph (B), for the provision of home and community
care and for community care settings, including -
(i) the requirements of subsection (c)(2) of this section
(relating to comprehensive functional assessments, including
the use of assessment instruments), of subsection (d)(2)(E)
of this section (relating to qualifications for qualified
case managers), of subsection (f) of this section (relating
to minimum requirements for home and community care), of
subsection (g) of this section (relating to minimum
requirements for small community care settings), and of
subsection (h) of this section (relating to minimum
requirements for large community care settings), and
(ii) survey protocols (for use under subsection (i)(3)(A)
of this section) which relate to such requirements.
(B) Minimum protections
Interim requirements under subparagraph (A) and final
requirements under paragraph (2) shall assure, through methods
other than reliance on State licensure processes, that
individuals receiving home and community care are protected
from neglect, physical and sexual abuse, financial
exploitation, inappropriate involuntary restraint, and the
provision of health care services by unqualified personnel in
community care settings.
(2) Development of final requirements
The Secretary shall develop, by not later than October 1, 1992 -

(A) final requirements, consistent with paragraph (1)(B),
respecting the provision of appropriate, quality home and
community care and respecting community care settings under
this section, and including at least the requirements referred
to in paragraph (1)(A)(i), and
(B) survey protocols and methods for evaluating and assuring
the quality of community care settings.
The Secretary may, from time to time, revise such requirements,
protocols, and methods.
(3) No delegation to States
The Secretary's authority under this subsection shall not be
delegated to States.
(4) No prevention of more stringent requirements by States
Nothing in this section shall be construed as preventing States
from imposing requirements that are more stringent than the
requirements published or developed by the Secretary under this
subsection.
(l) Waiver of Statewideness
States may waive the requirement of section 1396a(a)(1) of this
title (related to Statewideness) for a program of home and
community care under this section.
(m) Limitation on amount of expenditures as medical assistance
(1) Limitation on amount
The amount of funds that may be expended as medical assistance
to carry out the purposes of this section shall be for fiscal
year 1991, $40,000,000, for fiscal year 1992, $70,000,000, for
fiscal year 1993, $130,000,000, for fiscal year 1994,
$160,000,000, and for fiscal year 1995, $180,000,000.
(2) Assurance of entitlement to service
A State which receives Federal medical assistance for
expenditures for home and community care under this section must
provide home and community care specified under the Individual
Community Care Plan under subsection (d) of this section to
individuals described in subsection (b) of this section for the
duration of the election period, without regard to the amount of
funds available to the State under paragraph (1). For purposes of
this paragraph, an election period is the period of 4 or more
calendar quarters elected by the State, and approved by the
Secretary, for the provision of home and community care under
this section.
(3) Limitation on eligibility
The State may limit eligibility for home and community care
under this section during an election period under paragraph (2)
to reasonable classifications (based on age, degree of functional
disability, and need for services).
(4) Allocation of medical assistance
The Secretary shall establish a limitation on the amount of
Federal medical assistance available to any State during the
State's election period under paragraph (2). The limitation under
this paragraph shall take into account the limitation under
paragraph (1) and the number of elderly individuals age 65 or
over residing in such State in relation to the number of such
elderly individuals in the United States during 1990. For
purposes of the previous sentence, elderly individuals shall, to
the maximum extent practicable, be low-income elderly
individuals.