,,ii #aafth ,,congress #b;d ,session ,s4 #cbgg ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #ab1 #bjbj,mr4 ,casey introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xix of the ,social ,security ,act to strengthen the infrastructure of1 access to1 and reporting of ,medicaid home and community-based services1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,,hcbs ,infrastructure ,improvement ,act4 #b4 ,findings and purpose 7a7 ,findings ,congress finds the following3 7#a7 ,states are prioritizing funding of their ,medicaid programs for long-term services and supports 7referred to in this section as ,,ltss7 to offer a wider range of options for home and community-based services 7referred to in this section as ,,hcbs71 but gaps in ,,hcbs remain4 7#b7 ,in fiscal year #bjaf1 ,states were spending only #eg percent of their total ,,ltss budgets on ,,hcbs1 well short of the national goal of #fi percent set by the ,centers for ,medicare ,medicaid ,services4 7#c7 ,in #bjag1 more than #gjj1jjj people with disabilities1 older adults1 and children were on waiting lists to receive ,,hcbs through existing ,medicaid waver programs4 7#d7 ,according to projections by the ,bureau of the ,census1 the number of adults over age #fe will reach #hd1jjj1jjj by mid-century1 and the population of people #he and older will be nearly #ae million by #bjdj4 7#e7 ,absent strategic planning and investment1 ,states will experience greater difficulties as the needs of older adults increase demands on ,state home and community-based services ,,hcbs capacity4 7#f7 ,a one-time1 targeted investment to strengthen ,state capacity to build out ,medicaid infrastructure that supports multiple ,,hcbs programs and connects to other ,federal and ,state programs1 including ,medicare and the ,older ,americans ,act1 will improve the quality of health and daily living for the millions of older adults1 people with disabilities and their families4 7#g7 ,home and community-based services ,,hcbs play an outsized role in addressing the social determinants of health among older adults and people with disabilities1 who require accessible housing and accessible transportation and access to reliable personal care to avert costly medical crises4 7b7 ,purpose ,the purpose of this ,act is to establish to a one-time infrastructure improvement initiative for ,states to strengthen their ,,hcbs capacity in selected target areas1 including housing and transportation1 workforce1 and employment supports1 in order to improve the cost-effectiveness of long-term service and support 7,,ltss7 ,medicaid programs and coordination with other programs that provide supportive services to older adults and people with disabilities4 #c4 ,medicaid home and community-based services infrastructure improvement ,title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is amended by adding at the end the following3 #aidg4 ,home and community-based services infrastructure improvement 7a7 ,definitions ,in this section3 7#a7 ,direct support professional ,the term direct support professional means a person who1 in exchange for compensation1 provides services to a person with a disability 7as defined in section #c of the ,americans ,with ,disabilities ,act of #aiij7 that promote such person's independence1 including-- 7,a7 services that enhance independence and community inclusion for such person1 including traveling with such person1 attending and assisting such persons while visiting friends and family1 shopping1 or socializing2 7,b7 services such as coaching and supporting such person in communicating needs1 achieving self-expression1 pursuing personal goals1 living independently1 and participating actively in employment or voluntary roles in the community2 7,c7 services such as providing assistance with activities of daily living 7such as feeding1 bathing1 toileting1 and ambulation7 and with tasks such as meal preparation1 shopping1 light housekeeping1 and laundry2 or 7,d7 services that support such person at home1 work1 school1 church1 or other community settings4 7#b7 ,eligible ,,hcbs expenditures ,the term eligible ,,hcbs expenditures means expenditures by an ,,hcbs infrastructure ,state on medical assistance for home and community-based services that are provided under the ,state plan or waiver during the ,state's ,,hcbs infrastructure period and which aim to collaborate with other programs offering support for home and community-based services4 7#c7 ,first mile_/last mile transportation ,the term first mile_/last mile transportation means the transportation necessary to-- 7,a7 transport a person to a fixed route transit system that the person could not otherwise conveniently access by walking1 wheelchair1 walker1 or other self-propelled mobility method2 and 7,b7 transport a person from a fixed route transit system to the person's final destination when the final destination is not within a distance that the person could conveniently access by walking1 wheelchair1 walker1 or other self-propelled mobility method4 7#d7 ,,hcbs infrastructure period ,the term ,,hcbs infrastructure period means1 with respect to an ,,hcbs infrastructure ,state1 the #g-;fiscal year period that begins with the first fiscal year that begins after the date on which the ,state is granted approval by the ,secretary under subsection 7c7 to conduct an ,,hcbs infrastructure program4 7#e7 ,,hcbs infrastructure program ,the term ,,hcbs infrastructure program means a demonstration program conducted under this section4 7#f7 ,,hcbs infrastructure ,state ,the term ,,hcbs infrastructure ,state means a ,state that has been granted approval by the ,secretary under subsection 7c7 to conduct an ,,hcbs infrastructure program4 7#g7 ,home and community-based services ,the term home and community-based services means long-term1 person-centered services and supports that are not provided in an institutional setting1 including-- 7,a7 a home and community-based service provided under subsection 7c71 7d71 or 7i7 of section #aiae or under a waiver under section #aaae2 7,b7 home and community-based long-term services and supports 7provided in accordance with the requirements for home and community-based settings under sections #dda4ecj and #dda4gaj of title #db1 ,code of ,federal ,regulations71 including-- 7i7 services described in paragraphs 7#g71 7#h71 7#ac71 7#ai71 and 7#bd7 of section #aije7;a72 7ii7 home and community-based services described in subsection 7c77#d77;,b7 of section #aiae2 7iii7 self-directed home and community-based services described in subsection 7i7 of section #aiae2 7iv7 self-directed personal assistance services 7as defined in subsection 7j77#d77;,a7 of section #aiae72 and 7v7 home and community-based attendant services and supports described in subsection 7k7 of section #aiae2 7,c7 a home health care service2 and 7,d7 a personal care service4 7#h7 ,long-term services and supports ,the term long-term services and supports has the meaning given that term in section #dch4b of title #db1 ,code of ,federal ,regulations 7as of the date of enactment of this section74 7#i7 ,shared living ,the term shared living means a living arrangement involving-- 7,a7 not more than #b people with disabilities or an older adult with a disability1 except if #a or more of the people are related to each other 7by blood or a close association that is equivalent to a family relationship72 7,b7 a person who-- 7i7 provides long-term services and supports in exchange for compensation2 7ii7 lives together in a private home with the recipient of such services2 and 7iii7 receives a stipend or room and board as the primary form of payment for providing such services2 7,c7 a person receiving funding through a ,state ,medicaid program under this title or another publically funded program2 and 7,d7 the person receiving such services having the final decision regarding who is the provider of such services living with the person1 through a consumer-driven matching process that includes relationship building1 person-centered planning as defined by the ,administrator of the ,centers for ,medicare ,medicaid ,services1 and an assessment of individual compatibility4 7#aj7 ,state ,the term ,state means each of the #ej ,states1 the ,district of ,columbia1 the ,commonwealth of ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 ,american ,samoa1 and the ,northern ,mariana ,islands4 7#aa7 ,universal mobility service ,the term universal mobility service means a single platform through which people with disabilities or older adults are able to-- 7,a7 access a variety of public and private demand responsive and fixed-route transportation services which have the necessary vehicles and facilities to meet the needs of all users1 regardless of income1 geographic location1 disability1 or age2 7,b7 and identify their travel options and compare the cost and length of trips using each such option2 and 7,c7 schedule a ride1 monitor progress1 and pay for the trip1 regardless of the number of transfers and independent providers used4 7b7 ,planning grants 7#a7 ,in general ,not later than ,january #a of each of calendar years #bjba through #bjbd1 from the amount appropriated under paragraph 7#e71 the ,secretary shall1 subject to paragraph 7#b71 award planning grants to any ,state that applies for such a grant for the purpose of developing proposals for an ,,hcbs infrastructure program4 7#b7 ,selection1 duration1 and number of ,states 7,a7 ,selection criteria ,in awarding grants for a year under this subsection the ,secretary shall-- 7i7 consider the technical merits the proposed ,,hcbs infrastructure program of each ,state that is applying for a grant in such year2 and 7ii7 select a group of ,states that is diverse in terms of-- 7,i7 the geographic areas the group represents2 7,,ii7 the population sizes of the ,states comprising the group2 and 7,,iii7 the subparagraphs of subsection 7e77#b7 in which each such ,state is described 7based on data from the #b most recent years for which data is available74 7,b7 ,duration ,grants awarded under this subsection shall be available to ,states for a period of #a year4 7,c7 ,number of ,states ,the ,secretary shall not award planning grants under this subsection to more than #ag ,states in any year1 and no ,state may receive more than #a grant under this subsection4 7#c7 ,use of funds ,a ,state awarded a planning grant under this subsection shall-- 7,a7 establish a ,development and ,implementation ,council that meets the requirements described in paragraph 7#d7 to provide input into the development of the proposal and1 if the ,state receives approval to conduct a demonstration program under this section1 to monitor the ongoing implementation of the program2 7,b7 with guidance from the ,centers for ,medicare ,medicaid ,services1 identify populations in the ,state for which the per capita annual expenditures under the ,state plan or waiver of such plan on home and community-based services is less than the national average for that population2 7,c7 establish a set of standards and procedures to ensure the ,state makes measurable progress in expanding the availability of self-direction to people served by home and community-based service providers2 7,d7 develop a plan to increase home and community-based services1 increase the availability of providers of such service throughout the ,state1 and address at least #c of the ,,hcbs infrastructure priority areas described in subsection 7c77#c72 7,e7 solicit public comment to help determine what the priorities of the proposed demonstration program should be2 and 7,f7 execute memoranda of understanding between any ,state agencies that will be responsible for activities under the proposed demonstration program under which each such agency agrees to conduct the activities for which it will be responsible and to cooperate with other agencies as necessary4 7#d7 ,development and ,implementation ,council ,requirements ,the requirements described in this paragraph with respect to a ,development and ,implementation ,council established by a ,state 7referred to in this section as a ,council7 are the following3 7,a7 ,the members of the ,council 7the majority of whom shall be people with disabilities or older adults who need home and community-based services7 shall consist of-- 7i7 people with disabilities or older adults who receive home and community-based services2 7ii7 people with disabilities1 including older adults with disabilities1 who meet criteria for home and community-based services but are not receiving such services2 7iii7 family caregivers2 7iv7 direct support professionals2 7v7 providers of home and community-based services2 7vi7 one representative each from-- 7,i7 an organization that represents people with disabilities2 7,,ii7 an organization that represents older adults2 and 7,,iii7 an organization that represents direct support professionals2 and 7vii7 representatives from ,state agencies that provide aging1 disability1 transportation1 housing1 employment1 vocational rehabilitation1 mental health1 and substance use services and representatives1 as appropriate1 from programs providing transportation supports1 housing supports1 home and community-based services workforce development1 family caregiver supports1 and education and vocational rehabilitation services4 7,b7 ,the ,council is coordinated by the ,governor1 and any proposal of the ,council shall be submitted to1 and reviewed by1 by the ,governor before it is submitted to the ,secretary4 7,c7 ,the ,council shall conduct a public comment process to collect information to inform the priorities and activities identified in the grant application4 7#e7 ,funding 7,a7 ,in general ,out of any funds in the ,treasury not otherwise appropriated1 there is appropriated to the ,secretary for each of fiscal years #bjba through #bjbd #ajj1jjj1jjj for purposes of awarding grants under this subsection4 7,b7 ,availability ,funds appropriated under subparagraph 7,a7 shall remain available until expended4 7,c7 ,technical assistance 7i7 ,in general ,for each of fiscal years #bjba through #bjbd1 out of the funds appropriated for such year under subparagraph 7,a71 #c1jjj1jjj shall be reserved for the purpose of providing technical assistance 7through the ,administrator of the ,centers for ,medicare ,medicaid ,services7 to ,states in meeting the requirements of paragraph 7#b74 7ii7 ,coordination with relevant agencies ,in providing technical assistance to ,states in developing plans to improve ,,hcbs infrastructure priority areas described in subsection 7c77#c71 the ,administrator of the ,centers for ,medicare ,medicaid ,services shall consult with other agencies with relevant expertise in such areas1 such as the ,department of ,transportation1 the ,department of ,housing and ,urban ,development1 and the ,interagency ,transportation ,coordinating ,council on ,access and ,mobility established under ,executive ,order ,no4 #acccj4 7c7 ,,hcbs infrastructure implementation grants 7#a7 ,approval of ,states ,not later than #a year after awarding a planning grant to a ,state under subsection 7b71 the ,secretary shall1 subject to paragraph 7#d71 award to the ,state an ,,hcbs infrastructure implementation grant under this section if the application-- 7,a7 is developed through such planning grant2 and 7,b7 meets the requirements of paragraph 7#b74 7#b7 ,grant requirements ,the requirements of this paragraph with respect to a ,state implementation grant are the following3 7,a7 ,application ,the ,state submits an application1 using the most recent data available at the time the ,state was awarded a planning grant under subsection 7b71 to conduct an ,,hcbs infrastructure implementation grant to the ,secretary that includes1 in addition to such other information as the ,secretary may require-- 7i7 targets for spending under the ,state plan or waiver for home and community-based services under the ,state plan or waiver as a percentage of all spending under the plan or waiver on long-term services and supports1 and yearly milestones for such targets that-- 7,i7 provide ,states with the flexibility to focus on providing home and community-based services to certain populations2 and 7,,ii7 require the ,state-- 7aa7 to achieve spending targets for those populations2 7bb7 to identify populations in the ,state for which the per capita annual expenditures under the ,state plan or waiver on home and community-based services is less than the national average for that population2 and 7cc7 to increase the level of expenditures on home and community-based services for each population described in clause 7v77,,ii7 to a target level proposed by the ,state2 7ii7 a description of how the ,state will-- 7,i7 expand medical assistance for home and community-based services under the plan or waiver during the ,,hcbs infrastructure period2 7,,ii7 achieve the spending targets and milestones described in clause 7i72 and 7,,iii7 initiate or expand self-directed services1 with measurable targets and milestones2 7iii7 if the ,state limits the provision of home and community-based services to people under the plan or waiver or imposes any numerical limitation1 waiting list1 or similar limitation on the eligibility of people for such services1 a detailed plan for how the ,state will reduce such limitations2 7iv7 a detailed plan with measurable objectives and annual milestones for at least #c of the ,,hcbs infrastructure priority areas described in paragraph 7#c72 and 7v7 data on the extent to which the ,state has already balanced the long-term services and supports system of the ,state1 including-- 7,i7 the percentage of total annual expenditures under the ,state plan or waiver for long-term services and supports expenditures that are for home and community-based services2 and 7,,ii7 the percentage of total annual expenditures under the ,state plan or waiver for long-term services and supports expenditures that are for home and community-based services by population group1 including-- 7aa7 people with intellectual and developmental disabilities2 7bb7 people aged #fe and older2 7cc7 people with physical disabilities2 and 7dd7 people with mental health and substance use disorders4 7,b7 ,maintenance of eligibility requirements ,during the ,,hcbs infrastructure period1 the ,state does not apply eligibility standards1 methodologies1 or procedures for determining eligibility for medical assistance for home and community-based services under the plan or waiver that are more restrictive than the eligibility standards1 methodologies1 or procedures in effect for such purposes on ,december #ca1 #bjai4 7,c7 ,implementation and compliance with ,,hcbs ,settings ,rule ,the ,state has a final approved plan to-- 7i7 fully comply with the ,home and ,community-,based ,services ,final ,rule published by the ,centers for ,medicare ,medicaid ,services on ,january #af1 #bjad 7#gi ,fed4 ,reg4 #bidg7 7referred to in this section as the ,,hcbs ,settings ,rule72 and 7ii7 construct the activities of the grant such that the results will be to stabilize and expand the service delivery network available in the ,state to provide services and supports under the ,state plan or waiver of such plan in a manner that complies with the ,,hcbs ,settings ,rule4 7,d7 ,use of additional funds ,the ,state uses any additional ,federal funds paid to the ,state as a result of this section only for purposes of increasing the availability and improving the quality of home and community-based services in the ,state4 7,e7 ,data collection ,the ,state collects standardized data as determined by the ,secretary1 including-- 7i7 services data on a per-capita or family caregiver basis and1 to the extent possible1 in accordance with the ,transformed ,medicaid ,statistical ,information ,system 7,t-,,msis7 7or a successor system72 7ii7 quality data on a selected set of core home and community-based services measures determined by the ,secretary1 including-- 7,i7 measures of beneficiary and family caregiver experience2 7,,ii7 measures for the achievement of desired outcomes appropriate to a specific beneficiary or family caregiver1 including-- 7aa7 community inclusion2 7bb7 choice and personal control1 including through self-directed services2 and 7cc7 person-centered planning2 and 7,,iii7 measures for the achievement of home and community-based services infrastructure improvements1 including-- 7aa7 competitive1 integrated employment for people with disabilities and older adults2 7bb7 direct support professional workforce improvements1 including increased wages2 7cc7 caregiver supports2 7dd7 accessible housing and accessible transportation improvements2 and 7ee7 non-disability-specific settings2 7iii7 services data from providers of home and community-based services on a per-beneficiary or family caregiver basis and in accordance with such standardized coding procedures as the ,state shall establish in consultation with the ,secretary2 7iv7 quality data on a selected set of core quality measures agreed upon by the ,secretary and the ,state that are-- 7,i7 linked to population-specific outcomes measures2 and 7,,ii7 available to the public1 including consumers and providers of home and community-based services2 and 7v7 outcomes measures data on a selected set of core population-specific outcomes measures agreed upon by the ,secretary and the ,state that are accessible to providers and include-- 7,i7 measures of beneficiary and family caregiver experience with providers2 and 7,,ii7 measures for achieving desired outcomes appropriate to a specific beneficiary or family caregiver1 including-- 7aa7 competitive integrated employment 7as defined in section #c7aa7 of the ,workforce ,innovation and ,opportunity ,act72 7bb7 participation in community life2 7cc7 health stability2 7dd7 prevention of loss in function2 and 7ee7 improved family caregiver health and wellness4 7#c7 ,,hcbs infrastructure priority areas ,the ,,hcbs infrastructure priority areas described in this paragraph are the following3 7,a7 ,workforce and unpaid caregiver supports ,the ,state develops and implements1 in consultation with representatives of people with disabilities1 representatives of older adults1 and representatives of direct support workers-- 7i7 infrastructure to enhance supply and retention of the direct support workforce1 including through-- 7,i7 enhancement of payment rates1 contingent on wage increases for direct support professionals2 and 7,,ii7 training and career advancement programs for direct support professionals1 including programs that facilitate the participation of direct support professionals in organizations that foster their professional development and stakeholder engagement2 7ii7 infrastructure to support self-direction1 including-- 7,i7 matching service registries2 and 7,,ii7 training for consumers who want to self-direct2 and 7iii7 supports for family caregivers1 including-- 7,i7 use of family caregiver assessments2 7,,ii7 service offerings that support caregivers and may delay or ameliorate the need for more comprehensive non-institutional long-term services and supports2 and 7,,iii7 implementation of evidence-based caregiver supportive services1 increased access to and improvements in respite care1 and financial assistance to help with out-of-pocket costs incurred by family caregivers4 7,b7 ,employment supports ,the ,state develops and implements statewide infrastructure1 subject to the merit-based personnel standards and conflict of interest safeguards established and maintained by the ,state pursuant to section #aijb7;a77#d71 to support opportunities for competitive integrated employment 7as defined in section #c7aa7 of the ,workforce ,innovation and ,opportunity ,act7 for people with disabilities and older adults1 which may include-- 7i7 service delivery modifications and expansion2 and 7ii7 establishing and expanding linkages with other programs that support workers with disabilities1 such as-- 7,i7 vocational rehabilitation2 7,,ii7 one-stop centers described in section #aba of the ,workforce ,innovation and ,opportunity ,act2 and 7,,iii7 ,state departments of education4 7,c7 ,housing supports ,the ,state develops and implements infrastructure to increase the availability of affordable1 accessible housing in non-disability-specific settings for people with disabilities and older adults receiving home and community-based services1 which may include-- 7i7 assessing the supply and availability of such housing in communities across the ,state2 7ii7 creating or scaling incentives for ,state and local housing partners and developers to create more accessible housing2 7iii7 developing and implementing strategies to target people with the most significant developmental and other disabilities1 including people with challenging behavior1 complex medical needs1 people requiring round-the-clock1 one-on-one support from a direct support professional1 and people with very high-service needs1 for housing in non-disability-specific settings2 7iv7 scaling shared living within the ,state2 7v7 home modifications and repairs that make it possible for a person to remain in the person's home or building modifications that make it possible for a person with a disability or an older adult to reside in a house or apartment2 and 7vi7 developing administrative infrastructure to match people with housing and provide meaningful choices among non-disability-specific settings via the person-centered planning process4 7,d7 ,transportation supports 7i7 ,in general ,the ,state develops and implements strategies to improve access for all people with disabilities and older adults 7including people who are blind or visually impaired1 deaf or hard of hearing1 have other physical disabilities1 use a wheelchair or other mobility device1 use a guide animal1 or have an intellectual disability7 to accessible transportation options1 including first mile_/last mile transportation1 with the goal of improved community integration1 in accordance with the ,,hcbs ,setting ,rule1 which may include-- 7,i7 the provision of universal mobility services 7as defined in subsection 7a77#aa772 7,,ii7 partnering with existing non-emergency medical transportation brokers and their networks2 7,,iii7 partnering with demand-responsive providers1 non-disability-specific non-profit providers1 and other transportation providers2 7,,iv7 the targeted development of a community integration transportation system that leverages traditional and innovative transportation networks 7such as on-demand application-based transportation72 and 7,v7 expanding the non-emergency medical transportation services offered under the ,state plan to include transportation to-- 7aa7 employment training and jobs2 7bb7 community-based supportive services such as congregate meals or independent living centers2 and 7cc7 pharmacies1 grocery stores1 and other retail establishments to assist older adults and people with disabilities to remain in their homes and participate fully in their communities4 7ii7 ,training requirement ,any strategy to improve access to transportation under this subparagraph shall include the implementation of a ,state requirement that providers of transportation receive training on how to support people with disabilities and older adults4 7iii7 ,exclusion ,to the extent that any expansion1 development1 or financing of paratransit is required under the ,americans with ,disabilities ,act for fixed route service1 such expansion1 development1 or financing shall not be considered to be a strategy to improve access to transportation for purposes of this subparagraph4 7iv7 ,consideration of ,national ,aging and ,disability ,transportation ,center proposals ,a proposal for improvements described in this subparagraph shall consider and discuss the work of the ,national ,aging and ,disability ,transportation ,center1 the ,transactional ,data ,specification for ,demand ,responsive ,transportation published by the ,transportation ,research ,board1 and best practices for the delivery of ,medicaid non-emergency medical transportation services4 7,e7 ,no wrong door single entry point system ,the ,state develops and implements a statewide system 7which may include preadmission screening by nurses1 peer assessors1 and other necessary providers to ensure that the appropriate assessments with respect to any person with a disability or older adult are done as soon as required71 subject to the merit-based personnel standards and conflict of interest safeguards established and maintained by the ,state pursuant to section #aijb7;a77#d71 to enable people enrolled in the ,state plan or waiver to access1 on a timely basis1 all long-term services and supports through an agency1 organization1 coordinated network1 or portal1 in accordance with such standards as the ,state shall establish and that shall provide information regarding-- 7i7 the availability of such services2 7ii7 how to apply for such services2 7iii7 disability benefits counseling2 7iv7 referral services for services and supports otherwise available in the community2 and 7v7 determinations of financial and functional eligibility for such services and supports1 or assistance with assessment processes for financial and functional eligibility4 7#d7 ,number of ,states ,the ,secretary shall not grant approval to more than #ag ,states to conduct an ,,hcbs infrastructure demonstration program under this section in any year4 7d7 ,evaluation1 oversight1 and quality 7#a7 ,surveys and report on direct support professional compensation 7,a7 ,in general ,each ,,hcbs infrastructure ,state shall1 for each fiscal year of the ,state's ,,hcbs infrastructure period1 conduct surveys of providers that received increased rates under the ,,hcbs infrastructure program conducted by the ,state on the compensation paid by such providers to direct support professionals4 7,b7 ,report ,not later than #b years after the date that an ,,hcbs infrastructure ,state begins to conduct an ,,hcbs infrastructure program1 the ,state submits a report to the ,administrator of the ,centers for ,medicare ,medicaid ,services on the impact of the rate increases on the compensation1 benefits1 and training received by direct support professionals4 7#b7 ,evaluation 7,a7 ,in general ,the ,secretary shall evaluate the implementation and outcomes of the ,,hcbs infrastructure programs conducted by the ,states in the aggregate using an external evaluator with experience evaluating home and community-based services1 disability programs1 and older adult programs using the criteria described in each ,,hcbs infrastructure ,state's application and evaluating any change in ,,hcbs service availability and quality for each ,,hcbs infrastructure ,state4 7,b7 ,evaluation criteria ,the external evaluator shall document and evaluate changes in access1 availability1 and quality of ,,hcbs services in each of the priority areas described in subsection 7c77#c7 chosen by each ,,hcbs infrastructure ,state4 ,the external evaluator shall also evaluate the aggregate change changes in access1 availability1 and quality of ,,hcbs services in each of the priorities areas described in subsection 7c77#c7 across the ,,hcbs infrastructure ,states4 ,the external evaluator shall also evaluate the ,,hcbs infrastructure programs based on 7i7 the impact of the programs on increasing funding for home and community-based services1 7ii7 the impact of the programs on achieving targeted access1 availability1 and quality of home and community-based services1 and 7iii7 promising practices identified by the programs that increase access to1 availability of1 and quality of home and community based services4 7,c7 ,dissemination of evaluation findings ,the ,secretary shall-- 7i7 disseminate the findings from the evaluations of ,,hcbs infrastructure programs conducted under this paragraph to-- 7,i7 all ,state ,medicaid directors2 and 7,,ii7 the ,committees on ,ways and ,means and ,energy and ,commerce of the ,house of ,representatives1 the ,committee on ,finance of the ,senate1 and the ,special ,committee on ,aging of the ,senate2 and 7ii7 make all evaluation findings publicly available in an accessible electronic format and any other accessible format determined appropriate by the ,secretary4 7,d7 ,oversight ,each ,state awarded a grant under subsection 7c7 shall ensure adequate oversight of the expenditure of ,,hcbs infrastructure program grant funds in accordance with the ,medicaid regulations1 including waiver #aaae and #aiae waiver regulations4 7e7 ,financing incentives 7#a7 ,in general ,notwithstanding section #aije7;b71 with respect to each fiscal year in an ,,hcbs infrastructure ,state's ,,hcbs infrastructure period1 if such ,state meets the conditions described in subsection 7c77#b7 for the year1 the ,federal medical assistance percentage that would otherwise apply with respect to eligible ,,hcbs expenditures made by the ,state during the year shall be increased 7but in no case to exceed #ajj percent7 by the applicable percentage points increase determined for the ,state and year under paragraph 7#b7 7and as increased1 if applicable1 under paragraph 7#c774 7#b7 ,applicable percentage points increase ,the applicable percentage points increase for an ,,hcbs infrastructure ,state and year is-- 7,a7 in the case of a ,state in which1 for the #b years preceding the year involved1 less than #ce percent of the total expenditures for long-term services and supports were for home and community-based services1 #e percentage points2 7,b7 in the case of a ,state in which1 for the #b years preceding the year involved1 between #ce percent and #ej percent of the total expenditures for long-term services and supports were for home and community-based services1 #b percentage points2 7,c7 in the case of a ,state in which1 for the #b years preceding the year involved1 between #ej percent and #fe percent of the total expenditures for long-term services and supports were for home and community-based services1 #j4ej percentage points2 and 7,d7 in the case of a ,state in which1 for the #b years preceding the year involved1 #fe percent or more of the total expenditures for long-term services and supports were for home and community-based services1 #j4be percentage points4 7#c7 ,additional increase to incentivize targeting underserved populations ,beginning with the first full fiscal year for which the ,transformed ,medicaid ,statistical ,information ,system 7,t-,,msis7 is fully operational1 the applicable percentage points increase determined for an ,,hcbs infrastructure ,state and year under paragraph 7#b7 shall be increased by an additional-- 7,a7 in the case of a ,state that is providing home and community based services to #he percent or more of the people that make up the populations identified by the ,state under subsection 7b77#c77;,b71 #e percentage points2 7,b7 in the case of a ,state that is providing home and community based services to between #ge percent and #he percent of the people that make up the populations identified by the ,state under subsection 7b77#c77;,b71 #b percentage points2 7,c7 in the case of a ,state that is providing home and community based services to between #fe percent and #ge percent of the people that make up the populations identified by the ,state under subsection 7b77#c77;,b71 #j4e percentage points2 and 7,d7 in the case of a ,state that is providing home and community based services to less than #fe percent of the people that make up the populations identified by the ,state under subsection 7b77#c77;,b71 #j4be percentage points4 7#d7 ,exemption from limits on payments to territories ,the limitations on payment under subsections 7f7 and 7g7 of section #aajh shall not apply to ,federal payments under this title that are based on the ,federal medical assistance percentage as increased under this subsection1 and such payments shall not be taken into account in applying such subsections4 4