,,ii  #aag? ,,congress  #a/ ,session    
,s4 #bbaj  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #bd1 #bjba,mr4   
,casey 7= himself1 ,mr4 ,wyd51 ,mr4     
,s*um]1 ,mrs4 ,murray1 ,ms4 ,duckwor?1  
,mr4 ,br[n1 ,ms4 ,hassan1 ,mrs4         
,gillibr&1 ,mr4 ,:iteh\se1 ,mr4 ,durb91 
,ms4 ,baldw91 ,mr4 ,m>key1 ,mr4         
,blum5?al1 ,ms4 ,w>r51 ,mr4 ,re$1 ,mrs4 
,%ahe51 ,mr4 ,van ,holl51 ,ms4 ,smi?1   
,mr4 ,m]kley1 ,mr4 ,book]1 ,mr4 ,leahy1 
,mr4 ,padilla1 ,mr4 ,s*atz1 ,ms4        
,klobu*>1 ,mr4 ,ka9e1 ,mr4 ,b5net1 ,mr4 
,w>nock1 ,mr4 ,s&]s1 ,mr4 ,pet]s1 ,mr4  
,lujn1 ,mr4 ,he9ri*1 ,ms4 ,hirono1 ,ms4 
,/ab5[1 ,mrs4 ,fe9/e91 ,ms4 ,ros51 ,mr4 
,c>d91 ,mr4 ,murphy1 ,ms4 ,cantwell1    
,mr4 ,m55dez1 & ,mr4 ,k+7 introduc$ !   
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,f9ance  ,a ,,bill   
,to am5d title ,,xix ( ! ,social        
,security ,act to exp& access to home & 
community-bas$ s]vices 7,,hcbs7 "u      
,m$icaid1 & = o!r purposes4  #a4 ,%ort  
title2 table ( cont5ts  7a7 ,%ort title 

,?is ,act may be cit$ z ! ,bett] ,c>e   
,bett] ,jobs ,act4  7b7 ,table ( cont5ts
 ,! table ( cont5ts = ?is ,act is z     
foll[s3 ,sec4 #a4 ,%ort title2 table (  
cont5ts4,sec4 #b4 ,def9itions4,,title   
,i--,exp&+ ,access to ,m$icaid ,home &  
,community-,bas$ ,services,sec4 #aja4   
,,hcbs infra/ructure improvem5t plann+  
grants4,sec4 #ajb4 ,,hcbs ,infra/ructure
 ,improvem5t ,program4,sec4 #ajc4       
,reports2 te*nical assi/ance2 o!r       
adm9i/rative requirem5ts4,sec4 #ajd4    
,quality measurem5t & improvem5t4,,title
 ,,ii--,o!r ,provisions,sec4 #bja4      
,,macpac /udy & report on ,app5dix ,k   
em]g5cy home & community-bas$ s]vices   
7,,hcbs7 #aiae7;c7 waiv]s4,sec4 #bjb4   
,mak+ p]man5t ! ,/ate option to ext5d   
protection "u ,m$icaid = recipi5ts (    
home & community-bas$ s]vices aga9/     
sp\sal impov]i%m5t4,sec4 #bjc4 ,p]man5t 
ext5sion ( ,money ,foll[s ! ,p]son      
,rebalanc+ demon/ration4  #b4           
,def9itions ,9 ?is ,act3 7#a7           
,appropriate committees ( congress ,!   

t]m appropriate committees ( ,congress  
means ! ,committee on ,en]gy & ,comm]ce 
( ! ,h\se ( ,repres5tatives1 !          
,committee on ,education & ,labor ( !   
,h\se ( ,repres5tatives1 ! ,committee on
 ,f9ance ( ! ,s5ate1 ! ,committee on    
,heal?1 ,education1 ,labor & ,p5sions ( 
! ,s5ate1 & ! ,special ,committee on    
,ag+ ( ! ,s5ate4  7#b7 ,direct c>e      
work]2 direct c>e work=ce ,! t]ms direct
 c>e work] & direct c>e work=ce mean--  
7,a7 a direct support pr(essional2  7,b7
 a p]sonal c>e att5dant2  7,c7 a direct 
c>e work]2  7,d7 a home heal? aide2 &   
7,e7 any o!r relevant work]1 z det]m9$  
by ! ,secret>y4  7#c7 ,eligible         
individual ,! t]m eligible individual   
means an individual :o is eligible = &  
enroll$ = m$ical assi/ance "u a ,/ate   
,m$icaid program & includes an          
individual :o becomes eligible = m$ical 
assi/ance "u a ,/ate ,m$icaid program :5
 remov$ f a wait+ li/4  7#d7 ,heal? plan
 ,! t]m heal? plan means a gr\p heal?   
plan or heal? insurance issu] 7z su*    

t]ms are def9$ 9 section #bgia ( !      
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg-#ia774  7#e7 ,,hcbs   
program improvem5t ,/ate ,! t]m ,,hcbs  
program improvem5t ,/ate means a ,/ate )
 an ,,hcbs infra/ructure improvem5t plan
 approv$ by ! ,secret>y "u section      
#aja7;d74  7#f7 ,home & community-bas$  
s]vices ,! t]m home & community-bas$    
s]vices means any ( ! foll[+ 7:e!r      
provid$ on a fee-=-s]vice1 risk1 or o!r 
basis73 7,a7 ,home heal? c>e s]vices    
au?oriz$ "u p>agraph 7#g7 ( section     
#aije7;a7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acif;d7a774  7,b7       
,p]sonal c>e s]vices au?oriz$ "u        
p>agraph 7#bd7 ( su* section4  7,c7     
,,pace s]vices au?oriz$ "u p>agraph     
7#bf7 ( su* section4  7,d7 ,home &      
community-bas$ s]vices au?oriz$ "u      
subsections 7b71 7c71 7i71 7j71 & 7k7 ( 
section #aiae ( su* ,act 7#db ,u4,s4,c4 
#acifn71 su* s]vices au?oriz$ "u a waiv]
 "u section #aaae ( su* ,act 7#db       
,u4,s4,c4 #acae71 & su* s]vices provid$ 

?r\gh cov]age au?oriz$ "u section #aicg 
( su* ,act 7#db ,u4,s4,c4 #acifu-#g74   
7,e7 ,case managem5t s]vices au?oriz$ "u
 section #aije7;a77#ai7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#acif;d7a77#ai77 & section #aiae7;g7 (  
su* ,act 7#db ,u4,s4,c4 #acifn7g774     
7,f7 ,rehabilitative s]vices1 includ+ ^?
 relat$ to behavioral heal?1 describ$ 9 
section #aije7;a77#ac7 ( su* ,act 7#db  
,u4,s4,c4 #acif;d7a77#ac774  7,g7 ,su*  
o!r s]vices specifi$ by ! ,secret>y4    
7#g7 ,in/itutional sett+ ,! t]m         
in/itutional sett+ means-- 7,a7 a skill$
 nurs+ facility 7z def9$ 9 section      
#ahai7;a7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acie;i-#c7;a7772  7,b7 a
 nurs+ facility 7z def9$ 9 section      
#aiai7;a7 ( su* ,act 7#db ,u4,s4,c4     
#acifr7a7772  7,c7 a long-t]m c>e       
hospital 7z describ$ 9 section          
#ahhf7;d77#a77;,b77iv7 ( su* ,act 7#db  
,u4,s4,c4 #acieww7d77#a77;,b77iv7772    
7,d7 an in/itution 7or di/9ct "p !re(7  
describ$ 9 section #aije7;d7 ( su* ,act 

7#db ,u4,s4,c4 #acif;d7d7772  7,e7 an   
in/itution 7or di/9ct "p !re(7 :i* is a 
psy*iatric hospital 7z def9$ 9 section  
#ahfa7;f7 ( su* ,act 7#db ,u4,s4,c4     
#aciex7f777 or t provides inpati5t      
psy*iatric s]vices 9 ano!r resid5tial   
sett+ specifi$ by ! ,secret>y2  7,f7 an 
in/itution 7or di/9ct "p !re(7 describ$ 
9 section #aije7;i7 ( su* ,act 7#db     
,u4,s4,c4 #acif;d7i772 &  7,g7 any o!r  
relevant facility1 z det]m9$ by !       
,secret>y4  7#h7 ,m$icaid program ,! t]m
 ,m$icaid program means1 ) respect to a 
,/ate1 ! ,/ate program "u title ,,xix ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#acif et seq47 7includ+ any waiv] or    
demon/ration "u su* title or "u section 
#aaae ( su* ,act 7#db ,u4,s4,c4 #acae7  
relat+ to su* title74  7#i7 ,secret>y ,!
 t]m ,secret>y means ! ,secret>y (      
,heal? & ,human ,s]vices4  7#aj7 ,/ate  
,! t]m ,/ate has ! mean+ giv5 su* t]m = 
purposes ( title ,,xix ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #acif et  
seq474  ,i ,exp&+ ,access to ,m$icaid   

,home & ,community-,bas$ ,s]vices  #aja4
 ,,hcbs infra/ructure improvem5t plann+ 
grants  7a7 ,9 g5]al ,n lat] ?an #ab    
mon?s aft] ! date ( enactm5t ( ?is ,act1
 ! ,secret>y %all aw>d plann+ grants to 
,/ates = ! purpose ( exp&+ access to    
home & community-bas$ s]vices & /r5g!n+ 
! direct c>e work=ce t provides su*     
s]vices by develop+ ,,hcbs infra/ructure
 improvem5t plans t meet ! requirem5ts (
 subsections 7b7 & 7c74  7b7 ,cont5t    
requirem5ts ,9 ord] to meet !           
requirem5ts ( ?is subsection1 an ,,hcbs 
infra/ructure improvem5t plan %all      
include1 ) respect to a ,/ate1 ! foll[+3
 7#a7 ,exi/+ ,m$icaid ,,hcbs l&scape    
7,a7 ,eligibility & b5efits ,a          
description (-- 7i7 ! exi/+ /&>ds1      
pa?ways1 & me?odologies = eligibility = 
home & community-bas$ s]vices1 includ+  
limits on assets & income2  7ii7 ! home 
& community-bas$ s]vices available "u ! 
,/ate ,m$icaid program2 &  7iii7        
utilization managem5t /&>ds = su*       
s]vices4  7,b7 ,access ,an assessm5t ( !

 ext5t to :i* home & community-bas$     
s]vices are available to eligible       
individuals 9 ! ,/ate1 includ+-- 7i7    
e/imates ( ! numb] ( eligible           
individuals :o are on a waitli/ = su*   
s]vices2  7ii7 e/imates ( ! numb] (     
individuals :o w\ld be eligible         
individuals b are n enroll$ 9 ! ,/ate   
,m$icaid program or on a waitli/ = su*  
s]vices2  7iii7 a description ( ! home &
 community-bas$ s]vices n available "u !
 ,/ate ,m$icaid program2  7iv7 a        
description ( ! populations = :i* !     
,/ate is unable to provide home &       
community-bas$ s]vices "u ! ,/ate       
,m$icaid program t are provid$ "u !     
,m$icaid programs ( o!r ,/ates2 &  7v7 a
 description ( b>ri]s to access+ home & 
community-bas$ s]vices id5tifi$ by      
eligible individuals & families ( su*   
individuals4  7,c7 ,utilization ,an     
assessm5t ( ! utilization ( home &      
community-bas$ s]vices 9 ! ,/ate4  7,d7 
,s]vice deliv]y /ructures ,a description
 ( ! s]vice deliv]y /ructures = provid+ 

home & community-bas$ s]vices 9 ! ,/ate1
 includ+ ) respect to ! use & models (  
self-direction1 ! provision ( s]vices by
 ag5cies1 ! own]%ip ( s]vice provid]    
ag5cies1 ! use ( manag$ c>e v]sus       
fee-=-s]vice to provide su* s]vices1 & !
 supports provid$ = family c>egiv]s4    
7,e7 ,work=ce ,a description ( !        
*>act]i/ics ( ! direct c>e work=ce t    
provides home & community-bas$ s]vices1 
includ+ ! numb] ( full- & "p-"t direct  
c>e work]s1 ! av]age & range ( direct   
c>e work] wages1 ! b5efits provid$ to   
direct c>e work]s1 ! turnov] & vacancy  
rates ( direct c>e work] positions1 !   
memb]%ip ( direct c>e work]s 9 labor    
organizations or pr(essional            
organizations1 & ! race1 e?nicity1 &    
g5d] ( su* work=ce4  7,f7 ,paym5t rates 
,a description ( ! paym5t rates = home &
 community-bas$ s]vices1 includ+ :5 su* 
rates 7 la/ updat$1 an assessm5t ( !    
ext5t to :i* au?oriz$ s]vices are n     
deliv]$ z a result ( su* rates be+      
insuffici5t1 & ! ext5t to :i* paym5t    

rates are pass$ ?r\gh to direct c>e     
work] wages4  7,g7 ,quality ,a          
description ( h[ ! quality ( home &     
community-bas$ s]vices is measur$ &     
monitor$1 includ+ h[ ! ,/ate uses       
b5efici>y & family c>egiv] exp]i5ce (   
c>e surveys to assess ! quality ( home &
 community-bas$ s]vices provid$ by !    
,/ate4  7,h7 ,long-t]m s]vices &        
supports provid$ 9 in/itutional sett+s  
,a description (-- 7i7 ! ext5t to :i*   
eligible individuals receive long-t]m   
s]vices & supports 9 in/itutional sett+s
 9 ! ,/ate2 &  7ii7 ! populations       
provid$ su* s]vices & supports4  7,i7   
,,hcbs %>e ( ov]all ,m$icaid ,,ltss     
sp5d+ ,= ! mo/ rec5t fiscal ye> = :i*   
data is available1 ! p]c5tage (         
exp5ditures made by ! ,/ate "u ! ,/ate  
,m$icaid program = long-t]m s]vices &   
supports t are = home & community-bas$  
s]vices4  7,j7 ,demographic data ,ea*   
assessm5t requir$ "u subp>agraphs 7,b7 &
 7,c71 & ! description requir$ "u       
subp>agraph 7,h77ii7 %all include1 to ! 

ext5t available1 data disaggregat$ by   
disability /atus1 age1 income1 g5d]1    
race1 e?nicity1 geography1 prim>y       
language1 sexual ori5tation1 g5d]       
id5tity1 & type ( s]vice sett+4  7#b7   
,annual measures & reports ,a           
description ( ! ,/ate plan =-- 7,a7     
annually measur+ & report+ on-- 7i7 !   
availability & utilization ( home &     
community-bas$ s]vices2  7ii7 !         
*>act]i/ics ( ! direct c>e work=ce t    
provides home & community-bas$ s]vices &
 ! race1 e?nicity1 & g5d] ( su* work=ce2
  7iii7 *anges 9 paym5t rates = home &  
community-bas$ s]vices2 &  7iv7 progress
 ) respect to implem5tation ( !         
activities1 b5*m>ks1 & improvem5t       
activities provid$ "u subsection 7jj7 ( 
section #aije ( ! ,social ,security ,act
 7z add$ "u section #ajb72 &  7,b7      
collect+ & report+ disaggregat$ data by 
disability /atus1 age1 income1 g5d]1    
race1 e?nicity1 geography1 prim>y       
language1 sexual ori5tation1 g5d]       
id5tity1 & type ( s]vice sett+ = !      

in=mation requir$ by clause 7i7 (       
subp>agraph 7,a74  7#c7 ,implem5tation &
 goals = ,,hcbs improvem5ts ,a          
description ( h[ ! ,/ate w-- 7,a7       
conduct ! activities1 b5*m>ks1 &        
improvem5t activities provid$ "u        
subsection 7jj7 ( section #aije ( !     
,social ,security ,act 7z add$ "u       
section #ajb71 includ+ h[ ! ,/ate plans 
to meet ! b5*m>ks describ$ 9 p>agraph   
7#e7 ( su* subsection &1 if applicable1 
! additional ,,hcbs improvem5t ef=ts    
describ$ 9 p>agraph 7#c7 ( su*          
subsection2  7,b7 id5tify & r$uce b>ri]s
 to access+ home & community-bas$       
s]vices1 includ+ = individuals 9        
in/itutional sett+s1 individuals        
exp]i5c+ homelessness or h\s+           
in/ability1 & individuals 9 regions ) l[
 or no access to su* s]vices2  7,c7     
id5tify & r$uce disp>ities 9 access to1 
& utilization (1 home & community-bas$  
s]vices by disability /atus1 age1       
income1 g5d]1 race1 e?nicity1 geography1
 prim>y language1 sexual ori5tation1    

g5d] id5tity1 & type ( s]vice sett+2    
7,d7 coord9ate implem5tation ( ! ,,hcbs 
infra/ructure improvem5t plan among !   
,/ate ,m$icaid ag5cy1 ag5cies s]v+      
individuals ) disabilities1 ! eld]ly1 & 
o!r relevant ,/ate & local ag5cies2 &   
7,e7 facilitate access to relat$        
supports by coord9at+ ) ,/ate & local   
ag5cies & organizations t provide h\s+1 
transportation1 employm5t1 nutrition1 & 
o!r s]vices & supports4  7c7 ,developm5t
 & submission requirem5ts ,9 ord] to    
meet ! requirem5ts ( ?is subsection1 an 
,,hcbs infra/ructure improvem5t plan    
%all-- 7#a7 be develop$ ) input f       
/akehold]s ?r\gh a public notice &      
comm5t process t includes consultation )
 eligible individuals :o are recipi5ts (
 home & community-bas$ s]vices1 family  
c>egiv]s ( su* recipi5ts1 provid]s1     
heal? plans1 direct c>e work]s1 *os5    
repres5tatives ( direct c>e work]s1 &   
ag+1 disability1 & work=ce advocates2   
7#b7 be submitt$ = approval by !        
,secret>y n lat] ?an #bd mon?s aft] !   

date on :i* ! ,/ate 0 aw>d$ ! plann+    
grant "u ?is section2 &  7#c7 be        
publicly available 9 ! f9al v]sion      
submitt$ to ! ,secret>y on a ,/ate      
,int]net website4  7d7 ,approval2       
publication  7#a7 ,9 g5]al ,! ,secret>y 
%all approve an ,,hcbs infra/ructure    
improvem5t plan if ! plan-- 7,a7 is     
complete2 &  7,b7 provides assurances to
 ! satisfaction ( ! ,secret>y t ! ,/ate 
w meet ! requirem5ts ( ! ,,hcbs         
,infra/ructure ,improvem5t ,program     
e/abli%$ "u subsection 7jj7 ( section   
#aije ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acif;d71 z add$ by section   
#ajb1 & a*ieve ! b5*m>ks = improvem5t   
e/abli%$ by su* program4  7#b7          
,publication ,! ,secret>y1 act+ ?r\gh ! 
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices1 %all make publicly   
available on an ,int]net website-- 7,a7 
! f9al v]sion ( ea* approv$ ,,hcbs      
infra/ructure improvem5t plan2 &  7,b7 9
 ! case ( any ,,hcbs infra/ructure      
improvem5t plan submitt$ = approval t is

 n approv$-- 7i7 ! submitt$ plan2  7ii7 
! decision n approv+ su* plan2 &  7iii7 
in=mation relat+ to :y ! plan 0 n       
approv$4  7e7 ,cont9uation ( ,am]ican   
,rescue ,plan ,act increas$ ,,fmap =    
,,hcbs = ,/ates aw>d$ a plann+ grant    
7#a7 ,,fmap  7,a7 ,9 g5]al ,not)/&+     
subsections 7b7 or 7ff7 ( section #aije 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acif;d71 subject to          
subp>agraph 7,c71 9 ! case ( a ,/ate t  
is aw>d$ a plann+ grant "u ?is section &
 meets ! ma9t5ance ( ef=t requirem5ts "u
 p>agraph 7#b71 ! ,f$]al m$ical         
assi/ance p]c5tage det]m9$ = ! ,/ate "u 
su* subsection 7b7 7or su* subsection   
7ff71 if applicable7 &1 if applicable1 z
 increas$ "u subsection 7y71 7z71 7aa71 
or 7ii7 ( su* section1 section #aiae7k7 
( su* ,act 7#db ,u4,s4,c4 #acifn7k771 or
 section #fjjh ( ! ,families ,fir/      
,coronavirus ,response ,act 7,public    
,law #aaf-abg71 %all be increas$ by #aj 
p]c5tage po9ts 7b n to exce$ #ie p]c5t7 
) respect to am\nts exp5d$ by ! ,/ate   

,m$icaid program = m$ical assi/ance =   
home & community-bas$ s]vices t are     
provid$ dur+ ,,hcbs plann+ p]iod 7z     
def9$ 9 subp>agraph 7,b774  7,b7 ,,hcbs 
plann+ p]iod ,9 ?is p>agraph1 ! t]m     
,,hcbs plann+ p]iod means1 ) respect to 
a ,/ate1 ! p]iod-- 7i7 beg9n+ on ! date 
on :i* ! ,/ate is aw>d$ a plann+ grant  
"u ?is section2 &  7ii7 end+ on ! e>li] 
(-- 7,i7 ! fir/ day ( ! fir/ fiscal     
qu>t] = :i* ! ,/ate is an ,,hcbs program
 improvem5t ,/ate2 &  7,,ii7 ! date t is
 #c ye>s aft] ! date on :i* ! ,/ate is  
aw>d$ su* a grant4  7,c7 ,rule (        
application 9 case ( ov]lap ) p]iod =   
,am]ican ,rescue ,plan increase ,if !   
,,hcbs plann+ p]iod = a ,/ate beg9s dur+
 ! ,,hcbs program improvem5t p]iod 7z   
def9$ "u subsection 7a77#b77;,a7 (      
section #ihag ( ! ,am]ican ,rescue ,plan
 ,act 7,public ,law #aag-b771 & ! ,/ate 
meets ! ,,hcbs program requirem5ts "u   
subsection 7b7 ( su* section1 ! increase
 9 ! ,f$]al m$ical assi/ance p]c5tage t 
w\ld o!rwise apply to ! ,/ate "u        

subp>agraph 7,a7 ( ?is p>agraph %all n  
apply dur+ any portion ( ! ,,hcbs       
program improvem5t p]iod 7z def9$ "u    
subsection 7a77#b77;,a7 ( section #ihag 
( ! ,am]ican ,rescue ,plan ,act 7,public
 ,law #aag-b77 = :i* ! ,/ate receives an
 increase 9 ! ,f$]al m$ical assi/ance   
p]c5tage 9 accordance ) t section4  7,d7
 ,nonapplication ( t]ritorial fund+ caps
 ,any paym5t made to ,pu]to ,rico1 !    
,virg9 ,isl&s1 ,guam1 ! ,nor!rn ,m>iana 
,isl&s1 or ,am]ican ,samoa = exp5ditures
 on m$ical assi/ance t are subject to ! 
,f$]al m$ical assi/ance p]c5tage        
increase specifi$ "u subp>agraph 7,a7   
%all n be tak5 into acc\nt = purposes ( 
apply+ paym5t limits "u subsections 7f7 
& 7g7 ( section #aajh ( ! ,social       
,security ,act 7#db ,u4,s4,c4 #acjh74   
7#b7 ,ma9t5ance ( ef=t requirem5ts ,=   
purposes ( p>agraph 7#a77;,a71 !        
requirem5ts ( ?is p>agraph are1 )       
respect to ! p]iod = :i* a ,/ate is     
aw>d$ a plann+ grant "u ?is section1 !  
,/ate %all n-- 7,a7 l[] ! am\nt1        

duration1 or scope ( home &             
community-bas$ s]vices available "u !   
,/ate ,m$icaid program 7relative to !   
s]vices available "u ! program z ( !    
date on :i* ! ,/ate 0 aw>d$ su* grant72 
or  7,b7 adopt m re/rictive /&>ds1      
me?odologies1 or proc$ures = det]m9+    
eligibility1 b5efits1 or s]vices =      
receipt ( home & community-bas$ s]vices 
"u ! ,/ate ,m$icaid program1 includ+ )  
respect to utilization managem5t or     
co/-%>+1 ?an ! /&>ds1 me?odologies1 or  
proc$ures applicable z ( ! date on :i* !
 ,/ate 0 aw>d$ su* grant4  7f7 ,fund+   
7#a7 ,9 g5]al ,out ( any funds 9 !      
,treasury n o!rwise appropriat$1 !re is 
appropriat$ to ! ,secret>y = purposes ( 
aw>d+ plann+ grants "u ?is section1     
#ajj1jjj1jjj = fiscal ye> #bjbb1 to     
rema9 available until exp5d$4  7#b7     
,te*nical assi/ance & guidance ,!       
,secret>y %all res]ve #e1jjj1jjj ( !    
am\nt appropriat$ "u p>agraph 7#a7 =    
purposes ( issu+ guidance & provid+     
te*nical assi/ance to ,/ates seek+ or   

aw>d$ a plann+ grant "u ?is section4    
#ajb4 ,,hcbs ,infra/ructure ,improvem5t 
,program  7a7 ,enhanc$ ,,fmap = ,,hcbs  
program improvem5t ,/ates ,section #aije
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acif;d7 is am5d$-- 7#a7 9    
subsection 7b71 by /rik+ & 7ii7 & ins]t+
 7ii71 & 7jj72 &  7#b7 by add+ at ! end 
! foll[+ new subsection3  7jj7 ,enhanc$ 
,f$]al m$ical assi/ance p]c5tage =      
,,hcbs program improvem5t ,/ates  7#a7  
,9 g5]al  7,a7 ,increas$ f$]al f9ancial 
p>ticipation ,subject to p>agraph 7#e71 
9 ! case ( a ,/ate t is an ,,hcbs       
program improvem5t ,/ate & meets !      
requirem5ts describ$ 9 p>agraphs 7#b7 & 
7#d71 = ea* fiscal ye> qu>t] t beg9s on 
or aft] ! fir/ date on :i* a ,/ate is an
 ,,hcbs program improvem5t ,/ate-- 7i7  
not)/&+ subsection 7b7 or 7ff71 subject 
to subp>agraph 7,b71 ) respect to am\nts
 exp5d$ dur+ ! qu>t] by su* ,/ate =     
m$ical assi/ance = home & community-bas$
 s]vices1 ! ,f$]al m$ical assi/ance     
p]c5tage = su* ,/ate & qu>t] 7z det]m9$ 

= ! ,/ate "u subsection 7b7 &1 if       
applicable1 increas$ "u subsection 7y71 
7z71 7aa71 or 7ii71 or section #fjjh7;a7
 ( ! ,families ,fir/ ,coronavirus       
,response ,act7 %all be increas$ by #aj 
p]c5tage po9ts 7b n to exce$ #ie p]c5t72
 &  7ii7 not)/&+ ! p] c5tum specifi$ 9  
section #aijc7;a77#g71 ) respect to     
am\nts exp5d$ dur+ ! qu>t] & be=e       
,octob] #a1 #bjca1 = adm9i/rative co/s =
 exp&+ & enhanc+ home & community-bas$  
s]vices1 includ+ = enhanc+ ! ,m$icaid   
data & te*nology infra/ructure1 modify+ 
rate sett+ processes1 adopt+1 us+1 &    
report+ quality measures & b5efici>y &  
family c>egiv] exp]i5ce surveys1 adopt+ 
or improv+ tra9+ programs = direct c>e  
work]s & family c>egiv]s1 & adopt+1     
c>ry+ out1 or enhanc+ programs t regi/] 
qualifi$ direct c>e work]s or connect   
b5efici>ies to qualifi$ direct c>e      
work]s1 su* p] c5tum %all be increas$ to
 #hj p]c5t4  7,b7 ,additional ,,hcbs    
improvem5t ef=ts ,subject to p>agraph   
7#e71 9 addition to ! increase to !     

,f$]al m$ical assi/ance p]c5tage "u     
subp>agraph 7,a77i71 ) respect to am\nts
 exp5d$ = m$ical assi/ance dur+ ! fir/  
#d fiscal qu>t]s ?r\gh\t :i* an ,,hcbs  
program improvem5t ,/ate has implem5t$ a
 program to support self-direct$ c>e t  
meets ! requirem5ts ( p>agraph 7#c7 79  
addition to meet+ ! requirem5ts describ$
 9 p>agraph 7#b771 ! ,f$]al m$ical      
assi/ance p]c5tage = su* ,/ate & ea* su*
 qu>t] ) respect to su* am\nts %all be  
fur!r increas$ by #b p]c5tage po9ts 7b n
 to exce$ #ie p]c5t74  7,c7             
,nonapplication ( t]ritorial fund+ caps 
,any paym5t made to ,pu]to ,rico1 !     
,virg9 ,isl&s1 ,guam1 ! ,nor!rn ,m>iana 
,isl&s1 or ,am]ican ,samoa = exp5ditures
 t are subject to an increase 9 ! ,f$]al
 m$ical assi/ance p]c5tage "u           
subp>agraph 7,a77i7 or 7,b71 or an      
increase 9 an applicable ,f$]al mat*+   
p]c5tage "u subp>agraph 7,a77ii71 %all n
 be tak5 into acc\nt = purposes ( apply+
 paym5t limits "u subsections 7f7 & 7g7 
( section #aajh4  7#b7 ,requirem5ts ,!  

requirem5ts describ$ 9 ?is p>agraph1 )  
respect to a ,/ate & a fiscal ye> qu>t]1
 are ! foll[+3 7,a7 ,ma9t5ance ( ef=t   
7i7 ,9 g5]al ,except z provid$ "u clause
 7ii71 ! ,/ate does n-- 7,i7 l[] !      
am\nt1 duration1 or scope ( home &      
community-bas$ s]vices available "u !   
,/ate plan or waiv] 7relative to ! home 
& community-bas$ s]vices available "u ! 
plan or waiv] z ( ! date on :i* ! ,/ate 
0 aw>d$ a plann+ grant "u section #aja (
 ! ,bett] ,c>e ,bett] ,jobs ,act72 or   
7,,ii7 adopt m re/rictive /&>ds1        
me?odologies1 or proc$ures = det]m9+    
eligibility1 b5efits1 or s]vices =      
receipt ( home & community-bas$ s]vices1
 includ+ ) respect to utilization       
managem5t or co/-%>+ & ! am\nt1         
duration1 & scope ( available home &    
community-bas$ s]vices1 ?an ! /&>ds1    
me?odologies1 or proc$ures applicable z 
( su* date4  7ii7 ,exception ,on or aft]
 ,octob] #a1 #bjbh1 a ,/ate may modify  
su* /&>ds1 me?odologies1 or proc$ures if
 ! ,/ate demon/rates t su* modifications

 %all n result 9-- 7,i7 home &          
community-bas$ s]vices t are less       
compreh5sive or l[] 9 am\nt1 duration1  
or scope2  7,,ii7 few] individuals      
7ov]all & )9 p>ticul> b5efici>y         
populations7 receiv+ home &             
community-bas$ s]vices2 or  7,,iii7     
increas$ co/-%>+ = home & community-bas$
 s]vices4  7,b7 ,access to s]vices ,!   
,/ate enhances1 exp&s1 or /r5g!ns home &
 community-bas$ s]vices by do+ all ( !  
foll[+3 7i7 ,address+ access b>ri]s &   
disp>ities 9 access or utilization      
id5tifi$ 9 ! ,/ate ,,hcbs infra/ructure 
improvem5t plan4  7ii7 ,exp&+ f9ancial  
eligibility crit]ia = home &            
community-bas$ s]vices up to ,f$]al     
limits4  7iii7 ,requir+ cov]age (       
p]sonal c>e s]vices = all eligible      
populations receiv+ home &              
community-bas$ s]vices 9 ! ,/ate4  7iv7 
,us+ no wrong door programs1 provid+    
presumptive eligibility = home &        
community-bas$ s]vices1 & improv+ home &
 community-bas$ s]vices c\nsel+ &       

education programs4  7v7 ,exp&+ access  
to behavioral heal? s]vices &           
coord9ation ) employm5t1 h\s+1 &        
transportation supports4  7vi7 ,provid+ 
supports to family c>egiv]s1 :i* %all   
include provid+ respite c>e1 & may      
include provid+ su* s]vices z c>egiv]   
assessm5ts1 pe] supports1 or paid family
 c>egiv+4  7vii7 ,adopt+1 exp&+         
eligibility =1 or improv+ cov]age       
provid$ "u a ,m$icaid buy-9 program     
au?oriz$ "u subclause 7,,xiii71 7,,xv71 
or 7,,xvi7 ( section                    
#aijb7;a77#aj77;,a77ii74  7,c7 ,/r5g!n$ 
& exp&$ work=ce  7i7 ,9 g5]al ,! ,/ate  
/r5g!ns & exp&s ! direct c>e work=ce t  
provides home & community-bas$ s]vices  
by-- 7,i7 adopt+ processes to ensure t  
paym5ts = home & community-bas$ s]vices 
are suffici5t to ensure t c>e & s]vices 
are available to ! ext5t describ$ 9 !   
,/ate ,,hcbs infra/ructure improvem5t   
plan2 &  7,,ii7 updat+1 develop+1 &     
adopt+ qualification /&>ds & tra9+      
opportunities = ! cont9uum ( provid]s ( 

home & community-bas$ s]vices1 includ+  
programs = indep5d5t provid]s ( su*     
s]vices & ag5cy direct c>e work]s1 z    
well z unique programs & res\rces =     
family c>egiv]s4  7ii7 ,paym5t rates ,9 
c>ry+ out clause 7i77,i71 ! ,/ate %all--
 7,i7 address insuffici5t paym5t rates =
 deliv]y ( home & community-bas$        
s]vices1 ) an emphasis on support+ !    
recruitm5t & ret5tion ( ! direct c>e    
work=ce1 z id5tifi$ dur+ ! p]iod 9 :i* !
 ,/ate ,,hcbs infra/ructure improvem5t  
plan 0 develop$ & dur+ subsequ5t ye>s2  
7,,ii7 update paym5t rates = home &     
community-bas$ s]vices at lea/ e #b ye>s
 ?r\gh a transp>5t process involv+      
mean+ful input f /akehold]s1 includ+    
recipi5ts ( home & community-bas$       
s]vices1 family c>egiv]s ( su*          
recipi5ts1 provid]s1 heal? plans1 direct
 c>e work]s1 *os5 repres5tatives (      
direct c>e work]s1 & ag+1 disability1 & 
work=ce advocates2 &  7,,iii7 ensure t  
increases 9 ! paym5t rates = home &     
community-bas$ s]vices are-- 7aa7 at a  

m9imum1 proportionately pass$ ?r\gh to  
direct c>e work]s & 9 a mann] t is      
det]m9$ ) input f ! /akehold]s describ$ 
9 subclause 7,,ii72 &  7bb7 incorporat$ 
into paym5t rates = home &              
community-bas$ s]vices provid$ "u ?is   
title by a manag$ c>e entity 7z def9$ 9 
section #aicb7;a77#a77;,b77 or a prepaid
 inpati5t heal? plan or prepaid         
ambulatory heal? plan1 z def9$ 9 section
 #dch4b ( title #db1 ,code ( ,f$]al     
,regulations 7or any successor          
regulation771 "u a contract ) ! ,/ate4  
7#c7 ,,hcbs improvem5t to support       
self-direct$ models = ! deliv]y (       
s]vices ,= purposes ( p>agraph          
7#a77;,b71 ! requirem5ts ( ?is p>agraph1
 ) respect to a ,/ate & a fiscal ye>    
qu>t]1 are t ! ,/ate e/abli%es directly 
or by contract ) #a or m non-pr(it      
entities1 a program = ! p]=mance ( all (
 ! foll[+ functions3 7,a7 ,regi/]+      
qualifi$ direct c>e work]s & assi/+     
b5efici>ies 9 f9d+ direct c>e work]s4   
7,b7 ,und]tak+ activities to recruit &  

tra9 indep5d5t provid]s to enable       
b5efici>ies to direct _! own c>e1       
includ+ by provid+ or coord9at+ tra9+ = 
b5efici>ies on self-direct$ c>e4  7,c7  
,ensur+ ! safety (1 & support+ ! quality
 (1 c>e provid$ to b5efici>ies1 su* z by
 conduct+ backgr\nd *ecks & address+    
compla9ts report$ by recipi5ts ( home & 
community-bas$ s]vices4  7,d7           
,facilitat+ coord9ation betwe5 ,/ate &  
local ag5cies & direct c>e work]s =     
matt]s ( public heal?1 tra9+            
opportunities1 *anges 9 program         
requirem5ts1 workplace heal? & safety1  
or relat$ matt]s4  7,e7 ,support+       
b5efici>y hir+ ( indep5d5t provid]s (   
home & community-bas$ s]vices ?r\gh an  
ag5cy ) *oice or simil> model1 includ+  
by process+ applicable tax in=mation1   
collect+ & process+ time%eets1 submitt+ 
claims & process+ paym5ts to su*        
provid]s4  7,f7 ,to ! ext5t a ,/ate     
p]mits b5efici>ies to hire a family     
memb] or individual ) :om !y h an exi/+ 
relation%ip to provide home &           

community-bas$ s]vices1 provid+ support 
to b5efici>ies :o wi% to hire a c>egiv] 
:o is a family memb] or individual ) :om
 !y h an exi/+ relation%ip1 su* z by    
facilitat+ enrollm5t ( su* family memb] 
or individual z a provid] ( home &      
community-bas$ s]vices "u ! ,/ate plan  
or a waiv] ( su* plan4  7,g7 ,ensur+ t  
program policies & proc$ures all[ =     
coop]ation ) labor organizations t b>ga9
 on behalf ( direct c>e work]s 9 ! case 
( a ,/ate 9 :i* ! direct c>e work]s 9 ! 
,/ate h elect$ to jo91 or =m1 su* a     
labor organization1 or1 9 ! case ( a    
,/ate 9 :i* su* work]s h n jo9$ or =m$  
su* a labor organization1 are neutral ) 
reg>d to su* work]s jo9+ or =m+ su* a   
labor organization4  7#d7 ,quality1     
report+1 & ov]sight ,! requirem5ts      
describ$ 9 ?is p>agraph1 ) respect to a 
,/ate & a fiscal ye> qu>t]1 are !       
foll[+3 7,a7 ,! ,/ate adopts ! core     
quality measures = home & community-bas$
 s]vices develop$ by ! ,secret>y "u     
section #ajd ( ! ,bett] ,c>e ,bett]     

,jobs ,act1 or an alt]nate set ( quality
 measures approv$ by ! ,secret>y1 &1 at 
! option ( ! ,/ate1 exp&s ! use (       
b5efici>y & family c>egiv] exp]i5ce     
surveys4  7,b7 ,! ,/ate designates an   
,,hcbs ombudsman (fice t-- 7i7 op]ates  
indep5d5tly f ! ,/ate ,m$icaid ag5cy &  
manag$ c>e entities2  7ii7 provides     
direct assi/ance to b5efici>ies & _!    
families2 &  7iii7 id5tifies & reports  
sy/emic problems to ,/ate (ficials1 !   
public1 & ! ,secret>y4  7,c7 ,beg9n+ ) !
 #e? fiscal ye> qu>t] = :i* ! ,/ate is  
an ,,hcbs program improvem5t ,/ate1 &   
annually !reaft]1 ! ,/ate reports on !  
compon5ts ( ! exi/+ home &              
community-bas$ s]vices l&scape report$ 9
 ! ,/ate ,,hcbs infra/ructure improvem5t
 plan1 includ+ ) respect to-- 7i7 !     
availability & utilization ( home &     
community-bas$ s]vices1 disaggregat$ by 
disability /atus1 age1 income1 g5d]1    
race1 e?nicity1 geography1 prim>y       
language1 sexual ori5tation1 g5d]       
id5tity1 & type ( s]vice sett+2  7ii7 ! 

*>act]i/ics ( ! direct c>e work=ce t    
provides home & community-bas$ s]vices  
work=ce & ! race1 e?nicity1 & g5d] ( su*
 work=ce2  7iii7 *anges 9 paym5t rates =
 home & community-bas$ s]vices2  7iv7   
implem5tation ( ! activities to /r5g!n &
 exp& access to home & community-bas$   
s]vices & ! direct c>e work=ce t        
provides su* s]vices 9 accordance ) !   
requirem5ts ( subp>agraphs 7,b7 & 7,c7 (
 p>agraph 7#b72  7v7 if applicable1     
implem5tation ( ! activities describ$ 9 
p>agraph 7#c72 &  7vi7 ! progress made )
 respect to meet+ ! b5*m>ks = demon/rat+
 improvem5ts requir$ 9 p>agraph 7#e74   
7#e7 ,b5*m>ks = demon/rat+ improvem5ts  
,an ,,hcbs program improvem5t ,/ate %all
 cease to be eligible = an increase 9 ! 
,f$]al m$ical assi/ance p]c5tage "u     
p>agraph 7#a77;,a77i7 or 7#a77;,b7 or an
 increase 9 an applicable ,f$]al mat*+  
p]c5tage "u p>agraph 7#a77;,a77ii7      
beg9n+ ) ! #bi? fiscal ye> qu>t] t beg9s
 on or aft] ! fir/ date on :i* a ,/ate  
is an ,,hcbs program improvem5t ,/ate1  

unless1 n lat] ?an #ij days be=e ! fir/ 
day ( su* fiscal ye> qu>t]1 ! ,/ate     
submits to ! ,secret>y a report         
demon/rat+ ! foll[+ improvem5ts3 7,a7   
,increas$ availability ( home &         
community-bas$ s]vices 9 ! ,/ate        
relative to su* availability z report$ 9
 ! ,/ate ,,hcbs infra/ructure improvem5t
 plan & adju/$ = demographic *anges 9 ! 
,/ate s9ce ! submission ( su* plan4     
7,b7 ,increas$ utilization &            
availability ( home & community-bas$    
s]vices by populations ) ! l[e/         
utilization & availability ( su* s]vices
 7z report$ 9 ! ,/ate ,,hcbs            
infra/ructure improvem5t plan7 relative 
to ! utilization ( su* s]vices by su*   
populations z report$ 9 su* plan &      
adju/$ = demographic *anges 9 ! ,/ate   
s9ce ! submission ( su* plan4  7,c7     
,evid5ce t a majority ( direct c>e      
work]s receive competitive wages &      
b5efits4  7,d7 ,) respect to ! p]c5tage 
( exp5ditures made by ! ,/ate = long-t]m
 s]vices & supports t are = home &      

community-bas$ s]vices1 9 ! case ( an   
,,hcbs program improvem5t ,/ate = :i*   
su* p]c5tage 7z report$ 9 ! ,/ate ,,hcbs
 infra/ructure improvem5t plan7 0-- 7i7 
less ?an #ej p]c5t1 ! ,/ate demon/rates 
t ! p]c5tage ( su* exp5ditures has      
increas$ to at lea/ #ej p]c5t s9ce !    
plan 0 approv$2 &  7ii7 at lea/ #ej     
p]c5t1 ! ,/ate demon/rates t su*        
p]c5tage has n decreas$ s9ce ! plan 0   
approv$4  7#f7 ,def9itions ,9 ?is       
subsection1 ! t]ms direct c>e work]1    
direct c>e work=ce1 ,,hcbs program      
improvem5t ,/ate1 & home &              
community-bas$ s]vices h ! mean+s giv5  
^? t]ms 9 section #b ( ! ,bett] ,c>e    
,bett] ,jobs ,act4  4  #ajc4 ,reports2  
te*nical assi/ance2 o!r adm9i/rative    
requirem5ts  7a7 ,reports ,! ,secret>y  
%all submit to ! appropriate committees 
( ,congress ! foll[+ reports relat+ to !
 ,,hcbs ,infra/ructure ,improvem5t      
,program e/abli%$ "u ?is title3 7#a7    
,initial report ,n lat] ?an #d ye>s aft]
 ! date ( enactm5t ( ?is ,act1 a report 

t includes ! foll[+3 7,a7 ,a description
 ( ! ,,hcbs infra/ructure improvem5t    
plans approv$ by ! ,secret>y "u section 
#aja7;d74  7,b7 ,a description ( !      
national l&scape ) respect to gaps 9    
cov]age ( home & community-bas$ s]vices1
 disp>ities 9 access to1 & utilization  
(1 su* s]vices1 & b>ri]s to access+ su* 
s]vices4  7,c7 ,a description ( !       
national l&scape ) respect to ! direct  
c>e work=ce t provides home &           
community-bas$ s]vices1 includ+ )       
respect to comp5sation1 b5efits1 &      
*all5ges to ! availability ( su* work]s4
  7#b7 ,subsequ5t reports ,n lat] ?an #g
 ye>s aft] ! date ( enactm5t ( ?is ,act1
 & e #c ye>s !reaft]1 a report t        
includes ! foll[+3 7,a7 ,! numb] (      
,,hcbs program improvem5t ,/ates4  7,b7 
,a summ>y ( ! progress be+ made by su*  
,/ates ) respect to /r5g!n+ & exp&+     
access to home & community-bas$ s]vices 
& ! direct c>e work=ce t provides su*   
s]vices & meet+ ! b5*m>ks = demon/rat+  
improvem5ts requir$ "u section          

#aije7;jj77#e7 ( ! ,social ,security    
,act 7z add$ by section #ajb74  7,c7 ,a 
summ>y ( outcomes relat$ to home &      
community-bas$ s]vices core quality     
measures & b5efici>y & family c>egiv]   
surveys4  7,d7 ,a summ>y ( ! *all5ges & 
be/ practices report$ by ,/ates 9 exp&+ 
access to home & community-bas$ s]vices 
& support+ & exp&+ ! direct c>e work=ce 
t provides su* s]vices4  7b7 ,te*nical  
assi/ance2 guidance2 regulations ,!     
,secret>y %all provide ,,hcbs program   
improvem5t ,/ates ) te*nical assi/ance  
relat$ to c>ry+ out ! ,,hcbs            
infra/ructure improvem5t plans approv$  
by ! ,secret>y "u section #aja7;d7 &    
meet+ ! requirem5ts & b5*m>ks =         
demon/rat+ improvem5ts requir$ "u       
section #aije7;jj7 ( ! ,social ,security
 ,act 7z add$ by section #ajb7 & %all   
issue su* guidance or regulations z     
necess>y to c>ry out ?is title & !      
am5dm5ts made by ?is title1 includ+     
guidance specify+ h[ ,/ates %all assess 
& track ! availability ( home &         

community-bas$ s]vices ov] "t4  7c7     
,recomm5dations ,to guide infra/ructure 
improvem5t  7#a7 ,9 g5]al ,n lat] ?an   
#ah mon?s aft] ! date ( enactm5t ( ?is  
,act1 ! ,secret>y %all coord9ate ) !    
,secret>y ( ,labor & ! ,adm9i/rator ( ! 
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices =   
purposes ( issu+ recomm5dations = !     
,f$]al ,gov]nm5t & = ,/ates to /r5g!n ! 
direct c>e work=ce t provides home &    
community-bas$ s]vices1 includ+ )       
respect to h[ ! ,f$]al ,gov]nm5t %\ld   
classify ! direct c>e work=ce1 h[ su*   
,adm9i/rator & ,/ate ,m$icaid programs c
 en=ce & support ! provision (          
competitive wages & b5efits across !    
direct c>e work=ce1 includ+ = work]s )  
p>ticul> skills or exp]tise1 & h[ ,/ate 
,m$icaid programs c support tra9+       
opportunities & o!r relat$ ef=ts t      
support ! provision ( quality home &    
community-bas$ s]vices c>e4  7#b7       
,/akehold] consultation ,9 develop+ !   
recomm5dations requir$ "u p>agraph 7#a71
 ! ,secret>y %all ensure t su*          

recomm5dations are in=m$ by consultation
 ) recipi5ts ( home & community-bas$    
s]vices1 family c>egiv]s ( su*          
recipi5ts1 provid]s1 heal? plans1 direct
 c>e work]s1 *os5 repres5tatives (      
direct c>e work]s1 & ag+1 disability1 & 
work=ce advocates4  7d7 ,fund+ ,out (   
any funds 9 ! ,treasury n o!rwise       
appropriat$1 !re is appropriat$ to !    
,secret>y = purposes ( c>ry+ out ?is    
section1 #aj1jjj1jjj = fiscal ye> #bjbb1
 to rema9 available until exp5d$4  #ajd4
 ,quality measurem5t & improvem5t  7a7  
,developm5t & publication ( core &      
supplem5tal sets ( ,,hcbs quality       
measures  7#a7 ,9 g5]al ,n lat] ?an #b  
ye>s aft] ! date ( enactm5t ( ?is ,act1 
! ,secret>y %all id5tify & publi% =     
g5]al comm5t a recomm5d$ core set &     
supplem5tal set ( home & community-bas$ 
s]vices quality measures = use by ,/ate 
,m$icaid programs1 heal? plan & manag$  
c>e entities t ent] into contracts ) su*
 programs1 & provid]s ( items & s]vices 
"u su* programs4  7#b7 ,regul> reviews &

 updates ,! ,secret>y %all review &     
update ! recomm5d$ core set &           
supplem5tal set ( home & community-bas$ 
s]vices quality measures publi%$ "u     
p>agraph 7#a7 n less frequ5tly ?an once 
e ye>4  7#c7 ,requirem5ts  7,a7         
,int]ag5cy collaboration2 /akehold]     
input ,9 develop+ ! recomm5d$ core set &
 supplem5tal set ( home & community-bas$
 s]vices quality measures "u p>agraph   
7#a71 & subsequ5tly review+ & updat+ su*
 core & supplem5tal sets1 ! ,secret>y   
%all-- 7i7 collaborate ) ! ,adm9i/rator 
( ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices1
 ! ,adm9i/rator ( ! ,adm9i/ration =     
,community ,liv+1 ! ,director ( ! ,ag5cy
 = ,heal?c>e ,rese>* & ,quality1 & !    
,adm9i/rator ( ! ,sub/ance ,abuse &     
,m5tal ,heal? ,s]vices ,adm9i/ration2 & 
7ii7 ensure t su* core & supplem5tal    
sets are in=m$ by input f /akehold]s1   
includ+ recipi5ts ( home &              
community-bas$ s]vices1 family c>egiv]s 
( su* recipi5ts1 provid]s1 heal? plans1 
direct c>e work]s1 *os5 repres5tatives (

 direct c>e work]s1 & ag+1 disability1 &
 work=ce advocates4  7,b7 ,reflective ( 
full array ( s]vices ,su* recomm5d$ core
 set & supplem5tal set ( home &         
community-bas$ s]vices quality measures 
%all-- 7i7 reflect ! full array ( home &
 community-bas$ s]vices & recipi5ts (   
su* s]vices1 includ+ adults & *ildr52 & 
7ii7 include-- 7,i7 outcomes-bas$       
measures2  7,,ii7 measures (            
availability ( s]vices2  7,,iii7        
measures ( provid] capacity &           
availability2  7,,iv7 measures relat$ to
 p]son-c5t]$ c>e2  7,v7 measures        
specific to self-direct$ c>e2  7,,vi7   
measures relat$ to transitions to & f   
in/itutional c>e2 &  7,,vii7 b5efici>y &
 family c>egiv] surveys4  7,c7          
,demographics ,su* recomm5d$ core set & 
supplem5tal set ( home & community-bas$ 
s]vices quality measures %all all[ = !  
collection ( data t is disaggregat$ by  
disability /atus1 age1 income1 g5d]1    
race1 e?nicity1 geography1 prim>y       
language1 sexual ori5tation1 g5d]       

id5tity1 & type ( s]vice sett+4  7#d7   
,fund+ ,out ( any funds 9 ! ,treasury n 
o!rwise appropriat$1 !re is appropriat$ 
to ! ,secret>y = purposes ( c>ry+ out   
?is subsection1 #e1jjj1jjj = fiscal ye> 
#bjbb1 to rema9 available until exp5d$4 
7b7 ,/ate adoption & reports  7#a7 ,9   
g5]al ,n lat] ?an #b ye>s aft] ! date on
 :i* ! ,secret>y publi%es ! recomm5d$   
core set & supplem5tal set ( home &     
community-bas$ s]vices quality measures 
"u subsection 7a77#a71 & annually       
!reaft]1 ea* ,/ate ,m$icaid program %all
 use su* core & supplem5tal sets 7or an 
alt]native set ( quality measures       
approv$ by ! ,secret>y7 to report       
in=mation to ! ,secret>y reg>d+ !       
quality ( home & community-bas$ s]vices 
provid$ "u su* program4  7#b7 ,process  
,! in=mation requir$ "u p>agraph 7#a7   
%all be report$ us+ a /&>diz$ =mat &    
proc$ures e/abli%$ by ! ,secret>y4 ,su* 
proc$ures %all all[ a ,/ate ,m$icaid    
program to report su* in=mation         
sep>ately or z "p ( ! annual reports    

requir$ "u sections #aaci;,a7c7 &       
#aaci;,b7d7 ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #acbj;b-#i;a1            
#acbj;b-#i;b74  7#c7 ,publication (     
quality measures ,ea* ,/ate ,m$icaid    
program %all p]iodically make !         
in=mation report$ to ! ,secret>y "u     
p>agraph 7#a7 available to ! public4    
7#d7 ,increas$ ,f$]al mat*+ rate =      
adoption & report+ ,section             
#aijc7;a77#c7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acif;b7a77#c77 is      
am5d$-- 7,a7 9 subp>agraph 7,f77ii71 by 
/rik+ plus aft] ! semicolon & ins]t+ &2 
&  7,b7 by ins]t+ aft] subp>agraph 7,f71
 ! foll[+3  7,g7 #hj p]c5t ( s mu* ( !  
sums exp5d$ dur+ su* qu>t] z are        
attributable to ! report+ ( in=mation   
reg>d+ ! quality ( home & community-bas$
 s]vices 9 accordance ) section #ajd7;b7
 ( ! ,bett] ,c>e ,bett] ,jobs ,act2 &  4
  ,,ii ,o!r ,provisions  #bja4 ,,macpac 
/udy & report on ,app5dix ,k em]g5cy    
home & community-bas$ s]vices 7,,hcbs7  
#aiae7;c7 waiv]s  7a7 ,9 g5]al ,!       

,m$icaid & ,,*ip ,paym5t & ,access      
,commission 7ref]r$ to 9 ?is section z  
,,macpac7 %all conduct a /udy & submit  
to ,congress a report on ! accel]at$    
*anges & em]g5cy am5dm5ts to home &     
community-bas$ s]vices waiv]s "u section
 #aiae7;c7 ( ! ,social ,security ,act   
7#db ,u4,s4,c4 #acifn7c77 approv$ =     
,/ates dur+ ! ,,covid-#ai p&emic us+ !  
,app5dix ,k template issu$ by ! ,c5t]s =
 ,m$ic>e  ,m$icaid ,s]vices on ,m>* #bb1
 #bjbj4  7b7 ,report ,! report submitt$ 
"u subsection 7a7 %all-- 7#a7 describe !
 specific types ( flexibilities or o!r  
program *anges adopt$ by ,/ates us+ !   
,app5dix ,k template2  7#b7 evaluate !  
effici5cy1 managem5t1 & success &       
failures ( su* flexibilities & program  
*anges2 &  7#c7 include recomm5dations =
 legislative & adm9i/rative actions to  
cont9ue specific flexibilities1 program 
*anges1 & innovative s]vice deliv]y     
models t increase access to c>e 9 home &
 community sett+s4  #bjb4 ,mak+ p]man5t 
! ,/ate option to ext5d protection "u   

,m$icaid = recipi5ts ( home &           
community-bas$ s]vices aga9/ sp\sal     
impov]i%m5t  7a7 ,9 g5]al ,section      
#aibd7;h77#a77;,a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acifr-#e7;h77#a77;,a77 is am5d$ by     
/rik+ is describ$ 9 section             
#aijb7;a77#aj77;,a77ii77,,vi7 & ins]t+ !
 foll[+3 is eligible = m$ical assi/ance 
= home & community-bas$ s]vices provid$ 
"u subsection 7c71 7d71 or 7i7 ( section
 #aiae1 "u a waiv] approv$ "u section   
#aaae1 or :o is eligible = su* m$ical   
assi/ance by reason ( be+ det]m9$       
eligible "u section #aijb7;a77#aj77;,c7 
or by reason ( section #aijb7;f7 or     
o!rwise on ! basis ( a r$uction ( income
 bas$ on co/s incurr$ = m$ical or o!r   
rem$ial c>e1 or :o is eligible = m$ical 
assi/ance = home & community-bas$       
att5dant s]vices & supports "u section  
#aiae7k74  7b7 ,con=m+ am5dm5t ,section 
#bdjd ( ! ,pati5t ,protection &         
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#acifr-#e note7 is am5d$ by /rik+       

,septemb] #cj1 #bjbc & ins]t+ ! date (  
enactm5t ( ! ,bett] ,c>e ,bett] ,jobs   
,act4  #bjc4 ,p]man5t ext5sion ( ,money 
,foll[s ! ,p]son ,rebalanc+ demon/ration
  7a7 ,9 g5]al ,subsection 7h7 ( section
 #fjga ( ! ,deficit ,r$uction ,act (    
#bjje 7#db ,u4,s4,c4 #acif;a note7 is   
am5d$-- 7#a7 9 p>agraph 7#a7-- 7,a7 9   
subp>agraph 7,i71 by ins]t+ & aft] !    
semicolon2  7,b7 by am5d+ subp>agraph   
7,j7 to read z foll[s3  7,g7            
#dej1jjj1jjj = ea* fiscal ye> aft]      
fiscal ye> #bjba4  2 &  7,c7 by /rik+   
subp>agraph 7,k72 &  7#b7 9 p>agraph    
7#b71 by /rik+ ,septemb] #cj1 #bjbc &   
ins]t+ ,septemb] #cj ( su* fiscal ye>4  
7b7 ,r$i/ribution ( unexp5d$ grant aw>ds
 ,subsection 7e77#b7 ( section #fjga ( !
 ,deficit ,r$uction ,act ( #bjje 7#db   
,u4,s4,c4 #acif;a note7 is am5d$ by add+
 at ! end ! foll[+ new s5t5ce3 ,any     
portion ( a ,/ate grant aw>d = a fiscal 
ye> "u ?is section t is unexp5d$ by !   
,/ate at ! end ( ! f\r? succe$+ fiscal  
ye> %all be resc9d$ by ! ,secret>y &    

add$ to ! appropriation = ! fif? succe$+
 fiscal ye>44