,,ii  #aah? ,,congress  #a/ ,session    
,s4 #babh  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #bb1 #bjbc ,mrs4 
,gillibr& introduc$ ! foll[+ bill2 :i* 0
 read twice & ref]r$ to ! ,committee on 
,f9ance  ,a ,,bill  ,to am5d title ,,xix
 ( ! ,social ,security ,act to increase 
,f$]al ,m$icaid fund+ = ,/ates t provide
 int5sive community-bas$ s]vices =      
adults ) s]i\s m5tal illness1 & = o!r   
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,/r5g!n+ ,m$icaid = ,s]i\s 
,m5tal ,illness ,act4  #b4 ,purposes ,! 
purposes ( ?is ,act are ! foll[+3  7#a7 
,to am5d title ,,xix ( ! ,social        
,security ,act to increase ,f$]al       
,m$icaid fund+ = ,/ates t provide       
int5sive community-bas$ s]vices = adults
 ) s]i\s m5tal illness4  7#b7 ,to       
increase access to int5sive             
community-bas$ s]vices 9 ! mo/ integrat$
 sett+ appropriate4  7#c7 ,to prev5t    
unnecess>y hospitalization or o!r       
in/itutionalization4  7#d7 ,to promote  
cont9uity ( c>e & cov]age = "y adults   

aft] !y turn #ba & age out ( ! e>ly &   
p]iodic scre5+1 diagno/ic1 & treatm5t   
s]vices b5efit4  #c4 ,increas$ ,,fmap = 
provid+ int5sive community-bas$ s]vices 
"u ,m$icaid  7a7 ,9 g5]al ,section #aiae
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acifn7 is am5d$ by add+ at ! 
end ! foll[+ new subsection3  7m7 ,/ate 
plan am5dm5t option ,to provide int5sive
 community-,bas$ s]vices = eld]ly &     
disabl$ individuals  7#a7 ,9 g5]al      
,subject to ! succe$+ provisions ( ?is  
subsection1 beg9n+ ,janu>y #a1 #bjbe1 a 
,/ate may provide ?r\gh a ,/ate plan    
am5dm5t = ! provision ( m$ical assi/ance
 = int5sive community-bas$ s]vices 7n   
includ+ room & bo>d7 = eligible         
individuals 7z def9$ 9 p>agraph 7#b771  
)\t det]m9+ t b = ! provision ( su*     
s]vices ! individuals w\ld require !    
level ( c>e provid$ 9 a hospital1 nurs+ 
facility1 or int]m$iate c>e facility    
describ$ 9 section #aije7;d71 b only if 
! ,/ate meets ! foll[+ requirem5ts3     
7,a7 ,application ( ,,hcbs ,/ate plan   

am5dm5t requirem5ts  7i7 ,9 g5]al       
,except z provid$ 9 clause 7ii71 ! ,/ate
 satisfies ! requirem5ts describ$ 9     
subp>agraphs 7,a7 ?r\gh 7,j7 (          
subsection 7i77#a7 7except t1 9 apply+  
su* subp>agraphs = purposes ( ?is       
subsection1 ea* ref]5ce to home &       
community-bas$ s]vices %all be deem$ to 
be a ref]5ce to int5sive community-bas$ 
s]vices74  7ii7 ,modification (         
assessm5t requirem5t ,9 apply+          
subp>agraph 7,f77i7 ( subsection 7i77#a7
 = purposes ( ?is subsection1 or #a or m
 activity ( daily liv+ & #a or m        
in/rum5tal activity ( daily liv+ 7z     
def9$ 9 subsection 7k77#f77;,f77 %all be
 ins]t$ aft] #b or m activities ( daily 
liv+ 7z def9$ 9 section                 
#ggjb;,b7c77#b77;,b7 ( ! ,int]nal       
,rev5ue ,code ( #aihf74  7,b7           
,application ( regulations ,9 provid+   
int5sive community-bas$ s]vices "u ?is  
subsection1 ! ,/ate complies ) !        
regulations applicable to home &        
community-bas$ s]vices provid$ "u       

subsection 7i7 "u subp>t ,m ( "p #dda ( 
title #db1 ,code ( ,f$]al ,regulations1 
includ+ sections #dda4gaj 7commonly kn[n
 z ! ,,hcbs sett+s rule7 & #dda4gbe (   
su* title1 except to ! ext5t t su*      
regulations are inconsi/5t ) ?is        
subsection4  7#b7 ,def9itions ,9 ?is    
subsection3  7,a7 ,adult ) a s]i\s m5tal
 illness2 s]i\s m5tal illness  7i7      
,adult ) a s]i\s m5tal illness ,! t]m   
adult ) a s]i\s m5tal illness has !     
mean+ giv5 t t]m by ! ,secret>y pursuant
 to section #aiab7;c7 ( ! ,public ,heal?
 ,s]vice ,act4  7ii7 ,s]i\s m5tal       
illness ,! t]m s]i\s m5tal illness means
 a diagnosable m5tal1 behavioral or     
emotional disord] t meets ! crit]ia =   
qualify+ an individual z an adult ) a   
s]i\s m5tal illness4  7,b7 ,ass]tive    
community treatm5t ,! t]m ass]tive      
community treatm5t means s]vices = !    
treatm5t ( m5tal illness t are provid$  
?r\gh an evid5ce-bas$ practice t-- 7i7  
improves outcomes = individuals ) sev]e 
m5tal illness :o are at high risk (     

homelessness1 psy*iatric crisis1 or     
hospitalization1 or are involv$ 9 !     
crim9al ju/ice sy/em2  7ii7 is compris$ 
( a multidiscipl9>y /aff1 includ+ pe]   
speciali/s1 :o "w z a team to provide ! 
individualiz$ psy*iatric treatm5t1      
rehabilitation1 & support s]vices cli5ts
 ne$ = ! maximum r$uction ( physical or 
m5tal disability & re/oration to _! be/ 
possible functional level2  7iii7       
ensures t !re is #a direct c>e /aff     
p]son = e #aj cli5ts2 &  7iv7 provides  
s]vices #bd h\rs a day1 #g days a week1 
= z long z ne$$ & :]ev] !y are ne$$4    
7,c7 ,eligible individual ,! t]m        
eligible individual means an            
individual--  7i7 :o is eligible =      
m$ical assi/ance "u ! ,/ate plan or "u a
 waiv] ( su* plan2  7ii7 :o is age #ba  
or old]2  7iii7 ^: income does n exce$  
#aej p]c5t ( ! pov]ty l9e 7z def9$ 9    
section #baaj7;c77#e772 &  7iv7 :o is an
 adult ) a s]i\s m5tal illness4  7,d7   
,int5sive case managem5t ,! t]m int5sive
 case managem5t means a type ( case     

managem5t s]vice 7z def9$ 9 section     
#ddj4afi ( title #db1 ,code ( ,f$]al    
,regulations7-- 7i7 t is reliable1      
sy/ematic1 flexible1 & coord9at$1       
design$ to answ] ! unique comb9ation (  
heal? & social c>e ne$s ( individuals ) 
s]i\s m5tal illness2  7ii7 t is a       
long-t]m1 int5sive approa* to support+  
an individual 9 ! community by provid+ a
 compreh5sive range ( treatm5t1         
rehabilitation1 & support s]vices2      
7iii7 t helps individuals ) s]i\s m5tal 
illness acquire mat]ial res\rces 7su* z 
food1 %elt]1 clo?+1 & m$ical c>e7 &     
improve _! psy*osocial function+2  7iv7 
t provides suffici5t support to         
individuals ) s]i\s m5tal illness to    
keep !m involv$ 9 community life &      
enc\rage gr[? t[>ds great] autonomy &   
develop cop+ skills to meet ! dem&s (   
community life2  7v7 t ensures cont9uity
 ( c>e among treatm5t ag5cies2  7vi7 9  
:i* a case manag]1 work+ alone or z "p (
 a team1 makes #d or m face-to-face     
contact ) a cli5t ea* mon?2 &  7vii7 9  

:i* ! case manag]-to-cli5t ratio does n 
exce$ #a3ab4  7,e7 ,int5sive            
community-bas$ s]vices ,! t]m int5sive  
community-bas$ s]vices means a set (    
psy*osocial rehabilitation s]vices t    
includes all ( ! foll[+3 7i7 ,ass]tive  
community treatm5t4  7ii7 ,support$     
employm5t4  7iii7 ,pe] support s]vices4 
7iv7 ,qualify+ community-bas$ mobile    
crisis int]v5tion s]vices4  7v7         
,int5sive case managem5t4  7vi7         
,h\s+-relat$ activities & s]vices1      
includ+ individual h\s+ transition      
s]vices1 individual h\s+ & t5ancy su/a9+
 s]vices1 & ,/ate-level h\s+-relat$     
collaborative activities1 z ^? s]vices  
are describ$ 9 ! in=mational bullet9    
publi%$ by ! ,c5t] = ,m$icaid & ,,*ip   
,s]vices on ,june #bf1 #bjae1 ) !       
subject ,cov]age ( ,h\s+-,relat$        
,activities & ,s]vices = ,individuals ) 
,disabilities4  7vii7 ,su* o!r          
psy*osocial rehabilitation s]vices z a  
,/ate may reque/ & ! ,secret>y may      
approve4  7,f7 ,pe] support s]vices ,!  

t]m pe] support s]vices means culturally
 compet5t individual & gr\p s]vices =   
individuals ) s]i\s m5tal illness t     
promote recov]y1 resili5cy1 engagem5t1  
socialization1 self-suffici5cy1         
self-advocacy1 developm5t ( natural     
supports1 & id5tification ( /r5g?s ?r\gh
 /ructur$ activities su* z gr\p &       
individual coa*+ to set recov]y goals & 
id5tify /eps to rea* ! goals4 ,su*      
s]vices aim to prev5t relapse1 emp[]    
b5efici>ies ?r\gh /r5g?-bas$ coa*+1     
support l9kages to community res\rces1 &
 to educate b5efici>ies & _! families   
ab\t _! conditions & ! process (        
recov]y4 ,su* s]vices include ! foll[+3 
7i7 ,p>ticipat+ 9 ! treatm5t plann+     
process4  7ii7 ,m5tor+ & assi/+ !       
b5efici>y ) problem solv+1 goal sett+1 &
 skill build+4  7iii7 ,enc\rag+ a       
b5efici>y's int]e/ 9 pursu+ & ma9ta9+   
treatm5t s]vices4  7iv7 ,provid+ support
 & l9kages to facilitate p>ticipation 9 
recov]y-bas$ activities4  7v7 ,%>+      
exp]i5tial k1 hope1 & skills4  7vi7     

,advocat+ = ! b5efici>y4  7,g7 ,qualify+
 community-bas$ mobile crisis int]v5tion
 s]vices ,! t]m qualify+ community-bas$ 
mobile crisis int]v5tion s]vices means1 
) respect to a ,/ate1 items & s]vices = 
:i* m$ical assi/ance is available "u !  
,/ate plan "u ?is title or a waiv] ( su*
 plan1 t are--  7i7 furni%$ to an       
individual o!rwise eligible = m$ical    
assi/ance "u ! ,/ate plan 7or waiv] (   
su* plan7 :o is-- 7,i7 outside ( a      
hospital or o!r facility sett+2 &       
7,,ii7 exp]i5c+ a m5tal heal? or        
sub/ance use disord] crisis2  7ii7      
furni%$ by a multidiscipl9>y mobile     
crisis team--  7,i7 t includes at lea/  
#a behavioral heal? c>e pr(essional :o  
is capable ( conduct+ an assessm5t ( !  
individual1 9 accordance ) !            
pr(essional's p]mitt$ scope ( practice  
"u ,/ate law1 & o!r pr(essionals or     
p>apr(essionals ) appropriate exp]tise 9
 behavioral heal? or m5tal heal? crisis 
response1 includ+ nurses1 social work]s1
 pe] support speciali/s1 & o!rs1 z      

designat$ by ! ,/ate 9 ! ,/ate plan     
am5dm5t "u ?is subsection2  7,,ii7 ^:   
memb]s are tra9$ 9 trauma-in=m$ c>e1    
de-escalation /rategies1 & h>m r$uction2
  7,,iii7 t is able to respond 9 a      
timely mann] &1 :]e appropriate1        
provide-- 7aa7 scre5+ & assessm5t2  7bb7
 /abilization & de-escalation2 &  7cc7  
coord9ation )1 & ref]rals to1 heal?1    
social1 & o!r s]vices & supports z ne$$1
 & heal? s]vices z ne$$2  7,,iv7 t      
ma9ta9s relation%ips ) relevant         
community p>tn]s1 includ+ m$ical &      
behavioral heal? provid]s1 prim>y c>e   
provid]s1 community heal? c5t]s1 crisis 
respite c5t]s1 & manag$ c>e             
organizations 7if applicable72 &  7,v7 t
 ma9ta9s ! privacy & confid5tiality (   
pati5t in=mation consi/5t ) ,f$]al &    
,/ate requirem5ts2 &  7iii7 available   
#bd h\rs p] day1 e day ( ! ye>4  7,h7   
,support$ employm5t ,! t]m support$     
employm5t means ongo+ supports t are    
furni%$ to individuals :o1 because ( _! 
s]i\s m5tal illness1 ne$ int5sive       

support to obta9 & ma9ta9 an individual 
job 9 competitive or cu/omiz$ employm5t1
 or self-employm5t1 9 an integrat$ "w   
sett+ 9 ! g5]al work=ce at or above _!  
,/ate's m9imum wage1 b n less ?an !     
cu/om>y wage & level ( b5efits paid by !
 employ] = ! same or simil> "w p]=m$ by 
individuals )\t disabilities4 ,! desir$ 
outcome ( all support$ employm5t s]vices
 is su/a9$ paid employm5t at or above ! 
m9imum wage 9 an integrat$ sett+ 9 !    
g5]al work=ce1 9 a job t meets p]sonal &
 c>e] goals4  7#c7 ,increase fmap =     
m$ical assi/ance = int5sive             
community-bas$ s]vices  7,a7 ,9 g5]al   
,dur+ ea* fiscal qu>t] t a ,/ate meets !
 requirem5ts describ$ 9 subp>agraphs    
7,b7 ?r\gh 7,d71 ! ,f$]al m$ical        
assi/ance p]c5tage applicable to ! ,/ate
 = ! qu>t] 7z det]m9$ "u section        
#aije7;b7 )\t reg>d to any adju/m5ts    
applicable "u su* section or any o!r    
provision ( law7 %all be increas$ by !  
applicable numb] ( p]c5tage po9ts 7z    
det]m9$ "u subp>agraph 7,e7 b n to exce$

 #ajj p]c5t7 ) respect to am\nts exp5d$ 
by ! ,/ate = m$ical assi/ance = int5sive
 community-bas$ s]vices furni%$ to      
eligible individuals dur+ su* qu>t] "u a
 ,/ate plan am5dm5t "u ?is subsection4  
7,b7 ,s]vice quality crit]ia  7i7 ,9    
g5]al ,! ,/ate %all provide eligible    
individuals ) int5sive community-bas$   
s]vices 9 accordance ) su* quality      
crit]ia z ! ,secret>y %all by regulation
 e/abli%4  7ii7 ,crit]ia requirem5ts ,! 
crit]ia e/abli%$ by ! ,secret>y "u      
clause 7i7 %all be design$ to ensure t  
eligible individuals receive ! int5d$   
b5efits ( receipt ( ! s]vices1 includ+  
avoid+ prev5table hospitalization or o!r
 in/itutionalization4 ,! crit]ia w be   
adju/$ z ne$$ to acc\nt = future        
developm5ts & be/ practice4 ,! crit]ia  
%all include ! foll[+3 7,i7 ,! /&>ds =  
ass]tive community treatm5t 9 ! ,tool = 
,measurem5t ( ,ass]tive ,community      
,treatm5t 7,,tmact71 ,d>tm\? ,ass]tive  
,community ,treatm5t ,scale 7,,dacts71  
or o!r g5]ally accept$ tool = evaluat+  

ass]tive community treatm5t4  7,,ii7    
,individual ,placem5t & ,support 7,,ips7
 /&>ds = support$ employm5t s]vices4    
7,,iii7 ,secur+ & ma9ta9+ scatt]$-site  
h\s+ ) a ,h\s+ ,fir/ approa* z ! goal = 
h\s+-relat$ activities & s]vices4  7,c7 
,integrat$ sett+ ,eligible individuals  
%all receive int5sive community-bas$    
s]vices-- 7i7 9 ! mo/ integrat$ sett+   
appropriate2 &  7ii7 )\t limit+ access  
to any su* s]vice on ! basis (-- 7,i7 ! 
individual's ne$ = assi/ance )          
activities ( daily liv+ or in/rum5tal   
activities ( daily liv+2  7,,ii7 receipt
 ( o!r disability support s]vices2      
7,,iii7 ! pres5ce ( additional          
disabilities su* z a physical1          
communication1 intellectual1            
developm5tal1 or o!r disability or a    
record or hi/ory ( hav+ su* a           
disability2 or  7,,iv7 ! exi/5ce (      
co-occurr+ sub/ance use disord]s or a   
record or hi/ory ( hav+ su* sub/ance use
 disord]s4  7,d7 ,data collection &     
report+ ,n less frequ5tly ?an once e #b 

ye>s1 ! ,/ate %all collect & report data
 to ! ,secret>y1 includ+ ) respect to   
disp>ities 9 access to1 or receipt (1   
int5sive community-bas$ s]vices1 accord+
 to crit]ia e/abli%$ by ! ,secret>y & ! 
,secret>y %all analyze & report su*     
f9d+s to ,congress4 ,! crit]ia %all     
include ! collection & report+ ( data ) 
respect to ! foll[+3  7i7 ,demographic  
*>act]i/ics ( eligible individuals :o   
receive int5sive community-bas$ s]vices1
 includ+ b n limit$ to1 race1 e?nicity1 
disability /atus1 disability category1  
age1 sex1 sex *>act]i/ics1 sexual       
ori5tation1 g5d] id5tity1 prim>y        
language1 rural or urban environm5t1 &  
s]vice sett+4  7ii7 ,! utilization (    
int5sive community-bas$ s]vices1 includ+
 units ( s]vice & duration ( receipt (  
s]vice1 p] eligible individual receiv+  
s]vices4  7iii7 ,consum] outcomes1 z    
measur$ via a quality s]vice review tool
 & me?odology approv$ by ! ,secret>y4   
7,e7 ,applicable numb] ( p]c5tage po9ts 
,= purposes ( subp>agraph 7,a7--  7i7 if

 a ,/ate (f]s at lea/ #a b "u #b ( !    
categories ( int5sive community-bas$    
s]vices describ$ 9 clauses 7i7 ?r\gh    
7vii7 ( p>agraph 7#b77;,e7 9 a qu>t]1 ! 
applicable numb] ( p]c5tage po9ts = !   
,/ate & qu>t] is #c p]c5tage po9ts2     
7ii7 if a ,/ate (f]s at lea/ #b b "u #c 
( ! categories ( int5sive community-bas$
 s]vices describ$ 9 clauses 7i7 ?r\gh   
7vii7 ( p>agraph 7#b77;,e7 9 a qu>t]1 ! 
applicable numb] ( p]c5tage po9ts = !   
,/ate & qu>t] is #g p]c5tage po9ts2     
7iii7 if a ,/ate (f]s at lea/ #c b "u #d
 ( ! categories ( int5sive              
community-bas$ s]vices describ$ 9       
clauses 7i7 ?r\gh 7vii7 ( p>agraph      
7#b77;,e7 9 a qu>t]1 ! applicable numb] 
( p]c5tage po9ts = ! ,/ate & qu>t] is   
#ab p]c5tage po9ts2  7iv7 if a ,/ate    
(f]s at lea/ #d b "u #e ( ! categories (
 int5sive community-bas$ s]vices        
describ$ 9 clauses 7i7 ?r\gh 7vii7 (    
p>agraph 7#b77;,e7 9 a qu>t]1 !         
applicable numb] ( p]c5tage po9ts = !   
,/ate & qu>t] is #ah p]c5tage po9ts2 &  

7v7 if a ,/ate (f]s at lea/ #e ( !      
categories ( int5sive community-bas$    
s]vices describ$ 9 clauses 7i7 ?r\gh    
7vii7 ( p>agraph 7#b77;,e7 9 a qu>t]1 ! 
applicable numb] ( p]c5tage po9ts = !   
,/ate & qu>t] is #be p]c5tage po9ts4    
7#d7 ,application ( ,,hcbs ,/ate plan   
am5dm5t provisions ,p>agraphs 7#c71     
7#d71 7#e71 7#f71 & 7#g7 ( subsection   
7i7 %all apply to ,/ate plan am5dm5ts "u
 ?is subsection & int5sive              
community-bas$ s]vices 9 ! same mann] z 
su* p>agraphs apply to ,/ate plan       
am5dm5ts "u su* subsection 7i7 & home & 
community-bas$ s]vices4  7#e7 ,fund+ =  
/ate plann+ grants  7,a7 ,9 g5]al ,!re  
is appropriat$1 out ( any funds 9 !     
,treasury n o!rwise appropriat$1        
#bj1jjj1jjj to ! ,secret>y = purposes ( 
implem5t+1 adm9i/]+1 & mak+ plann+      
grants to ,/ates z soon z practicable = 
purposes ( develop+ a ,/ate plan am5dm5t
 reque/ to provide int5sive             
community-bas$ s]vices "u ?is           
subsection1 to rema9 available until    

exp5d$4  7,b7 ,use ( funds ,a ,/ate %all
 use funds receiv$ "u a grant "u ?is    
subsection to engage 9 plann+ activities
 = a ,/ate plan am5dm5t "u ?is          
subsection1 includ+--  7i7 collaborative
 activities1 at ! ,/ate & ,f$]al level1 
) provid]s ( h\s+-relat$ s]vices2  7ii7 
develop+ s]vice quality crit]ia2 &      
7iii7 develop+ ! infra/ructure necess>y 
to implem5t ! ,/ate plan am5dm5t1       
includ+ data infra/ructure & /aff+4  4  
7b7 ,rule ( con/ruction ,no?+ 9 ?is ,act
 or ! am5dm5ts made by ?is ,act may be  
con/ru$ to limit ! entitlem5t ( *ildr5 &
 y\? :o are eligible = m$ical assi/ance 
"u a ,/ate ,m$icaid program to receive  
int5sive community-bas$ s]vices ?r\gh ! 
e>ly & p]iodic scre5+1 diagno/ic1 &     
treatm5t s]vices b5efit4