,,ii #aahth ,,congress #ast ,session ,s4 #gfb ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #i1 #bjbc ,mr4 ,casey 7for himself1 ,ms4 ,hassan1 ,mr4 ,brown1 ,mr4 ,kaine1 ,mrs4 ,gillibrand1 ,mr4 ,blumenthal1 ,mr4 ,welch1 ,mr4 ,fetterman1 ,mr4 ,merkley1 ,mr4 ,sanders1 ,ms4 ,baldwin1 ,ms4 ,duckworth1 ,ms4 ,warren1 ,mr4 ,reed1 ,mr4 ,markey1 ,mrs4 ,shaheen1 and ,mrs4 ,murray7 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 require coverage of1 and expand access to1 home and community-based services under the ,medicaid program1 to award grants for the creation1 recruitment1 training and education1 retention1 and advancement of the direct care workforce and to award grants to support family caregivers1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,,hcbs ,access ,act4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,definitions4 ,,title ,i--,requiring and expanding access to ,,hcbs coverage under ,medicaid ,sec4 #aja4 ,purpose4 ,sec4 #ajb4 ,requiring coverage of home and community-based services under the ,medicaid program4 ,sec4 #ajc4 ,medicaid eligibility modifications4 ,sec4 #ajd4 ,home and community-based services implementation plan grant program4 ,sec4 #aje4 ,quality of services4 ,sec4 #ajf4 ,reports2 technical assistance2 other administrative requirements4 ,sec4 #ajg4 ,quality measurement and improvement4 ,sec4 #ajh4 ,making permanent the ,state option to extend protection under ,medicaid for recipients of home and community-based services against spousal impoverishment4 ,sec4 #aji4 ,permanent extension of ,money ,follows the ,person ,rebalancing demonstration4 ,,title ,,ii--,recognizing the role of direct support professionals ,sec4 #bja4 ,findings4 ,sec4 #bjb4 ,definition of direct support professional4 ,sec4 #bjc4 ,revision of ,standard ,occupational ,classification ,system4 ,,title ,,iii--,support for the direct care workforce ,sec4 #cja4 ,definitions4 ,sec4 #cjb4 ,authority to establish a technical assistance center for building the direct care workforce4 ,sec4 #cjc4 ,authority to award grants4 ,sec4 #cjd4 ,project plans4 ,sec4 #cje4 ,evaluations and reports2 technical assistance4 ,sec4 #cjf4 ,authorization of appropriations4 ,,title ,,iv--,evaluation ,sec4 #dja4 ,evaluation of impact on access to ,,hcbs4 #b4 ,definitions ,in this ,act3 7#a7 ,demographics ,the term demographics means information relating to the races1 ethnicities1 genders1 sexual orientations1 gender identities1 geographic locations1 incomes1 primary languages1 types of service setting1 and disability types represented within a particular group of individuals4 7#b7 ,private duty nursing ,the term private duty nursing means nursing services that are sufficient to meet the needs of an individual who requires more individualized and continuous care than is available from a visiting nurse or routinely provided by the nursing staff of a hospital or skilled nursing facility1 and includes services provided to an individual in the individual's own home by a registered nurse or licensed practical nurse under the direction of a physician4 7#c7 ,secretary ,except as otherwise provided1 the term ,secretary means the ,secretary of ,health and ,human ,services4 ,i ,requiring and expanding access to ,,hcbs coverage under ,medicaid #aja4 ,purpose ,it is the purpose of this title to require coverage of home and community-based services 7in this section referred to as ,,hcbs7 under a ,state plan 7or waiver of such plan7 under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 for the following reasons3 7#a7 ,to eliminate waiting lists for ,,hcbs1 which delay access to necessary services and civil rights for people with disabilities and older adults4 7#b7 ,to build on decades of progress in serving people with disabilities and older adults via ,,hcbs4 7#c7 ,to fulfill the purposes of the ,medicaid program to provide medical assistance for those whose income and resources are insufficient to meet the costs of necessary medical services1 and to provide rehabilitation1 long-term services and supports1 and other services to help such families and individuals attain or retain capability for independence or self-care4 7#d7 ,to ensure that people with all kinds of disabilities and with multiple disabilities1 including intellectual disability1 cognitive disabilities1 developmental disabilities1 behavioral health disabilities1 physical disabilities1 and substance use disorders1 and older adults1 receive the services they need to live in their communities4 7#e7 ,to streamline access to ,,hcbs by eliminating the need for ,states to repeatedly apply for waivers4 7#f7 ,to continue to increase the capacity of community services to ensure people with disabilities and older adults have safe and meaningful options in the community are not at risk of unnecessary institutionalization4 7#g7 ,to act on the decades of research and practice showing that everyone1 including people with the most severe disabilities1 can live in the community with the right services and supports4 7#h7 ,to support over #ec1jjj1jjj unpaid family caregivers who are often providing complex services and supports to older adults and people with disabilities because of a lack of affordable services1 workforce shortages1 and other inefficiencies4 7#i7 ,to improve direct care quality and address the decades long workforce barriers1 which have been exacerbated by the ,,covid-#ai pandemic1 for nearly #b1fjj1jjj direct care professionals providing support to people with disabilities and older adults in their homes and communities4 7#aj7 ,to eliminate the race1 gender1 sexual orientation1 and gender identity disparities that exist in accessing information and ,,hcbs and to prevent the unnecessary impoverishment and institutionalization of black and brown individuals with disabilities and older adults4 #ajb4 ,requiring coverage of home and community-based services under the ,medicaid program 7a7 ,definition of home and community-,based services 7#a7 ,in general ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended by adding at the end the following new subsection3 7jj7 ,home and community-,based services 7#a7 ,in general ,for purposes of this title1 the term home and community-based services means those services specified in paragraph 7#b7 furnished to an eligible individual 7as defined in paragraph 7#c771 based on an individualized assessment 7as described in paragraph 7#d77 of such individual1 in a setting that-- 7,a7 meets the qualities specified in paragraph 7#a7 of section #dda4gaj7;a7 of title #db1 ,code of ,federal ,regulations 7or a successor regulation72 7,b7 is not described in paragraph 7#b7 of such section 7or successor regulation72 and 7,c7 meets such other qualities as the ,secretary determines appropriate4 7#b7 ,services specified 7,a7 ,in general ,for purposes of paragraph 7#a71 the services specified in this paragraph are services described in any of paragraphs 7#g71 7#h71 7#ac77;,c71 7#ai71 7#bj71 7#bd71 and 7#bi7 7as applied without regard to the reference to ,september #cj1 #bjbe7 of subsection 7a7 or in any of subsections 7c77#d77;,b71 7c77#e71 7k77#a77;,a71 7k77#a77;,b71 or 7k77#a77;,d7 of section #aiae1 including the following3 7i7 ,supported employment and integrated day services4 7ii7 ,personal assistance1 including personal care attendants1 direct support professionals1 home health aides1 private duty nursing1 homemakers and chore assistance1 and companionship services4 7iii7 ,services that enhance independence1 inclusion1 and full participation in the broader community4 7iv7 ,non-emergency1 non-medical transportation services to facilitate community integration4 7v7 ,respite services provided in the individual's home or broader community4 7vi7 ,caregiver and family support services4 7vii7 ,case management1 including intensive case management1 fiscal intermediary1 and support brokerage services4 7viii7 ,services which support person-centered planning and self-direction4 7ix7 ,direct support services during acute hospitalizations4 7x7 ,necessary medical and nursing services not otherwise covered which are necessary in order for the individual to remain in their home and community1 including hospice services4 7xi7 ,home and community-based intensive behavioral health and crisis intervention services4 7xii7 ,peer support services4 7xiii7 ,housing support1 including transitional housing or transitional support services for individuals who are unhoused1 and wrap-around services4 7xiv7 ,necessary home modifications and assistive technology1 including those which substitute for human assistance4 7xv7 ,transition services to support an individual who is transitioning from an institutional setting to the community1 including appropriate services for individuals who are unhoused or at risk of becoming unhoused1 and including such transition services provided while the individual resides in an institution4 7xvi7 ,any other service recommended by the panel convened pursuant to subparagraph 7,b74 7,b7 ,specification of recommended services 7i7 ,in general ,not later than #f months after the date of the enactment of this subparagraph1 and not less frequently than once every #e years thereafter1 the ,secretary shall convene an advisory panel 7in this subparagraph referred to as the panel7 for purposes of recommending additional services which shall be included as home and community-based services under this paragraph4 7ii7 ,composition 7,i7 ,selection ,the panel shall be composed of at least one representative 7to be selected by the ,secretary7 from each of the following3 7aa7 ,individuals with disabilities receiving home and community-based services under this title and individuals with disabilities in need of such services1 including those with physical disabilities1 behavioral health disabilities1 or intellectual or developmental disabilities1 and including older adults4 7bb7 ,beneficiary-led disability rights organizations4 7cc7 ,disability-led organizations4 7dd7 ,disabled veterans organizations4 7ee7 ,disability organizations representing families4 7ff7 ,community-based provider organizations4 7gg7 ,organizations serving older adults4 7hh7 ,the ,protection and ,advocacy system1 the ,centers for ,independent ,living4 7ii7 ,health care providers4 7jj7 ,the ,national ,association of ,medicaid ,directors4 7kk7 ,the ,national ,association of ,state ,directors of ,developmental ,disabilities ,services4 7ll7 ,the ,national ,association of ,state ,mental ,health ,program ,directors4 7mm7 ,a,dvancing ,states4 7nn7 ,the ,centers for ,medicare ,medicaid ,services4 7oo7 ,the ,administration for ,community ,living of the ,department of ,health and ,human ,services4 7pp7 ,other relevant local1 ,state1 and ,federal home and community-based service systems1 as determined by the ,secretary4 7,,ii7 ,requirement for equal representation ,the ,secretary shall select an equal number of representatives from each category described in items 7aa7 through 7oo7 subclause 7,i7 in convening the panel4 7iii7 ,duties ,not later than #f months after a panel is convened under clause 7i71 the panel shall submit to the ,secretary and to ,congress a report recommending additional services which shall be included as home and community-based services under this paragraph4 ,such recommended services shall be so specified with the goal of increasing community integration and self-determination for individuals with disabilities receiving such services4 7iv7 ,implementation of recommended services 7,i7 ,in general ,services recommended by the panel in a report submitted under clause 7iii7 shall be treated as services described in subparagraph 7,a77xvi7 for calendar quarters beginning on or after the date that is #a year after the date of such submission4 7,,ii7 ,notification ,not later than #a year after the first report is submitted under clause 7iii71 and not later than #a year after the submission of each subsequent such report1 the ,secretary shall notify ,states of any additions or removals of home and community-based services based on services recommended under such report through ,state ,medicaid ,director letters4 7#c7 ,eligible individual 7,a7 ,in general ,for purposes of paragraph 7#a71 the term eligible individual means-- 7i7 an individual who is determined1 on an annual basis or on a longer basis specified by the ,state1 by a health care provider approved by the ,state under a process described in subparagraph 7,c7 to have a functional impairment 7as defined in subparagraph 7,b77 7not taking into account any items or services1 or any other ameliorative measures1 furnished to such individual to mitigate such impairment7 that is expected to last at least #ij days2 7ii7 during the period that ends on the day before the first day of the first calendar quarter beginning on or after the date that is #e years after the date of the enactment of this subsection1 an individual who1 as of such date of enactment1 is receiving or has been determined to be eligible for1 home and community-based services under this title under a waiver or ,state plan option in effect under section #aiae or #aaae1 provided that the individual continues to meet any level of care requirement applicable under such waiver or plan option2 or 7iii7 an individual who is eligible under the ,state plan or waiver and is under the age of #ba4 7,b7 ,functional impairment ,for purposes of subparagraph 7,a71 the term functional impairment means1 with respect to an individual the inability of such individual to perform1 without assistance-- 7i7 #b or more activities of daily living 7as described in section #ggjb;,b7c77#b77;,b7 of the ,internal ,revenue ,code of #aihf72 7ii7 #b or more instrumental activities of daily living 7as defined for purposes of section #aiae7k77#a77;,a772 or 7iii7 #a activity of daily living 7as so described7 and #a instrumental activity of daily living 7as so defined74 7,c7 ,health care provider ,state approval ,for purposes of subparagraph 7,a77i71 a process described in this subparagraph is a process established by the ,state to approve health care providers to make determinations described in such subparagraph that meets such standards as the ,secretary may prescribe4 7#d7 ,individualized assessment 7,a7 ,in general ,for purposes of paragraph 7#a71 an individualized assessment described in this paragraph is an independent assessment1 with respect to an eligible individual-- 7i7 to determine a necessary level of services and supports to be provided1 consistent with an individual's functional impairments1 to facilitate an individual's community integration1 self-determination1 and well-being2 7ii7 to prevent the provision of unnecessary or inappropriate care2 7iii7 to establish a person-centered care plan 7as described in subparagraph 7,c77 for the individual2 7iv7 that includes each of the elements described in clauses 7ii7 through 7v7 of section #aiae7;i77#a77;,f72 and 7v7 that occurs not later than #cj days after such individual is determined to be an eligible individual4 7,b7 ,presumption ,the assessment described in subparagraph 7,a7 shall be conducted with the presumption-- 7i7 that each eligible individual1 regardless of type or level of disability or service need1 can be served in the individual's own home and community2 and 7ii7 at the option of the individual1 that services may be self-directed 7as defined in section #aiae7;i77#a77;,g77iii77,,ii774 7,c7 ,person-centered care plan ,for purposes of subparagraph 7,a77iii71 a person-centered care plan described in this subparagraph is a written plan with respect to an individual that meets the requirements of section #aiae7;i77#a77;,g77ii74 7,d7 ,standards ,an individualized assessment described in subparagraph 7,a7 shall be conducted in accordance with standards specified by the ,secretary1 in consultation with the ,administration for ,community ,living1 that-- 7i7 safeguard against conflicts of interest2 7ii7 specify qualifications for who may perform such assessments2 7iii7 ensure transparency in the furnishing of such assessments1 including ensuring the provision of the results of such assessments that includes information in plain language necessary to interpret the methodology and results of such assessments2 7iv7 ensure that the methodologies used in such assessments are sound and evidence-based2 and 7v7 require such methodologies to be made available on the public website of the ,state and tested for reliability and validity by an independent evaluator4 4 7#b7 ,inclusion as medical assistance ,section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is amended-- 7,a7 in paragraph 7#cj71 by striking 2 and and inserting a semicolon2 7,b7 by redesignating paragraph 7#ca7 as paragraph 7#cb72 and 7,c7 by inserting after paragraph 7#cj7 the following new paragraph3 7#ca7 home and community-based services 7as defined in subsection 7jj772 and 4 7b7 ,mandatory benefit 7#a7 ,in general ,section #aijb7;a77#aj77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77 is amended by striking and 7#cj7 and inserting 7#cj71 and 7#ca74 7#b7 ,effective date ,the amendment made by this subsection shall take effect on the first day of the first calendar quarter that begins on or after the date that is #e years after the date of enactment of this ,act4 7c7 ,ensuring coverage of ,,hcbs for all ,medicaid-,eligible individuals ,section #aijb7;a77#aj77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77 is amended-- 7#a7 by inserting 7i7 after 7,d72 7#b7 by adding and after the semicolon2 and 7#c7 by adding at the end the following new clause3 7ii7 beginning on the first day of the first calendar quarter that begins on or after the date that is #e years after the date of enactment of this clause 7or at such earlier date as the ,state may elect7 for the inclusion of home and community-based services 7as defined in section #aije7;jj77 for any individual who-- 7,i7 is eligible for medical assistance under the ,state plan 7or waiver of such plan72 7,,ii7 is an eligible individual 7as defined in such section72 and 7,,iii7 elects to receive such services4 4 7d7 ,federal medical assistance percentage for home and community-,based services ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 as amended by subsection 7a71 is further amended-- 7#a7 in subsection 7b71 by striking and 7ii7 and inserting 7ii71 and 7kk72 and 7#b7 by adding at the end the following new subsection3 7kk7 ,specified ,,fmap for home and community-,based services 7#a7 ,in general ,notwithstanding any other provision of law and except as provided in paragraph 7#c71 the ,federal medical assistance percentage for amounts expended for medical assistance for home and community-based services 7as defined in subsection 7jj771 including any such services furnished under a waiver in effect under section #aiae1 on or after the date of the enactment of this subsection shall be equal to #ajj percent4 7#b7 ,access to essential ,,hcbs ,as a condition of receiving the ,federal medical assistance percentage described in paragraph 7#a71 a ,state shall enhance1 expand1 or strengthen the level of home and community-based services offered under the ,state plan under this title 7or a waiver of such a plan7 as of the date of enactment of this subsection by doing all of the following3 7,a7 ,addressing access barriers and disparities in access or utilization identified in the ,state ,,hcbs implementation plan4 7,b7 ,using no wrong door programs1 providing presumptive eligibility for home and community-based services1 and improving home and community-based services counseling and education programs4 7,c7 ,providing supports to family caregivers1 which shall include providing respite care1 and may include providing such services as caregiver assessments1 peer supports1 access to assistive technology1 or paid family caregiving4 7,d7 ,adopting processes to ensure that payments for home and community-based services are sufficient to ensure that such services are available to eligible beneficiaries4 7#c7 ,exception ,the ,federal medical assistance percentage applicable to medical assistance for home and community-based services furnished to an individual who is only eligible for medical assistance under a ,state plan or waiver on the basis of section #aijb7;a77#aj77;,a77ii77,,xxiv7 shall be determined without regard to this subsection4 4 7e7 ,sunset of ,,hcbs waivers ,section #aiae of the ,social ,security ,act 7#db ,u4,s4,c4 #acifn7 is amended by adding at the end the following new subsection3 7m7 ,sunset of provisions relating to home and community-,based services 7#a7 ,in general ,except as provided in paragraph 7#b71 the preceding provisions of this section1 insofar as such provisions relate to a waiver for home and community-based services1 shall not apply beginning with the first calendar quarter beginning on or after the date that is #e years after the date of the enactment of this subsection4 7#b7 ,exception ,the ,secretary may waive the application of paragraph 7#a7 for a calendar quarter and a ,state if the ,state requests such a waiver and the ,secretary determines that such a waiver is appropriate4 4 7f7 ,conforming amendments 7#a7 ,in general ,title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is amended-- 7,a7 in section #aije7;a71 in the matter preceding the first numbered paragraph-- 7i7 in clause 7xv71 by striking the comma at the end and inserting 1 or2 7ii7 in clause 7xvi7-- 7,i7 by moving the left margin #b ems to the left2 and 7,,ii7 by striking 1 or and inserting a comma2 and 7iii7 by striking clause 7xvii72 and 7,b7 in section #aidc7;b77#e71 by striking the ,state and all that follows through the period at the end and inserting a determination be conducted on an annual basis 7or on such longer basis as specified by the ,state7 in accordance with section #aije7;jj7 for purposes of providing home and community-based services under the ,state plan 7or waiver of such plan744 7#b7 ,effective date 7,a7 ,in general ,except as provided in subparagraph 7,b71 the amendments made by this subsection shall take effect on the first day of the first calendar quarter that begins on or after the date that is #e years after the date of enactment of this ,act4 7,b7 ,exception for ,states authorized to continue operating ,,hcbs waivers ,in the case of a ,state for which the ,secretary has waived the application of paragraph 7#a7 of subsection 7m7 of section #aiae of the ,social ,security ,act 7#db ,u4,s4,c4 #acifn71 as added by subsection 7e71 in accordance with paragraph 7#b7 of such subsection 7m71 clause 7xvii7 of section #aije7;a7 of the ,social ,security ,act shall continue to have effect with respect to such ,state for so long as paragraph 7#a7 of such subsection 7m7 does not apply to such ,state4 #ajc4 ,medicaid eligibility modifications ,section #aijb7;a77#aj7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77 is amended-- 7#a7 in subparagraph 7,a77i7-- 7,a7 in subclause 7,,viii71 by striking 2 or and inserting a semicolon2 7,b7 in subclause 7,,ix77dd71 by striking the semicolon at the end and inserting 2 or2 and 7,c7 by inserting after subclause 7,,ix7 the following new subclause3 7,x7 beginning with the first calendar quarter that begins on or after the date that is #e years after the date of enactment of this subclause 7or such earlier date as the ,state may elect71 who are eligible individuals described in subsection 7jj77#c77;,a7 and are not described in a previous subclause of this clause and whose income does not exceed the greater of-- 7aa7 #aej percent of the poverty line 7as defined in section #baaj7;c77#e77 applicable to a family of the size involved2 and 7bb7 #cjj percent of the supplemental security income benefit rate established by section #afaa7;b77#a72 2 and 7#b7 in subparagraph 7,a77ii7-- 7,a7 in subclause 7,,xxii71 by striking 2 or and inserting a semicolon2 7,b7 in subclause 7,,xxiii71 by striking the semicolon at the end and inserting 2 or2 and 7,c7 by adding at the end the following new subclause3 7,,xxiv7 who are eligible individuals who would be described in clause 7i77,x7 but for the fact that their income exceeds the income levels established under such clause but is less than such income level as the ,state may establish for purposes of this subclause2 4 #ajd4 ,home and community-based services implementation plan grant program 7a7 ,in general ,not later than #a year after the date of the enactment of this ,act1 the ,secretary shall award to each ,state a grant for purposes of enabling such ,state to implement the requirement to provide home and community-based services under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7b7 ,use of funds ,a grant awarded under subsection 7a7 shall be used by a ,state to develop an implementation plan described in subsection 7c7 to be submitted to the ,secretary for approval4 7c7 ,implementation plan ,an implementation plan described in this subsection is a plan developed by a ,state that includes the following3 7#a7 ,an explanation of how the ,state will operationalize the definition of an eligible individual under section #aije7;jj7 of the ,social ,security ,act1 including the process for determinations specified in paragraph 7#c77;,a77i7 of such section4 7#b7 ,a description of the ,state's plan to ensure a stable and high quality workforce and how the ,state plans to ensure a living wage for individuals furnishing home and community-based services and identify and address any additional workforce issues4 7#c7 ,a list of any home and community-based services provided under the ,state ,medicaid plan 7including any waiver of such plan7 as of the date of enactment of this ,act1 including a breakdown of use of such services by demographics 7as defined in section #b71 compared to such services that are required under the amendments made by section #ajb1 and a description of numerical goals to increase access to such services that have barriers to access for populations in need of such services4 7#d7 ,a description of how the ,state will incorporate existing ,state disability agencies into the new unified provision of home and community-based services and how such ,state will ensure that such services address all functional impairments4 7#e7 ,an explanation of how the ,state will ensure access to such services4 7#f7 ,a plan for carrying out outreach and education activities with respect to the availability of such services through ,aging and ,disability ,resource ,centers and other similar entities 7such as entities receiving funds from the ,administration for ,community ,living or the ,substance ,abuse and ,mental ,health ,services ,administration71 including a program that ensures that an individual is not denied such services based on the fact that the individual contacts the wrong entity 7commonly referred to as a ,no ,wrong ,door ,program74 7#g7 ,a plan for how such services will be coordinated with other relevant ,state agencies1 such as housing1 transportation1 child welfare1 food and income security1 and employment agencies4 7#h7 ,a description of how the ,state will build capacity prior to the implementation of the requirement described in subsection 7a7 to ensure that such services are available to every eligible individual under the ,medicaid program and how the ,state will ensure that such services are provided in a setting that meets the requirements specified in paragraph 7#a7 of section #aije7;jj7 of the ,social ,security ,act1 as added by section #ajb4 7#i7 ,in the case of a ,state that utilizes an alternative benefit plan1 a description of how the ,state will ensure that all individuals who are eligible individuals 7as defined in such section7 are appropriately identified as medically frail and exempted from such plan4 7#aj7 ,how the ,state will coordinate eligibility for such services with other disability eligibility programs1 such as disability buy-in programs4 7#aa7 ,data and milestone requirements to ensure community integration1 including such requirements with respect to utilization of such services by demographics 7as defined in section #b74 7d7 ,state plan requirement ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77 is amended-- 7#a7 in paragraph 7#hf71 by striking and at the end2 7#b7 in paragraph 7#hg71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following new paragraph3 7#hh7 provide for the submission to the ,secretary of an implementation plan described in section #ajd7;c7 of the ,,hcbs ,access ,act for approval by the ,secretary prior to the beginning of the first calendar quarter beginning on or after the date that is #e years after the date of the enactment of this paragraph4 4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to the ,secretary such sums as are necessary to carry out this section4 7f7 ,definitions ,in subsections 7a7 through 7c73 7#a7 ,home and community-based services ,the term home and community-based services has the meaning given such term in subsection 7jj7 of section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 as added by section #ajb4 7#b7 ,state ,the term ,state has the meaning given that term in section #aaja7a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acja7a77 for purposes of title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq474 #aje4 ,quality of services 7a7 ,in general 7#a7 ,development of metrics ,not later than #a year after the date of enactment of this ,act1 the ,director of the ,agency for ,healthcare ,research and ,quality1 in consultation with ,state ,medicaid ,directors1 shall develop standardized1 ,state-level metrics of access to1 and satisfaction with1 providers1 including primary care and specialist providers1 with respect to individuals who are enrolled in ,state ,medicaid plans under title ,,xix of the ,social ,security ,act1 broken down by demographics 7as defined in section #b7 and any other category determined by the ,secretary4 ,such metrics shall include metrics on the total number of individuals enrolled in the ,state plan or under a waiver of the plan during a fiscal year that required the level of care provided in a nursing facility1 intermediate care facility for individuals with intellectual disability1 institution for mental disease1 or other similarly restrictive or institutional setting4 7#b7 ,process ,the ,director of the ,agency for ,healthcare ,research and ,quality shall develop the metrics described in paragraph 7#a7 through a public process1 which shall provide opportunities for stakeholders to participate4 7b7 ,updating metrics ,the ,director of the ,agency for ,healthcare ,research and ,quality1 in consultation with the ,deputy ,administrator for the ,center for ,medicaid and ,,chip ,services and ,state ,medicaid ,directors1 shall update the metrics developed under subsection 7a7 not less than once every #c years4 7c7 ,state implementation funding ,the ,director of the ,agency for ,healthcare ,research and ,quality may award funds1 from the amount appropriated under subsection 7d71 to ,states for the purpose of implementing the metrics developed under this section4 7d7 ,appropriation ,there is appropriated to the ,director of the ,agency for ,healthcare ,research and ,quality1 out of any funds in the ,treasury not otherwise appropriated1 #bjj1jjj1jjj for fiscal year #bjbd1 to remain available until expended1 for the purpose of carrying out this section4 #ajf4 ,reports2 technical assistance2 other administrative requirements 7a7 ,reports ,the ,secretary shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives1 the ,committee on ,education and ,labor of the ,house of ,representatives1 the ,committee on ,finance of the ,senate1 the ,committee on ,health1 ,education1 ,labor and ,pensions of the ,senate1 and the ,special ,committee on ,aging of the ,senate the following reports relating to the ,,hcbs implementation plan grant program established under section #ajd3 7#a7 ,interim report ,not later than #b years after the date of enactment of this ,act1 a report that describes-- 7,a7 ,state efforts to develop their ,,hcbs implementation plans2 and 7,b7 the funds awarded to ,states4 7#b7 ,first implementation report ,not later than #d years after the date of enactment of this ,act1 a report that includes the following3 7,a7 ,a description of the ,,hcbs implementation plans approved by the ,secretary under section #ajd4 7,b7 ,a description of the national landscape with respect to gaps in coverage of home and community-based services1 disparities in access to1 and utilization of1 such services1 and barriers to accessing such services4 7,c7 ,a description of the national landscape with respect to the direct care workforce that provides home and community-based services1 including with respect to compensation1 benefits1 and challenges to the availability of such workers4 7#c7 ,subsequent reports ,not later than #g years after the date of enactment of this ,act1 and every #c years thereafter1 a report that includes the following3 7,a7 ,the number of ,,hcbs program improvement ,states and the funds awarded to ,states to develop their plans4 7,b7 ,a summary of the progress being made by such ,states with respect to strengthening and expanding access to home and community-based services and the direct care workforce that provides such services and meeting the benchmarks for demonstrating improvements required under section #aije7;jj77#e7 of the ,social ,security ,act 7as added by section #ajb74 7,c7 ,a summary of outcomes related to home and community-based services core quality measures and beneficiary and family caregiver surveys4 7,d7 ,a summary of the challenges and best practices reported by ,states in expanding access to home and community-based services and supporting and expanding the direct care workforce that provides such services4 7b7 ,technical assistance2 guidance2 regulations ,the ,secretary shall provide ,,hcbs program improvement ,states with technical assistance related to carrying out the ,,hcbs implementation plans approved by the ,secretary under section #ajd and meeting the requirements and benchmarks for demonstrating improvements required under section #aije7;jj7 of the ,social ,security ,act 7as added by section #ajb7 and shall issue such guidance or regulations as necessary to carry out this title and the amendments made by this title1 including guidance specifying how ,states shall assess and track the availability of home and community-based services over time4 7c7 ,recommendations ,to guide ,,hcbs implementation 7#a7 ,in general ,not later than #ah months after the date of enactment of this ,act1 the ,secretary shall coordinate with the ,secretary of ,labor and the ,administrator of the ,centers for ,medicare ,medicaid ,services for purposes of issuing recommendations for the ,federal ,government and for ,states to strengthen the direct care workforce that provides home and community-based services1 including with respect to how the ,federal ,government should classify the direct care workforce1 how such ,administrator and ,state ,medicaid programs can enforce and support the provision of competitive wages and benefits across the direct care workforce1 including for workers with particular skills or expertise1 and how ,state ,medicaid programs can support training opportunities and other related efforts that support the provision of quality home and community-based services care4 7#b7 ,stakeholder consultation 7,a7 ,in general ,in developing the recommendations required under paragraph 7#a71 the ,secretary shall ensure that such recommendations are informed by consultation with recipients of home and community-based services1 family caregivers of such recipients1 providers1 health plans1 direct care workers1 chosen representatives of direct care workers1 and aging1 disability1 and workforce advocates4 7,b7 ,consultation with current and potential ,,hcbs beneficiaries and family caregivers ,as part of the process of developing recommendations under subparagraph 7,a71 the ,secretary shall-- 7i7 hold at least #a meeting for the purpose of developing such recommendations that is solely with current and potential recipients of home and community-based services and family caregivers of such recipients2 and 7ii7 seek to achieve parity in terms of the level of participation in the development of such recommendations between-- 7,i7 current and potential recipients of home and community-based services and family caregivers of such recipients2 and 7,,ii7 other categories of stakeholder described in subparagraph 7,a74 7d7 ,funding ,out of any funds in the ,treasury not otherwise appropriated1 there is appropriated to the ,secretary for purposes of carrying out this section1 #aj1jjj1jjj for fiscal year #bjbd1 to remain available until expended4 #ajg4 ,quality measurement and improvement 7a7 ,development and publication of core and supplemental sets of ,,hcbs quality measures 7#a7 ,in general ,the ,secretary shall identify and publish a core set and supplemental set of home and community-based services quality measures for use by ,state ,medicaid programs1 health plans and managed care entities that enter into contracts with such programs1 and providers of items and services under such programs4 7#b7 ,regular reviews and updates ,the ,secretary shall review and update the core set and supplemental set of home and community-based services quality measures published under paragraph 7#a7 not less frequently than once every year4 7#c7 ,requirements 7,a7 ,interagency collaboration2 stakeholder input ,in developing the core set and supplemental set of home and community-based services quality measures under paragraph 7#a71 and subsequently reviewing and updating such core and supplemental sets1 the ,secretary shall-- 7i7 collaborate with the ,administrator of the ,centers for ,medicare ,medicaid ,services1 the ,administrator of the ,administration for ,community ,living1 the ,director of the ,agency for ,healthcare ,research and ,quality1 and the ,administrator of the ,substance ,abuse and ,mental ,health ,services ,administration2 and 7ii7 ensure that such core and supplemental sets are informed by input from stakeholders1 including recipients of home and community-based services1 family caregivers of such recipients1 providers1 health plans1 direct care workers1 chosen representatives of direct care workers1 and aging1 disability1 and workforce advocates1 with the goal that at least half of such input is from current and potential recipients of home and community-based services and family caregivers4 7,b7 ,reflective of full array of services ,such core set and supplemental set of home and community-based services quality measures shall-- 7i7 reflect the full array of home and community-based services and recipients of such services1 including adults and children2 and 7ii7 include-- 7,i7 outcomes-based measures2 7,,ii7 measures of availability of services2 7,,iii7 measures of provider capacity and availability2 7,,iv7 measures related to person-centered care2 7,v7 measures specific to self-directed care2 7,,vi7 measures related to transitions to and from institutional care2 and 7,,vii7 beneficiary and family caregiver surveys4 7,c7 ,demographics ,such core set and supplemental set of home and community-based services quality measures shall allow for the collection of data that is disaggregated by demographics 7as defined in section #b but including any additional category determined by the ,secretary74 7#d7 ,funding ,out of any funds in the ,treasury not otherwise appropriated1 there is appropriated to the ,secretary for purposes of carrying out this subsection1 #aj1jjj1jjj for fiscal year #bjbd1 to remain available until expended4 7b7 ,state adoption and reports 7#a7 ,in general ,not later than #b years after the date on which the ,secretary publishes the core set and supplemental set of home and community-based services quality measures under subsection 7a77#a71 and annually thereafter1 each ,state ,medicaid program shall use such core and supplemental sets 7or an alternative set of quality measures approved by the ,secretary7 to report information to the ,secretary regarding the quality of home and community-based services provided under such program4 7#b7 ,process ,the information required under paragraph 7#a7 shall be reported using a standardized format and procedures established by the ,secretary4 ,such procedures shall allow a ,state ,medicaid program to report such information separately or as part of the annual reports required under sections #aaci;,a7c7 and #aaci;,b7d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;a1 #acbj;b-#i;b74 7#c7 ,publication of quality measures ,each ,state ,medicaid program shall annually make the information reported to the ,secretary under paragraph 7#a7 available to the public4 7#d7 ,increased ,federal matching rate for adoption and reporting ,section #aijc7;a77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#c77 is amended-- 7,a7 in subparagraph 7,f77ii71 by striking plus after the semicolon and inserting and2 and 7,b7 by inserting after subparagraph 7,f71 the following3 7,g7 #hj percent of so much of the sums expended during such quarter as are attributable to the reporting of information regarding the quality of home and community-based services in accordance with section #ajg7;b7 of the ,,hcbs ,access ,act2 and 4 #ajh4 ,making permanent the ,state option to extend protection under ,medicaid for recipients of home and community-based services against spousal impoverishment 7a7 ,in general ,section #aibd7;h77#a77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#e7;h77#a77;,a77 is amended by striking is described in section #aijb7;a77#aj77;,a77ii77,,vi7 and inserting the following3 is an eligible individual 7as defined in section #aije7;jj77#c774 7b7 ,conforming amendment ,section #bdjd of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #acifr-#e note7 is amended by striking ,september #cj1 #bjbg and inserting the date of enactment of the ,,hcbs ,access ,act4 #aji4 ,permanent extension of ,money ,follows the ,person ,rebalancing demonstration ,subparagraph 7,l7 of section #fjga7;h77#a7 of the ,deficit ,reduction ,act of #bjje 7#db ,u4,s4,c4 #acif;a note7 is amended by striking each of fiscal years #bjbd through #bjbg and inserting each fiscal year after #bjbc4 ,,ii ,recognizing the role of direct support professionals #bja4 ,findings ,congress finds the following3 7#a7 ,direct support professionals play a critical role in the care provided to children and adults with intellectual and developmental disabilities4 7#b7 ,providers of home and community-based services are experiencing difficulty hiring and retaining direct support professionals1 with a national turnover rate of #de percent as identified in a #bjaf study by the ,national ,core ,indicators4 7#c7 ,high turnover rates can lead to instability for individuals receiving services1 and this may result in individuals not receiving enough personalized care to help them reach their goals for independent living4 7#d7 ,a discrete occupational category for direct support professionals will help ,states and the ,federal ,government-- 7,a7 better interpret the shortage in the labor market of direct support professionals2 and 7,b7 collect data on the high turnover rate of direct support professionals4 7#e7 ,the ,standard ,occupational ,classification system is designed and maintained solely for statistical purposes1 and is used by ,federal statistical agencies to classify workers and jobs into occupational categories for the purpose of collecting1 calculating1 analyzing1 or disseminating data4 7#f7 ,occupations in the ,standard ,occupational ,classification system are classified based on work performed and1 in some cases1 on the skills1 education1 or training needed to perform the work4 7#g7 ,establishing a discrete occupational category for direct support professionals will-- 7,a7 correct an inaccurate representation in the ,standard ,occupational ,classification system2 7,b7 recognize these professionals for the critical and often times overlooked work that they perform for the disabled community1 which work is different than the work of a home health aide or a personal care aide2 and 7,c7 better align the ,standard ,occupational ,classification system with related classification systems4 #bjb4 ,definition of direct support professional ,in this title1 the term direct support professional means an individual who1 in exchange for compensation1 provides services to an individual with a disability 7as defined in section #c of the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abajb771 including-- 7#a7 services that enhance independence and community inclusion for such individual1 including traveling with such individual1 attending and assisting such individual while visiting friends and family1 shopping1 or socializing2 7#b7 services such as coaching and supporting such individual 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 individual at home1 work1 school1 or any other community setting4 #bjc4 ,revision of ,standard ,occupational ,classification ,system ,the ,director of the ,office of ,management and ,budget shall1 not later than #cj days after the date of enactment of this ,act1 revise the ,standard ,occupational ,classification system to establish a separate code 7#ca-aabc7 for direct support professionals as a healthcare support occupation4 ,such code shall be a subset of #ca-aabj1 which includes home health aides and personal care aides4 ,,iii ,support for the direct care workforce #cja4 ,definitions ,in this title3 7#a7 ,apprenticeship program ,the term apprenticeship program means an apprenticeship program registered under the ,act of ,august #af1 #aicg 7commonly known as the ,national ,apprenticeship ,act2 #ej ,stat4 #ffd1 chapter #ffc2 #bi ,u4,s4,c4 #ej et seq471 including any requirement1 standard1 or rule promulgated under such ,act4 7#b7 ,community college ,the term community college means a public institution of higher education at which the highest degree that is predominantly awarded to students is an associate's degree1 including ,tribal ,colleges or ,universities receiving grants under section #caf of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajei;c7 that offer a #b-year program for completion of such degree and ,state public institutions of higher education that offer such a #b-year program4 7#c7 ,direct care professional ,the term direct care professional-- 7,a7 means an individual who1 in exchange for compensation1 provides services to a person with a disability or an older adult that promotes the independence of such person or individual1 including-- 7i7 services that enhance the independence and community inclusion for such person or individual1 including traveling with such person or individual or attending and assisting such person or individual while visiting friends and family1 shopping1 or socializing2 7ii7 services such as coaching and supporting such person or individual in communicating needs1 achieving self-expression1 pursuing personal goals1 living independently1 and participating actively in employment or voluntary roles in the community2 7iii7 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 7iv7 services that support such person or individual at home1 work1 school1 or in any other community setting2 or 7v7 services that promote health and wellness1 including scheduling and taking such person or individual to health care appointments1 communicating with health and allied health professionals administering medications1 implementing health and behavioral health interventions and treatment plans1 monitoring and recording health status and progress2 and 7,b7 may include-- 7i7 a service provider supporting people with intellectual disability and developmental disabilities1 and other disabilities2 7ii7 a home and community-based services manager or direct support professional manager2 7iii7 a self-directed care worker2 7iv7 a personal care service worker2 7v7 a direct care worker1 as defined in section #gii;,b of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #biep72 or 7vi7 any other position or job related to the home care or direct care workforce1 such as positions or jobs in respite care1 palliative care1 community support1 or peer support1 as determined by the ,secretary1 in consultation with the ,centers for ,medicare ,medicaid ,services and the ,secretary of ,labor4 7#d7 ,direct care workforce ,the term direct care workforce means the broad workforce of direct care professionals4 7#e7 ,family caregiver ,the term family caregiver has the meaning given such term in section #b of the ,,raise ,family ,caregivers ,act 7#db ,u4,s4,c4 #cjcjs note2 ,public ,law #aae-aai7 and includes paid and unpaid family caregivers4 7#f7 ,eligible entity ,the term eligible entity means an entity-- 7,a7 that is-- 7i7 a ,state2 7ii7 a labor organization1 joint labor-management organization1 or employer of direct care professionals2 7iii7 a nonprofit entity with experience in aging1 disability1 or supporting the rights and interests of1 training of1 or educating direct care professionals or family caregivers2 7iv7 an ,indian ,tribe1 ,tribal organization1 or ,urban ,indian organization2 7v7 a community college or other institution of higher education2 or 7vi7 a consortium of entities listed in any of clauses 7i7 through 7v72 7,b7 that agrees to include1 as applicable with respect to the type of grant the entity is seeking under this title and the activities supported through such grant1 older adults1 people with disabilities1 direct care professionals1 and family caregivers1 as advisors and trainers in such activities2 and 7,c7 that agrees to consult with the ,state ,medicaid agency of the ,state 7or each ,state7 served by the grant on the grant activities1 to the extent that such agency 7or each such agency7 is not the eligible entity4 7#g7 ,employer ,the terms employ and employer have the meanings given the terms in section #c of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjc74 7#h7 ,indian ,tribe2 ,tribal organization ,the terms ,indian ,tribe and ,tribal organization have the meanings given such terms in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd74 7#i7 ,institution of higher education ,the term institution of higher education means-- 7,a7 an institution of higher education defined in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja72 or 7,b7 an institution of higher education defined in section #ajb7;a77#a77;,b7 of such ,act 7#bj ,u4,s4,c4 #ajjb7;a77#a77;,b774 7#aj7 ,older adult ,the term older adult means an individual who is #fj years of age or older4 7#aa7 ,person with a disability ,the term person with a disability means an individual with a disability1 as defined in section #c of the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abajb74 7#ab7 ,project participant ,the term project participant means an individual participating in a project or activity assisted with a grant under this title1 including 7as applicable for the category of the grant7 a direct care professional1 or an individual training to be such a professional1 or a family caregiver4 7#ac7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services1 acting through the ,administrator for ,community ,living4 7#ad7 ,self-directed care professional ,the term self-directed care professional means a direct care professional who is employed by an individual who is an older adult1 a person with a disability1 or a representative of such older adult or person with a disability1 and such older adult or person with a disability has the decision-making authority over certain supports and services provided by the direct care professional and takes direct responsibility to manage those supports and services4 7#ae7 ,supportive services ,the term supportive services means services that are necessary to enable an individual to participate in activities assisted with a grant under this title1 such as transportation1 child care1 dependent care1 housing1 workplace accommodations1 employee benefits such as paid sick leave and child care1 workplace health and safety protections1 wages and overtime pay1 and needs-related payments4 7#af7 ,urban indian organization ,the term urban ,indian organization has the meaning given the term in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc74 7#ag7 ,workforce innovation and opportunity act terms ,the terms career pathway1 career planning1 in-demand industry sector or occupation1 individual with a barrier to employment1 local board1 on-the-job training1 recognized postsecondary credential1 region1 and ,state board have the meanings given such terms in section #c of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cajb74 7#ah7 ,work-based learning ,the term work-based learning has the meaning given the term in section #c of the ,carl ,d4 ,perkins ,career and ,technical ,education ,act of #bjjf 7#bj ,u4,s4,c4 #bcjb74 #cjb4 ,authority to establish a technical assistance center for building the direct care workforce 7a7 ,program authorized ,the ,secretary shall establish a national technical assistance center 7referred to in this section as the ,center7 for1 in consultation with the ,secretary of ,labor1 the ,secretary of ,education1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 and the heads of other entities as necessary-- 7#a7 supporting direct care workforce creation1 training and education1 recruitment1 retention1 and advancement2 and 7#b7 supporting family caregivers and activities of family caregivers as a critical part of the support team for older adults or people with disabilities4 7b7 ,advisory council ,the ,secretary shall convene an advisory council to provide recommendations to the ,center with respect to the duties of the ,center under this section and may engage individuals and entities described in paragraphs 7#c77;,b71 and 7#ab71 of section #cjd7;b7 7without regard to a specific project described in such paragraphs7 for service on the advisory council4 7c7 ,activities ,the ,center may-- 7#a7 develop recommendations for training and education curricula for direct care professionals1 which such recommendations may include recommendations for curricula for higher education1 postsecondary credentials1 and programs with community colleges2 7#b7 develop learning and dissemination strategies to-- 7,a7 engage ,states and other entities in activities supported under this title and best practices2 and 7,b7 distribute findings from activities supported by grants under this title2 7#c7 develop recommendations for training and education curricula and other strategies for supporting family caregivers2 7#d7 explore the national data gaps1 workforce shortage areas1 and data collection strategies for direct care professionals and make recommendations to the ,director of the ,office of ,management and ,budget for an occupation category in the ,standard ,occupational ,classification system for direct support professionals as a healthcare support occupation2 7#e7 recommend career development and advancement opportunities for direct care professionals1 which may include occupational frameworks1 national standards1 recruitment campaigns1 pre-apprenticeship and on-the-job training opportunities1 apprenticeship programs1 career ladders or pathways1 specializations or certifications1 or other activities2 and 7#f7 develop strategies for assisting with reporting and evaluation of grant activities under section #cje4 #cjc4 ,authority to award grants 7a7 ,grants 7#a7 ,in general ,not later than #ab months after the date of enactment of this title1 the ,secretary1 in consultation with the ,centers for ,medicare ,medicaid ,services1 the ,secretary of ,labor1 and the ,secretary of ,education1 shall award grants described in paragraph 7#b7 to eligible entities4 ,a grant awarded under this section may be in more than #a category described in such paragraph4 7#b7 ,categories of grants ,the categories of grants described in this paragraph are each of the following3 7,a7 ,direct care professional grants ,grants to eligible entities to create and carry out projects for the purposes of recruiting1 retaining1 or providing advancement opportunities for direct care professionals who are not described in subparagraph 7,b7 or 7,c71 including through education or training programs for such professionals or individuals seeking to become such professionals4 7,b7 ,direct care professional managers grants ,grants to eligible entities to create and carry out projects for the purposes of recruiting1 retaining1 or providing advancement opportunities for direct care professionals who are managers or supervisory staff that have coaching1 training1 managerial1 supervisory1 or other oversight responsibilities1 including through education or training programs for such professionals or individuals seeking to become such professionals4 7,c7 ,self-directed care professionals grants ,grants to eligible entities to create and carry out projects for the purposes of recruiting1 retaining1 or providing advancement opportunities for self-directed care professionals1 including through education or training programs for such professionals or individuals seeking to become such professionals4 7,d7 ,family caregiver grants ,grants to eligible entities to create and carry out projects for providing support to paid or unpaid family caregivers through educational1 training1 or other resources1 including resources for caregiver self-care or educational or training resources for individuals newly in a caregiving role or seeking additional support in the role of a family caregiver4 7#c7 ,projects for advancement opportunities ,not less than #cj percent of projects assisted with grants under this title shall be projects to provide career pathways that offer opportunities for professional development and advancement opportunities to direct care professionals4 7b7 ,treatment of continuation activities ,an eligible entity that carries out activities described in subsection 7a77#b7 prior to receipt of a grant under this title may use such grant to continue carrying out such activities1 and1 in using such grant to continue such activities1 shall be treated as an eligible entity carrying out a project through a grant under this title4 #cjd4 ,project plans 7a7 ,in general ,an eligible entity seeking a grant under this title shall submit to the ,secretary a project plan for each project to be developed and carried out 7or for activities to be continued as described in section #cjc7;b77 with the grant at such time1 in such manner1 and containing such information as the ,secretary may require4 7b7 ,contents ,a project plan submitted by an eligible entity under subsection 7a7 shall include a description of information determined relevant by the ,secretary for purposes of the category of the grant and the activities to be carried out through the grant4 ,such information may include 7as applicable7 the following3 7#a7 ,the demographics 7as defined in section #b7 of the population in the ,state or relevant geographic area1 including a description of the populations likely to need long-term care services1 such as people with disabilities and older adults4 7#b7 ,projections of unmet need for services provided by direct care professionals based on enrollment waiting lists under home and community-based waivers under section #aaae of the ,social ,security ,act 7#db ,u4,s4,c4 #acae7 or section #aiae of such ,act 7#db ,u4,s4,c4 #acifn7 and other relevant data to the extent practicable and feasible1 such as direct care workforce vacancy rates1 crude separation rates1 and the number of direct care professionals1 including such professionals who are managers or supervisors1 in the region4 7#c7 ,an advisory committee to advise the eligible entity on activities to be carried out through the grant4 ,such advisory committee-- 7,a7 may be comprised of entities listed in paragraph 7#ab72 and 7,b7 shall include-- 7i7 older adults or persons with a disability2 7ii7 organizations representing the rights and interests of people receiving services by the direct care professionals or family caregivers targeted by the project2 7iii7 individuals who are direct care professionals or family caregivers targeted by the project and organizations representing the rights and interests of direct care professionals or family caregivers2 7iv7 as applicable1 employers of individuals described in clause 7iii7 and labor organizations representing such individuals2 7v7 representatives of the ,state ,medicaid agency1 the ,state agency defined in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb71 the ,state developmental disabilities office1 and the ,state behavioral health agency1 in the ,state 7or each ,state7 to be served by the project2 and 7vi7 representatives reflecting diverse racial1 cultural1 ethnic1 geographic1 socioeconomic1 and gender identity and sexual orientation perspectives4 7#d7 ,current or projected job openings for1 or relevant labor market information related to1 the direct care professionals targeted by the project in the ,state or region to be served by the project1 and the geographic scope of the workforce to be served by the project4 7#e7 ,specific efforts and strategies that the project will undertake to reduce barriers to recruitment1 retention1 or advancement of the direct care professionals targeted by the project1 including an assurance that such efforts will include-- 7,a7 an assessment of the wages or other compensation or benefits necessary to recruit and retain the direct care professionals targeted by the project2 7,b7 a description of the project's projected compensation or benefits for the direct care professionals targeted by the project at the ,state or local level1 including a comparison of such projected compensation or benefits to regional and national compensation or benefits and a description of how wages and benefits received by project participants will be impacted by the participation in and completion of the project2 and 7,c7 a description of the projected impact of workplace safety issues on the recruitment and retention of direct care professionals targeted by the project1 including the availability of personal protective equipment4 7#f7 ,in the case of a project offering an education or training program for direct care professionals1 a description of such program 7including how the core competencies identified by the ,centers for ,medicare ,medicaid ,services will be incorporated1 curricula1 models1 and standards used under the program1 and any associated recognized postsecondary credentials for which the program provides preparation1 as applicable71 which shall include an assurance that such program will provide to each project participant in such program-- 7,a7 relevant training regarding the rights of recipients of home and community based services1 including their rights to-- 7i7 receive services in integrated settings that provide access to the broader community2 7ii7 exercise self-determination2 7iii7 be free from all forms of abuse1 neglect1 or exploitation2 and 7iv7 person-centered planning and practices1 including participation in planning activities2 7,b7 relevant training to ensure that each project participant has the necessary skills to recognize abuse and understand their obligations with regard to reporting and responding to abuse appropriately in accordance with relevant ,federal and ,state law2 7,c7 relevant training regarding the provision of culturally competent and disability competent supports to recipients of services provided by the direct care professionals targeted by the project2 7,d7 an apprenticeship program1 work-based learning1 or on-the-job training opportunities2 7,e7 supervision or mentoring2 and 7,f7 for any on-the-job training portion of the program1 a progressively increasing1 clearly defined schedule of wages to be paid to each such participant that-- 7i7 is consistent with skill gains or attainment of a recognized postsecondary credential received as a result of participation in or completion of such program2 and 7ii7 ensures the entry wage is not less than the greater of-- 7,i7 the minimum wage required under section #f7;a7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjf7;a772 or 7,,ii7 the applicable wage required by other applicable ,federal or ,state law1 or a collective bargaining agreement4 7#g7 ,any other innovative models or processes the eligible entity will implement to support the retention and career advancement of the direct care professionals targeted by the project4 7#h7 ,the supportive services and benefits to be provided to the project participants in order to support the employment1 retention1 or career advancement of the direct care professionals targeted by the project4 7#i7 ,how the eligible entity will make use of career planning to support the identification of advancement opportunities and career pathways for the direct care professionals in the ,state or region to be served by the project4 7#aj7 ,how the eligible entity will collect and submit to the ,secretary workforce data and outcomes of the project4 7#aa7 ,how the project-- 7,a7 will-- 7i7 provide adequate and safe equipment and facilities for training and supervision1 including a safe work environment free from discrimination1 which may include the provision of personal protective equipment and other necessary equipment to prevent the spread of infectious disease among the direct care professionals targeted by the project and recipients of services provided by such professionals2 7ii7 incorporate remote training and education opportunities or technology-supported opportunities2 7iii7 for training and education curricula1 incorporate evidenced-supported practices for adult learners and universal design for learning and ensure recipients of services provided by the direct care professionals or family caregivers targeted by the project participate in the development and implementation of such training and education curricula2 7iv7 use outreach1 recruitment1 and retention strategies designed to reach and retain a diverse workforce2 7v7 incorporate methods to monitor satisfaction with project activities for project participants and individuals receiving services from such participants2 7vi7 incorporate evidence-supported practices for family caregiver engagement2 and 7vii7 incorporate core competencies identified by the ,centers for ,medicare ,medicaid ,services2 and 7,b7 may incorporate continuing education programs and specialty training1 with a specific focus on-- 7i7 trauma-informed care2 7ii7 behavioral health1 including co-occurring behavioral health conditions and intellectual or developmental disabilities2 7iii7 ,alzheimer's and dementia care2 7iv7 chronic disease management2 and 7v7 the use of supportive or assistive technology4 7#ab7 ,how the eligible entity will consult on the implementation of the project1 or coordinate the project with1 each of the following entities1 to the extent that each such entity is not the eligible entity3 7,a7 ,the ,state ,medicaid agency1 ,state agency defined in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb71 and the ,state developmental disabilities office for the ,state 7or each ,state7 to be served by the project4 7,b7 ,the local board and ,state board for each region1 or ,state1 to be served by the project4 7,c7 ,in the case of a project that carries out an education or training program1 a nonprofit organization with demonstrated experience in the development or delivery of curricula or coursework4 7,d7 ,a nonprofit organization1 including a labor organization1 that fosters the professional development and collective engagement of the direct care professionals targeted by the project4 7,e7 ,area agencies on aging1 as defined in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb74 7,f7 ,centers for independent living1 as described in part ,c of title ,,vii of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gif;f et seq474 7,g7 ,the ,state ,council on ,developmental ,disabilities 7as such term is used in subtitle ,b of title ,i of the ,developmental ,disabilities ,assistance and ,bill of ,rights ,act of #bjjj 7#db ,u4,s4,c4 #aejba et seq477 for the ,state 7or each ,state7 to be served by the project4 7,h7 ,aging and ,disability ,resource ,centers 7as defined in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb774 7,i7 ,a nonprofit ,state provider association that represents providers who employ the direct care professionals targeted by the project1 where such associations exist4 7,j7 ,an entity that employs the direct care professionals targeted by the project4 7,k7 ,university ,centers for ,excellence in ,developmental ,disabilities ,education1 ,research1 and ,services supported under subtitle ,d of title ,i of the ,developmental ,disabilities ,assistance and ,bill of ,rights ,act of #bjjj 7#db ,u4,s4,c4 #aejfa et seq474 7,l7 ,the ,state protection and advocacy system described in section #adc of such ,act 7#db ,u4,s4,c4 #aejdc7 of the ,state 7or each ,state7 to be served by the project4 7,m7 ,direct care professionals or direct care workforce organizations representing underserved communities1 including communities of color4 7#ac7 ,how the eligible entity will consult throughout the project with-- 7,a7 individuals employed or working as the direct care professionals or family caregivers targeted by the project2 7,b7 representatives of such professionals or caregivers2 7,c7 individuals assisted by such professionals or caregivers2 7,d7 the families of such professionals or caregivers2 and 7,e7 individuals receiving education or training to become such professionals or caregivers4 7#ad7 ,outreach efforts to individuals for participation in such project1 including targeted outreach efforts to-- 7,a7 individuals who are recipients of assistance under a ,state program funded under part ,a of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq47 or individuals who are eligible for such assistance2 and 7,b7 individuals with barriers to employment4 7c7 ,considerations ,in selecting eligible entities to receive a grant under this title1 the ,secretary shall ensure-- 7#a7 equitable geographic diversity1 including by selecting recipients serving rural areas and selecting recipients serving urban areas2 and 7#b7 that selected eligible entities will serve areas where the occupation of direct care professional1 or a related occupation1 is an in-demand industry sector or occupation4 7d7 ,uses of funds2 supplement1 not supplant 7#a7 ,uses of funds 7,a7 ,in general ,each eligible entity receiving a grant under this title shall use the funds of such grant to carry out at least #a project described in section #cjc7;a77#b74 7,b7 ,administrative costs ,each eligible entity receiving a grant under this title shall not use more than #e percent of the funds of such grant for costs associated with the administration of activities under this title4 7,c7 ,direct support ,each eligible entity receiving a grant under this title shall use not less than #e percent of the funds of such grant to provide direct financial benefits or supportive services to direct care professionals and paid or unpaid family caregivers to support the financial needs of such participants during the duration of the project activities4 7#b7 ,supplement1 not supplant ,an eligible entity receiving a grant under this title shall use such grant only to supplement1 and not supplant1 the amount of funds that1 in the absence of such grant1 would be available to address the recruitment1 training and education1 retention1 and advancement of direct care professionals or provide support for family caregivers1 in the ,state or region served by the eligible entity4 7#c7 ,prohibition ,no amounts made available under this title may be used for any activity that is subject to the reporting requirements set forth in section #bjc7;a7 of the ,labor-,management ,reporting and ,disclosure ,act of #aiei 7#bi ,u4,s4,c4 #dcc7;a774 #cje4 ,evaluations and reports2 technical assistance 7a7 ,reporting requirements by grant recipients 7#a7 ,in general ,an eligible entity receiving a grant under this title shall cooperate with the ,secretary and annually provide a report to the ,secretary that includes any relevant data requested by the ,secretary in a manner specified by the ,secretary4 7#b7 ,contents ,the data requested by the ,secretary for an annual report may include any of the following 7as determined relevant by the ,secretary with respect to the category of the grant and each project supported through the grant73 7,a7 ,the number of individuals and the demographic categories 7as defined in section #b7 served by each project supported by the grant1 including-- 7i7 the number of individuals recruited through each such project to be employed as a direct care professional2 7ii7 the number of individuals who through each such project attained employment as a direct care professional2 and 7iii7 the number of individuals who enrolled in each such project and withdrew or were terminated from each such project without completing training or attaining employment as a direct care professional4 7,b7 ,the number of family caregivers participating in an education or training program through each project supported by the grant4 7,c7 ,the number of project participants who through each such project participated in and completed-- 7i7 work-based learning2 7ii7 on-the-job training2 7iii7 an apprenticeship program2 or 7iv7 a professional development or mentoring program4 7,d7 7i7 ,other services1 benefits1 or supports 7other than the services1 benefits1 or supports described in subparagraph 7,c77 provided through each such project to assist in the recruitment1 retention1 or advancement of direct care professionals 7including through education or training for such professionals or individuals seeking to become such professionals72 7ii7 the number of individuals who accessed such services1 benefits1 or supports2 and 7iii7 the impact of such services1 benefits1 or supports4 7,e7 ,the crude separation and vacancy rates of direct care professionals1 and such rates for those professionals who are managers or supervisors1 in the geographic region for a number of years before the grant was awarded1 as determined by the ,secretary1 and annually thereafter for the duration of the grant period4 7,f7 ,how each project supported by the grant assessed satisfaction with respect to-- 7i7 project participants assisted by the project2 7ii7 individuals receiving services delivered by project participants1 including-- 7,i7 any impact on the health or health outcomes of such individuals2 and 7,,ii7 any impact on the ability of individuals to transition to or remain in the community in an environment that meets the criteria established in the section #dda4cja7;c77#d7 of title #db1 ,code of ,federal ,regulations 7or successor regulations72 and 7iii7 employers of such project participants4 7,g7 ,the performance of the eligible entity with respect to the indicators of performance on unsubsidized employment1 median earnings1 credential attainment1 measurable skill gains1 and employer satisfaction4 7,h7 ,any other information with respect to outcomes of the project as determined by the ,secretary4 7b7 ,annual report to ,congress by ,secretary ,not later than #b years after the date of enactment of this title1 and each year thereafter until all projects supported through a grant under this title are completed1 the ,secretary shall prepare and submit to ,congress an annual report on the progress of each project supported through a grant under this title and the activities of the technical assistance center established under section #cjb4 7c7 ,,gao report ,not later than #a year after the date on which all projects supported through a grant under this title are completed1 the ,comptroller ,general of the ,united ,states shall conduct a study and submit to ,congress a report including-- 7#a7 an assessment of how the technical assistance center established under section #cjb and the projects supported through a grant under this title assisted in the creation1 recruitment1 training and education1 retention1 and advancement of the direct care workforce or in providing support for family caregivers2 and 7#b7 recommendations for such legislative or administrative actions needed for improving the assistance described in paragraph 7#a71 as the ,comptroller ,general determines appropriate4 7d7 ,independent evaluations ,not later than #f months after the date of enactment of this title1 the ,secretary shall enter into a contract with an independent entity to provide independent evaluations of activities supported by grants under this title and activities of the technical assistance center established under section #cjb4 #cjf4 ,authorization of appropriations 7a7 ,in general ,there are authorized to be appropriated-- 7#a7 for the establishment and activities of the technical assistance center under section #cjb1 #b1jjj1jjj for each of fiscal years #bjbd through #bjbh2 and 7#b7 for grants under section #cjc1 #a1jjj1jjj1jjj for fiscal year #bjbd4 7b7 ,availability ,amounts made available under this title shall remain available until ,september #cj1 #bjcc4 ,,iv ,evaluation #dja4 ,evaluation of impact on access to ,,hcbs 7a7 ,national survey on expanded ,,hcbs access ,the ,administrator of the ,centers for ,medicare ,medicaid ,services1 in coordination with the ,national ,academy of ,medicine1 shall1 not later than #g years after the date of enactment of this ,act1 conduct or contract for a national survey of ,states1 direct care professionals1 family caregivers1 and providers and recipients of home and community-based services1 to determine the effects of the implementation of this ,act and the amendments made by this ,act on-- 7#a7 the availability and access to home and community-based services under the ,medicaid program nationally and in each ,state2 7#b7 the capacity of the direct service workforce to provide home and community-based services and information on the demographics 7as defined in section #b7 of such workforce2 7#c7 the compensation and working conditions1 including scheduling and benefits1 of direct care workers2 7#d7 the economic effects on beneficiaries and on families with a member receiving home and community-based services through ,medicaid2 7#e7 the availability of direct care workers and services for people needing long-term services and supports who are not ,medicaid eligible2 7#f7 family caregivers2 and 7#g7 recommendations for measures to further expand and enhance access home and community-based services4 7b7 ,report ,not later than #i years after the date of enactment of this ,act1 the ,administrator of the ,centers for ,medicare ,medicaid ,services shall publish a report containing the results of the survey conducted under subsection 7a74 7c7 ,american ,community ,survey addition ,the ,secretary of ,commerce1 acting through the ,bureau of the ,census1 shall add to the ,american ,community ,survey a question designed to identify the need for long-term services and supports by residents of the ,united ,states4 7d7 ,authorization of appropriations ,there are authorized to be appropriated to the ,secretary such sums as are necessary to carry out this section4