,,ii  #aah? ,,congress  #a/ ,session    
,s4 #gfb  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,m>* #i1 #bjbc ,mr4    
,casey 7= himself1 ,ms4 ,hassan1 ,mr4   
,br[n1 ,mr4 ,ka9e1 ,mrs4 ,gillibr&1 ,mr4
 ,blum5?al1 ,mr4 ,wel*1 ,mr4 ,fett]man1 
,mr4 ,m]kley1 ,mr4 ,s&]s1 ,ms4 ,baldw91 
,ms4 ,duckwor?1 ,ms4 ,w>r51 ,mr4 ,re$1  
,mr4 ,m>key1 ,mrs4 ,%ahe51 & ,mrs4      
,murray7 introduc$ ! foll[+ bill2 :i* 0 
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title ,,xix
 ( ! ,social ,security ,act to require  
cov]age (1 & exp& access to1 home &     
community-bas$ s]vices "u ! ,m$icaid    
program1 to aw>d grants = ! creation1   
recruitm5t1 tra9+ & education1 ret5tion1
 & advancem5t ( ! direct c>e work=ce &  
to aw>d grants to support family        
c>egiv]s1 & = o!r purposes4  #a4 ,%ort  
title2 table ( cont5ts  7a7 ,%ort title 
,?is ,act may be cit$ z ! ,,hcbs ,access
 ,act4  7b7 ,table ( cont5ts ,! table ( 
cont5ts ( ?is ,act is z foll[s3  ,sec4  
#a4 ,%ort title2 table ( cont5ts4 ,sec4 

#b4 ,def9itions4 ,,title ,i--,requir+ & 
exp&+ access to ,,hcbs cov]age "u       
,m$icaid ,sec4 #aja4 ,purpose4 ,sec4    
#ajb4 ,requir+ cov]age ( home &         
community-bas$ s]vices "u ! ,m$icaid    
program4 ,sec4 #ajc4 ,m$icaid           
eligibility modifications4 ,sec4 #ajd4  
,home & community-bas$ s]vices          
implem5tation plan grant program4 ,sec4 
#aje4 ,quality ( s]vices4 ,sec4 #ajf4   
,reports2 te*nical assi/ance2 o!r       
adm9i/rative requirem5ts4 ,sec4 #ajg4   
,quality measurem5t & improvem5t4 ,sec4 
#ajh4 ,mak+ p]man5t ! ,/ate option to   
ext5d protection "u ,m$icaid = recipi5ts
 ( home & community-bas$ s]vices aga9/  
sp\sal impov]i%m5t4 ,sec4 #aji4 ,p]man5t
 ext5sion ( ,money ,foll[s ! ,p]son     
,rebalanc+ demon/ration4 ,,title        
,,ii--,recogniz+ ! role ( direct support
 pr(essionals ,sec4 #bja4 ,f9d+s4 ,sec4 
#bjb4 ,def9ition ( direct support       
pr(essional4 ,sec4 #bjc4 ,revision (    
,/&>d ,occupational ,classification     
,sy/em4 ,,title ,,iii--,support = !     

direct c>e work=ce ,sec4 #cja4          
,def9itions4 ,sec4 #cjb4 ,au?ority to   
e/abli% a te*nical assi/ance c5t] =     
build+ ! direct c>e work=ce4 ,sec4 #cjc4
 ,au?ority to aw>d grants4 ,sec4 #cjd4  
,project plans4 ,sec4 #cje4 ,evaluations
 & reports2 te*nical assi/ance4 ,sec4   
#cjf4 ,au?orization ( appropriations4   
,,title ,,iv--,evaluation ,sec4 #dja4   
,evaluation ( impact on access to       
,,hcbs4  #b4 ,def9itions ,9 ?is ,act3   
7#a7 ,demographics ,! t]m demographics  
means in=mation relat+ to ! races1      
e?nicities1 g5d]s1 sexual ori5tations1  
g5d] id5tities1 geographic locations1   
incomes1 prim>y languages1 types (      
s]vice sett+1 & disability types        
repres5t$ )9 a p>ticul> gr\p (          
individuals4  7#b7 ,private duty nurs+  
,! t]m private duty nurs+ means nurs+   
s]vices t are suffici5t to meet ! ne$s (
 an individual :o requires m            
individualiz$ & cont9u\s c>e ?an is     
available f a visit+ nurse or r\t9ely   
provid$ by ! nurs+ /aff ( a hospital or 

skill$ nurs+ facility1 & includes       
s]vices provid$ to an individual 9 !    
individual's own home by a regi/]$ nurse
 or lic5s$ practical nurse "u !         
direction ( a physician4  7#c7 ,secret>y
 ,except z o!rwise provid$1 ! t]m       
,secret>y means ! ,secret>y ( ,heal? &  
,human ,s]vices4  ,i ,requir+ & exp&+   
access to ,,hcbs cov]age "u ,m$icaid    
#aja4 ,purpose ,x is ! purpose ( ?is    
title to require cov]age ( home &       
community-bas$ s]vices 79 ?is section   
ref]r$ to z ,,hcbs7 "u a ,/ate plan 7or 
waiv] ( su* plan7 "u title ,,xix ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acif et seq47 = ! foll[+ reasons3 7#a7 
,to elim9ate wait+ li/s = ,,hcbs1 :i*   
delay access to necess>y s]vices & civil
 rights = p ) disabilities & old]       
adults4  7#b7 ,to build on decades (    
progress 9 s]v+ p ) disabilities & old] 
adults via ,,hcbs4  7#c7 ,to fulfill !  
purposes ( ! ,m$icaid program to provide
 m$ical assi/ance = ^? ^: income &      
res\rces are insuffici5t to meet ! co/s 

( necess>y m$ical s]vices1 & to provide 
rehabilitation1 long-t]m s]vices &      
supports1 & o!r s]vices to help su*     
families & individuals atta9 or reta9   
capability = indep5d5ce or self-c>e4    
7#d7 ,to ensure t p ) all k9ds (        
disabilities & ) multiple disabilities1 
includ+ intellectual disability1        
cognitive disabilities1 developm5tal    
disabilities1 behavioral heal?          
disabilities1 physical disabilities1 &  
sub/ance use disord]s1 & old] adults1   
receive ! s]vices !y ne$ to live 9 _!   
communities4  7#e7 ,to /reaml9e access  
to ,,hcbs by elim9at+ ! ne$ = ,/ates to 
repeat$ly apply = waiv]s4  7#f7 ,to     
cont9ue to increase ! capacity (        
community s]vices to ensure p )         
disabilities & old] adults h safe &     
mean+ful options 9 ! community are n at 
risk ( unnecess>y in/itutionalization4  
7#g7 ,to act on ! decades ( rese>* &    
practice %[+ t ev]yone1 includ+ p ) !   
mo/ sev]e disabilities1 c live 9 !      
community ) ! "r s]vices & supports4    

7#h7 ,to support ov] #ec1jjj1jjj unpaid 
family c>egiv]s :o are (t5 provid+      
complex s]vices & supports to old]      
adults & p ) disabilities because ( a   
lack ( af=dable s]vices1 work=ce        
%ortages1 & o!r ineffici5cies4  7#i7 ,to
 improve direct c>e quality & address ! 
decades long work=ce b>ri]s1 :i* h be5  
exac]bat$ by ! ,,covid-#ai p&emic1 =    
ne>ly #b1fjj1jjj direct c>e pr(essionals
 provid+ support to p ) disabilities &  
old] adults 9 _! homes & communities4   
7#aj7 ,to elim9ate ! race1 g5d]1 sexual 
ori5tation1 & g5d] id5tity disp>ities t 
exi/ 9 access+ in=mation & ,,hcbs & to  
prev5t ! unnecess>y impov]i%m5t &       
in/itutionalization ( black & br[n      
individuals ) disabilities & old]       
adults4  #ajb4 ,requir+ cov]age ( home &
 community-bas$ s]vices "u ! ,m$icaid   
program  7a7 ,def9ition ( home &        
community-,bas$ s]vices  7#a7 ,9 g5]al  
,section #aije ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;d7 is am5d$ by
 add+ at ! end ! foll[+ new subsection3 

7jj7 ,home & community-,bas$ s]vices    
7#a7 ,9 g5]al ,= purposes ( ?is title1 !
 t]m home & community-bas$ s]vices means
 ^? s]vices specifi$ 9 p>agraph 7#b7    
furni%$ to an eligible individual 7z    
def9$ 9 p>agraph 7#c771 bas$ on an      
individualiz$ assessm5t 7z describ$ 9   
p>agraph 7#d77 ( su* individual1 9 a    
sett+ t-- 7,a7 meets ! qualities        
specifi$ 9 p>agraph 7#a7 ( section      
#dda4gaj7;a7 ( title #db1 ,code ( ,f$]al
 ,regulations 7or a successor           
regulation72  7,b7 is n describ$ 9      
p>agraph 7#b7 ( su* section 7or         
successor regulation72 &  7,c7 meets su*
 o!r qualities z ! ,secret>y det]m9es   
appropriate4  7#b7 ,s]vices specifi$    
7,a7 ,9 g5]al ,= purposes ( p>agraph    
7#a71 ! s]vices specifi$ 9 ?is p>agraph 
are s]vices describ$ 9 any ( p>agraphs  
7#g71 7#h71 7#ac77;,c71 7#ai71 7#bj71   
7#bd71 & 7#bi7 7z appli$ )\t reg>d to ! 
ref]5ce to ,septemb] #cj1 #bjbe7 (      
subsection 7a7 or 9 any ( subsections   
7c77#d77;,b71 7c77#e71 7k77#a77;,a71    

7k77#a77;,b71 or 7k77#a77;,d7 ( section 
#aiae1 includ+ ! foll[+3 7i7 ,support$  
employm5t & integrat$ day s]vices4  7ii7
 ,p]sonal assi/ance1 includ+ p]sonal c>e
 att5dants1 direct support pr(essionals1
 home heal? aides1 private duty nurs+1  
homemak]s & *ore assi/ance1 &           
companion%ip s]vices4  7iii7 ,s]vices t 
enhance indep5d5ce1 inclusion1 & full   
p>ticipation 9 ! broad] community4  7iv7
 ,non-em]g5cy1 non-m$ical transportation
 s]vices to facilitate community        
integration4  7v7 ,respite s]vices      
provid$ 9 ! individual's home or broad] 
community4  7vi7 ,c>egiv] & family      
support s]vices4  7vii7 ,case managem5t1
 includ+ int5sive case managem5t1 fiscal
 int]m$i>y1 & support brok]age s]vices4 
7viii7 ,s]vices :i* support p]son-c5t]$ 
plann+ & self-direction4  7ix7 ,direct  
support s]vices dur+ acute              
hospitalizations4  7x7 ,necess>y m$ical 
& nurs+ s]vices n o!rwise cov]$ :i* are 
necess>y 9 ord] = ! individual to rema9 
9 _! home & community1 includ+ hospice  

s]vices4  7xi7 ,home & community-bas$   
int5sive behavioral heal? & crisis      
int]v5tion s]vices4  7xii7 ,pe] support 
s]vices4  7xiii7 ,h\s+ support1 includ+ 
transitional h\s+ or transitional       
support s]vices = individuals :o are    
unh\s$1 & wrap-ar\nd s]vices4  7xiv7    
,necess>y home modifications & assi/ive 
te*nology1 includ+ ^? :i* sub/itute =   
human assi/ance4  7xv7 ,transition      
s]vices to support an individual :o is  
transition+ f an in/itutional sett+ to !
 community1 includ+ appropriate s]vices 
= individuals :o are unh\s$ or at risk (
 becom+ unh\s$1 & includ+ su* transition
 s]vices provid$ :ile ! individual      
resides 9 an in/itution4  7xvi7 ,any o!r
 s]vice recomm5d$ by ! panel conv5$     
pursuant to subp>agraph 7,b74  7,b7     
,specification ( recomm5d$ s]vices  7i7 
,9 g5]al ,n lat] ?an #f mon?s aft] !    
date ( ! enactm5t ( ?is subp>agraph1 & n
 less frequ5tly ?an once e #e ye>s      
!reaft]1 ! ,secret>y %all conv5e an     
advisory panel 79 ?is subp>agraph ref]r$

 to z ! panel7 = purposes ( recomm5d+   
additional s]vices :i* %all be includ$ z
 home & community-bas$ s]vices "u ?is   
p>agraph4  7ii7 ,composition  7,i7      
,selection ,! panel %all be compos$ ( at
 lea/ "o repres5tative 7to be select$ by
 ! ,secret>y7 f ea* ( ! foll[+3 7aa7    
,individuals ) disabilities receiv+ home
 & community-bas$ s]vices "u ?is title &
 individuals ) disabilities 9 ne$ ( su* 
s]vices1 includ+ ^? ) physical          
disabilities1 behavioral heal?          
disabilities1 or intellectual or        
developm5tal disabilities1 & includ+    
old] adults4  7bb7 ,b5efici>y-l$        
disability rights organizations4  7cc7  
,disability-l$ organizations4  7dd7     
,disabl$ vet]ans organizations4  7ee7   
,disability organizations repres5t+     
families4  7ff7 ,community-bas$ provid] 
organizations4  7gg7 ,organizations s]v+
 old] adults4  7hh7 ,! ,protection &    
,advocacy sy/em1 ! ,c5t]s = ,indep5d5t  
,liv+4  7ii7 ,heal? c>e provid]s4  7jj7 
,! ,national ,association ( ,m$icaid    

,directors4  7kk7 ,! ,national          
,association ( ,/ate ,directors (       
,developm5tal ,disabilities ,s]vices4   
7ll7 ,! ,national ,association ( ,/ate  
,m5tal ,heal? ,program ,directors4  7mm7
 ,a,dvancing ,/ates4  7nn7 ,! ,c5t]s =  
,m$ic>e  ,m$icaid ,s]vices4  7oo7 ,!    
,adm9i/ration = ,community ,liv+ ( !    
,dep>tm5t ( ,heal? & ,human ,s]vices4   
7pp7 ,o!r relevant local1 ,/ate1 &      
,f$]al home & community-bas$ s]vice     
sy/ems1 z det]m9$ by ! ,secret>y4       
7,,ii7 ,requirem5t = equal repres5tation
 ,! ,secret>y %all select an equal numb]
 ( repres5tatives f ea* category        
describ$ 9 items 7aa7 ?r\gh 7oo7        
subclause 7,i7 9 conv5+ ! panel4  7iii7 
,duties ,n lat] ?an #f mon?s aft] a     
panel is conv5$ "u clause 7i71 ! panel  
%all submit to ! ,secret>y & to         
,congress a report recomm5d+ additional 
s]vices :i* %all be includ$ z home &    
community-bas$ s]vices "u ?is p>agraph4 
,su* recomm5d$ s]vices %all be s        
specifi$ ) ! goal ( increas+ community  

integration & self-det]m9ation =        
individuals ) disabilities receiv+ su*  
s]vices4  7iv7 ,implem5tation (         
recomm5d$ s]vices  7,i7 ,9 g5]al        
,s]vices recomm5d$ by ! panel 9 a report
 submitt$ "u clause 7iii7 %all be treat$
 z s]vices describ$ 9 subp>agraph       
7,a77xvi7 = cal5d> qu>t]s beg9n+ on or  
aft] ! date t is #a ye> aft] ! date (   
su* submission4  7,,ii7 ,notification ,n
 lat] ?an #a ye> aft] ! fir/ report is  
submitt$ "u clause 7iii71 & n lat] ?an  
#a ye> aft] ! submission ( ea* subsequ5t
 su* report1 ! ,secret>y %all notify    
,/ates ( any additions or removals (    
home & community-bas$ s]vices bas$ on   
s]vices recomm5d$ "u su* report ?r\gh   
,/ate ,m$icaid ,director lett]s4  7#c7  
,eligible individual  7,a7 ,9 g5]al ,=  
purposes ( p>agraph 7#a71 ! t]m eligible
 individual means--  7i7 an individual  
:o is det]m9$1 on an annual basis or on 
a long] basis specifi$ by ! ,/ate1 by a 
heal? c>e provid] approv$ by ! ,/ate "u 
a process describ$ 9 subp>agraph 7,c7 to

 h a functional impairm5t 7z def9$ 9    
subp>agraph 7,b77 7n tak+ into acc\nt   
any items or s]vices1 or any o!r        
ameliorative measures1 furni%$ to su*   
individual to mitigate su* impairm5t7 t 
is expect$ to la/ at lea/ #ij days2     
7ii7 dur+ ! p]iod t ends on ! day be=e !
 fir/ day ( ! fir/ cal5d> qu>t] beg9n+  
on or aft] ! date t is #e ye>s aft] !   
date ( ! enactm5t ( ?is subsection1 an  
individual :o1 z ( su* date ( enactm5t1 
is receiv+ or has be5 det]m9$ to be     
eligible =1 home & community-bas$       
s]vices "u ?is title "u a waiv] or ,/ate
 plan option 9 effect "u section #aiae  
or #aaae1 provid$ t ! individual        
cont9ues to meet any level ( c>e        
requirem5t applicable "u su* waiv] or   
plan option2 or  7iii7 an individual :o 
is eligible "u ! ,/ate plan or waiv] &  
is "u ! age ( #ba4  7,b7 ,functional    
impairm5t ,= purposes ( subp>agraph     
7,a71 ! t]m functional impairm5t means1 
) respect to an individual ! inability (
 su* individual to p]=m1 )\t assi/ance--

  7i7 #b or m activities ( daily liv+ 7z
 describ$ 9 section #ggjb;,b7c77#b77;,b7
 ( ! ,int]nal ,rev5ue ,code ( #aihf72   
7ii7 #b or m in/rum5tal activities (    
daily liv+ 7z def9$ = purposes ( section
 #aiae7k77#a77;,a772 or  7iii7 #a       
activity ( daily liv+ 7z s describ$7 &  
#a in/rum5tal activity ( daily liv+ 7z s
 def9$74  7,c7 ,heal? c>e provid] ,/ate 
approval ,= purposes ( subp>agraph      
7,a77i71 a process describ$ 9 ?is       
subp>agraph is a process e/abli%$ by !  
,/ate to approve heal? c>e provid]s to  
make det]m9ations describ$ 9 su*        
subp>agraph t meets su* /&>ds z !       
,secret>y may prescribe4  7#d7          
,individualiz$ assessm5t  7,a7 ,9 g5]al 
,= purposes ( p>agraph 7#a71 an         
individualiz$ assessm5t describ$ 9 ?is  
p>agraph is an indep5d5t assessm5t1 )   
respect to an eligible individual-- 7i7 
to det]m9e a necess>y level ( s]vices & 
supports to be provid$1 consi/5t ) an   
individual's functional impairm5ts1 to  
facilitate an individual's community    

integration1 self-det]m9ation1 &        
well-be+2  7ii7 to prev5t ! provision ( 
unnecess>y or inappropriate c>e2  7iii7 
to e/abli% a p]son-c5t]$ c>e plan 7z    
describ$ 9 subp>agraph 7,c77 = !        
individual2  7iv7 t includes ea* ( !    
elem5ts describ$ 9 clauses 7ii7 ?r\gh   
7v7 ( section #aiae7;i77#a77;,f72 &  7v7
 t occurs n lat] ?an #cj days aft] su*  
individual is det]m9$ to be an eligible 
individual4  7,b7 ,presumption ,!       
assessm5t describ$ 9 subp>agraph 7,a7   
%all be conduct$ ) ! presumption-- 7i7 t
 ea* eligible individual1 reg>dless (   
type or level ( disability or s]vice    
ne$1 c be s]v$ 9 ! individual's own home
 & community2 &  7ii7 at ! option ( !   
individual1 t s]vices may be            
self-direct$ 7z def9$ 9 section         
#aiae7;i77#a77;,g77iii77,,ii774  7,c7   
,p]son-c5t]$ c>e plan ,= purposes (     
subp>agraph 7,a77iii71 a p]son-c5t]$ c>e
 plan describ$ 9 ?is subp>agraph is a   
writt5 plan ) respect to an individual t
 meets ! requirem5ts ( section          

#aiae7;i77#a77;,g77ii74  7,d7 ,/&>ds ,an
 individualiz$ assessm5t describ$ 9     
subp>agraph 7,a7 %all be conduct$ 9     
accordance ) /&>ds specifi$ by !        
,secret>y1 9 consultation ) !           
,adm9i/ration = ,community ,liv+1 t--   
7i7 safegu>d aga9/ conflicts ( int]e/2  
7ii7 specify qualifications = :o may    
p]=m su* assessm5ts2  7iii7 ensure      
transp>5cy 9 ! furni%+ ( su* assessm5ts1
 includ+ ensur+ ! provision ( ! results 
( su* assessm5ts t includes in=mation 9 
pla9 language necess>y to int]pret !    
me?odology & results ( su* assessm5ts2  
7iv7 ensure t ! me?odologies us$ 9 su*  
assessm5ts are s\nd & evid5ce-bas$2 &   
7v7 require su* me?odologies to be made 
available on ! public website ( ! ,/ate 
& te/$ = reliability & validity by an   
indep5d5t evaluator4  4  7#b7 ,inclusion
 z m$ical assi/ance ,section #aije7;a7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acif;d7a77 is am5d$-- 7,a7 9 p>agraph 
7#cj71 by /rik+ 2 & & ins]t+ a          
semicolon2  7,b7 by r$esignat+ p>agraph 

7#ca7 z p>agraph 7#cb72 &  7,c7 by      
ins]t+ aft] p>agraph 7#cj7 ! foll[+ new 
p>agraph3  7#ca7 home & community-bas$  
s]vices 7z def9$ 9 subsection 7jj772 &  
4  7b7 ,m&atory b5efit  7#a7 ,9 g5]al   
,section #aijb7;a77#aj77;,a7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acif;a7a77#aj77;,a77 is am5d$ by /rik+ 
& 7#cj7 & ins]t+ 7#cj71 & 7#ca74  7#b7  
,effective date ,! am5dm5t made by ?is  
subsection %all take effect on ! fir/   
day ( ! fir/ cal5d> qu>t] t beg9s on or 
aft] ! date t is #e ye>s aft] ! date (  
enactm5t ( ?is ,act4  7c7 ,ensur+       
cov]age ( ,,hcbs = all                  
,m$icaid-,eligible individuals ,section 
#aijb7;a77#aj77;,d7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#aj77;,a77 is am5d$--  7#a7  
by ins]t+ 7i7 aft] 7,d72  7#b7 by add+ &
 aft] ! semicolon2 &  7#c7 by add+ at ! 
end ! foll[+ new clause3  7ii7 beg9n+ on
 ! fir/ day ( ! fir/ cal5d> qu>t] t     
beg9s on or aft] ! date t is #e ye>s    
aft] ! date ( enactm5t ( ?is clause 7or 

at su* e>li] date z ! ,/ate may elect7 =
 ! inclusion ( home & community-bas$    
s]vices 7z def9$ 9 section #aije7;jj77 =
 any individual :o--  7,i7 is eligible =
 m$ical assi/ance "u ! ,/ate plan 7or   
waiv] ( su* plan72  7,,ii7 is an        
eligible individual 7z def9$ 9 su*      
section72 &  7,,iii7 elects to receive  
su* s]vices4  4  7d7 ,f$]al m$ical      
assi/ance p]c5tage = home &             
community-,bas$ s]vices ,section #aije (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acif;d71 z am5d$ by subsection 7a71 is
 fur!r am5d$--  7#a7 9 subsection 7b71  
by /rik+ & 7ii7 & ins]t+ 7ii71 & 7kk72 &
  7#b7 by add+ at ! end ! foll[+ new    
subsection3  7kk7 ,specifi$ ,,fmap =    
home & community-,bas$ s]vices  7#a7 ,9 
g5]al ,not)/&+ any o!r provision ( law &
 except z provid$ 9 p>agraph 7#c71 !    
,f$]al m$ical assi/ance p]c5tage =      
am\nts exp5d$ = m$ical assi/ance = home 
& community-bas$ s]vices 7z def9$ 9     
subsection 7jj771 includ+ any su*       
s]vices furni%$ "u a waiv] 9 effect "u  

section #aiae1 on or aft] ! date ( !    
enactm5t ( ?is subsection %all be equal 
to #ajj p]c5t4  7#b7 ,access to ess5tial
 ,,hcbs ,z a condition ( receiv+ !      
,f$]al m$ical assi/ance p]c5tage        
describ$ 9 p>agraph 7#a71 a ,/ate %all  
enhance1 exp&1 or /r5g!n ! level ( home 
& community-bas$ s]vices (f]$ "u ! ,/ate
 plan "u ?is title 7or a waiv] ( su* a  
plan7 z ( ! date ( enactm5t ( ?is       
subsection by do+ all ( ! foll[+3  7,a7 
,address+ access b>ri]s & disp>ities 9  
access or utilization id5tifi$ 9 ! ,/ate
 ,,hcbs implem5tation plan4  7,b7 ,us+  
no wrong door programs1 provid+         
presumptive eligibility = home &        
community-bas$ s]vices1 & improv+ home &
 community-bas$ s]vices c\nsel+ &       
education programs4  7,c7 ,provid+      
supports to family c>egiv]s1 :i* %all   
include provid+ respite c>e1 & may      
include provid+ su* s]vices z c>egiv]   
assessm5ts1 pe] supports1 access to     
assi/ive te*nology1 or paid family      
c>egiv+4  7,d7 ,adopt+ processes to     

ensure t paym5ts = home & community-bas$
 s]vices are suffici5t to ensure t su*  
s]vices are available to eligible       
b5efici>ies4  7#c7 ,exception ,! ,f$]al 
m$ical assi/ance p]c5tage applicable to 
m$ical assi/ance = home & community-bas$
 s]vices furni%$ to an individual :o is 
only eligible = m$ical assi/ance "u a   
,/ate plan or waiv] on ! basis ( section
 #aijb7;a77#aj77;,a77ii77,,xxiv7 %all be
 det]m9$ )\t reg>d to ?is subsection4  4
  7e7 ,sunset ( ,,hcbs waiv]s ,section  
#aiae ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acifn7 is am5d$ by add+ at ! 
end ! foll[+ new subsection3  7m7       
,sunset ( provisions relat+ to home &   
community-,bas$ s]vices  7#a7 ,9 g5]al  
,except z provid$ 9 p>agraph 7#b71 !    
prec$+ provisions ( ?is section1 ins(> z
 su* provisions relate to a waiv] = home
 & community-bas$ s]vices1 %all n apply 
beg9n+ ) ! fir/ cal5d> qu>t] beg9n+ on  
or aft] ! date t is #e ye>s aft] ! date 
( ! enactm5t ( ?is subsection4  7#b7    
,exception ,! ,secret>y may waive !     

application ( p>agraph 7#a7 = a cal5d>  
qu>t] & a ,/ate if ! ,/ate reque/s su* a
 waiv] & ! ,secret>y det]m9es t su* a   
waiv] is appropriate4  4  7f7 ,con=m+   
am5dm5ts  7#a7 ,9 g5]al ,title ,,xix ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acif et seq47 is am5d$-- 7,a7 9 section
 #aije7;a71 9 ! matt] prec$+ ! fir/     
numb]$ p>agraph--  7i7 9 clause 7xv71 by
 /rik+ ! comma at ! end & ins]t+ 1 or2  
7ii7 9 clause 7xvi7--  7,i7 by mov+ !   
left m>g9 #b ems to ! left2 &  7,,ii7 by
 /rik+ 1 or & ins]t+ a comma2 &  7iii7  
by /rik+ clause 7xvii72 &  7,b7 9       
section #aidc7;b77#e71 by /rik+ ! ,/ate 
& all t foll[s ?r\gh ! p]iod at ! end & 
ins]t+ a det]m9ation be conduct$ on an  
annual basis 7or on su* long] basis z   
specifi$ by ! ,/ate7 9 accordance )     
section #aije7;jj7 = purposes ( provid+ 
home & community-bas$ s]vices "u ! ,/ate
 plan 7or waiv] ( su* plan744  7#b7     
,effective date  7,a7 ,9 g5]al ,except z
 provid$ 9 subp>agraph 7,b71 ! am5dm5ts 
made by ?is subsection %all take effect 

on ! fir/ day ( ! fir/ cal5d> qu>t] t   
beg9s on or aft] ! date t is #e ye>s    
aft] ! date ( enactm5t ( ?is ,act4  7,b7
 ,exception = ,/ates au?oriz$ to cont9ue
 op]at+ ,,hcbs waiv]s ,9 ! case ( a     
,/ate = :i* ! ,secret>y has waiv$ !     
application ( p>agraph 7#a7 ( subsection
 7m7 ( section #aiae ( ! ,social        
,security ,act 7#db ,u4,s4,c4 #acifn71 z
 add$ by subsection 7e71 9 accordance ) 
p>agraph 7#b7 ( su* subsection 7m71     
clause 7xvii7 ( section #aije7;a7 ( !   
,social ,security ,act %all cont9ue to h
 effect ) respect to su* ,/ate = s long 
z p>agraph 7#a7 ( su* subsection 7m7    
does n apply to su* ,/ate4  #ajc4       
,m$icaid eligibility modifications      
,section #aijb7;a77#aj7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#aj77 is am5d$-- 7#a7 9      
subp>agraph 7,a77i7--  7,a7 9 subclause 
7,,viii71 by /rik+ 2 or & ins]t+ a      
semicolon2  7,b7 9 subclause 7,,ix77dd71
 by /rik+ ! semicolon at ! end & ins]t+ 
2 or2 &  7,c7 by ins]t+ aft] subclause  

7,,ix7 ! foll[+ new subclause3  7,x7    
beg9n+ ) ! fir/ cal5d> qu>t] t beg9s on 
or aft] ! date t is #e ye>s aft] ! date 
( enactm5t ( ?is subclause 7or su* e>li]
 date z ! ,/ate may elect71 :o are      
eligible individuals describ$ 9         
subsection 7jj77#c77;,a7 & are n        
describ$ 9 a previ\s subclause ( ?is    
clause & ^: income does n exce$ ! great]
 (--  7aa7 #aej p]c5t ( ! pov]ty l9e 7z 
def9$ 9 section #baaj7;c77#e77          
applicable to a family ( ! size involv$2
 &  7bb7 #cjj p]c5t ( ! supplem5tal     
security income b5efit rate e/abli%$ by 
section #afaa7;b77#a72  2 &  7#b7 9     
subp>agraph 7,a77ii7-- 7,a7 9 subclause 
7,,xxii71 by /rik+ 2 or & ins]t+ a      
semicolon2  7,b7 9 subclause 7,,xxiii71 
by /rik+ ! semicolon at ! end & ins]t+ 2
 or2 &  7,c7 by add+ at ! end ! foll[+  
new subclause3  7,,xxiv7 :o are eligible
 individuals :o w\ld be describ$ 9      
clause 7i77,x7 b = ! fact t _! income   
exce$s ! income levels e/abli%$ "u su*  
clause b is less ?an su* income level z 

! ,/ate may e/abli% = purposes ( ?is    
subclause2  4  #ajd4 ,home &            
community-bas$ s]vices implem5tation    
plan grant program  7a7 ,9 g5]al ,n lat]
 ?an #a ye> aft] ! date ( ! enactm5t (  
?is ,act1 ! ,secret>y %all aw>d to ea*  
,/ate a grant = purposes ( enabl+ su*   
,/ate to implem5t ! requirem5t to       
provide home & community-bas$ s]vices "u
 title ,,xix ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #acif et seq474  7b7 ,use
 ( funds ,a grant aw>d$ "u subsection   
7a7 %all be us$ by a ,/ate to develop an
 implem5tation plan describ$ 9          
subsection 7c7 to be submitt$ to !      
,secret>y = approval4  7c7              
,implem5tation plan ,an implem5tation   
plan describ$ 9 ?is subsection is a plan
 develop$ by a ,/ate t includes !       
foll[+3  7#a7 ,an explanation ( h[ !    
,/ate w op]ationalize ! def9ition ( an  
eligible individual "u section          
#aije7;jj7 ( ! ,social ,security ,act1  
includ+ ! process = det]m9ations        
specifi$ 9 p>agraph 7#c77;,a77i7 ( su*  

section4  7#b7 ,a description ( !       
,/ate's plan to ensure a /able & high   
quality work=ce & h[ ! ,/ate plans to   
ensure a liv+ wage = individuals furni%+
 home & community-bas$ s]vices & id5tify
 & address any additional work=ce       
issues4  7#c7 ,a li/ ( any home &       
community-bas$ s]vices provid$ "u !     
,/ate ,m$icaid plan 7includ+ any waiv] (
 su* plan7 z ( ! date ( enactm5t ( ?is  
,act1 includ+ a breakd[n ( use ( su*    
s]vices by demographics 7z def9$ 9      
section #b71 comp>$ to su* s]vices t are
 requir$ "u ! am5dm5ts made by section  
#ajb1 & a description ( num]ical goals  
to increase access to su* s]vices t h   
b>ri]s to access = populations 9 ne$ (  
su* s]vices4  7#d7 ,a description ( h[ !
 ,/ate w incorporate exi/+ ,/ate        
disability ag5cies into ! new unifi$    
provision ( home & community-bas$       
s]vices & h[ su* ,/ate w ensure t su*   
s]vices address all functional          
impairm5ts4  7#e7 ,an explanation ( h[ !
 ,/ate w ensure access to su* s]vices4  

7#f7 ,a plan = c>ry+ out outrea* &      
education activities ) respect to !     
availability ( su* s]vices ?r\gh ,ag+ & 
,disability ,res\rce ,c5t]s & o!r simil>
 entities 7su* z entities receiv+ funds 
f ! ,adm9i/ration = ,community ,liv+ or 
! ,sub/ance ,abuse & ,m5tal ,heal?      
,s]vices ,adm9i/ration71 includ+ a      
program t ensures t an individual is n  
d5i$ su* s]vices bas$ on ! fact t !     
individual contacts ! wrong entity      
7commonly ref]r$ to z a ,no ,wrong ,door
 ,program74  7#g7 ,a plan = h[ su*      
s]vices w be coord9at$ ) o!r relevant   
,/ate ag5cies1 su* z h\s+1              
transportation1 *ild welf>e1 food &     
income security1 & employm5t ag5cies4   
7#h7 ,a description ( h[ ! ,/ate w build
 capacity prior to ! implem5tation ( !  
requirem5t describ$ 9 subsection 7a7 to 
ensure t su* s]vices are available to e 
eligible individual "u ! ,m$icaid       
program & h[ ! ,/ate w ensure t su*     
s]vices are provid$ 9 a sett+ t meets ! 
requirem5ts specifi$ 9 p>agraph 7#a7 (  

section #aije7;jj7 ( ! ,social ,security
 ,act1 z add$ by section #ajb4  7#i7 ,9 
! case ( a ,/ate t utilizes an          
alt]native b5efit plan1 a description ( 
h[ ! ,/ate w ensure t all individuals :o
 are eligible individuals 7z def9$ 9 su*
 section7 are appropriately id5tifi$ z  
m$ically frail & exempt$ f su* plan4    
7#aj7 ,h[ ! ,/ate w coord9ate           
eligibility = su* s]vices ) o!r         
disability eligibility programs1 su* z  
disability buy-9 programs4  7#aa7 ,data 
& mile/one requirem5ts to ensure        
community integration1 includ+ su*      
requirem5ts ) respect to utilization (  
su* s]vices by demographics 7z def9$ 9  
section #b74  7d7 ,/ate plan requirem5t 
,section #aijb7;a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acif;a7a77 is     
am5d$--  7#a7 9 p>agraph 7#hf71 by /rik+
 & at ! end2  7#b7 9 p>agraph 7#hg71 by 
/rik+ ! p]iod at ! end & ins]t+ 2 &2 &  
7#c7 by add+ at ! end ! foll[+ new      
p>agraph3  7#hh7 provide = ! submission 
to ! ,secret>y ( an implem5tation plan  

describ$ 9 section #ajd7;c7 ( ! ,,hcbs  
,access ,act = approval by ! ,secret>y  
prior to ! beg9n+ ( ! fir/ cal5d> qu>t] 
beg9n+ on or aft] ! date t is #e ye>s   
aft] ! date ( ! enactm5t ( ?is p>agraph4
  4  7e7 ,au?orization ( appropriations 
,!re is au?oriz$ to be appropriat$ to ! 
,secret>y su* sums z are necess>y to    
c>ry out ?is section4  7f7 ,def9itions  
,9 subsections 7a7 ?r\gh 7c73  7#a7     
,home & community-bas$ s]vices ,! t]m   
home & community-bas$ s]vices has !     
mean+ giv5 su* t]m 9 subsection 7jj7 (  
section #aije ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acif;d71 z add$ by     
section #ajb4  7#b7 ,/ate ,! t]m ,/ate  
has ! mean+ giv5 t t]m 9 section        
#aaja7a7 ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #acja7a77 = purposes ( title 
,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et
 seq474  #aje4 ,quality ( s]vices  7a7  
,9 g5]al  7#a7 ,developm5t ( metrics ,n 
lat] ?an #a ye> aft] ! date ( enactm5t (
 ?is ,act1 ! ,director ( ! ,ag5cy =     
,heal?c>e ,rese>* & ,quality1 9         

consultation ) ,/ate ,m$icaid           
,directors1 %all develop /&>diz$1       
,/ate-level metrics ( access to1 &      
satisfaction )1 provid]s1 includ+ prim>y
 c>e & speciali/ provid]s1 ) respect to 
individuals :o are enroll$ 9 ,/ate      
,m$icaid plans "u title ,,xix ( !       
,social ,security ,act1 brok5 d[n by    
demographics 7z def9$ 9 section #b7 &   
any o!r category det]m9$ by ! ,secret>y4
 ,su* metrics %all include metrics on ! 
total numb] ( individuals enroll$ 9 !   
,/ate plan or "u a waiv] ( ! plan dur+ a
 fiscal ye> t requir$ ! level ( c>e     
provid$ 9 a nurs+ facility1 int]m$iate  
c>e facility = individuals )            
intellectual disability1 in/itution =   
m5tal disease1 or o!r simil>ly          
re/rictive or in/itutional sett+4  7#b7 
,process ,! ,director ( ! ,ag5cy =      
,heal?c>e ,rese>* & ,quality %all       
develop ! metrics describ$ 9 p>agraph   
7#a7 ?r\gh a public process1 :i* %all   
provide opportunities = /akehold]s to   
p>ticipate4  7b7 ,updat+ metrics ,!     

,director ( ! ,ag5cy = ,heal?c>e ,rese>*
 & ,quality1 9 consultation ) ! ,deputy 
,adm9i/rator = ! ,c5t] = ,m$icaid &     
,,*ip ,s]vices & ,/ate ,m$icaid         
,directors1 %all update ! metrics       
develop$ "u subsection 7a7 n less ?an   
once e #c ye>s4  7c7 ,/ate implem5tation
 fund+ ,! ,director ( ! ,ag5cy =        
,heal?c>e ,rese>* & ,quality may aw>d   
funds1 f ! am\nt appropriat$ "u         
subsection 7d71 to ,/ates = ! purpose ( 
implem5t+ ! metrics develop$ "u ?is     
section4  7d7 ,appropriation ,!re is    
appropriat$ to ! ,director ( ! ,ag5cy = 
,heal?c>e ,rese>* & ,quality1 out ( any 
funds 9 ! ,treasury n o!rwise           
appropriat$1 #bjj1jjj1jjj = fiscal ye>  
#bjbd1 to rema9 available until exp5d$1 
= ! purpose ( c>ry+ out ?is section4    
#ajf4 ,reports2 te*nical assi/ance2 o!r 
adm9i/rative requirem5ts  7a7 ,reports  
,! ,secret>y %all submit to ! ,committee
 on ,en]gy & ,comm]ce ( ! ,h\se (       
,repres5tatives1 ! ,committee on        
,education & ,labor ( ! ,h\se (         

,repres5tatives1 ! ,committee on ,f9ance
 ( ! ,s5ate1 ! ,committee on ,heal?1    
,education1 ,labor & ,p5sions ( !       
,s5ate1 & ! ,special ,committee on ,ag+ 
( ! ,s5ate ! foll[+ reports relat+ to ! 
,,hcbs implem5tation plan grant program 
e/abli%$ "u section #ajd3  7#a7 ,int]im 
report ,n lat] ?an #b ye>s aft] ! date (
 enactm5t ( ?is ,act1 a report t        
describes-- 7,a7 ,/ate ef=ts to develop 
_! ,,hcbs implem5tation plans2 &  7,b7 !
 funds aw>d$ to ,/ates4  7#b7 ,fir/     
implem5tation report ,n lat] ?an #d ye>s
 aft] ! date ( enactm5t ( ?is ,act1 a   
report t includes ! foll[+3  7,a7 ,a    
description ( ! ,,hcbs implem5tation    
plans approv$ by ! ,secret>y "u section 
#ajd4  7,b7 ,a description ( ! national 
l&scape ) respect to gaps 9 cov]age (   
home & community-bas$ s]vices1          
disp>ities 9 access to1 & utilization (1
 su* s]vices1 & b>ri]s to access+ su*   
s]vices4  7,c7 ,a description ( !       
national l&scape ) respect to ! direct  
c>e work=ce t provides home &           

community-bas$ s]vices1 includ+ )       
respect to comp5sation1 b5efits1 &      
*all5ges to ! availability ( su* work]s4
  7#c7 ,subsequ5t reports ,n lat] ?an #g
 ye>s aft] ! date ( enactm5t ( ?is ,act1
 & e #c ye>s !reaft]1 a report t        
includes ! foll[+3  7,a7 ,! numb] (     
,,hcbs program improvem5t ,/ates & !    
funds aw>d$ to ,/ates to develop _!     
plans4  7,b7 ,a summ>y ( ! progress be+ 
made by su* ,/ates ) respect to /r5g!n+ 
& exp&+ access to home & community-bas$ 
s]vices & ! direct c>e work=ce t        
provides su* s]vices & meet+ ! b5*m>ks =
 demon/rat+ improvem5ts requir$ "u      
section #aije7;jj77#e7 ( ! ,social      
,security ,act 7z add$ by section #ajb74
  7,c7 ,a summ>y ( outcomes relat$ to   
home & community-bas$ s]vices core      
quality measures & b5efici>y & family   
c>egiv] surveys4  7,d7 ,a summ>y ( !    
*all5ges & be/ practices report$ by     
,/ates 9 exp&+ access to home &         
community-bas$ s]vices & support+ &     
exp&+ ! direct c>e work=ce t provides   

su* s]vices4  7b7 ,te*nical assi/ance2  
guidance2 regulations ,! ,secret>y %all 
provide ,,hcbs program improvem5t ,/ates
 ) te*nical assi/ance relat$ to c>ry+   
out ! ,,hcbs implem5tation plans approv$
 by ! ,secret>y "u section #ajd & meet+ 
! requirem5ts & b5*m>ks = demon/rat+    
improvem5ts requir$ "u section          
#aije7;jj7 ( ! ,social ,security ,act 7z
 add$ by section #ajb7 & %all issue su* 
guidance or regulations z necess>y to   
c>ry out ?is title & ! am5dm5ts made by 
?is title1 includ+ guidance specify+ h[ 
,/ates %all assess & track !            
availability ( home & community-bas$    
s]vices ov] "t4  7c7 ,recomm5dations ,to
 guide ,,hcbs implem5tation  7#a7 ,9    
g5]al ,n lat] ?an #ah mon?s aft] ! date 
( enactm5t ( ?is ,act1 ! ,secret>y %all 
coord9ate ) ! ,secret>y ( ,labor & !    
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices = purposes ( issu+    
recomm5dations = ! ,f$]al ,gov]nm5t & = 
,/ates to /r5g!n ! direct c>e work=ce t 
provides home & community-bas$ s]vices1 

includ+ ) respect to h[ ! ,f$]al        
,gov]nm5t %\ld classify ! direct c>e    
work=ce1 h[ su* ,adm9i/rator & ,/ate    
,m$icaid programs c en=ce & support !   
provision ( competitive wages & b5efits 
across ! direct c>e work=ce1 includ+ =  
work]s ) p>ticul> skills or exp]tise1 & 
h[ ,/ate ,m$icaid programs c support    
tra9+ opportunities & o!r relat$ ef=ts t
 support ! provision ( quality home &   
community-bas$ s]vices c>e4  7#b7       
,/akehold] consultation  7,a7 ,9 g5]al  
,9 develop+ ! recomm5dations requir$ "u 
p>agraph 7#a71 ! ,secret>y %all ensure t
 su* recomm5dations are in=m$ by        
consultation ) recipi5ts ( home &       
community-bas$ s]vices1 family c>egiv]s 
( su* recipi5ts1 provid]s1 heal? plans1 
direct c>e work]s1 *os5 repres5tatives (
 direct c>e work]s1 & ag+1 disability1 &
 work=ce advocates4  7,b7 ,consultation 
) curr5t & pot5tial ,,hcbs b5efici>ies &
 family c>egiv]s ,z "p ( ! process (    
develop+ recomm5dations "u subp>agraph  
7,a71 ! ,secret>y %all--  7i7 hold at   

lea/ #a meet+ = ! purpose ( develop+ su*
 recomm5dations t is solely ) curr5t &  
pot5tial recipi5ts ( home &             
community-bas$ s]vices & family c>egiv]s
 ( su* recipi5ts2 &  7ii7 seek to a*ieve
 p>ity 9 t]ms ( ! level ( p>ticipation 9
 ! developm5t ( su* recomm5dations      
betwe5--  7,i7 curr5t & pot5tial        
recipi5ts ( home & community-bas$       
s]vices & family c>egiv]s ( su*         
recipi5ts2 &  7,,ii7 o!r categories (   
/akehold] describ$ 9 subp>agraph 7,a74  
7d7 ,fund+ ,out ( any funds 9 !         
,treasury n o!rwise appropriat$1 !re is 
appropriat$ to ! ,secret>y = purposes ( 
c>ry+ out ?is section1 #aj1jjj1jjj =    
fiscal ye> #bjbd1 to rema9 available    
until exp5d$4  #ajg4 ,quality measurem5t
 & improvem5t  7a7 ,developm5t &        
publication ( core & supplem5tal sets ( 
,,hcbs quality measures  7#a7 ,9 g5]al  
,! ,secret>y %all id5tify & publi% a    
core set & supplem5tal set ( home &     
community-bas$ s]vices quality measures 
= use by ,/ate ,m$icaid programs1 heal? 

plans & manag$ c>e entities t ent] into 
contracts ) su* programs1 & provid]s (  
items & s]vices "u su* programs4  7#b7  
,regul> reviews & updates ,! ,secret>y  
%all review & update ! core set &       
supplem5tal set ( home & community-bas$ 
s]vices quality measures publi%$ "u     
p>agraph 7#a7 n less frequ5tly ?an once 
e ye>4  7#c7 ,requirem5ts  7,a7         
,int]ag5cy collaboration2 /akehold]     
input ,9 develop+ ! core set &          
supplem5tal set ( home & community-bas$ 
s]vices quality measures "u p>agraph    
7#a71 & subsequ5tly review+ & updat+ su*
 core & supplem5tal sets1 ! ,secret>y   
%all--  7i7 collaborate ) ! ,adm9i/rator
 ( ! ,c5t]s = ,m$ic>e  ,m$icaid         
,s]vices1 ! ,adm9i/rator ( !            
,adm9i/ration = ,community ,liv+1 !     
,director ( ! ,ag5cy = ,heal?c>e ,rese>*
 & ,quality1 & ! ,adm9i/rator ( !       
,sub/ance ,abuse & ,m5tal ,heal?        
,s]vices ,adm9i/ration2 &  7ii7 ensure t
 su* core & supplem5tal sets are in=m$  
by input f /akehold]s1 includ+ recipi5ts

 ( home & community-bas$ s]vices1 family
 c>egiv]s ( su* recipi5ts1 provid]s1    
heal? plans1 direct c>e work]s1 *os5    
repres5tatives ( direct c>e work]s1 &   
ag+1 disability1 & work=ce advocates1 ) 
! goal t at lea/ half ( su* input is f  
curr5t & pot5tial recipi5ts ( home &    
community-bas$ s]vices & family         
c>egiv]s4  7,b7 ,reflective ( full array
 ( s]vices ,su* core set & supplem5tal  
set ( home & community-bas$ s]vices     
quality measures %all-- 7i7 reflect !   
full array ( home & community-bas$      
s]vices & recipi5ts ( su* s]vices1      
includ+ adults & *ildr52 &  7ii7        
include-- 7,i7 outcomes-bas$ measures2  
7,,ii7 measures ( availability (        
s]vices2  7,,iii7 measures ( provid]    
capacity & availability2  7,,iv7        
measures relat$ to p]son-c5t]$ c>e2     
7,v7 measures specific to self-direct$  
c>e2  7,,vi7 measures relat$ to         
transitions to & f in/itutional c>e2 &  
7,,vii7 b5efici>y & family c>egiv]      
surveys4  7,c7 ,demographics ,su* core  

set & supplem5tal set ( home &          
community-bas$ s]vices quality measures 
%all all[ = ! collection ( data t is    
disaggregat$ by demographics 7z def9$ 9 
section #b b includ+ any additional     
category det]m9$ by ! ,secret>y74  7#d7 
,fund+ ,out ( any funds 9 ! ,treasury n 
o!rwise appropriat$1 !re is appropriat$ 
to ! ,secret>y = purposes ( c>ry+ out   
?is subsection1 #aj1jjj1jjj = fiscal ye>
 #bjbd1 to rema9 available until exp5d$4
  7b7 ,/ate adoption & reports  7#a7 ,9 
g5]al ,n lat] ?an #b ye>s aft] ! date on
 :i* ! ,secret>y publi%es ! core set &  
supplem5tal set ( home & community-bas$ 
s]vices quality measures "u subsection  
7a77#a71 & annually !reaft]1 ea* ,/ate  
,m$icaid program %all use su* core &    
supplem5tal sets 7or an alt]native set (
 quality measures approv$ by !          
,secret>y7 to report in=mation to !     
,secret>y reg>d+ ! quality ( home &     
community-bas$ s]vices provid$ "u su*   
program4  7#b7 ,process ,! in=mation    
requir$ "u p>agraph 7#a7 %all be report$

 us+ a /&>diz$ =mat & proc$ures e/abli%$
 by ! ,secret>y4 ,su* proc$ures %all    
all[ a ,/ate ,m$icaid program to report 
su* in=mation sep>ately or z "p ( !     
annual reports requir$ "u sections      
#aaci;,a7c7 & #aaci;,b7d7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#acbj;b-#i;a1 #acbj;b-#i;b74  7#c7      
,publication ( quality measures ,ea*    
,/ate ,m$icaid program %all annually    
make ! in=mation report$ to ! ,secret>y 
"u p>agraph 7#a7 available to ! public4 
7#d7 ,increas$ ,f$]al mat*+ rate =      
adoption & report+ ,section             
#aijc7;a77#c7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acif;b7a77#c77 is      
am5d$--  7,a7 9 subp>agraph 7,f77ii71 by
 /rik+ plus aft] ! semicolon & ins]t+ &2
 &  7,b7 by ins]t+ aft] subp>agraph     
7,f71 ! foll[+3  7,g7 #hj p]c5t ( s mu* 
( ! sums exp5d$ dur+ su* qu>t] z are    
attributable to ! report+ ( in=mation   
reg>d+ ! quality ( home & community-bas$
 s]vices 9 accordance ) section #ajg7;b7
 ( ! ,,hcbs ,access ,act2 &  4  #ajh4   

,mak+ p]man5t ! ,/ate option to ext5d   
protection "u ,m$icaid = recipi5ts (    
home & community-bas$ s]vices aga9/     
sp\sal impov]i%m5t  7a7 ,9 g5]al        
,section #aibd7;h77#a77;,a7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acifr-#e7;h77#a77;,a77 is am5d$ by     
/rik+ is describ$ 9 section             
#aijb7;a77#aj77;,a77ii77,,vi7 & ins]t+ !
 foll[+3 is an eligible individual 7z   
def9$ 9 section #aije7;jj77#c774  7b7   
,con=m+ am5dm5t ,section #bdjd ( !      
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #acifr-#e note7 is  
am5d$ by /rik+ ,septemb] #cj1 #bjbg &   
ins]t+ ! date ( enactm5t ( ! ,,hcbs     
,access ,act4  #aji4 ,p]man5t ext5sion (
 ,money ,foll[s ! ,p]son ,rebalanc+     
demon/ration ,subp>agraph 7,l7 ( section
 #fjga7;h77#a7 ( ! ,deficit ,r$uction   
,act ( #bjje 7#db ,u4,s4,c4 #acif;a     
note7 is am5d$ by /rik+ ea* ( fiscal    
ye>s #bjbd ?r\gh #bjbg & ins]t+ ea*     
fiscal ye> aft] #bjbc4  ,,ii ,recogniz+ 
! role ( direct support pr(essionals    

#bja4 ,f9d+s ,congress f9ds ! foll[+3   
7#a7 ,direct support pr(essionals play a
 critical role 9 ! c>e provid$ to *ildr5
 & adults ) intellectual & developm5tal 
disabilities4  7#b7 ,provid]s ( home &  
community-bas$ s]vices are exp]i5c+     
difficulty hir+ & reta9+ direct support 
pr(essionals1 ) a national turnov] rate 
( #de p]c5t z id5tifi$ 9 a #bjaf /udy by
 ! ,national ,core ,indicators4  7#c7   
,high turnov] rates c lead to in/ability
 = individuals receiv+ s]vices1 & ?is   
may result 9 individuals n receiv+ en\gh
 p]sonaliz$ c>e to help !m rea* _! goals
 = indep5d5t liv+4  7#d7 ,a discrete    
occupational category = direct support  
pr(essionals w help ,/ates & ! ,f$]al   
,gov]nm5t-- 7,a7 bett] int]pret !       
%ortage 9 ! labor m>ket ( direct support
 pr(essionals2 &  7,b7 collect data on !
 high turnov] rate ( direct support     
pr(essionals4  7#e7 ,! ,/&>d            
,occupational ,classification sy/em is  
design$ & ma9ta9$ solely = /ati/ical    
purposes1 & is us$ by ,f$]al /ati/ical  

ag5cies to classify work]s & jobs into  
occupational categories = ! purpose (   
collect+1 calculat+1 analyz+1 or        
dissem9at+ data4  7#f7 ,occupations 9 ! 
,/&>d ,occupational ,classification     
sy/em are classifi$ bas$ on "w p]=m$ &1 
9 "s cases1 on ! skills1 education1 or  
tra9+ ne$$ to p]=m ! "w4  7#g7 ,e/abli%+
 a discrete occupational category =     
direct support pr(essionals w--  7,a7   
correct an inaccurate repres5tation 9 ! 
,/&>d ,occupational ,classification     
sy/em2  7,b7 recognize ^! pr(essionals =
 ! critical & (t5 times ov]look$ "w t !y
 p]=m = ! disabl$ community1 :i* "w is  
diff]5t ?an ! "w ( a home heal? aide or 
a p]sonal c>e aide2 &  7,c7 bett] align 
! ,/&>d ,occupational ,classification   
sy/em ) relat$ classification sy/ems4   
#bjb4 ,def9ition ( direct support       
pr(essional ,9 ?is title1 ! t]m direct  
support pr(essional means an individual 
:o1 9 ex*ange = comp5sation1 provides   
s]vices to an individual ) a disability 
7z def9$ 9 section #c ( ! ,am]icans )   

,disabilities ,act ( #aiij 7#db         
,u4,s4,c4 #abajb771 includ+--  7#a7     
s]vices t enhance indep5d5ce & community
 inclusion = su* individual1 includ+    
travel+ ) su* individual1 att5d+ &      
assi/+ su* individual :ile visit+ fri5ds
 & family1 %opp+1 or socializ+2  7#b7   
s]vices su* z coa*+ & support+ su*      
individual 9 communicat+ ne$s1 a*iev+   
self-expression1 pursu+ p]sonal goals1  
liv+ indep5d5tly1 & p>ticipat+ actively 
9 employm5t or volunt>y roles 9 !       
community2  7#c7 s]vices su* z provid+  
assi/ance ) activities ( daily liv+ 7su*
 z fe$+1 ba?+1 toilet+1 & ambulation7 & 
) tasks su* z meal prep>ation1 %opp+1   
light h\sekeep+1 & laundry2 or  7#d7    
s]vices t support su* individual at     
home1 "w1 s*ool1 or any o!r community   
sett+4  #bjc4 ,revision ( ,/&>d         
,occupational ,classification ,sy/em ,! 
,director ( ! ,(fice ( ,managem5t &     
,budget %all1 n lat] ?an #cj days aft] !
 date ( enactm5t ( ?is ,act1 revise !   
,/&>d ,occupational ,classification     

sy/em to e/abli% a sep>ate code         
7#ca-aabc7 = direct support pr(essionals
 z a heal?c>e support occupation4 ,su*  
code %all be a subset ( #ca-aabj1 :i*   
includes home heal? aides & p]sonal c>e 
aides4  ,,iii ,support = ! direct c>e   
work=ce  #cja4 ,def9itions ,9 ?is title3
  7#a7 ,appr5tice%ip program ,! t]m     
appr5tice%ip program means an           
appr5tice%ip program regi/]$ "u ! ,act (
 ,augu/ #af1 #aicg 7commonly kn[n z !   
,national ,appr5tice%ip ,act2 #ej ,/at4 
#ffd1 *apt] #ffc2 #bi ,u4,s4,c4 #ej et  
seq471 includ+ any requirem5t1 /&>d1 or 
rule promulgat$ "u su* ,act4  7#b7      
,community college ,! t]m community     
college means a public in/itution (     
high] education at :i* ! highe/ degree t
 is pr$om9antly aw>d$ to /ud5ts is an   
associate's degree1 includ+ ,tribal     
,colleges or ,univ]sities receiv+ grants
 "u section #caf ( ! ,high] ,education  
,act ( #aife 7#bj ,u4,s4,c4 #ajei;c7 t  
(f] a #b-ye> program = completion ( su* 
degree & ,/ate public in/itutions (     

high] education t (f] su* a #b-ye>      
program4  7#c7 ,direct c>e pr(essional  
,! t]m direct c>e pr(essional-- 7,a7    
means an individual :o1 9 ex*ange =     
comp5sation1 provides s]vices to a p]son
 ) a disability or an old] adult t      
promotes ! indep5d5ce ( su* p]son or    
individual1 includ+--  7i7 s]vices t    
enhance ! indep5d5ce & community        
inclusion = su* p]son or individual1    
includ+ travel+ ) su* p]son or          
individual or att5d+ & assi/+ su* p]son 
or individual :ile visit+ fri5ds &      
family1 %opp+1 or socializ+2  7ii7      
s]vices su* z coa*+ & support+ su* p]son
 or individual 9 communicat+ ne$s1      
a*iev+ self-expression1 pursu+ p]sonal  
goals1 liv+ indep5d5tly1 & p>ticipat+   
actively 9 employm5t or volunt>y roles 9
 ! community2  7iii7 s]vices su* z      
provid+ assi/ance ) activities ( daily  
liv+ 7su* z fe$+1 ba?+1 toilet+1 &      
ambulation7 & ) tasks su* z meal        
prep>ation1 %opp+1 light h\sekeep+1 &   
laundry2  7iv7 s]vices t support su*    

p]son or individual at home1 "w1 s*ool1 
or 9 any o!r community sett+2 or  7v7   
s]vices t promote heal? & wellness1     
includ+ s*$ul+ & tak+ su* p]son or      
individual to heal? c>e appo9tm5ts1     
communicat+ ) heal? & alli$ heal?       
pr(essionals adm9i/]+ m$ications1       
implem5t+ heal? & behavioral heal?      
int]v5tions & treatm5t plans1 monitor+ &
 record+ heal? /atus & progress2 &  7,b7
 may include--  7i7 a s]vice provid]    
support+ p ) intellectual disability &  
developm5tal disabilities1 & o!r        
disabilities2  7ii7 a home &            
community-bas$ s]vices manag] or direct 
support pr(essional manag]2  7iii7 a    
self-direct$ c>e work]2  7iv7 a p]sonal 
c>e s]vice work]2  7v7 a direct c>e     
work]1 z def9$ 9 section #gii;,b ( !    
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #biep72 or  7vi7 any o!r      
position or job relat$ to ! home c>e or 
direct c>e work=ce1 su* z positions or  
jobs 9 respite c>e1 palliative c>e1     
community support1 or pe] support1 z    

det]m9$ by ! ,secret>y1 9 consultation )
 ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices &
 ! ,secret>y ( ,labor4  7#d7 ,direct c>e
 work=ce ,! t]m direct c>e work=ce means
 ! broad work=ce ( direct c>e           
pr(essionals4  7#e7 ,family c>egiv] ,!  
t]m family c>egiv] has ! mean+ giv5 su* 
t]m 9 section #b ( ! ,,raise ,family    
,c>egiv]s ,act 7#db ,u4,s4,c4 #cjcjs    
note2 ,public ,law #aae-aai7 & includes 
paid & unpaid family c>egiv]s4  7#f7    
,eligible entity ,! t]m eligible entity 
means an entity-- 7,a7 t is--  7i7 a    
,/ate2  7ii7 a labor organization1 jo9t 
labor-managem5t organization1 or employ]
 ( direct c>e pr(essionals2  7iii7 a    
nonpr(it entity ) exp]i5ce 9 ag+1       
disability1 or support+ ! rights &      
int]e/s (1 tra9+ (1 or educat+ direct   
c>e pr(essionals or family c>egiv]s2    
7iv7 an ,indian ,tribe1 ,tribal         
organization1 or ,urban ,indian         
organization2  7v7 a community college  
or o!r in/itution ( high] education2 or 
7vi7 a consortium ( entities li/$ 9 any 

( clauses 7i7 ?r\gh 7v72  7,b7 t agrees 
to include1 z applicable ) respect to ! 
type ( grant ! entity is seek+ "u ?is   
title & ! activities support$ ?r\gh su* 
grant1 old] adults1 p ) disabilities1   
direct c>e pr(essionals1 & family       
c>egiv]s1 z advisors & tra9]s 9 su*     
activities2 &  7,c7 t agrees to consult 
) ! ,/ate ,m$icaid ag5cy ( ! ,/ate 7or  
ea* ,/ate7 s]v$ by ! grant on ! grant   
activities1 to ! ext5t t su* ag5cy 7or  
ea* su* ag5cy7 is n ! eligible entity4  
7#g7 ,employ] ,! t]ms employ & employ] h
 ! mean+s giv5 ! t]ms 9 section #c ( !  
,fair ,labor ,/&>ds ,act ( #aich 7#bi   
,u4,s4,c4 #bjc74  7#h7 ,indian ,tribe2  
,tribal organization ,! t]ms ,indian    
,tribe & ,tribal organization h ! mean+s
 giv5 su* t]ms 9 section #d ( ! ,indian 
,self-,det]m9ation & ,education         
,assi/ance ,act 7#be ,u4,s4,c4 #ecjd74  
7#i7 ,in/itution ( high] education ,!   
t]m in/itution ( high] education means--
 7,a7 an in/itution ( high] education   
def9$ 9 section #aja ( ! ,high]         

,education ,act ( #aife 7#bj ,u4,s4,c4  
#ajja72 or  7,b7 an in/itution ( high]  
education def9$ 9 section               
#ajb7;a77#a77;,b7 ( su* ,act 7#bj       
,u4,s4,c4 #ajjb7;a77#a77;,b774  7#aj7   
,old] adult ,! t]m old] adult means an  
individual :o is #fj ye>s ( age or old]4
  7#aa7 ,p]son ) a disability ,! t]m    
p]son ) a disability means an individual
 ) a disability1 z def9$ 9 section #c ( 
! ,am]icans ) ,disabilities ,act ( #aiij
 7#db ,u4,s4,c4 #abajb74  7#ab7 ,project
 p>ticipant ,! t]m project p>ticipant   
means an individual p>ticipat+ 9 a      
project or activity assi/$ ) a grant "u 
?is title1 includ+ 7z applicable = !    
category ( ! grant7 a direct c>e        
pr(essional1 or an individual tra9+ to  
be su* a pr(essional1 or a family       
c>egiv]4  7#ac7 ,secret>y ,! t]m        
,secret>y means ! ,secret>y ( ,heal? &  
,human ,s]vices1 act+ ?r\gh !           
,adm9i/rator = ,community ,liv+4  7#ad7 
,self-direct$ c>e pr(essional ,! t]m    
self-direct$ c>e pr(essional means a    

direct c>e pr(essional :o is employ$ by 
an individual :o is an old] adult1 a    
p]son ) a disability1 or a repres5tative
 ( su* old] adult or p]son ) a          
disability1 & su* old] adult or p]son ) 
a disability has ! decision-mak+        
au?ority ov] c]ta9 supports & s]vices   
provid$ by ! direct c>e pr(essional &   
takes direct responsibility to manage ^?
 supports & s]vices4  7#ae7 ,supportive 
s]vices ,! t]m supportive s]vices means 
s]vices t are necess>y to enable an     
individual to p>ticipate 9 activities   
assi/$ ) a grant "u ?is title1 su* z    
transportation1 *ild c>e1 dep5d5t c>e1  
h\s+1 workplace accommodations1 employee
 b5efits su* z paid sick leave & *ild   
c>e1 workplace heal? & safety           
protections1 wages & ov]time pay1 &     
ne$s-relat$ paym5ts4  7#af7 ,urban      
indian organization ,! t]m urban ,indian
 organization has ! mean+ giv5 ! t]m 9  
section #d ( ! ,indian ,heal? ,c>e      
,improvem5t ,act 7#be ,u4,s4,c4 #afjc74 
7#ag7 ,work=ce innovation & opportunity 

act t]ms ,! t]ms c>e] pa?way1 c>e]      
plann+1 9-dem& indu/ry sector or        
occupation1 individual ) a b>ri] to     
employm5t1 local bo>d1 on-!-job tra9+1  
recogniz$ po/second>y cr$5tial1 region1 
& ,/ate bo>d h ! mean+s giv5 su* t]ms 9 
section #c ( ! ,work=ce ,innovation &   
,opportunity ,act 7#bi ,u4,s4,c4 #cajb74
  7#ah7 ,"w-bas$ le>n+ ,! t]m "w-bas$   
le>n+ has ! mean+ giv5 ! t]m 9 section  
#c ( ! ,c>l ,d4 ,p]k9s ,c>e] & ,te*nical
 ,education ,act ( #bjjf 7#bj ,u4,s4,c4 
#bcjb74  #cjb4 ,au?ority to e/abli% a   
te*nical assi/ance c5t] = build+ !      
direct c>e work=ce  7a7 ,program        
au?oriz$ ,! ,secret>y %all e/abli% a    
national te*nical assi/ance c5t] 7ref]r$
 to 9 ?is section z ! ,c5t]7 =1 9       
consultation ) ! ,secret>y ( ,labor1 !  
,secret>y ( ,education1 ! ,adm9i/rator (
 ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices1 
& ! heads ( o!r entities z necess>y--   
7#a7 support+ direct c>e work=ce        
creation1 tra9+ & education1 recruitm5t1
 ret5tion1 & advancem5t2 &  7#b7        

support+ family c>egiv]s & activities ( 
family c>egiv]s z a critical "p ( !     
support team = old] adults or p )       
disabilities4  7b7 ,advisory c\ncil ,!  
,secret>y %all conv5e an advisory c\ncil
 to provide recomm5dations to ! ,c5t] ) 
respect to ! duties ( ! ,c5t] "u ?is    
section & may engage individuals &      
entities describ$ 9 p>agraphs 7#c77;,b71
 & 7#ab71 ( section #cjd7;b7 7)\t reg>d 
to a specific project describ$ 9 su*    
p>agraphs7 = s]vice on ! advisory       
c\ncil4  7c7 ,activities ,! ,c5t] may-- 
7#a7 develop recomm5dations = tra9+ &   
education curricula = direct c>e        
pr(essionals1 :i* su* recomm5dations may
 include recomm5dations = curricula =   
high] education1 po/second>y cr$5tials1 
& programs ) community colleges2  7#b7  
develop le>n+ & dissem9ation /rategies  
to-- 7,a7 engage ,/ates & o!r entities 9
 activities support$ "u ?is title & be/ 
practices2 &  7,b7 di/ribute f9d+s f    
activities support$ by grants "u ?is    
title2  7#c7 develop recomm5dations =   

tra9+ & education curricula & o!r       
/rategies = support+ family c>egiv]s2   
7#d7 explore ! national data gaps1      
work=ce %ortage areas1 & data collection
 /rategies = direct c>e pr(essionals &  
make recomm5dations to ! ,director ( !  
,(fice ( ,managem5t & ,budget = an      
occupation category 9 ! ,/&>d           
,occupational ,classification sy/em =   
direct support pr(essionals z a heal?c>e
 support occupation2  7#e7 recomm5d c>e]
 developm5t & advancem5t opportunities =
 direct c>e pr(essionals1 :i* may       
include occupational frameworks1        
national /&>ds1 recruitm5t campaigns1   
pre-appr5tice%ip & on-!-job tra9+       
opportunities1 appr5tice%ip programs1   
c>e] ladd]s or pa?ways1 specializations 
or c]tifications1 or o!r activities2 &  
7#f7 develop /rategies = assi/+ )       
report+ & evaluation ( grant activities 
"u section #cje4  #cjc4 ,au?ority to    
aw>d grants  7a7 ,grants  7#a7 ,9 g5]al 
,n lat] ?an #ab mon?s aft] ! date (     
enactm5t ( ?is title1 ! ,secret>y1 9    

consultation ) ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices1 ! ,secret>y ( ,labor1
 & ! ,secret>y ( ,education1 %all aw>d  
grants describ$ 9 p>agraph 7#b7 to      
eligible entities4 ,a grant aw>d$ "u ?is
 section may be 9 m ?an #a category     
describ$ 9 su* p>agraph4  7#b7          
,categories ( grants ,! categories (    
grants describ$ 9 ?is p>agraph are ea* (
 ! foll[+3 7,a7 ,direct c>e pr(essional 
grants ,grants to eligible entities to  
create & c>ry out projects = ! purposes 
( recruit+1 reta9+1 or provid+          
advancem5t opportunities = direct c>e   
pr(essionals :o are n describ$ 9        
subp>agraph 7,b7 or 7,c71 includ+ ?r\gh 
education or tra9+ programs = su*       
pr(essionals or individuals seek+ to    
become su* pr(essionals4  7,b7 ,direct  
c>e pr(essional manag]s grants ,grants  
to eligible entities to create & c>ry   
out projects = ! purposes ( recruit+1   
reta9+1 or provid+ advancem5t           
opportunities = direct c>e pr(essionals 
:o are manag]s or sup]visory /aff t h   

coa*+1 tra9+1 manag]ial1 sup]visory1 or 
o!r ov]sight responsibilities1 includ+  
?r\gh education or tra9+ programs = su* 
pr(essionals or individuals seek+ to    
become su* pr(essionals4  7,c7          
,self-direct$ c>e pr(essionals grants   
,grants to eligible entities to create &
 c>ry out projects = ! purposes (       
recruit+1 reta9+1 or provid+ advancem5t 
opportunities = self-direct$ c>e        
pr(essionals1 includ+ ?r\gh education or
 tra9+ programs = su* pr(essionals or   
individuals seek+ to become su*         
pr(essionals4  7,d7 ,family c>egiv]     
grants ,grants to eligible entities to  
create & c>ry out projects = provid+    
support to paid or unpaid family        
c>egiv]s ?r\gh educational1 tra9+1 or   
o!r res\rces1 includ+ res\rces = c>egiv]
 self-c>e or educational or tra9+       
res\rces = individuals newly 9 a c>egiv+
 role or seek+ additional support 9 !   
role ( a family c>egiv]4  7#c7 ,projects
 = advancem5t opportunities ,n less ?an 
#cj p]c5t ( projects assi/$ ) grants "u 

?is title %all be projects to provide   
c>e] pa?ways t (f] opportunities =      
pr(essional developm5t & advancem5t     
opportunities to direct c>e             
pr(essionals4  7b7 ,treatm5t (          
cont9uation activities ,an eligible     
entity t c>ries out activities describ$ 
9 subsection 7a77#b7 prior to receipt ( 
a grant "u ?is title may use su* grant  
to cont9ue c>ry+ out su* activities1 &1 
9 us+ su* grant to cont9ue su*          
activities1 %all be treat$ z an eligible
 entity c>ry+ out a project ?r\gh a     
grant "u ?is title4  #cjd4 ,project     
plans  7a7 ,9 g5]al ,an eligible entity 
seek+ a grant "u ?is title %all submit  
to ! ,secret>y a project plan = ea*     
project to be develop$ & c>ri$ out 7or =
 activities to be cont9u$ z describ$ 9  
section #cjc7;b77 ) ! grant at su* "t1 9
 su* mann]1 & conta9+ su* in=mation z ! 
,secret>y may require4  7b7 ,cont5ts ,a 
project plan submitt$ by an eligible    
entity "u subsection 7a7 %all include a 
description ( in=mation det]m9$ relevant

 by ! ,secret>y = purposes ( ! category 
( ! grant & ! activities to be c>ri$ out
 ?r\gh ! grant4 ,su* in=mation may      
include 7z applicable7 ! foll[+3 7#a7 ,!
 demographics 7z def9$ 9 section #b7 ( !
 population 9 ! ,/ate or relevant       
geographic area1 includ+ a description (
 ! populations likely to ne$ long-t]m   
c>e s]vices1 su* z p ) disabilities &   
old] adults4  7#b7 ,projections ( unmet 
ne$ = s]vices provid$ by direct c>e     
pr(essionals bas$ on enrollm5t wait+    
li/s "u home & community-bas$ waiv]s "u 
section #aaae ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acae7 or section #aiae 
( su* ,act 7#db ,u4,s4,c4 #acifn7 & o!r 
relevant data to ! ext5t practicable &  
feasible1 su* z direct c>e work=ce      
vacancy rates1 crude sep>ation rates1 & 
! numb] ( direct c>e pr(essionals1      
includ+ su* pr(essionals :o are manag]s 
or sup]visors1 9 ! region4  7#c7 ,an    
advisory committee to advise ! eligible 
entity on activities to be c>ri$ out    
?r\gh ! grant4 ,su* advisory committee--

  7,a7 may be compris$ ( entities li/$ 9
 p>agraph 7#ab72 &  7,b7 %all include-- 
7i7 old] adults or p]sons ) a           
disability2  7ii7 organizations         
repres5t+ ! rights & int]e/s ( p receiv+
 s]vices by ! direct c>e pr(essionals or
 family c>egiv]s t>get$ by ! project2   
7iii7 individuals :o are direct c>e     
pr(essionals or family c>egiv]s t>get$  
by ! project & organizations repres5t+ !
 rights & int]e/s ( direct c>e          
pr(essionals or family c>egiv]s2  7iv7 z
 applicable1 employ]s ( individuals     
describ$ 9 clause 7iii7 & labor         
organizations repres5t+ su* individuals2
  7v7 repres5tatives ( ! ,/ate ,m$icaid 
ag5cy1 ! ,/ate ag5cy def9$ 9 section    
#ajb ( ! ,old] ,am]icans ,act ( #aife   
7#db ,u4,s4,c4 #cjjb71 ! ,/ate          
developm5tal disabilities (fice1 & !    
,/ate behavioral heal? ag5cy1 9 ! ,/ate 
7or ea* ,/ate7 to be s]v$ by ! project2 
&  7vi7 repres5tatives reflect+ div]se  
racial1 cultural1 e?nic1 geographic1    
socioeconomic1 & g5d] id5tity & sexual  

ori5tation p]spectives4  7#d7 ,curr5t or
 project$ job op5+s =1 or relevant labor
 m>ket in=mation relat$ to1 ! direct c>e
 pr(essionals t>get$ by ! project 9 !   
,/ate or region to be s]v$ by ! project1
 & ! geographic scope ( ! work=ce to be 
s]v$ by ! project4  7#e7 ,specific ef=ts
 & /rategies t ! project w und]take to  
r$uce b>ri]s to recruitm5t1 ret5tion1 or
 advancem5t ( ! direct c>e pr(essionals 
t>get$ by ! project1 includ+ an         
assurance t su* ef=ts w include--  7,a7 
an assessm5t ( ! wages or o!r           
comp5sation or b5efits necess>y to      
recruit & reta9 ! direct c>e            
pr(essionals t>get$ by ! project2  7,b7 
a description ( ! project's project$    
comp5sation or b5efits = ! direct c>e   
pr(essionals t>get$ by ! project at !   
,/ate or local level1 includ+ a         
comp>ison ( su* project$ comp5sation or 
b5efits to regional & national          
comp5sation or b5efits & a description (
 h[ wages & b5efits receiv$ by project  
p>ticipants w be impact$ by !           

p>ticipation 9 & completion ( ! project2
 &  7,c7 a description ( ! project$     
impact ( workplace safety issues on !   
recruitm5t & ret5tion ( direct c>e      
pr(essionals t>get$ by ! project1       
includ+ ! availability ( p]sonal        
protective equipm5t4  7#f7 ,9 ! case ( a
 project (f]+ an education or tra9+     
program = direct c>e pr(essionals1 a    
description ( su* program 7includ+ h[ ! 
core compet5cies id5tifi$ by ! ,c5t]s = 
,m$ic>e  ,m$icaid ,s]vices w be         
incorporat$1 curricula1 models1 & /&>ds 
us$ "u ! program1 & any associat$       
recogniz$ po/second>y cr$5tials = :i* ! 
program provides prep>ation1 z          
applicable71 :i* %all include an        
assurance t su* program w provide to ea*
 project p>ticipant 9 su* program--     
7,a7 relevant tra9+ reg>d+ ! rights (   
recipi5ts ( home & community bas$       
s]vices1 includ+ _! rights to-- 7i7     
receive s]vices 9 integrat$ sett+s t    
provide access to ! broad] community2   
7ii7 ex]cise self-det]m9ation2  7iii7 be

 free f all =ms ( abuse1 neglect1 or    
exploitation2 &  7iv7 p]son-c5t]$ plann+
 & practices1 includ+ p>ticipation 9    
plann+ activities2  7,b7 relevant tra9+ 
to ensure t ea* project p>ticipant has !
 necess>y skills to recognize abuse &   
und]/& _! obligations ) reg>d to report+
 & respond+ to abuse appropriately 9    
accordance ) relevant ,f$]al & ,/ate    
law2  7,c7 relevant tra9+ reg>d+ !      
provision ( culturally compet5t &       
disability compet5t supports to         
recipi5ts ( s]vices provid$ by ! direct 
c>e pr(essionals t>get$ by ! project2   
7,d7 an appr5tice%ip program1 "w-bas$   
le>n+1 or on-!-job tra9+ opportunities2 
7,e7 sup]vision or m5tor+2 &  7,f7 = any
 on-!-job tra9+ portion ( ! program1 a  
progressively increas+1 cle>ly def9$    
s*$ule ( wages to be paid to ea* su*    
p>ticipant t--  7i7 is consi/5t ) skill 
ga9s or atta9m5t ( a recogniz$          
po/second>y cr$5tial receiv$ z a result 
( p>ticipation 9 or completion ( su*    
program2 &  7ii7 ensures ! entry wage is

 n less ?an ! great] (--  7,i7 ! m9imum 
wage requir$ "u section #f7;a7 ( ! ,fair
 ,labor ,/&>ds ,act ( #aich 7#bi        
,u4,s4,c4 #bjf7;a772 or  7,,ii7 !       
applicable wage requir$ by o!r          
applicable ,f$]al or ,/ate law1 or a    
collective b>ga9+ agreem5t4  7#g7 ,any  
o!r innovative models or processes !    
eligible entity w implem5t to support ! 
ret5tion & c>e] advancem5t ( ! direct   
c>e pr(essionals t>get$ by ! project4   
7#h7 ,! supportive s]vices & b5efits to 
be provid$ to ! project p>ticipants 9   
ord] to support ! employm5t1 ret5tion1  
or c>e] advancem5t ( ! direct c>e       
pr(essionals t>get$ by ! project4  7#i7 
,h[ ! eligible entity w make use ( c>e] 
plann+ to support ! id5tification (     
advancem5t opportunities & c>e] pa?ways 
= ! direct c>e pr(essionals 9 ! ,/ate or
 region to be s]v$ by ! project4  7#aj7 
,h[ ! eligible entity w collect & submit
 to ! ,secret>y work=ce data & outcomes 
( ! project4  7#aa7 ,h[ ! project-- 7,a7
 w--  7i7 provide adequate & safe       

equipm5t & facilities = tra9+ &         
sup]vision1 includ+ a safe "w environm5t
 free f discrim9ation1 :i* may include !
 provision ( p]sonal protective equipm5t
 & o!r necess>y equipm5t to prev5t !    
spread ( infecti\s disease among !      
direct c>e pr(essionals t>get$ by !     
project & recipi5ts ( s]vices provid$ by
 su* pr(essionals2  7ii7 incorporate    
remote tra9+ & education opportunities  
or te*nology-support$ opportunities2    
7iii7 = tra9+ & education curricula1    
incorporate evid5c$-support$ practices =
 adult le>n]s & univ]sal design = le>n+ 
& ensure recipi5ts ( s]vices provid$ by 
! direct c>e pr(essionals or family     
c>egiv]s t>get$ by ! project p>ticipate 
9 ! developm5t & implem5tation ( su*    
tra9+ & education curricula2  7iv7 use  
outrea*1 recruitm5t1 & ret5tion         
/rategies design$ to rea* & reta9 a     
div]se work=ce2  7v7 incorporate me?ods 
to monitor satisfaction ) project       
activities = project p>ticipants &      
individuals receiv+ s]vices f su*       

p>ticipants2  7vi7 incorporate          
evid5ce-support$ practices = family     
c>egiv] engagem5t2 &  7vii7 incorporate 
core compet5cies id5tifi$ by ! ,c5t]s = 
,m$ic>e  ,m$icaid ,s]vices2 &  7,b7 may 
incorporate cont9u+ education programs &
 specialty tra9+1 ) a specific focus    
on--  7i7 trauma-in=m$ c>e2  7ii7       
behavioral heal?1 includ+ co-occurr+    
behavioral heal? conditions &           
intellectual or developm5tal            
disabilities2  7iii7 ,alzheim]'s &      
dem5tia c>e2  7iv7 *ronic disease       
managem5t2 &  7v7 ! use ( supportive or 
assi/ive te*nology4  7#ab7 ,h[ !        
eligible entity w consult on !          
implem5tation ( ! project1 or coord9ate 
! project )1 ea* ( ! foll[+ entities1 to
 ! ext5t t ea* su* entity is n !        
eligible entity3  7,a7 ,! ,/ate ,m$icaid
 ag5cy1 ,/ate ag5cy def9$ 9 section #ajb
 ( ! ,old] ,am]icans ,act ( #aife 7#db  
,u4,s4,c4 #cjjb71 & ! ,/ate developm5tal
 disabilities (fice = ! ,/ate 7or ea*   
,/ate7 to be s]v$ by ! project4  7,b7 ,!

 local bo>d & ,/ate bo>d = ea* region1  
or ,/ate1 to be s]v$ by ! project4  7,c7
 ,9 ! case ( a project t c>ries out an  
education or tra9+ program1 a nonpr(it  
organization ) demon/rat$ exp]i5ce 9 !  
developm5t or deliv]y ( curricula or    
c\rsework4  7,d7 ,a nonpr(it            
organization1 includ+ a labor           
organization1 t fo/]s ! pr(essional     
developm5t & collective engagem5t ( !   
direct c>e pr(essionals t>get$ by !     
project4  7,e7 ,area ag5cies on ag+1 z  
def9$ 9 section #ajb ( ! ,old] ,am]icans
 ,act ( #aife 7#db ,u4,s4,c4 #cjjb74    
7,f7 ,c5t]s = indep5d5t liv+1 z describ$
 9 "p ,c ( title ,,vii ( !              
,rehabilitation ,act ( #aigc 7#bi       
,u4,s4,c4 #gif;f et seq474  7,g7 ,!     
,/ate ,c\ncil on ,developm5tal          
,disabilities 7z su* t]m is us$ 9       
subtitle ,b ( title ,i ( ! ,developm5tal
 ,disabilities ,assi/ance & ,bill (     
,rights ,act ( #bjjj 7#db ,u4,s4,c4     
#aejba et seq477 = ! ,/ate 7or ea*      
,/ate7 to be s]v$ by ! project4  7,h7   

,ag+ & ,disability ,res\rce ,c5t]s 7z   
def9$ 9 section #ajb ( ! ,old] ,am]icans
 ,act ( #aife 7#db ,u4,s4,c4 #cjjb774   
7,i7 ,a nonpr(it ,/ate provid]          
association t repres5ts provid]s :o     
employ ! direct c>e pr(essionals t>get$ 
by ! project1 :]e su* associations exi/4
  7,j7 ,an entity t employs ! direct c>e
 pr(essionals t>get$ by ! project4  7,k7
 ,univ]sity ,c5t]s = ,excell5ce 9       
,developm5tal ,disabilities ,education1 
,rese>*1 & ,s]vices support$ "u subtitle
 ,d ( title ,i ( ! ,developm5tal        
,disabilities ,assi/ance & ,bill (      
,rights ,act ( #bjjj 7#db ,u4,s4,c4     
#aejfa et seq474  7,l7 ,! ,/ate         
protection & advocacy sy/em describ$ 9  
section #adc ( su* ,act 7#db ,u4,s4,c4  
#aejdc7 ( ! ,/ate 7or ea* ,/ate7 to be  
s]v$ by ! project4  7,m7 ,direct c>e    
pr(essionals or direct c>e work=ce      
organizations repres5t+ und]s]v$        
communities1 includ+ communities (      
color4  7#ac7 ,h[ ! eligible entity w   
consult ?r\gh\t ! project )--  7,a7     

individuals employ$ or work+ z ! direct 
c>e pr(essionals or family c>egiv]s     
t>get$ by ! project2  7,b7              
repres5tatives ( su* pr(essionals or    
c>egiv]s2  7,c7 individuals assi/$ by   
su* pr(essionals or c>egiv]s2  7,d7 !   
families ( su* pr(essionals or c>egiv]s2
 &  7,e7 individuals receiv+ education  
or tra9+ to become su* pr(essionals or  
c>egiv]s4  7#ad7 ,outrea* ef=ts to      
individuals = p>ticipation 9 su*        
project1 includ+ t>get$ outrea* ef=ts   
to--  7,a7 individuals :o are recipi5ts 
( assi/ance "u a ,/ate program fund$ "u 
"p ,a ( title ,,iv ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #fja et seq47 or   
individuals :o are eligible = su*       
assi/ance2 &  7,b7 individuals ) b>ri]s 
to employm5t4  7c7 ,consid]ations ,9    
select+ eligible entities to receive a  
grant "u ?is title1 ! ,secret>y %all    
ensure-- 7#a7 equitable geographic      
div]sity1 includ+ by select+ recipi5ts  
s]v+ rural areas & select+ recipi5ts    
s]v+ urban areas2 &  7#b7 t select$     

eligible entities w s]ve areas :]e !    
occupation ( direct c>e pr(essional1 or 
a relat$ occupation1 is an 9-dem&       
indu/ry sector or occupation4  7d7 ,uses
 ( funds2 supplem5t1 n supplant  7#a7   
,uses ( funds  7,a7 ,9 g5]al ,ea*       
eligible entity receiv+ a grant "u ?is  
title %all use ! funds ( su* grant to   
c>ry out at lea/ #a project describ$ 9  
section #cjc7;a77#b74  7,b7             
,adm9i/rative co/s ,ea* eligible entity 
receiv+ a grant "u ?is title %all n use 
m ?an #e p]c5t ( ! funds ( su* grant =  
co/s associat$ ) ! adm9i/ration (       
activities "u ?is title4  7,c7 ,direct  
support ,ea* eligible entity receiv+ a  
grant "u ?is title %all use n less ?an  
#e p]c5t ( ! funds ( su* grant to       
provide direct f9ancial b5efits or      
supportive s]vices to direct c>e        
pr(essionals & paid or unpaid family    
c>egiv]s to support ! f9ancial ne$s (   
su* p>ticipants dur+ ! duration ( !     
project activities4  7#b7 ,supplem5t1 n 
supplant ,an eligible entity receiv+ a  

grant "u ?is title %all use su* grant   
only to supplem5t1 & n supplant1 ! am\nt
 ( funds t1 9 ! abs5ce ( su* grant1 w\ld
 be available to address ! recruitm5t1  
tra9+ & education1 ret5tion1 &          
advancem5t ( direct c>e pr(essionals or 
provide support = family c>egiv]s1 9 !  
,/ate or region s]v$ by ! eligible      
entity4  7#c7 ,prohibition ,no am\nts   
made available "u ?is title may be us$ =
 any activity t is subject to ! report+ 
requirem5ts set =? 9 section #bjc7;a7 ( 
! ,labor-,managem5t ,report+ &          
,disclosure ,act ( #aiei 7#bi ,u4,s4,c4 
#dcc7;a774  #cje4 ,evaluations &        
reports2 te*nical assi/ance  7a7        
,report+ requirem5ts by grant recipi5ts 
7#a7 ,9 g5]al ,an eligible entity       
receiv+ a grant "u ?is title %all       
coop]ate ) ! ,secret>y & annually       
provide a report to ! ,secret>y t       
includes any relevant data reque/$ by ! 
,secret>y 9 a mann] specifi$ by !       
,secret>y4  7#b7 ,cont5ts ,! data       
reque/$ by ! ,secret>y = an annual      

report may include any ( ! foll[+ 7z    
det]m9$ relevant by ! ,secret>y )       
respect to ! category ( ! grant & ea*   
project support$ ?r\gh ! grant73  7,a7  
,! numb] ( individuals & ! demographic  
categories 7z def9$ 9 section #b7 s]v$  
by ea* project support$ by ! grant1     
includ+-- 7i7 ! numb] ( individuals     
recruit$ ?r\gh ea* su* project to be    
employ$ z a direct c>e pr(essional2     
7ii7 ! numb] ( individuals :o ?r\gh ea* 
su* project atta9$ employm5t z a direct 
c>e pr(essional2 &  7iii7 ! numb] (     
individuals :o enroll$ 9 ea* su* project
 & )drew or 7 t]m9at$ f ea* su* project 
)\t complet+ tra9+ or atta9+ employm5t z
 a direct c>e pr(essional4  7,b7 ,!     
numb] ( family c>egiv]s p>ticipat+ 9 an 
education or tra9+ program ?r\gh ea*    
project support$ by ! grant4  7,c7 ,!   
numb] ( project p>ticipants :o ?r\gh ea*
 su* project p>ticipat$ 9 & complet$--  
7i7 "w-bas$ le>n+2  7ii7 on-!-job tra9+2
  7iii7 an appr5tice%ip program2 or     
7iv7 a pr(essional developm5t or m5tor+ 

program4  7,d7  7i7 ,o!r s]vices1       
b5efits1 or supports 7o!r ?an ! s]vices1
 b5efits1 or supports describ$ 9        
subp>agraph 7,c77 provid$ ?r\gh ea* su* 
project to assi/ 9 ! recruitm5t1        
ret5tion1 or advancem5t ( direct c>e    
pr(essionals 7includ+ ?r\gh education or
 tra9+ = su* pr(essionals or individuals
 seek+ to become su* pr(essionals72     
7ii7 ! numb] ( individuals :o access$   
su* s]vices1 b5efits1 or supports2 &    
7iii7 ! impact ( su* s]vices1 b5efits1  
or supports4  7,e7 ,! crude sep>ation & 
vacancy rates ( direct c>e pr(essionals1
 & su* rates = ^? pr(essionals :o are   
manag]s or sup]visors1 9 ! geographic   
region = a numb] ( ye>s be=e ! grant 0  
aw>d$1 z det]m9$ by ! ,secret>y1 &      
annually !reaft] = ! duration ( ! grant 
p]iod4  7,f7 ,h[ ea* project support$ by
 ! grant assess$ satisfaction ) respect 
to-- 7i7 project p>ticipants assi/$ by !
 project2  7ii7 individuals receiv+     
s]vices deliv]$ by project p>ticipants1 
includ+-- 7,i7 any impact on ! heal? or 

heal? outcomes ( su* individuals2 &     
7,,ii7 any impact on ! ability (        
individuals to transition to or rema9 9 
! community 9 an environm5t t meets !   
crit]ia e/abli%$ 9 ! section            
#dda4cja7;c77#d7 ( title #db1 ,code (   
,f$]al ,regulations 7or successor       
regulations72 &  7iii7 employ]s ( su*   
project p>ticipants4  7,g7 ,! p]=mance (
 ! eligible entity ) respect to !       
indicators ( p]=mance on unsubsidiz$    
employm5t1 m$ian e>n+s1 cr$5tial        
atta9m5t1 measurable skill ga9s1 &      
employ] satisfaction4  7,h7 ,any o!r    
in=mation ) respect to outcomes ( !     
project z det]m9$ by ! ,secret>y4  7b7  
,annual report to ,congress by ,secret>y
 ,n lat] ?an #b ye>s aft] ! date (      
enactm5t ( ?is title1 & ea* ye> !reaft] 
until all projects support$ ?r\gh a     
grant "u ?is title are complet$1 !      
,secret>y %all prep>e & submit to       
,congress an annual report on ! progress
 ( ea* project support$ ?r\gh a grant "u
 ?is title & ! activities ( ! te*nical  

assi/ance c5t] e/abli%$ "u section #cjb4
  7c7 ,,gao report ,n lat] ?an #a ye>   
aft] ! date on :i* all projects support$
 ?r\gh a grant "u ?is title are         
complet$1 ! ,comptroll] ,g5]al ( !      
,unit$ ,/ates %all conduct a /udy &     
submit to ,congress a report includ+--  
7#a7 an assessm5t ( h[ ! te*nical       
assi/ance c5t] e/abli%$ "u section #cjb 
& ! projects support$ ?r\gh a grant "u  
?is title assi/$ 9 ! creation1          
recruitm5t1 tra9+ & education1 ret5tion1
 & advancem5t ( ! direct c>e work=ce or 
9 provid+ support = family c>egiv]s2 &  
7#b7 recomm5dations = su* legislative or
 adm9i/rative actions ne$$ = improv+ !  
assi/ance describ$ 9 p>agraph 7#a71 z ! 
,comptroll] ,g5]al det]m9es appropriate4
  7d7 ,indep5d5t evaluations ,n lat] ?an
 #f mon?s aft] ! date ( enactm5t ( ?is  
title1 ! ,secret>y %all ent] into a     
contract ) an indep5d5t entity to       
provide indep5d5t evaluations (         
activities support$ by grants "u ?is    
title & activities ( ! te*nical         

assi/ance c5t] e/abli%$ "u section #cjb4
  #cjf4 ,au?orization ( appropriations  
7a7 ,9 g5]al ,!re are au?oriz$ to be    
appropriat$--  7#a7 = ! e/abli%m5t &    
activities ( ! te*nical assi/ance c5t]  
"u section #cjb1 #b1jjj1jjj = ea* (     
fiscal ye>s #bjbd ?r\gh #bjbh2 &  7#b7 =
 grants "u section #cjc1 #a1jjj1jjj1jjj 
= fiscal ye> #bjbd4  7b7 ,availability  
,am\nts made available "u ?is title %all
 rema9 available until ,septemb] #cj1   
#bjcc4  ,,iv ,evaluation  #dja4         
,evaluation ( impact on access to ,,hcbs
  7a7 ,national survey on exp&$ ,,hcbs  
access ,! ,adm9i/rator ( ! ,c5t]s =     
,m$ic>e  ,m$icaid ,s]vices1 9           
coord9ation ) ! ,national ,academy (    
,m$ic9e1 %all1 n lat] ?an #g ye>s aft] !
 date ( enactm5t ( ?is ,act1 conduct or 
contract = a national survey ( ,/ates1  
direct c>e pr(essionals1 family         
c>egiv]s1 & provid]s & recipi5ts ( home 
& community-bas$ s]vices1 to det]m9e !  
effects ( ! implem5tation ( ?is ,act & !
 am5dm5ts made by ?is ,act on--  7#a7 ! 

availability & access to home &         
community-bas$ s]vices "u ! ,m$icaid    
program nationally & 9 ea* ,/ate2  7#b7 
! capacity ( ! direct s]vice work=ce to 
provide home & community-bas$ s]vices & 
in=mation on ! demographics 7z def9$ 9  
section #b7 ( su* work=ce2  7#c7 !      
comp5sation & work+ conditions1 includ+ 
s*$ul+ & b5efits1 ( direct c>e work]s2  
7#d7 ! economic effects on b5efici>ies &
 on families ) a memb] receiv+ home &   
community-bas$ s]vices ?r\gh ,m$icaid2  
7#e7 ! availability ( direct c>e work]s 
& s]vices = p ne$+ long-t]m s]vices &   
supports :o are n ,m$icaid eligible2    
7#f7 family c>egiv]s2 &  7#g7           
recomm5dations = measures to fur!r exp& 
& enhance access home & community-bas$  
s]vices4  7b7 ,report ,n lat] ?an #i    
ye>s aft] ! date ( enactm5t ( ?is ,act1 
! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e     
,m$icaid ,s]vices %all publi% a report  
conta9+ ! results ( ! survey conduct$ "u
 subsection 7a74  7c7 ,am]ican          
,community ,survey addition ,! ,secret>y

 ( ,comm]ce1 act+ ?r\gh ! ,bureau ( !   
,c5sus1 %all add to ! ,am]ican          
,community ,survey a "q design$ to      
id5tify ! ne$ = long-t]m s]vices &      
supports by resid5ts ( ! ,unit$ ,/ates4 
7d7 ,au?orization ( appropriations ,!re 
are au?oriz$ to be appropriat$ to !     
,secret>y su* sums z are necess>y to    
c>ry out ?is section4