,,ii #aaith ,,congress #b;d ,session ,s4 #ecba ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,august #f1 #bjbf,mr4 ,lujn 7for himself1 ,mr4 ,kaine1 ,ms4 ,baldwin1 ,ms4 ,duckworth1 ,mrs4 ,gillibrand1 ,ms4 ,hassan1 ,mr4 ,blumenthal1 ,mr4 ,merkley1 ,mr4 ,sanders1 ,ms4 ,warren1 ,mr4 ,reed1 ,mr4 ,markey1 ,mrs4 ,shaheen1 ,mr4 ,fetterman1 ,mr4 ,kim1 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 program 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 caregivers 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 plan4,sec4 #aje4 ,quality of services4,sec4 #ajf4 ,reports2 technical assistance2 other administrative requirements4,sec4 #ajg4 ,quality measurement and improvement4,sec4 #ajh4 ,making permanent the extended 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,sec4 #aaj4 ,liens1 adjustments1 and recoveries for medical assistance4,sec4 #aaa4 ,,hcbs provider tax4,sec4 #aab4 ,medicare amendment4,,title ,,ii--,recognizing the ,role of ,direct ,support ,professionals,sec4 #bja4 ,findings4,sec4 #bjb4 ,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 ,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 deny access to the promise of community inclusion guaranteed under the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abaja et seq47 for individuals with disabilities and older adults4 7#b7 ,to build on decades of progress in serving individuals with disabilities and older adults through access to ,,hcbs4 7#c7 ,to fulfill the purposes of the ,medicaid program to provide medical assistance for individuals 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 individuals attain or retain capacity for independence or self-care4 7#d7 ,to ensure that individuals with all kinds of disabilities and with multiple disabilities1 including intellectual disabilities1 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 waivers of their respective ,state plans for medical assistance4 7#f7 ,to continue to increase the capacity of community services to ensure individuals with disabilities and older adults have high-quality1 safe1 and meaningful options to receive care in their community and are not at risk of unnecessary institutionalization4 7#g7 ,to act on the decades of research and practice that show that everyone1 including individuals with the most severe disabilities1 can live in the community with the right services and supports4 7#h7 ,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 7#i7 ,to support over #fc1jjj1jjj unpaid family caregivers1 who are disproportionately women and often providing complex services and supports to older adults and individuals with disabilities because of a lack of affordable services1 workforce shortages1 and other inefficiencies4 7#aj7 ,to improve direct care quality and ensure access to services by improving workforce standards for the nearly #c1bjj1jjj direct care workers1 who are primarily women1 people of color1 and immigrants facing heightened risks of discrimination in employment1 providing support to individuals with disabilities and older adults in their homes and communities4 #ajb4 ,requiring coverage of home and community-based services under the ,medicaid program 7a7 ,definition of home and community-,based services 7#a7 ,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#ca71 by striking and at the end2 7,b7 by redesignating paragraph 7#cb7 as paragraph 7#cc72 and 7,c7 by inserting after paragraph 7#ca7 the following new paragraph3 7#cb7 home and community-based services 7as defined in subsection 7ll772 and 4 7#b7 ,home and community-based services defined ,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 7ll7 ,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 and person-centered service plan 7as described in paragraph 7#d77;,d77 for 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 a successor regulation72 and 7,c7 meets such other qualities as the ,secretary determines appropriate in line with recommendations for additional services made by the advisory panel described in paragraph 7#b77;,b7 of this subsection4 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#bb71 7#bd71 7#bi71 and 7#cc7 of subsection 7a7 of this section 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 that support person-centered planning and self-direction4 7ix7 ,direct support services during acute hospitalizations4 7x7 ,necessary medical and nursing services not otherwise covered that 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 that 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 ,nutrition services4 7xvii7 ,assisted living services4 7xviii7 ,any other service approved by the ,secretary1 pursuant to the recommendation of the advisory panel convened under 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 appoint an advisory panel for purposes of recommending additional services which may be included as home and community-based services under this paragraph4 7ii7 ,composition 7,i7 ,selection ,the advisory panel shall be comprised of not less than #ej members and include representatives of the following categories1 with the majority of all members being selected from the categories described in items 7aa71 7bb71 and 7cc73 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 adults1 that are representative of multiple ,states1 geographical locations1 races1 ethnicities1 and other demographic factors4 7bb7 ,beneficiary-led disability rights organizations4 7cc7 ,disability-led organizations4 7dd7 ,disabled veterans organizations4 7ee7 ,disability organizations representing families4 7ff7 ,organizations serving individuals with disabilities1 including intellectual or developmental disabilities4 7gg7 ,organizations serving older adults4 7hh7 ,direct care workers and the labor organizations that represent such workers4 7ii7 ,the ,protection and ,advocacy ,system4 7jj7 ,the ,centers for ,independent ,living4 7kk7 ,health care providers4 7ll7 ,the ,national ,association of ,medicaid ,directors4 7mm7 ,the ,national ,association of ,state ,directors of ,developmental ,disabilities ,services4 7nn7 ,the ,national ,association of ,state ,mental ,health ,program ,directors4 7oo7 ,advancing ,states4 7pp7 ,the ,centers for ,medicare ,medicaid ,services4 7qq7 ,the ,administration for ,community ,living of the ,department of ,health and ,human ,services4 7rr7 ,members of federally recognized tribes and tribally led organizations4 7ss7 ,other relevant ,federal1 ,state1 and local home and community-based service systems1 as determined by the ,secretary4 7,,ii7 ,requirement for proportionate representation ,the ,secretary shall seek to ensure proportionate representation among each category described in items 7dd7 through 7ss7 of subclause 7,i7 in convening the advisory panel4 7iii7 ,duties 7,i7 ,in general ,not later than #b years after an advisory panel is convened under clause 7i71 the advisory panel shall submit to the ,secretary and to ,congress a report recommending additional services which may be included as home and community-based services under this paragraph with the goal of increasing community integration and self-determination for individuals with disabilities receiving such services4 7,,ii7 ,considerations ,in developing recommendations1 the advisory panel shall consider-- 7aa7 available data on coverage gaps of needed home and community-based services1 including compliance reporting required by section #dda4caa7;d7 of title #db1 ,code of ,federal ,regulations2 7bb7 new technology or innovations that could promote access to home and community-based services for individuals with disabilities and older adults2 7cc7 relevant data based on the latest ,home and ,community-,based ,services ,quality ,measure ,set established and updated by the ,secretary pursuant to section #dda4cab of title #db1 ,code of ,federal ,regulations2 and 7dd7 other relevant research1 data1 or information that will help inform the adoption of home and community-based services for individuals with disabilities and older adults4 7iv7 ,implementation of recommended additional services 7,i7 ,in general ,the ,secretary shall consider the recommendations made in a report submitted by the advisory panel pursuant to clause 7iii77,i71 and review any other relevant information1 to identify additional services as home and community-based services pursuant to subparagraph 7,a77xviii74 7,,ii7 ,considerations ,in determining which recommendations of the advisory panel to implement1 the ,secretary shall consider-- 7aa7 available data on coverage gaps of needed home and community-based services1 including compliance reporting required by section #daa4caa7;d7 of title #db1 ,code of ,federal ,regulations2 7bb7 new technology or innovations that could promote access to home and community-based services for individuals with disabilities2 7cc7 relevant data based on the latest ,home and ,community-,based ,services ,quality ,measure ,set established and updated by the ,secretary pursuant to section #dda4cab of title #db1 ,code of ,federal ,regulations2 7dd7 public comment about additional home and community-based services obtained through the public notice and comment process described in subclause 7,,iii72 and 7ee7 other relevant research1 data1 or information that will help inform the adoption of home and community-based services for individuals with disabilities4 7,,iii7 ,notice and comment ,not later than #a year after an advisory panel is convened under clause 7i71 the ,secretary shall establish a process for public notice and comment1 including public hearings1 sufficient to ensure a meaningful level of public input4 7,,iv7 ,notification to ,state ,medicaid ,directors ,not later than #a year after the conclusion of the notice and comment process established by the ,secretary pursuant to subclause 7,,iii71 the ,secretary shall issue a ,state ,medicaid ,director ,letter to notify ,states of any additional home and community-based services approved by the ,secretary for purposes of subparagraph 7,a77xviii74 7,c7 ,private duty nursing defined ,for purposes of this paragraph1 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 ,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 for home and community-based services under this title 7or 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 ,state plan option72 or 7iii7 an individual who is eligible under the ,state plan or a waiver of such plan and is under the age of #ba4 7,b7 ,functional impairment ,for purposes of subparagraph 7,a77i71 the term functional impairment means1 with respect to an individual1 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 a health care provider to make a determination of functional impairment in accordance with 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 the individual's physical and health condition1 including any functional impairments2 7ii7 to identify needed medical and non-medical services and supports2 7iii7 to inform development of a person-centered care plan 7as described in subparagraph 7,d77 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 ,reassessments ,an individualized assessment shall be conducted at least once every #ab months1 and as needed when the individual's support needs or circumstances change significantly1 and an individual's person-centered service plan shall be revised as necessary to reflect the results of the most recent individualized assessment4 7,c7 ,presumption ,the individualized 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,d7 ,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 is developed in accordance with1 and meets the requirements of1 paragraphs 7#a7 through 7#c7 of section #dda4cja7;c7 of title #db1 ,code of ,federal ,regulations4 7,e7 ,standards ,an individualized assessment shall be conducted in accordance with standards specified by the ,secretary to-- 7i7 safeguard against conflicts of interest2 7ii7 specify qualifications for who may perform any such assessment2 7iii7 ensure transparency in the conducting of any such assessment1 including ensuring the provision of the results of the assessment and1 in plain language1 any information necessary to interpret the methodology and results of the assessment2 7iv7 ensure that the methodology used in any such assessment is sound and evidence-based2 7v7 require such methodology to be made available on the public website of the ,state and tested for reliability and validity by an independent evaluator2 7vi7 require assessment tools to include language assistance services and compliance with ,federal non-discrimination requirements1 including-- 7,i7 the availability of such assessments in the individual's primary language or with a qualified interpreter2 7,,ii7 accessibility for individuals who are blind or have low-vision2 7,,iii7 accessibility for deaf and hard-of-hearing individuals2 and 7,,iv7 accessibility for individuals who cannot rely on speech to communicate2 and 7vii7 ensure that any services and supports necessary for community integration are identified1 involve professionals knowledgeable about the range of services and supports available in the community1 and allow individuals getting assessed to present their own independent evidence of the appropriateness of an integrated setting4 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#cb74 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 #aije7ll77 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 7mm72 and 7#b7 by adding at the end the following new subsections3 7mm7 ,specified ,federal medical assistance percentage 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 7ll771 including any such services furnished under a waiver in effect under section #aiae or #aaae1 on or after the date of the enactment of this subsection shall be equal to #ajj percent for any ,state that meets the requirements of paragraph 7#b74 7#b7 ,access to essential home and community-based services ,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 and access to home and community-based services offered under the ,state plan under this title 7or a waiver of such plan7 as of the date of enactment of this subsection by doing each of the following3 7,a7 ,lowering or eliminating access barriers and disparities in access or utilization identified in the implementation plan described in section #aijb7zz74 7,b7 ,using a program to ensure that an individual is not denied services based on the fact that the individual contacts the wrong entity 7commonly referred to as a #8,no ,wrong ,door ,program'71 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 care 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 7including any payment to a direct care worker who delivers such services7 are sufficient to ensure that care and services are available to the extent described in the implementation plan described in section #aijb7zz74 ,in carrying out this subparagraph1 the ,state shall review and update payment rates for home and community-based services at least every #b years1 with an emphasis on ensuring that rates are adequate to recruit and retain a sufficient workforce to ensure access to the full set of services for eligible individuals as determined under subsection 7ll7 and through a transparent process involving meaningful 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 advocates4 7,e7 ,developing a process to ensure that increases in payment rates for home and community-based services are-- 7i7 at a minimum1 proportionately passed through to direct care workers and in a manner that is determined with input from the stakeholders described in subparagraph 7,d72 and 7ii7 incorporated into payment rates for home and community-based services provided under this title by a managed care entity 7as defined in section #aicb7;a77#a77;,b77 or a prepaid inpatient health plan or prepaid ambulatory health plan1 as such terms are defined in section #dch4b of title #db1 ,code of ,federal ,regulations 7or any successor regulation71 under a contract with the ,state4 7,f7 ,updating1 developing1 and adopting qualification standards and training opportunities for the continuum of providers of home and community-based services1 including programs for independent providers of such services and agency direct care workers1 as well as unique programs and resources for family caregivers4 7,g7 ,establishing an entity to strengthen the infrastructure supporting the delivery of home and community-based services under consumer-directed models of care in accordance with the requirements of subsection 7nn74 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 7#d7 ,administrative costs ,notwithstanding the per centum specified in section #aijc7;a77#g71 with respect to amounts expended for the first #d fiscal quarters during which this subsection is implemented and each of the succeeding #af fiscal quarters1 for administrative costs for expanding and enhancing home and community-based services1 including for enhancing the ,medicaid data and technology infrastructure1 modifying rate setting processes1 adopting1 using1 and reporting quality measures1 adopting or improving training programs for direct care workers and family caregivers1 and adopting1 carrying out1 or enhancing programs that register qualified direct care workers or connect beneficiaries to qualified direct care workers under subsection 7nn71 such per centum shall be #hj percent4 7nn7 ,,hcbs infrastructure ,to support self-,directed care models for the delivery of services ,for the purposes of paragraph 7#b77;,g7 of subsection 7mm71 the requirements of this subsection1 with respect to a ,state and fiscal quarter1 are that the ,state establishes1 directly or by contract with #a or more non-profit entities1 a program to support self-directed models for the delivery of services for the performance of each of the following functions3 7#a7 ,registering qualified direct care workers and assisting beneficiaries in finding direct care workers to furnish home and community-based services4 7#b7 ,undertaking activities to recruit and train independent providers to enable beneficiaries to direct their own care1 including by providing or coordinating training for beneficiaries on self-directed care4 7#c7 ,ensuring the safety of1 and supporting the quality of1 care provided to beneficiaries1 such as by conducting background checks and addressing complaints reported by recipients of home and community-based services4 7#d7 ,facilitating coordination between ,state and local agencies and direct care workers for matters of public health1 training opportunities1 changes in program requirements1 workplace health and safety1 or related matters4 7#e7 ,supporting beneficiary hiring of independent providers of home and community-based services through an agency with choice or similar model1 including by processing applicable tax information1 collecting and processing timesheets1 submitting claims1 and processing payments to such providers4 7#f7 ,to the extent a ,state permits beneficiaries to hire a family member or individual with whom they have an existing relationship to provide home and community-based services1 providing support to beneficiaries who wish to hire a caregiver who is a family member or individual with whom they have an existing relationship1 such as by facilitating enrollment of such family member or individual as a provider of home and community-based services under the ,state plan or a waiver of such plan4 7#g7 ,ensuring that program policies and procedures allow for cooperation with labor organizations that bargain on behalf of direct care workers in the case of a ,state in which the direct care workers in the ,state have elected to join1 or form1 such a labor organization1 or1 in the case of a ,state in which such workers have not joined or formed such a labor organization1 are neutral with regard to such workers joining or forming such a labor organization4 4 7e7 ,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 each of clauses 7xvi7 and 7xviii71 by moving the left margin #b ems to the left2 and 7ii7 in clause 7xvii71 by inserting or who are described in section #aijb7;a77#aj77;,d7 after a ,state plan amendment under such subsection2 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 #aije7ll7 for purposes of providing home and community-based services under the ,state plan 7or waiver of such plan744 7#b7 ,effective date ,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 #ajc4 ,medicaid eligibility modifications ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#aj7-- 7i7 in subparagraph 7,a77i7-- 7,i7 in subclause 7,,viii71 by striking 2 or and inserting a semicolon2 7,,ii7 in subclause 7,,ix77dd71 by striking the semicolon at the end and inserting 2 or2 and 7,,iii7 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 section #aije7ll77#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 or 7bb7 #cjj percent of the supplemental security income benefit rate established by section #afaa7;b77#a72 2 and 7ii7 in subparagraph 7,a77ii7-- 7,i7 in subclause 7,,xxii71 by striking 2 or and inserting a semicolon2 7,,ii7 in subclause 7,,xxiii71 by striking the semicolon at the end and inserting 2 or2 and 7,,iii7 by inserting after subclause 7,,xxiii7 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 2 and 7,b7 by amending paragraph 7#cd7 to read as follows3 7#cd7 provides that in the case of an individual eligible for home and community-based services 7as described in section #aije7ll77#c77;,a771 such services will be made available and furnished in or after the third month before the month in which such individual made application 7or application was made on behalf of such individual in the case of a deceased individual7 for such services if such individual was 7or upon application would have been7 eligible for such services at the time such services were furnished and1 that if services are provided through a service plan or any similar document1 including services provided under the authority of any provision of section #aaae or #aiae1 such services shall be available pursuant to this subsection without regard to whether the service plan or similar document was developed before or after the services were provided2 2 and 7#b7 in subsection 7xx77#i77;,a77ii7-- 7,a7 in subclause 7,,viii71 by striking or at the end2 7,b7 in subclause 7,,ix71 by striking the period and inserting 2 or2 and 7,c7 by adding at the end the following new subclause3 7,x7 who is described in subclause 7,x7 of subsection 7a77#aj77;,a77i7 or subclause 7,,xxiv7 of subsection 7a77#aj77;,a77ii74 4 #ajd4 ,home and community-based services implementation plan 7a7 ,in general ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#hi71 by striking and at the end2 7,b7 in paragraph 7#ij77;,c71 by striking the period at the end and inserting 2 and2 and 7,c7 by inserting after paragraph 7#ij7 the following new paragraph3 7#ia7 provide that1 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 paragraph 7or such earlier date at the ,state may elect71 the ,state shall submit to the ,secretary the implementation plan described in subsection 7zz74 2 and 7#b7 by adding at the end the following new subsection3 7zz7 ,implementation plan ,for purposes of subsection 7a77#ia71 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 #aije7ll71 including the process for any determination specified in paragraph 7#c77;,a77i7 of such section4 7#b7 ,a description of the characteristics of the ,state's direct care workforce that provides home and community-based services1 including the number of workers1 the average and range of direct care worker wages or service payments1 the health and other workplace benefits provided to direct care workers1 turnover and vacancy rates1 and an explanation of the ,state's plan to ensure a stable and high quality workforce and that compensation for individuals furnishing home and community-based services is sufficient to ensure an appropriate supply of workers to provide services to all eligible individuals and plans to 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 subsection1 including a breakdown of use of such services by demographics 7as defined in section #b of the ,,hcbs ,access ,act71 compared to such services that are required under the amendments made by section #ajb of such ,act1 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 and aging 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 ,a plan for carrying out outreach and education activities with respect to the availability of such services through appropriate entities1 including a program to ensure 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#f7 ,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#g7 ,a ,state with federally recognized ,indian tribes1 ,indian health programs1 or urban ,indian health organizations shall include a process to consult with the ,indian tribes and seek advice from ,indian health programs and urban ,indian health organizations in the ,state4 7#h7 ,a description of how the ,state will build capacity prior to the implementation of the requirements described in subclause 7,x7 of subsection 7a77#aj77;,a77i7 and subclause 7,,xxiv7 of subsection 7a77#aj77;,a77ii7 to ensure that such services are available to every eligible individual under the ,state ,medicaid program1 how the ,state will ensure an adequate provider network to provide access to and choice of provider1 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 #aije7ll71 as added by section #ajb of the ,,hcbs ,access ,act4 7#i7 ,a plan for how the ,state will prioritize individuals who have already met eligibility requirements but are on waiting lists to receive home and community-based services and ensure those individuals do not experience an increase in the amount of time they will wait to receive such services4 7#aj7 ,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 section #aije7ll77 are appropriately identified as medically frail and exempted from such plan4 7#aa7 ,how the ,state will coordinate eligibility for such services with other disability eligibility programs1 such as disability buy-in programs4 7#ab7 ,data and milestone requirements to ensure community integration1 including such requirements with respect to utilization of such services by demographics 7as defined in section #b of the ,,hcbs ,access ,act74 7#ac7 ,a description of how the ,state will evaluate and address disparities based on age1 disability1 race1 ethnicity1 sexual orientation1 gender identity1 and geographic equity4 4 7b7 ,,fmap increase ,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 at the end and inserting and2 and 7#b7 by inserting after subparagraph 7,f77ii7 the following new subparagraph3 7,g7 an amount equal to #ajj percent of the sums expended during the quarter which are attributable to the costs of developing the implementation plan described in section #aijb7zz72 and 4 #aje4 ,quality of services 7a7 ,in general 7#a7 ,development of metrics 7,a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services1 in consultation with ,state ,medicaid ,directors1 shall develop standardized1 ,state-level metrics regarding access to1 and satisfaction with1 providers1 including primary care and specialist providers1 with respect to individuals who are enrolled in a ,state ,medicaid plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 7or under a waiver of such plan71 broken down by demographics 7as defined in section #b7 and any other category determined appropriate by the ,secretary4 7,b7 ,inclusions ,the metrics developed under subparagraph 7,a7 shall include metrics on the total number of individuals enrolled in the ,state plan or under a waiver of such plan during a fiscal year that required the level of care provided in a nursing facility1 intermediate care facility for individuals with intellectual disabilities1 institution for mental disease1 or other similarly restrictive or institutional setting4 7#b7 ,process ,the ,secretary 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 ,secretary1 in consultation with the ,deputy ,administrator and ,director 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 ,secretary 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 ,secretary1 out of any funds in the ,treasury not otherwise appropriated1 #bjj1jjj1jjj for fiscal year #bjbg1 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 ,finance of the ,senate1 the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate1 the ,special ,committee on ,aging of the ,senate1 the ,committee on ,energy and ,commerce of the ,house of ,representatives1 and the ,committee on ,education and ,workforce of the ,house of ,representatives the following reports relating to the home and community-based services implementation plan 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 home and community-based services implementation plans as described in section #aijb7zz7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7zz77 7as added by section #ajd72 and 7,b7 the funds awarded to ,states for any administrative costs associated with the development of such implementation plans4 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 home and community-based services implementation plans approved by the ,secretary under section #aijb7zz7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7zz77 7as added by section #ajd74 7,b7 ,a description of the national landscape with respect to gaps in coverage of home and community-based services1 disparities in access to such services1 utilization of 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 ,states awarded funding1 and the funds awarded to such ,states1 to develop an implementation plan described in section #aijb7zz7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7zz77 7as added by section #ajd74 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 #aije7ll77#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 ,states awarded funding to develop an implementation plan described in section #aijb7zz7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7zz77 7as added by section #ajd7 with technical assistance related to carrying out the home and community-based services implementation plans approved by the ,secretary under such section and meeting the requirements and benchmarks for demonstrating improvements required under section #aije7mm7 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 ,secretary1 in coordination with the ,secretary of ,labor and the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall issue recommendations regarding how the ,federal ,government and ,states can 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 services4 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 educational agencies1 and aging1 disability1 and workforce advocates4 7,b7 ,consultation with current and potential ,,hcbs beneficiaries and family caregivers ,in consulting with stakeholders under subparagraph 7,a71 the ,secretary shall-- 7i7 hold at least #a meeting solely with current and potential recipients of home and community-based services and family caregivers of such recipients for the purpose of developing the recommendations required under paragraph 7#a72 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 #bjbg1 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 annually4 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 subagency heads determined appropriate by the ,secretary2 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 7,,vii7 beneficiary and family caregiver surveys2 and 7,,viii7 measures related to outcomes by race and ethnicity1 language1 sex1 gender identity1 geography1 and other demographic factors to track and reduce health disparities4 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 and 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 #bjbg1 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#c771 as amended by section #ajd7;b71 is amended-- 7,a7 in subparagraph 7,h77ii71 by striking plus after the semicolon and inserting and2 and 7,b7 by inserting after subparagraph 7,h77ii7 the following new subparagraph3 7,i7 #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 plus 4 7c7 ,ombudsman ,each ,state shall establish a home and community-based services ombudsman office that-- 7#a7 operates independently from the ,state ,medicaid agency and managed care entities2 7#b7 provides direct assistance to beneficiaries and their families with respect to accessing home and community-based services2 and 7#c7 identifies and reports systemic problems to ,state officials1 the public1 and the ,secretary with respect to the provision of or access to home and community-based services4 #ajh4 ,making permanent the extended 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 7at the option of the ,state7 is described in section #aijb7;a77#aj77;,a77ii77,,vi7 and inserting is an eligible individual 7as defined in section #aije7ll77#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 ,section #fjga7;h77#a77,l7 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 fiscal year #bjbd and each fiscal year thereafter4 #aaj4 ,liens1 adjustments1 and recoveries for medical assistance 7a7 ,liens ,section #aiag7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifp7a77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 in the matter preceding subparagraph 7,a71 by striking plan1 except-- and inserting plan1 except1 subject to paragraph 7#d7--2 and 7,b7 in subparagraph 7,b71 by striking in the case of and inserting with respect to liens imposed before the date of the enactment of the ,,hcbs ,access ,act1 in the case of2 and 7#b7 by adding at the end the following3 7#d7 ,notwithstanding any preceding provision of this subsection1 not later than #ij days after the date of the enactment of this paragraph1 a ,state shall-- 7,a7 withdraw any lien imposed under paragraph 7#a77;,b7 that is in effect as of such date2 and 7,b7 notify each individual 7or legal representative of such individual 7or of such individual's estate77 subject to such a lien so withdrawn of the withdrawal of such lien4 4 7b7 ,adjustments and recoveries ,section #aiag7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifp7b77 is amended-- 7#a7 in paragraph 7#a71 by striking except that and inserting except that1 subject to paragraph 7#f712 and 7#b7 by adding at the end the following3 7#f7 ,notwithstanding any preceding provision of this subsection1 no adjustment or recovery of any medical assistance correctly paid on behalf of an individual under the ,state plan may be initiated1 maintained1 or collected on or after the date of the enactment of this paragraph4 ,not later than #ij days after such date1 a ,state shall-- 7,a7 withdraw any lien in effect as of such date with respect to such medical assistance correctly paid2 and 7,b7 notify each individual 7or legal representative of such individual 7or of such individual's estate77 subject to such a lien so withdrawn of the withdrawal of such lien and the prohibition on adjustment or recovery under this paragraph4 4 #aaa4 ,,hcbs provider tax ,section #aijc7w7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7w77 is amended-- 7#a7 in paragraph 7#g77;,a7-- 7,a7 by redesignating clause 7ix7 as clause 7x72 and 7,b7 by inserting after clause 7viii7 the following new clause3 7ix7 home and community-based services4 2 and 7#b7 in paragraph 7#d77;,c77ii71 by inserting for a class of health care items and services other than the class described in paragraph 7#g77;,a77ix71 after #bjbf14 #aab4 ,medicare amendment ,section #ahfj;,d-#ad7;a77#a77;,d77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7 is amended by striking or subsection 7c7 or 7d7 of section #aiae or under a ,state plan amendment under subsection 7i7 of such section and inserting 1 section #aiae1 #aaae;,a1 or under a ,state plan amendment4 ,,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 #ci percent as identified in a #bjbc 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 ,revision of standard occupational classification system 7a7 ,in general ,the ,director of the ,office of ,management and ,budget 7in this ,act referred to as the ,director7 shall1 as part of the first revision process of the ,standard ,occupational ,classification system occurring after the date of enactment of this ,act1 consider establishing a separate code for direct support professionals as a subset of healthcare support occupations4 7b7 ,report to ,congress ,if the ,director decides not to establish the separate code for direct support professionals described in subsection 7a71 the ,director shall1 not later than #cj days after the ,director announces in the ,federal ,register the final decision of the revision process described in such subsection1 submit to the ,committee on ,homeland ,security and ,governmental ,affairs of the ,senate and the ,committee on ,education and ,workforce of the ,house of ,representatives a report explaining why such separate code was not established4 ,,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 promote the independence of such person or adult1 including-- 7i7 services that enhance the independence and community inclusion for such person or adult1 including traveling with such person or individual or attending and assisting such person or adult while visiting friends and family1 shopping1 or socializing2 7ii7 services such as coaching and supporting such person or adult 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 adult at home1 work1 or school1 or in any other community setting2 or 7v7 services that promote health and wellness1 including scheduling and taking such person or adult for or to health care appointments1 communicating with health and allied health professionals administering medications1 implementing health and behavioral health interventions and treatment plans1 and monitoring and recording health status and progress2 and 7,b7 includes-- 7i7 a service provider supporting people with intellectual disabilities1 developmental disabilities1 or 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 worker in another 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 ,administrator of 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 ,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 employer1 of direct care professionals2 7iii7 an organization or a nonprofit entity with experience in aging or disability1 or in supporting the rights and interests of1 training1 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#f7 ,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#g7 ,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 note7 and includes paid and unpaid family caregivers4 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 seeking 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 decisionmaking 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 shall1 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 necessary1 establish a national technical assistance center 7referred to in this section as the ,center7 for-- 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 establish 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 and programs for direct care professionals1 which 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 by grants under this title and in use of related 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 care professionals as a health care support occupation2 7#e7 recommend career development and advancement opportunities for direct care professionals1 which may include recommendations for 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 ,administrator of 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 and who have coaching1 training1 managerial1 supervisory1 or other oversight responsibilities1 including through education or training programs for such individuals 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 if the entity uses such grant to continue such activities1 the entity shall be treated as an eligible entity carrying out a project through a grant under this title and the activities shall be considered to be such a project4 #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 7including 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 shall include 7as applicable7 each of 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 rates and crude separation rates1 and the number of direct care professionals1 including such professionals who are managers or supervisors1 in the region4 7#c7 ,information on an advisory committee to advise the eligible entity on activities to be carried out through the grant4 ,such advisory committee-- 7,a7 may include 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 ,information on 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 geographic area to be served by the project1 and the geographic scope of the workforce to be served by the project4 7#e7 ,information on specific efforts and strategies that the entity carrying out 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 and a description of 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 ,administrator of 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 education or 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 education or 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 education or 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 described in the plan and 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 ,a description of any innovative models or processes1 not described in another paragraph of this subsection1 the eligible entity will implement to support the retention and career advancement of the direct care professionals targeted by the project4 7#h7 ,a description of 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 ,a description of 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 geographic area to be served by the project4 7#aj7 ,a description of how the eligible entity will collect and submit to the ,secretary workforce data and outcomes of the project4 7#aa7 ,a description of 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 ,administrator of 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 or 7v7 the use of supportive or assistive technology4 7#ab7 ,a description of 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 geographic area1 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 which may be a labor organization1 that fosters the professional development and collective engagement of the direct care professionals or family caregivers 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 chapter #a 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 or family caregivers targeted by the project1 where such an association exists4 7,j7 ,an entity that employs the direct care professionals or family caregivers targeted by the project4 7,k7 ,university ,centers for ,excellence in ,developmental ,disabilities ,education1 ,research1 and ,service 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 family caregivers targeted by the project1 or workforce organizations for such professionals or caregivers as applicable1 representing underserved communities4 7#ac7 ,a description of 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 ,a description of 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 a 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 project participants who are direct care professionals or 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 government 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 geographic area 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 demographics categories 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 that 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 area for a number of years before the grant was awarded1 as the number of years is 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 satisfaction regarding-- 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 has the qualities established in 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 #bjbi through #bjcj2 and 7#b7 for grants under section #cjc1 #a1jjj1jjj1jjj for fiscal year #bjbi4 7b7 ,availability ,amounts made available under this title shall remain available through ,september #cj1 #bjch4 ,,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