,,ii #aai? ,,congress #b;d ,session ,s4 #ecba ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,augu/ #f1 #bjbf,mr4 ,lujn 7= himself1 ,mr4 ,ka9e1 ,ms4 ,baldw91 ,ms4 ,duckwor?1 ,mrs4 ,gillibr&1 ,ms4 ,hassan1 ,mr4 ,blum5?al1 ,mr4 ,m]kley1 ,mr4 ,s&]s1 ,ms4 ,w>r51 ,mr4 ,re$1 ,mr4 ,m>key1 ,mrs4 ,%ahe51 ,mr4 ,fett]man1 ,mr4 ,kim1 & ,mrs4 ,murray7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to am5d title ,,xix ( ! ,social ,security ,act to require cov]age (1 & exp& access to1 home & community-bas$ s]vices "u ! ,m$icaid program to aw>d grants = ! creation1 recruitm5t1 tra9+ & education1 ret5tion1 & advancem5t ( ! direct c>e work=ce & to aw>d grants to support family c>egiv]s & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,,hcbs ,access ,act4 7b7 ,table ( cont5ts ,! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4,sec4 #b4 ,def9itions4,,title ,i--,requir+ & ,exp&+ ,access to ,,hcbs ,cov]age ,"u ,medicaid,sec4 #aja4 ,purpose4,sec4 #ajb4 ,requir+ cov]age ( home & community-bas$ s]vices "u ! ,m$icaid program4,sec4 #ajc4 ,m$icaid eligibility modifications4,sec4 #ajd4 ,home & community-bas$ s]vices implem5tation plan4,sec4 #aje4 ,quality ( s]vices4,sec4 #ajf4 ,reports2 te*nical assi/ance2 o!r adm9i/rative requirem5ts4,sec4 #ajg4 ,quality measurem5t & improvem5t4,sec4 #ajh4 ,mak+ p]man5t ! ext5d$ protection "u m$icaid = recipi5ts ( home & community-bas$ s]vices aga9/ sp\sal impov]i%m5t4,sec4 #aji4 ,p]man5t ext5sion ( money foll[s ! p]son rebalanc+ demon/ration4,sec4 #aaj4 ,li5s1 adju/m5ts1 & recov]ies = m$ical assi/ance4,sec4 #aaa4 ,,hcbs provid] tax4,sec4 #aab4 ,m$ic>e am5dm5t4,,title ,,ii--,recogniz+ ! ,role ( ,direct ,support ,professionals,sec4 #bja4 ,f9d+s4,sec4 #bjb4 ,revision ( /&>d occupational classification sy/em4,,title ,,iii--,support = ! ,direct ,c>e ,workforce,sec4 #cja4 ,def9itions4,sec4 #cjb4 ,au?ority to e/abli% a te*nical assi/ance c5t] = build+ ! direct c>e work=ce4,sec4 #cjc4 ,au?ority to aw>d grants4,sec4 #cjd4 ,project plans4,sec4 #cje4 ,evaluations & reports2 te*nical assi/ance4,sec4 #cjf4 ,au?orization ( appropriations4,,title ,,iv--,evaluation,sec4 #dja4 ,evaluation ( impact on access to ,,hcbs4 #b4 ,def9itions ,9 ?is ,act3 7#a7 ,demographics ,! t]m demographics means in=mation relat+ to ! races1 e?nicities1 g5d]s1 sexual ori5tations1 g5d] id5tities1 geographic locations1 incomes1 prim>y languages1 types ( s]vice sett+1 & disability types repres5t$ )9 a p>ticul> gr\p ( individuals4 7#b7 ,secret>y ,except z o!rwise provid$1 ! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 ,i ,requir+ & ,exp&+ ,access to ,,hcbs ,cov]age ,"u ,m$icaid #aja4 ,purpose ,x is ! purpose ( ?is title to require cov]age ( home & community-bas$ s]vices 79 ?is section ref]r$ to z ,,hcbs7 "u a ,/ate plan 7or waiv] ( su* plan7 "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 = ! foll[+ reasons3 7#a7 ,to elim9ate wait+ li/s = ,,hcbs1 :i* delay access to necess>y s]vices & d5y access to ! promise ( community inclusion gu>ante$ "u ! ,am]icans ) ,disabilities ,act ( #aiij 7#db ,u4,s4,c4 #abaja et seq47 = individuals ) disabilities & old] adults4 7#b7 ,to build on decades ( progress 9 s]v+ individuals ) disabilities & old] adults ?r\gh access to ,,hcbs4 7#c7 ,to fulfill ! purposes ( ! ,m$icaid program to provide m$ical assi/ance = individuals ^: income & res\rces are insuffici5t to meet ! co/s ( necess>y m$ical s]vices1 & to provide rehabilitation1 long-t]m s]vices & supports1 & o!r s]vices to help su* individuals atta9 or reta9 capacity = indep5d5ce or self-c>e4 7#d7 ,to ensure t individuals ) all k9ds ( disabilities & ) multiple disabilities1 includ+ intellectual disabilities1 cognitive disabilities1 developm5tal disabilities1 behavioral heal? disabilities1 physical disabilities1 & sub/ance use disord]s1 & old] adults1 receive ! s]vices !y ne$ to live 9 _! communities4 7#e7 ,to /reaml9e access to ,,hcbs by elim9at+ ! ne$ = ,/ates to repeat$ly apply = waiv]s ( _! respective ,/ate plans = m$ical assi/ance4 7#f7 ,to cont9ue to increase ! capacity ( community s]vices to ensure individuals ) disabilities & old] adults h high-quality1 safe1 & mean+ful options to receive c>e 9 _! community & are n at risk ( unnecess>y in/itutionalization4 7#g7 ,to act on ! decades ( rese>* & practice t %[ t ev]yone1 includ+ individuals ) ! mo/ sev]e disabilities1 c live 9 ! community ) ! "r s]vices & supports4 7#h7 ,to elim9ate ! race1 g5d]1 sexual ori5tation1 & g5d] id5tity disp>ities t exi/ 9 access+ in=mation & ,,hcbs & to prev5t ! unnecess>y impov]i%m5t & in/itutionalization ( black & br[n individuals ) disabilities & old] adults4 7#i7 ,to support ov] #fc1jjj1jjj unpaid family c>egiv]s1 :o are disproportionately wom5 & (t5 provid+ complex s]vices & supports to old] adults & individuals ) disabilities because ( a lack ( af=dable s]vices1 work=ce %ortages1 & o!r ineffici5cies4 7#aj7 ,to improve direct c>e quality & ensure access to s]vices by improv+ work=ce /&>ds = ! ne>ly #c1bjj1jjj direct c>e work]s1 :o are prim>ily wom51 p ( color1 & immigrants fac+ height5$ risks ( discrim9ation 9 employm5t1 provid+ support to individuals ) disabilities & old] adults 9 _! homes & communities4 #ajb4 ,requir+ cov]age ( home & community-bas$ s]vices "u ! ,m$icaid program 7a7 ,def9ition ( home & community-,bas$ s]vices 7#a7 ,inclusion z m$ical assi/ance ,section #aije7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is am5d$-- 7,a7 9 p>agraph 7#ca71 by /rik+ & at ! end2 7,b7 by r$esignat+ p>agraph 7#cb7 z p>agraph 7#cc72 & 7,c7 by ins]t+ aft] p>agraph 7#ca7 ! foll[+ new p>agraph3 7#cb7 home & community-bas$ s]vices 7z def9$ 9 subsection 7ll772 & 4 7#b7 ,home & community-bas$ s]vices def9$ ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7ll7 ,home & community-,bas$ s]vices 7#a7 ,9 g5]al ,= purposes ( ?is title1 ! t]m home & community-bas$ s]vices means ^? s]vices specifi$ 9 p>agraph 7#b7 furni%$ to an eligible individual 7z def9$ 9 p>agraph 7#c771 bas$ on an individualiz$ assessm5t 7z describ$ 9 p>agraph 7#d77 & p]son-c5t]$ s]vice plan 7z describ$ 9 p>agraph 7#d77;,d77 = su* individual1 9 a sett+ t-- 7,a7 meets ! qualities specifi$ 9 p>agraph 7#a7 ( section #dda4gaj7;a7 ( title #db1 ,code ( ,f$]al ,regulations 7or a successor regulation72 7,b7 is n describ$ 9 p>agraph 7#b7 ( su* section 7or a successor regulation72 & 7,c7 meets su* o!r qualities z ! ,secret>y det]m9es appropriate 9 l9e ) recomm5dations = additional s]vices made by ! advisory panel describ$ 9 p>agraph 7#b77;,b7 ( ?is subsection4 7#b7 ,s]vices specifi$ 7,a7 ,9 g5]al ,= purposes ( p>agraph 7#a71 ! s]vices specifi$ 9 ?is p>agraph are s]vices describ$ 9 any ( p>agraphs 7#g71 7#h71 7#ac77;,c71 7#ai71 7#bj71 7#bb71 7#bd71 7#bi71 & 7#cc7 ( subsection 7a7 ( ?is section or 9 any ( subsections 7c77#d77;,b71 7c77#e71 7k77#a77;,a71 7k77#a77;,b71 or 7k77#a77;,d7 ( section #aiae1 includ+ ! foll[+3 7i7 ,support$ employm5t & integrat$ day s]vices4 7ii7 ,p]sonal assi/ance1 includ+ p]sonal c>e att5dants1 direct support pr(essionals1 home heal? aides1 private duty nurs+1 homemak]s & *ore assi/ance1 & companion%ip s]vices4 7iii7 ,s]vices t enhance indep5d5ce1 inclusion1 & full p>ticipation 9 ! broad] community4 7iv7 ,non-em]g5cy1 non-m$ical transportation s]vices to facilitate community integration4 7v7 ,respite s]vices provid$ 9 ! individual's home or broad] community4 7vi7 ,c>egiv] & family support s]vices4 7vii7 ,case managem5t1 includ+ int5sive case managem5t1 fiscal int]m$i>y1 & support brok]age s]vices4 7viii7 ,s]vices t support p]son-c5t]$ plann+ & self-direction4 7ix7 ,direct support s]vices dur+ acute hospitalizations4 7x7 ,necess>y m$ical & nurs+ s]vices n o!rwise cov]$ t are necess>y 9 ord] = ! individual to rema9 9 _! home & community1 includ+ hospice s]vices4 7xi7 ,home & community-bas$ int5sive behavioral heal? & crisis int]v5tion s]vices4 7xii7 ,pe] support s]vices4 7xiii7 ,h\s+ support1 includ+ transitional h\s+ or transitional support s]vices = individuals :o are unh\s$1 & wrap-ar\nd s]vices4 7xiv7 ,necess>y home modifications & assi/ive te*nology1 includ+ ^? t sub/itute = human assi/ance4 7xv7 ,transition s]vices to support an individual :o is transition+ f an in/itutional sett+ to ! community1 includ+ appropriate s]vices = individuals :o are unh\s$ or at risk ( becom+ unh\s$1 & includ+ su* transition s]vices provid$ :ile ! individual resides 9 an in/itution4 7xvi7 ,nutrition s]vices4 7xvii7 ,assi/$ liv+ s]vices4 7xviii7 ,any o!r s]vice approv$ by ! ,secret>y1 pursuant to ! recomm5dation ( ! advisory panel conv5$ "u subp>agraph 7,b74 7,b7 ,specification ( recomm5d$ s]vices 7i7 ,9 g5]al ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ?is subp>agraph1 & n less frequ5tly ?an once e #e ye>s !reaft]1 ! ,secret>y %all appo9t an advisory panel = purposes ( recomm5d+ additional s]vices :i* may be includ$ z home & community-bas$ s]vices "u ?is p>agraph4 7ii7 ,composition 7,i7 ,selection ,! advisory panel %all be compris$ ( n less ?an #ej memb]s & include repres5tatives ( ! foll[+ categories1 ) ! majority ( all memb]s be+ select$ f ! categories describ$ 9 items 7aa71 7bb71 & 7cc73 7aa7 ,individuals ) disabilities receiv+ home & community-bas$ s]vices "u ?is title & individuals ) disabilities 9 ne$ ( su* s]vices1 includ+ ^? ) physical disabilities1 behavioral heal? disabilities1 or intellectual or developm5tal disabilities1 & includ+ old] adults1 t are repres5tative ( multiple ,/ates1 geographical locations1 races1 e?nicities1 & o!r demographic factors4 7bb7 ,b5efici>y-l$ disability rights organizations4 7cc7 ,disability-l$ organizations4 7dd7 ,disabl$ vet]ans organizations4 7ee7 ,disability organizations repres5t+ families4 7ff7 ,organizations s]v+ individuals ) disabilities1 includ+ intellectual or developm5tal disabilities4 7gg7 ,organizations s]v+ old] adults4 7hh7 ,direct c>e work]s & ! labor organizations t repres5t su* work]s4 7ii7 ,! ,protection & ,advocacy ,sy/em4 7jj7 ,! ,c5t]s = ,indep5d5t ,liv+4 7kk7 ,heal? c>e provid]s4 7ll7 ,! ,national ,association ( ,m$icaid ,directors4 7mm7 ,! ,national ,association ( ,/ate ,directors ( ,developm5tal ,disabilities ,s]vices4 7nn7 ,! ,national ,association ( ,/ate ,m5tal ,heal? ,program ,directors4 7oo7 ,advanc+ ,/ates4 7pp7 ,! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 7qq7 ,! ,adm9i/ration = ,community ,liv+ ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7rr7 ,memb]s ( f$]ally recogniz$ tribes & tribally l$ organizations4 7ss7 ,o!r relevant ,f$]al1 ,/ate1 & local home & community-bas$ s]vice sy/ems1 z det]m9$ by ! ,secret>y4 7,,ii7 ,requirem5t = proportionate repres5tation ,! ,secret>y %all seek to ensure proportionate repres5tation among ea* category describ$ 9 items 7dd7 ?r\gh 7ss7 ( subclause 7,i7 9 conv5+ ! advisory panel4 7iii7 ,duties 7,i7 ,9 g5]al ,n lat] ?an #b ye>s aft] an advisory panel is conv5$ "u clause 7i71 ! advisory panel %all submit to ! ,secret>y & to ,congress a report recomm5d+ additional s]vices :i* may be includ$ z home & community-bas$ s]vices "u ?is p>agraph ) ! goal ( increas+ community integration & self-det]m9ation = individuals ) disabilities receiv+ su* s]vices4 7,,ii7 ,consid]ations ,9 develop+ recomm5dations1 ! advisory panel %all consid]-- 7aa7 available data on cov]age gaps ( ne$$ home & community-bas$ s]vices1 includ+ compliance report+ requir$ by section #dda4caa7;d7 ( title #db1 ,code ( ,f$]al ,regulations2 7bb7 new te*nology or innovations t c\ld promote access to home & community-bas$ s]vices = individuals ) disabilities & old] adults2 7cc7 relevant data bas$ on ! late/ ,home & ,community-,bas$ ,s]vices ,quality ,measure ,set e/abli%$ & updat$ by ! ,secret>y pursuant to section #dda4cab ( title #db1 ,code ( ,f$]al ,regulations2 & 7dd7 o!r relevant rese>*1 data1 or in=mation t w help in=m ! adoption ( home & community-bas$ s]vices = individuals ) disabilities & old] adults4 7iv7 ,implem5tation ( recomm5d$ additional s]vices 7,i7 ,9 g5]al ,! ,secret>y %all consid] ! recomm5dations made 9 a report submitt$ by ! advisory panel pursuant to clause 7iii77,i71 & review any o!r relevant in=mation1 to id5tify additional s]vices z home & community-bas$ s]vices pursuant to subp>agraph 7,a77xviii74 7,,ii7 ,consid]ations ,9 det]m9+ :i* recomm5dations ( ! advisory panel to implem5t1 ! ,secret>y %all consid]-- 7aa7 available data on cov]age gaps ( ne$$ home & community-bas$ s]vices1 includ+ compliance report+ requir$ by section #daa4caa7;d7 ( title #db1 ,code ( ,f$]al ,regulations2 7bb7 new te*nology or innovations t c\ld promote access to home & community-bas$ s]vices = individuals ) disabilities2 7cc7 relevant data bas$ on ! late/ ,home & ,community-,bas$ ,s]vices ,quality ,measure ,set e/abli%$ & updat$ by ! ,secret>y pursuant to section #dda4cab ( title #db1 ,code ( ,f$]al ,regulations2 7dd7 public comm5t ab\t additional home & community-bas$ s]vices obta9$ ?r\gh ! public notice & comm5t process describ$ 9 subclause 7,,iii72 & 7ee7 o!r relevant rese>*1 data1 or in=mation t w help in=m ! adoption ( home & community-bas$ s]vices = individuals ) disabilities4 7,,iii7 ,notice & comm5t ,n lat] ?an #a ye> aft] an advisory panel is conv5$ "u clause 7i71 ! ,secret>y %all e/abli% a process = public notice & comm5t1 includ+ public he>+s1 suffici5t to ensure a mean+ful level ( public input4 7,,iv7 ,notification to ,/ate ,m$icaid ,directors ,n lat] ?an #a ye> aft] ! conclusion ( ! notice & comm5t process e/abli%$ by ! ,secret>y pursuant to subclause 7,,iii71 ! ,secret>y %all issue a ,/ate ,m$icaid ,director ,lett] to notify ,/ates ( any additional home & community-bas$ s]vices approv$ by ! ,secret>y = purposes ( subp>agraph 7,a77xviii74 7,c7 ,private duty nurs+ def9$ ,= purposes ( ?is p>agraph1 ! t]m private duty nurs+ means nurs+ s]vices t are suffici5t to meet ! ne$s ( an individual :o requires m individualiz$ & cont9u\s c>e ?an is available f a visit+ nurse or r\t9ely provid$ by ! nurs+ /aff ( a hospital or skill$ nurs+ facility1 & includes s]vices provid$ to an individual 9 ! individual's own home by a regi/]$ nurse or lic5s$ practical nurse "u ! direction ( a physician4 7#c7 ,eligible individual 7,a7 ,9 g5]al ,= purposes ( p>agraph 7#a71 ! t]m eligible individual means-- 7i7 an individual :o is det]m9$1 on an annual basis or on a long] basis specifi$ by ! ,/ate1 by a heal? c>e provid] approv$ by ! ,/ate "u a process describ$ 9 subp>agraph 7,c7 to h a functional impairm5t 7z def9$ 9 subp>agraph 7,b77 7n tak+ into acc\nt any items or s]vices1 or any o!r ameliorative measures1 furni%$ to su* individual to mitigate su* impairm5t7 t is expect$ to la/ at lea/ #ij days2 7ii7 dur+ ! p]iod t ends on ! day be=e ! fir/ day ( ! fir/ cal5d> qu>t] beg9n+ on or aft] ! date t is #e ye>s aft] ! date ( ! enactm5t ( ?is subsection1 an individual :o1 z ( su* date ( enactm5t1 is receiv+ or has be5 det]m9$ to be eligible = home & community-bas$ s]vices "u ?is title 7or "u a waiv] or ,/ate plan option 9 effect "u section #aiae or #aaae1 provid$ t ! individual cont9ues to meet any level ( c>e requirem5t applicable "u su* waiv] or ,/ate plan option72 or 7iii7 an individual :o is eligible "u ! ,/ate plan or a waiv] ( su* plan & is "u ! age ( #ba4 7,b7 ,functional impairm5t ,= purposes ( subp>agraph 7,a77i71 ! t]m functional impairm5t means1 ) respect to an individual1 ! inability ( su* individual to p]=m1 )\t assi/ance-- 7i7 #b or m activities ( daily liv+ 7z describ$ 9 section #ggjb;,b7c77#b77;,b7 ( ! ,int]nal ,rev5ue ,code ( #aihf72 7ii7 #b or m in/rum5tal activities ( daily liv+ 7z def9$ = purposes ( section #aiae7k77#a77;,a772 or 7iii7 #a activity ( daily liv+ 7z s describ$7 & #a in/rum5tal activity ( daily liv+ 7z s def9$74 7,c7 ,heal? c>e provid] ,/ate approval ,= purposes ( subp>agraph 7,a77i71 a process describ$ 9 ?is subp>agraph is a process e/abli%$ by ! ,/ate to approve a heal? c>e provid] to make a det]m9ation ( functional impairm5t 9 accordance ) su* /&>ds z ! ,secret>y may prescribe4 7#d7 ,individualiz$ assessm5t 7,a7 ,9 g5]al ,= purposes ( p>agraph 7#a71 an individualiz$ assessm5t describ$ 9 ?is p>agraph is an indep5d5t assessm5t1 ) respect to an eligible individual-- 7i7 to det]m9e a necess>y level ( s]vices & supports to be provid$1 consi/5t ) ! individual's physical & heal? condition1 includ+ any functional impairm5ts2 7ii7 to id5tify ne$$ m$ical & non-m$ical s]vices & supports2 7iii7 to in=m developm5t ( a p]son-c5t]$ c>e plan 7z describ$ 9 subp>agraph 7,d77 = ! individual2 7iv7 t includes ea* ( ! elem5ts describ$ 9 clauses 7ii7 ?r\gh 7v7 ( section #aiae7;i77#a77;,f72 & 7v7 t occurs n lat] ?an #cj days aft] su* individual is det]m9$ to be an eligible individual4 7,b7 ,reassessm5ts ,an individualiz$ assessm5t %all be conduct$ at lea/ once e #ab mon?s1 & z ne$$ :5 ! individual's support ne$s or circum/ances *ange significantly1 & an individual's p]son-c5t]$ s]vice plan %all be revis$ z necess>y to reflect ! results ( ! mo/ rec5t individualiz$ assessm5t4 7,c7 ,presumption ,! individualiz$ assessm5t describ$ 9 subp>agraph 7,a7 %all be conduct$ ) ! presumption-- 7i7 t ea* eligible individual1 reg>dless ( type or level ( disability or s]vice ne$1 c be s]v$ 9 ! individual's own home & community2 & 7ii7 at ! option ( ! individual1 t s]vices may be self-direct$ 7z def9$ 9 section #aiae7;i77#a77;,g77iii77,,ii774 7,d7 ,p]son-c5t]$ c>e plan ,= purposes ( subp>agraph 7,a77iii71 a p]son-c5t]$ c>e plan describ$ 9 ?is subp>agraph is a writt5 plan ) respect to an individual t is develop$ 9 accordance )1 & meets ! requirem5ts (1 p>agraphs 7#a7 ?r\gh 7#c7 ( section #dda4cja7;c7 ( title #db1 ,code ( ,f$]al ,regulations4 7,e7 ,/&>ds ,an individualiz$ assessm5t %all be conduct$ 9 accordance ) /&>ds specifi$ by ! ,secret>y to-- 7i7 safegu>d aga9/ conflicts ( int]e/2 7ii7 specify qualifications = :o may p]=m any su* assessm5t2 7iii7 ensure transp>5cy 9 ! conduct+ ( any su* assessm5t1 includ+ ensur+ ! provision ( ! results ( ! assessm5t &1 9 pla9 language1 any in=mation necess>y to int]pret ! me?odology & results ( ! assessm5t2 7iv7 ensure t ! me?odology us$ 9 any su* assessm5t is s\nd & evid5ce-bas$2 7v7 require su* me?odology to be made available on ! public website ( ! ,/ate & te/$ = reliability & validity by an indep5d5t evaluator2 7vi7 require assessm5t tools to include language assi/ance s]vices & compliance ) ,f$]al non-discrim9ation requirem5ts1 includ+-- 7,i7 ! availability ( su* assessm5ts 9 ! individual's prim>y language or ) a qualifi$ int]pret]2 7,,ii7 accessibility = individuals :o are bl9d or h l[-vision2 7,,iii7 accessibility = deaf & h>d-(-he>+ individuals2 & 7,,iv7 accessibility = individuals :o _c rely on spee* to communicate2 & 7vii7 ensure t any s]vices & supports necess>y = community integration are id5tifi$1 involve pr(essionals kn[l$geable ab\t ! range ( s]vices & supports available 9 ! community1 & all[ individuals gett+ assess$ to pres5t _! own indep5d5t evid5ce ( ! appropriat5ess ( an integrat$ sett+4 4 7b7 ,m&atory b5efit 7#a7 ,9 g5]al ,section #aijb7;a77#aj77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77 is am5d$ by /rik+ & 7#cj7 & ins]t+ 7#cj71 & 7#cb74 7#b7 ,effective date ,! am5dm5t made by ?is subsection %all take effect on ! fir/ day ( ! fir/ cal5d> qu>t] t beg9s on or aft] ! date t is #e ye>s aft] ! date ( enactm5t ( ?is ,act4 7c7 ,ensur+ cov]age ( ,,hcbs = all m$icaid-,eligible individuals ,section #aijb7;a77#aj77;,d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77 is am5d$-- 7#a7 by ins]t+ 7i7 aft] 7,d72 7#b7 by add+ & aft] ! semicolon2 & 7#c7 by add+ at ! end ! foll[+ new clause3 7ii7 beg9n+ on ! fir/ day ( ! fir/ cal5d> qu>t] t beg9s on or aft] ! date t is #e ye>s aft] ! date ( enactm5t ( ?is clause 7or at su* e>li] date z ! ,/ate may elect7 = ! inclusion ( home & community-bas$ s]vices 7z def9$ 9 section #aije7ll77 = any individual :o-- 7,i7 is eligible = m$ical assi/ance "u ! ,/ate plan 7or waiv] ( su* plan72 7,,ii7 is an eligible individual 7z def9$ 9 su* section72 & 7,,iii7 elects to receive su* s]vices4 4 7d7 ,f$]al m$ical assi/ance p]c5tage = home & community-,bas$ s]vices ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 z am5d$ by subsection 7a71 is fur!r am5d$-- 7#a7 9 subsection 7b71 by /rik+ & 7ii7 & ins]t+ 7ii71 & 7mm72 & 7#b7 by add+ at ! end ! foll[+ new subsections3 7mm7 ,specifi$ ,f$]al m$ical assi/ance p]c5tage = home & community-,bas$ s]vices 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law & except z provid$ 9 p>agraph 7#c71 ! ,f$]al m$ical assi/ance p]c5tage = am\nts exp5d$ = m$ical assi/ance = home & community-bas$ s]vices 7z def9$ 9 subsection 7ll771 includ+ any su* s]vices furni%$ "u a waiv] 9 effect "u section #aiae or #aaae1 on or aft] ! date ( ! enactm5t ( ?is subsection %all be equal to #ajj p]c5t = any ,/ate t meets ! requirem5ts ( p>agraph 7#b74 7#b7 ,access to ess5tial home & community-bas$ s]vices ,z a condition ( receiv+ ! ,f$]al m$ical assi/ance p]c5tage describ$ 9 p>agraph 7#a71 a ,/ate %all enhance1 exp&1 or /r5g!n ! level ( & access to home & community-bas$ s]vices (f]$ "u ! ,/ate plan "u ?is title 7or a waiv] ( su* plan7 z ( ! date ( enactm5t ( ?is subsection by do+ ea* ( ! foll[+3 7,a7 ,l[]+ or elim9at+ access b>ri]s & disp>ities 9 access or utilization id5tifi$ 9 ! implem5tation plan describ$ 9 section #aijb7zz74 7,b7 ,us+ a program to ensure t an individual is n d5i$ s]vices bas$ on ! fact t ! individual contacts ! wrong entity 7commonly ref]r$ to z a #8,no ,wrong ,door ,program'71 provid+ presumptive eligibility = home & community-bas$ s]vices1 & improv+ home & community-bas$ s]vices c\nsel+ & education programs4 7,c7 ,provid+ supports to family c>egiv]s1 :i* %all include provid+ respite c>e & may include provid+ su* s]vices z c>egiv] assessm5ts1 pe] supports1 access to assi/ive te*nology1 or paid family c>egiv+4 7,d7 ,adopt+ processes to ensure t paym5ts = home & community-bas$ s]vices 7includ+ any paym5t to a direct c>e work] :o deliv]s su* s]vices7 are suffici5t to ensure t c>e & s]vices are available to ! ext5t describ$ 9 ! implem5tation plan describ$ 9 section #aijb7zz74 ,9 c>ry+ out ?is subp>agraph1 ! ,/ate %all review & update paym5t rates = home & community-bas$ s]vices at lea/ e #b ye>s1 ) an emphasis on ensur+ t rates are adequate to recruit & reta9 a suffici5t work=ce to ensure access to ! full set ( s]vices = eligible individuals z det]m9$ "u subsection 7ll7 & ?r\gh a transp>5t process involv+ mean+ful input f /akehold]s1 includ+ recipi5ts ( home & community-bas$ s]vices1 family c>egiv]s ( su* recipi5ts1 provid]s1 heal? plans1 direct c>e work]s1 *os5 repres5tatives ( direct c>e work]s1 & ag+1 disability1 & work=ce advocates4 7,e7 ,develop+ a process to ensure t increases 9 paym5t rates = home & community-bas$ s]vices are-- 7i7 at a m9imum1 proportionately pass$ ?r\gh to direct c>e work]s & 9 a mann] t is det]m9$ ) input f ! /akehold]s describ$ 9 subp>agraph 7,d72 & 7ii7 incorporat$ into paym5t rates = home & community-bas$ s]vices provid$ "u ?is title by a manag$ c>e entity 7z def9$ 9 section #aicb7;a77#a77;,b77 or a prepaid inpati5t heal? plan or prepaid ambulatory heal? plan1 z su* t]ms are def9$ 9 section #dch4b ( title #db1 ,code ( ,f$]al ,regulations 7or any successor regulation71 "u a contract ) ! ,/ate4 7,f7 ,updat+1 develop+1 & adopt+ qualification /&>ds & tra9+ opportunities = ! cont9uum ( provid]s ( home & community-bas$ s]vices1 includ+ programs = indep5d5t provid]s ( su* s]vices & ag5cy direct c>e work]s1 z well z unique programs & res\rces = family c>egiv]s4 7,g7 ,e/abli%+ an entity to /r5g!n ! infra/ructure support+ ! deliv]y ( home & community-bas$ s]vices "u consum]-direct$ models ( c>e 9 accordance ) ! requirem5ts ( subsection 7nn74 7#c7 ,exception ,! ,f$]al m$ical assi/ance p]c5tage applicable to m$ical assi/ance = home & community-bas$ s]vices furni%$ to an individual :o is only eligible = m$ical assi/ance "u a ,/ate plan or waiv] on ! basis ( section #aijb7;a77#aj77;,a77ii77,,xxiv7 %all be det]m9$ )\t reg>d to ?is subsection4 7#d7 ,adm9i/rative co/s ,not)/&+ ! p] c5tum specifi$ 9 section #aijc7;a77#g71 ) respect to am\nts exp5d$ = ! fir/ #d fiscal qu>t]s dur+ :i* ?is subsection is implem5t$ & ea* ( ! succe$+ #af fiscal qu>t]s1 = adm9i/rative co/s = exp&+ & enhanc+ home & community-bas$ s]vices1 includ+ = enhanc+ ! ,m$icaid data & te*nology infra/ructure1 modify+ rate sett+ processes1 adopt+1 us+1 & report+ quality measures1 adopt+ or improv+ tra9+ programs = direct c>e work]s & family c>egiv]s1 & adopt+1 c>ry+ out1 or enhanc+ programs t regi/] qualifi$ direct c>e work]s or connect b5efici>ies to qualifi$ direct c>e work]s "u subsection 7nn71 su* p] c5tum %all be #hj p]c5t4 7nn7 ,,hcbs infra/ructure ,to support self-,direct$ c>e models = ! deliv]y ( s]vices ,= ! purposes ( p>agraph 7#b77;,g7 ( subsection 7mm71 ! requirem5ts ( ?is subsection1 ) respect to a ,/ate & fiscal qu>t]1 are t ! ,/ate e/abli%es1 directly or by contract ) #a or m non-pr(it entities1 a program to support self-direct$ models = ! deliv]y ( s]vices = ! p]=mance ( ea* ( ! foll[+ functions3 7#a7 ,regi/]+ qualifi$ direct c>e work]s & assi/+ b5efici>ies 9 f9d+ direct c>e work]s to furni% home & community-bas$ s]vices4 7#b7 ,und]tak+ activities to recruit & tra9 indep5d5t provid]s to enable b5efici>ies to direct _! own c>e1 includ+ by provid+ or coord9at+ tra9+ = b5efici>ies on self-direct$ c>e4 7#c7 ,ensur+ ! safety (1 & support+ ! quality (1 c>e provid$ to b5efici>ies1 su* z by conduct+ backgr\nd *ecks & address+ compla9ts report$ by recipi5ts ( home & community-bas$ s]vices4 7#d7 ,facilitat+ coord9ation betwe5 ,/ate & local ag5cies & direct c>e work]s = matt]s ( public heal?1 tra9+ opportunities1 *anges 9 program requirem5ts1 workplace heal? & safety1 or relat$ matt]s4 7#e7 ,support+ b5efici>y hir+ ( indep5d5t provid]s ( home & community-bas$ s]vices ?r\gh an ag5cy ) *oice or simil> model1 includ+ by process+ applicable tax in=mation1 collect+ & process+ time%eets1 submitt+ claims1 & process+ paym5ts to su* provid]s4 7#f7 ,to ! ext5t a ,/ate p]mits b5efici>ies to hire a family memb] or individual ) :om !y h an exi/+ relation%ip to provide home & community-bas$ s]vices1 provid+ support to b5efici>ies :o wi% to hire a c>egiv] :o is a family memb] or individual ) :om !y h an exi/+ relation%ip1 su* z by facilitat+ enrollm5t ( su* family memb] or individual z a provid] ( home & community-bas$ s]vices "u ! ,/ate plan or a waiv] ( su* plan4 7#g7 ,ensur+ t program policies & proc$ures all[ = coop]ation ) labor organizations t b>ga9 on behalf ( direct c>e work]s 9 ! case ( a ,/ate 9 :i* ! direct c>e work]s 9 ! ,/ate h elect$ to jo91 or =m1 su* a labor organization1 or1 9 ! case ( a ,/ate 9 :i* su* work]s h n jo9$ or =m$ su* a labor organization1 are neutral ) reg>d to su* work]s jo9+ or =m+ su* a labor organization4 4 7e7 ,con=m+ am5dm5ts 7#a7 ,9 g5]al ,title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is am5d$-- 7,a7 9 section #aije7;a71 9 ! matt] prec$+ ! fir/ numb]$ p>agraph-- 7i7 9 ea* ( clauses 7xvi7 & 7xviii71 by mov+ ! left m>g9 #b ems to ! left2 & 7ii7 9 clause 7xvii71 by ins]t+ or :o are describ$ 9 section #aijb7;a77#aj77;,d7 aft] a ,/ate plan am5dm5t "u su* subsection2 & 7,b7 9 section #aidc7;b77#e71 by /rik+ ! ,/ate & all t foll[s ?r\gh ! p]iod at ! end & ins]t+ a det]m9ation be conduct$ on an annual basis 7or on su* long] basis z specifi$ by ! ,/ate7 9 accordance ) section #aije7ll7 = purposes ( provid+ home & community-bas$ s]vices "u ! ,/ate plan 7or waiv] ( su* plan744 7#b7 ,effective date ,! am5dm5ts made by ?is subsection %all take effect on ! fir/ day ( ! fir/ cal5d> qu>t] t beg9s on or aft] ! date t is #e ye>s aft] ! date ( enactm5t ( ?is ,act4 #ajc4 ,m$icaid eligibility modifications ,section #aijb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is am5d$-- 7#a7 9 subsection 7a7-- 7,a7 9 p>agraph 7#aj7-- 7i7 9 subp>agraph 7,a77i7-- 7,i7 9 subclause 7,,viii71 by /rik+ 2 or & ins]t+ a semicolon2 7,,ii7 9 subclause 7,,ix77dd71 by /rik+ ! semicolon at ! end & ins]t+ 2 or2 & 7,,iii7 by ins]t+ aft] subclause 7,,ix7 ! foll[+ new subclause3 7,x7 beg9n+ ) ! fir/ cal5d> qu>t] t beg9s on or aft] ! date t is #e ye>s aft] ! date ( enactm5t ( ?is subclause 7or su* e>li] date z ! ,/ate may elect71 :o are eligible individuals describ$ 9 section #aije7ll77#c77;,a7 & are n describ$ 9 a previ\s subclause ( ?is clause & ^: income does n exce$ ! great] (-- 7aa7 #aej p]c5t ( ! pov]ty l9e 7z def9$ 9 section #baaj7;c77#e77 applicable to a family ( ! size involv$2 or 7bb7 #cjj p]c5t ( ! supplem5tal security income b5efit rate e/abli%$ by section #afaa7;b77#a72 2 & 7ii7 9 subp>agraph 7,a77ii7-- 7,i7 9 subclause 7,,xxii71 by /rik+ 2 or & ins]t+ a semicolon2 7,,ii7 9 subclause 7,,xxiii71 by /rik+ ! semicolon at ! end & ins]t+ 2 or2 & 7,,iii7 by ins]t+ aft] subclause 7,,xxiii7 ! foll[+ new subclause3 7,,xxiv7 :o are eligible individuals :o w\ld be describ$ 9 clause 7i77,x7 b = ! fact t _! income exce$s ! income levels e/abli%$ "u su* clause b is less ?an su* income level z ! ,/ate may e/abli% = purposes ( ?is subclause2 2 & 7,b7 by am5d+ p>agraph 7#cd7 to read z foll[s3 7#cd7 provides t 9 ! case ( an individual eligible = home & community-bas$ s]vices 7z describ$ 9 section #aije7ll77#c77;,a771 su* s]vices w be made available & furni%$ 9 or aft] ! ?ird mon? be=e ! mon? 9 :i* su* individual made application 7or application 0 made on behalf ( su* individual 9 ! case ( a deceas$ individual7 = su* s]vices if su* individual 0 7or ^u application w\ld h be57 eligible = su* s]vices at ! "t su* s]vices 7 furni%$ &1 t if s]vices are provid$ ?r\gh a s]vice plan or any simil> docum5t1 includ+ s]vices provid$ "u ! au?ority ( any provision ( section #aaae or #aiae1 su* s]vices %all be available pursuant to ?is subsection )\t reg>d to :e!r ! s]vice plan or simil> docum5t 0 develop$ be=e or aft] ! s]vices 7 provid$2 2 & 7#b7 9 subsection 7xx77#i77;,a77ii7-- 7,a7 9 subclause 7,,viii71 by /rik+ or at ! end2 7,b7 9 subclause 7,,ix71 by /rik+ ! p]iod & ins]t+ 2 or2 & 7,c7 by add+ at ! end ! foll[+ new subclause3 7,x7 :o is describ$ 9 subclause 7,x7 ( subsection 7a77#aj77;,a77i7 or subclause 7,,xxiv7 ( subsection 7a77#aj77;,a77ii74 4 #ajd4 ,home & community-bas$ s]vices implem5tation plan 7a7 ,9 g5]al ,section #aijb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is am5d$-- 7#a7 9 subsection 7a7-- 7,a7 9 p>agraph 7#hi71 by /rik+ & at ! end2 7,b7 9 p>agraph 7#ij77;,c71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by ins]t+ aft] p>agraph 7#ij7 ! foll[+ new p>agraph3 7#ia7 provide t1 prior to ! beg9n+ ( ! fir/ cal5d> qu>t] beg9n+ on or aft] ! date t is #e ye>s aft] ! date ( ! enactm5t ( ?is p>agraph 7or su* e>li] date at ! ,/ate may elect71 ! ,/ate %all submit to ! ,secret>y ! implem5tation plan describ$ 9 subsection 7zz74 2 & 7#b7 by add+ at ! end ! foll[+ new subsection3 7zz7 ,implem5tation plan ,= purposes ( subsection 7a77#ia71 an implem5tation plan describ$ 9 ?is subsection is a plan develop$ by a ,/ate t includes ! foll[+3 7#a7 ,an explanation ( h[ ! ,/ate w op]ationalize ! def9ition ( an eligible individual "u section #aije7ll71 includ+ ! process = any det]m9ation specifi$ 9 p>agraph 7#c77;,a77i7 ( su* section4 7#b7 ,a description ( ! *>act]i/ics ( ! ,/ate's direct c>e work=ce t provides home & community-bas$ s]vices1 includ+ ! numb] ( work]s1 ! av]age & range ( direct c>e work] wages or s]vice paym5ts1 ! heal? & o!r workplace b5efits provid$ to direct c>e work]s1 turnov] & vacancy rates1 & an explanation ( ! ,/ate's plan to ensure a /able & high quality work=ce & t comp5sation = individuals furni%+ home & community-bas$ s]vices is suffici5t to ensure an appropriate supply ( work]s to provide s]vices to all eligible individuals & plans to id5tify & address any additional work=ce issues4 7#c7 ,a li/ ( any home & community-bas$ s]vices provid$ "u ! ,/ate ,m$icaid plan 7includ+ any waiv] ( su* plan7 z ( ! date ( enactm5t ( ?is subsection1 includ+ a breakd[n ( use ( su* s]vices by demographics 7z def9$ 9 section #b ( ! ,,hcbs ,access ,act71 comp>$ to su* s]vices t are requir$ "u ! am5dm5ts made by section #ajb ( su* ,act1 & a description ( num]ical goals to increase access to su* s]vices t h b>ri]s to access = populations 9 ne$ ( su* s]vices4 7#d7 ,a description ( h[ ! ,/ate w incorporate exi/+ ,/ate disability & ag+ ag5cies into ! new unifi$ provision ( home & community-bas$ s]vices & h[ su* ,/ate w ensure t su* s]vices address all functional impairm5ts4 7#e7 ,a plan = c>ry+ out outrea* & education activities ) respect to ! availability ( su* s]vices ?r\gh appropriate entities1 includ+ a program to ensure t an individual is n d5i$ su* s]vices bas$ on ! fact t ! individual contacts ! wrong entity 7commonly ref]r$ to z a ,no ,wrong ,door ,program74 7#f7 ,a plan = h[ su* s]vices w be coord9at$ ) o!r relevant ,/ate ag5cies1 su* z h\s+1 transportation1 *ild welf>e1 food & income security1 & employm5t ag5cies4 7#g7 ,a ,/ate ) f$]ally recogniz$ ,indian tribes1 ,indian heal? programs1 or urban ,indian heal? organizations %all include a process to consult ) ! ,indian tribes & seek advice f ,indian heal? programs & urban ,indian heal? organizations 9 ! ,/ate4 7#h7 ,a description ( h[ ! ,/ate w build capacity prior to ! implem5tation ( ! requirem5ts describ$ 9 subclause 7,x7 ( subsection 7a77#aj77;,a77i7 & subclause 7,,xxiv7 ( subsection 7a77#aj77;,a77ii7 to ensure t su* s]vices are available to e eligible individual "u ! ,/ate ,m$icaid program1 h[ ! ,/ate w ensure an adequate provid] network to provide access to & *oice ( provid]1 & h[ ! ,/ate w ensure t su* s]vices are provid$ 9 a sett+ t meets ! requirem5ts specifi$ 9 p>agraph 7#a7 ( section #aije7ll71 z add$ by section #ajb ( ! ,,hcbs ,access ,act4 7#i7 ,a plan = h[ ! ,/ate w prioritize individuals :o h already met eligibility requirem5ts b are on wait+ li/s to receive home & community-bas$ s]vices & ensure ^? individuals d n exp]i5ce an increase 9 ! am\nt ( "t !y w wait to receive su* s]vices4 7#aj7 ,9 ! case ( a ,/ate t utilizes an alt]native b5efit plan1 a description ( h[ ! ,/ate w ensure t all individuals :o are eligible individuals 7z def9$ 9 section #aije7ll77 are appropriately id5tifi$ z m$ically frail & exempt$ f su* plan4 7#aa7 ,h[ ! ,/ate w coord9ate eligibility = su* s]vices ) o!r disability eligibility programs1 su* z disability buy-9 programs4 7#ab7 ,data & mile/one requirem5ts to ensure community integration1 includ+ su* requirem5ts ) respect to utilization ( su* s]vices by demographics 7z def9$ 9 section #b ( ! ,,hcbs ,access ,act74 7#ac7 ,a description ( h[ ! ,/ate w evaluate & address disp>ities bas$ on age1 disability1 race1 e?nicity1 sexual ori5tation1 g5d] id5tity1 & geographic equity4 4 7b7 ,,fmap increase ,section #aijc7;a77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#c77 is am5d$-- 7#a7 9 subp>agraph 7,f77ii71 by /rik+ plus at ! end & ins]t+ &2 & 7#b7 by ins]t+ aft] subp>agraph 7,f77ii7 ! foll[+ new subp>agraph3 7,g7 an am\nt equal to #ajj p]c5t ( ! sums exp5d$ dur+ ! qu>t] :i* are attributable to ! co/s ( develop+ ! implem5tation plan describ$ 9 section #aijb7zz72 & 4 #aje4 ,quality ( s]vices 7a7 ,9 g5]al 7#a7 ,developm5t ( metrics 7,a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices1 9 consultation ) ,/ate ,m$icaid ,directors1 %all develop /&>diz$1 ,/ate-level metrics reg>d+ access to1 & satisfaction )1 provid]s1 includ+ prim>y c>e & speciali/ provid]s1 ) respect to individuals :o are enroll$ 9 a ,/ate ,m$icaid plan "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 7or "u a waiv] ( su* plan71 brok5 d[n by demographics 7z def9$ 9 section #b7 & any o!r category det]m9$ appropriate by ! ,secret>y4 7,b7 ,inclusions ,! metrics develop$ "u subp>agraph 7,a7 %all include metrics on ! total numb] ( individuals enroll$ 9 ! ,/ate plan or "u a waiv] ( su* plan dur+ a fiscal ye> t requir$ ! level ( c>e provid$ 9 a nurs+ facility1 int]m$iate c>e facility = individuals ) intellectual disabilities1 in/itution = m5tal disease1 or o!r simil>ly re/rictive or in/itutional sett+4 7#b7 ,process ,! ,secret>y %all develop ! metrics describ$ 9 p>agraph 7#a7 ?r\gh a public process1 :i* %all provide opportunities = /akehold]s to p>ticipate4 7b7 ,updat+ metrics ,! ,secret>y1 9 consultation ) ! ,deputy ,adm9i/rator & ,director = ! ,c5t] = ,m$icaid & ,,*ip ,s]vices & ,/ate ,m$icaid ,directors1 %all update ! metrics develop$ "u subsection 7a7 n less ?an once e #c ye>s4 7c7 ,/ate implem5tation fund+ ,! ,secret>y may aw>d funds1 f ! am\nt appropriat$ "u subsection 7d71 to ,/ates = ! purpose ( implem5t+ ! metrics develop$ "u ?is section4 7d7 ,appropriation ,!re is appropriat$ to ! ,secret>y1 out ( any funds 9 ! ,treasury n o!rwise appropriat$1 #bjj1jjj1jjj = fiscal ye> #bjbg1 to rema9 available until exp5d$1 = ! purpose ( c>ry+ out ?is section4 #ajf4 ,reports2 te*nical assi/ance2 o!r adm9i/rative requirem5ts 7a7 ,reports ,! ,secret>y %all submit to ! ,committee on ,f9ance ( ! ,s5ate1 ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ( ! ,s5ate1 ! ,special ,committee on ,ag+ ( ! ,s5ate1 ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives1 & ! ,committee on ,education & ,work=ce ( ! ,h\se ( ,repres5tatives ! foll[+ reports relat+ to ! home & community-bas$ s]vices implem5tation plan e/abli%$ "u section #ajd3 7#a7 ,int]im report ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 a report t describes-- 7,a7 ,/ate ef=ts to develop _! home & community-bas$ s]vices implem5tation plans z describ$ 9 section #aijb7zz7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7zz77 7z add$ by section #ajd72 & 7,b7 ! funds aw>d$ to ,/ates = any adm9i/rative co/s associat$ ) ! developm5t ( su* implem5tation plans4 7#b7 ,fir/ implem5tation report ,n lat] ?an #d ye>s aft] ! date ( enactm5t ( ?is ,act1 a report t includes ! foll[+3 7,a7 ,a description ( ! home & community-bas$ s]vices implem5tation plans approv$ by ! ,secret>y "u section #aijb7zz7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7zz77 7z add$ by section #ajd74 7,b7 ,a description ( ! national l&scape ) respect to gaps 9 cov]age ( home & community-bas$ s]vices1 disp>ities 9 access to su* s]vices1 utilization ( su* s]vices1 & b>ri]s to access+ su* s]vices4 7,c7 ,a description ( ! national l&scape ) respect to ! direct c>e work=ce t provides home & community-bas$ s]vices1 includ+ ) respect to comp5sation1 b5efits1 & *all5ges to ! availability ( su* work]s4 7#c7 ,subsequ5t reports ,n lat] ?an #g ye>s aft] ! date ( enactm5t ( ?is ,act1 & e #c ye>s !reaft]1 a report t includes ! foll[+3 7,a7 ,! numb] ( ,/ates aw>d$ fund+1 & ! funds aw>d$ to su* ,/ates1 to develop an implem5tation plan describ$ 9 section #aijb7zz7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7zz77 7z add$ by section #ajd74 7,b7 ,a summ>y ( ! progress be+ made by su* ,/ates ) respect to /r5g!n+ & exp&+ access to home & community-bas$ s]vices & ! direct c>e work=ce t provides su* s]vices & meet+ ! b5*m>ks = demon/rat+ improvem5ts requir$ "u section #aije7ll77#e7 ( ! ,social ,security ,act 7z add$ by section #ajb74 7,c7 ,a summ>y ( outcomes relat$ to home & community-bas$ s]vices core quality measures & b5efici>y & family c>egiv] surveys4 7,d7 ,a summ>y ( ! *all5ges & be/ practices report$ by ,/ates 9 exp&+ access to home & community-bas$ s]vices & support+ & exp&+ ! direct c>e work=ce t provides su* s]vices4 7b7 ,te*nical assi/ance2 guidance2 regulations ,! ,secret>y %all provide ,/ates aw>d$ fund+ to develop an implem5tation plan describ$ 9 section #aijb7zz7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7zz77 7z add$ by section #ajd7 ) te*nical assi/ance relat$ to c>ry+ out ! home & community-bas$ s]vices implem5tation plans approv$ by ! ,secret>y "u su* section & meet+ ! requirem5ts & b5*m>ks = demon/rat+ improvem5ts requir$ "u section #aije7mm7 ( ! ,social ,security ,act 7z add$ by section #ajb7 & %all issue su* guidance or regulations z necess>y to c>ry out ?is title & ! am5dm5ts made by ?is title1 includ+ guidance specify+ h[ ,/ates %all assess & track ! availability ( home & community-bas$ s]vices ov] "t4 7c7 ,recomm5dations ,to guide ,,hcbs implem5tation 7#a7 ,9 g5]al ,n lat] ?an #ah mon?s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y1 9 coord9ation ) ! ,secret>y ( ,labor & ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 %all issue recomm5dations reg>d+ h[ ! ,f$]al ,gov]nm5t & ,/ates c /r5g!n ! direct c>e work=ce t provides home & community-bas$ s]vices1 includ+ ) respect to h[ ! ,f$]al ,gov]nm5t %\ld classify ! direct c>e work=ce1 h[ su* ,adm9i/rator & ,/ate ,m$icaid programs c en=ce & support ! provision ( competitive wages & b5efits across ! direct c>e work=ce1 includ+ = work]s ) p>ticul> skills or exp]tise1 & h[ ,/ate ,m$icaid programs c support tra9+ opportunities & o!r relat$ ef=ts t support ! provision ( quality home & community-bas$ s]vices4 7#b7 ,/akehold] consultation 7,a7 ,9 g5]al ,9 develop+ ! recomm5dations requir$ "u p>agraph 7#a71 ! ,secret>y %all ensure t su* recomm5dations are in=m$ by consultation ) recipi5ts ( home & community-bas$ s]vices1 family c>egiv]s ( su* recipi5ts1 provid]s1 heal? plans1 direct c>e work]s1 *os5 repres5tatives ( direct c>e work]s1 educational ag5cies1 & ag+1 disability1 & work=ce advocates4 7,b7 ,consultation ) curr5t & pot5tial ,,hcbs b5efici>ies & family c>egiv]s ,9 consult+ ) /akehold]s "u subp>agraph 7,a71 ! ,secret>y %all-- 7i7 hold at lea/ #a meet+ solely ) curr5t & pot5tial recipi5ts ( home & community-bas$ s]vices & family c>egiv]s ( su* recipi5ts = ! purpose ( develop+ ! recomm5dations requir$ "u p>agraph 7#a72 & 7ii7 seek to a*ieve p>ity 9 t]ms ( ! level ( p>ticipation 9 ! developm5t ( su* recomm5dations betwe5-- 7,i7 curr5t & pot5tial recipi5ts ( home & community-bas$ s]vices & family c>egiv]s ( su* recipi5ts2 & 7,,ii7 o!r categories ( /akehold] describ$ 9 subp>agraph 7,a74 7d7 ,fund+ ,out ( any funds 9 ! ,treasury n o!rwise appropriat$1 !re is appropriat$ to ! ,secret>y = purposes ( c>ry+ out ?is section1 #aj1jjj1jjj = fiscal ye> #bjbg1 to rema9 available until exp5d$4 #ajg4 ,quality measurem5t & improvem5t 7a7 ,developm5t & publication ( core & supplem5tal sets ( ,,hcbs quality measures 7#a7 ,9 g5]al ,! ,secret>y %all id5tify & publi% a core set & supplem5tal set ( home & community-bas$ s]vices quality measures = use by ,/ate ,m$icaid programs1 heal? plans & manag$ c>e entities t ent] into contracts ) su* programs1 & provid]s ( items & s]vices "u su* programs4 7#b7 ,regul> reviews & updates ,! ,secret>y %all review & update ! core set & supplem5tal set ( home & community-bas$ s]vices quality measures publi%$ "u p>agraph 7#a7 n less frequ5tly ?an annually4 7#c7 ,requirem5ts 7,a7 ,int]ag5cy collaboration2 /akehold] input ,9 develop+ ! core set & supplem5tal set ( home & community-bas$ s]vices quality measures "u p>agraph 7#a71 & subsequ5tly review+ & updat+ su* core & supplem5tal sets1 ! ,secret>y %all-- 7i7 collaborate ) subag5cy heads det]m9$ appropriate by ! ,secret>y2 & 7ii7 ensure t su* core & supplem5tal sets are in=m$ by input f /akehold]s1 includ+ recipi5ts ( home & community-bas$ s]vices1 family c>egiv]s ( su* recipi5ts1 provid]s1 heal? plans1 direct c>e work]s1 *os5 repres5tatives ( direct c>e work]s1 & ag+1 disability1 & work=ce advocates1 ) ! goal t at lea/ half ( su* input is f curr5t & pot5tial recipi5ts ( home & community-bas$ s]vices & family c>egiv]s4 7,b7 ,reflective ( full array ( s]vices ,su* core set & supplem5tal set ( home & community-bas$ s]vices quality measures %all-- 7i7 reflect ! full array ( home & community-bas$ s]vices & recipi5ts ( su* s]vices1 includ+ adults & *ildr52 & 7ii7 include-- 7,i7 outcomes-bas$ measures2 7,,ii7 measures ( availability ( s]vices2 7,,iii7 measures ( provid] capacity & availability2 7,,iv7 measures relat$ to p]son-c5t]$ c>e2 7,v7 measures specific to self-direct$ c>e2 7,,vi7 measures relat$ to transitions to & f in/itutional c>e2 7,,vii7 b5efici>y & family c>egiv] surveys2 & 7,,viii7 measures relat$ to outcomes by race & e?nicity1 language1 sex1 g5d] id5tity1 geography1 & o!r demographic factors to track & r$uce heal? disp>ities4 7,c7 ,demographics ,su* core set & supplem5tal set ( home & community-bas$ s]vices quality measures %all all[ = ! collection ( data t is disaggregat$ by demographics 7z def9$ 9 section #b & includ+ any additional category det]m9$ by ! ,secret>y74 7#d7 ,fund+ ,out ( any funds 9 ! ,treasury n o!rwise appropriat$1 !re is appropriat$ to ! ,secret>y = purposes ( c>ry+ out ?is subsection1 #aj1jjj1jjj = fiscal ye> #bjbg1 to rema9 available until exp5d$4 7b7 ,/ate adoption & reports 7#a7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date on :i* ! ,secret>y publi%es ! core set & supplem5tal set ( home & community-bas$ s]vices quality measures "u subsection 7a77#a71 & annually !reaft]1 ea* ,/ate ,m$icaid program %all use su* core & supplem5tal sets 7or an alt]native set ( quality measures approv$ by ! ,secret>y7 to report in=mation to ! ,secret>y reg>d+ ! quality ( home & community-bas$ s]vices provid$ "u su* program4 7#b7 ,process ,! in=mation requir$ "u p>agraph 7#a7 %all be report$ us+ a /&>diz$ =mat & proc$ures e/abli%$ by ! ,secret>y4 ,su* proc$ures %all all[ a ,/ate ,m$icaid program to report su* in=mation sep>ately or z "p ( ! annual reports requir$ "u sections #aaci;,a7c7 & #aaci;,b7d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;a1 #acbj;b-#i;b74 7#c7 ,publication ( quality measures ,ea* ,/ate ,m$icaid program %all annually make ! in=mation report$ to ! ,secret>y "u p>agraph 7#a7 available to ! public4 7#d7 ,increas$ ,f$]al mat*+ rate = adoption & report+ ,section #aijc7;a77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#c771 z am5d$ by section #ajd7;b71 is am5d$-- 7,a7 9 subp>agraph 7,h77ii71 by /rik+ plus aft] ! semicolon & ins]t+ &2 & 7,b7 by ins]t+ aft] subp>agraph 7,h77ii7 ! foll[+ new subp>agraph3 7,i7 #hj p]c5t ( s mu* ( ! sums exp5d$ dur+ su* qu>t] z are attributable to ! report+ ( in=mation reg>d+ ! quality ( home & community-bas$ s]vices 9 accordance ) section #ajg7;b7 ( ! ,,hcbs ,access ,act2 plus 4 7c7 ,ombudsman ,ea* ,/ate %all e/abli% a home & community-bas$ s]vices ombudsman (fice t-- 7#a7 op]ates indep5d5tly f ! ,/ate ,m$icaid ag5cy & manag$ c>e entities2 7#b7 provides direct assi/ance to b5efici>ies & _! families ) respect to access+ home & community-bas$ s]vices2 & 7#c7 id5tifies & reports sy/emic problems to ,/ate (ficials1 ! public1 & ! ,secret>y ) respect to ! provision ( or access to home & community-bas$ s]vices4 #ajh4 ,mak+ p]man5t ! ext5d$ protection "u m$icaid = recipi5ts ( home & community-bas$ s]vices aga9/ sp\sal impov]i%m5t 7a7 ,9 g5]al ,section #aibd7;h77#a77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#e7;h77#a77;,a77 is am5d$ by /rik+ 7at ! option ( ! ,/ate7 is describ$ 9 section #aijb7;a77#aj77;,a77ii77,,vi7 & ins]t+ is an eligible individual 7z def9$ 9 section #aije7ll77#c774 7b7 ,con=m+ am5dm5t ,section #bdjd ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #acifr-#e note7 is am5d$ by /rik+ ,septemb] #cj1 #bjbg & ins]t+ ! date ( enactm5t ( ! ,,hcbs ,access ,act4 #aji4 ,p]man5t ext5sion ( money foll[s ! p]son rebalanc+ demon/ration ,section #fjga7;h77#a77,l7 ( ! ,deficit ,r$uction ,act ( #bjje 7#db ,u4,s4,c4 #acif;a note7 is am5d$ by /rik+ ea* ( fiscal ye>s #bjbd ?r\gh #bjbg & ins]t+ fiscal ye> #bjbd & ea* fiscal ye> !reaft]4 #aaj4 ,li5s1 adju/m5ts1 & recov]ies = m$ical assi/ance 7a7 ,li5s ,section #aiag7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifp7a77 is am5d$-- 7#a7 9 p>agraph 7#a7-- 7,a7 9 ! matt] prec$+ subp>agraph 7,a71 by /rik+ plan1 except-- & ins]t+ plan1 except1 subject to p>agraph 7#d7--2 & 7,b7 9 subp>agraph 7,b71 by /rik+ 9 ! case ( & ins]t+ ) respect to li5s impos$ be=e ! date ( ! enactm5t ( ! ,,hcbs ,access ,act1 9 ! case (2 & 7#b7 by add+ at ! end ! foll[+3 7#d7 ,not)/&+ any prec$+ provision ( ?is subsection1 n lat] ?an #ij days aft] ! date ( ! enactm5t ( ?is p>agraph1 a ,/ate %all-- 7,a7 )draw any li5 impos$ "u p>agraph 7#a77;,b7 t is 9 effect z ( su* date2 & 7,b7 notify ea* individual 7or legal repres5tative ( su* individual 7or ( su* individual's e/ate77 subject to su* a li5 s )drawn ( ! )drawal ( su* li54 4 7b7 ,adju/m5ts & recov]ies ,section #aiag7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifp7b77 is am5d$-- 7#a7 9 p>agraph 7#a71 by /rik+ except t & ins]t+ except t1 subject to p>agraph 7#f712 & 7#b7 by add+ at ! end ! foll[+3 7#f7 ,not)/&+ any prec$+ provision ( ?is subsection1 no adju/m5t or recov]y ( any m$ical assi/ance correctly paid on behalf ( an individual "u ! ,/ate plan may be initiat$1 ma9ta9$1 or collect$ on or aft] ! date ( ! enactm5t ( ?is p>agraph4 ,n lat] ?an #ij days aft] su* date1 a ,/ate %all-- 7,a7 )draw any li5 9 effect z ( su* date ) respect to su* m$ical assi/ance correctly paid2 & 7,b7 notify ea* individual 7or legal repres5tative ( su* individual 7or ( su* individual's e/ate77 subject to su* a li5 s )drawn ( ! )drawal ( su* li5 & ! prohibition on adju/m5t or recov]y "u ?is p>agraph4 4 #aaa4 ,,hcbs provid] tax ,section #aijc7w7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7w77 is am5d$-- 7#a7 9 p>agraph 7#g77;,a7-- 7,a7 by r$esignat+ clause 7ix7 z clause 7x72 & 7,b7 by ins]t+ aft] clause 7viii7 ! foll[+ new clause3 7ix7 home & community-bas$ s]vices4 2 & 7#b7 9 p>agraph 7#d77;,c77ii71 by ins]t+ = a class ( heal? c>e items & s]vices o!r ?an ! class describ$ 9 p>agraph 7#g77;,a77ix71 aft] #bjbf14 #aab4 ,m$ic>e am5dm5t ,section #ahfj;,d-#ad7;a77#a77;,d77i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7 is am5d$ by /rik+ or subsection 7c7 or 7d7 ( section #aiae or "u a ,/ate plan am5dm5t "u subsection 7i7 ( su* section & ins]t+ 1 section #aiae1 #aaae;,a1 or "u a ,/ate plan am5dm5t4 ,,ii ,recogniz+ ! ,role ( ,direct ,support ,pr(essionals #bja4 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,direct support pr(essionals play a critical role 9 ! c>e provid$ to *ildr5 & adults ) intellectual & developm5tal disabilities4 7#b7 ,provid]s ( home & community-bas$ s]vices are exp]i5c+ difficulty hir+ & reta9+ direct support pr(essionals1 ) a national turnov] rate ( #ci p]c5t z id5tifi$ 9 a #bjbc /udy by ! ,national ,core ,indicators4 7#c7 ,high turnov] rates c lead to in/ability = individuals receiv+ s]vices1 & ?is may result 9 individuals n receiv+ en\gh p]sonaliz$ c>e to help !m rea* _! goals = indep5d5t liv+4 7#d7 ,a discrete occupational category = direct support pr(essionals w help ,/ates & ! ,f$]al ,gov]nm5t-- 7,a7 bett] int]pret ! %ortage 9 ! labor m>ket ( direct support pr(essionals2 & 7,b7 collect data on ! high turnov] rate ( direct support pr(essionals4 7#e7 ,! ,/&>d ,occupational ,classification sy/em is design$ & ma9ta9$ solely = /ati/ical purposes1 & is us$ by ,f$]al /ati/ical ag5cies to classify work]s & jobs into occupational categories = ! purpose ( collect+1 calculat+1 analyz+1 or dissem9at+ data4 7#f7 ,occupations 9 ! ,/&>d ,occupational ,classification sy/em are classifi$ bas$ on "w p]=m$ &1 9 "s cases1 on ! skills1 education1 or tra9+ ne$$ to p]=m ! "w4 7#g7 ,e/abli%+ a discrete occupational category = direct support pr(essionals w-- 7,a7 correct an inaccurate repres5tation 9 ! ,/&>d ,occupational ,classification sy/em2 7,b7 recognize ^! pr(essionals = ! critical & (t5 times ov]look$ "w t !y p]=m = ! disabl$ community1 :i* "w is diff]5t ?an ! "w ( a home heal? aide or a p]sonal c>e aide2 & 7,c7 bett] align ! ,/&>d ,occupational ,classification sy/em ) relat$ classification sy/ems4 #bjb4 ,revision ( /&>d occupational classification sy/em 7a7 ,9 g5]al ,! ,director ( ! ,(fice ( ,managem5t & ,budget 79 ?is ,act ref]r$ to z ! ,director7 %all1 z "p ( ! fir/ revision process ( ! ,/&>d ,occupational ,classification sy/em occurr+ aft] ! date ( enactm5t ( ?is ,act1 consid] e/abli%+ a sep>ate code = direct support pr(essionals z a subset ( heal?c>e support occupations4 7b7 ,report to ,congress ,if ! ,director decides n to e/abli% ! sep>ate code = direct support pr(essionals describ$ 9 subsection 7a71 ! ,director %all1 n lat] ?an #cj days aft] ! ,director ann\nces 9 ! ,f$]al ,regi/] ! f9al decision ( ! revision process describ$ 9 su* subsection1 submit to ! ,committee on ,homel& ,security & ,gov]nm5tal ,affairs ( ! ,s5ate & ! ,committee on ,education & ,work=ce ( ! ,h\se ( ,repres5tatives a report expla9+ :y su* sep>ate code 0 n e/abli%$4 ,,iii ,support = ! ,direct ,c>e ,work=ce #cja4 ,def9itions ,9 ?is title3 7#a7 ,appr5tice%ip program ,! t]m appr5tice%ip program means an appr5tice%ip program regi/]$ "u ! ,act ( ,augu/ #af1 #aicg 7commonly kn[n z ! ,national ,appr5tice%ip ,act2 #ej ,/at4 #ffd1 *apt] #ffc2 #bi ,u4,s4,c4 #ej et seq471 includ+ any requirem5t1 /&>d1 or rule promulgat$ "u su* ,act4 7#b7 ,community college ,! t]m community college means a public in/itution ( high] education at :i* ! highe/ degree t is pr$om9antly aw>d$ to /ud5ts is an associate's degree1 includ+ ,tribal ,colleges or ,univ]sities receiv+ grants "u section #caf ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajei;c7 t (f] a #b-ye> program = completion ( su* degree & ,/ate public in/itutions ( high] education t (f] su* a #b-ye> program4 7#c7 ,direct c>e pr(essional ,! t]m direct c>e pr(essional-- 7,a7 means an individual :o1 9 ex*ange = comp5sation1 provides s]vices to a p]son ) a disability or an old] adult t promote ! indep5d5ce ( su* p]son or adult1 includ+-- 7i7 s]vices t enhance ! indep5d5ce & community inclusion = su* p]son or adult1 includ+ travel+ ) su* p]son or individual or att5d+ & assi/+ su* p]son or adult :ile visit+ fri5ds & family1 %opp+1 or socializ+2 7ii7 s]vices su* z coa*+ & support+ su* p]son or adult 9 communicat+ ne$s1 a*iev+ self-expression1 pursu+ p]sonal goals1 liv+ indep5d5tly1 & p>ticipat+ actively 9 employm5t or volunt>y roles 9 ! community2 7iii7 s]vices su* z provid+ assi/ance ) activities ( daily liv+ 7su* z fe$+1 ba?+1 toilet+1 & ambulation7 & ) tasks su* z meal prep>ation1 %opp+1 light h\sekeep+1 & laundry2 7iv7 s]vices t support su* p]son or adult at home1 "w1 or s*ool1 or 9 any o!r community sett+2 or 7v7 s]vices t promote heal? & wellness1 includ+ s*$ul+ & tak+ su* p]son or adult = or to heal? c>e appo9tm5ts1 communicat+ ) heal? & alli$ heal? pr(essionals adm9i/]+ m$ications1 implem5t+ heal? & behavioral heal? int]v5tions & treatm5t plans1 & monitor+ & record+ heal? /atus & progress2 & 7,b7 includes-- 7i7 a s]vice provid] support+ p ) intellectual disabilities1 developm5tal disabilities1 or o!r disabilities2 7ii7 a home & community-bas$ s]vices manag] or direct support pr(essional manag]2 7iii7 a self-direct$ c>e work]2 7iv7 a p]sonal c>e s]vice work]2 7v7 a direct c>e work]1 z def9$ 9 section #gii;,b ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #biep72 or 7vi7 any work] 9 ano!r position or job relat$ to ! home c>e or direct c>e work=ce1 su* z positions or jobs 9 respite c>e1 palliative c>e1 community support1 or pe] support1 z det]m9$ by ! ,secret>y1 9 consultation ) ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices & ! ,secret>y ( ,labor4 7#d7 ,direct c>e work=ce ,! t]m direct c>e work=ce means ! broad work=ce ( direct c>e pr(essionals4 7#e7 ,eligible entity ,! t]m eligible entity means an entity-- 7,a7 t is-- 7i7 a ,/ate2 7ii7 a labor organization1 jo9t labor-managem5t organization1 or employ]1 ( direct c>e pr(essionals2 7iii7 an organization or a nonpr(it entity ) exp]i5ce 9 ag+ or disability1 or 9 support+ ! rights & int]e/s (1 tra9+1 or educat+ direct c>e pr(essionals or family c>egiv]s2 7iv7 an ,indian ,tribe1 ,tribal organization1 or ,urban ,indian organization2 7v7 a community college or o!r in/itution ( high] education2 or 7vi7 a consortium ( entities li/$ 9 any ( clauses 7i7 ?r\gh 7v72 7,b7 t agrees to include1 z applicable ) respect to ! type ( grant ! entity is seek+ "u ?is title & ! activities support$ ?r\gh su* grant1 old] adults1 p ) disabilities1 direct c>e pr(essionals1 & family c>egiv]s1 z advisors & tra9]s 9 su* activities2 & 7,c7 t agrees to consult ) ! ,/ate ,m$icaid ag5cy ( ! ,/ate 7or ea* ,/ate7 s]v$ by ! grant on ! grant activities1 to ! ext5t t su* ag5cy 7or ea* su* ag5cy7 is n ! eligible entity4 7#f7 ,employ] ,! t]ms employ & employ] h ! mean+s giv5 ! t]ms 9 section #c ( ! ,fair ,labor ,/&>ds ,act ( #aich 7#bi ,u4,s4,c4 #bjc74 7#g7 ,family c>egiv] ,! t]m family c>egiv] has ! mean+ giv5 su* t]m 9 section #b ( ! ,,raise ,family ,c>egiv]s ,act 7#db ,u4,s4,c4 #cjcjs note7 & includes paid & unpaid family c>egiv]s4 7#h7 ,indian tribe2 tribal organization ,! t]ms ,indian ,tribe & ,tribal organization h ! mean+s giv5 su* t]ms 9 section #d ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #ecjd74 7#i7 ,in/itution ( high] education ,! t]m in/itution ( high] education means-- 7,a7 an in/itution ( high] education def9$ 9 section #aja ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajja72 or 7,b7 an in/itution ( high] education def9$ 9 section #ajb7;a77#a77;,b7 ( su* ,act 7#bj ,u4,s4,c4 #ajjb7;a77#a77;,b774 7#aj7 ,old] adult ,! t]m old] adult means an individual :o is #fj ye>s ( age or old]4 7#aa7 ,p]son ) a disability ,! t]m p]son ) a disability means an individual ) a disability1 z def9$ 9 section #c ( ! ,am]icans ) ,disabilities ,act ( #aiij 7#db ,u4,s4,c4 #abajb74 7#ab7 ,project p>ticipant ,! t]m project p>ticipant means an individual p>ticipat+ 9 a project or activity assi/$ ) a grant "u ?is title1 includ+ 7z applicable = ! category ( ! grant7 a direct c>e pr(essional1 or an individual seek+ to be su* a pr(essional1 or a family c>egiv]4 7#ac7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,adm9i/rator = ,community ,liv+4 7#ad7 ,self-direct$ c>e pr(essional ,! t]m self-direct$ c>e pr(essional means a direct c>e pr(essional :o is employ$ by an individual :o is an old] adult1 a p]son ) a disability1 or a repres5tative ( su* old] adult or p]son ) a disability1 & su* old] adult or p]son ) a disability has ! decisionmak+ au?ority ov] c]ta9 supports & s]vices provid$ by ! direct c>e pr(essional & takes direct responsibility to manage ^? supports & s]vices4 7#ae7 ,supportive s]vices ,! t]m supportive s]vices means s]vices t are necess>y to enable an individual to p>ticipate 9 activities assi/$ ) a grant "u ?is title1 su* z transportation1 *ild c>e1 dep5d5t c>e1 h\s+1 workplace accommodations1 employee b5efits su* z paid sick leave & *ild c>e1 workplace heal? & safety protections1 wages & ov]time pay1 & ne$s-relat$ paym5ts4 7#af7 ,urban ,indian organization ,! t]m urban ,indian organization has ! mean+ giv5 ! t]m 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc74 7#ag7 ,work=ce innovation & opportunity act t]ms ,! t]ms c>e] pa?way1 c>e] plann+1 9-dem& indu/ry sector or occupation1 individual ) a b>ri] to employm5t1 local bo>d1 on-!-job tra9+1 recogniz$ po/second>y cr$5tial1 region1 & ,/ate bo>d h ! mean+s giv5 su* t]ms 9 section #c ( ! ,work=ce ,innovation & ,opportunity ,act 7#bi ,u4,s4,c4 #cajb74 7#ah7 ,"w-bas$ le>n+ ,! t]m "w-bas$ le>n+ has ! mean+ giv5 ! t]m 9 section #c ( ! ,c>l ,d4 ,p]k9s ,c>e] & ,te*nical ,education ,act ( #bjjf 7#bj ,u4,s4,c4 #bcjb74 #cjb4 ,au?ority to e/abli% a te*nical assi/ance c5t] = build+ ! direct c>e work=ce 7a7 ,program au?oriz$ ,! ,secret>y %all1 9 consultation ) ! ,secret>y ( ,labor1 ! ,secret>y ( ,education1 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 & ! heads ( o!r entities z necess>y1 e/abli% a national te*nical assi/ance c5t] 7ref]r$ to 9 ?is section z ! ,c5t]7 =-- 7#a7 support+ direct c>e work=ce creation1 tra9+ & education1 recruitm5t1 ret5tion1 & advancem5t2 & 7#b7 support+ family c>egiv]s & activities ( family c>egiv]s z a critical "p ( ! support team = old] adults or p ) disabilities4 7b7 ,advisory c\ncil ,! ,secret>y %all e/abli% an advisory c\ncil to provide recomm5dations to ! ,c5t] ) respect to ! duties ( ! ,c5t] "u ?is section & may engage individuals & entities describ$ 9 p>agraphs 7#c77;,b71 & 7#ab71 ( section #cjd7;b7 7)\t reg>d to a specific project describ$ 9 su* p>agraphs7 = s]vice on ! advisory c\ncil4 7c7 ,activities ,! ,c5t] may-- 7#a7 develop recomm5dations = tra9+ & education curricula & programs = direct c>e pr(essionals1 :i* recomm5dations may include recomm5dations = curricula = high] education1 po/second>y cr$5tials1 & programs ) community colleges2 7#b7 develop le>n+ & dissem9ation /rategies to-- 7,a7 engage ,/ates & o!r entities 9 activities support$ by grants "u ?is title & 9 use ( relat$ be/ practices2 & 7,b7 di/ribute f9d+s f activities support$ by grants "u ?is title2 7#c7 develop recomm5dations = tra9+ & education curricula & o!r /rategies = support+ family c>egiv]s2 7#d7 explore ! national data gaps1 work=ce %ortage areas1 & data collection /rategies = direct c>e pr(essionals & make recomm5dations to ! ,director ( ! ,(fice ( ,managem5t & ,budget = an occupation category 9 ! ,/&>d ,occupational ,classification sy/em = direct c>e pr(essionals z a heal? c>e support occupation2 7#e7 recomm5d c>e] developm5t & advancem5t opportunities = direct c>e pr(essionals1 :i* may include recomm5dations = occupational frameworks1 national /&>ds1 recruitm5t campaigns1 pre-appr5tice%ip & on-!-job tra9+ opportunities1 appr5tice%ip programs1 c>e] ladd]s or pa?ways1 specializations or c]tifications1 or o!r activities2 & 7#f7 develop /rategies = assi/+ ) report+ & evaluation ( grant activities "u section #cje4 #cjc4 ,au?ority to aw>d grants 7a7 ,grants 7#a7 ,9 g5]al ,n lat] ?an #ab mon?s aft] ! date ( enactm5t ( ?is title1 ! ,secret>y1 9 consultation ) ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 ! ,secret>y ( ,labor1 & ! ,secret>y ( ,education1 %all aw>d grants describ$ 9 p>agraph 7#b7 to eligible entities4 ,a grant aw>d$ "u ?is section may be 9 m ?an #a category describ$ 9 su* p>agraph4 7#b7 ,categories ( grants ,! categories ( grants describ$ 9 ?is p>agraph are ea* ( ! foll[+3 7,a7 ,direct c>e pr(essional grants ,grants to eligible entities to create & c>ry out projects = ! purposes ( recruit+1 reta9+1 or provid+ advancem5t opportunities = direct c>e pr(essionals :o are n describ$ 9 subp>agraph 7,b7 or 7,c71 includ+ ?r\gh education or tra9+ programs = su* pr(essionals or individuals seek+ to become su* pr(essionals4 7,b7 ,direct c>e pr(essional manag]s grants ,grants to eligible entities to create & c>ry out projects = ! purposes ( recruit+1 reta9+1 or provid+ advancem5t opportunities = direct c>e pr(essionals :o are manag]s or sup]visory /aff & :o h coa*+1 tra9+1 manag]ial1 sup]visory1 or o!r ov]sight responsibilities1 includ+ ?r\gh education or tra9+ programs = su* individuals pr(essionals or individuals seek+ to become su* pr(essionals4 7,c7 ,self-direct$ c>e pr(essionals grants ,grants to eligible entities to create & c>ry out projects = ! purposes ( recruit+1 reta9+1 or provid+ advancem5t opportunities = self-direct$ c>e pr(essionals1 includ+ ?r\gh education or tra9+ programs = su* pr(essionals or individuals seek+ to become su* pr(essionals4 7,d7 ,family c>egiv] grants ,grants to eligible entities to create & c>ry out projects = provid+ support to paid or unpaid family c>egiv]s ?r\gh educational1 tra9+1 or o!r res\rces1 includ+ res\rces = c>egiv] self-c>e or educational or tra9+ res\rces = individuals newly 9 a c>egiv+ role or seek+ additional support 9 ! role ( a family c>egiv]4 7#c7 ,projects = advancem5t opportunities ,n less ?an #cj p]c5t ( projects assi/$ ) grants "u ?is title %all be projects to provide c>e] pa?ways t (f] opportunities = pr(essional developm5t & advancem5t opportunities to direct c>e pr(essionals4 7b7 ,treatm5t ( cont9uation activities ,an eligible entity t c>ries out activities describ$ 9 subsection 7a77#b7 prior to receipt ( a grant "u ?is title may use su* grant to cont9ue c>ry+ out su* activities1 &1 if ! entity uses su* grant to cont9ue su* activities1 ! entity %all be treat$ z an eligible entity c>ry+ out a project ?r\gh a grant "u ?is title & ! activities %all be consid]$ to be su* a project4 #cjd4 ,project plans 7a7 ,9 g5]al ,an eligible entity seek+ a grant "u ?is title %all submit to ! ,secret>y a project plan = ea* project to be develop$ & c>ri$ out 7includ+ activities to be cont9u$ z describ$ 9 section #cjc7;b77 ) ! grant at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7b7 ,cont5ts ,a project plan submitt$ by an eligible entity "u subsection 7a7 %all include a description ( in=mation det]m9$ relevant by ! ,secret>y = purposes ( ! category ( ! grant & ! activities to be c>ri$ out ?r\gh ! grant4 ,su* in=mation %all include 7z applicable7 ea* ( ! foll[+3 7#a7 ,! demographics 7z def9$ 9 section #b7 ( ! population 9 ! ,/ate or relevant geographic area1 includ+ a description ( ! populations likely to ne$ long-t]m c>e s]vices1 su* z p ) disabilities & old] adults4 7#b7 ,projections ( unmet ne$ = s]vices provid$ by direct c>e pr(essionals bas$ on enrollm5t wait+ li/s "u home & community-bas$ waiv]s "u section #aaae ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae7 or section #aiae ( su* ,act 7#db ,u4,s4,c4 #acifn7 & o!r relevant data to ! ext5t practicable & feasible1 su* z direct c>e work=ce vacancy rates & crude sep>ation rates1 & ! numb] ( direct c>e pr(essionals1 includ+ su* pr(essionals :o are manag]s or sup]visors1 9 ! region4 7#c7 ,in=mation on an advisory committee to advise ! eligible entity on activities to be c>ri$ out ?r\gh ! grant4 ,su* advisory committee-- 7,a7 may include entities li/$ 9 p>agraph 7#ab72 & 7,b7 %all include-- 7i7 old] adults or p]sons ) a disability2 7ii7 organizations repres5t+ ! rights & int]e/s ( p receiv+ s]vices by ! direct c>e pr(essionals or family c>egiv]s t>get$ by ! project2 7iii7 individuals :o are direct c>e pr(essionals or family c>egiv]s t>get$ by ! project & organizations repres5t+ ! rights & int]e/s ( direct c>e pr(essionals or family c>egiv]s2 7iv7 z applicable1 employ]s ( individuals describ$ 9 clause 7iii7 & labor organizations repres5t+ su* individuals2 7v7 repres5tatives ( ! ,/ate ,m$icaid ag5cy1 ! ,/ate ag5cy def9$ 9 section #ajb ( ! ,old] ,am]icans ,act ( #aife 7#db ,u4,s4,c4 #cjjb71 ! ,/ate developm5tal disabilities (fice1 & ! ,/ate behavioral heal? ag5cy1 9 ! ,/ate 7or ea* ,/ate7 to be s]v$ by ! project2 & 7vi7 repres5tatives reflect+ div]se racial1 cultural1 e?nic1 geographic1 socioeconomic1 & g5d] id5tity & sexual ori5tation p]spectives4 7#d7 ,in=mation on curr5t or project$ job op5+s =1 or relevant labor m>ket in=mation relat$ to1 ! direct c>e pr(essionals t>get$ by ! project 9 ! ,/ate or geographic area to be s]v$ by ! project1 & ! geographic scope ( ! work=ce to be s]v$ by ! project4 7#e7 ,in=mation on specific ef=ts & /rategies t ! entity c>ry+ out ! project w und]take to r$uce b>ri]s to recruitm5t1 ret5tion1 or advancem5t ( ! direct c>e pr(essionals t>get$ by ! project1 includ+ an assurance t su* ef=ts w include-- 7,a7 an assessm5t ( ! wages or o!r comp5sation or b5efits necess>y to recruit & reta9 ! direct c>e pr(essionals t>get$ by ! project2 7,b7 a description ( ! project's project$ comp5sation or b5efits = ! direct c>e pr(essionals t>get$ by ! project at ! ,/ate or local level1 includ+ a comp>ison ( su* project$ comp5sation or b5efits to regional & national comp5sation or b5efits & a description ( h[ wages & b5efits receiv$ by project p>ticipants w be impact$ by ! p>ticipation 9 & completion ( ! project2 & 7,c7 a description ( ! project$ impact ( workplace safety issues on ! recruitm5t & ret5tion ( direct c>e pr(essionals t>get$ by ! project1 & a description ( ! availability ( p]sonal protective equipm5t4 7#f7 ,9 ! case ( a project (f]+ an education or tra9+ program = direct c>e pr(essionals1 a description ( su* program 7includ+ h[ ! core compet5cies id5tifi$ by ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices w be incorporat$1 curricula1 models1 & /&>ds us$ "u ! program1 & any associat$ recogniz$ po/second>y cr$5tials = :i* ! program provides prep>ation1 z applicable71 :i* %all include an assurance t su* program w provide to ea* project p>ticipant 9 su* program-- 7,a7 relevant education or tra9+ reg>d+ ! rights ( recipi5ts ( home & community-bas$ s]vices1 includ+ _! rights to-- 7i7 receive s]vices 9 integrat$ sett+s t provide access to ! broad] community2 7ii7 ex]cise self-det]m9ation2 7iii7 be free f all =ms ( abuse1 neglect1 or exploitation2 & 7iv7 p]son-c5t]$ plann+ & practices1 includ+ p>ticipation 9 plann+ activities2 7,b7 relevant education or tra9+ to ensure t ea* project p>ticipant has ! necess>y skills to recognize abuse & und]/& _! obligations ) reg>d to report+ & respond+ to abuse appropriately 9 accordance ) relevant ,f$]al & ,/ate law2 7,c7 relevant education or tra9+ reg>d+ ! provision ( culturally compet5t & disability compet5t supports to recipi5ts ( s]vices provid$ by ! direct c>e pr(essionals t>get$ by ! project2 7,d7 an appr5tice%ip program1 "w-bas$ le>n+1 or on-!-job tra9+ opportunities2 7,e7 sup]vision or m5tor+2 & 7,f7 = any on-!-job tra9+ portion ( ! program1 a progressively increas+1 cle>ly def9$ s*$ule ( wages to be paid to ea* su* p>ticipant t-- 7i7 is consi/5t ) skill ga9s or atta9m5t ( a recogniz$ po/second>y cr$5tial describ$ 9 ! plan & receiv$ z a result ( p>ticipation 9 or completion ( su* program2 & 7ii7 ensures ! entry wage is n less ?an ! great] (-- 7,i7 ! m9imum wage requir$ "u section #f7;a7 ( ! ,fair ,labor ,/&>ds ,act ( #aich 7#bi ,u4,s4,c4 #bjf7;a772 or 7,,ii7 ! applicable wage requir$ by o!r applicable ,f$]al or ,/ate law1 or a collective b>ga9+ agreem5t4 7#g7 ,a description ( any innovative models or processes1 n describ$ 9 ano!r p>agraph ( ?is subsection1 ! eligible entity w implem5t to support ! ret5tion & c>e] advancem5t ( ! direct c>e pr(essionals t>get$ by ! project4 7#h7 ,a description ( ! supportive s]vices & b5efits to be provid$ to ! project p>ticipants 9 ord] to support ! employm5t1 ret5tion1 or c>e] advancem5t ( ! direct c>e pr(essionals t>get$ by ! project4 7#i7 ,a description ( h[ ! eligible entity w make use ( c>e] plann+ to support ! id5tification ( advancem5t opportunities & c>e] pa?ways = ! direct c>e pr(essionals 9 ! ,/ate or geographic area to be s]v$ by ! project4 7#aj7 ,a description ( h[ ! eligible entity w collect & submit to ! ,secret>y work=ce data & outcomes ( ! project4 7#aa7 ,a description ( h[ ! project-- 7,a7 w-- 7i7 provide adequate & safe equipm5t & facilities = tra9+ & sup]vision1 includ+ a safe "w environm5t free f discrim9ation1 :i* may include ! provision ( p]sonal protective equipm5t & o!r necess>y equipm5t to prev5t ! spread ( infecti\s disease among ! direct c>e pr(essionals t>get$ by ! project & recipi5ts ( s]vices provid$ by su* pr(essionals2 7ii7 incorporate remote tra9+ & education opportunities or te*nology-support$ opportunities2 7iii7 = tra9+ & education curricula1 incorporate evid5c$-support$ practices = adult le>n]s & univ]sal design = le>n+ & ensure recipi5ts ( s]vices provid$ by ! direct c>e pr(essionals or family c>egiv]s t>get$ by ! project p>ticipate 9 ! developm5t & implem5tation ( su* tra9+ & education curricula2 7iv7 use outrea*1 recruitm5t1 & ret5tion /rategies design$ to rea* & reta9 a div]se work=ce2 7v7 incorporate me?ods to monitor satisfaction ) project activities = project p>ticipants & individuals receiv+ s]vices f su* p>ticipants2 7vi7 incorporate evid5ce-support$ practices = family c>egiv] engagem5t2 & 7vii7 incorporate core compet5cies id5tifi$ by ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices2 & 7,b7 may incorporate cont9u+ education programs & specialty tra9+1 ) a specific focus on-- 7i7 trauma-in=m$ c>e2 7ii7 behavioral heal?1 includ+ co-occurr+ behavioral heal? conditions & intellectual or developm5tal disabilities2 7iii7 ,alzheim]'s & dem5tia c>e2 7iv7 *ronic disease managem5t2 or 7v7 ! use ( supportive or assi/ive te*nology4 7#ab7 ,a description ( h[ ! eligible entity w consult on ! implem5tation ( ! project1 or coord9ate ! project )1 ea* ( ! foll[+ entities1 to ! ext5t t ea* su* entity is n ! eligible entity3 7,a7 ,! ,/ate ,m$icaid ag5cy1 ,/ate ag5cy def9$ 9 section #ajb ( ! ,old] ,am]icans ,act ( #aife 7#db ,u4,s4,c4 #cjjb71 & ! ,/ate developm5tal disabilities (fice = ! ,/ate 7or ea* ,/ate7 to be s]v$ by ! project4 7,b7 ,! local bo>d & ,/ate bo>d = ea* geographic area1 or ,/ate1 to be s]v$ by ! project4 7,c7 ,9 ! case ( a project t c>ries out an education or tra9+ program1 a nonpr(it organization ) demon/rat$ exp]i5ce 9 ! developm5t or deliv]y ( curricula or c\rsework4 7,d7 ,a nonpr(it organization1 :i* may be a labor organization1 t fo/]s ! pr(essional developm5t & collective engagem5t ( ! direct c>e pr(essionals or family c>egiv]s t>get$ by ! project4 7,e7 ,area ag5cies on ag+1 z def9$ 9 section #ajb ( ! ,old] ,am]icans ,act ( #aife 7#db ,u4,s4,c4 #cjjb74 7,f7 ,c5t]s = indep5d5t liv+1 z describ$ 9 "p ,c ( *apt] #a ( title ,,vii ( ! ,rehabilitation ,act ( #aigc 7#bi ,u4,s4,c4 #gif;f et seq474 7,g7 ,! ,/ate ,c\ncil on ,developm5tal ,disabilities 7z su* t]m is us$ 9 subtitle ,b ( title ,i ( ! ,developm5tal ,disabilities ,assi/ance & ,bill ( ,rights ,act ( #bjjj 7#db ,u4,s4,c4 #aejba et seq477 = ! ,/ate 7or ea* ,/ate7 to be s]v$ by ! project4 7,h7 ,ag+ & ,disability ,res\rce ,c5t]s 7z def9$ 9 section #ajb ( ! ,old] ,am]icans ,act ( #aife 7#db ,u4,s4,c4 #cjjb774 7,i7 ,a nonpr(it ,/ate provid] association t repres5ts provid]s :o employ ! direct c>e pr(essionals or family c>egiv]s t>get$ by ! project1 :]e su* an association exi/s4 7,j7 ,an entity t employs ! direct c>e pr(essionals or family c>egiv]s t>get$ by ! project4 7,k7 ,univ]sity ,c5t]s = ,excell5ce 9 ,developm5tal ,disabilities ,education1 ,rese>*1 & ,s]vice support$ "u subtitle ,d ( title ,i ( ! ,developm5tal ,disabilities ,assi/ance & ,bill ( ,rights ,act ( #bjjj 7#db ,u4,s4,c4 #aejfa et seq474 7,l7 ,! ,/ate protection & advocacy sy/em describ$ 9 section #adc ( su* ,act 7#db ,u4,s4,c4 #aejdc7 ( ! ,/ate 7or ea* ,/ate7 to be s]v$ by ! project4 7,m7 ,direct c>e pr(essionals or family c>egiv]s t>get$ by ! project1 or work=ce organizations = su* pr(essionals or c>egiv]s z applicable1 repres5t+ und]s]v$ communities4 7#ac7 ,a description ( h[ ! eligible entity w consult ?r\gh\t ! project )-- 7,a7 individuals employ$ or work+ z ! direct c>e pr(essionals or family c>egiv]s t>get$ by ! project2 7,b7 repres5tatives ( su* pr(essionals or c>egiv]s2 7,c7 individuals assi/$ by su* pr(essionals or c>egiv]s2 7,d7 ! families ( su* pr(essionals or c>egiv]s2 & 7,e7 individuals receiv+ education or tra9+ to become su* pr(essionals or c>egiv]s4 7#ad7 ,a description ( outrea* ef=ts to individuals = p>ticipation 9 su* project1 includ+ t>get$ outrea* ef=ts to-- 7,a7 individuals :o are recipi5ts ( assi/ance "u a ,/ate program fund$ "u "p ,a ( title ,,iv ( ! ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq47 or individuals :o are eligible = su* assi/ance2 & 7,b7 individuals ) b>ri]s to employm5t4 7c7 ,consid]ations ,9 select+ eligible entities to receive a grant "u ?is title1 ! ,secret>y %all ensure-- 7#a7 equitable geographic div]sity1 includ+ by select+ recipi5ts s]v+ rural areas & select+ recipi5ts s]v+ urban areas2 & 7#b7 t select$ eligible entities w s]ve areas :]e ! occupation ( a direct c>e pr(essional1 or a relat$ occupation1 is an 9-dem& indu/ry sector or occupation4 7d7 ,uses ( funds2 supplem5t1 n supplant 7#a7 ,uses ( funds 7,a7 ,9 g5]al ,ea* eligible entity receiv+ a grant "u ?is title %all use ! funds ( su* grant to c>ry out at lea/ #a project describ$ 9 section #cjc7;a77#b74 7,b7 ,adm9i/rative co/s ,ea* eligible entity receiv+ a grant "u ?is title %all n use m ?an #e p]c5t ( ! funds ( su* grant = co/s associat$ ) ! adm9i/ration ( activities "u ?is title4 7,c7 ,direct support ,ea* eligible entity receiv+ a grant "u ?is title %all use n less ?an #e p]c5t ( ! funds ( su* grant to provide direct f9ancial b5efits or supportive s]vices to project p>ticipants :o are direct c>e pr(essionals or paid or unpaid family c>egiv]s to support ! f9ancial ne$s ( su* p>ticipants dur+ ! duration ( ! project activities4 7#b7 ,supplem5t1 n supplant ,an eligible entity receiv+ a grant "u ?is title %all use su* grant only to supplem5t1 & n supplant1 ! am\nt ( gov]nm5t funds t1 9 ! abs5ce ( su* grant1 w\ld be available to address ! recruitm5t1 tra9+ & education1 ret5tion1 & advancem5t ( direct c>e pr(essionals or provide support = family c>egiv]s1 9 ! ,/ate or geographic area s]v$ by ! eligible entity4 7#c7 ,prohibition ,no am\nts made available "u ?is title may be us$ = any activity t is subject to ! report+ requirem5ts set =? 9 section #bjc7;a7 ( ! ,labor-,managem5t ,report+ & ,disclosure ,act ( #aiei 7#bi ,u4,s4,c4 #dcc7;a774 #cje4 ,evaluations & reports2 te*nical assi/ance 7a7 ,report+ requirem5ts by grant recipi5ts 7#a7 ,9 g5]al ,an eligible entity receiv+ a grant "u ?is title %all coop]ate ) ! ,secret>y & annually provide a report to ! ,secret>y t includes any relevant data reque/$ by ! ,secret>y 9 a mann] specifi$ by ! ,secret>y4 7#b7 ,cont5ts ,! data reque/$ by ! ,secret>y = an annual report may include any ( ! foll[+ 7z det]m9$ relevant by ! ,secret>y ) respect to ! category ( ! grant & ea* project support$ ?r\gh ! grant73 7,a7 ,! numb] ( individuals & ! demographics categories s]v$ by ea* project support$ by ! grant1 includ+-- 7i7 ! numb] ( individuals recruit$ ?r\gh ea* su* project to be employ$ z a direct c>e pr(essional2 7ii7 ! numb] ( individuals :o ?r\gh ea* su* project atta9$ employm5t z a direct c>e pr(essional2 & 7iii7 ! numb] ( individuals :o enroll$ 9 ea* su* project & )drew or 7 t]m9at$ f t project )\t complet+ tra9+ or atta9+ employm5t z a direct c>e pr(essional4 7,b7 ,! numb] ( family c>egiv]s p>ticipat+ 9 an education or tra9+ program ?r\gh ea* project support$ by ! grant4 7,c7 ,! numb] ( project p>ticipants :o ?r\gh ea* su* project p>ticipat$ 9 & complet$-- 7i7 "w-bas$ le>n+2 7ii7 on-!-job tra9+2 7iii7 an appr5tice%ip program2 or 7iv7 a pr(essional developm5t or m5tor+ program4 7,d7 7i7 ,o!r s]vices1 b5efits1 or supports 7o!r ?an ! s]vices1 b5efits1 or supports describ$ 9 subp>agraph 7,c77 provid$ ?r\gh ea* su* project to assi/ 9 ! recruitm5t1 ret5tion1 or advancem5t ( direct c>e pr(essionals 7includ+ ?r\gh education or tra9+ = su* pr(essionals or individuals seek+ to become su* pr(essionals72 7ii7 ! numb] ( individuals :o access$ su* s]vices1 b5efits1 or supports2 & 7iii7 ! impact ( su* s]vices1 b5efits1 or supports4 7,e7 ,! crude sep>ation & vacancy rates ( direct c>e pr(essionals1 & su* rates = ^? pr(essionals :o are manag]s or sup]visors1 9 ! geographic area = a numb] ( ye>s be=e ! grant 0 aw>d$1 z ! numb] ( ye>s is det]m9$ by ! ,secret>y1 & annually !reaft] = ! duration ( ! grant p]iod4 7,f7 ,h[ ea* project support$ by ! grant assess$ satisfaction ) respect to-- 7i7 project p>ticipants assi/$ by ! project2 7ii7 individuals receiv+ s]vices deliv]$ by project p>ticipants1 includ+ satisfaction reg>d+-- 7,i7 any impact on ! heal? or heal? outcomes ( su* individuals2 & 7,,ii7 any impact on ! ability ( individuals to transition to or rema9 9 ! community 9 an environm5t t has ! qualities e/abli%$ 9 section #dda4cja7;c77#d7 ( title #db1 ,code ( ,f$]al ,regulations 7or successor regulations72 & 7iii7 employ]s ( su* project p>ticipants4 7,g7 ,! p]=mance ( ! eligible entity ) respect to ! indicators ( p]=mance on unsubsidiz$ employm5t1 m$ian e>n+s1 cr$5tial atta9m5t1 measurable skill ga9s1 & employ] satisfaction4 7,h7 ,any o!r in=mation ) respect to outcomes ( ! project z det]m9$ by ! ,secret>y4 7b7 ,annual report to ,congress by ,secret>y ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is title1 & ea* ye> !reaft] until all projects support$ ?r\gh a grant "u ?is title are complet$1 ! ,secret>y %all prep>e & submit to ,congress an annual report on ! progress ( ea* project support$ ?r\gh a grant "u ?is title & ! activities ( ! te*nical assi/ance c5t] e/abli%$ "u section #cjb4 7c7 ,,gao report ,n lat] ?an #a ye> aft] ! date on :i* all projects support$ ?r\gh a grant "u ?is title are complet$1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all conduct a /udy & submit to ,congress a report includ+-- 7#a7 an assessm5t ( h[ ! te*nical assi/ance c5t] e/abli%$ "u section #cjb & ! projects support$ ?r\gh a grant "u ?is title assi/$ 9 ! creation1 recruitm5t1 tra9+ & education1 ret5tion1 & advancem5t ( ! direct c>e work=ce or 9 provid+ support = family c>egiv]s2 & 7#b7 recomm5dations = su* legislative or adm9i/rative actions ne$$ = improv+ ! assi/ance describ$ 9 p>agraph 7#a71 z ! ,comptroll] ,g5]al det]m9es appropriate4 7d7 ,indep5d5t evaluations ,n lat] ?an #f mon?s aft] ! date ( enactm5t ( ?is title1 ! ,secret>y %all ent] into a contract ) an indep5d5t entity to provide indep5d5t evaluations ( activities support$ by grants "u ?is title & activities ( ! te*nical assi/ance c5t] e/abli%$ "u section #cjb4 #cjf4 ,au?orization ( appropriations 7a7 ,9 g5]al ,!re are au?oriz$ to be appropriat$-- 7#a7 = ! e/abli%m5t & activities ( ! te*nical assi/ance c5t] "u section #cjb1 #b1jjj1jjj = ea* ( fiscal ye>s #bjbi ?r\gh #bjcj2 & 7#b7 = grants "u section #cjc1 #a1jjj1jjj1jjj = fiscal ye> #bjbi4 7b7 ,availability ,am\nts made available "u ?is title %all rema9 available ?r\gh ,septemb] #cj1 #bjch4 ,,iv ,evaluation #dja4 ,evaluation ( impact on access to ,,hcbs 7a7 ,national survey on exp&$ ,,hcbs access ,! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 9 coord9ation ) ! ,national ,academy ( ,m$ic9e1 %all1 n lat] ?an #g ye>s aft] ! date ( enactm5t ( ?is ,act1 conduct or contract = a national survey ( ,/ates1 direct c>e pr(essionals1 family c>egiv]s1 & provid]s & recipi5ts ( home & community-bas$ s]vices1 to det]m9e ! effects ( ! implem5tation ( ?is ,act & ! am5dm5ts made by ?is ,act on-- 7#a7 ! availability & access to home & community-bas$ s]vices "u ! ,m$icaid program nationally & 9 ea* ,/ate2 7#b7 ! capacity ( ! direct s]vice work=ce to provide home & community-bas$ s]vices & in=mation on ! demographics 7z def9$ 9 section #b7 ( su* work=ce2 7#c7 ! comp5sation & work+ conditions1 includ+ s*$ul+ & b5efits1 ( direct c>e work]s2 7#d7 ! economic effects on b5efici>ies & on families ) a memb] receiv+ home & community-bas$ s]vices ?r\gh ,m$icaid2 7#e7 ! availability ( direct c>e work]s & s]vices = p ne$+ long-t]m s]vices & supports :o are n ,m$icaid eligible2 7#f7 family c>egiv]s2 & 7#g7 recomm5dations = measures to fur!r exp& & enhance access home & community-bas$ s]vices4 7b7 ,report ,n lat] ?an #i ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices %all publi% a report conta9+ ! results ( ! survey conduct$ "u subsection 7a74 7c7 ,am]ican community survey addition ,! ,secret>y ( ,comm]ce1 act+ ?r\gh ! ,bureau ( ! ,c5sus1 %all add to ! ,am]ican ,community ,survey a "q design$ to id5tify ! ne$ = long-t]m s]vices & supports by resid5ts ( ! ,unit$ ,/ates4 7d7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to ! ,secret>y su* sums z are necess>y to c>ry out ?is section4