Making certain adjustments to coverage of home or community-based services under Medicaid

(a) Increasing transparency of HCBS coverage under Medicaid (1) In general Section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)) is amended— (A) in paragraph (2)— (i) in subparagraph (E)— (I) by inserting, not less frequently than before annually; and (II) by inserting (including, with respect to such information provided on or after July 9, 2027, the information specified in paragraph (11)) before the period at the end; and (ii) by adding at the end the following flush sentence: The Secretary shall make all information provided under subparagraph (E) on or after the date of the enactment of this sentence publicly available on the website of the Centers for Medicare & Medicaid Services.; and (B) by adding at the end the following new paragraph: (11) For purposes of paragraph (2)(E), the information specified in this paragraph is the following: (A) In the case of a State that limits the number of individuals who may be provided home or community-based services under a waiver granted under this subsection and maintains a list of individuals waiting to enroll in such waiver, a description of how the State maintains such list, including— (i) information on whether the State screens individuals on such list to determine whether such individuals are eligible to receive such services under such waiver; (ii) information on whether (and, if applicable, how often) the State periodically re-screens individuals on such list for eligibility; (iii) the number of people on such list of individuals waiting to enroll in such waiver; and (iv) the average amount of time that individuals newly enrolled in such waiver within the past 12 months were on such list of individuals waiting to enroll in such waiver. (B) With respect to homemaker services, home health aide services, personal care services, and habilitation services furnished under waivers under this subsection, by each such service type— (i) for individuals newly receiving such services within the past 12 months, the average amount of time (which may be determined using statistically valid random sampling of such individuals) from when such services are initially approved for such an individual to when such individual begins receiving such services; and (ii) the percentage of authorized hours (which may be determined using statistically valid random sampling of individuals authorized to receive such services) that are provided within the past 12 months.. (2) Conforming amendments Section 1915 of the Social Security Act (42 U.S.C. 1396n) is amended— (A) in subsection (i) by adding at the end the following new paragraph: (8) Reporting requirement With respect to homemaker services, home health aide services, personal care services, and habilitation services provided under this subsection on or after July 9, 2027, the State, not less frequently than annually, shall provide to the Secretary the same information regarding such services as the State is required to provide under subsection (c)(11)(B).; (B) in subsection (j)(2)(E), by inserting after the second sentence the following: With respect to any homemaker services, home health aide services, personal care services, and habilitation services provided under this subsection on or after July 9, 2027, the State, not less frequently than annually, shall provide to the Secretary the same information regarding such services as the State is required to provide under subsection (c)(11)(B).; and (C) in subsection (k)(3)(E)— (i) by striking and after the cost of such services and supports,; and (ii) by inserting before the period, the following:, and with respect to homemaker services, home health aide services, personal care services, and habilitation services provided under this subsection on or after July 9, 2027, not less frequently than annually, the same information regarding such services as the State is required to provide under subsection (c)(11)(B). (b) Demonstration program To expand HCBS coverage under section 1915(c) waivers Section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)), as amended by subsection (a), is further amended— (1) in paragraph (2)(E), by inserting, and the information specified in paragraph (12)(C)(v), when applicable after paragraph (11); and (2) by adding at the end the following new paragraph: (12) Demonstration program to expand coverage for home or community-based services (A) In general (i) Approval Not later than 24 months after the date on which the planning grants under subparagraph (B) are awarded, notwithstanding paragraph (1), the Secretary may approve a waiver that is standalone from any other waiver approved under this subsection for not more than 5 States, selected in accordance with clause (ii), to include as medical assistance under the State plan of such State, for the 3-year period beginning on the date of such approval, payment for part or all of the cost of home or community-based services (other than room and board (as described in paragraph (1))) approved by the Secretary which are provided pursuant to a written plan of care to individuals described in subparagraph (C)(iii). (ii) Selection criteria In selecting States for purposes of clause (i), the Secretary shall— (I) only select States that received a planning grant under subparagraph (B); (II) only select States that meet the requirements specified in subparagraph (C) and such other requirements as the Secretary may determine appropriate; (III) select States in a manner that ensures geographic diversity; (IV) give preference to States with a higher percentage (relative to other States that apply to be selected for purposes of clause (i)) of the total State population residing in rural areas (as determined by the Secretary); (V) give preference to States that have demonstrated more progress in rebalancing long-term services and supports systems under this title, as determined based on the relative share of individuals who use home or community-based services (as defined by the Secretary) under this title as a percentage of total individuals who use long-term services and supports (as defined by the Secretary) under this title (in the most recent year for which such data is available); and (VI) give preference to States that pursue a waiver under this paragraph that incorporates the provision of mental health services for adults with serious mental illness, children with serious emotional disturbances, or individuals with substance use disorder. (B) Planning grants (i) In general (I) Approval Not later than 18 months after the date of the enactment of this paragraph, the Secretary shall award planning grants of not more than $5,000,000 each to not more than 10 States for purposes of preparing to submit a request for a waiver under this subsection (including for costs to implement the waiver or other activities to expand the provision of home or community-based services under this section) to provide home or community-based services to individuals described in subparagraph (C)(iii). (II) Selection criteria In awarding planning grants under subclause (I), the Secretary shall use the selection criteria specified in subclauses (III) through (VI) of subparagraph (A)(ii). (ii) Consultation A State that is awarded a planning grant under clause (i) shall, in preparing to submit a request for a waiver described in such clause, consult with— (I) individuals in need of (and not receiving) home or community-based services, individuals receiving home or community-based services, and the caregivers of such individuals; (II) providers furnishing home or community-based services; and (III) such other stakeholders, as the Secretary may specify. (C) State requirements In addition to the requirements specified under this subsection (except for the requirements described in subparagraphs (C) and (D) of paragraph (2) and any other requirement the Secretary determines to be inapplicable in the context of a waiver relation to individuals who do not require the level of care described in paragraph (1)), the requirements specified in this paragraph are, with respect to a State, the following: (i) As of the date that such State requests a waiver under this subsection to provide home or community-based services to individuals described in clause (iii), all other waivers (if any) granted under this subsection to such State meet the requirements of this subsection. (ii) The State demonstrates to the Secretary that approval of a waiver under this subsection with respect to individuals described in clause (iii) will not result in a material increase of the average amount of time that individuals with respect to whom a determination described in paragraph (1) has been made will need to wait to receive home or community-based services under any waiver granted under this subsection, as determined by the Secretary. (iii) The State establishes needs-based criteria, subject to the approval of the Secretary, to identify individuals for whom a determination described in paragraph (1) is not applicable, who will be eligible for home or community-based services under a waiver approved under this paragraph, and specifies the home or community-based services such individuals so eligible will receive. (iv) The State established needs-based criteria for determining whether an individual described in clause (iii) requires the level of care provided in a hospital, nursing facility, or an intermediate care facility for individuals with developmental disabilities under the State plan or under any waiver of such plan that are more stringent than the needs-based criteria established under clause (iii) for determining eligibility for home or community-based services. (v) The State attests that the State's average per capita expenditure for medical assistance under the State plan (or waiver of such plan) provided with respect to such individuals enrolled in a waiver under this paragraph will not exceed the State's average per capita expenditures for medical assistance for individuals receiving institutional care under the State plan (or waiver of such plan) for the duration that the waiver under this paragraph is in effect. (vi) The State provides to the Secretary data (in such form and manner as the Secretary may specify) regarding the number of individuals described in clause (i) with respect to a State seeking approval of a waiver under this subsection, to whom the State will make such services available under such waiver. (vii) The State agrees to provide to the Secretary, not less frequently than annually, data for purposes of paragraph (2)(E) (in such form and manner as the Secretary may specify) regarding, with respect to each preceding year in which a waiver under this subsection to provide home and community-based services to individuals described in clause (iii) was in effect— (I) the cost (as such term is defined by the Secretary) of such services furnished to individuals described in clause (iii), broken down by type of service; (II) with respect to each type of home and community-based service provided under the waiver, the length of time that such individuals have received such service; (III) a comparison between the data described in subclause (I) and any comparable data available with respect to individuals with respect to whom a determination described in paragraph (1) has been made and with respect to individuals receiving institutional care under this title; and (IV) the number of individuals who have received home and community-based services under the waiver during the preceding year.. (c) Non-Application of the Paperwork Reduction Act Chapter 35 of title 44, United States Code (commonly referred to as the “Paperwork Reduction Act of 1995”), shall not apply to the implementation of the amendments made by subsections (a) and (b). (d) CMS guidance to States on interim coverage under section 1915 home and community-Based services authorities Not later than January 1, 2027, the Secretary of Health and Human Services shall issue guidance to the States to clarify how a State may provide, with respect to an individual who is eligible for home and community-based services under section 1915 of the Social Security Act (42 U.S.C. 1396n), coverage of such services pursuant to a provisional written plan of care, pending finalization, with respect to such individual. (e) Funding (1) In general There are appropriated, out of any funds in the Treasury not otherwise obligated, $71,000,000 for fiscal year 2025, to remain available until expended, to the Secretary of Health and Human Services for purposes of carrying out subsection (d) and the amendments made by subsection (b). (2) Reservation for planning grants Of the amount appropriated under paragraph (1), the Secretary of Health and Human Services shall reserve $50,000,000 of such amount to award planning grants under the demonstration program established by the amendments made by subsection (b).