P.L. 109–171, Approved February 8, 2006 (120 Stat. 4)

SECTION 1. [42 U.S.C. 1305 note]  SHORT TITLE.

This Act may be cited as the “Deficit Reduction Act of 2005”.

SEC. 5001.  HOSPITAL QUALITY IMPROVEMENT.

(b) [42 U.S.C. 1395ww note]  Plan for Hospital Value Based Purchasing Program.—

(1)  In general.—The Secretary of Health and Human Services shall develop a plan to implement a value based purchasing program for payments under the Medicare program for subsection (d) hospitals beginning with fiscal year 2009.

(2)  Details.— Such a plan shall include consideration of the following issues:

(A)  The on-going development, selection, and modification process for measures of quality and efficiency in hospital inpatient settings.

(B)  The reporting, collection, and validation of quality data.

(C)  The structure of value based payment adjustments, including the determination of thresholds or improvements in quality that would substantiate a payment adjustment, the size of such payments, and the sources of funding for the value based payments.

(D)  The disclosure of information on hospital performance. In developing such a plan, the Secretary shall consult with relevant affected parties and shall consider experience with such demonstrations that are relevant to the value based purchasing program under this subsection.

SEC. 5002.  CLARIFICATION OF DETERMINATION OF MEDICAID PATIENT DAYS FOR DSH COMPUTATION.

(b)  Ratification and Prospective Application of Previous Regulations.—

(1)  In general.—Subject to paragraph (2), regulations described in paragraph (3), insofar as such regulations provide for the treatment of individuals eligible for medical assistance under a demonstration project approved under title XI of the Social Security Act under section 1886 (d)(5)(F)(vi) of such Act, are hereby ratified, effective as of the date of their respective promulgations.

(2)  No application to closed cost reports.—Paragraph (1) shall not be applied in a manner that requires the reopening of any cost reports which are closed as of the date of the enactment of this Act.

(3)  Regulations described.—For purposes of paragraph (1), the regulations described in this paragraph are as follows:

(A)  2000 regulation.—Regulations promulgated on January 20, 2000, at 65 Federal Register 3135, et seq., including the policy in such regulations regarding discharges occurring prior to January 20, 2000.

(B)  2003 regulation.—Regulations promulgated on August 1, 2003, at 68 Federal Register 45345 et seq.

SEC. 5005. [42 U.S.C. 1395ww note]  EXTENDED PHASE-IN OF THE INPATIENT REHABILITATION FACILITY CLASSIFICATION CRITERIA.

(a)  In General.—Notwithstanding section 412.23(b)(2) of title 42, Code of Federal Regulations, the Secretary of Health and Human Services shall apply the applicable percent specified in subsection (b) in the classification criterion used under the IRF regulation (as defined in subsection (c)) to determine whether a hospital or unit of a hospital is an inpatient rehabilitation facility under the Medicare program under title XVIII of the Social Security Act.

(b)  Applicable Percent.—For purposes of subsection (a), the applicable percent specified in this subsection for cost reporting periods—

(1)  beginning during the 12-month period beginning on July 1, 2006, is 60 percent;

(2)  beginning during the 12-month period beginning on July 1, 2007, is 65 percent; and

(3)  beginning on or after July 1, 2008, is 75 percent.

(c)  IRF Regulation.—For purposes of subsection (a), the term “IRF regulation” means the rule published in the Federal Register on May 7, 2004, entitled “Medicare Program; Final Rule; Changes to the Criteria for Being Classified as an Inpatient Rehabilitation Facility” (69 Fed. Reg. 25752).

SEC. 5006.  DEVELOPMENT OF A STRATEGIC PLAN REGARDING PHYSICIAN INVESTMENT IN SPECIALITY HOSPITALS.

(a)  Development.—

(1)  In general.—The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall develop a strategic and implementing plan to address issues described in paragraph (2) regarding physician investment in specialty hospitals (as defined in section 1877(h)(7)(A) of the Social Security Act (42 U.S.C. 1395nn(h)(7)(A)).

(2)  Issues described.—The issues described in this paragraph are the following:

(A)  Proportionality of investment return.

(B)  Bona fide investment.

(C)  Annual disclosure of investment information.

(D)  The provision by specialty hospitals of—

(i)  care to patients who are eligible for medical assistance under a State plan approved under title XIX of the Social Security Act, including patients not so eligible but who are regarded as such because they receive benefits under a demonstration project approved under title XI of such Act; and

(ii)  charity care.

(E)  Appropriate enforcement.

(b)  Reports.—

(1)  Interim report.—Not later than 3 months after the date of the enactment of this Act, the Secretary shall submit an interim report to the appropriate committees of jurisdiction of Congress on the status of the development of the plan under subsection (a).

(2)  Final report.—Not later than six months after the date of the enactment of this Act, the Secretary shall submit a final report to the appropriate committees of jurisdiction of Congress on the plan developed under subsection (a) together with recommendations for such legislation and administrative actions as the Secretary considers appropriate.

(c)  Continuation of Suspension on Enrollment.—

(1)  In general.—Subject to paragraph (2), the Secretary shall continue the suspension on enrollment of new specialty hospitals (as so defined) under title XVIII of the Social Security Act until the earlier of—

(2)  Extension of suspension.—If the Secretary fails to submit the final report described in subsection (b)(2) by the date required under such subsection, the Secretary shall—

(A)  extend the suspension on enrollment under paragraph (1) for an additional two months; and

(B)  provide a certification to the appropriate committees of jurisdiction of Congress of such failure.

(d)  Waiver.—In developing the plan and report required under this section, the Secretary may waive such requirements of section 553 of title 5, United States Code, as the Secretary determines necessary.

(e)  Funding.—Out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary for fiscal year 2006, $2,000,000 to carry out this section.

SEC. 5007. [42 U.S.C. 1395ww note]  MEDICARE DEMONSTRATION PROJECTS TO PERMIT GAINSHARING ARRANGEMENTS.

(a)  Establishment.—The Secretary shall establish under this section a qualified gainsharing demonstration program under which the Secretary shall approve demonstration projects by not later than November 1, 2006, to test and evaluate methodologies and arrangements between hospitals and physicians designed to govern the utilization of inpatient hospital resources and physician work to improve the quality and efficiency of care provided to Medicare beneficiaries and to develop improved operational and financial hospital performance with sharing of remuneration as specified in the project. Such projects shall be operational by not later than January 1, 2007.

(b)  Requirements Described.—A demonstration project under this section shall meet the following requirements for purposes of maintaining or improving quality while achieving cost savings:

(1)  Arrangement for remuneration as share of savings.—The demonstration project shall involve an arrangement between a hospital and a physician under which the hospital provides remuneration to the physician that represents solely a share of the savings incurred directly as a result of collaborative efforts between the hospital and the physician.

(2)  Written plan agreement.—The demonstration project shall be conducted pursuant to a written agreement that—

(A)  is submitted to the Secretary prior to implementation of the project; and

(B)  includes a plan outlining how the project will achieve improvements in quality and efficiency.

(3)  Patient notification.—The demonstration project shall include a notification process to inform patients who are treated in a hospital participating in the project of the participation of the hospital in such project.

(4)  Monitoring quality and efficiency of care.—The demonstration project shall provide measures to ensure that the quality and efficiency of care provided to patients who are treated in a hospital participating in the demonstration project is continuously monitored to ensure that such quality and efficiency is maintained or improved.

(5)  Independent review.—The demonstration project shall certify, prior to implementation, that the elements of the demonstration project are reviewed by an organization that is not affiliated with the hospital or the physician participating in the project.

(6)  Referral limitations.—The demonstration project shall not be structured in such a manner as to reward any physician participating in the project on the basis of the volume or value of referrals to the hospital by the physician.

(c)  Waiver of Certain Restrictions.—

(1)  In general.—An incentive payment made by a hospital to a physician under and in accordance with a demonstration project shall not constitute—

(A)  remuneration for purposes of section 1128B of the Social Security Act (42 U.S.C. 1320a-7b);

(B)  a payment intended to induce a physician to reduce or limit services to a patient entitled to benefits under Medicare or a State plan approved under title XIX of such Act in violation of section 1128A of such Act (42 U.S.C. 1320a-7a); or

(C)  a financial relationship for purposes of section 1877 of such Act (42 U.S.C. 1395nn).

(2)  Protection for existing arrangements.—In no case shall the failure to comply with the requirements described in paragraph (1) affect a finding made by the Inspector General of the Department of Health and Human Services prior to the date of the enactment of this Act that an arrangement between a hospital and a physician does not violate paragraph (1) or (2) of section 1128A(a) of the Social Security Act (42 U.S.C. 1320a-7(a)).

(c)  IRF Regulation.—For purposes of subsection (a), the term “IRF regulation” means the rule published in the Federal Register on May 7, 2004, entitled “Medicare Program; Final Rule; Changes to the Criteria for Being Classified as an Inpatient Rehabilitation Facility” (69 Fed. Reg. 25752).

(d)  Program Administration.—

(1)  Solicitation of applications.—By not later than 90 days after the date of the enactment of this Act, the Secretary shall solicit applications for approval of a demonstration project, in such form and manner, and at such time specified by the Secretary.

(2)  Number of projects approved.—The Secretary shall approve not more than 6 demonstration projects, at least 2 of which shall be located in a rural area.

(3)  Duration.—The qualified gainsharing demonstration program under this section shall be conducted for the period beginning on January 1, 2007, and ending on December 31, 2009 (or September 30, 2011, in the case of a demonstration project in operation as of October 1, 2008).

(e)  Reports.—

(1)  Initial report.—By not later than December 1, 2006, the Secretary shall submit to Congress a report on the number of demonstration projects that will be conducted under this section.

(2)  Project update.—By not later than December 1, 2007, the Secretary shall submit to Congress a report on the details of such projects (including the project improvements towards quality and efficiency described in subsection (b)(2)(B)).

(3)  Quality improvement and savings.—By not later than March 31, 2011, the Secretary shall submit to Congress a report on quality improvement and savings achieved as a result of the qualified gainsharing demonstration program established under subsection (a).

(4)  Final report.—By not later than March 31, 2013, the Secretary shall submit to Congress a final report on the information described in paragraph (3).

(f)  Funding.—

(1)  In general.—Out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary for fiscal year 2006 $6,000,000, and for fiscal year 2010, $1,600,000, to carry out this section.

(2)  Availability.—Funds appropriated under paragraph (1) shall remain available for expenditure through fiscal year 2014 or until expended.

(g)  Definitions.—For purposes of this section:

(1)  Demonstration project.—The term “demonstration project” means a project implemented under the qualified gainsharing demonstration program established under subsection (a).

(2)  Hospital.—The term “hospital” means a hospital that receives payment under section 1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)), and does not include a critical access hospital (as defined in section 1861(mm) of such Act (42 U.S.C. 1395x(mm))).

(3)  Medicare.—The term “Medicare” means the programs under title XVIII of the Social Security Act.

(4)  Physician.—The term “physician” means, with respect to a demonstration project, a physician described in paragraph (1) or (3) of section 1861(r) of the Social Security Act (42 U.S.C. 1395x(r)) who is licensed as such a physician in the area in which the project is located and meets requirements to provide services for which benefits are provided under Medicare. Such term shall be deemed to include a practitioner described in section 1842(e)(18)(C) of such Act (42 U.S.C. 1395u(e)(18)(C)).

(5)  Secretary.—The term “Secretary” means the Secretary of Health and Human Services.

SEC. 5008. [42 U.S.C. 1395b-1 note]  POST-ACUTE CARE PAYMENT REFORM DEMONSTRATION PROGRAM.

(a)  Establishment.—

(1)  In general.—By not later than January 1, 2008, the Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall establish a demonstration program for purposes of understanding costs and outcomes across different post-acute care sites. Under such program, with respect to diagnoses specified by the Secretary, an individual who receives treatment from a provider for such a diagnosis shall receive a single comprehensive assessment on the date of discharge from a subsection (d) hospital (as defined in section 1886(d)(1)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(1)(B))) of the needs of the patient and the clinical characteristics of the diagnosis to determine the appropriate placement of such patient in a post-acute care site. The Secretary shall use a standardized patient assessment instrument across all post-acute care sites to measure functional status and other factors during the treatment and at discharge from each provider. Participants in the program shall provide information on the fixed and variable costs for each individual. An additional comprehensive assessment shall be provided at the end of the episode of care.

(2)  Number of sites.—The Secretary shall conduct the demonstration program under this section with sufficient numbers to determine statistically reliable results.

(3)  Duration.—The Secretary shall conduct the demonstration program under this section for a 3-year period.

(b)  Waiver Authority.—The Secretary may waive such requirements of titles XI and XVIII of the Social Security Act (42 U.S.C. 1301 et seq.; 42 U.S.C. 1395 et seq.) as may be necessary for the purpose of carrying out the demonstration program under this section.

(c)  Report.—Not later than 6 months after the completion of the demonstration program under this section, the Secretary shall submit to Congress a report on such program, that includes the results of the program and recommendations for such legislation and administrative action as the Secretary determines to be appropriate.

(d)  Funding.—The Secretary shall provide for the transfer from the Federal Hospital Insurance Trust Fund established under section 1817 of the Social Security Act (42 U.S.C. 1395i), $6,000,000 for the costs of carrying out the demonstration program under this section.

SEC. 5203.  TIMEFRAME FOR PART A AND B PAYMENTS.

Notwithstanding sections 1816(c) and 1842(c)(2) of the Social Security Act or any other provision of law—

(1)  any payment from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) or from the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t) for claims submitted under part A or B of title XVIII of such Act for items and services furnished under such part A or B, respectively, that would otherwise be payable during the period beginning on September 22, 2006, and ending on September 30, 2006, shall be paid on the first business day of October 2006; and

(2)  no interest or late penalty shall be paid to an entity or individual for any delay in a payment by reason of the application of paragraph (1).

SEC. 5302. [42 U.S.C. 1395eee note]  RURAL PROVIDER PACE GRANT PROGRAM.

(a)  Definitions.—In this section:

(1)  CMS.—The term “CMS” means the Centers for Medicare & Medicaid Services.

(2)  PACE program.—The term “PACE program” has the meaning given that term in sections 1894(a)(2) and 1934(a)(2) of the Social Security Act (42 U.S.C. 1395eee(a)(2); 1396u-4(a)(2)).

(3)  PACE provider.—The term “PACE provider” has the meaning given that term in section 1894(a)(3) or 1934(a)(3) of the Social Security Act (42 U.S.C. 1395eee(a)(3); 1396u-4(a)(3)).

(4)  Rural area.—The term “rural area” has the meaning given that term in section 1886(d)(2)(D) of the Social Security Act (42 U.S.C. 1395ww(d)(2)(D)).

(5)  Rural PACE pilot site.—The term “rural PACE pilot site” means a PACE provider that has been approved to provide services in a geographic service area that is, in whole or in part, a rural area, and that has received a site development grant under this section.

(6)  Secretary.—The term “Secretary” means the Secretary of Health and Human Services.

(b)  Site Development Grants and Technical Assistance Program.—

(1)  Site development grants.—

(A)  In general.—The Secretary shall establish a process and criteria to award site development grants to qualified PACE providers that have been approved to serve a rural area.

(B)  Amount per award.—A site development grant awarded under subparagraph (A) to any individual rural PACE pilot site shall not exceed $750,000.

(C)  Number of awards.—Not more than 15 rural PACE pilot sites shall be awarded a site development grant under subparagraph (A).

(D)  Use of funds.—Funds made available under a site development grant awarded under subparagraph (A) may be used for the following expenses only to the extent such expenses are incurred in relation to establishing or delivering PACE program services in a rural area:

(i)  Feasibility analysis and planning.

(ii)  Interdisciplinary team development.

(iii)  Development of a provider network, including contract development.

(iv)  Development or adaptation of claims processing systems.

(v)  Preparation of special education and outreach efforts required for the PACE program.

(vi)  Development of expense reporting required for calculation of outlier payments or reconciliation processes.

(vii)  Development of any special quality of care or patient satisfaction data collection efforts.

(viii)  Establishment of a working capital fund to sustain fixed administrative, facility, or other fixed costs until the provider reaches sufficient enrollment size.

(ix)  Startup and development costs incurred prior to the approval of the rural PACE pilot site’s PACE provider application by CMS.

(x)  Any other efforts determined by the rural PACE pilot site to be critical to its successful startup, as approved by the Secretary.

(E)  Appropriation.—

(i)  In general.—Out of funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary to carry out this subsection for fiscal year 2006, $7,500,000.

(ii)  Availability.—Funds appropriated under clause (i) shall remain available for expenditure through fiscal year 2008.

(2)  Technical assistance program.—The Secretary shall establish a technical assistance program to provide—

(A)  outreach and education to State agencies and provider organizations interested in establishing PACE programs in rural areas; and

(B)  technical assistance necessary to support rural PACE pilot sites.

(c)  Cost Outlier Protection for Rural PACE Pilot Sites.—

(1)  Establishment of fund for reimbursement of outlier costs.—Notwithstanding any other provision of law, the Secretary shall establish an outlier fund to reimburse rural PACE pilot sites for recognized outlier costs (as defined in paragraph (3)) incurred for eligible outlier participants (as defined in paragraph (2)) in an amount, subject to paragraph (4), equal to 80 percent of the amount by which the recognized outlier costs exceeds $50,000.

(2)  Eligible outlier participant.—For purposes of this subsection, the term “eligible outlier participant” means a PACE program eligible individual (as defined in sections 1894(a)(5) and 1934(a)(5) of the Social Security Act (42 U.S.C. 1395eee(a)(5); 1396u-4(a)(5))) who resides in a rural area and with respect to whom the rural PACE pilot site incurs more than $50,000 in recognized costs in a 12-month period.

(3)  Recognized outlier costs defined.—

(A)  In general.—For purposes of this subsection, the term “recognized outlier costs” means, with respect to services furnished to an eligible outlier participant by a rural PACE pilot site, the least of the following (as documented by the site to the satisfaction of the Secretary) for the provision of inpatient and related physician and ancillary services for the eligible outlier participant in a given 12-month period:

(i)  If the services are provided under a contract between the pilot site and the provider, the payment rate specified under the contract.

(ii)  The payment rate established under the original Medicare fee-for-service program for such service.

(iii)  The amount actually paid for the services by the pilot site.

(B)  Inclusion in only one period.—Recognized outlier costs may not be included in more than one 12-month period.

(3)  Outlier expense payment.—

(A)  Payment for outlier costs.—Subject to subparagraph (B), in the case of a rural PACE pilot site that has incurred outlier costs for an eligible outlier participant, the rural PACE pilot site shall receive an outlier expense payment equal to 80 percent of such costs that exceed $50,000.

(4)  Limitations.—

(A)  Costs incurred per eligible outlier participant.—The total amount of outlier expense payments made under this subsection to a rural PACE pilot site with respect to an eligible outlier participant for any 12-month period shall not exceed $100,000 for the 12-month period used to calculate the payment.

(B)  Costs incurred per provider.—No rural PACE pilot site may receive more than $500,000 in total outlier expense payments in a 12-month period.

(C)  Limitation of outlier cost reimbursement period.—A rural PACE pilot site shall only receive outlier expense payments under this subsection with respect to costs incurred during the first 3 years of the site’s operation.

(5)  Requirement to access risk reserves prior to payment.—A rural PACE pilot site shall access and exhaust any risk reserves held or arranged for the provider (other than revenue or reserves maintained to satisfy the requirements of section 460.80(c) of title 42, Code of Federal Regulations) and any working capital established through a site development grant awarded under subsection (b)(1), prior to receiving any payment from the outlier fund.

(6)  Application.—In order to receive an outlier expense payment under this subsection with respect to an eligible outlier participant, a rural PACE pilot site shall submit an application containing—

(A)  documentation of the costs incurred with respect to the participant;

(B)  a certification that the site has complied with the requirements under paragraph (4); and

(C)  such additional information as the Secretary may require.

(7)  Appropriation.—

(A)  In general.—Out of funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary $10,000,000 to carry out this subsection for the period of fiscal years 2006 through 2010.

(B)  Availability.—Funds appropriated under subparagraph (A) shall remain available for obligation through fiscal year 2010.

(d)  Evaluation of PACE Providers Serving Rural Service Areas.—Not later than 60 months after the date of enactment of this Act, the Secretary shall submit a report to Congress containing an evaluation of the experience of rural PACE pilot sites.

(e)  Amounts in Addition to Payments Under Social Security Act.—Any amounts paid under the authority of this section to a PACE provider shall be in addition to payments made to the provider under section 1894 or 1934 of the Social Security Act (42 U.S.C. 1395eee; 1396u-4).

SEC. 6011.  LENGTHENING LOOK-BACK PERIOD; CHANGE IN BEGINNING DATE FOR PERIOD OF INELIGIBILITY.

(d) [42 U.S.C. 1396p note]  Availability of Hardship Waivers.—Each State shall provide for a hardship waiver process in accordance with section 1917(c)(2)(D) of the Social Security Act (42 U.S.C. 1396p(c)(2)(D))—

(1)  under which an undue hardship exists when application of the transfer of assets provision would deprive the individual—

(A)  of medical care such that the individual’s health or life would be endangered; or

(B)  of food, clothing, shelter, or other necessities of life; and

(2)  which provides for—

(A)  notice to recipients that an undue hardship exception exists;

(B)  a timely process for determining whether an undue hardship waiver will be granted; and

(C)  a process under which an adverse determination can be appealed.

SEC. 6021.  EXPANSION OF STATE LONG-TERM CARE PARTNERSHIP PROGRAM.

(a)  *  *  *

(2)  State reporting requirements.—Nothing in clauses (iii)(VI) and (v) of section 1917(b)(1)(C) of the Social Security Act (as added by paragraph (1)) shall be construed as prohibiting a State from requiring an issuer of a long-term care insurance policy sold in the State (regardless of whether the policy is issued under a qualified State long-term care insurance partnership under section 1917(b)(1)(C)(iii) of such Act) to require the issuer to report information or data to the State that is in addition to the information or data required under such clauses.

(3)  Effective date.—A State plan amendment that provides for a qualified State long-term care insurance partnership under the amendments made by paragraph (1) may provide that such amendment is effective for long-term care insurance policies issued on or after a date, specified in the amendment, that is not earlier than the first day of the first calendar quarter in which the plan amendment was submitted to the Secretary of Health and Human Services.

(c)  Annual Reports to Congress.—

(1)  In general.—The Secretary of Health and Human Services shall annually report to Congress on the long-term care insurance partnerships established in accordance with section 1917(b)(1)(C)(ii) of the Social Security Act (42 U.S.C. 1396p(b)(1)(C)(ii)) (as amended by subsection (a)(1)). Such reports shall include analyses of the extent to which such partnerships expand or limit access of individuals to long-term care and the impact of such partnerships on Federal and State expenditures under the Medicare and Medicaid programs. Nothing in this section shall be construed as requiring the Secretary to conduct an independent review of each long-term care insurance policy offered under or in connection with such a partnership.

(2)  Appropriation.—Out of any funds in the Treasury not otherwise appropriated, there is appropriated to the Secretary of Health and Human Services, $1,000,000 for the period of fiscal years 2006 through 2010 to carry out paragraph (1).

(d)[404]  National Clearinghouse for Long-Term Care Information.—

(1)  Establishment.—The Secretary of Health and Human Services shall establish a National Clearinghouse for Long-Term Care Information. The Clearinghouse may be established through a contract or interagency agreement.

(2)  Duties.—

(A)  In general.—The National Clearinghouse for Long-Term Care Information shall—

(i)  educate consumers with respect to the availability and limitations of coverage for long-term care under the Medicaid program and provide contact information for obtaining State-specific information on long-term care coverage, including eligibility and estate recovery requirements under State Medicaid programs;

(ii)  provide objective information to assist consumers with the decisionmaking process for determining whether to purchase long-term care insurance or to pursue other private market alternatives for purchasing long-term care and provide contact information for additional objective resources on planning for long-term care needs; and

(iii)  maintain a list of States with State long-term care insurance partnerships under the Medicaid program that provide reciprocal recognition of long-term care insurance policies issued under such partnerships.

(B)  Requirement.—In providing information to consumers on long-term care in accordance with this subsection, the National Clearinghouse for Long-Term Care Information shall not advocate in favor of a specific long-term care insurance provider or a specific long-term care insurance policy.

(3)  Appropriation.—Out of any funds in the Treasury not otherwise appropriated, there is appropriated to carry out this subsection, $3,000,000 for each of fiscal years 2006 through 2010.

SEC. 6034.  MEDICAID INTEGRITY PROGRAM.

(c)  Increased Funding for Medicaid Fraud and Abuse Control Activities.—

(1)  In general.—Out of any money in the Treasury of the United States not otherwise appropriated, there are appropriated to the Office of the Inspector General of the Department of Health and Human Services, without further appropriation, $25,000,000 for each of fiscal years 2006 through 2010, for activities of such Office with respect to the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).

(2)  Availability; amounts in addition to other amounts appropriated for such activities.—Amounts appropriated pursuant to paragraph (1) shall—

(A)  remain available until expended; and

(B)  be in addition to any other amounts appropriated or made available to the Office of the Inspector General of the Department of Health and Human Services for activities of such Office with respect to the Medicaid program.

(3)  Annual report.—Not later than 180 days after the end of each fiscal year (beginning with fiscal year 2006), the Inspector General of the Department of Health and Human Services shall submit a report to Congress which identifies—

(A)  the use of funds appropriated pursuant to paragraph (1); and

(B)  the effectiveness of the use of such funds.

SEC. 6053. [42 U.S.C. 1396a note]  ADDITIONAL FMAP ADJUSTMENTS.

(b)  Hold Harmless for Katrina Impact.—Notwithstanding any other provision of law, for purposes of titles XIX and XXI of the Social Security Act, the Secretary of Health and Human Services, in computing the Federal medical assistance percentage under section 1905(b) of such Act (42 U.S.C. 1396d(b)) for any year after 2006 for a State that the Secretary determines has a significant number of evacuees who were evacuated to, and live in, the State as a result of Hurricane Katrina as of October 1, 2005, shall disregard such evacuees (and income attributable to such evacuees) from such computation.

SEC. 6063. [42 U.S.C. 1396a note]  DEMONSTRATION PROJECTS REGARDING HOME AND COMMUNITY-BASED ALTERNATIVES TO PSYCHIATRIC RESIDENTIAL FACILITIES FOR CHILDREN.

(a)  In General.—The Secretary is authorized to conduct, during each of fiscal years 2007 through 2011, demonstration projects (each in the section referred to as a “demonstration project”) in accordance with this section under which up to10 States (as defined for purposes of title XIX of the Social Security Act) are awarded grants, on a competitive basis, to test the effectiveness in improving or maintaining a child’s functional level and cost-effectiveness of providing coverage of home and community-based alternatives to psychiatric residential treatment for children enrolled in the Medicaid program under title XIX of such Act.

(b)  Application of Terms and Conditions Authority.—

(1)  In general.—Subject to the provisions of this section, for the purposes of the demonstration projects, and only with respect to children enrolled under such demonstration projects, a psychiatric residential treatment facility (as defined in section 483.352 of title 42 of the Code of Federal Regulations) shall be deemed to be a facility specified in section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)), and to be included in each reference in such section 1915(c) to hospitals, nursing facilities, and intermediate care facilities for the mentally retarded.

(2)  State option to assure continuity of medicaid coverage.—Upon the termination of a demonstration project under this section, the State that conducted the project may elect, only with respect to a child who is enrolled in such project on the termination date, to continue to provide medical assistance for coverage of home and community-based alternatives to psychiatric residential treatment for the child in accordance with section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)), as modified through the application of paragraph (1). Expenditures incurred for providing such medical assistance shall be treated as a home and community-based waiver program under section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)) for purposes of payment under section 1903 of such Act (42 U.S.C. 1396b).

(c)  Terms of Demonstration Projects.—

(1)  In general.—Except as otherwise provided in this section, a demonstration project shall be subject to the same terms and conditions as apply to a waiver under section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)), including the waiver of certain requirements under the first sentence of paragraph (3) of such section but not applying the second sentence of such paragraph.

(2)  Budget neutrality.—In conducting the demonstration projects under this section, the Secretary shall ensure that the aggregate payments made by the Secretary under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) do not exceed the amount which the Secretary estimates would have been paid under that title if the demonstration projects under this section had not been implemented.

(3)  Evaluation.—The application for a demonstration project shall include an assurance to provide for such interim and final evaluations of the demonstration project by independent third parties, and for such interim and final reports to the Secretary, as the Secretary may require.

(d)  Payments to States; Limitations to Scope and Funding.—

(1)  In general.—Subject to paragraph (2), a demonstration project approved by the Secretary under this section shall be treated as a home and community-based waiver program under section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)) for purposes of payment under section 1903 of such Act (42 U.S.C. 1396b).

(2)  Limitation.—In no case may the amount of payments made by the Secretary under this section for State demonstration projects for a fiscal year exceed the amount available under subsection (f)(2)(A) for such fiscal year.

(e)  Secretary’s Evaluation and Report.—The Secretary shall conduct an interim and final evaluation of State demonstration projects under this section and shall report to the President and Congress the conclusions of such evaluations within 12 months of completing such evaluations.

(f)  Funding.—

(1)  In general.—For the purpose of carrying out this section, there are appropriated, from amounts in the Treasury not otherwise appropriated, for fiscal years 2007 through 2011, a total of $218,000,000, of which—

(A)  the amount specified in paragraph (2) shall be available for each of fiscal years 2007 through 2011; and

(B)  a total of $1,000,000 shall be available to the Secretary for the evaluations and report under subsection (e).

(2)  Fiscal year limit.—In no case may the amount of payments made by the Secretary under this section for State demonstration projects for a fiscal year exceed the amount available under subsection (f)(2)(A) for such fiscal year.

(A)  In general.—For purposes of paragraph (1), the amount specified in this paragraph for a fiscal year is the amount specified in subparagraph (B) for the fiscal year plus the difference, if any, between the total amount available under this paragraph for prior fiscal years and the total amount previously expended under paragraph (1)(A) for such prior fiscal years.

(B)  Fiscal year amounts.—The amount specified in this subparagraph for—

(i)  fiscal year 2007 is $21,000,000;

(ii)  fiscal year 2008 is $37,000,000;

(iii)  fiscal year 2009 is $49,000,000;

(iv)  fiscal year 2010 is $53,000,000; and

(v)  fiscal year 2011 is $57,000,000.

SEC. 6071. [42 U.S.C. 1396a note]  MONEY FOLLOWS THE PERSON REBALANCING DEMONSTRATION.

(a)  Program Purpose and Authority.—The Secretary is authorized to award, on a competitive basis, grants to States in accordance with this section for demonstration projects (each in this section referred to as an “MFP demonstration project”) designed to achieve the following objectives with respect to institutional and home and community-based long-term care services under State Medicaid programs:

(1)  Rebalancing.—Increase the use of home and community-based, rather than institutional, long-term care services.

(2)  Money follows the person.—Eliminate barriers or mechanisms, whether in the State law, the State Medicaid plan, the State budget, or otherwise, that prevent or restrict the flexible use of Medicaid funds to enable Medicaid-eligible individuals to receive support for appropriate and necessary long-term services in the settings of their choice.

(3)  Continuity of service.—Increase the ability of the State Medicaid program to assure continued provision of home and community-based long-term care services to eligible individuals who choose to transition from an institutional to a community setting.

(4)  Quality assurance and quality improvement.—Ensure that procedures are in place (at least comparable to those required under the qualified HCB program) to provide quality assurance for eligible individuals receiving Medicaid home and community-based long-term care services and to provide for continuous quality improvement in such services.

(b)  Definitions.—For purposes of this section:

(1)  Home and community-based long-term care services.—The term “home and community-based long-term care services” means, with respect to a State Medicaid program, home and community-based services (including home health and personal care services) that are provided under the State’s qualified HCB program or that could be provided under such a program but are otherwise provided under the Medicaid program.

(2)  Eligible individual.—The term “eligible individual” means, with respect to an MFP demonstration project of a State, an individual in the State—

(A)  who, immediately before beginning participation in the MFP demonstration project—

(i)  resides (and has resided for a period of not less than 90 consecutive days) in an inpatient facility;

(ii)  is receiving Medicaid benefits for inpatient services furnished by such inpatient facility; and

(iii)  with respect to whom a determination has been made that, but for the provision of home and community-based long-term care services, the individual would continue to require the level of care provided in an inpatient facility and, in any case in which the State applies a more stringent level of care standard as a result of implementing the State plan option permitted under section 1915(i) of the Social Security Act, the individual must continue to require at least the level of care which had resulted in admission to the institution; and

(B)  who resides in a qualified residence beginning on the initial date of participation in the demonstration project.

Any days that an individual resides in an institution on the basis of having been admitted solely for purposes of receiving short-term rehabilitative services for a period for which payment for such services is limited under title XVIII shall not be taken into account for purposes of determining the 90-day period required under subparagraph (A)(i).

(3)  Inpatient facility.—The term “inpatient facility” means a hospital, nursing facility, or intermediate care facility for the mentally retarded. Such term includes an institution for mental diseases, but only, with respect to a State, to the extent medical assistance is available under the State Medicaid plan for services provided by such institution.

(4)  Medicaid.—The term “Medicaid” means, with respect to a State, the State program under title XIX of the Social Security Act (including any waiver or demonstration under such title or under section 1115 of such Act relating to such title).

(5)  Qualified hcb program.—The term “qualified HCB program” means a program providing home and community-based long-term care services operating under Medicaid, whether or not operating under waiver authority.

(6)  Qualified residence.—.The term “qualified residence” means, with respect to an eligible individual—

(A)  a home owned or leased by the individual or the individual’s family member;

(B)  an apartment with an individual lease, with lockable access and egress, and which includes living, sleeping, bathing, and cooking areas over which the individual or the individual’s family has domain and control; and

(C)  a residence, in a community-based residential setting, in which no more than 4 unrelated individuals reside.

(7)  Qualified expenditures.—The term “qualified expenditures” means expenditures by the State under its MFP demonstration project for home and community-based long-term care services for an eligible individual participating in the MFP demonstration project, but only with respect to services furnished during the 12-month period beginning on the date the individual is discharged from an inpatient facility referred to in paragraph (2)(A)(i).

(8)  Self-directed services.—The term “self-directed” means, with respect to home and community-based long-term care services for an eligible individual, such services for the individual which are planned and purchased under the direction and control of such individual or the individual’s authorized representative (as defined by the Secretary), including the amount, duration, scope, provider, and location of such services, under the State Medicaid program consistent with the following requirements:

(A)  Assessment.—There is an assessment of the needs, capabilities, and preferences of the individual with respect to such services.

(B)  Service plan.—Based on such assessment, there is developed jointly with such individual or the individual’s authorized representative a plan for such services for such individual that is approved by the State and that—

(i)  specifies those services, if any, which the individual or the individual’s authorized representative would be responsible for directing;

(ii)  identifies the methods by which the individual or the individual’s authorized representative or an agency designated by an individual or representative will select, manage, and dismiss providers of such services;

(iii)  specifies the role of family members and others whose participation is sought by the individual or the individual’s authorized representative with respect to such services;

(iv)  is developed through a person-centered process that—

(I)  is directed by the individual or the individual’s authorized representative;

(II)  builds upon the individual’s capacity to engage in activities that promote community life and that respects the individual’s preferences, choices, and abilities; and

(III)  involves families, friends, and professionals as desired or required by the individual or the individual’s authorized representative;

(v)  includes appropriate risk management techniques that recognize the roles and sharing of responsibilities in obtaining services in a self-directed manner and assure the appropriateness of such plan based upon the resources and capabilities of the individual or the individual’s authorized representative; and

(vi)  may include an individualized budget which identifies the dollar value of the services and supports under the control and direction of the individual or the individual’s authorized representative.

(C)  Budget process.—With respect to individualized budgets described in subparagraph (B)(vi), the State application under subsection (c)—

(i)  describes the method for calculating the dollar values in such budgets based on reliable costs and service utilization;

(ii)  defines a process for making adjustments in such dollar values to reflect changes in individual assessments and service plans; and

(iii)  provides a procedure to evaluate expenditures under such budgets.

(9)  State.—The term “State” has the meaning given such term for purposes of title XIX of the Social Security Act.

(10)  Secretary.—The term “Secretary” means the Secretary of Health and Human Services.^[405]

(c)  State Application.—A State seeking approval of an MFP demonstration project shall submit to the Secretary, at such time and in such format as the Secretary requires, an application meeting the following requirements and containing such additional information, provisions, and assurances, as the Secretary may require:

(1)  Assurance of a public development process.—The application contains an assurance that the State has engaged, and will continue to engage, in a public process for the design, development, and evaluation of the MFP demonstration project that allows for input from eligible individuals, the families of such individuals, authorized representatives of such individuals, providers, and other interested parties.

(2)  Operation in connection with qualified HCB program to assure continuity of services.—The State will conduct the MFP demonstration project for eligible individuals in conjunction with the operation of a qualified HCB program that is in operation (or approved) in the State for such individuals in a manner that assures continuity of Medicaid coverage for such individuals so long as such individuals continue to be eligible for medical assistance.

(3)  Demonstration project period.—The application shall specify the period of the MFP demonstration project, which shall include at least 2 consecutive fiscal years in the 5-fiscal-year period beginning with fiscal year 2007.

(4)  Service area.—The application shall specify the service area or areas of the MFP demonstration project, which may be a statewide area or 1 or more geographic areas of the State.

(5)  Targeted groups and numbers of individuals served.—The application shall specify—

(A)  the target groups of eligible individuals to be assisted to transition from an inpatient facility to a qualified residence during each fiscal year of the MFP demonstration project;

(B)  the projected numbers of eligible individuals in each targeted group of eligible individuals to be so assisted during each such year; and

(C)  the estimated total annual qualified expenditures for each fiscal year of the MFP demonstration project.

(6)  Individual choice, continuity of care.—The application shall contain assurances that—

(A)  each eligible individual or the individual’s authorized representative will be provided the opportunity to make an informed choice regarding whether to participate in the MFP demonstration project;

(B)  each eligible individual or the individual’s authorized representative will choose the qualified residence in which the individual will reside and the setting in which the individual will receive home and community-based long-term care services;

(C)  the State will continue to make available, so long as the State operates its qualified HCB program consistent with applicable requirements, home and community-based long-term care services to each individual who completes participation in the MFP demonstration project for as long as the individual remains eligible for medical assistance for such services under such qualified HCB program (including meeting a requirement relating to requiring a level of care provided in an inpatient facility and continuing to require such services, and, if the State applies a more stringent level of care standard as a result of implementing the State plan option permitted under section 1915(i) of the Social Security Act, meeting the requirement for at least the level of care which had resulted in the individual’s admission to the institution).

(7)  Rebalancing.—The application shall—

(A)  provide such information as the Secretary may require concerning the dollar amounts of State Medicaid expenditures for the fiscal year, immediately preceding the first fiscal year of the State’s MFP demonstration project, for long-term care services and the percentage of such expenditures that were for institutional long-term care services or were for home and community-based long-term care services;

(B) (i)  specify the methods to be used by the State to increase, for each fiscal year during the MFP demonstration project, the dollar amount of such total expenditures for home and community-based long-term care services and the percentage of such total expenditures for long-term care services that are for home and community-based long-term care services; and

(ii)  describe the extent to which the MFP demonstration project will contribute to accomplishment of objectives described in subsection (a).

(8)  Money follows the person.—The application shall describe the methods to be used by the State to eliminate any legal, budgetary, or other barriers to flexibility in the availability of Medicaid funds to pay for long-term care services for eligible individuals participating in the project in the appropriate settings of their choice, including costs to transition from an institutional setting to a qualified residence.

(9)  Maintenance of effort and cost-effectiveness.—The application shall contain or be accompanied by such information and assurances as may be required to satisfy the Secretary that—

(A)  total expenditures under the State Medicaid program for home and community-based long-term care services will not be less for any fiscal year during the MFP demonstration project than for the greater of such expenditures for—

(i)  fiscal year 2005; or

(ii)  any succeeding fiscal year before the first year of the MFP demonstration project; and

(B)  in the case of a qualified HCB program operating under a waiver under subsection (c) or (d) of section 1915 of the Social Security Act (42 U.S.C. 1396n), but for the amount awarded under a grant under this section, the State program would continue to meet the cost-effectiveness requirements of subsection (c)(2)(D) of such section or comparable requirements under subsection (d)(5) of such section, respectively.

(10)  Waiver requests.—The application shall contain or be accompanied by requests for any modification or adjustment of waivers of Medicaid requirements described in subsection (d)(3), including adjustments to the maximum numbers of individuals included and package of benefits, including one-time transitional services, provided.

(11)  Quality assurance and quality improvement.—The application shall include—

(A)  a plan satisfactory to the Secretary for quality assurance and quality improvement for home and community-based long-term care services under the State Medicaid program, including a plan to assure the health and welfare of individuals participating in the MFP demonstration project; and

(B)  an assurance that the State will cooperate in carrying out activities under subsection (f) to develop and implement continuous quality assurance and quality improvement systems for home and community-based long-term care services.

(12)  Optional program for self-directed services.—If the State elects to provide for any home and community-based long-term care services as self-directed services (as defined in subsection (b)(8)) under the MFP demonstration project, the application shall provide the following:

(A)  Meeting requirements.—A description of how the project will meet the applicable requirements of such subsection for the provision of self-directed services.

(B)  Voluntary election.—A description of how eligible individuals will be provided with the opportunity to make an informed election to receive self-directed services under the project and after the end of the project.

(C)  State support in service plan development.—Satisfactory assurances that the State will provide support to eligible individuals who self-direct in developing and implementing their service plans.

(D)  Oversight of receipt of services.—Satisfactory assurances that the State will provide oversight of eligible individual’s receipt of such self-directed services, including steps to assure the quality of services provided and that the provision of such services are consistent with the service plan under such subsection.

Nothing in this section shall be construed as requiring a State to make an election under the project to provide for home and community-based long-term care services as self-directed services, or as requiring an individual to elect to receive self-directed services under the project.

(13)  Reports and evaluation.—The application shall provide that—

(A)  the State will furnish to the Secretary such reports concerning the MFP demonstration project, on such timetable, in such uniform format, and containing such information as the Secretary may require, as will allow for reliable comparisons of MFP demonstration projects across States; and

(B)  the State will participate in and cooperate with the evaluation of the MFP demonstration project.

(d)  Secretary’s Award of Competitive Grants.—

(1)  In general.—The Secretary shall award grants under this section on a competitive basis to States selected from among those with applications meeting the requirements of subsection (c), in accordance with the provisions of this subsection.

(2)  Selection and modification of state applications.—In selecting State applications for the awarding of such a grant, the Secretary—

(A)  shall take into consideration the manner in which, and extent to which, the State proposes to achieve the objectives specified in subsection (a);

(B)  shall seek to achieve an appropriate national balance in the numbers of eligible individuals, within different target groups of eligible individuals, who are assisted to transition to qualified residences under MFP demonstration projects, and in the geographic distribution of States operating MFP demonstration projects;

(C)  shall give preference to State applications proposing—

(i)  to provide transition assistance to eligible individuals within multiple target groups; and

(ii)  to provide eligible individuals with the opportunity to receive home and community-based long-term care services as self-directed services, as defined in subsection (b)(8); and

(D)  shall take such objectives into consideration in setting the annual amounts of State grant awards under this section.

(3)  Waiver authority.—The Secretary is authorized to waive the following provisions of title XIX of the Social Security Act, to the extent necessary to enable a State initiative to meet the requirements and accomplish the purposes of this section:

(A)  Statewideness.—Section 1902(a)(1), in order to permit implementation of a State initiative in a selected area or areas of the State.

(B)  Comparability.—Section 1902(a)(10)(B), in order to permit a State initiative to assist a selected category or categories of individuals described in subsection (b)(2)(A).

(C)  Income and resources eligibility.—Section 1902(a)(10)(C)(i)(III), in order to permit a State to apply institutional eligibility rules to individuals transitioning to community-based care.

(D)  Provider agreements.—Section 1902(a)(27), in order to permit a State to implement self-directed services in a cost-effective manner.

(4)  Conditional approval of outyear grant.—In awarding grants under this section, the Secretary shall condition the grant for the second and any subsequent fiscal years of the grant period on the following:

(A)  Numerical benchmarks.—The State must demonstrate to the satisfaction of the Secretary that it is meeting numerical benchmarks specified in the grant agreement for—

(i)  increasing State Medicaid support for home and community-based long-term care services under subsection (c)(5); and

(ii)  numbers of eligible individuals assisted to transition to qualified residences.

(B)  Quality of care.—The State must demonstrate to the satisfaction of the Secretary that it is meeting the requirements under subsection (c)(11) to assure the health and welfare of MFP demonstration project participants.

(e)  Payments to States; Carryover of Unused Grant Amounts.—

(1)  Payments.—For each calendar quarter in a fiscal year during the period a State is awarded a grant under subsection (d), the Secretary shall pay to the State from its grant award for such fiscal year an amount equal to the lesser of—

(A)  the MFP-enhanced FMAP (as defined in paragraph (5)) of the amount of qualified expenditures made during such quarter; or

(B)  the total amount remaining in such grant award for such fiscal year (taking into account the application of paragraph (2)).

(2)  Carryover of unused amounts.—Any portion of a State grant award for a fiscal year under this section remaining at the end of such fiscal year shall remain available to the State for the next 4 fiscal years, subject to paragraph (3).

(3)  Reawarding of certain unused amounts.—In the case of a State that the Secretary determines pursuant to subsection (d)(4) has failed to meet the conditions for continuation of a MFP demonstration project under this section in a succeeding year or years, the Secretary shall rescind the grant awards for such succeeding year or years, together with any unspent portion of an award for prior years, and shall add such amounts to the appropriation for the immediately succeeding fiscal year for grants under this section.

(4)  Preventing duplication of payment.—The payment under a MFP demonstration project with respect to qualified expenditures shall be in lieu of any payment with respect to such expenditures that could otherwise be paid under Medicaid, including under section 1903(a) of the Social Security Act. Nothing in the previous sentence shall be construed as preventing the payment under Medicaid for such expenditures in a grant year after amounts available to pay for such expenditures under the MFP demonstration project have been exhausted.

(5)  MFP-enhanced FMAP.—For purposes of paragraph (1)(A), the “MFP-enhanced FMAP”, for a State for a fiscal year, is equal to the Federal medical assistance percentage (as defined in the first sentence of section 1905(b)) for the State increased by a number of percentage points equal to 50 percent of the number of percentage points by which (A) such Federal medical assistance percentage for the State, is less than (B) 100 percent; but in no case shall the MFP-enhanced FMAP for a State exceed 90 percent.

(f)  Quality Assurance and Improvement; Technical Assistance; Oversight.—

(1)  In general.—The Secretary, either directly or by grant or contract, shall provide for technical assistance to, and oversight of, States for purposes of upgrading quality assurance and quality improvement systems under Medicaid home and community-based waivers, including—

(A)  dissemination of information on promising practices;

(B)  guidance on system design elements addressing the unique needs of participating beneficiaries;

(C)  ongoing consultation on quality, including assistance in developing necessary tools, resources, and monitoring systems; and

(D)  guidance on remedying programmatic and systemic problems.

(2)  Funding.—From the amounts appropriated under subsection (h)(1)(F) for fiscal year 2019, $500,000, shall be available to the Secretary for such fiscal year to carry out this subsection.^[406]

(g)  Research and Evaluation.—

(1)  In general.—The Secretary, directly or through grant or contract, shall provide for research on, and a national evaluation of, the program under this section, including assistance to the Secretary in preparing the final report required under paragraph (2). The evaluation shall include an analysis of projected and actual savings related to the transition of individuals to qualified residences in each State conducting an MFP demonstration project.

(2)  Final report.—The Secretary shall make a final report to the President and Congress, not later than September 30, 2016, reflecting the evaluation described in paragraph (1) and providing findings and conclusions on the conduct and effectiveness of MFP demonstration projects.

(3)  Funding.—From the amounts appropriated under subsection (h)(1) for each of fiscal years 2008 through 2016, not more than $1,100,000 per year shall be available to the Secretary to carry out this subsection.

(h)[407]  Appropriations.—

(1)  In general.—There are appropriated, from any funds in the Treasury not otherwise appropriated, for grants to carry out this section—

(A)  $250,000,000 for the portion of fiscal year 2007 beginning on January 1, 2007, and ending on September 30, 2007;

(B)  $300,000,000 for fiscal year 2008;

(C)  $350,000,000 for fiscal year 2009;

(D)  $400,000,000 for fiscal year 2010;

(E)  $450,000,000 for each of fiscal years 2011 through 2016;

(F)  subject to paragraph (3), $254,500,000 for fiscal year 2019; and

(G)^[408]  subject to paragraph (3), $176,000,000 for the period beginning on January 1, 2020, and ending on May 22, 2020.

(2)  Availability.—Subject to paragraph (3), amounts made available under paragraph (1) for a fiscal year shall remain available for the awarding of grants to States by not later than September 30, 2021.

(3)^[409]  Special rule.—Funds appropriated under subparagraphs (F) and (G) of paragraph (1) shall be made available for grants to States only if such States have an approved MFP demonstration project under this section as of December 31, 2018.

SEC. 6086.  EXPANDED ACCESS TO HOME AND COMMUNITY-BASED SERVICES FOR THE ELDERLY AND DISABLED.

(b) [42 U.S.C. 1396n note]  Quality of Care Measures.—

(1)  In general.—The Secretary, acting through the Director of the Agency for Healthcare Research and Quality, shall consult with consumers, health and social service providers and other professionals knowledgeable about long-term care services and supports to develop program performance indicators, client function indicators, and measures of client satisfaction with respect to home and community-based services offered under State Medicaid programs.

(2)  Best practices.—The Secretary shall—

(A)  use the indicators and measures developed under paragraph (1) to assess such home and community-based services, the outcomes associated with the receipt of such services (particularly with respect to the health and welfare of the recipient of the services), and the overall system for providing home and community-based services under the Medicaid program under title XIX of the Social Security Act; and

(B)  make publicly available the best practices identified through such assessment and a comparative analyses of the system features of each State.

(3)  Appropriation.—Out of any funds in the Treasury not otherwise appropriated, there is appropriated to the Secretary of Health and Human Services, $1,000,000 for the period of fiscal years 2006 through 2010 to carry out this subsection.

SEC. 6102.  PROHIBITION AGAINST COVERING NONPREGNANT CHILDLESS ADULTS WITH SCHIP FUNDS.

(c) [42 U.S.C. 1397gg note]  Rule of construction.—Subject to section 2111 of the Social Security Act, as added by section 112 of the Children’s Health Insurance Program Reauthorization Act of 2009, nothing in this section or the amendments made by this section shall be construed to—

(1)  authorize the waiver of any provision of title XIX or XXI of the Social Security Act (42 U.S.C. 1396 et seq., 1397aa et seq.) that is not otherwise authorized to be waived under such titles or under title XI of such Act (42 U.S.C. 1301 et seq.) as of the date of enactment of this Act;

(2)  imply congressional approval of any waiver, experimental, pilot, or demonstration project affecting funds made available under the State children’s health insurance program under title XXI of the Social Security Act (42 U.S.C. 1397aa et. seq.) or any amendment to such a waiver or project that has been approved as of such date of enactment; or

(3)  apply to any waiver, experimental, pilot, or demonstration project that would allow funds made available under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.) to be used to provide child health assistance or other health benefits coverage to a nonpregnant childless adult that is approved before the date of enactment of this Act or to any extension, renewal, or amendment of such a waiver or project that is approved on or after such date of enactment.