TITLE XXIV-HEALTH SERVICES WITH RESPECT TO
ACQUIRED IMMUNE DEFICIENCY SYNDROME 1

PART A-FORMULA GRANTS TO STATES FOR HOME AND COMMUNITYBASED HEALTH SERVICES

SEC. 2401. [300dd] ESTABLISHMENT OF PROGRAM.

(a) ALLOTMENTS FOR STATES.-For the purpose described in subsection (b), the Secretary shall for each of the fiscal years 1989 and 1990 make an allotment for each State in an amount determined in accordance with section 2408. The Secretary shall make payments each such fiscal year to each State from the allotment for the State if the Secretary approves for the fiscal year involved an application submitted by the State pursuant to section 2407.

(b) PURPOSE OF GRANTS.-The Secretary may not make payments under subsection (a) for a fiscal year unless the State involved agrees to expend the payments only for the purpose of providing services in accordance with section 2402.

(c) ELIGIBLE INDIVIDUAL DEFINED.-For purposes of this part:

(1) The term "eligible individual" means an individual infected with the etiologic agent for acquired immune deficiency syndrome who either is medically dependent or chronically dependent.

(2) The term "medically dependent" means, with respect to an individual, that the individual has been certified by a physician as

(A) requiring the routine use of appropriate medical services (which may include home intravenous drug therapy) to prevent or compensate for the individual's serious deterioration, arising from infection with the etiologic agent for acquired immune deficiency syndrome, of physical health or cognitive function, and

(B) being able to avoid long-term or repeated care as an inpatient or resident in a hospital, nursing facility, or other institution if home and community-based health services are provided to the individual.

(3) The term "chronically dependent" means, with respect to an individual, that the individual has been certified by a physician as

(A) being unable to perform, because of physical or cognitive impairment (without substantial assistance from another individual) arising from infection with the etiologic agent for acquired immune deficiency syndrome, at least 2 of the following activities of daily living: bathing, dressing, toileting, transferring, and eating, or

1 See footnote 1 on page 617.

(B) having a similar level of disability due to cognitive impairment (as defined by the Secretary).

(d) HOME AND COMMUNITY-BASED HEALTH SERVICES DEFINED.— For purposes of this part, the term "home and community-based health services"

(1) means, with respect to an eligible individual, skilled health services furnished to the individual in the individual's home pursuant to a written plan of care established by a health care professional for the provision of such services and items and services described in paragraph (2);

(2) includes

(A) durable medical equipment,

(B) homemaker/home health aide services and personal care services furnished in the individual's home,

(C) day treatment or other partial hospitalization services,

(D) home intravenous drug therapy (including prescription drugs administered intravenously as part of such therapy), and

(E) routine diagnostic tests administered in the individual's home,

furnished pursuant to such plan of care; but

(3) does not include, except as specifically provided in paragraph (2)—

(A) diagnostic tests,

(B) inpatient hospital services,

(C) nursing facility services, and

(D) prescription drugs.

SEC. 2402. [300dd-1] PROVISIONS WITH RESPECT TO CARRYING OUT PURPOSE OF GRANTS.

(a) REQUIRED USES OF FUNDS.-The Secretary may not make payments under section 2401(a) unless the State involved agrees that the State will

(1) provide for home and community-based health services for eligible individuals pursuant to written plans of care established by health care professionals for providing such services to such individuals;

(2) provide for the identification, location, and provision of outreach to eligible individuals;

(3) provide for coordinating the provision of services under this part with the provision of similar or related services by public and private entities; and

(4) give priority to the provision of outreach and home and community-based services to eligible individuals with low incomes.

(b) AUTHORITY FOR GRANTS AND CONTRACTS.-A State may make payment for services under subsection (a) through grants to public and nonprofit private entities and through contracts with public and private entities. In providing such financial assistance, a State shall give priority to public and nonprofit private entities that have demonstrated experience in delivering home and communitybased health services to individuals infected with the etiologic agent for acquired immune deficiency syndrome.

SEC. 2403. [300dd-2] REQUIREMENT OF SUBMISSION OF DESCRIPTION OF INTENDED USES OF GRANT.

The Secretary may not make payments under section 2401(a) to a State for a fiscal year unless

(1) the State submits to the Secretary a description of the purposes for which the State intends to expend such payments for the fiscal year;

(2) such description provides information relating to the services and activities to be provided, including a description of the manner in which such services and activities will be coordinated with any similar services and activities of public and private entities; and

(3) such description includes information relating to (A) the process for determining which eligible individuals are medically dependent or chronically dependent and (B) the process for establishing written plans of care for the provision of home and community-based health services under this part.

SEC. 2404. [300dd-3] RESTRICTIONS ON USE OF GRANT.

(a) IN GENERAL.-The Secretary may not make payments under section 2401(a) for a fiscal year to a State unless the State agrees that the payments will not be expended

(1) to provide for items or services described in section 2401(d)(3);

(2) to make cash payments to intended recipients of services; (3) to purchase or improve real property (other than minor remodeling of existing improvements to real property) or to purchase major medical equipment; or

(4) to satisfy any requirement for the expenditure of nonFederal funds as a condition for the receipt of Federal funds. (b) LIMITATION ON ADMINISTRATIVE EXPENSES.-The Secretary may not make payments under section 2401(a) for a fiscal year unless the State involved agrees that the State will not expend more than 5 percent of the payments made to the State under such section for administrative expenses with respect to carrying out the purpose of this part.

(c) LIMITATION ON TOTAL PAYMENTS.

(1) Before March 1, 1989, for fiscal year 1989 and before September 1, 1989, for fiscal year 1990, the Secretary shall determine and publish the national average monthly payments, for extended care services under part A of title XVIII of the Social Security Act, for each resident of a skilled nursing facility the Secretary estimates will be paid in the fiscal year.

(2) The Secretary may not make payments under section 2401(a) for a fiscal year to a State to the extent that the average monthly payments for eligible individuals provided home and community-based health services under this part in the State exceeds 65 percent of the national average monthly payments determined and published for the fiscal year under paragraph (1).

SEC. 2405. [300dd-4] REQUIREMENT OF REPORTS AND AUDITS BY STATES.

(a) REPORTS.—

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(1) The Secretary may not make payments under section 2401(a) for a fiscal year unless the State involved agrees to prepare and submit to the Secretary, by not later than January 1 following the fiscal year, an annual report in such form and containing such information as the Secretary determines (after consultation with the States and the Comptroller General of the United States) to be necessary for

(A) securing a record and a description of the purposes for which payments received by the State pursuant to section 2401(a) were expended and of the recipients of such payments;

(B) determining whether the payments were expended in accordance with the purpose of this part; and

(C) determining the percentage of payments received pursuant to section 2401(a) that were expended by the State for administrative expenses during the fiscal year involved.

(2) Each report by a State under paragraph (1) for a fiscal year also shall include

(A) information on the number and type of eligible individuals provided home and community-based health services by the State under this part for the fiscal year;

(B) information on the types of home and communitybased health services so provided;

(C) information on the average monthly costs of such services and a comparison of such costs with costs of providing services in hospitals, nursing facilities, and similar institutions; and

(D) such other information as the Secretary may require to provide for an evaluation of the program under this part and its cost-effectiveness.

(b) AUDITS.

(1) The Secretary may not make payments under section 2401(a) for a fiscal year unless the State involved agrees to establish such fiscal control and fund accounting procedures as may be necessary to ensure the proper disbursal of, and accounting for, amounts received by the State under such section.

(2) The Secretary may not make payments under section 2401(a) for a fiscal year unless the State involved agrees that(A) the State will provide for

(i) a financial and compliance audit of such payments; or

(ii) a single financial and compliance audit of each entity administering such payments;

(B) the audit will be performed biennially and will cover expenditures in each fiscal year; and

(C) the audit will be conducted in accordance with standards established by the Comptroller General of the United States for the audit of governmental organizations, programs, activities, and functions.

(3) The Secretary may not make payments under section 2401(a) for a fiscal year unless the State involved agrees that,