Councilmember Sandra (Sandy) Allen
Councilmember Jim Graham
A BILL IN THE COUNCIL OF THE DISTRICT OF COLUMBIA
Councilmembers Allen and Graham introduced the following bill, which was referred to
the Committee on Human Services.
To provide for coverage of community-based attendant services and supports under the
Medicaid Program for persons with disabilities; to establish and enhance a comprehensive
system of consumer-responsive long-term services and supports in the most integrated
setting possible, to authorize a needs assessment for persons currently being provided
with services and supports in institutional settings; to create a Task Force to assist the
District of Columbia in creating an initiative to provide coverage of community-based
attendant services and supports; and to provide for quality assurance in the provision of
coverage for of community-based attendant services and supports.
BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this act may be cited as
the "Medicaid Community Attendant Services and Supports Act of 2001 ".
Sec. 2. For the purposes of this Act, the term:
(1) "Activities of daily living" includes eating, toileting, grooming,
dressing, bathing, and transferring.
2) "Agency-provider model" means, with respect to the provision of community
attendant services and supports for an individual, a method of providing consumer-directed
services and supports under which a single entity contracts for the provision of such
services and supports.
(3)(A) "Attendant services and supports" includes:
(i) All tasks necessary to assist an individual in accomplishing activities of daily
living, instrumental activities of daily living, and health-related functions;(ii) acquisition, maintenance, and enhancement of skills necessary for the individual
to accomplish activities of daily living, instrumental activities of daily living, and
health-related functions;(iii) back-up systems or mechanisms (such as the use of beepers) to ensure continuity
of services and supports; and
(iv) voluntary training for individuals on how to select, manage, and dismiss
attendants.(B) Except as provided in subsection (7), "Attendant services and supports"
shall not include:
(i) Provision of room and board for the individual;
(ii) special education and related services provided under the Individuals with
Disabilities Education Act and vocational rehabilitation services provided under the
Rehabilitation Act of 1973;
(iii) assistive technology devices and assistive technology services;
(iv) durable medical equipment; and
(v) home modifications.
(4) "Community attendant services and supports" means attendant services and
supports furnished to an individual, as needed, to assist in accomplishing activities of
daily living, instrumental activities of daily living, and health-related functions
through hands-on assistance and supervision;
(A) under a plan of services and supports that is based on an assessment of functional
need and that is agreed to by the individual or, as appropriate, the individual’s
representative;(B) in a home or community setting, which may include a school, workplace, or
recreation or religious facility, but does not include a nursing facility, an intermediate
care facility for the mentally retarded, or other institutional setting;(C) under an agency-provider model as defined in subsection (2), and other models as
defined in subsection (11) of this section; and(D) the furnishing of which is selected, managed, and dismissed by the individual or,
as appropriate, with assistance from the individual’s representative.
(5) "Consumer directed" means methods of providing services and supports that
allow the individual, or, where appropriate, the individual’s representative, maximum
control of the community attendant services and supports, regardless of who acts as the
employer of record.
(6) "Delivery models" includes both agency provider models and other models
for provision of consumer-directed services and supports.
(7) "Flexibility in transition to community-based home setting" includes
expenditures for transitional costs, such as rent and utility deposits, first month’s rent
and utilities, bedding, basic kitchen supplies, and other necessities required for an
individual to make the transition from a nursing facility or intermediate care facility
for the mentally retarded to a community-based home setting where the person resides.
(8) "Health-related functions" means functions that can be delegated or
assigned by a licensed health-care professional under District of Columbia law to be
performed by an attendant.
(9) "Individual’s representative" means a parent, a family member, a
guardian, an advocate, or an authorized representative of an individual.
(10) "Instrumental activities of daily living" includes meal planning and
preparation, financial management, shopping for food, clothing, and other essential items,
performing essential household chores, communicating by phone and other media, and getting
around and participating in the community.
(11) "Other models" means methods, other than an agency-provider model, for
provision of consumer-directed services and supports. Such models may include the
provision of vouchers, direct cash payments, or use of a fiscal agent to assist in
obtaining services.
Sec. 3. This act shall require coverage of community attendant services and supports
for individuals entitled to nursing facility services or those eligible for intermediate
care facility services for the mentally retarded under the Medicaid Program. These
services and supports shall be delivered to the individual in the most integrated
community setting appropriate to the unique needs and desires of the individual receiving
the services.
Sec. 4. (1) The Mayor shall establish and maintain a quality assurance program that
provides the following:
(A) minimum qualifications and training requirements for persons providing community
attendant services and supports;
(B) financial operating standards for agencies and organizations providing community
attendant services and supports; and
(C) an appeals procedure for eligibility denials and a grievance procedure for
disagreements with the terms of an individualized plan for the provision of community
attendant services and supports.
(2) The Mayor shall modify the quality assurance program, where appropriate, to
maximize consumer independence and consumer-direction in both agency-provider and other
models.
(3) The Mayor shall monitor the quality of community attendant services and supports
provided under this act through entities consisting of disabled persons and their
representatives, disability organizations, providers, family, members of the community,
and others.
(4) The Mayor shall provide ongoing monitoring of the health and well being of each
individual receiving community attendant services and supports.
(5) The Mayor shall require a written plan be created for each individual receiving
community attendant services and supports.
(6) The Mayor shall require quality assurance mechanisms appropriate for the individual
be included in the individual’s written plan.
(7) The Mayor shall establish a process for mandatory reporting, investigation, and
resolution of allegations of neglect, abuse, or exploitation.
(8) The Mayor shall obtain meaningful consumer input, including consumer surveys, that
measure the extent to which participants receive the services and supports described in
the individual plan and the degree of participant satisfaction with such services and
supports.
(9) The Mayor shall make available to the public the results of the quality assurance
program.
(10) The Mayor shall establish an on-going public process for development,
implementation, and review of the District of Columbia’s quality assurance program as
described in this subparagraph; and
(11) The Mayor shall develop sanctions for District of Columbia agencies which fail to
comply with this act.
Sec. 5. (1) The Mayor shall conduct a needs assessment which shall include information
about the number of persons within the District of Columbia who are receiving long-term
services and supports in institutional settings, the nature and extent to which current
programs respond to the preferences of individuals with disabilities to receive services
in home and community-based settings as well as in institutional settings, and the
expected change in demand for services provided in home and community settings as well as
institutional settings.
(2) The Mayor shall identify, develop, and implement strategies for modifying policies,
practices, and procedures that unnecessarily bias the provision of long-term services and
supports toward institutional settings and away from home and community-based settings,
including procedures governing policies, practices, and comparability in amount, scope and
duration of services, financial eligibility, individualized functional assessments and
screenings (including individual and family involvement), and knowledge about service
options.
(3) The Mayor shall develop and implement strategies for modifying policies, practices,
and procedures which bias the provision of long term services and supports by health care
professionals to the extent that quality services and supports can be provided by other
qualified individuals, including policies, practices, and procedures governing service
authorization, case management and service coordination, service delivery options, quality
controls, and supervision and training.
(4) The Mayor shall support activities to identify and coordinate Federal and District
of Columbia policies, resources, and services relating to the provision of long-term
services and supports. including the convening of interagency work groups and the entering
into of interagency agreements that provide for a single point of entry and the design and
implementation of coordinated screening and assessment system for all persons eligible for
long-term services and supports.
(5) The Mayor shall provide training and technical assistance for individuals with
disabilities, and, as appropriate, their representatives, attendants and personnel
(including professionals, paraprofessionals, volunteers, and other members of the
community). This assistance shall be provided either through a public agency, or by a
private entity selected by the Mayor.
(6) The Mayor shall create a public awareness program to provide information regarding
the availability of choices individuals with disabilities may select for receiving long
term services and support in the most integrated setting appropriate to their needs.
(7) The Mayor shall fund the per capita increased fixed costs in institutional settings
directly related to the movement of individuals with disabilities out of a specific
facility into community-based settings.
(8) The Mayor shall provide transitional costs as provided under section 1915(g) of the
Social Security Act, and interpreted in Attachment 3-b to the July 25, 2000 Letter to
State Medicaid Directors from HCFA Director Timothy M. Westmoreland.
(9) The Mayor shall conduct, on a time-limited basis, the demonstration of new
approaches to accomplishing the purposes described in section 2.
(10) The Mayor shall use funds available through grants from the federal government to
implement any changes necessary to policies and procedures of District of Columbia
agencies, or to the policies and procedures of entities regulated by the District of
Columbia, other than the activities described in this section, that are necessary for
developing, implementing, or evaluating the comprehensive District-wide system of long
term services and supports.
Sec. 6. (1) The Mayor shall establish a task force to assist the District of Columbia
in the development, implementation, and evaluation of an initiative moving individuals
from institutional to home-based settings.
(2) The task force shall recommend sanctions for non-compliance with this act, and
shall forward their recommendations to the Mayor for implementation.
(3) Members of the task force shall be appointed by the Mayor. The Mayor shall select
members after soliciting recommendations from representatives of organizations
representing a broad range of individuals with disabilities and organizations interested
in disabilities.
(4) The Task Force shall represent a broad range of individuals with disabilities from
diverse backgrounds and shall include representatives from organizations that provide
services to individuals with disabilities, consumers of long-term services and supports,
and disability advocacy organizations. A majority of Task Force members shall be
individuals with disabilities or their representatives.
(5) The Task Force shall not include employees of the District of Columbia who provide
services to individuals with disabilities other than employees of agencies described in
section 124 of the Developmental Disabilities Assistance and Bill of Rights Act approved
October 17, 1984 (98 Stat. 2675; 42 U.S.C. §6024).
(6) Funds allocated under grants awarded to the District of Columbia pursuant to this
section for a given fiscal year shall remain available until expended.
(7) The Mayor shall produce an annual report, to include the percentage increase in the
number of eligible individuals in the District of Columbia who receive long term services
and supports in the most integrated setting appropriate, including through community
attendant services and supports and other community-based settings.
Sec. 7. Fiscal impact statement.
The Council adopts the fiscal impact statement in the committee report as the fiscal
impact statement required by section 602(c)(3) of the District of Columbia Self-Government
and Governmental Reorganization Act, approved December 24, 1973 (87 Stat. 813; D.C. Code
§1-233(c)(3)).
Sec. 8. This act shall take effect following approval by the Mayor (or in the event of
veto by the Mayor, action by the Council to override the veto), approval by the Financial
Responsibility and Management Assistance Authority as provided in section 203(a) of the
District of Columbia Financial Responsibility and Management Assistance Act of 1995,
approved April 17, 1995 (109 Stat. 116; D.C. Code § 47-392.3(a)), a 30-day period of
Congressional review as provided in section 602(c)(1) of the District of Columbia Home
Rule Act, approved December 24, 1973 (87 Stat. 813; D.C. Code § 1-233(c)(1)), and
publication in the District of Columbia Register.