Helping Communities with Better Support Act · Introduced in Senate (2025-06-09)

S. 1989

119th CONGRESS 1st Session

To amend title XIX of the Social Security Act to increase transparency and expand coverage options with respect to home and community-based services, and for other purposes.

IN THE SENATE OF THE UNITED STATES · June 9, 2025 · Sponsor: Mr. Schmitt · Committee: Committee on Finance

SEC. 2. Increasing transparency and expanding HCBS coverage options

(a) In general

Section 1915(c) of the Social Security Act () is amended— 42 U.S.C. 1396n(c)
- in paragraph (2)(E)—
  - by inserting before ; and
  - by inserting before the period at the end; and
  - (11)
    - Notwithstanding paragraph (1), the Secretary may approve a waiver under this subsection for a State to include as under the State plan of such State payment for part or all of the cost of home or community-based services (other than room and board (as described in such paragraph)) approved by the Secretary which are provided pursuant to a written plan of care to individuals other than individuals described in such paragraph if such State meets the requirements specified in subparagraph (B). medical assistance
    - For purposes of subparagraph (A), the requirements specified in this subparagraph are, with respect to a State, the following:
      - (i) As of the date that such State requests a waiver under this paragraph to provide home or community-based services to individuals—
      - with respect to whom there has not been a determination described in paragraph (1) made; and
      - who meet the definition of disability under section 3 of the Americans with Disabilities Act of 1990 () or section 504 of the Rehabilitation Act of 1973 (), all other waivers (if any) granted under this subsection with respect to the State plan meet the requirements of this subsection. 42 U.S.C. 12102; 29 U.S.C. 794
      - (ii) The State demonstrates to the Secretary that approval of a waiver under this subsection with respect to individuals described in clause (i) will have no material impact on 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.
      - (iii) The State provides to the Secretary—
      - an estimate of the number of individuals described in clause (i) that the State will make such services available to under a waiver under this subsection; and
      - a description of how the types and quantities of such services furnished to such individuals under such a waiver may differ from the types and quantities of such services furnished to individuals not described in clause (i) under such a waiver.
    - For purposes of paragraph (2)(E), the information specified in this paragraph (which, beginning on January 1, 2028, shall be made publicly available on the website of the Centers for Medicare & Medicaid Services) is the following:
      - 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—
        
        (i) a description of how the State maintains its list of individuals who have applied to receive such services under such waiver but who, due to such limit, have not yet been approved to receive such services;
        
        (ii) information on whether the State screens individuals on such list to determine whether such individuals are eligible to receive such services under such waiver;
        
        (iii) information on whether (and, if applicable, how often) the State periodically re-screens such individuals to determine whether such individuals are so eligible; and
        
        (iv) the average amount of time that individuals approved to receive such services were on such list.
      - A description of the types of services furnished under a waiver under this subsection, including—
        
        (i) the average amount of time from when such services are initially approved for an individual to when such individual begins receiving such services; and
        
        (ii) with respect to the most recent 1-year period ending on the date that such information is provided to the Secretary for which data is available (or such other period as may be specified by the Secretary), the average percentage of hours of home or community-based services authorized under written plans of care for individuals receiving such services under a waiver granted under this subsection that are actually furnished to such individual.
      - Information regarding access to homemaker services, home health aide services, and personal care services under a waiver under this subsection, including—
        
        (i) with respect to the most recent 1-year period ending on the date that such information is provided to the Secretary for which data is available, the average amount of time from when homemaker services, home health aide services, or personal care services are initially approved to be furnished to individuals under such a waiver to when services began; and
        
        (ii) with respect to the period described in clause (i), the average percentage of hours of homemaker services, home health aide services, and personal care services authorized under written plans of care for individuals receiving such services under a waiver granted under this subsection that are actually furnished to such individual.
- by adding at the end the following new paragraphs:

(b) Guidance

Not later than January 1, 2026, the Secretary of Health and Human Services shall issue guidance to States to clarify how a State with a waiver in effect under section 1915(c) of the Social Security Act () may provide, with respect to an individual who is eligible for home and community-based services (as such term is described in such section) under such waiver, up to 60 days of coverage for such services under an interim care plan for the period beginning on the date such eligibility is determined and ending on the date that a written plan of care (as such term is described in such section) with respect to such individual is finalized. 42 U.S.C. 1396n(c)

S. 1989

Table of contents

SEC. 1. Short title

SEC. 2. Increasing transparency and expanding HCBS coverage options