
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document affected by Public Law 106-402 Section 401(b)(6)(B)]
[CITE: 42USC1396u]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
    SUBCHAPTER XIX--GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS
 
Sec. 1396u. Community supported living arrangements services


(a) Community supported living arrangements services

    In this subchapter, the term ``community supported living 
arrangements services'' means one or more of the following services 
meeting the requirements of subsection (h) of this section provided in a 
State eligible to provide services under this section (as defined in 
subsection (d) of this section) to assist a developmentally disabled 
individual (as defined in subsection (b) of this section) in activities 
of daily living necessary to permit such individual to live in the 
individual's own home, apartment, family home, or rental unit furnished 
in a community supported living arrangement setting:
        (1) Personal assistance.
        (2) Training and habilitation services (necessary to assist the 
    individual in achieving increased integration, independence and 
    productivity).
        (3) 24-hour emergency assistance (as defined by the Secretary).
        (4) Assistive technology.
        (5) Adaptive equipment.
        (6) Other services (as approved by the Secretary, except those 
    services described in subsection (g) of this section).
        (7) Support services necessary to aid an individual to 
    participate in community activities.

(b) ``Developmentally disabled individual'' defined

    In this subchapter the term,\1\ ``developmentally disabled 
individual'' means an individual who as defined by the Secretary is 
described within the term ``mental retardation and related conditions'' 
as defined in regulations as in effect on July 1, 1990, and who is 
residing with the individual's family or legal guardian in such 
individual's own home in which no more than 3 other recipients of 
services under this section are residing and without regard to whether 
or not such individual is at risk of institutionalization (as defined by 
the Secretary).
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    \1\ So in original. The comma probably should precede ``the term''.
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(c) Criteria for selection of participating States

    The Secretary shall develop criteria to review the applications of 
States submitted under this section to provide community supported 
living arrangement services. The Secretary shall provide in such 
criteria that during the first 5 years of the provision of services 
under this section that no less than 2 and no more than 8 States shall 
be allowed to receive Federal financial participation for providing the 
services described in this section.

(d) Quality assurance

    A State selected by the Secretary to provide services under this 
section shall in order to continue to receive Federal financial 
participation for providing services under this section be required to 
establish and maintain a quality assurance program, that provides that--
        (1) the State will certify and survey providers of services 
    under this section (such surveys to be unannounced and average at 
    least 1 a year);
        (2) the State will adopt standards for survey and certification 
    that include--
            (A) minimum qualifications and training requirements for 
        provider staff;
            (B) financial operating standards; and
            (C) a consumer grievance process;

        (3) the State will provide a system that allows for monitoring 
    boards consisting of providers, family members, consumers, and 
    neighbors;
        (4) the State will establish reporting procedures to make 
    available information to the public;
        (5) the State will provide ongoing monitoring of the health and 
    well-being of each recipient;
        (6) the State will provide the services defined in subsection 
    (a) of this section in accordance with an individual support plan 
    (as defined by the Secretary in regulations); and
        (7) the State plan amendment under this section shall be 
    reviewed by the State Planning Council established under section 
    6024 of this title, and the Protection and Advocacy System 
    established under section 6042 of this title.

The Secretary shall not approve a quality assurance plan under this 
subsection and allow a State to continue to receive Federal financial 
participation under this section unless the State provides for public 
hearings on the plan prior to adoption and implementation of its plan 
under this subsection.

(e) Maintenance of effort

    States selected by the Secretary to receive Federal financial 
participation to provide services under this section shall maintain 
current levels of spending for such services in order to be eligible to 
continue to receive Federal financial participation for the provision of 
such services under this section.

(f) Excluded services

    No Federal financial participation shall be allowed for the 
provision of the following services under this section:
        (1) Room and board.
        (2) Cost of prevocational, vocational and supported employment.

(g) Waiver of requirements

    The Secretary may waive such provisions of this subchapter as 
necessary to carry out the provisions of this section including the 
following requirements of this subchapter--
        (1) comparability of amount, duration, and scope of services; 
    and
        (2) statewideness.

(h) Minimum protections

          (1) Publication of interim and final requirements

        (A) In general

            The Secretary shall publish, by July 1, 1991, a regulation 
        (that shall be effective on an interim basis pending the 
        promulgation of final regulations), and by October 1, 1992, a 
        final regulation, that sets forth interim and final 
        requirements, respectively, consistent with subparagraph (B), to 
        protect the health, safety, and welfare of individuals receiving 
        community supported living arrangements services.

        (B) Minimum protections

            Interim and final requirements under subparagraph (A) shall 
        assure, through methods other than reliance on State licensure 
        processes or the State quality assurance programs under 
        subsection (d) of this section, that--
                (i) individuals receiving community supported living 
            arrangements services are protected from neglect, physical 
            and sexual abuse, and financial exploitation;
                (ii) a provider of community supported living 
            arrangements services may not use individuals who have been 
            convicted of child or client abuse, neglect, or mistreatment 
            or of a felony involving physical harm to an individual and 
            shall take all reasonable steps to determine whether 
            applicants for employment by the provider have histories 
            indicating involvement in child or client abuse, neglect, or 
            mistreatment or a criminal record involving physical harm to 
            an individual;
                (iii) individuals or entities delivering such services 
            are not unjustly enriched as a result of abusive financial 
            arrangements (such as owner lease-backs); and
                (iv) individuals or entities delivering such services to 
            clients, or relatives of such individuals, are prohibited 
            from being named beneficiaries of life insurance policies 
            purchased by (or on behalf of) such clients.

                       (2) Specified remedies

        If the Secretary finds that a provider has not met an applicable 
    requirement under subsection (h) of this section, the Secretary 
    shall impose a civil money penalty in an amount not to exceed 
    $10,000 for each day of noncompliance. The provisions of section 
    1320a-7a of this title (other than subsections (a) and (b)) shall 
    apply to a civil money penalty under the previous sentence in the 
    same manner as such provisions apply to a penalty or proceeding 
    under section 1320a-7a(a) of this title.

(i) Treatment of funds

    Any funds expended under this section for medical assistance shall 
be in addition to funds expended for any existing services covered under 
the State plan, including any waiver services for which an individual 
receiving services under this program is already eligible.

(j) Limitation on amounts of expenditures as medical assistance

    The amount of funds that may be expended as medical assistance to 
carry out the purposes of this section shall be for fiscal year 1991, 
$5,000,000, for fiscal year 1992, $10,000,000, for fiscal year 1993, 
$20,000,000, for fiscal year 1994, $30,000,000, for fiscal year 1995, 
$35,000,000, and for fiscal years thereafter such sums as provided by 
Congress.

(Aug. 14, 1935, ch. 531, title XIX, Sec. 1930, as added Pub. L. 101-508, 
title IV, Sec. 4712(b), Nov. 5, 1990, 104 Stat. 1388-187.)

                          Codification

    Pub. L. 101-508, title IV, Sec. 4712(b)(1), Nov. 5, 1990, 104 Stat. 
1388-187, which directed renumbering of section 1930 of the Social 
Security Act, act Aug. 14, 1935, as section 1931, could not be executed 
because there was no section 1930.


                             Effective Date

    Section 4712(c) of Pub. L. 101-508 provided that:
    ``(1) In general.--The amendments made by this section [enacting 
this section and amending section 1396d of this title] shall apply to 
community supported living arrangements services furnished on or after 
the later of July 1, 1991, or 30 days after the publication of 
regulations setting forth interim requirements under subsection (h) 
[probably means subsec. (h) of this section] without regard to whether 
or not final regulations to carry out such amendments have been 
promulgated by such date.
    ``(2) Application process.--The Secretary of Health and Human 
Services shall provide that the applications required to be submitted by 
States under this section shall be received and approved prior to the 
effective date specified in paragraph (1).''

                  Section Referred to in Other Sections

    This section is referred to in section 1396d of this title.
