H. B. 4544
(By Delegates Williams, Moye, Manypenny,
Rowan, Stephens, Perdue and Boggs)
[Introduced
February 18, 2010
; referred to the
Committee on Senior Citizen Issues then Finance.]
A BILL to to amend the Code of West Virginia, 1931, as amended, by
adding thereto a new article, designated §9-4F-1, §9-4F-2,
§9-4F-3, §9-4F-4, §9-4F-5 and §9-4F-6, all relating to
community-based services and supports for individuals with
disabilities; establishing the Community-Based Services Act;
providing definitions for certain terms; defining the purpose
of the Act; implementation of the Act; standards and
requirements of the Department of Health and Human Resources
to modify certain policies to improve access to
community-based long term care services; legislative
oversight; and requiring legislative rules.
Be it enacted by the Legislature of West Virginia:
That the Code of West Virginia, 1931, as amended, be amended
by adding thereto a new article, designated §9-4F-1, §9-4F-2,
§9-4F-3, §9-4F-4, §9-4F-5 and §9-4F-6, all to read as follows:
ARTICLE 4F. COMMUNITY-BASED SERVICES ACT.
§9-4F-1. Title.
This article is known as and may be cited as the
"Community-Based Services Act".
§9-4F-2. Definitions.
(a) "Community-based services and supports" means services and
supports designated to assist the recipient in accomplishing
activities of daily living, health maintenance tasks in the most
integrated setting appropriate. These services and supports are
furnished to a recipient through: informal supports; Medicaid
waiver programs; Medicaid personal care; and Medicaid home health.
(b) "Service or Support Recipient" means the eligible
individual who has a disability and is receiving long term care
supports under existing or new community-based supports or
institutional care.
(c) "Department" means Department of Health and Human
Resources.
(d) "Institution" means nursing facility and intermediate care
facility for persons with mentally challenged or other segregated
and congregated facility providing long term care services.
(e) "Long Term Care Services" means diverse, integrated
medical or nonmedical services provided over a sustained period of
time to ensure maximum physical, mental, and social functioning of
the service or support recipient.
(f) "Legal Representative" means a person legally authorized
to make decisions for the service or support recipient including, but not limited to, a conservator, guardian, power of attorney,
medical power of attorney, or health care surrogate.
(g) "Most integrated setting" means the individual has
opportunities to access and actively participate in a valued and
meaningful way as a member of their community.
§9-4F-3. Purpose.
(a) The intent of this legislation is to achieve the following
goals:
(1) Assuring the implementation of Title II of the Americans
with Disabilities Act as upheld by the United States Supreme Court
in Olmstead v. L.C.;
(2) Respecting the right of all people who can be supported in
their home and community regardless of severity of disability or
age;
(3) Reducing the reliance on institutional care;
(4) Reducing the cost of publicly funded services and
supports;
(5) Eliminating barriers that prevent or restrict the flexible
use of Medicaid funds in the most integrated setting;
(6) Increasing access to community-based alternatives to
institutional care;
(7) Ensuring continuous quality assurance and improvement in
providing community-based long term care supports; and
(8) Ensuring that, as home and community based services are
more fully developed, resources remain available to individuals who choose or need care in a long term care facility.
§9-4F-4. Implementation of the Community-Based Services Act.
(a) The department shall design and implement enduring
improvements to community-based supports to enable eligible service
or support recipients to live and participate in a valued and
meaningful way in community life, particularly with respect to
individuals who:
(1) Reside in or are at-risk of admission to an institutional
setting; and
(2) Would prefer to live in the community and could do so,
provided they have the appropriate supports.
(b) The department shall utilize the Olmstead Council as the
committee to assist in the planning, development, and
implementation of community-based supports, including program
standards, access, eligibility, and quality assurance related to
this act.
(c) The department shall identify and educate eligible
individuals residing in institutional long term care facilities.
(d) The department shall ensure that each individual
identified has the opportunity to make an informed choice for
community-based services as an alternative to institutional care.
(e) The department shall ensure to the maximum extent
possible, a service or supports recipient or their legal
representative shall be supported to design and manage his or her
community-based supports in a self-directed manner preserving individual choice, control and dignity.
(f) The service or support recipient shall have due process
rights through a responsive and efficient due process system.
§9-4F-5. Standards and requirements.
(a) The department shall modify methodology for funding long
term care supports to:
(1) Allow long term care Medicaid funding for institutional
care to be allocated in a flexible manner;
(2) Require long term care Medicaid funding methodology to
utilize a market-based approach that allows the service or support
recipient to guide the allocation of funding through need and
choice.
(b) The department shall eliminate the institutional bias in
eligibility determination for specific community-based services.
(1) The department shall utilize a presumptive eligibility, or
fast track eligibility process for Medicaid waiver programs. This
will allow for immediate access to services as already permitted
for alternative institutional programs.
(2) The department shall provide Medicaid personal care
services to allow services in the natural community setting as
needed by the service or support recipient.
(3) The department shall provide benefits counseling
(including alternative to institutional care) prior to any
individual being admitted to an institutional setting.
(4) The department shall provide benefits counseling (including all alternatives to institutional care) on an annual
basis to all individuals residing in an institutional setting.
(c) The department shall fund a statewide transition and
diversion program to assist people in returning to or remaining in
their home and community to avoid or delay institutionalization as
resources permit.
§9-4F-6. Legislative oversight.
The department shall report to the Select Committee on PEIA,
Seniors and Long Term Care every three months concerning the
progress of policy changes to eliminate institutional bias and
status of those eligible individuals who choose to move from
institutional facilities to community-based settings.
NOTE: The purpose of the bill is to ensure that the DHHR
focuses on the home and community based services as they make plans
for the elderly and people with disabilities.
This article is new; therefore, it has been completely
underscored.