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U.S. Code as of:
01/19/04
Section 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).
(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 Council on Developmental Disabilities
established under section 125 of the Developmental Disabilities
Assistance and Bill of Rights Act of 2000 [42 U.S.C. Sec. 15025]
and the protection and advocacy system established under subtitle
C of that Act [42 U.S.C. 15041 et seq.].
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.
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