Medicaid Community-Based Attendant Services and
Supports Act of 2003
S. 971 and HR 2032: MiCASSA
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A brief Summary of the
MEDICAID COMMUNITY ATTENDANT SERVICES and SUPPORTS
ACT S. 971 and HR 2032.
What does MiCASSA do? It gives people real choice in long term care.
MiCASSA: A Summary
MiCASSA gives people real choice in long term services. Amending Title XIX of the Social Security Act (Medicaid), it creates an alternative service
called Community Attendant Services and Supports. MiCASSA allows
individuals eligible for Nursing Facility Services or Intermediate Care
Facility Services for the Mentally Retarded (ICF-MR) the choice to use these
dollars for "Community Attendant Services and Supports." THE MONEY FOLLOWS
Specifically what does this bill do?
Provides community attendant services and supports which range from
assisting with activities of daily living (eating, toileting, grooming, dressing, bathing, transferring) instrumental activities of daily living (meal planning and preparation, managing finances, shopping, household chores, phoning, participating in the community), and health-related functions.
Includes hands-on assistance, supervision and/or cueing, as well as help
to learn, keep and enhance skills to accomplish such activities.
Requires services be provided in THE MOST INTEGRATED SETTING appropriate
to the needs of the individual.
Provides Community Attendant Services and Supports that are:
- based on an assessment of functional need;
- provided in home or community settings like -- school, work, recreation or
- selected, managed and controlled by the consumer of the services;
- supplemented with backup and emergency attendant services;
- furnished according to a service plan agreed to by the consumer;
- include voluntary training on selecting, managing and dismissing
Allows consumers to choose among various service delivery models
including vouchers, direct cash payments, fiscal agents and agency
providers, all of which are required to be consumer controlled.
For consumers who are not able to direct their own care independently,
MiCASSA allows for "individual's representative" to be authorized by the
consumer to assist. A representative might be a friend, family member,
guardian, or advocate.
Allows health-related functions or tasks to be assigned to, delegated to,
or performed by unlicensed personal attendants, according to state laws.
Covers individuals' transition costs from a nursing facility or ICF-MR
to a home setting, for example: rent and utility deposits, bedding, basic
kitchen supplies and other necessities required for the transition.
Serves individuals with incomes above the current institutional income
limitation -- if a state chooses to waive this limitation to enhance the
potential for employment.
Provides for quality assurance programs which promote consumer control
Allows states to limit the aggregate amount spent on long term care in
a year to that amount the state would have spent on institutional services
for such eligible individuals in the year.
Provides a maintenance of effort requirement so that states can not
diminish more enriched programs already being provided.
REAL CHOICE SYSTEMS CHANGE INITIATIVES
MiCASSA also provides grants for Real Choice Systems Change Initiatives
to help the states transition from current institutionally dominated service
systems to ones more focused on community services and supports.
Each state will create a Consumer Task Force to develop a plan for
transitioning services into a more community oriented system. A majority of
the members must be people with disabilities or their representatives.
The Secretary of Health and Human Services, along with the National
Council on Disabilities, will review regulations and report to Congress on
how to reduce excessive use of medical services. The Secretary will also
establish a task force to examine financing of long term care services.