Page:United States Statutes at Large Volume 101 Part 2.djvu/937

 PUBLIC LAW 100-203—DEC. 22, 1987

101 STAT. 1330-143

(5) Section 1902(1)(4) of such Act (42 U.S.C. 1396a(l)(4)) is amended by adding at the end the following new subparagraph: "(C) A State plan may not provide, in its election of the option of furnishing medical assistance to individuals described in paragraph (1), that such individuals must apply for benefits under part A of title IV as a condition of applying for, or receiving, medical assistance under this title.". (6)(A) The amendment made by paragraph ^o (i) shall become Effective dates. effective on the date of enactment of this Act. ^2JJSC I396a note. (B) The amendments made by paragraphs (2) and (3) shall be effective as if they had been included in the enactment of the Consolidated Omnibus Budget Reconciliation Act of 1985. (C) The amendment made by paragraph (4) shall apply to elections made on or after the enactment of this Act. (D) The amendment made by paragraph (5) shall apply as if included in the enactment of section 9401 of the Omnibus Budget Reconciliation Act of 1986. SEC. 4102. HOME AND COMMUNITY-BASED SERVICES FOR THE ELDERLY. (a) IN GENERAL.—

(1) Section 1915 of the Social Security Act (42 U.S.C. 1396n) is amended— (A) by transferring subsection (d) to the end of such section and redesignating it as subsection (h), and (B) by inserting after subsection (c) the following new subsection: "(d)(1) Subject to paragraph (2), the Secretary shall grant a waiver to provide that a State plan approved under this title shall include as 'medical assistance' under such plan payment for part or all of the cost of home or community-based services (other than room and board) which are provided pursuant to a written plan of care to individuals 65 years of age or older with respect to whom there has been a determination that but for the provision of such services the individuals would be likely to require the level of care provided in a skilled nursing facility or intermediate care facility the cost of which could be reimbursed under the State plan. "(2) A wgdver shall not be granted under this subsection unless the State provides assurances satisfactory to the Secretary that— "(A) necessary safeguards (including adequate standards for provider participation) have been taken to protect the health and welfare of individuals provided services under the waiver and to assure financial accountability for funds expended with respect to such services; (B) with respect to individuals 65 years of age or older who— "(i) are entitled to medical assistance for skilled nursing or intermediate care facility services under the State plan, ',. "(ii) may require such services, and "(iii) may be eligible for such home or community-based services under such waiver, the State will provide for an evaluation of the need for such skilled nursing facility or intermediate care facility services; and "(C) such individuals who are determined to be likely to require the level of care provided in a skilled nursing facility or intermediate care facility are informed of the feasible alter*° Ckjpy read "paragraphs".

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