Page:United States Statutes at Large Volume 104 Part 2.djvu/586

 104 STAT. 1388-178 PUBLIC LAW 101-508 —NOV. 5, 1990 "(A) has experience or has been trained in establishing, and in periodically reviewing and revising, individual community care plans and in the provision of case management services to the elderly; "(B) is responsible for (i) assuring that home and community care covered under the State plan and specified in the ICCP is being provided, (ii) visiting each individual's home or community setting where care is being provided not less often than once every 90 days, and (iii) informing the elderly individual or primary caregiver on how to contact the case manager if service providers fail to properly provide services or other similar problems occur; "(C) in the case of a nonpublic agency, does not provide home and community care or nursing facility services and does not have a direct or indirect ownership or control interest in, or direct or indirect affiliation or relationship with, an entity that provides, home and community care or nursing facility services; "(D) has procedures for assuring the quality of case management services that includes a peer review process; "(E) completes the ICCP in a timely manner and reviews and discusses new and revised ICCPs with elderly individuals or primary caregivers; and "(F) meets such other standards, established by the Secretary, as to assure that— "(i) such a manager is competent to perform case management functions; "(ii) individuals whose home and community care they mangige are not at risk of financial exploitation due to such a manager; and "(iii) meets such other standards as the State may establish. The Secretary may waive the requirement of subparagraph (C) in the case of a nonprofit agency located in a rural area. "(3) APPEALS PROCESS. —Each State which elects to provide home and community care under this section must have in effect an appeals process for individuals who disagree with the ICCP established. "(e) CEIUNG ON PAYMENT AMOUNTS AND MAINTENANCE OF EFFORT. — "(1) CEIUNG ON PAYMENT AMOUNTS.— Payments may not be made under section 1903(a) to a State for home and community care provided under this section in a quarter to the extent that the medical assistance for such care in the quarter exceeds 50 percent of the product of— "(A) the avergige number of individuals in the quarter receiving such care under this section; "(B) the average per diem rate of payment which the Secretary has determined (before the beginning of the quarter) will be payable under title XVIII (without regard to coinsurance) for extended care services to be provided in the State during such quarter; and "(C) the number of days in such quarter. "(2) MAINTENANCE OF EFFORT. — "(A) ANNUAL REPORTS.— As a condition for the receipt of payment under section 1903(a) with respect to medical assistance provided by a State for home and community

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