text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Medicaid Cash and Counseling Program 
  Act of 2005''.
  
  SEC. 2. OPTIONAL CHOICE OF SELF-DIRECTED PERSONAL ASSISTANCE SERVICES 
                (CASH AND COUNSELING).
  
      (a) Exemption From Certain Requirements.--Section 1915 of the 
  Social Security Act (42 U.S.C. 1396n) is amended by adding at the end 
  the following new subsection:
      ``(i)(1) A State may provide, as `medical assistance', payment for 
  part or all of the cost of self-directed personal assistance services 
  (other than room and board) under the plan which are provided pursuant 
  to a written plan of care to individuals with respect to whom there has 
  been a determination that, but for the provision of such services, the 
  individuals would require and receive personal care services under the 
  plan, or home and community-based services provided pursuant to a 
  waiver under sub-section (c). Self-directed personal assistance 
  services may not be provided under this subsection to individuals who 
  reside in a home or property that is owned, operated, or controlled by 
  a provider of services, not related by blood or marriage.
      ``(2) The Secretary shall not grant approval for a State self-
  directed personal assistance services program under this section unless 
  the State provides assurances satisfactory to the Secretary of the 
  following:
              ``(A) Necessary safeguards have been taken to protect the 
          health and welfare of individuals provided services under the 
          program, and to assure financial accountability for funds 
          expended with respect to such services.
              ``(B) The State will provide, with respect to individuals 
          who--
                      ``(i) are entitled to medical assistance for 
                  personal care services under the plan, or receive home 
                  and community-based services under a waiver granted 
                  under subsection (c);
                      ``(ii) may require self-directed personal 
                  assistance services; and
                      ``(iii) may be eligible for self-directed personal 
                  assistance services,
          an evaluation of the need for personal care under the plan, or 
          personal services under a waiver granted under subsection (c).
              ``(C) Such individuals who are determined to be likely to 
          require personal care under the plan, or home and community-
          based services under a waiver granted under subsection (c) are 
          informed of the feasible alternatives, if available under the 
          State's self-directed personal assistance services program, at 
          the choice of such individuals, to the provision of personal 
          care services under the plan, or personal assistance services 
          under a waiver granted under subsection (c).
              ``(D) The State will provide for a support system that 
          ensures participants in the self-directed personal assistance 
          services program are appropriately assessed and counseled prior 
          to enrollment and are able to manage their budgets. Additional 
          counseling and management support may be provided at the 
          request of the participant.
              ``(E) The State will provide to the Secretary an annual 
          report on the number of individuals served and total 
          expenditures on their behalf in the aggregate. The State shall 
          also provide an evaluation of overall impact on the health and 
          welfare of participating individuals compared to non-
          participants every three years.
      ``(3) A State may provide self-directed personal assistance 
  services under the State plan without regard to the requirements of 
  section 1902(a)(1) and may limit the population eligible to receive 
  these services and limit the number of persons served without regard to 
  section 1902(a)(10)(B).
      ``(4)(A) For purposes of this subsection, the term `self-directed 
  personal assistance services' means personal care and related services, 
  or home and community-based services otherwise available under the plan 
  under this title or subsection (c), that are provided to an eligible 
  participant under a self-directed personal assistance services program 
  under this section, under which individuals, within an approved self-
  directed services plan and budget, purchase personal assistance and 
  related services, and permits participants to hire, fire, supervise, 
  and manage the individuals providing such services.
      ``(B) At the election of the State--
              ``(i) a participant may choose to use any individual 
          capable of providing the assigned tasks including legally 
          liable relatives as paid providers of the services; and
              ``(ii) the individual may use the individual's budget to 
          acquire items that increase independence or substitute (such as 
          a microwave oven or an accessibility ramp) for human 
          assistance, to the extent that expenditures would otherwise be 
          made for the human assistance.
      ``(5) For purpose of this section, the term `approved self-directed 
  services plan and budget' means, with respect to a participant, the 
  establishment of a plan and budget for the provision of self-directed 
  personal assistance services, consistent with the following 
  requirements:
              ``(A) Self-direction.--The participant (or in the case of a 
          participant who is a minor child, the participant's parent or 
          guardian, or in the case of an incapacitated adult, another 
          individual recognized by state law to act on behalf of the 
          participant) exercises choice and control over the budget, 
          planning, and purchase of self-directed personal assistance 
          services, including the amount, duration, scope, provider and 
          location of service provision.
              ``(B) Assessment of needs.--There is an assessment of the 
          needs, strengths, and preferences of the participants for such 
          services.
              ``(C) Service plan.--A plan for such services (and supports 
          for such services) for the participant has been developed and 
          approved by the State based on such assessment through a 
          person-centered process that--
                      ``(i) builds upon the participant's capacity to 
                  engage in activities that promote community life and 
                  that respects the participant's preferences, choices 
                  and abilities; and
                      ``(ii) involves families, friends, and 
                  professionals in the planning or delivery of services 
                  or supports as desired or required by the participant.
              ``(D) Service budget.--A budget for such services and 
          supports for the participant has been developed and approved by 
          the State based on such assessment and plan and on a 
          methodology that uses valid, reliable cost data, is open to 
          public inspection, and includes a calculation of the expected 
          cost of such services if those services were not self-directed. 
          The budget may not restrict access to other medically necessary 
          care and services furnished under the plan and approved by the 
          state but not included in the budget.
              ``(E) Application of quality assurance and risk 
          management.--There are appropriate quality assurance and risk 
          management techniques used in establishing and implementing 
          such plan and budget that recognize the roles and 
          responsibilities in obtaining services in a self-directed 
          manner and assure the appropriateness of such plan and budget 
          based upon the participant's resources and capabilities.
      ``(6) A State may employ a financial management entity to make 
  payments to providers, track costs, and make reports under the program. 
  Payment for the activities of the financial management entity shall be 
  at the administrative rate established in section 1903(a).''.
      (b) Effective Date.--The amendment made by subsection (a) shall 
  apply to services furnished on or after January 1, 2006.
target: Medicaid Cash and Counseling Program Act of 2005 - Amends title XIX (Medicaid) of the Social Security Act to allow a state to provide, as medical assistance, payment for the cost of self-directed personal assistance services (other than room and board) provided pursuant to a written plan of care to individuals who, but for such services, would require and receive personal care services under the plan, or home and community-based services provided pursuant to a waiver.
  
  Prohibits the provision of self-directed personal assistamce services to individuals who reside in a home or property owned, operated, or controlled by a service provider not related by blood or marriage.
feat_title: To amend title XIX of the Social Security Act to permit Medicaid beneficiaries the choice of self-directed personal assistance services through a cash and counseling program under the Medicaid Program.