(a) Expanding HCBS coverage under section 1915(c) waivers.—Section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)) is amended—
(1) in paragraph (3), by inserting “paragraph (11) or” before “subsection (h)(2)”; and
(2) by adding at the end the following new paragraph:
“(11) Expanding coverage for home or community-based services.—
“(A) IN GENERAL.—Beginning July 1, 2028, notwithstanding paragraph (1), the Secretary may approve a waiver that is standalone from any other waiver approved under this subsection to include as medical assistance under the State plan of such State payment for part or all of the cost of home or community-based services (other than room and board (as described in paragraph (1))) approved by the Secretary which are provided pursuant to a written plan of care to individuals described in subparagraph (B)(iii). A waiver approved under this paragraph shall be for an initial term of 3 years and, upon the request of the State, shall be extended for additional 5-year periods unless the Secretary determines that for the previous waiver period the requirements specified under this subsection (excluding those excepted under subparagraph (B)) have not been met.
“(B) STATE REQUIREMENTS.—In addition to the requirements specified under this subsection (except for the requirements described in subparagraphs (C) and (D) of paragraph (2) and any other requirement specified under this subsection that the Secretary determines to be inapplicable in the context of a waiver that does not require individuals to have a determination described in paragraph (1)), a State shall meet the following requirements as a condition of waiver approval:
“(i) As of the date that such State requests a waiver under this subsection to provide home or community-based services to individuals described in clause (iii), all other waivers (if any) granted under this subsection to such State meet the requirements of this subsection.
“(ii) The State demonstrates to the Secretary that approval of a waiver under this subsection with respect to individuals described in clause (iii) will not result in a material increase of the average amount of time that individuals with respect to whom a determination described in paragraph (1) has been made will need to wait to receive home or community-based services under any other waiver granted under this subsection, as determined by the Secretary.
“(iii) The State establishes needs-based criteria, subject to the approval of the Secretary, regarding who will be eligible for home or community-based services under a waiver approved under this paragraph without requiring such individuals to have a determination described in paragraph (1), and specifies the home or community-based services such individuals so eligible will receive.
“(iv) The State establishes needs-based criteria for determining whether an individual described in clause (iii) requires the level of care provided in a hospital, nursing facility, or an intermediate care facility for individuals with developmental disabilities under the State plan or under any waiver of such plan that are more stringent than the needs-based criteria established under clause (iii) for determining eligibility for home or community-based services.
“(v) The State attests that the State’s average per capita expenditure for medical assistance under the State plan (or waiver of such plan) provided with respect to such individuals enrolled in a waiver under this paragraph will not exceed the State’s average per capita expenditure for medical assistance for individuals receiving institutional care under the State plan (or waiver of such plan) for the duration that the waiver under this paragraph is in effect.
“(vi) The State provides to the Secretary data (in such form and manner as the Secretary may specify) regarding the number of individuals described in clause (iii) with respect to a State seeking approval of a waiver under this subsection, to whom the State will make such services available under such waiver.
“(vii) The State agrees to provide to the Secretary, not less frequently than annually, data for purposes of paragraph (2)(E) (in such form and manner as the Secretary may specify) regarding, with respect to each preceding year in which a waiver under this subsection to provide home or community-based services to individuals described in clause (iii) was in effect—
“(I) the cost (as such term is defined by the Secretary) of such services furnished to individuals described in clause (iii), broken down by type of service;
“(II) with respect to each type of home or community-based service provided under the waiver, the length of time that such individuals have received such service;
“(III) a comparison between the data described in subclause (I) and any comparable data available with respect to individuals with respect to whom a determination described in paragraph (1) has been made and with respect to individuals receiving institutional care under this title; and
“(IV) the number of individuals who have received home or community-based services under the waiver during the preceding year.
“(C) LIMITATION ON PAYMENTS.—No payments made to carry out this paragraph shall be used by a State to make payments to a third party on behalf of an individual practitioner for benefits such as health insurance, skills training, and other benefits customary for employees, in the case of a class of practitioners for which the program established under this title is the primary source of revenue.”.
(b) Implementation funding.—
(1) IN GENERAL.—There are appropriated, out of any monies in the Treasury not otherwise appropriated, to the Administrator of the Centers for Medicare & Medicaid Services—
(A) for fiscal year 2026, $50,000,000 for purposes of carrying out the provisions of, and the amendments made by, this section, to remain available until expended; and
(B) for fiscal year 2027, $100,000,000 for purposes of making payments to States, subject to paragraph (2), to support State systems to deliver home or community-based services under section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)) (as amended by this section) or under section 1115 of such Act (42 U.S.C. 1315), to remain available until expended.
(2) PAYMENTS BASED ON STATE HCBS ELIGIBLE POPULATION.—Payments to States from amounts made available by paragraph (1)(B) shall be made, with respect to a State, on the basis of the proportion of the population of the State that is receiving home or community-based services under section1915(c) of the Social Security Act (42 U.S.C. 1396n(c)) (as amended by this section) or under section 1115 of such Act (42 U.S.C. 1315), as compared to all States.