32 "SEC. 3202. DEFINITIONS. ";

Wed, 07/08/2009 - 3:07pm — lambert

"SEC. 3202. DEFINITIONS.

In this title:

(1) ACTIVE ENROLLEE.-The term active en-rollee means an individual who is enrolled in the CLASS program in accordance with section 3204

and who has paid any premiums due to maintain such enrollment. (2) ACTIVELY EMPLOYED.-The term actively employed means an individual who-

(A) is reporting for work at the individ-uals usual place of employment or at another location to which the individual is required to travel because of the individuals employment (or in the case of an individual who is a mem-ber of the uniformed services, is on active duty and is physically able to perform the duties of the individuals position); and

(B) is able to perform all the usual and customary duties of the individuals employment on the individuals regular work schedule. (3) ACTIVITIES OF DAILY LIVING.-The term

activities of daily living means each of the following activities specified in section 7702B(c)(2)(B) of the Internal Revenue Code of 1986:

(A) Eating. (B) Toileting. (C) Transferring. (D) Bathing. (E) Dressing. (F) Continence.

(4) CLASS PROGRAM.-The term CLASS program means the program established under this title.

(5) DISABILITY DETERMINATION SERVICE.- The term Disability Determination Service means, with respect to each State, the entity that has an agreement with the Commissioner of Social Security to make disability determinations for purposes of title II or XVI of the Social Security Act (42 U.S.C. 401 et seq., 1381 et seq.).

(6) ELIGIBLE BENEFICIARY.-

(A) IN GENERAL.-The term eligible beneficiary means any individual who is an ac-tive enrollee in the CLASS program and, as of the date described in subparagraph (B)-

(i) has paid premiums for enrollment in such program for at least 60 months; and

(ii) has paid premiums for enroll-ment in such program for at least 12 con-secutive months, if a lapse in premium payments of more than 3 months has oc-curred during the period that begins on the date of the individuals enrollment and ends on the date of such determination.

(B) DATE DESCRIBED.-For purposes of subparagraph (A), the date described in this subparagraph is the date on which the indi-vidual is determined to have a functional limita-tion described in section 3203(a)(1)(C) that is expected to last for a continuous period of more than 90 days. (7) HOSPITAL; NURSING FACILITY; INTER-

MEDIATE CARE FACILITY FOR THE MENTALLY RE-TARDED; INSTITUTION FOR MENTAL DISEASES.- The terms hospital, nursing facility, intermediate care facility for the mentally retarded, and institu-tion for mental diseases have the meanings given such terms for purposes of Medicaid.

(8) CLASS INDEPENDENCE ADVISORY COUN-CIL.-The term CLASS Independence Advisory Council or Council means the Advisory Council es-tablished under section 3207 to advise the Secretary.

(9) CLASS INDEPENDENCE BENEFIT PLAN.- The term CLASS Independence Benefit Plan means the benefit plan developed and designated by the Secretary in accordance with section 3203.

(10) CLASS INDEPENDENCE FUND.-The term CLASS Independence Fund or Fund means the fund established under section 3206.

(11) MEDICAID.-The term Medicaid means

the program established under title XIX of the So

cial Security Act (42 U.S.C. 1396 et seq.).

(12) POVERTY LINE.-The term poverty line has the meaning given that term in section 2110(c)(5) of the Social Security Act (42 U.S.C. 1397jj(c)(5)).

(13) PROTECTION AND ADVOCACY SYSTEM.- The term Protection and Advocacy System means the system for each State established under section 143 of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (42 U.S.C. 15043).

"SEC. 3203. CLASS INDEPENDENCE BENEFIT PLAN.

(a) PROCESS FOR DEVELOPMENT.-

(1) IN GENERAL.-The Secretary, in consulta-tion with appropriate actuaries and other experts, shall develop at least 2 actuarially sound benefit plans as alternatives for consideration for designa-tion by the Secretary as the CLASS Independence Benefit Plan under which eligible beneficiaries shall receive benefits under this title. Each of the plan al-ternatives developed shall be designed to provide eli-gible beneficiaries with the benefits described in sec-tion 3205 consistent with the following require-ments:

(A) PREMIUMS.- (i) MAXIMUM MONTHLY LIMIT.- (I) IN GENERAL.-With respect to all premiums to be paid by enroll-ees for a year, the maximum monthly premium for enrollment in the CLASS program for all reasonably anticipated new and continuing enroll-ees during the year, shall not exceed the average estimated average dollar amount determined in subclause (II) for the year. (II) ESTIMATED AVERAGE DOL-LAR AMOUNT.-Subject to subclause (III), the estimated average dollar amount described in this subclause for a year is the amount equal to $65, in-creased by the percentage increase in the consumer price index for all urban consumers (U.S. city average) for each year occurring after 2009 and before such year. (III) ADJUSTMENT TO ENSURE MINIMUM CASH BENEFIT.-The Sec-retary may adjust the estimated aver-

age dollar amount determined in sub-clause (II) for a year as necessary to ensure payment of the minimum cash benefit required under subparagraph (D)(i). (ii) NOMINAL PREMIUM FOR POOR-

EST INDIVIDUALS AND FULL-TIME STU-DENTS.-

(I) IN GENERAL.-The monthly premium for enrollment in the CLASS program shall not exceed the applicable dollar amount per month determined under subclause (II) for-

(aa) any individual whose income does not exceed the poverty line; and

(bb) any individual who has not attained age 22, and is actively employed during any pe-riod in which the individual is a full-time student (as determined by the Secretary). (II) APPLICABLE DOLLAR

AMOUNT.-The applicable dollar amount described in this subclause is the amount equal to $5, increased by the percentage increase in the con-sumer price index for all urban con-sumers (U.S. city average) for each year occurring after 2009 and before such year. (iii) AGE-BASED PREMIUMS PER-

MITTED FOR ALL OTHER INDIVIDUALS.- The monthly premium for enrollment in the CLASS program for individuals who are not described in clause (ii) may be lower for younger individuals than for older individuals, but the same premium shall be established for all such individuals who are the same age.

(iv) OTHER REQUIREMENTS.-The premiums satisfy the additional require-ments specified in subsection (b). (B) VESTING PERIOD.-A 5-year vesting

period for eligibility for benefits.

(C) BENEFIT TRIGGERS.-A benefit trig-ger for provision of benefits that requires a de-termination that an individual has a functional limitation described in any of the following

clauses that is expected to last for a continuous

period of more than 90 days: (i) The individual is determined to be unable to perform at least the minimum number (which may be 2 or 3) of activities of daily living as are required under the plan for the provision of benefits without substantial assistance (as defined by the Secretary) from another individual. (ii) The individual requires substan-tial supervision to protect the individual from threats to health and safety due to substantial cognitive impairment. (iii) The individual has a level of functional limitation similar (as determined under regulations prescribed by the Sec-retary) to the level of functional limitation described in clause (i) or (ii). (D) CASH BENEFIT.-Payment of a cash

benefit that satisfies the following requirements: (i) MINIMUM REQUIRED AMOUNT.- The benefit amount provides an eligible beneficiary with not less than an average of $50 per day (as determined based on the reasonably expected distribution of

beneficiaries receiving benefits at various benefit levels).

(ii) AMOUNT SCALED TO FUNC-TIONAL ABILITY.-The benefit amount is varied based on a scale of functional abil-ity, with not less than 2, and not more than 6, benefit level amounts.

(iii) DAILY OR WEEKLY.-The ben-efit is paid on a daily or weekly basis.

(iv) NO LIFETIME OR AGGREGATE LIMIT.-The benefit is not subject to any lifetime or aggregate limit. (E) COORDINATION WITH SUPPLE-

MENTAL COVERAGE OBTAINED THROUGH THE EXCHANGE.-The benefits allow for coordina-tion with any supplemental coverage purchased from a health insurance issuer (as defined in section 2791) through a Gateway established under section 3101. (2) REVIEW AND RECOMMENDATION BY THE

CLASS INDEPENDENCE ADVISORY COUNCIL.-The CLASS Independence Advisory Council shall- (A) evaluate the alternative benefit plans developed under paragraph (1); and

(B) recommend for designation as the CLASS Independence Benefit Plan for offering to the public the plan that the Council deter-mines best balances price and benefits to meet enrollees needs in an actuarially sound manner, while optimizing the probability of the long-term sustainability of the CLASS program. (3) DESIGNATION BY THE SECRETARY.-Not

later than October 1, 2012, the Secretary, taking into consideration the recommendation of the CLASS Independence Advisory Council under para-graph (2)(B), shall designate a benefit plan as the CLASS Independence Benefit Plan. The Secretary shall publish such designation, along with details of the plan and the reasons for the selection by the Secretary, in an interim final rule that allows for a period of public comment and subsequent response by the Secretary before being final. (b) ADDITIONAL PREMIUM REQUIREMENTS.-

(1) ANNUAL ESTABLISHMENT OF PREMIUM FOR NEW ENROLLEES AFTER FIRST YEAR OF THE PROGRAM.-The Secretary shall annually establish the monthly premium for enrollment in the CLASS program during any year after the first year in which the program is in effect under this title. The

Secretary shall determine such annual monthly pre

mium based on the following: (A) The most recent report of the CLASS Independence Fund Board of Trustees under section 3105(d). (B) The advice and recommendations of the CLASS Independence Advisory Council. (C) The projected distribution and amount of benefits under the CLASS program. (D) Such other factors as the Secretary determines appropriate. (2) ADJUSTMENT OF PREMIUMS.- (A) IN GENERAL.-Except as provided in subparagraphs (B), (C), (D), and (E), the amount of the monthly premium determined for an individual upon such individuals enrollment in the CLASS program shall remain the same for as long as the individual is an active en-rollee in the program. (B) RECALCULATED PREMIUM IF RE-QUIRED FOR PROGRAM SOLVENCY.- (i) IN GENERAL.-Subject to clause (ii), if the Secretary determines, based on the most recent report of the Board of Trustees of the CLASS Independence

Fund, the advice of the CLASS Independ-ence Advisory Council, or such other infor-mation as the Secretary determines appro-priate, that the monthly premiums and in-come to the CLASS Independence Fund for a year are projected to be insufficient with respect to the 20-year period that be-gins with that year, the Secretary shall ad-just the monthly premiums for individuals enrolled in the CLASS program as nec-essary (but maintaining a nominal pre-mium for enrollees whose income is below the poverty line or who are full-time stu-dents actively employed).

(ii) EXEMPTION FROM INCREASE.- Any increase in a monthly premium im-posed as result of a determination de-scribed in clause (i) shall not apply with respect to the monthly premium of any ac-tive enrollee who-

(I) has attained age 65;

(II) has paid premiums for en

rollment in the program for at least

20 years; and

(III) is not actively employed.

ENROLLMENT AFTER MORE THAN A 3-MONTH

LAPSE.- (i) IN GENERAL.-The reenrollment of an individual after a 90-day period dur-ing which the individual failed to pay the monthly premium required to maintain the individuals enrollment in the CLASS pro-gram shall be treated as an initial enroll-ment for purposes of age-adjusting the premium for enrollment in the program. (ii) CREDIT FOR PRIOR MONTHS IF REENROLLED WITHIN 5 YEARS.-An indi-vidual who reenrolls in the CLASS pro-gram after such a 90-day period and be-fore the end of the 5-year period that be-gins with the first month for which the in-dividual failed to pay the monthly premium required to maintain the individuals en-rollment in the program shall be- (I) credited with any months of paid premiums that accrued prior to the individuals lapse in enrollment; and

(II) notwithstanding the total

amount of any such credited months,

required to satisfy section

3201(7)(A)(ii) before being eligible to

receive benefits.

(D) NO LONGER STATUS AS A FULL-TIME STUDENT.-An individual subject to a nominal premium on the basis of being described in sub-section (a)(1)(A)(ii)(I)(bb) who ceases to be de-scribed in that subsection, beginning with the first month following the month in which the individual ceases to be so described, shall be subject to the same monthly premium as the monthly premium that applies to an individual of the same age who first enrolls in the pro-gram under the most similar circumstances as the individual (such as the first year of eligi-bility for enrollment in the program or in a sub-sequent year).

(E) PENALTY FOR REENOLLMENT AFTER 5-YEAR LAPSE.-In the case of an individual who reenrolls in the CLASS program after the end of the 5-year period described in subpara-graph (C)(ii), the monthly premium required for the individual shall be the age-adjusted pre-mium that would be applicable to an initially enrolling individual who is the same age as the reenrolling individual, increased by the greater of-

(i) an amount that the Secretary de-termines is actuarially sound for each month that occurs during the period that begins with the first month for which the individual failed to pay the monthly pre-mium required to maintain the individuals enrollment in the CLASS program and ends with the month preceding the month in which the reenollment is effective; or

(ii) 1 percent of the applicable age-adjusted premium for each such month oc-curring in such period. (3) ADMINISTRATIVE EXPENSES.-In deter-

mining the monthly premiums for the CLASS pro

gram the Secretary may factor in costs for admin

istering the program, not to exceed- (A) in the case of the first 5 years in which the program is in effect under this title, an amount equal to 3 percent of all premiums paid during each such year; and

(B) in the case of subsequent years, an amount equal to 5 percent of the total amount of all expenditures (including benefits paid) under this title with respect to that year. (4) NO UNDERWRITING REQUIREMENTS.-No

underwriting (other than on the basis of age in ac-cordance with paragraph (3)) shall be used to- (A) determine the monthly premium for enrollment in the CLASS program; or (B) prevent an individual from enrolling in the program. (c) SELF-ATTESTATION AND VERIFICATION OF IN-COME.-The Secretary shall establish procedures to-

(1) permit an individual who is eligible for the nominal premium required under subsection (a)(1)(A)(ii), as part of their automatic enrollment in the CLASS program, to self-attest that their in-come does not exceed the poverty line or that their status as a full-time student who is actively em-ployed;

(2) verify, using procedures similar to the procedures used by the Commissioner of Social Security under section 1631(e)(1)(B)(ii) of the Social Security Act and consistent with the requirements applicable to the conveyance of data and information under section 1942 of such Act, the validity of such self-attestation; and

(3) require an individual to confirm, on at least an annual basis, that their income does not exceed the poverty line or that they continue to maintain such status.

"SEC. 3204. ENROLLMENT AND DISENROLLMENT REQUIRE

MENTS.

(a) AUTOMATIC ENROLLMENT.-

(1) IN GENERAL.-Subject to paragraph (2), the Secretary shall establish procedures under which each individual described in subsection (c) shall be automatically enrolled in the CLASS program by an employer of such individual in the same manner as an employer may elect to automatically enroll em-ployees in a plan under section 401(k), 403(b), or 457 of the Internal Revenue Code of 1986.

(2) ALTERNATIVE ENROLLMENT PROCE-DURES.-The procedures established under para-graph (1) shall provide for an alternative enrollment process for an individual described in subsection (c) in the case of such an individual-

(A) who is self-employed; (B) who has more than 1 employer;

(D) who is a spouse described in sub-section (c)(2) of who is not subject to automatic enrollment. (3) ADMINISTRATION.-

(A) IN GENERAL.-The Secretary shall, by regulation, establish procedures to-

(i) ensure that an individual is not automatically enrolled in the CLASS program by more than 1 employer; and

(ii) allow for an individuals em-ployer to deduct a premium for a spouse described in subsection (c)(1)(B) who is not subject to automatic enrollment. (B) FORM.-Enrollment in the CLASS

program shall be made in such manner as the Secretary may prescribe in order to ensure ease of administration.

(b) ELECTION TO OPT-OUT.-An individual de-scribed in subsection (c) may elect to waive enrollment in the CLASS program at any time in such form and manner as the Secretary shall prescribe.

(1) an individual- (A) who has attained age 18; (B) who-

(i) receives wages on which there is imposed a tax under section 3201(a) of the Internal Revenue Code of 1986; or

(ii) derives self-employment income on which there is imposed a tax under sec-tion 1401(a) of the Internal Revenue Code of 1986; (C) who is actively employed; and (D) who is not-

(i) a patient in a hospital or nursing facility, an intermediate care facility for the mentally retarded, or an institution for mental diseases and receiving medical assistance under Medicaid; or

(ii) confined in a jail, prison, other penal institution or correctional facility, or by court order pursuant to conviction of a criminal offense or in connection with a verdict or finding described in section 202(x)(1)(A)(ii) of the Social Security Act (42 U.S.C. 402(x)(1)(A)(ii)); or

(2) the spouse of an individual described in paragraph (1) and who would be an individual so de-scribed but for subparagraph (B) or (C) of that paragraph. (d) RULE OF CONSTRUCTION.-Nothing in this title

shall be construed as requiring an active enrollee to con

tinue to satisfy subparagraph (B) or (C) of subsection

(c)(1) in order to maintain enrollment in the CLASS pro

gram. (e) PAYMENT.- (1) PAYROLL DEDUCTION.-An amount equal to the monthly premium for the enrollment in the CLASS program of an individual shall be deducted from the wages or self-employment income of such individual in accordance with such procedures as the Secretary, in consultation with the Secretary of the Treasury, shall establish for employers who elect to deduct and withhold such premiums on behalf of en-rolled employees. (2) ALTERNATIVE PAYMENT MECHANISM.- The Secretary shall establish alternative procedures for the payment of monthly premiums by an indi-vidual enrolled in the CLASS program-

(A) who does not have an employer who elects to deduct and withhold premiums in accordance with subparagraph (A); or

(B) who does not earn wages or derive self-employment income. (f) TRANSFER OF PREMIUMS COLLECTED.-

(1) IN GENERAL.-During each calendar year the Secretary of the Treasury shall deposit into the CLASS Independence Fund a total amount equal, in the aggregate, to 100 percent of the premiums col-lected during that year.

(2) TRANSFERS BASED ON ESTIMATES.-The amount deposited pursuant to paragraph (1) shall be transferred in at least monthly payments to the CLASS Independence Fund on the basis of esti-mates by the Secretary and certified to the Sec-retary of the Treasury of the amounts collected in accordance with subparagraphs (A) and (B) of para-graph (5). Proper adjustments shall be made in amounts subsequently transferred to the Fund to the extent prior estimates were in excess of, or were less than, actual amounts collected. (g) OTHER ENROLLMENT AND DISENROLLMENT

OPPORTUNITIES.-The Secretary shall establish proce-

dures under which-

(1) an individual who, in the year of the indi-viduals initial eligibility to enroll in the CLASS pro-gram, has elected to waive enrollment in the pro-gram, is eligible to elect to enroll in the program, in such form and manner as the Secretary shall estab-lish, only during an open enrollment period estab-lished by the Secretary that is specific to the indi-vidual and that may not occur more frequently than biennially after the date on which the individual first elected to waive enrollment in the program; and

(2) an individual shall only be permitted to disenroll from the program during an annual disenrollment period established by the Secretary and in such form and manner as the Secretary shall establish.

"SEC. 3205. BENEFITS.

(a) DETERMINATION OF ELIGIBILITY.-

(1) APPLICATION FOR RECEIPT OF BENE-FITS.-The Secretary shall establish procedures under which an active enrollee shall apply for receipt of benefits under the CLASS Independence Benefit Plan.

(2) ELIGIBILITY ASSESSMENTS.-

(A) IN GENERAL.-Not later than Janu-ary 1, 2012, the Secretary shall enter into agreements with-

(i) the Disability Determination Service for each State to provide for eligi-bility assessments of active enrollees who apply for receipt of benefits;

(ii) the Protection and Advocacy System for each State to provide advocacy services in accordance with subsection (d); and

(iii) public and private entities to provide advice and assistance counseling in accordance with subsection (e). (B) 30-DAY PERIOD FOR APPROVAL OR

DISAPPROVAL.-An agreement under subpara-graph (A) shall require that a Disability Deter-mination Service determine within 30 days of the receipt of an application for benefits under the CLASS Independence Benefit Plan whether an applicant is eligible for a cash benefit under the program and if so, the amount of the cash benefit in accordance the sliding scale estab-lished under the plan. An application that is pending after 45 days shall be deemed approved.

(C) PRESUMPTIVE ELIGIBILITY FOR CER-TAIN INSTITUTIONALIZED ENROLLEES PLAN-NING TO DISCHARGE.-An active enrollee shall be deemed presumptively eligible if the en-rollee-

(i) has applied for, and attests is eligible for, the maximum cash benefit available under the sliding scale established under the CLASS Independence Benefit Plan;

(ii) is a patient in a hospital (but only if the hospitalization is for long-term care), nursing facility, intermediate care facility for the mentally retarded, or an institution for mental diseases; and

(iii) is in the process of, or about to being the process of, planning to discharge from the hospital, facility, or institution, or within 60 days from the date of discharge from the hospital, facility, or institution. (D) APPEALS.-The Secretary shall es-

tablish procedures under which an applicant for benefits under the CLASS Independence Benefit Plan shall be guaranteed the right to appeal an adverse determination.

(b) BENEFITS.-An eligible beneficiary shall receive

the following benefits under the CLASS Independence

Benefit Plan: (1) CASH BENEFIT.-A cash benefit estab-lished by the Secretary in accordance with the re-quirements of section 3203(a)(1)(D) that- (A) the first year in which beneficiaries receive the benefits under the plan, is not less than the average dollar amount specified in clause (i) of such section; and (B) for any subsequent year, is not less than the average per day dollar limit applicable under this subparagraph for the preceding year, increased by the percentage increase in the con-sumer price index for all urban consumers

(U.S. city average) over the previous year. (2) ADVOCACY SERVICES.-Advocacy services in accordance with subsection (d).

(3) ADVICE AND ASSISTANCE COUNSELING.- Advice and assistance counseling in accordance with subsection (e). (c) PAYMENT OF BENEFITS.-

(1) LIFE INDEPENDENCE ACCOUNT.-

(A) IN GENERAL.-The Secretary shall establish procedures for administering the pro-vision of benefits to eligible beneficiaries under the CLASS Independence Benefit Plan, includ-ing the payment of the cash benefit for the ben-eficiary into a Life Independence Account es-tablished by the Secretary on behalf of each eli-gible beneficiary.

(B) USE OF CASH BENEFITS.-Cash ben-efits paid into a Life Independence Account of an eligible beneficiary shall be used to purchase nonmedical services and supports that the bene-ficiary needs to maintain his or her independ-ence at home or in another residential setting of their choice in the community, including (but not limited to) home modifications, assistive technology, accessible transportation, home-maker services, respite care, personal assistance services, home care aides, and nursing support.

(i) crediting an account established

on behalf of a beneficiary with the bene

ficiarys cash daily benefit;

(ii) allowing the beneficiary to access such account through debit cards; and

(iii) accounting for withdrawals by the beneficiary from such account. (D) PRIMARY PAYOR RULES FOR BENE-

FICIARIES WHO ARE ENROLLED IN MEDICAID.-

In the case of an eligible beneficiary who is en

rolled in Medicaid, the following payment rules

shall apply: (i) INSTITUTIONALIZED BENE-FICIARY.-If the beneficiary is a patient in a hospital, nursing facility, intermediate care facility for the mentally retarded, or an institution for mental diseases, the ben-eficiary shall retain an amount equal to 5 percent of the beneficiarys daily or weekly cash benefit (as applicable) (which shall be in addition to the amount of the bene-ficiarys personal needs allowance provided under Medicaid), and the remainder of such benefit shall be applied toward the fa-cilitys cost of providing the beneficiarys care, and Medicaid shall provide secondary coverage for such care.

(ii) BENEFICIARIES RECEIVING

HOME AND COMMUNITY-BASED SERV-

ICES.- (I) 50 PERCENT OF BENEFIT RETAINED BY BENEFICIARY.-Subject to subclause (II), if a beneficiary is receiving medical assistance under Medicaid for home and community based services, the beneficiary shall retain an amount equal to 50 percent of the beneficiarys daily or weekly cash benefit (as applicable), and the remainder of the daily or weekly cash benefit shall be applied toward the cost to the State of providing such as-sistance (and shall not be used to claim Federal matching funds under Medicaid), and Medicaid shall provide secondary coverage for the remainder of any costs incurred in providing such assistance. (II) REQUIREMENT FOR STATE OFFSET.-A State shall be paid the remainder of a beneficiarys daily or weekly cash benefit under subclause

(I) only if the State home and community-based waiver under section 1115 of the Social Security Act (42

U.S.C.
1315) or subsection (c) or (d) of section 1915 of such Act (42

U.S.C.
1396n), or the State plan amendment under subsection (i) of such section does not include a waiver of the requirements of section 1902(a)(1) of the Social Security Act (relating to statewideness) or of sec-tion 1902(a)(10)(B) of such Act (re-lating to comparability) and the State offers at a minimum case manage-ment services, personal care services, habilitation services, and respite care under such a waiver or State plan amendment.

(III) DEFINITION OF HOME AND COMMUNITY-BASED SERVICES.-In this clause, the term home and com-munity-based services means any services which may be offered under a home and community-based waiver authorized for a State under section 1115 of the Social Security Act (42

U.S.C.
1315) or subsection (c) or (d) of section 1915 of such Act (42

U.S.C.
1396n) or under a State plan amendment under subsection (i) of such section. (iii) BENEFICIARIES ENROLLED IN

PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE).-

(I) IN GENERAL.-Subject to subclause (II), if a beneficiary is re-ceiving medical assistance under Med-icaid for PACE program services under section 1934 of the Social Secu-rity Act (42 U.S.C. 1396u-4), the beneficiary shall retain an amount equal to 50 percent of the bene-ficiarys daily or weekly cash benefit (as applicable), and the remainder of the daily or weekly cash benefit shall be applied toward the cost to the State of providing such assistance (and shall not be used to claim Fed-eral matching funds under Medicaid), and Medicaid shall provide secondary coverage for the remainder of any costs incurred in providing such assistance.

(II) INSTITUTIONALIZED RE-CIPIENTS OF PACE PROGRAM SERV-ICES.-If a beneficiary receiving as-sistance under Medicaid for PACE program services is a patient in a hos-pital, nursing facility, intermediate care facility for the mentally retarded, or an institution for mental diseases, the beneficiary shall be treated as in institutionalized beneficiary under clause (i).

(2) AUTHORIZED REPRESENTATIVES.-

(A) IN GENERAL.-The Secretary shall establish procedures to allow access to a bene-ficiarys cash benefits by an authorized rep-resentative of the eligible beneficiary on whose behalf such benefits are paid.

(B) QUALITY ASSURANCE AND PROTEC-TION AGAINST FRAUD AND ABUSE.-The proce-dures established under subparagraph (A) shall ensure that authorized representatives of eligi-ble beneficiaries comply with standards of con-duct established by the Secretary, including standards requiring that such representatives provide quality services on behalf of such bene-ficiaries, do not have conflicts of interest, and do not misuse benefits paid on behalf of such beneficiaries or otherwise engage in fraud or abuse. (3) COMMENCEMENT OF BENEFITS.-Benefits

shall be paid to, or on behalf of, an eligible beneficiary beginning with the first month in which an application for such benefits is approved.

(4) ROLLOVER OPTION FOR LUMP-SUM PAY-MENT.-An eligible beneficiary may elect to-

(A) defer payment of their daily or weekly benefit and to rollover any such deferred bene-fits from month-to-month, but not from year-to-year; and

(B) receive a lump-sum payment of such deferred benefits in an amount that may not exceed the lesser of-

(i) the total amount of the accrued deferred benefits; or (ii) the applicable annual benefit. (5) PERIOD FOR DETERMINATION OF ANNUAL BENEFITS.-

(A) IN GENERAL.-The applicable period for determining with respect to an eligible bene-ficiary the applicable annual benefit and the amount of any accrued deferred benefits is the 12-month period that commences with the first month in which the beneficiary began to receive such benefits, and each 12-month period there-after.

(B) INCLUSION OF INCREASED BENE-FITS.-The Secretary shall establish procedures under which cash benefits paid to an eligible beneficiary that increase or decrease as a result of a change in the functional status of the bene-ficiary before the end of a 12-month benefit pe-riod shall be included in the determination of the applicable annual benefit paid to the eligible beneficiary.

(i) IN GENERAL.-The Secretary

shall recoup any accrued benefits in the

event of-

(I) the death of a beneficiary; or

(II) the failure of a beneficiary

to elect under paragraph (4)(B) to receive such benefits as a lump-sum payment before the end of the 12-month period in which such benefits accrued. (ii) PAYMENT INTO CLASS INDE-

PENDENCE FUND.-Any benefits recouped in accordance with clause (i) shall be paid into the CLASS Independence Fund and used in accordance with section 3206.

(6) REQUIREMENT TO RECERTIFY ELIGIBILITY FOR RECEIPT OF BENEFITS.-An eligible beneficiary shall periodically, as determined by the Secretary-

(A) recertify by submission of medical evidence the beneficiarys continued eligibility for receipt of benefits; and

(B) submit records of expenditures attrib-utable to the aggregate cash benefit received by the beneficiary during the preceding year. (7) SUPPLEMENT, NOT SUPPLANT OTHER

HEALTH CARE BENEFITS.-Subject to the Medicaid payment rules under paragraph (1)(D), benefits re-ceived by an eligible beneficiary shall supplement, but not supplant, other health care benefits for which the beneficiary is eligible under Medicaid or any other Federally funded program that provides health care benefits or assistance. (d) ADVOCACY SERVICES.-An agreement entered

into under subsection (a)(2)(A)(ii) shall require the Protection and Advocacy System for the State to-

(1) assign, as needed, an advocacy counselor to each eligible beneficiary that is covered by such agreement and who shall provide an eligible beneficiary with-

(A) information regarding how to access the appeals process established for the program;

(B) assistance with respect to the annual recertification and notification required under subsection (c)(6); and

(C) such other assistance with obtaining services as the Secretary, by regulation, shall require; and (2) ensure that the System and such coun

selors comply with the requirements of subsection (i). (e) ADVICE AND ASSISTANCE COUNSELING.-An

agreement entered into under subsection (a)(2)(A)(iii) shall require the entity to assign, as requested by an eligible beneficiary that is covered by such agreement, an ad

vice and assistance counselor who shall provide an eligible beneficiary with information regarding- (1) accessing and coordinating long-term serv-ices and supports in the most integrated setting; (2) possible eligibility for other benefits and

services;

(3) development of a service and support plan;

(4) information about programs established

under the Assistive Technology Act of 1998 and the

services offered under such programs; and

(5) such other services as the Secretary, by

regulation, may require.

(f) NO EFFECT ON ELIGIBILITY FOR OTHER BENE-FITS.-Benefits paid to an eligible beneficiary under the CLASS program shall be disregarded for purposes of de-termining or continuing the beneficiarys eligibility for re-ceipt of benefits under any other Federal, State, or locally funded assistance program, including benefits paid under titles II, XVI, XVIII, XIX, or XXI of the Social Security Act (42 U.S.C. 401 et seq., 1381 et seq., 1395 et seq., 1396 et seq., 1397aa et seq.), under the laws administered by the Secretary of Veterans Affairs, under low-income housing assistance programs, or under the supplemental nutrition assistance program established under the Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.).

(g) RULE OF CONSTRUCTION.-Nothing in this title shall be construed as prohibiting benefits paid under the CLASS Independence Benefit Plan from being used to compensate a family caregiver for providing community living assistance services and supports to an eligible bene-ficiary.

(h) PROTECTION AGAINST CONFLICT OF INTER-ESTS.-The Secretary shall establish procedures to ensure that the Disability Determination Service and Protection and Advocacy System for a State, advocacy counselors for eligible beneficiaries, and any other entities that provide services to active enrollees and eligible beneficiaries under the CLASS program comply with the following:

(1) If the entity provides counseling or planning services, such services are provided in a manner that fosters the best interests of the active enrollee or beneficiary.

(2) The entity has established operating procedures that are designed to avoid or minimize conflicts of interest between the entity and an active enrollee or beneficiary.

(3) The entity provides information about all services and options available to the active enrollee or beneficiary, to the best of its knowledge, including services available through other entities or providers.

(4) The entity assists the active enrollee or beneficiary to access desired services, regardless of the provider.

(5) The entity reports the number of active enrollees and beneficiaries provided with assistance by age, disability, and whether such enrollees and beneficiaries received services from the entity or another entity.

(6) If the entity provides counseling or planning services, the entity ensures that an active enrollee or beneficiary is informed of any financial interest that the entity has in a service provider.

(7) The entity provides an active enrollee or beneficiary with a list of available service providers that can meet the needs of the active enrollee or beneficiary.