ROBERT L. EHRLICH, JR., Governor                            S.B. 819

(3) CONSISTENT WITH THE FEDERAL WAIVER UNDER PARAGRAPH (1) OF
THIS SUBSECTION, IF THE SECRETARY ESTABLISHES A PROGRAM UNDER
PARAGRAPH (2) OF THIS SUBSECTION, THE PROGRAM MAY NOT OPERATE IN MORE
THAN TWO AREAS OF THE STATE.

(C) ANY WAIVER DEVELOPED UNDER THIS SECTION SHALL INCLUDE THE
FOLLOWING GOALS AND OBJECTIVES:

(1)      INCREASING PARTICIPANT SATISFACTION;

(2)     ALLOWING PARTICIPANTS TO AGE IN PLACE;

(3)      REDUCING MEDICAID EXPENDITURES BY ENCOURAGING THE MOST
APPROPRIATE UTILIZATION OF HIGH QUALITY SERVICES; AND

(4)      ENHANCING COMPLIANCE WITH THE FEDERAL AMERICANS WITH
DISABILITIES ACT BY OFFERING COST-EFFECTIVE COMMUNITY-BASED SERVICES IN
THE MOST APPROPRIATE HIGH QUALITY AND LEAST RESTRICTIVE SETTING.

(D)     (1) THE BENEFITS PROVIDED BY THE COMMUNITY CHOICE PROGRAM
SHALL INCLUDE THOSE SERVICES AVAILABLE UNDER THE MEDICAID STATE PLAN
AND SERVICES COVERED UNDER HOME AND COMMUNITY-BASED SERVICES
WAIVERS.

(2)      EXCEPT WHEN SERVICES ARE LIMITED OR EXCLUDED FROM THE
COMMUNITY CHOICE PROGRAM BY THE SECRETARY, THE COMMUNITY CARE
ORGANIZATION SHALL PROVIDE ALL THE SERVICES ESTABLISHED IN REGULATION
AND REQUIRED BY THE SECRETARY.

(3)      THE SECRETARY MAY EXCLUDE SPECIFIC POPULATIONS.

(4)     THE SECRETARY SHALL INCLUDE A DEFINITION OF "MEDICAL
NECESSITY" IN ITS QUALITY AND ACCESS STANDARDS.

(5)     NOTHING IN THE COMMUNITY CHOICE PROGRAM MAY PRECLUDE A
NURSING HOME FROM UTILIZING AN INSTITUTIONAL PHARMACY OF ITS OWN
CHOICE FOR THE PROVISION OF INSTITUTIONAL PHARMACY SERVICES AND
BENEFITS FOR WAIVER ENROLLEES IN THE NURSING HOME.

(E)     COMMUNITY CHOICE PROGRAM RECIPIENTS SERVED BY THE PROGRAM
DEVELOPED UNDER THIS SECTION SHALL BE ALLOWED TO CHOOSE AMONG AT
LEAST TWO COMMUNITY CARE ORGANIZATIONS THAT HAVE DEMONSTRATED A
NETWORK CAPACITY SUFFICIENT TO MEET THE NEEDS OF THE POPULATION.

(F)     (1) ON AN ANNUAL BASIS OR FOR CAUSE, AN ENROLLEE MAY CHOOSE
TO DISENROLL FROM A COMMUNITY CARE ORGANIZATION AND ENROLL IN ANOTHER
COMMUNITY CARE ORGANIZATION.

(2) EACH ENROLLEE RECEIVING SERVICES IN A NURSING HOME, AN
ASSISTED LIVING FACILITY, OR AN ADULT DAY CARE FACILITY, A PSYCHIATRIC
REHABILITATION PROGRAM, OR A RESIDENTIAL REHABILITATION PROGRAM SHALL
HAVE THE OPTION OF REMAINING IN THE NURSING HOME, ASSISTED LIVING

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