Title II, SEC. 2104. HOME AND COMMUNITY-BASED SERVICES COVERED UNDER STATE 
PLAN. 
      (a) Specification. 

        (1) In general. Subject to the succeeding provisions of this section, 
      the State plan under this subpart shall specify 

          (A) the home and community-based services available under the plan to 
        individuals with disabilities (or to such categories of such 
        individuals), and 

          (B) any limits with respect to such services. 

        (2) Flexibility in meeting individual needs. The services shall be 
      specified in a manner that permits sufficient flexibility for providers 
      to meet the needs of individuals with disabilities in a cost effective 
      manner. Subject to subsection (e)(1)(B), such services may be delivered 
      in an individual's home, a range of community residential arrangements, 
      or outside the home. 

      (b) Requirement for Needs Assessment and Plan of Care. 

        (1) In general. The State plan shall provide for home and 
      community-based services to an individual with disabilities only if 

          (A) a comprehensive assessment of the individual's need for home and 
        community-based services (regardless of whether all needed services are 
        available under the plan) has been made, 

          (B) an individualized plan of care based on such assessment is 
        developed, and 

          (C) such services are provided consistent with such plan of care. 

        (2) Involvement of individuals. The individualized plan of care under 
      paragraph (1)(B) for an individual with disabilities shall 

          (A) be developed by qualified individuals (specified under the State 
        plan), 

          (B) be developed and implemented in close consultation with the 
        individual and the individual's family, 

          (C) be approved by the individual (or the individual's 
        representative), and 

          (D) be reviewed and updated not less often than every 6 months. 

        (3) Plan of care. The plan of care under paragraph (1)(B) shall 

          (A) specify which services specified under the individual plan will 
        be provided under the State plan under this subpart, 

          (B) identify (to the extent possible) how the individual will be 
        provided any services specified under the plan of care and not provided 
        under the State plan, and 

          (C) specify how the provision of services to the individual under the 
        plan will be coordinated with the provision of other health care 
        services to the individual. 

          The State shall make reasonable efforts to identify and arrange for 
        services described in subparagraph (B). Nothing in this subsection 
        shall be construed as requiring a State (under the State plan or 
        otherwise) to provide all the services specified in such a plan. 

      (c) Mandatory Coverage of Personal Assistance Services. The State plan 
    shall include, in the array of services made available to each category of 
    individuals with disabilities, both agency-administered and 
    consumer-directed personal assistance services (as defined in subsection 
    (g)). 

      (d) Additional Services. 

        (1) Types of services. Subject to subsection (e), services available 
      under a State plan under this subpart shall include any (or all) of the 
      following: 

          (A) Case management. 

          (B) Homemaker and chore assistance. 

          (C) Home modifications. 

          (D) Respite services. 

          (E) Assistive devices. 

          (F) Adult day services. 

          (G) Habilitation and rehabilitation. 

          (H) Supported employment. 

          (I) Home health services. 

          (J) Any other care or assistive services (approved by the Secretary) 
        that the State determines will help individuals with disabilities to 
        remain in their homes and communities. 

        (2) Criteria for selection of services. The State plan shall specify 

          (A) the methods and standards used to select the types, and the 
        amount, duration, and scope, of services to be covered under the plan 
        and to be available to each category of individuals with disabilities, 
        and 

          (B) how the types, and the amount, duration, and scope, of services 
        specified meet the needs of individuals within each of the 4 categories 
        of individuals with disabilities. 

      (e) Exclusions and Limitations. 

        (1) In general. A State plan may not provide for coverage of 

          (A) room and board, 

          (B) services furnished in a hospital, nursing facility, intermediate 
        care facility for the mentally retarded, or other institutional setting 
        specified by the Secretary, 

          (C) items and services to the extent coverage is provided for the 
        individual under a health plan or the medicare program. 

        (2) Taking into account informal care. A State plan may take into 
      account, in determining the amount and array of services made available 
      to covered individuals with disability, the availability of informal 
      care. 

      (f) Payment for Services. A State plan may provide for the use of 

        (1) vouchers, 

        (2) cash payments directly to individuals with disabilities, 

        (3) capitation payments to health plans, and 

        (4) payment to providers, 

        to pay for covered services. 

      (g) Personal Assistance Services. 

        (1) In general. In this section, the term ``personal assistance 
      services'' means those services specified under the State plan as 
      personal assistance services and shall include at least hands-on and 
      standby assistance, supervision, and cueing with activities of daily 
      living, whether agency-administered or consumer-directed (as defined in 
      paragraph (2)). 

        (2) Consumer-directed; agency-administered. In this part: 

          (A) The term ``consumer-directed'' means, with reference to personal 
        assistance services or the provider of such services, services that are 
        provided by an individual who is selected and managed (and, at the 
        individual's option, trained) by the individual receiving the services. 

          (B) The term ``agency-administered'' means, with respect to such 
        services, services that are not consumer-directed.