104 STAT. 1388-176 PUBLIC LAW 101-508—NOV. 5, 1990 "(A) is unable to perform without substantial assistance from another individual at least 2 of the following 3 activities of daily living: toileting, transferring, and eating; or "(B) has a primary or secondary diagnosis of Alzheimer's disease and is (i) unable to perform without substantial human assistance (including verbal reminding or physical cueing) or supervision at least 2 of the following 5 activities of daily living: bathing, dressing, toileting, transferring, and eating; or (ii) cognitively impaired so as to require substantial supervision from another individual because he or she engages in inappropriate behaviors that pose serious health or safety hazards to himself or herself or others. "(2) ASSESSMENTS OF FUNCTIONAL DISABILITY.— "(A) REQUESTS FOR ASSESSMENTS.—I f a State has elected to provide home and community care under this section, upon the request of an individual who is 65 years of age or older and who meets the requirements of subsection (b)(1)(C) (or another person on such individual's behalf), the State shall provide for a comprehensive functional assessment under this subparagraph which— "(i) is used to determine whether or not the individual is functionally disabled, "(ii) is based on a uniform minimum data set specified by the Secretary under subparagraph (C)(i), and "(iii) uses an instrument which has been specified by the State under subparagraph (B). No fee may be charged for such an assessment. "(B) SPECIFICATION OF ASSESSMENT INSTRUMENT. —The State shall specify the instrument to be used in the State in complying with the requirement of subparagraph (A)(iii) which instrument shall be— "(i) one of the instruments designated under subparagraph (C)(ii); or "(ii) an instrument which the Secretary has approved as being consistent with the minimum data set of core elements, common definitions, and utilization guidelines specified by the Secretary in subparagraph (C)(i). "(C) SPECIFICATION OF ASSESSMENT DATA SET AND IN- STRUMENTS. — The Secretary shall— "(i) not later than July 1, 1991— "(I) specify a minimum data set of core elements and common definitions for use in conducting the assessments required under subparagraph (A); and "(II) establish guidelines for use of the data set; and "(ii) by not later than July 1, 1991, designate one or more instruments which are consistent with the specification made under subparagraph (A) and which a State may specify under subparagraph (B) for use in complying with the requirements of subparagraph (A). "(D) PERIODIC REVIEW. —Each individual who qualifies as a functionally disabled elderly individual shall have the individual's assessment periodically reviewed and revised not less often than once every 12 months. " (E) CONDUCT OF ASSESSMENT BY INTERDISCIPLINARY TEAMS. —An assessment under subparagraph (A) and a review under subparagraph (D) must be conducted by an
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