124 STAT. 924 PUBLIC LAW 111–148—MAR. 23, 2010 (1) in which less than 50 percent of the total expenditures for medical assistance under the State Medicaid program for a fiscal year for long-term services and supports (as defined by the Secretary under subsection (f))(1)) are for non-institution- ally-based long-term services and supports described in sub- section (f)(1)(B); (2) that submits an application and meets the conditions described in subsection (c); and (3) that is selected by the Secretary to participate in the State balancing incentive payment program established under this section. (c) CONDITIONS.—The conditions described in this subsection are the following: (1) APPLICATION.—The State submits an application to the Secretary that includes, in addition to such other information as the Secretary shall require— (A) a proposed budget that details the State’s plan to expand and diversify medical assistance for non-institu- tionally-based long-term services and supports described in subsection (f)(1)(B) under the State Medicaid program during the balancing incentive period and achieve the tar- get spending percentage applicable to the State under para- graph (2), including through structural changes to how the State furnishes such assistance, such as through the establishment of a ‘‘no wrong door—single entry point system’’, optional presumptive eligibility, case management services, and the use of core standardized assessment instruments, and that includes a description of the new or expanded offerings of such services that the State will provide and the projected costs of such services; and (B) in the case of a State that proposes to expand the provision of home and community-based services under its State Medicaid program through a State plan amend- ment under section 1915(i) of the Social Security Act, at the option of the State, an election to increase the income eligibility for such services from 150 percent of the poverty line to such higher percentage as the State may establish for such purpose, not to exceed 300 percent of the supple- mental security income benefit rate established by section 1611(b)(1) of the Social Security Act (42 U.S.C. 1382(b)(1)). (2) TARGET SPENDING PERCENTAGES.— (A) In the case of a balancing incentive payment State in which less than 25 percent of the total expenditures for long-term services and supports under the State Med- icaid program for fiscal year 2009 are for home and commu- nity-based services, the target spending percentage for the State to achieve by not later than October 1, 2015, is that 25 percent of the total expenditures for long-term services and supports under the State Medicaid program are for home and community-based services. (B) In the case of any other balancing incentive pay- ment State, the target spending percentage for the State to achieve by not later than October 1, 2015, is that 50 percent of the total expenditures for long-term services and supports under the State Medicaid program are for home and community-based services. Deadlines.
