Page:United States Statutes at Large Volume 124.djvu/864

124 STAT. 838 PUBLIC LAW 111–148—MAR. 23, 2010 right to formulate advance directives or other written instructions recognized under State law, such as a living will or durable power of attorney for health care, in the case that an injury or illness causes the individual to be unable to make health care decisions. ‘‘(C) ELECTRONIC MANAGEMENT OF FUNDS.—The Sec- retary shall establish procedures for— ‘‘(i) crediting an account established on behalf of a beneficiary with the beneficiary’s 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 BENEFICIARIES WHO ARE ENROLLED IN MEDICAID.—In the case of an eligible beneficiary who is enrolled in Medicaid, the following pay- ment rules shall apply: ‘‘(i) INSTITUTIONALIZED BENEFICIARY.—If the bene- ficiary is a patient in a hospital, nursing facility, inter- mediate care facility for the mentally retarded, or an institution for mental diseases, the beneficiary shall retain an amount equal to 5 percent of the beneficiary’s daily or weekly cash benefit (as applicable) (which shall be in addition to the amount of the beneficiary’s personal needs allowance provided under Medicaid), and the remainder of such benefit shall be applied toward the facility’s cost of providing the beneficiary’s care, and Medicaid shall provide secondary coverage for such care. ‘‘(ii) BENEFICIARIES RECEIVING HOME AND COMMU- NITY-BASED SERVICES.— ‘‘(I) 50 PERCENT OF BENEFIT RETAINED BY BENE- FICIARY.—Subject to subclause (II), if a beneficiary is receiving medical assistance under Medicaid for home and community based services, the bene- ficiary shall retain an amount equal to 50 percent of the beneficiary’s 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 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 beneficiary’s 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 (relating to com- parability) and the State offers at a minimum Procedures.