extent a State permits beneficiaries to hire a family member or individual with whom they have an existing relationship to provide home and community-based services, providing support to beneficiaries who wish to hire a caregiver who is a family member or individual with whom they have an existing relationship, such as by facilitating enrollment of such family member or individual as a provider of home and community-based services under the State plan or a waiver of such plan. (G) Ensuring that program policies and procedures allow for cooperation with labor organizations that bargain on behalf of direct care workers in the case of a State in which the direct care workers in the State have elected to join, or form, such a labor organization, or, in the case of a State in which such workers have not joined or formed such a labor organization, are neutral with regard to such workers joining or forming such a labor organization. (4) Quality, reporting, and oversight The requirements described in this paragraph, with respect to a State and a fiscal year quarter, are the following: (A) The State adopts the core quality measures for home and community-based services developed by the Secretary under section 104 of the Better Care Better Jobs Act , or an alternate set of quality measures approved by the Secretary, and, at the option of the State, expands the use of beneficiary and family caregiver experience surveys. (B) The State designates an HCBS ombudsman office that— (i) operates independently from the State Medicaid agency and managed care entities