II 

110TH CONGRESS 

2D SESSION S. 3327 

To amend title XIX of the Social Security Act to improve the State plan 

amendment option for providing home and community-based services 

under the Medicaid program, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 24 (legislative day, JULY 23), 2008 

Mr. KERRY (for himself and Mr. GRASSLEY) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XIX of the Social Security Act to improve 

the State plan amendment option for providing home 

and community-based services under the Medicaid program, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Empowered at Home Act of 2008’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 


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TITLE I—STRENGTHENING THE MEDICAID HOME AND 

COMMUNITY-BASED STATE PLAN AMENDMENT OPTION 

Sec. 101. Removal of barriers to providing home and community-based services 

under State plan amendment option for individuals in need. 

Sec. 102. State option to provide home and community-based services to individuals for whom such services are likely to prevent, delay, or 

decrease the likelihood of an individual’s need for institutionalized care. 

Sec. 103. Implementation assistance grants for States electing to provide home 

and community-based services under Medicaid through the 

State plan amendment option. 

TITLE II—STATE GRANTS TO FACILITATE HOME AND 

COMMUNITY-BASED SERVICES AND PROMOTE HEALTH 

Sec. 201. Reauthorization of medicaid transformation grants and expansion of 

permissible uses in order to facilitate the provision of home and 

community-based and other long-term care services. 

Sec. 202. Health promotion grants. 

TITLE III—LONG TERM CARE INSURANCE 

Sec. 301. Treatment of premiums on qualified long-term care insurance contracts. 

Sec. 302. Credit for taxpayers with long-term care needs. 

Sec. 303. Treatment of premiums on qualified long-term care insurance contracts. 

Sec. 304. Additional consumer protections for long-term care insurance. 

TITLE IV—PROMOTING AND PROTECTING COMMUNITY LIVING 

Sec. 401. Mandatory application of spousal impoverishment protections to recipients of home and community-based services. 

Sec. 402. State authority to elect to exclude up to 6 months of average cost 

of nursing facility services from assets or resources for purposes of eligibility for home and community-based services. 

TITLE V—MISCELLANEOUS 

Sec. 501. Improved data collection. 

Sec. 502. GAO report on Medicaid home health services and the extent of consumer self-direction of such services. 


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1 TITLE I—STRENGTHENING THE 

2 MEDICAID HOME AND COM3 MUNITY-BASED STATE PLAN 

4 AMENDMENT OPTION 

5 SEC. 101. REMOVAL OF BARRIERS TO PROVIDING HOME 

6 AND COMMUNITY-BASED SERVICES UNDER 

7 STATE PLAN AMENDMENT OPTION FOR INDI8 VIDUALS IN NEED. 

9 (a) PARITY WITH INCOME ELIGIBILITY STANDARD

10 FOR INSTITUTIONALIZED INDIVIDUALS.—Paragraph (1) 

11 of section 1915(i) of the Social Security Act (42 U.S.C. 

12 1396n(i)) is amended by striking ‘‘150 percent of the pov13 erty line (as defined in section 2110(c)(5))’’ and inserting 

14 ‘‘300 percent of the supplemental security income benefit 

15 rate established by section 1611(b)(1)’’. 

16 (b) ADDITIONAL STATE OPTION TO PROVIDE HOME

17 AND COMMUNITY-BASED SERVICES TO INDIVIDUALS ELI18 GIBLE FOR SERVICES UNDER A WAIVER.—Section 

19 1915(i) of the Social Security Act (42 U.S.C. 1396n(i)) 

20 is amended by adding at the end the following new para21 graph: 

22 ‘‘(6) STATE OPTION TO PROVIDE HOME AND

23 COMMUNITY-BASED SERVICES TO INDIVIDUALS ELI24 GIBLE FOR SERVICES UNDER A WAIVER.— 


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1 ‘‘(A) IN GENERAL.—A State that provides 

2 home and community-based services in accord3 ance with this subsection to individuals who 

4 satisfy the needs-based criteria for the receipt 

5 of such services established under paragraph 

6 (1)(A) may, in addition to continuing to provide 

7 such services to such individuals, elect to pro8 vide home and community-based services in ac9 cordance with the requirements of this para10 graph to individuals who are eligible for home 

11 and community-based services under a waiver 

12 approved for the State under subsection (c), 

13 (d), or (e) or under section 1115 to provide 

14 such services, but only for those individuals 

15 whose income does not exceed 300 percent of 

16 the supplemental security income benefit rate 

17 established by section 1611(b)(1). 

18 ‘‘(B) APPLICATION OF SAME REQUIRE19 MENTS FOR INDIVIDUALS SATISFYING NEEDS20 BASED CRITERIA.—Subject to subparagraph 

21 (C), a State shall provide home and community22 based services to individuals under this para23 graph in the same manner and subject to the 

24 same requirements as apply under the other 

25 paragraphs of this subsection to the provision 


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1 of home and community-based services to indi2 viduals who satisfy the needs-based criteria es3 tablished under paragraph (1)(A). 

4 ‘‘(C) AUTHORITY TO OFFER DIFFERENT

5 TYPE, AMOUNT, DURATION, OR SCOPE OF HOME

6 AND COMMUNITY-BASED SERVICES.—A State 

7 may offer home and community-based services 

8 to individuals under this paragraph that differ 

9 in type, amount, duration, or scope from the 

10 home and community-based services offered for 

11 individuals who satisfy the needs-based criteria 

12 established under paragraph (1)(A), so long as 

13 such services are within the scope of services 

14 described in paragraph (4)(B) of subsection (c) 

15 for which the Secretary has the authority to ap16 prove a waiver and do not include room or 

17 board.’’. 

18 (c) REMOVAL OF LIMITATION ON SCOPE OF SERV19 ICES.—Paragraph (1) of section 1915(i) of the Social Se20 curity Act (42 U.S.C. 1396n(i)), as amended by sub21 section (a), is amended by striking ‘‘or such other services 

22 requested by the State as the Secretary may approve’’ 

23 (d) OPTIONAL ELIGIBILITY CATEGORY TO PROVIDE

24 FULL MEDICAID BENEFITS TO INDIVIDUALS RECEIVING


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1 HOME AND COMMUNITY-BASED SERVICES UNDER A

2 STATE PLAN AMENDMENT.— 

3 (1) IN GENERAL.—Section 1902(a)(10)(A)(ii) 

4 of the Social Security Act (42 U.S.C. 

5 1396a(a)(10)(A)(ii)) is amended— 

6 (A) in subclause (XVIII), by striking ‘‘or’’ 

7 at the end; 

8 (B) in subclause (XIX), by adding ‘‘or’’ at 

9 the end; and 

10 (C) by inserting after subclause (XIX), the 

11 following new subclause: 

12 ‘‘(XX) who are eligible for home 

13 and community-based services under 

14 needs-based criteria established under 

15 paragraph (1)(A) of section 1915(i), 

16 or who are eligible for home and com17 munity-based services under para18 graph (6) of such section, and who 

19 will receive home and community20 based services pursuant to a State 

21 plan amendment under such sub22 section;’’. 

23 (2) CONFORMING AMENDMENTS.— 

24 (A) Section 1903(f)(4) of the Social Secu25 rity Act (42 U.S.C. 1396b(f)(4)) is amended in 


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1 the matter preceding subparagraph (A), by in2 serting ‘‘1902(a)(10)(A)(ii)(XX),’’ after 

3 ‘‘1902(a)(10)(A)(ii)(XIX),’’. 

4 (B) Section 1905(a) of the Social Security 

5 Act (42 U.S.C. 1396d(a)) is amended in the 

6 matter preceding paragraph (1)— 

7 (i) in clause (xii), by striking ‘‘or’’ at 

8 the end; 

9 (ii) in clause (xiii), by adding ‘‘or’’ at 

10 the end; and 

11 (iii) by inserting after clause (xiii) the 

12 following new clause: 

13 ‘‘(xiv) individuals who are eligible for home and 

14 community-based services under needs-based criteria 

15 established under paragraph (1)(A) of section 

16 1915(i), or who are eligible for home and commu17 nity-based services under paragraph (6) of such sec18 tion, and who will receive home and community19 based services pursuant to a State plan amendment 

20 under such subsection,’’. 

21 (e) ELIMINATION OF OPTION TO LIMIT NUMBER OF

22 ELIGIBLE INDIVIDUALS OR LENGTH OF PERIOD FOR

23 GRANDFATHERED INDIVIDUALS IF ELIGIBILITY CRITERIA

24 IS MODIFIED.—Paragraph (1) of section 1915(i) of such 

25 Act (42 U.S.C. 1396n(i)) is amended— 


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1 (1) by striking subparagraph (C) and inserting 

2 the following: 

3 ‘‘(C) PROJECTION OF NUMBER OF INDI4 VIDUALS TO BE PROVIDED HOME AND COMMU5 NITY-BASED SERVICES.—The State submits to 

6 the Secretary, in such form and manner, and 

7 upon such frequency as the Secretary shall 

8 specify, the projected number of individuals to 

9 be provided home and community-based serv10 ices.’’; and 

11 (2) in subclause (II) of subparagraph (D)(ii), 

12 by striking ‘‘to be eligible for such services for a pe13 riod of at least 12 months beginning on the date the 

14 individual first received medical assistance for such 

15 services’’ and inserting ‘‘to continue to be eligible for 

16 such services after the effective date of the modifica17 tion and until such time as the individual no longer 

18 meets the standard for receipt of such services under 

19 such pre-modified criteria’’. 

20 (f) ELIMINATION OF OPTION TO WAIVE

21 STATEWIDENESS.—Paragraph (3) of section 1915(i) of 

22 such Act (42 U.S.C. 1396n(3)) is amended by striking 

23 ‘‘section 1902(a)(1) (relating to statewideness) and’’. 

24 (g) EFFECTIVE DATE.—The amendments made by 

25 this section take effect on the first day of the first fiscal 


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1 year quarter that begins after the date of enactment of 

2 this Act. 

3 SEC. 102. STATE OPTION TO PROVIDE HOME AND COMMU4 NITY-BASED SERVICES TO INDIVIDUALS FOR 

5 WHOM SUCH SERVICES ARE LIKELY TO PRE6 VENT, DELAY, OR DECREASE THE LIKELI7 HOOD OF AN INDIVIDUAL’S NEED FOR INSTI8 TUTIONALIZED CARE. 

9 (a) STATE PLAN AMENDMENT REQUIRED.— 

10 (1) IN GENERAL.—Section 1915 of the Social 

11 Security Act (42 U.S.C. 1396n) is amended by add12 ing at the end the following new subsection: 

13 ‘‘(k) STATE PLAN AMENDMENT OPTION TO PROVIDE

14 HOME AND COMMUNITY-BASED SERVICES TO INDIVID15 UALS FOR WHOM SUCH SERVICES ARE LIKELY TO PRE16 VENT, DELAY, OR DECREASE THE LIKELIHOOD OF AN IN17 DIVIDUAL’S NEED FOR INSTITUTIONALIZED CARE.— 

18 ‘‘(1) IN GENERAL.—Subject to the succeeding 

19 provisions of this subsection, a State that has an ap20 proved State plan amendment under subsection (i) 

21 may provide, through a State plan amendment for 

22 the provision of medical assistance for home and 

23 community-based services that are within the scope 

24 of services described in paragraph (4)(B) of sub25 section (c) for which the Secretary has the authority 


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1 to approve a waiver and do not include room or 

2 board to individuals— 

3 ‘‘(A) who are not otherwise eligible for 

4 medical assistance under the State plan or 

5 under a waiver of such plan; 

6 ‘‘(B) whose income does not exceed 300 

7 percent of the supplemental security income 

8 benefit rate established by section 1611(b)(1); 

9 and 

10 ‘‘(C) who satisfy such needs-based criteria 

11 for determining eligibility for medical assistance 

12 for such services as the State shall establish in 

13 accordance with paragraph (2). 

14 ‘‘(2) REQUIREMENT FOR NEEDS-BASED CRI15 TERIA.—In establishing needs-based criteria for pur16 poses of determining eligibility for medical assistance 

17 for home and community-based services under this 

18 subsection, a State shall specify the specific physical, 

19 mental, cognitive, or intellectual impairments, or the 

20 inability of an individual to perform 1 or more spe21 cific activities of daily living (as defined in section 

22 7702B(c)(2)(B) of the Internal Revenue Code of 

23 1986) or the need for significant assistance to per24 form such activities, for which the State determines 

25 that the provision of home and community-based 


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1 services are reasonably expected to prevent, delay, or 

2 decrease the likelihood of an individual’s need for in3 stitutionalized care. 

4 ‘‘(3) APPLICATION OF SAME REQUIREMENTS

5 FOR PROVIDING HOME AND COMMUNITY-BASED

6 SERVICES UNDER SUBSECTION (i).—Subject to para7 graphs (4) and (5), a State shall provide home and 

8 community-based services to individuals under this 

9 paragraph in the same manner and subject to the 

10 same requirements as apply to the provision of home 

11 and community-based services to individuals under 

12 subsection (i). 

13 ‘‘(4) AUTHORITY TO LIMIT NUMBER OF INDI14 VIDUALS.—A State may limit the number of individ15 uals who are eligible to receive home and commu16 nity-based services under this subsection and may 

17 establish waiting lists for the receipt of such serv18 ices. 

19 ‘‘(5) AUTHORITY TO OFFER DIFFERENT TYPE, 

20 AMOUNT, DURATION, OR SCOPE OF HOME AND COM21 MUNITY-BASED SERVICES.—A State may offer home 

22 and community-based services to individuals under 

23 this subsection that differ in type, amount, duration, 

24 or scope from the home and community-based serv25 ices offered for individuals under paragraph (1)(A) 


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1 of subsection (i) and, if applicable, under paragraph 

2 (6) of such subsection.’’. 

3 (2) OPTIONAL CATEGORICALLY NEEDY GROUP; 

4 STATE OPTION TO LIMIT BENEFITS TO HOME AND

5 COMMUNITY-BASED SERVICES OR TO PROVIDE FULL

6 MEDICAL ASSISTANCE.— 

7 (A) IN GENERAL.—Section 1902(a)(10) of 

8 the Social Security Act (42 U.S.C. 

9 1396a(a)(10)) is amended— 

10 (i) in subparagraph (A)(ii), as amend11 ed by section 101(d)(1)— 

12 (I) in subclause (XIX), by strik13 ing ‘‘or’’ at the end; 

14 (II) in subclause (XX), by adding 

15 ‘‘or’’ at the end; and 

16 (III) by inserting after subclause 

17 (XX), the following new subclause: 

18 ‘‘(XXI) who are eligible for home 

19 and community-based services under 

20 section 1915(k) and who will receive 

21 home and community-based services 

22 pursuant to a State plan amendment 

23 under such subsection;’’; and 

24 (ii) in the matter following subpara25 graph (G)— 


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1 (I) by striking ‘‘and (XIV)’’ and 

2 inserting ‘‘(XIV)’’; and 

3 (II) by inserting ‘‘, and (XV) at 

4 the option of the State, the medical 

5 assistance made available to an indi6 vidual described in section 1915 (k) 

7 who is eligible for medical assistance 

8 only because of subparagraph 

9 (A)(ii)(XXI) may be limited to med10 ical assistance for home and commu11 nity-based services described in a 

12 State plan amendment submitted 

13 under that section’’ before the semi14 colon. 

15 (B) CONFORMING AMENDMENTS.— 

16 (i) Section 1903(f)(4) of the Social 

17 Security Act (42 U.S.C. 1396b(f)(4)), as 

18 amended by section 101(d)(2)(A), is 

19 amended in the matter preceding subpara20 graph (A), by inserting 

21 ‘‘1902(a)(10)(A)(ii)(XXI),’’ after 

22 ‘‘1902(a)(10)(A)(ii)(XX),’’. 

23 (ii) Section 1905(a) of the Social Se24 curity Act (42 U.S.C. 1396d(a)), as 

25 amended by section 101(d)(2)(B), is 


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1 amended in the matter preceding para2 graph (1)— 

3 (I) in clause (xiii), by striking 

4 ‘‘or’’ at the end; 

5 (II) in clause (xiv), by adding 

6 ‘‘or’’ at the end; and 

7 (iii) by inserting after clause (xiv) the 

8 following new clause: 

9 ‘‘(xv) who are eligible for home and community10 based services under section 1915(k) and who will 

11 receive home and community-based services pursu12 ant to a State plan amendment under such sub13 section,’’. 

14 (b) EFFECTIVE DATE.—The amendments made by 

15 this section take effect on the first day of the first fiscal 

16 year quarter that begins after the date of enactment of 

17 this Act. 

18 SEC. 103. IMPLEMENTATION ASSISTANCE GRANTS FOR 

19 STATES ELECTING TO PROVIDE HOME AND 

20 COMMUNITY-BASED SERVICES UNDER MED21 ICAID THROUGH THE STATE PLAN AMEND22 MENT OPTION. 

23 (a) AUTHORITY TO AWARD GRANTS.—The Secretary 

24 of Health and Human Services (in this section referred 

25 to as the ‘‘Secretary’’) shall award grants to eligible States 


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1 to provide incentives to States for the implementation of 

2 State plan amendments that meet the requirements of sec3 tion 1915(i) of the Social Security Act (42 U.S.C. 

4 1396n(i)). 

5 (b) ELIGIBLE STATE.—For purposes of this section, 

6 an eligible State is a State that— 

7 (1) has an approved State plan amendment de8 scribed in subsection (a); and 

9 (2) submits an application to the Secretary, in 

10 such form and manner as the Secretary shall re11 quire, specifying the costs the State will incur in im12 plementing such amendment and such additional in13 formation as the Secretary may require. 

14 (c) AMOUNT AND DURATION OF GRANTS.— 

15 (1) AMOUNT.—The Secretary shall determine 

16 the amount to be awarded all eligible States under 

17 this section for a fiscal year based on the applica18 tions submitted by such States and the amount 

19 available for such fiscal year under subsection (d). 

20 (2) LIMITATION ON DURATION OF AWARD.—A 

21 State may receive a grant under this section for not 

22 more than 3 consecutive fiscal years. 

23 (d) APPROPRIATIONS.—There are appropriated, from 

24 any funds in the Treasury not otherwise appropriated, 

25 $40,000,000 for each of fiscal years 2009 through 2013 


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1 for making grants to States under this section. Funds ap2 propriated under this subsection for a fiscal year shall re3 main available for expenditure through September 30, 

4 2013. 

5 TITLE II—STATE GRANTS TO FA6 CILITATE HOME AND COMMU7 NITY-BASED SERVICES AND 

8 PROMOTE HEALTH 

9 SEC. 201. REAUTHORIZATION OF MEDICAID TRANS10 FORMATION GRANTS AND EXPANSION OF 

11 PERMISSIBLE USES IN ORDER TO FACILI12 TATE THE PROVISION OF HOME AND COMMU13 NITY-BASED AND OTHER LONG-TERM CARE 

14 SERVICES. 

15 (a) 2-YEAR REAUTHORIZATION; INCREASED FUND16 ING.—Section 1903(z)(4)(A) of the Social Security Act 

17 (42 U.S.C. 1396b(z)(4)(A)) is amended— 

18 (1) in clause (i), by striking ‘‘and’’ at the end; 

19 (2) in clause (ii), by striking the period at the 

20 end and inserting ‘‘; and’’; and 

21 (3) by inserting after clause (ii), the following 

22 new clauses: 

23 ‘‘(iii) $150,000,000 for fiscal year 

24 2009; and 


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1 ‘‘(iv) $150,000,000 for fiscal year 

2 2010.’’. 

3 (b) EXPANSION OF PERMISSIBLE USES.—Section 

4 1903(z)(2) of the Social Security Act (42 U.S.C. 

5 1396b(z)(2)) is amended by adding at the end the fol6 lowing new subparagraphs: 

7 ‘‘(G)(i) Methods for ensuring the avail8 ability and accessibility of home and commu9 nity-based services in the State, recognizing 

10 multiple delivery options that take into account 

11 differing needs of individuals, through the cre12 ation or designation (in consultation with orga13 nizations representing elderly individuals and 

14 individuals of all ages with physical, mental, 

15 cognitive, or intellectual impairments, and orga16 nizations representing the long-term care work17 force, including organized labor, and health 

18 care and direct service providers) of one or 

19 more statewide or regional public entities or 

20 non-profit organizations (such as fiscal inter21 mediaries, agencies with choice, home care com22 missions, public authorities, worker associa23 tions, consumer-owned and controlled organiza24 tions (including representatives of individuals 

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1 ment), area agencies on aging, independent liv2 ing centers, aging and disability resource cen3 ters, or other disability organizations) which 

4 may— 

5 ‘‘(I) develop programs where qualified 

6 individuals provide home- and community7 based services while solely or jointly em8 ployed by recipients of such services; 

9 ‘‘(II) facilitate the training and re10 cruitment of qualified health and direct 

11 service professionals and consumers who 

12 use services; 

13 ‘‘(III) recommend or develop a system 

14 to set wages and benefits, and recommend 

15 commensurate reimbursement rates; 

16 ‘‘(IV) with meaningful ongoing in17 volvement from consumers and workers (or 

18 their respective representatives), develop 

19 procedures for the appropriate screening of 

20 workers, create a registry or registries of 

21 available workers, including policies and 

22 procedures to ensure no interruption of 

23 care for eligible individuals; 

24 ‘‘(V) assist consumers in identifying 

25 workers; 


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1 ‘‘(VI) act as a fiscal intermediary; 

2 ‘‘(VII) assist workers in finding em3 ployment, including consumer-directed em4 ployment; 

5 ‘‘(VIII) provide funding for disability 

6 organizations, aging organizations, or 

7 other organizations, to assume roles that 

8 promote consumers’ ability to acquire the 

9 necessary skills for directing their own 

10 services and financial resources; or 

11 ‘‘(IX) create workforce development 

12 plans on a regional or statewide basis (or 

13 both), to ensure a sufficient supply of 

14 qualified home and community-based serv15 ices workers, including reviews and anal16 yses of actual and potential worker short17 ages, training and retention programs for 

18 home and community-based services work19 ers (which may include, as determined ap20 propriate by the State, allowing participa21 tion in such training to count as an allow22 able work activity under the State tem23 porary assistance for needy families pro24 gram funded under part A of title IV), and 


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1 plans to assist consumers with finding and 

2 retaining qualified workers. 

3 ‘‘(ii) Nothing in clause (i) shall be con4 strued as prohibiting the use of funds made 

5 available to carry out this subparagraph for 

6 start-up costs associated with any of the activi7 ties described in subclauses (I) through (IX), as 

8 requiring any consumer to hire workers who are 

9 listed in a worker registry developed with such 

10 funds, or to limit the ability of consumers to 

11 hire or fire their own workers. 

12 ‘‘(H) Methods for providing an integrated 

13 and efficient system of long-term care through 

14 a review of the Federal, State, local, and pri15 vate long-term care resources, services, and 

16 supports available to elderly individuals and in17 dividuals of all ages with physical, mental, cog18 nitive, or intellectual impairments and the de19 velopment and implementation of a plan to fully 

20 integrate such resources, services, and supports 

21 by aggregating such resources, services, and 

22 supports to create a consumer-centered and 

23 cost-effective resource and delivery system and 

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1 sult in administrative savings, consolidation of 

2 common activities, and the elimination of re3 dundant processes.’’. 

4 (c) ALLOCATION OF FUNDS.— 

5 (1) ELIMINATION OF CURRENT LAW REQUIRE6 MENTS FOR ALLOCATION OF FUNDS.—Section 

7 1903(z)(4)(B) of the Social Security Act (42 U.S.C. 

8 1396b(z)(4)(B)) is amended by striking the second 

9 and third sentences. 

10 (2) ASSURANCE OF FUNDS TO FACILITATE THE

11 PROVISION OF HOME AND COMMUNITY-BASED SERV12 ICES AND INTEGRATED SYSTEMS OF LONG-TERM

13 CARE.—Section 1903(z)(4)(B) of the Social Security 

14 Act (42 U.S.C. 1396b(z)(4)(B)), as amended by 

15 paragraph (1), is amended by inserting after the 

16 first sentence the following new sentence: ‘‘Such 

17 method shall provide that 50 percent of such funds 

18 shall be allocated among States that design pro19 grams to adopt the innovative methods described in 

20 subparagraph (G) or (H) (or both) of paragraph 

21 (2).’’. 

22 (d) EFFECTIVE DATE.—The amendments made by 

23 this section take effect on October 1, 2008. 

24 SEC. 202. HEALTH PROMOTION GRANTS. 

25 (a) DEFINITIONS.—In this section: 


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1 (1) ELIGIBLE MEDICAID BENEFICIARY.—The 

2 term ‘‘eligible Medicaid beneficiary’’ means an indi3 vidual who is enrolled in the State Medicaid plan 

4 under title XIX of the Social Security Act and— 

5 (A) has attained the age of 60 and is not 

6 a resident of a nursing facility; or 

7 (B) is an adult with a physical, mental, 

8 cognitive, or intellectual impairment. 

9 (2) ELIGIBLE STATE.—The term ‘‘eligible 

10 State’’ means a State that submits an application to 

11 the Secretary for a grant under this section, in such 

12 form and manner as the Secretary shall require. 

13 (3) EVIDENCE- AND COMMUNITY-BASED

14 HEALTH PROMOTION PROGRAM.—The term 

15 ‘‘evidence- and community-based health promotion 

16 program’’ means a community-based program (such 

17 as a program for chronic disease self-management, 

18 physical or mental activity, falls prevention, smoking 

19 cessation, or dietary modification) that has been ob20 jectively evaluated and found to improve health out21 comes or meet health promotion goals by preventing, 

22 delaying, or decreasing the severity of physical, men23 tal, cognitive, or intellectual impairment and that 

24 meets generally accepted standards for best profes25 sional practice. 


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1 (4) SECRETARY.—The term ‘‘Secretary’’ means 

2 the Secretary of Health and Human Services. 

3 (b) AUTHORITY TO CONDUCT DEMONSTRATION

4 PROJECT.—The Secretary shall award grants on a com5 petitive basis to eligible States to conduct in accordance 

6 with this section an evidence- and community-based health 

7 promotion program that is designed to achieve the fol8 lowing objectives with respect to eligible Medicaid bene9 ficiaries: 

10 (1) LIFESTYLE CHANGES.—To empower eligible 

11 Medicaid beneficiaries to take more control over 

12 their own health through lifestyle changes that have 

13 proven effective in reducing the effects of chronic 

14 disease and slowing the progression of disability. 

15 (2) DIFFUSION.—To mobilize the Medicaid, 

16 aging, disability, public health, and nonprofit net17 works at the State and local levels to accelerate the 

18 translation of credible research into practice through 

19 the deployment of low-cost evidence-based health 

20 promotion and disability prevention programs at the 

21 community level. 

22 (c) SELECTION AND AMOUNT OF GRANT AWARDS.— 

23 In awarding grants to eligible States under this section 

24 and determining the amount of the awards, the Secretary 

25 shall— 


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1 (1) take into consideration the manner and ex2 tent to which the eligible State proposes to achieve 

3 the objectives specified in subsection (b); and 

4 (2) give preference to eligible States pro5 posing— 

6 (A) programs through public service pro7 vider organizations or other organizations with 

8 expertise in serving eligible Medicaid bene9 ficiaries; 

10 (B) strong State-level collaboration across, 

11 Medicaid agencies, State units on aging, State 

12 independent living councils, State associations 

13 of Area Agencies on Aging, and State agencies 

14 responsible for public health; or 

15 (C) interventions that have already dem16 onstrated effectiveness and replicability in a 

17 community-based, non-medical setting. 

18 (d) USE OF FUNDS.—An eligible State awarded a 

19 grant under this section shall use the funds awarded to 

20 develop, implement, and sustain high quality evidence- and 

21 community-based health promotion programs. As a condi22 tion of being awarded such a grant, an eligible State shall 

23 agree to— 

24 (1) implement such programs in at least 3 geo25 graphic areas of the State; and 


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1 (2) develop the infrastructure and partnerships 

2 that will be necessary over the long-term to effec3 tively embed evidence-and community-based health 

4 promotion programs for eligible Medicaid bene5 ficiaries within the statewide health, aging, dis6 ability, and long-term care systems. 

7 (e) TECHNICAL ASSISTANCE.—The Secretary shall 

8 provide assistance to eligible States awarded grants under 

9 this section, sub-grantees and their partners, program or10 ganizers, and others in developing evidence- and commu11 nity-based health promotion programs. 

12 (f) PAYMENTS TO ELIGIBLE STATES; CARRYOVER OF

13 UNUSED GRANT AMOUNTS.— 

14 (1) PAYMENTS.—For each calendar quarter of 

15 a fiscal year that begins during the period for which 

16 an eligible State is awarded a grant under this sec17 tion, the Secretary shall pay to the State from its 

18 grant award for such fiscal year an amount equal to 

19 the lesser of— 

20 (A) the amount of qualified expenditures 

21 made by the State for such quarter; or 

22 (B) the total amount remaining in such 

23 grant award for such fiscal year (taking into 

24 account the application of paragraph (2)). 


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1 (2) CARRYOVER OF UNUSED AMOUNTS.—Any 

2 portion of a State grant award for a fiscal year 

3 under this section remaining available at the end of 

4 such fiscal year shall remain available for making 

5 payments to the State for the next 4 fiscal years, 

6 subject to paragraph (3). 

7 (3) REAWARDING OF CERTAIN UNUSED

8 AMOUNTS.—In the case of a State that the Sec9 retary determines has failed to meet the conditions 

10 for continuation of a demonstration project under 

11 this section in a succeeding year, the Secretary shall 

12 rescind the grant award for each succeeding year, 

13 together with any unspent portion of an award for 

14 prior years, and shall add such amounts to the ap15 propriation for the immediately succeeding fiscal 

16 year for grants under this section. 

17 (4) PREVENTING DUPLICATION OF PAYMENT.— 

18 The payment under a demonstration project with re19 spect to qualified expenditures shall be in lieu of any 

20 payment with respect to such expenditures that 

21 would otherwise be paid to the State under section 

22 1903(a) of the Social Security Act (42 U.S.C. 

23 1396a(a)). Nothing in the previous sentence shall be 

24 construed as preventing a State from being paid 

25 under such section for expenditures in a grant year 


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1 for which payment is available under such section 

2 1903(a) after amounts available to pay for such ex3 penditures under the grant awarded to the State 

4 under this section for the fiscal year have been ex5 hausted. 

6 (g) EVALUATION.—Not later than 3 years after the 

7 date on which the first grant is awarded to an eligible 

8 State under this section, the Secretary shall, by grant, 

9 contract, or interagency agreement, conduct an evaluation 

10 of the demonstration projects carried out under this sec11 tion that measures the health-related, quality of life, and 

12 cost outcomes for eligible Medicaid beneficiaries and in13 cludes information relating to the quality, infrastructure, 

14 sustainability, and effectiveness of such projects. 

15 (h) APPROPRIATIONS.—There are appropriated, from 

16 any funds in the Treasury not otherwise appropriated, the 

17 following amounts to carry out this section: 

18 (1) GRANTS TO STATES.—For grants to States, 

19 to remain available until expended— 

20 (A) $4,000,000 for fiscal year 2009; 

21 (B) $6,000,000 for fiscal year 2010; 

22 (C) $8,000,000 for fiscal year 2011; 

23 (D) $10,000,000 for fiscal year 2012; and 

24 (E) $12,000,000 for fiscal year 2013. 


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1 (2) TECHNICAL ASSISTANCE.—For the provi2 sion of technical assistance through such center in 

3 accordance with subsection (e)— 

4 (A) $800,000 for fiscal year 2009; 

5 (B) $1,200,000 for fiscal year 2010; 

6 (C) $1,600,000 for fiscal year 2011; 

7 (D) $2,000,000 for fiscal year 2012; and 

8 (E) $2,400,000 for fiscal year 2013. 

9 (3) EVALUATION.—For conducting the evalua10 tion required under subsection (g), $4,000,000 for 

11 fiscal year 2011. 

12 TITLE III—LONG TERM CARE 

13 INSURANCE 

14 SEC. 301. TREATMENT OF PREMIUMS ON QUALIFIED LONG15 TERM CARE INSURANCE CONTRACTS. 

16 (a) IN GENERAL.—Part VII of subchapter B of chap17 ter 1 of the Internal Revenue Code of 1986 (relating to 

18 additional itemized deductions) is amended by redesig19 nating section 224 as section 225 and by inserting after 

20 section 223 the following new section: 

21 ‘‘SEC. 224. PREMIUMS ON QUALIFIED LONG-TERM CARE IN22 SURANCE CONTRACTS. 

23 ‘‘(a) IN GENERAL.—In the case of an individual, 

24 there shall be allowed as a deduction an amount equal to 

25 the applicable percentage of the amount of eligible longVerDate Aug 31 2005 21:32 Jul 25, 2008 Jkt 069200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\S3327.IS S3327

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1 term care premiums (as defined in section 213(d)(10)) 

2 paid during the taxable year for coverage for the taxpayer 

3 and the taxpayer’s spouse and dependents under a quali4 fied long-term care insurance contract (as defined in sec5 tion 7702B(b)). 

6 ‘‘(b) APPLICABLE PERCENTAGE.—For purposes of 

7 subsection (a), the applicable percentage shall be deter8 mined in accordance with the following table: 

‘‘For taxable years beginning in 

calendar year—

The applicable 

percentage is—

2010 or 2011 ............................................................................... 25

2012 ............................................................................................. 35

2013 ............................................................................................. 65

2014 or thereafter ....................................................................... 100. 

9 ‘‘(c) COORDINATION WITH OTHER DEDUCTIONS.— 

10 Any amount paid by a taxpayer for any qualified long11 term care insurance contract to which subsection (a) ap12 plies shall not be taken into account in computing the 

13 amount allowable to the taxpayer as a deduction under 

14 section 162(l) or 213(a).’’. 

15 (b) CONFORMING AMENDMENTS.— 

16 (1) Section 62(a) of the Internal Revenue Code 

17 of 1986 is amended by inserting before the last sen18 tence at the end the following new paragraph: 

19 ‘‘(22) PREMIUMS ON QUALIFIED LONG-TERM

20 CARE INSURANCE CONTRACTS.—The deduction al21 lowed by section 224.’’. 


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1 (2) The table of sections for part VII of sub2 chapter B of chapter 1 of such Code is amended by 

3 striking the last item and inserting the following 

4 new items: 

‘‘Sec. 224. Premiums on qualified long-term care insurance contracts. 

‘‘Sec. 225. Cross reference.’’. 

5 (c) EFFECTIVE DATE.—The amendments made by 

6 this section shall apply to taxable years beginning after 

7 December 31, 2009. 

8 SEC. 302. CREDIT FOR TAXPAYERS WITH LONG-TERM CARE 

9 NEEDS. 

10 (a) IN GENERAL.—Subpart A of part IV of sub11 chapter A of chapter 1 of the Internal Revenue Code of 

12 1986 (relating to nonrefundable personal credits) is 

13 amended by inserting after section 25D the following new 

14 section: 

15 ‘‘SEC. 25E. CREDIT FOR TAXPAYERS WITH LONG-TERM 

16 CARE NEEDS. 

17 ‘‘(a) ALLOWANCE OF CREDIT.— 

18 ‘‘(1) IN GENERAL.—There shall be allowed as a 

19 credit against the tax imposed by this chapter for 

20 the taxable year an amount equal to the applicable 

21 credit amount multiplied by the number of applica22 ble individuals with respect to whom the taxpayer is 

23 an eligible caregiver for the taxable year. 


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1 ‘‘(2) APPLICABLE CREDIT AMOUNT.—For pur2 poses of paragraph (1), the applicable credit amount 

3 shall be determined in accordance with the following 

4 table: 

‘‘For taxable years beginning in 

calendar year—

The applicable 

credit 

amount 

is—

2010 ............................................................................................. $1,000

2011 ............................................................................................. 1,500

2012 ............................................................................................. 2,000

2013 ............................................................................................. 2,500

2014 or thereafter ....................................................................... 3,000. 

5 ‘‘(b) LIMITATION BASED ON ADJUSTED GROSS IN6 COME.— 

7 ‘‘(1) IN GENERAL.—The amount of the credit 

8 allowable under subsection (a) shall be reduced (but 

9 not below zero) by $100 for each $1,000 (or fraction 

10 thereof) by which the taxpayer’s modified adjusted 

11 gross income exceeds the threshold amount. For 

12 purposes of the preceding sentence, the term ‘modi13 fied adjusted gross income’ means adjusted gross in14 come increased by any amount excluded from gross 

15 income under section 911, 931, or 933. 

16 ‘‘(2) THRESHOLD AMOUNT.—For purposes of 

17 paragraph (1), the term ‘threshold amount’ means— 

18 ‘‘(A) $150,000 in the case of a joint re19 turn, and 

20 ‘‘(B) $75,000 in any other case. 


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1 ‘‘(3) INDEXING.—In the case of any taxable 

2 year beginning in a calendar year after 2010, each 

3 dollar amount contained in paragraph (2) shall be 

4 increased by an amount equal to the product of— 

5 ‘‘(A) such dollar amount, and 

6 ‘‘(B) the medical care cost adjustment de7 termined under section 213(d)(10)(B)(ii) for 

8 the calendar year in which the taxable year be9 gins, determined by substituting ‘August 2009’ 

10 for ‘August 1996’ in subclause (II) thereof. 

11 If any increase determined under the preceding sen12 tence is not a multiple of $50, such increase shall 

13 be rounded to the next lowest multiple of $50. 

14 ‘‘(c) DEFINITIONS.—For purposes of this section— 

15 ‘‘(1) APPLICABLE INDIVIDUAL.— 

16 ‘‘(A) IN GENERAL.—The term ‘applicable 

17 individual’ means, with respect to any taxable 

18 year, any individual who has been certified, be19 fore the due date for filing the return of tax for 

20 the taxable year (without extensions), by a phy21 sician (as defined in section 1861(r)(1) of the 

22 Social Security Act) as being an individual with 

23 long-term care needs described in subparagraph 

24 (B) for a period— 


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1 ‘‘(i) which is at least 180 consecutive 

2 days, and 

3 ‘‘(ii) a portion of which occurs within 

4 the taxable year. 

5 Notwithstanding the preceding sentence, a cer6 tification shall not be treated as valid unless it 

is made within the 391 7 ⁄2 month period ending 

8 on such due date (or such other period as the 

9 Secretary prescribes). 

10 ‘‘(B) INDIVIDUALS WITH LONG-TERM CARE

11 NEEDS.—An individual is described in this sub12 paragraph if the individual meets any of the fol13 lowing requirements: 

14 ‘‘(i) The individual is at least 6 years 

15 of age and— 

16 ‘‘(I) is unable to perform (with17 out substantial assistance from an18 other individual) at least 3 activities 

19 of daily living (as defined in section 

20 7702B(c)(2)(B)) due to a loss of 

21 functional capacity, or 

22 ‘‘(II) requires substantial super23 vision to protect such individual from 

24 threats to health and safety due to se25 vere cognitive impairment and is unVerDate Aug 31 2005 21:32 Jul 25, 2008 Jkt 069200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\S3327.IS S3327

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1 able to perform, without reminding or 

2 cuing assistance, at least 1 activity of 

3 daily living (as so defined) or to the 

4 extent provided in regulations pre5 scribed by the Secretary (in consulta6 tion with the Secretary of Health and 

7 Human Services), is unable to engage 

8 in age appropriate activities. 

9 ‘‘(ii) The individual is at least 2 but 

10 not 6 years of age and is unable due to a 

11 loss of functional capacity to perform 

12 (without substantial assistance from an13 other individual) at least 2 of the following 

14 activities: eating, transferring, or mobility. 

15 ‘‘(iii) The individual is under 2 years 

16 of age and requires specific durable med17 ical equipment by reason of a severe health 

18 condition or requires a skilled practitioner 

19 trained to address the individual’s condi20 tion to be available if the individual’s par21 ents or guardians are absent. 

22 ‘‘(2) ELIGIBLE CAREGIVER.— 

23 ‘‘(A) IN GENERAL.—A taxpayer shall be 

24 treated as an eligible caregiver for any taxable 

25 year with respect to the following individuals: 


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1 ‘‘(i) The taxpayer. 

2 ‘‘(ii) The taxpayer’s spouse. 

3 ‘‘(iii) An individual with respect to 

4 whom the taxpayer is allowed a deduction 

5 under section 151(c) for the taxable year. 

6 ‘‘(iv) An individual who would be de7 scribed in clause (iii) for the taxable year 

8 if section 151(c) were applied by sub9 stituting for the exemption amount an 

10 amount equal to the sum of the exemption 

11 amount, the standard deduction under sec12 tion 63(c)(2)(C), and any additional stand13 ard deduction under section 63(c)(3) which 

14 would be applicable to the individual if 

15 clause (iii) applied. 

16 ‘‘(v) An individual who would be de17 scribed in clause (iii) for the taxable year 

18 if— 

19 ‘‘(I) the requirements of clause 

20 (iv) are met with respect to the indi21 vidual, and 

22 ‘‘(II) the requirements of sub23 paragraph (B) are met with respect to 

24 the individual in lieu of the support 


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1 test under subsection (c)(1)(D) or 

2 (d)(1)(C) of section 152. 

3 ‘‘(B) RESIDENCY TEST.—The require4 ments of this subparagraph are met if an indi5 vidual has as his principal place of abode the 

6 home of the taxpayer and— 

7 ‘‘(i) in the case of an individual who 

8 is an ancestor or descendant of the tax9 payer or the taxpayer’s spouse, is a mem10 ber of the taxpayer’s household for over 

11 half the taxable year, or 

12 ‘‘(ii) in the case of any other indi13 vidual, is a member of the taxpayer’s 

14 household for the entire taxable year. 

15 ‘‘(C) SPECIAL RULES WHERE MORE THAN

16 1 ELIGIBLE CAREGIVER.— 

17 ‘‘(i) IN GENERAL.—If more than 1 in18 dividual is an eligible caregiver with re19 spect to the same applicable individual for 

20 taxable years ending with or within the 

21 same calendar year, a taxpayer shall be 

22 treated as the eligible caregiver if each 

23 such individual (other than the taxpayer) 

24 files a written declaration (in such form 

25 and manner as the Secretary may preVerDate Aug 31 2005 21:32 Jul 25, 2008 Jkt 069200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\S3327.IS S3327

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1 scribe) that such individual will not claim 

2 such applicable individual for the credit 

3 under this section. 

4 ‘‘(ii) NO AGREEMENT.—If each indi5 vidual required under clause (i) to file a 

6 written declaration under clause (i) does 

7 not do so, the individual with the highest 

8 adjusted gross income shall be treated as 

9 the eligible caregiver. 

10 ‘‘(iii) MARRIED INDIVIDUALS FILING

11 SEPARATELY.—In the case of married indi12 viduals filing separately, the determination 

13 under this subparagraph as to whether the 

14 husband or wife is the eligible caregiver 

15 shall be made under the rules of clause (ii) 

16 (whether or not one of them has filed a 

17 written declaration under clause (i)). 

18 ‘‘(d) IDENTIFICATION REQUIREMENT.—No credit 

19 shall be allowed under this section to a taxpayer with re20 spect to any applicable individual unless the taxpayer in21 cludes the name and taxpayer identification number of 

22 such individual, and the identification number of the phy23 sician certifying such individual, on the return of tax for 

24 the taxable year. 


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1 ‘‘(e) TAXABLE YEAR MUST BE FULL TAXABLE

2 YEAR.—Except in the case of a taxable year closed by rea3 son of the death of the taxpayer, no credit shall be allow4 able under this section in the case of a taxable year cov5 ering a period of less than 12 months.’’. 

6 (b) CONFORMING AMENDMENTS.— 

7 (1) Section 6213(g)(2) of the Internal Revenue 

8 Code of 1986 is amended by striking ‘‘and’’ at the 

9 end of subparagraph (L), by striking the period at 

10 the end of subparagraph (M) and inserting ‘‘, and’’, 

11 and by inserting after subparagraph (M) the fol12 lowing new subparagraph: 

13 ‘‘(N) an omission of a correct TIN or phy14 sician identification required under section 

15 25E(d) (relating to credit for taxpayers with 

16 long-term care needs) to be included on a re17 turn.’’. 

18 (2) The table of sections for subpart A of part 

19 IV of subchapter A of chapter 1 of such Code is 

20 amended by inserting after the item relating to sec21 tion 25D the following new item: 

‘‘Sec. 25E. Credit for taxpayers with long-term care needs.’’. 

22 (c) EFFECTIVE DATE.—The amendments made by 

23 this section shall apply to taxable years beginning after 

24 December 31, 2009. 


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1 SEC. 303. TREATMENT OF PREMIUMS ON QUALIFIED LONG2 TERM CARE INSURANCE CONTRACTS. 

3 (a) IN GENERAL.— 

4 (1) CAFETERIA PLANS.—The last sentence of 

5 section 125(f) of the Internal Revenue Code of 1986 

6 (defining qualified benefits) is amended by inserting 

7 before the period at the end ‘‘; except that such term 

8 shall include the payment of premiums for any quali9 fied long-term care insurance contract (as defined in 

10 section 7702B) to the extent the amount of such 

11 payment does not exceed the eligible long-term care 

12 premiums (as defined in section 213(d)(10)) for 

13 such contract’’. 

14 (2) FLEXIBLE SPENDING ARRANGEMENTS.— 

15 Section 106 of such Code (relating to contributions 

16 by an employer to accident and health plans) is 

17 amended by striking subsection (c) and redesig18 nating subsection (d) as subsection (c). 

19 (b) CONFORMING AMENDMENTS.— 

20 (1) Section 6041 of the Internal Revenue Code 

21 of 1986 is amended by adding at the end the fol22 lowing new subsection: 

23 ‘‘(h) FLEXIBLE SPENDING ARRANGEMENT DE24 FINED.—For purposes of this section, a flexible spending 

25 arrangement is a benefit program which provides employ26 ees with coverage under which— 


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1 ‘‘(1) specified incurred expenses may be reim2 bursed (subject to reimbursement maximums and 

3 other reasonable conditions), and 

4 ‘‘(2) the maximum amount of reimbursement 

5 which is reasonably available to a participant for 

6 such coverage is less than 500 percent of the value 

7 of such coverage. 

8 In the case of an insured plan, the maximum amount rea9 sonably available shall be determined on the basis of the 

10 underlying coverage.’’. 

11 (2) The following sections of such Code are 

12 each amended by striking ‘‘section 106(d)’’ and in13 serting ‘‘section 106(c)’’: sections 223(b)(4)(B), 

14 223(d)(4)(C), 223(f)(3)(B), 3231(e)(11), 

15 3306(b)(18), 3401(a)(22), 4973(g)(1), and 

16 4973(g)(2)(B)(i). 

17 (3) Section 6041(f)(1) of such Code is amended 

18 by striking ‘‘(as defined in section 106(c)(2))’’. 

19 (c) EFFECTIVE DATE.—The amendments made by 

20 this section shall apply to taxable years beginning after 

21 December 31, 2009. 

22 SEC. 304. ADDITIONAL CONSUMER PROTECTIONS FOR 

23 LONG-TERM CARE INSURANCE. 

24 (a) ADDITIONAL PROTECTIONS APPLICABLE TO

25 LONG-TERM CARE INSURANCE.—Subparagraphs (A) and 


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1 (B) of section 7702B(g)(2) of the Internal Revenue Code 

2 of 1986 (relating to requirements of model regulation and 

3 Act) are amended to read as follows: 

4 ‘‘(A) IN GENERAL.—The requirements of 

5 this paragraph are met with respect to any con6 tract if such contract meets— 

7 ‘‘(i) MODEL REGULATION.—The fol8 lowing requirements of the model regula9 tion: 

10 ‘‘(I) Section 6A (relating to guar11 anteed renewal or noncancellability), 

12 other than paragraph (5) thereof, and 

13 the requirements of section 6B of the 

14 model Act relating to such section 6A. 

15 ‘‘(II) Section 6B (relating to pro16 hibitions on limitations and exclu17 sions) other than paragraph (7) there18 of. 

19 ‘‘(III) Section 6C (relating to ex20 tension of benefits). 

21 ‘‘(IV) Section 6D (relating to 

22 continuation or conversion of cov23 erage). 


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1 ‘‘(V) Section 6E (relating to dis2 continuance and replacement of poli3 cies). 

4 ‘‘(VI) Section 7 (relating to unin5 tentional lapse). 

6 ‘‘(VII) Section 8 (relating to dis7 closure), other than sections 8F, 8G, 

8 8H, and 8I thereof. 

9 ‘‘(VIII) Section 11 (relating to 

10 prohibitions against post-claims un11 derwriting). 

12 ‘‘(IX) Section 12 (relating to 

13 minimum standards). 

14 ‘‘(X) Section 13 (relating to re15 quirement to offer inflation protec16 tion). 

17 ‘‘(XI) Section 25 (relating to pro18 hibition against preexisting conditions 

19 and probationary periods in replace20 ment policies or certificates). 

21 ‘‘(XII) The provisions of section 

22 28 relating to contingent nonforfeiture 

23 benefits, if the policyholder declines 

24 the offer of a nonforfeiture provision 


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1 described in paragraph (4) of this 

2 subsection. 

3 ‘‘(ii) MODEL ACT.—The following re4 quirements of the model Act: 

5 ‘‘(I) Section 6C (relating to pre6 existing conditions). 

7 ‘‘(II) Section 6D (relating to 

8 prior hospitalization). 

9 ‘‘(III) The provisions of section 8 

10 relating to contingent nonforfeiture 

11 benefits, if the policyholder declines 

12 the offer of a nonforfeiture provision 

13 described in paragraph (4) of this 

14 subsection. 

15 ‘‘(B) DEFINITIONS.—For purposes of this 

16 paragraph— 

17 ‘‘(i) MODEL REGULATION.—The term 

18 ‘model regulation’ means the long-term 

19 care insurance model regulation promul20 gated by the National Association of Insur21 ance Commissioners (as adopted as of De22 cember 2006). 

23 ‘‘(ii) MODEL ACT.—The term ‘model 

24 Act’ means the long-term care insurance 

25 model Act promulgated by the National 


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•S 3327 IS

1 Association of Insurance Commissioners 

2 (as adopted as of December 2006). 

3 ‘‘(iii) COORDINATION.—Any provision 

4 of the model regulation or model Act listed 

5 under clause (i) or (ii) of subparagraph 

6 (A) shall be treated as including any other 

7 provision of such regulation or Act nec8 essary to implement the provision. 

9 ‘‘(iv) DETERMINATION.—For pur10 poses of this section and section 4980C, 

11 the determination of whether any require12 ment of a model regulation or the model 

13 Act has been met shall be made by the 

14 Secretary.’’. 

15 (b) EXCISE TAX.—Paragraph (1) of section 

16 4980C(c) of the Internal Revenue Code of 1986 (relating 

17 to requirements of model provisions) is amended to read 

18 as follows: 

19 ‘‘(1) REQUIREMENTS OF MODEL PROVISIONS.— 

20 ‘‘(A) MODEL REGULATION.—The following 

21 requirements of the model regulation must be 

22 met: 

23 ‘‘(i) Section 9 (relating to required 

24 disclosure of rating practices to consumer). 


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1 ‘‘(ii) Section 14 (relating to applica2 tion forms and replacement coverage). 

3 ‘‘(iii) Section 15 (relating to reporting 

4 requirements). 

5 ‘‘(iv) Section 22 (relating to filing re6 quirements for marketing). 

7 ‘‘(v) Section 23 (relating to standards 

8 for marketing), including inaccurate com9 pletion of medical histories, other than 

10 paragraphs (1), (6), and (9) of section 

11 23C. 

12 ‘‘(vi) Section 24 (relating to suit13 ability). 

14 ‘‘(vii) Section 26 (relating to policy15 holder notifications). 

16 ‘‘(viii) Section 27 (relating to the 

17 right to reduce coverage and lower pre18 miums). 

19 ‘‘(ix) Section 31 (relating to standard 

20 format outline of coverage). 

21 ‘‘(x) Section 32 (relating to require22 ment to deliver shopper’s guide). 

23 ‘‘(B) MODEL ACT.—The following require24 ments of the model Act must be met: 


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1 ‘‘(i) Section 6F (relating to right to 

2 return). 

3 ‘‘(ii) Section 6G (relating to outline of 

4 coverage). 

5 ‘‘(iii) Section 6H (relating to require6 ments for certificates under group plans). 

7 ‘‘(iv) Section 6J (relating to policy 

8 summary). 

9 ‘‘(v) Section 6K (relating to monthly 

10 reports on accelerated death benefits). 

11 ‘‘(vi) Section 7 (relating to incontest12 ability period). 

13 ‘‘(vii) Section 9 (relating to producer 

14 training requirements). 

15 ‘‘(C) DEFINITIONS.—For purposes of this 

16 paragraph, the terms ‘model regulation’ and 

17 ‘model Act’ have the meanings given such terms 

18 by section 7702B(g)(2)(B).’’. 

19 (c) EFFECTIVE DATE.—The amendments made by 

20 this section shall apply to policies issued more than 1 year 

21 after the date of the enactment of this Act. 


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1 TITLE IV—PROMOTING AND 

2 PROTECTING COMMUNITY 

3 LIVING 

4 SEC. 401. MANDATORY APPLICATION OF SPOUSAL IMPOV5 ERISHMENT PROTECTIONS TO RECIPIENTS 

6 OF HOME AND COMMUNITY-BASED SERVICES. 

7 (a) IN GENERAL.—Section 1924(h)(1)(A) of the So8 cial Security Act (42 U.S.C. 1396r–5(h)(1)(A)) is amend9 ed by striking ‘‘(at the option of the State)is described 

10 in section 1902(a)(10)(A)(ii)(VI)’’ and inserting ‘‘is eligi11 ble for medical assistance for home and community-based 

12 services under subsection (c), (d), (e), (i), or (k) of section 

13 1915’’. 

14 (b) EFFECTIVE DATE.—The amendment made by 

15 subsection (a) takes effect on October 1, 2008. 

16 SEC. 402. STATE AUTHORITY TO ELECT TO EXCLUDE UP TO 

17 6 MONTHS OF AVERAGE COST OF NURSING 

18 FACILITY SERVICES FROM ASSETS OR RE19 SOURCES FOR PURPOSES OF ELIGIBILITY 

20 FOR HOME AND COMMUNITY-BASED SERV21 ICES. 

22 (a) IN GENERAL.—Section 1917 of the Social Secu23 rity Act (42 U.S.C. 1396p) is amended by adding at the 

24 end the following new subsection: 


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•S 3327 IS

1 ‘‘(i) STATE AUTHORITY TO EXCLUDE UP TO 6 

2 MONTHS OF AVERAGE COST OF NURSING FACILITY

3 SERVICES FROM HOME AND COMMUNITY-BASED SERV4 ICES ELIGIBILITY DETERMINATIONS.—Nothing in this 

5 section or any other provision of this title, shall be con6 strued as prohibiting a State from excluding from any de7 termination of an individual’s assets or resources for pur8 poses of determining the eligibility of the individual for 

9 medical assistance for home and community-based services 

10 under subsection (c), (d), (e), (i), or (k) of section 1915 

11 (if a State imposes an limitation on assets or resources 

12 for purposes of eligibility for such services), an amount 

13 equal to the product of the amount applicable under sub14 section (c)(1)(E)(ii)(II) (at the time such determination 

15 is made) and such number, not to exceed 6, as the State 

16 may elect.’’. 

17 (b) RULE OF CONSTRUCTION.—Nothing in the 

18 amendment made by subsection (a) shall be construed as 

19 affecting a State’s option to apply less restrictive meth20 odologies under section 1902(r)(2) for purposes of deter21 mining income and resource eligibility for individuals spec22 ified in that section. 

23 (c) EFFECTIVE DATE.—The amendment made by 

24 subsection (a) takes effect on October 1, 2008. 


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1 TITLE V—MISCELLANEOUS 

2 SEC. 501. IMPROVED DATA COLLECTION. 

3 (a) SECRETARIAL REQUIREMENT TO REVISE DATA

4 REPORTING FORMS AND SYSTEMS TO ENSURE UNIFORM

5 AND CONSISTENT REPORTING BY STATES.—Not later 

6 than 6 months after the date of enactment of this Act, 

7 the Secretary of Health and Human Services, acting 

8 through the Administrator of the Centers for Medicare & 

9 Medicaid Services, shall revise CMS Form 372, CMS 

10 Form 64, and CMS Form 64.9 (or any successor forms) 

11 and the Medicaid Statistical Information Statistics 

12 (MSIS) claims processing system to ensure that, with re13 spect to any State that provides medical assistance to indi14 viduals under a waiver or State plan amendment approved 

15 under subsection (c), (d), (e), (i), (j), or (k) of section 

16 1915 of the Social Security Act (42 U.S.C. 1396n), the 

17 State reports to the Secretary, not less than annually and 

18 in a manner that is consistent and uniform for all States 

19 (and, in the case of medical assistance provided under a 

20 waiver or State plan amendment under any such sub21 section for home and community-based services, in a man22 ner that is consistent and uniform with the data required 

23 to be reported for purposes of monitoring or evaluating 

24 the provision of such services under the State plan or 

25 under a waiver approved under section 1115 of the Social 


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1 Security Act (42 U.S.C. 1315) to provide such services) 

2 the following data: 

3 (1) The total number of individuals provided 

4 medical assistance for such services under each waiv5 er to provide such services conducted by the State 

6 and each State plan amendment option to provide 

7 such services elected by the State. 

8 (2) The total amount of expenditures incurred 

9 for such services under each such waiver and State 

10 plan amendment option, disaggregated by expendi11 tures for medical assistance and administrative or 

12 other expenditures. 

13 (3) The types of such services provided by the 

14 State under each such waiver and State plan amend15 ment option. 

16 (4) The number of individuals on a waiting list 

17 (if any) to be enrolled under each such waiver and 

18 State plan amendment option or to receive services 

19 under each such waiver and State plan amendment 

20 option. 

21 (5) With respect to home health services, pri22 vate duty nursing services, case management serv23 ices, and rehabilitative services provided under each 

24 such waiver and State plan amendment option, the 

25 total number of individuals provided each type of 


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1 such services, the total amount of expenditures in2 curred for each type of services, and whether each 

3 such service was provided for long-term care or 

4 acute care purposes. 

5 (b) PUBLIC AVAILABILITY.—Not later than 6 months 

6 after the date of enactment of this Act, the Secretary of 

7 Health and Human Services, acting through the Adminis8 trator of the Centers for Medicare & Medicaid Services, 

9 shall make publicly available, in a State identifiable man10 ner, the data described in subsection (a) through an Inter11 net website and otherwise as the Secretary determines ap12 propriate. 

13 SEC. 502. GAO REPORT ON MEDICAID HOME HEALTH SERV14 ICES AND THE EXTENT OF CONSUMER SELF15 DIRECTION OF SUCH SERVICES. 

16 (a) STUDY.—The Comptroller General of the United 

17 States shall study the provision of home health services 

18 under State Medicaid plans under title XIX of the Social 

19 Security Act. Such study shall include an examination of 

20 the extent to which there are variations among the States 

21 with respect to the provision of home health services in 

22 general under State Medicaid plans, including the extent 

23 to which such plans impose limits on the types of services 

24 that a home health aide may provide a Medicaid bene25 ficiary and the extent to which States offer consumer selfVerDate Aug 31 2005 21:32 Jul 25, 2008 Jkt 069200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\S3327.IS S3327

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1 direction of such services or allow for other consumer-ori2 ented policies with respect to such services. 

3 (b) REPORT.—Not later than 1 year after the date 

4 of enactment of this Act, the Comptroller General shall 

5 submit a report to Congress on the results of the study 

6 conducted under subsection (a), together with such rec7 ommendations for legislative or administrative changes as 

8 the Comptroller General determines appropriate in order 

9 to provide home health services under State Medicaid 

10 plans in accordance with identified best practices for the 

11 provision of such services. 

Æ 


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