I 

111TH CONGRESS 

1ST SESSION H. R. 2688 

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 HOUSE OF REPRESENTATIVES 

JUNE 3, 2009 

Mr. PALLONE (for himself and Ms. DEGETTE) introduced the following bill; 

which was referred to the Committee on Energy and Commerce 

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 2009’’. 

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. Increase in Federal medical assistance percentage (FMAP) for the 

provision of home and community-based services under Medicaid through the State plan amendment option. 

Sec. 103. Annual report on use of Medicaid State plan amendment option for 

home and community-based services. 

TITLE II—STATE GRANTS TO FACILITATE HOME AND 

COMMUNITY-BASED SERVICES AND PROMOTE HEALTH 

Sec. 201. Reauthorization of Medicaid investment 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—PROMOTING AND PROTECTING COMMUNITY LIVING 

Sec. 301. Mandatory application of spousal impoverishment protections to recipients of home and community-based services. 

Sec. 302. Exclusion of 6 months of average cost of nursing facility services 

from assets or resources for purposes of eligibility for home 

and community-based services. 

TITLE IV—MISCELLANEOUS 

Sec. 401. Improved data collection. 

Sec. 402. GAO report on Medicaid home health services and the extent of consumer self-direction of such services. 

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. 


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1 1396n(i)) is amended by striking ‘‘150 percent of the pov2 erty line (as defined in section 2110(c)(5))’’ and inserting 

3 ‘‘300 percent of the supplemental security income benefit 

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

5 (b) AUTHORITY TO OFFER DIFFERENT TYPE, 

6 AMOUNT, DURATION, OR SCOPE OF HOME AND COMMU7 NITY-BASED SERVICES.—Section 1915(i) of the Social Se8 curity Act (42 U.S.C. 1396n(i)) is amended by adding at 

9 the end the following new paragraph: 

10 ‘‘(6) AUTHORITY TO OFFER DIFFERENT TYPE, 

11 AMOUNT, DURATION, OR SCOPE OF HOME AND COM12 MUNITY-BASED SERVICES.—A State may offer home 

13 and community-based services to individuals under 

14 this paragraph that differ in type, amount, duration, 

15 or scope from the home and community-based serv16 ices offered to other such individuals, taking into ac17 count the needs-based criteria established under 

18 paragraph (1)(A), so long as such services are with19 in the scope of services described in paragraph 

20 (4)(B) of subsection (c) for which the Secretary has 

21 the authority to approve a waiver and do not include 

22 room or board.’’. 

23 (c) REMOVAL OF LIMITATION ON SCOPE OF SERV24 ICES.—Paragraph (1) of section 1915(i) of the Social Se25 curity Act (42 U.S.C. 1396n(i)), as amended by subVerDate Nov 24 2008 05:32 Jun 04, 2009 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2688.IH H2688

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1 section (a), is amended by striking ‘‘or such other services 

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

3 (d) OPTIONAL ELIGIBILITY CATEGORY TO PROVIDE

4 FULL MEDICAID BENEFITS TO INDIVIDUALS RECEIVING

5 HOME AND COMMUNITY-BASED SERVICES UNDER A

6 STATE PLAN AMENDMENT.— 

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

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

9 1396a(a)(10)(A)(ii)) is amended— 

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

11 at the end; 

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

13 the end; and 

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

15 following new subclause: 

16 ‘‘(XX) who are eligible for home 

17 and community-based services under 

18 needs-based criteria established under 

19 paragraph (1)(A) of section 1915(i) 

20 and who will receive home and com21 munity-based services pursuant to a 

22 State plan amendment under section 

23 1915(i);’’. 

24 (2) CONFORMING AMENDMENTS.— 


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1 (A) Section 1903(f)(4) of the Social Secu2 rity Act (42 U.S.C. 1396b(f)(4)) is amended in 

3 the matter preceding subparagraph (A), by in4 serting ‘‘1902(a)(10)(A)(ii)(XX),’’ after 

5 ‘‘1902(a)(10)(A)(ii)(XIX),’’. 

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

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

8 matter preceding paragraph (1)— 

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

10 the end; 

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

12 the end; and 

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

14 following new clause: 

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

16 community-based services under needs-based criteria 

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

18 1915(i) 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. INCREASE IN FEDERAL MEDICAL ASSISTANCE 

4 PERCENTAGE (FMAP) FOR THE PROVISION 

5 OF HOME AND COMMUNITY-BASED SERVICES 

6 UNDER MEDICAID THROUGH THE STATE 

7 PLAN AMENDMENT OPTION. 

8 (a) IN GENERAL.—Section 1905(b) of the Social Se9 curity Act (42 U.S.C. 1396d(b)) is amended by adding 

10 at the end the following: ‘‘Notwithstanding the previous 

11 provisions of this subsection, the Federal medical assist12 ance percentage with respect to amounts expended as 

13 medical assistance for home and community-based services 

14 provided through a State plan amendment that satisfies 

15 the requirements of section 1915(i) shall be the enhanced 

16 FMAP (as defined in section 2105(b)), but determined by 

17 substituting ‘10 percent’ for ‘30 percent’ in such section.’’. 

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

19 subsection (a) shall apply to home and community-based 

20 services furnished on or after October 1, 2009. 

21 SEC. 103. ANNUAL REPORT ON USE OF MEDICAID STATE 

22 PLAN AMENDMENT OPTION FOR HOME AND 

23 COMMUNITY-BASED SERVICES. 

24 The Secretary of Health and Human Services shall 

25 submit to Congress an annual report on the extent to 


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1 which State Medicaid plans have adopted a State plan 

2 amendment under section 1915(i) of the Social Security 

3 Act (42 U.S.C. 1396n(i)), as amended by this title, for 

4 medical assistance for home and community-based services 

5 for elderly and disabled individuals. Each such report shall 

6 include the number of beneficiaries who are provided serv7 ices under such an amendment and on changes made in 

8 the use of waiver authority under section 1915(c) of such 

9 Act (42 U.S.C. 1396n(c)) as a result of implementation 

10 of such a State plan amendment. 

11 TITLE II—STATE GRANTS TO FA12 CILITATE HOME AND COMMU13 NITY-BASED SERVICES AND 

14 PROMOTE HEALTH 

15 SEC. 201. REAUTHORIZATION OF MEDICAID INVESTMENT 

16 GRANTS AND EXPANSION OF PERMISSIBLE 

17 USES IN ORDER TO FACILITATE THE PROVI18 SION OF HOME AND COMMUNITY-BASED AND 

19 OTHER LONG-TERM CARE SERVICES. 

20 (a) 2-YEAR REAUTHORIZATION; INCREASED FUND21 ING.—Section 1903(z)(4)(A) of the Social Security Act 

22 (42 U.S.C. 1396b(z)(4)(A)) is amended— 

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

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

25 end and inserting ‘‘; and’’; and 


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

2 new clauses: 

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

4 2010; and 

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

6 2011.’’. 

7 (b) EXPANSION OF PERMISSIBLE USES.—Section 

8 1903(z)(2) of the Social Security Act (42 U.S.C. 

9 1396b(z)(2)) is amended by adding at the end the fol10 lowing new subparagraphs: 

11 ‘‘(G)(i) Methods for ensuring the avail12 ability and accessibility of home- and commu13 nity-based services in the State, recognizing 

14 multiple delivery options that take into account 

15 differing needs of individuals, through the cre16 ation or designation (in consultation with orga17 nizations representing elderly individuals and 

18 individuals of all ages with physical, mental, 

19 cognitive, or intellectual impairments, and orga20 nizations representing the long-term care work21 force, including organized labor, and health 

22 care and direct service providers) of one or 

23 more statewide or regional public entities or 

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1 missions, public authorities, worker associa2 tions, consumer-owned and controlled organiza3 tions (including representatives of individuals 

4 with severe intellectual or cognitive impair5 ment), area agencies on aging, independent liv6 ing centers, aging and disability resource cen7 ters, or other disability organizations) which 

8 may— 

9 ‘‘(I) develop programs where qualified 

10 individuals provide home- and community11 based services while solely or jointly em12 ployed by recipients of such services; 

13 ‘‘(II) facilitate the training and re14 cruitment of qualified health and direct 

15 service professionals and consumers who 

16 use services; 

17 ‘‘(III) recommend or develop a system 

18 to set wages and benefits, and recommend 

19 commensurate reimbursement rates; 

20 ‘‘(IV) with meaningful ongoing in21 volvement from consumers and workers (or 

22 their respective representatives), develop 

23 procedures for the appropriate screening of 

24 workers, create a registry or registries of 

25 available workers, including policies and 


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1 procedures to ensure no interruption of 

2 care for eligible individuals; 

3 ‘‘(V) assist consumers in identifying 

4 workers; 

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

6 ‘‘(VII) assist workers in finding em7 ployment, including consumer-directed em8 ployment; 

9 ‘‘(VIII) provide funding for disability 

10 organizations, aging organizations, or 

11 other organizations, to assume roles that 

12 promote consumers’ ability to acquire the 

13 necessary skills for directing their own 

14 services and financial resources; or 

15 ‘‘(IX) create workforce development 

16 plans on a regional or statewide basis (or 

17 both), to ensure a sufficient supply of 

18 qualified home and community-based serv19 ices workers, including reviews and anal20 yses of actual and potential worker short21 ages, training and retention programs for 

22 home and community-based services work23 ers (which may include, as determined ap24 propriate by the State, allowing participa25 tion in such training to count as an allowVerDate Nov 24 2008 05:32 Jun 04, 2009 Jkt 079200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H2688.IH H2688

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1 able work activity under the State tem2 porary assistance for needy families pro3 gram funded under part A of title IV), and 

4 plans to assist consumers with finding and 

5 retaining qualified workers. 

6 ‘‘(ii) Nothing in clause (i) shall be con7 strued as prohibiting the use of funds made 

8 available to carry out this subparagraph for 

9 start-up costs associated with any of the activi10 ties described in subclauses (I) through (IX), as 

11 requiring any consumer to hire workers who are 

12 listed in a worker registry developed with such 

13 funds, or to limit the ability of consumers to 

14 hire or fire their own workers. 

15 ‘‘(H) Methods for providing an integrated 

16 and efficient system of long-term care through 

17 a review of the Federal, State, local, and pri18 vate long-term care resources, services, and 

19 supports available to elderly individuals and in20 dividuals of all ages with physical, mental, cog21 nitive, or intellectual impairments and the de22 velopment and implementation of a plan to fully 

23 integrate such resources, services, and supports 

24 by aggregating such resources, services, and 

25 supports to create a consumer-centered and 


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1 cost-effective resource and delivery system and 

2 expanding the availability of home and commu3 nity-based services, and that is designed to re4 sult in administrative savings, consolidation of 

5 common activities, and the elimination of re6 dundant processes.’’. 

7 (c) ALLOCATION OF FUNDS.— 

8 (1) ELIMINATION OF CURRENT LAW REQUIRE9 MENTS FOR ALLOCATION OF FUNDS.—Section 

10 1903(z)(4)(B) of the Social Security Act (42 U.S.C. 

11 1396b(z)(4)(B)) is amended by striking the second 

12 and third sentences. 

13 (2) ASSURANCE OF FUNDS TO FACILITATE THE

14 PROVISION OF HOME AND COMMUNITY-BASED SERV15 ICES AND INTEGRATED SYSTEMS OF LONG-TERM

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

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

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

19 first sentence the following new sentence: ‘‘Such 

20 method shall provide that 50 percent of such funds 

21 shall be allocated among States that design pro22 grams to adopt the innovative methods described in 

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

24 (2).’’. 


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1 (d) RENAMING PROGRAM.—The heading of section 

2 1903(z) of such Act is amended by striking ‘‘TRANS3 FORMATION’’ and inserting ‘‘INVESTMENT’’. 

4 (e) CLARIFICATION.—Such section is further amend5 ed by adding at the end the following new paragraph: 

6 ‘‘(6) CLARIFICATION OF PROTECTION OF BENE7 FICIARIES.—Nothing in this section shall be con8 strued as authorizing States to use payments pro9 vided under this subsection for the purpose of lim10 iting eligibility or benefits under this title.’’. 

11 (f) EFFECTIVE DATE.—The amendments made by 

12 this section take effect on October 1, 2009. 

13 SEC. 202. HEALTH PROMOTION GRANTS. 

14 (a) DEFINITIONS.—In this section: 

15 (1) ELIGIBLE MEDICAID BENEFICIARY.—The 

16 term ‘‘eligible Medicaid beneficiary’’ means an indi17 vidual who is enrolled in the State Medicaid plan 

18 under title XIX of the Social Security Act and— 

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

20 a resident of a nursing facility; or 

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

22 cognitive, or intellectual impairment. 

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

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


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

2 form and manner as the Secretary shall require. 

3 (3) EVIDENCE- AND COMMUNITY-BASED

4 HEALTH PROMOTION PROGRAM.—The term 

5 ‘‘evidence- and community-based health promotion 

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

7 as a program for chronic disease self-management, 

8 physical or mental activity, falls prevention, smoking 

9 cessation, or dietary modification) that has been ob10 jectively evaluated and found to improve health out11 comes or meet health promotion goals by preventing, 

12 delaying, or decreasing the severity of physical, men13 tal, cognitive, or intellectual impairment and that 

14 meets generally accepted standards for best profes15 sional practice. 

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

17 the Secretary of Health and Human Services. 

18 (b) AUTHORITY TO CONDUCT DEMONSTRATION

19 PROJECT.—The Secretary shall award grants on a com20 petitive basis to eligible States to conduct in accordance 

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

22 promotion program that is designed to achieve the fol23 lowing objectives with respect to eligible Medicaid bene24 ficiaries: 


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1 (1) LIFESTYLE CHANGES.—To empower eligible 

2 Medicaid beneficiaries to take more control over 

3 their own health through lifestyle changes that have 

4 proven effective in reducing the effects of chronic 

5 disease and slowing the progression of disability. 

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

7 aging, disability, public health, and nonprofit net8 works at the State and local levels to accelerate the 

9 translation of credible research into practice through 

10 the deployment of low-cost evidence-based health 

11 promotion and disability prevention programs at the 

12 community level. 

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

14 In awarding grants to eligible States under this section 

15 and determining the amount of the awards, the Secretary 

16 shall— 

17 (1) take into consideration the manner and ex18 tent to which the eligible State proposes to achieve 

19 the objectives specified in subsection (b); and 

20 (2) give preference to eligible States pro21 posing— 

22 (A) programs through public service pro23 vider organizations or other organizations with 

24 expertise in serving eligible Medicaid bene25 ficiaries; 


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1 (B) strong State-level collaboration across, 

2 Medicaid agencies, State units on aging, State 

3 independent living councils, State associations 

4 of Area Agencies on Aging, and State agencies 

5 responsible for public health; or 

6 (C) interventions that have already dem7 onstrated effectiveness and replicability in a 

8 community-based, nonmedical setting. 

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

10 grant under this section shall use the funds awarded to 

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

12 community-based health promotion programs. As a condi13 tion of being awarded such a grant, an eligible State shall 

14 agree to— 

15 (1) implement such programs in at least 3 geo16 graphic areas of the State; and 

17 (2) develop the infrastructure and partnerships 

18 that will be necessary over the long-term to effec19 tively embed evidence- and community-based health 

20 promotion programs for eligible Medicaid bene21 ficiaries within the statewide health, aging, dis22 ability, and long-term care systems. 

23 (e) TECHNICAL ASSISTANCE.—The Secretary shall 

24 provide assistance to eligible States awarded grants under 

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1 ganizers, and others in developing evidence- and commu2 nity-based health promotion programs. 

3 (f) PAYMENTS TO ELIGIBLE STATES; CARRYOVER OF

4 UNUSED GRANT AMOUNTS.— 

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

6 a fiscal year that begins during the period for which 

7 an eligible State is awarded a grant under this sec8 tion, the Secretary shall pay to the State from its 

9 grant award for such fiscal year an amount equal to 

10 the lesser of— 

11 (A) the amount of qualified expenditures 

12 made by the State for such quarter; or 

13 (B) the total amount remaining in such 

14 grant award for such fiscal year (taking into 

15 account the application of paragraph (2)). 

16 (2) CARRYOVER OF UNUSED AMOUNTS.—Any 

17 portion of a State grant award for a fiscal year 

18 under this section remaining available at the end of 

19 such fiscal year shall remain available for making 

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

21 subject to paragraph (3). 

22 (3) REAWARDING OF CERTAIN UNUSED

23 AMOUNTS.—In the case of a State that the Sec24 retary determines has failed to meet the conditions 

25 for continuation of a demonstration project under 


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1 this section in a succeeding year, the Secretary shall 

2 rescind the grant award for each succeeding year, 

3 together with any unspent portion of an award for 

4 prior years, and shall add such amounts to the ap5 propriation for the immediately succeeding fiscal 

6 year for grants under this section. 

7 (4) PREVENTING DUPLICATION OF PAYMENT.— 

8 The payment under a demonstration project with re9 spect to qualified expenditures shall be in lieu of any 

10 payment with respect to such expenditures that 

11 would otherwise be paid to the State under section 

12 1903(a) of the Social Security Act (42 U.S.C. 

13 1396a(a)). Nothing in the previous sentence shall be 

14 construed as preventing a State from being paid 

15 under such section for expenditures in a grant year 

16 for which payment is available under such section 

17 1903(a) after amounts available to pay for such ex18 penditures under the grant awarded to the State 

19 under this section for the fiscal year have been ex20 hausted. 

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

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

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

24 contract, or interagency agreement, conduct an evaluation 

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1 tion that measures the health-related, quality of life, and 

2 cost outcomes for eligible Medicaid beneficiaries and in3 cludes information relating to the quality, infrastructure, 

4 sustainability, and effectiveness of such projects. 

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

6 any funds in the Treasury not otherwise appropriated, the 

7 following amounts to carry out this section: 

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

9 to remain available until expended— 

10 (A) $4,000,000 for fiscal year 2010; 

11 (B) $6,000,000 for fiscal year 2011; 

12 (C) $8,000,000 for fiscal year 2012; 

13 (D) $10,000,000 for fiscal year 2013; and 

14 (E) $12,000,000 for fiscal year 2014. 

15 (2) TECHNICAL ASSISTANCE.—For the provi16 sion of technical assistance through such center in 

17 accordance with subsection (e)— 

18 (A) $800,000 for fiscal year 2010; 

19 (B) $1,200,000 for fiscal year 2011; 

20 (C) $1,600,000 for fiscal year 2012; 

21 (D) $2,000,000 for fiscal year 2013; and 

22 (E) $2,400,000 for fiscal year 2014. 

23 (3) EVALUATION.—For conducting the evalua24 tion required under subsection (g), $4,000,000 for 

25 fiscal year 2012. 


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1 TITLE III—PROMOTING AND 

2 PROTECTING COMMUNITY 

3 LIVING 

4 SEC. 301. 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, 2009. 

16 SEC. 302. EXCLUSION OF 6 MONTHS OF AVERAGE COST OF 

17 NURSING FACILITY SERVICES FROM ASSETS 

18 OR RESOURCES FOR PURPOSES OF ELIGI19 BILITY FOR HOME AND COMMUNITY-BASED 

20 SERVICES. 

21 (a) IN GENERAL.—Section 1917 of the Social Secu22 rity Act (42 U.S.C. 1396p) is amended by adding at the 

23 end the following new subsection: 

24 ‘‘(i) EXCLUSION OF 6 MONTHS OF AVERAGE COST

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1 MUNITY-BASED SERVICES ELIGIBILITY DETERMINA2 TIONS.—Notwithstanding any other provision of law, each 

3 State shall exclude from any determination of an individ4 ual’s assets or resources, for purposes of determining the 

5 eligibility of the individual for medical assistance for home 

6 and community-based services under subsection (c), (d), 

7 (e), (i), or (k) of section 1915 (if a State imposes an limi8 tation on assets or resources for purposes of eligibility for 

9 such services), an amount equal to six times the amount 

10 applicable under subsection (c)(1)(E)(ii)(II) (at the time 

11 such determination is made).’’. 

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

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

14 affecting a State’s option to apply less restrictive meth15 odologies under section 1902(r)(2) for purposes of deter16 mining income and resource eligibility for individuals spec17 ified in that section. 

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

19 subsection (a) takes effect on October 1, 2009. 

20 TITLE IV—MISCELLANEOUS 

21 SEC. 401. IMPROVED DATA COLLECTION. 

22 (a) SECRETARIAL REQUIREMENT TO REVISE DATA

23 REPORTING FORMS AND SYSTEMS TO ENSURE UNIFORM

24 AND CONSISTENT REPORTING BY STATES.—Not later 

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


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1 the Secretary of Health and Human Services, acting 

2 through the Administrator of the Centers for Medicare & 

3 Medicaid Services, shall revise CMS Form 372, CMS 

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

5 and the Medicaid Statistical Information Statistics 

6 (MSIS) claims processing system to ensure that, with re7 spect to any State that provides medical assistance to indi8 viduals under a waiver or State plan amendment approved 

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

10 1915 of the Social Security Act (42 U.S.C. 1396n), the 

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

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

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

14 waiver or State plan amendment under any such sub15 section for home- and community-based services, in a 

16 manner that is consistent and uniform with the data re17 quired to be reported for purposes of monitoring or evalu18 ating the provision of such services under the State plan 

19 or under a waiver approved under section 1115 of the So20 cial Security Act (42 U.S.C. 1315) to provide such serv21 ices) the following data: 

22 (1) The total number of individuals provided 

23 medical assistance for such services under each waiv24 er to provide such services conducted by the State 


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1 and each State plan amendment option to provide 

2 such services elected by the State. 

3 (2) The total amount of expenditures incurred 

4 for such services under each such waiver and State 

5 plan amendment option, disaggregated by expendi6 tures for medical assistance and administrative or 

7 other expenditures. 

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

9 State under each such waiver and State plan amend10 ment option. 

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

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

13 State plan amendment option or to receive services 

14 under each such waiver and State plan amendment 

15 option. 

16 (5) With respect to home health services, pri17 vate duty nursing services, case management serv18 ices, and rehabilitative services provided under each 

19 such waiver and State plan amendment option, the 

20 total number of individuals provided each type of 

21 such services, the total amount of expenditures in22 curred for each type of services, and whether each 

23 such service was provided for long-term care or 

24 acute care purposes. 


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

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

3 Health and Human Services, acting through the Adminis4 trator of the Centers for Medicare & Medicaid Services, 

5 shall make publicly available, in a State identifiable man6 ner, the data described in subsection (a) through an Inter7 net website and otherwise as the Secretary determines ap8 propriate. 

9 SEC. 402. GAO REPORT ON MEDICAID HOME HEALTH SERV10 ICES AND THE EXTENT OF CONSUMER SELF11 DIRECTION OF SUCH SERVICES. 

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

13 States shall study the provision of home health services 

14 under State Medicaid plans under title XIX of the Social 

15 Security Act. Such study shall include an examination of 

16 the extent to which there are variations among the States 

17 with respect to the provision of home health services in 

18 general under State Medicaid plans, including the extent 

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

20 that a home health aide may provide a Medicaid bene21 ficiary and the extent to which States offer consumer self22 direction of such services or allow for other consumer-ori23 ented policies with respect to such services. 

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

25 of enactment of this Act, the Comptroller General shall 


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

2 conducted under subsection (a), together with such rec3 ommendations for legislative or administrative changes as 

4 the Comptroller General determines appropriate in order 

5 to provide home health services under State Medicaid 

6 plans in accordance with identified best practices for the 

7 provision of such services. 

Æ 


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