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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2688 Introduced in House (IH)]

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.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Empowered at Home 
Act of 2009''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
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.

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.

    (a) Parity With Income Eligibility Standard for Institutionalized 
Individuals.--Paragraph (1) of section 1915(i) of the Social Security 
Act (42 U.S.C. 1396n(i)) is amended by striking ``150 percent of the 
poverty line (as defined in section 2110(c)(5))'' and inserting ``300 
percent of the supplemental security income benefit rate established by 
section 1611(b)(1)''.
    (b) Authority To Offer Different Type, Amount, Duration, or Scope 
of Home and Community-Based Services.--Section 1915(i) of the Social 
Security Act (42 U.S.C. 1396n(i)) is amended by adding at the end the 
following new paragraph:
            ``(6) Authority to offer different type, amount, duration, 
        or scope of home and community-based services.--A State may 
        offer home and community-based services to individuals under 
        this paragraph that differ in type, amount, duration, or scope 
        from the home and community-based services offered to other 
        such individuals, taking into account the needs-based criteria 
        established under paragraph (1)(A), so long as such services 
        are within the scope of services described in paragraph (4)(B) 
        of subsection (c) for which the Secretary has the authority to 
        approve a waiver and do not include room or board.''.
    (c) Removal of Limitation on Scope of Services.--Paragraph (1) of 
section 1915(i) of the Social Security Act (42 U.S.C. 1396n(i)), as 
amended by subsection (a), is amended by striking ``or such other 
services requested by the State as the Secretary may approve''
    (d) Optional Eligibility Category To Provide Full Medicaid Benefits 
to Individuals Receiving Home and Community-Based Services Under a 
State Plan Amendment.--
            (1) In general.--Section 1902(a)(10)(A)(ii) of the Social 
        Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--
                    (A) in subclause (XVIII), by striking ``or'' at the 
                end;
                    (B) in subclause (XIX), by adding ``or'' at the 
                end; and
                    (C) by inserting after subclause (XIX), the 
                following new subclause:
                                    ``(XX) who are eligible for home 
                                and community-based services under 
                                needs-based criteria established under 
                                paragraph (1)(A) of section 1915(i) and 
                                who will receive home and community-
                                based services pursuant to a State plan 
                                amendment under section 1915(i);''.
            (2) Conforming amendments.--
                    (A) Section 1903(f)(4) of the Social Security Act 
                (42 U.S.C. 1396b(f)(4)) is amended in the matter 
                preceding subparagraph (A), by inserting 
                ``1902(a)(10)(A)(ii)(XX),'' after 
                ``1902(a)(10)(A)(ii)(XIX),''.
                    (B) Section 1905(a) of the Social Security Act (42 
                U.S.C. 1396d(a)) is amended in the matter preceding 
                paragraph (1)--
                            (i) in clause (xii), by striking ``or'' at 
                        the end;
                            (ii) in clause (xiii), by adding ``or'' at 
                        the end; and
                            (iii) by inserting after clause (xiii) the 
                        following new clause:
            ``(xiv) individuals who are eligible for home and 
        community-based services under needs-based criteria established 
        under paragraph (1)(A) of section 1915(i) and who will receive 
        home and community-based services pursuant to a State plan 
        amendment under such subsection,''.
    (e) Elimination of Option To Limit Number of Eligible Individuals 
or Length of Period for Grandfathered Individuals if Eligibility 
Criteria Is Modified.--Paragraph (1) of section 1915(i) of such Act (42 
U.S.C. 1396n(i)) is amended--
            (1) by striking subparagraph (C) and inserting the 
        following:
                    ``(C) Projection of number of individuals to be 
                provided home and community-based services.--The State 
                submits to the Secretary, in such form and manner, and 
                upon such frequency as the Secretary shall specify, the 
                projected number of individuals to be provided home and 
                community-based services.''; and
            (2) in subclause (II) of subparagraph (D)(ii), by striking 
        ``to be eligible for such services for a period of at least 12 
        months beginning on the date the individual first received 
        medical assistance for such services'' and inserting ``to 
        continue to be eligible for such services after the effective 
        date of the modification and until such time as the individual 
        no longer meets the standard for receipt of such services under 
        such pre-modified criteria''.
    (f) Elimination of Option To Waive Statewideness.--Paragraph (3) of 
section 1915(i) of such Act (42 U.S.C. 1396n(3)) is amended by striking 
``section 1902(a)(1) (relating to statewideness) and''.
    (g) Effective Date.--The amendments made by this section take 
effect on the first day of the first fiscal year quarter that begins 
after the date of enactment of this Act.

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.

    (a) In General.--Section 1905(b) of the Social Security Act (42 
U.S.C. 1396d(b)) is amended by adding at the end the following: 
``Notwithstanding the previous provisions of this subsection, the 
Federal medical assistance percentage with respect to amounts expended 
as medical assistance for home and community-based services provided 
through a State plan amendment that satisfies the requirements of 
section 1915(i) shall be the enhanced FMAP (as defined in section 
2105(b)), but determined by substituting `10 percent' for `30 percent' 
in such section.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to home and community-based services furnished on or after 
October 1, 2009.

SEC. 103. ANNUAL REPORT ON USE OF MEDICAID STATE PLAN AMENDMENT OPTION 
              FOR HOME AND COMMUNITY-BASED SERVICES.

    The Secretary of Health and Human Services shall submit to Congress 
an annual report on the extent to which State Medicaid plans have 
adopted a State plan amendment under section 1915(i) of the Social 
Security Act (42 U.S.C. 1396n(i)), as amended by this title, for 
medical assistance for home and community-based services for elderly 
and disabled individuals. Each such report shall include the number of 
beneficiaries who are provided services under such an amendment and on 
changes made in the use of waiver authority under section 1915(c) of 
such Act (42 U.S.C. 1396n(c)) as a result of implementation of such a 
State plan amendment.

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.

    (a) 2-Year Reauthorization; Increased Funding.--Section 
1903(z)(4)(A) of the Social Security Act (42 U.S.C. 1396b(z)(4)(A)) is 
amended--
            (1) in clause (i), by striking ``and'' at the end;
            (2) in clause (ii), by striking the period at the end and 
        inserting ``; and''; and
            (3) by inserting after clause (ii), the following new 
        clauses:
                            ``(iii) $150,000,000 for fiscal year 2010; 
                        and
                            ``(iv) $150,000,000 for fiscal year 
                        2011.''.
    (b) Expansion of Permissible Uses.--Section 1903(z)(2) of the 
Social Security Act (42 U.S.C. 1396b(z)(2)) is amended by adding at the 
end the following new subparagraphs:
                    ``(G)(i) Methods for ensuring the availability and 
                accessibility of home- and community-based services in 
                the State, recognizing multiple delivery options that 
                take into account differing needs of individuals, 
                through the creation or designation (in consultation 
                with organizations representing elderly individuals and 
                individuals of all ages with physical, mental, 
                cognitive, or intellectual impairments, and 
                organizations representing the long-term care 
                workforce, including organized labor, and health care 
                and direct service providers) of one or more statewide 
                or regional public entities or nonprofit organizations 
                (such as fiscal intermediaries, agencies with choice, 
                home care commissions, public authorities, worker 
                associations, consumer-owned and controlled 
                organizations (including representatives of individuals 
                with severe intellectual or cognitive impairment), area 
                agencies on aging, independent living centers, aging 
                and disability resource centers, or other disability 
                organizations) which may--
                            ``(I) develop programs where qualified 
                        individuals provide home- and community-based 
                        services while solely or jointly employed by 
                        recipients of such services;
                            ``(II) facilitate the training and 
                        recruitment of qualified health and direct 
                        service professionals and consumers who use 
                        services;
                            ``(III) recommend or develop a system to 
                        set wages and benefits, and recommend 
                        commensurate reimbursement rates;
                            ``(IV) with meaningful ongoing involvement 
                        from consumers and workers (or their respective 
                        representatives), develop procedures for the 
                        appropriate screening of workers, create a 
                        registry or registries of available workers, 
                        including policies and procedures to ensure no 
                        interruption of care for eligible individuals;
                            ``(V) assist consumers in identifying 
                        workers;
                            ``(VI) act as a fiscal intermediary;
                            ``(VII) assist workers in finding 
                        employment, including consumer-directed 
                        employment;
                            ``(VIII) provide funding for disability 
                        organizations, aging organizations, or other 
                        organizations, to assume roles that promote 
                        consumers' ability to acquire the necessary 
                        skills for directing their own services and 
                        financial resources; or
                            ``(IX) create workforce development plans 
                        on a regional or statewide basis (or both), to 
                        ensure a sufficient supply of qualified home 
                        and community-based services workers, including 
                        reviews and analyses of actual and potential 
                        worker shortages, training and retention 
                        programs for home and community-based services 
                        workers (which may include, as determined 
                        appropriate by the State, allowing 
                        participation in such training to count as an 
                        allowable work activity under the State 
                        temporary assistance for needy families program 
                        funded under part A of title IV), and plans to 
                        assist consumers with finding and retaining 
                        qualified workers.
                    ``(ii) Nothing in clause (i) shall be construed as 
                prohibiting the use of funds made available to carry 
                out this subparagraph for start-up costs associated 
                with any of the activities described in subclauses (I) 
                through (IX), as requiring any consumer to hire workers 
                who are listed in a worker registry developed with such 
                funds, or to limit the ability of consumers to hire or 
                fire their own workers.
                    ``(H) Methods for providing an integrated and 
                efficient system of long-term care through a review of 
                the Federal, State, local, and private long-term care 
                resources, services, and supports available to elderly 
                individuals and individuals of all ages with physical, 
                mental, cognitive, or intellectual impairments and the 
                development and implementation of a plan to fully 
                integrate such resources, services, and supports by 
                aggregating such resources, services, and supports to 
                create a consumer-centered and cost-effective resource 
                and delivery system and expanding the availability of 
                home and community-based services, and that is designed 
                to result in administrative savings, consolidation of 
                common activities, and the elimination of redundant 
                processes.''.
    (c) Allocation of Funds.--
            (1) Elimination of current law requirements for allocation 
        of funds.--Section 1903(z)(4)(B) of the Social Security Act (42 
        U.S.C. 1396b(z)(4)(B)) is amended by striking the second and 
        third sentences.
            (2) Assurance of funds to facilitate the provision of home 
        and community-based services and integrated systems of long-
        term care.--Section 1903(z)(4)(B) of the Social Security Act 
        (42 U.S.C. 1396b(z)(4)(B)), as amended by paragraph (1), is 
        amended by inserting after the first sentence the following new 
        sentence: ``Such method shall provide that 50 percent of such 
        funds shall be allocated among States that design programs to 
        adopt the innovative methods described in subparagraph (G) or 
        (H) (or both) of paragraph (2).''.
    (d) Renaming Program.--The heading of section 1903(z) of such Act 
is amended by striking ``Transformation'' and inserting ``Investment''.
    (e) Clarification.--Such section is further amended by adding at 
the end the following new paragraph:
            ``(6) Clarification of protection of beneficiaries.--
        Nothing in this section shall be construed as authorizing 
        States to use payments provided under this subsection for the 
        purpose of limiting eligibility or benefits under this 
        title.''.
    (f) Effective Date.--The amendments made by this section take 
effect on October 1, 2009.

SEC. 202. HEALTH PROMOTION GRANTS.

    (a) Definitions.--In this section:
            (1) Eligible medicaid beneficiary.--The term ``eligible 
        Medicaid beneficiary'' means an individual who is enrolled in 
        the State Medicaid plan under title XIX of the Social Security 
        Act and--
                    (A) has attained the age of 60 and is not a 
                resident of a nursing facility; or
                    (B) is an adult with a physical, mental, cognitive, 
                or intellectual impairment.
            (2) Eligible state.--The term ``eligible State'' means a 
        State that submits an application to the Secretary for a grant 
        under this section, in such form and manner as the Secretary 
        shall require.
            (3) Evidence- and community-based health promotion 
        program.--The term ``evidence- and community-based health 
        promotion program'' means a community-based program (such as a 
        program for chronic disease self-management, physical or mental 
        activity, falls prevention, smoking cessation, or dietary 
        modification) that has been objectively evaluated and found to 
        improve health outcomes or meet health promotion goals by 
        preventing, delaying, or decreasing the severity of physical, 
        mental, cognitive, or intellectual impairment and that meets 
        generally accepted standards for best professional practice.
            (4) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (b) Authority To Conduct Demonstration Project.--The Secretary 
shall award grants on a competitive basis to eligible States to conduct 
in accordance with this section an evidence- and community-based health 
promotion program that is designed to achieve the following objectives 
with respect to eligible Medicaid beneficiaries:
            (1) Lifestyle changes.--To empower eligible Medicaid 
        beneficiaries to take more control over their own health 
        through lifestyle changes that have proven effective in 
        reducing the effects of chronic disease and slowing the 
        progression of disability.
            (2) Diffusion.--To mobilize the Medicaid, aging, 
        disability, public health, and nonprofit networks at the State 
        and local levels to accelerate the translation of credible 
        research into practice through the deployment of low-cost 
        evidence-based health promotion and disability prevention 
        programs at the community level.
    (c) Selection and Amount of Grant Awards.--In awarding grants to 
eligible States under this section and determining the amount of the 
awards, the Secretary shall--
            (1) take into consideration the manner and extent to which 
        the eligible State proposes to achieve the objectives specified 
        in subsection (b); and
            (2) give preference to eligible States proposing--
                    (A) programs through public service provider 
                organizations or other organizations with expertise in 
                serving eligible Medicaid beneficiaries;
                    (B) strong State-level collaboration across, 
                Medicaid agencies, State units on aging, State 
                independent living councils, State associations of Area 
                Agencies on Aging, and State agencies responsible for 
                public health; or
                    (C) interventions that have already demonstrated 
                effectiveness and replicability in a community-based, 
                nonmedical setting.
    (d) Use of Funds.--An eligible State awarded a grant under this 
section shall use the funds awarded to develop, implement, and sustain 
high quality evidence- and community-based health promotion programs. 
As a condition of being awarded such a grant, an eligible State shall 
agree to--
            (1) implement such programs in at least 3 geographic areas 
        of the State; and
            (2) develop the infrastructure and partnerships that will 
        be necessary over the long-term to effectively embed evidence- 
        and community-based health promotion programs for eligible 
        Medicaid beneficiaries within the statewide health, aging, 
        disability, and long-term care systems.
    (e) Technical Assistance.--The Secretary shall provide assistance 
to eligible States awarded grants under this section, subgrantees and 
their partners, program organizers, and others in developing evidence- 
and community-based health promotion programs.
    (f) Payments to Eligible States; Carryover of Unused Grant 
Amounts.--
            (1) Payments.--For each calendar quarter of a fiscal year 
        that begins during the period for which an eligible State is 
        awarded a grant under this section, the Secretary shall pay to 
        the State from its grant award for such fiscal year an amount 
        equal to the lesser of--
                    (A) the amount of qualified expenditures made by 
                the State for such quarter; or
                    (B) the total amount remaining in such grant award 
                for such fiscal year (taking into account the 
                application of paragraph (2)).
            (2) Carryover of unused amounts.--Any portion of a State 
        grant award for a fiscal year under this section remaining 
        available at the end of such fiscal year shall remain available 
        for making payments to the State for the next 4 fiscal years, 
        subject to paragraph (3).
            (3) Reawarding of certain unused amounts.--In the case of a 
        State that the Secretary determines has failed to meet the 
        conditions for continuation of a demonstration project under 
        this section in a succeeding year, the Secretary shall rescind 
        the grant award for each succeeding year, together with any 
        unspent portion of an award for prior years, and shall add such 
        amounts to the appropriation for the immediately succeeding 
        fiscal year for grants under this section.
            (4) Preventing duplication of payment.--The payment under a 
        demonstration project with respect to qualified expenditures 
        shall be in lieu of any payment with respect to such 
        expenditures that would otherwise be paid to the State under 
        section 1903(a) of the Social Security Act (42 U.S.C. 
        1396a(a)). Nothing in the previous sentence shall be construed 
        as preventing a State from being paid under such section for 
        expenditures in a grant year for which payment is available 
        under such section 1903(a) after amounts available to pay for 
        such expenditures under the grant awarded to the State under 
        this section for the fiscal year have been exhausted.
    (g) Evaluation.--Not later than 3 years after the date on which the 
first grant is awarded to an eligible State under this section, the 
Secretary shall, by grant, contract, or interagency agreement, conduct 
an evaluation of the demonstration projects carried out under this 
section that measures the health-related, quality of life, and cost 
outcomes for eligible Medicaid beneficiaries and includes information 
relating to the quality, infrastructure, sustainability, and 
effectiveness of such projects.
    (h) Appropriations.--There are appropriated, from any funds in the 
Treasury not otherwise appropriated, the following amounts to carry out 
this section:
            (1) Grants to states.--For grants to States, to remain 
        available until expended--
                    (A) $4,000,000 for fiscal year 2010;
                    (B) $6,000,000 for fiscal year 2011;
                    (C) $8,000,000 for fiscal year 2012;
                    (D) $10,000,000 for fiscal year 2013; and
                    (E) $12,000,000 for fiscal year 2014.
            (2) Technical assistance.--For the provision of technical 
        assistance through such center in accordance with subsection 
        (e)--
                    (A) $800,000 for fiscal year 2010;
                    (B) $1,200,000 for fiscal year 2011;
                    (C) $1,600,000 for fiscal year 2012;
                    (D) $2,000,000 for fiscal year 2013; and
                    (E) $2,400,000 for fiscal year 2014.
            (3) Evaluation.--For conducting the evaluation required 
        under subsection (g), $4,000,000 for fiscal year 2012.

          TITLE III--PROMOTING AND PROTECTING COMMUNITY LIVING

SEC. 301. MANDATORY APPLICATION OF SPOUSAL IMPOVERISHMENT PROTECTIONS 
              TO RECIPIENTS OF HOME AND COMMUNITY-BASED SERVICES.

    (a) In General.--Section 1924(h)(1)(A) of the Social Security Act 
(42 U.S.C. 1396r-5(h)(1)(A)) is amended by striking ``(at the option of 
the State)is described in section 1902(a)(10)(A)(ii)(VI)'' and 
inserting ``is eligible for medical assistance for home and community-
based services under subsection (c), (d), (e), (i), or (k) of section 
1915''.
    (b) Effective Date.--The amendment made by subsection (a) takes 
effect on October 1, 2009.

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.

    (a) In General.--Section 1917 of the Social Security Act (42 U.S.C. 
1396p) is amended by adding at the end the following new subsection:
    ``(i) Exclusion of 6 Months of Average Cost of Nursing Facility 
Services From Home and Community-Based Services Eligibility 
Determinations.--Notwithstanding any other provision of law, each State 
shall exclude from any determination of an individual's assets or 
resources, for purposes of determining the eligibility of the 
individual for medical assistance for home and community-based services 
under subsection (c), (d), (e), (i), or (k) of section 1915 (if a State 
imposes an limitation on assets or resources for purposes of 
eligibility for such services), an amount equal to six times the amount 
applicable under subsection (c)(1)(E)(ii)(II) (at the time such 
determination is made).''.
    (b) Rule of Construction.--Nothing in the amendment made by 
subsection (a) shall be construed as affecting a State's option to 
apply less restrictive methodologies under section 1902(r)(2) for 
purposes of determining income and resource eligibility for individuals 
specified in that section.
    (c) Effective Date.--The amendment made by subsection (a) takes 
effect on October 1, 2009.

                        TITLE IV--MISCELLANEOUS

SEC. 401. IMPROVED DATA COLLECTION.

    (a) Secretarial Requirement To Revise Data Reporting Forms and 
Systems To Ensure Uniform and Consistent Reporting by States.--Not 
later than 6 months after the date of enactment of this Act, the 
Secretary of Health and Human Services, acting through the 
Administrator of the Centers for Medicare & Medicaid Services, shall 
revise CMS Form 372, CMS Form 64, and CMS Form 64.9 (or any successor 
forms) and the Medicaid Statistical Information Statistics (MSIS) 
claims processing system to ensure that, with respect to any State that 
provides medical assistance to individuals under a waiver or State plan 
amendment approved under subsection (c), (d), (e), (i), (j), or (k) of 
section 1915 of the Social Security Act (42 U.S.C. 1396n), the State 
reports to the Secretary, not less than annually and in a manner that 
is consistent and uniform for all States (and, in the case of medical 
assistance provided under a waiver or State plan amendment under any 
such subsection for home- and community-based services, in a manner 
that is consistent and uniform with the data required to be reported 
for purposes of monitoring or evaluating the provision of such services 
under the State plan or under a waiver approved under section 1115 of 
the Social Security Act (42 U.S.C. 1315) to provide such services) the 
following data:
            (1) The total number of individuals provided medical 
        assistance for such services under each waiver to provide such 
        services conducted by the State and each State plan amendment 
        option to provide such services elected by the State.
            (2) The total amount of expenditures incurred for such 
        services under each such waiver and State plan amendment 
        option, disaggregated by expenditures for medical assistance 
        and administrative or other expenditures.
            (3) The types of such services provided by the State under 
        each such waiver and State plan amendment option.
            (4) The number of individuals on a waiting list (if any) to 
        be enrolled under each such waiver and State plan amendment 
        option or to receive services under each such waiver and State 
        plan amendment option.
            (5) With respect to home health services, private duty 
        nursing services, case management services, and rehabilitative 
        services provided under each such waiver and State plan 
        amendment option, the total number of individuals provided each 
        type of such services, the total amount of expenditures 
        incurred for each type of services, and whether each such 
        service was provided for long-term care or acute care purposes.
    (b) Public Availability.--Not later than 6 months after the date of 
enactment of this Act, the Secretary of Health and Human Services, 
acting through the Administrator of the Centers for Medicare & Medicaid 
Services, shall make publicly available, in a State identifiable 
manner, the data described in subsection (a) through an Internet 
website and otherwise as the Secretary determines appropriate.

SEC. 402. GAO REPORT ON MEDICAID HOME HEALTH SERVICES AND THE EXTENT OF 
              CONSUMER SELF-DIRECTION OF SUCH SERVICES.

    (a) Study.--The Comptroller General of the United States shall 
study the provision of home health services under State Medicaid plans 
under title XIX of the Social Security Act. Such study shall include an 
examination of the extent to which there are variations among the 
States with respect to the provision of home health services in general 
under State Medicaid plans, including the extent to which such plans 
impose limits on the types of services that a home health aide may 
provide a Medicaid beneficiary and the extent to which States offer 
consumer self-direction of such services or allow for other consumer-
oriented policies with respect to such services.
    (b) Report.--Not later than 1 year after the date of enactment of 
this Act, the Comptroller General shall submit a report to Congress on 
the results of the study conducted under subsection (a), together with 
such recommendations for legislative or administrative changes as the 
Comptroller General determines appropriate in order to provide home 
health services under State Medicaid plans in accordance with 
identified best practices for the provision of such services.
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