(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 net-
works 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 ex-
tent to which the eligible State proposes to achieve 
the objectives specified in subsection (b); and 
(2) give preference to eligible States pro-
posing— 
(A) programs through public service pro-
vider organizations or other organizations with 
expertise in serving eligible Medicaid bene-
ficiaries; 
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(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 dem-
onstrated effectiveness and replicability in a 
community-based, non-medical 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 condi-
tion of being awarded such a grant, an eligible State shall 
agree to— 
(1) implement such programs in at least 3 geo-
graphic areas of the State; and 
(2) develop the infrastructure and partnerships 
that will be necessary over the long-term to effec-
tively embed evidence-and community-based health 
promotion programs for eligible Medicaid bene-
ficiaries within the statewide health, aging, dis-
ability, and long-term care systems. 
(e) TECHNICAL ASSISTANCE.—The Secretary shall 
provide assistance to eligible States awarded grants under 
this section, sub-grantees and their partners, program or-
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ganizers, and others in developing evidence- and commu-
nity-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 sec-
tion, 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 Sec-
retary determines has failed to meet the conditions 
for continuation of a demonstration project under 
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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 ap-
propriation for the immediately succeeding fiscal 
year for grants under this section. 
(4) PREVENTING DUPLICATION OF PAYMENT.— 
The payment under a demonstration project with re-
spect 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 ex-
penditures under the grant awarded to the State 
under this section for the fiscal year have been ex-
hausted. 
(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 sec-
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tion that measures the health-related, quality of life, and 
cost outcomes for eligible Medicaid beneficiaries and in-
cludes 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 2009; 
(B) $6,000,000 for fiscal year 2010; 
(C) $8,000,000 for fiscal year 2011; 
(D) $10,000,000 for fiscal year 2012; and 
(E) $12,000,000 for fiscal year 2013. 
(2) TECHNICAL
ASSISTANCE.—For the provi-
sion of technical assistance through such center in 
accordance with subsection (e)— 
(A) $800,000 for fiscal year 2009; 
(B) $1,200,000 for fiscal year 2010; 
(C) $1,600,000 for fiscal year 2011; 
(D) $2,000,000 for fiscal year 2012; and 
(E) $2,400,000 for fiscal year 2013. 
(3) EVALUATION.—For conducting the evalua-
tion required under subsection (g), $4,000,000 for 
fiscal year 2011. 
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TITLE 
III—PROMOTING 
AND 
PROTECTING 
COMMUNITY 
LIVING 
SEC. 301. MANDATORY APPLICATION OF SPOUSAL IMPOV-
ERISHMENT PROTECTIONS TO RECIPIENTS 
OF HOME AND COMMUNITY-BASED SERVICES. 
(a) IN GENERAL.—Section 1924(h)(1)(A) of the So-
cial Security Act (42 U.S.C. 1396r–5(h)(1)(A)) is amend-
ed by striking ‘‘(at the option of the State)is described 
in section 1902(a)(10)(A)(ii)(VI)’’ and inserting ‘‘is eligi-
ble 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, 2008. 
SEC. 302. EXCLUSION OF 6 MONTHS OF AVERAGE COST OF 
NURSING FACILITY SERVICES FROM ASSETS 
OR RESOURCES FOR PURPOSES OF ELIGI-
BILITY FOR HOME AND COMMUNITY-BASED 
SERVICES. 
(a) IN GENERAL.—Section 1917 of the Social Secu-
rity 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 COM-
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MUNITY-BASED
SERVICES
ELIGIBILITY
DETERMINA-
TIONS.—Notwithstanding any other provision of law, each 
State shall exclude from any determination of an individ-
ual’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 limi-
tation 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 meth-
odologies under section 1902(r)(2) for purposes of deter-
mining income and resource eligibility for individuals spec-
ified in that section. 
(c) EFFECTIVE DATE.—The amendment made by 
subsection (a) takes effect on October 1, 2008. 
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, 
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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 re-
spect to any State that provides medical assistance to indi-
viduals 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 sub-
section for home and community-based services, in a man-
ner 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 waiv-
er to provide such services conducted by the State 
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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 expendi-
tures 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 amend-
ment 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, pri-
vate duty nursing services, case management serv-
ices, 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 in-
curred for each type of services, and whether each 
such service was provided for long-term care or 
acute care purposes. 
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(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 Adminis-
trator of the Centers for Medicare & Medicaid Services, 
shall make publicly available, in a State identifiable man-
ner, the data described in subsection (a) through an Inter-
net website and otherwise as the Secretary determines ap-
propriate. 
SEC. 402. GAO REPORT ON MEDICAID HOME HEALTH SERV-
ICES 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 bene-
ficiary and the extent to which States offer consumer self- 
direction of such services or allow for other consumer-ori-
ented 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 
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submit a report to Congress on the results of the study 
conducted under subsection (a), together with such rec-
ommendations 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. 
Æ 
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