1.Short title; table of
contents
(a)This Act may be cited
as the Empowered at Home Act of
2009
.
(b)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.
<enum>I</enum><header>Strengthening the
Medicaid Home and Community-Based State Plan Amendment Option</header>
<section id="H355C8B2FC8CE4502AEBECFC608287C9D"><enum>101.</enum><header>Removal of
barriers to providing home and community-based services under State plan
amendment option for individuals in need</header>
<subsection id="H489633B69C574B98A7C9423EE8A9F9E3"><enum>(a)</enum><header>Parity with
income eligibility standard for institutionalized individuals</header><text display-inline="yes-display-inline">Paragraph (1) of section 1915(i) of the
Social Security Act (42 U.S.C. 1396n(i)) is amended by striking <quote>150
percent of the poverty line (as defined in section 2110(c)(5))</quote> and
inserting <quote>300 percent of the supplemental security income benefit rate
established by section 1611(b)(1)</quote>.</text>
</subsection><subsection id="H58B81F012AF74D8E9602E04390BC6743"><enum>(b)</enum><header>Authority To
offer different type, amount, duration, or scope of home and community-based
services</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="HAD4886AAB55840E7BEDE8EC6A4A3B8C1" style="OLC">
<paragraph id="HBCA477B6E8254016AAE25BDFB1B2F1E0"><enum>(6)</enum><header>Authority to
offer different type, amount, duration, or scope of home and community-based
services</header><text>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.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H89BF6EFE7B944C80B73F4FE77E60AE96"><enum>(c)</enum><header>Removal of
limitation on scope of services</header><text display-inline="yes-display-inline">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 <quote>or such other services requested by the State as the
Secretary may approve</quote></text>
</subsection><subsection id="H7E2E9A5EB3494797A5D46CCE570241C7"><enum>(d)</enum><header>Optional
eligibility category To provide full medicaid benefits to individuals receiving
home and community-based services under a State plan amendment</header>
<paragraph id="H5512C091229C493C00DD8F5D73A58187"><enum>(1)</enum><header>In
general</header><text>Section 1902(a)(10)(A)(ii) of the Social Security Act (42
U.S.C. 1396a(a)(10)(A)(ii)) is amended—</text>
<subparagraph id="H51C235681ED746178D2500BACF4EC24"><enum>(A)</enum><text>in subclause
(XVIII), by striking <quote>or</quote> at the end;</text>
</subparagraph><subparagraph id="H52EC7D84D3C0450E9ED1F5BFCD978B76"><enum>(B)</enum><text>in subclause
(XIX), by adding <quote>or</quote> at the end; and</text>
</subparagraph><subparagraph id="H2640CFB0972F4FA486B3206200003351"><enum>(C)</enum><text>by inserting after
subclause (XIX), the following new subclause:</text>
<quoted-block display-inline="no-display-inline" id="H2DA8AF3AADEF469AAD55E04E2484D309" style="OLC">
<subclause id="HCFB183ECFDA9463AB33677698EAEEFA3"><enum>(XX)</enum><text>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);</text>
</subclause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H42E4051A54AF4BCD91A1312753CEDEC7"><enum>(2)</enum><header>Conforming
amendments</header>
<subparagraph id="H398258039A24477AA918A80600372D98"><enum>(A)</enum><text>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 <quote>1902(a)(10)(A)(ii)(XX),</quote>
after <quote>1902(a)(10)(A)(ii)(XIX),</quote>.</text>
</subparagraph><subparagraph id="H47EEBED12C1C43F2B9EA2E9076CD9C07"><enum>(B)</enum><text>Section 1905(a) of
the Social Security Act (42 U.S.C. 1396d(a)) is amended in the matter preceding
paragraph (1)—</text>
<clause id="H84345A4496214F98BB6DC9BFC086D1C5"><enum>(i)</enum><text>in
clause (xii), by striking <quote>or</quote> at the end;</text>
</clause><clause id="H3B6CA41A76974FC89B90B28FA9FAE3FE"><enum>(ii)</enum><text>in
clause (xiii), by adding <quote>or</quote> at the end; and</text>
</clause><clause id="HFE20BD6B1C604F10AE41E4E0D582ADBC"><enum>(iii)</enum><text>by
inserting after clause (xiii) the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="H8A045462073240289E8D54E5C2FEE547" style="OLC">
<clause id="HFDB7C3E348EE40FDB35357F09226199B" indent="up2"><enum>(xiv)</enum><text>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,</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph></paragraph></subsection><subsection id="HED316CF4BA6543DDA06975A7FF690038"><enum>(e)</enum><header>Elimination of
option To limit number of eligible individuals or length of period for
grandfathered individuals if eligibility criteria is modified</header><text display-inline="yes-display-inline">Paragraph (1) of section 1915(i) of such
Act (42 U.S.C. 1396n(i)) is amended—</text>
<paragraph id="H85164DD8BE7C4043B1BB1F00FEC0DAA1"><enum>(1)</enum><text display-inline="yes-display-inline">by striking subparagraph (C) and inserting
the following:</text>
<quoted-block display-inline="no-display-inline" id="H5087E15AC89540BBAC202E8040C8FEF3" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="HF17BBBB4DFE445D8B03134132FCE9F85"><enum>(C)</enum><header display-inline="yes-display-inline">Projection of number of individuals to be
provided home and community-based services</header><text>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.</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</paragraph><paragraph id="H24D592CD7DC5429CBB3C0631ADB96DFE"><enum>(2)</enum><text>in subclause (II)
of subparagraph (D)(ii), by striking <quote>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</quote> and inserting <quote>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</quote>.</text>
</paragraph></subsection><subsection id="HF4F21A73C8964604B5161C708E5CFDFC"><enum>(f)</enum><header>Elimination of
option To waive statewideness</header><text display-inline="yes-display-inline">Paragraph (3) of section 1915(i) of such
Act (42 U.S.C. 1396n(3)) is amended by striking <quote>section 1902(a)(1)
(relating to statewideness) and </quote>.</text>
</subsection><subsection id="H557F5F3161724A2400FE839E6FF0BE"><enum>(g)</enum><header>Effective
date</header><text>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.</text>
</subsection></section><section id="HB7D8F62B535D4C3AB72D619742224B56"><enum>102.</enum><header>Increase in
Federal medical assistance percentage (FMAP) for the provision of home and
community-based services under Medicaid through the State plan amendment
option</header>
<subsection id="H53E833C330484A5E929E7DC0403D223C"><enum>(a)</enum><header>In
general</header><text>Section 1905(b) of the Social Security Act (42 U.S.C.
1396d(b)) is amended by adding at the end the following: <quote>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 <quote>10 percent</quote> for
<quote>30 percent</quote> in such section.</quote>.</text>
</subsection><subsection id="H9C9940C4553D499EBB68275ED7512D9C"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall apply to home and
community-based services furnished on or after October 1, 2009.</text>
</subsection></section><section id="HEBD121A67FE1477A0025066B937865A"><enum>103.</enum><header>Annual report on
use of Medicaid State plan amendment option for home and community-based
services</header><text display-inline="no-display-inline">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.</text>
</section><enum>II</enum><header>State
Grants to Facilitate Home and Community-Based Services and Promote
Health</header>
<section id="HE5B0A17F55794F7EA4E39D4D04E6859D"><enum>201.</enum><header>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</header>
<subsection id="H127D3B196CDC474DAFE5800BB183233"><enum>(a)</enum><header>2-year
reauthorization; increased funding</header><text>Section 1903(z)(4)(A) of the
Social Security Act (42 U.S.C. 1396b(z)(4)(A)) is amended—</text>
<paragraph id="H0CE2BFB4F6C847F6AC5E91F899BD6F34"><enum>(1)</enum><text>in clause (i), by
striking <quote>and</quote> at the end;</text>
</paragraph><paragraph id="H728CFE4AC1964129AA9721B96D801C00"><enum>(2)</enum><text>in clause (ii), by
striking the period at the end and inserting <quote>; and</quote>; and</text>
</paragraph><paragraph id="HEC5A641170524EE68B8F98082456D627"><enum>(3)</enum><text>by inserting after
clause (ii), the following new clauses:</text>
<quoted-block display-inline="no-display-inline" id="H4DCB281DB49F40E08632B446D0F710A7" style="OLC">
<clause id="HF0F7BD9FB8FE4777B576E9F1B7571132"><enum>(iii)</enum><text>$150,000,000 for
fiscal year 2010; and</text>
</clause><clause id="HAE36B6C41DED45E6B71637C8EBF081F"><enum>(iv)</enum><text>$150,000,000 for
fiscal year
2011.</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HF667BA52DED24D318600D1CF104531F1"><enum>(b)</enum><header>Expansion of
permissible uses</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H9B578004177B4EF9B6B7C6CD5B55E9B5" style="OLC">
<subparagraph id="HEC3E4DC277B643FFB8DF8481EFE54669"><enum>(G)</enum><clause commented="no" display-inline="yes-display-inline" id="HB998AE78F38449CCB5CF482D1302E23E"><enum>(i)</enum><text>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—</text>
<subclause id="HEDBB81B0816746F3944C68818C0335E3" indent="up1"><enum>(I)</enum><text>develop programs where qualified
individuals provide home- and community-based services while solely or jointly
employed by recipients of such services;</text>
</subclause><subclause id="H1F594FDBD187455F867819C1F707A1A1" indent="up1"><enum>(II)</enum><text>facilitate the training and recruitment
of qualified health and direct service professionals and consumers who use
services;</text>
</subclause><subclause id="H1FD4DAF9073C4A2ABC00AF8342640726" indent="up1"><enum>(III)</enum><text>recommend or develop a system to set
wages and benefits, and recommend commensurate reimbursement rates;</text>
</subclause><subclause id="H7B8958BD74CC451DB006F449CCB890E0" indent="up1"><enum>(IV)</enum><text>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;</text>
</subclause><subclause id="H41B7142A186A43ABB92E89007D5285CA" indent="up1"><enum>(V)</enum><text>assist consumers in identifying
workers;</text>
</subclause><subclause id="HD8A63A35979C4CAAA9BA6BC100355100" indent="up1"><enum>(VI)</enum><text>act as a fiscal intermediary;</text>
</subclause><subclause id="H564BCB341C144E02B4F225CE8931C51" indent="up1"><enum>(VII)</enum><text>assist workers in finding employment,
including consumer-directed employment;</text>
</subclause><subclause id="H86EE765F57A44711B5D6D4BA8D920120" indent="up1"><enum>(VIII)</enum><text>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</text>
</subclause><subclause id="H22430A491A1F4974893B91F5F100AB43" indent="up1"><enum>(IX)</enum><text>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.</text>
</subclause></clause><clause id="HCA51B46C32364150001E3BEF26A819FF" indent="up1"><enum>(ii)</enum><text>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.</text>
</clause></subparagraph><subparagraph id="HD52EBD47D805486F93FF347C07AD2E2C"><enum>(H)</enum><text>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.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H8E1980B96AC2469C8EFAE45B18A68DE5"><enum>(c)</enum><header>Allocation of
funds</header>
<paragraph id="HA1313228586643BAADE7DD9D36EEF06D"><enum>(1)</enum><header>Elimination of
current law requirements for allocation of funds</header><text>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.</text>
</paragraph><paragraph id="HD50FD94BF33040B69840771674CB6B8E"><enum>(2)</enum><header>Assurance of
funds to facilitate the provision of home and community-based services and
integrated systems of long-term care</header><text>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:
<quote>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).</quote>.</text>
</paragraph></subsection><subsection id="H9ED5448D4A0743A29213A9A32161DB2F"><enum>(d)</enum><header>Renaming
program</header><text>The heading of section 1903(z) of such Act is amended by
striking <quote><header-in-text level="subsection" style="OLC">Transformation</header-in-text></quote> and inserting
<quote><header-in-text level="subsection" style="OLC">Investment</header-in-text></quote>.</text>
</subsection><subsection id="HAEE59895BA4E4D20A2A1211345412FB2"><enum>(e)</enum><header>Clarification</header><text>Such
section is further amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HBB3EAFA5F586401EACA5FCBDA5D92532" style="OLC">
<paragraph id="H8006BA9DA4C443839B5CEA0362261BEB"><enum>(6)</enum><header>Clarification of
protection of beneficiaries</header><text display-inline="yes-display-inline">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.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H62A683D339E1483C87D9DED436E6F2DA"><enum>(f)</enum><header>Effective
date</header><text>The amendments made by this section take effect on October
1, 2009.</text>
</subsection></section><section id="HAEDFFA7EE6EA4BBD00CF219DBB3D5B18"><enum>202.</enum><header>Health
promotion grants</header>
<subsection id="H4B4D27D976314E68A966B9C356355C4"><enum>(a)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="HC8EAAB93352D429EA736C63DD23DE3F4"><enum>(1)</enum><header>Eligible
Medicaid beneficiary</header><text>The term <term>eligible Medicaid
beneficiary</term> means an individual who is enrolled in the State Medicaid
plan under title XIX of the Social Security Act and—</text>
<subparagraph id="HDF32715EDD1344ECA4D1E2B86765578"><enum>(A)</enum><text>has attained the
age of 60 and is not a resident of a nursing facility; or</text>
</subparagraph><subparagraph id="HFA904EA8B609441198D174BB523B1D2"><enum>(B)</enum><text>is an adult with a
physical, mental, cognitive, or intellectual impairment.</text>
</subparagraph></paragraph><paragraph id="H6C8983818ED64069007BDF00004E12BC"><enum>(2)</enum><header>Eligible
State</header><text>The term <term>eligible State</term> 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.</text>
</paragraph><paragraph id="H31B4BF96402A449EB00070F7AA3C58C2"><enum>(3)</enum><header>Evidence- and
community-based health promotion program</header><text>The term <term>evidence-
and community-based health promotion program</term> 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.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HA1EA2C39F7864CDF8784B5BD80152B69"><enum>(4)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Health and Human
Services.</text>
</paragraph></subsection><subsection id="H736DEE244D2D430480B526E655751557"><enum>(b)</enum><header>Authority To
conduct demonstration project</header><text>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:</text>
<paragraph id="H49BFBD15326845B1935E40520130BF41"><enum>(1)</enum><header>Lifestyle
changes</header><text>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.</text>
</paragraph><paragraph id="HA585A372F87040F4AAF826002B89EDC3"><enum>(2)</enum><header>Diffusion</header><text>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.</text>
</paragraph></subsection><subsection id="HD2A20C8EA0164E439893BACB05C600BC"><enum>(c)</enum><header>Selection and
amount of grant awards</header><text>In awarding grants to eligible States
under this section and determining the amount of the awards, the Secretary
shall—</text>
<paragraph id="H825EB3628C794E2790DEE1509E2C763C"><enum>(1)</enum><text>take into
consideration the manner and extent to which the eligible State proposes to
achieve the objectives specified in subsection (b); and</text>
</paragraph><paragraph id="H48C99E944386417FAA07150776B96386"><enum>(2)</enum><text>give preference to
eligible States proposing—</text>
<subparagraph id="HA1B0D12057964AA6A02D978D783955A3"><enum>(A)</enum><text>programs through
public service provider organizations or other organizations with expertise in
serving eligible Medicaid beneficiaries;</text>
</subparagraph><subparagraph id="HB1591E5761FF42DCB7A728B19E94008D"><enum>(B)</enum><text>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</text>
</subparagraph><subparagraph id="HE2D700D9D86F4D7F925C0138218183AE"><enum>(C)</enum><text>interventions that
have already demonstrated effectiveness and replicability in a community-based,
nonmedical setting.</text>
</subparagraph></paragraph></subsection><subsection id="H8DB8D527132341B5BDD630BB12EA305F"><enum>(d)</enum><header>Use of
funds</header><text>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—</text>
<paragraph id="H2DDA544AAAD44057A431004681175701"><enum>(1)</enum><text>implement such
programs in at least 3 geographic areas of the State; and</text>
</paragraph><paragraph id="H6FB4CBF842FE4CBD8E9DBD61F425F195"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection id="H529DC18940124C9FAAE0308FAB6B1701"><enum>(e)</enum><header>Technical
assistance</header><text>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.</text>
</subsection><subsection id="HB944A163F1004FC1B8C00086B25B4C00"><enum>(f)</enum><header>Payments to
eligible States; carryover of unused grant amounts</header>
<paragraph id="HB2C7BF442FA04ECF855335A2E3E8FA5D"><enum>(1)</enum><header>Payments</header><text>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—</text>
<subparagraph id="HFF376CE5BDFB435CA0DB80535BF3DE98"><enum>(A)</enum><text>the amount of
qualified expenditures made by the State for such quarter; or</text>
</subparagraph><subparagraph id="H45310D7B04274661B0686191A414D7E7"><enum>(B)</enum><text>the total amount
remaining in such grant award for such fiscal year (taking into account the
application of paragraph (2)).</text>
</subparagraph></paragraph><paragraph id="H0DEF2B3EC65C4FFAAEEEA0D9A35116B8"><enum>(2)</enum><header>Carryover of
unused amounts</header><text>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).</text>
</paragraph><paragraph id="HD98841140357436FB5672B088E229651"><enum>(3)</enum><header>Reawarding of
certain unused amounts</header><text>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.</text>
</paragraph><paragraph id="H4C2075FCA9BC436BBC5D868391D81BAC"><enum>(4)</enum><header>Preventing
duplication of payment</header><text>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.</text>
</paragraph></subsection><subsection id="H10C0B4261F1B4AFEA807A97CB5CFA98C"><enum>(g)</enum><header>Evaluation</header><text>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.</text>
</subsection><subsection id="H5EA73AB09224410292A976F9BA324E93"><enum>(h)</enum><header>Appropriations</header><text>There
are appropriated, from any funds in the Treasury not otherwise appropriated,
the following amounts to carry out this section:</text>
<paragraph id="H42EF387984FA4EA58B56D05C1E8C7900"><enum>(1)</enum><header>Grants to
states</header><text>For grants to States, to remain available until
expended—</text>
<subparagraph id="HA15999452CB843ADBC7E9FAEE2DFFFA7"><enum>(A)</enum><text>$4,000,000 for
fiscal year 2010;</text>
</subparagraph><subparagraph id="HE35E34F1889D410E8F00D495D30A36E"><enum>(B)</enum><text>$6,000,000 for
fiscal year 2011;</text>
</subparagraph><subparagraph id="H9A5713A67DCA423F915B8031A5762252"><enum>(C)</enum><text>$8,000,000 for
fiscal year 2012;</text>
</subparagraph><subparagraph id="HCD96F4299D0F4A528597884267DCD2A2"><enum>(D)</enum><text>$10,000,000 for
fiscal year 2013; and</text>
</subparagraph><subparagraph id="H1695525DB4EF40FC9366B0E5FB00DD03"><enum>(E)</enum><text>$12,000,000 for
fiscal year 2014.</text>
</subparagraph></paragraph><paragraph id="H30EC654DDB9B47B69E7BB66171C495BF"><enum>(2)</enum><header>Technical
assistance</header><text>For the provision of technical assistance through such
center in accordance with subsection (e)—</text>
<subparagraph id="H507B2D51165A45F1943036F901C963B"><enum>(A)</enum><text>$800,000 for fiscal
year 2010;</text>
</subparagraph><subparagraph id="H32C95697716041F7B07896F74031E932"><enum>(B)</enum><text>$1,200,000 for
fiscal year 2011;</text>
</subparagraph><subparagraph id="H622E8701B7E944A683E02CDF0B561A0"><enum>(C)</enum><text>$1,600,000 for
fiscal year 2012;</text>
</subparagraph><subparagraph id="H618FFE82759B4C56BD3DE2C975F7FBF"><enum>(D)</enum><text>$2,000,000 for
fiscal year 2013; and</text>
</subparagraph><subparagraph id="HF78B9BA1185642778F1B8B8539B611C"><enum>(E)</enum><text>$2,400,000 for
fiscal year 2014.</text>
</subparagraph></paragraph><paragraph id="H762CF9C114384CC995EB7C00004B4500"><enum>(3)</enum><header>Evaluation</header><text>For
conducting the evaluation required under subsection (g), $4,000,000 for fiscal
year 2012.</text>
</paragraph></subsection></section><enum>III</enum><header>Promoting and
Protecting Community Living</header>
<section id="H39FC04428C4C4231ABF1F25F0085C400"><enum>301.</enum><header>Mandatory
application of spousal impoverishment protections to recipients of home and
community-based services</header>
<subsection id="HB35E22F714D64C3F948496E13ACEF47"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1924(h)(1)(A)
of the Social Security Act (42 U.S.C. 1396r–5(h)(1)(A)) is amended by striking
<quote>(at the option of the State)is described in section
1902(a)(10)(A)(ii)(VI)</quote> and inserting <quote>is eligible for medical
assistance for home and community-based services under subsection (c), (d),
(e), (i), or (k) of section 1915</quote>.</text>
</subsection><subsection id="H9A6C1870DAAD44B3A63CDEB259DE7468"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) takes effect on October
1, 2009.</text>
</subsection></section><section id="H708170EC4A5941CF94D7002015D49D95"><enum>302.</enum><header>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</header>
<subsection id="H6F98A1E0E5A54F99A2BE3ED161E01971"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1917 of the
Social Security Act (42 U.S.C. 1396p) is amended by adding at the end the
following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H53A574399E57473C9F6B30CD8F85E3E" style="OLC">
<subsection id="HB314BC24E4BC4EB0B8CBDB7730CD90B0"><enum>(i)</enum><header>Exclusion of 6
months of average cost of nursing facility services from home and
community-based services eligibility
determinations</header><text>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).</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HFBBC077B16BF475598AC8110FFB277DE"><enum>(b)</enum><header>Rule of
construction</header><text>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.</text>
</subsection><subsection id="H7E52CCF891974554B1A9362CAA3C95B4"><enum>(c)</enum><header>Effective
date</header><text>The amendment made by subsection (a) takes effect on October
1, 2009.</text>
</subsection></section><enum>IV</enum><header>Miscellaneous</header>
<section id="HFD77A67185224C36B788DE079D9BAE22"><enum>401.</enum><header>Improved data
collection</header>
<subsection id="HD46F2CA079E84760AEED572B213421F"><enum>(a)</enum><header>Secretarial
requirement To revise data reporting forms and systems To ensure uniform and
consistent reporting by States</header><text display-inline="yes-display-inline">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:</text>
<paragraph id="HD659FF8318684EB2B1C7410046DA449F"><enum>(1)</enum><text display-inline="yes-display-inline">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.</text>
</paragraph><paragraph id="HAF029FD60BC84300A69C2E91F5B751F8"><enum>(2)</enum><text display-inline="yes-display-inline">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.</text>
</paragraph><paragraph id="H025BF7403E6C47AF8BC279C052DC7BF1"><enum>(3)</enum><text>The types of such
services provided by the State under each such waiver and State plan amendment
option.</text>
</paragraph><paragraph id="H7E7266B93A624889BB44A2D4BCF35BFF"><enum>(4)</enum><text>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.</text>
</paragraph><paragraph id="H3632EB04715648CE811DD5FA604EDA"><enum>(5)</enum><text>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.</text>
</paragraph></subsection><subsection id="HD7BF0DBA48244895AF80CA06B3C56655"><enum>(b)</enum><header>Public
availability</header><text>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.</text>
</subsection></section><section id="HF8B5AB9B964A4EA9A1D96EB5975464E4"><enum>402.</enum><header>GAO report on
Medicaid home health services and the extent of consumer self-direction of such
services</header>
<subsection id="H2BF4EB69424444A5B3749488E9CD73A0"><enum>(a)</enum><header>Study</header><text display-inline="yes-display-inline">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.</text>
</subsection><subsection id="HB77FC57613104A34B45C4F70CF597CA9"><enum>(b)</enum><header>Report</header><text display-inline="yes-display-inline">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.</text>
</subsection></section>