[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 434 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                 S. 434

To amend title XIX of the Social Security Act to improve the State plan 
amendment option for providing home and community-based services under 
             the Medicaid program, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 13, 2009

Mr. Kerry (for himself and Mr. Grassley) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XIX of the Social Security Act to improve the State plan 
amendment option for providing home and community-based services under 
             the Medicaid program, and for other purposes.

    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. State option to provide home and community-based services to 
                            individuals for whom such services are 
                            likely to prevent, delay, or decrease the 
                            likelihood of an individual's need for 
                            institutionalized care.
Sec. 103. Implementation assistance grants for States electing to 
                            provide home and community-based services 
                            under Medicaid through the State plan 
                            amendment option.
TITLE II--STATE GRANTS TO FACILITATE HOME AND COMMUNITY-BASED SERVICES 
                           AND PROMOTE HEALTH

Sec. 201. Reauthorization of medicaid transformation grants and 
                            expansion of permissible uses in order to 
                            facilitate the provision of home and 
                            community-based and other long-term care 
                            services.
Sec. 202. Health promotion grants.
                  TITLE III--LONG-TERM CARE INSURANCE

Sec. 301. Treatment of premiums on qualified long-term care insurance 
                            contracts.
Sec. 302. Credit for taxpayers with long-term care needs.
Sec. 303. Treatment of premiums on qualified long-term care insurance 
                            contracts.
Sec. 304. Additional consumer protections for long-term care insurance.
          TITLE IV--PROMOTING AND PROTECTING COMMUNITY LIVING

Sec. 401. Mandatory application of spousal impoverishment protections 
                            to recipients of home and community-based 
                            services.
Sec. 402. State authority to elect to exclude up to 6 months of average 
                            cost of nursing facility services from 
                            assets or resources for purposes of 
                            eligibility for home and community-based 
                            services.
                         TITLE V--MISCELLANEOUS

Sec. 501. Improved data collection.
Sec. 502. GAO report on Medicaid home health services and the extent of 
                            consumer self-direction of such services.

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) Additional State Option To Provide Home and Community-Based 
Services to Individuals Eligible for Services Under a Waiver.--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) State option to provide home and community-based 
        services to individuals eligible for services under a waiver.--
                    ``(A) In general.--A State that provides home and 
                community-based services in accordance with this 
                subsection to individuals who satisfy the needs-based 
                criteria for the receipt of such services established 
                under paragraph (1)(A) may, in addition to continuing 
                to provide such services to such individuals, elect to 
                provide home and community-based services in accordance 
                with the requirements of this paragraph to individuals 
                who are eligible for home and community-based services 
                under a waiver approved for the State under subsection 
                (c), (d), or (e) or under section 1115 to provide such 
                services, but only for those individuals whose income 
                does not exceed 300 percent of the supplemental 
                security income benefit rate established by section 
                1611(b)(1).
                    ``(B) Application of same requirements for 
                individuals satisfying needs-based criteria.--Subject 
                to subparagraph (C), a State shall provide home and 
                community-based services to individuals under this 
                paragraph in the same manner and subject to the same 
                requirements as apply under the other paragraphs of 
                this subsection to the provision of home and community-
                based services to individuals who satisfy the needs-
                based criteria established under paragraph (1)(A).
                    ``(C) 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 for 
                individuals who satisfy 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), or 
                                who are eligible for home and 
                                community-based services under 
                                paragraph (6) of such section, and who 
                                will receive home and community-based 
                                services pursuant to a State plan 
                                amendment under such subsection;''.
            (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), or who are eligible 
        for home and community-based services under paragraph (6) of 
        such section, 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. STATE OPTION TO PROVIDE HOME AND COMMUNITY-BASED SERVICES TO 
              INDIVIDUALS FOR WHOM SUCH SERVICES ARE LIKELY TO PREVENT, 
              DELAY, OR DECREASE THE LIKELIHOOD OF AN INDIVIDUAL'S NEED 
              FOR INSTITUTIONALIZED CARE.

    (a) State Plan Amendment Required.--
            (1) In general.--Section 1915 of the Social Security Act 
        (42 U.S.C. 1396n) is amended by adding at the end the following 
        new subsection:
    ``(k) State Plan Amendment Option To Provide Home and Community-
Based Services to Individuals for Whom Such Services Are Likely To 
Prevent, Delay, or Decrease the Likelihood of an Individual's Need for 
Institutionalized Care.--
            ``(1) In general.--Subject to the succeeding provisions of 
        this subsection, a State that has an approved State plan 
        amendment under subsection (i) may provide, through a State 
        plan amendment for the provision of medical assistance for home 
        and community-based services that 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 to individuals--
                    ``(A) who are not otherwise eligible for medical 
                assistance under the State plan or under a waiver of 
                such plan;
                    ``(B) whose income does not exceed 300 percent of 
                the supplemental security income benefit rate 
                established by section 1611(b)(1); and
                    ``(C) who satisfy such needs-based criteria for 
                determining eligibility for medical assistance for such 
                services as the State shall establish in accordance 
                with paragraph (2).
            ``(2) Requirement for needs-based criteria.--In 
        establishing needs-based criteria for purposes of determining 
        eligibility for medical assistance for home and community-based 
        services under this subsection, a State shall specify the 
        specific physical, mental, cognitive, or intellectual 
        impairments, or the inability of an individual to perform 1 or 
        more specific activities of daily living (as defined in section 
        7702B(c)(2)(B) of the Internal Revenue Code of 1986) or the 
        need for significant assistance to perform such activities, for 
        which the State determines that the provision of home and 
        community-based services are reasonably expected to prevent, 
        delay, or decrease the likelihood of an individual's need for 
        institutionalized care.
            ``(3) Application of same requirements for providing home 
        and community-based services under subsection (i).--Subject to 
        paragraphs (4) and (5), a State shall provide home and 
        community-based services to individuals under this paragraph in 
        the same manner and subject to the same requirements as apply 
        to the provision of home and community-based services to 
        individuals under subsection (i).
            ``(4) Authority to limit number of individuals.--A State 
        may limit the number of individuals who are eligible to receive 
        home and community-based services under this subsection and may 
        establish waiting lists for the receipt of such services.
            ``(5) 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 subsection that differ in type, amount, duration, or scope 
        from the home and community-based services offered for 
        individuals under paragraph (1)(A) of subsection (i) and, if 
        applicable, under paragraph (6) of such subsection.''.
            (2) Optional categorically needy group; state option to 
        limit benefits to home and community-based services or to 
        provide full medical assistance.--
                    (A) In general.--Section 1902(a)(10) of the Social 
                Security Act (42 U.S.C. 1396a(a)(10)) is amended--
                            (i) in subparagraph (A)(ii), as amended by 
                        section 101(d)(1)--
                                    (I) in subclause (XIX), by striking 
                                ``or'' at the end;
                                    (II) in subclause (XX), by adding 
                                ``or'' at the end; and
                                    (III) by inserting after subclause 
                                (XX), the following new subclause:
                                    ``(XXI) who are eligible for home 
                                and community-based services under 
                                section 1915(k) and who will receive 
                                home and community-based services 
                                pursuant to a State plan amendment 
                                under such subsection;''; and
                            (ii) in the matter following subparagraph 
                        (G)--
                                    (I) by striking ``and (XIV)'' and 
                                inserting ``(XIV)''; and
                                    (II) by inserting ``, and (XV) at 
                                the option of the State, the medical 
                                assistance made available to an 
                                individual described in section 1915(k) 
                                who is eligible for medical assistance 
                                only because of subparagraph 
                                (A)(ii)(XXI) may be limited to medical 
                                assistance for home and community-based 
                                services described in a State plan 
                                amendment submitted under that 
                                section'' before the semicolon.
                    (B) Conforming amendments.--
                            (i) Section 1903(f)(4) of the Social 
                        Security Act (42 U.S.C. 1396b(f)(4)), as 
                        amended by section 101(d)(2)(A), is amended in 
                        the matter preceding subparagraph (A), by 
                        inserting ``1902(a)(10)(A)(ii)(XXI),'' after 
                        ``1902(a)(10)(A)(ii)(XX),''.
                            (ii) Section 1905(a) of the Social Security 
                        Act (42 U.S.C. 1396d(a)), as amended by section 
                        101(d)(2)(B), is amended in the matter 
                        preceding paragraph (1)--
                                    (I) in clause (xiii), by striking 
                                ``or'' at the end;
                                    (II) in clause (xiv), by adding 
                                ``or'' at the end; and
                                    (III) by inserting after clause 
                                (xiv) the following new clause:
            ``(xv) who are eligible for home and community-based 
        services under section 1915(k) and who will receive home and 
        community-based services pursuant to a State plan amendment 
        under such subsection,''.
    (b) 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. 103. IMPLEMENTATION ASSISTANCE GRANTS FOR STATES ELECTING TO 
              PROVIDE HOME AND COMMUNITY-BASED SERVICES UNDER MEDICAID 
              THROUGH THE STATE PLAN AMENDMENT OPTION.

    (a) Authority To Award Grants.--The Secretary of Health and Human 
Services (in this section referred to as the ``Secretary'') shall award 
grants to eligible States to provide incentives to States for the 
implementation of State plan amendments that meet the requirements of 
section 1915(i) of the Social Security Act (42 U.S.C. 1396n(i)).
    (b) Eligible State.--For purposes of this section, an eligible 
State is a State that--
            (1) has an approved State plan amendment described in 
        subsection (a); and
            (2) submits an application to the Secretary, in such form 
        and manner as the Secretary shall require, specifying the costs 
        the State will incur in implementing such amendment and such 
        additional information as the Secretary may require.
    (c) Amount and Duration of Grants.--
            (1) Amount.--The Secretary shall determine the amount to be 
        awarded all eligible States under this section for a fiscal 
        year based on the applications submitted by such States and the 
        amount available for such fiscal year under subsection (d).
            (2) Limitation on duration of award.--A State may receive a 
        grant under this section for not more than 3 consecutive fiscal 
        years.
    (d) Appropriations.--There are appropriated, from any funds in the 
Treasury not otherwise appropriated, $40,000,000 for each of fiscal 
years 2010 through 2014 for making grants to States under this section. 
Funds appropriated under this subsection for a fiscal year shall remain 
available for expenditure through September 30, 2014.

TITLE II--STATE GRANTS TO FACILITATE HOME AND COMMUNITY-BASED SERVICES 
                           AND PROMOTE HEALTH

SEC. 201. REAUTHORIZATION OF MEDICAID TRANSFORMATION GRANTS AND 
              EXPANSION OF PERMISSIBLE USES IN ORDER TO FACILITATE THE 
              PROVISION OF HOME AND COMMUNITY-BASED AND OTHER LONG-TERM 
              CARE SERVICES.

    (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 non-profit 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) 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, 
                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 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, sub-grantees 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--LONG-TERM CARE INSURANCE

SEC. 301. TREATMENT OF PREMIUMS ON QUALIFIED LONG-TERM CARE INSURANCE 
              CONTRACTS.

    (a) In General.--Part VII of subchapter B of chapter 1 of the 
Internal Revenue Code of 1986 (relating to additional itemized 
deductions) is amended by redesignating section 224 as section 225 and 
by inserting after section 223 the following new section:

``SEC. 224. PREMIUMS ON QUALIFIED LONG-TERM CARE INSURANCE CONTRACTS.

    ``(a) In General.--In the case of an individual, there shall be 
allowed as a deduction an amount equal to the applicable percentage of 
the amount of eligible long-term care premiums (as defined in section 
213(d)(10)) paid during the taxable year for coverage for the taxpayer 
and the taxpayer's spouse and dependents under a qualified long-term 
care insurance contract (as defined in section 7702B(b)).
    ``(b) Applicable Percentage.--For purposes of subsection (a), the 
applicable percentage shall be determined in accordance with the 
following table:

``For taxable years beginning in                                    The
        calendar year--                                      applicable
                                                             percentage
                                                                   is--
        2010 or 2011.......................................         25 
        2012...............................................         35 
        2013...............................................         65 
        2014 or thereafter.................................        100.
    ``(c) Coordination With Other Deductions.--Any amount paid by a 
taxpayer for any qualified long-term care insurance contract to which 
subsection (a) applies shall not be taken into account in computing the 
amount allowable to the taxpayer as a deduction under section 162(l) or 
213(a).''.
    (b) Conforming Amendments.--
            (1) Section 62(a) of the Internal Revenue Code of 1986 is 
        amended by inserting before the last sentence at the end the 
        following new paragraph:
            ``(22) Premiums on qualified long-term care insurance 
        contracts.--The deduction allowed by section 224.''.
            (2) The table of sections for part VII of subchapter B of 
        chapter 1 of such Code is amended by striking the last item and 
        inserting the following new items:

``Sec. 224. Premiums on qualified long-term care insurance contracts.
``Sec. 225. Cross reference.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2009.

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

    (a) In General.--Subpart A of part IV of subchapter A of chapter 1 
of the Internal Revenue Code of 1986 (relating to nonrefundable 
personal credits) is amended by inserting after section 25D the 
following new section:

``SEC. 25E. CREDIT FOR TAXPAYERS WITH LONG-TERM CARE NEEDS.

    ``(a) Allowance of Credit.--
            ``(1) In general.--There shall be allowed as a credit 
        against the tax imposed by this chapter for the taxable year an 
        amount equal to the applicable credit amount multiplied by the 
        number of applicable individuals with respect to whom the 
        taxpayer is an eligible caregiver for the taxable year.
            ``(2) Applicable credit amount.--For purposes of paragraph 
        (1), the applicable credit amount shall be determined in 
        accordance with the following table:

``For taxable years beginning in                                    The
        calendar year--                                      applicable
                                                                 credit
                                                                 amount
                                                                   is--
        2010...............................................     $1,000 
        2011...............................................      1,500 
        2012...............................................      2,000 
        2013...............................................      2,500 
        2014 or thereafter.................................      3,000.
    ``(b) Limitation Based on Adjusted Gross Income.--
            ``(1) In general.--The amount of the credit allowable under 
        subsection (a) shall be reduced (but not below zero) by $100 
        for each $1,000 (or fraction thereof) by which the taxpayer's 
        modified adjusted gross income exceeds the threshold amount. 
        For purposes of the preceding sentence, the term `modified 
        adjusted gross income' means adjusted gross income increased by 
        any amount excluded from gross income under section 911, 931, 
        or 933.
            ``(2) Threshold amount.--For purposes of paragraph (1), the 
        term `threshold amount' means--
                    ``(A) $150,000 in the case of a joint return, and
                    ``(B) $75,000 in any other case.
            ``(3) Indexing.--In the case of any taxable year beginning 
        in a calendar year after 2010, each dollar amount contained in 
        paragraph (2) shall be increased by an amount equal to the 
        product of--
                    ``(A) such dollar amount, and
                    ``(B) the medical care cost adjustment determined 
                under section 213(d)(10)(B)(ii) for the calendar year 
                in which the taxable year begins, determined by 
                substituting `August 2009' for `August 1996' in 
                subclause (II) thereof.
        If any increase determined under the preceding sentence is not 
        a multiple of $50, such increase shall be rounded to the next 
        lowest multiple of $50.
    ``(c) Definitions.--For purposes of this section--
            ``(1) Applicable individual.--
                    ``(A) In general.--The term `applicable individual' 
                means, with respect to any taxable year, any individual 
                who has been certified, before the due date for filing 
                the return of tax for the taxable year (without 
                extensions), by a physician (as defined in section 
                1861(r)(1) of the Social Security Act) as being an 
                individual with long-term care needs described in 
                subparagraph (B) for a period--
                            ``(i) which is at least 180 consecutive 
                        days, and
                            ``(ii) a portion of which occurs within the 
                        taxable year.
                Notwithstanding the preceding sentence, a certification 
                shall not be treated as valid unless it is made within 
                the 39\1/2\ month period ending on such due date (or 
                such other period as the Secretary prescribes).
                    ``(B) Individuals with long-term care needs.--An 
                individual is described in this subparagraph if the 
                individual meets any of the following requirements:
                            ``(i) The individual is at least 6 years of 
                        age and--
                                    ``(I) is unable to perform (without 
                                substantial assistance from another 
                                individual) at least 3 activities of 
                                daily living (as defined in section 
                                7702B(c)(2)(B)) due to a loss of 
                                functional capacity, or
                                    ``(II) requires substantial 
                                supervision to protect such individual 
                                from threats to health and safety due 
                                to severe cognitive impairment and is 
                                unable to perform, without reminding or 
                                cuing assistance, at least 1 activity 
                                of daily living (as so defined) or to 
                                the extent provided in regulations 
                                prescribed by the Secretary (in 
                                consultation with the Secretary of 
                                Health and Human Services), is unable 
                                to engage in age appropriate 
                                activities.
                            ``(ii) The individual is at least 2 but not 
                        6 years of age and is unable due to a loss of 
                        functional capacity to perform (without 
                        substantial assistance from another individual) 
                        at least 2 of the following activities: eating, 
                        transferring, or mobility.
                            ``(iii) The individual is under 2 years of 
                        age and requires specific durable medical 
                        equipment by reason of a severe health 
                        condition or requires a skilled practitioner 
                        trained to address the individual's condition 
                        to be available if the individual's parents or 
                        guardians are absent.
            ``(2) Eligible caregiver.--
                    ``(A) In general.--A taxpayer shall be treated as 
                an eligible caregiver for any taxable year with respect 
                to the following individuals:
                            ``(i) The taxpayer.
                            ``(ii) The taxpayer's spouse.
                            ``(iii) An individual with respect to whom 
                        the taxpayer is allowed a deduction under 
                        section 151(c) for the taxable year.
                            ``(iv) An individual who would be described 
                        in clause (iii) for the taxable year if section 
                        151(c) were applied by substituting for the 
                        exemption amount an amount equal to the sum of 
                        the exemption amount, the standard deduction 
                        under section 63(c)(2)(C), and any additional 
                        standard deduction under section 63(c)(3) which 
                        would be applicable to the individual if clause 
                        (iii) applied.
                            ``(v) An individual who would be described 
                        in clause (iii) for the taxable year if--
                                    ``(I) the requirements of clause 
                                (iv) are met with respect to the 
                                individual, and
                                    ``(II) the requirements of 
                                subparagraph (B) are met with respect 
                                to the individual in lieu of the 
                                support test under subsection (c)(1)(D) 
                                or (d)(1)(C) of section 152.
                    ``(B) Residency test.--The requirements of this 
                subparagraph are met if an individual has as his 
                principal place of abode the home of the taxpayer and--
                            ``(i) in the case of an individual who is 
                        an ancestor or descendant of the taxpayer or 
                        the taxpayer's spouse, is a member of the 
                        taxpayer's household for over half the taxable 
                        year, or
                            ``(ii) in the case of any other individual, 
                        is a member of the taxpayer's household for the 
                        entire taxable year.
                    ``(C) Special rules where more than 1 eligible 
                caregiver.--
                            ``(i) In general.--If more than 1 
                        individual is an eligible caregiver with 
                        respect to the same applicable individual for 
                        taxable years ending with or within the same 
                        calendar year, a taxpayer shall be treated as 
                        the eligible caregiver if each such individual 
                        (other than the taxpayer) files a written 
                        declaration (in such form and manner as the 
                        Secretary may prescribe) that such individual 
                        will not claim such applicable individual for 
                        the credit under this section.
                            ``(ii) No agreement.--If each individual 
                        required under clause (i) to file a written 
                        declaration under clause (i) does not do so, 
                        the individual with the highest adjusted gross 
                        income shall be treated as the eligible 
                        caregiver.
                            ``(iii) Married individuals filing 
                        separately.--In the case of married individuals 
                        filing separately, the determination under this 
                        subparagraph as to whether the husband or wife 
                        is the eligible caregiver shall be made under 
                        the rules of clause (ii) (whether or not one of 
                        them has filed a written declaration under 
                        clause (i)).
    ``(d) Identification Requirement.--No credit shall be allowed under 
this section to a taxpayer with respect to any applicable individual 
unless the taxpayer includes the name and taxpayer identification 
number of such individual, and the identification number of the 
physician certifying such individual, on the return of tax for the 
taxable year.
    ``(e) Taxable Year Must Be Full Taxable Year.--Except in the case 
of a taxable year closed by reason of the death of the taxpayer, no 
credit shall be allowable under this section in the case of a taxable 
year covering a period of less than 12 months.''.
    (b) Conforming Amendments.--
            (1) Section 6213(g)(2) of the Internal Revenue Code of 1986 
        is amended by striking ``and'' at the end of subparagraph (L), 
        by striking the period at the end of subparagraph (M) and 
        inserting ``, and'', and by inserting after subparagraph (M) 
        the following new subparagraph:
                    ``(N) an omission of a correct TIN or physician 
                identification required under section 25E(d) (relating 
                to credit for taxpayers with long-term care needs) to 
                be included on a return.''.
            (2) The table of sections for subpart A of part IV of 
        subchapter A of chapter 1 of such Code is amended by inserting 
        after the item relating to section 25D the following new item:

``Sec. 25E. Credit for taxpayers with long-term care needs.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2009.

SEC. 303. TREATMENT OF PREMIUMS ON QUALIFIED LONG-TERM CARE INSURANCE 
              CONTRACTS.

    (a) In General.--
            (1) Cafeteria plans.--The last sentence of section 125(f) 
        of the Internal Revenue Code of 1986 (defining qualified 
        benefits) is amended by inserting before the period at the end 
        ``; except that such term shall include the payment of premiums 
        for any qualified long-term care insurance contract (as defined 
        in section 7702B) to the extent the amount of such payment does 
        not exceed the eligible long-term care premiums (as defined in 
        section 213(d)(10)) for such contract''.
            (2) Flexible spending arrangements.--Section 106 of such 
        Code (relating to contributions by an employer to accident and 
        health plans) is amended by striking subsection (c) and 
        redesignating subsection (d) as subsection (c).
    (b) Conforming Amendments.--
            (1) Section 6041 of the Internal Revenue Code of 1986 is 
        amended by adding at the end the following new subsection:
    ``(h) Flexible Spending Arrangement Defined.--For purposes of this 
section, a flexible spending arrangement is a benefit program which 
provides employees with coverage under which--
            ``(1) specified incurred expenses may be reimbursed 
        (subject to reimbursement maximums and other reasonable 
        conditions), and
            ``(2) the maximum amount of reimbursement which is 
        reasonably available to a participant for such coverage is less 
        than 500 percent of the value of such coverage.
In the case of an insured plan, the maximum amount reasonably available 
shall be determined on the basis of the underlying coverage.''.
            (2) The following sections of such Code are each amended by 
        striking ``section 106(d)'' and inserting ``section 106(c)'': 
        sections 223(b)(4)(B), 223(d)(4)(C), 223(f)(3)(B), 3231(e)(11), 
        3306(b)(18), 3401(a)(22), 4973(g)(1), and 4973(g)(2)(B)(i).
            (3) Section 6041(f)(1) of such Code is amended by striking 
        ``(as defined in section 106(c)(2))''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2009.

SEC. 304. ADDITIONAL CONSUMER PROTECTIONS FOR LONG-TERM CARE INSURANCE.

    (a) Additional Protections Applicable to Long-Term Care 
Insurance.--Subparagraphs (A) and (B) of section 7702B(g)(2) of the 
Internal Revenue Code of 1986 (relating to requirements of model 
regulation and Act) are amended to read as follows:
                    ``(A) In general.--The requirements of this 
                paragraph are met with respect to any contract if such 
                contract meets--
                            ``(i) Model regulation.--The following 
                        requirements of the model regulation:
                                    ``(I) Section 6A (relating to 
                                guaranteed renewal or 
                                noncancellability), other than 
                                paragraph (5) thereof, and the 
                                requirements of section 6B of the model 
                                Act relating to such section 6A.
                                    ``(II) Section 6B (relating to 
                                prohibitions on limitations and 
                                exclusions) other than paragraph (7) 
                                thereof.
                                    ``(III) Section 6C (relating to 
                                extension of benefits).
                                    ``(IV) Section 6D (relating to 
                                continuation or conversion of 
                                coverage).
                                    ``(V) Section 6E (relating to 
                                discontinuance and replacement of 
                                policies).
                                    ``(VI) Section 7 (relating to 
                                unintentional lapse).
                                    ``(VII) Section 8 (relating to 
                                disclosure), other than sections 8F, 
                                8G, 8H, and 8I thereof.
                                    ``(VIII) Section 11 (relating to 
                                prohibitions against post-claims 
                                underwriting).
                                    ``(IX) Section 12 (relating to 
                                minimum standards).
                                    ``(X) Section 13 (relating to 
                                requirement to offer inflation 
                                protection).
                                    ``(XI) Section 25 (relating to 
                                prohibition against preexisting 
                                conditions and probationary periods in 
                                replacement policies or certificates).
                                    ``(XII) The provisions of section 
                                28 relating to contingent nonforfeiture 
                                benefits, if the policyholder declines 
                                the offer of a nonforfeiture provision 
                                described in paragraph (4) of this 
                                subsection.
                            ``(ii) Model act.--The following 
                        requirements of the model Act:
                                    ``(I) Section 6C (relating to 
                                preexisting conditions).
                                    ``(II) Section 6D (relating to 
                                prior hospitalization).
                                    ``(III) The provisions of section 8 
                                relating to contingent nonforfeiture 
                                benefits, if the policyholder declines 
                                the offer of a nonforfeiture provision 
                                described in paragraph (4) of this 
                                subsection.
                    ``(B) Definitions.--For purposes of this 
                paragraph--
                            ``(i) Model regulation.--The term `model 
                        regulation' means the long-term care insurance 
                        model regulation promulgated by the National 
                        Association of Insurance Commissioners (as 
                        adopted as of December 2006).
                            ``(ii) Model act.--The term `model Act' 
                        means the long-term care insurance model Act 
                        promulgated by the National Association of 
                        Insurance Commissioners (as adopted as of 
                        December 2006).
                            ``(iii) Coordination.--Any provision of the 
                        model regulation or model Act listed under 
                        clause (i) or (ii) of subparagraph (A) shall be 
                        treated as including any other provision of 
                        such regulation or Act necessary to implement 
                        the provision.
                            ``(iv) Determination.--For purposes of this 
                        section and section 4980C, the determination of 
                        whether any requirement of a model regulation 
                        or the model Act has been met shall be made by 
                        the Secretary.''.
    (b) Excise Tax.--Paragraph (1) of section 4980C(c) of the Internal 
Revenue Code of 1986 (relating to requirements of model provisions) is 
amended to read as follows:
            ``(1) Requirements of model provisions.--
                    ``(A) Model regulation.--The following requirements 
                of the model regulation must be met:
                            ``(i) Section 9 (relating to required 
                        disclosure of rating practices to consumer).
                            ``(ii) Section 14 (relating to application 
                        forms and replacement coverage).
                            ``(iii) Section 15 (relating to reporting 
                        requirements).
                            ``(iv) Section 22 (relating to filing 
                        requirements for marketing).
                            ``(v) Section 23 (relating to standards for 
                        marketing), including inaccurate completion of 
                        medical histories, other than paragraphs (1), 
                        (6), and (9) of section 23C.
                            ``(vi) Section 24 (relating to 
                        suitability).
                            ``(vii) Section 26 (relating to 
                        policyholder notifications).
                            ``(viii) Section 27 (relating to the right 
                        to reduce coverage and lower premiums).
                            ``(ix) Section 31 (relating to standard 
                        format outline of coverage).
                            ``(x) Section 32 (relating to requirement 
                        to deliver shopper's guide).
                    ``(B) Model act.--The following requirements of the 
                model Act must be met:
                            ``(i) Section 6F (relating to right to 
                        return).
                            ``(ii) Section 6G (relating to outline of 
                        coverage).
                            ``(iii) Section 6H (relating to 
                        requirements for certificates under group 
                        plans).
                            ``(iv) Section 6J (relating to policy 
                        summary).
                            ``(v) Section 6K (relating to monthly 
                        reports on accelerated death benefits).
                            ``(vi) Section 7 (relating to 
                        incontestability period).
                            ``(vii) Section 9 (relating to producer 
                        training requirements).
                    ``(C) Definitions.--For purposes of this paragraph, 
                the terms `model regulation' and `model Act' have the 
                meanings given such terms by section 7702B(g)(2)(B).''.
    (c) Effective Date.--The amendments made by this section shall 
apply to policies issued more than 1 year after the date of the 
enactment of this Act.

          TITLE IV--PROMOTING AND PROTECTING COMMUNITY LIVING

SEC. 401. 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. 402. STATE AUTHORITY TO ELECT TO EXCLUDE UP TO 6 MONTHS OF AVERAGE 
              COST OF NURSING FACILITY SERVICES FROM ASSETS OR 
              RESOURCES FOR PURPOSES OF ELIGIBILITY FOR HOME AND 
              COMMUNITY-BASED SERVICES.

    (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) State Authority To Exclude up to 6 Months of Average Cost of 
Nursing Facility Services From Home and Community-Based Services 
Eligibility Determinations.--Nothing in this section or any other 
provision of this title, shall be construed as prohibiting a State from 
excluding 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 the product of the 
amount applicable under subsection (c)(1)(E)(ii)(II) (at the time such 
determination is made) and such number, not to exceed 6, as the State 
may elect.''.
    (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 V--MISCELLANEOUS

SEC. 501. 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. 502. 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.
                                 <all>