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. 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.
<enum>I</enum><header>Strengthening the
Medicaid Home and Community-Based State Plan Amendment Option</header>
<section id="id0700AC5B6F664697BD9D927AA3E0C3B9"><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="idAD62ECC2ADB34822B6C388E862E47158"><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="id5F1B2B99DC7F45518587CC39B61EEA83"><enum>(b)</enum><header>Additional
state option To provide home and community-based services to individuals
eligible for services under a waiver</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="id5F81AF4CDFA8435F865124490AD67848" style="OLC">
<paragraph id="idA8E1F695281A4CE5ADC15D8ED0E2D79B"><enum>(6)</enum><header>State option to
provide home and community-based services to individuals eligible for services
under a waiver</header>
<subparagraph id="id25DBE7DBD81E44319CC7C5BE15B5B8D1"><enum>(A)</enum><header>In
general</header><text>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).</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id55A018A10ED4431192563EF503AE13A8"><enum>(B)</enum><header display-inline="yes-display-inline">Application of same requirements for
individuals satisfying needs-based criteria</header><text display-inline="yes-display-inline">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).</text>
</subparagraph><subparagraph id="idB2467B9F6241412A8D2E6EA5098A3CBE"><enum>(C)</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 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.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="idA3939D7392B742769F2972B757CC2B9F"><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="idAFF56FF588974B87A013A9F671AC573C"><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="id1B06FDA9BE8045FF86BE67AC4A80253F"><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="idBC0EAF0C6C8C4BFAA0F3EF3E2D7595B7"><enum>(A)</enum><text>in subclause
(XVIII), by striking <quote>or</quote> at the end;</text>
</subparagraph><subparagraph id="id8BA6592A6F0E4D1BA30D2872CDE2DDF6"><enum>(B)</enum><text>in subclause
(XIX), by adding <quote>or</quote> at the end; and</text>
</subparagraph><subparagraph id="id6CE2AC48899F43BD8FAC15070230B346"><enum>(C)</enum><text>by inserting
after subclause (XIX), the following new subclause:</text>
<quoted-block display-inline="no-display-inline" id="id967E86257D5342B2A7B20CB881C0FBAA" style="OLC">
<subclause id="id8AD8296B6C49443F8077CB2BD2DC6E3E"><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), 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;</text>
</subclause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="idC2114BC2077F40ECAA6BBE7FBB28DB9A"><enum>(2)</enum><header>Conforming
amendments</header>
<subparagraph id="idF96D2AA40D2A4EA2B4B09EFCB1869B03"><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="idD22455EA991C4EDAB79900400E5213D6"><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="id35086E95AA1F49ECB6C4BB8860B9A290"><enum>(i)</enum><text>in
clause (xii), by striking <quote>or</quote> at the end;</text>
</clause><clause id="id49077152B6CE4D50830363B6894C679C"><enum>(ii)</enum><text>in
clause (xiii), by adding <quote>or</quote> at the end; and</text>
</clause><clause id="id63723A9E68E5477F92C26704DC00F182"><enum>(iii)</enum><text>by inserting
after clause (xiii) the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="idD1E4EF3B930846FE81CB502ADC16A13D" style="OLC">
<clause id="id31D269F133874BA386D85644092ABC6A" 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), 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,</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph></paragraph></subsection><subsection id="id4C547D34BB554DA2B8386D2212090167"><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="id38110720C6FB4379850162CF2E825AD2"><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="id9E94DCCF06074B4F912C3B11C00CA6F8" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="ID33E13429CA62499DB4572002F982FCA1"><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="id32C2F3EA143F4331853CF415F03D21F7"><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="id3C848183CA474F4194F900C5F88F92ED"><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="idF863593FE7DA48D285EEA656D45CE311"><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="id9B2022A6EC684597B5882F92E21E867B"><enum>102.</enum><header>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</header>
<subsection id="idC2D4FE179CB64CA8845C62292F3CF64C"><enum>(a)</enum><header>State plan
amendment required</header>
<paragraph id="idC5CED97BB96F4A08B3BBE9C2341B4CD4"><enum>(1)</enum><header>In
general</header><text>Section 1915 of the Social Security Act (42 U.S.C. 1396n)
is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="idBA90E92E4BE2478F8CBBB45CFF61181C" style="OLC">
<subsection id="idAA8120FCD3CC44B0B06D34090EA06576"><enum>(k)</enum><header>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</header>
<paragraph id="id6F287B001AF24674980FABCB1E6BA7A8"><enum>(1)</enum><header>In
general</header><text>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—</text>
<subparagraph id="idDB1AB74911574747A26343B8C0F05DE0"><enum>(A)</enum><text>who are not
otherwise eligible for medical assistance under the State plan or under a
waiver of such plan;</text>
</subparagraph><subparagraph id="id1E4D063B8BD144DAB771890AD6E0197F"><enum>(B)</enum><text>whose income does
not exceed 300 percent of the supplemental security income benefit rate
established by section 1611(b)(1); and</text>
</subparagraph><subparagraph id="idF95866C60327419F9599A4D04CC08A1A"><enum>(C)</enum><text>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).</text>
</subparagraph></paragraph><paragraph id="id3A746F0C637C4CEFACEFAF51DF6BAA4A"><enum>(2)</enum><header>Requirement for
needs-based criteria</header><text>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.</text>
</paragraph><paragraph id="id83ED413014EB42728BF0FACE09D84425"><enum>(3)</enum><header>Application of
same requirements for providing home and community-based services under
subsection <enum-in-header>(i)</enum-in-header></header><text>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).</text>
</paragraph><paragraph id="id54B8C4CDC5EE4C57BDF46A4631C7C28D"><enum>(4)</enum><header>Authority to
limit number of individuals</header><text>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.</text>
</paragraph><paragraph id="id91A52E852C2246F58BEC53AFF2CC2E5D"><enum>(5)</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 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.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="id2FC9373D89424632B9F1665AC016F1DD"><enum>(2)</enum><header>Optional
categorically needy group; State option to limit benefits to home and
community-based services or to provide full medical assistance</header>
<subparagraph id="id359C2251278142BBAB16741C123D7720"><enum>(A)</enum><header>In
general</header><text>Section 1902(a)(10) of the Social Security Act (42 U.S.C.
1396a(a)(10)) is amended—</text>
<clause id="idD1CE6984AC9D4862AFAE74B7405CF301"><enum>(i)</enum><text>in
subparagraph (A)(ii), as amended by section 101(d)(1)—</text>
<subclause id="id43253527056D40A9850903BE2E4A1A57"><enum>(I)</enum><text>in subclause
(XIX), by striking <quote>or</quote> at the end;</text>
</subclause><subclause id="id247496CCAC224F18A4A9C24ADFEB7089"><enum>(II)</enum><text>in subclause
(XX), by adding <quote>or</quote> at the end; and</text>
</subclause><subclause id="idB89B092F994F4988B6C76FD6D16AE0E1"><enum>(III)</enum><text>by inserting
after subclause (XX), the following new subclause:</text>
<quoted-block display-inline="no-display-inline" id="id0A2EE185367B43A7AD83BE8687878D30" style="OLC">
<subclause id="id7EB21BA78913487CAF92A643E8E90905"><enum>(XXI)</enum><text>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;</text>
</subclause><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subclause></clause><clause id="idC9C38093EFD7470C97BE29C7A4DDBE05"><enum>(ii)</enum><text>in
the matter following subparagraph (G)—</text>
<subclause id="id5DDA226DBD134BC3AE600EC5EE41EB72"><enum>(I)</enum><text>by striking
<quote>and (XIV)</quote> and inserting <quote>(XIV)</quote>; and</text>
</subclause><subclause id="idFEF47A7FF30E4C2D82036F86E287E07B"><enum>(II)</enum><text>by inserting
<quote>, 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</quote> before the
semicolon.</text>
</subclause></clause></subparagraph><subparagraph id="idEF1D3C49DCBC4E4385ED039E2DDE1B82"><enum>(B)</enum><header>Conforming
amendments</header>
<clause id="idABE5A5B499A74E8AACFA78857733A0CD"><enum>(i)</enum><text>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 <quote>1902(a)(10)(A)(ii)(XXI),</quote> after
<quote>1902(a)(10)(A)(ii)(XX),</quote>.</text>
</clause><clause id="id14B94199928B4194A67399F2840FE79C"><enum>(ii)</enum><text>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)—</text>
<subclause id="idE75A1C9E2B7B49859778AF3C3015E490"><enum>(I)</enum><text>in clause (xiii),
by striking <quote>or</quote> at the end;</text>
</subclause><subclause id="idCD926CC995E14CDABB980FFBA5EAF74B"><enum>(II)</enum><text>in clause (xiv),
by adding <quote>or</quote> at the end; and</text>
</subclause></clause><clause id="id935A5A272A26467DB464B751FB73C610"><enum>(iii)</enum><text>by inserting
after clause (xiv) the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="id2319B6F61B184C3FA0B0C8A573BABEB8" style="OLC">
<clause id="id479A306C08564B34B063544FE9BE0B7F" indent="up2"><enum>(xv)</enum><text>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,</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph></paragraph></subsection><subsection id="id00A7936F2B1D4D959E941065E1A4C7C9"><enum>(b)</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="id8A4C2B00587B4889A4C80BFBE4D173E1"><enum>103.</enum><header>Implementation
assistance grants for States electing to provide home and community-based
services under Medicaid through the State plan amendment option</header>
<subsection id="id1C46B046096C49D8BAF12D333DF36F66"><enum>(a)</enum><header>Authority To
award grants</header><text>The Secretary of Health and Human Services (in this
section referred to as the <quote>Secretary</quote>) 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)).</text>
</subsection><subsection id="id9D171ECC42044321862CA76482AEB353"><enum>(b)</enum><header>Eligible
State</header><text>For purposes of this section, an eligible State is a State
that—</text>
<paragraph id="id0F660D1E7C2C40BF87AE5028B8524E97"><enum>(1)</enum><text>has an approved
State plan amendment described in subsection (a); and</text>
</paragraph><paragraph id="id22F115CAF35E42E88F7C20E4CC930436"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection id="id38036FB478144804BE99B54DBBF680EA"><enum>(c)</enum><header>Amount and
duration of grants</header>
<paragraph id="id60F420DF884C4E4F855B0B8A11B5251B"><enum>(1)</enum><header>Amount</header><text>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).</text>
</paragraph><paragraph id="idAB3F1C6A4F09483FB40D37D179DD6D1A"><enum>(2)</enum><header>Limitation on
duration of award</header><text>A State may receive a grant under this section
for not more than 3 consecutive fiscal years.</text>
</paragraph></subsection><subsection id="idDE4401E5F46B417BB65A75E9CA31E8C3"><enum>(d)</enum><header>Appropriations</header><text>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.</text>
</subsection></section><enum>II</enum><header>State Grants to
Facilitate Home and Community-Based Services and Promote Health</header>
<section id="id74AD0936D6E640368DBCD87BBF6F75DF"><enum>201.</enum><header>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</header>
<subsection id="id2D424456288F444F97EE053E31D7B4A6"><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="idE74283BC5F6D472CAC5FD2363CA3602E"><enum>(1)</enum><text>in clause (i), by
striking <quote>and</quote> at the end;</text>
</paragraph><paragraph id="idAE4C284CDB7E4E53A89430086649CF52"><enum>(2)</enum><text>in clause (ii),
by striking the period at the end and inserting <quote>; and</quote>;
and</text>
</paragraph><paragraph id="idB623EBCCA5E644FBB7E14223158867BC"><enum>(3)</enum><text>by inserting
after clause (ii), the following new clauses:</text>
<quoted-block display-inline="no-display-inline" id="id86C181DC10574B979FF23C66F3F815B4" style="OLC">
<clause id="idB3E3293B65634EA4B8E5E96EA9F0C4F9"><enum>(iii)</enum><text>$150,000,000
for fiscal year 2010; and</text>
</clause><clause id="id469C215CBD27425BB02ADC305250CE04"><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="id677A2E22E98C48489B70EC51836C0301"><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="idBAFD3FACF5064682BE3BAA964C4DFA82" style="OLC">
<subparagraph id="idBE21B129C5C645F69D3E263FDE751512"><enum>(G)</enum><clause commented="no" display-inline="yes-display-inline" id="idD64851E3D91C44F88B392706AD06D7EF"><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 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—</text>
<subclause id="id7057AB1087054AA49BDE20F67441EE1B" 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="id761DC3B9E30646FFACD6544A80AA983C" 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="idF3CFE532A96E423F80D04EC54BF9802B" 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="id46FD8604DAFB4555AED1D665FD9ED4B5" 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="id471BB2F457304F75B5472E0DD9F64AA0" indent="up1"><enum>(V)</enum><text>assist consumers in identifying
workers;</text>
</subclause><subclause id="id5038D13EA45640FB935F835F5A6238F2" indent="up1"><enum>(VI)</enum><text>act as a fiscal intermediary;</text>
</subclause><subclause id="idF9ED3CB24D304E7E9B39A56F513EEA4A" indent="up1"><enum>(VII)</enum><text>assist workers in finding employment,
including consumer-directed employment;</text>
</subclause><subclause id="id1D0BA81884144F078A9375FA7A7F6E72" 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="id59C407971D76479882004BFAB42BF367" 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="id6C4C439C32D04D50BC35C37CDBBBED0C" 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="id4AA01625D03A45C1B2905752CEF66C11"><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="idD7EAB332AA614786AA50B570BC9B2DB9"><enum>(c)</enum><header>Allocation of
funds</header>
<paragraph id="idDEABA11BE4D14896AB4A7EB1ABFAA548"><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="idCA577FBDE94747A1818CC7C0CC557F5B"><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="id98D3F371507E446CA6718BDCEB7B0F14"><enum>(d)</enum><header>Effective
date</header><text>The amendments made by this section take effect on October
1, 2009.</text>
</subsection></section><section id="idB5D80557F5C649E4948D2AEAE05560E7"><enum>202.</enum><header>Health
promotion grants</header>
<subsection id="id52522A34415F4B1B97C6A4865CCCFB58"><enum>(a)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="idAE5E5C17ED3A42F7ABF2E39C975A120F"><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="id052DB1111D3E4F728A5AE18B53F809D8"><enum>(A)</enum><text>has attained the
age of 60 and is not a resident of a nursing facility; or</text>
</subparagraph><subparagraph id="id1BDC67C867A44C8C9AD1B3E2C36ADC5D"><enum>(B)</enum><text>is an adult with
a physical, mental, cognitive, or intellectual impairment.</text>
</subparagraph></paragraph><paragraph id="idA9496A79B4BE4F33BD558322C4B9EF9B"><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="idD3FBF00FEF2145A9A6866A114F202DAC"><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="idB18D9268121D4FA4959B5308B3E98FAF"><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="idE85AB89DA15A4195964C5417C0D30867"><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="id69E7BCD1A1A045A69BFB342C779639A9"><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="id90C7889708094434AD3A0920B32EB28A"><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="id30A6F59BEE3B46C6A154C4C249A7E8A8"><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="id2B76B96C4D434F839F7234B9B0EA7A6A"><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="idCBD8FDDD657F42968FABE20255FC86A6"><enum>(2)</enum><text>give preference
to eligible States proposing—</text>
<subparagraph id="id6500EC3DA85F4F6E8437C753D393EB09"><enum>(A)</enum><text>programs through
public service provider organizations or other organizations with expertise in
serving eligible Medicaid beneficiaries;</text>
</subparagraph><subparagraph id="idFC42F82458264EB9AC42A38779E99052"><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="id1448C87DE3F64F6BB93B0CC261497349"><enum>(C)</enum><text>interventions
that have already demonstrated effectiveness and replicability in a
community-based, non-medical setting.</text>
</subparagraph></paragraph></subsection><subsection id="idB19DB2B2855A4A759E854144FA8836A4"><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="idA3B6608A437F4E94B0A731ECABF10391"><enum>(1)</enum><text>implement such
programs in at least 3 geographic areas of the State; and</text>
</paragraph><paragraph id="id5DCD0F9A2B974A92BBAA4068099E726F"><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="idA0D39A4A43EB49EC957ACABB059D793C"><enum>(e)</enum><header>Technical
assistance</header><text>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.</text>
</subsection><subsection id="id8D36B8676A4F4257AB44C18B74546C5A"><enum>(f)</enum><header>Payments to
eligible States; carryover of unused grant amounts</header>
<paragraph id="id0669198B6020411FB6F36CC4B545CB3F"><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="id31B02FF6383744579AEFFC08C5C0D0EE"><enum>(A)</enum><text>the amount of
qualified expenditures made by the State for such quarter; or</text>
</subparagraph><subparagraph id="idBA202502C06141A1A83DAAB6D33DE046"><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="idABD7036A20F146EDAEB7428FA2F8AB13"><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="id8BDED9429F1149E88A8310080607D8B0"><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="id23E74B8F09A74F789CF839AC73A65DD9"><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="id63E0395C1F2244CA93DDBD8D42857DC1"><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="id8AFAE42CBE4F431FA4818777876C6188"><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="ID73e65d70f63f47c18acef9a8b98e2d35"><enum>(1)</enum><header>Grants to
states</header><text>For grants to States, to remain available until
expended—</text>
<subparagraph id="id893EB30E8EE14E3899FB4074E4E8F4AC"><enum>(A)</enum><text>$4,000,000 for
fiscal year 2010;</text>
</subparagraph><subparagraph id="id031AC3B469A941348F6E2ACFA961CD06"><enum>(B)</enum><text>$6,000,000 for
fiscal year 2011;</text>
</subparagraph><subparagraph id="id4DF7DF7C137A4FA3957094C336704330"><enum>(C)</enum><text>$8,000,000 for
fiscal year 2012;</text>
</subparagraph><subparagraph id="id659935F5C7B34B1E93EBF266A81411B9"><enum>(D)</enum><text>$10,000,000 for
fiscal year 2013; and</text>
</subparagraph><subparagraph id="id3BCA071DBCBC4CB9B2D59C899E9920BD"><enum>(E)</enum><text>$12,000,000 for
fiscal year 2014.</text>
</subparagraph></paragraph><paragraph id="id32DD01562A704862A6D8ABE5BEC1E548"><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="idFFBA0379AA954683A65AFFF8F328B8E0"><enum>(A)</enum><text>$800,000 for
fiscal year 2010;</text>
</subparagraph><subparagraph id="id4DB56B59055544658C359B18348BBE7C"><enum>(B)</enum><text>$1,200,000 for
fiscal year 2011;</text>
</subparagraph><subparagraph id="idE70F6191E8A5492DBAB72604507B9105"><enum>(C)</enum><text>$1,600,000 for
fiscal year 2012;</text>
</subparagraph><subparagraph id="idA97E0254AC6E4F03B6A1EB4441497ECE"><enum>(D)</enum><text>$2,000,000 for
fiscal year 2013; and</text>
</subparagraph><subparagraph id="id324671A474254CB285C871D162F8AD6A"><enum>(E)</enum><text>$2,400,000 for
fiscal year 2014.</text>
</subparagraph></paragraph><paragraph id="id63999B9B1FD747A084822D419BBB56FC"><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>Long-term care
insurance</header>
<section id="IDFC08B5C495964236A19F5949DCEC1AD8"><enum>301.</enum><header>Treatment of
premiums on qualified long-term care insurance contracts</header>
<subsection id="ID75DDDD82A86447588919F57E112BD9C4"><enum>(a)</enum><header>In
general</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="ID9903A70868E04D14B0BA00F03EC3EA14" style="OLC">
<section id="ID4C92A6FBB50B4CDFAAD527C6C211B667"><enum>224.</enum><header>Premiums on
qualified long-term care insurance contracts</header>
<subsection id="IDC4DD7CB4635C4E20B43270104224164A"><enum>(a)</enum><header>In
general</header><text>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)).</text>
</subsection><subsection id="IDE82C4DD5A6A848BF88A5757EE784F370"><enum>(b)</enum><header>Applicable
percentage</header><text>For purposes of subsection (a), the applicable
percentage shall be determined in accordance with the following table:</text>
<table align-to-level="section" blank-lines-before="1" colsep="0" frame="none" line-rules="no-gen" rowsep="0" rule-weights="0.0.0.0.0.0" table-template-name="Tax (No Calculation)" table-type="Leaderwork">
<tgroup cols="2" rowsep="0"><colspec align="center" coldef="txt" colname="column1" colwidth="275pts" min-data-value="55"></colspec><colspec align="justify" coldef="fig" colname="column2" colwidth="180.75pt" min-data-value="9"></colspec>
<thead>
<row><entry align="center" colname="column1" morerows="0" namest="column1" valign="middle"><bold>For taxable years beginning in calendar
year—</bold></entry><entry align="center" colname="column2" morerows="0" namest="column2" valign="middle"><bold>The
<linebreak></linebreak>applicable<linebreak></linebreak> percentage<linebreak></linebreak> is—</bold></entry>
</row>
</thead>
<tbody>
<row><entry align="left" colname="column1" stub-definition="txt-ldr">2010 or 2011</entry><entry align="right" colname="column2">25</entry>
</row>
<row><entry align="left" colname="column1" stub-definition="txt-ldr">2012</entry><entry align="right" colname="column2">35</entry>
</row>
<row><entry align="left" colname="column1" stub-definition="txt-ldr">2013</entry><entry align="right" colname="column2">65</entry>
</row>
<row><entry align="left" colname="column1" stub-definition="txt-ldr">2014 or thereafter</entry><entry align="right" colname="column2">100.</entry>
</row>
</tbody>
</tgroup>
</table>
</subsection><subsection id="ID713FB3685C924D7396BE9F32D16E2806"><enum>(c)</enum><header>Coordination
with other deductions</header><text>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).</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="ID81F48088D9914A4181990E9695CC635A"><enum>(b)</enum><header>Conforming
amendments</header>
<paragraph id="ID7AB1103E08ED47ADB6B11911461D59E5"><enum>(1)</enum><text>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:</text>
<quoted-block display-inline="no-display-inline" id="ID6B0686A391BA45AF8EC8562575AEAA49" style="OLC">
<paragraph id="ID034DD9BAB1F74380AED0905445C5C501"><enum>(22)</enum><header>Premiums on
qualified long-term care insurance contracts</header><text>The deduction
allowed by section
224.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="ID9F56EAEF424141DBA26BF8BB2881350E"><enum>(2)</enum><text>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:</text>
<quoted-block display-inline="no-display-inline" id="IDFF89655D44DE48D888D8CF3DD22AB185" style="OLC">
<toc regeneration="no-regeneration">
<toc-entry level="section">Sec. 224. Premiums on qualified long-term
care insurance contracts.</toc-entry>
<toc-entry level="section">Sec. 225. Cross
reference.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="IDE806AE190176471986668E9974FC8792"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to taxable
years beginning after December 31, 2009.</text>
</subsection></section><section id="ID66A225CCF856464F92C217D95FFE8897"><enum>302.</enum><header>Credit for
taxpayers with long-term care needs</header>
<subsection id="ID4FDBC06232474DF395492F036C35D9D4"><enum>(a)</enum><header>In
general</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="ID6A14DB69DA314F2D8597370C54D8DA08" style="OLC">
<section id="ID1A12A00FB3FA45589412518D3ACC4AA4"><enum>25E.</enum><header>Credit for
taxpayers with long-term care needs</header>
<subsection id="ID793D1E9FE8FC4B6AB199DC6786CD150B"><enum>(a)</enum><header>Allowance of
credit</header>
<paragraph id="ID474819055A4D42269D39856767AE1CE1"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph id="ID4916DDE42AAF4C2CBFCA3B867A5D493F"><enum>(2)</enum><header>Applicable
credit amount</header><text>For purposes of paragraph (1), the applicable
credit amount shall be determined in accordance with the following
table:</text>
<table align-to-level="section" blank-lines-before="1" colsep="0" frame="none" line-rules="no-gen" rowsep="0" rule-weights="0.0.0.0.0.0" table-template-name="Tax (No Calculation)" table-type="Leaderwork">
<tgroup cols="2" rowsep="0"><colspec align="center" coldef="txt" colname="column1" colwidth="275pts" min-data-value="55"></colspec><colspec align="justify" coldef="fig" colname="column2" colwidth="125.25pt" min-data-value="9"></colspec>
<thead>
<row><entry align="center" colname="column1" morerows="0" namest="column1" valign="middle"><bold>For taxable years beginning in calendar
year—</bold></entry><entry align="center" colname="column2" morerows="0" namest="column2" valign="middle"><bold>The
<linebreak></linebreak>applicable<linebreak></linebreak> credit <linebreak></linebreak>amount<linebreak></linebreak>
is—</bold></entry>
</row>
</thead>
<tbody>
<row><entry align="left" colname="column1" rowsep="0" stub-definition="txt-ldr">2010</entry><entry align="right" colname="column2" rowsep="0">$1,000</entry>
</row>
<row><entry align="left" colname="column1" rowsep="0" stub-definition="txt-ldr">2011</entry><entry align="right" colname="column2" rowsep="0">1,500</entry>
</row>
<row><entry align="left" colname="column1" rowsep="0" stub-definition="txt-ldr">2012</entry><entry align="right" colname="column2" rowsep="0">2,000</entry>
</row>
<row><entry align="left" colname="column1" rowsep="0" stub-definition="txt-ldr">2013</entry><entry align="right" colname="column2" rowsep="0">2,500</entry>
</row>
<row><entry align="left" colname="column1" rowsep="0" stub-definition="txt-ldr">2014 or thereafter</entry><entry align="right" colname="column2" rowsep="0">3,000.</entry>
</row>
</tbody>
</tgroup>
</table>
</paragraph></subsection><subsection id="IDB99AF85A450B4575BE3D763C4F0CF315"><enum>(b)</enum><header>Limitation
based on adjusted gross income</header>
<paragraph id="ID4B8528C1F2D544319B5F9265887ED516"><enum>(1)</enum><header>In
general</header><text>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
<term>modified adjusted gross income</term> means adjusted gross income
increased by any amount excluded from gross income under section 911, 931, or
933.</text>
</paragraph><paragraph id="ID00BABFCACC684F98A7F3B17009B99638"><enum>(2)</enum><header>Threshold
amount</header><text>For purposes of paragraph (1), the term <term>threshold
amount</term> means—</text>
<subparagraph id="ID7B07AB9C88804BCDAD40A7EC39D69664"><enum>(A)</enum><text>$150,000 in the
case of a joint return, and</text>
</subparagraph><subparagraph id="IDAC8E6D1B706E410AA16D8E8E94ED13D1"><enum>(B)</enum><text>$75,000 in any
other case.</text>
</subparagraph></paragraph><paragraph id="IDCFAD10CF9E1344F19E593665E25DD5E8"><enum>(3)</enum><header>Indexing</header><text>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—</text>
<subparagraph id="IDF501AAF721004D698A94D22526865B27"><enum>(A)</enum><text>such dollar
amount, and</text>
</subparagraph><subparagraph id="ID22C473674D8340918692808060C22372"><enum>(B)</enum><text>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 <quote>August
2009</quote> for <quote>August 1996</quote> in subclause (II) thereof.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">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.</continuation-text></paragraph></subsection><subsection id="IDEA194306AE964E2F98DD3DBCEB0C776B"><enum>(c)</enum><header>Definitions</header><text>For
purposes of this section—</text>
<paragraph id="ID1537ED930AF54A599087D8FAFF4910A1"><enum>(1)</enum><header>Applicable
individual</header>
<subparagraph id="IDBC4FA8D7F6AA4BE382E855F869285154"><enum>(A)</enum><header>In
general</header><text>The term <term>applicable individual</term> 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
<act-name parsable-cite="SSA">Social Security Act</act-name>) as being an
individual with long-term care needs described in subparagraph (B) for a
period—</text>
<clause id="ID012C4C5E19FC4ADDBFB59E64C76AC457"><enum>(i)</enum><text>which is at least
180 consecutive days, and</text>
</clause><clause id="ID87FC5246DA7A499C83F9BFC2DB3E1509"><enum>(ii)</enum><text>a portion of
which occurs within the taxable year.</text>
</clause><continuation-text continuation-text-level="subparagraph">Notwithstanding the preceding
sentence, a certification shall not be treated as valid unless it is made
within the 39<fraction>1/2</fraction> month period ending on such due date (or
such other period as the Secretary prescribes).</continuation-text></subparagraph><subparagraph id="IDF43A1B9793CB4380BB328DA4C23BB400"><enum>(B)</enum><header>Individuals
with long-term care needs</header><text>An individual is described in this
subparagraph if the individual meets any of the following requirements:</text>
<clause id="ID6AAE8E996907459B91E468169FE63CC3"><enum>(i)</enum><text>The individual is
at least 6 years of age and—</text>
<subclause id="ID1763B9096F6548948915E6839D3E6FC4"><enum>(I)</enum><text>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</text>
</subclause><subclause id="ID4369AC48679049DE8DAAE8AD8FC9C935"><enum>(II)</enum><text>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.</text>
</subclause></clause><clause id="IDB4439ACBF2AB462889B8C9EAB3308E9C"><enum>(ii)</enum><text>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.</text>
</clause><clause id="ID91CB865024D74BA6AAFEA55C351D3515"><enum>(iii)</enum><text>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.</text>
</clause></subparagraph></paragraph><paragraph id="ID1DE91FF24BA946DE81437EC297D0676B"><enum>(2)</enum><header>Eligible
caregiver</header>
<subparagraph id="IDE526E68D6F3149C4AE76F46D36517785"><enum>(A)</enum><header>In
general</header><text>A taxpayer shall be treated as an eligible caregiver for
any taxable year with respect to the following individuals:</text>
<clause id="IDE3A8E3A8C30E4185B5ECDD3D9DC8A90A"><enum>(i)</enum><text>The
taxpayer.</text>
</clause><clause id="IDE4575492912B43C78D866914948D8603"><enum>(ii)</enum><text>The taxpayer's
spouse.</text>
</clause><clause id="ID3471118575714994AC42516E106EE31D"><enum>(iii)</enum><text>An individual
with respect to whom the taxpayer is allowed a deduction under section 151(c)
for the taxable year.</text>
</clause><clause id="IDCC1DD5211D2F4EA892E3858C28243615"><enum>(iv)</enum><text>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.</text>
</clause><clause id="IDB6F6B04EF7424506A68EBC6FDE3DC7BA"><enum>(v)</enum><text>An individual who
would be described in clause (iii) for the taxable year if—</text>
<subclause id="ID2A15BFF911874FBBBA037E5DDFF138A4"><enum>(I)</enum><text>the requirements
of clause (iv) are met with respect to the individual, and</text>
</subclause><subclause id="ID2A9F8407471A4AD3A2DF76CED81FC28E"><enum>(II)</enum><text>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.</text>
</subclause></clause></subparagraph><subparagraph id="ID0A4A9FA6712F4BDFA38A48EB15387ACC"><enum>(B)</enum><header>Residency
test</header><text>The requirements of this subparagraph are met if an
individual has as his principal place of abode the home of the taxpayer
and—</text>
<clause id="ID6F6E6A6016F0445B9240FFF6CA4D8B8A"><enum>(i)</enum><text>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</text>
</clause><clause id="ID7B51296648C544A194AA417EE864348B"><enum>(ii)</enum><text>in the case of
any other individual, is a member of the taxpayer's household for the entire
taxable year.</text>
</clause></subparagraph><subparagraph id="ID2EDF0E21A6C142C0AD03C281056C85E1"><enum>(C)</enum><header>Special rules
where more than 1 eligible caregiver</header>
<clause id="ID4B8CB024C698401F90E763999F4B6199"><enum>(i)</enum><header>In
general</header><text>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.</text>
</clause><clause id="ID16FD833456DB41BEAE11E2F81459B623"><enum>(ii)</enum><header>No
agreement</header><text>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.</text>
</clause><clause id="IDDBF61521F8E5487A9C119CEFAD2EFB6A"><enum>(iii)</enum><header>Married
individuals filing separately</header><text>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)).</text>
</clause></subparagraph></paragraph></subsection><subsection id="ID07F471F1CDCC4622B57A4A6CBABBA259"><enum>(d)</enum><header>Identification
requirement</header><text>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.</text>
</subsection><subsection id="IDF95824F1BC5945CC8590B702CE0770B4"><enum>(e)</enum><header>Taxable year
must be full taxable year</header><text>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.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="IDF64D12A9E0B74AF7B03D3B7EF5B32047"><enum>(b)</enum><header>Conforming
amendments</header>
<paragraph id="ID145058F5B6FC49289746336C1D022C47"><enum>(1)</enum><text>Section
6213(g)(2) of the Internal Revenue Code of 1986 is amended by striking
<quote>and</quote> at the end of subparagraph (L), by striking the period at
the end of subparagraph (M) and inserting <quote>, and</quote>, and by
inserting after subparagraph (M) the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="ID7C5218699DA643FAAC03504C58DD12C8" style="OLC">
<subparagraph id="ID67C96FD87C594C42B9DA4F16A1517CBC"><enum>(N)</enum><text>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.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="ID270AE43DD1F54B6C9FCE076D544908E5"><enum>(2)</enum><text>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:</text>
<quoted-block display-inline="no-display-inline" id="IDB2C9049F9A86416287A7F1EAB6BD34A4" style="OLC">
<toc regeneration="no-regeneration">
<toc-entry level="section">Sec. 25E. Credit for taxpayers with
long-term care
needs.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="ID70B0A8ED0F544E3A9F858FF388930D67"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to taxable
years beginning after December 31, 2009.</text>
</subsection></section><section id="H209A1D03C737483BB866CB81CE503E8C" section-type="subsequent-section"><enum>303.</enum><header>Treatment of
premiums on qualified long-term care insurance contracts</header>
<subsection id="H91C6C3414CDA473C89E7BE07AF31DD6D"><enum>(a)</enum><header>In
general</header>
<paragraph id="HF35603C8E66B4CFBB0EDF4F71D908D05"><enum>(1)</enum><header>Cafeteria
plans</header><text>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 <quote>; 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</quote>.</text>
</paragraph><paragraph id="H6F047C60A5734E539EB6D14846992EFA"><enum>(2)</enum><header>Flexible
spending arrangements</header><text>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).</text>
</paragraph></subsection><subsection id="HFD55CABF9251431A9FA5A48C0700F23E"><enum>(b)</enum><header>Conforming
amendments</header>
<paragraph id="H8897CC5E2EB54B90B4008F143B7BB485"><enum>(1)</enum><text>Section 6041 of
the Internal Revenue Code of 1986 is amended by adding at the end the following
new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H26E9C900AFE44FA7B6C79F6C52134CC2" style="OLC">
<subsection id="HCCB1BDB98E9D44B490BBAD20458F7B53"><enum>(h)</enum><header>Flexible
spending arrangement defined</header><text display-inline="yes-display-inline">For purposes of this section, a flexible
spending arrangement is a benefit program which provides employees with
coverage under which—</text>
<paragraph id="HC0BD23EF6938466B004100CD8875DDBA"><enum>(1)</enum><text>specified incurred
expenses may be reimbursed (subject to reimbursement maximums and other
reasonable conditions), and</text>
</paragraph><paragraph id="H1875191E2D4A4350AD7119C416325C75"><enum>(2)</enum><text>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.</text>
</paragraph><continuation-text continuation-text-level="subsection">In the
case of an insured plan, the maximum amount reasonably available shall be
determined on the basis of the underlying
coverage.</continuation-text></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph display-inline="no-display-inline" id="H5B6D704DB9BC46F982034B3162651F83"><enum>(2)</enum><text>The following
sections of such Code are each amended by striking <quote>section
106(d)</quote> and inserting <quote>section 106(c)</quote>: 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).</text>
</paragraph><paragraph id="HCECA53FCDAD74FEA895C6BB6CB878D03"><enum>(3)</enum><text>Section 6041(f)(1)
of such Code is amended by striking <quote>(as defined in section
106(c)(2))</quote>.</text>
</paragraph></subsection><subsection id="H16D0D42F706B4C8F841E89B40298DB53"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to taxable
years beginning after December 31, 2009.</text>
</subsection></section><section display-inline="no-display-inline" id="H359BE9924BE44201007E52D66543C255" section-type="subsequent-section"><enum>304.</enum><header>Additional consumer
protections for long-term care insurance</header>
<subsection id="HB39D4A9A87ED45B295D8797FB5DB6399"><enum>(a)</enum><header>Additional
protections applicable to long-term care insurance</header><text>Subparagraphs
(A) and (B) of <external-xref legal-doc="usc" parsable-cite="usc/26/7702B">section 7702B(g)(2)</external-xref> of the
Internal Revenue Code of 1986 (relating to requirements of model regulation and
Act) are amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="H6C3B1D74E63A47F6980088D48B7EC7" style="OLC">
<subparagraph id="HA3D0D237EDBB4AD391D17489009C6E43"><enum>(A)</enum><header>In
general</header><text>The requirements of this paragraph are met with respect
to any contract if such contract meets—</text>
<clause id="H9A87A69D666748ED81A2918FFEBA6C9D"><enum>(i)</enum><header>Model
regulation</header><text>The following requirements of the model
regulation:</text>
<subclause id="HF489813F481743CF92468500B5344773"><enum>(I)</enum><text>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.</text>
</subclause><subclause id="H1868816259654EE891C886FAC0047FAE"><enum>(II)</enum><text>Section 6B
(relating to prohibitions on limitations and exclusions) other than paragraph
(7) thereof.</text>
</subclause><subclause id="H8BAA2B21CD2D4A4EB700690057785E03"><enum>(III)</enum><text>Section 6C
(relating to extension of benefits).</text>
</subclause><subclause id="H3047BF324D594B1DB286650930D579C1"><enum>(IV)</enum><text>Section 6D
(relating to continuation or conversion of coverage).</text>
</subclause><subclause id="HA485C8DED65D4C8FAC00C0C4594679A2"><enum>(V)</enum><text>Section 6E
(relating to discontinuance and replacement of policies).</text>
</subclause><subclause id="HC8D1BFEACA484760B60044F77106B926"><enum>(VI)</enum><text>Section 7
(relating to unintentional lapse).</text>
</subclause><subclause id="H46A8FC46F5FA4992000454BC87BDE13"><enum>(VII)</enum><text>Section 8
(relating to disclosure), other than sections 8F, 8G, 8H, and 8I
thereof.</text>
</subclause><subclause id="H4295AD7EB7364D5100603C0021C31B9E"><enum>(VIII)</enum><text>Section 11
(relating to prohibitions against post-claims underwriting).</text>
</subclause><subclause id="HC88C53FA5DE746349939D0F1F1081853"><enum>(IX)</enum><text>Section 12
(relating to minimum standards).</text>
</subclause><subclause id="H67C42FDDDF264F1085D8681DBE8B76ED"><enum>(X)</enum><text>Section 13
(relating to requirement to offer inflation protection).</text>
</subclause><subclause id="HC80BA07E0ED048A3BA9367D199D2F5AA"><enum>(XI)</enum><text>Section 25
(relating to prohibition against preexisting conditions and probationary
periods in replacement policies or certificates).</text>
</subclause><subclause id="HE508F136675F434EBC3FE782CD4C00BC"><enum>(XII)</enum><text>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.</text>
</subclause></clause><clause id="H9B5F486160D7431900E1ED306FEC0281"><enum>(ii)</enum><header>Model
Act</header><text>The following requirements of the model Act:</text>
<subclause id="H9B60CADA23E24FBBA6DC8CFB00968191"><enum>(I)</enum><text>Section 6C
(relating to preexisting conditions).</text>
</subclause><subclause id="H9EF296D29F47442CBDB454A187E3F9E7"><enum>(II)</enum><text>Section 6D
(relating to prior hospitalization).</text>
</subclause><subclause id="HBA115BC9905F4CB1892809D418CDDB4D"><enum>(III)</enum><text>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.</text>
</subclause></clause></subparagraph><subparagraph id="HD38AF51BDC684688A5A7CF21FF90B1AF"><enum>(B)</enum><header>Definitions</header><text>For
purposes of this paragraph—</text>
<clause id="H62FA10AE23E244E180FB498F5DD60045"><enum>(i)</enum><header>Model
regulation</header><text>The term <term>model regulation</term> means the
long-term care insurance model regulation promulgated by the National
Association of Insurance Commissioners (as adopted as of December 2006).</text>
</clause><clause id="H16595FEFECD74E32A672734BF6722581"><enum>(ii)</enum><header>Model
Act</header><text display-inline="yes-display-inline">The term <term>model
Act</term> means the long-term care insurance model Act promulgated by the
National Association of Insurance Commissioners (as adopted as of December
2006).</text>
</clause><clause id="H288DD04137F74564AA31C522F447983D"><enum>(iii)</enum><header>Coordination</header><text>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.</text>
</clause><clause id="H9C5712CEDB674BD8B590A5E761CF1EFD"><enum>(iv)</enum><header>Determination</header><text>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.</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H23D4D9987CD244F191438D57CF693C46"><enum>(b)</enum><header>Excise
tax</header><text>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:</text>
<quoted-block id="H71FBDAD52CF3425A9800CC35008EA9F9">
<paragraph id="H42926731281F4FB5B8BB925B6398AA41"><enum>(1)</enum><header>Requirements of
model provisions</header>
<subparagraph id="H6B391EC8D8C54A199C7323CD00E728E3"><enum>(A)</enum><header>Model
regulation</header><text display-inline="yes-display-inline">The following
requirements of the model regulation must be met:</text>
<clause id="H3E4BEF9DB0FB48CF9C350007C11F2767"><enum>(i)</enum><text>Section 9
(relating to required disclosure of rating practices to consumer).</text>
</clause><clause id="H663B4EC6782E482DA288695D34000267"><enum>(ii)</enum><text>Section 14
(relating to application forms and replacement coverage).</text>
</clause><clause id="H26966840FCAB4DE68F80D0ED90F504D6"><enum>(iii)</enum><text>Section 15
(relating to reporting requirements).</text>
</clause><clause id="H3E29A53DCA2D4C7BA7A2C8EFB48935C"><enum>(iv)</enum><text>Section 22
(relating to filing requirements for marketing).</text>
</clause><clause id="HE0AB52D4F44B46FEBC3EA2C138F31D36"><enum>(v)</enum><text>Section 23
(relating to standards for marketing), including inaccurate completion of
medical histories, other than paragraphs (1), (6), and (9) of section
23C.</text>
</clause><clause id="H403EE85BDA64491183582F952CAFFBEA"><enum>(vi)</enum><text>Section 24
(relating to suitability).</text>
</clause><clause id="idA53656F7E61A4B09BC7FC088935912FE"><enum>(vii)</enum><text>Section 26
(relating to policyholder notifications).</text>
</clause><clause id="HFD69A552A7B348A19D6FA1B2ED1BF832"><enum>(viii)</enum><text display-inline="yes-display-inline">Section 27 (relating to the right to reduce
coverage and lower premiums).</text>
</clause><clause id="H31F2F7713EFB45BBB748B03052854F59"><enum>(ix)</enum><text>Section 31
(relating to standard format outline of coverage).</text>
</clause><clause id="H57BB2C72121F4810BAAF050075C99DAB"><enum>(x)</enum><text>Section 32
(relating to requirement to deliver shopper’s guide).</text>
</clause></subparagraph><subparagraph display-inline="no-display-inline" id="H81B33BE334214821A54C40C8EAEE6F08"><enum>(B)</enum><header>Model
Act</header><text>The following requirements of the model Act must be
met:</text>
<clause id="H06FD6496187C4B4DA2E3C36C2B05B200"><enum>(i)</enum><text>Section 6F
(relating to right to return).</text>
</clause><clause id="H5B2CF39991B44FCEBABCB46BFFC3359"><enum>(ii)</enum><text>Section 6G
(relating to outline of coverage).</text>
</clause><clause id="HA7576BE32E424C6BA22C694FB42EEAFB"><enum>(iii)</enum><text>Section 6H
(relating to requirements for certificates under group plans).</text>
</clause><clause id="H1EE53F118CA9442CB3005C2B59C9FE4F"><enum>(iv)</enum><text>Section 6J
(relating to policy summary).</text>
</clause><clause id="H578856A3C3CA4E23ADCA6191FC00C49F"><enum>(v)</enum><text>Section 6K
(relating to monthly reports on accelerated death benefits).</text>
</clause><clause id="H2FA80FA0CCB84B55A8F04853BB00DCA0"><enum>(vi)</enum><text>Section 7
(relating to incontestability period).</text>
</clause><clause id="HF0CF06D8686A4F96847DC7B24DD12EF0"><enum>(vii)</enum><text display-inline="yes-display-inline">Section 9 (relating to producer training
requirements).</text>
</clause></subparagraph><subparagraph id="HBAFE7A0F47684A3B8F73A75934865962"><enum>(C)</enum><header>Definitions</header><text>For
purposes of this paragraph, the terms <term>model regulation</term> and
<term>model Act</term> have the meanings given such terms by section
7702B(g)(2)(B).</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="HCC8A32ABBACE48C7A4A8634825793F1F"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to policies
issued more than 1 year after the date of the enactment of this Act.</text>
</subsection></section><enum>IV</enum><header>Promoting and
Protecting Community Living</header>
<section id="idB3C759BEF27D438298E5E35B125BEC07"><enum>401.</enum><header>Mandatory
application of spousal impoverishment protections to recipients of home and
community-based services</header>
<subsection id="id269D58A9FD4E4D1394AA91E81D005DAC"><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="idED2B051D77564BE0A2B2DC069DC82C51"><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="id72F54816BBA64A1A92A60AE813FB375E"><enum>402.</enum><header>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</header>
<subsection id="idFF2D076FBC9D496399D11A0CDAC579D8"><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="idC417D7AA89FC42A2A5D68E05982FF51D" style="OLC">
<subsection id="id32210DD99EC244D3B6E3A3712E3FDC04"><enum>(i)</enum><header>State authority
To exclude up to 6 months of average cost of nursing facility services from
home and community-based services eligibility
determinations</header><text>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.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="id9121387CCAAE421E83D5657B1EF74D11"><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="idC81E46F4211B426B891D469DF61C880B"><enum>(c)</enum><header>Effective
date</header><text>The amendment made by subsection (a) takes effect on October
1, 2009.</text>
</subsection></section><enum>V</enum><header>Miscellaneous</header>
<section id="idDEBEF1BE53644FDFBB22ED1F4D3A409C"><enum>501.</enum><header>Improved data
collection</header>
<subsection id="id251AD4EF34784E3D84DC6E00F5E7636B"><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="idD0FA8823D7A240D0A96F2C8090E1CAC9"><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="idDF4AA8C55689499CABDF2D4A80FA5237"><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="idE542E62C58B34CCD9FDBFA83DAD5BB52"><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="id3E8D37BF1F8F4790BC19993D368AB7B8"><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="id1F8242DE232149B1BBB4B6DAB4E1429C"><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="idB8D9120F9C734A99A3AF19E6B503DB7C"><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="idE82703B351084CBD97426E733AAB95CC"><enum>502.</enum><header>GAO report on
Medicaid home health services and the extent of consumer self-direction of such
services</header>
<subsection id="idA7DB4A8457974EDABDAADC067EC1EAA3"><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="idB422233EF206477FB9A0D278B8B883CB"><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>