S 3327 ISCommentsClose CommentsPermalink

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.CommentsClose CommentsPermalink

July 24 (legislative day, July 23), 2008CommentsClose CommentsPermalink

Mr. KERRY (for himself and Mr. GRASSLEY) introduced the following bill; which was read twice and referred to the Committee on FinanceCommentsClose CommentsPermalink

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.CommentsClose CommentsPermalink

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title- This Act may be cited as the ‘Empowered at Home Act of 2008’.CommentsClose CommentsPermalink





(b) Table of Contents- The table of contents of this Act is as follows:CommentsClose CommentsPermalink





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

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.CommentsClose CommentsPermalink





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.CommentsClose CommentsPermalink





Sec. 103. Implementation assistance grants for States electing to provide home and community-based services under Medicaid through the State plan amendment option.CommentsClose CommentsPermalink

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.CommentsClose CommentsPermalink





Sec. 202. Health promotion grants.CommentsClose CommentsPermalink

TITLE III--LONG TERM CARE INSURANCE

Sec. 301. Treatment of premiums on qualified long-term care insurance contracts.CommentsClose CommentsPermalink





Sec. 302. Credit for taxpayers with long-term care needs.CommentsClose CommentsPermalink





Sec. 303. Treatment of premiums on qualified long-term care insurance contracts.CommentsClose CommentsPermalink





Sec. 304. Additional consumer protections for long-term care insurance.CommentsClose CommentsPermalink

TITLE IV--PROMOTING AND PROTECTING COMMUNITY LIVING

Sec. 401. Mandatory application of spousal impoverishment protections to recipients of home and community-based services.CommentsClose CommentsPermalink





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.CommentsClose CommentsPermalink

TITLE V--MISCELLANEOUS

Sec. 501. Improved data collection.CommentsClose CommentsPermalink





Sec. 502. GAO report on Medicaid home health services and the extent of consumer self-direction of such services.CommentsClose CommentsPermalink

TITLE I--STRENGTHENING THE MEDICAID HOME AND COMMUNITY-BASED STATE PLAN AMENDMENT OPTIONCommentsClose CommentsPermalink

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)’.CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





‘(6) STATE OPTION TO PROVIDE HOME AND COMMUNITY-BASED SERVICES TO INDIVIDUALS ELIGIBLE FOR SERVICES UNDER A WAIVER-CommentsClose CommentsPermalink





‘(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).CommentsClose CommentsPermalink





‘(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).CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink





(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’CommentsClose CommentsPermalink





(d) Optional Eligibility Category To Provide Full Medicaid Benefits to Individuals Receiving Home and Community-Based Services Under a State Plan Amendment-CommentsClose CommentsPermalink





(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--CommentsClose CommentsPermalink





(A) in subclause (XVIII), by striking ‘or’ at the end;CommentsClose CommentsPermalink





(B) in subclause (XIX), by adding ‘or’ at the end; andCommentsClose CommentsPermalink





(C) by inserting after subclause (XIX), the following new subclause:CommentsClose CommentsPermalink





‘(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;’.CommentsClose CommentsPermalink





(2) CONFORMING AMENDMENTS-CommentsClose CommentsPermalink





(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),’.CommentsClose CommentsPermalink





(B) Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended in the matter preceding paragraph (1)--CommentsClose CommentsPermalink





(i) in clause (xii), by striking ‘or’ at the end;CommentsClose CommentsPermalink





(ii) in clause (xiii), by adding ‘or’ at the end; andCommentsClose CommentsPermalink





(iii) by inserting after clause (xiii) the following new clause:CommentsClose CommentsPermalink





‘(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,’.CommentsClose CommentsPermalink





(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--CommentsClose CommentsPermalink





(1) by striking subparagraph (C) and inserting the following:CommentsClose CommentsPermalink





‘(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.’; andCommentsClose CommentsPermalink





(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’.CommentsClose CommentsPermalink





(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’.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink

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-CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





‘(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-CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(A) who are not otherwise eligible for medical assistance under the State plan or under a waiver of such plan;CommentsClose CommentsPermalink





‘(B) whose income does not exceed 300 percent of the supplemental security income benefit rate established by section 1611(b)(1); andCommentsClose CommentsPermalink





‘(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).CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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).CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink





(2) OPTIONAL CATEGORICALLY NEEDY GROUP; STATE OPTION TO LIMIT BENEFITS TO HOME AND COMMUNITY-BASED SERVICES OR TO PROVIDE FULL MEDICAL ASSISTANCE-CommentsClose CommentsPermalink





(A) IN GENERAL- Section 1902(a)(10) of the Social Security Act (42 U.S.C. 1396a(a)(10)) is amended--CommentsClose CommentsPermalink





(i) in subparagraph (A)(ii), as amended by section 101(d)(1)--CommentsClose CommentsPermalink





(I) in subclause (XIX), by striking ‘or’ at the end;CommentsClose CommentsPermalink





(II) in subclause (XX), by adding ‘or’ at the end; andCommentsClose CommentsPermalink





(III) by inserting after subclause (XX), the following new subclause:CommentsClose CommentsPermalink





‘(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;’; andCommentsClose CommentsPermalink





(ii) in the matter following subparagraph (G)--CommentsClose CommentsPermalink





(I) by striking ‘and (XIV)’ and inserting ‘(XIV)’; andCommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(B) CONFORMING AMENDMENTS-CommentsClose CommentsPermalink





(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),’.CommentsClose CommentsPermalink





(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)--CommentsClose CommentsPermalink





(I) in clause (xiii), by striking ‘or’ at the end;CommentsClose CommentsPermalink





(II) in clause (xiv), by adding ‘or’ at the end; andCommentsClose CommentsPermalink





(iii) by inserting after clause (xiv) the following new clause:CommentsClose CommentsPermalink





‘(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,’.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink

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)).CommentsClose CommentsPermalink





(b) Eligible State- For purposes of this section, an eligible State is a State that--CommentsClose CommentsPermalink





(1) has an approved State plan amendment described in subsection (a); andCommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(c) Amount and Duration of Grants-CommentsClose CommentsPermalink





(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).CommentsClose CommentsPermalink





(2) LIMITATION ON DURATION OF AWARD- A State may receive a grant under this section for not more than 3 consecutive fiscal years.CommentsClose CommentsPermalink





(d) Appropriations- There are appropriated, from any funds in the Treasury not otherwise appropriated, $40,000,000 for each of fiscal years 2009 through 2013 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, 2013.CommentsClose CommentsPermalink

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

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--CommentsClose CommentsPermalink





(1) in clause (i), by striking ‘and’ at the end;CommentsClose CommentsPermalink





(2) in clause (ii), by striking the period at the end and inserting ‘; and’; andCommentsClose CommentsPermalink





(3) by inserting after clause (ii), the following new clauses:CommentsClose CommentsPermalink





‘(iii) $150,000,000 for fiscal year 2009; andCommentsClose CommentsPermalink





‘(iv) $150,000,000 for fiscal year 2010.’.CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(I) develop programs where qualified individuals provide home- and community-based services while solely or jointly employed by recipients of such services;CommentsClose CommentsPermalink





‘(II) facilitate the training and recruitment of qualified health and direct service professionals and consumers who use services;CommentsClose CommentsPermalink





‘(III) recommend or develop a system to set wages and benefits, and recommend commensurate reimbursement rates;CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(V) assist consumers in identifying workers;CommentsClose CommentsPermalink





‘(VI) act as a fiscal intermediary;CommentsClose CommentsPermalink





‘(VII) assist workers in finding employment, including consumer-directed employment;CommentsClose CommentsPermalink





‘(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; orCommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink





(c) Allocation of Funds-CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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).’.CommentsClose CommentsPermalink





(d) Effective Date- The amendments made by this section take effect on October 1, 2008.CommentsClose CommentsPermalink

SEC. 202. HEALTH PROMOTION GRANTS.

(a) Definitions- In this section:CommentsClose CommentsPermalink





(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--CommentsClose CommentsPermalink





(A) has attained the age of 60 and is not a resident of a nursing facility; orCommentsClose CommentsPermalink





(B) is an adult with a physical, mental, cognitive, or intellectual impairment.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(4) SECRETARY- The term ‘Secretary’ means the Secretary of Health and Human Services.CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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--CommentsClose CommentsPermalink





(1) take into consideration the manner and extent to which the eligible State proposes to achieve the objectives specified in subsection (b); andCommentsClose CommentsPermalink





(2) give preference to eligible States proposing--CommentsClose CommentsPermalink





(A) programs through public service provider organizations or other organizations with expertise in serving eligible Medicaid beneficiaries;CommentsClose CommentsPermalink





(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; orCommentsClose CommentsPermalink





(C) interventions that have already demonstrated effectiveness and replicability in a community-based, non-medical setting.CommentsClose CommentsPermalink





(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--CommentsClose CommentsPermalink





(1) implement such programs in at least 3 geographic areas of the State; andCommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(f) Payments to Eligible States; Carryover of Unused Grant Amounts-CommentsClose CommentsPermalink





(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--CommentsClose CommentsPermalink





(A) the amount of qualified expenditures made by the State for such quarter; orCommentsClose CommentsPermalink





(B) the total amount remaining in such grant award for such fiscal year (taking into account the application of paragraph (2)).CommentsClose CommentsPermalink





(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).CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(h) Appropriations- There are appropriated, from any funds in the Treasury not otherwise appropriated, the following amounts to carry out this section:CommentsClose CommentsPermalink





(1) GRANTS TO STATES- For grants to States, to remain available until expended--CommentsClose CommentsPermalink





(A) $4,000,000 for fiscal year 2009;CommentsClose CommentsPermalink





(B) $6,000,000 for fiscal year 2010;CommentsClose CommentsPermalink





(C) $8,000,000 for fiscal year 2011;CommentsClose CommentsPermalink





(D) $10,000,000 for fiscal year 2012; andCommentsClose CommentsPermalink





(E) $12,000,000 for fiscal year 2013.CommentsClose CommentsPermalink





(2) TECHNICAL ASSISTANCE- For the provision of technical assistance through such center in accordance with subsection (e)--CommentsClose CommentsPermalink





(A) $800,000 for fiscal year 2009;CommentsClose CommentsPermalink





(B) $1,200,000 for fiscal year 2010;CommentsClose CommentsPermalink





(C) $1,600,000 for fiscal year 2011;CommentsClose CommentsPermalink





(D) $2,000,000 for fiscal year 2012; andCommentsClose CommentsPermalink





(E) $2,400,000 for fiscal year 2013.CommentsClose CommentsPermalink





(3) EVALUATION- For conducting the evaluation required under subsection (g), $4,000,000 for fiscal year 2011.CommentsClose CommentsPermalink

TITLE III--LONG TERM CARE INSURANCECommentsClose CommentsPermalink

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:CommentsClose CommentsPermalink

‘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)).CommentsClose CommentsPermalink





‘(b) Applicable Percentage- For purposes of subsection (a), the applicable percentage shall be determined in accordance with the following table:CommentsClose CommentsPermalink

‘For taxable years beginning in calendar year--CommentsClose CommentsPermalink

2010 or 2011CommentsClose CommentsPermalink

--25CommentsClose CommentsPermalink

2012CommentsClose CommentsPermalink

--35CommentsClose CommentsPermalink

2013CommentsClose CommentsPermalink

--65CommentsClose CommentsPermalink

2014 or thereafterCommentsClose CommentsPermalink

--100.CommentsClose CommentsPermalink

‘(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).’.CommentsClose CommentsPermalink





(b) Conforming Amendments-CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





‘(22) PREMIUMS ON QUALIFIED LONG-TERM CARE INSURANCE CONTRACTS- The deduction allowed by section 224.’.CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





‘Sec. 224. Premiums on qualified long-term care insurance contracts.CommentsClose CommentsPermalink





‘Sec. 225. Cross reference.’.CommentsClose CommentsPermalink





(c) Effective Date- The amendments made by this section shall apply to taxable years beginning after December 31, 2009.CommentsClose CommentsPermalink

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:CommentsClose CommentsPermalink

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

‘(a) Allowance of Credit-CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(2) APPLICABLE CREDIT AMOUNT- For purposes of paragraph (1), the applicable credit amount shall be determined in accordance with the following table:CommentsClose CommentsPermalink

‘For taxable years beginning in calendar year--CommentsClose CommentsPermalink

2010CommentsClose CommentsPermalink

--$1,000CommentsClose CommentsPermalink

2011CommentsClose CommentsPermalink

--1,500CommentsClose CommentsPermalink

2012CommentsClose CommentsPermalink

--2,000CommentsClose CommentsPermalink

2013CommentsClose CommentsPermalink

--2,500CommentsClose CommentsPermalink

2014 or thereafterCommentsClose CommentsPermalink

--3,000.CommentsClose CommentsPermalink

‘(b) Limitation Based on Adjusted Gross Income-CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(2) THRESHOLD AMOUNT- For purposes of paragraph (1), the term ‘threshold amount’ means--CommentsClose CommentsPermalink





‘(A) $150,000 in the case of a joint return, andCommentsClose CommentsPermalink





‘(B) $75,000 in any other case.CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(A) such dollar amount, andCommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





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.CommentsClose CommentsPermalink





‘(c) Definitions- For purposes of this section--CommentsClose CommentsPermalink





‘(1) APPLICABLE INDIVIDUAL-CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(i) which is at least 180 consecutive days, andCommentsClose CommentsPermalink





‘(ii) a portion of which occurs within the taxable year.CommentsClose CommentsPermalink





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).CommentsClose CommentsPermalink





‘(B) INDIVIDUALS WITH LONG-TERM CARE NEEDS- An individual is described in this subparagraph if the individual meets any of the following requirements:CommentsClose CommentsPermalink





‘(i) The individual is at least 6 years of age and--CommentsClose CommentsPermalink





‘(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, orCommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(2) ELIGIBLE CAREGIVER-CommentsClose CommentsPermalink





‘(A) IN GENERAL- A taxpayer shall be treated as an eligible caregiver for any taxable year with respect to the following individuals:CommentsClose CommentsPermalink





‘(i) The taxpayer.CommentsClose CommentsPermalink





‘(ii) The taxpayer’s spouse.CommentsClose CommentsPermalink





‘(iii) An individual with respect to whom the taxpayer is allowed a deduction under section 151(c) for the taxable year.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(v) An individual who would be described in clause (iii) for the taxable year if--CommentsClose CommentsPermalink





‘(I) the requirements of clause (iv) are met with respect to the individual, andCommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(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, orCommentsClose CommentsPermalink





‘(ii) in the case of any other individual, is a member of the taxpayer’s household for the entire taxable year.CommentsClose CommentsPermalink





‘(C) SPECIAL RULES WHERE MORE THAN 1 ELIGIBLE CAREGIVER-CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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)).CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink





(b) Conforming Amendments-CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





‘Sec. 25E. Credit for taxpayers with long-term care needs.’.CommentsClose CommentsPermalink





(c) Effective Date- The amendments made by this section shall apply to taxable years beginning after December 31, 2009.CommentsClose CommentsPermalink

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

(a) In General-CommentsClose CommentsPermalink





(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’.CommentsClose CommentsPermalink





(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).CommentsClose CommentsPermalink





(b) Conforming Amendments-CommentsClose CommentsPermalink





(1) Section 6041 of the Internal Revenue Code of 1986 is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(1) specified incurred expenses may be reimbursed (subject to reimbursement maximums and other reasonable conditions), andCommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





In the case of an insured plan, the maximum amount reasonably available shall be determined on the basis of the underlying coverage.’.CommentsClose CommentsPermalink





(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).CommentsClose CommentsPermalink





(3) Section 6041(f)(1) of such Code is amended by striking ‘(as defined in section 106(c)(2))’.CommentsClose CommentsPermalink





(c) Effective Date- The amendments made by this section shall apply to taxable years beginning after December 31, 2009.CommentsClose CommentsPermalink

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:CommentsClose CommentsPermalink





‘(A) IN GENERAL- The requirements of this paragraph are met with respect to any contract if such contract meets--CommentsClose CommentsPermalink





‘(i) MODEL REGULATION- The following requirements of the model regulation:CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(II) Section 6B (relating to prohibitions on limitations and exclusions) other than paragraph (7) thereof.CommentsClose CommentsPermalink





‘(III) Section 6C (relating to extension of benefits).CommentsClose CommentsPermalink





‘(IV) Section 6D (relating to continuation or conversion of coverage).CommentsClose CommentsPermalink





‘(V) Section 6E (relating to discontinuance and replacement of policies).CommentsClose CommentsPermalink





‘(VI) Section 7 (relating to unintentional lapse).CommentsClose CommentsPermalink





‘(VII) Section 8 (relating to disclosure), other than sections 8F, 8G, 8H, and 8I thereof.CommentsClose CommentsPermalink





‘(VIII) Section 11 (relating to prohibitions against post-claims underwriting).CommentsClose CommentsPermalink





‘(IX) Section 12 (relating to minimum standards).CommentsClose CommentsPermalink





‘(X) Section 13 (relating to requirement to offer inflation protection).CommentsClose CommentsPermalink





‘(XI) Section 25 (relating to prohibition against preexisting conditions and probationary periods in replacement policies or certificates).CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(ii) MODEL ACT- The following requirements of the model Act:CommentsClose CommentsPermalink





‘(I) Section 6C (relating to preexisting conditions).CommentsClose CommentsPermalink





‘(II) Section 6D (relating to prior hospitalization).CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(B) DEFINITIONS- For purposes of this paragraph--CommentsClose CommentsPermalink





‘(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).CommentsClose CommentsPermalink





‘(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).CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





‘(1) REQUIREMENTS OF MODEL PROVISIONS-CommentsClose CommentsPermalink





‘(A) MODEL REGULATION- The following requirements of the model regulation must be met:CommentsClose CommentsPermalink





‘(i) Section 9 (relating to required disclosure of rating practices to consumer).CommentsClose CommentsPermalink





‘(ii) Section 14 (relating to application forms and replacement coverage).CommentsClose CommentsPermalink





‘(iii) Section 15 (relating to reporting requirements).CommentsClose CommentsPermalink





‘(iv) Section 22 (relating to filing requirements for marketing).CommentsClose CommentsPermalink





‘(v) Section 23 (relating to standards for marketing), including inaccurate completion of medical histories, other than paragraphs (1), (6), and (9) of section 23C.CommentsClose CommentsPermalink





‘(vi) Section 24 (relating to suitability).CommentsClose CommentsPermalink





‘(vii) Section 26 (relating to policyholder notifications).CommentsClose CommentsPermalink





‘(viii) Section 27 (relating to the right to reduce coverage and lower premiums).CommentsClose CommentsPermalink





‘(ix) Section 31 (relating to standard format outline of coverage).CommentsClose CommentsPermalink





‘(x) Section 32 (relating to requirement to deliver shopper’s guide).CommentsClose CommentsPermalink





‘(B) MODEL ACT- The following requirements of the model Act must be met:CommentsClose CommentsPermalink





‘(i) Section 6F (relating to right to return).CommentsClose CommentsPermalink





‘(ii) Section 6G (relating to outline of coverage).CommentsClose CommentsPermalink





‘(iii) Section 6H (relating to requirements for certificates under group plans).CommentsClose CommentsPermalink





‘(iv) Section 6J (relating to policy summary).CommentsClose CommentsPermalink





‘(v) Section 6K (relating to monthly reports on accelerated death benefits).CommentsClose CommentsPermalink





‘(vi) Section 7 (relating to incontestability period).CommentsClose CommentsPermalink





‘(vii) Section 9 (relating to producer training requirements).CommentsClose CommentsPermalink





‘(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).’.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink

TITLE IV--PROMOTING AND PROTECTING COMMUNITY LIVINGCommentsClose CommentsPermalink

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’.CommentsClose CommentsPermalink





(b) Effective Date- The amendment made by subsection (a) takes effect on October 1, 2008.CommentsClose CommentsPermalink

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:CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(c) Effective Date- The amendment made by subsection (a) takes effect on October 1, 2008.CommentsClose CommentsPermalink

TITLE V--MISCELLANEOUSCommentsClose CommentsPermalink

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:CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(3) The types of such services provided by the State under each such waiver and State plan amendment option.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink

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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink