Text: H.R.2688 — 111th Congress (2009-2010)All Information (Except Text)

There is one version of the bill.

Text available as:

Shown Here:
Introduced in House (06/03/2009)


111th CONGRESS
1st Session
H. R. 2688


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


IN THE HOUSE OF REPRESENTATIVES

June 3, 2009

Mr. Pallone (for himself and Ms. DeGette) introduced the following bill; which was referred to the Committee on Energy and Commerce


A BILL

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

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

SECTION 1. Short title; table of contents.

(a) Short title.—This Act may be cited as the “Empowered at Home Act of 2009”.

(b) Table of contents.—The table of contents of this Act is as follows:


Sec. 1. Short title; table of contents.

Sec. 101. Removal of barriers to providing home and community-based services under State plan amendment option for individuals in need.

Sec. 102. Increase in Federal medical assistance percentage (FMAP) for the provision of home and community-based services under Medicaid through the State plan amendment option.

Sec. 103. Annual report on use of Medicaid State plan amendment option for home and community-based services.

Sec. 201. Reauthorization of Medicaid investment grants and expansion of permissible uses in order to facilitate the provision of home and community-based and other long-term care services.

Sec. 202. Health promotion grants.

Sec. 301. Mandatory application of spousal impoverishment protections to recipients of home and community-based services.

Sec. 302. Exclusion of 6 months of average cost of nursing facility services from assets or resources for purposes of eligibility for home and community-based services.

Sec. 401. Improved data collection.

Sec. 402. GAO report on Medicaid home health services and the extent of consumer self-direction of such services.

SEC. 101. Removal of barriers to providing home and community-based services under State plan amendment option for individuals in need.

(a) Parity with income eligibility standard for institutionalized individuals.—Paragraph (1) of section 1915(i) of the Social Security Act (42 U.S.C. 1396n(i)) is amended by striking “150 percent of the poverty line (as defined in section 2110(c)(5))” and inserting “300 percent of the supplemental security income benefit rate established by section 1611(b)(1)”.

(b) Authority To offer different type, amount, duration, or scope of home and community-based services.—Section 1915(i) of the Social Security Act (42 U.S.C. 1396n(i)) is amended by adding at the end the following new paragraph:

“(6) 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 to other such individuals, taking into account the needs-based criteria established under paragraph (1)(A), so long as such services are within the scope of services described in paragraph (4)(B) of subsection (c) for which the Secretary has the authority to approve a waiver and do not include room or board.”.

(c) Removal of limitation on scope of services.—Paragraph (1) of section 1915(i) of the Social Security Act (42 U.S.C. 1396n(i)), as amended by subsection (a), is amended by striking “or such other services requested by the State as the Secretary may approve”

(d) Optional eligibility category To provide full medicaid benefits to individuals receiving home and community-based services under a State plan amendment.—

(1) IN GENERAL.—Section 1902(a)(10)(A)(ii) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended—

(A) in subclause (XVIII), by striking “or” at the end;

(B) in subclause (XIX), by adding “or” at the end; and

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

“(XX) who are eligible for home and community-based services under needs-based criteria established under paragraph (1)(A) of section 1915(i) and who will receive home and community-based services pursuant to a State plan amendment under section 1915(i);”.

(2) CONFORMING AMENDMENTS.—

(A) Section 1903(f)(4) of the Social Security Act (42 U.S.C. 1396b(f)(4)) is amended in the matter preceding subparagraph (A), by inserting “1902(a)(10)(A)(ii)(XX),” after “1902(a)(10)(A)(ii)(XIX),”.

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

(i) in clause (xii), by striking “or” at the end;

(ii) in clause (xiii), by adding “or” at the end; and

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

“(xiv) individuals who are eligible for home and community-based services under needs-based criteria established under paragraph (1)(A) of section 1915(i) and who will receive home and community-based services pursuant to a State plan amendment under such subsection,”.

(e) Elimination of option To limit number of eligible individuals or length of period for grandfathered individuals if eligibility criteria is modified.—Paragraph (1) of section 1915(i) of such Act (42 U.S.C. 1396n(i)) is amended—

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

“(C) PROJECTION OF NUMBER OF INDIVIDUALS TO BE PROVIDED HOME AND COMMUNITY-BASED SERVICES.—The State submits to the Secretary, in such form and manner, and upon such frequency as the Secretary shall specify, the projected number of individuals to be provided home and community-based services.”; and

(2) in subclause (II) of subparagraph (D)(ii), by striking “to be eligible for such services for a period of at least 12 months beginning on the date the individual first received medical assistance for such services” and inserting “to continue to be eligible for such services after the effective date of the modification and until such time as the individual no longer meets the standard for receipt of such services under such pre-modified criteria”.

(f) Elimination of option To waive statewideness.—Paragraph (3) of section 1915(i) of such Act (42 U.S.C. 1396n(3)) is amended by striking “section 1902(a)(1) (relating to statewideness) and ”.

(g) Effective date.—The amendments made by this section take effect on the first day of the first fiscal year quarter that begins after the date of enactment of this Act.

SEC. 102. Increase in Federal medical assistance percentage (FMAP) for the provision of home and community-based services under Medicaid through the State plan amendment option.

(a) In general.—Section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) is amended by adding at the end the following: “Notwithstanding the previous provisions of this subsection, the Federal medical assistance percentage with respect to amounts expended as medical assistance for home and community-based services provided through a State plan amendment that satisfies the requirements of section 1915(i) shall be the enhanced FMAP (as defined in section 2105(b)), but determined by substituting ‘10 percent’ for ‘30 percent’ in such section.”.

(b) Effective date.—The amendment made by subsection (a) shall apply to home and community-based services furnished on or after October 1, 2009.

SEC. 103. Annual report on use of Medicaid State plan amendment option for home and community-based services.

The Secretary of Health and Human Services shall submit to Congress an annual report on the extent to which State Medicaid plans have adopted a State plan amendment under section 1915(i) of the Social Security Act (42 U.S.C. 1396n(i)), as amended by this title, for medical assistance for home and community-based services for elderly and disabled individuals. Each such report shall include the number of beneficiaries who are provided services under such an amendment and on changes made in the use of waiver authority under section 1915(c) of such Act (42 U.S.C. 1396n(c)) as a result of implementation of such a State plan amendment.

SEC. 201. Reauthorization of Medicaid investment grants and expansion of permissible uses in order to facilitate the provision of home and community-based and other long-term care services.

(a) 2-year reauthorization; increased funding.—Section 1903(z)(4)(A) of the Social Security Act (42 U.S.C. 1396b(z)(4)(A)) is amended—

(1) in clause (i), by striking “and” at the end;

(2) in clause (ii), by striking the period at the end and inserting “; and”; and

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

“(iii) $150,000,000 for fiscal year 2010; and

“(iv) $150,000,000 for fiscal year 2011.”.

(b) Expansion of permissible uses.—Section 1903(z)(2) of the Social Security Act (42 U.S.C. 1396b(z)(2)) is amended by adding at the end the following new subparagraphs:

“(G)(i) Methods for ensuring the availability and accessibility of home- and community-based services in the State, recognizing multiple delivery options that take into account differing needs of individuals, through the creation or designation (in consultation with organizations representing elderly individuals and individuals of all ages with physical, mental, cognitive, or intellectual impairments, and organizations representing the long-term care workforce, including organized labor, and health care and direct service providers) of one or more statewide or regional public entities or nonprofit organizations (such as fiscal intermediaries, agencies with choice, home care commissions, public authorities, worker associations, consumer-owned and controlled organizations (including representatives of individuals with severe intellectual or cognitive impairment), area agencies on aging, independent living centers, aging and disability resource centers, or other disability organizations) which may—

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

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

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

“(IV) with meaningful ongoing involvement from consumers and workers (or their respective representatives), develop procedures for the appropriate screening of workers, create a registry or registries of available workers, including policies and procedures to ensure no interruption of care for eligible individuals;

“(V) assist consumers in identifying workers;

“(VI) act as a fiscal intermediary;

“(VII) assist workers in finding employment, including consumer-directed employment;

“(VIII) provide funding for disability organizations, aging organizations, or other organizations, to assume roles that promote consumers’ ability to acquire the necessary skills for directing their own services and financial resources; or

“(IX) create workforce development plans on a regional or statewide basis (or both), to ensure a sufficient supply of qualified home and community-based services workers, including reviews and analyses of actual and potential worker shortages, training and retention programs for home and community-based services workers (which may include, as determined appropriate by the State, allowing participation in such training to count as an allowable work activity under the State temporary assistance for needy families program funded under part A of title IV), and plans to assist consumers with finding and retaining qualified workers.

“(ii) Nothing in clause (i) shall be construed as prohibiting the use of funds made available to carry out this subparagraph for start-up costs associated with any of the activities described in subclauses (I) through (IX), as requiring any consumer to hire workers who are listed in a worker registry developed with such funds, or to limit the ability of consumers to hire or fire their own workers.

“(H) Methods for providing an integrated and efficient system of long-term care through a review of the Federal, State, local, and private long-term care resources, services, and supports available to elderly individuals and individuals of all ages with physical, mental, cognitive, or intellectual impairments and the development and implementation of a plan to fully integrate such resources, services, and supports by aggregating such resources, services, and supports to create a consumer-centered and cost-effective resource and delivery system and expanding the availability of home and community-based services, and that is designed to result in administrative savings, consolidation of common activities, and the elimination of redundant processes.”.

(c) Allocation of funds.—

(1) ELIMINATION OF CURRENT LAW REQUIREMENTS FOR ALLOCATION OF FUNDS.—Section 1903(z)(4)(B) of the Social Security Act (42 U.S.C. 1396b(z)(4)(B)) is amended by striking the second and third sentences.

(2) ASSURANCE OF FUNDS TO FACILITATE THE PROVISION OF HOME AND COMMUNITY-BASED SERVICES AND INTEGRATED SYSTEMS OF LONG-TERM CARE.—Section 1903(z)(4)(B) of the Social Security Act (42 U.S.C. 1396b(z)(4)(B)), as amended by paragraph (1), is amended by inserting after the first sentence the following new sentence: “Such method shall provide that 50 percent of such funds shall be allocated among States that design programs to adopt the innovative methods described in subparagraph (G) or (H) (or both) of paragraph (2).”.

(d) Renaming program.—The heading of section 1903(z) of such Act is amended by striking “Transformation” and inserting “Investment”.

(e) Clarification.—Such section is further amended by adding at the end the following new paragraph:

“(6) CLARIFICATION OF PROTECTION OF BENEFICIARIES.—Nothing in this section shall be construed as authorizing States to use payments provided under this subsection for the purpose of limiting eligibility or benefits under this title.”.

(f) Effective date.—The amendments made by this section take effect on October 1, 2009.

SEC. 202. Health promotion grants.

(a) Definitions.—In this section:

(1) ELIGIBLE MEDICAID BENEFICIARY.—The term “eligible Medicaid beneficiary” means an individual who is enrolled in the State Medicaid plan under title XIX of the Social Security Act and—

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

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

(2) ELIGIBLE STATE.—The term “eligible State” means a State that submits an application to the Secretary for a grant under this section, in such form and manner as the Secretary shall require.

(3) EVIDENCE- AND COMMUNITY-BASED HEALTH PROMOTION PROGRAM.—The term “evidence- and community-based health promotion program” means a community-based program (such as a program for chronic disease self-management, physical or mental activity, falls prevention, smoking cessation, or dietary modification) that has been objectively evaluated and found to improve health outcomes or meet health promotion goals by preventing, delaying, or decreasing the severity of physical, mental, cognitive, or intellectual impairment and that meets generally accepted standards for best professional practice.

(4) SECRETARY.—The term “Secretary” means the Secretary of Health and Human Services.

(b) Authority To conduct demonstration project.—The Secretary shall award grants on a competitive basis to eligible States to conduct in accordance with this section an evidence- and community-based health promotion program that is designed to achieve the following objectives with respect to eligible Medicaid beneficiaries:

(1) LIFESTYLE CHANGES.—To empower eligible Medicaid beneficiaries to take more control over their own health through lifestyle changes that have proven effective in reducing the effects of chronic disease and slowing the progression of disability.

(2) DIFFUSION.—To mobilize the Medicaid, aging, disability, public health, and nonprofit networks at the State and local levels to accelerate the translation of credible research into practice through the deployment of low-cost evidence-based health promotion and disability prevention programs at the community level.

(c) Selection and amount of grant awards.—In awarding grants to eligible States under this section and determining the amount of the awards, the Secretary shall—

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

(2) give preference to eligible States proposing—

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

(B) strong State-level collaboration across, Medicaid agencies, State units on aging, State independent living councils, State associations of Area Agencies on Aging, and State agencies responsible for public health; or

(C) interventions that have already demonstrated effectiveness and replicability in a community-based, nonmedical setting.

(d) Use of funds.—An eligible State awarded a grant under this section shall use the funds awarded to develop, implement, and sustain high quality evidence- and community-based health promotion programs. As a condition of being awarded such a grant, an eligible State shall agree to—

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

(2) develop the infrastructure and partnerships that will be necessary over the long-term to effectively embed evidence- and community-based health promotion programs for eligible Medicaid beneficiaries within the statewide health, aging, disability, and long-term care systems.

(e) Technical assistance.—The Secretary shall provide assistance to eligible States awarded grants under this section, subgrantees and their partners, program organizers, and others in developing evidence- and community-based health promotion programs.

(f) Payments to eligible States; carryover of unused grant amounts.—

(1) PAYMENTS.—For each calendar quarter of a fiscal year that begins during the period for which an eligible State is awarded a grant under this section, the Secretary shall pay to the State from its grant award for such fiscal year an amount equal to the lesser of—

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

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

(2) CARRYOVER OF UNUSED AMOUNTS.—Any portion of a State grant award for a fiscal year under this section remaining available at the end of such fiscal year shall remain available for making payments to the State for the next 4 fiscal years, subject to paragraph (3).

(3) REAWARDING OF CERTAIN UNUSED AMOUNTS.—In the case of a State that the Secretary determines has failed to meet the conditions for continuation of a demonstration project under this section in a succeeding year, the Secretary shall rescind the grant award for each succeeding year, together with any unspent portion of an award for prior years, and shall add such amounts to the appropriation for the immediately succeeding fiscal year for grants under this section.

(4) PREVENTING DUPLICATION OF PAYMENT.—The payment under a demonstration project with respect to qualified expenditures shall be in lieu of any payment with respect to such expenditures that would otherwise be paid to the State under section 1903(a) of the Social Security Act (42 U.S.C. 1396a(a)). Nothing in the previous sentence shall be construed as preventing a State from being paid under such section for expenditures in a grant year for which payment is available under such section 1903(a) after amounts available to pay for such expenditures under the grant awarded to the State under this section for the fiscal year have been exhausted.

(g) Evaluation.—Not later than 3 years after the date on which the first grant is awarded to an eligible State under this section, the Secretary shall, by grant, contract, or interagency agreement, conduct an evaluation of the demonstration projects carried out under this section that measures the health-related, quality of life, and cost outcomes for eligible Medicaid beneficiaries and includes information relating to the quality, infrastructure, sustainability, and effectiveness of such projects.

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

(1) GRANTS TO STATES.—For grants to States, to remain available until expended—

(A) $4,000,000 for fiscal year 2010;

(B) $6,000,000 for fiscal year 2011;

(C) $8,000,000 for fiscal year 2012;

(D) $10,000,000 for fiscal year 2013; and

(E) $12,000,000 for fiscal year 2014.

(2) TECHNICAL ASSISTANCE.—For the provision of technical assistance through such center in accordance with subsection (e)—

(A) $800,000 for fiscal year 2010;

(B) $1,200,000 for fiscal year 2011;

(C) $1,600,000 for fiscal year 2012;

(D) $2,000,000 for fiscal year 2013; and

(E) $2,400,000 for fiscal year 2014.

(3) EVALUATION.—For conducting the evaluation required under subsection (g), $4,000,000 for fiscal year 2012.

SEC. 301. Mandatory application of spousal impoverishment protections to recipients of home and community-based services.

(a) In general.—Section 1924(h)(1)(A) of the Social Security Act (42 U.S.C. 1396r–5(h)(1)(A)) is amended by striking “(at the option of the State)is described in section 1902(a)(10)(A)(ii)(VI)” and inserting “is eligible for medical assistance for home and community-based services under subsection (c), (d), (e), (i), or (k) of section 1915”.

(b) Effective date.—The amendment made by subsection (a) takes effect on October 1, 2009.

SEC. 302. Exclusion of 6 months of average cost of nursing facility services from assets or resources for purposes of eligibility for home and community-based services.

(a) In general.—Section 1917 of the Social Security Act (42 U.S.C. 1396p) is amended by adding at the end the following new subsection:

“(i) Exclusion of 6 months of average cost of nursing facility services from home and community-based services eligibility determinations.—Notwithstanding any other provision of law, each State shall exclude from any determination of an individual's assets or resources, for purposes of determining the eligibility of the individual for medical assistance for home and community-based services under subsection (c), (d), (e), (i), or (k) of section 1915 (if a State imposes an limitation on assets or resources for purposes of eligibility for such services), an amount equal to six times the amount applicable under subsection (c)(1)(E)(ii)(II) (at the time such determination is made).”.

(b) Rule of construction.—Nothing in the amendment made by subsection (a) shall be construed as affecting a State's option to apply less restrictive methodologies under section 1902(r)(2) for purposes of determining income and resource eligibility for individuals specified in that section.

(c) Effective date.—The amendment made by subsection (a) takes effect on October 1, 2009.

SEC. 401. Improved data collection.

(a) Secretarial requirement To revise data reporting forms and systems To ensure uniform and consistent reporting by States.—Not later than 6 months after the date of enactment of this Act, the Secretary of Health and Human Services, acting through the Administrator of the Centers for Medicare & Medicaid Services, shall revise CMS Form 372, CMS Form 64, and CMS Form 64.9 (or any successor forms) and the Medicaid Statistical Information Statistics (MSIS) claims processing system to ensure that, with respect to any State that provides medical assistance to individuals under a waiver or State plan amendment approved under subsection (c), (d), (e), (i), (j), or (k) of section 1915 of the Social Security Act (42 U.S.C. 1396n), the State reports to the Secretary, not less than annually and in a manner that is consistent and uniform for all States (and, in the case of medical assistance provided under a waiver or State plan amendment under any such subsection for home- and community-based services, in a manner that is consistent and uniform with the data required to be reported for purposes of monitoring or evaluating the provision of such services under the State plan or under a waiver approved under section 1115 of the Social Security Act (42 U.S.C. 1315) to provide such services) the following data:

(1) The total number of individuals provided medical assistance for such services under each waiver to provide such services conducted by the State and each State plan amendment option to provide such services elected by the State.

(2) The total amount of expenditures incurred for such services under each such waiver and State plan amendment option, disaggregated by expenditures for medical assistance and administrative or other expenditures.

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

(4) The number of individuals on a waiting list (if any) to be enrolled under each such waiver and State plan amendment option or to receive services under each such waiver and State plan amendment option.

(5) With respect to home health services, private duty nursing services, case management services, and rehabilitative services provided under each such waiver and State plan amendment option, the total number of individuals provided each type of such services, the total amount of expenditures incurred for each type of services, and whether each such service was provided for long-term care or acute care purposes.

(b) Public availability.—Not later than 6 months after the date of enactment of this Act, the Secretary of Health and Human Services, acting through the Administrator of the Centers for Medicare & Medicaid Services, shall make publicly available, in a State identifiable manner, the data described in subsection (a) through an Internet website and otherwise as the Secretary determines appropriate.

SEC. 402. GAO report on Medicaid home health services and the extent of consumer self-direction of such services.

(a) Study.—The Comptroller General of the United States shall study the provision of home health services under State Medicaid plans under title XIX of the Social Security Act. Such study shall include an examination of the extent to which there are variations among the States with respect to the provision of home health services in general under State Medicaid plans, including the extent to which such plans impose limits on the types of services that a home health aide may provide a Medicaid beneficiary and the extent to which States offer consumer self-direction of such services or allow for other consumer-oriented policies with respect to such services.

(b) Report.—Not later than 1 year after the date of enactment of this Act, the Comptroller General shall submit a report to Congress on the results of the study conducted under subsection (a), together with such recommendations for legislative or administrative changes as the Comptroller General determines appropriate in order to provide home health services under State Medicaid plans in accordance with identified best practices for the provision of such services.