,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #bei  ,,9 ,,! ,,h\se ,,(            
,,repres5tatives  ,janu>y #d1 #bjai,mr4 
,pallone 7= himself & ,mr4 ,wald57      
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce1 & 9 
addition to ! ,committee on ! ,budget1 =
 a p]iod to be subsequ5tly det]m9$ by ! 
,speak]1 9 ea* case = consid]ation ( su*
 provisions z fall )9 ! jurisdiction ( !
 committee conc]n$  ,a ,,bill  ,to ext5d
 ! ,m$icaid ,money ,foll[s ! ,p]son     
,rebalanc+ demon/ration1 to ext5d       
protection = ,m$icaid recipi5ts ( home &
 community-bas$ s]vices aga9/ sp\sal    
impov]i%m5t1 & = o!r purposes4  #a4     
,%ort title ,?is ,act may be cit$ z !   
,m$icaid ,ext5d]s ,act ( #bjai4  #b4    
,ext5sion ( ,money ,foll[s ! ,p]son     
,rebalanc+ demon/ration  7a7 ,g5]al     
,fund+ ,section #fjga7;h7 ( ! ,deficit  
,r$uction ,act ( #bjje 7#db ,u4,s4,c4   
#acif;a note7 is am5d$--  7#a7 9        
p>agraph 7#a7-- 7,a7 9 subp>agraph 7,d71
 by /rik+ & aft] ! semicolon2  7,b7 9   

subp>agraph 7,e71 by /rik+ ! p]iod at ! 
end & ins]t+ 2 &2 &  7,c7 by add+ at !  
end ! foll[+3  7,f7 subject to p>agraph 
7#c71 #aab1jjj1jjj = fiscal ye> #bjai4  
2  7#b7 9 p>agraph 7#b7--  7,a7 by /rik+
 ,am\nts made & ins]t+ ,subject to      
p>agraph 7#c71 am\nts made2 &  7,b7 by  
/rik+ ,septemb] #cj1 #bjaf & ins]t+     
,septemb] #cj1 #bjba2 &  7#c7 by add+ at
 ! end ! foll[+ new p>agraph3  7#c7     
,special rule = ,,fy #bjai ,funds       
appropriat$ "u p>agraph 7#a77;,f7 %all  
be made available = grants to ,/ates    
only if su* ,/ates h an approv$ ,,mfp   
demon/ration project "u ?is section z ( 
,decemb] #ca1 #bjah4  4  7b7 ,fund+ =   
quality assurance & improvem5t2 te*nical
 assi/ance2 ov]sight ,section #fjga7;f7 
( ! ,deficit ,r$uction ,act ( #bjje 7#db
 ,u4,s4,c4 #acif;a note7 is am5d$ by    
/rik+ p>agraph 7#b7 & ins]t+ ! foll[+3  
7#b7 ,fund+ ,f ! am\nts appropriat$ "u  
subsection 7h77#a77;,f7 = fiscal ye>    
#bjai1 #ejj1jjj %all be available to !  
,secret>y = su* fiscal ye> to c>ry out  

?is subsection4  4  7c7 ,te*nical       
am5dm5t ,section #fjga7;b7 ( ! ,deficit 
,r$uction ,act ( #bjje 7#db ,u4,s4,c4   
#acif;a note7 is am5d$ by add+ at ! end 
! foll[+3  7#aj7 ,secret>y ,! t]m       
,secret>y means ! ,secret>y ( ,heal? &  
,human ,s]vices4  4  #c4 ,ext5sion (    
protection = ,m$icaid recipi5ts ( home &
 community-bas$ s]vices aga9/ sp\sal    
impov]i%m5t  7a7 ,9 g5]al ,section #bdjd
 ( ,public ,law #aaa-adh 7#db ,u4,s4,c4 
#acifr-#e note7 is am5d$ by /rik+ !     
#e-ye> p]iod t beg9s on ,janu>y #a1     
#bjad1 & ins]t+ ! p]iod beg9n+ on       
,janu>y #a1 #bjad1 & end+ on ,m>* #ca1  
#bjai14  7b7 ,rule ( con/ruction  7#a7  
,protect+ ,/ate sp\sal income & asset   
disreg>d flexibility "u waiv]s & plan   
am5dm5ts ,no?+ 9 section #bdjd ( ,public
 ,law #aaa-adh 7#db ,u4,s4,c4 #acifr-#e 
note7 or section #aibd ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #acifr-#e7
 %all be con/ru$ z prohibit+ a ,/ate f  
disreg>d+ an individual's sp\sal income 
& assets "u a ,/ate waiv] or plan       

am5dm5t describ$ 9 p>agraph 7#b7 =      
purposes ( mak+ det]m9ations (          
eligibility = home & community-bas$     
s]vices or home & community-bas$        
att5dant s]vices & supports "u su* waiv]
 or plan am5dm5t4  7#b7 ,/ate waiv] or  
plan am5dm5t describ$ ,a ,/ate waiv] or 
plan am5dm5t describ$ 9 ?is p>agraph is 
any ( ! foll[+3 7,a7 ,a waiv] or plan   
am5dm5t to provide m$ical assi/ance =   
home & community-bas$ s]vices "u a waiv]
 or plan am5dm5t "u subsection 7c71 7d71
 or 7i7 ( section #aiae ( ! ,social     
,security ,act 7#db ,u4,s4,c4 #acifn7 or
 "u section #aaae ( su* ,act 7#db       
,u4,s4,c4 #acae74  7,b7 ,a plan am5dm5t 
to provide m$ical assi/ance = home &    
community-bas$ s]vices = individuals by 
reason ( be+ det]m9$ eligible "u section
 #aijb7;a77#aj77;,c7 ( su* ,act 7#db    
,u4,s4,c4 #acif;a7a77#aj77;,c77 or by   
reason ( section #aijb7;f7 ( su* ,act   
7#db ,u4,s4,c4 #acif;a7f77 or o!rwise on
 ! basis ( a r$uction ( income bas$ on  
co/s incurr$ = m$ical or o!r rem$ial c>e

 "u :i* ! ,/ate disreg>d$ ! income &    
assets ( ! individual's sp\se 9 det]m9+ 
! initial & ongo+ f9ancial eligibility (
 an individual = su* s]vices 9 place ( !
 sp\sal impov]i%m5t provisions appli$ "u
 section #aibd ( su* ,act 7#db ,u4,s4,c4
 #acifr-#e74  7,c7 ,a plan am5dm5t to   
provide m$ical assi/ance = home &       
community-bas$ att5dant s]vices &       
supports "u section #aiae7k7 ( su* ,act 
7#db ,u4,s4,c4 #acifn7k774  #d4         
,r$uction 9 ,,fmap aft] #bjbj = ,/ates  
)\t asset v]ification program ,section  
#aidj ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acifw7 is am5d$ by add+ at ! 
end ! foll[+ new subsection3  7k7       
,r$uction 9 ,,fmap aft] #bjbj =         
non-,compliant ,/ates  7#a7 ,9 g5]al ,) 
respect to a cal5d> qu>t] beg9n+ on or  
aft] ,janu>y #a1 #bjba1 ! ,f$]al m$ical 
assi/ance p]c5tage o!rwise det]m9$ "u   
section #aije7;b7 = a non-compliant     
,/ate %all be r$uc$--  7,a7 = cal5d>    
qu>t]s 9 #bjba & #bjbb1 by #j4ab        
p]c5tage po9ts2  7,b7 = cal5d> qu>t]s 9 

#bjbc1 by #j4be p]c5tage po9ts2  7,c7 = 
cal5d> qu>t]s 9 #bjbd1 by #j4ce p]c5tage
 po9ts2 &  7,d7 = cal5d> qu>t]s 9 #bjbe 
& ea* ye> !reaft]1 by #j4e p]c5tage     
po9ts4  7#b7 ,non-compliant ,/ate def9$ 
,= purposes ( ?is subsection1 ! t]m     
non-compliant ,/ate means a ,/ate-- 7,a7
 t is "o ( ! #ej ,/ates or ! ,di/rict ( 
,columbia2  7,b7 ) respect to :i* !     
,secret>y has n approv$ a ,/ate plan    
am5dm5t submitt$ "u subsection 7a77#b72 
&  7,c7 t is n op]at+1 on an ongo+      
basis1 an asset v]ification program 9   
accordance ) ?is section4  4  #e4       
,m$icaid ,improvem5t ,fund ,section     
#aida7;b77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acifw-#a7;b77#a77 is   
am5d$ by /rik+ #ca1jjj1jjj & ins]t+     
#f1jjj1jjj4  #f4 ,budget>y ,effects  7a7
 ,/atutory ,,paygo scorec>ds ,! budget>y
 effects ( ?is ,act %all n be ent]$ on  
ei!r ,,paygo scorec>d ma9ta9$ pursuant  
to section #d7;d7 ( ! ,/atutory         
,pay-,z-,y-,g ,act ( #bjaj 7#b ,u4,s4,c4
 #icc7;d774  7b7 ,s5ate ,,paygo         

scorec>ds ,! budget>y effects ( ?is ,act
 %all n be ent]$ on any ,,paygo scorec>d
 ma9ta9$ = purposes ( section #dajf (   
,h4 ,con4 ,res4 #ga 7#aae? ,congress74  
7c7 ,classification ( budget>y effects  
,not)/&+ ,rule #c ( ! ,budget           
,scorekeep+ ,guidel9es set =? 9 ! jo9t  
explanatory /atem5t ( ! committee (     
conf]5ce accompany+ ,conf]5ce ,report   
#aje-bag & section #bej7;c77#h7 ( !     
,balanc$ ,budget & ,em]g5cy ,deficit    
,control ,act ( #aihe1 ! budget>y       
effects ( ?is ,act %all n be e/imat$--  
7#a7 = purposes ( section #bea ( !      
,balanc$ ,budget & ,em]g5cy ,deficit    
,control ,act ( #aihe2 &  7#b7 =        
purposes ( p>agraph 7#d77;,c7 ( section 
#c ( ! ,/atutory ,pay-,z-,y-,g ,act (   
#bjaj z be+ includ$ 9 an appropriation  
,act4  7d7 ,,paygo annual report ,= !   
purposes ( ! annual report issu$        
pursuant to section #e ( ! ,/atutory    
,pay-,z-,y-,g ,act ( #bjaj 7#b ,u4,s4,c4
 #icd7 aft] adj\rnm5t ( ! second session
 ( ! #aae? ,congress1 & = det]m9+ :e!r a

 seque/ration ord] is necess>y "u su*   
section1 ! debit = ! budget ye> on !    
#e-ye> scorec>d1 if any1 & ! #aj-ye>    
scorec>d1 if any1 %all be d$uct$ f su*  
scorec>d 9 #bjai & add$ to su* scorec>d 
9 #bjbj4