,i #aac? ,,congress #a/ ,session ,h4 ,r4 #bcgf ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,june #ad1 #bjac ,mr4 ,fitzpatrick introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committee on ,ways & ,means1 = 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 implem5t a demon/ration project "u titles ,,xviii & ,,xix ( ! ,social ,security ,act to exam9e ! co/s & b5efits ( provid+ paym5ts = compreh5sive coord9at$ heal? c>e s]vices provid$ by purpose-built1 cont9u+ c>e retirem5t communities to ,m$ic>e b5efici>ies4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,m$ic>e ,resid5tial ,c>e ,coord9ation ,act ( #bjac4 #b4 ,m$ic>e & ,m$icaid resid5tial c>e coord9ation demon/ration project 7a7 ,e/abli%m5t & implem5tation 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y7 %all e/abli% & implem5t a demon/ration project 79 ?is section ref]r$ to z ! demon/ration project7 "u titles ,,xviii & ,,xix ( ! ,social ,security ,act to evaluate ! use ( capitat$ paym5ts made to eligible cont9u+ c>e retirem5t communities = resid5tial c>e coord9ation programs4 7#b7 ,timetable = implem5tation ,9 c>ry+ out ?is section-- 7,a7 n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act ! ,secret>y %all complete ! design = ! demon/ration project & ent] into "o or m agreem5ts ) eligible ,c,c,r,cs = ! implem5tation ( ! project ) respect to su* ,c,c,r,cs2 & 7,b7 n lat] ?an #d ye>s aft] ! date ( ent]+ into su* agreem5ts1 fir/ provide = implem5tation ( ! project ?r\gh su* ,c,c,r,cs4 7b7 ,budget neutrality ,) respect to ! p]iod ( ! demon/ration project "u ?is section1 ! aggregate exp5ditures "u titles ,,xviii & ,,xix ( ! ,social ,security ,act = su* p]iod %all n exce$ ! aggregate exp5ditures t w\ld h be5 exp5d$ "u su* titles if ! demon/ration project _h n be5 implem5t$4 7c7 ,/ate election requir$ 7#a7 ,9 g5]al ,! ,secret>y may only implem5t ! demon/ration project 9 a ,/ate t elects to p>ticipate 9 ! demon/ration project4 7#b7 ,b5efits & paym5ts ,a ,/ate t elects to p>ticipate 9 ! demon/ration project %all provide m$ical assi/ance ?r\gh title ,,xix ( ! ,social ,security ,act = ea* eligible ,,ccrc resid5t :o is eligible = m$ical assi/ance "u ! ,/ate plan "u su* title 7includ+ su* resid5ts :o are made eligible "u subsection 7d77#c77;,b77iii77 & :o is enroll$ 9 a resid5tial c>e coord9ation program 9 a mann] t is consi/5t ) ! requirem5ts ( ?is section1 includ+ mak+ ! paym5ts "u subsection 7e74 7#c7 ,limitation ,a ,/ate may e/abli% a num]ical limit on-- 7,a7 ! numb] ( eligible ,,ccrc resid5ts :o may be enroll$ 9 resid5tial c>e coord9ation programs 9 ! ,/ate2 & 7,b7 ! numb] ( eligible ,c,c,r,cs t may op]ate resid5tial c>e coord9ation programs 9 ! ,/ate4 7d7 ,resid5tial c>e coord9ation program 7,,rccp72 eligible cont9ue c>e retirem5t community 7,,ccrc72 eligible ,,ccrc resid5ts2 compreh5sive coord9at$ heal? c>e s]vices def9$ 7#a7 ,resid5tial c>e coord9ation program2 ,,rccp ,= purposes ( ?is section1 ! t]ms resid5tial c>e coord9ation program & ,,rccp mean a program t-- 7,a7 is op]at$ )9 "o or m eligible cont9u+ c>e retirem5t communities 7z def9$ 9 p>agraph 7#b772 7,b7 is design$ ) a capacity ( s]v+ at lea/ #a1jjj1 b n m ?an #a1ejj1 eligible ,,ccrc resid5ts 7z def9$ 9 p>agraph 7#c77 at any "o "t2 & 7,c7 provides compreh5sive coord9at$ heal? c>e s]vices 7z def9$ 9 p>agraph 7#d77 to p>ticipat+ ,,ccrc resid5ts enroll$ 9 ! program 9 accordance ) ! program agreem5t "u subsection 7f7 & ! requirem5ts ( ?is section4 7#b7 ,eligible cont9u+ c>e retirem5t community2 eligible ,,ccrc ,9 ?is section1 ! t]ms eligible cont9u+ c>e retirem5t community & eligible ,,ccrc mean an entity t is a cont9u+ c>e retirem5t community 7z def9$ 9 section #aheb7l77#d77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7l77#d77;,b777 t-- 7,a7 is built = ! purposes ( p>ticipat+ 9 ! demon/ration project2 7,b7 provides onsite-- 7i7 h\s+ accommodations = eligible ,,ccrc resid5ts1 includ+ ap>tm5ts = indep5d5t liv+2 & 7ii7 additional s]vices to facilitate ag+ 9 place = su* resid5ts1 includ+ assi/$ liv+ & skill$ nurs+ facilities or alt]natives2 & 7,c7 has ent]$ into a program agreem5t ) ! ,secret>y & ! ,/ate ) respect to its op]ation ( ! resid5tial c>e coord9ation program & su* agreem5t is consi/5t ) ! requirem5ts ( ?is section4 7#c7 ,eligible ,,ccrc resid5t2 p>ticipat+ ,,ccrc resid5t 7,a7 ,9 g5]al ,= purposes ( ?is section3 7i7 ,eligible ,,ccrc resid5t ,! t]m eligible ,,ccrc resid5t means an individual :o-- 7,i7 is entitl$ to1 or enroll$ =1 b5efits "u "p ,a ( title ,,xviii ( ! ,social ,security ,act1 & enroll$ = b5efits "u "p ,b ( su* title2 & 7,,ii7 resides 9 an eligible ,,ccrc4 7ii7 ,p>ticipat+ ,,ccrc resid5t ,! t]m p>ticipat+ ,,ccrc resid5t means1 ) respect to a resid5t c>e coord9ation program1 an eligible ,,ccrc resid5t :o is enroll$ 9 t program4 7,b7 ,p>ticipation by dual-eligible individuals2 exp&$ eligibility 7i7 ,9 g5]al ,an eligible ,,ccrc resid5t may be1 b is n requir$ to be1 a dual-eligible individual4 7ii7 ,dual-eligible individual def9$ ,9 ?is section1 ! t]m dual-eligible individual means any individual :o is-- 7,i7 a full-b5efit dual eligible individual 7z def9$ 9 section #aice7;c77#f7 ( ! ,social ,security ,act72 or 7,,ii7 is describ$ 9 clause 7iii74 7iii7 ,qualification ( p>ticipat+ ,,ccrc resid5ts = ,m$icaid b5efits ,an individual :o is a p>ticipat+ ,,ccrc resid5t1 reg>dless ( ! level ( c>e1 :o meets income & res\rce eligibility crit]ia e/abli%$ "u ! ,/ate ,m$icaid plan = an individual to obta9 cov]age = nurs+ facility s]vices on ! basis ( ! individual's requirem5t = ! level ( c>e = su* s]vices1 %all be treat$ z a dual-eligible individual "u ?is section & "u title ,,xix ( ! ,social ,security ,act s long z ! individual rema9s a p>ticipat+ ,,ccrc resid5t4 7,c7 ,enrollm5t & dis5rollm5t rules 7i7 ,deem$ enrollm5t at "t ( initial resid5cy ,an individual :o is describ$ 9 subclause 7,i7 ( subp>agraph 7,a77i7 is deem$1 at ! "t ( becom+ a resid5t 9 an eligible ,,ccrc1 to h volunt>ily cons5t$ to enroll 9 ! ,,rccp op]at$ by t ,,ccrc = purposes ( subp>agraph 7,a77ii74 7ii7 ,dis5rollm5t process ,! demon/ration project %all provide a me?od = ! dis5rollm5t f ! project ( p>ticipat+ ,,ccrc resid5ts1 :i* me?od %all take into acc\nt ! unique circum/ances ( resid5ts :o are requir$ to leave ! ,,ccrc & %all p]mit dis5rollm5t at lea/ 9 ! same circum/ances z w\ld p]mit an individual to dis5roll f a ,m$ic>e ,advantage plan "u "p ,c ( title ,,xviii ( ! ,social ,security ,act = cause4 7,d7 ,relation to ,m$ic>e ,advantage & prescription drug program 7i7 ,sup]c$es enrollm5t ,a p>ticipat+ ,,ccrc resid5t is n eligible to enroll 9 an ,,ma plan "u "p ,c ( title ,,xviii ( ! ,social ,security ,act or "u a prescription drug plan "u "p ,d ( su* title4 7ii7 ,coord9ation 9 case ( dis5rollm5t ,9 ! case ( a p>ticipat+ ,,ccrc resid5t :o dis5rolls f ! demon/ration project1 ! dis5rollm5t %all be treat$1 = purposes ( p>ts ,c & ,d ( su* title1 z if ! individual _h be5 previ\sly enroll$ 91 & dis5roll$ f1 an ,,ma-,,pd plan "u "p ,c ( su* title4 7,e7 ,premium paym5ts ,dur+ ! p]iod 9 :i* an individual is a p>ticipat+ ,,ccrc resid5t-- 7i7 = purposes ( paym5t ( premiums "u p>ts ,b1 ,c1 & ,d ( title ,,xviii ( ! ,social ,security ,act1 ! individual %all be treat$ z if ! individual 7 enroll$ "u an ,,ma-,,pd plan ) a premium equal to an am\nt specifi$ 9 ! program agreem5t2 & 7ii7 ! individual %all be eligible = assi/ance ) respect to su* premiums "u "p ,d & ,m$ic>e co/-%>+ 9 ! same mann] & 9 ! equival5t am\nts z if ! individual _h n be5 enroll$ z a p>ticipat+ ,,ccrc resid5t4 7#d7 ,compreh5sive coord9at$ heal? c>e s]vices def9$ ,= purposes ( ?is section1 ! t]m compreh5sive coord9at$ heal? c>e s]vices1 ) respect to an eligible ,,ccrc resid5t-- 7,a7 means all items & s]vices t are o!rwise payable "u title ,,xviii ( ! ,social ,security ,act1 includ+ ! m9imum prescription drug cov]age requir$ "u a prescription drug plan "u "p ,d ( su* title2 7,b7 includes 9 ! case ( a dual eligible individual all items & s]vices t are o!rwise payable "u ! ,/ate plan "u title ,,xix ( su* ,act ( ! ,/ate 9 :i* ! resid5t resides2 & 7,c7 also includes-- 7i7 c>e managem5t s]vices t coord9ate acute & specialty s]vices 7includ+ inpati5t hospital s]vices1 s]vices provid$ by specialty physicians1 & o!r necess>y s]vices7 provid$ to eligible ,,ccrc resid5ts2 7ii7 wellness s]vices1 includ+ assi/ance & in/ruction 9 heal?y liv+ 7includ+ diet & ex]cise72 & 7iii7 o!r heal? c>e items & s]vices to manage *ronic conditions1 treat subacute conditions1 & provide prev5tive c>e4 7e7 ,paym5t "u ,m$ic>e & ,m$icaid 7#a7 ,9 g5]al ,9 ! case ( an individual :o is a p>ticipat+ ,,ccrc resid5t :o is enroll$ 9 a resid5tial c>e coord9ation program op]at$ by an eligible ,,ccrc-- 7,a7 ! individual %all receive b5efits "u title ,,xviii ( ! ,social ,security ,act1 &1 if su* individual is a dual-eligible individual 7z def9$ 9 subsection 7d77#c77;,b77ii771 "u ! ,/ate ,m$icaid plan or waiv] "u title ,,xix ( su* ,act1 solely ?r\gh ! resid5tial c>e coord9ation program1 :i* %all provide su* individual ) compreh5sive coord9at$ heal? c>e s]vices2 & 7,b7 ! eligible ,,ccrc %all receive capitat$ paym5ts = ! provision ( su* s]vices 7f ! ,secret>y = b5efits "u title ,,xviii & f ! ,/ate = b5efits "u su* ,/ate plan or waiv]71 9 accordance ) ?is section4 7#b7 ,paym5t me?odology 7,a7 ,paym5t "u ,m$ic>e 7i7 ,paym5t on mon?ly basis ,) respect to ea* eligible ,,ccrc1 ! ,secret>y %all make prospective mon?ly paym5ts ( a capitat$ am\nt1 bas$ on ! rate e/abli%$ "u clause 7ii71 = ea* p>ticipat+ ,,ccrc resid5t enroll$ 9 ! resid5tial c>e coord9ation program op]at$ by su* ,,ccrc 9 ! same mann] & f ! same s\rces z paym5ts are made to a ,m$ic>e ,advantage organization "u section #ahec ( ! ,social ,security ,act4 ,su* paym5ts %all be subject to adju/m5t 9 ! mann] describ$ 9 p>agraphs 7#b7 & 7#c7 ( section #ahec7;a74 7ii7 ,e/abli%m5t ( paym5t rate 7,i7 ,9 g5]al ,! ,secret>y %all e/abli% a risk-adju/$ capitat$ paym5t rate "u title ,,xviii ( ! ,social ,security ,act = compreh5sive coord9at$ heal? c>e s]vices provid$ to eligible ,,ccrc resid5ts ?r\gh a resid5tial c>e coord9ation program op]at$ by an eligible ,,ccrc4 ,! paym5t rate %all be #ij p]c5t ( ! adju/$ av]age p] capita co/ describ$ 9 section #ahec7;c77#a77;,d77i7 ( su* ,act 7#db ,u4,s4,c4 #aciew-#bc7;c77#a77;,d77i771 plus an am\nt equival5t to #ij p]c5t ( ! am\nt t w\ld h be5 paid to a prescription drug plan ! /&>diz$ bid am\nt ( :i* 7z def9$ 9 #ahfj;,d-#ac7;a77#e7 ( su* ,act7 0 equal to ! adju/$ national av]age mon?ly bid am\nt 7z def9$ 9 section #ahfj;,d-#ac7;a77#a77;,b77iii7 ( su* ,act7 & tak+ into acc\nt l[-income subsidies paid "u section #ahfj;,d-#ad4 7,,ii7 ,program agreem5t ,! me*anism = e/abli%+ ! capitat$ am\nt "u ?is subp>agraph = a specific eligible ,,ccrc %all be specifi$ 9 ! program agreem5t4 7,b7 ,paym5t "u ,m$icaid 7i7 ,paym5t on a mon?ly basis ,) respect to an eligible ,,ccrc op]at+ an ,,rccp1 ! ,/ate %all make prospective mon?ly paym5ts ( ! capitat$ am\nt det]m9$ "u & specifi$ 9 ! program agreem5t = ea* eligible ,,ccrc resid5t ( su* community :o is a dual-eligible individual4 7ii7 ,relation%ip to ,m$ic>e paym5ts ,! paym5t made "u ?is subp>agraph %all be 9 addition to any paym5t made "u subp>agraph 7,a7 to an eligible ,,ccrc = eligible ,,ccrc resid5ts :o are dual-eligible individuals4 7iii7 ,program agreem5t ,! capitat$ am\nt "u ?is subp>agraph = a specific eligible ,,ccrc %all be specifi$ 9 ! program agreem5t4 7iv7 ,paym5ts to ! ,/ate ,! ,secret>y %all treat ! paym5ts made "u clause 7i7 z m$ical assi/ance "u title ,,xix ( ! ,social ,security ,act = purposes ( mak+ paym5ts to ! ,/ate "u section #aijc ( su* ,act 7#db ,u4,s4,c4 #acif;b74 7v7 ,paym5ts to reflect sp5d d[n am\nts & p]sonal ne$s all[ances ,! paym5ts "u ?is subp>agraph %all be made 9 a mann] t takes into acc\nt ! f9ancial contributions requir$ ( dual-eligible individuals & ! p]sonal ne$s all[ance e/abli%$ "u ! ,/ate plan4 ,su* p]sonal ne$s all[ances may v>y dep5d+ ^u ! level ( c>e requir$ by su* an individual4 7#c7 ,treatm5t ( s]vices furni%$ by noncontract physicians & o!r entities 7,a7 ,application ( ,m$ic>e ,advantage requirem5ts ,section #aheb7k77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7k77#a77 7relat+ to limitations on balance bill+ aga9/ ,m$ic>e ,advantage organizations = noncontract physicians & o!r entities ) respect to s]vices cov]$ "u title ,,xviii ( su* ,act7 %all apply to eligible ,c,c,r,cs1 eligible ,,ccrc resid5ts enroll$ 9 a resid5tial c>e coord9ation program1 & physicians & o!r entities t d n h a contract or o!r agreem5t e/abli%+ paym5t am\nts = s]vices furni%$ to su* a resid5t 9 ! same mann] z su* section applies to ,m$ic>e ,advantage organizations1 individuals enroll$ ) su* organizations1 & physicians & o!r entities ref]r$ to 9 su* section4 7,b7 ,application ( balanc$ bill+ limitations ,section #ahff7;a77#a77,o7 %all apply to s]vices t are cov]$ "u title ,,xviii ( ! ,social ,security ,act & are furni%$ to any eligible ,,ccrc resid5ts enroll$ 9 a resid5tial c>e coord9ation program 9 ! same mann] t su* section applies to s]vices furni%$ to an individual enroll$ ) a ,,pace provid] "u section #ahid or #aicd ( su* ,act4 7f7 ,program agreem5t 7#a7 ,requirem5t ,! ,secret>y1 9 close coop]ation ) ! s+le ,/ate ag5cy t adm9i/]s or sup]vises ! adm9i/ration ( ! ,/ate plan "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 79 ?is section ref]r$ to z ! ,/ate ,m$icaid ag5cy71 %all e/abli% proc$ures = ent]+ into1 ext5d+1 & t]m9at+ program agreem5ts 7ea* 9 ?is section ref]r$ to z a program agreem5t7 = ! op]ation ( resid5tial c>e coord9ation programs by eligible ,c,c,r,cs4 7#b7 ,agreem5t requir$ = paym5t ,9 ord] to receive paym5t "u subsection 7e71 ea* eligible ,,ccrc op]at+ a resid5tial c>e coord9ation program %all ent] into a program agreem5t ) ! ,secret>y & ! ,/ate1 :i* %all conta9 su* t]ms & conditions z ! p>ties may agree to1 s long z su* t]ms & conditions are consi/5t ) ?is section4 7#c7 ,duration 7,a7 ,9 g5]al ,a program agreem5t "u ?is section %all be effective = a contract ye>1 beg9n+ consi/5t ) subsection 7a77#b77;,b7 n lat] ?an ! f\r? cal5d> ye> to beg9 aft] ! e/abli%m5t ( ! demon/ration project1 & %all be ext5d$ = additional contract ye>s 9 ! abs5ce ( notice by a p>ty to t]m9ate4 7,b7 ,t]m9ation 7i7 ,end ( demon/ration project ,! ,secret>y & ! ,/ate ,m$icaid ag5cy %all t]m9ate ! program agreem5t at ! t]m9ation ( ! demon/ration project "u subsection 7i74 7ii7 ,notice ( provid] t]m9ation ,! eligible ,,ccrc may t]m9ate ! agreem5t aft] appropriate notice to ! ,secret>y1 ! ,/ate ,m$icaid ag5cy1 & eligible ,,ccrc resid5ts4 7iii7 ,t]m9ation = cause ,! ,secret>y & ! ,/ate ,m$icaid ag5cy may t]m9ate ! program agreem5t at any "t = cause 7z provid$ "u ! agreem5t74 ,reasons = t]m9at+ an agreem5t "u ?is clause include t ! ,secret>y or ,/ate adm9i/]+ ag5cy det]m9es t-- 7,i7 !re are significant defici5cies 9 ! quality ( c>e provid$ to eligible ,,ccrc resid5ts enroll$ 9 ! program or ! eligible ,,ccrc has fail$ to comply sub/antially ) ! requirem5ts ( ?is section2 & 7,,ii7 ! entity has fail$ to develop & successfully initiate1 )9 #cj days ( ! date ( ! receipt ( writt5 notice ( su* a det]m9ation1 a plan to correct ! defici5cies1 or has fail$ to cont9ue implem5tation ( su* a plan4 7iv7 ,"r to rema9 ,no?+ 9 ?is p>agraph %all be con/ru$1 9 ! case t a program agreem5t is t]m9at$-- 7,i7 = a previ\sly p>ticipat+ ,,ccrc resid5t cont9u+1 z affect+ ! individual's "r to cont9ue to reside 9 ! ,,ccrc & to receive traditional ,,ccrc c>e & s]vices 9 accordance ) ! contract betwe5 ! ,,ccrc resid5t & ! ,,ccrc2 & 7,,ii7 z reliev+ ! ,/ate f cont9u+ to provide m$ical assi/ance ) respect to su* s]vices = individuals :o w\ld qualify z dual-eligible individuals if ! agreem5t _h n be5 t]m9at$4 7#d7 ,scope ( b5efits 7,a7 ,9 g5]al ,"u ! agreem5t "u p>agraph 7#b71 ! eligible ,,ccrc %all-- 7i7 provide to p>ticipat+ ,,ccrc resid5ts ( su* community1 reg>dless ( s\rce ( paym5t1 directly or "u contracts ) o!r entities1 at a m9imum1 all compreh5sive coord9at$ heal? c>e s]vices1 )\t reg>d to any limitation or condition z to am\nt1 duration1 or scope "u title ,,xviii or title ,,xix ( ! ,social ,security ,act2 7ii7 provide su* resid5ts ) access to necess>y cov]$ items & s]vices #bd h\rs a day1 e day ( ! ye>2 7iii7 provide s]vices to su* resid5ts onsite at ! eligible ,,ccrc ?r\gh a multidiscipl9>y team t is l$ by a prim>y c>e physician & includes c>e coord9ators1 case manag]s1 & nurses2 7iv7 has a ratio ( accessible physicians to eligible ,,ccrc resid5ts t ! ,secret>y det]m9es is adequate2 & 7v7 specify ! cov]$ items & s]vices t w n be provid$ directly by ! eligible ,,ccrc &-- 7,i7 provide = deliv]y ( ^? items & s]vices ?r\gh contracts to ensure compliance ) ! requirem5ts ( ?is section2 & 7,,ii7 provides1 on an z ne$$ basis = ^? resid5ts :o _c transport !mselves1 = necess>y transportation s]vices to ! provid]s ( su* items & s]vices1 if su* items & s]vices are provid$ outside ( ! eligible ,,ccrc4 7,b7 ,application ( regul> co/-%>+ rules ,"u su* agreem5t ! eligible ,,ccrc may apply d$uctibles1 copaym5ts1 co9surance1 or o!r co/ %>+ t w\ld o!rwise apply "u titles ,,xviii & ,,xix ( ! ,social ,security ,act 9 ! case ( a ,,ma-,,pd plan "u "p ,c ( title ,,xviii ( su* ,act4 7#e7 ,quality control 7,a7 ,9 g5]al ,"u ! program agreem5t1 ! eligible ,,ccrc %all-- 7i7 collect data2 7ii7 ma9ta91 & af=d ! ,secret>y & ! ,/ate ,m$icaid ag5cy access to1 ! records relat+ to ! program1 includ+ p]t95t f9ancial1 m$ical1 & p]sonnel records2 & 7iii7 submit to ! ,secret>y & ! ,/ate ,m$icaid ag5cy su* reports z ! ,secret>y f9ds 79 consultation ) ,/ate ,m$icaid ag5cies7 necess>y to monitor ! op]ation1 co/1 & effectiv5ess ( ! demon/ration project1 includ+ data relevant to ! measurem5ts e/abli%$ by ! ,secret>y "u subp>agraph 7,b71 to p]mit ! ,secret>y & ! ,/ate to evaluate su* demon/ration project4 7,b7 ,quality & outcome measures ,! ,secret>y %all e/abli% cl9ical & o!r outcome measurem5ts to assess ! efficacy ( ! demon/ration project 9-- 7i7 improv+-- 7,i7 ! heal? /atus & outcomes ( p>ticipat+ ,,ccrc resid5ts enroll$ 9 resid5tial c>e coord9ation programs "u ?is demon/ration project1 comp>$ to ,m$ic>e b5efici>ies 7includ+ traditional dual-eligible individuals describ$ 9 subsection 7d77#c77;,b77ii77,i77 :o are n enroll$ 9 su* programs2 & 7,,ii7 ! quality ( heal? c>e provid$ to su* p>ticipat+ ,,ccrc resid5ts2 & 7ii7 controll+ ! ov]all co/ ( provid+ heal? c>e items & s]vices to su* p>ticipat+ ,,ccrc resid5ts1 comp>$ to ! co/ ( provid+ su* items & s]vices to o!r ,m$ic>e b5efici>ies4 7#f7 ,pati5t safegu>ds ,! agreem5t "u p>agraph 7#b7 %all provide = writt5 safegu>ds ( ! rights ( p>ticipat+ ,,ccrc resid5ts enroll$ 9 a resid5tial c>e coord9ation program 7includ+ a pati5t bill ( rights & proc$ures = grievances & appeals74 ,su* safegu>ds %all be simil> to ! safegu>ds requir$ "u ! section #ahid7;b77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;eee7b77#b77;,b77 ) respect to ! ,,pace program4 7#g7 ,transition ,if a p>ticipat+ ,,ccrc resid5t :o is enroll$ 9 a resid5tial c>e coord9ation program is dis5roll$ f su* program1 ! eligible ,,ccrc %all provide assi/ance to ! individual 9 obta9+ necess>y c>e ?r\gh appropriate ref]rals & mak+ ! individual's m$ical records available to new provid]s4 7#h7 ,rule ( con/ruction ,no?+ is ?is subsection %all be con/ru$ z prev5t+ ! eligible ,,ccrc f assess+ typical & appropriate fees to eligible ,,ccrc resid5ts4 7g7 ,secret>y's ov]sight2 en=cem5t au?ority 7#a7 ,ov]sight 7,a7 ,9 g5]al ,dur+ ! duration ( ! demon/ration project1 ) respect to an eligible ,,ccrc op]at+ a resid5tial c>e coord9ation program "u a program agreem5t "u subsection 7f71 ! ,secret>y 7act+ 9 coop]ation ) ! ,/ate ,m$icaid ag5cy7 %all conduct a compreh5sive annual review ( ! op]ation ( ! eligible ,,ccrc 9 ord] to ensure compliance ) ! requirem5ts ( ?is section4 ,su* review %all include-- 7i7 an onsite visit to ! eligible ,,ccrc2 7ii7 a compreh5sive assessm5t ( ! community's fiscal s\ndness2 7iii7 a compreh5sive assessm5t ( ! eligible ,,ccrc's capacity to provide all compreh5sive coord9at$ heal? c>e s]vices to p>ticipat+ ,,ccrc resid5ts2 7iv7 detail$ analysis ( ! community's sub/antial compliance ) ! requirem5ts ( ?is section2 & 7v7 any o!r elem5ts t ! ,secret>y or ! ,/ate ,m$icaid ag5cy consid]s necess>y or appropriate4 7,b7 ,disclosure ,! results ( reviews "u ?is p>agraph %all be report$ promptly to ! eligible ,,ccrc1 along ) any recomm5dations = *anges to ! community's program1 & %all be made available to ! public ?r\gh a public ,web site ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7#b7 ,sanctions 7,a7 ,9 g5]al ,if ! ,secret>y det]m9es 7aft] consultation ) ! ,/ate ,m$icaid ag5cy7 t an eligible ,,ccrc op]at+ a resid5tial c>e coord9ation program "u a program agreem5t "u subsection 7f7 is fail+ sub/antially to comply ) ! requirem5ts ( ?is section1 ! ,secret>y 7& ! ,/ate ,m$icaid ag5cy7 may take any or all ( ! foll[+ actions3 7i7 ,condition ! cont9uation ( ! program agreem5t ^u timely execution ( a corrective action plan4 7ii7 ,)hold "s or all fur!r paym5ts "u ! program agreem5t "u ?is section ) respect to s]vices furni%$ by su* community until ! defici5cies h be5 correct$4 7iii7 ,t]m9ate su* agreem5t "u subsection 7f77#c77;,b74 7,b7 ,application ( int]m$iate sanctions ,! ,secret>y may1 by regulation1 provide = ! application aga9/ an eligible ,,ccrc op]at+ a resid5tial c>e coord9ation program "u a program agreem5t "u ?is section ( rem$ies describ$ 9 section #aheg7;g77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7;g77#b77 or section #aijc7m77#e77;,b7 ( su* ,act 7#db ,u4,s4,c4 #acif;b7m77#e77;,b77 9 ! case ( violations by ! community ( ! type describ$ 9 section #aheg7;g77#a7 or #aijc7m77#e77;,a7 ( su* ,act1 respectively 79 relation to agreem5ts1 enrollees1 & requirem5ts "u ?is section74 7,c7 ,proc$ures = t]m9ation or imposition ( sanctions ,! provisions ( section #aheg7;h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7;h77 %all apply1 by regulation1 to t]m9ation & sanctions respect+ a program agreem5t & an eligible ,,ccrc op]at+ a resid5tial c>e coord9ation program "u a program agreem5t "u ?is subsection 9 ! same mann] z !y apply to a t]m9ation & sanctions ) respect to a contract & a ,m$ic>e ,advantage organization "u "p ,c ( title ,,xviii ( su* ,act4 7h7 ,waiv] ,not)/&+ section #aaae7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae7;a771 ! ,secret>y may waive su* provisions ( titles ,,xi1 ,,xviii1 & ,,xix ( t ,act z may be necess>y to-- 7#a7 accompli% ! goals ( ! demon/ration project "u ?is section2 & 7#b7 maximize ! quality ( life ( eligible ,,ccrc b5efici>ies1 z det]m9$ us+ ! measures e/abli%$ "u subsection 7f77#e77;,b74 7i7 ,duration ( #aj ye>s 7#a7 ,9 g5]al ,subject to p>agraph 7#b7 & subsection 7f77#c77;,b71 ! demon/ration project %all t]m9ate #aj ye>s aft] ! date on :i* ! demon/ration project is fir/ implem5t$ "u subsection 7a77#b77;,b74 7#b7 ,ext5sion ,! ,secret>y1 act+ ?r\gh ! ,c5t] = ,m$ic>e & ,m$icaid ,innovation1 may ext5d ! use ( capitat$ paym5ts = eligible ,c,c,r,cs = resid5tial c>e coord9ation programs "u ?is section if1 by ! t]m9ation date t w\ld o!rwise apply "u p>agraph 7#a71 ! ,secret>y has demon/rat$ t ! demon/ration project has improv$ ! coord9ation1 quality1 & effici5cy ( heal? c>e s]vices furni%$ to ,m$ic>e b5efici>ies4 7j7 ,/udy & report to congress 7#a7 ,int]im evaluation & report ,n lat] ?an #c ye>s aft] ! date on :i* ! demon/ration project is fir/ implem5t$ "u subsection 7a77#b77;,b71 ! ,secret>y %all submit to ,congress a report t conta9s ! foll[+3 7,a7 ,an int]im evaluation ( ! co/s & b5efits ( provid+ compreh5sive coord9at$ heal? c>e s]vices to ,m$ic>e b5efici>ies 7includ+ dual-eligible individuals7 ?r\gh resid5tial c>e coord9ation programs1 includ+ ! co/s & b5efits ( us+ paym5ts "u title ,,xix ( ! ,social ,security ,act to provide cont9uity ( c>e by p]mitt+ c]ta9 individuals to cont9ue to p>ticipate 9 su* programs aft] qualify+ = enrollm5t 9 ! ,m$icaid program "u ?is section due to r$uc$ income & assets4 7,b7 ,an analysis ( ! appropriat5ess ( implem5t+ a new paym5t me?odology "u titles ,,xviii & ,,xix ( ! ,social ,security ,act = su* s]vices 9 ! future4 7#b7 ,f9al evaluation & report ,n lat] ?an #aj ye>s aft] ! date on :i* ! demon/ration project is fir/ s implem5t$1 ! ,secret>y %all submit to ,congress a report t conta9s a f9al evaluation ( ! impact ( ! demon/ration project4