,,ii ,calendar ,no4 #ahb #aadth ,,congress #ast ,session ,s4 #gjd ,report ,no4 #aad-ajc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #aa1 #bjae,mr4 ,grassley 7for himself1 ,mr4 ,cardin1 ,mr4 ,schumer1 ,mr4 ,franken1 ,mr4 ,heller1 and ,mrs4 ,gillibrand7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,july #cj1 #bjae,reported by ,mr4 ,hatch1 with an amendment,strike out all after the enacting clause and insert the part printed in italic ,a ,,bill ,to establish a ,community-,based ,institutional ,special ,needs ,plan demonstration program to target home and community-based care to eligible ,medicare beneficiaries4 #a4 ,short title ,this ,act may be cited as the ,community ,based ,independence for ,seniors ,act4 #b4 ,findings ,congress makes the following findings3 7#a7 ,community-based services play an essential role in keeping individuals healthy4 7#b7 ,without community-based long-term services and supports1 which are not typically covered by ,medicare1 seniors frequently experience negative health outcomes and lose their ability to live independently4 7#c7 ,seniors who deplete their resources often have no option but to turn to ,medicaid for coverage of long-term care expenses4 7#d7 ,targeting community-based services and supports to at-risk seniors can help these individuals avoid depleting their assets and becoming ,medicaid dependent4 #c4 ,community-based institutional special needs plan demonstration 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall establish a ,community-,based ,institutional ,special ,needs ,plan demonstration program 7in this section referred to as the ,,cbi-,,snp demonstration program7 to target home and community-based care to eligible ,medicare beneficiaries4 7b7 ,establishment 7#a7 ,in general ,the ,secretary shall enter into agreements with up to #e ,medicare ,advantage plans to conduct the ,,cbi-,,snp demonstration program4 ,each such ,,ma plan may enroll up to #a1jjj eligible ,medicare beneficiaries 7including new enrollees7 in such program4 7#b7 ,benefits ,under the ,,cbi-,,snp demonstration program1 eligible ,medicare beneficiaries shall receive benefits1 in addition to those under part ,c of title ,,xviii of the ,social ,security ,act 7including benefits under section #aheb7;a77#c7 of such ,act 7#db ,u4,s4,c4 #aciew#bb7;a77#c777 and notwithstanding any waivers under section #aiae7;c7 7#db ,u4,s4,c4 #acifn7c771 including long-term care services and supports1 that the ,secretary determines appropriate for the purposes of the ,,cbi-,,snp demonstration program1 such as-- 7,a7 homemaker services2 7,b7 home delivered meals2 7,c7 transportation services2 7,d7 respite care2 7,e7 adult day care services2 and 7,f7 non-,medicare-covered safety and other equipment4 7#c7 ,payments ,the ,secretary shall establish a benchmark payment amount for reimbursing ,medicare ,advantage plans participating in the ,,cbi-,,snp demonstration program for benefits provided to eligible beneficiaries under such program4 ,such payments shall be in addition to payments made to such plans under part ,c of title ,,xviii of the ,social ,security ,act4 7c7 ,eligible plans ,to be eligible to participate in the ,,cbi-,,snp demonstration program1 a ,medicare ,advantage plan must-- 7#a7 have experience in offering special needs plans for nursing home-eligible1 non-institutionalized ,medicare beneficiaries who live in the community2 7#b7 have experience working with low income seniors groups2 7#c7 be located in a ,state that the ,secretary has determined will participate in the ,,cbi-,,snp demonstration program by agreeing to make available data necessary for purposes of conducting the independent evaluation required under subsection 7h72 and 7#d7 meet such other criteria as the ,secretary may require4 7d7 ,eligible ,medicare beneficiary defined ,in this section1 the term eligible ,medicare beneficiary means a ,medicare beneficiary who-- 7#a7 is enrolled or eligible to enroll in a ,medicare ,advantage plan that has been selected to participate in the ,,cbi-,,snp demonstration program2 7#b7 is a subsidy eligible individual 7as defined in section #ahfj;,d-#ad7;a77#c77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew#aad7;a77#c77;,a7772 7#c7 is not eligible to receive benefits under title ,,xix of the ,social ,security ,act2 7#d7 is unable to perform #b or more activities of daily living 7as defined in section #ggjb;,b7c77#b77;,b7 of the ,internal ,revenue ,code of #aihf72 and 7#e7 is age #fe or older4 7e7 ,special election period ,notwithstanding sections #aheb7;e77#b77;,c7 and #ahfj;,d-#a7;b77#a77;,b77iii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba7;e77#b77;,c72 #aciew-#aja7;b77#a77;,b77iii771 an eligible ,medicare beneficiary may1 other than during the annual1 coordinated election periods under such sections-- 7#a7 discontinue enrollment in a ,medicare ,advantage plan not participating in the ,,cbi-,,snp demonstration program and enroll in a ,medicare ,advantage plan participating in such program2 and 7#b7 discontinue enrollment under the original medicare fee-for-service program under parts ,a and ,b of such title and the enrollment in a prescription drug plan under part ,d of such title and enroll in a ,medicare ,advantage plan participating in the ,,cbi-,,snp demonstration program4 7f7 ,beneficiary education ,the ,secretary shall help to educate eligible ,medicare beneficiaries on the availability of the ,,cbi-,,snp demonstration program through ,state ,health ,insurance ,assistance ,programs and other organizations dedicated to assisting seniors with ,medicare benefits and enrollment4 7g7 ,implementation 7#a7 ,deadline ,the ,,cbi-,,snp demonstration program shall be implemented not later than ,january #a1 #bjag4 7#b7 ,duration ,subject to paragraph 7#c71 the ,,cbi-,,snp demonstration program shall be conducted for a period of #e years4 7#c7 ,extension or expansion ,taking into account the report under subsection 7h77#b71 the ,secretary may1 through rulemaking1 expand 7including implementation on a nationwide or permanent basis7 the duration or the scope ,,cbi-,,snp demonstration program to the extent determined appropriate by the ,secretary1 unless the ,secretary determines that such expansion is expected to-- 7,a7 increase expenditures under titles ,,xviii and ,,xix of the ,social ,security ,act with respect to eligible ,medicare beneficiaries participating in the ,,cbi-,,snp demonstration program2 or 7,b7 decrease the quality of health care services furnished to eligible ,medicare beneficiaries participating in the ,,cbi-,,snp demonstration program4 7h7 ,independent evaluation and reports 7#a7 ,independent evaluation ,the ,secretary shall provide for the evaluation of the ,,cbi-,,snp demonstration program by an independent third party4 ,such evaluation shall be completed using evaluation criteria that are clearly articulated prior to the implementation of such program4 ,such criteria shall include specific goals of such program1 hypotheses being tested1 clear data collection and reporting requirements1 recognizing that definitions1 benefits and program requirements for long-term care services and supports vary across ,states4 ,such evaluation shall determine whether the ,,cbi-,,snp demonstration program has-- 7,a7 improved patient care2 7,b7 reduced hospitalizations or rehospitalizations2 7,c7 reduced or delayed ,medicaid nursing facility admissions and lengths of stay2 7,d7 reduced spend down of income and assets for purposes of becoming eligible for ,medicaid2 and 7,e7 improved quality of life for the demonstration population and beneficiary and caregiver satisfaction4 7#b7 ,reports ,not later than #d years after the implementation of the ,,cbi-,,snp demonstration program1 the ,secretary shall submit to ,congress a report containing the results of the evaluation conducted under paragraph 7#a71 together with such recommendations for legislative or administrative action as the ,secretary determines appropriate4 ,in preparing such report1 the ,secretary shall use at least #c years worth of data under the demonstration program4 7i7 ,budget neutrality ,by the end of the third year of the ,,cbi-,,snp demonstration program1 the ,secretary shall ensure that the aggregate payments made under titles ,,xviii and ,,xix of the ,social ,security ,act1 including under the demonstration program1 for subsequent periods do not exceed the amount which the ,secretary estimates would have been expended under such titles during such a period if the ,,cbi-,,snp demonstration program had not been implemented4 7j7 ,paperwork reduction act ,chapter #ce of title #dd1 ,united ,states ,code1 shall not apply to the testing and evaluation of the ,,cbi-,,snp demonstration program4 #a4 ,short title ,this ,act may be cited as the ,community ,based ,independence for ,seniors ,act4 #b4 ,findings ,congress makes the following findings3 7#a7 ,community-based services play an essential role in keeping individuals healthy4 7#b7 ,without community-based long-term services and supports1 which are not typically covered by ,medicare1 seniors frequently experience negative health outcomes and lose their ability to live independently4 7#c7 ,seniors who deplete their resources often have no option but to turn to ,medicaid for coverage of long-term care expenses4 7#d7 ,targeting community-based services and supports to at-risk seniors can help these individuals avoid depleting their assets and becoming ,medicaid dependent4 #c4 ,community-based institutional special needs plan demonstration 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall establish a ,community-,based ,institutional ,special ,needs ,plan demonstration program 7in this section referred to as the ,,cbi-,,snp demonstration program7 to prevent and delay institutionalization under the ,medicaid program among eligible low-income ,medicare beneficiaries4 7b7 ,establishment 7#a7 ,in general ,the ,secretary shall enter into agreements with not more than #e eligible ,,ma plans to conduct the ,,cbi-,,snp demonstration program4 ,each such eligible ,,ma plan may enroll up to #a1jjj eligible low-income ,medicare beneficiaries 7including new enrollees7 in such program4 7#b7 ,use of ,part ,c rebate to furnish certain benefits ,under the ,,cbi-,,snp demonstration program1 an eligible ,,ma plan selected to participate in such program shall use the rebate that the plan is required 7under section #ahed of the ,social ,security ,act 7#db ,u4,s4,c4 #acied-bd77 to provide to eligible low-income ,medicare beneficiaries enrolled in the plan in order to furnish1 as supplemental benefits under section #aheb7;a77#c7 of such ,act 7#db ,u4,s4,c4 #aciew-#bb7;a77#c77 and notwithstanding any waivers under section #aiae7;c7 of such ,act 7#db ,u4,s4,c4 #acifn7c771 benefits to such beneficiaries1 including long-term care services and supports1 that the ,secretary determines appropriate for the purposes of the ,,cbi-,,snp demonstration program1 such as-- 7,a7 homemaker services2 7,b7 home delivered meals2 7,c7 transportation services2 7,d7 respite care2 7,e7 adult day care services2 and 7,f7 non-,medicare-covered safety and other equipment4 7c7 ,eligible ,,ma plan ,in this section1 the term eligible ,,ma plan means a specialized ,,ma plan for special needs individuals 7as defined in section #ahei7;b77#f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;b77#f77 that-- 7#a7 has experience in offering special needs plans for nursing home-eligible1 non-institutionalized ,medicare beneficiaries who live in the community2 7#b7 has experience working with low income beneficiaries1 including low income beneficiaries dually eligible for benefits under titles ,,xviii and ,,xix of such ,act2 7#c7 has a service area in a ,state that has agreed to make available to the ,secretary ,medicaid data necessary for purposes of conducting the independent evaluation required under subsection 7j72 and 7#d7 meets such other criteria as the ,secretary may require4 7d7 ,eligible low-income ,medicare beneficiary defined ,in this section1 the term eligible low-income ,medicare beneficiary means an individual who is-- 7#a7 a ,medicare ,advantage eligible individual 7as defined in section #ahea7;a77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba7;a77#c772 7#b7 a subsidy eligible individual 7as defined in section #ahfj;,d-#ad7;a77#c77;,a7 of such ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#c77;,a772 7#c7 not eligible to receive benefits under title ,,xix of the ,social ,security ,act2 7#d7 unable to perform #b or more activities of daily living 7as defined in section #ggjb;,b7c77#b77;,b7 of the ,internal ,revenue ,code of #aihf72 and 7#e7 age #fe or older4 7e7 ,special election period ,notwithstanding sections #aheb7;e77#b77;,c7 and #ahfj;,d-#a7;b77#a77;,b77iii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba7;e77#b77;,c72 #aciew-#aja7;b77#a77;,b77iii771 an eligible ,medicare beneficiary may1 other than during the annual1 coordinated election periods under such sections-- 7#a7 discontinue enrollment in a ,medicare ,advantage plan not participating in the ,,cbi-,,snp demonstration program and enroll in an eligible ,,ma plan participating in such program if the beneficiary resides in the participating plan's service area2 and 7#b7 discontinue enrollment under the original medicare fee-for-service program under parts ,a and ,b of title ,,xviii of such ,act and the enrollment in a prescription drug plan under part ,d of such title and enroll in an eligible ,,ma plan participating in the ,,cbi-,,snp demonstration program if the beneficiary resides in the participating plan's service area4 7f7 ,beneficiary education ,the ,secretary shall help to educate eligible ,medicare beneficiaries on the availability of the ,,cbi-,,snp demonstration program through ,state ,health ,insurance ,assistance ,programs and other organizations dedicated to assisting seniors with ,medicare benefits and enrollment4 7g7 ,duration ,the ,,cbi-,,snp demonstration program shall be implemented not later than ,january #a1 #bjah1 and shall be conducted for a period of #e years4 7h7 ,budget neutrality ,in conducting the ,,cbi-,,snp demonstration program1 the ,secretary shall ensure that the aggregate payments made by the ,secretary do not exceed the amount which the ,secretary estimates would have been expended under titles ,,xviii and ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq41 #acif et seq47 if the ,,cbi-,,snp demonstration program had not been implemented4 7i7 ,expansion of demonstration program ,taking into account the evaluation under subsection 7j71 the ,secretary may1 through notice and comment rulemaking1 expand 7including implementation on a nationwide basis7 the duration and scope of the ,,cbi-,,snp demonstration program under title ,,xviii of the ,social ,security ,act1 other than under the original medicare fee-for-service program under parts ,a and ,b of such title1 to the extent determined appropriate by the ,secretary1 if the requirements of paragraphs 7#a71 7#b7 and 7#c7 of subsection 7c7 of section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a71 as applied to the testing of a model under subsection 7b7 of such section1 applied to the ,,cbi-,,snp demonstration program4 7j7 ,independent evaluation and reports 7#a7 ,independent evaluation ,the ,secretary shall provide for the evaluation of the ,,cbi-,,snp demonstration program by an independent third party4 ,such evaluation shall be completed using evaluation criteria that are clearly articulated prior to the implementation of such program4 ,such criteria shall include specific goals of such program1 hypotheses being tested1 and clear data collection and reporting requirements1 recognizing that definitions1 benefits1 and program requirements for long-term care services and supports vary across ,states4 ,such evaluation shall determine whether the ,,cbi-,,snp demonstration program has-- 7,a7 improved patient care2 7,b7 reduced hospitalizations or rehospitalizations2 7,c7 reduced or delayed ,medicaid nursing facility admissions and lengths of stay2 7,d7 reduced spend down of income and assets for purposes of becoming eligible for ,medicaid2 and 7,e7 improved quality of life for the demonstration population and beneficiary and caregiver satisfaction4 7#b7 ,reports ,not later than ,january #a1 #bjbb1 the ,secretary shall submit to ,congress a report containing the results of the evaluation conducted under paragraph 7#a71 together with such recommendations for legislative or administrative action as the ,secretary determines appropriate4 ,in preparing such report1 the ,secretary shall use at least #c years worth of data under the ,,cbi-,,snp demonstration program4 7k7 ,funding 7#a7 ,funding for implementation ,for purposes of administering the ,,cbi-,,snp demonstration program 7other than the evaluation and report under subsection 7j771 the ,secretary shall provide for the transfer from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i7 and the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda of such ,act 7#db ,u4,s4,c4 #aciet71 in such proportion as the ,secretary determines appropriate1 of #c1jjj1jjj to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account4 7#b7 ,funding for evaluation and report ,for purposes of carrying out the evaluation and report under subsection 7j71 the ,secretary shall provide for the transfer from the ,federal ,hospital ,insurance ,trust ,fund under such section #ahag and the ,federal ,supplementary ,medical ,insurance ,trust ,fund under such section #ahda1 in such proportion as the ,secretary determines appropriate1 of #ejj1jjj to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account4 7#c7 ,availability ,amounts transferred under paragraph 7#a7 or 7#b7 shall remain available until expended4 7l7 ,paperwork reduction act ,chapter #ce of title #dd1 ,united ,states ,code1 shall not apply to the testing and evaluation of the ,,cbi-,,snp demonstration program4 ,july #cj1 #bjae,reported with an amendment