,,ii ,cal5d> ,no4 #ahb #aad? ,,congress 
#a/ ,session  ,s4 #gjd ,report ,no4     
#aad-ajc ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$
 ,,/ates  ,m>* #aa1 #bjae,mr4 ,grassley 
7= himself1 ,mr4 ,c>d91 ,mr4 ,s*um]1    
,mr4 ,frank51 ,mr4 ,hell]1 & ,mrs4      
,gillibr&7 introduc$ ! foll[+ bill2 :i* 
0 read twice & ref]r$ to ! ,committee on
 ,f9ance  ,july #cj1 #bjae,report$ by   
,mr4 ,hat*1 ) an amendment,strike out   
all aft] ! enact+ clause & ins]t ! "p   
pr9t$ 9 italic  ,a ,,bill  ,to e/abli% a
 ,community-,bas$ ,in/itutional ,special
 ,ne$s ,plan demon/ration program to    
t>get home & community-bas$ c>e to      
eligible ,m$ic>e b5efici>ies4  #a4 ,%ort
 title ,?is ,act may be cit$ z !        
,community ,bas$ ,indep5d5ce = ,s5iors  
,act4  #b4 ,f9d+s ,congress makes !     
foll[+ f9d+s3 7#a7 ,community-bas$      
s]vices play an ess5tial role 9 keep+   
individuals heal?y4  7#b7 ,)\t          
community-bas$ long-t]m s]vices &       
supports1 :i* are n typically cov]$ by  
,m$ic>e1 s5iors frequ5tly exp]i5ce      

negative heal? outcomes & lose _!       
ability to live indep5d5tly4  7#c7      
,s5iors :o deplete _! res\rces (t5 h no 
option b to turn to ,m$icaid = cov]age (
 long-t]m c>e exp5ses4  7#d7 ,t>get+    
community-bas$ s]vices & supports to    
at-risk s5iors c help ^! individuals    
avoid deplet+ _! assets & becom+        
,m$icaid dep5d5t4  #c4 ,community-bas$  
in/itutional special ne$s plan          
demon/ration  7a7 ,9 g5]al ,! ,secret>y 
( ,heal? & ,human ,s]vices 79 ?is       
section ref]r$ to z ! ,secret>y7 %all   
e/abli% a ,community-,bas$ ,in/itutional
 ,special ,ne$s ,plan demon/ration      
program 79 ?is section ref]r$ to z !    
,,cbi-,,snp demon/ration program7 to    
t>get home & community-bas$ c>e to      
eligible ,m$ic>e b5efici>ies4  7b7      
,e/abli%m5t  7#a7 ,9 g5]al ,! ,secret>y 
%all ent] into agreem5ts ) up to #e     
,m$ic>e ,advantage plans to conduct !   
,,cbi-,,snp demon/ration program4 ,ea*  
su* ,,ma plan may enroll up to #a1jjj   
eligible ,m$ic>e b5efici>ies 7includ+   

new enrollees7 9 su* program4  7#b7     
,b5efits ,"u ! ,,cbi-,,snp demon/ration 
program1 eligible ,m$ic>e b5efici>ies   
%all receive b5efits1 9 addition to ^?  
"u "p ,c ( title ,,xviii ( ! ,social    
,security ,act 7includ+ b5efits "u      
section #aheb7;a77#c7 ( su* ,act 7#db   
,u4,s4,c4 #aciew#bb7;a77#c777 & not)/&+ 
any waiv]s "u section #aiae7;c7 7#db    
,u4,s4,c4 #acifn7c771 includ+ long-t]m  
c>e s]vices & supports1 t ! ,secret>y   
det]m9es appropriate = ! purposes ( !   
,,cbi-,,snp demon/ration program1 su*   
z--  7,a7 homemak] s]vices2  7,b7 home  
deliv]$ meals2  7,c7 transportation     
s]vices2  7,d7 respite c>e2  7,e7 adult 
day c>e s]vices2 &  7,f7                
non-,m$ic>e-cov]$ safety & o!r equipm5t4
  7#c7 ,paym5ts ,! ,secret>y %all       
e/abli% a b5*m>k paym5t am\nt =         
reimburs+ ,m$ic>e ,advantage plans      
p>ticipat+ 9 ! ,,cbi-,,snp demon/ration 
program = b5efits provid$ to eligible   
b5efici>ies "u su* program4 ,su* paym5ts
 %all be 9 addition to paym5ts made to  

su* plans "u "p ,c ( title ,,xviii ( !  
,social ,security ,act4  7c7 ,eligible  
plans ,to be eligible to p>ticipate 9 ! 
,,cbi-,,snp demon/ration program1 a     
,m$ic>e ,advantage plan mu/-- 7#a7 h    
exp]i5ce 9 (f]+ special ne$s plans =    
nurs+ home-eligible1 non-in/itutionaliz$
 ,m$ic>e b5efici>ies :o live 9 !        
community2  7#b7 h exp]i5ce work+ ) l[  
income s5iors gr\ps2  7#c7 be locat$ 9 a
 ,/ate t ! ,secret>y has det]m9$ w      
p>ticipate 9 ! ,,cbi-,,snp demon/ration 
program by agree+ to make available data
 necess>y = purposes ( conduct+ !       
indep5d5t evaluation requir$ "u         
subsection 7h72 &  7#d7 meet su* o!r    
crit]ia z ! ,secret>y may require4  7d7 
,eligible ,m$ic>e b5efici>y def9$ ,9 ?is
 section1 ! t]m eligible ,m$ic>e        
b5efici>y means a ,m$ic>e b5efici>y :o--
  7#a7 is enroll$ or eligible to enroll 
9 a ,m$ic>e ,advantage plan t has be5   
select$ to p>ticipate 9 ! ,,cbi-,,snp   
demon/ration program2  7#b7 is a subsidy
 eligible individual 7z def9$ 9 section 

#ahfj;,d-#ad7;a77#c77;,a7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#aciew#aad7;a77#c77;,a7772  7#c7 is n   
eligible to receive b5efits "u title    
,,xix ( ! ,social ,security ,act2  7#d7 
is unable to p]=m #b or m activities (  
daily liv+ 7z def9$ 9 section           
#ggjb;,b7c77#b77;,b7 ( ! ,int]nal       
,rev5ue ,code ( #aihf72 &  7#e7 is age  
#fe or old]4  7e7 ,special election     
p]iod ,not)/&+ sections                 
#aheb7;e77#b77;,c7 &                    
#ahfj;,d-#a7;b77#a77;,b77iii7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#ba7;e77#b77;,c72                
#aciew-#aja7;b77#a77;,b77iii771 an      
eligible ,m$ic>e b5efici>y may1 o!r ?an 
dur+ ! annual1 coord9at$ election p]iods
 "u su* sections--  7#a7 discont9ue     
enrollm5t 9 a ,m$ic>e ,advantage plan n 
p>ticipat+ 9 ! ,,cbi-,,snp demon/ration 
program & enroll 9 a ,m$ic>e ,advantage 
plan p>ticipat+ 9 su* program2 &  7#b7  
discont9ue enrollm5t "u ! orig9al m$ic>e
 fee-=-s]vice program "u p>ts ,a & ,b ( 

su* title & ! enrollm5t 9 a prescription
 drug plan "u "p ,d ( su* title & enroll
 9 a ,m$ic>e ,advantage plan p>ticipat+ 
9 ! ,,cbi-,,snp demon/ration program4   
7f7 ,b5efici>y education ,! ,secret>y   
%all help to educate eligible ,m$ic>e   
b5efici>ies on ! availability ( !       
,,cbi-,,snp demon/ration program ?r\gh  
,/ate ,heal? ,insurance ,assi/ance      
,programs & o!r organizations d$icat$ to
 assi/+ s5iors ) ,m$ic>e b5efits &      
enrollm5t4  7g7 ,implem5tation  7#a7    
,deadl9e ,! ,,cbi-,,snp demon/ration    
program %all be implem5t$ n lat] ?an    
,janu>y #a1 #bjag4  7#b7 ,duration      
,subject to p>agraph 7#c71 ! ,,cbi-,,snp
 demon/ration program %all be conduct$ =
 a p]iod ( #e ye>s4  7#c7 ,ext5sion or  
expansion ,tak+ into acc\nt ! report "u 
subsection 7h77#b71 ! ,secret>y may1    
?r\gh rulemak+1 exp& 7includ+           
implem5tation on a nationwide or p]man5t
 basis7 ! duration or ! scope           
,,cbi-,,snp demon/ration program to !   
ext5t det]m9$ appropriate by !          

,secret>y1 unless ! ,secret>y det]m9es t
 su* expansion is expect$ to--  7,a7    
increase exp5ditures "u titles ,,xviii &
 ,,xix ( ! ,social ,security ,act )     
respect to eligible ,m$ic>e b5efici>ies 
p>ticipat+ 9 ! ,,cbi-,,snp demon/ration 
program2 or  7,b7 decrease ! quality (  
heal? c>e s]vices furni%$ to eligible   
,m$ic>e b5efici>ies p>ticipat+ 9 !      
,,cbi-,,snp demon/ration program4  7h7  
,indep5d5t evaluation & reports  7#a7   
,indep5d5t evaluation ,! ,secret>y %all 
provide = ! evaluation ( ! ,,cbi-,,snp  
demon/ration program by an indep5d5t    
?ird p>ty4 ,su* evaluation %all be      
complet$ us+ evaluation crit]ia t are   
cle>ly articulat$ prior to !            
implem5tation ( su* program4 ,su*       
crit]ia %all include specific goals (   
su* program1 hypo!ses be+ te/$1 cle>    
data collection & report+ requirem5ts1  
recogniz+ t def9itions1 b5efits &       
program requirem5ts = long-t]m c>e      
s]vices & supports v>y across ,/ates4   
,su* evaluation %all det]m9e :e!r !     

,,cbi-,,snp demon/ration program has--  
7,a7 improv$ pati5t c>e2  7,b7 r$uc$    
hospitalizations or rehospitalizations2 
7,c7 r$uc$ or delay$ ,m$icaid nurs+     
facility admissions & l5g?s ( /ay2  7,d7
 r$uc$ sp5d d[n ( income & assets =     
purposes ( becom+ eligible = ,m$icaid2 &
  7,e7 improv$ quality ( life = !       
demon/ration population & b5efici>y &   
c>egiv] satisfaction4  7#b7 ,reports ,n 
lat] ?an #d ye>s aft] ! implem5tation ( 
! ,,cbi-,,snp demon/ration program1 !   
,secret>y %all submit to ,congress a    
report conta9+ ! results ( ! evaluation 
conduct$ "u p>agraph 7#a71 toge!r ) su* 
recomm5dations = legislative or         
adm9i/rative action z ! ,secret>y       
det]m9es appropriate4 ,9 prep>+ su*     
report1 ! ,secret>y %all use at lea/ #c 
ye>s wor? ( data "u ! demon/ration      
program4  7i7 ,budget neutrality ,by !  
end ( ! ?ird ye> ( ! ,,cbi-,,snp        
demon/ration program1 ! ,secret>y %all  
ensure t ! aggregate paym5ts made "u    
titles ,,xviii & ,,xix ( ! ,social      

,security ,act1 includ+ "u !            
demon/ration program1 = subsequ5t p]iods
 d n exce$ ! am\nt :i* ! ,secret>y      
e/imates w\ld h be5 exp5d$ "u su* titles
 dur+ su* a p]iod if ! ,,cbi-,,snp      
demon/ration program _h n be5 implem5t$4
  7j7 ,pap]work r$uction act ,*apt] #ce 
( title #dd1 ,unit$ ,/ates ,code1 %all n
 apply to ! te/+ & evaluation ( !       
,,cbi-,,snp demon/ration program4  #a4  
,%ort title ,?is ,act may be cit$ z !   
,community ,bas$ ,indep5d5ce = ,s5iors  
,act4  #b4 ,f9d+s ,congress makes !     
foll[+ f9d+s3 7#a7 ,community-bas$      
s]vices play an ess5tial role 9 keep+   
individuals heal?y4  7#b7 ,)\t          
community-bas$ long-t]m s]vices &       
supports1 :i* are n typically cov]$ by  
,m$ic>e1 s5iors frequ5tly exp]i5ce      
negative heal? outcomes & lose _!       
ability to live indep5d5tly4  7#c7      
,s5iors :o deplete _! res\rces (t5 h no 
option b to turn to ,m$icaid = cov]age (
 long-t]m c>e exp5ses4  7#d7 ,t>get+    
community-bas$ s]vices & supports to    

at-risk s5iors c help ^! individuals    
avoid deplet+ _! assets & becom+        
,m$icaid dep5d5t4  #c4 ,community-bas$  
in/itutional special ne$s plan          
demon/ration  7a7 ,9 g5]al ,! ,secret>y 
( ,heal? & ,human ,s]vices 7ref]r$ to 9 
?is section z ! ,secret>y7 %all e/abli% 
a ,community-,bas$ ,in/itutional        
,special ,ne$s ,plan demon/ration       
program 79 ?is section ref]r$ to z !    
,,cbi-,,snp demon/ration program7 to    
prev5t & delay in/itutionalization "u ! 
,m$icaid program among eligible         
l[-income ,m$ic>e b5efici>ies4  7b7     
,e/abli%m5t  7#a7 ,9 g5]al ,! ,secret>y 
%all ent] into agreem5ts ) n m ?an #e   
eligible ,,ma plans to conduct !        
,,cbi-,,snp demon/ration program4 ,ea*  
su* eligible ,,ma plan may enroll up to 
#a1jjj eligible l[-income ,m$ic>e       
b5efici>ies 7includ+ new enrollees7 9   
su* program4  7#b7 ,use ( ,"p ,c rebate 
to furni% c]ta9 b5efits ,"u !           
,,cbi-,,snp demon/ration program1 an    
eligible ,,ma plan select$ to p>ticipate

 9 su* program %all use ! rebate t !    
plan is requir$ 7"u section #ahed ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acied-bd77 to provide to eligible      
l[-income ,m$ic>e b5efici>ies enroll$ 9 
! plan 9 ord] to furni%1 z supplem5tal  
b5efits "u section #aheb7;a77#c7 ( su*  
,act 7#db ,u4,s4,c4 #aciew-#bb7;a77#c77 
& not)/&+ any waiv]s "u section         
#aiae7;c7 ( su* ,act 7#db ,u4,s4,c4     
#acifn7c771 b5efits to su* b5efici>ies1 
includ+ long-t]m c>e s]vices & supports1
 t ! ,secret>y det]m9es appropriate = ! 
purposes ( ! ,,cbi-,,snp demon/ration   
program1 su* z--  7,a7 homemak] s]vices2
  7,b7 home deliv]$ meals2  7,c7        
transportation s]vices2  7,d7 respite   
c>e2  7,e7 adult day c>e s]vices2 &     
7,f7 non-,m$ic>e-cov]$ safety & o!r     
equipm5t4  7c7 ,eligible ,,ma plan ,9   
?is section1 ! t]m eligible ,,ma plan   
means a specializ$ ,,ma plan = special  
ne$s individuals 7z def9$ 9 section     
#ahei7;b77#f7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciew-#bh7;b77#f77 t-- 

7#a7 has exp]i5ce 9 (f]+ special ne$s   
plans = nurs+ home-eligible1            
non-in/itutionaliz$ ,m$ic>e b5efici>ies 
:o live 9 ! community2  7#b7 has        
exp]i5ce work+ ) l[ income b5efici>ies1 
includ+ l[ income b5efici>ies dually    
eligible = b5efits "u titles ,,xviii &  
,,xix ( su* ,act2  7#c7 has a s]vice    
area 9 a ,/ate t has agre$ to make      
available to ! ,secret>y ,m$icaid data  
necess>y = purposes ( conduct+ !        
indep5d5t evaluation requir$ "u         
subsection 7j72 &  7#d7 meets su* o!r   
crit]ia z ! ,secret>y may require4  7d7 
,eligible l[-income ,m$ic>e b5efici>y   
def9$ ,9 ?is section1 ! t]m eligible    
l[-income ,m$ic>e b5efici>y means an    
individual :o is--  7#a7 a ,m$ic>e      
,advantage eligible individual 7z def9$ 
9 section #ahea7;a77#c7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#aciew-#ba7;a77#c772  7#b7 a subsidy    
eligible individual 7z def9$ 9 section  
#ahfj;,d-#ad7;a77#c77;,a7 ( su* ,act    
7#db ,u4,s4,c4                          

#aciew-#aad7;a77#c77;,a772  7#c7 n      
eligible to receive b5efits "u title    
,,xix ( ! ,social ,security ,act2  7#d7 
unable to p]=m #b or m activities (     
daily liv+ 7z def9$ 9 section           
#ggjb;,b7c77#b77;,b7 ( ! ,int]nal       
,rev5ue ,code ( #aihf72 &  7#e7 age #fe 
or old]4  7e7 ,special election p]iod   
,not)/&+ sections #aheb7;e77#b77;,c7 &  
#ahfj;,d-#a7;b77#a77;,b77iii7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#ba7;e77#b77;,c72                
#aciew-#aja7;b77#a77;,b77iii771 an      
eligible ,m$ic>e b5efici>y may1 o!r ?an 
dur+ ! annual1 coord9at$ election p]iods
 "u su* sections--  7#a7 discont9ue     
enrollm5t 9 a ,m$ic>e ,advantage plan n 
p>ticipat+ 9 ! ,,cbi-,,snp demon/ration 
program & enroll 9 an eligible ,,ma plan
 p>ticipat+ 9 su* program if ! b5efici>y
 resides 9 ! p>ticipat+ plan's s]vice   
area2 &  7#b7 discont9ue enrollm5t "u ! 
orig9al m$ic>e fee-=-s]vice program "u  
p>ts ,a & ,b ( title ,,xviii ( su* ,act 
& ! enrollm5t 9 a prescription drug plan

 "u "p ,d ( su* title & enroll 9 an     
eligible ,,ma plan p>ticipat+ 9 !       
,,cbi-,,snp demon/ration program if !   
b5efici>y resides 9 ! p>ticipat+ plan's 
s]vice area4  7f7 ,b5efici>y education  
,! ,secret>y %all help to educate       
eligible ,m$ic>e b5efici>ies on !       
availability ( ! ,,cbi-,,snp            
demon/ration program ?r\gh ,/ate ,heal? 
,insurance ,assi/ance ,programs & o!r   
organizations d$icat$ to assi/+ s5iors )
 ,m$ic>e b5efits & enrollm5t4  7g7      
,duration ,! ,,cbi-,,snp demon/ration   
program %all be implem5t$ n lat] ?an    
,janu>y #a1 #bjah1 & %all be conduct$ = 
a p]iod ( #e ye>s4  7h7 ,budget         
neutrality ,9 conduct+ ! ,,cbi-,,snp    
demon/ration program1 ! ,secret>y %all  
ensure t ! aggregate paym5ts made by !  
,secret>y d n exce$ ! am\nt :i* !       
,secret>y e/imates w\ld h be5 exp5d$ "u 
titles ,,xviii & ,,xix ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #acie et  
seq41 #acif et seq47 if ! ,,cbi-,,snp   
demon/ration program _h n be5 implem5t$4

  7i7 ,expansion ( demon/ration program 
,tak+ into acc\nt ! evaluation "u       
subsection 7j71 ! ,secret>y may1 ?r\gh  
notice & comm5t rulemak+1 exp& 7includ+ 
implem5tation on a nationwide basis7 !  
duration & scope ( ! ,,cbi-,,snp        
demon/ration program "u title ,,xviii ( 
! ,social ,security ,act1 o!r ?an "u !  
orig9al m$ic>e fee-=-s]vice program "u  
p>ts ,a & ,b ( su* title1 to ! ext5t    
det]m9$ appropriate by ! ,secret>y1 if !
 requirem5ts ( p>agraphs 7#a71 7#b7 &   
7#c7 ( subsection 7c7 ( section #aaae;,a
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acae;a71 z appli$ to ! te/+ (
 a model "u subsection 7b7 ( su*        
section1 appli$ to ! ,,cbi-,,snp        
demon/ration program4  7j7 ,indep5d5t   
evaluation & reports  7#a7 ,indep5d5t   
evaluation ,! ,secret>y %all provide = !
 evaluation ( ! ,,cbi-,,snp demon/ration
 program by an indep5d5t ?ird p>ty4 ,su*
 evaluation %all be complet$ us+        
evaluation crit]ia t are cle>ly         
articulat$ prior to ! implem5tation (   

su* program4 ,su* crit]ia %all include  
specific goals ( su* program1 hypo!ses  
be+ te/$1 & cle> data collection &      
report+ requirem5ts1 recogniz+ t        
def9itions1 b5efits1 & program          
requirem5ts = long-t]m c>e s]vices &    
supports v>y across ,/ates4 ,su*        
evaluation %all det]m9e :e!r !          
,,cbi-,,snp demon/ration program has--  
7,a7 improv$ pati5t c>e2  7,b7 r$uc$    
hospitalizations or rehospitalizations2 
7,c7 r$uc$ or delay$ ,m$icaid nurs+     
facility admissions & l5g?s ( /ay2  7,d7
 r$uc$ sp5d d[n ( income & assets =     
purposes ( becom+ eligible = ,m$icaid2 &
  7,e7 improv$ quality ( life = !       
demon/ration population & b5efici>y &   
c>egiv] satisfaction4  7#b7 ,reports ,n 
lat] ?an ,janu>y #a1 #bjbb1 ! ,secret>y 
%all submit to ,congress a report       
conta9+ ! results ( ! evaluation        
conduct$ "u p>agraph 7#a71 toge!r ) su* 
recomm5dations = legislative or         
adm9i/rative action z ! ,secret>y       
det]m9es appropriate4 ,9 prep>+ su*     

report1 ! ,secret>y %all use at lea/ #c 
ye>s wor? ( data "u ! ,,cbi-,,snp       
demon/ration program4  7k7 ,fund+  7#a7 
,fund+ = implem5tation ,= purposes (    
adm9i/]+ ! ,,cbi-,,snp demon/ration     
program 7o!r ?an ! evaluation & report  
"u subsection 7j771 ! ,secret>y %all    
provide = ! transf] f ! ,f$]al ,hospital
 ,insurance ,tru/ ,fund "u section #ahag
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acie;i7 & ! ,f$]al           
,supplem5t>y ,m$ical ,insurance ,tru/   
,fund "u section #ahda ( su* ,act 7#db  
,u4,s4,c4 #aciet71 9 su* proportion z ! 
,secret>y det]m9es appropriate1 (       
#c1jjj1jjj to ! ,c5t]s = ,m$ic>e        
,m$icaid ,s]vices ,program ,managem5t   
,acc\nt4  7#b7 ,fund+ = evaluation &    
report ,= purposes ( c>ry+ out !        
evaluation & report "u subsection 7j71 !
 ,secret>y %all provide = ! transf] f ! 
,f$]al ,hospital ,insurance ,tru/ ,fund 
"u su* section #ahag & ! ,f$]al         
,supplem5t>y ,m$ical ,insurance ,tru/   
,fund "u su* section #ahda1 9 su*       

proportion z ! ,secret>y det]m9es       
appropriate1 ( #ejj1jjj to ! ,c5t]s =   
,m$ic>e  ,m$icaid ,s]vices ,program     
,managem5t ,acc\nt4  7#c7 ,availability 
,am\nts transf]r$ "u p>agraph 7#a7 or   
7#b7 %all rema9 available until exp5d$4 
7l7 ,pap]work r$uction act ,*apt] #ce ( 
title #dd1 ,unit$ ,/ates ,code1 %all n  
apply to ! te/+ & evaluation ( !        
,,cbi-,,snp demon/ration program4  ,july
 #cj1 #bjae,report$ ) an am5dm5t