,i #aafth ,,congress #ast ,session ,h4 ,r4 #cdfa ,,in ,,the ,,house ,,of ,,representatives ,june #be1 #bjai,ms4 ,snchez 7for herself1 ,mr4 ,kelly of ,pennsylvania1 and ,mr4 ,schrader7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to establish a ,community-,based ,institutional ,special ,needs ,plan demonstration program to target home and community-based care to eligible ,medicare beneficiaries1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,community-,based ,independence for ,seniors ,act of #bjai4 #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 ,part ,c of title ,,xviii of the ,social ,security ,act is amended by inserting after section #ahei 7#db ,u4,s4,c4 #aciew-#bh7 the following new section3 #ahei;,a4 ,community-based institutional special needs plan demonstration 7a7 ,establishment 7#a7 ,in general ,the ,secretary shall establish a ,community-,based ,institutional ,special ,needs ,plan demonstration program 7in this section referred to as the ,,cbi-,,snp demonstration program7 to provide home and community-based care to eligible ,medicare beneficiaries4 7#b7 ,agreements ,the ,secretary shall enter into agreements with eligible ,,ma organizations under which such organizations shall offer eligible ,,ma plans under the ,,cbi-,,snp demonstration program to eligible ,medicare beneficiaries4 7#c7 ,limitations on scope of demonstration program 7,a7 ,number of plans ,the ,,cbi-,,snp demonstration program shall be carried out with respect to not greater than five ,,ma plans4 7,b7 ,number of enrollees per plan ,an eligible ,,ma organization that enters into an agreement with the ,secretary under paragraph 7#b7 to offer an eligible ,,ma plan under the ,,cbi-,,snp demonstration program may not enroll more than #a1jjj eligible ,medicare beneficiaries 7including new enrollees7 in such plan4 7#d7 ,eligible ,,ma plans defined ,for purposes of this section1 the term eligible ,,ma plan means a plan that1 in addition to items and services for which coverage is otherwise provided under this part 7including benefits under section #aheb7;a77#c7 and notwithstanding any waivers under section #aiae7;c771 provides for coverage of long-term care services and supports 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 safety and other equipment not otherwise covered under this title4 7b7 ,eligible ,,ma organizations ,for purposes of this section1 the term eligible ,,ma organization means an ,,ma organization that-- 7#a7 has experience in offering specialized ,,ma plans for special needs individuals1 as defined in section #ahei7;b77#f77;,a71 to individuals who live in the community in which the eligible ,,ma plan is offered2 7#b7 has experience working with low income seniors groups2 7#c7 is located in a ,state that the ,secretary has determined is able to 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 meets such other criteria as the ,secretary may require4 7c7 ,eligible ,medicare beneficiary defined ,in this section1 the term eligible ,medicare beneficiary means a ,medicare beneficiary who-- 7#a7 is eligible to enroll in an eligible ,,ma plan under the ,,cbi-,,snp demonstration program2 7#b7 is a subsidy-eligible individual 7as defined in section #ahfj;,d-#ad7;a77#c77;,a772 7#c7 is not eligible to receive benefits under title ,,xix2 7#d7 is unable to perform two 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 7d7 ,payments ,the ,secretary shall establish payment rates for eligible ,,ma organizations offering eligible ,,ma plans under the ,,cbi-,,snp demonstration program for benefits covered under such program 7and not otherwise covered under part ,c7 and provided to eligible ,medicare beneficiaries under such plans4 ,such payment rates shall-- 7#a7 be based upon payment rates established for purposes of payment under section #ahec2 7#b7 be in addition to payments otherwise made to such organization with respect to such plans under part ,c2 7#c7 be adjusted to reflect the costs of treating eligible ,medicare beneficiaries under this section2 and 7#d7 not1 with respect to a month in which an eligible ,,ma organization provides home and community-based care to eligible ,medicare beneficiaries under such demonstration program1 exceed an amount for such month that is equal to the amount that would be awarded to such organization if the organization were to receive #djj with respect to each such beneficiary that the organization provides with such care during such month4 7e7 ,special election period ,notwithstanding sections #aheb7;e77#b77;,c7 and #ahfj;,d-#a7;b77#a77;,b77iii71 an eligible ,medicare beneficiary may1 other than during the annual1 coordinated election periods under such sections-- 7#a7 discontinue enrollment in an ,,ma plan not participating in the ,,cbi-,,snp demonstration program and enroll in an ,,ma plan participating in such program2 and 7#b7 discontinue enrollment under the original ,medicare fee-for-service program under parts ,a and ,b and the enrollment in a prescription drug plan under part ,d and enroll in an ,,ma plan participating in the ,,cbi-,,snp demonstration program4 7f7 ,beneficiary education ,the ,secretary shall help to educate1 through ,state ,health ,insurance ,assistance ,programs and other organizations that assist seniors with respect to benefits and enrollment under this title1 eligible ,medicare beneficiaries on the availability of the ,,cbi-,,snp demonstration program4 7g7 ,implementation 7#a7 ,deadline ,the ,,cbi-,,snp demonstration program shall be implemented not later than ,january #a of the second year beginning after the date of the enactment of this section4 7#b7 ,duration ,subject to paragraph 7#c71 the ,,cbi-,,snp demonstration program shall be conducted for a period of five years4 7#c7 ,extension or expansion ,taking into account the report under subsection 7h77#b71 the ,secretary may1 through notice and comment rulemaking1 expand the duration1 scope1 or both the duration and scope of the ,,cbi-,,snp demonstration program 7including implementation on a nationwide or permanent basis or both71 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 unless the ,secretary determines that such expansion is expected to-- 7,a7 increase aggregate expenditures under this title and title ,,xix 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 7,a7 ,in general ,the ,secretary shall provide for the evaluation of the ,,cbi-,,snp demonstration program by an independent third party4 7,b7 ,evaluation objectives ,such evaluation shall determine the extent to which the ,,cbi-,,snp demonstration program has resulted in-- 7i7 improved patient care2 7ii7 reduced hospitalizations or rehospitalizations2 7iii7 reduced or delayed nursing facility admissions and lengths of stay under title ,,xix2 7iv7 reduced spend down of income and assets for purposes of becoming eligible for medical assistance under a ,state plan under title ,,xix2 7v7 improved quality of life for the eligible ,medicare beneficiaries enrolled in an eligible ,,ma plan participating in the ,,cbi-,,snp demonstration program2 and 7vi7 improved caregiver satisfaction4 7,c7 ,evaluation process ,such evaluation shall be completed in accordance with the following process3 7i7 ,the ,secretary shall1 prior to the implementation of such program1 establish goals for such program with respect to the evaluation objectives described in subparagraph 7,b7 and criteria for measuring the extent to which an eligible ,,ma plan participating in the ,,cbi-,,snp demonstration program meets such goals4 7ii7 ,the ,secretary shall implement clear data collection and reporting requirements for such eligible ,,ma plans in order to carry out such evaluation4 ,in carrying out such process1 the ,secretary shall recognize that definitions1 benefits1 and program requirements for long-term care services and supports vary across ,states4 7#b7 ,reports ,not later than four 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 three years worth of data under the demonstration program4 7i7 ,budget neutrality ,for any year after the third year of the ,,cbi-,,snp demonstration program1 the ,secretary shall ensure that the aggregate payments made under this title and title ,,xix1 including under the demonstration program1 do not exceed the amount which the ,secretary estimates would have been expended under such titles during such year 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 4