,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #cdfa  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,june #be1 #bjai,ms4  
,sn*ez 7= h]self1 ,mr4 ,kelly (         
,p5nsylvania1 & ,mr4 ,s*rad]7 introduc$ 
! foll[+ bill2 :i* 0 ref]r$ to !        
,committee on ,ways & ,means1 & 9       
addition to ! ,committee on ,en]gy &    
,comm]ce1 = 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 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$ic>e  
b5efici>ies1 & = o!r purposes4  #a4     
,%ort title ,?is ,act may be cit$ z !   
,community-,bas$ ,indep5d5ce = ,s5iors  
,act ( #bjai4  #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$s plan          
demon/ration ,"p ,c ( title ,,xviii ( ! 
,social ,security ,act is am5d$ by      
ins]t+ aft] section #ahei 7#db ,u4,s4,c4
 #aciew-#bh7 ! foll[+ new section3      
#ahei;,a4 ,community-bas$ in/itutional  
special ne$s plan demon/ration  7a7     
,e/abli%m5t  7#a7 ,9 g5]al ,! ,secret>y 
%all e/abli% a ,community-,bas$         
,in/itutional ,special ,ne$s ,plan      
demon/ration program 79 ?is section     
ref]r$ to z ! ,,cbi-,,snp demon/ration  
program7 to provide home &              
community-bas$ c>e to eligible ,m$ic>e  
b5efici>ies4  7#b7 ,agreem5ts ,!        

,secret>y %all ent] into agreem5ts )    
eligible ,,ma organizations "u :i* su*  
organizations %all (f] eligible ,,ma    
plans "u ! ,,cbi-,,snp demon/ration     
program to eligible ,m$ic>e b5efici>ies4
  7#c7 ,limitations on scope (          
demon/ration program  7,a7 ,numb] (     
plans ,! ,,cbi-,,snp demon/ration       
program %all be c>ri$ out ) respect to n
 great] ?an five ,,ma plans4  7,b7      
,numb] ( enrollees p] plan ,an eligible 
,,ma organization t ent]s into an       
agreem5t ) ! ,secret>y "u p>agraph 7#b7 
to (f] an eligible ,,ma plan "u !       
,,cbi-,,snp demon/ration program may n  
enroll m ?an #a1jjj eligible ,m$ic>e    
b5efici>ies 7includ+ new enrollees7 9   
su* plan4  7#d7 ,eligible ,,ma plans    
def9$ ,= purposes ( ?is section1 ! t]m  
eligible ,,ma plan means a plan t1 9    
addition to items & s]vices = :i*       
cov]age is o!rwise provid$ "u ?is "p    
7includ+ b5efits "u section             
#aheb7;a77#c7 & not)/&+ any waiv]s "u   
section #aiae7;c771 provides = cov]age (

 long-t]m c>e s]vices & supports 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 safety & o!r equipm5t n o!rwise    
cov]$ "u ?is title4  7b7 ,eligible ,,ma 
organizations ,= purposes ( ?is section1
 ! t]m eligible ,,ma organization means 
an ,,ma organization t-- 7#a7 has       
exp]i5ce 9 (f]+ specializ$ ,,ma plans = 
special ne$s individuals1 z def9$ 9     
section #ahei7;b77#f77;,a71 to          
individuals :o live 9 ! community 9 :i* 
! eligible ,,ma plan is (f]$2  7#b7 has 
exp]i5ce work+ ) l[ income s5iors gr\ps2
  7#c7 is locat$ 9 a ,/ate t ! ,secret>y
 has det]m9$ is able to 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 meets su* o!r crit]ia z ! ,secret>y

 may require4  7c7 ,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 eligible
 to enroll 9 an eligible ,,ma plan "u ! 
,,cbi-,,snp demon/ration program2  7#b7 
is a subsidy-eligible individual 7z     
def9$ 9 section                         
#ahfj;,d-#ad7;a77#c77;,a772  7#c7 is n  
eligible to receive b5efits "u title    
,,xix2  7#d7 is unable to p]=m two 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  7d7 ,paym5ts ,!   
,secret>y %all e/abli% paym5t rates =   
eligible ,,ma organizations (f]+        
eligible ,,ma plans "u ! ,,cbi-,,snp    
demon/ration program = b5efits cov]$ "u 
su* program 7& n o!rwise cov]$ "u "p ,c7
 & provid$ to eligible ,m$ic>e          
b5efici>ies "u su* plans4 ,su* paym5t   
rates %all--  7#a7 be bas$ ^u paym5t    
rates e/abli%$ = purposes ( paym5t "u   
section #ahec2  7#b7 be 9 addition to   

paym5ts o!rwise made to su* organization
 ) respect to su* plans "u "p ,c2  7#c7 
be adju/$ to reflect ! co/s ( treat+    
eligible ,m$ic>e b5efici>ies "u ?is     
section2 &  7#d7 n1 ) respect to a mon? 
9 :i* an eligible ,,ma organization     
provides home & community-bas$ c>e to   
eligible ,m$ic>e b5efici>ies "u su*     
demon/ration program1 exce$ an am\nt =  
su* mon? t is equal to ! am\nt t w\ld be
 aw>d$ to su* organization if !         
organization 7 to receive #djj ) respect
 to ea* su* b5efici>y t ! organization  
provides ) su* c>e dur+ su* mon?4  7e7  
,special election p]iod ,not)/&+        
sections #aheb7;e77#b77;,c7 &           
#ahfj;,d-#a7;b77#a77;,b77iii71 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 an ,,ma plan n p>ticipat+ 9 
! ,,cbi-,,snp demon/ration program &    
enroll 9 an ,,ma plan p>ticipat+ 9 su*  
program2 &  7#b7 discont9ue enrollm5t "u
 ! orig9al ,m$ic>e fee-=-s]vice program 

"u p>ts ,a & ,b & ! enrollm5t 9 a       
prescription drug plan "u "p ,d & enroll
 9 an ,,ma plan p>ticipat+ 9 !          
,,cbi-,,snp demon/ration program4  7f7  
,b5efici>y education ,! ,secret>y %all  
help to educate1 ?r\gh ,/ate ,heal?     
,insurance ,assi/ance ,programs & o!r   
organizations t assi/ s5iors ) respect  
to b5efits & enrollm5t "u ?is title1    
eligible ,m$ic>e b5efici>ies on !       
availability ( ! ,,cbi-,,snp            
demon/ration program4  7g7              
,implem5tation  7#a7 ,deadl9e ,!        
,,cbi-,,snp demon/ration program %all be
 implem5t$ n lat] ?an ,janu>y #a ( !    
second ye> beg9n+ aft] ! date ( !       
enactm5t ( ?is section4  7#b7 ,duration 
,subject to p>agraph 7#c71 ! ,,cbi-,,snp
 demon/ration program %all be conduct$ =
 a p]iod ( five ye>s4  7#c7 ,ext5sion or
 expansion ,tak+ into acc\nt ! report "u
 subsection 7h77#b71 ! ,secret>y may1   
?r\gh notice & comm5t rulemak+1 exp& !  
duration1 scope1 or bo? ! duration &    
scope ( ! ,,cbi-,,snp demon/ration      

program 7includ+ implem5tation on a     
nationwide or p]man5t basis or bo?71 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 unless ! ,secret>y det]m9es t
 su* expansion is expect$ to--  7,a7    
increase aggregate exp5ditures "u ?is   
title & title ,,xix ) 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$ic>e     
b5efici>ies p>ticipat+ 9 ! ,,cbi-,,snp  
demon/ration program4  7h7 ,indep5d5t   
evaluation & reports  7#a7 ,indep5d5t   
evaluation  7,a7 ,9 g5]al ,! ,secret>y  
%all provide = ! evaluation ( !         
,,cbi-,,snp demon/ration program by an  
indep5d5t ?ird p>ty4  7,b7 ,evaluation  
objectives ,su* evaluation %all det]m9e 
! ext5t to :i* ! ,,cbi-,,snp            
demon/ration program has result$ 9--    
7i7 improv$ pati5t c>e2  7ii7 r$uc$     
hospitalizations or rehospitalizations2 

7iii7 r$uc$ or delay$ nurs+ facility    
admissions & l5g?s ( /ay "u title ,,xix2
  7iv7 r$uc$ sp5d d[n ( income & assets 
= purposes ( becom+ eligible = m$ical   
assi/ance "u a ,/ate plan "u title      
,,xix2  7v7 improv$ quality ( life = !  
eligible ,m$ic>e b5efici>ies enroll$ 9  
an eligible ,,ma plan p>ticipat+ 9 !    
,,cbi-,,snp demon/ration program2 &     
7vi7 improv$ c>egiv] satisfaction4  7,c7
 ,evaluation process ,su* evaluation    
%all be complet$ 9 accordance ) ! foll[+
 process3  7i7 ,! ,secret>y %all1 prior 
to ! implem5tation ( su* program1       
e/abli% goals = su* program ) respect to
 ! evaluation objectives describ$ 9     
subp>agraph 7,b7 & crit]ia = measur+ !  
ext5t to :i* an eligible ,,ma plan      
p>ticipat+ 9 ! ,,cbi-,,snp demon/ration 
program meets su* goals4  7ii7 ,!       
,secret>y %all implem5t cle> data       
collection & report+ requirem5ts = su*  
eligible ,,ma plans 9 ord] to c>ry out  
su* evaluation4  ,9 c>ry+ out su*       
process1 ! ,secret>y %all recognize t   

def9itions1 b5efits1 & program          
requirem5ts = long-t]m c>e s]vices &    
supports v>y across ,/ates4  7#b7       
,reports ,n lat] ?an f\r 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/    
?ree ye>s wor? ( data "u ! demon/ration 
program4  7i7 ,budget neutrality ,= any 
ye> aft] ! ?ird ye> ( ! ,,cbi-,,snp     
demon/ration program1 ! ,secret>y %all  
ensure t ! aggregate paym5ts made "u ?is
 title & title ,,xix1 includ+ "u !      
demon/ration program1 d n exce$ ! am\nt 
:i* ! ,secret>y e/imates w\ld h be5     
exp5d$ "u su* titles dur+ su* ye> 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  4