,,ii  #aagth ,,congress  #b;d ,session  
,s4 #cfcj  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,february #aj1 
#bjbb,mr4 ,scott of ,south ,carolina    
introduced the following bill2 which was
 read twice and referred to the         
,committee on ,finance  ,a ,,bill  ,to  
establish a ,dual ,eligible ,quality    
,care ,fund to provide grants to ,state 
,medicaid programs to improve their     
capacity to ensure the provision of     
quality integrated care for dual        
eligible beneficiaries4  #a4 ,short     
title ,this ,act may be cited as the    
,supporting ,care for ,dual ,eligibles  
,act4  #b4 ,improving ,medicaid's       
capacity to protect dual eligible       
beneficiaries  7a7 ,establishment of    
,dual ,eligible ,quality ,care ,fund    
7#a7 ,in general ,not later than #f     
months after the date of enactment of   
this ,act1 the ,secretary of ,health and
 ,human ,services 7referred to in this  
section as the ,secretary7 shall        
establish a fund to be known as the     

,dual ,eligible ,quality ,care ,fund4   
7#b7 ,establishment within ,federal     
,coordinated ,health ,care ,office ,the 
,dual ,eligible ,quality ,care ,fund    
shall be established within1 and        
administered by the ,director of1 the   
,federal ,coordinated ,health ,care     
,office established under section #bfjb 
of the ,patient ,protection and         
,affordable ,care ,act 7#db ,u4,s4,c4   
#acae;b74  7#c7 ,funding ,there is      
appropriated to the ,dual ,eligible     
,quality ,care ,fund for fiscal year    
#bjbb #ajj1jjj1jjj1 to remain available 
until expended4  7b7 ,purpose ,the      
purpose of the ,dual ,eligible ,quality 
,care ,fund is to provide timely1       
targeted assistance in the way of grants
 to ,state ,medicaid programs to improve
 their capacity to ensure the provision 
of quality integrated care for dual     
eligible beneficiaries4  7c7 ,allowable 
uses of grant funds ,a ,state ,medicaid 
program may use amounts received under a
 grant from the ,dual ,eligible ,quality

 ,care ,fund to improve its capacity to 
provide quality integrated care for dual
 eligible beneficiaries through any of  
the following3 7#a7 ,recruiting and     
paying workers with needed subject      
matter knowledge1 skills1 or            
capabilities4  7#b7 ,actuarial support  
for rate development and analysis and   
development or purchase of risk         
adjustment tools4  7#c7 ,information    
technology system changes1 including    
changes that-- 7,a7 improve member      
enrollments2  7,b7 improve encounter    
data collection and analysis2  7,c7     
improve the ability of ,state ,medicaid 
programs to develop customized data     
management tools 7such as queries and   
dashboards72  7,d7 improve compliance   
with ,federal reporting requirements2   
7,e7 enhance financial analysis2  7,f7  
improve quality reporting and           
monitoring2  7,g7 improve modifications 
to capitation payments2  7,h7 transfer  
eligibility and enrollment data between 
systems2  7,i7 improve the grievances   

and appeals process2 and  7,j7 improve  
interaction with ,medicare data and     
related systems4  7#d7 ,providing       
support for dual eligible beneficiaries 
during enrollment processes1 assistance 
to dual eligible beneficiaries          
evaluating their enrollment choices1    
informational materials to dual eligible
 beneficiaries and those assisting with 
decision support1 and coordination with 
,medicare enrollment processes4  7#e7   
,monitoring and oversight of efforts    
undertaken by ,state ,medicaid using    
grant funds1 including measuring the    
level of participation by stakeholders  
and dual eligible beneficiaries4  7#f7  
,quality measurement and ,state         
evaluation activities1 development and  
deployment of survey tools1 and costs of
 accessing1 transferring1 and analyzing 
data4  7#g7 ,develop knowledge and      
understanding within the ,state         
,medicaid agency of the ,medicare       
program under title ,,xviii of the      
,social ,security ,act 7#db ,u4,s4,c4   

#acie et seq474  7#h7 ,supporting and   
improving ,medicare initiatives1        
including new initiatives and existing  
or past initiatives such as the         
,financial ,alignment ,initiative for   
,medicare-,medicaid ,enrollees          
demonstration projects conducted under  
section #aaae;,a of the ,social         
,security ,act 7#db ,u4,s4,c4 #acae;a74 
7d7 ,awarding grants  7#a7 ,in general  
,a ,state ,medicaid program that wishes 
to receive a grant under this section   
from the ,dual ,eligible ,quality ,care 
,fund shall submit an application to the
 ,director of the ,federal ,coordinated 
,health ,care ,office 7referred to in   
this subsection as the ,director71 in   
such form and manner as the ,director   
shall specify4 ,the ,director may award 
a grant under this section to any       
,state1 without regard to the ,state's  
existing capacity to provide quality    
integrated care for dual eligible       
beneficiaries4  7#b7 ,application       
requirements ,an application for a grant

 under this section shall include an    
identification of the uses of funds     
described in subsection 7c7 for which   
the ,state ,medicaid program will use   
the grant funds4  7#c7 ,methodology for 
disbursing funds  7,a7 ,in general ,not 
later than #f months after the date of  
enactment of this ,act1 the ,director   
shall issue guidance establishing a     
clear and equitable methodology for     
awarding grants to ,state ,medicaid     
programs under this section4  7,b7      
,methodology requirements ,the          
methodology established by the ,director
 under this paragraph shall1 to the     
extent practical-- 7i7 ensure that grant
 funds are used in accordance with      
subsection 7c72  7ii7 provide that      
grants are awarded by the ,director in a
 manner that is transparent and         
equitable to ,state ,medicaid programs2 
and  7iii7 provide that1 in determining 
the grant amount to be awarded to a     
,state ,medicaid program1 the ,director 
shall take into consideration-- 7,i7 the

 percentage of enrollees in the program 
who are dual eligible beneficiaries2 and
  7,,ii7 the total number of dual       
eligible beneficiaries enrolled in the  
program4  7,c7 ,limitations ,the        
,director shall not award more than #a  
grant under this section to any ,state  
,medicaid program1 and in no case may   
the amount of a grant awarded under this
 section exceed #b1jjj1jjj4  7e7 ,state 
program reporting  7#a7 ,quarterly      
,reporting ,states receiving a grant    
under this section shall1 in a form and 
manner specified by the ,director of the
 ,federal ,coordinated ,health ,care    
,office 7referred to in this subsection 
as the ,director71 report no less       
frequently than once a quarter regarding
 the amount of grant funds spent by the 
,state and how funds received from the  
grant are being used within the ,state4 
7#b7 ,longitudinal ,report ,states      
receiving a grant under this section    
shall1 no later than #b years after the 
receipt of such grant1 submit to the    

,director and make available on a ,state
 website a report summarizing how the   
funds received under such grant were    
used4 ,such report shall include the    
following3 7,a7 ,an explanation of which
 uses of funds described in subsection  
7c7 the grant funds supported4  7,b7 ,an
 assessment of each of the following3   
7i7 ,the manner in which the grant funds
 improved the ,state ,medicaid program's
 capacity to provide quality integrated 
care for dual eligible beneficiaries4   
7ii7 ,the manner in which the grant     
funds improved the quality of care for  
dual eligible beneficiaries4  7iii7 ,the
 manner in which the grant funds        
improved the integration and            
coordination of care for dual eligible  
beneficiaries4  7f7 ,definitions ,in    
this section3 7#a7 ,dual eligible       
beneficiary ,the term dual eligible     
beneficiary means an individual who is  
entitled to1 or enrolled for1 benefits  
under part ,a of title ,,xviii of the   
,social ,security ,act 7#db ,u4,s4,c4   

#acie et seq471 or enrolled for benefits
 under part ,b of such title1 and is    
eligible for medical assistance under a 
,state plan under title ,,xix of such   
,act 7#db ,u4,s4,c4 #acif et seq47 or   
under a waiver of such a plan4  7#b7    
,quality integrated care ,the term      
quality integrated care means the       
provision of services provided under the
 ,medicare program under title ,,xviii  
of the ,social ,security ,act 7#db      
,u4,s4,c4 #acie et seq47 and services   
provided under a ,state ,medicaid       
program-- 7,a7 through systems in which 
,medicaid and ,medicare program         
administrative requirements1 financing1 
benefits1 or care delivery are aligned2 
and  7,b7 in a coordinated fashion1     
which may include coverage of such      
services through a single entity or     
coordinating entities4  7#c7 ,state ,the
 term ,state has the meaning given such 
term for purposes of title ,,xix of the 
,social ,security ,act 7#db ,u4,s4,c4   
#acif et seq474  7#d7 ,state ,medicaid  

program ,the term ,state ,medicaid      
program means a ,state plan under title 
,,xix of the ,social ,security ,act 7#db
 ,u4,s4,c4 #acif et seq471 and includes 
any waiver of such a plan4  #c4 ,payment
 error rate measurement 7,,perm7 audit  
requirements  7a7 ,biennial ,,perm audit
 requirement ,beginning with fiscal year
 #bjbc1 the ,administrator shall conduct
 payment error rate measurement 7,,perm7
 audits of each ,state ,medicaid program
 on a biennial basis4  7b7              
,notification2 identification of sources
 of improper payments  7#a7             
,notification ,not later than #f months 
after the date of enactment of this     
,act1 the ,administrator shall notify   
the contractor conducting ,,perm audits 
of the ,administrator's intent to modify
 contracts to require ,,perm audits not 
less than once every other year in each 
,state4  7#b7 ,identification of sources
 of improper payments ,the              
,administrator shall direct the         
contractor conducting ,,perm audits of  

,state ,medicaid programs to identify   
areas known to be sources of improper   
payments under such programs to identify
 program areas or components known to be
 sources of high risk for improper      
payments under such programs4  7c7      
,state ,medicaid director letter ,not   
later than #ab months after the date of 
enactment of this ,act1 the             
,administrator shall issue a ,state     
,medicaid ,director letter regarding    
,state requirements under ,federal law  
and regulations regarding avoiding and  
responding to improper payments under   
,state ,medicaid programs4  7d7 ,state  
improper payment mitigation plans  7#a7 
,in general ,not later than ,january #a1
 #bjbc1 each ,state ,medicaid program   
shall submit to the ,administrator a    
plan1 which shall include specific      
actions and timeframes for taking such  
actions and achieving specified results1
 for mitigating improper payments under 
such program4  7#b7 ,publication of     
,state plans ,the ,administrator shall  

make ,state plans submitted under       
paragraph 7#a7 available to the public4 
7e7 ,definitions ,in this section3 7#a7 
,administrator ,the term ,administrator 
means the ,administrator of the ,centers
 for ,medicare  ,medicaid ,services4    
7#b7 ,state ,the term ,state has the    
meaning given such term for purposes of 
title ,,xix of the ,social ,security    
,act 7#db ,u4,s4,c4 #acif et seq474     
7#c7 ,state ,medicaid program ,the term 
,state ,medicaid program means a ,state 
plan under title ,,xix of the ,social   
,security ,act 7#db ,u4,s4,c4 #acif et  
seq471 and includes any waiver of such a
 plan4