,,ii #aagth ,,congress #b;d ,session ,s4 #dbgc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #ai 7legislative day1 ,may #ag71 #bjbb,mr4 ,casey introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xix of the ,social ,security ,act to provide ,states with resources to support efforts to integrate or coordinate ,medicare and ,medicaid benefits for individuals that are eligible for both programs4 #a4 ,short title ,this ,act may be cited as the ,supporting ,states in ,integrating ,care ,act of #bjbb4 #b4 ,supporting ,state efforts to integrate ,medicare and ,medicaid benefits for full-benefit dual eligible individuals 7a7 ,in general ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by striking and at the end of paragraph 7#hf72 7,b7 by striking the period at the end of paragraph 7#hg7 and inserting 2 and2 and 7,c7 by inserting after paragraph 7#hg7 the following new paragraph3 7#hh7 in the case of a ,state that is #a of the #ej ,states or the ,district of ,columbia1 provide that the ,state will carry out activities to coordinate and integrate benefits for full-benefit dual eligible individuals 7as defined in section #aice7;c77#f77 in accordance with a ,dual ,coordination and ,integration ,plan approved by the ,secretary under subsection 7tt74 2 and 7#b7 by adding at the end the following new subsection3 7tt7 ,supporting ,state efforts ,to integrate ,medicare and ,medicaid benefits for full-,benefit dual eligible individuals 7#a7 ,definitions ,in this subsection3 7,a7 ,full-benefit dual eligible individual ,the term full-benefit dual eligible individual has the meaning given that term in section #aice7;c77#f74 7,b7 ,medicaid ,the term ,medicaid means the program for grants to ,states for medical assistance programs established under this title4 7,c7 ,medicare ,the term ,medicare the program of health insurance for the aged and disabled established under title ,,xviii4 7,d7 ,medicare and ,medicaid benefits ,the term ,medicare and ,medicaid benefits means benefits available under ,medicaid and ,medicare4 7,e7 ,medicare-,medicaid ,coordination ,office ,the term ,medicare-,medicaid ,coordination ,office means the ,medicare ,medicaid ,coordination ,office established as the ,federal ,coordinated ,health ,care ,office under section #bfjb of the ,patient ,protection and ,affordable ,care ,act4 7,f7 ,relevant stakeholders ,the term relevant stakeholders means the following3 7i7 ,full-benefit dual eligible individuals and their representatives4 7ii7 ,beneficiary advocates4 7iii7 ,health plans4 7iv7 ,health care providers1 such as physicians1 hospitals1 and nursing homes4 7v7 ,,pace providers4 7vi7 ,community-based organizations4 7vii7 ,other interested individuals or groups as determined by the ,secretary or the ,state4 7#b7 ,planning grants 7,a7 ,in general ,not later than #a year after the date of enactment of this subsection1 from the amount reserved under paragraph 7#h77;,b71 the ,secretary shall award a planning grant to each ,state to carry out planning activities to develop and submit to the ,secretary a ,dual ,coordination and ,integration ,plan described in paragraph 7#c74 7,b7 ,limitation ,the ,secretary shall award planning grants to ,states under this paragraph in such amounts as the ,secretary shall determine except that in no case shall a grant awarded under this paragraph exceed #e1jjj1jjj4 7,c7 ,use of funds ,a ,state may only use grant funds awarded under this paragraph for the planning activities described in subparagraph 7,a71 except that1 if a ,state does not use all of the grant funds and receives approval for a ,dual ,coordination and ,integration ,plan described in paragraph 7#c71 the ,state may use any remaining funds to carry out activities described in paragraph 7#d7 that are in accordance with such plan4 7#c7 ,dual ,coordination and ,integration ,plan 7,a7 ,in general ,as a condition of receiving a payment under this subsection1 a ,state shall submit to the ,secretary for approval a ,dual ,coordination and ,integration ,plan 7to be developed by the ,state with input from relevant stakeholders7 describing the ,state's strategy for integrating and coordinating health benefits coverage for full-benefit dual eligible individuals that includes detailed descriptions of the following components3 7i7 ,a description of the activities described in paragraph 7#d7 that will be carried out under the plan4 7ii7 ,the integration and coordination approaches selected by the ,state4 7iii7 ,the eligibility requirements and benefits available under such strategy4 7iv7 ,the education1 enrollment1 and outreach strategy for participation by full-benefit dual eligible individuals4 7v7 ,beneficiary protections intended to preserve and strengthen beneficiary choice and access to care4 7vi7 ,the plan for collecting data analytics and measuring the quality of care provided under such strategy4 7vii7 ,structures to promote health equity4 7viii7 ,the coordination and integration of mental health benefits with other benefits and services available under ,medicare and ,medicaid for full-benefit dual eligible individuals under such strategy4 7ix7 ,such other components as the ,secretary may require4 7,b7 ,development and submission ,in order to meet the requirements of this subsection1 a ,dual ,coordination and ,integration ,plan shall-- 7i7 be submitted for approval by the ,secretary not later than #bd months after the date on which the ,state was awarded a planning grant under paragraph 7#b72 and 7ii7 be made publicly available in the final version submitted to the ,secretary on a ,state ,internet website4 7,c7 ,approval2 publication 7i7 ,in general ,the ,secretary shall approve a ,dual ,coordination and ,integration ,plan submitted by a ,state under this paragraph if-- 7,i7 the plan contains each of the components required under subparagraph 7,a72 and 7,,ii7 the ,state provides assurances to the satisfaction of the ,secretary that the ,state will carry out the ,dual ,coordination and ,integration ,plan as it is written4 7ii7 ,regular reviews and updates ,the ,state regularly shall review and update a ,dual ,coordination and ,integration ,plan approved under this subparagraph at such times and in accordance with such requirements as the ,secretary shall specify4 7#d7 ,medicare and ,medicaid coordination and integration activities 7,a7 ,in general ,the activities described in this paragraph are the following3 7i7 ,activities to recruit or retain expert capacity at the ,state agency responsible for administering the ,state plan under this title to inform the integration of ,medicare and ,medicaid for full-benefit dual eligible individuals4 7ii7 ,training for staff at such ,state agency to develop expertise to inform the integration of ,medicare and ,medicaid benefits for full-benefit dual eligible individuals4 7iii7 ,support for development of payment rates and alternative payment models4 7iv7 ,development of information technology infrastructure to-- 7,i7 support data sharing among health plans1 providers1 ,,pace providers1 community-based organizations1 and ,federal1 ,state1 and local government agencies2 and 7,,ii7 transfer ,medicare and ,medicaid eligibility and enrollment data4 7v7 ,advancement of a unified ,medicare and ,medicaid grievance and appeals structure for determinations made by integrated agencies 7as permissible under the rules and regulations of the ,centers for ,medicare ,medicaid ,services74 7vi7 ,development of1 or enhancements to1 enrollment1 outreach1 and education supports for full-benefit dual eligible individuals4 7vii7 ,development of1 or enhancements to1 administration1 monitoring1 and oversight systems and protocols for all entities that provide coordinated or integrated ,medicare and ,medicaid benefits to full-benefit dual eligible individuals4 7viii7 ,development of1 or enhancements to1 administration of quality measurement and improvement programs for services furnished to full-benefit dual eligible individuals4 7ix7 ,stakeholder engagement processes1 including-- 7,i7 the establishment and maintenance of a ,consumer ,advisory ,council comprised of full-benefit dual eligible individuals1 as well as beneficiary advocates1 and their representatives that is reflective of the local population in terms of status for dual eligible qualification as well as race1 ethnicity1 sexual orientation1 and other characteristics determined by the ,state2 and 7,,ii7 the establishment and maintenance of a stakeholder engagement group that regularly solicits and incorporates into the ,state's ,medicare and ,medicaid coordination or integration strategy input from the ,consumer ,advisory ,council and other relevant stakeholders 7as defined in paragraph 7#a77 in the ,state4 7x7 ,development of a workforce needs assessment to identify the needs of the full-benefit dually eligible population1 including strategies to ensure adequate compensation for the workforce4 7,b7 ,limitations ,no payment may be made under this subsection for expenditures on an activity that the ,state carried out before the date of enactment of this subsection4 7#e7 ,payments to ,states 7,a7 ,in general ,subject to subparagraph 7,b71 for each fiscal quarter during which a ,state has in effect a ,dual ,coordination and ,integration ,plan approved under paragraph 7#c71 the ,secretary shall pay to the ,state an amount equal to #ej percent 7or1 during the first #bj full fiscal quarters during which the plan is in effect1 #hj percent7 of the amounts expended by the ,state during the quarter on activities described in paragraph 7#d7 that are in accordance with such plan4 7,b7 ,limitations 7i7 ,use of planning grant funds ,a ,state shall not be eligible for a payment under this paragraph until the ,state has expended the full amount of the planning grant awarded to the ,state under paragraph 7#b74 7ii7 ,non-duplication of payment2 application of higher rates ,no payment shall be made under this paragraph with respect to ,state expenditures of funds made available from ,federal sources1 and to the extent that a ,state expenditure is eligible for a ,federal payment under both subparagraph 7,a7 and another provision of this title or any other law1 payment shall only be made under the provision that results in the ,state receiving the higher payment4 7,c7 ,manner of payment ,payment to a ,state under this subsection shall be made in the same manner as payments for ,state expenditures for the proper and efficient administration of the ,state plan described in section #aijc7;a77#g74 7#f7 ,evaluation of plan implementation2 reporting requirement 7,a7 ,evaluation benchmarks ,the ,secretary shall establish benchmarks for evaluating whether a ,state's use of payments received under this subsection is in alignment with the ,state's ,dual ,coordination and ,integration ,plan 7as approved under paragraph 7#c774 7,b7 ,annual report ,as a condition of payment under this subsection-- 7i7 a ,state shall submit to the ,secretary an annual report detailing how the ,state is using payments received under this subsection2 and 7ii7 the ,secretary shall certify1 based on such report1 that the ,state's use of such payments is in alignment with the ,state's ,dual ,coordination and ,integration ,plan 7as approved under paragraph 7#c774 7#g7 ,administration ,in carrying out this subsection1 the ,secretary shall coordinate with the ,medicare-,medicaid ,coordination ,office and other ,federal agencies as appropriate4 7#h7 ,funding 7,a7 ,in general ,out of any funds in the ,treasury not otherwise appropriated1 there is appropriated to the ,secretary #cjj1jjj1jjj for fiscal year #bjbc to carry out this subsection1 to remain available until expended4 7,b7 ,reservation for planning grants ,of the amount appropriated under subparagraph 7,a71 #aej1jjj1jjj is reserved to award planning grants under paragraph 7#b74 7,c7 ,technical assistance and guidance ,of the amount appropriated under subparagraph 7,a71 #aej1jjj1jjj is reserved for issuing guidance and providing technical assistance to ,states in-- 7i7 developing and implementing ,dual ,coordination and ,integration ,plans under this subsection2 and 7ii7 completing the annual reports required under paragraph 7#f74 4 7b7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b71 the amendments made by this section shall take effect on the date of enactment of this ,act4 7#b7 ,delay if ,state legislation needed ,in the case of a ,state plan for medical assistance under title ,,xix of the ,social ,security ,act which the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the plan to meet the additional requirements imposed by the amendments made by the section1 the ,state plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of the enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of such session shall be deemed to be a separate regular session of the ,state legislature4