,,ii  #aag? ,,congress  #b;d ,session   
,s4 #dbgc  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #ai 7legislative  
day1 ,may #ag71 #bjbb,mr4 ,casey        
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title ,,xix
 ( ! ,social ,security ,act to provide  
,/ates ) res\rces to support ef=ts to   
integrate or coord9ate ,m$ic>e &        
,m$icaid b5efits = individuals t are    
eligible = bo? programs4  #a4 ,%ort     
title ,?is ,act may be cit$ z !         
,support+ ,/ates 9 ,integrat+ ,c>e ,act 
( #bjbb4  #b4 ,support+ ,/ate ef=ts to  
integrate ,m$ic>e & ,m$icaid b5efits =  
full-b5efit dual eligible individuals   
7a7 ,9 g5]al ,section #aijb ( ! ,social 
,security ,act 7#db ,u4,s4,c4 #acif;a7  
is am5d$-- 7#a7 9 subsection 7a7-- 7,a7 
by /rik+ & at ! end ( p>agraph 7#hf72   
7,b7 by /rik+ ! p]iod at ! end (        
p>agraph 7#hg7 & ins]t+ 2 &2 &  7,c7 by 
ins]t+ aft] p>agraph 7#hg7 ! foll[+ new 
p>agraph3  7#hh7 9 ! case ( a ,/ate t is

 #a ( ! #ej ,/ates or ! ,di/rict (      
,columbia1 provide t ! ,/ate w c>ry out 
activities to coord9ate & integrate     
b5efits = full-b5efit dual eligible     
individuals 7z def9$ 9 section          
#aice7;c77#f77 9 accordance ) a ,dual   
,coord9ation & ,integration ,plan       
approv$ by ! ,secret>y "u subsection    
7tt74  2 &  7#b7 by add+ at ! end !     
foll[+ new subsection3  7tt7 ,support+  
,/ate ef=ts ,to integrate ,m$ic>e &     
,m$icaid b5efits = full-,b5efit dual    
eligible individuals  7#a7 ,def9itions  
,9 ?is subsection3 7,a7 ,full-b5efit    
dual eligible individual ,! t]m         
full-b5efit dual eligible individual has
 ! mean+ giv5 t t]m 9 section           
#aice7;c77#f74  7,b7 ,m$icaid ,! t]m    
,m$icaid means ! program = grants to    
,/ates = m$ical assi/ance programs      
e/abli%$ "u ?is title4  7,c7 ,m$ic>e ,! 
t]m ,m$ic>e ! program ( heal? insurance 
= ! ag$ & disabl$ e/abli%$ "u title     
,,xviii4  7,d7 ,m$ic>e & ,m$icaid       
b5efits ,! t]m ,m$ic>e & ,m$icaid       

b5efits means b5efits available "u      
,m$icaid & ,m$ic>e4  7,e7               
,m$ic>e-,m$icaid ,coord9ation ,(fice ,! 
t]m ,m$ic>e-,m$icaid ,coord9ation ,(fice
 means ! ,m$ic>e ,m$icaid ,coord9ation  
,(fice e/abli%$ z ! ,f$]al ,coord9at$   
,heal? ,c>e ,(fice "u section #bfjb ( ! 
,pati5t ,protection & ,af=dable ,c>e    
,act4  7,f7 ,relevant /akehold]s ,! t]m 
relevant /akehold]s means ! foll[+3 7i7 
,full-b5efit dual eligible individuals &
 _! repres5tatives4  7ii7 ,b5efici>y    
advocates4  7iii7 ,heal? plans4  7iv7   
,heal? c>e provid]s1 su* z physicians1  
hospitals1 & nurs+ homes4  7v7 ,,pace   
provid]s4  7vi7 ,community-bas$         
organizations4  7vii7 ,o!r int]e/$      
individuals or gr\ps z det]m9$ by !     
,secret>y or ! ,/ate4  7#b7 ,plann+     
grants  7,a7 ,9 g5]al ,n lat] ?an #a ye>
 aft] ! date ( enactm5t ( ?is           
subsection1 f ! am\nt res]v$ "u p>agraph
 7#h77;,b71 ! ,secret>y %all aw>d a     
plann+ grant to ea* ,/ate to c>ry out   
plann+ activities to develop & submit to

 ! ,secret>y a ,dual ,coord9ation &     
,integration ,plan describ$ 9 p>agraph  
7#c74  7,b7 ,limitation ,! ,secret>y    
%all aw>d plann+ grants to ,/ates "u ?is
 p>agraph 9 su* am\nts z ! ,secret>y    
%all det]m9e except t 9 no case %all a  
grant aw>d$ "u ?is p>agraph exce$       
#e1jjj1jjj4  7,c7 ,use ( funds ,a ,/ate 
may only use grant funds aw>d$ "u ?is   
p>agraph = ! plann+ activities describ$ 
9 subp>agraph 7,a71 except t1 if a ,/ate
 does n use all ( ! grant funds &       
receives approval = a ,dual ,coord9ation
 & ,integration ,plan describ$ 9        
p>agraph 7#c71 ! ,/ate may use any      
rema9+ funds to c>ry out activities     
describ$ 9 p>agraph 7#d7 t are 9        
accordance ) su* plan4  7#c7 ,dual      
,coord9ation & ,integration ,plan  7,a7 
,9 g5]al ,z a condition ( receiv+ a     
paym5t "u ?is subsection1 a ,/ate %all  
submit to ! ,secret>y = approval a ,dual
 ,coord9ation & ,integration ,plan 7to  
be develop$ by ! ,/ate ) input f        
relevant /akehold]s7 describ+ ! ,/ate's 

/rategy = integrat+ & coord9at+ heal?   
b5efits cov]age = full-b5efit dual      
eligible individuals t includes detail$ 
descriptions ( ! foll[+ compon5ts3 7i7  
,a description ( ! activities describ$ 9
 p>agraph 7#d7 t w be c>ri$ out "u !    
plan4  7ii7 ,! integration & coord9ation
 approa*es select$ by ! ,/ate4  7iii7 ,!
 eligibility requirem5ts & b5efits      
available "u su* /rategy4  7iv7 ,!      
education1 enrollm5t1 & outrea* /rategy 
= p>ticipation by full-b5efit dual      
eligible individuals4  7v7 ,b5efici>y   
protections int5d$ to pres]ve & /r5g!n  
b5efici>y *oice & access to c>e4  7vi7  
,! plan = collect+ data analytics &     
measur+ ! quality ( c>e provid$ "u su*  
/rategy4  7vii7 ,/ructures to promote   
heal? equity4  7viii7 ,! coord9ation &  
integration ( m5tal heal? b5efits ) o!r 
b5efits & s]vices available "u ,m$ic>e &
 ,m$icaid = full-b5efit dual eligible   
individuals "u su* /rategy4  7ix7 ,su*  
o!r compon5ts z ! ,secret>y may require4
  7,b7 ,developm5t & submission ,9 ord] 

to meet ! requirem5ts ( ?is subsection1 
a ,dual ,coord9ation & ,integration     
,plan %all-- 7i7 be submitt$ = approval 
by ! ,secret>y n lat] ?an #bd mon?s aft]
 ! date on :i* ! ,/ate 0 aw>d$ a plann+ 
grant "u p>agraph 7#b72 &  7ii7 be made 
publicly available 9 ! f9al v]sion      
submitt$ to ! ,secret>y on a ,/ate      
,int]net website4  7,c7 ,approval2      
publication  7i7 ,9 g5]al ,! ,secret>y  
%all approve a ,dual ,coord9ation &     
,integration ,plan submitt$ by a ,/ate  
"u ?is p>agraph if-- 7,i7 ! plan conta9s
 ea* ( ! compon5ts requir$ "u           
subp>agraph 7,a72 &  7,,ii7 ! ,/ate     
provides assurances to ! satisfaction ( 
! ,secret>y t ! ,/ate w c>ry out ! ,dual
 ,coord9ation & ,integration ,plan z x  
is writt54  7ii7 ,regul> reviews &      
updates ,! ,/ate regul>ly %all review & 
update a ,dual ,coord9ation &           
,integration ,plan approv$ "u ?is       
subp>agraph at su* times & 9 accordance 
) su* requirem5ts z ! ,secret>y %all    
specify4  7#d7 ,m$ic>e & ,m$icaid       

coord9ation & integration activities    
7,a7 ,9 g5]al ,! activities describ$ 9  
?is p>agraph are ! foll[+3 7i7          
,activities to recruit or reta9 exp]t   
capacity at ! ,/ate ag5cy responsible = 
adm9i/]+ ! ,/ate plan "u ?is title to   
in=m ! integration ( ,m$ic>e & ,m$icaid 
= full-b5efit dual eligible individuals4
  7ii7 ,tra9+ = /aff at su* ,/ate ag5cy 
to develop exp]tise to in=m !           
integration ( ,m$ic>e & ,m$icaid b5efits
 = full-b5efit dual eligible            
individuals4  7iii7 ,support =          
developm5t ( paym5t rates & alt]native  
paym5t models4  7iv7 ,developm5t (      
in=mation te*nology infra/ructure to--  
7,i7 support data %>+ among heal? plans1
 provid]s1 ,,pace provid]s1             
community-bas$ organizations1 & ,f$]al1 
,/ate1 & local gov]nm5t ag5cies2 &      
7,,ii7 transf] ,m$ic>e & ,m$icaid       
eligibility & enrollm5t data4  7v7      
,advancem5t ( a unifi$ ,m$ic>e &        
,m$icaid grievance & appeals /ructure = 
det]m9ations made by integrat$ ag5cies  

7z p]missible "u ! rules & regulations (
 ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices74
  7vi7 ,developm5t (1 or enhancem5ts to1
 enrollm5t1 outrea*1 & education        
supports = full-b5efit dual eligible    
individuals4  7vii7 ,developm5t (1 or   
enhancem5ts to1 adm9i/ration1 monitor+1 
& ov]sight sy/ems & protocols = all     
entities t provide coord9at$ or         
integrat$ ,m$ic>e & ,m$icaid b5efits to 
full-b5efit dual eligible individuals4  
7viii7 ,developm5t (1 or enhancem5ts to1
 adm9i/ration ( quality measurem5t &    
improvem5t programs = s]vices furni%$ to
 full-b5efit dual eligible individuals4 
7ix7 ,/akehold] engagem5t processes1    
includ+-- 7,i7 ! e/abli%m5t & ma9t5ance 
( a ,consum] ,advisory ,c\ncil compris$ 
( full-b5efit dual eligible individuals1
 z well z b5efici>y advocates1 & _!     
repres5tatives t is reflective ( ! local
 population 9 t]ms ( /atus = dual       
eligible qualification z well z race1   
e?nicity1 sexual ori5tation1 & o!r      
*>act]i/ics det]m9$ by ! ,/ate2 &       

7,,ii7 ! e/abli%m5t & ma9t5ance ( a     
/akehold] engagem5t gr\p t regul>ly     
solicits & incorporates into ! ,/ate's  
,m$ic>e & ,m$icaid coord9ation or       
integration /rategy input f ! ,consum]  
,advisory ,c\ncil & o!r relevant        
/akehold]s 7z def9$ 9 p>agraph 7#a77 9 !
 ,/ate4  7x7 ,developm5t ( a work=ce    
ne$s assessm5t to id5tify ! ne$s ( !    
full-b5efit dually eligible population1 
includ+ /rategies to ensure adequate    
comp5sation = ! work=ce4  7,b7          
,limitations ,no paym5t may be made "u  
?is subsection = exp5ditures on an      
activity t ! ,/ate c>ri$ out be=e ! date
 ( enactm5t ( ?is subsection4  7#e7     
,paym5ts to ,/ates  7,a7 ,9 g5]al       
,subject to subp>agraph 7,b71 = ea*     
fiscal qu>t] dur+ :i* a ,/ate has 9     
effect a ,dual ,coord9ation &           
,integration ,plan approv$ "u p>agraph  
7#c71 ! ,secret>y %all pay to ! ,/ate an
 am\nt equal to #ej p]c5t 7or1 dur+ !   
fir/ #bj full fiscal qu>t]s dur+ :i* !  
plan is 9 effect1 #hj p]c5t7 ( ! am\nts 

exp5d$ by ! ,/ate dur+ ! qu>t] on       
activities describ$ 9 p>agraph 7#d7 t   
are 9 accordance ) su* plan4  7,b7      
,limitations  7i7 ,use ( plann+ grant   
funds ,a ,/ate %all n be eligible = a   
paym5t "u ?is p>agraph until ! ,/ate has
 exp5d$ ! full am\nt ( ! plann+ grant   
aw>d$ to ! ,/ate "u p>agraph 7#b74  7ii7
 ,non-duplication ( paym5t2 application 
( high] rates ,no paym5t %all be made "u
 ?is p>agraph ) respect to ,/ate        
exp5ditures ( funds made available f    
,f$]al s\rces1 & to ! ext5t t a ,/ate   
exp5diture is eligible = a ,f$]al paym5t
 "u bo? subp>agraph 7,a7 & ano!r        
provision ( ?is title or any o!r law1   
paym5t %all only be made "u ! provision 
t results 9 ! ,/ate receiv+ ! high]     
paym5t4  7,c7 ,mann] ( paym5t ,paym5t to
 a ,/ate "u ?is subsection %all be made 
9 ! same mann] z paym5ts = ,/ate        
exp5ditures = ! prop] & effici5t        
adm9i/ration ( ! ,/ate plan describ$ 9  
section #aijc7;a77#g74  7#f7 ,evaluation
 ( plan implem5tation2 report+          

requirem5t  7,a7 ,evaluation b5*m>ks ,! 
,secret>y %all e/abli% b5*m>ks =        
evaluat+ :e!r a ,/ate's use ( paym5ts   
receiv$ "u ?is subsection is 9 alignm5t 
) ! ,/ate's ,dual ,coord9ation &        
,integration ,plan 7z approv$ "u        
p>agraph 7#c774  7,b7 ,annual report ,z 
a condition ( paym5t "u ?is subsection--
 7i7 a ,/ate %all submit to ! ,secret>y 
an annual report detail+ h[ ! ,/ate is  
us+ paym5ts receiv$ "u ?is subsection2 &
  7ii7 ! ,secret>y %all c]tify1 bas$ on 
su* report1 t ! ,/ate's use ( su*       
paym5ts is 9 alignm5t ) ! ,/ate's ,dual 
,coord9ation & ,integration ,plan 7z    
approv$ "u p>agraph 7#c774  7#g7        
,adm9i/ration ,9 c>ry+ out ?is          
subsection1 ! ,secret>y %all coord9ate )
 ! ,m$ic>e-,m$icaid ,coord9ation ,(fice 
& o!r ,f$]al ag5cies z appropriate4     
7#h7 ,fund+  7,a7 ,9 g5]al ,out ( any   
funds 9 ! ,treasury n o!rwise           
appropriat$1 !re is appropriat$ to !    
,secret>y #cjj1jjj1jjj = fiscal ye>     
#bjbc to c>ry out ?is subsection1 to    

rema9 available until exp5d$4  7,b7     
,res]vation = plann+ grants ,( ! am\nt  
appropriat$ "u subp>agraph 7,a71        
#aej1jjj1jjj is res]v$ to aw>d plann+   
grants "u p>agraph 7#b74  7,c7 ,te*nical
 assi/ance & guidance ,( ! am\nt        
appropriat$ "u subp>agraph 7,a71        
#aej1jjj1jjj is res]v$ = issu+ guidance 
& provid+ te*nical assi/ance to ,/ates  
9-- 7i7 develop+ & implem5t+ ,dual      
,coord9ation & ,integration ,plans "u   
?is subsection2 &  7ii7 complet+ !      
annual reports requir$ "u p>agraph 7#f74
  4  7b7 ,effective date  7#a7 ,9 g5]al 
,except z provid$ 9 p>agraph 7#b71 !    
am5dm5ts made by ?is section %all take  
effect on ! date ( enactm5t ( ?is ,act4 
7#b7 ,delay if ,/ate legislation ne$$ ,9
 ! case ( a ,/ate plan = m$ical         
assi/ance "u title ,,xix ( ! ,social    
,security ,act :i* ! ,secret>y ( ,heal? 
& ,human ,s]vices det]m9es requires     
,/ate legislation 7o!r ?an legislation  
appropriat+ funds7 9 ord] = ! plan to   
meet ! additional requirem5ts impos$ by 

! am5dm5ts made by ! section1 ! ,/ate   
plan %all n be reg>d$ z fail+ to comply 
) ! requirem5ts ( su* title solely on ! 
basis ( its failure to meet ^!          
additional requirem5ts be=e ! fir/ day (
 ! fir/ cal5d> qu>t] beg9n+ aft] ! close
 ( ! fir/ regul> session ( ! ,/ate      
legislature t beg9s aft] ! date ( !     
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 su* session %all be deem$ to be a      
sep>ate regul> session ( ! ,/ate        
legislature4