,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #fgdb  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #ac1         
#bjbc,mr4 ,blum5au] 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 pilot program to provide an   
add-on paym5t to c]ta9 plans (f]+       
b5efits design$ to address ! ne$s (     
dual-eligible individuals relat$ to     
social det]m9ants ( heal?1 & to provide 
adm9i/rative flexibility to improve     
integration = c]ta9 dual-eligible       
individuals4  #a4 ,%ort title ,?is ,act 
may be cit$ z ! ,inc5tiviz+             
,dual-,eligible ,alignm5t ,act or !     
,,ideal ,act4  #b4 ,social det]m9ants ( 
heal? pilot program  7a7 ,9 g5]al ,!    
,secret>y ( ,heal? & ,human ,s]vices 79 
?is section ref]r$ to z ! ,secret>y71   

act+ ?r\gh ! ,director ( ! ,f$]al       
,coord9at$ ,heal? ,c>e ,(fice e/abli%$  
"u section #bfjb ( ,public ,law #aaa-adh
 79 ?is section ref]r$ to z ! ,director7
 %all conduct a pilot program 79 ?is    
section ref]r$ to z ! program7 to       
demon/rate improvem5ts 9 pati5t outcomes
 ?r\gh ! provision ( cov]$ b5efits 7z   
describ$ 9 subsection 7c77 design$ to   
address social det]m9ants ( heal? )     
respect to c]ta9 dual-eligible          
individuals4 ,"u ! program1 ! ,director 
%all provide an add-on paym5t to #d     
cohorts ( safety net heal? plans 7z     
def9$ 9 subsection 7e77 to furni% su*   
b5efits to dual-eligible individuals    
enroll$ 9 su* plans4  7b7 ,program      
requirem5ts  7#a7 ,9 g5]al ,= cal5d> ye>
 #bjbe & ea* ye> !reaft] ?r\gh #bjbh1 ! 
,director %all ent] into #e-ye>         
agreem5ts ) safety net heal? plans "u   
:i* ea* su* safety net heal? plan t     
qualifies = a rebate "u section         
#ahec7;a77#a77;,e7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    

#aciew-#bc7;a77#a77;,e77 = a ye> dur+ ! 
agreem5t p]iod %all receive ! add-on    
paym5t describ$ 9 p>agraph 7#b7 = su*   
ye>1 to provide "o or m cov]$ b5efits to
 dual-eligible individuals enroll$ 9 su*
 plan4  7#b7 ,add-on paym5t  7,a7 ,9    
g5]al ,! am\nt ( ! add-on paym5t = ea*  
ye> = an safety net heal? plan          
p>ticipat+ 9 ! pilot program %all be #e 
p]c5t ( ! am\nt paid "u section         
#ahec7;a77#a77;,e7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#aciew-#bc7;a77#a77;,e774  7,b7         
,supplem5t1 n supplant ,! add-on paym5t 
describ$ 9 p>agraph 7#a7 %all supplem5t1
 & n supplant1 any o!r paym5ts made to  
an safety net heal? plan "u title       
,,xviii or ,,xix ( ! ,social ,security  
,act 7#db ,u4,s4,c4 #acie et seq41 #acif
 et seq474  7c7 ,b5efits ,to address    
social det]m9ants ( heal?  7#a7 ,cov]$  
b5efits ,an safety net heal? plan       
p>ticipat+ 9 ! pilot program may use !  
add-on paym5t provid$ "u ?is section to 
provide "o or m cov]$ b5efits1 includ+--

 7,a7 transportation = ! purpose (      
obta9+ non-m$ical items & s]vices1 su*  
groc]y %opp+ or bank+2  7,b7 pe/        
eradication s]vices1 includ+ traps1 pe/ 
control sprays1 & clean+ supplies2  7,c7
 equipm5t & s]vices1 includ+ in/allation
 & ma9t5ance ( su* equipm5t1 to improve 
indoor air quality1 includ+ tempor>y or 
portable air condition+ units1          
humidifi]s1 dehumidifi]s1 high effici5cy
 p>ticulate air filt]s1 & c>pet clean+2 
7,d7 community or plan-sponsor$ programs
 & ev5ts to address isolation among     
enrollees & improve emotional &         
cognitive function1 includ+ programs1   
ev5ts1 & o!r b5efits su* z non-fitness  
club memb]%ips1 community or social     
clubs1 p>k passes1 & access to companion
 c>e1 m>ital or family c\nsel+1 or      
classes = enrollees ) prim>y c>egiv+    
responsibilities = a *ild2  7,e7        
complem5t>y !rapies provid$ by lic5s$ or
 c]tifi$ practition]s2  7,f7 s]vices to 
assi/ ) decision-mak+ ) respect to heal?
 c>e ne$s2  7,g7 educational s]vices or 

classes1 includ+ f9ancial lit]acy       
classes1 te*nology education1 or        
language classes2  7,h7 g5]al supports =
 liv+1 includ+ h\s+ consultations1 &    
subsidies = r5t or assi/$ liv+          
communities1 or subsidies = utilities   
su* z gas1 electric1 & wat]2 &  7,i7    
b5efits to address specific ne$s (      
*ronically ill individuals1 includ+--   
7i7 food1 produce1 & meals = enrollees )
 a *ronic illness1 deliv]$ to ! home (  
su* individual or 9 a congregate sett+2 
&  7ii7 /ructural home modifications t h
 a reasonable expectation ( improv+ or  
ma9ta9+ ! heal?1 mobility1 or ov]all    
function ( a *ronically ill individual4 
7#b7 ,au?ority to add or modify b5efits 
,! ,director may add to1 or o!rwise     
modify1 ! cov]$ b5efits describ$ 9      
p>agraph 7#a74  7d7 ,evaluation &       
reports  7#a7 ,report+ requirem5t =     
safety net heal? plans ,"u ! agreem5ts  
ent]$ into "u subsection 7a71 ea* safety
 net heal? plan %all submit to !        
,secret>y su* in=mation z requir$ by !  

,secret>y1 at su* "t & 9 su* mann] z    
det]m9$ by ! ,secret>y1 = purposes (    
in=m+ ! evaluation "u p>agraph 7#b74    
7#b7 ,evaluation ,at ! end ( ea* #e-ye> 
agreem5t1 ! ,secret>y %all conduct an   
evaluation ( ! program "u ?is section4  
,su* evaluation %all incorporate        
in=mation submitt$ by ea* safety net    
heal? plan pursuant to p>agraph 7#a74   
7#c7 ,report to ,congress ,n lat] ?an   
,decemb] #ca1 #bjca1 ! ,secret>y %all   
submit to ,congress a report conta9+ !  
evaluations conduct$ "u p>agraph 7#b74  
,su* report %all also include ! foll[+  
in=mation3 7,a7 ,! numb] ( enrollees    
eligible = cov]$ b5efits1 includ+ !     
demographic in=mation &1 to ! ext5t     
possible1 ! heal? *>act]i/ics (         
enrollees utiliz+ su* b5efits4  7,b7 ,! 
numb] ( fully integrat$ dual eligible   
special ne$s plans & highly integrat$   
dual eligible special ne$s plans        
p>ticipat+ 9 ! program4  7,c7 ,a li/ ( !
 cov]$ b5efits provid$ ?r\gh ! program &
 ! co/ to ea* safety net heal? plan to  

provide su* b5efits4  7,d7 ,in=mation ) 
respect to ! utilization ( ! cov]$      
b5efits by enrollees4  7,e7             
,enrollee-report$ satisfaction ) respect
 to ea* cov]$ b5efit provid$ "u !       
program4  7,f7 ,heal? outcomes z measur$
 by prim>y c>e appo9tm5ts1 visits to an 
em]g5cy dep>tm5t1 ! numb] & l5g? (      
hospitalizations1 admissions to a skill$
 nurs+ facility or nurs+ facility1 & o!r
 outcomes z det]m9$ appropriate by !    
,secret>y4  7,g7 ,! co/ to ! ,m$ic>e    
program "u title ,,xviii ( ! ,social    
,security ,act ( provid+ ! add-on paym5t
 describ$ 9 subsection 7b77#b74  7,h7 ,!
 p] memb]1 p] mon? am\nt ( ! add-on     
paym5t receiv$ by ea* safety net heal?  
plan4  7e7 ,def9itions ,9 ?is section3  
7#a7 ,cohort ,! t]m cohort ref]s to !   
safety net heal? plans t beg9 p>ticipat+
 9 ! program 9 ! same cal5d> ye>4  7#b7 
,dual eligible special ne$s plan2 highly
 integrat$ dual eligible special ne$s   
plan2 fully integrat$ dual eligible     
special ne$s plan ,! t]ms dual eligible 

special ne$s plan1 highly integrat$ dual
 eligible special ne$s plan1 & fully    
integrat$ dual eligible special ne$s    
plan h ! mean+ giv5 su* t]ms 9 section  
#dbb4b ( title #db1 ,code ( ,f$]al      
,regulations4  7#c7 ,safety net heal?   
plan ,! t]m safety net heal? plan means 
a specializ$ ma plan = special ne$s     
individuals 7z su* t]m is def9$ 9       
section #ahei7;b77#f7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#aciew-#bh7;b77#f77 t-- 7,a7 is         
incorporat$ z a nonpr(it corporation or 
op]at$ by a public ag5cy1 public entity1
 local gov]nm5t1 or gr\p ( gov]nm5tal   
units "u ,/ate law2  7,b7 no "p ( ! net 
e>n+s ( :i* inures to ! b5efit ( any    
private %>ehold] or individual2  7,c7   
receives m ?an #hj p]c5t ( its annual   
gross rev5ue f gov]nm5t programs t t>get
 l[ income1 eld]ly1 or disabl$          
populations "u title ,,xviii1 ,,xix1 or 
,,xxi ( ! ,social ,security ,act2 &     
7,d7 9 ! case ( a highly integrat$ dual 
eligible special ne$s plan or a fully   

integrat$ dual eligible special ne$s    
plan1 meets ! requirem5ts 9 subclause   
7,,ii7 or 7,,iii7 ( subp>agraph 7,d77i7 
( su* section2 or  7,e7 9 ! case ( a    
dual eligible special ne$s plan-- 7i7   
meets ! requirem5ts "u subp>agraph      
7,d77i77,i7 ( su* section2 or  7ii7 is  
likely1 z det]m9$ by ! ,secret>y1 to    
meet ! requirem5ts "u subclauses 7,,ii7 
& 7,,iii7 ( su* subp>agraph )9 #a ye> ( 
a ,/ate's reque/ = "o or m adm9i/rative 
flexibilities ) respect to su* plan4    
#c4 ,adm9i/rative flexibility to improve
 integration = c]ta9 dual-eligible      
individuals ,section #ahei7;f77#h7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#bh7;f77#h77 is am5d$ by add+ at 
! end ! foll[+ new subp>agraph3  7,f7   
,adm9i/rative flexibility  7i7 ,9 g5]al 
,n lat] ?an #fj days aft] ! date (      
enactm5t ( ?is subp>agraph1 ! ,secret>y1
 act+ ?r\gh ! ,director ( ! ,f$]al      
,coord9at$ ,heal? ,c>e ,(fice1 %all     
comm5ce rulemak+ to e/abli% proc$ures = 
,/ates to reque/ "o or m ( !            

adm9i/rative flexibilities describ$ 9   
clause 7ii7 = applicable plans 7z def9$ 
9 clause 7iv77 to improve integration "u
 ?is title & title ,,xix = dual-eligible
 individuals enroll$ 9 su* plans4 ,9    
e/abli%+ su* proc$ures1 ! ,secret>y %all
 ensure t su* proc$ures d n r$uce su*   
individuals' *oices ) respect to plans  
"u ?is title1 or su* individuals' access
 to c>e4  7ii7 ,adm9i/rative            
flexibilities describ$ ,! adm9i/rative  
flexibilities describ$ 9 ?is clause     
include flexibility ) respect to-- 7,i7 
enrollm5t timel9es & processes "u       
section #ahea7;e77#b7 & clauses 7iii7 & 
7iv7 ( section #ahfj;,d-#a7;b77#a77;,b72
  7,,ii7 approval ( m>ket+ mat]ial "u   
p>agraphs 7#a7 & 7#b7 ( section         
#ahea7;h72  7,,iii7 enrollm5t mat]ials  
"u section #ahgf7;c77#c77;,c72 &  7,,iv7
 o!r adm9i/rative requirem5ts su* z     
application processes "u ?is title &    
det]m9$ appropriate by ! ,f$]al         
,coord9at$ ,heal? ,c>e ,(fice 9         
consultation ) b5efici>y advocacy gr\ps4

  7iii7 ,report ,beg9n+ on ! date t is  
#b ye>s aft] ! date ( enactm5t ( ?is    
subp>agraph1 & annually !reaft]1 !      
,director ( ! ,f$]al ,coord9at$ ,heal?  
,c>e ,(fice %all submit to ! ,congress a
 report on ! flexibilities grant$       
pursuant to ?is subp>agraph1 & make ea* 
su* report publicly available on !      
website ( su* ,(fice4  7iv7 ,def9itions 
,9 ?is subp>agraph3 7,i7 ,applicable    
plan ,! t]m applicable plan means a     
specializ$ ,,ma plan = special ne$s     
individuals 7z describ$ 9 subsection    
7b77#f77;,b77ii77 t-- 7aa7 9 ! case ( a 
highly integrat$ dual eligible special  
ne$s plan or a fully integrat$ dual     
eligible special ne$s plan1 meets !     
requirem5ts 9 subclause 7,,ii7 or       
7,,iii7 ( subp>agraph 7,d77i72 or  7bb7 
9 ! case ( a dual eligible special ne$s 
plan-- 7,,aa7 meets ! requirem5ts "u    
subp>agraph 7,d77i77,i72 or 7,,bb7 is   
likely1 z det]m9$ by ! ,secret>y1 to    
meet ! requirem5ts "u subclauses 7,,ii7 
& 7,,iii7 ( su* subp>agraph )9 #a ye> ( 

a ,/ate's reque/ = "o or m adm9i/rative 
flexibilities ) respect to su* plan4    
7,,ii7 ,dual eligible special ne$s plan2
 highly integrat$ dual eligible special 
ne$s plan2 fully integrat$ dual eligible
 special ne$s plan ,! t]ms dual eligible
 special ne$s plan1 highly integrat$    
dual eligible special ne$s plan1 & fully
 integrat$ dual eligible special ne$s   
plan h ! mean+ giv5 su* t]ms 9 section  
#dbb4b ( title #db1 ,code ( ,f$]al      
,regulations4  4