,,ii  #aah? ,,congress  #a/ ,session    
,s4 #fbf  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,m>* #b1 #bjbc,ms4     
,/ab5[ 7= h]self & ,mrs4 ,capito7       
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to recomm5d t !    
,c5t] = ,m$ic>e & ,m$icaid ,innovation  
te/ ! effect ( a dem5tia c>e managem5t  
model1 & = o!r purposes4  #a4 ,%ort     
title ,?is ,act may be cit$ z !         
,compreh5sive ,c>e = ,alzheim]'s ,act4  
#b4 ,,cmi te/+ ( dem5tia c>e managem5t  
,section #aaae;,a ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acae;a7 is am5d$-- 
7#a7 9 subsection 7b77#b77;,b71 by add+ 
at ! end ! foll[+ new clause3  7xxviii7 
,furni%+ compreh5sive c>e managem5t     
s]vices to eligible individuals )       
,alzheim]'s disease or a relat$ dem5tia 
?r\gh a ,dem5tia ,c>e ,managem5t ,model1
 z describ$ 9 subsection 7h74  2 &  7#b7
 by add+ at ! end ! foll[+ new          
subsection3  7h7 ,dem5tia ,c>e          
,managem5t ,model  7#a7 ,description (  

model & requirem5ts  7,a7 ,9 g5]al ,!   
,dem5tia ,c>e ,managem5t ,model describ$
 9 ?is subsection is a model "u :i*     
paym5ts are made "u title ,,xviii to    
eligible entities t furni% compreh5sive 
c>e managem5t s]vices to eligible       
individuals ) ,alzheim]'s disease or a  
relat$ dem5tia1 9 ord] to te/ !         
effectiv5ess ( compreh5sive c>e         
managem5t s]vices on pati5t heal?1 c>e  
quality1 & c>e exp]i5ce1 z well z on    
unpaid c>egiv]s1 & on r$uc+ sp5d+ "u    
title ,,xviii )\t r$uc+ ! quality ( c>e4
  7,b7 ,volunt>y p>ticipation           
,p>ticipation "u ! ,dem5tia ,c>e        
,managem5t ,model %all be volunt>y )    
respect to bo? eligible individuals &   
eligible entities4  7,c7 ,implem5tation 
( dem5tia c>e managem5t model  7i7 ,9   
g5]al ,! ,secret>y %all-- 7,i7 implem5t 
! ,dem5tia ,c>e ,managem5t ,model z a   
/&-alone model2  7,,ii7 incorporate !   
,dem5tia ,c>e ,managem5t ,model into !  
,prim>y ,c>e ,fir/ ,model2 or  7,,iii7  
incorporate ! ,dem5tia ,c>e ,managem5t  

,model into-- 7aa7 ! ,prim>y ,c>e ,fir/ 
,model2 &  7bb7 ! ,direct ,contract+    
,model4  7ii7 ,additional au?ority ,9   
addition to ! models describ$ 9         
subclauses 7,i7 ?r\gh 7,,iii7 ( clause  
7i71 ! ,secret>y may incorporate !      
,dem5tia ,c>e ,managem5t ,model into o!r
 exi/+ coord9at$ c>e models e/abli%$ "u 
title ,,xviii or "u ?is section1 includ+
 acc\ntable c>e organizations1          
value-bas$ pur*as+ arrangem5ts1 & su*   
o!r coord9at$ c>e models z ! ,secret>y  
det]m9es to be appropriate4  7#b7       
,compreh5sive c>e managem5t s]vices     
def9$ ,9 ?is subsection1 ! t]m          
compreh5sive c>e managem5t s]vices means
 ! foll[+ s]vices furni%$ by an eligible
 entity ) respect to an eligible        
individual3 7,a7 ,cont9u\s monitor+ &   
assessm5t ,an eligible entity %all      
regul>ly assess & cont9u\sly monitor !  
foll[+3 7i7 ,neuropsy*iatric symptoms1  
includ+ behavior1 physical safety1 &    
function ( an eligible individual4  7ii7
 ,comorbidities4  7iii7 ,f9ancial       

res\rces & ne$s4  7iv7 ,c>egiv] supports
 & res\rces1 includ+ c>egiv] education1 
tra9+1 & support4  7v7 ,! well-be+ (    
unpaid c>egiv]s ( ! eligible individual4
  7vi7 ,pot5tial risks & h>ms ( !       
eligible individual's home & environm5t 
& ! ne$ = support = activities ( daily  
liv+4  7,b7 ,ongo+ dem5tia c>e plan ,an 
eligible entity %all develop & implem5t 
an ,alzheim]'s disease or relat$ dem5tia
 c>e plan1 includ+ advance c>e plann+ z 
appropriate1 = an eligible individual4  
,! c>e plan %all include pati5t-c5t]$   
goals = ! eligible individual z well z  
goals = unpaid c>egiv]s ( ! eligible    
individual4 ,su* c>e plan %all be       
cont9u\sly evaluat$ & modifi$ z         
appropriate4  7,c7 ,psy*osocial         
int]v5tions ,an eligible entity may     
implem5t psy*osocial int]v5tions design$
 to prev5t or r$uce ! burd5 ( cognitive1
 functional1 behavioral1 & psy*ological 
*all5ges z well z ! associat$ /ress on  
unpaid c>egiv]s ( ! eligible individual4
  7,d7 ,self-managem5t tools ,an        

eligible entity %all provide            
self-managem5t tools to enhance ! skills
 ( ! unpaid c>egiv] ( ! eligible        
individual to manage ! ,alzheim]'s      
disease or relat$ dem5tia ( ! eligible  
individual & to navigate ! heal? c>e    
sy/em4 ,su* tools %all include tra9+ &  
support = unpaid c>egiv]s 9 manag+ !    
limitations ( eligible individuals1     
includ+ education1 problem solv+        
/rategies1 c>e navigation support1      
support aft] dis*>ge f a hospital or    
nurs+ home1 & decision-mak+ support4    
7,e7 ,m$ication managem5t ,an eligible  
entity %all furni% evid5ce-bas$         
m$ication review & managem5t s]vices to 
an eligible individual1 includ+         
polyph>macy managem5t1 us+ a plann$     
process to r$uce or /op m$ications t may
 no long] be ( b5efit or may be hav+    
adv]se cognitive effects1 prescrib+     
approv$ m$ications1 & enhanc+ adh]5ce to
 appropriate m$ications4  7,f7 ,treatm5t
 ( relat$ conditions ,an eligible entity
 %all provide int]v5tions to prev5t or  

treat conditions relat$ to ! ,alzheim]'s
 disease or relat$ dem5tia ( ! eligible 
individual1 su* z depression & delirium4
  7,g7 ,c>e coord9ation ,an eligible    
entity %all provide ongo+ c>e managem5t 
s]vices & %all coord9ate s]vices &      
supports among provid]s ( s]vices &     
suppli]s1 z well z social & community   
res\rces4 ,su* s]vices %all include     
necess>y assi/ance = ref]rals to social 
& community-bas$ organizations1         
collaboration ) prim>y c>e provid]s & ! 
int]discipl9>y team ( ! eligible        
individual1 & support = c>e transitions 
& cont9uity ( c>e4  7,h7 ,exclusion (   
palliative c>e & hospice c>e            
,compreh5sive c>e managem5t s]vices %all
 n include palliative c>e or hospice    
c>e4  7,i7 ,o!r s]vices ,! ,secret>y may
 require or p]mit o!r s]vices1 z        
appropriate4  7#c7 ,eligible entity     
def9$ ,9 ?is subsection1 ! t]m eligible 
entity means an entity1 su* z a heal?   
sy/em1 hospital1 physician or           
nonphysician gr\p practice1 multiple    

physician practices1 a ,f$]ally qualifi$
 heal? c5t]1 a rural heal? cl9ic1 or an 
acc\ntable c>e organization1 t-- 7,a7 is
 qualifi$ to furni% compreh5sive c>e    
managem5t s]vices to an eligible        
individual1 & any unpaid c>egiv] ( su*  
eligible individual1 "u ! ,dem5tia ,c>e 
,managem5t ,model ei!r directly or ?r\gh
 arrangem5ts ) ,m$ic>e p>ticipat+       
provid]s ( s]vices & suppli]s z well z  
social & community-bas$ organizations2  
7,b7 is acc\ntable = ! quality (        
compreh5sive c>e managem5t s]vices      
furni%$ to an eligible individual "u !  
model2  7,c7 furni%es compreh5sive c>e  
managem5t s]vices ?r\gh an              
int]discipl9>y team t has at lea/ #a    
physician1 physician assi/ant1 nurse    
practition]1 or advanc$ practice nurse  
:o devotes #be p]c5t or m ( pati5t      
contact "t to ! evaluation & c>e (      
pati5ts ) acquir$ cognitive impairm5t2  
7,d7 furni%es compreh5sive c>e managem5t
 s]vices 9 a culturally appropriate     
mann]2  7,e7 utilizes a compreh5sive1   

p]son-c5t]$ c>e managem5t approa*2  7,f7
 furni%es wellness & heal?c>e plann+1   
includ+ m$ication review & managem5t2   
7,g7 supports family & c>egiv]          
engagem5t2  7,h7 provides access to a   
prim>y c>e provid] or a memb] ( !       
int]discipl9>y team #bd h\rs a day #g   
days a week2  7,i7 has relation%ips )   
m$ical & nonm$ical community-bas$       
organizations t support pati5ts )       
,alzheim]'s disease or a relat$ dem5tia 
& _! c>egiv]s2 &  7,j7 meets su* o!r    
requirem5ts z ! ,secret>y may det]m9e to
 be appropriate4  7#d7 ,eligible        
individual def9$ ,9 ?is subsection1 !   
t]m eligible individual means an        
individual-- 7,a7 :o-- 7i7 is entitl$   
to1 or enroll$ =1 b5efits "u "p ,a (    
title ,,xviii & enroll$ "u "p ,b ( su*  
title 7includ+ su* an individual :o is a
 dual eligible individual describ$ 9    
subsection 7a77#d77;,a77iii772 &  7ii7  
is n enroll$ "u "p ,c ( su* title or "u 
a ,,pace program "u section #ahid2  7,b7
 :o has be5 diagnos$ ) a =m ( dem5tia2  

7,c7 :o has n made an election to       
receive hospice c>e2 &  7,d7 :o is n a  
resid5t ( a nurs+ home4  7#e7 ,pati5t   
pa?ways  7,a7 ,initial placem5t  7i7    
,placem5t ( pati5ts into c>e pa?ways ,an
 eligible entity %all assign an eligible
 individual to an appropriate pa?way 7z 
describ$ 9 clauses 7ii71 7iii71 & 7iv77 
bas$ on an assessm5t ( ! cl9ical &      
f9ancial /atus ( ! eligible individual t
 is conduct$ n lat] ?an #fj days aft] ! 
eligible individual is enroll$ 9 !      
model4  7ii7 ,pa?way = uncomplicat$     
dem5tia diagnosis ,dur+ ! prec$+        
#ab-mon? p]iod1 ! eligible individual   
has n m ?an #a unplann$ inpati5t        
hospitalization or visit to a hospital  
em]g5cy dep>tm5t4  7iii7 ,pa?way =      
dem5tia diagnosis ) enhanc$ c>e         
coord9ation ne$s ,dur+ ! prec$+ #ab-mon?
 p]iod1 ! eligible individual-- 7,i7    
7aa7 has #b or m unplann$ inpati5t      
hospitalizations or visits to a hospital
 em]g5cy dep>tm5t2 or  7bb7 has a       
psy*iatric hospitalization2 &  7,,ii7   

has suffici5t f9ancial or c>egiv]       
res\rces 7z det]m9$ by ! ,secret>y74    
7iv7 ,pa?way = dem5tia diagnosis )      
complex c>e ne$s ,dur+ ! prec$+ #ab-mon?
 p]iod1 ! eligible individual-- 7,i7    
7aa7 has #b or m unplann$ inpati5t      
hospitalizations or visits to a hospital
 em]g5cy dep>tm5t2 or  7bb7 has a       
psy*iatric hospitalization2 &  7,,ii7   
has insuffici5t f9ancial or c>egiv]     
res\rces 7z det]m9$ by ! ,secret>y74    
7,b7 ,regul> pati5t assessm5ts =        
appropriate pa?way  7i7 ,9 g5]al ,aft]  
det]m9ation ( ! initial pa?way1 at a    
frequ5cy to be det]m9$ by ! ,secret>y1 b
 n less ?an once p] ye>1 an eligible    
entity %all reassess ! pa?way           
det]m9ation ( ea* eligible individual   
enroll$ "u ! model4  7ii7 ,increas$     
,,adl limitations ,ea* eligible         
individual enroll$ 9 ! pa?way =         
uncomplicat$ dem5tia diagnosis 7z       
describ$ 9 subp>agraph 7,a77ii77 :o has 
_h increas$ limitations 9 p]=m+         
activities ( daily liv+ s9ce ! prior    

assessm5t %all be assign$ to ! pa?way = 
dem5tia diagnosis ) enhanc$ c>e         
coord9ation ne$s 7z describ$ 9          
subp>agraph 7,a77iii77 or ! pa?way =    
dem5tia diagnosis ) complex c>e ne$s 7z 
describ$ 9 subp>agraph 7,a77iv771 dep5d+
 on ! eligible individual's f9ancial &  
c>egiv] res\rces applicable to ea*      
pa?way4  7iii7 ,enhanc$ or complex c>e  
ne$s ,ea* eligible individual enroll$ 9 
! pa?way = dem5tia diagnosis ) enhanc$  
c>e coord9ation ne$s 7z describ$ 9      
subp>agraph 7,a77iii77 or ! pa?way =    
dem5tia diagnosis ) complex c>e ne$s 7z 
describ$ 9 subp>agraph 7,a77iv77 %all be
 assign$ to #a ( ! #b pa?ways bas$ on ! 
eligible individual's f9ancial & c>egiv]
 res\rces applicable to ea* pa?way4     
7#f7 ,quality assessm5t  7,a7 ,9 g5]al  
,! ,secret>y %all specify appropriate   
measures to assess ! quality ( c>e      
furni%$ by an eligible entity "u !      
,dem5tia ,c>e ,managem5t ,model4 ,su*   
measures %all include1 z appropriate1   
measures = cl9ical processes & outcomes1

 pati5t & c>egiv] exp]i5ce ( c>e1 &     
utilization ( s]vices = :i* paym5t is   
made "u ! orig9al m$ic>e fee-=-s]vice   
program "u title ,,xviii1 includ+       
measures =-- 7i7 em]g5cy dep>tm5t       
utilization2  7ii7 inpati5t hospital    
utilization2  7iii7 docum5t$ advanc$ c>e
 plan2  7iv7 m$ication review2  7v7     
scre5+ = future fall risk2  7vi7        
depression scre5+ = c>egiv]s2  7vii7    
c>egiv] /ress assessm5t2 &  7viii7      
c>egiv] assessm5t ( outcomes4  7,b7     
,report+ ,an eligible entity %all submit
 data 9 a =m & mann] det]m9$ by !       
,secret>y on measures specifi$ by !     
,secret>y4  7,c7 ,p]=mance assessm5t ,9 
ord] to assess ! quality ( c>e furni%$  
by an eligible entity "u ! model1 !     
,secret>y %all e/abli%-- 7i7 quality    
p]=mance /&>ds2 &  7ii7 me?odologies =  
quality p]=mance scor+ & relat$ paym5t  
adju/m5ts4  7,d7 ,/akehold] input ,!    
,secret>y %all seek input f eligible    
entities on f9al measure specifications1
 includ+ appropriate adju/m5t = pati5t  

pref]5ces4  7#g7 ,paym5ts  7,a7 ,9 g5]al
 ,"u ! ,dem5tia ,c>e ,managem5t ,model1 
! ,secret>y %all e/abli% paym5t am\nts =
 c>e managem5t s]vices furni%$ to       
eligible individuals1 includ+ initial   
inve/m5t co/s4 ,su* am\nts %all reflect 
/>t-up co/s & initial inve/m5ts incurr$ 
by an eligible entity 9 e/abli%+ !      
,dem5tia ,c>e ,managem5t ,model4  7,b7  
,capitat$ basis ,paym5ts "u ! ,dem5tia  
,c>e ,managem5t ,model %all be made on a
 capitat$ basis1 su* z a p]-memb]1      
p]-mon? paym5t1 or su* o!r simil> paym5t
 me*anisms t ! ,secret>y det]m9es to be 
appropriate4 ,paym5ts %all v>y bas$ on !
 assign$ pa?way ( ea* pati5t z describ$ 
9 p>agraph 7#e74  7,c7 ,quality bonus   
,"u ! ,dem5tia ,c>e ,managem5t ,model1  
additional paym5ts %all be made to any  
eligible entity = quality bonuses bas$  
on ! p]=mance ( ! eligible entity 9     
provid+ quality c>e 7z det]m9$ "u       
p>agraph 7#f774  7,d7 ,z]o co/-%>+ ,an  
eligible individual %all n be liable =  
any co/-%>+1 includ+ d$uctibles1        

co9surance1 or copaym5ts1 = c>e         
managem5t s]vices = dem5tia c>e furni%$ 
to su* eligible individual "u ! model4  
7,e7 ,supplem5tal to paym5ts = cov]$    
s]vices ,paym5ts made "u ! model %all be
 9 addition to any paym5ts = items or   
s]vices n provid$ "u ! model = :i*      
paym5t may be made "u title ,,xviii =   
s]vices furni%$ to su* eligible         
individuals4  7,f7 ,nonduplication      
,paym5ts = c>e managem5t s]vices furni%$
 to eligible individuals "u ! ,dem5tia  
,c>e ,managem5t ,model may n duplicate  
paym5ts = s]vices furni%$ to su*        
eligible individuals = :i* paym5ts are  
made "u ! orig9al m$ic>e fee-=-s]vice   
program "u title ,,xviii4  7#h7 ,waiv]s 
,! ,secret>y %all waive provisions ( ?is
 title1 & title ,,xviii1 to p]mit an    
eligible entity op]at+ a ,dem5tia ,c>e  
,managem5t ,model to provide ! foll[+3  
7,a7 ,b5efici>y rew>ds ,gift c>ds or o!r
 rew>ds = pati5ts :o successfully       
p>ticipate 9 ! program 7z det]m9$ by !  
,secret>y74  7,b7 ,c>egiv]s ,supports = 

c>egiv]s4  7,c7 ,teleheal? ,teleheal?   
s]vices )\t reg>d to geographic or o!r  
orig9at+ site limitations "u section    
#ahcd7m74  7,d7 ,s]vices f community    
organizations ,paym5ts1 co/-%>+ support1
 or bo?1 = nonm$ical s]vices furni%$ by 
community-bas$ organizations1 su* z     
limit$ c>egiv+ s]vices1 respite c>e1    
adult day c>e c\nsel+ s]vices1 & su* o!r
 s]vices z ! ,secret>y det]m9es to be   
appropriate4  7#i7 ,modifications =     
application 9 ! ,prim>y ,c>e ,fir/ &    
,direct ,contract+ ,models  7,a7 ,9     
g5]al ,except z provid$ "u subp>agraph  
7,b71 if ! ,secret>y elects to          
incorporate ! ,dem5tia ,c>e ,managem5t  
,model into ! ,prim>y ,c>e ,fir/ ,model1
 ! ,direct ,contract+ ,model1 or bo?1 z 
provid$ = "u p>agraph 7#a77;,c77i71 !   
,secret>y %all ma9ta9 ! requirem5ts (   
?is subsection4  7,b7 ,p]missible       
modifications ,! ,secret>y may adju/ !  
requirem5ts ( ?is subsection to ! ext5t 
necess>y to ensure consi/5cy ( !        
,dem5tia ,c>e ,managem5t ,model ) !     

,prim>y ,c>e ,fir/ ,model1 ! ,direct    
,contract+ ,model1 or bo?1 ) respect    
to-- 7i7 any eligible entity1 includ+   
b5efici>y alignm5t ?re%olds2  7ii7 any  
eligible individual2  7iii7 capitat$    
paym5ts2 &  7iv7 quality-bonus paym5ts4 
7,c7 ,consultation ) /akehold]s ,prior  
to mak+ any adju/m5t "u subp>agraph     
7,b71 ! ,secret>y %all consult )        
appropriate /akehold]s & pati5t advocacy
 organizations4  7#aj7 ,outrea* to      
und]repres5t$ m9ority populations ,an   
eligible entity %all c>ry out public    
outrea* & education ef=ts1 includ+ !    
dissem9ation ( in=mation1 = memb]s (    
und]repres5t$ m9ority populations reg>d+
 p>ticipation 9 ! ,dem5tia ,c>e         
,managem5t ,model to ensure div]sity 9 !
 pati5t population ( su* model4  7#aa7  
,option to exp& to ,m$icaid ,! ,secret>y
 may design a model "u :i* paym5ts are  
made "u title ,,xix1 9 a simil> mann] to
 ! mann] 9 :i* paym5ts are made "u title
 ,,xviii "u ! ,dem5tia ,c>e ,managem5t  
,model describ$ 9 ?is subsection1 to    

eligible entities t furni% compreh5sive 
c>e managem5t s]vices to individuals :o 
are eligible = m$ical assi/ance "u a    
,/ate plan "u title ,,xix 7or a waiv] ( 
su* a plan7 ) ,alzheim]'s disease or a  
relat$ dem5tia1 9 ord] to te/ !         
effectiv5ess ( compreh5sive c>e         
managem5t s]vices on pati5t heal?1 c>e  
quality1 & c>e exp]i5ce1 z well z on    
unpaid c>egiv]s1 & on r$uc+ sp5d+ "u    
title ,,xix )\t r$uc+ ! quality ( c>e4  
4