[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4212 Introduced in House (IH)]

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114th CONGRESS
  1st Session
                                H. R. 4212

    To establish a Community-Based Institutional Special Needs Plan 
   demonstration program to target home and community-based care to 
        eligible Medicare beneficiaries, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           December 10, 2015

   Ms. Linda T. Sanchez of California (for herself, Mr. Meehan, Mr. 
   Schrader, and Mr. Lance) introduced the following bill; which was 
  referred to the Committee on Ways and Means, and in addition to the 
   Committee on Energy and Commerce, for a period to be subsequently 
   determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
    To establish a Community-Based Institutional Special Needs Plan 
   demonstration program to target home and community-based care to 
        eligible Medicare beneficiaries, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Community-Based Independence for 
Seniors Act of 2015''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Community-based services play an essential role in 
        keeping individuals healthy.
            (2) Without community-based long-term services and 
        supports, which are not typically covered by Medicare, seniors 
        frequently experience negative health outcomes and lose their 
        ability to live independently.
            (3) Seniors who deplete their resources often have no 
        option but to turn to Medicaid for coverage of long-term care 
        expenses.
            (4) Targeting community-based services and supports to at-
        risk seniors can help these individuals avoid depleting their 
        assets and becoming Medicaid dependent.

SEC. 3. COMMUNITY-BASED INSTITUTIONAL SPECIAL NEEDS PLAN DEMONSTRATION.

    Part C of title XVIII of the Social Security Act is amended by 
inserting after section 1859 (42 U.S.C. 1395w-28) the following new 
section:

``SEC. 1859A. COMMUNITY-BASED INSTITUTIONAL SPECIAL NEEDS PLAN 
              DEMONSTRATION.

    ``(a) Establishment.--
            ``(1) In general.--The Secretary shall establish a 
        Community-Based Institutional Special Needs Plan demonstration 
        program (in this section referred to as the `CBI-SNP 
        demonstration program') to provide home and community-based 
        care to eligible Medicare beneficiaries.
            ``(2) Agreements.--The Secretary shall enter into 
        agreements with eligible MA organizations under which such 
        organizations shall offer eligible MA plans under the CBI-SNP 
        demonstration program to eligible Medicare beneficiaries.
            ``(3) Limitation on number of plans.--The CBI-SNP 
        demonstration program shall be carried out with respect to not 
        greater than five MA plans.
            ``(4) Eligible ma plans defined.--For purposes of this 
        section, the term `eligible MA plan' means a plan that, in 
        addition to items and services for which coverage is otherwise 
        provided under this part (including benefits under section 
        1852(a)(3) and notwithstanding any waivers under section 
        1915(c)), provides for coverage of long-term care services and 
        supports that the Secretary determines appropriate for the 
        purposes of the CBI-SNP demonstration program, such as--
                    ``(A) homemaker services;
                    ``(B) home delivered meals;
                    ``(C) transportation services;
                    ``(D) respite care;
                    ``(E) adult day care services; and
                    ``(F) safety and other equipment not otherwise 
                covered under this title.
    ``(b) Eligible MA Organizations.--For purposes of this section, the 
term `eligible MA organization' means an MA organization that--
            ``(1) has experience in offering specialized MA plans for 
        special needs individuals, as defined in section 1859(b)(6)(A), 
        to individuals who live in the community in which the eligible 
        MA plan is offered;
            ``(2) has experience working with low-income seniors 
        groups;
            ``(3) is located in a State that the Secretary has 
        determined is able to participate in the CBI-SNP demonstration 
        program by agreeing to make available data necessary for 
        purposes of conducting the independent evaluation required 
        under subsection (h); and
            ``(4) meets such other criteria as the Secretary may 
        require.
    ``(c) Eligible Medicare Beneficiary Defined.--In this section, the 
term `eligible Medicare beneficiary' means a Medicare beneficiary who--
            ``(1) is eligible to enroll in an eligible MA plan under 
        the CBI-SNP demonstration program;
            ``(2) is a subsidy eligible individual (as defined in 
        section 1860D-14(a)(3)(A));
            ``(3) is not eligible to receive benefits under title XIX;
            ``(4) is unable to perform 2 or more activities of daily 
        living (as defined in section 7702B(c)(2)(B) of the Internal 
        Revenue Code of 1986); and
            ``(5) is age 65 or older.
    ``(d) Payments.--The Secretary shall establish payment rates for 
eligible MA organizations offering eligible MA plans under the CBI-SNP 
demonstration program for benefits covered under such program (and not 
otherwise covered under part C) and provided to eligible Medicare 
beneficiaries under such plans. Such payment rates shall--
            ``(1) be based upon payment rates established for purposes 
        of payment under section 1853;
            ``(2) be in addition to payments otherwise made to such 
        organization with respect to such plans under part C;
            ``(3) be adjusted to reflect the costs of treating eligible 
        Medicare beneficiaries under this section; and
            ``(4) not, with respect to a month in which an eligible MA 
        organization provides home and community-based care to eligible 
        Medicare beneficiaries under such demonstration program, exceed 
        an amount for such month that is equal to the amount that would 
        be awarded to such organization if the organization were to 
        receive $400 with respect to each such beneficiary that the 
        organization provides with such care during such month.
    ``(e) Special Election Period.--Notwithstanding sections 
1852(e)(2)(C) and 1860D-1(b)(1)(B)(iii), an eligible Medicare 
beneficiary may, other than during the annual, coordinated election 
periods under such sections--
            ``(1) discontinue enrollment in an MA plan not 
        participating in the CBI-SNP demonstration program and enroll 
        in an MA plan participating in such program; and
            ``(2) discontinue enrollment under the original medicare 
        fee-for-service program under parts A and B and the enrollment 
        in a prescription drug plan under part D and enroll in an MA 
        plan participating in the CBI-SNP demonstration program.
    ``(f) Beneficiary Education.--The Secretary shall help to educate, 
through State Health Insurance Assistance Programs and other 
organizations that assist seniors with respect to benefits and 
enrollment under this title, eligible Medicare beneficiaries on the 
availability of the CBI-SNP demonstration program.
    ``(g) Implementation.--
            ``(1) Deadline.--The CBI-SNP demonstration program shall be 
        implemented not later than January 1 of the second year 
        beginning after the date of the enactment of this section.
            ``(2) Duration.--Subject to paragraph (3), the CBI-SNP 
        demonstration program shall be conducted for a period of five 
        years.
            ``(3) Extension or expansion.--Taking into account the 
        report under subsection (h)(2), the Secretary may, through 
        rulemaking, expand (including implementation on a nationwide or 
        permanent basis) the duration or the scope CBI-SNP 
        demonstration program to the extent determined appropriate by 
        the Secretary, unless the Secretary determines that such 
        expansion is expected to--
                    ``(A) increase aggregate expenditures under this 
                title and title XIX with respect to eligible Medicare 
                beneficiaries participating in the CBI-SNP 
                demonstration program; or
                    ``(B) decrease the quality of health care services 
                furnished to eligible Medicare beneficiaries 
                participating in the CBI-SNP demonstration program.
    ``(h) Independent Evaluation and Reports.--
            ``(1) Independent evaluation.--
                    ``(A) In general.--The Secretary shall provide for 
                the evaluation of the CBI-SNP demonstration program by 
                an independent third party.
                    ``(B) Evaluation objectives.--Such evaluation shall 
                determine the extent to which the CBI-SNP demonstration 
                program has resulted in--
                            ``(i) improved patient care;
                            ``(ii) reduced hospitalizations or 
                        rehospitalizations;
                            ``(iii) reduced or delayed nursing facility 
                        admissions and lengths of stay under title XIX;
                            ``(iv) reduced spend down of income and 
                        assets for purposes of becoming eligible for 
                        medical assistance under a State plan under 
                        title XIX;
                            ``(v) improved quality of life for the 
                        eligible Medicare beneficiaries enrolled in an 
                        eligible MA plan participating in the CBI-SNP 
                        demonstration program; and
                            ``(vi) improved caregiver satisfaction.
                    ``(C) Evaluation process.--Such evaluation shall be 
                completed in accordance with the following process:
                            ``(i) The Secretary shall, prior to the 
                        implementation of such program, establish goals 
                        for such program with respect to the evaluation 
                        objectives described in subparagraph (B) and 
                        criteria for measuring the extent to which an 
                        eligible MA plan participating in the CBI-SNP 
                        demonstration program meets such goals.
                            ``(ii) The Secretary shall implement clear 
                        data collection and reporting requirements for 
                        such eligible MA plans in order to carry out 
                        such evaluation.
                In carrying out such process, the Secretary shall 
                recognize that definitions, benefits, and program 
                requirements for long-term care services and supports 
                vary across States.
            ``(2) Reports.--Not later than four years after the 
        implementation of the CBI-SNP demonstration program, the 
        Secretary shall submit to Congress a report containing the 
        results of the evaluation conducted under paragraph (1), 
        together with such recommendations for legislative or 
        administrative action as the Secretary determines appropriate. 
        In preparing such report, the Secretary shall use at least 
        three years worth of data under the demonstration program.
    ``(i) Budget Neutrality.--For any year after the third year of the 
CBI-SNP demonstration program, the Secretary shall ensure that the 
aggregate payments made under this title and title XIX, including under 
the demonstration program, do not exceed the amount which the Secretary 
estimates would have been expended under such titles during such year 
if the CBI-SNP demonstration program had not been implemented.
    ``(j) Paperwork Reduction Act.--Chapter 35 of title 44, United 
States Code, shall not apply to the testing and evaluation of the CBI-
SNP demonstration program.''.
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