[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 837 Introduced in House (IH)]

114th CONGRESS
  1st Session
                                H. R. 837

To implement a demonstration project under titles XVIII and XIX of the 
  Social Security Act to examine the costs and benefits of providing 
payments for comprehensive coordinated health care services provided by 
   purpose-built, continuing care retirement communities to Medicare 
                             beneficiaries.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 10, 2015

     Mr. Fitzpatrick (for himself, Mr. Kelly of Pennsylvania, Mr. 
  Cartwright, Mr. Rothfus, Mr. Brendan F. Boyle of Pennsylvania, Mr. 
      Michael F. Doyle of Pennsylvania, Mr. Barton, Mr. Brady of 
  Pennsylvania, Mr. Fattah, Mr. Buchanan, and Ms. Jenkins of Kansas) 
 introduced the following bill; which was referred to the Committee on 
   Energy and Commerce, and in addition to the Committee on Ways and 
 Means, 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 implement a demonstration project under titles XVIII and XIX of the 
  Social Security Act to examine the costs and benefits of providing 
payments for comprehensive coordinated health care services provided by 
   purpose-built, continuing care retirement communities to Medicare 
                             beneficiaries.

    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 ``Medicare Residential Care 
Coordination Act of 2015''.

SEC. 2. MEDICARE AND MEDICAID RESIDENTIAL CARE COORDINATION 
              DEMONSTRATION PROJECT.

    (a) Establishment and Implementation.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary'') shall 
        establish and implement a demonstration project (in this 
        section referred to as the ``demonstration project'') under 
        titles XVIII and XIX of the Social Security Act to evaluate the 
        use of capitated payments made to eligible continuing care 
        retirement communities for residential care coordination 
        programs.
            (2) Timetable for implementation.--In carrying out this 
        section--
                    (A) not later than 1 year after the date of the 
                enactment of this Act the Secretary shall complete the 
                design for the demonstration project and enter into one 
                or more agreements with eligible CCRCs for the 
                implementation of the project with respect to such 
                CCRCs; and
                    (B) not later than 4 years after the date of 
                entering into such agreements, first provide for 
                implementation of the project through such CCRCs.
    (b) Budget Neutrality.--With respect to the period of the 
demonstration project under this section, the aggregate expenditures 
under titles XVIII and XIX of the Social Security Act for such period 
shall not exceed the aggregate expenditures that would have been 
expended under such titles if the demonstration project had not been 
implemented.
    (c) State Election Required.--
            (1) In general.--The Secretary may only implement the 
        demonstration project in a State that elects to participate in 
        the demonstration project.
            (2) Benefits and payments.--A State that elects to 
        participate in the demonstration project shall provide medical 
        assistance through title XIX of the Social Security Act for 
        each eligible CCRC resident who is eligible for medical 
        assistance under the State plan under such title (including 
        such residents who are made eligible under subsection 
        (d)(3)(B)(iii)) and who is enrolled in a residential care 
        coordination program in a manner that is consistent with the 
        requirements of this section, including making the payments 
        under subsection (e).
            (3) Limitation.--A State may establish a numerical limit 
        on--
                    (A) the number of eligible CCRC residents who may 
                be enrolled in residential care coordination programs 
                in the State; and
                    (B) the number of eligible CCRCs that may operate 
                residential care coordination programs in the State.
    (d) Residential Care Coordination Program (RCCP); Eligible 
Continuing Care Retirement Community (CCRC); Eligible CCRC Residents; 
Comprehensive Coordinated Health Care Services Defined.--
            (1) Residential care coordination program; rccp.--For 
        purposes of this section, the terms ``residential care 
        coordination program'' and ``RCCP'' mean a program that--
                    (A) is operated within one or more eligible 
                continuing care retirement communities (as defined in 
                paragraph (2));
                    (B) is designed with a capacity of serving at least 
                1,000, but not more than 1,500, eligible CCRC residents 
                (as defined in paragraph (3)) at any one time; and
                    (C) provides comprehensive coordinated health care 
                services (as defined in paragraph (4)) to participating 
                CCRC residents enrolled in the program in accordance 
                with the program agreement under subsection (f) and the 
                requirements of this section.
            (2) Eligible continuing care retirement community; eligible 
        ccrc.--In this section, the terms ``eligible continuing care 
        retirement community'' and ``eligible CCRC'' mean an entity 
        that is a continuing care retirement community (as defined in 
        section 1852(l)(4)(B) of the Social Security Act (42 U.S.C. 
        1395w-22(l)(4)(B))) that--
                    (A) is built for the purposes of participating in 
                the demonstration project;
                    (B) provides onsite--
                            (i) housing accommodations for eligible 
                        CCRC residents, including apartments for 
                        independent living; and
                            (ii) additional services to facilitate 
                        aging in place for such residents, including 
                        assisted living and skilled nursing facilities 
                        or alternatives; and
                    (C) has entered into a program agreement with the 
                Secretary and the State with respect to its operation 
                of the residential care coordination program and such 
                agreement is consistent with the requirements of this 
                section.
            (3) Eligible ccrc resident; participating ccrc resident.--
                    (A) In general.--For purposes of this section:
                            (i) Eligible ccrc resident.--The term 
                        ``eligible CCRC resident'' means an individual 
                        who--
                                    (I) is entitled to, or enrolled 
                                for, benefits under part A of title 
                                XVIII of the Social Security Act, and 
                                enrolled for benefits under part B of 
                                such title; and
                                    (II) resides in an eligible CCRC.
                            (ii) Participating ccrc resident.--The term 
                        ``participating CCRC resident'' means, with 
                        respect to a resident care coordination 
                        program, an eligible CCRC resident who is 
                        enrolled in that program.
                    (B) Participation by dual-eligible individuals; 
                expanded eligibility.--
                            (i) In general.--An eligible CCRC resident 
                        may be, but is not required to be, a dual-
                        eligible individual.
                            (ii) Dual-eligible individual defined.--In 
                        this section, the term ``dual-eligible 
                        individual'' means any individual who is--
                                    (I) a full-benefit dual eligible 
                                individual (as defined in section 
                                1935(c)(6) of the Social Security Act); 
                                or
                                    (II) is described in clause (iii).
                            (iii) Qualification of participating ccrc 
                        residents for medicaid benefits.--An individual 
                        who is a participating CCRC resident, 
                        regardless of the level of care, who meets 
                        income and resource eligibility criteria 
                        established under the State Medicaid plan for 
                        an individual to obtain coverage for nursing 
                        facility services on the basis of the 
                        individual's requirement for the level of care 
                        for such services, shall be treated as a dual-
                        eligible individual under this section and 
                        under title XIX of the Social Security Act so 
                        long as the individual remains a participating 
                        CCRC resident.
                    (C) Enrollment and disenrollment rules.--
                            (i) Deemed enrollment at time of initial 
                        residency.--An individual who is described in 
                        subclause (I) of subparagraph (A)(i) is deemed, 
                        at the time of becoming a resident in an 
                        eligible CCRC, to have voluntarily consented to 
                        enroll in the RCCP operated by that CCRC for 
                        purposes of subparagraph (A)(ii).
                            (ii) Disenrollment process.--The 
                        demonstration project shall provide a method 
                        for the disenrollment from the project of 
                        participating CCRC residents, which method 
                        shall take into account the unique 
                        circumstances of residents who are required to 
                        leave the CCRC and shall permit disenrollment 
                        at least in the same circumstances as would 
                        permit an individual to disenroll from a 
                        Medicare Advantage plan under part C of title 
                        XVIII of the Social Security Act for cause.
                    (D) Relation to medicare advantage and prescription 
                drug program.--
                            (i) Supercedes enrollment.--A participating 
                        CCRC resident is not eligible to enroll in an 
                        MA plan under part C of title XVIII of the 
                        Social Security Act or under a prescription 
                        drug plan under part D of such title.
                            (ii) Coordination in case of 
                        disenrollment.--In the case of a participating 
                        CCRC resident who disenrolls from the 
                        demonstration project, the disenrollment shall 
                        be treated, for purposes of parts C and D of 
                        such title, as if the individual had been 
                        previously enrolled in, and disenrolled from, 
                        an MA-PD plan under part C of such title.
                    (E) Premium payments.--During the period in which 
                an individual is a participating CCRC resident--
                            (i) for purposes of payment of premiums 
                        under parts B, C, and D of title XVIII of the 
                        Social Security Act, the individual shall be 
                        treated as if the individual were enrolled 
                        under an MA-PD plan with a premium equal to an 
                        amount specified in the program agreement; and
                            (ii) the individual shall be eligible for 
                        assistance with respect to such premiums under 
                        part D and Medicare cost-sharing in the same 
                        manner and in the equivalent amounts as if the 
                        individual had not been enrolled as a 
                        participating CCRC resident.
            (4) Comprehensive coordinated health care services 
        defined.--For purposes of this section, the term 
        ``comprehensive coordinated health care services'', with 
        respect to an eligible CCRC resident--
                    (A) means all items and services that are otherwise 
                payable under title XVIII of the Social Security Act, 
                including the minimum prescription drug coverage 
                required under a prescription drug plan under part D of 
                such title;
                    (B) includes in the case of a dual eligible 
                individual all items and services that are otherwise 
                payable under the State plan under title XIX of such 
                Act of the State in which the resident resides; and
                    (C) also includes--
                            (i) care management services that 
                        coordinate acute and specialty services 
                        (including inpatient hospital services, 
                        services provided by specialty physicians, and 
                        other necessary services) provided to eligible 
                        CCRC residents;
                            (ii) wellness services, including 
                        assistance and instruction in healthy living 
                        (including diet and exercise); and
                            (iii) other health care items and services 
                        to manage chronic conditions, treat subacute 
                        conditions, and provide preventive care.
    (e) Payment Under Medicare and Medicaid.--
            (1) In general.--In the case of an individual who is a 
        participating CCRC resident who is enrolled in a residential 
        care coordination program operated by an eligible CCRC--
                    (A) the individual shall receive benefits under 
                title XVIII of the Social Security Act, and, if such 
                individual is a dual-eligible individual (as defined in 
                subsection (d)(3)(B)(ii)), under the State Medicaid 
                plan or waiver under title XIX of such Act, solely 
                through the residential care coordination program, 
                which shall provide such individual with comprehensive 
                coordinated health care services; and
                    (B) the eligible CCRC shall receive capitated 
                payments for the provision of such services (from the 
                Secretary for benefits under title XVIII and from the 
                State for benefits under such State plan or waiver), in 
                accordance with this section.
            (2) Payment methodology.--
                    (A) Payment under medicare.--
                            (i) Payment on monthly basis.--With respect 
                        to each eligible CCRC, the Secretary shall make 
                        prospective monthly payments of a capitated 
                        amount, based on the rate established under 
                        clause (ii), for each participating CCRC 
                        resident enrolled in the residential care 
                        coordination program operated by such CCRC in 
                        the same manner and from the same sources as 
                        payments are made to a Medicare Advantage 
                        organization under section 1853 of the Social 
                        Security Act (42 U.S.C. 1395w-23). Such 
                        payments shall be subject to adjustment in the 
                        manner described in paragraphs (2) and (3) of 
                        subsection (a) of such section 1853.
                            (ii) Establishment of payment rate.--
                                    (I) In general.--The Secretary 
                                shall establish a risk-adjusted 
                                capitated payment rate under title 
                                XVIII of the Social Security Act for 
                                comprehensive coordinated health care 
                                services provided to eligible CCRC 
                                residents through a residential care 
                                coordination program operated by an 
                                eligible CCRC. The payment rate shall 
                                be 90 percent of the adjusted average 
                                per capita cost described in section 
                                1853(c)(1)(D)(i) of such Act (42 U.S.C. 
                                1395w-23(c)(1)(D)(i)), plus an amount 
                                equivalent to 90 percent of the amount 
                                that would have been paid to a 
                                prescription drug plan the standardized 
                                bid amount of which (as defined in 
                                section 1860D-13(a)(5) of such Act (42 
                                U.S.C. 1395w-113(a)(5))) was equal to 
                                the adjusted national average monthly 
                                bid amount (as defined in section 
                                1860D-13(a)(1)(B)(iii) of such Act (42 
                                U.S.C. 1395w-113(a)(1)(B)(iii))) and 
                                taking into account low-income 
                                subsidies paid under section 1860D-14 
                                (42 U.S.C. 1395w-114).
                                    (II) Program agreement.--The 
                                mechanism for establishing the 
                                capitated amount under this 
                                subparagraph for a specific eligible 
                                CCRC shall be specified in the program 
                                agreement.
                    (B) Payment under medicaid.--
                            (i) Payment on a monthly basis.--With 
                        respect to an eligible CCRC operating an RCCP, 
                        the State shall make prospective monthly 
                        payments of the capitated amount determined 
                        under and specified in the program agreement 
                        for each eligible CCRC resident of such 
                        community who is a dual-eligible individual.
                            (ii) Relationship to medicare payments.--
                        The payment made under this subparagraph shall 
                        be in addition to any payment made under 
                        subparagraph (A) to an eligible CCRC for 
                        eligible CCRC residents who are dual-eligible 
                        individuals.
                            (iii) Program agreement.--The capitated 
                        amount under this subparagraph for a specific 
                        eligible CCRC shall be specified in the program 
                        agreement.
                            (iv) Payments to the state.--The Secretary 
                        shall treat the payments made under clause (i) 
                        as medical assistance under title XIX of the 
                        Social Security Act for purposes of making 
                        payments to the State under section 1903 of 
                        such Act (42 U.S.C. 1396b).
                            (v) Payments to reflect spend down amounts 
                        and personal needs allowances.--The payments 
                        under this subparagraph shall be made in a 
                        manner that takes into account the financial 
                        contributions required of dual-eligible 
                        individuals and the personal needs allowance 
                        established under the State plan. Such personal 
                        needs allowances may vary depending upon the 
                        level of care required by such an individual.
            (3) Treatment of services furnished by noncontract 
        physicians and other entities.--
                    (A) Application of medicare advantage 
                requirements.--Section 1852(k)(1) of the Social 
                Security Act (42 U.S.C. 1395w-22(k)(1)) (relating to 
                limitations on balance billing against Medicare 
                Advantage organizations for noncontract physicians and 
                other entities with respect to services covered under 
                title XVIII of such Act) shall apply to eligible CCRCs, 
                eligible CCRC residents enrolled in a residential care 
                coordination program, and physicians and other entities 
                that do not have a contract or other agreement 
                establishing payment amounts for services furnished to 
                such a resident in the same manner as such section 
                applies to Medicare Advantage organizations, 
                individuals enrolled with such organizations, and 
                physicians and other entities referred to in such 
                section.
                    (B) Application of balanced billing limitations.--
                Section 1866(a)(1)(O) of the Social Security Act (42 
                U.S.C. 1395cc(a)(1)(O)) shall apply to services that 
                are covered under title XVIII of the Social Security 
                Act and are furnished to any eligible CCRC residents 
                enrolled in a residential care coordination program in 
                the same manner that such section applies to services 
                furnished to an individual enrolled with a PACE 
                provider under section 1894 or 1934 of such Act (42 
                U.S.C. 1395eee).
    (f) Program Agreement.--
            (1) Requirement.--The Secretary, in close cooperation with 
        the single State agency that administers or supervises the 
        administration of the State plan under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.) (in this section referred 
        to as the ``State Medicaid agency''), shall establish 
        procedures for entering into, extending, and terminating 
        program agreements (each in this section referred to as a 
        ``program agreement'') for the operation of residential care 
        coordination programs by eligible CCRCs.
            (2) Agreement required for payment.--In order to receive 
        payment under subsection (e), each eligible CCRC operating a 
        residential care coordination program shall enter into a 
        program agreement with the Secretary and the State, which shall 
        contain such terms and conditions as the parties may agree to, 
        so long as such terms and conditions are consistent with this 
        section.
            (3) Duration.--
                    (A) In general.--A program agreement under this 
                section shall be effective for a contract year, 
                beginning consistent with subsection (a)(2)(B) not 
                later than the fourth calendar year to begin after the 
                establishment of the demonstration project, and shall 
                be extended for additional contract years in the 
                absence of notice by a party to terminate.
                    (B) Termination.--
                            (i) End of demonstration project.--The 
                        Secretary and the State Medicaid agency shall 
                        terminate the program agreement at the 
                        termination of the demonstration project under 
                        subsection (i).
                            (ii) Notice of provider termination.--The 
                        eligible CCRC may terminate the agreement after 
                        appropriate notice to the Secretary, the State 
                        Medicaid agency, and eligible CCRC residents.
                            (iii) Termination for cause.--The Secretary 
                        and the State Medicaid agency may terminate the 
                        program agreement at any time for cause (as 
                        provided under the agreement). Reasons for 
                        terminating an agreement under this clause 
                        include that the Secretary or State 
                        administering agency determines that--
                                    (I) there are significant 
                                deficiencies in the quality of care 
                                provided to eligible CCRC residents 
                                enrolled in the program or the eligible 
                                CCRC has failed to comply substantially 
                                with the requirements of this section; 
                                and
                                    (II) the entity has failed to 
                                develop and successfully initiate, 
                                within 30 days of the date of the 
                                receipt of written notice of such a 
                                determination, a plan to correct the 
                                deficiencies, or has failed to continue 
                                implementation of such a plan.
                            (iv) Right to remain.--Nothing in this 
                        paragraph shall be construed, in the case that 
                        a program agreement is terminated--
                                    (I) for a previously participating 
                                CCRC resident continuing, as affecting 
                                the individual's right to continue to 
                                reside in the CCRC and to receive 
                                traditional CCRC care and services in 
                                accordance with the contract between 
                                the CCRC resident and the CCRC; and
                                    (II) as relieving the State from 
                                continuing to provide medical 
                                assistance with respect to such 
                                services for individuals who would 
                                qualify as dual-eligible individuals if 
                                the agreement had not been terminated.
            (4) Scope of benefits.--
                    (A) In general.--Under the agreement under 
                paragraph (2), the eligible CCRC shall--
                            (i) provide to participating CCRC residents 
                        of such community, regardless of source of 
                        payment, directly or under contracts with other 
                        entities, at a minimum, all comprehensive 
                        coordinated health care services, without 
                        regard to any limitation or condition as to 
                        amount, duration, or scope under title XVIII or 
                        title XIX of the Social Security Act;
                            (ii) provide such residents with access to 
                        necessary covered items and services 24 hours a 
                        day, every day of the year;
                            (iii) provide services to such residents 
                        onsite at the eligible CCRC through a 
                        multidisciplinary team that is led by a primary 
                        care physician and includes care coordinators, 
                        case managers, and nurses;
                            (iv) has a ratio of accessible physicians 
                        to eligible CCRC residents that the Secretary 
                        determines is adequate; and
                            (v) specify the covered items and services 
                        that will not be provided directly by the 
                        eligible CCRC and--
                                    (I) provide for delivery of those 
                                items and services through contracts to 
                                ensure compliance with the requirements 
                                of this section; and
                                    (II) provides, on an as needed 
                                basis for those residents who cannot 
                                transport themselves, for necessary 
                                transportation services to the 
                                providers of such items and services, 
                                if such items and services are provided 
                                outside of the eligible CCRC.
                    (B) Application of regular cost-sharing rules.--
                Under such agreement the eligible CCRC may apply 
                deductibles, copayments, coinsurance, or other cost 
                sharing that would otherwise apply under titles XVIII 
                and XIX of the Social Security Act in the case of an 
                MA-PD plan under part C of title XVIII of such Act.
            (5) Quality control.--
                    (A) In general.--Under the program agreement, the 
                eligible CCRC shall--
                            (i) collect data;
                            (ii) maintain, and afford the Secretary and 
                        the State Medicaid agency access to, the 
                        records relating to the program, including 
                        pertinent financial, medical, and personnel 
                        records; and
                            (iii) submit to the Secretary and the State 
                        Medicaid agency such reports as the Secretary 
                        finds (in consultation with State Medicaid 
                        agencies) necessary to monitor the operation, 
                        cost, and effectiveness of the demonstration 
                        project, including data relevant to the 
                        measurements established by the Secretary under 
                        subparagraph (B), to permit the Secretary and 
                        the State to evaluate such demonstration 
                        project.
                    (B) Quality and outcome measures.--The Secretary 
                shall establish clinical and other outcome measurements 
                to assess the efficacy of the demonstration project 
                in--
                            (i) improving--
                                    (I) the health status and outcomes 
                                of participating CCRC residents 
                                enrolled in residential care 
                                coordination programs under this 
                                demonstration project, compared to 
                                Medicare beneficiaries (including 
                                traditional dual-eligible individuals 
                                described in subsection 
                                (d)(3)(B)(ii)(I)) who are not enrolled 
                                in such programs; and
                                    (II) the quality of health care 
                                provided to such participating CCRC 
                                residents; and
                            (ii) controlling the overall cost of 
                        providing health care items and services to 
                        such participating CCRC residents, compared to 
                        the cost of providing such items and services 
                        to other Medicare beneficiaries.
            (6) Patient safeguards.--The agreement under paragraph (2) 
        shall provide for written safeguards of the rights of 
        participating CCRC residents enrolled in a residential care 
        coordination program (including a patient bill of rights and 
        procedures for grievances and appeals). Such safeguards shall 
        be similar to the safeguards required under the section 
        1894(b)(2)(B) of the Social Security Act (42 U.S.C. 
        1395eee(b)(2)(B)) with respect to the PACE program.
            (7) Transition.--If a participating CCRC resident who is 
        enrolled in a residential care coordination program is 
        disenrolled from such program, the eligible CCRC shall provide 
        assistance to the individual in obtaining necessary care 
        through appropriate referrals and making the individual's 
        medical records available to new providers.
            (8) Rule of construction.--Nothing is this subsection shall 
        be construed as preventing the eligible CCRC from assessing 
        typical and appropriate fees to eligible CCRC residents.
    (g) Secretary's Oversight; Enforcement Authority.--
            (1) Oversight.--
                    (A) In general.--During the duration of the 
                demonstration project, with respect to an eligible CCRC 
                operating a residential care coordination program under 
                a program agreement under subsection (f), the Secretary 
                (acting in cooperation with the State Medicaid agency) 
                shall conduct a comprehensive annual review of the 
                operation of the eligible CCRC in order to ensure 
                compliance with the requirements of this section. Such 
                review shall include--
                            (i) an onsite visit to the eligible CCRC;
                            (ii) a comprehensive assessment of the 
                        community's fiscal soundness;
                            (iii) a comprehensive assessment of the 
                        eligible CCRC's capacity to provide all 
                        comprehensive coordinated health care services 
                        to participating CCRC residents;
                            (iv) detailed analysis of the community's 
                        substantial compliance with the requirements of 
                        this section; and
                            (v) any other elements that the Secretary 
                        or the State Medicaid agency considers 
                        necessary or appropriate.
                    (B) Disclosure.--The results of reviews under this 
                paragraph shall be reported promptly to the eligible 
                CCRC, along with any recommendations for changes to the 
                community's program, and shall be made available to the 
                public through a public Web site of the Department of 
                Health and Human Services.
            (2) Sanctions.--
                    (A) In general.--If the Secretary determines (after 
                consultation with the State Medicaid agency) that an 
                eligible CCRC operating a residential care coordination 
                program under a program agreement under subsection (f) 
                is failing substantially to comply with the 
                requirements of this section, the Secretary (and the 
                State Medicaid agency) may take any or all of the 
                following actions:
                            (i) Condition the continuation of the 
                        program agreement upon timely execution of a 
                        corrective action plan.
                            (ii) Withhold some or all further payments 
                        under the program agreement under this section 
                        with respect to services furnished by such 
                        community until the deficiencies have been 
                        corrected.
                            (iii) Terminate such agreement under 
                        subsection (f)(3)(B).
                    (B) Application of intermediate sanctions.--The 
                Secretary may, by regulation, provide for the 
                application against an eligible CCRC operating a 
                residential care coordination program under a program 
                agreement under this section of remedies described in 
                section 1857(g)(2) of the Social Security Act (42 
                U.S.C. 1395w-27(g)(2)) or section 1903(m)(5)(B) of such 
                Act (42 U.S.C. 1396b(m)(5)(B)) in the case of 
                violations by the community of the type described in 
                section 1857(g)(1) or 1903(m)(5)(A) of such Act, 
                respectively (in relation to agreements, enrollees, and 
                requirements under this section).
                    (C) Procedures for termination or imposition of 
                sanctions.--The provisions of section 1857(h) of the 
                Social Security Act (42 U.S.C. 1395w-27(h)) shall 
                apply, by regulation, to termination and sanctions 
                respecting a program agreement and an eligible CCRC 
                operating a residential care coordination program under 
                a program agreement under this subsection in the same 
                manner as they apply to a termination and sanctions 
                with respect to a contract and a Medicare Advantage 
                organization under part C of title XVIII of such Act.
    (h) Waiver.--Notwithstanding section 1115(a) of the Social Security 
Act (42 U.S.C. 1315(a)), the Secretary may waive such provisions of 
titles XI, XVIII, and XIX of that Act as may be necessary to--
            (1) accomplish the goals of the demonstration project under 
        this section; and
            (2) maximize the quality of life of eligible CCRC 
        beneficiaries, as determined using the measures established 
        under subsection (f)(5)(B).
    (i) Duration of 10 Years.--
            (1) In general.--Subject to paragraph (2) and subsection 
        (f)(3)(B), the demonstration project shall terminate 10 years 
        after the date on which the demonstration project is first 
        implemented under subsection (a)(2)(B).
            (2) Extension.--The Secretary, acting through the Center 
        for Medicare and Medicaid Innovation, may extend the use of 
        capitated payments for eligible CCRCs for residential care 
        coordination programs under this section if, by the termination 
        date that would otherwise apply under paragraph (1), the 
        Secretary has demonstrated that the demonstration project has 
        improved the coordination, quality, and efficiency of health 
        care services furnished to Medicare beneficiaries.
    (j) Study and Report to Congress.--
            (1) Interim evaluation and report.--Not later than 3 years 
        after the date on which the demonstration project is first 
        implemented under subsection (a)(2)(B), the Secretary shall 
        submit to Congress a report that contains the following:
                    (A) An interim evaluation of the costs and benefits 
                of providing comprehensive coordinated health care 
                services to Medicare beneficiaries (including dual-
                eligible individuals) through residential care 
                coordination programs, including the costs and benefits 
                of using payments under title XIX of the Social 
                Security Act to provide continuity of care by 
                permitting certain individuals to continue to 
                participate in such programs after qualifying for 
                enrollment in the Medicaid program under this section 
                due to reduced income and assets.
                    (B) An analysis of the appropriateness of 
                implementing a new payment methodology under titles 
                XVIII and XIX of the Social Security Act for such 
                services in the future.
            (2) Final evaluation and report.--Not later than 10 years 
        after the date on which the demonstration project is first so 
        implemented, the Secretary shall submit to Congress a report 
        that contains a final evaluation of the impact of the 
        demonstration project.
                                 <all>