[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 704 Introduced in Senate (IS)]

114th CONGRESS
  1st Session
                                 S. 704

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 11, 2015

  Mr. Grassley (for himself and Mr. Cardin) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
    To establish a Community-Based Institutional Special Needs Plan 
   demonstration program to target home and community-based care to 
                    eligible 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 ``Community Based Independence for 
Seniors Act''.

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.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as 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 target home and community-based care to eligible Medicare 
beneficiaries.
    (b) Establishment.--
            (1) In general.--The Secretary shall enter into agreements 
        with up to 5 Medicare Advantage plans to conduct the CBI-SNP 
        demonstration program. Each such MA plan may enroll up to 1,000 
        eligible Medicare beneficiaries (including new enrollees) in 
        such program.
            (2) Benefits.--Under the CBI-SNP demonstration program, 
        eligible Medicare beneficiaries shall receive benefits, in 
        addition to those under part C of title XVIII of the Social 
        Security Act (including benefits under section 1852(a)(3) of 
        such Act (42 U.S.C. 1395w22(a)(3))) and notwithstanding any 
        waivers under section 1915(c) (42 U.S.C. 1396n(c)), including 
        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) non-Medicare-covered safety and other 
                equipment.
            (3) Payments.--The Secretary shall establish a benchmark 
        payment amount for reimbursing Medicare Advantage plans 
        participating in the CBI-SNP demonstration program for benefits 
        provided to eligible beneficiaries under such program. Such 
        payments shall be in addition to payments made to such plans 
        under part C of title XVIII of the Social Security Act.
    (c) Eligible Plans.--To be eligible to participate in the CBI-SNP 
demonstration program, a Medicare Advantage plan must--
            (1) have experience in offering special needs plans for 
        nursing home-eligible, non-institutionalized Medicare 
        beneficiaries who live in the community;
            (2) have experience working with low income seniors groups;
            (3) be located in a State that the Secretary has determined 
        will 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) meet such other criteria as the Secretary may require.
    (d) Eligible Medicare Beneficiary Defined.--In this section, the 
term ``eligible Medicare beneficiary'' means a Medicare beneficiary 
who--
            (1) is enrolled or eligible to enroll in a Medicare 
        Advantage plan that has been selected to participate in the 
        CBI-SNP demonstration program;
            (2) is a subsidy eligible individual (as defined in section 
        1860D-14(a)(3)(A) of the Social Security Act (42 U.S.C. 
        1395w114(a)(3)(A)));
            (3) is not eligible to receive benefits under title XIX of 
        the Social Security Act;
            (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.
    (e) Special Election Period.--Notwithstanding sections 
1852(e)(2)(C) and 1860D-1(b)(1)(B)(iii) of the Social Security Act (42 
U.S.C. 1395w-21(e)(2)(C); 1395w-101(b)(1)(B)(iii)), an eligible 
Medicare beneficiary may, other than during the annual, coordinated 
election periods under such sections--
            (1) discontinue enrollment in a Medicare Advantage plan not 
        participating in the CBI-SNP demonstration program and enroll 
        in a Medicare Advantage plan participating in such program; and
            (2) discontinue enrollment under the original medicare fee-
        for-service program under parts A and B of such title and the 
        enrollment in a prescription drug plan under part D of such 
        title and enroll in a Medicare Advantage plan participating in 
        the CBI-SNP demonstration program.
    (f) Beneficiary Education.--The Secretary shall help to educate 
eligible Medicare beneficiaries on the availability of the CBI-SNP 
demonstration program through State Health Insurance Assistance 
Programs and other organizations dedicated to assisting seniors with 
Medicare benefits and enrollment.
    (g) Implementation.--
            (1) Deadline.--The CBI-SNP demonstration program shall be 
        implemented not later than January 1, 2017.
            (2) Duration.--Subject to paragraph (3), the CBI-SNP 
        demonstration program shall be conducted for a period of 5 
        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 expenditures under titles XVIII and 
                XIX of the Social Security Act 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.--The Secretary shall provide 
        for the evaluation of the CBI-SNP demonstration program by an 
        independent third party. Such evaluation shall be completed 
        using evaluation criteria that are clearly articulated prior to 
        the implementation of such program. Such criteria shall include 
        specific goals of such program, hypotheses being tested, clear 
        data collection and reporting requirements, recognizing that 
        definitions, benefits and program requirements for long-term 
        care services and supports vary across States. Such evaluation 
        shall determine whether the CBI-SNP demonstration program has--
                    (A) improved patient care;
                    (B) reduced hospitalizations or rehospitalizations;
                    (C) reduced or delayed Medicaid nursing facility 
                admissions and lengths of stay;
                    (D) reduced spend down of income and assets for 
                purposes of becoming eligible for Medicaid; and
                    (E) improved quality of life for the demonstration 
                population and beneficiary and caregiver satisfaction.
            (2) Reports.--Not later than 4 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 3 
        years worth of data under the demonstration program.
    (i) Budget Neutrality.--By the end of the third year of the CBI-SNP 
demonstration program, the Secretary shall ensure that the aggregate 
payments made under titles XVIII and XIX of the Social Security Act, 
including under the demonstration program, for subsequent periods do 
not exceed the amount which the Secretary estimates would have been 
expended under such titles during such a period 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.
                                 <all>