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

                                                       Calendar No. 182
114th CONGRESS
  1st Session
                                 S. 704

                          [Report No. 114-103]

    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, Mr. Cardin, Mr. Schumer, Mr. Franken, Mr. 
 Heller, and Mrs. Gillibrand) introduced the following bill; which was 
          read twice and referred to the Committee on Finance

                             July 30, 2015

                Reported by Mr. Hatch, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 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,

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Community Based 
Independence for Seniors Act''.</DELETED>

<DELETED>SEC. 2. FINDINGS.</DELETED>

<DELETED>    Congress makes the following findings:</DELETED>
        <DELETED>    (1) Community-based services play an essential 
        role in keeping individuals healthy.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (3) Seniors who deplete their resources often have 
        no option but to turn to Medicaid for coverage of long-term 
        care expenses.</DELETED>
        <DELETED>    (4) Targeting community-based services and 
        supports to at-risk seniors can help these individuals avoid 
        depleting their assets and becoming Medicaid 
        dependent.</DELETED>

<DELETED>SEC. 3. COMMUNITY-BASED INSTITUTIONAL SPECIAL NEEDS PLAN 
              DEMONSTRATION.</DELETED>

<DELETED>    (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.</DELETED>
<DELETED>    (b) Establishment.--</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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--</DELETED>
                <DELETED>    (A) homemaker services;</DELETED>
                <DELETED>    (B) home delivered meals;</DELETED>
                <DELETED>    (C) transportation services;</DELETED>
                <DELETED>    (D) respite care;</DELETED>
                <DELETED>    (E) adult day care services; and</DELETED>
                <DELETED>    (F) non-Medicare-covered safety and other 
                equipment.</DELETED>
        <DELETED>    (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.</DELETED>
<DELETED>    (c) Eligible Plans.--To be eligible to participate in the 
CBI-SNP demonstration program, a Medicare Advantage plan must--
</DELETED>
        <DELETED>    (1) have experience in offering special needs 
        plans for nursing home-eligible, non-institutionalized Medicare 
        beneficiaries who live in the community;</DELETED>
        <DELETED>    (2) have experience working with low income 
        seniors groups;</DELETED>
        <DELETED>    (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</DELETED>
        <DELETED>    (4) meet such other criteria as the Secretary may 
        require.</DELETED>
<DELETED>    (d) Eligible Medicare Beneficiary Defined.--In this 
section, the term ``eligible Medicare beneficiary'' means a Medicare 
beneficiary who--</DELETED>
        <DELETED>    (1) is enrolled or eligible to enroll in a 
        Medicare Advantage plan that has been selected to participate 
        in the CBI-SNP demonstration program;</DELETED>
        <DELETED>    (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)));</DELETED>
        <DELETED>    (3) is not eligible to receive benefits under 
        title XIX of the Social Security Act;</DELETED>
        <DELETED>    (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</DELETED>
        <DELETED>    (5) is age 65 or older.</DELETED>
<DELETED>    (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--</DELETED>
        <DELETED>    (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</DELETED>
        <DELETED>    (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.</DELETED>
<DELETED>    (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.</DELETED>
<DELETED>    (g) Implementation.--</DELETED>
        <DELETED>    (1) Deadline.--The CBI-SNP demonstration program 
        shall be implemented not later than January 1, 2017.</DELETED>
        <DELETED>    (2) Duration.--Subject to paragraph (3), the CBI-
        SNP demonstration program shall be conducted for a period of 5 
        years.</DELETED>
        <DELETED>    (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--</DELETED>
                <DELETED>    (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</DELETED>
                <DELETED>    (B) decrease the quality of health care 
                services furnished to eligible Medicare beneficiaries 
                participating in the CBI-SNP demonstration 
                program.</DELETED>
<DELETED>    (h) Independent Evaluation and Reports.--</DELETED>
        <DELETED>    (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--</DELETED>
                <DELETED>    (A) improved patient care;</DELETED>
                <DELETED>    (B) reduced hospitalizations or 
                rehospitalizations;</DELETED>
                <DELETED>    (C) reduced or delayed Medicaid nursing 
                facility admissions and lengths of stay;</DELETED>
                <DELETED>    (D) reduced spend down of income and 
                assets for purposes of becoming eligible for Medicaid; 
                and</DELETED>
                <DELETED>    (E) improved quality of life for the 
                demonstration population and beneficiary and caregiver 
                satisfaction.</DELETED>
        <DELETED>    (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.</DELETED>
<DELETED>    (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.</DELETED>
<DELETED>    (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.</DELETED>

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 
(referred to in this section 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 prevent and delay institutionalization under the Medicaid program 
among eligible low-income Medicare beneficiaries.
    (b) Establishment.--
            (1) In general.--The Secretary shall enter into agreements 
        with not more than 5 eligible MA plans to conduct the CBI-SNP 
        demonstration program. Each such eligible MA plan may enroll up 
        to 1,000 eligible low-income Medicare beneficiaries (including 
        new enrollees) in such program.
            (2) Use of part c rebate to furnish certain benefits.--
        Under the CBI-SNP demonstration program, an eligible MA plan 
        selected to participate in such program shall use the rebate 
        that the plan is required (under section 1854 of the Social 
        Security Act (42 U.S.C. 13954-24)) to provide to eligible low-
        income Medicare beneficiaries enrolled in the plan in order to 
        furnish, as supplemental benefits under section 1852(a)(3) of 
        such Act (42 U.S.C. 1395w-22(a)(3)) and notwithstanding any 
        waivers under section 1915(c) of such Act (42 U.S.C. 1396n(c)), 
        benefits to such beneficiaries, 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.
    (c) Eligible MA Plan.--In this section, the term ``eligible MA 
plan'' means a specialized MA plan for special needs individuals (as 
defined in section 1859(b)(6) of the Social Security Act (42 U.S.C. 
1395w-28(b)(6)) that--
            (1) has experience in offering special needs plans for 
        nursing home-eligible, non-institutionalized Medicare 
        beneficiaries who live in the community;
            (2) has experience working with low income beneficiaries, 
        including low income beneficiaries dually eligible for benefits 
        under titles XVIII and XIX of such Act;
            (3) has a service area in a State that has agreed to make 
        available to the Secretary Medicaid data necessary for purposes 
        of conducting the independent evaluation required under 
        subsection (j); and
            (4) meets such other criteria as the Secretary may require.
    (d) Eligible Low-income Medicare Beneficiary Defined.--In this 
section, the term ``eligible low-income Medicare beneficiary'' means an 
individual who is--
            (1) a Medicare Advantage eligible individual (as defined in 
        section 1851(a)(3) of the Social Security Act (42 U.S.C. 1395w-
        21(a)(3));
            (2) a subsidy eligible individual (as defined in section 
        1860D-14(a)(3)(A) of such Act (42 U.S.C. 1395w-114(a)(3)(A));
            (3) not eligible to receive benefits under title XIX of the 
        Social Security Act;
            (4) 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) 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 an eligible MA plan participating in such program if the 
        beneficiary resides in the participating plan's service area; 
        and
            (2) discontinue enrollment under the original medicare fee-
        for-service program under parts A and B of title XVIII of such 
        Act and the enrollment in a prescription drug plan under part D 
        of such title and enroll in an eligible MA plan participating 
        in the CBI-SNP demonstration program if the beneficiary resides 
        in the participating plan's service area.
    (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) Duration.--The CBI-SNP demonstration program shall be 
implemented not later than January 1, 2018, and shall be conducted for 
a period of 5 years.
    (h) Budget Neutrality.--In conducting the CBI-SNP demonstration 
program, the Secretary shall ensure that the aggregate payments made by 
the Secretary do not exceed the amount which the Secretary estimates 
would have been expended under titles XVIII and XIX of the Social 
Security Act (42 U.S.C. 1395 et seq., 1396 et seq.) if the CBI-SNP 
demonstration program had not been implemented.
    (i) Expansion of Demonstration Program.--Taking into account the 
evaluation under subsection (j), the Secretary may, through notice and 
comment rulemaking, expand (including implementation on a nationwide 
basis) the duration and scope of the CBI-SNP demonstration program 
under title XVIII of the Social Security Act, other than under the 
original medicare fee-for-service program under parts A and B of such 
title, to the extent determined appropriate by the Secretary, if the 
requirements of paragraphs (1), (2) and (3) of subsection (c) of 
section 1115A of the Social Security Act (42 U.S.C. 1315a), as applied 
to the testing of a model under subsection (b) of such section, applied 
to the CBI-SNP demonstration program.
    (j)  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, and 
        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 January 1, 2022, 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 
        CBI-SNP demonstration program.
    (k) Funding.--
            (1) Funding for implementation.--For purposes of 
        administering the CBI-SNP demonstration program (other than the 
        evaluation and report under subsection (j)), the Secretary 
        shall provide for the transfer from the Federal Hospital 
        Insurance Trust Fund under section 1817 of the Social Security 
        Act (42 U.S.C. 1395i) and the Federal Supplementary Medical 
        Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 
        1395t), in such proportion as the Secretary determines 
        appropriate, of $3,000,000 to the Centers for Medicare & 
        Medicaid Services Program Management Account.
            (2) Funding for evaluation and report.--For purposes of 
        carrying out the evaluation and report under subsection (j), 
        the Secretary shall provide for the transfer from the Federal 
        Hospital Insurance Trust Fund under such section 1817 and the 
        Federal Supplementary Medical Insurance Trust Fund under such 
        section 1841, in such proportion as the Secretary determines 
        appropriate, of $500,000 to the Centers for Medicare & Medicaid 
        Services Program Management Account.
            (3) Availability.--Amounts transferred under paragraph (1) 
        or (2) shall remain available until expended.
    (l) 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.
                                                       Calendar No. 182

114th CONGRESS

  1st Session

                                 S. 704

                          [Report No. 114-103]

_______________________________________________________________________

                                 A BILL

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

_______________________________________________________________________

                             July 30, 2015

                       Reported with an amendment