[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 309 Introduced in Senate (IS)]

<DOC>




115th CONGRESS
  1st Session
                                 S. 309

    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

                            February 6, 2017

  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 
(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 two 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.
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