Coverage integration and coordination strategy for full-benefit dual eligible individuals

(a)

Medicaid state plan requirement

Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended—(1)in subsection (a)—(A)by striking and at the end of paragraph (86);(B)by striking the period at the end of paragraph (87) and inserting ; and; and(C)by inserting after paragraph (87) the following new paragraph:

(88)include a strategy for integrating and coordinating health benefits coverage under this title and title XVIII for full-benefit dual eligible individuals (as defined in section 1935(c)(6)) in accordance with the requirements of subsection (tt).

; and

(2)by adding at the end the following new subsection:

(tt)

Coverage integration and coordination strategy for full-Benefit dual eligible individuals

For purposes of subsection (a)(88), the requirements under this subsection are the following:(1)

General requirements

Not later than 2 years after the date of enactment of this subsection, the State shall develop, in consultation with relevant stakeholders, and submit to the Secretary for approval a strategy for integrating and coordinating health benefits coverage for full-benefit dual eligible individuals (as defined in section 1935(c)(6)) that includes detailed descriptions of the following components:(A)The integration and coordination approaches selected by the State.(B)The eligibility requirements and benefits available under such strategy.(C)The education and enrollment strategy for participation by full-benefit dual eligible individuals (as so defined).(D)Beneficiary protections intended to preserve and strengthen beneficiary choice and access to care.(E)The plan for collecting data analytics and measuring the quality of care provided under such strategy.(F)Structures to promote health equity.(G)The coordination and integration of mental health benefits with other benefits and services available under this title and title XVIII for full-benefit dual eligible individuals under such strategy.(H)Such other components as the Secretary may require.(2)

Regular reviews and updates

The State regularly shall review and update the strategy developed and approved under paragraph (1) in accordance with such timing and other requirements as the Secretary shall specify.(3)

Relevant stakeholders

For purposes of paragraph (1), the term relevant stakeholders means each of the following:(A)Full-benefit dual eligible individuals (as defined in section 1935(c)(6)) and their representatives.(B)Health plans.(C)Health care providers, such as physicians, hospitals, and nursing homes.(D)PACE providers.(E)Community-based organizations.(F)Beneficiary advocates.(G)Others as determined appropriate by the Secretary or the State.

(b)

Effective date; implementation

(1)

In general

Except as provided in paragraph (2), the amendments made by this section shall take effect on the date of enactment of this Act.(2)

Delay if state legislation needed

In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by the section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.