[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 3950 Introduced in Senate (IS)]

<DOC>






118th CONGRESS
  2d Session
                                S. 3950

 To provide States with support to establish integrated care programs 
for individuals who are dually eligible for Medicare and Medicaid, and 
                          for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 14, 2024

Mr. Cassidy (for himself, Mr. Carper, Mr. Cornyn, Mr. Warner, Mr. Scott 
  of South Carolina, and Mr. Menendez) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To provide States with support to establish integrated care programs 
for individuals who are dually eligible for Medicare and Medicaid, and 
                          for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Delivering Unified 
Access to Lifesaving Services Act of 2024'' or the ``DUALS Act of 
2024''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
 TITLE I--STATE INTEGRATED CARE PROGRAMS FOR DUAL ELIGIBLE INDIVIDUALS

Sec. 101. State implementation.
    ``TITLE XXII--STATE INTEGRATED CARE PROGRAMS FOR DUAL ELIGIBLE 
                              INDIVIDUALS

        ``Sec. 2201. Definitions.
        ``Sec. 2202. State selection of program models, development, 
                            and implementation.
        ``Sec. 2203. Enrollment in integrated care plans.
        ``Sec. 2204. Plan requirements and payments.
        ``Sec. 2205. Data collection and reporting.
        ``Sec. 2206. State ombudsman.
        ``Sec. 2207. Funding.
        ``Sec. 2208. Federal administration through the Federal 
                            Coordinated Health Care Office.
Sec. 102. Providing Federal Coordinated Health Care Office authority 
                            over dual snps.
Sec. 103. Additional conforming amendments.
 TITLE II--IMPROVING ELIGIBILITY DETERMINATIONS, ENROLLMENT PROCESSES, 
           AND QUALITY OF CARE FOR DUAL ELIGIBLE INDIVIDUALS

Sec. 201. Identifying opportunities for State coordination with respect 
                            to eligibility determinations.
Sec. 202. Alignment of bidding, reporting, and other dates and 
                            deadlines for integrated care plans.
Sec. 203. Grants to State and local community organizations for 
                            outreach and enrollment.
Sec. 204. Application of model standards to information requirements 
                            for integrated care plans.
Sec. 205. Enrollment through independent brokers.
Sec. 206. Reducing threshold for look-alike D-SNP plans under Medicare 
                            Advantage.
Sec. 207. Requiring regular update of provider directories.
Sec. 208. Review of hospital quality star rating system.
Sec. 209. Requirement for FCHCO and State Medicaid agencies to develop 
                            maximum staffing ratios for care 
                            coordinators.
Sec. 210. CMMI testing of coverage of partial benefit dual eligible 
                            individuals through State Integrated Care 
                            Programs.
                       TITLE III--ADMINISTRATION

Sec. 301. Alignment of billing codes under titles XVIII, XIX, and XXII.
                             TITLE IV--PACE

Sec. 401. Requiring States to offer PACE program services to eligible 
                            individuals.
Sec. 402. Enrollment of PACE beneficiaries at any time.
Sec. 403. Extending eligibility for PACE to medicare-eligible 
                            individuals under the age of 55.
Sec. 404. Removal of quarterly restrictions for submission of a new 
                            pace organization application, and removal 
                            quarterly restrictions for applications in 
                            a new service area.
Sec. 405. Ensuring Medicare-only PACE program enrollees have a choice 
                            of prescription drug plans under Medicare 
                            part D.

 TITLE I--STATE INTEGRATED CARE PROGRAMS FOR DUAL ELIGIBLE INDIVIDUALS

SEC. 101. STATE IMPLEMENTATION.

    The Social Security Act is amended by adding at the end the 
following new title:

    ``TITLE XXII--STATE INTEGRATED CARE PROGRAMS FOR DUAL ELIGIBLE 
                              INDIVIDUALS

``SEC. 2201. DEFINITIONS.

    ``In this title:
            ``(1) Director.--The term `Director' means the Director of 
        the Federal Coordinated Health Care Office of the Centers for 
        Medicare & Medicaid Services.
            ``(2) Dual eligible individual.--The term `dual eligible 
        individual' means an individual who is entitled to, or enrolled 
        for, benefits under part A of title XVIII, or enrolled for 
        benefits under part B of title XVIII, and is eligible for 
        medical assistance for full benefits under title XIX under 
        section 1902(a)(10)(A) or 1902(a)(10)(C), by reason of section 
        1902(f), or under any other category of eligibility for medical 
        assistance for full benefits under such title, as determined by 
        the Secretary.
            ``(3) Integrated care plan.--The term `integrated care 
        plan' means an entity or organization that is selected by a 
        State under section 2202(a) to provide fully integrated care 
        for a dual eligible individual in accordance with the 
        requirements of this title and related Federal and State 
        regulations. Such term shall not include a PACE program (as 
        defined in sections 1894(a)(2) and 1934(a)(2)).

``SEC. 2202. STATE SELECTION OF PROGRAM MODELS, DEVELOPMENT, AND 
              IMPLEMENTATION.

    ``(a) State Selection of Program Models.--Not later than 1 year 
after the date on which the Director first publishes the range of 
program models for providing integrated care for dual eligible 
individuals required by section 2208(b)(1), each State shall select 
from such published models, and shall work with the Director to 
implement such models in the State in accordance with the requirements 
of this title a program model to provide comprehensive, fully 
integrated care for dual eligible individuals.
    ``(b) Timing.--Each State shall work with the Director to implement 
the models selected by the State under subsection (a) so that, to the 
extent practicable, the State may begin to enroll dual eligible 
individuals in the program models selected during the 4th year that 
occurs after the year in which the State makes such selection and, by 
the end of such 4th year, the models are fully implemented and operated 
in accordance with the requirements of this title and related Federal 
and State regulations. Nothing in this subsection shall prohibit a 
State from enrolling dual eligible individuals in such program models 
earlier than the end of such 4th year if the models are fully 
implemented and operated in accordance with the requirements of this 
title and related Federal and State regulations.
    ``(c) Adjustment Authority.--The Director may modify the timing 
required by subsections (a) and (b) as appropriate to account for the 
particular needs or circumstances of a State.
    ``(d) Implementation Council.--
            ``(1) In general.--A State shall establish an 
        implementation council in accordance with such requirements as 
        the Secretary shall establish. The members of the council shall 
        include representatives of a wide range of stakeholders 
        relevant to the provision of integrated care for dual eligible 
        individuals.
            ``(2) Duties.--The implementation council shall provide 
        advice and counsel to the State with respect to the 
        implementation of the models selected by the State under 
        subsection (a).

``SEC. 2203. ENROLLMENT IN INTEGRATED CARE PLANS.

    ``(a) Passive Enrollment; Opt-Out Permitted.--
            ``(1) Passive enrollment and notice requirements.--A State 
        shall automatically enroll a dual eligible individual with an 
        integrated care plan under a contract with the State provided 
        that the State notifies the individual that the individual will 
        be enrolled with such plan at least 60 days (90 days, in the 
        case of the first time the individual is provided such notice) 
        prior to the effective date of such enrollment. Notice provided 
        to a dual eligible individual under this paragraph shall 
        include the following:
                    ``(A) The name and contact information for the 
                integrated care plan.
                    ``(B) The date on which the enrollment takes effect 
                and, if applicable, whether the State has elected the 
                option for a 12-month continuous eligibility period 
                under paragraph (4).
                    ``(C) A summary of the benefits to be provided by 
                the plan.
                    ``(D) Information regarding the provider network of 
                the plan.
                    ``(E) Information regarding how the dual eligible 
                individual may elect to opt-out of enrollment with the 
                plan within 60 days (90 days, in the case of the first 
                time the individual is provided such notice).
            ``(2) Enrollment in plan with in-network, participating 
        primary care provider required.--A State shall not passively 
        enroll a dual eligible individual in an integrated care plan 
        unless the individual's primary care physician is an in-
        network, participating provider for the plan.
            ``(3) Voluntary enrollment.--A State shall offer a dual 
        eligible individual the option to enroll in an integrated care 
        plan without regard to meeting the requirement of paragraph 
        (2).
            ``(4) State option for continuous eligibility and 
        enrollment.--A State may elect for a dual eligible individual 
        who is determined to be eligible for medical assistance under 
        the State plan under title XIX or under a waiver of such plan 
        and who is enrolled with an integrated care plan under a 
        contract with the State to remain eligible for medical 
        assistance and enrolled with such plan until the earlier of--
                    ``(A) the end of the 12-month period beginning on 
                the date of such determination; or
                    ``(B) the date that such individual ceases to be a 
                resident of such State.
    ``(b) Change of Enrollment.--A State shall permit a dual eligible 
individual to change enrollment in an integrated care plan--
            ``(1) on a monthly basis if the individual is electing to 
        enroll in another integrated care plan;
            ``(2) during the general enrollment period applicable under 
        section 1837, if the individual is electing to disenroll from 
        an integrated care plan and not enroll in another integrated 
        care plan; and
            ``(3) during the 60-day period beginning on the date the 
        individual receives notice from the State that the individual 
        has been determined to no longer be eligible for treatment as a 
        dual eligible individual, if the individual is no longer 
        eligible to enroll in an integrated care plan.
    ``(c) Contact by Plan Care Coordinator Permitted Prior to Effective 
Date of Enrollment.--A care coordinator for an integrated care plan may 
contact a dual eligible individual who has been passively enrolled in 
the plan prior to the effective date of the enrollment.

``SEC. 2204. PLAN REQUIREMENTS AND PAYMENTS.

    ``(a) In General.--A contract between a State, an offeror of an 
integrated care plan, and the Director shall not be considered to meet 
the requirements of this title unless--
            ``(1) in the case of a dual eligible individual enrolled 
        with the plan who changes enrollment to another integrated care 
        plan for which the individual's primary care provider is not a 
        participating, in-network provider, or who disenrolls from the 
        plan and does not enroll in another integrated care plan, the 
        offeror of the plan will, during the 30-day period that begins 
        on the date on which the individual's disenrollment from the 
        plan takes effect--
                    ``(A) allow the individual to continue to be 
                treated by the individual's primary care provider; and
                    ``(B) cover any treatment provided to the 
                individual by such provider as if the individual were 
                still enrolled with the plan;
            ``(2) the offeror of the plan administers a health risk 
        assessment to each dual eligible individual enrolled with the 
        plan within 90 days of the effective date of the individual's 
        enrollment in accordance with the requirements of subsection 
        (c) and shall affirm that there are no changes in the 
        information provided at least every 12 months thereafter;
            ``(3) the offeror of the plan provides benefits for a dual 
        eligible individual under a comprehensive care plan in 
        accordance with the requirements of subsections (d) and (f);
            ``(4) the offeror of the plan assigns a care coordinator to 
        each dual eligible individual enrolled with the plan in 
        accordance with the requirements of subsection (e) and notifies 
        such individual in a timely and accessible manner when a new 
        care coordinator is assigned; and
            ``(5) the contract provides for payment to the offeror for 
        benefits provided to dual eligible individuals enrolled with 
        the plan using a financing structure that satisfies the 
        requirements of section 2208(c).
    ``(b) Disregard of Certain Disenrollment Data for Ratings 
Purposes.--The disenrollment of a dual eligible individual from an 
integrated care plan who was passively enrolled in the plan under 
section 2203 shall be disregarded for purposes of any data used for 
rating of the plan for such plan year.
    ``(c) Health Risk Assessment.--An offeror of an integrated care 
plan shall administer a health risk assessment to each dual eligible 
individual enrolled with the plan using the standardized health risk 
assessment questionnaire developed by the Director under section 
2208(b)(3) and in accordance with such additional requirements as the 
State may establish. An integrated care plan may rely on the results of 
a previously administered health risk assessment of a dual eligible 
individual if such results are accessible to the plan and the dual 
eligible individual affirms that there are no changes in the 
information previously provided.
    ``(d) Benefits.--
            ``(1) In general.--An integrated care plan shall provide 
        benefits under the plan in accordance with requirements 
        established by the Director and the State, and which shall 
        include the following:
                    ``(A) Clinical health services.
                    ``(B) Behavioral health services.
                    ``(C) Long-term services and supports.
            ``(2) Carve-out exceptions.--The Director may permit a 
        State and integrated care plan to separately contract for the 
        provision of services or supports required under paragraph (1) 
        but only if the State demonstrates to the Director that--
                    ``(A) the level of care provided for a dual 
                eligible individual under the separate contract with 
                respect to such services or supports is not less than 
                the level of care that would be provided without the 
                exception; and
                    ``(B) the dual eligible individual will not be 
                subject to any unreasonable administrative requirements 
                to access the services or supports, as determined by 
                the Secretary.
            ``(3) Supplemental benefits.--An integrated care plan may 
        provide customized, supplemental benefits to a dual eligible 
        individual enrolled with the plan, including supplemental 
        health care benefits described in section 1852(a)(3), other 
        primarily health-related benefits offered by Medicare Advantage 
        plans and benefits permitted by the Secretary to be offered as 
        Special Supplemental Benefits for the Chronically Ill (SSBCI), 
        without regard to whether the dual eligible individual has a 
        requisite condition or diagnosis, so long as the plan 
        demonstrates to the Director and the State that the offering of 
        such benefits has a positive impact on patient health.
    ``(e) Care Coordinator Requirements.--A care coordinator assigned 
to a dual eligible individual enrolled in an integrated care plan 
shall--
            ``(1) serve as the single point of contact between the 
        individual and the plan;
            ``(2) be responsible for helping the individual and the 
        individual's caregivers and family make benefit and service 
        decisions;
            ``(3) design a beneficiary-focused comprehensive care plan 
        for the individual that meets the requirements of subsection 
        (f); and
            ``(4) connect and coordinate acute, subacute, social, 
        primary, and specialty care for the individual and the 
        provision of long-term services and supports for the 
        individual.
    ``(f) Comprehensive Care Plan Requirements.--The comprehensive care 
plan for a dual eligible individual enrolled in an integrated care plan 
shall be--
            ``(1) designed to address the totality of the individual's 
        medical, functional, behavioral, social, and caregiving needs 
        and goals, and to the extent practicable, to apply to multiple 
        years;
            ``(2) be based on the health risk assessment of the 
        individual required by subsection (c);
            ``(3) be implemented by an interdisciplinary care team that 
        includes relevant specialists to ensure access to all aspects 
        of care that are required for the individual;
            ``(4) be approved by the individual (or by an authorized 
        caregiver or guardian) prior to implementation; and
            ``(5) be reviewed at least annually and within 30 days of a 
        major health event, such as hospitalization or an emergency 
        room visit.
    ``(g) Continuity of Care Requirement.--An integrated care plan 
shall provide a dual eligible individual enrolled in the plan with a 
minimum 90-day transition period for any active course of treatment 
when the individual has enrolled in an integrated care plan after 
starting a course of treatment, even if the service is furnished by an 
out-of-network provider. This includes enrollees new to a plan and 
enrollees new to Medicare. The integrated care plan must not disrupt or 
require reauthorization for an active course of treatment for new plan 
enrollees for a period of at least 90 days. An integrated care plan may 
provide for a longer transition period than 90 days at the option of 
the plan. For purposes of this subsection the following definitions 
apply:
            ``(1) The term `course of treatment' means as a prescribed 
        order or ordered course of treatment for a specific individual 
        with a specific condition is outlined and decided upon ahead of 
        time with the patient and provider. A course of treatment may 
        but is not required to be part of a treatment plan.
            ``(2) The term `active course of treatment' means a course 
        of treatment in which a patient is actively seeing the provider 
        and following the course of treatment.
    ``(h) Authority To Apply Frailty Adjustment Factor To Plan 
Payments.--A contract between a State, an integrated care plan, and the 
Director under this title may apply a frailty adjustment factor with 
respect to dual eligible individuals enrolled in the plan in the same 
manner as is permitted under section 1853(a)(1)(B)(iv), but without 
regard to requiring the plan to demonstrate enrollment of a high 
concentration of frail individuals.

``SEC. 2205. DATA COLLECTION AND REPORTING.

    ``(a) Annual Collection and Reporting by States and Integrated Care 
Plans.--Each State, and each integrated care plan with a contract with 
a State under this title, annually shall collect and report information 
and data to the Director in accordance with the requirements of this 
section and guidance and regulations issued under section 2208(b)(7) 
that includes data collected by such States and plans with respect to a 
plan year regarding age, gender, disability (including specific 
disability statuses required to be reported by the Director), smoking 
status, mobility, employment status, education, race and ethnicity, and 
ZIP Code, of dual eligible individuals enrolled in the plan.
    ``(b) Collection and Reporting of Additional Data and Information 
Permitted.--A State may require an integrated care plan with a contract 
with the State under this title to collect and report to the State 
additional data and information.

``SEC. 2206. STATE OMBUDSMAN.

    ``(a) In General.--Each State shall establish and operate an Office 
of the Ombudsman for Integrated Care Plans for Dual Eligible 
Individuals (in this section referred to as the `Office'). The Office 
may operate independently of, or in connection with, the State agency 
responsible for administering the Medicaid program under title XIX.
    ``(b) Ombudsman.--The Office shall be headed by an individual, to 
be known as the State Integrated Care for Dual Eligible Individuals 
Ombudsman, who shall be selected from among individuals with expertise 
in and experience with integrated care models for dual eligible 
individuals, the Medicare program under title XVIII, and the Medicaid 
program under title XIX. The Ombudsman shall be responsible for the 
management, including the fiscal management, of the Office.
    ``(c) Requirements.--
            ``(1) In general.--The primary responsibility of the Office 
        shall be to provide support and feedback for dual eligible 
        individuals enrolled in integrated care plans under this title 
        and caregivers or family members of such individuals who need 
        assistance.
            ``(2) Minimum staffing ratio.--The Office shall have a 
        minimum staffing ratio of 1 employee for every 2,000 dual 
        eligible individuals in the State.
    ``(d) Funding.--
            ``(1) Initial funding.--During the first 2 years in which a 
        State operates the Office, the Secretary shall pay to the State 
        for each such year for expenditures necessary to establish and 
        operate the Office, from amounts appropriated under section 
        2207(c), an amount equal to $50,000,000 multiplied by the ratio 
        of--
                    ``(A) the number of dual eligible individuals in 
                the State; to
                    ``(B) the number of dual eligible individuals in 
                all States.
            ``(2) Subsequent funding.--Beginning with the 3rd year of 
        the Office's operation, expenditures necessary to operate the 
        Office shall be considered, for purposes of section 1903(a)(7), 
        to be necessary for the proper and efficient administration of 
        the State plan under title XIX and reimbursed to a State in 
        accordance with that section.

``SEC. 2207. FUNDING.

    ``(a) Treatment of State Payments to Integrated Care Plans as 
Medical Assistance.--Amounts expended by a State for payments to an 
integrated care plan for the Medicaid component of the capitation 
payment described in section 2208(c) shall be treated as medical 
assistance for which payment is made under section 1903(a). Nothing in 
this title shall prevent a State from providing medical assistance 
under title XIX to a dual eligible individual for services for which 
coverage is not provided under the integrated care plan with which the 
individual is enrolled or from receiving payment under section 1903(a) 
with respect to expenditures attributable to providing such medical 
assistance.
    ``(b) Payments to States.--From the sums appropriated under 
subsection (c), the Secretary shall pay to each State for each calendar 
year (beginning January 1 of the first full calendar year in which this 
title is implemented in the State), an amount equal to the sum of the 
following:
            ``(1) Shared savings component.--The shared savings payment 
        applicable to the State and the year, as determined in 
        accordance with section 2208(b)(6)(D).
            ``(2) General administrative expenses.--For administrative 
        expenses to carry out this title, other than section 2205, an 
        amount that bears the same proportion to $50,000,000 as the 
        number of dual eligible individuals in the State bears to the 
        number of dual eligible individuals in all States, as 
        determined by the Secretary.
            ``(3) Data collection and reporting.--For data collection 
        and reporting expenses under section 2205, an amount that bears 
        the same proportion to $50,000,000 as the number of dual 
        eligible individuals in the State bears to the number of dual 
        eligible individuals in all States, as determined by the 
        Secretary.
    ``(c) Appropriation.--There is appropriated, out of any money in 
the Treasury not otherwise appropriated, such amounts as may be 
required to provide payments to States under this section, for each 
calendar year (beginning January 1 of the first full calendar year in 
which this title is implemented in any State), reduced by any amounts 
made available from the Medicare trust funds under subsection (d).
    ``(d) Relation to Medicare Trust Funds.--There shall be made 
available for carrying out this title, and the Secretary shall provide 
for the transfer from the Federal Hospital Insurance Trust Fund (under 
section 1817) and from the Federal Supplementary Medical Insurance 
Trust Fund (under section 1841) (and from the Medicare Prescription 
Drug Account (under section 1860D-16) within such Trust Fund) such 
amounts as the Secretary determines appropriate, taking into account 
the reductions in payments from such Trust Funds and Account that are 
attributable to the enrollment of dual eligible individuals in 
integrated care plans under this title, for each calendar year 
(beginning January 1 of the first full calendar year in which this 
title is implemented in any State).
    ``(e) Relation to Other Payments.--Payments provided under this 
section to a State are in addition to payments provided under section 
2208.

``SEC. 2208. FEDERAL ADMINISTRATION THROUGH THE FEDERAL COORDINATED 
              HEALTH CARE OFFICE.

    ``(a) In General.--The Director shall have primary authority for 
implementing and carrying out responsibilities of the Federal 
Government under this title.
    ``(b) Responsibilities of the FCHCO.--In carrying out this title, 
the Director shall have the following responsibilities:
            ``(1) Development and publication of integrated care 
        program models.--Subject to subsection (c), to develop and, not 
        later than 180 days after the date of enactment of this 
        paragraph, publish, a range of program models (including but 
        not limited to Medicare-Medicaid plans, accountable care 
        organizations, and dual eligible special needs plans) for 
        providing integrated care for dual eligible individuals from 
        which States shall select to develop and administer integrated 
        care programs for dual eligible individuals in accordance with 
        this title.
            ``(2) Unified appeals process.--To develop and, not later 
        than 1 year after the date of enactment of this paragraph, 
        publish a unified administrative appeals process for State 
        integrated care programs for dual eligible individuals under 
        this title to use in lieu of other administrative appeals 
        processes involving Medicare and Medicaid.
            ``(3) Health risk assessment.--To develop a standardized 
        health risk assessment questionnaire for dual eligible 
        individuals that collects standard demographic data and 
        information relating to food insecurity, access to 
        transportation, internet access, utility difficulty, 
        interpersonal safety, and housing instability.
            ``(4) Supplemental benefits standards and reporting 
        requirements.--To establish standards for reporting by States 
        and integrated care plans under title XXII information relating 
        to the offering and provision of supplemental benefits under 
        section 2204(d)(3), including data relating to enrollment, 
        utilization, and outcomes, to annually publish a report 
        regarding the offering and utilization of such benefits, and to 
        study and report to the Secretary on whether to cap the 
        actuarial dollar value allowed for such benefits under titles 
        XVIII, XIX, and XXII.
            ``(5) Care coordinator requirements.--To--
                    ``(A) establish a formula based on patient chronic 
                conditions, activities of daily living standards, 
                geographic, and such other factors as the Director 
                determines are necessary for States and integrated care 
                plans to use to determine the maximum staffing ratio 
                for assigning care coordinators to dual eligible 
                individuals enrolled with integrated care plans under 
                this title; and
                    ``(B) develop online training and professional 
                development materials relating to the statutory and 
                administrative requirements for providing integrated 
                care for care coordinators for dual eligible 
                individuals enrolled with integrated care plans under 
                this title.
            ``(6) Administration and oversight of integrated care plans 
        for dual eligible individuals.--To--
                    ``(A) develop and issue guidance and regulations 
                related to the alignment of policy and operational 
                process under the Medicare program under title XVIII 
                and the Medicaid program under title XIX, necessary for 
                implementation, administration, and oversight of 
                integrated care plans for dual eligible individuals 
                under this title; and
                    ``(B) administer and provide oversight of 
                integrated care plans for dual eligible individuals 
                under this title, including with respect to--
                            ``(i) the development and application of an 
                        integrated medical loss ratio for such plans, 
                        in lieu of compliance with separate medical 
                        loss ratio requirements under titles XVIII and 
                        XIX;
                            ``(ii) the establishment and application of 
                        network adequacy standards for such plans 
                        that--
                                    ``(I) apply only with respect to 
                                such plans;
                                    ``(II) allow the Director to waive 
                                compliance with such standards for 
                                integrated care plans that cannot meet 
                                the requirements in certain areas, but 
                                must operate statewide to meet a 
                                State's selective contracting 
                                requirements; and
                                    ``(III) allow the Director to 
                                consider flexibilities to support 
                                innovative models that do not rely on 
                                traditional time and distance 
                                standards, such as the use of 
                                telehealth; and
                            ``(iii) the establishment and application 
                        of targeted, streamlined model-of-care 
                        requirements for such plans that include an 
                        integrated audit process, with shared 
                        responsibilities between the Director and 
                        States, and that requires the Director to share 
                        the results of such audits with State Medicaid 
                        programs. To the extent practicable, such 
                        requirements also shall be designed to be 
                        integrated with model of care requirements 
                        applicable to Medicaid managed care 
                        organizations;
                    ``(C) develop contract management teams, consisting 
                of representatives from integrated care plans with 
                contracts with States under this title, State agencies 
                responsible for administering the State plan under 
                title XIX or a waiver of such plan, and the Federal 
                Coordinated Health Care Office, to oversee compliance 
                and performance of integrated care plans under this 
                title;
                    ``(D) develop and implement a shared savings 
                payment for States to receive a share of savings to 
                Federal spending in the Medicaid program under title 
                XIX as a result of the implementation and operation of 
                integrated care plans for dual eligible individuals 
                under this title; and
                    ``(E) develop a new star rating system for 
                integrated care plans for dual eligible individuals 
                under this title that rates the performance of each 
                plan type separately, with State-specific measures and 
                tied to single contracts, instead of the collective 
                performance of all of the offeror's plans under 
                contract with the State under that title, that include 
                measures which directly reflect enrollee satisfaction, 
                and that awards higher star ratings to plans based on 
                their ability to retain enrollees.
            ``(7) Data collection and reporting.--To establish data and 
        information collection and reporting requirements for States 
        and integrated care plans under section 2205, including 
        required reporting of specific disability statuses and 
        safeguards to protect patient privacy, and to annually publish 
        not later than April 30 of any year, the data and information 
        collected and reported to the Director under such section for 
        the preceding year.
            ``(8) Quality measures.--To develop quality measures for 
        the population of dual eligible individuals that are designed 
        to be uniformly implemented across all platforms and health 
        benefits plans that provide integrated care for such 
        individuals under this title. Such measures shall include 
        measures relating to patient satisfaction, quality of life, 
        rates of emergency room use, institutionalization for long-term 
        care, hospital admission and readmission rates, and medication 
        errors. The Director shall regularly review and update such 
        measures as necessary and may develop outcome-based quality 
        measures for determining payments to health benefits plans that 
        provide integrated care for dual eligible individuals under 
        this title.
            ``(9) Best practices.--To not less than annually publish 
        best practices under this title for States and integrated care 
        plans, including with respect to improving outreach to 
        beneficiaries, improving comprehensive care plans and health 
        risk assessments for dual eligible individuals, and developing 
        a workforce that provides culturally intelligent and respectful 
        care.
            ``(10) Training programs.--To develop training programs 
        related to integrated care plans under this title for--
                    ``(A) providers of care, services, and supports 
                under such plans with respect to issues such as 
                coordination of benefits, data sharing barriers, 
                quality ratings, and provider incentives;
                    ``(B) State employees to increase Medicare 
                expertise at State agencies responsible for 
                administering Medicaid plans and waivers and 
                contracting with integrated care plans under this 
                title; and
                    ``(C) insurance brokers and local counselors who 
                help enroll individuals in Medicare, Medicaid, and 
                integrated care plans under this title.
    ``(c) Capitated Payment Structure for Integrated Care Program 
Models.--
            ``(1) In general.--Each program model that is designed by 
        the Director under subsection (b)(1) shall provide that 
        payments shall be made to an integrated care plan for benefits 
        provided under a contract under this title using a capitated 
        payment structure under which, for each month that the 
        integrated care plan provides such benefits--
                    ``(A) the State shall pay the integrated care plan 
                an amount equal to the Medicaid component payment 
                determined for the month; and
                    ``(B) the Secretary shall pay the integrated care 
                plan an amount equal to the Medicare component payment 
                determined for the month.
            ``(2) Determination of medicaid component payment.--For 
        purposes of paragraph (1), the Medicaid component payment 
        payable to an integrated care plan for a month shall be an 
        amount equal to the sum of the products of--
                    ``(A) for each category of beneficiary, the 
                Medicaid capitation rate applicable to the category of 
                beneficiary (as determined by the Secretary and 
                specified in the contract between the State, the 
                Secretary, and the offeror of the plan); and
                    ``(B) the number of beneficiaries in such category 
                enrolled with the plan for the month.
            ``(3) Determination of medicare component payment.--For 
        purposes of paragraph (1), the Medicare component payment 
        payable to an integrated care plan for a month shall be an 
        amount equal to the sum of the products of--
                    ``(A) for each category of beneficiary, the 
                Medicare capitation rate applicable to the category of 
                beneficiary (as determined by the Secretary and 
                specified in the contract between the State, the 
                Secretary, and the offeror of the plan); and
                    ``(B) the number of beneficiaries in such category 
                enrolled with the plan for the month.
            ``(4) Application of risk adjustment model to capitation 
        rates.--The Medicaid and Medicare capitation rates for each 
        category of beneficiary specified in a contract between a 
        State, the Secretary, and the offeror of an integrated care 
        plan shall be determined using the risk adjustment payment 
        model developed under subsection (d).
    ``(d) Risk Adjustment Payment Model for Providing Health Benefits 
Coverage for Dual Eligible Individuals.--Not later than 1 year after 
the date of enactment of this subsection, the Director shall enter into 
a contract or other agreement with an independent entity to develop a 
risk adjustment payment model for dual eligible individuals that--
            ``(1) is designed to be uniformly implemented across all 
        platforms and health benefits plans that provide integrated 
        care for such individuals under title XXII of the Social 
        Security Act;
            ``(2) includes factors based on the health status of such 
        individuals; and
            ``(3) allows plan payments to be made and updated on a 
        monthly basis.
    ``(e) Additional Responsibilities With Respect to Integrated Care 
Plans.--
            ``(1) Outreach to medicaid providers.--Not later than 180 
        days after the date of enactment of this subsection, the 
        Director, in consultation with State Medicaid programs, shall 
        develop outreach plans for such programs to use to contact 
        providers of health benefits, services, or supports for dual 
        eligible individuals and provide information and education 
        regarding the State Integrated Care Programs for Dual Eligible 
        Individuals established under this title, how such program will 
        operate in the State where such providers offer health 
        benefits, services or supports for such individuals, and the 
        impact of such program on such providers.
            ``(2) Collection of data on quality measures from 
        integrated care plans under medicaid and medicare.--
                    ``(A) In general.--Not later than 180 days after 
                the date of enactment of this subsection, the Director, 
                in consultation with the Administrator of the Centers 
                for Medicare & Medicaid Services and State Medicaid 
                programs, shall establish a plan for collecting data on 
                quality measures from health benefits plans that 
                provide integrated care for dual eligible individuals 
                under Medicare or Medicaid. Such data shall include, at 
                a minimum, data relating to provider network 
                availability in both Medicare and Medicaid, providers 
                in-network who are accepting new Medicare and Medicaid 
                patients, spending on supplemental benefits, and claims 
                denials.
                    ``(B) Authority to collect additional data and 
                information; publication.--The Director may--
                            ``(i) collect additional data and 
                        information relating to the quality of care 
                        provided for dual eligible individuals by 
                        health benefits plans that provide integrated 
                        care for such individuals under Medicare or 
                        Medicaid; and
                            ``(ii) make the data and information 
                        collected in accordance with this paragraph 
                        publicly available.
            ``(3) Development of an aligned program for institutional 
        special needs plans under medicaid.--Not later than 180 days 
        after the date of enactment of this subsection, the Director, 
        in consultation with the Administrator of the Centers for 
        Medicare & Medicaid Services and State Medicaid programs, shall 
        develop an aligned program for offering Institutional Special 
        Needs Plans under Medicaid that has 1 entity financially 
        responsible for providing health benefits, services, and 
        supports for dual eligible individuals.
            ``(4) Assessment of need for criteria to regulate and 
        expand utilization of institutional special needs plans.--Not 
        later than 180 days after the date of enactment of this 
        subsection, the Director, in consultation with the 
        Administrator of the Centers for Medicare & Medicaid Services, 
        shall assess the adequacy of regulations and oversight of 
        Institutional Special Needs Plan to determine whether new, or 
        additional requirements should be established to improve the 
        utilization, performance, and oversight of such plans and how 
        such plans may be offered under State Integrated Care Programs 
        for Dual Eligible Individuals established under this title.
    ``(f) Appropriations.--There are hereby appropriated, out of any 
funds in the Treasury not otherwise appropriated, for the first fiscal 
year that begins after the date of enactment of this title, and for 
each fiscal year thereafter, such sums as are necessary to carry out 
this title.
    ``(g) Direct-Hire Authority.--In carrying out this title, the 
Director shall have direct-hire authority to the extent required to 
implement and administer this title on a timely basis.''.

SEC. 102. PROVIDING FEDERAL COORDINATED HEALTH CARE OFFICE AUTHORITY 
              OVER DUAL SNPS.

    (a) In General.--Section 1859(f)(8) of the Social Security Act (42 
U.S.C. 1395w-28(f)(8)) is amended by adding at the end the following 
new subparagraph:
                    ``(F) Authority of federal coordinated health care 
                office.--For plan years beginning on or after January 
                1, 2025, the Federal Coordinated Health Care Office 
                established under section 2602 of Public Law 111-148 
                shall have primary authority for implementing and 
                carrying out responsibilities of the Secretary with 
                respect to the integration of specialized MA plans for 
                special needs individuals described in subsection 
                (b)(6)(B)(ii) under this subsection.''.
    (b) Conforming Amendment.--Section 2602(d)(6) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 1315b(d)(6)) is amended 
by inserting the following before the period: ``and, for plan years 
beginning on or after January 1, 2025, to carry out subsection 
(f)(8)(F) of such section''.

SEC. 103. ADDITIONAL CONFORMING AMENDMENTS.

    (a) Definition of State.--Section 1101(a)(1) of the Social Security 
Act (42 U.S.C. 1301(a)(1)) is amended--
            (1) by striking ``XIX, and XXI'' and inserting ``XIX, XXI, 
        and XXII''; and
            (2) by striking ``XIX and XXI'' and inserting ``XIX, XXI, 
        and XXII''.
    (b) Medicare Enrollment.--Section 1851(a) of the Social Security 
Act (42 U.S.C. 1395w-21(a)) is amended by adding at the end the 
following new paragraph:
            ``(4) Additional enrollment option for dual eligible 
        individuals.--Dual eligible individuals (as defined in section 
        2201) may also be eligible to enroll in an integrated care plan 
        under title XXII.''.
    (c) Preventing Duplicate Payments Under Medicaid.--Section 1903(i) 
of the Social Security Act (42 U.S.C. 1396b(i)) is amended--
            (1) by striking ``or'' at the end of paragraph (26);
            (2) by striking the period at the end of paragraph (27) and 
        inserting ``; or'';
            (3) by inserting after paragraph (27) the following new 
        paragraph:
            ``(28) with respect to any amount expended for medical 
        assistance for a dual eligible individual (as defined in 
        section 2201) enrolled in an integrated care plan under title 
        XXII, except as specifically permitted under such title.''; and
            (4) in the third sentence, by striking ``, and (18)'' and 
        inserting ``, (18), and (28)''.

 TITLE II--IMPROVING ELIGIBILITY DETERMINATIONS, ENROLLMENT PROCESSES, 
           AND QUALITY OF CARE FOR DUAL ELIGIBLE INDIVIDUALS

SEC. 201. IDENTIFYING OPPORTUNITIES FOR STATE COORDINATION WITH RESPECT 
              TO ELIGIBILITY DETERMINATIONS.

    Not later than 1 year after the date of enactment of this Act, the 
Secretary of Health and Human Services, in consultation with States, 
shall--
            (1) review State processes for determining whether an 
        individual is a full-benefit dual individual (as defined in 
        section 1935(c)(6) of the Social Security Act (42 U.S.C. 1396u-
        5(c)(6)) but without the application of subparagraph (A)(i) of 
        such section) and whether an individual is eligible for the 
        low-income subsidy program under section 1860D-14 of the Social 
        Security Act (42 U.S.C. 1395w-114) and the Medicare Savings 
        Program (as defined in section 1144(c)(7) of such Act (42 
        U.S.C. 1320b-14(c)(7))); and
            (2) issue guidance for States that identifies opportunities 
        for better coordination of such processes between the States 
        and the Federal Government.

SEC. 202. ALIGNMENT OF BIDDING, REPORTING, AND OTHER DATES AND 
              DEADLINES FOR INTEGRATED CARE PLANS.

    Not later than 180 days after the date of enactment of this Act, 
the Director of the Federal Coordinated Health Care Office of the 
Centers for Medicare & Medicaid Services and the Administrator of the 
Centers for Medicare & Medicaid Services shall--
            (1) review bidding, reporting, and other significant dates 
        and deadlines applicable to integrated care plans under the 
        Medicare program, the Medicaid program, and State Integrated 
        Care Programs for Dual Eligible Individuals under title XXII of 
        the Social Security Act; and
            (2) identify such administrative and legislative changes as 
        are needed to ensure that all such dates and deadlines are 
        aligned and consistent under all such programs.

SEC. 203. GRANTS TO STATE AND LOCAL COMMUNITY ORGANIZATIONS FOR 
              OUTREACH AND ENROLLMENT.

    (a) In General.--From the amounts appropriated under subsection (c) 
for a fiscal year, the Secretary of Health and Human Services (in this 
section referred to as the ``Secretary'') shall award grants to State 
and local community organizations to conduct outreach and enrollment 
efforts that are designed to increase the enrollment of dual eligible 
individuals (as defined in section 2201 of the Social Security Act) in 
health benefits plans that provide integrated care for such individuals 
under State Integrated Care Programs for Dual Eligible Individuals 
established under XXII of the Social Security Act.
    (b) Model Standards.--The Secretary, in consultation with the 
Administrator of the Administration for Community Living and States, 
shall develop and issue model standards for outreach and education 
conducted by State and local community organizations awarded grants 
under this section that include the following:
            (1) Information and education support is available for 
        individuals in a range of languages, and online, over the 
        phone, and in person.
            (2) Materials presented are easy to read, written in as low 
        a reading comprehension level as possible, and are in the 
        proper language for the individual involved.
            (3) Information presented online is accessible for 
        individuals with disabilities.
            (4) Information is presented in a manner that takes into 
        consideration the accessibility needs of the individual, such 
        as language access requirements and the health literacy level 
        of the individual.
    (c) Appropriation.--There is appropriated, out of any money in the 
Treasury not otherwise appropriated, for the first fiscal year that 
begins after the date of enactment of this Act, and for each fiscal 
year thereafter, $50,000,000 to carry out this section.

SEC. 204. APPLICATION OF MODEL STANDARDS TO INFORMATION REQUIREMENTS 
              FOR INTEGRATED CARE PLANS.

    Not later than 1 year after the date of enactment of this Act, the 
Director of the Federal Coordinated Health Care Office of the Centers 
for Medicare & Medicaid Services and the Administrator of the Centers 
for Medicare & Medicaid Services jointly shall issue guidance or 
regulations requiring that any notice or informational materials 
provided to a dual eligible individual (as defined in section 2201 of 
the Social Security Act) by such Director, Administrator, States, or 
health benefits plans that provide integrated care for such individuals 
under the Medicare program, the Medicaid program, or under State 
Integrated Care Programs for Dual Eligible Individuals established 
under XXII of the Social Security Act complies with the model standards 
issued under section 203(b).

SEC. 205. ENROLLMENT THROUGH INDEPENDENT BROKERS.

    Not later than 1 year after the date of enactment of this Act, the 
Director of the Federal Coordinated Health Care Office of the Centers 
for Medicare & Medicaid Services and the Administrator of the Centers 
for Medicare & Medicaid Services jointly shall issue guidance or 
regulations providing that--
            (1) a dual eligible individual (as defined in section 2201 
        of the Social Security Act) may not be enrolled in a health 
        benefits plan that provides integrated care for such individual 
        under title XXII of the Social Security Act through a broker 
        unless the broker is an independent broker (as defined under 
        such guidance or regulations);
            (2) an independent broker may receive a commission for the 
        initial enrollment of a dual eligible individual in such a 
        plan, but no commission shall be available to any broker for 
        any subsequent enrollment of such individual in any such plan;
            (3) if a broker disenrolls a dual eligible individual from 
        any such health benefits plan to a plan that provides partial 
        or no integrated care, the broker, in accordance with the model 
        standards issued under section 204(b), shall inform the 
        individual--
                    (A) of the health benefits plan the individual is 
                being disenrolled from; and
                    (B) that the individual is being enrolled in a 
                health benefits plan that provides partial or no 
                integrated care and the potential implications of such 
                disenrollment and enrollment on the individual's care.

SEC. 206. REDUCING THRESHOLD FOR LOOK-ALIKE D-SNP PLANS UNDER MEDICARE 
              ADVANTAGE.

    For the first full plan year that begins on or after the date that 
is 1 year after the date of enactment of this Act, and each subsequent 
plan year, the Secretary of Health and Human Services--
            (1) shall implement section 422.514(d)(1)(ii) of title 42, 
        Code of Federal Regulations (or any successor regulations) by 
        substituting ``50 percent'' for ``80 percent''; and
            (2) shall only count full-benefit dual eligible individuals 
        (as defined in section 1935(c)(6) of the Social Security Act 
        (42 U.S.C. 1396u-5(c)(6))) for purposes of applying the 
        threshold under such section.

SEC. 207. REQUIRING REGULAR UPDATE OF PROVIDER DIRECTORIES.

    Not later than 1 year after the date of enactment of this Act, the 
Director of the Federal Coordinated Health Care Office of the Centers 
for Medicare & Medicaid Services and the Administrator of the Centers 
for Medicare & Medicaid Services shall promulgate regulations that--
            (1) require Medicare Advantage plans under part C of title 
        XVIII of the Social Security Act (42 U.S.C. 1395w-21) and 
        integrated care plans under title XXII of such Act to regularly 
        update provider directories; and
            (2) include a measure relating to provider director 
        currency rating on star rating systems for Medicare Advantage 
        plans under section 1853(o) of the Social Security Act (42 
        U.S.C. 1395w-23(o)) and integrated care plans under title XXII 
        of such Act.

SEC. 208. REVIEW OF HOSPITAL QUALITY STAR RATING SYSTEM.

    Not later than 180 days after the date of enactment of this Act, 
the Administrator of the Centers for Medicare & Medicaid Services 
shall--
            (1) review the hospital quality star rating system under 
        the Medicare program under title XVIII of the Social Security 
        Act (42 U.S.C. 1395 et seq.); and
            (2) identify such administrative and legislative changes as 
        are needed to ensure that sufficient information is collected 
        under such system regarding hospitals to effectively measure 
        hospital quality.

SEC. 209. REQUIREMENT FOR FCHCO AND STATE MEDICAID AGENCIES TO DEVELOP 
              MAXIMUM STAFFING RATIOS FOR CARE COORDINATORS.

    (a) In General.--The Director of the Federal Coordinated Health 
Care Office, in consultation with State Medicaid agencies, shall 
develop model Federal legislation that would establish a process for 
determining a maximum care coordinator-to-patient ratio for integrated 
care plans providing care to dual eligible individuals under an 
integrated care model under title XXII of the Social Security Act. Such 
process shall take into account the varying needs required by different 
categories of patients.
    (b) Submission of Model Legislation.--Not later than 180 days after 
the date of enactment of this Act, the Director of the Federal 
Coordinated Health Care Office shall submit the model legislation 
developed under subsection (a) to--
            (1) the Secretary of Health and Human Services;
            (2) the Committee on Finance of the Senate;
            (3) the Committee on Energy and Commerce of the House of 
        Representatives; and
            (4) the Committee on Ways and Means of the House of 
        Representatives.

SEC. 210. CMMI TESTING OF COVERAGE OF PARTIAL BENEFIT DUAL ELIGIBLE 
              INDIVIDUALS THROUGH STATE INTEGRATED CARE PROGRAMS.

    Section 1115A of the Social Security Act (42 U.S.C. 1315a) is 
amended--
            (1) in subsection (b)(2)(A), by adding at the end the 
        following new sentence: ``The models selected under this 
        subparagraph shall include the testing of the model described 
        in subsection (h)(1).''; and
            (2) by adding at the end the following new subsection:
    ``(h) Testing of Model for Providing Coverage of Partial Benefit 
Dual Eligible Individuals Through Partially Integrated Care Plans Under 
State Integrated Care Programs.--
            ``(1) In general.--The model described in this paragraph is 
        a model under which States may offer coverage to partial 
        benefit dual eligible individuals through partially integrated 
        care plans under State Integrated Care Programs established 
        under title XXII.
            ``(2) Partial benefit dual eligible individual.--For 
        purposes of this subsection, the term `partial benefit dual 
        eligible individual' means an individual who--
                    ``(A) is eligible for the low-income subsidy 
                program under section 1860D-14, the Medicare Savings 
                Program (as defined in section 1144(c)(7)), or both; 
                and
                    ``(B) is not a full-benefit dual eligible 
                individual (as such term is defined in section 
                1935(c)(6), but without the application of subparagraph 
                (A)(i) of such section).''.

                       TITLE III--ADMINISTRATION

SEC. 301. ALIGNMENT OF BILLING CODES UNDER TITLES XVIII, XIX, AND XXII.

    Not later than 180 days after the date of enactment of this Act, 
the Director of the Federal Coordinated Health Care Office of the 
Centers for Medicare & Medicaid Services and the Administrator of the 
Centers for Medicare & Medicaid Services shall--
            (1) review billing codes under the Medicare program, the 
        Medicaid program, and State Integrated Care Programs for Dual 
        Eligible Individuals under XXII of the Social Security Act;
            (2) conduct at least 1 listening session open to the public 
        on the alignment of billing under the programs identified in 
        paragraph (1); and
            (3) identify such administrative and legislative changes as 
        are needed to ensure that all such billing codes are aligned 
        and consistent under all such programs.

                             TITLE IV--PACE

SEC. 401. REQUIRING STATES TO OFFER PACE PROGRAM SERVICES TO ELIGIBLE 
              INDIVIDUALS.

    (a) In General.--Section 1934 of the Social Security Act (42 U.S.C. 
1396u-4) is amended--
            (1) in subsection (a)(1)--
                    (A) by striking ``A State may elect to provide'' 
                and inserting ``A State shall provide''; and
                    (B) by striking ``A State may establish a numerical 
                limit on the number of individuals who may be enrolled 
                in a PACE program under a PACE program agreement.'';
            (2) in subsection (e)--
                    (A) in paragraph (1)--
                            (i) by striking ``(A) In general.--The 
                        Secretary'' and inserting ``The Secretary''; 
                        and
                            (ii) by striking subparagraph (B);
                    (B) in paragraph (2)(A)(ii); and
            (3) in subsection (h)(2)--
                    (A) by striking ``(A) In general.--Except as 
                provided under subparagraph (B), and'' and inserting 
                ``Except as provided under''; and
                    (B) by striking subparagraph (B).
    (b) State Plan Requirement.--Section 1902(a) of the Social Security 
Act (42 U.S.C. 1396a(a)) is amended--
            (1) in paragraph (86), by striking ``; and'' and inserting 
        a semicolon;
            (2) in paragraph (87)(D), by striking the period at the end 
        and inserting ``; and''; and
            (3) by inserting after paragraph (87) the following new 
        paragraph;
            ``(88) provide, in accordance with section 1934, that the 
        State shall provide medical assistance with respect to PACE 
        program services to PACE program eligible individuals who are 
        eligible for medical assistance under the State plan and who 
        are enrolled in a PACE program under a PACE program 
        agreement.''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on the date that is 180 days after the date of enactment of this 
Act.

SEC. 402. ENROLLMENT OF PACE BENEFICIARIES AT ANY TIME.

    (a) In General.--Sections 1894(d)(5)(A) and 1934(d)(5)(A) (42 
U.S.C. 1395eee(d)(5)(A), 1396u-4(d)(5)(A)) are each amended--
            (1) in the subparagraph header, by inserting ``enrollment 
        or'';
            (2) by inserting ``PACE program eligible individuals to 
        enroll in a PACE program at any time and'' after ``shall 
        permit''; and
            (3) by adding at the end the following sentence: ``The 
        amount of any capitated payment made to a PACE provider under 
        subsection (d)(1) may be adjusted to account for any PACE 
        program eligible individuals who enroll after the first day of 
        a month (with the amount of such payment adjustment being 
        proportional to the portion of such month for which the 
        individual is enrolled)''.
    (b) Effective Date.--The amendments made by this section shall take 
effect on the date that is 180 days after the date of enactment of this 
Act.

SEC. 403. EXTENDING ELIGIBILITY FOR PACE TO MEDICARE-ELIGIBLE 
              INDIVIDUALS UNDER THE AGE OF 55.

    (a) In General.--Sections 1894(a)(5)(A) and 1934(a)(5)(A) of the 
Social Security Act (42 U.S.C. 1395eee(a)(5), 1396u-4(a)(5)) are each 
amended by inserting ``(or any age in the case of an individual who is 
eligible for benefits under part A, or enrolled under part B, of title 
XVIII)'' after ``is 55 years of age or older''.
    (b) Effective Date.--The amendments made by this section shall take 
effect on the date that is 180 days after the date of enactment of this 
Act.

SEC. 404. REMOVAL OF QUARTERLY RESTRICTIONS FOR SUBMISSION OF A NEW 
              PACE ORGANIZATION APPLICATION, AND REMOVAL QUARTERLY 
              RESTRICTIONS FOR APPLICATIONS IN A NEW SERVICE AREA.

    (a) In General.--Sections 1894(e) and 1934(e) of the Social 
Security Act (42 U.S.C. 1395eee(e), 1396u-4(e)) are each amended by 
adding at the end the following new paragraph:
            ``(9) No quarterly or geographic limitations on 
        applications for pace provider status.--The Secretary shall not 
        prohibit an entity that meets the requirements for a PACE 
        provider under this section from--
                    ``(A) submitting multiple applications in the same 
                quarter; or
                    ``(B) submitting multiple applications to operate a 
                PACE program in the same service area.''.
    (b) Effective Date.--The amendments made by this section shall take 
effect on the date that is 180 days after the date of enactment of this 
Act.

SEC. 405. ENSURING MEDICARE-ONLY PACE PROGRAM ENROLLEES HAVE A CHOICE 
              OF PRESCRIPTION DRUG PLANS UNDER MEDICARE PART D.

    Section 1860D-21(f) of the Social Security Act (42 U.S.C. 1395w-
131(f)) is amended-- 
            (1) in paragraph (1), by striking ``and (3)'' and inserting 
        ``(3), and (4)''; and
            (2) by adding at the end the following new paragraph:
            ``(4) Ensuring choice of prescription drug plans.--
                    ``(A) In general.--For plan years beginning on or 
                after January 1, 2024, subject to the succeeding 
                provisions of this paragraph, an applicable PACE 
                program enrollee may elect to enroll in a qualified 
                standalone prescription drug plan, in accordance with 
                rules established by the Secretary pursuant to this 
                paragraph, while enrolled under a PACE program.
                    ``(B) Definition of applicable pace program 
                enrollee; qualified standalone prescription drug 
                plan.--In this paragraph:
                            ``(i) Applicable pace program enrollee.--
                        The term `applicable PACE program enrollee' 
                        means a part D eligible individual who--
                                    ``(I) is not entitled to medical 
                                assistance under title XIX; and
                                    ``(II) is enrolled under a PACE 
                                program offered by a PACE provider.
                            ``(ii) Qualified standalone prescription 
                        drug plan.--The term `qualified standalone 
                        prescription drug plan' means, with respect to 
                        an applicable PACE program enrollee, a 
                        prescription drug plan--
                                    ``(I) that is not an MA-PD plan;
                                    ``(II) that is not operated by the 
                                PACE program under which the individual 
                                is enrolled; and
                                    ``(III) for which the Secretary 
                                determines, with respect to the 
                                applicable PACE program enrollees 
                                enrolled in a PACE program offered by 
                                such PACE provider, that--
                                            ``(aa) the estimated 
                                        beneficiary out-of-pocket costs 
                                        (as defined in clause (iii)) 
                                        for the plan year for qualified 
                                        prescription drug coverage 
                                        under the plan is equal to or 
                                        less than the estimated out-of-
                                        pocket costs for such coverage 
                                        under the prescription drug 
                                        plan offered by the PACE 
                                        program in which the applicable 
                                        PACE program enrollee is 
                                        enrolled; and
                                            ``(bb) the estimated total 
                                        amount of Federal subsidies for 
                                        the plan year for qualified 
                                        prescription drug coverage 
                                        under the plan (which may be 
                                        estimated using data from the 
                                        previous plan year) is equal to 
                                        or less than the estimated 
                                        subsidy amount for such 
                                        coverage under the prescription 
                                        drug plan offered by the PACE 
                                        program in which the applicable 
                                        PACE program enrollee is 
                                        enrolled.
                            ``(iii) Out-of-pocket costs defined.--In 
                        this paragraph, the term `out-of-pocket costs' 
                        includes premiums imposed under a prescription 
                        drug plan and, in the case of coverage under a 
                        qualified standalone prescription drug plan, 
                        deductibles, copayments, coinsurance, and other 
                        cost-sharing.
                    ``(C) Out-of-pocket costs.--In the case where an 
                applicable PACE program enrollee elects to enroll in a 
                qualified standalone prescription drug plan pursuant to 
                this paragraph, the individual shall be responsible for 
                any out-of-pocket costs imposed under the plan 
                (including costs for nonformulary drugs) after the 
                application of any subsidies under section 1860D-14 for 
                an applicable PACE program enrollee who is a subsidy 
                eligible individual (as defined in section 1860D-
                14(a)(3)).
                    ``(D) Requirements for pace programs.--
                            ``(i) Educating and helping enroll 
                        beneficiaries into a part d plan option.--A 
                        PACE program shall be required to provide--
                                    ``(I) information to all applicable 
                                PACE program enrollees who are enrolled 
                                under the PACE program regarding the 
                                option to enroll in a qualified 
                                standalone prescription drug plan under 
                                this paragraph; and
                                    ``(II) upon request of an 
                                applicable PACE program enrollee, 
                                counseling and coordination to assist 
                                applicable PACE program enrollees in 
                                making decisions regarding the 
                                selection of qualified standalone 
                                prescription drug plans available to 
                                them.
                            ``(ii) Monitoring drug utilization, 
                        adherence, and spend.--A PACE program shall be 
                        required to monitor drug utilization, 
                        medication adherence, and drug spending 
                        (through claims data shared pursuant to 
                        subparagraph (F) and otherwise) throughout the 
                        year with respect to any applicable PACE 
                        program enrollee who elects to enroll in a 
                        qualified standalone prescription drug plan 
                        under this paragraph in order to coordinate 
                        with the PDP sponsor of such plan regarding the 
                        drug benefits offered by the plan, including 
                        upon request of an applicable PACE program 
                        enrollee the filing of any grievances or 
                        appeals with the plan on behalf of the 
                        applicable PACE program enrollee.
                    ``(E) Disenrollment.--An applicable PACE program 
                enrollee may disenroll from the qualified standalone 
                prescription drug plan elected by such applicable PACE 
                program enrollee under subparagraph (A) if the enrollee 
                changes medication during the plan year or can 
                demonstrate an unexpected increase in out-of-pocket 
                costs post enrollment.
                    ``(F) Claims sharing.--In the case where an 
                applicable PACE program enrollee enrolls in a qualified 
                standalone prescription drug plan, the PACE program in 
                which the individual is enrolled and the PDP sponsor of 
                the qualified standalone prescription drug plan shall 
                share claims data with each other with respect to the 
                applicable PACE program enrollee as needed to support 
                care management for the applicable PACE program 
                enrollee (including for purposes of monitoring and 
                coordination required under subparagraph (D)(ii)) and 
                for purposes of comprehensive risk adjustment under 
                section 1894(d). Such data shall be shared without the 
                need for any formal or informal request of the PACE 
                program in which the individual is enrolled or the PDP 
                sponsor of the qualified standalone prescription drug 
                plan in which the applicable PACE program enrollee is 
                enrolled.
                    ``(G) Rule of construction.--The authority 
                established under this paragraph for an applicable PACE 
                program enrollee to elect to enroll in a qualified 
                standalone prescription drug plan shall not be 
                construed as permitting an applicable PACE program 
                enrollee to enroll in a prescription drug plan that is 
                not a qualified standalone prescription drug plan.
                    ``(H) Relation to pace statutes.--
                            ``(i) In general.--The authority provided 
                        under this paragraph for an applicable PACE 
                        program enrollee to elect to enroll in a 
                        qualified standalone prescription drug plan 
                        shall apply notwithstanding subsection 
                        (a)(1)(B)(1) of section 1894 and such other 
                        provisions of sections 1894 and 1934 as the 
                        Secretary determines may conflict with the 
                        authority provided for under this paragraph, 
                        including subsections (a)(2)(B), (b)(1)(A)(i), 
                        (b)(1)(C), (f)(2)(B)(ii), and (f)(2)(B)(v) of 
                        such sections.
                            ``(ii) Clarification on payment for part d 
                        drug coverage.--Insofar as an applicable PACE 
                        program enrollee is enrolled in a qualified 
                        standalone prescription drug plan under this 
                        paragraph, the PACE program shall not be 
                        entitled to payment under section 1894(d) for 
                        the provision of qualified prescription drug 
                        coverage under such standalone prescription 
                        drug plan with respect to such applicable PACE 
                        program enrollee.''.
                                 <all>