Community-Based Independence for Seniors Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 3461 To establish a Community-Based Institutional Special Needs Plan demonstra- tion program to target home and community-based care to eligible Medi- care beneficiaries, and for other purposes. IN THE HOUSE OF REPRESENTATIVES JUNE 25, 2019 Ms. SA´NCHEZ (for herself, Mr. KELLY of Pennsylvania, and Mr. SCHRADER) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Com- merce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdic- tion of the committee concerned A BILL To establish a Community-Based Institutional Special Needs Plan demonstration program to target home and commu- nity-based care to eligible Medicare beneficiaries, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Community-Based 4 Independence for Seniors Act of 2019’’. 5 VerDate Sep 11 2014 22:04 Jul 01, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3461.IH H3461 kjohnson on DSK79L0C42 with BILLS 2 •HR 3461 IH SEC. 2. FINDINGS. 1 Congress makes the following findings: 2 (1) Community-based services play an essential 3 role in keeping individuals healthy. 4 (2) Without community-based long-term serv- 5 ices and supports, which are not typically covered by 6 Medicare, seniors frequently experience negative 7 health outcomes and lose their ability to live inde- 8 pendently. 9 (3) Seniors who deplete their resources often 10 have no option but to turn to Medicaid for coverage 11 of long term care expenses. 12 (4) Targeting community-based services and 13 supports to at-risk seniors can help these individuals 14 avoid depleting their assets and becoming Medicaid 15 dependent. 16 SEC. 3. COMMUNITY-BASED INSTITUTIONAL SPECIAL 17 NEEDS PLAN DEMONSTRATION. 18 Part C of title XVIII of the Social Security Act is 19 amended by inserting after section 1859 (42 U.S.C. 20 1395w–28) the following new section: 21 ‘‘SEC. 1859A. COMMUNITY-BASED INSTITUTIONAL SPECIAL 22 NEEDS PLAN DEMONSTRATION. 23 ‘‘(a) ESTABLISHMENT.— 24 ‘‘(1) IN GENERAL.—The Secretary shall estab- 25 lish a Community-Based Institutional Special Needs 26 VerDate Sep 11 2014 22:04 Jul 01, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3461.IH H3461 kjohnson on DSK79L0C42 with BILLS 3 •HR 3461 IH Plan demonstration program (in this section referred 1 to as the ‘CBI–SNP demonstration program’) to 2 provide home and community-based care to eligible 3 Medicare beneficiaries. 4 ‘‘(2) AGREEMENTS.—The Secretary shall enter 5 into agreements with eligible MA organizations 6 under which such organizations shall offer eligible 7 MA plans under the CBI–SNP demonstration pro- 8 gram to eligible Medicare beneficiaries. 9 ‘‘(3) LIMITATIONS ON SCOPE OF DEMONSTRA- 10 TION PROGRAM.— 11 ‘‘(A) NUMBER OF PLANS.—The CBI–SNP 12 demonstration program shall be carried out 13 with respect to not greater than five MA plans. 14 ‘‘(B) NUMBER OF ENROLLEES PER 15 PLAN.—An eligible MA organization that enters 16 into an agreement with the Secretary under 17 paragraph (2) to offer an eligible MA plan 18 under the CBI–SNP demonstration program 19 may not enroll more than 1,000 eligible Medi- 20 care beneficiaries (including new enrollees) in 21 such plan. 22 ‘‘(4) ELIGIBLE MA PLANS DEFINED.—For pur- 23 poses of this section, the term ‘eligible MA plan’ 24 means a plan that, in addition to items and services 25 VerDate Sep 11 2014 22:04 Jul 01, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3461.IH H3461 kjohnson on DSK79L0C42 with BILLS 4 •HR 3461 IH for which coverage is otherwise provided under this 1 part (including benefits under section 1852(a)(3) 2 and notwithstanding any waivers under section 3 1915(c)), provides for coverage of long-term care 4 services and supports that the Secretary determines 5 appropriate for the purposes of the CBI–SNP dem- 6 onstration program, such as— 7 ‘‘(A) homemaker services; 8 ‘‘(B) home delivered meals; 9 ‘‘(C) transportation services; 10 ‘‘(D) respite care; 11 ‘‘(E) adult day care services; and 12 ‘‘(F) safety and other equipment not other- 13 wise covered under this title. 14 ‘‘(b) ELIGIBLE MA ORGANIZATIONS.—For purposes 15 of this section, the term ‘eligible MA organization’ means 16 an MA organization that— 17 ‘‘(1) has experience in offering specialized MA 18 plans for special needs individuals, as defined in sec- 19 tion 1859(b)(6)(A), to individuals who live in the 20 community in which the eligible MA plan is offered; 21 ‘‘(2) has experience working with low income 22 seniors groups; 23 ‘‘(3) is located in a State that the Secretary has 24 determined is able to participate in the CBI–SNP 25 VerDate Sep 11 2014 22:04 Jul 01, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3461.IH H3461 kjohnson on DSK79L0C42 with BILLS 5 •HR 3461 IH demonstration program by agreeing to make avail- 1 able data necessary for purposes of conducting the 2 independent evaluation required under subsection 3 (h); and 4 ‘‘(4) meets such other criteria as the Secretary 5 may require. 6 ‘‘(c) ELIGIBLE MEDICARE BENEFICIARY DE- 7 FINED.—In this section, the term ‘eligible Medicare bene- 8 ficiary’ means a Medicare beneficiary who— 9 ‘‘(1) is eligible to enroll in an eligible MA plan 10 under the CBI–SNP demonstration program; 11 ‘‘(2) is a subsidy-eligible individual (as defined 12 in section 1860D–14(a)(3)(A)); 13 ‘‘(3) is not eligible to receive benefits under title 14 XIX; 15 ‘‘(4) is unable to perform two or more activities 16 of daily living (as defined in section 7702B(c)(2)(B) 17 of the Internal Revenue Code of 1986); and 18 ‘‘(5) is age 65 or older. 19 ‘‘(d) PAYMENTS.—The Secretary shall establish pay- 20 ment rates for eligible MA organizations offering eligible 21 MA plans under the CBI–SNP demonstration program for 22 benefits covered under such program (and not otherwise 23 covered under part C) and provided to eligible Medicare 24 VerDate Sep 11 2014 22:04 Jul 01, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3461.IH H3461 kjohnson on DSK79L0C42 with BILLS 6 •HR 3461 IH beneficiaries under such plans. Such payment rates 1 shall— 2 ‘‘(1) be based upon payment rates established 3 for purposes of payment under section 1853; 4 ‘‘(2) be in addition to payments otherwise made 5 to such organization with respect to such plans 6 under part C; 7 ‘‘(3) be adjusted to reflect the costs of treating 8 eligible Medicare beneficiaries under this section; 9 and 10 ‘‘(4) not, with respect to a month in which an 11 eligible MA organization provides home and commu- 12 nity-based care to eligible Medicare beneficiaries 13 under such demonstration program, exceed an 14 amount for such month that is equal to the amount 15 that would be awarded to such organization if the 16 organization were to receive $400 with respect to 17 each such beneficiary that the organization provides 18 with such care during such month. 19 ‘‘(e) SPECIAL ELECTION PERIOD.—Notwithstanding 20 sections 1852(e)(2)(C) and 1860D–1(b)(1)(B)(iii), an eli- 21 gible Medicare beneficiary may, other than during the an- 22 nual, coordinated election periods under such sections— 23 ‘‘(1) discontinue enrollment in an MA plan not 24 participating in the CBI–SNP demonstration pro- 25 VerDate Sep 11 2014 22:04 Jul 01, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3461.IH H3461 kjohnson on DSK79L0C42 with BILLS 7 •HR 3461 IH gram and enroll in an MA plan participating in such 1 program; and 2 ‘‘(2) discontinue enrollment under the original 3 Medicare fee-for-service program under parts A and 4 B and the enrollment in a prescription drug plan 5 under part D and enroll in an MA plan participating 6 in the CBI–SNP demonstration program. 7 ‘‘(f) BENEFICIARY EDUCATION.—The Secretary shall 8 help to educate, through State Health Insurance Assist- 9 ance Programs and other organizations that assist seniors 10 with respect to benefits and enrollment under this title, 11 eligible Medicare beneficiaries on the availability of the 12 CBI–SNP demonstration program. 13 ‘‘(g) IMPLEMENTATION.— 14 ‘‘(1) DEADLINE.—The CBI–SNP demonstra- 15 tion program shall be implemented not later than 16 January 1 of the second year beginning after the 17 date of the enactment of this section. 18 ‘‘(2) DURATION.—Subject to paragraph (3), the 19 CBI–SNP demonstration program shall be con- 20 ducted for a period of five years. 21 ‘‘(3) EXTENSION OR EXPANSION.—Taking into 22 account the report under subsection (h)(2), the Sec- 23 retary may, through notice and comment rule- 24 making, expand the duration, scope, or both the du- 25 VerDate Sep 11 2014 22:04 Jul 01, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3461.IH H3461 kjohnson on DSK79L0C42 with BILLS 8 •HR 3461 IH ration and scope of the CBI–SNP demonstration 1 program (including implementation on a nationwide 2 or permanent basis or both), other than under the 3 original Medicare fee-for-service program under 4 parts A and B of such title, to the extent determined 5 appropriate by the Secretary, unless the Secretary 6 determines that such expansion is expected to— 7 ‘‘(A) increase aggregate expenditures 8 under this title and title XIX with respect to el- 9 igible Medicare beneficiaries participating in the 10 CBI–SNP demonstration program; or 11 ‘‘(B) decrease the quality of health care 12 services furnished to eligible Medicare bene- 13 ficiaries participating in the CBI–SNP dem- 14 onstration program. 15 ‘‘(h) INDEPENDENT EVALUATION AND REPORTS.— 16 ‘‘(1) INDEPENDENT EVALUATION.— 17 ‘‘(A) IN GENERAL.—The Secretary shall 18 provide for the evaluation of the CBI–SNP 19 demonstration program by an independent third 20 party. 21 ‘‘(B) EVALUATION OBJECTIVES.—Such 22 evaluation shall determine the extent to which 23 the CBI–SNP demonstration program has re- 24 sulted in— 25 VerDate Sep 11 2014 22:04 Jul 01, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3461.IH H3461 kjohnson on DSK79L0C42 with BILLS 9 •HR 3461 IH ‘‘(i) improved patient care; 1 ‘‘(ii) reduced hospitalizations or rehos- 2 pitalizations; 3 ‘‘(iii) reduced or delayed nursing facil- 4 ity admissions and lengths of stay under 5 title XIX; 6 ‘‘(iv) reduced spend down of income 7 and assets for purposes of becoming eligi- 8 ble for medical assistance under a State 9 plan under title XIX; 10 ‘‘(v) improved quality of life for the 11 eligible Medicare beneficiaries enrolled in 12 an eligible MA plan participating in the 13 CBI–SNP demonstration program; and 14 ‘‘(vi) improved caregiver satisfaction. 15 ‘‘(C) EVALUATION PROCESS.—Such eval- 16 uation shall be completed in accordance with 17 the following process: 18 ‘‘(i) The Secretary shall, prior to the 19 implementation of such program, establish 20 goals for such program with respect to the 21 evaluation objectives described in subpara- 22 graph (B) and criteria for measuring the 23 extent to which an eligible MA plan par- 24 VerDate Sep 11 2014 22:04 Jul 01, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3461.IH H3461 kjohnson on DSK79L0C42 with BILLS 10 •HR 3461 IH ticipating in the CBI–SNP demonstration 1 program meets such goals. 2 ‘‘(ii) The Secretary shall implement 3 clear data collection and reporting require- 4 ments for such eligible MA plans in order 5 to carry out such evaluation. 6 In carrying out such process, the Secretary 7 shall recognize that definitions, benefits, and 8 program requirements for long-term care serv- 9 ices and supports vary across States. 10 ‘‘(2) REPORTS.—Not later than four years after 11 the implementation of the CBI–SNP demonstration 12 program, the Secretary shall submit to Congress a 13 report containing the results of the evaluation con- 14 ducted under paragraph (1), together with such rec- 15 ommendations for legislative or administrative action 16 as the Secretary determines appropriate. In pre- 17 paring such report, the Secretary shall use at least 18 three years worth of data under the demonstration 19 program. 20 ‘‘(i) BUDGET NEUTRALITY.—For any year after the 21 third year of the CBI–SNP demonstration program, the 22 Secretary shall ensure that the aggregate payments made 23 under this title and title XIX, including under the dem- 24 onstration program, do not exceed the amount which the 25 VerDate Sep 11 2014 22:04 Jul 01, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3461.IH H3461 kjohnson on DSK79L0C42 with BILLS 11 •HR 3461 IH Secretary estimates would have been expended under such 1 titles during such year if the CBI–SNP demonstration 2 program had not been implemented. 3 ‘‘(j) PAPERWORK REDUCTION ACT.—Chapter 35 of 4 title 44, United States Code, shall not apply to the testing 5 and evaluation of the CBI–SNP demonstration program.’’. 6 Æ VerDate Sep 11 2014 22:04 Jul 01, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\H3461.IH H3461 kjohnson on DSK79L0C42 with BILLS