[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6770 Introduced in House (IH)]
<DOC>
117th CONGRESS
2d Session
H. R. 6770
To improve access to the Program of All-Inclusive Care for the Elderly,
and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 18, 2022
Mrs. Dingell (for herself and Mr. Blumenauer) introduced the following
bill; which was referred to the Committee on Energy and Commerce, and
in addition to the Committee on Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To improve access to the Program of All-Inclusive Care for the Elderly,
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.
This Act may be cited as the ``Program of All-Inclusive Care for
the Elderly Plus Act'' or the ``PACE Plus Act''.
SEC. 2. PACE EXPANSION GRANT PROGRAM.
(a) Definitions.--In this section:
(1) Area agency on aging.--The term ``area agency on
aging'' has the meaning given that term in section 102 of the
Older Americans Act of 1965 (42 U.S.C. 3002).
(2) CMS.--The term ``CMS'' means the Centers for Medicare &
Medicaid Services.
(3) For-profit pace provider.--The term ``for-profit PACE
provider'' means a PACE provider that is operated by an entity
that is not a public entity or a private, nonprofit entity
organized for charitable purposes under section 501(c)(3) of
the Internal Revenue Code of 1986.
(4) PACE pilot site.--The term ``PACE pilot site'' means a
PACE provider that--
(A) has been approved to provide services in a
geographic service area that is, in whole or in part, a
rural area or an underserved urban area; and
(B) has received a grant under subsection (b).
(5) PACE program.--The term ``PACE program'' has the
meaning given that term in sections 1894(a)(2) and 1934(a)(2)
of the Social Security Act (42 U.S.C. 1395eee(a)(2); 1396u-
4(a)(2)).
(6) PACE provider.--The term ``PACE provider'' has the
meaning given that term in section 1894(a)(3) or 1934(a)(3) of
the Social Security Act (42 U.S.C. 1395eee(a)(3); 1396u-
4(a)(3)).
(7) Rural area.--The term ``rural area'' has the meaning
given that term in section 1886(d)(2)(D) of the Social Security
Act (42 U.S.C. 1395ww(d)(2)(D)).
(8) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(9) Underserved urban area.--The term ``underserved urban
area'' means an urban health professional shortage area (as
such term is defined in section 332 of the Public Health
Service Act (42 U.S.C. 254e)).
(b) Site Development Assistance Program.--
(1) Site development assistance.--
(A) In general.--The Secretary shall establish a
process and criteria to award grants to qualified PACE
providers that have been approved to serve a rural area
or an underserved urban area.
(B) Requirements for participating pace
providers.--To be eligible for a grant under
subparagraph (A), a PACE provider shall demonstrate to
the Secretary that the provider has a plan to partner
with--
(i) each area agency on aging serving the
area that the provider is approved to serve; or
(ii) if there is no area agency on aging
serving such area, the applicable State Unit on
Aging.
(C) Amount per award.--A grant awarded under
subparagraph (A) to any individual PACE pilot site
shall not exceed $1,000,000.
(D) Number of awards.--Not more than 30 PACE pilot
sites shall be awarded a grant under subparagraph (A).
(E) Use of funds.--Funds made available under a
grant awarded under subparagraph (A) may be used for
the following expenses only to the extent such expenses
are incurred in relation to establishing or delivering
PACE program services in a rural area or underserved
urban area:
(i) Feasibility analysis and planning.
(ii) Interdisciplinary team development.
(iii) Development of a provider network,
including contract development.
(iv) Development or adaptation of claims
processing systems.
(v) Preparation of special education and
outreach efforts required for the PACE program.
(vi) Development of any special quality of
care or patient satisfaction data collection
efforts.
(vii) Purchase or lease of a building.
(viii) Modifications to a building.
(ix) To cover the cost of reinsurance
during the grant period.
(x) Establishment of a working capital fund
to sustain fixed administrative, facility, or
other fixed costs until the provider reaches
sufficient enrollment size.
(xi) Startup and development costs incurred
prior to the approval of the PACE pilot site's
PACE provider application, new center
application, or service area expansion
application by CMS.
(xii) Any other efforts determined by the
PACE pilot site to be critical to its
successful startup, as approved by the
Secretary.
(F) Site development grant eligibility.--
(i) Grant eligibility.--A PACE provider
shall only be eligible to receive a grant under
this subsection if the provider is not a for-
profit PACE provider.
(ii) Limitation on eligibility to providers
in 3-way pace program agreements.--A PACE
provider shall not be eligible for a grant
under this subsection unless the provider has
entered into an agreement, consistent with
sections 1894 and 1934 of the Social Security
Act (42 U.S.C. 1395eee, 1396u-4), and
regulations promulgated to carry out such
sections, among the PACE provider, the
Secretary, and a State administering agency for
the operation of a PACE program by the provider
under such sections.
(2) Technical assistance program.--The Secretary shall
establish a technical assistance program to provide--
(A) outreach and education to State agencies and
provider organizations interested in establishing and
expanding PACE programs in rural areas or underserved
urban areas; and
(B) technical assistance necessary to support PACE
pilot sites.
(3) Appropriation.--There is appropriated to the Secretary
$30,000,000 to carry out this subsection, to remain available
until expended.
(c) Evaluation of PACE Providers Serving Rural or Underserved Urban
Service Areas.--Not later than 60 months after the date of enactment of
this Act, the Secretary shall submit a report to Congress, including
the Special Committee on Aging of the Senate and the Committee on
Finance of the Senate, containing an evaluation of the experience of
PACE pilot sites in rural areas and underserved urban areas.
(d) State Expansion Grants.--
(1) In general.--The Secretary shall establish a process
and criteria to award State expansion grants to qualified State
agencies in States that do not currently have PACE providers.
(2) Amount per award.--A State expansion grant awarded
under subparagraph (A) to any State agency shall not exceed
$100,000.
(3) Use of funds.--Funds made available under a State
expansion grant awarded under paragraph (1) may be used for the
following expenses only to the extent such expenses are
incurred in relation to establishing a PACE program in the
State:
(A) Expenditures related to the development of a
capitated payment rate model, including appropriate
risk adjustment, for making payments to PACE providers
under a PACE program agreement.
(B) Expenditures on any other efforts determined by
the State Medicaid agency to be critical to the
successful implementation of a PACE program in the
State, as approved by the Secretary.
(4) Appropriation.--There are appropriated to the Secretary
$2,000,000 to carry out this subsection, to remain available
until expended.
(e) Amounts in Addition to Payments Under Social Security Act.--Any
amounts paid under the authority of this section to a PACE provider
shall be in addition to payments made to the provider under section
1894 or 1934 of the Social Security Act (42 U.S.C. 1395eee; 1396u-4).
SEC. 3. TWO-WAY PACE PROGRAM AGREEMENTS.
(a) Medicare.--Section 1894(a)(4) of the Social Security Act (42
U.S.C. 1395eee(a)(4)) is amended by adding at the end the following new
sentence: ``Beginning January 1, 2022, with respect to a PACE provider
operating in a State that has not entered into an agreement described
in the previous sentence as of such date, such term shall include an
agreement, consistent with this section and regulations promulgated to
carry out this section, between such a PACE provider and the Secretary
for the operation of a PACE program in such State by the provider under
this section alone.''.
(b) Medicaid.--Section 1934 of the Social Security Act (42 U.S.C.
1396u-4) is amended--
(1) in subsection (a)(4), by adding at the end the
following new sentence: ``Beginning January 1, 2022, with
respect to a PACE provider operating in a State that has not
entered into an agreement described in the previous sentence as
of such date, such term shall include an agreement, consistent
with section 1894 and regulations promulgated to carry out such
section, between such a PACE provider and the Secretary for the
operation of a PACE program in such State by the provider under
such section 1894 alone.''; and
(2) by adding at the end the following new subsection:
``(k) Application to PACE Providers in 2-Way PACE Program Agreement
States.--
``(1) In general.--In the case of a State described in the
second sentence of subsection (a)(4), the Secretary shall
administer the preceding provisions of this section with
respect to PACE programs offered by PACE providers under PACE
program agreements described in such sentence to PACE program
eligible individuals who are eligible for benefits under part
A, or enrolled under part B, of title XVIII.
``(2) Assessment of need of nursing home level of care.--
``(A) In general.--For purposes of the
administration of this section pursuant to this
subsection, the determination under subsection
(a)(5)(B) of whether an individual requires the level
of care required under the State plan for coverage of
nursing facility services shall be made by an
independent entity based on a level of care assessment
tool used by the State to determine whether an
individual requires such level of care.
``(B) Independent entity defined.--In this
subsection, the term `independent entity' means an
entity with demonstrated professional knowledge to
identify institutional level of care needs that--
``(i) is not the PACE provider operating
the PACE program involved;
``(ii) is not owned or controlled by, or an
employee of, such PACE provider;
``(iii) does not receive any differential
payment (such as a bonus) for identifying
individuals who are PACE program eligible
individuals under the PACE program agreement
involved; and
``(iv) is free of any other conflict of
interest (as defined by the Secretary) between
the entity and the PACE provider operating the
PACE program involved.''.
SEC. 4. ANY TIME ENROLLMENT IN PACE.
(a) In General.--
(1) Any time enrollment and effective date.--Section
1894(c)(5) of the Social Security Act (42 U.S.C. 1395eee(c)(5))
is amended by adding at the end the following new subparagraph:
``(C) Any time enrollment and effective date of
enrollment.--
``(i) Any time enrollment.--A PACE program
eligible individual may enroll in a PACE
program at any time during a month.
``(ii) Effective date.--Subject to clause
(iii), the enrollment of a PACE program
eligible individual in a PACE program shall be
effective on the date the PACE provider
operating the PACE program receives an
enrollment agreement signed by such PACE
program eligible individual with respect to
such PACE program.
``(iii) Special rule in the case of dual
eligible beneficiaries.--In the case of a PACE
program eligible individual who is eligible for
benefits under this title and title XIX, clause
(i) shall only apply if the State in which such
individual resides has made an election under
section 1934(c)(5)(C) to permit PACE program
eligible individuals enroll in a PACE program
at any time during a month in such State.''.
(2) Prorated payments.--Section 1894(d) of the Social
Security Act (42 U.S.C. 1395eee(d)) is amended by adding at the
end the following new paragraph:
``(4) Prorated payments.--In the case of a PACE program
eligible individual enrolled in a PACE program operated by a
PACE provider with an enrollment effective date that is not the
first day of a month, the capitation amount that would
otherwise be made under this subsection to the PACE provider
for such individual for the first month in which such
individual is so enrolled shall be prorated accordingly.''.
(b) Conforming Amendments.--
(1) Any time enrollment and effective date.--Section
1934(c)(5) of the Social Security Act (42 U.S.C. 1396u-4(c)(5))
is amended by adding at the end the following new subparagraph:
``(C) State option to permit any time enrollment
and effective date of enrollment.--
``(i) Any time enrollment.--A State may
elect to permit a PACE program eligible
individual to enroll in a PACE program at any
time during a month.
``(ii) Effective date.--Pursuant to a State
election made under clause (i), the enrollment
of a PACE program eligible individual in a PACE
program shall be effective on the date the PACE
provider operating the PACE program receives an
enrollment agreement signed by such PACE
program eligible individual with respect to
such PACE program.''.
(2) Prorated payments.--Section 1934(d) of the Social
Security Act (42 U.S.C. 1396u-4(d)) is amended by adding at the
end the following new paragraph:
``(3) Prorated payments.--If a State elects under
subsection (c)(5)(C) to permit enrollment at any time during a
month, in the case of a PACE program eligible individual
enrolled in a PACE program operated by a PACE provider with an
enrollment effective date that is not the first day of a month,
the State shall prorate the capitation amount that would
otherwise be made under this subsection to the PACE provider
for such individual for the first month in which such
individual is so enrolled.''.
(c) Effective Date.--The amendments made by this section shall take
effect on January 1, 2022.
SEC. 5. IMPROVING ACCESS TO AND AFFORDABILITY OF PACE PROGRAMS FOR
MEDICARE BENEFICIARIES WHO ARE NOT DUAL ELIGIBLE
BENEFICIARIES THROUGH FLEXIBILITY IN RATE SETTING FOR
SERVICES NOT COVERED BY MEDICARE.
(a) In General.--Section 1894 of the Social Security Act (42 U.S.C.
1395eee) is amended by adding at the end the following new subsection:
``(j) Flexibility in Establishing Premiums for Medicare PACE
Participants Who Are Not Also Entitled to Benefits Under a State
Medicaid Program.--
``(1) Codification of authority to charge a monthly
capitation amount for non-medicare services.--Subject to the
succeeding provisions of this subsection, a PACE program
operated by a PACE provider under a PACE program agreement in
any State may charge a Medicare-only PACE program eligible
individual (as defined in paragraph (4)(A)) who is enrolled in
such PACE program a monthly capitation payment amount for the
provision of non-Medicare services (as defined in paragraph
(4)(B)) under the PACE program.
``(2) Determination of monthly capitation payment amount.--
``(A) In general.--Notwithstanding section 460.186
of title 42, Code of Federal Regulations (or any
successor regulation), the monthly capitation payment
amount that may be charged under paragraph (1) shall be
determined by the PACE provider operating the PACE
program. Such monthly capitation payment amount shall
be based on assessments conducted on the Medicare-only
PACE program eligible individual who is enrolled in
such PACE program by the PACE program interdisciplinary
team and shall take into account the health status of
such individual. In determining the monthly capitation
amount for a Medicare-only PACE program eligible
individual under this paragraph, a PACE provider may
take into account the services determined necessary for
the individual by the PACE program interdisciplinary
team based upon their assessment of the individual. A
determination described in the preceding sentence shall
not be construed as limiting the responsibility of the
PACE provider to meet any unforeseen needs or provide
for any required services for such individual.
``(B) Authority to adjust monthly capitation
amount.--
``(i) In general.--Subject to clause (ii)
and paragraph (3), the monthly capitation
payment amount that may be charged under
paragraph (1) to a Medicare-only PACE program
eligible individual enrolled in a PACE program
for non-Medicare services may increase or
decrease based on assessments conducted on such
individual. Any change in the monthly
capitation payment amount charged to such an
individual shall take effect beginning with the
first day of the first month that begins after
the month during which the plan of care is
developed for such individual based on such an
assessment.
``(ii) Limitation on frequency of
increase.--The monthly capitation payment
amount that may be charged under paragraph (1)
to such an individual may not increase more
frequently than once per calendar quarter.
``(3) Beneficiary protections.--
``(A) Disclosure of premium rate structure.--A PACE
provider shall disclose to Medicare-only PACE program
eligible individuals the capitation payment amounts
that may be charged under this section to such
individuals for non-Medicare services under the PACE
program operated by such PACE provider under this
section--
``(i) prior to enrollment of such
individual in such PACE program, and
``(ii) periodically, and upon request of
such individual, after enrollment.
``(B) Assessment instrument.--
``(i) In general.--The Secretary shall
develop an assessment instrument for use by
PACE programs with respect to Medicare-only
PACE program eligible individuals under this
subsection.
``(ii) Requirement for disclosure of
assessment instrument.--The monthly capitation
payment amount charged under paragraph (1) to a
Medicare-only PACE program eligible individual
for non-Medicare services shall be based on an
assessment of such individual conducted by the
PACE provider (using the assessment instrument
developed by the Secretary under clause (i)),
accounting for health status and corresponding
needs.
``(iii) Requirement for disclosure of
assessment instrument.--The assessment
instrument used by the interdisciplinary team
of the PACE program to evaluate the health and
social status of PACE participants shall be
disclosed to the individual prior to the
assessment.
``(C) Process to seek review of assessments.--The
Secretary shall establish a process for a Medicare-only
PACE program eligible individual to seek review of any
assessment conducted on the individual under this
subsection.
``(4) Rule of construction.--Nothing in this subsection
shall be construed to preclude the testing under section 1115A
of a model to permit a PACE provider operating a PACE program
to establish and charge monthly capitation payment amounts for
the provision of non-Medicare services under the PACE program
to Medicare-only PACE program eligible individuals under a rate
structure established by such PACE provider for such purpose,
including the use of an assessment instrument developed by the
PACE program to assign such individuals to an appropriate rate
category under such rate structure.
``(5) Definitions.--In this subsection--
``(A) the term `Medicare-only PACE program eligible
individual' means an individual who is described in
subsection (a)(1) and who is not entitled to medical
assistance under title XIX, and includes the designated
representative of the individual as appropriate; and
``(B) the term `non-Medicare services' means items
and services covered under title XIX that are not
covered under this title and items and services
described in subsection (b)(1)(A)(ii).''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on the date of the enactment of this Act, and apply with
respect to capitation amounts that may be charged for months beginning
on or after January 1, 2022.
(c) Rule of Construction.--Nothing in this section, or the
amendments made by this section, shall be construed to modify or
otherwise impact the following Medicare capitation rates that may be
charged by PACE plans for PACE participants who are Medicare
beneficiaries who are not both entitled to (or enrolled for) benefits
under part A of title XVIII of the Social Security Act (42 U.S.C. 1395
et seq.) and enrolled for benefits under part B of such title:
(1) Part a only medicare beneficiary.--In the case of a
Medicare beneficiary who is a PACE participant who is entitled
to (or enrolled for) benefits under part A of such title XVIII
but who is not enrolled for benefits under part B of such
title, the Medicare Part B capitation rate under paragraph (b)
of section 460.186 of title 42, Code of Federal Regulations (or
any successor regulations).
(2) Part b only medicare beneficiary.--In the case of a
Medicare beneficiary who is a PACE participant who is enrolled
for benefits under part B of such title XVIII but who is not
entitled to (or enrolled for) benefits under part A of such
title, the Medicare Part A capitation rate under paragraph (c)
of such section 460.186 (or any successor regulations).
SEC. 6. PACE SITE APPROVAL AND EXPANSION.
(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
striking paragraph (8) and inserting the following:
``(8) Authority to submit applications at any time; timely
consideration of applications.--
``(A) Authority to submit applications at any
time.--
``(i) New pace provider status.--An entity
that seeks to become a PACE provider may submit
an application for PACE provider status at any
time.
``(ii) Service area expansion and addition
of pace center site.--To the extent the
Secretary requires a PACE provider to submit an
application to expand its service area or to
add a PACE center site, a PACE provider may
submit such an application at any time, subject
to the requirements of section 460.12(d) of
title 42, Code of Federal Regulations (relating
to the first trial period audit), or any
successor regulation.
``(iii) Assurances.--An application for
PACE provider status under clause (i) or to add
a PACE center site under clause (ii) shall
include the following assurances:
``(I) An assurance that the
required members of the
interdisciplinary team are employees or
contractors of the proposed PACE center
or will be employees or contractors of
the proposed PACE center by the time
the PACE center becomes operational.
``(II) An assurance that--
``(aa) the PACE provider's
contracts for all contractors
and contracted personnel will
be executed by the time the
proposed PACE center becomes
operational; and
``(bb) executed contracts
may include provisions for
staffing levels to commensurate
with enrollment to full
projected census.
``(B) Deemed approval.--An application described in
subparagraph (A) shall be deemed approved unless the
Secretary, within 45 days after the date of the
submission of the application to the Secretary, either
denies such request in writing or informs the applicant
in writing with respect to any additional information
that is needed in order to make a final determination
with respect to the application. After the date the
Secretary receives such additional information, the
application shall be deemed approved unless the
Secretary, within 45 days of such date, denies such
request.''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on January 1, 2022.
SEC. 7. PACE PILOT.
Section 1115A(b)(2) of the Social Security Act (42 U.S.C.
1315a(b)(2)) is amended--
(1) in subparagraph (B), by adding at the end the following
new clause:
``(xxviii) National testing of a model for
expanded eligibility for the Program of All-
Inclusive Care for the Elderly as described in
subparagraph (D).''; and
(2) by adding at the end the following new subparagraph:
``(D) National testing of model for expanded
eligibility for the program of all-inclusive care for
the elderly.--In the case where the Secretary selects
the model described in clause (ii) of this subparagraph
for testing pursuant to clause (xxviii) of subparagraph
(B), the following shall apply:
``(i) National testing.--
``(I) In general.--Subject to
subclause (II), the Secretary shall
design a demonstration that allows each
PACE provider with an executed PACE
agreement to develop and submit to the
Secretary an application to begin
testing expanded PACE eligibility for
high-need and high-cost populations
that are not otherwise eligible to
participate in a PACE program within 1
year of the date on which the model is
selected.
``(II) No effect on ongoing models
or demonstration projects.--Nothing in
this subparagraph shall affect the
testing of any model under this
subsection or any demonstration project
under this Act that is implemented
prior to the date of the enactment of
this subparagraph.
``(ii) Model described.--The model
described in this clause seeks to increase
access to quality, integrated, care for high-
need, high-cost individuals who are not
otherwise eligible to participate in a PACE
program in order to improve health and reduce
cost. Under this model, participating PACE
providers would--
``(I) be paid fixed, monthly
capitated rates from both Medicare and
the applicable State Medicaid agency
for all services provided to each
enrollee fitting the criteria of the
PACE provider's designated population;
``(II) partner with non-PACE
providers, such as Area Agencies on
Aging, Centers for Independent Living,
local hospitals, and non-hospital
providers such as physicians,
behavioral health providers and other
community-based organizations to
effectively reach the PACE provider's
selected population;
``(III) adapt the PACE program
model of care to appropriately serve
the PACE provider's selected population
to integrate care and meet the unique
needs of said population; and
``(IV) if the PACE provider is
located in a State that has not yet
served the selected population through
a PACE program under section 1934,
receive an up-front fixed payment to
coordinate with the State to develop a
capitated payment rate, with
appropriate risk adjustment, for the
PACE provider's selected population.
``(iii) Requirements for participating pace
organizations.--In order to participate in the
model, a PACE provider must--
``(I) conduct a survey or needs
assessment of their service area to
determine the most appropriate
population with which to expand their
services;
``(II) receive prior approval from
the applicable State Medicaid agency to
submit an application to participate in
the model; and
``(III) following such survey or
needs assessment and approval from the
applicable State Medicaid agency,
submit and receive approval of an
application of expansion from the
Secretary.
``(iv) Application.--A PACE provider's
application to participate in this model shall
include the following information:
``(I) Results of the survey or
needs assessment of their service area
under clause (iii)(I) and an
explanation of the expanded population
the PACE organization will serve.
``(II) The types of services that
the expanded population will require
and the PACE provider's plan to
implement these services.
``(III) How the PACE provider will
achieve engagement and enrollment of
the new population in the model,
including how it will partner with non-
PACE providers in the applicable
service area.
``(IV) How the expanded
population's participation in the PACE
program is intended to improve quality
of care and health outcomes under the
model.
``(V) Certification that the
applicable State Medicaid agency has
approved the PACE provider's
application to participate in the
model.
``(VI) Plans to coordinate with the
State Medicaid agency to develop an
initial capitated rate with appropriate
risk adjustment.
``(VII) Plans for the PACE provider
and the State Medicaid agency to review
and adjust the Medicaid capitated rate
on a biennial basis, as needed.
``(VIII) Any other information
required by the Secretary.
``(v) Technical assistance.--The Secretary
shall provide, or designate an entity to
provide, technical assistance to participating
PACE providers as they apply for and implement
the model.
``(vi) Accounting for uncertainty.--In
order for implementing PACE providers to
receive unanticipated additional resources
needed to implement the model, the Secretary
shall establish procedures for the implementing
PACE providers to submit to the Secretary a
request for additional resources.
``(vii) Monitoring outcomes.--The
Secretary, in conjunction with PACE providers
and in consultation with States that have
elected to expand PACE program eligibility
under section 1934(l), shall develop a plan
to--
``(I) annually monitor outcomes
under the model, which may include
financial, quality, access, and
utilization outcomes;
``(II) annually monitor the health
outcomes of the PACE provider's
expanded population; and
``(III) any other outcomes as
determined by the Secretary.
``(viii) Reporting requirements.--
``(I) Report to congress.--Not less
frequently than every 3 years (for the
duration of the implementation of the
model under this subparagraph), the
Secretary shall submit to Congress a
report on the implementation of the
model under this subparagraph. The
report shall include demographic
information on the populations served
under the demonstration, best practices
for future implementation efforts and
any other information the Secretary
determines appropriate together with
recommendations for such legislation
and administrative action as the
Secretary determines appropriate.
``(ix) Funding.--The Secretary shall
allocate funds made available under subsection
(f)(1) to design, implement, evaluate, and
report on the model described in clause (ii) in
accordance with this subparagraph.''.
SEC. 8. STATE OPTION TO EXPAND ELIGIBILITY FOR PACE PROGRAM.
(a) In General.--Section 1934 of the Social Security Act (42 U.S.C.
1396u-4), as amended by section 3(b), is amended--
(1) in subsection (a)(5)(B), by inserting ``, subsection
(k), and subsection (l)'' after ``subsection (c)(4)''; and
(2) by adding at the end the following new subsection:
``(l) State Option To Expand Eligibility.--
``(1) In general.--A State described in paragraph (3) may,
at the option of the State, deem individuals described in
paragraph (2) to be PACE program eligible individuals for the
purposes of this section without regard to the requirement
under subsection (a)(5)(B) that a PACE program eligible
individual require the level of care required under the State
medicaid plan for coverage of nursing facility services.
``(2) Expansion of eligibility.--An individual is described
in this paragraph if--
``(A) the individual meets the requirements of
subparagraphs (A), (C), and (D) of subsection (a)(5);
``(B) the individual is unable to perform at least
2 (or such higher number as the State may establish)
activities of daily living, as determined by the State;
and
``(C) the individual's income does not exceed 150
percent of the poverty line (as defined in section
2110(c)(5)) or, if greater, the income level applicable
for an individual who has been determined to require an
institutional level of care to be eligible for nursing
facility services under the State plan and with respect
to whom there has been a determination that, but for
the provision of such services, the individual would
require the level of care provided in a hospital, a
nursing facility, an intermediate care facility for the
mentally retarded, or an institution for mental
diseases, the cost of which could be reimbursed under
the State plan.
``(3) States eligible for option.--A State shall only be
eligible to exercise the option under this subsection if--
``(A) the State administering agency has entered
into an agreement for the operation of a PACE program
under this section (and section 1894, if applicable)
among such agency, the Secretary, and a PACE provider;
and
``(B) the State provides coverage under the State
plan under this title (or a waiver of such plan) for
long-term services and supports.
``(4) Enhanced fmap.--Notwithstanding section 1905(b), in
the case of a State that exercises the option under this
subsection, the Federal medical assistance percentage
applicable with respect to expenditures by such State on
monthly payments made to PACE providers under a PACE program
agreement under this section for individuals who are deemed to
be PACE program eligible individuals in accordance with
paragraph (2) shall be equal to 90 percent.''.
(b) Conforming Amendment.--Section 1894(a)(5) of the Social
Security Act (42 U.S.C. 1395eee(a)(5)) is amended by inserting ``and
section 1934(l)'' after ``subsection (c)(4)''.
SEC. 9. COORDINATION WITH THE FEDERAL COORDINATED HEALTH CARE OFFICE.
Section 1934 of the Social Security Act (42 U.S.C. 1396u-4), as
amended by sections 3 and 8, is amended by adding at the end the
following new subsection:
``(m) Coordination With the Federal Coordinated Health Care
Office.--
``(1) State coordination with fchco.--The Director of the
Federal Coordinated Health Care Office established under
section 2602 of the Patient Protection and Affordable Care Act
shall serve as a point of contact between State administering
agencies and the Federal Government for purposes of
implementing and operating a PACE program in a State, and shall
coordinate with other relevant offices and staff of the Centers
for Medicare & Medicaid Services involved in carrying out this
section.
``(2) Annual report.--Not later than January 1, 2023, and
annually thereafter, the Director of the Federal Coordinated
Health Care Office shall submit to Congress a report on the
demographics of the populations served by PACE programs
operated under this section and section 1894.''.
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