[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 3630 Introduced in Senate (IS)]
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117th CONGRESS
2d Session
S. 3630
To establish a Dual Eligible Quality Care Fund to provide grants to
State Medicaid programs to improve their capacity to ensure the
provision of quality integrated care for dual eligible beneficiaries.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 10, 2022
Mr. Scott of South Carolina introduced the following bill; which was
read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To establish a Dual Eligible Quality Care Fund to provide grants to
State Medicaid programs to improve their capacity to ensure the
provision of quality integrated care for dual eligible beneficiaries.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Supporting Care for Dual Eligibles
Act''.
SEC. 2. IMPROVING MEDICAID'S CAPACITY TO PROTECT DUAL ELIGIBLE
BENEFICIARIES.
(a) Establishment of Dual Eligible Quality Care Fund.--
(1) In general.--Not later than 6 months after the date of
enactment of this Act, the Secretary of Health and Human
Services (referred to in this section as the ``Secretary'')
shall establish a fund to be known as the ``Dual Eligible
Quality Care Fund''.
(2) Establishment within federal coordinated health care
office.--The Dual Eligible Quality Care Fund shall be
established within, and administered by the Director of, the
Federal Coordinated Health Care Office established under
section 2602 of the Patient Protection and Affordable Care Act
(42 U.S.C. 1315b).
(3) Funding.--There is appropriated to the Dual Eligible
Quality Care Fund for fiscal year 2022 $100,000,000, to remain
available until expended.
(b) Purpose.--The purpose of the Dual Eligible Quality Care Fund is
to provide timely, targeted assistance in the way of grants to State
Medicaid programs to improve their capacity to ensure the provision of
quality integrated care for dual eligible beneficiaries.
(c) Allowable Uses of Grant Funds.--A State Medicaid program may
use amounts received under a grant from the Dual Eligible Quality Care
Fund to improve its capacity to provide quality integrated care for
dual eligible beneficiaries through any of the following:
(1) Recruiting and paying workers with needed subject
matter knowledge, skills, or capabilities.
(2) Actuarial support for rate development and analysis and
development or purchase of risk adjustment tools.
(3) Information technology system changes, including
changes that--
(A) improve member enrollments;
(B) improve encounter data collection and analysis;
(C) improve the ability of State Medicaid programs
to develop customized data management tools (such as
queries and dashboards);
(D) improve compliance with Federal reporting
requirements;
(E) enhance financial analysis;
(F) improve quality reporting and monitoring;
(G) improve modifications to capitation payments;
(H) transfer eligibility and enrollment data
between systems;
(I) improve the grievances and appeals process; and
(J) improve interaction with Medicare data and
related systems.
(4) Providing support for dual eligible beneficiaries
during enrollment processes, assistance to dual eligible
beneficiaries evaluating their enrollment choices,
informational materials to dual eligible beneficiaries and
those assisting with decision support, and coordination with
Medicare enrollment processes.
(5) Monitoring and oversight of efforts undertaken by State
Medicaid using grant funds, including measuring the level of
participation by stakeholders and dual eligible beneficiaries.
(6) Quality measurement and State evaluation activities,
development and deployment of survey tools, and costs of
accessing, transferring, and analyzing data.
(7) Develop knowledge and understanding within the State
Medicaid agency of the Medicare program under title XVIII of
the Social Security Act (42 U.S.C. 1395 et seq.).
(8) Supporting and improving Medicare initiatives,
including new initiatives and existing or past initiatives such
as the Financial Alignment Initiative for Medicare-Medicaid
Enrollees demonstration projects conducted under section 1115A
of the Social Security Act (42 U.S.C. 1315a).
(d) Awarding Grants.--
(1) In general.--A State Medicaid program that wishes to
receive a grant under this section from the Dual Eligible
Quality Care Fund shall submit an application to the Director
of the Federal Coordinated Health Care Office (referred to in
this subsection as the ``Director''), in such form and manner
as the Director shall specify. The Director may award a grant
under this section to any State, without regard to the State's
existing capacity to provide quality integrated care for dual
eligible beneficiaries.
(2) Application requirements.--An application for a grant
under this section shall include an identification of the uses
of funds described in subsection (c) for which the State
Medicaid program will use the grant funds.
(3) Methodology for disbursing funds.--
(A) In general.--Not later than 6 months after the
date of enactment of this Act, the Director shall issue
guidance establishing a clear and equitable methodology
for awarding grants to State Medicaid programs under
this section.
(B) Methodology requirements.--The methodology
established by the Director under this paragraph shall,
to the extent practical--
(i) ensure that grant funds are used in
accordance with subsection (c);
(ii) provide that grants are awarded by the
Director in a manner that is transparent and
equitable to State Medicaid programs; and
(iii) provide that, in determining the
grant amount to be awarded to a State Medicaid
program, the Director shall take into
consideration--
(I) the percentage of enrollees in
the program who are dual eligible
beneficiaries; and
(II) the total number of dual
eligible beneficiaries enrolled in the
program.
(C) Limitations.--The Director shall not award more
than 1 grant under this section to any State Medicaid
program, and in no case may the amount of a grant
awarded under this section exceed $2,000,000.
(e) State Program Reporting.--
(1) Quarterly reporting.--States receiving a grant under
this section shall, in a form and manner specified by the
Director of the Federal Coordinated Health Care Office
(referred to in this subsection as the ``Director''), report no
less frequently than once a quarter regarding the amount of
grant funds spent by the State and how funds received from the
grant are being used within the State.
(2) Longitudinal report.--States receiving a grant under
this section shall, no later than 2 years after the receipt of
such grant, submit to the Director and make available on a
State website a report summarizing how the funds received under
such grant were used. Such report shall include the following:
(A) An explanation of which uses of funds described
in subsection (c) the grant funds supported.
(B) An assessment of each of the following:
(i) The manner in which the grant funds
improved the State Medicaid program's capacity
to provide quality integrated care for dual
eligible beneficiaries.
(ii) The manner in which the grant funds
improved the quality of care for dual eligible
beneficiaries.
(iii) The manner in which the grant funds
improved the integration and coordination of
care for dual eligible beneficiaries.
(f) Definitions.--In this section:
(1) Dual eligible beneficiary.--The term ``dual eligible
beneficiary'' means an individual who is entitled to, or
enrolled for, benefits under part A of title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.), or enrolled for
benefits under part B of such title, and is eligible for
medical assistance under a State plan under title XIX of such
Act (42 U.S.C. 1396 et seq.) or under a waiver of such a plan.
(2) Quality integrated care.--The term ``quality integrated
care'' means the provision of services provided under the
Medicare program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.) and services provided under a State
Medicaid program--
(A) through systems in which Medicaid and Medicare
program administrative requirements, financing,
benefits, or care delivery are aligned; and
(B) in a coordinated fashion, which may include
coverage of such services through a single entity or
coordinating entities.
(3) State.--The term ``State'' has the meaning given such
term for purposes of title XIX of the Social Security Act (42
U.S.C. 1396 et seq.).
(4) State medicaid program.--The term ``State Medicaid
program'' means a State plan under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.), and includes any waiver
of such a plan.
SEC. 3. PAYMENT ERROR RATE MEASUREMENT (PERM) AUDIT REQUIREMENTS.
(a) Biennial PERM Audit Requirement.--Beginning with fiscal year
2023, the Administrator shall conduct payment error rate measurement
(``PERM'') audits of each State Medicaid program on a biennial basis.
(b) Notification; Identification of Sources of Improper Payments.--
(1) Notification.--Not later than 6 months after the date
of enactment of this Act, the Administrator shall notify the
contractor conducting PERM audits of the Administrator's intent
to modify contracts to require PERM audits not less than once
every other year in each State.
(2) Identification of sources of improper payments.--The
Administrator shall direct the contractor conducting PERM
audits of State Medicaid programs to identify areas known to be
sources of improper payments under such programs to identify
program areas or components known to be sources of high risk
for improper payments under such programs.
(c) State Medicaid Director Letter.--Not later than 12 months after
the date of enactment of this Act, the Administrator shall issue a
State Medicaid Director letter regarding State requirements under
Federal law and regulations regarding avoiding and responding to
improper payments under State Medicaid programs.
(d) State Improper Payment Mitigation Plans.--
(1) In general.--Not later than January 1, 2023, each State
Medicaid program shall submit to the Administrator a plan,
which shall include specific actions and timeframes for taking
such actions and achieving specified results, for mitigating
improper payments under such program.
(2) Publication of state plans.--The Administrator shall
make State plans submitted under paragraph (1) available to the
public.
(e) Definitions.--In this section:
(1) Administrator.--The term ``Administrator'' means the
Administrator of the Centers for Medicare & Medicaid Services.
(2) State.--The term ``State'' has the meaning given such
term for purposes of title XIX of the Social Security Act (42
U.S.C. 1396 et seq.).
(3) State medicaid program.--The term ``State Medicaid
program'' means a State plan under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.), and includes any waiver
of such a plan.
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