[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 4264 Introduced in Senate (IS)]
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117th CONGRESS
2d Session
S. 4264
To amend title XIX of the Social Security Act to require States to
develop a strategy to integrate and coordinate Medicaid and Medicare
coverage for full-benefit dual eligible individuals.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 19 (legislative day, May 17), 2022
Mr. Scott of South Carolina (for himself, Mr. Casey, and Mr. Cassidy)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to require States to
develop a strategy to integrate and coordinate Medicaid and Medicare
coverage for full-benefit dual eligible individuals.
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 ``Advancing Integration in Medicare
and Medicaid (AIM) Act''.
SEC. 2. COVERAGE INTEGRATION AND COORDINATION STRATEGY FOR FULL-BENEFIT
DUAL ELIGIBLE INDIVIDUALS.
(a) Medicaid State Plan Requirement.--Section 1902 of the Social
Security Act (42 U.S.C. 1396a) is amended--
(1) in subsection (a)--
(A) by striking ``and'' at the end of paragraph
(86);
(B) by striking the period at the end of paragraph
(87) and inserting ``; and''; and
(C) by inserting after paragraph (87) the following
new paragraph:
``(88) include a strategy for integrating and coordinating
health benefits coverage under this title and title XVIII for
full-benefit dual eligible individuals (as defined in section
1935(c)(6)) in accordance with the requirements of subsection
(tt).''; and
(2) by adding at the end the following new subsection:
``(tt) Coverage Integration and Coordination Strategy for Full-
Benefit Dual Eligible Individuals.--For purposes of subsection (a)(88),
the requirements under this subsection are the following:
``(1) General requirements.--Not later than 2 years after
the date of enactment of this subsection, the State shall
develop, in consultation with relevant stakeholders, and submit
to the Secretary for approval a strategy for integrating and
coordinating health benefits coverage for full-benefit dual
eligible individuals (as defined in section 1935(c)(6)) that
includes detailed descriptions of the following components:
``(A) The integration and coordination approaches
selected by the State.
``(B) The eligibility requirements and benefits
available under such strategy.
``(C) The education and enrollment strategy for
participation by full-benefit dual eligible individuals
(as so defined).
``(D) Beneficiary protections intended to preserve
and strengthen beneficiary choice and access to care.
``(E) The plan for collecting data analytics and
measuring the quality of care provided under such
strategy.
``(F) Structures to promote health equity.
``(G) The coordination and integration of mental
health benefits with other benefits and services
available under this title and title XVIII for full-
benefit dual eligible individuals under such strategy.
``(H) Such other components as the Secretary may
require.
``(2) Regular reviews and updates.--The State regularly
shall review and update the strategy developed and approved
under paragraph (1) in accordance with such timing and other
requirements as the Secretary shall specify.
``(3) Relevant stakeholders.--For purposes of paragraph
(1), the term `relevant stakeholders' means each of the
following:
``(A) Full-benefit dual eligible individuals (as
defined in section 1935(c)(6)) and their
representatives.
``(B) Health plans.
``(C) Health care providers, such as physicians,
hospitals, and nursing homes.
``(D) PACE providers.
``(E) Community-based organizations.
``(F) Beneficiary advocates.
``(G) Others as determined appropriate by the
Secretary or the State.''.
(b) Effective Date; Implementation.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by this section shall take effect on the date
of enactment of this Act.
(2) Delay if state legislation needed.--In the case of a
State plan for medical assistance under title XIX of the Social
Security Act which the Secretary of Health and Human Services
determines requires State legislation (other than legislation
appropriating funds) in order for the plan to meet the
additional requirements imposed by the amendments made by the
section, the State plan shall not be regarded as failing to
comply with the requirements of such title solely on the basis
of its failure to meet these additional requirements before the
first day of the first calendar quarter beginning after the
close of the first regular session of the State legislature
that begins after the date of the enactment of this Act. For
purposes of the previous sentence, in the case of a State that
has a 2-year legislative session, each year of such session
shall be deemed to be a separate regular session of the State
legislature.
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