[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 3882 Introduced in Senate (IS)]
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118th CONGRESS
2d Session
S. 3882
To amend title XIX of the Social Security Act to provide States with
resources to support efforts to integrate or coordinate Medicare and
Medicaid benefits for individuals that are eligible for both programs.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 6, 2024
Mr. Casey 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 provide States with
resources to support efforts to integrate or coordinate Medicare and
Medicaid benefits for individuals that are eligible for both programs.
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 ``Helping States Integrate Medicare
and Medicaid Act''.
SEC. 2. SUPPORTING STATE EFFORTS TO INTEGRATE MEDICARE AND MEDICAID
BENEFITS FOR FULL-BENEFIT DUAL ELIGIBLE INDIVIDUALS.
(a) In General.--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) in the case of a State that is 1 of the 50 States or
the District of Columbia, provide that the State will carry out
activities to coordinate and integrate benefits for full-
benefit dual eligible individuals (as defined in section
1935(c)(6)) in accordance with a Dual Coordination and
Integration Plan approved by the Secretary under subsection
(uu).''; and
(2) by adding at the end the following new subsection:
``(uu) Supporting State Efforts To Integrate Medicare and Medicaid
Benefits for Full-Benefit Dual Eligible Individuals.--
``(1) Definitions.--In this subsection:
``(A) Full-benefit dual eligible individual.--The
term `full-benefit dual eligible individual' has the
meaning given that term in section 1935(c)(6).
``(B) Medicaid.--The term `Medicaid' means the
program for grants to States for medical assistance
programs established under this title.
``(C) Medicare.--The term `Medicare' the program of
health insurance for the aged and disabled established
under title XVIII.
``(D) Medicare and medicaid benefits.--The term
`Medicare and Medicaid benefits' means benefits
available under Medicaid and Medicare.
``(E) Medicare-medicaid coordination office.--The
term `Medicare-Medicaid Coordination Office' means the
Medicare Medicaid Coordination Office established as
the Federal Coordinated Health Care Office under
section 2602 of the Patient Protection and Affordable
Care Act.
``(F) Relevant stakeholders.--The term `relevant
stakeholders' means the following:
``(i) Full-benefit dual eligible
individuals and their representatives.
``(ii) Beneficiary advocates.
``(iii) Health plans.
``(iv) Health care providers, such as
physicians, hospitals, and nursing homes.
``(v) PACE providers.
``(vi) Community-based organizations.
``(vii) Other interested individuals or
groups as determined by the Secretary or the
State.
``(2) Planning grants.--
``(A) In general.--Not later than 1 year after the
date of enactment of this subsection, from the amount
reserved under paragraph (8)(B), the Secretary shall
award a planning grant to each State to carry out
planning activities to develop and submit to the
Secretary a Dual Coordination and Integration Plan
described in paragraph (3).
``(B) Limitation.--The Secretary shall award
planning grants to States under this paragraph in such
amounts as the Secretary shall determine except that in
no case shall a grant awarded under this paragraph
exceed $5,000,000.
``(C) Use of funds.--A State may only use grant
funds awarded under this paragraph for the planning
activities described in subparagraph (A), except that,
if a State does not use all of the grant funds and
receives approval for a Dual Coordination and
Integration Plan described in paragraph (3), the State
may use any remaining funds to carry out activities
described in paragraph (4) that are in accordance with
such plan.
``(3) Dual coordination and integration plan.--
``(A) In general.--As a condition of receiving a
payment under this subsection, a State shall submit to
the Secretary for approval a Dual Coordination and
Integration Plan (to be developed by the State with
input from relevant stakeholders) describing the
State's strategy for integrating and coordinating
health benefits coverage for full-benefit dual eligible
individuals that includes detailed descriptions of the
following components:
``(i) A description of the activities
described in paragraph (4) that will be carried
out under the plan.
``(ii) The integration and coordination
approaches selected by the State.
``(iii) The eligibility requirements and
benefits available under such strategy.
``(iv) The education, enrollment, and
outreach strategy for participation by full-
benefit dual eligible individuals.
``(v) Beneficiary protections intended to
preserve and strengthen beneficiary choice and
access to care.
``(vi) The plan for collecting data
analytics and measuring the quality of care
provided under such strategy.
``(vii) Structures to promote health
equity.
``(viii) The coordination and integration
of mental health benefits with other benefits
and services available under Medicare and
Medicaid for full-benefit dual eligible
individuals under such strategy.
``(ix) Such other components as the
Secretary may require.
``(B) Development and submission.--In order to meet
the requirements of this subsection, a Dual
Coordination and Integration Plan shall--
``(i) be submitted for approval by the
Secretary not later than 24 months after the
date on which the State was awarded a planning
grant under paragraph (2); and
``(ii) be made publicly available in the
final version submitted to the Secretary on a
State internet website.
``(C) Approval; publication.--
``(i) In general.--The Secretary shall
approve a Dual Coordination and Integration
Plan submitted by a State under this paragraph
if--
``(I) the plan contains each of the
components required under subparagraph
(A); and
``(II) the State provides
assurances to the satisfaction of the
Secretary that the State will carry out
the Dual Coordination and Integration
Plan as it is written.
``(ii) Regular reviews and updates.--The
State regularly shall review and update a Dual
Coordination and Integration Plan approved
under this subparagraph at such times and in
accordance with such requirements as the
Secretary shall specify.
``(4) Medicare and medicaid coordination and integration
activities.--
``(A) In general.--The activities described in this
paragraph are the following:
``(i) Activities to recruit or retain
expert capacity at the State agency responsible
for administering the State plan under this
title to inform the integration of Medicare and
Medicaid for full-benefit dual eligible
individuals.
``(ii) Training for staff at such State
agency to develop expertise to inform the
integration of Medicare and Medicaid benefits
for full-benefit dual eligible individuals.
``(iii) Support for development of payment
rates and alternative payment models.
``(iv) Development of information
technology infrastructure to--
``(I) support data sharing among
health plans, providers, PACE
providers, community-based
organizations, and Federal, State, and
local government agencies; and
``(II) transfer Medicare and
Medicaid eligibility and enrollment
data.
``(v) Advancement of a unified Medicare and
Medicaid grievance and appeals structure for
determinations made by integrated agencies (as
permissible under the rules and regulations of
the Centers for Medicare & Medicaid Services).
``(vi) Development of, or enhancements to,
enrollment, outreach, and education supports
for full-benefit dual eligible individuals.
``(vii) Development of, or enhancements to,
administration, monitoring, and oversight
systems and protocols for all entities that
provide coordinated or integrated Medicare and
Medicaid benefits to full-benefit dual eligible
individuals.
``(viii) Development of, or enhancements
to, administration of quality measurement and
improvement programs for services furnished to
full-benefit dual eligible individuals.
``(ix) Stakeholder engagement processes,
including--
``(I) the establishment and
maintenance of a Consumer Advisory
Council comprised of full-benefit dual
eligible individuals, as well as
beneficiary advocates, and their
representatives that is reflective of
the local population in terms of status
for dual eligible qualification as well
as race, ethnicity, sexual orientation,
and other characteristics determined by
the State; and
``(II) the establishment and
maintenance of a stakeholder engagement
group that regularly solicits and
incorporates into the State's Medicare
and Medicaid coordination or
integration strategy input from the
Consumer Advisory Council and other
relevant stakeholders (as defined in
paragraph (1)) in the State.
``(x) Development of a workforce needs
assessment to identify the needs of the full-
benefit dually eligible population, including
strategies to ensure adequate compensation for
the workforce.
``(B) Limitations.--No payment may be made under
this subsection for expenditures on an activity that
the State carried out before the date of enactment of
this subsection.
``(5) Payments to states.--
``(A) In general.--Subject to subparagraph (B), for
each fiscal quarter during which a State has in effect
a Dual Coordination and Integration Plan approved under
paragraph (3), the Secretary shall pay to the State an
amount equal to 50 percent (or, during the first 20
full fiscal quarters during which the plan is in
effect, 80 percent) of the amounts expended by the
State during the quarter on activities described in
paragraph (4) that are in accordance with such plan.
``(B) Limitations.--
``(i) Use of planning grant funds.--A State
shall not be eligible for a payment under this
paragraph until the State has expended the full
amount of the planning grant awarded to the
State under paragraph (2).
``(ii) Non-duplication of payment;
application of higher rates.--No payment shall
be made under this paragraph with respect to
State expenditures of funds made available from
Federal sources, and to the extent that a State
expenditure is eligible for a Federal payment
under both subparagraph (A) and another
provision of this title or any other law,
payment shall only be made under the provision
that results in the State receiving the higher
payment.
``(C) Manner of payment.--Payment to a State under
this subsection shall be made in the same manner as
payments for State expenditures for the proper and
efficient administration of the State plan described in
section 1903(a)(7).
``(6) Evaluation of plan implementation; reporting
requirement.--
``(A) Evaluation benchmarks.--The Secretary shall
establish benchmarks for evaluating whether a State's
use of payments received under this subsection is in
alignment with the State's Dual Coordination and
Integration Plan (as approved under paragraph (3)).
``(B) Annual report.--As a condition of payment
under this subsection--
``(i) a State shall submit to the Secretary
an annual report detailing how the State is
using payments received under this subsection;
and
``(ii) the Secretary shall certify, based
on such report, that the State's use of such
payments is in alignment with the State's Dual
Coordination and Integration Plan (as approved
under paragraph (3)).
``(7) Administration.--In carrying out this subsection, the
Secretary shall coordinate with the Medicare-Medicaid
Coordination Office and other Federal agencies as appropriate.
``(8) Funding.--
``(A) In general.--Out of any funds in the Treasury
not otherwise appropriated, there is appropriated to
the Secretary $300,000,000 for fiscal year 2025 to
carry out this subsection, to remain available until
expended.
``(B) Reservation for planning grants.--Of the
amount appropriated under subparagraph (A),
$150,000,000 is reserved to award planning grants under
paragraph (2).
``(C) Technical assistance and guidance.--Of the
amount appropriated under subparagraph (A),
$150,000,000 is reserved for issuing guidance and
providing technical assistance to States in--
``(i) developing and implementing Dual
Coordination and Integration Plans under this
subsection; and
``(ii) completing the annual reports
required under paragraph (6).''.
(b) Effective Date.--
(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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