I 

114TH CONGRESS 

1ST SESSION H. R. 2704 

To establish a Community-Based Institutional Special Needs Plan demonstration program to target home and community-based care to eligible Medicare beneficiaries, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 9, 2015 

Ms. LINDA T. SA ́NCHEZ of California (for herself and Mr. MEEHAN) introduced the following bill; which was referred to the Committee on Ways 

and Means, and in addition to the Committee on Energy and Commerce, 

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 establish a Community-Based Institutional Special Needs 

Plan demonstration program to target home and community-based care to eligible Medicare beneficiaries, and 

for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Community Based 

5 Independence for Seniors Act of 2015’’. 


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1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) Community-based services play an essential 

4 role in keeping individuals healthy. 

5 (2) Without community-based long-term serv6 ices and supports, which are not typically covered by 

7 Medicare, seniors frequently experience negative 

8 health outcomes and lose their ability to live inde9 pendently. 

10 (3) Seniors who deplete their resources often 

11 have no option but to turn to Medicaid for coverage 

12 of long-term care expenses. 

13 (4) Targeting community-based services and 

14 supports to at-risk seniors can help these individuals 

15 avoid depleting their assets and becoming Medicaid 

16 dependent. 

17 SEC. 3. COMMUNITY-BASED INSTITUTIONAL SPECIAL 

18 NEEDS PLAN DEMONSTRATION. 

19 Part C of title XVIII of the Social Security Act is 

20 amended by inserting after section 1859 (42 U.S.C. 

21 1395w–28) the following new section: 

22 ‘‘SEC. 1859A. COMMUNITY-BASED INSTITUTIONAL SPECIAL 

23 NEEDS PLAN DEMONSTRATION. 

24 ‘‘(a) ESTABLISHMENT.— 

25 ‘‘(1) IN GENERAL.—The Secretary shall estab26 lish a Community-Based Institutional Special Needs 


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1 Plan demonstration program (in this section referred 

2 to as the ‘CBI-SNP demonstration program’) to pro3 vide home and community-based care to eligible 

4 Medicare beneficiaries. 

5 ‘‘(2) AGREEMENTS.—The Secretary shall enter 

6 into agreements with eligible MA organizations 

7 under which such organizations shall offer eligible 

8 MA plans under the CBI-SNP demonstration pro9 gram to eligible Medicare beneficiaries. 

10 ‘‘(3) LIMITATION ON NUMBER OF PLANS.—The 

11 CBI-SNP demonstration program shall be carried 

12 out with respect to not greater than five MA plans. 

13 ‘‘(4) ELIGIBLE MA PLANS DEFINED.—For pur14 poses of this section, the term ‘eligible MA plan’ 

15 means a plan that, in addition to items and services 

16 for which coverage is otherwise provided under this 

17 part (including benefits under section 1852(a)(3) 

18 and notwithstanding any waivers under section 

19 1915(c)), provides for coverage of long-term care 

20 services and supports that the Secretary determines 

21 appropriate for the purposes of the CBI-SNP dem22 onstration program, such as— 

23 ‘‘(A) homemaker services; 

24 ‘‘(B) home delivered meals; 

25 ‘‘(C) transportation services; 


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1 ‘‘(D) respite care; 

2 ‘‘(E) adult day care services; and 

3 ‘‘(F) safety and other equipment not other4 wise covered under this title. 

5 ‘‘(b) ELIGIBLE MA ORGANIZATIONS.—For purposes 

6 of this section, the term ‘eligible MA organization’ means 

7 an MA organization that— 

8 ‘‘(1) has experience in offering specialized MA 

9 plans for special needs individuals, as defined in sec10 tion 1859(b)(6)(A), to individuals who live in the 

11 community in which the eligible MA plan is offered; 

12 ‘‘(2) has experience working with low-income 

13 seniors groups; 

14 ‘‘(3) is located in a State that the Secretary has 

15 determined is able to participate in the CBI-SNP 

16 demonstration program by agreeing to make avail17 able data necessary for purposes of conducting the 

18 independent evaluation required under subsection 

19 (h); and 

20 ‘‘(4) meets such other criteria as the Secretary 

21 may require. 

22 ‘‘(c) ELIGIBLE MEDICARE BENEFICIARY DE23 FINED.—In this section, the term ‘eligible Medicare bene24 ficiary’ means a Medicare beneficiary who— 


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1 ‘‘(1) is eligible to enroll in an eligible MA plan 

2 under the CBI-SNP demonstration program; 

3 ‘‘(2) is a subsidy eligible individual (as defined 

4 in section 1860D–14(a)(3)(A)); 

5 ‘‘(3) is not eligible to receive benefits under title 

6 XIX; 

7 ‘‘(4) is unable to perform 2 or more activities 

8 of daily living (as defined in section 7702B(c)(2)(B) 

9 of the Internal Revenue Code of 1986); and 

10 ‘‘(5) is age 65 or older. 

11 ‘‘(d) PAYMENTS.—The Secretary shall establish a 

12 benchmark payment amount for reimbursing eligible MA 

13 organizations offering eligible MA plans under the CBI14 SNP demonstration program for benefits covered under 

15 such program (and not otherwise covered under part C) 

16 and provided to eligible Medicare beneficiaries under such 

17 plans. Such payments shall be in addition to payments 

18 otherwise made to such organization with respect to such 

19 plans under part C. 

20 ‘‘(e) SPECIAL ELECTION PERIOD.—Notwithstanding 

21 sections 1852(e)(2)(C) and 1860D–1(b)(1)(B)(iii), an eli22 gible Medicare beneficiary may, other than during the an23 nual, coordinated election periods under such sections— 

24 ‘‘(1) discontinue enrollment in an MA plan not 

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1 gram and enroll in an MA plan participating in such 

2 program; and 

3 ‘‘(2) discontinue enrollment under the original 

4 medicare fee-for-service program under parts A and 

5 B and the enrollment in a prescription drug plan 

6 under part D and enroll in an MA plan participating 

7 in the CBI-SNP demonstration program. 

8 ‘‘(f) BENEFICIARY EDUCATION.—The Secretary shall 

9 help to educate, through State Health Insurance Assist10 ance Programs and other organizations that assist seniors 

11 with respect to benefits and enrollment under this title, 

12 eligible Medicare beneficiaries on the availability of the 

13 CBI-SNP demonstration program. 

14 ‘‘(g) IMPLEMENTATION.— 

15 ‘‘(1) DEADLINE.—The CBI-SNP demonstration 

16 program shall be implemented not later than Janu17 ary 1 of the second year beginning after the date of 

18 the enactment of this section. 

19 ‘‘(2) DURATION.—Subject to paragraph (3), the 

20 CBI-SNP demonstration program shall be conducted 

21 for a period of five years. 

22 ‘‘(3) EXTENSION OR EXPANSION.—Taking into 

23 account the report under subsection (h)(2), the Sec24 retary may, through rulemaking, expand (including 

25 implementation on a nationwide or permanent basis) 


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1 the duration or the scope CBI-SNP demonstration 

2 program to the extent determined appropriate by the 

3 Secretary, unless the Secretary determines that such 

4 expansion is expected to— 

5 ‘‘(A) increase aggregate expenditures 

6 under this title and title XIX with respect to el7 igible Medicare beneficiaries participating in the 

8 CBI-SNP demonstration program; or 

9 ‘‘(B) decrease the quality of health care 

10 services furnished to eligible Medicare bene11 ficiaries participating in the CBI-SNP dem12 onstration program. 

13 ‘‘(h) INDEPENDENT EVALUATION AND REPORTS.— 

14 ‘‘(1) INDEPENDENT EVALUATION.— 

15 ‘‘(A) IN GENERAL.—The Secretary shall 

16 provide for the evaluation of the CBI-SNP dem17 onstration program by an independent third 

18 party. 

19 ‘‘(B) EVALUATION OBJECTIVES.—Such 

20 evaluation shall determine the extent to which 

21 the CBI-SNP demonstration program has re22 sulted in— 

23 ‘‘(i) improved patient care; 

24 ‘‘(ii) reduced hospitalizations or rehos25 pitalizations; 


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1 ‘‘(iii) reduced or delayed nursing facil2 ity admissions and lengths of stay under 

3 title XIX; 

4 ‘‘(iv) reduced spend down of income 

5 and assets for purposes of becoming eligi6 ble for medical assistance under a State 

7 plan under title XIX; 

8 ‘‘(v) improved quality of life for the 

9 eligible Medicare beneficiaries enrolled in 

10 an eligible MA plan participating in the 

11 CBI-SNP demonstration program; and 

12 ‘‘(vi) improved caregiver satisfaction. 

13 ‘‘(C) EVALUATION PROCESS.—Such eval14 uation shall be completed in accordance with 

15 the following process: 

16 ‘‘(i) The Secretary shall, prior to the 

17 implementation of such program, establish 

18 goals for such program with respect to the 

19 evaluation objectives described in subpara20 graph (B) and criteria for measuring the 

21 extent to which an eligible MA plan par22 ticipating in the CBI-SNP demonstration 

23 program meets such goals. 

24 ‘‘(ii) The Secretary shall implement 

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1 ments for such eligible MA plans in order 

2 to carry out such evaluation. 

3 In carrying out such process, the Secretary 

4 shall recognize that definitions, benefits, and 

5 program requirements for long-term care serv6 ices and supports vary across States. 

7 ‘‘(2) REPORTS.—Not later than four years after 

8 the implementation of the CBI-SNP demonstration 

9 program, the Secretary shall submit to Congress a 

10 report containing the results of the evaluation con11 ducted under paragraph (1), together with such rec12 ommendations for legislative or administrative action 

13 as the Secretary determines appropriate. In pre14 paring such report, the Secretary shall use at least 

15 three years worth of data under the demonstration 

16 program. 

17 ‘‘(i) BUDGET NEUTRALITY.—For any year after the 

18 third year of the CBI-SNP demonstration program, the 

19 Secretary shall ensure that the aggregate payments made 

20 under this title and title XIX, including under the dem21 onstration program, do not exceed the amount which the 

22 Secretary estimates would have been expended under such 

23 titles during such year if the CBI-SNP demonstration pro24 gram had not been implemented. 


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1 ‘‘(j) PAPERWORK REDUCTION ACT.—Chapter 35 of 

2 title 44, United States Code, shall not apply to the testing 

3 and evaluation of the CBI-SNP demonstration program.’’. 

Æ 


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