I 

116TH CONGRESS 

1ST SESSION H. R. 3461 

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 25, 2019 

Ms. SA ́NCHEZ (for herself, Mr. KELLY of Pennsylvania, and Mr. SCHRADER) 

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 2019’’. 


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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 

3 provide 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) LIMITATIONS ON SCOPE OF DEMONSTRA11 TION PROGRAM.— 

12 ‘‘(A) NUMBER OF PLANS.—The CBI–SNP 

13 demonstration program shall be carried out 

14 with respect to not greater than five MA plans. 

15 ‘‘(B) NUMBER OF ENROLLEES PER

16 PLAN.—An eligible MA organization that enters 

17 into an agreement with the Secretary under 

18 paragraph (2) to offer an eligible MA plan 

19 under the CBI–SNP demonstration program 

20 may not enroll more than 1,000 eligible Medi21 care beneficiaries (including new enrollees) in 

22 such plan. 

23 ‘‘(4) ELIGIBLE MA PLANS DEFINED.—For pur24 poses of this section, the term ‘eligible MA plan’ 

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


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1 for which coverage is otherwise provided under this 

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

3 and notwithstanding any waivers under section 

4 1915(c)), provides for coverage of long-term care 

5 services and supports that the Secretary determines 

6 appropriate for the purposes of the CBI–SNP dem7 onstration program, such as— 

8 ‘‘(A) homemaker services; 

9 ‘‘(B) home delivered meals; 

10 ‘‘(C) transportation services; 

11 ‘‘(D) respite care; 

12 ‘‘(E) adult day care services; and 

13 ‘‘(F) safety and other equipment not other14 wise covered under this title. 

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

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

17 an MA organization that— 

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

19 plans for special needs individuals, as defined in sec20 tion 1859(b)(6)(A), to individuals who live in the 

21 community in which the eligible MA plan is offered; 

22 ‘‘(2) has experience working with low income 

23 seniors groups; 

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

25 determined is able to participate in the CBI–SNP 


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1 demonstration program by agreeing to make avail2 able data necessary for purposes of conducting the 

3 independent evaluation required under subsection 

4 (h); and 

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

6 may require. 

7 ‘‘(c) ELIGIBLE MEDICARE BENEFICIARY DE8 FINED.—In this section, the term ‘eligible Medicare bene9 ficiary’ means a Medicare beneficiary who— 

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

11 under the CBI–SNP demonstration program; 

12 ‘‘(2) is a subsidy-eligible individual (as defined 

13 in section 1860D–14(a)(3)(A)); 

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

15 XIX; 

16 ‘‘(4) is unable to perform two or more activities 

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

18 of the Internal Revenue Code of 1986); and 

19 ‘‘(5) is age 65 or older. 

20 ‘‘(d) PAYMENTS.—The Secretary shall establish pay21 ment rates for eligible MA organizations offering eligible 

22 MA plans under the CBI–SNP demonstration program for 

23 benefits covered under such program (and not otherwise 

24 covered under part C) and provided to eligible Medicare 


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1 beneficiaries under such plans. Such payment rates 

2 shall— 

3 ‘‘(1) be based upon payment rates established 

4 for purposes of payment under section 1853; 

5 ‘‘(2) be in addition to payments otherwise made 

6 to such organization with respect to such plans 

7 under part C; 

8 ‘‘(3) be adjusted to reflect the costs of treating 

9 eligible Medicare beneficiaries under this section; 

10 and 

11 ‘‘(4) not, with respect to a month in which an 

12 eligible MA organization provides home and commu13 nity-based care to eligible Medicare beneficiaries 

14 under such demonstration program, exceed an 

15 amount for such month that is equal to the amount 

16 that would be awarded to such organization if the 

17 organization were to receive $400 with respect to 

18 each such beneficiary that the organization provides 

19 with such care during such month. 

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 

25 participating in the CBI–SNP demonstration proVerDate Sep 11 2014 22:04 Jul 01, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3461.IH H3461

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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 demonstra16 tion program shall be implemented not later than 

17 January 1 of the second year beginning after the 

18 date of the enactment of this section. 

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

20 CBI–SNP demonstration program shall be con21 ducted 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 notice and comment rule25 making, expand the duration, scope, or both the duVerDate Sep 11 2014 22:04 Jul 01, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3461.IH H3461

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1 ration and scope of the CBI–SNP demonstration 

2 program (including implementation on a nationwide 

3 or permanent basis or both), other than under the 

4 original Medicare fee-for-service program under 

5 parts A and B of such title, to the extent determined 

6 appropriate by the Secretary, unless the Secretary 

7 determines that such expansion is expected to— 

8 ‘‘(A) increase aggregate expenditures 

9 under this title and title XIX with respect to el10 igible Medicare beneficiaries participating in the 

11 CBI–SNP demonstration program; or 

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

13 services furnished to eligible Medicare bene14 ficiaries participating in the CBI–SNP dem15 onstration program. 

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

17 ‘‘(1) INDEPENDENT EVALUATION.— 

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

19 provide for the evaluation of the CBI–SNP 

20 demonstration program by an independent third 

21 party. 

22 ‘‘(B) EVALUATION OBJECTIVES.—Such 

23 evaluation shall determine the extent to which 

24 the CBI–SNP demonstration program has re25 sulted in— 


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1 ‘‘(i) improved patient care; 

2 ‘‘(ii) reduced hospitalizations or rehos3 pitalizations; 

4 ‘‘(iii) reduced or delayed nursing facil5 ity admissions and lengths of stay under 

6 title XIX; 

7 ‘‘(iv) reduced spend down of income 

8 and assets for purposes of becoming eligi9 ble for medical assistance under a State 

10 plan under title XIX; 

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

12 eligible Medicare beneficiaries enrolled in 

13 an eligible MA plan participating in the 

14 CBI–SNP demonstration program; and 

15 ‘‘(vi) improved caregiver satisfaction. 

16 ‘‘(C) EVALUATION PROCESS.—Such eval17 uation shall be completed in accordance with 

18 the following process: 

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

20 implementation of such program, establish 

21 goals for such program with respect to the 

22 evaluation objectives described in subpara23 graph (B) and criteria for measuring the 

24 extent to which an eligible MA plan parVerDate Sep 11 2014 22:04 Jul 01, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3461.IH H3461

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1 ticipating in the CBI–SNP demonstration 

2 program meets such goals. 

3 ‘‘(ii) The Secretary shall implement 

4 clear data collection and reporting require5 ments for such eligible MA plans in order 

6 to carry out such evaluation. 

7 In carrying out such process, the Secretary 

8 shall recognize that definitions, benefits, and 

9 program requirements for long-term care serv10 ices and supports vary across States. 

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

12 the implementation of the CBI–SNP demonstration 

13 program, the Secretary shall submit to Congress a 

14 report containing the results of the evaluation con15 ducted under paragraph (1), together with such rec16 ommendations for legislative or administrative action 

17 as the Secretary determines appropriate. In pre18 paring such report, the Secretary shall use at least 

19 three years worth of data under the demonstration 

20 program. 

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

22 third year of the CBI–SNP demonstration program, the 

23 Secretary shall ensure that the aggregate payments made 

24 under this title and title XIX, including under the dem25 onstration program, do not exceed the amount which the 


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1 Secretary estimates would have been expended under such 

2 titles during such year if the CBI–SNP demonstration 

3 program had not been implemented. 

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

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

6 and evaluation of the CBI–SNP demonstration program.’’. 

Æ 


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