II 

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. 

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 ‘‘Supporting Care for 

5 Dual Eligibles Act’’. 


kjohnson on DSK79L0C42PROD with BILLS
2 

•S 3630 IS

1 SEC. 2. IMPROVING MEDICAID’S CAPACITY TO PROTECT 

2 DUAL ELIGIBLE BENEFICIARIES. 

3 (a) ESTABLISHMENT OF DUAL ELIGIBLE QUALITY

4 CARE FUND.— 

5 (1) IN GENERAL.—Not later than 6 months 

6 after the date of enactment of this Act, the Sec7 retary of Health and Human Services (referred to in 

8 this section as the ‘‘Secretary’’) shall establish a 

9 fund to be known as the ‘‘Dual Eligible Quality Care 

10 Fund’’. 

11 (2) ESTABLISHMENT WITHIN FEDERAL COORDI12 NATED HEALTH CARE OFFICE.—The Dual Eligible 

13 Quality Care Fund shall be established within, and 

14 administered by the Director of, the Federal Coordi15 nated Health Care Office established under section 

16 2602 of the Patient Protection and Affordable Care 

17 Act (42 U.S.C. 1315b). 

18 (3) FUNDING.—There is appropriated to the 

19 Dual Eligible Quality Care Fund for fiscal year 

20 2022 $100,000,000, to remain available until ex21 pended. 

22 (b) PURPOSE.—The purpose of the Dual Eligible 

23 Quality Care Fund is to provide timely, targeted assist24 ance in the way of grants to State Medicaid programs to 

25 improve their capacity to ensure the provision of quality 

26 integrated care for dual eligible beneficiaries. 


kjohnson on DSK79L0C42PROD with BILLS
3 

•S 3630 IS

1 (c) ALLOWABLE USES OF GRANT FUNDS.—A State 

2 Medicaid program may use amounts received under a 

3 grant from the Dual Eligible Quality Care Fund to im4 prove its capacity to provide quality integrated care for 

5 dual eligible beneficiaries through any of the following: 

6 (1) Recruiting and paying workers with needed 

7 subject matter knowledge, skills, or capabilities. 

8 (2) Actuarial support for rate development and 

9 analysis and development or purchase of risk adjust10 ment tools. 

11 (3) Information technology system changes, in12 cluding changes that— 

13 (A) improve member enrollments; 

14 (B) improve encounter data collection and 

15 analysis; 

16 (C) improve the ability of State Medicaid 

17 programs to develop customized data manage18 ment tools (such as queries and dashboards); 

19 (D) improve compliance with Federal re20 porting requirements; 

21 (E) enhance financial analysis; 

22 (F) improve quality reporting and moni23 toring; 

24 (G) improve modifications to capitation 

25 payments; 


kjohnson on DSK79L0C42PROD with BILLS
4 

•S 3630 IS

1 (H) transfer eligibility and enrollment data 

2 between systems; 

3 (I) improve the grievances and appeals 

4 process; and 

5 (J) improve interaction with Medicare data 

6 and related systems. 

7 (4) Providing support for dual eligible bene8 ficiaries during enrollment processes, assistance to 

9 dual eligible beneficiaries evaluating their enrollment 

10 choices, informational materials to dual eligible 

11 beneficiaries and those assisting with decision sup12 port, and coordination with Medicare enrollment 

13 processes. 

14 (5) Monitoring and oversight of efforts under15 taken by State Medicaid using grant funds, includ16 ing measuring the level of participation by stake17 holders and dual eligible beneficiaries. 

18 (6) Quality measurement and State evaluation 

19 activities, development and deployment of survey 

20 tools, and costs of accessing, transferring, and ana21 lyzing data. 

22 (7) Develop knowledge and understanding with23 in the State Medicaid agency of the Medicare pro24 gram under title XVIII of the Social Security Act 

25 (42 U.S.C. 1395 et seq.). 


kjohnson on DSK79L0C42PROD with BILLS
5 

•S 3630 IS

1 (8) Supporting and improving Medicare initia2 tives, including new initiatives and existing or past 

3 initiatives such as the Financial Alignment Initiative 

4 for Medicare-Medicaid Enrollees demonstration 

5 projects conducted under section 1115A of the So6 cial Security Act (42 U.S.C. 1315a). 

7 (d) AWARDING GRANTS.— 

8 (1) IN GENERAL.—A State Medicaid program 

9 that wishes to receive a grant under this section 

10 from the Dual Eligible Quality Care Fund shall sub11 mit an application to the Director of the Federal Co12 ordinated Health Care Office (referred to in this 

13 subsection as the ‘‘Director’’), in such form and 

14 manner as the Director shall specify. The Director 

15 may award a grant under this section to any State, 

16 without regard to the State’s existing capacity to 

17 provide quality integrated care for dual eligible bene18 ficiaries. 

19 (2) APPLICATION REQUIREMENTS.—An applica20 tion for a grant under this section shall include an 

21 identification of the uses of funds described in sub22 section (c) for which the State Medicaid program 

23 will use the grant funds. 

24 (3) METHODOLOGY FOR DISBURSING FUNDS.— 


kjohnson on DSK79L0C42PROD with BILLS
6 

•S 3630 IS

1 (A) IN GENERAL.—Not later than 6 

2 months after the date of enactment of this Act, 

3 the Director shall issue guidance establishing a 

4 clear and equitable methodology for awarding 

5 grants to State Medicaid programs under this 

6 section. 

7 (B) METHODOLOGY REQUIREMENTS.—The 

8 methodology established by the Director under 

9 this paragraph shall, to the extent practical— 

10 (i) ensure that grant funds are used 

11 in accordance with subsection (c); 

12 (ii) provide that grants are awarded 

13 by the Director in a manner that is trans14 parent and equitable to State Medicaid 

15 programs; and 

16 (iii) provide that, in determining the 

17 grant amount to be awarded to a State 

18 Medicaid program, the Director shall take 

19 into consideration— 

20 (I) the percentage of enrollees in 

21 the program who are dual eligible 

22 beneficiaries; and 

23 (II) the total number of dual eli24 gible beneficiaries enrolled in the pro25 gram. 


kjohnson on DSK79L0C42PROD with BILLS
7 

•S 3630 IS

1 (C) LIMITATIONS.—The Director shall not 

2 award more than 1 grant under this section to 

3 any State Medicaid program, and in no case 

4 may the amount of a grant awarded under this 

5 section exceed $2,000,000. 

6 (e) STATE PROGRAM REPORTING.— 

7 (1) QUARTERLY REPORTING.—States receiving 

8 a grant under this section shall, in a form and man9 ner specified by the Director of the Federal Coordi10 nated Health Care Office (referred to in this sub11 section as the ‘‘Director’’), report no less frequently 

12 than once a quarter regarding the amount of grant 

13 funds spent by the State and how funds received 

14 from the grant are being used within the State. 

15 (2) LONGITUDINAL REPORT.—States receiving 

16 a grant under this section shall, no later than 2 

17 years after the receipt of such grant, submit to the 

18 Director and make available on a State website a re19 port summarizing how the funds received under such 

20 grant were used. Such report shall include the fol21 lowing: 

22 (A) An explanation of which uses of funds 

23 described in subsection (c) the grant funds sup24 ported. 


kjohnson on DSK79L0C42PROD with BILLS
8 

•S 3630 IS

1 (B) An assessment of each of the fol2 lowing: 

3 (i) The manner in which the grant 

4 funds improved the State Medicaid pro5 gram’s capacity to provide quality inte6 grated care for dual eligible beneficiaries. 

7 (ii) The manner in which the grant 

8 funds improved the quality of care for dual 

9 eligible beneficiaries. 

10 (iii) The manner in which the grant 

11 funds improved the integration and coordi12 nation of care for dual eligible bene13 ficiaries. 

14 (f) DEFINITIONS.—In this section: 

15 (1) DUAL ELIGIBLE BENEFICIARY.—The term 

16 ‘‘dual eligible beneficiary’’ means an individual who 

17 is entitled to, or enrolled for, benefits under part A 

18 of title XVIII of the Social Security Act (42 U.S.C. 

19 1395 et seq.), or enrolled for benefits under part B 

20 of such title, and is eligible for medical assistance 

21 under a State plan under title XIX of such Act (42 

22 U.S.C. 1396 et seq.) or under a waiver of such a 

23 plan. 

24 (2) QUALITY INTEGRATED CARE.—The term 

25 ‘‘quality integrated care’’ means the provision of 


kjohnson on DSK79L0C42PROD with BILLS
9 

•S 3630 IS

1 services provided under the Medicare program under 

2 title XVIII of the Social Security Act (42 U.S.C. 

3 1395 et seq.) and services provided under a State 

4 Medicaid program— 

5 (A) through systems in which Medicaid 

6 and Medicare program administrative require7 ments, financing, benefits, or care delivery are 

8 aligned; and 

9 (B) in a coordinated fashion, which may 

10 include coverage of such services through a sin11 gle entity or coordinating entities. 

12 (3) STATE.—The term ‘‘State’’ has the mean13 ing given such term for purposes of title XIX of the 

14 Social Security Act (42 U.S.C. 1396 et seq.). 

15 (4) STATE MEDICAID PROGRAM.—The term 

16 ‘‘State Medicaid program’’ means a State plan 

17 under title XIX of the Social Security Act (42 

18 U.S.C. 1396 et seq.), and includes any waiver of 

19 such a plan. 

20 SEC. 3. PAYMENT ERROR RATE MEASUREMENT (PERM) 

21 AUDIT REQUIREMENTS. 

22 (a) BIENNIAL PERM AUDIT REQUIREMENT.—Be23 ginning with fiscal year 2023, the Administrator shall con24 duct payment error rate measurement (‘‘PERM’’) audits 

25 of each State Medicaid program on a biennial basis. 


kjohnson on DSK79L0C42PROD with BILLS
10 

•S 3630 IS

1 (b) NOTIFICATION; IDENTIFICATION OF SOURCES OF

2 IMPROPER PAYMENTS.— 

3 (1) NOTIFICATION.—Not later than 6 months 

4 after the date of enactment of this Act, the Adminis5 trator shall notify the contractor conducting PERM 

6 audits of the Administrator’s intent to modify con7 tracts to require PERM audits not less than once 

8 every other year in each State. 

9 (2) IDENTIFICATION OF SOURCES OF IMPROPER

10 PAYMENTS.—The Administrator shall direct the con11 tractor conducting PERM audits of State Medicaid 

12 programs to identify areas known to be sources of 

13 improper payments under such programs to identify 

14 program areas or components known to be sources 

15 of high risk for improper payments under such pro16 grams. 

17 (c) STATE MEDICAID DIRECTOR LETTER.—Not later 

18 than 12 months after the date of enactment of this Act, 

19 the Administrator shall issue a State Medicaid Director 

20 letter regarding State requirements under Federal law and 

21 regulations regarding avoiding and responding to im22 proper payments under State Medicaid programs. 

23 (d) STATE IMPROPER PAYMENT MITIGATION

24 PLANS.— 


kjohnson on DSK79L0C42PROD with BILLS
11 

•S 3630 IS

1 (1) IN GENERAL.—Not later than January 1, 

2 2023, each State Medicaid program shall submit to 

3 the Administrator a plan, which shall include spe4 cific actions and timeframes for taking such actions 

5 and achieving specified results, for mitigating im6 proper payments under such program. 

7 (2) PUBLICATION OF STATE PLANS.—The Ad8 ministrator shall make State plans submitted under 

9 paragraph (1) available to the public. 

10 (e) DEFINITIONS.—In this section: 

11 (1) ADMINISTRATOR.—The term ‘‘Adminis12 trator’’ means the Administrator of the Centers for 

13 Medicare & Medicaid Services. 

14 (2) STATE.—The term ‘‘State’’ has the mean15 ing given such term for purposes of title XIX of the 

16 Social Security Act (42 U.S.C. 1396 et seq.). 

17 (3) STATE MEDICAID PROGRAM.—The term 

18 ‘‘State Medicaid program’’ means a State plan 

19 under title XIX of the Social Security Act (42 

20 U.S.C. 1396 et seq.), and includes any waiver of 

21 such a plan. 

Æ 


kjohnson on DSK79L0C42PROD with BILLS