II 

117TH CONGRESS 

2D SESSION S. 4273 

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 

MAY 19 (legislative day, MAY 17), 2022 

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. 

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 States in 

5 Integrating Care Act of 2022’’. 


kjohnson on DSK79L0C42PROD with BILLS
2 

•S 4273 IS

1 SEC. 2. SUPPORTING STATE EFFORTS TO INTEGRATE MEDI2 CARE AND MEDICAID BENEFITS FOR FULL3 BENEFIT DUAL ELIGIBLE INDIVIDUALS. 

4 (a) IN GENERAL.—Section 1902 of the Social Secu5 rity Act (42 U.S.C. 1396a) is amended— 

6 (1) in subsection (a)— 

7 (A) by striking ‘‘and’’ at the end of para8 graph (86); 

9 (B) by striking the period at the end of 

10 paragraph (87) and inserting ‘‘; and’’; and 

11 (C) by inserting after paragraph (87) the 

12 following new paragraph: 

13 ‘‘(88) in the case of a State that is 1 of the 50 

14 States or the District of Columbia, provide that the 

15 State will carry out activities to coordinate and inte16 grate benefits for full-benefit dual eligible individuals 

17 (as defined in section 1935(c)(6)) in accordance with 

18 a Dual Coordination and Integration Plan approved 

19 by the Secretary under subsection (tt).’’; and 

20 (2) by adding at the end the following new sub21 section: 

22 ‘‘(tt) SUPPORTING STATE EFFORTS TO INTEGRATE

23 MEDICARE AND MEDICAID BENEFITS FOR FULL-BEN24 EFIT DUAL ELIGIBLE INDIVIDUALS.— 

25 ‘‘(1) DEFINITIONS.—In this subsection: 


kjohnson on DSK79L0C42PROD with BILLS
3 

•S 4273 IS

1 ‘‘(A) FULL-BENEFIT DUAL ELIGIBLE INDI2 VIDUAL.—The term ‘full-benefit dual eligible in3 dividual’ has the meaning given that term in 

4 section 1935(c)(6). 

5 ‘‘(B) MEDICAID.—The term ‘Medicaid’ 

6 means the program for grants to States for 

7 medical assistance programs established under 

8 this title. 

9 ‘‘(C) MEDICARE.—The term ‘Medicare’ the 

10 program of health insurance for the aged and 

11 disabled established under title XVIII. 

12 ‘‘(D) MEDICARE AND MEDICAID BENE13 FITS.—The term ‘Medicare and Medicaid bene14 fits’ means benefits available under Medicaid 

15 and Medicare. 

16 ‘‘(E) MEDICARE-MEDICAID COORDINATION

17 OFFICE.—The term ‘Medicare-Medicaid Coordi18 nation Office’ means the Medicare Medicaid Co19 ordination Office established as the Federal Co20 ordinated Health Care Office under section 

21 2602 of the Patient Protection and Affordable 

22 Care Act. 

23 ‘‘(F) RELEVANT STAKEHOLDERS.—The 

24 term ‘relevant stakeholders’ means the fol25 lowing: 


kjohnson on DSK79L0C42PROD with BILLS
4 

•S 4273 IS

1 ‘‘(i) Full-benefit dual eligible individ2 uals and their representatives. 

3 ‘‘(ii) Beneficiary advocates. 

4 ‘‘(iii) Health plans. 

5 ‘‘(iv) Health care providers, such as 

6 physicians, hospitals, and nursing homes. 

7 ‘‘(v) PACE providers. 

8 ‘‘(vi) Community-based organizations. 

9 ‘‘(vii) Other interested individuals or 

10 groups as determined by the Secretary or 

11 the State. 

12 ‘‘(2) PLANNING GRANTS.— 

13 ‘‘(A) IN GENERAL.—Not later than 1 year 

14 after the date of enactment of this subsection, 

15 from the amount reserved under paragraph 

16 (8)(B), the Secretary shall award a planning 

17 grant to each State to carry out planning activi18 ties to develop and submit to the Secretary a 

19 Dual Coordination and Integration Plan de20 scribed in paragraph (3). 

21 ‘‘(B) LIMITATION.—The Secretary shall 

22 award planning grants to States under this 

23 paragraph in such amounts as the Secretary 

24 shall determine except that in no case shall a 


kjohnson on DSK79L0C42PROD with BILLS
5 

•S 4273 IS

1 grant awarded under this paragraph exceed 

2 $5,000,000. 

3 ‘‘(C) USE OF FUNDS.—A State may only 

4 use grant funds awarded under this paragraph 

5 for the planning activities described in subpara6 graph (A), except that, if a State does not use 

7 all of the grant funds and receives approval for 

8 a Dual Coordination and Integration Plan de9 scribed in paragraph (3), the State may use any 

10 remaining funds to carry out activities de11 scribed in paragraph (4) that are in accordance 

12 with such plan. 

13 ‘‘(3) DUAL COORDINATION AND INTEGRATION

14 PLAN.— 

15 ‘‘(A) IN GENERAL.—As a condition of re16 ceiving a payment under this subsection, a 

17 State shall submit to the Secretary for approval 

18 a Dual Coordination and Integration Plan (to 

19 be developed by the State with input from rel20 evant stakeholders) describing the State’s strat21 egy for integrating and coordinating health ben22 efits coverage for full-benefit dual eligible indi23 viduals that includes detailed descriptions of the 

24 following components: 


kjohnson on DSK79L0C42PROD with BILLS
6 

•S 4273 IS

1 ‘‘(i) A description of the activities de2 scribed in paragraph (4) that will be car3 ried out under the plan. 

4 ‘‘(ii) The integration and coordination 

5 approaches selected by the State. 

6 ‘‘(iii) The eligibility requirements and 

7 benefits available under such strategy. 

8 ‘‘(iv) The education, enrollment, and 

9 outreach strategy for participation by full10 benefit dual eligible individuals. 

11 ‘‘(v) Beneficiary protections intended 

12 to preserve and strengthen beneficiary 

13 choice and access to care. 

14 ‘‘(vi) The plan for collecting data ana15 lytics and measuring the quality of care 

16 provided under such strategy. 

17 ‘‘(vii) Structures to promote health 

18 equity. 

19 ‘‘(viii) The coordination and integra20 tion of mental health benefits with other 

21 benefits and services available under Medi22 care and Medicaid for full-benefit dual eli23 gible individuals under such strategy. 

24 ‘‘(ix) Such other components as the 

25 Secretary may require. 


kjohnson on DSK79L0C42PROD with BILLS
7 

•S 4273 IS

1 ‘‘(B) DEVELOPMENT AND SUBMISSION.— 

2 In order to meet the requirements of this sub3 section, a Dual Coordination and Integration 

4 Plan shall— 

5 ‘‘(i) be submitted for approval by the 

6 Secretary not later than 24 months after 

7 the date on which the State was awarded 

8 a planning grant under paragraph (2); and 

9 ‘‘(ii) be made publicly available in the 

10 final version submitted to the Secretary on 

11 a State Internet website. 

12 ‘‘(C) APPROVAL; PUBLICATION.— 

13 ‘‘(i) IN GENERAL.—The Secretary 

14 shall approve a Dual Coordination and In15 tegration Plan submitted by a State under 

16 this paragraph if— 

17 ‘‘(I) the plan contains each of the 

18 components required under subpara19 graph (A); and 

20 ‘‘(II) the State provides assur21 ances to the satisfaction of the Sec22 retary that the State will carry out 

23 the Dual Coordination and Integra24 tion Plan as it is written. 


kjohnson on DSK79L0C42PROD with BILLS
8 

•S 4273 IS

1 ‘‘(ii) REGULAR REVIEWS AND UP2 DATES.—The State regularly shall review 

3 and update a Dual Coordination and Inte4 gration Plan approved under this subpara5 graph at such times and in accordance 

6 with such requirements as the Secretary 

7 shall specify. 

8 ‘‘(4) MEDICARE AND MEDICAID COORDINATION

9 AND INTEGRATION ACTIVITIES.— 

10 ‘‘(A) IN GENERAL.—The activities de11 scribed in this paragraph are the following: 

12 ‘‘(i) Activities to recruit or retain ex13 pert capacity at the State agency respon14 sible for administering the State plan 

15 under this title to inform the integration of 

16 Medicare and Medicaid for full-benefit dual 

17 eligible individuals. 

18 ‘‘(ii) Training for staff at such State 

19 agency to develop expertise to inform the 

20 integration of Medicare and Medicaid ben21 efits for full-benefit dual eligible individ22 uals. 

23 ‘‘(iii) Support for development of pay24 ment rates and alternative payment mod25 els. 


kjohnson on DSK79L0C42PROD with BILLS
9 

•S 4273 IS

1 ‘‘(iv) Development of information 

2 technology infrastructure to— 

3 ‘‘(I) support data sharing among 

4 health plans, providers, PACE pro5 viders, community-based organiza6 tions, and Federal, State, and local 

7 government agencies; and 

8 ‘‘(II) transfer Medicare and Med9 icaid eligibility and enrollment data. 

10 ‘‘(v) Advancement of a unified Medi11 care and Medicaid grievance and appeals 

12 structure for determinations made by inte13 grated agencies (as permissible under the 

14 rules and regulations of the Centers for 

15 Medicare & Medicaid Services). 

16 ‘‘(vi) Development of, or enhance17 ments to, enrollment, outreach, and edu18 cation supports for full-benefit dual eligible 

19 individuals. 

20 ‘‘(vii) Development of, or enhance21 ments to, administration, monitoring, and 

22 oversight systems and protocols for all en23 tities that provide coordinated or inte24 grated Medicare and Medicaid benefits to 

25 full-benefit dual eligible individuals. 


kjohnson on DSK79L0C42PROD with BILLS
10 

•S 4273 IS

1 ‘‘(viii) Development of, or enhance2 ments to, administration of quality meas3 urement and improvement programs for 

4 services furnished to full-benefit dual eligi5 ble individuals. 

6 ‘‘(ix) Stakeholder engagement proc7 esses, including— 

8 ‘‘(I) the establishment and main9 tenance of a Consumer Advisory 

10 Council comprised of full-benefit dual 

11 eligible individuals, as well as bene12 ficiary advocates, and their represent13 atives that is reflective of the local 

14 population in terms of status for dual 

15 eligible qualification as well as race, 

16 ethnicity, sexual orientation, and 

17 other characteristics determined by 

18 the State; and 

19 ‘‘(II) the establishment and 

20 maintenance of a stakeholder engage21 ment group that regularly solicits and 

22 incorporates into the State’s Medicare 

23 and Medicaid coordination or integra24 tion strategy input from the Con25 sumer Advisory Council and other relVerDate Sep 11 2014 00:13 May 28, 2022 Jkt 029200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S4273.IS S4273

kjohnson on DSK79L0C42PROD with BILLS
11 

•S 4273 IS

1 evant stakeholders (as defined in 

2 paragraph (1)) in the State. 

3 ‘‘(x) Development of a workforce 

4 needs assessment to identify the needs of 

5 the full-benefit dually eligible population, 

6 including strategies to ensure adequate 

7 compensation for the workforce. 

8 ‘‘(B) LIMITATIONS.—No payment may be 

9 made under this subsection for expenditures on 

10 an activity that the State carried out before the 

11 date of enactment of this subsection. 

12 ‘‘(5) PAYMENTS TO STATES.— 

13 ‘‘(A) IN GENERAL.—Subject to subpara14 graph (B), for each fiscal quarter during which 

15 a State has in effect a Dual Coordination and 

16 Integration Plan approved under paragraph (3), 

17 the Secretary shall pay to the State an amount 

18 equal to 50 percent (or, during the first 20 full 

19 fiscal quarters during which the plan is in ef20 fect, 80 percent) of the amounts expended by 

21 the State during the quarter on activities de22 scribed in paragraph (4) that are in accordance 

23 with such plan. 

24 ‘‘(B) LIMITATIONS.— 


kjohnson on DSK79L0C42PROD with BILLS
12 

•S 4273 IS

1 ‘‘(i) USE OF PLANNING GRANT

2 FUNDS.—A State shall not be eligible for a 

3 payment under this paragraph until the 

4 State has expended the full amount of the 

5 planning grant awarded to the State under 

6 paragraph (2). 

7 ‘‘(ii) NON-DUPLICATION OF PAYMENT; 

8 APPLICATION OF HIGHER RATES.—No pay9 ment shall be made under this paragraph 

10 with respect to State expenditures of funds 

11 made available from Federal sources, and 

12 to the extent that a State expenditure is el13 igible for a Federal payment under both 

14 subparagraph (A) and another provision of 

15 this title or any other law, payment shall 

16 only be made under the provision that re17 sults in the State receiving the higher pay18 ment. 

19 ‘‘(C) MANNER OF PAYMENT.—Payment to 

20 a State under this subsection shall be made in 

21 the same manner as payments for State ex22 penditures for the proper and efficient adminis23 tration of the State plan described in section 

24 1903(a)(7). 


kjohnson on DSK79L0C42PROD with BILLS
13 

•S 4273 IS

1 ‘‘(6) EVALUATION OF PLAN IMPLEMENTATION; 

2 REPORTING REQUIREMENT.— 

3 ‘‘(A) EVALUATION BENCHMARKS.—The 

4 Secretary shall establish benchmarks for evalu5 ating whether a State’s use of payments re6 ceived under this subsection is in alignment 

7 with the State’s Dual Coordination and Inte8 gration Plan (as approved under paragraph 

9 (3)). 

10 ‘‘(B) ANNUAL REPORT.—As a condition of 

11 payment under this subsection— 

12 ‘‘(i) a State shall submit to the Sec13 retary an annual report detailing how the 

14 State is using payments received under 

15 this subsection; and 

16 ‘‘(ii) the Secretary shall certify, based 

17 on such report, that the State’s use of 

18 such payments is in alignment with the 

19 State’s Dual Coordination and Integration 

20 Plan (as approved under paragraph (3)). 

21 ‘‘(7) ADMINISTRATION.—In carrying out this 

22 subsection, the Secretary shall coordinate with the 

23 Medicare-Medicaid Coordination Office and other 

24 Federal agencies as appropriate. 

25 ‘‘(8) FUNDING.— 


kjohnson on DSK79L0C42PROD with BILLS
14 

•S 4273 IS

1 ‘‘(A) IN GENERAL.—Out of any funds in 

2 the Treasury not otherwise appropriated, there 

3 is appropriated to the Secretary $300,000,000 

4 for fiscal year 2023 to carry out this sub5 section, to remain available until expended. 

6 ‘‘(B) RESERVATION FOR PLANNING

7 GRANTS.—Of the amount appropriated under 

8 subparagraph (A), $150,000,000 is reserved to 

9 award planning grants under paragraph (2). 

10 ‘‘(C) TECHNICAL ASSISTANCE AND GUID11 ANCE.—Of the amount appropriated under sub12 paragraph (A), $150,000,000 is reserved for 

13 issuing guidance and providing technical assist14 ance to States in— 

15 ‘‘(i) developing and implementing 

16 Dual Coordination and Integration Plans 

17 under this subsection; and 

18 ‘‘(ii) completing the annual reports re19 quired under paragraph (6).’’. 

20 (b) EFFECTIVE DATE.— 

21 (1) IN GENERAL.—Except as provided in para22 graph (2), the amendments made by this section 

23 shall take effect on the date of enactment of this 

24 Act. 


kjohnson on DSK79L0C42PROD with BILLS
15 

•S 4273 IS

1 (2) DELAY IF STATE LEGISLATION NEEDED.— 

2 In the case of a State plan for medical assistance 

3 under title XIX of the Social Security Act which the 

4 Secretary of Health and Human Services determines 

5 requires State legislation (other than legislation ap6 propriating funds) in order for the plan to meet the 

7 additional requirements imposed by the amendments 

8 made by the section, the State plan shall not be re9 garded as failing to comply with the requirements of 

10 such title solely on the basis of its failure to meet 

11 these additional requirements before the first day of 

12 the first calendar quarter beginning after the close 

13 of the first regular session of the State legislature 

14 that begins after the date of the enactment of this 

15 Act. For purposes of the previous sentence, in the 

16 case of a State that has a 2-year legislative session, 

17 each year of such session shall be deemed to be a 

18 separate regular session of the State legislature. 

Æ 


kjohnson on DSK79L0C42PROD with BILLS