II 

117TH CONGRESS 

2D SESSION S. 4264 

To amend title XIX of the Social Security Act to require States to develop 

a strategy to integrate and coordinate Medicaid and Medicare coverage 

for full-benefit dual eligible individuals. 

IN THE SENATE OF THE UNITED STATES 

MAY 19 (legislative day, MAY 17), 2022 

Mr. SCOTT of South Carolina (for himself, Mr. CASEY, and Mr. CASSIDY) 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 require 

States to develop a strategy to integrate and coordinate 

Medicaid and Medicare coverage for full-benefit dual eligible individuals. 

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 ‘‘Advancing Integration 

5 in Medicare and Medicaid (AIM) Act’’. 


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1 SEC. 2. COVERAGE INTEGRATION AND COORDINATION 

2 STRATEGY FOR FULL-BENEFIT DUAL ELIGI3 BLE INDIVIDUALS. 

4 (a) MEDICAID STATE PLAN REQUIREMENT.—Section 

5 1902 of the Social Security Act (42 U.S.C. 1396a) is 

6 amended— 

7 (1) in subsection (a)— 

8 (A) by striking ‘‘and’’ at the end of para9 graph (86); 

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

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

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

13 following new paragraph: 

14 ‘‘(88) include a strategy for integrating and co15 ordinating health benefits coverage under this title 

16 and title XVIII for full-benefit dual eligible individ17 uals (as defined in section 1935(c)(6)) in accordance 

18 with the requirements of subsection (tt).’’; and 

19 (2) by adding at the end the following new sub20 section: 

21 ‘‘(tt) COVERAGE INTEGRATION AND COORDINATION

22 STRATEGY FOR FULL-BENEFIT DUAL ELIGIBLE INDIVID23 UALS.—For purposes of subsection (a)(88), the require24 ments under this subsection are the following: 

25 ‘‘(1) GENERAL REQUIREMENTS.—Not later 

26 than 2 years after the date of enactment of this subVerDate Sep 11 2014 22:42 May 26, 2022 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4264.IS S4264

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1 section, the State shall develop, in consultation with 

2 relevant stakeholders, and submit to the Secretary 

3 for approval a strategy for integrating and coordi4 nating health benefits coverage for full-benefit dual 

5 eligible individuals (as defined in section 1935(c)(6)) 

6 that includes detailed descriptions of the following 

7 components: 

8 ‘‘(A) The integration and coordination ap9 proaches selected by the State. 

10 ‘‘(B) The eligibility requirements and bene11 fits available under such strategy. 

12 ‘‘(C) The education and enrollment strat13 egy for participation by full-benefit dual eligible 

14 individuals (as so defined). 

15 ‘‘(D) Beneficiary protections intended to 

16 preserve and strengthen beneficiary choice and 

17 access to care. 

18 ‘‘(E) The plan for collecting data analytics 

19 and measuring the quality of care provided 

20 under such strategy. 

21 ‘‘(F) Structures to promote health equity. 

22 ‘‘(G) The coordination and integration of 

23 mental health benefits with other benefits and 

24 services available under this title and title 


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1 XVIII for full-benefit dual eligible individuals 

2 under such strategy. 

3 ‘‘(H) Such other components as the Sec4 retary may require. 

5 ‘‘(2) REGULAR REVIEWS AND UPDATES.—The 

6 State regularly shall review and update the strategy 

7 developed and approved under paragraph (1) in ac8 cordance with such timing and other requirements 

9 as the Secretary shall specify. 

10 ‘‘(3) RELEVANT STAKEHOLDERS.—For pur11 poses of paragraph (1), the term ‘relevant stake12 holders’ means each of the following: 

13 ‘‘(A) Full-benefit dual eligible individuals 

14 (as defined in section 1935(c)(6)) and their rep15 resentatives. 

16 ‘‘(B) Health plans. 

17 ‘‘(C) Health care providers, such as physi18 cians, hospitals, and nursing homes. 

19 ‘‘(D) PACE providers. 

20 ‘‘(E) Community-based organizations. 

21 ‘‘(F) Beneficiary advocates. 

22 ‘‘(G) Others as determined appropriate by 

23 the Secretary or the State.’’. 

24 (b) EFFECTIVE DATE; IMPLEMENTATION.— 


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1 (1) IN GENERAL.—Except as provided in para2 graph (2), the amendments made by this section 

3 shall take effect on the date of enactment of this 

4 Act. 

5 (2) DELAY IF STATE LEGISLATION NEEDED.— 

6 In the case of a State plan for medical assistance 

7 under title XIX of the Social Security Act which the 

8 Secretary of Health and Human Services determines 

9 requires State legislation (other than legislation ap10 propriating funds) in order for the plan to meet the 

11 additional requirements imposed by the amendments 

12 made by the section, the State plan shall not be re13 garded as failing to comply with the requirements of 

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

15 these additional requirements before the first day of 

16 the first calendar quarter beginning after the close 

17 of the first regular session of the State legislature 

18 that begins after the date of the enactment of this 

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

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

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

22 separate regular session of the State legislature. 

Æ 


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