II 

Calendar No. 182 

114TH CONGRESS 

1ST SESSION S. 704 

[Report No. 114–103] 

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

IN THE SENATE OF THE UNITED STATES 

MARCH 11, 2015 

Mr. GRASSLEY (for himself, Mr. CARDIN, Mr. SCHUMER, Mr. FRANKEN, Mr. 

HELLER, and Mrs. GILLIBRAND) introduced the following bill; which was 

read twice and referred to the Committee on Finance 

JULY 30, 2015 

Reported by Mr. HATCH, with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

A BILL 

To establish a Community-Based Institutional Special Needs 

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

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


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1 SECTION 1. SHORT TITLE. 

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

3 Independence for Seniors Act’’. 

4 SEC. 2. FINDINGS. 

5 Congress makes the following findings: 

6 (1) Community-based services play an essential 

7 role in keeping individuals healthy. 

8 (2) Without community-based long-term serv9 ices and supports, which are not typically covered by 

10 Medicare, seniors frequently experience negative 

11 health outcomes and lose their ability to live inde12 pendently. 

13 (3) Seniors who deplete their resources often 

14 have no option but to turn to Medicaid for coverage 

15 of long-term care expenses. 

16 (4) Targeting community-based services and 

17 supports to at-risk seniors can help these individuals 

18 avoid depleting their assets and becoming Medicaid 

19 dependent. 

20 SEC. 3. COMMUNITY-BASED INSTITUTIONAL SPECIAL 

21 NEEDS PLAN DEMONSTRATION. 

22 (a) IN GENERAL.—The Secretary of Health and 

23 Human Services (in this section referred to as the ‘‘Sec24 retary’’) shall establish a Community-Based Institutional 

25 Special Needs Plan demonstration program (in this sec26 tion referred to as the ‘‘CBI-SNP demonstration proVerDate Sep 11 2014 23:15 Jul 30, 2015 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6401 E:\BILLS\S704.RS S704

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1 gram’’) to target home and community-based care to eligi2 ble Medicare beneficiaries. 

3 (b) ESTABLISHMENT.— 

4 (1) IN GENERAL.—The Secretary shall enter 

5 into agreements with up to 5 Medicare Advantage 

6 plans to conduct the CBI-SNP demonstration pro7 gram. Each such MA plan may enroll up to 1,000 

8 eligible Medicare beneficiaries (including new enroll9 ees) in such program. 

10 (2) BENEFITS.—Under the CBI-SNP dem11 onstration program, eligible Medicare beneficiaries 

12 shall receive benefits, in addition to those under part 

13 C of title XVIII of the Social Security Act (including 

14 benefits under section 1852(a)(3) of such Act (42 

15 U.S.C. 1395w22(a)(3))) and notwithstanding any 

16 waivers under section 1915(c) (42 U.S.C. 1396n(c)), 

17 including long-term care services and supports, that 

18 the Secretary determines appropriate for the pur19 poses of the CBI-SNP demonstration program, such 

20 as— 

21 (A) homemaker services; 

22 (B) home delivered meals; 

23 (C) transportation services; 

24 (D) respite care; 

25 (E) adult day care services; and 


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1 (F) non-Medicare-covered safety and other 

2 equipment. 

3 (3) PAYMENTS.—The Secretary shall establish 

4 a benchmark payment amount for reimbursing Medi5 care Advantage plans participating in the CBI-SNP 

6 demonstration program for benefits provided to eligi7 ble beneficiaries under such program. Such pay8 ments shall be in addition to payments made to such 

9 plans under part C of title XVIII of the Social Secu10 rity Act. 

11 (c) ELIGIBLE PLANS.—To be eligible to participate 

12 in the CBI-SNP demonstration program, a Medicare Ad13 vantage plan must— 

14 (1) have experience in offering special needs 

15 plans for nursing home-eligible, non-institutionalized 

16 Medicare beneficiaries who live in the community; 

17 (2) have experience working with low income 

18 seniors groups; 

19 (3) be located in a State that the Secretary has 

20 determined will participate in the CBI-SNP dem21 onstration program by agreeing to make available 

22 data necessary for purposes of conducting the inde23 pendent evaluation required under subsection (h); 

24 and 


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1 (4) meet such other criteria as the Secretary 

2 may require. 

3 (d) ELIGIBLE MEDICARE BENEFICIARY DEFINED.— 

4 In this section, the term ‘‘eligible Medicare beneficiary’’ 

5 means a Medicare beneficiary who— 

6 (1) is enrolled or eligible to enroll in a Medicare 

7 Advantage plan that has been selected to participate 

8 in the CBI-SNP demonstration program; 

9 (2) is a subsidy eligible individual (as defined in 

10 section 1860D–14(a)(3)(A) of the Social Security 

11 Act (42 U.S.C. 1395w114(a)(3)(A))); 

12 (3) is not eligible to receive benefits under title 

13 XIX of the Social Security Act; 

14 (4) is unable to perform 2 or more activities of 

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

16 the Internal Revenue Code of 1986); and 

17 (5) is age 65 or older. 

18 (e) SPECIAL ELECTION PERIOD.—Notwithstanding 

19 sections 1852(e)(2)(C) and 1860D–1(b)(1)(B)(iii) of the 

20 Social Security Act (42 U.S.C. 1395w–21(e)(2)(C); 

21 1395w–101(b)(1)(B)(iii)), an eligible Medicare beneficiary 

22 may, other than during the annual, coordinated election 

23 periods under such sections— 

24 (1) discontinue enrollment in a Medicare Ad25 vantage plan not participating in the CBI-SNP demVerDate Sep 11 2014 23:15 Jul 30, 2015 Jkt 049200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6401 E:\BILLS\S704.RS S704

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1 onstration program and enroll in a Medicare Advan2 tage plan participating in such program; and 

3 (2) discontinue enrollment under the original 

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

5 B of such title and the enrollment in a prescription 

6 drug plan under part D of such title and enroll in 

7 a Medicare Advantage plan participating in the CBI8 SNP demonstration program. 

9 (f) BENEFICIARY EDUCATION.—The Secretary shall 

10 help to educate eligible Medicare beneficiaries on the avail11 ability of the CBI-SNP demonstration program through 

12 State Health Insurance Assistance Programs and other 

13 organizations dedicated to assisting seniors with Medicare 

14 benefits and enrollment. 

15 (g) IMPLEMENTATION.— 

16 (1) DEADLINE.—The CBI-SNP demonstration 

17 program shall be implemented not later than Janu18 ary 1, 2017. 

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

20 CBI-SNP demonstration program shall be conducted 

21 for a period of 5 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 expenditures under titles 

6 XVIII and XIX of the Social Security Act with 

7 respect to eligible Medicare beneficiaries partici8 pating in the CBI-SNP demonstration program; 

9 or 

10 (B) decrease the quality of health care 

11 services furnished to eligible Medicare bene12 ficiaries participating in the CBI-SNP dem13 onstration program. 

14 (h) INDEPENDENT EVALUATION AND REPORTS.— 

15 (1) INDEPENDENT EVALUATION.—The Sec16 retary shall provide for the evaluation of the CBI17 SNP demonstration program by an independent 

18 third party. Such evaluation shall be completed 

19 using evaluation criteria that are clearly articulated 

20 prior to the implementation of such program. Such 

21 criteria shall include specific goals of such program, 

22 hypotheses being tested, clear data collection and re23 porting requirements, recognizing that definitions, 

24 benefits and program requirements for long-term 

25 care services and supports vary across States. Such 


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1 evaluation shall determine whether the CBI-SNP 

2 demonstration program has— 

3 (A) improved patient care; 

4 (B) reduced hospitalizations or rehos5 pitalizations; 

6 (C) reduced or delayed Medicaid nursing 

7 facility admissions and lengths of stay; 

8 (D) reduced spend down of income and as9 sets for purposes of becoming eligible for Med10 icaid; and 

11 (E) improved quality of life for the dem12 onstration population and beneficiary and care13 giver satisfaction. 

14 (2) REPORTS.—Not later than 4 years after the 

15 implementation of the CBI-SNP demonstration pro16 gram, the Secretary shall submit to Congress a re17 port containing the results of the evaluation con18 ducted under paragraph (1), together with such rec19 ommendations for legislative or administrative action 

20 as the Secretary determines appropriate. In pre21 paring such report, the Secretary shall use at least 

22 3 years worth of data under the demonstration pro23 gram. 

24 (i) BUDGET NEUTRALITY.—By the end of the third 

25 year of the CBI-SNP demonstration program, the SecVerDate Sep 11 2014 23:15 Jul 30, 2015 Jkt 049200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6401 E:\BILLS\S704.RS S704

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1 retary shall ensure that the aggregate payments made 

2 under titles XVIII and XIX of the Social Security Act, 

3 including under the demonstration program, for subse4 quent periods do not exceed the amount which the Sec5 retary estimates would have been expended under such ti6 tles during such a period if the CBI-SNP demonstration 

7 program had not been implemented. 

8 (j) PAPERWORK REDUCTION ACT.—Chapter 35 of 

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

10 and evaluation of the CBI-SNP demonstration program. 

11 SECTION 1. SHORT TITLE. 

12 This Act may be cited as the ‘‘Community Based Inde13 pendence for Seniors Act’’. 

14 SEC. 2. FINDINGS. 

15 Congress makes the following findings: 

16 (1) Community-based services play an essential 

17 role in keeping individuals healthy. 

18 (2) Without community-based long-term services 

19 and supports, which are not typically covered by 

20 Medicare, seniors frequently experience negative 

21 health outcomes and lose their ability to live inde22 pendently. 

23 (3) Seniors who deplete their resources often have 

24 no option but to turn to Medicaid for coverage of 

25 long-term care expenses. 


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1 (4) Targeting community-based services and sup2 ports to at-risk seniors can help these individuals 

3 avoid depleting their assets and becoming Medicaid 

4 dependent. 

5 SEC. 3. COMMUNITY-BASED INSTITUTIONAL SPECIAL 

6 NEEDS PLAN DEMONSTRATION. 

7 (a) IN GENERAL.—The Secretary of Health and 

8 Human Services (referred to in this section as the ‘‘Sec9 retary’’) shall establish a Community-Based Institutional 

10 Special Needs Plan demonstration program (in this section 

11 referred to as the ‘‘CBI-SNP demonstration program’’) to 

12 prevent and delay institutionalization under the Medicaid 

13 program among eligible low-income Medicare beneficiaries. 

14 (b) ESTABLISHMENT.— 

15 (1) IN GENERAL.—The Secretary shall enter into 

16 agreements with not more than 5 eligible MA plans 

17 to conduct the CBI-SNP demonstration program. 

18 Each such eligible MA plan may enroll up to 1,000 

19 eligible low-income Medicare beneficiaries (including 

20 new enrollees) in such program. 

21 (2) USE OF PART C REBATE TO FURNISH CER22 TAIN BENEFITS.—Under the CBI-SNP demonstration 

23 program, an eligible MA plan selected to participate 

24 in such program shall use the rebate that the plan is 

25 required (under section 1854 of the Social Security 


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1 Act (42 U.S.C. 13954–24)) to provide to eligible low2 income Medicare beneficiaries enrolled in the plan in 

3 order to furnish, as supplemental benefits under sec4 tion 1852(a)(3) of such Act (42 U.S.C. 1395w– 

5 22(a)(3)) and notwithstanding any waivers under 

6 section 1915(c) of such Act (42 U.S.C. 1396n(c)), ben7 efits to such beneficiaries, including long-term care 

8 services and supports, that the Secretary determines 

9 appropriate for the purposes of the CBI-SNP dem10 onstration program, such as— 

11 (A) homemaker services; 

12 (B) home delivered meals; 

13 (C) transportation services; 

14 (D) respite care; 

15 (E) adult day care services; and 

16 (F) non-Medicare-covered safety and other 

17 equipment. 

18 (c) ELIGIBLE MA PLAN.—In this section, the term ‘‘el19 igible MA plan’’ means a specialized MA plan for special 

20 needs individuals (as defined in section 1859(b)(6) of the 

21 Social Security Act (42 U.S.C. 1395w–28(b)(6)) that— 

22 (1) has experience in offering special needs plans 

23 for nursing home-eligible, non-institutionalized Medi24 care beneficiaries who live in the community; 


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1 (2) has experience working with low income 

2 beneficiaries, including low income beneficiaries du3 ally eligible for benefits under titles XVIII and XIX 

4 of such Act; 

5 (3) has a service area in a State that has agreed 

6 to make available to the Secretary Medicaid data nec7 essary for purposes of conducting the independent 

8 evaluation required under subsection (j); and 

9 (4) meets such other criteria as the Secretary 

10 may require. 

11 (d) ELIGIBLE LOW-INCOME MEDICARE BENEFICIARY

12 DEFINED.—In this section, the term ‘‘eligible low-income 

13 Medicare beneficiary’’ means an individual who is— 

14 (1) a Medicare Advantage eligible individual (as 

15 defined in section 1851(a)(3) of the Social Security 

16 Act (42 U.S.C. 1395w–21(a)(3)); 

17 (2) a subsidy eligible individual (as defined in 

18 section 1860D–14(a)(3)(A) of such Act (42 U.S.C. 

19 1395w-114(a)(3)(A)); 

20 (3) not eligible to receive benefits under title XIX 

21 of the Social Security Act; 

22 (4) unable to perform 2 or more activities of 

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

24 the Internal Revenue Code of 1986); and 

25 (5) age 65 or older. 


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1 (e) SPECIAL ELECTION PERIOD.—Notwithstanding 

2 sections 1852(e)(2)(C) and 1860D–1(b)(1)(B)(iii) of the So3 cial Security Act (42 U.S.C. 1395w–21(e)(2)(C); 1395w– 

4 101(b)(1)(B)(iii)), an eligible Medicare beneficiary may, 

5 other than during the annual, coordinated election periods 

6 under such sections— 

7 (1) discontinue enrollment in a Medicare Advan8 tage plan not participating in the CBI-SNP dem9 onstration program and enroll in an eligible MA plan 

10 participating in such program if the beneficiary re11 sides in the participating plan’s service area; and 

12 (2) discontinue enrollment under the original 

13 medicare fee-for-service program under parts A and B 

14 of title XVIII of such Act and the enrollment in a 

15 prescription drug plan under part D of such title and 

16 enroll in an eligible MA plan participating in the 

17 CBI-SNP demonstration program if the beneficiary 

18 resides in the participating plan’s service area. 

19 (f) BENEFICIARY EDUCATION.—The Secretary shall 

20 help to educate eligible Medicare beneficiaries on the avail21 ability of the CBI-SNP demonstration program through 

22 State Health Insurance Assistance Programs and other or23 ganizations dedicated to assisting seniors with Medicare 

24 benefits and enrollment. 


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1 (g) DURATION.—The CBI-SNP demonstration pro2 gram shall be implemented not later than January 1, 2018, 

3 and shall be conducted for a period of 5 years. 

4 (h) BUDGET NEUTRALITY.—In conducting the CBI5 SNP demonstration program, the Secretary shall ensure 

6 that the aggregate payments made by the Secretary do not 

7 exceed the amount which the Secretary estimates would 

8 have been expended under titles XVIII and XIX of the So9 cial Security Act (42 U.S.C. 1395 et seq., 1396 et seq.) if 

10 the CBI-SNP demonstration program had not been imple11 mented. 

12 (i) EXPANSION OF DEMONSTRATION PROGRAM.—Tak13 ing into account the evaluation under subsection (j), the 

14 Secretary may, through notice and comment rulemaking, 

15 expand (including implementation on a nationwide basis) 

16 the duration and scope of the CBI-SNP demonstration pro17 gram under title XVIII of the Social Security Act, other 

18 than under the original medicare fee-for-service program 

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

20 appropriate by the Secretary, if the requirements of para21 graphs (1), (2) and (3) of subsection (c) of section 1115A 

22 of the Social Security Act (42 U.S.C. 1315a), as applied 

23 to the testing of a model under subsection (b) of such section, 

24 applied to the CBI-SNP demonstration program. 

25 (j) INDEPENDENT EVALUATION AND REPORTS.— 


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1 (1) INDEPENDENT EVALUATION.—The Secretary 

2 shall provide for the evaluation of the CBI-SNP dem3 onstration program by an independent third party. 

4 Such evaluation shall be completed using evaluation 

5 criteria that are clearly articulated prior to the im6 plementation of such program. Such criteria shall in7 clude specific goals of such program, hypotheses being 

8 tested, and clear data collection and reporting re9 quirements, recognizing that definitions, benefits, and 

10 program requirements for long-term care services and 

11 supports vary across States. Such evaluation shall de12 termine whether the CBI-SNP demonstration pro13 gram has— 

14 (A) improved patient care; 

15 (B) reduced hospitalizations or rehos16 pitalizations; 

17 (C) reduced or delayed Medicaid nursing fa18 cility admissions and lengths of stay; 

19 (D) reduced spend down of income and as20 sets for purposes of becoming eligible for Med21 icaid; and 

22 (E) improved quality of life for the dem23 onstration population and beneficiary and care24 giver satisfaction. 


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1 (2) REPORTS.—Not later than January 1, 2022, 

2 the Secretary shall submit to Congress a report con3 taining the results of the evaluation conducted under 

4 paragraph (1), together with such recommendations 

5 for legislative or administrative action as the Sec6 retary determines appropriate. In preparing such re7 port, the Secretary shall use at least 3 years worth of 

8 data under the CBI-SNP demonstration program. 

9 (k) FUNDING.— 

10 (1) FUNDING FOR IMPLEMENTATION.—For pur11 poses of administering the CBI-SNP demonstration 

12 program (other than the evaluation and report under 

13 subsection (j)), the Secretary shall provide for the 

14 transfer from the Federal Hospital Insurance Trust 

15 Fund under section 1817 of the Social Security Act 

16 (42 U.S.C. 1395i) and the Federal Supplementary 

17 Medical Insurance Trust Fund under section 1841 of 

18 such Act (42 U.S.C. 1395t), in such proportion as the 

19 Secretary determines appropriate, of $3,000,000 to 

20 the Centers for Medicare & Medicaid Services Pro21 gram Management Account. 

22 (2) FUNDING FOR EVALUATION AND REPORT.— 

23 For purposes of carrying out the evaluation and re24 port under subsection (j), the Secretary shall provide 

25 for the transfer from the Federal Hospital Insurance 


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1 Trust Fund under such section 1817 and the Federal 

2 Supplementary Medical Insurance Trust Fund under 

3 such section 1841, in such proportion as the Secretary 

4 determines appropriate, of $500,000 to the Centers for 

5 Medicare & Medicaid Services Program Management 

6 Account. 

7 (3) AVAILABILITY.—Amounts transferred under 

8 paragraph (1) or (2) shall remain available until ex9 pended. 

10 (l) PAPERWORK REDUCTION ACT.—Chapter 35 of title 

11 44, United States Code, shall not apply to the testing and 

12 evaluation of the CBI-SNP demonstration program. 


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Calendar No. 182 

114TH CONGRESS 

1ST SESSION S. 704 

[Report No. 114–103] 

A BILL 

To establish a Community-Based Institutional Specare beneficiaries. home and community-based care to eligible Medi- cial Needs Plan demonstration program to target 

JULY 30, 2015 

Reported with an amendment 


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