II 

114TH CONGRESS 

1ST SESSION S. 704 

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 and Mr. CARDIN) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

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, 

3 SECTION 1. SHORT TITLE. 

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

5 Independence for Seniors Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 

8 (1) Community-based services play an essential 

9 role in keeping individuals healthy. 


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1 (2) Without community-based long-term serv2 ices and supports, which are not typically covered by 

3 Medicare, seniors frequently experience negative 

4 health outcomes and lose their ability to live inde5 pendently. 

6 (3) Seniors who deplete their resources often 

7 have no option but to turn to Medicaid for coverage 

8 of long-term care expenses. 

9 (4) Targeting community-based services and 

10 supports to at-risk seniors can help these individuals 

11 avoid depleting their assets and becoming Medicaid 

12 dependent. 

13 SEC. 3. COMMUNITY-BASED INSTITUTIONAL SPECIAL 

14 NEEDS PLAN DEMONSTRATION. 

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

16 Human Services (in this section referred to as the ‘‘Sec17 retary’’) shall establish a Community-Based Institutional 

18 Special Needs Plan demonstration program (in this sec19 tion referred to as the ‘‘CBI-SNP demonstration pro20 gram’’) to target home and community-based care to eligi21 ble Medicare beneficiaries. 

22 (b) ESTABLISHMENT.— 

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

24 into agreements with up to 5 Medicare Advantage 

25 plans to conduct the CBI-SNP demonstration proVerDate Sep 11 2014 02:06 Mar 17, 2015 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S704.IS S704

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1 gram. Each such MA plan may enroll up to 1,000 

2 eligible Medicare beneficiaries (including new enroll3 ees) in such program. 

4 (2) BENEFITS.—Under the CBI-SNP dem5 onstration program, eligible Medicare beneficiaries 

6 shall receive benefits, in addition to those under part 

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

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

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

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

11 including long-term care services and supports, that 

12 the Secretary determines appropriate for the pur13 poses of the CBI-SNP demonstration program, such 

14 as— 

15 (A) homemaker services; 

16 (B) home delivered meals; 

17 (C) transportation services; 

18 (D) respite care; 

19 (E) adult day care services; and 

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

21 equipment. 

22 (3) PAYMENTS.—The Secretary shall establish 

23 a benchmark payment amount for reimbursing Medi24 care Advantage plans participating in the CBI-SNP 

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1 ble beneficiaries under such program. Such pay2 ments shall be in addition to payments made to such 

3 plans under part C of title XVIII of the Social Secu4 rity Act. 

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

6 in the CBI-SNP demonstration program, a Medicare Ad7 vantage plan must— 

8 (1) have experience in offering special needs 

9 plans for nursing home-eligible, non-institutionalized 

10 Medicare beneficiaries who live in the community; 

11 (2) have experience working with low income 

12 seniors groups; 

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

14 determined will participate in the CBI-SNP dem15 onstration program by agreeing to make available 

16 data necessary for purposes of conducting the inde17 pendent evaluation required under subsection (h); 

18 and 

19 (4) meet such other criteria as the Secretary 

20 may require. 

21 (d) ELIGIBLE MEDICARE BENEFICIARY DEFINED.— 

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

23 means a Medicare beneficiary who— 


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

2 Advantage plan that has been selected to participate 

3 in the CBI-SNP demonstration program; 

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

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

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

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

8 XIX of the Social Security Act; 

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

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

11 the Internal Revenue Code of 1986); and 

12 (5) is age 65 or older. 

13 (e) SPECIAL ELECTION PERIOD.—Notwithstanding 

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

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

16 1395w–101(b)(1)(B)(iii)), an eligible Medicare beneficiary 

17 may, other than during the annual, coordinated election 

18 periods under such sections— 

19 (1) discontinue enrollment in a Medicare Ad20 vantage plan not participating in the CBI-SNP dem21 onstration program and enroll in a Medicare Advan22 tage plan participating in such program; and 

23 (2) discontinue enrollment under the original 

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

25 B of such title and the enrollment in a prescription 


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

2 a Medicare Advantage plan participating in the CBI3 SNP demonstration program. 

4 (f) BENEFICIARY EDUCATION.—The Secretary shall 

5 help to educate eligible Medicare beneficiaries on the avail6 ability of the CBI-SNP demonstration program through 

7 State Health Insurance Assistance Programs and other 

8 organizations dedicated to assisting seniors with Medicare 

9 benefits and enrollment. 

10 (g) IMPLEMENTATION.— 

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

12 program shall be implemented not later than Janu13 ary 1, 2017. 

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

15 CBI-SNP demonstration program shall be conducted 

16 for a period of 5 years. 

17 (3) EXTENSION OR EXPANSION.—Taking into 

18 account the report under subsection (h)(2), the Sec19 retary may, through rulemaking, expand (including 

20 implementation on a nationwide or permanent basis) 

21 the duration or the scope CBI-SNP demonstration 

22 program to the extent determined appropriate by the 

23 Secretary, unless the Secretary determines that such 

24 expansion is expected to— 


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1 (A) increase expenditures under titles 

2 XVIII and XIX of the Social Security Act with 

3 respect to eligible Medicare beneficiaries partici4 pating in the CBI-SNP demonstration program; 

5 or 

6 (B) decrease the quality of health care 

7 services furnished to eligible Medicare bene8 ficiaries participating in the CBI-SNP dem9 onstration program. 

10 (h) INDEPENDENT EVALUATION AND REPORTS.— 

11 (1) INDEPENDENT EVALUATION.—The Sec12 retary shall provide for the evaluation of the CBI13 SNP demonstration program by an independent 

14 third party. Such evaluation shall be completed 

15 using evaluation criteria that are clearly articulated 

16 prior to the implementation of such program. Such 

17 criteria shall include specific goals of such program, 

18 hypotheses being tested, clear data collection and re19 porting requirements, recognizing that definitions, 

20 benefits and program requirements for long-term 

21 care services and supports vary across States. Such 

22 evaluation shall determine whether the CBI-SNP 

23 demonstration program has— 

24 (A) improved patient care; 


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1 (B) reduced hospitalizations or rehos2 pitalizations; 

3 (C) reduced or delayed Medicaid nursing 

4 facility admissions and lengths of stay; 

5 (D) reduced spend down of income and as6 sets for purposes of becoming eligible for Med7 icaid; and 

8 (E) improved quality of life for the dem9 onstration population and beneficiary and care10 giver satisfaction. 

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

12 implementation of the CBI-SNP demonstration pro13 gram, the Secretary shall submit to Congress a re14 port 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 3 years worth of data under the demonstration pro20 gram. 

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

22 year of the CBI-SNP demonstration program, the Sec23 retary shall ensure that the aggregate payments made 

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

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1 quent periods do not exceed the amount which the Sec2 retary estimates would have been expended under such ti3 tles during such a period if the CBI-SNP demonstration 

4 program had not been implemented. 

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

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

7 and evaluation of the CBI-SNP demonstration program. 

Æ 


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