Comprehensive Care for Dual Eligible Individuals Act

To amend the Social Security Act to establish an optional State-administered program to provide fully integrated, comprehensive, coordinated care for full-benefit dual eligible individuals under the Medicare and Medicaid programs, and for other purposes. 1. Short title; table of contents (a) Short title This Act may be cited as the Comprehensive Care for Dual Eligible Individuals Act (b) Table of contents The table of contents for this Act is as follows: Sec. 1. Short title; table of contents. Sec. 2. Establishment of All Inclusive Medicare-Medicaid Program for Full-Benefit Dual Eligible Individuals. TITLE XXII—All Inclusive Medicare-Medicaid (AIM) Program for Full-Benefit Dual Eligible Individuals Sec. 2201. Purpose; General requirements. Sec. 2202. Eligibility. Sec. 2203. Enrollment. Sec. 2204. Benefits. Sec. 2205. Beneficiary protections. Sec. 2206. Federal administration. Sec. 2207. Selection and role of AIM-administering entities. Sec. 2208. Program financing. Sec. 2209. Accountability and oversight. Sec. 2210. Definitions; miscellaneous provisions. Sec. 3. MedPAC study and report. 2. Establishment of All Inclusive Medicare-Medicaid Program for Full-Benefit Dual Eligible Individuals (a) In general The Social Security Act is amended by adding at the end the following new title: XXII All Inclusive Medicare-Medicaid (AIM) Program for Full-Benefit Dual Eligible Individuals 2201. Purpose; General requirements (a) Purpose The purpose of this title is to provide, at the option of a State, for a program implemented and administered by the State of comprehensive, coordinated care for individuals eligible for benefits under the Medicare program under title XVIII and for full benefits under the Medicaid program under title XIX in order to improve quality, control costs, address health disparities, and support independence, community participation, and quality of life. (b) Requirement for approved AIM program application A State may not be approved to implement an AIM program under this title unless, consistent with the process specified for approval of AIM programs under subsection (c)— (1) the State has completed, in a pre-printed format and manner specified by the Secretary, a notice of intent to establish such a program not earlier than 3 years after the date on which the State submits the notice of intent to the Secretary, and which includes a plan for such a program (or the State is working with the Federal Coordinated Health Care Office to transition an integrated care program of the State into an AIM program under this title); and (2) the Secretary has received assurances, satisfactory to the Secretary, that the proposed State AIM program and its plan (or, in the case of a State working with the Federal Coordinated Health Care Office to transition an integrated care program of the State into an AIM program under this title, the State AIM program after such transition is completed) meet the applicable requirements for such a program under this title, including the requirements specified in subsection (c). (c) General requirements The requirements specified in this subsection for an AIM program of a State are as follows: (1) Eligibility and enrollment The program provides for eligibility and enrollment of AIMP-eligible individuals under the program in accordance with sections 2202 and 2203. (2) Benefits The program provides for benefits for AIMP enrollees under the program in accordance with section 2204. (3) Beneficiary protections The program provides for beneficiary protections for AIMP enrollees under the program that are not less than those required under section 2205. (4) Coordinating and integration of benefits The program provides for the coordination and integration of benefits by AIM-administering entities in accordance with section 2205. (5) Program accountability The program provides for accountability in administration and financing in accordance with section 2208. (6) Other requirements The program meets such other requirements as the Secretary may establish to carry out this title. (d) Program approval process The Secretary shall establish a process for the initial approval of AIM programs of States based on the process used for approval of waivers under section 1115 with respect to title XIX. The process established under this subsection shall include at least the following elements: (1) Notice of intent (A) In general Subject to subparagraph (B), the State submits to the Secretary a notice of intent to establish the AIMP. (B) Conditions for transparent process The Secretary shall not accept a notice of intent submitted under subparagraph (A) unless, before the date of such submission, the State— (i) has provided a period of not less than 90 days for notice and public comment on the proposed establishment of the program in the State; (ii) has held at least 2 public meetings regarding the establishment of the program; and (iii) has conducted relevant consultation with any relevant tribal authorities of Federally recognized Indian tribes located in the State. (2) Federal readiness review completed At least 1 year before the identified initial implementation date for an AIM program in a State, the State has passed a review by the Secretary of the State’s readiness to implement the program. (3) State readiness review of aim-administering entities After a State passes the Federal readiness review under paragraph (2), the State shall conduct a review of the proposed AIM-administering entities under proposed AIMP contracts with the State with respect to their readiness to administer the program for benefits for AIMP enrollees assigned to such entities. Such review— (A) shall include elements specified by the Secretary, including a network adequacy review; (B) may include activities such as a desk review, separate network validation review, and site visit; and (C) must be passed by an AIMP-administering entity before any outreach or marketing of or by that entity is permitted under a State AIM program. (e) Technical assistance planning grants (1) Eligibility A State that has provided a notice of intent under subsection (d)(1) to implement an AIM program is eligible for funding assistance with technical planning necessary to implement the program. Such funding shall be provided in amounts of up to $10,000,000 per State, and under such conditions as the Secretary shall specify. (2) Use of funds Funding made available to a State under this subsection may be used to assist the State with the staffing, information technology, planning and evaluation, and initial implementation of the AIM program in the State for expenses incurred during the 3-year period that begins on the date the State submits a notice of intent under subsection (d)(1). (3) Funding For the purpose of providing funding assistance under this subsection, there is appropriated, out of any money in the Treasury not otherwise appropriated, such sums as may be necessary to carry out this subsection. 2202. Eligibility (a) In general In this title, the term AIMP-eligible individual (1) is 21 years of age or older; (2) is entitled (or eligible to be enrolled) under part A or part B, or both, of title XVIII; (3) subject to subsection (c), is eligible for medical assistance under the State plan (including a waiver thereof) under title XIX as a full-benefit dual eligible individual; and (4) meets such income and asset standards as the State may establish for the AIM program in accordance with subsection (d) (and which shall be applied in addition to the income and asset standards the individual is required to meet for purposes of eligibility for medical assistance under the State plan (or a waiver) under title XIX). (b) Process for determination of eligibility Except as otherwise provided in this title, the determination of whether an individual is an AIMP-eligible individual with respect to the AIM program of a State shall be made in accordance with the processes used to determine the individual’s eligibility for medical assistance under the State plan (or waiver thereof) under title XIX of the State. (c) Flexibility permitted (1) Geographic scope (A) Statewide Except as provided in subparagraph (B), an AIMP-participating State shall provide for the implementation of its AIM program on a statewide basis. (B) Phase-in permitted on a time-limited basis An AIMP-participating State may provide for the implementation of its AIM program not on a statewide basis so long as the program is phased in geographically in a manner so that it is implemented statewide no later than the 4th year of implementation, except that the Secretary may permit a longer phase-in period due to extenuating circumstances. (2) New population phase-in permitted (A) Carve-outs not permitted Except as provided in subparagraph (B), an AIMP-participating State may not deny eligibility under its AIM program to subpopulations of AIMP-eligible individuals and shall enroll all AIMP-eligible individuals under the program without the application of any waiting lists. (B) Time-limited exception permitted The Secretary may allow States to phase in the enrollment of certain subpopulations over a specified period, not to exceed a period of 4 years. (3) Pace continuation permitted Nothing in this title shall be construed as preventing an AIMP-participating State from continuing to offer a Program of All-Inclusive Care for the Elderly (PACE) under section 1894 or 1934. (d) Income and asset standards (1) Income eligibility floor In no case shall an AIMP-participating State have an income eligibility threshold under its AIM program that is less than 73 percent of the official poverty line (as defined by the Office of Management and Budget, and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family of the size involved or, if greater, the income threshold applied during the fiscal year preceding the year in which this title is enacted. (2) Asset threshold floor In no case shall an AIMP-participating State apply an asset threshold for eligibility for a fiscal year that is less than the following: (A) For first fiscal year For the 1st fiscal year (or portion of a fiscal year) in which the AIM program is implemented in the State, the greater of— (i) $2,000; and (ii) the asset eligibility standard applied under the State plan (including a waiver thereof) under title XIX for a full-benefit dual eligible individual during the fiscal year preceding the fiscal year in which this title is enacted. (B) For subsequent fiscal year For a subsequent fiscal year, the minimum asset threshold applied under this paragraph for the previous fiscal year increased (and rounded to the nearest $10) by the annual increase in the consumer price index for all urban consumers (United States city average). (3) Flexibility Nothing in this subsection shall be construed as limiting the ability of an AIMP-participating State to increase the income eligibility threshold, asset eligibility threshold, or income or asset disregards, including by allowing buy-ins or spenddowns, above the minimum levels required under this subsection. (4) Eligibility threshold The income and asset thresholds that a State establishes under this subsection shall be applied under the State AIM program to determine whether an individual is an AIMP-eligible individual without regard to whether the individual elects to enroll, or is enrolled, in the State AIM program. (e) Use of streamlined eligibility determination and enrollment processes (1) In general Each AIMP-participating State shall use streamlined eligibility and enrollment processes in order to promote continuity and incentivize States that invest in improving quality and costs, including those specified in this subsection. (2) Specific streamlined eligibility required Each AIMP-participating State shall utilize the following with respect to streamlining the eligibility determination and enrollment of individuals in the State's AIM program: (A) 12-month continuous eligibility. (B) Use of electronic data matches with trusted third-party sources (such as the Social Security Administration or the Supplemental Nutrition Assistance Program) to verify eligibility under the State AIM program both for initial eligibility applications and for renewals. (C) Streamlined eligibility recertification every 12 months, including— (i) for individuals who have been determined eligible and enrolled, only requiring submission of information on any changes to their financial or disability status (instead of submitting an entire renewal application); (ii) with respect to verification of eligibility, initially using of available information to auto-verify eligibility; (iii) if additional information is needed for renewal of eligibility, using pre-populated forms and allowing submission of information online, in person, by telephone, fax, or mail; and (iv) using a standard reconsideration period of 90 days from the time of termination of coverage. (3) Use of deeming Each AIMP-participating State shall use deemed eligibility for a period of not less than 6 months. (4) Data sharing on enrollment Under an AIMP contract, an AIMP-participating State, the Secretary, and AIM-administering entities shall routinely and frequently share data among themselves with regard to eligibility and enrollment of individuals under AIM programs. Such data sharing may include monthly changes in program enrollment and eligibility, beneficiary opt-out rates, and other changes specified by the Secretary. (f) Rule of construction of continuation as a medicare and medicaid beneficiary for purposes other than benefits The fact that an individual qualifies as an AIMP-eligible individual shall not be construed as removing the individual’s status as an individual entitled to benefits under title XVIII or XIX, but insofar as the individual becomes an AIMP enrollee entitled to benefits under this title, such entitlement to benefits under titles XVIII and XIX shall be considered as met through the provision of benefits under this title. 2203. Enrollment (a) Beneficiary choice In an AIMP-participating State under its AIM program, an AIMP-eligible individual may select (in a manner specified by the State consistent with this section) to receive benefits through any of the following: (1) The State AIM program. (2) A PACE program (if available to the individual in the State). (3) A combination of Medicare fee-for-service program (under parts A, B, and D, as applicable, of title XVIII) and medical assistance under title XIX (whether delivered through fee-for-service or managed care, as provided by the State under such title). (b) Initial assignment at time of program implementation or initial enrollment An AIMP-participating State may provide that all AIMP-eligible individuals in the State who are not enrolled in a PACE program under section 1894 or 1934 and who do not make an affirmative selection under subsection (a)(3) shall be deemed to have elected to enroll in the AIM program of the State. (c) Coordination of selection and enrollment with medicare enrollment processes The process for selection and enrollment of AIMP-eligible individuals in AIM programs shall be consistent and coordinated with the processes for enrollment in Medicare Advantage plans under part C of title XVIII during open and special enrollment periods. Such processes shall, consistent with section 423.38(c) of title 42, Code of Federal Regulations (or any successor regulation) and any other applicable regulations, provide— (1) a special enrollment period for individuals who— (A) are dually eligible individuals enrolled in fee-for-service Medicare when the State AIM program is first established to permit such individuals to elect to enroll in the State AIM program; or (B) become AIMP-eligible individuals; and (2) for the right of an AIMP-enrolled individual to disenroll from the AIM program and to otherwise to make changes in the selection in enrollment described in subsection (a). (d) Assistance in enrollment choice An AIMP-participating State must contract with 1 or more independent enrollment brokers, at least 1 of which is a nonprofit, community-based organization, and all of which are approved by the Secretary, to assist AIMP-eligible individuals in understanding the AIM program and making enrollment choices under this section in the same manner as such brokers are permitted with respect to enrollment of individuals under its State plan under title XIX (or waiver thereof), except that no individual sales commissions shall be permitted (including to the extent such commissions may otherwise be permitted by brokers and employed or captive agents under the Medicare Advantage program under part C of title XVIII). (e) Construction regarding continued medicaid use of managed care Nothing in this subsection shall be construed as affecting the authority of an AIMP-participating State to require, in the case of an AIMP-eligible individual who makes the election described in subsection (a)(3) (or otherwise opts-out of enrollment in the AIM program and into benefits under title XIX), to obtain benefits for covered services under title XIX through participation in a managed care plan or arrangement. (f) Assignment of enrollees to AIMP-Administering entities (1) In general An AIMP-eligible individual enrolled under an AIM program shall be provided with a choice of the AIMP-administering entity to which the individual is assigned for purposes of obtaining benefits under the program. (2) Initial assignment at time of program implementation or initial enrollment (A) In general In the case of an AIMP-eligible individual who, at the time of enrollment under an AIM program, is enrolled in an integrated program for individuals dually eligible for Medicare and Medicaid participating in the Financial Alignment Initiative of the Federal Coordinated Health Care Office, or enrolled in a Medicare Advantage plan that is a highly integrated dual eligible special needs plan or a fully integrated dual eligible special needs plan, the State AIM program may initially assign the individual to the AIMP-administering entity for such Medicare Advantage plan (or, in the case of an AIMP-eligible individual who, at the time of enrollment under an AIM program, is enrolled in an integrated program for individuals dually eligible for Medicare and Medicaid participating in the Financial Alignment Initiative of the Federal Coordinated Health Care Office, to the AIMP-administering entity designated by the State), or another AIMP-administering entity, if necessary if— (i) the provider network of such entity under the AIM program is substantially similar to the network used under the plan offered by the entity that the individual is enrolled in prior to such assignment; and (ii) the individual is provided with— (I) at least 1 written notice of such assignment at least 60 days in advance of the effective date of the assignment; and (II) at least 1 phone call notifying the individual of the assignment in advance of the effective date of the assignment. (B) Continuity of care To the extent possible to prevent disruption and promote continuity of care, a State AIM program shall seek to ensure that individuals described in subparagraph (A) are assigned to the AIMP-administering entity that offers the plan or program in which the individual is enrolled in prior to the individual's transfer to, and enrollment in, the State AIM program. (C) Conditional initial assignment for other AIMP-eligible individuals In the case of an AIMP-eligible individual who, at the time of enrollment under a State AIM program is enrolled in a Medicare Advantage plan that is operating as an AIMP-administering entity other than a plan described in subparagraph (A), or is enrolled in a Medicaid managed care plan offered by the same entity that is operating as an AIMP-administering entity in the State AIM Program, the State AIM program may initially assign the individual to that AIMP-administering entity if— (i) the provider network of such entity under the State AIM program is substantially similar to the network used under the Medicare Advantage plan or Medicaid managed care plan offered by the entity that the individual is enrolled in prior to such assignment; and (ii) the individual is provided with— (I) at least 1 written notice of such assignment at least 60 days in advance of the effective date of the assignment; and (II) at least 1 phone call notifying the individual of the assignment in advance of the effective date of the assignment. (3) Rule of construction Nothing in this subsection shall be construed as— (A) preventing an individual from choosing to be assigned to a different participating AIMP-administering entity; (B) preventing an individual from changing their assignment to an AIMP-administering entity or from opting-out of participating in the State AIM program; or (C) constraining or changing the authority of a State under the State plan under title XIX or under a waiver of such plan to require a Medicaid-eligible individual to enroll with a managed care entity if the individual chooses not to participate in the AIM Program. (4) Choice of enrollment from fee-for-service medicare An AIMP-eligible individual who, as of the date on which a State first implements the State AIM program, is enrolled in the Medicare fee-for-service program under title XVIII, may elect to enroll in the State AIM Program through a special enrollment period established for such individuals, consistent with the requirements of section 423.38(c)(4) of title 42, Code of Federal Regulations (or a successor regulation). (g) Effect of enrollment on medicare and medicaid payments to states Except as provided in this title, in the case of an individual who is enrolled as an AIMP enrollee under a State AIM program under this title, during the period of such enrollment payment to the State under this title shall be instead of the payment amounts which would otherwise be payable under title XVIII or XIX for items and services furnished to the enrollee. (h) Outreach and enrollment support (1) Funding For the purpose of providing funding assistance to AIMP-participating States for outreach to, and enrollment support of, AIMP-eligible individuals, there is appropriated, out of any money in the Treasury not otherwise appropriated, such sums as may be necessary for each fiscal year beginning with the first fiscal year that begins on or after the date of enactment of this title. (2) Use of funds An AIMP-participating State shall use funds provided to the State under this subsection for outreach to, and enrollment support of, AIMP-eligible individuals, that includes the following: (A) Distributing outreach and enrollment materials printed in accessible language formats (including primary languages, Braille, large print, and alternative texts). (B) Engaging community-based organizations to conduct outreach to, and provide enrollment assistance for, AIMP-eligible individuals. (C) Referring AIMP-eligible individuals to the State long-term care ombudsman, the qualified nonprofit AIM Ombudsman selected for the AIM program under section 2205(c), and other beneficiary support entities for enrollment assistance and information. 2204. Benefits (a) Covered benefits (1) In general A State AIM program shall provide a core package of covered benefits to address medical, behavioral, long-term care, and social needs of AIMP enrollees in accordance with an individual assessment and plan of care. Such core package of available benefits shall include the following: (A) Medicare benefits All benefits available under parts A, B, and D of title XVIII, including with respect to benefits available under such part D, coverage of the 6 protected classes and 2 drugs from each class. (B) Medicaid mandatory benefits All benefits otherwise required to be provided to AIMP-eligible individuals under title XIX in the State if they were not AIMP enrollees. (C) Historic benefits All Medicaid services and benefits offered as of 1 year prior to the enactment of this title, as required by section 2204(d). (D) Drugs All prescription drugs and covered outpatient drugs available under the State Medicaid program, including any such drugs that are available under a prescription drug plan under part D of title XVIII. (E) Additional services An AIMP-participating State may, with approval from the Federal Coordinated Health Care Office, make available under the State AIM program additional behavioral health, social, and supportive services that enable flexibility to achieve person-centered outcomes in the most cost-effective setting. (2) Limitation on benefit carve-outs The Secretary may permit a State AIM program to exclude benefits for some services under paragraph (1)(C) if the Secretary determines that such an exclusion is essential for the State to implement the AIM program but such exclusion may not extend over a period of longer than 4 years. (b) Benefit assessment process (1) Assessment tool and plan of care (A) Development Not later than 18 months after the date of the enactment of this title, the Secretary, in consultation with State agencies administering State plans or waivers under title XIX and with input from other stakeholders, shall develop and publish a robust, comprehensive standard assessment tool for use by all AIM programs in evaluating the condition and needs of AIMP enrollees for benefits under the program. (B) Application to plan of care Each AIM program shall provide for an assessment for each AIMP enrollee, using such standard assessment tool, to form a basis for the enrollee’s plan of care under the program. Such an assessment shall be conducted at least annually, and when a triggering event (as defined by the Secretary) affecting the enrollee’s need for care occurs. (C) Application of grievance and appeals procedures Disagreements concerning the plan of care for an AIM enrollee shall be subject to grievance and appeal rights under section 2205(b). (2) Standard assessment tool The standard assessment tool under paragraph (1) shall— (A) contain a required set of core elements, to which States and AIMP-administering entities may add additional requirements so long as the requirements a State or AIMP administering entity uses contain at a minimum the core set of elements; (B) cover multiple domains, including medical, functional, behavioral, and social domains; and (C) be applicable to the full range of AIMP enrollees, including individuals with serious mental illness and with needs for assistance with activities of daily living. (c) State provision of covered benefits (1) Use of tiered-benefit model An AIMP-participating State may establish a tiered-benefit design structure for benefits so that specialized benefits may be available to meet the needs of specific subpopulations of AIMP enrollees so long as such tiering— (A) only applies to benefits described in subparagraph (E) of subsection (a)(1) and does not limit the coverage of core covered benefits described in subparagraphs (A) and (B) of such subsection; and (B) is no more restrictive than the benefit structure in place in the State under title XIX in the year before the date of the enactment of this title. (2) In-lieu-thereof alternative services permitted An AIMP-participating State may permit AIMP-administering entities to cover benefits for cost-effective alternative services (known as in lieu of services (3) Continuity of services (A) In general Except as provided in subparagraph (B), during the first 6 months of an AIM enrollee’s enrollment in an AIM program (or for such longer period as the AIM program may provide) an AIMP-participating State shall continue to provide access to all medically necessary covered items and services and providers (for continuity of care) that were being provided at the time of enrollment. (B) Exception Subparagraph (A) shall not apply in cases in which it is determined by the State, and agreed to by the Secretary, that the AIMP enrollee was not eligible for such services at the time of enrollment or was enrolled in the AIM program due to error or fraud. (d) Maintenance of effort As a condition for approval of an AIM program of a State, the State shall maintain levels of benefits for AIM enrollees under the program that are not less than the level of benefits under its State plan (including under a waiver) under title XIX for full-benefit dual eligible individuals as of fiscal year 2021, as of the fiscal year before the fiscal year in which this title is enacted, or as of the fiscal year before the 1st fiscal year in which the program is implemented in the State, whichever fiscal year has the highest level of benefits. (e) Administration of benefits through AIM-Administering entities AIMP-participating States shall provide for the coordination of, and the responsibility for the delivery of covered services through AIM-administering entities under an AIM contract under section 2207. 2205. Beneficiary protections (a) In general Except as otherwise provided, the beneficiary protections applicable to individuals enrolled under plans under parts C and D of title XVIII and under a State plan under title XIX shall apply in a manner specified by the Secretary to AIMP enrollees under an AIM program under this title and are in addition to beneficiary protections provided under this title. (b) Application of grievances and internal and external appeals under AIMP contracts The rights of individuals with respect to internal and external complaints and appeals processes shall be specified in the contract between the AIMP-participating State and an AIMP-administering entity. Such processes shall, at a minimum, incorporate relevant rights and processes from the requirements for plans under parts C and D of title XVIII as well as requirements for Medicaid managed care organizations under title XIX. (c) Requirement for qualified AIM ombudsman program (1) In general As a condition for approval of an AIM program for a State under this title— (A) the State shall have established and have ready for implementation not later than 18 months prior to implementing the AIM program, a qualified nonprofit AIM Ombudsman program run by a community-based organization for such AIM program; and (B) the State, before implementation of its AIM program, shall demonstrate to the satisfaction of the Secretary (through an application of certification process specified by the Secretary) that its AIM Ombudsman program has the capacity to carry out its functions in the State, including that the program has the independence, expertise, and adequate resources in place to serve AIMP-eligible individuals and AIMP enrollees under the State AIM program. (2) Qualifications for qualified aim ombudsman program (A) In general In order to be a qualified AIM Ombudsman program, such program must meet the requirements of this subsection for such a program. (B) Construction Nothing in this subsection shall be construed as preventing a qualified AIM Ombudsman program from being structured as part of another protection service (including those specified in paragraph (3)), so long as such other protection service meets the requirements of this subsection for a qualified AIM Ombudsman program. (3) Coordination with other beneficiary protection services A qualified AIM Ombudsman program shall coordinate with State and Federal beneficiary protection services, including the following: (A) Demonstration Ombudsman Programs Serving Medicare-Medicaid Enrollees. (B) Managed Care Beneficiary Support Systems. (C) Long-Term Care Ombudsman Programs. (D) Disability Protection and Advocacy Programs. (4) Core services A qualified AIM Ombudsman program for an AIMP-participating State shall have authority to provide the following core services with respect to the AIM program in the State: (A) Individual assistance (including consumer education and empowerment, assistance with and representation in beneficiary appeals, fair hearings, and grievances, guidance regarding plan and provider selection, and support during enrollment and disenrollment) for AIMP-eligible individuals considering enrollment in the State AIM program and for AIMP enrollees in such program. (B) Systemic monitoring and reporting to the State regarding compliance with applicable requirements. (5) Providing reports to consumer advisory boards A qualified AIM Ombudsman program for a State shall provide, on a timely basis, any reports it produces to the consumer advisory boards (established under subsection (e)) for the State and shall make them publicly available. (6) Funding and oversight (A) In general The Secretary shall oversee and administer Federal funding directly to qualified AIM Ombudsman programs established by States. (B) Funding level For the purpose of providing funding to qualified AIMP Ombudsman programs in each State over a period of 3 fiscal years, there is appropriated, out of any money in the Treasury not otherwise appropriated, not less than $1,000,000, and not more than $5,000,000. The Secretary shall determine the funding for each such program based on the estimated number of AIMP-eligible individuals in each State. (C) Supplemental funding Nothing in this paragraph shall be construed as preventing an AIMP-participating State from providing supplemental funding for the qualified AIM Ombudsman program for the State. (d) Beneficiary advisory council Each AIMP-participating State shall have in operation a Beneficiary Advisory Council to advise the State regarding the treatment of AIMP-eligible individuals and AIMP enrollees under this title. The composition and specific functions and authority of such a Council shall be delineated in readiness review requirements specified by the Secretary in carrying out paragraphs (2) and (3) of section 2201(d). (e) Consumer advisory boards (1) In general Each AIMP-participating State and each AIMP-administering entity in each such State shall establish a consumer advisory board that will provide regular feedback to the State or governing board of the entity, respectively, on issues of care of AIMP enrollees under the AIM program in that State or through that entity, respectively. (2) Composition; functions Each such consumer advisory board shall— (A) meet at least quarterly; (B) be comprised of members who— (i) may be subject to approval by the Secretary and the AIMP-participating State; (ii) are AIMP enrollees; (iii) are family members and other caregivers for AIMP enrollees; and (iv) are chosen in a manner that reflects the demographic diversity of the population of AIMP enrollees, including with respect to race, ethnicity, age, and urban and rural populations, and which includes individuals with disabilities; (C) meet the requirements for member advisory committees under section 438.110 of title 42, Code of Federal Regulations; and (D) file and make publicly available an annual report that includes at least information on— (i) the dates for its meetings held within the reporting year; (ii) the names of board members invited and of those members in attendance at each such meeting; and (iii) the agenda and minutes for each such meeting. 2206. Federal administration (a) Primary administration through the Federal Coordinated Health Care Office (1) In general The Secretary shall carry out this title through the Federal Coordinated Health Care Office, except that with respect to payments under section 2208, the Secretary may delegate such authority to the Administrator of the Centers for Medicare & Medicaid Services. (2) Appropriations There are hereby appropriated to the Secretary to carry out this title, out of any funds in the Treasury not otherwise appropriated— (A) for each of fiscal years 2022, 2023, and 2024, $100,000,000; and (B) for each succeeding fiscal year, $30,000,000. (b) Standards and process (1) Federal standards In carrying out this title, the Secretary shall specify a minimum set of Federal standards, including standards relating to access to care, quality of care, beneficiary protections, marketing and enrollment, grievances and appeals, and procurement. (2) Transparency in rulemaking In implementing the provisions of this title, to the extent practical, the Secretary shall utilize notice and comment rulemaking to ensure transparency for stakeholders. (3) Application of knowledge gained from demonstration projects and contract management teams under the financial alignment initiative The Secretary shall carry out this title taking into account the knowledge gained from the use of contract management teams in demonstration projects under the Financial Alignment Initiative for Medicare-Medicaid Enrollees administered by the Federal Coordinated Health Care Office. (c) Direct-Hire authority In carrying out this title, the Secretary (acting through the Federal Coordinated Health Care Office) shall have direct-hire authority to the extent required to implement and administer this title on a timely basis. 2207. Selection and role of AIM-administering entities (a) Requirements for State selection of AIM-Administering entities The Secretary, in consultation with States, shall develop (not later than 1 year after the date of the enactment of this title) a set of standardized requirements for the selection of qualified organizations to serve as AIMP-administering entities in the AIM programs in each AIMP-participating State. (b) Application of criteria for the qualification and selection of AIMP-Administering entities (1) In general Each AIM program in an AIMP-participating State shall be implemented through contracts entered into by the AIMP-participating State and organizations that qualify as AIMP-administering entities under this title. A contract with an AIMP-administrating entity shall require the entity to assume 2-sided financial risk in return for payment for the arrangement and delivery of covered benefits to AIMP enrollees assigned to the entity under the program. (2) Specification of criteria The Secretary and AIMP-participating States shall establish basic national criteria for the qualification and selection of organizations to be AIMP-administering entities. Such criteria shall take into account the prior experience (including under both the Medicare program under title XVIII and Medicaid programs under title XIX) of such an organization in serving the population of AIMP-eligible individuals as well as other criteria, including the following: (A) The organization’s experience serving AIMP-eligible individuals in that State (or another State), including the organization’s experience in providing covered services described in section 2204(a)(1) (including long-term services and supports and behavioral health services) to such individuals, and in integrating all of those services and supports for such individuals in that State (or another State). (B) The organization’s performance on key quality measures in providing such services, such as on measures of key health outcomes and enrollee satisfaction. (C) The adequacy of the organization’s provider network in ensuring timely access to care. (D) The organization’s demonstrated experience in implementing models of care for the full range of such services, including with respect to non-medical services described in section 2204(a)(1). (3) Additional state-specific criteria Nothing in this subsection shall be construed as preventing a State, with the approval of the Secretary, from applying additional criteria or requirements regarding health care quality, equity, or access on AIMP-administering entities specific to quality, equity, or access, so long as such requirements and criteria— (A) can be applied consistently to all AIMP-administering entities; and (B) are made available for public comment prior to being imposed. (4) Application of medical loss ratio requirements (A) In general Any AIMP contract between an AIMP-participating State and an AIMP-administering entity to administer benefits under an AIM program shall include a requirement that the medical loss ratio under the AIM program shall not be not less than a percentage (not less than 85 percent) specified by the State and that the entity shall return to the State payment amounts that result in the medical loss ratio being below such percentage. (B) Special rules If an administering entity who is contracting with a participating State to administer a program under this title is an entity bearing 2-sided risk, the State shall establish with the approval of the Secretary a mechanism comparable to a medical loss ratio target to ensure appropriate spending on services by the entity. (c) State procurement process for AIMP-Administering entities (1) In general Each AIMP-participating State shall be responsible for establishing and implementing a process for the procurement and selection of AIMP-administering entities for the State AIM program, subject to the approval of the Secretary. The Secretary shall not approve such a process unless the State demonstrates to the Secretary’s satisfaction that the process results in the selection of AIMP-administering entities that meet the requirements of this title and are qualified to serve the needs of AIMP enrollees in the State under the State’s AIM program. An AIMP-participating State may add additional requirements specific to quality, equity, or access that further the State’s overall integrated care strategy and goals, so long as such requirements are posted for public comment and approved by the Federal Coordinated Health Care Office. (2) Separate procurement process required for initial procurement For the initial procurement executed to establish an AIM program in an AIMP-participating State, the State shall not combine its AIM administering entity procurement process with a procurement process that is also used for procurement under the State plan or waiver under title XIX and shall select AIM administering entities through a standalone procurement process. (d) Payments to AIM-Administering entities Each AIMP-participating State shall make payments to AIM-administering entities under a risk-adjusted payment model that— (1) reflects the risk of the population of AIMP enrollees served by each entity; (2) ensures that there are appropriate resources to serve the AIMP enrollees in the State; and (3) protects against any adverse selection of AIMP enrollees by entities. 2208. Program financing (a) Payments to States with AIM programs (1) For program benefits (A) In general From the sums appropriated under paragraph (3), the Secretary shall pay to each AIMP-participating State for each quarter in a fiscal year (beginning with the first fiscal year that begins after the date of enactment of this title), an amount equal to the Federal AIMP matching percentage (as defined in subsection (b)(1)) of the total amount expended during the quarter as AIMP assistance (as defined in subparagraph (B). (B) AIMP assistance defined In this title, the term AIMP assistance medical assistance (i) the services described in section 2204(a)(1) shall be substituted for the services described in paragraph (1) and the subsequent paragraphs of such section 1905(a); (ii) an AIMP enrollee shall be treated as an individual referred to in the matter in section 1905(a) before paragraph (1) of such section; and (iii) the exclusion in the subdivision (B) following the last paragraph of the first sentence of section 1905(a) shall not apply. (2) For administrative expenses In addition to the amount paid for each quarter in a fiscal year to an AIMP-participating State under paragraph (1), the Secretary shall pay to each such State for each quarter in a fiscal year (beginning with the first fiscal year that begins after the date of enactment of this title), from the sums appropriated under paragraph (3), not less than 50 percent of the total amount expended during such quarter as found necessary by the Secretary for the proper and efficient administration of the State AIM program under this title. (3) Appropriation There is appropriated, out of any money in the Treasury not otherwise appropriated, such amounts as may be required to provide payments to States under this section, reduced by any amounts made available from the Medicare trust funds under paragraph (5). (4) Relation to other payments Payment amounts provided under this subsection are in addition to payments provided under other provisions of this title. (5) Relation to medicare trust funds There shall be made available for application under this title from the Federal Hospital Insurance Trust Fund (under section 1817) and from the Federal Supplementary Medical Insurance Trust Fund (under section 1841) (and from the Medicare Prescription Drug Account (under section 1860D–16) within such Trust Fund) such amounts as the Secretary determines appropriate, taking into account the reductions in payments from such Trust Funds and Account that are attributable to the coverage of AIMP enrollees under AIM programs under this title. (b) Federal AIMP matching percentage (1) In general In this section, the term Federal AIMP matching percentage (2) State contribution percentage formula (A) In general In this section, the term State contribution percentage (i) the 1st fiscal year of the AIM program in the State, the base AIMP State percentage computed under subsection (c); or (ii) a subsequent fiscal year, the State contribution percentage under this paragraph for the previous fiscal year adjusted in accordance with subparagraph (B) or (C), as applicable. (B) Annual adjustment based on changes in expenditures For an AIMP-participating State for a fiscal year after such 1st fiscal year, if the expenditures for AIMP assistance for which payment is made under subsection (a)(1) under the State AIM program for the second previous fiscal year— (i) are not greater than 110 percent, or less than 90 percent, of the AIMP assistance expenditures for the previous fiscal year, there shall be no adjustment for the fiscal year involved under this subparagraph; (ii) is greater than 110 percent of the AIMP assistance expenditures for the previous fiscal year, the adjustment under this subparagraph for the fiscal year involved shall be an increase in the State contribution percentage of 1 percentage point for each multiple of 10 percentage points by which such AIMP assistance expenditures exceed 110 percent; or (iii) is less than 90 percent of the AIMP assistance expenditures for the previous fiscal year, the adjustment under this subparagraph for the fiscal year involved shall be a decrease in the State contribution percentage of 1 percentage point for each multiple of 10 percentage points by which such AIMP assistance expenditures is less than 90 percent. (C) Additional adjustments for exceptions The Secretary shall provide a process by which adjustments may be made to the State contribution percentage to take into account increases and decreases in AIMP expenditures described in clause (ii) or (iii) of subparagraph (B) in which the adjustments under such clauses would not apply, such as in cases of a significant increase or decrease in AIMP enrollees, a declaration of a national emergency that impacts on AIMP expenditures under this title, or a significant cost increase beyond the control of the State, as determined by the Secretary. (c) Baseline expenditure and percentage computations (1) In general Using the data reported under paragraph (2): (A) Computation of base aimp percentages For the base Federal fiscal year (as defined in paragraph (3)), the Secretary shall compute and publish for each State— (i) the base AIMP State percentage (as defined in subparagraph (B)) for the State and such fiscal year; and (ii) the Federal AIMP matching percentage for the State and such fiscal year. (B) Base AIMP state percentage defined In this section, the base AIMP State percentage (i) the sum of— (I) the amount of the State share of expenditures under title XIX for medical assistance during the base Federal fiscal year attributable to full-benefit dual eligible individuals; and (II) the amount of the payment made to the Federal Government during the base Federal fiscal year under section 1935(c) (commonly referred to as the part D clawback (ii) the sum of— (I) the total expenses paid under title XVIII that are attributable to full-benefit dual eligible individuals for services (or periods of coverage) occurring the base Federal fiscal year (as estimated by the Secretary); and (II) the total amount expended on items and services described in section 2204(a)(1) paid under title XIX (including any waivers under title XI) for full-benefit dual eligible individuals in the base Federal fiscal year. (C) Adjustments to base AIMP percentages With respect to the base AIMP State percentages and the Federal AIMP matching percentages otherwise computed under this paragraph for the base Federal fiscal year, the Secretary shall adjust such percentages to take into account material changes in the programs under titles XVIII and XIX between the base Federal fiscal year and the first fiscal year for which AIM programs may be implemented under this title insofar as such material changes have a direct material impact on AIMP expenditures relating to AIMP-eligible individuals. (2) Data reporting for baseline computations Each State, in its application for approval of its AIM program, shall provide the Secretary (in such form and manner as the Secretary may require) such financial data (including detailed and aggregate, historical and projected expenditures data) on its expenditures under title XIX as the Secretary may require to carry out the computations required under this section. The Secretary shall share with the State, in a process defined by the Secretary, Medicare expenditure data (including detailed and aggregate historical and projected expenditures data) for services and benefits for full-benefit dual eligible individuals in such State. (3) Base federal fiscal year defined In this section, the term base Federal fiscal year (d) Reinvestment of shared savings (1) In general (A) In general If, with respect to a fiscal year, an AIMP-participating State has expenditures under this title for AIMP assistance that for the preceding fiscal year, are less than 85 percent of the expenditures for such assistance under the State AIM program for the second preceding fiscal year, the Secretary shall ensure that for each quarter in the following fiscal year, the State spends at least the shared savings amount determined for the State for the fiscal year on 1 or more of the core applications described in paragraph (3). Amounts expended by a State to meet the requirement of the preceding sentence shall not be subject to any Federal matching payments under this title. (B) Shared savings amount defined In this subsection, the term shared savings amount (2) Application of shared savings The Secretary shall issue guidance outlining allowable use of the shared savings payments under paragraph (1). Under such guidance, the Secretary shall outline the types of services and benefits for which a State has the authority to apply the payments for the benefit of consumers who are AIMP-eligible individuals. Such guidance shall permit the use of such payments consistent with the core applications described in paragraph (3) and with paragraph (4), and may be used for existing State-funded health programs or new health-related initiatives that serve full-benefit dual eligible individuals under this title. (3) Core applications The core applications described in this paragraph for such consumers are as follows: (A) Consumer power and choice To provide such consumers more information and control over their health care and community support options. (B) Equity and access to care To improve access to, and quality of, care across populations, advance health equity for consumers, and reduce health disparities and eliminate barriers to care. (C) Prevention and wellness To strive to better enable such consumers to receive individualized health care that is outcomes-oriented and focused on prevention, wellness, recovery and maintaining independence. (D) Pay for performance To employ purchasing and payment methods that encourage and reward service quality and cost-effectiveness by linking reimbursements for services to such consumers to common, evidence-based quality performance measures, including patient satisfaction. (E) Innovative advancement To implement innovative and technological advancements that facilitate such consumers remaining in the community. (F) Service integration To increase integration of services with social needs to improve health outcomes for such consumers. (G) State personnel To hire additional State personnel to carry out this title. (H) Capacity building To expand capacity in providing services to such consumers, such as in— (i) community-based care; and (ii) caregiver assistance. (I) Improve enrollment policies and process To improve the ability to enroll in the State AIMP program through streamlining enrollment policies and processes. (J) Increase education for providers and beneficiaries To ensure providers and beneficiaries understand the State AIMP program and the choices available under such program. (K) Improve data collection regarding racial disparities and health inequities To ensure appropriate data is collected and used to determine program inequities. (L) Other services and initiatives Other services and initiatives approved by the Secretary that serve full-benefit dual eligible individuals under this title. (4) Limitation on payment to AIMP-administering entities An AIMP-participating State may use payments under this subsection for an AIMP-administering entity only if the State demonstrates, to the satisfaction of the Secretary, that the State’s AIM program provides appropriate maintenance of access to and quality of care based on the requirements imposed by the State on the applicable AIMP-administering entities. (e) Application of medicaid payment methodologies financing limitations for the non-Federal share of expenditures (1) In general Except as the Secretary may otherwise provide through notice and comment regulation, the following provisions of title XIX (and related regulations) shall apply to AIMP-participating States’ expenditures in the AIM program in a manner similar to the manner in which such provisions apply under title XIX: (A) Section 1903(d) (relating to estimated payments, recovery of overpayments, disallowance of provisions). (B) Section 1903(w) (relating to provider-related donations, health care related taxes, and broad-based health care related taxes). (C) Section 1903(w)(6) (relating to certified public expenditures and intergovernmental transfers). (D) Other provisions relating to deferral of payments, preventing fraud and abuse, and ensuring program integrity. (2) Processes and forms (A) In general The Secretary shall establish appropriate forms and processes (including expenditure reconciliation processes) for submission of information on State expenditures under this title in a manner similar to the processes used for purposes of payments to States under title XIX, but through the use of such alternative forms as may be appropriate in implementing this title. (B) Reporting of estimated expenditures by quarter An AIMP-participating State shall estimate matchable expenditures (including both total expenditures as well as the estimated Federal share of those expenditures) and separately report these expenditures by quarter for each fiscal year for its AIM program. The Secretary shall make Federal funds available based upon the State's estimate, as approved by the Secretary. (C) Reporting and reconciliation of actual expenditures on a quarterly basis Not later than 30 days after the end of each quarter, each AIMP-participating State shall submit to the Secretary (on an appropriate form) a quarterly expenditure report, showing expenditures made in the quarter just ended under its AIM program. The Secretary shall reconcile expenditures so reported with Federal funding previously made available to the State under this section and include the reconciling adjustment in the finalization of the grant award to the State. (3) Rule of construction Nothing in this title shall be construed as constraining or limiting the authority of the Secretary, the Administrator of the Centers for Medicare & Medicaid Services, the Inspector General of the Department of Health and Human Services, or the Comptroller General of the United States, to conduct routine and targeted program and financial management audits and other oversight activities of funds expended under this title, including oversight activities relating to the allowable use of funds. (f) Option for multi-Year investment initiative The Secretary may specify a process by which an AIM-participating State may elect to participate in a multi-year investment initiative during the first 3-year period in which the State participates in the AIM program. Under such option, an AIM-participating State shall be eligible for additional Federal financial participation (as determined by the Secretary) for expenditures under this title that do not exceed an annual budget target established for the State, based on the expenditures of the State used to determined the base AIMP State percentage under subsection (c)(1)(B), and increased for the 2d and 3rd years of such period, by 9.99 percent over the budget target established for the preceding year. 2209. Accountability and oversight (a) Quality assessment To ensure that full-benefit dual eligible individuals receive high quality care and to encourage quality improvement under AIM programs, each AIM-participating State shall establish a quality incentive program that uses financial rewards, penalties, or both that are meaningful enough to influence the administering entity’s behavior and is approved by the Federal Coordinated Health Care Office. Each AIM program will be expected to tie financial incentives to performance either in the form of quality withholds or incentives, such as making additional quality payments to an AIMP-administering entity that achieves quality or equity goals or the withholding of a portion of a capitation payment to an entity that fails to achieve such goals. Each AIM-participating State shall publicly post and seek comment on its proposed quality incentive program prior to submitting to the Federal Coordinated Health Care Office for approval. (b) Monitoring and program evaluation (1) Consolidated reporting requirements for aim-administering entities The Secretary and each AIMP-participating State shall define and specify in the contract for each AIMP-administering entity under this title a consolidated reporting process that ensures the provision of the necessary data on diagnosis, HEDIS measures, encounter reports, enrollee satisfaction, and evidence-based measures and other information as may be useful in order to monitor each AIMP-administering entity’s performance under the AIMP contract. (2) Evaluation The Secretary and each AIMP-participating State shall develop processes and protocols for collecting (or ensuring that AIMP-administering entities collect) and reporting to the Secretary and the State the data needed for an evaluation by the Secretary to measure the impact of AIMP-administering entities, the effectiveness of the process in enrolling AIMP-eligible individuals under the AIM program, and the effectiveness of the AIM program in reducing disparities, improving quality of care, and advancing health equity. (3) Collaborative evaluation The Secretary and AIMP-participating States shall collaborate on and coordinate during any evaluation activity conducted under this subsection. (c) Administrative oversight responsibilities (1) State role Each AIMP-participating State shall be responsible for day-to-day oversight of the AIMP-administering entities providing services with respect to AIMP enrollees under the AIMP contract with the State under its AIM program. Such oversight shall include the following activities: (A) Conducting a comprehensive readiness review of each entity (as required under section 2201(d)). (B) Monitoring compliance of the entity with the terms of its AIMP contract under the AIM program, including— (i) ensuring adherence to and protection of enrollee rights as provided under this title; (ii) monitoring the entity to ensure it authorizes, arranges, coordinates, and provides all covered and medically necessary services (as required under this title) to AIMP enrollees receiving benefits administered by the entity, in accordance with the requirements of the AIMP contract; and (iii) ensuring compliance with applicable reporting requirements under this title. (C) Reviewing, approving, and monitoring— (i) the entity’s network adequacy; (ii) the outreach and orientation materials and procedures of the entity; (iii) the complaint and appeals procedures carried out by the entity; (iv) the utilization management functions of the entity; (v) the entity’s adherence to required continuity of care provisions under section 2204(c)(3); (vi) the entity’s use of required standard assessment tool under section 2204(b); (vii) the entity’s informational materials, particularly for those individuals who will be assigned to the entity under section 2203(f); and (viii) the entity's use of streamlined eligibility processes under this title. (D) Conducting monthly (or more frequent) performance review meetings with the entity. (E) Conducting periodic audits of the entity, including at least an annual independent external review and an annual site visit. (F) Receiving and responding to complaints about the entity. (G) Conducting annual surveys of AIMP enrollees and providing the entity with written results of such surveys. (H) Applying 1 or more sanctions (such as those provided under title XIX), which may include termination of the contract, if the State or the Secretary determines that the entity is in material violation of any of the terms of the AIMP contract. (2) Federal oversight role (A) In general The Secretary shall be responsible for the oversight of AIMP-participating States. Such oversight shall include activities developed through engagement with stakeholders, including consumer advocates, and shall include at the least the following activities: (i) Monitoring the process to select organizations to serve as AIMP-administering entities under the AIM program. (ii) Conducting a thorough readiness review of the State (before readiness reviews for such organizations) under section 2201(d)(2). (iii) Ensuring, including through complaint tracking and secret shopping, the State creates and maintains a highly functional, dedicated AIMP Ombudsman program under section 2205(c). (iv) Ensuring, through direct monitoring, State oversight of compliance of AIMP-administering entities with the terms of their AIMP contracts under the AIM program. (v) Reviewing eligibility and enrollment processes and procedures. (vi) Monitoring State data systems to ensure they are sufficient for providing timely data on program performance. (vii) Ensuring payment rates to AIMP-administering entities under the AIMP contract are actuarially sound, including by establishing a rate setting process established through rulemaking whereby, at a minimum— (I) States and the Secretary provide AIMP-administering entities with comprehensive and timely data as part of the rate setting process and procurement, including historical Medicaid and Medicare cost and utilization data for full-benefit dual eligible individuals by region and including detailed categories of service; (II) States may elect to share the final rate certification package provided to the Secretary with AIMP-administering entities; and (III) an opportunity for public input is established for annual rate setting or when rates are significantly modified whereby stakeholders, including patient advocacy groups, health care providers, and AIMP-administering entities, can provide feedback to the Secretary prior to rate approval. (viii) Coordinating periodic audits of the State with respect o its AIM program. (ix) Conducting regular meetings with the State. (x) Applying discretionary action, if warranted. (xi) Ensuring regular engagement with dually eligible individuals and their caregivers. (B) Compliance authority If the Secretary finds with respect to a State AIM program that the State failed to achieve the appropriate performance levels or compliance with the activities required under subparagraph (A), the Secretary shall take such action as is necessary to address and correct the State failures, which may include, to the extent the Secretary determines appropriate, 1 or more of the following: (i) Developing in consultation with the State, a corrective compliance plan for achieving appropriate performance levels or compliance. (ii) Remedial education and supervised training. (iii) Imposition of penalties or sanctions. (iv) Removal of the State from the AIM program. (3) State-federal partnership role through joint contract management teams (cmt) (A) Establishment The Secretary shall, jointly with each AIMP-participating State, establish a Joint Contract Management Team (in this paragraph referred to as a CMT (B) Composition and structure (i) In general Each CMT shall include at least 1 contract officer from the Centers for Medicare & Medicaid Services and at least 1 contract officer from the AIMP-participating State, each of whom is authorized and empowered to represent the Secretary and the State, respectively, about all aspects of the AIMP contract with an AIMP-administering entity under the AIM program of the State. (ii) Lead The representation from the Federal Government shall be led by the individual from the Federal Coordinated Health Care Office who is assigned to work with the State, who will bring in additional individuals, as appropriate. (iii) State lead The representation from the AIMP-participating State shall be led by the Director of the State Medicaid program under title XIX (or such Director’s designee) who will bring in additional individual to represent the State, as appropriate. (C) Responsibilities of cmt Each CMT for a State shall act as a liaison among the AIMP-administering entity, the Secretary, and the State for the duration of the AIMP contract with such entity and shall serve to facilitate communications and operations among the 3 parties. Each CMT shall, among other functions— (i) receive and respond to complaints; (ii) conduct quarterly meetings among the parties; (iii) establish a mechanism for ongoing consumer engagement; (iv) coordinate requests for assistance from the entity and assign Federal and State staff with appropriate expertise to provide technical assistance to the entity; (v) make best efforts to resolve any issues applicable to the parties; and (vi) monitor any discretionary action by the State or the Secretary under the provisions of the AIMP contract. 2210. Definitions; miscellaneous provisions (a) Definitions In this title: (1) Terms relating to AIMP (A) AIMP-administering entity The term AIMP-administering entity (B) AIMP assistance The term AIMP assistance (C) AIMP contract The term AIMP contract (D) AIMP-eligible individual The term AIMP-eligible individual (E) AIMP enrollee The term AIMP enrollee (F) AIMP-participating State The term AIMP-participating State (G) AIM program; AIMP The terms AIM program AIMP (2) Other definitions (A) Full-benefit dual eligible individual The term full-benefit dual eligible individual (B) Federal Coordinated Health Care Office The term Federal Coordinated Health Care Office (C) Medicaid managed care organization The term medicaid managed care organization (b) Miscellaneous provisions (1) Relation to other requirements Except as otherwise provided under this title or by regulation, the requirements of title XIX shall apply under an AIM program in relation to AIMP-eligible individuals, AIMP enrollees, and the provision of benefits under an AIM program, in the same manner as such requirements apply with respect to individuals eligible for medical assistance who are enrolled in under a medicaid managed care organization. (2) Limitation on waiver authority Except as provided in this title, the Secretary is not authorized (under section 1115, 1115A, or otherwise) to waive the requirements specified in this title. . (b) Conforming amendments to medicare (1) Enrollment Section 1851(a) of the Social Security Act ( 42 U.S.C. 1395w–21(a) (4) Additional enrollment option for certain full-benefit dual eligible individuals Full-benefit dual eligible individuals may also be eligible to enroll under a State AIM program under title XXII. . (2) Prohibition During the period in which an AIM program is fully implemented in an AIMP-participating State under title XXII, AIMP-eligible individuals in the State may not enroll in a managed Medicare and other integrated duals product (other than a PACE program). (c) Conforming amendments to medicaid (1) Preventing duplicate payments Section 1903(i) of the Social Security Act ( 42 U.S.C. 1396(i) (A) by striking or (B) by striking the period at the end of paragraph (27) and inserting ; or (C) by inserting after paragraph (27) the following new paragraph: (28) with respect to any amount expended for medical assistance for an individual who is an AIMP enrollee under a State AIM program under title XXII, except specifically permitted under such title. . (2) Note: Additional conforming amendments to be provided. (d) Conforming amendment Section 2602(d) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 1315b(d) (9) To be primarily responsible for the Federal administration of title XXII of the Social Security Act. . (e) Other conforming amendments Section 1101(a)(1) of the Social Security Act ( 42 U.S.C. 1301(a)(1) (1) by striking XIX, and XXI XIX, XXI, and XXII (2) by striking XIX and XXI XIX, XXI, and XXII 3. MedPAC study and report (a) Study The Medicare Payment Advisory Commission shall conduct a study for purposes of making recommendations regarding how to improve health care and other support needs of individuals who are eligible for and are receiving medical assistance for the payment of medicare cost-sharing under a State Medicaid program pursuant to clause (i), (iii), or (iv) of section 1902(a)(10)(E) of the Social Security Act ( 42 U.S.C. 1396a(a)(10)(E) (b) Report Not later than 18 months after the date of enactment of this Act, the Medicare Payment Advisory Commission shall submit to Congress a report on the study conducted under subsection (a), together with recommendations for such legislation and administrative action as the Commission determines to be appropriate.

Summary: Comprehensive Care for Dual Eligible Individuals Act This bill provides states with the option to establish a separate health care program for individuals who are dually eligible for Medicare and Medicaid. Programs must provide a core package of covered benefits to address the individualized medical, behavioral, long-term care, and social needs of enrollees, including all basic Medicare and Medicaid benefits. States may receive federal matching payments in accordance with a specified formula; the bill provides funds for the Federal Coordinated Health Care Office to implement the bill.