SEC. 5. ADVANCE ALIGNMENT OF MEDICARE AND MED-
ICAID FOR DUAL ELIGIBLES. 
(a) ALIGNMENT OF MEDICARE AND MEDICAID POLI-
CIES AND PROCEDURES FOR SNPS SERVING DUAL ELIGI-
BLES.—In order to increase simplicity for dual eligibles 
in accessing and coordinating Medicare and Medicaid ben-
efits by enhancing coordination between CMS and State 
Medicaid agencies in the oversight of SNPs insofar as they 
serve dual eligibles, the Secretary may modify rules, poli-
cies, and procedures under titles XVIII and XIX of such 
Act in order to provide for the alignment of Medicare and 
Medicaid requirements, including marketing, enrollment, 
care coordination, auditing, reporting, quality assurance, 
and other relevant oversight functions. 
(b) OFFICE
OF
MEDICARE/MEDICAID
INTEGRA-
TION.— 
(1) ESTABLISHMENT.—The Secretary shall es-
tablish or designate an Office on Medicare/Medicaid 
Integration (in this subsection referred to as the 
‘‘Office’’) for the purpose of aligning Medicare and 
Medicaid policies and procedures and developing 
tools to support State integration efforts in order— 
(A) to simplify dual eligible access to Medi-
care and Medicaid benefits and services; 
(B) to improve care continuity and ensure 
safe and effective care transitions; 
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(C) to eliminate cost shifting between 
Medicare and Medicaid and among related care 
providers; 
(D) to eliminate regulatory conflicts be-
tween Medicare and Medicaid rules; and 
(E) to improve total cost and quality per-
formance. 
(2) HEAD.—The head of the Office who shall 
report to the Administrator of the Centers for Medi-
care & Medicaid Services. 
(3) RESPONSIBILITIES.—The responsibilities of 
the Office are to develop policies and procedures— 
(A) to support State efforts to coordinate 
and align acute and long-term care benefits for 
dual eligibles through a State plan option or 
other means; 
(B) to provide support for coordination of 
State and Federal contracting and oversight for 
dual integration programs supportive of the 
goals described in paragraph (1); and 
(C) to align Federal rules for Medicaid 
managed care and Medicare Advantage Plans 
to include methods for integrating marketing, 
enrollment, grievances and appeals, auditing, 
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reporting, quality assurance and other relevant 
oversight functions. 
(c) FACILITATION OF ALIGNMENT.—The Secretary 
shall— 
(1) submit to Congress a report on statutory 
changes needed to facilitate the alignment of Medi-
care and Medicaid policies for dual eligibles; 
(2) work with the Congressional Budget Office 
and the Office of Management and Budget to estab-
lish a process for evaluating total Medicare and 
Medicaid spending for beneficiaries who are dually 
eligible for Medicare and Medicaid and enrolled in 
plans that integrate Medicare and Medicaid benefits 
such that the enrollment of such beneficiaries in 
such plans is treated as ‘‘budget neutral’’ if the com-
bined Medicare and Medicaid costs under such plans 
do not exceed the combined costs of providing Medi-
care and Medicaid services on a fee-for-service basis 
for a comparable risk group; and 
(3) provide States and SNPs with education 
and tools for developing programs that align Medi-
care and Medicaid benefits for dual eligibles. 
(d) IDENTIFICATION OF INCENTIVES IN SUPPORT OF 
STATE INTEGRATION EFFORTS.—The Secretary shall 
identify incentives for States to advance the development 
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of integrated approaches in providing health care services 
for dual eligibles. 
(e) DEFINITIONS.—In this section: 
(1) CMS.—The term ‘‘CMS’’ means the Cen-
ters for Medicare & Medicaid Services. 
(2) DUAL ELIGIBLE.—The term ‘‘dual eligible’’ 
means an MA eligible individual (as defined in sec-
tion 1851(a)(3) of the Social Security Act, 42 
U.S.C. 13195w–21(a)(3)) who is also entitled to 
medical assistance under a State plan under title 
XIX of the Social Security Act. 
(3) DUAL ELIGIBLE SNP.—The term ‘‘dual eli-
gible SNP’’ means a SNP described in section 
1859(b)(6)(A)(ii)(II) of the Social Security Act, as 
amended by section 3(a). 
(4) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(5) SNP.—The term ‘‘SNP’’ means a special-
ized MA plan for special needs individuals, as de-
fined in section 1859(b)(6)(A) of the Social Security 
Act (42 U.S.C. 1395w–28(b)(6)(A)). 
(6) STATE.—The term ‘‘State’’ has the mean-
ing given such term for purposes of title XIX of the 
Social Security Act. 
Æ 
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