permit the Secretary and the State to 
evaluate such demonstration project. 
(B) QUALITY AND OUTCOME MEASURES.— 
The Secretary shall establish clinical and other 
outcome measurements to assess the efficacy of 
the demonstration project in— 
(i) improving— 
(I) the health status and out-
comes of participating CCRC resi-
dents enrolled in residential care co-
ordination programs under this dem-
onstration project, compared to Medi-
care beneficiaries (including tradi-
tional dual-eligible individuals de-
scribed in subsection (d)(3)(B)(ii)(I)) 
who are not enrolled in such pro-
grams; and 
(II) the quality of health care 
provided to such participating CCRC 
residents; and 
(ii) controlling the overall cost of pro-
viding health care items and services to 
such participating CCRC residents, com-
pared to the cost of providing such items 
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and services to other Medicare bene-
ficiaries. 
(6) PATIENT
SAFEGUARDS.—The agreement 
under paragraph (2) shall provide for written safe-
guards of the rights of participating CCRC residents 
enrolled in a residential care coordination program 
(including a patient bill of rights and procedures for 
grievances and appeals). Such safeguards shall be 
similar to the safeguards required under the section 
1894(b)(2)(B) of the Social Security Act (42 U.S.C. 
1395eee(b)(2)(B)) with respect to the PACE pro-
gram. 
(7) TRANSITION.—If a participating CCRC 
resident who is enrolled in a residential care coordi-
nation program is disenrolled from such program, 
the eligible CCRC shall provide assistance to the in-
dividual in obtaining necessary care through appro-
priate referrals and making the individual’s medical 
records available to new providers. 
(8) RULE OF CONSTRUCTION.—Nothing is this 
subsection shall be construed as preventing the eligi-
ble CCRC from assessing typical and appropriate 
fees to eligible CCRC residents. 
(g) SECRETARY’S OVERSIGHT; ENFORCEMENT AU-
THORITY.— 
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(1) OVERSIGHT.— 
(A) IN GENERAL.—During the duration of 
the demonstration project, with respect to an el-
igible CCRC operating a residential care coordi-
nation program under a program agreement 
under subsection (f), the Secretary (acting in 
cooperation with the State Medicaid agency) 
shall conduct a comprehensive annual review of 
the operation of the eligible CCRC in order to 
ensure compliance with the requirements of this 
section. Such review shall include— 
(i) an onsite visit to the eligible 
CCRC; 
(ii) a comprehensive assessment of the 
community’s fiscal soundness; 
(iii) a comprehensive assessment of 
the eligible CCRC’s capacity to provide all 
comprehensive coordinated health care 
services to participating CCRC residents; 
(iv) detailed analysis of the commu-
nity’s substantial compliance with the re-
quirements of this section; and 
(v) any other elements that the Sec-
retary or the State Medicaid agency con-
siders necessary or appropriate. 
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(B) DISCLOSURE.—The results of reviews 
under this paragraph shall be reported prompt-
ly to the eligible CCRC, along with any rec-
ommendations for changes to the community’s 
program, and shall be made available to the 
public through a public Web site of the Depart-
ment of Health and Human Services. 
(2) SANCTIONS.— 
(A) IN GENERAL.—If the Secretary deter-
mines (after consultation with the State Med-
icaid agency) that an eligible CCRC operating 
a residential care coordination program under a 
program agreement under subsection (f) is fail-
ing substantially to comply with the require-
ments of this section, the Secretary (and the 
State Medicaid agency) may take any or all of 
the following actions: 
(i) Condition the continuation of the 
program agreement upon timely execution 
of a corrective action plan. 
(ii) Withhold some or all further pay-
ments under the program agreement under 
this section with respect to services fur-
nished by such community until the defi-
ciencies have been corrected. 
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(iii) Terminate such agreement under 
subsection (f)(3)(B). 
(B) 
APPLICATION
OF
INTERMEDIATE 
SANCTIONS.—The Secretary may, by regulation, 
provide for the application against an eligible 
CCRC operating a residential care coordination 
program under a program agreement under this 
section 
of 
remedies 
described 
in 
section 
1857(g)(2) of the Social Security Act (42 
U.S.C. 
1395w–27(g)(2)) 
or 
section 
1903(m)(5)(B) 
of 
such 
Act 
(42 
U.S.C. 
1396b(m)(5)(B)) in the case of violations by 
the community of the type described in section 
1857(g)(1) or 1903(m)(5)(A) of such Act, re-
spectively (in relation to agreements, enrollees, 
and requirements under this section). 
(C) PROCEDURES
FOR
TERMINATION
OR 
IMPOSITION OF SANCTIONS.—The provisions of 
section 1857(h) of the Social Security Act (42 
U.S.C. 1395w–27(h)) shall apply, by regulation, 
to termination and sanctions respecting a pro-
gram agreement and an eligible CCRC oper-
ating a residential care coordination program 
under a program agreement under this sub-
section in the same manner as they apply to a 
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termination and sanctions with respect to a 
contract and a Medicare Advantage organiza-
tion under part C of title XVIII of such Act. 
(h) WAIVER.—Notwithstanding section 1115(a) of 
the Social Security Act (42 U.S.C. 1315(a)), the Secretary 
may waive such provisions of titles XI, XVIII, and XIX 
of that Act as may be necessary to— 
(1) accomplish the goals of the demonstration 
project under this section; and 
(2) maximize the quality of life of eligible 
CCRC beneficiaries, as determined using the meas-
ures established under subsection (f)(5)(B). 
(i) DURATION OF 10 YEARS.— 
(1) IN
GENERAL.—Subject to paragraph (2) 
and subsection (f)(3)(B), the demonstration project 
shall terminate 10 years after the date on which the 
demonstration project is first implemented under 
subsection (a)(2)(B). 
(2) 
EXTENSION.—The 
Secretary, 
acting 
through the Center for Medicare and Medicaid Inno-
vation, may extend the use of capitated payments 
for eligible CCRCs for residential care coordination 
programs under this section if, by the termination 
date that would otherwise apply under paragraph 
(1), the Secretary has demonstrated that the dem-
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onstration project has improved the coordination, 
quality, and efficiency of health care services fur-
nished to Medicare beneficiaries. 
(j) STUDY AND REPORT TO CONGRESS.— 
(1) INTERIM EVALUATION AND REPORT.—Not 
later than 3 years after the date on which the dem-
onstration project is first implemented under sub-
section (a)(2)(B), the Secretary shall submit to Con-
gress a report that contains the following: 
(A) An interim evaluation of the costs and 
benefits of providing comprehensive coordinated 
health care services to Medicare beneficiaries 
(including dual-eligible individuals) through res-
idential care coordination programs, including 
the costs and benefits of using payments under 
title XIX of the Social Security Act to provide 
continuity of care by permitting certain individ-
uals to continue to participate in such programs 
after qualifying for enrollment in the Medicaid 
program under this section due to reduced in-
come and assets. 
(B) An analysis of the appropriateness of 
implementing a new payment methodology 
under titles XVIII and XIX of the Social Secu-
rity Act for such services in the future. 
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(2) FINAL
EVALUATION
AND
REPORT.—Not 
later than 10 years after the date on which the dem-
onstration project is first so implemented, the Sec-
retary shall submit to Congress a report that con-
tains a final evaluation of the impact of the dem-
onstration project. 
Æ 
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