I 
116TH CONGRESS 
1ST SESSION H. R. 3461 
To establish a Community-Based Institutional Special Needs Plan demonstra-
tion program to target home and community-based care to eligible Medi-
care beneficiaries, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 25, 2019 
Ms. SA´NCHEZ (for herself, Mr. KELLY of Pennsylvania, and Mr. SCHRADER) 
introduced the following bill; which was referred to the Committee on 
Ways and Means, and in addition to the Committee on Energy and Com-
merce, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
A BILL 
To establish a Community-Based Institutional Special Needs 
Plan demonstration program to target home and commu-
nity-based care to eligible Medicare beneficiaries, and 
for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Community-Based 
Independence for Seniors Act of 2019’’. 
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SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) Community-based services play an essential 
role in keeping individuals healthy. 
(2) Without community-based long-term serv-
ices and supports, which are not typically covered by 
Medicare, seniors frequently experience negative 
health outcomes and lose their ability to live inde-
pendently. 
(3) Seniors who deplete their resources often 
have no option but to turn to Medicaid for coverage 
of long term care expenses. 
(4) Targeting community-based services and 
supports to at-risk seniors can help these individuals 
avoid depleting their assets and becoming Medicaid 
dependent. 
SEC. 
3. 
COMMUNITY-BASED 
INSTITUTIONAL 
SPECIAL 
NEEDS PLAN DEMONSTRATION. 
Part C of title XVIII of the Social Security Act is 
amended by inserting after section 1859 (42 U.S.C. 
1395w–28) the following new section: 
‘‘SEC. 1859A. COMMUNITY-BASED INSTITUTIONAL SPECIAL 
NEEDS PLAN DEMONSTRATION. 
‘‘(a) ESTABLISHMENT.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a Community-Based Institutional Special Needs 
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Plan demonstration program (in this section referred 
to as the ‘CBI–SNP demonstration program’) to 
provide home and community-based care to eligible 
Medicare beneficiaries. 
‘‘(2) AGREEMENTS.—The Secretary shall enter 
into agreements with eligible MA organizations 
under which such organizations shall offer eligible 
MA plans under the CBI–SNP demonstration pro-
gram to eligible Medicare beneficiaries. 
‘‘(3) LIMITATIONS ON SCOPE OF DEMONSTRA-
TION PROGRAM.— 
‘‘(A) NUMBER OF PLANS.—The CBI–SNP 
demonstration program shall be carried out 
with respect to not greater than five MA plans. 
‘‘(B) 
NUMBER
OF
ENROLLEES
PER 
PLAN.—An eligible MA organization that enters 
into an agreement with the Secretary under 
paragraph (2) to offer an eligible MA plan 
under the CBI–SNP demonstration program 
may not enroll more than 1,000 eligible Medi-
care beneficiaries (including new enrollees) in 
such plan. 
‘‘(4) ELIGIBLE MA PLANS DEFINED.—For pur-
poses of this section, the term ‘eligible MA plan’ 
means a plan that, in addition to items and services 
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for which coverage is otherwise provided under this 
part (including benefits under section 1852(a)(3) 
and notwithstanding any waivers under section 
1915(c)), provides for coverage of long-term care 
services and supports that the Secretary determines 
appropriate for the purposes of the CBI–SNP dem-
onstration program, such as— 
‘‘(A) homemaker services; 
‘‘(B) home delivered meals; 
‘‘(C) transportation services; 
‘‘(D) respite care; 
‘‘(E) adult day care services; and 
‘‘(F) safety and other equipment not other-
wise covered under this title. 
‘‘(b) ELIGIBLE MA ORGANIZATIONS.—For purposes 
of this section, the term ‘eligible MA organization’ means 
an MA organization that— 
‘‘(1) has experience in offering specialized MA 
plans for special needs individuals, as defined in sec-
tion 1859(b)(6)(A), to individuals who live in the 
community in which the eligible MA plan is offered; 
‘‘(2) has experience working with low income 
seniors groups; 
‘‘(3) is located in a State that the Secretary has 
determined is able to participate in the CBI–SNP 
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demonstration program by agreeing to make avail-
able data necessary for purposes of conducting the 
independent evaluation required under subsection 
(h); and 
‘‘(4) meets such other criteria as the Secretary 
may require. 
‘‘(c) 
ELIGIBLE
MEDICARE
BENEFICIARY
DE-
FINED.—In this section, the term ‘eligible Medicare bene-
ficiary’ means a Medicare beneficiary who— 
‘‘(1) is eligible to enroll in an eligible MA plan 
under the CBI–SNP demonstration program; 
‘‘(2) is a subsidy-eligible individual (as defined 
in section 1860D–14(a)(3)(A)); 
‘‘(3) is not eligible to receive benefits under title 
XIX; 
‘‘(4) is unable to perform two or more activities 
of daily living (as defined in section 7702B(c)(2)(B) 
of the Internal Revenue Code of 1986); and 
‘‘(5) is age 65 or older. 
‘‘(d) PAYMENTS.—The Secretary shall establish pay-
ment rates for eligible MA organizations offering eligible 
MA plans under the CBI–SNP demonstration program for 
benefits covered under such program (and not otherwise 
covered under part C) and provided to eligible Medicare 
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beneficiaries under such plans. Such payment rates 
shall— 
‘‘(1) be based upon payment rates established 
for purposes of payment under section 1853; 
‘‘(2) be in addition to payments otherwise made 
to such organization with respect to such plans 
under part C; 
‘‘(3) be adjusted to reflect the costs of treating 
eligible Medicare beneficiaries under this section; 
and 
‘‘(4) not, with respect to a month in which an 
eligible MA organization provides home and commu-
nity-based care to eligible Medicare beneficiaries 
under such demonstration program, exceed an 
amount for such month that is equal to the amount 
that would be awarded to such organization if the 
organization were to receive $400 with respect to 
each such beneficiary that the organization provides 
with such care during such month. 
‘‘(e) SPECIAL ELECTION PERIOD.—Notwithstanding 
sections 1852(e)(2)(C) and 1860D–1(b)(1)(B)(iii), an eli-
gible Medicare beneficiary may, other than during the an-
nual, coordinated election periods under such sections— 
‘‘(1) discontinue enrollment in an MA plan not 
participating in the CBI–SNP demonstration pro-
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gram and enroll in an MA plan participating in such 
program; and 
‘‘(2) discontinue enrollment under the original 
Medicare fee-for-service program under parts A and 
B and the enrollment in a prescription drug plan 
under part D and enroll in an MA plan participating 
in the CBI–SNP demonstration program. 
‘‘(f) BENEFICIARY EDUCATION.—The Secretary shall 
help to educate, through State Health Insurance Assist-
ance Programs and other organizations that assist seniors 
with respect to benefits and enrollment under this title, 
eligible Medicare beneficiaries on the availability of the 
CBI–SNP demonstration program. 
‘‘(g) IMPLEMENTATION.— 
‘‘(1) DEADLINE.—The CBI–SNP demonstra-
tion program shall be implemented not later than 
January 1 of the second year beginning after the 
date of the enactment of this section. 
‘‘(2) DURATION.—Subject to paragraph (3), the 
CBI–SNP demonstration program shall be con-
ducted for a period of five years. 
‘‘(3) EXTENSION OR EXPANSION.—Taking into 
account the report under subsection (h)(2), the Sec-
retary may, through notice and comment rule-
making, expand the duration, scope, or both the du-
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ration and scope of the CBI–SNP demonstration 
program (including implementation on a nationwide 
or permanent basis or both), other than under the 
original Medicare fee-for-service program under 
parts A and B of such title, to the extent determined 
appropriate by the Secretary, unless the Secretary 
determines that such expansion is expected to— 
‘‘(A) 
increase 
aggregate 
expenditures 
under this title and title XIX with respect to el-
igible Medicare beneficiaries participating in the 
CBI–SNP demonstration program; or 
‘‘(B) decrease the quality of health care 
services furnished to eligible Medicare bene-
ficiaries participating in the CBI–SNP dem-
onstration program. 
‘‘(h) INDEPENDENT EVALUATION AND REPORTS.— 
‘‘(1) INDEPENDENT EVALUATION.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
provide for the evaluation of the CBI–SNP 
demonstration program by an independent third 
party. 
‘‘(B) 
EVALUATION
OBJECTIVES.—Such 
evaluation shall determine the extent to which 
the CBI–SNP demonstration program has re-
sulted in— 
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