I 
113TH CONGRESS 
1ST SESSION H. R. 2376 
To implement a demonstration project under titles XVIII and XIX of the 
Social Security Act to examine the costs and benefits of providing pay-
ments for comprehensive coordinated health care services provided by 
purpose-built, continuing care retirement communities to Medicare bene-
ficiaries. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 14, 2013 
Mr. FITZPATRICK introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committee 
on Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To implement a demonstration project under titles XVIII 
and XIX of the Social Security Act to examine the 
costs and benefits of providing payments for comprehen-
sive coordinated health care services provided by purpose- 
built, continuing care retirement communities to Medi-
care beneficiaries. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Residential 
Care Coordination Act of 2013’’. 
SEC. 2. MEDICARE AND MEDICAID RESIDENTIAL CARE CO-
ORDINATION DEMONSTRATION PROJECT. 
(a) ESTABLISHMENT AND IMPLEMENTATION.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the 
‘‘Secretary’’) shall establish and implement a dem-
onstration project (in this section referred to as the 
‘‘demonstration project’’) under titles XVIII and 
XIX of the Social Security Act to evaluate the use 
of capitated payments made to eligible continuing 
care retirement communities for residential care co-
ordination programs. 
(2) TIMETABLE
FOR
IMPLEMENTATION.—In 
carrying out this section— 
(A) not later than 1 year after the date of 
the enactment of this Act the Secretary shall 
complete the design for the demonstration 
project and enter into one or more agreements 
with eligible CCRCs for the implementation of 
the project with respect to such CCRCs; and 
(B) not later than 4 years after the date 
of entering into such agreements, first provide 
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for implementation of the project through such 
CCRCs. 
(b) BUDGET NEUTRALITY.—With respect to the pe-
riod of the demonstration project under this section, the 
aggregate expenditures under titles XVIII and XIX of the 
Social Security Act for such period shall not exceed the 
aggregate expenditures that would have been expended 
under such titles if the demonstration project had not been 
implemented. 
(c) STATE ELECTION REQUIRED.— 
(1) IN GENERAL.—The Secretary may only im-
plement the demonstration project in a State that 
elects to participate in the demonstration project. 
(2) BENEFITS AND PAYMENTS.—A State that 
elects to participate in the demonstration project 
shall provide medical assistance through title XIX of 
the Social Security Act for each eligible CCRC resi-
dent who is eligible for medical assistance under the 
State plan under such title (including such residents 
who 
are 
made 
eligible 
under 
subsection 
(d)(3)(B)(iii)) and who is enrolled in a residential 
care coordination program in a manner that is con-
sistent with the requirements of this section, includ-
ing making the payments under subsection (e). 
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(3) LIMITATION.—A State may establish a nu-
merical limit on— 
(A) the number of eligible CCRC residents 
who may be enrolled in residential care coordi-
nation programs in the State; and 
(B) the number of eligible CCRCs that 
may operate residential care coordination pro-
grams in the State. 
(d) RESIDENTIAL CARE COORDINATION PROGRAM 
(RCCP); ELIGIBLE CONTINUE CARE RETIREMENT COM-
MUNITY (CCRC); ELIGIBLE CCRC RESIDENTS; COM-
PREHENSIVE COORDINATED HEALTH CARE SERVICES 
DEFINED.— 
(1) RESIDENTIAL
CARE
COORDINATION
PRO-
GRAM; RCCP.—For purposes of this section, the 
terms ‘‘residential care coordination program’’ and 
‘‘RCCP’’ mean a program that— 
(A) is operated within one or more eligible 
continuing care retirement communities (as de-
fined in paragraph (2)); 
(B) is designed with a capacity of serving 
at least 1,000, but not more than 1,500, eligible 
CCRC residents (as defined in paragraph (3)) 
at any one time; and 
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(C) provides comprehensive coordinated 
health care services (as defined in paragraph 
(4)) to participating CCRC residents enrolled in 
the program in accordance with the program 
agreement under subsection (f) and the require-
ments of this section. 
(2) ELIGIBLE CONTINUING CARE RETIREMENT 
COMMUNITY; ELIGIBLE CCRC.—In this section, the 
terms ‘‘eligible continuing care retirement commu-
nity’’ and ‘‘eligible CCRC’’ mean an entity that is a 
continuing care retirement community (as defined in 
section 1852(l)(4)(B) of the Social Security Act (42 
U.S.C. 1395w–22(l)(4)(B))) that— 
(A) is built for the purposes of partici-
pating in the demonstration project; 
(B) provides onsite— 
(i) housing accommodations for eligi-
ble CCRC residents, including apartments 
for independent living; and 
(ii) additional services to facilitate 
aging in place for such residents, including 
assisted living and skilled nursing facilities 
or alternatives; and 
(C) has entered into a program agreement 
with the Secretary and the State with respect 
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to its operation of the residential care coordina-
tion program and such agreement is consistent 
with the requirements of this section. 
(3) ELIGIBLE CCRC RESIDENT; PARTICIPATING 
CCRC RESIDENT.— 
(A) IN GENERAL.—For purposes of this 
section: 
(i) ELIGIBLE
CCRC
RESIDENT.—The 
term ‘‘eligible CCRC resident’’ means an 
individual who— 
(I) is entitled to, or enrolled for, 
benefits under part A of title XVIII of 
the Social Security Act, and enrolled 
for benefits under part B of such title; 
and 
(II) resides in an eligible CCRC. 
(ii) 
PARTICIPATING
CCRC
RESI-
DENT.—The term ‘‘participating CCRC 
resident’’ means, with respect to a resident 
care coordination program, an eligible 
CCRC resident who is enrolled in that pro-
gram. 
(B) PARTICIPATION BY DUAL-ELIGIBLE IN-
DIVIDUALS; EXPANDED ELIGIBILITY.— 
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(i) IN GENERAL.—An eligible CCRC 
resident may be, but is not required to be, 
a dual-eligible individual. 
(ii) DUAL-ELIGIBLE INDIVIDUAL DE-
FINED.—In this section, the term ‘‘dual-el-
igible individual’’ means any individual 
who is— 
(I) a full-benefit dual eligible in-
dividual 
(as 
defined 
in 
section 
1935(c)(6) of the Social Security 
Act); or 
(II) is described in clause (iii). 
(iii) 
QUALIFICATION
OF
PARTICI-
PATING
CCRC
RESIDENTS
FOR
MEDICAID 
BENEFITS.—An individual who is a partici-
pating CCRC resident, regardless of the 
level of care, who meets income and re-
source eligibility criteria established under 
the State Medicaid plan for an individual 
to obtain coverage for nursing facility serv-
ices on the basis of the individual’s re-
quirement for the level of care for such 
services, shall be treated as a dual-eligible 
individual under this section and under 
title XIX of the Social Security Act so long 
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as the individual remains a participating 
CCRC resident. 
(C) ENROLLMENT
AND
DISENROLLMENT 
RULES.— 
(i) DEEMED
ENROLLMENT
AT
TIME 
OF
INITIAL
RESIDENCY.—An individual 
who is described in subclause (I) of sub-
paragraph (A)(i) is deemed, at the time of 
becoming a resident in an eligible CCRC, 
to have voluntarily consented to enroll in 
the RCCP operated by that CCRC for pur-
poses of subparagraph (A)(ii). 
(ii) DISENROLLMENT PROCESS.—The 
demonstration project shall provide a 
method for the disenrollment from the 
project of participating CCRC residents, 
which method shall take into account the 
unique circumstances of residents who are 
required to leave the CCRC and shall per-
mit disenrollment at least in the same cir-
cumstances as would permit an individual 
to disenroll from a Medicare Advantage 
plan under part C of title XVIII of the So-
cial Security Act for cause. 
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(D) RELATION TO MEDICARE ADVANTAGE 
AND PRESCRIPTION DRUG PROGRAM.— 
(i) SUPERCEDES
ENROLLMENT.—A 
participating CCRC resident is not eligible 
to enroll in an MA plan under part C of 
title XVIII of the Social Security Act or 
under a prescription drug plan under part 
D of such title. 
(ii) 
COORDINATION
IN
CASE
OF 
DISENROLLMENT.—In the case of a par-
ticipating CCRC resident who disenrolls 
from 
the 
demonstration 
project, 
the 
disenrollment shall be treated, for purposes 
of parts C and D of such title, as if the in-
dividual had been previously enrolled in, 
and disenrolled from, an MA–PD plan 
under part C of such title. 
(E) PREMIUM PAYMENTS.—During the pe-
riod in which an individual is a participating 
CCRC resident— 
(i) for purposes of payment of pre-
miums under parts B, C, and D of title 
XVIII of the Social Security Act, the indi-
vidual shall be treated as if the individual 
were enrolled under an MA–PD plan with 
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a premium equal to an amount specified in 
the program agreement; and 
(ii) the individual shall be eligible for 
assistance with respect to such premiums 
under part D and Medicare cost-sharing in 
the same manner and in the equivalent 
amounts as if the individual had not been 
enrolled as a participating CCRC resident. 
(4) COMPREHENSIVE
COORDINATED
HEALTH 
CARE
SERVICES
DEFINED.—For purposes of this 
section, the term ‘‘comprehensive coordinated health 
care services’’, with respect to an eligible CCRC resi-
dent— 
(A) means all items and services that are 
otherwise payable under title XVIII of the So-
cial Security Act, including the minimum pre-
scription drug coverage required under a pre-
scription drug plan under part D of such title; 
(B) includes in the case of a dual eligible 
individual all items and services that are other-
wise payable under the State plan under title 
XIX of such Act of the State in which the resi-
dent resides; and 
(C) also includes— 
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(i) care management services that co-
ordinate acute and specialty services (in-
cluding inpatient hospital services, services 
provided by specialty physicians, and other 
necessary services) provided to eligible 
CCRC residents; 
(ii) wellness services, including assist-
ance and instruction in healthy living (in-
cluding diet and exercise); and 
(iii) other health care items and serv-
ices to manage chronic conditions, treat 
subacute conditions, and provide preventive 
care. 
(e) PAYMENT UNDER MEDICARE AND MEDICAID.— 
(1) IN GENERAL.—In the case of an individual 
who is a participating CCRC resident who is en-
rolled in a residential care coordination program op-
erated by an eligible CCRC— 
(A) the individual shall receive benefits 
under title XVIII of the Social Security Act, 
and, if such individual is a dual-eligible indi-
vidual (as defined in subsection (d)(3)(B)(ii)), 
under the State Medicaid plan or waiver under 
title XIX of such Act, solely through the resi-
dential care coordination program, which shall 
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provide such individual with comprehensive co-
ordinated health care services; and 
(B) the eligible CCRC shall receive 
capitated payments for the provision of such 
services (from the Secretary for benefits under 
title XVIII and from the State for benefits 
under such State plan or waiver), in accordance 
with this section. 
(2) PAYMENT METHODOLOGY.— 
(A) PAYMENT UNDER MEDICARE.— 
(i) PAYMENT ON MONTHLY BASIS.— 
With respect to each eligible CCRC, the 
Secretary shall make prospective monthly 
payments of a capitated amount, based on 
the rate established under clause (ii), for 
each participating CCRC resident enrolled 
in the residential care coordination pro-
gram operated by such CCRC in the same 
manner and from the same sources as pay-
ments are made to a Medicare Advantage 
organization under section 1853 of the So-
cial Security Act. Such payments shall be 
subject to adjustment in the manner de-
scribed in paragraphs (2) and (3) of sec-
tion 1853(a). 
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(ii) ESTABLISHMENT
OF
PAYMENT 
RATE.— 
(I) IN GENERAL.—The Secretary 
shall 
establish 
a 
risk-adjusted 
capitated payment rate under title 
XVIII of the Social Security Act for 
comprehensive coordinated health care 
services provided to eligible CCRC 
residents through a residential care 
coordination program operated by an 
eligible CCRC. The payment rate shall 
be 90 percent of the adjusted average 
per capita cost described in section 
1853(c)(1)(D)(i) of such Act (42 
U.S.C. 1395w–23(c)(1)(D)(i)), plus 
an amount equivalent to 90 percent of 
the amount that would have been paid 
to a prescription drug plan the stand-
ardized bid amount of which (as de-
fined in 1860D–13(a)(5) of such Act) 
was equal to the adjusted national av-
erage monthly bid amount (as defined 
in section 1860D–13(a)(1)(B)(iii) of 
such Act) and taking into account 
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low-income subsidies paid under sec-
tion 1860D–14. 
(II) PROGRAM
AGREEMENT.— 
The mechanism for establishing the 
capitated amount under this subpara-
graph for a specific eligible CCRC 
shall be specified in the program 
agreement. 
(B) PAYMENT UNDER MEDICAID.— 
(i) PAYMENT ON A MONTHLY BASIS.— 
With respect to an eligible CCRC oper-
ating an RCCP, the State shall make pro-
spective monthly payments of the capitated 
amount determined under and specified in 
the program agreement for each eligible 
CCRC resident of such community who is 
a dual-eligible individual. 
(ii) RELATIONSHIP TO MEDICARE PAY-
MENTS.—The payment made under this 
subparagraph shall be in addition to any 
payment made under subparagraph (A) to 
an eligible CCRC for eligible CCRC resi-
dents who are dual-eligible individuals. 
(iii) 
PROGRAM
AGREEMENT.—The 
capitated amount under this subparagraph 
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for a specific eligible CCRC shall be speci-
fied in the program agreement. 
(iv) PAYMENTS TO THE STATE.—The 
Secretary shall treat the payments made 
under clause (i) as medical assistance 
under title XIX of the Social Security Act 
for purposes of making payments to the 
State under section 1903 of such Act (42 
U.S.C. 1396b). 
(v) PAYMENTS
TO
REFLECT
SPEND 
DOWN
AMOUNTS
AND
PERSONAL
NEEDS 
ALLOWANCES.—The payments under this 
subparagraph shall be made in a manner 
that takes into account the financial con-
tributions required of dual-eligible individ-
uals and the personal needs allowance es-
tablished under the State plan. Such per-
sonal needs allowances may vary depending 
upon the level of care required by such an 
individual. 
(3) TREATMENT OF SERVICES FURNISHED BY 
NONCONTRACT PHYSICIANS AND OTHER ENTITIES.— 
(A) APPLICATION
OF
MEDICARE
ADVAN-
TAGE REQUIREMENTS.—Section 1852(k)(1) of 
the Social Security Act (42 U.S.C. 1395w– 
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22(k)(1)) (relating to limitations on balance 
billing against Medicare Advantage organiza-
tions for noncontract physicians and other enti-
ties with respect to services covered under title 
XVIII of such Act) shall apply to eligible 
CCRCs, eligible CCRC residents enrolled in a 
residential care coordination program, and phy-
sicians and other entities that do not have a 
contract or other agreement establishing pay-
ment amounts for services furnished to such a 
resident in the same manner as such section ap-
plies to Medicare Advantage organizations, indi-
viduals enrolled with such organizations, and 
physicians and other entities referred to in such 
section. 
(B) APPLICATION OF BALANCED BILLING 
LIMITATIONS.—Section 
1866(a)(1)(O) 
shall 
apply to services that are covered under title 
XVIII of the Social Security Act and are fur-
nished to any eligible CCRC residents enrolled 
in a residential care coordination program in 
the same manner that such section applies to 
services furnished to an individual enrolled with 
a PACE provider under section 1894 or 1934 
of such Act. 
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(f) PROGRAM AGREEMENT.— 
(1) REQUIREMENT.—The Secretary, in close co-
operation with the single State agency that admin-
isters or supervises the administration of the State 
plan under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) (in this section referred to as 
the ‘‘State Medicaid agency’’), shall establish proce-
dures for entering into, extending, and terminating 
program agreements (each in this section referred to 
as a ‘‘program agreement’’) for the operation of resi-
dential care coordination programs by eligible 
CCRCs. 
(2) AGREEMENT REQUIRED FOR PAYMENT.—In 
order to receive payment under subsection (e), each 
eligible CCRC operating a residential care coordina-
tion program shall enter into a program agreement 
with the Secretary and the State, which shall con-
tain such terms and conditions as the parties may 
agree to, so long as such terms and conditions are 
consistent with this section. 
(3) DURATION.— 
(A) IN GENERAL.—A program agreement 
under this section shall be effective for a con-
tract year, beginning consistent with subsection 
(a)(2)(B) not later than the fourth calendar 
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year to begin after the establishment of the 
demonstration project, and shall be extended 
for additional contract years in the absence of 
notice by a party to terminate. 
(B) TERMINATION.— 
(i) 
END
OF
DEMONSTRATION 
PROJECT.—The Secretary and the State 
Medicaid agency shall terminate the pro-
gram agreement at the termination of the 
demonstration project under subsection (i). 
(ii) NOTICE
OF
PROVIDER
TERMI-
NATION.—The eligible CCRC may termi-
nate the agreement after appropriate no-
tice to the Secretary, the State Medicaid 
agency, and eligible CCRC residents. 
(iii) TERMINATION FOR CAUSE.—The 
Secretary and the State Medicaid agency 
may terminate the program agreement at 
any time for cause (as provided under the 
agreement). Reasons for terminating an 
agreement under this clause include that 
the Secretary or State administering agen-
cy determines that— 
(I) there are significant defi-
ciencies in the quality of care provided 
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to eligible CCRC residents enrolled in 
the program or the eligible CCRC has 
failed to comply substantially with the 
requirements of this section; and 
(II) the entity has failed to de-
velop and successfully initiate, within 
30 days of the date of the receipt of 
written notice of such a determina-
tion, a plan to correct the deficiencies, 
or has failed to continue implementa-
tion of such a plan. 
(iv) RIGHT TO REMAIN.—Nothing in 
this paragraph shall be construed, in the 
case that a program agreement is termi-
nated— 
(I) for a previously participating 
CCRC resident continuing, as affect-
ing the individual’s right to continue 
to reside in the CCRC and to receive 
traditional CCRC care and services in 
accordance with the contract between 
the CCRC resident and the CCRC; 
and 
(II) as relieving the State from 
continuing to provide medical assist-
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ance with respect to such services for 
individuals who would qualify as dual- 
eligible individuals if the agreement 
had not been terminated. 
(4) SCOPE OF BENEFITS.— 
(A) IN GENERAL.—Under the agreement 
under paragraph (2), the eligible CCRC shall— 
(i) provide to participating CCRC 
residents of such community, regardless of 
source of payment, directly or under con-
tracts with other entities, at a minimum, 
all comprehensive coordinated health care 
services, without regard to any limitation 
or condition as to amount, duration, or 
scope under title XVIII or title XIX of the 
Social Security Act; 
(ii) provide such residents with access 
to necessary covered items and services 24 
hours a day, every day of the year; 
(iii) provide services to such residents 
onsite at the eligible CCRC through a mul-
tidisciplinary team that is led by a primary 
care physician and includes care coordina-
tors, case managers, and nurses; 
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(iv) has a ratio of accessible physi-
cians to eligible CCRC residents that the 
Secretary determines is adequate; and 
(v) specify the covered items and serv-
ices that will not be provided directly by 
the eligible CCRC and— 
(I) provide for delivery of those 
items and services through contracts 
to ensure compliance with the require-
ments of this section; and 
(II) provides, on an as needed 
basis for those residents who cannot 
transport themselves, for necessary 
transportation services to the pro-
viders of such items and services, if 
such items and services are provided 
outside of the eligible CCRC. 
(B) APPLICATION
OF
REGULAR
COST- 
SHARING RULES.—Under such agreement the 
eligible CCRC may apply deductibles, copay-
ments, coinsurance, or other cost sharing that 
would otherwise apply under titles XVIII and 
XIX of the Social Security Act in the case of 
a MA–PD plan under part C of title XVIII of 
such Act. 
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(5) QUALITY CONTROL.— 
(A) IN
GENERAL.—Under the program 
agreement, the eligible CCRC shall— 
(i) collect data; 
(ii) maintain, and afford the Secretary 
and the State Medicaid agency access to, 
the records relating to the program, in-
cluding pertinent financial, medical, and 
personnel records; and 
(iii) submit to the Secretary and the 
State Medicaid agency such reports as the 
Secretary finds (in consultation with State 
Medicaid agencies) necessary to monitor 
the operation, cost, and effectiveness of the 
demonstration project, including data rel-
evant to the measurements established by 
the Secretary under subparagraph (B), to 
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— 
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(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 
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 
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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.— 
(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 
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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. 
(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.— 
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(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. 
(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 
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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 
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— 
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(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-
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-
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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. 
(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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