adverse health outcomes, and require 
intensive care coordination and that is 
listed under subsection (f)(9)(A).’’. 
(B) PANEL OF CLINICAL ADVISORS.—Sec-
tion 1859(f) of the Social Security Act (42 
U.S.C. 1395w–28(f)), as amended by subsection 
(b), is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(9) LIST OF CONDITIONS FOR CLARIFICATION 
OF THE DEFINITION OF A SEVERE OR DISABLING 
CHRONIC
CONDITIONS
SPECIALIZED
NEEDS
INDI-
VIDUAL.— 
‘‘(A) IN
GENERAL.—Not later than De-
cember 31, 2020, and every 5 years thereafter, 
the Secretary shall convene a panel of clinical 
advisors to establish and update a list of condi-
tions that meet each of the following criteria: 
‘‘(i) Conditions that meet the defini-
tion of a severe or disabling chronic condi-
tion under subsection (b)(6)(B)(iii) on or 
after January 1, 2022. 
‘‘(ii) Conditions that require prescrip-
tion drugs, providers, and models of care 
that are unique to the specific population 
of enrollees in a specialized MA plan for 
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special needs individuals described in such 
subsection on or after such date and— 
‘‘(I) as a result of such special 
needs individuals with such a condi-
tion having access to and being en-
rolled in such a plan, as compared to 
access to and enrollment in other 
Medicare Advantage plans under this 
part, it is projected that such individ-
uals would improve health outcomes 
with respect to such condition, that 
such individuals would have reduced 
overall costs under this title, and that 
there would not be any increase in ex-
penditures under this title for such in-
dividuals; or 
‘‘(II) have a low prevalence in the 
general population of beneficiaries 
under this title or a disproportionally 
high per-beneficiary cost under this 
title. 
‘‘(B) GAO STUDY ON HEALTH OUTCOMES 
OF
INDIVIDUALS
ENROLLED
IN
SPECIALIZED 
MA PLANS.—Not later than the date that is 3 
years after the date of the enactment of this 
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paragraph, the Comptroller General of the 
United States shall conduct a study and submit 
to Congress a report on the extent to which 
health outcomes can be compared across spe-
cialized MA plans for special needs individuals 
(as defined in section 1859(b)(6)) and other 
Medicare Advantage plans under this part 
across similar populations, using existing meas-
ures and that identifies any potential limita-
tions where new measures may need to be de-
veloped for such population.’’. 
(d) QUALITY MEASUREMENT AT THE PLAN LEVEL 
FOR SNPS AND DETERMINATION OF FEASABILITY OF 
QUALITY MEASUREMENT AT THE PLAN LEVEL FOR ALL 
MA PLANS.—Section 1853(o) of the Social Security Act 
(42 U.S.C. 1395w–23(o)) is amended by adding at the end 
the following new paragraphs: 
‘‘(6) QUALITY
MEASUREMENT
AT
THE
PLAN 
LEVEL FOR SNPS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the Secretary may require reporting 
of data under section 1852(e) for, and apply 
under this subsection, quality measures at the 
plan level for specialized MA plans for special 
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needs individuals instead of at the contract 
level. 
‘‘(B) CONSIDERATIONS.—Prior to applying 
quality measurement at the plan level under 
this paragraph, the Secretary shall— 
‘‘(i) take into consideration the min-
imum number of enrollees in a specialized 
MA plan for special needs individuals in 
order to determine if a statistically signifi-
cant or valid measurement of quality at 
the plan level is possible under this para-
graph; 
‘‘(ii) if quality measures are reported 
at the plan level, ensure that MA plans are 
not required to provide duplicative infor-
mation; and 
‘‘(iii) ensure that such reporting does 
not interfere with the collection of encoun-
ter data submitted by MA organizations or 
the administration of any changes to the 
program under this part as a result of the 
collection of such data. 
‘‘(C) APPLICATION.—If the Secretary ap-
plies quality measurement at the plan level 
under this paragraph— 
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‘‘(i) such quality measurement may 
include Medicare Health Outcomes Survey 
(HOS), Healthcare Effectiveness Data and 
Information Set (HEDIS), Consumer As-
sessment of Healthcare Providers and Sys-
tems (CAHPS) measures and quality 
measures under part D; and 
‘‘(ii) the Secretary shall consider ap-
plying administrative actions, such as rem-
edies described in section 1857(g)(2), to 
the plan level. 
‘‘(7) DETERMINATION
OF
FEASIBILITY
OF 
QUALITY MEASUREMENT AT THE PLAN LEVEL FOR 
ALL MA PLANS.— 
‘‘(A) DETERMINATION OF FEASIBILITY.— 
The Secretary shall determine the feasibility of 
requiring reporting of data under section 
1852(e) for, and applying under this subsection, 
quality measures at the plan level for all MA 
plans under this part. 
‘‘(B) CONSIDERATION OF CHANGE.—After 
making a determination under subparagraph 
(A), the Secretary shall consider requiring such 
reporting and applying such quality measures 
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at the plan level as described in such subpara-
graph.’’. 
(e) GAO STUDY AND REPORT ON STATE-LEVEL IN-
TEGRATION BETWEEN DUAL SNPS AND MEDICAID.— 
(1) STUDY.—The Comptroller General of the 
United States (in this paragraph referred to as the 
‘‘Comptroller General’’) shall conduct a study on 
State-level integration between specialized MA plans 
for special needs individuals described in subsection 
(b)(6)(B)(ii) of section 1859 of the Social Security 
Act (42 U.S.C. 1395w–28) and the Medicaid pro-
gram under title XIX of such Act (42 U.S.C. 1396 
et seq.). Such study shall include an analysis of the 
following: 
(A) The characteristics of States in which 
the State agency responsible for administering 
the State plan under such title XIX has a con-
tract with such a specialized MA plan and that 
delivers long-term services and supports under 
the State plan under such title XIX through a 
managed care program, including the require-
ments under such State plan with respect to 
long-term services and supports. 
(B) The types of such specialized MA 
plans, which may include the following: 
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(i) A plan described in section 
1853(a)(1)(B)(iv)(II) of such Act (42 
U.S.C. 1395w–23(a)(1)(B)(iv)(II)). 
(ii) A plan that meets the require-
ments described in subsection (f)(3)(D) of 
such section 1859. 
(iii) A plan described in clause (ii) 
that also meets additional requirements es-
tablished by the State. 
(C) The characteristics of individuals en-
rolled in such specialized MA plans. 
(D) As practicable, the following with re-
spect to State programs for the delivery of long- 
term services and supports under such title 
XIX through a managed care program: 
(i) Which populations of individuals 
are eligible to receive such services and 
supports. 
(ii) Whether all such services and sup-
ports are provided on a capitated basis or 
if any of such services and supports are 
carved out and provided through fee-for- 
service. 
(E) As, practicable, how the availability 
and variation of integration arrangements of 
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such specialized MA plans offered in States af-
fects spending, service delivery options, access 
to community-based care, and utilization of 
care. 
(F) Barriers and opportunities for making 
further progress on dual integration, as well as 
recommend legislation to expedite or refine 
pathways toward fully integrated care. 
(2) REPORT.—Not later than 2 years after the 
date of the enactment of this Act, the Comptroller 
General shall submit to Congress a report containing 
the results of the study conducted under paragraph 
(1), together with recommendations for such legisla-
tion and administrative action as the Comptroller 
General determines appropriate. 
SEC. 2. EXPANDING SUPPLEMENTAL BENEFITS TO MEET 
THE NEEDS OF CHRONICALLY ILL MEDICARE 
ADVANTAGE ENROLLEES. 
(a) IN GENERAL.—Section 1852(a)(3) of the Social 
Security Act (42 U.S.C. 1395w–22(a)(3)) is amended— 
(1) in subparagraph (A), by striking ‘‘Each’’ 
and inserting ‘‘Subject to subparagraph (D), each’’; 
and 
(2) by adding at the end the following new sub-
paragraph: 
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‘‘(D) EXPANDING
SUPPLEMENTAL
BENE-
FITS TO MEET THE NEEDS OF CHRONICALLY 
ILL ENROLLEES.— 
‘‘(i) IN
GENERAL.—For plan year 
2020 and subsequent plan years, in addi-
tion to any supplemental health care bene-
fits otherwise provided under this para-
graph, an MA plan, including a specialized 
MA plan for special needs individuals de-
scribed in subsection (b)(6) of section 
1859, may provide supplemental benefits 
described in clause (ii) to a chronically ill 
enrollee (as defined in clause (iii)). 
‘‘(ii) SUPPLEMENTAL
BENEFITS
DE-
SCRIBED.— 
‘‘(I) IN GENERAL.—Supplemental 
benefits described in this clause are 
supplemental benefits that, with re-
spect to a chronically ill enrollee, have 
a reasonable expectation of improving 
or maintaining the health or overall 
function of the chronically ill enrollee 
and may not be limited to being pri-
marily health related benefits. 
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‘‘(II) AUTHORITY TO WAIVE UNI-
FORMITY
REQUIREMENTS.—The Sec-
retary may, with respect to supple-
mental benefits provided to a chron-
ically ill enrollee under this subpara-
graph, waive the uniformity require-
ment, as determined appropriate by 
the Secretary. 
‘‘(iii) CHRONICALLY
ILL
ENROLLEE 
DEFINED.—In this subparagraph, the term 
‘chronically ill enrollee’ means an enrollee 
in an MA plan that the Secretary deter-
mines— 
‘‘(I) has one or more comorbid 
and medically complex chronic condi-
tions that is life threatening or signifi-
cantly limits the overall health or 
function of the enrollee; 
‘‘(II) has a high risk of hos-
pitalization or other adverse health 
outcomes; or 
‘‘(III) requires intensive care co-
ordination.’’. 
(b) GAO STUDY AND REPORT.— 
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(1) STUDY.—The Comptroller General of the 
United States (in this subsection referred to as the 
‘‘Comptroller General’’) shall conduct a study on 
supplemental benefits provided to enrollees in Medi-
care Advantage plans under part C of title XVIII of 
the Social Security Act, including specialized MA 
plans for special needs individuals described in sec-
tion 1859(b)(6) of such Act (42 U.S.C. 1395w– 
28(b)(6)). Such study shall be conducted in con-
sultation with the Centers for Medicare & Medicaid 
Services and Medicare Advantage plans as necessary 
and, to the extent data is available, shall include an 
analysis of the following: 
(A) The type of supplemental benefits pro-
vided to such enrollees, the total number of en-
rollees receiving each supplemental benefit, and 
whether the supplemental benefit is covered by 
the standard benchmark cost of the benefit or 
with an additional premium. 
(B) The frequency in which supplemental 
benefits are utilized by such enrollees. 
(C) The impact supplemental benefits have 
on— 
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(i) indicators of the quality of care re-
ceived by such enrollees, including overall 
health and function of the enrollees; 
(ii) the utilization of items and serv-
ices for which benefits are available under 
the original Medicare fee-for-service pro-
gram option under parts A and B of such 
title XVIII by such enrollees; and 
(iii) the amount of the bids submitted 
by Medicare Advantage Organizations for 
Medicare Advantage plans under such part 
C. 
(2) REPORT.—Not later than 5 years after the 
date of the enactment of this Act, the Comptroller 
General shall submit to Congress a report containing 
the results of the study conducted under paragraph 
(1), together with recommendations for such legisla-
tion and administrative action as the Comptroller 
General determines appropriate. 
Æ 
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