SEC. 205. ENROLLMENT THROUGH INDEPENDENT BRO-
KERS. 
Not later than 1 year after the date of enactment 
of this Act, the Director of the Federal Coordinated 
Health Care Office of the Centers for Medicare & Med-
icaid Services and the Administrator of the Centers for 
Medicare & Medicaid Services jointly shall issue guidance 
or regulations providing that— 
(1) a dual eligible individual (as defined in sec-
tion 2201 of the Social Security Act) may not be en-
rolled in a health benefits plan that provides inte-
grated care for such individual under title XXII of 
the Social Security Act through a broker unless the 
broker is an independent broker (as defined under 
such guidance or regulations); 
(2) an independent broker may receive a com-
mission for the initial enrollment of a dual eligible 
individual in such a plan, but no commission shall 
be available to any broker for any subsequent enroll-
ment of such individual in any such plan; 
(3) if a broker disenrolls a dual eligible indi-
vidual from any such health benefits plan to a plan 
that provides partial or no integrated care, the 
broker, in accordance with the model standards 
issued under section 204(b), shall inform the indi-
vidual— 
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(A) of the health benefits plan the indi-
vidual is being disenrolled from; and 
(B) that the individual is being enrolled in 
a health benefits plan that provides partial or 
no integrated care and the potential implica-
tions of such disenrollment and enrollment on 
the individual’s care. 
SEC. 206. REDUCING THRESHOLD FOR LOOK-ALIKE D–SNP 
PLANS UNDER MEDICARE ADVANTAGE. 
For the first full plan year that begins on or after 
the date that is 1 year after the date of enactment of this 
Act, and each subsequent plan year, the Secretary of 
Health and Human Services— 
(1) shall implement section 422.514(d)(1)(ii) of 
title 42, Code of Federal Regulations (or any suc-
cessor regulations) by substituting ‘‘50 percent’’ for 
‘‘80 percent’’; and 
(2) shall only count full-benefit dual eligible in-
dividuals (as defined in section 1935(c)(6) of the So-
cial Security Act (42 U.S.C. 1396u–5(c)(6))) for 
purposes of applying the threshold under such sec-
tion. 
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SEC. 207. REQUIRING REGULAR UPDATE OF PROVIDER DI-
RECTORIES. 
Not later than 1 year after the date of enactment 
of this Act, the Director of the Federal Coordinated 
Health Care Office of the Centers for Medicare & Med-
icaid Services and the Administrator of the Centers for 
Medicare & Medicaid Services shall promulgate regula-
tions that— 
(1) require Medicare Advantage plans under 
part C of title XVIII of the Social Security Act (42 
U.S.C. 1395w–21) and integrated care plans under 
title XXII of such Act to regularly update provider 
directories; and 
(2) include a measure relating to provider direc-
tor currency rating on star rating systems for Medi-
care Advantage plans under section 1853(o) of the 
Social Security Act (42 U.S.C. 1395w–23(o)) and 
integrated care plans under title XXII of such Act. 
SEC. 208. REVIEW OF HOSPITAL QUALITY STAR RATING 
SYSTEM. 
Not later than 180 days after the date of enactment 
of this Act, the Administrator of the Centers for Medicare 
& Medicaid Services shall— 
(1) review the hospital quality star rating sys-
tem under the Medicare program under title XVIII 
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of the Social Security Act (42 U.S.C. 1395 et seq.); 
and 
(2) identify such administrative and legislative 
changes as are needed to ensure that sufficient in-
formation is collected under such system regarding 
hospitals to effectively measure hospital quality. 
SEC. 209. REQUIREMENT FOR FCHCO AND STATE MEDICAID 
AGENCIES TO DEVELOP MAXIMUM STAFFING 
RATIOS FOR CARE COORDINATORS. 
(a) IN GENERAL.—The Director of the Federal Co-
ordinated Health Care Office, in consultation with State 
Medicaid agencies, shall develop model Federal legislation 
that would establish a process for determining a maximum 
care coordinator-to-patient ratio for integrated care plans 
providing care to dual eligible individuals under an inte-
grated care model under title XXII of the Social Security 
Act. Such process shall take into account the varying 
needs required by different categories of patients. 
(b) SUBMISSION
OF MODEL LEGISLATION.—Not 
later than 180 days after the date of enactment of this 
Act, the Director of the Federal Coordinated Health Care 
Office shall submit the model legislation developed under 
subsection (a) to— 
(1) the Secretary of Health and Human Serv-
ices; 
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(2) the Committee on Finance of the Senate; 
(3) the Committee on Energy and Commerce of 
the House of Representatives; and 
(4) the Committee on Ways and Means of the 
House of Representatives. 
SEC. 210. CMMI TESTING OF COVERAGE OF PARTIAL BEN-
EFIT DUAL ELIGIBLE INDIVIDUALS THROUGH 
STATE INTEGRATED CARE PROGRAMS. 
Section 1115A of the Social Security Act (42 U.S.C. 
1315a) is amended— 
(1) in subsection (b)(2)(A), by adding at the 
end the following new sentence: ‘‘The models se-
lected under this subparagraph shall include the 
testing of the model described in subsection (h)(1).’’; 
and 
(2) by adding at the end the following new sub-
section: 
‘‘(h) TESTING OF MODEL FOR PROVIDING COVERAGE 
OF PARTIAL BENEFIT DUAL ELIGIBLE INDIVIDUALS 
THROUGH PARTIALLY INTEGRATED CARE PLANS UNDER 
STATE INTEGRATED CARE PROGRAMS.— 
‘‘(1) IN GENERAL.—The model described in this 
paragraph is a model under which States may offer 
coverage to partial benefit dual eligible individuals 
through partially integrated care plans under State 
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Integrated Care Programs established under title 
XXII. 
‘‘(2) PARTIAL BENEFIT DUAL ELIGIBLE INDI-
VIDUAL.—For purposes of this subsection, the term 
‘partial benefit dual eligible individual’ means an in-
dividual who— 
‘‘(A) is eligible for the low-income subsidy 
program under section 1860D–14, the Medicare 
Savings 
Program 
(as 
defined 
in 
section 
1144(c)(7)), or both; and 
‘‘(B) is not a full-benefit dual eligible indi-
vidual (as such term is defined in section 
1935(c)(6), but without the application of sub-
paragraph (A)(i) of such section).’’. 
TITLE III—ADMINISTRATION 
SEC. 301. ALIGNMENT OF BILLING CODES UNDER TITLES 
XVIII, XIX, AND XXII. 
Not later than 180 days after the date of enactment 
of this Act, the Director of the Federal Coordinated 
Health Care Office of the Centers for Medicare & Med-
icaid Services and the Administrator of the Centers for 
Medicare & Medicaid Services shall— 
(1) review billing codes under the Medicare pro-
gram, the Medicaid program, and State Integrated 
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Care Programs for Dual Eligible Individuals under 
XXII of the Social Security Act; 
(2) conduct at least one listening session open 
to the public on the alignment of billing under the 
programs identified in paragraph (1); and 
(3) identify such administrative and legislative 
changes as are needed to ensure that all such billing 
codes are aligned and consistent under all such pro-
grams. 
TITLE IV—PACE 
SEC. 401. REQUIRING STATES TO OFFER PACE PROGRAM 
SERVICES TO ELIGIBLE INDIVIDUALS. 
(a) IN GENERAL.—Section 1934 of the Social Secu-
rity Act (42 U.S.C. 1396u–4) is amended— 
(1) in subsection (a)(1)— 
(A) by striking ‘‘A State may elect to pro-
vide’’ and inserting ‘‘A State shall provide’’; 
and 
(B) by striking ‘‘A State may establish a 
numerical limit on the number of individuals 
who may be enrolled in a PACE program under 
a PACE program agreement.’’; 
(2) in subsection (e)— 
(A) in paragraph (1)— 
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(i) by striking ‘‘(A) IN GENERAL.— 
The Secretary’’ and inserting ‘‘The Sec-
retary’’; and 
(ii) by striking subparagraph (B); 
(B) in paragraph (2)(A)(ii); and 
(3) in subsection (h)(2)— 
(A) by striking ‘‘(A) IN GENERAL.—Except 
as provided under subparagraph (B), and’’ and 
inserting ‘‘Except as provided under’’; and 
(B) by striking subparagraph (B). 
(b) STATE PLAN REQUIREMENT.—Section 1902(a) 
of the Social Security Act (42 U.S.C. 1396a(a)) is amend-
ed— 
(1) in paragraph (86), by striking ‘‘; and’’ and 
inserting a semicolon; 
(2) in paragraph (87)(D), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (87) the fol-
lowing new paragraph; 
‘‘(88) provide, in accordance with section 1934, 
that the State shall provide medical assistance with 
respect to PACE program services to PACE pro-
gram eligible individuals who are eligible for medical 
assistance under the State plan and who are enrolled 
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in a PACE program under a PACE program agree-
ment.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date that is 180 days 
after the date of enactment of this Act. 
SEC. 402. ENROLLMENT OF PACE BENEFICIARIES AT ANY 
TIME. 
(a) IN
GENERAL.—Sections 1894(d)(5)(A) and 
1934(d)(5)(A) (42 U.S.C. 1395eee(d)(5)(A), 1396u– 
4(d)(5)(A)) are each amended— 
(1) in the subparagraph header, by inserting 
‘‘ENROLLMENT OR’’; 
(2) by inserting ‘‘PACE program eligible indi-
viduals to enroll in a PACE program at any time 
and’’ after ‘‘shall permit’’; and 
(3) by adding at the end the following sentence: 
‘‘The amount of any capitated payment made to a 
PACE provider under subsection (d)(1) may be ad-
justed to account for any PACE program eligible in-
dividuals who enroll after the first day of a month 
(with the amount of such payment adjustment being 
proportional to the portion of such month for which 
the individual is enrolled)’’. 
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(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date that is 180 days 
after the date of enactment of this Act. 
SEC. 403. EXTENDING ELIGIBILITY FOR PACE TO MEDI-
CARE-ELIGIBLE INDIVIDUALS UNDER THE 
AGE OF 55. 
(a) IN
GENERAL.—Sections 1894(a)(5)(A) and 
1934(a)(5)(A) of the Social Security Act (42 U.S.C. 
1395eee(a)(5), 1396u–4(a)(5)) are each amended by in-
serting ‘‘(or any age in the case of an individual who is 
eligible for benefits under part A, or enrolled under part 
B, of title XVIII)’’ after ‘‘is 55 years of age or older’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date that is 180 days 
after the date of enactment of this Act. 
SEC. 404. REMOVAL OF QUARTERLY RESTRICTIONS FOR 
SUBMISSION OF A NEW PACE ORGANIZATION 
APPLICATION, AND REMOVAL OF QUARTERLY 
RESTRICTIONS FOR APPLICATIONS IN A NEW 
SERVICE AREA. 
(a) IN GENERAL.—Sections 1894(e) and 1934(e) of 
the Social Security Act (42 U.S.C. 1395eee(e), 1396u– 
4(e)) are each amended by adding at the end the following 
new paragraph: 
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‘‘(9) NO QUARTERLY OR GEOGRAPHIC LIMITA-
TIONS ON APPLICATIONS FOR PACE PROVIDER STA-
TUS.—The Secretary shall not prohibit an entity 
that meets the requirements for a PACE provider 
under this section from— 
‘‘(A) submitting multiple applications in 
the same quarter; or 
‘‘(B) submitting multiple applications to 
operate a PACE program in the same service 
area.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date that is 180 days 
after the date of enactment of this Act. 
SEC. 405. ENSURING MEDICARE-ONLY PACE PROGRAM EN-
ROLLEES HAVE A CHOICE OF PRESCRIPTION 
DRUG PLANS UNDER MEDICARE PART D. 
Section 1860D–21(f) of the Social Security Act (42 
U.S.C. 1395w–131(f)) is amended— 
(1) in paragraph (1), by striking ‘‘and (3)’’ and 
inserting ‘‘(3), and (4)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(4) ENSURING
CHOICE
OF
PRESCRIPTION 
DRUG PLANS.— 
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‘‘(A) IN GENERAL.—For plan years begin-
ning on or after January 1, 2024, subject to 
the succeeding provisions of this paragraph, an 
applicable PACE program enrollee may elect to 
enroll in a qualified standalone prescription 
drug plan, in accordance with rules established 
by the Secretary pursuant to this paragraph, 
while enrolled under a PACE program. 
‘‘(B) DEFINITION
OF
APPLICABLE
PACE 
PROGRAM ENROLLEE; QUALIFIED STANDALONE 
PRESCRIPTION DRUG PLAN.—In this paragraph: 
‘‘(i) APPLICABLE PACE PROGRAM EN-
ROLLEE.—The term ‘applicable PACE pro-
gram enrollee’ means a part D eligible in-
dividual who— 
‘‘(I) is not entitled to medical as-
sistance under title XIX; and 
‘‘(II) is enrolled under a PACE 
program offered by a PACE provider. 
‘‘(ii) QUALIFIED
STANDALONE
PRE-
SCRIPTION DRUG PLAN.—The term ‘quali-
fied standalone prescription drug plan’ 
means, with respect to an applicable PACE 
program enrollee, a prescription drug 
plan— 
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‘‘(I) that is not an MA–PD plan; 
‘‘(II) that is not operated by the 
PACE program under which the indi-
vidual is enrolled; and 
‘‘(III) for which the Secretary de-
termines, with respect to the applica-
ble PACE program enrollees enrolled 
in a PACE program offered by such 
PACE provider, that— 
‘‘(aa) the estimated bene-
ficiary out-of-pocket costs (as de-
fined in clause (iii)) for the plan 
year for qualified prescription 
drug coverage under the plan is 
equal to or less than the esti-
mated out-of-pocket costs for 
such coverage under the prescrip-
tion drug plan offered by the 
PACE program in which the ap-
plicable PACE program enrollee 
is enrolled; and 
‘‘(bb) the estimated total 
amount of Federal subsidies for 
the plan year for qualified pre-
scription drug coverage under the 
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plan (which may be estimated 
using data from the previous 
plan year) is equal to or less than 
the estimated subsidy amount for 
such coverage under the prescrip-
tion drug plan offered by the 
PACE program in which the ap-
plicable PACE program enrollee 
is enrolled. 
‘‘(iii) 
OUT-OF-POCKET
COSTS
DE-
FINED.—In this paragraph, the term ‘out- 
of-pocket costs’ includes premiums imposed 
under a prescription drug plan and, in the 
case of coverage under a qualified stand-
alone prescription drug plan, deductibles, 
copayments, coinsurance, and other cost- 
sharing. 
‘‘(C) OUT-OF-POCKET COSTS.—In the case 
where an applicable PACE program enrollee 
elects to enroll in a qualified standalone pre-
scription drug plan pursuant to this paragraph, 
the individual shall be responsible for any out- 
of-pocket costs imposed under the plan (includ-
ing costs for nonformulary drugs) after the ap-
plication of any subsidies under section 1860D– 
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14 for an applicable PACE program enrollee 
who is a subsidy eligible individual (as defined 
in section 1860D–14(a)(3)). 
‘‘(D) REQUIREMENTS
FOR
PACE
PRO-
GRAMS.— 
‘‘(i) EDUCATING
AND
HELPING
EN-
ROLL BENEFICIARIES INTO A PART D PLAN 
OPTION.—A PACE program shall be re-
quired to provide— 
‘‘(I) information to all applicable 
PACE program enrollees who are en-
rolled under the PACE program re-
garding the option to enroll in a quali-
fied standalone prescription drug plan 
under this paragraph; and 
‘‘(II) upon request of an applica-
ble PACE program enrollee, coun-
seling and coordination to assist appli-
cable PACE program enrollees in 
making decisions regarding the selec-
tion of qualified standalone prescrip-
tion drug plans available to them. 
‘‘(ii) MONITORING DRUG UTILIZATION, 
ADHERENCE, AND SPEND.—A PACE pro-
gram shall be required to monitor drug 
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utilization, medication adherence, and drug 
spending (through claims data shared pur-
suant to subparagraph (F) and otherwise) 
throughout the year with respect to any 
applicable PACE program enrollee who 
elects to enroll in a qualified standalone 
prescription drug plan under this para-
graph in order to coordinate with the PDP 
sponsor of such plan regarding the drug 
benefits offered by the plan, including 
upon request of an applicable PACE pro-
gram enrollee the filing of any grievances 
or appeals with the plan on behalf of the 
applicable PACE program enrollee. 
‘‘(E) 
DISENROLLMENT.—An 
applicable 
PACE program enrollee may disenroll from the 
qualified standalone prescription drug plan 
elected by such applicable PACE program en-
rollee under subparagraph (A) if the enrollee 
changes medication during the plan year or can 
demonstrate an unexpected increase in out-of- 
pocket costs post enrollment. 
‘‘(F) CLAIMS SHARING.—In the case where 
an applicable PACE program enrollee enrolls in 
a qualified standalone prescription drug plan, 
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the PACE program in which the individual is 
enrolled and the PDP sponsor of the qualified 
standalone prescription drug plan shall share 
claims data with each other with respect to the 
applicable PACE program enrollee as needed to 
support care management for the applicable 
PACE program enrollee (including for purposes 
of monitoring and coordination required under 
subparagraph (D)(ii)) and for purposes of com-
prehensive 
risk 
adjustment 
under 
section 
1894(d). Such data shall be shared without the 
need for any formal or informal request of the 
PACE program in which the individual is en-
rolled or the PDP sponsor of the qualified 
standalone prescription drug plan in which the 
applicable PACE program enrollee is enrolled. 
‘‘(G) RULE OF CONSTRUCTION.—The au-
thority established under this paragraph for an 
applicable PACE program enrollee to elect to 
enroll in a qualified standalone prescription 
drug plan shall not be construed as permitting 
an applicable PACE program enrollee to enroll 
in a prescription drug plan that is not a quali-
fied standalone prescription drug plan. 
‘‘(H) RELATION TO PACE STATUTES.— 
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‘‘(i) IN GENERAL.—The authority pro-
vided under this paragraph for an applica-
ble PACE program enrollee to elect to en-
roll in a qualified standalone prescription 
drug plan shall apply notwithstanding sub-
section (a)(1)(B)(1) of section 1894 and 
such other provisions of sections 1894 and 
1934 as the Secretary determines may con-
flict with the authority provided for under 
this 
paragraph, 
including 
subsections 
(a)(2)(B), 
(b)(1)(A)(i), 
(b)(1)(C), 
(f)(2)(B)(ii), and (f)(2)(B)(v) of such sec-
tions. 
‘‘(ii) CLARIFICATION
ON
PAYMENT 
FOR PART D DRUG COVERAGE.—Insofar as 
an applicable PACE program enrollee is 
enrolled in a qualified standalone prescrip-
tion drug plan under this paragraph, the 
PACE program shall not be entitled to 
payment under section 1894(d) for the 
provision of qualified prescription drug 
coverage under such standalone prescrip-
tion drug plan with respect to such appli-
cable PACE program enrollee.’’. 
Æ 
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