627 
(5) To effectively treat behavioral health condi-
tions among HIV positive beneficiaries that impair 
their HIV treatment adherence and lead to sec-
ondary HIV infections through services funded 
under Medicare and Medicaid and programs admin-
istered by SAMHSA. 
(6) To promote independence, treatment adher-
ence, and stable housing for HIV positive bene-
ficiaries through highly coordinated HIV health, 
housing, and support services funded by HRSA and 
HUD. 
(c) DEMONSTRATION DESIGN.— 
(1) IN GENERAL.—The Secretary shall design 
the demonstration to test both— 
(A) the service delivery model described in 
paragraph (2); and 
(B) the payment model described in para-
graph (3). 
(2) SERVICE DELIVERY MODEL.— 
(A) IN GENERAL.—Under the service deliv-
ery model described in this paragraph, the dem-
onstration shall test comprehensive HIV test-
ing, linkage to care, HIV medical care, and an-
cillary services to individuals enrolled under 
Medicare, Medicaid, or both. The service deliv-
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ery model will integrate services furnished 
under Medicare and Medicaid with prevention 
services funded by CDC for HIV positive bene-
ficiaries, intensive case management services 
funded by HRSA, behavioral services funded by 
SAMHSA, and housing assistance services 
funded through HUD. 
(B) CORE ELEMENTS.—The model under 
this paragraph shall have the following 8 core 
elements: 
(i) HIV testing services that apply the 
CDC’s 2006 recommendations for uni-
versal opt-out testing among Medicare and 
Medicaid beneficiary populations. 
(ii) Rapid linkage from HIV testing 
settings to treatment for HIV positive 
beneficiaries to ensure they are engaged in 
care in a timely basis. 
(iii) Access to high quality HIV expe-
rienced medical care, laboratory moni-
toring, HIV medications, and other re-
quired services. 
(iv) Routine screening and treatment 
for HIV-related and other chronic condi-
tions, including behavioral health. 
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(v) Prevention and treatment edu-
cation services, including an adapted Medi-
cation Therapy Management (MTM) pro-
gram model, to optimize the benefit of 
HIV therapeutics. 
(vi) Risk-stratified medical case man-
agement. 
(vii) Provision of preventive care, in-
cluding counseling to prevent secondary 
HIV infection. 
(viii) Wrap-around support and hous-
ing services. 
(3) PAYMENT
MODEL.—Under the payment 
model described in this paragraph, the demonstra-
tion shall test the following: 
(A) A prepaid capitated payment model 
that adjusts payment for HIV and behavioral 
health acuity, to be applied under contracts 
with managed care organizations with dem-
onstrated HIV experience. 
(B) Use of funds under the Ryan White 
HIV/AIDS Program to purchase capitated serv-
ices from the contracted managed care organi-
zations. 
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(C) Provision of additional funds to sup-
port services to the extent that Medicaid and 
Medicare coverage is limited, including for serv-
ices such as HIV testing (for Medicaid bene-
ficiaries), medical case management, prevention 
case management, treatment education, case 
finding, behavioral health services, and housing 
assistance. 
(d) BENEFICIARY CRITERIA.—Beneficiaries eligible 
for participation in the demonstration are the following: 
(1) MEDICAID
FFS
BENEFICIARIES.—Fee-for- 
service Medicaid beneficiaries 18 years of age or 
older. 
(2) DUAL ELIGIBLES.—Individuals who are— 
(A) entitled to medical assistance under 
Medicaid; and 
(B) entitled to benefits under part A, and 
enrolled under part B, of Medicare but are not 
enrolled under a Medicare Advantage plan 
under Medicare. 
(e) ROLES AND RESPONSIBILITIES IN DEMONSTRA-
TION.— 
(1) IN GENERAL.—Consistent with the National 
HIV/AIDS Strategy for the United States, Federal 
agencies shall coordinate their funding for the se-
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lected States or cities covered under the demonstra-
tion to provide resources to fund the delivery of serv-
ices within the demonstration. 
(2) HHS.—In carrying out the demonstration, 
the Secretary shall— 
(A) design the application process; 
(B) solicit applications from 5 to 7 State 
Medicaid agencies to host the demonstration; 
(C) with respect to the service delivery 
model described in subsection (c)(2), collaborate 
with the CDC, HRSA, and the National Insti-
tutes of Health to design a minimum service de-
livery model that reflects the current standard 
of care as established by the Public Health 
Service and CDC guidelines and recommenda-
tions; and 
(D) fund an evaluation of the demonstra-
tion to ensure collection of system, provider, 
and beneficiary-level data to address their rou-
tine reporting requirements. 
The Secretary may carry out the Secretary’s author-
ity under this paragraph through CMMI. 
(3) CDC.—The CDC shall collaborate with the 
Secretary and CDC-funded HIV prevention grantees 
in the selected States and cities to provide technical 
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assistance to design cost-effective HIV and sexually 
transmitted infection (STI) screening and testing 
services for Medicaid and Medicare beneficiaries, in-
cluding partner notification services and commu-
nicable disease reporting. CDC and CMS shall deter-
mine the extent to which testing funds shall be sup-
ported jointly or separately by these agencies. 
(4) HRSA.—HRSA shall allocate funds avail-
able through the Special Projects of National Sig-
nificance (SPNS) Initiative Program (under subpart 
I of part F of the Ryan White HIV/AIDS Program) 
to support wrap-around core and support services 
not covered under Medicare or Medicaid and shall 
authorize the use of Ryan White HIV/AIDS Pro-
gram funds to purchase services through capitated 
managed care programs that meet or exceed the 
services covered by the Ryan White HIV/AIDS Pro-
gram at rates that are no greater than current per 
capita expenditures. HRSA is authorized to use 
funds under SPNS, and to waive such requirements 
of SPNS as may be necessary, to carry out the dem-
onstration. 
(5) SAMHSA.—SAMHSA shall allocate funds 
through the Minority HIV/AIDS Initiative or other 
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