Advancing Integration in Medicare and Medicaid (AIM) Act
Bill: S.4264 | Sponsor: Sen. Scott, Tim (R-SC)
Policy area: Health

Summary:
Advancing Integration in Medicare and Medicaid (AIM) Act
This bill requires state Medicaid programs to develop strategies for integrating and coordinating Medicaid and Medicare coverage for individuals who are dually eligible for both, including with respect to enrollment, quality measures, and access to care.

To amend title XIX of the Social Security Act to require States to 
 develop a strategy to integrate and coordinate Medicaid and Medicare 
          coverage for full-benefit dual eligible individuals.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Advancing Integration in Medicare 
and Medicaid (AIM) Act''.

SEC. 2. COVERAGE INTEGRATION AND COORDINATION STRATEGY FOR FULL-BENEFIT 
              DUAL ELIGIBLE INDIVIDUALS.

    (a) Medicaid State Plan Requirement.--Section 1902 of the Social 
Security Act (42 U.S.C. 1396a) is amended--
            (1) in subsection (a)--
                    (A) by striking ``and'' at the end of paragraph 
                (86);
                    (B) by striking the period at the end of paragraph 
                (87) and inserting ``; and''; and
                    (C) by inserting after paragraph (87) the following 
                new paragraph:
            ``(88) include a strategy for integrating and coordinating 
        health benefits coverage under this title and title XVIII for 
        full-benefit dual eligible individuals (as defined in section 
        1935(c)(6)) in accordance with the requirements of subsection 
        (tt).''; and
            (2) by adding at the end the following new subsection:
    ``(tt) Coverage Integration and Coordination Strategy for Full-
Benefit Dual Eligible Individuals.--For purposes of subsection (a)(88), 
the requirements under this subsection are the following:
            ``(1) General requirements.--Not later than 2 years after 
        the date of enactment of this subsection, the State shall 
        develop, in consultation with relevant stakeholders, and submit 
        to the Secretary for approval a strategy for integrating and 
        coordinating health benefits coverage for full-benefit dual 
        eligible individuals (as defined in section 1935(c)(6)) that 
        includes detailed descriptions of the following components:
                    ``(A) The integration and coordination approaches 
                selected by the State.
                    ``(B) The eligibility requirements and benefits 
                available under such strategy.
                    ``(C) The education and enrollment strategy for 
                participation by full-benefit dual eligible individuals 
                (as so defined).
                    ``(D) Beneficiary protections intended to preserve 
                and strengthen beneficiary choice and access to care.
                    ``(E) The plan for collecting data analytics and 
                measuring the quality of care provided under such 
                strategy.
                    ``(F) Structures to promote health equity.
                    ``(G) The coordination and integration of mental 
                health benefits with other benefits and services 
                available under this title and title XVIII for full-
                benefit dual eligible individuals under such strategy.
                    ``(H) Such other components as the Secretary may 
                require.
            ``(2) Regular reviews and updates.--The State regularly 
        shall review and update the strategy developed and approved 
        under paragraph (1) in accordance with such timing and other 
        requirements as the Secretary shall specify.
            ``(3) Relevant stakeholders.--For purposes of paragraph 
        (1), the term `relevant stakeholders' means each of the 
        following:
                    ``(A) Full-benefit dual eligible individuals (as 
                defined in section 1935(c)(6)) and their 
                representatives.
                    ``(B) Health plans.
                    ``(C) Health care providers, such as physicians, 
                hospitals, and nursing homes.
                    ``(D) PACE providers.
                    ``(E) Community-based organizations.
                    ``(F) Beneficiary advocates.
                    ``(G) Others as determined appropriate by the 
                Secretary or the State.''.
    (b) Effective Date; Implementation.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by this section shall take effect on the date 
        of enactment of this Act.
            (2) Delay if state legislation needed.--In the case of a 
        State plan for medical assistance under title XIX of the Social 
        Security Act which the Secretary of Health and Human Services 
        determines requires State legislation (other than legislation 
        appropriating funds) in order for the plan to meet the 
        additional requirements imposed by the amendments made by the 
        section, the State plan shall not be regarded as failing to 
        comply with the requirements of such title solely on the basis 
        of its failure to meet these additional requirements before the 
        first day of the first calendar quarter beginning after the 
        close of the first regular session of the State legislature 
        that begins after the date of the enactment of this Act. For 
        purposes of the previous sentence, in the case of a State that 
        has a 2-year legislative session, each year of such session 
        shall be deemed to be a separate regular session of the State 
        legislature.
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