Supporting Care for Dual Eligibles Act
Bill: S.3630 | Sponsor: Sen. Scott, Tim (R-SC)
Policy area: Health

Summary:
Supporting Care for Dual Eligibles Act
This bill establishes and provides funds for grants to support the provision of services to those who are dually eligible for Medicare and Medicaid.
Specifically, the bill establishes and provides funds for FY2022 for the Dual Eligible Quality Care Fund. The Centers for Medicare & Medicaid Services (CMS) must use the funds for grants to state Medicaid programs to support quality integrated care for dual eligible beneficiaries, including technology improvements, staff support, and administrative services for beneficiaries.
The bill also requires the CMS to biennially audit state Medicaid programs with respect to improper payments; states must also submit plans for mitigating improper payments.

To establish a Dual Eligible Quality Care Fund to provide grants to 
    State Medicaid programs to improve their capacity to ensure the 
 provision of quality integrated care for dual eligible beneficiaries.

    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 ``Supporting Care for Dual Eligibles 
Act''.

SEC. 2. IMPROVING MEDICAID'S CAPACITY TO PROTECT DUAL ELIGIBLE 
              BENEFICIARIES.

    (a) Establishment of Dual Eligible Quality Care Fund.--
            (1) In general.--Not later than 6 months after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services (referred to in this section as the ``Secretary'') 
        shall establish a fund to be known as the ``Dual Eligible 
        Quality Care Fund''.
            (2) Establishment within federal coordinated health care 
        office.--The Dual Eligible Quality Care Fund shall be 
        established within, and administered by the Director of, the 
        Federal Coordinated Health Care Office established under 
        section 2602 of the Patient Protection and Affordable Care Act 
        (42 U.S.C. 1315b).
            (3) Funding.--There is appropriated to the Dual Eligible 
        Quality Care Fund for fiscal year 2022 $100,000,000, to remain 
        available until expended.
    (b) Purpose.--The purpose of the Dual Eligible Quality Care Fund is 
to provide timely, targeted assistance in the way of grants to State 
Medicaid programs to improve their capacity to ensure the provision of 
quality integrated care for dual eligible beneficiaries.
    (c) Allowable Uses of Grant Funds.--A State Medicaid program may 
use amounts received under a grant from the Dual Eligible Quality Care 
Fund to improve its capacity to provide quality integrated care for 
dual eligible beneficiaries through any of the following:
            (1) Recruiting and paying workers with needed subject 
        matter knowledge, skills, or capabilities.
            (2) Actuarial support for rate development and analysis and 
        development or purchase of risk adjustment tools.
            (3) Information technology system changes, including 
        changes that--
                    (A) improve member enrollments;
                    (B) improve encounter data collection and analysis;
                    (C) improve the ability of State Medicaid programs 
                to develop customized data management tools (such as 
                queries and dashboards);
                    (D) improve compliance with Federal reporting 
                requirements;
                    (E) enhance financial analysis;
                    (F) improve quality reporting and monitoring;
                    (G) improve modifications to capitation payments;
                    (H) transfer eligibility and enrollment data 
                between systems;
                    (I) improve the grievances and appeals process; and
                    (J) improve interaction with Medicare data and 
                related systems.
            (4) Providing support for dual eligible beneficiaries 
        during enrollment processes, assistance to dual eligible 
        beneficiaries evaluating their enrollment choices, 
        informational materials to dual eligible beneficiaries and 
        those assisting with decision support, and coordination with 
        Medicare enrollment processes.
            (5) Monitoring and oversight of efforts undertaken by State 
        Medicaid using grant funds, including measuring the level of 
        participation by stakeholders and dual eligible beneficiaries.
            (6) Quality measurement and State evaluation activities, 
        development and deployment of survey tools, and costs of 
        accessing, transferring, and analyzing data.
            (7) Develop knowledge and understanding within the State 
        Medicaid agency of the Medicare program under title XVIII of 
        the Social Security Act (42 U.S.C. 1395 et seq.).
            (8) Supporting and improving Medicare initiatives, 
        including new initiatives and existing or past initiatives such 
        as the Financial Alignment Initiative for Medicare-Medicaid 
        Enrollees demonstration projects conducted under section 1115A 
        of the Social Security Act (42 U.S.C. 1315a).
    (d) Awarding Grants.--
            (1) In general.--A State Medicaid program that wishes to 
        receive a grant under this section from the Dual Eligible 
        Quality Care Fund shall submit an application to the Director 
        of the Federal Coordinated Health Care Office (referred to in 
        this subsection as the ``Director''), in such form and manner 
        as the Director shall specify. The Director may award a grant 
        under this section to any State, without regard to the State's 
        existing capacity to provide quality integrated care for dual 
        eligible beneficiaries.
            (2) Application requirements.--An application for a grant 
        under this section shall include an identification of the uses 
        of funds described in subsection (c) for which the State 
        Medicaid program will use the grant funds.
            (3) Methodology for disbursing funds.--
                    (A) In general.--Not later than 6 months after the 
                date of enactment of this Act, the Director shall issue 
                guidance establishing a clear and equitable methodology 
                for awarding grants to State Medicaid programs under 
                this section.
                    (B) Methodology requirements.--The methodology 
                established by the Director under this paragraph shall, 
                to the extent practical--
                            (i) ensure that grant funds are used in 
                        accordance with subsection (c);
                            (ii) provide that grants are awarded by the 
                        Director in a manner that is transparent and 
                        equitable to State Medicaid programs; and
                            (iii) provide that, in determining the 
                        grant amount to be awarded to a State Medicaid 
                        program, the Director shall take into 
                        consideration--
                                    (I) the percentage of enrollees in 
                                the program who are dual eligible 
                                beneficiaries; and
                                    (II) the total number of dual 
                                eligible beneficiaries enrolled in the 
                                program.
                    (C) Limitations.--The Director shall not award more 
                than 1 grant under this section to any State Medicaid 
                program, and in no case may the amount of a grant 
                awarded under this section exceed $2,000,000.
    (e) State Program Reporting.--
            (1) Quarterly reporting.--States receiving a grant under 
        this section shall, in a form and manner specified by the 
        Director of the Federal Coordinated Health Care Office 
        (referred to in this subsection as the ``Director''), report no 
        less frequently than once a quarter regarding the amount of 
        grant funds spent by the State and how funds received from the 
        grant are being used within the State.
            (2) Longitudinal report.--States receiving a grant under 
        this section shall, no later than 2 years after the receipt of 
        such grant, submit to the Director and make available on a 
        State website a report summarizing how the funds received under 
        such grant were used. Such report shall include the following:
                    (A) An explanation of which uses of funds described 
                in subsection (c) the grant funds supported.
                    (B) An assessment of each of the following:
                            (i) The manner in which the grant funds 
                        improved the State Medicaid program's capacity 
                        to provide quality integrated care for dual 
                        eligible beneficiaries.
                            (ii) The manner in which the grant funds 
                        improved the quality of care for dual eligible 
                        beneficiaries.
                            (iii) The manner in which the grant funds 
                        improved the integration and coordination of 
                        care for dual eligible beneficiaries.
    (f) Definitions.--In this section:
            (1) Dual eligible beneficiary.--The term ``dual eligible 
        beneficiary'' means an individual who is entitled to, or 
        enrolled for, benefits under part A of title XVIII of the 
        Social Security Act (42 U.S.C. 1395 et seq.), or enrolled for 
        benefits under part B of such title, and is eligible for 
        medical assistance under a State plan under title XIX of such 
        Act (42 U.S.C. 1396 et seq.) or under a waiver of such a plan.
            (2) Quality integrated care.--The term ``quality integrated 
        care'' means the provision of services provided under the 
        Medicare program under title XVIII of the Social Security Act 
        (42 U.S.C. 1395 et seq.) and services provided under a State 
        Medicaid program--
                    (A) through systems in which Medicaid and Medicare 
                program administrative requirements, financing, 
                benefits, or care delivery are aligned; and
                    (B) in a coordinated fashion, which may include 
                coverage of such services through a single entity or 
                coordinating entities.
            (3) State.--The term ``State'' has the meaning given such 
        term for purposes of title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.).
            (4) State medicaid program.--The term ``State Medicaid 
        program'' means a State plan under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.), and includes any waiver 
        of such a plan.

SEC. 3. PAYMENT ERROR RATE MEASUREMENT (PERM) AUDIT REQUIREMENTS.

    (a) Biennial PERM Audit Requirement.--Beginning with fiscal year 
2023, the Administrator shall conduct payment error rate measurement 
(``PERM'') audits of each State Medicaid program on a biennial basis.
    (b) Notification; Identification of Sources of Improper Payments.--
            (1) Notification.--Not later than 6 months after the date 
        of enactment of this Act, the Administrator shall notify the 
        contractor conducting PERM audits of the Administrator's intent 
        to modify contracts to require PERM audits not less than once 
        every other year in each State.
            (2) Identification of sources of improper payments.--The 
        Administrator shall direct the contractor conducting PERM 
        audits of State Medicaid programs to identify areas known to be 
        sources of improper payments under such programs to identify 
        program areas or components known to be sources of high risk 
        for improper payments under such programs.
    (c) State Medicaid Director Letter.--Not later than 12 months after 
the date of enactment of this Act, the Administrator shall issue a 
State Medicaid Director letter regarding State requirements under 
Federal law and regulations regarding avoiding and responding to 
improper payments under State Medicaid programs.
    (d) State Improper Payment Mitigation Plans.--
            (1) In general.--Not later than January 1, 2023, each State 
        Medicaid program shall submit to the Administrator a plan, 
        which shall include specific actions and timeframes for taking 
        such actions and achieving specified results, for mitigating 
        improper payments under such program.
            (2) Publication of state plans.--The Administrator shall 
        make State plans submitted under paragraph (1) available to the 
        public.
    (e) Definitions.--In this section:
            (1) Administrator.--The term ``Administrator'' means the 
        Administrator of the Centers for Medicare & Medicaid Services.
            (2) State.--The term ``State'' has the meaning given such 
        term for purposes of title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.).
            (3) State medicaid program.--The term ``State Medicaid 
        program'' means a State plan under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.), and includes any waiver 
        of such a plan.
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