Supporting States in Integrating Care Act of 2022
Bill: S.4273 | Sponsor: Sen. Casey, Robert P., Jr. (D-PA)
Policy area: Health

Summary:
Supporting States in Integrating Care Act of 2022
This bill requires state Medicaid programs to integrate and coordinate Medicaid and Medicare coverage for individuals who are dually eligible for both, including with respect to enrollment, quality measures, and access to care. The bill provides funds for FY2023 for planning grants and related implementation.

To amend title XIX of the Social Security Act to provide States with 
 resources to support efforts to integrate or coordinate Medicare and 
 Medicaid benefits for individuals that are eligible for both programs.

    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 States in Integrating 
Care Act of 2022''.

SEC. 2. SUPPORTING STATE EFFORTS TO INTEGRATE MEDICARE AND MEDICAID 
              BENEFITS FOR FULL-BENEFIT DUAL ELIGIBLE INDIVIDUALS.

    (a) In General.--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) in the case of a State that is 1 of the 50 States or 
        the District of Columbia, provide that the State will carry out 
        activities to coordinate and integrate benefits for full-
        benefit dual eligible individuals (as defined in section 
        1935(c)(6)) in accordance with a Dual Coordination and 
        Integration Plan approved by the Secretary under subsection 
        (tt).''; and
            (2) by adding at the end the following new subsection:
    ``(tt) Supporting State Efforts To Integrate Medicare and Medicaid 
Benefits for Full-Benefit Dual Eligible Individuals.--
            ``(1) Definitions.--In this subsection:
                    ``(A) Full-benefit dual eligible individual.--The 
                term `full-benefit dual eligible individual' has the 
                meaning given that term in section 1935(c)(6).
                    ``(B) Medicaid.--The term `Medicaid' means the 
                program for grants to States for medical assistance 
                programs established under this title.
                    ``(C) Medicare.--The term `Medicare' the program of 
                health insurance for the aged and disabled established 
                under title XVIII.
                    ``(D) Medicare and medicaid benefits.--The term 
                `Medicare and Medicaid benefits' means benefits 
                available under Medicaid and Medicare.
                    ``(E) Medicare-medicaid coordination office.--The 
                term `Medicare-Medicaid Coordination Office' means the 
                Medicare Medicaid Coordination Office established as 
                the Federal Coordinated Health Care Office under 
                section 2602 of the Patient Protection and Affordable 
                Care Act.
                    ``(F) Relevant stakeholders.--The term `relevant 
                stakeholders' means the following:
                            ``(i) Full-benefit dual eligible 
                        individuals and their representatives.
                            ``(ii) Beneficiary advocates.
                            ``(iii) Health plans.
                            ``(iv) Health care providers, such as 
                        physicians, hospitals, and nursing homes.
                            ``(v) PACE providers.
                            ``(vi) Community-based organizations.
                            ``(vii) Other interested individuals or 
                        groups as determined by the Secretary or the 
                        State.
            ``(2) Planning grants.--
                    ``(A) In general.--Not later than 1 year after the 
                date of enactment of this subsection, from the amount 
                reserved under paragraph (8)(B), the Secretary shall 
                award a planning grant to each State to carry out 
                planning activities to develop and submit to the 
                Secretary a Dual Coordination and Integration Plan 
                described in paragraph (3).
                    ``(B) Limitation.--The Secretary shall award 
                planning grants to States under this paragraph in such 
                amounts as the Secretary shall determine except that in 
                no case shall a grant awarded under this paragraph 
                exceed $5,000,000.
                    ``(C) Use of funds.--A State may only use grant 
                funds awarded under this paragraph for the planning 
                activities described in subparagraph (A), except that, 
                if a State does not use all of the grant funds and 
                receives approval for a Dual Coordination and 
                Integration Plan described in paragraph (3), the State 
                may use any remaining funds to carry out activities 
                described in paragraph (4) that are in accordance with 
                such plan.
            ``(3) Dual coordination and integration plan.--
                    ``(A) In general.--As a condition of receiving a 
                payment under this subsection, a State shall submit to 
                the Secretary for approval a Dual Coordination and 
                Integration Plan (to be developed by the State with 
                input from relevant stakeholders) describing the 
                State's strategy for integrating and coordinating 
                health benefits coverage for full-benefit dual eligible 
                individuals that includes detailed descriptions of the 
                following components:
                            ``(i) A description of the activities 
                        described in paragraph (4) that will be carried 
                        out under the plan.
                            ``(ii) The integration and coordination 
                        approaches selected by the State.
                            ``(iii) The eligibility requirements and 
                        benefits available under such strategy.
                            ``(iv) The education, enrollment, and 
                        outreach strategy for participation by full-
                        benefit dual eligible individuals.
                            ``(v) Beneficiary protections intended to 
                        preserve and strengthen beneficiary choice and 
                        access to care.
                            ``(vi) The plan for collecting data 
                        analytics and measuring the quality of care 
                        provided under such strategy.
                            ``(vii) Structures to promote health 
                        equity.
                            ``(viii) The coordination and integration 
                        of mental health benefits with other benefits 
                        and services available under Medicare and 
                        Medicaid for full-benefit dual eligible 
                        individuals under such strategy.
                            ``(ix) Such other components as the 
                        Secretary may require.
                    ``(B) Development and submission.--In order to meet 
                the requirements of this subsection, a Dual 
                Coordination and Integration Plan shall--
                            ``(i) be submitted for approval by the 
                        Secretary not later than 24 months after the 
                        date on which the State was awarded a planning 
                        grant under paragraph (2); and
                            ``(ii) be made publicly available in the 
                        final version submitted to the Secretary on a 
                        State Internet website.
                    ``(C) Approval; publication.--
                            ``(i) In general.--The Secretary shall 
                        approve a Dual Coordination and Integration 
                        Plan submitted by a State under this paragraph 
                        if--
                                    ``(I) the plan contains each of the 
                                components required under subparagraph 
                                (A); and
                                    ``(II) the State provides 
                                assurances to the satisfaction of the 
                                Secretary that the State will carry out 
                                the Dual Coordination and Integration 
                                Plan as it is written.
                            ``(ii) Regular reviews and updates.--The 
                        State regularly shall review and update a Dual 
                        Coordination and Integration Plan approved 
                        under this subparagraph at such times and in 
                        accordance with such requirements as the 
                        Secretary shall specify.
            ``(4) Medicare and medicaid coordination and integration 
        activities.--
                    ``(A) In general.--The activities described in this 
                paragraph are the following:
                            ``(i) Activities to recruit or retain 
                        expert capacity at the State agency responsible 
                        for administering the State plan under this 
                        title to inform the integration of Medicare and 
                        Medicaid for full-benefit dual eligible 
                        individuals.
                            ``(ii) Training for staff at such State 
                        agency to develop expertise to inform the 
                        integration of Medicare and Medicaid benefits 
                        for full-benefit dual eligible individuals.
                            ``(iii) Support for development of payment 
                        rates and alternative payment models.
                            ``(iv) Development of information 
                        technology infrastructure to--
                                    ``(I) support data sharing among 
                                health plans, providers, PACE 
                                providers, community-based 
                                organizations, and Federal, State, and 
                                local government agencies; and
                                    ``(II) transfer Medicare and 
                                Medicaid eligibility and enrollment 
                                data.
                            ``(v) Advancement of a unified Medicare and 
                        Medicaid grievance and appeals structure for 
                        determinations made by integrated agencies (as 
                        permissible under the rules and regulations of 
                        the Centers for Medicare & Medicaid Services).
                            ``(vi) Development of, or enhancements to, 
                        enrollment, outreach, and education supports 
                        for full-benefit dual eligible individuals.
                            ``(vii) Development of, or enhancements to, 
                        administration, monitoring, and oversight 
                        systems and protocols for all entities that 
                        provide coordinated or integrated Medicare and 
                        Medicaid benefits to full-benefit dual eligible 
                        individuals.
                            ``(viii) Development of, or enhancements 
                        to, administration of quality measurement and 
                        improvement programs for services furnished to 
                        full-benefit dual eligible individuals.
                            ``(ix) Stakeholder engagement processes, 
                        including--
                                    ``(I) the establishment and 
                                maintenance of a Consumer Advisory 
                                Council comprised of full-benefit dual 
                                eligible individuals, as well as 
                                beneficiary advocates, and their 
                                representatives that is reflective of 
                                the local population in terms of status 
                                for dual eligible qualification as well 
                                as race, ethnicity, sexual orientation, 
                                and other characteristics determined by 
                                the State; and
                                    ``(II) the establishment and 
                                maintenance of a stakeholder engagement 
                                group that regularly solicits and 
                                incorporates into the State's Medicare 
                                and Medicaid coordination or 
                                integration strategy input from the 
                                Consumer Advisory Council and other 
                                relevant stakeholders (as defined in 
                                paragraph (1)) in the State.
                            ``(x) Development of a workforce needs 
                        assessment to identify the needs of the full-
                        benefit dually eligible population, including 
                        strategies to ensure adequate compensation for 
                        the workforce.
                    ``(B) Limitations.--No payment may be made under 
                this subsection for expenditures on an activity that 
                the State carried out before the date of enactment of 
                this subsection.
            ``(5) Payments to states.--
                    ``(A) In general.--Subject to subparagraph (B), for 
                each fiscal quarter during which a State has in effect 
                a Dual Coordination and Integration Plan approved under 
                paragraph (3), the Secretary shall pay to the State an 
                amount equal to 50 percent (or, during the first 20 
                full fiscal quarters during which the plan is in 
                effect, 80 percent) of the amounts expended by the 
                State during the quarter on activities described in 
                paragraph (4) that are in accordance with such plan.
                    ``(B) Limitations.--
                            ``(i) Use of planning grant funds.--A State 
                        shall not be eligible for a payment under this 
                        paragraph until the State has expended the full 
                        amount of the planning grant awarded to the 
                        State under paragraph (2).
                            ``(ii) Non-duplication of payment; 
                        application of higher rates.--No payment shall 
                        be made under this paragraph with respect to 
                        State expenditures of funds made available from 
                        Federal sources, and to the extent that a State 
                        expenditure is eligible for a Federal payment 
                        under both subparagraph (A) and another 
                        provision of this title or any other law, 
                        payment shall only be made under the provision 
                        that results in the State receiving the higher 
                        payment.
                    ``(C) Manner of payment.--Payment to a State under 
                this subsection shall be made in the same manner as 
                payments for State expenditures for the proper and 
                efficient administration of the State plan described in 
                section 1903(a)(7).
            ``(6) Evaluation of plan implementation; reporting 
        requirement.--
                    ``(A) Evaluation benchmarks.--The Secretary shall 
                establish benchmarks for evaluating whether a State's 
                use of payments received under this subsection is in 
                alignment with the State's Dual Coordination and 
                Integration Plan (as approved under paragraph (3)).
                    ``(B) Annual report.--As a condition of payment 
                under this subsection--
                            ``(i) a State shall submit to the Secretary 
                        an annual report detailing how the State is 
                        using payments received under this subsection; 
                        and
                            ``(ii) the Secretary shall certify, based 
                        on such report, that the State's use of such 
                        payments is in alignment with the State's Dual 
                        Coordination and Integration Plan (as approved 
                        under paragraph (3)).
            ``(7) Administration.--In carrying out this subsection, the 
        Secretary shall coordinate with the Medicare-Medicaid 
        Coordination Office and other Federal agencies as appropriate.
            ``(8) Funding.--
                    ``(A) In general.--Out of any funds in the Treasury 
                not otherwise appropriated, there is appropriated to 
                the Secretary $300,000,000 for fiscal year 2023 to 
                carry out this subsection, to remain available until 
                expended.
                    ``(B) Reservation for planning grants.--Of the 
                amount appropriated under subparagraph (A), 
                $150,000,000 is reserved to award planning grants under 
                paragraph (2).
                    ``(C) Technical assistance and guidance.--Of the 
                amount appropriated under subparagraph (A), 
                $150,000,000 is reserved for issuing guidance and 
                providing technical assistance to States in--
                            ``(i) developing and implementing Dual 
                        Coordination and Integration Plans under this 
                        subsection; and
                            ``(ii) completing the annual reports 
                        required under paragraph (6).''.
    (b) Effective Date.--
            (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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