Title: EMPOWER Care Act
Policy area: Health

Summary:
Ensuring Medicaid Provides Opportunities for Widespread Equity, Resources, and Care Act or the EMPOWER Care Act
This bill extends funding through FY2023 for the Money Follows the Person Rebalancing Demonstration Program and otherwise revises the program. (Under this program, the Centers for Medicare & Medicaid Services may award grants to state Medicaid programs to assist states in increasing the use of home and community care for long-term care and decreasing the use of institutional care.)


[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 548 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  1st Session
                                 S. 548

   To reauthorize the Money Follows the Person Demonstration Program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 25, 2019

  Mr. Portman (for himself and Ms. Cantwell) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
   To reauthorize the Money Follows the Person Demonstration Program.

    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 ``Ensuring Medicaid Provides 
Opportunities for Widespread Equity, Resources, and Care Act'' or the 
``EMPOWER Care Act''.

SEC. 2. EXTENSION OF MONEY FOLLOWS THE PERSON REBALANCING 
              DEMONSTRATION.

    (a) Funding.--Section 6071(h) of the Deficit Reduction Act of 2005 
(42 U.S.C. 1396a note) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (E), by striking ``and'' after 
                the semicolon;
                    (B) in subparagraph (F)--
                            (i) by striking ``subject to subparagraph 
                        (3), $112,000,000'' and inserting 
                        ``$450,000,000''; and
                            (ii) by striking the period at the end and 
                        inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(G) $450,000,000 for each of fiscal years 2020 
                through 2023.'';
            (2) in paragraph (2)--
                    (A) by striking ``Subject to paragraph (3), 
                amounts'' and inserting ``Amounts''; and
                    (B) by striking ``2021'' and inserting ``2023''; 
                and
            (3) by striking paragraph (3).
    (b) Research and Evaluation.--Section 6071(g) of the Deficit 
Reduction Act of 2005 (42 U.S.C. 1396a note) is amended--
            (1) in paragraph (2), by striking ``2016'' and inserting 
        ``2023''; and
            (2) in paragraph (3), by inserting ``and for each of fiscal 
        years 2019 through 2023,'' after ``2016,''.

SEC. 3. CHANGES TO INSTITUTIONAL RESIDENCY PERIOD REQUIREMENT.

    (a) In General.--Section 6071(b)(2) of the Deficit Reduction Act of 
2005 (42 U.S.C. 1396a note) is amended--
            (1) in subparagraph (A)(i), by striking ``90'' and 
        inserting ``60''; and
            (2) by striking the flush sentence after subparagraph (B).
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on the date that is 30 days after the date of enactment of 
this Act.

SEC. 4. UPDATES TO STATE APPLICATION REQUIREMENTS.

    Section 6071(c) of the Deficit Reduction Act of 2005 (42 U.S.C. 
1396a note) is amended--
            (1) in paragraph (3), by striking ``, which shall include'' 
        and all that follows through ``2007'';
            (2) in paragraph (7)--
                    (A) in the paragraph heading, by striking 
                ``Rebalancing'' and inserting ``Expenditures''; and
                    (B) in subparagraph (B)--
                            (i) in clause (i), by striking ``and'' 
                        after the semicolon;
                            (ii) in clause (ii), by striking the period 
                        at the end and inserting a semicolon; and
                            (iii) by adding at the end the following:
                    ``(iii) include a work plan that describes for each 
                Federal fiscal year that occurs during the proposed MFP 
                demonstration project--
                            ``(I) the use of grant funds for each 
                        proposed initiative that is designed to 
                        accomplish the objective described in 
                        subsection (a)(1), including a funding source 
                        for each activity that is part of each such 
                        proposed initiative;
                            ``(II) an evaluation plan that identifies 
                        expected results for each such proposed 
                        initiative; and
                            ``(III) a sustainability plan for 
                        components of such proposed initiatives that 
                        are intended to improve transitions, which 
                        shall be updated with actual expenditure 
                        information for each Federal fiscal year that 
                        occurs during the MFP demonstration project; 
                        and
                    ``(iv) contain assurances that grant funds used to 
                accomplish the objective described in subsection (a)(1) 
                shall be obligated not later than 24 months after the 
                date on which the funds are awarded and shall be 
                expended not later than 60 months after the date on 
                which the funds are awarded (unless the Secretary 
                approves a waiver of either such requirement).''; and
            (3) in paragraph (13)--
                    (A) in subparagraph (A), by striking ``; and'' and 
                inserting ``, and in such manner as will meet the 
                reporting requirements set forth for the Transformed 
                Medicaid Statistical Management Information System (T-
                MSIS);'';
                    (B) by redesignating subparagraph (B) as 
                subparagraph (D); and
                    (C) by inserting after subparagraph (A) the 
                following:
                    ``(B) the State shall report on a quarterly basis 
                on the use of grant funds by distinct activity, as 
                described in the approved work plan, and by specific 
                population as targeted by the State;
                    ``(C) if the State fails to report the information 
                required under subparagraph (B), fails to report such 
                information on a quarterly basis, or fails to make 
                progress under the approved work plan, the State shall 
                implement a corrective action plan and any lack of 
                progress under the approved work plan may result in 
                withholding of grant funds made available to the State; 
                and''.

SEC. 5. FUNDING FOR QUALITY ASSURANCE AND IMPROVEMENT; TECHNICAL 
              ASSISTANCE; OVERSIGHT.

    Section 6071(f) of the Deficit Reduction Act of 2005 (42 U.S.C. 
1396a note) is amended by striking paragraph (2) and inserting the 
following:
            ``(2) Funding.--From the amounts appropriated under 
        subsection (h)(1) for each of fiscal years 2019 through 2023, 
        $1,000,000 shall be available to the Secretary for each such 
        fiscal year to carry out this subsection.''.

SEC. 6. BEST PRACTICES EVALUATION.

    Section 6071 of the Deficit Reduction Act of 2005 (42 U.S.C. 1396a 
note) is amended by adding at the end the following:
    ``(i) Best Practices.--
            ``(1) Report.--The Secretary, directly or through grant or 
        contract, shall submit a report to the President and Congress 
        not later than September 30, 2020, that contains findings and 
        conclusions on best practices from the State MFP demonstration 
        projects carried out with grants made under this section. The 
        report shall include information and analyses with respect to 
        the following:
                    ``(A) The most effective State strategies for 
                transitioning beneficiaries from institutional to 
                qualified community settings carried out under the 
                State MFP demonstration projects and how such 
                strategies may vary for different types of 
                beneficiaries, such as beneficiaries who are aged, 
                physically disabled, intellectually or developmentally 
                disabled, or individuals with serious mental illnesses, 
                and other targeted waiver beneficiary populations.
                    ``(B) The most common and the most effective State 
                uses of grant funds carried out under the State MFP 
                demonstration projects for transitioning beneficiaries 
                from institutional to qualified community settings and 
                improving health outcomes, including differentiating 
                funding for current initiatives that are designed for 
                such purpose and funding for proposed initiatives that 
                are designed for such purpose.
                    ``(C) The most effective State approaches carried 
                out under State MFP demonstration projects for 
                improving person-centered care and planning.
                    ``(D) Identification of program, financing, and 
                other flexibilities available under the State MFP 
                demonstration projects, that are not available under 
                the traditional Medicaid program, and which directly 
                contributed to successful transitions and improved 
                health outcomes under the State MFP demonstration 
                projects.
                    ``(E) State strategies and financing mechanisms for 
                effective coordination of housing financed or supported 
                under State MFP demonstration projects with local 
                housing authorities and other resources.
                    ``(F) Effective State approaches for delivering 
                Money Follows the Person transition services through 
                managed care entities.
                    ``(G) Other best practices and effective transition 
                strategies demonstrated by States with approved MFP 
                demonstration projects, as determined by the Secretary.
                    ``(H) Identification and analyses of opportunities 
                and challenges to integrating effective Money Follows 
                the Person practices and State strategies into the 
                traditional Medicaid program.
            ``(2) Collaboration.--In preparing the report required 
        under this subsection, the Secretary shall collect and 
        incorporate information from States with approved MFP 
        demonstration projects and beneficiaries participating in such 
        projects, and providers participating in such projects.
            ``(3) Funding.--From the amounts appropriated under 
        subsection (h)(1) for each of fiscal years 2019 through 2020, 
        not more than $300,000 shall be available to the Secretary for 
        each such fiscal year to carry out this subsection.''.

SEC. 7. MACPAC REPORT ON QUALIFIED SETTINGS CRITERIA.

    Section 6071 of the Deficit Reduction Act of 2005 (42 U.S.C. 1396a 
note), as amended by section 6, is amended by adding at the end the 
following:
    ``(j) MACPAC Report.--Prior to the final implementation date 
established by the Secretary for the criteria established for home and 
community-based settings in section 441.301(c)(4) of title 42, Code of 
Federal Regulations, as part of final implementation of the Home and 
Community Based Services (HCBS) Final Rule published on January 16, 
2014 (79 Fed. Reg. 2947) (referred to in this subsection as the `HCBS 
final rule'), the Medicaid and CHIP Payment and Access Commission 
(MACPAC) shall submit to Congress a report that--
            ``(1) identifies the types of home and community-based 
        settings and associated services that are available to eligible 
        individuals in both the MFP demonstration program and sites in 
        compliance with the HCBS final rule; and
            ``(2) if determined appropriate by the Commission, 
        recommends policies to align the criteria for a qualified 
        residence under subsection (b)(6) (as in effect on October 1, 
        2017) with the criteria in the HCBS final rule.''.

SEC. 8. APPLICATION TO CURRENT PROJECTS.

    Not later than 1 year after the date of enactment of this Act, any 
State with an approved MFP demonstration project under section 6071 of 
the Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) on the date of 
enactment of this Act shall submit a revised application to the 
Secretary that contains the same information and assurances as are 
required for any new State applicant under the amendments made by this 
Act.
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