S. 599 — what changed

“(d) Length of demonstration project

“(1) In general—Except as provided in paragraphs (2) and (3), the demonstration project established under this section shall be conducted for a period of 3 consecutive years.

“(2) Temporary extension of participation eligibility for selected States

changed “(A) In general—Subject to subparagraph (B) and paragraph (3), (4), a State selected as an eligible State to participate in the demonstration project on or prior to March 13, 2012, shall, upon the request of the State, be permitted to continue to participate in the demonstration project through the date described in subparagraph (B) September 30, 2016, if—

changed “(i) the Secretary determines that the continued participation of the State in the demonstration project is projected not expected to increase net program spending under title XIX of the Social Security Act; and

changed “(ii) the Chief Actuary of the Centers for Medicare & Medicaid Services certifies that such extension for that State is projected to reduce (or is projected not to result in any increase in) net program spending under title XIX of the Social Security Act.

changed “(B) Date described—The date described Notice of projections—The Secretary shall provide each State selected to participate in this the demonstration project on or prior to March 13, 2012, with notice of the determination and certification made under subparagraph is (A) for the earlier of—State.

removed “(i) the date on which Secretary submits the recommendations required under subsection (f)(3); or

removed “(ii) September 30, 2016.

“(3) Extension and expansion of demonstration project

added “(A) Additional extension—Taking into account the recommendations submitted to Congress under subsection (f)(3), the Secretary may permit an eligible State participating in the demonstration project as of the date such recommendations are submitted to continue to participate in the project through December 31, 2019, if, with respect to the State—

added “(i) the Secretary determines that the continued participation of the State in the demonstration project is projected not to increase net program spending under title XIX of the Social Security Act; and

changed “(A) Additional extension—Taking into account the recommendations submitted to Congress pursuant to subsection (f)(3), “(ii) the Secretary may, if Chief Actuary of the Secretary determines Centers for Medicare & Medicaid Services certifies that extension and expansion the continued participation of the State in the demonstration project satisfies the criteria for the temporary extension is projected not to increase net program spending under subparagraphs (A) and (B) title XIX of paragraph (2)—the Social Security Act.

changed “(i) extend “(B) Option for expansion to additional States—Taking into account the recommendations submitted to Congress pursuant to subsection (f)(3), the Secretary may expand the number of eligible States participating in the demonstration project through December 31, 2019; and2019, if, with respect to any new eligible State—

changed “(ii) permit any eligible “(i) the Secretary determines that the participation of the State participating in the demonstration project as of the date such recommendations are submitted to continue is projected not to participate in increase net program spending under title XIX of the project.Social Security Act; and

changed “(B) Option for expansion to additional States—Taking into account “(ii) the recommendations submitted to Congress pursuant to subsection (f)(3), Chief Actuary of the Secretary may expand (including on a nationwide basis) Centers for Medicare & Medicaid Services certifies that the number participation of eligible States participating the State in the demonstration project during the extension period established under subparagraph (A) if, with respect is projected not to any new eligible State—increase net program spending under title XIX of the Social Security Act.

changed “(i) the Secretary determines that the participation “(C) Notice of the projections—The Secretary shall provide each State participating in the demonstration project is not expected as of the date the Secretary submits recommendations to increase spending Congress under title XIX subsection (f)(3), and any additional State that applies to be added to the demonstration project, with notice of the Social Security Act; anddetermination and certification made for the State under subparagraphs (A) and (B), respectively, and the standards used to make such determination and certification—

changed “(ii) the Chief Actuary of the Centers for Medicare & Medicaid Services certifies that “(i) in the participation case of the a State participating in the demonstration project is projected to reduce (or is projected not to result in any increase in) net program spending under title XIX as of the Social Security Act.date the Secretary submits recommendations to Congress under subsection (f)(3), not later than August 31, 2016; and

changed “(4) Authority to ensure budget neutrality—The Secretary annually shall review each participating State’s demonstration project expenditures to ensure compliance with “(ii) in the requirements case of paragraphs (2)(A), (2)(B), (3)(B)(i), and (3)(B)(ii) (as applicable). If the Secretary determines with respect an additional State that applies to a State's participation in be added to the demonstration project that the State's net program spending under title XIX of the Social Security Act has increased as a result of the State's participation in the project, the Secretary shall treat the demonstration project excess expenditures of prior to the State as an overpayment under title XIX of making a final election to participate in the Social Security Act.”project.

added “(4) Authority to ensure budget neutrality—The Secretary annually shall review each participating State’s demonstration project expenditures to ensure compliance with the requirements of paragraphs (2)(A)(i), (2)(A)(ii), (3)(A)(i), (3)(A)(ii), (3)(B)(i), and (3)(B)(ii) (as applicable). If the Secretary determines with respect to a State's participation in the demonstration project that the State's net program spending under title XIX of the Social Security Act has increased as a result of the State's participation in the project, the Secretary shall treat the demonstration project excess expenditures of the State as an overpayment under title XIX of the Social Security Act.”

“(3) Recommendation to congress regarding extension and expansion of project—Not later than September 30, 2016, the Secretary shall submit to Congress and make available to the public recommendations based on an evaluation of the demonstration project, including the use of appropriate quality measures, regarding—

changed “(A) whether the demonstration project should be continued after December 31, September 30, 2016; and

changed “(B) whether the demonstration project should be expanded (including on a nationwide basis).to additional States.

“(4) Recommendation to congress regarding permanent extension and nationwide expansion

“(A) In general—Not later than April 1, 2019, the Secretary shall submit to Congress and make available to the public recommendations based on an evaluation of the demonstration project, including the use of appropriate quality measures, regarding—

“(i) whether the demonstration project should be permanently continued after December 31, 2019, in 1 or more States; and

“(ii) whether the demonstration project should be expanded (including on a nationwide basis).

changed “(B) Requirements—Any recommendation submitted under subparagraph (A) to permanently continue the project in a State, or to expand the project to 1 or more other States (including on a nationwide basis) shall include a certification from the Chief Actuary of the Centers for Medicare & Medicaid Services that permanently continuing the project in a particular State, or expanding the project to a particular State (or all States) is projected to reduce (or is projected not to result in any increase in) net program spending under title XIX of the Social Security Act. If the Secretary determines with respect to a State's participation in the demonstration project that net program spending under title XIX of such Act has increased as a result of the project, the Secretary shall treat the demonstration project excess expenditures of the State as an overpayment under title XIX of the Social Security Act.

changed “(C) Congressional approval required—The Secretary shall not permanently continue the demonstration project in any State after December 31, 2019, or expand the demonstration project to any additional State after December 31, 2019, unless Congress enacts a law approving either or both such actions.actions and the law includes provisions that—

added “(i) ensure that each State's participation in the project complies with budget neutrality requirements; and

added “(ii) require the Secretary to treat any expenditures of a State participating in the demonstration project that are excess of the expenditures projected under the budget neutrality standard for the State as an overpayment under title XIX of the Social Security Act.

“(5) Funding—Out of any funds in the Treasury not otherwise appropriated, there is appropriated to the Centers for Medicare & Medicaid Services Program Management Account to carry out this subsection, $100,000 for fiscal year 2015, to remain available until expended.”

“(4) Nationwide availability—In the event that the Secretary makes a recommendation pursuant to subsection (f)(4) that the demonstration project be expanded on a national basis, any State that has submitted or submits an application pursuant to paragraph (2) shall be deemed to have been selected to be an eligible State to participate in the demonstration project.”