US Codex
Bill
Notes

Title II — Improving Eligibility Determinations, Enrollment Processes, and Quality of Care for Dual Eligible Individuals

S. 3950 · 118th Congress · Mar 14, 2024 · Lineage

II Improving Eligibility Determinations, Enrollment Processes, and Quality of Care for Dual Eligible Individuals

Sec. 201 Identifying opportunities for State coordination with respect to eligibility determinations

Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services, in consultation with States, shall—
(1)
review State processes for determining whether an individual is a full-benefit dual individual (as defined in section 1935(c)(6) of the Social Security Act (42 U.S.C. 1396u–5(c)(6)) but without the application of subparagraph (A)(i) of such section) and whether an individual is eligible for the low-income subsidy program under section 1860D–14 of the Social Security Act (42 U.S.C. 1395w–114) and the Medicare Savings Program (as defined in section 1144(c)(7) of such Act (42 U.S.C. 1320b–14(c)(7))); and
(2)
issue guidance for States that identifies opportunities for better coordination of such processes between the States and the Federal Government.

Sec. 202 Alignment of bidding, reporting, and other dates and deadlines for integrated care plans

Not later than 180 days after the date of enactment of this Act, the Director of the Federal Coordinated Health Care Office of the Centers for Medicare & Medicaid Services and the Administrator of the Centers for Medicare & Medicaid Services shall—
(1)
review bidding, reporting, and other significant dates and deadlines applicable to integrated care plans under the Medicare program, the Medicaid program, and State Integrated Care Programs for Dual Eligible Individuals under title XXII of the Social Security Act; and
(2)
identify such administrative and legislative changes as are needed to ensure that all such dates and deadlines are aligned and consistent under all such programs.

Sec. 203 Grants to State and local community organizations for outreach and enrollment

(a)
In general— From the amounts appropriated under subsection (c) for a fiscal year, the Secretary of Health and Human Services (in this section referred to as the Secretary) shall award grants to State and local community organizations to conduct outreach and enrollment efforts that are designed to increase the enrollment of dual eligible individuals (as defined in section 2201 of the Social Security Act) in health benefits plans that provide integrated care for such individuals under State Integrated Care Programs for Dual Eligible Individuals established under XXII of the Social Security Act.
(b)
Model standards— The Secretary, in consultation with the Administrator of the Administration for Community Living and States, shall develop and issue model standards for outreach and education conducted by State and local community organizations awarded grants under this section that include the following:
(1)
Information and education support is available for individuals in a range of languages, and online, over the phone, and in person.
(2)
Materials presented are easy to read, written in as low a reading comprehension level as possible, and are in the proper language for the individual involved.
(3)
Information presented online is accessible for individuals with disabilities.
(4)
Information is presented in a manner that takes into consideration the accessibility needs of the individual, such as language access requirements and the health literacy level of the individual.
(c)
Appropriation— There is appropriated, out of any money in the Treasury not otherwise appropriated, for the first fiscal year that begins after the date of enactment of this Act, and for each fiscal year thereafter, $50,000,000 to carry out this section.

Sec. 204 Application of model standards to information requirements for integrated care plans

Not later than 1 year after the date of enactment of this Act, the Director of the Federal Coordinated Health Care Office of the Centers for Medicare & Medicaid Services and the Administrator of the Centers for Medicare & Medicaid Services jointly shall issue guidance or regulations requiring that any notice or informational materials provided to a dual eligible individual (as defined in section 2201 of the Social Security Act) by such Director, Administrator, States, or health benefits plans that provide integrated care for such individuals under the Medicare program, the Medicaid program, or under State Integrated Care Programs for Dual Eligible Individuals established under XXII of the Social Security Act complies with the model standards issued under section 203(b).

Sec. 205 Enrollment through independent brokers

Not later than 1 year after the date of enactment of this Act, the Director of the Federal Coordinated Health Care Office of the Centers for Medicare & Medicaid Services and the Administrator of the Centers for Medicare & Medicaid Services jointly shall issue guidance or regulations providing that—
(1)
a dual eligible individual (as defined in section 2201 of the Social Security Act) may not be enrolled in a health benefits plan that provides integrated care for such individual under title XXII of the Social Security Act through a broker unless the broker is an independent broker (as defined under such guidance or regulations);
(2)
an independent broker may receive a commission for the initial enrollment of a dual eligible individual in such a plan, but no commission shall be available to any broker for any subsequent enrollment of such individual in any such plan;
(3)
if a broker disenrolls a dual eligible individual from any such health benefits plan to a plan that provides partial or no integrated care, the broker, in accordance with the model standards issued under section 204(b), shall inform the individual—
(A)
of the health benefits plan the individual is being disenrolled from; and
(B)
that the individual is being enrolled in a health benefits plan that provides partial or no integrated care and the potential implications of such disenrollment and enrollment on the individual's care.

Sec. 206 Reducing threshold for look-alike D–SNP plans under Medicare Advantage

For the first full plan year that begins on or after the date that is 1 year after the date of enactment of this Act, and each subsequent plan year, the Secretary of Health and Human Services—
(1)
shall implement section 422.514(d)(1)(ii) of title 42, Code of Federal Regulations (or any successor regulations) by substituting “50 percent” for “80 percent”; and
(2)
shall only count full-benefit dual eligible individuals (as defined in section 1935(c)(6) of the Social Security Act (42 U.S.C. 1396u–5(c)(6))) for purposes of applying the threshold under such section.

Sec. 207 Requiring regular update of provider directories

Not later than 1 year after the date of enactment of this Act, the Director of the Federal Coordinated Health Care Office of the Centers for Medicare & Medicaid Services and the Administrator of the Centers for Medicare & Medicaid Services shall promulgate regulations that—
(1)
require Medicare Advantage plans under part C of title XVIII of the Social Security Act (42 U.S.C. 1395w–21) and integrated care plans under title XXII of such Act to regularly update provider directories; and
(2)
include a measure relating to provider director currency rating on star rating systems for Medicare Advantage plans under section 1853(o) of the Social Security Act (42 U.S.C. 1395w–23(o)) and integrated care plans under title XXII of such Act.

Sec. 208 Review of hospital quality star rating system

Not later than 180 days after the date of enactment of this Act, the Administrator of the Centers for Medicare & Medicaid Services shall—
(1)
review the hospital quality star rating system under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.); and
(2)
identify such administrative and legislative changes as are needed to ensure that sufficient information is collected under such system regarding hospitals to effectively measure hospital quality.

Sec. 209 Requirement for FCHCO and State Medicaid agencies to develop maximum staffing ratios for care coordinators

(a)
In general— The Director of the Federal Coordinated Health Care Office, in consultation with State Medicaid agencies, shall develop model Federal legislation that would establish a process for determining a maximum care coordinator-to-patient ratio for integrated care plans providing care to dual eligible individuals under an integrated care model under title XXII of the Social Security Act. Such process shall take into account the varying needs required by different categories of patients.
(b)
Submission of model legislation— Not later than 180 days after the date of enactment of this Act, the Director of the Federal Coordinated Health Care Office shall submit the model legislation developed under subsection (a) to—
(1)
the Secretary of Health and Human Services;
(2)
the Committee on Finance of the Senate;
(3)
the Committee on Energy and Commerce of the House of Representatives; and
(4)
the Committee on Ways and Means of the House of Representatives.

Sec. 210 CMMI testing of coverage of partial benefit dual eligible individuals through State Integrated Care Programs

Section 1115A of the Social Security Act (42 U.S.C. 1315a) is amended—
(1)
in subsection (b)(2)(A), by adding at the end the following new sentence: “The models selected under this subparagraph shall include the testing of the model described in subsection (h)(1).”; and
(2)
by adding at the end the following new subsection:

“(h) Testing of model for providing coverage of partial benefit dual eligible individuals through partially integrated care plans under State Integrated Care Programs

“(1) In general—The model described in this paragraph is a model under which States may offer coverage to partial benefit dual eligible individuals through partially integrated care plans under State Integrated Care Programs established under title XXII.

“(2) Partial benefit dual eligible individual—For purposes of this subsection, the term partial benefit dual eligible individual means an individual who—

“(A) is eligible for the low-income subsidy program under section 1860D–14, the Medicare Savings Program (as defined in section 1144(c)(7)), or both; and

“(B) is not a full-benefit dual eligible individual (as such term is defined in section 1935(c)(6), but without the application of subparagraph (A)(i) of such section).”