Sec. 5. Performance bonuses for enrollment and retention improvements for certain individuals
1,017 words·~5 min read·
/bill/113/s/1980/is/section-5A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 1903 of the Social Security Act ( 42 U.S.C. 1396b ) is amended by adding at the end the following new subsection: In addition to performance bonuses for enrollment and retention described in section 2105(a) (related to children), a State may qualify for 1 or more performance bonuses related to the enrollment and retention of individuals described in section 1902(e)(12)(C)(iii)(III). For purposes of this paragraph, a State meets the condition of this paragraph for such individuals if, for each category of individuals specified in section 1902(e)(12)(C)(iii)(III) and selected by the State for additional enrollment and retention provisions, the State is implementing at least 3 of the following enrollment and retention provisions (treating each subparagraph as a separate enrollment and retention provision) throughout the entire fiscal year:
The State implements policies, including prorating income over annual periods, so as to align its treatment of income for purposes of a determination of eligibility for medical assistance with that of other affordability insurance programs with the goal of eliminating inconsistent determinations among these programs. Upon determination that an individual is no longer eligible for medical assistance, the State implements policies to maintain eligibility for medical assistance, including enrollment in the managed care organization in which the individual was enrolled at the time of the determination of ineligibility, during the period of time in which— eligibility-related information is transmitted to the other insurance affordability programs; a determination is made as to for which other insurance affordability program the individual is eligible; and coverage in such program and any related managed care organization becomes effective.
The State shall also implement policies to enroll the individual in the managed care organization in which the individual was a member prior to the loss of medical assistance eligibility, if such managed care organization participates in the other insurance affordability program, unless the individual voluntarily selects a separate managed care organization. The State utilizes findings from an American Health Benefit Exchange, an Express Lane Agency (as identified by the State and as described in section 1902(e)(13)(F)) or the Social Security Administration or other agencies administering employment, educational, or social services programs as identified by the State, to document income, assets, residency, age or other relevant information in determining or renewing eligibility.
The State maintains eligibility for enrollees whose renewal status has not yet been determined and for whom eligibility based on alternative eligibility criteria has not yet been ruled out. In the case of individuals who are determined to be eligible for medical assistance under this title after the loss of eligibility for fewer than 6 months, and who previously had been members of a managed care organization, the State re-enrolls the individual in the managed care organization in which the individual was a member prior to the loss of eligibility, unless the individual voluntarily selects a separate managed care organization.
In addition to the payments provided under section 2105(a) of the Social Security Act, subject to subparagraph
(C)the Secretary shall make payments to a State (beginning with fiscal year 2016) that satisfies the requirements of subparagraph (B). Payments to States shall be allocated annually among States in accordance with regulations promulgated by the Secretary not later than July 1, 2015. The payment under this paragraph shall be made, to a State for a fiscal year, as a single payment not later than the last day of the first calendar quarter of the following fiscal year to which the performance payment applies. A State shall be eligible for bonus payments under this subsection if— the State has adopted at least 3 of the 5 policies described in subparagraphs
(A)through
(E)of paragraph (1); and the State is able to demonstrate improvement in the continuity of enrollment by aged, blind, and disabled and adult populations, compared to its baseline performance in fiscal year 2013. The total amount of payments under paragraphs
(1)and
(2)of this section shall be equal to $500,000,000 for fiscal year 2016 for making payments under this paragraph, to be available until expended. This subsection constitutes budget authority in advance of appropriations Acts and represents the obligation of the Secretary to provide for the payment of amounts provided under this subsection. Nothing in this section shall prohibit a State from establishing criteria which would permit the State to distribute a portion of the proceeds of any performance bonuses received pursuant to this section to financially support providers who have contributed to improved enrollment and retention activities. For purposes of allocation of Enrollment and Retention Performance Bonuses the definition of provider shall have the meaning given to it in a State Plan. . Section 2105(a)(3) of the Social Security Act ( 42 U.S.C. 1397ee(a)(3) ) is amended— in subparagraph (A), by striking 2013 and inserting 2015 ; in subparagraph (E)(ii)— in the heading for subclause (I)(aa), by striking and inserting 2012 ; 2014 in subclause (I)(aa)— by striking 2012 and inserting 2014 ; by striking subsection
(a)and inserting section 2104(a) ; and by striking subsection
(m)and inserting section 2104(m) ; in the heading for subclause (I)(bb), by striking and inserting 2013 ; 2015 in subclause (I)(bb)— by striking fiscal year 2013 and inserting fiscal year 2015 ; by striking subsection (a)(16)(A) and inserting section 2104(a)(18)(A) ; by striking October 1, 2012, and ending on March 31, 2013 and inserting October 1, 2014, and ending on March 31, 2015 ; by striking subsection
(m)and inserting section 2104(m) ; and by striking or set aside under subsection (b)(2) of section 2111 for such fiscal year ; in the heading for subclause (I)(cc), by striking and inserting 2013 ; 2015 in subclause (I)(cc)— by striking 2013 each place it appears and inserting 2015 ; by striking subsection (a)(16)(B) and inserting section 2104(a)(18)(B) ; by striking subsection
(m)and inserting section 2104(m) ; and by striking or set aside under subsection (b)(2) of section 2111 for such fiscal year ; in subclause (II), by striking 2013 and inserting 2015 ; and in subclause (III), by striking 2013 and inserting 2015 ; and in subparagraph (F)(iii), by striking 2013 and inserting 2015 .
Connectionstraces to 2
Traces to 2 documents
Citation graph
cites case law
Sec. 5
Performance bonuses for enrollment and retention improvements for certain individuals
Cites 2Cited by 0 across 0 sources