Sec. 410. Community-Based Institutional Special Needs Plan Demonstration Program

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The Secretary of Health and Human Services (referred to in this section as the Secretary ) shall establish a Community-Based Institutional Special Needs Plan (CBI-SNP) demonstration program to prevent and delay institutionalization under Medicaid among targeted low-income Medicare beneficiaries. The Secretary shall enter into agreements with not more than 5 specialized MA plans for special needs individuals, as defined in section 1859(b)(6)(B)(i) of the Social Security Act ( 42 U.S.C. 1395w–28(b)(6)(B)(i) ), to conduct the CBI-SNP demonstration program.

Under the CBI-SNP demonstration program, a targeted low-income Medicare beneficiary shall receive, as supplemental benefits under section 1852(a)(3) of such Act ( 42 U.S.C. 1395w-22(a)(3) ), long-term care services or supports that— the Secretary determines appropriate for the purposes of the CBI-SNP demonstration program; and for which payment may be made under the State plan under title XIX of such Act (42 U.S.C. 1396 et seq.) of the State in which the targeted low-income Medicare beneficiary is located.

To be eligible to participate in the CBI-SNP demonstration program, a specialized MA plan for special needs individuals must— serve special needs individuals (as defined in section 1859(b)(6)(B)(i) of the Social Security Act ( 42 U.S.C. 1395w–28(b)(6)(B)(i) ); have experience in offering special needs plans for nursing home-eligible, non-institutionalized Medicare beneficiaries who live in the community; be located in a State that the Secretary has determined will participate in the CBI-SNP demonstration program by agreeing to make available data necessary for purposes of conducting the independent evaluation required under subsection (f); and meet such other criteria as the Secretary may require.

In this section, the term targeted low-income Medicare beneficiary means a Medicare beneficiary who— is enrolled in a specialized MA plan for special needs individuals that has been selected to participate in the CBI-SNP demonstration program; is a subsidy eligible individual (as defined in section 1860D–14(a)(3)(A) of the Social Security Act ( 42 U.S.C. 1395w-114(a)(3)(A) ); and is unable to perform 2 or more activities of daily living (as defined in section 7702B(c)(2)(B) of the Internal Revenue Code of 1986).

The CBI-SNP demonstration program shall be implemented not later than January 1, 2016, and shall be conducted for a period of 3 years. Not later than 2 years after the completion of the CBI-SNP demonstration program, the Secretary shall provide for the evaluation of the CBI-SNP demonstration program by an independent third party. The evaluation shall determine whether the CBI-SNP demonstration program has improved patient care and quality of life for the targeted low-income Medicare beneficiaries participating in the CBI-SNP demonstration program.

Specifically, the evaluation shall determine if the CBI-SNP demonstration program has— reduced hospitalizations or re-hospitalizations; reduced Medicaid nursing home facility stays; and reduced spenddown of income and assets for purposes of becoming eligible for Medicaid. Not later than 3 years after the completion of the CBI-SNP demonstration program, the Secretary shall submit to Congress a report containing the results of the evaluation conducted under paragraph (1), together with such recommendations for legislative or administrative action as the Secretary determines appropriate.

For purposes of carrying out the demonstration program under this section (other than the evaluation and report under subsection (f)), the Secretary shall provide for the transfer from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act ( 42 U.S.C. 1395i ) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act ( 42 U.S.C. 1395t ), in such proportion as the Secretary determines appropriate, of $3,000,000 to the Centers for Medicare & Medicaid Services Program Management Account.

For purposes of carrying out the evaluation and report under subsection (f), the Secretary shall provide for the transfer from the Federal Hospital Insurance Trust Fund under such section 1817 and the Federal Supplementary Medical Insurance Trust Fund under such section 1841, in such proportion as the Secretary determines appropriate, of $500,000. Amounts transferred under paragraph

(1)or

(2)shall remain available until expended. In conducting the CBI-SNP demonstration program, the Secretary shall ensure that the aggregate payments made by the Secretary do not exceed the amount which the Secretary estimates would have been expended under titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq., 1396 et seq.) if the CBI-SNP demonstration program had not been implemented. Chapter 35 of title 44, United States Code, shall not apply to the testing and evaluation of the CBI-SNP demonstration program under this section.

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