Senate Finance Committee Issues Report on Community Based Independence for Seniors Act
Excerpts of the report follow:
I. LEGISLATIVE BACKGROUND
Background and need for legislative action
[Footnote 1: Social Security Act (SSA) Sec. 1862(a)(1).]
[Footnote 2: For more information on
The Committee recognizes the success of the
II. EXPLANATION OF THE BILL
PRESENT LAW
The Medicare Modernization Act of 2003 (MMA, P.L. 108-273) established a new type of
[Footnote 3: SSA Sec. 1859(f) Requirements Regarding Enrollment in Specialized MA Plans for Special Needs Individuals.]
In general, SNPs are required to meet all applicable statutory and regulatory requirements that apply to MA plans, including: state licensure as a risk-bearing entity; MA reporting requirements that are applicable depending on plan size; and Part D prescription drug benefit requirements. SNP payment procedures mirror CMS's procedures for MA plans. SNPs prepare and submit a bid like other MA plans, and are paid in the same manner as other MA plans based on the plan's enrollment and risk adjustment payment methodology. In addition to the MA requirements, SNPs must have evidenced-based models of care (MOC) tailored to the special health needs of the SNP's target population. 4 [Footnote] A
[Footnote 4: SSA Sec. 1859(f)(5), Care Management Requirements.]
In
Availability of long term services and supports to
The Patient Protection and Affordable Care Act (ACA, P.L. 111-148) authorized MA senior housing facility plans to continue operating indefinitely if they participated in a demonstration prior to
[Footnote 5: The MA senior housing facility plan demonstration was established by the Secretary, see the Patient Protection and Affordable Care Act, Section 3208. Making Senior Housing Facility Demonstration Permanent.]
[Footnote 6: SSA Sec. 1859(g)(1), Special Rules for a Senior Housing Facility Plan.]
[Footnote 7: SSA Sec. 1852(l)(4)(B), Continuing Care Retirement Communities are an arrangement under which housing and health-related services are provided (or arranged) through an organization for the enrollee under an agreement that is effective for the life of the enrollee or for a specified period.]
State Health Insurance Counseling and Assistance Programs (SHIPs) and other entities provide outreach activities such as counseling, education, enrollment assistance, health promotion, and other activities to help low-income
[Footnote 8: SHIPs were authorized under a grant program in the Omnibus Budget Reconciliation Act of 1990 (P.L. 105-508), Sec. 4360, Health Insurance Information, Counseling, and Assistance Grants.]
REASONS FOR CHANGE
The Committee recognizes the success of the
EXPLANATION OF PROVISION
This bill would require the Secretary to establish a Community-Based Institutional Special Needs Plan (CBI-SNP) demonstration program intended to prevent or delay low-income
The Secretary would be required to enter into agreements with up to five eligible MA plans to participate in the CBI-SNP demonstration. The Secretary also would be authorized to permit each participating MA plan to enroll up to 1,000 frail, low-income
MA SNPs that meet the following conditions would be eligible to participate in the CBI-SNP demonstration has offered SNPs to nursing home-eligible, non-institutionalized
Low-income
The Secretary would be authorized to permit beneficiaries certain exceptions to the normal annual coordinated election period. Beneficiaries eligible for the CBI-SNP demonstration could dis-enroll at any time from an MA plan that was not participating in the CBI-SNP and then enroll in an MA plan that was participating in the CBI-SNP demonstration as long as the eligible beneficiary resided in the CBI-SNP demonstration plan's service area. In addition, beneficiaries eligible to participate in the CBI-SNP demonstration who were enrolled in original
The Secretary would be required to help educate eligible
EVALUATION AND EXPANSION
The Secretary will ensure the CBI-SNP demonstration is budget neutral. Taking into account the evaluation described below, the Secretary may expand the duration and scope of the CBI-SNP demonstration if: the expansion is expected to improve the quality of care (as defined by the CMS Administrator) without increasing net
If the Secretary determined that the CBI-SNP demonstration was expected to reduce
The Secretary would be required to arrange for an independent, third-party evaluation of the CBI-SNP demonstration. Prior to implementation of the CBI-SNP demonstration, the Secretary would be required to clearly articulate the evaluation criteria which would include the following criteria: specific demonstration goals, hypotheses to be tested, and clear data collection and reporting requirements. The Secretary would be required to ensure that the evaluation determined whether or not the CBI-SNP demonstration program met the following conditions: improved patient care, reduced hospitalizations or rehospitalizations, reduced or delayed
By
EFFECTIVE DATE
The Secretary would be required to implement the CBI-SNP demonstration by
III. BUDGET EFFECTS OF THE BILL
B. COMMITTEE ESTIMATES
In compliance with paragraph 11(a) of rule XXVI of the Standing Rules of the
The bill is estimated to have the following effects on Federal budget receipts for fiscal years 2016-2025:
To view the table, click this link: http://thomas.loc.gov/cgi-bin/cpquery/3?&sid=cp114fauyo&refer=&r_n=sr103.114&db_id=114&item=3&&sid=cp114fauyo&r_n=sr103.114&hd_count=50&item=3&&sel=TOC_14620&
C. BUDGET AUTHORITY AND TAX EXPENDITURES
Budget authority
In compliance with section 308(a)(1) of the Congressional Budget and Impoundment Control Act of 1974 (`Budget Act'), the Committee states that the bill as reported involves increased budget authority (see table in Part A, above).
Tax expenditures
In compliance with section 308(a)(1) of the Budget Act, the Committee states that the bill does not involve increased tax expenditures.
D. CONSULTATION WITH CONGRESSIONAL BUDGET OFFICE
In accordance with section 403 of the Budget Act, the Committee advises that the
S. 704--Community Based Independence for Seniors Act
Summary: S. 704 would establish a demonstration program in the
CBO estimates that enacting S. 704 would increase direct spending by about
S. 704 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act (UMRA) and would not affect the budgets of state, local, or tribal governments.
Estimated cost to the Federal Government: The estimated budgetary effect of S. 704 is shown in the following table. The costs of this legislation fall within budget function 570 (
To view the table, click this link: http://thomas.loc.gov/cgi-bin/cpquery/3?&sid=cp114fauyo&refer=&r_n=sr103.114&db_id=114&item=3&&sid=cp114fauyo&r_n=sr103.114&hd_count=50&item=3&&sel=TOC_14620&
Basis of estimate: S. 704 would require the Secretary of
Community-Based Institutional Special Needs Plan Demonstration
Under current law, MA plans submit a bid indicating the per capita payment they are willing to accept for providing Part A and Part B benefits to a beneficiary of average health. That bid is compared with a benchmark that is set according to a statutory formula, and represents the maximum amount that
S. 704 would require the Secretary of
Pay-As-You-Go considerations: The Statutory Pay-As-You-Go Act of 2010 establishes budget-reporting and enforcement procedures for legislation affecting direct spending or revenues. The net changes in outlays that are subject to those pay-as-you-go procedures are shown in the following table.
CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR S. 704, AS ORDERED REPORTED BY THE SENATE COMMITTEE ON FINANCE ON
To view the table, click this link: http://thomas.loc.gov/cgi-bin/cpquery/3?&sid=cp114fauyo&refer=&r_n=sr103.114&db_id=114&item=3&&sid=cp114fauyo&r_n=sr103.114&hd_count=50&item=3&&sel=TOC_14620&
Intergovernmental and private-sector impact: S. 704 contains no intergovernmental or private-sector mandates as defined in UMRA and would not affect the budgets of state, local, or tribal governments.
Estimate prepared by: Federal Costs:
Estimate approved by:
IV. VOTES OF THE COMMITTEE
In compliance with paragraph 7(b) of rule XXVI of the Standing Rules of the
Final Passage of The Community Based Independence for Seniors Act--approved, as modified, by voice vote.
V. REGULATORY IMPACT AND OTHER MATTERS
A. REGULATORY IMPACT
Pursuant to paragraph 11(b) of rule XXVI of the Standing Rules of the
Impact on individuals and businesses, personal privacy and paperwork
The bill is not expected to impose additional administrative requirements or regulatory burdens on individuals. The bill is expected to reduce administrative requirements and regulatory burdens on some businesses.
The provisions of the bill do not impact personal privacy.
B. UNFUNDED MANDATES STATEMENT
This information is provided in accordance with section 423 of the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104-4).
The Committee has determined that the bill does not contain any private sector mandates. The Committee has determined that the bill contains no intergovernmental mandate.
VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
In the opinion of the Committee, it is necessary in order to expedite the business of the
The full text of the report is found at: http://thomas.loc.gov/cgi-bin/cpquery/3?cp114:temp/~cp114fauyo&sid=cp114fauyo&item=3&sel=TOCLIST&l_f=101&l_file=list/cp114cs.lst&l_b=51&l_file=list/cp114cs.lst&report=sr103.114&hd_count=50&&&l_t=170&&&
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