Grassley-Casey Amendment #8 to the Chairman’s Mark



Continuing Care Retirement Communities and Medicare Demonstration Project


Proposed by:

Senator Chuck Grassley of Iowa and Senator Bob Casey of Pennsylvania



The purpose of this amendment is to require the Center for Medicare and Medicaid Innovation (CMMI) to eliminate the barriers in allowing Continuing Care Retirement Communities (CCRC) to receive Medicare services provided under a risk-adjusted, capitated payment arrangement.


Description of Amendment:

This amendment would provide for comprehensive, affordable, high-quality healthcare into the homes of Medicare beneficiaries by combining established and successful models of care – PACE (Program of All-inclusive Care for the Elderly) and CCRC – to improve the efficiency and quality of senior care and align incentives to provide the right care, at the right time, in the right setting.


Medical homes, care coordination and disease management are among the most promising strategies for cost containment and quality improvement in health care delivery, especially the costs associated with Medicare beneficiaries with chronic conditions. There are currently 2,000 Continuing Care Retirement Communities in America today. Recent studies, including the New England Journal of Medicine, demonstrate that a congregate senior living environment such as a CCRC is actually the ideal setting to integrate these cost containment strategies to lower cost and improve outcomes for Medicare seniors because of the near-constant interaction between staff and residents.


The CCRC would accept a diverse group of independent, non-acute seniors whose mix of chronic conditions could benefit from the care coordination and disease management services provided onsite to avoid hospitalizations and lower the total cost of care for seniors as they age in place and their needs increase. An interdisciplinary health care team led by salaried primary care physicians would integrate comprehensive primary and post-acute health care services into the CCRC and coordinate acute and specialist care. Beneficiaries would receive Medicare services provided under a risk-adjusted, capitated payment arrangement.



Rodney Whitlock, x4-8990

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