[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3746 Introduced in House (IH)]







107th CONGRESS
  2d Session
                                H. R. 3746

 To amend title XVIII to establish a comprehensive centers for medical 
                   excellence demonstration program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 13, 2002

 Mr. Houghton introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on Energy 
    and Commerce, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII to establish a comprehensive centers for medical 
                   excellence demonstration program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medical Excellence Demonstration 
Program Act of 2002''.

SEC. 2. COMPREHENSIVE CENTERS FOR MEDICAL EXCELLENCE DEMONSTRATION 
              PROGRAM.

    (a) Program Authorized.--Title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.) is amended--
            (1) by redesignating section 1866B as section 1866C; and
            (2) by inserting after section 1866A the following new 
        section:

  ``comprehensive centers for medical excellence demonstration program

    ``Sec. 1866B. (a) Demonstration Program Authorized.--
            ``(1) In general.--The Secretary shall establish a 
        demonstration program under which the Secretary conducts 
        population-based demonstration projects to test the use of 
        providing incentives to comprehensive centers for medical 
        excellence that--
                    ``(A) eliminate underuse of effective care by 
                beneficiaries;
                    ``(B) ensure the safety of care provided to such 
                individuals;
                    ``(C) reduce scientific uncertainty in the delivery 
                of care through outcomes measurement and research;
                    ``(D) encourage shared decision-making for--
                            ``(i) specific treatments, the use of which 
                        should depend on patient preferences (such as 
                        discretionary surgery); and
                            ``(ii) the management of chronic disease 
                        and end-of-life care;
                    ``(E) encourage resource allocation decisions based 
                on efficient practice benchmarks;
                    ``(F) promote the conservative delivery of care 
                when more intensive care is wasteful if not harmful; 
                and
                    ``(G) reward such centers for improving the quality 
                of care and achieving efficient allocation of 
                resources.
            ``(2) Administration by contract.--Except as otherwise 
        specifically provided, the Secretary may administer the 
        demonstration program under this section in accordance with 
        section 1866C.
            ``(3) Waiver authority.--The Secretary may waive such 
        requirements of this title and title XI as may be necessary for 
        the purpose of carrying out the demonstration program under 
        this section.
            ``(4) Definitions.--In this section:
                    ``(A) Beneficiary.--The term `beneficiary' means a 
                beneficiary under this title who is enrolled in the 
                original medicare fee-for-service program under parts A 
                and B and not under the Medicare+Choice program under 
                part C.
                    ``(B) Comprehensive center for medical 
                excellence.--The term `comprehensive center for medical 
                excellence' means a health care group (as defined in 
                subparagraph (C)) or an organization representing 
                regional coalitions of health care groups.
                    ``(C) Health care group.--
                            ``(i) In general.--The term `health care 
                        group' means--
                                    ``(I) a group of physicians (as 
                                defined in subparagraph (D)) organized 
                                at least in part for the purpose of 
                                providing physicians' services under 
                                this title; or
                                    ``(II) an integrated delivery 
                                system that delivers care through 
                                coordinated hospitals, clinics, and 
                                employed and contracted physicians.
                            ``(ii) Inclusion.--As the Secretary finds 
                        appropriate, a health care group may include a 
                        hospital or any other individual or entity 
furnishing items or services for which payment may be made under this 
title that is affiliated with the health care group under an 
arrangement structured so that such individual or entity participates 
in a demonstration project under this section.
                    ``(D) Physician.--Except as the Secretary may 
                otherwise provide, the term `physician' means any 
                individual who furnishes services which may be paid for 
                as physicians' services under this title.
    ``(b) Planning and Implementation of Demonstration Program.--
            ``(1) Planning phase.--
                    ``(A) Selection of 4 sites.--The Secretary shall 
                select 4 comprehensive centers for medical excellence 
                to participate in the planning phase of the 
                demonstration program described in subparagraph (B).
                    ``(B) Operation.--During the 18-month period 
                beginning after the selection of the centers under 
                subparagraph (A), the Secretary, in consultation with 
                the National Steering Committee for Comprehensive 
                Centers for Medical Excellence Demonstration Program 
                (established under subsection (g)) and the Center for 
                the Evaluative Clinical Sciences at Dartmouth College, 
                shall work with the 4 centers selected under 
                subparagraph (A) with regard to the following:
                            ``(i) Subject to subsection (c), the 
                        establishment of criteria that the 
                        comprehensive centers for medical excellence 
                        must meet in order to be eligible to 
                        participate in a demonstration project under 
                        this section.
                            ``(ii) The establishment of standards to 
                        determine whether a comprehensive center for 
                        medical excellence meets the criteria 
                        established under clause (i).
                            ``(iii) The development of appropriate 
                        alternative payment systems under subparagraph 
                        (D).
                            ``(iv) Any other aspect of the 
                        demonstration program determined appropriate by 
                        the Secretary to improve the implementation of 
                        the program under paragraph (2).
                    ``(C) Establishment of medicare claims-based 
                information system that links individual sites and 
                provides benchmarks for evaluating health care quality 
                and efficiency.--
                            ``(i) In general.--During the 18-month 
                        period described in subparagraph (B), the 
                        Secretary, in consultation with the Center for 
                        the Evaluative Clinical Sciences at Dartmouth 
                        College, shall establish and implement a health 
                        information system that--
                                    ``(I) is modeled after the 
                                Dartmouth Atlas of Health Care Project;
                                    ``(II) provides information on 
                                practice variations based on cross 
                                sectional and longitudinal profiles; 
                                and
                                    ``(III) links to the registry data 
                                developed under subsection (c)(2)(A).
                            ``(ii) Availability of information.--In 
                        order to make the information described in 
                        clause (i)(II) as useful as possible for 
                        evaluating the quality and efficiency of care, 
                        the Secretary shall ensure that such 
                        information incorporates relevant claims data 
                        within 3 months after such claims have been 
                        adjudicated under this title.
                    ``(D) Development of alternative payment systems.--
                            ``(i) In general.--During the 18-month 
                        period described in subparagraph (B), a 
                        comprehensive center for medical excellence 
                        selected under subparagraph (A) shall develop a 
                        proposal for an alternative payment system for 
                        items and services provided by the center to 
                        beneficiaries under the demonstration program. 
                        The alternative payment system shall be 
                        designed to--
                                    ``(I) maximize flexibility in 
                                delivering high-quality care and 
                                accomplishing the goals described in 
                                subsection (a)(1); and
                                    ``(II) streamline or eliminate 
                                documentation and reporting 
                                requirements otherwise required under 
                                this title.
                            ``(ii) Benefits.--In order to accomplish 
                        the goals described in subsection (a)(1), a 
comprehensive center for medical excellence may include in the proposal 
described in clause (i) modifications to the package of benefits 
available under the original medicare fee-for-service program under 
parts A and B, such as--
                                    ``(I) providing additional items 
                                and services than are available under 
                                such program; and
                                    ``(II) waiving part or all of 
                                beneficiary cost-sharing requirements 
                                under such program.
            ``(2) Implementation phase.--
                    ``(A) In general.--As soon a practicable after the 
                18-month period described in paragraph (1)(B), the 
                Secretary shall fully implement the demonstration 
                program under this section.
                    ``(B) Application.--A comprehensive center for 
                medical excellence seeking to participate in the 
                demonstration program under this section shall submit 
                an application to the Secretary at such time, in such 
                manner, and containing such information, as the 
                Secretary may require. The Secretary shall require that 
                an application include the center's proposal for an 
                alternative payment system (as described in paragraph 
                (1)(D)).
                    ``(C) Selection of sites.--
                            ``(i) In general.--The Secretary shall 
                        select up to 10 comprehensive centers for 
                        medical excellence in which to conduct the 
                        demonstration program under this section. If a 
                        center selected under paragraph (1)(A) meets 
                        the criteria established by the Secretary under 
                        paragraph (1)(B)(i), develops a proposal for an 
                        alternative payment system that is approved by 
                        the Secretary, and desires to participate in 
                        the implementation phase under this paragraph, 
                        the Secretary shall select such center to 
                        conduct the demonstration program under this 
                        section.
                            ``(ii) Budget neutrality not required.--The 
                        Secretary may select centers under clause (i) 
                        even if the alternative payment systems 
                        proposed by the centers would result in 
                        aggregate expenditures under this title with 
                        respect to beneficiaries within the scope of 
                        the demonstration program that are greater than 
                        the expenditures under this title that the 
                        Secretary estimates would have been expended if 
                        the demonstration program had not been 
                        implemented.
            ``(3) Urban and rural sites.--Notwithstanding section 
        1866C(a)(2)(A), in selecting the centers pursuant to paragraphs 
        (1)(A) and (2)(B), the Secretary shall ensure that the needs of 
        beneficiaries residing in urban and rural areas are addressed.
    ``(c) Eligibility Criteria.--The criteria established under 
subsection (b)(1)(B)(i) shall include the following:
            ``(1) Quality improvement.--
                    ``(A) In general.--The comprehensive center for 
                medical excellence has the ability to practice 
                continuous quality improvement aimed at integrating 
                community-based support services, primary care, and 
                referral care in order to meet the needs of 
                beneficiaries.
                    ``(B) Considerations.--In determining whether a 
                comprehensive center for medical excellence meets the 
                criteria described in subparagraph (A), the Secretary 
                shall consider the mechanisms that the comprehensive 
                center will utilize in order to--
                            ``(i) enhance the delivery of effective 
                        care to beneficiaries;
                            ``(ii) ensure patient participation in 
                        preference-based decisions, including the use 
                        of shared decision-making tools;
                            ``(iii) implement an effective disease 
                        management program for beneficiaries with 
                        chronic conditions; and
                            ``(iv) address the specific needs of 
                        beneficiaries with terminal illnesses, 
                        including beneficiaries receiving hospice care 
                        under a hospice program.
            ``(2) Information systems.--The comprehensive center for 
        medical excellence provides assurances that it will--
                    ``(A) develop uniform and comprehensive registries 
                that track population-based rates of use of health care 
                resources and services to provide resource allocation 
                and disease management support; and
                    ``(B) participate in the health information system 
                established by the Secretary pursuant to subsection 
                (b)(1)(C)(i).
            ``(3) Organizational and administrative structures.--The 
        comprehensive center for medical excellence has in place 
        organizational and administrative structures that ensure 
        accountability, leadership, and community involvement.
            ``(4) Data reporting.--The comprehensive center for medical 
        excellence provides assurances that it will report to the 
        Secretary such data, at such times and in such format as the 
        Secretary requires, for purposes of monitoring and evaluation 
        of the demonstration project.
    ``(d) Payments to Centers Participating in Implementation Phase of 
Program.--A comprehensive center for medical excellence participating 
in a demonstration project under this section shall agree with respect 
to items and services furnished to beneficiaries within the scope of 
the demonstration project (as determined under subsection (e))--
            ``(1) to be paid based on the center's proposal for an 
        alternative payment system (submitted pursuant to subsection 
        (b)(2)(B)); and
            ``(2) that payment with respect to all such items and 
        services furnished by the comprehensive center for medical 
        excellence to such beneficiaries shall (where determined 
appropriate by the Secretary) be made to the center.
    ``(e) Beneficiaries Within Scope of Demonstration.--
            ``(1) In general.--The Secretary shall specify, in 
        accordance with this subsection, the criteria for identifying 
        those beneficiaries who are patients of a comprehensive center 
        for medical excellence who shall be considered within the scope 
        of the demonstration program under this section and for 
        assessment of the effectiveness of the center in achieving the 
        objectives of this section.
            ``(2) Other criteria.--The Secretary may establish 
        additional criteria for inclusion of beneficiaries within a 
        demonstration project under this section, which may include 
        frequency of contact with physicians in the center or other 
        factors or criteria that the Secretary finds to be appropriate.
            ``(3) Notice requirements.--In the case of each beneficiary 
        determined to be within the scope of a demonstration project 
        under this section with respect to a specific comprehensive 
        center for medical excellence, the Secretary shall ensure that 
        such beneficiary is notified of any waivers of coverage or 
        payment rules, applicable to such center under the 
        demonstration project.
    ``(f) Participation and Support by Federal Agencies.--In carrying 
out the demonstration program under this section the Secretary may 
direct--
            ``(1) the Director of the National Institutes of Health to 
        expand the efforts of the Institutes to evaluate current 
        medical technologies and improve the foundation for evidence-
        based practice; and
            ``(2) the Administrator of the Agency for Healthcare 
        Research and Quality to, where possible and appropriate, use 
        the demonstration program under this section as a laboratory 
        for the study of quality improvement strategies for the 
        national health care system.
    ``(g) National Steering Committee for Comprehensive Centers for 
Medical Excellence Demonstration Projects.--
            ``(1) Establishment.--The Secretary shall establish within 
        the Department of Health and Human Services a National Steering 
        Committee for Comprehensive Centers for Medical Excellence 
        Demonstration Projects (in this subsection referred to as the 
        `Steering Committee') to carry out the duties described in 
        paragraph (3).
            ``(2) Membership.--The Steering Committee shall include the 
        following members:
                    ``(A) At least 1 representative from--
                            ``(i) the National Institutes of Health;
                            ``(ii) the Agency for Healthcare Research 
                        and Quality; and
                            ``(iii) the Centers for Medicare & Medicaid 
                        Services.
                    ``(B) A nationally recognized leader from the field 
                of health care quality improvement.
                    ``(C) An employer.
                    ``(D) A consumer.
                    ``(E) At least 2 health care providers.
            ``(3) Duties.--The duties of the Steering Committee shall 
        be to--
                    ``(A) make recommendations to the Secretary 
                regarding--
                            ``(i) the design of the demonstration 
                        program under this section;
                            ``(ii) the development of the performance 
                        monitoring systems for the comprehensive 
                        centers for medical excellence participating in 
                        the demonstration program under this section;
                            ``(iii) which requirements of titles XI and 
                        XVIII will need to be waived by the Secretary 
                        pursuant to subsection (a)(3) in order to carry 
                        out the demonstration program under this 
                        section, including payment system requirements 
                        for items and services provided under this 
                        title that would otherwise apply;
                            ``(iv) whether to expand the demonstration 
                        program under this section; and
                            ``(v) whether to implement the program on a 
                        permanent basis; and
                    ``(B) provide a forum for coordination of Federal 
                support for the demonstration program under this 
                section.
    ``(h) Authorization of Appropriations.--
            ``(1) In general.--There is authorized to be appropriated 
        $6,000,000 to complete the planning phase of the demonstration 
        program under subsection (b)(1), including the establishment of 
        the health information system under subparagraph (C) of such 
        subsection.
            ``(2) Availability.--Any amounts appropriated pursuant to 
        paragraph (1) shall remain available until expended.''.
    (b) Conforming Amendments.--
            (1) Conforming change to physician group practice 
        demonstration.--Section 1866A(a)(2) of the Social Security Act 
        (42 U.S.C. 1395cc-1(a)(2)) is amended by striking ``1866B'' and 
        inserting ``1866C''.
            (2) Conforming changes to administrative provisions.--
        Section 1866C of the Social Security Act (as redesignated by 
        subsection (a)) is amended--
                    (A) in subsection (a)(1), in the matter preceding 
                subparagraph (A), by striking ``program under section 
                1866A (in this section referred to as the 
                `demonstration program')'' and inserting ``programs 
                under sections 1866A and 1866B (in this section 
                referred to as the `demonstration programs')''; and
                    (B) by striking ``the demonstration program'' each 
                place it appears and inserting ``the demonstration 
                programs''.
                                 <all>