1.Short title; table of
contents
(a)This Act may be cited as the Geriatric Assessment and Chronic Care Coordination Act of
2007
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Medicare coverage of geriatric assessments.
Sec. 4. Medicare coverage of chronic care coordination
services.
Sec. 5. Outreach activities regarding geriatric assessments and
chronic care coordination services under the Medicare program.
Sec. 6. Study and report on geriatric assessments and chronic
care coordination services under the Medicare program.
Sec. 7. Study and report on best practices for Medicare chronic
care coordination.
Sec. 8. Rule of construction.
2.Congress makes the following
findings:
(1)The Medicare
program must be redesigned to provide high-quality, cost-effective care to the
growing population of elderly individuals with multiple chronic
conditions.
(2)According to the
Congressional Budget Office, approximately 43 percent of Medicare costs can be
attributed to 5 percent of Medicare’s most costly beneficiaries.
(3)Currently, 78
percent of the Medicare population has at least 1 chronic condition, and
2/3 have more than 1 chronic condition. The 20 percent of
beneficiaries with 5 or more chronic conditions account for
2/3 of all Medicare spending. In addition, the large baby
boomer generation is moving toward retirement and Medicare eligibility.
(4)The prevalence of
chronic conditions increases with age: 74 percent of the 65- to 69-year-old
group has at least 1 chronic condition, while 86 percent of the 85 years and
older group has at least 1 chronic condition. Similarly, just 14 percent of the
65- to 69-year-old group has 5 or more chronic conditions, while 28 percent of
the 85 years and older group has 5 or more chronic conditions.
(5)There is a strong
pattern of increasing utilization as the number of conditions increase.
Fifty-five percent of Medicare beneficiaries with 5 or more conditions
experienced an inpatient hospital stay compared to 5 percent of those with 1
condition or 9 percent of those with 2 conditions.
(6)In terms of
physician visits, the average Medicare beneficiary has over 15 physician visits
annually and sees 6 different physicians annually.
(7)When Alzheimer’s
disease or other form of dementia are present along with 1 or more other
chronic conditions, utilization also increases. For example, in 2000, total
average per person Medicare expenditures for those with congestive heart
failure and Alzheimer’s or dementia were 47 percent higher than for those with
congestive heart failure and no dementia.
(8)Research
conducted in the United States and internationally indicate that the delivery
of higher quality health care, increased efficiency, and cost-effectiveness are
the result of systems in which patients are linked with a physician or another
qualified health professional who coordinates their care.
(9)The current
Medicare program does not reward physicians for integrating and coordinating
health care because these services are not explicitly recognized and distinctly
paid for. Instead, physicians are incentivized to provide episodic care and to
generate more individual patient visits to the doctor’s office and hospital for
separately reimbursed tests and procedures.
(10)The chronic care
model established by this Act includes several elements that are effective in
managing chronic disease, including—
(A)linkages with
community resources;
(B)health care
system changes that reward quality chronic care;
(C)support for
patient self-management of chronic disease;
(D)practice
redesign;
(E)evidence-based
clinical practice guidelines; and
(F)clinical
information systems, such as electronic medical records and continuity of care
records.
(11)Financial
incentives within the Medicare program should be realigned as part of a
comprehensive system change. The Medicare program should be restructured to
reimburse physicians and other qualified health professionals for the cost of
coordinating care.
(12)The provisions
of, and amendments made by, this Act are intended to—
(A)create savings to
the Medicare program;
(B)establish a
process to identify those Medicare beneficiaries most likely to benefit from
having a provider coordinate their health care needs; and
(C)establish a
payment under the Medicare program for—
(i)the
assessment of those health care needs; and
(ii)the activities
required to coordinate those health care needs.
3.Medicare
coverage of geriatric assessments
(a)Coverage of
geriatric assessments
(1)Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is
amended—
(A)in subparagraph
(Z), by striking and
at the end;
(B)in subparagraph
(AA), by adding and
at the end; and
(C)by adding at the
end the following new subparagraph:
(BB)geriatric assessments (as defined in
subsection
(ccc)(1));
.
(2)(A)Section 1862(a)(7) of
the Social Security Act (42 U.S.C.
1395y(a)(7)) is amended by striking or (K)
and inserting
(K), or (BB)
.
(B)Clauses (i) and (ii) of section
1861(s)(2)(K) of the Social Security
Act (42 U.S.C. 1395x(s)(2)(K)) are each amended by striking
subsection (ww)(1)
and inserting subsections (ww)(1) and
(ccc)(1)
.
(b)Geriatric
Assessments DefinedSection 1861 of the
Social Security Act (42 U.S.C. 1395x)
is amended by adding at the end the following new subsections:
(ccc)(1)The term
geriatric assessment means each of the following:
(A)An assessment of the clinical status,
functional status, social and environmental functioning, and need for
caregiving of a geriatric assessment eligible individual (as defined in
subsection (ddd)). The assessment shall include a comprehensive history and
physical examination and assessments of the following domains using
standardized validated clinical tools:
(i)Comprehensive review of medications
and the individual's adherence to the medication regimen.
(ii)Measurement of affect, cognition
and executive function, mobility, balance, gait, risk of falling, and sensory
function.
(iii)Social functioning, environmental
needs, and caregiver resources and needs.
(iv)Any other domain determined
appropriate by the Secretary.
(B)Subsequent assessments, which may not
be conducted more frequently than annually, unless the subsequent assessment is
medically necessary due to a significant change in the condition of the
geriatric assessment eligible individual.
(C)The development of a written care plan
based on the results of the assessment under subparagraph (A) (and any
subsequent assessment under subparagraph (B)). The care plan shall detail
identified problems, outline therapies, assign responsibility for actions, and
indicate whether the individual is likely to benefit from chronic care
coordination services (as defined in subsection (eee)(1)). If the individual is
determined likely to benefit from chronic care coordination services, the care
plan shall also provide the basis for the chronic care coordination plan to be
developed by the chronic care manager pursuant to subsection (eee).
(2)A geriatric assessment may only be
conducted by—
(A)a physician;
(B)a practitioner described in section
1842(b)(18)(C)(i) under the supervision of a physician; or
(C)any other provider that meets such
conditions as the Secretary may specify.
(ddd)Geriatric Assessment Eligible
Individual(1)Subject to paragraph
(3), the term geriatric assessment eligible individual means an
individual identified by the Secretary as eligible for a geriatric
assessment.
(2)In identifying individuals under
paragraph (1), the following rules shall apply:
(A)The individual must have at least 1 of
the following present:
(i)Multiple chronic conditions.
(ii)Dementia, as defined in the most
recent Diagnostic and Statistical Manual of Mental Disorders, and at least 1
chronic condition.
(iii)Any other factor identified by
the Secretary.
(B)(i)The individual, as
determined by the Secretary—
(I)must have aggregate medical costs under
this title in the top 10 percent of all applicable individuals during the
previous 36 months; or
(II)is likely to incur costs under this
title in the top 10 percent of all applicable individuals during the current or
subsequent calendar year.
(ii)The determination under clause
(i)(II) of future costs shall be based on the medical condition of the
individual, the individual's past cost to the program under this title, and
other factors as identified by the Secretary.
(iii)The individual meets such
additional criteria (if any) as the Secretary establishes under subparagraph
(C).
(C)(i)If the Secretary
estimates that the total number of applicable individuals that would be
geriatric assessment eligible individuals in a year (but for this subparagraph)
exceeds 10 percent of the total number of applicable individuals in the year,
the Secretary shall establish and apply under subparagraph (B)(iii) such
additional criteria as is designed to eliminate such excess.
(ii)The Secretary shall consult with
physicians, physician groups, organizations representing individuals with
chronic conditions and older adults, and other stakeholders in identifying any
additional criteria under clause (i).
(D)For purposes of this paragraph, the
term applicable individual
means an individual enrolled for
benefits under part B but not enrolled in a Medicare Advantage plan or a plan
under section 1876.
(3)The term geriatric assessment
eligible individual
shall not include the following individuals:
(A)An individual who is receiving hospice
care under this title.
(B)An individual who is residing in a
skilled nursing facility, a nursing facility (as defined in section 1919), or
any other facility identified by the Secretary.
(C)An individual medically determined to
have end-stage renal disease.
(D)An individual enrolled in a Medicare
Advantage plan or a plan under section 1876.
(E)An individual enrolled in a PACE
program under section 1894.
(F)Any other categories of individuals
determined appropriate by the Secretary.
(4)For purposes of this subsection, the term
chronic condition means a condition, such as dementia, that lasts
or is expected to last 1 year or longer, limits what an individual can do, and
requires ongoing
care.
.
(c)Payment and
Elimination of Cost-Sharing
(1)Payment and
elimination of coinsuranceSection 1833(a)(1) of the
Social Security Act (42 U.S.C.
1395l(a)(1)) is amended—
(A)in subparagraph
(N), by inserting other than geriatric assessments (as defined in
section 1861(ccc)(1))
after (as defined in section
1848(j)(3))
;
(B)by striking
and
before (V)
; and
(C)by inserting
before the semicolon at the end the following: , and (W) with respect to
geriatric assessments (as defined in section 1861(ccc)(1)), the amount paid
shall be 100 percent of the lesser of the actual charge for the services or the
amount determined under the payment basis determined under section
1848
.
(2)Payment under
physician fee scheduleSection 1848(j)(3) of the
Social Security Act (42 U.S.C.
1395w–4(j)(3)) is amended by inserting (2)(BB),
after
(2)(AA),
.
(3)Elimination of
coinsurance in outpatient hospital settings
(A)Exclusion from
OPD fee scheduleSection 1833(t)(1)(B)(iv) of the
Social Security Act (42 U.S.C.
1395l(t)(1)(B)(iv)) is amended by striking and diagnostic
mammography
and inserting , diagnostic mammography, or geriatric
assessments (as defined in section 1861(ccc)(1))
.
(B)Section 1833(a)(2) of the
Social Security Act (42 U.S.C.
1395l(a)(2)) is amended—
(i)in
subparagraph (F), by striking and
at the end;
(ii)in
subparagraph (G)(ii), by striking the comma at the end and inserting ;
and
; and
(iii)by inserting
after subparagraph (G)(ii) the following new subparagraph:
(H)with respect to
geriatric assessments (as defined in section 1861(ccc)(1)) furnished by an
outpatient department of a hospital, the amount determined under paragraph
(1)(W),
.
(4)Elimination of
deductibleThe first sentence of section 1833(b) of the
Social Security Act (42 U.S.C.
1395l(b)) is amended—
(A)by striking
and
before (8)
; and
(B)by inserting
before the period the following: , and (9) such deductible shall not
apply with respect to geriatric assessments (as defined in section
1861(ccc)(1))
.
(d)Section 1862(a)(1) of the
Social Security Act (42 U.S.C.
1395y(a)(1)) is amended—
(1)by striking
and
at the end of subparagraph (M);
(2)by striking the
semicolon at the end of subparagraph (N) and inserting , and
;
and
(3)by adding at the
end the following new subparagraph:
(O)in the case of geriatric assessments
(as defined in section 1861(ccc)(1)), which are performed more frequently than
is covered under such
section;
.
(e)Exception to
Limits on Physician ReferralsSection 1877(b) of the
Social Security Act (42 U.S.C.
1395nn(b)) is amended by adding at the end the following new paragraph:
(6)In the case of a designated health service, if the
designated health service is a geriatric assessment (as defined in section
1861(ccc)(1)) and furnished by a
physician.
.
(f)The
Secretary of Health and Human Services shall define such terms, establish such
procedures, and promulgate such regulations as the Secretary determines
necessary to implement the amendments made by, and the provisions of, this
section, including the establishment of additional domains under subsection
(ccc)(1)(A)(iv) of section 1861 of the Social Security Act, as added by
subsection (b). In promulgating such regulations, the Secretary shall consult
with physicians, physician groups and organizations, and organizations
representing individuals with chronic conditions and older adults.
(g)The amendments made by this section shall apply to
assessments furnished on or after January 1, 2008.
4.Medicare
coverage of chronic care coordination services
(a)Part
B coverage of chronic care coordination
services
(1)Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), as
amended by section 3(a)(1), is amended—
(A)in subparagraph
(AA), by striking and
at the end;
(B)in subparagraph
(BB), by adding and
at the end; and
(C)by adding at the
end the following new subparagraph:
(CC)chronic care coordination services
(as defined in subsection
(eee));
.
(2)
(A)Section
1862(a)(7) of the Social Security Act
(42 U.S.C. 1395y(a)(7)), as amended by section 3(a)(2)(A), is amended by
striking or (BB)
and inserting (BB), or
(CC)
.
(B)Clauses (i) and
(ii) of section 1861(s)(2)(K) of the Social
Security Act (42 U.S.C. 1395x(s)(2)(K)), as amended by section
3(a)(2)(B), are each amended by striking subsections (ww)(1) and
(ccc)
and inserting subsections (ww)(1), (ccc), and
(eee)
.
(b)Section 1861 of the Social Security Act (42 U.S.C. 1395x), as
amended by section 3(b), is amended by adding at the end the following new
subsection:
(eee)Chronic Care Coordination Services; Chronic Care Manager;
Chronic Care Eligible Individual(1)The term chronic
care coordination services means services that are furnished to a
chronic care eligible individual (as defined in paragraph (3)) by a single
chronic care manager (as defined in paragraph (2)) chosen by the individual
under a plan of care prescribed by such chronic care manager for the purpose of
chronic care and dementia coordination, which may include any of the following
services:
(A)The development of an initial plan of
care (based on the results of a geriatric assessment, as defined in subsection
ccc)), and subsequent appropriate revisions to that plan of care.
(B)The management of, and referral for,
medical and other health services, including interdisciplinary care conferences
and management with other providers.
(C)The monitoring and management of
medications.
(D)Patient education and counseling
services.
(E)Family caregiver education and
counseling services.
(F)Self-management services, including
health education and risk appraisal to identify behavioral risk factors through
self-assessment.
(G)Providing access by telephone with
physicians and other appropriate health care professionals, including 24-hour
availability of such professionals for emergencies.
(H)Management with the principal
nonprofessional caregiver in the home.
(I)Managing and facilitating transitions
among health care professionals and across settings of care, including the
following:
(i)Pursuing the treatment option
elected by the individual.
(ii)Including any advance directive
executed by the individual in the medical file of the individual.
(J)Information about, and referral to,
hospice care, including patient and family caregiver education and counseling
about hospice care, and facilitating transition to hospice care when
elected.
(K)Information about, referral to, and
management with, community services.
(L)Such additional services for which
payment would not otherwise be made under this title that the Secretary may
specify that encourage the receipt of, or improve the effectiveness of, the
services described in the preceding subparagraphs.
(2)(A)For purposes of this
subsection, the term chronic care manager means an individual or
entity that—
(i)is—
(I)a physician;
(II)a practitioner described in clause
(i) or (iv) of section 1842(b)(18)(C) under the supervision of a physician;
or
(III)any other provider that meets
such conditions as the Secretary may specify; and
(ii)has entered into a chronic care
coordination agreement with the Secretary.
(B)(i)For purposes of
subparagraph (A)(ii), each chronic care coordination agreement shall meet the
requirements described in subparagraph (C) and shall—
(I)subject to clause (ii), be entered
into for a period of 3 years and may be renewed if the Secretary is satisfied
that the chronic care manager continues to meet such terms and conditions as
the Secretary may require; and
(II)contain such other terms and
conditions as the Secretary may require.
(ii)Each chronic care coordination
agreement shall provide for the termination of such agreement prior to such
3-year period in the case where the chronic care manager—
(I)is no longer able to provide chronic
care services; or
(II)does not meet such terms and
conditions as the Secretary may require.
(C)(i)Subject to clause (ii),
the requirements of this subparagraph are met if the agreement requires the
chronic care manager to perform, or provide for the performance of, the
following services:
(I)Advocating for, and providing ongoing
support, oversight, and guidance with respect to the implementation of a plan
of care that provides an integrated, coherent, and cross-disciplined plan for
ongoing medical care that is developed in partnership with the chronic care
eligible individual and all other physicians and other care providers and
agencies (including home health agencies) providing care to the chronic care
eligible individual.
(II)Using evidence-based medicine and
clinical decision support tools to guide decision making at the point of care
and on the basis of specific patient factors.
(III)Using health information technology,
including, where appropriate, remote monitoring and patient registries, to
monitor and track the health status of patients and to provide patients with
enhanced and convenient access to health care services.
(IV)Encouraging patients to engage in the
management of their own health through education and support systems.
(V)Incorporating family caregivers into
the chronic care planning process.
(ii)The Secretary may modify the
services required under the agreement under clause (i), including by requiring
different services or services in addition to those described in subclauses (I)
through (V) of such clause.
(D)The Secretary shall adopt procedures
which exempt providers in rural areas from providing 1 or more of the services
otherwise required to be provided under subparagraph (C) or modify such
requirements for such providers. In establishing such procedures, the Secretary
shall ensure that such exemptions and modifications do not impact the quality
of chronic care coordination services furnished by such providers.
(3)For purposes of this subsection, the
term chronic care eligible individual means a geriatric assessment
eligible individual (as defined in subsection (ddd)) who has undergone a
geriatric assessment (as defined in subsection (ccc)(1)) which determined that
the individual would benefit from chronic care
coordination.
.
(c)Payment and
Elimination of Cost-Sharing
(1)Payment and
elimination of coinsuranceSection 1833(a)(1) of the
Social Security Act (42 U.S.C.
1395l(a)(1)), as amended by section 3(c)(1), is amended—
(A)in subparagraph
(N), by inserting or chronic care coordination services (as defined in
section 1861(eee))
after other than geriatric assessments (as
defined in section 1861(ccc)(1))
;
(B)by striking
and
before (W)
; and
(C)by inserting
before the semicolon at the end the following: , and (X) with respect to
chronic care coordination services (as defined in section 1861(eee)), the
amount paid shall be 100 percent of the amount determined under section
1848(m)
.
(2)
(A)Section 1848 of the Social
Security Act (42 U.S.C. 1395w–4) is amended by adding at the end the
following new subsection:
(m)Payment for
chronic care coordination services
(1)
(A)The Secretary shall establish a monthly care coordination
payment amount under this section for chronic care coordination services (as
defined in paragraph (1) of section 1861(eee)(1)) furnished to a chronic care
eligible individual (as defined in paragraph (3) of such section) by a chronic
care manager (as defined in paragraph (2) of such section 1861).
(B)In
establishing payment amounts under subparagraph (A), the Secretary
shall—
(i)take into account
the time required of the chronic care manager in providing the care
coordination services to chronic care eligible individuals and the costs
associated with the practice-level health information technologies and systems
incurred by the chronic care manager in providing such services; and
(ii)ensure that such
payments do not result in a reduction in payments for office visits or other
evaluation and management services that would otherwise be allowable.
(2)Under
the conditions set forth in this section, the Secretary shall develop a care
coordination payment code for chronic care coordination services and a value
for such code.
(3)Separate
payments from payments for geriatric assessmentsPayments for
chronic care coordination services shall be made separately from payments for
geriatric assessments (as defined in section 1861(ccc)(1)) and other services
for which payment is made under this
title.
.
(B)Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w–4(j)(3)),
as amended by section 3(c)(2)), is amended by inserting (2)(CC),
after (2)(BB),
.
(3)Elimination of
coinsurance in outpatient hospital settings
(A)Exclusion from
OPD fee scheduleSection 1833(t)(1)(B)(iv) of the
Social Security Act (42 U.S.C.
1395l(t)(1)(B)(iv)), as amended by section 3(c)(3)(A), is amended by striking
or geriatric assessments (as defined in section 1861(ccc)(1))
and inserting geriatric assessments (as defined in section
1861(ccc)(1)), or chronic care coordination services (as defined in section
1861(eee)(1))
.
(B)Section 1833(a)(2) of the
Social Security Act (42 U.S.C.
1395l(a)(2)), as amended by section 3(c)(3)(B), is amended—
(i)in
subparagraph (G)(ii), by striking and
at the end;
(ii)in
subparagraph (H), by striking the comma at the end and inserting ;
and
; and
(iii)by inserting
after subparagraph (H) the following new subparagraph:
(I)with respect to
chronic care coordination services (as defined in section 1861(eee)(1))
furnished by an outpatient department of a hospital, the amount determined
under section
1848(m),
.
(4)Elimination of
deductibleParagraph (9) of section 1833(b) of the
Social Security Act (42 U.S.C.
1395l(b)), as added by section 3(c)(4), is amended by inserting or
chronic care coordination services (as defined in section 1861(eee)(1))
after geriatric assessments (as defined in section
1861(ccc)(1))
.
(d)Application of
Limits on BillingSection 1842(b)(18)(C) of the
Social Security Act (42 U.S.C.
1395u(b)(18)(C)) is amended by adding at the end the following new
clause:
(vii)A chronic care manager (as defined
in section 1861(eee)(2)) that is not a
physician.
.
(e)Exception to
Limits on Physician ReferralsSection 1877(b)(6) of the
Social Security Act (42 U.S.C.
1395nn(b)(6)), as amended by section 3(e), is amended to read as
follows:
(6)Geriatric
assessments and chronic care coordination servicesIn the case of
a designated health service, if the designated health service is—
(A)a geriatric
assessment or a chronic care coordination service (as defined in subsections
(ccc)(1) or (eee)(1) of section 1861, respectively); and
(B)provided by a
physician or a chronic care manager (as defined in section
1861(eee)(2)).
.
(f)The
Secretary of Health and Human Services shall define such terms, establish such
procedures, and promulgate such regulations as the Secretary determines
necessary to implement the amendments made by, and the provisions of, this
section. In promulgating such regulations, the Secretary shall consult with
physicians, physician groups and organizations, and organizations representing
individuals with chronic conditions and older adults.
(g)The amendments made by this section shall apply to chronic
care coordination services furnished on or after January 1, 2008.
5.Outreach
activities regarding geriatric assessments and chronic care coordination
services under the Medicare programThe Secretary of Health and Human Services
shall conduct outreach activities to individuals likely to be eligible to
receive coverage of geriatric assessments (as defined in subsection (ccc) of
section 1861 of the Social Security Act, as added by section 3) under the
Medicare program and individuals likely to be eligible to receive coverage of
chronic care coordination services (as defined in subsection (eee) of such
section 1861, as added by section 4) under the Medicare program, to inform such
individuals about the availability of such benefits under the Medicare
program.
6.Study and report
on geriatric assessments and chronic care coordination services under the
Medicare program
(a)The
Secretary of Health and Human Services shall enter into a contract with an
entity to conduct a study on—
(1)the effectiveness
of the coverage of geriatric assessments and chronic care coordination services
under the Medicare program (under the amendments made by sections 3 and 4) on
improving the quality of care provided to Medicare beneficiaries with chronic
conditions, including dementia; and
(2)the impact of
such geriatric assessments and care coordination services on reducing
expenditures under title XVIII of the Social Security Act, including reduced
expenditures that may result from—
(A)reducing
preventable hospital admissions;
(B)more appropriate
use of pharmaceuticals; and
(C)reducing
duplicate or unnecessary tests.
(b)Not
later than 3 years after the date of enactment of this Act, the entity
conducting the study under subsection (a) shall submit to Congress and the
Secretary of Health and Human Services a report on the study, together with
recommendations for such legislation or administrative action as such entity
determines appropriate.
(c)Authorization
of appropriationsThere are authorized to be appropriated such
sums as may be necessary to carry out this section.
7.Study and report
on best practices for Medicare chronic care coordination
(a)The
Secretary of Health and Human Services, in consultation with the Medicare
Payment Advisory Commission, shall conduct a study of the following
issues:
(1)The effectiveness
of pay-for-performance programs to serve Medicare beneficiaries with multiple
chronic conditions, including dementia.
(2)The
cost-effectiveness of chronic care coordination under the Medicare
program.
(3)Whether the
quality measures used for making payments under part B of the Medicare program,
including the measures developed under subsection (k) of section 1848 of the
Social Security Act (as added by section 101 of division B of the Tax Relief
and Health Care Act of 2006, Public Law 109–432), improve the quality of care
provided to Medicare beneficiaries with multiple chronic illnesses, including
dementia.
(b)Not
later than 3 years after the date of enactment of this Act, the Secretary of
Health and Human Services shall submit to Congress a report on the study
conducted under subsection (a) that contains—
(1)recommendations
on the best quality indicators for monitoring the chronic care coordination of
the conditions of Medicare beneficiaries with multiple chronic conditions,
including dementia; and
(2)such other
recommendations for legislation or administrative action as the Secretary
determines appropriate.
8.Nothing in this
Act, or in the amendments made by this Act, shall be construed as requiring an
individual to receive a geriatric assessment (as defined in section
1861(ccc)(1) of the Social Security Act, as added by section 3(b)) or chronic
care coordination services (as defined in section 1861(eee)(1) of such Act, as
added by section 4(b)).