[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2307 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 2307
To amend title XVIII of the Social Security Act to provide Medicare
beneficiaries with access to geriatric assessments and chronic care
management and coordination services, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 7, 2009
Mr. Gene Green of Texas (for himself and Mr. Upton) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, 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 of the Social Security Act to provide Medicare
beneficiaries with access to geriatric assessments and chronic care
management and coordination services, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``The Reaching
Elders with Assessment and Chronic Care Management and Coordination
Act'' or the ``RE-Aligning Care Act''.
(b) Table of Contents.--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 management and coordination
services.
Sec. 5. Outreach activities regarding geriatric assessments and chronic
care management and coordination services
under the Medicare program.
Sec. 6. Utilization of telehealth services to furnish geriatric
assessments and chronic care management and
coordination services under the Medicare
program.
Sec. 7. Study and report on geriatric assessments and chronic care
management and coordination services under
the Medicare program.
Sec. 8. Rule of construction.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) The Medicare program must be redesigned to provide
high-quality, cost-effective and coordinated care to the
growing population of elderly individuals with multiple and
complex chronic conditions.
(2) Between 2005 and 2030, it is estimated that the number
of adults aged 65 and older will almost double from 37,000,000
to more than 70,000,000. The number of those age 80 and over,
is also expected to nearly double from 11,000,000 to
20,000,000. This demographic shift will create the largest ever
proportion of adults over 65, increasing from 12 percent of the
United States population in 2005 to almost 20 percent by 2030.
(3) With the unprecedented growth of our Nation's aging
population, the number of older patients with multiple chronic
conditions and cognitive impairments is expected to increase.
Currently, about 65 percent of Medicare beneficiaries have two
or more chronic conditions. To address the health care needs
unique to older adults with chronic conditions, it will require
innovations in care delivery and comprehensive coordinated
care.
(4) According to the Congressional Budget Office,
approximately 75 percent of Medicare spending pays for care for
beneficiaries who have five or more chronic conditions and see
an average of 14 different physicians per year. In addition,
approximately 43 percent of Medicare costs can be attributed to
5 percent of Medicare's most costly beneficiaries.
(5) Total Medicare costs per beneficiary age 65 or older
with Alzheimer's and other dementias were almost three times
higher than for other Medicare beneficiaries in 2004.
(6) There is a strong pattern of increasing utilization as
the number of conditions increase. In 2003, 61 percent of
Medicare beneficiaries with 3 chronic conditions saw 10 or more
different physicians compared to 40 percent with 2 conditions
and 18 percent of those with 1 condition.
(7) According to a June 2006 MedPAC report, even if
individual providers deliver care efficiently, overall care for
a beneficiary may be inefficient if providers do not coordinate
across settings or assist beneficiaries in managing their
conditions between visits. Beneficiaries with multiple chronic
conditions may benefit the most from care coordination as they
do not always receive necessary care and often at high cost.
(8) On average, individuals 65 to 69 years old take nearly
14 prescriptions per year and individuals aged 80 to 84 take an
average of 18 prescriptions per year. As the number of chronic
conditions increases, so does the number of medications,
increasing the risk for negative drug interactions that can
lead to serious injury requiring hospitalization or can even be
fatal. Studies have found that 25 percent to 50 percent adverse
drug events among older persons are preventable and that
preventable adverse drug events may cost the Medicare program
$887,000,000 per year.
(9) 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. According to the Congressional Budget
Office, an intervention that focused on coordinating care for
high-cost beneficiaries with multiple chronic conditions could
both improve their health and reduce Medicare spending.
(10) In addition, chronic care management and coordination
may help prevent negative medication interactions and prevent
hospital stays because the chronic care team holistically
manages and treats illness. Reducing the rate of preventable
adverse drug events will both improve patient care and may
result in savings to the Medicare program.
(11) The Medicare fee-for-service program currently does
not pay for care coordination services. Instead, the delivery
and payment systems are organized to support the diagnosis and
treatment of acute or episodic conditions, resulting in
fragmented, ineffective and costly care for beneficiaries with
chronic diseases. It currently rewards the overuse and
duplication of services rather than rewarding the effective
control of chronic conditions, which can improve health
outcomes and prevent hospitalization or rehospitalization.
(12) The Institute of Medicine Report, ``Retooling for an
Aging America: Building the Health Care Workforce'', cited
misaligned financial incentives, including the inability to
reimburse for care coordination, as factors that result in
fragmented care for older Americans.
(13) 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.
(14) The patient-centered chronic care model established by
the provisions of, and the amendments made by, this Act
includes several elements that are effective in managing older
adults with chronic disease, including--
(A) a comprehensive assessment of the individual's
physical, cognitive, affective, functional and social
status, and caregiving needs;
(B) access to patient-centered care coordination
services provided by interdisciplinary team members;
(C) support for patient self-management of chronic
disease;
(D) linkages with community resources;
(E) health care system changes that reward quality
chronic care;
(F) practice redesign;
(G) evidence-based clinical practice guidelines;
and
(H) clinical information systems, such as
electronic medical records and continuity of care
records.
(15) The provisions of, and amendments made by, this Act
are intended to--
(A) improve health outcomes appropriate for older
patients with multiple chronic conditions;
(B) increase beneficiary, caregiver, and provider
satisfaction;
(C) increase cost-effectiveness and high value to
the Medicare program for those served with multiple
chronic conditions;
(D) establish a process to identify those Medicare
beneficiaries most likely to benefit from having a
provider coordinate their health care needs; and
(E) 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.
SEC. 3. MEDICARE COVERAGE OF GERIATRIC ASSESSMENTS.
(a) Coverage of Geriatric Assessments.--
(1) In general.--Section 1861(s)(2) of the Social Security
Act (42 U.S.C. 1395x(s)(2)) is amended--
(A) in subparagraph (DD), by striking ``and'' at
the end;
(B) in subparagraph (EE), by adding ``and'' at the
end; and
(C) by adding at the end the following new
subparagraph:
``(FF) geriatric assessments (as defined in subsection
(hhh)(1));''.
(2) Conforming amendments.--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 (hhh)(1)''.
(b) Geriatric Assessments Defined.--Section 1861 of the Social
Security Act (42 U.S.C. 1395x) is amended by adding at the end the
following new subsections:
``Geriatric Assessment
``(hhh)(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 (iii)). 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) 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 management and
coordination services (as defined in subsection (jjj)(1)). If
the individual is determined likely to benefit from chronic
care management and coordination services, the care plan shall
also provide the basis for the chronic care management and
coordination plan to be developed by the chronic care manager
pursuant to subsection (jjj).
``(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.
``(3) An individual described in subclause (A), (B), or, if
applicable, (C) may provide for the furnishing of services included in
the geriatric assessment by other qualified health care professionals.
``(4)(A) Subject to subparagraph (B), a geriatric assessment of a
geriatric assessment eligible individual may not be conducted more
frequently than annually.
``(B) A geriatric assessment of a geriatric assessment eligible
individual may be conducted more frequently than annually if the
assessment is medically necessary due to a significant change in the
condition of the individual.
``Geriatric Assessment Eligible Individual
``(iii)(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 that the
Secretary identifies as likely to result in high
expenditures under this title. In identifying such
conditions, the Secretary may consider--
``(I) the hierarchal condition category
methodology employed for risk adjustment under
part C or other comparable methodologies the
Secretary deems appropriate;
``(II) data from the Chronic Condition Data
Warehouse under section 723 of the Medicare
Prescription Drug, Improvement, and
Modernization Act of 2003; and
``(III) indicators of geriatric syndromes,
such as experiencing 2 or more falls in the
past year, urinary incontinence, clinically
significant depression, or other such
indicators that the Secretary indicates as
likely to result in high expenditures under
this title when they exist in combination with
one or more chronic conditions).
``(ii) Dementia, as defined in the most recent
Diagnostic and Statistical Manual of Mental Disorders,
and at least 1 other chronic condition.
``(iii) Any other factor identified by the
Secretary.
``(B) The Secretary shall consult with physicians,
physician groups and organizations, other health care
professional groups and organizations, organizations
representing individuals with chronic conditions and older
adults, and other stakeholders in identifying conditions under
clauses (i) and (ii) of subparagraph (A) and any factors under
subparagraph (A)(iii).
``(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 coinsurance.--Section
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(hhh)(1))'' after ``(as defined in section
1848(j)(3))'';
(B) by striking ``and'' before ``(W)''; and
(C) by inserting before the semicolon at the end
the following: ``, and (X) with respect to geriatric
assessments (as defined in section 1861(hhh)(1)), the
amount paid shall be 100 percent of the lesser of the
actual charge for the services or the amount determined
under section 1848(o)''.
(2) Payment.--
(A) In general.--Section 1848 of the Social
Security Act (42 U.S.C. 1395w-4) is amended by adding
at the end the following new subsection:
``(o) Payment for Geriatric Assessments.--
``(1) Establishment.--
``(A) In general.--The Secretary shall establish--
``(i) a payment code (or codes) under this
section for a geriatric assessment (as defined
in section 1861(hhh)(1)) furnished to a
geriatric assessment eligible individual (as
defined in section 1861(iii)) by a physician,
practitioner, or other provider described in
section 1861(hhh)(2); and
``(ii) a payment amount for each such code.
``(B) Requirements.--In establishing payment
amounts under subparagraph (A)(ii), the Secretary
shall--
``(i) take into account--
``(I) the amount of work required
to perform a geriatric assessment,
including the time and effort put forth
by each qualified health care
professional involved in performing the
geriatric assessment; and
``(II) all of the costs associated
with the geriatric assessment,
including labor, supplies, equipment,
and the costs of health information
technologies and systems incurred by
the physician, practitioner, or other
provider (as described in section
1861(hhh)(2)) in providing the
assessment; 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) Separate payments from payments for chronic care
management and coordination services.--Payments for geriatric
assessments shall be made separately from payments for chronic
care management and coordination services (as defined in
section 1861(jjj)(1)) and other services for which payment is
made under this title.''.
(B) Conforming amendment.--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)(FF),'' after ``(2)(EE),''.
(3) Elimination of coinsurance in outpatient hospital
settings.--
(A) Exclusion from opd fee schedule.--Section
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(hhh)(1))''.
(B) Conforming amendments.--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(hhh)(1)) furnished by an
outpatient department of a hospital, the amount
determined under paragraph (1)(X),''.
(4) Elimination of deductible.--The first sentence of
section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b))
is amended--
(A) by striking ``and'' before ``(9)''; and
(B) by inserting before the period the following:
``, and (10) such deductible shall not apply with
respect to geriatric assessments (as defined in section
1861(hhh)(1))''.
(d) Frequency Limitation.--Section 1862(a) of the Social Security
Act (42 U.S.C. 1395y(a)(1)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (N), by striking ``and'' at the
end;
(B) in subparagraph (O) by striking the semicolon
at the end and inserting ``, and''; and
(C) by adding at the end the following new
subparagraph:
``(P) in the case of geriatric assessments (as defined in
section 1861(hhh)(1)), which are performed more frequently than
is covered under such section;''; and
(2) in paragraph (7), by striking ``or (K)'' and inserting
``(K), or (P)''.
(e) Exception to Limits on Physician Referrals.--Section 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) Geriatric assessments.--In the case of a designated
health service, if the designated health service is a geriatric
assessment (as defined in section 1861(hhh)(1)) and furnished
by a physician.''.
(f) Rulemaking.--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 (hhh)(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, other health care
professional groups and organizations representing individuals with
chronic conditions and older adults.
(g) Effective Date.--The amendments made by this section shall
apply to assessments furnished on or after January 1, 2010.
SEC. 4. MEDICARE COVERAGE OF CHRONIC CARE MANAGEMENT AND COORDINATION
SERVICES.
(a) Part B Coverage of Chronic Care Management and Coordination
Services.--
(1) In general.--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 (EE), by striking ``and'' at
the end;
(B) in subparagraph (FF), by adding ``and'' at the
end; and
(C) by adding at the end the following new
subparagraph:
``(GG) chronic care management and coordination services
(as defined in subsection (jjj));''.
(2) Conforming amendments.--(A) 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), are each
amended by striking ``subsections (ww)(1) and (hhh)(1)'' and
inserting ``subsections (ww)(1), (hhh)(1), and (jjj)(1)''.
(B) Section 1862(a)(7) of the Social Security Act (42
U.S.C. 1395y(a)(7)), as amended by section 3(d), is amended by
striking ``section 1861(s)(10)'' and inserting ``paragraphs
(2)(GG) and (10) of section 1861(s)''.
(b) Services Described.--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:
``Chronic Care Management and Coordination Services; Chronic Care
Manager; Chronic Care Eligible Individual
``(jjj)(1) The term `chronic care management and coordination
services' means services that are furnished to a chronic care eligible
individual (as defined in paragraph (3)) by, or under the supervision
of, a single chronic care manager (as defined in paragraph (2)) chosen
by the chronic care eligible individual, a caregiver designated by the
individual in writing, or a representative authorized to make decisions
on the individual's behalf, under a plan of care prescribed by such
chronic care manager for the purpose of chronic care coordination,
including dementia as appropriate, 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
(hhh)), 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,
including preventive care consistent with the patient's
condition.
``(F) Self-management services, including health education
and risk appraisal to identify behavioral risk factors through
self-assessment.
``(G) Providing access for individuals, and caregivers or
authorized representatives as appropriate, by telephone and e-
mail to physicians or other appropriate health care
professionals, including 24-hour availability of such
professionals for after hours consultation.
``(H) Coordination with the principal nonprofessional
caregiver in the home.
``(I) Managing and facilitating transitions that occur
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 pain management and palliative
care.
``(K) 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.
``(L) Information about, referral to, and coordination
with, community resources.
``(M) 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); or
``(III) any other provider that meets such
conditions as the Secretary may specify;
``(ii) has entered into a chronic care management and
coordination agreement with the Secretary; and
``(iii) is working in collaboration with, or under the
supervision of, as determined by the Secretary--
``(I) the physician, practitioner, or other
provider who completed the geriatric assessment of the
individual; or
``(II) a physician, practitioner, or other provider
to whom the individual's care was transferred by the
physician, practitioner, or other provider who
performed the geriatric assessment.
``(B)(i) For purposes of subparagraph (A)(ii), each chronic care
management and 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 management and 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 decisionmaking 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 management and 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 (iii)) who has undergone a geriatric
assessment (as defined in subsection (hhh)(1)) which determined that
the individual would benefit from chronic care management and
coordination.
``(4) Chronic care management and coordination services may be
furnished in the chronic care eligible individual's home or
residence.''.
(c) Payment and Elimination of Cost-Sharing.--
(1) Payment and elimination of coinsurance.--Section
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 management and coordination services (as defined
in section 1861(jjj)(1))'' after ``other than geriatric
assessments (as defined in section 1861(hhh)(1))'';
(B) by striking ``and'' before ``(X)''; and
(C) by inserting before the semicolon at the end
the following: ``, and (Y) with respect to chronic care
management and coordination services (as defined in
section 1861(jjj)(1)), the amount paid shall be 100
percent of the lesser of the actual charge for the
services or the amount determined under section
1848(p)''.
(2) Payment.--
(A) In general.--Section 1848 of the Social
Security Act (42 U.S.C. 1395w-4), as amended by section
3(c)(2), is amended by adding at the end the following
new subsection:
``(p) Payment for Chronic Care Management and Coordination
Services.--
``(1) Establishment.--
``(A) In general.--The Secretary shall establish--
``(i) a payment code (or codes) under this
section for chronic care management and
coordination services (as defined in paragraph
(1) of section 1861(jjj)) 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); and
``(ii) a payment amount for each such code.
``(B) Requirements.--In establishing payment
amounts under subparagraph (A)(ii), the Secretary
shall--
``(i) take into account--
``(I) the amount of work required
of the chronic care manager in
providing chronic care management and
coordination services to eligible
individuals; and
``(II) all of the costs associated
with providing chronic care management
and coordination services, including
labor, supplies, equipment, and the
costs of health information
technologies and systems incurred by
the chronic care manager in providing
such services;
``(ii) ensure that such payments are for
such services furnished during a 30-day period;
and
``(iii) 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) Separate payments from payments for geriatric
assessments.--Payments for chronic care management and
coordination services shall be made separately from payments
for geriatric assessments (as defined in section 1861(hhh)(1))
and other services for which payment is made under this
title.''.
(B) Conforming amendment.--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)(GG),'' after ``(2)(FF),''.
(3) Elimination of coinsurance in outpatient hospital
settings.--
(A) Exclusion from opd fee schedule.--Section
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(hhh)(1))'' and inserting
``geriatric assessments (as defined in section
1861(hhh)(1)), or chronic care management and
coordination services (as defined in section
1861(jjj)(1))''.
(B) Conforming amendments.--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 management and
coordination services (as defined in section
1861(jjj)(1)) furnished by an outpatient department of
a hospital, the amount determined under paragraph
(1)(Y),''.
(4) Elimination of deductible.--Paragraph (10) 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 management and coordination services (as defined in
section 1861(jjj)(1))'' after ``geriatric assessments (as
defined in section 1861(hhh)(1))''.
(d) Exception to Limits on Physician Referrals.--Section 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 management and
coordination services.--In the case of a designated health
service, if the designated health service is--
``(A) a geriatric assessment or a chronic care
management and coordination service (as defined in
subsections (hhh)(1) or (jjj)(1) of section 1861,
respectively); and
``(B) furnished by a physician.''.
(e) Rulemaking.--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, other health care
professional groups and organizations, and organizations representing
individuals with chronic conditions and older adults.
(f) Effective Date.--The amendments made by this section shall
apply to chronic care management and coordination services furnished on
or after January 1, 2010.
SEC. 5. OUTREACH ACTIVITIES REGARDING GERIATRIC ASSESSMENTS AND CHRONIC
CARE MANAGEMENT AND COORDINATION SERVICES UNDER THE
MEDICARE PROGRAM.
The 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 (hhh)(1) 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 management and coordination services (as
defined in subsection (jjj)(1) 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.
SEC. 6. UTILIZATION OF TELEHEALTH SERVICES TO FURNISH GERIATRIC
ASSESSMENTS AND CHRONIC CARE MANAGEMENT AND COORDINATION
SERVICES UNDER THE MEDICARE PROGRAM.
(a) In General.--Section 1834(m)(4)(F) of the Social Security Act
(42 U.S.C. 1395m(m)(4)(F)) is amended by adding at the end the
following new clause:
``(iii) Geriatric assessments and chronic
care management and coordination services.--The
term `telehealth service' shall also include
geriatric assessments (as defined in section
1861(hhh)(1)) and chronic care management and
coordination services (as defined in section
1861(jjj)).''.
(b) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1, 2010.
SEC. 7. STUDY AND REPORT ON GERIATRIC ASSESSMENTS AND CHRONIC CARE
MANAGEMENT AND COORDINATION SERVICES UNDER THE MEDICARE
PROGRAM.
(a) Study.--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 management and coordination
services, including an evaluation of the use of
interdisciplinary teams in providing such 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) Report.--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 Appropriations.--There are authorized to be
appropriated such sums as may be necessary to carry out this section.
SEC. 8. RULE OF CONSTRUCTION.
Nothing in the provisions of, 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(hhh)(1) of the Social
Security Act, as added by section 3(b)) or chronic care management and
coordination services (as defined in section 1861(jjj)(1) of such Act,
as added by section 4(b)).
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