1.Short title; table of
contents
(a)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)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.
2.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.
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
(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)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 DefinedSection 1861 of the
Social Security Act (42 U.S.C. 1395x)
is amended by adding at the end the following new subsections:
(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.
(iii)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 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 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(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)
(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:
(o)Payment for
geriatric assessments
(1)
(A)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)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
servicesPayments 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)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 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(hhh)(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(hhh)(1)) furnished by an
outpatient department of a hospital, the amount determined under paragraph
(1)(X),
.
(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 (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)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 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(hhh)(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
(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)The amendments made by this section shall apply to
assessments furnished on or after January 1, 2010.
4.Medicare coverage
of chronic care management and coordination services
(a)Part
B coverage of chronic care management and
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
(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)(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)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:
(jjj)Chronic Care Management and Coordination Services; Chronic
Care Manager; Chronic Care Eligible Individual(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 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 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)
(A)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)
(A)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)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 assessmentsPayments 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)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 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(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)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
deductibleParagraph (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 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 management and coordination
servicesIn 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)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)The amendments made by this section shall apply to chronic
care management and coordination services furnished on or after January 1,
2010.
5.Outreach
activities regarding geriatric assessments and chronic care management and
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 (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.
6.Utilization of
telehealth services to furnish geriatric assessments and chronic care
management and coordination services under the Medicare program
(a)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
servicesThe 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)The amendments made by this section shall apply to services
furnished on or after January 1, 2010.
7.Study and report
on geriatric assessments and chronic care management and 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 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)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.
8.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)).