1.This Act may be cited as the
Healthcare Innovation Zone Program Act
of 2009
.
2.Healthcare
Innovation Zone demonstration program
(a)Not later than 6 months after the date of
enactment of this Act, the Secretary of Health and Human Services shall
establish a Healthcare Innovation Zone pilot program to increase healthcare
provider integration and align healthcare provider incentives to improve health
and to reduce healthcare costs.
(b)The HIZ pilot program established under subsection (a)
shall consist of the following:
(1)An HIZ planning
grant program, as described in section 3.
(2)An HIZ
demonstration project, as described in section 4.
(c)In this Act:
(1)The term grant program
means the HIZ
planning grant program as described in section 3.
(2)The term HIZ
means a
Healthcare Innovation Zone, consisting of an integrated healthcare delivery
network that works with local employers, community leaders, and private and
governmental payors in a geographic region, that—
(A)provides a full
spectrum of care, including inpatient, outpatient, post-acute, and preventive
care, to individuals including Medicare beneficiaries;
(B)has an academic
medical center that provides tertiary and quaternary care, has existing
capabilities to conduct health services research, and provides clinical
training for health professionals; and
(C)is able to accept
alternative payment structures beyond fee-for-service and per diem
amounts.
(3)The term Secretary
means the
Secretary of Health and Human Services.
3.HIZ planning
grant program
(a)The
Secretary shall make grants to eligible entities for the purposes of
researching and preparing an HIZ model plan, in accordance with subsection
(f).
(b)A grant recipient under this section must
apply for the HIZ demonstration project described in section 4. If a grant
recipient under this section is not selected to participate in such project,
then such recipient must return any unused grant funds to the Secretary.
(c)The
following persons are eligible entities for purposes of this section:
(1)A
healthcare institution or provider licensed and accredited in the United
States.
(2)An
academic medical center.
(3)A
large multispecialty group practice.
(4)Any other clinical
organization.
(5)Any
other organization that is able to establish, through a memorandum of
understanding or by other means to be defined by the Secretary, an intent to
collaborate with a person listed in paragraphs (1) through (4).
(d)An
application for a grant under this section shall include the following:
(1)A
demonstration that the grant applicant is located in a geographic region that
has the necessary breadth of healthcare providers to support the HIZ.
(2)The support and
endorsement of the HIZ concept by the following persons:
(A)At least one
leader of a clinical entity that provides the full spectrum of care.
(B)At least one
private payer.
(3)A
demonstration that the grant applicant has the resources and expertise to
implement the features listed in subsection (f).
(4)A
proposed budget setting forth the costs to be incurred in creating the model
HIZ plan.
(e)Criteria for
awarding grantsThe Secretary shall give preference to a grant
application that demonstrates a likelihood that the HIZ model plan will meet
the requirements of subsection (f).
(f)HIZ model plan
requirementsA recipient of a grant under this section must
submit to the Secretary, within 6 months of receiving such grant, an HIZ model
plan describing the HIZ to be implemented in the demonstration project under
section 4. Such HIZ model plan must contain the following:
(1)A
description of innovative models of care that improve quality and decrease
costs.
(2)A
provider network that will provide the full spectrum of care.
(3)A
target population and mechanisms to enroll such population, supported by
evidence that such population is willing to participate in an HIZ
demonstration.
(4)A
mechanism to provide for knowledge and information-sharing across the HIZ
participants.
(5)A
description of how the HIZ would incorporate the training of the next
generation of physicians, nurses, and allied health professionals in a new
model of cost-effective quality healthcare.
(6)A
description of the governance of the HIZ, and how it would affect the
administration of the model and management of the organizational and cultural
changes necessary for a successful HIZ.
(7)A
description of non-financial barriers to innovation that must be addressed for
the creation of a successful HIZ, including physician self-referral laws,
anti-trust considerations, State laws, and accreditation or certification
requirements.
(8)A
process for data reporting, annual site visits, and developing community health
impact assessments.
(9)A
set of indicators to help track performance and success of the HIZ model plan,
including measures to address cost containment, access to care, and quality
improvement, and how the HIZ model plan would facilitate achievement of these
improvements.
(10)A description of
mechanisms to achieve involvement by the community and external experts as
ongoing monitors of the success of the HIZ model plan.
(11)Payment
methodology options that address both funding mechanisms to the HIZ as well as
how the HIZ would distribute funds to the HIZ participants.
(g)Number and
amount of planning grantsThe Secretary shall award at least 10
but not more than 25 grants under this section in an amount of at least
$250,000 and not more than $1,000,000 per grant.
(h)Amounts
made available under the heading Agency for Healthcare Research and
Quality—Healthcare Research and Quality
in title VIII of division I of
the American Recovery and Reinvestment Act of 2009 (Public Law 111–5) may be
used by the Secretary to make grants under this section.
4.Healthcare
Innovation Zone demonstration project
(a)The
Secretary shall establish an HIZ demonstration project in order to test the
effectiveness of HIZs in increasing healthcare provider integration, improving
healthcare services, and reducing healthcare costs. Such demonstration project
shall not be subject to current requirements regarding shared savings under
demonstration projects. The Secretary shall select demonstration project
participants from the persons that have received grants under section 3.
(b)The demonstration project shall operate for
a period of at least 3 years, and shall be subject to renewal at the
Secretary’s discretion.
(c)An eligible entity shall submit an
application for participation in the HIZ demonstration project to the Secretary
at such time and manner, and containing such information as the Secretary may
require.
(d)To
be eligible to participate in the demonstration project established under this
section, a person must—
(1)have submitted an
HIZ model plan in accordance with section 3(f) that is approved by the
Secretary;
(2)agree to submit
the necessary data so that Secretary can assess the costs, quality of care, and
access to care for the population participating in the HIZ demonstration
project;
(3)demonstrate a
culture of innovation and commitment to preventive and public health;
(4)possess structural
elements to provide the full range of care necessary for a successful
HIZ;
(5)provide clinical
training for healthcare professionals in a medical environment that emphasizes
coordinated, integrated, high-quality care delivered at a controlled
cost;
(6)have the ability
to allocate resources within the members of the HIZ;
(7)have a broad
research infrastructure that supports data gathering, analytics, and synthesis
of unrelated population elements, including quality-related data
elements;
(8)have significant
investment in health information technology that extends across the system to
include healthcare providers, physicians, and other clinicians;
(9)possess advance
innovations including, but not limited to, creation of medical homes, pay for
performance, and other cost-effective delivery platforms;
(10)demonstrate
long-term economic sustainability;
(11)demonstrate
strong hospital and physician leadership and the willingness to undergo a full
portfolio assessment and reengineering of core patient care and administrative
processes;
(12)possess robust
financial infrastructure and administrative support to assure the HIZ’s
success; and
(13)demonstrate
arrangements that maintain oversight and accreditation standards.
(e)An HIZ
established under this section shall—
(1)provide healthcare
services to individuals who voluntarily enroll to receive such services for
multi-year periods from the HIZ; and
(2)provide
comprehensive healthcare services, as described in subsection (f).
(f)Comprehensive
healthcare servicesThe
comprehensive healthcare services referred to in subsection (e)(2) shall
consist of hospital care, physician services, post-acute care, preventive care,
education, tertiary and quaternary care, and palliative care, and shall include
the following:
(1)For a primary care
practice, contractual agreements with practices that deliver both primary and
preventive care.
(2)For a teaching
hospital or other hospital, arrangements with teaching and nonteaching
hospitals and arrangements with community hospitals.
(3)For a network of
outpatient facilities, arrangements with outpatient facilities, including
Federally Qualified Health Centers and community health providers.
(4)For a network of
post-acute care providers, arrangements with post-acute care providers for
rehabilitation services, home health services, hospice services, skilled
nursing services, and such other post-acute care services as the Secretary
determines to be appropriate.
(5)For a network of
community services, arrangements for the provision of ambulance services and
community outreach service.
(6)Arrangements for
the provision such additional services as the Secretary may require.
(g)The Secretary may determine the payments
that are required to be made for receipt of healthcare services provided under
a model plan implemented with a grant under this section. The Secretary shall
determine those amounts based on the methodology options submitted through the
grant program established under section 3.
(h)Assumption of
financial risk for costs above HIZ payment amountsAn HIZ
established under this section shall assume the full financial risk for the
costs of healthcare services delivered to an individual receiving services from
the HIZ that are in excess of any payments made to the HIZ and must have
sufficient reserves to accommodate any such additional costs.
(i)Waiver of rights
to payment under private or public programsAn HIZ established
with amounts provided under this section shall waive any right to additional
reimbursement under any Federal healthcare entitlement program, including under
titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 42
U.S.C. 1396 et seq.), and under any group health plan or from any health
insurance issuer offering group or individual health insurance coverage for
healthcare services furnished to an individual receiving healthcare services
from the HIZ and for which payment is made under this subsection for such
services.
(j)The Secretary shall
collaborate with the Government Accountability Office in scoring the healthcare
costs and savings associated with implementing HIZs on a nationwide
basis.
(k)Any requirements under titles XI and XVIII
of the Social Security Act (42 U.S.C. 1301 et seq.; 42 U.S.C. 1395 et seq.), or
under any other provision of law that would preclude the establishment or
operation of an HIZ under this section, shall not apply with respect to such
establishment or operation.
(l)
(1)An entity that
establishes an HIZ under this section shall submit to the Secretary a report
that describes and evaluates the activities of the HIZ.
(2)The Secretary shall
submit to Congress an evaluation of the current status of the demonstration
program within 6 months after the end of the first year of the demonstration
program, and every 6 months thereafter until the end of the demonstration
program.