[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3340 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 3340

To establish a Medicare Chronic Care Rapid Learning Network to develop 
     and apply improved practices in care management for Medicare 
            beneficiaries with multiple chronic conditions.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 24, 2009

  Mr. Johnson of Illinois (for himself, Ms. Schwartz, Mr. Patrick J. 
Murphy of Pennsylvania, and Mr. Latham) 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 establish a Medicare Chronic Care Rapid Learning Network to develop 
     and apply improved practices in care management for Medicare 
            beneficiaries with multiple chronic conditions.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Chronic Care Rapid Learning 
Network (MCCRLN) Act of 2009''.

SEC. 2. FINDINGS.

    The Congress makes the following findings:
            (1) Two-thirds of all Medicare spending involves 
        beneficiaries living with 5 or more chronic conditions.
            (2) Eighty-four percent of people ages 65 to 70 live with 
        at least one of the following chronic conditions: hypertension, 
        heart disease or heart attack, cancer, diabetes, arthritis, or 
        high cholesterol.
            (3) Medicare beneficiaries with chronic conditions are more 
        likely to undergo duplicative tests, receive contradictory 
        information from their health care providers, experience 
        adverse responses to medications, and undergo hospital visits 
        that could have been prevented.
            (4) Both traditional fee-for-service Medicare and Medicare 
        Advantage are not currently configured to meet the unique needs 
        of beneficiaries living with multiple chronic conditions.
            (5) Care for these patients is typically fragmented and 
        delivered by multiple providers working at multiple sites.
            (6) Medicare has implemented a number of demonstration 
        projects focused on ways to improve care for beneficiaries with 
        multiple chronic conditions, yet there has been limited 
        translation of evidence-based results to the wider chronic care 
        community in a timely manner.
            (7) Using evidence-based approaches to care coordination 
        and care management have shown promise in reducing illness 
        burden and improving health for at-risk patients, but the 
        evidence is not easy to consistently translate into practice.
            (8) As the population of Medicare beneficiaries living with 
        multiple chronic conditions continues to increase, the Centers 
        for Medicare & Medicaid Services should seek more effective 
        actions to test various care models, analyze the outcomes, and 
        implement evidence-based best practices as soon as possible.
            (9) The United States Government should partner with 
        qualified and experienced health care institutions and 
        universities already serving these beneficiaries to effectively 
        and efficiently develop, evaluate, and translate improvements 
        in coordinated care for them. Generating this information and 
        supporting its translation into clinical practice will serve 
        beneficiaries far more effectively.

SEC. 3. MEDICARE CHRONIC CARE RAPID LEARNING NETWORK TO DEVELOP AND 
              APPLY IMPROVED PRACTICES IN COORDINATED CARE FOR MEDICARE 
              BENEFICIARIES WITH MULTIPLE, CHRONIC CONDITIONS.

    (a) Establishment.--
            (1) In general.--Not later than 60 days after the date of 
        the enactment of this Act, the Secretary of Health and Human 
        Services (in this section referred to as the ``Secretary'') 
        shall establish in accordance with this section a Medicare 
        Chronic Care Rapid Learning Network (in this section referred 
        to as the ``Network'').
            (2) Duration.--The initial period of the Network shall be 
        not less than five years. The Secretary may extend or make 
        permanent the Network if the Network's performance demonstrates 
        benefit to the Medicare program. The Secretary may continue or 
        make permanent any network project site if--
                    (A)(i) the costs to the Medicare program resulting 
                from activities carried out by such site pursuant to 
                this section are not more than the costs to such 
                program without application of this section; and
                    (ii) such activities result in improved quality of 
                care furnished to Medicare beneficiaries who have two 
                or more chronic illnesses; or
                    (B) the costs to the Medicare program resulting 
                from activities carried out by such site pursuant to 
                this section are less than the costs to such program 
                without application of this section.
    (b) Purpose and Duties of Network.--
            (1) Purpose.--The purpose of the Network is to enable 
        highly qualified health care organizations and universities to 
        form a stable and flexible research infrastructure that 
        accelerates the development and deployment of evidence-based 
        chronic care management practices for Medicare beneficiaries 
        with multiple, chronic conditions.
            (2) Duties of the network.--
                    (A) In general.--The Network shall develop and 
                evaluate evidence-based chronic care management 
                practices for Medicare beneficiaries who have two or 
                more chronic illnesses, with a focus on such 
                beneficiaries who are provided benefits under the 
                Medicare fee-for-service program and whose care is most 
                costly. In carrying out its duties, the Network shall 
                use and build upon applicable interventions that have 
                been proven successful through demonstrations carried 
                out by the Centers for Medicare & Medicaid Services, 
                including the Medicare Coordinated Care Demonstration 
                project.
                    (B) Specific duties.--The Network shall--
                            (i) research, design, implement, test, and 
                        validate specific interventions designed to 
                        improve care management for Medicare 
                        beneficiaries with multiple chronic conditions;
                            (ii) provide a reproducible, reliable, and 
                        scalable framework to standardize and translate 
                        best practices for all Medicare beneficiaries; 
                        and
                            (iii) not later than 90 days after the date 
                        of the enactment of this Act, establish target 
                        enrollment numbers and capitated payment rates 
                        for care management interventions to be 
                        established for each Medicare Chronic Care 
                        Rapid Learning Network site.
    (c) Membership.--
            (1) Initial sites.--The network shall initially consist of 
        not less than 12 network project sites. Nothing in this Act 
        prohibits more than 1 network project site from participating 
        under this section together as a network.
            (2) Additional sites.--The Secretary may appoint network 
        project sites, in addition to such initial sites under 
        paragraph (1), to the network either as standing members or in 
        order to meet the goals of a specific project if such sites 
        satisfy each of the characteristics described in subparagraph 
        (B).
            (3) Required characteristics of network.--The network shall 
        collectively--
                    (A) be a group of health care organizations, 
                universities, or researchers and clinicians in health 
                care organizations or universities experienced in 
                research and direct delivery of care management 
                services for Medicare beneficiaries;                     

                    (B) have previously participated in care 
                coordination projects, demonstrations, or research 
                projects (or any combination of such projects); and
                    (C) have demonstrated an existing ability to 
                interact with each other to design and implement 
                projects and share and analyze information.
    (d) Coordinating Center.--A Coordinating Center shall be 
established to facilitate network communication, training of network 
project sites, and development and reporting of performance and 
implementation metrics.
    (e) Advisory Board.--The Network shall have an Advisory Board (in 
this section referred to as the ``Board'') composed of the following:
            (1) CMS administrator.--The Administrator of the Centers 
        for Medicare & Medicaid Services, who shall serve as chairman 
        of the Board and head of the Network.
            (2) Appointed members.--
                    (A) Initial appointments.--Twelve individuals 
                appointed by the Secretary to serve on the Board, 
                including one individual representing each network 
                site.
                    (B) Additional members.--Any additional members to 
                the Board, which the Secretary may appoint, including 
                representatives from other relevant Federal agencies, 
                experts in the fields of quality improvement, public 
                health, geriatrics, research methodology, health 
                economists, and other individuals to the extent the 
                Secretary determines such additions further the work of 
                the Network.
    (f) Project Evaluations.--The Board shall provide for both an 
internal and external evaluation of each Network project. Network 
members will receive timely and regular access to data for purposes of 
modifying, refining, and evaluating the project under study.
    (g) Biennial Reports.--
            (1) Congressional reports.--Beginning not later than 2 
        years after the date of the establishment of the Network, the 
        Secretary shall submit to the appropriate committees of 
        Congress biennial reports on the Network.
            (2) Public reports on care models.--Every two years, the 
        Network shall develop and the Secretary shall issue a public 
        report of recommended practices and guidelines for chronic care 
        that summarizes the care models the Network has found to be 
        most effective in managing Medicare beneficiaries with 
        multiple, chronic problems.
    (h) Waiver.--The Secretary shall waive such provisions of title 
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) as may be 
necessary for the Network to conduct activities under this section.
    (i) Funding.--There are authorized to be appropriated from the 
Federal Hospital Insurance Trust Fund under section 1817 of the Social 
Security Act (42 U.S.C. 1395i) and from the Federal Supplementary 
Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 
1395t), in such proportions as the Secretary determines to be 
appropriate, $60,000,000 to carry out this section during the 5-year 
period beginning with fiscal year 2010.
    (j) Definitions.--For purposes of this section:
            (1) Medicare program.--The term ``Medicare program'' means 
        the programs under title XVIII of the Social Security Act.
            (2) Network project site.--The term ``Network project 
        site'' means the site of a chronic care management program 
        conducted under the authority of the Network.
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