I 111th CONGRESS 1st Session H. R. 3340 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.

1.

Short title

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

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.

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.