1.This Act may be cited as the
Healthcare Innovation Zone Pilot Act
of 2009
.
2.Healthcare
Innovation Zone pilot program
(a)The Secretary of Health and Human Services
shall establish a Healthcare Innovation Zone pilot program to increase health
care provider integration and align health care provider incentives to reduce
the rate of growth of health care costs while improving quality of care for
Medicare, Medicaid, and privately insured patients. The HIZ program, by
including teaching hospitals, shall provide for the incorporation of new and
innovative clinical initiatives for the training of the next generation of
physicians, nurses, and other health professionals in a new model of
cost-effective, high-quality health care.
(b)The HIZ pilot program established under subsection (a)
shall consist of—
(1)an HIZ planning
grant program, as described in section 3; and
(2)an HIZ pilot
project, as described in section 4.
3.HIZ planning
grant program
(a)Within
6 months after the date of the enactment of this Act, the Secretary shall begin
accepting applications for HIZ planning grants. The Secretary will make grants
to successful applicants for the purposes of researching and preparing an HIZ
design plan, in accordance with subsection (d).
(b)An applicant for
a grant under this section shall be a group of clinical or other entities that
provides a full spectrum of health care, including inpatient, outpatient,
post-acute, and preventive care, to Medicare beneficiaries, Medicaid enrollees,
and other individuals enrolled in private insurance plans. Such applicants must
include a teaching hospital, and may include—
(1)other clinical
entities, including community hospitals and health centers or physician group
practices;
(2)schools of
medicine or other health professions; and
(3)other nonclinical
entities, including community organizations.
(c)An
application for a grant under this section shall include—
(1)a
description of the geographic region to be included in the HIZ established
under section 4, including population and health care provider demographics, as
well as an estimate of the number of people that could be cared for in the
HIZ;
(2)a
demonstration that the grant applicant has the expertise to engage community
and clinical care leaders in developing a design plan for the HIZ that will
meet the requirements listed in subsection (e); and
(3)a
proposed budget setting forth the costs to be incurred in creating the HIZ
design plan.
(d)Criteria for
awarding grantsThe Secretary shall give preference to grant
applications in which the potential HIZ would care for large and diverse
populations and that also demonstrate the commitment of clinical and community
partners to participate in the planning process for creating and submitting the
HIZ design plan as set forth in subsection (e).
(e)HIZ design plan
requirementsA recipient of a grant under this section must
submit to the Secretary, within 1 year after receiving such grant funds, an HIZ
design plan describing the HIZ to be created in the pilot program under section
4. Such HIZ design plan must contain—
(1)an estimate of the number of people to whom
health care will be delivered by the providers in the HIZ using the models of
care described in such plan;
(2)a
description of the legal and management structure of the HIZ Coordinating
Entity under which the full spectrum of care would be provided through the HIZ,
and that will receive and administer payments received under the pilot
program;
(3)a
description of how the full spectrum of care will be provided and by
whom;
(4)a
description, including supporting financial documentation, of how the HIZ will
reduce the rate of increase in Medicare and other health care spending
including the level of the reduction and over what time frame such reduction
will be achieved;
(5)a
description of how physician, hospital, and other providers will be integrated
and aligned, and how health care delivery processes will be changed to reduce
the rate of growth of health care costs while improving quality of care for
Medicare, Medicaid, and privately insured patients;
(6)a
description of the target population to be served by the HIZ;
(7)a
list and description of quality metrics that will be used to measure quality
improvement, including both quality of care and community health status; and
cost indicators that best would track cost containment over time;
(8)a
description of how the HIZ will incorporate the training of the next generation
of physicians, nurses, and other health professionals in a new model of
cost-effective, high-quality health care;
(9)a
proposal to address non-financial barriers to the provision of the full
spectrum of care, including physician self-referral laws, anti-trust
considerations, State laws, and accreditation or certification
requirements;
(10)a description of
the infrastructure and mechanisms to be used to collect, analyze, and
appropriately share data among clinical partners;
(11)a description of
the methods to be used to monitor and track health costs and
utilization;
(12)a description of
a strategy to improve prevention and public health and the health status of the
community;
(13)a description of
mechanisms to achieve involvement by the community and external experts as
ongoing partners in and monitors of the HIZ;
(14)a description of
payment methodology options that address both funding level and mechanisms to
distribute funds to HIZ providers; and
(15)a description of
the start-up and other additional costs that would be required to establish and
operate the HIZ.
(f)Number and
amount of planning grantsThe Secretary shall award no more than
25 grants under this section in an amount of at least $250,000 and not more
than $1,000,000 per grant.
(g)Authorization of
appropriationsThere are authorized to be appropriated to carry
out this section $25,000,000 for the first fiscal year beginning after the date
of enactment of this section and such sums as may be necessary for subsequent
fiscal years.
4.Healthcare
innovation zone pilot project
(a)The
Secretary shall establish an HIZ pilot project to test the effectiveness of
HIZs in reducing the rate of growth of health care costs while improving
quality of care for Medicare, Medicaid, and privately insured patients.
(b)The
pilot project shall operate for a period of at least 3 years and shall be
subject to renewal at the Secretary’s discretion.
(c)A person who is eligible under section 3(b)
may submit an application for participation in the HIZ pilot project to the
Secretary at such time and manner, and containing the information described in
sections 3(e) and section 4(d) and any such additional information, as the
Secretary may require.
(d)In
addition to the requirements established by the Secretary under subsection (c),
to be eligible to participate in the HIZ pilot project under this section, the
HIZ providers shall—
(1)provide comprehensive health care services,
as defined by the Secretary, to at least 50 percent of the population within
the HIZ;
(2)maintain or
improve the quality of health care services provided under the HIZ, according
to metrics approved by the Secretary, and submit the information necessary to
the Secretary so that the Secretary may determine whether such maintenance or
improvement has occurred; and
(3)collect and submit
information on changes that are being made to clinical education processes to
reflect changes made in the delivery of health care.
(e)The
Secretary shall distribute payments to the HIZ Coordinating Entity so that the
aggregate level of payment for all Medicare beneficiaries participating in the
HIZ pilot project will be equal to a base level of Medicare payments, as
defined by the Secretary, increased by a rate of growth that is 1.5 percentage
points less than the projected rate of growth for the HIZ. The Secretary may
modify the 1.5 percentage point reduction if the estimated growth rate is lower
than the national average. The types of payments subject of this arrangement
and additional payment mechanisms shall be at the discretion of the Secretary
and each HIZ based on the methodology options submitted by the grant recipient,
as set forth under section 3(e)(14).
(f)Waiver of rights
to payment under public programsA health care provider receiving
payments for patients under this section shall waive any right to additional
reimbursement under title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) beyond those established under subsection (e) for those services provided
to Medicare beneficiaries participating in the HIZ pilot.
(g)The
Secretary may waive any requirements under titles XI, XVIII, and XIX of the
Social Security Act (42 U.S.C. 1301 et seq.; 42 U.S.C. 1395 et seq.; and 42
U.S.C. 1396 et seq.), including the antikickback and civil monetary penalty
statutes, and with regard to title XIX, statewideness, comparability, and
managed care requirements, as necessary to carry out the pilot program
established under this section. In the interest of facilitating the development
of HIZ pilot projects, the Secretary shall release a streamlined Medicare or
Medicaid waiver application form. Use of such form is voluntary. Nothing
contained in the antitrust laws shall be construed to prohibit persons
providing health care services as part of a pilot project authorized under this
section from lawfully carrying out the legitimate object thereof, nor shall
such persons be held or construed to be illegal combinations or conspiracies in
restraint of trade under the antitrust laws, if acting in accordance with the
business model approved by the Secretary under this section.
(h)
(1)A person that
establishes an HIZ pilot project under this section shall submit, 2 years after
the beginning of such project 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 pilot within 6 months after the end of the first year
of the pilot and every year thereafter until the end of pilot.
5.In this Act:
(1)The term planning grant program
means the
HIZ planning grant program as described in section 3.
(2)Each
of the terms HIZ
and Healthcare Innovation Zone
mean a geographic region that contains—
(A)clinical and other
entities that provide a full spectrum of health care, including inpatient,
outpatient, post-acute, and preventive care, to Medicare beneficiaries,
Medicaid enrollees, and other individuals enrolled in private insurance plans;
and
(B)a teaching
hospital that has the capacity to conduct health services research and provides
clinical training for health professionals.
(3)The term HIZ Coordinating Entity
means a
legal and management structure that is responsible for overseeing the delivery
of the full spectrum of care in the HIZ, and that will receive and administer
payments received under the pilot program.
(4)The
term Secretary
means the Secretary of Health and Human
Services.