[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1136 Introduced in Senate (IS)]
111th CONGRESS
1st Session
S. 1136
To establish a chronic care improvement demonstration program for
Medicaid beneficiaries with severe mental illnesses.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 21, 2009
Ms. Stabenow (for herself and Mr. Levin) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To establish a chronic care improvement demonstration program for
Medicaid beneficiaries with severe mental illnesses.
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 ``Mental Illness Chronic Care
Improvement Act of 2009''.
SEC. 2. CHRONIC CARE IMPROVEMENT DEMONSTRATION PROGRAM FOR MEDICAID
BENEFICIARIES WITH SEVERE MENTAL ILLNESSES.
(a) Definitions.--In this section:
(1) Chronic care improvement program operator.--
(A) In general.--Subject to subparagraph (B), the
term ``chronic care improvement program operator''
means a qualified community program under section
1913(b)(1) of the Public Health Service Act that has
entered into a chronic care improvement program
operator agreement that meets the requirements of
subsection (e) with a participating State to carry out,
directly or through contracts with subcontractors, a
severe mental illness chronic care improvement
demonstration program for targeted beneficiaries in the
State.
(B) Other entities permitted.--Subject to approval
by the Secretary, such term may include any other
entity that a participating State determines is
appropriate to carry out a severe mental illness
chronic care improvement demonstration program for
targeted beneficiaries in the State.
(2) Medicaid.--The term ``Medicaid'' means the Federal-
State medical assistance program established under title XIX of
the Social Security Act (42 U.S.C. 1396 et seq.).
(3) Participating state.--The term ``participating State''
means a State with an approved application that has entered
into a chronic care improvement demonstration agreement with
the Secretary to conduct a severe mental illness chronic care
improvement demonstration program under this section.
(4) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(5) Severe mental illness chronic care improvement
demonstration program.--The term ``severe mental illness
chronic care improvement demonstration program'' means a
program described in subsection (d) that is conducted pursuant
to a chronic care improvement demonstration agreement between
the Secretary and a participating State.
(6) State.--The term ``State'' has the meaning given that
term for purposes of Medicaid.
(7) Threshold condition.--
(A) In general.--The term ``threshold condition''
means a chronic mental illness such as schizophrenia,
schizoaffective disorder, bipolar disorder, major
clinical depression, or such conditions with co-
occurring substance abuse disorders.
(B) Other state-specified conditions.--Such term
includes other conditions contained in the Diagnostic
and Statistical Manual of Mental Disorders IV published
by the American Psychiatric Association (or any
successor publication by such Association) selected by
the participating State as appropriate criteria for
selection of targeted beneficiaries for participation
in a severe mental illness chronic care improvement
demonstration program.
(8) Targeted beneficiary.--
(A) In general.--The term ``targeted beneficiary''
means an adult individual who--
(i) is entitled to benefits under the State
Medicaid plan (or a waiver of such plan);
(ii) has 1 or more of the threshold
conditions; and
(iii) has been identified by the State as
likely to benefit from participation in a
severe mental illness chronic care improvement
demonstration program.
(B) Voluntary participation.--A targeted
beneficiary may participate in a severe mental illness
chronic care improvement demonstration program on a
voluntary basis and may terminate participation at any
time.
(b) Authority To Conduct Demonstration Program.--
(1) Chronic care improvement demonstration agreements.--
(A) In general.--The Secretary shall enter into
chronic care improvement demonstration agreements with
States that submit approved applications under this
section to provide for the development, testing,
evaluation, and implementation of severe mental illness
chronic care improvement demonstration programs in
accordance with this section.
(B) Period.--A chronic care improvement
demonstration agreement entered into by the Secretary
and a participating State shall be for a period of 4
years.
(C) Deadline for initial agreements.--Not later
than October 1, 2010, the Secretary shall enter into
chronic care improvement demonstration agreements with
not more than 10 participating States to conduct a
severe mental illness chronic care improvement
demonstration program under this section.
(2) Chronic care improvement program operator agreements.--
A chronic care improvement demonstration agreement entered into
between the Secretary and a participating State shall require
the participating State to enter into chronic care improvement
program operator agreements, consistent with subsection (e),
with chronic care improvement program operators to carry out
the severe mental illness chronic care improvement
demonstration program in the State.
(3) Post-demonstration plan for continuity of services.--A
State desiring to conduct a severe mental illness chronic care
improvement demonstration program under this section shall
include in its application to be selected as a participating
State a plan for ensuring continuity of services for targeted
beneficiaries who are participating in the program on any date
(expected or unexpected) that the demonstration program ceases
to be conducted in the State.
(c) Payments; Funding.--
(1) In general.--Beginning October 1, 2010, the Secretary
shall provide for payments for not more than 10 participating
States to conduct a severe mental illness chronic care
improvement demonstration program in accordance with the
requirements of this section.
(2) Manner of payment.--Payment to a State under this
section shall be made in the same manner as other payments are
made to the State under section 1903(a) of the Social Security
Act (42 U.S.C. 1396b(a)).
(3) No state match required.--No State shall be required to
provide State matching funds as a condition for receiving
payments under this section.
(4) Funding.--
(A) Limitation on funds.--The total amount of
payments under this section shall not exceed
$250,000,000 for the period of fiscal years 2011
through 2014.
(B) Budget authority.--This section constitutes
budget authority in advance of appropriations Acts and
represents the obligation of the Secretary to provide
for the payment of amounts provided under this section.
(C) Limitation on payments.--In no case may--
(i) the aggregate amount of payments made
by the Secretary to a participating State for
administrative expenses relating to conducting
a severe mental illness chronic care
improvement demonstration program under this
section exceed 10 percent of the aggregate
amount of payments made to the State under this
section; and
(ii) payments be provided by the Secretary
under this section for services provided under
a severe mental illness chronic care
improvement demonstration program conducted
under this section for any fiscal year after
fiscal year 2014.
(d) Severe Mental Illness Chronic Care Improvement Demonstration
Program.--
(1) In general.--A severe mental chronic care improvement
demonstration program shall be designed to improve the health
outcomes and satisfaction of targeted beneficiaries
participating in the program and shall--
(A) provide such beneficiaries with regular
screening, registry tracking, and outcome measurement
processes at the time of psychiatric visits for, among
other purposes, developing an individualized, goal-
oriented care management plan that satisfies the
requirements of paragraph (2);
(B) provide each such beneficiary with such a plan;
and
(C) carry out such plan and other chronic care
improvement activities carried out by the State;
(2) Elements of care management plan.--A care management
plan for a targeted beneficiary shall be developed with the
beneficiary using person-centered planning principles and
shall, to the extent appropriate, include the following:
(A) Explicit general health care goals, measured on
a regular basis, such as--
(i) improved access to primary care
services;
(ii) improved prevention;
(iii) early identification and intervention
to avoid serious health issues; and
(iv) better management of chronic diseases,
including but not limited to hypertension,
diabetes, obesity, and cardiovascular disease.
(B) A designated point of contact responsible for
communications with the beneficiary and for
facilitating communications with other health care and
related community providers under the plan.
(C) Coordination and communication with family
members who are actively engaged in supporting the
targeted beneficiary's participation in the program.
(D) Self-care education for the beneficiary in
recognizing and managing symptoms of threshold
conditions, educating parents and family members, and
educating physicians and medical specialists as
appropriate.
(E) Education for physicians and other community
providers on required collaboration to enhance
communication of relevant clinical information.
(F) Active coordination of supportive community
services, including peer support, transportation, day
care, personal assistance, housing, primary care
(including accompanying targeted beneficiaries to
medical appointments), mental health care, and other
required services.
(G) The use of monitoring technologies that enable
patient guidance through the exchange of pertinent
clinical information.
(e) Terms and Conditions of Chronic Care Improvement Program
Operator Agreements.--
(1) Requirements.--A chronic care improvement program
operator agreement entered into under this section between a
participating State and a chronic care improvement program
operator shall require the operator, with respect to targeted
beneficiaries enrolled in the program and covered by the
agreement, to--
(A) guide the beneficiaries in managing their
health (including all co-occurring medical or surgical
conditions, relevant health care services, and
pharmaceutical needs) and in performing activities as
specified under each such beneficiaries care management
plan;
(B) use decision-support tools, such as evidenced-
based practice guidelines, medication algorithms, or
other criteria as determined by the Secretary;
(C) arrange for core medical home team staff
members, such as medical nurse practitioners, primary
care supervising physicians, and embedded nurse care
managers;
(D) initiate wellness activities, including smoking
cessation and weight management and physical exercise
programs;
(E) participate with the State to develop a
clinical information database to track and monitor the
beneficiaries across settings and to evaluate outcomes;
(F) monitor and report to the participating State,
in a manner specified by the Secretary, on health care
quality, cost, outcomes, and clinical milestones in
achieving recovery from mental illnesses and co-
occurring addiction disorders;
(G) meet medical home quality standards, as
promulgated by the National Committee on Quality
Assurance (NCQA) or such other quality assurance
organizations as the Secretary may specify;
(H) meet such clinical, quality improvement,
financial, and other requirements as the participating
State deems to be appropriate for the targeted
beneficiaries to be served; and
(I) comply with such additional requirements as the
participating State may specify.
(2) Optional services.--The chronic care improvement
program operator agreement may permit a chronic care
improvement program operator to--
(A) use intake assessment, health examination,
medication management, vital signs monitoring,
preventive healthcare, disease specific goals
implementation, patient health education, or other
primary care or general healthcare services as deemed
appropriate by the operator to carry out the program;
(B) be recognized as a patient-centered medical
home in accordance with paragraph (4); and
(C) where feasible, to collaborate with primary
care providers, including federally qualified health
centers or other community health centers, to provide
the services described in clause (i).
(3) Manner of payment.--The chronic care improvement
program operator agreement shall provide that the State shall
pay the chronic care improvement program operator in accordance
with a methodology developed by the Secretary for determining
payment.
(4) Patient-centered medical home recognition.--The
Secretary shall enter into an agreement with the National
Committee for Quality Assurance (NCQA), or other quality
assurance organization with appropriate experience evaluating
patient-centered medical homes as the Secretary may specify,
for the purposes of granting patient-centered medical home
status to qualified chronic care improvement operator sites.
(f) Independent Evaluation.--
(1) In general.--The Secretary shall conduct an independent
evaluation of the severe mental chronic care improvement
demonstration programs conducted under this section. Such
evaluation shall be done by grant, contract, or interagency
agreement with an entity with knowledge of severe mental
illness chronic care improvement programs and demonstrated
experience in the evaluation of such programs. The evaluation
shall include an assessment of whether the State demonstration
programs conducted under this section--
(A) enhance coordination and integration of primary
care and community mental health and substance use
disorder services;
(B) improve prevention, early identification, and
intervention to avoid serious health issues, including
chronic diseases;
(C) improve the overall health status of targeted
beneficiaries using a patient-centered approach; and
(D) produce financial outcomes, including any cost
savings to Medicaid.
(2) Inclusion of family members.--The Secretary shall
ensure that the evaluation collects and assesses information
from family members who are involved with supporting a targeted
beneficiary's participation in a severe mental illness chronic
care improvement demonstration program conducted under this
section with respect to the results of the beneficiary's
participation in the program.
(3) Report to congress.--The Secretary shall submit a
report to Congress on the results of the evaluation conducted
under this subsection. The report shall include such
recommendations as the Secretary determines appropriate to--
(A) guide the development of future programs that
provide comprehensive and integrated behavioral and
physical health care services to the severely mentally
ill;
(B) assist pediatric populations (with adjustments
made based on age-related clinical profiles); and
(C) assist Medicare beneficiaries under title XVIII
of the Social Security Act (42 U.S.C. 1395 et seq.).
(g) Rules of Construction.--Nothing in this section shall be
construed as--
(1) expanding the amount, duration, or scope of benefits
under a State Medicaid plan (or waiver of such plan);
(2) providing an individual entitlement to participate in a
severe mental illness chronic care improvement demonstration
program; or
(3) providing any hearing or appeal rights with respect to
a severe mental illness chronic care improvement demonstration
program established under this section.
(h) Clarification of Medicaid Reimbursement for Integrated Mental
Health and Primary Care Services.--Not later than October 1, 2010, the
Secretary shall provide, by regulation, for changes to requirements
under Medicaid relating to reimbursement for primary care and
behavioral health services to the same patient, on the same day, at the
same service site, so as to permit payment for the provision of both
types of services on the same day to the same patient.
(i) Secretarial Oversight and Coordination.--The Secretary shall
establish procedures to promote active and effective coordination,
collaboration, and communication among the agencies, administrations,
and centers of the Department of Health and Human Services that are
responsible for any matter relating to the conduct or evaluation of the
severe mental illness chronic care improvement demonstration programs
carried out under this section.
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