[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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