[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1181 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                S. 1181

  To provide for a demonstration project to examine whether community-
level public health interventions can result in lower rates of chronic 
         disease for individuals entering the Medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              June 4, 2009

   Mr. Wyden introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
  To provide for a demonstration project to examine whether community-
level public health interventions can result in lower rates of chronic 
         disease for individuals entering the Medicare program.

    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 ``Healthy Living and Health Aging 
Demonstration Project Act of 2009''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Chronic diseases are the leading cause of death and 
        disability in the United States. Seven in every 10 deaths are 
        attributable to chronic disease, with more than 1,700,000 
        Americans dying each year. Approximately 133,000,000 Americans, 
        representing 45 percent of the Nation's population, have at 
        least 1 chronic disease.
            (2) In 2007, the United States spent over 
        $2,200,000,000,000 on health care, with 75 cents out of every 
        dollar spent going towards treatment of individuals with 1 or 
        more chronic disease. In public programs, treatment for chronic 
        diseases constitutes an even higher percentage of total 
        spending, with 83 cents of every dollar spent by Medicaid 
        programs and more than 95 cents of every dollar spent by the 
        Medicare program going towards costs related to chronic 
        disease.
            (3) Since 1987, the rate of obesity in the United States 
        has doubled, accounting for a 20 to 30 percent increase in 
        health care spending. Additionally, the percentage of young 
        Americans who are overweight has tripled since 1980. If the 
        prevalence of obesity was at the same level as it was in 1987, 
        health care spending would be nearly 10 percent lower per 
        person, for a total savings of nearly $200,000,000,000.
            (4) The vast majority of cases of chronic disease could be 
        better prevented or managed. The World Health Organization has 
        estimated that if the major risk factors for chronic diseases 
        were eliminated, at least 80 percent of all cases of heart 
        disease, stroke, and type 2 diabetes could be prevented, while 
        also averting more than 40 percent of cancer cases.
            (5) Depressive disorders are also becoming increasingly 
        common, chronic, and costly. In 1990, the World Health 
        Organization identified major depression as the fourth leading 
        cause of disease worldwide, leading to more cases of disability 
        than ischemic heart disease or cerebrovascular disease. 
        Research has shown that mental health screenings following 
        disease diagnosis for diabetic patients can improve health 
        while remaining cost-effective.
            (6) A report by the Trust for America's Health found that 
        an annual investment of $10 per person in proven community-
        based programs to increase physical activity, improve 
        nutrition, and prevent tobacco use and smoking could, within 5 
        years, save the United States more than $16,000,000,000 
        annually, with savings of more than $5,000,000,000 for Medicare 
        and $1,900,000,000 for Medicaid, as well as over $9,000,000,000 
        in savings for private health insurance payers.

SEC. 3. DEMONSTRATION PROJECT FOR COMMUNITY-LEVEL PUBLIC HEALTH 
              INTERVENTIONS.

    (a) Definitions.--In this Act:
            (1) Administrator.--The term ``Administrator'' means the 
        Administrator of the Centers for Medicare & Medicaid Services.
            (2) Chronic disease or condition.--The term ``chronic 
        disease or condition'' means diabetes, hypertension, pulmonary 
        diseases (including asthma), hyperlipidemia, obesity, and any 
        other disease or condition as determined by the Secretary of 
        Health and Human Services.
            (3) Community-based prevention and intervention strategy.--
        The term ``community-based prevention and intervention 
        strategy'' means programs and services intended to prevent and 
        reduce the incidence of chronic disease, including walking 
        programs, group exercise classes, anti-smoking programs, 
        healthy eating programs, increased access to nutritious and 
        organic foods, programs and services that have been recommended 
        by the Task Force on Community Preventive Services, and any 
        programs or services that have been proposed by an eligible 
        partnership and certified by the Director of the Centers for 
        Disease Control and Prevention as evidence-based.
            (4) Director.--The term ``Director'' means the Director of 
        the Centers for Disease Control and Prevention.
            (5) Medicare.--The term ``Medicare'' means the program 
        established under title XVIII of the Social Security Act (42 
        U.S.C. 1395 et seq.).
            (6) Pre-medicare eligible individual.--The term ``pre-
        Medicare eligible individual'' means an individual who has 
        attained age 55, but not age 65.
            (7) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (8) State.--The term ``State'' means each of the 50 States, 
        the District of Columbia, the Commonwealth of Puerto Rico, the 
        United States Virgin Islands, Guam, the Commonwealth of the 
        Northern Mariana Islands, and American Samoa.
    (b) Establishment.--
            (1) In general.--The Secretary, acting through the 
        Administrator and in consultation with the Director, shall 
        establish a demonstration project under which eligible 
        partnerships, as described in subsection (d)(1), are awarded 
        grants to examine whether community-based prevention and 
        intervention strategies, targeted towards pre-Medicare eligible 
        individuals, result in--
                    (A) lower rates of chronic diseases and conditions 
                after such individuals become eligible for benefits 
                under Medicare; and
                    (B) lower costs under Medicare.
            (2) Federal agency responsibilities.--
                    (A) Centers for medicare & medicaid services.--The 
                Administrator shall have primary responsibility for 
                administering and evaluating the demonstration project 
                established under this section.
                    (B) Centers for disease control and prevention.--
                The Director shall--
                            (i) certify that community-based prevention 
                        and intervention strategies proposed by 
                        eligible partnerships are evidence-based;
                            (ii) administer and provide grants for 
                        health screenings and risk assessments and 
                        community-based prevention and intervention 
                        strategies conducted by eligible partnerships; 
                        and
                            (iii) provide grants to designated clinical 
                        referral sites (as described in subsection 
                        (d)(1)(B)(ii)(I)) for reimbursement of 
                        administrative costs associated with their 
                        participation in the demonstration project.
    (c) Duration and Selection of Partnerships.--
            (1) Duration.--The demonstration project shall be conducted 
        for a 5-year period, beginning not later than 2010.
            (2) Number of partnerships.--The Administrator, in 
        consultation with the Director, shall select not more than 6 
        eligible partnerships.
            (3) Selection of partnerships.--Eligible partnerships shall 
        be selected by the Administrator in a manner that--
                    (A) ensures such partnerships represent racially, 
                ethnically, economically, and geographically diverse 
                populations, including urban, rural, and underserved 
                areas; and
                    (B) gives priority to such partnerships that 
                include employers (as described in subsection 
                (d)(1)(C)).
    (d) Eligible Partnerships.--
            (1) Description.--
                    (A) In general.--Subject to subparagraph (C), for 
                purposes of this section, an eligible partnership is a 
                partnership that submits an approved application to 
                participate in the demonstration project under this 
                section and includes both of the entities described in 
                subparagraph (B).
                    (B) Required entities.--An eligible partnership 
                shall consist of a partnership between the following:
                            (i) A State or local public health 
                        department that shall--
                                    (I) serve as the lead organization 
                                for the eligible partnership;
                                    (II) develop appropriate community-
                                based prevention and intervention 
                                strategies and present such strategies 
                                to the Director for certification; and
                                    (III) administer certified 
                                community-based prevention and 
                                intervention strategies and conduct 
                                such strategies in association with 
                                local community organizations.
                            (ii) A medical facility as deemed 
                        appropriate by the Administrator, including 
                        health centers (as described under section 330 
                        of the Public Health Service Act (42 U.S.C. 
                        254b)) and rural health clinics (as described 
                        in section 1861(aa)(2) of the Social Security 
                        Act (42 U.S.C. 1395x(aa)(2))), that shall--
                                    (I) serve as the designated 
                                clinical referral site for medical 
                                services, as described in subsection 
                                (e)(4)(B)(i);
                                    (II) provide assistance to the 
                                designated public health department 
                                with organization and administration of 
                                individual health screenings and risk 
                                assessments, as described in subsection 
                                (e)(3);
                                    (III) collect payment for medical 
                                treatment and services that have been 
                                provided to individuals under the 
                                demonstration project in a manner that 
                                is consistent with State law and 
                                applicable clinic policy; and
                                    (IV) provide mental health services 
                                or obtain an agreement with a 
                                designated mental health provider for 
                                referral and provision of such 
                                services.
                    (C) Optional entities.--An eligible partnership may 
                include other organizations as practicable and 
                necessary to assist in community outreach activities 
                and to engage health care providers, insurers, 
                employers, and other community stakeholders in meeting 
                the goals of the demonstration project.
            (2) Applications.--An eligible partnership that desires to 
        participate in the demonstration project shall submit to the 
        Administrator an application at such time, in such manner, and 
        containing such information as the Administrator may require.
    (e) Use of Funds.--
            (1) In general.--An eligible partnership shall use funds 
        received under this section to conduct community-based 
        prevention and intervention strategies and health screenings 
        and risk assessments for pre-Medicare eligible individuals from 
        a diverse selection of ethnic backgrounds and income levels.
            (2) Community-based prevention and intervention strategy.--
        An eligible partnership, acting through the State or local 
        health department, shall promote healthy lifestyle choices 
        among pre-Medicare eligible individuals by implementing and 
        conducting a certified community-based prevention and 
        intervention strategy that shall be made available to all such 
        individuals.
            (3) Individual health screenings and risk assessments.--An 
        eligible partnership, acting through the State or local public 
        health department (or an appropriately designated facility), 
        shall agree to provide the following:
                    (A) Screenings for chronic diseases and 
                conditions.--Individual health screenings for chronic 
                diseases or conditions, which shall include appropriate 
                tests for--
                            (i) diabetes;
                            (ii) high blood pressure;
                            (iii) high cholesterol;
                            (iv) body mass index;
                            (v) physical inactivity;
                            (vi) poor nutrition;
                            (vii) tobacco use; and
                            (viii) any other chronic disease or 
                        condition as determined by the Director.
                    (B) Mental health screenings.--A mental health 
                screening and, if appropriate, referral for additional 
                mental health services, for any individual who has been 
                screened and diagnosed with a chronic disease or 
                condition.
            (4) Clinical treatment for chronic diseases.--The eligible 
        partnership shall agree to provide the following:
                    (A) Treatment and prevention referrals for insured 
                individuals.--To refer an individual determined to be 
                covered under a health insurance program who has been 
                screened and diagnosed with a chronic disease or 
                chronic disease risk factors (including high blood 
                pressure, high cholesterol, obesity, or tobacco use)--
                            (i) to a provider under such program for 
                        further medical or mental health treatment; and
                            (ii) for enrollment in an appropriate 
                        community-based prevention and intervention 
                        strategy program.
                    (B) Treatment and prevention referrals for 
                uninsured individuals.--To refer an individual 
                determined to be without coverage under a health 
                insurance program who has been screened and diagnosed 
                with a chronic disease or chronic disease risk factors 
                (including high blood pressure, high cholesterol, 
                obesity, or tobacco use) to the designated clinical 
                referral site--
                            (i) for determination of eligibility for 
                        public health programs, or appropriate 
                        treatment (including mental health services) 
                        pursuant to the facility's existing authority 
                        and funding and in accordance with applicable 
                        fees and payment collection as described in 
                        subsection (d)(1)(B)(ii)(III); and
                            (ii) for enrollment in an appropriate 
                        community-based prevention and intervention 
                        strategy program.
                    (C) Healthy individuals.--To provide an individual 
                who is not diagnosed with a chronic disease and does 
                not exhibit any chronic disease risk factors with 
                appropriate information on healthy lifestyle choices 
                and available community-based prevention and 
                intervention strategy programs.
            (5) Rule of construction.--Nothing in this section shall be 
        construed as entitling an individual who participates in the 
        demonstration project to benefits under Medicare.
    (f) Monitoring.--The Secretary shall develop and administer a 
program to evaluate the effectiveness of the demonstration project by 
collecting the following:
            (1) Health risk assessment results.--Each eligible 
        partnership shall maintain records of medical information and 
        results obtained during each individual's health screening and 
        risk assessment to establish baseline data for continued 
        monitoring and assessment of such individuals.
            (2) Medicare examination results.--The Secretary shall 
        collect medical information obtained during the initial 
        preventive physical examination under Medicare (as defined in 
        section 1861(ww) of the Social Security Act (42 U.S.C. 
        1395x(ww))) for those individuals who received health 
        screenings and risk assessments through the demonstration 
        project.
    (g) Evaluation.--
            (1) Independent research.--The Secretary, in consultation 
        with the Director and the Administrator, shall enter into a 
        contract with an independent entity or organization that has 
        demonstrated--
                    (A) prior experience in population-based assessment 
                of public health interventions designed to prevent or 
                treat chronic diseases and conditions; and
                    (B) knowledge and prior study of the general health 
                and lifestyle behaviors of pre-Medicare eligible 
                individuals.
            (2) Evaluation designs.--The entity or organization 
        selected by the Secretary under paragraph (1) shall, using the 
        information and data collected pursuant to subsection (f), 
        conduct an assessment of the demonstration project through--
                    (A) a population-based design that compares those 
                populations targeted under the demonstration project 
                with a matched control group; and
                    (B) a pre-post design that measures changes in 
                health indicators (including improved diet or increased 
                physical activity) and health outcomes in the targeted 
                populations for those individuals who participated in 
                individual health risk assessments and, prior to 
                completion of the demonstration project, became 
                eligible for benefits under Medicare.
    (h) Reporting.--
            (1) Progress report.--Not later than 3 years after 
        implementation of the demonstration project, the Secretary 
        shall prepare and submit a report on the status of the project 
        to Congress, including--
                    (A) the progress and results of any activities 
                conducted under the demonstration project; and
                    (B) identification of health indicators (such as 
                improved diet or increased physical activity) that have 
                been determined to be associated with controlling or 
                reducing the level of chronic disease for pre-Medicare 
                eligible individuals.
            (2) Final report.--Not later than 18 months after 
        completion of the demonstration project, the Secretary shall 
        prepare and submit a final report and evaluation of the project 
        to Congress, including--
                    (A) the results of the assessment conducted under 
                subsection (g)(2);
                    (B) a description of community-based prevention and 
                intervention strategies that have been determined to be 
                effective in controlling or reducing the level of 
                chronic disease for pre-Medicare eligible individuals;
                    (C) calculation of potential savings under Medicare 
                based upon a comparison of chronic disease rates 
                between the populations targeted under the 
                demonstration project and the matched control group; 
                and
                    (D) recommendations for such legislation and 
                administrative action as the Secretary determines 
                appropriate.
    (i) Authorization of Appropriations.--For the purpose of carrying 
out the demonstration project established under this section, there is 
authorized to be appropriated $200,000,000 for the period of fiscal 
years 2010 through 2016.
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