[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 870 Engrossed in Senate (ES)]

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115th CONGRESS
  1st Session
                                 S. 870

_______________________________________________________________________

                                 AN ACT


 
 To amend title XVIII of the Social Security Act to implement Medicare 
  payment policies designed to improve management of chronic disease, 
  streamline care coordination, and improve quality outcomes without 
                         adding to the deficit.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Creating High-
Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) 
Care Act of 2017''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
            TITLE I--RECEIVING HIGH QUALITY CARE IN THE HOME

Sec. 101. Extending the Independence at Home Demonstration Program.
Sec. 102. Expanding access to home dialysis therapy.
                  TITLE II--ADVANCING TEAM-BASED CARE

Sec. 201. Providing continued access to Medicare Advantage special 
                            needs plans for vulnerable populations.
             TITLE III--EXPANDING INNOVATION AND TECHNOLOGY

Sec. 301. Adapting benefits to meet the needs of chronically ill 
                            Medicare Advantage enrollees.
Sec. 302. Expanding supplemental benefits to meet the needs of 
                            chronically ill Medicare Advantage 
                            enrollees.
Sec. 303. Increasing convenience for Medicare Advantage enrollees 
                            through telehealth.
Sec. 304. Providing accountable care organizations the ability to 
                            expand the use of telehealth.
Sec. 305. Expanding the use of telehealth for individuals with stroke.
          TITLE IV--IDENTIFYING THE CHRONICALLY ILL POPULATION

Sec. 401. Providing flexibility for beneficiaries to be part of an 
                            accountable care organization.
    TITLE V--EMPOWERING INDIVIDUALS AND CAREGIVERS IN CARE DELIVERY

Sec. 501. Eliminating barriers to care coordination under accountable 
                            care organizations.
Sec. 502. GAO study and report on longitudinal comprehensive care 
                            planning services under Medicare part B.
    TITLE VI--OTHER POLICIES TO IMPROVE CARE FOR THE CHRONICALLY ILL

Sec. 601. Providing prescription drug plans with parts A and B claims 
                            data to promote the appropriate use of 
                            medications and improve health outcomes.
Sec. 602. GAO study and report on improving medication synchronization.
Sec. 603. GAO study and report on impact of obesity drugs on patient 
                            health and spending.
Sec. 604. HHS study and report on long-term risk factors for chronic 
                            conditions among Medicare beneficiaries.
                           TITLE VII--OFFSETS

Sec. 701. Medicare Improvement Fund.
Sec. 702. Medicaid Improvement Fund

            TITLE I--RECEIVING HIGH QUALITY CARE IN THE HOME

SEC. 101. EXTENDING THE INDEPENDENCE AT HOME DEMONSTRATION PROGRAM.

    Section 1866E of the Social Security Act (42 U.S.C. 1395cc-5) is 
amended--
            (1) in subsection (e)--
                    (A) in paragraph (1), by striking ``5-year period'' 
                and inserting ``7-year period''; and
                    (B) in paragraph (5), by striking ``10,000'' and 
                inserting ``15,000'';
            (2) in subsection (g), in the first sentence, by inserting 
        ``, including, to the extent practicable, the use of electronic 
        health information systems as described in subsection 
        (b)(1)(A)(vi),'' after ``program''; and
            (3) in subsection (i)(A), by striking ``will not receive an 
        incentive payment for the second of 2'' and inserting ``did not 
        achieve savings for the third of 3''.

SEC. 102. EXPANDING ACCESS TO HOME DIALYSIS THERAPY.

    (a) In General.--Section 1881(b)(3) of the Social Security Act (42 
U.S.C. 1395rr(b)(3)) is amended--
            (1) by redesignating subparagraphs (A) and (B) as clauses 
        (i) and (ii), respectively;
            (2) in clause (ii), as redesignated by subparagraph (A), 
        strike ``on a comprehensive'' and insert ``subject to 
        subparagraph (B), on a comprehensive'';
            (3) by striking ``With respect to'' and inserting ``(A) 
        With respect to''; and
            (4) by adding at the end the following new subparagraph:
    ``(B) For purposes of subparagraph (A)(ii), an individual 
determined to have end stage renal disease receiving home dialysis may 
choose to receive monthly end stage renal disease-related clinical 
assessments furnished on or after January 1, 2019, via telehealth if 
the individual receives a face-to-face clinical assessment, without the 
use of telehealth, at least once every three consecutive months.''.
    (b) Originating Site Requirements.--
            (1) In general.--Section 1834(m) of the Social Security Act 
        (42 U.S.C. 1395m(m)) is amended--
                    (A) in paragraph (4)(C)(ii), by adding at the end 
                the following new subclauses:
                                    ``(IX) A renal dialysis facility, 
                                but only for purposes of section 
                                1881(b)(3)(B).
                                    ``(X) The home of an individual, 
                                but only for purposes of section 
                                1881(b)(3)(B).''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(5) Treatment of home dialysis monthly esrd-related 
        visit.--The geographic requirements described in paragraph 
        (4)(C)(i) shall not apply with respect to telehealth services 
        furnished on or after January 1, 2019, for purposes of section 
        1881(b)(3)(B), at an originating site described in subclause 
        (VI), (IX), or (X) of paragraph (4)(C)(ii).''.
            (2) No facility fee if originating site for home dialysis 
        therapy is the home.--Section 1834(m)(2)(B) of the Social 
        Security (42 U.S.C. 1395m(m)(2)(B)) is amended--
                    (A) by redesignating clauses (i) and (ii) as 
                subclauses (I) and (II), and indenting appropriately;
                    (B) in subclause (II), as redesignated by 
                subparagraph (A), by striking ``clause (i) or this 
                clause'' and inserting ``subclause (I) or this 
                subclause'';
                    (C) by striking ``site.--With respect to'' and 
                inserting ``site.--
                            ``(i) In general.--Subject to clause (ii), 
                        with respect to''; and
                    (D) by adding at the end the following new clause:
                            ``(ii) No facility fee if originating site 
                        for home dialysis therapy is the home.--No 
                        facility fee shall be paid under this 
                        subparagraph to an originating site described 
                        in paragraph (4)(C)(ii)(X).''.
    (c) Conforming Amendment.--Section 1881(b)(1) of the Social 
Security Act (42 U.S.C. 1395rr(b)(1)) is amended by striking 
``paragraph (3)(A)'' and inserting ``paragraph (3)(A)(i)''.

                  TITLE II--ADVANCING TEAM-BASED CARE

SEC. 201. PROVIDING CONTINUED ACCESS TO MEDICARE ADVANTAGE SPECIAL 
              NEEDS PLANS FOR VULNERABLE POPULATIONS.

    (a) Extension.--Section 1859(f)(1) of the Social Security Act (42 
U.S.C. 1395w-28(f)(1)) is amended by striking ``and for periods before 
January 1, 2019''.
    (b) Increased Integration of Dual SNPs.--
            (1) In general.--Section 1859(f) of the Social Security Act 
        (42 U.S.C. 1395w-28(f)) is amended--
                    (A) in paragraph (3), by adding at the end the 
                following new subparagraph:
                    ``(F) The plan meets the requirements applicable 
                under paragraph (8).''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(8) Increased integration of dual snps.--
                    ``(A) Designated contact.--The Secretary, acting 
                through the Federal Coordinated Health Care Office 
                established under section 2602 of the Patient 
                Protection and Affordable Care Act, shall serve as a 
                dedicated point of contact for States to address 
                misalignments that arise with the integration of 
                specialized MA plans for special needs individuals 
                described in subsection (b)(6)(B)(ii) under this 
                paragraph and, consistent with such role, shall--
                            ``(i) establish a uniform process for 
                        disseminating to State Medicaid agencies 
                        information under this title impacting 
                        contracts between such agencies and such plans 
                        under this subsection; and
                            ``(ii) establish basic resources for States 
                        interested in exploring such plans as a 
                        platform for integration, such as a model 
                        contract or other tools to achieve those goals.
                    ``(B) Unified grievances and appeals process.--
                            ``(i) In general.--Not later than April 1, 
                        2020, the Secretary shall establish procedures, 
                        to the extent feasible, unifying grievances and 
                        appeals procedures under sections 1852(f), 
                        1852(g), 1902(a)(3), 1902(a)(5), and 1932(b)(4) 
                        for items and services provided by specialized 
                        MA plans for special needs individuals 
                        described in subsection (b)(6)(B)(ii) under 
                        this title and title XIX. The Secretary shall 
                        solicit comment in developing such procedures 
                        from States, plans, beneficiaries and their 
                        representatives, and other relevant 
                        stakeholders.
                            ``(ii) Procedures.--The procedures 
                        established under clause (i) shall be included 
                        in the plan contract under paragraph (3)(D) and 
                        shall--
                                    ``(I) adopt the provisions for the 
                                enrollee that are most protective for 
                                the enrollee and, to the extent 
                                feasible as determined by the 
                                Secretary, are compatible with unified 
                                timeframes and consolidated access to 
                                external review under an integrated 
                                process;
                                    ``(II) take into account 
                                differences in State plans under title 
                                XIX to the extent necessary;
                                    ``(III) be easily navigable by an 
                                enrollee; and
                                    ``(IV) include the elements 
                                described in clause (iii), as 
                                applicable.
                            ``(iii) Elements described.--Both unified 
                        appeals and unified grievance procedures shall 
                        include, as applicable, the following elements 
                        described in this clause:
                                    ``(I) Single written notification 
                                of all applicable grievances and appeal 
                                rights under this title and title XIX. 
                                For purposes of this subparagraph, the 
                                Secretary may waive the requirements 
                                under section 1852(g)(1)(B) when the 
                                specialized MA plan covers items or 
                                services under this part or under title 
                                XIX.
                                    ``(II) Single pathways for 
                                resolution of any grievance or appeal 
                                related to a particular item or service 
                                provided by specialized MA plans for 
                                special needs individuals described in 
                                subsection (b)(6)(B)(ii) under this 
                                title and title XIX.
                                    ``(III) Notices written in plain 
                                language and available in a language 
                                and format that is accessible to the 
                                enrollee, including in non-English 
                                languages that are prevalent in the 
                                service area of the specialized MA 
                                plan.
                                    ``(IV) Unified timeframes for 
                                grievances and appeals processes, such 
                                as an individual's filing of a 
                                grievance or appeal, a plan's 
                                acknowledgment and resolution of a 
                                grievance or appeal, and notification 
                                of decisions with respect to a 
                                grievance or appeal.
                                    ``(V) Requirements for how the plan 
                                must process, track, and resolve 
                                grievances and appeals, to ensure 
                                beneficiaries are notified on a timely 
                                basis of decisions that are made 
                                throughout the grievance or appeals 
                                process and are able to easily 
                                determine the status of a grievance or 
                                appeal.
                            ``(iv) Continuation of benefits pending 
                        appeal.--The unified procedures under clause 
                        (i) shall, with respect to all benefits under 
                        parts A and B and title XIX subject to appeal 
                        under such procedures, incorporate provisions 
                        under current law and implementing regulations 
                        that provide continuation of benefits pending 
                        appeal under this title and title XIX.
                    ``(C) Requirement for unified grievances and 
                appeals.--For 2021 and subsequent years, the contract 
                of a specialized MA plan for special needs individuals 
                described in subsection (b)(6)(B)(ii) with a State 
                Medicaid agency under paragraph (3)(D) shall require 
                the use of unified grievances and appeals procedures as 
                described in subparagraph (B).
                    ``(D) Requirements for integration.--For 2021 and 
                subsequent years, a specialized MA plan for special 
                needs individuals described in subsection (b)(6)(B)(ii) 
                shall meet one or more of the following requirements, 
                to the extent permitted under State law, for 
                integration of benefits under this title and title XIX:
                            ``(i) The specialized MA plan must meet the 
                        requirements of contracting with the State 
                        Medicaid agency described in paragraph (3)(D) 
                        in addition to coordinating long-term services 
                        and supports or behavioral health services, or 
                        both, by meeting an additional minimum set of 
                        requirements determined by the Secretary 
                        through the Federal Coordinated Health Care 
                        Office established under section 2602 of the 
                        Patient Protection and Affordable Care Act 
                        based on input from stakeholders, such as 
                        notifying the State in a timely manner of 
                        hospitalizations, emergency room visits, and 
                        hospital or nursing home discharges of 
                        enrollees, assigning one primary care provider 
                        for each enrollee, or sharing data that would 
                        benefit the coordination of items and services 
                        under this title and the State plan under title 
                        XIX. Such minimum set of requirements must be 
                        included in the contract of the specialized MA 
                        plan with the State Medicaid agency under such 
                        paragraph.
                            ``(ii) The specialized MA plan must meet 
                        the requirements of a fully integrated plan 
                        described in section 1853(a)(1)(B)(iv)(II) 
                        (other than the requirement that the plan have 
                        similar average levels of frailty, as 
                        determined by the Secretary, as the PACE 
                        program), or enter into a capitated contract 
                        with the State Medicaid agency to provide long-
                        term services and supports or behavioral health 
                        services, or both.
                            ``(iii) In the case where an individual is 
                        enrolled in both the specialized MA plan and a 
                        Medicaid managed care organization (as defined 
                        in section 1903(m)(1)(A)) providing long term 
                        services and supports or behavioral health 
                        services that have the same parent 
                        organization, the parent organization offering 
                        both the specialized MA plan and the Medicaid 
                        managed care plan must assume clinical and 
                        financial responsibility for benefits provided 
                        under this title and title XIX.''.
            (2) Conforming amendment to responsibilities of federal 
        coordinated health care office.--Section 2602(d) of the Patient 
        Protection and Affordable Care Act (42 U.S.C. 1315b(d)) is 
        amended by adding at the end the following new paragraphs:
            ``(6) To act as a designated contact for States under 
        subsection (f)(8)(A) of section 1859 of the Social Security Act 
        (42 U.S.C. 1395w-28) with respect to the integration of 
        specialized MA plans for special needs individuals described in 
        subsection (b)(6)(B)(ii) of such section.
            ``(7) To be responsible for developing regulations and 
        guidance related to the implementation of a unified grievance 
        and appeals process as described in subparagraphs (B) and (C) 
        of section 1859(f)(8) of the Social Security Act (42 U.S.C. 
        1395w-28(f)(8)).''.
    (c) Improvements to Severe or Disabling Chronic Condition SNPs.--
            (1) Care management requirements.--Section 1859(f)(5) of 
        the Social Security Act (42 U.S.C. 1395w-28(f)(5)) is amended--
                    (A) by striking ``all snps.--The requirements'' and 
                inserting ``all snps.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                requirements'';
                    (B) by redesignating subparagraphs (A) and (B) as 
                clauses (i) and (ii), respectively, and indenting 
                appropriately;
                    (C) in clause (ii), as redesignated by subparagraph 
                (B), by redesignating clauses (i) through (iii) as 
                subclauses (I) through (III), respectively, and 
                indenting appropriately; and
                    (D) by adding at the end the following new 
                subparagraph:
                    ``(B) Improvements to care management requirements 
                for severe or disabling chronic condition snps.--For 
                2020 and subsequent years, in the case of a specialized 
                MA plan for special needs individuals described in 
                subsection (b)(6)(B)(iii), the requirements described 
                in this paragraph include the following:
                            ``(i) The interdisciplinary team under 
                        subparagraph (A)(ii)(III) includes a team of 
                        providers with demonstrated expertise, 
                        including training in an applicable specialty, 
                        in treating individuals similar to the targeted 
                        population of the plan.
                            ``(ii) Requirements developed by the 
                        Secretary to provide face-to-face encounters 
                        with individuals enrolled in the plan not less 
                        frequently than on an annual basis.
                            ``(iii) As part of the model of care under 
                        clause (i) of subparagraph (A), the results of 
                        the initial assessment and annual reassessment 
                        under clause (ii)(I) of such subparagraph of 
                        each individual enrolled in the plan are 
                        addressed in the individual's individualized 
                        care plan under clause (ii)(II) of such 
                        subparagraph.
                            ``(iv) As part of the annual evaluation and 
                        approval of such model of care, the Secretary 
                        shall take into account whether the plan 
                        fulfilled the previous year's goals (as 
                        required under the model of care).
                            ``(v) The Secretary shall establish a 
                        minimum benchmark for each element of the model 
                        of care of a plan. The Secretary shall only 
                        approve a plan's model of care under this 
                        paragraph if each element of the model of care 
                        meets the minimum benchmark applicable under 
                        the preceding sentence.''.
            (2) Revisions to the definition of a severe or disabling 
        chronic conditions specialized needs individual.--
                    (A) In general.--Section 1859(b)(6)(B)(iii) of the 
                Social Security Act (42 U.S.C. 1395w-28(b)(6)(B)(iii)) 
                is amended--
                            (i) by striking ``who have'' and inserting 
                        ``who--
                                    ``(I) before January 1, 2022, 
                                have'';
                            (ii) in subclause (I), as added by clause 
                        (i), by striking the period at the end and 
                        inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new subclause:
                                    ``(II) on or after January 1, 2022, 
                                have one or more comorbid and medically 
                                complex chronic conditions that is life 
                                threatening or significantly limits 
                                overall health or function, have a high 
                                risk of hospitalization or other 
                                adverse health outcomes, and require 
                                intensive care coordination and that is 
                                listed under subsection (f)(9)(A).''.
                    (B) Panel of clinical advisors.--Section 1859(f) of 
                the Social Security Act (42 U.S.C. 1395w-28(f)), as 
                amended by subsection (b), is amended by adding at the 
                end the following new paragraph:
            ``(9) List of conditions for clarification of the 
        definition of a severe or disabling chronic conditions 
        specialized needs individual.--
                    ``(A) In general.--Not later than December 31, 
                2020, and every 5 years thereafter, the Secretary shall 
                convene a panel of clinical advisors to establish and 
                update a list of conditions that meet each of the 
                following criteria:
                            ``(i) Conditions that meet the definition 
                        of a severe or disabling chronic condition 
                        under subsection (b)(6)(B)(iii) on or after 
                        January 1, 2022.
                            ``(ii) Conditions that require prescription 
                        drugs, providers, and models of care that are 
                        unique to the specific population of enrollees 
                        in a specialized MA plan for special needs 
                        individuals described in such subsection on or 
                        after such date and--
                                    ``(I) as a result of access to, and 
                                enrollment in, such a specialized MA 
                                plan for special needs individuals, 
                                individuals with such condition would 
                                have a reasonable expectation of 
                                slowing or halting the progression of 
                                the disease, improving health outcomes 
                                and decreasing overall costs for 
                                individuals diagnosed with such 
                                condition compared to available options 
                                of care other than through such a 
                                specialized MA plan for special needs 
                                individuals; or
                                    ``(II) have a low prevalence in the 
                                general population of beneficiaries 
                                under this title or a disproportionally 
                                high per-beneficiary cost under this 
                                title.
                    ``(B) Requirement.--In establishing and updating 
                the list under subparagraph (A), the panel shall take 
                into account the availability of varied benefits, cost-
                sharing, and supplemental benefits under the model 
                described in paragraph (2) of section 1859(h), 
                including the expansion under paragraph (1) of such 
                section.''.
    (d) Quality Measurement at the Plan Level for SNPs and 
Determination of Feasability of Quality Measurement at the Plan Level 
for All MA Plans.--Section 1853(o) of the Social Security Act (42 
U.S.C. 1395w-23(o)) is amended by adding at the end the following new 
paragraphs:
            ``(6) Quality measurement at the plan level for snps.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                Secretary may require reporting of data under section 
                1852(e) for, and apply under this subsection, quality 
                measures at the plan level for specialized MA plans for 
                special needs individuals instead of at the contract 
                level.
                    ``(B) Considerations.--Prior to applying quality 
                measurement at the plan level under this paragraph, the 
                Secretary shall--
                            ``(i) take into consideration the minimum 
                        number of enrollees in a specialized MA plan 
                        for special needs individuals in order to 
                        determine if a statistically significant or 
                        valid measurement of quality at the plan level 
                        is possible under this paragraph;
                            ``(ii) take into consideration the impact 
                        of such application on plans that serve a 
                        disproportionate number of individuals dually 
                        eligible for benefits under this title and 
                        under title XIX;
                            ``(iii) if quality measures are reported at 
                        the plan level, ensure that MA plans are not 
                        required to provide duplicative information;
                            ``(iv) ensure that such reporting does not 
                        interfere with the collection of encounter data 
                        submitted by MA organizations or the 
                        administration of any changes to the program 
                        under this part as a result of the collection 
                        of such data.
                    ``(C) Application.--If the Secretary applies 
                quality measurement at the plan level under this 
                paragraph, such quality measurement may include 
                Medicare Health Outcomes Survey (HOS), Healthcare 
                Effectiveness Data and Information Set (HEDIS), 
                Consumer Assessment of Healthcare Providers and Systems 
                (CAHPS) measures and quality measures under part D.
            ``(7) Determination of feasibility of quality measurement 
        at the plan level for all ma plans.--
                    ``(A) Determination of feasibility.--The Secretary 
                shall determine the feasibility of requiring reporting 
                of data under section 1852(e) for, and applying under 
                this subsection, quality measures at the plan level for 
                all MA plans under this part.
                    ``(B) Consideration of change.--After making a 
                determination under subparagraph (A), the Secretary 
                shall consider requiring such reporting and applying 
                such quality measures at the plan level as described in 
                such subparagraph.''.
    (e) GAO Study and Report on State-Level Integration Between Dual 
SNPs and Medicaid.--
            (1) Study.--The Comptroller General of the United States 
        (in this paragraph referred to as the ``Comptroller General'') 
        shall conduct a study on State-level integration between 
        specialized MA plans for special needs individuals described in 
        subsection (b)(6)(B)(ii) of section 1859 of the Social Security 
        Act (42 U.S.C. 1395w-28) and the Medicaid program under title 
        XIX of such Act (42 U.S.C. 1396 et seq.). Such study shall 
        include an analysis of the following:
                    (A) The characteristics of States in which the 
                State agency responsible for administering the State 
                plan under such title XIX has a contract with such a 
                specialized MA plan and that delivers long term 
                services and supports under the State plan under such 
                title XIX through a managed care program, including the 
                requirements under such State plan with respect to long 
                term services and supports.
                    (B) The types of such specialized MA plans, which 
                may include the following:
                            (i) A plan described in section 
                        1853(a)(1)(B)(iv)(II) of such Act (42 U.S.C. 
                        1395w-23(a)(1)(B)(iv)(II)).
                            (ii) A plan that meets the requirements 
                        described in subsection (f)(3)(D) of such 
                        section 1859.
                            (iii) A plan described in clause (ii) that 
                        also meets additional requirements established 
                        by the State.
                    (C) The characteristics of individuals enrolled in 
                such specialized MA plans.
                    (D) As practicable, the following with respect to 
                State programs for the delivery of long term services 
                and supports under such title XIX through a managed 
                care program:
                            (i) Which populations of individuals are 
                        eligible to receive such services and supports.
                            (ii) Whether all such services and supports 
                        are provided on a capitated basis or if any of 
                        such services and supports are carved out and 
                        provided through fee-for-service.
                    (E) How the availability and variation of 
                integration arrangements of such specialized MA plans 
                offered in States affects spending, service delivery 
                options, access to community-based care, and 
                utilization of care.
                    (F) The efforts of State Medicaid programs to 
                transition dually-eligible beneficiaries receiving long 
                term services and supports (LTSS) from institutional 
                settings to home and community-based settings and 
                related financial impacts of such transitions.
            (2) Report.--Not later than 2 years after the date of the 
        enactment of this Act, the Comptroller General shall submit to 
        Congress a report containing the results of the study conducted 
        under paragraph (1), together with recommendations for such 
        legislation and administrative action as the Comptroller 
        General determines appropriate.

             TITLE III--EXPANDING INNOVATION AND TECHNOLOGY

SEC. 301. ADAPTING BENEFITS TO MEET THE NEEDS OF CHRONICALLY ILL 
              MEDICARE ADVANTAGE ENROLLEES.

    Section 1859 of the Social Security Act (42 U.S.C. 1395w-28) is 
amended by adding at the end the following new subsection:
    ``(h) National Testing of Model for Medicare Advantage Value-Based 
Insurance Design.--
            ``(1) In general.--In implementing the model described in 
        paragraph (2) proposed to be tested under section 1115A(b), the 
        Secretary shall revise the testing of the model under such 
        section to cover, effective not later than January 1, 2020, all 
        States.
            ``(2) Model described.--The model described in this 
        paragraph is the testing of a model of Medicare Advantage 
        value-based insurance design that would allow Medicare 
        Advantage plans the option to propose and design benefit 
        structures that vary benefits, cost-sharing, and supplemental 
        benefits offered to enrollees with specific chronic diseases 
        proposed to be carried out in Oregon, Arizona, Texas, Iowa, 
        Michigan, Indiana, Tennessee, Alabama, Pennsylvania, and 
        Massachusetts.
            ``(3) Termination and modification provision not applicable 
        until january 1, 2022.--The provisions of section 
        1115A(b)(3)(B) shall apply to the model described in paragraph 
        (2), including such model as expanded under paragraph (1), 
        beginning January 1, 2022, but shall not apply to such model, 
        as so expanded, prior to such date.
            ``(4) Funding.--The Secretary shall allocate funds made 
        available under section 1115A(f)(1) to design, implement, and 
        evaluate the model described in paragraph (2), as expanded 
        under paragraph (1).''.

SEC. 302. EXPANDING SUPPLEMENTAL BENEFITS TO MEET THE NEEDS OF 
              CHRONICALLY ILL MEDICARE ADVANTAGE ENROLLEES.

    (a) In General.--Section 1852(a)(3) of the Social Security Act (42 
U.S.C. 1395w-22(a)(3)) is amended--
            (1) in subparagraph (A), by striking ``Each'' and inserting 
        ``Subject to subparagraph (D), each''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Expanding supplemental benefits to meet the 
                needs of chronically ill enrollees.--
                            ``(i) In general.--For plan year 2020 and 
                        subsequent plan years, in addition to any 
                        supplemental health care benefits otherwise 
                        provided under this paragraph, an MA plan may 
                        provide supplemental benefits described in 
                        clause (ii) to a chronically ill enrollee (as 
                        defined in clause (iii)).
                            ``(ii) Supplemental benefits described.--
                                    ``(I) In general.--Supplemental 
                                benefits described in this clause are 
                                supplemental benefits that, with 
                                respect to a chronically ill enrollee, 
                                have a reasonable expectation of 
                                improving or maintaining the health or 
                                overall function of the chronically ill 
                                enrollee and may not be limited to 
                                being primarily health related 
                                benefits.
                                    ``(II) Authority to waive 
                                uniformity requirements.--The Secretary 
                                may, only with respect to supplemental 
                                benefits provided to a chronically ill 
                                enrollee under this subparagraph, waive 
                                the uniformity requirement under 
                                subsection (d)(1)(A), as determined 
                                appropriate by the Secretary.
                            ``(iii) Chronically ill enrollee defined.--
                        In this subparagraph, the term `chronically ill 
                        enrollee' means an enrollee in an MA plan that 
                        the Secretary determines--
                                    ``(I) has one or more comorbid and 
                                medically complex chronic conditions 
                                that is life threatening or 
                                significantly limits the overall health 
                                or function of the enrollee;
                                    ``(II) has a high risk of 
                                hospitalization or other adverse health 
                                outcomes; and
                                    ``(III) requires intensive care 
                                coordination.''.
    (b) GAO Study and Report.--
            (1) Study.--The Comptroller General of the United States 
        (in this subsection referred to as the ``Comptroller General'') 
        shall conduct a study on supplemental benefits provided to 
        enrollees in Medicare Advantage plans under part C of title 
        XVIII of the Social Security Act. To the extend data are 
        available, such study shall include an analysis of the 
        following:
                    (A) The type of supplemental benefits provided to 
                such enrollees, the total number of enrollees receiving 
                each supplemental benefit, and whether the supplemental 
                benefit is covered by the standard benchmark cost of 
                the benefit or with an additional premium.
                    (B) The frequency in which supplemental benefits 
                are utilized by such enrollees.
                    (C) The impact supplemental benefits have on--
                            (i) indicators of the quality of care 
                        received by such enrollees, including overall 
                        health and function of the enrollees;
                            (ii) the utilization of items and services 
                        for which benefits are available under the 
                        original Medicare fee-for-service program 
                        option under parts A and B of such title XVIII 
                        by such enrollees; and
                            (iii) the amount of the bids submitted by 
                        Medicare Advantage Organizations for Medicare 
                        Advantage plans under such part C.
            (2) Report.--Not later than 5 years after the date of the 
        enactment of this Act, the Comptroller General shall submit to 
        Congress a report containing the results of the study conducted 
        under paragraph (1), together with recommendations for such 
        legislation and administrative action as the Comptroller 
        General determines appropriate.

SEC. 303. INCREASING CONVENIENCE FOR MEDICARE ADVANTAGE ENROLLEES 
              THROUGH TELEHEALTH.

    (a) In General.--Section 1852 of the Social Security Act (42 U.S.C. 
1395w-22) is amended--
            (1) in subsection (a)(1)(B)(i), by inserting ``, subject to 
        subsection (m),'' after ``means''; and
            (2) by adding at the end the following new subsection:
    ``(m) Provision of Additional Telehealth Benefits.--
            ``(1) MA plan option.--For plan year 2020 and subsequent 
        plan years, subject to the requirements of paragraph (3), an MA 
        plan may provide additional telehealth benefits (as defined in 
        paragraph (2)) to individuals enrolled under this part.
            ``(2) Additional telehealth benefits defined.--
                    ``(A) In general.--For purposes of this subsection 
                and section 1854:
                            ``(i) Definition.--The term `additional 
                        telehealth benefits' means services--
                                    ``(I) for which benefits are 
                                available under part B, including 
                                services for which payment is not made 
                                under section 1834(m) due to the 
                                conditions for payment under such 
                                section; and
                                    ``(II) that are identified as 
                                clinically appropriate to furnish using 
                                electronic information and 
                                telecommunications technology when a 
                                physician (as defined in section 
                                1861(r)) or practitioner (described in 
                                section 1842(b)(18)(C)) providing the 
                                service is not at the same location as 
                                the plan enrollee.
                            ``(ii) Exclusion of capital and 
                        infrastructure costs and investments.--The term 
                        `additional telehealth benefits' does not 
                        include capital and infrastructure costs and 
                        investments relating to such benefits.
                    ``(B) Public comment.--Not later than November 30, 
                2018, the Secretary shall solicit comments on--
                            ``(i) what types of items and services 
                        (including those provided through supplemental 
                        health care benefits) should be considered to 
                        be additional telehealth benefits; and
                            ``(ii) the requirements for the provision 
                        or furnishing of such benefits (such as 
                        licensure, training, and coordination 
                        requirements).
            ``(3) Requirements for additional telehealth benefits.--The 
        Secretary shall specify requirements for the provision or 
        furnishing of additional telehealth benefits, including with 
        respect to the following:
                    ``(A) Physician or practitioner licensure and other 
                requirements such as specific training.
                    ``(B) Factors necessary to ensure the coordination 
                of such benefits with items and services furnished in-
                person.
                    ``(C) Such other areas as determined by the 
                Secretary.
            ``(4) Enrollee choice.--If an MA plan provides a service as 
        an additional telehealth benefit (as defined in paragraph 
        (2))--
                    ``(A) the MA plan shall also provide access to such 
                benefit through an in-person visit (and not only as an 
                additional telehealth benefit); and
                    ``(B) an individual enrollee shall have discretion 
                as to whether to receive such service through the in-
                person visit or as an additional telehealth benefit.
            ``(5) Treatment under ma.--For purposes of this subsection 
        and section 1854, additional telehealth benefits shall be 
        treated as if they were benefits under the original Medicare 
        fee-for-service program option.
            ``(6) Construction.--Nothing in this subsection shall be 
        construed as affecting the requirement under subsection (a)(1) 
        that MA plans provide enrollees with items and services (other 
        than hospice care) for which benefits are available under parts 
        A and B, including benefits available under section 1834(m).''.
    (b) Clarification Regarding Inclusion in Bid Amount.--Section 
1854(a)(6)(A)(ii)(I) of the Social Security Act (42 U.S.C. 1395w-
24(a)(6)(A)(ii)(I)) is amended by inserting ``, including, for plan 
year 2020 and subsequent plan years, the provision of additional 
telehealth benefits as described in section 1852(m)'' before the 
semicolon at the end.

SEC. 304. PROVIDING ACCOUNTABLE CARE ORGANIZATIONS THE ABILITY TO 
              EXPAND THE USE OF TELEHEALTH.

    (a) In General.--Section 1899 of the Social Security Act (42 U.S.C. 
1395jjj) is amended by adding at the end the following new subsection:
    ``(l) Providing ACOs the Ability To Expand the Use of Telehealth 
Services.--
            ``(1) In general.--In the case of telehealth services for 
        which payment would otherwise be made under this title 
        furnished on or after January 1, 2020, for purposes of this 
        subsection only, the following shall apply with respect to such 
        services furnished by a physician or practitioner participating 
        in an applicable ACO (as defined in paragraph (2)) to a 
        Medicare fee-for-service beneficiary assigned to the applicable 
        ACO:
                    ``(A) Inclusion of home as originating site.--
                Subject to paragraph (3), the home of a beneficiary 
                shall be treated as an originating site described in 
                section 1834(m)(4)(C)(ii).
                    ``(B) No application of geographic limitation.--The 
                geographic limitation under section 1834(m)(4)(C)(i) 
                shall not apply with respect to an originating site 
                described in section 1834(m)(4)(C)(ii) (including the 
                home of a beneficiary under subparagraph (A)), subject 
                to State licensing requirements.
            ``(2) Definitions.--In this subsection:
                    ``(A) Applicable aco.--The term `applicable ACO' 
                means an ACO participating in a model tested or 
                expanded under section 1115A or under this section--
                            ``(i) that operates under a two-sided 
                        model--
                                    ``(I) described in section 
                                425.600(a) of title 42, Code of Federal 
                                Regulations; or
                                    ``(II) tested or expanded under 
                                section 1115A; and
                            ``(ii) for which Medicare fee-for-service 
                        beneficiaries are assigned to the ACO using a 
                        prospective assignment method, as determined 
                        appropriate by the Secretary.
                    ``(B) Home.--The term `home' means, with respect to 
                a Medicare fee-for-service beneficiary, the place of 
                residence used as the home of the beneficiary.
            ``(3) Telehealth services received in the home.--In the 
        case of telehealth services described in paragraph (1) where 
        the home of a Medicare fee-for-service beneficiary is the 
        originating site, the following shall apply:
                    ``(A) No facility fee.--There shall be no facility 
                fee paid to the originating site under section 
                1834(m)(2)(B).
                    ``(B) Exclusion of certain services.--No payment 
                may be made for such services that are inappropriate to 
                furnish in the home setting such as services that are 
                typically furnished in inpatient settings such as a 
                hospital.''.
    (b) Study and Report.--
            (1) Study.--
                    (A) In general.--The Secretary of Health and Human 
                Services (in this subsection referred to as the 
                ``Secretary'') shall conduct a study on the 
                implementation of section 1899(l) of the Social 
                Security Act, as added by subsection (a). Such study 
                shall include an analysis of the utilization of, and 
                expenditures for, telehealth services under such 
                section.
                    (B) Collection of data.--The Secretary may collect 
                such data as the Secretary determines necessary to 
                carry out the study under this paragraph.
            (2) Report.--Not later than January 1, 2026, the Secretary 
        shall submit to Congress a report containing the results of the 
        study conducted under paragraph (1), together with 
        recommendations for such legislation and administrative action 
        as the Secretary determines appropriate.

SEC. 305. EXPANDING THE USE OF TELEHEALTH FOR INDIVIDUALS WITH STROKE.

    Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)), as 
amended by section 102(b)(2), is amended by adding at the end the 
following new paragraph:
            ``(6) Treatment of stroke telehealth services.--
                    ``(A) Non-application of originating site 
                requirements.--The requirements described in paragraph 
                (4)(C) shall not apply with respect to telehealth 
                services furnished on or after January 1, 2021, for 
                purposes of evaluation of an acute stroke, as 
                determined by the Secretary.
                    ``(B) No originating site facility fee.--In the 
                case of an originating site that does not meet the 
                requirements described in paragraph (4)(C), he 
                Secretary shall not pay an originating site facility 
                fee (as described in paragraph (2)(B)) to the 
                originating site with respect to such telehealth 
                services.''.

          TITLE IV--IDENTIFYING THE CHRONICALLY ILL POPULATION

SEC. 401. PROVIDING FLEXIBILITY FOR BENEFICIARIES TO BE PART OF AN 
              ACCOUNTABLE CARE ORGANIZATION.

    Section 1899(c) of the Social Security Act (42 U.S.C. 1395jjj(c)) 
is amended--
            (1) by redesignating paragraphs (1) and (2) as 
        subparagraphs (A) and (B), respectively, and indenting 
        appropriately;
            (2) by striking ``ACOs.--The Secretary'' and inserting 
        ``ACOs.--
            ``(1) In general.--Subject to paragraph (2), the 
        Secretary''; and
            (3) by adding at the end the following new paragraph:
            ``(2) Providing flexibility.--
                    ``(A) Choice of prospective assignment.--For each 
                agreement period (effective for agreements entered into 
                or renewed on or after January 1, 2020), in the case 
                where an ACO established under the program is in a 
                Track that provides for the retrospective assignment of 
                Medicare fee-for-service beneficiaries to the ACO, the 
                Secretary shall permit the ACO to choose to have 
                Medicare fee-for-service beneficiaries assigned 
                prospectively, rather than retrospectively, to the ACO 
                for an agreement period.
                    ``(B) Assignment based on voluntary identification 
                by medicare fee-for-service beneficiaries.--
                            ``(i) In general.--For performance year 
                        2018 and each subsequent performance year, if a 
                        system is available for electronic designation, 
                        the Secretary shall permit a Medicare fee-for-
                        service beneficiary to voluntarily identify an 
                        ACO professional as the primary care provider 
                        of the beneficiary for purposes of assigning 
                        such beneficiary to an ACO, as determined by 
                        the Secretary.
                            ``(ii) Notification process.--The Secretary 
                        shall establish a process under which a 
                        Medicare fee-for-service beneficiary is--
                                    ``(I) notified of their ability to 
                                make an identification described in 
                                clause (i); and
                                    ``(II) informed of the process by 
                                which they may make and change such 
                                identification.
                            ``(iii) Superseding claims-based 
                        assignment.--A voluntary identification by a 
                        Medicare fee-for-service beneficiary under this 
                        subparagraph shall supersede any claims-based 
                        assignment otherwise determined by the 
                        Secretary.''.

    TITLE V--EMPOWERING INDIVIDUALS AND CAREGIVERS IN CARE DELIVERY

SEC. 501. ELIMINATING BARRIERS TO CARE COORDINATION UNDER ACCOUNTABLE 
              CARE ORGANIZATIONS.

    (a) In General.--Section 1899 of the Social Security Act (42 U.S.C. 
1395jjj), as amended by section 304(a), is amended--
            (1) in subsection (b)(2), by adding at the end the 
        following new subparagraph:
                    ``(I) An ACO that seeks to operate an ACO 
                Beneficiary Incentive Program pursuant to subsection 
                (m) shall apply to the Secretary at such time, in such 
                manner, and with such information as the Secretary may 
                require.'';
            (2) by adding at the end the following new subsection:
    ``(m) Authority To Provide Incentive Payments to Beneficiaries With 
Respect to Qualifying Primary Care Services.--
            ``(1) Program.--
                    ``(A) In general.--In order to encourage Medicare 
                fee-for-service beneficiaries to obtain medically 
                necessary primary care services, an ACO participating 
                under this section under a payment model described in 
                clause (i) or (ii) of paragraph (2)(B) may apply to 
                establish an ACO Beneficiary Incentive Program to 
                provide incentive payments to such beneficiaries who 
                are furnished qualifying services in accordance with 
                this subsection. The Secretary shall permit such an ACO 
                to establish such a program at the Secretary's 
                discretion and subject to such requirements, including 
                program integrity requirements, as the Secretary 
                determines necessary.
                    ``(B) Implementation.--The Secretary shall 
                implement this subsection on a date determined 
                appropriate by the Secretary. Such date shall be no 
                earlier than January 1, 2019, and no later than January 
                1, 2020.
            ``(2) Conduct of program.--
                    ``(A) Duration.--Subject to subparagraph (H), an 
                ACO Beneficiary Incentive Program established under 
                this subsection shall be conducted for such period (of 
                not less than 1 year) as the Secretary may approve.
                    ``(B) Scope.--An ACO Beneficiary Incentive Program 
                established under this subsection shall provide 
                incentive payments to all of the following Medicare 
                fee-for-service beneficiaries who are furnished 
                qualifying services by the ACO:
                            ``(i) With respect to the Track 2 and Track 
                        3 payment models described in section 
                        425.600(a) of title 42, Code of Federal 
                        Regulations (or in any successor regulation), 
                        Medicare fee-for-service beneficiaries who are 
                        preliminarily prospectively or prospectively 
                        assigned (or otherwise assigned, as determined 
                        by the Secretary) to the ACO.
                            ``(ii) With respect to any future payment 
                        models involving two-sided risk, Medicare fee-
                        for-service beneficiaries who are assigned to 
                        the ACO, as determined by the Secretary.
                    ``(C) Qualifying service.--For purposes of this 
                subsection, a qualifying service is a primary care 
                service, as defined in section 425.20 of title 42, Code 
                of Federal Regulations (or in any successor 
                regulation), with respect to which coinsurance applies 
                under part B, furnished through an ACO by--
                            ``(i) an ACO professional described in 
                        subsection (h)(1)(A) who has a primary care 
                        specialty designation included in the 
                        definition of primary care physician under 
                        section 425.20 of title 42, Code of Federal 
                        Regulations (or any successor regulation);
                            ``(ii) an ACO professional described in 
                        subsection (h)(1)(B); or
                            ``(iii) a Federally qualified health center 
                        or rural health clinic (as such terms are 
                        defined in section 1861(aa)).
                    ``(D) Incentive payments.--An incentive payment 
                made by an ACO pursuant to an ACO Beneficiary Incentive 
                Program established under this subsection shall be--
                            ``(i) in an amount up to $20, with such 
                        maximum amount updated annually by the 
                        percentage increase in the consumer price index 
                        for all urban consumers (United States city 
                        average) for the 12-month period ending with 
                        June of the previous year;
                            ``(ii) in the same amount for each Medicare 
                        fee-for-service beneficiary described in clause 
                        (i) or (ii) of subparagraph (B) without regard 
                        to enrollment of such a beneficiary in a 
                        medicare supplemental policy (described in 
                        section 1882(g)(1)), in a State Medicaid plan 
                        under title XIX or a waiver of such a plan, or 
                        in any other health insurance policy or health 
                        benefit plan;
                            ``(iii) made for each qualifying service 
                        furnished to such a beneficiary described in 
                        clause (i) or (ii) of subparagraph (B) during a 
                        period specified by the Secretary; and
                            ``(iv) made no later than 30 days after a 
                        qualifying service is furnished to such a 
                        beneficiary described in clause (i) or (ii) of 
                        subparagraph (B).
                    ``(E) No separate payments from the secretary.--The 
                Secretary shall not make any separate payment to an ACO 
                for the costs, including incentive payments, of 
                carrying out an ACO Beneficiary Incentive Program 
                established under this subsection. Nothing in this 
                subparagraph shall be construed as prohibiting an ACO 
                from using shared savings received under this section 
                to carry out an ACO Beneficiary Incentive Program.
                    ``(F) No application to shared savings 
                calculation.--Incentive payments made by an ACO under 
                this subsection shall be disregarded for purposes of 
                calculating benchmarks, estimated average per capita 
                Medicare expenditures, and shared savings under this 
                section.
                    ``(G) Reporting requirements.--An ACO conducting an 
                ACO Beneficiary Incentive Program under this subsection 
                shall, at such times and in such format as the 
                Secretary may require, report to the Secretary such 
                information and retain such documentation as the 
                Secretary may require, including the amount and 
                frequency of incentive payments made and the number of 
                Medicare fee-for-service beneficiaries receiving such 
                payments.
                    ``(H) Termination.--The Secretary may terminate an 
                ACO Beneficiary Incentive Program established under 
                this subsection at any time for reasons determined 
                appropriate by the Secretary.
            ``(3) Exclusion of incentive payments.--Any payment made 
        under an ACO Beneficiary Incentive Program established under 
        this subsection shall not be considered income or resources or 
        otherwise taken into account for purposes of--
                    ``(A) determining eligibility for benefits or 
                assistance (or the amount or extent of benefits or 
                assistance) under any Federal program or under any 
                State or local program financed in whole or in part 
                with Federal funds; or
                    ``(B) any Federal or State laws relating to 
                taxation.'';
            (3) in subsection (e), by inserting ``, including an ACO 
        Beneficiary Incentive Program under subsections (b)(2)(I) and 
        (m)'' after ``the program''; and
            (4) in subsection (g)(6), by inserting ``or of an ACO 
        Beneficiary Incentive Program under subsections (b)(2)(I) and 
        (m)'' after ``under subsection (d)(4)''.
    (b) Amendment to Section 1128B.--Section 1128B(b)(3) of the Social 
Security Act (42 U.S.C. 1320a-7b(b)(3)) is amended--
            (1) by striking ``and'' at the end of subparagraph (I);
            (2) by striking the period at the end of subparagraph (J) 
        and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(K) an incentive payment made to a Medicare fee-
                for-service beneficiary by an ACO under an ACO 
                Beneficiary Incentive Program established under 
                subsection (m) of section 1899, if the payment is made 
                in accordance with the requirements of such subsection 
                and meets such other conditions as the Secretary may 
                establish.''.
    (c) Evaluation and Report.--
            (1) Evaluation.--The Secretary of Health and Human Services 
        (in this subsection referred to as the ``Secretary'') shall 
        conduct an evaluation of the ACO Beneficiary Incentive Program 
        established under subsections (b)(2)(I) and (m) of section 1899 
        of the Social Security Act (42 U.S.C. 1395jjj), as added by 
        subsection (a). The evaluation shall include an analysis of the 
        impact of the implementation of the Program on expenditures and 
        beneficiary health outcomes under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.).
            (2) Report.--Not later than October 1, 2023, the Secretary 
        shall submit to Congress a report containing the results of the 
        evaluation under paragraph (1), together with recommendations 
        for such legislation and administrative action as the Secretary 
        determines appropriate.

SEC. 502. GAO STUDY AND REPORT ON LONGITUDINAL COMPREHENSIVE CARE 
              PLANNING SERVICES UNDER MEDICARE PART B.

    (a) Study.--The Comptroller General shall conduct a study on the 
establishment under part B of the Medicare program under title XVIII of 
the Social Security Act of a payment code for a visit for longitudinal 
comprehensive care planning services. Such study shall include an 
analysis of the following to the extent such information is available:
            (1) The frequency with which services similar to 
        longitudinal comprehensive care planning services are furnished 
        to Medicare beneficiaries, which providers of services and 
        suppliers are furnishing those services, whether Medicare 
        reimbursement is being received for those services, and, if so, 
        through which codes those services are being reimbursed.
            (2) Whether, and the extent to which, longitudinal 
        comprehensive care planning services would overlap, and could 
        therefore result in duplicative payment, with services covered 
        under the hospice benefit as well as the chronic care 
        management code, evaluation and management codes, or other 
        codes that already exist under part B of the Medicare program.
            (3) Any barriers to hospitals, skilled nursing facilities, 
        hospice programs, home health agencies, and other applicable 
        providers working with a Medicare beneficiary to engage in the 
        care planning process and complete the necessary documentation 
        to support the treatment and care plan of the beneficiary and 
        provide such documentation to other providers and the 
        beneficiary or the beneficiary's representative.
            (4) Any barriers to providers, other than the provider 
        furnishing longitudinal comprehensive care planning services, 
        accessing the care plan and associated documentation for use 
        related to the care of the Medicare beneficiary.
            (5) Potential options for ensuring that applicable 
        providers are notified of a patient's existing longitudinal 
        care plan and that applicable providers consider that plan in 
        making their treatment decisions, and what the challenges might 
        be in implementing such options.
            (6) Stakeholder's views on the need for the development of 
        quality metrics with respect to longitudinal comprehensive care 
        planning services, such as measures related to--
                    (A) the process of eliciting input from the 
                Medicare beneficiary or from a legally authorized 
                representative and documenting in the medical record 
                the patient-directed care plan;
                    (B) the effectiveness and patient-centeredness of 
                the care plan in organizing delivery of services 
                consistent with the plan;
                    (C) the availability of the care plan and 
                associated documentation to other providers that care 
                for the beneficiary; and
                    (D) the extent to which the beneficiary received 
                services and support that is free from discrimination 
                based on advanced age, disability status, or advanced 
                illness.
            (7) Stakeholder's views on how such quality metrics would 
        provide information on--
                    (A) the goals, values, and preferences of the 
                beneficiary;
                    (B) the documentation of the care plan;
                    (C) services furnished to the beneficiary; and
                    (D) outcomes of treatment.
            (8) Stakeholder's views on--
                    (A) the type of training and education needed for 
                applicable providers, individuals, and caregivers in 
                order to facilitate longitudinal comprehensive care 
                planning services;
                    (B) the types of providers of services and 
                suppliers that should be included in the 
                interdisciplinary team of an applicable provider; and
                    (C) the characteristics of Medicare beneficiaries 
                that would be most appropriate to receive longitudinal 
                comprehensive care planning services, such as 
                individuals with advanced disease and individuals who 
                need assistance with multiple activities of daily 
                living.
            (9) Stakeholder's views on the frequency with which 
        longitudinal comprehensive care planning services should be 
        furnished.
    (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General shall submit to Congress 
a report containing the results of the study conducted under subsection 
(a), together with recommendations for such legislation and 
administrative action as the Comptroller General determines 
appropriate.
    (c) Definitions.--In this section:
            (1) Applicable provider.--The term ``applicable provider'' 
        means a hospice program (as defined in subsection (dd)(2) of 
        section 1861 of the Social Security Act (42 U.S.C. 1395ww)) or 
        other provider of services (as defined in subsection (u) of 
        such section) or supplier (as defined in subsection (d) of such 
        section) that--
                    (A) furnishes longitudinal comprehensive care 
                planning services through an interdisciplinary team; 
                and
                    (B) meets such other requirements as the Secretary 
                may determine to be appropriate.
            (2) Comptroller general.--The term ``Comptroller General'' 
        means the Comptroller General of the United States.
            (3) Interdisciplinary team.--The term ``interdisciplinary 
        team'' means a group that--
                    (A) includes the personnel described in subsection 
                (dd)(2)(B)(i) of such section 1861;
                    (B) may include a chaplain, minister, or other 
                clergy; and
                    (C) may include other direct care personnel.
            (4) Longitudinal comprehensive care planning services.--The 
        term ``longitudinal comprehensive care planning services'' 
        means a voluntary shared decisionmaking process that is 
        furnished by an applicable provider through an 
        interdisciplinary team and includes a conversation with 
        Medicare beneficiaries who have received a diagnosis of a 
        serious or life-threatening illness. The purpose of such 
        services is to discuss a longitudinal care plan that addresses 
        the progression of the disease, treatment options, the goals, 
        values, and preferences of the beneficiary, and the 
        availability of other resources and social supports that may 
        reduce the beneficiary's health risks and promote self-
        management and shared decisionmaking.
            (5) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

    TITLE VI--OTHER POLICIES TO IMPROVE CARE FOR THE CHRONICALLY ILL

SEC. 601. PROVIDING PRESCRIPTION DRUG PLANS WITH PARTS A AND B CLAIMS 
              DATA TO PROMOTE THE APPROPRIATE USE OF MEDICATIONS AND 
              IMPROVE HEALTH OUTCOMES.

    Section 1860D-4(c) of the Social Security Act (42 U.S.C. 1395w-
104(c)) is amended by adding at the end the following new paragraph:
            ``(6) Providing prescription drug plans with parts a and b 
        claims data to promote the appropriate use of medications and 
        improve health outcomes.--
                    ``(A) Process.--Subject to subparagraph (B), the 
                Secretary shall establish a process under which a PDP 
                sponsor of a prescription drug plan may submit a 
                request for the Secretary to provide the sponsor, on a 
                periodic basis and in an electronic format, beginning 
                in plan year 2020, data described in subparagraph (D) 
                with respect to enrollees in such plan. Such data shall 
                be provided without regard to whether such enrollees 
                are described in clause (ii) of paragraph (2)(A).
                    ``(B) Purposes.--A PDP sponsor may use the data 
                provided to the sponsor pursuant to subparagraph (A) 
                for any of the following purposes:
                            ``(i) To optimize therapeutic outcomes 
                        through improved medication use, as such phrase 
                        is used in clause (i) of paragraph (2)(A).
                            ``(ii) To improving care coordination so as 
                        to prevent adverse health outcomes, such as 
                        preventable emergency department visits and 
                        hospital readmissions.
                            ``(iii) For any other purpose determined 
                        appropriate by the Secretary.
                    ``(C) Limitations on data use.--A PDP sponsor shall 
                not use data provided to the sponsor pursuant to 
                subparagraph (A) for any of the following purposes:
                            ``(i) To inform coverage determinations 
                        under this part.
                            ``(ii) To conduct retroactive reviews of 
                        medically accepted indications determinations.
                            ``(iii) To facilitate enrollment changes to 
                        a different prescription drug plan or an MA-PD 
                        plan offered by the same parent organization.
                            ``(iv) To inform marketing of benefits.
                            ``(v) For any other purpose that the 
                        Secretary determines is necessary to include in 
                        order to protect the identity of individuals 
                        entitled to, or enrolled for, benefits under 
                        this title and to protect the security of 
                        personal health information.
                    ``(D) Data described.--The data described in this 
                clause are standardized extracts (as determined by the 
                Secretary) of claims data under parts A and B for items 
                and services furnished under such parts for time 
                periods specified by the Secretary. Such data shall 
                include data as current as practicable.''.

SEC. 602. GAO STUDY AND REPORT ON IMPROVING MEDICATION SYNCHRONIZATION.

    (a) Study.--The Comptroller General of the United States (in this 
section referred to as the ``Comptroller General'') shall conduct a 
study on the extent to which Medicare prescription drug plans (MA-PD 
plans and standalone prescription drug plans) under part D of title 
XVIII of the Social Security Act and private payors use programs that 
synchronize pharmacy dispensing so that individuals may receive 
multiple prescriptions on the same day to facilitate comprehensive 
counseling and promote medication adherence. The study shall include a 
analysis of the following:
            (1) The extent to which pharmacies have adopted such 
        programs.
            (2) The common characteristics of such programs, including 
        how pharmacies structure counseling sessions under such 
        programs and the types of payment and other arrangements that 
        Medicare prescription drug plans and private payors employ 
        under such programs to support the efforts of pharmacies.
            (3) How such programs compare for Medicare prescription 
        drug plans and private payors.
            (4) What is known about how such programs affect patient 
        medication adherence and overall patient health outcomes, 
        including if adherence and outcomes vary by patient 
        subpopulations, such as disease state and socioeconomic status.
            (5) What is known about overall patient satisfaction with 
        such programs and satisfaction with such programs, including 
        within patient subpopulations, such as disease state and 
        socioeconomic status.
            (6) The extent to which laws and regulations of the 
        Medicare program support such programs.
            (7) Barriers to the use of medication synchronization 
        programs by Medicare prescription drug plans.
    (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General shall submit to Congress 
a report containing the results of the study under subsection (a), 
together with recommendations for such legislation and administrative 
action as the Comptroller General determines appropriate.

SEC. 603. GAO STUDY AND REPORT ON IMPACT OF OBESITY DRUGS ON PATIENT 
              HEALTH AND SPENDING.

    (a) Study.--The Comptroller General of the United States (in this 
section referred to as the ``Comptroller General'') shall, to the 
extent data are available, conduct a study on the use of prescription 
drugs to manage the weight of obese patients and the impact of coverage 
of such drugs on patient health and on health care spending. Such study 
shall examine the use and impact of these obesity drugs in the non-
Medicare population and for Medicare beneficiaries who have such drugs 
covered through an MA-PD plan (as defined in section 1860D-1(a)(3)(C) 
of the Social Security Act (42 U.S.C. 1395w-101(a)(3)(C))) as a 
supplemental health care benefit. The study shall include an analysis 
of the following:
            (1) The prevalence of obesity in the Medicare and non-
        Medicare population.
            (2) The utilization of obesity drugs.
            (3) The distribution of Body Mass Index by individuals 
        taking obesity drugs, to the extent practicable.
            (4) What is known about the use of obesity drugs in 
        conjunction with the receipt of other items or services, such 
        as behavioral counseling, and how these compare to items and 
        services received by obese individuals who do not take obesity 
        drugs.
            (5) Physician considerations and attitudes related to 
        prescribing obesity drugs.
            (6) The extent to which coverage policies cease or limit 
        coverage for individuals who fail to receive clinical benefit.
            (7) What is known about the extent to which individuals who 
        take obesity drugs adhere to the prescribed regimen.
            (8) What is known about the extent to which individuals who 
        take obesity drugs maintain weight loss over time.
            (9) What is known about the subsequent impact such drugs 
        have on medical services that are directly related to obesity, 
        including with respect to subpopulations determined based on 
        the extent of obesity.
            (10) What is known about the spending associated with the 
        care of individuals who take obesity drugs, compared to the 
        spending associated with the care of individuals who do not 
        take such drugs.
    (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General shall submit to Congress 
a report containing the results of the study under subsection (a), 
together with recommendations for such legislation and administrative 
action as the Comptroller General determines appropriate.

SEC. 604. HHS STUDY AND REPORT ON LONG-TERM RISK FACTORS FOR CHRONIC 
              CONDITIONS AMONG MEDICARE BENEFICIARIES.

    (a) Study.--The Secretary of Health and Human Services (in this 
section referred to as the ``Secretary'') shall conduct a study on 
long-term cost drivers to the Medicare program, including obesity, 
tobacco use, mental health conditions, and other factors that may 
contribute to the deterioration of health conditions among individuals 
with chronic conditions in the Medicare population. The study shall 
include an analysis of any barriers to collecting and analyzing such 
information and how to remove any such barriers (including through 
legislation and administrative actions).
    (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Secretary shall submit to Congress a report 
containing the results of the study under subsection (a), together with 
recommendations for such legislation and administrative action as the 
Secretary determines appropriate. The Secretary shall also post such 
report on the Internet website of the Department of Health and Human 
Services.

                           TITLE VII--OFFSETS

SEC. 701. MEDICARE IMPROVEMENT FUND.

    Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
1395iii(b)(1)) is amended by striking ``$270,000,000'' and inserting 
``$0''.

SEC. 702. MEDICAID IMPROVEMENT FUND.

    Section 1941(b)(1) of the Social Security Act (42 U.S.C. 1396w-
1(b)(1)) is amended by striking ``$5,000,000'' and inserting ``$0''.

            Passed the Senate September 26, 2017.

            Attest:

                                                             Secretary.
115th CONGRESS

  1st Session

                                 S. 870

_______________________________________________________________________

                                 AN ACT

 To amend title XVIII of the Social Security Act to implement Medicare 
  payment policies designed to improve management of chronic disease, 
  streamline care coordination, and improve quality outcomes without 
                         adding to the deficit.