[Congressional Record Volume 155, Number 83 (Thursday, June 4, 2009)]
[Senate]
[Pages S6189-S6191]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. WYDEN:
  S. 1181. 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; 
to the Committee on Finance.
  Mr. WYDEN. Mr. President, today I am introducing the Healthy Living, 
Healthy Aging Demonstration Project Act of 2009. This act will provide 
for a demonstration project to examine whether community-level public 
health interventions can result in lower rates of chronic disease for 
individuals who are about to enter the Medicare program. Prevention is 
a key to health at any age, but especially later in life. I am proud to 
be introducing a cornerstone of health care reform today.
  American people and the U.S. Government need this prevention act for 
two main reasons. Health care costs continue to rise exponentially and 
chronic diseases are the number one cause of death and disability in 
the U.S. One hundred thirty-three million Americans, representing 45 
percent of the total population, have at least one chronic disease. 
Chronic diseases kill more than 1.7 million Americans each year, and 
are responsible for 7 out of every 10 deaths in the U.S. Furthermore, 
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 disease were eliminated, at least 80 percent of all 
heart disease, stroke, and type 2 diabetes would be prevented, and that 
more than 40 percent of cancer cases would be prevented. In addition, 
depressive disorders are common, chronic, and costly. The World Health 
Organization identified major depression as the fourth leading cause of 
worldwide disease in 1990, causing more disability than even certain 
types of heart disease. Research shows that mental health screenings 
after disease diagnosis for diabetic patients can be cost effective and 
improve health.
  The Healthy Living, Healthy Aging Demonstration Project Act of 2009 
will address these costly and chronic health problems before people 
enter the Medicare program. It calls for the Secretary of Health and 
Human Services to provide 5-year grants to community partnerships that 
include the state or local public health department and other community 
stakeholders such as health centers, providers, small businesses, and 
rural health clinics to fund evidence-based community-level prevention 
and wellness strategies. The types of community-based prevention 
strategies we are looking at in this program include walking programs, 
group exercise classes, anti-smoking programs, programs to highlight 
healthy dining options at restaurants, and expanding access to farmer's 
markets, nutritious foods, and other programs and services recommended 
by the Task Force on Community Preventive Services.
  The Secretary, acting through the Administrator of the Centers for 
Medicare and Medicaid Services, CMS and in partnership with the 
Director of the Centers for Disease Control and Prevention, CDC would 
implement the demonstration program to test whether these public health 
interventions targeting 55-64 year olds result in lower rates of 
chronic disease and reduce costs for the Medicare program. One 
assessment level of the act will measure the effects of adopting 
healthy lifestyle strategies on specific individuals who enroll in 
prevention programs in their communities.
  More specifically, program requirements in this act include an 
individual

[[Page S6190]]

health screening conducted by the state or local public health 
department or its designee. An individual health screening will include 
the appropriate test for diabetes, high blood pressure, high 
cholesterol, obesity, and tobacco use. Insured individuals who screen 
positive for chronic disease will be referred for treatment and for 
mental health screening and treatment to their existing providers or 
in-network providers. Individuals identified with chronic disease risk 
factors, such as high blood pressure or obesity, would be engaged in 
the community health interventions funded through the demonstration, 
such as walking programs, group exercise classes, or anti-smoking 
programs. Uninsured individuals who screen positive for chronic disease 
would be referred to the pre-selected clinical referral source for the 
demonstration site. Uninsured individuals who do not screen positive 
for chronic disease will receive information on healthy lifestyle 
choices and may also enroll in community level prevention 
interventions.
  This program will not only conduct community-based prevention 
strategies, screenings and health assessments, but also help support 
follow-up care for uninsured individuals identified with chronic 
diseases, including determining eligibility for public programs.
  I would like to thank Dr. Mary Polce-Lynch from Randolph-Macon 
College, who has been working in my office through the American 
Psychological Association and the American Association for the 
Advancement of Science, and Daniella Gratale from Trust for America's 
Health, for their work on this important prevention bill.
  I urge all of my colleagues to support this important legislation to 
help Americans adopt the healthiest lifestyles possible and to prevent 
chronic diseases in later life.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1181

       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. 7 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.

[[Page S6191]]

       (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.
                                 ______