[Congressional Record Volume 159, Number 93 (Wednesday, June 26, 2013)]
[Senate]
[Pages S5266-S5268]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
By Mr. WYDEN (for himself and Mr. Portman):
S. 1228. A bill to establish a program to provide incentive payments
to participating Medicare beneficiaries who voluntarily establish and
maintain better health; to the Committee on Finance.
Mr. WYDEN. 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. 1228
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 ``Medicare Better Health
Rewards Program Act of 2013''.
SEC. 2. MEDICARE BETTER HEALTH REWARDS PROGRAM.
Part B of title XVIII of the Social Security Act (42 U.S.C.
1395j et seq.) is amended by adding at the end the following
new section:
``medicare better health rewards program
``Sec. 1849. (a) In General.--The Secretary shall
establish a Better Health Rewards Program (in this section
referred to as the `Program') under which incentives are
provided to Medicare beneficiaries who voluntarily agree to
participate in the Program.
``(b) Enrollment.--A health professional participating in
the Program shall provide their patients who are Medicare
beneficiaries with a description of and an opportunity to
enroll in the Program on a voluntary basis. If a Medicare
beneficiary elects to enroll in the Program, the health
professional shall inform the Secretary of the individual's
enrollment through a process established by the Secretary,
which does not impose additional administrative requirements
on the participating health professional.
``(c) Establishment of Better Health Target Standards.--
``(1) In general.--
``(A) Establishment.--The Secretary shall establish
standards for measuring better health targets and points for
achieving such standards for participating Medicare
beneficiaries, including such standards and points with
respect to the following:
``(i) Annual wellness visit.
``(ii) Tobacco cessation.
``(iii) Body Mass Index (BMI).
``(iv) Diabetes screening test.
``(v) Cardiovascular disease screening.
``(vi) Cholesterol level screening.
``(vii) Screening tests and specified vaccinations.
``(B) Consultation.--In establishing standards and points
for achieving such standards under this subsection, the
Secretary--
``(i) shall consult with 1 or more nationally recognized
health care quality organizations, as determined appropriate
by the Secretary; and
``(ii) may consult with physicians and other professionals
experienced with wellness programs.
``(C) Points.--The number of points awarded for a year for
achieving standards with respect to each of the targets
described in clauses (i) through (vii) of subparagraph (A)
shall not exceed 5. Such points may be awarded on a sliding
scale, based on standards established under this subsection,
as determined appropriate by the Secretary.
``(2) Modification of better health target standards and
assigned points.--
``(A) In general.--The Secretary may modify standards for
measuring better health targets and, subject to paragraph
(1)(C), points for achieving such standards for participating
Medicare beneficiaries under this subsection.
``(B) Consultation.--In modifying standards and points for
achieving such standards under this paragraph, the
Secretary--
``(i) shall consult with 1 or more nationally recognized
health care quality organizations, as determined appropriate
by the Secretary; and
``(ii) may consult with physicians and other professionals
experienced with wellness programs.
``(d) Conduct of Program.--
``(1) Duration.--
``(A) In general.--Subject to subparagraph (B), the Program
shall be conducted for not less than a 3-year period.
``(B) Expansion.--The Secretary shall expand the duration
and scope of the Program, to the extent determined
appropriate by the Secretary, if--
``(i) the Secretary determines that such expansion is
expected to--
``(I) reduce spending under this title without reducing the
quality of care; or
``(II) improve the quality of care and reduce spending;
``(ii) the Chief Actuary of the Centers for Medicare &
Medicaid Services certifies that such expansion would reduce
program spending under this title; and
``(iii) the Secretary determines that such expansion would
not deny or limit the coverage or provision of benefits under
this title for individuals.
``(2) Collection and use of baseline data.--During the
first year of the Program, a health professional shall
establish and report to the Secretary baseline information
for each participating Medicare beneficiary who is a patient
of the health professional as part of that beneficiary's
first year assessment under paragraph (3)(A). The health
professional shall use such data to aid in the determination
of whether and to what extent the participating Medicare
beneficiary is meeting the target standards under subsection
(c) in each of years 2 and 3 of the Program.
``(3) Required assessments for participating medicare
beneficiaries.--
``(A) First year.--During year 1 of the Program, a health
professional shall furnish to each participating Medicare
beneficiary that is a patient of the health professional
either an annual wellness visit or an initial preventive
physical examination.
[[Page S5267]]
``(B) Second and third years.--During each of years 2 and 3
of the Program, a health professional shall furnish to each
participating Medicare beneficiary that is a patient of the
health professional an annual wellness visit to determine
whether and to what extent the participating Medicare
beneficiary has met the target standards under subsection
(c).
``(e) Determination of Points and Payment of Incentives.--
``(1) Determination of points.--During each of years 2 and
3 of the Program, a health professional shall--
``(A) evaluate and report to the Secretary whether each
participating Medicare beneficiary that is a patient of the
health professional has achieved the target standards under
subsection (c); and
``(B) determine the total amount of points that each such
participating Medicare beneficiary has achieved for the year
based on the points assigned for achieving such standards
under subsection (c).
``(2) Incentive payment.--
``(A) In general.--The Secretary shall pay to each
participating Medicare beneficiary who achieves at least 20
points under paragraph (1)(B) for the year an incentive
payment. Such payment shall be equal to an amount determined
appropriate by the Secretary, but no case shall such amount
exceed the following:
------------------------------------------------------------------------
Year 3 or a
``Points Year 2 Payment Subsequent Year
Amount Payment Amount
------------------------------------------------------------------------
20-24 points...................... $100 $200
------------------------------------------------------------------------
25 or more points................. $200 $400.
------------------------------------------------------------------------
``(B) Inflation adjustment.--The dollar amounts specified
in this paragraph shall be increased, beginning with 2017,
from year to year based on the percentage increase in the
consumer price index for all urban consumers (all items;
United States city average), rounded to the nearest $1.
``(3) Final determination of standards achievement made by
participating health professional.--Under the Program, a
participating health professional shall make the final
determination as to whether or not a participating Medicare
beneficiary has met the target standards under subsection (c)
and what screening tests and specified vaccinations, or other
services, are necessary for purposes of making such
determination.
``(f) Spending Benchmarks.--
``(1) In general.--The Secretary shall collect relevant
data, including data on claims paid under this title for
services furnished to participating Medicare beneficiaries
during the Program, for purposes of determining the aggregate
estimated savings achieved under this title for participating
Medicare beneficiaries during each of years 2 and 3 of the
Program in accordance with paragraph (2) (and for a
subsequent year if the Program is expanded under subsection
(d)(1)(B)).
``(2) Determination of aggregate estimated savings.--
``(A) In general.--The amount of the aggregate estimated
savings under this title for participating Medicare
beneficiaries under paragraph (1), with respect to a year,
shall be equal to--
``(i) the estimated savings determined under subparagraph
(B) for the year; minus
``(ii) the aggregate incentive payments made under the
Program during the year.
``(B) Determination of estimated savings.--For purposes of
subparagraph (A)(i), the estimated savings determined under
this subparagraph for a year shall be equal to--
``(i) the estimated aggregate expenditures under this title
(as projected under subparagraph (C)) for the year; minus
``(ii) the actual aggregate expenditures under this title
(as determined by the Secretary and taking into account any
reduction in specific health risks of the participating
Medicare beneficiaries) for the year.
``(C) Projection of estimated aggregate claims cost.--
``(i) Benchmark base year.--The Secretary shall establish a
benchmark base year amount of expenditures under this title
for participating Medicare beneficiaries during year 1 of the
Program.
``(ii) Projection.--The Secretary shall use the benchmark
base year amount established under clause (i) to project the
estimated aggregate expenditures for all participating
Medicare beneficiaries during each of years 2 and 3 of the
Program as if the beneficiaries were not participating in the
Program. In making such projection, the Secretary may include
adjustments for health status or other specific risk factors
and geographic variation for the participating Medicare
beneficiaries.
``(D) Public report of determination and other program
information.--Not later than 90 days after determining the
aggregate estimated savings (if any) under subparagraph (A)
with respect to a year, the Secretary shall make available to
the public a report containing a description of the amount of
the savings determined, including the methodology and any
other calculations or determinations involved in the
determination of such amount. Such report shall include--
``(i) a description of any reduction in specific health
risks of participating Medicare beneficiaries identified by
the Secretary;
``(ii) a description of--
``(I) standards for measuring better health targets under
subsection (c); and
``(II) the points available for achieving each such
standard under that subsection; and
``(iii) recommendations for such legislation and
administrative action as the Secretary determines
appropriate.
``(3) Monitoring of program costs.--During the operation of
the Program, the Chief Actuary of the Centers for Medicare &
Medicaid Services shall--
``(A) monitor the Program to determine whether or not the
Program is reducing aggregate expenditures under this title;
and
``(B) submit to the Secretary an annual report on the
results of such monitoring.
``(4) Required action if aggregate incentive payments
exceed savings.--If the Secretary, taking into account the
reports under paragraph (3)(B), determines that the aggregate
expenditures under this title exceed the aggregate
expenditures under this title that would have been made if
the Program had not been implemented, the Secretary shall
provide for changes to the provisions of the program in order
to eliminate such excess.
``(g) Waiver Authority.--The Secretary may waive such
requirements of titles XI and XVIII as may be necessary to
carry out the purposes of the Program established under this
section.
``(h) Definitions.--In this section:
``(1) Annual wellness visit.--The term `annual wellness
visit' includes personalized prevention plan services (as
defined in section 1861(hhh)(1)).
``(2) Health professional.--The term `health professional'
includes a physician (as defined in section 1861(r)(1)) and a
practitioner described in clause (i) of section
1842(b)(18)(C).
``(3) Initial preventive physical examination.--The term
`initial preventive physical examination' has the meaning
given that term in section 1861(ww)(1).
``(4) Medicare beneficiary.--The term `Medicare
beneficiary' means an individual enrolled in part B.
``(5) Participating medicare beneficiary.--The term
`participating Medicare beneficiary' means a Medicare
beneficiary who enrolls in the Program under subsection (b).
``(6) Screening tests.--The term `screening tests' means
any of the following that are determined by a health
professional to be appropriate for a participating Medicare
beneficiary:
``(A) Colorectal cancer screening tests (as defined in
section 1861(pp)).
``(B) Screening mammography (as described in section
1861(jj)).
``(C) Screening pap smear and screening pelvic exam (as
defined in section 1861(nn)).
``(D) Screening for glaucoma (as defined in section
1861(uu)).
``(E) Bone mass measurement (as defined in section
1861(rr)) for qualified individuals described in paragraph
(2)(A) of such section.
``(F) HIV screening for high-risk groups (as identified by
the Secretary).
``(7) Specified vaccinations.--The term `specified
vaccinations' means the vaccinations described in section
1861(ww)(1) that are determined by a health professional to
be appropriate for a participating Medicare beneficiary.''.
SEC. 3. PARTICIPATION BY MEDICARE ADVANTAGE PLANS.
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) Providing Incentives for Voluntary Participation in a
Better Health Rewards Program.--
``(1) In general.--Effective for plan years beginning on or
after the date of enactment of the Medicare Better Health
Rewards Program Act of 2013, a Medicare Advantage
organization may provide to individuals enrolled in an MA
plan offered by the organization incentive payments,
including cash, cash-equivalent, or other types of
incentives, for voluntary participation in a Better Health
Rewards Program (in this subsection referred to as the
`Program') that rewards individuals for meeting certain
health targets established by the Secretary.
``(2) Limitation.--In no case shall the monthly bid amount
submitted by a Medicare Advantage organization under section
1834(a)(6) (or the monthly premium charged by the
organization under section 1854(b)) with respect to an MA
plan offered by the organization take into account any
incentive payments made to enrollees under the Program.
``(3) Implementation.--The Program under this subsection
shall be conducted in a similar manner to the manner in which
the program under section 1849 is conducted, in accordance
with standards established by the Secretary.
``(4) Notification and provision of information.--A
Medicare Advantage organization seeking to participate in the
Program shall--
``(A) notify the Secretary of the organization's intent to
participate in the Program; and
``(B) agree to provide to the Secretary--
``(i) information regarding--
``(I) which enrollees participate in the Program;
``(II) the scores of those enrollees with respect to
applicable health targets under the Program; and
``(III) the incentives enrollees receive for meeting such
health targets; and
[[Page S5268]]
``(ii) any other information specified by the Secretary for
purposes of this subsection.
``(5) Waiver authority.--The Secretary may waive such
requirements of titles XI and XVIII as may be necessary to
carry out the purposes of the Program established under this
subsection.''.
SEC. 4. PARTICIPATION OF SECTION 1876 COST PLANS.
Section 1876 of the Social Security Act (42 U.S.C. 1395mm)
is amended by inserting at the end the following:
``(l) Providing Incentives for Voluntary Participation in a
Better Health Rewards Program.--
``(1) In general.--Effective for contract periods beginning
on or after the date of enactment of the Medicare Better
Health Rewards Program Act of 2013, an eligible organization
may provide to members enrolled under this section with the
organization incentive payments, including cash, cash-
equivalent, or other types of incentives, for voluntary
participation in a Better Health Rewards Program (in this
subsection referred to as the `Program') that rewards members
for meeting certain health targets established by the
Secretary.
``(2) Limitation.--In no case shall the payment to an
eligible organization under this section (or the premium rate
charged by the organization under this section) with respect
to members enrolled with the organization take into account
any incentive payments made to members under the Program.
``(3) Implementation.--The Program under this subsection
shall be conducted in a similar manner to the manner in which
the program under section 1849 is conducted, in accordance
with standards established by the Secretary.
``(4) Notification and provision of information.--An
eligible organization seeking to participate in the Program
shall--
``(A) notify the Secretary of the organization's intent to
participate in the Program; and
``(B) agree to provide to the Secretary--
``(i) information regarding--
``(I) which members participate in the Program;
``(II) the scores of those members with respect to
applicable health targets under the Program; and
``(III) the incentives members receive for meeting such
health targets; and
``(ii) any other information specified by the Secretary for
purposes of this subsection.
``(5) Waiver authority.--The Secretary may waive such
requirements of titles XI and XVIII as may be necessary to
carry out the purposes of the Program established under this
subsection.''.
SEC. 5. PARTICIPATION OF PROGRAMS OF ALL-INCLUSIVE CARE FOR
THE ELDERLY (PACE).
(a) Medicare.--Section 1894 of the Social Security Act (42
U.S.C. 1395eee) is amended by inserting at the end the
following:
``(j) Providing Incentives for Voluntary Participation in a
Better Health Rewards Program.--
``(1) In general.--Effective for PACE program agreements
entered into on or after the date of enactment of the
Medicare Better Health Rewards Program Act of 2013, a PACE
provider may provide to PACE program eligible individuals
enrolled under this section with the PACE provider incentive
payments, including cash, cash-equivalent, or other types of
incentives, for voluntary participation in a Better Health
Rewards Program (in this subsection referred to as the
`Program') that rewards enrollees for meeting certain health
targets established by the Secretary.
``(2) Limitation.--In no case shall the payment to a PACE
provider under this section (or any premium charged by the
provider under this section) with respect to PACE program
eligible individuals enrolled with the PACE provider take
into account any incentive payments made to individuals under
the Program.
``(3) Implementation.--The Program under this subsection
shall be conducted in a similar manner to the manner in which
the program under section 1849 is conducted, in accordance
with standards established by the Secretary.
``(4) Notification and provision of information.--A PACE
provider seeking to participate in the Program shall--
``(A) notify the Secretary of the PACE provider's intent to
participate in the Program; and
``(B) agree to provide to the Secretary--
``(i) information regarding--
``(I) which PACE program eligible individuals enrolled with
the PACE provider participate in the Program;
``(II) the scores of those individuals with respect to
applicable health targets under the Program; and
``(III) the incentives individuals receive for meeting such
health targets; and
``(ii) any other information specified by the Secretary for
purposes of this subsection.
``(5) Waiver authority.--The Secretary may waive such
requirements of titles XI, XVIII, and XIX as may be necessary
to carry out the purposes of the Program established under
this subsection.''.
(b) Medicaid.--Section 1934 of the Social Security Act (42
U.S.C. 1396u-4) is amended by adding at the end the following
new subsection:
``(k) Providing Incentives for Voluntary Participation in a
Better Health Rewards Program.--
``(1) In general.--Effective for PACE program agreements
entered into on or after the date of enactment of the
Medicare Better Health Rewards Program Act of 2013, a PACE
provider may provide to PACE program eligible individuals
enrolled under this section with the PACE provider incentive
payments, including cash, cash-equivalent, or other types of
incentives, for voluntary participation in a Better Health
Rewards Program (in this subsection referred to as the
`Program') that rewards enrollees for meeting certain health
targets established by the Secretary.
``(2) Limitation.--In no case shall the payment to a PACE
provider under this section (or any premium charged by the
provider under this section) with respect to PACE program
eligible individuals enrolled with the PACE provider take
into account any incentive payments made to individuals under
the Program.
``(3) Implementation.--The Program under this subsection
shall be conducted in a similar manner to the manner in which
the program under section 1849 is conducted, in accordance
with standards established by the Secretary.
``(4) Notification and provision of information.--A PACE
provider seeking to participate in the Program shall--
``(A) notify the Secretary of the PACE provider's intent to
participate in the Program; and
``(B) agree to provide to the Secretary--
``(i) information regarding--
``(I) which PACE program eligible individuals enrolled with
the PACE provider participate in the Program;
``(II) the scores of those individuals with respect to
applicable health targets under the Program; and
``(III) the incentives individuals receive for meeting such
health targets; and
``(ii) any other information specified by the Secretary for
purposes of this subsection.
``(5) Waiver authority.--The Secretary may waive such
requirements of titles XI, XVIII, and XIX as may be necessary
to carry out the purposes of the Program established under
this subsection.''.
SEC. 6. EXCLUSION OF INCENTIVE PAYMENTS.
(a) In General.--Part III of subchapter B of chapter 1 of
the Internal Revenue Code of 1986 is amended by inserting
after section 139D the following new section:
``SEC. 139E. MEDICARE BETTER HEALTH REWARDS PAYMENTS.
``Gross income shall not include any payment made under the
following programs:
``(1) The Medicare Better Health Rewards Program
established under section 1849 of the Social Security Act.
``(2) A Better Health Rewards Program established pursuant
to section 1859(h), 1876(l), 1894(j), or 1934(k) of the
Social Security Act.''.
(b) Clerical Amendment.--The table of sections for part III
of subchapter B of chapter 1 of such Code is amended by
inserting after the item relating to section 139D the
following new item:
``Sec. 139E. Medicare Better Health Rewards payments.''.
______