[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.''.
                                 ______