[Congressional Record Volume 163, Number 154 (Tuesday, September 26, 2017)]
[Senate]
[Pages S6147-S6153]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CREATING HIGH-QUALITY RESULTS AND OUTCOMES NECESSARY TO IMPROVE CHRONIC
(CHRONIC) CARE ACT OF 2017
Mr. CORNYN. Mr. President, I ask unanimous consent that the Senate
proceed to the immediate consideration of Calendar No. 206, S. 870.
The PRESIDING OFFICER. The clerk will report the bill by title.
The bill clerk read as follows:
A bill (S. 870) 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.
There being no objection, the Senate proceeded to consider the bill,
which had been reported from the Committee on Finance, with an
amendment to strike all after the enacting clause and insert in lieu
thereof the following:
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--
[[Page S6148]]
``(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
[[Page S6149]]
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.
[[Page S6150]]
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:
[[Page S6151]]
``(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.
[[Page S6152]]
(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''.
Mr. WYDEN. Mr. President, today is a big day in the ongoing effort to
update and strengthen Medicare's guarantee to seniors. Senate passage
of the
[[Page S6153]]
Finance Committee's chronic care bill means seniors with multiple
chronic illnesses will have their individual needs better met and get
the type of care they need earlier.
It is my judgment that the Finance Committee has no job more
significant than updating the Medicare guarantee, and that is exactly
what today is all about. The CHRONIC Care Act begins a transformational
change in the way Medicare works for seniors who suffer from chronic
illnesses like cancer, diabetes, and Alzheimer's disease.
If you could bring the lawmakers responsible for the creation of
Medicare into 2017, they would barely recognize the program they
created more than half a century ago. Back then, if a senior needed
surgery for a broken hip, he or she visited a hospital and used
Medicare Part A. If a senior needed treatment for a nasty bout of the
flu, he or she visited their doctor and used Part B.
Today, more than 90 percent of the Medicare dollar goes toward
seniors who have two or more chronic conditions. Today's seniors get
their care in a variety of ways. It is not just fee-for-service; there
are Medicare Advantage, Accountable Care Organizations, and other new
systems under development.
Keeping up with those changes--updating the Medicare guarantee--is a
big policymaking challenge, and that is why the Finance Committee
worked so hard, for so long, to get this bill across the finish line.
There are still more steps before these policies reach the President's
desk, but with strong bipartisan backing of the entire U.S. Senate, I
am confident the job will get done.
The CHRONIC Care Act will mean more care at home and less in
institutions. It will expand the use of lifesaving technology. It
places a stronger focus on primary care. It gives seniors, however they
get Medicare, more tools and options to receive care specifically
targeted to address their chronic illnesses and keep them healthy.
Those are all important steps forward in updating the Medicare
guarantee. Still to come is ensuring that every senior with multiple
chronic conditions has an advocate to help them navigate through the
Byzantine healthcare system.
Finally just a few points about the bipartisan process leading to
this bill's passage today. The Finance Committee, in my view, has
handed the Congress a model for how to legislate on a bipartisan basis.
I want to thank Chairman Hatch, with whom I formed a bipartisan chronic
care working group almost exactly 2 years ago, and I want to thank
Senators Warner and Isakson who generously took on the challenge of
leading it.
Of course this bill wouldn't have materialized at all if not for the
sweat equity put in by staff. Somewhere amid all the endless hours of
work that went into writing this bill, they found time for multiple
weddings, the birth of three children, and a handful of job changes.
Thank you to Karen Fisher, Hannah Hawkins, Kelsey Avery, Leigh
Stuckhardt, Liz Jurinka, Beth Vrabel, and Matt Kazan--our chronic care
lead--all on my team. Chairman Hatch, I thank you for your commitment
to keep working on this and to your staff, including Jay Khosla, Brett
Baker, Jen Kuskowski, Katie Meyer-Simeon, and the chronic care lead,
Erin Dempsey. Thank you also to Senators Warner and Isakson for lending
us Marvin Figueroa and Jordan Bartolomeo.
Mr. CORNYN. Mr. President, I ask unanimous consent that the
committee-reported amendment be agreed to, and the bill, as amended, be
considered read a third time.
The PRESIDING OFFICER. Without objection, it is so ordered.
The committee-reported amendment in the nature of a substitute was
agreed to.
The bill was ordered to be engrossed for a third reading and was read
the third time.
Mr. CORNYN. Mr. President, I know of no further debate on the bill.
The PRESIDING OFFICER. Is there further debate on the bill?
Hearing none, the bill having been read the third time, the question
is, Shall it pass?
The bill (S. 870), as amended, was passed.
Mr. CORNYN. Mr. President, I ask unanimous consent that the motion to
reconsider be considered made and laid upon the table.
The PRESIDING OFFICER. Without objection, it is so ordered.
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