[Congressional Record (Bound Edition), Volume 163 (2017), Part 10]
[Senate]
[Pages 15062-15068]
[From the U.S. 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--
       ``(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

[[Page 15063]]

     and services provided by specialized MA plans for special 
     needs individuals described in subsection (b)(6)(B)(ii) under 
     this title and title XIX. The Secretary shall solicit comment 
     in developing such procedures from States, plans, 
     beneficiaries and their representatives, and other relevant 
     stakeholders.
       ``(ii) Procedures.--The procedures established under clause 
     (i) shall be included in the plan contract under paragraph 
     (3)(D) and shall--

       ``(I) adopt the provisions for the enrollee that are most 
     protective for the enrollee and, to the extent feasible as 
     determined by the Secretary, are compatible with unified 
     timeframes and consolidated access to external review under 
     an integrated process;
       ``(II) take into account differences in State plans under 
     title XIX to the extent necessary;
       ``(III) be easily navigable by an enrollee; and
       ``(IV) include the elements described in clause (iii), as 
     applicable.

       ``(iii) Elements described.--Both unified appeals and 
     unified grievance procedures shall include, as applicable, 
     the following elements described in this clause:

       ``(I) Single written notification of all applicable 
     grievances and appeal rights under this title and title XIX. 
     For purposes of this subparagraph, the Secretary may waive 
     the requirements under section 1852(g)(1)(B) when the 
     specialized MA plan covers items or services under this part 
     or under title XIX.
       ``(II) Single pathways for resolution of any grievance or 
     appeal related to a particular item or service provided by 
     specialized MA plans for special needs individuals described 
     in subsection (b)(6)(B)(ii) under this title and title XIX.
       ``(III) Notices written in plain language and available in 
     a language and format that is accessible to the enrollee, 
     including in non-English languages that are prevalent in the 
     service area of the specialized MA plan.
       ``(IV) Unified timeframes for grievances and appeals 
     processes, such as an individual's filing of a grievance or 
     appeal, a plan's acknowledgment and resolution of a grievance 
     or appeal, and notification of decisions with respect to a 
     grievance or appeal.
       ``(V) Requirements for how the plan must process, track, 
     and resolve grievances and appeals, to ensure beneficiaries 
     are notified on a timely basis of decisions that are made 
     throughout the grievance or appeals process and are able to 
     easily determine the status of a grievance or appeal.

       ``(iv) Continuation of benefits pending appeal.--The 
     unified procedures under clause (i) shall, with respect to 
     all benefits under parts A and B and title XIX subject to 
     appeal under such procedures, incorporate provisions under 
     current law and implementing regulations that provide 
     continuation of benefits pending appeal under this title and 
     title XIX.
       ``(C) Requirement for unified grievances and appeals.--For 
     2021 and subsequent years, the contract of a specialized MA 
     plan for special needs individuals described in subsection 
     (b)(6)(B)(ii) with a State Medicaid agency under paragraph 
     (3)(D) shall require the use of unified grievances and 
     appeals procedures as described in subparagraph (B).
       ``(D) Requirements for integration.--For 2021 and 
     subsequent years, a specialized MA plan for special needs 
     individuals described in subsection (b)(6)(B)(ii) shall meet 
     one or more of the following requirements, to the extent 
     permitted under State law, for integration of benefits under 
     this title and title XIX:
       ``(i) The specialized MA plan must meet the requirements of 
     contracting with the State Medicaid agency described in 
     paragraph (3)(D) in addition to coordinating long-term 
     services and supports or behavioral health services, or both, 
     by meeting an additional minimum set of requirements 
     determined by the Secretary through the Federal Coordinated 
     Health Care Office established under section 2602 of the 
     Patient Protection and Affordable Care Act based on input 
     from stakeholders, such as notifying the State in a timely 
     manner of hospitalizations, emergency room visits, and 
     hospital or nursing home discharges of enrollees, assigning 
     one primary care provider for each enrollee, or sharing data 
     that would benefit the coordination of items and services 
     under this title and the State plan under title XIX. Such 
     minimum set of requirements must be included in the contract 
     of the specialized MA plan with the State Medicaid agency 
     under such paragraph.
       ``(ii) The specialized MA plan must meet the requirements 
     of a fully integrated plan described in section 
     1853(a)(1)(B)(iv)(II) (other than the requirement that the 
     plan have similar average levels of frailty, as determined by 
     the Secretary, as the PACE program), or enter into a 
     capitated contract with the State Medicaid agency to provide 
     long-term services and supports or behavioral health 
     services, or both.
       ``(iii) In the case where an individual is enrolled in both 
     the specialized MA plan and a Medicaid managed care 
     organization (as defined in section 1903(m)(1)(A)) providing 
     long term services and supports or behavioral health services 
     that have the same parent organization, the parent 
     organization offering both the specialized MA plan and the 
     Medicaid managed care plan must assume clinical and financial 
     responsibility for benefits provided under this title and 
     title XIX.''.
       (2) Conforming amendment to responsibilities of federal 
     coordinated health care office.--Section 2602(d) of the 
     Patient Protection and Affordable Care Act (42 U.S.C. 
     1315b(d)) is amended by adding at the end the following new 
     paragraphs:
       ``(6) To act as a designated contact for States under 
     subsection (f)(8)(A) of section 1859 of the Social Security 
     Act (42 U.S.C. 1395w-28) with respect to the integration of 
     specialized MA plans for special needs individuals described 
     in subsection (b)(6)(B)(ii) of such section.
       ``(7) To be responsible for developing regulations and 
     guidance related to the implementation of a unified grievance 
     and appeals process as described in subparagraphs (B) and (C) 
     of section 1859(f)(8) of the Social Security Act (42 U.S.C. 
     1395w-28(f)(8)).''.
       (c) Improvements to Severe or Disabling Chronic Condition 
     SNPs.--
       (1) Care management requirements.--Section 1859(f)(5) of 
     the Social Security Act (42 U.S.C. 1395w-28(f)(5)) is 
     amended--
       (A) by striking ``all snps.--The requirements'' and 
     inserting ``all snps.--
       ``(A) In general.--Subject to subparagraph (B), the 
     requirements'';
       (B) by redesignating subparagraphs (A) and (B) as clauses 
     (i) and (ii), respectively, and indenting appropriately;
       (C) in clause (ii), as redesignated by subparagraph (B), by 
     redesignating clauses (i) through (iii) as subclauses (I) 
     through (III), respectively, and indenting appropriately; and
       (D) by adding at the end the following new subparagraph:
       ``(B) Improvements to care management requirements for 
     severe or disabling chronic condition snps.--For 2020 and 
     subsequent years, in the case of a specialized MA plan for 
     special needs individuals described in subsection 
     (b)(6)(B)(iii), the requirements described in this paragraph 
     include the following:
       ``(i) The interdisciplinary team under subparagraph 
     (A)(ii)(III) includes a team of providers with demonstrated 
     expertise, including training in an applicable specialty, in 
     treating individuals similar to the targeted population of 
     the plan.
       ``(ii) Requirements developed by the Secretary to provide 
     face-to-face encounters with individuals enrolled in the plan 
     not less frequently than on an annual basis.
       ``(iii) As part of the model of care under clause (i) of 
     subparagraph (A), the results of the initial assessment and 
     annual reassessment under clause (ii)(I) of such subparagraph 
     of each individual enrolled in the plan are addressed in the 
     individual's individualized care plan under clause (ii)(II) 
     of such subparagraph.
       ``(iv) As part of the annual evaluation and approval of 
     such model of care, the Secretary shall take into account 
     whether the plan fulfilled the previous year's goals (as 
     required under the model of care).
       ``(v) The Secretary shall establish a minimum benchmark for 
     each element of the model of care of a plan. The Secretary 
     shall only approve a plan's model of care under this 
     paragraph if each element of the model of care meets the 
     minimum benchmark applicable under the preceding sentence.''.
       (2) Revisions to the definition of a severe or disabling 
     chronic conditions specialized needs individual.--
       (A) In general.--Section 1859(b)(6)(B)(iii) of the Social 
     Security Act (42 U.S.C. 1395w-28(b)(6)(B)(iii)) is amended--
       (i) by striking ``who have'' and inserting ``who--

       ``(I) before January 1, 2022, have'';

       (ii) in subclause (I), as added by clause (i), by striking 
     the period at the end and inserting ``; and''; and
       (iii) by adding at the end the following new subclause:

       ``(II) on or after January 1, 2022, have one or more 
     comorbid and medically complex chronic conditions that is 
     life threatening or significantly limits overall health or 
     function, have a high risk of hospitalization or other 
     adverse health outcomes, and require intensive care 
     coordination and that is listed under subsection 
     (f)(9)(A).''.

       (B) Panel of clinical advisors.--Section 1859(f) of the 
     Social Security Act (42 U.S.C. 1395w-28(f)), as amended by 
     subsection (b), is amended by adding at the end the following 
     new paragraph:
       ``(9) List of conditions for clarification of the 
     definition of a severe or disabling chronic conditions 
     specialized needs individual.--
       ``(A) In general.--Not later than December 31, 2020, and 
     every 5 years thereafter, the Secretary shall convene a panel 
     of clinical advisors to establish and update a list of 
     conditions that meet each of the following criteria:
       ``(i) Conditions that meet the definition of a severe or 
     disabling chronic condition under subsection (b)(6)(B)(iii) 
     on or after January 1, 2022.
       ``(ii) Conditions that require prescription drugs, 
     providers, and models of care that are unique to the specific 
     population of enrollees in a specialized MA plan for special 
     needs individuals described in such subsection on or after 
     such date and--

       ``(I) as a result of access to, and enrollment in, such a 
     specialized MA plan for special needs individuals, 
     individuals with such condition would have a reasonable 
     expectation of slowing or halting the progression of the 
     disease, improving health outcomes and decreasing overall 
     costs for individuals diagnosed with such condition compared 
     to available options of care other than through such a 
     specialized MA plan for special needs individuals; or
       ``(II) have a low prevalence in the general population of 
     beneficiaries under this title or a disproportionally high 
     per-beneficiary cost under this title.

       ``(B) Requirement.--In establishing and updating the list 
     under subparagraph (A), the

[[Page 15064]]

     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

[[Page 15065]]

     under paragraph (1), together with recommendations for such 
     legislation and administrative action as the Comptroller 
     General determines appropriate.

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

       (a) In General.--Section 1852 of the Social Security Act 
     (42 U.S.C. 1395w-22) is amended--
       (1) in subsection (a)(1)(B)(i), by inserting ``, subject to 
     subsection (m),'' after ``means''; and
       (2) by adding at the end the following new subsection:
       ``(m) Provision of Additional Telehealth Benefits.--
       ``(1) MA plan option.--For plan year 2020 and subsequent 
     plan years, subject to the requirements of paragraph (3), an 
     MA plan may provide additional telehealth benefits (as 
     defined in paragraph (2)) to individuals enrolled under this 
     part.
       ``(2) Additional telehealth benefits defined.--
       ``(A) In general.--For purposes of this subsection and 
     section 1854:
       ``(i) Definition.--The term `additional telehealth 
     benefits' means services--

       ``(I) for which benefits are available under part B, 
     including services for which payment is not made under 
     section 1834(m) due to the conditions for payment under such 
     section; and
       ``(II) that are identified as clinically appropriate to 
     furnish using electronic information and telecommunications 
     technology when a physician (as defined in section 1861(r)) 
     or practitioner (described in section 1842(b)(18)(C)) 
     providing the service is not at the same location as the plan 
     enrollee.

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

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

       (a) In General.--Section 1899 of the Social Security Act 
     (42 U.S.C. 1395jjj) is amended by adding at the end the 
     following new subsection:
       ``(l) Providing ACOs the Ability To Expand the Use of 
     Telehealth Services.--
       ``(1) In general.--In the case of telehealth services for 
     which payment would otherwise be made under this title 
     furnished on or after January 1, 2020, for purposes of this 
     subsection only, the following shall apply with respect to 
     such services furnished by a physician or practitioner 
     participating in an applicable ACO (as defined in paragraph 
     (2)) to a Medicare fee-for-service beneficiary assigned to 
     the applicable ACO:
       ``(A) Inclusion of home as originating site.--Subject to 
     paragraph (3), the home of a beneficiary shall be treated as 
     an originating site described in section 1834(m)(4)(C)(ii).
       ``(B) No application of geographic limitation.--The 
     geographic limitation under section 1834(m)(4)(C)(i) shall 
     not apply with respect to an originating site described in 
     section 1834(m)(4)(C)(ii) (including the home of a 
     beneficiary under subparagraph (A)), subject to State 
     licensing requirements.
       ``(2) Definitions.--In this subsection:
       ``(A) Applicable aco.--The term `applicable ACO' means an 
     ACO participating in a model tested or expanded under section 
     1115A or under this section--
       ``(i) that operates under a two-sided model--

       ``(I) described in section 425.600(a) of title 42, Code of 
     Federal Regulations; or
       ``(II) tested or expanded under section 1115A; and

       ``(ii) for which Medicare fee-for-service beneficiaries are 
     assigned to the ACO using a prospective assignment method, as 
     determined appropriate by the Secretary.
       ``(B) Home.--The term `home' means, with respect to a 
     Medicare fee-for-service beneficiary, the place of residence 
     used as the home of the beneficiary.
       ``(3) Telehealth services received in the home.--In the 
     case of telehealth services described in paragraph (1) where 
     the home of a Medicare fee-for-service beneficiary is the 
     originating site, the following shall apply:
       ``(A) No facility fee.--There shall be no facility fee paid 
     to the originating site under section 1834(m)(2)(B).
       ``(B) Exclusion of certain services.--No payment may be 
     made for such services that are inappropriate to furnish in 
     the home setting such as services that are typically 
     furnished in inpatient settings such as a hospital.''.
       (b) Study and Report.--
       (1) Study.--
       (A) In general.--The Secretary of Health and Human Services 
     (in this subsection referred to as the ``Secretary'') shall 
     conduct a study on the implementation of section 1899(l) of 
     the Social Security Act, as added by subsection (a). Such 
     study shall include an analysis of the utilization of, and 
     expenditures for, telehealth services under such section.
       (B) Collection of data.--The Secretary may collect such 
     data as the Secretary determines necessary to carry out the 
     study under this paragraph.
       (2) Report.--Not later than January 1, 2026, the Secretary 
     shall submit to Congress a report containing the results of 
     the study conducted under paragraph (1), together with 
     recommendations for such legislation and administrative 
     action as the Secretary determines appropriate.

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

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

          TITLE IV--IDENTIFYING THE CHRONICALLY ILL POPULATION

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

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

       ``(I) notified of their ability to make an identification 
     described in clause (i); and
       ``(II) informed of the process by which they may make and 
     change such identification.

       ``(iii) Superseding claims-based assignment.--A voluntary 
     identification by a Medicare fee-for-service beneficiary 
     under this subparagraph shall supersede any claims-based 
     assignment otherwise determined by the Secretary.''.

[[Page 15066]]



    TITLE V--EMPOWERING INDIVIDUALS AND CAREGIVERS IN CARE DELIVERY

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

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

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

       (a) Study.--The Comptroller General shall conduct a study 
     on the establishment under part B of the Medicare program 
     under title XVIII of the Social Security Act of a payment 
     code for a visit for longitudinal comprehensive care planning 
     services. Such study shall include an analysis of the 
     following to the extent such information is available:
       (1) The frequency with which services similar to 
     longitudinal comprehensive care planning services are 
     furnished to Medicare beneficiaries, which providers of 
     services and suppliers are furnishing those services, whether 
     Medicare reimbursement is being received for those services, 
     and, if so, through which codes those services are being 
     reimbursed.
       (2) Whether, and the extent to which, longitudinal 
     comprehensive care planning services would overlap, and could 
     therefore result in duplicative payment, with services 
     covered under the hospice benefit as well as the chronic care 
     management code, evaluation and management codes, or other 
     codes that already exist under part B of the Medicare 
     program.
       (3) Any barriers to hospitals, skilled nursing facilities, 
     hospice programs, home health agencies, and other applicable 
     providers working with a Medicare beneficiary to engage in 
     the care planning process and complete the necessary 
     documentation to support the treatment and care plan of the 
     beneficiary and provide such documentation to other providers 
     and the beneficiary or the beneficiary's representative.
       (4) Any barriers to providers, other than the provider 
     furnishing longitudinal comprehensive care planning services, 
     accessing the care plan and associated documentation for use 
     related to the care of the Medicare beneficiary.
       (5) Potential options for ensuring that applicable 
     providers are notified of a patient's existing longitudinal 
     care plan and that applicable providers consider that plan in 
     making their treatment decisions, and what the challenges 
     might be in implementing such options.
       (6) Stakeholder's views on the need for the development of 
     quality metrics with respect to longitudinal comprehensive 
     care planning services, such as measures related to--
       (A) the process of eliciting input from the Medicare 
     beneficiary or from a legally authorized representative and 
     documenting in the medical record the patient-directed care 
     plan;
       (B) the effectiveness and patient-centeredness of the care 
     plan in organizing delivery of services consistent with the 
     plan;

[[Page 15067]]

       (C) the availability of the care plan and associated 
     documentation to other providers that care for the 
     beneficiary; and
       (D) the extent to which the beneficiary received services 
     and support that is free from discrimination based on 
     advanced age, disability status, or advanced illness.
       (7) Stakeholder's views on how such quality metrics would 
     provide information on--
       (A) the goals, values, and preferences of the beneficiary;
       (B) the documentation of the care plan;
       (C) services furnished to the beneficiary; and
       (D) outcomes of treatment.
       (8) Stakeholder's views on--
       (A) the type of training and education needed for 
     applicable providers, individuals, and caregivers in order to 
     facilitate longitudinal comprehensive care planning services;
       (B) the types of providers of services and suppliers that 
     should be included in the interdisciplinary team of an 
     applicable provider; and
       (C) the characteristics of Medicare beneficiaries that 
     would be most appropriate to receive longitudinal 
     comprehensive care planning services, such as individuals 
     with advanced disease and individuals who need assistance 
     with multiple activities of daily living.
       (9) Stakeholder's views on the frequency with which 
     longitudinal comprehensive care planning services should be 
     furnished.
       (b) Report.--Not later than 18 months after the date of the 
     enactment of this Act, the Comptroller General shall submit 
     to Congress a report containing the results of the study 
     conducted under subsection (a), together with recommendations 
     for such legislation and administrative action as the 
     Comptroller General determines appropriate.
       (c) Definitions.--In this section:
       (1) Applicable provider.--The term ``applicable provider'' 
     means a hospice program (as defined in subsection (dd)(2) of 
     section 1861 of the Social Security Act (42 U.S.C. 1395ww)) 
     or other provider of services (as defined in subsection (u) 
     of such section) or supplier (as defined in subsection (d) of 
     such section) that--
       (A) furnishes longitudinal comprehensive care planning 
     services through an interdisciplinary team; and
       (B) meets such other requirements as the Secretary may 
     determine to be appropriate.
       (2) Comptroller general.--The term ``Comptroller General'' 
     means the Comptroller General of the United States.
       (3) Interdisciplinary team.--The term ``interdisciplinary 
     team'' means a group that--
       (A) includes the personnel described in subsection 
     (dd)(2)(B)(i) of such section 1861;
       (B) may include a chaplain, minister, or other clergy; and
       (C) may include other direct care personnel.
       (4) Longitudinal comprehensive care planning services.--The 
     term ``longitudinal comprehensive care planning services'' 
     means a voluntary shared decisionmaking process that is 
     furnished by an applicable provider through an 
     interdisciplinary team and includes a conversation with 
     Medicare beneficiaries who have received a diagnosis of a 
     serious or life-threatening illness. The purpose of such 
     services is to discuss a longitudinal care plan that 
     addresses the progression of the disease, treatment options, 
     the goals, values, and preferences of the beneficiary, and 
     the availability of other resources and social supports that 
     may reduce the beneficiary's health risks and promote self-
     management and shared decisionmaking.
       (5) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.

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

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

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

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

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

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

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

[[Page 15068]]



     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 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.

                          ____________________