Provides for fast-track consideration of prevention benefit legislation.
Directs the Secretary to conduct demonstration projects for the purpose of promoting disease self-management for conditions identified, and appropriately prioritized, by the Secretary for specified at-risk target individuals.
Amends SSA title XVIII to require the Secretary to establish a comprehensive and systematic model for delivering health promotion and disease prevention services, and conduct demonstration projects to develop it.
Provides for coverage of care coordination and assessment services furnished by a care coordinator as a Medicare part B medical service.
Directs the Secretary to provide for appropriate adjustments to specified payment systems to take into account the additional costs incurred in providing items and services under the Medicare program to Medicare beneficiaries who suffer from serious and disabling chronic conditions.
Requires the Secretary to: (1) revise the risk adjustment methodology under SSA title XVIII part C (Medicare+Choice) applicable to payments to Medicare+Choice organizations offering specialized programs for frail elderly and at-risk beneficiaries to take into account variations in costs incurred by such organizations; and (2) establish a demonstration program under which additional payments may be made to such an organization, if certain requirements are met.
Directs the Secretary to: (1) study and report to Congress on chronic condition trends of Medicare beneficiaries and associated service utilization, quality indicators, and cumulative costs; and (2) contract with the Institute of Medicine of the National Academy of Sciences to make a Medicare chronic condition care improvement study and report.
[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 1589 Introduced in Senate (IS)]
107th CONGRESS
1st Session
S. 1589
To amend title XVIII of the Social Security Act to expand medicare
benefits to prevent, delay, and minimize the progression of chronic
conditions, establish payment incentives for furnishing quality
services to people with serious and disabling chronic conditions, and
develop national policies on effective chronic condition care, and for
other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
October 30, 2001
Mr. Rockefeller (for himself, Mr. Wellstone, and Mr. Baucus) introduced
the following bill; which was read twice and referred to the Committee
on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to expand medicare
benefits to prevent, delay, and minimize the progression of chronic
conditions, establish payment incentives for furnishing quality
services to people with serious and disabling chronic conditions, and
develop national policies on effective chronic condition care, and for
other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Medicare Chronic
Care Improvement Act of 2001''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
TITLE I--EXPANSION OF BENEFITS TO PREVENT, DELAY, AND MINIMIZE THE
PROGRESSION OF CHRONIC CONDITIONS.
Subtitle A--Improving Access to Preventive Services
Sec. 101. Definitions.
Sec. 102. Elimination of deductibles and coinsurance for existing
preventive health benefits.
Sec. 103. Institute of Medicine medicare prevention benefit study and
report.
Sec. 104. Authority to administratively provide for coverage of
additional preventive benefits.
Sec. 105. Fast-track consideration of prevention benefit legislation.
Subtitle B--Expansion of Access to Health Promotion Services
Sec. 111. Disease self-management demonstration projects.
Sec. 112. Medicare health education and risk appraisal program.
Subtitle C--Medicare Coverage for Care Coordination and Assessment
Services
Sec. 121. Care coordination and assessment services.
TITLE II--PAYMENT INCENTIVES FOR QUALITY CARE FOR INDIVIDUALS WITH
SERIOUS AND DISABLING CHRONIC CONDITIONS
Sec. 201. Adjustments to fee-for-service payment systems.
Sec. 202. Medicare+Choice.
TITLE III--DEVELOPMENT OF NATIONAL POLICIES ON EFFECTIVE CHRONIC
CONDITION CARE
Sec. 301. Study and report on effective chronic condition care.
Sec. 302. Institute of Medicine medicare chronic condition care
improvement study and report.
SEC. 2. DEFINITIONS.
In this Act:
(1) Secretary.--Unless otherwise specifically provided, the
term ``Secretary'' means the Secretary of Health and Human
Services.
(2) Serious and disabling chronic condition.--The term
``serious and disabling chronic condition'' means, with respect
to an individual, that the individual has at least one physical
or mental condition and a licensed health care practitioner has
certified within the preceding 12-month period that--
(A) the individual has a level of disability such
that the individual is unable to perform (without
substantial assistance from another individual) for a
period of at least 90 days due to a loss of functional
capacity--
(i) at least 2 activities of daily living;
or
(ii) such number of instrumental activities
of daily living that is equivalent (as
determined by the Secretary) to the level of
disability described in clause (i);
(B) the individual has a level of disability
equivalent (as determined by the Secretary) to the
level of disability described in subparagraph (A); or
(C) the individual requires substantial supervision
to protect the individual from threats to health and
safety due to severe cognitive impairment.
(3) Activities of daily living.--The term ``activities of
daily living'' means each of the following:
(A) Eating.
(B) Toileting.
(C) Transferring.
(D) Bathing.
(E) Dressing.
(F) Continence.
(4) Instrumental activities of daily living.--The term
``instrumental activities of daily living'' means each of the
following:
(A) Medication management.
(B) Meal preparation.
(C) Shopping.
(D) Housekeeping.
(E) Laundry.
(F) Money management.
(G) Telephone use.
(H) Transportation use.
TITLE I--EXPANSION OF BENEFITS TO PREVENT, DELAY, AND MINIMIZE THE
PROGRESSION OF CHRONIC CONDITIONS.
Subtitle A--Improving Access to Preventive Services
SEC. 101. DEFINITIONS.
In this title:
(1) Cost-effective benefit.--The term ``cost-effective
benefit'' means a benefit or technique that has--
(A) been subject to peer review;
(B) been described in scientific journals; and
(C) demonstrated value as measured by unit costs
relative to health outcomes achieved.
(2) Cost-saving benefit.--The term ``cost-saving benefit''
means a benefit or technique that has--
(A) been subject to peer review;
(B) been described in scientific journals; and
(C) caused a net reduction in health care costs for
medicare beneficiaries.
(3) Medically effective.--The term ``medically effective''
means, with respect to a benefit or technique, that the benefit
or technique has been--
(A) subject to peer review;
(B) described in scientific journals; and
(C) determined to achieve an intended goal under
normal programmatic conditions.
(4) Medically efficacious.--The term ``medically
efficacious'' means, with respect to a benefit or technique,
that the benefit or technique has been--
(A) subject to peer review;
(B) described in scientific journals; and
(C) determined to achieve an intended goal under
controlled conditions.
SEC. 102. ELIMINATION OF DEDUCTIBLES AND COINSURANCE FOR EXISTING
PREVENTIVE HEALTH BENEFITS.
(a) In General.--Section 1833 of the Social Security Act (42 U.S.C.
1395l) is amended by inserting after subsection (o) the following new
subsection:
``(p) Deductibles and Coinsurance Waived for Preventive Health
Items and Services.--The Secretary shall not require the payment of any
deductible or coinsurance under subsection (a) or (b), respectively, of
any individual enrolled for coverage under this part for any of the
following preventive health items and services:
``(1) Blood-testing strips, lancets, and blood glucose
monitors for individuals with diabetes described in section
1861(n).
``(2) Diabetes outpatient self-management training services
(as defined in section 1861(qq)(1)).
``(3) Pneumococcal, influenza, and hepatitis B vaccines and
administration described in section 1861(s)(10).
``(4) Screening mammography (as defined in section
1861(jj)).
``(5) Screening pap smear and screening pelvic exam (as
defined in paragraphs (1) and (2) of section 1861(nn),
respectively).
``(6) Bone mass measurement (as defined in section
1861(rr)(1)).
``(7) Prostate cancer screening test (as defined in section
1861(oo)(1)).
``(8) Colorectal cancer screening test (as defined in
section 1861(pp)(1)).
``(9) Screening for glaucoma (as defined in section
1861(uu)).
``(10) Medical nutrition therapy services (as defined in
section 1861(vv)(1)).''.
(b) Waiver of Coinsurance.--
(1) In general.--Section 1833(a)(1)(B) of the Social
Security Act (42 U.S.C. 1395l(a)(1)(B)) is amended to read as
follows: ``(B) with respect to preventive health items and
services described in subsection (p), the amounts paid shall be
100 percent of the fee schedule or other basis of payment under
this title for the particular item or service,''.
(2) Elimination of coinsurance in outpatient hospital
settings.--The third sentence of section 1866(a)(2)(A) of the
Social Security Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by
inserting after ``1861(s)(10)(A)'' the following: ``,
preventive health items and services described in section
1833(p),''.
(c) Waiver of Application of Deductible.--Section 1833(b)(1) of the
Social Security Act (42 U.S.C. 1395l(b)(1)) is amended to read as
follows: ``(1) such deductible shall not apply with respect to
preventive health items and services described in subsection (p),''.
(d) Adding ``Lancet'' to Definition of DME.--Section 1861(n) of the
Social Security Act (42 U.S.C. 1395x(n)) is amended by striking
``blood-testing strips and blood glucose monitors'' and inserting
``blood-testing strips, lancets, and blood glucose monitors''.
(e) Conforming Amendments.--
(1) Elimination of coinsurance for clinical diagnostic
laboratory tests.--Paragraphs (1)(D)(i) and (2)(D)(i) of
section 1833(a) of the Social Security Act (42 U.S.C.
1395l(a)), as amended by section 201(b)(1) of the Medicare,
Medicaid, and SCHIP Benefits Improvement and Protection Act of
2000 (114 Stat. 2763A-481), as enacted into law by section
1(a)(6) of Public Law 106-554, are each amended by inserting
``or which are described in subsection (p)'' after
``assignment-related basis''.
(2) Elimination of coinsurance for certain dme.--Section
1834(a)(1)(A) of the Social Security Act (42 U.S.C.
1395m(a)(1)(A)) is amended by inserting ``(or 100 percent, in
the case of such an item described in section 1833(p))'' after
``80 percent''.
(3) Elimination of deductibles and coinsurance for
colorectal cancer screening tests.--Section 1834(d) of the
Social Security Act (42 U.S.C. 1395m(d)) is amended--
(A) in paragraph (2)(C)--
(i) by striking ``(C) Facility payment
limit.--'' and all that follows through
``Notwithstanding subsections'' and inserting
the following:
``(C) Facility payment limit.--Notwithstanding
subsections'';
(ii) by striking ``(I) in accordance'' and
inserting the following:
``(i) in accordance'';
(iii) by striking ``(II) are performed''
and all that follows through ``payment under''
and inserting the following:
``(ii) are performed in an ambulatory
surgical center or hospital outpatient
department,
payment under''; and
(iv) by striking clause (ii); and
(B) in paragraph (3)(C)--
(i) by striking ``(C) Facility payment
limit.--'' and all that follows through
``Notwithstanding subsections'' and inserting
the following:
``(C) Facility payment limit.--Notwithstanding
subsections''; and
(ii) by striking clause (ii).
(f) Effective Date.--The amendments made by this section shall
apply to services furnished on or after the day that is 1 year after
the date of enactment of this Act.
SEC. 103. INSTITUTE OF MEDICINE MEDICARE PREVENTION BENEFIT STUDY AND
REPORT.
(a) Study.--
(1) In general.--The Secretary shall contract with the
Institute of Medicine of the National Academy of Sciences to--
(A) conduct a comprehensive study of current
literature and best practices in the field of health
promotion and disease prevention among medicare
beneficiaries, including the issues described in
paragraph (2); and
(B) submit the report described in subsection (b).
(2) Issues studied.--The study required under paragraph (1)
shall include an assessment of--
(A) whether each health promotion and disease
prevention benefit covered under the medicare program
is--
(i) medically effective (as defined in
section 101(3)); or
(ii) a cost-effective benefit (as defined
in section 101(1)) or a cost-saving benefit (as
defined in section 101(2));
(B) utilization by medicare beneficiaries of such
benefits (including any barriers to or incentives to
increase utilization);
(C) quality of life issues associated with such
benefits; and
(D) whether health promotion and disease prevention
benefits that are not covered under the medicare
program that would affect all medicare beneficiaries
are--
(i) likely to be medically effective (as
defined in section 101(3)); or
(ii) likely to be a cost-effective benefit
(as defined in section 101(1)) or a cost-saving
benefit (as defined in section 101(2));
(b) Reports.--
(1) Three-year report.--On the date that is 3 years after
the date of enactment of this Act, and each successive 3-year
anniversary thereafter, the Institute of Medicine of the
National Academy of Sciences shall submit to the President a
report that contains--
(A) a detailed statement of the findings and
conclusions of the study conducted under subsection
(a); and
(B) the recommendations for legislation described
in paragraph (3).
(2) Interim report based on new guidelines.--If the United
States Preventive Services Task Force or the Task Force on
Community Preventive Services establishes new guidelines
regarding preventive health benefits for medicare beneficiaries
more than 1 year prior to the date that a report described in
paragraph (1) is due to be submitted to the President, then not
later than 6 months after the date such new guidelines are
established, the Institute of Medicine of the National Academy
of Sciences shall submit to the President a report that
contains a detailed description of such new guidelines. Such
report may also contain recommendations for legislation
described in paragraph (3).
(3) Recommendations for legislation.--The Institute of
Medicine of the National Academy of Sciences, in consultation
with the United States Preventive Services Task Force and the
Task Force on Community Preventive Services, shall develop
recommendations in legislative form that--
(A) prioritize the preventive health benefits under
the medicare program; and
(B) modify such benefits, including adding new
benefits under such program, based on the study
conducted under subsection (a).
(c) Transmission to Congress.--
(1) In general.--Subject to paragraph (2), on the day that
is 6 months after the date on which the report described in
paragraph (1) of subsection (b) (or paragraph (2) of such
subsection if the report contains recommendations in
legislative form described in subsection (b)(3)) is submitted
to the President, the President shall transmit the report and
recommendations to Congress.
(2) Regulatory action by the secretary of health and human
services.--If the Secretary of Health and Human Services has
exercised the authority under section 104(a) to adopt by
regulation one or more of the recommendations under subsection
(b)(3), the President shall only submit to Congress those
recommendations under subsection (b)(3) that have not been
adopted by the Secretary.
(3) Delivery.--Copies of the report and recommendations in
legislative form required to be transmitted to Congress under
paragraph (1) shall be delivered--
(A) to both Houses of Congress on the same day;
(B) to the Clerk of the House of Representatives if
the House is not in session; and
(C) to the Secretary of the Senate if the Senate is
not in session.
SEC. 104. AUTHORITY TO ADMINISTRATIVELY PROVIDE FOR COVERAGE OF
ADDITIONAL PREVENTIVE BENEFITS.
(a) In General.--The Secretary of Health and Human Services may by
regulation adopt any or all of the legislative recommendations
developed by the Institute of Medicine of the National Academy of
Sciences, in consultation with the United States Preventive Services
Task Force and the Task Force on Community Preventive Services in a
report under section 103(b)(3) (relating to prioritizing and modifying
preventive health benefits under the medicare program and the addition
of new preventive benefits), consistent with subsection (b).
(b) Elimination of Cost-Sharing.--With respect to items and
services furnished under the medicare program that the Secretary has
incorporated by regulation under subsection (a), the provisions of
section 1833(p) of the Social Security Act (relating to elimination of
cost-sharing for preventive benefits), as added by section 102(a),
shall apply to those items and services in the same manner as such
section applies to the items and services described in paragraphs (1)
through (10) of such section.
(c) Deadline.--The Secretary must publish a notice of rulemaking
with respect to the adoption by regulation under subsection (a) of any
such recommendation within 6 months of the date on which a report
described in section 103(b) is submitted to the President.
SEC. 105. FAST-TRACK CONSIDERATION OF PREVENTION BENEFIT LEGISLATION.
(a) Rules of House of Representatives and Senate.--This section is
enacted by Congress--
(1) as an exercise of the rulemaking power of the House of
Representatives and the Senate, respectively, and is deemed a
part of the rules of each House of Congress, but--
(A) is applicable only with respect to the
procedure to be followed in that House of Congress in
the case of an implementing bill (as defined in
subsection (d)); and
(B) supersedes other rules only to the extent that
such rules are inconsistent with this section; and
(2) with full recognition of the constitutional right of
either House of Congress to change the rules (so far as
relating to the procedure of that House of Congress) at any
time, in the same manner and to the same extent as in the case
of any other rule of that House of Congress.
(b) Introduction and Referral.--
(1) Introduction.--
(A) In general.--Subject to paragraph (2), on the
day on which the President transmits the report
pursuant to section 103(c) to the House of
Representatives and the Senate, the recommendations in
legislative form transmitted by the President with
respect to such report shall be introduced as a bill
(by request) in the following manner:
(i) House of representatives.--In the House
of Representatives, by the Majority Leader, for
himself and the Minority Leader, or by Members
of the House of Representatives designated by
the Majority Leader and Minority Leader.
(ii) Senate.--In the Senate, by the
Majority Leader, for himself and the Minority
Leader, or by Members of the Senate designated
by the Majority Leader and Minority Leader.
(B) Special rule.--If either House of Congress is
not in session on the day on which such recommendations
in legislative form are transmitted, the
recommendations in legislative form shall be introduced
as a bill in that House of Congress, as provided in
subparagraph (A), on the first day thereafter on which
that House of Congress is in session.
(2) Referral.--Such bills shall be referred by the
presiding officers of the respective Houses to the appropriate
committee, or, in the case of a bill containing provisions
within the jurisdiction of 2 or more committees, jointly to
such committees for consideration of those provisions within
their respective jurisdictions.
(c) Consideration.--After the recommendations in legislative form
have been introduced as a bill and referred under subsection (b), such
implementing bill shall be considered in the same manner as an
implementing bill is considered under subsections (d), (e), (f), and
(g) of section 151 of the Trade Act of 1974 (19 U.S.C. 2191).
(d) Implementing Bill Defined.--In this section, the term
``implementing bill'' means only the recommendations in legislative
form of the Institute of Medicine of the National Academy of Sciences
described in section 103(b)(3), transmitted by the President to the
House of Representatives and the Senate under subsection 103(c), and
introduced and referred as provided in subsection (b) as a bill of
either House of Congress.
(e) Counting of Days.--For purposes of this section, any period of
days referred to in section 151 of the Trade Act of 1974 shall be
computed by excluding--
(1) the days on which either House of Congress is not in
session because of an adjournment of more than 3 days to a day
certain or an adjournment of Congress sine die; and
(2) any Saturday and Sunday, not excluded under paragraph
(1), when either House is not in session.
Subtitle B--Expansion of Access to Health Promotion Services
SEC. 111. DISEASE SELF-MANAGEMENT DEMONSTRATION PROJECTS.
(a) Demonstration Projects.--
(1) In general.--The Secretary shall conduct demonstration
projects for the purpose of promoting disease self-management
for conditions identified, and appropriately prioritized, by
the Secretary for target individuals (as defined in paragraph (2)).
(2) Target individual defined.--In this section, the term
``target individual'' means an individual who--
(A) is at risk for, or has, 1 or more of the
conditions identified by the Secretary as being
appropriate for disease self-management; and
(B) is entitled to benefits under part A of title
XVIII of the Social Security Act (42 U.S.C. 1395c et
seq.), or enrolled under part B of such title ( 42
U.S.C. 1395j et seq.) or is enrolled under the
Medicare+Choice program under part C of such title (42
U.S.C. 1395w-21 et seq.).
(b) Number; Project Areas; Duration.--
(1) Number.--Not later than 2 years after the date of
enactment of this Act, the Secretary shall implement a series
of demonstration projects to carry out the purpose described in
subsection (a)(1).
(2) Project areas.--The Secretary shall implement the
demonstration projects described in paragraph (1) in urban,
suburban, and rural areas.
(3) Duration.--The demonstration projects under this
section shall be conducted during the 3-year period beginning
on the date on which the initial demonstration project is
implemented.
(c) Report to Congress.--
(1) In general.--Not later than 18 months after the
conclusion of the demonstration projects under this section,
the Secretary shall submit a report to Congress on such
projects.
(2) Contents of report.--The report required under
paragraph (1) shall include the following:
(A) A description of the demonstration projects.
(B) An evaluation of--
(i) whether each benefit provided under the
demonstration projects is--
(I) medically effective;
(II) medically efficacious;
(III) cost-effective; or
(IV) cost-saving;
(ii) the level of the disease self-
management attained by target individuals under
the demonstration projects; and
(iii) the satisfaction of target
individuals under the demonstration projects.
(C) Recommendations of the Secretary regarding
whether to conduct the demonstration projects on a
permanent basis.
(D) Such recommendations for legislation and
administrative action as the Secretary determines to be
appropriate.
(E) Any other information regarding the
demonstration projects that the Secretary determines to
be appropriate.
(d) Funding.--The Secretary shall provide for the transfer from the
Federal Hospital Insurance Trust Fund under section 1817 of the Social
Security Act (42 U.S.C. 1395i) an amount not to exceed $30,000,000 for
the costs of carrying out this section.
SEC. 112. MEDICARE HEALTH EDUCATION AND RISK APPRAISAL PROGRAM.
Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is
amended by adding at the end the following new section:
``medicare health education and risk appraisal program
``Sec. 1897. (a) Establishment.--Not later than 18 months after the
date of the conclusion of the demonstration projects conducted under
subsection (b)(1), the Secretary shall establish a comprehensive and
systematic model for delivering health promotion and disease prevention
services that--
``(1) through self-assessment identifies--
``(A) behavioral risk factors, such as tobacco use,
physical inactivity, alcohol use, depression, lack of
proper nutrition, and risk of falling, among target
individuals;
``(B) needed medicare clinical preventive and
screening health benefits among target individuals; and
``(C) functional and self-management information
the Secretary determines to be appropriate;
``(2) provides ongoing followup to reduce risk factors and
promote the appropriate use of preventive and screening health
benefits;
``(3) improves clinical outcomes, satisfaction, quality of
life, and appropriate use by target individuals of items and
services covered under the medicare program; and
``(4) provides target individuals with information
regarding the adoption of healthy behaviors.
``(b) Demonstration Projects.--
``(1) Establishment.--Not later than 1 year after the date
of enactment of this section, the Secretary, in consultation
with the Director of the Centers for Disease Control and
Prevention, and the Director of the Agency for Healthcare
Research and Quality, shall conduct demonstration projects for
the purpose of developing a comprehensive and systematic model
for delivering health promotion and disease prevention services
described in subsection (a).
``(2) Self-assessment and provision of information.--The
Secretary shall conduct the demonstration projects established
under paragraph (1) in the following manner:
``(A) Self-assessment.--
``(i) In general.--The Secretary shall test
different--
``(I) methods of making self-
assessments available to each target
individual;
``(II) methods of encouraging each
target individual to participate in the
self-assessment; and
``(III) methods for processing
responses to the self-assessment.
``(ii) Contents.--A self-assessment made
available under clause (i) shall include--
``(I) questions regarding
behavioral risk factors;
``(II) questions regarding needed
preventive screening health services;
``(III) questions regarding the
target individual's preferences for
receiving follow-up information; and
``(IV) other information that the
Secretary determines appropriate.
``(B) Provision of information.--After each target
individual completes the self-assessment, the Secretary
shall ensure that the target individual is provided
with such information as the Secretary determines
appropriate, which may include--
``(i) information regarding the results of
the self-assessment;
``(ii) recommendations regarding any
appropriate behavior modification based on the
self-assessment;
``(iii) information regarding how to access
behavior modification assistance that promotes
healthy behavior, including information on
nurse hotlines, counseling services, provider
services, and case-management services;
``(iv) information, feedback, support, and
recommendations regarding any need for clinical
preventive and screening health services or
treatment; and
``(v) referrals to available community
resources in order to assist the target
individual in reducing health risks.
``(3) Project areas and duration.--
``(A) Project areas.--The Secretary shall implement
the demonstration projects in geographic areas that
include urban, suburban, and rural areas.
``(B) Duration.--The Secretary shall conduct the
demonstration projects during the 3-year period
beginning on the date on which the first demonstration
project is implemented.
``(c) Report to Congress.--
``(1) In general.--Not later than 1 year after the date on
which the demonstration projects conclude, the Secretary shall
submit to Congress a report on such projects.
``(2) Contents of report.--The report submitted under
paragraph (1) shall--
``(A) describe the demonstration projects conducted
under this section;
``(B) identify the demonstration project that is
the most effective; and
``(C) contain such other information regarding the
demonstration projects as the Secretary determines
appropriate.
``(3) Measurement of effectiveness.--For purposes of
paragraph (2)(B), in identifying the demonstration project that
is the most effective, the Secretary shall consider--
``(A) how successful the project was at--
``(i) reaching target individuals and
engaging them in an assessment of the risk
factors of such individuals;
``(ii) educating target individuals on
healthy behaviors and getting such individuals
to modify their behaviors in order to diminish
the risk of chronic disease; and
``(iii) ensuring that target individuals
were provided with necessary information;
``(B) the cost-effectiveness of the demonstration
project; and
``(C) the degree of beneficiary satisfaction under
the demonstration projects.
``(d) Waiver Authority.--The Secretary may waive such requirements
under this title as the Secretary determines necessary to carry out the
demonstration projects under this section.
``(e) Funding.--There are authorized to be appropriated $25,000,000
to the Secretary for carrying out the demonstration projects under this
section.
``(f) Definition of Target Individual.--The term `target
individual' means each individual who is--
``(1) entitled to benefits under part A or enrolled under
part B, including an individual enrolled under the
Medicare+Choice program under part C; or
``(2) between the ages of 50 and 64 and who is not
described in paragraph (1).''.
Subtitle C--Medicare Coverage for Care Coordination and Assessment
Services
SEC. 121. CARE COORDINATION AND ASSESSMENT SERVICES.
(a) Services Authorized.--Title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.), as amended by section 112, is further amended
by adding at the end the following new section:
``care coordination and assessment services
``Sec. 1898. (a) Purpose.--The purpose of this section is to
provide assistance to a beneficiary with a serious and disabling
chronic condition (as defined in subsection (f)(1)) to obtain the
appropriate level and mix of follow-up care.
``(b) Election of Care Coordination and Assessment Services.--
``(1) In general.--On or after January 1, 2003, a
beneficiary with a serious and disabling chronic condition may
elect to receive care coordination services in accordance with
the provisions of this section under which, in appropriate
circumstances, the eligible beneficiary has health care
services covered under this title managed and coordinated by a
care coordinator who is qualified under subsection (e) to
furnish care coordination services under this section.
``(2) Revocation of election.--An eligible beneficiary who
has made an election under paragraph (1) may revoke that
election at any time.
``(c) Outreach.--The Secretary shall provide for the wide
dissemination of information to beneficiaries and providers of
services, physicians, practitioners, and suppliers with respect to the
availability of and requirements for care coordination services under
this section.
``(d) Care Coordination and Assessment Services Described.--Care
coordination services under this section shall include the following:
``(1) Basic care coordination and assessment services.--
``(A) In general.--Except as otherwise provided in
this section, eligible beneficiaries who have made an
election under this section shall receive the following
services:
``(i)(I) An initial assessment of an
individual's medical condition, functional and
cognitive capacity, and environmental and
psychosocial needs.
``(II) Annual assessments after the initial
assessment performed under subclause (I),
unless the physician or care coordinator of the
individual determines that additional
assessments are required due to sentinel health
events or changes in the health status of the
individual that may require changes in plans of
care developed for the individual.
``(ii) The development of an initial plan
of care, and subsequent appropriate revisions
to that plan of care.
``(iii) The management of, and referral
for, medical and other health services,
including multidisciplinary care conferences
and coordination with other providers.
``(iv) The monitoring and management of
medications.
``(v) Patient education and counseling
services.
``(vi) Family caregiver education and
counseling services.
``(vii) Self-management services, including
health education and risk appraisal to identify
behavioral risk factors through self-
assessment.
``(viii) Providing access for consultations
by telephone with physicians and other
appropriate health care professionals,
including 24-hour availability of such
professionals for emergency consultations.
``(ix) Coordination with the principal
nonprofessional caregiver in the home.
``(x) Managing and facilitating transitions
among health care professionals and across
settings of care, including the following:
``(I) Pursuing the treatment option
elected by the individual.
``(II) Including any advance
directive executed by the individual in
the medical file of the individual.
``(xi) Activities that facilitate
continuity of care and patient adherence to
plans of care.
``(xii) Information about, and referral to,
hospice services, including patient and family
caregiver education and counseling about
hospice, and facilitating transition to hospice
when elected.
``(xiii) Such other medical and health care
services for which payment would not otherwise
be made under this title as the Secretary
determines to be appropriate for effective care
coordination, including the additional items
and services as described in subparagraph (B).
``(B) Additional benefits.--The Secretary may
specify additional benefits for which payment would not
otherwise be made under this title that may be
available to eligible beneficiaries who have made an
election under this section (subject to an assessment
by the care coordinator of an individual beneficiary's
circumstances and need for such benefits) in order to
encourage the receipt of, or to improve the
effectiveness of, care coordination services.
``(2) Care coordination and assessment requirement.--
Notwithstanding any other provision of this title, with respect
to items and services for which payment is made under this
title furnished to a beneficiary for the diagnosis and
treatment of the beneficiary's serious and disabling chronic
condition, if the beneficiary has made an election to receive
care coordination and assessment services under this section,
the Secretary may require that payment may only be made under
this title for such items and services relating to such
condition if the items and services have been furnished by or
coordinated through the care coordinator. Under such provision,
the Secretary shall prescribe exceptions for emergency medical
services (as described in section 1852(d)(3), but without
regard to enrollment with a Medicare+Choice organization), and
other exceptions determined by the Secretary for the delivery
of timely and needed care.
``(e) Care Coordinators.--
``(1) Conditions of participation.--In order to be
qualified to furnish care coordination and assessment services
under this section, an individual or entity shall--
``(A) be a health care professional or entity
(which may include physicians, physician group
practices, or other health care professionals or
entities the Secretary may find appropriate) meeting
such conditions as the Secretary may specify;
``(B) enter into a care coordination agreement
under paragraph (2); and
``(C) meet such criteria as the Secretary may
establish (which may include experience in the
provision of care coordination or primary care
physician's services).
``(2) Agreement term; payment.--
``(A) Duration and renewal.--A care coordination
agreement under this subsection shall--
``(i) be entered into for a period of 1
year and may be renewed if the Secretary is
satisfied that the care coordinator continues
to meet the conditions of participation
specified in paragraph (1);
``(ii) assure the compliance of the care
coordinator with such data collection and
reporting requirements as the Secretary
determines necessary to assess the effect of
care coordination on health outcomes; and
``(iii) contain such other terms and
conditions as the Secretary may require.
``(B) Payment for services.--The Secretary shall
establish payment terms and conditions and payment
rates for basic care coordination and assessment
services described in subsection (d)(1). The Secretary
may establish new billing codes to carry out the
provisions of this subparagraph.
``(f) Definitions.--In this section:
``(1) Serious and disabling chronic condition.--The term
`serious and disabling chronic condition' means, with respect
to an individual, that the individual has at least one physical
or mental condition and a licensed health care practitioner has
certified within the preceding 12-month period that--
``(A) the individual has a level of disability such
that the individual is unable to perform (without
substantial assistance from another individual) for a
period of at least 90 days due to a loss of functional
capacity--
``(i) at least 2 activities of daily
living; or
``(ii) such number of instrumental
activities of daily living that is equivalent
(as determined by the Secretary) to the level
of disability described in clause (i);
``(B) the individual has a level of disability
equivalent (as determined by the Secretary) to the
level of disability described in subparagraph (A); or
``(C) the individual requires substantial
supervision to protect the individual from threats to
health and safety due to severe cognitive impairment.
``(2) Activities of daily living.--The term `activities of
daily living' means each of the following:
``(A) Eating.
``(B) Toileting.
``(C) Transferring.
``(D) Bathing.
``(E) Dressing.
``(F) Continence.
``(3) Instrumental activities of daily living.--The term
`instrumental activities of daily living' means each of the
following:
``(A) Medication management.
``(B) Meal preparation.
``(C) Shopping.
``(D) Housekeeping.
``(E) Laundry.
``(F) Money management.
``(G) Telephone use.
``(H) Transportation use.
``(4) Beneficiary.--The term `beneficiary' means an
individual entitled to benefits under part A, or enrolled under
part B, including an individual enrolled under the
Medicare+Choice program under part C.''.
(b) Coverage of Care Coordination and Assessment Services as a Part
B Medical Service.--
(1) In general.--Section 1861(s) of the Social Security Act
(42 U.S.C. 1395x(s)) is amended--
(A) in the second sentence, by redesignating
paragraphs (16) and (17) as clauses (i) and (ii); and
(B) in the first sentence--
(i) by striking ``and'' at the end of
paragraph (14);
(ii) by striking the period at the end of
paragraph (15) and inserting ``; and''; and
(iii) by adding after paragraph (15) the
following new paragraph:
``(16) care coordination and assessment services furnished
by a care coordinator in accordance with section 1866C.''.
(2) Conforming amendments.--Sections 1864(a) 1902(a)(9)(C),
and 1915(a)(1)(B)(ii)(I) of such Act (42 U.S.C. 1395aa(a),
1396a(a)(9)(C), and 1396n(a)(1)(B)(ii)(I)) are each amended by
striking ``paragraphs (16) and (17)'' each place it appears and
inserting ``clauses (i) and (ii) of the second sentence''.
(3) Part b coinsurance and deductible not applicable to
care coordination and assessment services.--
(A) Coinsurance.--Section 1833(a)(1) of the Social
Security Act (42 U.S.C. 1395l(a)(1)), as amended by
sections 105 and 223 of the Medicare, Medicaid, and
SCHIP Benefits Improvement and Protection Act of 2000,
as enacted into law by section 1(a)(6) of Public Law
106-554, is amended--
(i) by striking ``and'' at the end of
subparagraph (T); and
(ii) by inserting before the final
semicolon ``, and (V) with respect to care
coordination and assessment services described
in section 1861(s)(16) that are furnished by,
or coordinated through, a care coordinator, the
amounts paid shall be 100 percent of the
payment amount established under section
1866C''.
(B) Deductible.--Section 1833(b) of such Act (42
U.S.C. 1395l(b)) is amended--
(i) by striking ``and'' at the end of
paragraph (5); and
(ii) by inserting before the final period
``, and (7) such deductible shall not apply
with respect to care coordination and
assessment services (as described in section
1861(s)(16))''.
(C) Elimination of coinsurance in outpatient
hospital settings.--The third sentence of section
1866(a)(2)(A) of such Act (42 U.S.C. 1395cc(a)(2)(A)),
as amended by section 102(b)(2), is further amended by
inserting after ``section 1833(p),'' the following:
``with respect to care coordination and assessment
services (as described in section 1861(s)(16)),''.
TITLE II--PAYMENT INCENTIVES FOR QUALITY CARE FOR INDIVIDUALS WITH
SERIOUS AND DISABLING CHRONIC CONDITIONS
SEC. 201. ADJUSTMENTS TO FEE-FOR-SERVICE PAYMENT SYSTEMS.
(a) In General.--The Secretary of Health and Human Services shall
provide for appropriate adjustments to each of the payment systems
described in subsection (b) to take into account the additional costs
incurred in providing items and services under the medicare program to
medicare beneficiaries who suffer from serious and disabling chronic
conditions, including the consideration of the patient classification
system (or other methodology) under subsection (d). The Secretary shall
implement such adjustments for items and services furnished on or after
October 1, 2005.
(b) Payment Systems Described.--The payment systems referred to in
subsection (a) are the following:
(1) The prospective payment system for covered skilled
nursing facility services under section 1888(e) of such Act (42
U.S.C. 1395yy(e)).
(2) The prospective payment system for home health services
under section 1895 of such Act (42 U.S.C. 1395fff).
(3) The prospective payment system for outpatient hospital
services under section 1833(t) of such Act (42 U.S.C.
1395l(t)).
(4) The physician fee schedule under section 1848 of such
Act (42 U.S.C. 1395w-4).
(5) The composite rate of payment for dialysis services
under section 1881(b)(7) of such Act (42 U.S.C. 1395rr(b)(7)).
(6) The payment rate for outpatient therapy services and
comprehensive outpatient rehabilitation services under section
1834(k) of such Act (42 U.S.C. 1395m(k)).
(7) The payment rate for partial hospitalization services
established by the Secretary in regulations under title XVIII
of such Act.
(8) The payment rate for hospice services under section
1814(i) of such Act (42 U.S.C. 1395f(i)).
(c) Interim Report.--Not later than 18 months after the date of
enactment of this Act, the Secretary shall submit to Congress a report
on the proposed adjustments required under subsection (a) to the
payment systems described in subsection (b), the methodology employed
by the Secretary in providing for such proposed adjustments, and an
assessment of the impact of such adjustments on access to effective
care for medicare beneficiaries.
(d) Patient Classification System.--The Secretary shall develop a
patient classification system or other methodology to predict costs
within and across postacute care settings attributable to furnishing
items and services to medicare beneficiaries who suffer from serious
and disabling chronic conditions. The Secretary shall develop such
system by not later than October 1, 2004, and shall consult with
representatives of providers of services and individuals with expertise
in health care financing and risk adjustment methodology in developing
such system.
SEC. 202. MEDICARE+CHOICE.
(a) Revisions to Risk Adjustment Methodology.--
(1) In general.--The Secretary shall revise the risk
adjustment methodology under section 1853(a)(3) of the Social
Security Act (42 U.S.C. 1395w-23(a)(3)) applicable to payments
to Medicare+Choice organizations offering specialized programs
for frail elderly and at-risk beneficiaries to take into
account variations in costs incurred by such organizations.
(2) Methods considered.--In revising the risk adjustment
methodology under paragraph (1), the Secretary shall consider--
(A) hybrid risk adjustment payment systems, such as
partial capitation;
(B) new diagnostic and service markers that more
accurately predict high risk;
(C) improving the structural components of the
applicable method of payment, such as reducing payment
lag, using multiple site diagnostic data, and using
several years of data;
(D) providing for adjustments to payment amounts
for beneficiaries with comorbidities;
(E) testing concurrent risk adjustment
methodologies; and
(F) testing payment methods using data from
specialized programs for frail elderly and at-risk
beneficiaries.
(3) Implementation.--The Secretary shall implement such
revisions to the risk adjustment methodology for items and
services furnished on or after January 1, 2005.
(4) Interim report.--Not later than January 1, 2004, the
Secretary shall submit to Congress a report on revision of the
risk adjustment methodology required under paragraph (1),
including a description of the methods considered and employed
by the Secretary in providing for such revision and an
assessment of the impacts of such methods on access to
effective care for medicare beneficiaries.
(b) Interim Continuation of Blended Rate for Specialized Programs
for Frail Elderly and At-Risk Medicare Beneficiaries Residing in
Institutions.--
(1) In general.--In the case of a Medicare+Choice
organization that complies with the requirements under
paragraph (2) and that offers a Medicare+Choice plan that
provides for a specialized program for frail elderly and at-
risk beneficiaries that exclusively serves beneficiaries in
institutions or beneficiaries that are entitled to medical
assistance under a State plan under title XIX, notwithstanding
section 1853(a)(3)(C)(ii) of the Social Security Act (42 U.S.C.
1395w-23(a)(3)(C)(ii)), such organization shall be paid
according to the method described in section
1853(a)(3)(C)(ii)(I) until such time as the Secretary has
implemented the revised risk adjustment methodology required in
subsection (a).
(2) Requirements.--A Medicare+Choice organization may not
qualify for the payment methodology under paragraph (1) unless
the organization collects such data (and in such format) as the
Secretary requires to monitor quality of services provided,
outcomes, and costs, including functional and diagnostic data
and information collected through the Health Outcomes Survey.
(c) Interim Continuation of Payment Methodologies for Demonstration
Programs.--
(1) In general.--Notwithstanding any other provision of
law, payment methodologies for medicare demonstration programs
for specialized programs for frail elderly and at-risk
beneficiaries that comply with the requirements under paragraph
(2) shall continue under the terms and conditions of the
demonstration authority, including the risk adjustment factors
and formula used for paying such demonstration programs, until
such time as the Secretary has implemented the revised risk
adjustment methodology required in subsection (a).
(2) Requirements.--A medicare demonstration program may not
qualify for the payment methodology under paragraph (1) unless
the program collects such data (and in such format) as the
Secretary requires to monitor quality of services provided,
outcomes, and costs, including functional and diagnostic data
and information collected through the Health Outcomes Survey.
(d) Interim Demonstration Program for Additional Payments for
Specialized Programs.--
(1) In general.--The Secretary shall establish a
demonstration program under which additional payments (in such
manner and amount as the Secretary determines appropriate) may
be made to a Medicare+Choice organization that complies with
the requirements under paragraph (2) and that offers a
Medicare+Choice plan that--
(A) provides, directly or through contract, for a
specialized program of care for enrollees with serious
and disabling chronic conditions; and
(B) exclusively serves enrollees with serious and
disabling chronic conditions or serves a
disproportionate share of such enrollees.
(2) Requirements.--A Medicare+Choice organization may not
qualify for additional payments under paragraph (1) unless the
organization and the specialized program of care meet the
following requirements:
(A) Under the specialized program of care, a
clinical delivery system is established that meets the
needs of such enrollees, including--
(i) methods to prevent, delay, or minimize
the progression of disabilities;
(ii) disease management protocols, such as
high risk screening to identify risk of
hospitalization, nursing home placement,
functional decline, death, and other factors
that increase the costs of care provided;
(iii) appropriate specially trained health
care staff, such as nurse practitioners,
geriatric care managers, or mental health
professionals; and
(iv) methods for promoting integration of
care, financing, and administrative functions
across health care settings.
(B) The organization collects such data (and in
such format) as the Secretary requires to monitor
quality of services provided, outcomes, and costs,
including functional and diagnostic data and
information collected through the Health Outcomes
Survey.
(C) The organization employs quality standards and
tracks quality indicators specified by the Secretary
that are relevant to the special needs of enrollees
with serious and disabling chronic conditions.
(D) The organization does not receive payments, or
adjustment to payments, with respect to any enrollee by
reason of subsection (b) or (c).
(3) Waiver authority.--The Secretary may waive such
requirements of title XVIII of the Social Security Act as may
be necessary to carry out this demonstration program.
(4) Termination.--The demonstration program under this
subsection shall terminate 1 year after such time as the
Secretary has implemented the revised risk adjustment
methodology required in subsection (a).
(5) Funding.--There are authorized to be appropriated to
the Secretary $25,000,000 for carrying out the demonstration
program under this subsection.
(e) Definition.--In this section, the term ``specialized programs
for frail elderly and at-risk beneficiaries'' means--
(1) demonstrations approved by the Secretary for purposes
of testing the integration of acute and expanded care services
under prepaid financing which include prescription drugs and
other noncovered ancillary services, care coordination, and
home and community-based services, such as the social health
maintenance organization demonstration project authorized under
section 2355 of the Deficit Reduction Act of 1984 and expanded
under section 4207(b)(4)(B)(i) of the Omnibus Reconciliation
Act of 1990;
(2) demonstrations approved by the Secretary for purposes
of improving quality of care and preventing hospitalizations
for nursing home residents, such as the EverCare demonstration
project;
(3) demonstrations approved by the Secretary for purposes
of testing methods for integrating medicare and medicaid
benefits for the dually eligible, such as the Minnesota Senior
Health Options program, the Wisconsin Partnership program, the
Massachusetts Senior Care Organization program, and the
Rochester Community Care Network program;
(4) demonstrations approved by the Secretary under
subsection (d); and
(5) such other demonstrations or programs approved by the
Secretary for similar purposes, as determined by the Secretary.
TITLE III--DEVELOPMENT OF NATIONAL POLICIES ON EFFECTIVE CHRONIC
CONDITION CARE
SEC. 301. STUDY AND REPORT ON EFFECTIVE CHRONIC CONDITION CARE.
(a) Study.--For purposes of improving chronic condition care
furnished to medicare beneficiaries under the medicare program, the
Secretary of Health and Human Services shall conduct a comprehensive
study of chronic condition trends of medicare beneficiaries and
associated service utilization, quality indicators, and cumulative
costs.
(b) Specific Matters Studied.--The study conducted under subsection
(a) shall include an assessment of the following:
(1) Chronic condition prevalence rates.
(2) Demographic, medical, and functional information about
medicare beneficiaries with chronic conditions.
(3) Utilization, cost, and quality data across settings,
including--
(A) expenditures under a State plan under title XIX
of the Social Security Act for individuals dually
eligible for benefits under the medicare and medicaid
programs,
(B) data on out-of-pocket expenses paid by medicare
beneficiaries,
(C) data on payments made by non-Federal health
insurance programs,
(D) amounts and percentages of overall payments
made to medicare providers of services and suppliers
for medicare beneficiaries with chronic conditions, and
(E) current and future cost-shifting for treatment
of such beneficiaries between the medicare and medicaid
programs.
(c) Information.--
(1) In general.--The Secretary may collect such data from
providers of services, suppliers, fiscal intermediaries, and
carriers. Such providers, suppliers, fiscal intermediaries, and
carriers shall furnish to the Secretary the data the Secretary
requires to conduct the study under subsection (a).
(2) Requirement to consider data previously collected.--To
the maximum extent practicable, in conducting the study, the
Secretary shall analyze existing data and utilize existing data
collection methodologies.
(3) Consultation.--The Secretary shall consult with
representatives of providers of services, suppliers, fiscal
intermediaries, and carriers with respect to data collection
requirements to conduct the study with respect to the specific
matters described in subsection (b).
(d) Report.--
(1) In general.--Not later than 3 years after the date of
enactment of this Act, and triennially thereafter, the
Secretary shall submit to Congress a report on the study
conducted under subsection (a) and the specific matters studied
under subsection (b).
(2) Recommendations.--Each report shall also include
specific recommendations with respect to appropriate care for
medicare beneficiaries with chronic conditions, including the
establishment, and refinement, of goals for reducing chronic
condition prevalence rates and related medical expenses.
(e) Definition.--In this section, the term ``chronic condition''
means one or more physical or mental conditions which are likely to
last for an unspecified period of time, or for the duration of an
individual's life, for which there is no known cure, and which may
affect an individual's ability to carry out basic activities of daily
living, instrumental activities of daily living, or both.
(f) Reduction of Paperwork; Assistance With Development of
Computer-Assisted Paperwork Reduction Technology.--
(1) Reduction of paperwork.--Not later than one year after
the date of enactment of this Act, the Secretary shall, in
consultation with providers of services and suppliers under the
medicare program, patient advocacy groups, and State and local
health care administration experts, implement a program to
eliminate or simplify those paperwork requirements that are not
required by law, and do not contribute to the quality of care furnished
to medicare beneficiaries or the integrity of the medicare program.
(2) Development of best practices software.--
(A) In general.--The Secretary, through the Office
of Research and Development of the Center for Medicare
and Medicaid Services, shall develop and disseminate to
providers of services and suppliers participating in
the medicare program best practices electronic software
and medical technology information systems designed to
reduce the duplicative recording of information, to
reduce the need for handwritten entries, and to reduce
the risk of medical and pharmaceutical errors in data
entry.
(B) Technical assistance.--The Secretary shall
provide for technical assistance in the use of the
electronic software developed under subparagraph (A).
(C) Authorization of appropriations.--For each of
fiscal years 2002, 2003, and 2004, there are authorized
to be appropriated to the Secretary $10,000,000 to
carry out this paragraph.
SEC. 302. INSTITUTE OF MEDICINE MEDICARE CHRONIC CONDITION CARE
IMPROVEMENT STUDY AND REPORT.
(a) Study.--
(1) In general.--The Secretary shall contract with the
Institute of Medicine of the National Academy of Sciences to--
(A) conduct a comprehensive study of the medicare
program to identify--
(i) factors that facilitate access to
effective care (including, where appropriate,
hospice care) for medicare beneficiaries with
chronic conditions; and
(ii) factors that impede access to such
care for such beneficiaries,
including the issues studied under paragraph (2); and
(B) submit the report described in subsection (b).
(2) Issues studied.--The study required under paragraph (1)
shall--
(A) identify inconsistent clinical, financial, or
administrative requirements across provider and
supplier settings or professional services with respect
to medicare beneficiaries;
(B) identify requirements under the program imposed
by law or regulation that--
(i) promote costshifting across providers
and suppliers;
(ii) impede access to effective chronic
condition care by requiring the demonstration
of continuing clinical improvement of the
condition as a prerequisite to coverage of
certain benefits;
(iii) impose unnecessary burdens on such
beneficiaries and their family caregivers;
(iv) impede coverage for services that
prevent, delay, or minimize the progression of
chronic conditions;
(v) impede the establishment of
administrative information systems to track
health status, utilization, cost, and quality
data across providers and suppliers and
provider settings;
(vi) impede the establishment of clinical
information systems that support continuity of
care across settings and over time;
(vii) impede the alignment of financial
incentives among the medicare program, the
medicaid program, and group health plans and
providers and suppliers that furnish services
to the same beneficiary; or
(viii) impede payment methods that
encourage the enrollment of high-risk
populations, support innovation, or encourage
providers and suppliers to maintain or improve
health status for such medicare beneficiaries.
(b) Report.--On the date that is 18 months after the date of
enactment of this Act, the Institute of Medicine of the National
Academy of Sciences shall submit to Congress and the Secretary of
Health and Human Services a report that contains--
(1) a detailed statement of the findings and conclusions of
the study conducted under subsection (a); and
(2) recommendations to improve access to effective care for
medicare beneficiaries with chronic conditions.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S11206-11207, S11213)
Read twice and referred to the Committee on Finance. (text of measure as introduced: CR S11207-11213)
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