Medicare Better Health Rewards Program Act of 2012 - Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services (HHS) to establish a three-year Better Health Rewards Program under which incentives are provided to Medicare beneficiaries who voluntarily agree to participate in the Program.
Directs the Secretary to establish standards for measuring better health targets and points for achieving them for participating Medicare beneficiaries, including those for: (1) an annual wellness visit, (2) tobacco cessation, (3) Body Mass Index (BMI), (4) a diabetes screening test, (5) cardiovascular disease screening, (6) cholesterol level screening, and (7) screening tests and specified vaccinations.
Requires the Secretary to make specified incentive payments to each participating Medicare beneficiary who achieves at least 20 points during a year.
Authorizes Medicare Advantage Plans, "Section 1876" health maintenance organization and competitive medical cost plans, and programs of all-inclusive care for the elderly (PACE) to make incentives to their enrollees to participate in a Better Health Rewards Program.
Amends the Internal Revenue Code to exclude from gross income any payment made under: (1) the Medicare Better Health Rewards Program; and (2) any other Better Health Rewards Program.
[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6232 Introduced in House (IH)]
112th CONGRESS
2d Session
H. R. 6232
To establish a program to provide incentive payments to participating
Medicare beneficiaries who voluntarily establish and maintain better
health.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 31, 2012
Mr. Paulsen (for himself, Mr. Kind, Mr. Griffin of Arkansas, and Ms.
Fudge) introduced the following bill; which was referred to the
Committee on Ways and Means, and in addition to the Committee on Energy
and Commerce, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To establish a program to provide incentive payments to participating
Medicare beneficiaries who voluntarily establish and maintain better
health.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Better Health Rewards
Program Act of 2012''.
SEC. 2. MEDICARE BETTER HEALTH REWARDS PROGRAM.
(a) In General.--Part B of title XVIII of the Social Security Act
(42 U.S.C. 1395j et seq.) is amended by adding at the end the following
new section:
``medicare better health rewards program
``Sec. 1849. (a) In General.--The Secretary shall establish a
Better Health Rewards Program (in this section referred to as the
`Program') under which incentives are provided to Medicare
beneficiaries who voluntarily agree to participate in the Program.
``(b) Enrollment.--A health professional participating in the
Program shall provide their patients who are Medicare beneficiaries
with a description of and an opportunity to enroll in the Program on a
voluntary basis. If a Medicare beneficiary elects to enroll in the
Program, the health professional shall inform the Secretary of the
individual's enrollment through a process established by the Secretary,
which does not impose additional administrative requirements on the
participating health professional.
``(c) Establishment of Better Health Target Standards.--
``(1) In general.--
``(A) Establishment.--The Secretary shall establish
standards for measuring better health targets and
points for achieving such standards for participating
Medicare beneficiaries, including such standards and
points with respect to the following:
``(i) Annual wellness visit.
``(ii) Tobacco cessation.
``(iii) Body Mass Index (BMI).
``(iv) Diabetes screening test.
``(v) Cardiovascular disease screening.
``(vi) Cholesterol level screening.
``(vii) Screening tests and specified
vaccinations.
``(B) Consultation.--In establishing standards and
points for achieving such standards under this
subsection, the Secretary--
``(i) shall consult with 1 or more
nationally recognized health care quality
organizations, as determined appropriate by the
Secretary; and
``(ii) may consult with physicians and
other professionals experienced with wellness
programs.
``(C) Points.--The number of points awarded for a
year for achieving standards with respect to each of
the targets described in clauses (i) through (vii) of
subparagraph (A) shall not exceed 5. Such points may be
awarded on a sliding scale, based on standards
established under this subsection, as determined
appropriate by the Secretary.
``(2) Modification of better health target standards and
assigned points.--
``(A) In general.--The Secretary may modify
standards for measuring better health targets and,
subject to paragraph (1)(C), points for achieving such
standards for participating Medicare beneficiaries
under this subsection.
``(B) Consultation.--In modifying standards and
points for achieving such standards under this
paragraph, the Secretary--
``(i) shall consult with 1 or more
nationally recognized health care quality
organizations, as determined appropriate by the
Secretary; and
``(ii) may consult with physicians and
other professionals experienced with wellness
programs.
``(d) Conduct of Program.--
``(1) Duration.--
``(A) In general.--Subject to subparagraph (B), the
Program shall be conducted for not less than a 3-year
period.
``(B) Expansion.--The Secretary shall expand the
duration and scope of the Program, to the extent
determined appropriate by the Secretary, if--
``(i) the Secretary determines that such
expansion is expected to--
``(I) reduce spending under this
title without reducing the quality of
care; or
``(II) improve the quality of care
and reduce spending;
``(ii) the Chief Actuary of the Centers for
Medicare & Medicaid Services certifies that
such expansion would reduce program spending
under this title; and
``(iii) the Secretary determines that such
expansion would not deny or limit the coverage
or provision of benefits under this title for
individuals.
``(2) Collection and use of baseline data.--During the
first year of the Program, a health professional shall
establish and report to the Secretary baseline information for
each participating Medicare beneficiary who is a patient of the
health professional as part of that beneficiary's first year
assessment under paragraph (3)(A). The health professional
shall use such data to aid in the determination of whether and
to what extent the participating Medicare beneficiary is
meeting the target standards under subsection (c) in each of
years 2 and 3 of the Program.
``(3) Required assessments for participating medicare
beneficiaries.--
``(A) First year.--During year 1 of the Program, a
health professional shall furnish to each participating
Medicare beneficiary that is a patient of the health
professional either an annual wellness visit or an
initial preventive physical examination.
``(B) Second and third years.--During each of years
2 and 3 of the Program, a health professional shall
furnish to each participating Medicare beneficiary that
is a patient of the health professional an annual
wellness visit to determine whether and to what extent
the participating Medicare beneficiary has met the
target standards under subsection (c).
``(e) Determination of Points and Payment of Incentives.--
``(1) Determination of points.--During each of years 2 and
3 of the Program, a health professional shall--
``(A) evaluate and report to the Secretary whether
each participating Medicare beneficiary that is a
patient of the health professional has achieved the
target standards under subsection (c); and
``(B) determine the total amount of points that
each such participating Medicare beneficiary has
achieved for the year based on the points assigned for
achieving such standards under subsection (c).
``(2) Incentive payment.--
``(A) In general.--The Secretary shall pay to each
participating Medicare beneficiary who achieves at
least 20 points under paragraph (1)(B) for the year an
incentive payment as follows:
------------------------------------------------------------------------
Year 3 or a
``Points Year 2 Payment Subsequent Year
Amount Payment Amount
------------------------------------------------------------------------
20-24 points................. $100................ $200
------------------------------------------------------------------------
25 or more points............ $200................ $400.
------------------------------------------------------------------------
``(B) Inflation adjustment.--The dollar amounts
specified in this paragraph shall be increased,
beginning with 2016, from year to year based on the
percentage increase in the consumer price index for all
urban consumers (all items; United States city
average), rounded to the nearest $1.
``(3) Final determination of standards achievement made by
participating health professional.--Under the Program, a
participating health professional shall make the final
determination as to whether or not a participating Medicare
beneficiary has met the target standards under subsection (c)
and what screening tests and specified vaccinations, or other
services, are necessary for purposes of making such
determination.
``(f) Spending Benchmarks.--
``(1) In general.--The Secretary shall collect relevant
data, including data on claims paid under this title for
services furnished to participating Medicare beneficiaries
during the Program, for purposes of determining the aggregate
estimated savings achieved under this title for participating
Medicare beneficiaries during each of years 2 and 3 of the
Program in accordance with paragraph (2) (and for a subsequent
year if the Program is expanded under subsection (d)(1)(B)).
``(2) Determination of aggregate estimated savings.--
``(A) In general.--The amount of the aggregate
estimated savings under this title for participating
Medicare beneficiaries under paragraph (1), with
respect to a year, shall be equal to--
``(i) the estimated savings determined
under subparagraph (B) for the year; minus
``(ii) the aggregate incentive payments
made under the Program during the year.
``(B) Determination of estimated savings.--For
purposes of subparagraph (A)(i), the estimated savings
determined under this subparagraph for a year shall be
equal to--
``(i) the estimated aggregate expenditures
under this title (as projected under
subparagraph (C)) for the year; minus
``(ii) the actual aggregate expenditures
under this title (as determined by the
Secretary and taking into account any reduction
in specific health risks of the participating
Medicare beneficiaries) for the year.
``(C) Projection of estimated aggregate claims
cost.--
``(i) Benchmark base year.--The Secretary
shall establish a benchmark base year amount of
expenditures under this title for participating
Medicare beneficiaries during year 1 of the
Program.
``(ii) Projection.--The Secretary shall use
the benchmark base year amount established
under clause (i) to project the estimated
aggregate expenditures for all participating
Medicare beneficiaries during each of years 2
and 3 of the Program as if the beneficiaries
were not participating in the Program. In
making such projection, the Secretary may
include adjustments for health status or other
specific risk factors and geographic variation
for the participating Medicare beneficiaries.
``(D) Public report of determination and other
program information.--Not later than 90 days after
determining the aggregate estimated savings (if any)
under subparagraph (A) with respect to a year, the
Secretary shall make available to the public a report
containing a description of the amount of the savings
determined, including the methodology and any other
calculations or determinations involved in the
determination of such amount. Such report shall
include--
``(i) a description of any reduction in
specific health risks of participating Medicare
beneficiaries identified by the Secretary;
``(ii) a description of--
``(I) standards for measuring
better health targets under subsection
(c); and
``(II) the points available for
achieving each such standard under that
subsection; and
``(iii) recommendations for such
legislation and administrative action as the
Secretary determines appropriate.
``(3) Additional funding if aggregate incentive payments
exceed estimated savings.--If, for a year during the Program,
the aggregate incentive payments made during the year exceed
the estimated savings determined under paragraph (2)(B) for the
year, the Secretary shall provide for the transfer, from the
Prevention and Public Health Fund established under section
4002 of the Patient Protection and Affordable Care Act, of an
amount equal to the amount of such excess, to the Federal
Supplementary Medical Insurance Trust Fund under section 1841.
``(g) Waiver Authority.--The Secretary may waive such requirements
of this title and title XI as may be necessary to carry out the
purposes of the Program established under this section.
``(h) Definitions.--In this section:
``(1) Annual wellness visit.--The term `annual wellness
visit' includes personalized prevention plan services (as
defined in section 1861(hhh)(1)).
``(2) Health professional.--The term `health professional'
includes a physician (as defined in section 1861(r)(1)) and a
practitioner described in clause (i) of section 1842(b)(18)(C).
``(3) Initial preventive physical examination.--The term
`initial preventive physical examination' has the meaning given
that term in section 1861(ww)(1).
``(4) Medicare beneficiary.--The term `Medicare
beneficiary' means an individual enrolled under this part.
``(5) Participating medicare beneficiary.--The term
`participating Medicare beneficiary' means a Medicare
beneficiary who enrolls in the Program under subsection (b).
``(6) Screening tests.--The term `screening tests' means
any of the following that are determined by a health
professional to be appropriate for a participating Medicare
beneficiary:
``(A) Colorectal cancer screening tests (as defined
in section 1861(pp)).
``(B) Screening mammography (as described in
section 1861(jj)).
``(C) Screening pap smear and screening pelvic exam
(as defined in section 1861(nn)).
``(D) Screening for glaucoma (as defined in section
1861(uu)).
``(E) Bone mass measurement (as defined in section
1861(rr)) for qualified individuals described in
paragraph (2)(A) of such section.
``(F) HIV screening for high-risk groups (as
identified by the Secretary).
``(7) Specified vaccinations.--The term `specified
vaccinations' means the vaccinations described in section
1861(ww)(1) that are determined by a health professional to be
appropriate for a participating Medicare beneficiary.''.
(b) Conforming Amendment.--Section 4002(c) of the Patient
Protection and Affordable Care Act (Public Law 111-148) is amended by
inserting ``and shall transfer amounts in the Fund to the Federal
Supplementary Medical Insurance Trust Fund under section 1841 of the
Social Security Act in accordance with section 1849(f)(3) of such Act''
before the period at the end.
SEC. 3. PARTICIPATION BY MEDICARE ADVANTAGE PLANS.
Section 1859 of the Social Security Act (42 U.S.C. 1395w-28) is
amended by adding at the end the following new subsection:
``(h) Providing Incentives for Voluntary Participation in a Better
Health Rewards Program.--
``(1) In general.--Effective for plan years beginning on or
after the date of enactment of the Medicare Better Health
Rewards Program Act of 2012, a Medicare Advantage organization
may provide to individuals enrolled in an MA plan offered by
the organization incentive payments, including cash, cash-
equivalent, or other types of incentives, for voluntary
participation in a Better Health Rewards Program (in this
subsection referred to as the `Program') that rewards
individuals for meeting certain health targets established by
the Secretary.
``(2) Limitation.--In no case shall the monthly bid amount
submitted by a Medicare Advantage organization under section
1834(a)(6) (or the monthly premium charged by the organization
under section 1854(b)) with respect to an MA plan offered by
the organization take into account any incentive payments made
to enrollees under the Program.
``(3) Implementation.--The Program under this subsection
shall be conducted in a similar manner to the manner in which
the program under section 1849 is conducted, in accordance with
standards established by the Secretary.
``(4) Notification and provision of information.--A
Medicare Advantage organization seeking to participate in the
Program shall--
``(A) notify the Secretary of the organization's
intent to participate in the Program; and
``(B) agree to provide to the Secretary--
``(i) information regarding--
``(I) which enrollees participate
in the Program;
``(II) the scores of those
enrollees with respect to applicable
health targets under the Program; and
``(III) the incentives enrollees
receive for meeting such health
targets; and
``(ii) any other information specified by
the Secretary for purposes of this subsection.
``(5) Waiver authority.--The Secretary may waive such
requirements of this title and title XI as may be necessary to
carry out the purposes of the Program established under this
subsection.''.
SEC. 4. PARTICIPATION OF SECTION 1876 COST PLANS.
Section 1876 of the Social Security Act (42 U.S.C. 1395mm) is
amended by inserting at the end the following:
``(l) Providing Incentives for Voluntary Participation in a Better
Health Rewards Program.--
``(1) In general.--Effective for contract periods beginning
on or after the date of enactment of the Medicare Better Health
Rewards Program Act of 2012, an eligible organization may
provide to members enrolled under this section with the
organization incentive payments, including cash, cash-
equivalent, or other types of incentives, for voluntary
participation in a Better Health Rewards Program (in this
subsection referred to as the `Program') that rewards members
for meeting certain health targets established by the
Secretary.
``(2) Limitation.--In no case shall the payment to an
eligible organization under this section (or the premium rate
charged by the organization under this section) with respect to
members enrolled with the organization take into account any
incentive payments made to members under the Program.
``(3) Implementation.--The Program under this subsection
shall be conducted in a similar manner to the manner in which
the program under section 1849 is conducted, in accordance with
standards established by the Secretary.
``(4) Notification and provision of information.--An
eligible organization seeking to participate in the Program
shall--
``(A) notify the Secretary of the organization's
intent to participate in the Program; and
``(B) agree to provide to the Secretary--
``(i) information regarding--
``(I) which members participate in
the Program;
``(II) the scores of those members
with respect to applicable health
targets under the Program; and
``(III) the incentives members
receive for meeting such health
targets; and
``(ii) any other information specified by
the Secretary for purposes of this subsection.
``(5) Waiver authority.--The Secretary may waive such
requirements of this title and title XI as may be necessary to
carry out the purposes of the Program established under this
subsection.''.
SEC. 5. PARTICIPATION OF PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY
(PACE).
(a) Medicare.--Section 1894 of the Social Security Act (42 U.S.C.
1395eee) is amended by inserting at the end the following:
``(j) Providing Incentives for Voluntary Participation in a Better
Health Rewards Program.--
``(1) In general.--Effective for PACE program agreements
entered into on or after the date of enactment of the Medicare
Better Health Rewards Program Act of 2012, a PACE provider may
provide to PACE program eligible individuals enrolled under
this section with the PACE provider incentive payments,
including cash, cash-equivalent, or other types of incentives,
for voluntary participation in a Better Health Rewards Program
(in this subsection referred to as the `Program') that rewards
enrollees for meeting certain health targets established by the
Secretary.
``(2) Limitation.--In no case shall the payment to a PACE
provider under this section (or any premium charged by the
provider under this section) with respect to PACE program
eligible individuals enrolled with the PACE provider take into
account any incentive payments made to individuals under the
Program.
``(3) Implementation.--The Program under this subsection
shall be conducted in a similar manner to the manner in which
the program under section 1849 is conducted, in accordance with
standards established by the Secretary.
``(4) Notification and provision of information.--A PACE
provider seeking to participate in the Program shall--
``(A) notify the Secretary of the PACE provider's
intent to participate in the Program; and
``(B) agree to provide to the Secretary--
``(i) information regarding--
``(I) which PACE program eligible
individuals enrolled with the PACE
provider participate in the Program;
``(II) the scores of those
individuals with respect to applicable
health targets under the Program; and
``(III) the incentives individuals
receive for meeting such health
targets; and
``(ii) any other information specified by
the Secretary for purposes of this subsection.
``(5) Waiver authority.--The Secretary may waive such
requirements of this title and titles XI and XIX as may be
necessary to carry out the purposes of the Program established
under this subsection.''.
(b) Medicaid.--Section 1934 of the Social Security Act (42 U.S.C.
1396u-4) is amended by adding at the end the following new subsection:
``(k) Providing Incentives for Voluntary Participation in a Better
Health Rewards Program.--
``(1) In general.--Effective for PACE program agreements
entered into on or after the date of enactment of the Medicare
Better Health Rewards Program Act of 2012, a PACE provider may
provide to PACE program eligible individuals enrolled under
this section with the PACE provider incentive payments,
including cash, cash-equivalent, or other types of incentives,
for voluntary participation in a Better Health Rewards Program
(in this subsection referred to as the `Program') that rewards
enrollees for meeting certain health targets established by the
Secretary.
``(2) Limitation.--In no case shall the payment to a PACE
provider under this section (or any premium charged by the
provider under this section) with respect to PACE program
eligible individuals enrolled with the PACE provider take into
account any incentive payments made to individuals under the
Program.
``(3) Implementation.--The Program under this subsection
shall be conducted in a similar manner to the manner in which
the program under section 1849 is conducted, in accordance with
standards established by the Secretary.
``(4) Notification and provision of information.--A PACE
provider seeking to participate in the Program shall--
``(A) notify the Secretary of the PACE provider's
intent to participate in the Program; and
``(B) agree to provide to the Secretary--
``(i) information regarding--
``(I) which PACE program eligible
individuals enrolled with the PACE
provider participate in the Program;
``(II) the scores of those
individuals with respect to applicable
health targets under the Program; and
``(III) the incentives individuals
receive for meeting such health
targets; and
``(ii) any other information specified by
the Secretary for purposes of this subsection.
``(5) Waiver authority.--The Secretary may waive such
requirements of this title and titles XI and XVIII as may be
necessary to carry out the purposes of the Program established
under this subsection.''.
SEC. 6. EXCLUSION OF INCENTIVE PAYMENTS.
(a) In General.--Part III of subchapter B of chapter 1 of the
Internal Revenue Code of 1986 is amended by inserting after section
139D the following new section:
``SEC. 139E. MEDICARE BETTER HEALTH REWARDS PAYMENTS.
``Gross income shall not include any payment made under the
following programs:
``(1) The Medicare Better Health Rewards Program
established under section 1849 of the Social Security Act.
``(2) A Better Health Rewards Program established pursuant
to section 1859(h), 1876(l), 1894(j), or 1934(k) of the Social
Security Act.''.
(b) Clerical Amendment.--The table of sections for part III of
subchapter B of chapter 1 of such Code is amended by inserting after
the item relating to section 139D the following new item:
``Sec. 139E. Medicare Better Health Rewards payments.''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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