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[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 870 Reported in Senate (RS)]

<DOC>

                                                       Calendar No. 206
115th CONGRESS
  1st Session
                                 S. 870

                          [Report No. 115-146]

 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.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                April 6 (legislative day, April 4), 2017

Mr. Hatch (for himself, Mr. Wyden, Mr. Isakson, Mr. Warner, Mr. Bennet, 
Mr. Cardin, Mr. Thune, Mr. Casey, Mr. Cornyn, Mr. Crapo, Mr. Grassley, 
Mr. Carper, Ms. Stabenow, Mrs. McCaskill, Mr. Roberts, Mr. Cassidy, Mr. 
  Wicker, Mr. Nelson, and Mr. Schatz) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

                             August 3, 2017

                Reported by Mr. Hatch, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL

 
 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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

<DELETED>SECTION 1. SHORT TITLE; TABLE OF CONTENTS.</DELETED>

<DELETED>    (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''.</DELETED>
<DELETED>    (b) Table of Contents.--The table of contents of this Act 
is as follows:</DELETED>

<DELETED>Sec. 1. Short title; table of contents.
       <DELETED>TITLE I--RECEIVING HIGH QUALITY CARE IN THE HOME

<DELETED>Sec. 101. Extending the Independence at Home Demonstration 
                            Program.
<DELETED>Sec. 102. Expanding access to home dialysis therapy.
              <DELETED>TITLE II--ADVANCING TEAM-BASED CARE

<DELETED>Sec. 201. Providing continued access to Medicare Advantage 
                            special needs plans for vulnerable 
                            populations.
        <DELETED>TITLE III--EXPANDING INNOVATION AND TECHNOLOGY

<DELETED>Sec. 301. Adapting benefits to meet the needs of chronically 
                            ill Medicare Advantage enrollees.
<DELETED>Sec. 302. Expanding supplemental benefits to meet the needs of 
                            chronically ill Medicare Advantage 
                            enrollees.
<DELETED>Sec. 303. Increasing convenience for Medicare Advantage 
                            enrollees through telehealth.
<DELETED>Sec. 304. Providing accountable care organizations the ability 
                            to expand the use of telehealth.
<DELETED>Sec. 305. Expanding the use of telehealth for individuals with 
                            stroke.
     <DELETED>TITLE IV--IDENTIFYING THE CHRONICALLY ILL POPULATION

<DELETED>Sec. 401. Providing flexibility for beneficiaries to be part 
                            of an accountable care organization.
    <DELETED>TITLE V--EMPOWERING INDIVIDUALS AND CAREGIVERS IN CARE 
                                DELIVERY

<DELETED>Sec. 501. Eliminating barriers to care coordination under 
                            accountable care organizations.
<DELETED>Sec. 502. GAO study and report on longitudinal comprehensive 
                            care planning services under Medicare part 
                            B.
 <DELETED>TITLE VI--OTHER POLICIES TO IMPROVE CARE FOR THE CHRONICALLY 
                                  ILL

<DELETED>Sec. 601. GAO study and report on improving medication 
                            synchronization.
<DELETED>Sec. 602. GAO study and report on impact of obesity drugs on 
                            patient health and spending.

  <DELETED>TITLE I--RECEIVING HIGH QUALITY CARE IN THE HOME</DELETED>

<DELETED>SEC. 101. EXTENDING THE INDEPENDENCE AT HOME DEMONSTRATION 
              PROGRAM.</DELETED>

<DELETED>    Section 1866E of the Social Security Act (42 U.S.C. 
1395cc-5) is amended--</DELETED>
        <DELETED>    (1) in subsection (e)--</DELETED>
                <DELETED>    (A) in paragraph (1), by striking ``5-year 
                period'' and inserting ``7-year period''; and</DELETED>
                <DELETED>    (B) in paragraph (5), by striking 
                ``10,000'' and inserting ``15,000''; and</DELETED>
        <DELETED>    (2) in subsection (i), by striking ``second of 2'' 
        and inserting ``third of 3''.</DELETED>

<DELETED>SEC. 102. EXPANDING ACCESS TO HOME DIALYSIS THERAPY.</DELETED>

<DELETED>    (a) In General.--Section 1881(b)(3) of the Social Security 
Act (42 U.S.C. 1395rr(b)(3)) is amended--</DELETED>
        <DELETED>    (1) by redesignating subparagraphs (A) and (B) as 
        clauses (i) and (ii), respectively;</DELETED>
        <DELETED>    (2) in clause (ii), as redesignated by 
        subparagraph (A), strike ``on a comprehensive'' and insert 
        ``subject to subparagraph (B), on a comprehensive'';</DELETED>
        <DELETED>    (3) by striking ``With respect to'' and inserting 
        ``(A) With respect to''; and</DELETED>
        <DELETED>    (4) by adding at the end the following new 
        subparagraph:</DELETED>
<DELETED>    ``(B) For purposes of subparagraph (A)(ii), an individual 
determined to have end stage renal disease receiving home dialysis may 
choose to receive the monthly end stage renal disease-related visits 
furnished on or after January 1, 2019, via telehealth if the individual 
receives a face-to-face visit, without the use of telehealth, at least 
once every three consecutive months.''.</DELETED>
<DELETED>    (b) Originating Site Requirements.--</DELETED>
        <DELETED>    (1) In general.--Section 1834(m) of the Social 
        Security Act (42 U.S.C. 1395m(m)) is amended--</DELETED>
                <DELETED>    (A) in paragraph (4)(C)(ii), by adding at 
                the end the following new subclauses:</DELETED>
                                <DELETED>    ``(IX) A renal dialysis 
                                facility, but only for purposes of 
                                section 1881(b)(3)(B).</DELETED>
                                <DELETED>    ``(X) The home of an 
                                individual, but only for purposes of 
                                section 1881(b)(3)(B).''; and</DELETED>
                <DELETED>    (B) by adding at the end the following new 
                paragraph:</DELETED>
        <DELETED>    ``(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).''.</DELETED>
        <DELETED>    (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--
        </DELETED>
                <DELETED>    (A) by redesignating clauses (i) and (ii) 
                as subclauses (I) and (II), and indenting 
                appropriately;</DELETED>
                <DELETED>    (B) in subclause (II), as redesignated by 
                subparagraph (A), by striking ``clause (i) or this 
                clause'' and inserting ``subclause (I) or this 
                subclause'';</DELETED>
                <DELETED>    (C) by striking ``site.--With respect to'' 
                and inserting ``site.--</DELETED>
                        <DELETED>    ``(i) In general.--Subject to 
                        clause (ii), with respect to''; and</DELETED>
                <DELETED>    (D) by adding at the end the following new 
                clause:</DELETED>
                        <DELETED>    ``(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).''.</DELETED>
<DELETED>    (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)''.</DELETED>

         <DELETED>TITLE II--ADVANCING TEAM-BASED CARE</DELETED>

<DELETED>SEC. 201. PROVIDING CONTINUED ACCESS TO MEDICARE ADVANTAGE 
              SPECIAL NEEDS PLANS FOR VULNERABLE POPULATIONS.</DELETED>

<DELETED>    (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''.</DELETED>
<DELETED>    (b) Increased Integration of Dual SNPs.--</DELETED>
        <DELETED>    (1) In general.--Section 1859(f) of the Social 
        Security Act (42 U.S.C. 1395w-28(f)) is amended--</DELETED>
                <DELETED>    (A) in paragraph (3), by adding at the end 
                the following new subparagraph:</DELETED>
                <DELETED>    ``(F) The plan meets the requirements 
                applicable under paragraph (8).''; and</DELETED>
                <DELETED>    (B) by adding at the end the following new 
                paragraph:</DELETED>
        <DELETED>    ``(8) Increased integration of dual snps.--
        </DELETED>
                <DELETED>    ``(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--
                </DELETED>
                        <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(B) Unified grievances and appeals 
                process.--</DELETED>
                        <DELETED>    ``(i) In general.--Not later than 
                        April 1, 2020, the Secretary shall establish 
                        procedures, to the extent feasible, unifying 
                        grievances and appeals procedures under 
                        sections 1852(f), 1852(g), 1902(a)(3), 
                        1902(a)(5), and 1932(b)(4) for items and 
                        services provided by specialized MA plans for 
                        special needs individuals described in 
                        subsection (b)(6)(B)(ii) under this title and 
                        title XIX. The Secretary shall solicit comment 
                        in developing such procedures from States, 
                        plans, beneficiaries and their representatives, 
                        and other relevant stakeholders.</DELETED>
                        <DELETED>    ``(ii) Procedures.--The procedures 
                        established under clause (i) shall be included 
                        in the plan contract under paragraph (3)(D) and 
                        shall--</DELETED>
                                <DELETED>    ``(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;</DELETED>
                                <DELETED>    ``(II) take into account 
                                differences in State plans under title 
                                XIX to the extent necessary;</DELETED>
                                <DELETED>    ``(III) be easily 
                                navigable by an enrollee; and</DELETED>
                                <DELETED>    ``(IV) include the 
                                elements described in clause (iii), as 
                                applicable.</DELETED>
                        <DELETED>    ``(iii) Elements described.--Both 
                        unified appeals and unified grievance 
                        procedures shall include, as applicable, the 
                        following elements described in this 
                        clause:</DELETED>
                                <DELETED>    ``(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.</DELETED>
                                <DELETED>    ``(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.</DELETED>
                                <DELETED>    ``(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.</DELETED>
                                <DELETED>    ``(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.</DELETED>
                                <DELETED>    ``(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.</DELETED>
                        <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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).</DELETED>
                <DELETED>    ``(D) Requirements for integration.--For 
                2022 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:</DELETED>
                        <DELETED>    ``(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 
                        2018 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.</DELETED>
                        <DELETED>    ``(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.</DELETED>
                        <DELETED>    ``(iii) In the case where an 
                        individual is enrolled in the specialized MA 
                        plan and a Medicaid managed care organization 
                        (as defined in section 1903(m)(1)(A)) that 
                        provides long term services and supports or 
                        behavioral health services with 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.''.</DELETED>
        <DELETED>    (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:</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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)).''.</DELETED>
<DELETED>    (c) Improvements to Severe or Disabling Chronic Condition 
SNPs.--</DELETED>
        <DELETED>    (1) Care management requirements.--Section 
        1859(f)(5) of the Social Security Act (42 U.S.C. 1395w-
        28(f)(5)) is amended--</DELETED>
                <DELETED>    (A) by striking ``all snps.--The 
                requirements'' and inserting ``all snps.--</DELETED>
                <DELETED>    ``(A) In general.--Subject to subparagraph 
                (B), the requirements'';</DELETED>
                <DELETED>    (B) by redesignating subparagraphs (A) and 
                (B) as clauses (i) and (ii), respectively, and 
                indenting appropriately;</DELETED>
                <DELETED>    (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</DELETED>
                <DELETED>    (D) by adding at the end the following new 
                subparagraph:</DELETED>
                <DELETED>    ``(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:</DELETED>
                        <DELETED>    ``(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.</DELETED>
                        <DELETED>    ``(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.</DELETED>
                        <DELETED>    ``(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.</DELETED>
                        <DELETED>    ``(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).</DELETED>
                        <DELETED>    ``(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.''.</DELETED>
        <DELETED>    (2) Revisions to the definition of a severe or 
        disabling chronic conditions specialized needs individual.--
        </DELETED>
                <DELETED>    (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--</DELETED>
                        <DELETED>    (i) by striking ``who have'' and 
                        inserting ``who--</DELETED>
                                <DELETED>    ``(I) before January 1, 
                                2022, have'';</DELETED>
                        <DELETED>    (ii) in subclause (I), as added by 
                        clause (i), by striking the period at the end 
                        and inserting ``; and''; and</DELETED>
                        <DELETED>    (iii) by adding at the end the 
                        following new subclause:</DELETED>
                                <DELETED>    ``(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).''.</DELETED>
                <DELETED>    (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:</DELETED>
        <DELETED>    ``(9) List of conditions for clarification of the 
        definition of a severe or disabling chronic conditions 
        specialized needs individual.--</DELETED>
                <DELETED>    ``(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:</DELETED>
                        <DELETED>    ``(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.</DELETED>
                        <DELETED>    ``(ii) Conditions that--</DELETED>
                                <DELETED>    ``(I) 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 
                                would not be needed by the general 
                                population of beneficiaries under this 
                                title; and</DELETED>
                                <DELETED>    ``(II) have a low 
                                prevalence in the general population of 
                                beneficiaries under this title or a 
                                disproportionally high per-beneficiary 
                                cost under this title.</DELETED>
                <DELETED>    ``(B) Requirement.--In establishing and 
                updating the list under subparagraph (A), the panel 
                shall take into account the availability of varied 
                benefits, cost-sharing, and supplemental benefits under 
                the model described in paragraph (2) of section 
                1859(h), including the expansion under paragraph (1) of 
                such section.''.</DELETED>
<DELETED>    (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:</DELETED>
        <DELETED>    ``(6) Quality measurement at the plan level for 
        snps.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(B) Considerations.--Prior to applying 
                quality measurement at the plan level under this 
                paragraph, the Secretary shall--</DELETED>
                        <DELETED>    ``(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;</DELETED>
                        <DELETED>    ``(ii) if quality measures are 
                        reported at the plan level, ensure that MA 
                        plans are not required to provide duplicative 
                        information; and</DELETED>
                        <DELETED>    ``(iii) 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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(7) Determination of feasibility of quality 
        measurement at the plan level for all ma plans.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.''.</DELETED>
<DELETED>    (e) GAO Study and Report on State-Level Integration 
Between Dual SNPs and Medicaid.--</DELETED>
        <DELETED>    (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:</DELETED>
                <DELETED>    (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.</DELETED>
                <DELETED>    (B) The types of such specialized MA 
                plans, which may include the following:</DELETED>
                        <DELETED>    (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)).</DELETED>
                        <DELETED>    (ii) A plan that meets the 
                        requirements described in subsection (f)(3)(D) 
                        of such section 1859.</DELETED>
                        <DELETED>    (iii) A plan described in clause 
                        (ii) that also meets additional requirements 
                        established by the State.</DELETED>
                <DELETED>    (C) The characteristics of individuals 
                enrolled in such specialized MA plans.</DELETED>
                <DELETED>    (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:</DELETED>
                        <DELETED>    (i) Which populations of 
                        individuals are eligible to receive such 
                        services and supports.</DELETED>
                        <DELETED>    (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.</DELETED>
                <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>

   <DELETED>TITLE III--EXPANDING INNOVATION AND TECHNOLOGY</DELETED>

<DELETED>SEC. 301. ADAPTING BENEFITS TO MEET THE NEEDS OF CHRONICALLY 
              ILL MEDICARE ADVANTAGE ENROLLEES.</DELETED>

<DELETED>    Section 1859 of the Social Security Act (42 U.S.C. 1395w-
28) is amended by adding at the end the following new 
subsection:</DELETED>
<DELETED>    ``(h) National Testing of Model for Medicare Advantage 
Value-Based Insurance Design.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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).''.</DELETED>

<DELETED>SEC. 302. EXPANDING SUPPLEMENTAL BENEFITS TO MEET THE NEEDS OF 
              CHRONICALLY ILL MEDICARE ADVANTAGE ENROLLEES.</DELETED>

<DELETED>    (a) In General.--Section 1852(a)(3) of the Social Security 
Act (42 U.S.C. 1395w-22(a)(3)) is amended--</DELETED>
        <DELETED>    (1) in subparagraph (A), by striking ``Each'' and 
        inserting ``Subject to subparagraph (D), each''; and</DELETED>
        <DELETED>    (2) by adding at the end the following new 
        subparagraph:</DELETED>
                <DELETED>    ``(D) Expanding supplemental benefits to 
                meet the needs of chronically ill enrollees.--
                </DELETED>
                        <DELETED>    ``(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)).</DELETED>
                        <DELETED>    ``(ii) Supplemental benefits 
                        described.--</DELETED>
                                <DELETED>    ``(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.</DELETED>
                                <DELETED>    ``(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.</DELETED>
                        <DELETED>    ``(iii) Chronically ill enrollee 
                        defined.--In this subparagraph, the term 
                        `chronically ill enrollee' means an enrollee in 
                        an MA plan that the Secretary determines--
                        </DELETED>
                                <DELETED>    ``(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;</DELETED>
                                <DELETED>    ``(II) has a high risk of 
                                hospitalization or other adverse health 
                                outcomes; and</DELETED>
                                <DELETED>    ``(III) requires intensive 
                                care coordination.''.</DELETED>
<DELETED>    (b) GAO Study and Report.--</DELETED>
        <DELETED>    (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. Such study shall 
        include an analysis of the following:</DELETED>
                <DELETED>    (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.</DELETED>
                <DELETED>    (B) The frequency in which supplemental 
                benefits are utilized by such enrollees.</DELETED>
                <DELETED>    (C) The impact supplemental benefits have 
                on--</DELETED>
                        <DELETED>    (i) indicators of the quality of 
                        care received by such enrollees, including 
                        overall health and function of the 
                        enrollees;</DELETED>
                        <DELETED>    (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</DELETED>
                        <DELETED>    (iii) the amount of the bids 
                        submitted by Medicare Advantage Organizations 
                        for Medicare Advantage plans under such part 
                        C.</DELETED>
        <DELETED>    (2) Report.--Not later than 5 years after the date 
        of the enactment of this Act, the Comptroller General shall 
        submit to Congress a report containing the results of the study 
        conducted under paragraph (1), together with recommendations 
        for such legislation and administrative action as the 
        Comptroller General determines appropriate.</DELETED>

<DELETED>SEC. 303. INCREASING CONVENIENCE FOR MEDICARE ADVANTAGE 
              ENROLLEES THROUGH TELEHEALTH.</DELETED>

<DELETED>    (a) In General.--Section 1852 of the Social Security Act 
(42 U.S.C. 1395w-22) is amended--</DELETED>
        <DELETED>    (1) in subsection (a)(1)(B)(i), by inserting ``, 
        subject to subsection (m),'' after ``means''; and</DELETED>
        <DELETED>    (2) by adding at the end the following new 
        subsection:</DELETED>
<DELETED>    ``(m) Provision of Additional Telehealth Benefits.--
</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Additional telehealth benefits defined.--
        </DELETED>
                <DELETED>    ``(A) In general.--For purposes of this 
                subsection and section 1854:</DELETED>
                        <DELETED>    ``(i) Definition.--The term 
                        `additional telehealth benefits' means 
                        services--</DELETED>
                                <DELETED>    ``(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</DELETED>
                                <DELETED>    ``(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.</DELETED>
                        <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(B) Public comment.--Not later than 
                November 30, 2018, the Secretary shall solicit comments 
                on what types of telehealth services currently offered 
                to enrollees under this part through supplemental 
                health care benefits should be considered to meet the 
                definition of additional telehealth benefits under this 
                paragraph.</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(A) Physician or practitioner licensure 
                and other requirements such as specific 
                training.</DELETED>
                <DELETED>    ``(B) Factors necessary to ensure the 
                coordination of such benefits with items and services 
                furnished in-person.</DELETED>
                <DELETED>    ``(C) Such other areas as determined by 
                the Secretary.</DELETED>
        <DELETED>    ``(4) Enrollee choice.--If an MA plan provides a 
        service as an additional telehealth benefit (as defined in 
        paragraph (2)), an individual enrollee shall have discretion as 
        to whether to receive such service as an additional telehealth 
        benefit.</DELETED>
        <DELETED>    ``(5) Construction regarding network access 
        adequacy.--Provision of additional telehealth benefits under 
        this subsection shall not be construed as making such benefits 
        available and accessible for purposes of compliance with 
        subsection (d).</DELETED>
        <DELETED>    ``(6) 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.</DELETED>
        <DELETED>    ``(7) 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).''.</DELETED>
<DELETED>    (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.</DELETED>

<DELETED>SEC. 304. PROVIDING ACCOUNTABLE CARE ORGANIZATIONS THE ABILITY 
              TO EXPAND THE USE OF TELEHEALTH.</DELETED>

<DELETED>    (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:</DELETED>
<DELETED>    ``(l) Providing ACOs the Ability To Expand the Use of 
Telehealth Services.--</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(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).</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Definitions.--In this subsection:</DELETED>
                <DELETED>    ``(A) Applicable aco.--The term 
                `applicable ACO' means an ACO participating in a model 
                tested or expanded under section 1115A or under this 
                section--</DELETED>
                        <DELETED>    ``(i) that operates under a two-
                        sided model--</DELETED>
                                <DELETED>    ``(I) described in section 
                                425.600(a) of title 42, Code of Federal 
                                Regulations; or</DELETED>
                                <DELETED>    ``(II) tested or expanded 
                                under section 1115A; and</DELETED>
                        <DELETED>    ``(ii) for which Medicare fee-for-
                        service beneficiaries are assigned to the ACO 
                        using a prospective assignment method, as 
                        determined appropriate by the 
                        Secretary.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(A) No facility fee.--There shall be no 
                facility fee paid to the originating site under section 
                1834(m)(2)(B).</DELETED>
                <DELETED>    ``(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.''.</DELETED>
<DELETED>    (b) Study and Report.--</DELETED>
        <DELETED>    (1) Study.--</DELETED>
                <DELETED>    (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.</DELETED>
                <DELETED>    (B) Collection of data.--The Secretary may 
                collect such data as the Secretary determines necessary 
                to carry out the study under this paragraph.</DELETED>
        <DELETED>    (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.</DELETED>

<DELETED>SEC. 305. EXPANDING THE USE OF TELEHEALTH FOR INDIVIDUALS WITH 
              STROKE.</DELETED>

<DELETED>    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:</DELETED>
        <DELETED>    ``(6) Treatment of stroke telehealth services.--
        </DELETED>
                <DELETED>    ``(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, 2019, for 
                purposes of evaluation of an acute stroke, as 
                determined by the Secretary.</DELETED>
                <DELETED>    ``(B) No originating site facility fee.--
                The Secretary shall not pay an originating site 
                facility fee (as described in paragraph (2)(B)) with 
                respect to such telehealth services.''.</DELETED>

<DELETED>TITLE IV--IDENTIFYING THE CHRONICALLY ILL POPULATION</DELETED>

<DELETED>SEC. 401. PROVIDING FLEXIBILITY FOR BENEFICIARIES TO BE PART 
              OF AN ACCOUNTABLE CARE ORGANIZATION.</DELETED>

<DELETED>    Section 1899(c) of the Social Security Act (42 U.S.C. 
1395jjj(c)) is amended--</DELETED>
        <DELETED>    (1) by redesignating paragraphs (1) and (2) as 
        subparagraphs (A) and (B), respectively, and indenting 
        appropriately;</DELETED>
        <DELETED>    (2) by striking ``ACOs.--The Secretary'' and 
        inserting ``ACOs.--</DELETED>
        <DELETED>    ``(1) In general.--Subject to paragraph (2), the 
        Secretary''; and</DELETED>
        <DELETED>    (3) by adding at the end the following new 
        paragraph:</DELETED>
        <DELETED>    ``(2) Providing flexibility.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(B) Assignment based on voluntary 
                identification by medicare fee-for-service 
                beneficiaries.--</DELETED>
                        <DELETED>    ``(i) In general.--For performance 
                        year 2019 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.</DELETED>
                        <DELETED>    ``(ii) Notification process.--The 
                        Secretary shall establish a process under which 
                        a Medicare fee-for-service beneficiary is--
                        </DELETED>
                                <DELETED>    ``(I) notified of their 
                                ability to make an identification 
                                described in clause (i); and</DELETED>
                                <DELETED>    ``(II) informed of the 
                                process by which they may make and 
                                change such identification.</DELETED>
                        <DELETED>    ``(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.''.</DELETED>

    <DELETED>TITLE V--EMPOWERING INDIVIDUALS AND CAREGIVERS IN CARE 
                           DELIVERY</DELETED>

<DELETED>SEC. 501. ELIMINATING BARRIERS TO CARE COORDINATION UNDER 
              ACCOUNTABLE CARE ORGANIZATIONS.</DELETED>

<DELETED>    (a) In General.--Section 1899 of the Social Security Act 
(42 U.S.C. 1395jjj), as amended by section 304(a), is amended--
</DELETED>
        <DELETED>    (1) in subsection (b)(2), by adding at the end the 
        following new subparagraph:</DELETED>
                <DELETED>    ``(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.'';</DELETED>
        <DELETED>    (2) by adding at the end the following new 
        subsection:</DELETED>
<DELETED>    ``(m) Authority To Provide Incentive Payments to 
Beneficiaries With Respect to Qualifying Primary Care Services.--
</DELETED>
        <DELETED>    ``(1) Program.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Conduct of program.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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:</DELETED>
                        <DELETED>    ``(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.</DELETED>
                        <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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--</DELETED>
                        <DELETED>    ``(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);</DELETED>
                        <DELETED>    ``(ii) an ACO professional 
                        described in subsection (h)(1)(B); or</DELETED>
                        <DELETED>    ``(iii) a Federally qualified 
                        health center or rural health clinic (as such 
                        terms are defined in section 
                        1861(aa)).</DELETED>
                <DELETED>    ``(D) Incentive payments.--An incentive 
                payment made by an ACO pursuant to an ACO Beneficiary 
                Incentive Program established under this subsection 
                shall be--</DELETED>
                        <DELETED>    ``(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;</DELETED>
                        <DELETED>    ``(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;</DELETED>
                        <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(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).</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(B) any Federal or State laws relating 
                to taxation.'';</DELETED>
        <DELETED>    (3) in subsection (e), by inserting ``, including 
        an ACO Beneficiary Incentive Program under subsections 
        (b)(2)(I) and (m)'' after ``the program''; and</DELETED>
        <DELETED>    (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)''.</DELETED>
<DELETED>    (b) Amendment to Section 1128B.--Section 1128B(b)(3) of 
the Social Security Act (42 U.S.C. 1320a-7b(b)(3)) is amended--
</DELETED>
        <DELETED>    (1) by striking ``and'' at the end of subparagraph 
        (I);</DELETED>
        <DELETED>    (2) by striking the period at the end of 
        subparagraph (J) and inserting ``; and''; and</DELETED>
        <DELETED>    (3) by adding at the end the following new 
        subparagraph:</DELETED>
                <DELETED>    ``(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.''.</DELETED>
<DELETED>    (c) Evaluation and Report.--</DELETED>
        <DELETED>    (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.).</DELETED>
        <DELETED>    (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.</DELETED>

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

<DELETED>    (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:</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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 his representative.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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--</DELETED>
                <DELETED>    (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;</DELETED>
                <DELETED>    (B) the effectiveness and patient-
                centeredness of the care plan in organizing delivery of 
                services consistent with the plan;</DELETED>
                <DELETED>    (C) the availability of the care plan and 
                associated documentation to other providers that care 
                for the beneficiary; and</DELETED>
                <DELETED>    (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.</DELETED>
        <DELETED>    (7) Stakeholder's views on how such quality 
        metrics would provide information on--</DELETED>
                <DELETED>    (A) the goals, values, and preferences of 
                the beneficiary;</DELETED>
                <DELETED>    (B) the documentation of the care 
                plan;</DELETED>
                <DELETED>    (C) services furnished to the beneficiary; 
                and</DELETED>
                <DELETED>    (D) outcomes of treatment.</DELETED>
        <DELETED>    (8) Stakeholder's views on--</DELETED>
                <DELETED>    (A) the type of training and education 
                needed for applicable providers, individuals, and 
                caregivers in order to facilitate longitudinal 
                comprehensive care planning services;</DELETED>
                <DELETED>    (B) the types of providers of services and 
                suppliers that should be included in the 
                interdisciplinary team of an applicable provider; 
                and</DELETED>
                <DELETED>    (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.</DELETED>
        <DELETED>    (9) Stakeholder's views on the frequency with 
        which longitudinal comprehensive care planning services should 
        be furnished.</DELETED>
<DELETED>    (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.</DELETED>
<DELETED>    (c) Definitions.--In this section:</DELETED>
        <DELETED>    (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--</DELETED>
                <DELETED>    (A) furnishes longitudinal comprehensive 
                care planning services through an interdisciplinary 
                team; and</DELETED>
                <DELETED>    (B) meets such other requirements as the 
                Secretary may determine to be appropriate.</DELETED>
        <DELETED>    (2) Comptroller general.--The term ``Comptroller 
        General'' means the Comptroller General of the United 
        States.</DELETED>
        <DELETED>    (3) Interdisciplinary team.--The term 
        ``interdisciplinary team'' means a group that--</DELETED>
                <DELETED>    (A) includes the personnel described in 
                subsection (dd)(2)(B)(i) of such section 
                1861;</DELETED>
                <DELETED>    (B) may include a chaplain, minister, or 
                other clergy; and</DELETED>
                <DELETED>    (C) may include other direct care 
                personnel.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (5) Secretary.--The term ``Secretary'' means the 
        Secretary of Health and Human Services.</DELETED>

 <DELETED>TITLE VI--OTHER POLICIES TO IMPROVE CARE FOR THE CHRONICALLY 
                             ILL</DELETED>

<DELETED>SEC. 601. GAO STUDY AND REPORT ON IMPROVING MEDICATION 
              SYNCHRONIZATION.</DELETED>

<DELETED>    (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 
review of the following:</DELETED>
        <DELETED>    (1) The extent to which pharmacies have adopted 
        such programs.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (3) How such programs compare for Medicare 
        prescription drug plans and private payors.</DELETED>
        <DELETED>    (4) What is known about how such programs affect 
        patient medication adherence and overall patient health 
        outcomes and health outcomes, including if adherence and 
        outcomes vary by patient subpopulations, such as disease state 
        and socioeconomic status.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (6) The extent to which laws and regulations of 
        the Medicare program support such programs.</DELETED>
        <DELETED>    (7) Barriers to the use of medication 
        synchronization programs by Medicare prescription drug 
        plans.</DELETED>
<DELETED>    (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.</DELETED>

<DELETED>SEC. 602. GAO STUDY AND REPORT ON IMPACT OF OBESITY DRUGS ON 
              PATIENT HEALTH AND SPENDING.</DELETED>

<DELETED>    (a) Study.--The Comptroller General of the United States 
(in this section referred to as the ``Comptroller General'') shall 
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:</DELETED>
        <DELETED>    (1) The prevalence of obesity in the Medicare and 
        non-Medicare population.</DELETED>
        <DELETED>    (2) The utilization of obesity drugs.</DELETED>
        <DELETED>    (3) The distribution of Body Mass Index by 
        individuals taking obesity drugs, to the extent 
        practicable.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (5) Physician considerations and attitudes related 
        to prescribing obesity drugs.</DELETED>
        <DELETED>    (6) The extent to which coverage policies cease or 
        limit coverage for individuals who fail to receive clinical 
        benefit.</DELETED>
        <DELETED>    (7) What is known about the extent to which 
        individuals who take obesity drugs adhere to the prescribed 
        regimen.</DELETED>
        <DELETED>    (8) What is known about the extent to which 
        individuals who take obesity drugs maintain weight loss over 
        time.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
<DELETED>    (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.</DELETED>

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 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 panel shall take 
                into account the availability of varied benefits, cost-
                sharing, and supplemental benefits under the model 
                described in paragraph (2) of section 1859(h), 
                including the expansion under paragraph (1) of such 
                section.''.
    (d) Quality Measurement at the Plan Level for SNPs and 
Determination of Feasability of Quality Measurement at the Plan Level 
for All MA Plans.--Section 1853(o) of the Social Security Act (42 
U.S.C. 1395w-23(o)) is amended by adding at the end the following new 
paragraphs:
            ``(6) Quality measurement at the plan level for snps.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                Secretary may require reporting of data under section 
                1852(e) for, and apply under this subsection, quality 
                measures at the plan level for specialized MA plans for 
                special needs individuals instead of at the contract 
                level.
                    ``(B) Considerations.--Prior to applying quality 
                measurement at the plan level under this paragraph, the 
                Secretary shall--
                            ``(i) take into consideration the minimum 
                        number of enrollees in a specialized MA plan 
                        for special needs individuals in order to 
                        determine if a statistically significant or 
                        valid measurement of quality at the plan level 
                        is possible under this paragraph;
                            ``(ii) take into consideration the impact 
                        of such application on plans that serve a 
                        disproportionate number of individuals dually 
                        eligible for benefits under this title and 
                        under title XIX;
                            ``(iii) if quality measures are reported at 
                        the plan level, ensure that MA plans are not 
                        required to provide duplicative information;
                            ``(iv) ensure that such reporting does not 
                        interfere with the collection of encounter data 
                        submitted by MA organizations or the 
                        administration of any changes to the program 
                        under this part as a result of the collection 
                        of such data.
                    ``(C) Application.--If the Secretary applies 
                quality measurement at the plan level under this 
                paragraph, such quality measurement may include 
                Medicare Health Outcomes Survey (HOS), Healthcare 
                Effectiveness Data and Information Set (HEDIS), 
                Consumer Assessment of Healthcare Providers and Systems 
                (CAHPS) measures and quality measures under part D.
            ``(7) Determination of feasibility of quality measurement 
        at the plan level for all ma plans.--
                    ``(A) Determination of feasibility.--The Secretary 
                shall determine the feasibility of requiring reporting 
                of data under section 1852(e) for, and applying under 
                this subsection, quality measures at the plan level for 
                all MA plans under this part.
                    ``(B) Consideration of change.--After making a 
                determination under subparagraph (A), the Secretary 
                shall consider requiring such reporting and applying 
                such quality measures at the plan level as described in 
                such subparagraph.''.
    (e) GAO Study and Report on State-Level Integration Between Dual 
SNPs and Medicaid.--
            (1) Study.--The Comptroller General of the United States 
        (in this paragraph referred to as the ``Comptroller General'') 
        shall conduct a study on State-level integration between 
        specialized MA plans for special needs individuals described in 
        subsection (b)(6)(B)(ii) of section 1859 of the Social Security 
        Act (42 U.S.C. 1395w-28) and the Medicaid program under title 
        XIX of such Act (42 U.S.C. 1396 et seq.). Such study shall 
        include an analysis of the following:
                    (A) The characteristics of States in which the 
                State agency responsible for administering the State 
                plan under such title XIX has a contract with such a 
                specialized MA plan and that delivers long term 
                services and supports under the State plan under such 
                title XIX through a managed care program, including the 
                requirements under such State plan with respect to long 
                term services and supports.
                    (B) The types of such specialized MA plans, which 
                may include the following:
                            (i) A plan described in section 
                        1853(a)(1)(B)(iv)(II) of such Act (42 U.S.C. 
                        1395w-23(a)(1)(B)(iv)(II)).
                            (ii) A plan that meets the requirements 
                        described in subsection (f)(3)(D) of such 
                        section 1859.
                            (iii) A plan described in clause (ii) that 
                        also meets additional requirements established 
                        by the State.
                    (C) The characteristics of individuals enrolled in 
                such specialized MA plans.
                    (D) As practicable, the following with respect to 
                State programs for the delivery of long term services 
                and supports under such title XIX through a managed 
                care program:
                            (i) Which populations of individuals are 
                        eligible to receive such services and supports.
                            (ii) Whether all such services and supports 
                        are provided on a capitated basis or if any of 
                        such services and supports are carved out and 
                        provided through fee-for-service.
                    (E) How the availability and variation of 
                integration arrangements of such specialized MA plans 
                offered in States affects spending, service delivery 
                options, access to community-based care, and 
                utilization of care.
                    (F) The efforts of State Medicaid programs to 
                transition dually-eligible beneficiaries receiving long 
                term services and supports (LTSS) from institutional 
                settings to home and community-based settings and 
                related financial impacts of such transitions
            (2) Report.--Not later than 2 years after the date of the 
        enactment of this Act, the Comptroller General shall submit to 
        Congress a report containing the results of the study conducted 
        under paragraph (1), together with recommendations for such 
        legislation and administrative action as the Comptroller 
        General determines appropriate.

             TITLE III--EXPANDING INNOVATION AND TECHNOLOGY

SEC. 301. ADAPTING BENEFITS TO MEET THE NEEDS OF CHRONICALLY ILL 
              MEDICARE ADVANTAGE ENROLLEES.

    Section 1859 of the Social Security Act (42 U.S.C. 1395w-28) is 
amended by adding at the end the following new subsection:
    ``(h) National Testing of Model for Medicare Advantage Value-Based 
Insurance Design.--
            ``(1) In general.--In implementing the model described in 
        paragraph (2) proposed to be tested under section 1115A(b), the 
        Secretary shall revise the testing of the model under such 
        section to cover, effective not later than January 1, 2020, all 
        States.
            ``(2) Model described.--The model described in this 
        paragraph is the testing of a model of Medicare Advantage 
        value-based insurance design that would allow Medicare 
        Advantage plans the option to propose and design benefit 
        structures that vary benefits, cost-sharing, and supplemental 
        benefits offered to enrollees with specific chronic diseases 
        proposed to be carried out in Oregon, Arizona, Texas, Iowa, 
        Michigan, Indiana, Tennessee, Alabama, Pennsylvania, and 
        Massachusetts.
            ``(3) Termination and modification provision not applicable 
        until january 1, 2022.--The provisions of section 
        1115A(b)(3)(B) shall apply to the model described in paragraph 
        (2), including such model as expanded under paragraph (1), 
        beginning January 1, 2022, but shall not apply to such model, 
        as so expanded, prior to such date.
            ``(4) Funding.--The Secretary shall allocate funds made 
        available under section 1115A(f)(1) to design, implement, and 
        evaluate the model described in paragraph (2), as expanded 
        under paragraph (1).''.

SEC. 302. EXPANDING SUPPLEMENTAL BENEFITS TO MEET THE NEEDS OF 
              CHRONICALLY ILL MEDICARE ADVANTAGE ENROLLEES.

    (a) In General.--Section 1852(a)(3) of the Social Security Act (42 
U.S.C. 1395w-22(a)(3)) is amended--
            (1) in subparagraph (A), by striking ``Each'' and inserting 
        ``Subject to subparagraph (D), each''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Expanding supplemental benefits to meet the 
                needs of chronically ill enrollees.--
                            ``(i) In general.--For plan year 2020 and 
                        subsequent plan years, in addition to any 
                        supplemental health care benefits otherwise 
                        provided under this paragraph, an MA plan may 
                        provide supplemental benefits described in 
                        clause (ii) to a chronically ill enrollee (as 
                        defined in clause (iii)).
                            ``(ii) Supplemental benefits described.--
                                    ``(I) In general.--Supplemental 
                                benefits described in this clause are 
                                supplemental benefits that, with 
                                respect to a chronically ill enrollee, 
                                have a reasonable expectation of 
                                improving or maintaining the health or 
                                overall function of the chronically ill 
                                enrollee and may not be limited to 
                                being primarily health related 
                                benefits.
                                    ``(II) Authority to waive 
                                uniformity requirements.--The Secretary 
                                may, only with respect to supplemental 
                                benefits provided to a chronically ill 
                                enrollee under this subparagraph, waive 
                                the uniformity requirement under 
                                subsection (d)(1)(A), as determined 
                                appropriate by the Secretary.
                            ``(iii) Chronically ill enrollee defined.--
                        In this subparagraph, the term `chronically ill 
                        enrollee' means an enrollee in an MA plan that 
                        the Secretary determines--
                                    ``(I) has one or more comorbid and 
                                medically complex chronic conditions 
                                that is life threatening or 
                                significantly limits the overall health 
                                or function of the enrollee;
                                    ``(II) has a high risk of 
                                hospitalization or other adverse health 
                                outcomes; and
                                    ``(III) requires intensive care 
                                coordination.''.
    (b) GAO Study and Report.--
            (1) Study.--The Comptroller General of the United States 
        (in this subsection referred to as the ``Comptroller General'') 
        shall conduct a study on supplemental benefits provided to 
        enrollees in Medicare Advantage plans under part C of title 
        XVIII of the Social Security Act. To the extend data are 
        available, such study shall include an analysis of the 
        following:
                    (A) The type of supplemental benefits provided to 
                such enrollees, the total number of enrollees receiving 
                each supplemental benefit, and whether the supplemental 
                benefit is covered by the standard benchmark cost of 
                the benefit or with an additional premium.
                    (B) The frequency in which supplemental benefits 
                are utilized by such enrollees.
                    (C) The impact supplemental benefits have on--
                            (i) indicators of the quality of care 
                        received by such enrollees, including overall 
                        health and function of the enrollees;
                            (ii) the utilization of items and services 
                        for which benefits are available under the 
                        original Medicare fee-for-service program 
                        option under parts A and B of such title XVIII 
                        by such enrollees; and
                            (iii) the amount of the bids submitted by 
                        Medicare Advantage Organizations for Medicare 
                        Advantage plans under such part C.
            (2) Report.--Not later than 5 years after the date of the 
        enactment of this Act, the Comptroller General shall submit to 
        Congress a report containing the results of the study conducted 
        under paragraph (1), together with recommendations for such 
        legislation and administrative action as the Comptroller 
        General determines appropriate.

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

    (a) In General.--Section 1852 of the Social Security Act (42 U.S.C. 
1395w-22) is amended--
            (1) in subsection (a)(1)(B)(i), by inserting ``, subject to 
        subsection (m),'' after ``means''; and
            (2) by adding at the end the following new subsection:
    ``(m) Provision of Additional Telehealth Benefits.--
            ``(1) MA plan option.--For plan year 2020 and subsequent 
        plan years, subject to the requirements of paragraph (3), an MA 
        plan may provide additional telehealth benefits (as defined in 
        paragraph (2)) to individuals enrolled under this part.
            ``(2) Additional telehealth benefits defined.--
                    ``(A) In general.--For purposes of this subsection 
                and section 1854:
                            ``(i) Definition.--The term `additional 
                        telehealth benefits' means services--
                                    ``(I) for which benefits are 
                                available under part B, including 
                                services for which payment is not made 
                                under section 1834(m) due to the 
                                conditions for payment under such 
                                section; and
                                    ``(II) that are identified as 
                                clinically appropriate to furnish using 
                                electronic information and 
                                telecommunications technology when a 
                                physician (as defined in section 
                                1861(r)) or practitioner (described in 
                                section 1842(b)(18)(C)) providing the 
                                service is not at the same location as 
                                the plan enrollee.
                            ``(ii) Exclusion of capital and 
                        infrastructure costs and investments.--The term 
                        `additional telehealth benefits' does not 
                        include capital and infrastructure costs and 
                        investments relating to such benefits.
                    ``(B) Public comment.--Not later than November 30, 
                2018, the Secretary shall solicit comments on--
                            ``(i) what types of items and services 
                        (including those provided through supplemental 
                        health care benefits) should be considered to 
                        be additional telehealth benefits; and
                            ``(ii) the requirements for the provision 
                        or furnishing of such benefits (such as 
                        licensure, training, and coordination 
                        requirements).
            ``(3) Requirements for additional telehealth benefits.--The 
        Secretary shall specify requirements for the provision or 
        furnishing of additional telehealth benefits, including with 
        respect to the following:
                    ``(A) Physician or practitioner licensure and other 
                requirements such as specific training.
                    ``(B) Factors necessary to ensure the coordination 
                of such benefits with items and services furnished in-
                person.
                    ``(C) Such other areas as determined by the 
                Secretary.
            ``(4) Enrollee choice.--If an MA plan provides a service as 
        an additional telehealth benefit (as defined in paragraph 
        (2))--
                    ``(A) the MA plan shall also provide access to such 
                benefit through an in-person visit (and not only as an 
                additional telehealth benefit); and
                    ``(B) an individual enrollee shall have discretion 
                as to whether to receive such service through the in-
                person visit or as an additional telehealth benefit.
            ``(5) Treatment under ma.--For purposes of this subsection 
        and section 1854, additional telehealth benefits shall be 
        treated as if they were benefits under the original Medicare 
        fee-for-service program option.
            ``(6) Construction.--Nothing in this subsection shall be 
        construed as affecting the requirement under subsection (a)(1) 
        that MA plans provide enrollees with items and services (other 
        than hospice care) for which benefits are available under parts 
        A and B, including benefits available under section 1834(m).''.
    (b) Clarification Regarding Inclusion in Bid Amount.--Section 
1854(a)(6)(A)(ii)(I) of the Social Security Act (42 U.S.C. 1395w-
24(a)(6)(A)(ii)(I)) is amended by inserting ``, including, for plan 
year 2020 and subsequent plan years, the provision of additional 
telehealth benefits as described in section 1852(m)'' before the 
semicolon at the end.

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

    (a) In General.--Section 1899 of the Social Security Act (42 U.S.C. 
1395jjj) is amended by adding at the end the following new subsection:
    ``(l) Providing ACOs the Ability To Expand the Use of Telehealth 
Services.--
            ``(1) In general.--In the case of telehealth services for 
        which payment would otherwise be made under this title 
        furnished on or after January 1, 2020, for purposes of this 
        subsection only, the following shall apply with respect to such 
        services furnished by a physician or practitioner participating 
        in an applicable ACO (as defined in paragraph (2)) to a 
        Medicare fee-for-service beneficiary assigned to the applicable 
        ACO:
                    ``(A) Inclusion of home as originating site.--
                Subject to paragraph (3), the home of a beneficiary 
                shall be treated as an originating site described in 
                section 1834(m)(4)(C)(ii).
                    ``(B) No application of geographic limitation.--The 
                geographic limitation under section 1834(m)(4)(C)(i) 
                shall not apply with respect to an originating site 
                described in section 1834(m)(4)(C)(ii) (including the 
                home of a beneficiary under subparagraph (A)), subject 
                to State licensing requirements.
            ``(2) Definitions.--In this subsection:
                    ``(A) Applicable aco.--The term `applicable ACO' 
                means an ACO participating in a model tested or 
                expanded under section 1115A or under this section--
                            ``(i) that operates under a two-sided 
                        model--
                                    ``(I) described in section 
                                425.600(a) of title 42, Code of Federal 
                                Regulations; or
                                    ``(II) tested or expanded under 
                                section 1115A; and
                            ``(ii) for which Medicare fee-for-service 
                        beneficiaries are assigned to the ACO using a 
                        prospective assignment method, as determined 
                        appropriate by the Secretary.
                    ``(B) Home.--The term `home' means, with respect to 
                a Medicare fee-for-service beneficiary, the place of 
                residence used as the home of the beneficiary.
            ``(3) Telehealth services received in the home.--In the 
        case of telehealth services described in paragraph (1) where 
        the home of a Medicare fee-for-service beneficiary is the 
        originating site, the following shall apply:
                    ``(A) No facility fee.--There shall be no facility 
                fee paid to the originating site under section 
                1834(m)(2)(B).
                    ``(B) Exclusion of certain services.--No payment 
                may be made for such services that are inappropriate to 
                furnish in the home setting such as services that are 
                typically furnished in inpatient settings such as a 
                hospital.''.
    (b) Study and Report.--
            (1) Study.--
                    (A) In general.--The Secretary of Health and Human 
                Services (in this subsection referred to as the 
                ``Secretary'') shall conduct a study on the 
                implementation of section 1899(l) of the Social 
                Security Act, as added by subsection (a). Such study 
                shall include an analysis of the utilization of, and 
                expenditures for, telehealth services under such 
                section.
                    (B) Collection of data.--The Secretary may collect 
                such data as the Secretary determines necessary to 
                carry out the study under this paragraph.
            (2) Report.--Not later than January 1, 2026, the Secretary 
        shall submit to Congress a report containing the results of the 
        study conducted under paragraph (1), together with 
        recommendations for such legislation and administrative action 
        as the Secretary determines appropriate.

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

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

          TITLE IV--IDENTIFYING THE CHRONICALLY ILL POPULATION

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

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

    TITLE V--EMPOWERING INDIVIDUALS AND CAREGIVERS IN CARE DELIVERY

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

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

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

    (a) Study.--The Comptroller General shall conduct a study on the 
establishment under part B of the Medicare program under title XVIII of 
the Social Security Act of a payment code for a visit for longitudinal 
comprehensive care planning services. Such study shall include an 
analysis of the following to the extent such information is available:
            (1) The frequency with which services similar to 
        longitudinal comprehensive care planning services are furnished 
        to Medicare beneficiaries, which providers of services and 
        suppliers are furnishing those services, whether Medicare 
        reimbursement is being received for those services, and, if so, 
        through which codes those services are being reimbursed.
            (2) Whether, and the extent to which, longitudinal 
        comprehensive care planning services would overlap, and could 
        therefore result in duplicative payment, with services covered 
        under the hospice benefit as well as the chronic care 
        management code, evaluation and management codes, or other 
        codes that already exist under part B of the Medicare program.
            (3) Any barriers to hospitals, skilled nursing facilities, 
        hospice programs, home health agencies, and other applicable 
        providers working with a Medicare beneficiary to engage in the 
        care planning process and complete the necessary documentation 
        to support the treatment and care plan of the beneficiary and 
        provide such documentation to other providers and the 
        beneficiary or the beneficiary's representative.
            (4) Any barriers to providers, other than the provider 
        furnishing longitudinal comprehensive care planning services, 
        accessing the care plan and associated documentation for use 
        related to the care of the Medicare beneficiary.
            (5) Potential options for ensuring that applicable 
        providers are notified of a patient's existing longitudinal 
        care plan and that applicable providers consider that plan in 
        making their treatment decisions, and what the challenges might 
        be in implementing such options.
            (6) Stakeholder's views on the need for the development of 
        quality metrics with respect to longitudinal comprehensive care 
        planning services, such as measures related to--
                    (A) the process of eliciting input from the 
                Medicare beneficiary or from a legally authorized 
                representative and documenting in the medical record 
                the patient-directed care plan;
                    (B) the effectiveness and patient-centeredness of 
                the care plan in organizing delivery of services 
                consistent with the plan;
                    (C) the availability of the care plan and 
                associated documentation to other providers that care 
                for the beneficiary; and
                    (D) the extent to which the beneficiary received 
                services and support that is free from discrimination 
                based on advanced age, disability status, or advanced 
                illness.
            (7) Stakeholder's views on how such quality metrics would 
        provide information on--
                    (A) the goals, values, and preferences of the 
                beneficiary;
                    (B) the documentation of the care plan;
                    (C) services furnished to the beneficiary; and
                    (D) outcomes of treatment.
            (8) Stakeholder's views on--
                    (A) the type of training and education needed for 
                applicable providers, individuals, and caregivers in 
                order to facilitate longitudinal comprehensive care 
                planning services;
                    (B) the types of providers of services and 
                suppliers that should be included in the 
                interdisciplinary team of an applicable provider; and
                    (C) the characteristics of Medicare beneficiaries 
                that would be most appropriate to receive longitudinal 
                comprehensive care planning services, such as 
                individuals with advanced disease and individuals who 
                need assistance with multiple activities of daily 
                living.
            (9) Stakeholder's views on the frequency with which 
        longitudinal comprehensive care planning services should be 
        furnished.
    (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General shall submit to Congress 
a report containing the results of the study conducted under subsection 
(a), together with recommendations for such legislation and 
administrative action as the Comptroller General determines 
appropriate.
    (c) Definitions.--In this section:
            (1) Applicable provider.--The term ``applicable provider'' 
        means a hospice program (as defined in subsection (dd)(2) of 
        section 1861 of the Social Security Act (42 U.S.C. 1395ww)) or 
        other provider of services (as defined in subsection (u) of 
        such section) or supplier (as defined in subsection (d) of such 
        section) that--
                    (A) furnishes longitudinal comprehensive care 
                planning services through an interdisciplinary team; 
                and
                    (B) meets such other requirements as the Secretary 
                may determine to be appropriate.
            (2) Comptroller general.--The term ``Comptroller General'' 
        means the Comptroller General of the United States.
            (3) Interdisciplinary team.--The term ``interdisciplinary 
        team'' means a group that--
                    (A) includes the personnel described in subsection 
                (dd)(2)(B)(i) of such section 1861;
                    (B) may include a chaplain, minister, or other 
                clergy; and
                    (C) may include other direct care personnel.
            (4) Longitudinal comprehensive care planning services.--The 
        term ``longitudinal comprehensive care planning services'' 
        means a voluntary shared decisionmaking process that is 
        furnished by an applicable provider through an 
        interdisciplinary team and includes a conversation with 
        Medicare beneficiaries who have received a diagnosis of a 
        serious or life-threatening illness. The purpose of such 
        services is to discuss a longitudinal care plan that addresses 
        the progression of the disease, treatment options, the goals, 
        values, and preferences of the beneficiary, and the 
        availability of other resources and social supports that may 
        reduce the beneficiary's health risks and promote self-
        management and shared decisionmaking.
            (5) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

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

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

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

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

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

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

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

SEC. 604. HHS STUDY AND REPORT ON LONG-TERM RISK FACTORS FOR CHRONIC 
              CONDITIONS AMONG MEDICARE BENEFICIARIES.

    (a) Study.--The Secretary of Health and Human Services (in this 
section referred to as the ``Secretary'') shall conduct a study on 
long-term cost drivers to the Medicare program, including obesity, 
tobacco use, mental health conditions, and other factors that may 
contribute to the deterioration of health conditions among individuals 
with chronic conditions in the Medicare population. The study shall 
include an analysis of any barriers to collecting and analyzing such 
information and how to remove any such barriers (including through 
legislation and administrative actions).
    (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Secretary shall submit to Congress a report 
containing the results of the study under subsection (a), together with 
recommendations for such legislation and administrative action as the 
Secretary determines appropriate. The Secretary shall also post such 
report on the Internet website of the Department of Health and Human 
Services.

                           TITLE VII--OFFSETS

SEC. 701. MEDICARE IMPROVEMENT FUND.

    Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
1395iii(b)(1)) is amended by striking ``$270,000,000'' and inserting 
``$0''.

SEC. 702. MEDICAID IMPROVEMENT FUND.

    Section 1941(b)(1) of the Social Security Act (42 U.S.C. 1396w-
1(b)(1)) is amended by striking ``$5,000,000'' and inserting ``$0''.
                                                       Calendar No. 206

115th CONGRESS

  1st Session

                                 S. 870

                          [Report No. 115-146]

_______________________________________________________________________

                                 A BILL

 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.

_______________________________________________________________________

                             August 3, 2017

                       Reported with an amendment
```