I 

111TH CONGRESS 

1ST SESSION H. R. 2535 

To establish a Blueprint for Health in order to create a comprehensive 

system of care incorporating medical homes to improve the delivery 

and affordability of health care through disease prevention, health promotion, and education about and better management of chronic conditions. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 20, 2009 

Mr. WELCH introduced the following bill; which was referred to the Committee 

on Energy and Commerce 

A BILL 

To establish a Blueprint for Health in order to create a 

comprehensive system of care incorporating medical 

homes to improve the delivery and affordability of health 

care through disease prevention, health promotion, and 

education about and better management of chronic conditions. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Blueprint for Health Act of 2009’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents of 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Purpose. 

Sec. 3. Establishment of a Blueprint for Health for disease prevention, health 

promotion, and education about and better management of 

chronic conditions. 

Sec. 4. Strategic plan. 

Sec. 5. Chronic care management programs. 

Sec. 6. Incentives for prevention of chronic disease. 

Sec. 7. Health information technology. 

Sec. 8. Recommendations to Congress; annual report. 

3 SEC. 2. PURPOSE. 

4 It is the purpose of this Act to establish a Blueprint 

5 for Health which is designed— 

6 (1) to create a national integrated medical 

7 home model of care that enhances primary care, en8 courages multidisciplinary coordination, and pro9 motes disease prevention, health promotion, and 

10 education about and better management of chronic 

11 conditions; 

12 (2) to increase Americans’ access to affordable, 

13 appropriate, high quality care through the use of the 

14 integrated medical home model; and 

15 (3) to reduce costs to the United States health 

16 care system through the application of such model. 


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1 SEC. 3. ESTABLISHMENT OF A BLUEPRINT FOR HEALTH 

2 FOR DISEASE PREVENTION, HEALTH PRO3 MOTION, AND EDUCATION ABOUT AND BET4 TER MANAGEMENT OF CHRONIC CONDI5 TIONS. 

6 (a) IN GENERAL.—The Secretary of Health and 

7 Human Services (in this Act referred to as the ‘‘Sec8 retary’’) shall create consistent with this Act a program 

9 (in this Act referred to as the ‘‘Blueprint for Health’’) 

10 that provides a national infrastructure for disease preven11 tion, health promotion, and education about and better 

12 management of chronic conditions through the use of a 

13 nationwide integrated medical home model of care (in this 

14 Act referred to as the ‘‘integrated medical home model of 

15 care’’) in a manner that is designed to initiate, coordinate, 

16 and evaluate measures for promoting health and pre17 venting disease in the United States. 

18 (b) ELEMENTS OF BLUEPRINT.—The Blueprint for 

19 Health shall include the following elements: 

20 (1) STRATEGIC PLAN.—A strategic plan de21 scribed in section 4 for designing the integrated 

22 medical home model of care. 

23 (2) CHRONIC CARE MANAGEMENT PROGRAMS.— 

24 Chronic care management programs described in 

25 section 5. 


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1 (3) PREVENTION INCENTIVES.—Incentives for 

2 the prevention of chronic disease described in section 

3 6. 

4 (4) ASSESSMENT OF HIT INITIATIVES.—A plan 

5 described in section 7 for the assessment of current 

6 health information technology initiatives. 

7 (c) EXECUTIVE COMMITTEE.— 

8 (1) IN GENERAL.—The Secretary shall convene 

9 an executive committee to advise the Secretary on 

10 the creation and implementation of the Blueprint for 

11 Health. 

12 (2) COMPOSITION.—The executive committee 

13 shall include representation from national and State 

14 medical, hospital, and pharmaceutical associations, 

15 consumer and patient advocacy groups, labor 

16 groups, employer and other purchasing groups, and 

17 the health insurance industry. 

18 SEC. 4. STRATEGIC PLAN. 

19 The Blueprint for Health shall include a strategic 

20 plan for designing the integrated medical home model of 

21 care that includes the following: 

22 (1) Recommended elements of an integrated co23 ordinated chronic care management model that in24 corporates the following: 


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1 (A) Medical practices acting as medical 

2 homes in being primary caregivers in close co3 ordination with other elements. The elements 

4 for such homes may be based on guidelines de5 veloped for such homes by the National Com6 mittee for Quality Assurance. 

7 (B) Early disease detection and risk strati8 fication. 

9 (C) Community care teams that provide 

10 care support for medical homes and assist in 

11 coordinating care among medical homes, hos12 pitals, prevention programs, multidisciplinary 

13 specialists, and others. 

14 (2) A plan for the formation of such community 

15 care teams that may include panel managers, public 

16 health prevention specialists, nurse coordinators, so17 cial workers, dieticians, community health workers, 

18 care coordinators, behavioral health specialists, and 

19 other patient support personnel. 

20 (3) Incentives for patient self management, 

21 community-based initiatives, and system and infor22 mation technology reforms, intended for use by all 

23 providers and health plans, including Medicare, 

24 Medicaid, the Federal employees health benefits pro25 gram, and other Federal programs. 


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1 (4) A description of recommended prevention 

2 programs and a strategy for integrating them into 

3 the integrated medical home model of care. 

4 (5) A plan to ensure that chronically ill patients 

5 have a low level of cost sharing under the integrated 

6 medical home model of care. 

7 (6) Alignment of health care information tech8 nology initiatives with information technology needs. 

9 (7) Development and use of outcome and re10 porting measures designed to track the progress of 

11 patients meeting clinically recommended treatment 

12 goals. 

13 (8) A strategy for ensuring the broad support 

14 of the integrated medical home model of care by 

15 health insurers, hospitals, and health care profes16 sionals, including specialists and other physicians. 

17 (9) Recommendations for better integrating 

18 specialty care services into primary care practices to 

19 ensure care coordination and the use of best prac20 tices. 

21 (10) Recommendations for the consultation of 

22 providers experienced with the development and im23 plementation of an integrated medical home model 

24 of care as this Act’s care coordination model is de25 veloped. 


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1 (11) A strategy for standardizing outcome and 

2 financial measures to ensure consistency among all 

3 health plans, including Medicare, Medicaid, the Fed4 eral employees health benefits program, and other 

5 Federal programs. 

6 SEC. 5. CHRONIC CARE MANAGEMENT PROGRAMS. 

7 The Secretary shall include in the Blueprint for 

8 Health chronic care management programs which provide 

9 for at least the following: 

10 (1) Methods for identifying and enrolling chron11 ically ill patients and for encouraging primary care 

12 physicians, specialists, hospitals, and others to par13 ticipate in such programs. 

14 (2) Development of health risk appraisal or as15 sessment for individuals enrolled under Medicare, 

16 Medicaid, or the Federal employees health benefits 

17 program. 

18 (3) A process for coordinating care among 

19 health professionals including multidisciplinary care 

20 teams and specialty care providers. 

21 (4) Methods for increasing communication 

22 among health care professionals and patients, in23 cluding patient education, self-management, and fol24 low up plans. 


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1 (5) Process and outcome measures to provide 

2 performance feedback for health care professionals 

3 and information on the quality of care. 

4 (6) Payment methodologies to create financial 

5 incentives for patient participation and to allow pri6 mary care physicians to meet specific standards of 

7 a medical home program. Such financial incentives 

8 shall include— 

9 (A) enhanced payment to medical prac10 tices, such as a per member per month fee, 

11 based on standards for a medical home, such as 

12 the National Committee for Quality Assurance 

13 standards for a patient centered medical home; 

14 (B) payment for care support services, 

15 such as community care teams or other applica16 ble approaches, across all insurers, including 

17 multi-payer private plans and Medicare, Med18 icaid, and other public plans; and 

19 (C) the support of a community based sav20 ings sharing and reinvestment model, such as 

21 an accountable care organization, which incor22 porates a balanced set of financial and quality 

23 incentives, such as the Institute for Healthcare 

24 Improvement’s Triple Aims. 


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1 SEC. 6. INCENTIVES FOR PREVENTION OF CHRONIC DIS2 EASE. 

3 (a) IN GENERAL.—The Secretary shall include in the 

4 Blueprint for Health a plan to provide incentives to pre5 vent chronic diseases, including investments in healthy 

6 and sustainable local and regional food systems as well 

7 as the broader use of lifestyle changes, such as through 

8 diet, exercise, and smoking cessation in the schools, com9 munities, and workplace. 

10 (b) COMPILATION OF EFFECTIVE PRACTICES.— 

11 Based on recommendations set forth by the United States 

12 Preventive Services Task Force, the Secretary shall com13 pile a list of effective practices that would serve as a basis 

14 for establishing programs to prevent chronic disease and 

15 that could be included in the Blueprint for Health. 

16 (c) RECOMMENDATIONS.—The plan under subsection 

17 (a) may include the following: 

18 (1) Grant opportunities and Federal tax credits 

19 for localities to conduct community assessment, 

20 intervention, and activation plans in which public 

21 health data are collected and analyzed to identify 

22 areas in greatest need of prevention and wellness 

23 programs. 

24 (2) Federal tax credits and incentive grants to 

25 local education agencies, businesses, local depart26 ments of public health, communities, hospitals, 


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1 health care providers, and other entities so that they 

2 may adopt effective models of wellness shown to 

3 lower costs and improve health. 

4 (3) Incentives for individuals to take proactive 

5 preventative measures, including weight manage6 ment and smoking cessation. 

7 (4) Federal tax credits and incentive grants to 

8 local education agencies, businesses, local depart9 ments of public health, communities, hospitals, 

10 health care providers and other entities to promote 

11 the development of healthy and sustainable local and 

12 regional food systems. 

13 SEC. 7. HEALTH INFORMATION TECHNOLOGY. 

14 (a) IN GENERAL.—The Blueprint for Health shall 

15 promote the effective, efficient, national use of health care 

16 information technology initiatives. 

17 (b) ASSESSMENT.—As part of the Blueprint for 

18 Health, the Secretary shall commission an assessment to 

19 be presented to Congress not later than two years after 

20 the date of the enactment of this Act that examines the 

21 implementation of the health information technology pro22 visions enacted as part of the American Recovery and Re23 investment Act of 2009 (Public Law 111–5). This assess24 ment shall evaluate the implementation of such provisions 

25 as they apply to chronic care management, and determine 


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1 if further action is needed to ensure that the funding pro2 vided in such Act under such provisions is used effectively 

3 and efficiently to help ensure the effective management 

4 of chronic disease. 

5 SEC. 8. RECOMMENDATIONS TO CONGRESS; ANNUAL RE6 PORT. 

7 (a) IN GENERAL.—Not later than 1 year after the 

8 date of the enactment of this Act, the Secretary shall 

9 present to Congress recommendations for legislation to 

10 implement the Blueprint for Health, including the estab11 lishment of programs designed to enhance primary care, 

12 promote multidisciplinary care coordination, prevent dis13 ease, improve quality, contain costs, more effectively man14 age chronic illness, and promote good health and preven15 tion initiatives. 

16 (b) ANNUAL REPORT.—The Secretary shall submit 

17 an annual report to Congress on the status of the imple18 mentation of the Blueprint for Health. 

Æ 


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