II 

113TH CONGRESS 

1ST SESSION S. 1228 

To establish a program to provide incentive payments to participating 

Medicare beneficiaries who voluntarily establish and maintain better health. 

IN THE SENATE OF THE UNITED STATES 

JUNE 26, 2013 

Mr. WYDEN (for himself and Mr. PORTMAN) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To establish a program to provide incentive payments to 

participating Medicare beneficiaries who voluntarily establish and maintain better health. 

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. 

4 This Act may be cited as the ‘‘Medicare Better 

5 Health Rewards Program Act of 2013’’. 

6 SEC. 2. MEDICARE BETTER HEALTH REWARDS PROGRAM. 

7 Part B of title XVIII of the Social Security Act (42 

8 U.S.C. 1395j et seq.) is amended by adding at the end 

9 the following new section: 


tjames on DSK6SPTVN1PROD with BILLS
2 

•S 1228 IS

1 ‘‘MEDICARE BETTER HEALTH REWARDS PROGRAM

2 ‘‘SEC. 1849. (a) IN GENERAL.—The Secretary shall 

3 establish a Better Health Rewards Program (in this sec4 tion referred to as the ‘Program’) under which incentives 

5 are provided to Medicare beneficiaries who voluntarily 

6 agree to participate in the Program. 

7 ‘‘(b) ENROLLMENT.—A health professional partici8 pating in the Program shall provide their patients who are 

9 Medicare beneficiaries with a description of and an oppor10 tunity to enroll in the Program on a voluntary basis. If 

11 a Medicare beneficiary elects to enroll in the Program, the 

12 health professional shall inform the Secretary of the indi13 vidual’s enrollment through a process established by the 

14 Secretary, which does not impose additional administra15 tive requirements on the participating health professional. 

16 ‘‘(c) ESTABLISHMENT OF BETTER HEALTH TARGET

17 STANDARDS.— 

18 ‘‘(1) IN GENERAL.— 

19 ‘‘(A) ESTABLISHMENT.—The Secretary 

20 shall establish standards for measuring better 

21 health targets and points for achieving such 

22 standards for participating Medicare bene23 ficiaries, including such standards and points 

24 with respect to the following: 

25 ‘‘(i) Annual wellness visit. 


tjames on DSK6SPTVN1PROD with BILLS
3 

•S 1228 IS

1 ‘‘(ii) Tobacco cessation. 

2 ‘‘(iii) Body Mass Index (BMI). 

3 ‘‘(iv) Diabetes screening test. 

4 ‘‘(v) Cardiovascular disease screening. 

5 ‘‘(vi) Cholesterol level screening. 

6 ‘‘(vii) Screening tests and specified 

7 vaccinations. 

8 ‘‘(B) CONSULTATION.—In establishing 

9 standards and points for achieving such stand10 ards under this subsection, the Secretary— 

11 ‘‘(i) shall consult with 1 or more na12 tionally recognized health care quality or13 ganizations, as determined appropriate by 

14 the Secretary; and 

15 ‘‘(ii) may consult with physicians and 

16 other professionals experienced with well17 ness programs. 

18 ‘‘(C) POINTS.—The number of points 

19 awarded for a year for achieving standards with 

20 respect to each of the targets described in 

21 clauses (i) through (vii) of subparagraph (A) 

22 shall not exceed 5. Such points may be awarded 

23 on a sliding scale, based on standards estab24 lished under this subsection, as determined ap25 propriate by the Secretary. 


tjames on DSK6SPTVN1PROD with BILLS
4 

•S 1228 IS

1 ‘‘(2) MODIFICATION OF BETTER HEALTH TAR2 GET STANDARDS AND ASSIGNED POINTS.— 

3 ‘‘(A) IN GENERAL.—The Secretary may 

4 modify standards for measuring better health 

5 targets and, subject to paragraph (1)(C), points 

6 for achieving such standards for participating 

7 Medicare beneficiaries under this subsection. 

8 ‘‘(B) CONSULTATION.—In modifying 

9 standards and points for achieving such stand10 ards under this paragraph, the Secretary— 

11 ‘‘(i) shall consult with 1 or more na12 tionally recognized health care quality or13 ganizations, as determined appropriate by 

14 the Secretary; and 

15 ‘‘(ii) may consult with physicians and 

16 other professionals experienced with well17 ness programs. 

18 ‘‘(d) CONDUCT OF PROGRAM.— 

19 ‘‘(1) DURATION.— 

20 ‘‘(A) IN GENERAL.—Subject to subpara21 graph (B), the Program shall be conducted for 

22 not less than a 3-year period. 

23 ‘‘(B) EXPANSION.—The Secretary shall ex24 pand the duration and scope of the Program, to 


tjames on DSK6SPTVN1PROD with BILLS
5 

•S 1228 IS

1 the extent determined appropriate by the Sec2 retary, if— 

3 ‘‘(i) the Secretary determines that 

4 such expansion is expected to— 

5 ‘‘(I) reduce spending under this 

6 title without reducing the quality of 

7 care; or 

8 ‘‘(II) improve the quality of care 

9 and reduce spending; 

10 ‘‘(ii) the Chief Actuary of the Centers 

11 for Medicare & Medicaid Services certifies 

12 that such expansion would reduce program 

13 spending under this title; and 

14 ‘‘(iii) the Secretary determines that 

15 such expansion would not deny or limit the 

16 coverage or provision of benefits under this 

17 title for individuals. 

18 ‘‘(2) COLLECTION AND USE OF BASELINE

19 DATA.—During the first year of the Program, a 

20 health professional shall establish and report to the 

21 Secretary baseline information for each participating 

22 Medicare beneficiary who is a patient of the health 

23 professional as part of that beneficiary’s first year 

24 assessment under paragraph (3)(A). The health pro25 fessional shall use such data to aid in the determinaVerDate Mar 15 2010 03:19 Jul 02, 2013 Jkt 029200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1228.IS S1228

tjames on DSK6SPTVN1PROD with BILLS
6 

•S 1228 IS

1 tion of whether and to what extent the participating 

2 Medicare beneficiary is meeting the target standards 

3 under subsection (c) in each of years 2 and 3 of the 

4 Program. 

5 ‘‘(3) REQUIRED ASSESSMENTS FOR PARTICI6 PATING MEDICARE BENEFICIARIES.— 

7 ‘‘(A) FIRST YEAR.—During year 1 of the 

8 Program, a health professional shall furnish to 

9 each participating Medicare beneficiary that is 

10 a patient of the health professional either an 

11 annual wellness visit or an initial preventive 

12 physical examination. 

13 ‘‘(B) SECOND AND THIRD YEARS.—During 

14 each of years 2 and 3 of the Program, a health 

15 professional shall furnish to each participating 

16 Medicare beneficiary that is a patient of the 

17 health professional an annual wellness visit to 

18 determine whether and to what extent the par19 ticipating Medicare beneficiary has met the tar20 get standards under subsection (c). 

21 ‘‘(e) DETERMINATION OF POINTS AND PAYMENT OF

22 INCENTIVES.— 

23 ‘‘(1) DETERMINATION OF POINTS.—During 

24 each of years 2 and 3 of the Program, a health pro25 fessional shall— 


tjames on DSK6SPTVN1PROD with BILLS
7 

•S 1228 IS

1 ‘‘(A) evaluate and report to the Secretary 

2 whether each participating Medicare beneficiary 

3 that is a patient of the health professional has 

4 achieved the target standards under subsection 

5 (c); and 

6 ‘‘(B) determine the total amount of points 

7 that each such participating Medicare bene8 ficiary has achieved for the year based on the 

9 points assigned for achieving such standards 

10 under subsection (c). 

11 ‘‘(2) INCENTIVE PAYMENT.— 

12 ‘‘(A) IN GENERAL.—The Secretary shall 

13 pay to each participating Medicare beneficiary 

14 who achieves at least 20 points under para15 graph (1)(B) for the year an incentive payment. 

16 Such payment shall be equal to an amount de17 termined appropriate by the Secretary, but no 

18 case shall such amount exceed the following: 

‘‘Points Year 2 Payment 

Amount 

Year 3 or a Subsequent 

Year Payment Amount 

20–24 points ................. $100 $200

25 or more points .......... $200 $400. 

19 ‘‘(B) INFLATION ADJUSTMENT.—The dol20 lar amounts specified in this paragraph shall be 

21 increased, beginning with 2017, from year to 

22 year based on the percentage increase in the 


tjames on DSK6SPTVN1PROD with BILLS
8 

•S 1228 IS

1 consumer price index for all urban consumers 

2 (all items; United States city average), rounded 

3 to the nearest $1. 

4 ‘‘(3) FINAL DETERMINATION OF STANDARDS

5 ACHIEVEMENT MADE BY PARTICIPATING HEALTH

6 PROFESSIONAL.—Under the Program, a partici7 pating health professional shall make the final deter8 mination as to whether or not a participating Medi9 care beneficiary has met the target standards under 

10 subsection (c) and what screening tests and specified 

11 vaccinations, or other services, are necessary for 

12 purposes of making such determination. 

13 ‘‘(f) SPENDING BENCHMARKS.— 

14 ‘‘(1) IN GENERAL.—The Secretary shall collect 

15 relevant data, including data on claims paid under 

16 this title for services furnished to participating 

17 Medicare beneficiaries during the Program, for pur18 poses of determining the aggregate estimated sav19 ings achieved under this title for participating Medi20 care beneficiaries during each of years 2 and 3 of 

21 the Program in accordance with paragraph (2) (and 

22 for a subsequent year if the Program is expanded 

23 under subsection (d)(1)(B)). 

24 ‘‘(2) DETERMINATION OF AGGREGATE ESTI25 MATED SAVINGS.— 


tjames on DSK6SPTVN1PROD with BILLS
9 

•S 1228 IS

1 ‘‘(A) IN GENERAL.—The amount of the 

2 aggregate estimated savings under this title for 

3 participating Medicare beneficiaries under para4 graph (1), with respect to a year, shall be equal 

5 to— 

6 ‘‘(i) the estimated savings determined 

7 under subparagraph (B) for the year; 

8 minus 

9 ‘‘(ii) the aggregate incentive payments 

10 made under the Program during the year. 

11 ‘‘(B) DETERMINATION OF ESTIMATED SAV12 INGS.—For purposes of subparagraph (A)(i), 

13 the estimated savings determined under this 

14 subparagraph for a year shall be equal to— 

15 ‘‘(i) the estimated aggregate expendi16 tures under this title (as projected under 

17 subparagraph (C)) for the year; minus 

18 ‘‘(ii) the actual aggregate expendi19 tures under this title (as determined by the 

20 Secretary and taking into account any re21 duction in specific health risks of the par22 ticipating Medicare beneficiaries) for the 

23 year. 

24 ‘‘(C) PROJECTION OF ESTIMATED AGGRE25 GATE CLAIMS COST.— 


tjames on DSK6SPTVN1PROD with BILLS
10 

•S 1228 IS

1 ‘‘(i) BENCHMARK BASE YEAR.—The 

2 Secretary shall establish a benchmark base 

3 year amount of expenditures under this 

4 title for participating Medicare bene5 ficiaries during year 1 of the Program. 

6 ‘‘(ii) PROJECTION.—The Secretary 

7 shall use the benchmark base year amount 

8 established under clause (i) to project the 

9 estimated aggregate expenditures for all 

10 participating Medicare beneficiaries during 

11 each of years 2 and 3 of the Program as 

12 if the beneficiaries were not participating 

13 in the Program. In making such projec14 tion, the Secretary may include adjust15 ments for health status or other specific 

16 risk factors and geographic variation for 

17 the participating Medicare beneficiaries. 

18 ‘‘(D) PUBLIC REPORT OF DETERMINATION

19 AND OTHER PROGRAM INFORMATION.—Not 

20 later than 90 days after determining the aggre21 gate estimated savings (if any) under subpara22 graph (A) with respect to a year, the Secretary 

23 shall make available to the public a report con24 taining a description of the amount of the sav25 ings determined, including the methodology and 


tjames on DSK6SPTVN1PROD with BILLS
11 

•S 1228 IS

1 any other calculations or determinations in2 volved in the determination of such amount. 

3 Such report shall include— 

4 ‘‘(i) a description of any reduction in 

5 specific health risks of participating Medi6 care beneficiaries identified by the Sec7 retary; 

8 ‘‘(ii) a description of— 

9 ‘‘(I) standards for measuring bet10 ter health targets under subsection 

11 (c); and 

12 ‘‘(II) the points available for 

13 achieving each such standard under 

14 that subsection; and 

15 ‘‘(iii) recommendations for such legis16 lation and administrative action as the 

17 Secretary determines appropriate. 

18 ‘‘(3) MONITORING OF PROGRAM COSTS.—Dur19 ing the operation of the Program, the Chief Actuary 

20 of the Centers for Medicare & Medicaid Services 

21 shall— 

22 ‘‘(A) monitor the Program to determine 

23 whether or not the Program is reducing aggre24 gate expenditures under this title; and 


tjames on DSK6SPTVN1PROD with BILLS
12 

•S 1228 IS

1 ‘‘(B) submit to the Secretary an annual re2 port on the results of such monitoring. 

3 ‘‘(4) REQUIRED ACTION IF AGGREGATE INCEN4 TIVE PAYMENTS EXCEED SAVINGS.—If the Sec5 retary, taking into account the reports under para6 graph (3)(B), determines that the aggregate expend7 itures under this title exceed the aggregate expendi8 tures under this title that would have been made if 

9 the Program had not been implemented, the Sec10 retary shall provide for changes to the provisions of 

11 the program in order to eliminate such excess. 

12 ‘‘(g) WAIVER AUTHORITY.—The Secretary may 

13 waive such requirements of titles XI and XVIII as may 

14 be necessary to carry out the purposes of the Program 

15 established under this section. 

16 ‘‘(h) DEFINITIONS.—In this section: 

17 ‘‘(1) ANNUAL WELLNESS VISIT.—The term ‘an18 nual wellness visit’ includes personalized prevention 

19 plan services (as defined in section 1861(hhh)(1)). 

20 ‘‘(2) HEALTH PROFESSIONAL.—The term 

21 ‘health professional’ includes a physician (as defined 

22 in section 1861(r)(1)) and a practitioner described 

23 in clause (i) of section 1842(b)(18)(C). 

24 ‘‘(3) INITIAL PREVENTIVE PHYSICAL EXAMINA25 TION.—The term ‘initial preventive physical examVerDate Mar 15 2010 03:19 Jul 02, 2013 Jkt 029200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1228.IS S1228

tjames on DSK6SPTVN1PROD with BILLS
13 

•S 1228 IS

1 ination’ has the meaning given that term in section 

2 1861(ww)(1). 

3 ‘‘(4) MEDICARE BENEFICIARY.—The term 

4 ‘Medicare beneficiary’ means an individual enrolled 

5 in part B. 

6 ‘‘(5) PARTICIPATING MEDICARE BENE7 FICIARY.—The term ‘participating Medicare bene8 ficiary’ means a Medicare beneficiary who enrolls in 

9 the Program under subsection (b). 

10 ‘‘(6) SCREENING TESTS.—The term ‘screening 

11 tests’ means any of the following that are deter12 mined by a health professional to be appropriate for 

13 a participating Medicare beneficiary: 

14 ‘‘(A) Colorectal cancer screening tests (as 

15 defined in section 1861(pp)). 

16 ‘‘(B) Screening mammography (as de17 scribed in section 1861(jj)). 

18 ‘‘(C) Screening pap smear and screening 

19 pelvic exam (as defined in section 1861(nn)). 

20 ‘‘(D) Screening for glaucoma (as defined 

21 in section 1861(uu)). 

22 ‘‘(E) Bone mass measurement (as defined 

23 in section 1861(rr)) for qualified individuals de24 scribed in paragraph (2)(A) of such section. 


tjames on DSK6SPTVN1PROD with BILLS
14 

•S 1228 IS

1 ‘‘(F) HIV screening for high-risk groups 

2 (as identified by the Secretary). 

3 ‘‘(7) SPECIFIED VACCINATIONS.—The term 

4 ‘specified vaccinations’ means the vaccinations de5 scribed in section 1861(ww)(1) that are determined 

6 by a health professional to be appropriate for a par7 ticipating Medicare beneficiary.’’. 

8 SEC. 3. PARTICIPATION BY MEDICARE ADVANTAGE PLANS. 

9 Section 1859 of the Social Security Act (42 U.S.C. 

10 1395w–28) is amended by adding at the end the following 

11 new subsection: 

12 ‘‘(h) PROVIDING INCENTIVES FOR VOLUNTARY PAR13 TICIPATION IN A BETTER HEALTH REWARDS PRO14 GRAM.— 

15 ‘‘(1) IN GENERAL.—Effective for plan years be16 ginning on or after the date of enactment of the 

17 Medicare Better Health Rewards Program Act of 

18 2013, a Medicare Advantage organization may pro19 vide to individuals enrolled in an MA plan offered by 

20 the organization incentive payments, including cash, 

21 cash-equivalent, or other types of incentives, for vol22 untary participation in a Better Health Rewards 

23 Program (in this subsection referred to as the ‘Pro24 gram’) that rewards individuals for meeting certain 

25 health targets established by the Secretary. 


tjames on DSK6SPTVN1PROD with BILLS
15 

•S 1228 IS

1 ‘‘(2) LIMITATION.—In no case shall the month2 ly bid amount submitted by a Medicare Advantage 

3 organization under section 1834(a)(6) (or the 

4 monthly premium charged by the organization under 

5 section 1854(b)) with respect to an MA plan offered 

6 by the organization take into account any incentive 

7 payments made to enrollees under the Program. 

8 ‘‘(3) IMPLEMENTATION.—The Program under 

9 this subsection shall be conducted in a similar man10 ner to the manner in which the program under sec11 tion 1849 is conducted, in accordance with stand12 ards established by the Secretary. 

13 ‘‘(4) NOTIFICATION AND PROVISION OF INFOR14 MATION.—A Medicare Advantage organization seek15 ing to participate in the Program shall— 

16 ‘‘(A) notify the Secretary of the organiza17 tion’s intent to participate in the Program; and 

18 ‘‘(B) agree to provide to the Secretary— 

19 ‘‘(i) information regarding— 

20 ‘‘(I) which enrollees participate 

21 in the Program; 

22 ‘‘(II) the scores of those enrollees 

23 with respect to applicable health tar24 gets under the Program; and 


tjames on DSK6SPTVN1PROD with BILLS
16 

•S 1228 IS

1 ‘‘(III) the incentives enrollees re2 ceive for meeting such health targets; 

3 and 

4 ‘‘(ii) any other information specified 

5 by the Secretary for purposes of this sub6 section. 

7 ‘‘(5) WAIVER AUTHORITY.—The Secretary may 

8 waive such requirements of titles XI and XVIII as 

9 may be necessary to carry out the purposes of the 

10 Program established under this subsection.’’. 

11 SEC. 4. PARTICIPATION OF SECTION 1876 COST PLANS. 

12 Section 1876 of the Social Security Act (42 U.S.C. 

13 1395mm) is amended by inserting at the end the fol14 lowing: 

15 ‘‘(l) PROVIDING INCENTIVES FOR VOLUNTARY PAR16 TICIPATION IN A BETTER HEALTH REWARDS PRO17 GRAM.— 

18 ‘‘(1) IN GENERAL.—Effective for contract peri19 ods beginning on or after the date of enactment of 

20 the Medicare Better Health Rewards Program Act 

21 of 2013, an eligible organization may provide to 

22 members enrolled under this section with the organi23 zation incentive payments, including cash, cash24 equivalent, or other types of incentives, for voluntary 

25 participation in a Better Health Rewards Program 


tjames on DSK6SPTVN1PROD with BILLS
17 

•S 1228 IS

1 (in this subsection referred to as the ‘Program’) that 

2 rewards members for meeting certain health targets 

3 established by the Secretary. 

4 ‘‘(2) LIMITATION.—In no case shall the pay5 ment to an eligible organization under this section 

6 (or the premium rate charged by the organization 

7 under this section) with respect to members enrolled 

8 with the organization take into account any incentive 

9 payments made to members under the Program. 

10 ‘‘(3) IMPLEMENTATION.—The Program under 

11 this subsection shall be conducted in a similar man12 ner to the manner in which the program under sec13 tion 1849 is conducted, in accordance with stand14 ards established by the Secretary. 

15 ‘‘(4) NOTIFICATION AND PROVISION OF INFOR16 MATION.—An eligible organization seeking to partici17 pate in the Program shall— 

18 ‘‘(A) notify the Secretary of the organiza19 tion’s intent to participate in the Program; and 

20 ‘‘(B) agree to provide to the Secretary— 

21 ‘‘(i) information regarding— 

22 ‘‘(I) which members participate 

23 in the Program; 


tjames on DSK6SPTVN1PROD with BILLS
18 

•S 1228 IS

1 ‘‘(II) the scores of those members 

2 with respect to applicable health tar3 gets under the Program; and 

4 ‘‘(III) the incentives members re5 ceive for meeting such health targets; 

6 and 

7 ‘‘(ii) any other information specified 

8 by the Secretary for purposes of this sub9 section. 

10 ‘‘(5) WAIVER AUTHORITY.—The Secretary may 

11 waive such requirements of titles XI and XVIII as 

12 may be necessary to carry out the purposes of the 

13 Program established under this subsection.’’. 

14 SEC. 5. PARTICIPATION OF PROGRAMS OF ALL-INCLUSIVE 

15 CARE FOR THE ELDERLY (PACE). 

16 (a) MEDICARE.—Section 1894 of the Social Security 

17 Act (42 U.S.C. 1395eee) is amended by inserting at the 

18 end the following: 

19 ‘‘(j) PROVIDING INCENTIVES FOR VOLUNTARY PAR20 TICIPATION IN A BETTER HEALTH REWARDS PRO21 GRAM.— 

22 ‘‘(1) IN GENERAL.—Effective for PACE pro23 gram agreements entered into on or after the date 

24 of enactment of the Medicare Better Health Re25 wards Program Act of 2013, a PACE provider may 


tjames on DSK6SPTVN1PROD with BILLS
19 

•S 1228 IS

1 provide to PACE program eligible individuals en2 rolled under this section with the PACE provider in3 centive payments, including cash, cash-equivalent, or 

4 other types of incentives, for voluntary participation 

5 in a Better Health Rewards Program (in this sub6 section referred to as the ‘Program’) that rewards 

7 enrollees for meeting certain health targets estab8 lished by the Secretary. 

9 ‘‘(2) LIMITATION.—In no case shall the pay10 ment to a PACE provider under this section (or any 

11 premium charged by the provider under this section) 

12 with respect to PACE program eligible individuals 

13 enrolled with the PACE provider take into account 

14 any incentive payments made to individuals under 

15 the Program. 

16 ‘‘(3) IMPLEMENTATION.—The Program under 

17 this subsection shall be conducted in a similar man18 ner to the manner in which the program under sec19 tion 1849 is conducted, in accordance with stand20 ards established by the Secretary. 

21 ‘‘(4) NOTIFICATION AND PROVISION OF INFOR22 MATION.—A PACE provider seeking to participate 

23 in the Program shall— 


tjames on DSK6SPTVN1PROD with BILLS
20 

•S 1228 IS

1 ‘‘(A) notify the Secretary of the PACE 

2 provider’s intent to participate in the Program; 

3 and 

4 ‘‘(B) agree to provide to the Secretary— 

5 ‘‘(i) information regarding— 

6 ‘‘(I) which PACE program eligi7 ble individuals enrolled with the 

8 PACE provider participate in the Pro9 gram; 

10 ‘‘(II) the scores of those individ11 uals with respect to applicable health 

12 targets under the Program; and 

13 ‘‘(III) the incentives individuals 

14 receive for meeting such health tar15 gets; and 

16 ‘‘(ii) any other information specified 

17 by the Secretary for purposes of this sub18 section. 

19 ‘‘(5) WAIVER AUTHORITY.—The Secretary may 

20 waive such requirements of titles XI, XVIII, and 

21 XIX as may be necessary to carry out the purposes 

22 of the Program established under this subsection.’’. 

23 (b) MEDICAID.—Section 1934 of the Social Security 

24 Act (42 U.S.C. 1396u–4) is amended by adding at the 

25 end the following new subsection: 


tjames on DSK6SPTVN1PROD with BILLS
21 

•S 1228 IS

1 ‘‘(k) PROVIDING INCENTIVES FOR VOLUNTARY PAR2 TICIPATION IN A BETTER HEALTH REWARDS PRO3 GRAM.— 

4 ‘‘(1) IN GENERAL.—Effective for PACE pro5 gram agreements entered into on or after the date 

6 of enactment of the Medicare Better Health Re7 wards Program Act of 2013, a PACE provider may 

8 provide to PACE program eligible individuals en9 rolled under this section with the PACE provider in10 centive payments, including cash, cash-equivalent, or 

11 other types of incentives, for voluntary participation 

12 in a Better Health Rewards Program (in this sub13 section referred to as the ‘Program’) that rewards 

14 enrollees for meeting certain health targets estab15 lished by the Secretary. 

16 ‘‘(2) LIMITATION.—In no case shall the pay17 ment to a PACE provider under this section (or any 

18 premium charged by the provider under this section) 

19 with respect to PACE program eligible individuals 

20 enrolled with the PACE provider take into account 

21 any incentive payments made to individuals under 

22 the Program. 

23 ‘‘(3) IMPLEMENTATION.—The Program under 

24 this subsection shall be conducted in a similar man25 ner to the manner in which the program under secVerDate Mar 15 2010 03:19 Jul 02, 2013 Jkt 029200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\S1228.IS S1228

tjames on DSK6SPTVN1PROD with BILLS
22 

•S 1228 IS

1 tion 1849 is conducted, in accordance with stand2 ards established by the Secretary. 

3 ‘‘(4) NOTIFICATION AND PROVISION OF INFOR4 MATION.—A PACE provider seeking to participate 

5 in the Program shall— 

6 ‘‘(A) notify the Secretary of the PACE 

7 provider’s intent to participate in the Program; 

8 and 

9 ‘‘(B) agree to provide to the Secretary— 

10 ‘‘(i) information regarding— 

11 ‘‘(I) which PACE program eligi12 ble individuals enrolled with the 

13 PACE provider participate in the Pro14 gram; 

15 ‘‘(II) the scores of those individ16 uals with respect to applicable health 

17 targets under the Program; and 

18 ‘‘(III) the incentives individuals 

19 receive for meeting such health tar20 gets; and 

21 ‘‘(ii) any other information specified 

22 by the Secretary for purposes of this sub23 section. 

24 ‘‘(5) WAIVER AUTHORITY.—The Secretary may 

25 waive such requirements of titles XI, XVIII, and 


tjames on DSK6SPTVN1PROD with BILLS
23 

•S 1228 IS

1 XIX as may be necessary to carry out the purposes 

2 of the Program established under this subsection.’’. 

3 SEC. 6. EXCLUSION OF INCENTIVE PAYMENTS. 

4 (a) IN GENERAL.—Part III of subchapter B of chap5 ter 1 of the Internal Revenue Code of 1986 is amended 

6 by inserting after section 139D the following new section: 

7 ‘‘SEC. 139E. MEDICARE BETTER HEALTH REWARDS PAY8 MENTS. 

9 ‘‘Gross income shall not include any payment made 

10 under the following programs: 

11 ‘‘(1) The Medicare Better Health Rewards Pro12 gram established under section 1849 of the Social 

13 Security Act. 

14 ‘‘(2) A Better Health Rewards Program estab15 lished pursuant to section 1859(h), 1876(l), 1894(j), 

16 or 1934(k) of the Social Security Act.’’. 

17 (b) CLERICAL AMENDMENT.—The table of sections 

18 for part III of subchapter B of chapter 1 of such Code 

19 is amended by inserting after the item relating to section 

20 139D the following new item: 

‘‘Sec. 139E. Medicare Better Health Rewards payments.’’. 

Æ 


tjames on DSK6SPTVN1PROD with BILLS