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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1004 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                S. 1004

  To amend title XVIII of the Social Security Act to provide Medicare 
  beneficiaries with access to geriatric assessments and chronic care 
     management and coordination services, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                              May 7, 2009

  Mrs. Lincoln (for herself and Ms. Collins) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL

 
  To amend title XVIII of the Social Security Act to provide Medicare 
  beneficiaries with access to geriatric assessments and chronic care 
     management and coordination services, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``The Reaching 
Elders with Assessment and Chronic Care Management and Coordination 
Act'' or the ``RE-Aligning Care Act''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Medicare coverage of geriatric assessments.
Sec. 4. Medicare coverage of chronic care management and coordination 
                            services.
Sec. 5. Outreach activities regarding geriatric assessments and chronic 
                            care management and coordination services 
                            under the Medicare program.
Sec. 6. Utilization of telehealth services to furnish geriatric 
                            assessments and chronic care management and 
                            coordination services under the Medicare 
                            program.
Sec. 7. Study and report on geriatric assessments and chronic care 
                            management and coordination services under 
                            the Medicare program.
Sec. 8. Rule of construction.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The Medicare program must be redesigned to provide 
        high-quality, cost-effective and coordinated care to the 
        growing population of elderly individuals with multiple and 
        complex chronic conditions.
            (2) Between 2005 and 2030, it is estimated that the number 
        of adults aged 65 and older will almost double from 37,000,000 
        to more than 70,000,000. The number of those age 80 and over, 
        is also expected to nearly double from 11,000,000 to 
        20,000,000. This demographic shift will create the largest ever 
        proportion of adults over 65, increasing from 12 percent of the 
        United States population in 2005 to almost 20 percent by 2030.
            (3) With the unprecedented growth of our Nation's aging 
        population, the number of older patients with multiple chronic 
        conditions and cognitive impairments is expected to increase. 
        Currently, about 65 percent of Medicare beneficiaries have two 
        or more chronic conditions. To address the health care needs 
        unique to older adults with chronic conditions, it will require 
        innovations in care delivery and comprehensive coordinated 
        care.
            (4) According to the Congressional Budget Office, 
        approximately 75 percent of Medicare spending pays for care for 
        beneficiaries who have five or more chronic conditions and see 
        an average of 14 different physicians per year. In addition, 
        approximately 43 percent of Medicare costs can be attributed to 
        5 percent of Medicare's most costly beneficiaries.
            (5) Total Medicare costs per beneficiary age 65 or older 
        with Alzheimer's and other dementias were almost three times 
        higher than for other Medicare beneficiaries in 2004.
            (6) There is a strong pattern of increasing utilization as 
        the number of conditions increase. In 2003, 61 percent of 
        Medicare beneficiaries with 3 chronic conditions saw 10 or more 
        different physicians compared to 40 percent with 2 conditions 
        and 18 percent of those with 1 condition.
            (7) According to a June 2006 MedPAC report, even if 
        individual providers deliver care efficiently, overall care for 
        a beneficiary may be inefficient if providers do not coordinate 
        across settings or assist beneficiaries in managing their 
        conditions between visits. Beneficiaries with multiple chronic 
        conditions may benefit the most from care coordination as they 
        do not always receive necessary care and often at high cost.
            (8) On average, individuals 65 to 69 years old take nearly 
        14 prescriptions per year and individuals aged 80 to 84 take an 
        average of 18 prescriptions per year. As the number of chronic 
        conditions increases, so does the number of medications, 
        increasing the risk for negative drug interactions that can 
        lead to serious injury requiring hospitalization or can even be 
        fatal. Studies have found that 25 percent to 50 percent adverse 
        drug events among older persons are preventable and that 
        preventable adverse drug events may cost the Medicare program 
        $887,000,000 per year.
            (9) Research conducted in the United States and 
        internationally indicate that the delivery of higher quality 
        health care, increased efficiency, and cost-effectiveness are 
        the result of systems in which patients are linked with a 
        physician or another qualified health professional who 
        coordinates their care. According to the Congressional Budget 
        Office, an intervention that focused on coordinating care for 
        high-cost beneficiaries with multiple chronic conditions could 
        both improve their health and reduce Medicare spending.
            (10) In addition, chronic care management and coordination 
        may help prevent negative medication interactions and prevent 
        hospital stays because the chronic care team holistically 
        manages and treats illness. Reducing the rate of preventable 
        adverse drug events will both improve patient care and may 
        result in savings to the Medicare program.
            (11) The Medicare fee-for-service program currently does 
        not pay for care coordination services. Instead, the delivery 
        and payment systems are organized to support the diagnosis and 
        treatment of acute or episodic conditions, resulting in 
        fragmented, ineffective and costly care for beneficiaries with 
        chronic diseases. It currently rewards the overuse and 
        duplication of services rather than rewarding the effective 
        control of chronic conditions, which can improve health 
        outcomes and prevent hospitalization or rehospitalization.
            (12) The Institute of Medicine Report, ``Retooling for an 
        Aging America: Building the Health Care Workforce'', cited 
        misaligned financial incentives, including the inability to 
        reimburse for care coordination, as factors that result in 
        fragmented care for older Americans.
            (13) Financial incentives within the Medicare program 
        should be realigned as part of a comprehensive system change. 
        The Medicare program should be restructured to reimburse 
        physicians and other qualified health professionals for the 
        cost of coordinating care.
            (14) The patient-centered chronic care model established by 
        the provisions of, and the amendments made by, this Act 
        includes several elements that are effective in managing older 
        adults with chronic disease, including--
                    (A) a comprehensive assessment of the individual's 
                physical, cognitive, affective, functional and social 
                status, and caregiving needs;
                    (B) access to patient-centered care coordination 
                services provided by interdisciplinary team members;
                    (C) support for patient self-management of chronic 
                disease;
                    (D) linkages with community resources;
                    (E) health care system changes that reward quality 
                chronic care;
                    (F) practice redesign;
                    (G) evidence-based clinical practice guidelines; 
                and
                    (H) clinical information systems, such as 
                electronic medical records and continuity of care 
                records.
            (15) The provisions of, and amendments made by, this Act 
        are intended to--
                    (A) improve health outcomes appropriate for older 
                patients with multiple chronic conditions;
                    (B) increase beneficiary, caregiver, and provider 
                satisfaction;
                    (C) increase cost-effectiveness and high value to 
                the Medicare program for those served with multiple 
                chronic conditions;
                    (D) establish a process to identify those Medicare 
                beneficiaries most likely to benefit from having a 
                provider coordinate their health care needs; and
                    (E) establish a payment under the Medicare program 
                for--
                            (i) the assessment of those health care 
                        needs; and
                            (ii) the activities required to coordinate 
                        those health care needs.

SEC. 3. MEDICARE COVERAGE OF GERIATRIC ASSESSMENTS.

    (a) Coverage of Geriatric Assessments.--
            (1) In general.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)) is amended--
                    (A) in subparagraph (DD), by striking ``and'' at 
                the end;
                    (B) in subparagraph (EE), by adding ``and'' at the 
                end; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(FF) geriatric assessments (as defined in subsection 
        (hhh)(1));''.
            (2) Conforming amendments.--Clauses (i) and (ii) of section 
        1861(s)(2)(K) of the Social Security Act (42 U.S.C. 
        1395x(s)(2)(K)) are each amended by striking ``subsection 
        (ww)(1)'' and inserting ``subsections (ww)(1) and (hhh)(1)''.
    (b) Geriatric Assessments Defined.--Section 1861 of the Social 
Security Act (42 U.S.C. 1395x) is amended by adding at the end the 
following new subsections:

                         ``Geriatric Assessment

    ``(hhh)(1) The term `geriatric assessment' means each of the 
following:
            ``(A) An assessment of the clinical status, functional 
        status, social and environmental functioning, and need for 
        caregiving of a geriatric assessment eligible individual (as 
        defined in subsection (iii)). The assessment shall include a 
        comprehensive history and physical examination and assessments 
        of the following domains using standardized validated clinical 
        tools:
                    ``(i) Comprehensive review of medications and the 
                individual's adherence to the medication regimen.
                    ``(ii) Measurement of affect, cognition and 
                executive function, mobility, balance, gait, risk of 
                falling, and sensory function.
                    ``(iii) Social functioning, environmental needs, 
                and caregiver resources and needs.
                    ``(iv) Any other domain determined appropriate by 
                the Secretary.
            ``(B) The development of a written care plan based on the 
        results of the assessment under subparagraph (A) (and any 
        subsequent assessment under subparagraph (B)). The care plan 
        shall detail identified problems, outline therapies, assign 
        responsibility for actions, and indicate whether the individual 
        is likely to benefit from chronic care management and 
        coordination services (as defined in subsection (jjj)(1)). If 
        the individual is determined likely to benefit from chronic 
        care management and coordination services, the care plan shall 
        also provide the basis for the chronic care management and 
        coordination plan to be developed by the chronic care manager 
        pursuant to subsection (jjj).
    ``(2) A geriatric assessment may only be conducted by--
            ``(A) a physician;
            ``(B) a practitioner described in section 1842(b)(18)(C)(i) 
        under the supervision of a physician; or
            ``(C) any other provider that meets such conditions as the 
        Secretary may specify.
    ``(3) An individual described in subclause (A), (B), or, if 
applicable, (C) may provide for the furnishing of services included in 
the geriatric assessment by other qualified health care professionals.
    ``(4)(A) Subject to subparagraph (B), a geriatric assessment of a 
geriatric assessment eligible individual may not be conducted more 
frequently than annually.
    ``(B) A geriatric assessment of a geriatric assessment eligible 
individual may be conducted more frequently than annually if the 
assessment is medically necessary due to a significant change in the 
condition of the individual.

               ``Geriatric Assessment Eligible Individual

    ``(iii)(1) Subject to paragraph (3), the term `geriatric assessment 
eligible individual' means an individual identified by the Secretary as 
eligible for a geriatric assessment.
    ``(2) In identifying individuals under paragraph (1), the following 
rules shall apply:
            ``(A) The individual must have at least 1 of the following 
        present:
                    ``(i) Multiple chronic conditions that the 
                Secretary identifies as likely to result in high 
                expenditures under this title. In identifying such 
                conditions, the Secretary may consider--
                            ``(I) the hierarchal condition category 
                        methodology employed for risk adjustment under 
                        part C or other comparable methodologies the 
                        Secretary deems appropriate;
                            ``(II) data from the Chronic Condition Data 
                        Warehouse under section 723 of the Medicare 
                        Prescription Drug, Improvement, and 
                        Modernization Act of 2003; and
                            ``(III) indicators of geriatric syndromes, 
                        such as experiencing 2 or more falls in the 
                        past year, urinary incontinence, clinically 
                        significant depression, or other such 
                        indicators that the Secretary indicates as 
                        likely to result in high expenditures under 
                        this title when they exist in combination with 
                        one or more chronic conditions).
                    ``(ii) Dementia, as defined in the most recent 
                Diagnostic and Statistical Manual of Mental Disorders, 
                and at least 1 other chronic condition.
                    ``(iii) Any other factor identified by the 
                Secretary.
            ``(B) The Secretary shall consult with physicians, 
        physician groups and organizations, other health care 
        professional groups and organizations, organizations 
        representing individuals with chronic conditions and older 
        adults, and other stakeholders in identifying conditions under 
        clauses (i) and (ii) of subparagraph (A) and any factors under 
        subparagraph (A)(iii).
    ``(3) The term `geriatric assessment eligible individual' shall not 
include the following individuals:
            ``(A) An individual who is receiving hospice care under 
        this title.
            ``(B) An individual who is residing in a skilled nursing 
        facility, a nursing facility (as defined in section 1919), or 
        any other facility identified by the Secretary.
            ``(C) An individual medically determined to have end-stage 
        renal disease.
            ``(D) An individual enrolled in a Medicare Advantage plan 
        or a plan under section 1876.
            ``(E) An individual enrolled in a PACE program under 
        section 1894.
            ``(F) Any other categories of individuals determined 
        appropriate by the Secretary.
    ``(4) For purposes of this subsection, the term `chronic condition' 
means a condition, such as dementia, that lasts or is expected to last 
1 year or longer, limits what an individual can do, and requires 
ongoing care.''.
    (c) Payment and Elimination of Cost-Sharing.--
            (1) Payment and elimination of coinsurance.--Section 
        1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) 
        is amended--
                    (A) in subparagraph (N), by inserting ``other than 
                geriatric assessments (as defined in section 
                1861(hhh)(1))'' after ``(as defined in section 
                1848(j)(3))'';
                    (B) by striking ``and'' before ``(W)''; and
                    (C) by inserting before the semicolon at the end 
                the following: ``, and (X) with respect to geriatric 
                assessments (as defined in section 1861(hhh)(1)), the 
                amount paid shall be 100 percent of the lesser of the 
                actual charge for the services or the amount determined 
                under section 1848(o)''.
            (2) Payment.--
                    (A) In general.--Section 1848 of the Social 
                Security Act (42 U.S.C. 1395w-4) is amended by adding 
                at the end the following new subsection:
    ``(o) Payment for Geriatric Assessments.--
            ``(1) Establishment.--
                    ``(A) In general.--The Secretary shall establish--
                            ``(i) a payment code (or codes) under this 
                        section for a geriatric assessment (as defined 
                        in section 1861(hhh)(1)) furnished to a 
                        geriatric assessment eligible individual (as 
                        defined in section 1861(iii)) by a physician, 
                        practitioner, or other provider described in 
                        section 1861(hhh)(2); and
                            ``(ii) a payment amount for each such code.
                    ``(B) Requirements.--In establishing payment 
                amounts under subparagraph (A)(ii), the Secretary 
                shall--
                            ``(i) take into account--
                                    ``(I) the amount of work required 
                                to perform a geriatric assessment, 
                                including the time and effort put forth 
                                by each qualified health care 
                                professional involved in performing the 
                                geriatric assessment; and
                                    ``(II) all of the costs associated 
                                with the geriatric assessment, 
                                including labor, supplies, equipment, 
                                and the costs of health information 
                                technologies and systems incurred by 
                                the physician, practitioner, or other 
                                provider (as described in section 
                                1861(hhh)(2)) in providing the 
                                assessment; and
                            ``(ii) ensure that such payments do not 
                        result in a reduction in payments for office 
                        visits or other evaluation and management 
                        services that would otherwise be allowable.
            ``(2) Separate payments from payments for chronic care 
        management and coordination services.--Payments for geriatric 
        assessments shall be made separately from payments for chronic 
        care management and coordination services (as defined in 
        section 1861(jjj)(1)) and other services for which payment is 
        made under this title.''.
                    (B) Conforming amendment.--Section 1848(j)(3) of 
                the Social Security Act (42 U.S.C. 1395w-4(j)(3)), as 
                amended by section 3(c)(2), is amended by inserting 
                ``(2)(FF),'' after ``(2)(EE),''.
            (3) Elimination of coinsurance in outpatient hospital 
        settings.--
                    (A) Exclusion from opd fee schedule.--Section 
                1833(t)(1)(B)(iv) of the Social Security Act (42 U.S.C. 
                1395l(t)(1)(B)(iv)) is amended by striking ``and 
                diagnostic mammography'' and inserting ``, diagnostic 
                mammography, or geriatric assessments (as defined in 
                section 1861(hhh)(1))''.
                    (B) Conforming amendments.--Section 1833(a)(2) of 
                the Social Security Act (42 U.S.C. 1395l(a)(2)) is 
                amended--
                            (i) in subparagraph (F), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (G)(ii), by striking 
                        the comma at the end and inserting ``; and''; 
                        and
                            (iii) by inserting after subparagraph 
                        (G)(ii) the following new subparagraph:
                    ``(H) with respect to geriatric assessments (as 
                defined in section 1861(hhh)(1)) furnished by an 
                outpatient department of a hospital, the amount 
                determined under paragraph (1)(X),''.
            (4) Elimination of deductible.--The first sentence of 
        section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) 
        is amended--
                    (A) by striking ``and'' before ``(9)''; and
                    (B) by inserting before the period the following: 
                ``, and (10) such deductible shall not apply with 
                respect to geriatric assessments (as defined in section 
                1861(hhh)(1))''.
    (d) Frequency Limitation.--Section 1862(a) of the Social Security 
Act (42 U.S.C. 1395y(a)(1)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (N), by striking ``and'' at the 
                end;
                    (B) in subparagraph (O) by striking the semicolon 
                at the end and inserting ``, and''; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(P) in the case of geriatric assessments (as defined in 
        section 1861(hhh)(1)), which are performed more frequently than 
        is covered under such section;''; and
            (2) in paragraph (7), by striking ``or (K)'' and inserting 
        ``(K), or (P)''.
    (e) Exception to Limits on Physician Referrals.--Section 1877(b) of 
the Social Security Act (42 U.S.C. 1395nn(b)) is amended by adding at 
the end the following new paragraph:
            ``(6) Geriatric assessments.--In the case of a designated 
        health service, if the designated health service is a geriatric 
        assessment (as defined in section 1861(hhh)(1)) and furnished 
        by a physician.''.
    (f) Rulemaking.--The Secretary of Health and Human Services shall 
define such terms, establish such procedures, and promulgate such 
regulations as the Secretary determines necessary to implement the 
amendments made by, and the provisions of, this section, including the 
establishment of additional domains under subsection (hhh)(1)(A)(iv) of 
section 1861 of the Social Security Act, as added by subsection (b). In 
promulgating such regulations, the Secretary shall consult with 
physicians, physician groups and organizations, other health care 
professional groups and organizations representing individuals with 
chronic conditions and older adults.
    (g) Effective Date.--The amendments made by this section shall 
apply to assessments furnished on or after January 1, 2010.

SEC. 4. MEDICARE COVERAGE OF CHRONIC CARE MANAGEMENT AND COORDINATION 
              SERVICES.

    (a) Part B Coverage of Chronic Care Management and Coordination 
Services.--
            (1) In general.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)), as amended by section 3(a)(1), is 
        amended--
                    (A) in subparagraph (EE), by striking ``and'' at 
                the end;
                    (B) in subparagraph (FF), by adding ``and'' at the 
                end; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(GG) chronic care management and coordination services 
        (as defined in subsection (jjj));''.
            (2) Conforming amendments.--(A) Clauses (i) and (ii) of 
        section 1861(s)(2)(K) of the Social Security Act (42 U.S.C. 
        1395x(s)(2)(K)), as amended by section 3(a)(2), are each 
        amended by striking ``subsections (ww)(1) and (hhh)(1)'' and 
        inserting ``subsections (ww)(1), (hhh)(1), and (jjj)(1)''.
            (B) Section 1862(a)(7) of the Social Security Act (42 
        U.S.C. 1395y(a)(7)), as amended by section 3(d), is amended by 
        striking ``section 1861(s)(10)'' and inserting ``paragraphs 
        (2)(GG) and (10) of section 1861(s)''.
    (b) Services Described.--Section 1861 of the Social Security Act 
(42 U.S.C. 1395x), as amended by section 3(b), is amended by adding at 
the end the following new subsection:

   ``Chronic Care Management and Coordination Services; Chronic Care 
               Manager; Chronic Care Eligible Individual

    ``(jjj)(1) The term `chronic care management and coordination 
services' means services that are furnished to a chronic care eligible 
individual (as defined in paragraph (3)) by, or under the supervision 
of, a single chronic care manager (as defined in paragraph (2)) chosen 
by the chronic care eligible individual, a caregiver designated by the 
individual in writing, or a representative authorized to make decisions 
on the individual's behalf, under a plan of care prescribed by such 
chronic care manager for the purpose of chronic care coordination, 
including dementia as appropriate, which may include any of the 
following services:
            ``(A) The development of an initial plan of care (based on 
        the results of a geriatric assessment, as defined in subsection 
        (hhh)), and subsequent appropriate revisions to that plan of 
        care.
            ``(B) The management of, and referral for, medical and 
        other health services, including interdisciplinary care 
        conferences and management with other providers.
            ``(C) The monitoring and management of medications.
            ``(D) Patient education and counseling services.
            ``(E) Family caregiver education and counseling services, 
        including preventive care consistent with the patient's 
        condition.
            ``(F) Self-management services, including health education 
        and risk appraisal to identify behavioral risk factors through 
        self-assessment.
            ``(G) Providing access for individuals, and caregivers or 
        authorized representatives as appropriate, by telephone and 
        email to physicians or other appropriate health care 
        professionals, including 24-hour availability of such 
        professionals for after hours consultation.
            ``(H) Coordination with the principal nonprofessional 
        caregiver in the home.
            ``(I) Managing and facilitating transitions that occur 
        among health care professionals and across settings of care, 
        including the following:
                    ``(i) Pursuing the treatment option elected by the 
                individual.
                    ``(ii) Including any advance directive executed by 
                the individual in the medical file of the individual.
            ``(J) Information about pain management and palliative 
        care.
            ``(K) Information about, and referral to, hospice care, 
        including patient and family caregiver education and counseling 
        about hospice care, and facilitating transition to hospice care 
        when elected.
            ``(L) Information about, referral to, and coordination 
        with, community resources.
            ``(M) Such additional services for which payment would not 
        otherwise be made under this title that the Secretary may 
        specify that encourage the receipt of, or improve the 
        effectiveness of, the services described in the preceding 
        subparagraphs.
    ``(2)(A) For purposes of this subsection, the term `chronic care 
manager' means an individual or entity that--
            ``(i) is--
                    ``(I) a physician;
                    ``(II) a practitioner described in clause (i) or 
                (iv) of section 1842(b)(18)(C); or
                    ``(III) any other provider that meets such 
                conditions as the Secretary may specify;
            ``(ii) has entered into a chronic care management and 
        coordination agreement with the Secretary; and
            ``(iii) is working in collaboration with, or under the 
        supervision of, as determined by the Secretary--
                    ``(I) the physician, practitioner, or other 
                provider who completed the geriatric assessment of the 
                individual; or
                    ``(II) a physician, practitioner, or other provider 
                to whom the individual's care was transferred by the 
                physician, practitioner, or other provider who 
                performed the geriatric assessment.
    ``(B)(i) For purposes of subparagraph (A)(ii), each chronic care 
management and coordination agreement shall meet the requirements 
described in subparagraph (C) and shall--
            ``(I) subject to clause (ii), be entered into for a period 
        of 3 years and may be renewed if the Secretary is satisfied 
        that the chronic care manager continues to meet such terms and 
        conditions as the Secretary may require; and
            ``(II) contain such other terms and conditions as the 
        Secretary may require.
    ``(ii) Each chronic care management and coordination agreement 
shall provide for the termination of such agreement prior to such 3-
year period in the case where the chronic care manager--
            ``(I) is no longer able to provide chronic care services; 
        or
            ``(II) does not meet such terms and conditions as the 
        Secretary may require.
    ``(C)(i) Subject to clause (ii), the requirements of this 
subparagraph are met if the agreement requires the chronic care manager 
to perform, or provide for the performance of, the following services:
            ``(I) Advocating for, and providing ongoing support, 
        oversight, and guidance with respect to the implementation of a 
        plan of care that provides an integrated, coherent, and cross-
        disciplined plan for ongoing medical care that is developed in 
        partnership with the chronic care eligible individual and all 
        other physicians and other care providers and agencies 
        (including home health agencies) providing care to the chronic 
        care eligible individual.
            ``(II) Using evidence-based medicine and clinical decision 
        support tools to guide decision making at the point of care and 
        on the basis of specific patient factors.
            ``(III) Using health information technology, including, 
        where appropriate, remote monitoring and patient registries, to 
        monitor and track the health status of patients and to provide 
        patients with enhanced and convenient access to health care 
        services.
            ``(IV) Encouraging patients to engage in the management of 
        their own health through education and support systems.
            ``(V) Incorporating family caregivers into the chronic care 
        planning process.
    ``(ii) The Secretary may modify the services required under the 
agreement under clause (i), including by requiring different services 
or services in addition to those described in subclauses (I) through 
(V) of such clause.
    ``(D) The Secretary shall adopt procedures which exempt providers 
in rural areas from providing 1 or more of the services otherwise 
required to be provided under subparagraph (C) or modify such 
requirements for such providers. In establishing such procedures, the 
Secretary shall ensure that such exemptions and modifications do not 
impact the quality of chronic care management and coordination services 
furnished by such providers.
    ``(3) For purposes of this subsection, the term `chronic care 
eligible individual' means a geriatric assessment eligible individual 
(as defined in subsection (iii)) who has undergone a geriatric 
assessment (as defined in subsection (hhh)(1)) which determined that 
the individual would benefit from chronic care management and 
coordination.
    ``(4) Chronic care management and coordination services may be 
furnished in the chronic care eligible individual's home or 
residence.''.
    (c) Payment and Elimination of Cost-Sharing.--
            (1) Payment and elimination of coinsurance.--Section 
        1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)), 
        as amended by section 3(c)(1), is amended--
                    (A) in subparagraph (N), by inserting ``or chronic 
                care management and coordination services (as defined 
                in section 1861(jjj)(1))'' after ``other than geriatric 
                assessments (as defined in section 1861(hhh)(1))'';
                    (B) by striking ``and'' before ``(X)''; and
                    (C) by inserting before the semicolon at the end 
                the following: ``, and (Y) with respect to chronic care 
                management and coordination services (as defined in 
                section 1861(jjj)(1)), the amount paid shall be 100 
                percent of the lesser of the actual charge for the 
                services or the amount determined under section 
                1848(p)''.
            (2) Payment.--
                    (A) In general.--Section 1848 of the Social 
                Security Act (42 U.S.C. 1395w-4), as amended by section 
                3(c)(2), is amended by adding at the end the following 
                new subsection:
    ``(p) Payment for Chronic Care Management and Coordination 
Services.--
            ``(1) Establishment.--
                    ``(A) In general.--The Secretary shall establish--
                            ``(i) a payment code (or codes) under this 
                        section for chronic care management and 
                        coordination services (as defined in paragraph 
                        (1) of section 1861(jjj)) furnished to a 
                        chronic care eligible individual (as defined in 
                        paragraph (3) of such section) by a chronic 
                        care manager (as defined in paragraph (2) of 
                        such section); and
                            ``(ii) a payment amount for each such code.
                    ``(B) Requirements.--In establishing payment 
                amounts under subparagraph (A)(ii), the Secretary 
                shall--
                            ``(i) take into account--
                                    ``(I) the amount of work required 
                                of the chronic care manager in 
                                providing chronic care management and 
                                coordination services to eligible 
                                individuals; and
                                    ``(II) all of the costs associated 
                                with providing chronic care management 
                                and coordination services, including 
                                labor, supplies, equipment, and the 
                                costs of health information 
                                technologies and systems incurred by 
                                the chronic care manager in providing 
                                such services;
                            ``(ii) ensure that such payments are for 
                        such services furnished during a 30-day period; 
                        and
                            ``(iii) ensure that such payments do not 
                        result in a reduction in payments for office 
                        visits or other evaluation and management 
                        services that would otherwise be allowable.
            ``(2) Separate payments from payments for geriatric 
        assessments.--Payments for chronic care management and 
        coordination services shall be made separately from payments 
        for geriatric assessments (as defined in section 1861(hhh)(1)) 
        and other services for which payment is made under this 
        title.''.
                    (B) Conforming amendment.--Section 1848(j)(3) of 
                the Social Security Act (42 U.S.C. 1395w-4(j)(3)), as 
                amended by section 3(c)(2), is amended by inserting 
                ``(2)(GG),'' after ``(2)(FF),''.
            (3) Elimination of coinsurance in outpatient hospital 
        settings.--
                    (A) Exclusion from opd fee schedule.--Section 
                1833(t)(1)(B)(iv) of the Social Security Act (42 U.S.C. 
                1395l(t)(1)(B)(iv)), as amended by section 3(c)(3)(A), 
                is amended by striking ``or geriatric assessments (as 
                defined in section 1861(hhh)(1))'' and inserting 
                ``geriatric assessments (as defined in section 
                1861(hhh)(1)), or chronic care management and 
                coordination services (as defined in section 
                1861(jjj)(1))''.
                    (B) Conforming amendments.--Section 1833(a)(2) of 
                the Social Security Act (42 U.S.C. 1395l(a)(2)), as 
                amended by section 3(c)(3)(B), is amended--
                            (i) in subparagraph (G)(ii), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (H), by striking the 
                        comma at the end and inserting ``; and''; and
                            (iii) by inserting after subparagraph (H) 
                        the following new subparagraph:
                    ``(I) with respect to chronic care management and 
                coordination services (as defined in section 
                1861(jjj)(1)) furnished by an outpatient department of 
                a hospital, the amount determined under paragraph 
                (1)(Y),''.
            (4) Elimination of deductible.--Paragraph (10) of section 
        1833(b) of the Social Security Act (42 U.S.C. 1395l(b)), as 
        added by section 3(c)(4), is amended by inserting ``or chronic 
        care management and coordination services (as defined in 
        section 1861(jjj)(1))'' after ``geriatric assessments (as 
        defined in section 1861(hhh)(1))''.
    (d) Exception to Limits on Physician Referrals.--Section 1877(b)(6) 
of the Social Security Act (42 U.S.C. 1395nn(b)(6)), as amended by 
section 3(e), is amended to read as follows:
            ``(6) Geriatric assessments and chronic care management and 
        coordination services.--In the case of a designated health 
        service, if the designated health service is--
                    ``(A) a geriatric assessment or a chronic care 
                management and coordination service (as defined in 
                subsections (hhh)(1) or (jjj)(1) of section 1861, 
                respectively); and
                    ``(B) furnished by a physician.''.
    (e) Rulemaking.--The Secretary of Health and Human Services shall 
define such terms, establish such procedures, and promulgate such 
regulations as the Secretary determines necessary to implement the 
amendments made by, and the provisions of, this section. In 
promulgating such regulations, the Secretary shall consult with 
physicians, physician groups and organizations, other health care 
professional groups and organizations, and organizations representing 
individuals with chronic conditions and older adults.
    (f) Effective Date.--The amendments made by this section shall 
apply to chronic care management and coordination services furnished on 
or after January 1, 2010.

SEC. 5. OUTREACH ACTIVITIES REGARDING GERIATRIC ASSESSMENTS AND CHRONIC 
              CARE MANAGEMENT AND COORDINATION SERVICES UNDER THE 
              MEDICARE PROGRAM.

    The Secretary of Health and Human Services shall conduct outreach 
activities to individuals likely to be eligible to receive coverage of 
geriatric assessments (as defined in subsection (hhh)(1) of section 
1861 of the Social Security Act, as added by section 3) under the 
Medicare program and individuals likely to be eligible to receive 
coverage of chronic care management and coordination services (as 
defined in subsection (jjj)(1) of such section 1861, as added by 
section 4) under the Medicare program, to inform such individuals about 
the availability of such benefits under the Medicare program.

SEC. 6. UTILIZATION OF TELEHEALTH SERVICES TO FURNISH GERIATRIC 
              ASSESSMENTS AND CHRONIC CARE MANAGEMENT AND COORDINATION 
              SERVICES UNDER THE MEDICARE PROGRAM.

    (a) In General.--Section 1834(m)(4)(F) of the Social Security Act 
(42 U.S.C. 1395m(m)(4)(F)) is amended by adding at the end the 
following new clause:
                            ``(iii) Geriatric assessments and chronic 
                        care management and coordination services.--The 
                        term `telehealth service' shall also include 
                        geriatric assessments (as defined in section 
                        1861(hhh)(1)) and chronic care management and 
                        coordination services (as defined in section 
                        1861(jjj)).''.
    (b) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2010.

SEC. 7. STUDY AND REPORT ON GERIATRIC ASSESSMENTS AND CHRONIC CARE 
              MANAGEMENT AND COORDINATION SERVICES UNDER THE MEDICARE 
              PROGRAM.

    (a) Study.--The Secretary of Health and Human Services shall enter 
into a contract with an entity to conduct a study on--
            (1) the effectiveness of the coverage of geriatric 
        assessments and chronic care management and coordination 
        services, including an evaluation of the use of 
        interdisciplinary teams in providing such services, under the 
        Medicare program (under the amendments made by sections 3 and 
        4) on improving the quality of care provided to Medicare 
        beneficiaries with chronic conditions, including dementia; and
            (2) the impact of such geriatric assessments and care 
        coordination services on reducing expenditures under title 
        XVIII of the Social Security Act, including reduced 
        expenditures that may result from--
                    (A) reducing preventable hospital admissions;
                    (B) more appropriate use of pharmaceuticals; and
                    (C) reducing duplicate or unnecessary tests.
    (b) Report.--Not later than 3 years after the date of enactment of 
this Act, the entity conducting the study under subsection (a) shall 
submit to Congress and the Secretary of Health and Human Services a 
report on the study, together with recommendations for such legislation 
or administrative action as such entity determines appropriate.
    (c) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section.

SEC. 8. RULE OF CONSTRUCTION.

    Nothing in the provisions of, or in the amendments made by, this 
Act shall be construed as requiring an individual to receive a 
geriatric assessment (as defined in section 1861(hhh)(1) of the Social 
Security Act, as added by section 3(b)) or chronic care management and 
coordination services (as defined in section 1861(jjj)(1) of such Act, 
as added by section 4(b)).
                                 <all>
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