II 

111TH CONGRESS 

1ST SESSION S. 1009 

To amend title XVIII of the Social Security Act to establish a Care Transitions Program in order to improve quality and cost-effectiveness of care 

for Medicare beneficiaries. 

IN THE SENATE OF THE UNITED STATES 

MAY 7, 2009 

Mr. BENNET 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 establish 

a Care Transitions Program in order to improve quality 

and cost-effectiveness of care for Medicare beneficiaries. 

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 Care Transi5 tions Program Act of 2009’’. 

6 SEC. 2. MEDICARE CARE TRANSITIONS PROGRAM. 

7 Title XVIII of the Social Security Act (42 U.S.C. 

8 1395 et seq.) is amended by adding at the end the fol9 lowing new section: 


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1 ‘‘CARE TRANSITIONS PROGRAM

2 ‘‘SEC. 1899. (a) PROGRAM.— 

3 ‘‘(1) IN GENERAL.—The Secretary shall estab4 lish a Care Transitions Program (in this section re5 ferred to as the ‘Program’) under which outcomes6 based payments are made to community-based tran7 sitional care suppliers (in this section referred to as 

8 ‘CTCs’) for furnishing care transition services, im9 proving quality of care, and reducing rehospitaliza10 tion rates. 

11 ‘‘(2) CARE TRANSITION SERVICES.—For pur12 poses of this section, the term ‘care transition serv13 ices’ means the following services furnished to indi14 viduals entitled to, or enrolled for, benefits under 

15 part A or enrolled for benefits under part B after 

16 the individual is discharged from inpatient care: 

17 ‘‘(A) Self-management goal-setting. 

18 ‘‘(B) Medication self-management support. 

19 ‘‘(C) Arrangement of timely follow-up care. 

20 ‘‘(D) Individualized training in manage21 ment of clinical exacerbation. 

22 ‘‘(E) Establishment and maintenance of a 

23 paper or electronic personal health record. Such 

24 personal health record shall be written and for25 matted using language that is easily underVerDate Nov 24 2008 06:47 May 08, 2009 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1009.IS S1009

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1 standable by individuals receiving benefits 

2 under this title. 

3 ‘‘(F) Preparation for anticipated clinical 

4 encounters. 

5 ‘‘(G) Monitoring of service effectiveness, 

6 including measures of transitional care as en7 dorsed by the National Quality Forum and hos8 pital readmission rates. 

9 ‘‘(H) Other services determined appro10 priate by the Secretary. 

11 ‘‘(3) TARGETING AND TIMING OF CARE TRANSI12 TION SERVICES.—Care transition services may only 

13 be provided— 

14 ‘‘(A) to an individual entitled to, or en15 rolled for, benefits under part A or enrolled for 

16 benefits under part B who is part of the tar17 geted beneficiary population under the CTC’s 

18 plan (as described in subsection (b)(2)(E)) that 

19 is approved by the Secretary; and 

20 ‘‘(B) during the 90-day period beginning 

21 with the day such individual is discharged from 

22 a hospitalization. 

23 ‘‘(b) CONTRACTS WITH CTCS.— 

24 ‘‘(1) IN GENERAL.—Under the program, the 

25 Secretary shall establish a process for awarding conVerDate Nov 24 2008 06:47 May 08, 2009 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1009.IS S1009

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1 tracts to entities meeting the requirements of para2 graph (2). 

3 ‘‘(2) REQUIREMENTS FOR CTCS.—The Sec4 retary shall establish an application process by 

5 which entities seeking contracts to serve as CTCs 

6 demonstrate that they meet the following require7 ments: 

8 ‘‘(A) The entity is recognized by the Sec9 retary as having the appropriate professional 

10 expertise, safeguards for privacy and confiden11 tiality, and authority to review medical records 

12 in order to review cases and identify patterns of 

13 care involving items and services furnished to 

14 individuals entitled to, or enrolled for, benefits 

15 under part A or enrolled for benefits under part 

16 B. 

17 ‘‘(B) The entity does not currently receive 

18 payments for items or services furnished to in19 dividuals described in subparagraph (A). 

20 ‘‘(C) The entity has the demonstrated ca21 pability to form cooperative processes with pro22 viders of medical services through local commu23 nity presence and other characteristics. 

24 ‘‘(D) The entity has received appropriate 

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1 dence of its capability to deliver care transition 

2 services. 

3 ‘‘(E) The entity submits a proposed plan 

4 that identifies a carefully selected target bene5 ficiary population, particularly those most at 

6 risk for rehospitalizations, for which the entity 

7 will provide care transition services, identifies 

8 targeted inappropriate or wasteful services con9 tributing to preventable rehospitalizations, and 

10 identifies any targeted disparities in the quality 

11 of care transitions associated with race, eth12 nicity, language, or gender. 

13 ‘‘(3) INTERVENTION.—Under the contract 

14 awarded under this subsection, a CTC shall under15 take community-based interventions, including the 

16 following: 

17 ‘‘(A) Partner with local entities designated 

18 under section 3025(a)(2)(A) of the Older Amer19 icans Act of 1965, and such other individuals 

20 and organizations as the CTC may recruit for 

21 the purposes of this section, to develop and im22 plement an intervention plan. Such plan shall 

23 be aimed at reducing rehospitalizations and im24 proving quality outcomes among the individuals 

25 served. Throughout the intervention period, the 


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1 CTC shall be accountable for ongoing project 

2 management and facilitation. The CTC shall as3 sist providers and the community in creating 

4 resources for more effective transitions and in 

5 implementing improvement activities. 

6 ‘‘(B) Review cases involving items and 

7 services provided to individuals entitled to, or 

8 enrolled for, benefits under part A or enrolled 

9 for benefits under part B who have been re10 hospitalized within 30 days of discharge from 

11 an inpatient hospital stay. 

12 ‘‘(C) Engage providers and practitioners in 

13 interventions to identify and eliminate the 

14 causes of preventable rehospitalizations. 

15 ‘‘(D) Engage partners to implement care 

16 transition services which primarily target indi17 viduals served who have complex conditions ac18 cording to the needs, structures, and hospital 

19 readmissions patterns of the local community. 

20 ‘‘(4) DEIDENTIFIED PATIENT DATA.—Notwith21 standing any other provision of law, the CTC may, 

22 as determined appropriate by the CTC, provide to 

23 providers and practitioners consenting to participate 

24 in an intervention deidentified patient data that 

25 identifies providers and practitioners treating the 


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1 same population of patients, for the purpose of 

2 measuring and improving the safety, quality, and ef3 fectiveness of transitions of such patients from the 

4 care of one provider or practitioner to another. 

5 Nothing in this paragraph shall be construed to 

6 limit, alter, or affect the requirements imposed by 

7 section 264(c) of the Health Insurance Portability 

8 and Accountability Act of 1996. 

9 ‘‘(5) REPORTS.—Under the contract awarded 

10 under this subsection, a CTC shall submit to the 

11 Secretary reports (in such frequency determined ap12 propriate by the Secretary) on the implementation of 

13 the requirements under the contract. 

14 ‘‘(c) PAYMENTS TO CTCS.— 

15 ‘‘(1) IN GENERAL.—Under the Program, the 

16 Secretary shall establish payment amounts for orga17 nizations awarded a contract under this section. 

18 Such payment amounts shall be directly linked to 

19 the ability of the CTC to achieve or exceed quality 

20 and cost targets, including a shared savings payment 

21 for demonstrated reductions in the expected rehos22 pitalization rate for individuals receiving care from 

23 the CTC. 

24 ‘‘(2) ADJUSTMENT.—The Secretary shall make 

25 appropriate adjustments to payments to CTCs under 


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1 this section to take into account adverse selection of 

2 individuals and the variation in the health status of 

3 individuals among CTCs, including high cost 

4 outliers. Such adjustments shall be made in a budg5 et-neutral manner. 

6 ‘‘(3) TRUST FUNDS.—Payments to CTCs under 

7 this section shall be payable from— 

8 ‘‘(A) funds in the Federal Hospital Insur9 ance Trust Fund; and 

10 ‘‘(B) funds in the Federal Supplementary 

11 Medical Insurance Trust Fund, 

12 in such proportion as the Secretary shall deem to be 

13 fair and equitable after taking into consideration the 

14 quality improvements and cost savings achieved by 

15 such entities. 

16 ‘‘(d) REGULATIONS.—The Secretary shall promul17 gate regulations to carry out this section. Such regulations 

18 shall be promulgated by not later than 18 months after 

19 the date of enactment of this section.’’. 

Æ 


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