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[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 1340 Introduced in Senate (IS)]

110th CONGRESS
  1st Session
                                S. 1340

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

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                              May 9, 2007

   Mrs. Lincoln (for herself, Ms. Collins, Mr. Kohl, Mr. Kerry, Ms. 
   Mikulski, Mrs. Clinton, Mrs. Boxer, and Mr. Casey) 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 
             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 ``Geriatric 
Assessment and Chronic Care Coordination Act of 2007''.
    (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 coordination services.
Sec. 5. Outreach activities regarding geriatric assessments and chronic 
                            care coordination services under the 
                            Medicare program.
Sec. 6. Study and report on geriatric assessments and chronic care 
                            coordination services under the Medicare 
                            program.
Sec. 7. Study and report on best practices for Medicare chronic care 
                            coordination.
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 care to the growing population of 
        elderly individuals with multiple chronic conditions.
            (2) According to the Congressional Budget Office, 
        approximately 43 percent of Medicare costs can be attributed to 
        5 percent of Medicare's most costly beneficiaries.
            (3) Currently, 78 percent of the Medicare population has at 
        least 1 chronic condition, and \2/3\ have more than 1 chronic 
        condition. The 20 percent of beneficiaries with 5 or more 
        chronic conditions account for \2/3\ of all Medicare spending. 
        In addition, the large baby boomer generation is moving toward 
        retirement and Medicare eligibility.
            (4) The prevalence of chronic conditions increases with 
        age: 74 percent of the 65- to 69-year-old group has at least 1 
        chronic condition, while 86 percent of the 85 years and older 
        group has at least 1 chronic condition. Similarly, just 14 
        percent of the 65- to 69-year-old group has 5 or more chronic 
        conditions, while 28 percent of the 85 years and older group 
        has 5 or more chronic conditions.
            (5) There is a strong pattern of increasing utilization as 
        the number of conditions increase. Fifty-five percent of 
        Medicare beneficiaries with 5 or more conditions experienced an 
        inpatient hospital stay compared to 5 percent of those with 1 
        condition or 9 percent of those with 2 conditions.
            (6) In terms of physician visits, the average Medicare 
        beneficiary has over 15 physician visits annually and sees 6 
        different physicians annually.
            (7) When Alzheimer's disease or other form of dementia are 
        present along with 1 or more other chronic conditions, 
        utilization also increases. For example, in 2000, total average 
        per person Medicare expenditures for those with congestive 
        heart failure and Alzheimer's or dementia were 47 percent 
        higher than for those with congestive heart failure and no 
        dementia.
            (8) 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.
            (9) The current Medicare program does not reward physicians 
        for integrating and coordinating health care because these 
        services are not explicitly recognized and distinctly paid for. 
        Instead, physicians are incentivized to provide episodic care 
        and to generate more individual patient visits to the doctor's 
        office and hospital for separately reimbursed tests and 
        procedures.
            (10) The chronic care model established by this Act 
        includes several elements that are effective in managing 
        chronic disease, including--
                    (A) linkages with community resources;
                    (B) health care system changes that reward quality 
                chronic care;
                    (C) support for patient self-management of chronic 
                disease;
                    (D) practice redesign;
                    (E) evidence-based clinical practice guidelines; 
                and
                    (F) clinical information systems, such as 
                electronic medical records and continuity of care 
                records.
            (11) 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.
            (12) The provisions of, and amendments made by, this Act 
        are intended to--
                    (A) create savings to the Medicare program;
                    (B) establish a process to identify those Medicare 
                beneficiaries most likely to benefit from having a 
                provider coordinate their health care needs; and
                    (C) 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 (Z), by striking ``and'' at the 
                end;
                    (B) in subparagraph (AA), by adding ``and'' at the 
                end; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(BB) geriatric assessments (as defined in subsection 
        (ccc)(1));''.
            (2) Conforming amendments.--(A) Section 1862(a)(7) of the 
        Social Security Act (42 U.S.C. 1395y(a)(7)) is amended by 
        striking ``or (K)'' and inserting ``(K), or (BB)''.
            (B) 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 (ccc)(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

    ``(ccc)(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 (ddd)). 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) Subsequent assessments, which may not be conducted 
        more frequently than annually, unless the subsequent assessment 
        is medically necessary due to a significant change in the 
        condition of the geriatric assessment eligible individual.
            ``(C) 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 coordination services 
        (as defined in subsection (eee)(1)). If the individual is 
        determined likely to benefit from chronic care coordination 
        services, the care plan shall also provide the basis for the 
        chronic care coordination plan to be developed by the chronic 
        care manager pursuant to subsection (eee).
    ``(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.

               ``Geriatric Assessment Eligible Individual

    ``(ddd)(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.
                    ``(ii) Dementia, as defined in the most recent 
                Diagnostic and Statistical Manual of Mental Disorders, 
                and at least 1 chronic condition.
                    ``(iii) Any other factor identified by the 
                Secretary.
            ``(B)(i) The individual, as determined by the Secretary--
                            ``(I) must have aggregate medical costs 
                        under this title in the top 10 percent of all 
                        applicable individuals during the previous 36 
                        months; or
                            ``(II) is likely to incur costs under this 
                        title in the top 10 percent of all applicable 
                        individuals during the current or subsequent 
                        calendar year.
                    ``(ii) The determination under clause (i)(II) of 
                future costs shall be based on the medical condition of 
                the individual, the individual's past cost to the 
                program under this title, and other factors as 
                identified by the Secretary.
                    ``(iii) The individual meets such additional 
                criteria (if any) as the Secretary establishes under 
                subparagraph (C).
            ``(C)(i) If the Secretary estimates that the total number 
        of applicable individuals that would be geriatric assessment 
        eligible individuals in a year (but for this subparagraph) 
        exceeds 10 percent of the total number of applicable 
        individuals in the year, the Secretary shall establish and 
        apply under subparagraph (B)(iii) such additional criteria as 
        is designed to eliminate such excess.
            ``(ii) The Secretary shall consult with physicians, 
        physician groups, organizations representing individuals with 
        chronic conditions and older adults, and other stakeholders in 
        identifying any additional criteria under clause (i).
            ``(D) For purposes of this paragraph, the term `applicable 
        individual' means an individual enrolled for benefits under 
        part B but not enrolled in a Medicare Advantage plan or a plan 
        under section 1876.
    ``(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(ccc)(1))'' after ``(as defined in section 
                1848(j)(3))'';
                    (B) by striking ``and'' before ``(V)''; and
                    (C) by inserting before the semicolon at the end 
                the following: ``, and (W) with respect to geriatric 
                assessments (as defined in section 1861(ccc)(1)), the 
                amount paid shall be 100 percent of the lesser of the 
                actual charge for the services or the amount determined 
                under the payment basis determined under section 
                1848''.
            (2) Payment under physician fee schedule.--Section 
        1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-4(j)(3)) 
        is amended by inserting ``(2)(BB),'' after ``(2)(AA),''.
            (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(ccc)(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(ccc)(1)) furnished by an 
                outpatient department of a hospital, the amount 
                determined under paragraph (1)(W),''.
            (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 ``(8)''; and
                    (B) by inserting before the period the following: 
                ``, and (9) such deductible shall not apply with 
                respect to geriatric assessments (as defined in section 
                1861(ccc)(1))''.
    (d) Frequency Limitation.--Section 1862(a)(1) of the Social 
Security Act (42 U.S.C. 1395y(a)(1)) is amended--
            (1) by striking ``and'' at the end of subparagraph (M);
            (2) by striking the semicolon at the end of subparagraph 
        (N) and inserting ``, and''; and
            (3) by adding at the end the following new subparagraph:
            ``(O) in the case of geriatric assessments (as defined in 
        section 1861(ccc)(1)), which are performed more frequently than 
        is covered under such section;''.
    (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(ccc)(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 (ccc)(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, 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, 2008.

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

    (a) Part B Coverage of Chronic Care 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 (AA), by striking ``and'' at 
                the end;
                    (B) in subparagraph (BB), by adding ``and'' at the 
                end; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(CC) chronic care coordination services (as defined in 
        subsection (eee));''.
            (2) Conforming amendments.--
                    (A) Section 1862(a)(7) of the Social Security Act 
                (42 U.S.C. 1395y(a)(7)), as amended by section 
                3(a)(2)(A), is amended by striking ``or (BB)'' and 
                inserting ``(BB), or (CC)''.
                    (B) 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)(B), are each amended by 
                striking ``subsections (ww)(1) and (ccc)'' and 
                inserting ``subsections (ww)(1), (ccc), and (eee)''.
    (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 Coordination Services; Chronic Care Manager; Chronic 
                        Care Eligible Individual

    ``(eee)(1) The term `chronic care coordination services' means 
services that are furnished to a chronic care eligible individual (as 
defined in paragraph (3)) by a single chronic care manager (as defined 
in paragraph (2)) chosen by the individual under a plan of care 
prescribed by such chronic care manager for the purpose of chronic care 
and dementia coordination, 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 
        ccc)), 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.
            ``(F) Self-management services, including health education 
        and risk appraisal to identify behavioral risk factors through 
        self-assessment.
            ``(G) Providing access by telephone with physicians and 
        other appropriate health care professionals, including 24-hour 
        availability of such professionals for emergencies.
            ``(H) Management with the principal nonprofessional 
        caregiver in the home.
            ``(I) Managing and facilitating transitions 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, and referral to, hospice care, 
        including patient and family caregiver education and counseling 
        about hospice care, and facilitating transition to hospice care 
        when elected.
            ``(K) Information about, referral to, and management with, 
        community services.
            ``(L) 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) under the supervision of 
                a physician; or
                    ``(III) any other provider that meets such 
                conditions as the Secretary may specify; and
            ``(ii) has entered into a chronic care coordination 
        agreement with the Secretary.
    ``(B)(i) For purposes of subparagraph (A)(ii), each chronic care 
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 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 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 (ddd)) who has undergone a geriatric 
assessment (as defined in subsection (ccc)(1)) which determined that 
the individual would benefit from chronic care coordination.''.
    (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 coordination services (as defined in section 
                1861(eee))'' after ``other than geriatric assessments 
                (as defined in section 1861(ccc)(1))'';
                    (B) by striking ``and'' before ``(W)''; and
                    (C) by inserting before the semicolon at the end 
                the following: ``, and (X) with respect to chronic care 
                coordination services (as defined in section 
                1861(eee)), the amount paid shall be 100 percent of the 
                amount determined under section 1848(m)''.
            (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:
    ``(m) Payment for Chronic Care Coordination Services.--
            ``(1) Establishment.--
                    ``(A) In general.--The Secretary shall establish a 
                monthly care coordination payment amount under this 
                section for chronic care coordination services (as 
                defined in paragraph (1) of section 1861(eee)(1)) 
                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 1861).
                    ``(B) Requirements.--In establishing payment 
                amounts under subparagraph (A), the Secretary shall--
                            ``(i) take into account the time required 
                        of the chronic care manager in providing the 
                        care coordination services to chronic care 
                        eligible individuals and the costs associated 
                        with the practice-level health information 
                        technologies and systems incurred by the 
                        chronic care manager in providing such 
                        services; 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) Code.--Under the conditions set forth in this 
        section, the Secretary shall develop a care coordination 
        payment code for chronic care coordination services and a value 
        for such code.
            ``(3) Separate payments from payments for geriatric 
        assessments.--Payments for chronic care coordination services 
        shall be made separately from payments for geriatric 
        assessments (as defined in section 1861(ccc)(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)(CC),'' after ``(2)(BB),''.
            (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(ccc)(1))'' and inserting 
                ``geriatric assessments (as defined in section 
                1861(ccc)(1)), or chronic care coordination services 
                (as defined in section 1861(eee)(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 coordination 
                services (as defined in section 1861(eee)(1)) furnished 
                by an outpatient department of a hospital, the amount 
                determined under section 1848(m),''.
            (4) Elimination of deductible.--Paragraph (9) 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 coordination services (as defined in section 
        1861(eee)(1))'' after ``geriatric assessments (as defined in 
        section 1861(ccc)(1))''.
    (d) Application of Limits on Billing.--Section 1842(b)(18)(C) of 
the Social Security Act (42 U.S.C. 1395u(b)(18)(C)) is amended by 
adding at the end the following new clause:
            ``(vii) A chronic care manager (as defined in section 
        1861(eee)(2)) that is not a physician.''.
    (e) 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 coordination 
        services.--In the case of a designated health service, if the 
        designated health service is--
                    ``(A) a geriatric assessment or a chronic care 
                coordination service (as defined in subsections 
                (ccc)(1) or (eee)(1) of section 1861, respectively); 
                and
                    ``(B) provided by a physician or a chronic care 
                manager (as defined in section 1861(eee)(2)).''.
    (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. In 
promulgating such regulations, the Secretary shall consult with 
physicians, physician groups and organizations, and organizations 
representing individuals with chronic conditions and older adults.
    (g) Effective Date.--The amendments made by this section shall 
apply to chronic care coordination services furnished on or after 
January 1, 2008.

SEC. 5. OUTREACH ACTIVITIES REGARDING GERIATRIC ASSESSMENTS AND CHRONIC 
              CARE 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 (ccc) 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 coordination services (as defined in subsection (eee) 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. STUDY AND REPORT ON GERIATRIC ASSESSMENTS AND CHRONIC CARE 
              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 coordination 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. 7. STUDY AND REPORT ON BEST PRACTICES FOR MEDICARE CHRONIC CARE 
              COORDINATION.

    (a) Study.--The Secretary of Health and Human Services, in 
consultation with the Medicare Payment Advisory Commission, shall 
conduct a study of the following issues:
            (1) The effectiveness of pay-for-performance programs to 
        serve Medicare beneficiaries with multiple chronic conditions, 
        including dementia.
            (2) The cost-effectiveness of chronic care coordination 
        under the Medicare program.
            (3) Whether the quality measures used for making payments 
        under part B of the Medicare program, including the measures 
        developed under subsection (k) of section 1848 of the Social 
        Security Act (as added by section 101 of division B of the Tax 
        Relief and Health Care Act of 2006, Public Law 109-432), 
        improve the quality of care provided to Medicare beneficiaries 
        with multiple chronic illnesses, including dementia.
    (b) Report.--Not later than 3 years after the date of enactment of 
this Act, the Secretary of Health and Human Services shall submit to 
Congress a report on the study conducted under subsection (a) that 
contains--
            (1) recommendations on the best quality indicators for 
        monitoring the chronic care coordination of the conditions of 
        Medicare beneficiaries with multiple chronic conditions, 
        including dementia; and
            (2) such other recommendations for legislation or 
        administrative action as the Secretary determines appropriate.

SEC. 8. RULE OF CONSTRUCTION.

    Nothing in this Act, 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(ccc)(1) of the Social Security 
Act, as added by section 3(b)) or chronic care coordination services 
(as defined in section 1861(eee)(1) of such Act, as added by section 
4(b)).
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