II 

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. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Geriatric Assessment and Chronic Care Coordination Act 

6 of 2007’’. 


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

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. 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. 

3 SEC. 2. FINDINGS. 

4 Congress makes the following findings: 

5 (1) The Medicare program must be redesigned 

6 to provide high-quality, cost-effective care to the 

7 growing population of elderly individuals with mul8 tiple chronic conditions. 

9 (2) According to the Congressional Budget Of10 fice, approximately 43 percent of Medicare costs can 

11 be attributed to 5 percent of Medicare’s most costly 

12 beneficiaries. 

13 (3) Currently, 78 percent of the Medicare population has at least 1 chronic condition, and 2 14 ⁄3 have 

15 more than 1 chronic condition. The 20 percent of 

16 beneficiaries with 5 or more chronic conditions account for 2 17 ⁄3 of all Medicare spending. In addition, 

18 the large baby boomer generation is moving toward 

19 retirement and Medicare eligibility. 


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1 (4) The prevalence of chronic conditions in2 creases with age: 74 percent of the 65- to 69-year3 old group has at least 1 chronic condition, while 86 

4 percent of the 85 years and older group has at least 

5 1 chronic condition. Similarly, just 14 percent of the 

6 65- to 69-year-old group has 5 or more chronic con7 ditions, while 28 percent of the 85 years and older 

8 group has 5 or more chronic conditions. 

9 (5) There is a strong pattern of increasing utili10 zation as the number of conditions increase. Fifty11 five percent of Medicare beneficiaries with 5 or more 

12 conditions experienced an inpatient hospital stay 

13 compared to 5 percent of those with 1 condition or 

14 9 percent of those with 2 conditions. 

15 (6) In terms of physician visits, the average 

16 Medicare beneficiary has over 15 physician visits an17 nually and sees 6 different physicians annually. 

18 (7) When Alzheimer’s disease or other form of 

19 dementia are present along with 1 or more other 

20 chronic conditions, utilization also increases. For ex21 ample, in 2000, total average per person Medicare 

22 expenditures for those with congestive heart failure 

23 and Alzheimer’s or dementia were 47 percent higher 

24 than for those with congestive heart failure and no 

25 dementia. 


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1 (8) Research conducted in the United States 

2 and internationally indicate that the delivery of high3 er quality health care, increased efficiency, and cost4 effectiveness are the result of systems in which pa5 tients are linked with a physician or another quali6 fied health professional who coordinates their care. 

7 (9) The current Medicare program does not re8 ward physicians for integrating and coordinating 

9 health care because these services are not explicitly 

10 recognized and distinctly paid for. Instead, physi11 cians are incentivized to provide episodic care and to 

12 generate more individual patient visits to the doc13 tor’s office and hospital for separately reimbursed 

14 tests and procedures. 

15 (10) The chronic care model established by this 

16 Act includes several elements that are effective in 

17 managing chronic disease, including— 

18 (A) linkages with community resources; 

19 (B) health care system changes that re20 ward quality chronic care; 

21 (C) support for patient self-management of 

22 chronic disease; 

23 (D) practice redesign; 

24 (E) evidence-based clinical practice guide25 lines; and 


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1 (F) clinical information systems, such as 

2 electronic medical records and continuity of 

3 care records. 

4 (11) Financial incentives within the Medicare 

5 program should be realigned as part of a com6 prehensive system change. The Medicare program 

7 should be restructured to reimburse physicians and 

8 other qualified health professionals for the cost of 

9 coordinating care. 

10 (12) The provisions of, and amendments made 

11 by, this Act are intended to— 

12 (A) create savings to the Medicare pro13 gram; 

14 (B) establish a process to identify those 

15 Medicare beneficiaries most likely to benefit 

16 from having a provider coordinate their health 

17 care needs; and 

18 (C) establish a payment under the Medi19 care program for— 

20 (i) the assessment of those health care 

21 needs; and 

22 (ii) the activities required to coordi23 nate those health care needs. 


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1 SEC. 3. MEDICARE COVERAGE OF GERIATRIC ASSESS2 MENTS. 

3 (a) COVERAGE OF GERIATRIC ASSESSMENTS.— 

4 (1) IN GENERAL.—Section 1861(s)(2) of the 

5 Social Security Act (42 U.S.C. 1395x(s)(2)) is 

6 amended— 

7 (A) in subparagraph (Z), by striking 

8 ‘‘and’’ at the end; 

9 (B) in subparagraph (AA), by adding 

10 ‘‘and’’ at the end; and 

11 (C) by adding at the end the following new 

12 subparagraph: 

13 ‘‘(BB) geriatric assessments (as defined in sub14 section (ccc)(1));’’. 

15 (2) CONFORMING AMENDMENTS.—(A) Section 

16 1862(a)(7) of the Social Security Act (42 U.S.C. 

17 1395y(a)(7)) is amended by striking ‘‘or (K)’’ and 

18 inserting ‘‘(K), or (BB)’’. 

19 (B) Clauses (i) and (ii) of section 

20 1861(s)(2)(K) of the Social Security Act (42 U.S.C. 

21 1395x(s)(2)(K)) are each amended by striking ‘‘sub22 section (ww)(1)’’ and inserting ‘‘subsections (ww)(1) 

23 and (ccc)(1)’’. 

24 (b) GERIATRIC ASSESSMENTS DEFINED.—Section 

25 1861 of the Social Security Act (42 U.S.C. 1395x) is 


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1 amended by adding at the end the following new sub2 sections: 

3 ‘‘Geriatric Assessment 

4 ‘‘(ccc)(1) The term ‘geriatric assessment’ means each 

5 of the following: 

6 ‘‘(A) An assessment of the clinical status, func7 tional status, social and environmental functioning, 

8 and need for caregiving of a geriatric assessment eli9 gible individual (as defined in subsection (ddd)). The 

10 assessment shall include a comprehensive history 

11 and physical examination and assessments of the fol12 lowing domains using standardized validated clinical 

13 tools: 

14 ‘‘(i) Comprehensive review of medications 

15 and the individual’s adherence to the medica16 tion regimen. 

17 ‘‘(ii) Measurement of affect, cognition and 

18 executive function, mobility, balance, gait, risk 

19 of falling, and sensory function. 

20 ‘‘(iii) Social functioning, environmental 

21 needs, and caregiver resources and needs. 

22 ‘‘(iv) Any other domain determined appro23 priate by the Secretary. 

24 ‘‘(B) Subsequent assessments, which may not 

25 be conducted more frequently than annually, unless 


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1 the subsequent assessment is medically necessary 

2 due to a significant change in the condition of the 

3 geriatric assessment eligible individual. 

4 ‘‘(C) The development of a written care plan 

5 based on the results of the assessment under sub6 paragraph (A) (and any subsequent assessment 

7 under subparagraph (B)). The care plan shall detail 

8 identified problems, outline therapies, assign respon9 sibility for actions, and indicate whether the indi10 vidual is likely to benefit from chronic care coordina11 tion services (as defined in subsection (eee)(1)). If 

12 the individual is determined likely to benefit from 

13 chronic care coordination services, the care plan 

14 shall also provide the basis for the chronic care co15 ordination plan to be developed by the chronic care 

16 manager pursuant to subsection (eee). 

17 ‘‘(2) A geriatric assessment may only be conducted 

18 by— 

19 ‘‘(A) a physician; 

20 ‘‘(B) a practitioner described in section 

21 1842(b)(18)(C)(i) under the supervision of a physi22 cian; or 

23 ‘‘(C) any other provider that meets such condi24 tions as the Secretary may specify. 


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1 ‘‘Geriatric Assessment Eligible Individual 

2 ‘‘(ddd)(1) Subject to paragraph (3), the term ‘geri3 atric assessment eligible individual’ means an individual 

4 identified by the Secretary as eligible for a geriatric as5 sessment. 

6 ‘‘(2) In identifying individuals under paragraph (1), 

7 the following rules shall apply: 

8 ‘‘(A) The individual must have at least 1 of the 

9 following present: 

10 ‘‘(i) Multiple chronic conditions. 

11 ‘‘(ii) Dementia, as defined in the most re12 cent Diagnostic and Statistical Manual of Men13 tal Disorders, and at least 1 chronic condition. 

14 ‘‘(iii) Any other factor identified by the 

15 Secretary. 

16 ‘‘(B)(i) The individual, as determined by the 

17 Secretary— 

18 ‘‘(I) must have aggregate medical 

19 costs under this title in the top 10 percent 

20 of all applicable individuals during the pre21 vious 36 months; or 

22 ‘‘(II) is likely to incur costs under this 

23 title in the top 10 percent of all applicable 

24 individuals during the current or subse25 quent calendar year. 


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1 ‘‘(ii) The determination under clause 

2 (i)(II) of future costs shall be based on the 

3 medical condition of the individual, the individ4 ual’s past cost to the program under this title, 

5 and other factors as identified by the Secretary. 

6 ‘‘(iii) The individual meets such additional 

7 criteria (if any) as the Secretary establishes 

8 under subparagraph (C). 

9 ‘‘(C)(i) If the Secretary estimates that the total 

10 number of applicable individuals that would be geri11 atric assessment eligible individuals in a year (but 

12 for this subparagraph) exceeds 10 percent of the 

13 total number of applicable individuals in the year, 

14 the Secretary shall establish and apply under sub15 paragraph (B)(iii) such additional criteria as is de16 signed to eliminate such excess. 

17 ‘‘(ii) The Secretary shall consult with physi18 cians, physician groups, organizations representing 

19 individuals with chronic conditions and older adults, 

20 and other stakeholders in identifying any additional 

21 criteria under clause (i). 

22 ‘‘(D) For purposes of this paragraph, the term 

23 ‘applicable individual’ means an individual enrolled 

24 for benefits under part B but not enrolled in a Medi25 care Advantage plan or a plan under section 1876. 


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1 ‘‘(3) The term ‘geriatric assessment eligible indi2 vidual’ shall not include the following individuals: 

3 ‘‘(A) An individual who is receiving hospice care 

4 under this title. 

5 ‘‘(B) An individual who is residing in a skilled 

6 nursing facility, a nursing facility (as defined in sec7 tion 1919), or any other facility identified by the 

8 Secretary. 

9 ‘‘(C) An individual medically determined to 

10 have end-stage renal disease. 

11 ‘‘(D) An individual enrolled in a Medicare Ad12 vantage plan or a plan under section 1876. 

13 ‘‘(E) An individual enrolled in a PACE pro14 gram under section 1894. 

15 ‘‘(F) Any other categories of individuals deter16 mined appropriate by the Secretary. 

17 ‘‘(4) For purposes of this subsection, the term ‘chron18 ic condition’ means a condition, such as dementia, that 

19 lasts or is expected to last 1 year or longer, limits what 

20 an individual can do, and requires ongoing care.’’. 

21 (c) PAYMENT AND ELIMINATION OF COST-SHAR22 ING.— 

23 (1) PAYMENT AND ELIMINATION OF COINSUR24 ANCE.—Section 1833(a)(1) of the Social Security 

25 Act (42 U.S.C. 1395l(a)(1)) is amended— 


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1 (A) in subparagraph (N), by inserting 

2 ‘‘other than geriatric assessments (as defined in 

3 section 1861(ccc)(1))’’ after ‘‘(as defined in sec4 tion 1848(j)(3))’’; 

5 (B) by striking ‘‘and’’ before ‘‘(V)’’; and 

6 (C) by inserting before the semicolon at 

7 the end the following: ‘‘, and (W) with respect 

8 to geriatric assessments (as defined in section 

9 1861(ccc)(1)), the amount paid shall be 100 

10 percent of the lesser of the actual charge for 

11 the services or the amount determined under 

12 the payment basis determined under section 

13 1848’’. 

14 (2) PAYMENT UNDER PHYSICIAN FEE SCHED15 ULE.—Section 1848(j)(3) of the Social Security Act 

16 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

17 ‘‘(2)(BB),’’ after ‘‘(2)(AA),’’. 

18 (3) ELIMINATION OF COINSURANCE IN OUT19 PATIENT HOSPITAL SETTINGS.— 

20 (A) EXCLUSION FROM OPD FEE SCHED21 ULE.—Section 1833(t)(1)(B)(iv) of the Social 

22 Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)) is 

23 amended by striking ‘‘and diagnostic mammog24 raphy’’ and inserting ‘‘, diagnostic mammogVerDate Aug 31 2005 06:16 May 10, 2007 Jkt 059200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1340.IS S1340

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1 raphy, or geriatric assessments (as defined in 

2 section 1861(ccc)(1))’’. 

3 (B) CONFORMING AMENDMENTS.—Section 

4 1833(a)(2) of the Social Security Act (42 

5 U.S.C. 1395l(a)(2)) is amended— 

6 (i) in subparagraph (F), by striking 

7 ‘‘and’’ at the end; 

8 (ii) in subparagraph (G)(ii), by strik9 ing the comma at the end and inserting ‘‘; 

10 and’’; and 

11 (iii) by inserting after subparagraph 

12 (G)(ii) the following new subparagraph: 

13 ‘‘(H) with respect to geriatric assessments 

14 (as defined in section 1861(ccc)(1)) furnished 

15 by an outpatient department of a hospital, the 

16 amount determined under paragraph (1)(W),’’. 

17 (4) ELIMINATION OF DEDUCTIBLE.—The first 

18 sentence of section 1833(b) of the Social Security 

19 Act (42 U.S.C. 1395l(b)) is amended— 

20 (A) by striking ‘‘and’’ before ‘‘(8)’’; and 

21 (B) by inserting before the period the fol22 lowing: ‘‘, and (9) such deductible shall not 

23 apply with respect to geriatric assessments (as 

24 defined in section 1861(ccc)(1))’’. 


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1 (d) FREQUENCY LIMITATION.—Section 1862(a)(1) of 

2 the Social Security Act (42 U.S.C. 1395y(a)(1)) is amend3 ed— 

4 (1) by striking ‘‘and’’ at the end of subpara5 graph (M); 

6 (2) by striking the semicolon at the end of sub7 paragraph (N) and inserting ‘‘, and’’; and 

8 (3) by adding at the end the following new sub9 paragraph: 

10 ‘‘(O) in the case of geriatric assessments (as de11 fined in section 1861(ccc)(1)), which are performed 

12 more frequently than is covered under such sec13 tion;’’. 

14 (e) EXCEPTION TO LIMITS ON PHYSICIAN REFER15 RALS.—Section 1877(b) of the Social Security Act (42 

16 U.S.C. 1395nn(b)) is amended by adding at the end the 

17 following new paragraph: 

18 ‘‘(6) GERIATRIC ASSESSMENTS.—In the case of 

19 a designated health service, if the designated health 

20 service is a geriatric assessment (as defined in sec21 tion 1861(ccc)(1)) and furnished by a physician.’’. 

22 (f) RULEMAKING.—The Secretary of Health and 

23 Human Services shall define such terms, establish such 

24 procedures, and promulgate such regulations as the Sec25 retary determines necessary to implement the amendVerDate Aug 31 2005 06:16 May 10, 2007 Jkt 059200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S1340.IS S1340

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1 ments made by, and the provisions of, this section, includ2 ing the establishment of additional domains under sub3 section (ccc)(1)(A)(iv) of section 1861 of the Social Secu4 rity Act, as added by subsection (b). In promulgating such 

5 regulations, the Secretary shall consult with physicians, 

6 physician groups and organizations, and organizations 

7 representing individuals with chronic conditions and older 

8 adults. 

9 (g) EFFECTIVE DATE.—The amendments made by 

10 this section shall apply to assessments furnished on or 

11 after January 1, 2008. 

12 SEC. 4. MEDICARE COVERAGE OF CHRONIC CARE COORDI13 NATION SERVICES. 

14 (a) PART B COVERAGE OF CHRONIC CARE COORDI15 NATION SERVICES.— 

16 (1) IN GENERAL.—Section 1861(s)(2) of the 

17 Social Security Act (42 U.S.C. 1395x(s)(2)), as 

18 amended by section 3(a)(1), is amended— 

19 (A) in subparagraph (AA), by striking 

20 ‘‘and’’ at the end; 

21 (B) in subparagraph (BB), by adding 

22 ‘‘and’’ at the end; and 

23 (C) by adding at the end the following new 

24 subparagraph: 


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1 ‘‘(CC) chronic care coordination services (as de2 fined in subsection (eee));’’. 

3 (2) CONFORMING AMENDMENTS.— 

4 (A) Section 1862(a)(7) of the Social Secu5 rity Act (42 U.S.C. 1395y(a)(7)), as amended 

6 by section 3(a)(2)(A), is amended by striking 

7 ‘‘or (BB)’’ and inserting ‘‘(BB), or (CC)’’. 

8 (B) Clauses (i) and (ii) of section 

9 1861(s)(2)(K) of the Social Security Act (42 

10 U.S.C. 1395x(s)(2)(K)), as amended by section 

11 3(a)(2)(B), are each amended by striking ‘‘sub12 sections (ww)(1) and (ccc)’’ and inserting ‘‘sub13 sections (ww)(1), (ccc), and (eee)’’. 

14 (b) SERVICES DESCRIBED.—Section 1861 of the So15 cial Security Act (42 U.S.C. 1395x), as amended by sec16 tion 3(b), is amended by adding at the end the following 

17 new subsection: 

18 ‘‘Chronic Care Coordination Services; Chronic Care 

19 Manager; Chronic Care Eligible Individual 

20 ‘‘(eee)(1) The term ‘chronic care coordination serv21 ices’ means services that are furnished to a chronic care 

22 eligible individual (as defined in paragraph (3)) by a single 

23 chronic care manager (as defined in paragraph (2)) chosen 

24 by the individual under a plan of care prescribed by such 

25 chronic care manager for the purpose of chronic care and 


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1 dementia coordination, which may include any of the fol2 lowing services: 

3 ‘‘(A) The development of an initial plan of care 

4 (based on the results of a geriatric assessment, as 

5 defined in subsection ccc)), and subsequent appro6 priate revisions to that plan of care. 

7 ‘‘(B) The management of, and referral for, 

8 medical and other health services, including inter9 disciplinary care conferences and management with 

10 other providers. 

11 ‘‘(C) The monitoring and management of medi12 cations. 

13 ‘‘(D) Patient education and counseling services. 

14 ‘‘(E) Family caregiver education and counseling 

15 services. 

16 ‘‘(F) Self-management services, including 

17 health education and risk appraisal to identify be18 havioral risk factors through self-assessment. 

19 ‘‘(G) Providing access by telephone with physi20 cians and other appropriate health care profes21 sionals, including 24-hour availability of such profes22 sionals for emergencies. 

23 ‘‘(H) Management with the principal nonprofes24 sional caregiver in the home. 


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1 ‘‘(I) Managing and facilitating transitions 

2 among health care professionals and across settings 

3 of care, including the following: 

4 ‘‘(i) Pursuing the treatment option elected 

5 by the individual. 

6 ‘‘(ii) Including any advance directive exe7 cuted by the individual in the medical file of the 

8 individual. 

9 ‘‘(J) Information about, and referral to, hospice 

10 care, including patient and family caregiver edu11 cation and counseling about hospice care, and facili12 tating transition to hospice care when elected. 

13 ‘‘(K) Information about, referral to, and man14 agement with, community services. 

15 ‘‘(L) Such additional services for which pay16 ment would not otherwise be made under this title 

17 that the Secretary may specify that encourage the 

18 receipt of, or improve the effectiveness of, the serv19 ices described in the preceding subparagraphs. 

20 ‘‘(2)(A) For purposes of this subsection, the term 

21 ‘chronic care manager’ means an individual or entity 

22 that— 

23 ‘‘(i) is— 

24 ‘‘(I) a physician; 


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1 ‘‘(II) a practitioner described in clause (i) 

2 or (iv) of section 1842(b)(18)(C) under the su3 pervision of a physician; or 

4 ‘‘(III) any other provider that meets such 

5 conditions as the Secretary may specify; and 

6 ‘‘(ii) has entered into a chronic care coordina7 tion agreement with the Secretary. 

8 ‘‘(B)(i) For purposes of subparagraph (A)(ii), each 

9 chronic care coordination agreement shall meet the re10 quirements described in subparagraph (C) and shall— 

11 ‘‘(I) subject to clause (ii), be entered into for a 

12 period of 3 years and may be renewed if the Sec13 retary is satisfied that the chronic care manager 

14 continues to meet such terms and conditions as the 

15 Secretary may require; and 

16 ‘‘(II) contain such other terms and conditions 

17 as the Secretary may require. 

18 ‘‘(ii) Each chronic care coordination agreement shall 

19 provide for the termination of such agreement prior to 

20 such 3-year period in the case where the chronic care man21 ager— 

22 ‘‘(I) is no longer able to provide chronic care 

23 services; or 

24 ‘‘(II) does not meet such terms and conditions 

25 as the Secretary may require. 


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1 ‘‘(C)(i) Subject to clause (ii), the requirements of this 

2 subparagraph are met if the agreement requires the chron3 ic care manager to perform, or provide for the perform4 ance of, the following services: 

5 ‘‘(I) Advocating for, and providing ongoing sup6 port, oversight, and guidance with respect to the im7 plementation of a plan of care that provides an inte8 grated, coherent, and cross-disciplined plan for ongo9 ing medical care that is developed in partnership 

10 with the chronic care eligible individual and all other 

11 physicians and other care providers and agencies (in12 cluding home health agencies) providing care to the 

13 chronic care eligible individual. 

14 ‘‘(II) Using evidence-based medicine and clin15 ical decision support tools to guide decision making 

16 at the point of care and on the basis of specific pa17 tient factors. 

18 ‘‘(III) Using health information technology, in19 cluding, where appropriate, remote monitoring and 

20 patient registries, to monitor and track the health 

21 status of patients and to provide patients with en22 hanced and convenient access to health care services. 

23 ‘‘(IV) Encouraging patients to engage in the 

24 management of their own health through education 

25 and support systems. 


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1 ‘‘(V) Incorporating family caregivers into the 

2 chronic care planning process. 

3 ‘‘(ii) The Secretary may modify the services required 

4 under the agreement under clause (i), including by requir5 ing different services or services in addition to those de6 scribed in subclauses (I) through (V) of such clause. 

7 ‘‘(D) The Secretary shall adopt procedures which ex8 empt providers in rural areas from providing 1 or more 

9 of the services otherwise required to be provided under 

10 subparagraph (C) or modify such requirements for such 

11 providers. In establishing such procedures, the Secretary 

12 shall ensure that such exemptions and modifications do 

13 not impact the quality of chronic care coordination serv14 ices furnished by such providers. 

15 ‘‘(3) For purposes of this subsection, the term ‘chron16 ic care eligible individual’ means a geriatric assessment 

17 eligible individual (as defined in subsection (ddd)) who has 

18 undergone a geriatric assessment (as defined in subsection 

19 (ccc)(1)) which determined that the individual would ben20 efit from chronic care coordination.’’. 

21 (c) PAYMENT AND ELIMINATION OF COST-SHAR22 ING.— 

23 (1) PAYMENT AND ELIMINATION OF COINSUR24 ANCE.—Section 1833(a)(1) of the Social Security 


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1 Act (42 U.S.C. 1395l(a)(1)), as amended by section 

2 3(c)(1), is amended— 

3 (A) in subparagraph (N), by inserting ‘‘or 

4 chronic care coordination services (as defined in 

5 section 1861(eee))’’ after ‘‘other than geriatric 

6 assessments (as defined in section 

7 1861(ccc)(1))’’; 

8 (B) by striking ‘‘and’’ before ‘‘(W)’’; and 

9 (C) by inserting before the semicolon at 

10 the end the following: ‘‘, and (X) with respect 

11 to chronic care coordination services (as defined 

12 in section 1861(eee)), the amount paid shall be 

13 100 percent of the amount determined under 

14 section 1848(m)’’. 

15 (2) PAYMENT.— 

16 (A) IN GENERAL.—Section 1848 of the So17 cial Security Act (42 U.S.C. 1395w–4) is 

18 amended by adding at the end the following 

19 new subsection: 

20 ‘‘(m) PAYMENT FOR CHRONIC CARE COORDINATION

21 SERVICES.— 

22 ‘‘(1) ESTABLISHMENT.— 

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

24 establish a monthly care coordination payment 

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1 ordination services (as defined in paragraph (1) 

2 of section 1861(eee)(1)) furnished to a chronic 

3 care eligible individual (as defined in paragraph 

4 (3) of such section) by a chronic care manager 

5 (as defined in paragraph (2) of such section 

6 1861). 

7 ‘‘(B) REQUIREMENTS.—In establishing 

8 payment amounts under subparagraph (A), the 

9 Secretary shall— 

10 ‘‘(i) take into account the time re11 quired of the chronic care manager in pro12 viding the care coordination services to 

13 chronic care eligible individuals and the 

14 costs associated with the practice-level 

15 health information technologies and sys16 tems incurred by the chronic care manager 

17 in providing such services; and 

18 ‘‘(ii) ensure that such payments do 

19 not result in a reduction in payments for 

20 office visits or other evaluation and man21 agement services that would otherwise be 

22 allowable. 

23 ‘‘(2) CODE.—Under the conditions set forth in 

24 this section, the Secretary shall develop a care coVerDate Aug 31 2005 06:16 May 10, 2007 Jkt 059200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\S1340.IS S1340

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1 ordination payment code for chronic care coordina2 tion services and a value for such code. 

3 ‘‘(3) SEPARATE PAYMENTS FROM PAYMENTS

4 FOR GERIATRIC ASSESSMENTS.—Payments for 

5 chronic care coordination services shall be made sep6 arately from payments for geriatric assessments (as 

7 defined in section 1861(ccc)(1)) and other services 

8 for which payment is made under this title.’’. 

9 (B) CONFORMING AMENDMENT.—Section 

10 1848(j)(3) of the Social Security Act (42 

11 U.S.C. 1395w–4(j)(3)), as amended by section 

12 3(c)(2)), is amended by inserting ‘‘(2)(CC),’’ 

13 after ‘‘(2)(BB),’’. 

14 (3) ELIMINATION OF COINSURANCE IN OUT15 PATIENT HOSPITAL SETTINGS.— 

16 (A) EXCLUSION FROM OPD FEE SCHED17 ULE.—Section 1833(t)(1)(B)(iv) of the Social 

18 Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)), as 

19 amended by section 3(c)(3)(A), is amended by 

20 striking ‘‘or geriatric assessments (as defined in 

21 section 1861(ccc)(1))’’ and inserting ‘‘geriatric 

22 assessments (as defined in section 

23 1861(ccc)(1)), or chronic care coordination 

24 services (as defined in section 1861(eee)(1))’’. 


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1 (B) CONFORMING AMENDMENTS.—Section 

2 1833(a)(2) of the Social Security Act (42 

3 U.S.C. 1395l(a)(2)), as amended by section 

4 3(c)(3)(B), is amended— 

5 (i) in subparagraph (G)(ii), by strik6 ing ‘‘and’’ at the end; 

7 (ii) in subparagraph (H), by striking 

8 the comma at the end and inserting ‘‘; 

9 and’’; and 

10 (iii) by inserting after subparagraph 

11 (H) the following new subparagraph: 

12 ‘‘(I) with respect to chronic care coordina13 tion services (as defined in section 

14 1861(eee)(1)) furnished by an outpatient de15 partment of a hospital, the amount determined 

16 under section 1848(m),’’. 

17 (4) ELIMINATION OF DEDUCTIBLE.—Paragraph 

18 (9) of section 1833(b) of the Social Security Act (42 

19 U.S.C. 1395l(b)), as added by section 3(c)(4), is 

20 amended by inserting ‘‘or chronic care coordination 

21 services (as defined in section 1861(eee)(1))’’ after 

22 ‘‘geriatric assessments (as defined in section 

23 1861(ccc)(1))’’. 

24 (d) APPLICATION OF LIMITS ON BILLING.—Section 

25 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 


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1 1395u(b)(18)(C)) is amended by adding at the end the 

2 following new clause: 

3 ‘‘(vii) A chronic care manager (as defined in 

4 section 1861(eee)(2)) that is not a physician.’’. 

5 (e) EXCEPTION TO LIMITS ON PHYSICIAN REFER6 RALS.—Section 1877(b)(6) of the Social Security Act (42 

7 U.S.C. 1395nn(b)(6)), as amended by section 3(e), is 

8 amended to read as follows: 

9 ‘‘(6) GERIATRIC ASSESSMENTS AND CHRONIC

10 CARE COORDINATION SERVICES.—In the case of a 

11 designated health service, if the designated health 

12 service is— 

13 ‘‘(A) a geriatric assessment or a chronic 

14 care coordination service (as defined in sub15 sections (ccc)(1) or (eee)(1) of section 1861, re16 spectively); and 

17 ‘‘(B) provided by a physician or a chronic 

18 care manager (as defined in section 

19 1861(eee)(2)).’’. 

20 (f) RULEMAKING.—The Secretary of Health and 

21 Human Services shall define such terms, establish such 

22 procedures, and promulgate such regulations as the Sec23 retary determines necessary to implement the amend24 ments made by, and the provisions of, this section. In pro25 mulgating such regulations, the Secretary shall consult 


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1 with physicians, physician groups and organizations, and 

2 organizations representing individuals with chronic condi3 tions and older adults. 

4 (g) EFFECTIVE DATE.—The amendments made by 

5 this section shall apply to chronic care coordination serv6 ices furnished on or after January 1, 2008. 

7 SEC. 5. OUTREACH ACTIVITIES REGARDING GERIATRIC AS8 SESSMENTS AND CHRONIC CARE COORDINA9 TION SERVICES UNDER THE MEDICARE PRO10 GRAM. 

11 The Secretary of Health and Human Services shall 

12 conduct outreach activities to individuals likely to be eligi13 ble to receive coverage of geriatric assessments (as defined 

14 in subsection (ccc) of section 1861 of the Social Security 

15 Act, as added by section 3) under the Medicare program 

16 and individuals likely to be eligible to receive coverage of 

17 chronic care coordination services (as defined in sub18 section (eee) of such section 1861, as added by section 

19 4) under the Medicare program, to inform such individuals 

20 about the availability of such benefits under the Medicare 

21 program. 


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1 SEC. 6. STUDY AND REPORT ON GERIATRIC ASSESSMENTS 

2 AND CHRONIC CARE COORDINATION SERV3 ICES UNDER THE MEDICARE PROGRAM. 

4 (a) STUDY.—The Secretary of Health and Human 

5 Services shall enter into a contract with an entity to con6 duct a study on— 

7 (1) the effectiveness of the coverage of geriatric 

8 assessments and chronic care coordination services 

9 under the Medicare program (under the amendments 

10 made by sections 3 and 4) on improving the quality 

11 of care provided to Medicare beneficiaries with 

12 chronic conditions, including dementia; and 

13 (2) the impact of such geriatric assessments 

14 and care coordination services on reducing expendi15 tures under title XVIII of the Social Security Act, 

16 including reduced expenditures that may result 

17 from— 

18 (A) reducing preventable hospital admis19 sions; 

20 (B) more appropriate use of pharma21 ceuticals; and 

22 (C) reducing duplicate or unnecessary 

23 tests. 

24 (b) REPORT.—Not later than 3 years after the date 

25 of enactment of this Act, the entity conducting the study 

26 under subsection (a) shall submit to Congress and the SecVerDate Aug 31 2005 06:16 May 10, 2007 Jkt 059200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\S1340.IS S1340

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1 retary of Health and Human Services a report on the 

2 study, together with recommendations for such legislation 

3 or administrative action as such entity determines appro4 priate. 

5 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

6 are authorized to be appropriated such sums as may be 

7 necessary to carry out this section. 

8 SEC. 7. STUDY AND REPORT ON BEST PRACTICES FOR 

9 MEDICARE CHRONIC CARE COORDINATION. 

10 (a) STUDY.—The Secretary of Health and Human 

11 Services, in consultation with the Medicare Payment Advi12 sory Commission, shall conduct a study of the following 

13 issues: 

14 (1) The effectiveness of pay-for-performance 

15 programs to serve Medicare beneficiaries with mul16 tiple chronic conditions, including dementia. 

17 (2) The cost-effectiveness of chronic care co18 ordination under the Medicare program. 

19 (3) Whether the quality measures used for 

20 making payments under part B of the Medicare pro21 gram, including the measures developed under sub22 section (k) of section 1848 of the Social Security Act 

23 (as added by section 101 of division B of the Tax 

24 Relief and Health Care Act of 2006, Public Law 

25 109–432), improve the quality of care provided to 


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1 Medicare beneficiaries with multiple chronic ill2 nesses, including dementia. 

3 (b) REPORT.—Not later than 3 years after the date 

4 of enactment of this Act, the Secretary of Health and 

5 Human Services shall submit to Congress a report on the 

6 study conducted under subsection (a) that contains— 

7 (1) recommendations on the best quality indica8 tors for monitoring the chronic care coordination of 

9 the conditions of Medicare beneficiaries with mul10 tiple chronic conditions, including dementia; and 

11 (2) such other recommendations for legislation 

12 or administrative action as the Secretary determines 

13 appropriate. 

14 SEC. 8. RULE OF CONSTRUCTION. 

15 Nothing in this Act, or in the amendments made by 

16 this Act, shall be construed as requiring an individual to 

17 receive a geriatric assessment (as defined in section 

18 1861(ccc)(1) of the Social Security Act, as added by sec19 tion 3(b)) or chronic care coordination services (as defined 

20 in section 1861(eee)(1) of such Act, as added by section 

21 4(b)). 

Æ 


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