II 

109TH CONGRESS 

1ST SESSION S. 40 

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

IN THE SENATE OF THE UNITED STATES 

JANUARY 24, 2005 

Mrs. LINCOLN (for herself, Mr. BINGAMAN, Mrs. MURRAY, Ms. LANDRIEU, 

Mrs. BOXER, Mr. SARBANES, 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 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 and Chronic Care Management Act of 2005’’. 

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 
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Sec. 2. Findings. 

Sec. 3. Medicare coverage of geriatric assessments. 

Sec. 4. Medicare coverage of chronic care management services. 

Sec. 5. Study and report on best practices for medicare chronic care management. 

1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) We must redesign the medicare system to 

4 provide high-quality, cost-effective care to a growing 

5 population: elderly individuals with multiple chronic 

6 conditions. 

7 (2) According to the Congressional Budget Of8 fice, 50 percent of medicare costs can be attributed 

9 to 5 percent of medicare’s most costly beneficiaries. 

10 (3) Currently, 82 percent of the medicare population has at least 1 chronic condition, and 2 11 ⁄3 have 

12 more than 1 chronic condition. The 20 percent of 

13 beneficiaries with 5 or more chronic conditions account for 2 14 ⁄3 of all medicare spending. In addition, 

15 the large Baby Boomer generation is moving toward 

16 retirement and medicare eligibility. 

17 (4) In general, the prevalence of chronic condi18 tions increases with age: 74 percent of the 65- to 

19 69-year-old group have at least 1 chronic condition, 

20 while 86 percent of the 85 years and older group 

21 have at least 1 chronic condition. Similarly, just 14 

22 percent of the 65- to 69-year-olds have 5 or more 
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1 chronic conditions, but 28 percent of the 85 years 

2 and older group have 5 or more chronic conditions. 

3 (5) There is a strong pattern of increasing utili4 zation as the number of conditions increase. Fifty5 five percent of medicare beneficiaries with 5 or more 

6 conditions experienced an inpatient hospital stay 

7 compared to 5 percent for those with 1 condition or 

8 9 percent for those with 2 conditions. 

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

10 medicare beneficiary has over 15 physician visits an11 nually and sees 6 different physicians annually. 

12 (7) There is almost a 4-fold increase in visits by 

13 people with 5 chronic conditions compared to visits 

14 by people with 1 chronic condition. The number of 

specific physicians seen increases almost 21 15 ⁄2 times 

16 for people with 5 or more chronic conditions relative 

17 to those with just 1 chronic condition. 

18 (8) When Alzheimer’s disease and dementia are 

19 present along with 1 or more other chronic condi20 tions, utilization also increases. For example, in 

21 2000, total average per person medicare expendi22 tures for those with congestive heart failure and Alz23 heimer’s or dementia were 47 percent higher than 

24 for those with congestive heart failure and no de25 mentia. 
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1 (9) Based on numerous studies in the United 

2 States and internationally, we know that the delivery 

3 of higher quality health care, increased efficiency 

4 and cost-effectiveness are the result of systems in 

5 which patients are linked with a physician or other 

6 qualified health professional who coordinates their 

7 care. 

8 (10) The current medicare program penalizes 

9 physicians for integrating and coordinating health 

10 care because these services are not explicitly recog11 nized and distinctly paid for. Instead, physicians are 

12 incentivized to provide episodic care and to generate 

13 more individual patient visits to the doctor’s office 

14 and hospital for separately reimbursed tests and 

15 procedures. 

16 (11) The chronic care model established by this 

17 Act includes several elements that are effective in 

18 managing chronic disease— 

19 (A) linkages with community resources; 

20 (B) health care system changes that re21 ward quality chronic care; 

22 (C) support for patient self-management of 

23 chronic disease; 

24 (D) practice redesign; 
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1 (E) evidence-based clinical practice guide2 lines; and 

3 (F) clinical information systems, such as 

4 electronic medical records and continuity of 

5 care records. 

6 (12) We must realign the financial incentives 

7 within medicare as part of a comprehensive system 

8 change. Medicare should be restructured to reim9 burse physicians and other qualified health profes10 sionals for the cost of coordinating care. 

11 SEC. 3. MEDICARE COVERAGE OF GERIATRIC ASSESS12 MENTS. 

13 (a) PART B COVERAGE OF GERIATRIC ASSESS14 MENTS.— 

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

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

17 amended— 

18 (A) in subparagraph (Y), by striking 

19 ‘‘and’’ after the semicolon at the end; 

20 (B) in subparagraph (Z), by adding ‘‘and’’ 

21 after the semicolon at the end; and 

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

23 subparagraph: 

24 ‘‘(AA) geriatric assessments (as defined in sub25 section (bbb)(1));’’. 
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1 (2) CONFORMING AMENDMENTS.—(A) Section 

2 1862(a)(7) of the Social Security Act (42 U.S.C. 

3 1395y(a)(7)) is amended by striking ‘‘or (K)’’ and 

4 inserting ‘‘(K), or (AA)’’. 

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

6 1861(s)(2)(K) of the Social Security Act (42 U.S.C. 

7 1395x(s)(2)(K)) are each amended by striking ‘‘sub8 section (ww)(1)’’ and inserting ‘‘subsections (ww)(1) 

9 and (bbb)(1)’’. 

10 (b) GERIATRIC ASSESSMENTS DEFINED.—Section 

11 1861 of the Social Security Act (42 U.S.C. 1395x) is 

12 amended by adding at the end the following new sub13 section: 

14 ‘‘Geriatric Assessment; Eligible Individual 

15 ‘‘(bbb)(1) The term ‘geriatric assessment’ means— 

16 ‘‘(A) an initial assessment of an eligible individ17 ual’s medical condition, functional and cognitive ca18 pacity, primary caregiver needs, and environmental 

19 and psychosocial needs that is conducted by a physi20 cian or an entity that meets such conditions as the 

21 Secretary may specify (which may include physi22 cians, physician group practices, or other health care 

23 professionals or entities the Secretary may find ap24 propriate) working in collaboration with a physician; 

25 and 
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1 ‘‘(B) subsequent assessments, which may not be 

2 conducted more frequently than annually, unless a 

3 physician or chronic care manager of the eligible in4 dividual determines that such assessments are re5 quired due to sentinel health events or changes in 

6 the health status of the individual that may require 

7 changes in plans of care developed for the individual. 

8 ‘‘(2)(A) For purposes of this subsection, the term ‘eli9 gible individual’ means an individual who has— 

10 ‘‘(i) at least 5 chronic conditions and an inabil11 ity to manage care (as defined by the Secretary); or 

12 ‘‘(ii) a mental or cognitive impairment, includ13 ing dementia, and at least 1 other chronic condition. 

14 ‘‘(B) For purposes of this paragraph, the term 

15 ‘chronic condition’ means an illness, functional limitation, 

16 or cognitive impairment that is expected to last at least 

17 1 year, limits the activities of an individual, and requires 

18 ongoing care.’’. 

19 (c) PAYMENT AND ELIMINATION OF COST-SHAR20 ING.— 

21 (1) PAYMENT AND ELIMINATION OF COINSUR22 ANCE.—Section 1833(a)(1) of the Social Security 

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

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

25 ‘‘other than geriatric assessments (as defined in 
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1 section 1861(bbb)(1))’’ after ‘‘(as defined in 

2 section 1848(j)(3))’’; 

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

4 (C) by inserting before the semicolon at 

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

6 to geriatric assessments (as defined in section 

7 1861(bbb)(1)), the amount paid shall be 100 

8 percent of the lesser of the actual charge for 

9 the services or the amount determined under 

10 the payment basis determined under section 

11 1848’’. 

12 (2) PAYMENT UNDER PHYSICIAN FEE SCHED13 ULE.—Section 1848(j)(3) of the Social Security Act 

14 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

15 ‘‘(2)(AA),’’ after ‘‘(2)(W),’’. 

16 (3) ELIMINATION OF COINSURANCE IN OUT17 PATIENT HOSPITAL SETTINGS.— 

18 (A) EXCLUSION FROM OPD FEE SCHED19 ULE.—Section 1833(t)(1)(B)(iv) of the Social 

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

21 amended by striking ‘‘and diagnostic mammog22 raphy’’ and inserting ‘‘, diagnostic mammog23 raphy, or geriatric assessments (as defined in 

24 section 1861(bbb)(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)) is amended— 

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

5 ‘‘and’’ after the semicolon at the end; 

6 (ii) in subparagraph (G)(ii), by strik7 ing the comma at the end and inserting ‘‘; 

8 and’’; and 

9 (iii) by inserting after subparagraph 

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

11 ‘‘(H) with respect to geriatric assessments 

12 (as defined in section 1861(bbb)(1)) furnished 

13 by an outpatient department of a hospital, the 

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

15 (4) ELIMINATION OF DEDUCTIBLE.—The first 

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

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

18 (A) by striking ‘‘and’’ before ‘‘(6)’’; and 

19 (B) by inserting before the period the fol20 lowing: ‘‘, and (7) such deductible shall not 

21 apply with respect to geriatric assessments (as 

22 defined in section 1861(bbb)(1))’’. 

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

24 the Social Security Act (42 U.S.C. 1395y(a)(1)) is amend25 ed— 
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1 (1) by striking ‘‘and’’ at the end of subpara2 graph (L); 

3 (2) by striking the semicolon at the end of sub4 paragraph (M) and inserting ‘‘, and’’; and 

5 (3) by adding at the end the following new sub6 paragraph: 

7 ‘‘(N) in the case of geriatric assessments (as 

8 defined in section 1861(bbb)(1)), which are per9 formed more frequently than is covered under such 

10 section;’’. 

11 (e) EXCEPTION TO LIMITS ON PHYSICIAN REFER12 RALS.—Section 1877(b) of the Social Security Act (42 

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

14 following new paragraph: 

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

16 a designated health service, if the designated health 

17 service is a geriatric assessment (as defined in sec18 tion 1861(bbb)(1)) and furnished by a physician.’’. 

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

20 Human Services shall define such terms and establish 

21 such procedures as the Secretary determines necessary to 

22 implement the provisions of this section. 

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

24 this section shall apply to assessments and chronic care 
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1 management services furnished on or after January 1, 

2 2006. 

3 SEC. 4. MEDICARE COVERAGE OF CHRONIC CARE MANAGE4 MENT SERVICES. 

5 (a) PART B COVERAGE OF CHRONIC CARE MANAGE6 MENT SERVICES.— 

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

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

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

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

11 ‘‘and’’ after the semicolon at the end; 

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

13 ‘‘and’’ after the semicolon at the end; and 

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

15 subparagraph: 

16 ‘‘(BB) chronic care management services (as 

17 defined in subsection (ccc));’’. 

18 (2) CONFORMING AMENDMENTS.— 

19 (A) Section 1862(a)(7) of the Social Secu20 rity Act (42 U.S.C. 1395y(a)(7)), as amended 

21 section 3(a)(2)(A), is amended by striking ‘‘or 

22 (AA)’’ and inserting ‘‘(AA), or (BB)’’. 

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

24 1861(s)(2)(K) of the Social Security Act (42 

25 U.S.C. 1395x(s)(2)(K)), as amended by section 
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1 3(a)(2)(B), are each amended by striking ‘‘sub2 sections (ww)(1) and (bbb)’’ and inserting ‘‘sub3 sections (ww)(1), (bbb), and (ccc)’’. 

4 (b) SERVICES DESCRIBED.—Section 1861 of the So5 cial Security Act (42 U.S.C. 1395x), as amended by sec6 tion 3(b), is amended by adding at the end the following 

7 new subsection: 

8 ‘‘Chronic Care Management Services; Chronic Care 

9 Manager; Eligible Individual 

10 ‘‘(ccc)(1) The term ‘chronic care management serv11 ices’ means services that are furnished to an eligible indi12 vidual (as defined in paragraph (3)) by a chronic care 

13 manager (as defined in paragraph (2)) under a plan of 

14 care prescribed by such chronic care manager for the pur15 pose of chronic care management, which may include any 

16 of the following services: 

17 ‘‘(A) The development of an initial plan of care, 

18 and subsequent appropriate revisions to that plan of 

19 care. 

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

21 medical and other health services, including inter22 disciplinary care conferences and management with 

23 other providers. 

24 ‘‘(C) The monitoring and management of medi25 cations. 
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1 ‘‘(D) Patient education and counseling services. 

2 ‘‘(E) Family caregiver education and counseling 

3 services. 

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

5 health education and risk appraisal to identify be6 havioral risk factors through self-assessment. 

7 ‘‘(G) Providing access for consultations by tele8 phone with physicians and other appropriate health 

9 care professionals, including 24-hour availability of 

10 such professionals for emergency consultations. 

11 ‘‘(H) Management with the principal nonprofes12 sional caregiver in the home. 

13 ‘‘(I) Managing and facilitating transitions 

14 among health care professionals and across settings 

15 of care, including the following: 

16 ‘‘(i) Pursuing the treatment option elected 

17 by the individual. 

18 ‘‘(ii) Including any advance directive exe19 cuted by the individual in the medical file of the 

20 individual. 

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

22 services, including patient and family caregiver edu23 cation and counseling about hospice, and facilitating 

24 transition to hospice when elected. 
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1 ‘‘(K) Information about, referral to, and man2 agement with, community services. 

3 ‘‘(L) Such additional services for which pay4 ment would not otherwise be made under this title 

5 that the Secretary may specify that encourage the 

6 receipt of, or to improve the effectiveness of, the 

7 services described in the preceding subparagraphs. 

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

9 ‘chronic care manager’ means an individual or entity 

10 that— 

11 ‘‘(i) is— 

12 ‘‘(I) a physician (as defined in subsection 

13 (r)(1)); or 

14 ‘‘(II) a practitioner described in section 

15 1842(b)(18)(C) or an entity that meets such 

16 conditions as the Secretary may specify (which 

17 may include physicians, physician group prac18 tices, or other health care professionals or enti19 ties the Secretary may find appropriate) work20 ing in collaboration with a physician; 

21 ‘‘(ii) has entered into a chronic care manage22 ment agreement with the Secretary; and 

23 ‘‘(iii) meets such other criteria as the Secretary 

24 may establish (which may include experience in the 
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1 provision of chronic care management or primary 

2 care physicians’ services). 

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

4 chronic care management agreement shall— 

5 ‘‘(i) be entered into for a period of 1 year and 

6 may be renewed if the Secretary is satisfied that the 

7 chronic care manager continues to meet the condi8 tions of participation specified in subparagraph (A); 

9 ‘‘(ii) ensure that the chronic care manager will 

10 submit reports to the Secretary on the functional 

11 and medical status of eligible individuals who receive 

12 chronic care management services, expenditures re13 lating to such services, and health outcomes relating 

14 to such services, except that the Secretary may not 

15 require a chronic care manager to submit more than 

16 one such report during a year; and 

17 ‘‘(iii) contain such other terms and conditions 

18 as the Secretary may require. 

19 ‘‘(3) For purposes of this subsection, the term ‘eligi20 ble individual’ means an eligible individual (as defined in 

21 subsection (bbb)(2)) who has undergone a geriatric assess22 ment (as defined in subsection (bbb)(1)) and who a physi23 cian has determined would benefit from chronic care man24 agement.’’. 
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1 (c) PAYMENT AND ELIMINATION OF COST-SHAR2 ING.— 

3 (1) PAYMENT AND ELIMINATION OF COINSUR4 ANCE.—Section 1833(a)(1) of the Social Security 

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

6 3(c)(1), is amended— 

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

8 chronic care management services (as defined in 

9 section 1861(ccc))’’ after ‘‘other than geriatric 

10 assessments (as defined in section 

11 1861(bbb)(1))’’; 

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

13 (C) by inserting before the semicolon at 

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

15 to chronic care management services (as de16 fined in section 1861(ccc)), the amount paid 

17 shall be 100 percent of the amount determined 

18 under section 1834(n)’’. 

19 (2) PAYMENT.—Section 1834 of the Social Se20 curity Act (42 U.S.C. 1395m) is amended by adding 

21 at the end the following new subsection: 

22 ‘‘(n) PAYMENT FOR CHRONIC CARE MANAGEMENT

23 SERVICES.— 

24 ‘‘(1) IN GENERAL.—The Secretary shall pay for 

25 chronic care management services (as defined in sec-
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1 tion 1861(ccc)(1)) furnished to an eligible individual 

2 (as defined in section 1861(ccc)(3)) by a chronic 

3 care manager (as defined in section 1861(ccc)(2))— 

4 ‘‘(A) separately from geriatric assessments 

5 (as defined in section 1861(bbb)(1)) and other 

6 services for which payment is made under this 

7 title; and 

8 ‘‘(B) based on the methodology selected by 

9 the chronic care manager (as so defined) from 

10 among the methodologies developed and imple11 mented by the Secretary under paragraph (2). 

12 ‘‘(2) DEVELOPMENT AND IMPLEMENTATION OF

13 PAYMENT METHODOLOGIES.—The Secretary, in con14 sultation with national membership associations rep15 resenting physicians, qualified health professionals, 

16 and patients, shall develop and implement payment 

17 methodologies applicable with respect to chronic care 

18 management services (as defined in section 

19 1861(ccc)(1)) as follows: 

20 ‘‘(A) UNADJUSTED MONTHLY CAPITATED

21 PAYMENT AMOUNT.—A per patient per month 

22 chronic care management fee separate from 

23 evaluation and management services for which 

24 payment is made under the physician fee sched25 ule under section 1848 that does not take into 
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1 account the severity of the eligible individual’s 

2 condition. 

3 ‘‘(B) ADJUSTED MONTHLY CAPITATED

4 PAYMENT AMOUNT.—A per patient per month 

5 chronic care management fee separate from 

6 evaluation and management services for which 

7 payment is made under the physician fee sched8 ule under section 1848 that provides for an ad9 justment to the payment amount based on the 

10 severity of the eligible individual’s condition. 

11 ‘‘(C) UNADJUSTED FEE SCHEDULE

12 AMOUNT.—A chronic care management fee for 

13 care coordination that includes payment for re14 lated evaluation and management services for 

15 which payment would otherwise be made under 

16 the physician fee schedule under section 1848 

17 that does not take into account the severity of 

18 the eligible individual’s condition. 

19 ‘‘(D) ADJUSTED FEE SCHEDULE

20 AMOUNT.—A chronic care management fee for 

21 care coordination that includes payment for re22 lated evaluation and management services for 

23 which payment would otherwise be made under 

24 the physician fee schedule under section 1848 

25 that provides for an adjustment to the payment 
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1 amount based on the severity of the eligible in2 dividual’s condition. 

3 ‘‘(E) OTHER PAYMENT METHODOLO4 GIES.—Any other payment methodology that 

5 the Secretary determines effective in creating 

6 incentives for physicians and other chronic care 

7 managers to make practice-based improvements 

8 to improve the quality and cost-effectiveness of 

9 care provided to eligible individuals.’’. 

10 (3) ELIMINATION OF COINSURANCE IN OUT11 PATIENT HOSPITAL SETTINGS.— 

12 (A) EXCLUSION FROM OPD FEE SCHED13 ULE.—Section 1833(t)(1)(B)(iv) of the Social 

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

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

16 striking ‘‘or geriatric assessments (as defined in 

17 section 1861(bbb)(1))’’ and inserting ‘‘geriatric 

18 assessments (as defined in section 

19 1861(bbb)(1)), or chronic care management 

20 services (as defined in section 1861(ccc)(1))’’. 

21 (B) CONFORMING AMENDMENTS.—Section 

22 1833(a)(2) of the Social Security Act (42 

23 U.S.C. 1395l(a)(2)) is amended— 

24 (i) in subparagraph (G)(ii), by strik25 ing ‘‘and’’ after the semicolon at the end; 
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1 (ii) in subparagraph (H), by striking 

2 the comma at the end and inserting ‘‘; 

3 and’’; and 

4 (iii) by inserting after subparagraph 

5 (H) the following new subparagraph: 

6 ‘‘(I) with respect to chronic care manage7 ment services (as defined in section 

8 1861(ccc)(1)) furnished by an outpatient de9 partment of a hospital, the amount determined 

10 under section 1834(n),’’. 

11 (4) ELIMINATION OF DEDUCTIBLE.—Section 

12 1833(b)(7) of the Social Security Act (42 U.S.C. 

13 1395l(b)(7)), as added by section 3(c)(4), is amend14 ed by inserting ‘‘or chronic care management serv15 ices (as defined in section 1861(ccc)(1))’’ after 

16 ‘‘geriatric assessments (as defined in section 

17 1861(bbb)(1))’’. 

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

19 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 

20 1395u(b)(18)(C)) is amended by adding at the end the 

21 following new clause: 

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

23 section 1861(ccc)(2)) that is not a physician.’’. 

24 (e) EXCEPTION TO LIMITS ON PHYSICIAN REFER25 RALS.—Section 1877(b)(6) of the Social Security Act (42 
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1 U.S.C. 1395nn(b)(6)), as amended by section 3(e), is 

2 amended to read as follows: 

3 ‘‘(6) GERIATRIC ASSESSMENTS AND CHRONIC

4 CARE MANAGEMENT SERVICES.—In the case of a 

5 designated health service, if the designated health 

6 service is— 

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

8 care management service (as defined in sub9 sections (bbb)(1) or (ccc)(1) of section 1861, 

10 respectively); and 

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

12 care manager (as defined in section 

13 1861(ccc)(2)).’’. 

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

15 Human Services shall define such terms and establish 

16 such procedures as the Secretary determines necessary to 

17 implement the provisions of this section. 

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

19 this section shall apply to assessments and chronic care 

20 management services furnished on or after January 1, 

21 2006. 

22 SEC. 5. STUDY AND REPORT ON BEST PRACTICES FOR 

23 MEDICARE CHRONIC CARE MANAGEMENT. 

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

25 Services, in consultation with the Medicare Payment Advi-
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1 sory Commission, shall conduct a thorough study of the 

2 following issues: 

3 (1) The effectiveness of the different payment 

4 methodologies applicable with respect to chronic care 

5 management services developed and implemented 

6 under section 1834(n)(2) of the Social Security Act 

7 (as added by section 4(c)(2)). 

8 (2) The effectiveness of pay-for-performance 

9 programs to serve medicare beneficiaries with mul10 tiple chronic conditions, including dementia. 

11 (3) Process measures and outcomes for medi12 care beneficiaries with multiple chronic illnesses, in13 cluding dementia. 

14 (4) The cost-effectiveness and quality associated 

15 with chronic care management under the medicare 

16 program. 

17 (5) The feasibility of broadening and incor18 porating the findings of the Assessing Care of Vul19 nerable Elders (ACOVE) study into the medicare 

20 program. 

21 (b) REPORT.—Not later than the date that is 1 year 

22 after the date of enactment of this Act, the Secretary of 

23 Health and Human Services shall submit to Congress a 

24 report on the study conducted under subsection (a) that 

25 contains— 
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1 (1) recommendations on the best practices for 

2 chronic care management of the conditions of medi3 care beneficiaries with multiple chronic conditions, 

4 including dementia; and 

5 (2) such other recommendations for legislation 

6 or administrative action as the Secretary determines 

7 appropriate. 

Æ