I 

111TH CONGRESS 

1ST SESSION H. R. 3340 

To establish a Medicare Chronic Care Rapid Learning Network to develop 

and apply improved practices in care management for Medicare beneficiaries with multiple chronic conditions. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 24, 2009 

Mr. JOHNSON of Illinois (for himself, Ms. SCHWARTZ, Mr. PATRICK J. MURPHY of Pennsylvania, and Mr. LATHAM) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such 

provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To establish a Medicare Chronic Care Rapid Learning Network to develop and apply improved practices in care 

management for Medicare beneficiaries with multiple 

chronic conditions. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Chronic Care 

5 Rapid Learning Network (MCCRLN) Act of 2009’’. 


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1 SEC. 2. FINDINGS. 

2 The Congress makes the following findings: 

3 (1) Two-thirds of all Medicare spending involves 

4 beneficiaries living with 5 or more chronic condi5 tions. 

6 (2) Eighty-four percent of people ages 65 to 70 

7 live with at least one of the following chronic condi8 tions: hypertension, heart disease or heart attack, 

9 cancer, diabetes, arthritis, or high cholesterol. 

10 (3) Medicare beneficiaries with chronic condi11 tions are more likely to undergo duplicative tests, re12 ceive contradictory information from their health 

13 care providers, experience adverse responses to medi14 cations, and undergo hospital visits that could have 

15 been prevented. 

16 (4) Both traditional fee-for-service Medicare 

17 and Medicare Advantage are not currently config18 ured to meet the unique needs of beneficiaries living 

19 with multiple chronic conditions. 

20 (5) Care for these patients is typically frag21 mented and delivered by multiple providers working 

22 at multiple sites. 

23 (6) Medicare has implemented a number of 

24 demonstration projects focused on ways to improve 

25 care for beneficiaries with multiple chronic condi26 tions, yet there has been limited translation of eviVerDate Nov 24 2008 07:48 Jul 25, 2009 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3340.IH H3340

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1 dence-based results to the wider chronic care com2 munity in a timely manner. 

3 (7) Using evidence-based approaches to care co4 ordination and care management have shown prom5 ise in reducing illness burden and improving health 

6 for at-risk patients, but the evidence is not easy to 

7 consistently translate into practice. 

8 (8) As the population of Medicare beneficiaries 

9 living with multiple chronic conditions continues to 

10 increase, the Centers for Medicare & Medicaid Serv11 ices should seek more effective actions to test var12 ious care models, analyze the outcomes, and imple13 ment evidence-based best practices as soon as pos14 sible. 

15 (9) The United States Government should part16 ner with qualified and experienced health care insti17 tutions and universities already serving these bene18 ficiaries to effectively and efficiently develop, evalu19 ate, and translate improvements in coordinated care 

20 for them. Generating this information and sup21 porting its translation into clinical practice will serve 

22 beneficiaries far more effectively. 


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1 SEC. 3. MEDICARE CHRONIC CARE RAPID LEARNING NET2 WORK TO DEVELOP AND APPLY IMPROVED 

3 PRACTICES IN COORDINATED CARE FOR 

4 MEDICARE BENEFICIARIES WITH MULTIPLE, 

5 CHRONIC CONDITIONS. 

6 (a) ESTABLISHMENT.— 

7 (1) IN GENERAL.—Not later than 60 days after 

8 the date of the enactment of this Act, the Secretary 

9 of Health and Human Services (in this section re10 ferred to as the ‘‘Secretary’’) shall establish in ac11 cordance with this section a Medicare Chronic Care 

12 Rapid Learning Network (in this section referred to 

13 as the ‘‘Network’’). 

14 (2) DURATION.—The initial period of the Net15 work shall be not less than five years. The Secretary 

16 may extend or make permanent the Network if the 

17 Network’s performance demonstrates benefit to the 

18 Medicare program. The Secretary may continue or 

19 make permanent any network project site if— 

20 (A)(i) the costs to the Medicare program 

21 resulting from activities carried out by such site 

22 pursuant to this section are not more than the 

23 costs to such program without application of 

24 this section; and 


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1 (ii) such activities result in improved qual2 ity of care furnished to Medicare beneficiaries 

3 who have two or more chronic illnesses; or 

4 (B) the costs to the Medicare program re5 sulting from activities carried out by such site 

6 pursuant to this section are less than the costs 

7 to such program without application of this sec8 tion. 

9 (b) PURPOSE AND DUTIES OF NETWORK.— 

10 (1) PURPOSE.—The purpose of the Network is 

11 to enable highly qualified health care organizations 

12 and universities to form a stable and flexible re13 search infrastructure that accelerates the develop14 ment and deployment of evidence-based chronic care 

15 management practices for Medicare beneficiaries 

16 with multiple, chronic conditions. 

17 (2) DUTIES OF THE NETWORK.— 

18 (A) IN GENERAL.—The Network shall de19 velop and evaluate evidence-based chronic care 

20 management practices for Medicare bene21 ficiaries who have two or more chronic illnesses, 

22 with a focus on such beneficiaries who are pro23 vided benefits under the Medicare fee-for-serv24 ice program and whose care is most costly. In 

25 carrying out its duties, the Network shall use 


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1 and build upon applicable interventions that 

2 have been proven successful through demonstra3 tions carried out by the Centers for Medicare & 

4 Medicaid Services, including the Medicare Co5 ordinated Care Demonstration project. 

6 (B) SPECIFIC DUTIES.—The Network 

7 shall— 

8 (i) research, design, implement, test, 

9 and validate specific interventions designed 

10 to improve care management for Medicare 

11 beneficiaries with multiple chronic condi12 tions; 

13 (ii) provide a reproducible, reliable, 

14 and scalable framework to standardize and 

15 translate best practices for all Medicare 

16 beneficiaries; and 

17 (iii) not later than 90 days after the 

18 date of the enactment of this Act, establish 

19 target enrollment numbers and capitated 

20 payment rates for care management inter21 ventions to be established for each Medi22 care Chronic Care Rapid Learning Net23 work site. 

24 (c) MEMBERSHIP.— 


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1 (1) INITIAL SITES.—The network shall initially 

2 consist of not less than 12 network project sites. 

3 Nothing in this Act prohibits more than 1 network 

4 project site from participating under this section to5 gether as a network. 

6 (2) ADDITIONAL SITES.—The Secretary may 

7 appoint network project sites, in addition to such 

8 initial sites under paragraph (1), to the network ei9 ther as standing members or in order to meet the 

10 goals of a specific project if such sites satisfy each 

11 of the characteristics described in subparagraph (B). 

12 (3) REQUIRED CHARACTERISTICS OF NET13 WORK.—The network shall collectively— 

14 (A) be a group of health care organiza15 tions, universities, or researchers and clinicians 

16 in health care organizations or universities ex17 perienced in research and direct delivery of care 

18 management services for Medicare beneficiaries;

19 (B) have previously participated in care co20 ordination projects, demonstrations, or research 

21 projects (or any combination of such projects); 

22 and 

23 (C) have demonstrated an existing ability 

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1 ment projects and share and analyze informa2 tion. 

3 (d) COORDINATING CENTER.—A Coordinating Cen4 ter shall be established to facilitate network communica5 tion, training of network project sites, and development 

6 and reporting of performance and implementation metrics. 

7 (e) ADVISORY BOARD.—The Network shall have an 

8 Advisory Board (in this section referred to as the 

9 ‘‘Board’’) composed of the following: 

10 (1) CMS ADMINISTRATOR.—The Administrator 

11 of the Centers for Medicare & Medicaid Services, 

12 who shall serve as chairman of the Board and head 

13 of the Network. 

14 (2) APPOINTED MEMBERS.— 

15 (A) INITIAL APPOINTMENTS.—Twelve indi16 viduals appointed by the Secretary to serve on 

17 the Board, including one individual representing 

18 each network site. 

19 (B) ADDITIONAL MEMBERS.—Any addi20 tional members to the Board, which the Sec21 retary may appoint, including representatives 

22 from other relevant Federal agencies, experts in 

23 the fields of quality improvement, public health, 

24 geriatrics, research methodology, health econo25 mists, and other individuals to the extent the 


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1 Secretary determines such additions further the 

2 work of the Network. 

3 (f) PROJECT EVALUATIONS.—The Board shall pro4 vide for both an internal and external evaluation of each 

5 Network project. Network members will receive timely and 

6 regular access to data for purposes of modifying, refining, 

7 and evaluating the project under study. 

8 (g) BIENNIAL REPORTS.— 

9 (1) CONGRESSIONAL REPORTS.—Beginning not 

10 later than 2 years after the date of the establish11 ment of the Network, the Secretary shall submit to 

12 the appropriate committees of Congress biennial re13 ports on the Network. 

14 (2) PUBLIC REPORTS ON CARE MODELS.— 

15 Every two years, the Network shall develop and the 

16 Secretary shall issue a public report of recommended 

17 practices and guidelines for chronic care that sum18 marizes the care models the Network has found to 

19 be most effective in managing Medicare beneficiaries 

20 with multiple, chronic problems. 

21 (h) WAIVER.—The Secretary shall waive such provi22 sions of title XVIII of the Social Security Act (42 U.S.C. 

23 1395 et seq.) as may be necessary for the Network to con24 duct activities under this section. 


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1 (i) FUNDING.—There are authorized to be appro2 priated from the Federal Hospital Insurance Trust Fund 

3 under section 1817 of the Social Security Act (42 U.S.C. 

4 1395i) and from the Federal Supplementary Medical In5 surance Trust Fund under section 1841 of such Act (42 

6 U.S.C. 1395t), in such proportions as the Secretary deter7 mines to be appropriate, $60,000,000 to carry out this 

8 section during the 5-year period beginning with fiscal year 

9 2010. 

10 (j) DEFINITIONS.—For purposes of this section: 

11 (1) MEDICARE PROGRAM.—The term ‘‘Medicare 

12 program’’ means the programs under title XVIII of 

13 the Social Security Act. 

14 (2) NETWORK PROJECT SITE.—The term ‘‘Net15 work project site’’ means the site of a chronic care 

16 management program conducted under the authority 

17 of the Network. 

Æ 


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