(B) CONFORMING AMENDMENTS.—Section 
1833(a)(2) of the Social Security Act (42 
U.S.C. 1395l(a)(2)) is amended— 
(i) in subparagraph (G)(ii), by strik-
ing ‘‘and’’ after the semicolon 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 manage-
ment 
services 
(as 
defined 
in 
section 
1861(ccc)(1)) furnished by an outpatient de-
partment of a hospital, the amount determined 
under section 1834(n),’’. 
(4) ELIMINATION
OF
DEDUCTIBLE.—Section 
1833(b)(7) of the Social Security Act (42 U.S.C. 
1395l(b)(7)), as added by section 3(c)(4), is amend-
ed by inserting ‘‘or chronic care management serv-
ices (as defined in section 1861(ccc)(1))’’ after 
‘‘geriatric assessments (as defined in section 
1861(bbb)(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(ccc)(2)) that is not a physician.’’. 
(e) EXCEPTION TO LIMITS ON PHYSICIAN REFER-
RALS.—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
MANAGEMENT
SERVICES.—In the case of a 
designated health service, if the designated health 
service is— 
‘‘(A) a geriatric assessment or a chronic 
care management service (as defined in sub-
sections (bbb)(1) or (ccc)(1) of section 1861, 
respectively); and 
‘‘(B) provided by a physician or a chronic 
care 
manager 
(as 
defined 
in 
section 
1861(ccc)(2)).’’. 
(f) RULEMAKING.—The Secretary of Health and 
Human Services shall define such terms and establish 
such procedures as the Secretary determines necessary to 
implement the provisions of this section. 
(g) EFFECTIVE DATE.—The amendments made by 
this section shall apply to assessments and chronic care
management services furnished on or after January 1, 
2005. 
SEC. 5. STUDY AND REPORT ON BEST PRACTICES FOR 
MEDICARE CHRONIC CARE MANAGEMENT. 
(a) STUDY.—The Secretary, in consultation with the 
Medicare Payment Advisory Commission, shall conduct a 
thorough study of the following issues: 
(1) The effectiveness of the different payment 
methodologies applicable with respect to chronic care 
management services developed and implemented 
under section 1834(n)(2) of the Social Security Act 
(as added by section 4(c)(2)). 
(2) The effectiveness of pay-for-performance 
programs to serve medicare beneficiaries with mul-
tiple chronic conditions, including dementia. 
(3) Process measures and outcomes for medi-
care beneficiaries with multiple chronic illnesses, in-
cluding dementia. 
(4) The cost-effectiveness and quality associated 
with chronic care management under the medicare 
program. 
(5) The feasibility of broadening and incor-
porating the findings of the Assessing Care of Vul-
nerable Elders (ACOVE) study into the medicare 
program.
(b) REPORT.—Not later than the date that is 1 year 
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 practices for 
chronic care management of the conditions of medi-
care beneficiaries with multiple chronic conditions, 
including dementia; and 
(2) such other recommendations for legislation 
or administrative action as the Secretary determines 
appropriate. 
Æ