H. R. 3590—273 
‘‘(vii) Utilizing medication therapy management 
services, such as those described in section 935 of 
the Public Health Service Act. 
‘‘(viii) Establishing community-based health teams 
to support small-practice medical homes by assisting 
the primary care practitioner in chronic care manage-
ment, including patient self-management, activities. 
‘‘(ix) Assisting applicable individuals in making 
informed health care choices by paying providers of 
services and suppliers for using patient decision-sup-
port tools, including tools that meet the standards 
developed and identified under section 936(c)(2)(A) of 
the Public Health Service Act, that improve applicable 
individual and caregiver understanding of medical 
treatment options. 
‘‘(x) Allowing States to test and evaluate fully inte-
grating care for dual eligible individuals in the State, 
including the management and oversight of all funds 
under the applicable titles with respect to such individ-
uals. 
‘‘(xi) Allowing States to test and evaluate systems 
of all-payer payment reform for the medical care of 
residents of the State, including dual eligible individ-
uals. 
‘‘(xii) Aligning nationally recognized, evidence- 
based guidelines of cancer care with payment incen-
tives under title XVIII in the areas of treatment plan-
ning and follow-up care planning for applicable individ-
uals described in clause (i) or (iii) of subsection (a)(4)(A) 
with cancer, including the identification of gaps in 
applicable quality measures. 
‘‘(xiii) Improving post-acute care through con-
tinuing care hospitals that offer inpatient rehabilita-
tion, long-term care hospitals, and home health or 
skilled nursing care during an inpatient stay and the 
30 days immediately following discharge. 
‘‘(xiv) Funding home health providers who offer 
chronic care management services to applicable 
individuals in cooperation with interdisciplinary teams. 
‘‘(xv) Promoting improved quality and reduced cost 
by developing a collaborative of high-quality, low-cost 
health care institutions that is responsible for— 
‘‘(I) developing, documenting, and dissemi-
nating best practices and proven care methods; 
‘‘(II) implementing such best practices and 
proven care methods within such institutions to 
demonstrate further improvements in quality and 
efficiency; and 
‘‘(III) providing assistance to other health care 
institutions on how best to employ such best prac-
tices and proven care methods to improve health 
care quality and lower costs. 
‘‘(xvi) Facilitate inpatient care, including intensive 
care, of hospitalized applicable individuals at their local 
hospital through the use of electronic monitoring by 
specialists, including intensivists and critical care 
specialists, based at integrated health systems.
H. R. 3590—274 
‘‘(xvii) Promoting greater efficiencies and timely 
access to outpatient services (such as outpatient phys-
ical therapy services) through models that do not 
require a physician or other health professional to 
refer the service or be involved in establishing the 
plan of care for the service, when such service is fur-
nished by a health professional who has the authority 
to furnish the service under existing State law. 
‘‘(xviii) Establishing comprehensive payments to 
Healthcare Innovation Zones, consisting of groups of 
providers that include a teaching hospital, physicians, 
and other clinical entities, that, through their struc-
ture, operations, and joint-activity deliver a full spec-
trum of integrated and comprehensive health care serv-
ices to applicable individuals while also incorporating 
innovative methods for the clinical training of future 
health care professionals. 
‘‘(C) ADDITIONAL
FACTORS
FOR
CONSIDERATION.—In 
selecting models for testing under subparagraph (A), the 
CMI may consider the following additional factors: 
‘‘(i) Whether the model includes a regular process 
for monitoring and updating patient care plans in a 
manner that is consistent with the needs and pref-
erences of applicable individuals. 
‘‘(ii) Whether the model places the applicable indi-
vidual, including family members and other informal 
caregivers of the applicable individual, at the center 
of the care team of the applicable individual. 
‘‘(iii) Whether the model provides for in-person 
contact with applicable individuals. 
‘‘(iv) Whether the model utilizes technology, such 
as electronic health records and patient-based remote 
monitoring systems, to coordinate care over time and 
across settings. 
‘‘(v) Whether the model provides for the mainte-
nance of a close relationship between care coordinators, 
primary 
care 
practitioners, 
specialist 
physicians, 
community-based organizations, and other providers 
of services and suppliers. 
‘‘(vi) Whether the model relies on a team-based 
approach to interventions, such as comprehensive care 
assessments, care planning, and self-management 
coaching. 
‘‘(vii) Whether, under the model, providers of serv-
ices and suppliers are able to share information with 
patients, caregivers, and other providers of services 
and suppliers on a real time basis. 
‘‘(3) BUDGET NEUTRALITY.— 
‘‘(A) INITIAL PERIOD.—The Secretary shall not require, 
as a condition for testing a model under paragraph (1), 
that the design of such model ensure that such model 
is budget neutral initially with respect to expenditures 
under the applicable title. 
‘‘(B) TERMINATION
OR
MODIFICATION.—The Secretary 
shall terminate or modify the design and implementation 
of a model unless the Secretary determines (and the Chief 
Actuary of the Centers for Medicare & Medicaid Services,
H. R. 3590—275 
with respect to program spending under the applicable 
title, certifies), after testing has begun, that the model 
is expected to— 
‘‘(i) improve the quality of care (as determined 
by the Administrator of the Centers for Medicare & 
Medicaid Services) without increasing spending under 
the applicable title; 
‘‘(ii) reduce spending under the applicable title 
without reducing the quality of care; or 
‘‘(iii) improve the quality of care and reduce 
spending. 
Such termination may occur at any time after such testing 
has begun and before completion of the testing. 
‘‘(4) EVALUATION.— 
‘‘(A) IN
GENERAL.—The Secretary shall conduct an 
evaluation of each model tested under this subsection. Such 
evaluation shall include an analysis of— 
‘‘(i) the quality of care furnished under the model, 
including the measurement of patient-level outcomes 
and patient-centeredness criteria determined appro-
priate by the Secretary; and 
‘‘(ii) the changes in spending under the applicable 
titles by reason of the model. 
‘‘(B) INFORMATION.—The Secretary shall make the 
results of each evaluation under this paragraph available 
to the public in a timely fashion and may establish require-
ments for States and other entities participating in the 
testing of models under this section to collect and report 
information that the Secretary determines is necessary to 
monitor and evaluate such models. 
‘‘(c) EXPANSION OF MODELS (PHASE II).—Taking into account 
the evaluation under subsection (b)(4), the Secretary may, through 
rulemaking, expand (including implementation on a nationwide 
basis) the duration and the scope of a model that is being tested 
under subsection (b) or a demonstration project under section 
1866C, to the extent determined appropriate by the Secretary, 
if— 
‘‘(1) the Secretary determines that such expansion is 
expected to— 
‘‘(A) reduce spending under applicable title without 
reducing the quality of care; or 
‘‘(B) improve the quality of care and reduce spending; 
and 
‘‘(2) the Chief Actuary of the Centers for Medicare & Med-
icaid Services certifies that such expansion would reduce pro-
gram spending under applicable titles. 
‘‘(d) IMPLEMENTATION.— 
‘‘(1) WAIVER AUTHORITY.—The Secretary may waive such 
requirements of titles XI and XVIII and of sections 1902(a)(1), 
1902(a)(13), and 1903(m)(2)(A)(iii) as may be necessary solely 
for purposes of carrying out this section with respect to testing 
models described in subsection (b). 
‘‘(2) LIMITATIONS ON REVIEW.—There shall be no adminis-
trative or judicial review under section 1869, section 1878, 
or otherwise of— 
‘‘(A) the selection of models for testing or expansion 
under this section;
H. R. 3590—276 
‘‘(B) the selection of organizations, sites, or participants 
to test those models selected; 
‘‘(C) the elements, parameters, scope, and duration of 
such models for testing or dissemination; 
‘‘(D) determinations regarding budget neutrality under 
subsection (b)(3); 
‘‘(E) the termination or modification of the design and 
implementation of a model under subsection (b)(3)(B); and 
‘‘(F) determinations about expansion of the duration 
and scope of a model under subsection (c), including the 
determination that a model is not expected to meet criteria 
described in paragraph (1) or (2) of such subsection. 
‘‘(3) ADMINISTRATION.—Chapter 35 of title 44, United States 
Code, shall not apply to the testing and evaluation of models 
or expansion of such models under this section. 
‘‘(e) APPLICATION TO CHIP.—The Center may carry out activi-
ties under this section with respect to title XXI in the same manner 
as provided under this section with respect to the program under 
the applicable titles. 
‘‘(f) FUNDING.— 
‘‘(1) IN GENERAL.—There are appropriated, from amounts 
in the Treasury not otherwise appropriated— 
‘‘(A) $5,000,000 for the design, implementation, and 
evaluation of models under subsection (b) for fiscal year 
2010; 
‘‘(B) $10,000,000,000 for the activities initiated under 
this section for the period of fiscal years 2011 through 
2019; and 
‘‘(C) the amount described in subparagraph (B) for 
the activities initiated under this section for each subse-
quent 10-year fiscal period (beginning with the 10-year 
fiscal period beginning with fiscal year 2020). 
Amounts appropriated under the preceding sentence shall 
remain available until expended. 
‘‘(2) USE OF CERTAIN FUNDS.—Out of amounts appropriated 
under subparagraphs (B) and (C) of paragraph (1), not less 
than $25,000,000 shall be made available each such fiscal year 
to design, implement, and evaluate models under subsection 
(b). 
‘‘(g) REPORT TO CONGRESS.—Beginning in 2012, and not less 
than once every other year thereafter, the Secretary shall submit 
to Congress a report on activities under this section. Each such 
report shall describe the models tested under subsection (b), 
including the number of individuals described in subsection 
(a)(4)(A)(i) and of individuals described in subsection (a)(4)(A)(ii) 
participating in such models and payments made under applicable 
titles for services on behalf of such individuals, any models chosen 
for expansion under subsection (c), and the results from evaluations 
under subsection (b)(4). In addition, each such report shall provide 
such recommendations as the Secretary determines are appropriate 
for legislative action to facilitate the development and expansion 
of successful payment models.’’. 
(b) MEDICAID CONFORMING AMENDMENT.—Section 1902(a) of 
the Social Security Act (42 U.S.C. 1396a(a)), as amended by section 
8002(b), is amended— 
(1) in paragraph (81), by striking ‘‘and’’ at the end;