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 bene-
ficiaries with multiple chronic conditions. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 24, 2009 
Mr. JOHNSON of Illinois (for himself, Ms. SCHWARTZ, Mr. PATRICK J. MUR-
PHY 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 subse-
quently 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 Net-
work to develop and apply improved practices in care 
management for Medicare beneficiaries with multiple 
chronic conditions. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Chronic Care 
Rapid Learning Network (MCCRLN) Act of 2009’’. 
VerDate Nov 24 2008 
07:48 Jul 25, 2009
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H3340.IH
H3340
cprice-sewell on DSK89S0YB1PROD with BILLS
SEC. 2. FINDINGS. 
The Congress makes the following findings: 
(1) Two-thirds of all Medicare spending involves 
beneficiaries living with 5 or more chronic condi-
tions. 
(2) Eighty-four percent of people ages 65 to 70 
live with at least one of the following chronic condi-
tions: hypertension, heart disease or heart attack, 
cancer, diabetes, arthritis, or high cholesterol. 
(3) Medicare beneficiaries with chronic condi-
tions are more likely to undergo duplicative tests, re-
ceive contradictory information from their health 
care providers, experience adverse responses to medi-
cations, and undergo hospital visits that could have 
been prevented. 
(4) Both traditional fee-for-service Medicare 
and Medicare Advantage are not currently config-
ured to meet the unique needs of beneficiaries living 
with multiple chronic conditions. 
(5) Care for these patients is typically frag-
mented and delivered by multiple providers working 
at multiple sites. 
(6) Medicare has implemented a number of 
demonstration projects focused on ways to improve 
care for beneficiaries with multiple chronic condi-
tions, yet there has been limited translation of evi-
VerDate Nov 24 2008 
07:48 Jul 25, 2009
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H3340.IH
H3340
cprice-sewell on DSK89S0YB1PROD with BILLS
dence-based results to the wider chronic care com-
munity in a timely manner. 
(7) Using evidence-based approaches to care co-
ordination and care management have shown prom-
ise in reducing illness burden and improving health 
for at-risk patients, but the evidence is not easy to 
consistently translate into practice. 
(8) As the population of Medicare beneficiaries 
living with multiple chronic conditions continues to 
increase, the Centers for Medicare & Medicaid Serv-
ices should seek more effective actions to test var-
ious care models, analyze the outcomes, and imple-
ment evidence-based best practices as soon as pos-
sible. 
(9) The United States Government should part-
ner with qualified and experienced health care insti-
tutions and universities already serving these bene-
ficiaries to effectively and efficiently develop, evalu-
ate, and translate improvements in coordinated care 
for them. Generating this information and sup-
porting its translation into clinical practice will serve 
beneficiaries far more effectively. 
VerDate Nov 24 2008 
07:48 Jul 25, 2009
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H3340.IH
H3340
cprice-sewell on DSK89S0YB1PROD with BILLS
SEC. 3. MEDICARE CHRONIC CARE RAPID LEARNING NET-
WORK TO DEVELOP AND APPLY IMPROVED 
PRACTICES IN COORDINATED CARE FOR 
MEDICARE BENEFICIARIES WITH MULTIPLE, 
CHRONIC CONDITIONS. 
(a) ESTABLISHMENT.— 
(1) IN GENERAL.—Not later than 60 days after 
the date of the enactment of this Act, the Secretary 
of Health and Human Services (in this section re-
ferred to as the ‘‘Secretary’’) shall establish in ac-
cordance with this section a Medicare Chronic Care 
Rapid Learning Network (in this section referred to 
as the ‘‘Network’’). 
(2) DURATION.—The initial period of the Net-
work shall be not less than five years. The Secretary 
may extend or make permanent the Network if the 
Network’s performance demonstrates benefit to the 
Medicare program. The Secretary may continue or 
make permanent any network project site if— 
(A)(i) the costs to the Medicare program 
resulting from activities carried out by such site 
pursuant to this section are not more than the 
costs to such program without application of 
this section; and 
VerDate Nov 24 2008 
07:48 Jul 25, 2009
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H3340.IH
H3340
cprice-sewell on DSK89S0YB1PROD with BILLS
(ii) such activities result in improved qual-
ity of care furnished to Medicare beneficiaries 
who have two or more chronic illnesses; or 
(B) the costs to the Medicare program re-
sulting from activities carried out by such site 
pursuant to this section are less than the costs 
to such program without application of this sec-
tion. 
(b) PURPOSE AND DUTIES OF NETWORK.— 
(1) PURPOSE.—The purpose of the Network is 
to enable highly qualified health care organizations 
and universities to form a stable and flexible re-
search infrastructure that accelerates the develop-
ment and deployment of evidence-based chronic care 
management practices for Medicare beneficiaries 
with multiple, chronic conditions. 
(2) DUTIES OF THE NETWORK.— 
(A) IN GENERAL.—The Network shall de-
velop and evaluate evidence-based chronic care 
management practices for Medicare bene-
ficiaries who have two or more chronic illnesses, 
with a focus on such beneficiaries who are pro-
vided benefits under the Medicare fee-for-serv-
ice program and whose care is most costly. In 
carrying out its duties, the Network shall use 
VerDate Nov 24 2008 
07:48 Jul 25, 2009
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H3340.IH
H3340
cprice-sewell on DSK89S0YB1PROD with BILLS
and build upon applicable interventions that 
have been proven successful through demonstra-
tions carried out by the Centers for Medicare & 
Medicaid Services, including the Medicare Co-
ordinated Care Demonstration project. 
(B) 
SPECIFIC
DUTIES.—The 
Network 
shall— 
(i) research, design, implement, test, 
and validate specific interventions designed 
to improve care management for Medicare 
beneficiaries with multiple chronic condi-
tions; 
(ii) provide a reproducible, reliable, 
and scalable framework to standardize and 
translate best practices for all Medicare 
beneficiaries; and 
(iii) not later than 90 days after the 
date of the enactment of this Act, establish 
target enrollment numbers and capitated 
payment rates for care management inter-
ventions to be established for each Medi-
care Chronic Care Rapid Learning Net-
work site. 
(c) MEMBERSHIP.— 
VerDate Nov 24 2008 
07:48 Jul 25, 2009
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H3340.IH
H3340
cprice-sewell on DSK89S0YB1PROD with BILLS
(1) INITIAL SITES.—The network shall initially 
consist of not less than 12 network project sites. 
Nothing in this Act prohibits more than 1 network 
project site from participating under this section to-
gether as a network. 
(2) ADDITIONAL
SITES.—The Secretary may 
appoint network project sites, in addition to such 
initial sites under paragraph (1), to the network ei-
ther as standing members or in order to meet the 
goals of a specific project if such sites satisfy each 
of the characteristics described in subparagraph (B). 
(3) REQUIRED
CHARACTERISTICS
OF
NET-
WORK.—The network shall collectively— 
(A) be a group of health care organiza-
tions, universities, or researchers and clinicians 
in health care organizations or universities ex-
perienced in research and direct delivery of care 
management services for Medicare beneficiaries;
(B) have previously participated in care co-
ordination projects, demonstrations, or research 
projects (or any combination of such projects); 
and 
(C) have demonstrated an existing ability 
to interact with each other to design and imple-
VerDate Nov 24 2008 
07:48 Jul 25, 2009
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H3340.IH
H3340
cprice-sewell on DSK89S0YB1PROD with BILLS
ment projects and share and analyze informa-
tion. 
(d) COORDINATING CENTER.—A Coordinating Cen-
ter shall be established to facilitate network communica-
tion, training of network project sites, and development 
and reporting of performance and implementation metrics. 
(e) ADVISORY BOARD.—The Network shall have an 
Advisory Board (in this section referred to as the 
‘‘Board’’) composed of the following: 
(1) CMS ADMINISTRATOR.—The Administrator 
of the Centers for Medicare & Medicaid Services, 
who shall serve as chairman of the Board and head 
of the Network. 
(2) APPOINTED MEMBERS.— 
(A) INITIAL APPOINTMENTS.—Twelve indi-
viduals appointed by the Secretary to serve on 
the Board, including one individual representing 
each network site. 
(B) ADDITIONAL
MEMBERS.—Any addi-
tional members to the Board, which the Sec-
retary may appoint, including representatives 
from other relevant Federal agencies, experts in 
the fields of quality improvement, public health, 
geriatrics, research methodology, health econo-
mists, and other individuals to the extent the 
VerDate Nov 24 2008 
07:48 Jul 25, 2009
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H3340.IH
H3340
cprice-sewell on DSK89S0YB1PROD with BILLS
Secretary determines such additions further the 
work of the Network. 
(f) PROJECT EVALUATIONS.—The Board shall pro-
vide for both an internal and external evaluation of each 
Network project. Network members will receive timely and 
regular access to data for purposes of modifying, refining, 
and evaluating the project under study. 
(g) BIENNIAL REPORTS.— 
(1) CONGRESSIONAL REPORTS.—Beginning not 
later than 2 years after the date of the establish-
ment of the Network, the Secretary shall submit to 
the appropriate committees of Congress biennial re-
ports on the Network. 
(2) PUBLIC
REPORTS
ON
CARE
MODELS.— 
Every two years, the Network shall develop and the 
Secretary shall issue a public report of recommended 
practices and guidelines for chronic care that sum-
marizes the care models the Network has found to 
be most effective in managing Medicare beneficiaries 
with multiple, chronic problems. 
(h) WAIVER.—The Secretary shall waive such provi-
sions of title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) as may be necessary for the Network to con-
duct activities under this section. 
VerDate Nov 24 2008 
07:48 Jul 25, 2009
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H3340.IH
H3340
cprice-sewell on DSK89S0YB1PROD with BILLS
(i) FUNDING.—There are authorized to be appro-
priated from the Federal Hospital Insurance Trust Fund 
under section 1817 of the Social Security Act (42 U.S.C. 
1395i) and from the Federal Supplementary Medical In-
surance Trust Fund under section 1841 of such Act (42 
U.S.C. 1395t), in such proportions as the Secretary deter-
mines to be appropriate, $60,000,000 to carry out this 
section during the 5-year period beginning with fiscal year 
2010. 
(j) DEFINITIONS.—For purposes of this section: 
(1) MEDICARE PROGRAM.—The term ‘‘Medicare 
program’’ means the programs under title XVIII of 
the Social Security Act. 
(2) NETWORK PROJECT SITE.—The term ‘‘Net-
work project site’’ means the site of a chronic care 
management program conducted under the authority 
of the Network. 
Æ 
VerDate Nov 24 2008 
07:48 Jul 25, 2009
Jkt 079200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6301
E:\BILLS\H3340.IH
H3340
cprice-sewell on DSK89S0YB1PROD with BILLS