I
107TH CONGRESS
1ST SESSION
H. R. 3188
To amend title XVIII of the Social Security Act to expand Medicare benefits
to prevent, delay, and minimize the progression of chronic conditions,
establish payment incentives for furnishing quality services to people
with serious and disabling chronic conditions, and develop national poli-
cies on effective chronic condition care, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
OCTOBER 30, 2001
Mr. STARK (for himself, Mr. MCNULTY, Ms. ESHOO, Mr. WYNN, Mr. FRANK,
Ms. ROYBAL-ALLARD, Ms. SCHAKOWSKY, Mr. MCGOVERN, Mr. BRADY of
Pennsylvania, Mr. KUCINICH, and Mr. HINCHEY) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committees on Ways and Means, and
Rules, 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 amend title XVIII of the Social Security Act to expand
Medicare benefits to prevent, delay, and minimize the
progression of chronic conditions, establish payment in-
centives for furnishing quality services to people with
serious and disabling chronic conditions, and develop na-
tional policies on effective chronic condition care, and
for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Medicare Chronic Care Improvement Act of 2001’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
TITLE I—EXPANSION OF BENEFITS TO PREVENT, DELAY, AND
MINIMIZE THE PROGRESSION OF CHRONIC CONDITIONS.
Subtitle A—Improving Access to Preventive Services
Sec. 101. Definitions.
Sec. 102. Elimination of deductibles and coinsurance for existing preventive
health benefits.
Sec. 103. Institute of Medicine medicare prevention benefit study and report.
Sec. 104. Authority to administratively provide for coverage of additional pre-
ventive benefits.
Sec. 105. Fast-track consideration of prevention benefit legislation.
Subtitle B—Expansion of Access to Health Promotion Services
Sec. 111. Disease self-management demonstration projects.
Sec. 112. Medicare health education and risk appraisal program.
Subtitle C—Medicare Coverage for Care Coordination and Assessment
Services
Sec. 121. Care coordination and assessment services.
TITLE II—PAYMENT INCENTIVES FOR QUALITY CARE FOR INDI-
VIDUALS WITH SERIOUS AND DISABLING CHRONIC CONDI-
TIONS
Sec. 201. Adjustments to fee-for-service payment systems.
Sec. 202. Medicare+Choice.
TITLE III—DEVELOPMENT OF NATIONAL POLICIES ON
EFFECTIVE CHRONIC CONDITION CARE
Sec. 301. Study and report on effective chronic condition care.
Sec. 302. Institute of Medicine medicare chronic condition care improvement
study and report.
SEC. 2. DEFINITIONS.
In this Act:
(1) SECRETARY.—Unless otherwise specifically
provided, the term ‘‘Secretary’’ means the Secretary
of Health and Human Services.
(2) SERIOUS AND DISABLING CHRONIC CONDI-
TION.—The term ‘‘serious and disabling chronic con-
dition’’ means, with respect to an individual, that
the individual has at least one physical or mental
condition and a licensed health care practitioner has
certified within the preceding 12-month period
that—
(A) the individual has a level of disability
such that the individual is unable to perform
(without substantial assistance from another in-
dividual) for a period of at least 90 days due
to a loss of functional capacity—
(i) at least 2 activities of daily living;
or
(ii) such number of instrumental ac-
tivities of daily living that is equivalent (as
determined by the Secretary) to the level
of disability described in clause (i);
(B) the individual has a level of disability
equivalent (as determined by the Secretary) to
the level of disability described in subparagraph
(A); or
(C) the individual requires substantial su-
pervision to protect the individual from threats
to health and safety due to severe cognitive im-
pairment.
(3) ACTIVITIES OF DAILY LIVING.—The term
‘‘activities of daily living’’ means each of the fol-
lowing:
(A) Eating.
(B) Toileting.
(C) Transferring.
(D) Bathing.
(E) Dressing.
(F) Continence.
(4) INSTRUMENTAL ACTIVITIES OF DAILY LIV-
ING.—The term ‘‘instrumental activities of daily liv-
ing’’ means each of the following:
(A) Medication management.
(B) Meal preparation.
(C) Shopping.
(D) Housekeeping.
(E) Laundry.
(F) Money management.
(G) Telephone use.
(H) Transportation use.
TITLE I—EXPANSION OF BENE-
FITS TO PREVENT, DELAY,
AND 
MINIMIZE 
THE 
PRO-
GRESSION OF CHRONIC CON-
DITIONS.
Subtitle A—Improving Access to
Preventive Services
SEC. 101. DEFINITIONS.
In this title:
(1) 
COST-EFFECTIVE
BENEFIT.—The 
term
‘‘cost-effective benefit’’ means a benefit or technique
that has—
(A) been subject to peer review;
(B) been described in scientific journals;
and
(C) demonstrated value as measured by
unit costs relative to health outcomes achieved.
(2) COST-SAVING BENEFIT.—The term ‘‘cost-
saving benefit’’ means a benefit or technique that
has—
(A) been subject to peer review;
(B) been described in scientific journals;
and
(C) caused a net reduction in health care
costs for medicare beneficiaries.
(3) MEDICALLY EFFECTIVE.—The term ‘‘medi-
cally effective’’ means, with respect to a benefit or
technique, that the benefit or technique has been—
(A) subject to peer review;
(B) described in scientific journals; and
(C) determined to achieve an intended goal
under normal programmatic conditions.
(4) 
MEDICALLY
EFFICACIOUS.—The 
term
‘‘medically efficacious’’ means, with respect to a ben-
efit or technique, that the benefit or technique has
been—
(A) subject to peer review;
(B) described in scientific journals; and
(C) determined to achieve an intended goal
under controlled conditions.
SEC. 102. ELIMINATION OF DEDUCTIBLES AND COINSUR-
ANCE FOR EXISTING PREVENTIVE HEALTH
BENEFITS.
(a) IN GENERAL.—Section 1833 of the Social Secu-
rity Act (42 U.S.C. 1395l) is amended by inserting after
subsection (o) the following new subsection:
‘‘(p) DEDUCTIBLES AND COINSURANCE WAIVED FOR
PREVENTIVE HEALTH ITEMS AND SERVICES.—The Sec-
retary shall not require the payment of any deductible or
coinsurance under subsection (a) or (b), respectively, of
any individual enrolled for coverage under this part for
any of the following preventive health items and services:
‘‘(1) Blood-testing strips, lancets, and blood
glucose monitors for individuals with diabetes de-
scribed in section 1861(n).
‘‘(2) 
Diabetes 
outpatient 
self-management
training services (as defined in section 1861(qq)(1)).
‘‘(3) Pneumococcal, influenza, and hepatitis B
vaccines and administration described in section
1861(s)(10).
‘‘(4) Screening mammography (as defined in
section 1861(jj)).
‘‘(5) Screening pap smear and screening pelvic
exam (as defined in paragraphs (1) and (2) of sec-
tion 1861(nn), respectively).
‘‘(6) Bone mass measurement (as defined in
section 1861(rr)(1)).
‘‘(7) Prostate cancer screening test (as defined
in section 1861(oo)(1)).
‘‘(8) Colorectal cancer screening test (as de-
fined in section 1861(pp)(1)).
‘‘(9) Screening for glaucoma (as defined in sec-
tion 1861(uu)).
‘‘(10) Medical nutrition therapy services (as de-
fined in section 1861(vv)(1)).’’.
(b) WAIVER OF COINSURANCE.—
(1) IN GENERAL.—Section 1833(a)(1)(B) of the
Social Security Act (42 U.S.C. 1395l(a)(1)(B)) is
amended to read as follows: ‘‘(B) with respect to
preventive health items and services described in
subsection (p), the amounts paid shall be 100 per-
cent of the fee schedule or other basis of payment
under this title for the particular item or service,’’.
(2) ELIMINATION
OF
COINSURANCE
IN
OUT-
PATIENT HOSPITAL SETTINGS.—The third sentence
of section 1866(a)(2)(A) of the Social Security Act
(42 U.S.C. 1395cc(a)(2)(A)) is amended by insert-
ing after ‘‘1861(s)(10)(A)’’ the following: ‘‘, preven-
tive health items and services described in section
1833(p),’’.
(c) WAIVER OF APPLICATION OF DEDUCTIBLE.—
Section 1833(b)(1) of the Social Security Act (42 U.S.C.
1395l(b)(1)) is amended to read as follows: ‘‘(1) such de-
ductible shall not apply with respect to preventive health
items and services described in subsection (p),’’.
(d) ADDING ‘‘LANCET’’ TO DEFINITION OF DME.—
Section 1861(n) of the Social Security Act (42 U.S.C.
1395x(n)) is amended by striking ‘‘blood-testing strips
and blood glucose monitors’’ and inserting ‘‘blood-testing
strips, lancets, and blood glucose monitors’’.
(e) CONFORMING AMENDMENTS.—
(1) ELIMINATION OF COINSURANCE FOR CLIN-
ICAL DIAGNOSTIC LABORATORY TESTS.—Paragraphs
(1)(D)(i) and (2)(D)(i) of section 1833(a) of the So-
cial Security Act (42 U.S.C. 1395l(a)), as amended
by section 201(b)(1) of the Medicare, Medicaid, and
SCHIP Benefits Improvement and Protection Act of
2000 (114 Stat. 2763A–481), as enacted into law by
section 1(a)(6) of Public Law 106–554, are each
amended by inserting ‘‘or which are described in
subsection (p)’’ after ‘‘assignment-related basis’’.
(2) ELIMINATION OF COINSURANCE FOR CER-
TAIN DME.—Section 1834(a)(1)(A) of the Social Se-
curity Act (42 U.S.C. 1395m(a)(1)(A)) is amended
by inserting ‘‘(or 100 percent, in the case of such an
item described in section 1833(p))’’ after ‘‘80 per-
cent’’.
(3) ELIMINATION OF DEDUCTIBLES AND COIN-
SURANCE
FOR
COLORECTAL
CANCER
SCREENING
TESTS.—Section 1834(d) of the Social Security Act
(42 U.S.C. 1395m(d)) is amended—
(A) in paragraph (2)(C)—
(i) by striking ‘‘(C) FACILITY
PAY-
MENT
LIMIT.—’’ and all that follows
through 
‘‘Notwithstanding 
subsections’’
and inserting the following:
‘‘(C) FACILITY PAYMENT LIMIT.—Notwith-
standing subsections’’;
(ii) by striking ‘‘(I) in accordance’’
and inserting the following:
‘‘(i) in accordance’’;
(iii) by striking ‘‘(II) are performed’’
and all that follows through ‘‘payment
under’’ and inserting the following:
‘‘(ii) are performed in an ambulatory
surgical center or hospital outpatient de-
partment,
payment under’’; and
(iv) by striking clause (ii); and
(B) in paragraph (3)(C)—
(i) by striking ‘‘(C) FACILITY
PAY-
MENT
LIMIT.—’’ and all that follows
through 
‘‘Notwithstanding 
subsections’’
and inserting the following:
‘‘(C) FACILITY PAYMENT LIMIT.—Notwith-
standing subsections’’; and
(ii) by striking clause (ii).
(f) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
the day that is 1 year after the date of enactment of this
Act.
SEC. 103. INSTITUTE OF MEDICINE MEDICARE PREVEN-
TION BENEFIT STUDY AND REPORT.
(a) STUDY.—
(1) IN GENERAL.—The Secretary shall contract
with the Institute of Medicine of the National Acad-
emy of Sciences to—
(A) conduct a comprehensive study of cur-
rent literature and best practices in the field of
health promotion and disease prevention among
medicare beneficiaries, including the issues de-
scribed in paragraph (2); and
(B) submit the report described in sub-
section (b).
(2) ISSUES
STUDIED.—The study required
under paragraph (1) shall include an assessment
of—
(A) whether each health promotion and
disease prevention benefit covered under the
medicare program is—
(i) medically effective (as defined in
section 101(3)); or
(ii) a cost-effective benefit (as defined
in section 101(1)) or a cost-saving benefit
(as defined in section 101(2));
(B) utilization by medicare beneficiaries of
such benefits (including any barriers to or in-
centives to increase utilization);
(C) quality of life issues associated with
such benefits; and
(D) whether health promotion and disease
prevention benefits that are not covered under
the medicare program that would affect all
medicare beneficiaries are—
(i) likely to be medically effective (as
defined in section 101(3)); or
(ii) likely to be a cost-effective benefit
(as defined in section 101(1)) or a cost-
saving benefit (as defined in section
101(2));
(b) REPORTS.—
(1) THREE-YEAR REPORT.—On the date that is
3 years after the date of enactment of this Act, and
each successive 3-year anniversary thereafter, the
Institute of Medicine of the National Academy of
Sciences shall submit to the President a report that
contains—
(A) a detailed statement of the findings
and conclusions of the study conducted under
subsection (a); and
(B) the recommendations for legislation
described in paragraph (3).
(2) INTERIM REPORT BASED ON NEW GUIDE-
LINES.—If the United States Preventive Services
Task Force or the Task Force on Community Pre-
ventive Services establishes new guidelines regarding
preventive health benefits for medicare beneficiaries
more than 1 year prior to the date that a report de-
scribed in paragraph (1) is due to be submitted to
the President, then not later than 6 months after
the date such new guidelines are established, the In-
stitute of Medicine of the National Academy of
Sciences shall submit to the President a report that
contains a detailed description of such new guide-
lines. Such report may also contain recommenda-
tions for legislation described in paragraph (3).
(3) RECOMMENDATIONS
FOR
LEGISLATION.—
The Institute of Medicine of the National Academy
of Sciences, in consultation with the United States
Preventive Services Task Force and the Task Force
on Community Preventive Services, shall develop
recommendations in legislative form that—
(A) prioritize the preventive health benefits
under the medicare program; and
(B) modify such benefits, including adding
new benefits under such program, based on the
study conducted under subsection (a).
(c) TRANSMISSION TO CONGRESS.—
(1) IN GENERAL.—Subject to paragraph (2), on
the day that is 6 months after the date on which the
report described in paragraph (1) of subsection (b)
(or paragraph (2) of such subsection if the report
contains recommendations in legislative form de-
scribed in subsection (b)(3)) is submitted to the
President, the President shall transmit the report
and recommendations to Congress.
(2) REGULATORY ACTION BY THE SECRETARY
OF
HEALTH
AND
HUMAN
SERVICES.—If the Sec-
retary of Health and Human Services has exercised
the authority under section 104(a) to adopt by regu-
lation one or more of the recommendations under
subsection (b)(3), the President shall only submit to
Congress those recommendations under subsection
(b)(3) that have not been adopted by the Secretary.
(3) DELIVERY.—Copies of the report and rec-
ommendations in legislative form required to be
transmitted to Congress under paragraph (1) shall
be delivered—
(A) to both Houses of Congress on the
same day;
(B) to the Clerk of the House of Rep-
resentatives if the House is not in session; and
(C) to the Secretary of the Senate if the
Senate is not in session.
SEC. 104. AUTHORITY TO ADMINISTRATIVELY PROVIDE
FOR COVERAGE OF ADDITIONAL PREVEN-
TIVE BENEFITS.
(a) IN GENERAL.—The Secretary of Health and
Human Services may by regulation adopt any or all of
the legislative recommendations developed by the Institute
of Medicine of the National Academy of Sciences, in con-
sultation with the United States Preventive Services Task
Force and the Task Force on Community Preventive Serv-
ices in a report under section 103(b)(3) (relating to
prioritizing and modifying preventive health benefits
under the medicare program and the addition of new pre-
ventive benefits), consistent with subsection (b).
(b) ELIMINATION OF COST-SHARING.—With respect
to items and services furnished under the medicare pro-
gram that the Secretary has incorporated by regulation
under subsection (a), the provisions of section 1833(p) of
the Social Security Act (relating to elimination of cost-
sharing for preventive benefits), as added by section
102(a), shall apply to those items and services in the same
manner as such section applies to the items and services
described in paragraphs (1) through (10) of such section.
(c) DEADLINE.—The Secretary must publish a notice
of rulemaking with respect to the adoption by regulation
under subsection (a) of any such recommendation within
6 months of the date on which a report described in sec-
tion 103(b) is submitted to the President.
SEC. 105. FAST-TRACK CONSIDERATION OF PREVENTION
BENEFIT LEGISLATION.
(a) RULES OF HOUSE OF REPRESENTATIVES AND
SENATE.—This section is enacted by Congress—
(1) as an exercise of the rulemaking power of
the House of Representatives and the Senate, re-
spectively, and is deemed a part of the rules of each
House of Congress, but—
(A) is applicable only with respect to the
procedure to be followed in that House of Con-
gress in the case of an implementing bill (as de-
fined in subsection (d)); and
(B) supersedes other rules only to the ex-
tent that such rules are inconsistent with this
section; and
(2) with full recognition of the constitutional
right of either House of Congress to change the
rules (so far as relating to the procedure of that
House of Congress) at any time, in the same man-
ner and to the same extent as in the case of any
other rule of that House of Congress.
(b) INTRODUCTION AND REFERRAL.—
(1) INTRODUCTION.—
(A) IN GENERAL.—Subject to paragraph
(2), on the day on which the President trans-
mits the report pursuant to section 103(c) to
the House of Representatives and the Senate,
the recommendations in legislative form trans-
mitted by the President with respect to such re-
port shall be introduced as a bill (by request)
in the following manner:
(i) HOUSE OF REPRESENTATIVES.—In
the House of Representatives, by the Ma-
jority Leader, for himself and the Minority
Leader, or by Members of the House of
Representatives designated by the Majority
Leader and Minority Leader.
(ii) SENATE.—In the Senate, by the
Majority Leader, for himself and the Mi-
nority Leader, or by Members of the Sen-
ate designated by the Majority Leader and
Minority Leader.
(B) SPECIAL
RULE.—If either House of
Congress is not in session on the day on which
such recommendations in legislative form are
transmitted, the recommendations in legislative
form shall be introduced as a bill in that House
of Congress, as provided in subparagraph (A),
on the first day thereafter on which that House
of Congress is in session.
(2) REFERRAL.—Such bills shall be referred by
the presiding officers of the respective Houses to the
appropriate committee, or, in the case of a bill con-
taining provisions within the jurisdiction of 2 or
more committees, jointly to such committees for con-
sideration of those provisions within their respective
jurisdictions.
(c) CONSIDERATION.—After the recommendations in
legislative form have been introduced as a bill and referred
under subsection (b), such implementing bill shall be con-
sidered in the same manner as an implementing bill is con-
sidered under subsections (d), (e), (f), and (g) of section
151 of the Trade Act of 1974 (19 U.S.C. 2191).
(d) IMPLEMENTING BILL DEFINED.—In this section,
the term ‘‘implementing bill’’ means only the recommenda-
tions in legislative form of the Institute of Medicine of the
National Academy of Sciences described in section
103(b)(3), transmitted by the President to the House of
Representatives and the Senate under subsection 103(c),
and introduced and referred as provided in subsection (b)
as a bill of either House of Congress.
(e) COUNTING OF DAYS.—For purposes of this sec-
tion, any period of days referred to in section 151 of the
Trade Act of 1974 shall be computed by excluding—
(1) the days on which either House of Congress
is not in session because of an adjournment of more
than 3 days to a day certain or an adjournment of
Congress sine die; and
(2) any Saturday and Sunday, not excluded
under paragraph (1), when either House is not in
session.
Subtitle B—Expansion of Access to
Health Promotion Services
SEC. 111. DISEASE SELF-MANAGEMENT DEMONSTRATION
PROJECTS.
(a) DEMONSTRATION PROJECTS.—
(1) IN GENERAL.—The Secretary shall conduct
demonstration projects for the purpose of promoting
disease self-management for conditions identified,
and appropriately prioritized, by the Secretary for
target individuals (as defined in paragraph (2)).
(2) TARGET
INDIVIDUAL
DEFINED.—In this
section, the term ‘‘target individual’’ means an indi-
vidual who—
(A) is at risk for, or has, 1 or more of the
conditions identified by the Secretary as being
appropriate for disease self-management; and
(B) is entitled to benefits under part A of
title XVIII of the Social Security Act (42
U.S.C. 1395c et seq.), or enrolled under part B
of such title ( 42 U.S.C. 1395j et seq.) or is en-
rolled under the Medicare+Choice program
under part C of such title (42 U.S.C. 1395w–
21 et seq.).
(b) NUMBER; PROJECT AREAS; DURATION.—
(1) NUMBER.—Not later than 2 years after the
date of enactment of this Act, the Secretary shall
implement a series of demonstration projects to
carry out the purpose described in subsection (a)(1).
(2) PROJECT AREAS.—The Secretary shall im-
plement the demonstration projects described in
paragraph (1) in urban, suburban, and rural areas.
(3) DURATION.—The demonstration projects
under this section shall be conducted during the 3-
year period beginning on the date on which the ini-
tial demonstration project is implemented.
(c) REPORT TO CONGRESS.—
(1) IN GENERAL.—Not later than 18 months
after the conclusion of the demonstration projects
under this section, the Secretary shall submit a re-
port to Congress on such projects.
(2) CONTENTS
OF
REPORT.—The report re-
quired under paragraph (1) shall include the fol-
lowing:
(A) A description of the demonstration
projects.
(B) An evaluation of—
(i) whether each benefit provided
under the demonstration projects is—
(I) medically effective;
(II) medically efficacious;
(III) cost-effective; or
(IV) cost-saving;
(ii) the level of the disease self-man-
agement attained by target individuals
under the demonstration projects; and
(iii) the satisfaction of target individ-
uals under the demonstration projects.
(C) Recommendations of the Secretary re-
garding whether to conduct the demonstration
projects on a permanent basis.
(D) Such recommendations for legislation
and administrative action as the Secretary de-
termines to be appropriate.
(E) Any other information regarding the
demonstration projects that the Secretary de-
termines to be appropriate.
(d) FUNDING.—The Secretary shall provide for the
transfer from the Federal Hospital Insurance Trust Fund
under section 1817 of the Social Security Act (42 U.S.C.
1395i) an amount not to exceed $30,000,000 for the costs
of carrying out this section.
SEC. 112. MEDICARE HEALTH EDUCATION AND RISK AP-
PRAISAL PROGRAM.
Title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.) is amended by adding at the end the fol-
lowing new section:
‘‘MEDICARE HEALTH EDUCATION AND RISK APPRAISAL
PROGRAM
‘‘SEC. 1897. (a) ESTABLISHMENT.—Not later than
18 months after the date of the conclusion of the dem-
onstration projects conducted under subsection (b)(1), the
Secretary shall establish a comprehensive and systematic
model for delivering health promotion and disease preven-
tion services that—
‘‘(1) through self-assessment identifies—
‘‘(A) behavioral risk factors, such as to-
bacco use, physical inactivity, alcohol use, de-
pression, lack of proper nutrition, and risk of
falling, among target individuals;
‘‘(B) needed medicare clinical preventive
and screening health benefits among target in-
dividuals; and
‘‘(C) functional and self-management in-
formation the Secretary determines to be appro-
priate;
‘‘(2) provides ongoing followup to reduce risk
factors and promote the appropriate use of preven-
tive and screening health benefits;
‘‘(3) improves clinical outcomes, satisfaction,
quality of life, and appropriate use by target individ-
uals of items and services covered under the medi-
care program; and
‘‘(4) provides target individuals with informa-
tion regarding the adoption of healthy behaviors.
‘‘(b) DEMONSTRATION PROJECTS.—
‘‘(1) ESTABLISHMENT.—Not later than 1 year
after the date of enactment of this section, the Sec-
retary, in consultation with the Director of the Cen-
ters for Disease Control and Prevention, and the Di-
rector of the Agency for Healthcare Research and
Quality, shall conduct demonstration projects for the
purpose of developing a comprehensive and system-
atic model for delivering health promotion and dis-
ease prevention services described in subsection (a).
‘‘(2) SELF-ASSESSMENT AND PROVISION OF IN-
FORMATION.—The Secretary shall conduct the dem-
onstration projects established under paragraph (1)
in the following manner:
‘‘(A) SELF-ASSESSMENT.—
‘‘(i) IN
GENERAL.—The Secretary
shall test different—
‘‘(I) methods of making self-as-
sessments available to each target in-
dividual;
‘‘(II) methods of encouraging
each target individual to participate in
the self-assessment; and
‘‘(III) methods for processing re-
sponses to the self-assessment.
‘‘(ii) CONTENTS.—A self-assessment
made available under clause (i) shall
include—
‘‘(I) questions regarding behav-
ioral risk factors;
‘‘(II) questions regarding needed
preventive screening health services;
‘‘(III) questions regarding the
target individual’s preferences for re-
ceiving follow-up information; and
‘‘(IV) other information that the
Secretary determines appropriate.
‘‘(B) PROVISION OF INFORMATION.—After
each target individual completes the self-assess-
ment, the Secretary shall ensure that the target
individual is provided with such information as
the Secretary determines appropriate, which
may include—
‘‘(i) information regarding the results
of the self-assessment;
‘‘(ii) recommendations regarding any
appropriate behavior modification based on
the self-assessment;
‘‘(iii) information regarding how to
access behavior modification assistance
that promotes healthy behavior, including
information on nurse hotlines, counseling
services, provider services, and case-man-
agement services;
‘‘(iv) information, feedback, support,
and recommendations regarding any need
for clinical preventive and screening health
services or treatment; and
‘‘(v) referrals to available community
resources in order to assist the target indi-
vidual in reducing health risks.
‘‘(3) PROJECT AREAS AND DURATION.—
‘‘(A) PROJECT
AREAS.—The Secretary
shall implement the demonstration projects in
geographic areas that include urban, suburban,
and rural areas.
‘‘(B) DURATION.—The Secretary shall
conduct the demonstration projects during the
3-year period beginning on the date on which
the first demonstration project is implemented.
‘‘(c) REPORT TO CONGRESS.—
‘‘(1) IN GENERAL.—Not later than 1 year after
the date on which the demonstration projects con-
clude, the Secretary shall submit to Congress a re-
port on such projects.
‘‘(2) CONTENTS OF REPORT.—The report sub-
mitted under paragraph (1) shall—
‘‘(A) describe the demonstration projects
conducted under this section;
‘‘(B) identify the demonstration project
that is the most effective; and
‘‘(C) contain such other information re-
garding the demonstration projects as the Sec-
retary determines appropriate.
‘‘(3) MEASUREMENT OF EFFECTIVENESS.—For
purposes of paragraph (2)(B), in identifying the
demonstration project that is the most effective, the
Secretary shall consider—
‘‘(A) how successful the project was at—
‘‘(i) reaching target individuals and
engaging them in an assessment of the risk
factors of such individuals;
‘‘(ii) educating target individuals on
healthy behaviors and getting such individ-
uals to modify their behaviors in order to
diminish the risk of chronic disease; and
‘‘(iii) ensuring that target individuals
were provided with necessary information;
‘‘(B) the cost-effectiveness of the dem-
onstration project; and
‘‘(C) the degree of beneficiary satisfaction
under the demonstration projects.