I 
110TH CONGRESS 
1ST SESSION H. R. 2244 
To amend title XVIII of the Social Security Act to provide Medicare bene-
ficiaries with access to geriatric assessments and chronic care coordina-
tion services, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 9, 2007 
Mr. GENE GREEN of Texas introduced the following bill; which was referred 
to the Committee on Energy and Commerce, and in addition to the Com-
mittee 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 amend title XVIII of the Social Security Act to provide 
Medicare beneficiaries with access to geriatric assess-
ments and chronic care coordination services, 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 
‘‘Geriatric Assessment and Chronic Care Coordination Act 
of 2007’’. 
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(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Findings. 
Sec. 3. Medicare coverage of geriatric assessments. 
Sec. 4. Medicare coverage of chronic care coordination services. 
Sec. 5. Outreach activities regarding geriatric assessments and chronic care co-
ordination services under the Medicare program. 
Sec. 6. Study and report on geriatric assessments and chronic care coordination 
services under the Medicare program. 
Sec. 7. Study and report on best practices for Medicare chronic care coordina-
tion. 
Sec. 8. Rule of construction. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) The Medicare program must be redesigned 
to provide high-quality, cost-effective care to the 
growing population of elderly individuals with mul-
tiple chronic conditions. 
(2) According to the Congressional Budget Of-
fice, approximately 43 percent of Medicare costs can 
be attributed to 5 percent of Medicare’s most costly 
beneficiaries. 
(3) Currently, 78 percent of the Medicare popu-
lation has at least 1 chronic condition, and 2⁄3 have 
more than 1 chronic condition. The 20 percent of 
beneficiaries with 5 or more chronic conditions ac-
count for 2⁄3 of all Medicare spending. In addition, 
the large baby boomer generation is moving toward 
retirement and Medicare eligibility. 
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(4) The prevalence of chronic conditions in-
creases with age: 74 percent of the 65- to 69-year- 
old group has at least 1 chronic condition, while 86 
percent of the 85 years and older group has at least 
1 chronic condition. Similarly, just 14 percent of the 
65- to 69-year-old group has 5 or more chronic con-
ditions, while 28 percent of the 85 years and older 
group has 5 or more chronic conditions. 
(5) There is a strong pattern of increasing utili-
zation as the number of conditions increase. Fifty- 
five percent of Medicare beneficiaries with 5 or more 
conditions experienced an inpatient hospital stay 
compared to 5 percent of those with 1 condition or 
9 percent of those with 2 conditions. 
(6) In terms of physician visits, the average 
Medicare beneficiary has over 15 physician visits an-
nually and sees 6 different physicians annually. 
(7) When Alzheimer’s disease or other form of 
dementia are present along with 1 or more other 
chronic conditions, utilization also increases. For ex-
ample, in 2000, total average per person Medicare 
expenditures for those with congestive heart failure 
and Alzheimer’s or dementia were 47 percent higher 
than for those with congestive heart failure and no 
dementia. 
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(8) Research conducted in the United States 
and internationally indicate that the delivery of high-
er quality health care, increased efficiency, and cost- 
effectiveness are the result of systems in which pa-
tients are linked with a physician or another quali-
fied health professional who coordinates their care. 
(9) The current Medicare program does not re-
ward physicians for integrating and coordinating 
health care because these services are not explicitly 
recognized and distinctly paid for. Instead, physi-
cians are incentivized to provide episodic care and to 
generate more individual patient visits to the doc-
tor’s office and hospital for separately reimbursed 
tests and procedures. 
(10) The chronic care model established by this 
Act includes several elements that are effective in 
managing chronic disease, including— 
(A) linkages with community resources; 
(B) health care system changes that re-
ward quality chronic care; 
(C) support for patient self-management of 
chronic disease; 
(D) practice redesign; 
(E) evidence-based clinical practice guide-
lines; and 
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(F) clinical information systems, such as 
electronic medical records and continuity of 
care records. 
(11) Financial incentives within the Medicare 
program should be realigned as part of a com-
prehensive system change. The Medicare program 
should be restructured to reimburse physicians and 
other qualified health professionals for the cost of 
coordinating care. 
(12) The provisions of, and amendments made 
by, this Act are intended to— 
(A) create savings to the Medicare pro-
gram; 
(B) establish a process to identify those 
Medicare beneficiaries most likely to benefit 
from having a provider coordinate their health 
care needs; and 
(C) establish a payment under the Medi-
care program for— 
(i) the assessment of those health care 
needs; and 
(ii) the activities required to coordi-
nate those health care needs. 
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SEC. 3. MEDICARE COVERAGE OF GERIATRIC ASSESS-
MENTS. 
(a) COVERAGE OF GERIATRIC ASSESSMENTS.— 
(1) IN
GENERAL.—Section 1861(s)(2) of the 
Social Security Act (42 U.S.C. 1395x(s)(2)) is 
amended— 
(A) in subparagraph (Z), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (AA), by adding 
‘‘and’’ at the end; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(BB) geriatric assessments (as defined in sub-
section (ccc)(1));’’. 
(2) CONFORMING AMENDMENTS.—(A) Section 
1862(a)(7) of the Social Security Act (42 U.S.C. 
1395y(a)(7)) is amended by striking ‘‘or (K)’’ and 
inserting ‘‘(K), or (BB)’’. 
(B) 
Clauses 
(i) 
and 
(ii) 
of 
section 
1861(s)(2)(K) of the Social Security Act (42 U.S.C. 
1395x(s)(2)(K)) are each amended by striking ‘‘sub-
section (ww)(1)’’ and inserting ‘‘subsections (ww)(1) 
and (ccc)(1)’’. 
(b) GERIATRIC ASSESSMENTS DEFINED.—Section 
1861 of the Social Security Act (42 U.S.C. 1395x) is 
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