(C) AMOUNT
DESCRIBED.—The amount 
described in this subparagraph is the amount 
equal to the amount that the Federal Govern-
ment would have incurred with respect to a 
quarter for providing coverage to an individual 
described in subparagraph (B) under title 
XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.). 
(d) IMPLEMENTATION DATE.—No State may submit 
a request for a waiver under this section before October 
1, 2011. 
TITLE II—IMPROVING QUALITY 
AND SAFETY THROUGH PRE-
VENTIVE SERVICES, CARE CO-
ORDINATION, AND THE USE 
OF 
HEALTH 
INFORMATION 
TECHNOLOGY 
SEC. 201. ADDITIONAL WAIVER AUTHORITY. 
(a) IN
GENERAL.—Notwithstanding the require-
ments to submit a state waiver under title I, the Secretary 
shall establish a process by which States may apply for 
a waiver to implement policies that emphasize the use of 
preventive services, care coordination by a personal physi-
cian, and health information technology (in this section 
referred to as a qualified patient-centered medical home). 
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(b) DEFINITIONS.—For purposes of this title: 
(1) QUALIFIED
PATIENT-CENTERED
MEDICAL 
HOME.—The term ‘‘qualified patient-centered med-
ical home’’ or ‘‘PC–MH’’ means a physician-directed 
practice that has voluntarily participated in a quali-
fication process to demonstrate it has the capabili-
ties to achieve improvements in the management and 
coordination of care of eligible beneficiaries, includ-
ing those with multiple chronic diseases, by incor-
porating attributes of the care management model. 
(2) CARE
MANAGEMENT
MODEL.—The term 
‘‘care management model’’ means a model that uses 
health information and other physician practice in-
novations to improve the management and coordina-
tion of care provided to patients with one or more 
chronic illnesses. Attributes of the model include the 
following: 
(A) Practices advocate for their patients to 
support the attainment of optimal, patient-cen-
tered outcomes that are defined by a care plan-
ning process driven by a compassionate, robust 
partnership between physicians, patients, and 
the patient’s family. 
(B) Evidence-based medicine and clinical 
decision-support tools guide decision making. 
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(C) Physicians in the practice accept ac-
countability for continuous quality improvement 
through voluntary engagement in performance 
measurement and improvement. 
(D) Patients actively participate in deci-
sion-making and feedback is sought to ensure 
patients’ expectations are being met. 
(E) Information technology is utilized ap-
propriately to support optimal patient care, per-
formance measurement, patient education, and 
enhanced communication. 
(F) Practices go through a voluntary rec-
ognition process by an appropriate non-govern-
mental entity to demonstrate that they have the 
capabilities to provide patient centered services 
consistent with the medical home model. 
(G) Patients and families participate in 
quality improvement activities at the practice 
level. 
(3) PATIENT CENTERED MEDICAL HOME REIM-
BURSEMENT METHODOLOGY.—The patient centered 
medical home reimbursement methodology is a 
methodology to reimburse physicians in qualified 
PC–MH practices based on the value of the services 
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provided by such practices. Such methodology shall 
include, at a minimum the following: 
(A) Recognition of the value of physician 
and clinical staff work associated with patient 
care that falls outside the face-to-face visit, 
such as the time and effort spent on educating 
family caregivers and arranging appropriate fol-
low-up services with other health care profes-
sionals, such as nurse educators. 
(B) Services associated with coordination 
of care both within a given practice and be-
tween consultants, ancillary providers, and com-
munity resources. 
(C) Recognition of expenses that the PC– 
MH practices will incur to acquire and utilize 
health information technology, such as clinical 
decision support tools, patient registries and/or 
electronic medical records. 
(D) Reimbursement for separately identifi-
able email and telephonic consultations, either 
as separately-billable services or as part of a 
global management fee. 
(E) Recognition of the value of physician 
work associated with remote monitoring of clin-
ical data using technology. 
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(F) Allowance for separate fee-for-service 
payments for face-to-face visits. 
(G) Recognition of case mix differences in 
the patient population being treated within the 
practice. 
(H) Recognition and sharing of savings 
from reduced hospitalizations associated with 
physician-guided care management in the office 
setting. 
(I) Allowance for additional payments for 
achieving measurable and continuous quality 
improvements. 
(4) PERSONAL
PHYSICIAN.—The term ‘‘per-
sonal physician’’ means a physician who practices in 
a qualified PC–MH and whom the practice has de-
termined has the training to provide first contact, 
continuous and comprehensive care for the whole 
person, not limited to a specific disease condition or 
organ system. 
(5) ELIGIBLE BENEFICIARY.—The term ‘‘eligi-
ble beneficiary’’ means a beneficiary enrolled under 
the Medicaid or SCHIP program or other State resi-
dent who selects a primary care or principal care 
physician in a qualified PC–MH as their personal 
physician. 
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