‘‘(II) a practitioner described in clause (i) 
or (iv) of section 1842(b)(18)(C) under the su-
pervision of a physician; or 
‘‘(III) any other provider that meets such 
conditions as the Secretary may specify; and 
‘‘(ii) has entered into a chronic care coordina-
tion agreement with the Secretary. 
‘‘(B)(i) For purposes of subparagraph (A)(ii), each 
chronic care coordination agreement shall meet the re-
quirements described in subparagraph (C) and shall— 
‘‘(I) subject to clause (ii), be entered into for a 
period of 3 years and may be renewed if the Sec-
retary is satisfied that the chronic care manager 
continues to meet such terms and conditions as the 
Secretary may require; and 
‘‘(II) contain such other terms and conditions 
as the Secretary may require. 
‘‘(ii) Each chronic care coordination agreement shall 
provide for the termination of such agreement prior to 
such 3-year period in the case where the chronic care man-
ager— 
‘‘(I) is no longer able to provide chronic care 
services; or 
‘‘(II) does not meet such terms and conditions 
as the Secretary may require. 
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‘‘(C)(i) Subject to clause (ii), the requirements of this 
subparagraph are met if the agreement requires the chron-
ic care manager to perform, or provide for the perform-
ance of, the following services: 
‘‘(I) Advocating for, and providing ongoing sup-
port, oversight, and guidance with respect to the im-
plementation of a plan of care that provides an inte-
grated, coherent, and cross-disciplined plan for ongo-
ing medical care that is developed in partnership 
with the chronic care eligible individual and all other 
physicians and other care providers and agencies (in-
cluding home health agencies) providing care to the 
chronic care eligible individual. 
‘‘(II) Using evidence-based medicine and clin-
ical decision support tools to guide decision making 
at the point of care and on the basis of specific pa-
tient factors. 
‘‘(III) Using health information technology, in-
cluding, where appropriate, remote monitoring and 
patient registries, to monitor and track the health 
status of patients and to provide patients with en-
hanced and convenient access to health care services. 
‘‘(IV) Encouraging patients to engage in the 
management of their own health through education 
and support systems. 
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‘‘(V) Incorporating family caregivers into the 
chronic care planning process. 
‘‘(ii) The Secretary may modify the services required 
under the agreement under clause (i), including by requir-
ing different services or services in addition to those de-
scribed in subclauses (I) through (V) of such clause. 
‘‘(D) The Secretary shall adopt procedures which ex-
empt providers in rural areas from providing 1 or more 
of the services otherwise required to be provided under 
subparagraph (C) or modify such requirements for such 
providers. In establishing such procedures, the Secretary 
shall ensure that such exemptions and modifications do 
not impact the quality of chronic care coordination serv-
ices furnished by such providers. 
‘‘(3) For purposes of this subsection, the term ‘chron-
ic care eligible individual’ means a geriatric assessment 
eligible individual (as defined in subsection (ddd)) who has 
undergone a geriatric assessment (as defined in subsection 
(ccc)(1)) which determined that the individual would ben-
efit from chronic care coordination.’’. 
(c) PAYMENT
AND ELIMINATION
OF COST-SHAR-
ING.— 
(1) PAYMENT AND ELIMINATION OF COINSUR-
ANCE.—Section 1833(a)(1) of the Social Security 
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Act (42 U.S.C. 1395l(a)(1)), as amended by section 
3(c)(1), is amended— 
(A) in subparagraph (N), by inserting ‘‘or 
chronic care coordination services (as defined in 
section 1861(eee))’’ after ‘‘other than geriatric 
assessments 
(as 
defined 
in 
section 
1861(ccc)(1))’’; 
(B) by striking ‘‘and’’ before ‘‘(W)’’; and 
(C) by inserting before the semicolon at 
the end the following: ‘‘, and (X) with respect 
to chronic care coordination services (as defined 
in section 1861(eee)), the amount paid shall be 
100 percent of the amount determined under 
section 1848(m)’’. 
(2) PAYMENT.— 
(A) IN GENERAL.—Section 1848 of the So-
cial Security Act (42 U.S.C. 1395w–4) is 
amended by adding at the end the following 
new subsection: 
‘‘(m) PAYMENT FOR CHRONIC CARE COORDINATION 
SERVICES.— 
‘‘(1) ESTABLISHMENT.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
establish a monthly care coordination payment 
amount under this section for chronic care co-
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ordination services (as defined in paragraph (1) 
of section 1861(eee)(1)) furnished to a chronic 
care eligible individual (as defined in paragraph 
(3) of such section) by a chronic care manager 
(as defined in paragraph (2) of such section 
1861). 
‘‘(B) 
REQUIREMENTS.—In 
establishing 
payment amounts under subparagraph (A), the 
Secretary shall— 
‘‘(i) take into account the time re-
quired of the chronic care manager in pro-
viding the care coordination services to 
chronic care eligible individuals and the 
costs associated with the practice-level 
health information technologies and sys-
tems incurred by the chronic care manager 
in providing such services; and 
‘‘(ii) ensure that such payments do 
not result in a reduction in payments for 
office visits or other evaluation and man-
agement services that would otherwise be 
allowable. 
‘‘(2) CODE.—Under the conditions set forth in 
this section, the Secretary shall develop a care co-
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ordination payment code for chronic care coordina-
tion services and a value for such code. 
‘‘(3) SEPARATE
PAYMENTS
FROM
PAYMENTS 
FOR
GERIATRIC
ASSESSMENTS.—Payments 
for 
chronic care coordination services shall be made sep-
arately from payments for geriatric assessments (as 
defined in section 1861(ccc)(1)) and other services 
for which payment is made under this title.’’. 
(B) CONFORMING
AMENDMENT.—Section 
1848(j)(3) of the Social Security Act (42 
U.S.C. 1395w–4(j)(3)), as amended by section 
3(c)(2)), is amended by inserting ‘‘(2)(CC),’’ 
after ‘‘(2)(BB),’’. 
(3) ELIMINATION
OF
COINSURANCE
IN
OUT-
PATIENT HOSPITAL SETTINGS.— 
(A) EXCLUSION FROM OPD FEE SCHED-
ULE.—Section 1833(t)(1)(B)(iv) of the Social 
Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)), as 
amended by section 3(c)(3)(A), is amended by 
striking ‘‘or geriatric assessments (as defined in 
section 1861(ccc)(1))’’ and inserting ‘‘geriatric 
assessments 
(as 
defined 
in 
section 
1861(ccc)(1)), or chronic care coordination 
services (as defined in section 1861(eee)(1))’’. 
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(B) CONFORMING AMENDMENTS.—Section 
1833(a)(2) of the Social Security Act (42 
U.S.C. 1395l(a)(2)), as amended by section 
3(c)(3)(B), is amended— 
(i) in subparagraph (G)(ii), by strik-
ing ‘‘and’’ at the end; 
(ii) in subparagraph (H), by striking 
the comma at the end and inserting ‘‘; 
and’’; and 
(iii) by inserting after subparagraph 
(H) the following new subparagraph: 
‘‘(I) with respect to chronic care coordina-
tion 
services 
(as 
defined 
in 
section 
1861(eee)(1)) furnished by an outpatient de-
partment of a hospital, the amount determined 
under section 1848(m),’’. 
(4) ELIMINATION OF DEDUCTIBLE.—Paragraph 
(9) of section 1833(b) of the Social Security Act (42 
U.S.C. 1395l(b)), as added by section 3(c)(4), is 
amended by inserting ‘‘or chronic care coordination 
services (as defined in section 1861(eee)(1))’’ after 
‘‘geriatric assessments (as defined in section 
1861(ccc)(1))’’. 
(d) APPLICATION OF LIMITS ON BILLING.—Section 
1842(b)(18)(C) of the Social Security Act (42 U.S.C. 
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1395u(b)(18)(C)) is amended by adding at the end the 
following new clause: 
‘‘(vii) A chronic care manager (as defined in 
section 1861(eee)(2)) that is not a physician.’’. 
(e) EXCEPTION TO LIMITS ON PHYSICIAN REFER-
RALS.—Section 1877(b)(6) of the Social Security Act (42 
U.S.C. 1395nn(b)(6)), as amended by section 3(e), is 
amended to read as follows: 
‘‘(6) GERIATRIC
ASSESSMENTS
AND
CHRONIC 
CARE COORDINATION SERVICES.—In the case of a 
designated health service, if the designated health 
service is— 
‘‘(A) a geriatric assessment or a chronic 
care coordination service (as defined in sub-
sections (ccc)(1) or (eee)(1) of section 1861, re-
spectively); and 
‘‘(B) provided by a physician or a chronic 
care 
manager 
(as 
defined 
in 
section 
1861(eee)(2)).’’. 
(f) RULEMAKING.—The Secretary of Health and 
Human Services shall define such terms, establish such 
procedures, and promulgate such regulations as the Sec-
retary determines necessary to implement the amend-
ments made by, and the provisions of, this section. In pro-
mulgating such regulations, the Secretary shall consult 
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with physicians, physician groups and organizations, and 
organizations representing individuals with chronic condi-
tions and older adults. 
(g) EFFECTIVE DATE.—The amendments made by 
this section shall apply to chronic care coordination serv-
ices furnished on or after January 1, 2008. 
SEC. 5. OUTREACH ACTIVITIES REGARDING GERIATRIC AS-
SESSMENTS AND CHRONIC CARE COORDINA-
TION SERVICES UNDER THE MEDICARE PRO-
GRAM. 
The Secretary of Health and Human Services shall 
conduct outreach activities to individuals likely to be eligi-
ble to receive coverage of geriatric assessments (as defined 
in subsection (ccc) of section 1861 of the Social Security 
Act, as added by section 3) under the Medicare program 
and individuals likely to be eligible to receive coverage of 
chronic care coordination services (as defined in sub-
section (eee) of such section 1861, as added by section 
4) under the Medicare program, to inform such individuals 
about the availability of such benefits under the Medicare 
program. 
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SEC. 6. STUDY AND REPORT ON GERIATRIC ASSESSMENTS 
AND CHRONIC CARE COORDINATION SERV-
ICES UNDER THE MEDICARE PROGRAM. 
(a) STUDY.—The Secretary of Health and Human 
Services shall enter into a contract with an entity to con-
duct a study on— 
(1) the effectiveness of the coverage of geriatric 
assessments and chronic care coordination services 
under the Medicare program (under the amendments 
made by sections 3 and 4) on improving the quality 
of care provided to Medicare beneficiaries with 
chronic conditions, including dementia; and 
(2) the impact of such geriatric assessments 
and care coordination services on reducing expendi-
tures under title XVIII of the Social Security Act, 
including reduced expenditures that may result 
from— 
(A) reducing preventable hospital admis-
sions; 
(B) more appropriate use of pharma-
ceuticals; and 
(C) reducing duplicate or unnecessary 
tests. 
(b) REPORT.—Not later than 3 years after the date 
of enactment of this Act, the entity conducting the study 
under subsection (a) shall submit to Congress and the Sec-
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retary of Health and Human Services a report on the 
study, together with recommendations for such legislation 
or administrative action as such entity determines appro-
priate. 
(c) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out this section. 
SEC. 7. STUDY AND REPORT ON BEST PRACTICES FOR 
MEDICARE CHRONIC CARE COORDINATION. 
(a) STUDY.—The Secretary of Health and Human 
Services, in consultation with the Medicare Payment Advi-
sory Commission, shall conduct a study of the following 
issues: 
(1) The effectiveness of pay-for-performance 
programs to serve Medicare beneficiaries with mul-
tiple chronic conditions, including dementia. 
(2) The cost-effectiveness of chronic care co-
ordination under the Medicare program. 
(3) Whether the quality measures used for 
making payments under part B of the Medicare pro-
gram, including the measures developed under sub-
section (k) of section 1848 of the Social Security Act 
(as added by section 101 of division B of the Tax 
Relief and Health Care Act of 2006, Public Law 
109–432), improve the quality of care provided to 
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Medicare beneficiaries with multiple chronic ill-
nesses, including dementia. 
(b) REPORT.—Not later than 3 years after the date 
of enactment of this Act, the Secretary of Health and 
Human Services shall submit to Congress a report on the 
study conducted under subsection (a) that contains— 
(1) recommendations on the best quality indica-
tors for monitoring the chronic care coordination of 
the conditions of Medicare beneficiaries with mul-
tiple chronic conditions, including dementia; and 
(2) such other recommendations for legislation 
or administrative action as the Secretary determines 
appropriate. 
SEC. 8. RULE OF CONSTRUCTION. 
Nothing in this Act, or in the amendments made by 
this Act, shall be construed as requiring an individual to 
receive a geriatric assessment (as defined in section 
1861(ccc)(1) of the Social Security Act, as added by sec-
tion 3(b)) or chronic care coordination services (as defined 
in section 1861(eee)(1) of such Act, as added by section 
4(b)). 
Æ 
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