HR 3065 IH1S 
(3) PARTICIPATING STATE.—The term ‘‘partici-
pating State’’ means a State with an approved appli-
cation that has entered into a chronic care improve-
ment demonstration agreement with the Secretary to 
conduct a severe mental illness chronic care improve-
ment demonstration program under this section. 
(4) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(5) SEVERE MENTAL ILLNESS CHRONIC CARE 
IMPROVEMENT
DEMONSTRATION
PROGRAM.—The 
term ‘‘severe mental illness chronic care improve-
ment demonstration program’’ means a program de-
scribed in subsection (d) that is conducted pursuant 
to a chronic care improvement demonstration agree-
ment between the Secretary and a participating 
State. 
(6) STATE.—The term ‘‘State’’ has the mean-
ing given that term for purposes of Medicaid. 
(7) THRESHOLD CONDITION.— 
(A) IN
GENERAL.—The term ‘‘threshold 
condition’’ means a chronic mental illness such 
as schizophrenia, schizoaffective disorder, bipo-
lar disorder, major clinical depression, or such 
conditions with co-occurring substance abuse 
disorders. 
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(B) 
OTHER
STATE-SPECIFIED
CONDI-
TIONS.—Such term includes other conditions 
contained in the Diagnostic and Statistical 
Manual of Mental Disorders IV published by 
the American Psychiatric Association (or any 
successor publication by such Association) se-
lected by the participating State as appropriate 
criteria for selection of targeted beneficiaries 
for participation in a severe mental illness 
chronic care improvement demonstration pro-
gram. 
(8) TARGETED BENEFICIARY.— 
(A) IN
GENERAL.—The term ‘‘targeted 
beneficiary’’ means an adult individual who— 
(i) is entitled to benefits under the 
State Medicaid plan (or a waiver of such 
plan); 
(ii) has 1 or more of the threshold 
conditions; and 
(iii) has been identified by the State 
as likely to benefit from participation in a 
severe mental illness chronic care improve-
ment demonstration program. 
(B) VOLUNTARY PARTICIPATION.—A tar-
geted beneficiary may participate in a severe 
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mental illness chronic care improvement dem-
onstration program on a voluntary basis and 
may terminate participation at any time. 
(b) AUTHORITY TO CONDUCT DEMONSTRATION PRO-
GRAM.— 
(1) CHRONIC CARE IMPROVEMENT DEMONSTRA-
TION AGREEMENTS.— 
(A) IN
GENERAL.—The Secretary shall 
enter into chronic care improvement demonstra-
tion agreements with States that submit ap-
proved applications under this section to pro-
vide for the development, testing, evaluation, 
and implementation of severe mental illness 
chronic care improvement demonstration pro-
grams in accordance with this section. 
(B) PERIOD.—A chronic care improvement 
demonstration agreement entered into by the 
Secretary and a participating State shall be for 
a period of 4 years. 
(C) 
DEADLINE
FOR
INITIAL
AGREE-
MENTS.—Not later than October 1, 2010, the 
Secretary shall enter into chronic care improve-
ment demonstration agreements with not more 
than 10 participating States to conduct a severe 
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mental illness chronic care improvement dem-
onstration program under this section. 
(2) CHRONIC
CARE
IMPROVEMENT
PROGRAM 
OPERATOR AGREEMENTS.—A chronic care improve-
ment demonstration agreement entered into between 
the Secretary and a participating State shall require 
the participating State to enter into chronic care im-
provement program operator agreements, consistent 
with subsection (e), with chronic care improvement 
program operators to carry out the severe mental ill-
ness chronic care improvement demonstration pro-
gram in the State. 
(3) POST-DEMONSTRATION
PLAN
FOR
CON-
TINUITY OF SERVICES.—A State desiring to conduct 
a severe mental illness chronic care improvement 
demonstration program under this section shall in-
clude in its application to be selected as a partici-
pating State a plan for ensuring continuity of serv-
ices for targeted beneficiaries who are participating 
in the program on any date (expected or unexpected) 
that the demonstration program ceases to be con-
ducted in the State. 
(c) PAYMENTS; FUNDING.— 
(1) IN GENERAL.—Beginning October 1, 2010, 
the Secretary shall provide for payments for not 
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more than 10 participating States to conduct a se-
vere mental illness chronic care improvement dem-
onstration program in accordance with the require-
ments of this section. 
(2) MANNER
OF
PAYMENT.—Payment to a 
State under this section shall be made in the same 
manner as other payments are made to the State 
under section 1903(a) of the Social Security Act (42 
U.S.C. 1396b(a)). 
(3) NO STATE MATCH REQUIRED.—No State 
shall be required to provide State matching funds as 
a condition for receiving payments under this sec-
tion. 
(4) FUNDING.— 
(A) LIMITATION
ON
FUNDS.—The total 
amount of payments under this section shall 
not exceed $250,000,000 for the period of fiscal 
years 2011 through 2014. 
(B) BUDGET
AUTHORITY.—This section 
constitutes budget authority in advance of ap-
propriations Acts and represents the obligation 
of the Secretary to provide for the payment of 
amounts provided under this section. 
(C) LIMITATION
ON
PAYMENTS.—In no 
case may— 
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(i) the aggregate amount of payments 
made by the Secretary to a participating 
State for administrative expenses relating 
to conducting a severe mental illness 
chronic care improvement demonstration 
program under this section exceed 10 per-
cent of the aggregate amount of payments 
made to the State under this section; and 
(ii) payments be provided by the Sec-
retary under this section for services pro-
vided under a severe mental illness chronic 
care improvement demonstration program 
conducted under this section for any fiscal 
year after fiscal year 2014. 
(d) SEVERE MENTAL ILLNESS CHRONIC CARE IM-
PROVEMENT DEMONSTRATION PROGRAM.— 
(1) IN
GENERAL.—A severe mental illness 
chronic care improvement demonstration program 
shall be designed to improve the health outcomes 
and satisfaction of targeted beneficiaries partici-
pating in the program and shall— 
(A) provide such beneficiaries with regular 
screening, registry tracking, and outcome meas-
urement processes at the time of psychiatric 
visits for, among other purposes, developing an 
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individualized, goal-oriented care management 
plan that satisfies the requirements of para-
graph (2); 
(B) provide each such beneficiary with 
such a plan; and 
(C) carry out such plan and other chronic 
care improvement activities carried out by the 
State; 
(2) ELEMENTS OF CARE MANAGEMENT PLAN.— 
A care management plan for a targeted beneficiary 
shall be developed with the beneficiary using person- 
centered planning principles and shall, to the extent 
appropriate, include the following: 
(A) Explicit general health care goals, 
measured on a regular basis, such as— 
(i) improved access to primary care 
services; 
(ii) improved prevention; 
(iii) early identification and interven-
tion to avoid serious health issues; and 
(iv) better management of chronic dis-
eases, including but not limited to hyper-
tension, diabetes, obesity, and cardio-
vascular disease. 
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(B) A designated point of contact respon-
sible for communications with the beneficiary 
and for facilitating communications with other 
health care and related community providers 
under the plan. 
(C) Coordination and communication with 
family members who are actively engaged in 
supporting the targeted beneficiary’s participa-
tion in the program. 
(D) Self-care education for the beneficiary 
in recognizing and managing symptoms of 
threshold conditions, educating parents and 
family members, and educating physicians and 
medical specialists as appropriate. 
(E) Education for physicians and other 
community providers on required collaboration 
to enhance communication of relevant clinical 
information. 
(F) Active coordination of supportive com-
munity services, including peer support, trans-
portation, day care, personal assistance, hous-
ing, primary care (including accompanying tar-
geted beneficiaries to medical appointments), 
mental health care, and other required services. 
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(G) The use of monitoring technologies 
that enable patient guidance through the ex-
change of pertinent clinical information. 
(e) TERMS AND CONDITIONS OF CHRONIC CARE IM-
PROVEMENT PROGRAM OPERATOR AGREEMENTS.— 
(1) REQUIREMENTS.—A chronic care improve-
ment program operator agreement entered into 
under this section between a participating State and 
a chronic care improvement program operator shall 
require the operator, with respect to targeted bene-
ficiaries enrolled in the program and covered by the 
agreement, to— 
(A) guide the beneficiaries in managing 
their health (including all co-occurring medical 
or surgical conditions, relevant health care serv-
ices, and pharmaceutical needs) and in per-
forming activities as specified under each such 
beneficiaries care management plan; 
(B) use decision-support tools, such as evi-
dence-based practice guidelines, medication al-
gorithms, or other criteria as determined by the 
Secretary; 
(C) arrange for core medical home team 
staff members, such as medical nurse practi-
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tioners, primary care supervising physicians, 
and embedded nurse care managers; 
(D) initiate wellness activities, including 
smoking cessation and weight management and 
physical exercise programs; 
(E) participate with the State to develop a 
clinical information database to track and mon-
itor the beneficiaries across settings and to 
evaluate outcomes; 
(F) monitor and report to the participating 
State, in a manner specified by the Secretary, 
on health care quality, cost, outcomes, and clin-
ical milestones in achieving recovery from men-
tal illnesses and co-occurring addiction dis-
orders; 
(G) meet medical home quality standards, 
as promulgated by the National Committee on 
Quality Assurance (NCQA) or such other qual-
ity assurance organizations as the Secretary 
may specify; 
(H) meet such clinical, quality improve-
ment, financial, and other requirements as the 
participating State deems to be appropriate for 
the targeted beneficiaries to be served; and 
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(I) comply with such additional require-
ments as the participating State may specify. 
(2) OPTIONAL SERVICES.—The chronic care im-
provement program operator agreement may permit 
a chronic care improvement program operator to— 
(A) use intake assessment, health examina-
tion, medication management, vital signs moni-
toring, preventive healthcare, disease specific 
goals implementation, patient health education, 
or other primary care or general healthcare 
services as deemed appropriate by the operator 
to carry out the program; 
(B) be recognized as a patient-centered 
medical home in accordance with paragraph 
(4); and 
(C) where feasible, to collaborate with pri-
mary care providers, including federally quali-
fied health centers or other community health 
centers, to provide the services described in 
clause (i). 
(3) MANNER OF PAYMENT.—The chronic care 
improvement program operator agreement shall pro-
vide that the State shall pay the chronic care im-
provement program operator in accordance with a 
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methodology developed by the Secretary for deter-
mining payment. 
(4) PATIENT-CENTERED MEDICAL HOME REC-
OGNITION.—The Secretary shall enter into an agree-
ment with the National Committee for Quality As-
surance (NCQA), or other quality assurance organi-
zation with appropriate experience evaluating pa-
tient-centered medical homes as the Secretary may 
specify, for the purposes of granting patient-centered 
medical home status to qualified chronic care im-
provement operator sites. 
(f) INDEPENDENT EVALUATION.— 
(1) IN GENERAL.—The Secretary shall conduct 
an independent evaluation of the severe mental 
chronic care improvement demonstration programs 
conducted under this section. Such evaluation shall 
be done by grant, contract, or interagency agree-
ment with an entity with knowledge of severe mental 
illness chronic care improvement programs and dem-
onstrated experience in the evaluation of such pro-
grams. The evaluation shall include an assessment 
of whether the State demonstration programs con-
ducted under this section— 
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(A) enhance coordination and integration 
of primary care and community mental health 
and substance use disorder services; 
(B) improve prevention, early identifica-
tion, and intervention to avoid serious health 
issues, including chronic diseases; 
(C) improve the overall health status of 
targeted beneficiaries using a patient-centered 
approach; and 
(D) produce financial outcomes, including 
any cost savings to Medicaid. 
(2) INCLUSION
OF
FAMILY
MEMBERS.—The 
Secretary shall ensure that the evaluation collects 
and assesses information from family members who 
are involved with supporting a targeted beneficiary’s 
participation in a severe mental illness chronic care 
improvement 
demonstration 
program 
conducted 
under this section with respect to the results of the 
beneficiary’s participation in the program. 
(3) REPORT
TO
CONGRESS.—The Secretary 
shall submit a report to Congress on the results of 
the evaluation conducted under this subsection. The 
report shall include such recommendations as the 
Secretary determines appropriate to— 
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(A) guide the development of future pro-
grams that provide comprehensive and inte-
grated behavioral and physical health care serv-
ices to the severely mentally ill; 
(B) assist pediatric populations (with ad-
justments made based on age-related clinical 
profiles); and 
(C) assist Medicare beneficiaries under 
title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.). 
(g) RULES OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed as— 
(1) expanding the amount, duration, or scope of 
benefits under a State Medicaid plan (or waiver of 
such plan); 
(2) providing an individual entitlement to par-
ticipate in a severe mental illness chronic care im-
provement demonstration program; or 
(3) providing any hearing or appeal rights with 
respect to a severe mental illness chronic care im-
provement demonstration program established under 
this section. 
(h) CLARIFICATION OF MEDICAID REIMBURSEMENT 
FOR INTEGRATED MENTAL HEALTH AND PRIMARY CARE 
SERVICES.—Not later than October 1, 2010, the Sec-
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retary shall provide, by regulation, for changes to require-
ments under Medicaid relating to reimbursement for pri-
mary care and behavioral health services to the same pa-
tient, on the same day, at the same service site, so as to 
permit payment for the provision of both types of services 
on the same day to the same patient. 
(i) SECRETARIAL OVERSIGHT AND COORDINATION.— 
The Secretary shall establish procedures to promote active 
and effective coordination, collaboration, and communica-
tion among the agencies, administrations, and centers of 
the Department of Health and Human Services that are 
responsible for any matter relating to the conduct or eval-
uation of the severe mental illness chronic care improve-
ment demonstration programs carried out under this sec-
tion. 
Æ 
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