I 
111TH CONGRESS 
1ST SESSION H. R. 2560 
To amend title XVIII of the Social Security Act to provide certain high 
cost Medicare beneficiaries suffering from multiple chronic conditions 
with access to coordinated, primary care medical services in lower cost 
treatment settings, such as their residences, under a plan of care devel-
oped by a team of qualified and experienced health care professionals. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 21, 2009 
Mr. MARKEY of Massachusetts (for himself and Mr. SMITH of New Jersey) 
introduced the following bill; which was referred to the Committee on 
Ways and Means, and in addition to the Committee on Energy and Com-
merce, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
certain high cost Medicare beneficiaries suffering from 
multiple chronic conditions with access to coordinated, 
primary care medical services in lower cost treatment 
settings, such as their residences, under a plan of care 
developed by a team of qualified and experienced health 
care professionals. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Independence at Home 
Act of 2009’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) According to the November 2007 Congres-
sional Budget Office Long Term Outlook for Health 
Care Spending, unless changes are made to the way 
health care is delivered, growing demand for re-
sources caused by rising health care costs and to a 
lesser extent the Nation’s expanding elderly popu-
lation will confront Americans with increasingly dif-
ficult choices between health care and other prior-
ities. However, opportunities exist to constrain 
health care costs without adverse health care con-
sequences. 
(2) Medicare beneficiaries with multiple chronic 
conditions account for a disproportionate share of 
Medicare spending compared to their representation 
in the overall Medicare population, and evidence sug-
gests that such patients often receive poorly coordi-
nated care, including conflicting information from 
health providers and different diagnoses of the same 
symptoms. 
(3) People with chronic conditions account for 
76 percent of all hospital admissions, 88 percent of 
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all prescriptions filled, and 72 percent of physician 
visits. 
(4) Studies show that hospital utilization and 
emergency room visits for patients with multiple 
chronic conditions can be reduced and significant 
savings can be achieved through the use of inter-
disciplinary teams of health care professionals caring 
for patients in their places of residence. 
(5) The Independence at Home Act creates a 
chronic care coordination pilot project to bring pri-
mary care medical services to the highest cost Medi-
care beneficiaries with multiple chronic conditions in 
their home or place of residence so that they may be 
as independent as possible for as long as possible in 
a comfortable setting. 
(6) The Independence at Home Act generates 
savings by providing better, more coordinated care 
across all treatment settings to the highest cost 
Medicare beneficiaries with multiple chronic condi-
tions, reducing duplicative and unnecessary services, 
and avoiding unnecessary hospitalizations, nursing 
home admissions, and emergency room visits. 
(7) The Independence at Home Act holds pro-
viders accountable for improving beneficiary out-
comes, ensuring patient and caregiver satisfaction, 
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and achieving cost savings to Medicare on an annual 
basis. 
(8) The Independence at Home Act creates in-
centives for practitioners and providers to develop 
methods and technologies for providing better and 
lower cost health care to the highest cost Medicare 
beneficiaries with the greatest incentives provided in 
the case of highest cost beneficiaries. 
(9) The Independence at Home Act contains 
the central elements of proven home-based primary 
care delivery models that have been utilized for years 
by the Department of Veterans Affairs and ‘‘house 
calls’’ programs across the country to deliver coordi-
nated care for chronic conditions in the comfort of 
a patient’s home or place of residence. 
SEC. 3. ESTABLISHMENT OF VOLUNTARY INDEPENDENCE 
AT HOME CHRONIC CARE COORDINATION 
PILOT PROJECT UNDER TRADITIONAL MEDI-
CARE FEE-FOR-SERVICE PROGRAM. 
(a) IN GENERAL.—Title XVIII of the Social Security 
Act is amended— 
(1) by amending subsection (c) of section 1807 
(42 U.S.C. 1395b–8) to read as follows: 
‘‘(c) INDEPENDENCE AT HOME CHRONIC CARE CO-
ORDINATION PILOT PROJECT.—A pilot project for Inde-
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