disciplinary care conferences and management with 
other providers. 
‘‘(C) The monitoring and management of medi-
cations. 
‘‘(D) Patient education and counseling services. 
‘‘(E) Family caregiver education and counseling 
services, including preventive care consistent with 
the patient’s condition. 
‘‘(F) 
Self-management 
services, 
including 
health education and risk appraisal to identify be-
havioral risk factors through self-assessment. 
‘‘(G) Providing access for individuals, and care-
givers or authorized representatives as appropriate, 
by telephone and e-mail to physicians or other ap-
propriate health care professionals, including 24- 
hour availability of such professionals for after hours 
consultation. 
‘‘(H) Coordination with the principal nonprofes-
sional caregiver in the home. 
‘‘(I) Managing and facilitating transitions that 
occur among health care professionals and across 
settings of care, including the following: 
‘‘(i) Pursuing the treatment option elected 
by the individual. 
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‘‘(ii) Including any advance directive exe-
cuted by the individual in the medical file of the 
individual. 
‘‘(J) Information about pain management and 
palliative care. 
‘‘(K) Information about, and referral to, hos-
pice care, including patient and family caregiver 
education and counseling about hospice care, and fa-
cilitating transition to hospice care when elected. 
‘‘(L) Information about, referral to, and coordi-
nation with, community resources. 
‘‘(M) Such additional services for which pay-
ment would not otherwise be made under this title 
that the Secretary may specify that encourage the 
receipt of, or improve the effectiveness of, the serv-
ices described in the preceding subparagraphs. 
‘‘(2)(A) For purposes of this subsection, the term 
‘chronic care manager’ means an individual or entity 
that— 
‘‘(i) is— 
‘‘(I) a physician; 
‘‘(II) a practitioner described in clause (i) 
or (iv) of section 1842(b)(18)(C); or 
‘‘(III) any other provider that meets such 
conditions as the Secretary may specify; 
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‘‘(ii) has entered into a chronic care manage-
ment and coordination agreement with the Sec-
retary; and 
‘‘(iii) is working in collaboration with, or under 
the supervision of, as determined by the Secretary— 
‘‘(I) the physician, practitioner, or other 
provider who completed the geriatric assessment 
of the individual; or 
‘‘(II) a physician, practitioner, or other 
provider to whom the individual’s care was 
transferred by the physician, practitioner, or 
other provider who performed the geriatric as-
sessment. 
‘‘(B)(i) For purposes of subparagraph (A)(ii), each 
chronic care management and coordination agreement 
shall meet the requirements 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. 
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‘‘(ii) Each chronic care management and coordination 
agreement shall provide for the termination of such agree-
ment prior to such 3-year period in the case where the 
chronic care manager— 
‘‘(I) is no longer able to provide chronic care 
services; or 
‘‘(II) does not meet such terms and conditions 
as the Secretary may require. 
‘‘(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 decisionmaking 
at the point of care and on the basis of specific pa-
tient factors. 
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‘‘(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. 
‘‘(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 management and 
coordination services 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 (iii)) who has 
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undergone a geriatric assessment (as defined in subsection 
(hhh)(1)) which determined that the individual would ben-
efit from chronic care management and coordination. 
‘‘(4) Chronic care management and coordination 
services may be furnished in the chronic care eligible indi-
vidual’s home or residence.’’. 
(c) PAYMENT
AND ELIMINATION
OF COST-SHAR-
ING.— 
(1) PAYMENT AND ELIMINATION OF COINSUR-
ANCE.—Section 1833(a)(1) of the Social Security 
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 management and coordination 
services (as defined in section 1861(jjj)(1))’’ 
after ‘‘other than geriatric assessments (as de-
fined in section 1861(hhh)(1))’’; 
(B) by striking ‘‘and’’ before ‘‘(X)’’; and 
(C) by inserting before the semicolon at 
the end the following: ‘‘, and (Y) with respect 
to chronic care management and coordination 
services (as defined in section 1861(jjj)(1)), the 
amount paid shall be 100 percent of the lesser 
of the actual charge for the services or the 
amount determined under section 1848(p)’’. 
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‘‘(I) the amount of work required 
of the chronic care manager in pro-
viding chronic care management and 
coordination services to eligible indi-
viduals; and 
‘‘(II) all of the costs associated 
with providing chronic care manage-
ment and coordination services, in-
cluding labor, supplies, equipment, 
and the costs of health information 
technologies and systems incurred by 
the chronic care manager in providing 
such services; 
‘‘(ii) ensure that such payments are 
for such services furnished during a 30-day 
period; and 
‘‘(iii) 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) SEPARATE
PAYMENTS
FROM
PAYMENTS 
FOR
GERIATRIC
ASSESSMENTS.—Payments 
for 
chronic care management and coordination services 
shall be made separately from payments for geriatric 
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assessments (as defined in section 1861(hhh)(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)(GG),’’ 
after ‘‘(2)(FF),’’. 
(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(hhh)(1))’’ and inserting ‘‘geriatric 
assessments 
(as 
defined 
in 
section 
1861(hhh)(1)), or chronic care management 
and coordination services (as defined in section 
1861(jjj)(1))’’. 
(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— 
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(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 manage-
ment and coordination services (as defined in 
section 1861(jjj)(1)) furnished by an outpatient 
department of a hospital, the amount deter-
mined under paragraph (1)(Y),’’. 
(4) ELIMINATION OF DEDUCTIBLE.—Paragraph 
(10) 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 management 
and coordination services (as defined in section 
1861(jjj)(1))’’ after ‘‘geriatric assessments (as de-
fined in section 1861(hhh)(1))’’. 
(d) 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
MANAGEMENT
AND
COORDINATION
SERV-
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ICES.—In the case of a designated health service, if 
the designated health service is— 
‘‘(A) a geriatric assessment or a chronic 
care management and coordination service (as 
defined in subsections (hhh)(1) or (jjj)(1) of 
section 1861, respectively); and 
‘‘(B) furnished by a physician.’’. 
(e) 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 
with physicians, physician groups and organizations, other 
health care professional groups and organizations, and or-
ganizations representing individuals with chronic condi-
tions and older adults. 
(f) EFFECTIVE DATE.—The amendments made by 
this section shall apply to chronic care management and 
coordination services furnished on or after January 1, 
2010. 
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SEC. 5. OUTREACH ACTIVITIES REGARDING GERIATRIC AS-
SESSMENTS AND CHRONIC CARE MANAGE-
MENT AND COORDINATION SERVICES UNDER 
THE MEDICARE PROGRAM. 
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 (hhh)(1) of section 1861 of the Social Secu-
rity Act, as added by section 3) under the Medicare pro-
gram and individuals likely to be eligible to receive cov-
erage of chronic care management and coordination serv-
ices (as defined in subsection (jjj)(1) of such section 1861, 
as added by section 4) under the Medicare program, to 
inform such individuals about the availability of such ben-
efits under the Medicare program. 
SEC. 6. UTILIZATION OF TELEHEALTH SERVICES TO FUR-
NISH GERIATRIC ASSESSMENTS AND CHRON-
IC CARE MANAGEMENT AND COORDINATION 
SERVICES UNDER THE MEDICARE PROGRAM. 
(a) IN GENERAL.—Section 1834(m)(4)(F) of the So-
cial Security Act (42 U.S.C. 1395m(m)(4)(F)) is amended 
by adding at the end the following new clause: 
‘‘(iii) GERIATRIC
ASSESSMENTS
AND 
CHRONIC
CARE
MANAGEMENT
AND
CO-
ORDINATION
SERVICES.—The term ‘tele-
health service’ shall also include geriatric 
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assessments 
(as 
defined 
in 
section 
1861(hhh)(1)) and chronic care manage-
ment and coordination services (as defined 
in section 1861(jjj)).’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
January 1, 2010. 
SEC. 7. STUDY AND REPORT ON GERIATRIC ASSESSMENTS 
AND CHRONIC CARE MANAGEMENT AND CO-
ORDINATION SERVICES UNDER THE MEDI-
CARE 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 management and co-
ordination services, including an evaluation of the 
use of interdisciplinary teams in providing such serv-
ices, under the Medicare program (under the amend-
ments 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, 
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