amended by adding at the end the following new sub-
sections: 
‘‘Geriatric Assessment 
‘‘(ccc)(1) The term ‘geriatric assessment’ means each 
of the following: 
‘‘(A) An assessment of the clinical status, func-
tional status, social and environmental functioning, 
and need for caregiving of a geriatric assessment eli-
gible individual (as defined in subsection (ddd)). The 
assessment shall include a comprehensive history 
and physical examination and assessments of the fol-
lowing domains using standardized validated clinical 
tools: 
‘‘(i) Comprehensive review of medications 
and the individual’s adherence to the medica-
tion regimen. 
‘‘(ii) Measurement of affect, cognition and 
executive function, mobility, balance, gait, risk 
of falling, and sensory function. 
‘‘(iii) Social functioning, environmental 
needs, and caregiver resources and needs. 
‘‘(iv) Any other domain determined appro-
priate by the Secretary. 
‘‘(B) Subsequent assessments, which may not 
be conducted more frequently than annually, unless 
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the subsequent assessment is medically necessary 
due to a significant change in the condition of the 
geriatric assessment eligible individual. 
‘‘(C) The development of a written care plan 
based on the results of the assessment under sub-
paragraph (A) (and any subsequent assessment 
under subparagraph (B)). The care plan shall detail 
identified problems, outline therapies, assign respon-
sibility for actions, and indicate whether the indi-
vidual is likely to benefit from chronic care coordina-
tion services (as defined in subsection (eee)(1)). If 
the individual is determined likely to benefit from 
chronic care coordination services, the care plan 
shall also provide the basis for the chronic care co-
ordination plan to be developed by the chronic care 
manager pursuant to subsection (eee). 
‘‘(2) A geriatric assessment may only be conducted 
by— 
‘‘(A) a physician; 
‘‘(B) 
a 
practitioner 
described 
in 
section 
1842(b)(18)(C)(i) under the supervision of a physi-
cian; or 
‘‘(C) any other provider that meets such condi-
tions as the Secretary may specify. 
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‘‘Geriatric Assessment Eligible Individual 
‘‘(ddd)(1) Subject to paragraph (3), the term ‘geri-
atric assessment eligible individual’ means an individual 
identified by the Secretary as eligible for a geriatric as-
sessment. 
‘‘(2) In identifying individuals under paragraph (1), 
the following rules shall apply: 
‘‘(A) The individual must have at least 1 of the 
following present: 
‘‘(i) Multiple chronic conditions. 
‘‘(ii) Dementia, as defined in the most re-
cent Diagnostic and Statistical Manual of Men-
tal Disorders, and at least 1 chronic condition. 
‘‘(iii) Any other factor identified by the 
Secretary. 
‘‘(B)(i) The individual, as determined by the 
Secretary— 
‘‘(I) must have aggregate medical 
costs under this title in the top 10 percent 
of all applicable individuals during the pre-
vious 36 months; or 
‘‘(II) is likely to incur costs under this 
title in the top 10 percent of all applicable 
individuals during the current or subse-
quent calendar year. 
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‘‘(ii) The determination under clause 
(i)(II) of future costs shall be based on the 
medical condition of the individual, the individ-
ual’s past cost to the program under this title, 
and other factors as identified by the Secretary. 
‘‘(iii) The individual meets such additional 
criteria (if any) as the Secretary establishes 
under subparagraph (C). 
‘‘(C)(i) If the Secretary estimates that the total 
number of applicable individuals that would be geri-
atric assessment eligible individuals in a year (but 
for this subparagraph) exceeds 10 percent of the 
total number of applicable individuals in the year, 
the Secretary shall establish and apply under sub-
paragraph (B)(iii) such additional criteria as is de-
signed to eliminate such excess. 
‘‘(ii) The Secretary shall consult with physi-
cians, physician groups, organizations representing 
individuals with chronic conditions and older adults, 
and other stakeholders in identifying any additional 
criteria under clause (i). 
‘‘(D) For purposes of this paragraph, the term 
‘applicable individual’ means an individual enrolled 
for benefits under part B but not enrolled in a Medi-
care Advantage plan or a plan under section 1876. 
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‘‘(3) The term ‘geriatric assessment eligible indi-
vidual’ shall not include the following individuals: 
‘‘(A) An individual who is receiving hospice care 
under this title. 
‘‘(B) An individual who is residing in a skilled 
nursing facility, a nursing facility (as defined in sec-
tion 1919), or any other facility identified by the 
Secretary. 
‘‘(C) An individual medically determined to 
have end-stage renal disease. 
‘‘(D) An individual enrolled in a Medicare Ad-
vantage plan or a plan under section 1876. 
‘‘(E) An individual enrolled in a PACE pro-
gram under section 1894. 
‘‘(F) Any other categories of individuals deter-
mined appropriate by the Secretary. 
‘‘(4) For purposes of this subsection, the term ‘chron-
ic condition’ means a condition, such as dementia, that 
lasts or is expected to last 1 year or longer, limits what 
an individual can do, and requires ongoing care.’’. 
(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)) is amended— 
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(A) in subparagraph (N), by inserting 
‘‘other than geriatric assessments (as defined in 
section 1861(ccc)(1))’’ after ‘‘(as defined in sec-
tion 1848(j)(3))’’; 
(B) by striking ‘‘and’’ before ‘‘(V)’’; and 
(C) by inserting before the semicolon at 
the end the following: ‘‘, and (W) with respect 
to geriatric assessments (as defined in section 
1861(ccc)(1)), the amount paid shall be 100 
percent of the lesser of the actual charge for 
the services or the amount determined under 
the payment basis determined under section 
1848’’. 
(2) PAYMENT UNDER PHYSICIAN FEE SCHED-
ULE.—Section 1848(j)(3) of the Social Security Act 
(42 U.S.C. 1395w–4(j)(3)) is amended by inserting 
‘‘(2)(BB),’’ after ‘‘(2)(AA),’’. 
(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)) is 
amended by striking ‘‘and diagnostic mammog-
raphy’’ and inserting ‘‘, diagnostic mammog-
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raphy, or geriatric assessments (as defined in 
section 1861(ccc)(1))’’. 
(B) CONFORMING AMENDMENTS.—Section 
1833(a)(2) of the Social Security Act (42 
U.S.C. 1395l(a)(2)) is amended— 
(i) in subparagraph (F), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (G)(ii), by strik-
ing the comma at the end and inserting ‘‘; 
and’’; and 
(iii) by inserting after subparagraph 
(G)(ii) the following new subparagraph: 
‘‘(H) with respect to geriatric assessments 
(as defined in section 1861(ccc)(1)) furnished 
by an outpatient department of a hospital, the 
amount determined under paragraph (1)(W),’’. 
(4) ELIMINATION OF DEDUCTIBLE.—The first 
sentence of section 1833(b) of the Social Security 
Act (42 U.S.C. 1395l(b)) is amended— 
(A) by striking ‘‘and’’ before ‘‘(8)’’; and 
(B) by inserting before the period the fol-
lowing: ‘‘, and (9) such deductible shall not 
apply with respect to geriatric assessments (as 
defined in section 1861(ccc)(1))’’. 
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(d) FREQUENCY LIMITATION.—Section 1862(a)(1) of 
the Social Security Act (42 U.S.C. 1395y(a)(1)) is amend-
ed— 
(1) by striking ‘‘and’’ at the end of subpara-
graph (M); 
(2) by striking the semicolon at the end of sub-
paragraph (N) and inserting ‘‘, and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(O) in the case of geriatric assessments (as de-
fined in section 1861(ccc)(1)), which are performed 
more frequently than is covered under such sec-
tion;’’. 
(e) EXCEPTION TO LIMITS ON PHYSICIAN REFER-
RALS.—Section 1877(b) of the Social Security Act (42 
U.S.C. 1395nn(b)) is amended by adding at the end the 
following new paragraph: 
‘‘(6) GERIATRIC ASSESSMENTS.—In the case of 
a designated health service, if the designated health 
service is a geriatric assessment (as defined in sec-
tion 1861(ccc)(1)) and furnished by a physician.’’. 
(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-
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ments made by, and the provisions of, this section, includ-
ing the establishment of additional domains under sub-
section (ccc)(1)(A)(iv) of section 1861 of the Social Secu-
rity Act, as added by subsection (b). In promulgating such 
regulations, the Secretary shall consult with physicians, 
physician groups and organizations, and organizations 
representing individuals with chronic conditions and older 
adults. 
(g) EFFECTIVE DATE.—The amendments made by 
this section shall apply to assessments furnished on or 
after January 1, 2008. 
SEC. 4. MEDICARE COVERAGE OF CHRONIC CARE COORDI-
NATION SERVICES. 
(a) PART B COVERAGE OF CHRONIC CARE COORDI-
NATION SERVICES.— 
(1) IN
GENERAL.—Section 1861(s)(2) of the 
Social Security Act (42 U.S.C. 1395x(s)(2)), as 
amended by section 3(a)(1), is amended— 
(A) in subparagraph (AA), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (BB), by adding 
‘‘and’’ at the end; and 
(C) by adding at the end the following new 
subparagraph: 
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‘‘(CC) chronic care coordination services (as de-
fined in subsection (eee));’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 1862(a)(7) of the Social Secu-
rity Act (42 U.S.C. 1395y(a)(7)), as amended 
by section 3(a)(2)(A), is amended by striking 
‘‘or (BB)’’ and inserting ‘‘(BB), or (CC)’’. 
(B) Clauses (i) and (ii) of section 
1861(s)(2)(K) of the Social Security Act (42 
U.S.C. 1395x(s)(2)(K)), as amended by section 
3(a)(2)(B), are each amended by striking ‘‘sub-
sections (ww)(1) and (ccc)’’ and inserting ‘‘sub-
sections (ww)(1), (ccc), and (eee)’’. 
(b) SERVICES DESCRIBED.—Section 1861 of the So-
cial Security Act (42 U.S.C. 1395x), as amended by sec-
tion 3(b), is amended by adding at the end the following 
new subsection: 
‘‘Chronic Care Coordination Services; Chronic Care 
Manager; Chronic Care Eligible Individual 
‘‘(eee)(1) The term ‘chronic care coordination serv-
ices’ means services that are furnished to a chronic care 
eligible individual (as defined in paragraph (3)) by a single 
chronic care manager (as defined in paragraph (2)) chosen 
by the individual under a plan of care prescribed by such 
chronic care manager for the purpose of chronic care and 
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dementia coordination, which may include any of the fol-
lowing services: 
‘‘(A) The development of an initial plan of care 
(based on the results of a geriatric assessment, as 
defined in subsection ccc)), and subsequent appro-
priate revisions to that plan of care. 
‘‘(B) The management of, and referral for, 
medical and other health services, including inter-
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. 
‘‘(F) 
Self-management 
services, 
including 
health education and risk appraisal to identify be-
havioral risk factors through self-assessment. 
‘‘(G) Providing access by telephone with physi-
cians and other appropriate health care profes-
sionals, including 24-hour availability of such profes-
sionals for emergencies. 
‘‘(H) Management with the principal nonprofes-
sional caregiver in the home. 
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‘‘(I) Managing and facilitating transitions 
among health care professionals and across settings 
of care, including the following: 
‘‘(i) Pursuing the treatment option elected 
by the individual. 
‘‘(ii) Including any advance directive exe-
cuted by the individual in the medical file of the 
individual. 
‘‘(J) Information about, and referral to, hospice 
care, including patient and family caregiver edu-
cation and counseling about hospice care, and facili-
tating transition to hospice care when elected. 
‘‘(K) Information about, referral to, and man-
agement with, community services. 
‘‘(L) 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; 
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