‘‘CARE COORDINATION AND ASSESSMENT SERVICES
‘‘SEC. 1898. (a) PURPOSE.—The purpose of this sec-
tion is to provide assistance to a beneficiary with a serious
and disabling chronic condition (as defined in subsection
(f)(1)) to obtain the appropriate level and mix of follow-
up care.
‘‘(b) ELECTION OF CARE COORDINATION AND AS-
SESSMENT SERVICES.—
‘‘(1) IN
GENERAL.—On or after January 1,
2003, a beneficiary with a serious and disabling
chronic condition may elect to receive care coordina-
tion services in accordance with the provisions of
this section under which, in appropriate cir-
cumstances, the eligible beneficiary has health care
services covered under this title managed and coordi-
nated by a care coordinator who is qualified under
subsection (e) to furnish care coordination services
under this section.
‘‘(2) REVOCATION OF ELECTION.—An eligible
beneficiary who has made an election under para-
graph (1) may revoke that election at any time.
‘‘(c) OUTREACH.—The Secretary shall provide for the
wide dissemination of information to beneficiaries and pro-
viders of services, physicians, practitioners, and suppliers
with respect to the availability of and requirements for
care coordination services under this section.
‘‘(d) CARE COORDINATION AND ASSESSMENT SERV-
ICES DESCRIBED.—Care coordination services under this
section shall include the following:
‘‘(1) BASIC CARE COORDINATION AND ASSESS-
MENT SERVICES.—
‘‘(A) IN GENERAL.—Except as otherwise
provided in this section, eligible beneficiaries
who have made an election under this section
shall receive the following services:
‘‘(i)(I) An initial assessment of an in-
dividual’s medical condition, functional and
cognitive capacity, and environmental and
psychosocial needs.
‘‘(II) Annual assessments after the
initial assessment performed under sub-
clause (I), unless the physician or care co-
ordinator of the individual determines that
additional assessments are required due to
sentinel health events or changes in the
health status of the individual that may re-
quire changes in plans of care developed
for the individual.
‘‘(ii) The development of an initial
plan of care, and subsequent appropriate
revisions to that plan of care.
‘‘(iii) The management of, and refer-
ral for, medical and other health services,
including 
multidisciplinary 
care 
con-
ferences and coordination with other pro-
viders.
‘‘(iv) The monitoring and manage-
ment of medications.
‘‘(v) Patient education and counseling
services.
‘‘(vi) Family caregiver education and
counseling services.
‘‘(vii) Self-management services, in-
cluding health education and risk appraisal
to identify behavioral risk factors through
self-assessment.
‘‘(viii) Providing access for consulta-
tions by telephone with physicians and
other appropriate health care professionals,
including 24-hour availability of such pro-
fessionals for emergency consultations.
‘‘(ix) Coordination with the principal
nonprofessional caregiver in the home.
‘‘(x) Managing and facilitating transi-
tions among health care professionals and
across settings of care, including the fol-
lowing:
‘‘(I) Pursuing the treatment op-
tion elected by the individual.
‘‘(II) Including any advance di-
rective executed by the individual in
the medical file of the individual.
‘‘(xi) Activities that facilitate con-
tinuity of care and patient adherence to
plans of care.
‘‘(xii) Information about, and referral
to, hospice services, including patient and
family caregiver education and counseling
about hospice, and facilitating transition to
hospice when elected.
‘‘(xiii) Such other medical and health
care services for which payment would not
otherwise be made under this title as the
Secretary determines to be appropriate for
effective care coordination, including the
additional items and services as described
in subparagraph (B).
‘‘(B) ADDITIONAL
BENEFITS.—The Sec-
retary may specify additional benefits for which
payment would not otherwise be made under
this title that may be available to eligible bene-
ficiaries who have made an election under this
section (subject to an assessment by the care
coordinator of an individual beneficiary’s cir-
cumstances and need for such benefits) in order
to encourage the receipt of, or to improve the
effectiveness of, care coordination services.
‘‘(2) CARE
COORDINATION
AND
ASSESSMENT
REQUIREMENT.—Notwithstanding any other provi-
sion of this title, with respect to items and services
for which payment is made under this title furnished
to a beneficiary for the diagnosis and treatment of
the beneficiary’s serious and disabling chronic condi-
tion, if the beneficiary has made an election to re-
ceive care coordination and assessment services
under this section, the Secretary may require that
payment may only be made under this title for such
items and services relating to such condition if the
items and services have been furnished by or coordi-
nated through the care coordinator. Under such pro-
vision, the Secretary shall prescribe exceptions for
emergency medical services (as described in section
1852(d)(3), but without regard to enrollment with
a Medicare+Choice organization), and other excep-
tions determined by the Secretary for the delivery
of timely and needed care.
‘‘(e) CARE COORDINATORS.—
‘‘(1) CONDITIONS OF PARTICIPATION.—In order
to be qualified to furnish care coordination and as-
sessment services under this section, an individual or
entity shall—
‘‘(A) be a health care professional or entity
(which may include physicians, physician group
practices, or other health care professionals or
entities the Secretary may find appropriate)
meeting such conditions as the Secretary may
specify;
‘‘(B) enter into a care coordination agree-
ment under paragraph (2); and
‘‘(C) meet such criteria as the Secretary
may establish (which may include experience in
the provision of care coordination or primary
care physician’s services).
‘‘(2) AGREEMENT TERM; PAYMENT.—
‘‘(A) DURATION AND RENEWAL.—A care
coordination agreement under this subsection
shall—
‘‘(i) be entered into for a period of 1
year and may be renewed if the Secretary
is satisfied that the care coordinator con-
tinues to meet the conditions of participa-
tion specified in paragraph (1);
‘‘(ii) assure the compliance of the care
coordinator with such data collection and
reporting requirements as the Secretary
determines necessary to assess the effect of
care coordination on health outcomes; and
‘‘(iii) contain such other terms and
conditions as the Secretary may require.
‘‘(B) PAYMENT FOR SERVICES.—The Sec-
retary shall establish payment terms and condi-
tions and payment rates for basic care coordi-
nation and assessment services described in
subsection (d)(1). The Secretary may establish
new billing codes to carry out the provisions of
this subparagraph.
‘‘(f) DEFINITIONS.—In this section:
‘‘(1) SERIOUS AND DISABLING CHRONIC CONDI-
TION.—The term ‘serious and disabling chronic con-
dition’ means, with respect to an individual, that the
individual has at least one physical or mental condi-
tion and a licensed health care practitioner has cer-
tified within the preceding 12-month period that—
‘‘(A) the individual has a level of disability
such that the individual is unable to perform
(without substantial assistance from another in-
dividual) for a period of at least 90 days due
to a loss of functional capacity—
‘‘(i) at least 2 activities of daily living;
or
‘‘(ii) such number of instrumental ac-
tivities of daily living that is equivalent (as
determined by the Secretary) to the level
of disability described in clause (i);
‘‘(B) the individual has a level of disability
equivalent (as determined by the Secretary) to
the level of disability described in subparagraph
(A); or
‘‘(C) the individual requires substantial su-
pervision to protect the individual from threats
to health and safety due to severe cognitive im-
pairment.
‘‘(2) ACTIVITIES OF DAILY LIVING.—The term
‘activities of daily living’ means each of the fol-
lowing:
‘‘(A) Eating.
‘‘(B) Toileting.
‘‘(C) Transferring.
‘‘(D) Bathing.
‘‘(E) Dressing.
‘‘(F) Continence.
‘‘(3) INSTRUMENTAL ACTIVITIES OF DAILY LIV-
ING.—The term ‘instrumental activities of daily liv-
ing’ means each of the following:
‘‘(A) Medication management.
‘‘(B) Meal preparation.
‘‘(C) Shopping.
‘‘(D) Housekeeping.
‘‘(E) Laundry.
‘‘(F) Money management.
‘‘(G) Telephone use.
‘‘(H) Transportation use.
‘‘(4) BENEFICIARY.—The term ‘beneficiary’
means an individual entitled to benefits under part
A, or enrolled under part B, including an individual
enrolled under the Medicare+Choice program under
part C.’’.
(b) COVERAGE OF CARE COORDINATION AND AS-
SESSMENT SERVICES AS A PART B MEDICAL SERVICE.—
(1) IN GENERAL.—Section 1861(s) of the So-
cial Security Act (42 U.S.C. 1395x(s)) is amended—
(A) in the second sentence, by redesig-
nating paragraphs (16) and (17) as clauses (i)
and (ii); and
(B) in the first sentence—
(i) by striking ‘‘and’’ at the end of
paragraph (14);
(ii) by striking the period at the end
of paragraph (15) and inserting ‘‘; and’’;
and
(iii) by adding after paragraph (15)
the following new paragraph:
‘‘(16) care coordination and assessment services
furnished by a care coordinator in accordance with
section 1866C.’’.
(2) 
CONFORMING
AMENDMENTS.—Sections
1864(a) 1902(a)(9)(C), and 1915(a)(1)(B)(ii)(I) of
such Act (42 U.S.C. 1395aa(a), 1396a(a)(9)(C), and
1396n(a)(1)(B)(ii)(I)) are each amended by striking
‘‘paragraphs (16) and (17)’’ each place it appears
and inserting ‘‘clauses (i) and (ii) of the second sen-
tence’’.
(3) PART
B
COINSURANCE
AND
DEDUCTIBLE
NOT APPLICABLE TO CARE COORDINATION AND AS-
SESSMENT SERVICES.—
(A) COINSURANCE.—Section 1833(a)(1) of
the 
Social 
Security 
Act 
(42 
U.S.C.
1395l(a)(1)), as amended by sections 105 and
223 of the Medicare, Medicaid, and SCHIP
Benefits Improvement and Protection Act of
2000, as enacted into law by section 1(a)(6) of
Public Law 106–554, is amended—
(i) by striking ‘‘and’’ at the end of
subparagraph (T); and
(ii) by inserting before the final semi-
colon ‘‘, and (V) with respect to care co-
ordination and assessment services de-
scribed in section 1861(s)(16) that are fur-
nished by, or coordinated through, a care
coordinator, the amounts paid shall be 100
percent of the payment amount established
under section 1866C’’.
(B) DEDUCTIBLE.—Section 1833(b) of
such Act (42 U.S.C. 1395l(b)) is amended—
(i) by striking ‘‘and’’ at the end of
paragraph (5); and
(ii) by inserting before the final period
‘‘, and (7) such deductible shall not apply
with respect to care coordination and as-
sessment services (as described in section
1861(s)(16))’’.
(C) ELIMINATION
OF
COINSURANCE
IN
OUTPATIENT HOSPITAL SETTINGS.—The third
sentence of section 1866(a)(2)(A) of such Act
(42 U.S.C. 1395cc(a)(2)(A)), as amended by
section 102(b)(2), is further amended by insert-
ing after ‘‘section 1833(p),’’ the following:
‘‘with respect to care coordination and assess-
ment 
services 
(as 
described 
in 
section
1861(s)(16)),’’.
TITLE II—PAYMENT INCENTIVES
FOR QUALITY CARE FOR INDI-
VIDUALS WITH SERIOUS AND
DISABLING CHRONIC CONDI-
TIONS
SEC. 201. ADJUSTMENTS TO FEE-FOR-SERVICE PAYMENT
SYSTEMS.
(a) IN GENERAL.—The Secretary of Health and
Human Services shall provide for appropriate adjustments
to each of the payment systems described in subsection
(b) to take into account the additional costs incurred in
providing items and services under the medicare program
to medicare beneficiaries who suffer from serious and dis-
abling chronic conditions, including the consideration of
the patient classification system (or other methodology)
under subsection (d). The Secretary shall implement such
adjustments for items and services furnished on or after
October 1, 2005.
(b) PAYMENT SYSTEMS DESCRIBED.—The payment
systems referred to in subsection (a) are the following:
(1) The prospective payment system for covered
skilled nursing facility services under section
1888(e) of such Act (42 U.S.C. 1395yy(e)).
(2) The prospective payment system for home
health services under section 1895 of such Act (42
U.S.C. 1395fff).
(3) The prospective payment system for out-
patient hospital services under section 1833(t) of
such Act (42 U.S.C. 1395l(t)).
(4) The physician fee schedule under section
1848 of such Act (42 U.S.C. 1395w–4).
(5) The composite rate of payment for dialysis
services under section 1881(b)(7) of such Act (42
U.S.C. 1395rr(b)(7)).
(6) The payment rate for outpatient therapy
services and comprehensive outpatient rehabilitation
services under section 1834(k) of such Act (42
U.S.C. 1395m(k)).
(7) The payment rate for partial hospitalization
services established by the Secretary in regulations
under title XVIII of such Act.
(8) The payment rate for hospice services under
section 1814(i) of such Act (42 U.S.C. 1395f(i)).
(c) INTERIM REPORT.—Not later than 18 months
after the date of the enactment of this Act, the Secretary
shall submit to Congress a report on the proposed adjust-
ments required under subsection (a) to the payment sys-
tems described in subsection (b), the methodology em-
ployed by the Secretary in providing for such proposed ad-
justments, and an assessment of the impact of such ad-
justments on access to effective care for medicare bene-
ficiaries.
(d) PATIENT CLASSIFICATION SYSTEM.—The Sec-
retary shall develop a patient classification system or other
methodology to predict costs within and across postacute
care settings attributable to furnishing items and services
to medicare beneficiaries who suffer from serious and dis-
abling chronic conditions. The Secretary shall develop
such system by not later than October 1, 2004, and shall
consult with representatives of providers of services and
individuals with expertise in health care financing and risk
adjustment methodology in developing such system.
SEC. 202. MEDICARE+CHOICE.
(a) REVISIONS
TO RISK ADJUSTMENT METHOD-
OLOGY.—
(1) IN GENERAL.—The Secretary shall revise
the risk adjustment methodology under section
1853(a)(3) of the Social Security Act (42 U.S.C.
1395w–23(a)(3)) 
applicable 
to 
payments 
to
Medicare+Choice organizations offering specialized
programs for frail elderly and at-risk beneficiaries to
take into account variations in costs incurred by
such organizations.
(2) METHODS
CONSIDERED.—In revising the
risk adjustment methodology under paragraph (1),
the Secretary shall consider—
(A) hybrid risk adjustment payment sys-
tems, such as partial capitation;
(B) new diagnostic and service markers
that more accurately predict high risk;
(C) improving the structural components
of the applicable method of payment, such as
reducing payment lag, using multiple site diag-
nostic data, and using several years of data;
(D) providing for adjustments to payment
amounts for beneficiaries with comorbidities;
(E) testing concurrent risk adjustment
methodologies; and
(F) testing payment methods using data
from specialized programs for frail elderly and
at-risk beneficiaries.
(3) IMPLEMENTATION.—The Secretary shall
implement such revisions to the risk adjustment
methodology for items and services furnished on or
after January 1, 2005.
(4) INTERIM REPORT.—Not later than January
1, 2004, the Secretary shall submit to Congress a
report on revision of the risk adjustment method-
ology required under paragraph (1), including a de-
scription of the methods considered and employed by
the Secretary in providing for such revision and an
assessment of the impacts of such methods on access
to effective care for medicare beneficiaries.
(b) INTERIM CONTINUATION OF BLENDED RATE FOR
SPECIALIZED PROGRAMS FOR FRAIL ELDERLY AND AT-
RISK MEDICARE BENEFICIARIES RESIDING IN INSTITU-
TIONS.—
(1) 
IN
GENERAL.—In 
the 
case 
of 
a
Medicare+Choice organization that complies with
the requirements under paragraph (2) and that of-
fers a Medicare+Choice plan that provides for a
specialized program for frail elderly and at-risk
beneficiaries that exclusively serves beneficiaries in
institutions or beneficiaries that are entitled to med-
ical assistance under a State plan under title XIX,
notwithstanding section 1853(a)(3)(C)(ii) of the So-
cial Security Act (42 U.S.C. 1395w–23(a)(3)(C)(ii)),
such organization shall be paid according to the
method described in section 1853(a)(3)(C)(ii)(I)
until such time as the Secretary has implemented
the revised risk adjustment methodology required in
subsection (a).
(2) REQUIREMENTS.—A Medicare+Choice or-
ganization may not qualify for the payment method-
ology under paragraph (1) unless the organization
collects such data (and in such format) as the Sec-
retary requires to monitor quality of services pro-
vided, outcomes, and costs, including functional and
diagnostic data and information collected through
the Health Outcomes Survey.
(c) INTERIM CONTINUATION OF PAYMENT METH-
ODOLOGIES FOR DEMONSTRATION PROGRAMS.—
(1) IN GENERAL.—Notwithstanding any other
provision of law, payment methodologies for medi-
care demonstration programs for specialized pro-
grams for frail elderly and at-risk beneficiaries that
comply with the requirements under paragraph (2)
shall continue under the terms and conditions of the
demonstration authority, including the risk adjust-
ment factors and formula used for paying such dem-
onstration programs, until such time as the Sec-
retary has implemented the revised risk adjustment
methodology required in subsection (a).
(2) REQUIREMENTS.—A medicare demonstra-
tion program may not qualify for the payment meth-
odology under paragraph (1) unless the program col-
lects such data (and in such format) as the Sec-
retary requires to monitor quality of services pro-
vided, outcomes, and costs, including functional and
diagnostic data and information collected through
the Health Outcomes Survey.
(d) INTERIM DEMONSTRATION PROGRAM FOR ADDI-
TIONAL PAYMENTS FOR SPECIALIZED PROGRAMS.—
(1) IN GENERAL.—The Secretary shall establish
a demonstration program under which additional
payments (in such manner and amount as the Sec-
retary determines appropriate) may be made to a
Medicare+Choice organization that complies with
the requirements under paragraph (2) and that of-
fers a Medicare+Choice plan that—
(A) provides, directly or through contract,
for a specialized program of care for enrollees
with serious and disabling chronic conditions;
and
(B) exclusively serves enrollees with serious
and disabling chronic conditions or serves a dis-
proportionate share of such enrollees.
(2) REQUIREMENTS.—A Medicare+Choice or-
ganization may not qualify for additional payments
under paragraph (1) unless the organization and the
specialized program of care meet the following re-
quirements:
(A) Under the specialized program of care,
a clinical delivery system is established that
meets the needs of such enrollees, including—
(i) methods to prevent, delay, or mini-
mize the progression of disabilities;
(ii) disease management protocols,
such as high risk screening to identify risk
of hospitalization, nursing home placement,
functional decline, death, and other factors
that increase the costs of care provided;
(iii) 
appropriate 
specially 
trained
health care staff, such as nurse practi-
tioners, geriatric care managers, or mental
health professionals; and
(iv) methods for promoting integra-
tion of care, financing, and administrative
functions across health care settings.
(B) The organization collects such data
(and in such format) as the Secretary requires
to monitor quality of services provided, out-
comes, and costs, including functional and diag-
nostic data and information collected through
the Health Outcomes Survey.
(C) The organization employs quality
standards and tracks quality indicators speci-
fied by the Secretary that are relevant to the
special needs of enrollees with serious and dis-
abling chronic conditions.
(D) The organization does not receive pay-
ments, or adjustment to payments, with respect
to any enrollee by reason of subsection (b) or
(c).
(3) WAIVER AUTHORITY.—The Secretary may
waive such requirements of title XVIII of the Social
Security Act as may be necessary to carry out this
demonstration program.
(4) TERMINATION.—The demonstration pro-
gram under this subsection shall terminate 1 year
after such time as the Secretary has implemented
the revised risk adjustment methodology required in
subsection (a).
(5) FUNDING.—There are authorized to be ap-
propriated to the Secretary $25,000,000 for carrying
out the demonstration program under this sub-
section.
(e) DEFINITION.—In this section, the term ‘‘special-
ized programs for frail elderly and at-risk beneficiaries’’
means—
(1) demonstrations approved by the Secretary
for purposes of testing the integration of acute and
expanded care services under prepaid financing
which include prescription drugs and other non-
covered ancillary services, care coordination, and
home and community-based services, such as the so-
cial health maintenance organization demonstration
project authorized under section 2355 of the Deficit
Reduction Act of 1984 and expanded under section
4207(b)(4)(B)(i) of the Omnibus Reconciliation Act
of 1990;
(2) demonstrations approved by the Secretary
for purposes of improving quality of care and pre-
venting hospitalizations for nursing home residents,
such as the EverCare demonstration project;
(3) demonstrations approved by the Secretary
for purposes of testing methods for integrating
medicare and medicaid benefits for the dually eligi-
ble, such as the Minnesota Senior Health Options
program, the Wisconsin Partnership program, the
Massachusetts Senior Care Organization program,
and the Rochester Community Care Network pro-
gram;
(4) demonstrations approved by the Secretary
under subsection (d); and
(5) such other demonstrations or programs ap-
proved by the Secretary for similar purposes, as de-
termined by the Secretary.
TITLE 
III—DEVELOPMENT 
OF
NATIONAL POLICIES ON EF-
FECTIVE 
CHRONIC 
CONDI-
TION CARE
SEC. 301. STUDY AND REPORT ON EFFECTIVE CHRONIC
CONDITION CARE.
(a) STUDY.—For purposes of improving chronic con-
dition care furnished to medicare beneficiaries under the
medicare program, the Secretary of Health and Human
Services shall conduct a comprehensive study of chronic
condition trends of medicare beneficiaries and associated
service utilization, quality indicators, and cumulative
costs.
(b) SPECIFIC MATTERS STUDIED.—The study con-
ducted under subsection (a) shall include an assessment
of the following:
(1) Chronic condition prevalence rates.
(2) Demographic, medical, and functional infor-
mation about medicare beneficiaries with chronic
conditions.
(3) Utilization, cost, and quality data across
settings, including—
(A) expenditures under a State plan under
title XIX of the Social Security Act for individ-
uals dually eligible for benefits under the medi-
care and medicaid programs,
(B) data on out-of-pocket expenses paid by
medicare beneficiaries,
(C) data on payments made by non-Fed-
eral health insurance programs,
(D) amounts and percentages of overall
payments made to medicare providers of serv-
ices and suppliers for medicare beneficiaries
with chronic conditions, and
(E) current and future costshifting for
treatment of such beneficiaries between the
medicare and medicaid programs.
(c) INFORMATION.—
(1) IN GENERAL.—The Secretary may collect
such data from providers of services, suppliers, fiscal
intermediaries, and carriers. Such providers, sup-
pliers, fiscal intermediaries, and carriers shall fur-
nish to the Secretary the data the Secretary requires
to conduct the study under subsection (a).
(2) REQUIREMENT
TO
CONSIDER
DATA
PRE-
VIOUSLY
COLLECTED.—To the maximum extent
practicable, in conducting the study, the Secretary
shall analyze existing data and utilize existing data
collection methodologies.
(3) CONSULTATION.—The Secretary shall con-
sult with representatives of providers of services,
suppliers, fiscal intermediaries, and carriers with re-
spect to data collection requirements to conduct the
study with respect to the specific matters described
in subsection (b).
(d) REPORT.—
(1) IN GENERAL.—Not later than 3 years after
the date of the enactment of this Act, and triennially
thereafter, the Secretary shall submit to Congress a
report on the study conducted under subsection (a)
and the specific matters studied under subsection
(b).
(2) RECOMMENDATIONS.—Each report shall
also include specific recommendations with respect
to appropriate care for medicare beneficiaries with
chronic conditions, including the establishment, and
refinement, of goals for reducing chronic condition
prevalence rates and related medical expenses.
(e) DEFINITION.—In this section, the term ‘‘chronic
condition’’ means one or more physical or mental condi-
tions which are likely to last for an unspecified period of
time, or for the duration of an individual’s life, for which
there is no known cure, and which may affect an individ-
ual’s ability to carry out basic activities of daily living,
instrumental activities of daily living, or both.
(f) REDUCTION OF PAPERWORK; ASSISTANCE WITH
DEVELOPMENT
OF
COMPUTER-ASSISTED
PAPERWORK
REDUCTION TECHNOLOGY.—
(1) REDUCTION
OF
PAPERWORK.—Not later
than one year after the date of the enactment of this
Act, the Secretary shall, in consultation with pro-
viders of services and suppliers under the medicare
program, patient advocacy groups, and State and
local health care administration experts, implement
a program to eliminate or simplify those paperwork
requirements that are not required by law, and do
not contribute to the quality of care furnished to
medicare beneficiaries or the integrity of the medi-
care program.
(2) DEVELOPMENT OF BEST PRACTICES SOFT-
WARE.—
(A) IN GENERAL.—The Secretary, through
the Office of Research and Development of the
Center for Medicare and Medicaid Services,
shall develop and disseminate to providers of
services and suppliers participating in the medi-
care program best practices electronic software
and medical technology information systems de-
signed to reduce the duplicative recording of in-
formation, to reduce the need for handwritten
entries, and to reduce the risk of medical and
pharmaceutical errors in data entry.
(B) TECHNICAL
ASSISTANCE.—The Sec-
retary shall provide for technical assistance in
the use of the electronic software developed
under subparagraph (A).
(C) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—For each of fiscal years 2002, 2003,
and 2004, there are authorized to be appro-
priated to the Secretary $10,000,000 to carry
out this paragraph.
SEC. 302. INSTITUTE OF MEDICINE MEDICARE CHRONIC
CONDITION CARE IMPROVEMENT STUDY AND
REPORT.
(a) STUDY.—
(1) IN GENERAL.—The Secretary shall contract
with the Institute of Medicine of the National Acad-
emy of Sciences to—
(A) conduct a comprehensive study of the
medicare program to identify—
(i) factors that facilitate access to ef-
fective care (including, where appropriate,
hospice care) for medicare beneficiaries
with chronic conditions; and
(ii) factors that impede access to such
care for such beneficiaries,
including the issues studied under paragraph
(2); and
(B) submit the report described in sub-
section (b).
(2) ISSUES
STUDIED.—The study required
under paragraph (1) shall—
(A) identify inconsistent clinical, financial,
or administrative requirements across provider
and supplier settings or professional services
with respect to medicare beneficiaries;
(B) identify requirements under the pro-
gram imposed by law or regulation that—
(i) promote costshifting across pro-
viders and suppliers;
(ii) impede access to effective chronic
condition care by requiring the demonstra-
tion of continuing clinical improvement of
the condition as a prerequisite to coverage
of certain benefits;
(iii) impose unnecessary burdens on
such beneficiaries and their family care-
givers;
(iv) impede coverage for services that
prevent, delay, or minimize the progression
of chronic conditions;
(v) impede the establishment of ad-
ministrative information systems to track
health status, utilization, cost, and quality
data across providers and suppliers and
provider settings;
(vi) impede the establishment of clin-
ical information systems that support con-
tinuity of care across settings and over
time;
(vii) impede the alignment of financial
incentives among the medicare program,
the medicaid program, and group health
plans and providers and suppliers that fur-
nish services to the same beneficiary; or
(viii) impede payment methods that
encourage the enrollment of high-risk pop-
ulations, support innovation, or encourage
providers and suppliers to maintain or im-
prove health status for such medicare
beneficiaries.
(b) REPORT.—On the date that is 18 months after
the date of enactment of this Act, the Institute of Medi-
cine of the National Academy of Sciences shall submit to
Congress and the Secretary of Health and Human Serv-
ices a report that contains—
(1) a detailed statement of the findings and
conclusions of the study conducted under subsection
(a); and
(2) recommendations to improve access to effec-
tive care for medicare beneficiaries with chronic con-
ditions.
Æ