I 
111TH CONGRESS 
1ST SESSION H. R. 2773 
To amend title XVIII of the Social Security Act to cover transitional care 
services to improve the quality and cost effectiveness of care under 
the Medicare Program. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 9, 2009 
Mr. BLUMENAUER (for himself, Mr. BOUSTANY, Mrs. CAPPS, and Mr. MASSA) 
introduced the following bill; which was referred to the Committee on En-
ergy and Commerce, and in addition to the Committee on Ways and 
Means, 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 cover 
transitional care services to improve the quality and cost 
effectiveness of care under the Medicare Program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Transitional 
Care Act of 2009’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) More than 20 percent of older Americans 
suffer from five or more chronic conditions and 
these older adults typically require health care serv-
ices from numerous providers across several care 
settings each year. 
(2) Insufficient communication among older 
adults, family caregivers, and health care providers 
contributes to poor continuity of care, inadequate 
management of complex health care needs, and pre-
ventable hospital admissions. 
(3) Research suggests that family caregivers 
often lack the knowledge, skills, and resources to ef-
fectively address the complex needs of older adults 
coping with multiple coexisting conditions. 
(4) In 2005, health care services for Medicare 
beneficiaries with five or more chronic conditions ac-
counted for 75 percent of total Medicare spending. 
The vast majority of these costs were due to high 
rates of hospital admission and readmission. 
(5) According to Medicare claims data from 
2003–2004, almost one fifth (19.6 percent) of the 
11,855,702 Medicare beneficiaries who had been dis-
charged from a hospital were rehospitalized within 
30 days, and 34.0 percent were rehospitalized within 
90 days. 
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(6) A New England Journal of Medicine study 
estimates that the cost to Medicare of unplanned re-
hospitalizations in 2004 was $17.4 billion. 
(7) The MetLife Caregiving Cost Study dem-
onstrates that American businesses lose an esti-
mated $34 billion each year due to employees’ need 
to care for loved ones. 
(8) The Transitional Care Model, developed by 
the University of Pennsylvania, is a care manage-
ment strategy that identifies patients’ health goals, 
coordinates care throughout acute episodes of illness, 
develops a streamlined plan of care to prevent future 
hospitalizations, and prepares the beneficiary and 
family caregivers to implement this care plan. 
(9) The major goal of the Transitional Care 
Model is to interrupt cycles of avoidable hospitaliza-
tions and promote longer-term positive health out-
comes. 
(10) The Transitional Care Model has shown 
through multiple randomized clinical trials to 
produce significant health outcome improvements, 
reductions in health care costs among at-risk and 
chronically ill older adults, and increased patient 
satisfaction. 
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(11) Preliminary results from a clinical trial of 
the Guided Care Model (based on a Medical Home 
which includes transitional care) demonstrated re-
ductions in hospital days, skilled nursing facility 
days, and home health episodes, as well as prelimi-
nary findings of net savings. 
(12) A clinical trial of the Care Transitions 
Intervention demonstrated lower re-hospitalization 
rates and lower hospital costs per patient. 
SEC. 3. MEDICARE COVERAGE OF TRANSITIONAL CARE. 
Title XVIII of the Social Security Act is amended by 
adding at the end the following new section: 
‘‘COVERAGE OF TRANSITIONAL CARE SERVICES FOR 
QUALIFIED INDIVIDUALS 
‘‘SEC. 1899. (a) COVERAGE UNDER PART B.— 
‘‘(1) IN GENERAL.—In the case of a qualified 
individual (as defined in subsection (b)), the Sec-
retary shall provide under part B for benefits for 
transitional care services (as defined in subsection 
(c)) furnished by a transitional care clinician (as de-
fined in subsection (d)) acting as an employee of (or 
pursuant to a contract with) a qualified transitional 
care entity (as defined in paragraph (3)(A)) in ac-
cordance with this section during the transitional 
care period (as defined in paragraph (3)(B)) for the 
qualified individual. 
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‘‘(2) INITIAL
IMPLEMENTATION.—The Sec-
retary shall first implement this section for services 
furnished on or after January 1, 2010. 
‘‘(3) GENERAL DEFINITIONS.—In this section: 
‘‘(A) QUALIFIED TRANSITIONAL CARE EN-
TITY.—The term ‘qualified transitional care en-
tity’ means— 
‘‘(i) a hospital or a critical care hos-
pital; 
‘‘(ii) a home health agency; 
‘‘(iii) a primary care practice; 
‘‘(iv) a federally qualified health cen-
ter; or 
‘‘(v) another entity approved by the 
Secretary for purposes of this section. 
‘‘(B) TRANSITIONAL CARE PERIOD.—The 
term ‘transitional care period’ means, with re-
spect to a qualified individual, the period— 
‘‘(i) beginning on the date the indi-
vidual is admitted to a subsection (d) hos-
pital (as defined for purposes of section 
1886) for inpatient hospital services, or is 
admitted to a critical care hospital for in-
patient critical access hospital services, for 
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which payment may be made under this 
title; and 
‘‘(ii) ending on the last day of the 90- 
day period beginning on the date of the in-
dividual’s discharge from such hospital or 
critical care hospital. 
‘‘(b) QUALIFIED INDIVIDUALS.— 
‘‘(1) LIMITING FIRST PHASE OF IMPLEMENTA-
TION TO HIGH-RISK INDIVIDUALS.—Except as pro-
vided in this subsection, qualified individuals are 
limited to individuals who— 
‘‘(A) have been admitted to a subsection 
(d) hospital (as defined for purposes of section 
1886) for inpatient hospital services or to a 
critical care hospital for inpatient critical access 
hospital services; and 
‘‘(B) are identified by the Secretary as 
being at highest risk for readmission or for a 
poor transition from such a hospital to a post- 
hospital site of care. 
The identification under subparagraph (B) shall be 
based on achieving a minimum hierarchical condition 
category score (specified by the Secretary) in order 
to target eligibility for benefits under this section to 
individuals with multiple chronic conditions and 
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