116 S618 IS: Medicare Choices Empowerment and Protection Act
U.S. Senate
2019-02-28
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

II116th CONGRESS1st SessionS. 618IN THE SENATE OF THE UNITED STATESFebruary 28, 2019Mr. Coons (for himself, Mr. Cassidy, Mr. Barrasso, and Mr. Bennet) introduced the following bill; which was read twice and referred to the Committee on FinanceA BILLTo amend title XVIII of the Social Security Act to encourage Medicare beneficiaries to voluntarily
			 adopt advance directives guiding the medical care they receive.

 1.Short titleThis Act may be cited as the Medicare Choices Empowerment and Protection Act. 2.Medicare advance directive certification programPart B of title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by adding at the end the following new section:
			1849.Medicare advance directive certification program(a)In general
 (1)Establishment of ProgramThe Secretary shall establish and implement an Advance Directive Certification Program (in this section referred to as the Program) under which the Secretary shall encourage eligible beneficiaries to adopt and maintain certified advance directives to guide the delivery of health care to such beneficiaries. The Secretary shall implement the Program not later than 3 years after the date of enactment of this section.
 (2)DefinitionsIn this section: (A)Certified advance directiveThe term certified advance directive means any electronically stored statement by an eligible beneficiary which—
 (i)provides instructions that outline the kind of medical treatments and care that such beneficiary would want or not want under particular conditions, and may also include the identification of a health care proxy or legal representative to make medical treatment decisions for the beneficiary if the beneficiary becomes unable to make or communicate those decisions;
 (ii)is executed in accordance with the law governing advance directives of the State involved; and (iii)is offered by an entity that has received accreditation from the Secretary under this section.
 (B)Eligible BeneficiaryThe term eligible beneficiary means an individual enrolled under this part. (3)VoluntaryParticipation in the Program shall be voluntary with respect to the eligible beneficiary and an eligible beneficiary who has registered a certified advance directive under the Program may terminate such directive at any time. Nothing in this section shall require an eligible beneficiary to adopt or maintain a certified advance directive.
 (4)Best practicesIn establishing and implementing the Program, the Secretary shall consider— (A)best practices within existing advance directive registry technologies, programs, and systems, including web-based or cloud-based advance directive technologies—
 (i)which may utilize time and date stamps, video, or other innovative measures to protect the authenticity, improve the quality, and enhance the security of such directives; and
 (ii)which may utilize secure email and messaging technologies and nationally recognized health care information technology standards to improve the accessibility and interoperability of such directives; and
 (B)best practices for educating beneficiaries on means for communicating beneficiaries’ authenticated wishes to applicable family members, legal representatives, providers or health care proxies, including the use of email or other mail formats as well as access through mobile devices (as defined by the Secretary).
 (5)Enrollment and disenrollmentThe Secretary shall establish procedures for eligible beneficiaries to enroll and disenroll under the Program. Such procedures shall ensure that enrollment and disenrollment is available through an online process. The Secretary shall also establish procedures to ensure Program participants can update or amend an advance directive in a timely and secure manner.
 (6)State LawThis section shall in no way supercede, abrogate, or otherwise interfere with State law governing advance directives. Under the Program, the Secretary shall establish a process under which the Secretary is required to verify that digital advance directive vendors or other entities providing a digital advance directive participating in the program enable those using their services to complete advance directives that fully comply with the law governing advance directives of the State involved.
 (7)Display of Statutory and Alternative Advance Directive FormsUnder the Program, the Centers for Medicare & Medicaid Services shall provide, through a clearinghouse website, links to statutory and alternative advance directive forms and a State-by-State index to such forms to allow a beneficiary to create, adopt, modify, and terminate an advance directive with any content permitted or required, and in any form authorized by a State, in accordance with the requirements of subparagraphs (C) through (E) of subsection (e)(1) and subsection (e)(2).
 (8)Access in Cases of Dispute over TreatmentUnder the Program: (A)Special AccessThe Secretary shall establish a process whereby, with respect to a beneficiary with a certified advance directive, a person described in subparagraph (B) may obtain access to the beneficiary’s advance directive for the purposes of viewing and sharing such advance directive when—
 (i)the provisions of the advance directive have come into force under the applicable State’s law because the beneficiary has become incapable of making health care decisions or under other circumstances provided under State law; and
 (ii)at least one person described in subparagraph (B) is questioning or disputing the provision, withholding, or withdrawal of medical treatment, food, or fluids with respect to the beneficiary.
 (B)Interested IndividualsA person described in this subparagraph, with respect to a beneficiary, is— (i)any individual who is a member of any class of persons who, under the applicable State’s law, would potentially be eligible to serve as a health care decision maker for the beneficiary if an advance directive had not been executed regardless of whether higher priority for such eligibility would be accorded to another individual or individuals; and
 (ii)if the applicable State’s law does not designate persons or classes of persons described in clause (i), any person related within the third degree of consanguinity or affinity to the beneficiary.
								(b)Registration
 (1)In generalThe Secretary shall establish procedures for an eligible beneficiary to register such beneficiary’s adoption of a certified advance directive under the Program. Such procedures shall ensure that registration is available through an online process. The Secretary shall also establish procedures to ensure Program participants can update previously registered information that is no longer accurate and indicate that an advance directive has been terminated.
 (2)Required informationIn addition to such other information as the Secretary may deem appropriate, an eligible beneficiary seeking to register a certified advance directive under the Program shall indicate where the advance directive is maintained or how it may be accessed.
 (3)Registration periodsThe procedures established under paragraph (1) shall provide that registration under the Program shall occur during—
 (A)an eligible beneficiary’s initial enrollment under an MA plan under part C as described in paragraph (1) of section 1851(e); and
 (B)the annual, coordinated election period under paragraph (3) of such section. (4)Privacy and security (A)In generalThe Secretary shall ensure that all aspects of the registration system comply with the Federal regulations (concerning the privacy of individually identifiable health information) promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 subject to the access authorized under subsection (a)(8), in accordance with subsection (c)(2)(E).
 (B)AccessThe Secretary shall utilize standardized data protections and privacy standards, including the Federal regulations described in paragraph (1), to ensure that the registration record of an eligible beneficiary can only be accessed by—
 (i)the beneficiary, through the process established under paragraph (1); (ii)those authorized to access the advance directive under subsection (a)(8) and subsection (c)(2)(E); and
 (iii)providers of services and suppliers participating under this title, through a process established by the Secretary.
								(c)Accreditation
 (1)In generalUnder the Program, the Secretary shall— (A)grant accreditation to advance directive vendors and other entities providing advance directives that meet the accreditation criteria established under paragraph (2); and
 (B)establish a process whereby advance directive vendors and other entities providing advance directives may obtain accreditation under this subsection.
 (2)Accreditation criteriaThe Secretary, in consultation with the General Accounting Office, shall establish accreditation criteria for advance directive vendors and other entities providing advance directives that seek to offer advance directives to be certified under the Program. Such criteria shall consist of the following:
 (A)Process for adopting advance directiveThe advance directive vendor or other entity providing an advance directive shall allow a beneficiary to create, adopt, modify, and terminate an advance directive through an online process.
 (B)VendorsThe advance directive vendor or other entity providing an advance directive shall comply with an annual quality review to be conducted by the Secretary.
 (C)Use of statutory and alternative advance directive formsThe advance directive vendor or other entity providing an advance directive shall enable a beneficiary to access, complete, modify, and adopt any advance directive applicable to the State indicated by the beneficiary who is posted as provided under subparagraphs (C) through (E) of subsection (e)(1) and of subsection (e)(2).
 (D)AccessThe advance directive vendor or other entity providing an advance directive shall maintain advance directives in such a way that—
 (i)an eligible beneficiary who has adopted an advance directive with such vendor or entity and any family member, legal representative, or health care proxy legally designated by such beneficiary has direct, has near real-time online access to the beneficiary’s advance directive for purposes of viewing and sharing such advance directive, including communication of the advance directive and corresponding beneficiary’s wishes using nationally recognized health care information technology data content and data transport standards specified by the Secretary;
 (ii)in the case of an eligible beneficiary who has adopted an advance directive with such vendor or entity or any family member, legal representative, or health care proxy legally designated by such beneficiary who is unable or unwilling to use the online access under subparagraph (A), such individual is able to obtain a hard copy of the beneficiary’s advance directive for the purposes of viewing and sharing such advance directive; and
 (iii)providers of services and suppliers participating under this title have near real-time online access to the advance directive of an eligible beneficiary who has adopted an advance directive with such vendor or entity, including communication of the advance directive and corresponding beneficiary’s wishes through secure email and messaging technologies and nationally recognized health care information technology standards specified by the Secretary to improve the accessibility and interoperability of such directives.
								(E)Privacy protections
 (i)In generalThe advance directive vendor or other entity providing an advance directive shall comply with the Federal regulations (concerning the privacy of individually identifiable health information) promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d–2 note), subject to the access authorized under subparagraph (D) and subsection (a)(8).
 (ii)AccessSuch vendor or entity shall utilize standardized data protections and privacy standards, including the Federal regulations described in clause (i), to ensure that the content of an eligible beneficiary’s advance directive is owned and maintained by the beneficiary and can only be accessed by those authorized to access the advance directive under subparagraph (D) and subsection (a)(8).
 (F)Security and testingThe advance directive vendor or other entity providing an advance directive shall certify that— (i)all data management and data transfer elements involved in adopting, maintaining, and accessing the advance directive have successfully passed rigorous independent testing regarding standards of timeliness, accuracy, and efficiency;
 (ii)the data management and data transfer elements involved in adopting, maintaining, and accessing the advance directive meet widely accepted industry security standards; and
 (iii)the system that provides access to the advance directive has passed real-time tests simulating a realistic volume of beneficiaries and providers accessing advance directives simultaneously.
 (G)Certified advance directivesThe advance directive vendor or other entity providing an advance directive shall agree to offer certified advance directives (as defined in subsection (a)(2)(A)).
							(H)Beneficiary Surveys
 (i)In generalThe advance directive vendor or other entity providing an advance directive shall agree to administer annual beneficiary surveys on the information described in clause (ii) and submit the results of such surveys to the Centers for Medicare & Medicaid Services.
 (ii)InformationThe information described in this clause, with respect to an annual beneficiary survey and certified advance directive of a beneficiary, is the following:
 (I)Whether the beneficiary had to pay any third party for the creation, storage, or retrieval of the certified advance directive.
 (II)Whether the beneficiary had a health care encounter or emergency that required the location, access, retrieval, or consultation of the certified advance directive and if so, whether the certified advance directive was accessible in online and in near real-time, as required under this section.
 (III)Whether the certified advance directive was actionable. (IV)Whether medical personnel followed the certified advance directive.
									(d)Incentive
 (1)In generalThe Secretary shall make a one-time payment of the amount specified in paragraph (2) to each eligible beneficiary who adopts a certified advance directive and registers such directive with the Program.
						(2)Amount
 (A)In generalFor purposes of paragraph (1), the amount specified in this paragraph is— (i)for a beneficiary who registers a certified advance directive with the Program in 2019, $75; or
 (ii)for a beneficiary who registers a certified advance directive with the Program in a subsequent year, the amount specified in this paragraph for the preceding year increased by the percentage increase in the Chained Consumer Price Index for All Urban Consumers (as published by the Bureau of Labor Statistics of the Department of Labor) over the preceding year.
 (B)RoundingIf any amount determined under subparagraph (A) is not a multiple of 10 cents, such amount shall be rounded to the nearest multiple of 10 cents.
 (3)FundingFor purposes of carrying out this subsection, the Secretary shall provide for the transfer, from the Federal Supplementary Medical Insurance Trust Fund under section 1841, of such sums as the Secretary determines necessary.
 (4)AdministrationThe Secretary shall, through a full notice and comment rulemaking process, establish procedures for—
 (A)making the incentive payment directly to the eligible beneficiary or a personal account maintained by the beneficiary at a financial institution that has been designated by the beneficiary, and ensuring that no other entity receives the payment on the beneficiary’s behalf; and
 (B)ensuring that a beneficiary does not receive an incentive payment under this section more than once.
							(e)Education and outreach
 (1)In generalThe Secretary shall provide for— (A)the inclusion of the statement set forth in paragraph (3) in the Medicare and You handbook under section 1804 and on a clearinghouse website linked to the Internet website of the Centers for Medicare & Medicaid Services;
 (B)the promotion of the benefits of electronic advance directives services, as they become available, through the use of mass communications and other means;
 (C)the inclusion, under the heading Statutory Advance Directive Forms, of any relevant forms, whether mandatory or optional, specified in the statues or regulations of the States to be displayed on a clearinghouse website;
 (D)the inclusion, under the heading Alternative Advance Directive Forms, on a separate clearinghouse website, and in accordance with paragraph (2)— (i)of other advance directive forms submitted to the Secretary by individuals and groups in an electronic format specified by the Secretary for which the submitting entity includes, for each form submitted, an opinion by an attorney licensed to practice in the relevant State demonstrating that the submitted form complies with the law of that State; and
 (ii)of the following disclaimer, which shall be prominently posted on the website: This website includes for your consideration alternative advance directive forms submitted by individuals or groups reflecting different perspectives on advance health care decisions which you may wish to review before completing your own advance directive.; and
 (E)the inclusion of a user-friendly index on the clearinghouse website by State and, in the case of the Alternative Advance Directive Forms, by the name of the provider, so that a user may readily access those statutory and alternative forms.
							(2)Alternative advance directive forms
 (A)In generalFor purposes of paragraph (1)(D), the following shall apply: (i)Not later than 60 days after receiving an advance directive form submitted under such paragraph, the Secretary shall either post the submitted form on a clearinghouse website or provide to the submitting entity a detailed explanation of the basis for the Secretary’s determination that the submitted form does not comply with relevant State or Federal law, which determination shall be subject to judicial review under section 702 of title 5 of the United States Code; and
 (ii)the Secretary shall either remove or refuse to post any submitted form if provided with an official determination by the Attorney General of the applicable State that the form is not in compliance with State law, subject to applicable State law described in subparagraph (B).
 (B)State law describedFor purposes of subparagraph (A), State law described in this subparagraph is— (i)a ruling by a court of the applicable State, or by a Federal court applying that State’s law, subject to subsequent rulings by a court or courts with authority to supercede that ruling; or
 (ii)a statute or regulation of the applicable State that provides for a specific procedure for officially determining whether particular advance directive forms comply with State law.
 (3)StatementFor purposes of paragraph (1)(A), the statement included in this paragraph is the following statement, with appropriate insertions in the bracketed segments updated at least annually:WHY YOU MAY WANT TO CONSIDER AN ADVANCE DIRECTIVE Do you ever worry what would happen if you
			 became unable to make health care decisions for yourself because of an
			 illness or injury? Do you hold certain values and beliefs with respect to
			 your medical treatment that you would want to be upheld if you were unable
			 to convey them yourself? That’s what an advance directive is for. You
			 can use it to give directions for your health care providers and family
			 about your health care wishes that are to be followed if you are no longer
			 able to speak for yourself. You can also name someone you trust, like a
			 family member or friend, to give health care directions for you when you
			 can’t do so yourself.You should consider carefully who to choose to speak for you and what directions you want to give
			 to ensure your representative clearly reflects your own values and
			 treatment preferences. You should not feel pressured to violate your own
			 values and preferences, and you are entitled to implement them without
			 discrimination based on age or degree of disability. There are many resources to help you.By choosing the name of a State at [INSERT name of webpage for the index provided in paragraph
			 (1)(E) of
			 this subsection and its URL (and, on the clearinghouse website, include a
			 hyperlink to it)], you can find sample advance directives for that State.
			 You can see any sample or required forms given in State law, as well as
			 others from individuals or groups with different viewpoints on advance
			 health care decisions which you may wish to review before completing your
			 own advance directive.Below is contact information for the accredited vendor in your State who will arrange for your
			 advance directive to be confidentially kept online, where it can be seen
			 by doctors who are treating you so they are made aware of your wishes. You
			 can also give permission to certain other people, like family members or
			 friends, you want to be able to get a copy of your advance directive. If a
			 disagreement about your treatment develops, depending on your State’s law
			 certain other people may also be allowed to see it.This vendor can also help you create an advance directive online or with paper documents, if you
			 wish. Online directives allow you to change or cancel one that no longer
			 fits with your wishes in a more timely manner.[INSERT, name and contact information for currently accredited advance directive vendor (and, on
			 the clearinghouse website, hyperlinks to their website).]Although any adult who is capable of doing so can use these resources to complete an advance
			 directive at any time, Medicare beneficiaries are particularly encouraged
			 to do so when enrolling in Medicare or during the annual enrollment period
			 when you can choose among different Medicare health insurance
			 alternatives.In addition, some Medicare Advantage plans or supplemental insurance plans may offer a financial
			 incentive or other additional benefits for creating an advance directive
			 online.By completing an advance directive you can not only make it more likely that your wishes about
			 health care will be known if you are unable to tell them at the time, but
			 also spare family, friends, and doctors the difficulty of trying to figure
			 out what you would have wanted. These are matters of the highest
			 importance that can affect life-or-death decisions, as well as your future
			 comfort and well-being. You are encouraged to think about them carefully,
			 and give serious consideration to recording your wishes in an advance
			 directive..


		II
		111th CONGRESS
		1st Session
		S. 571
		IN THE SENATE OF THE UNITED STATES

			March 11, 2009
			Mr. Menendez (for
			 himself, Mr. Wyden,
			 Mr. Kerry, Mr.
			 Casey, and Mr. Dodd)
			 introduced the following bill; which was read twice and referred to the
			 Committee on Health, Education, Labor,
			 and Pensions

		A BILL
		To strengthen the Nation's research efforts to identify
		  the causes and cure of psoriasis and psoriatic arthritis, expand psoriasis and
		  psoriatic arthritis data collection, and study access to and quality of care
		  for people with psoriasis and psoriatic arthritis, and for other purposes.

		1.Short titleThis Act may be cited as the
			 Psoriasis and Psoriatic Arthritis
			 Research, Cure, and Care Act of 2009.
		2.Table of
			 contentsThe table of contents
			 for this Act is as follows:

				Sec. 1. Short title.
				Sec. 2. Table of contents.
				Sec. 3. Findings.
				Sec. 4. Expansion of biomedical research.
				Sec. 5. Psoriasis and psoriatic arthritis data collection and
				national patient registry.
				Sec. 6. National summit.
				Sec. 7. Study and report by the Institute of
				Medicine.
				Sec. 8. Authorization of appropriations.

		3.FindingsThe Congress finds as follows:
			(1)Psoriasis and
			 psoriatic arthritis are autoimmune, chronic, inflammatory, painful,
			 disfiguring, and life-altering diseases that require lifelong sophisticated
			 medical intervention and care and have no cure.
			(2)Psoriasis and
			 psoriatic arthritis affect as many as 7,500,000 men, women, and children of all
			 ages and have an adverse impact on the quality of life for virtually all
			 affected.
			(3)Psoriasis often is
			 overlooked or dismissed because it does not cause death. Psoriasis is commonly
			 and incorrectly considered by insurers, employers, policymakers, and the public
			 as a mere annoyance, a superficial problem, mistakenly thought to be contagious
			 and due to poor hygiene. Treatment for psoriasis often is categorized, wrongly,
			 as life-style and not medically necessary.
			(4)Psoriasis goes
			 hand-in-hand with myriad co-morbidities such as Crohn’s disease, diabetes,
			 metabolic syndrome, obesity, hypertension, heart attack, cardiovascular
			 disease, liver disease, and psoriatic arthritis, which occurs in 10 to 30
			 percent of people with psoriasis.
			(5)The National
			 Institute of Mental Health funded a study that found that psoriasis may cause
			 as much physical and mental disability as other major diseases, including
			 cancer, arthritis, hypertension, heart disease, diabetes, and
			 depression.
			(6)Psoriasis is
			 associated with elevated rates of depression and suicidal ideation.
			(7)The risk of premature death is 50 percent
			 higher for individuals with severe psoriasis than for individuals without any
			 form of psoriasis.
			(8)Total direct and
			 indirect health care costs of psoriasis are calculated at over $11,250,000,000
			 annually with work loss accounting for 40 percent of the cost burden.
			(9)Early diagnosis
			 and treatment of psoriatic arthritis may help prevent irreversible joint
			 damage.
			(10)Treating
			 psoriasis and psoriatic arthritis presents a challenge for patients and their
			 health care providers because no one treatment works for everyone, some
			 treatments lose effectiveness over time, many treatments are used in
			 combination with others, and all treatments may cause a unique set of side
			 effects.
			(11)Although new and
			 more effective treatments finally are becoming available, too many people do
			 not yet have access to the types of therapies that may make a significant
			 difference in the quality of their lives.
			(12)Psoriasis and
			 psoriatic arthritis constitute a significant national health issue that
			 deserves a comprehensive and coordinated response by Federal and State
			 governments with involvement of the health care provider, patient, and public
			 health communities.
			4.Expansion of
			 biomedical research
			(a)In
			 GeneralThe Secretary of Health and Human Services (in this Act
			 referred to as the Secretary), acting through the Director of
			 the National Institutes of Health, shall continue to expand and intensify
			 research and related activities of the Institutes with respect to psoriasis and
			 psoriatic arthritis.
			(b)Research by
			 National Institute of Arthritis and Musculoskeletal and Skin Diseases
				(1)In
			 generalThe directors of the National Institute of Arthritis and
			 Musculoskeletal and Skin Diseases and the National Institute of Allergy and
			 Infectious Diseases shall continue to conduct and support research to expand
			 understanding of the causes of, and to find a cure for, psoriasis and psoriatic
			 arthritis, including the following:
					(A)Basic research to
			 discover the pathogenesis and pathophysiology of the disease.
					(B)Expansion of
			 molecular biology and immunology studies, including additional animal
			 models.
					(C)Global association
			 mapping with single nucleotide polymorphisms.
					(D)Identification of
			 environmental triggers and autoantigens in psoriasis.
					(E)Elucidation of
			 specific immunologic cells and their products involved.
					(F)Pharmacogenetic
			 studies to understand the molecular basis for varying patient response to
			 treatment.
					(G)Identification of
			 genetic markers of psoriatic arthritis susceptibility.
					(H)Research to
			 increase understanding of joint inflammation and destruction in psoriatic
			 arthritis.
					(I)Investigator-initiated
			 clinical research for the development and evaluation of new treatments,
			 including new biological agents.
					(J)Research to
			 develop enhanced diagnostic tests that allow for earlier diagnosis of psoriasis
			 and improved outcomes.
					(K)Research to increase
			 understanding of the epidemiology and pathophysiology of co-morbidities
			 associated with psoriasis, including shared molecular pathways.
					(2)Coordination
			 with other institutesIn
			 carrying out paragraph (1), the directors of the National Institute of
			 Arthritis and Musculoskeletal and Skin Diseases and the National Institute of
			 Allergy and Infectious Diseases shall coordinate the activities of such
			 Institutes with the activities of other national research institutes and other
			 agencies and offices of the National Institutes of Health relating to psoriasis
			 or psoriatic arthritis.
				5.Psoriasis and
			 psoriatic arthritis data collection and national patient registryThe Secretary, acting through the Director
			 of the Centers for Disease Control and Prevention and in collaboration with a
			 national organization serving people with psoriasis and psoriatic arthritis,
			 shall undertake psoriasis and psoriatic arthritis data collection and develop a
			 psoriasis and psoriatic arthritis patient registry.
		6.National
			 summit
			(a)In
			 GeneralNot later than one year after the date of the enactment
			 of this Act, the Secretary is encouraged to convene a summit on the Federal
			 Government’s current and future efforts, and the initiatives necessary to fill
			 any gaps, with respect to the conduct or support of psoriasis and psoriatic
			 arthritis research, treatment, education, quality-of-life, and data collection
			 activities. The summit should also address psoriasis and psoriatic arthritis
			 related co-morbidities and should include researchers, public health
			 professionals, representatives of voluntary health agencies and patient
			 advocacy organizations, representatives of academic institutions,
			 representatives from the pharmaceutical and medical research industry, and
			 Federal and State policymakers, including representatives of the Agency for
			 Healthcare Research and Quality, the Centers for Disease Control and
			 Prevention, the Food and Drug Administration, and the National Institutes of
			 Health.
			(b)FocusThe
			 summit convened under this section should focus on—
				(1)a
			 broad range of research activities relating to biomedical, epidemiological,
			 psychosocial, and rehabilitative issues;
				(2)clinical research
			 for the development and evaluation of new treatments, including new biological
			 agents;
				(3)translational
			 research;
				(4)information and
			 education programs for health care professionals and the public;
				(5)priorities among
			 the programs and activities of the various Federal agencies involved in
			 psoriasis and psoriatic arthritis and related co-morbidities; and
				(6)challenges,
			 opportunities, and recommendations for scientists, clinicians, patients, and
			 voluntary organizations.
				(c)Report to
			 CongressNot later than 180 days after the first day of the
			 summit convened under this section, the Secretary shall submit to the Congress
			 and make publicly available a report that includes a description of—
				(1)the proceedings at
			 the summit; and
				(2)recommendations
			 related to the research, treatment, education, and quality-of-life activities
			 conducted or supported by the Federal Government with respect to psoriasis and
			 psoriatic arthritis, including psoriasis and psoriatic arthritis related
			 co-morbidities.
				7.Study and report
			 by the Institute of Medicine
			(a)In
			 GeneralThe Secretary shall enter into an agreement with the
			 Institute of Medicine to conduct a study on the following:
				(1)The extent to
			 which public and private insurers cover prescription medications and other
			 treatments for psoriasis and psoriatic arthritis.
				(2)The payment
			 structures, such as deductibles and co-payments, and the amounts and duration
			 of coverage under health plans and their adequacy to cover the costs of
			 providing ongoing care to, and ensure access for, patients with psoriasis and
			 psoriatic arthritis.
				(3)Health plan and
			 insurer coverage policies and practices, including lifetime caps, and their
			 impact on the access of such patients to the best regimen and most appropriate
			 care for their particular disease state.
				(b)ReportThe
			 agreement entered into under subsection (a) shall provide for the Institute of
			 Medicine to submit to the Secretary and the Congress, not later than 18 months
			 after the date of the enactment of this Act, a report containing a description
			 of—
				(1)the results of the
			 study conducted under this section; and
				(2)the conclusions
			 and recommendations of the Institutes of Medicine regarding each of the issues
			 described in paragraphs (1) through (3) of subsection (a).
				8.Authorization of
			 appropriationsTo carry out
			 this Act, there are authorized to be appropriated such sums as may be necessary
			 for each of fiscal years 2010 through 2014.


		I
		111th CONGRESS
		1st Session
		H. R. 3030
		IN THE HOUSE OF REPRESENTATIVES

			June 24, 2009
			Mr. Walz (for himself
			 and Ms. Ginny Brown-Waite of Florida)
			 introduced the following bill; which was referred to the
			 Committee on Ways and
			 Means, and in addition to the Committee on
			 Energy and Commerce, for
			 a period to be subsequently determined by the Speaker, in each case for
			 consideration of such provisions as fall within the jurisdiction of the
			 committee concerned

		A BILL
		To establish pilot projects under the Medicare Program to
		  provide incentives for home health agencies to utilize home monitoring and
		  communications technologies.

		1.Short titleThis Act may be cited as the
			 Fostering Independence Through
			 Technology Act of 2009.
		2.Remote monitoring
			 pilot projects
			(a)Pilot
			 Projects
				(1)In
			 generalNot later than 9 months after the date of enactment of
			 this Act, the Secretary of Health and Human Services (in this section referred
			 to as the Secretary) shall conduct pilot projects under title
			 XVIII of the Social Security Act for the purpose of providing incentives to
			 home health agencies to utilize home monitoring and communications technologies
			 that—
					(A)enhance health
			 outcomes for Medicare beneficiaries; and
					(B)reduce
			 expenditures under such title.
					(2)Site
			 requirements
					(A)Urban and
			 ruralThe Secretary shall conduct the pilot projects under this
			 section in both urban and rural areas.
					(B)Site in a small
			 stateThe Secretary shall conduct at least 1 of the pilot
			 projects in a State with a population of less than 1,000,000.
					(3)Definition of
			 home health agencyIn this section, the term home health
			 agency has the meaning given that term in section 1861(o) of the Social
			 Security Act (42 U.S.C. 1395x(o)).
				(b)Medicare
			 Beneficiaries Within the Scope of ProjectsThe Secretary shall
			 specify the criteria for identifying those Medicare beneficiaries who shall be
			 considered within the scope of the pilot projects under this section for
			 purposes of the application of subsection (c) and for the assessment of the
			 effectiveness of the home health agency in achieving the objectives of this
			 section. Such criteria may provide for the inclusion in the projects of
			 Medicare beneficiaries who begin receiving home health services under title
			 XVIII of the Social Security Act after the date of the implementation of the
			 projects.
			(c)Incentives
				(1)Performance
			 targetsThe Secretary shall establish for each home health agency
			 participating in a pilot project under this section a performance target using
			 one of the following methodologies, as determined appropriate by the
			 Secretary:
					(A)Adjusted
			 historical performance targetThe Secretary shall establish for
			 the agency—
						(i)a
			 base expenditure amount equal to the average total payments made to the agency
			 under parts A and B of title XVIII of the Social Security Act for Medicare
			 beneficiaries determined to be within the scope of the pilot project in a base
			 period determined by the Secretary; and
						(ii)an
			 annual per capita expenditure target for such beneficiaries, reflecting the
			 base expenditure amount adjusted for risk and adjusted growth rates.
						(B)Comparative
			 performance targetThe Secretary shall establish for the agency a
			 comparative performance target equal to the average total payments under such
			 parts A and B during the pilot project for comparable individuals in the same
			 geographic area that are not determined to be within the scope of the pilot
			 project.
					(2)IncentiveSubject
			 to paragraph (3), the Secretary shall pay to each participating home care
			 agency an incentive payment for each year under the pilot project equal to a
			 portion of the Medicare savings realized for such year relative to the
			 performance target under paragraph (1).
				(3)Limitation on
			 expendituresThe Secretary shall limit incentive payments under
			 this section in order to ensure that the aggregate expenditures under title
			 XVIII of the Social Security Act (including incentive payments under this
			 subsection) do not exceed the amount that the Secretary estimates would have
			 been expended if the pilot projects under this section had not been
			 implemented.
				(d)Waiver
			 AuthorityThe Secretary may waive such provisions of titles XI
			 and XVIII of the Social Security Act as the Secretary determines to be
			 appropriate for the conduct of the pilot projects under this section.
			(e)Report to
			 CongressNot later than 5 years after the date that the first
			 pilot project under this section is implemented, the Secretary shall submit to
			 Congress a report on the pilot projects. Such report shall contain a detailed
			 description of issues related to the expansion of the projects under subsection
			 (f) and recommendations for such legislation and administrative actions as the
			 Secretary considers appropriate.
			(f)ExpansionIf
			 the Secretary determines that any of the pilot projects under this section
			 enhance health outcomes for Medicare beneficiaries and reduce expenditures
			 under title XVIII of the Social Security Act, the Secretary may initiate
			 comparable projects in additional areas.
			(g)Incentive
			 Payments Have No Effect on Other Medicare Payments to AgenciesAn
			 incentive payment under this section—
				(1)shall be in
			 addition to the payments that a home health agency would otherwise receive
			 under title XVIII of the Social Security Act for the provision of home health
			 services; and
				(2)shall have no
			 effect on the amount of such payments.