,,ii #aacth ,,congress #ast ,session ,s4 #abbh ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #bf1 #bjac ,mr4 ,wyden 7for himself and ,mr4 ,portman7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to establish a program to provide incentive payments to participating ,medicare beneficiaries who voluntarily establish and maintain better health4 #a4 ,short title ,this ,act may be cited as the ,medicare ,better ,health ,rewards ,program ,act of #bjac4 #b4 ,medicare ,better ,health ,rewards ,program ,part ,b of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;j et seq47 is amended by adding at the end the following new section3 #ahdi4 ,medicare ,better ,health ,rewards ,program 7a7 ,in general ,the ,secretary shall establish a ,better ,health ,rewards ,program 7in this section referred to as the ,program7 under which incentives are provided to ,medicare beneficiaries who voluntarily agree to participate in the ,program4 7b7 ,enrollment ,a health professional participating in the ,program shall provide their patients who are ,medicare beneficiaries with a description of and an opportunity to enroll in the ,program on a voluntary basis4 ,if a ,medicare beneficiary elects to enroll in the ,program1 the health professional shall inform the ,secretary of the individual's enrollment through a process established by the ,secretary1 which does not impose additional administrative requirements on the participating health professional4 7c7 ,establishment of better health target standards 7#a7 ,in general 7,a7 ,establishment ,the ,secretary shall establish standards for measuring better health targets and points for achieving such standards for participating ,medicare beneficiaries1 including such standards and points with respect to the following3 7i7 ,annual wellness visit4 7ii7 ,tobacco cessation4 7iii7 ,body ,mass ,index 7,,bmi74 7iv7 ,diabetes screening test4 7v7 ,cardiovascular disease screening4 7vi7 ,cholesterol level screening4 7vii7 ,screening tests and specified vaccinations4 7,b7 ,consultation ,in establishing standards and points for achieving such standards under this subsection1 the ,secretary-- 7i7 shall consult with #a or more nationally recognized health care quality organizations1 as determined appropriate by the ,secretary2 and 7ii7 may consult with physicians and other professionals experienced with wellness programs4 7,c7 ,points ,the number of points awarded for a year for achieving standards with respect to each of the targets described in clauses 7i7 through 7vii7 of subparagraph 7,a7 shall not exceed #e4 ,such points may be awarded on a sliding scale1 based on standards established under this subsection1 as determined appropriate by the ,secretary4 7#b7 ,modification of better health target standards and assigned points 7,a7 ,in general ,the ,secretary may modify standards for measuring better health targets and1 subject to paragraph 7#a77;,c71 points for achieving such standards for participating ,medicare beneficiaries under this subsection4 7,b7 ,consultation ,in modifying standards and points for achieving such standards under this paragraph1 the ,secretary-- 7i7 shall consult with #a or more nationally recognized health care quality organizations1 as determined appropriate by the ,secretary2 and 7ii7 may consult with physicians and other professionals experienced with wellness programs4 7d7 ,conduct of program 7#a7 ,duration 7,a7 ,in general ,subject to subparagraph 7,b71 the ,program shall be conducted for not less than a #c-year period4 7,b7 ,expansion ,the ,secretary shall expand the duration and scope of the ,program1 to the extent determined appropriate by the ,secretary1 if-- 7i7 the ,secretary determines that such expansion is expected to-- 7,i7 reduce spending under this title without reducing the quality of care2 or 7,,ii7 improve the quality of care and reduce spending2 7ii7 the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services certifies that such expansion would reduce program spending under this title2 and 7iii7 the ,secretary determines that such expansion would not deny or limit the coverage or provision of benefits under this title for individuals4 7#b7 ,collection and use of baseline data ,during the first year of the ,program1 a health professional shall establish and report to the ,secretary baseline information for each participating ,medicare beneficiary who is a patient of the health professional as part of that beneficiary's first year assessment under paragraph 7#c77;,a74 ,the health professional shall use such data to aid in the determination of whether and to what extent the participating ,medicare beneficiary is meeting the target standards under subsection 7c7 in each of years #b and #c of the ,program4 7#c7 ,required assessments for participating ,medicare beneficiaries 7,a7 ,first year ,during year #a of the ,program1 a health professional shall furnish to each participating ,medicare beneficiary that is a patient of the health professional either an annual wellness visit or an initial preventive physical examination4 7,b7 ,second and third years ,during each of years #b and #c of the ,program1 a health professional shall furnish to each participating ,medicare beneficiary that is a patient of the health professional an annual wellness visit to determine whether and to what extent the participating ,medicare beneficiary has met the target standards under subsection 7c74 7e7 ,determination of points and payment of incentives 7#a7 ,determination of points ,during each of years #b and #c of the ,program1 a health professional shall-- 7,a7 evaluate and report to the ,secretary whether each participating ,medicare beneficiary that is a patient of the health professional has achieved the target standards under subsection 7c72 and 7,b7 determine the total amount of points that each such participating ,medicare beneficiary has achieved for the year based on the points assigned for achieving such standards under subsection 7c74 7#b7 ,incentive payment 7,a7 ,in general ,the ,secretary shall pay to each participating ,medicare beneficiary who achieves at least #bj points under paragraph 7#a77;,b7 for the year an incentive payment4 ,such payment shall be equal to an amount determined appropriate by the ,secretary1 but no case shall such amount exceed the following3 ,points,year #b ,payment ,amount,year #c or a ,subsequent ,year ,payment ,amount #bj-bd points#ajjbjj #be or more points#bjjdjj4 7,b7 ,inflation adjustment ,the dollar amounts specified in this paragraph shall be increased1 beginning with #bjag1 from year to year based on the percentage increase in the consumer price index for all urban consumers 7all items2 ,united ,states city average71 rounded to the nearest #a4 7#c7 ,final determination of standards achievement made by participating health professional ,under the ,program1 a participating health professional shall make the final determination as to whether or not a participating ,medicare beneficiary has met the target standards under subsection 7c7 and what screening tests and specified vaccinations1 or other services1 are necessary for purposes of making such determination4 7f7 ,spending benchmarks 7#a7 ,in general ,the ,secretary shall collect relevant data1 including data on claims paid under this title for services furnished to participating ,medicare beneficiaries during the ,program1 for purposes of determining the aggregate estimated savings achieved under this title for participating ,medicare beneficiaries during each of years #b and #c of the ,program in accordance with paragraph 7#b7 7and for a subsequent year if the ,program is expanded under subsection 7d77#a77;,b774 7#b7 ,determination of aggregate estimated savings 7,a7 ,in general ,the amount of the aggregate estimated savings under this title for participating ,medicare beneficiaries under paragraph 7#a71 with respect to a year1 shall be equal to-- 7i7 the estimated savings determined under subparagraph 7,b7 for the year2 minus 7ii7 the aggregate incentive payments made under the ,program during the year4 7,b7 ,determination of estimated savings ,for purposes of subparagraph 7,a77i71 the estimated savings determined under this subparagraph for a year shall be equal to-- 7i7 the estimated aggregate expenditures under this title 7as projected under subparagraph 7,c77 for the year2 minus 7ii7 the actual aggregate expenditures under this title 7as determined by the ,secretary and taking into account any reduction in specific health risks of the participating ,medicare beneficiaries7 for the year4 7,c7 ,projection of estimated aggregate claims cost 7i7 ,benchmark base year ,the ,secretary shall establish a benchmark base year amount of expenditures under this title for participating ,medicare beneficiaries during year #a of the ,program4 7ii7 ,projection ,the ,secretary shall use the benchmark base year amount established under clause 7i7 to project the estimated aggregate expenditures for all participating ,medicare beneficiaries during each of years #b and #c of the ,program as if the beneficiaries were not participating in the ,program4 ,in making such projection1 the ,secretary may include adjustments for health status or other specific risk factors and geographic variation for the participating ,medicare beneficiaries4 7,d7 ,public report of determination and other ,program information ,not later than #ij days after determining the aggregate estimated savings 7if any7 under subparagraph 7,a7 with respect to a year1 the ,secretary shall make available to the public a report containing a description of the amount of the savings determined1 including the methodology and any other calculations or determinations involved in the determination of such amount4 ,such report shall include-- 7i7 a description of any reduction in specific health risks of participating ,medicare beneficiaries identified by the ,secretary2 7ii7 a description of-- 7,i7 standards for measuring better health targets under subsection 7c72 and 7,,ii7 the points available for achieving each such standard under that subsection2 and 7iii7 recommendations for such legislation and administrative action as the ,secretary determines appropriate4 7#c7 ,monitoring of ,program costs ,during the operation of the ,program1 the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services shall-- 7,a7 monitor the ,program to determine whether or not the ,program is reducing aggregate expenditures under this title2 and 7,b7 submit to the ,secretary an annual report on the results of such monitoring4 7#d7 ,required action if aggregate incentive payments exceed savings ,if the ,secretary1 taking into account the reports under paragraph 7#c77;,b71 determines that the aggregate expenditures under this title exceed the aggregate expenditures under this title that would have been made if the ,program had not been implemented1 the ,secretary shall provide for changes to the provisions of the program in order to eliminate such excess4 7g7 ,waiver authority ,the ,secretary may waive such requirements of titles ,,xi and ,,xviii as may be necessary to carry out the purposes of the ,program established under this section4 7h7 ,definitions ,in this section3 7#a7 ,annual wellness visit ,the term annual wellness visit includes personalized prevention plan services 7as defined in section #ahfa7;hhh77#a774 7#b7 ,health professional ,the term health professional includes a physician 7as defined in section #ahfa7r77#a77 and a practitioner described in clause 7i7 of section #ahdb7;b77#ah77;,c74 7#c7 ,initial preventive physical examination ,the term initial preventive physical examination has the meaning given that term in section #ahfa7ww77#a74 7#d7 ,medicare beneficiary ,the term ,medicare beneficiary means an individual enrolled in part ,b4 7#e7 ,participating ,medicare beneficiary ,the term participating ,medicare beneficiary means a ,medicare beneficiary who enrolls in the ,program under subsection 7b74 7#f7 ,screening tests ,the term screening tests means any of the following that are determined by a health professional to be appropriate for a participating ,medicare beneficiary3 7,a7 ,colorectal cancer screening tests 7as defined in section #ahfa7pp774 7,b7 ,screening mammography 7as described in section #ahfa7;jj774 7,c7 ,screening pap smear and screening pelvic exam 7as defined in section #ahfa7nn774 7,d7 ,screening for glaucoma 7as defined in section #ahfa7uu774 7,e7 ,bone mass measurement 7as defined in section #ahfa7rr77 for qualified individuals described in paragraph 7#b77;,a7 of such section4 7,f7 ,,hiv screening for high-risk groups 7as identified by the ,secretary74 7#g7 ,specified vaccinations ,the term specified vaccinations means the vaccinations described in section #ahfa7ww77#a7 that are determined by a health professional to be appropriate for a participating ,medicare beneficiary4 4 #c4 ,participation by ,medicare ,advantage plans ,section #ahei of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7 is amended by adding at the end the following new subsection3 7h7 ,providing incentives for voluntary participation in a ,better ,health ,rewards ,program 7#a7 ,in general ,effective for plan years beginning on or after the date of enactment of the ,medicare ,better ,health ,rewards ,program ,act of #bjac1 a ,medicare ,advantage organization may provide to individuals enrolled in an ,,ma plan offered by the organization incentive payments1 including cash1 cash-equivalent1 or other types of incentives1 for voluntary participation in a ,better ,health ,rewards ,program 7in this subsection referred to as the ,program7 that rewards individuals for meeting certain health targets established by the ,secretary4 7#b7 ,limitation ,in no case shall the monthly bid amount submitted by a ,medicare ,advantage organization under section #ahcd7;a77#f7 7or the monthly premium charged by the organization under section #ahed7;b77 with respect to an ,,ma plan offered by the organization take into account any incentive payments made to enrollees under the ,program4 7#c7 ,implementation ,the ,program under this subsection shall be conducted in a similar manner to the manner in which the program under section #ahdi is conducted1 in accordance with standards established by the ,secretary4 7#d7 ,notification and provision of information ,a ,medicare ,advantage organization seeking to participate in the ,program shall-- 7,a7 notify the ,secretary of the organization's intent to participate in the ,program2 and 7,b7 agree to provide to the ,secretary-- 7i7 information regarding-- 7,i7 which enrollees participate in the ,program2 7,,ii7 the scores of those enrollees with respect to applicable health targets under the ,program2 and 7,,iii7 the incentives enrollees receive for meeting such health targets2 and 7ii7 any other information specified by the ,secretary for purposes of this subsection4 7#e7 ,waiver authority ,the ,secretary may waive such requirements of titles ,,xi and ,,xviii as may be necessary to carry out the purposes of the ,program established under this subsection4 4 #d4 ,participation of section #ahgf cost plans ,section #ahgf of the ,social ,security ,act 7#db ,u4,s4,c4 #aciemm7 is amended by inserting at the end the following3 7l7 ,providing incentives for voluntary participation in a ,better ,health ,rewards ,program 7#a7 ,in general ,effective for contract periods beginning on or after the date of enactment of the ,medicare ,better ,health ,rewards ,program ,act of #bjac1 an eligible organization may provide to members enrolled under this section with the organization incentive payments1 including cash1 cash-equivalent1 or other types of incentives1 for voluntary participation in a ,better ,health ,rewards ,program 7in this subsection referred to as the ,program7 that rewards members for meeting certain health targets established by the ,secretary4 7#b7 ,limitation ,in no case shall the payment to an eligible organization under this section 7or the premium rate charged by the organization under this section7 with respect to members enrolled with the organization take into account any incentive payments made to members under the ,program4 7#c7 ,implementation ,the ,program under this subsection shall be conducted in a similar manner to the manner in which the program under section #ahdi is conducted1 in accordance with standards established by the ,secretary4 7#d7 ,notification and provision of information ,an eligible organization seeking to participate in the ,program shall-- 7,a7 notify the ,secretary of the organization's intent to participate in the ,program2 and 7,b7 agree to provide to the ,secretary-- 7i7 information regarding-- 7,i7 which members participate in the ,program2 7,,ii7 the scores of those members with respect to applicable health targets under the ,program2 and 7,,iii7 the incentives members receive for meeting such health targets2 and 7ii7 any other information specified by the ,secretary for purposes of this subsection4 7#e7 ,waiver authority ,the ,secretary may waive such requirements of titles ,,xi and ,,xviii as may be necessary to carry out the purposes of the ,program established under this subsection4 4 #e4 ,participation of programs of all-inclusive care for the elderly 7,,pace7 7a7 ,medicare ,section #ahid of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;eee7 is amended by inserting at the end the following3 7j7 ,providing incentives for voluntary participation in a ,better ,health ,rewards ,program 7#a7 ,in general ,effective for ,,pace program agreements entered into on or after the date of enactment of the ,medicare ,better ,health ,rewards ,program ,act of #bjac1 a ,,pace provider may provide to ,,pace program eligible individuals enrolled under this section with the ,,pace provider incentive payments1 including cash1 cash-equivalent1 or other types of incentives1 for voluntary participation in a ,better ,health ,rewards ,program 7in this subsection referred to as the ,program7 that rewards enrollees for meeting certain health targets established by the ,secretary4 7#b7 ,limitation ,in no case shall the payment to a ,,pace provider under this section 7or any premium charged by the provider under this section7 with respect to ,,pace program eligible individuals enrolled with the ,,pace provider take into account any incentive payments made to individuals under the ,program4 7#c7 ,implementation ,the ,program under this subsection shall be conducted in a similar manner to the manner in which the program under section #ahdi is conducted1 in accordance with standards established by the ,secretary4 7#d7 ,notification and provision of information ,a ,,pace provider seeking to participate in the ,program shall-- 7,a7 notify the ,secretary of the ,,pace provider's intent to participate in the ,program2 and 7,b7 agree to provide to the ,secretary-- 7i7 information regarding-- 7,i7 which ,,pace program eligible individuals enrolled with the ,,pace provider participate in the ,program2 7,,ii7 the scores of those individuals with respect to applicable health targets under the ,program2 and 7,,iii7 the incentives individuals receive for meeting such health targets2 and 7ii7 any other information specified by the ,secretary for purposes of this subsection4 7#e7 ,waiver authority ,the ,secretary may waive such requirements of titles ,,xi1 ,,xviii1 and ,,xix as may be necessary to carry out the purposes of the ,program established under this subsection4 4 7b7 ,medicaid ,section #aicd of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#d7 is amended by adding at the end the following new subsection3 7k7 ,providing incentives for voluntary participation in a ,better ,health ,rewards ,program 7#a7 ,in general ,effective for ,,pace program agreements entered into on or after the date of enactment of the ,medicare ,better ,health ,rewards ,program ,act of #bjac1 a ,,pace provider may provide to ,,pace program eligible individuals enrolled under this section with the ,,pace provider incentive payments1 including cash1 cash-equivalent1 or other types of incentives1 for voluntary participation in a ,better ,health ,rewards ,program 7in this subsection referred to as the ,program7 that rewards enrollees for meeting certain health targets established by the ,secretary4 7#b7 ,limitation ,in no case shall the payment to a ,,pace provider under this section 7or any premium charged by the provider under this section7 with respect to ,,pace program eligible individuals enrolled with the ,,pace provider take into account any incentive payments made to individuals under the ,program4 7#c7 ,implementation ,the ,program under this subsection shall be conducted in a similar manner to the manner in which the program under section #ahdi is conducted1 in accordance with standards established by the ,secretary4 7#d7 ,notification and provision of information ,a ,,pace provider seeking to participate in the ,program shall-- 7,a7 notify the ,secretary of the ,,pace provider's intent to participate in the ,program2 and 7,b7 agree to provide to the ,secretary-- 7i7 information regarding-- 7,i7 which ,,pace program eligible individuals enrolled with the ,,pace provider participate in the ,program2 7,,ii7 the scores of those individuals with respect to applicable health targets under the ,program2 and 7,,iii7 the incentives individuals receive for meeting such health targets2 and 7ii7 any other information specified by the ,secretary for purposes of this subsection4 7#e7 ,waiver authority ,the ,secretary may waive such requirements of titles ,,xi1 ,,xviii1 and ,,xix as may be necessary to carry out the purposes of the ,program established under this subsection4 4 #f4 ,exclusion of incentive payments 7a7 ,in general ,part ,,iii of subchapter ,b of chapter #a of the ,internal ,revenue ,code of #aihf is amended by inserting after section #aci;,d the following new section3 #aci;,e4 ,medicare ,better ,health ,rewards payments ,gross income shall not include any payment made under the following programs3 7#a7 ,the ,medicare ,better ,health ,rewards ,program established under section #ahdi of the ,social ,security ,act4 7#b7 ,a ,better ,health ,rewards ,program established pursuant to section #ahei7;h71 #ahgf7l71 #ahid7;j71 or #aicd7k7 of the ,social ,security ,act4 4 7b7 ,clerical amendment ,the table of sections for part ,,iii of subchapter ,b of chapter #a of such ,code is amended by inserting after the item relating to section #aci;,d the following new item3 ,sec4 #aci;,e4 ,medicare ,better ,health ,rewards payments4 4