,i #aaeth ,,congress #ast ,session ,h4 ,r4 #degi ,,in ,,the ,,house ,,of ,,representatives ,december #f1 #bjag,mr4 ,welch 7for himself and ,mr4 ,schrader7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to implement ,medicare payment policies designed to improve management of chronic disease1 streamline care coordination1 and improve quality outcomes without adding to the deficit4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,creating ,high-,quality ,results and ,outcomes ,necessary to ,improve ,chronic 7,,chronic7 ,care ,act of #bjag4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,,title ,i--,receiving ,high-,quality ,care in the ,home ,sec4 #aja4 ,extending the ,independence at ,home ,demonstration ,program4 ,sec4 #ajb4 ,expanding access to home dialysis therapy4 ,,title ,,ii--,advancing ,team-,based ,care ,sec4 #bja4 ,providing continued access to ,medicare ,advantage special needs plans for vulnerable populations4 ,,title ,,iii--,expanding ,innovation and ,technology ,sec4 #cja4 ,adapting benefits to meet the needs of chronically ill ,medicare ,advantage enrollees4 ,sec4 #cjb4 ,expanding supplemental benefits to meet the needs of chronically ill ,medicare ,advantage enrollees4 ,sec4 #cjc4 ,increasing convenience for ,medicare ,advantage enrollees through telehealth4 ,sec4 #cjd4 ,providing accountable care organizations the ability to expand the use of telehealth4 ,sec4 #cje4 ,expanding the use of telehealth for individuals with stroke4 ,,title ,,iv--,identifying the ,chronically ,ill ,population ,sec4 #dja4 ,providing flexibility for beneficiaries to be part of an accountable care organization4 ,,title ,v--,empowering ,individuals and ,caregivers in ,care ,delivery ,sec4 #eja4 ,eliminating barriers to care coordination under accountable care organizations4 ,sec4 #ejb4 ,,gao study and report on longitudinal comprehensive care planning services under ,medicare part ,b4 ,,title ,,vi--,other ,policies to ,improve ,care for the ,chronically ,ill ,sec4 #fja4 ,providing prescription drug plans with parts ,a and ,b claims data to promote the appropriate use of medications and improve health outcomes4 ,sec4 #fjb4 ,,gao study and report on improving medication synchronization4 ,sec4 #fjc4 ,,gao study and report on impact of obesity drugs on patient health and spending4 ,sec4 #fjd4 ,,hhs study and report on long-term risk factors for chronic conditions among ,medicare beneficiaries4 ,,title ,,vii--,offsets ,sec4 #gja4 ,medicare ,improvement ,fund4 ,sec4 #gjb4 ,medicaid ,improvement ,fund4 ,i ,receiving ,high-,quality ,care in the ,home #aja4 ,extending the ,independence at ,home ,demonstration ,program ,section #ahff;,e of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc-#e7 is amended-- 7#a7 in subsection 7e7-- 7,a7 in paragraph 7#a71 by striking #e-year period and inserting #g-year period2 and 7,b7 in paragraph 7#e71 by striking #aj1jjj and inserting #ae1jjj2 7#b7 in subsection 7g71 in the first sentence1 by inserting 1 including1 to the extent practicable1 the use of electronic health information systems as described in subsection 7b77#a77;,a77vi71 after program2 and 7#c7 in subsection 7i77,a71 by striking will not receive an incentive payment for the second of #b and inserting did not achieve savings for the third of #c4 #ajb4 ,expanding access to home dialysis therapy 7a7 ,in general ,section #ahha7;b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#c77 is amended-- 7#a7 by redesignating subparagraphs 7,a7 and 7,b7 as clauses 7i7 and 7ii71 respectively2 7#b7 in clause 7ii71 as redesignated by subparagraph 7,a71 strike on a comprehensive and insert subject to subparagraph 7,b71 on a comprehensive2 7#c7 by striking ,with respect to and inserting 7,a7 ,with respect to2 and 7#d7 by adding at the end the following new subparagraph3 7,b7 ,for purposes of subparagraph 7,a77ii71 an individual determined to have end stage renal disease receiving home dialysis may choose to receive monthly end stage renal disease-related clinical assessments furnished on or after ,january #a1 #bjai1 via telehealth if the individual receives a face-to-face clinical assessment1 without the use of telehealth1 at least once every three consecutive months4 4 7b7 ,originating site requirements 7#a7 ,in general ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 is amended-- 7,a7 in paragraph 7#d77;,c77ii71 by adding at the end the following new subclauses3 7,,ix7 ,a renal dialysis facility1 but only for purposes of section #ahha7;b77#c77;,b74 7,x7 ,the home of an individual1 but only for purposes of section #ahha7;b77#c77;,b74 2 and 7,b7 by adding at the end the following new paragraph3 7#e7 ,treatment of home dialysis monthly ,,esrd-related visit ,the geographic requirements described in paragraph 7#d77;,c77i7 shall not apply with respect to telehealth services furnished on or after ,january #a1 #bjai1 for purposes of section #ahha7;b77#c77;,b71 at an originating site described in subclause 7,,vi71 7,,ix71 or 7,x7 of paragraph 7#d77;,c77ii74 4 7#b7 ,no facility fee if originating site for home dialysis therapy is the home ,section #ahcd7m77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#b77;,b77 is amended-- 7,a7 by redesignating clauses 7i7 and 7ii7 as subclauses 7,i7 and 7,,ii71 and indenting appropriately2 7,b7 in subclause 7,,ii71 as redesignated by subparagraph 7,a71 by striking clause 7i7 or this clause and inserting subclause 7,i7 or this subclause2 7,c7 by striking site4--,with respect to and inserting site4-- 7i7 ,in general ,subject to clause 7ii71 with respect to 2 and 7,d7 by adding at the end the following new clause3 7ii7 ,no facility fee if originating site for home dialysis therapy is the home ,no facility fee shall be paid under this subparagraph to an originating site described in paragraph 7#d77;,c77ii77,x74 4 7c7 ,conforming amendment ,section #ahha7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#a77 is amended by striking paragraph 7#c77;,a7 and inserting paragraph 7#c77;,a77i74 ,,ii ,advancing ,team-,based ,care #bja4 ,providing continued access to ,medicare ,advantage special needs plans for vulnerable populations 7a7 ,extension ,section #ahei7;f77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;f77#a77 is amended by striking and for periods before ,january #a1 #bjai4 7b7 ,increased integration of dual ,s,n,ps 7#a7 ,in general ,section #ahei7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;f77 is amended-- 7,a7 in paragraph 7#c71 by adding at the end the following new subparagraph3 7,f7 ,the plan meets the requirements applicable under paragraph 7#h74 2 and 7,b7 by adding at the end the following new paragraph3 7#h7 ,increased integration of dual ,s,n,ps 7,a7 ,designated contact ,the ,secretary1 acting through the ,federal ,coordinated ,health ,care ,office established under section #bfjb of the ,patient ,protection and ,affordable ,care ,act1 shall serve as a dedicated point of contact for ,states to address misalignments that arise with the integration of specialized ,,ma plans for special needs individuals described in subsection 7b77#f77;,b77ii7 under this paragraph and1 consistent with such role1 shall-- 7i7 establish a uniform process for disseminating to ,state ,medicaid agencies information under this title impacting contracts between such agencies and such plans under this subsection2 and 7ii7 establish basic resources for ,states interested in exploring such plans as a platform for integration1 such as a model contract or other tools to achieve those goals4 7,b7 ,unified grievances and appeals process 7i7 ,in general ,not later than ,april #a1 #bjbj1 the ,secretary shall establish procedures1 to the extent feasible1 unifying grievances and appeals procedures under sections #aheb7;f71 #aheb7;g71 #aijb7;a77#c71 #aijb7;a77#e71 and #aicb7;b77#d7 for items and services provided by specialized ,,ma plans for special needs individuals described in subsection 7b77#f77;,b77ii7 under this title and title ,,xix4 ,the ,secretary shall solicit comment in developing such procedures from ,states1 plans1 beneficiaries and their representatives1 and other relevant stakeholders4 7ii7 ,procedures ,the procedures established under clause 7i7 shall be included in the plan contract under paragraph 7#c77;,d7 and shall-- 7,i7 adopt the provisions for the enrollee that are most protective for the enrollee and1 to the extent feasible as determined by the ,secretary1 are compatible with unified timeframes and consolidated access to external review under an integrated process2 7,,ii7 take into account differences in ,state plans under title ,,xix to the extent necessary2 7,,iii7 be easily navigable by an enrollee2 and 7,,iv7 include the elements described in clause 7iii71 as applicable4 7iii7 ,elements described ,both unified appeals and unified grievance procedures shall include1 as applicable1 the following elements described in this clause3 7,i7 ,single written notification of all applicable grievances and appeal rights under this title and title ,,xix4 ,for purposes of this subparagraph1 the ,secretary may waive the requirements under section #aheb7;g77#a77;,b7 when the specialized ,,ma plan covers items or services under this part or under title ,,xix4 7,,ii7 ,single pathways for resolution of any grievance or appeal related to a particular item or service provided by specialized ,,ma plans for special needs individuals described in subsection 7b77#f77;,b77ii7 under this title and title ,,xix4 7,,iii7 ,notices written in plain language and available in a language and format that is accessible to the enrollee1 including in non-,english languages that are prevalent in the service area of the specialized ,,ma plan4 7,,iv7 ,unified timeframes for grievances and appeals processes1 such as an individual's filing of a grievance or appeal1 a plan's acknowledgment and resolution of a grievance or appeal1 and notification of decisions with respect to a grievance or appeal4 7,v7 ,requirements for how the plan must process1 track1 and resolve grievances and appeals1 to ensure beneficiaries are notified on a timely basis of decisions that are made throughout the grievance or appeals process and are able to easily determine the status of a grievance or appeal4 7iv7 ,continuation of benefits pending appeal ,the unified procedures under clause 7i7 shall1 with respect to all benefits under parts ,a and ,b and title ,,xix subject to appeal under such procedures1 incorporate provisions under current law and implementing regulations that provide continuation of benefits pending appeal under this title and title ,,xix4 7,c7 ,requirement for unified grievances and appeals ,for #bjba and subsequent years1 the contract of a specialized ,,ma plan for special needs individuals described in subsection 7b77#f77;,b77ii7 with a ,state ,medicaid agency under paragraph 7#c77;,d7 shall require the use of unified grievances and appeals procedures as described in subparagraph 7,b74 7,d7 ,requirements for integration ,for #bjba and subsequent years1 a specialized ,,ma plan for special needs individuals described in subsection 7b77#f77;,b77ii7 shall meet one or more of the following requirements1 to the extent permitted under ,state law1 for integration of benefits under this title and title ,,xix3 7i7 ,the specialized ,,ma plan must meet the requirements of contracting with the ,state ,medicaid agency described in paragraph 7#c77;,d7 in addition to coordinating long-term services and supports or behavioral health services1 or both1 by meeting an additional minimum set of requirements determined by the ,secretary through the ,federal ,coordinated ,health ,care ,office established under section #bfjb of the ,patient ,protection and ,affordable ,care ,act based on input from stakeholders1 such as notifying the ,state in a timely manner of hospitalizations1 emergency room visits1 and hospital or nursing home discharges of enrollees1 assigning one primary care provider for each enrollee1 or sharing data that would benefit the coordination of items and services under this title and the ,state plan under title ,,xix4 ,such minimum set of requirements must be included in the contract of the specialized ,,ma plan with the ,state ,medicaid agency under such paragraph4 7ii7 ,the specialized ,,ma plan must meet the requirements of a fully integrated plan described in section #ahec7;a77#a77;,b77iv77,,ii7 7other than the requirement that the plan have similar average levels of frailty1 as determined by the ,secretary1 as the ,,pace program71 or enter into a capitated contract with the ,state ,medicaid agency to provide long-term services and supports or behavioral health services1 or both4 7iii7 ,in the case where an individual is enrolled in both the specialized ,,ma plan and a ,medicaid managed care organization 7as defined in section #aijc7m77#a77;,a77 providing long-term services and supports or behavioral health services that have the same parent organization1 the parent organization offering both the specialized ,,ma plan and the ,medicaid managed care plan must assume clinical and financial responsibility for benefits provided under this title and title ,,xix4 4 7#b7 ,conforming amendment to responsibilities of ,federal ,coordinated ,health ,care ,office ,section #bfjb7;d7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #acae;b7d77 is amended by adding at the end the following new paragraphs3 7#f7 ,to act as a designated contact for ,states under subsection 7f77#h77;,a7 of section #ahei of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7 with respect to the integration of specialized ,,ma plans for special needs individuals described in subsection 7b77#f77;,b77ii7 of such section4 7#g7 ,to be responsible for developing regulations and guidance related to the implementation of a unified grievance and appeals process as described in subparagraphs 7,b7 and 7,c7 of section #ahei7;f77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;f77#h774 4 7c7 ,improvements to severe or disabling chronic condition ,s,n,ps 7#a7 ,care management requirements ,section #ahei7;f77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;f77#e77 is amended-- 7,a7 by striking all ,s,n,ps4--,the requirements and inserting all ,s,n,ps4-- 7,a7 ,in general ,subject to subparagraph 7,b71 the requirements 2 7,b7 by redesignating subparagraphs 7,a7 and 7,b7 as clauses 7i7 and 7ii71 respectively1 and indenting appropriately2 7,c7 in clause 7ii71 as redesignated by subparagraph 7,b71 by redesignating clauses 7i7 through 7iii7 as subclauses 7,i7 through 7,,iii71 respectively1 and indenting appropriately2 and 7,d7 by adding at the end the following new subparagraph3 7,b7 ,improvements to care management requirements for severe or disabling chronic condition ,s,n,ps ,for #bjbj and subsequent years1 in the case of a specialized ,,ma plan for special needs individuals described in subsection 7b77#f77;,b77iii71 the requirements described in this paragraph include the following3 7i7 ,the interdisciplinary team under subparagraph 7,a77ii77,,iii7 includes a team of providers with demonstrated expertise1 including training in an applicable specialty1 in treating individuals similar to the targeted population of the plan4 7ii7 ,requirements developed by the ,secretary to provide face-to-face encounters with individuals enrolled in the plan not less frequently than on an annual basis4 7iii7 ,as part of the model of care under clause 7i7 of subparagraph 7,a71 the results of the initial assessment and annual reassessment under clause 7ii77,i7 of such subparagraph of each individual enrolled in the plan are addressed in the individual's individualized care plan under clause 7ii77,,ii7 of such subparagraph4 7iv7 ,as part of the annual evaluation and approval of such model of care1 the ,secretary shall take into account whether the plan fulfilled the previous year's goals 7as required under the model of care74 7v7 ,the ,secretary shall establish a minimum benchmark for each element of the model of care of a plan4 ,the ,secretary shall only approve a plan's model of care under this paragraph if each element of the model of care meets the minimum benchmark applicable under the preceding sentence4 4 7#b7 ,revisions to the definition of a severe or disabling chronic conditions specialized needs individual 7,a7 ,in general ,section #ahei7;b77#f77;,b77iii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;b77#f77;,b77iii77 is amended-- 7i7 by striking who have and inserting who-- 7,i7 before ,january #a1 #bjbb1 have 2 7ii7 in subclause 7,i71 as added by clause 7i71 by striking the period at the end and inserting 2 and2 and 7iii7 by adding at the end the following new subclause3 7,,ii7 on or after ,january #a1 #bjbb1 have one or more comorbid and medically complex chronic conditions that is life threatening or significantly limits overall health or function1 have a high risk of hospitalization or other adverse health outcomes1 and require intensive care coordination and that is listed under subsection 7f77#i77;,a74 4 7,b7 ,panel of clinical advisors ,section #ahei7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;f771 as amended by subsection 7b71 is amended by adding at the end the following new paragraph3 7#i7 ,list of conditions for clarification of the definition of a severe or disabling chronic conditions specialized needs individual 7,a7 ,in general ,not later than ,december #ca1 #bjbj1 and every #e years thereafter1 the ,secretary shall convene a panel of clinical advisors to establish and update a list of conditions that meet each of the following criteria3 7i7 ,conditions that meet the definition of a severe or disabling chronic condition under subsection 7b77#f77;,b77iii7 on or after ,january #a1 #bjbb4 7ii7 ,conditions that require prescription drugs1 providers1 and models of care that are unique to the specific population of enrollees in a specialized ,,ma plan for special needs individuals described in such subsection on or after such date and-- 7,i7 as a result of access to1 and enrollment in1 such a specialized ,,ma plan for special needs individuals1 individuals with such condition would have a reasonable expectation of slowing or halting the progression of the disease1 improving health outcomes and decreasing overall costs for individuals diagnosed with such condition compared to available options of care other than through such a specialized ,,ma plan for special needs individuals2 or 7,,ii7 have a low prevalence in the general population of beneficiaries under this title or a disproportionally high per-beneficiary cost under this title4 7,b7 ,requirement ,in establishing and updating the list under subparagraph 7,a71 the panel shall take into account the availability of varied benefits1 cost-sharing1 and supplemental benefits under the model described in paragraph 7#b7 of section #ahei7;h71 including the expansion under paragraph 7#a7 of such section4 4 7d7 ,quality measurement at the plan level for ,s,n,ps and determination of feasibility of quality measurement at the plan level for all ,,ma plans ,section #ahec7o7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bc7o77 is amended by adding at the end the following new paragraphs3 7#f7 ,quality measurement at the plan level for ,s,n,ps 7,a7 ,in general ,subject to subparagraph 7,b71 the ,secretary may require reporting of data under section #aheb7;e7 for1 and apply under this subsection1 quality measures at the plan level for specialized ,,ma plans for special needs individuals instead of at the contract level4 7,b7 ,considerations ,prior to applying quality measurement at the plan level under this paragraph1 the ,secretary shall-- 7i7 take into consideration the minimum number of enrollees in a specialized ,,ma plan for special needs individuals in order to determine if a statistically significant or valid measurement of quality at the plan level is possible under this paragraph2 7ii7 take into consideration the impact of such application on plans that serve a disproportionate number of individuals dually eligible for benefits under this title and under title ,,xix2 7iii7 if quality measures are reported at the plan level1 ensure that ,,ma plans are not required to provide duplicative information2 and 7iv7 ensure that such reporting does not interfere with the collection of encounter data submitted by ,,ma organizations or the administration of any changes to the program under this part as a result of the collection of such data4 7,c7 ,application ,if the ,secretary applies quality measurement at the plan level under this paragraph1 such quality measurement may include ,medicare ,health ,outcomes ,survey 7,,hos71 ,healthcare ,effectiveness ,data and ,information ,set 7,,hedis71 ,consumer ,assessment of ,healthcare ,providers and ,systems 7,,cahps7 measures and quality measures under part ,d4 7#g7 ,determination of feasibility of quality measurement at the plan level for all ,,ma plans 7,a7 ,determination of feasibility ,the ,secretary shall determine the feasibility of requiring reporting of data under section #aheb7;e7 for1 and applying under this subsection1 quality measures at the plan level for all ,,ma plans under this part4 7,b7 ,consideration of change ,after making a determination under subparagraph 7,a71 the ,secretary shall consider requiring such reporting and applying such quality measures at the plan level as described in such subparagraph4 4 7e7 ,,gao study and report on ,state-,level integration between dual ,s,n,ps and ,medicaid 7#a7 ,study ,the ,comptroller ,general of the ,united ,states 7in this paragraph referred to as the ,comptroller ,general7 shall conduct a study on ,state-level integration between specialized ,,ma plans for special needs individuals described in subsection 7b77#f77;,b77ii7 of section #ahei of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7 and the ,medicaid program under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq474 ,such study shall include an analysis of the following3 7,a7 ,the characteristics of ,states in which the ,state agency responsible for administering the ,state plan under such title ,,xix has a contract with such a specialized ,,ma plan and that delivers long-term services and supports under the ,state plan under such title ,,xix through a managed care program1 including the requirements under such ,state plan with respect to long-term services and supports4 7,b7 ,the types of such specialized ,,ma plans1 which may include the following3 7i7 ,a plan described in section #ahec7;a77#a77;,b77iv77,,ii7 of such ,act 7#db ,u4,s4,c4 #aciew-#bc7;a77#a77;,b77iv77,,ii774 7ii7 ,a plan that meets the requirements described in subsection 7f77#c77;,d7 of such section #ahei4 7iii7 ,a plan described in clause 7ii7 that also meets additional requirements established by the ,state4 7,c7 ,the characteristics of individuals enrolled in such specialized ,,ma plans4 7,d7 ,as practicable1 the following with respect to ,state programs for the delivery of long-term services and supports under such title ,,xix through a managed care program3 7i7 ,which populations of individuals are eligible to receive such services and supports4 7ii7 ,whether all such services and supports are provided on a capitated basis or if any of such services and supports are carved out and provided through fee-for-service4 7,e7 ,how the availability and variation of integration arrangements of such specialized ,,ma plans offered in ,states affects spending1 service delivery options1 access to community-based care1 and utilization of care4 7,f7 ,the efforts of ,state ,medicaid programs to transition dually eligible beneficiaries receiving long-term services and supports 7,,ltss7 from institutional settings to home and community-based settings and related financial impacts of such transitions4 7#b7 ,report ,not later than #b years after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 ,,iii ,expanding ,innovation and ,technology #cja4 ,adapting benefits to meet the needs of chronically ill ,medicare ,advantage enrollees ,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 ,national testing of model for ,medicare ,advantage value-,based insurance design 7#a7 ,in general ,in implementing the model described in paragraph 7#b7 proposed to be tested under section #aaae;,a7b71 the ,secretary shall revise the testing of the model under such section to cover1 effective not later than ,january #a1 #bjbj1 all ,states4 7#b7 ,model described ,the model described in this paragraph is the testing of a model of ,medicare ,advantage value-based insurance design that would allow ,medicare ,advantage plans the option to propose and design benefit structures that vary benefits1 cost-sharing1 and supplemental benefits offered to enrollees with specific chronic diseases proposed to be carried out in ,oregon1 ,arizona1 ,texas1 ,iowa1 ,michigan1 ,indiana1 ,tennessee1 ,alabama1 ,pennsylvania1 and ,massachusetts4 7#c7 ,termination and modification provision not applicable until ,january #a1 #bjbb ,the provisions of section #aaae;,a7b77#c77;,b7 shall apply to the model described in paragraph 7#b71 including such model as expanded under paragraph 7#a71 beginning ,january #a1 #bjbb1 but shall not apply to such model1 as so expanded1 prior to such date4 7#d7 ,funding ,the ,secretary shall allocate funds made available under section #aaae;,a7f77#a7 to design1 implement1 and evaluate the model described in paragraph 7#b71 as expanded under paragraph 7#a74 4 #cjb4 ,expanding supplemental benefits to meet the needs of chronically ill ,medicare ,advantage enrollees 7a7 ,in general ,section #aheb7;a77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;a77#c77 is amended-- 7#a7 in subparagraph 7,a71 by striking ,each and inserting ,subject to subparagraph 7,d71 each2 and 7#b7 by adding at the end the following new subparagraph3 7,d7 ,expanding supplemental benefits to meet the needs of chronically ill enrollees 7i7 ,in general ,for plan year #bjbj and subsequent plan years1 in addition to any supplemental health care benefits otherwise provided under this paragraph1 an ,,ma plan may provide supplemental benefits described in clause 7ii7 to a chronically ill enrollee 7as defined in clause 7iii774 7ii7 ,supplemental benefits described 7,i7 ,in general ,supplemental benefits described in this clause are supplemental benefits that1 with respect to a chronically ill enrollee1 have a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee and may not be limited to being primarily health related benefits4 7,,ii7 ,authority to waive uniformity requirements ,the ,secretary may1 only with respect to supplemental benefits provided to a chronically ill enrollee under this subparagraph1 waive the uniformity requirement under subsection 7d77#a77;,a71 as determined appropriate by the ,secretary4 7iii7 ,chronically ill enrollee defined ,in this subparagraph1 the term chronically ill enrollee means an enrollee in an ,,ma plan that the ,secretary determines-- 7,i7 has one or more comorbid and medically complex chronic conditions that is life threatening or significantly limits the overall health or function of the enrollee2 7,,ii7 has a high risk of hospitalization or other adverse health outcomes2 and 7,,iii7 requires intensive care coordination4 4 7b7 ,,gao study and report 7#a7 ,study ,the ,comptroller ,general of the ,united ,states 7in this subsection referred to as the ,comptroller ,general7 shall conduct a study on supplemental benefits provided to enrollees in ,medicare ,advantage plans under part ,c of title ,,xviii of the ,social ,security ,act4 ,to the extent data are available1 such study shall include an analysis of the following3 7,a7 ,the type of supplemental benefits provided to such enrollees1 the total number of enrollees receiving each supplemental benefit1 and whether the supplemental benefit is covered by the standard benchmark cost of the benefit or with an additional premium4 7,b7 ,the frequency in which supplemental benefits are utilized by such enrollees4 7,c7 ,the impact supplemental benefits have on-- 7i7 indicators of the quality of care received by such enrollees1 including overall health and function of the enrollees2 7ii7 the utilization of items and services for which benefits are available under the original ,medicare fee-for-service program option under parts ,a and ,b of such title ,,xviii by such enrollees2 and 7iii7 the amount of the bids submitted by ,medicare ,advantage ,organizations for ,medicare ,advantage plans under such part ,c4 7#b7 ,report ,not later than #e years after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 #cjc4 ,increasing convenience for ,medicare ,advantage enrollees through telehealth 7a7 ,in general ,section #aheb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7 is amended-- 7#a7 in subsection 7a77#a77;,b77i71 by inserting 1 subject to subsection 7m71 after means2 and 7#b7 by adding at the end the following new subsection3 7m7 ,provision of additional telehealth benefits 7#a7 ,,ma plan option ,for plan year #bjbj and subsequent plan years1 subject to the requirements of paragraph 7#c71 an ,,ma plan may provide additional telehealth benefits 7as defined in paragraph 7#b77 to individuals enrolled under this part4 7#b7 ,additional telehealth benefits defined 7,a7 ,in general ,for purposes of this subsection and section #ahed-- 7i7 ,definition ,the term additional telehealth benefits means services-- 7,i7 for which benefits are available under part ,b1 including services for which payment is not made under section #ahcd7m7 due to the conditions for payment under such section2 and 7,,ii7 that are identified as clinically appropriate to furnish using electronic information and telecommunications technology when a physician 7as defined in section #ahfa7r77 or practitioner 7described in section #ahdb7;b77#ah77;,c77 providing the service is not at the same location as the plan enrollee4 7ii7 ,exclusion of capital and infrastructure costs and investments ,the term additional telehealth benefits does not include capital and infrastructure costs and investments relating to such benefits4 7,b7 ,public comment ,not later than ,november #cj1 #bjah1 the ,secretary shall solicit comments on-- 7i7 what types of items and services 7including those provided through supplemental health care benefits7 should be considered to be additional telehealth benefits2 and 7ii7 the requirements for the provision or furnishing of such benefits 7such as licensure1 training1 and coordination requirements74 7#c7 ,requirements for additional telehealth benefits ,the ,secretary shall specify requirements for the provision or furnishing of additional telehealth benefits1 including with respect to the following3 7,a7 ,physician or practitioner licensure and other requirements such as specific training4 7,b7 ,factors necessary to ensure the coordination of such benefits with items and services furnished in-person4 7,c7 ,such other areas as determined by the ,secretary4 7#d7 ,enrollee choice ,if an ,,ma plan provides a service as an additional telehealth benefit 7as defined in paragraph 7#b77-- 7,a7 the ,,ma plan shall also provide access to such benefit through an in-person visit 7and not only as an additional telehealth benefit72 and 7,b7 an individual enrollee shall have discretion as to whether to receive such service through the in-person visit or as an additional telehealth benefit4 7#e7 ,treatment under ,,ma ,for purposes of this subsection and section #ahed1 additional telehealth benefits shall be treated as if they were benefits under the original ,medicare fee-for-service program option4 7#f7 ,construction ,nothing in this subsection shall be construed as affecting the requirement under subsection 7a77#a7 that ,,ma plans provide enrollees with items and services 7other than hospice care7 for which benefits are available under parts ,a and ,b1 including benefits available under section #ahcd7m74 4 7b7 ,clarification regarding inclusion in bid amount ,section #ahed7;a77#f77;,a77ii77,i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bd7;a77#f77;,a77ii77,i77 is amended by inserting 1 including1 for plan year #bjbj and subsequent plan years1 the provision of additional telehealth benefits as described in section #aheb7m7 before the semicolon at the end4 #cjd4 ,providing accountable care organizations the ability to expand the use of telehealth 7a7 ,in general ,section #ahii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj7 is amended by adding at the end the following new subsection3 7l7 ,providing ,a,c,os the ability ,to expand the use of telehealth services 7#a7 ,in general ,in the case of telehealth services for which payment would otherwise be made under this title furnished on or after ,january #a1 #bjbj1 for purposes of this subsection only1 the following shall apply with respect to such services furnished by a physician or practitioner participating in an applicable ,,aco 7as defined in paragraph 7#b77 to a ,medicare fee-for-service beneficiary assigned to the applicable ,,aco3 7,a7 ,inclusion of home as originating site ,subject to paragraph 7#c71 the home of a beneficiary shall be treated as an originating site described in section #ahcd7m77#d77;,c77ii74 7,b7 ,no application of geographic limitation ,the geographic limitation under section #ahcd7m77#d77;,c77i7 shall not apply with respect to an originating site described in section #ahcd7m77#d77;,c77ii7 7including the home of a beneficiary under subparagraph 7,a771 subject to ,state licensing requirements4 7#b7 ,definitions ,in this subsection3 7,a7 ,applicable ,,aco ,the term applicable ,,aco means an ,,aco participating in a model tested or expanded under section #aaae;,a or under this section-- 7i7 that operates under a two-sided model-- 7,i7 described in section #dbe4fjj7;a7 of title #db1 ,code of ,federal ,regulations2 or 7,,ii7 tested or expanded under section #aaae;,a2 and 7ii7 for which ,medicare fee-for-service beneficiaries are assigned to the ,,aco using a prospective assignment method1 as determined appropriate by the ,secretary4 7,b7 ,home ,the term home means1 with respect to a ,medicare fee-for-service beneficiary1 the place of residence used as the home of the beneficiary4 7#c7 ,telehealth services received in the home ,in the case of telehealth services described in paragraph 7#a7 where the home of a ,medicare fee-for-service beneficiary is the originating site1 the following shall apply3 7,a7 ,no facility fee ,there shall be no facility fee paid to the originating site under section #ahcd7m77#b77;,b74 7,b7 ,exclusion of certain services ,no payment may be made for such services that are inappropriate to furnish in the home setting such as services that are typically furnished in inpatient settings such as a hospital4 4 7b7 ,study and report 7#a7 ,study 7,a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary7 shall conduct a study on the implementation of section #ahii7l7 of the ,social ,security ,act1 as added by subsection 7a74 ,such study shall include an analysis of the utilization of1 and expenditures for1 telehealth services under such section4 7,b7 ,collection of data ,the ,secretary may collect such data as the ,secretary determines necessary to carry out the study under this paragraph4 7#b7 ,report ,not later than ,january #a1 #bjbf1 the ,secretary shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,secretary determines appropriate4 #cje4 ,expanding the use of telehealth for individuals with stroke ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m771 as amended by section #ajb7;b77#b71 is amended by adding at the end the following new paragraph3 7#f7 ,treatment of stroke telehealth services 7,a7 ,non-application of originating site requirements ,the requirements described in paragraph 7#d77;,c7 shall not apply with respect to telehealth services furnished on or after ,january #a1 #bjba1 for purposes of evaluation of an acute stroke1 as determined by the ,secretary4 7,b7 ,no originating site facility fee ,in the case of an originating site that does not meet the requirements described in paragraph 7#d77;,c71 the ,secretary shall not pay an originating site facility fee 7as described in paragraph 7#b77;,b77 to the originating site with respect to such telehealth services4 4 ,,iv ,identifying the ,chronically ,ill ,population #dja4 ,providing flexibility for beneficiaries to be part of an accountable care organization ,section #ahii7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj7c77 is amended-- 7#a7 by redesignating paragraphs 7#a7 and 7#b7 as subparagraphs 7,a7 and 7,b71 respectively1 and indenting appropriately2 7#b7 by striking ,a,c,os4--,the ,secretary and inserting ,a,c,os4-- 7#a7 ,in general ,subject to paragraph 7#b71 the ,secretary 2 and 7#c7 by adding at the end the following new paragraph3 7#b7 ,providing flexibility 7,a7 ,choice of prospective assignment ,for each agreement period 7effective for agreements entered into or renewed on or after ,january #a1 #bjbj71 in the case where an ,,aco established under the program is in a ,track that provides for the retrospective assignment of ,medicare fee-for-service beneficiaries to the ,,aco1 the ,secretary shall permit the ,,aco to choose to have ,medicare fee-for-service beneficiaries assigned prospectively1 rather than retrospectively1 to the ,,aco for an agreement period4 7,b7 ,assignment based on voluntary identification by ,medicare fee-for-service beneficiaries 7i7 ,in general ,for performance year #bjah and each subsequent performance year1 if a system is available for electronic designation1 the ,secretary shall permit a ,medicare fee-for-service beneficiary to voluntarily identify an ,,aco professional as the primary care provider of the beneficiary for purposes of assigning such beneficiary to an ,,aco1 as determined by the ,secretary4 7ii7 ,notification process ,the ,secretary shall establish a process under which a ,medicare fee-for-service beneficiary is-- 7,i7 notified of their ability to make an identification described in clause 7i72 and 7,,ii7 informed of the process by which they may make and change such identification4 7iii7 ,superseding claims-based assignment ,a voluntary identification by a ,medicare fee-for-service beneficiary under this subparagraph shall supersede any claims-based assignment otherwise determined by the ,secretary4 4 ,v ,empowering ,individuals and ,caregivers in ,care ,delivery #eja4 ,eliminating barriers to care coordination under accountable care organizations 7a7 ,in general ,section #ahii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj71 as amended by section #cjd7;a71 is amended-- 7#a7 in subsection 7b77#b71 by adding at the end the following new subparagraph3 7,i7 ,an ,,aco that seeks to operate an ,,aco ,beneficiary ,incentive ,program pursuant to subsection 7m7 shall apply to the ,secretary at such time1 in such manner1 and with such information as the ,secretary may require4 2 7#b7 by adding at the end the following new subsection3 7m7 ,authority ,to provide incentive payments to beneficiaries with respect to qualifying primary care services 7#a7 ,program 7,a7 ,in general ,in order to encourage ,medicare fee-for-service beneficiaries to obtain medically necessary primary care services1 an ,,aco participating under this section under a payment model described in clause 7i7 or 7ii7 of paragraph 7#b77;,b7 may apply to establish an ,,aco ,beneficiary ,incentive ,program to provide incentive payments to such beneficiaries who are furnished qualifying services in accordance with this subsection4 ,the ,secretary shall permit such an ,,aco to establish such a program at the ,secretary's discretion and subject to such requirements1 including program integrity requirements1 as the ,secretary determines necessary4 7,b7 ,implementation ,the ,secretary shall implement this subsection on a date determined appropriate by the ,secretary4 ,such date shall be no earlier than ,january #a1 #bjai1 and no later than ,january #a1 #bjbj4 7#b7 ,conduct of program 7,a7 ,duration ,subject to subparagraph 7,h71 an ,,aco ,beneficiary ,incentive ,program established under this subsection shall be conducted for such period 7of not less than #a year7 as the ,secretary may approve4 7,b7 ,scope ,an ,,aco ,beneficiary ,incentive ,program established under this subsection shall provide incentive payments to all of the following ,medicare fee-for-service beneficiaries who are furnished qualifying services by the ,,aco3 7i7 ,with respect to the ,track #b and ,track #c payment models described in section #dbe4fjj7;a7 of title #db1 ,code of ,federal ,regulations 7or in any successor regulation71 ,medicare fee-for-service beneficiaries who are preliminarily prospectively or prospectively assigned 7or otherwise assigned1 as determined by the ,secretary7 to the ,,aco4 7ii7 ,with respect to any future payment models involving two-sided risk1 ,medicare fee-for-service beneficiaries who are assigned to the ,,aco1 as determined by the ,secretary4 7,c7 ,qualifying service ,for purposes of this subsection1 a qualifying service is a primary care service1 as defined in section #dbe4bj of title #db1 ,code of ,federal ,regulations 7or in any successor regulation71 with respect to which coinsurance applies under part ,b1 furnished through an ,,aco by-- 7i7 an ,,aco professional described in subsection 7h77#a77;,a7 who has a primary care specialty designation included in the definition of primary care physician under section #dbe4bj of title #db1 ,code of ,federal ,regulations 7or any successor regulation72 7ii7 an ,,aco professional described in subsection 7h77#a77;,b72 or 7iii7 a ,federally qualified health center or rural health clinic 7as such terms are defined in section #ahfa7;aa774 7,d7 ,incentive payments ,an incentive payment made by an ,,aco pursuant to an ,,aco ,beneficiary ,incentive ,program established under this subsection shall be-- 7i7 in an amount up to #bj1 with such maximum amount updated annually by the percentage increase in the consumer price index for all urban consumers 7,united ,states city average7 for the #ab-month period ending with ,june of the previous year2 7ii7 in the same amount for each ,medicare fee-for-service beneficiary described in clause 7i7 or 7ii7 of subparagraph 7,b7 without regard to enrollment of such a beneficiary in a medicare supplemental policy 7described in section #ahhb7;g77#a771 in a ,state ,medicaid plan under title ,,xix or a waiver of such a plan1 or in any other health insurance policy or health benefit plan2 7iii7 made for each qualifying service furnished to such a beneficiary described in clause 7i7 or 7ii7 of subparagraph 7,b7 during a period specified by the ,secretary2 and 7iv7 made no later than #cj days after a qualifying service is furnished to such a beneficiary described in clause 7i7 or 7ii7 of subparagraph 7,b74 7,e7 ,no separate payments from the ,secretary ,the ,secretary shall not make any separate payment to an ,,aco for the costs1 including incentive payments1 of carrying out an ,,aco ,beneficiary ,incentive ,program established under this subsection4 ,nothing in this subparagraph shall be construed as prohibiting an ,,aco from using shared savings received under this section to carry out an ,,aco ,beneficiary ,incentive ,program4 7,f7 ,no application to shared savings calculation ,incentive payments made by an ,,aco under this subsection shall be disregarded for purposes of calculating benchmarks1 estimated average per capita ,medicare expenditures1 and shared savings under this section4 7,g7 ,reporting requirements ,an ,,aco conducting an ,,aco ,beneficiary ,incentive ,program under this subsection shall1 at such times and in such format as the ,secretary may require1 report to the ,secretary such information and retain such documentation as the ,secretary may require1 including the amount and frequency of incentive payments made and the number of ,medicare fee-for-service beneficiaries receiving such payments4 7,h7 ,termination ,the ,secretary may terminate an ,,aco ,beneficiary ,incentive ,program established under this subsection at any time for reasons determined appropriate by the ,secretary4 7#c7 ,exclusion of incentive payments ,any payment made under an ,,aco ,beneficiary ,incentive ,program established under this subsection shall not be considered income or resources or otherwise taken into account for purposes of-- 7,a7 determining eligibility for benefits or assistance 7or the amount or extent of benefits or assistance7 under any ,federal program or under any ,state or local program financed in whole or in part with ,federal funds2 or 7,b7 any ,federal or ,state laws relating to taxation4 2 7#c7 in subsection 7e71 by inserting 1 including an ,,aco ,beneficiary ,incentive ,program under subsections 7b77#b77;,i7 and 7m7 after the program2 and 7#d7 in subsection 7g77#f71 by inserting or of an ,,aco ,beneficiary ,incentive ,program under subsections 7b77#b77;,i7 and 7m7 after under subsection 7d77#d74 7b7 ,amendment to section #aabh;,b ,section #aabh;,b7b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7b77#c77 is amended-- 7#a7 by striking and at the end of subparagraph 7,i72 7#b7 by striking the period at the end of subparagraph 7,j7 and inserting 2 and2 and 7#c7 by adding at the end the following new subparagraph3 7,k7 an incentive payment made to a ,medicare fee-for-service beneficiary by an ,,aco under an ,,aco ,beneficiary ,incentive ,program established under subsection 7m7 of section #ahii1 if the payment is made in accordance with the requirements of such subsection and meets such other conditions as the ,secretary may establish4 4 7c7 ,evaluation and report 7#a7 ,evaluation ,the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary7 shall conduct an evaluation of the ,,aco ,beneficiary ,incentive ,program established under subsections 7b77#b77;,i7 and 7m7 of section #ahii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj71 as added by subsection 7a74 ,the evaluation shall include an analysis of the impact of the implementation of the ,program on expenditures and beneficiary health outcomes under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7#b7 ,report ,not later than ,october #a1 #bjbc1 the ,secretary shall submit to ,congress a report containing the results of the evaluation under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,secretary determines appropriate4 #ejb4 ,,gao study and report on longitudinal comprehensive care planning services under ,medicare part ,b 7a7 ,study ,the ,comptroller ,general shall conduct a study on the establishment under part ,b of the ,medicare program under title ,,xviii of the ,social ,security ,act of a payment code for a visit for longitudinal comprehensive care planning services4 ,such study shall include an analysis of the following to the extent such information is available3 7#a7 ,the frequency with which services similar to longitudinal comprehensive care planning services are furnished to ,medicare beneficiaries1 which providers of services and suppliers are furnishing those services1 whether ,medicare reimbursement is being received for those services1 and1 if so1 through which codes those services are being reimbursed4 7#b7 ,whether1 and the extent to which1 longitudinal comprehensive care planning services would overlap1 and could therefore result in duplicative payment1 with services covered under the hospice benefit as well as the chronic care management code1 evaluation and management codes1 or other codes that already exist under part ,b of the ,medicare program4 7#c7 ,any barriers to hospitals1 skilled nursing facilities1 hospice programs1 home health agencies1 and other applicable providers working with a ,medicare beneficiary to engage in the care planning process and complete the necessary documentation to support the treatment and care plan of the beneficiary and provide such documentation to other providers and the beneficiary or the beneficiary's representative4 7#d7 ,any barriers to providers1 other than the provider furnishing longitudinal comprehensive care planning services1 accessing the care plan and associated documentation for use related to the care of the ,medicare beneficiary4 7#e7 ,potential options for ensuring that applicable providers are notified of a patient's existing longitudinal care plan and that applicable providers consider that plan in making their treatment decisions1 and what the challenges might be in implementing such options4 7#f7 ,stakeholder's views on the need for the development of quality metrics with respect to longitudinal comprehensive care planning services1 such as measures related to-- 7,a7 the process of eliciting input from the ,medicare beneficiary or from a legally authorized representative and documenting in the medical record the patient-directed care plan2 7,b7 the effectiveness and patient-centeredness of the care plan in organizing delivery of services consistent with the plan2 7,c7 the availability of the care plan and associated documentation to other providers that care for the beneficiary2 and 7,d7 the extent to which the beneficiary received services and support that is free from discrimination based on advanced age1 disability status1 or advanced illness4 7#g7 ,stakeholder's views on how such quality metrics would provide information on-- 7,a7 the goals1 values1 and preferences of the beneficiary2 7,b7 the documentation of the care plan2 7,c7 services furnished to the beneficiary2 and 7,d7 outcomes of treatment4 7#h7 ,stakeholder's views on-- 7,a7 the type of training and education needed for applicable providers1 individuals1 and caregivers in order to facilitate longitudinal comprehensive care planning services2 7,b7 the types of providers of services and suppliers that should be included in the interdisciplinary team of an applicable provider2 and 7,c7 the characteristics of ,medicare beneficiaries that would be most appropriate to receive longitudinal comprehensive care planning services1 such as individuals with advanced disease and individuals who need assistance with multiple activities of daily living4 7#i7 ,stakeholder's views on the frequency with which longitudinal comprehensive care planning services should be furnished4 7b7 ,report ,not later than #ah months after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under subsection 7a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 7c7 ,definitions ,in this section3 7#a7 ,applicable provider ,the term applicable provider means a hospice program 7as defined in subsection 7dd77#b7 of section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww77 or other provider of services 7as defined in subsection 7u7 of such section7 or supplier 7as defined in subsection 7d7 of such section7 that-- 7,a7 furnishes longitudinal comprehensive care planning services through an interdisciplinary team2 and 7,b7 meets such other requirements as the ,secretary may determine to be appropriate4 7#b7 ,comptroller ,general ,the term ,comptroller ,general means the ,comptroller ,general of the ,united ,states4 7#c7 ,interdisciplinary team ,the term interdisciplinary team means a group that-- 7,a7 includes the personnel described in subsection 7dd77#b77;,b77i7 of such section #ahfa2 7,b7 may include a chaplain1 minister1 or other clergy2 and 7,c7 may include other direct care personnel4 7#d7 ,longitudinal comprehensive care planning services ,the term longitudinal comprehensive care planning services means a voluntary shared decisionmaking process that is furnished by an applicable provider through an interdisciplinary team and includes a conversation with ,medicare beneficiaries who have received a diagnosis of a serious or life-threatening illness4 ,the purpose of such services is to discuss a longitudinal care plan that addresses the progression of the disease1 treatment options1 the goals1 values1 and preferences of the beneficiary1 and the availability of other resources and social supports that may reduce the beneficiary's health risks and promote self-management and shared decisionmaking4 7#e7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 ,,vi ,other ,policies to ,improve ,care for the ,chronically ,ill #fja4 ,providing prescription drug plans with parts ,a and ,b claims data to promote the appropriate use of medications and improve health outcomes ,section #ahfj;,d-#d7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;c77 is amended by adding at the end the following new paragraph3 7#f7 ,providing prescription drug plans with parts ,a and ,b claims data to promote the appropriate use of medications and improve health outcomes 7,a7 ,process ,subject to subparagraph 7,b71 the ,secretary shall establish a process under which a ,,pdp sponsor of a prescription drug plan may submit a request for the ,secretary to provide the sponsor1 on a periodic basis and in an electronic format1 beginning in plan year #bjbj1 data described in subparagraph 7,d7 with respect to enrollees in such plan4 ,such data shall be provided without regard to whether such enrollees are described in clause 7ii7 of paragraph 7#b77;,a74 7,b7 ,purposes ,a ,,pdp sponsor may use the data provided to the sponsor pursuant to subparagraph 7,a7 for any of the following purposes3 7i7 ,to optimize therapeutic outcomes through improved medication use1 as such phrase is used in clause 7i7 of paragraph 7#b77;,a74 7ii7 ,to improving care coordination so as to prevent adverse health outcomes1 such as preventable emergency department visits and hospital readmissions4 7iii7 ,for any other purpose determined appropriate by the ,secretary4 7,c7 ,limitations on data use ,a ,,pdp sponsor shall not use data provided to the sponsor pursuant to subparagraph 7,a7 for any of the following purposes3 7i7 ,to inform coverage determinations under this part4 7ii7 ,to conduct retroactive reviews of medically accepted indications determinations4 7iii7 ,to facilitate enrollment changes to a different prescription drug plan or an ,,ma-,,pd plan offered by the same parent organization4 7iv7 ,to inform marketing of benefits4 7v7 ,for any other purpose that the ,secretary determines is necessary to include in order to protect the identity of individuals entitled to1 or enrolled for1 benefits under this title and to protect the security of personal health information4 7,d7 ,data described ,the data described in this clause are standardized extracts 7as determined by the ,secretary7 of claims data under parts ,a and ,b for items and services furnished under such parts for time periods specified by the ,secretary4 ,such data shall include data as current as practicable4 4 #fjb4 ,,gao study and report on improving medication synchronization 7a7 ,study ,the ,comptroller ,general of the ,united ,states 7in this section referred to as the ,comptroller ,general7 shall conduct a study on the extent to which ,medicare prescription drug plans 7,,ma-,,pd plans and standalone prescription drug plans7 under part ,d of title ,,xviii of the ,social ,security ,act and private payors use programs that synchronize pharmacy dispensing so that individuals may receive multiple prescriptions on the same day to facilitate comprehensive counseling and promote medication adherence4 ,the study shall include a analysis of the following3 7#a7 ,the extent to which pharmacies have adopted such programs4 7#b7 ,the common characteristics of such programs1 including how pharmacies structure counseling sessions under such programs and the types of payment and other arrangements that ,medicare prescription drug plans and private payors employ under such programs to support the efforts of pharmacies4 7#c7 ,how such programs compare for ,medicare prescription drug plans and private payors4 7#d7 ,what is known about how such programs affect patient medication adherence and overall patient health outcomes1 including if adherence and outcomes vary by patient subpopulations1 such as disease state and socioeconomic status4 7#e7 ,what is known about overall patient satisfaction with such programs and satisfaction with such programs1 including within patient subpopulations1 such as disease state and socioeconomic status4 7#f7 ,the extent to which laws and regulations of the ,medicare program support such programs4 7#g7 ,barriers to the use of medication synchronization programs by ,medicare prescription drug plans4 7b7 ,report ,not later than #ah months after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study under subsection 7a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 #fjc4 ,,gao study and report on impact of obesity drugs on patient health and spending 7a7 ,study ,the ,comptroller ,general of the ,united ,states 7in this section referred to as the ,comptroller ,general7 shall1 to the extent data are available1 conduct a study on the use of prescription drugs to manage the weight of obese patients and the impact of coverage of such drugs on patient health and on health care spending4 ,such study shall examine the use and impact of these obesity drugs in the non-,medicare population and for ,medicare beneficiaries who have such drugs covered through an ,,ma-,,pd plan 7as defined in section #ahfj;,d-#a7;a77#c77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aja7;a77#c77;,c777 as a supplemental health care benefit4 ,the study shall include an analysis of the following3 7#a7 ,the prevalence of obesity in the ,medicare and non-,medicare population4 7#b7 ,the utilization of obesity drugs4 7#c7 ,the distribution of ,body ,mass ,index by individuals taking obesity drugs1 to the extent practicable4 7#d7 ,what is known about the use of obesity drugs in conjunction with the receipt of other items or services1 such as behavioral counseling1 and how these compare to items and services received by obese individuals who do not take obesity drugs4 7#e7 ,physician considerations and attitudes related to prescribing obesity drugs4 7#f7 ,the extent to which coverage policies cease or limit coverage for individuals who fail to receive clinical benefit4 7#g7 ,what is known about the extent to which individuals who take obesity drugs adhere to the prescribed regimen4 7#h7 ,what is known about the extent to which individuals who take obesity drugs maintain weight loss over time4 7#i7 ,what is known about the subsequent impact such drugs have on medical services that are directly related to obesity1 including with respect to subpopulations determined based on the extent of obesity4 7#aj7 ,what is known about the spending associated with the care of individuals who take obesity drugs1 compared to the spending associated with the care of individuals who do not take such drugs4 7b7 ,report ,not later than #ah months after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study under subsection 7a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 #fjd4 ,,hhs study and report on long-term risk factors for chronic conditions among ,medicare beneficiaries 7a7 ,study ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall conduct a study on long-term cost drivers to the ,medicare program1 including obesity1 tobacco use1 mental health conditions1 and other factors that may contribute to the deterioration of health conditions among individuals with chronic conditions in the ,medicare population4 ,the study shall include an analysis of any barriers to collecting and analyzing such information and how to remove any such barriers 7including through legislation and administrative actions74 7b7 ,report ,not later than #ah months after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report containing the results of the study under subsection 7a71 together with recommendations for such legislation and administrative action as the ,secretary determines appropriate4 ,the ,secretary shall also post such report on the ,internet website of the ,department of ,health and ,human ,services4 ,,vii ,offsets #gja4 ,medicare ,improvement ,fund ,section #ahih7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;iii7b77#a77 is amended by striking #bgj1jjj1jjj and inserting #j4 #gjb4 ,medicaid ,improvement ,fund ,section #aida7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifw-#a7;b77#a77 is amended by striking #e1jjj1jjj and inserting #j4