,,ii #aagth ,,congress #b;d ,session ,s4 #h ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,november #ag1 #bjbb,mr4 ,bennet introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to establish a demonstration program to promote collaborative treatment of mental and physical health comorbidities under the ,medicare program4 #a4 ,short title ,this ,act may be cited as the ,mental and ,physical ,health ,care ,comorbidities ,act of #bjbb4 #b4 ,establishing a demonstration program to promote collaborative treatment of mental and physical health comorbidities under the ,medicare program ,title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is amended by inserting after section #ahff;,f the following new section3 #ahff;,g4 ,mental and physical health comorbidities collaborative demonstration program 7a7 ,in general ,consistent with the model described in section #aaae;,a7b77#b77;,b77xv7 7relating to promoting improved quality and reduced cost by developing a collaborative of high-quality1 low-cost health care institutions71 the ,secretary shall conduct a demonstration program 7in this section referred to as the #8program'7 to test and evaluate innovations implemented by eligible hospitals 7as defined in subsection 7f77 in the furnishing of items and services to applicable individuals 7as defined in subsection 7f77 with mental and physical health comorbidities 7and those at risk of developing such comorbidities71 including by addressing the adverse social determinants of health that such individuals often experience4 7b7 ,activities under program ,under the program1 the ,secretary shall1 in coordination with eligible hospitals participating in the program-- 7#a7 identify1 validate1 and disseminate innovative1 effective evidence-based best practices and models that improve care and outcomes for applicable individuals with mental and physical health comorbidities located in vulnerable communities1 including by addressing the social determinants of health that adversely impact such individuals2 and 7#b7 assist in the identification of potential payment reforms under this title and title ,,xix that could more broadly effectuate such improvements4 7c7 ,duration and scope ,the program conducted under this section shall operate during the period beginning on ,october #a1 #bjbc1 and ending no later than ,september #cj1 #bjbh4 7d7 ,program elements 7#a7 ,in general ,an eligible hospital electing to participate in the program shall enter into an agreement with the ,secretary for purposes of carrying out the activities described in subsection 7b74 ,such an agreement shall include the plan described in paragraph 7#b71 along with an annualized payment arrangement as described in paragraph 7#c7 to support implementation of such plan4 ,such agreement shall include a requirement for the hospital to-- 7,a7 engage in the learning collaborative established under subsection 7e72 7,b7 certify that all proposed innovations under such plan will supplement and not supplant existing activities1 whether by augmenting existing activities or initiating new activities2 and 7,c7 remit payments made under such arrangement to the ,secretary if the ,secretary determines that such hospital has not complied with the terms of such agreement4 7#b7 ,program elements ,an eligible hospital electing to participate in the program shall submit a proposed plan and associated quality metrics for review and approval by the ,secretary4 ,such plan and metrics shall1 at a minimum1 address-- 7,a7 the specific innovations addressing mental and physical health comorbidities 7as defined in subsection 7f77 and innovations addressing social determinants of health 7as defined in such subsection7 that will be employed and the evidence base supporting the proposed approach2 7,b7 the proposed target population of applicable individuals with respect to which such innovations will be employed1 including a description of the extent to which such population consists of applicable individuals described in subparagraph 7,a71 7,b71 or 7,c7 of subsection 7f77#a72 7,c7 the evidence-based data supporting a community's status as a vulnerable community through sources1 such as ,bureau of the ,census data and measures such as the ,neighborhood ,deprivation ,index or the ,child ,opportunity ,index2 7,d7 community partners1 such as nonprofit organizations1 federally qualified health centers1 rural health clinics1 and units of local government 7including law enforcement and judicial entities7 that will participate in the implementation of such innovations2 7,e7 how such innovations will address mental and physical health comorbidities and social determinants of health for the target population2 7,f7 how such innovations may inform changes in payment and other policies under this title and title ,,xix 7such as care coordination reimbursement1 mental health homes1 improvements to home and community-based service portfolios1 and coverage of supportive services72 7,g7 how such innovations might contribute to a reduction in overall health care costs1 including under this title and title ,,xix and for uninsured persons1 through improvements in population health1 reductions in health care utilization 7such as inpatient admissions1 utilization of emergency departments1 and boarding of patients71 and otherwise2 7,h7 how such innovations can be expected to improve the mental and physical health status of minority populations2 7,i7 how such innovations can be expected to reduce other non-medical public expenditures2 7,j7 metrics to track care quality1 improvement in outcomes1 and the impact of such innovations on health care and other public expenditures2 7,k7 how program outcomes will be assessed and evaluated2 and 7,l7 how the hospital will collect and organize data and fully participate in the learning collaborative established under subsection 7e74 7#c7 ,participation2 payments ,the ,secretary shall negotiate an annualized payment arrangement with each eligible hospital participating in the program4 ,such arrangement may include an annual lump sum amount1 capitated payment amount1 or such other arrangement as determined appropriate by the ,secretary1 and which may include an arrangement that includes financial risk for the hospital1 to support implementation of the innovations specified in the plan described in paragraph 7#b74 7e7 ,learning collaborative 7#a7 ,in general ,the ,secretary shall establish a learning collaborative that shall convene eligible hospitals participating in the program and other interested parties on a regular basis to report on and share information regarding evidence-based innovations addressing mental and physical health comorbidities1 innovations addressing social determinants of health1 and associated metrics and outcomes4 7#b7 ,focused forums ,the ,secretary may establish different focused forums within the collaborative1 such as ones that specifically address different geographic regions 7such as urban and rural71 certain types of comorbidities1 or as the ,secretary otherwise determines appropriate based on the types of agreements entered into under subsection 7d74 7#c7 ,dissemination of information ,the ,secretary shall provide for the dissemination to other health care providers and interested parties of information on promising and effective activities4 7f7 ,definitions ,for purposes of this section3 7#a7 ,applicable individual ,the term applicable individual means an individual with mental and physical health comorbidities who is-- 7,a7 a subsidy eligible individual 7as defined in section #ahfj;,d-#ad7;a77#c77;,a77 without regard to clause 7i7 of such section2 7,b7 enrolled under a ,state plan 7or waiver of such plan7 under title ,,xix2 or 7,c7 uninsured4 7#b7 ,eligible hospital ,the term eligible hospital means a hospital that is-- 7,a7 a rural hospital with a disproportionate patient percentage of at least #ce percent 7as determined by the ,secretary under section #ahhf7;d77#e77;,f77vi77 or would have a disproportionate patient percentage of at least #ce percent 7as so determined7 if the hospital were a subsection 7d7 hospital 7or1 a percentage of inpatient days consisting of items and services furnished to individuals entitled to benefits under part ,a that exceeds #he percent of all such days7 that is either a critical access hospital1 a sole community hospital 7as defined in section #ahhf7;d77#e77;,d77iii771 or a medicare-dependent1 small rural hospital 7as defined in section #ahhf7;d77#e77;,g77iv772 7,b7 a large subsection 7d7 teaching and tertiary hospital with more than #bjj beds that as of1 or subsequent to ,july #a1 #bjbj1 has an average ,medicare case mix index of at least #a4e1 an intern and resident-to-bed ratio of at least #j4be percent 7or at least #aej full-time equivalent interns1 residents1 and fellows71 and is either a public hospital with a disproportionate patient percentage of at least #ce percent 7as determined by the ,secretary under section #ahhf7;d77#e77;,f77vi77 or a nonprofit hospital with a disproportionate patient percentage of at least #de percent2 or 7,c7 a small subsection 7d7 urban safety net hospital 7as determined by the ,secretary7 with less than #bjj beds that is deemed to be a disproportionate share hospital under section #aibc7;b74 7#c7 ,innovations addressing mental and physical health comorbidities ,the term innovations addressing mental and physical health comorbidities means innovations implemented by an eligible hospital that seek to promote holistic care and treatment of an applicable individual's co-occurring mental and physical health comorbidities1 support early detection of such comorbidities1 or prevent their onset1 including the following3 7,a7 ,implementation of interdisciplinary integrative coordinated care team models1 including those that utilize mental health emergency department in-reach staff 7and other emergency-department interventions71 care coordination staff and social services support1 and clinic-based services4 7,b7 ,integration of mental health services into medical homes1 coordinated care organizations1 accountable care entities1 and in-home services4 7,c7 ,incorporation of mental health and social risk screening into medical screening1 particularly in child and adolescent populations4 7,d7 ,preventing adverse impacts on mental health resulting from physical health treatments or medications1 or on physical health resulting from mental health treatments or medications1 through cross disciplinary provider education1 quality metrics1 and other mechanisms4 7,e7 ,improvements in electronic health records and other technology platforms or networks to capture1 track1 and monitor mental and physical health treatments and medications provided across care settings and otherwise facilitate care coordination4 7,f7 ,piloting of reimbursement modifications that utilize site-neutral payments and that address conflicts and disincentives related to chronic care management and behavioral health management and differential treatment of inpatient and outpatient settings4 7,g7 ,mitigating the incidence of admission and readmission into psychiatric inpatient settings of chronically ill elderly patients through methods such as active inpatient management1 variations in initial length of stay1 enhanced discharge planning1 and psychosocial interventions4 7,h7 ,delivering health behavior assessments and interventions to improve physical health outcomes for patients and aid in the management of chronic health conditions4 7,i7 ,in coordination with law enforcement agencies and judicial entities1 interventions targeted at providing mental and physical health services 7including1 as appropriate1 substance use disorder services7 to individuals convicted of criminal offenses for purposes of mitigating recidivism4 7#d7 ,innovations addressing social determinants of health ,the term innovations addressing social determinants of health means innovations implemented by an eligible hospital that seek to address social determinants of health that negatively impact the health outcomes of applicable individuals1 including the following3 7,a7 ,improvements in electronic health records to better integrate mental health1 medical care1 and social care 7such as screening for social factors1 facilitated or closed loop referral1 risk stratification1 and shared records with community-based organizations74 7,b7 ,personnel-supported wrap around services for at-risk individuals with mental and physical health comorbidities 7such as nutrition and diet counseling1 social services referral1 respiratory therapy1 medical-legal assistance1 financial counseling1 consumer education1 pharmacy education1 asthma education1 and referral to food resources such as referral to the ,,snap program1 the ,,wic program1 a food bank1 case management assistance1 employment or education support1 intimate partner violence1 and behavioral health support74 7,c7 ,home and community-based services that provide collaborative care to address mental and physical health comorbidities through health behavior services1 nutrition support1 medication management1 transitional care1 telehealth1 mobile integrated health care1 paramedic-based home visitation1 or utilization of community health workers4 7,d7 ,hospital-based interventions 7such as same day primary care services1 skilled nursing interventions1 substance use disorder and behavioral health treatment coordination of care1 collaborative care models1 discharge planning and medication reconciliation1 long-term care management1 and post-traumatic injury management74 7#e7 ,individual with mental and physical health comorbidities ,the term individual with mental and physical health comorbidities means an individual who is challenged by serious mental illness or serious emotional disturbance as well as #a or more of the following conditions or characteristics3 7,a7 ,has or is at risk for one or more chronic conditions 7as defined by the ,secretary74 7,b7 ,high-risk pregnancy4 7,c7 ,history of high utilization of acute care services4 7,d7 ,frail elderly 7defined by impairments in activities of daily living74 7,e7 ,disability1 including traumatic brain injury4 7,f7 ,critical illness or injury requiring long-term recovery4 7#f7 ,vulnerable community ,the term vulnerable community means a geographic area served by an eligible hospital characterized by a population that has a statistically significant number of individuals with mental and physical health comorbidities1 indicators of poor population health status1 low-income status1 or status as a ,,usda-recognized food desert4 7g7 ,evaluation and report ,not later than #a year after the date of completion of the program under this section1 the ,secretary shall submit to ,congress a report containing an evaluation of the activities supported by the program4 ,such report shall include the following3 7#a7 ,a description of each such activity1 including-- 7,a7 the target population of such activity2 7,b7 how such activity addressed the adverse social determinants of health in such population2 and 7,c7 the role of community-based organizations and other community partners 7such as nonprofits and units of local government7 in such activity4 7#b7 ,evidence showing whether and how each such activity advanced any of the following objectives3 7,a7 ,improved access to care4 7,b7 ,improved quality of care4 7,c7 ,improved health outcomes4 7,d7 ,amelioration of disparities in care4 7,e7 ,improved care coordination4 7,f7 ,reduction in health care costs 7including such reductions under this title and title ,,xix and such reductions occurring for uninsured individuals74 7,g7 ,reduction in health care utilization 7including with respect to inpatient admissions1 utilization of emergency departments1 and room and board provided to individuals74 7,h7 ,reduction in non-medical public expenditures4 7,i7 ,changes in patient and provider satisfaction with care delivery4 7,j7 ,reductions in involvement with the justice system1 including reductions in recidivism4 7#c7 ,a description of the metrics used to track the implementation and results of each such activity4 7#d7 ,recommendations for any legislation or administrative action the ,secretary determines appropriate4 7h7 ,funding ,any funds appropriated under section #aaae;,a7f7 shall be available to the ,secretary without further appropriation for the purposes of carrying out this section4 4