TITLE VI--PROVISIONS RELATING TO PART B
Subtitle D--Additional Demonstrations, Studies, and Other Provisions
SEC. 646. MEDICARE HEALTH CARE QUALITY DEMONSTRATION PROGRAMS.
Title XVIII (42 U.S.C. 1395 et seq.) is amended by inserting after section
1866B the following new section:
`HEALTH CARE QUALITY DEMONSTRATION PROGRAM
`SEC. 1866C. (a) DEFINITIONS- In this section:
`(1) BENEFICIARY- The term `beneficiary' means an individual who is
entitled to benefits under part A and enrolled under part B, including any
individual who is enrolled in a Medicare Advantage plan under part C.
`(A) IN GENERAL- The term `health care group' means--
`(i) a group of physicians that is organized at least in part for
the purpose of providing physician's services under this
title;
`(ii) an integrated health care delivery system that delivers care
through coordinated hospitals, clinics, home health agencies, ambulatory
surgery centers, skilled nursing facilities, rehabilitation facilities
and clinics, and employed, independent, or contracted physicians;
or
`(iii) an organization representing regional coalitions of groups or
systems described in clause (i) or (ii).
`(B) INCLUSION- As the Secretary determines appropriate, a health care
group may include a hospital or any other individual or entity furnishing
items or services for which payment may be made under this title that is
affiliated with the health care group under an arrangement structured so
that such hospital, individual, or entity participates in a demonstration
project under this section.
`(3) PHYSICIAN- Except as otherwise provided for by the Secretary, the
term `physician' means any individual who furnishes services that may be
paid for as physicians' services under this title.
`(b) DEMONSTRATION PROJECTS- The Secretary shall establish a 5-year
demonstration program under which the Secretary shall approve demonstration
projects that examine health delivery factors that encourage the delivery of
improved quality in patient care, including--
`(1) the provision of incentives to improve the safety of care provided
to beneficiaries;
`(2) the appropriate use of best practice guidelines by providers and
services by beneficiaries;
`(3) reduced scientific uncertainty in the delivery of care through the
examination of variations in the utilization and allocation of services, and
outcomes measurement and research;
`(4) encourage shared decision making between providers and
patients;
`(5) the provision of incentives for improving the quality and safety of
care and achieving the efficient allocation of resources;
`(6) the appropriate use of culturally and ethnically sensitive health
care delivery; and
`(7) the financial effects on the health care marketplace of altering
the incentives for care delivery and changing the allocation of
resources.
`(c) ADMINISTRATION BY CONTRACT-
`(1) IN GENERAL- Except as otherwise provided in this section, the
Secretary may administer the demonstration program established under this
section in a manner that is similar to the manner in which the demonstration
program established under section 1866A is administered in accordance with
section 1866B.
`(2) ALTERNATIVE PAYMENT SYSTEMS- A health care group that receives
assistance under this section may, with respect to the demonstration project
to be carried out with such assistance, include proposals for the use of
alternative payment systems for items and services provided to beneficiaries
by the group that are designed to--
`(A) encourage the delivery of high quality care while accomplishing
the objectives described in subsection (b); and
`(B) streamline documentation and reporting requirements otherwise
required under this title.
`(3) BENEFITS- A health care group that receives assistance under this
section may, with respect to the demonstration project to be carried out
with such assistance, include modifications to the package of benefits
available under the original medicare fee-for-service program under parts A
and B or the package of benefits available through a Medicare Advantage plan
under part C. The criteria employed under the demonstration program under
this section to evaluate outcomes and determine best practice guidelines and
incentives shall not be used as a basis for the denial of medicare benefits
under the demonstration program to patients against their wishes (or if the
patient is incompetent, against the wishes of the patient's surrogate) on
the basis of the patient's age or expected length of life or of the
patient's present or predicted disability, degree of medical dependency, or
quality of life.
`(d) ELIGIBILITY CRITERIA- To be eligible to receive assistance under this
section, an entity shall--
`(1) be a health care group;
`(2) meet quality standards established by the Secretary,
including--
`(A) the implementation of continuous quality improvement mechanisms
that are aimed at integrating community-based support services, primary
care, and referral care;
`(B) the implementation of activities to increase the delivery of
effective care to beneficiaries;
`(C) encouraging patient participation in preference-based
decisions;
`(D) the implementation of activities to encourage the coordination
and integration of medical service delivery; and
`(E) the implementation of activities to measure and document the
financial impact on the health care marketplace of altering the incentives
of health care delivery and changing the allocation of resources;
and
`(3) meet such other requirements as the Secretary may establish.
`(e) WAIVER AUTHORITY- The Secretary may waive such requirements of titles
XI and XVIII as may be necessary to carry out the purposes of the
demonstration program established under this section.
`(f) BUDGET NEUTRALITY- With respect to the 5-year period of the
demonstration program under subsection (b), the aggregate expenditures under
this title for such period shall not exceed the aggregate expenditures that
would have been expended under this title if the program established under
this section had not been implemented.
`(g) NOTICE REQUIREMENTS- In the case of an individual that receives
health care items or services under a demonstration program carried out under
this section, the Secretary shall ensure that such individual is notified of
any waivers of coverage or payment rules that are applicable to such
individual under this title as a result of the participation of the individual
in such program.
`(h) PARTICIPATION AND SUPPORT BY FEDERAL AGENCIES- In carrying out the
demonstration program under this section, the Secretary may direct--
`(1) the Director of the National Institutes of Health to expand the
efforts of the Institutes to evaluate current medical technologies and
improve the foundation for evidence-based practice;
`(2) the Administrator of the Agency for Healthcare Research and Quality
to, where possible and appropriate, use the program under this section as a
laboratory for the study of quality improvement strategies and to evaluate,
monitor, and disseminate information relevant to such program; and
`(3) the Administrator of the Centers for Medicare & Medicaid Services
and the Administrator of the Center for Medicare Choices to support linkages
of relevant medicare data to registry information from participating health
care groups for the beneficiary populations served by the participating groups,
for analysis supporting the purposes of the demonstration program, consistent
with the applicable provisions of the Health Insurance Portability and Accountability
Act of 1996.'.
