TITLE VI--PROVISIONS RELATING TO PART B
Subtitle D--Additional Demonstrations, Studies, and Other Provisions
SEC. 648. DEMONSTRATION PROJECT FOR CONSUMER-DIRECTED CHRONIC
OUTPATIENT SERVICES.
(1) IN GENERAL- Subject to the succeeding
provisions of this section, the Secretary shall establish demonstration projects
(in this section referred to as `demonstration projects') under which the
Secretary shall evaluate methods that improve the quality of care provided
to individuals with chronic conditions and that reduce expenditures that would
otherwise be made under the medicare program on behalf of such individuals
for such chronic conditions, such methods to include permitting those beneficiaries
to direct their own health care needs and services.
(2) INDIVIDUALS WITH CHRONIC CONDITIONS
DEFINED- In this section, the term `individuals with chronic conditions' means
an individual entitled to benefits under part A of title XVIII of the Social
Security Act, and enrolled under part B of such title, but who is not enrolled
under part C of such title who is diagnosed as having one or more chronic
conditions (as defined by the Secretary), such as diabetes.
(1) EVALUATION BEFORE IMPLEMENTATION
OF PROJECT-
(A) IN GENERAL- In establishing
the demonstration projects under this section, the Secretary shall evaluate
best practices employed by group health plans and practices under State
plans for medical assistance under the medicaid program under title XIX
of the Social Security Act, as well as best practices in the private sector
or other areas, of methods that permit patients to self-direct the provision
of personal care services. The Secretary shall evaluate such practices for
a 1-year period and, based on such evaluation, shall design the demonstration
project.
(B) REQUIREMENT FOR ESTIMATE
OF BUDGET NEUTRAL COSTS- As part of the evaluation under subparagraph (A),
the Secretary shall evaluate the costs of furnishing care under the projects.
The Secretary may not implement the demonstration projects under this section
unless the Secretary determines that the costs of providing care to individuals
with chronic conditions under the project will not exceed the costs, in
the aggregate, of furnishing care to such individuals under title XVIII
of the Social Security Act, that would otherwise be paid without regard
to the demonstration projects for the period of the project.
(2) SCOPE OF SERVICES- The Secretary
shall determine the appropriate scope of personal care services that would
apply under the demonstration projects.
(c) VOLUNTARY PARTICIPATION- Participation
of providers of services and suppliers, and of individuals with chronic conditions,
in the demonstration projects shall be voluntary.
(d) DEMONSTRATION PROJECTS SITES- Not later
than 2 years after the date of the enactment of this Act, the Secretary shall
conduct a demonstration project in at least one area that the Secretary determines
has a population of individuals entitled to benefits under part A of title XVIII
of the Social Security Act, and enrolled under part B of such title, with a
rate of incidence of diabetes that significantly exceeds the national average
rate of all areas.
(e) EVALUATION AND REPORT-
(1) EVALUATIONS- The Secretary shall
conduct evaluations of the clinical and cost effectiveness of the demonstration
projects.
(2) REPORTS- Not later than 2 years
after the commencement of the demonstration projects, and biannually thereafter,
the Secretary shall submit to Congress a report on the evaluation, and shall
include in the report the following:
(A) An analysis of the patient
outcomes and costs of furnishing care to the individuals with chronic conditions
participating in the projects as compared to such outcomes and costs to
other individuals for the same health conditions.
(B) Evaluation of patient satisfaction
under the demonstration projects.
(C) Such recommendations regarding
the extension, expansion, or termination of the projects as the Secretary
determines appropriate.
(f) WAIVER AUTHORITY- The Secretary shall waive
compliance with the requirements of title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) to such extent and for such period as the Secretary determines
is necessary to conduct demonstration projects.
(g) AUTHORIZATION OF APPROPRIATIONS- (1)
Payments for the costs of carrying out the demonstration project under this
section shall be made from the Federal Supplementary Medical Insurance Trust
Fund under section 1841 of such Act (42 U.S.C. 1395t).
(2) There are authorized to be appropriated
from such Trust Fund such sums as may be necessary for the Secretary to enter
into contracts with appropriate organizations for the deign, implementation,
and evaluation of the demonstration project.
(3) In no case may expenditures under
this section exceed the aggregate expenditures that would otherwise have been
made for the provision of personal care services.
