Index for HR3962: Affordable Health Care for America Act
DIVISION B — MEDICARE AND MEDICAID IMPROVEMENTS.
TITLE III — PROMOTING PRIMARY CARE, MENTAL HEALTH SERVICES, AND COORDINATED CARE.
SEC 1302. — MEDICAL HOME PILOT PROGRAM.
Table Of Contents of the INDEX
Beneficiary
Sec 1302. -- Medical Home Pilot Program.
(C) TARGETED HIGH NEED BENEFICIARY DEFINED.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (1) (C)
Automated Concept:
Automated Concept:
BENEFICIARY meaning beneficiary being generally within upper 50th percentile of Medicare beneficiaries ; Term targeted high need
Index of Sec 1302. ... (D) AMOUNT OF PAYMENT. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (D) (iii)
Automated Concept:
Automated Concept:
PAYMENT under paragraph in manner ensuring that higher payments being made for higher risk beneficiaries ; Use appropriate risk-adjustment in determining amount of per beneficiary per month
Index of Sec 1302. ... (D) AMOUNT OF PAYMENT. - paragraph (ii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (5) (D) (ii)
Automated Concept:
Automated Concept:
PAYMENT under paragraph ; Use appropriate risk-adjustment in determining amount of per beneficiary per month
Index of Sec 1302. ...Beneficiary risk scores
Sec 1302. -- Medical Home Pilot Program.
(A) ESTABLISHMENT OF METHODOLOGY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (A)
Automated Concept:
Automated Concept:
BENEFICIARY risk scores to ensure that higher payments being made for higher risk beneficiaries ; Secretary adjusting payments to medical homes based on
Index of Sec 1302. ...Chronic conditions
Sec 1302. -- Medical Home Pilot Program.
(3) PRINCIPAL CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (b) (3)
Automated Concept:
Automated Concept:
CHRONIC conditions requiring specialist or subspecialist's expertise specialist or subspecialist assuming care management ; Accessible health care provided by physician being medical specialist or subspecialist addressing majority of personal health care needs of patients with
Index of Sec 1302. ...Chronic diseases or help: multiple
Sec 1302. -- Medical Home Pilot Program.
(B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (1) (B) (iii)
Automated Concept:
Automated Concept:
CHRONIC diseases or help beneficiaries accessing health care and community-based resources in local geographic area ; Medication therapy management services for patients with multiple
Index of Sec 1302. ...Chronic illnesses
Sec 1302. -- Medical Home Pilot Program.
(B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (1) (B) (iii)
Automated Concept:
Automated Concept:
CHRONIC illnesses, transitional care services, care plan ; Teaching self-care skills for managing
Index of Sec 1302. ...Clinical work and practice expenses
Sec 1302. -- Medical Home Pilot Program.
(D) AMOUNT OF PAYMENT. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (D) (i)
Automated Concept:
Automated Concept:
CLINICAL work and practice expenses involved in providing medical home services provided by independent patient-centered medical home For which payment being not made under title as of date of enactment of section ;
Index of Sec 1302. ... (D) AMOUNT OF PAYMENT. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (5) (D) (i)
Automated Concept:
Automated Concept:
CLINICAL work and practice expenses involved in providing medical home services provided by primary or principal care practice For which payment being not made under title as of date of enactment of section ;
Index of Sec 1302. ...Feasability and advisability
Sec 1302. -- Medical Home Pilot Program.
(1) EVALUATION OF COST AND QUALITY. - paragraph (B)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (e) (1) (B)
Automated Concept:
Automated Concept:
FEASABILITY and advisability of reimbursing medical homes for medical home services under title on permanent basis ;
Index of Sec 1302. ...Feasibility and advisability
Sec 1302. -- Medical Home Pilot Program.
(1) ESTABLISHMENT OF PILOT PROGRAM.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (a) (1)
Automated Concept:
Automated Concept:
HOME services to beneficiaries and targeted high need beneficiaries ; Secretary establishing medical home pilot program for purpose of evaluating feasibility and advisability of reimbursing qualified patient-centered medical homes for furnishing medical
Index of Sec 1302. ...Fiscal year
Sec 1302. -- Medical Home Pilot Program.
(1) OPERATIONAL COSTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (g) (1)
Automated Concept:
Automated Concept:
FISCAL year to be available until expended ; Amounts appropriated under paragraph for
Index of Sec 1302. ...Fiscal years 2010
Sec 1302. -- Medical Home Pilot Program.
(1) OPERATIONAL COSTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (g) (1)
Automated Concept:
Automated Concept:
FISCAL years 2010 through 2014 ; Transferring from Federal Supplementary Medical Insurance Trust Fund under section 1841 to Secretary for Centers for Medicare and Medicaid Services programming Management Account $6,000,000 for
Index of Sec 1302. ...Functional status
Sec 1302. -- Medical Home Pilot Program.
(1) EVALUATION OF COST AND QUALITY. - paragraph (A) - paragraph (vi)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (e) (1) (A) (vi)
Automated Concept:
Automated Concept:
FUNCTIONAL status where applicable ; Improvement in health outcomes including patient
Index of Sec 1302. ...Geographic area: local
Sec 1302. -- Medical Home Pilot Program.
(B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (1) (B) (iii)
Automated Concept:
Automated Concept:
GEOGRAPHIC area ; Medication therapy management services for patients with multiple chronic diseases or help beneficiaries accessing health care and community-based resources in local
Index of Sec 1302. ...Health: community
Sec 1302. -- Medical Home Pilot Program.
(B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (1) (B) (iii)
Automated Concept:
Automated Concept:
HEALTH workers including nurses or other non-physician practitioners ; Organization employing community
Index of Sec 1302. ...Health care
Sec 1302. -- Medical Home Pilot Program.
(2) PRIMARY CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (b) (2)
Automated Concept:
Automated Concept:
HEALTH care provided by physician, nurse practitioner or physician assistant practicing in field of family medicine, general internal medicine, geriatric medicine or pediatric medicine ; Term primary care meaning
Index of Sec 1302. ...Health care and community
Sec 1302. -- Medical Home Pilot Program.
(B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (1) (B) (iii)
Automated Concept:
Automated Concept:
GEOGRAPHIC area ; Medication therapy management services for patients with multiple chronic diseases or help beneficiaries accessing health care and community-based resources in local
Index of Sec 1302. ...Health care: accessible
Sec 1302. -- Medical Home Pilot Program.
(3) PRINCIPAL CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (b) (3)
Automated Concept:
Automated Concept:
CHRONIC conditions requiring specialist or subspecialist's expertise specialist or subspecialist assuming care management ; Accessible health care provided by physician being medical specialist or subspecialist addressing majority of personal health care needs of patients with
Index of Sec 1302. ...Health care items and services
Sec 1302. -- Medical Home Pilot Program.
(4) PREFERENCE. - paragraph (A)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (4) (A)
Automated Concept:
Automated Concept:
HEALTH care items and services under title for chronically ill beneficiaries relying on small physician or nurse practitioner practices ; Applications proposing to coordinate
Index of Sec 1302. ...Health care needs
Health care needs: patient's
Sec 1302. -- Medical Home Pilot Program.
(1) PATIENT-CENTERED MEDICAL HOME SERVICES. - paragraph (C)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (b) (1) (C)
Automated Concept:
Automated Concept:
HEALTH care needs or take responsibility for appropriately arranging care with other qualified physicians or providers for stages of life ; Providing patient's
Index of Sec 1302. ...Health care needs: personal
Sec 1302. -- Medical Home Pilot Program.
(3) PRINCIPAL CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (b) (3)
Automated Concept:
Automated Concept:
CHRONIC conditions requiring specialist or subspecialist's expertise specialist or subspecialist assuming care management ; Accessible health care provided by physician being medical specialist or subspecialist addressing majority of personal health care needs of patients with
Index of Sec 1302. ...Health care services
Sec 1302. -- Medical Home Pilot Program.
(4) PREFERENCE. - paragraph (C)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (4) (C)
Automated Concept:
Automated Concept:
HEALTH care services ; Applications from States proposing to use medical home model to coordinate
Index of Sec 1302. ...Health disparities
Sec 1302. -- Medical Home Pilot Program.
(4) PREFERENCE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (4)
Automated Concept:
Automated Concept:
HEALTH disparities ; Secretary giving preference to applications seeking to eliminate
Index of Sec 1302. ... (1) EVALUATION OF COST AND QUALITY. - paragraph (A) - paragraph (ii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (e) (1) (A) (ii)
Automated Concept:
Automated Concept:
HEALTH disparities ; Improvement in reducing
Index of Sec 1302. ...Health outcomes
Sec 1302. -- Medical Home Pilot Program.
(1) EVALUATION OF COST AND QUALITY. - paragraph (A) - paragraph (vi)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (e) (1) (A) (vi)
Automated Concept:
Automated Concept:
FUNCTIONAL status where applicable ; Improvement in health outcomes including patient
Index of Sec 1302. ...Home
Home: medical
Sec 1302. -- Medical Home Pilot Program.
(C) UPDATED STANDARDS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (e) (3) (C)
Automated Concept:
Automated Concept:
HOME and community based medical home and establishing process for ensuring that medical homes meeting updated standards ; Secretary periodically reviewing and updating standards for qualification as independent patient centered medical
Index of Sec 1302. ...Home: based medical
Sec 1302. -- Medical Home Pilot Program.
(A) AUTHORITY FOR PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (1) (A)
Automated Concept:
Automated Concept:
HOME pursuant to paragraph for beneficiaries ; Secretary making payments for furnishing of medical home services by community-based medical
Index of Sec 1302. ... (B) COMMUNITY-BASED MEDICAL HOME DEFINED.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (1) (B)
Automated Concept:
Automated Concept:
HOME meaning nonprofit community-based or State-based organization or State certified under paragraph as meeting following requirements ; Term community-based medical
Index of Sec 1302. ...Home: centered medical
Sec 1302. -- Medical Home Pilot Program.
(A) PAYMENT AUTHORITY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (1) (A)
Automated Concept:
Automated Concept:
HOME pursuant to paragraph for targeted high need beneficiaries ; Secretary making payments for medical home services furnished by independent patient-centered medical
Index of Sec 1302. ... (B) INDEPENDENT PATIENT-CENTERED MEDICAL HOME DEFINED.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (1) (B)
Automated Concept:
Automated Concept:
HOME meaning physician-directed or nurse-practitioner-directed practice qualified under paragraph ; Term independent patient-centered medical
Index of Sec 1302. ... (D) AMOUNT OF PAYMENT. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (D) (i)
Automated Concept:
Automated Concept:
HOME For which payment being not made under title as of date of enactment of section ; Clinical work and practice expenses involved in providing medical home services provided by independent patient-centered medical
Index of Sec 1302. ... (D) AMOUNT OF PAYMENT. - paragraph (ii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (D) (ii)
Automated Concept:
Automated Concept:
HOME ; Allowing for differential payments based on capabilities of independent patient-centered medical
Index of Sec 1302. ...Home: medical
Sec 1302. -- Medical Home Pilot Program.
(4) PARTICIPATION OF NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS. - paragraph (A)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (a) (4) (A)
Automated Concept:
Automated Concept:
HOME so long ; Nothing in section to be construed as preventing nurse practitioner from leading patient centered medical
Index of Sec 1302. ... (4) PARTICIPATION OF NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS. - paragraph (B)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (a) (4) (B)
Automated Concept:
Automated Concept:
HOME so long ; Nothing in section to be construed as preventing physician assistant from participating in patient centered medical
Index of Sec 1302. ... (B) PER BENEFICIARY PER MONTH PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (B)
Automated Concept:
Automated Concept:
HOME ; Secretary paying independent patient-centered medical homing monthly fee for targeted high need beneficiary consenting to receive medical home services through medical
Index of Sec 1302. ... (B) PER BENEFICIARY PER MONTH PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (5) (B)
Automated Concept:
Automated Concept:
HOME ; Secretary making two separate monthly payments for beneficiary consenting to receive medical home services through medical
Index of Sec 1302. ... (C) UPDATED STANDARDS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (e) (3) (C)
Automated Concept:
Automated Concept:
HOME and establishing process for ensuring that medical homes meeting updated standards ; Secretary periodically reviewing and updating standards for qualification as independent patient centered medical home and community based medical
Index of Sec 1302. ... (4) NO DUPLICATION IN PHYSICIAN PILOT PARTICIPATION.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (f) (4)
Automated Concept:
Automated Concept:
HOME ; Secretary not making payments to independent or community based medical
Index of Sec 1302. ...Home: one medical
Sec 1302. -- Medical Home Pilot Program.
(1) NO DUPLICATION IN PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (f) (1)
Automated Concept:
Automated Concept:
HOME services to individual ; Secretary not making payments under section under more than one model or more than one medical home under model for furnishing of medical
Index of Sec 1302. ...Home demonstration: medical
Sec 1302. -- Medical Home Pilot Program.
(h) TREATMENT OF TRHCA MEDICARE MEDICAL HOME DEMONSTRATION FUNDING. - paragraph (2)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (h) (2)
Automated Concept:
Automated Concept:
HOME demonstration implemented of section to be available to independent patient-centered medical home model described in subsection ; Funding for medical home services otherwise to be available if section 204 medical
Index of Sec 1302. ...Home model
Home model: centered medical
Sec 1302. -- Medical Home Pilot Program.
(h) TREATMENT OF TRHCA MEDICARE MEDICAL HOME DEMONSTRATION FUNDING. - paragraph (2)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (h) (2)
Automated Concept:
Automated Concept:
HOME model described in subsection ; Funding for medical home services otherwise to be available if section 204 medical home demonstration implemented of section to be available to independent patient-centered medical
Index of Sec 1302. ...Home model: medical
Sec 1302. -- Medical Home Pilot Program.
(2) SCOPE. - paragraph (B)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (a) (2) (B)
Automated Concept:
Automated Concept:
HOME model to be successful in improving quality and reducing costing ; Secretary finding medical
Index of Sec 1302. ... (4) PREFERENCE. - paragraph (C)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (4) (C)
Automated Concept:
Automated Concept:
HEALTH care services ; Applications from States proposing to use medical home model to coordinate
Index of Sec 1302. ...Home model: following medical
Sec 1302. -- Medical Home Pilot Program.
(3) MODELS OF MEDICAL HOMES IN THE PILOT PROGRAM.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (a) (3)
Automated Concept:
Automated Concept:
HOME models ; Pilot program evaluating following medical
Index of Sec 1302. ...Home pilot program: medical
Sec 1302. -- Medical Home Pilot Program.
(1) ESTABLISHMENT OF PILOT PROGRAM.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (a) (1)
Automated Concept:
Automated Concept:
HOME pilot program for purpose of evaluating feasibility and advisability of reimbursing qualified patient-centered medical homes for furnishing medical home services to beneficiaries and targeted high need beneficiaries ; Secretary establishing medical
Index of Sec 1302. ...Home services
Home services: centered medical
Sec 1302. -- Medical Home Pilot Program.
(1) PATIENT-CENTERED MEDICAL HOME SERVICES.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (b) (1)
Automated Concept:
Automated Concept:
HOME services meaning services ; Term patient-centered medical
Index of Sec 1302. ...Home services: medical
Sec 1302. -- Medical Home Pilot Program.
(1) ESTABLISHMENT OF PILOT PROGRAM.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (a) (1)
Automated Concept:
Automated Concept:
HOME services to beneficiaries and targeted high need beneficiaries ; Secretary establishing medical home pilot program for purpose of evaluating feasibility and advisability of reimbursing qualified patient-centered medical homes for furnishing medical
Index of Sec 1302. ... (A) PAYMENT AUTHORITY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (1) (A)
Automated Concept:
Automated Concept:
HOME pursuant to paragraph for targeted high need beneficiaries ; Secretary making payments for medical home services furnished by independent patient-centered medical
Index of Sec 1302. ... (A) ESTABLISHMENT OF METHODOLOGY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (A)
Automated Concept:
Automated Concept:
HOME services furnished by independent patient-centered medical homes ; Secretary establishing methodolology for payment for medical
Index of Sec 1302. ... (B) PER BENEFICIARY PER MONTH PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (B)
Automated Concept:
Automated Concept:
HOME services through medical home ; Secretary paying independent patient-centered medical homing monthly fee for targeted high need beneficiary consenting to receive medical
Index of Sec 1302. ... (D) AMOUNT OF PAYMENT. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (D) (i)
Automated Concept:
Automated Concept:
HOME For which payment being not made under title as of date of enactment of section ; Clinical work and practice expenses involved in providing medical home services provided by independent patient-centered medical
Index of Sec 1302. ... (B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (1) (B) (i)
Automated Concept:
Automated Concept:
HOME services ; Organization providing beneficiaries with medical
Index of Sec 1302. ... (B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (ii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (1) (B) (ii)
Automated Concept:
Automated Concept:
HOME services under supervision in close collaboration with primary care or principal care physician, nurse practitioner or physician assistant designated by beneficiary ; Organization providing medical
Index of Sec 1302. ... (4) PREFERENCE. - paragraph (B)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (4) (B)
Automated Concept:
Automated Concept:
HOME services for chronically ill patients covered by third-party payors ; Applications including other third-party payors furnishing medical
Index of Sec 1302. ... (A) ESTABLISHMENT OF METHODOLOGY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (5) (A)
Automated Concept:
Automated Concept:
HOME services furnished under CBMH model ; Secretary establishing methodolology for payment for medical
Index of Sec 1302. ... (B) PER BENEFICIARY PER MONTH PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (5) (B)
Automated Concept:
Automated Concept:
HOME services through medical home ; Secretary making two separate monthly payments for beneficiary consenting to receive medical
Index of Sec 1302. ... (D) AMOUNT OF PAYMENT. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (5) (D) (i)
Automated Concept:
Automated Concept:
HOME services provided by primary or principal care practice For which payment being not made under title as of date of enactment of section ; Clinical work and practice expenses involved in providing medical
Index of Sec 1302. ... (1) EVALUATION OF COST AND QUALITY. - paragraph (B)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (e) (1) (B)
Automated Concept:
Automated Concept:
HOME services under title on permanent basis ; Feasability and advisability of reimbursing medical homes for medical
Index of Sec 1302. ... (1) NO DUPLICATION IN PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (f) (1)
Automated Concept:
Automated Concept:
HOME services to individual ; Secretary not making payments under section under more than one model or more than one medical home under model for furnishing of medical
Index of Sec 1302. ... (h) TREATMENT OF TRHCA MEDICARE MEDICAL HOME DEMONSTRATION FUNDING. - paragraph (2)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (h) (2)
Automated Concept:
Automated Concept:
HOME demonstration implemented of section to be available to independent patient-centered medical home model described in subsection ; Funding for medical home services otherwise to be available if section 204 medical
Index of Sec 1302. ...Home services community: medical
Sec 1302. -- Medical Home Pilot Program.
(A) AUTHORITY FOR PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (1) (A)
Automated Concept:
Automated Concept:
HOME pursuant to paragraph for beneficiaries ; Secretary making payments for furnishing of medical home services by community-based medical
Index of Sec 1302. ...Implementation
Sec 1302. -- Medical Home Pilot Program.
(A) IN GENERAL.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (e) (3) (A)
Automated Concept:
Automated Concept:
IMPLEMENTATION improving quality of care as determined by Secretary ; Including that
Index of Sec 1302. ...Implementation: available initial
Sec 1302. -- Medical Home Pilot Program.
(6) INITIAL IMPLEMENTATION FUNDING.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (6)
Automated Concept:
Automated Concept:
IMPLEMENTATION funding to non-profit community based or State-based organization or State participating in pilot program under subsection ; Secretary making available initial
Index of Sec 1302. ...Implementation: initial
Sec 1302. -- Medical Home Pilot Program.
(3) DURATION.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (3)
Automated Concept:
Automated Concept:
IMPLEMENTATION funding under paragraph ; Without regard to receipt of initial
Index of Sec 1302. ...Implementation phase: initial
Sec 1302. -- Medical Home Pilot Program.
(3) DURATION.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (3)
Automated Concept:
Automated Concept:
IMPLEMENTATION phase ; Demonstration site under pilot program operating for period of up to 5 years after initial
Index of Sec 1302. ...Implementation plan: detailed
Sec 1302. -- Medical Home Pilot Program.
(6) INITIAL IMPLEMENTATION FUNDING.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (6)
Automated Concept:
Automated Concept:
IMPLEMENTATION plan including funds to be used ; Organization providing Secretary with detailed
Index of Sec 1302. ...Information: useful
Sec 1302. -- Medical Home Pilot Program.
(1) PATIENT-CENTERED MEDICAL HOME SERVICES. - paragraph (F)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (b) (1) (F)
Automated Concept:
Automated Concept:
INFORMATION on participating patients enabling practice to treat patients comprehensively ; Clinically useful
Index of Sec 1302. ...Medical
Sec 1302. -- Medical Home Pilot Program.
(3) PRINCIPAL CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (b) (3)
Automated Concept:
Automated Concept:
CHRONIC conditions requiring specialist or subspecialist's expertise specialist or subspecialist assuming care management ; Accessible health care provided by physician being medical specialist or subspecialist addressing majority of personal health care needs of patients with
Index of Sec 1302. ...Medical: centered
Sec 1302. -- Medical Home Pilot Program.
(B) PER BENEFICIARY PER MONTH PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (B)
Automated Concept:
Automated Concept:
HOME services through medical home ; Secretary paying independent patient-centered medical homing monthly fee for targeted high need beneficiary consenting to receive medical
Index of Sec 1302. ...Medical homes
Sec 1302. -- Medical Home Pilot Program.
(2) STANDARD SETTING AND QUALIFICATION PROCESS FOR PATIENT-CENTERED MEDICAL HOMES.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (2)
Automated Concept:
Automated Concept:
MEDICAL homes ; Secretary establishing process for practices to qualify as
Index of Sec 1302. ... (A) ESTABLISHMENT OF METHODOLOGY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (A)
Automated Concept:
Automated Concept:
BENEFICIARY risk scores to ensure that higher payments being made for higher risk beneficiaries ; Secretary adjusting payments to medical homes based on
Index of Sec 1302. ... (1) EVALUATION OF COST AND QUALITY. - paragraph (B)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (e) (1) (B)
Automated Concept:
Automated Concept:
HOME services under title on permanent basis ; Feasability and advisability of reimbursing medical homes for medical
Index of Sec 1302. ... (C) UPDATED STANDARDS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (e) (3) (C)
Automated Concept:
Automated Concept:
MEDICAL homes meeting updated standards ; Secretary periodically reviewing and updating standards for qualification as independent patient centered medical home and community based medical home and establishing process for ensuring that
Index of Sec 1302. ...Medical homes: based
Sec 1302. -- Medical Home Pilot Program.
(2) QUALIFICATION PROCESS FOR COMMUNITY-BASED MEDICAL HOMES.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (2)
Automated Concept:
Automated Concept:
MEDICAL homes pursuant to criteria established by Secretary ; Secretary establishing process to provide for review and qualification of community-based
Index of Sec 1302. ... (3) DURATION.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (3)
Automated Concept:
Automated Concept:
MEDICAL homes under subsection starting no later than 2 years after date of enactment of section ; Pilot program for community-based
Index of Sec 1302. ...Medical homes: centered
Sec 1302. -- Medical Home Pilot Program.
(1) ESTABLISHMENT OF PILOT PROGRAM.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (a) (1)
Automated Concept:
Automated Concept:
HOME services to beneficiaries and targeted high need beneficiaries ; Secretary establishing medical home pilot program for purpose of evaluating feasibility and advisability of reimbursing qualified patient-centered medical homes for furnishing medical
Index of Sec 1302. ... (A) ESTABLISHMENT OF METHODOLOGY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (A)
Automated Concept:
Automated Concept:
MEDICAL homes ; Secretary establishing methodolology for payment for medical home services furnished by independent patient-centered
Index of Sec 1302. ...Medical visits
Sec 1302. -- Medical Home Pilot Program.
(2) NO EFFECT ON PAYMENT FOR MEDICAL VISITS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (f) (2)
Automated Concept:
Automated Concept:
TITLE ; Payment for medical visits making under
Index of Sec 1302. ...Medicine
Medicine: family
Sec 1302. -- Medical Home Pilot Program.
(2) PRIMARY CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (b) (2)
Automated Concept:
Automated Concept:
MEDICINE or pediatric medicine ; Term primary care meaning health care provided by physician, nurse practitioner or physician assistant practicing in field of family medicine, general internal medicine, geriatric
Index of Sec 1302. ...Medicine: general internal
Sec 1302. -- Medical Home Pilot Program.
(2) PRIMARY CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (b) (2)
Automated Concept:
Automated Concept:
MEDICINE or pediatric medicine ; Term primary care meaning health care provided by physician, nurse practitioner or physician assistant practicing in field of family medicine, general internal medicine, geriatric
Index of Sec 1302. ...Medicine: geriatric
Sec 1302. -- Medical Home Pilot Program.
(2) PRIMARY CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (b) (2)
Automated Concept:
Automated Concept:
MEDICINE or pediatric medicine ; Term primary care meaning health care provided by physician, nurse practitioner or physician assistant practicing in field of family medicine, general internal medicine, geriatric
Index of Sec 1302. ...Medicine: pediatric
Sec 1302. -- Medical Home Pilot Program.
(2) PRIMARY CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (b) (2)
Automated Concept:
Automated Concept:
MEDICINE ; Term primary care meaning health care provided by physician, nurse practitioner or physician assistant practicing in field of family medicine, general internal medicine, geriatric medicine or pediatric
Index of Sec 1302. ...Nonprofit community
Sec 1302. -- Medical Home Pilot Program.
(B) COMMUNITY-BASED MEDICAL HOME DEFINED.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (1) (B)
Automated Concept:
Automated Concept:
NONPROFIT community-based or State-based organization or State certified under paragraph as meeting following requirements ; Term community-based medical home meaning
Index of Sec 1302. ...Payment
Sec 1302. -- Medical Home Pilot Program.
(A) ESTABLISHMENT OF METHODOLOGY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (A)
Automated Concept:
Automated Concept:
HOME services furnished by independent patient-centered medical homes ; Secretary establishing methodolology for payment for medical
Index of Sec 1302. ... (D) AMOUNT OF PAYMENT. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (D) (i)
Automated Concept:
Automated Concept:
PAYMENT being not made under title as of date of enactment of section ; Clinical work and practice expenses involved in providing medical home services provided by independent patient-centered medical home For which
Index of Sec 1302. ... (A) ESTABLISHMENT OF METHODOLOGY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (5) (A)
Automated Concept:
Automated Concept:
HOME services furnished under CBMH model ; Secretary establishing methodolology for payment for medical
Index of Sec 1302. ... (D) AMOUNT OF PAYMENT. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (5) (D) (i)
Automated Concept:
Automated Concept:
PAYMENT being not made under title as of date of enactment of section ; Clinical work and practice expenses involved in providing medical home services provided by primary or principal care practice For which
Index of Sec 1302. ... (2) NO EFFECT ON PAYMENT FOR MEDICAL VISITS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (f) (2)
Automated Concept:
Automated Concept:
PAYMENT for medical visits making under title ;
Index of Sec 1302. ...Payment: per month
Sec 1302. -- Medical Home Pilot Program.
(D) AMOUNT OF PAYMENT. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (D) (iii)
Automated Concept:
Automated Concept:
PAYMENT under paragraph in manner ensuring that higher payments being made for higher risk beneficiaries ; Use appropriate risk-adjustment in determining amount of per beneficiary per month
Index of Sec 1302. ... (D) AMOUNT OF PAYMENT. - paragraph (ii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (5) (D) (ii)
Automated Concept:
Automated Concept:
PAYMENT under paragraph ; Use appropriate risk-adjustment in determining amount of per beneficiary per month
Index of Sec 1302. ...Payments
Sec 1302. -- Medical Home Pilot Program.
(A) PAYMENT AUTHORITY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (1) (A)
Automated Concept:
Automated Concept:
HOME pursuant to paragraph for targeted high need beneficiaries ; Secretary making payments for medical home services furnished by independent patient-centered medical
Index of Sec 1302. ... (A) ESTABLISHMENT OF METHODOLOGY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (A)
Automated Concept:
Automated Concept:
BENEFICIARY risk scores to ensure that higher payments being made for higher risk beneficiaries ; Secretary adjusting payments to medical homes based on
Index of Sec 1302. ... (A) AUTHORITY FOR PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (1) (A)
Automated Concept:
Automated Concept:
HOME pursuant to paragraph for beneficiaries ; Secretary making payments for furnishing of medical home services by community-based medical
Index of Sec 1302. ... (B) PER BENEFICIARY PER MONTH PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (5) (B)
Automated Concept:
Automated Concept:
HOME services through medical home ; Secretary making two separate monthly payments for beneficiary consenting to receive medical
Index of Sec 1302. ... (C) PROSPECTIVE PAYMENT.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (5) (C)
Automated Concept:
Automated Concept:
PAYMENTS under subparagraph to be paid on prospective basis ;
Index of Sec 1302. ... (1) NO DUPLICATION IN PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (f) (1)
Automated Concept:
Automated Concept:
HOME services to individual ; Secretary not making payments under section under more than one model or more than one medical home under model for furnishing of medical
Index of Sec 1302. ... (2) NO EFFECT ON PAYMENT FOR MEDICAL VISITS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (f) (2)
Automated Concept:
Automated Concept:
PAYMENTS making under section in addition ;
Index of Sec 1302. ... (4) NO DUPLICATION IN PHYSICIAN PILOT PARTICIPATION.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (f) (4)
Automated Concept:
Automated Concept:
HOME ; Secretary not making payments to independent or community based medical
Index of Sec 1302. ...Payment: differential
Sec 1302. -- Medical Home Pilot Program.
(D) AMOUNT OF PAYMENT. - paragraph (ii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (D) (ii)
Automated Concept:
Automated Concept:
HOME ; Allowing for differential payments based on capabilities of independent patient-centered medical
Index of Sec 1302. ...Payment: higher
Sec 1302. -- Medical Home Pilot Program.
(A) ESTABLISHMENT OF METHODOLOGY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (A)
Automated Concept:
Automated Concept:
PAYMENTS being made for higher risk beneficiaries ; Secretary adjusting payments to medical homes based on beneficiary risk scores to ensure that higher
Index of Sec 1302. ... (D) AMOUNT OF PAYMENT. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (D) (iii)
Automated Concept:
Automated Concept:
PAYMENTS being made for higher risk beneficiaries ; Use appropriate risk-adjustment in determining amount of per beneficiary per month payment under paragraph in manner ensuring that higher
Index of Sec 1302. ...Primary or principal care practice
Sec 1302. -- Medical Home Pilot Program.
(D) AMOUNT OF PAYMENT. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (5) (D) (i)
Automated Concept:
Automated Concept:
PAYMENT being not made under title as of date of enactment of section ; Clinical work and practice expenses involved in providing medical home services provided by primary or principal care practice For which
Index of Sec 1302. ...Primary care
Sec 1302. -- Medical Home Pilot Program.
(1) PATIENT-CENTERED MEDICAL HOME SERVICES. - paragraph (A)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (b) (1) (A)
Automated Concept:
Automated Concept:
PRIMARY care or principal care physician or nurse practitioner accepting responsibility for providing first contact, continuous and comprehensive care to beneficiary ; Providing beneficiaries with direct and ongoing access to
Index of Sec 1302. ... (2) PRIMARY CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (b) (2)
Automated Concept:
Automated Concept:
HEALTH care provided by physician, nurse practitioner or physician assistant practicing in field of family medicine, general internal medicine, geriatric medicine or pediatric medicine ; Term primary care meaning
Index of Sec 1302. ... (B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (ii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (1) (B) (ii)
Automated Concept:
Automated Concept:
PRIMARY care or principal care physician, nurse practitioner or physician assistant designated by beneficiary ; Organization providing medical home services under supervision in close collaboration with
Index of Sec 1302. ...Principal care
Sec 1302. -- Medical Home Pilot Program.
(1) PATIENT-CENTERED MEDICAL HOME SERVICES. - paragraph (A)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (b) (1) (A)
Automated Concept:
Automated Concept:
PRINCIPAL care physician or nurse practitioner accepting responsibility for providing first contact, continuous and comprehensive care to beneficiary ; Providing beneficiaries with direct and ongoing access to primary care or
Index of Sec 1302. ... (B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (ii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (1) (B) (ii)
Automated Concept:
Automated Concept:
PRINCIPAL care physician, nurse practitioner or physician assistant designated by beneficiary ; Organization providing medical home services under supervision in close collaboration with primary care or
Index of Sec 1302. ...Pursuant
Sec 1302. -- Medical Home Pilot Program.
(A) PAYMENT AUTHORITY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (1) (A)
Automated Concept:
Automated Concept:
HOME pursuant to paragraph for targeted high need beneficiaries ; Secretary making payments for medical home services furnished by independent patient-centered medical
Index of Sec 1302. ... (A) AUTHORITY FOR PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (1) (A)
Automated Concept:
Automated Concept:
HOME pursuant to paragraph for beneficiaries ; Secretary making payments for furnishing of medical home services by community-based medical
Index of Sec 1302. ... (2) QUALIFICATION PROCESS FOR COMMUNITY-BASED MEDICAL HOMES.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (2)
Automated Concept:
Automated Concept:
MEDICAL homes pursuant to criteria established by Secretary ; Secretary establishing process to provide for review and qualification of community-based
Index of Sec 1302. ...Responsibility
Sec 1302. -- Medical Home Pilot Program.
(1) PATIENT-CENTERED MEDICAL HOME SERVICES. - paragraph (A)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (b) (1) (A)
Automated Concept:
Automated Concept:
RESPONSIBILITY for providing first contact, continuous and comprehensive care to beneficiary ; Providing beneficiaries with direct and ongoing access to primary care or principal care physician or nurse practitioner accepting
Index of Sec 1302. ...Risk: higher
Sec 1302. -- Medical Home Pilot Program.
(A) ESTABLISHMENT OF METHODOLOGY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (A)
Automated Concept:
Automated Concept:
RISK beneficiaries ; Secretary adjusting payments to medical homes based on beneficiary risk scores to ensure that higher payments being made for higher
Index of Sec 1302. ... (D) AMOUNT OF PAYMENT. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (D) (iii)
Automated Concept:
Automated Concept:
RISK beneficiaries ; Use appropriate risk-adjustment in determining amount of per beneficiary per month payment under paragraph in manner ensuring that higher payments being made for higher
Index of Sec 1302. ...Risk-adjustment: appropriate
Sec 1302. -- Medical Home Pilot Program.
(D) AMOUNT OF PAYMENT. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (D) (iii)
Automated Concept:
Automated Concept:
PAYMENT under paragraph in manner ensuring that higher payments being made for higher risk beneficiaries ; Use appropriate risk-adjustment in determining amount of per beneficiary per month
Index of Sec 1302. ... (D) AMOUNT OF PAYMENT. - paragraph (ii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (5) (D) (ii)
Automated Concept:
Automated Concept:
PAYMENT under paragraph ; Use appropriate risk-adjustment in determining amount of per beneficiary per month
Index of Sec 1302. ...Specific goals
Sec 1302. -- Medical Home Pilot Program.
(2) SCOPE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (a) (2)
Automated Concept:
Automated Concept:
SPECIFIC goals for number of practices and communities and number of patients served under pilot program in initial tests to ensure that pilot program of sufficient size and scope ; Secretary setting
Index of Sec 1302. ...Teaching self-care skills
Sec 1302. -- Medical Home Pilot Program.
(B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (1) (B) (iii)
Automated Concept:
Automated Concept:
CHRONIC illnesses, transitional care services, care plan ; Teaching self-care skills for managing
Index of Sec 1302. ...Title
Sec 1302. -- Medical Home Pilot Program.
(D) AMOUNT OF PAYMENT. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (c) (3) (D) (i)
Automated Concept:
Automated Concept:
TITLE as of date of enactment of section ; Clinical work and practice expenses involved in providing medical home services provided by independent patient-centered medical home For which payment being not made under
Index of Sec 1302. ... (4) PREFERENCE. - paragraph (A)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (4) (A)
Automated Concept:
Automated Concept:
TITLE for chronically ill beneficiaries relying on small physician or nurse practitioner practices ; Applications proposing to coordinate health care items and services under
Index of Sec 1302. ... (D) AMOUNT OF PAYMENT. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (d) (5) (D) (i)
Automated Concept:
Automated Concept:
TITLE as of date of enactment of section ; Clinical work and practice expenses involved in providing medical home services provided by primary or principal care practice For which payment being not made under
Index of Sec 1302. ... (1) EVALUATION OF COST AND QUALITY. - paragraph (B)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (e) (1) (B)
Automated Concept:
Automated Concept:
TITLE on permanent basis ; Feasability and advisability of reimbursing medical homes for medical home services under
Index of Sec 1302. ... (2) NO EFFECT ON PAYMENT FOR MEDICAL VISITS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (f) (2)
Automated Concept:
Automated Concept:
TITLE ; Payment for medical visits making under
Index of Sec 1302. ...Title: provisions of
Sec 1302. -- Medical Home Pilot Program.
(5) WAIVER.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (f) (5)
Automated Concept:
Automated Concept:
TITLE and titling XI in manner Secretary determining necessary in order to implement section ; Secretary waiving provisions of
Index of Sec 1302. ...Title 44: chapter 35 of
Sec 1302. -- Medical Home Pilot Program.
(3) ADMINISTRATION.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866F. (f) (3)
Automated Concept:
Automated Concept:
TITLE 44, United States Code not applying to section ; Chapter 35 of
Index of Sec 1302. ...Title xviii
Title xviii
Sec 1302. -- Medical Home Pilot Program.
(a) IN GENERAL.
DIVISION B TITLE III SEC 1302. (a)
Automated Concept:
Automated Concept:
TITLE XVIII of Social Security Act amended by inserting after section 1866e as inserted by section 1301 ;
Index of Sec 1302. ...The Index is © 2009 healthcarebillindex.com
1st Session |
To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.
Mr. Dingell (for himself, Mr. Rangel, Mr. Waxman, Mr. George Miller of California, Mr. Stark, Mr. Pallone, and Mr. Andrews) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Labor, Oversight and Government Reform, and the Budget, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SEC. 1302. Medical home pilot program.
(a) In general.—Title XVIII of the Social Security Act is amended by inserting after section 1866E, as inserted by section 1301, the following new section:
“Medical home pilot program
“Sec. 1866F. (a) Establishment and medical home models.—
“(1) ESTABLISHMENT OF PILOT PROGRAM.—The Secretary shall establish a medical home pilot program (in this section referred to as the ‘pilot program’) for the purpose of evaluating the feasibility and advisability of reimbursing qualified patient-centered medical homes for furnishing medical home services (as defined under subsection (b)(1)) to beneficiaries (as defined in subsection (b)(4)) and to targeted high need beneficiaries (as defined in subsection (c)(1)(C)).
“(2) SCOPE.—Subject to subsection (g), the Secretary shall set specific goals for the number of practices and communities, and the number of patients served, under the pilot program in the initial tests to ensure that the pilot program is of sufficient size and scope to—
“(A) test the approach involved in a variety of settings, including urban, rural, and underserved areas; and
“(B) subject to subsection (e)(1), disseminate such approach rapidly on a national basis.
To the extent that the Secretary finds a medical home model to be successful in improving quality and reducing costs, the Secretary shall implement such model on as large a geographic scale as practical and economical.
“(3) MODELS OF MEDICAL HOMES IN THE PILOT PROGRAM.—The pilot program shall evaluate each of the following medical home models:
“(A) INDEPENDENT PATIENT-CENTERED MEDICAL HOME MODEL.—Independent patient-centered medical home model under subsection (c).
“(B) COMMUNITY-BASED MEDICAL HOME MODEL.—Community-based medical home model under subsection (d).
“(4) PARTICIPATION OF NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS.—
“(A) Nothing in this section shall be construed as preventing a nurse practitioner from leading a patient centered medical home so long as—
“(i) all the requirements of this section are met; and
“(ii) the nurse practitioner is acting in a manner that is consistent with State law.
“(B) Nothing in this section shall be construed as preventing a physician assistant from participating in a patient centered medical home so long as—
“(i) all the requirements of this section are met; and
“(ii) the physician assistant is acting in a manner that is consistent with State law.
“(1) EVALUATION OF COST AND QUALITY.—The Secretary shall evaluate the pilot program to determine—
“(A) the extent to which medical homes result in—
“(i) improvement in the quality and coordination of items and services under this title, particularly with regard to the care of complex patients;
“(ii) improvement in reducing health disparities;
“(iii) reductions in preventable hospitalizations;
“(iv) prevention of readmissions;
“(v) reductions in emergency room visits;
“(vi) improvement in health outcomes, including patient functional status where applicable;
“(vii) improvement in patient satisfaction;
“(viii) improved efficiency of care such as reducing duplicative diagnostic tests and laboratory tests; and
“(ix) reductions in health care expenditures; and
“(B) the feasability and advisability of reimbursing medical homes for medical home services under this title on a permanent basis.
“(2) REPORT.—Not later than 60 days after the date of completion of the evaluation under paragraph (1), the Secretary shall submit to Congress and make available to the public a report on the findings of the evaluation under paragraph (1) and the extent to which standards for the certification of medical homes need to be periodically updated.
“(A) IN GENERAL.—Subject to the results of the evaluation under paragraph (1) and subparagraph (B), the Secretary may issue regulations to implement, on a permanent basis, one or more models, if, and to the extent that such model or models, are beneficial to the program under this title, including that such implementation will improve quality of care, as determined by the Secretary.
“(B) CERTIFICATION REQUIREMENT.—The Secretary may not issue such regulations unless the Chief Actuary of the Centers for Medicare & Medicaid Services certifies that the expansion of the components of the pilot program described in subparagraph (A) would result in estimated spending under this title that would be no more than the level of spending that the Secretary estimates would otherwise be spent under this title in the absence of such expansion.
“(C) UPDATED STANDARDS.—The Secretary shall periodically review and update the standards for qualification as an independent patient centered medical home and as a community based medical home and shall establish a process for ensuring that medical homes meet such updated standards, as applicable
(b) Effective date.—The amendment made by this section shall apply to services furnished on or after the date of the enactment of this Act.
(c) Conforming repeal.—Section 204 of division B of the Tax Relief and Health Care Act of 2006 (42 U.S.C. 1395b–1 note), as amended by section 133(a)(2) of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110–275), is repealed.
The information contained here is believed to be correct, but healthcarebillindex.com cannot guarantee or warrant the accuracy of this information.
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