CASE MANAGEMENT DEMONSTRATION PROJECTS.

SEC. 425. CASE MANAGEMENT DEMONSTRATION PROJECTS. (a) In General.—Within 12 months after the date of the enactment of this Act, the Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall establish 4 demonstration projects under which an appropriate entity agrees to provide case management services to medicare beneficiaries with selected catastrophic illnesses, particularly those with high costs of health care services. At least one such demonstration project shall be conducted through an agreement with a utilization and quality control peer review organization with a contract with the Secretary under part B of title )(I of the Social Security Act. (b) Purpose of Projects.—It is the purpose of the demonstration projects established under this section to provide the Secretary and the Congress with the information necessary— (1) to evaluate the appropriateness of providing case management services under the medicare program for medicare beneficiaries with high costs of medical care, and (2) to determine the most effective approach to implementing a case management system under the program for such beneficiaries. (c) Agreement.—The agreement entered into under subsection (a) shall specify— (1) the high cost cases with respect to which case management services will be provided under the project, (2) the payments to be made to the entity conducting the project for carrying out the project, and (3) such other terms and conditions as the Secretary and the entity conducting the project may agree to. (d) Waivers.— The Secretary shall waive— (1) such provisions of part B of title XI of the Social Security Act, and (2) such provisions of title XVIII of such Act as relate to limitations or restrictions on benefits under such title, as the Secretary determines to be appropriate for the conduct of demonstration projects under this section. (e) Duration.— (1) Except as provided in paragraph (2), a demonstration project under this section shall be conducted for a 2-year period. (2) The Secretary may terminate a demonstration project before the end of the 2-year period specified in paragraph (1) if the Secretary determines that the entity conducting the project is not in substantial compliance with the terms of the agreement entered into under subsection (a). (f) Information and Reports.— (1) An entity with an agreement under subsection (a) shall furnish the Secretary with such information as the Secretary determines to be necessary to evaluate the results of that project. (2) (A) The Secretary shall submit to the Congress an interim report on the projects conducted under this section based upon information that is derived from the first year of project oper-102 STAT. 814 ations and shall set forth any interim findings, recommendations, and conclusions that the Secretary determines to be appropriate. (B) The Secretary shall submit to the Congress a final report on the demonstration projects conducted under this section based upon data derived from the projects and shall update the findings, recommendations, and conclusions set forth in the interim report submitted under paragraph (1). (g) Authorization To Use Certain Funds.—The Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Insurance Trust Fund in such proportions as the Secretary determines to be appropriate, of not to exceed $2,000,000 in each of 2 fiscal years for administrative costs in carrying out the demonstration projects under this section. Such amounts shall be transferred without regard to amounts appropriated in advance in appropriation Acts.