MEDICARE COORDINATED CARE DEMONSTRATION PROJECT.

SEC. 4016. MEDICARE COORDINATED CARE DEMONSTRATION PROJECT. (a) Demonstration Projects.— (1) In general.—The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall conduct demonstration projects for the purpose of evaluating methods, such as case management and other models of coordinated care, that—111 STAT. 344 (A) improve the quality of items and services provided to target individuals; and (B) reduce expenditures under the medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) for items and services provided to target individuals. (2) Target individual defined.—In this section, the term “target individual” means an individual that has a chronic illness, as defined and identified by the Secretary, and is enrolled under the fee-for-service program under parts A and B of title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.; 1395j et seq.). (b) Program Design.— (1) Initial design.—The Secretary shall evaluate best practices in the private sector of methods of coordinated care for a period of 1 year and design the demonstration project based on such evaluation. (2) Number and project areas.—Not later than 2 years after the date of enactment of this Act, the Secretary shall implement at least 9 demonstration projects, including— (A) 5 projects in urban areas; (B) 3 projects in rural areas; and (C) 1 project within the District of Columbia which is operated by a nonprofit academic medical center that maintains a National Cancer Institute certified comprehensive cancer center. (3) Expansion of projects; implementation of demonstration project results.— (A) Expansion of projects.—If the initial report under subsection (c) contains an evaluation that demonstration projects— (i) reduce expenditures under the medicare program; or (ii) do not increase expenditures under the medicare program and increase the quality of health care services provided to target individuals and satisfaction of beneficiaries and health care providers; the Secretary shall continue the existing demonstration projects and may expand the number of demonstration projects. (B) Implementation of demonstration project results.—If a report under subsection (c) contains an evaluation as described in subparagraph (A), the Secretary may issue regulations to implement, on a permanent basis, the components of the demonstration project that are beneficial to the medicare program. (c) Report to Congress.— (1) In general.—Not later than 2 years after the Secretary implements the initial demonstration projects under this section, and biannually thereafter, the Secretary shall submit to Congress a report regarding the demonstration projects conducted under this section. (2) Contents of report.—The report in paragraph (1) shall include the following: (A) A description of the demonstration projects conducted under this section. (B) An evaluation of—111 STAT. 345 (i) the cost-effectiveness of the demonstration projects; (ii) the quality of the health care services provided to target individuals under the demonstration projects; and (iii) beneficiary and health care provider satisfaction under the demonstration project. (C) Any other information regarding the demonstration projects conducted under this section that the Secretary determines to be appropriate. (d) 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. (e) Funding.— (1) Demonstration projects.— (A) In general.— (i) State projects.—Except as provided in clause (ii), the Secretary shall provide for the transfer from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Insurance Trust Fund under title XVIII of the Social Security Act (42 U.S.C. 1395i, 1395t), in such proportions as the Secretary determines to be appropriate, of such funds as are necessary for the costs of carrying out the demonstration projects under this section. (ii) Cancer hospital.—In the case of the project described in subsection (b)(2)(C), amounts shall be available only as provided in any Federal law making appropriations for the District of Columbia. (B) Limitation.—In conducting the demonstration project under this section, the Secretary shall ensure that the aggregate payments made by the Secretary do not exceed the amount which the Secretary would have paid if the demonstration projects under this section were not implemented. (2) Evaluation and report.—There are authorized to be appropriated such sums as are necessary for the purpose of developing and submitting the report to Congress under subsection (c).