MEDICARE MEDICAL HOME DEMONSTRATION PROJECT.

SEC. 204. MEDICARE MEDICAL HOME DEMONSTRATION PROJECT.(a) In General.—The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall establish under title XVIII of the Social Security Act a medical home demonstration project (in this section referred to as the “project”) to redesign the health care delivery system to provide targeted, accessible, continuous and coordinated, family-centered care to high-need populations and under which—(1) care management fees are paid to persons performing services as personal physicians; and(2) incentive payments are paid to physicians participating in practices that provide services as a medical home under subsection (d).For purposes of this subsection, the term “high-need population” means individuals with multiple chronic illnesses that require regular medical monitoring, advising, or treatment.(b) Details.—(1) Duration; scope.—The project shall operate during a period of three years and shall include urban, rural, and underserved areas in a total of no more than 8 States.(2) Encouraging participation of small physician practices.—The project shall be designed to include the participation of physicians in practices with fewer than three full-time equivalent physicians, as well as physicians in larger practices particularly in rural and underserved areas.(c) Personal Physician Defined.—120 STAT. 2988(1) In general.—For purposes of this section, the term “personal physician” means a physician (as defined in section 1861(r)(1) of the Social Security Act (42 U.S.C. 1395x(r)(1)) who—(A) meets the requirements described in paragraph (2); and(B) performs the services described in paragraph (3).Nothing in this paragraph shall be construed as preventing such a physician from being a specialist or subspecialist for an individual requiring ongoing care for a specific chronic condition or multiple chronic conditions (such as severe asthma, complex diabetes, cardiovascular disease, rheumatologic disorder) or for an individual with a prolonged illness.(2) Requirements.—The requirements described in this paragraph for a personal physician are as follows:(A) The physician is a board certified physician who provides first contact and continuous care for individuals under the physician’s care.(B) The physician has the staff and resources to manage the comprehensive and coordinated health care of each such individual.(3) Services performed.—A personal physician shall perform or provide for the performance of at least the following services:(A) Advocates for and provides ongoing support, oversight, and guidance to implement a plan of care that provides an integrated, coherent, cross-discipline plan for ongoing medical care developed in partnership with patients and including all other physicians furnishing care to the patient involved and other appropriate medical personnel or agencies (such as home health agencies).(B) Uses evidence-based medicine and clinical decision support tools to guide decision-making at the point-of-care based on patient-specific factors.(C) Uses health information technology, that may include remote monitoring and patient registries, to monitor and track the health status of patients and to provide patients with enhanced and convenient access to health care services.(D) Encourages patients to engage in the management of their own health through education and support systems.(d) Medical Home Defined.—For purposes of this section, the term “medical home” means a physician practice that—(1) is in charge of targeting beneficiaries for participation in the project; and(2) is responsible for—(A) providing safe and secure technology to promote patient access to personal health information;(B) developing a health assessment tool for the individuals targeted; and(C) providing training programs for personnel involved in the coordination of care.(e) Payment Mechanisms.—(1) Personal physician care management fee.—Under the project, the Secretary shall provide for payment under section 1848 of the Social Security Act (42 U.S.C. 1395w–4) of a care management fee to personal physicians providing 120 STAT. 2989 care management under the project. Under such section and using the relative value scale update committee (RUC) process under such section, the Secretary shall develop a care management fee code for such payments and a value for such code.(2) Medical home sharing in savings.—The Secretary shall provide for payment under the project of a medical home based on the payment methodology applied to physician group practices under section 1866A of the Social Security Act (42 U.S.C. 1395cc–1). Under such methodology, 80 percent of the reductions in expenditures under title XVIII of the Social Security Act resulting from participation of individuals that are attributable to the medical home (as reduced by the total care managements fees paid to the medical home under the project) shall be paid to the medical home. The amount of such reductions in expenditures shall be determined by using assumptions with respect to reductions in the occurrence of health complications, hospitalization rates, medical errors, and adverse drug reactions.(3) Source.—Payments paid under the project shall be made from the Federal Supplementary Medical Insurance Trust Fund under section 1841 of the Social Security Act (42 U.S.C. 1395t).(f) Evaluations and Reports.—(1) Annual interim evaluations and reports.—For each year of the project, the Secretary shall provide for an evaluation of the project and shall submit to Congress, by a date specified by the Secretary, a report on the project and on the evaluation of the project for each such year.(2) Final evaluation and report.—The Secretary shall provide for an evaluation of the project and shall submit to Congress, not later than one year after completion of the project, a report on the project and on the evaluation of the project.