Sec. 4. Encouraging care coordination and medical homes

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Section 1848(b) of the Social Security Act ( 42 U.S.C. 1395w–4(b) ) is amended by adding at the end the following new paragraph: In order to promote the coordination of care by an applicable provider (as defined in subparagraph (B)) for individuals with complex chronic care needs who are furnished items and services by multiple physicians and other suppliers and providers of services, the Secretary shall— develop one or more HCPCS codes for complex chronic care management services for individuals with complex chronic care needs; and for such services furnished on or after January 1, 2015, by an applicable provider, make payment (as the Secretary determines to be appropriate) under the fee schedule under this section using such HCPCS codes.

For purposes of this paragraph, the term applicable provider means a physician (as defined in section 1861(r)(1)) or a physician assistant or nurse practitioner (as defined in section 1861(aa)(5)(A)) who— is certified as a medical home (by achieving an accreditation status of level 3 by the National Committee for Quality Assurance); is recognized as a patient-centered specialty practice by the National Committee for Quality Assurance; has received equivalent certification (as determined by the Secretary); or meets such other comparable qualifications as the Secretary determines to be appropriate.

The budget neutrality provision under subsection (c)(2)(B)(ii)(II) shall apply in establishing the payment under subparagraph (A)(ii). In carrying out this paragraph, the Secretary shall only make payment to a single applicable provider for complex chronic care management services furnished to an individual. .

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42 USC 1395w–4(b)

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Sec. 4

Encouraging care coordination and medical homes

Cite42 USC 1395w–4(b)

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