Sec. 4. Encouraging care management for individuals with chronic care needs

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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 encourage the management of care by an applicable provider (as defined in subparagraph (B)) for individuals with chronic care needs the Secretary shall— establish one or more HCPCS codes for chronic care management services for such individuals; and subject to subparagraph (D), make payment (as the Secretary determines to be appropriate) under this section for such management services furnished on or after January 1, 2015, by an applicable provider.

For purposes of this paragraph, the term applicable provider means a physician (as defined in section 1861(r)(1)), physician assistant or nurse practitioner (as defined in section 1861(aa)(5)(A)), or clinical nurse specialist (as defined in section 1861(aa)(5)(B)) who furnishes services as part of a patient-centered medical home or a comparable specialty practice that— is recognized as such a medical home or comparable specialty practice by an organization that is recognized by the Secretary for purposes of such recognition as such a medical home or practice; 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, with respect to chronic care management services, the Secretary shall— make payment to only one applicable provider for such services furnished to an individual during a period; not make payment under subparagraph

(A)if such payment would be duplicative of payment that is otherwise made under this title for such services (such as in the case of hospice care or home health services); and not require that an annual wellness visit (as defined in section 1861(hhh)) or an initial preventive physical examination (as defined in section 1861(ww)) be furnished as a condition of payment for such management services. . The Secretary of Health and Human Services (in this subsection referred to as the Secretary ) shall conduct an education and outreach campaign to inform professionals who furnish items and services under part B of title XVIII of the Social Security Act and individuals enrolled under such part of the benefits of chronic care management services described in section 1848(b)(8) of the Social Security Act, as added by subsection (a), and encourage such individuals with chronic care needs to receive such services. Such campaign shall— be directed by the Office of Rural Health Policy of the Department of Health and Human Services and the Office of Minority Health of the Centers for Medicare & Medicaid Services; and focus on encouraging participation by underserved rural populations and racial and ethnic minority populations. Not later than December 31, 2017, the Secretary shall submit to Congress a report on the use of chronic care management services described in such section 1848(b)(8) by individuals living in rural areas and by racial and ethnic minority populations. Such report shall— identify barriers to receiving chronic care management services; and make recommendations for increasing the appropriate use of chronic care management services.

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42 USC 1395w–4(b)

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Sec. 4

Encouraging care management for individuals with chronic care needs

Cite42 USC 1395w–4(b)

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