Sec. 3026. COMMUNITY-BASED CARE TRANSITIONS PROGRAM
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## SEC. 3026 COMMUNITY-BASED CARE TRANSITIONS PROGRAM ###
(a)In General The Secretary shall establish a Community-Based Care Transitions Program under which the Secretary provides funding to eligible entities that furnish improved care transition services to high-risk Medicare beneficiaries. ###
(b)Definitions In this section: ####
(1)Eligible entity The term “**eligible entity**” means the following: #####
(A)A subsection
(d)hospital (as defined in section 1886(d)(1)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(1)(B))) identified by the Secretary as having a high readmission rate, such as under section 1886(q) of the Social Security Act, as added by section 3025. #####
(B)An appropriate community-based organization that provides care transition services under this section across a continuum of care through arrangements with subsection
(d)hospitals (as so defined) to furnish the services described in subsection (c)(2)(B)(i) and whose governing body includes sufficient representation of multiple health care stakeholders (including consumers). ####
(2)High-risk Medicare beneficiary The term “**high-risk Medicare beneficiary**” means a Medicare beneficiary who has attained a minimum hierarchical condition category score, as determined by the Secretary, based on a diagnosis of multiple chronic conditions or other risk factors associated with a hospital readmission or substandard transition into post-hospitalization care, which may include 1 or more of the following: #####
(A)Cognitive impairment. #####
(B)Depression. #####
(C)A history of multiple readmissions. #####
(D)Any other chronic disease or risk factor as determined by the Secretary. ####
(3)Medicare beneficiary The term “**Medicare beneficiary**” means an individual who is entitled to benefits under part A of title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) and enrolled under part B of such title, but not enrolled under part C of such title. ####
(4)Program The term “**program**” means the program conducted under this section. ####
(5)Readmission The term “**readmission**” has the meaning given such term in section 1886(q)(5)(E) of the Social Security Act, as added by section 3025. ####
(6)Secretary The term “**Secretary**” means the Secretary of Health and Human Services. ###
(c)Requirements ####
(1)Duration #####
(A)In General The program shall be conducted for a 5-year period, beginning January 1, 2011. #####
(B)Expansion The Secretary may expand the duration and the scope of the program, to the extent determined appropriate by the Secretary, if the Secretary determines (and the Chief Actuary of the Centers for Medicare & Medicaid Services, with respect to spending under this title, certifies) that such expansion would reduce spending under this title without reducing quality. ####
(2)Application; Participation #####
(A)In General ######
(i)Application An eligible entity seeking to participate in the program shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require. ######
(ii)Partnership If an eligible entity is a hospital, such hospital shall enter into a partnership with a community-based organization to participate in the program. #####
(B)Intervention proposal Subject to subparagraph (C), an application submitted under subparagraph (A)(i) shall include a detailed proposal for at least 1 care transition intervention, which may include the following: ######
(i)Initiating care transition services for a high-risk Medicare beneficiary not later than 24 hours prior to the discharge of the beneficiary from the eligible entity. ######
(ii)Arranging timely post-discharge follow-up services to the high-risk Medicare beneficiary to provide the beneficiary (and, as appropriate, the primary caregiver of the beneficiary) with information regarding responding to symptoms that may indicate additional health problems or a deteriorating condition. ######
(iii)Providing the high-risk Medicare beneficiary (and, as appropriate, the primary caregiver of the beneficiary) with assistance to ensure productive and timely interactions between patients and post-acute and outpatient providers. ######
(iv)Assessing and actively engaging with a high-risk Medicare beneficiary (and, as appropriate, the primary caregiver of the beneficiary) through the provision of self-management support and relevant information that is specific to the beneficiary's condition. ######
(v)Conducting comprehensive medication review and management (including, if appropriate, counseling and self-management support). #####
(C)Limitation A care transition intervention proposed under subparagraph
(B)may not include payment for services required under the discharge planning process described in section 1861(ee) of the Social Security Act (42 U.S.C. 1395x(ee)). ####
(3)Selection In selecting eligible entities to participate in the program, the Secretary shall give priority to eligible entities that— #####
(A)participate in a program administered by the Administration on Aging to provide concurrent care transitions interventions with multiple hospitals and practitioners; or #####
(B)provide services to medically underserved populations, small communities, and rural areas. ###
(d)Implementation Notwithstanding any other provision of law, the Secretary may implement the provisions of this section by program instruction or otherwise. ###
(e)Waiver Authority The Secretary may waive such requirements of titles XI and XVIII of the Social Security Act as may be necessary to carry out the program. ###
(f)Funding For purposes of carrying out this section, the Secretary of Health and Human Services shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), in such proportion as the Secretary determines appropriate, of $500,000,000, to the Centers for Medicare & Medicaid Services Program Management Account for the period of fiscal years 2011 through 2015. Amounts transferred under the preceding sentence shall remain available until expended.
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Sec. 3026
COMMUNITY-BASED CARE TRANSITIONS PROGRAM
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