Independence at Home Act of 2019

II 116TH CONGRESS 1ST SESSION S. 1202 To amend title XVIII of the Social Security Act to provide for a permanent Independence at Home medical practice program under the Medicare program. IN THE SENATE OF THE UNITED STATES APRIL 11, 2019 Mr. MARKEY (for himself and Mr. PORTMAN) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to provide for a permanent Independence at Home medical practice program under the Medicare program. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Independence at Home 4 Act of 2019’’. 5 SEC. 2. INDEPENDENCE AT HOME MEDICAL PRACTICE PRO- 6 GRAM. 7 (a) PROGRAM.—Title XVIII of the Social Security 8 Act is amended by inserting after section 1866F the fol- 9 lowing new section: 10 VerDate Sep 11 2014 00:10 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1202.IS S1202 pamtmann on DSKBFK8HB2PROD with BILLS 2 •S 1202 IS ‘‘INDEPENDENCE AT HOME MEDICAL PRACTICE PROGRAM 1 ‘‘SEC. 1866G. (a) ESTABLISHMENT.— 2 ‘‘(1) IN GENERAL.—Not later than January 1, 3 2021, the Secretary shall establish and implement a 4 national independence at home medical practice pro- 5 gram (in this section referred to as the ‘Program’) 6 that utilizes primary care teams that— 7 ‘‘(A) are directed by physicians, nurse 8 practitioners, or physician assistants; and 9 ‘‘(B) emphasize home-based care that is 10 designed to reduce expenditures and improve 11 health outcomes in the provision of items and 12 services under this title to applicable bene- 13 ficiaries. 14 ‘‘(2) GOALS.—Under the Program, an inde- 15 pendence at home medical practice shall be account- 16 able for providing comprehensive, coordinated, con- 17 tinuous, and accessible care to applicable bene- 18 ficiaries at home and coordinating health care across 19 all treatment settings, resulting in— 20 ‘‘(A) reducing preventable hospitalizations; 21 ‘‘(B) preventing hospital readmissions; 22 ‘‘(C) reducing emergency room visits; 23 VerDate Sep 11 2014 00:10 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1202.IS S1202 pamtmann on DSKBFK8HB2PROD with BILLS 3 •S 1202 IS ‘‘(D) improving health outcomes commen- 1 surate with each applicable beneficiary’s stage 2 of chronic illness; 3 ‘‘(E) improving the efficiency of care, such 4 as by reducing duplicative diagnostic and lab- 5 oratory tests; 6 ‘‘(F) reducing the cost of items and serv- 7 ices covered under this title; and 8 ‘‘(G) achieving applicable beneficiary and 9 family caregiver satisfaction. 10 ‘‘(b) INDEPENDENCE AT HOME MEDICAL PRAC- 11 TICE.— 12 ‘‘(1) INDEPENDENCE AT HOME MEDICAL PRAC- 13 TICE DEFINED.—In this section: 14 ‘‘(A) IN GENERAL.—The term ‘independ- 15 ence at home medical practice’ means a legal 16 entity that meets each of the following require- 17 ments: 18 ‘‘(i) The entity is comprised of an in- 19 dividual physician, nurse practitioner, or 20 physician assistant or group of such practi- 21 tioners that furnishes care as part of a 22 team that may include physicians, nurse 23 practitioners, nurses, physician assistants, 24 pharmacists, licensed mental health practi- 25 VerDate Sep 11 2014 00:10 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1202.IS S1202 pamtmann on DSKBFK8HB2PROD with BILLS 4 •S 1202 IS tioners, social workers, and other health 1 and social services staff, as appropriate. 2 ‘‘(ii) The entity is organized, at least 3 in part, for the purpose of furnishing phy- 4 sicians’ services. 5 ‘‘(iii) The entity— 6 ‘‘(I) has experience in furnishing 7 home-based primary care services to 8 applicable beneficiaries, as determined 9 appropriate by the Secretary; 10 ‘‘(II) makes in-home visits; and 11 ‘‘(III) is available 24 hours per 12 day, seven days per week, to carry out 13 plans of care that are tailored to an 14 applicable beneficiary’s chronic condi- 15 tions and designed to achieve the 16 goals described in subparagraphs (A) 17 through (G) of subsection (a)(2). 18 ‘‘(iv) The entity enters into an agree- 19 ment with the Secretary. 20 ‘‘(v) The entity furnishes services to 21 at least 200 applicable beneficiaries during 22 each year covered under the agreement un- 23 less the Secretary determines that a lower 24 minimum number of applicable bene- 25 VerDate Sep 11 2014 00:10 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1202.IS S1202 pamtmann on DSKBFK8HB2PROD with BILLS 5 •S 1202 IS ficiaries is necessary for the goals of the 1 Program to be achieved. 2 ‘‘(vi) The entity uses certified elec- 3 tronic health record technology and may 4 use remote monitoring, mobile diagnostic 5 technology, telehealth, and other commu- 6 nications-based technology services, as de- 7 termined appropriate by the Secretary. 8 ‘‘(vii) The entity meets such other cri- 9 teria as the Secretary determines to be ap- 10 propriate to participate in the Program. 11 ‘‘(B) PHYSICIAN.—The term ‘physician’ 12 means a physician described in section 13 1861(r)(1) who has the medical training or ex- 14 perience to fulfill the physician’s role described 15 in subparagraph (A)(i). 16 ‘‘(2) INCLUSION OF AFFILIATED PROVIDERS 17 AND PRACTITIONERS.—Nothing in this subsection 18 shall prevent an independence at home medical prac- 19 tice from including providers of services, practi- 20 tioners described in section 1842(b)(18)(C), or other 21 practitioners, including pharmacists, in an arrange- 22 ment with the practice to share in any savings under 23 the Program. 24 VerDate Sep 11 2014 00:10 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1202.IS S1202 pamtmann on DSKBFK8HB2PROD with BILLS 6 •S 1202 IS ‘‘(c) QUALITY MEASURES AND PERFORMANCE 1 STANDARDS.— 2 ‘‘(1) QUALITY MEASURES.— 3 ‘‘(A) IN GENERAL.—The Secretary shall 4 solicit stakeholder input and, taking into con- 5 sideration such input, determine appropriate 6 quality measures to assess the quality of care 7 furnished by independence at home medical 8 practices. To the extent possible, such measures 9 shall include outcome measures and experience 10 of care measures. 11 ‘‘(B) REPORTING REQUIREMENTS.—Under 12 the Program, an independence at home medical 13 practice shall submit data in a form and man- 14 ner and at a frequency specified by the Sec- 15 retary. 16 ‘‘(2) QUALITY PERFORMANCE STANDARDS.— 17 The Secretary shall establish quality performance 18 standards that independence at home medical prac- 19 tices must meet in order to be eligible to receive in- 20 centive payments under subsection (d)(2). 21 ‘‘(3) DATA SHARING.—Not less frequently than 22 on a quarterly basis, the Secretary shall provide 23 independence at home medical practices with regular 24 practice-level feedback reports on cost and utilization 25 VerDate Sep 11 2014 00:10 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1202.IS S1202 pamtmann on DSKBFK8HB2PROD with BILLS 7 •S 1202 IS data in a clear and actionable manner. These reports 1 shall include, to the extent practicable, information 2 on fee-for-service cost and utilization, as well as ben- 3 eficiary-level lists of emergency department visits, 4 hospitalizations, hierarchical condition category risk 5 scores, quality performance data, claims line feed, 6 and other high-cost services used in the previous 7 quarter, together with other data that may be useful 8 for practices, as determined by the Secretary. 9 ‘‘(d) INCENTIVE PAYMENT METHODOLOGY.— 10 ‘‘(1) ESTABLISHMENT OF TARGET SPENDING 11 LEVEL.—The Secretary shall establish an estimated 12 annual spending target based on the amount the 13 Secretary estimates would have been spent in the ab- 14 sence of the Program, for items and services covered 15 under parts A and B furnished to applicable bene- 16 ficiaries or comparable beneficiaries, as determined 17 by the Secretary, for each independence at home 18 medical practice under this section. Such spending 19 targets shall be determined on a per capita basis. 20 Such spending targets shall include a risk corridor 21 that takes into account normal variation in expendi- 22 tures for items and services covered under parts A 23 and B furnished to such beneficiaries with the size 24 of the corridor being related to the number of appli- 25 VerDate Sep 11 2014 00:10 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1202.IS S1202 pamtmann on DSKBFK8HB2PROD with BILLS 8 •S 1202 IS cable beneficiaries furnished services by each inde- 1 pendence at home medical practice. The spending 2 targets may also be adjusted for applicable bene- 3 ficiary risk characteristics, factors relevant to char- 4 acterize random variation among practices, and 5 other factors as the Secretary determines appro- 6 priate. 7 ‘‘(2) INCENTIVE PAYMENTS.—Subject to meet- 8 ing the quality performance standards under sub- 9 section (c)(2), an independence at home medical 10 practice is eligible to receive an incentive payment 11 under the Program if actual expenditures for a year 12 for the applicable beneficiaries who are attributed to 13 the practice are less than the estimated spending 14 target established under paragraph (1) for such 15 year. An incentive payment for such year shall be 16 equal to a portion (as determined by the Secretary 17 but in no case greater than 80 percent) of the 18 amount by which actual expenditures (including in- 19 centive payments under this paragraph) for applica- 20 ble beneficiaries under parts A and B for such year 21 are estimated to be less than 5 percent less than the 22 estimated spending target for such year, as deter- 23 mined under paragraph (1). 24 ‘‘(e) APPLICABLE BENEFICIARY.— 25 VerDate Sep 11 2014 00:10 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1202.IS S1202 pamtmann on DSKBFK8HB2PROD with BILLS 9 •S 1202 IS ‘‘(1) IN GENERAL.—In this section, the term 1 ‘applicable beneficiary’, with respect to an independ- 2 ence at home medical practice, is an individual who 3 is attributed to such practice as a newly-assigned 4 beneficiary or a continuously-assigned beneficiary 5 (as such terms are defined in paragraphs (2) and 6 (3), respectively). 7 ‘‘(2) NEWLY-ASSIGNED BENEFICIARY DE- 8 FINED.—For purposes of paragraph (1), the term 9 ‘newly-assigned beneficiary’ means an individual 10 whom the independence at home medical practice 11 has determined— 12 ‘‘(A) is entitled to benefits under part A 13 and enrolled for benefits under part B; 14 ‘‘(B) is not— 15 ‘‘(i) enrolled in a Medicare Advantage 16 plan under part C or a PACE program 17 under section 1894; 18 ‘‘(ii) attributed under— 19 ‘‘(I) another shared savings pro- 20 gram, under this title, such as under 21 section 1899; or 22 ‘‘(II) a model tested or expanded 23 under section 1115A that involves 24 shared savings under this title, or any 25 VerDate Sep 11 2014 00:10 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1202.IS S1202 pamtmann on DSKBFK8HB2PROD with BILLS 10 •S 1202 IS other demonstration that involves 1 such shared savings; or 2 ‘‘(iii) determined to have end stage 3 renal disease as provided in section 226A 4 or receiving dialysis at home; 5 ‘‘(C) has two or more chronic illnesses, as 6 determined by the Secretary, such as congestive 7 heart failure, diabetes, chronic obstructive pul- 8 monary disease, ischemic heart disease, stroke, 9 Alzheimer’s Disease and neurodegenerative dis- 10 eases, other dementias designated by the Sec- 11 retary, and other diseases and conditions which 12 result in high costs under this title; 13 ‘‘(D) subject to paragraph (4), during the 14 12-month period immediately preceding the in- 15 dividual’s attribution to an independence at 16 home medical practice— 17 ‘‘(i) had a nonelective hospital admis- 18 sion; and 19 ‘‘(ii) received— 20 ‘‘(I) skilled nursing care or reha- 21 bilitation services in a skilled nursing 22 facility paid under section 1888(e); 23 ‘‘(II) rehabilitation services in an 24 inpatient rehabilitation facility; or 25 VerDate Sep 11 2014 00:10 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1202.IS S1202 pamtmann on DSKBFK8HB2PROD with BILLS 11 •S 1202 IS ‘‘(III) part-time or intermittent 1 nursing care (as described in section 2 1861(m)(1)) through a home health 3 agency or physical or occupational 4 therapy or speech-language pathology 5 services (as described in section 6 1861(m)(2)) through a home health 7 agency; 8 ‘‘(E) has not been assigned to an inde- 9 pendence at home medical practice in a pre- 10 vious participation year during an agreement 11 period; and 12 ‘‘(F) meets such other criteria as the Sec- 13 retary determines appropriate. 14 ‘‘(3) CONTINUOUSLY-ASSIGNED BENEFICIARY 15 DEFINED.—For purposes of paragraph (1), the term 16 ‘continuously-assigned beneficiary’ means an indi- 17 vidual whom the independence at home medical 18 practice has determined— 19 ‘‘(A) meets the criteria described in sub- 20 paragraphs (A) through (C) and subparagraph 21 (F) of paragraph (2); and 22 ‘‘(B) has two or more functional depend- 23 encies requiring the assistance of another per- 24 VerDate Sep 11 2014 00:10 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1202.IS S1202 pamtmann on DSKBFK8HB2PROD with BILLS 12 •S 1202 IS son (such as bathing, dressing, toileting, walk- 1 ing, or feeding). 2 ‘‘(4) WAIVER OF CERTAIN REQUIREMENTS 3 WHEN BENEFICIARY CHANGES PLANS.—The require- 4 ments under paragraph (2)(D) shall not apply when 5 an individual is attributed to an independence at 6 home medical practice under this section subsequent 7 to the first time an individual is attributed to such 8 a practice under this section. 9 ‘‘(5) PATIENT ELECTION TO PARTICIPATE.— 10 The Secretary shall adopt an appropriate method to 11 determine that applicable beneficiaries have agreed 12 to enroll in an independence at home medical prac- 13 tice. Enrollment in an independence at home medical 14 practice shall be voluntary. 15 ‘‘(6) BENEFICIARY ACCESS TO SERVICES.— 16 Nothing in this section shall be construed as— 17 ‘‘(A) encouraging physicians, nurse practi- 18 tioners, physician assistants, or other team 19 members to limit applicable beneficiary access 20 to services covered under this title; or 21 ‘‘(B) requiring applicable beneficiaries to 22 relinquish access to any benefit under this title 23 as a condition of receiving services from an 24 independence at home medical practice. 25 VerDate Sep 11 2014 00:10 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1202.IS S1202 pamtmann on DSKBFK8HB [Text truncated for display. Full text available on Congress.gov.]