On June 14th, Representative Michael G. Fitzpatrick from Pennsylvania introduced the “Medicare Residential Care Coordination Act of 2013” (H.R. 2376) to implement a ten year demonstration project. The demonstration would provide payments for comprehensive coordinated healthcare services for Continuing Care Retirement Communities (CCRC) for Medicare beneficiaries. The states would be involved but only if a state elects to participate in the demonstration project.
The demonstration would refer to a Residential Care Coordination Program (RCCP) that is designed to serve at least 1,000 but not more than 1,500 eligible CCRC residents. The demonstration project would provide comprehensive coordinated healthcare services to CCRC residents 24/7. The coordinated care services would be provided by a primary care physician and include care coordinators, case manager, and nurses
The coordinated care services provides would include:
- Minimum prescription drug coverage required under a prescription drug plan under Part D
- Care management services that coordinate acute and specialty service provided to eligible CCRC residents
- Wellness services, including assistance and instruction in health living
- Assistance to manage chronic conditions, treat subacute conditions, and provide preventive care
The CCRC will receive capitated payments for providing the services. The Secretary would establish a risk-adjusted capitated payment for comprehensive coordinated healthcare services provided to eligible CCRC residents.
The CCRC will need to maintain and provide access to the Secretary and State Medicaid agencies to records related to pertinent financial, medical, and personnel records. Reports will need to be submitted that are necessary to monitor the operation, cost, and effectiveness of the project.
Clinical and other outcome measurements will need to be established to assess the project and look at the health and outcomes of participating CCRC residents. In addition, costs would need to be reported under this demonstration project comparing Medicare beneficiaries along with traditional dual-eligible individuals who are not enrolled in such programs.
The bill has been referred to the House Committee on Energy and Commerce and to the House Committee on Ways and Means.
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