§1395cc–3 Health Care Quality Demonstration Program

Summary

Creates a federal demonstration program to test new ways to improve the quality and safety of care for people on Medicare. A "beneficiary" means someone with Medicare Part A and enrolled in Part B, including people in Medicare Advantage. A "health care group" can be a physician group, a joined health system (hospitals, clinics, home health, surgery centers, nursing homes, rehab, and doctors), or a regional group of those. A "physician" means someone who provides Medicare-paid doctor services unless HHS says otherwise. The Health and Human Services Secretary must approve projects that try things like giving incentives to make care safer, promoting best-practice guidelines, studying why care use varies, encouraging shared decision making, improving quality while using resources well, making care culturally sensitive, and studying how changing incentives affects the market. HHS can run the program like other Medicare demos. Participating groups may propose new payment methods, or change benefit packages for the demo, but cannot use the demo’s rules to deny Medicare benefits against a patient’s wishes based on age, life expectancy, disability, dependency, or quality of life. To join, groups must meet HHS quality rules and other HHS requirements. HHS can waive Medicare rules as needed, but total spending during the demo must not be more than it would have been without the demo. Patients must be told about any coverage or payment waivers that affect them. HHS may ask NIH, AHRQ, and CMS to help with research and data sharing, consistent with HIPAA.