§300u–14 Healthy Aging, Living Well; Evaluation of Community-based Prevention and Wellness Programs for Medicare Beneficiaries

Summary

The Secretary of Health and Human Services must give grants to state and local health departments and Indian tribes to run five-year pilot programs that offer community public-health work, ongoing health screenings, and clinical follow-up for people aged 55 to 64. To get a grant, an applicant must be a state or local health department or an Indian tribe, file an application, have a plan to improve health for the 55–64 age group, and show it can work with health agencies, providers, community groups, and insurers and name a community clinical partner (for example, a community health center or rural clinic). Grant money must pay for things like better nutrition, more physical activity, less tobacco and substance use, mental-health support, and other healthy-living efforts; regular screenings for heart disease, cancer, stroke, and diabetes (and related measures like mental health, activity, smoking, and nutrition); keeping screening records as a baseline; and making sure people with found risks get clinical follow-up. Grantees must check whether people are insured and refer insured patients to in-network providers. For uninsured patients, the community clinical partner must help find public coverage or other local care. Grantees must also contract with community health centers, rural clinics, and mental-health/substance-use providers and measure changes in chronic disease risk factors among participants. Money was authorized as needed for fiscal years 2010 through 2014. The Secretary must also evaluate community prevention and wellness programs for Medicare beneficiaries and make a plan to promote healthy lifestyles and chronic disease self-management. That work includes reviewing evidence on topics such as physical activity, nutrition and obesity, falls, chronic-disease self-management, and mental health; and, where possible, having the Centers for Medicare & Medicaid Services, with the Assistant Secretary for Aging, independently assess Administration on Aging programs to see if they lower risks, improve self-care, and reduce Medicare use and costs. A report with recommendations, findings, and evaluation results must be sent to Congress by September 30, 2013. For this work, $50,000,000 will be transferred from the Medicare Hospital Insurance and Supplemental Medical Insurance Trust Funds to the CMS Program Management Account and kept until spent. Chapter 35 of title 44 does not apply to this part. “Medicare beneficiary” here means someone entitled to Part A and enrolled in Part B.