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42 U.S. Code § 1395cc-5. Independence at home medical practice demonstration program
(a) Establishment
(1) In general
The Secretary shall conduct a demonstration program (in this section referred to as the “demonstration program”) to test a payment incentive and service delivery model that utilizes physician and nurse practitioner directed home-based primary care teams designed to reduce expenditures and improve health outcomes in the provision of items and services under this subchapter to applicable beneficiaries (as defined in subsection (d)).
(2) RequirementThe demonstration program shall test whether a model described in paragraph (1), which is accountable for providing comprehensive, coordinated, continuous, and accessible care to high-need populations at home and coordinating health care across all treatment settings, results in—
(A)
reducing preventable hospitalizations;
(B)
preventing hospital readmissions;
(C)
reducing emergency room visits;
(D)
improving health outcomes commensurate with the beneficiaries’ stage of chronic illness;
(E)
improving the efficiency of care, such as by reducing duplicative diagnostic and laboratory tests;
(F)
reducing the cost of health care services covered under this subchapter; and
(G)
achieving beneficiary and family caregiver satisfaction.
(b) Independence at home medical practice
(1) Independence at home medical practice definedIn this section:
(A) In generalThe term “independence at home medical practice” means a legal entity that—
(i)
is comprised of an individual physician or nurse practitioner or group of physicians and nurse practitioners that provides care as part of a team that includes physicians, nurses, physician assistants, pharmacists, and other health and social services staff as appropriate who have experience providing home-based primary care to applicable beneficiaries, make in-home visits, and are available 24 hours per day, 7 days per week to carry out plans of care that are tailored to the individual beneficiary’s chronic conditions and designed to achieve the results in subsection (a);
(ii)
is organized at least in part for the purpose of providing physicians’ services;
(iii)
has documented experience in providing home-based primary care services to high-cost chronically ill beneficiaries, as determined appropriate by the Secretary;
(iv)
furnishes services to at least 200 applicable beneficiaries (as defined in subsection (d)) during each year of the demonstration program;
(v)
has entered into an agreement with the Secretary;
(vi)
uses electronic health information systems, remote monitoring, and mobile diagnostic technology; and
(vii)
meets such other criteria as the Secretary determines to be appropriate to participate in the demonstration program.
The entity shall report on quality measures (in such form, manner, and frequency as specified by the Secretary, which may be for the group, for providers of services and suppliers, or both) and report to the Secretary (in a form, manner, and frequency as specified by the Secretary) such data as the Secretary determines appropriate to monitor and evaluate the demonstration program.
(B) Physician
The term “physician” includes, except as the Secretary may otherwise provide, any individual who furnishes services for which payment may be made as physicians’ services and has the medical training or experience to fulfill the physician’s role described in subparagraph (A)(i).