42 U.S.C. § 300u–14 — Healthy aging, living well; evaluation of community-based prevention and wellness programs for Medicare beneficiaries

(a) Healthy aging, living well: (1) In general: The Secretary, through the Director of the Centers for Disease Control and Prevention, must award grants to state or local health departments and Indian tribes to run 5-year pilot programs. These programs give people ages 55 to 64 community public health interventions, screenings, and — where needed — referrals to clinical care. (2) Eligibility: To get a grant, an applicant must: (A) be a state health department, local health department, or Indian tribe; (B) submit an application to the Secretary, in the required form, describing the proposed program; (C) design a strategy to improve the health of 55-to-64-year-olds through community-based public health work; and (D) show it can build the needed relationships with health agencies, providers, community groups, and insurers — including identifying a community-based clinical partner, like a community health center or rural health clinic. (3) Use of funds: (A) A grantee must use the money to serve people ages 55 to 64. (B) Public health interventions: (i) A grantee must work with the Centers for Disease Control and Prevention and the Administration on Aging, plus relevant local agencies, in designing and running these activities. (ii) These activities may include improving nutrition, boosting physical activity, cutting tobacco and substance use, improving mental health, and promoting healthy living for this age group. (C) Community preventive screenings: (i) A grantee must also run ongoing health screenings, in both urban and rural areas, to find risk factors for heart disease, cancer, stroke, and diabetes among 55-to-64-year-olds. (ii) Screening may cover: (I) mental health, behavioral health, and substance use disorders; (II) physical activity, smoking, and nutrition; and (III) other measures the Secretary picks. (iii) A grantee must keep records of screening results to build a baseline for tracking this population. (D) Clinical referral/treatment for chronic diseases: (i) A grantee must make sure that people found to have chronic-disease risk factors through screening get referred for follow-up clinical care. (ii) Mechanism: (I) For each person with risk factors for, or an existing case of, heart disease, stroke, diabetes, or another screened condition, the grantee must check whether that person has public or private health insurance. (II) An insured person gets referred to their existing provider, or — if they don't have one — to an in-network provider. (III) For an uninsured person, the grantee's community-based clinical partner must help them find out if they qualify for public coverage, and connect them to other community health resources and assistance programs. (iii) A grantee must also use grant money to contract with community health centers, rural health clinics, and mental-health and substance-use providers, to help refer and treat at-risk patients and determine their eligibility for other public programs. (E) Grantee evaluation: A grantee must use grant money to measure changes in chronic-disease risk factors among participants. (4) Pilot program evaluation: The Secretary must evaluate the pilot program's effectiveness every year — comparing changes in uncontrolled chronic-disease risk factors among people nearing or newly entering Medicare (ages 63 to 65) in grant-funded states or areas, against national and historical data for the same population. (5) Authorization of appropriations: Congress authorizes whatever money is necessary to carry out this subsection for fiscal years 2010 through 2014. (b) Evaluation and plan for community-based prevention and wellness programs for Medicare beneficiaries: (1) In general: The Secretary must evaluate community-based prevention and wellness programs and build a plan to promote healthy living and chronic-disease self-management for Medicare beneficiaries. (2) Medicare evaluation of prevention and wellness programs: (A) The Secretary must evaluate community prevention and wellness programs — including ones run by the Administration on Aging that are evidence-based — that could help Medicare beneficiaries, especially those 65 and older, cut their risk of disease, disability, and injury through healthy choices like exercise, diet, and chronic-disease self-management. (B) This evaluation must include: (i) Evidence review: The Secretary must review the available evidence, literature, best practices, and resources on programs that promote healthy living and cut risk factors for the Medicare population, covering at least: (I) physical activity, nutrition, and obesity; (II) falls; (III) chronic disease self-management; and (IV) mental health. (ii) Independent evaluation: The Administrator of the Centers for Medicare & Medicaid Services, working with the Assistant Secretary for Aging, must — as far as feasible — evaluate existing Administration on Aging community prevention and wellness programs to see how well participating Medicare beneficiaries: (I) cut their health risks, improve their outcomes, and adopt and keep healthy habits; (II) get better at managing their chronic conditions; and (III) use fewer health services and lower Medicare costs for conditions those programs can help. (3) Report: By September 30, 2013, the Secretary must send Congress a report with: (A) recommended laws or administrative steps to promote healthy living and chronic-disease self-management for Medicare beneficiaries; (B) findings from the evidence review; and (C) results of the evaluation. (4) Funding: The Secretary must transfer $50,000,000 — split between the Medicare Hospital Insurance Trust Fund and the Medicare Supplemental Medical Insurance Trust Fund, in whatever proportion the Secretary decides — to the Centers for Medicare & Medicaid Services Program Management Account. That money stays available until spent. (5) Administration: The Paperwork Reduction Act (chapter 35 of title 44) does not apply to this subsection. (6) Definition: In this subsection, "Medicare beneficiary" means someone entitled to Medicare Part A benefits and enrolled in Part B.