Page:United States Statutes at Large Volume 124.djvu/418

124 STAT. 392 PUBLIC LAW 111–148—MAR. 23, 2010 ‘‘(xvii) Promoting greater efficiencies and timely access to outpatient services (such as outpatient phys- ical therapy services) through models that do not require a physician or other health professional to refer the service or be involved in establishing the plan of care for the service, when such service is fur- nished by a health professional who has the authority to furnish the service under existing State law. ‘‘(xviii) Establishing comprehensive payments to Healthcare Innovation Zones, consisting of groups of providers that include a teaching hospital, physicians, and other clinical entities, that, through their struc- ture, operations, and joint-activity deliver a full spec- trum of integrated and comprehensive health care serv- ices to applicable individuals while also incorporating innovative methods for the clinical training of future health care professionals. ‘‘(C) ADDITIONAL FACTORS FOR CONSIDERATION.—In selecting models for testing under subparagraph (A), the CMI may consider the following additional factors: ‘‘(i) Whether the model includes a regular process for monitoring and updating patient care plans in a manner that is consistent with the needs and pref- erences of applicable individuals. ‘‘(ii) Whether the model places the applicable indi- vidual, including family members and other informal caregivers of the applicable individual, at the center of the care team of the applicable individual. ‘‘(iii) Whether the model provides for in-person contact with applicable individuals. ‘‘(iv) Whether the model utilizes technology, such as electronic health records and patient-based remote monitoring systems, to coordinate care over time and across settings. ‘‘(v) Whether the model provides for the mainte- nance of a close relationship between care coordinators, primary care practitioners, specialist physicians, community-based organizations, and other providers of services and suppliers. ‘‘(vi) Whether the model relies on a team-based approach to interventions, such as comprehensive care assessments, care planning, and self-management coaching. ‘‘(vii) Whether, under the model, providers of serv- ices and suppliers are able to share information with patients, caregivers, and other providers of services and suppliers on a real time basis. ‘‘(3) BUDGET NEUTRALITY.— ‘‘(A) INITIAL PERIOD.—The Secretary shall not require, as a condition for testing a model under paragraph (1), that the design of such model ensure that such model is budget neutral initially with respect to expenditures under the applicable title. ‘‘(B) TERMINATION OR MODIFICATION.—The Secretary shall terminate or modify the design and implementation of a model unless the Secretary determines (and the Chief Actuary of the Centers for Medicare & Medicaid Services, Determination.