Page:United States Statutes at Large Volume 124.djvu/440

 124 STAT. 414 PUBLIC LAW 111–148—MAR. 23, 2010 title, certifies) that such expansion would reduce spending under this title without reducing quality. (2) APPLICATION; PARTICIPATION.— (A) IN GENERAL.— (i) APPLICATION.—An eligible entity seeking to participate in the program shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require. (ii) PARTNERSHIP.—If an eligible entity is a hos- pital, such hospital shall enter into a partnership with a community-based organization to participate in the program. (B) INTERVENTION PROPOSAL.—Subject to subparagraph (C), an application submitted under subparagraph (A)(i) shall include a detailed proposal for at least 1 care transi- tion intervention, which may include the following: (i) Initiating care transition services for a high- risk Medicare beneficiary not later than 24 hours prior to the discharge of the beneficiary from the eligible entity. (ii) Arranging timely post-discharge follow-up serv- ices to the high-risk Medicare beneficiary to provide the beneficiary (and, as appropriate, the primary care- giver of the beneficiary) with information regarding responding to symptoms that may indicate additional health problems or a deteriorating condition. (iii) Providing the high-risk Medicare beneficiary (and, as appropriate, the primary caregiver of the bene- ficiary) with assistance to ensure productive and timely interactions between patients and post-acute and out- patient providers. (iv) Assessing and actively engaging with a high- risk Medicare beneficiary (and, as appropriate, the pri- mary caregiver of the beneficiary) through the provi- sion of self-management support and relevant informa- tion that is specific to the beneficiary’s condition. (v) Conducting comprehensive medication review and management (including, if appropriate, counseling and self-management support). (C) LIMITATION.—A care transition intervention pro- posed under subparagraph (B) may not include payment for services required under the discharge planning process described in section 1861(ee) of the Social Security Act (42 U.S.C. 1395x(ee)). (3) SELECTION.—In selecting eligible entities to participate in the program, the Secretary shall give priority to eligible entities that— (A) participate in a program administered by the Administration on Aging to provide concurrent care transi- tions interventions with multiple hospitals and practi- tioners; or (B) provide services to medically underserved popu- lations, small communities, and rural areas. (d) IMPLEMENTATION.—Notwithstanding any other provision of law, the Secretary may implement the provisions of this section by program instruction or otherwise.