12 2 STA T . 2 574PUBLIC LA W 11 0– 275 —J UL Y 15 , 200 8‘ ‘ (B)withresp e c tt o e a chi nd i v id u a l enrolled in the plan — ‘‘(i) conduct an initial assess m ent and an annual reassessment o f the individual ’ sph y sical , psychosocial, and functional needs
‘‘(ii) develop a plan, in consultation with the indi - vidual as feasi b le, that identifies g oals and ob j ectives, including measurable outcomes as well as specific serv- ices and benefits to be provided; and ‘‘(iii) use an interdisciplinary team in the manage- ment of care . ’’. ( 2 ) REVI E WTO E NSUR E C O MPL I A NCE WIT H CARE MANA G E- MENT RE Q UIREMENTS.— S ection 1857 (d) of the Social Security A ct( 4 2 U .S. C . 1 39 5w – 27(d)) is amended by adding at the end the following new paragraph
‘‘( 6 ) REVIEW TO ENSURE COMPLIANCE WITH CARE MANAGE- MENT REQUIREMENTS F OR SPECIALI Z E D MEDICARE ADVANTAGE PLANS FOR SPECIAL NEEDS INDIVIDUALS.— I n conjunction with the periodic audit of a speciali z ed M edicare Advantage plan for special needs individuals under paragraph (1), the Secretary shall conduct a review to ensure that such organization offering the plan meets the re q uirements described in section 1859(f)(5).’’. (e) CLARIFICATION OF THE D EFINITION OF A SEVERE OR DIS- A B LING CHRONIC CONDITIONS SPECIALIZED N EEDS INDIVIDUAL.— (1) IN GENERAL.—Section 1859(b)(6)(B)(iii) of the Social Security Act (42 U.S.C. 1395w–28(b)(6)(B)(iii)) is amended by inserting ‘‘who have one or more comorbid and medically com- ple x chronic conditions that are substantially disabling or life threatening, have a high ris k of hospitalization or other signifi- cant adverse health outcomes, and require specialized delivery systems across domains of care’’ before the period at the end. (2) P ANEL.— T he Secretary of H ealth and Human Services shall convene a panel of clinical advisors to determine the conditions that meet the definition of severe and disabling chronic conditions under section 1859(b)(6)(B)(iii) of the Social Security Act (42 U.S.C. 1395w–28(b)(6)(B)(iii)), as amended by paragraph (1). The panel shall include the Director of the Agency for Healthcare Research and Q uality (or the Director’s designee). (f) SPECIAL REQUIREMENTS REGARDING QUALIT Y REPORTING FOR SPECIALIZED MA PLANS FOR SPECIAL NEEDS INDIVIDUALS.— (1) IN GENERAL.—Section 1852(e)(3)(A) of the Social Secu- rity Act (42 U.S.C. 1395w–22(e)(3)(A)), as amended by section 163, is amended by inserting after clause (i) the following new clause: ‘‘(ii) SPECIAL REQUIREMENTS FOR SPECIALIZED MA PLANS FOR SPECIAL NEEDS INDIVIDUALS.—In addition to the data required to be collected, analyzed, and reported under clause (i) and notwithstanding the limitations under subparagraph (B), as part of the quality improvement program under paragraph (1), each MA organization offering a specialized Medicare Advantage plan for special needs individuals shall pro- vide for the collection, analysis, and reporting of data that permits the measurement of health outcomes and Establi s hmen t .
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