chronic care improvement program

(2) Definitions For purposes of this section: (A) Chronic care improvement program The term “chronic care improvement program” means a program described in paragraph (1) that is offered under an agreement under subsection (b) or (c). (B) Chronic care improvement organization The term “chronic care improvement organization” means an entity that has entered into an agreement under subsection (b) or (c) to provide, directly or through contracts with subcontractors, a chronic care improvement program under this section. Such an entity may be a disease management organization, health insurer, integrated delivery system, physician group practice, a consortium of such entities, or any other legal entity that the Secretary determines appropriate to carry out a chronic care improvement program under this section. (C) Care management plan The term “care management plan” means a plan established under subsection (d) for a participant in a chronic care improvement program. (D) Threshold condition The term “threshold condition” means a chronic condition, such as congestive heart failure, diabetes, chronic obstructive pulmonary disease (COPD), or other diseases or conditions, as selected by the Secretary as appropriate for the establishment of a chronic care improvement program. (E) Targeted beneficiary The term “targeted beneficiary” means, with respect to a chronic care improvement program, an individual who— (i) is entitled to benefits under part A and enrolled under part B, but not enrolled in a plan under part C; (ii) has one or more threshold conditions covered under such program; and (iii) has been identified under subsection (d)(1) as a potential participant in such program.

Source

42 USC § 1395b-8(a)(2)


Scoping language

For purposes of this section
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