In response to a request by the Health Care Financing Administration (HCFA), the Institute of Medicine proposed a study to examine definitions of serious or complex medical conditions and related issues. Health plans participating in the Medicare+Choice program are required to have procedures approved by HCFA for

1. identification of individuals (enrollees) with serious or complex medical conditions;
2. assessment of these conditions, including medical procedures to diagnose and monitor them on an ongoing basis; and
3. establishment and implementation of a treatment plan appropriate to these conditions, with an adequate number of direct access visits to specialists to accommodate the treatment plan. Such treatment plans must be time-specific and updated periodically by the primary care physician.