2000 
[DOCID: f:s775is.txt]






107th CONGRESS
  1st Session
                                 S. 775

To amend title XVIII of the Social Security Act to permit expansion of 
   medical residency training programs in geriatric medicine and to 
provide for reimbursement of care coordination and assessment services 
                  provided under the medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 25, 2001

Mrs. Lincoln (for herself and Mr. Reid) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to permit expansion of 
   medical residency training programs in geriatric medicine and to 
provide for reimbursement of care coordination and assessment services 
                  provided under the medicare program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Geriatric Care Act of 2001''.

SEC. 2. DISREGARD OF CERTAIN GERIATRIC RESIDENTS AGAINST GRADUATE 
              MEDICAL EDUCATION LIMITATIONS.

    (a) Direct GME.--Section 1886(h)(4)(F) of the Social Security Act 
(42 U.S.C. 1395ww(h)(4)(F)) is amended by adding at the end the 
following new clause:
                            ``(iii) Increase in limitation for 
                        geriatric fellowships.--For cost reporting 
                        periods beginning on or after the date that is 
                        6 months after the date of enactment of the 
                        Geriatric Care Act of 2001, in applying the 
                        limitations regarding the total number of full-
                        time equivalent residents in the field of 
                        allopathic or osteopathic medicine under clause 
                        (i) for a hospital, the Secretary shall not 
                        take into account a maximum of 3 residents 
                        enrolled in a fellowship in geriatric medicine 
                        within an approved medical residency training 
                        program to the extent that the hospital 
                        increases the number of geriatric residents 
                        above the number of such residents for the 
                        hospital's most recent cost reporting period 
                        ending before the date that is 6 months after 
                        the date of enactment of such Act.''.
    (b) Indirect GME.--Section 1886(d)(5)(B) of the Social Security Act 
(42 U.S.C. 1395ww(d)(5)(B)) is amended by adding at the end the 
following new clause:
            ``(ix) Clause (iii) of subsection (h)(4)(F) shall apply to 
        clause (v) in the same manner and for the same period as such 
        clause (iii) applies to clause (i) of such subsection.''.

SEC. 3. MEDICARE COVERAGE OF CARE COORDINATION AND ASSESSMENT SERVICES.

    (a) Part B Coverage of Care Coordination and Assessment Services.--
Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), 
as amended by section 105(a) of the Medicare, Medicaid, and SCHIP 
Benefits Improvement and Protection Act of 2000 (114 Stat. 2763A-471), 
as enacted into law by section 1(a)(6) of Public Law 106-554, is 
amended--
            (1) in subparagraph (U), by striking ``and'' at the end;
            (2) in subparagraph (V), by inserting ``and'' after the 
        semicolon at the end; and
            (3) by adding at the end the following new subparagraph:
            ``(W) care coordination and assessment services (as defined 
        in subsection (ww)).''.
    (b) Care Coordination and Assessment Services Defined.--Section 
1861 of the Social Security Act (42 U.S.C. 1395x), as amended by 
section 105(b) of the Medicare, Medicaid, and SCHIP Benefits 
Improvement and Protection Act of 2000 (114 Stat. 2763A-471), as 
enacted into law by section 1(a)(6) of Public Law 106-554), is amended 
by adding at the end the following new subsection:

``Care Coordination and Assessment Services; Qualified Frail Elderly or 
                  At-Risk Individual; Care Coordinator

    ``(ww)(1) The term `care coordination and assessment services' 
means services that are furnished to a qualified frail elderly or at-
risk individual (as defined in paragraph (2)) by a care coordinator (as 
defined in paragraph (3)) under a plan of care prescribed by such care 
coordinator for the purpose of care coordination and assessment, which 
may include any of the following services:
            ``(A) An initial and periodic health screening and 
        assessment.
            ``(B) The management of, and referral for, medical and 
        other health services, including multidisciplinary care 
        conferences and coordination with other providers.
            ``(C) The monitoring and management of medications, 
        particularly with respect to the management on behalf of a 
        qualified frail elderly or at-risk individual of multiple 
        medications prescribed for that individual.
            ``(D) Patient and family caregiver education and counseling 
        services.
            ``(E) Self-management services, including health education 
        and risk appraisal to identify behavioral risk factors through 
        self-assessment.
            ``(F) Providing access for consultations by telephone with 
        physicians and other appropriate health care professionals, 
        including 24-hour availability of such professionals for 
        emergency consultations.
            ``(G) Coordination with the principal nonprofessional 
        caregiver in the home.
            ``(H) Managing and facilitating transitions among health 
        care professionals and across settings of care.
            ``(I) Activities that facilitate continuity of care and 
        patient adherence to plans of care.
            ``(J) Such other services for which payment would not 
        otherwise be made under this title as the Secretary determines 
        to be appropriate.
    ``(2) For purposes of this subsection, the term `qualified frail 
elderly or at-risk individual' means an individual who a care 
coordinator certifies--
            ``(A) is at risk of institutionalization, functional 
        decline, or death because the individual is an individual--
                    ``(i) with 2 or more serious and disabling chronic 
                conditions;
                    ``(ii) who is unable to carry out 2 or more than 
                activities of daily living (as described in section 
                7702B(c)(2)(B) of the Internal Revenue Code of 1986) 
                without the assistance of another individual or the use 
                of an assistive device;
                    ``(iii) who is cognitively impaired or has severe 
                depression;
                    ``(iv) who has a poor self-rating of health status, 
                as determined using a survey instrument specified by 
                the Secretary, such as SF 36;
                    ``(v) who, because of their physical or mental 
                condition, would satisfy the requirements (other than 
                with respect to income and assets) for receiving 
                nursing facility services under the medicaid program in 
                the individual's State of residence; or
                    ``(vi) for whom professional coordination of care 
                and assessment can reasonably be expected to improve 
                outcomes of health care or prevent, delay, or minimize 
                disability progression; or
            ``(B) has a severity of condition that makes the individual 
        frail or disabled (as determined under guidelines approved by 
        the Secretary).
    ``(3)(A) For purposes of this subsection, th
12d2
e term `care 
coordinator' means an individual or entity that--
            ``(i) is--
                    ``(I) a physician (as defined in subsection 
                (r)(1)); or
                    ``(II) a practitioner described in section 
                1842(b)(18)(C) or an entity that meets such conditions 
                as the Secretary may specify (which may include 
                physicians, physician group practices, or other health 
                care professionals or entities the Secretary may find 
                appropriate) and that is under the appropriate 
                supervision of a physician;
            ``(ii) has entered into a care coordination agreement with 
        the Secretary; and
            ``(iii) meets such other criteria as the Secretary may 
        establish (which may include experience in the provision of 
        care coordination or primary care physicians' services).
    ``(B) For purposes of subparagraph (A)(ii), each care coordination 
agreement shall--
            ``(i) be entered into for a period of 1 year and may be 
        renewed if the Secretary is satisfied that the care coordinator 
        continues to meet the conditions of participation specified in 
        subparagraph (A);
            ``(ii) assure the compliance of the care coordinator with 
        such data collection and reporting requirements as the 
        Secretary determines necessary to assess the effect of care 
        coordination on health outcomes; and
            ``(iii) contain such other terms and conditions as the 
        Secretary may require.''.
    (c) Payment and Elimination of Coinsurance.--
            (1) In general.--Section 1833(a)(1) of the Social Security 
        Act (42 U.S.C. 1395l(a)(1)), as amended by section 223(c) of 
        the Medicare, Medicaid, and SCHIP Benefits Improvement and 
        Protection Act of 2000 (114 Stat. 2763A-489), as enacted into 
        law by section 1(a)(6) of Public Law 106-554, is amended--
                    (A) by striking ``and (U)'' and inserting ``(U)''; 
                and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (V) with respect to care 
                coordination and assessment services described in 
                section 1861(s)(2)(W), the amounts paid shall be 100 
                percent of the lesser of the actual charge for the 
                service or the amount determined under the payment 
                basis determined under section 1848 by the Secretary 
                for such service''.
            (2) Payment under physician fee schedule.--Section 
        1848(j)(3) (42 U.S.C. 1395w-4(j)(3)) is amended by inserting 
        ``(2)(W),'' after ``(2)(S),''.
            (3) Elimination of coinsurance in outpatient hospital 
        settings.--The third sentence of section 1866(a)(2)(A) of the 
        Social Security Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by 
        inserting after ``1861(s)(10)(A)'' the following: ``, with 
        respect to care coordination and assessment services (as 
        defined in section 1861(ww)(1)),''.
    (d) Application of Limits on Billing.--Section 1842(b)(18)(C) of 
the Social Security Act (42 U.S.C. 1395u(b)(18)(C)), as amended by 
section 105(d) of the Medicare, Medicaid, and SCHIP Benefits 
Improvement and Protection Act of 2000 (114 Stat. 2763A-472), as 
enacted into law by section 1(a)(6) of Public Law 106-554, is amended 
by adding at the end the following new clause:
            ``(vii) A care coordinator (as defined in section 
        1861(ww)(3)) that is not a physician.''.
    (e) Exception to Limits on Physician Referrals.--Section 1877(b) of 
the Social Security Act (42 U.S.C. 1395nn(b)) is amended--
            (1) by redesignating paragraph (4) as paragraph (5); and
            (2) by inserting after paragraph (3) the following new 
        paragraph:
            ``(4) Private sector purchasing and quality improvement 
        tools for original medicare.--In the case of a designated 
        health service, if the designated health service is--
                    ``(A) a care coordination and assessment service 
                (as defined in section 1861(ww)(1)); and
                    ``(B) provided by a care coordinator (as defined in 
                paragraph (3) of such section).''.
    (f) Rulemaking.--The Secretary of Health and Human Services shall 
define such terms and establish such procedures as the Secretary 
determines necessary to implement the provisions of this section.
    (g) Effective Date.--The amendments made by this section shall 
apply to care coordination and assessment services furnished on or 
after January 1, 2002.
                                 <all>

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