[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 2057 Introduced in Senate (IS)]
107th CONGRESS
2d Session
S. 2057
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
March 21, 2002
Mrs. Lincoln (for herself, Mr. Reid, Mr. Bingaman, Mrs. Murray, Ms.
Landrieu, Ms. Mikulski, Mr. Graham, Ms. Snowe, Mr. Corzine, and Mrs.
Carnahan) 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 2002''.
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 2002, 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, rural health clinic, or
Federally qualified health center, the
Secretary shall not take into account a maximum
of 3 residents enrolled in a fellowship or
residency in geriatric medicine or geriatric
psychiatry within an approved medical residency
training program to the extent that the
hospital, rural health clinic, or Federally
qualified health center increases the number of
such residents above the number of such
residents for the hospital's, rural health
clinic's, or Federally qualified health
center'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), insofar as
such clause applies with respect to hospitals, 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) is amended by adding
at the end the following new subsection:
``Care Coordination and Assessment Services; Individual With a Serious
and Disabling Chronic Condition; Care Coordinator
``(ww)(1) The term `care coordination and assessment services'
means services that are furnished to an individual with a serious and
disabling chronic condition (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)(i)(I) An initial assessment of an individual's
medical condition, functional and cognitive capacity, and
environmental and psychosocial needs.
``(II) Annual assessments after the initial assessment
performed under subclause (I), unless the physician or care
coordinator of the individual determines that additional
assessments are required due to sentinel health events or
changes in the health status of the individual that may require
changes in plans of care developed for the individual.
``(ii) The development of an initial plan of care, and
subsequent appropriate revisions to that plan of care.
``(iii) The management of, and referral for, medical and
other health services, including multidisciplinary care
conferences and coordination with other providers.
``(iv) The monitoring and management of medications.
``(v) Patient education and counseling services.
``(vi) Family caregiver education and counseling services.
``(vii) Self-management services, including health
education and risk appraisal to identify behavioral risk
factors through self-assessment.
``(viii) Providing access for consultations by telephone
with physicians and other appropriate health care
professionals, including 24-hour availability of such
professionals for emergency consultations.
``(ix) Coordination with the principal nonprofessional
caregiver in the home.
``(x) Managing and facilitating transitions among health
care professionals and across settings of care, including the
following:
``(I) Pursuing the treatment option elected by the
individual.
``(II) Including any advance directive executed by
the individual in the medical file of the individual.
``(xi) Activities that facilitate continuity of care and
patient adherence to plans of care.
``(xii) Information about, and referral to, hospice
services, including patient and family caregiver education and
counseling about hospice, and facilitating transition to
hospice when elected.
``(xiii) Such other medical and health care services for
which payment would not otherwise be made under this title as
the Secretary determines to be appropriate for effective care
coordination, including the additional items and services as
described in subparagraph (B).
``(B) The Secretary may specify additional benefits for
which payment would not otherwise be made under this title that
may be available to eligible beneficiaries who have made an
election under this section (subject to an assessment by the
care coordinator of an individual beneficiary's circumstances
and need for such benefits) in order to encourage the receipt
of, or to improve the effectiveness of, care coordination
services.
``(2) For purposes of this subsection, the term `individual with a
serious and disabling chronic condition' means an individual who a care
coordinator annually certifies--
``(A) is unable to perform (without substantial assistance
from another individual) at least 2 activities of daily living
(as defined in paragraph (4)) for a period of at least 60 days
due to a loss of functional capacity;
``(B) has a level of disability similar to the level of
disability described in subparagraph (A) (as determined under
regulations promulgated by the Secretary);
``(C) has a complex medical condition (as defined by the
Secretary) that requires medical management and coordination of
care; or
``(D) requires substantial supervision to protect such
individual from threats to health and safety due to a severe
cognitive impairment (as defined by the Secretary) or mental
condition (as defined by the Secretary).
``(3)(A) For purposes of this subsection, the 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) working in collaboration with 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 that the care coordinator will submit reports
to the Secretary on the functional and medical status of
individuals with a chronic and disabling condition who receive
care coordination services, expenditures relating to such
services, and health outcomes relating to such services, except
that the Secretary may not require a care coordinator to submit
more than 1 such report during a year; and
``(iii) contain such other terms and conditions as the
Secretary may require.
``(4) For purposes of this subsection, the term `activities of
daily living' means each of the following:
``(A) Eating.
``(B) Toileting.
``(C) Transferring.
``(D) Bathing.
``(E) Dressing.
``(F) Continence.
``(5) Rural health clinics and Federally qualified health centers
shall be eligible sites at which care coordination and assessment
services may be provided.''.
(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, 2003.
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