[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[S. 779 Introduced in Senate (IS)]







105th CONGRESS
  1st Session
                                 S. 779

To amend title XVIII of the Social Security Act to increase the number 
  of physicians that complete a fellowship in geriatric medicine and 
             geriatric psychiatry, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 22, 1997

  Mr. Reid (for himself, Mr. Grassley, and Mr. Glenn) 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 increase the number 
  of physicians that complete a fellowship in geriatric medicine and 
             geriatric psychiatry, and for other purposes.

    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 ``Medicare Physician Workforce 
Improvement Act of 1997''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The Institute of Medicine, the Alliance for Aging 
        Research, the National Institute on Aging, and the Council on 
        Graduate Medical Education have reported that there is a 
        critical shortage of certified geriatricians.
            (2) The average total educational debt that a physician who 
        completes required training including a fellowship in geriatric 
        medicine or geriatric psychiatry in order to become a certified 
        geriatrician exceeds $75,000, and the current reimbursement 
        policy for these physicians creates significant financial 
        disincentives to entering the practice of geriatric medicine 
        and geriatric psychiatry.
            (3) It is essential that physicians that provide clinical 
        services to elderly individuals be trained in the range of 
        settings in which medical care is delivered in order to provide 
        those services appropriately.

SEC. 3. GRADUATE MEDICAL EDUCATION FUNDING.

    (a) In General.--Section 1886(h)(4) of the Social Security Act (42 
U.S.C. 1395ww(h)(4)) is amended by adding at the end the following:
                    ``(F) Geriatric programs.--
                            ``(i) In general.--The rules established 
                        under this paragraph shall specify that a 
                        resident that is enrolled in a fellowship in 
                        geriatric medicine or geriatric psychiatry 
                        within an approved medical residency training 
                        program shall be, for the computation of the 
                        number of full-time-equivalent residents in an 
                        approved medical residency training program, 
                        counted 2 times for the period such resident is 
                        enrolled in such fellowship.
                            ``(ii) Limitation.--The number of residents 
                        that are counted 2 times for the computation of 
                        the number of full-time-equivalent residents in 
                        an approved medical residency training program 
                        under clause (i) shall not exceed 400 in any 
                        calendar year.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to cost reporting periods beginning on or after the date of 
enactment of this Act.

SEC. 4. DEMONSTRATION PROJECTS TO INCREASE THE NUMBER OF GERIATRICIANS.

    (a) Definitions.--In this section:
            (1) Geriatric training consortium.--The term ``geriatric 
        training consortium'' means a State, regional, or local entity 
        that--
                    (A) is developed and supported by an accredited 
                geriatric training program;
                    (B) consists of--
                            (i) a teaching hospital;
                            (ii) a skilled nursing facility; and
                            (iii) an ambulatory care or community-based 
                        facility, such as a community clinic, a day 
                        treatment program, a hospice program, a managed 
                        care organization, or a rehabilitation 
                        facility; and
                    (C) is organized for--
                            (i) the training of residents enrolled in 
                        formal postgraduate training programs in 
                        geriatric medicine or geriatric psychiatry; and
                            (ii) the provision of appropriate training 
                        experiences in the care of elderly individuals 
                        to residents in primary care disciplines and 
                        other health professionals.
            (2) Primary care.--The term ``primary care'' means family 
        medicine, general internal medicine, general pediatrics, 
        preventive medicine, geriatric medicine, and osteopathic 
        general practice.
            (3) Resident.--The term ``resident'' has the meaning given 
        such term in section 1886(h)(5)(I) of the Social Security Act 
        (42 U.S.C. 1395ww(h)(5)(I)).
            (4) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (b) Demonstration Projects.--
            (1) Authority.--The Secretary, through geriatric training 
        consortia, shall establish and conduct 5 demonstration projects 
        to increase the number of certified geriatricians that are 
        appropriately trained to provide items and services to 
        beneficiaries under title XVIII of the Social Security Act (42 
        U.S.C. 1395 et seq.) in a range of patient settings. In 
        conducting demonstration projects under this section, the 
        Secretary shall make payments for the indirect costs of medical 
        education and the direct graduate medical education costs 
        relating to the training of residents to the geriatric training 
        consortia carrying out the projects.
            (2) Application.--Any geriatric training consortium seeking 
        to conduct a demonstration project under this section shall 
        submit to the Secretary an application at such time, in such 
        form and manner, and containing such information as the 
        Secretary may require.
    (c) Waiver Authority.--The Secretary may waive compliance with any 
requirement of titles XI, XVIII, and XIX of the Social Security Act (42 
U.S.C. 1301 et seq., 1395 et seq., 1396 et seq.) which, if applied, 
would prevent a demonstration project carried out under this section 
from effectively achieving the purpose of the project.
    (d) Annual Report to Congress.--
            (1) In general.--Beginning 1 year after the date of 
        enactment of this Act, and annually thereafter, the Secretary 
        shall submit to Congress a report that evaluates the 
        effectiveness of the demonstration projects conducted under 
        this section and that contains any legislative recommendations 
        determined appropriate by the Secretary.
            (2) Continuation or replication of demonstration 
        projects.--Beginning 3 years after the date of enactment of 
        this Act, the report required under paragraph (1) shall include 
        recommendations regarding whether the demonstration projects 
        conducted under this section should be continued and whether 
        broad replication of the project should be initiated.
    (e) Duration.--A demonstration project under this section shall be 
conducted for a period of not more than 5 years. The Secretary may 
terminate a project if the Secretary determines that the consortium 
conducting the project is not in substantial compliance with the terms 
of the application approved by the Secretary.
    (f) Funding.--
            (1) In general.--The Secretary shall provide for the 
        transfer from the Federal Hospital Insurance Trust Fund and the 
        Federal Supplementary Insurance Trust Fund under title XVIII of 
        the Social Security Act (42 U.S.C. 1395i, 1395t), in such 
        proportions as the Secretary determines to be appropriate, of 
        such funds as are necessary for the costs of carrying out the 
        demonstration projects under this section.
            (2) Limitation.--
                    (A) In general.--With respect to any year that a 
                demonstration project is conducted under this section, 
                the total amount paid to such a demonstration project 
                shall not exceed the lessor of--
                            (i) an amount described in subparagraph 
                        (B); or
                            (ii) $1,000,000.
                    (B) Amount described.--An amount described in this 
                subparagraph is an amount equal to the number of 
                geriatric fellows enrolled in a geriatric training 
                consortium for that year multiplied by the amount that 
                the hospital that is part of that geriatric training 
                consortium conducting the demonstration project 
                received under the medicare program under title XVIII 
                of the Social Security Act (42 U.S.C. 1395 et seq.) for 
                the indirect costs of medical education and for direct 
                graduate medical education costs for each full-time-
                equivalent resident during the hospital's most recent 
                cost reporting period, determined without regard to 
                section 1886(h)(4)(F) of that Act (42 U.S.C. 
                1395ww(h)(4)(F)) (as added by section 3), and 
                determined as of the date the Secretary appropriates 
                the funds for the demonstration project for that year.
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