[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5080 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 5080

To revise and extend the Medicare community nursing organization (CNO) 
                         demonstration project.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 27, 2000

  Mr. Ramstad (for himself, Mr. Rangel, and Mr. Kolbe) introduced the 
following bill; which was referred to the Committee on Ways and Means, 
   and in addition to the Committee on Commerce, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL


 
To revise and extend the Medicare community nursing organization (CNO) 
                         demonstration project.

    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 Community Nursing 
Organization Demonstration Project Revision and Extension Act of 
2000''.

SEC. 2. REVISED TERMS AND CONDITIONS FOR EXTENSION OF MEDICARE 
              COMMUNITY NURSING ORGANIZATION (CNO) DEMONSTRATION 
              PROJECT.

    (a) In General.--Section 532 of the Medicare, Medicaid, and SCHIP 
Balanced Budget Refinement Act of 1999 (113 Stat. 1501A-388), as 
enacted into law by section 1000(a)(6) of Public Law 106-113, is 
amended--
            (1) in subsection (a), by striking the second sentence; and
            (2) by striking subsection (b) and inserting the following:
    ``(b) Terms and Conditions.--
            ``(1) January through september 2000.--For the 9-month 
        period beginning with January 2000, any such demonstration 
        project shall be conducted under the same terms and conditions 
        as applied to such demonstration during 1999.
            ``(2) October 2000 through december 2001.--For the 15-month 
        period beginning with October 2000, any such demonstration 
        project shall be conducted under the same terms and conditions 
        as applied to such demonstration during 1999, except that the 
        following modifications shall apply:
                    ``(A) Basic capitation rate.--The basic capitation 
                rate paid for services covered under the project (other 
                than case management services) per enrollee per month 
                shall be basic capitation rate paid for such services 
                for 1999, reduced by 10 percent in the case of the 
                demonstration sites located in Arizona, Minnesota, and 
                Illinois, and 15 percent for the demonstration site 
                located in New York.
                    ``(B) Targeted case management fee.--A case 
                management fee shall be paid only for enrollees who are 
                classified as `moderate' or `at risk' through a 
                baseline health assessment (as required for 
                Medicare+Choice plans under section 1852(e) of the 
                Social Security Act (42 U.S.C.1395ww-22(e)).
                    ``(C) Greater uniformity in clinical features among 
                sites.--Each project shall implement for each site--
                            ``(i) protocols for periodic telephonic 
                        contact with enrollees based on--
                                    ``(I) the results of such 
                                standardized written health assessment; 
                                and
                                    ``(II) the application of 
                                appropriate care planning approaches;
                            ``(ii) disease management programs for 
                        targeted diseases (such as congestive heart 
                        failure, arthritis, diabetes, and hypertension) 
                        that are highly prevalent in the enrolled 
                        populations;
                            ``(iii) systems and protocols to track 
                        enrollees through hospitalizations, including 
                        pre-admission planning, concurrent management 
                        during inpatient hospital stays, and post-
                        discharge assessment, planning, and follow-up; 
                        and
                            ``(iv) standardized patient educational 
                        materials for specified diseases and health 
                        conditions.
                    ``(D) Quality improvement.--Each project shall 
                implement at each site once during the 15-month 
                period--
                            ``(i) enrollee satisfaction surveys; and
                            ``(ii) reporting on specified quality 
                        indicators for the enrolled population.
    ``(c) Evaluation.--
            ``(1) Preliminary report.--Not later than July 1, 2001, the 
        Secretary of Health and Human Services shall submit to the 
        Committees on Ways and Means and Commerce of the House of 
        Representatives and the Committee on Finance of the Senate a 
        preliminary report that--
                    ``(A) evaluates such demonstration projects for the 
                period beginning July 1, 1997, and ending December 31, 
                1999, on a site-specific basis with respect to the 
                impact on per beneficiary spending, specific health 
                utilization measures, and enrollee satisfaction; and
                    ``(B) includes a similar evaluation of such 
                projects for the portion of the extension period that 
                occurs after September 30, 2000.
            ``(2) Final report.--The Secretary shall submit a final 
        report to such Committees on such demonstration projects not 
        later than July 1, 2002. Such report shall include the same 
        elements as the preliminary report required by paragraph (1), 
        but for the period after December 31, 1999.
            ``(3) Methodology for spending comparisons.--Any evaluation 
        of the impact of the demonstration projects on per beneficiary 
        spending included in such reports shall be based on a 
        comparison of--
                    ``(A) data for all individuals who--
                            ``(i) were enrolled in such demonstration 
                        projects as of the first day of the period 
                        under evaluation; and
                            ``(ii) were enrolled for a minimum of 6 
                        months thereafter; with
                    ``(B) data for a matched sample of individuals who 
                are enrolled under part B of title XVIII of the Social 
                Security Act and are not enrolled in such a project, or 
                in a Medicare+Choice plan under part C of such title, a 
                plan offered by an eligible organization under section 
                1876 of such Act, or a health care prepayment plan 
                under section 1833(a)(1)(A) of such Act.''.
    (b) Effective Date.--The amendments made by subsection (a) shall be 
effective as if included in the enactment of section 532 of the 
Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 
(113 Stat. 1501A-388), as enacted into law by section 1000(a)(6) of 
Public Law 106-113.
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