[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2727 Introduced in Senate (IS)]







106th CONGRESS
  2d Session
                                S. 2727

To improve the health of older Americans and persons with disabilities, 
                        and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 14, 2000

 Mr. Kennedy (for himself, Mr. Bryan, Ms. Mikulski, and Mr. Wellstone) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To improve the health of older Americans and persons with disabilities, 
                        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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare Health 
Improvement Act of 2000''.
    (b) Table of Contents.--The table of contents is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
                    TITLE I--HCFA MISSION STATEMENT

Sec. 101. Establishment of HCFA mission statement with regard to the 
                            medicare program.
  TITLE II--ENABLING OLDER AMERICANS AND PERSONS WITH DISABILITIES TO 
                      IMPROVE THEIR HEALTH STATUS

Sec. 201. Waiver of all preventive services cost sharing under the 
                            medicare program.
Sec. 202. Information campaign on preventive health care for older 
                            Americans and individuals with 
                            disabilities.
Sec. 203. Development of health status self-assessment tool for 
                            medicare beneficiaries.
 TITLE III--IMPROVING THE QUALITY OF CARE PROVIDED TO OLDER AMERICANS 
                     AND PERSONS WITH DISABILITIES

Sec. 301. Information campaign for the best practices for the treatment 
                            of conditions of medicare beneficiaries.
Sec. 302. Program to promote the use of best practices for the 
                            treatment of conditions of medicare 
                            beneficiaries and to reduce hospital and 
                            physician visits that result from improper 
                            drug use.
Sec. 303. Studies on preventive interventions in primary care for older 
                            Americans.
Sec. 304. Smoking cessation demonstration project.
 TITLE IV--DEMONSTRATION PROJECTS TO IMPROVE THE CARE OF RESIDENTS OF 
     SKILLED NURSING FACILITIES AND PERSONS WITH SERIOUS ILLNESSES

Sec. 401. Demonstration projects to provide effective care for skilled 
                            nursing facility residents.
Sec. 402. Demonstration projects to improve the care of persons with 
                            serious illnesses.
   TITLE V--WHITE HOUSE CONFERENCE ON IMPROVING THE HEALTH OF OLDER 
                               AMERICANS

Sec. 501. White House Conference on Improving the Health of Older 
                            Americans.

SEC. 2. DEFINITIONS.

    In this Act:
            (1) Commissioner.--The term ``Commissioner'' means the 
        Commissioner of Social Security.
            (2) Medicare beneficiaries.--The term ``medicare 
        beneficiaries'' means individuals who are entitled to benefits 
        under part A or enrolled under part B of the medicare program, 
        including individuals enrolled in a Medicare+Choice plan 
        offered by a Medicare+Choice organization under part C of such 
        program.
            (3) Medicare program.--The term ``medicare program'' means 
        the health insurance program under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.).
            (4) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

                    TITLE I--HCFA MISSION STATEMENT

SEC. 101. ESTABLISHMENT OF HCFA MISSION STATEMENT WITH REGARD TO THE 
              MEDICARE PROGRAM.

    Part A of title XVIII of the Social Security Act (42 U.S.C. 1395 et 
seq.) is amended by inserting before section 1801 the following:

                        ``hcfa mission statement

    ``Sec. 1800. In administering the health insurance program 
established under this title, it is the mission of the Health Care 
Financing Administration to--
            ``(1) effectively and efficiently administer a program of 
        health insurance coverage for individuals who are entitled to 
        benefits under part A or enrolled under part B of this title, 
        including individuals enrolled in a Medicare+Choice plan 
        offered by a Medicare+Choice organization under part C of this 
        title, in accordance with the requirements of this title;
            ``(2) assure that health care provided to such individuals 
        is of the highest quality; and
            ``(3) carry out programs in cooperation with other 
        Government agencies and the private sector to promote health, 
        prevent disease, and assure the highest possible functional 
        level for such individuals.''.

  TITLE II--ENABLING OLDER AMERICANS AND PERSONS WITH DISABILITIES TO 
                      IMPROVE THEIR HEALTH STATUS

SEC. 201. WAIVER OF ALL PREVENTIVE SERVICES COST SHARING UNDER THE 
              MEDICARE PROGRAM.

    (a) Waiver of Coinsurance and Deductibles.--
            (1) In general.--Section 1834 of the Social Security Act 
        (42 U.S.C. 1395m) is amended by adding at the end the 
        following:
    ``(m) Waiver of Coinsurance and Deductible for Preventive 
Services.--
            ``(1) Coinsurance.--
                    ``(A) In general.--Notwithstanding any other 
                provision of this part--
                            ``(i) the Secretary shall waive any 
                        coinsurance applicable to services described in 
                        subparagraph (B); and
                            ``(ii) with respect to payment for such 
                        services, any reference to a percent that is 
                        less than 100 percent shall be deemed to be a 
                        reference to 100 percent.
                    ``(B) Services described.--The services described 
                in this subparagraph are the following services:
                            ``(i) Screening mammography (as defined in 
                        section 1861(jj)).
                            ``(ii) Screening pelvic exam (as defined in 
                        section 1861(nn)(2)).
                            ``(iii) Hepatitis B vaccine and its 
                        administration (under section 1861(s)(10)(B)).
                            ``(iv) Colorectal cancer screening test (as 
                        defined in section 1861(pp)).
                            ``(v) Bone mass measurement (as defined in 
                        section 1861(rr)).
                            ``(vi) Prostate cancer screening test (as 
                        defined in section 1861(oo)).
                            ``(vii) Diabetes outpatient self-management 
                        training services (as defined in section 
                        1861(qq)).
            ``(2) Deductible.--
                    ``(A) In general.--Notwithstanding any other 
                provision of this part, the deductible described in 
                section 1833(b) shall not apply with respect to 
                services described in subparagraph (B).
                    ``(B) Services described.--The services described 
                in this subparagraph are the following services:
                            ``(i) Hepatitis B vaccine and its 
                        administration (under section 1861(s)(10)(B)).
                            ``(ii) Colorectal cancer screening test (as 
                        defined in section 1861(pp)).
                            ``(iii) Bone mass measurement (as defined 
                        in section 1861(rr)).
                            ``(iv) Prostate cancer screening test (as 
                        defined in section 1861(oo)).
                            ``(v) Diabetes outpatient self-management 
                        training services (as defined in section 
                        1861(qq)).''.
            (2) Conforming amendment.--Section 1833(a) of the Social 
        Security Act (42 U.S.C. 1395l(a)) is amended by striking 
        ``section 1876'' and inserting ``sections 1834 and 1876'' in 
        the matter preceding paragraph (1).
    (b) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after December 31, 2001.

SEC. 202. INFORMATION CAMPAIGN ON PREVENTIVE HEALTH CARE FOR OLDER 
              AMERICANS AND INDIVIDUALS WITH DISABILITIES.

    (a) In General.--The Secretary and the Commissioner shall jointly 
conduct an information campaign, in consultation with the heads of 
other Government agencies and States and the private sector, for 
individuals who have attained age 50 and individuals with disabilities 
to promote--
            (1) the use of preventive health services among such 
        individuals, including services that are available to medicare 
        beneficiaries and are covered by the medicare program;
            (2) the proper use of prescription and over-the-counter 
        drugs in order to reduce the number of hospital stays and 
        physician visits among such individuals that are a result of 
        the improper use of such drugs; and
            (3) the steps (including exercise, maintenance of a proper 
        diet, and utilization of accident prevention techniques) that 
        such individuals may take in order to promote and safeguard 
        their health.
    (b) Use of Services.--The information campaign described in 
subsection (a) shall stress the benefits of--
            (1) using the services described in subsection (a)(1);
            (2) following the proper directions for using prescription 
        and over-the-counter drugs as described in subsection (a)(2); 
        and
            (3) utilizing the steps described in subsection (a)(3).
    (c) Elements of Campaign.--In conducting the information campaign 
described in subsection (a), the Secretary and the Commissioner (as 
applicable) shall--
            (1) expand the section in the Medicare and You handbook on 
        preventive benefits to include a more detailed description of 
        the importance of using preventive health services and the 
        benefits offered under the medicare program;
            (2) instruct fiscal intermediaries and carriers under the 
        medicare program to include preventive benefits messages on the 
        Medicare Summary Notice statement and the Explanation of 
        Medicare Benefits;
            (3) regularly include preventive benefits messages on the 
        medicare part B benefits statement;
            (4) combine public service announcements and a print media 
        campaign to raise awareness of the value of using preventive 
        health services;
            (5) distribute brochures and other information on health 
        promotion and disease prevention activities through--
                    (A) State health insurance assistance programs;
                    (B) area agencies on aging;
                    (C) Social Security Administration field offices; 
                and
                    (D) any other appropriate entities, as determined 
                by the Secretary and the Commissioner; and
            (6) include information on the importance of using 
        preventive health services--
                    (A) on the cost of living adjustment (COLA) notice, 
                which is sent to individuals who receive disability 
                benefits under titles II and XVI of the Social Security 
                Act (42 U.S.C. 401 et seq.; 1381 et seq.);
                    (B) on the social security account statements 
                distributed pursuant to section 1143 of the Social 
                Security Act (42 U.S.C. 1320b-13); and
                    (C) in brochures on retirement and survivors' 
                benefits that are produced by the Commissioner.
    (d) Targeted Populations.--To the extent appropriate, aspects of 
the information campaign described in subsection (a) may be targeted to 
specific subpopulations of medicare beneficiaries.
    (e) Grants and Contracts.--
            (1) In general.--The Secretary and the Commissioner shall 
        provide grants to, and enter into contracts with, eligible 
        entities to assist with carrying out the purposes of this 
        section.
            (2) Eligible entity defined.--In this subsection, the term 
        ``eligible entity'' means--
                    (A) any community organization working with 
                medicare beneficiaries;
                    (B) any organization representing medicare 
                beneficiaries;
                    (C) area agencies on aging; and
                    (D) any other appropriate entities, as determined 
                by the Secretary and the Commissioner.

SEC. 203. DEVELOPMENT OF HEALTH STATUS SELF-ASSESSMENT TOOL FOR 
              MEDICARE BENEFICIARIES.

    (a) Development.--The Secretary, in conjunction with the Director 
of the National Institutes of Health (NIH), the Director of the Centers 
for Disease Control and Prevention (CDC), the Administrator of the 
Substance Abuse and Mental Health Services Administration (SAMHSA), and 
the Administrator of the Agency for Healthcare Research and Quality 
(AHRQ), shall develop a health status self-assessment tool that 
includes assessment of mental health status, alcohol use, and substance 
use, and assists medicare beneficiaries in identifying important health 
information, risk factors, or significant symptoms that should be acted 
upon or discussed with the beneficiary's health care provider.
    (b) Distribution.--The Secretary shall establish procedures for the 
distribution of the self-assessment form developed under subsection (a) 
and may contract with the eligible entities described in section 
202(e)(2) to distribute and promote the use of such forms.
    (c) Training.--The Secretary shall establish a training program for 
the staff of State health insurance assistance programs that will 
enable such staff to assist medicare beneficiaries in completing the 
self-assessment form developed under subsection (a).

 TITLE III--IMPROVING THE QUALITY OF CARE PROVIDED TO OLDER AMERICANS 
                     AND PERSONS WITH DISABILITIES

SEC. 301. INFORMATION CAMPAIGN FOR THE BEST PRACTICES FOR THE TREATMENT 
              OF CONDITIONS OF MEDICARE BENEFICIARIES.

    (a) Study.--The Secretary, in consultation with the Administrator 
for Health Care Policy and Research, the Director of the National 
Institutes of Health, and such other professional societies and experts 
as the Secretary considers appropriate, shall--
            (1) conduct a study to determine areas where treatment of 
        medicare beneficiaries falls short of the highest professional 
        standards; and
            (2) determine the best practices in the areas described in 
        paragraph (1).
    (b) Information Campaign.--The Secretary shall provide for an 
information campaign to inform medicare beneficiaries about the results 
of the study conducted under subsection (a).

SEC. 302. PROGRAM TO PROMOTE THE USE OF BEST PRACTICES FOR THE 
              TREATMENT OF CONDITIONS OF MEDICARE BENEFICIARIES AND TO 
              REDUCE HOSPITAL AND PHYSICIAN VISITS THAT RESULT FROM 
              IMPROPER DRUG USE.

    (a) In General.--The Secretary, in conjunction with the 
Administrator of the Health Resources and Service Administration and 
such other agencies and professional societies as the Secretary deems 
appropriate, shall establish a program to--
            (1) improve treatment of medicare beneficiaries based on 
        the results of the study conducted under section 301(a) and 
        other relevant information; and
            (2) reduce the number of hospital stays and physician 
        visits among medicare beneficiaries that are a result of the 
        improper use of prescription and over-the-counter drugs.
    (b) Elements of Program.--The program described in subsection (a) 
shall include--
            (1) an information campaign for health professionals;
            (2) coordination of the part of the program established 
        under subsection (a) that is designed to achieve the purpose 
        described in paragraph (2) of that subsection with the 
        information campaign conducted under section 202; and
            (3) any other activity the Secretary considers appropriate 
        to carry out the purposes described in subsection (a).
    (c) Demonstrations and Grants.--In establishing the program under 
subsection (a), the Secretary may conduct demonstration projects and 
award grants to eligible entities (as defined in subsection (d)).
    (d) Eligible Entity Defined.--In this section, the term ``eligible 
entity'' means an entity that is an academic health center, a 
professional medical society, or such other entity as the Secretary 
considers appropriate to carry out the purposes of this section.
    (e) Report to Congress.--Not later than 1 year after the date of 
enactment of this Act, and annually thereafter, the Secretary shall 
annually report to Congress on the program conducted under this 
section.

SEC. 303. STUDIES ON PREVENTIVE INTERVENTIONS IN PRIMARY CARE FOR OLDER 
              AMERICANS.

    (a) Studies.--The Secretary, acting through the United States 
Preventive Services Task Force, shall conduct a series of studies 
designed to identify preventive interventions that can be delivered in 
the primary care setting that are most valuable to older Americans.
    (b) Mission Statement.--The mission statement of the United States 
Preventive Services Task Force is amended to include the evaluation of 
services that are of particular relevance to older Americans.
    (c) Report.--Not later than 1 year after the date of enactment of 
this Act, and annually thereafter, the Secretary shall submit a report 
to Congress on the conclusions of the studies conducted under 
subsection (a), together with recommendations for such legislation and 
administrative actions as the Secretary considers appropriate.

SEC. 304. SMOKING CESSATION DEMONSTRATION PROJECT.

    (a) In General.--The Secretary, acting through the Administrator of 
the Health Care Financing Administration, shall conduct a demonstration 
project to--
            (1) evaluate the most successful and cost-effective means 
        of providing smoking cessation services to medicare 
        beneficiaries; and
            (2) test incentive systems for physicians, other health 
        care professionals, and medicare beneficiaries to optimize 
        rates of successful smoking cessation among medicare 
        beneficiaries.
    (b) Latest Scientific Evidence.--The Secretary shall use the latest 
scientific evidence regarding smoking cessation strategies and 
guidelines in conducting the demonstration project under this section.
    (c) Payment.--Payment to an individual or an entity for a service 
provided under the demonstration project shall be equal to the lesser 
of--
            (1) the actual charge for providing the service to a 
        medicare beneficiary; or
            (2) the amount determined by a fee schedule established by 
        the Secretary for the purposes of this section for such 
        service.
    (d) Waiver Authority.--
            (1) In general.--The Secretary may waive such requirements 
        of the medicare program as may be necessary for the purposes of 
        carrying out the demonstration project conducted under this 
        section.
            (2) Non-medicare providers.--Individuals and entities that 
        do not provide items and services under the medicare program 
        shall be permitted to participate in the demonstration project 
        conducted under this section.
    (e)  Report to Congress.--Not later than 1 year after the date of 
enactment of this Act, and annually thereafter, the Secretary shall 
report to Congress on the demonstration project conducted under this 
section.

 TITLE IV--DEMONSTRATION PROJECTS TO IMPROVE THE CARE OF RESIDENTS OF 
     SKILLED NURSING FACILITIES AND PERSONS WITH SERIOUS ILLNESSES

SEC. 401. DEMONSTRATION PROJECTS TO PROVIDE EFFECTIVE CARE FOR SKILLED 
              NURSING FACILITY RESIDENTS.

    (a) In General.--The Secretary shall conduct demonstration projects 
that are designed to provide medicare beneficiaries who are residents 
of skilled nursing facilities (as defined in section 1819(a) of the 
Social Security Act (42 U.S.C. 1395i-3(a)) with higher quality and more 
cost-effective services in order to avoid unnecessary hospitalizations 
of such residents.
    (b) Requirements.--
            (1) In general.--The demonstration projects conducted under 
        this section shall include the following:
                    (A) Programs of case management.
                    (B) Programs of disease management.
                    (C) Such other programs as the Secretary determines 
                are likely to increase the quality of, and reduce the 
                cost of, the care provided to such residents.
            (2) Authorized techniques.--The demonstration projects 
        conducted under this section may utilize--
                    (A) contracts with centers of excellence or other 
                entities or individuals with special expertise in 
                providing quality services to residents of skilled 
                nursing facilities;
                    (B) innovative payment techniques, including 
                capitation payments, for all or selected services 
                provided under such projects and incentive payments to 
                reward favorable cost and quality outcomes;
                    (C) provision of services not normally covered 
                under the medicare program, if the provision of such 
                services would result in the more cost-effective 
                provision of, or higher quality of, services covered 
                under such program; or
                    (D) reduced cost-sharing requirements for medicare 
                beneficiaries participating in such projects.
    (c) Waiver Authority.--The Secretary may waive such requirements of 
the medicare program as may be necessary for the purposes of carrying 
out the demonstration projects conducted under this section other than 
requirements relating to providing medicare beneficiaries with freedom 
of choice of provider under section 1802 of the Social Security Act (42 
U.S.C.1395a) or any other provision of law.
    (d)  Report to Congress.--Not later than 1 year after the date of 
enactment of this Act, and annually thereafter, the Secretary shall 
report to Congress on the demonstration projects conducted under this 
section.

SEC. 402. DEMONSTRATION PROJECTS TO IMPROVE THE CARE OF PERSONS WITH 
              SERIOUS ILLNESSES.

    (a) Expansion of Medicare Coordinated Care Demonstration Project.--
Section 4016 of the Balanced Budget Act (Public Law 105-33; 111 Stat. 
343) is amended--
            (1) by striking subsection (a)(2) and inserting the 
        following:
            ``(2) Target individual defined.--In this section, the term 
        ``target individual'' means an individual that is enrolled 
        under the fee-for-service program under parts A and B of title 
        XVIII of the Social Security Act (42 U.S.C. 1395c et seq.; 
        1395j et seq.) and--
                    ``(A) has a chronic illness, as defined and 
                identified by the Secretary; or
                    ``(B) has a serious illness, as so defined and 
                identified.'';
            (2) in subsection (b)(2), by striking ``Not'' and inserting 
        ``With respect to demonstration projects for items and services 
        provided to target individuals described in subsection 
        (a)(2)(A), not''; and
            (3) by adding at the end the following:
    ``(f) Requirements.--
            ``(1) In general.--The demonstration projects conducted 
        under this section shall include--
                    ``(A) programs of case management;
                    ``(B) programs of disease management; and
                    ``(C) such other programs as the Secretary 
                determines are likely to increase the quality of, and 
                reduce the cost of, the care provided to target 
                individuals.
            ``(2) Authorized techniques.--The demonstration projects 
        conducted under this section may include--
                    ``(A) contracts with centers of excellence or other 
                entities or individuals with special expertise in 
                providing quality services to target individuals;
                    ``(B) innovative payment techniques, including 
                capitation payments, for all or selected services 
                provided under such projects and incentive payments to 
                reward favorable cost and quality outcomes;
                    ``(C) provision of services not normally covered 
                under title XVIII of the Social Security Act (42 U.S.C 
                1395 et seq.), if the provision of such services would 
                result in the more cost-effective provision of, or 
                higher quality of, services covered under that title; 
                or
                    ``(D) reduced cost-sharing requirements for target 
                individuals participating in such projects.''.
    (b) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act.

   TITLE V--WHITE HOUSE CONFERENCE ON IMPROVING THE HEALTH OF OLDER 
                               AMERICANS

SEC. 501. WHITE HOUSE CONFERENCE ON IMPROVING THE HEALTH OF OLDER 
              AMERICANS.

    (a) In General.--Not later than December 31, 2002, the President 
shall convene a White House Conference on Improving the Health of Older 
Americans.
    (b) Goal of Conference.--The goal of the Conference shall be to--
            (1) develop a consensus on a program to enable older 
        Americans to protect and improve their own health;
            (2) develop procedures to ensure that--
                    (A) older Americans are provided with the highest 
                standard of health care available, with an emphasis on 
                assuring that standard practice is also the best 
                practice; and
                    (B) the needs of older Americans are more 
                effectively met through the benefits provided under the 
                medicare program; and
            (3) outline a research and demonstration agenda to further 
        the goals described in paragraphs (1) and (2).
    (c) Conference Participants.--
            (1) Participants.--In order to carry out the purposes of 
        this section, the Conference shall bring together--
                    (A) representatives of older Americans and those 
                who care for older Americans;
                    (B) researchers and research institutions with an 
                expertise in issues related to older Americans;
                    (C) health professionals and members of 
                professional societies with expertise in caring for 
                older Americans; and
                    (D) other appropriate parties.
            (2) Selection of delegates.--The participants shall be 
        selected without regard to political affiliation or past 
        partisan activity and shall, to the best of the President's 
        ability, be representative of the spectrum of thought in the 
        field of geriatric health care.
                                 <all>