[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3027 Introduced in House (IH)]
107th CONGRESS
1st Session
H. R. 3027
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 HOUSE OF REPRESENTATIVES
October 4, 2001
Mr. Green of Texas introduced the following bill; which was referred to
the Committee on Energy and Commerce, and in addition to the Committee
on Ways and Means, 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 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, 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), 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; 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) An initial assessment of an individual's medical
condition, functional and cognitive capacity, and environmental
and psychological needs and an annual reassessment of such
condition, capacity, and needs, unless the care coordinator
determines that a more frequent reassessment is necessary based
on sentinel health events (as defined by the Secretary) or a
change in health status that may require a change in the
individual's plan of care.
``(B) The coordination of, and referral for, medical and
other health services, including--
``(i) multidisciplinary care conferences;
``(ii) coordination with other providers (including
telephone consultations with physicians); and
``(iii) the monitoring and management of
medications, with special emphasis on the management on
behalf of an individual with a serious and disabling
chronic condition that uses multiple medications
(including coordination with the entity managing
benefits for the individual).
``(C) Patient and family caregiver education and counseling
services (through office visits or telephone consultation),
including self-management services and risk appraisal services
to identify behavioral risk factors through self-assessment.
``(D) Such other services for which payment would not
otherwise be made under this title as the Secretary determines
to be appropriate, including activities to facilitate
continuity of care and patient adherence to plans of care.
``(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 described in section 7702B(c)(2)(B) of the Internal Revenue
Code of 1986) for a period of at least 90 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) requires medical management and coordination of care
due to a complex medical condition (as defined by the
Secretary); 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).
``(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.''.
(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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