[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 2557 Introduced in Senate (IS)]







107th CONGRESS
  2d Session
                                S. 2557

 To amend title XVIII of the Social Security Act to improve access to 
Medicare+Choice plans for special needs medicare beneficiaries, and for 
                            other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 23, 2002

 Mr. Hatch (for himself, Mr. Graham, Mr. Allard, Mr. Kennedy, and Ms. 
   Mikulski) 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 improve access to 
Medicare+Choice plans for special needs medicare beneficiaries, 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 Improvements for Special 
Needs Beneficiaries Act of 2002''.

SEC. 2. SPECIALIZED MEDICARE+CHOICE PLANS FOR SPECIAL NEEDS 
              BENEFICIARIES.

    (a) Establishment of Specialized Medicare+Choice Plans for Special 
Needs Beneficiaries.--
            (1) Treatment as coordinated care plan.--Section 
        1851(a)(2)(A) of the Social Security Act (42 U.S.C. 1395w-
        21(a)(2)(A)) is amended by adding at the end the following new 
        sentence: ``Specialized Medicare+Choice plans for special needs 
        beneficiaries (as defined in section 1859(b)(4)) may be any 
        type of coordinated care plan.''.
            (2) Specialized medicare+choice plan for special needs 
        beneficiaries defined.--Section 1859(b) of the Social Security 
        Act (42 U.S.C. 1395w-28(b)) is amended by adding at the end the 
        following new paragraph:
            ``(4) Specialized medicare+choice plans for special needs 
        beneficiaries.--
                    ``(A) In general.--The term `specialized 
                Medicare+Choice plan for special needs beneficiaries' 
                means a Medicare+Choice plan that exclusively serves 
                special needs beneficiaries (as defined in subparagraph 
                (B)).
                    ``(B) Special needs beneficiary.--The term `special 
                needs beneficiary' means a Medicare+Choice eligible 
                individual who--
                            ``(i) is institutionalized (as defined by 
                        the Secretary);
                            ``(ii) is entitled to medical assistance 
                        under a State plan under title XIX; or
                            ``(iii) meets such other requirements as 
                        the Secretary may establish for purposes of 
                        identifying beneficiaries with a severe and 
                        disabling chronic condition who would benefit 
                        from enrollment in a Medicare+Choice plan 
                        described in subparagraph (A).''.
            (3) Restriction on enrollment permitted.--Section 1859 of 
        the Social Security Act (42 U.S.C. 1395w-28) is amended by 
        adding at the end the following new subsection:
    ``(f) Restriction on Enrollment for Specialized Medicare+Choice 
Plans for Special Needs Beneficiaries.--In the case of a specialized 
Medicare+Choice plan for special needs beneficiaries (as defined in 
subsection (b)(4)), notwithstanding any other provision of this part 
and in accordance with regulations of the Secretary and for periods 
before January 1, 2008, the plan may restrict the enrollment of 
individuals under the plan to individuals who are within 1 or more 
classes of special needs beneficiaries.''.
            (4) Additional requirements for specialized medicare+choice 
        plans for special needs beneficiaries.--Section 1857(e) of the 
        Social Security Act (42 U.S.C. 1395w-27(e)) is amended by 
        adding at the end the following new paragraph:
            ``(3) Additional requirements for specialized 
        medicare+choice plans for special needs beneficiaries.--In the 
        case of a specialized Medicare+Choice plan for special needs 
        beneficiaries (as defined in section 1859(b)(4)), the contract 
        shall include additional terms and conditions as follows:
                    ``(A) Clinical delivery system.--
                            ``(i) In general.--Under the contract, the 
                        organization offering the specialized 
                        Medicare+Choice plan for special needs 
                        beneficiaries shall establish a clinical 
                        delivery system that meets the needs of special 
                        needs beneficiaries (as defined in section 
                        1859(b)(4)(B)) enrolled in the plan.
                            ``(ii) Elements.--The clinical delivery 
                        system established under clause (i) shall 
                        include the following:
                                    ``(I) A comprehensive patient 
                                assessment and plan of care.
                                    ``(II) Methods to prevent, delay, 
                                or minimize the progression of severe 
                                and disabling chronic conditions.
                                    ``(III) Care management protocols, 
                                including high-risk screening to 
                                identify factors that may increase the 
                                cost of care provided to special needs 
                                beneficiaries.
                                    ``(IV) Appropriate specially 
                                trained health care staff, such as 
                                nurse practitioners, geriatric care 
                                managers, and mental health 
                                professionals.
                                    ``(V) Methods for promoting the 
                                integration of care, financing, and 
                                administrative functions across health 
                                care settings.
                    ``(B) Data collection; development of outcome 
                measures.--
                            ``(i) Data collection.--Under the contract, 
                        the organization offering the specialized 
                        Medicare+Choice plan for special needs 
                        beneficiaries shall--
                                    ``(I) collect such data as the 
                                Secretary may specify for the purpose 
                                of monitoring the quality of health 
                                care items and services provided to 
                                special needs beneficiaries enrolled in 
                                the plan, outcomes, and costs, 
                                including functional and diagnostic 
                                data and information collected through 
                                outcome measures developed under clause 
                                (ii);
                                    ``(II) maintain, and afford the 
                                Secretary access to, the records 
                                relating to the plan, including 
                                pertinent financial, medical, and 
                                personnel records; and
                                    ``(III) make available to the 
                                Secretary reports that the Secretary 
                                finds necessary to monitor the 
                                operation, cost, and effectiveness of 
                                the plan.
                            ``(ii) Development of outcome measures.--
                        Under the contract, the organization offering 
                        the specialized Medicare+Choice plan for 
                        special needs beneficiaries and the Secretary 
                        shall jointly cooperate in the development and 
                        implementation of health status and quality of 
                        life outcome measures with respect to special 
                        needs beneficiaries (as defined in section 
                        1859(b)(4)(B)) enrolled in the plan.
                    ``(C) Quality assurance; patient safeguards.--The 
                contract shall require the organization offering the 
                specialized Medicare+Choice plan for special needs 
                beneficiaries to have in effect, at a minimum, a 
                written plan of quality assurance and improvement, and 
                procedures implementing such plan, in accordance with 
                regulations.
                    ``(D) Oversight.--The contract shall provide that 
                the Secretary shall conduct, in addition to any other 
                review conducted under this part, such review of the 
                operation of specialized Medicare+Choice plans for 
                special needs beneficiaries and organizations offering 
                such plans as may be appropriate in order to ensure the 
                compliance of the plans and organizations with the 
                requirements of this part and regulations to carry out 
                such requirements.''.
    (b) Effective Dates.--
            (1) In general.--The amendments made by subsection (a) 
        shall take effect upon the date of enactment of this Act.
            (2) Deadline for issuance of requirements for special needs 
        beneficiaries; transition.--Not later than October 1, 2003, the 
        Secretary of Health and Human Services shall issue final 
        regulations to establish requirements for special needs 
        beneficiaries under section 1859(b)(4)(B)(iii) of the Social 
        Security Act (as added by subsection (a)(2)).

SEC. 3. GAO REPORT TO CONGRESS ON SPECIALIZED MEDICARE+CHOICE PLANS FOR 
              SPECIAL NEEDS BENEFICIARIES.

    (a) In General.--Not later than December 31, 2006, the Comptroller 
General of the United States shall submit to Congress a report that 
assesses the impact of specialized Medicare+Choice plans for special 
needs beneficiaries (as defined in section 1859(b)(4) of the Social 
Security Act (as added by section 2(a)(2))) on the cost and quality of 
services provided to enrollees.
    (b) Contents.--The report submitted under subsection (a) shall 
contain the following elements:
            (1) A general assessment of the operations of the 
        specialized Medicare+Choice plans for special needs 
        beneficiaries.
            (2) Information on the demographics and health status of 
        beneficiaries enrolled in such plans.
            (3) Information on such plans' clinical models of care.
            (4) Information on the performance of such plans related to 
        such quality indicators as the Secretary determines to be 
        appropriate.
            (5) An assessment of the marketing materials and practices 
        of the plans.
            (6) An assessment of the plans' ability to integrate care, 
        financing, and administrative functions across health care 
        settings.
            (7) A general assessment of the costs and any savings to 
        the medicare program under title XVIII of the Social Security 
        Act as a result of amendments made by section 2.
                                 <all>