[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 102 Introduced in House (IH)]







108th CONGRESS
  1st Session
                                H. R. 102

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

                            January 7, 2003

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 2003''.

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 2003, 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)) 
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) 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 form 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)) 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) of such Act (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 such 
        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 
such Act (42 U.S.C. 1395u(b)(18)(C)) 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 
such 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, 2004.
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