[Congressional Record Volume 147, Number 112 (Friday, August 3, 2001)]
[Senate]
[Pages S8930-S8933]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. HUTCHINSON (for himself and Mr. Craig):
  S. 1362. A bill to amend title XVIII of the Social Security Act and 
title VII of the Public Health Service Act to expand medical residency 
training programs in geriatrics, and for other purposes; to the 
Committee on Finance.
  Mr. HUTCHINSON. Mr. President, I am pleased today to be joined by my 
colleague, Senator Craig, In introducing the Advancement of Geriatric 
Education Act of 2001, or AGE Act is comprehensive legislation which 
seeks to prepare physicians and other health care professionals to care 
for our Nation's growing aging population.
  It is a know fact that children cannot be treated like little adults 
and prescribed the same medications in the same dosage amounts. For 
this reason, we have pediatricians. But just as there are differences 
between children and adults, so are there differences between middle 
aged adults and seniors. Many people are unaware that aging individuals 
often exhibit different symptoms than younger adults with the same 
illness. For example, an older person who has a heart attack may not 
experience excruciating chest pain, but rather, show signs of dizziness 
and confusion. Similarly, older people often exhibit different 
responses to medications than younger people.
  The demographic reality is that there is an enormous segment of the 
population which will soon be age 65 or older, and there is serious 
doubt that the U.S. health system will be equipped to handle the 
multiple needs and demand of an aging population. By 2030, it is 
projected that one in five Americans will be over age 65.
  Geriatricians are physicians who are experts in aging-related issues 
and the

[[Page S8932]]

study of the aging process itself. They are specially trained to 
prevent and manage the unique and often multiple health problems of 
older adults. Geriatric training can provide health care professionals 
with the skills and knowledge to recognize special characteristics of 
older patients and distinguish between disease states and the normal 
physiological changes associated with aging. Our health care system 
must increase its focus in this vital area.
  Today, there are 9,000 practicing, certified geriatricians in the 
United States, far short of the 20,000 geriatricians estimated to be 
necessary to meet the needs of the current aging population. By the 
year 2030, it is estimated that at least 36,000 geriatricians will be 
needed to manage the complex health and social needs of the elderly. 
These figures, as astounding as they sound, say nothing of the 
geriatrics training needed for all health care professionals who are 
facing such an increasingly older patient population.
  Unfortunately, out of 125 medical schools in our country, only 3 have 
actual Departments of Geriatrics, including the University of Arkansas 
for Medical Sciences. Moreover, only 14 schools include geriatrics as a 
required course, and one-third of medical schools do not even offer 
geriatrics as a separate course elective.
  Congress has taken some positive steps to increase our focus on 
geriatrics, including the establishment of Geriatric Education Centers 
and Geriatric Training Programs, which seek to train all health 
professionals in the area of geriatrics. Congress has also established 
the Geriatric Academic Career Award program, which promotes the 
development of academic geriatricians.
  It is clear to me, however, that more steps need to be taken, which 
is why I have introduced the AGE Act today. The AGE Act encourages more 
physicians to specialize in the area of geriatrics and enhances the 
current federal programs relating to geriatrics under the Public Health 
Service Act. The AGE Act is supported by the American Geriatrics 
Society, the International Longevity Center, and the American 
Association of Geriatric Psychiatry. I ask unanimous consent that a 
summary of the AGE Act and the text of the bill be printed in the 
Record.
  There being no objection, the material ordered to be printed in the 
Record, as follows:

                                S. 1362

       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 
     ``Advancement of Geriatric Education Act of 2001''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Disregard of certain geriatric residents and fellows against 
              graduate medical education limitations.
Sec. 3. Extension of eligibility periods for geriatric graduate medical 
              education.
Sec. 4. Study and report on improvement of graduate medical education.
Sec. 5. Improved funding for education and training relating to 
              geriatrics.

     SEC. 2. DISREGARD OF CERTAIN GERIATRIC RESIDENTS AND FELLOWS 
                   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 residencies 
     and fellowships.--For cost reporting periods beginning on or 
     after the date that is 6 months after the date of enactment 
     of the Advancement of Geriatric Education 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, the 
     Secretary shall not take into account a maximum of 5 
     residents enrolled in a geriatric residency or fellowship 
     program approved by the Secretary for purposes of paragraph 
     (5)(A) to the extent that the hospital increases the number 
     of geriatric residents or fellows above the number of such 
     residents or fellows for the hospital'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) 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. EXTENSION OF ELIGIBILITY PERIODS FOR GERIATRIC 
                   GRADUATE MEDICAL EDUCATION.

       (a) Direct GME.--Section 1886(h)(5)(G) of the Social 
     Security Act (42 U.S.C. 1395ww(h)(5)(G)) is amended by adding 
     at the end the following new clause:
       ``(vi) Geriatric residency and fellowship programs.--In the 
     case of an individual enrolled in a geriatric residency or 
     fellowship program approved by the Secretary for purposes of 
     subparagraph (A), the period of board eligibility and the 
     initial residency period shall be the period of board 
     eligibility for the subspecialty involved, plus 1 year.''.
       (b) Conforming Amendment.--Section 1886(h)(5)(F) of the 
     Social Security Act (42 U.S.C. 1395ww(h)(5)(F)) is amended by 
     striking ``subparagraph (G)(v)'' and inserting ``clauses (v) 
     and (vi) of subparagraph (G)''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to cost reporting periods beginning on or after 
     the date that is 6 months after the date of enactment of this 
     Act.

     SEC. 4. STUDY AND REPORT ON IMPROVEMENT OF GRADUATE MEDICAL 
                   EDUCATION.

       (a) Study.--The Secretary of Health and Human Services 
     shall conduct a study to determine how to improve the 
     graduate medical education programs under subsections 
     (d)(5)(B) and (h) of section 1886 of the Social Security Act 
     (42 U.S.C. 1395ww) so that such programs prepare the 
     physician workforce to serve the aging population of the 
     United States. Such study shall include a determination of 
     whether the establishment of an initiative to encourage the 
     development of individuals as academic geriatricians would 
     improve such programs.
       (b) Report.--Not later than the date that is 6 months after 
     the date of enactment of this Act, the Secretary of Health 
     and Human Services shall submit to Congress a report on the 
     study conducted under subsection (a) together with such 
     recommendations for legislative and administrative action as 
     the Secretary determines appropriate.

     SEC. 5. IMPROVED FUNDING FOR EDUCATION AND TRAINING RELATING 
                   TO GERIATRICS.

       (a) Geriatric Faculty Fellowships.--Section of 753(c)(4) of 
     the Public Health Service Act (42 U.S.C. 294c(c)(4)) is 
     amended--
       (1) in subparagraph (A), by striking ``$50,000 for fiscal 
     year 1998'' and inserting ``$75,000 for fiscal year 2002''; 
     and
       (2) in subparagraph (B), by striking ``shall not exceed 5 
     years'' and inserting ``shall be 5 years''.
       (b) Authorization of Appropriations.--Section 757 of the 
     Public Health Service Act (42 U.S.C. 294g) is amended--
       (1) in subsection (a)--
       (A) by striking ``In General.--There are authorized'' and 
     inserting ``Authorization.--
       ``(1) In general.--Except as provided in paragraph (2), 
     there are authorized''; and
       (B) by adding at the end the following:
       ``(2) Education and training relating to geriatrics.--There 
     are authorized to be appropriated to carry out section 753 
     such sums as may be necessary for each of fiscal years 2002 
     through 2006.''; and
       (2) in subsection (b)--
       (A) in paragraph (1)--
       (i) in subparagraph (B), by striking ``and'' at the end; 
     and
       (ii) by striking subparagraph (C) and inserting the 
     following:
       ``(C) not less than $22,631,000 for awards of grants and 
     contracts under--
       ``(i) section 753 for fiscal years 1998 through 2001; and
       ``(ii) sections 754 and 755 for fiscal years 1998 through 
     2002; and
       ``(D) for awards of grants and contracts under section 753 
     after fiscal year 2001--
       ``(i) in 2002, not less than $20,000,000;
       ``(ii) in 2003, not less than $24,000,000;
       ``(iii) in 2004, not less than $28,000,000;
       ``(iv) in 2005, not less than $32,000,000; and
       ``(v) in 2006, not less than $36,000,000.'';
       (B) in paragraph (2), by striking ``subparagraphs (A) 
     through (C)'' and inserting ``subparagraphs (A) through 
     (D)''; and
       (C) in paragraph (3), by striking ``subparagraphs (A) 
     through (C) of paragraph (2)'' and inserting ``subparagraphs 
     (A) through (D) of paragraph (1)''.
       (c) Effective Date.--The amendments made by this section 
     shall take effect on October 1, 2001.
                                  ____


   Advancement of Geriatric Education (AGE) Act of 2001--Legislative 
                                Summary


    i. provides an exception to the cap on residents for geriatric 
                               residents

       The AGE Act amends the Medicare graduate medical education 
     (GME) resident cap imposed under BBA 97 to provide exceptions 
     for geriatric residents in approved training programs. The 
     1997 BBA instituted a per-hospital cap based on the number of 
     GME residency slots in existence on or before December 31, 
     1996. As geriatrics is a relatively new specialty, the cap 
     has resulted in either the elimination or reduction of 
     geriatric of geriatric training programs. This is because a 
     lower number of geriatric residents existed prior to December 
     31, 1996. The AGE Act provides for an exception from the cap 
     for up to 5 geriatric residents.


    ii. requires medicare gme payment for the 2nd year of geriatric 
                          fellowship training

       Under current law, hospitals receive 100 percent GME 
     reimbursement for an individuals's initial residency period, 
     up to five years. The law also includes a geriatric exception 
     allowing programs training geriatric fellows to receive full 
     funding for an

[[Page S8933]]

     additional period comprised of the first and second years of 
     fellowship training. Programs training non-geriatric fellows 
     receive 50 percent of GME funding for fellowship training. In 
     1998, the period of board eligibility for geriatrics was 
     decreased to one year, in an effort to encourage more 
     geriatrics specialists. However, this change was not intended 
     to reduce support for training of teachers and researchers in 
     geriatrics. A two-year fellowship remains the generally 
     accepted standard, and is generally required to become an 
     academic geriatrician. The AGE Act explicitly authorizes 
     Medicare GME payments for the second year of fellowship.


  iii. directs the secretary of hhs to report to congress on ways to 
improve the medicare programs to ready the physician workforce to serve 
    the aging population, including whether an initiative should be 
             established to develop academic geriatricians

       It is estimated that the country currently has one-quarter 
     of the academic geriatricians necessary to train and educate 
     physicians in the area of geriatrics. Out of 125 medical 
     schools in our country, only 3 have actual Departments of 
     Geriatrics. Moreover, only 14 schools include geriatrics as a 
     requried course, and one third of medical schools do not even 
     offer geriatrics as a separate course elective. The AGE Act 
     requires the Secretary of HHS to examine ways to prepare the 
     physician workforce to serve the aging population, including 
     initiatives to develop academic geriatricians, and to report 
     to Congress within 6 months after the date of enactment.


iv. enhances and authorizes greater funding for the geriatric training 
               sections of the public health service act

       Section 735, Title VII of the Public Health Service Act, 
     encompasses Geriatric Education Centers, which provide 
     geriatrics training to all health professionals (Arkansas has 
     a Geriatric Education Center program), a program to provide 
     geriatric training to dentists and behavioral and mental 
     health benefits, and the Geriatrics Academic Development 
     Award program, which creates junior faculty awards to 
     encourage the development of academic geriatricians. The AGE 
     Act increases the amount of the Geriatric Academic 
     Development Award from $50,000 to $75,000, and authorizes 
     greater funding for all three programs in Fiscal Years 2002 
     through 2006 ($20 million in Fiscal Year 2002, $24 million in 
     Fiscal Year 2003, $28 million in Fiscal Year 2004, $32 
     million in Fiscal Year 2005, and $36 million in Fiscal Year 
     2006).
                                 ______