[Congressional Record Volume 147, Number 147 (Tuesday, October 30, 2001)]
[Extensions of Remarks]
[Pages E1943-E1944]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




       INTRODUCING MEDICARE CHRONIC CARE IMPROVEMENT ACT OF 2001

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                       Tuesday, October 30, 2001

  Mr. STARK. Mr. Speaker, today I join with several colleagues to 
introduce the Medicare Chronic Care Improvement Act of 2001. This 
comprehensive piece of legislation would update and improve the 
Medicare healthcare delivery system to better meet the needs of people 
with serious and disabling chronic health conditions.
  Individuals with chronic illnesses represent the highest-cost, 
fastest-growing sector in healthcare, accounting for 90% of morbidity, 
80% of deaths, and over 75% of national direct medical expenditures. 
For a person who is seriously disabled by their chronic condition, 
annual medical expenditures can be nearly 15 times that of a healthy 
person. Furthermore approximately 100 million Americans have chronic 
conditions and this number is expected to increase to 157 million--or 
half the population--by 2020.
  Although chronic conditions are America's number one healthcare 
problem, we have a healthcare system that is designed around acute care 
needs. A recent IOM report, Crossing the Quality Chasm, appropriately 
concludes, ``chronic conditions should serve as a starting point for 
the restructuring of health care delivery because chronic conditions 
are now the leading cause of illness, disability, and death in the 
United States, affecting almost half of the population and accounting 
for the majority of health care resources used.''
  This statement is particularly true with respect to Medicare 
beneficiaries--about 80% of those aged 65 and older have one chronic 
condition and two thirds have two or more. For women, the numbers are 
even higher--90% have one or more chronic diseases.
  Chronic illnesses are physical and mental conditions that are 
persistent, recurring, and can range from mild to severely disabling. 
Some have acute periods that require hospitalization, while others can 
be successfully managed to prevent costly hospitalizations. Conditions 
like arthritis, depression, and hypertension are particularly common 
among older Americans. Others, such as schizophrenia and multiple 
sclerosis, can lead to profound impairment and disability in Americans 
under 65.
  We cannot deliver 21st century healthcare with a system that was 
designed a half-century ago, before angioplasty or bypass surgery for 
heart disease and before L-dopa for Parkinson's disease. Medical 
discoveries like these have transformed many illnesses from rapidly 
disabling conditions to chronic conditions that people live with for a 
long time. But the healthcare system that works for devastating heart 
attack does not work for chronic

[[Page E1944]]

illnesses, which benefit from a completely different group of services.
  For example, Medicare data show that people with chronic conditions 
see eight different physicians on average. Yet Medicare does not 
compensate physicians for time spent communicating with each other 
around complex patient needs, monitoring for harmful drug interactions, 
or teaching patients and caregivers how to better manage their 
conditions. As a result, these crucial care coordination services are 
rarely provided.
  To effectively meet the needs of individuals with chronic conditions, 
our healthcare system must reward care coordination as well as 
prevention and health promotion. We must promote early diagnosis, 
interdisciplinary care, and counseling and education for patients and 
their caregivers. Furthermore, we must develop more effective national 
policies on chronic condition care by studying chronic condition 
trends, including utilization, quality, and costs of services for 
patients with chronic conditions.
  The medical discoveries of the 20th century have dramatically 
prolonged the life expectancy of persons with all types of chronic 
conditions. In the 21st century, our challenge is to reduce the 
progression of disability and improve the functional status and quality 
of life of persons with chronic illness.
  The Medicare Chronic Care Improvement Act of 2001 strives to achieve 
these goals by:
  Improving access to preventive and wellness services for Medicare 
beneficiaries;
  Covering assessment and care coordination services for Medicare 
beneficiaries with serious and disabling chronic conditions;
  Refining fee-for-service payments for physician and post-acute 
services and M+C risk adjustment methodologies to more accurately 
account for the costs of chronic illnesses and disabilities;
  Studying chronic condition trends and costs to serve as the basis for 
improved Medicare policies on chronic care; and
  Commissioning an Institute of Medicine study to identify barriers and 
facilitators to effective chronic illness care, with a report and 
recommendations to Congress.
  For more detail, I am also entering a section-by-section bill summary 
into the Congressional Record following this statement.
  This legislation has been endorsed by a variety of health 
organizations representing consumers and providers:
  Chronic Care Coalition: American Association of Homes and Services 
for the Aging; American Geriatrics Society, Catholic Health Association 
of the United States, Elderplan Social HMO, National Chronic Care 
Consortium, National Council on the Aging, National Family Caregivers 
Association.
  National Depressive and Manic-Depressive Association.
  Association for Ambulatory Behavioral Healthcare.
  American Lung Association.
  American Academy of Neurology.
  United Seniors Health Cooperative.
  American Neurological Association.
  Let us not forget--Medicare is the major source of health coverage 
for seniors with chronic conditions. As Congress considers 
modernization strategies, we must take action to protect Medicare and 
ensure that its benefit, financing and oversight structures are able to 
better meet the needs of persons with chronic conditions. I urge my 
colleagues to join me in taking a major step forward in improving the 
quality of care for Medicare beneficiaries with chronic health 
conditions.

             Medicare Chronic Care Improvement Act of 2001


  TITLE I--Expansion of Benefits to Prevent, Delay, and Minimize the 
                   Progresssion of Chronic Conditions

     Improve access to preventive services
       Eliminate deductibles and co-insurance for Medicare covered 
     preventive services.
       Streamline process of approving preventive benefits by 
     directing the Secretary of Health and Human Services to 
     contract with the Institute of Medicine (IOM) to investigate 
     and recommend new preventive benefits every 3 years. Grant 
     the Secretary the authority to implement these 
     recommendations, and fast-track the recommendations through 
     Congress if the Secretary chooses not to act upon this 
     authority.
     Expand access to health promotion services
       Establish demonstration projects to promote disease self-
     management.
       Implement a Medicare health education and risk appraisal 
     program no later than 18 months after a series of 
     demonstration projects conclude.
     Expand coverage for care coordination and assessment services
       Create a new benefit that covers assessment, care 
     coordination, counseling, and education assistance for 
     individuals with serious and disabling chronic conditions. 
     Services could be provided by health care professionals, 
     including physicians, social workers, and nurses. Examples of 
     items and services to be covered include: initial and 
     periodic health screening and assessments; management and 
     referral for medical and other health services; medication 
     management; and patient and family caregiver education and 
     counseling.


Title II--Establish Payment Incentives for Furnishing Quality Services 
      to Individuals with serious and disabling chronic conditions

     Improve Medicare financing methods
       Direct the Secretary to refine Medicare prospective payment 
     systems for skilled nursing facility (SNF), home health, 
     therapy, partial hospitalization, end stage renal dialysis 
     (ESRD), and outpatient hospital services and refine resource-
     based relative value scale (RBRVS) payment methods for 
     physicians to ensure appropriate payment for serving 
     individuals with serious and disabling chronic conditions.
       Direct the Secretary to refine Medicare+Choice risk 
     adjustment methodology to provide adequate payment for plans 
     with specialized programs for frail elderly and at-risk 
     beneficiaries.
       Until the refined risk adjustment methodology is 
     implemented, direct the Secretary to continue current payment 
     methodologies for existing specialized programs for frail 
     elderly and at-risk beneficiaries.
       Create a demonstration program to provide additional 
     payments to Medicare+Choice plans that provide a specialized 
     program of care for beneficiaries with serious and disabling 
     chronic conditions. These plans must exclusively serve such 
     beneficiaries or serve a disproportionate share of such 
     beneficiaries. The demonstration program would expire one 
     year after the refined risk adjustment methodology is 
     implemented.


    title iii--study and report on effective chronic condition care

     Evaluate Medicare policies regarding chronic condition care
       Direct the Secretary to study chronic condition trends and 
     associated service utilization, cumulative costs, and quality 
     indicators in Medicare.
       Direct the Secretary to report the study results to 
     Congress every 3 years. The report must include 
     recommendations on improving care for Medicare beneficiaries 
     with chronic conditions, reducing chronic conditions, and 
     reducing related medical expenses.
     Identify improvements in Medicare to ensure effective chronic 
         condition care
       Direct the Secretary to contract with the IOM to 
     investigate and identify barriers and facilitators to 
     effective care for Medicare beneficiaries with chronic 
     conditions, including inconsistent clinical, financial, or 
     administrative requirements across care settings. The IOM's 
     report must include recommendations to improve access to 
     effective care.
     Definitions
       ``Chronic condition'' means one or more physical or mental 
     conditions which are likely to last for an unspecified period 
     of time, or for the duration of an individual's life, for 
     which there is no known cure, and which may affect an 
     individual's ability to carry out basic activities of daily 
     living (ADLs), instrumental activities of daily living 
     (IADLs), or both.
       ``Serious and disabling chronic condition(s)'' means the 
     individual has one or more physical or mental conditions and 
     has been certified by a licensed health care practitioner 
     within the preceding 12 months as having a level of 
     disability such that the individual for at least 90 days, is 
     unable to perform at least 2 ADLs or a number of IADLs or 
     other measure indicating an equivalent level of disability or 
     requiring substantial supervision due to severe cognitive 
     impairment.

     

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