[Congressional Record Volume 149, Number 81 (Wednesday, June 4, 2003)]
[Extensions of Remarks]
[Page E1122]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




       INTRODUCTION OF THE MEDICARE CHRONIC CARE IMPROVEMENT ACT

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Wednesday, June 4, 2003

  Mr. STARK. Mr. Speaker, today I join with several colleagues to 
introduce the Medicare Chronic Care Improvement Act of 2003. This 
legislation would strengthen Medicare in the truest sense, by improving 
the quality of care delivered to Medicare beneficiaries. The bill would 
make these improvements without forcing beneficiaries to leave the 
traditional Medicare program and join private insurance plans, and 
without restricting beneficiaries' choice of doctor, hospital, or other 
health care provider.
  Medicare beneficiaries have significant chronic care needs. Nearly 90 
percent of those aged 65 and older have one chronic condition and two 
thirds have two or more chronic conditions. Beneficiaries with five or 
more chronic conditions comprise 20 percent of the Medicare population, 
but they account for an astonishing 66 percent of program spending. On 
average, Medicare beneficiaries with chronic conditions see eight 
different physicians regularly.
  Unfortunately, Medicare--like the rest of our health care system--is 
designed around acute care needs. We generally do not adequately 
compensate providers for on-going care such as the 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.
  President Bush and some of my Republican colleagues would have us 
believe that we can solve this problem by forcing seniors into private 
insurance plans. Simply put, that claim is ridiculous. The need for 
chronic care improvements is just as pervasive among private insurers 
and the rest of the health care system as it is in Medicare. That is 
why the National Academy of Social Insurance (NASI) Study Panel on 
Medicare and Chronic Care in the 21st Century concluded earlier this 
year that, ``Medicare has the potential to refocus its Medicare 
program--as well as the nation's health care system--and should take a 
leading role in improving chronic care.''
  The Medicare Chronic Care Improvement Act would follow through on 
that expert recommendation. This bill provides the Medicare 
improvements that seniors and people with disabilities need by: 
Improving access to preventive and wellness services; expanding 
coverage for care coordination and assessment services for Medicare 
beneficiaries with chronic conditions; implementing a chronic care 
Quality Improvement Program; providing federal matching grants for 
clinical information technology systems that improve the coordination 
and quality of chronic care; ensuring that Medicare beneficiaries are 
not inappropriately denied coverage for services that are necessary to 
maintain health or functional status; commissioning an Institute of 
Medicine study and report on additional ways to ensure effective 
chronic care.
  For more detail, I am entering a section-by-section bill summary into 
the Congressional Record following this statement.
  The Medicare Chronic Care Improvement Act is supported by a variety 
of health organizations representing consumers and providers, including 
the Alzheimer's Association, the American Geriatrics Society, the 
Center for Medicare Advocacy, Families USA, the Medicare Rights Center, 
and the National Chronic Care Consortium.
  The Medicare Chronic Care Improvement Act enjoys wide support because 
it strengthens Medicare for all beneficiaries, whether they are in 
traditional Medicare or private plans that contract with Medicare. 
Unlike the President's Medicare ``reform'' plan or plans being 
developing by Congressional Republicans, the Medicare Chronic Care 
Improve Act would never force elderly and disabled Americans to give up 
traditional Medicare in order to get crucial benefits. They will never 
be forced to choose between the doctors they know and trust and the 
coverage they need. Those are not real choices and will not improve the 
quality of care beneficiaries receive.
  I urge my colleagues to support real Medicare reform by cosponsoring 
the Medicare Chronic Care Improvement Act.

             Medicare Chronic Care Improvement Act of 2003

              Representative Stark and Senator Rockefeller


 title I--benefits to prevent, delay, and minimize the progression of 
                           chronic conditions

       Improve Access to Preventive Services: Eliminate all cost-
     sharing (deductibles and co-insurance) for preventive 
     services that Medicare covers today; Direct the Secretary of 
     Health and Human Services (HHS) to contract with the 
     Institute of Medicine (IOM) to investigate and recommend new 
     Medicare preventive benefits every three years; Streamline 
     Medicare benefit improvements by granting the Secretary the 
     authority to expand Medicare coverage of preventive benefits 
     in accordance with IOM recommendations; Provide coverage for 
     a ``Welcome to Medicare'' initial preventive exam, in which 
     beneficiaries would receive initial preventive screening 
     tests, a physical exam, and discuss prevention and health 
     promotion with their doctors.
       Expand Coverage for Care Coordination and Assessment 
     Services: Create a new care coordination benefit for Medicare 
     beneficiaries with chronic conditions; Examples of items and 
     services to be covered include: initial and periodic health 
     assessments; management and referral for medical and other 
     health services; medication management; patient and family 
     caregiver education and counseling; 24-hour access to care 
     coordinators; management of transitions across care settings; 
     information and referral to community-based services and 
     hospice care; other services and benefits specified by the 
     Secretary; Beneficiaries eligible for these benefits include 
     those with either a serious and disabling chronic condition 
     or four or more chronic conditions; Care coordinators 
     (including physicians, physician group practices, or other 
     health care professionals or entities) must be periodically 
     certified and must agree to participate in a quality 
     improvement program.
       Implement Chronic Care Quality Improvement Program: Direct 
     the Secretary of HHS to establish a program to monitor and 
     improve clinical outcomes for beneficiaries with chronic 
     conditions. Under this program, the Secretary will establish 
     performance measures, collect data, and provide performance 
     reports to care coordinators and beneficiaries.
       Improve Medicare+Choice for Beneficiaries with Chronic 
     Conditions: Require Medicare+Choice plans to provide care 
     coordination services and implement chronic care quality 
     improvement programs.
       Improve Chronic Care Coordination through Information 
     Technology: Establish federal matching grants to support 
     clinical information technology systems development, 
     implementation, and training among Medicare-participating 
     care coordinators.
       Ensure Proper Medicare Coverage Standards: Direct the 
     Secretary of HHS to review all Medicare coverage policies. 
     The Secretary must ensure that Medicare contractors properly 
     apply the Medicare statute and not demand a showing of 
     improvement to find that items or services are reasonable and 
     necessary.


 title II--institute of medicine study on effective chronic condition 
                                  care

       Recommend Medicare Improvements to Ensure Effective Care 
     for Beneficiaries with Chronic Conditions: 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 report must 
     include recommendations to improve the provision of effective 
     care, including seamless transitions across health care 
     settings.
       Definitions: ``Chronic condition'' means an illness, 
     functional limitation, or cognitive impairment that is 
     expected to last at least one year, limits what a person can 
     do, and requires on-going medical care; ``Serious and 
     disabling chronic condition(s)'' means the individual has at 
     least one chronic condition 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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