[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>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S4844)
Read twice and referred to the Committee on Finance.
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