n 107thCONGRESS 2557 2dSession S. To amend title XVIII of the Social Security Act to improve access to Medicare+Choiceplansforspecialneedsmedicarebeneficiaries,andfor otherpurposes. IN THE SENATE OF THE UNITED STATES May23,2002 Mr.HATCH(forhimself,Mr.GRAHAM,Mr.ALLARD,Mr.KENNEDY,andMs. MlKULSKl) introducedthefollowingbill;whichwasreadtwice andre- ferredtotheCommitteeonFinance A BILL To amend titleXVIII ofthe Social SecurityAct to improve accesstoMedicare+Choiceplans forspecialneedsmedi- carebeneficiaries,andforotherpurposes. 1 BeitenactedbytheSenateandHouseofRepresenta- 2 tivesoftheUnitedStatesofAmericainCongressassembled, 3 SECTION1.SHORTTITLE. 4 This Act may be cited as the "Medicare Improve- 5 mentsforSpecialNeedsBeneficiariesActof2002". — 2 1 SEC.2.SPECIALIZEDMEDICARE+CHOICEPLANSFORSPE- 2 CIALNEEDSBENEFICIARIES. 3 (a) Establishment of Specialized 4 Medicare+Choice PlansforSpecialNeedsBene- — 5 ficiaries. 6 (1) Treatment as coordinated care — 7 PLAN. Section1851(a)(2)(A) ofthe Social Security 8 Act (42 U.S.C. 1395w-21(a)(2)(A)) is amended by 9 addingattheendthefollowingnewsentence: "Spe- 10 cialized Medicare+Choice plans for special needs 11 beneficiaries (as defined in section 1859(b)(4)) may 12 beanytypeofcoordinatedcareplan.". 13 (2) Specialized medicare+choice plan — 14 for special needs beneficiaries defined. 15 Section 1859(b) of the Social Security Act (42 16 U.S.C. 1395w-28(b)) is amended by adding at the 17 endthefollowingnewparagraph: 18 "(4) Specialized medicare+choice plans 19 forspecialneedsbeneficiaries. — 20 "(A) In general. The term 'specialized 21 Medicare+Choice plan for special needs bene- 22 ficiaries' means a Medicare+Choice plan that 23 exclusivelyserves specialneedsbeneficiaries (as 24 definedinsubparagraph(B)). S2557is — 3 — 1 "(B) Special needs beneficiary. The 2 term 'special needs beneficiary' means a 3 Medicare+Choiceeligibleindividualwho 4 "(i) is institutionalized (as definedby 5 theSecretary); 6 "(ii) is entitled to medical assistance 7 underaStateplanundertitleXLX;or 8 "(iii) meets such other requirements 9 as the Secretary may establish for pur- 10 posesofidentifyingbeneficiarieswithase- 11 vere and disabling chronic condition who 12 would benefit from enrollment in a 13 Medicare+Choice plan described in sub- 14 paragraph(A).". 15 (3) Restriction on enrollment per- — 16 mitted. Section 1859 of the Social Security Act 17 (42 U.S.C. 1395w-28) is amendedbyaddingatthe 18 endthefollowingnewsubsection: 19 "(f) Restriction on Enrollment for Special- 20 ized Medicare+Choice Plans for Special Needs — 21 Beneficiaries. In the case of a specialized 22 Medicare+Choiceplanfor special needs beneficiaries (as 23 defined in subsection (b)(4)), notwithstanding anyother 24 provision ofthispart andin accordancewithregulations 25 ofthe SecretaryandforperiodsbeforeJanuary1, 2008, •S2557is 4 1 theplanmayrestricttheenrollmentofindividualsunder 2 the plan to individualswho arewithin 1 ormore classes 3 ofspecialneedsbeneficiaries.". 4 (4) Additional requirements for special- 5 ized medicare+choice plans for special — 6 NEEDSBENEFICIARIES. Section 1857(e) ofthe So- 7 cial Security Act (42 U.S.C. 1395w-27(e)) is 8 amended by adding at the end the following new 9 paragraph: 10 "(3) Additional requirements for spe- 11 cialized medicare+choice plans for special — 12 needsbeneficiaries. Inthecaseofaspecialized 13 Medicare+Choiceplanforspecialneedsbeneficiaries 14 (asdefinedinsection1859(b)(4)),thecontractshall 15 includeadditionaltermsandconditionsasfollows: — 16 "(A)Clinicaldeliverysystem. — 17 "(i) In general. Under the con- 18 tract, theorganizationofferingthespecial- 19 ized Medicare+Choice plan for special 20 needsbeneficiaries shallestablishaclinical 21 delivery system that meets the- needs of 22 special needs beneficiaries (as defined in 23 section 1859(b)(4)(B)) enrolled in the 24 plan. •S2557IS — 5 — 1 "(ii) Elements. The clinical deliv- 2 ery system established under clause (i) 3 shallincludethefollowing: 4 "(I) Acomprehensive patient as- 5 sessmentandplanofcare. 6 "(II) Methods to prevent, delay, 7 or minimize the progression ofsevere 8 anddisablingchronicconditions. 9 "(HO Care management proto- 10 cols, including high-risk screening to 11 identifyfactors that mayincrease the 12 cost ofcare provided to special needs 13 beneficiaries. 14 "(IV) Appropriate specially 15 trained health care staff, such as 16 nurse practitioners, geriatric care 17 managers, and mental health profes- 18 sionals. 19 "(V) Methods for promoting the 20 integrationofcare, financing, andad- 21 ministrative functions across health 22 caresettings. 23 "(B) Data collection; development 24 OFOUTCOMEMEASURES. •S2557IS — 6 — 1 "(i) Data collection. Under the 2 contract, theorganizationofferingthe spe- 3 cialized Medicare+Choice plan for special 4 needsbeneficiariesshall 5 "(I) collectsuchdataasthe Sec- 6 retarymay specifyforthe purpose of 7 monitoring the quality of health care 8 items and services provided to special 9 needs beneficiaries enrolled in the 10 plan, outcomes, and costs, including 11 functionalanddiagnosticdataandin- 12 formation collected through outcome 13 measures developed under clause (ii); 14 "(II) maintain, and afford the 15 Secretaryaccess to, the records relat- 16 ingtotheplan, includingpertinentfi- 17 nancial, medical, and personnel 18 records;and 19 "(III) make available to the Sec- 20 retaryreportsthattheSecretaryfinds 21 necessary to monitor the operation, 22 cost,andeffectivenessoftheplan. 23 "(ii) Development of outcome — 24 MEASURES. Underthecontract, theorga- 25 nization offering the specialized S2557IS Medicare+Choice plan for special needs beneficiariesandtheSecretary7shalljointly cooperate in the development and imple- mentation of health status and quality of life outcome measureswithrespectto spe- cial needs beneficiaries (as defined in sec- tion1859(b)(4)(B)) enrolledintheplan. "(C) Qualityassurance; patientsafe- — guards. The contract shall require the orga- nization offering the specialized Medicare-)-Choice plan for special needs bene- ficiariestohaveineffect,ataminimum,awrit- tenplanofqualityassuranceandimprovement, and procedures implementing such plan, in ac- cordancewithregulations. — "(D) Oversight. Thecontractshallpro- vide that the Secretary shall conduct, in addi- tion to any other review conducted under this part, suchreviewoftheoperationofspecialized Medicare+Choice plans for special needs bene- ficiaries and organizations' offering such plans as may be appropriate in order to ensure the compliance oftheplans and organizationswith therequirementsofthispartandregulationsto carryoutsuchrequirements.". 8 — 1 (b)EffectiveDates. — 2 (1) In general. The amendments made by 3 subsection (a) shalltake effectuponthe date ofen- 4 actmentofthisAct. 5 (2) Deadline for issuance of require- 6 ments for special needs beneficiaries; tran- — 7 SITION. Not later than October 1, 2003, the Sec- 8 retary of Health and Human Services shall issue 9 finalregulationstoestablishrequirementsforspecial 10 needs beneficiaries under section 1859(b)(4)(B)(iii) 11 ofthe Social SecurityAct (as added by subsection 12 (a)(2)). 13 SEC. 3. GAO REPORT TO CONGRESS ON SPECIALIZED 14 MEDICARE+CHOICE PLANS FOR SPECIAL 15 NEEDSBENEFICIARIES. — 16 (a) In General. Not later than December 31, 17 2006, theComptrollerGeneraloftheUnited Statesshall 18 submit to Congress a report that assesses the impact of 19 specializedMedicare+Choiceplansforspecialneedsbene- 20 ficiaries(asdefinedinsection1859(b)(4)oftheSocialSe- 21 curityAct (asaddedbysection2(a)(2))) onthecostand 22 qualityofservicesprovidedtoenrollees. — 23 (b) Contents. The report submitted under sub- 24 section(a)shallcontainthefollowingelements: •S2557IS 9 1 (1) A general assessment of the operations of 2 the specialized Medicare+Choice plans for special 3 needsbeneficiaries. 4 (2) Information on the demographics and 5 health status ofbeneficiaries enrolled in suchplans. 6 (3) Information on such plans' clinical models 7 ofcare. 8 (4) Information on the performance of such 9 plans related to such quality indicators as the Sec- 10 retarydeterminestobeappropriate. 11 (5) An assessment of the marketing materials 12 andpracticesoftheplans. 13 (6) An assessment oftheplans' abilityto inte- 14 grate care, financing, and administrative functions 15 acrosshealthcaresettings. 16 (7) A general assessment ofthe costs and any 17 savings to the medicare program under title XVIII 18 oftheSocialSecurityActasaresultofamendments 19 madebysection2. O •S2557IS CHSLIBRARY 3 ODOlflbtH «J