text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Geriatric Care Act of 2001''.
  
  SEC. 2. DISREGARD OF CERTAIN GERIATRIC RESIDENTS 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 fellowships.--For cost reporting 
                          periods beginning on or after the date that is 
                          6 months after the date of enactment of the 
                          Geriatric Care 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, rural health clinic, or 
                          Federally qualified health center, the 
                          Secretary shall not take into account a maximum 
                          of 3 residents enrolled in a fellowship or 
                          residency in geriatric medicine or geriatric 
                          psychiatry within an approved medical residency 
                          training program to the extent that the 
                          hospital, rural health clinic, or Federally 
                          qualified health center increases the number of 
                          such residents above the number of such 
                          residents for the hospital's, rural health 
                          clinic's, or Federally qualified health 
                          center'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), insofar as 
          such clause applies with respect to hospitals, 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. MEDICARE COVERAGE OF CARE COORDINATION AND ASSESSMENT SERVICES.
  
      (a) Part B Coverage of Care Coordination and Assessment Services.--
  Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), 
  as amended by section 105(a) of the Medicare, Medicaid, and SCHIP 
  Benefits Improvement and Protection Act of 2000 (114 Stat. 2763A-471), 
  as enacted into law by section 1(a)(6) of Public Law 106-554, is 
  amended--
              (1) in subparagraph (U), by striking ``and'' at the end;
              (2) in subparagraph (V), by inserting ``and'' after the 
          semicolon at the end; and
              (3) by adding at the end the following new subparagraph:
              ``(W) care coordination and assessment services (as defined 
          in subsection (ww)).''.
      (b) Care Coordination and Assessment Services Defined.--Section 
  1861 of the Social Security Act (42 U.S.C. 1395x), as amended by 
  section 105(b) of the Medicare, Medicaid, and SCHIP Benefits 
  Improvement and Protection Act of 2000 (114 Stat. 2763A-471), as 
  enacted into law by section 1(a)(6) of Public Law 106-554), is amended 
  by adding at the end the following new subsection:
  
  ``Care Coordination and Assessment Services; Individual with a Serious 
             and Disabling Chronic Condition; Care Coordinator
  
      ``(ww)(1) The term `care coordination and assessment services' 
  means services that are furnished to an individual with a serious and 
  disabling chronic condition (as defined in paragraph (2)) by a care 
  coordinator (as defined in paragraph (3)) under a plan of care 
  prescribed by such care coordinator for the purpose of care 
  coordination and assessment, which may include any of the following 
  services:
              ``(A) An initial assessment of an individual's medical 
          condition, functional and cognitive capacity, and environmental 
          and psychological needs and an annual reassessment of such 
          condition, capacity, and needs, unless the care coordinator 
          determines that a more frequent reassessment is necessary based 
          on sentinel health events (as defined by the Secretary) or a 
          change in health status that may require a change in the 
          individual's plan of care.
              ``(B) The coordination of, and referral for, medical and 
          other health services, including--
                      ``(i) multidisciplinary care conferences;
                      ``(ii) coordination with other providers (including 
                  telephone consultations with physicians); and
                      ``(iii) the monitoring and management of 
                  medications, with special emphasis on the management on 
                  behalf of an individual with a serious and disabling 
                  chronic condition that uses multiple medications 
                  (including coordination with the entity managing 
                  benefits for the individual).
              ``(C) Patient and family caregiver education and counseling 
          services (through office visits or telephone consultation), 
          including self-management services and risk appraisal services 
          to identify behavioral risk factors through self-assessment.
              ``(D) Such other services for which payment would not 
          otherwise be made under this title as the Secretary determines 
          to be appropriate, including activities to facilitate 
          continuity of care and patient adherence to plans of care.
      ``(2) For purposes of this subsection, the term `individual with a 
  serious and disabling chronic condition' means an individual who a care 
  coordinator annually certifies--
              ``(A) is unable to perform (without substantial assistance 
          from another individual) at least 2 activities of daily living 
          (as described in section 7702B(c)(2)(B) of the Internal Revenue 
          Code of 1986) for a period of at least 90 days due to a loss of 
          functional capacity;
              ``(B) has a level of disability similar to the level of 
          disability described in subparagraph (A) (as determined under 
          regulations promulgated by the Secretary);
              ``(C) requires medical management and coordination of care 
          due to a complex medical condition (as defined by the 
          Secretary); or
              ``(D) requires substantial supervision to protect such 
          individual from threats to health and safety due to a severe 
          cognitive impairment (as defined by the Secretary).
      ``(3)(A) For purposes of this subsection, the term `care 
  coordinator' means an individual or entity that--
              ``(i) is--
                      ``(I) a physician (as defined in subsection 
                  (r)(1)); or
                      ``(II) a practitioner described in section 
                  1842(b)(18)(C) or an entity that meets such conditions 
                  as the Secretary may specify (which may include 
                  physicians, physician group practices, or other health 
                  care professionals or entities the Secretary may find 
                  appropriate) working in collaboration with a physician;
              ``(ii) has entered into a care coordination agreement with 
          the Secretary; and
              ``(iii) meets such other criteria as the Secretary may 
          establish (which may include experience in the provision of 
          care coordination or primary care physicians' services).
      ``(B) For purposes of subparagraph (A)(ii), each care coordination 
  agreement shall--
              ``(i) be entered into for a period of 1 year and may be 
          renewed if the Secretary is satisfied that the care coordinator 
          continues to meet the conditions of participation specified in 
          subparagraph (A);
              ``(ii) assure that the care coordinator will submit reports 
          to the Secretary on the functional and medical status of 
          individuals with a chronic and disabling condition who receive 
          care coordination services, expenditures relating to such 
          services, and health outcomes relating to such services, except 
          that the Secretary may not require a care coordinator to submit 
          more than 1 such report during a year; and
              ``(iii) contain such other terms and conditions as the 
          Secretary may require.''.
      (c) Payment and Elimination of Coinsurance.--
              (1) In general.--Section 1833(a)(1) of the Social Security 
          Act (42 U.S.C. 1395l(a)(1)), as amended by section 223(c) of 
          the Medicare, Medicaid, and SCHIP Benefits Improvement and 
          Protection Act of 2000 (114 Stat. 2763A-489), as enacted into 
          law by section 1(a)(6) of Public Law 106-554, is amended--
                      (A) by striking ``and (U)'' and inserting ``(U)''; 
                  and
                      (B) by inserting before the semicolon at the end 
                  the following: ``, and (V) with respect to care 
                  coordination and assessment services described in 
                  section 1861(s)(2)(W), the amounts paid shall be 100 
                  percent of the lesser of the actual charge for the 
                  service or the amount determined under the payment 
                  basis determined under section 1848 by the Secretary 
                  for such service''.
              (2) Payment under physician fee schedule.--Section 
          1848(j)(3) (42 U.S.C. 1395w-4(j)(3)) is amended by inserting 
          ``(2)(W),'' after ``(2)(S),''.
              (3) Elimination of coinsurance in outpatient hospital 
          settings.--The third sentence of section 1866(a)(2)(A) of the 
          Social Security Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by 
          inserting after ``1861(s)(10)(A)'' the following: ``, with 
          respect to care coordination and assessment services (as 
          defined in section 1861(ww)(1)),''.
      (d) Application of Limits on Billing.--Section 1842(b)(18)(C) of 
  the Social Security Act (42 U.S.C. 1395u(b)(18)(C)), as amended by 
  section 105(d) of the Medicare, Medicaid, and SCHIP Benefits 
  Improvement and Protection Act of 2000 (114 Stat. 2763A-472), as 
  enacted into law by section 1(a)(6) of Public Law 106-554, is amended 
  by adding at the end the following new clause:
              ``(vii) A care coordinator (as defined in section 
          1861(ww)(3)) that is not a physician.''.
      (e) Exception to Limits on Physician Referrals.--Section 1877(b) of 
  the Social Security Act (42 U.S.C. 1395nn(b)) is amended--
              (1) by redesignating paragraph (4) as paragraph (5); and
              (2) by inserting after paragraph (3) the following new 
          paragraph:
              ``(4) Private sector purchasing and quality improvement 
          tools for original medicare.--In the case of a designated 
          health service, if the designated health service is--
                      ``(A) a care coordination and assessment service 
                  (as defined in section 1861(ww)(1)); and
                      ``(B) provided by a care coordinator (as defined in 
                  paragraph (3) of such section).''.
      (f) Rulemaking.--The Secretary of Health and Human Services shall 
  define such terms and establish such procedures as the Secretary 
  determines necessary to implement the provisions of this section.
      (g) Effective Date.--The amendments made by this section shall 
  apply to care coordination and assessment services furnished on or 
  after January 1, 2003.
target: Geriatric Care Act of 2001 - Amends title XVIII (Medicare) of the Social Security Act (SSA) with respect to payments to hospitals, rural health clinics, or Federally qualified health centers for direct graduate medical education costs and the limitation on the number of full-time-equivalent residents in allopathic and osteopathic medicine. Provides for the disregard of up to three geriatric residents in applying such limitation.Amends SSA title XVIII, as amended by the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, to provide for Medicare coverage of care coordination and assessment services to an individual with a serious and disabling chronic condition.
feat_title: To amend title XVIII of the Social Security Act to permit expansion of medical residency training programs in geriatric medicine and to provide for reimbursement of care coordination and assessment services provided under the Medicare Program.