text: 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.
target: Medicare Improvements for Special Needs Beneficiaries Act of 2002 - Amends part C (Medicare+Choice) of title XVIII (Medicare) of the Social Security Act to provide for specialized Medicare+Choice plans for special needs beneficiaries and the treatment of such plans as coordinated care plans under Medicare part C. Permits restriction on the enrollment of individuals in a specialized Medicare+Choice plan to special needs beneficiaries. Establishes additional requirements for specialized Medicare+choice plans for special needs beneficiaries.
feat_title: 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.