A bill to amend title XVIII of the Social Security Act to extend the eligibility periods for geriatric graduate medical education, to permit the expansion of medical residency training programs in geriatric medicine, to provide for reimbursement of care coordination and assessment services provided under the medicare program, and for other purposes.

Summary: Geriatric Care Act of 2003 - 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 (GME) 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. Extends the eligibility period for GME payment for geriatric fellowship training.Amends SSA title XVIII to provide for Medicare coverage of care coordination and assessment services to an individual with a serious and disabling chronic condition.

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Geriatric Care Act 
of 2003''.
    (b) Table of Contents.--

Sec. 1. Short title; table of contents.
Sec. 2. Extension of eligibility periods for geriatric graduate medical 
                            education.
Sec. 3. Disregard of certain geriatric residents against graduate 
                            medical education limitations.
Sec. 4. Medicare coverage of care coordination and assessment services.

SEC. 2. EXTENSION OF ELIGIBILITY PERIODS FOR GERIATRIC GRADUATE MEDICAL 
              EDUCATION.

    (a) Direct GME.--Section 1886(h)(5)(G) of the Social Security Act 
(42 U.S.C. 1395ww(h)(5)(G)) is amended by adding at the end the 
following new clause:
                            ``(vi) Geriatric residency and fellowship 
                        programs.--In the case of an individual 
                        enrolled in a geriatric residency or fellowship 
                        program approved by the Secretary for purposes 
                        of subparagraph (A), the period of board 
                        eligibility and the initial residency period 
                        shall be the period of board eligibility for 
                        the subspecialty involved, plus 1 year.''.
    (b) Conforming Amendment.--Section 1886(h)(5)(F) of the Social 
Security Act (42 U.S.C. 1395ww(h)(5)(F)) is amended by striking 
``subparagraph (G)(v)'' and inserting ``clauses (v) and (vi) of 
subparagraph (G)''.
    (c) Effective Date.--The amendments made by this section shall 
apply to cost reporting periods beginning on or after the date that is 
6 months after the date of enactment of this Act.

SEC. 3. 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 2003, 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. 4. 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)) 
is amended--
            (1) in subparagraph (U), by striking ``and'' at the end;
            (2) in subparagraph (V)(iii), by adding ``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) 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)(i)(I) An initial assessment of an individual's 
        medical condition, functional and cognitive capacity, and 
        environmental and psychosocial needs.
            ``(II) Annual assessments after the initial assessment 
        performed under subclause (I), unless the physician or care 
        coordinator of the individual determines that additional 
        assessments are required due to sentinel health events or 
        changes in the health status of the individual that may require 
        changes in plans of care developed for the individual.
            ``(ii) The development of an initial plan of care, and 
        subsequent appropriate revisions to that plan of care.
            ``(iii) The management of, and referral for, medical and 
        other health services, including multidisciplinary care 
        conferences and coordination with other providers.
            ``(iv) The monitoring and management of medications.
            ``(v) Patient education and counseling services.
            ``(vi) Family caregiver education and counseling services.
            ``(vii) Self-management services, including health 
        education and risk appraisal to identify behavioral risk 
        factors through self-assessment.
            ``(viii) Providing access for consultations by telephone 
        with physicians and other appropriate health care 
        professionals, including 24-hour availability of such 
        professionals for emergency consultations.
            ``(ix) Coordination with the principal nonprofessional 
        caregiver in the home.
            ``(x) Managing and facilitating transitions among health 
        care professionals and across settings of care, including the 
        following:
                    ``(I) Pursuing the treatment option elected by the 
                individual.
                    ``(II) Including any advance directive executed by 
                the individual in the medical file of the individual.
            ``(xi) Activities that facilitate continuity of care and 
        patient adherence to plans of care.
            ``(xii) Information about, and referral to, hospice 
        services, including patient and family caregiver education and 
        counseling about hospice, and facilitating transition to 
        hospice when elected.
            ``(xiii) Such other medical and health care services for 
        which payment would not otherwise be made under this title as 
        the Secretary determines to be appropriate for effective care 
        coordination, including the additional items and services as 
        described in subparagraph (B).
            ``(B) The Secretary may specify additional benefits for 
        which payment would not otherwise be made under this title that 
        may be available to eligible beneficiaries who have made an 
        election under this section (subject to an assessment by the 
        care coordinator of an individual beneficiary's circumstances 
        and need for such benefits) in order to encourage the receipt 
        of, or to improve the effectiveness of, care coordination 
        services.
    ``(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 defined in paragraph (4)) for a period of at least 60 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) has a complex medical condition (as defined by the 
        Secretary) that requires medical management and coordination of 
        care; 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) or mental 
condition (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.
    ``(4) For purposes of this subsection, the term `activities of 
daily living' means each of the following:
            ``(A) Eating.
            ``(B) Toileting.
            ``(C) Transferring.
            ``(D) Bathing.
            ``(E) Dressing.
            ``(F) Continence.
    ``(5) Rural health clinics and Federally qualified health centers 
shall be eligible sites at which care coordination and assessment 
services may be provided.''.
    (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)) is amended--
                    (A) by striking ``and'' before ``(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) of the Social Security Act (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)) 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, 2004.