Rural Case Management Act of 1999

SECTION 1. SHORT TITLE.

    This Act may be referred to as the ``Rural Case Management Act of 
1999''.

SEC. 2. ADDITIONAL PAYMENT AMOUNT TO RURAL PROVIDERS OF SERVICES WHO 
              FURNISH CASE MANAGER SERVICES.

    (a) Authority To Provide Additional Payment for Rural Case Manager 
Services.--In the case of a provider of services or a physician that 
furnishes services to Medicare beneficiaries in a rural area, the 
Secretary of Health and Human Services may provide for an additional 
payment under the Medicare Program for rural case manager services 
furnished by such provider or physician to Medicare beneficiaries.
    (b) Requirement for Rural Case Management Plan.--No payment may be 
made under subsection (a) for rural case manager services furnished to 
a Medicare beneficiary unless such provider or physician establishes, 
and periodically reviews, a rural case management plan for furnishing 
items and services for the treatment of the illness or injury of the 
Medicare beneficiary. The Secretary shall establish such standards as 
the Secretary finds necessary for the effective and efficient 
development and oversight of rural case manager services and rural case 
management plans to ensure the health and safety of Medicare 
beneficiaries furnished services under such a plan.
    (c) Payment.--
            (1) In general.--Payment may be made under this section for 
        rural case manager services with respect to a Medicare 
        beneficiary only--
                    (A) for the initial development of the rural case 
                management plan for the individual, and
                    (B) for the subsequent review and modification of 
                such plan, as provided by the Secretary in regulations.
            (2) Payment under fee schedule.--Payment under this section 
        for rural case manager services shall be made pursuant to the 
        fee schedule established by the Secretary.
            (3) Establishment of fee schedule.--
                    (A) In general.--The Secretary shall establish a 
                fee schedule for payment for rural case manager 
                services. Such schedule may provide for rates that 
                differ for such services that comprise the 
                establishment of a rural case management plan and that 
                comprise review and modification of such a plan.
                    (B) Considerations.--In establishing such fee 
                schedule, the Secretary shall consider appropriate 
                regional and operational differences and adjustments to 
                payment rates to account for inflation and other 
                relevant factors.
                    (C) Consultation.--In establishing the fee schedule 
                for rural case manager services under this subsection, 
                the Secretary shall consult with appropriate 
                organizations representing individuals and entities who 
                furnish referral services in rural areas for health 
                care items and services furnished and share with such 
                organizations relevant data in establishing such 
                schedule.
    (d) Guidance on Initiation of Case Manager Services.--The Secretary 
of Health and Human Services shall provide guidance on the process or 
processes that may be used to develop rural case management plans on a 
timely basis.
    (e) Limitation on Referrals.--Section 1877 of the Social Security 
Act (42 U.S.C. 1395nn) shall apply to a referral by a rural case 
manager to a rural agency in the same manner as such section applies to 
a referral by a physician to an entity described in section 1877(a)(2) 
of such Act.
    (f) Definitions.--In this section:
            (1) The term ``rural case manager services'' means the 
        development, coordination, and monitoring of a rural case 
        management plan for an individual furnished items and services 
        for the diagnosis and treatment of an illness or injury, and 
        includes the periodic review of such a plan.
            (2) The term ``rural case management plan'' means a 
        structured plan for the delivery of items and services that is 
        developed by a rural case manager, after consultation with the 
        physician and, if available, the family of the individual 
        involved.
            (3) The term ``provider of service'' has the meaning given 
        that term in section 1861(u) of the Social Security Act (42 
        U.S.C. 1395x(u)).
            (4) The term ``physician'' has the meaning given that term 
        in section 1861(r) of such Act (42 U.S.C. 1395x(r)).
            (5) The term ``rural area'' means an area designated as a 
        rural area under section 1886(d)(2)(D) of such Act (42 U.S.C. 
        1395ww(d)(2)(D)).
            (6) The term ``Medicare beneficiary'' means an individual 
        entitled to benefits under part A of title XVIII of such Act, 
        or enrolled under part B of such title, or both.
            (7) The term ``Medicare Program'' means the insurance 
        program established under title XVIII of the Social Security 
        Act.
    (g) Effective Date.--This section shall take effect on October 1, 
2000, and apply with respect to rural services furnished on or after 
October 1, 2001.

Summary: Rural Case Management Act of 1999 - Authorizes the Secretary of Health and Human Services to provide for an additional payment under title XVIII (Medicare) of the Social Security Act to rural service providers or physicians who furnish rural case manager services to Medicare beneficiaries. Prohibits any payment for such case manager services furnished to a Medicare beneficiary unless the provider or physician establishes and periodically reviews a rural case management plan for the treatment of such beneficiary. Requires the Secretary to establish the necessary standards for effective and efficient development and oversight of rural case manager services and management plans to: (1) ensure the health and safety of Medicare beneficiaries furnished plan services. And (2) provide guidance on the process or processes that may be used to timely develop such plans. Provides that Medicare limitations on certain physician referrals shall apply to a referral by a rural case manager to a rural agency in the same manner as such limitations apply to a referral by a physician to an entity with which the physician has a financial relationship.