I

106TH CONGRESS

2D SESSION H. R. 5080

To revise and extend the Medicare community nursing organization (CNO)

demonstration project.

IN THE HOUSE OF REPRESENTATIVES

JULY 27, 2000

Mr. RAMSTAD (for himself, Mr. RANGEL, and Mr. KOLBE) introduced the following bill; which was referred to the Committee on Ways and Means,

and in addition to the Committee on Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such

provisions as fall within the jurisdiction of the committee concerned

A BILL

To revise and extend the Medicare community nursing

organization (CNO) demonstration project.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Medicare Community

5 Nursing Organization Demonstration Project Revision

6 and Extension Act of 2000’’.
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1 SEC. 2. REVISED TERMS AND CONDITIONS FOR EXTENSION

2 OF MEDICARE COMMUNITY NURSING ORGA3 NIZATION (CNO) DEMONSTRATION PROJECT.

4 (a) IN GENERAL.—Section 532 of the Medicare,

5 Medicaid, and SCHIP Balanced Budget Refinement Act

6 of 1999 (113 Stat. 1501A–388), as enacted into law by

7 section 1000(a)(6) of Public Law 106–113, is amended—

8 (1) in subsection (a), by striking the second

9 sentence; and

10 (2) by striking subsection (b) and inserting the

11 following:

12 ‘‘(b) TERMS AND CONDITIONS.—

13 ‘‘(1) JANUARY THROUGH SEPTEMBER 2000.—

14 For the 9-month period beginning with January

15 2000, any such demonstration project shall be con16 ducted under the same terms and conditions as ap17 plied to such demonstration during 1999.

18 ‘‘(2) OCTOBER 2000 THROUGH DECEMBER

19 2001.—For the 15-month period beginning with Oc20 tober 2000, any such demonstration project shall be

21 conducted under the same terms and conditions as

22 applied to such demonstration during 1999, except

23 that the following modifications shall apply:

24 ‘‘(A) BASIC CAPITATION RATE.—The basic

25 capitation rate paid for services covered under

26 the project (other than case management serv-
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1 ices) per enrollee per month shall be basic capi2 tation rate paid for such services for 1999, re3 duced by 10 percent in the case of the dem4 onstration sites located in Arizona, Minnesota,

5 and Illinois, and 15 percent for the demonstra6 tion site located in New York.

7 ‘‘(B) TARGETED CASE MANAGEMENT

8 FEE.—A case management fee shall be paid

9 only for enrollees who are classified as ‘mod10 erate’ or ‘at risk’ through a baseline health as11 sessment (as required for Medicare+Choice

12 plans under section 1852(e) of the Social Secu13 rity Act (42 U.S.C.1395ww–22(e)).

14 ‘‘(C) GREATER UNIFORMITY IN CLINICAL

15 FEATURES AMONG SITES.—Each project shall

16 implement for each site—

17 ‘‘(i) protocols for periodic telephonic

18 contact with enrollees based on—

19 ‘‘(I) the results of such standard20 ized written health assessment; and

21 ‘‘(II) the application of appro22 priate care planning approaches;

23 ‘‘(ii) disease management programs

24 for targeted diseases (such as congestive

25 heart failure, arthritis, diabetes, and hy-
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1 pertension) that are highly prevalent in the

2 enrolled populations;

3 ‘‘(iii) systems and protocols to track

4 enrollees through hospitalizations, includ5 ing pre-admission planning, concurrent

6 management during inpatient hospital

7 stays, and post-discharge assessment, plan8 ning, and follow-up; and

9 ‘‘(iv) standardized patient educational

10 materials for specified diseases and health

11 conditions.

12 ‘‘(D) QUALITY IMPROVEMENT.—Each

13 project shall implement at each site once during

14 the 15-month period—

15 ‘‘(i) enrollee satisfaction surveys; and

16 ‘‘(ii) reporting on specified quality in17 dicators for the enrolled population.

18 ‘‘(c) EVALUATION.—

19 ‘‘(1) PRELIMINARY REPORT.—Not later than

20 July 1, 2001, the Secretary of Health and Human

21 Services shall submit to the Committees on Ways

22 and Means and Commerce of the House of Rep23 resentatives and the Committee on Finance of the

24 Senate a preliminary report that—
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1 ‘‘(A) evaluates such demonstration projects

2 for the period beginning July 1, 1997, and end3 ing December 31, 1999, on a site-specific basis

4 with respect to the impact on per beneficiary

5 spending, specific health utilization measures,

6 and enrollee satisfaction; and

7 ‘‘(B) includes a similar evaluation of such

8 projects for the portion of the extension period

9 that occurs after September 30, 2000.

10 ‘‘(2) FINAL REPORT.—The Secretary shall sub11 mit a final report to such Committees on such dem12 onstration projects not later than July 1, 2002.

13 Such report shall include the same elements as the

14 preliminary report required by paragraph (1), but

15 for the period after December 31, 1999.

16 ‘‘(3) METHODOLOGY FOR SPENDING COMPARI17 SONS.—Any evaluation of the impact of the dem18 onstration projects on per beneficiary spending in19 cluded in such reports shall be based on a compari20 son of—

21 ‘‘(A) data for all individuals who—

22 ‘‘(i) were enrolled in such demonstra23 tion projects as of the first day of the pe24 riod under evaluation; and
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1 ‘‘(ii) were enrolled for a minimum of

2 6 months thereafter; with

3 ‘‘(B) data for a matched sample of individ4 uals who are enrolled under part B of title

5 XVIII of the Social Security Act and are not

6 enrolled in such a project, or in a

7 Medicare+Choice plan under part C of such

8 title, a plan offered by an eligible organization

9 under section 1876 of such Act, or a health

10 care prepayment plan under section

11 1833(a)(1)(A) of such Act.’’.

12 (b) EFFECTIVE DATE.—The amendments made by

13 subsection (a) shall be effective as if included in the enact14 ment of section 532 of the Medicare, Medicaid, and

15 SCHIP Balanced Budget Refinement Act of 1999 (113

16 Stat. 1501A–388), as enacted into law by section

17 1000(a)(6) of Public Law 106–113.

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