II

106TH CONGRESS

2D SESSION S. 2727

To improve the health of older Americans and persons with disabilities,

and for other purposes.

IN THE SENATE OF THE UNITED STATES

JUNE 14, 2000

Mr. KENNEDY (for himself, Mr. BRYAN, Ms. MIKULSKI, and Mr.

WELLSTONE) introduced the following bill; which was read twice and referred to the Committee on Finance

A BILL

To improve the health of older Americans and persons with

disabilities, and for other purposes.

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; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Medicare Health Improvement Act of 2000’’.

6 (b) TABLE OF CONTENTS.—The table of contents is

7 as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Definitions.

TITLE I—HCFA MISSION STATEMENT
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Sec. 101. Establishment of HCFA mission statement with regard to the medicare program.

TITLE II—ENABLING OLDER AMERICANS AND PERSONS WITH

DISABILITIES TO IMPROVE THEIR HEALTH STATUS

Sec. 201. Waiver of all preventive services cost sharing under the medicare program.

Sec. 202. Information campaign on preventive health care for older Americans

and individuals with disabilities.

Sec. 203. Development of health status self-assessment tool for medicare beneficiaries.

TITLE III—IMPROVING THE QUALITY OF CARE PROVIDED TO

OLDER AMERICANS AND PERSONS WITH DISABILITIES

Sec. 301. Information campaign for the best practices for the treatment of conditions of medicare beneficiaries.

Sec. 302. Program to promote the use of best practices for the treatment of

conditions of medicare beneficiaries and to reduce hospital and

physician visits that result from improper drug use.

Sec. 303. Studies on preventive interventions in primary care for older Americans.

Sec. 304. Smoking cessation demonstration project.

TITLE IV—DEMONSTRATION PROJECTS TO IMPROVE THE CARE

OF RESIDENTS OF SKILLED NURSING FACILITIES AND PERSONS WITH SERIOUS ILLNESSES

Sec. 401. Demonstration projects to provide effective care for skilled nursing

facility residents.

Sec. 402. Demonstration projects to improve the care of persons with serious

illnesses.

TITLE V—WHITE HOUSE CONFERENCE ON IMPROVING THE

HEALTH OF OLDER AMERICANS

Sec. 501. White House Conference on Improving the Health of Older Americans.

1 SEC. 2. DEFINITIONS.

2 In this Act:

3 (1) COMMISSIONER.—The term ‘‘Commis4 sioner’’ means the Commissioner of Social Security.

5 (2) MEDICARE BENEFICIARIES.—The term

6 ‘‘medicare beneficiaries’’ means individuals who are

7 entitled to benefits under part A or enrolled under

8 part B of the medicare program, including individ-
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1 uals enrolled in a Medicare+Choice plan offered by

2 a Medicare+Choice organization under part C of

3 such program.

4 (3) MEDICARE PROGRAM.—The term ‘‘medicare

5 program’’ means the health insurance program

6 under title XVIII of the Social Security Act (42

7 U.S.C. 1395 et seq.).

8 (4) SECRETARY.—The term ‘‘Secretary’’ means

9 the Secretary of Health and Human Services.

10 TITLE I—HCFA MISSION

11 STATEMENT

12 SEC. 101. ESTABLISHMENT OF HCFA MISSION STATEMENT

13 WITH REGARD TO THE MEDICARE PROGRAM.

14 Part A of title XVIII of the Social Security Act (42

15 U.S.C. 1395 et seq.) is amended by inserting before sec16 tion 1801 the following:

17 ‘‘HCFA MISSION STATEMENT

18 ‘‘SEC. 1800. In administering the health insurance

19 program established under this title, it is the mission of

20 the Health Care Financing Administration to—

21 ‘‘(1) effectively and efficiently administer a pro22 gram of health insurance coverage for individuals

23 who are entitled to benefits under part A or enrolled

24 under part B of this title, including individuals en25 rolled in a Medicare+Choice plan offered by a

26 Medicare+Choice organization under part C of this
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1 title, in accordance with the requirements of this

2 title;

3 ‘‘(2) assure that health care provided to such

4 individuals is of the highest quality; and

5 ‘‘(3) carry out programs in cooperation with

6 other Government agencies and the private sector to

7 promote health, prevent disease, and assure the

8 highest possible functional level for such individ9 uals.’’.

10 TITLE II—ENABLING OLDER

11 AMERICANS AND PERSONS

12 WITH DISABILITIES TO IM13 PROVE THEIR HEALTH STA14 TUS

15 SEC. 201. WAIVER OF ALL PREVENTIVE SERVICES COST

16 SHARING UNDER THE MEDICARE PROGRAM.

17 (a) WAIVER OF COINSURANCE AND DEDUCTIBLES.—

18 (1) IN GENERAL.—Section 1834 of the Social

19 Security Act (42 U.S.C. 1395m) is amended by add20 ing at the end the following:

21 ‘‘(m) WAIVER OF COINSURANCE AND DEDUCTIBLE

22 FOR PREVENTIVE SERVICES.—

23 ‘‘(1) COINSURANCE.—

24 ‘‘(A) IN GENERAL.—Notwithstanding any

25 other provision of this part—
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1 ‘‘(i) the Secretary shall waive any co2 insurance applicable to services described

3 in subparagraph (B); and

4 ‘‘(ii) with respect to payment for such

5 services, any reference to a percent that is

6 less than 100 percent shall be deemed to

7 be a reference to 100 percent.

8 ‘‘(B) SERVICES DESCRIBED.—The services

9 described in this subparagraph are the following

10 services:

11 ‘‘(i) Screening mammography (as de12 fined in section 1861(jj)).

13 ‘‘(ii) Screening pelvic exam (as de14 fined in section 1861(nn)(2)).

15 ‘‘(iii) Hepatitis B vaccine and its ad16 ministration (under section

17 1861(s)(10)(B)).

18 ‘‘(iv) Colorectal cancer screening test

19 (as defined in section 1861(pp)).

20 ‘‘(v) Bone mass measurement (as de21 fined in section 1861(rr)).

22 ‘‘(vi) Prostate cancer screening test

23 (as defined in section 1861(oo)).
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1 ‘‘(vii) Diabetes outpatient self-man2 agement training services (as defined in

3 section 1861(qq)).

4 ‘‘(2) DEDUCTIBLE.—

5 ‘‘(A) IN GENERAL.—Notwithstanding any

6 other provision of this part, the deductible de7 scribed in section 1833(b) shall not apply with

8 respect to services described in subparagraph

9 (B).

10 ‘‘(B) SERVICES DESCRIBED.—The services

11 described in this subparagraph are the following

12 services:

13 ‘‘(i) Hepatitis B vaccine and its ad14 ministration (under section

15 1861(s)(10)(B)).

16 ‘‘(ii) Colorectal cancer screening test

17 (as defined in section 1861(pp)).

18 ‘‘(iii) Bone mass measurement (as de19 fined in section 1861(rr)).

20 ‘‘(iv) Prostate cancer screening test

21 (as defined in section 1861(oo)).

22 ‘‘(v) Diabetes outpatient self-manage23 ment training services (as defined in sec24 tion 1861(qq)).’’.
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1 (2) CONFORMING AMENDMENT.—Section

2 1833(a) of the Social Security Act (42 U.S.C.

3 1395l(a)) is amended by striking ‘‘section 1876’’

4 and inserting ‘‘sections 1834 and 1876’’ in the mat5 ter preceding paragraph (1).

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

7 this section shall apply to services furnished on or after

8 December 31, 2001.

9 SEC. 202. INFORMATION CAMPAIGN ON PREVENTIVE

10 HEALTH CARE FOR OLDER AMERICANS AND

11 INDIVIDUALS WITH DISABILITIES.

12 (a) IN GENERAL.—The Secretary and the Commis13 sioner shall jointly conduct an information campaign, in

14 consultation with the heads of other Government agencies

15 and States and the private sector, for individuals who have

16 attained age 50 and individuals with disabilities to

17 promote—

18 (1) the use of preventive health services among

19 such individuals, including services that are available

20 to medicare beneficiaries and are covered by the

21 medicare program;

22 (2) the proper use of prescription and over-the23 counter drugs in order to reduce the number of hos24 pital stays and physician visits among such individ-
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1 uals that are a result of the improper use of such

2 drugs; and

3 (3) the steps (including exercise, maintenance

4 of a proper diet, and utilization of accident preven5 tion techniques) that such individuals may take in

6 order to promote and safeguard their health.

7 (b) USE OF SERVICES.—The information campaign

8 described in subsection (a) shall stress the benefits of—

9 (1) using the services described in subsection

10 (a)(1);

11 (2) following the proper directions for using

12 prescription and over-the-counter drugs as described

13 in subsection (a)(2); and

14 (3) utilizing the steps described in subsection

15 (a)(3).

16 (c) ELEMENTS OF CAMPAIGN.—In conducting the in17 formation campaign described in subsection (a), the Sec18 retary and the Commissioner (as applicable) shall—

19 (1) expand the section in the Medicare and You

20 handbook on preventive benefits to include a more

21 detailed description of the importance of using pre22 ventive health services and the benefits offered under

23 the medicare program;

24 (2) instruct fiscal intermediaries and carriers

25 under the medicare program to include preventive
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1 benefits messages on the Medicare Summary Notice

2 statement and the Explanation of Medicare Benefits;

3 (3) regularly include preventive benefits mes4 sages on the medicare part B benefits statement;

5 (4) combine public service announcements and

6 a print media campaign to raise awareness of the

7 value of using preventive health services;

8 (5) distribute brochures and other information

9 on health promotion and disease prevention activities

10 through—

11 (A) State health insurance assistance pro12 grams;

13 (B) area agencies on aging;

14 (C) Social Security Administration field of15 fices; and

16 (D) any other appropriate entities, as de17 termined by the Secretary and the Commis18 sioner; and

19 (6) include information on the importance of

20 using preventive health services—

21 (A) on the cost of living adjustment

22 (COLA) notice, which is sent to individuals who

23 receive disability benefits under titles II and

24 XVI of the Social Security Act (42 U.S.C. 401

25 et seq.; 1381 et seq.);
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1 (B) on the social security account state2 ments distributed pursuant to section 1143 of

3 the Social Security Act (42 U.S.C. 1320b–13);

4 and

5 (C) in brochures on retirement and sur6 vivors’ benefits that are produced by the Com7 missioner.

8 (d) TARGETED POPULATIONS.—To the extent appro9 priate, aspects of the information campaign described in

10 subsection (a) may be targeted to specific subpopulations

11 of medicare beneficiaries.

12 (e) GRANTS AND CONTRACTS.—

13 (1) IN GENERAL.—The Secretary and the Com14 missioner shall provide grants to, and enter into con15 tracts with, eligible entities to assist with carrying

16 out the purposes of this section.

17 (2) ELIGIBLE ENTITY DEFINED.—In this sub18 section, the term ‘‘eligible entity’’ means—

19 (A) any community organization working

20 with medicare beneficiaries;

21 (B) any organization representing medi22 care beneficiaries;

23 (C) area agencies on aging; and
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1 (D) any other appropriate entities, as de2 termined by the Secretary and the Commis3 sioner.

4 SEC. 203. DEVELOPMENT OF HEALTH STATUS SELF-ASSESS5 MENT TOOL FOR MEDICARE BENEFICIARIES.

6 (a) DEVELOPMENT.—The Secretary, in conjunction

7 with the Director of the National Institutes of Health

8 (NIH), the Director of the Centers for Disease Control

9 and Prevention (CDC), the Administrator of the Sub10 stance Abuse and Mental Health Services Administration

11 (SAMHSA), and the Administrator of the Agency for

12 Healthcare Research and Quality (AHRQ), shall develop

13 a health status self-assessment tool that includes assess14 ment of mental health status, alcohol use, and substance

15 use, and assists medicare beneficiaries in identifying im16 portant health information, risk factors, or significant

17 symptoms that should be acted upon or discussed with the

18 beneficiary’s health care provider.

19 (b) DISTRIBUTION.—The Secretary shall establish

20 procedures for the distribution of the self-assessment form

21 developed under subsection (a) and may contract with the

22 eligible entities described in section 202(e)(2) to distribute

23 and promote the use of such forms.

24 (c) TRAINING.—The Secretary shall establish a train25 ing program for the staff of State health insurance assist-
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1 ance programs that will enable such staff to assist medi2 care beneficiaries in completing the self-assessment form

3 developed under subsection (a).

4 TITLE III—IMPROVING THE

5 QUALITY OF CARE PROVIDED

6 TO OLDER AMERICANS AND

7 PERSONS WITH DISABILITIES

8 SEC. 301. INFORMATION CAMPAIGN FOR THE BEST PRAC9 TICES FOR THE TREATMENT OF CONDITIONS

10 OF MEDICARE BENEFICIARIES.

11 (a) STUDY.—The Secretary, in consultation with the

12 Administrator for Health Care Policy and Research, the

13 Director of the National Institutes of Health, and such

14 other professional societies and experts as the Secretary

15 considers appropriate, shall—

16 (1) conduct a study to determine areas where

17 treatment of medicare beneficiaries falls short of the

18 highest professional standards; and

19 (2) determine the best practices in the areas de20 scribed in paragraph (1).

21 (b) INFORMATION CAMPAIGN.—The Secretary shall

22 provide for an information campaign to inform medicare

23 beneficiaries about the results of the study conducted

24 under subsection (a).
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1 SEC. 302. PROGRAM TO PROMOTE THE USE OF BEST PRAC2 TICES FOR THE TREATMENT OF CONDITIONS

3 OF MEDICARE BENEFICIARIES AND TO RE4 DUCE HOSPITAL AND PHYSICIAN VISITS

5 THAT RESULT FROM IMPROPER DRUG USE.

6 (a) IN GENERAL.—The Secretary, in conjunction

7 with the Administrator of the Health Resources and Serv8 ice Administration and such other agencies and profes9 sional societies as the Secretary deems appropriate, shall

10 establish a program to—

11 (1) improve treatment of medicare beneficiaries

12 based on the results of the study conducted under

13 section 301(a) and other relevant information; and

14 (2) reduce the number of hospital stays and

15 physician visits among medicare beneficiaries that

16 are a result of the improper use of prescription and

17 over-the-counter drugs.

18 (b) ELEMENTS OF PROGRAM.—The program de19 scribed in subsection (a) shall include—

20 (1) an information campaign for health profes21 sionals;

22 (2) coordination of the part of the program es23 tablished under subsection (a) that is designed to

24 achieve the purpose described in paragraph (2) of

25 that subsection with the information campaign con26 ducted under section 202; and
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1 (3) any other activity the Secretary considers

2 appropriate to carry out the purposes described in

3 subsection (a).

4 (c) DEMONSTRATIONS AND GRANTS.—In establishing

5 the program under subsection (a), the Secretary may con6 duct demonstration projects and award grants to eligible

7 entities (as defined in subsection (d)).

8 (d) ELIGIBLE ENTITY DEFINED.—In this section,

9 the term ‘‘eligible entity’’ means an entity that is an aca10 demic health center, a professional medical society, or

11 such other entity as the Secretary considers appropriate

12 to carry out the purposes of this section.

13 (e) REPORT TO CONGRESS.—Not later than 1 year

14 after the date of enactment of this Act, and annually

15 thereafter, the Secretary shall annually report to Congress

16 on the program conducted under this section.

17 SEC. 303. STUDIES ON PREVENTIVE INTERVENTIONS IN

18 PRIMARY CARE FOR OLDER AMERICANS.

19 (a) STUDIES.—The Secretary, acting through the

20 United States Preventive Services Task Force, shall con21 duct a series of studies designed to identify preventive

22 interventions that can be delivered in the primary care set23 ting that are most valuable to older Americans.

24 (b) MISSION STATEMENT.—The mission statement of

25 the United States Preventive Services Task Force is
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1 amended to include the evaluation of services that are of

2 particular relevance to older Americans.

3 (c) REPORT.—Not later than 1 year after the date

4 of enactment of this Act, and annually thereafter, the Sec5 retary shall submit a report to Congress on the conclu6 sions of the studies conducted under subsection (a), to7 gether with recommendations for such legislation and ad8 ministrative actions as the Secretary considers appro9 priate.

10 SEC. 304. SMOKING CESSATION DEMONSTRATION

11 PROJECT.

12 (a) IN GENERAL.—The Secretary, acting through the

13 Administrator of the Health Care Financing Administra14 tion, shall conduct a demonstration project to—

15 (1) evaluate the most successful and cost-effec16 tive means of providing smoking cessation services

17 to medicare beneficiaries; and

18 (2) test incentive systems for physicians, other

19 health care professionals, and medicare beneficiaries

20 to optimize rates of successful smoking cessation

21 among medicare beneficiaries.

22 (b) LATEST SCIENTIFIC EVIDENCE.—The Secretary

23 shall use the latest scientific evidence regarding smoking

24 cessation strategies and guidelines in conducting the dem25 onstration project under this section.
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1 (c) PAYMENT.—Payment to an individual or an enti2 ty for a service provided under the demonstration project

3 shall be equal to the lesser of—

4 (1) the actual charge for providing the service

5 to a medicare beneficiary; or

6 (2) the amount determined by a fee schedule es7 tablished by the Secretary for the purposes of this

8 section for such service.

9 (d) WAIVER AUTHORITY.—

10 (1) IN GENERAL.—The Secretary may waive

11 such requirements of the medicare program as may

12 be necessary for the purposes of carrying out the

13 demonstration project conducted under this section.

14 (2) NON-MEDICARE PROVIDERS.—Individuals

15 and entities that do not provide items and services

16 under the medicare program shall be permitted to

17 participate in the demonstration project conducted

18 under this section.

19 (e) REPORT TO CONGRESS.—Not later than 1 year

20 after the date of enactment of this Act, and annually

21 thereafter, the Secretary shall report to Congress on the

22 demonstration project conducted under this section.
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1 TITLE IV—DEMONSTRATION

2 PROJECTS TO IMPROVE THE

3 CARE OF RESIDENTS OF

4 SKILLED NURSING FACILI5 TIES AND PERSONS WITH SE6 RIOUS ILLNESSES

7 SEC. 401. DEMONSTRATION PROJECTS TO PROVIDE EFFEC8 TIVE CARE FOR SKILLED NURSING FACILITY

9 RESIDENTS.

10 (a) IN GENERAL.—The Secretary shall conduct dem11 onstration projects that are designed to provide medicare

12 beneficiaries who are residents of skilled nursing facilities

13 (as defined in section 1819(a) of the Social Security Act

14 (42 U.S.C. 1395i–3(a)) with higher quality and more cost15 effective services in order to avoid unnecessary hospitaliza16 tions of such residents.

17 (b) REQUIREMENTS.—

18 (1) IN GENERAL.—The demonstration projects

19 conducted under this section shall include the fol20 lowing:

21 (A) Programs of case management.

22 (B) Programs of disease management.

23 (C) Such other programs as the Secretary

24 determines are likely to increase the quality of,
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1 and reduce the cost of, the care provided to

2 such residents.

3 (2) AUTHORIZED TECHNIQUES.—The dem4 onstration projects conducted under this section may

5 utilize—

6 (A) contracts with centers of excellence or

7 other entities or individuals with special exper8 tise in providing quality services to residents of

9 skilled nursing facilities;

10 (B) innovative payment techniques, includ11 ing capitation payments, for all or selected serv12 ices provided under such projects and incentive

13 payments to reward favorable cost and quality

14 outcomes;

15 (C) provision of services not normally cov16 ered under the medicare program, if the provi17 sion of such services would result in the more

18 cost-effective provision of, or higher quality of,

19 services covered under such program; or

20 (D) reduced cost-sharing requirements for

21 medicare beneficiaries participating in such

22 projects.

23 (c) WAIVER AUTHORITY.—The Secretary may waive

24 such requirements of the medicare program as may be

25 necessary for the purposes of carrying out the demonstra-
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1 tion projects conducted under this section other than re2 quirements relating to providing medicare beneficiaries

3 with freedom of choice of provider under section 1802 of

4 the Social Security Act (42 U.S.C.1395a) or any other

5 provision of law.

6 (d) REPORT TO CONGRESS.—Not later than 1 year

7 after the date of enactment of this Act, and annually

8 thereafter, the Secretary shall report to Congress on the

9 demonstration projects conducted under this section.

10 SEC. 402. DEMONSTRATION PROJECTS TO IMPROVE THE

11 CARE OF PERSONS WITH SERIOUS ILL12 NESSES.

13 (a) EXPANSION OF MEDICARE COORDINATED CARE

14 DEMONSTRATION PROJECT.—Section 4016 of the Bal15 anced Budget Act (Public Law 105–33; 111 Stat. 343)

16 is amended—

17 (1) by striking subsection (a)(2) and inserting

18 the following:

19 ‘‘(2) TARGET INDIVIDUAL DEFINED.—In this

20 section, the term ‘‘target individual’’ means an indi21 vidual that is enrolled under the fee-for-service pro22 gram under parts A and B of title XVIII of the So23 cial Security Act (42 U.S.C. 1395c et seq.; 1395j et

24 seq.) and—
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1 ‘‘(A) has a chronic illness, as defined and

2 identified by the Secretary; or

3 ‘‘(B) has a serious illness, as so defined

4 and identified.’’;

5 (2) in subsection (b)(2), by striking ‘‘Not’’ and

6 inserting ‘‘With respect to demonstration projects

7 for items and services provided to target individuals

8 described in subsection (a)(2)(A), not’’; and

9 (3) by adding at the end the following:

10 ‘‘(f) REQUIREMENTS.—

11 ‘‘(1) IN GENERAL.—The demonstration projects

12 conducted under this section shall include—

13 ‘‘(A) programs of case management;

14 ‘‘(B) programs of disease management;

15 and

16 ‘‘(C) such other programs as the Secretary

17 determines are likely to increase the quality of,

18 and reduce the cost of, the care provided to tar19 get individuals.

20 ‘‘(2) AUTHORIZED TECHNIQUES.—The dem21 onstration projects conducted under this section may

22 include—

23 ‘‘(A) contracts with centers of excellence or

24 other entities or individuals with special exper-
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1 tise in providing quality services to target indi2 viduals;

3 ‘‘(B) innovative payment techniques, in4 cluding capitation payments, for all or selected

5 services provided under such projects and incen6 tive payments to reward favorable cost and

7 quality outcomes;

8 ‘‘(C) provision of services not normally cov9 ered under title XVIII of the Social Security

10 Act (42 U.S.C 1395 et seq.), if the provision of

11 such services would result in the more cost-ef12 fective provision of, or higher quality of, serv13 ices covered under that title; or

14 ‘‘(D) reduced cost-sharing requirements for

15 target individuals participating in such

16 projects.’’.

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

18 this section shall take effect on the date of enactment of

19 this Act.
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1 TITLE V—WHITE HOUSE CON2 FERENCE ON IMPROVING

3 THE HEALTH OF OLDER

4 AMERICANS

5 SEC. 501. WHITE HOUSE CONFERENCE ON IMPROVING THE

6 HEALTH OF OLDER AMERICANS.

7 (a) IN GENERAL.—Not later than December 31,

8 2002, the President shall convene a White House Con9 ference on Improving the Health of Older Americans.

10 (b) GOAL OF CONFERENCE.—The goal of the Con11 ference shall be to—

12 (1) develop a consensus on a program to enable

13 older Americans to protect and improve their own

14 health;

15 (2) develop procedures to ensure that—

16 (A) older Americans are provided with the

17 highest standard of health care available, with

18 an emphasis on assuring that standard practice

19 is also the best practice; and

20 (B) the needs of older Americans are more

21 effectively met through the benefits provided

22 under the medicare program; and

23 (3) outline a research and demonstration agen24 da to further the goals described in paragraphs (1)

25 and (2).
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1 (c) CONFERENCE PARTICIPANTS.—

2 (1) PARTICIPANTS.—In order to carry out the

3 purposes of this section, the Conference shall bring

4 together—

5 (A) representatives of older Americans and

6 those who care for older Americans;

7 (B) researchers and research institutions

8 with an expertise in issues related to older

9 Americans;

10 (C) health professionals and members of

11 professional societies with expertise in caring

12 for older Americans; and

13 (D) other appropriate parties.

14 (2) SELECTION OF DELEGATES.—The partici15 pants shall be selected without regard to political af16 filiation or past partisan activity and shall, to the

17 best of the President’s ability, be representative of

18 the spectrum of thought in the field of geriatric

19 health care.

Æ