I

106TH CONGRESS

1ST SESSION H. R. 1646

To authorize the Secretary of Health and Human Services to provide for

an extra payment amount under the Medicare Program to rural providers

of services who furnish case manager services to Medicare beneficiaries.

IN THE HOUSE OF REPRESENTATIVES

APRIL 29, 1999

Mr. STARK 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 authorize the Secretary of Health and Human Services

to provide for an extra payment amount under the Medicare Program to rural providers of services who furnish

case manager services to Medicare beneficiaries.

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 referred to as the ‘‘Rural Case Man5 agement Act of 1999’’.
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1 SEC. 2. ADDITIONAL PAYMENT AMOUNT TO RURAL PRO2 VIDERS OF SERVICES WHO FURNISH CASE

3 MANAGER SERVICES.

4 (a) AUTHORITY TO PROVIDE ADDITIONAL PAYMENT

5 FOR RURAL CASE MANAGER SERVICES.—In the case of

6 a provider of services or a physician that furnishes services

7 to Medicare beneficiaries in a rural area, the Secretary

8 of Health and Human Services may provide for an addi9 tional payment under the Medicare Program for rural case

10 manager services furnished by such provider or physician

11 to Medicare beneficiaries.

12 (b) REQUIREMENT FOR RURAL CASE MANAGEMENT

13 PLAN.—No payment may be made under subsection (a)

14 for rural case manager services furnished to a Medicare

15 beneficiary unless such provider or physician establishes,

16 and periodically reviews, a rural case management plan

17 for furnishing items and services for the treatment of the

18 illness or injury of the Medicare beneficiary. The Secretary

19 shall establish such standards as the Secretary finds nec20 essary for the effective and efficient development and over21 sight of rural case manager services and rural case man22 agement plans to ensure the health and safety of Medicare

23 beneficiaries furnished services under such a plan.

24 (c) PAYMENT.—
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1 (1) IN GENERAL.—Payment may be made

2 under this section for rural case manager services

3 with respect to a Medicare beneficiary only—

4 (A) for the initial development of the rural

5 case management plan for the individual, and

6 (B) for the subsequent review and modi7 fication of such plan, as provided by the Sec8 retary in regulations.

9 (2) PAYMENT UNDER FEE SCHEDULE.—Pay10 ment under this section for rural case manager serv11 ices shall be made pursuant to the fee schedule es12 tablished by the Secretary.

13 (3) ESTABLISHMENT OF FEE SCHEDULE.—

14 (A) IN GENERAL.—The Secretary shall es15 tablish a fee schedule for payment for rural

16 case manager services. Such schedule may pro17 vide for rates that differ for such services that

18 comprise the establishment of a rural case man19 agement plan and that comprise review and

20 modification of such a plan.

21 (B) CONSIDERATIONS.—In establishing

22 such fee schedule, the Secretary shall consider

23 appropriate regional and operational differences

24 and adjustments to payment rates to account

25 for inflation and other relevant factors.
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1 (C) CONSULTATION.—In establishing the

2 fee schedule for rural case manager services

3 under this subsection, the Secretary shall con4 sult with appropriate organizations representing

5 individuals and entities who furnish referral

6 services in rural areas for health care items and

7 services furnished and share with such organi8 zations relevant data in establishing such sched9 ule.

10 (d) GUIDANCE ON INITIATION OF CASE MANAGER

11 SERVICES.—The Secretary of Health and Human Services

12 shall provide guidance on the process or processes that

13 may be used to develop rural case management plans on

14 a timely basis.

15 (e) LIMITATION ON REFERRALS.—Section 1877 of

16 the Social Security Act (42 U.S.C. 1395nn) shall apply

17 to a referral by a rural case manager to a rural agency

18 in the same manner as such section applies to a referral

19 by a physician to an entity described in section 1877(a)(2)

20 of such Act.

21 (f) DEFINITIONS.—In this section:

22 (1) The term ‘‘rural case manager services’’

23 means the development, coordination, and moni24 toring of a rural case management plan for an indi25 vidual furnished items and services for the diagnosis
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1 and treatment of an illness or injury, and includes

2 the periodic review of such a plan.

3 (2) The term ‘‘rural case management plan’’

4 means a structured plan for the delivery of items

5 and services that is developed by a rural case man6 ager, after consultation with the physician and, if

7 available, the family of the individual involved.

8 (3) The term ‘‘provider of service’’ has the

9 meaning given that term in section 1861(u) of the

10 Social Security Act (42 U.S.C. 1395x(u)).

11 (4) The term ‘‘physician’’ has the meaning

12 given that term in section 1861(r) of such Act (42

13 U.S.C. 1395x(r)).

14 (5) The term ‘‘rural area’’ means an area des15 ignated as a rural area under section 1886(d)(2)(D)

16 of such Act (42 U.S.C. 1395ww(d)(2)(D)).

17 (6) The term ‘‘Medicare beneficiary’’ means an

18 individual entitled to benefits under part A of title

19 XVIII of such Act, or enrolled under part B of such

20 title, or both.

21 (7) The term ‘‘Medicare Program’’ means the

22 insurance program established under title XVIII of

23 the Social Security Act.
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1 (g) EFFECTIVE DATE.—This section shall take effect

2 on October 1, 2000, and apply with respect to rural serv3 ices furnished on or after October 1, 2001.

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