II

106TH CONGRESS

1ST SESSION S. 1628

To amend title XVIII of the Social Security Act to increase the number

of physicians that complete a fellowship in geriatric medicine and geriatric psychiatry, and for other purposes.

IN THE SENATE OF THE UNITED STATES

SEPTEMBER 23 (legislative day, SEPTEMBER 22), 1999

Mr. REID (for himself, Mr. GRASSLEY, Mr. HARKIN, and Mr. CLELAND) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions

A BILL

To amend title XVIII of the Social Security Act to increase

the number of physicians that complete a fellowship in

geriatric medicine and geriatric psychiatry, 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.

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

5 Workforce Improvement Act of 1999’’.

6 SEC. 2. FINDINGS.

7 Congress makes the following findings:
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1 (1) The Institute of Medicine, the Alliance for

2 Aging Research, the National Institute on Aging,

3 and the Council on Graduate Medical Education

4 have reported that there is a critical shortage of cer5 tified geriatricians.

6 (2) The average total educational debt that a

7 physician who completes required training including

8 a fellowship in geriatric medicine or geriatric psychi9 atry in order to become a certified geriatrician ex10 ceeds $75,000, and the current reimbursement pol11 icy for these physicians creates significant financial

12 disincentives to entering the practice of geriatric

13 medicine and geriatric psychiatry.

14 (3) It is essential that physicians that provide

15 clinical services to elderly individuals be trained in

16 the range of settings in which medical care is deliv17 ered in order to provide those services appropriately.

18 SEC. 3. GRADUATE MEDICAL EDUCATION FUNDING.

19 (a) IN GENERAL.—Section 1886(h)(4) of the Social

20 Security Act (42 U.S.C. 1395ww(h)(4)) is amended by

21 adding at the end the following:

22 ‘‘(I) GERIATRIC PROGRAMS.—

23 ‘‘(i) IN GENERAL.—The rules estab24 lished under this paragraph shall specify

25 that a resident that is enrolled in a fellow-
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1 ship in geriatric medicine or geriatric psy2 chiatry within an approved medical resi3 dency training program shall be, for the

4 computation of the number of full-time5 equivalent residents in an approved med6 ical residency training program, counted 2

7 times for the period such resident is en8 rolled in such fellowship.

9 ‘‘(ii) LIMITATION.—The number of

10 residents that are counted 2 times for the

11 computation of the number of full-time12 equivalent residents in an approved med13 ical residency training program under

14 clause (i) shall not exceed 400 in any cal15 endar year.’’.

16 (b) EFFECTIVE DATE.—The amendment made by

17 subsection (a) shall apply to cost reporting periods begin18 ning on or after the date of enactment of this Act.

19 SEC. 4. DEMONSTRATION PROJECTS TO INCREASE THE

20 NUMBER OF GERIATRICIANS.

21 (a) DEFINITIONS.—In this section:

22 (1) GERIATRIC TRAINING CONSORTIUM.—The

23 term ‘‘geriatric training consortium’’ means a State,

24 regional, or local entity that—
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1 (A) is developed and supported by an ac2 credited geriatric training program;

3 (B) consists of—

4 (i) a teaching hospital;

5 (ii) a skilled nursing facility; and

6 (iii) an ambulatory care or commu7 nity-based facility, such as a community

8 clinic, a day treatment program, a hospice

9 program, a managed care organization, or

10 a rehabilitation facility; and

11 (C) is organized for—

12 (i) the training of residents enrolled in

13 formal postgraduate training programs in

14 geriatric medicine or geriatric psychiatry;

15 and

16 (ii) the provision of appropriate train17 ing experiences in the care of elderly indi18 viduals to residents in primary care dis19 ciplines and other health professionals.

20 (2) PRIMARY CARE.—The term ‘‘primary care’’

21 means family medicine, general internal medicine,

22 general pediatrics, preventive medicine, geriatric

23 medicine, and osteopathic general practice.

24 (3) RESIDENT.—The term ‘‘resident’’ has the

25 meaning given such term in section 1886(h)(5)(I) of
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1 the Social Security Act (42 U.S.C.

2 1395ww(h)(5)(I)).

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

4 the Secretary of Health and Human Services.

5 (b) DEMONSTRATION PROJECTS.—

6 (1) AUTHORITY.—The Secretary, through geri7 atric training consortia, shall establish and conduct

8 5 demonstration projects to increase the number of

9 certified geriatricians that are appropriately trained

10 to provide items and services to beneficiaries under

11 title XVIII of the Social Security Act (42 U.S.C.

12 1395 et seq.) in a range of patient settings. In con13 ducting demonstration projects under this section,

14 the Secretary shall make payments for the indirect

15 costs of medical education and the direct graduate

16 medical education costs relating to the training of

17 residents to the geriatric training consortia carrying

18 out the projects.

19 (2) APPLICATION.—Any geriatric training con20 sortium seeking to conduct a demonstration project

21 under this section shall submit to the Secretary an

22 application at such time, in such form and manner,

23 and containing such information as the Secretary

24 may require.
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1 (c) WAIVER AUTHORITY.—The Secretary may waive

2 compliance with any requirement of titles XI, XVIII, and

3 XIX of the Social Security Act (42 U.S.C. 1301 et seq.,

4 1395 et seq., 1396 et seq.) which, if applied, would prevent

5 a demonstration project carried out under this section

6 from effectively achieving the purpose of the project.

7 (d) ANNUAL REPORT TO CONGRESS.—

8 (1) IN GENERAL.—Beginning 1 year after the

9 date of enactment of this Act, and annually there10 after, the Secretary shall submit to Congress a re11 port that evaluates the effectiveness of the dem12 onstration projects conducted under this section and

13 that contains any legislative recommendations deter14 mined appropriate by the Secretary.

15 (2) CONTINUATION OR REPLICATION OF DEM16 ONSTRATION PROJECTS.—Beginning 3 years after

17 the date of enactment of this Act, the report re18 quired under paragraph (1) shall include rec19 ommendations regarding whether the demonstration

20 projects conducted under this section should be con21 tinued and whether broad replication of the project

22 should be initiated.

23 (e) DURATION.—A demonstration project under this

24 section shall be conducted for a period of not more than

25 5 years. The Secretary may terminate a project if the Sec-
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1 retary determines that the consortium conducting the

2 project is not in substantial compliance with the terms of

3 the application approved by the Secretary.

4 (f) FUNDING.—

5 (1) IN GENERAL.—The Secretary shall provide

6 for the transfer from the Federal Hospital Insurance

7 Trust Fund and the Federal Supplementary Insur8 ance Trust Fund under sections 1817 and 1841 of

9 title XVIII of the Social Security Act (42 U.S.C.

10 1395i, 1395t), in such proportions as the Secretary

11 determines to be appropriate, of such funds as are

12 necessary for the costs of carrying out the dem13 onstration projects under this section.

14 (2) LIMITATION.—

15 (A) IN GENERAL.—With respect to any

16 year that a demonstration project is conducted

17 under this section, the total amount paid to

18 such a demonstration project shall not exceed

19 the lessor of—

20 (i) an amount described in subpara21 graph (B); or

22 (ii) $1,000,000.

23 (B) AMOUNT DESCRIBED.—An amount de24 scribed in this subparagraph is an amount

25 equal to the number of geriatric fellows enrolled
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1 in a geriatric training consortium for that year

2 multiplied by the amount that the hospital that

3 is part of that geriatric training consortium

4 conducting the demonstration project received

5 under the medicare program under title XVIII

6 of the Social Security Act (42 U.S.C. 1395 et

7 seq.) for the indirect costs of medical education

8 and for direct graduate medical education costs

9 for each full-time-equivalent resident during the

10 hospital’s most recent cost reporting period, de11 termined without regard to section

12 1886(h)(4)(I) of that Act (42 U.S.C.

13 1395ww(h)(4)(I)) (as added by section 3), and

14 determined as of the date the Secretary appro15 priates the funds for the demonstration project

16 for that year.

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