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(B) the value of collecting such information by small
home health agencies compared to the administrative bur-
den related to such collection.
In conducting the study the Secretary shall obtain recommenda-
tions from quality assessment experts in the use of such
information and the necessity of small, as well as large, home
health agencies collecting such information.
(2) REPORT.—The Secretary shall submit to Congress a
report on the study conducted under paragraph (1) by not
later than 18 months after the date of the enactment of this
Act.
(d) CONSTRUCTION.—Nothing in this section shall be construed
as preventing home health agencies from collecting non-medicare/
medicaid OASIS information for their own use.
SEC. 705. MEDPAC STUDY ON MEDICARE MARGINS OF HOME HEALTH
AGENCIES.
(a) STUDY.—The Medicare Payment Advisory Commission shall
conduct a study of payment margins of home health agencies under
the home health prospective payment system under section 1895
of the Social Security Act (42 U.S.C. 1395fff). Such study shall
examine whether systematic differences in payment margins are
related to differences in case mix (as measured by home health
resource groups (HHRGs)) among such agencies. The study shall
use the partial or full-year cost reports filed by home health agen-
cies.
(b) REPORT.—Not later than 2 years after the date of the
enactment of this Act, the Commission shall submit to Congress
a report on the study under subsection (a).
SEC. 706. COVERAGE OF RELIGIOUS NONMEDICAL HEALTH CARE
INSTITUTION SERVICES FURNISHED IN THE HOME.
(a) IN GENERAL.—Section 1821(a) (42 U.S.C. 1395i–5(a)) is
amended—
(1) in the matter preceding paragraph (1), by inserting
‘‘and for home health services furnished an individual by a
religious nonmedical health care institution’’ after ‘‘religious
nonmedical health care institution’’; and
(2) in paragraph (2)—
(A) by striking ‘‘or extended care services’’ and
inserting ‘‘, extended care services, or home health serv-
ices’’; and
(B) by inserting ‘‘, or receiving services from a home
health agency,’’ after ‘‘skilled nursing facility’’.
(b) DEFINITION.—Section 1861 (42 U.S.C. 1395x), as amended
by section 642, is amended by adding at the end the following
new section:
‘‘Extended Care in Religious Nonmedical Health Care Institutions
‘‘(aaa)(1) The term ‘home health agency’ also includes a religious
nonmedical health care institution (as defined in subsection (ss)(1)),
but only with respect to items and services ordinarily furnished
by such an institution to individuals in their homes, and that
are comparable to items and services furnished to individuals by
a home health agency that is not religious nonmedical health care
institution.
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‘‘(2)(A) Subject to subparagraphs (B), payment may be made
with respect to services provided by such an institution only to
such extent and under such conditions, limitations, and require-
ments (in addition to or in lieu of the conditions, limitations, and
requirements otherwise applicable) as may be provided in regula-
tions consistent with section 1821.
‘‘(B) Notwithstanding any other provision of this title, payment
may not be made under subparagraph (A)—
‘‘(i) in a year insofar as such payments exceed $700,000;
and
‘‘(ii) after December 31, 2006.’’.
Subtitle B—Graduate Medical Education
SEC. 711. EXTENSION OF UPDATE LIMITATION ON HIGH COST PRO-
GRAMS.
Section 1886(h)(2)(D)(iv) (42 U.S.C. 1395ww(h)(2)(D)(iv)) is
amended—
(1) in subclause (I)—
(A) by inserting ‘‘AND 2004 THROUGH 2013’’ after ‘‘AND
2002’’; and
(B) by inserting ‘‘or during the period beginning with
fiscal year 2004 and ending with fiscal year 2013’’ after
‘‘during fiscal year 2001 or fiscal year 2002’’; and
(2) in subclause (II)—
(A) by striking ‘‘fiscal year 2004, or fiscal year 2005,’’
and
(B) by striking ‘‘For a’’ and inserting ‘‘For the’’.
SEC. 712. EXCEPTION TO INITIAL RESIDENCY PERIOD FOR GERIATRIC
RESIDENCY OR FELLOWSHIP PROGRAMS.
(a) CLARIFICATION
OF
CONGRESSIONAL
INTENT.—Congress
intended section 1886(h)(5)(F)(ii) of the Social Security Act (42
U.S.C. 1395ww(h)(5)(F)(ii)), as added by section 9202 of the Consoli-
dated Omnibus Budget Reconciliation Act of 1985 (Public Law
99–272), to provide an exception to the initial residency period
for geriatric residency or fellowship programs such that, where
a particular approved geriatric training program requires a resident
to complete 2 years of training to initially become board eligible
in the geriatric specialty, the 2 years spent in the geriatric training
program are treated as part of the resident’s initial residency period,
but are not counted against any limitation on the initial residency
period.
(b) INTERIM FINAL REGULATORY AUTHORITY
AND EFFECTIVE
DATE.—The Secretary shall promulgate interim final regulations
consistent with the congressional intent expressed in this section
after notice and pending opportunity for public comment to be
effective for cost reporting periods beginning on or after October
1, 2003.
SEC. 713. TREATMENT OF VOLUNTEER SUPERVISION.
(a) MORATORIUM ON CHANGES IN TREATMENT.—During the 1-
year period beginning on January 1, 2004, for purposes of applying
subsections (d)(5)(B) and (h) of section 1886 of the Social Security
Act (42 U.S.C. 1395ww), the Secretary shall allow all hospitals
to count residents in osteopathic and allopathic family practice
programs in existence as of January 1, 2002, who are training
H. R. 1—276
at non-hospital sites, without regard to the financial arrangement
between the hospital and the teaching physician practicing in the
non-hospital site to which the resident has been assigned.
(b) STUDY AND REPORT.—
(1) STUDY.—The Inspector General of the Department of
Health and Human Services shall conduct a study of the appro-
priateness of alternative payment methodologies under such
sections for the costs of training residents in non-hospital set-
tings.
(2) REPORT.—Not later than 1 year after the date of the
enactment of this Act, the Inspector General shall submit to
Congress a report on the study conducted under paragraph
(1), together with such recommendations as the Inspector Gen-
eral determines appropriate.
Subtitle C—Chronic Care Improvement
SEC. 721. VOLUNTARY CHRONIC CARE IMPROVEMENT UNDER TRADI-
TIONAL FEE-FOR-SERVICE.
(a) IN GENERAL.—Title XVIII is amended by inserting after
section 1806 the following new section:
‘‘CHRONIC CARE IMPROVEMENT
‘‘SEC. 1807. (a) IMPLEMENTATION OF CHRONIC CARE IMPROVE-
MENT PROGRAMS.—
‘‘(1) IN
GENERAL.—The Secretary shall provide for the
phased-in development, testing, evaluation, and implementa-
tion of chronic care improvement programs in accordance with
this section. Each such program shall be designed to improve
clinical quality and beneficiary satisfaction and achieve
spending targets with respect to expenditures under this title
for targeted beneficiaries with one or more threshold conditions.
‘‘(2) DEFINITIONS.—For purposes of this section:
‘‘(A) CHRONIC CARE IMPROVEMENT PROGRAM.—The term
‘chronic care improvement program’ means a program
described in paragraph (1) that is offered under an agree-
ment under subsection (b) or (c).
‘‘(B) CHRONIC CARE IMPROVEMENT ORGANIZATION.—The
term ‘chronic care improvement organization’ means an
entity that has entered into an agreement under subsection
(b) or (c) to provide, directly or through contracts with
subcontractors, a chronic care improvement program under
this section. Such an entity may be a disease management
organization, health insurer, integrated delivery system,
physician group practice, a consortium of such entities,
or any other legal entity that the Secretary determines
appropriate to carry out a chronic care improvement pro-
gram under this section.
‘‘(C) 
CARE
MANAGEMENT
PLAN.—The 
term 
‘care
management plan’ means a plan established under sub-
section (d) for a participant in a chronic care improvement
program.
‘‘(D) THRESHOLD
CONDITION.—The term ‘threshold
condition’ means a chronic condition, such as congestive
heart failure, diabetes, chronic obstructive pulmonary dis-
ease (COPD), or other diseases or conditions, as selected
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by the Secretary as appropriate for the establishment of
a chronic care improvement program.
‘‘(E) TARGETED BENEFICIARY.—The term ‘targeted bene-
ficiary’ means, with respect to a chronic care improvement
program, an individual who—
‘‘(i) is entitled to benefits under part A and enrolled
under part B, but not enrolled in a plan under part
C;
‘‘(ii) has one or more threshold conditions covered
under such program; and
‘‘(iii) has been identified under subsection (d)(1)
as a potential participant in such program.
‘‘(3) CONSTRUCTION.—Nothing in this section shall be con-
strued as—
‘‘(A) expanding the amount, duration, or scope of bene-
fits under this title;
‘‘(B) providing an entitlement to participate in a chronic
care improvement program under this section;
‘‘(C) providing for any hearing or appeal rights under
section 1869, 1878, or otherwise, with respect to a chronic
care improvement program under this section; or
‘‘(D) providing benefits under a chronic care improve-
ment program for which a claim may be submitted to
the Secretary by any provider of services or supplier (as
defined in section 1861(d)).
‘‘(b) DEVELOPMENTAL PHASE (PHASE I).—
‘‘(1) IN GENERAL.—In carrying out this section, the Sec-
retary shall enter into agreements consistent with subsection
(f) with chronic care improvement organizations for the develop-
ment, testing, and evaluation of chronic care improvement pro-
grams using randomized controlled trials. The first such agree-
ment shall be entered into not later than 12 months after
the date of the enactment of this section.
‘‘(2) AGREEMENT
PERIOD.—The period of an agreement
under this subsection shall be for 3 years.
‘‘(3) MINIMUM PARTICIPATION.—
‘‘(A) IN GENERAL.—The Secretary shall enter into agree-
ments under this subsection in a manner so that chronic
care improvement programs offered under this section are
offered in geographic areas that, in the aggregate, consist
of areas in which at least 10 percent of the aggregate
number of medicare beneficiaries reside.
‘‘(B) MEDICARE BENEFICIARY DEFINED.—In this para-
graph, the term ‘medicare beneficiary’ means an individual
who is entitled to benefits under part A, enrolled under
part B, or both, and who resides in the United States.
‘‘(4) SITE
SELECTION.—In selecting geographic areas in
which agreements are entered into under this subsection, the
Secretary shall ensure that each chronic care improvement
program is conducted in a geographic area in which at least
10,000 targeted beneficiaries reside among other individuals
entitled to benefits under part A, enrolled under part B, or
both to serve as a control population.
‘‘(5) INDEPENDENT EVALUATIONS OF PHASE I PROGRAMS.—
The Secretary shall contract for an independent evaluation
of the programs conducted under this subsection. Such evalua-
tion shall be done by a contractor with knowledge of chronic