H. R. 1—265
(3) PRACTICE STANDARDS.—Each physician participating in
the demonstration program under this section must dem-
onstrate the ability—
(A) to assess each eligible beneficiary for conditions
other than chronic conditions, such as impaired cognitive
ability and co-morbidities, for the purposes of developing
care management requirements;
(B) to serve as the primary contact of eligible bene-
ficiaries in accessing items and services for which payment
may be made under the medicare program;
(C) to establish and maintain health care information
system for such beneficiaries;
(D) to promote continuity of care across providers and
settings;
(E) to use evidence-based guidelines and meet such
clinical quality and outcome measures as the Secretary
shall require;
(F) to promote self-care through the provision of patient
education and support for patients or, where appropriate,
family caregivers;
(G) when appropriate, to refer such beneficiaries to
community service organizations; and
(H) to meet such other complex care management
requirements as the Secretary may specify.
The guidelines and measures required under subparagraph
(E) shall be designed to take into account beneficiaries with
multiple chronic conditions.
(c) PAYMENT METHODOLOGY.—Under the demonstration pro-
gram under this section the Secretary shall pay a per beneficiary
amount to each participating physician who meets or exceeds spe-
cific performance standards established by the Secretary with
respect to the clinical quality and outcome measures reported under
subsection (b)(1)(B). Such amount may vary based on different
levels of performance or improvement.
(d) ADMINISTRATION.—
(1) USE OF QUALITY IMPROVEMENT ORGANIZATIONS.—The
Secretary shall contract with quality improvement organiza-
tions or such other entities as the Secretary deems appropriate
to enroll physicians and evaluate their performance under the
demonstration program under this section.
(2) TECHNICAL ASSISTANCE.—The Secretary shall require
in such contracts that the contractor be responsible for technical
assistance and education as needed to physicians enrolled in
the demonstration program under this section for the purpose
of aiding their adoption of health information technology,
meeting practice standards, and implementing required clinical
and outcomes measures.
(e) FUNDING.—
(1) IN
GENERAL.—The Secretary shall provide for the
transfer from the Federal Supplementary Medical Insurance
Trust Fund established under section 1841 of the Social Secu-
rity Act (42 U.S.C. 1395t) of such funds as are necessary
for the costs of carrying out the demonstration program under
this section.
(2) BUDGET NEUTRALITY.—In conducting the demonstration
program under this section, the Secretary shall ensure that
the aggregate payments made by the Secretary do not exceed
H. R. 1—266
the amount which the Secretary estimates would have been
paid if the demonstration program under this section was not
implemented.
(f) WAIVER AUTHORITY.—The Secretary may waive such require-
ments of titles XI and XVIII of the Social Security Act (42 U.S.C.
1301 et seq. and 1395 et seq.) as may be necessary for the purpose
of carrying out the demonstration program under this section.
(g) REPORT.—Not later than 12 months after the date of comple-
tion of the demonstration program under this section, the Secretary
shall submit to Congress a report on such program, together with
recommendations for such legislation and administrative action as
the Secretary determines to be appropriate.
(h) DEFINITIONS.—In this section:
(1) ELIGIBLE BENEFICIARY.—The term ‘‘eligible beneficiary’’
means any individual who—
(A) is entitled to benefits under part A and enrolled
for benefits under part B of title XVIII of the Social Security
Act and is not enrolled in a plan under part C of such
title; and
(B) has one or more chronic medical conditions specified
by the Secretary (one of which may be cognitive impair-
ment).
(2) HEALTH INFORMATION TECHNOLOGY.—The term ‘‘health
information technology’’ means email communication, clinical
alerts and reminders, and other information technology that
meets such functionality, interoperability, and other standards
as prescribed by the Secretary.
SEC. 650. GAO STUDY AND REPORT ON THE PROPAGATION OF CON-
CIERGE CARE.
(a) STUDY.—
(1) IN GENERAL.—The Comptroller General of the United
States shall conduct a study on concierge care (as defined
in paragraph (2)) to determine the extent to which such care—
(A) is used by medicare beneficiaries (as defined in
section 1802(b)(5)(A) of the Social Security Act (42 U.S.C.
1395a(b)(5)(A))); and
(B) has impacted upon the access of medicare bene-
ficiaries (as so defined) to items and services for which
reimbursement is provided under the medicare program
under title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.).
(2) CONCIERGE CARE.—In this section, the term ‘‘concierge
care’’ means an arrangement under which, as a prerequisite
for the provision of a health care item or service to an indi-
vidual, a physician, practitioner (as described in section
1842(b)(18)(C) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C.
1395u(b)(18)(C))), or other individual—
(A) charges a membership fee or another incidental
fee to an individual desiring to receive the health care
item or service from such physician, practitioner, or other
individual; or
(B) requires the individual desiring to receive the
health care item or service from such physician, practi-
tioner, or other individual to purchase an item or service.
(b) REPORT.—Not later than the date that is 12 months after
the date of enactment of this Act, the Comptroller General of
H. R. 1—267
the United States shall submit to Congress a report on the study
conducted under subsection (a)(1) together with such recommenda-
tions for legislative or administrative action as the Comptroller
General determines to be appropriate.
SEC. 651. DEMONSTRATION OF COVERAGE OF CHIROPRACTIC SERV-
ICES UNDER MEDICARE.
(a) DEFINITIONS.—In this section:
(1) CHIROPRACTIC SERVICES.—The term ‘‘chiropractic serv-
ices’’ has the meaning given that term by the Secretary for
purposes of the demonstration projects, but shall include, at
a minimum—
(A) care for neuromusculoskeletal conditions typical
among eligible beneficiaries; and
(B) diagnostic and other services that a chiropractor
is legally authorized to perform by the State or jurisdiction
in which such treatment is provided.
(2) DEMONSTRATION
PROJECT.—The term ‘‘demonstration
project’’ means a demonstration project established by the Sec-
retary under subsection (b)(1).
(3) ELIGIBLE BENEFICIARY.—The term ‘‘eligible beneficiary’’
means an individual who is enrolled under part B of the medi-
care program.
(4) MEDICARE
PROGRAM.—The term ‘‘medicare program’’
means the health benefits program under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.).
(b) DEMONSTRATION OF COVERAGE OF CHIROPRACTIC SERVICES
UNDER MEDICARE.—
(1) ESTABLISHMENT.—The Secretary shall establish dem-
onstration projects in accordance with the provisions of this
section for the purpose of evaluating the feasibility and advis-
ability of covering chiropractic services under the medicare
program (in addition to the coverage provided for services con-
sisting of treatment by means of manual manipulation of the
spine to correct a subluxation described in section 1861(r)(5)
of the Social Security Act (42 U.S.C. 1395x(r)(5))).
(2) NO PHYSICIAN APPROVAL REQUIRED.—In establishing the
demonstration projects, the Secretary shall ensure that an
eligible beneficiary who participates in a demonstration project,
including an eligible beneficiary who is enrolled for coverage
under a Medicare+Choice plan (or, on and after January 1,
2006, under a Medicare Advantage plan), is not required to
receive approval from a physician or other health care provider
in order to receive a chiropractic service under a demonstration
project.
(3) CONSULTATION.—In establishing the demonstration
projects, the Secretary shall consult with chiropractors,
organizations representing chiropractors, eligible beneficiaries,
and organizations representing eligible beneficiaries.
(4) PARTICIPATION.—Any eligible beneficiary may partici-
pate in the demonstration projects on a voluntary basis.
(c) CONDUCT OF DEMONSTRATION PROJECTS.—
(1) DEMONSTRATION SITES.—
(A) SELECTION
OF
DEMONSTRATION
SITES.—The Sec-
retary shall conduct demonstration projects at 4 demonstra-
tion sites.
H. R. 1—268
(B) GEOGRAPHIC DIVERSITY.—Of the sites described in
subparagraph (A)—
(i) two shall be in rural areas; and
(ii) two shall be in urban areas.
(C) SITES LOCATED IN HPSAS.—At least 1 site described
in clause (i) of subparagraph (B) and at least 1 site
described in clause (ii) of such subparagraph shall be
located in an area that is designated under section
332(a)(1)(A) of the Public Health Service Act (42 U.S.C.
254e(a)(1)(A)) as a health professional shortage area.
(2) IMPLEMENTATION; DURATION.—
(A) IMPLEMENTATION.—The Secretary shall not imple-
ment the demonstration projects before October 1, 2004.
(B) DURATION.—The Secretary shall complete the dem-
onstration projects by the date that is 2 years after the
date on which the first demonstration project is imple-
mented.
(d) EVALUATION AND REPORT.—
(1) EVALUATION.—The Secretary shall conduct an evalua-
tion of the demonstration projects—
(A) to determine whether eligible beneficiaries who
use chiropractic services use a lesser overall amount of
items and services for which payment is made under the
medicare program than eligible beneficiaries who do not
use such services;
(B) to determine the cost of providing payment for
chiropractic services under the medicare program;
(C) to determine the satisfaction of eligible beneficiaries
participating in the demonstration projects and the quality
of care received by such beneficiaries; and
(D) to evaluate such other matters as the Secretary
determines is appropriate.
(2) REPORT.—Not later than the date that is 1 year after
the date on which the demonstration projects conclude, the
Secretary shall submit to Congress a report on the evaluation
conducted under paragraph (1) together with such recommenda-
tions for legislation or administrative action as the Secretary
determines is appropriate.
(e) WAIVER OF MEDICARE REQUIREMENTS.—The Secretary shall
waive compliance with such requirements of the medicare program
to the extent and for the period the Secretary finds necessary
to conduct the demonstration projects.
(f) FUNDING.—
(1) DEMONSTRATION PROJECTS.—
(A) IN
GENERAL.—Subject to subparagraph (B) and
paragraph (2), the Secretary shall provide for the transfer
from the Federal Supplementary Insurance Trust Fund
under section 1841 of the Social Security Act (42 U.S.C.
1395t) of such funds as are necessary for the costs of
carrying out the demonstration projects under this section.
(B) LIMITATION.—In conducting the demonstration
projects under this section, the Secretary shall ensure that
the aggregate payments made by the Secretary under the
medicare program do not exceed the amount which the
Secretary would have paid under the medicare program
if the demonstration projects under this section were not
implemented.
H. R. 1—269
(2) EVALUATION AND REPORT.—There are authorized to be
appropriated such sums as are necessary for the purpose of
developing and submitting the report to Congress under sub-
section (d).
TITLE VII—PROVISIONS RELATING TO
PARTS A AND B
Subtitle A—Home Health Services
SEC. 701. UPDATE IN HOME HEALTH SERVICES.
(a) CHANGE TO CALENDAR YEAR UPDATE.—Section 1895(b) (42
U.S.C. 1395fff(b)(3)) is amended—
(1) in paragraph (3)(B)(i)—
(A) by striking ‘‘each fiscal year (beginning with fiscal
year 2002)’’ and inserting ‘‘fiscal year 2002 and for fiscal
year 2003 and for each subsequent year (beginning with
2004)’’; and
(B) by inserting ‘‘or year’’ after ‘‘the fiscal year’’;
(2) in paragraph (3)(B)(ii)—
(A) in subclause (I), by striking ‘‘or’’ at the end;
(B) by redesignating subclause (II) as subclause (III);
(C) in subclause (III), as so redesignated, by striking
‘‘any subsequent fiscal year’’ and inserting ‘‘2004 and any
subsequent year’’; and
(D) by inserting after subclause (I) the following new
subclause:
‘‘(II) for the last calendar quarter of 2003 and
the first calendar quarter of 2004, the home health
market basket percentage increase; or’’;
(3) in paragraph (3)(B)(iii), by inserting ‘‘or year’’ after
‘‘fiscal year’’ each place it appears; and
(4) in paragraph (3)(B)(iv)—
(A) by inserting ‘‘or year’’ after ‘‘fiscal year’’ each place
it appears; and
(B) by inserting ‘‘or years’’ after ‘‘fiscal years’’; and
(5) in paragraph (5), by inserting ‘‘or year’’ after ‘‘fiscal
year’’.
(b) ADJUSTMENT
TO UPDATES
FOR 2004, 2005, AND 2006.—
Section 1895(b)(3)(B)(ii) (42 U.S.C. 1395fff(b)(3)(B)(ii)), as amended
by subsection (a)(2), is amended—
(1) by striking ‘‘or’’ at the end of subclause (II);
(2) by redesignating subclause (III) as subclause (IV);
(3) in subclause (IV), as so redesignated, by striking ‘‘2004’’
and inserting ‘‘2007’’; and
(4) by inserting after subclause (II) the following new sub-
clause:
‘‘(III) the last 3 calendar quarters of 2004,
and each of 2005 and 2006 the home health market
basket percentage increase minus 0.8 percentage
points; or’’.
H. R. 1—270
SEC. 702. DEMONSTRATION PROJECT TO CLARIFY THE DEFINITION
OF HOMEBOUND.
(a) DEMONSTRATION PROJECT.—Not later than 180 days after
the date of the enactment of this Act, the Secretary shall conduct
a 2-year demonstration project under part B of title XVIII of the
Social Security Act under which medicare beneficiaries with chronic
conditions described in subsection (b) are deemed to be homebound
for purposes of receiving home health services under the medicare
program.
(b) MEDICARE BENEFICIARY DESCRIBED.—For purposes of sub-
section (a), a medicare beneficiary is eligible to be deemed to be
homebound, without regard to the purpose, frequency, or duration
of absences from the home, if—
(1) the beneficiary has been certified by one physician
as an individual who has a permanent and severe, disabling
condition that is not expected to improve;
(2) the beneficiary is dependent upon assistance from
another individual with at least 3 out of the 5 activities of
daily living for the rest of the beneficiary’s life;
(3) the beneficiary requires skilled nursing services for
the rest of the beneficiary’s life and the skilled nursing is
more than medication management;
(4) an attendant is required to visit the beneficiary on
a daily basis to monitor and treat the beneficiary’s medical
condition or to assist the beneficiary with activities of daily
living;
(5) the beneficiary requires technological assistance or the
assistance of another person to leave the home; and
(6) the beneficiary does not regularly work in a paid posi-
tion full-time or part-time outside the home.
(c) DEMONSTRATION PROJECT SITES.—The demonstration project
established under this section shall be conducted in 3 States selected
by the Secretary to represent the Northeast, Midwest, and Western
regions of the United States.
(d) LIMITATION ON NUMBER OF PARTICIPANTS.—The aggregate
number of such beneficiaries that may participate in the project
may not exceed 15,000.
(e) DATA.—The Secretary shall collect such data on the dem-
onstration project with respect to the provision of home health
services to medicare beneficiaries that relates to quality of care,
patient outcomes, and additional costs, if any, to the medicare
program.
(f) REPORT TO CONGRESS.—Not later than 1 year after the
date of the completion of the demonstration project under this
section, the Secretary shall submit to Congress a report on the
project using the data collected under subsection (e). The report
shall include the following:
(1) An examination of whether the provision of home health
services to medicare beneficiaries under the project has had
any of the following effects:
(A) Has adversely affected the provision of home health
services under the medicare program.
(B) Has directly caused an increase of expenditures
under the medicare program for the provision of such serv-
ices that is directly attributable to such clarification.
H. R. 1—271
(2) The specific data evidencing the amount of any increase
in expenditures that is directly attributable to the demonstra-
tion project (expressed both in absolute dollar terms and as
a percentage) above expenditures that would otherwise have
been incurred for home health services under the medicare
program.
(3) Specific recommendations to exempt permanently and
severely disabled homebound beneficiaries from restrictions on
the length, frequency, and purpose of their absences from the
home to qualify for home health services without incurring
additional costs to the medicare program.
(g) WAIVER AUTHORITY.—The Secretary shall waive compliance
with the requirements of title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.) to such extent and for such period as
the Secretary determines is necessary to conduct demonstration
projects.
(h) CONSTRUCTION.—Nothing in this section shall be construed
as waiving any applicable civil monetary penalty, criminal penalty,
or other remedy available to the Secretary under title XI or title
XVIII of the Social Security Act for acts prohibited under such
titles, including penalties for false certifications for purposes of
receipt of items or services under the medicare program.
(i) AUTHORIZATION OF APPROPRIATIONS.—Payments for the costs
of carrying out the demonstration project under this section shall
be made from the Federal Supplementary Medical Insurance Trust
Fund under section 1841 of such Act (42 U.S.C. 1395t).
(j) DEFINITIONS.—In this section:
(1) MEDICARE
BENEFICIARY.—The term ‘‘medicare bene-
ficiary’’ means an individual who is enrolled under part B
of title XVIII of the Social Security Act.
(2) HOME HEALTH SERVICES.—The term ‘‘home health serv-
ices’’ has the meaning given such term in section 1861(m)
of the Social Security Act (42 U.S.C. 1395x(m)).
(3) ACTIVITIES OF DAILY LIVING DEFINED.—The term ‘‘activi-
ties of daily living’’ means eating, toileting, transferring,
bathing, and dressing.
SEC. 703. DEMONSTRATION PROJECT FOR MEDICAL ADULT DAY-CARE
SERVICES.
(a) ESTABLISHMENT.—Subject to the succeeding provisions of
this section, the Secretary shall establish a demonstration project
(in this section referred to as the ‘‘demonstration project’’) under
which the Secretary shall, as part of a plan of an episode of
care for home health services established for a medicare beneficiary,
permit a home health agency, directly or under arrangements with
a medical adult day-care facility, to provide medical adult day-
care services as a substitute for a portion of home health services
that would otherwise be provided in the beneficiary’s home.
(b) PAYMENT.—
(1) IN
GENERAL.—Subject to paragraph (2), the amount
of payment for an episode of care for home health services,
a portion of which consists of substitute medical adult day-
care services, under the demonstration project shall be made
at a rate equal to 95 percent of the amount that would otherwise
apply for such home health services under section 1895 of
the Social Security Act (42 U.S.C. 1395fff). In no case may
a home health agency, or a medical adult day-care facility
H. R. 1—272
under arrangements with a home health agency, separately
charge a beneficiary for medical adult day-care services fur-
nished under the plan of care.
(2) ADJUSTMENT
IN
CASE
OF
OVERUTILIZATION
OF
SUB-
STITUTE ADULT DAY-CARE SERVICES TO ENSURE BUDGET NEU-
TRALITY.—The Secretary shall monitor the expenditures under
the demonstration project and under title XVIII of the Social
Security Act for home health services. If the Secretary estimates
that the total expenditures under the demonstration project
and under such title XVIII for home health services for a
period determined by the Secretary exceed expenditures that
would have been made under such title XVIII for home health
services for such period if the demonstration project had not
been conducted, the Secretary shall adjust the rate of payment
to medical adult day-care facilities under paragraph (1) in
order to eliminate such excess.
(c) DEMONSTRATION PROJECT SITES.—The demonstration project
established under this section shall be conducted in not more than
5 sites in States selected by the Secretary that license or certify
providers of services that furnish medical adult day-care services.
(d) DURATION.—The Secretary shall conduct the demonstration
project for a period of 3 years.
(e) VOLUNTARY PARTICIPATION.—Participation of medicare bene-
ficiaries in the demonstration project shall be voluntary. The total
number of such beneficiaries that may participate in the project
at any given time may not exceed 15,000.
(f) PREFERENCE IN SELECTING AGENCIES.—In selecting home
health agencies to participate under the demonstration project,
the Secretary shall give preference to those agencies that are cur-
rently licensed or certified through common ownership and control
to furnish medical adult day-care services.
(g) WAIVER
AUTHORITY.—The Secretary may waive such
requirements of title XVIII of the Social Security Act as may be
necessary for the purposes of carrying out the demonstration project,
other than waiving the requirement that an individual be home-
bound in order to be eligible for benefits for home health services.
(h) EVALUATION AND REPORT.—The Secretary shall conduct an
evaluation of the clinical and cost-effectiveness of the demonstration
project. Not later than 6 months after the completion of the project,
the Secretary shall submit to Congress a report on the evaluation,
and shall include in the report the following:
(1) An analysis of the patient outcomes and costs of fur-
nishing care to the medicare beneficiaries participating in the
project as compared to such outcomes and costs to beneficiaries
receiving only home health services for the same health condi-
tions.
(2) Such recommendations regarding the extension, expan-
sion, or termination of the project as the Secretary determines
appropriate.
(i) DEFINITIONS.—In this section:
(1) HOME
HEALTH
AGENCY.—The term ‘‘home health
agency’’ has the meaning given such term in section 1861(o)
of the Social Security Act (42 U.S.C. 1395x(o)).
(2) MEDICAL ADULT DAY-CARE FACILITY.—The term ‘‘medical
adult day-care facility’’ means a facility that—
H. R. 1—273
(A) has been licensed or certified by a State to furnish
medical adult day-care services in the State for a contin-
uous 2-year period;
(B) is engaged in providing skilled nursing services
and other therapeutic services directly or under arrange-
ment with a home health agency;
(C) is licensed and certified by the State in which
it operates or meets such standards established by the
Secretary to assure quality of care and such other require-
ments as the Secretary finds necessary in the interest
of the health and safety of individuals who are furnished
services in the facility; and
(D) provides medical adult day-care services.
(3) MEDICAL ADULT DAY-CARE SERVICES.—The term ‘‘med-
ical adult day-care services’’ means—
(A) home health service items and services described
in paragraphs (1) through (7) of section 1861(m) furnished
in a medical adult day-care facility;
(B) a program of supervised activities furnished in
a group setting in the facility that—
(i) meet such criteria as the Secretary determines
appropriate; and
(ii) is designed to promote physical and mental
health of the individuals; and
(C) such other services as the Secretary may specify.
(4) MEDICARE
BENEFICIARY.—The term ‘‘medicare bene-
ficiary’’ means an individual entitled to benefits under part
A of this title, enrolled under part B of this title, or both.
SEC. 704. TEMPORARY SUSPENSION OF OASIS REQUIREMENT FOR
COLLECTION OF DATA ON NON-MEDICARE AND NON-
MEDICAID PATIENTS.
(a) IN GENERAL.—During the period described in subsection
(b), the Secretary may not require, under section 4602(e) of the
Balanced Budget Act of 1997 (Public Law 105–33; 111 Stat. 467)
or otherwise under OASIS, a home health agency to gather or
submit information that relates to an individual who is not eligible
for benefits under either title XVIII or title XIX of the Social
Security Act (such information in this section referred to as ‘‘non-
medicare/medicaid OASIS information’’).
(b) PERIOD
OF SUSPENSION.—The period described in this
subsection—
(1) begins on the date of the enactment of this Act; and
(2) ends on the last day of the second month beginning
after the date as of which the Secretary has published final
regulations regarding the collection and use by the Centers
for Medicare & Medicaid Services of non-medicare/medicaid
OASIS information following the submission of the report
required under subsection (c).
(c) REPORT.—
(1) STUDY.—The Secretary shall conduct a study on how
non-medicare/medicaid OASIS information is and can be used
by large home health agencies. Such study shall examine—
(A) whether there are unique benefits from the analysis
of such information that cannot be derived from other
information available to, or collected by, such agencies;
and