I
107TH CONGRESS
1ST SESSION
H. R. 3027
To amend title XVIII of the Social Security Act to permit expansion of
medical residency training programs in geriatric medicine and to provide
for reimbursement of care coordination and assessment services provided
under the Medicare Program.
IN THE HOUSE OF REPRESENTATIVES
OCTOBER 4, 2001
Mr. GREEN of Texas introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committee
on Ways and Means, 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 amend title XVIII of the Social Security Act to permit
expansion of medical residency training programs in geri-
atric medicine and to provide for reimbursement of care
coordination and assessment services provided under the
Medicare Program.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Geriatric Care Act of
2001’’.
SEC. 2. DISREGARD OF CERTAIN GERIATRIC RESIDENTS
AGAINST GRADUATE MEDICAL EDUCATION
LIMITATIONS.
(a) DIRECT GME.—Section 1886(h)(4)(F) of the So-
cial Security Act (42 U.S.C. 1395ww(h)(4)(F)) is amend-
ed by adding at the end the following new clause:
‘‘(iii) INCREASE IN LIMITATION FOR
GERIATRIC
FELLOWSHIPS.—For cost re-
porting periods beginning on or after the
date that is 6 months after the date of en-
actment of the Geriatric Care Act of 2001,
in applying the limitations regarding the
total number of full-time equivalent resi-
dents in the field of allopathic or osteo-
pathic medicine under clause (i) for a hos-
pital, rural health clinic, or Federally
qualified health center, the Secretary shall
not take into account a maximum of 3
residents enrolled in a fellowship or resi-
dency in geriatric medicine or geriatric
psychiatry within an approved medical
residency training program to the extent
that the hospital, rural health clinic, or
Federally qualified health center increases
the number of such residents above the
number of such residents for the hospital’s,
rural health clinic’s, or Federally qualified
health center’s most recent cost reporting
period ending before the date that is 6
months after the date of enactment of such
Act.’’.
(b) INDIRECT GME.—Section 1886(d)(5)(B) of the
Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is
amended by adding at the end the following new clause:
‘‘(ix) Clause (iii) of subsection (h)(4)(F), inso-
far as such clause applies with respect to hospitals,
shall apply to clause (v) in the same manner and for
the same period as such clause (iii) applies to clause
(i) of such subsection.’’.
SEC. 3. MEDICARE COVERAGE OF CARE COORDINATION
AND ASSESSMENT SERVICES.
(a) PART B COVERAGE OF CARE COORDINATION AND
ASSESSMENT SERVICES.—Section 1861(s)(2) of the So-
cial Security Act (42 U.S.C. 1395x(s)(2)), as amended by
section 105(a) of the Medicare, Medicaid, and SCHIP
Benefits Improvement and Protection Act of 2000 (114
Stat. 2763A–471), as enacted into law by section 1(a)(6)
of Public Law 106–554, is amended—
(1) in subparagraph (U), by striking ‘‘and’’ at
the end;
(2) in subparagraph (V), by inserting ‘‘and’’
after the semicolon at the end; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(W) care coordination and assessment services
(as defined in subsection (ww)).’’.
(b) CARE COORDINATION AND ASSESSMENT SERV-
ICES DEFINED.—Section 1861 of the Social Security Act
(42 U.S.C. 1395x), as amended by section 105(b) of the
Medicare, Medicaid, and SCHIP Benefits Improvement
and Protection Act of 2000 (114 Stat. 2763A–471), as
enacted into law by section 1(a)(6) of Public Law 106–
554), is amended by adding at the end the following new
subsection:
‘‘Care Coordination and Assessment Services; Individual
with a Serious and Disabling Chronic Condition;
Care Coordinator
‘‘(ww)(1) The term ‘care coordination and assess-
ment services’ means services that are furnished to an in-
dividual with a serious and disabling chronic condition (as
defined in paragraph (2)) by a care coordinator (as de-
fined in paragraph (3)) under a plan of care prescribed
by such care coordinator for the purpose of care coordina-
tion and assessment, which may include any of the fol-
lowing services:
‘‘(A) An initial assessment of an individual’s
medical condition, functional and cognitive capacity,
and environmental and psychological needs and an
annual reassessment of such condition, capacity, and
needs, unless the care coordinator determines that a
more frequent reassessment is necessary based on
sentinel health events (as defined by the Secretary)
or a change in health status that may require a
change in the individual’s plan of care.
‘‘(B) The coordination of, and referral for, med-
ical and other health services, including—
‘‘(i) multidisciplinary care conferences;
‘‘(ii) coordination with other providers (in-
cluding telephone consultations with physi-
cians); and
‘‘(iii) the monitoring and management of
medications, with special emphasis on the man-
agement on behalf of an individual with a seri-
ous and disabling chronic condition that uses
multiple medications (including coordination
with the entity managing benefits for the indi-
vidual).
‘‘(C) Patient and family caregiver education
and counseling services (through office visits or tele-
phone consultation), including self-management serv-
ices and risk appraisal services to identify behavioral
risk factors through self-assessment.
‘‘(D) Such other services for which payment
would not otherwise be made under this title as the
Secretary determines to be appropriate, including ac-
tivities to facilitate continuity of care and patient
adherence to plans of care.
‘‘(2) For purposes of this subsection, the term ‘indi-
vidual with a serious and disabling chronic condition’
means an individual who a care coordinator annually
certifies—
‘‘(A) is unable to perform (without substantial
assistance from another individual) at least 2 activi-
ties of daily living (as described in section
7702B(c)(2)(B) of the Internal Revenue Code of
1986) for a period of at least 90 days due to a loss
of functional capacity;
‘‘(B) has a level of disability similar to the level
of disability described in subparagraph (A) (as de-
termined under regulations promulgated by the Sec-
retary);
‘‘(C) requires medical management and coordi-
nation of care due to a complex medical condition
(as defined by the Secretary); or
‘‘(i) be entered into for a period of 1 year and
may be renewed if the Secretary is satisfied that the
care coordinator continues to meet the conditions of
participation specified in subparagraph (A);
‘‘(ii) assure that the care coordinator will sub-
mit reports to the Secretary on the functional and
medical status of individuals with a chronic and dis-
abling condition who receive care coordination serv-
ices, expenditures relating to such services, and
health outcomes relating to such services, except
that the Secretary may not require a care coordi-
nator to submit more than 1 such report during a
year; and
‘‘(iii) contain such other terms and conditions
as the Secretary may require.’’.
(c) PAYMENT
AND
ELIMINATION
OF
COINSUR-
ANCE.—
(1) IN GENERAL.—Section 1833(a)(1) of the
Social Security Act (42 U.S.C. 1395l(a)(1)), as
amended by section 223(c) of the Medicare, Med-
icaid, and SCHIP Benefits Improvement and Pro-
tection Act of 2000 (114 Stat. 2763A–489), as en-
acted into law by section 1(a)(6) of Public Law 106–
554, is amended—
(A) by striking ‘‘and (U)’’ and inserting
‘‘(U)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (V) with respect
to care coordination and assessment services de-
scribed in section 1861(s)(2)(W), the amounts
paid shall be 100 percent of the lesser of the
actual charge for the service or the amount de-
termined under the payment basis determined
under section 1848 by the Secretary for such
service’’.
(2) PAYMENT UNDER PHYSICIAN FEE SCHED-
ULE.—Section 
1848(j)(3) 
(42 
U.S.C. 
1395w–
4(j)(3)) is amended by inserting ‘‘(2)(W),’’ after
‘‘(2)(S),’’.
(3) ELIMINATION
OF
COINSURANCE
IN
OUT-
PATIENT HOSPITAL SETTINGS.—The third sentence
of section 1866(a)(2)(A) of the Social Security Act
(42 U.S.C. 1395cc(a)(2)(A)) is amended by insert-
ing after ‘‘1861(s)(10)(A)’’ the following: ‘‘, with re-
spect to care coordination and assessment services
(as defined in section 1861(ww)(1)),’’.
(d) APPLICATION OF LIMITS ON BILLING.—Section
1842(b)(18)(C) of the Social Security Act (42 U.S.C.
1395u(b)(18)(C)), as amended by section 105(d) of the
Medicare, Medicaid, and SCHIP Benefits Improvement
and Protection Act of 2000 (114 Stat. 2763A–472), as
enacted into law by section 1(a)(6) of Public Law 106–
554, is amended by adding at the end the following new
clause:
‘‘(vii) A care coordinator (as defined in section
1861(ww)(3)) that is not a physician.’’.
(e) EXCEPTION TO LIMITS ON PHYSICIAN REFER-
RALS.—Section 1877(b) of the Social Security Act (42
U.S.C. 1395nn(b)) is amended—
(1) by redesignating paragraph (4) as para-
graph (5); and
(2) by inserting after paragraph (3) the fol-
lowing new paragraph:
‘‘(4) PRIVATE SECTOR PURCHASING AND QUAL-
ITY
IMPROVEMENT
TOOLS
FOR
ORIGINAL
MEDI-
CARE.—In the case of a designated health service, if
the designated health service is—
‘‘(A) a care coordination and assessment
service (as defined in section 1861(ww)(1)); and
‘‘(B) provided by a care coordinator (as
defined in paragraph (3) of such section).’’.
(f) RULEMAKING.—The Secretary of Health and
Human Services shall define such terms and establish
such procedures as the Secretary determines necessary to
implement the provisions of this section.
(g) EFFECTIVE DATE.—The amendments made by
this section shall apply to care coordination and assess-
ment services furnished on or after January 1, 2003.
Æ