I 
108TH CONGRESS 
1ST SESSION 
H. R. 102
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 
JANUARY 7, 2003
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 
2003’’.
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 2003, 
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)) 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) 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 cer-
tifies—
‘‘(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 
‘‘(D) requires substantial supervision to protect 
such individual form threats to health and safety 
due to a severe cognitive impairment (as defined by 
the Secretary). 
‘‘(3)(A) For purposes of this subsection, the term 
‘care coordinator’ means an individual or entity that—
‘‘(i) is—
‘‘(I) a physician (as defined in subsection 
(r)(1)); or 
‘‘(II) a practitioner described in section 
1842(b)(18)(C) or an entity that meets such 
conditions as the Secretary may specify (which 
may include physicians, physician group prac-
tices, or other health care professionals or enti-
ties the Secretary may find appropriate) work-
ing in collaboration with a physician; 
‘‘(ii) has entered into a care coordination agree-
ment with the Secretary; and 
‘‘(iii) meets such other criteria as the Secretary 
may establish (which may include experience in the 
provision of care coordination or primary care physi-
cians’ services). 
‘‘(B) For purposes of subparagraph (A)(ii), each care 
coordination agreement shall—
‘‘(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)) 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) of such Act (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 such Act (42 U.S.C. 
1395cc(a)(2)(A)) is amended by inserting after 
‘‘1861(s)(10)(A)’’ the following: ‘‘, with respect to 
care coordination and assessment services (as de-
fined in section 1861(ww)(1)),’’. 
(d) APPLICATION OF LIMITS ON BILLING.—Section 
1842(b)(18)(C) of such Act (42 U.S.C. 1395u(b)(18)(C)) 
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 such 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, 2004.
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