Detailed Instructions: In this task, you are given text for US Congressional and California state bills, your task is to generate a summary for this bill.
Problem:SECTION 1. SHORT TITLE; FINDINGS.

(a) Short Title.--This Act may be cited as the ''Medicare Home
Health Case Manager Act of 1998''.
(b) Findings.--The Congress finds as follows:
(1) A Medicare beneficiary experiencing a severe or chronic
illness faces a bewildering array of home health and post-acute
care hospital services at a time in life when the Medicare
beneficiary is least able to ''manage'' the choices, especially
for beneficiaries who do not have family members to help them
consider the choices.
(2) Such a Medicare beneficiary may be unaware of the
financial relationships between institutions and agencies which
may cause the patient to be referred for home health services
that are unnecessary or not furnished in the most appropriate
setting.
(3) Medicare fee-for-service does not currently have a
system in which a physician or other health care provider is
encouraged to guide the patient through this maze of services
and help ensure that choices are made that maximize benefits
while minimizing costs.
(4) Chronically ill medicare patients need an independent
ombudsman to help develop a plan of care and to periodically
adjust the plan for the sole benefit of the patient and the
patient's family.

SEC. 2. ESTABLISHMENT OF MEDICARE HOME HEALTH CARE CASE MANAGERS FOR
LONG TERM HOME HEALTH SPELLS OF ILLNESS.

(a) Requirement for Case Management Plan for Beneficiaries
Requiring Extended Home Health Services.--
(1) In general.--Section 1861(m) of the Social Security Act
(42 U.S.C. 1395x(m)) is amended, in the matter preceding
paragraph (1), by inserting after ''under a plan (for
furnishing such items and services to such individual)
established and periodically reviewed by a physician'' the
following: ''and, in the case of such services furnished (or
likely to be required to be furnished) for an extended period
(as defined by the Secretary in regulations), under a home
health case management plan (as defined in subsection (uu)(2))
established by a home health case manager (as defined in
subsection (uu)(1)) in consultation with the physician and, if
available, the family of the individual''.
(2) Definitions.--Section 1861 of such Act (42 U.S.C.
1395x) is amended by adding at the end the following new
subsection:

''Home Health Case Manager

''(uu)(1) The term 'home health case manager' means a public agency
or private organization (or a subdivision thereof) that--
''(A) develops, coordinates, and monitors the delivery of
home health services by home health agencies to an individual;
''(B) has experience and expertise in the furnishing of
home health services; and
''(C) meets such other standards as the Secretary finds
necessary for the effective and efficient development and
oversight of home health case management plans and to ensure
the health and safety of individuals furnished services under
such a plan.
''(2) The term 'home health case management plan' means a
structured plan for the delivery of home health services that is
developed by a home health case manager, after consultation with the
physician and, if available, the family of the individual involved.
''(3) The term 'home health case manager services' means the
development, coordination, and monitoring of a home health case
management plan for an individual furnished (or likely to be required
to be furnished) home health services for an extended period (as
defined by the Secretary in regulations under subsection (m)) and
includes the periodic review of such a plan.''.
(3) Guidance on initiation of case manager services.--The
Secretary of Health and Human Services shall provide guidance
on the process or processes that may be used to identify
Medicare beneficiaries requiring home health services for
extended periods and to develop home health case management
plans on a timely basis.
(4) Limitation on referrals.--Section 1877 of the Social
Security Act (42 U.S.C. 1395nn) shall apply to a referral by a
home health case manager to a home health agency in the same
manner as such section applies to a referral by a physician to
an entity described in section 1877(a)(2) of such Act.
(b) Coverage of and Payment for Home Health Case Manager
Services.--
(1) Part a.--
(A) Coverage.--Section 1812(a)(3) of such Act (42
U.S.C. 1395d(a)(3)) is amended by inserting before the
semicolon '', and home health case manager services (as
defined in section 1861(uu)(3))''.
(B) Eligibility.--Section 1814(a)(2)(C) of such Act
(42 U.S.C. 1395f(a)(2)(C)) is amended by inserting
''and, in the case of such services furnished for an
extended period (as defined by the Secretary under
section 1861(m)), under a home health case management
plan that has been established and periodically
reviewed by a home health case manager'' after ''is
periodically reviewed by a physician''.
(C) Payment.--Section 1812 of such Act (42 U.S.C.
1395d) is amended by adding at the end the following
new subsection:
''(h)(1) Payment under this part for home health case manager
services (as defined in section 1861(uu)(3)) shall be made pursuant to
the fee schedule established by the Secretary under section 1834(m).
''(2)(A) Payment may be made under this title for home health case
manager services in the case of an individual only--
''(i) for the initial development of the home health case
management plan for the individual, and
''(ii) for the subsequent review and modification of such
plan, as provided by the Secretary in regulations.''.
(2) Coverage under part b.--
(A) In general.--Section 1832(a)(2)(A) of such Act
(42 U.S.C. 1395k(a)(2)(A)) is amended by inserting
before the semicolon '', and home health case manager
services (as defined in section 1861(uu)(3))''.
(B) Eligibility.--Section 1835(a)(2) of such Act
(42 U.S.C. 1395n(a)(2)) is amended by inserting ''and,
in the case of such services furnished for an extended
period (as defined by the Secretary under section
1861(m)), under a home health case management plan that
has been established and periodically reviewed by a
home health case manager'' after ''is periodically
reviewed by a physician''.
(C) Payment.--Section 1833 of such Act (42 U.S.C.
1395l) is amended--
(i) in subsection (a)(2)--
(I) by striking ''and'' at the end
of subparagraph (F);
(II) by adding ''and'' at the end
of subparagraph (G); and
(III) by adding after subparagraph
(G) the following new subparagraph:
''(H) subject to subsection (u), with respect to
home health case manager services (as defined in
section 1861(uu)(3), the amount determined under the
fee schedule established under section 1834(m);'', and
(ii) by adding at the end the following new
subsection:
''(u)(1) Payment may be made under this title for home health case
manager services in the case of an individual only--
''(A) for the initial development of the home health case
management plan for the individual, and
''(B) for the subsequent review and modification of such
plan, as provided by the Secretary in regulations.''.
(3) Establishment of Fee Schedule.--Section 1834 of such
Act (42 U.S.C. 1395m) is amended by adding at the end the
following new section:
''(m) Establishment of Fee Schedule for Home Health Case Manager
Services.--
''(1) In general.--The Secretary shall establish a fee
schedule for payment for home health case manager services.
Such schedule may provide for rates that differ for such
services that comprise the establishment of a home health case
management plan and that comprise review and modification of
such a plan.
''(2) Considerations.--In establishing such fee schedule,
the Secretary shall consider appropriate regional and
operational differences and adjustments to payment rates to
account for inflation and other relevant factors.
''(3) Consultation.--In establishing the fee schedule for
home health case manager services under this subsection, the
Secretary shall consult with appropriate organizations
representing individuals and entities who furnish referral
services for home health services and share with such
organizations relevant data in establishing such schedule.''.
(c) Effective Dates.--
(1) Requirement of case management plan.--The amendment
made by subsection (a)(1) applies with respect to home health
services furnished on or after October 1, 2000.
(2) Payment for case manager services.--The amendments made
by subsection (b) apply to home health case manager services
furnished on or after 6 months before the effective date
specified in paragraph (1).

SEC. 3. REPORT TO CONGRESS ON FEASIBILITY OF CASE MANAGERS WITH RESPECT
TO OTHER MEDICARE SERVICES.

(a) Study.--The Secretary of Health and Human Services shall
conduct a study of the types of services consisting of post-acute
hospital care furnished under the Medicare program under title XVIII of
the Social Security Act to determine whether use of case managers and
case management plans similar to home health case managers (as defined
in section 1861(uu)(1)) and home health case management plans (as
defined in section 1861(uu)(2)) is feasible and appropriate for each
such type of service. In conducting the study, the Secretary shall also
determine whether such case managers and case management plans may
improve quality of care and patient outcomes under the medicare
program, may result in cost savings to the program, and may reduce
incidents of waste, fraud and abuse against the program.
(b) Report.--Not later than January 1, 2001, the Secretary shall
submit to Congress a report containing the determinations made pursuant
to the study conducted under subsection (a) and any recommendations for
legislative and administrative action the Secretary deems appropriate.
Solution:
Medicare Home Health Case Manager Act of 1998 - Amends title XVIII (Medicare) of the Social Security Act with regard to home health services to: (1) require a case management plan established by a home health case manager for beneficiaries requiring extended home health services; and (2) provide for coverage of and payment for home health case manager services under Medicare part A (Hospital Insurance) and B (Supplementary Medical Insurance).
Directs the Secretary of Health and Human Services to: (1) establish a fee schedule for payment for home health case manager services; and (2) study and report to the Congress on the feasibility of case managers with respect to Medicare post-acute hospital care services.