Title II: Enabling Older Americans and Persons with Disabilities to Improve Their Health Status - Amends SSA title XVIII to provide for the waiver of coinsurance and deductibles for specified preventive services.
(Sec. 202) Directs the Secretary and the Commissioner of Social Security jointly to conduct an information campaign for individuals who have attained age 50 and individuals with disabilities to promote: (1) the use of preventive health services; (2) the proper use of prescription and over-the-counter drugs in order to reduce the number of hospital stays and physician visits among such individuals that result from improper use of such drugs; and (3) the steps that such individuals may take in order to promote and safeguard their health. Directs such officials to provide grants to, and enter into contracts with, eligible entities to assist with carrying out the purposes of this paragraph.
(Sec. 203) Requires the Secretary to develop a health status self-assessment form that includes assessment of mental health status, alcohol use, and substance use, and assists Medicare beneficiaries in identifying important health information, risk factors, or significant symptoms that should be acted upon or discussed with the beneficiary's health care provider.
Directs the Secretary to establish a training program for the staff of State health insurance assistance programs that will enable them to assist Medicare beneficiaries in completing the self-assessment form.
Title III: Improving the Quality of Care Provided to Older Americans and Persons with Disabilities - Directs the Secretary to: (1) conduct a study to determine areas where treatment of Medicare beneficiaries falls short of the highest professional standards and to determine the best practices in such areas; and (2) provide for an information campaign to inform Medicare beneficiaries about the results of such study.
(Sec. 302) Requires the Secretary to establish and report to Congress on a program to: (1) improve treatment of Medicare beneficiaries based on the results of such study and other relevant information; and (2) reduce the number of hospital stays and physician visits among Medicare beneficiaries that result from improper use of prescription and over-the-counter drugs.
(Sec. 303) Directs the Secretary to conduct and report to Congress on a series of studies designed to identify preventive interventions that can be delivered in the primary care setting that are most valuable to older Americans.
Amends the mission statement of the United States Preventive Services Task Force to include the evaluation of services that are of particular relevance to older Americans.
(Sec. 304) Requires the Secretary to conduct and report to Congress on a demonstration project to: (1) evaluate the most successful and cost-effective means of providing smoking cessation services to Medicare beneficiaries; and (2) test incentive systems for physicians, other health care professionals, and Medicare beneficiaries to optimize rates of successful smoking cessation among such beneficiaries.
Title IV: Demonstration Projects to Improve the Care of Residents of Skilled Nursing Facilities and Persons with Serious Illnesses - Directs the Secretary to conduct and report to Congress on demonstration projects designed to provide Medicare beneficiaries who are residents of skilled nursing facilities (SNFs) with higher quality and more cost-effective services in order to avoid unnecessary hospitalizations of such residents.
(Sec. 402) Amends the Balanced Budget Act of 1997 to revise the Medicare coordinated care demonstration project to include fee-for-service program enrollees with a serious illness or a chronic illness. (Currently, only such enrollees with a chronic illness are covered.)
Title V: White House Conference on Improving the Health of Older Americans - Directs the President to convene a White House Conference on Improving the Health of Older Americans.
[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2727 Introduced in Senate (IS)]
106th CONGRESS
2d Session
S. 2727
To improve the health of older Americans and persons with disabilities,
and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 14, 2000
Mr. Kennedy (for himself, Mr. Bryan, Ms. Mikulski, and Mr. Wellstone)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
A BILL
To improve the health of older Americans and persons with disabilities,
and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Medicare Health
Improvement Act of 2000''.
(b) Table of Contents.--The table of contents is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
TITLE I--HCFA MISSION STATEMENT
Sec. 101. Establishment of HCFA mission statement with regard to the
medicare program.
TITLE II--ENABLING OLDER AMERICANS AND PERSONS WITH DISABILITIES TO
IMPROVE THEIR HEALTH STATUS
Sec. 201. Waiver of all preventive services cost sharing under the
medicare program.
Sec. 202. Information campaign on preventive health care for older
Americans and individuals with
disabilities.
Sec. 203. Development of health status self-assessment tool for
medicare beneficiaries.
TITLE III--IMPROVING THE QUALITY OF CARE PROVIDED TO OLDER AMERICANS
AND PERSONS WITH DISABILITIES
Sec. 301. Information campaign for the best practices for the treatment
of conditions of medicare beneficiaries.
Sec. 302. Program to promote the use of best practices for the
treatment of conditions of medicare
beneficiaries and to reduce hospital and
physician visits that result from improper
drug use.
Sec. 303. Studies on preventive interventions in primary care for older
Americans.
Sec. 304. Smoking cessation demonstration project.
TITLE IV--DEMONSTRATION PROJECTS TO IMPROVE THE CARE OF RESIDENTS OF
SKILLED NURSING FACILITIES AND PERSONS WITH SERIOUS ILLNESSES
Sec. 401. Demonstration projects to provide effective care for skilled
nursing facility residents.
Sec. 402. Demonstration projects to improve the care of persons with
serious illnesses.
TITLE V--WHITE HOUSE CONFERENCE ON IMPROVING THE HEALTH OF OLDER
AMERICANS
Sec. 501. White House Conference on Improving the Health of Older
Americans.
SEC. 2. DEFINITIONS.
In this Act:
(1) Commissioner.--The term ``Commissioner'' means the
Commissioner of Social Security.
(2) Medicare beneficiaries.--The term ``medicare
beneficiaries'' means individuals who are entitled to benefits
under part A or enrolled under part B of the medicare program,
including individuals enrolled in a Medicare+Choice plan
offered by a Medicare+Choice organization under part C of such
program.
(3) Medicare program.--The term ``medicare program'' means
the health insurance program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.).
(4) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
TITLE I--HCFA MISSION STATEMENT
SEC. 101. ESTABLISHMENT OF HCFA MISSION STATEMENT WITH REGARD TO THE
MEDICARE PROGRAM.
Part A of title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) is amended by inserting before section 1801 the following:
``hcfa mission statement
``Sec. 1800. In administering the health insurance program
established under this title, it is the mission of the Health Care
Financing Administration to--
``(1) effectively and efficiently administer a program of
health insurance coverage for individuals who are entitled to
benefits under part A or enrolled under part B of this title,
including individuals enrolled in a Medicare+Choice plan
offered by a Medicare+Choice organization under part C of this
title, in accordance with the requirements of this title;
``(2) assure that health care provided to such individuals
is of the highest quality; and
``(3) carry out programs in cooperation with other
Government agencies and the private sector to promote health,
prevent disease, and assure the highest possible functional
level for such individuals.''.
TITLE II--ENABLING OLDER AMERICANS AND PERSONS WITH DISABILITIES TO
IMPROVE THEIR HEALTH STATUS
SEC. 201. WAIVER OF ALL PREVENTIVE SERVICES COST SHARING UNDER THE
MEDICARE PROGRAM.
(a) Waiver of Coinsurance and Deductibles.--
(1) In general.--Section 1834 of the Social Security Act
(42 U.S.C. 1395m) is amended by adding at the end the
following:
``(m) Waiver of Coinsurance and Deductible for Preventive
Services.--
``(1) Coinsurance.--
``(A) In general.--Notwithstanding any other
provision of this part--
``(i) the Secretary shall waive any
coinsurance applicable to services described in
subparagraph (B); and
``(ii) with respect to payment for such
services, any reference to a percent that is
less than 100 percent shall be deemed to be a
reference to 100 percent.
``(B) Services described.--The services described
in this subparagraph are the following services:
``(i) Screening mammography (as defined in
section 1861(jj)).
``(ii) Screening pelvic exam (as defined in
section 1861(nn)(2)).
``(iii) Hepatitis B vaccine and its
administration (under section 1861(s)(10)(B)).
``(iv) Colorectal cancer screening test (as
defined in section 1861(pp)).
``(v) Bone mass measurement (as defined in
section 1861(rr)).
``(vi) Prostate cancer screening test (as
defined in section 1861(oo)).
``(vii) Diabetes outpatient self-management
training services (as defined in section
1861(qq)).
``(2) Deductible.--
``(A) In general.--Notwithstanding any other
provision of this part, the deductible described in
section 1833(b) shall not apply with respect to
services described in subparagraph (B).
``(B) Services described.--The services described
in this subparagraph are the following services:
``(i) Hepatitis B vaccine and its
administration (under section 1861(s)(10)(B)).
``(ii) Colorectal cancer screening test (as
defined in section 1861(pp)).
``(iii) Bone mass measurement (as defined
in section 1861(rr)).
``(iv) Prostate cancer screening test (as
defined in section 1861(oo)).
``(v) Diabetes outpatient self-management
training services (as defined in section
1861(qq)).''.
(2) Conforming amendment.--Section 1833(a) of the Social
Security Act (42 U.S.C. 1395l(a)) is amended by striking
``section 1876'' and inserting ``sections 1834 and 1876'' in
the matter preceding paragraph (1).
(b) Effective Date.--The amendments made by this section shall
apply to services furnished on or after December 31, 2001.
SEC. 202. INFORMATION CAMPAIGN ON PREVENTIVE HEALTH CARE FOR OLDER
AMERICANS AND INDIVIDUALS WITH DISABILITIES.
(a) In General.--The Secretary and the Commissioner shall jointly
conduct an information campaign, in consultation with the heads of
other Government agencies and States and the private sector, for
individuals who have attained age 50 and individuals with disabilities
to promote--
(1) the use of preventive health services among such
individuals, including services that are available to medicare
beneficiaries and are covered by the medicare program;
(2) the proper use of prescription and over-the-counter
drugs in order to reduce the number of hospital stays and
physician visits among such individuals that are a result of
the improper use of such drugs; and
(3) the steps (including exercise, maintenance of a proper
diet, and utilization of accident prevention techniques) that
such individuals may take in order to promote and safeguard
their health.
(b) Use of Services.--The information campaign described in
subsection (a) shall stress the benefits of--
(1) using the services described in subsection (a)(1);
(2) following the proper directions for using prescription
and over-the-counter drugs as described in subsection (a)(2);
and
(3) utilizing the steps described in subsection (a)(3).
(c) Elements of Campaign.--In conducting the information campaign
described in subsection (a), the Secretary and the Commissioner (as
applicable) shall--
(1) expand the section in the Medicare and You handbook on
preventive benefits to include a more detailed description of
the importance of using preventive health services and the
benefits offered under the medicare program;
(2) instruct fiscal intermediaries and carriers under the
medicare program to include preventive benefits messages on the
Medicare Summary Notice statement and the Explanation of
Medicare Benefits;
(3) regularly include preventive benefits messages on the
medicare part B benefits statement;
(4) combine public service announcements and a print media
campaign to raise awareness of the value of using preventive
health services;
(5) distribute brochures and other information on health
promotion and disease prevention activities through--
(A) State health insurance assistance programs;
(B) area agencies on aging;
(C) Social Security Administration field offices;
and
(D) any other appropriate entities, as determined
by the Secretary and the Commissioner; and
(6) include information on the importance of using
preventive health services--
(A) on the cost of living adjustment (COLA) notice,
which is sent to individuals who receive disability
benefits under titles II and XVI of the Social Security
Act (42 U.S.C. 401 et seq.; 1381 et seq.);
(B) on the social security account statements
distributed pursuant to section 1143 of the Social
Security Act (42 U.S.C. 1320b-13); and
(C) in brochures on retirement and survivors'
benefits that are produced by the Commissioner.
(d) Targeted Populations.--To the extent appropriate, aspects of
the information campaign described in subsection (a) may be targeted to
specific subpopulations of medicare beneficiaries.
(e) Grants and Contracts.--
(1) In general.--The Secretary and the Commissioner shall
provide grants to, and enter into contracts with, eligible
entities to assist with carrying out the purposes of this
section.
(2) Eligible entity defined.--In this subsection, the term
``eligible entity'' means--
(A) any community organization working with
medicare beneficiaries;
(B) any organization representing medicare
beneficiaries;
(C) area agencies on aging; and
(D) any other appropriate entities, as determined
by the Secretary and the Commissioner.
SEC. 203. DEVELOPMENT OF HEALTH STATUS SELF-ASSESSMENT TOOL FOR
MEDICARE BENEFICIARIES.
(a) Development.--The Secretary, in conjunction with the Director
of the National Institutes of Health (NIH), the Director of the Centers
for Disease Control and Prevention (CDC), the Administrator of the
Substance Abuse and Mental Health Services Administration (SAMHSA), and
the Administrator of the Agency for Healthcare Research and Quality
(AHRQ), shall develop a health status self-assessment tool that
includes assessment of mental health status, alcohol use, and substance
use, and assists medicare beneficiaries in identifying important health
information, risk factors, or significant symptoms that should be acted
upon or discussed with the beneficiary's health care provider.
(b) Distribution.--The Secretary shall establish procedures for the
distribution of the self-assessment form developed under subsection (a)
and may contract with the eligible entities described in section
202(e)(2) to distribute and promote the use of such forms.
(c) Training.--The Secretary shall establish a training program for
the staff of State health insurance assistance programs that will
enable such staff to assist medicare beneficiaries in completing the
self-assessment form developed under subsection (a).
TITLE III--IMPROVING THE QUALITY OF CARE PROVIDED TO OLDER AMERICANS
AND PERSONS WITH DISABILITIES
SEC. 301. INFORMATION CAMPAIGN FOR THE BEST PRACTICES FOR THE TREATMENT
OF CONDITIONS OF MEDICARE BENEFICIARIES.
(a) Study.--The Secretary, in consultation with the Administrator
for Health Care Policy and Research, the Director of the National
Institutes of Health, and such other professional societies and experts
as the Secretary considers appropriate, shall--
(1) conduct a study to determine areas where treatment of
medicare beneficiaries falls short of the highest professional
standards; and
(2) determine the best practices in the areas described in
paragraph (1).
(b) Information Campaign.--The Secretary shall provide for an
information campaign to inform medicare beneficiaries about the results
of the study conducted under subsection (a).
SEC. 302. PROGRAM TO PROMOTE THE USE OF BEST PRACTICES FOR THE
TREATMENT OF CONDITIONS OF MEDICARE BENEFICIARIES AND TO
REDUCE HOSPITAL AND PHYSICIAN VISITS THAT RESULT FROM
IMPROPER DRUG USE.
(a) In General.--The Secretary, in conjunction with the
Administrator of the Health Resources and Service Administration and
such other agencies and professional societies as the Secretary deems
appropriate, shall establish a program to--
(1) improve treatment of medicare beneficiaries based on
the results of the study conducted under section 301(a) and
other relevant information; and
(2) reduce the number of hospital stays and physician
visits among medicare beneficiaries that are a result of the
improper use of prescription and over-the-counter drugs.
(b) Elements of Program.--The program described in subsection (a)
shall include--
(1) an information campaign for health professionals;
(2) coordination of the part of the program established
under subsection (a) that is designed to achieve the purpose
described in paragraph (2) of that subsection with the
information campaign conducted under section 202; and
(3) any other activity the Secretary considers appropriate
to carry out the purposes described in subsection (a).
(c) Demonstrations and Grants.--In establishing the program under
subsection (a), the Secretary may conduct demonstration projects and
award grants to eligible entities (as defined in subsection (d)).
(d) Eligible Entity Defined.--In this section, the term ``eligible
entity'' means an entity that is an academic health center, a
professional medical society, or such other entity as the Secretary
considers appropriate to carry out the purposes of this section.
(e) Report to Congress.--Not later than 1 year after the date of
enactment of this Act, and annually thereafter, the Secretary shall
annually report to Congress on the program conducted under this
section.
SEC. 303. STUDIES ON PREVENTIVE INTERVENTIONS IN PRIMARY CARE FOR OLDER
AMERICANS.
(a) Studies.--The Secretary, acting through the United States
Preventive Services Task Force, shall conduct a series of studies
designed to identify preventive interventions that can be delivered in
the primary care setting that are most valuable to older Americans.
(b) Mission Statement.--The mission statement of the United States
Preventive Services Task Force is amended to include the evaluation of
services that are of particular relevance to older Americans.
(c) Report.--Not later than 1 year after the date of enactment of
this Act, and annually thereafter, the Secretary shall submit a report
to Congress on the conclusions of the studies conducted under
subsection (a), together with recommendations for such legislation and
administrative actions as the Secretary considers appropriate.
SEC. 304. SMOKING CESSATION DEMONSTRATION PROJECT.
(a) In General.--The Secretary, acting through the Administrator of
the Health Care Financing Administration, shall conduct a demonstration
project to--
(1) evaluate the most successful and cost-effective means
of providing smoking cessation services to medicare
beneficiaries; and
(2) test incentive systems for physicians, other health
care professionals, and medicare beneficiaries to optimize
rates of successful smoking cessation among medicare
beneficiaries.
(b) Latest Scientific Evidence.--The Secretary shall use the latest
scientific evidence regarding smoking cessation strategies and
guidelines in conducting the demonstration project under this section.
(c) Payment.--Payment to an individual or an entity for a service
provided under the demonstration project shall be equal to the lesser
of--
(1) the actual charge for providing the service to a
medicare beneficiary; or
(2) the amount determined by a fee schedule established by
the Secretary for the purposes of this section for such
service.
(d) Waiver Authority.--
(1) In general.--The Secretary may waive such requirements
of the medicare program as may be necessary for the purposes of
carrying out the demonstration project conducted under this
section.
(2) Non-medicare providers.--Individuals and entities that
do not provide items and services under the medicare program
shall be permitted to participate in the demonstration project
conducted under this section.
(e) Report to Congress.--Not later than 1 year after the date of
enactment of this Act, and annually thereafter, the Secretary shall
report to Congress on the demonstration project conducted under this
section.
TITLE IV--DEMONSTRATION PROJECTS TO IMPROVE THE CARE OF RESIDENTS OF
SKILLED NURSING FACILITIES AND PERSONS WITH SERIOUS ILLNESSES
SEC. 401. DEMONSTRATION PROJECTS TO PROVIDE EFFECTIVE CARE FOR SKILLED
NURSING FACILITY RESIDENTS.
(a) In General.--The Secretary shall conduct demonstration projects
that are designed to provide medicare beneficiaries who are residents
of skilled nursing facilities (as defined in section 1819(a) of the
Social Security Act (42 U.S.C. 1395i-3(a)) with higher quality and more
cost-effective services in order to avoid unnecessary hospitalizations
of such residents.
(b) Requirements.--
(1) In general.--The demonstration projects conducted under
this section shall include the following:
(A) Programs of case management.
(B) Programs of disease management.
(C) Such other programs as the Secretary determines
are likely to increase the quality of, and reduce the
cost of, the care provided to such residents.
(2) Authorized techniques.--The demonstration projects
conducted under this section may utilize--
(A) contracts with centers of excellence or other
entities or individuals with special expertise in
providing quality services to residents of skilled
nursing facilities;
(B) innovative payment techniques, including
capitation payments, for all or selected services
provided under such projects and incentive payments to
reward favorable cost and quality outcomes;
(C) provision of services not normally covered
under the medicare program, if the provision of such
services would result in the more cost-effective
provision of, or higher quality of, services covered
under such program; or
(D) reduced cost-sharing requirements for medicare
beneficiaries participating in such projects.
(c) Waiver Authority.--The Secretary may waive such requirements of
the medicare program as may be necessary for the purposes of carrying
out the demonstration projects conducted under this section other than
requirements relating to providing medicare beneficiaries with freedom
of choice of provider under section 1802 of the Social Security Act (42
U.S.C.1395a) or any other provision of law.
(d) Report to Congress.--Not later than 1 year after the date of
enactment of this Act, and annually thereafter, the Secretary shall
report to Congress on the demonstration projects conducted under this
section.
SEC. 402. DEMONSTRATION PROJECTS TO IMPROVE THE CARE OF PERSONS WITH
SERIOUS ILLNESSES.
(a) Expansion of Medicare Coordinated Care Demonstration Project.--
Section 4016 of the Balanced Budget Act (Public Law 105-33; 111 Stat.
343) is amended--
(1) by striking subsection (a)(2) and inserting the
following:
``(2) Target individual defined.--In this section, the term
``target individual'' means an individual that is enrolled
under the fee-for-service program under parts A and B of title
XVIII of the Social Security Act (42 U.S.C. 1395c et seq.;
1395j et seq.) and--
``(A) has a chronic illness, as defined and
identified by the Secretary; or
``(B) has a serious illness, as so defined and
identified.'';
(2) in subsection (b)(2), by striking ``Not'' and inserting
``With respect to demonstration projects for items and services
provided to target individuals described in subsection
(a)(2)(A), not''; and
(3) by adding at the end the following:
``(f) Requirements.--
``(1) In general.--The demonstration projects conducted
under this section shall include--
``(A) programs of case management;
``(B) programs of disease management; and
``(C) such other programs as the Secretary
determines are likely to increase the quality of, and
reduce the cost of, the care provided to target
individuals.
``(2) Authorized techniques.--The demonstration projects
conducted under this section may include--
``(A) contracts with centers of excellence or other
entities or individuals with special expertise in
providing quality services to target individuals;
``(B) innovative payment techniques, including
capitation payments, for all or selected services
provided under such projects and incentive payments to
reward favorable cost and quality outcomes;
``(C) provision of services not normally covered
under title XVIII of the Social Security Act (42 U.S.C
1395 et seq.), if the provision of such services would
result in the more cost-effective provision of, or
higher quality of, services covered under that title;
or
``(D) reduced cost-sharing requirements for target
individuals participating in such projects.''.
(b) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act.
TITLE V--WHITE HOUSE CONFERENCE ON IMPROVING THE HEALTH OF OLDER
AMERICANS
SEC. 501. WHITE HOUSE CONFERENCE ON IMPROVING THE HEALTH OF OLDER
AMERICANS.
(a) In General.--Not later than December 31, 2002, the President
shall convene a White House Conference on Improving the Health of Older
Americans.
(b) Goal of Conference.--The goal of the Conference shall be to--
(1) develop a consensus on a program to enable older
Americans to protect and improve their own health;
(2) develop procedures to ensure that--
(A) older Americans are provided with the highest
standard of health care available, with an emphasis on
assuring that standard practice is also the best
practice; and
(B) the needs of older Americans are more
effectively met through the benefits provided under the
medicare program; and
(3) outline a research and demonstration agenda to further
the goals described in paragraphs (1) and (2).
(c) Conference Participants.--
(1) Participants.--In order to carry out the purposes of
this section, the Conference shall bring together--
(A) representatives of older Americans and those
who care for older Americans;
(B) researchers and research institutions with an
expertise in issues related to older Americans;
(C) health professionals and members of
professional societies with expertise in caring for
older Americans; and
(D) other appropriate parties.
(2) Selection of delegates.--The participants shall be
selected without regard to political affiliation or past
partisan activity and shall, to the best of the President's
ability, be representative of the spectrum of thought in the
field of geriatric health care.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S5109)
Read twice and referred to the Committee on Finance. (text of measure as introduced: CR S5109-5112)
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