Home > 105th Congressional Bills > S. 1149 (es) To amend title 11, United States Code, to provide for increased education funding, and for other purposes. ...S. 1149 (es) To amend title 11, United States Code, to provide for increased education funding, and for other purposes. ...
108th CONGRESS
1st Session
S. 1148
To amend title XVIII of the Social Security Act to provide for the
establishment of medicare demonstration programs to improve health care
quality.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 23, 2003
Mr. Jeffords (for himself, Mr. Frist, Mr. Gregg, Mr. Breaux, Mr.
Feingold, and Ms. Collins) introduced the following bill; which was
read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for the
establishment of medicare demonstration programs to improve health care
quality.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Quality Improvement Act''.
SEC. 2. MEDICARE HEALTH CARE QUALITY DEMONSTRATION PROGRAMS.
Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is
amended by inserting after section 1866B the following:
``health care quality demonstration program
``Sec. 1866C. (a) Definitions.--In this section:
``(1) Beneficiary.--The term `beneficiary' means a
beneficiary who is enrolled in the traditional fee-for-service
program under parts A and B or a beneficiary in a staff model
or dedicated group model health maintenance organization under
the Medicare+Choice program under part C.
``(2) Health care group.--
``(A) In general.--The term `health care group'
means--
``(i) a group of physicians that is
organized at least in part for the purpose of
providing physician's services under this
title;
``(ii) an integrated health care delivery
system that delivers care through coordinated
hospitals, clinics, home health agencies,
ambulatory surgery centers, skilled nursing
facilities, rehabilitation facilities and
clinics, and employed, independent, or
contracted physicians; or
``(iii) an organization representing
regional coalitions of groups or systems
described in clause (i) or (ii).
``(B) Inclusion.--As the Secretary determines
appropriate, a health care group may include a hospital
or any other individual or entity furnishing items or
services for which payment may be made under this title
that is affiliated with the health care group under an
arrangement structured so that such individual or
entity participates in a demonstration project under
this section.
``(3) Physician.--Except as otherwise provided for by the
Secretary, the term `physician' means any individual who
furnishes services that may be paid for as physicians' services
under this title.
``(b) Demonstration Projects.--The Secretary shall establish a 5-
year demonstration program under which the Secretary shall approve
demonstration projects that examine health delivery factors that
encourage the delivery of improved quality in patient care, including--
``(1) the provision of incentives to improve the safety of
care provided to beneficiaries;
``(2) the appropriate use of best practice guidelines by
providers and services by beneficiaries;
``(3) reduced scientific uncertainty in the delivery of
care through the examination of variations in the utilization
and allocation of services, and outcomes measurement and
research;
``(4) encourage shared decision-making between providers
and patients;
``(5) the provision of incentives for improving the quality
and safety of care and achieving the efficient allocation of
resources;
``(6) the appropriate use of culturally and ethnically
sensitive health care delivery; and
``(7) the financial effects on the health care marketplace
of altering the incentives for care delivery and changing the
allocation of resources.
``(c) Administration by Contract.--
``(1) In general.--Except as otherwise provided in this
section, the Secretary may administer the demonstration program
established under this section in the same manner as a
demonstration program established under section 1866A is
administered in accordance with section 1866B.
``(2) Alternative payment systems.--A health care group
that receives assistance under this section may, with respect
to the demonstration project to be carried out with such
assistance, include proposals for the use of alternative
payment systems for items and services provided to
beneficiaries by the group that are designed to--
``(A) encourage the delivery of high quality care
while accomplishing the objectives described in
subsection (b); and
``(B) streamline documentation and reporting
requirements otherwise required under this title.
``(3) Benefits.--A health care group that receives
assistance under this section may, with respect to the
demonstration project to be carried out with such assistance,
include modifications to the package of benefits available
under the traditional fee-for-service program under parts A and
B or the package of benefits available through a staff model or
a dedicated group model health maintenance organization under
part C. The criteria employed under the demonstration program
under this section to evaluate outcomes and determine best
practice guidelines and incentives shall not be used as a basis
for the denial of medicare benefits under the demonstration
program to patients against their wishes (or if the patient is
incompetent, against the wishes of the patient's surrogate) on the
basis of the patient's age or expected length of life or of the
patient's present or predicted disability, degree of medical
dependency, or quality of life.
``(d) Eligibility Criteria.--To be eligible to receive assistance
under this section, an entity shall--
``(1) be a health care group;
``(2) meet quality standards established by the Secretary,
including--
``(A) the implementation of continuous quality
improvement mechanisms that are aimed at integrating
community-based support services, primary care, and
referral care;
``(B) the implementation of activities to increase
the delivery of effective care to beneficiaries;
``(C) encouraging patient participation in
preference-based decisions;
``(D) the implementation of activities to encourage
the coordination and integration of medical service
delivery; and
``(E) the implementation of activities to measure
and document the financial impact of altering the
incentives of health care delivery and changing the
allocation of resources, on the health care
marketplace; and
``(3) meet such other requirements as the Secretary may
establish.
``(e) Waiver Authority.--The Secretary may waive such requirements
of titles XI and XVIII as may be necessary to carry out the purposes of
the demonstration program established under this section.
``(f) Budget Neutrality.--With respect to the 5-year period of the
demonstration program under subsection (b), the aggregate expenditures
under this title for such period shall not exceed the aggregate
expenditures that would have been expended under this title if the
program established under this section had not been implemented.
``(g) Notice Requirements.--In the case of an individual that
receives health care items or services under a demonstration program
carried out under this section, the Secretary shall ensure that such
individual is notified of any waivers of coverage or payment rules that
are applicable to such individual under this title as a result of the
participation of the individual in such program.
``(h) Participation and Support by Federal Agencies.--In carrying
out the demonstration program under this section, the Secretary may
direct--
``(1) the Director of the National Institutes of Health to
expand the efforts of the Institutes to evaluate current
medical technologies and improve the foundation for evidence-
based practice;
``(2) the Administrator of the Agency for Healthcare
Research and Quality to, where possible and appropriate, use
the program under this section as a laboratory for the study of
quality improvement strategies and to evaluate, monitor, and
disseminate information relevant to such program; and
``(3) the Administrator of the Centers for Medicare &
Medicaid Services to support linkages of relevant medicare data
to registry information from participating health care groups
for the beneficiary populations served by the participating
groups, for analysis supporting the purposes of the
demonstration program, consistent with the applicable
provisions of the Health Insurance Portability and
Accountability Act.
``(i) National Steering Committee for Medicare Quality and Safety
Demonstration Programs.--
``(1) Establishment.--The Secretary shall establish within
the Department of Health and Human Services a national steering
committee for medical excellence demonstration programs to
carry out the duties described in paragraph (3).
``(2) Membership.--The membership of the steering committee
established under paragraph (1) shall be appointed by the
Secretary and shall include--
``(A) at least 1 representative from--
``(i) the Assistant Secretary for Planning
and Evaluation;
``(ii) the Agency for Healthcare Research
and Quality;
``(iii) the National Institutes of Health;
and
``(iv) the Centers for Medicare & Medicaid
Services;
``(B) a nationally recognized leader from the field
of health care quality improvement;
``(C) an employer that provides employer-based
health care;
``(D) a health care consumer;
``(E) a representative from the disability
community;
``(F) at least 2 health care providers; and
``(G) an expert in quality of health care
monitoring or in the evaluation of patient safety
standards.
``(3) Duties.--The steering committee shall make
recommendations to the Secretary regarding the design,
evaluation, and participation criteria of the program
established under this section.''.
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