S.Amdt. 1025
What it does: Adds SEC. ____. COST-BENEFIT EVALUATION OF SOCIAL HEALTH MAINTENANCE ORGANIZATION II DEMONSTRATION PROJECT AND EXTENSION OF PROJECT AUTHORITY at the end of title VI
Sen. John Ensign (R-NV)What it changes
1 change to S. 1 · shown in the bill's text
Adds SEC. ____. COST-BENEFIT EVALUATION OF SOCIAL HEALTH MAINTENANCE ORGANIZATION II DEMONSTRATION PROJECT AND EXTENSION OF PROJECT AUTHORITY at the end of title VI
Adds a sectionIn S. 1 · Reported to Senate
Section 13031(j)(3) of the Consolidated Omnibus Budget Reconciliation Act of 1985 (19 U.S.C. 58c(j)(3)) is amended by striking "September 30, 2003" and inserting "September 30, 2013". Amend the title so as to read: "A bill to amend title XVIII of the Social Security Act to provide for a voluntary prescription drug benefit under the medicare program and to strengthen and improve the medicare program, and for other purposes.".
Inserted: SEC. ____. COST-BENEFIT EVALUATION OF SOCIAL HEALTH MAINTENANCE ORGANIZATION II DEMONSTRATION PROJECT AND EXTENSION OF PROJECT AUTHORITY.
Inserted: (a) Extension.--Notwithstanding any other provision of law, the Social Health Maintenance Organization II demonstration project described under section 2355(b)(1)(B) of the Deficit Reduction Act of 1984, as amended, shall be conducted for an additional period of 5 years beginning October 1, 2004 under applicable contractual provisions existing on December 31, 2002. Such demonstration project shall be evaluated by an independent organization in accordance with subsection (b). The report on the evaluation and related recommendations shall be provided as described in subsection (c).
Inserted: (b) Evaluation.--
Inserted: (1) Research design.--The Secretary shall provide for a project research design that includes information on the Medicare beneficiaries who are participating in the project and on other Medicare beneficiaries who are covered under fee-for-service and other Medicare+Choice plans and that allows for an appropriate statistical analysis and evaluation of the demonstration project by an independent organization.
Inserted: (2) Data collection.--The Secretary shall require the Social Health Maintenance Organization II to comply with such data collection and reporting requirements as the Secretary determines necessary in order that the assessments can be made as described under subsection (c)(2); and
Inserted: (3) Duration.--The project evaluation period shall last for a period of 3 years.
Inserted: (c) Report.--
Inserted: (1) In general.--The Secretary shall issue to the Congress a final report on the project not later than 9 months after the date of the completion of the evaluation period.
Inserted: (2) Contents of report.--The report under paragraph (1) shall include the following:
Inserted: (A) A description of the demonstration project and the distinguishing characteristics of the Social Health Maintenance Organization II project, including the project's geriatric approach to patient care, extensive care coordination and patient assessments, provision of extended benefits to beneficiaries with targeted health risks, and risk adjusted payment methodology.
Inserted: (B) An evaluation of--
Inserted: (i) the cost-effectiveness of the project compared to the comparison group with respect to the extent of any delay or reduction in the incidence or length of stay in nursing homes or similar institutions and the estimated Medicare and Medicaid cost savings relating to such delay or reductions,
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Inserted: (ii) the extent to which the utilization of physician, home health, coordinated care, geriatric, prescription drug, extended care benefits and other services which are unique to the project result in any reduction in the incidence or length of inpatient stays and in the improvement or lessening in the deterioration of the physical status and mental health functioning of beneficiaries, and
Inserted: (iii) the feasibility of replicating the elements of the Social Health Maintenance Organization II model under other Medicare+Choice plans.
Inserted: To the extent feasible, an evaluation of the elements described in this subparagraph shall be conducted on a longitudinal basis for noninstitutionalized beneficiaries who are at high risk of hospitalization or institutionalization, for other noninstitutionalized beneficiaries who are not at high risk, and for institutionalized beneficiaries. To the extent feasible such evaluations shall be conducted for appropriate age and gender beneficiary categories.
Inserted: (C) A description of the data and criteria and methodology used in conducting the evaluation.
Inserted: (D) Any other information regarding the project that the Secretary determines to be appropriate and any recommendations the Secretary may make regarding the extent to which changes should be made in connection with the project or the extension of the project as a model under the Medicare+Choice program.
Inserted: (d) Definitions.--In this section:
Inserted: (1) Demonstration project.--The term "demonstration project" means the demonstration project described under subsection (a).
Inserted: (2) Medicare beneficiary.--The term "Medicare beneficiary" means an individual entitled to benefits under part A and covered under part B of title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
Inserted: (3) Medicare.--The term "Medicare" means the health benefits program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
Inserted: (4) Medicare+choice.--The term "Medicare+Choice" means the Medicare+Choice health benefits program described under part C of title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), and for years after 2005, the MedicareAdvantage program described under such part.
Inserted: (5) Secretary.--The term "Secretary" means the Secretary of Health and Human Services.
Inserted: (6) Social health maintenance organization ii.--The term "Social Health Maintenance Organization II" means the project described under section 2355(b)(1)(B) of the Deficit Reduction Act of 1984, as amended.
Inserted: (e) Effective Date.--The effective date of this section is the date of the enactment of this Act.
Original wording
At the end of title VI, insert the following:
Read automatically from the Congressional Record. Check the original before relying on it.
As printed
SA 1025. Mr. ENSIGN submitted an amendment intended to be proposed by him to the bill S. 1, to amend title XVIII of the Social Security Act to make improvements in the medicare program, to provide prescription drug coverage under the medicare program, and for other purposes; which was ordered to lie on the table; as follows:
At the end of title VI, insert the following:
SEC. ____. COST-BENEFIT EVALUATION OF SOCIAL HEALTH MAINTENANCE ORGANIZATION II DEMONSTRATION PROJECT AND EXTENSION OF PROJECT AUTHORITY.
(a) Extension.--Notwithstanding any other provision of law, the Social Health Maintenance Organization II demonstration project described under section 2355(b)(1)(B) of the Deficit Reduction Act of 1984, as amended, shall be conducted for an additional period of 5 years beginning October 1, 2004 under applicable contractual provisions existing on December 31, 2002. Such demonstration project shall be evaluated by an independent organization in accordance with subsection (b). The report on the evaluation and related recommendations shall be provided as described in subsection (c).
(b) Evaluation.--
(1) Research design.--The Secretary shall provide for a project research design that includes information on the Medicare beneficiaries who are participating in the project and on other Medicare beneficiaries who are covered under fee-for-service and other Medicare+Choice plans and that allows for an appropriate statistical analysis and evaluation of the demonstration project by an independent organization.
(2) Data collection.--The Secretary shall require the Social Health Maintenance Organization II to comply with such data collection and reporting requirements as the Secretary determines necessary in order that the assessments can be made as described under subsection (c)(2); and
(3) Duration.--The project evaluation period shall last for a period of 3 years.
(c) Report.--
(1) In general.--The Secretary shall issue to the Congress a final report on the project not later than 9 months after the date of the completion of the evaluation period.
(2) Contents of report.--The report under paragraph (1) shall include the following:
(A) A description of the demonstration project and the distinguishing characteristics of the Social Health Maintenance Organization II project, including the project's geriatric approach to patient care, extensive care coordination and patient assessments, provision of extended benefits to beneficiaries with targeted health risks, and risk adjusted payment methodology.
(B) An evaluation of--
(i) the cost-effectiveness of the project compared to the comparison group with respect to the extent of any delay or reduction in the incidence or length of stay in nursing homes or similar institutions and the estimated Medicare and Medicaid cost savings relating to such delay or reductions,
(ii) the extent to which the utilization of physician, home health, coordinated care, geriatric, prescription drug, extended care benefits and other services which are unique to the project result in any reduction in the incidence or length of inpatient stays and in the improvement or lessening in the deterioration of the physical status and mental health functioning of beneficiaries, and
(iii) the feasibility of replicating the elements of the Social Health Maintenance Organization II model under other Medicare+Choice plans.
To the extent feasible, an evaluation of the elements described in this subparagraph shall be conducted on a longitudinal basis for noninstitutionalized beneficiaries who are at high risk of hospitalization or institutionalization, for other noninstitutionalized beneficiaries who are not at high risk, and for institutionalized beneficiaries. To the extent feasible such evaluations shall be conducted for appropriate age and gender beneficiary categories.
(C) A description of the data and criteria and methodology used in conducting the evaluation.
(D) Any other information regarding the project that the Secretary determines to be appropriate and any recommendations the Secretary may make regarding the extent to which changes should be made in connection with the project or the extension of the project as a model under the Medicare+Choice program.
(d) Definitions.--In this section:
(1) Demonstration project.--The term “demonstration project” means the demonstration project described under subsection (a).
(2) Medicare beneficiary.--The term “Medicare beneficiary” means an individual entitled to benefits under part A and covered under part B of title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
(3) Medicare.--The term “Medicare” means the health benefits program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
(4) Medicare+choice.--The term “Medicare+Choice” means the Medicare+Choice health benefits program described under part C of title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), and for years after 2005, the MedicareAdvantage program described under such part.
(5) Secretary.--The term “Secretary” means the Secretary of Health and Human Services.
(6) Social health maintenance organization ii.--The term “Social Health Maintenance Organization II” means the project described under section 2355(b)(1)(B) of the Deficit Reduction Act of 1984, as amended.
(e) Effective Date.--The effective date of this section is the date of the enactment of this Act.
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Senate amendment submitted
June 24, 2003