article: SECTION 1. SHORT TITLE. This Act may be cited as the ``Medicare Improvements for Special Needs Beneficiaries Act of 2002''. SEC. 2. SPECIALIZED MEDICARE+CHOICE PLANS FOR SPECIAL NEEDS BENEFICIARIES. (a) Establishment of Specialized Medicare+Choice Plans for Special Needs Beneficiaries.-- (1) Treatment as coordinated care plan.--Section 1851(a)(2)(A) of the Social Security Act (42 U.S.C. 1395w- 21(a)(2)(A)) is amended by adding at the end the following new sentence: ``Specialized Medicare+Choice plans for special needs beneficiaries (as defined in section 1859(b)(4)) may be any type of coordinated care plan.''. (2) Specialized medicare+choice plan for special needs beneficiaries defined.--Section 1859(b) of the Social Security Act (42 U.S.C. 1395w-28(b)) is amended by adding at the end the following new paragraph: ``(4) Specialized medicare+choice plans for special needs beneficiaries.-- ``(A) In general.--The term `specialized Medicare+Choice plan for special needs beneficiaries' means a Medicare+Choice plan that exclusively serves special needs beneficiaries (as defined in subparagraph (B)). ``(B) Special needs beneficiary.--The term `special needs beneficiary' means a Medicare+Choice eligible individual who-- ``(i) is institutionalized (as defined by the Secretary); ``(ii) is entitled to medical assistance under a State plan under title XIX; or ``(iii) meets such other requirements as the Secretary may establish for purposes of identifying beneficiaries with a severe and disabling chronic condition who would benefit from enrollment in a Medicare+Choice plan described in subparagraph (A).''. (3) Restriction on enrollment permitted.--Section 1859 of the Social Security Act (42 U.S.C. 1395w-28) is amended by adding at the end the following new subsection: ``(f) Restriction on Enrollment for Specialized Medicare+Choice Plans for Special Needs Beneficiaries.--In the case of a specialized Medicare+Choice plan for special needs beneficiaries (as defined in subsection (b)(4)), notwithstanding any other provision of this part and in accordance with regulations of the Secretary and for periods before January 1, 2008, the plan may restrict the enrollment of individuals under the plan to individuals who are within 1 or more classes of special needs beneficiaries.''. (4) Additional requirements for specialized medicare+choice plans for special needs beneficiaries.--Section 1857(e) of the Social Security Act (42 U.S.C. 1395w-27(e)) is amended by adding at the end the following new paragraph: ``(3) Additional requirements for specialized medicare+choice plans for special needs beneficiaries.--In the case of a specialized Medicare+Choice plan for special needs beneficiaries (as defined in section 1859(b)(4)), the contract shall include additional terms and conditions as follows: ``(A) Clinical delivery system.-- ``(i) In general.--Under the contract, the organization offering the specialized Medicare+Choice plan for special needs beneficiaries shall establish a clinical delivery system that meets the needs of special needs beneficiaries (as defined in section 1859(b)(4)(B)) enrolled in the plan. ``(ii) Elements.--The clinical delivery system established under clause (i) shall include the following: ``(I) A comprehensive patient assessment and plan of care. ``(II) Methods to prevent, delay, or minimize the progression of severe and disabling chronic conditions. ``(III) Care management protocols, including high-risk screening to identify factors that may increase the cost of care provided to special needs beneficiaries. ``(IV) Appropriate specially trained health care staff, such as nurse practitioners, geriatric care managers, and mental health professionals. ``(V) Methods for promoting the integration of care, financing, and administrative functions across health care settings. ``(B) Data collection; development of outcome measures.-- ``(i) Data collection.--Under the contract, the organization offering the specialized Medicare+Choice plan for special needs beneficiaries shall-- ``(I) collect such data as the Secretary may specify for the purpose of monitoring the quality of health care items and services provided to special needs beneficiaries enrolled in the plan, outcomes, and costs, including functional and diagnostic data and information collected through outcome measures developed under clause (ii); ``(II) maintain, and afford the Secretary access to, the records relating to the plan, including pertinent financial, medical, and personnel records; and ``(III) make available to the Secretary reports that the Secretary finds necessary to monitor the operation, cost, and effectiveness of the plan. ``(ii) Development of outcome measures.-- Under the contract, the organization offering the specialized Medicare+Choice plan for special needs beneficiaries and the Secretary shall jointly cooperate in the development and implementation of health status and quality of life outcome measures with respect to special needs beneficiaries (as defined in section 1859(b)(4)(B)) enrolled in the plan. ``(C) Quality assurance; patient safeguards.--The contract shall require the organization offering the specialized Medicare+Choice plan for special needs beneficiaries to have in effect, at a minimum, a written plan of quality assurance and improvement, and procedures implementing such plan, in accordance with regulations. ``(D) Oversight.--The contract shall provide that the Secretary shall conduct, in addition to any other review conducted under this part, such review of the operation of specialized Medicare+Choice plans for special needs beneficiaries and organizations offering such plans as may be appropriate in order to ensure the compliance of the plans and organizations with the requirements of this part and regulations to carry out such requirements.''. (b) Effective Dates.-- (1) In general.--The amendments made by subsection (a) shall take effect upon the date of enactment of this Act. (2) Deadline for issuance of requirements for special needs beneficiaries; transition.--Not later than October 1, 2003, the Secretary of Health and Human Services shall issue final regulations to establish requirements for special needs beneficiaries under section 1859(b)(4)(B)(iii) of the Social Security Act (as added by subsection (a)(2)). SEC. 3. GAO REPORT TO CONGRESS ON SPECIALIZED MEDICARE+CHOICE PLANS FOR SPECIAL NEEDS BENEFICIARIES. (a) In General.--Not later than December 31, 2006, the Comptroller General of the United States shall submit to Congress a report that assesses the impact of specialized Medicare+Choice plans for special needs beneficiaries (as defined in section 1859(b)(4) of the Social Security Act (as added by section 2(a)(2))) on the cost and quality of services provided to enrollees. (b) Contents.--The report submitted under subsection (a) shall contain the following elements: (1) A general assessment of the operations of the specialized Medicare+Choice plans for special needs beneficiaries. (2) Information on the demographics and health status of beneficiaries enrolled in such plans. (3) Information on such plans' clinical models of care. (4) Information on the performance of such plans related to such quality indicators as the Secretary determines to be appropriate. (5) An assessment of the marketing materials and practices of the plans. (6) An assessment of the plans' ability to integrate care, financing, and administrative functions across health care settings. (7) A general assessment of the costs and any savings to the medicare program under title XVIII of the Social Security Act as a result of amendments made by section 2.
summary: Medicare Improvements for Special Needs Beneficiaries Act of 2002 - Amends part C (Medicare+Choice) of title XVIII (Medicare) of the Social Security Act to provide for specialized Medicare+Choice plans for special needs beneficiaries and the treatment of such plans as coordinated care plans under Medicare part C. Permits restriction on the enrollment of individuals in a specialized Medicare+Choice plan to special needs beneficiaries. Establishes additional requirements for specialized Medicare+choice plans for special needs beneficiaries.