S 1628 IS

To amend title XVIII of the Social Security Act to increase the number of physicians that complete a fellowship in geriatric medicine and geriatric psychiatry, and for other purposes.

September 23 (legislative day, SEPTEMBER 22), 1999

Mr. REID (for himself, Mr. GRASSLEY, Mr. HARKIN, and Mr. CLELAND) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions

To amend title XVIII of the Social Security Act to increase the number of physicians that complete a fellowship in geriatric medicine and geriatric psychiatry, 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.

This Act may be cited as the `Medicare Physician Workforce Improvement Act of 1999'.

SEC. 2. FINDINGS.

Congress makes the following findings:

(1) The Institute of Medicine, the Alliance for Aging Research, the National Institute on Aging, and the Council on Graduate Medical Education have reported that there is a critical shortage of certified geriatricians.

(2) The average total educational debt that a physician who completes required training including a fellowship in geriatric medicine or geriatric psychiatry in order to become a certified geriatrician exceeds $75,000, and the current reimbursement policy for these physicians creates significant financial disincentives to entering the practice of geriatric medicine and geriatric psychiatry.

(3) It is essential that physicians that provide clinical services to elderly individuals be trained in the range of settings in which medical care is delivered in order to provide those services appropriately.

SEC. 3. GRADUATE MEDICAL EDUCATION FUNDING.

(a) IN GENERAL- Section 1886(h)(4) of the Social Security Act (42 U.S.C. 1395ww(h)(4)) is amended by adding at the end the following:

`(I) GERIATRIC PROGRAMS-

`(i) IN GENERAL- The rules established under this paragraph shall specify that a resident that is enrolled in a fellowship in geriatric medicine or geriatric psychiatry within an approved medical residency training program shall be, for the computation of the number of full-time-equivalent residents in an approved medical residency training program, counted 2 times for the period such resident is enrolled in such fellowship.

`(ii) LIMITATION- The number of residents that are counted 2 times for the computation of the number of full-time-equivalent residents in an approved medical residency training program under clause (i) shall not exceed 400 in any calendar year.'.

(b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to cost reporting periods beginning on or after the date of enactment of this Act.

SEC. 4. DEMONSTRATION PROJECTS TO INCREASE THE NUMBER OF GERIATRICIANS.

(a) DEFINITIONS- In this section:

(1) GERIATRIC TRAINING CONSORTIUM- The term `geriatric training consortium' means a State, regional, or local entity that--

(A) is developed and supported by an accredited geriatric training program;

(B) consists of--

(i) a teaching hospital;

(ii) a skilled nursing facility; and

(iii) an ambulatory care or community-based facility, such as a community clinic, a day treatment program, a hospice program, a managed care organization, or a rehabilitation facility; and

(C) is organized for--

(i) the training of residents enrolled in formal postgraduate training programs in geriatric medicine or geriatric psychiatry; and

(ii) the provision of appropriate training experiences in the care of elderly individuals to residents in primary care disciplines and other health professionals.

(2) PRIMARY CARE- The term `primary care' means family medicine, general internal medicine, general pediatrics, preventive medicine, geriatric medicine, and osteopathic general practice.

(3) RESIDENT- The term `resident' has the meaning given such term in section 1886(h)(5)(I) of the Social Security Act (42 U.S.C. 1395ww(h)(5)(I)).

(4) SECRETARY- The term `Secretary' means the Secretary of Health and Human Services.

(b) DEMONSTRATION PROJECTS-

(1) AUTHORITY- The Secretary, through geriatric training consortia, shall establish and conduct 5 demonstration projects to increase the number of certified geriatricians that are appropriately trained to provide items and services to beneficiaries under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) in a range of patient settings. In conducting demonstration projects under this section, the Secretary shall make payments for the indirect costs of medical education and the direct graduate medical education costs relating to the training of residents to the geriatric training consortia carrying out the projects.

(2) APPLICATION- Any geriatric training consortium seeking to conduct a demonstration project under this section shall submit to the Secretary an application at such time, in such form and manner, and containing such information as the Secretary may require.

(c) WAIVER AUTHORITY- The Secretary may waive compliance with any requirement of titles XI, XVIII, and XIX of the Social Security Act (42 U.S.C. 1301 et seq., 1395 et seq., 1396 et seq.) which, if applied, would prevent a demonstration project carried out under this section from effectively achieving the purpose of the project.

(d) ANNUAL REPORT TO CONGRESS-

(1) IN GENERAL- Beginning 1 year after the date of enactment of this Act, and annually thereafter, the Secretary shall submit to Congress a report that evaluates the effectiveness of the demonstration projects conducted under this section and that contains any legislative recommendations determined appropriate by the Secretary.

(2) CONTINUATION OR REPLICATION OF DEMONSTRATION PROJECTS- Beginning 3 years after the date of enactment of this Act, the report required under paragraph (1) shall include recommendations regarding whether the demonstration projects conducted under this section should be continued and whether broad replication of the project should be initiated.

(e) DURATION- A demonstration project under this section shall be conducted for a period of not more than 5 years. The Secretary may terminate a project if the Secretary determines that the consortium conducting the project is not in substantial compliance with the terms of the application approved by the Secretary.

(f) FUNDING-

(1) IN GENERAL- The Secretary shall provide for the transfer from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Insurance Trust Fund under sections 1817 and 1841 of title XVIII of the Social Security Act (42 U.S.C. 1395i, 1395t), in such proportions as the Secretary determines to be appropriate, of such funds as are necessary for the costs of carrying out the demonstration projects under this section.

(2) LIMITATION-

(A) IN GENERAL- With respect to any year that a demonstration project is conducted under this section, the total amount paid to such a demonstration project shall not exceed the lessor of--

(i) an amount described in subparagraph (B); or

(ii) $1,000,000.

(B) AMOUNT DESCRIBED- An amount described in this subparagraph is an amount equal to the number of geriatric fellows enrolled in a geriatric training consortium for that year multiplied by the amount that the hospital that is part of that geriatric training consortium conducting the demonstration project received under the medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) for the indirect costs of medical education and for direct graduate medical education costs for each full-time-equivalent resident during the hospital's most recent cost reporting period, determined without regard to section 1886(h)(4)(I) of that Act (42 U.S.C. 1395ww(h)(4)(I)) (as added by section 3), and determined as of the date the Secretary appropriates the funds for the demonstration project for that year.

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