P.L. 105–33, Approved August 5, 1997 (111 Stat. 329)

SEC. 4105. [42 U.S.C. 1395x note]  DIABETES SELF-MANAGEMENT BENEFITS.

(c)  Establishment of Outcome Measures for Beneficiaries With Diabetes.—

(1)  In general.—The Secretary of Health and Human Services, in consultation with appropriate organizations, shall establish outcome measures, including glysolated hemoglobin (past 90-day average blood sugar levels), for purposes of evaluating the improvement of the health status of medicare beneficiaries with diabetes mellitus.

(2)  Recommendations for modifications to screening benefits.—Taking into account information on the health status of medicare beneficiaries with diabetes mellitus as measured under the outcome measures established under paragraph (1), the Secretary shall from time to time submit recommendations to Congress regarding modifications to the coverage of services for such beneficiaries under the medicare program.

SEC. 4202. [42 U.S.C. 1395ww note]  PROHIBITING DENIAL OF REQUEST BY RURAL REFERRAL CENTERS FOR CLASSIFICATION ON BASIS OF COMPARABILITY OF WAGES.

(b)  Continuing Treatment of Previously Designated Centers.—

(1)  In general.—Any hospital classified as a rural referral center by the Secretary of Health and Human Services undersection 1886(d)(5)(C) of the Social Security Act for fiscal year 1991 shall be classified as such a rural referral center for fiscal year 1998 and each subsequent fiscal year.

(2)  Budget neutrality.—The provisions of section 1886(d)(8)(D) of the Social Security Act shall apply to reclassifications made pursuant to paragraph (1) in the same manner as such provisions apply to a reclassification under section 1886(d)(10) of such Act.

SEC. 4409. [42 U.S.C. 1395ww note]  GEOGRAPHIC RECLASSIFICATION FOR CERTAIN DISPROPORTIONATELY LARGE HOSPITALS.

(a)  New Guidelines for Reclassification.—Notwithstanding the guidelines published under section 1886(d)(10)(D)(i)(I) of the Social Security Act (42 U.S.C. 1395ww(d)(10)(D)(i)(I)), the Secretary of Health and Human Services shall publish and use alternative guidelines under which a hospital described in subsection (b) qualifies for geographic reclassification under such section for a fiscal year beginning with fiscal year 1998.

SEC. 4410. [42 U.S.C. 1395ww note]  FLOOR ON AREA WAGE INDEX.

(a)  In General.—For purposes of section 1886(d)(3)(E) of the Social Security Act (42 U.S.C. 1395ww(d)(3)(E)) for discharges occurring on or after October 1, 1997, the area wage index applicable under such section to any hospital which is not located in a rural area (as defined in section 1886(d)(2)(D) of such Act (42 U.S.C. 1395ww(d)(2)(D)) may not be less than the area wage index applicable under such section to hospitals located in rural areas in the State in which the hospital is located.

(b)  Implementation.—The Secretary of Health and Human Services shall adjust the area wage index referred to in subsection (a) for hospitals not described in such subsection in a manner which assures that the aggregate payments made under section 1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)) in a fiscal year for the operating costs of inpatient hospital services are not greater or less than those which would have been made in the year if this section did not apply.

SEC. 4628. [42 U.S.C. 1395ww note]  DEMONSTRATION PROJECT ON USE OF CONSORTIA.

(a)  In General.—The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall establish a demonstration project under which, instead of making payments to teaching hospitals pursuant to section 1886(h) of the Social Security Act, the Secretary shall make payments under this section to each consortium that meets the requirements of subsection (b) and that applies to be included under the project.

(b)  Qualifying Consortia.—For purposes of subsection (a), a consortium meets the requirements of this subsection if the consortium is in compliance with the following:

(1)  The consortium consists of a teaching hospital with one or more approved medical residency training programs and one or more of the following entities:

(A)  A school of allopathic medicine or osteopathic medicine.

(B)  Another teaching hospital, which may be a children’s hospital.

(C)  A Federally qualified health center.

(D)  A medical group practice.

(E)  A managed care entity

(F)  An entity furnishing outpatient services.

(G)  Such other entity as the Secretary determines to be appropriate.

(2)  The members of the consortium have agreed to participate in the programs of graduate medical education that are operated by the entities in the consortium.

(3)  With respect to the receipt by the consortium of payments made pursuant to this section, the members of the consortium have agreed on a method for allocating the payments among the members.

(4)  The consortium meets such additional requirements.

(c)  Amount and Source of Payment.—The total of payments to a qualifying consortium for a fiscal year pursuant to subsection (a) shall not exceed the amount that would have been paid under section 1886 (h) or (k) of the Social Security Act for the teaching hospital (or hospitals) in the consortium. Such payments shall be made in such proportion from each of the trust funds established under title XVIII of such Act as the Secretary specifies.

SEC. 4804.  STUDY AND REPORTS.

(c) [42 U.S.C. 1395b-6 note]  Information Included in Annual Recommendations.—The Medicare Payment Advisory Commission shall include in its annual report under section 1805(b)(1)(B) of the Social Security Act recommendations on the methodology and level of payments made to PACE providers under sections 1894(d) and 1934(d) of such Act and on the treatment of private, for-profit entities as PACE providers.