HR 2419 IH

To amend title XVIII of the Social Security Act to reflect original Congressional intent by requiring that the new risk adjustment methodology for Medicare+Choice payment rates be implemented in a budget neutral manner, and for other purposes.

July 1, 1999

Mr. BILIRAKIS (for himself, Mr. DEUTSCH, Mr. LATOURETTE, Mr. TAUZIN, Ms. BROWN of Florida, Mr. GREENWOOD, Mr. TOWNS, Mr. MCCOLLUM, Mr. CANADY of Florida, Mr. GILCHREST, Mr. KOLBE, Mr. BASS, Mrs. FOWLER, Mr. WALDEN of Oregon, and Mr. STEARNS) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

To amend title XVIII of the Social Security Act to reflect original Congressional intent by requiring that the new risk adjustment methodology for Medicare+Choice payment rates be implemented in a budget neutral manner, 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; FINDINGS AND PURPOSE.

(a) SHORT TITLE- This Act may be cited as the `Medicare+Choice Risk Adjustment Amendments of 1999'.

(b) FINDINGS- Congress finds as follows:

(1) The enactment of the Balanced Budget Act of 1997 provided for development and implementation of a new, more sophisticated risk adjustment methodology under the Medicare+Choice program, to assure a better match between payment rates for individuals with different risks enrolled in Medicare+Choice plans. This was in addition to changes in the underlying payment system that was designed to provide for savings to the medicare program.

(2) The Congressional Budget Office did not estimate that this new risk adjustment system would change the overall payment levels for such plans or the participation of such plans in the Medicare+Choice program.

(3) The Health Care Financing Administration has proposed implementation of a new risk adjustment methodology that not only results in substantial reductions in payments to Medicare+Choice plans beyond those contemplated in the Balanced Budget Act of 1997, but also would result in a decrease in the participation of such plans in the program, directly against the intent of Congress and the projections made at the time of the enactment of that Act.

(c) PURPOSE- It is the purpose of section 2 of this Act to restore the original intent of Congress when it required implementation of a new risk adjustment methodology for Medicare+Choice payment rates by assuring that such methodology is established in a budget neutral manner that does not affect overall spending levels under the medicare program using the current risk adjustment methodology.

SEC. 2. APPLICATION OF BUDGET NEUTRALITY PRINCIPLE TO THE NEW MEDICARE+CHOICE RISK ADJUSTMENT METHODOLOGY.

(a) IN GENERAL- Section 1853(a)(3) of the Social Security Act (42 U.S.C. 1395w-23(a)(3)) is amended by adding at the end the following new subparagraph:

`(E) IMPLEMENTATION IN A BUDGET NEUTRAL MANNER- The methodology under this paragraph shall be designed and implemented in a manner so that it does not result in any material change in the aggregate level of expenditures under this title compared to the level that would have occurred if such methodology had not been implemented (and if the previous risk adjustment methodology had continued to be implemented).'.

(b) EFFECTIVE DATE- The amendment made by subsection (a) takes effect on the date of the enactment of this Act and applies to payments for months beginning on or after January 2000.

SEC. 3. ELIMINATION OF ANY FURTHER ADJUSTMENT IN THE NATIONAL PER CAPITA MEDICARE+CHOICE GROWTH PERCENTAGE.

Section 1853(c)(6)(B) of the Social Security Act (42 U.S.C. 1395w-23(c)(6)(B)) is amended--

(1) by inserting `and' at the end of clause (ii);

(2) by striking clauses (iii) through (v); and

(3) in clause (vi), by striking `2002' and inserting `1999' and redesignating such clause as clause (iii).

END