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H.R.3075
Medicare Balanced Budget Refinement Act of 1999 (Introduced in the
House)
SEC. 501. PHASE-IN OF NEW RISK
ADJUSTMENT METHODOLOGY.
Section 1853(a)(3)(C) (42 U.S.C. 1395w-23(a)(3)(C)) is amended--
(1) by redesignating the first sentence as clause (i) with the heading
`IN GENERAL- ' and appropriate indentation; and
(2) by adding at the end the following new clause:
`(ii) PHASE-IN- Such risk adjustment methodology shall be
implemented in a phased-in manner so that the new methodology applies
only to--
`(I) 10 percent of the payment amount in 2000 and
2001;
`(II) 20 percent of such amount in 2002;
`(III) 30 percent of such amount in 2003; and
`(IV) 100 percent of such amount in any subsequent year (in which
the risk adjustment methodology should
reflect data from all settings).'.
SEC. 502. ENCOURAGING OFFERING OF MEDICARE+CHOICE PLANS IN AREAS WITHOUT
PLANS.
Section 1853 (42 U.S.C. 1395w-23) is amended--
(1) in subsection (a)(1), by striking `subsections (e) and (f)' and
inserting `subsections (e), (g), and (i)';
(2) in subsection (c)(5), by inserting `(other than those attributable
to subsection (i))' after `payments under this part'; and
(3) by adding at the end the following new subsection:
`(1) IN GENERAL- Subject to paragraphs (2) and (3), in the case of
Medicare+Choice payment area in which a Medicare+Choice plan has not been
offered since 1997 (or in which any organization that offered a plan since
such date has announced, as of October 13, 1999, that it will not be
offering such plan as of January 1, 2000), the amount of the monthly payment
otherwise made under this subsection shall be increased--
`(A) only for the first 12 months in which any Medicare+Choice plan is
offered in the area, by 5 percent of the payment rate otherwise computed;
and
`(B) only for the subsequent 12 months, by 3 percent of the payment
rate otherwise computed.
If such 12 months are not a calendar year, the Secretary shall provide
for an appropriate blend of such percentage increases for the second and
third calendar years in which months described in subparagraph (B) occur to
reflect the proportion of such months in each such year.
`(2) PERIOD OF APPLICATION- Paragraph (1) shall only apply to payment
for Medicare+Choice plans which are first offered in a Medicare+Choice
payment area during the 2-year period beginning with January 1, 2000.
`(3) LIMITATION TO ORGANIZATION OFFERING FIRST PLAN IN AN AREA-
Paragraph (1) shall only apply to payment to the first Medicare+Choice
organization that offers a Medicare+Choice plan in each Medicare+Choice
payment area, except that if more than one such organization first offers
such a plan in an area on the same date, paragraph (1) shall apply to
payment for such organizations.
`(4) CONSTRUCTION- Nothing in paragraph (1) shall be construed as
affecting the Medicare+Choice capitation rate for any area or as applying to
payment for any period not described in such paragraph.'.
SEC. 503. MODIFICATION OF 5-YEAR RE-ENTRY RULE FOR CONTRACT
TERMINATIONS.
(a) IN GENERAL- Section 1857(c)(4) (42 U.S.C. 1395w-27(c)(4)) is
amended--
(1) by inserting `as provided in paragraph (2) and except' after `except
as provided';
(2) by redesignating the first sentence as a subparagraph (A) with an
appropriate indentation and the heading `IN GENERAL- '; and
(3) by adding at the end the following new subparagraph:
`(B) EARLIER RE-ENTRY PERMITTED WHERE CHANGE IN PAYMENT POLICY AND NO
MORE THAN ONE OTHER PLAN AVAILABLE- Subparagraph (A) shall not apply with
respect to the offering by a Medicare+Choice organization of a
Medicare+Choice plan in a Medicare+Choice payment area if--
`(i) during the 6-month period beginning on the date the
organization notified the Secretary of the intention to terminate the
most recent previous contract, there was a legislative change enacted
(or a regulatory change adopted) that has the effect of increasing
payment rates under section 1853 for that Medicare+Choice payment area;
and
`(ii) at the time the organization notifies the Secretary of its
intent to enter into a contract to offer such a plan in the area, there
is no more than one
Medicare+Choice plan offered in the area.'.
(b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply to
contract terminations occurring before, on, or after the date of the enactment
of this Act.
SEC. 504. CONTINUED COMPUTATION AND PUBLICATION OF AAPCC DATA.
(a) IN GENERAL- Section 1853(b) (42 U.S.C. 1395w-23(b)) is amended by
adding at the end the following new paragraph:
`(4) CONTINUED COMPUTATION AND PUBLICATION OF COUNTY-SPECIFIC PER CAPITA
FEE-FOR-SERVICE EXPENDITURE INFORMATION- The Secretary, through the Chief
Actuary of the Health Care Financing Administration, shall provide for the
computation and publication, on an annual basis at the time of publication
of the annual Medicare+Choice capitation rates, of information on the level
of the average annual per capita costs (described in section 1876(a)(4)) for
each Medicare+Choice payment area.'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) shall take effect
on the date of the enactment of this Act and apply to publications of the
annual Medicare+Choice capitation rates made on or after such date.
SEC. 505. PERMITTING ENROLLMENT IN ALTERNATIVE MEDICARE+CHOICE PLANS AND
MEDIGAP COVERAGE IN CASE OF INVOLUNTARY TERMINATION OF MEDICARE+CHOICE
ENROLLMENT.
(a) IN GENERAL- Section 1851(e)(4) (42 U.S.C. 1395w-21(e)(4)) is amended
by striking subparagraph (A) and inserting the following:
`(A)(i) the certification of the organization or plan under this part
has been terminated, or the organization or plan has notified the
individual or the Secretary of an impending termination of such
certification; or
`(ii) the organization has terminated or otherwise discontinued
providing the plan in the area in which the individual resides, or has
notified the individual or Secretary of an impending termination or
discontinuation of such plan;'.
(b) CONFORMING MEDIGAP AMENDMENT- Section 1882(s)(3)(A) (42 U.S.C.
1395ss(s)(3)(A)) is amended, in the matter following clause (iii)--
(1) by inserting `(or, if elected by the individual, the date of
notification of the individual or the Secretary by the plan or organization
of the impending termination or discontinuance of the plan in the area in
which the individual resides)' after `the date of the termination of
enrollment described in such subparagraph'; and
(2) by inserting `(or the date of such notification)' after `the date of
termination or disenrollment'.
(c) EFFECTIVE DATE- The amendments made by this subsection shall apply to
notices of impending terminations or discontinuances made before, on, or after
the date of the enactment of this Act, except that, for purposes of applying
such amendments with respect to a notice of a termination or discontinuance
that was made before such date and for which the termination or discontinuance
occurs after such date, such notice shall be treated as having occurred on the
date of the enactment of this Act.
SEC. 506. ALLOWING VARIATION IN PREMIUM WAIVERS WITHIN A SERVICE AREA IF
MEDICARE+CHOICE PAYMENT RATES VARY WITHIN THE AREA.
(a) IN GENERAL- Section 1854(c) (42 U.S.C. 1395w-24(c)) is amended--
(1) by striking `The' and inserting `Subject to paragraph (2),
the';
(2) by redesignating the first sentence as a paragraph (1) with an
appropriate indentation and the heading `IN GENERAL- '; and
(3) by adding at the end the following new paragraph:
`(2) VARIATION IN PREMIUM WAIVER PERMITTED- A Medicare+Choice
organization may waive part or all of a premium described in paragraph (1)
for one or more Medicare+Choice payment areas within its service area if the
annual Medicare+Choice capitation rates under section 1853(c) vary between
such payment area and other payment areas within such service area.'.
(b) EFFECTIVE DATE- The amendments made by subsection (a) apply to
premiums for contract years beginning on or after January 1, 2001.
SEC. 507. DELAY IN DEADLINE FOR SUBMISSION OF ADJUSTED COMMUNITY RATES AND
RELATED INFORMATION.
(a) DELAY IN DEADLINE FOR SUBMISSION OF ADJUSTED COMMUNITY RATES AND
RELATED INFORMATION- Section 1854(a)(1) (42 U.S.C. 1395w-24(a)(1)) is amended
by striking `May 1' and inserting `July 1'.
(b) ADJUSTMENT IN
INFORMATION DISCLOSURE PROVISIONS- Section 1851(d)(2)(A)(ii) (42 U.S.C.
1395w-21(d)(2)(A)(ii)) is amended by inserting after `information described in
paragraph (4) concerning such plans' the following: `, to the extent such
information is available at the time of preparation of the material for
mailing'.
SEC. 508. 2 YEAR EXTENSION OF MEDICARE COST CONTRACTS.
Section 1876(h)(5)(B) (42 U.S.C. 1395mm(h)(5)(B)) is amended by striking
`2002' and inserting `2004'.
SEC. 509. MISCELLANEOUS CHANGES.
(a) PERMITTING RELIGIOUS FRATERNAL BENEFIT SOCIETIES TO OFFER A RANGE OF
MEDICARE+CHOICE PLANS- Section 1859(e)(2)(A) (42 U.S.C. 1395w-29(e)(2)(A)) is
amended by striking `section 1851(a)(2)(A)' and inserting `section
1851(a)(2)'.
SEC. 510. MEDPAC REPORT ON MEDICARE MSA (MEDICAL SAVINGS ACCOUNT)
PLANS.
Not later than 1 year after the date of the enactment of this Act, the
Medicare Payment Advisory Commission shall submit to Congress a report on
specific legislative changes that should be made to make MSA plans a viable
option under the Medicare+Choice program.
Subtitle B--Social Health Maintenance Organizations
(SHMOs)
SEC. 511. EXTENSION OF SOCIAL HEALTH MAINTENANCE ORGANIZATION DEMONSTRATION
PROJECT AUTHORITY.
(a) EXTENSION- Section 4018(b) of the Omnibus Budget Reconciliation Act of
1987, as amended by section 4014(a)(1) of BBA, is amended--
(1) in paragraph (1), by striking `December 31, 2000' and inserting `the
date that is 18 months after the date that Secretary submits to Congress the
report described in section 4014(c) of the Balanced Budget Act of 1997';
and
(2) by adding at the end of paragraph (4) the following: `Not later than
6 months after the date the Secretary submits such final report, the
Medicare Payment Advisory Commission shall submit to Congress a report
containing recommendations regarding such project.'.
(b) SUBSTITUTION OF AGGREGATE CAP- Section 13567(c) of the Omnibus Budget
Reconciliation Act of 1993, as amended by section 4014(b) of BBA, is amended
to read as follows:
`(c) AGGREGATE LIMIT ON NUMBER OF MEMBERS- The Secretary of Health and
Human Services may not impose a limit on the number of individuals that may
participate in a project conducted under section 2355 of the Deficit Reduction
Act of 1984, other than an aggregate limit of not less than 324,000 for all
sites.'.
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