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H.R.3146
Health Care Restoration Act of 1999 (Introduced in the
House)
SEC. 510. MEDPAC STUDIES RELATING TO RISK ADJUSTMENT .
(a) STUDY- The Medicare Payment Advisory Commission established under
section 1805 of the Social Security Act (42 U.S.C. 1395b-6) (in this section
referred to as `MedPAC') shall conduct a study on the adequacy and accuracy of
health-based risk adjustment methodologies being
developed and used by the Health Care Financing Administration in the
Medicare+Choice program.
(b) REPORT- The Commission shall submit to Congress by March 1, 2001, a
report on the study under subsection (a) and shall include recommendations
regarding alternative risk adjustment methodologies that are less
onerous.
SEC. 511. 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.
SEC. 512. 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)'.
Subtitle B--Other Managed Care Provisions
SEC. 521. MEDICARE+CHOICE COMPETITIVE BIDDING DEMONSTRATION PROJECT.
Section 4011 of BBA is amended--
(A) by striking `The Secretary' and inserting the following:
`(1) IN GENERAL- Subject to the succeeding provisions of this
subsection, the Secretary'; and
(B) by adding at the end the following:
`(2) DELAY IN IMPLEMENTATION- The Secretary shall not implement the
project until January 1, 2002, or, if later, 6 months after the date the
Competitive Pricing Advisory Committee has submitted to Congress a report on
each of the following topics:
`(A) INCORPORATION OF ORIGINAL FEE-FOR-SERVICE MEDICARE PROGRAM INTO
PROJECT- What changes would be required in the project to feasibly
incorporate the original fee-for-service medicare program into the project
in the areas in which the project is operational.
`(B) QUALITY ACTIVITIES- The nature and extent of the quality
reporting and monitoring activities that should be required of plans
participating in the project, the estimated costs that plans will incur as
a result of these requirements, and the current ability of the Health Care
Financing Administration to collect and report comparable data, sufficient
to support comparable quality reporting and monitoring activities with
respect to beneficiaries enrolled in the original fee-for-service medicare
program generally.
`(C) RURAL PROJECT- The current viability of initiating a project site
in a rural area, given the site specific budget neutrality requirements of
the project, and insofar as the Committee decides that the addition of
such a site is not viable, recommendations on how the project might best
be changed so that such a site is viable.
`(D) BENEFIT STRUCTURE- The nature and extent of the benefit structure
that should be required of plans participating in the project, the
rationale for such benefit structure, the potential implications that any
benefit standardization requirement may have on the number of plan choices
available to a beneficiary in an area designated under the project, the
potential implications of requiring participating plans to offer
variations on any standardized benefit package the committee might
recommend, such that a beneficiary could elect to pay a higher percentage
of out-of-pocket costs in exchange for a lower premium (or premium rebate
as the case may be), and the potential implications of expanding the
project (in conjunction with the potential inclusion of the original
fee-for-service medicare program) to require medicare supplemental
insurance plans operating in an area designated under the project to offer
a coordinated and comparable standardized benefit package.
`(3) CONFORMING DEADLINES- Any dates specified in the succeeding
provisions of this section shall be delayed (as specified by the Secretary)
in a manner consistent with the delay effected under paragraph (2).';
and
(2) in subsection (c)(1)(A)--
(A) by striking `and' at the end of clause (i); and
(B) by adding at the end the following new clause:
`(iii) establish beneficiary premiums for plans offered in such area
in a manner such that a beneficiary who enrolls in an offered plan with
a below average price (as established by the competitive pricing
methodology established for such area) may, at the plan's election, be
offered a rebate of some or all of the medicare part B premium that such
individual must otherwise pay in order to participate in a
Medicare+Choice plan under the Medicare+Choice program;
and'.
SEC. 522. INAPPLICABILITY OF OASIS TO PACE.
Sections 1894(e)(3) and 1934(e)(3) (42 U.S.C. 1395eee(e)(3);
1396u-4(e)(3)) are each amended by adding at the end the following:
`(C) INAPPLICABILITY OF OASIS TO PACE- Notwithstanding the previous
provisions of this paragraph, with respect to any home health service
provided under a PACE program under this section, the Secretary shall not
apply the data collection and reporting requirements under the Outcome and
Assessment Information Set (OASIS) to such program or to any enrollee of
such program, regardless of whether such service is provided by a PACE
program directly or through a contract with a home health
agency.'.
TITLE VI--MEDICAID
SEC. 601. MAKING MEDICAID DSH TRANSITION RULE PERMANENT.
(a) IN GENERAL- Section 4721(e) of the Balanced Budget Act of 1997 (42
U.S.C. 1396r-4 note) is amended--
(1) in the matter before paragraph (1), by striking `1923(g)(2)(A)' and
`1396r-4(g)(2)(A)' and inserting `1923(g)(2)' and `1396r-4(g)(2)',
respectively;
(2) in paragraphs (1) and (2)--
(A) by striking `, and before July 1, 1999'; and
(B) by striking `in such section' and inserting `in subparagraph (A)
of such section'; and
(3) by striking `and' at the end of paragraph (1), by striking the
period at the end of paragraph (2) and inserting `; and', and by adding at
the end the following new paragraph:
`(3) effective for State fiscal years that begin on or after July 1,
1999, `or (b)(1)(B)' were inserted in section 1923(g)(2)(B)(ii)(I) after
`(b)(1)(A)'.'.
(b) EFFECTIVE DATE- The amendments made by subsection (a) shall take
effect as if included in the enactment of section 4721(e) of the Balanced
Budget Act of 1997 (Public Law 105-33; 110 Stat. 514).
SEC. 602. INCREASE IN DSH ALLOTMENT FOR CERTAIN STATES AND THE DISTRICT OF
COLUMBIA.
(a) IN GENERAL- The table in section 1923(f)(2) (42 U.S.C. 1396r-4(f)(2))
is amended under each of the columns for FY 00, FY 01, and FY 02--
(1) in the entry for the District of Columbia, by striking `23' and
inserting `32';
(2) in the entry for Minnesota, by striking `16' and inserting
`33';
(3) in the entry for New Mexico, by striking `5' and inserting `9';
and
(4) in the entry for Wyoming, by striking `0' and inserting
`.100'.
(b) EFFECTIVE DATE- The amendments made by subsection (a) take effect on
October 1, 1999, and applies to expenditures made on or after such date.
SEC. 603. NEW PROSPECTIVE PAYMENT SYSTEM FOR FEDERALLY-QUALIFIED HEALTH
CENTERS AND RURAL HEALTH CLINICS.
(a) IN GENERAL- Section 1902(a) of the Social Security Act (42 U.S.C.
1396a(a)) is amended--
(A) in subparagraph (A), by adding `and' at the end;
(B) in subparagraph (B), by striking `and' at the end; and
(C) by striking subparagraph (C); and
(2) by inserting after paragraph (14) the following new paragraph:
`(15) for payment for services described in clause (B) or (C) of section
1905(a)(2) under the plan in accordance with subsection (aa);'.
(b) NEW PROSPECTIVE PAYMENT SYSTEM- Section 1902 of the Social Security
Act (42 U.S.C. 1396a) is amended by adding at the end the following:
`(aa) PAYMENT FOR SERVICES PROVIDED BY FEDERALLY-QUALIFIED HEALTH CENTERS
AND RURAL HEALTH CLINICS-
`(1) IN GENERAL- Beginning with fiscal year 2000 and each succeeding
fiscal year, the State plan shall provide for payment for services described
in section 1905(a)(2)(C) furnished by a Federally-qualified health center
and services described in section 1905(a)(2)(B) furnished by a rural health
clinic in accordance with the provisions of this subsection.
`(2) FISCAL YEAR 2000- Subject to paragraph (4), for services furnished
during fiscal year 2000, the State plan shall provide for payment for such
services in an amount (calculated on a per visit basis) that is equal to 100
percent of the costs of the center or clinic of furnishing such services
during fiscal year 1999 which are reasonable and related to the cost of
furnishing such services, or based on such other tests of reasonableness as
the Secretary prescribes in regulations under section 1833(a)(3), or, in the
case of services to which such regulations do not apply, the same
methodology used under section 1833(a)(3), adjusted to take into account any
increase in the scope of such services furnished by the center or clinic
during fiscal year 2000.
`(3) FISCAL YEAR 2001 AND SUCCEEDING FISCAL YEARS- Subject to paragraph
(4), for services furnished during fiscal year 2001 or a succeeding fiscal
year, the State plan shall provide for payment for such services in an
amount (calculated on a per visit basis) that is equal to the amount
calculated for such services under this subsection for the preceding fiscal
year--
`(A) increased by the percentage increase in the MEI (as defined in
section 1842(i)(3)) applicable to primary care services (as defined in
section 1842(i)(4)) for that fiscal year; and
`(B) adjusted to take into account any increase in the scope of such
services furnished by the center or clinic during that fiscal
year.
`(4) ESTABLISHMENT OF INITIAL YEAR PAYMENT AMOUNT FOR NEW CENTERS OR
CLINICS- In any case in which an entity first qualifies as a
Federally-qualified health center or rural health clinic after fiscal year
1999, the State plan shall provide for payment for services described in
section 1905(a)(2)(C) furnished by the center or services described in
section 1905(a)(2)(B) furnished by the clinic in the first fiscal year in
which the center or clinic so qualifies in an amount (calculated on a per
visit basis) that is equal to 100 percent of the costs of furnishing such
services during such fiscal year in accordance with the regulations and
methodology referred to in paragraph (2). For each fiscal year following the
fiscal year in which the entity first qualifies as a Federally-qualified
health center or rural health clinic, the State plan shall provide for the
payment amount to be calculated in accordance with paragraph (3).
`(5) ADMINISTRATION IN THE CASE OF MANAGED CARE- In the case of services
furnished by a Federally-qualified health center or rural health clinic
pursuant to a contract between the center or clinic and a managed care
entity (as defined in section 1932(a)(1)(B)), the State plan shall provide
for payment to the center or clinic (at least quarterly) by the State of a
supplemental payment equal to the amount (if any) by which the amount
determined under paragraphs (2), (3), and (4) of this subsection exceeds the
amount of the payments provided under the contract.
`(6) ALTERNATIVE PAYMENT METHODOLOGIES- Notwithstanding any other
provision of this section, the State plan may provide for payment in any
fiscal year to a Federally-qualified health center for services described in
section 1905(a)(2)(C) or to a rural health clinic for services described in
section 1905(a)(2)(B) in an amount which is determined under an alternative
payment methodology that--
`(A) is agreed to by the State and the center or clinic; and
`(B) results in payment to the center or clinic of an amount which is
at least equal to the amount otherwise required to be paid to the center
or clinic under this section.'.
(c) CONFORMING AMENDMENTS-
(1) Section 4712 of the Balanced Budget Act of 1997 (Public Law 105-33;
111 Stat. 508) is amended by striking subsection (c).
(2) Section 1915(b) of the Social Security Act (42 U.S.C. 1396n(b)) is
amended by striking `1902(a)(13)(E)' and inserting `1902(a)(15),
1902(aa),'.
(d) EFFECTIVE DATE- The amendments made by this section take effect on
October 1, 1999, and apply to services furnished on or after such date.
SEC. 604. PARITY IN REIMBURSEMENT FOR CERTAIN UTILIZATION AND QUALITY
CONTROL SERVICES.
(a) IN GENERAL- Section 1903(a)(3)(C)(i) (42 U.S.C. 1396b(a)(3)(C)(i)) is
amended--
(1) by inserting `(other than a review described in clause (ii))' after
`quality review'; and
(2) by inserting `(or under a contract with the State that sets forth
standards of performance equivalent to those under section 1902(d))' before
the semicolon.
(b) EFFECTIVE DATE- The amendments made by subsection (a) apply to
expenditures made on and after the date of the enactment of this Act.
TITLE VII--STATE CHILDREN'S HEALTH INSURANCE PROGRAM
(SCHIP)
SEC. 701. STABILIZING THE SCHIP ALLOTMENT FORMULA.
(a) IN GENERAL- Section 2104(b) (42 U.S.C. 1397dd(b)) is amended--
(1) in paragraph (2)(A)--
(A) in clause (i), by striking `through 2000' and inserting `and
1999'; and
(B) in clause (ii), by striking `2001' and inserting `2000';
(2) by amending paragraph (4) to read as follows:
`(4) FLOORS AND CEILINGS IN STATE ALLOTMENTS-
`(A) IN GENERAL- The proportion of the allotment under this subsection
for a subsection (b) State (as defined in subparagraph (D)) for fiscal
year 2000 and each fiscal year thereafter shall be subject to the
following floors and ceilings:
`(i) FLOOR OF $2,000,000- A floor equal to $2,000,000 divided by the
total of the amount available under this subsection for all such
allotments for the fiscal year.
`(ii) ANNUAL FLOOR OF 10 PERCENT BELOW PRECEDING FISCAL YEAR'S
PROPORTION- A floor of 90 percent of the proportion for the State for
the preceding fiscal year.
`(iii) CUMULATIVE FLOOR OF 30 PERCENT BELOW THE FY 1999 PROPORTION-
A floor of 70 percent of the proportion for the State for fiscal year
1999.
`(iv) CUMULATIVE CEILING OF 45 PERCENT ABOVE FY 1999 PROPORTION- A
ceiling of 145 percent of the proportion for the State for fiscal year
1999.
`(i) ELIMINATION OF ANY DEFICIT BY ESTABLISHING A PERCENTAGE
INCREASE CEILING FOR STATES WITH HIGHEST ANNUAL PERCENTAGE INCREASES- To
the extent that the application of subparagraph (A) would result in the
sum of the proportions of the allotments for all subsection (b) States
exceeding 1.0, the Secretary shall establish a maximum percentage
increase in such proportions for all subsection (b) States for the
fiscal year in a manner so that such sum equals 1.0.
`(ii) ALLOCATION OF SURPLUS THROUGH PRO RATA INCREASE- To the extent
that the application of subparagraph (A) would result in the sum of the
proportions of the allotments for all subsection (b) States being less
than 1.0, the proportions of such allotments (as computed before the
application of floors under clauses (i), (ii), and (iii) of subparagraph
(A)) for all subsection (b) States shall be increased in a pro rata
manner (but not to exceed the ceiling established under subparagraph
(A)(iv)) so that (after the application of such floors and ceiling) such
sum equals 1.0.
`(C) CONSTRUCTION- This paragraph shall not be construed as applying
to (or taking into account) amounts of allotments redistributed under
subsection (f).
`(D) DEFINITIONS- In this paragraph:
`(i) PROPORTION OF ALLOTMENT- The term `proportion' means, with
respect to the allotment of a subsection (b) State for a fiscal year,
the amount of the allotment of such State under this subsection for the
fiscal year divided by the total of the amount available under this
subsection for all such allotments for the fiscal year.
`(ii) SUBSECTION (b) STATE- The term `subsection (b) State' means
one of the 50 States or the District of Columbia.';
(3) in paragraph (2)(B), by striking `the fiscal year' and inserting
`the calendar year in which such fiscal year begins'; and
(4) in paragraph (3)(B), by striking `the fiscal year involved' and
inserting `the calendar year in which such fiscal year begins'.
(b) EFFECTIVE DATE- The amendments made by this section apply to
allotments determined under title XXI of the Social Security Act (42 U.S.C.
1397aa et seq.) for fiscal year 2000 and each fiscal year thereafter.
SEC. 702. INCREASED ALLOTMENTS FOR TERRITORIES UNDER THE STATE CHILDREN'S
HEALTH INSURANCE PROGRAM.
Section 2104(c)(4)(B) (42 U.S.C. 1397dd(c)(4)(B)) is amended by inserting
`, $34,200,000 for each of fiscal years 2000 and 2001, $25,200,000 for each of
fiscal years 2002 through 2004, $32,400,000 for each of fiscal years 2005 and
2006, and $40,000,000 for fiscal year 2007' before the period.
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