HR 3284 IH

To amend part C of title XVIII to provide for an improved methodology for the calculation of Medicare+Choice payment rates.

November 9, 1999

Mr. PALLONE 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 part C of title XVIII to provide for an improved methodology for the calculation of Medicare+Choice payment rates.

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 Beneficiaries' Choice Protection Act of 1999'.

SEC. 2. ESTABLISHMENT OF PAYMENT FLOOR FOR MEDICARE+CHOICE PAYMENT RATES AFTER APPLYING RISK-ADJUSTMENT METHODOLOGY.

(a) IN GENERAL- Section 1853(c)(1) of the Social Security Act (42 U.S.C. 1395w-23(c)(1)) is amended--

(1) in the matter preceding subparagraph (A), by striking `or (C)' and inserting `(C), or (D)'; and

(2) by adding at the end the following new subparagraph:

`(D) DEMOGRAPHICALLY ADJUSTED FEE-FOR-SERVICE PER CAPITA EXPENDITURES-

`(i) IN GENERAL- For 2001 and each subsequent year, 94 percent of the adjusted average per capita cost for the year for the Medicare+Choice payment area determined by the Secretary based upon the rule specified under paragraph (4) of section 1876(a) and calculated without regard to the adjustment under paragraph (1)(C) of such section.

`(ii) SPECIAL RULE FOR RISK ADJUSTMENT- For purposes of applying risk adjustment to the payment amount determined under this subparagraph for a demographic class, the risk adjustment for such demographic class shall be determined under the methodology applied by the Secretary under section 1876(a)(4) without regard to subsection (a)(3) of this section.'.

(b) CONTINUATION OF COMPUTATION OF AAPCC DATA- Section 1853(b) of such Act (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- Using the most recent data available, the Secretary 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.'.

END