HR 4951 IH
106th CONGRESS
2d Session
H. R. 4951
To amend part C of title XVIII to stabilize the Medicare+Choice
Program by improving the methodology for the calculation of Medicare+Choice
payment rates, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
July 25, 2000
Mr. GREENWOOD (for himself, Mr. DOOLEY of California, Mr. SHERWOOD, Mr.
BAKER, Mr. PETERSON of Minnesota, Mr. ENGLISH, Mr. TOOMEY, Mr. HOBSON, Mr.
TAUZIN, Mr. FOLEY, Mr. HOLDEN, Mr. PETERSON of Pennsylvania, Mr. BRYANT, Mr.
BILBRAY, Mr. RAMSTAD, Mr. SHAYS, Mr. CAMPBELL, and Mr. VITTER) 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 jursidiction of the committee concerned
A BILL
To amend part C of title XVIII to stabilize the Medicare+Choice
Program by improving the methodology for the calculation of Medicare+Choice
payment rates, 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; TABLE OF CONTENTS.
(a) SHORT TITLE- This Act may be cited as the `Medicare Beneficiaries'
Choice Stabilization Act of 2000'.
(b) TABLE OF CONTENTS- The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Establishment of payment floor for Medicare+Choice payment rates
after applying risk-adjustment methodology.
Sec. 3. Change in application of budget neutrality adjustment for 2001
and 2002.
Sec. 4. Increase in national per capita Medicare+Choice growth
percentage in 2001 and 2002.
Sec. 5. Increasing minimum payment amount.
Sec. 6. Allowing movement to 50:50 percent blend in 2002.
Sec. 7. Increased update for payment areas with only one or no
Medicare+Choice contracts.
Sec. 8. Permitting higher negotiated rates in certain Medicare+Choice
payment areas below national average.
Sec. 9. 10-year phase in of risk adjustment based on data from all
settings.
Sec. 10. Delay from July to November, 2000 in deadline for offering and
withdrawing Medicare+Choice plans for 2001.
Sec. 11. Miscellaneous regulatory changes.
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, 90 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.'.
SEC. 3. ELIMINATION OF BUDGET NEUTRALITY ADJUSTMENT FOR 2001 AND 2002.
Section 1853(c) of the Social Security Act (42 U.S.C. 1395w-23(c)) is
amended--
(1) in paragraph (1)(A) in the matter following clause (ii), by
inserting `for a year (other than 2001 or 2002)' after `multiplied';
and
(2) in paragraph (5), by inserting `(other than 2001 or 2002)' after
`for each year'.
SEC. 4. INCREASE IN NATIONAL PER CAPITA MEDICARE+CHOICE GROWTH PERCENTAGE IN
2001 AND 2002.
Section 1853(c)(6)(B) of the Social Security Act (42 U.S.C.
1395w-23(c)(6)(B)) is amended--
(1) in clause (iv), by striking `for 2001, 0.5 percentage points' and
inserting `for 2001, 0 percentage points'; and
(2) in clause (v), by striking `for 2002, 0.3 percentage points' and
inserting `for 2002, 0 percentage points'.
SEC. 5. INCREASING MINIMUM PAYMENT AMOUNT.
(a) IN GENERAL- Section 1853(c)(1)(B)(ii) of the Social Security Act (42
U.S.C. 1395w-23(c)(1)(B)(ii)) is amended--
(1) by striking `(ii) For a succeeding year' and inserting `(ii)(I)
Subject to subclause (II), for a succeeding year'; and
(2) by adding at the end the following new subclause:
`(II) For 2001 for any of the 50 States and the District of
Columbia, $450.'.
(b) EFFECTIVE DATE- The amendments made by subsection (a) apply to years
beginning with 2001.
SEC. 6. ALLOWING MOVEMENT TO 50:50 PERCENT BLEND IN 2002.
Section 1853(c)(2) of the Social Security Act (42 U.S.C. 1395w-23(c)(2))
is amended--
(1) by striking the period at the end of subparagraph (F) and inserting
a semicolon; and
(2) by adding after and below subparagraph (F) the following:
`except that a Medicare+Choice organization may elect to apply
subparagraph (F) (rather than subparagraph (E)) for 2001 and for
2002.'.
SEC. 7. INCREASED UPDATE FOR PAYMENT AREAS WITH ONLY ONE OR NO
MEDICARE+CHOICE CONTRACTS.
(a) IN GENERAL- Section 1853(c)(1)(C)(ii) of the Social Security Act (42
U.S.C. 1395w-23(c)(1)(C)(ii)) is amended--
(1) by striking `(ii) For a subsequent year' and inserting `(ii)(I)
Subject to subclause (II), for a subsequent year'; and
(2) by adding at the end the following new subclause:
`(II) During 2001, 2002, 2003, 2004, and 2005, in the case of a
Medicare+Choice payment area in which there is no more than one contract
entered into under this part as of July 1 before the beginning of the
year, 102.5 percent of the annual Medicare+Choice capitation rate under
this paragraph for the area for the previous year.'.
(b) CONSTRUCTION- The amendments made by subsection (a) do not affect the
payment of a first time bonus under section 1853(i) of the Social Security Act
(42 U.S.C. 1395w-23(i)).
SEC. 8. PERMITTING HIGHER NEGOTIATED RATES IN CERTAIN MEDICARE+CHOICE
PAYMENT AREAS BELOW NATIONAL AVERAGE.
Section 1853(c)(1) of the Social Security Act (42 U.S.C. 1395w-23(c)(1))
is amended--
(1) in the matter before subparagraph (A), by striking `or (C)' and
inserting `(C), or (D)'; and
(2) by adding at the end the following new subparagraph:
`(D) PERMITTING HIGHER RATES THROUGH NEGOTIATION-
`(i) IN GENERAL- For each year beginning with 2004, in the case of a
Medicare+Choice payment area for which the Medicare+Choice capitation
rate under this paragraph would otherwise be less than the United States
per capita cost (USPCC), as calculated by the Secretary, a
Medicare+Choice organization may negotiate with the Secretary an annual
per capita rate that--
`(I) reflects an annual rate of increase up to the rate of
increase specified in clause (ii);
`(II) takes into account audited current data supplied by the
organization on its adjusted community rate (as defined in section
1854(f)(3)); and
`(III) does not exceed the United States per capita cost, as
projected by the Secretary for the year involved.
`(ii) MAXIMUM RATE DESCRIBED- The rate of increase specified in this
clause for a year is the rate of inflation in private health insurance
for the year involved, as projected by the Secretary, and includes such
adjustments as may be necessary--
`(I) to reflect the demographic characteristics in the population
under this title; and
`(II) to eliminate the costs of prescription drugs.
`(iii) ADJUSTMENTS FOR OVER OR UNDER PROJECTIONS- If subparagraph is
applied to an organization and payment area for a year, in applying this
subparagraph for a subsequent year the provisions of paragraph (6)(C)
shall apply in the same manner as such provisions apply under this
paragraph.'.
SEC. 9. 10-YEAR PHASE IN OF RISK ADJUSTMENT BASED ON DATA FROM ALL
SETTINGS.
Section 1853(a)(3)(C)(ii) of the Social Security Act (42 U.S.C.
1395w-23(c)(1)(C)(ii)) is amended--
(1) by striking the period at the end of subclause (II) and inserting a
semicolon; and
(2) by adding after and below subclause (II) the following:
`and, beginning in 2004, insofar as such risk adjustment is based on
data from all (or substantially all) settings, the methodology shall be
phased in equal increments over a 10 year period, beginning with 2004 or
(if later) the first year in which such data is used.'.
SEC. 10. DELAY FROM JULY TO NOVEMBER, 2000 IN DEADLINE FOR OFFERING AND
WITHDRAWING MEDICARE+CHOICE PLANS FOR 2001.
Notwithstanding any other provision of law, the deadline for a
Medicare+Choice organization to withdraw the offering of a Medicare+Choice
plan under part C of title XVIII of the Social Security Act (or otherwise to
submit information required for the offering of such a plan) for 2001 is
delayed from July 1, 2000, to November 1, 2000, and any such organization that
provided notice of withdrawal of such a plan during 2000 before the date of
the enactment of this Act may rescind such withdrawal at any time before
November 1, 2000.
SEC. 11. MISCELLANEOUS REGULATORY CHANGES.
(a) PROHIBITION ON REQUIREMENT TO SUBMIT ENCOUNTER DATA- Section
1853(a)(3)(B) of the Social Security Act (42 U.S.C. 1395w-23(a)(3)(B)) is
amended--
(1) by designating the matter following `DATA COLLECTION' as a clause
(i) with appropriate indentation and the heading `IN GENERAL'; and
(2) by adding at the end the following new clauses:
`(ii) ISSUANCE OF DATA SUBMISSION REQUIREMENTS- The Secretary may
not require under clause (i) the submission of encounter data to support
a risk adjustment methodology based on all (or substantially all)
settings until a reasonable time after the Secretary issues the complete
requirements for data submission. Such requirements shall be limited to
the minimum data elements necessary to support the risk adjustment
methodology. Such system shall be designed to accept the required
minimum data elements in a form and manner compatible with
Medicare+Choice organizations' operations.
`(iii) EVALUATION- In issuing such data submission requirements, the
Secretary must include an evaluation by an outside, independent actuary
of whether the proposed data elements are the minimum necessary to
support the risk adjustment methodology.'.
(b) POST-STABILIZATION GUIDELINES- Section 1852(d)(2) of such Act (42
U.S.C. 1395w-22(d)(2)) is amended by adding at the end the following: `In
prescribing such guidelines--
`(A) post-stabilization care shall be limited to care related to
treatment of the condition that precipitated the provision of emergency
services; and
`(B) the provider of emergency services is not authorized to provide
post-stabilization care unless--
`(i) the Medicare+Choice organization has been notified as soon as
practicable, but not later than 2 hours after stabilization, in advance
of the request to provide such care;
`(ii) the organization has either approved the request or not
responded to such request within a reasonable period (of at least 3
hours) after it has been notified; and
`(iii) the emergency services provider maintains a written
documentation concerning the notice and the organization's response to
such notice.'.
(1) ALLOWING ON-LINE ENROLLMENT- Section 1851(c)(2) of such Act (42
U.S.C. 1395w-21(c)(2)) is amended by adding at the end the following:
`(C) ON-LINE APPLICATIONS- Such process shall permit the filing of
appropriate election forms under subparagraphs (A) and (B) to be done
through electronic means (including use of the Internet).'.
(2) MORATORIUM ON CHANGES IN MEDICARE+CHOICE ENROLLMENT RULES- The
Secretary of Health and Human Services shall not make any changes in the
enrollment and disenrollment instructions and related materials (including
operational policy letters and evidence of coverage) under the
Medicare+Choice program under part C of title XVIII of the Social Security
Act between the date of the enactment of this Act and January 1, 2002,
except as may be specifically and only required to comply with a change in
statute.
END