HR 5099 IH

To amend title XVIII of the Social Security Act to make improvements to the Medicare+Choice Program under part C of the Medicare Program.

July 27, 2000

Mr. UDALL of New Mexico 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 make improvements to the Medicare+Choice Program under part C of the Medicare Program.

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+Choice Program Improvement 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. Increase in national per capita Medicare+Choice growth percentage in 2001 and 2002.

Sec. 3. Increasing minimum payment amount.

Sec. 4. Allowing movement to 50:50 percent blend in 2002.

Sec. 5. Increased update for payment areas with only one or no Medicare+Choice contracts.

Sec. 6. Permitting higher negotiated rates in certain Medicare+Choice payment areas below national average.

Sec. 7. 10-year phase-in of risk adjustment based on data from all settings.

Sec. 8. Delay from July to November 2000 in deadline for offering and withdrawing Medicare+Choice plans for 2001.

SEC. 2. 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 (iii), by adding `and' at the end;

(2) by striking clauses (iv) and (v);

(3) by redesignating clause (vi) as clause (iv); and

(4) in clause (iv), as so redesignated, by striking `after 2002' and inserting `after 2000'.

SEC. 3. 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 2002 for any of the 50 States and the District of Columbia, $500.'.

(b) EFFECTIVE DATE- The amendments made by subsection (a) apply to years beginning with 2002.

SEC. 4. 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 at the end the following flush matter:

`except that a Medicare+Choice organization may elect to apply subparagraph (F) (rather than subparagraph (E)) for 2002.'.

SEC. 5. 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 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. 6. 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 preceding 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 2001, 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 this 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.

`(iv) DEADLINE FOR COMPLETION OF NEGOTIATIONS- The Secretary shall complete negotiations with a Medicare+Choice organization under clause (i) for a year by not later than 90 days after the date the organization entered into negotiations with the Secretary.'.

SEC. 7. 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 at the end the following flush matter:

`and, beginning in 2004, insofar as such risk adjustment is based on data from all settings, the methodology shall be phased-in in equal increments over a 10-year period, beginning with 2004 or (if later) the first year in which such data is used.'.

SEC. 8. 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 enactment of this Act may rescind such withdrawal at any time before November 1, 2000.

END