HR 5320 IH

To amend part C of title XVIII of the Social Security Act to revise and improve the Medicare+Choice Program, and for other purposes.

September 27, 2000

Mr. KOLBE 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 of the Social Security Act to revise and improve the Medicare+Choice Program, 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.

This Act may be cited as the `Medicare+Choice Rescue Act of 2000'.

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 (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. 3. ELIMINATION OF REDUCTION IN MEDICARE+CHOICE PAYMENT RATES BY BUDGET NEUTRALITY ADJUSTMENTS.

(a) IN GENERAL- Section 1853(c)(1)(A) of the Social Security Act (42 U.S.C. 1395w-23(c)(1)(A)) is amended by adding at the end the following: `With respect to years beginning on or after January 1, 2001, in no case shall the budget neutrality adjustment provided for in the previous sentence result in a reduction of the payment amount that would otherwise be made under this subparagraph but for such adjustment.'.

SEC. 4. PAYMENT FLOOR FOR MEDICARE+CHOICE PLANS.

(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 before subparagraph (A), by striking `or (C)' and inserting `(C), or (D)'; and

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

`(D) TRUE FLOOR BASED ON 90 PERCENT OF THE FEE-FOR-SERVICE PER CAPITA EXPENDITURES FOR MEDICARE+CHOICE PLANS- In the case of a plan, 90 percent of an amount equal to the annual per capita rate of payment described in section 1876(a)(1)(C) for the area involved.'.

(b) EFFECTIVE DATE- The amendments made by subsection (a) apply to payments for months beginning on or after January 2001.

SEC. 5. CORRECTING FOR MISESTIMATES IN THE GROWTH RATE; LIMITING RETROACTIVE ADJUSTMENTS.

(a) IN GENERAL- Notwithstanding any other provision of law, for purposes of payments under section 1853(c) of the Social Security Act (42 U.S.C. 1395w-23(c)) to Medicare+Choice organizations offering Medicare+Choice plans for 2001, the Secretary of Health and Human Services shall provide for an increase by 3.6 percent the amount of payment otherwise applicable to such plans under that section in 2001.

(b) HOLD HARMLESS FOR ERRORS IN ESTIMATES- Section 1853(c)(6) of such Act (42 U.S.C. 1395w-23(c)(6)) is amended--

(1) in subparagraph (C), by striking `Beginning with rates' and inserting `Subject to subparagraph (D), beginning with rates'; and

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

`(D) HOLD HARMLESS FOR OVER PROJECTIONS- Beginning with rates calculated for 2002, in making adjustments under subparagraph (C), in no case may the Secretary provide for an adjustment in a year for that results in a reduction of the national per capita Medicare+Choice growth percentage that is greater than 0.5 percent.'.

SEC. 6. ADDITIONAL FLOOR FOR ANNUAL INCREASE IN MEDICARE+CHOICE CAPITATION RATES.

Section 1853(c)(3)(C) of the Social Security Act (42 U.S.C. 1395w-23(c)(3)(C)) is amended--

(1) in clause (ii), by inserting `(before 2002)' after `For a subsequent year'; and

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

`(iii) For 2002 and each subsequent year, the greater of (I) 102 percent of the annual Medicare+Choice capitation rate under this paragraph for the area for the previous year, or (II) such rate for the previous year increased by the national per capita Medicare+Choice growth percentage, described in paragraph (6)(A) for the succeeding year.'.

SEC. 7. APPLICATION OF BUDGET NEUTRALITY PRINCIPLE TO THE NEW MEDICARE+CHOICE RISK ADJUSTMENT METHODOLOGY.

(a) IN GENERAL- Section 1853(a)(3) of the Social Security Act (42 U.S.C. 1395w-23(a)(3)) is amended by adding at the end the following new subparagraph:

`(E) IMPLEMENTATION IN A BUDGET NEUTRAL MANNER- The methodology under this paragraph shall be designed and implemented in a manner so that it does not result in any material change in the aggregate level of expenditures under this title compared to the level that would have occurred if such methodology had not been implemented (and if the previous risk adjustment methodology used in 1998 had continued to be implemented).'.

(b) EFFECTIVE DATE- The amendment made by subsection (a) takes effect on the date of the enactment of this Act and applies to payments for months beginning on or after January 2001.

SEC. 8. PROVIDING FOR CONTINUOUS OPEN ENROLLMENT AND DISENROLLMENT.

(a) IN GENERAL- Section 1851(e)(2) of the Social Security Act (42 U.S.C. 1395w-21(e)(2)) is amended to read as follows:

`(2) CONTINUOUS OPEN ENROLLMENT AND DISENROLLMENT- Subject to paragraph (5), a Medicare+Choice eligible individual may change the election under subsection (a)(1) at any time.'.

(b) CONFORMING AMENDMENTS-

(1) MEDICARE+CHOICE- Section 1851(e) of such Act (42 U.S.C. 1395w-21(e)) is amended--

(A) in paragraph (4)--

(i) by striking `Effective as of January 1, 2002, an' and inserting `An';

(ii) by striking `other than during an annual, coordinated election period';

(iii) by inserting `in a special election period for such purpose' after `make a new election under this section'; and

(iv) by striking the second sentence; and

(B) in paragraphs (5)(B) and (6)(A), by striking `the first sentence of'.

(2) MEDIGAP- Section 1882(s)(3)(B) of such Act (42 U.S.C. 1395ss(s)(3)(B)) is amended--

(A) in clause (ii), by striking `permitting discontinuance of the individual's election of the plan under the first sentence of section 1851(e)(4)' and inserting `providing the individual a special election period under section 1851(e)(4)'; and

(B) in clause (iii), by striking `permit discontinuance of an individual's election of coverage under the first sentence of section 1851(e)(4)' and inserting `provide the individual a special election period under section 1851(e)(4)'.

(c) EFFECTIVE DATE- The amendments made by this section apply with respect to plan years beginning on or after January 1, 2002.

SEC. 9. ALLOWING VARIATION IN PREMIUMS AND BENEFITS WITHIN COUNTIES.

(a) IN GENERAL- Subsections (c) and (f)(1)(D) of section 1854 of the Social Security Act (42 U.S.C. 1395w-24) are each amended by inserting before the period at the end the following: `, expect that the Secretary shall provide for exceptions based on provider catchment area that may be a geographic area that is smaller than a county or a catchment area that crosses the boundaries of two or more counties'.

(b) EFFECTIVE DATE- The amendments made by subsection (a) apply with respect to years beginning on or after January 1, 2001.

SEC. 10. MODIFYING PHASE-IN OF MEDICARE+CHOICE RISK-ADJUSTMENT METHODOLOGY FOR INSTITUTIONALIZED MEDICARE BENEFICIARIES.

The Secretary of Health and Human Services shall provide that the risk-adjustment methodology applied under section 1853(a) of the Social Security Act (42 U.S.C. 1395w-23(a)), insofar as it makes adjustments to capitation rates for health status, shall only apply to 10 percent of 1/12 of the annual Medicare+Choice capitation rate in the case of an eligible individual who is institutionalized (as defined for purposes of section 1851(e)(2)(D) of such Act (42 U.S.C. 1395w-21(e)(2)(D))) until the first year in which the Secretary implements a modification of such methodology based on health status so that such methodology includes medical diagnostic factors from all provider settings (including hospital and nursing facility settings).

END