|Subcommittee on Health and Environment||Referral|
|House Ways and Means||Referral|
|Rep Bilirakis, Michael - 10/25/2000||Rep Bliley, Tom - 10/25/2000|
TABLE OF CONTENTS:
Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 - Title I: Medicare Beneficiary Improvements - Subtitle A: Improved Preventive Benefits - Amends title XVIII (Medicare) of the Social Security Act (SSA) to provide for coverage of: (1) biennial (currently, triennial) screening pap smear and pelvic exams; (2) screening for glaucoma for high-risk individuals; and (3) screening colonoscopy for average risk individuals.
(Sec. 104) Revises provisions for payments and standards for screening mammography.
Outlines payment for certain screening mammographies that use a specified new technology.
(Sec. 105) Amends SSA title XVIII to provide for coverage of specified medical nutrition therapy services for certain beneficiaries with diabetes or a renal disease.
Directs the Secretary of Health and Human Services (HHS) to report to Congress any recommendations with respect to the expansion to other Medicare beneficiary populations of such medical nutrition therapy services benefit.
Subtitle B: Other Beneficiary Improvements - Amends SSA title XVIII with regard to the prospective payment system(PPS) for hospital outpatient department (ODP) services, reducing the upper limit on beneficiary copayment.
(Sec. 111) Directs the Comptroller General to evaluate and report to Congress on the extent to which the premium levels for Medicare supplemental (Medigap) policies reflect the reductions in copayment resulting from this subtitle.
(Sec. 112) Amends SSA title XVIII to include as "medical and other health services," for coverage purposes, drugs and biologicals which are not usually self-administered by the patient (currently, drugs and biologicals which cannot be self-administered).
(Sec. 113) Eliminates the time limitation on Medicare benefits for immunosuppressive drugs.
(Sec. 114) Provides for the imposition of billing limits on prescription drugs.
Subtitle C: Demonstration Projects and Studies - Directs the Secretary to conduct a demonstration project with respect to the impact on costs and on health outcomes of applying disease management to eligible Medicare beneficiaries with diagnosed, advanced-stage congestive heart failure, diabetes, or coronary heart disease.
(Sec. 122) Directs the Secretary to conduct demonstration projects for the purpose of developing models and evaluating methods that: (1) improve the quality of items and services provided to target individuals in order to facilitate reduced disparities in early detection and treatment of cancer; (2) improve clinical outcomes, satisfaction, quality of life, and appropriate use of Medicare-covered services and referral patterns among those target individuals with cancer; (3) eliminate disparities in the rate of preventive cancer screening measures among target individuals; and (4) promote collaboration with community-based organizations to ensure cultural competency of health care professionals and linguistic access for persons with limited English proficiency.
Directs the Secretary to: (1) evaluate best practices in the private sector, community programs, and academic research of methods that reduce disparities among individuals of racial and ethnic minority groups in the prevention and treatment of cancer; (2) design the demonstration projects based on such evaluation; and (3) implement at least nine such projects, including two for each of the four major racial and ethnic minority groups.
Provides that if a report on the cost-effectiveness of the demonstration projects contains an evaluation that they reduce or do not increase Medicare expenditures, reduce racial and ethnic health disparities in the quality of health care services provided to target individuals, and increase satisfaction of beneficiaries and health care providers, the Secretary shall continue the existing projects, and may expand their numbers. Provides for funding.
(Sec. 123) Directs the Secretary to request the National Academy of Sciences to study and report to Congress on the addition of Medicare coverage of routine thyroid screening using a thyroid stimulating hormone test as a preventive benefit.
(Sec. 124) Directs the Medicare Payment Advisory Commission (MEDPAC) to study and report to Congress on the use of consumer coalitions in the marketing of Medicare+Choice (Medicare part C (Medicare+Choice) plans.
(Sec. 125) Directs the Secretary to study and report to Congress on whether access to certain services (including mental health services) for qualified Medicare beneficiaries has been affected by limitations on a State's payment for Medicare cost-sharing for such beneficiaries.
(Sec. 126) Directs the Secretary to contract with the Institute of Medicine to study and report to Congress and the Secretary on the appropriateness of waiving the 24-month waiting period for Medicare disability eligibility for individuals with amyotrophic lateral sclerosis (ALS) and other similar diseases.
(Sec. 127) Requires the Secretary to conduct a series of studies for a report to Congress identifying preventive interventions most valuable to older Americans that can be delivered in the primary care setting.
Amends the mission statement of the United States Preventive Services Task Force to include the evaluation of services of particular relevance to older Americans.
(Sec. 128) Directs MEDPAC to study and report to Congress on Medicare coverage of cardiac and pulmonary rehabilitation therapy services.
Title II: Rural Health Care Improvements - Subtitle A: Critical Access Hospital Provisions - Amends SSA title XVIII with regard to special payment rules for particular items and services to: (1) prohibit the application of beneficiary cost-sharing under Medicare part B (Supplementary Medical Insurance) to clinical diagnostic laboratory services furnished as an outpatient critical access hospital service; (2) increase the amount a critical access hospital may elect to be paid for outpatient critical access hospital (OCAH) services with respect to the fee schedule payment for OCAH professional services; (3) direct the Secretary to cover the reasonable costs for emergency room on-call physicians; and (4) provide for the treatment of ambulance services furnished by certain critical access hospitals.
(Sec. 203) Amends SSA title XVIII with regard to payment to skilled nursing facilities (SNFs) for routine service costs to: (1) exempt critical access hospital swing beds from the SNF PPS; and (2) base payment on a reasonable cost basis for swing bed services furnished by critical access hospitals.
(Sec. 206) Directs the Comptroller General to study and report to Congress on the eligibility requirements for Medicare critical access hospitals with respect to limitations on average length of stay and number of beds in such a hospital.
Subtitle B: Other Rural Hospitals Provisions - Amends SSA title XVIII with regard to payment to hospitals for inpatient hospital services to provide for: (1) application of a uniform threshold for urban and rural hospitals to be classified as disproportionate share hospitals (DSHs) for discharges occurring on or after April 1, 2001; (2) adjustment of payment formulas for various specified hospitals, including hospitals that are both sole community hospitals and rural referral centers for discharges occurring during such period; (3) establishment of the option to base eligibility for the Medicare dependent, small rural hospital program on discharges during two of the three most recently audited cost reporting periods; and (4) extension of the option to use rebased target amounts to all sole community hospitals.
(Sec. 214) Directs MEDPAC, in its study of and report to Congress on rural providers under BBRA, to analyze the impact of volume on the per unit cost of rural hospitals with psychiatric units, and recommend whether special treatment for such hospitals may be warranted.
Subtitle C: Other Rural Provisions - Amends SSA title XVIII with regard to special payment rules for particular items and services to provide transitional assistance for providers of ambulance services in rural areas.
(Sec. 221) Directs the Comptroller General to study and report to Congress on the: (1) cost of efficiently providing ambulance services for trips originating in rural areas; and (2) means by which rural areas with low population densities can be identified for the purpose of designating areas in which, because of low usage, the cost of providing ambulance services would be expected to be higher than similar services provided in more heavily populated areas.
(Sec. 222) Amends SSA title XVIII part B with regard to the use of carriers for administration of benefits concerning payment for certain physician assistant services.
(Sec. 223) Amends BBA'97 to: (1) set a time limit for Medicare reimbursement for telehealth services; and (2) provide for an expansion of Medicare payment for such services.
Directs the Secretary to study and report to Congress on additional: (1) settings and sites for the provision of telehealth services; (2) practitioners that may be reimbursed for furnishing telehealth services; and (3) geographic areas in which telehealth services may be reimbursed.
(Sec. 224) Amends SSA title XVIII part B to provide for expanding access to rural health clinics.
(Sec. 225) Directs MEDPAC to study and report to Congress on the effect of low patient and procedure volume on the financial status of low-volume, isolated rural health care providers participating in Medicare.
Title III: Provisions Relating to Part A - Subtitle A: Inpatient Hospital Services - Amends SSA title XVIII to revise the acute care hospital payment update for 2001, with a special rule for payment for FY 2001 for inpatient hospital services furnished by DSH hospitals.
(Sec. 301) Directs the Secretary, when rebasing and revising the hospital market basket index, to consider the prices of blood and blood products purchased by hospitals and to determine whether those prices are adequately reflected in such index.
Requires MEDPAC to study and report to Congress on: (1) any increased costs incurred by DSHs in providing inpatient hospital services to Medicare beneficiaries during the period from October 1, 1983, through September 30, 1999, that were attributable to complying with new blood safety measure requirements and providing such services using new technologies; (2) the extent to which the PPS for such services provides adequate and timely recognition of such increased costs; (3) the prospects for cost increases that hospitals will incur in providing such services that are attributable to complying with new blood safety measure requirements and providing such services using new technologies during the ten years after enactment of this Act; and (4) the feasibility and advisability of establishing mechanisms under such PPS to provide for more timely and accurate recognition of such cost increases in the future.
Amends SSA title XVIII with respect to payment to hospitals for inpatient hospital services and updating previous standardized amounts to provide for: (1) an adjustment for inpatient case mix changes; (2) modification of the transition for indirect medical education percentage adjustment for DSHs; and (3) decreases in reductions for DSH payments.
(Sec. 304) Provides for a three-year effective period for any decision of the Medicare Geographic Classification Review Board to reclassify a DSH for purposes of adjusting the diagnosis-related group (DRG) prospective payment rate for hospital wage level area differences for FY 2001 or any fiscal year thereafter. Requires the Secretary to establish procedures under which a DSH hospital may elect to terminate such reclassification before the end of such period.
Directs the Secretary to: (1) establish a process under which an appropriate statewide entity may apply to have all the geographic areas in a State treated as a single geographic area for purposes of computing and applying the area wage index; and (2) provide for the collection of data every three years on occupational mix for employees of each DSH in the provision of inpatient hospital services in order to construct an occupational mix adjustment in the applicable hospital area wage index.
(Sec. 305) Amends SSA title XVIII with respect to prospective payment for inpatient rehabilitation hospital services and: (1) assistance with administrative costs associated with completion of patient assessment; and (2) a rehabilitation facility election to apply full prospective payment rate without phase-in.
(Sec. 306) Provides that, with respect to the inpatient services of psychiatric hospitals and certain psychiatric units, in making incentive payments to such hospitals for cost reporting periods from October 1, 2000, through October 1, 2001, the Secretary shall increase the percent of the target amount used in determining such payments.
(Sec. 307) Amends SSA title XVIII to provide for: (1) increased target amounts and caps for long-term care hospitals before implementation of the PPS required under the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 for payment for inpatient hospital services provided in long-term care hospitals; and (2) alternative implementation of such PPS by the Secretary based on the use of existing hospital DRGs that have been modified.
Subtitle B: Adjustments to PPS Payments for Skilled Nursing Facilities - Amends SSA title XVIII with respect to payment to SNFs for routine service costs to revise updating requirements, among other changes eliminating the reduction in the skilled nursing facility market basket update in 2001.
(Sec. 311) Directs the Comptroller General to report to Congress on the adequacy of Medicare payment rates to SNFs and the extent to which Medicare contributes to the financial viability of such facilities.
Requires the Secretary to study and report to Congress on the different systems for categorizing patients in Medicare SNFs in a manner that accounts for the relative resource utilization of different patient types.
(Sec. 312) Directs the Secretary to increase the nursing component of the case-mix adjusted Federal prospective payment rate specified in the final rule published in the Federal Register by the Health Care Financing Administration on July 31, 2000, effective for services furnished on or after April 1, 2001, and before October 1, 2002.
Requires the Comptroller General to conduct an audit for a report to Congress on nursing staffing ratios in a representative sample of Medicare SNFs.
(Sec. 313) Amends SSA title XVIII to limit application of the SNF consolidated billing requirement to a period during which the resident is provided Medicare part A (Hospital Insurance) covered post-hospital extended care services.
Requires the Secretary to monitor payments made under Medicare part B for items and services furnished to SNF residents during a time in which they are not being provided Medicare covered post-hospital extended care services, in order to ensure that there is not duplicate billing for services or excessive services provided.
(Sec. 314) Provides that, for purposes of computing payments for certain covered SNF services, the Secretary shall increase the adjusted Federal per diem rate for covered SNF services for specified RUG-III (resource utilization group) rehabilitation groups furnished to an individual during the period in which such individual is classified in such a RUG-III category.
Directs the HHS Inspector General to review the Medicare payment structure for services classified within RUGs and report to Congress on whether payment incentives exist for the delivery of inadequate care.
(Sec. 315) Authorizes the Secretary to establish a procedure for the geographic reclassification of a SNF for purposes of payment for covered SNF services under the PPS for SNFs for routine service costs.
Subtitle C: Hospice Care - Amends SSA title XVIII to provide for a full market basket increase for hospice care for FY 2001.
(Sec. 322) Requires that the certification regarding an individual's terminal illness be based on the physician's or medical director's clinical judgment regarding the normal course of the illness.
Directs the Secretary to study and report to Congress on the appropriateness of requiring such a certification in order for an individual to receive hospice benefits under Medicare.
(Sec. 323) Directs MEDPAC to study and report to Congress on the factors affecting the use of hospice benefits under Medicare program and differences in such use between urban and rural hospice programs and based upon the presenting condition of the patient.
Subtitle D: Other Provisions - Amends SSA title XVIII to provide for a reduction in Medicare part A late enrollment premium increases (penalty) for a qualified State or local government retiree group in the case where a State, a local government, or an agency or instrumentality of a State or local government, determines to pay, for the life of each individual in such a group, the monthly premiums due.
Title IV: Provisions Relating to Part B - Subtitle A: Hospital Outpatient Services - Amends SSA title XVIII with respect to the PPS for hospital OPD services to provide for: (1) a full market basket increase for such services for 2001; (2) adjustment for service mix changes; (3) use of categories in determining eligibility of a device for pass-through payments; (4) application of OPD PPS transitional corridor payments to certain hospitals that did not submit a 1996 cost report; (5) treatment of children's hospitals under the PPS; and (6) inclusion of temperature monitored cryoablation in transitional pass-through for certain medical devices, drugs, and biologicals under the PPS.
(Sec. 404) Provides that, for purposes of making determinations of provider-based status under Medicare on or after October 1, 2000, any facility or organization that is treated as provider-based in relation to a hospital or critical access hospital under Medicare as of October 1, 2000: (1) shall continue to be treated as provider-based in relation to such hospital or critical access hospital under Medicare during the two year period beginning on October 1, 2000; and (2) the requirements, limitations, and exclusions specified in appropriate Federal regulations detailing requirements for a determination that a facility or an organization has provider-based status shall not apply to such facility or organization in relation to such hospital or critical access hospital until after the end of such two year period.
Prohibits a facility or organization for which a determination of provider-based status in relation to a hospital or critical access hospital is requested during FY 2001 or 2002 from being treated as not having such status in relation to such a hospital for any period before a determination is made with respect to such status pursuant to such request and in making a determination with respect to such status for any facility or organization in relationship to such a hospital on or after October 1, 2000, the facility or organization shall be treated as satisfying any requirements and standards for geographic location in relation to such a hospital if the facility or organization: (1) satisfies appropriate Federal regulations pertaining to location in immediate vicinity or is located not more than 35 miles from the main campus of the hospital or critical access hospital; and (2) is owned and operated by a hospital or critical access hospital that meets specified criteria.
Subtitle B: Provisions Relating to Physicians' Services - Directs the Comptroller General to study and report to Congress on: (1) the appropriateness of furnishing in physicians' offices specialist physicians' services which are ordinarily furnished in hospital outpatient departments; and (2) the refinements to the practice expense relative value units during the transition to a resource-based practice expense system for physician payments under Medicare.
(Sec. 412) Amends SSA title XVIII to require the Secretary to conduct demonstration projects to test and, if proven effective, expand the use of incentives to health care groups participating in Medicare that: (1) encourage coordination of the care furnished to individuals under Medicare parts A and B by institutional and other providers, practitioners, and suppliers of health care items and services; (2) encourage investment in administrative structures and processes to ensure efficient service delivery; and (3) reward physicians for improving health outcomes.
(Sec. 413) Directs the Comptroller General to study and report to Congress on the current Medicare enrollment process for groups that retain independent contractor physicians with particular emphasis on hospital-based physicians.
Subtitle C: Other Services - Amends SSA title XVIII to provide for a one-year extension of the moratorium on certain physical therapy services caps.
(Sec. 421) Directs the Secretary to study and report to Congress on the implications: (1) of eliminating the "in the room" supervision requirement for Medicare payment for services of physical therapy assistants supervised by physical therapists; and (2) of such requirement on the cap imposed under Medicare on physical therapy services.
(Sec. 422) Amends SSA title XVIII with respect to Medicare coverage for end stage renal disease (ESRD) patients to increase the update for dialysis services furnished on or after January 1, 2001.
Directs the Secretary to: (1) collect data and develop an ESRD market basket whereby the Secretary can estimate, before the beginning of a year, the percentage by which the costs for the year of the mix of labor and nonlabor goods and services included in the ESRD composite rate will exceed the costs of such mix for the preceding year; and (2) develop a system which includes in such composite rate, to the maximum extent feasible, payment for clinical diagnostic laboratory tests and drugs that are routinely used in furnishing dialysis services to Medicare beneficiaries, but which are currently separately billable by renal dialysis facilities.
Directs the Comptroller General to study and report to Congress on the access of Medicare beneficiaries to renal dialysis services.
(Sec. 423) Amends SSA title XVIII with respect to payment for ambulance services to provide for: (1) restoration of the full consumer price index (CPI) increase for 2001; and (2) continued phase-in of the application of the payment rates under the ambulance services fee schedule in an efficient and fair manner; except that when the Secretary implements such fee schedule, such phase-in shall provide for full payment of any national mileage rate for ambulance services provided by suppliers that are paid by carriers in any of the 50 States where payment by a carrier for such services for all such suppliers in such State, before the fee schedule's implementation, did not include a separate amount for all mileage within the county from which the beneficiary is transported.
(Sec. 424) Prohibits the Secretary from implementing a revised PPS for services of ambulatory surgical facilities before January 1, 2002.
Amends BBRA with respect to the phase-in of the PPS for ambulatory surgical centers to: (1) extend the phase-in to four years; and (2) direct the Secretary, by January 1, 2003, to incorporate data from a 1999 Medicare cost survey or a subsequent cost survey for purposes of implementing or revising such PPS.
(Sec. 425) Amends SSA title XVIII, with respect to special payment rules for particular items and services, to provide for: (1) the full update for durable medical equipment, orthotics, and prosthetics in 2001; and (3) addition of special payment provisions and requirements for prosthetics and certain custom fabricated orthotic items.
Directs the Comptroller General to study and report to Congress on Health Care Financing Administration (HCFA) Ruling 96-1, issued on September 1, 1996, with respect to distinguishing orthotics from durable medical equipment under Medicare.
(Sec. 428) Amends SSA title XVIII to provide for the replacement of, and payment for, prosthetic devices and parts.
(Sec. 429) Directs the Comptroller General to study and report to Congress and the Secretary on the reimbursement for drugs and biologicals under the current Medicare payment methodology and for related services under Medicare part B, with recommendations for revised payment methodologies. Directs the Secretary to revise such payment methodology based on such recommendations.
(Sec. 430) Amends SSA title XVIII with respect to the PPS for hospital OPD services to direct the Secretary to create additional groups of covered OPD services that classify separately those procedures that utilize contrast media from those that do not.
(Sec. 431) Amends SSA title XVIII part D (Miscellaneous) to revise the qualifications for community mental health centers under provisions defining partial hospitalization services.
(Sec. 432) Makes a hospital or a free-standing ambulatory care clinic, whether operated by the Indian Health Service or by an Indian tribe or tribal organization, eligible for payments for services for which payment is made under Medicare part B for physicians' services if and for so long as it meets all of the requirements which are applicable generally to such payments, services, hospitals, and clinics.
(Sec. 433) Directs the Comptroller General to study and report to Congress on the effect on Medicare and on Medicare beneficiaries of coverage of surgical first assisting services of certified registered nurse first assistants.
(Sec. 434) Directs MEDPAC to study and report to Congress on the appropriateness of: (1) the current Medicare payment rates for services provided by a certified nurse-midwife, a physician assistant, a nurse practitioner, and a clinical nurse specialist; and (2) Medicare coverage for services provided by a surgical technologist, a marriage counselor, a marriage and family therapist, a pastoral care counselor, and a licensed professional counselor of mental health.
(Sec. 436) Directs the Comptroller General to study and report to Congress on: (1) the costs of providing emergency and medical transportation services across the range of acuity levels of conditions for which such transportation services are provided; (2) the post-payment audit process under Medicare as such process applies to physicians; and (3) the aggregate effects of regulatory, audit, oversight, and paperwork burdens on physicians and other health care providers participating in Medicare.
(Sec. 438) Directs MEDPAC to study and report to Congress on the barriers to coverage and payment for outpatient interventional pain medicine procedures under Medicare.
Title V: Provisions Relating to Parts A and B - Subtitle A: Home Health Services - Amends SSA title XVIII to provide for a one-year additional delay in the application of the 15 percent reduction on payment limits for home health services.
(Sec. 501) Amends BBRA to delay for an additional year the 15 percent reduction in payment rates for home health services after implementation of the PPS. Requires the Comptroller General, instead of the Secretary (as currently required), to report to Congress an analysis of the need for such a reduction.
Amends SSA title XVIII with regard to the PPS for home health services concerning the annual update to provide for an adjustment for case mix changes.
(Sec. 502) Amends SSA title XVIII to provide for restoration of the full home health market basket update for home health services for FY 2001.
Establishes a special rule for payment under the PPS for home health services for FY 2001 based on adjusted prospective payment amounts.
(Sec. 503) Provides for a temporary two-month extension of periodic interim payments under BBA '97 in the case of a home health agency receiving periodic interim payments as of September 30, 2000.
(Sec. 504) Amends SSA title XVIII to provide for the use of telehealth in the delivery of home health services.
(Sec. 505) Directs the Comptroller General to study and report to Congress on variations in prices paid by home health agencies furnishing home health services under Medicare in purchasing nonroutine medical supplies and volumes if such supplies used determine the effect (if any) of variations on prices and volumes in the provision of such services.
(Sec. 506) Provides that, in determining for Medicare purposes whether an office of a home health agency constitutes a branch office or a separate home health agency, neither the time nor distance between a parent office of the home health agency and a branch office shall be the sole determinant of a home health agency's branch office status.
Directs the Comptroller General to study and report to Congress on the provision of adequate supervision to maintain quality of home health services delivered under Medicare in isolated rural areas.
(Sec. 507) Amends SSA title XVIII with regard to the Medicare home health benefit to declare that absences from home to receive medical treatment shall not disqualify an individual from such benefit.
Directs the Comptroller General to evaluate and report to Congress on the effect of such amendment on the cost of and access to home health services under Medicare.
Subtitle B: Direct Graduate Medical Education - Amends SSA title XVIII to provide for an increase in the floor for direct graduate medical education payments for FY 2002.
(Sec. 512) Changes the distribution formula for Medicare+Choice-related nursing and allied health education costs.
Subtitle C: Changes in Medicare Coverage and Appeals Process - Amends SSA title XVIII to revise the Medicare appeals process. Provides for initial determinations of entitlement and benefits by the Secretary, by a utilization and quality control peer review organization, or by an independent contractor. Provides for redeterminations of denied benefit claims. Specifies appeals rights.
(Sec. 522) Provides for the review of coverage determinations under the Medicare appeals process.
Amends SSA title XI to require any advisory committee on certain Medicare coverage exclusions to: (1) assure the full participation of a nonvoting member in its deliberations; and (2) provide such nonvoting member access to all information and data (with certain exceptions) made available to the committee's voting members. Provides that, if such committee organizes into panels of experts according to types of items or services, any such panel may report directly to the Secretary without prior approval.
Subtitle D: Improving Access to New Technologies - Amends SSA title XVIII to establish a new payment rule for any clinical diagnostic laboratory test performed on or after January 1, 2001, that is a new test for which no limitation amount has previously been established.
(Sec. 531) Directs the Secretary to: (1) establish procedures for coding and payment determinations for the categories of new clinical diagnostic laboratory tests and new durable medical equipment under Medicare part B that permit public consultation in a manner consistent with the procedures established for implementing coding modifications for ICD-9-CM; and (2) report to Congress on the specific procedures used under Medicare part B to adjust payments for clinical diagnostic laboratory tests and durable medical equipment which are classified to existing codes where, because of a technology advance, there has been a significant increase or decrease in the resources used in the test or in the manufacture of the equipment, and a significant improvement in test or equipment performance.
(Sec. 532) Directs the Secretary to: (1) maintain and continue through December 31, 2003, the use of level III codes of the HCPCS (HCFA Common Procedure Coding System) coding system (as such system was in effect on August 16, 2000); and (2) make such codes publicly available.
(Sec. 533) Directs the Secretary to: (1) report to Congress on methods of expeditiously incorporating new medical services and technologies into the clinical coding system used with respect to Medicare payment for inpatient hospital services, together with a detailed description of the Secretary's preferred methods to achieve this purpose; and (2) implement such preferred methods.
Amends SSA title XVIII to direct the Secretary to establish a mechanism to recognize the costs of new medical services and technologies with respect to inpatient hospital services under the hospital reimbursement control system.
Subtitle E: Other Provisions - Amends SSA title XVIII to reduce from 45 percent to 30 percent the reduction in the amount of bad debts otherwise treated as allowable costs attributable to the deductibles and coinsurance amounts under Medicare for FY 2001 and subsequent fiscal years in determining the reasonable costs of outpatient hospital services. (Thus increases by 15 percent the amount that may be reimbursed.)
(Sec. 542) Provides for the treatment of certain physician pathology services under Medicare.
Directs the Comptroller General to study and report to Congress on the effects of this treatment on hospitals and laboratories and access of fee-for-service Medicare beneficiaries to the technical component of physician pathology services.
(Sec. 543) Amends SSA title XI to make permanent the authority for the Secretary to issue written advisory opinions under provisions for guidance regarding application of health care fraud and abuse sanctions.
(Sec. 544) Amends SSA title XVIII to make various specified changes in annual MEDPAC reporting with regard to revision of deadlines for submission of reports and on the record votes on recommendations.
(Sec. 545) Directs the Secretary to submit to the Committee on Ways and Means and the Committee on Commerce of the House of Representatives and the Committee on Finance of the Senate a report on the development of standard instruments for the assessment of the health and functional status of patients, for whom specified items and services are furnished, and include in the report a recommendation on the use of such standard instruments for payment purposes.
(Sec. 546) Directs the Comptroller General to report to specified congressional committees on the effect of the Emergency Medical Treatment and Active Labor Act on hospitals, emergency physicians, and physicians covering emergency department call throughout the United States.
Title VI: Provisions Relating to Part C (Medicare+Choice Program) and Other Medicare Managed Care Provisions - Subtitle A: Medicare+Choice Payment Reforms - Amends SSA title XVIII part C (Medicare+Choice) with regard to payments to Medicare+Choice organizations to: (1) increase the minimum payment amount for 2001 for certain areas; (2) increase the minimum percentage increase for 2001; and (3) provide for a ten-year phase in of risk adjustment.
(Sec. 604) Provides for a transition to revised Medicare+Choice payment rates.
(Sec. 605) Amends SSA title XVIII part C to provide for revision of payment rates for ESRD patients enrolled in Medicare+Choice plans.
(Sec. 606) Amends SSA title XVIII part C with regard to premiums to permit Medicare part B premium reductions as additional benefits under Medicare+Choice plans.
(Sec. 607) Amends SSA title XVIII part C with regard to payments to Medicare+Choice organizations to: (1) ensure full implementation of risk adjustment methodology for congestive heart failure enrollees for 2001; and (2) provide for the expansion of the application of Medicare+Choice's new entry bonus.
(Sec. 609) Directs the Secretary to report to Congress on a method to phase-in the costs of military facility services furnished by the Department of Veterans Affairs, and those furnished by the Department of Defense, to Medicare-eligible beneficiaries in the calculation of an area's Medicare+Choice capitation payment.
Subtitle B: Other Medicare+Choice Reforms - Amends SSA title XVIII part C to provide for payment of additional amounts for new Medicare+Choice benefits covered during a contract term.
(Sec. 612) Prohibits the Secretary from implementing, other than at the beginning of a calendar year, regulations that impose, significant regulatory requirements on a Medicare+Choice organization or plan.
(Sec. 613) Provides for timely approval of marketing material that follows model marketing language, and for avoiding duplicative regulation with respect to plan requirements.
(Sec. 615) Provides that, in the case of a Medicare+Choice organization that offers a Medicare+Choice plan in an area in which more than one local coverage policy is applied with respect to different parts of the area, the organization may elect to have the local coverage policy for the part of the area that is most beneficial to Medicare+Choice enrollees apply with respect to all Medicare+Choice enrollees enrolled in the plan.
(Sec. 616) Requires: (1) the quality assurance program under the Medicare+Choice program to include a separate focus on racial and ethnic minorities; and (2) the Secretary to submit to Congress a report regarding how such quality assurance programs focus on racial and ethnic minorities.
(Sec. 617) Authorizes the Secretary to waive or to modify requirements that hinder the design of, the offering of, or enrollment in Medicare+Choice plans under contracts between Medicare+Choice organizations and employers, labor organizations, or the trustees of a fund established by one or more employers or labor organizations (or combination thereof) to furnish benefits to the entity's employees, former employees (or combination thereof) or to members or former members (or combination thereof) of the labor organizations.
(Sec. 618) Amends SSA title XVIII part D with regard to special Medigap enrollment anti-discrimination provision for certain beneficiaries.
(Sec. 619) Amends SSA title XVIII part C to restore the effective date of elections and changes of elections of Medicare+Choice plans.
(Sec. 620) Permits ESRD beneficiaries to enroll in another Medicare+Choice plan if the plan in which they are enrolled is terminated.
(Sec. 621) Provides that, in covering post-hospital extended care services, a Medicare+Choice plan shall provide for such coverage through a home SNF if: (1) the enrollee elects to receive such coverage through such SNF; and (2) the SNF has a contract with the Medicare+Choice organization for the provision of such services, or the SNF agrees to accept substantially similar payment under the same terms and conditions that apply to similarly situated SNFs under contract with the Medicare+Choice organization through which the enrollee would otherwise receive such services. Requires a MEDPAC report to Congress on the effects of such requirements.
(Sec. 622) Directs HCFA's Chief Actuary to review the actuarial assumptions and data used by the Medicare+Choice organization with respect to such rates, amounts, and values to determine the appropriateness of such assumptions and data.
Subtitle C: Other Managed Care Reforms - Amends the Omnibus Budget Reconciliation Act of 1987 to provide for a one-year extension of the social health maintenance organization (SHMO) demonstration project authority.
(Sec. 632) Amends BBRA to provide for revised terms and conditions for extension of Medicare community nursing organization (CNO) demonstration project.
(Sec. 633) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to provide for a two-year extension of Medicare municipal health services demonstration projects.
(Sec. 634) Amends SSA title XVIII part D with regard to payments to health maintenance organizations and competitive medical plans and service area expansion for Medicare cost contracts during transition period.
Title VII: Medicaid - Amends SSA title XIX (Medicaid) with respect to adjustment in payment for inpatient hospital services furnished by DSH hospitals and the limit on Federal financial participation to provide for: (1) increased allotments for FY 2001 and 2002; and (2) a special rule for Medicaid DSH allotment for extremely low DSH States.
(Sec. 701) Amends SSA title XIX with respect to adjustment in payment for inpatient hospital services furnished by DSH hospitals and Medicaid provisions relating to managed care to provide for identification of patients for purposes of making DSH payments.
Provides, during a specified period, for application of Medicaid DSH transition rule under BBA '97 to public hospitals in all States, except California.
States that beginning with FY 2002, and subject to a specified limitation on expenditures, with respect to a State, payment adjustments made under Medicaid to a specified hospital shall be made without regard to the DSH allotment limitation for the State.
Directs the Secretary to implement accountability standards to ensure that Federal funds provided with respect to DSH adjustments made under Medicaid provisions for adjustment in payment for inpatient hospital services furnished by DSH are used to reimburse States and hospitals eligible for such payment adjustments for providing uncompensated health care to low-income patients.
(Sec. 702) Amends SSA title XIX to create a new PPS for Federally-qualified health centers and rural health clinics.
Directs the Comptroller General to provide for a study and report to Congress on the need for, and how to, rebase or refine costs for making Medicaid payment for services provided by Federally-qualified health centers and rural health clinics.
(Sec. 703) Amends SSA XI to establish an approval process for a State's application for an extension of any State-wide comprehensive demonstration project for which a waiver of compliance with Medicaid requirements is granted.
(Sec. 704) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 with respect to Medicaid county-organized health systems.
(Sec. 705) Directs the Secretary to issue a final regulation based on the proposed rule announced on October 5, 2000, that: (1) modifies the upper payment limit test applied to State Medicaid spending for inpatient hospital services, outpatient hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services by applying an aggregate upper payment limit to payments made to government facilities that are not State-owned or operated facilities; and (2) provides for a specified transition period.
(Sec. 706) Prescribes a formula for the Federal medical assistance percentage for Alaska for purposes of SSA titles XIX and XXI (State Children's Health Insurance) (SCHIP), which shall be applicable only for FY 2001 through 2005.
Title VIII: State Children's Health Insurance Program - Amends SSA title XXI to: (1) establish a rule for redistribution and extended availability of unused FY 1998 and 1999 SCHIP allotments; (2) provide authority to pay Medicaid expansion SCHIP costs from SCHIP appropriations; (3) eliminate requirement to reduce SCHIP allotment by Medicaid expansion SCHIP costs; and (4) provide authority to transfer SCHIP appropriations to the Medicaid appropriation account as reimbursement for Medicaid expenditures for Medicaid expansion SCHIP services.
Title IX: Other Provisions - Subtitle A: PACE Program - Amends BBA '97 with respect to programs of all-inclusive care for the elderly (PACE programs) to provide for an extension of transition for the current PACE demonstration project waiver authority.
(Sec. 902) Amends SSA title XVIII with respect to payments to, and coverage of benefits under, PACE programs, and regulations and use of PACE protocol to provide for the continuation of modifications or waivers of operational requirements under demonstration status.
(Sec. 903) Directs the Secretary to approve or deny a request for a modification or a waiver of provisions of the PACE protocol not later than 90 days after the Secretary receives the request, in order to provide flexibility in exercising waiver authority.
Permits the Secretary to exercise authority to modify or to waive such provisions in a manner that responds promptly to the needs of PACE programs relating to areas of employment and the use of community-based primary care physicians in order to provide flexibility in exercising waiver authority.
Subtitle B: Outreach to Eligible Low-Income Medicare Beneficiaries - Amends SSA title XI to direct the Commissioner of Social Security to: (1) conduct outreach efforts to identify individuals entitled to Medicare benefits who may be eligible for medical assistance for payment of the cost of Medicare cost-sharing under Medicaid; and (2) notify such individuals of the availability of such medical assistance.
(Sec. 911) Directs the Comptroller General to study and report to Congress on the impact of such outreach efforts on the enrollment of individuals for Medicare cost-sharing under Medicaid.
Subtitle C: Maternal and Child Health Block Grant - Amends SSA title V (Maternal and Child Health Services) to increase the authorization of appropriations for the Maternal and Child Health Services block grant for FY 2001 and each fiscal year thereafter.
Subtitle D: Diabetes - Amends the Public Health Service Act to increase FY 2001 through 2003 appropriations for special diabetes programs for children with type I diabetes and for special diabetes programs for Indians.
(Sec. 931) Amends BBA '97 to extend the final report on diabetes grant programs.
(Sec. 932) Amends the Ricky Ray Hemophilia Relief Fund Act of 1998 to make appropriations to the Ricky Ray Hemophilia Relief Fund for FY 2001.