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S.1788
Medicare, Medicaid, and SCHIP Adjustment Act of 1999 (Placed on the
Calendar in the Senate)
SEC. 521. MODERATION OF MEDICARE+CHOICE RISK ADJUSTMENT IMPLEMENTATION.
Section 1853(a)(3)(C) (42 U.S.C. 1395w-23(a)(3)(C)) is amended--
(1) by redesignating the first sentence as clause (i) with the heading
`IN GENERAL- ' and appropriate indentation; and
(2) by adding at the end the following:
`(ii) PHASE-IN- Such risk adjustment methodology shall be
implemented in a phased-in manner so that the new methodology applies
only to--
`(I) 10 percent of the payment amount in 2000 and 2001 (in which
the risk adjustment methodology should
reflect only data from inpatient settings);
`(II) 20 percent of such amount in 2002 (in which such methodology
should reflect only data from inpatient settings);
`(III) 30 percent of such amount in 2003 (in which such
methodology should reflect only data from inpatient
settings);
`(IV) 55 percent of such amount in 2004 (in which such methodology
should reflect a blend of 67 percent of only data from inpatient
settings and 33 percent of data from inpatient and other
settings);
`(V) 80 percent of such amount in 2005 (in which such methodology
should reflect a blend of 33 percent of only data from inpatient
settings and 67 percent of data from inpatient and other settings);
and
`(VI) 100 percent of such amount in any subsequent year (in which
such methodology should reflect data from inpatient and other
settings).'.
SEC. 522. DELAY IN DEADLINE FOR SUBMISSION OF ADJUSTED COMMUNITY RATES UNDER
MEDICARE+CHOICE PROGRAM AND RELATED MODIFICATIONS.
(a) DELAY IN DEADLINE FOR SUBMISSION OF ADJUSTED COMMUNITY RATES- Section
1854(a)(1) (42 U.S.C. 1395w-24(a)(1)) is amended by striking `May 1' and
inserting `July 1' in the matter preceding subparagraph (A).
(b) ADJUSTMENT IN
INFORMATION DISCLOSURE PROVISIONS TO CONFORM TO DELAY IN DEADLINE FOR ACR
SUBMISSION- Section 1851(d)(2)(A)(ii) (42 U.S.C. 1395w-21(d)(2)(A)(ii)) is
amended--
(1) by inserting after `information described in paragraph (4)
concerning such plans' the following: `, to the extent such information is
available at the time of preparation of the material for mailing'; and
(2) by adding at the end the following: `If any item described in
paragraph (4) is not available at the time of preparation of the material
for mailing, the Secretary shall provide general information concerning such
item.'.
(c) MEDICARE+CHOICE ORGANIZATION REQUIRED TO PROVIDE TERMINATION NOTICE BY
DATE FOR ACR SUBMISSION- Section 1857(c)(1) (42 U.S.C. 1395w-27(c)(1)) is
amended--
(1) by striking `Each contract' and inserting the following:
`(A) IN GENERAL- Each contract'; and
(2) by adding at the end the following:
`(B) TERMINATION NOTICE- If a Medicare+Choice organization intends to
terminate a contract under this section at the end of the current term of
the contract, the organization shall notify the Secretary of such intent
by not later than July 1 of such term.'.
(1) ACR AND INFORMATION DISCLOSURE- The amendments made by subsections
(a) and (b) shall apply to submissions required to be made on or after the
date of enactment of this Act.
(2) TERMINATION NOTICE- The amendment made by subsection (c) shall apply
to contract years beginning on or after the date of enactment of this
Act.
SEC. 523. USER FEE FOR MEDICARE+CHOICE ORGANIZATIONS BASED ON NUMBER OF
ENROLLED BENEFICIARIES.
(a) DETERMINATION- Section 1857(e)(2) (42 U.S.C. 1395w-27(e)(2)) is
amended to read as follows:
`(2) COST-SHARING IN ENROLLMENT-RELATED COSTS-
`(A) IN GENERAL- A Medicare+Choice organization shall pay the fee
established by the Secretary under subparagraph (B)(i).
`(i) IN GENERAL- The Secretary is authorized to charge a fee to each
Medicare+Choice organization with a contract under this part that is
equal to the organization's pro rata share (as determined by the
Secretary) of the aggregate amount of fees which the Secretary is
directed to collect in a fiscal year (as determined under clause
(ii)).
`(ii) AGGREGATE AMOUNT OF FEES TO BE COLLECTED- For purposes of
clause (i), the aggregate amount of fees which the Secretary is directed
to collect in a fiscal year is an amount equal to the applicable
percentage of the aggregate expenses incurred by the Secretary in
carrying out the sections described in clause (iii)(I) in such year. For
purposes of the preceding sentence, the applicable percentage in a
fiscal year is equal to the ratio (expressed as a percentage)
of--
`(I) the total number of individuals enrolled in Medicare+Choice
plans in such year; to
`(II) the total number of individuals enrolled in part A or B in
such year.
`(iii) FEES COLLECTED- For any fiscal year, the fees authorized to
be collected under this subparagraph shall be available to the
Secretary--
`(I) only for the purpose of carrying out section 1851 (relating
to enrollment and dissemination of information) and section 4360 of
the Omnibus Budget Reconciliation Act of 1990 (relating to the health
insurance counseling and assistance program); and
`(II) without further appropriation.
`(C) AMOUNTS FROM PART A TRUST FUND-
`(i) IN GENERAL- Subject to clause (ii), amounts in the Federal
Hospital Insurance Trust Fund shall be available to the Secretary in a
fiscal year (beginning in fiscal year 2000) to cover the expenses
associated with carrying out the sections described in subparagraph
(B)(iii)(I).
`(ii) LIMITATION- The total amount available to the Secretary from
the Federal Hospital Insurance Trust Fund under clause (i) in any fiscal
year shall not exceed $100,000,000 minus an amount equal to the amount
authorized to be collected under subparagraph (B)(i) for the fiscal
year.'.
(b) EFFECTIVE DATE- The amendment made by this section shall apply to fees
charged on or after October 1, 1999.
SEC. 524. CHANGE IN TIME PERIOD FOR EXCLUSION OF MEDICARE+CHOICE
ORGANIZATIONS THAT HAVE HAD A CONTRACT TERMINATED.
(a) IN GENERAL- Section 1857(c)(4) (42 U.S.C. 1395w-27(c)(4)) is amended
by striking `5-year period' and inserting `2-year period'.
(b) EFFECTIVE DATE- The amendment made by this section shall apply to
contract years beginning on or after January 1, 1999.
SEC. 525. FLEXIBILITY TO TAILOR BENEFITS UNDER MEDICARE+CHOICE PLANS.
(a) IN GENERAL- Section 1854 (42 U.S.C. 1395w-24) is amended--
(1) in subsection (a)(1), by inserting `(or segment of such an area if
permitted under subsection (h))' after `service area' in the matter
preceding subparagraph (A); and
(2) by adding at the end the following:
`(h) PERMITTING USE OF SEGMENTS OF SERVICE AREAS- The Secretary shall
permit a Medicare+Choice organization to elect to apply the provisions of this
section uniformly to separate segments of a service area (rather than
uniformly to an entire service area) as long as such segments are composed of
1 or more counties.'.
(b) EFFECTIVE DATE- The amendments made by this section shall apply to
contract years beginning on or after January 1, 2000.
SEC. 526. INAPPLICABILITY OF QISMC TO PREFERRED PROVIDER ORGANIZATIONS.
(a) IN GENERAL- A Medicare+Choice plan that is operating as a preferred
provider organization plan shall
not be subject to the requirements of the Quality Improvement System for
Managed Care (QISMC) established by the Secretary of Health and Human Services
to carry out section 1852(e) of the Social Security Act (42 U.S.C. 1395w-22(e))
.
(b) APPLICATION OF FEE-FOR-SERVICE QUALITY SYSTEM TO PPOS- If the
Secretary of Health and Human Services establishes a system that is--
(1) applicable to providers under the original fee-for-service program
under parts A and B of title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.); and
(2) similar to the system described in subsection (a);
a Medicare+Choice plan that is operating as a preferred provider
organization plan shall comply with the requirements of that system.
(c) EFFECTIVE DATE- This section shall apply to contract years beginning
on or after January 1, 2000.
SEC. 527. TIMING OF MEDICARE+CHOICE HEALTH INFORMATION FAIRS.
(a) IN GENERAL- Section 1851(e)(3) (42 U.S.C. 1395w-21(e)(3)) is amended
in subparagraph (C), by striking `In the month of November' and inserting
`During the fall season'.
(b) EFFECTIVE DATE- The amendment made by this section shall take effect
on the date of enactment of this Act.
SEC. 528. RULES REGARDING PHYSICIAN REFERRALS FOR MEDICARE+CHOICE
PROGRAM.
(a) IN GENERAL- Section 1877(b)(3) (42 U.S.C. 1395nn(b)(3)) is
amended--
(1) in subparagraph (C), by striking `or' at the end;
(2) in subparagraph (D), by striking the period at the end and inserting
`, or'; and
(3) by adding at the end the following:
`(E) that is a Medicare+Choice organization under part C that is
offering a coordinated care plan described in section 1851(a)(2)(A) to an
individual enrolled with the organization.'.
(b) EFFECTIVE DATE- The amendment made by this section shall take effect
on the date of enactment of this Act.
SEC. 529. CLARIFICATION REGARDING THE ABILITY OF A RELIGIOUS FRATERNAL
BENEFIT SOCIETY TO OPERATE A MEDICARE+CHOICE PRIVATE FEE-FOR-SERVICE PLAN.
(a) IN GENERAL- Section 1859(e)(2) (42 U.S.C. 1395w-28(e)(2)) is amended
by striking `section 1851(a)(2)(A)' and inserting `subparagraphs (A) and (C)
of section 1851(a)(2)'.
(b) EFFECTIVE DATE- The amendment made by this section shall apply to
contract years beginning on or after the date of enactment of this Act.
Subtitle C--Provisions Regarding Special Medicare
Populations
SEC. 541. EXTENSION OF SOCIAL HEALTH MAINTENANCE ORGANIZATION DEMONSTRATION
PROJECT AUTHORITY.
Section 4018(b) of the Omnibus Budget Reconciliation Act of 1987 is
amended--
(1) in paragraph (1), by striking `December 31, 2000' and inserting `the
date that is 1 year after the date on which the Secretary submits to
Congress the report described in section 4014(c) of the Balanced Budget Act
of 1997'; and
(2) in paragraph (4), by striking `March 31, 2001' and inserting `the
date that is 1 year after the date on which Secretary submits to Congress
the report described in section 4014(c) of the Balanced Budget Act of
1997'.
SEC. 542. INAPPLICABILITY OF OASIS TO PACE.
Sections 1894(e)(3) and 1934(e)(3) (42 U.S.C. 1395eee(e)(3) and
1396u-4(e)(3)) are each amended by adding at the end the following:
`(C) INAPPLICABILITY OF OASIS TO PACE- Notwithstanding the previous
provisions of this paragraph, with respect to any home health service
provided under a PACE program under this section, the Secretary shall not
apply the data collection and reporting requirements under the Outcome and
Assessment Information Set (OASIS) to such program or to any enrollee of
such program, regardless of whether such service is provided by a PACE
program directly or through a contract with a home health
agency.'.
SEC. 543. MEDIGAP PROTECTIONS FOR PACE PROGRAM ENROLLEES.
(a) IN GENERAL- Section 1882(s)(3)(B) (42 U.S.C. 1395ss(s)(3)(B)) is
amended--
(1) in clause (ii), by inserting `or the individual is enrolled with a
PACE provider under section 1894, and there are circumstances that would
permit the discontinuance of the individual's enrollment with such provider
under circumstances that are similar to the circumstances that would permit
discontinuance of the individual's election under the first sentence of such
section if such individual were enrolled in a Medicare+Choice plan' before
the period;
(2) in clause (v)(II), by inserting `any PACE provider under section
1894,' after `demonstration project authority,'; and
(A) by inserting `or in a PACE program under section 1894' after `part
C'; and
(B) by striking `such plan' and inserting `such plan or such
program'.
(b) EXTENDED DISENROLLMENT WINDOW FOR INVOLUNTARILY TERMINATED ENROLLEES-
Section 1882(s)(3)(B) (42 U.S.C. 1395ss(s)(3)(B)), as amended by section 505,
is amended by adding at the end the following: `If any individual is enrolled
with any PACE provider under clause (v), or in any PACE program under clause
(vi), and the PACE program in which the individual is enrolled is terminated
or such individual is disenrolled from such program under circumstances that
are similar to the circumstances described in section 1851(e)(4)(A), such
individual may reenroll for a 12-month period (beginning on the date of such
enrollment) with a PACE provider in a PACE program and such reenrollment shall
be
considered to be an enrollment under clause (v) or (vi) (as applicable).'.
(c) EFFECTIVE DATE- The amendments made by this section shall apply to
terminations or discontinuances made on or after the date of enactment of this
Act.
SEC. 544. CONTINUATION OF THE FRAIL ELDERLY DEMONSTRATION PROJECT.
With respect to the demonstration project (known as the `EverCare'
project) to demonstrate the application of capitation payment rates for frail
elderly medicare beneficiaries under a specialized program that utilizes a
specialized interdisciplinary team, the Secretary of Health and Human Services
shall--
(1) extend the project for an additional 2-year period from the
termination date of the project (as in effect on the date of enactment of
this Act); and
(2) not apply with respect to a frail elderly medicare beneficiary who
is receiving services under the demonstration project--
(A) during 2000, the risk -adjustment described in section
1853(c)(3) of the Social Security Act (42 U.S.C. 1395w-23(c)(3));
or
(B) during any year in which the demonstration project is in effect,
the rules under subparagraphs (B) and (C) of section 1851(e)(2) of such
Act (42 U.S.C. 1395w-21(e)(2)) applicable to open enrollment and
disenrollment opportunities under the Medicare+Choice program.
Subtitle D--Studies and Reports To Assist in Making Future Improvements
in the Medicare Program
SEC. 561. GAO STUDIES, AUDITS, AND REPORTS.
(a) STUDY OF MEDIGAP POLICIES-
(1) IN GENERAL- The Comptroller General of the United States (in this
section referred to as the `Comptroller General') shall conduct a study of
the issues described in paragraph (2) regarding medicare supplemental
policies described in section 1882(g)(1) of the Social Security Act (42
U.S.C. 1395ss(g)(1)).
(2) ISSUES TO BE STUDIED- The issues described in this paragraph are the
following:
(A) The level of coverage provided by each type of medicare
supplemental policy.
(B) The current enrollment levels in each type of medicare
supplemental policy.
(C) The availability of each type of medicare supplemental policy to
medicare beneficiaries over age 65 1/2 .
(D) The number of States that offer each type of medicare supplemental
policy.
(E) The average out-of-pocket costs (including premiums) per
beneficiary under each type of medicare supplemental policy.
(3) REPORT- Not later than July 31, 2001, the Comptroller General shall
submit a report to Congress on the results of the study conducted under this
subsection, together with any recommendations for legislation that the
Comptroller General determines to be appropriate as a result of such
study.
(b) GAO AUDIT AND REPORTS ON THE PROVISION OF MEDICARE+CHOICE HEALTH
INFORMATION TO BENEFICIARIES-
(1) IN GENERAL- Beginning in 2000, the Comptroller General shall conduct
an annual audit of the expenditures by the Secretary of Health and Human
Services during the preceding year in providing information regarding the
Medicare+Choice program under part C of title XVIII of the Social Security
Act (42 U.S.C. 1395w-21 et seq.) to eligible medicare beneficiaries.
(3) REPORTS- Not later than March 31 of 2001, 2004, 2007, and 2010, the
Comptroller General shall submit a report to Congress on the results of the
audit of the expenditures of the preceding 3 years conducted pursuant to
subsection (a), together with an evaluation of the effectiveness of the
means used by the Secretary of Health and Human Services in providing
information regarding the Medicare+Choice program under part C of title
XVIII of the Social Security Act (42 U.S.C. 1395w-21 et seq.) to eligible
medicare beneficiaries.
SEC. 562. MEDICARE PAYMENT ADVISORY COMMISSION STUDIES AND REPORTS.
(1) STUDY- The Medicare Payment Advisory Commission established under
section 1805 of the Social Security Act (42 U.S.C. 1395b-6) (in this section
referred to as `MedPAC') shall conduct a study that evaluates the
methodology used by the Secretary of Health and Human Services in developing
the risk factors used in
adjusting the Medicare+Choice capitation rate paid to Medicare+Choice
organizations under section 1853 of the Social Security Act (42 U.S.C.
1395w-23) and includes the issues described in paragraph (2).
(2) ISSUES TO BE STUDIED- The issues described in this paragraph are the
following:
(A) The ability of the average risk adjustment factor applied to a
Medicare+Choice plan to explain variations in plans' average per capita
medicare costs, as reported by Medicare+Choice plans in the plans'
adjusted community rate filings.
(B) The year-to-year stability of the risk factors applied to each
Medicare+Choice plan and the potential for substantial changes in payment
for small Medicare+Choice plans.
(C) For medicare beneficiaries newly enrolled in Medicare+Choice plans
in a given year, the correspondence between the average risk factor calculated from
medicare fee-for-service data for those individuals from the period prior
to their enrollment in a Medicare+Choice plan and the average risk factor calculated for such
individuals during their initial year of enrollment in a Medicare+Choice
plan.
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