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S.1788
Medicare, Medicaid, and SCHIP Adjustment Act of 1999 (Placed on the
Calendar in the Senate)
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.
(D) For medicare beneficiaries disenrolling from or switching among
Medicare+Choice plans in a given year, the correspondence between the
average risk factor
calculated from data pertaining to the period prior to their disenrollment
from a Medicare+Choice plan and the average risk factor calculated from data
pertaining to the period after disenrollment.
(E) An evaluation of the exclusion of `discretionary' hospitalizations
from consideration in the risk adjustment methodology.
(F) Suggestions for changes or improvements in the risk adjustment methodology.
(3) REPORT- Not later than December 1, 2000, MedPAC shall submit a
report to Congress on the study conducted under paragraph (1), together with
any recommendations for legislation that MedPAC determines to be appropriate
as a result of such study.
(b) DEVELOPMENT OF SPECIAL PAYMENT RULES UNDER THE MEDICARE+CHOICE PROGRAM
FOR FRAIL ELDERLY ENROLLED IN SPECIALIZED PROGRAMS-
(1) STUDY- MedPAC shall conduct a study on the development of a payment
methodology under the Medicare+Choice program for frail elderly
Medicare+Choice beneficiaries enrolled in a Medicare+Choice plan under a
specialized program for the frail elderly that--
(A) accounts for the prevalence, mix, and severity of chronic
conditions among such frail elderly Medicare+Choice
beneficiaries;
(B) includes medical diagnostic factors from all provider settings
(including hospital and nursing facility settings); and
(C) includes functional indicators of health status and such other
factors as may be necessary to achieve appropriate payments for plans
serving such beneficiaries.
(2) REPORT- Not later than 1 year after the date of enactment of this Act,
MedPAC shall submit a report to Congress on the study conducted under
paragraph (1), together with any recommendations for legislation that MedPAC
determines to be appropriate as a result of such study.
SEC. 563. COMPUTATION AND REPORT ON MEDICARE ORIGINAL FEE-FOR-SERVICE
EXPENDITURES ON A COUNTY-BY-COUNTY BASIS.
(a) COMPUTATION- The Secretary of Health and Human Services shall compute
the expenditures under the original medicare fee-for-service program under
parts A and B of title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) on a county-by-county basis.
(b) REPORT- Not later than January 1, 2000, and annually thereafter, the
Secretary of Health and Human Services shall submit a report to Congress on
the computation performed under subsection (a), together with any
recommendations for legislation that the Secretary determines to be
appropriate as a result of such computation.
SEC. 564. STUDY AND REPORT ON THE EFFECTS, COSTS, AND FEASIBILITY OF
REQUIRING MEDICARE ORIGINAL FEE-FOR-SERVICE ENTITIES AND MEDICARE+CHOICE
COORDINATED CARE PLANS TO COMPLY WITH UNIFORM QUALITY STANDARDS AND RELATED
REPORTING REQUIREMENTS.
(a) STUDY- The Secretary of Health and Human Services shall conduct a
study on the effects, costs, and feasibility of--
(1) requiring entities, physicians, and other health care providers that
provide items and services under the original medicare fee-for-service
program under parts A and B of title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) to comply with quality standards and related reporting
requirements that are comparable to the quality standards and related
reporting requirements that are applicable to Medicare+Choice organizations
under part C of such title; and
(2) developing specific quality standards for different types of
Medicare+Choice coordinated care plans (as defined in section 1851(a)(2)(A)
of the Social Security Act (42 U.S.C. 1395w-21(a)(2)(A))).
(b) REPORT- Not later than March 1, 2000, the Secretary of Health and
Human Services shall submit a report to Congress on the study conducted under
subsection (a), together with any recommendations for legislation that the
Secretary determines to be appropriate as a result of such study.
SEC. 565. STUDY AND REPORT TO CONGRESS REGARDING DATA SUBMISSION USED TO
ESTABLISH RISK ADJUSTMENT METHODOLOGY UNDER THE
MEDICARE+CHOICE PROGRAM.
(a) STUDY- The Secretary of Health and Human Services shall conduct a
study on reducing the amount of data that is required to be submitted by
Medicare+Choice organizations in order for the Secretary to establish a risk adjustment methodology used in making
payments to such organizations under section 1853 of the Social Security Act
(42 U.S.C. 1395w-23) and that includes the issues described in subsection
(b).
(b) ISSUES TO BE STUDIED- The issues described in this subsection are the
following:
(1) In consultation with representatives of Medicare+Choice plans,
identification of modifications of Health Care Financing Administration
administrative systems that would reduce the costs or burden on such plans
for reporting encounter data from all sites of service.
(2) Evaluation of alternative risk adjustment methods that would
require submission from Medicare+Choice plans of data only from limited
sites of services.
(3) The potential for Medicare+Choice plans to misreport, overreport, or
underreport prevalence of diagnoses in outpatient sites of care, the
potential for increases in payments to Medicare+Choice plans from changes in
Medicare+Choice plan coding practices (commonly known as `coding creep') and
proposed methods for detecting and adjusting for such variations in
diagnosis coding as part of the risk adjustment methodology using
encounter data from all sites of care.
(4) The impact of the requirement to report complete encounter data on
the willingness of insurers to offer high deductible medical savings account
plans to medicare beneficiaries, and options for modifying data reporting
requirements to accommodate such plans.
(5) Differences in the ability of Medicare+Choice plans to report
complete encounter data, and the potential for adverse competitive impacts
on group and staff model health maintenance organizations or other
integrated providers of care based on data reporting capabilities.
(c) REPORT- Not later than January 1, 2001, the Secretary of Health and
Human Services shall submit a report to Congress on the study conducted under
this section, together with any recommendations for legislation that the
Secretary determines to be appropriate as a result of such study.
TITLE VI--OTHER MEDICARE PROVISIONS
SEC. 601. 2-YEAR MORATORIUM ON THERAPY CAPS.
(1) IN GENERAL- Section 1833(g) of the Social Security Act (42 U.S.C.
1395l(g)) is amended--
(A) in paragraphs (1) and (3), by striking `In the case' each place it
appears and inserting `Subject to paragraph (4), in the case';
and
(B) by adding at the end the following:
`(4) This subsection shall not apply in 2000 and 2001.'.
(2) EFFECTIVE DATE- The amendments made by paragraph (1) shall apply to
expenses incurred on or after January 1, 2000.
(1) IN GENERAL- Section 4541(d)(2) of the Balanced Budget Act of 1997
(42 U.S.C. 1395l note) is amended to read as follows:
`(2) REPORT- By not later than January 1, 2001, the Secretary of Health
and Human Services shall submit to Congress a report that includes
recommendations on--
`(A) the establishment of a mechanism for assuring appropriate
utilization of outpatient physical therapy services, outpatient
occupational therapy services, and speech-language pathology services that
are covered under the medicare program under title XVIII of the Social
Security Act (42 U.S.C. 1395); and
`(B) the establishment of an alternative payment policy for such
services based on classification of individuals by diagnostic category,
functional status, prior use of services (in both inpatient and outpatient
settings), and such other criteria as the Secretary determines
appropriate, in place of the uniform dollar limitations specified in
section 1833(g) of such Act, as amended by paragraph (1).
The recommendations shall include how such a mechanism or policy might
be implemented in a budget-neutral manner.'.
(2) EFFECTIVE DATE- The amendment made by paragraph (1) shall take
effect as if included in the enactment of section 4541 of the Balanced
Budget Act of 1997 (Public Law 105-33; 111 Stat. 454).
(c) STUDY AND REPORT ON UTILIZATION-
(A) IN GENERAL- The Secretary of Health and Human Services shall
conduct a study which compares--
(i) utilization patterns (including nationwide patterns, and
patterns by region, types of settings, and diagnosis or condition) of
outpatient physical therapy services, outpatient occupational therapy
services, and speech-language pathology services that are covered under
the medicare program under title XVIII of the Social Security Act (42
U.S.C. 1395) and provided on or after January 1, 2000; with
(ii) such patterns for such services that were provided in 1998 and
1999.
(B) REVIEW OF CLAIMS- In conducting the study under this subsection
the Secretary of Health and Human Services shall review a statistically
significant number of claims for reimbursement for the services described
in subparagraph (A).
(2) REPORT- Not later than March 31, 2001, the Secretary of Health and
Human Services shall submit a report to Congress on the study conducted
under paragraph (1), together with any recommendations for legislation that
the Secretary determines to be appropriate as a result of such study.
SEC. 602. INCREASE IN PAYMENT AMOUNT FOR RENAL DIALYSIS SERVICES FURNISHED
UNDER THE MEDICARE PROGRAM.
(a) IN GENERAL- Section 1881(b)(7) (42 U.S.C. 1395rr(b)(7)) is amended by
adding at the end the following flush sentence:
`The amount of each composite rate payment for dialysis services furnished
on or after October 1, 2000, shall be equal to 102 percent of each such
composite rate payment amount for such services furnished on December 31,
1999.'.
(b) CONFORMING AMENDMENT-
(1) IN GENERAL- Section 9335(a) of the Omnibus Budget Reconciliation Act
of 1986 (42 U.S.C. 1395rr note) is amended by striking paragraph (1).
(2) EFFECTIVE DATE- The amendment made by paragraph (1) shall take
effect on October 1, 2000.
SEC. 603. INCREASE IN PAYMENT AMOUNT FOR PAP SMEAR LABORATORY TESTS.
(a) PAP SMEAR PAYMENT INCREASE- Section 1833(h) (42 U.S.C. 1395l(h)) is
amended by adding at the end the following:
`(7) Notwithstanding paragraphs (1) and (4), the Secretary shall establish
a minimum payment amount under this subsection for all areas for a diagnostic
or
screening pap smear laboratory test (including all cervical cancer screening
technologies that have been approved by the Food and Drug Administration) of not
less than $14.60.'.
(b) EFFECTIVE DATE- The amendment made by this subsection shall apply with
respect to laboratory tests furnished on or after January 1, 2000 and before
January 1, 2002.
SEC. 604. LIMITATION IN REDUCTION OF PAYMENTS TO DISPROPORTIONATE SHARE
HOSPITALS.
(a) IN GENERAL- Section 1886(d)(5)(F)(ix) (42 U.S.C. 1395ww(d)(5)(F)(ix))
is amended--
(1) in subclause (III), by striking `fiscal year 2000' and inserting
`fiscal years 2000 and 2001';
(2) by striking subclauses (IV); and
(3) by redesignating subclauses (V) and (VI) as subclauses (IV) and (V),
respectively.
(b) EFFECTIVE DATE- The amendments made by this section shall take effect
as if included in the amendments made by section 4403 of the Balanced Budget
Act of 1997 (Public Law 105-33; 111 Stat. 398).
SEC. 605. CLARIFICATION OF THE INHERENT REASONABLENESS (IR) AUTHORITY.
The Secretary of Health and Human Services may not use, or permit fiscal
intermediaries or carriers to use, the inherent reasonableness authority under
part B of title XVIII of such Act until the date that is 90 days after the
date that the Comptroller General of the United States releases a report
regarding the impact of the Secretary's, fiscal intermediaries', and carriers'
use of such authority.
SEC. 606. TECHNICAL AMENDMENTS RELATING TO BBA PROVISIONS.
(a) MEDICARE RURAL HOSPITAL FLEXIBILITY PROGRAM- Section 1820(c)(2)(B)(i)
(42 U.S.C. 1395i-4(c)(2)(B)(i)) is amended by striking `and is located in a
county (or equivalent unit of local government) in a rural area (as defined in
section 1886(d)(2)(D))' and inserting `that is located in a rural area (as
defined in section 1886(d)(2)(D)) and'.
(b) RURAL HEALTH CLINIC SERVICES- Section 4205(a)(1)(B) of the Balanced
Budget Act of 1997 (42 U.S.C. 1395l note) is amended by striking `services
furnished' and inserting `cost reporting periods beginning'.
(c) PPS HOSPITAL PAYMENT UPDATE- Section 4401(b)(1)(B) of the Balanced
Budget Act of 1997 (42 U.S.C. 1395ww note) is amended by striking `section
1886(b)(3)(B)(i)(XIII) of the Social Security Act (42 U.S.C.
1395ww(b)(3)(B)(i)(XIII))' and inserting `section 1886(b)(3)(B)(i)(XIV) of the
Social Security Act (42 U.S.C. 1395ww(b)(3)(B)(i)(XIV))'.
(d) MAINTAINING SAVINGS FROM TEMPORARY REDUCTION IN CAPITAL PAYMENTS FOR
PPS HOSPITALS- The last sentence of section 1886(g)(1)(A) (42 U.S.C.
1395ww(g)(1)(A)) is amended by striking `September 30, 2002' and inserting
`October 1, 2002'.
(e) PROSPECTIVE PAYMENT FOR SKILLED NURSING FACILITY SERVICES- Section
1888(e)(8)(B) (42 U.S.C. 1395yy(e)(8)(B)) is amended by striking `January 1,
1999,' and inserting `July 1, 1999'.
(f) TRANSFER OF CRIMINAL FINES RECOVERED AS A RESULT OF A FEDERAL HEALTH
CARE OFFENSE TO FEDERAL HOSPITAL INSURANCE TRUST FUND-
(1) IN GENERAL- Section 1817(k)(2)(C)(i) (42 U.S.C. 1395i(k)(2)(C)(i))
is amended by striking `section 982(a)(6)(B)' and inserting `section
24(a)'.
(2) EFFECTIVE DATE- The amendment made by this subsection shall take
effect as if included in the amendment made by section 201 of the Health
Insurance Portability and Accountability Act of 1996 (Public Law 104-191;
110 Stat. 1992).
(g) MEDICARE PAYMENTS TO NEWLY ESTABLISHED PPS EXEMPT PROVIDERS- Section
1886(b)(7)(A)(i)(II) (42 U.S.C. 1395ww(b)(7)(A)(i)(II)) is amended by
inserting `(as estimated by the Secretary)' after `median'.
(h) OTHER TECHNICAL AMENDMENTS-
(1) Section 1812(b) (42 U.S.C. 1395d(b)) is amended in the matter
following paragraph (3) by inserting `during' after `100 visits'.
(2) Section 1833(a)(1)(O) (42 U.S.C. 1395l(a)(1)(O)) is amended by
striking the semicolon and inserting a comma.
(3) Section 1834(h)(4)(A) (42 U.S.C. 1395m(h)(4)(A)) is amended--
(A) in clause (i), by striking the comma at the end and inserting a
semicolon; and
(B) in clause (v), by striking `, and' and inserting `; and'.
(4) Section 1842(s)(2)(E) (42 U.S.C. 1395u(s)(2)(E)) is amended by
inserting a period at the end.
(5) Section 1848(j)(3) (42 U.S.C. 1395w-4(j)(3)) is amended--
(A) by striking `1861(oo)(2),' and inserting `1861(oo)(2))';
(B) by striking `(B) ,' and inserting `(B),'; and
(C) by striking `and (15)' and inserting `, and (15)'.
(6) Section 1851(i)(2) (42 U.S.C. 1395w-21(i)(2)) is amended by striking
`and' after `1857(f)(2),'.
(7) Section 1852 (42 U.S.C. 1395w-22) is amended--
(A) in subsection (a)(3)(A)--
(i) by striking the comma after `MSA plan'; and
(ii) by inserting a comma after `the coverage)';
(i) in paragraph (1)(B), by inserting `or' after `in whole';
and
(ii) in paragraph (3)(B)(ii), by inserting a period at the
end;
(C) in subsection (h)(2), by striking the comma and inserting a
semicolon; and
(D) in subsection (k)(2)(C)(ii), by striking `balancing' and inserting
`balance'.
(8) Section 1854(a) (42 U.S.C. 1395w-24(a)) is amended--
(i) in subparagraph (A), in the matter preceding clause (i), by
inserting `section' before `1852(a)(1)(A)'; and
(ii) in subparagraph (B), in the matter preceding clause (i), by
inserting `section' after `described in';
(i) in subparagraph (A), by inserting `section' after `described
in'; and
(ii) in subparagraph (B), by inserting `section' after `described
in'; and
(i) in the matter preceding subparagraph (A), by inserting `section'
after `described in';
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