S 3165 IS
106th CONGRESS
2d Session
S. 3165
To amend the Social Security Act to make corrections and refinements
in the Medicare, Medicaid, and SCHIP health insurance programs, as revised by
the Balanced Budget Act of 1997 and the Medicare, Medicaid, and SCHIP Balanced
Budget Refinement Act of 1999, and for other purposes.
IN THE SENATE OF THE UNITED STATES
October 5 (legislative day, SEPTEMBER 22), 2000
Mr. ROTH (for himself, Mr. MOYNIHAN, Mr. JEFFORDS, Mr. MURKOWSKI, Mr. HATCH,
and Mr. KERREY) introduced the following bill; which was read the first time
A BILL
To amend the Social Security Act to make corrections and refinements
in the Medicare, Medicaid, and SCHIP health insurance programs, as revised by
the Balanced Budget Act of 1997 and the Medicare, Medicaid, and SCHIP Balanced
Budget Refinement Act of 1999, 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; AMENDMENTS TO SOCIAL SECURITY ACT; REFERENCES TO
OTHER ACTS; TABLE OF CONTENTS.
(a) SHORT TITLE- This Act may be cited as the `Medicare, Medicaid, and
SCHIP Balanced Budget Refinement Act of 2000'.
(b) AMENDMENTS TO SOCIAL SECURITY ACT- Except as otherwise specifically
provided, whenever in this Act an amendment is expressed in terms of an
amendment to or repeal of a section or other provision, the reference shall be
considered to be made to that section or other provision of the Social
Security Act.
(c) REFERENCES TO OTHER ACTS- In this Act:
(1) THE BALANCED BUDGET ACT OF 1997- The term `BBA' means the Balanced
Budget Act of 1997 (Public Law 105-33; 111 Stat. 251).
(2) THE MEDICARE, MEDICAID, AND SCHIP BALANCED BUDGET REFINEMENT ACT OF
1999- The term `BBRA' means the Medicare, Medicaid, and SCHIP Balanced
Budget Refinement Act of 1999 (113 Stat. 1501A-321), as enacted into law by
section 1000(a)(6) of Public Law 106-113.
(d) TABLE OF CONTENTS- The table of contents of this Act is as follows:
Sec. 1. Short title; amendments to Social Security Act; references to
other acts; table of contents.
TITLE I--BENEFIT IMPROVEMENTS
Subtitle A--Beneficiary Assistance
Sec. 101. Limiting copayment amount for hospital outpatient
services.
Sec. 102. Coverage of immunosuppressive drugs.
Sec. 103. Preservation of coverage of drugs and biologicals under part B
of the medicare program.
Sec. 104. Moratorium on reductions in current reimbursement rates for
outpatient drugs and biologicals; GAO study and report and HHS
comments.
Subtitle B--Improved Preventive Benefits
Sec. 111. Coverage of biannual screening pap smear and pelvic
exams.
Sec. 112. Coverage of screening colonoscopy for average risk
individuals.
Sec. 113. Medical nutrition therapy services for beneficiaries with
diabetes, a cardiovascular disease, or a renal disease.
Sec. 114. State accreditation of diabetes self-management training
programs.
Sec. 115. Studies on preventive interventions in primary care for older
Americans.
Sec. 116. Institute of Medicine 3-year medicare prevention benefit study
and report.
Sec. 117. MedPAC study and report on medicare coverage of cardiac and
pulmonary rehabilitation therapy services.
TITLE II--RURAL HEALTH CARE IMPROVEMENTS
Subtitle A--Critical Access Hospital Provisions
Sec. 201. Clarification of no beneficiary cost-sharing for clinical
diagnostic laboratory tests furnished by critical access hospitals.
Sec. 202. Revision of payment for professional services provided by a
critical access hospital.
Sec. 203. Permitting critical access hospitals to operate PPS exempt
distinct part psychiatric and rehabilitation units.
Sec. 204. Exemption of critical access hospital swing beds from SNF
PPS.
Subtitle B--Other Rural Hospital Provisions
Sec. 211. Equitable treatment for rural disproportionate share
hospitals.
Sec. 212. Option to base eligibility for medicare dependent, small rural
hospital program on discharges during any of the 3 most recent audited cost
reporting periods.
Sec. 213. Extension of option to use rebased target amounts to all sole
community hospitals.
Sec. 214. MedPAC analysis of impact of volume on per unit cost of rural
hospitals with psychiatric units.
Subtitle C--Other Rural Provisions
Sec. 221. Provider-based rural health clinic cap exemption.
Sec. 222. Payment for certain physician assistant services.
Sec. 223. Temporary increase for home health services furnished in a
rural area.
Sec. 224. Refinement of medicare reimbursement for telehealth
services.
Sec. 225. MedPAC study on low-volume, isolated rural health care
providers.
TITLE III--PROVISIONS RELATING TO PART A
Subtitle A--PPS Hospitals
Sec. 301. Delay of reduction in PPS hospital payment update.
Sec. 302. Revision of reduction of indirect graduate medical education
payments.
Sec. 303. Decrease in reductions for disproportionate share hospital
payments.
Sec. 304. Modification of payment rate for Puerto Rico hospitals.
Sec. 305. MedPAC study and report on hospital area wage indexes.
Sec. 306. MedPAC study and report regarding certain hospital
costs.
Subtitle B--PPS Exempt Hospitals
Sec. 311. Permanent guarantee of pre-BBA payment levels for outpatient
services furnished by children's hospitals.
Sec. 312. Payment for inpatient services of rehabilitation
hospitals.
Sec. 313. Implementation of prospective payment system for long-term
care hospitals.
Subtitle C--Skilled Nursing Facilities
Sec. 321. Revision to the skilled nursing facility (SNF) market basket
update for fiscal years 2001 and 2002.
Sec. 322. Application of SNF consolidated billing requirement limited to
part A covered stays.
Sec. 323. Reexamination of, and authority to revise, the skilled nursing
facility market basket percentage increase.
Subtitle D--Hospice Care
Sec. 331. Revision of market basket increase for 2001 and 2002.
Sec. 332. Study and report on physician certification requirement for
hospice benefits.
Sec. 333. Hospice demonstration program and hospice education
grants.
Subtitle E--Other Provisions
Sec. 341. Six-month delay in implementation of rule regarding
provider-based criteria.
TITLE IV--PROVISIONS RELATING TO PART B
Subtitle A--Hospital Outpatient Services
Sec. 401. Application of transitional corridor to certain hospitals that
did not submit a 1996 cost report.
Sec. 402. Clarifying process and standards for determining eligibility
of devices for pass-through payments under hospital outpatient PPS.
Sec. 403. Contrast enhanced diagnostic procedures under hospital
prospective payment system.
Sec. 404. Transitional pass-through for contrast agents.
Subtitle B--Provisions Relating to Physicians
Sec. 411. MedPAC study on the resource-based practice expense
system.
Sec. 412. GAO studies and reports on medicare payments.
Sec. 413. GAO study on gastrointestinal endoscopic services furnished in
physicians' offices and hospital outpatient department services.
Subtitle C--Ambulance Services
Sec. 421. Elimination of reduction in inflation adjustments for
ambulance services.
Sec. 422. Election to forego phase-in of fee schedule for ambulance
services.
Sec. 423. Study and report on the costs of rural ambulance
services.
Sec. 424. GAO study and report on the costs of emergency and medical
transportation services.
Subtitle D--Other Services
Sec. 431. Revision of moratorium in caps for therapy services.
Sec. 432. Update in renal dialysis composite rate.
Sec. 433. Full update in 2001 for durable medical equipment, oxygen, and
oxygen equipment.
Sec. 434. National limitation amount equal to 100 percent of national
median for new pap smear technologies and other new clinical laboratory test
technologies.
Sec. 435. Delay and revision of PPS for ambulatory surgical
centers.
Sec. 436. Treatment of certain physician pathology services.
Sec. 437. Modification of medicare billing requirements for certain
Indian providers.
Sec. 438. Replacement of prosthetic devices and parts.
Sec. 439. MedPAC study and report on medicare reimbursement for services
provided by certain providers.
Sec. 440. MedPAC study and report on medicare coverage of services
provided by certain non-physician providers.
TITLE V--PROVISIONS RELATING TO PARTS A AND B
Subtitle A--Home Health Services
Sec. 501. 1-year additional delay in application of 15 percent reduction
on payment limits for home health services.
Sec. 502. Restoration of full home health market basket update for home
health services for fiscal year 2001.
Sec. 503. Exclusion of certain nonroutine medical supplies under the PPS
for home health services.
Sec. 504. Treatment of branch offices; GAO study on supervision of home
health care provided in isolated rural areas.
Sec. 505. Temporary additional payments for high-cost patients.
Sec. 506. Clarification of the homebound definition under the medicare
home health benefit.
Subtitle B--Direct Graduate Medical Education
Sec. 511. Authority to include costs of training of clinical
psychologists in payments to hospitals.
TITLE VI--PROVISIONS RELATING TO PART C (MEDICARE+CHOICE PROGRAM) AND OTHER
MEDICARE MANAGED CARE PROVISIONS
Subtitle A--Medicare+Choice Payment Reforms
Sec. 601. Increase in national per capita medicare+choice growth
percentage in 2001 and 2002.
Sec. 602. Removing application of budget neutrality for 2002.
Sec. 603. Increase in minimum payment amount.
Sec. 604. Allowing movement to 50:50 percent blend in 2002.
Sec. 605. Increased update for payment areas with only one or no
medicare+choice contracts.
Sec. 606. 10-year phase-in of risk adjustment and new methodology.
Sec. 607. Permitting premium reductions as additional benefits under
medicare+choice plans.
Sec. 608. Delay from July to November 2000, in deadline for offering and
withdrawing medicare+choice plans for 2001.
Sec. 609. Revision of payment rates for ESRD patients enrolled in
medicare+choice plans.
Sec. 610. Modification of payment rules for certain frail elderly
medicare beneficiaries.
Sec. 611. Full implementation of risk adjustment for congestive heart
failure enrollees for 2001.
Sec. 612. Inclusion of costs of DOD military treatment facility services
to medicare-eligible beneficiaries in calculation of medicare+choice payment
rates.
Subtitle B--Other Medicare+Choice Reforms
Sec. 621. Amounts in medicare trust funds available for Secretary's
share of medicare+choice education and enrollment-related costs.
Sec. 622. Special medigap enrollment antidiscrimination provision for
certain beneficiaries.
Sec. 623. Restoring effective date of elections and changes of elections
of medicare+choice plans.
Sec. 624. Permitting ESRD beneficiaries to enroll in another
medicare+choice plan if the plan in which they are enrolled is
terminated.
Sec. 625. Election of uniform local coverage policy for medicare+choice
plan covering multiple localities.
Subtitle C--Other Managed Care Reforms
Sec. 631. Revised terms and conditions for extension of medicare
community nursing organization (CNO) demonstration project.
Sec. 632. Service area expansion for medicare cost contracts during
transition period.
TITLE VII--MEDICAID
Sec. 701. New prospective payment system for Federally-qualified health
centers and rural health clinics.
Sec. 702. Medicaid DSH allotments.
Sec. 703. Permanent extension of payment of medicare part B premiums for
qualified medicare beneficiaries with income up to 135 percent of
poverty.
Sec. 704. Streamlined approval of continued State-wide section 1115
medicaid waivers.
TITLE VIII--STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP)
Sec. 801. Special rule for redistribution and availability of unused
fiscal year 1998 and 1999 SCHIP allotments.
Sec. 802. Presumptive eligibility under SCHIP.
Sec. 803. Authority to pay medicaid expansion SCHIP costs from title XXI
appropriation.
TITLE IX--OTHER PROVISIONS
Sec. 901. Increase in authorization of appropriations for the maternal
and child health services block grant.
Sec. 902. Increase in appropriations for special diabetes programs for
children with type I diabetes and Indians.
TITLE I--BENEFIT IMPROVEMENTS
Subtitle A--Beneficiary Assistance
SEC. 101. LIMITING COPAYMENT AMOUNT FOR HOSPITAL OUTPATIENT SERVICES.
(a) IN GENERAL- Section 1833(t)(8)(C) (42 U.S.C. 1395l(t)(8)(C)) is
amended--
(1) in the heading, by striking `TO INPATIENT HOSPITAL DEDUCTIBLE
AMOUNT'; and
(2) by striking `exceed the amount' and all that follows before the
period and inserting `exceed an amount equal to the greater of--
`(i) one-half of the amount of the inpatient hospital deductible
established under section 1813(b) for that year; or
`(ii) 20 percent of the payment amount determined under this
subsection for the procedure.'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply with
respect to services furnished on or after January 1, 2001.
SEC. 102. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.
(a) ELIMINATION OF TIME LIMITATION FOR COVERAGE OF IMMUNOSUPPRESSIVE
DRUGS-
(1) IN GENERAL- Section 1861(s)(2)(J) (42 U.S.C. 1395x(s)(2)(J)) is
amended to read as follows:
`(J) prescription drugs used in immunosuppressive therapy furnished to
an individual who--
`(A) receives an organ transplant for which payment is made under this
title; or
`(B) received an organ transplant during the 36-month period
immediately preceding the individual's most recent effective date of
coverage of benefits under this part.'.
(2) CONFORMING AMENDMENTS-
(A) EXTENDED COVERAGE- Section 1832 (42 U.S.C. 1395k) is
amended--
(i) by striking subsection (b); and
(ii) by redesignating subsection (c) as subsection (b).
(B) PASS-THROUGH; REPORT- Subsections (c) and (d) of section 227 of
BBRA (113 Stat. 1501A-355) are repealed.
(b) CONTINUED ENTITLEMENT FOR IMMUNOSUPPRESSIVE DRUGS FOR CERTAIN
INDIVIDUALS AFTER MEDICARE BENEFITS END-
(1) IN GENERAL- Section 226A(b)(2) (42 U.S.C. 426-1(b)(2)) is amended by
inserting `(except for the provision of immunosuppressive drugs pursuant to
section 1861(s)(2)(J))' after `shall end'.
(2) APPLICATION- In the case of an individual whose eligibility for
benefits under title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) has ended except for the provision of immunosuppressive drugs pursuant
to the amendment made by paragraph (1), such individual shall be deemed to
be enrolled in the original medicare fee-for-service program for purposes of
receiving coverage of such drugs.
(3) TECHNICAL AMENDMENT- Subsection (c) of section 226A (42 U.S.C.
426-1), as added by section 201(a)(3)(D)(ii) of the Social Security
Independence and Program Improvements Act of 1994 (Public Law 103-296; 108
Stat. 1497), is redesignated as subsection (d).
(c) EFFECTIVE DATE- The amendments made by this section shall apply to
immunosuppressive drugs furnished on or after January 1, 2000, to individuals
whose period of entitlement (without regard to the amendment made by
subsection (b)(1)) to such drugs under title XVIII of the Social Security Act
ends after such date.
SEC. 103. PRESERVATION OF COVERAGE OF DRUGS AND BIOLOGICALS UNDER PART B OF
THE MEDICARE PROGRAM.
(a) IN GENERAL- Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is
amended, in each of subparagraphs (A) and (B), by striking `(including drugs
and biologicals which cannot, as determined in accordance with regulations, be
self-administered)' and inserting `(including injectable and infusable drugs and
biologicals which are not usually self-administered by the patient)'.
(b) PRESERVING EXISTING COVERAGE OF INJECTABLE AND INFUSABLE DRUGS AND
BIOLOGICALS-
(1) REPORT TO CONGRESS REQUIRED BEFORE COVERAGE IS LIMITED OR
TERMINATED- Notwithstanding any other provision of law, beginning on the
date of enactment of this Act, the Secretary of Health and Human Services
(in this subsection referred to as the `Secretary') may not limit or
terminate coverage (or permit an agency or organization with a contract
under section 1816 or 1842 of the Social Security Act (42 U.S.C. 1395h; 42
U.S.C. 1395u) to limit or terminate coverage) of any injectable or infusable
drug or biological that was reimbursed (as determined under policies
established by each such agency or organization) under section 1861(s)(2) of
such Act (42 U.S.C. 1395x(s)(2)) on January 1, 2000, solely on the basis
that the drug or biological can be self-administered. This paragraph shall
apply to any such drug or biological until the date that is 60 days after
the date on which the Secretary submits to Congress a report described in
paragraph (2) with respect to such drug or biological.
(2) REPORT DESCRIBED- A report described in this paragraph is a report
that describes in detail--
(A) the action the Secretary (or any agency or organization described
in paragraph (1)) proposes to take with respect to the limitation or
termination of coverage of an injectable or infusable drug or biological
under section 1861(s)(2) of the Social Security Act (42 U.S.C.
1395x(s)(2)); and
(B) the reasons for taking such action.
(c) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to
drugs and biologicals furnished on or after October 1, 2000.
SEC. 104. MORATORIUM ON REDUCTIONS IN CURRENT REIMBURSEMENT RATES FOR
OUTPATIENT DRUGS AND BIOLOGICALS; GAO STUDY AND REPORT AND HHS COMMENTS.
(a) MORATORIUM- Notwithstanding any other provision of law, the Secretary
of Health and Human Services may not implement any reduction in the rate of
reimbursement for any outpatient drug or biological under the medicare program
under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) during
the period that begins on the date of enactment of this Act and ends on
September 15, 2001.
(b) GAO STUDY AND REPORT REGARDING REIMBURSEMENT RATES FOR OUTPATIENT
DRUGS AND BIOLOGICALS-
(A) IN GENERAL- The Comptroller General of the United States shall
conduct a study on the reasonableness of the reimbursement policy for
outpatient drugs and biologicals under the medicare program under title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) based on the
average wholesale price of such drugs.
(B) REQUIREMENTS- The study described in subparagraph (A) shall
include an examination of the purchase prices providers pay for such drugs
and biologicals and an identification of the factors that affect such
purchase prices.
(2) REPORT- Not later than July 1, 2001, the Comptroller General of the
United States shall submit to the Secretary of Health and Human Services and
Congress a report on the study conducted under paragraph (1) together with
recommendations for such legislation and administrative actions as the
Comptroller General considers appropriate regarding any adjustment in
payment policy necessary to ensure reasonable reimbursement for outpatient
drugs and biologicals under the medicare program.
(c) COMMENTS- Not later than 90 days after the date on which the
Comptroller General of the United States submits the report under subsection
(b) to the Secretary of Health and Human Services, the Secretary shall submit
comments on such report to Congress.
Subtitle B--Improved Preventive Benefits
SEC. 111. COVERAGE OF BIANNUAL SCREENING PAP SMEAR AND PELVIC EXAMS.
(1) BIANNUAL SCREENING PAP SMEAR- Section 1861(nn)(1) (42 U.S.C.
1395x(nn)(1)) is
amended by striking `3 years' and inserting `2 years'.
(2) BIANNUAL SCREENING PELVIC EXAM- Section 1861(nn)(2) (42 U.S.C.
1395x(nn)(2)) is amended by striking `3 years' and inserting `2
years'.
(b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply to
items and services furnished on or after January 1, 2001.
SEC. 112. COVERAGE OF SCREENING COLONOSCOPY FOR AVERAGE RISK
INDIVIDUALS.
(a) IN GENERAL- Section 1861(pp) (42 U.S.C. 1395x(pp)) is amended--
(1) in paragraph (1)(C), by striking `In the case of an individual at
high risk for colorectal cancer, screening colonoscopy' and inserting
`Screening colonoscopy'; and
(2) in paragraph (2), by striking `In paragraph (1)(C), an' and
inserting `An'.
(b) FREQUENCY LIMITS FOR SCREENING COLONOSCOPY- Section 1834(d) (42 U.S.C.
1395m(d)) is amended--
(1) in paragraph (2)(E)(ii), by inserting before the period at the end
the following: `or, in the case of an individual who is not at high risk for
colorectal cancer, if the procedure is performed within the 119 months after
a previous screening colonoscopy';
(A) in the heading by striking `FOR INDIVIDUALS AT HIGH RISK FOR
COLORECTAL CANCER';
(B) in subparagraph (A), by striking `for individuals at high risk for
colorectal cancer (as defined in section 1861(pp)(2))';
(C) in subparagraph (E), by inserting before the period at the end the
following: `or for other individuals if the procedure is performed within
the 119 months after a previous screening colonoscopy or within 47 months
of a previous screening flexible sigmoidoscopy'.
(c) EFFECTIVE DATE- The amendments made by this section apply to
colorectal cancer screening services provided on or after January 1, 2001.
SEC. 113. MEDICAL NUTRITION THERAPY SERVICES FOR BENEFICIARIES WITH
DIABETES, A CARDIOVASCULAR DISEASE, OR A RENAL DISEASE.
(a) COVERAGE- Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is amended--
(1) in subparagraph (S), by striking `and' at the end;
(2) in subparagraph (T), by adding `and' at the end; and
(3) by adding at the end the following new subparagraph:
`(U) medical nutrition therapy services (as defined in subsection
(uu)(1)) in the case of a beneficiary with diabetes, a cardiovascular
disease (including congestive heart failure, arteriosclerosis,
hyperlipidemia, hypertension, and hypercholesterolemia), or a renal
disease;'.
(b) SERVICES DESCRIBED- Section 1861 (42 U.S.C. 1395x) is amended by
adding at the end the following new subsection:
`Medical Nutrition Therapy Services; Registered Dietitian or Nutrition
Professional
`(uu)(1) The term `medical nutrition therapy services' means nutritional
diagnostic, therapy, and counseling services for the purpose of disease
management which are furnished by a registered dietitian or nutrition
professional (as defined in paragraph (2)) pursuant to a referral by a
physician (as defined in subsection (r)(1)).
`(2) Subject to paragraph (3), the term `registered dietitian or nutrition
professional' means an individual who--
`(A) holds a baccalaureate or higher degree granted by a regionally
accredited college or university in the United States (or an equivalent
foreign degree) with completion of the academic requirements of a program in
nutrition or dietetics, as accredited by an appropriate national
accreditation organization recognized by the Secretary for this
purpose;
`(B) has completed at least 900 hours of supervised dietetics practice
under the supervision of a registered dietitian or nutrition professional;
and
`(C)(i) is licensed or certified as a dietitian or nutrition
professional by the State in which the service is performed; or
`(ii) in the case of an individual in a State that does not provide for
such licensure or certification, meets such other criteria as the Secretary
establishes.
`(3) Subparagraphs (A) and (B) of paragraph (2) shall not apply in the
case of an individual who, as of the date of enactment of this subsection, is
licensed or certified as a dietitian or nutrition professional by the State in
which the medical nutrition therapy service is performed.'.
(c) LIMITATION ON FREQUENCY- Section 1834 (42 U.S.C. 1395m) is amended by
adding at the end the following new subsection:
`(m) FREQUENCY LIMITATION FOR COVERAGE OF MEDICAL NUTRITION THERAPY
SERVICES- Notwithstanding any other provision of this part, no payment may be
made under this part for a medical nutrition therapy service (as defined in
section 1861(uu)) provided to an individual if such service is provided--
`(1) during the 12-month period beginning on the date that such
individual first received a medical nutrition therapy service covered under
this part and such individual has previously received 3 medical nutritional
therapy services during such period; or
`(2) at any time after such 12-month period if such individual has
previously received 3 medical nutritional therapy services covered under
this part after such 12-month period.
(d) PAYMENT- Section 1833(a)(1) (42 U.S.C. 1395l(a)(1)) is amended--
(1) by striking `and' before `(S)'; and
(2) by inserting before the semicolon at the end the following: `, and
(T) with respect to medical nutrition therapy services (as defined in
section 1861(uu)(1)), the amount paid shall be 85 percent
of the lesser of the actual charge for the services or the amount determined
under the fee schedule established under section 1848(b) for the same services
if furnished by a physician'.
(e) CONFORMING AMENDMENTS- Section 1862(a)(1) (42 U.S.C. 1395y(a)(1)) is
amended--
(1) in subparagraph (H), by striking `and' at the end;
(2) in subparagraph (I), by striking the semicolon at the end and
inserting `, and'; and
(3) by adding at the end the following new subparagraph:
`(J) in the case of medical nutrition therapy services (as defined in
section 1861(uu)(1)), which are provided more frequently than is covered
under section 1834(m);'.
(f) EFFECTIVE DATE- The amendments made by this section apply to services
furnished on or after July 1, 2001.
SEC. 114. STATE ACCREDITATION OF DIABETES SELF-MANAGEMENT TRAINING
PROGRAMS.
Section 1861(qq)(2) (42 U.S.C. 1395xx(qq)(2)) is amended--
(1) in the matter preceding subparagraph (A), by striking `paragraph
(1)--' and inserting `paragraph (1):';
(2) in subparagraph (A)--
(A) by striking `a `certified provider' and inserting `A `certified
provider'; and
(B) by striking `; and' and inserting a period; and
(3) in subparagraph (B)--
(A) by striking `a physician, or such other individual' and inserting
`(i) A physician, or such other individual';
(B) by inserting `(I)' before `meets applicable standards';
(C) by inserting `(II)' before `is recognized';
(D) by inserting `, or by a program described in clause (ii),' after
`recognized by an organization that represents individuals (including
individuals under this title) with diabetes'; and
(E) by adding at the end the following new clause:
`(ii) Notwithstanding any reference to `a national accreditation body'
in section 1865(b), for purposes of clause (i), a program described in this
clause is a program operated by a State for the purposes of accrediting
diabetes self-management training programs, if the Secretary determines that
such State program has established quality standards that meet or exceed the
standards established by the Secretary under clause (i) or the standards
originally established by the National Diabetes Advisory Board and
subsequently revised as described in clause (i).'.
SEC. 115. STUDIES ON PREVENTIVE INTERVENTIONS IN PRIMARY CARE FOR OLDER
AMERICANS.
(a) STUDIES- The Secretary of Health and Human Services, acting through
the United States Preventive Services Task Force, shall conduct a series of
studies designed to identify preventive interventions that can be delivered in
the primary care setting and that are most valuable to older Americans.
(b) MISSION STATEMENT- The mission statement of the United States
Preventive Services Task Force is amended to include the evaluation of
services that are of particular relevance to older Americans.
(c) REPORT- Not later than 1 year after the date of enactment of this Act,
and annually thereafter, the Secretary of Health and Human Services shall
submit a report to Congress on the conclusions of the studies conducted under
subsection (a), together with recommendations for such legislation and
administrative actions as the Secretary considers appropriate.
SEC. 116. INSTITUTE OF MEDICINE 3-YEAR MEDICARE PREVENTION BENEFIT STUDY AND
REPORT.
(1) IN GENERAL- The Secretary of Health and Human Services shall
contract with the Institute of Medicine of the National Academy of
Sciences--
(A) to conduct a comprehensive study of current literature and best
practices in the field of health promotion and disease prevention among
medicare beneficiaries, including the issues described in paragraph (2);
and
(B) to submit the report described in subsection (b).
(2) ISSUES STUDIED- The study required under paragraph (1) shall include
an assessment of--
(A) whether each covered benefit is--
(i) medically effective; and
(ii) a cost-effective benefit or a cost-saving benefit;
(B) utilization of covered benefits (including any barriers to or
incentives to increase utilization); and
(C) quality of life issues associated with both health promotion and
disease prevention benefits covered under the medicare program and those
that are not covered under such program that would affect all medicare
beneficiaries.
(1) IN GENERAL- Not later than 3 years after the date of enactment of
this Act, and every third year thereafter, the Institute of Medicine of the
National Academy of Sciences shall submit to the Secretary of Health and
Human Services and Congress a report that contains a detailed statement of
the findings and conclusions of the study conducted under subsection (a) and
the recommendations for legislation described in paragraph (2).
(2) RECOMMENDATIONS FOR LEGISLATION- The Institute of Medicine of the
National Academy of Sciences, in consultation with the Partnership for
Prevention, shall develop recommendations in legislative form that--
(A) prioritize the preventive benefits under the medicare program;
and
(B) modify preventive benefits offered under the medicare program
based on the study conducted under subsection (a).
(3) REQUIREMENTS FOR INITIAL REPORT- The initial report submitted
pursuant to paragraph (1) shall address issues related to the following
preventive benefits:
(B) Smoking cessation therapy services.
(C) Glaucoma detection tests.
(D) Appropriate preventive treatments for precancerous skin
lesions.
(c) DEFINITIONS- In this section:
(1) COST-EFFECTIVE BENEFIT- The term `cost-effective benefit' means a
benefit or technique that has--
(A) been subject to peer review;
(B) been described in scientific journals; and
(C) demonstrated value as measured by unit costs relative to health
outcomes achieved.
(2) COST-SAVING BENEFIT- The term `cost-saving benefit' means a benefit
or technique that has--
(A) been subject to peer review;
(B) been described in scientific journals; and
(C) caused a net reduction in health care costs for medicare
beneficiaries.
(3) MEDICALLY EFFECTIVE- The term `medically effective' means, with
respect to a benefit or technique, that the benefit or technique has
been--
(A) subject to peer review;
(B) described in scientific journals; and
(C) determined to achieve an intended goal under normal programmatic
conditions.
(4) MEDICARE BENEFICIARY- The term `medicare beneficiary' means any
individual who is entitled to benefits under part A or enrolled under part B
of the medicare program under title XVIII of the Social Security Act,
including any individual enrolled in a Medicare+Choice plan offered by a
Medicare+Choice organization under part C of such program.
SEC. 117. MEDPAC STUDY AND REPORT ON MEDICARE COVERAGE OF CARDIAC AND
PULMONARY REHABILITATION THERAPY SERVICES.
(1) IN GENERAL- 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 on coverage of
cardiac and pulmonary rehabilitation therapy services under the medicare
program under title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.).
(2) FOCUS- In conducting the study under paragraph (1), MedPAC shall
focus on the appropriate--
(A) qualifying diagnoses required for coverage of cardiac and
pulmonary rehabilitation therapy services;
(B) level of physician direct involvement and supervision in
furnishing such services; and
(C) level of reimbursement for such services.
(b) REPORT- Not later than 18 months after the date of enactment of this
Act, MedPAC shall submit a report to the Secretary of Health and Human
Services and Congress on the study conducted under subsection (a) together
with such recommendations for legislation and administrative action as MedPAC
determines appropriate.
TITLE II--RURAL HEALTH CARE IMPROVEMENTS
Subtitle A--Critical Access Hospital Provisions
SEC. 201. CLARIFICATION OF NO BENEFICIARY COST-SHARING FOR CLINICAL
DIAGNOSTIC LABORATORY TESTS FURNISHED BY CRITICAL ACCESS HOSPITALS.
(a) PAYMENT CLARIFICATION- Section 1834(g) (42 U.S.C. 1395m(g)) is amended
by adding at the end the following new paragraph:
`(4) NO BENEFICIARY COST-SHARING FOR CLINICAL DIAGNOSTIC LABORATORY
SERVICES- No coinsurance, deductible, copayment, or other cost sharing
otherwise applicable under this part shall apply with respect to clinical
diagnostic laboratory services furnished as an outpatient critical access
hospital service. Nothing in this title shall be construed as providing for
payment for clinical diagnostic laboratory services furnished as part of
outpatient critical access hospital services, other than on the basis
described in this subsection.'.
(b) TECHNICAL AND CONFORMING AMENDMENTS-
(1) Paragraphs (1)(D)(i) and (2)(D)(i) of section 1833(a) (42 U.S.C.
1395l(a)(1)(D)(i); 1395l(a)(2)(D)(i)) are each amended by striking `or which
are furnished on an outpatient basis by a critical access hospital'.
(2) Section 403(d)(2) of BBRA (113 Stat. 1501A-371) is amended by
striking `The amendment made by subsection (a) shall apply' and inserting
`Paragraphs (1) through (3) of section 1834(g) of the Social Security Act
(as amended by paragraph (1)) apply'.
(c) EFFECTIVE DATES- The amendment made--
(1) by subsection (a) applies to services furnished on or after the date
of the enactment of BBRA;
(2) by subsection (b)(1) applies as if included in the enactment of
section 403(e)(1) of BBRA (113 Stat. 1501A-371); and
(3) by subsection (b)(2) applies as if included in the enactment of
section 403(d)(2) of BBRA (113 Stat. 1501A-371).
SEC. 202. REVISION OF PAYMENT FOR PROFESSIONAL SERVICES PROVIDED BY A
CRITICAL ACCESS HOSPITAL.
(a) IN GENERAL- Section 1834(g)(2)(B) (42 U.S.C. 1395m(g)(2)(B)), as
amended by section 403(d) of BBRA (113 Stat. 1501A-371), is amended by
inserting `120 percent of' after `hospital services,'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) shall take effect
as if included in the enactment of section 403(d) of BBRA (113 Stat.
1501A-371).
SEC. 203. PERMITTING CRITICAL ACCESS HOSPITALS TO OPERATE PPS EXEMPT
DISTINCT PART PSYCHIATRIC AND REHABILITATION UNITS.
(a) CRITERIA FOR DESIGNATION AS A CRITICAL ACCESS HOSPITAL- Section
1820(c)(2)(B)(iii) (42 U.S.C. 1395i-4(c)(2)(B)(iii)) is amended by inserting
`excluding any psychiatric or rehabilitation unit of the facility which is a
distinct part of the facility,' before `provides not'.
(b) DEFINITION OF PPS EXEMPT DISTINCT PART PSYCHIATRIC AND REHABILITATION
UNITS- Section 1886(d)(1)(B) (42 U.S.C. 1395ww(d)(1)(B)) is amended by
inserting before the last sentence the following new sentence: `In
establishing such definition, the Secretary may not exclude from such
definition a psychiatric or rehabilitation unit of a critical access hospital
which is a distinct part of such hospital solely because such hospital is
exempt from the prospective payment system under this section.'.
(c) EFFECTIVE DATE- The amendments made by this section shall take effect
on the date of enactment of this Act.
SEC. 204. EXEMPTION OF CRITICAL ACCESS HOSPITAL SWING BEDS FROM SNF
PPS.
(a) IN GENERAL- Section 1888(e)(7) Act (42 U.S.C. 1395yy(e)(7)) is
amended--
(1) in the heading, by striking `TRANSITION FOR' and inserting
`TREATMENT OF';
(2) in subparagraph (A), by striking `IN GENERAL- The' and inserting
`TRANSITION- Subject to subparagraph (C), the';
(3) in subparagraph (A), by inserting `(other than critical access
hospitals)' after `facilities described in subparagraph (B)';
(4) in subparagraph (B), by striking `, for which payment' and all that
follows before the period at the end; and
(5) by adding at the end the following new subparagraph:
`(C) EXEMPTION FROM PPS OF SWING-BED SERVICES FURNISHED IN CRITICAL
ACCESS HOSPITALS- The prospective payment system established under this
subsection shall not apply to services furnished by a critical access
hospital pursuant to an agreement under section 1883.'.
(b) PAYMENT ON A REASONABLE COST BASIS FOR SWING BED SERVICES FURNISHED BY
CRITICAL ACCESS HOSPITALS- Section 1883(a) (42 U.S.C 1395tt(a)) is
amended--
(1) in paragraph (2)(A), by inserting `(other than a critical access
hospital)' after `any hospital'; and
(2) by adding at the end the following new paragraph:
`(3) Notwithstanding any other provision of this title, a critical
access hospital shall be paid for covered skilled nursing facility services
furnished under an agreement entered into under this section on the basis of
the reasonable costs of such services (as determined under section
1861(v)).'.
(c) EFFECTIVE DATE- The amendments made by this section shall apply to
cost reporting periods beginning on or after the date of the enactment of this
Act.
Subtitle B--Other Rural Hospital Provisions
SEC. 211. EQUITABLE TREATMENT FOR RURAL DISPROPORTIONATE SHARE
HOSPITALS.
(a) APPLICATION OF UNIFORM THRESHOLD- Section 1886(d)(5)(F)(v) (42 U.S.C.
1395ww(d)(5)(F)(v)) is amended--
(1) in subclause (II), by inserting `(or 15 percent, for discharges
occurring on or after October 1, 2001)' after `30 percent';
(2) in subclause (III), by inserting `(or 15 percent, for discharges
occurring on or after October 1, 2001)' after `40 percent'; and
(3) in subclause (IV), by inserting `(or 15 percent, for discharges
occurring on or after October 1, 2001)' after `45 percent'.
(b) ADJUSTMENT OF PAYMENT FORMULAS-
(1) SOLE COMMUNITY HOSPITALS- Section 1886(d)(5)(F) (42 U.S.C.
1395ww(d)(5)(F)) is amended--
(A) in clause (iv)(VI), by inserting after `10 percent' the following:
`or, for discharges occurring on or after October 1, 2001, is equal to the
percent determined in accordance with clause (x)'; and
(B) by adding at the end the following new clause:
`(x) For purposes of clause (iv)(VI), in the case of a hospital for a cost
reporting period with a disproportionate patient percentage (as defined in
clause (vi)) that--
`(I) is less than 17.3, the disproportionate share adjustment percentage
is determined in accordance with the following formula: (P-15)(.65) +
2.5;
`(II) is equal to or exceeds 17.3, but is less than 30.0, such
adjustment percentage is equal to 4 percent; or
`(III) is equal to or exceeds 30, such adjustment percentage is equal to
10 percent,
where `P' is the hospital's disproportionate patient percentage (as
defined in clause (vi)).'.
(2) RURAL REFERRAL CENTERS- Such section is further amended--
(A) in clause (iv)(V), by inserting after `clause (viii)' the
following: `or, for discharges occurring on or after October 1, 2001, is
equal to the percent determined in accordance with clause (xi)';
and
(B) by adding at the end the following new clause:
`(xi) For purposes of clause (iv)(V), in the case of a hospital for a cost
reporting period with a disproportionate patient percentage (as defined in
clause (vi)) that--
`(I) is less than 17.3, the disproportionate share adjustment percentage
is determined in accordance with the following formula: (P-15)(.65) +
2.5;
`(II) is equal to or exceeds 17.3, but is less than 30.0, such
adjustment percentage is equal to 4 percent; or
`(III) is equal to or exceeds 30, such adjustment percentage is
determined in accordance with the following formula: (P-30)(.6) + 4,
where `P' is the hospital's disproportionate patient percentage (as
defined in clause (vi)).'.
(3) SMALL RURAL HOSPITALS GENERALLY- Such section is further
amended--
(A) in clause (iv)(III), by inserting after `4 percent' the following:
`or, for discharges occurring on or after October 1, 2001, is equal to the
percent determined in accordance with clause (xii)'; and
(B) by adding at the end the following new clause:
`(xii) For purposes of clause (iv)(III), in the case of a hospital for a
cost reporting period with a disproportionate patient percentage (as defined
in clause (vi)) that--
`(I) is less than 17.3, the disproportionate share adjustment percentage
is determined in accordance with the following formula: (P-15)(.65) +
2.5;
`(II) is equal to or exceeds 17.3, such adjustment percentage is equal
to 4 percent,
where `P' is the hospital's disproportionate patient percentage (as
defined in clause (vi)).'.
(4) HOSPITALS THAT ARE BOTH SOLE COMMUNITY HOSPITALS AND RURAL REFERRAL
CENTERS- Such section is further amended, in clause (iv)(IV), by inserting
after `clause (viii)' the following: `or, for discharges occurring on or
after October 1, 2001, the greater of the percentages determined under
clause (x) or (xi)'.
(5) URBAN HOSPITALS WITH LESS THAN 100 BEDS- Such section is further
amended--
(A) in clause (iv)(II), by inserting after `5 percent' the following:
`or, for discharges occurring on or after October 1, 2001, is equal to the
percent determined in accordance with clause (xiii)'; and
(B) by adding at the end the following new clause:
`(xiii) For purposes of clause (iv)(II), in the case of a hospital for a
cost reporting period with a disproportionate patient percentage (as defined
in clause (vi)) that--
`(I) is less than 17.3, the disproportionate share adjustment percentage
is determined in accordance with the following formula: (P-15)(.65) +
2.5;
`(II) is equal to or exceeds 17.3, but is less than 40.0, such
adjustment percentage is equal to 4 percent; or
`(III) is equal to or exceeds 40, such adjustment percentage is equal to
5 percent,
where `P' is the hospital's disproportionate patient percentage (as
defined in clause (vi)).'.
(c) TECHNICAL AMENDMENT- Section 1886(d)(5)(F)(i) (42 U.S.C.
1395ww(d)(5)(F)(i)) is amended by striking `and before October 1, 1997,'.
SEC. 212. OPTION TO BASE ELIGIBILITY FOR MEDICARE DEPENDENT, SMALL RURAL
HOSPITAL PROGRAM ON DISCHARGES DURING ANY OF THE 3 MOST RECENT AUDITED COST
REPORTING PERIODS.
(a) IN GENERAL- Section 1886(d)(5)(G)(iv)(IV) (42 U.S.C.
1395ww(d)(5)(G)(iv)(IV)) is amended by inserting `, or any of the 3 most
recent audited cost reporting periods,' after `1987'.
(b) EFFECTIVE DATE- The amendment made by this section shall apply with
respect to cost reporting periods beginning on or after the date of enactment
of this Act.
SEC. 213. EXTENSION OF OPTION TO USE REBASED TARGET AMOUNTS TO ALL SOLE
COMMUNITY HOSPITALS.
(a) IN GENERAL- Section 1886(b)(3)(I)(i) (42 U.S.C. 1395ww(b)(3)(I)(i)) is
amended--
(1) in the matter preceding subclause (I)--
(A) by striking `that for its cost reporting period beginning during
1999 is paid on the basis of the target amount applicable to the hospital
under subparagraph (C) and that elects (in a form and manner determined by
the Secretary) this subparagraph to apply to the hospital'; and
(B) by striking `substituted for such target amount' and inserting
`substituted, if such substitution results in a greater payment under this
section for such hospital, for the amount otherwise determined under
subsection (d)(5)(D)(i)';
(2) in subclause (I), by striking `target amount otherwise applicable'
and all that follows through `target amount')' and inserting `the amount
otherwise applicable to the hospital under subsection (d)(5)(D)(i) (referred
to in this clause as the `subsection (d)(5)(D)(i) amount')'; and
(3) in each of subclauses (II) and (III), by striking `subparagraph (C)
target amount' and inserting `subsection (d)(5)(D)(i) amount'.
(b) EFFECTIVE DATE- The amendments made by this section shall take effect
as if included in the enactment of section 405 of BBRA (113 Stat.
1501A-372).
SEC. 214. MEDPAC ANALYSIS OF IMPACT OF VOLUME ON PER UNIT COST OF RURAL
HOSPITALS WITH PSYCHIATRIC UNITS.
The Medicare Payment Advisory Commission, in its study conducted pursuant
to subsection (a) of section 411 of BBRA (113 Stat. 1501A-377), shall
include--
(1) in such study an analysis of the impact of volume on the per unit
cost of rural hospitals with psychiatric units; and
(2) in its report under subsection (b) of such section a recommendation
on whether special treatment for such hospitals may be warranted.
Subtitle C--Other Rural Provisions
SEC. 221. PROVIDER-BASED RURAL HEALTH CLINIC CAP EXEMPTION.
(a) IN GENERAL- The matter in section 1833(f) (42 U.S.C. 1395l(f))
preceding paragraph (1) is amended by striking `with less than 50 beds' and
inserting `with an average daily patient census that does not exceed 50'.
(b) EFFECTIVE DATE- The amendment made by subparagraph (A) shall apply to
services furnished on or after January 1, 2001.
SEC. 222. PAYMENT FOR CERTAIN PHYSICIAN ASSISTANT SERVICES.
(a) PAYMENT FOR CERTAIN PHYSICIAN ASSISTANT SERVICES- Section
1842(b)(6)(C) (42 U.S.C. 1395u(b)(6)(C)) is amended by striking `for such
services provided before January 1, 2003,'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) shall take effect
on the date of enactment of this Act.
SEC. 223. TEMPORARY INCREASE FOR HOME HEALTH SERVICES FURNISHED IN A RURAL
AREA.
(a) INCREASE FOR 2001 AND 2002- In the case of a unit of home health
service furnished in a rural area (as defined in section 1886(d)(2)(D) of the
Social Security Act (42 U.S.C. 1395ww(d)(2)(D))) during 2001 or 2002, the
Secretary of Health and Human Services (in this section referred to as the
`Secretary') shall increase the payment amount otherwise made under section
1895 of such Act (42 U.S.C. 1395fff) for such unit of service by 10
percent.
(b) ADDITIONAL PAYMENT NOT BUILT INTO THE BASE- The Secretary shall not
include any additional payment made under subsection (a) in updating the
standard prospective payment amount (or amounts) applicable to units of home
health services furnished during a period, as increased by the home health
applicable increase percentage for the fiscal year involved under section
1895(b)(3)(B) of the Social Security Act (42 U.S.C. 1395fff(b)(3)(B)).
(c) WAIVING BUDGET NEUTRALITY- The Secretary shall not reduce the standard
prospective payment amount (or amounts) under section 1895 of the Social
Security Act (42 U.S.C. 1395fff) applicable to units of home health services
furnished during a period to offset the increase in payments resulting from
the application of subsection (a).
SEC. 224. REFINEMENT OF MEDICARE REIMBURSEMENT FOR TELEHEALTH SERVICES.
(a) REVISION OF TELEHEALTH PAYMENT METHODOLOGY AND ELIMINATION OF
FEE-SHARING REQUIREMENT- Section 4206(b) of the Balanced Budget Act of 1997
(42 U.S.C. 1395l note) is amended to read as follows:
`(b) METHODOLOGY FOR DETERMINING AMOUNT OF PAYMENTS-
`(1) IN GENERAL- The Secretary shall pay to--
`(A) the physician or practitioner at a distant site that provides an
item or service under subsection (a) an amount equal to the amount that
such physician or provider would have been paid had the item or service
been provided without the use of a telecommunications system; and
`(B) the originating site a facility fee for facility services
furnished in connection with such item or service.
`(2) APPLICATION OF PART B COINSURANCE AND DEDUCTIBLE- Any payment made
under this section shall be subject to the coinsurance and deductible
requirements under subsections (a)(1) and (b) of section 1833 of the Social
Security Act (42 U.S.C. 1395l).
`(3) DEFINITIONS- In this subsection:
`(A) DISTANT SITE- The term `distant site' means the site at which the
physician or practitioner is located at the time the item or service is
provided via a telecommunications system.
`(B) FACILITY FEE- The term `facility fee' means an amount equal
to--
`(i) for 2000 and 2001, $20; and
`(ii) for a subsequent year, the facility fee under this subsection
for the previous year increased by the percentage increase in the MEI
(as defined in section 1842(i)(3)) for such subsequent year.
`(i) IN GENERAL- The term `originating site' means the site
described in clause (ii) at which the eligible telehealth beneficiary
under the medicare program is located at the time the item or service is
provided via a telecommunications system.
`(ii) SITES DESCRIBED- The sites described in this paragraph are as
follows:
`(I) On or before January 1, 2002, the office of a physician or a
practitioner, a critical access hospital, a rural health clinic, and a
Federally qualified health center.
`(II) On or before January 1, 2003, a hospital, a skilled nursing
facility, a comprehensive outpatient rehabilitation facility, a renal
dialysis facility, an ambulatory surgical center, an Indian Health
Service facility, and a community mental health
center.'.
(b) ELIMINATION OF REQUIREMENT FOR TELEPRESENTER- Section 4206 of the
Balanced Budget Act of 1997 (42 U.S.C. 1395l note) is amended--
(1) in subsection (a), by striking `, notwithstanding that the
individual physician' and all that follows before the period at the end;
and
(2) by adding at the end the following new subsection:
`(e) TELEPRESENTER NOT REQUIRED- Nothing in this section shall be
construed as requiring an eligible telehealth beneficiary to be presented by a
physician or practitioner for the provision of an item or service via a
telecommunications system.'.
(c) REIMBURSEMENT FOR MEDICARE BENEFICIARIES WHO DO NOT RESIDE IN A HPSA-
Section 4206(a) of the Balanced Budget Act of 1997 (42 U.S.C. 1395l note), as
amended by subsection (b), is amended--
(1) by striking `IN GENERAL- Not later than' and inserting the
following: `TELEHEALTH SERVICES REIMBURSED-
`(1) IN GENERAL- Not later than';
(2) by striking `furnishing a service for which payment' and all that
follows before the period and inserting `to an eligible telehealth
beneficiary'; and
(3) by adding at the end the following new paragraph:
`(2) ELIGIBLE TELEHEALTH BENEFICIARY DEFINED- In this section, the term
`eligible telehealth beneficiary' means a beneficiary under the medicare
program under title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) that resides in--
`(A) an area that is designated as a health professional shortage area
under section 332(a)(1)(A) of the Public Health Service Act (42 U.S.C.
254e(a)(1)(A));
`(B) a county that is not included in a Metropolitan Statistical Area;
or
`(C) an inner-city area that is medically underserved (as defined in
section 330(b)(3) of the Public Health Service Act (42 U.S.C.
254b(b)(3))).'.
(d) TELEHEALTH COVERAGE FOR DIRECT PATIENT CARE-
(1) IN GENERAL- Section 4206 of the Balanced Budget Act of 1997 (42
U.S.C. 1395l note), as amended by subsection (c), is amended--
(A) in subsection (a)(1), by striking `professional consultation via
telecommunications systems with a physician' and inserting `items and
services for which payment may be made under such part that are furnished
via a telecommunications system by a physician'; and
(B) by adding at the end the following new subsection:
`(f) COVERAGE OF ITEMS AND SERVICES- Payment for items and services
provided pursuant to subsection (a) shall include payment for professional
consultations, office visits, office psychiatry services, including any
service identified as of July 1, 2000, by HCPCS codes 99241-99275,
99201-99215, 90804-90815, and 90862.'.
(2) STUDY AND REPORT REGARDING ADDITIONAL ITEMS AND SERVICES-
(A) STUDY- The Secretary of Health and Human Services shall conduct a
study to identify items and services in addition to those described in
section 4206(f) of the Balanced Budget Act of 1997 (as added by paragraph
(1)) that would be appropriate to provide payment under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.).
(B) REPORT- Not later than 2 years after the date of enactment of this
Act, the Secretary shall submit a report to Congress on the study
conducted under subparagraph (A) together with such recommendations for
legislation that the Secretary determines are appropriate.
(e) ALL PHYSICIANS AND PRACTITIONERS ELIGIBLE FOR TELEHEALTH
REIMBURSEMENT- Section 4206(a) of the Balanced Budget Act of 1997 (42 U.S.C.
1395l note), as amended by subsection (d), is amended--
(1) in paragraph (1), by striking `(described in section 1842(b)(18)(C)
of such Act (42 U.S.C. 1395u(b)(18)(C))'; and
(2) by adding at the end the following new paragraph:
`(3) PRACTITIONER DEFINED- For purposes of paragraph (1), the term
`practitioner' includes--
`(A) a practitioner described in section 1842(b)(18)(C) of the Social
Security Act (42 U.S.C. 1395u(b)(18)(C)); and
`(B) a physical, occupational, or speech therapist.'.
(f) TELEHEALTH SERVICES PROVIDED USING STORE-AND-FORWARD TECHNOLOGIES-
Section 4206(a)(1) of the Balanced Budget Act of 1997 (42 U.S.C. 1395l note),
as amended by subsection (e), is amended by adding at the end the following
new paragraph:
`(4) USE OF STORE-AND-FORWARD TECHNOLOGIES- For purposes of paragraph
(1), in the case of any Federal telemedicine demonstration program in Alaska
or Hawaii, the term `telecommunications system' includes store-and-forward
technologies that provide for the asynchronous transmission of health care
information in single or multimedia formats.'.
(g) CONSTRUCTION RELATING TO HOME HEALTH SERVICES- Section 4206(a) of the
Balanced Budget Act of 1997 (42 U.S.C. 1395l note), as amended by subsection
(f), is amended by adding at the end the following new paragraph:
`(5) CONSTRUCTION RELATING TO HOME HEALTH SERVICES-
`(A) IN GENERAL- Nothing in this section or in section 1895 of the
Social Security Act (42 U.S.C. 1395fff) shall be construed as preventing a
home health agency that is receiving payment under the prospective payment
system described in such section from furnishing a home health service via
a telecommunications system.
`(B) LIMITATION- The Secretary shall not consider a home health
service provided in the manner described in subparagraph (A) to be a home
health visit for purposes of--
`(i) determining the amount of payment to be made under the
prospective payment system established under section 1895 of the Social
Security Act (42 U.S.C. 1395fff); or
`(ii) any requirement relating to the certification of a physician
required under section 1814(a)(2)(C) of such Act (42 U.S.C.
1395f(a)(2)(C)).'.
(h) FIVE-YEAR APPLICATION- The amendments made by this section shall apply
to items and services provided on or after April 1, 2001, and before April 1,
2006.
SEC. 225. MEDPAC STUDY ON LOW-VOLUME, ISOLATED RURAL HEALTH CARE
PROVIDERS.
(a) 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 on the effect of low patient
and procedure volume on the financial status of low-volume, isolated rural
health care providers participating in the medicare program under title XVIII
of the Social Security Act (42 U.S.C. 1395 et seq.).
(b) REPORT- Not later than 18 months after the date of enactment of this
Act, MedPAC shall submit a report to the Secretary of Health and Human
Services and Congress on the study conducted under subsection (a)
indicating--
(1) whether low-volume, isolated rural health care providers are having,
or may have, significantly decreased medicare margins or other financial
difficulties resulting from any of the payment methodologies described in
subsection (c);
(2) whether the status as a low-volume, isolated rural health care
provider should be designated
under the medicare program and any criteria that should be used to qualify
for such a status; and
(3) any changes in the payment methodologies described in subsection (c)
that are necessary to provide appropriate reimbursement under the medicare
program to low-volume, isolated rural health care providers (as designated
pursuant to paragraph (2)).
(c) PAYMENT METHODOLOGIES DESCRIBED- The payment methodologies described
in this subsection are the following:
(1) The prospective payment system for hospital outpatient department
services under section 1833(t) of the Social Security Act (42 U.S.C.
1395l).
(2) The fee schedule for ambulance services under section 1834(l) of
such Act (42 U.S.C. 1395m(l)).
(3) The prospective payment system for inpatient hospital services under
section 1886 of such Act (42 U.S.C. 1395ww).
(4) The prospective payment system for routine service costs of skilled
nursing facilities under section 1888(e) of such Act (42 U.S.C.
1395yy(e)).
(5) The prospective payment system for home health services under
section 1895 of such Act (42 U.S.C. 1395fff).
TITLE III--PROVISIONS RELATING TO PART A
Subtitle A--PPS Hospitals
SEC. 301. DELAY OF REDUCTION IN PPS HOSPITAL PAYMENT UPDATE.
(a) IN GENERAL- Section 1886(b)(3)(B)(i) (42 U.S.C. 1395ww(b)(3)(B)(i)) is
amended--
(1) in subclause (XVI), by striking `minus 1.1 percentage points for
hospitals (other than sole community hospitals) in all areas, and the market
basket percentage increase for sole community hospitals,' and inserting `for
hospitals in all areas,';
(2) in subclause (XVII)--
(A) by striking `minus 1.1 percentage points'; and
(B) by striking `and' at the end;
(3) by redesignating subclause (XVIII) as subclause (XIX);
(4) in subclause (XIX), as so redesignated, by striking `fiscal year
2003' and inserting `fiscal year 2004'; and
(5) by inserting after subclause (XVII) the following new
subclause:
`(XVIII) for fiscal year 2003, the market basket percentage increase
minus 1 percentage point for hospitals in all areas, and'.
(b) SPECIAL RULE FOR PAYMENT FOR INPATIENT HOSPITAL SERVICES FOR FISCAL
YEAR 2001- Notwithstanding the amendments made by subsection (a), for purposes
of making payments for fiscal year 2001 for inpatient hospital services
furnished by subsection (d) hospitals (as defined in section 1886(d)(1)(B) of
the Social Security Act (42 U.S.C. 1395ww(d)(1)(B))), the `applicable
percentage increase' referred to in section 1886(b)(3)(B)(i) of such Act (42
U.S.C. 1395ww(b)(3)(B)(i))--
(1) for discharges occurring on or after October 1, 2000, and before
April 1, 2001, shall be determined in accordance with subclause (XVI) of
such section as in effect on the day before the date of enactment of this
Act; and
(2) for discharges occurring on or after April 1, 2001, and before
October 1, 2001, shall be equal to--
(A) the market basket percentage increase plus 1.1 percentage points
for hospitals (other than sole community hospitals) in all areas;
and
(B) the market basket percentage increase for sole community
hospitals.
SEC. 302. REVISION OF REDUCTION OF INDIRECT GRADUATE MEDICAL EDUCATION
PAYMENTS.
(a) REVISION- Section 1886(d)(5)(B)(ii) (42 U.S.C. 1395ww(d)(5)(B)(ii)) is
amended--
(A) by striking `fiscal year 2001' and inserting `each of fiscal years
2001 and 2002'; and
(B) by striking `equal to 1.54' and inserting `equal to 1.6';
and
(2) in subclause (VI), by striking `2001' and inserting `2002'.
(b) SPECIAL RULE FOR PAYMENT FOR FISCAL YEAR 2001- Notwithstanding
paragraph (5)(B)(ii)(V) of section 1886(d) of the Social Security Act (42
U.S.C. 1395ww(d)(5)(B)(ii)(V)) (as amended by subsection (a)), for purposes of
making payments for fiscal year 2001 for subsection (d) hospitals (as defined
in paragraph (1)(B) of such section) with indirect costs of medical education,
the indirect teaching adjustment factor referred to in paragraph (5)(B)(ii) of
such section shall be determined--
(1) for discharges occurring on or after October 1, 2000, and before
April 1, 2001, in accordance with paragraph (5)(B)(ii)(V) of such section as
in effect on the day before the date of enactment of this Act; and
(2) for discharges occurring on or after April 1, 2001, and before
October 1, 2001, as if `c' in such paragraph equalled 1.66.
(c) CONFORMING AMENDMENT RELATING TO DETERMINATION OF STANDARDIZED AMOUNT-
Section 1886(d)(2)(C)(i) (42 U.S.C. 1395ww(d)(2)(C)(i)) is amended--
(1) by striking `1997' and inserting `1997,'; and
(2) by inserting `, or any additional payments under such paragraph
resulting from the application of section 302 of the Medicare, Medicaid, and
SCHIP Balanced Budget Refinement Act of 2000' after `Balanced Budget
Refinement Act of 1999'.
(d) CLERICAL AMENDMENTS- Section 1886(d)(5)(B) (42 U.S.C.
1395ww(d)(5)(B)), as amended by subsection (a), is amended by moving the
indentation of each of the following 2 ems to the left:
(1) Clauses (ii), (v), and (vi).
(2) Subclauses (I) through (VI) of clause (ii).
(3) Subclauses (I) and (II) of clause (vi) and the flush sentence at the
end of such clause.
SEC. 303. DECREASE IN REDUCTIONS FOR DISPROPORTIONATE SHARE HOSPITAL
PAYMENTS.
(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 `each of fiscal years 2000 and 2001'
and inserting `fiscal year 2000';
(2) by redesignating subclauses (IV) and (V) as subclauses (V) and (IV),
respectively;
(3) in subclause (V), as redesignated, by striking `4 percent' and
inserting `3 percent'; and
(4) by inserting after subclause (III) the following new
subclause:
`(IV) during fiscal year 2001, such additional payment amount shall be
reduced by 2 percent;'.
(b) SPECIAL RULE FOR DSH PAYMENT- Notwithstanding the amendments made by
subsection (a), for purposes of making disproportionate share payments for
subsection (d) hospitals (as defined in section 1886(d)(1)(B) of the Social
Security Act (42 U.S.C. 1395ww(d)(1)(B)) for fiscal year 2001, the additional
payment amount otherwise determined under clause (ii) of section 1886(d)(5)(F)
of the Social Security Act (42 U.S.C. 1395ww(d)(5)(F))--
(1) for discharges occurring on or after October 1, 2000, and before
April 1, 2001, shall be adjusted as provided by clause (ix)(III) of such
section as in effect on the day before the date of enactment of this Act;
and
(2) for discharges occurring on or after April 1, 2001, and before
October 1, 2001, shall, instead of being adjusted as provided by clause
(ix)(IV) of such section as in effect after the date of enactment of this
Act, shall be decreased by 1 percent.
(c) CONFORMING AMENDMENTS RELATING TO DETERMINATION OF STANDARDIZED
AMOUNT- Section 1886(d)(2)(C)(iv) (42 U.S.C. 1395ww(d)(2)(C)(iv)), is
amended--
(1) by striking `1989 or' and inserting `1989,'; and
(2) by inserting `, or the enactment of section 303 of the Medicare,
Medicaid, and SCHIP Balanced Budget Further Refinement Act of 2000' after
`Omnibus Budget Reconciliation Act of 1990'.
SEC. 304. MODIFICATION OF PAYMENT RATE FOR PUERTO RICO HOSPITALS.
(a) MODIFICATION OF PAYMENT RATE- Section 1886(d)(9)(A) (42 U.S.C.
1395ww(d)(9)(A)) is amended--
(1) in clause (i), by striking `October 1, 1997, 50 percent (' and
inserting `October 1, 2000, 25 percent (for discharges between October 1,
1997, and September 30, 2000, 50 percent,'; and
(2) in clause (ii), in the matter preceding subclause (I), by striking
`after October 1, 1997, 50 percent (' and inserting `after October 1, 2000,
75 percent (for discharges between October 1, 1997, and September 30, 2000,
50 percent,'.
(b) SPECIAL RULE FOR PAYMENT FOR FISCAL YEAR 2001-
(1) IN GENERAL- Notwithstanding the amendment made by subsection (a),
for purposes of making payments for the operating costs of inpatient
hospital services of a section 1886(d) Puerto Rico hospital for fiscal year
2001, the amount referred to in the matter preceding clause (i) of section
1886(d)(9)(A) of the Social Security Act (42 U.S.C. 1395ww(d)(9)(A))--
(A) for discharges occurring on or after October 1, 2000, and before
April 1, 2001, shall be determined in accordance with such section as in
effect on the day before the date of enactment of this Act; and
(B) for discharges occurring on or after April 1, 2001, and before
October 1, 2001, shall be determined--
(i) using 0 percent of the Puerto Rico adjusted DRG prospective
payment rate referred to in clause (i) of such section; and
(ii) using 100 percent of the discharge-weighted average referred to
in clause (ii) of such section.
(2) SECTION 1886(d) PUERTO RICO HOSPITAL- For purposes of this
subsection, the term `section 1886(d) Puerto Rico hospital' has the meaning
given the term `subsection (d) Puerto Rico hospital' in the last sentence of
section 1886(d)(9)(A) of the Social Security Act (42 U.S.C.
1395ww(d)(9)(A)).
SEC. 305. MEDPAC STUDY AND REPORT ON HOSPITAL AREA WAGE INDEXES.
(1) IN GENERAL- 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 on the hospital area
wage indexes used in making payments to hospitals under section 1886(d) of
the Social Security Act (42 U.S.C. 1395ww(d)), including an assessment of
the accuracy of those indexes in reflecting geographic differences in wage
and wage-related costs of hospitals.
(2) CONSIDERATIONS- In conducting the study under paragraph (1), MedPAC
shall consider--
(A) the appropriate method for determining hospital area wage
indexes;
(B) the appropriate portion of hospital payments that should be
adjusted by the applicable area wage index;
(C) the appropriate method for adjusting the wage index by
occupational mix; and
(D) the feasibility and impact of making changes (as determined
appropriate by MedPAC) to the methods used to determine such indexes,
including the need for a data system required to implement such
changes.
(b) REPORT- Not later than 18 months after the date of enactment of this
Act, MedPAC shall submit a report to the Secretary of Health and Human
Services and Congress on the study conducted under subsection (a) together
with such recommendations for legislation and administrative action as MedPAC
determines appropriate.
SEC. 306. MEDPAC STUDY AND REPORT REGARDING CERTAIN HOSPITAL COSTS.
(1) IN GENERAL- 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 on--
(A) any increased costs incurred by subsection (d) hospitals (as
defined in paragraph (1)(B) of section 1886(d) of the Social Security Act
(42 U.S.C. 1395ww(d))) in providing inpatient hospital services to
medicare beneficiaries under title XVIII of such Act during the period
beginning on October 1, 1983, and ending on September 30, 1999, that were
attributable to--
(i) complying with new blood safety measure requirements;
and
(ii) providing such services using new technologies;
(B) the extent to which the prospective payment system for such
services under such
section provides adequate and timely recognition of such increased costs;
(C) the prospects for (and to the extent practicable, the magnitude
of) 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
10 years after the date of enactment of this Act; and
(D) the feasibility and advisability of establishing mechanisms under
such payment system to provide for more timely and accurate recognition of
such cost increases in the future.
(2) CONSULTATION- In conducting the study under this section, MedPAC
shall consult with representatives of the blood community, including
(B) organizations involved in the collection, processing, and delivery
of blood; and
(C) organizations involved in the development of new blood safety
technologies.
(b) REPORT- Not later than 1 year after the date of enactment of this Act,
MedPAC shall submit a report to the Secretary of Health and Human Services and
Congress on the study conducted under subsection (a) together with such
recommendations for legislation and administrative action as MedPAC determines
appropriate.
Subtitle B--PPS Exempt Hospitals
SEC. 311. PERMANENT GUARANTEE OF PRE-BBA PAYMENT LEVELS FOR OUTPATIENT
SERVICES FURNISHED BY CHILDREN'S HOSPITALS.
(a) IN GENERAL- Section 1833(t) (42 U.S.C. 1395l(t)) is amended--
(1) in the heading of paragraph (7)(D)(ii), by inserting `AND CHILDREN'S
HOSPITALS' after `CANCER HOSPITALS'; and
(2) in paragraphs (7)(D)(ii) and (11), by striking `section
1886(d)(1)(B)(v)' and inserting `clause (iii) or (v) of section
1886(d)(1)(B)'.
(b) EFFECTIVE DATE- The amendments made by subsection (a) apply as if
included in the enactment of section 202 of BBRA.
SEC. 312. PAYMENT FOR INPATIENT SERVICES OF REHABILITATION HOSPITALS.
(a) ASSISTANCE WITH ADMINISTRATIVE COSTS ASSOCIATED WITH COMPLETION OF
PATIENT ASSESSMENT- Section 1886(j)(3)(B) (42 U.S.C. 1395ww(j)(3)(B)) is
amended by striking `98 percent' and inserting `100 percent for fiscal year
2001 and 98 percent for fiscal year 2002'.
(b) ELECTION TO APPLY FULL PROSPECTIVE PAYMENT RATE WITHOUT PHASE-IN-
(1) IN GENERAL- Paragraph (1) of section 1886(j) (42 U.S.C. 1395ww(j))
is amended--
(A) in subparagraph (A), by inserting `other than a facility making an
election under subparagraph (F)' before `, in a cost reporting
period';
(B) in subparagraph (B), by inserting `or, in the case of a facility
making an election under subparagraph (F), for any cost reporting period
described in such subparagraph,' after `2002,'; and
(C) by adding at the end the following new subparagraph:
`(F) ELECTION TO APPLY FULL PROSPECTIVE PAYMENT SYSTEM- A
rehabilitation facility may elect, at least 30 days before the first date
on which the payment methodology under this subsection applies, to have
payment made to the facility under this subsection under the provisions of
subparagraph (B) (rather than subparagraph (A)) for each cost reporting
period to which such payment methodology applies.'.
(2) CLARIFICATION- Paragraph (3)(B) of such section is amended by
inserting `but not taking into account any payment adjustment resulting from
an election permitted under paragraph (1)(F)' after `paragraphs (4) and
(6)'.
(c) EFFECTIVE DATE- The amendments made by this section take effect as if
included in the enactment of BBA.
SEC. 313. IMPLEMENTATION OF PROSPECTIVE PAYMENT SYSTEM FOR LONG-TERM CARE
HOSPITALS.
(a) MODIFICATION OF REQUIREMENT- In developing the prospective payment
system required under section 123 of BBRA (113 Stat. 1501A-331), the Secretary
of Health and Human Services shall examine the feasibility and the impact of
basing payment under such system on the use of existing (or refined) hospital
diagnosis-related groups (DRGs) and the use of the most recently available
hospital discharge data.
(b) DEFAULT IMPLEMENTATION OF SYSTEM BASED ON EXISTING DRG METHODOLOGY- If
the Secretary is unable to implement the prospective payment system described
in subsection (a) by October 1, 2002, the Secretary shall implement a
prospective payment system for long-term care hospitals that bases payment
under such a system using existing hospital diagnosis-related groups (DRGs),
consistent with subsection (a), for such services furnished on or after that
date.
Subtitle C--Skilled Nursing Facilities
SEC. 321. REVISION TO THE SKILLED NURSING FACILITY (SNF) MARKET BASKET
UPDATE FOR FISCAL YEARS 2001 AND 2002.
(a) REVISION- Section 1888(e)(4)(E)(ii)(II) of the Social Security Act (42
U.S.C. 1395yy(e)(4)(E)(ii)(II)) is amended by striking `minus 1 percentage
point' and inserting `plus 1 percentage point'.
(b) SPECIAL RULE FOR PAYMENT FOR SKILLED NURSING FACILITY SERVICES FOR
FISCAL YEAR 2001- Notwithstanding the amendment made by subsection (a), for
purposes of making payments for covered skilled nursing facility services
under section 1888(e) of the Social Security Act (42 U.S.C. 1395yy(e)) for
fiscal year 2001, the Federal per diem rate referred to in paragraph
(4)(E)(ii) of such section--
(1) for the period beginning on October 1, 2000, and ending on March 31,
2001, shall be the rate determined in accordance with subclause (II)
of
such paragraph as in effect on the day before the date of enactment of this
Act; and
(2) for the period beginning on April 1, 2001, and ending on September
30, 2001, shall be the rate computed for fiscal year 2000 pursuant to
subclause (I) of such paragraph increased by the skilled nursing facility
market basket percentage change for fiscal year 2001 plus 3 percentage
points.
SEC. 322. APPLICATION OF SNF CONSOLIDATED BILLING REQUIREMENT LIMITED TO
PART A COVERED STAYS.
(a) IN GENERAL- Section 1862(a)(18) (42 U.S.C. 1395y(a)(18)) is amended by
inserting after `(as determined under regulations)' the following: `during a
period in which the resident is provided covered post-hospital extended care
services'.
(b) CONFORMING AMENDMENTS- (1) Section 1842(b)(6)(E) (42 U.S.C.
1395u(b)(6)(E)) is amended by striking `in the case of an item or service
(other than services described in section 1888(e)(2)(A)(ii))' and inserting
`in the case of services described in section 1861(s)(2)(D)'.
(2) Section 1866(a)(1)(H)(ii)(I) (42 U.S.C. 1395cc(a)(1)(H)(ii)(I)) is
amended by inserting after `who is a resident of the skilled nursing facility'
the following: `during a period in which the resident is provided covered
post-hospital extended care services (or, for services described in section
1861(s)(2)(D), that are furnished to such an individual without regard to such
period)'.
(c) EFFECTIVE DATE- The amendment made by subsection (a) applies to
services furnished on or after January 1, 2001.
(d) OVERSIGHT- The Secretary of Health and Human Services, through the
Office of the Inspector General in the Department of Health and Human Services
or otherwise, shall monitor payments made under part B of the title XVIII of
the Social Security Act for items and services furnished to residents of
skilled nursing facilities during a time in which the residents are not being
provided medicare covered post-hospital extended care services to ensure that
there is not duplicate billing for services or excessive services provided.
SEC. 323. REEXAMINATION OF, AND AUTHORITY TO REVISE, THE SKILLED NURSING
FACILITY MARKET BASKET PERCENTAGE INCREASE.
(1) IN GENERAL- The Secretary of Health and Human Services shall
reexamine the skilled nursing facility market basket percentage (as defined
in paragraph (5)(B) of section 1888(e) of the Social Security Act (42 U.S.C.
1395yy(e)) that was used in making the update to the first fiscal year under
paragraph (4)(B) of such section under the prospective payment system for
skilled nursing facility services.
(2) SPECIFIC ELEMENTS- In conducting the reexamination under paragraph
(1), the Secretary of Health and Human Services shall account for costs
based on actual data and actual medicare skilled nursing facility cost
increases.
(b) AUTHORITY- Notwithstanding any other provision of law, the Secretary
of Health and Human Services shall make adjustments to payments under the
prospective payment system under section 1888(e) of the Social Security Act
(42 U.S.C. 1395yy(e)) for covered skilled nursing facility services furnished
in fiscal year 2002 to reflect any necessary adjustments to such payments as
is appropriate as a result of the reexamination conducted under subsection
(a).
(1) IN GENERAL- Not later than April 1, 2001, the Secretary of Health
and Human Services shall publish for public comment a description of--
(A) whether the Secretary will make any adjustments pursuant to this
section; and
(B) if so, the form of such adjustments.
(2) FINAL FORM- Not later than August 1, 2001, the Secretary of Health
and Human Services shall publish the description described in paragraph (1)
in final form.
Subtitle D--Hospice Care
SEC. 331. REVISION OF MARKET BASKET INCREASE FOR 2001 AND 2002.
(a) IN GENERAL- Section 1814(i)(1)(C)(ii) (42 U.S.C. 1395f(i)(1)(C)(ii))
is amended--
(1) by redesignating subclause (VII) as subclause (VIII);
(A) by striking `through 2002' and inserting `through 2000';
and
(B) by striking `and' at the end; and
(3) by inserting after subclause (VI) the following new subclause:
`(VII) for each of fiscal years 2001 and 2002, the market basket
percentage increase for the fiscal year plus 1.0 percentage point;
and'.
(b) REPEAL OF BBRA TEMPORARY INCREASE-
(1) IN GENERAL- Section 131 of BBRA (113 Stat. 1501A-333) is
repealed.
(2) EFFECTIVE DATE- The amendments made by paragraph (1) shall take
effect as if included in the enactment of BBRA.
(c) TRANSITION DURING FISCAL YEAR 2001- Notwithstanding the amendments
made by subsection (a), for purposes of making payments for hospice care under
section 1814(i) of the Social Security Act (42 U.S.C. 1395f(i)) for fiscal
year 2001, the payment rates referred to in paragraph (1)(C) of such
section--
(1) for the period beginning on October 1, 2000, and ending on March 31,
2001, shall be the rate determined in accordance with the law as in effect
on the day before the date of enactment of this Act; and
(2) for the period beginning on April 1, 2001, and ending on September
30, 2001, shall be the rate that would have been determined under paragraph
(1) if `plus 3.0 percentage points' were substituted for `minus 1.0
percentage points under paragraph (1)(C)(ii)(VI) of such section for fiscal
year 2001.
(d) TECHNICAL AMENDMENT- Section 1814(a)(7)(A)(ii) (42 U.S.C.
1395f(a)(7)(A)(ii)) is amended by striking the period at the end and inserting
a semicolon.
SEC. 332. STUDY AND REPORT ON PHYSICIAN CERTIFICATION REQUIREMENT FOR
HOSPICE BENEFITS.
(a) IN GENERAL- The Secretary of Health and Human Services shall conduct a
study to examine the appropriateness of the certification regarding terminal
illness of an individual under section 1814(a)(7) of the Social Security Act
(42 U.S.C. 1395f(a)(7)) that is required in order for such individual to
receive hospice benefits under the medicare program under title XVIII of such
Act (42 U.S.C. 1395 et seq.).
(b) REPORT- Not later than 1 year after the date of enactment of this Act,
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 deems appropriate.
SEC. 333. HOSPICE DEMONSTRATION PROGRAM AND HOSPICE EDUCATION GRANTS.
(a) DEFINITIONS- In this section:
(1) DEMONSTRATION PROGRAM- The term `demonstration program' means the
Hospice Demonstration Program established by the Secretary under subsection
(b)(1).
(2) HOSPICE CARE; HOSPICE PROGRAM- Except as otherwise provided, the
terms `hospice care' and `hospice program' have the meanings given such
terms in paragraphs (1) and (2) of section 1861(dd) of the Social Security
Act (42 U.S.C. 1395x(dd)).
(3) MEDICARE BENEFICIARY- The term `medicare beneficiary' means any
individual who is entitled to benefits under part A or enrolled under part B
of the medicare program, including any individual enrolled in a
Medicare+Choice plan offered by a Medicare+Choice organization under part C
of such program.
(4) MEDICARE PROGRAM- The term `medicare program' means the health
benefits program under title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.).
(5) SECRETARY- The term `Secretary' means the Secretary of Health and
Human Services, acting through the Administrator of the Health Care
Financing Administration.
(6) SERIOUSLY ILL- The term `seriously ill' has the meaning given such
term by the Secretary (in consultation with hospice programs and academic
experts in end-of-life care), except that the Secretary may not limit such
term to individuals that are terminally ill (as defined in section
1861(dd)(3) of the Social Security Act (42 U.S.C. 1395x(dd)(3))).
(b) HOSPICE DEMONSTRATION PROGRAM-
(1) ESTABLISHMENT- Not later than 2 years after the date of enactment of
this Act, the Secretary shall establish a Hospice Demonstration Program in
accordance with the provisions of this subsection to increase the utility of
hospice care for seriously ill medicare beneficiaries.
(A) HOSPICE PROGRAMS- Except as provided in paragraph (4)(A), only a
hospice program with an agreement under section 1866 of the Social
Security Act (42 U.S.C. 1395cc), a consortium of such hospice programs, or
a State hospice association may participate in the demonstration
program.
(B) MEDICARE BENEFICIARIES- The Secretary shall permit any seriously
ill medicare beneficiary residing in the service area of a hospice program
participating in the demonstration program to participate in the
demonstration program on a voluntary basis.
(3) HOSPICE CARE UNDER DEMONSTRATION PROGRAM- The provisions of section
1814(i) of the Social Security Act (42 U.S.C. 1395f(i)) shall apply to the
payment for hospice care provided under the demonstration program, except
that--
(A) notwithstanding section 1862(a)(1)(C) of such Act (42 U.S.C.
1395y(a)(1)(C)), the Secretary shall provide for reimbursement for hospice
care provided under the supportive and comfort care benefit established
under paragraph (4);
(B) any licensed nurse practitioner or physician assistant may admit a
seriously ill medicare beneficiary as the primary care provider when
necessary and within the scope of practice of such practitioner or
assistant under State law;
(C) if a community does not have a qualified social worker, any
professional (other than a social worker) who has the necessary knowledge,
skills, and ability to provide medical social services may provide such
services;
(D) the Secretary shall waive any requirement that nursing facilities
used for respite care have skilled nurses on the premises 24 hours per
day;
(E) the Secretary shall permit respite care to be provided to a
seriously ill medicare beneficiary at home; and
(F) the Secretary shall waive reimbursement regulations to
provide--
(i) reimbursement for consultations and preadmission informational
visits, even if the seriously ill medicare beneficiary does not elect
hospice care (including the supportive and comfort care benefit under
paragraph (4)) at that time;
(ii) except with respect to the supportive and comfort care benefit
under paragraph (4), a minimum payment for hospice care provided under
the demonstration program based on the provision of hospice care to a
seriously ill medicare beneficiary for a period of 14 days
that--
(I) the Secretary shall pay to any hospice program participating
in the demonstration program and providing hospice care (regardless of
the length of stay of the seriously ill medicare beneficiary);
and
(II) may not be less than the amount of payment that would have
been made for hospice care if payment had been made at the daily rate
of payment for such care under section 1814(i) of the Social Security
Act (42 U.S.C. 1395f(i));
(iii) an increase in the reimbursement rates for hospice care to
offset--
(I) changes in hospice care and oversight under the demonstration
program; and
(II) the higher costs of providing hospice care in rural areas due
to lack of economies of scale or large geographic
areas;
(iv) direct payment of any nurse practitioner or physician assistant
practicing within the scope of State law in relation to hospice care
provided by such practitioner or assistant; and
(v) a per diem rate of payment for in-home care under subparagraph
(E) that reflects the range of care needs of the seriously ill medicare
beneficiary and that--
(I) in the case of a seriously ill medicare beneficiary that needs
routine care, is not less than 150 percent, and not more than 200
percent, of the routine home care rate for hospice care;
and
(II) in the case of a seriously ill medicare beneficiary that
needs acute care, is equal to the continuous home care day rate for
hospice care.
(4) SUPPORTIVE AND COMFORT CARE BENEFIT-
(A) IN GENERAL- For purposes of the demonstration program, the
Secretary shall establish a supportive and comfort care benefit for any
seriously ill medicare beneficiary electing hospice care.
(B) PARTICIPATION- Any individual or entity with an agreement under
section 1866 of the Social Security Act (42 U.S.C. 1395cc) may furnish
items or services covered under the supportive and comfort care
benefit.
(C) BENEFIT- Under the supportive and comfort care benefit, any
seriously ill medicare beneficiary may--
(i) continue to receive benefits for disease and symptom modifying
treatment under the medicare program (and the Secretary may not require
or prohibit any specific treatment or decision);
(ii) receive case management and hospice care through a hospice
program participating in the demonstration program (for which payment
shall be made under paragraph (3)(F)(ii)); and
(iii) receive information and experience in order to better
understand the utility of hospice care.
(D) PAYMENT- The Secretary shall establish procedures under which the
Secretary pays for items and services furnished to seriously ill medicare
beneficiaries under the supportive and comfort care benefit on a
fee-for-service basis.
(5) CONDUCT OF DEMONSTRATION PROGRAM-
(A) SITES- The demonstration program shall be conducted in 3 sites,
only 1 of which may be multistate.
(i) IN GENERAL- Except as provided in clause (ii), the Secretary
shall select demonstration sites, on the basis of proposals submitted
under subparagraph (C), that are located in geographic areas
that--
(I) include both urban and rural hospice programs;
and
(II) are geographically diverse and readily accessible to a
significant number of medicare beneficiaries.
(I) UNDERSERVED URBAN AREAS- If a geographic area does not have
any rural hospice program available to participate in the
demonstration program, such area may substitute an underserved urban
area, but the Secretary shall give priority to those proposals that
include a rural hospice program.
(II) SPECIFIC SITE- The Secretary shall select 1 demonstration
site in the State in which, according to the Hospital Referral Region
of Residence, 1994-1995, as listed in the Dartmouth Atlas of Health
Care 1998, the largest metropolitan area of such State had the lowest
percentage of medicare beneficiary deaths in a hospital compared to
the largest metropolitan area of each other State and the percentage
of enrollees who experienced intensive care during the last 6 months
of life was 21.5 percent.
(i) IN GENERAL- Under the demonstration program, the Secretary shall
accept proposals by any State hospice association, hospice program, or
consortium of hospice programs at such time, in such manner, and in such
form as the Secretary may reasonably require.
(ii) RESEARCH DESIGNS- The Secretary shall permit research designs
that use time series, sequential implementation of the intervention,
randomization by wait list, or any other design that allows the
strongest possible implementation of the demonstration
program.
(D) FACILITATION OF EVALUATION- The Secretary shall design the
demonstration program to facilitate the evaluation conducted under
paragraph (7).
(6) DURATION- The Secretary shall conduct the demonstration program for
a period of 3 years.
(7) EVALUATION- During the 18-month period following the completion of
the demonstration program, the Secretary shall conduct an evaluation of the
demonstration program in order to determine--
(A) the short-term and long-term costs and benefits of changing
hospice care provided under the medicare program to include the items,
services, and reimbursement options provided under the demonstration
program;
(B) whether any increase in payments for hospice care provided under
the medicare program is offset by savings in other parts of the medicare
program;
(C) the projected cost of implementing the demonstration program on a
national basis; and
(D) in consultation with hospice organizations and hospice programs
(including organizations and programs that represent rural areas), whether
a payment system based on diagnosis-related groups is useful for
administering the
hospice care provided under the medicare program.
(A) INTERIM REPORT- Not later than 2 years after the implementation of
the demonstration program, the Secretary, in consultation with
participants in the program, shall submit to the to the Committee on Ways
and Means of the House of Representatives and to the Committee on Finance
of the Senate an interim report on the demonstration program.
(B) FINAL REPORT- Not later than 2 years after the date on which the
demonstration program ends, the Secretary shall submit to the committees
described in subparagraph (A) a final report on the demonstration program
that includes the results of the evaluation conducted under paragraph (7)
and recommendations for appropriate legislative changes.
(9) WAIVER OF MEDICARE REQUIREMENTS- The Secretary shall waive
compliance with such requirements of the medicare program to the extent and
for the period the Secretary finds necessary for the conduct of the
demonstration program.
(10) SPECIAL RULES FOR PAYMENT OF MEDICARE+CHOICE ORGANIZATIONS- The
Secretary shall establish procedures under which the Secretary provides for
an appropriate adjustment in the monthly payments made under section 1853 of
the Social Security Act (42 U.S.C. 1395w-23) to any Medicare+Choice
organization offering a Medicare+Choice plan to reflect the participation of
each medicare beneficiary enrolled in such plan in the demonstration
program.
(c) HOSPICE EDUCATION GRANT PROGRAM-
(1) ESTABLISHMENT- The Secretary shall establish a Hospice Education
Grant Program under which the Secretary awards education grants to hospice
programs participating in the demonstration program for the purpose of
providing information about--
(A) hospice care under the medicare program; and
(B) the benefits available to medicare beneficiaries under the
demonstration program.
(2) USE OF FUNDS- Grants awarded under paragraph (1) shall be
used--
(i) individual or group education to medicare beneficiaries and the
families of such beneficiaries; and
(ii) individual or group education of the medical and mental health
community caring for medicare beneficiaries; and
(B) to test strategies to improve the general public knowledge about
hospice care under the medicare program and the benefits available to
seriously ill medicare beneficiaries under the demonstration
program.
(1) HOSPICE DEMONSTRATION PROGRAM-
(A) IN GENERAL- Except as provided in subparagraph (B), expenditures
made for the demonstration program shall be in lieu of the funds that
would have been provided to participating hospices under section 1814(i)
of the Social Security Act (42 U.S.C. 1395f(i)).
(B) SUPPORTIVE AND COMFORT CARE BENEFIT- The Secretary shall pay any
expenses for the supportive and comfort care benefit established under
subsection (a)(4) from the Federal Hospital Insurance Trust Fund
established under section 1817 of the Social Security Act (42 U.S.C.
1395i) and the Federal Supplementary Medical Insurance Trust Fund
established under section 1841 of such Act (42 U.S.C. 1395t), in such
proportion as the Secretary determines is appropriate.
(2) HOSPICE EDUCATION GRANTS- The Secretary is authorized to expend such
sums as may be necessary for the purposes of carrying out the Hospice
Education Grant program established under subsection (c)(1) from the
Research and Demonstration Budget of the Health Care Financing
Administration.
Subtitle E--Other Provisions
SEC. 341. SIX-MONTH DELAY IN IMPLEMENTATION OF RULE REGARDING PROVIDER-BASED
CRITERIA.
The Secretary of Health and Human Services may not implement the
provider-based criteria contained in the final rule that was published in the
Federal Register by the Health Care Financing Administration on April 7, 2000
(65 Fed. Reg. 18434) until after July 9, 2001.
TITLE IV--PROVISIONS RELATING TO PART B
Subtitle A--Hospital Outpatient Services
SEC. 401. APPLICATION OF TRANSITIONAL CORRIDOR TO CERTAIN HOSPITALS THAT DID
NOT SUBMIT A 1996 COST REPORT.
(a) IN GENERAL- Section 1833(t)(7)(F)(ii)(I) (42 U.S.C.
1395l(t)(7)(F)(ii)(I)) is amended by inserting `(or, in the case of a hospital
that did not submit a cost report for such period, during the first cost
reporting period ending in a year after 1996 and before 2001 for which the
hospital submitted a cost report)' after `1996'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) shall take effect
as if included in the enactment of section 202 of BBRA.
SEC. 402. CLARIFYING PROCESS AND STANDARDS FOR DETERMINING ELIGIBILITY OF
DEVICES FOR PASS-THROUGH PAYMENTS UNDER HOSPITAL OUTPATIENT PPS.
(a) IN GENERAL- Section 1833(t)(6) (42 U.S.C. 1395l(t)(6)) is amended--
(1) by redesignating subparagraphs (C) and (D) as subparagraphs (D) and
(E), respectively; and
(2) by striking subparagraph (B) and inserting the following new
subparagraphs:
`(B) USE OF CATEGORIES IN DETERMINING ELIGIBILITY OF A DEVICE FOR
PASS-THROUGH PAYMENTS- The following provisions apply for purposes of
determining whether a medical device qualifies for additional payments
under clause (ii) or (iv) of subparagraph (A):
`(i) ESTABLISHMENT OF INITIAL CATEGORIES- The Secretary shall
initially establish under this clause categories of medical devices
based on type of device by April 1, 2001. Such categories shall be
established in a manner such that each medical device that meets the
requirements of clause (ii) or (iv) of subparagraph (A) as of such date
is included in such a category and no such device is included in more
than one category. For purposes of the preceding sentence, whether a
medical device meets such requirements as of such date shall be
determined on the basis of the program memoranda issued before such date
or if the Secretary determines the medical device would have been
included in the program memoranda but for the requirement of
subparagraph (A)(iv)(I). The categories may be established under this
clause by program memorandum or otherwise, after consultation with
groups representing hospitals, manufacturers of medical devices, and
other affected parties.
`(ii) ESTABLISHING CRITERIA FOR ADDITIONAL CATEGORIES-
`(I) IN GENERAL- The Secretary shall establish criteria that will
be used for creation of additional categories (other than those
established under clause (i)) through rulemaking (which may include
use of an interim final rule with comment period).
`(II) STANDARD- Such categories shall be established under this
clause in a manner such that no medical device is described by more
than one category. Such criteria shall include a test of whether the
average cost of devices that would be included in a category and are
in use at the time the category is established is not insignificant,
as described in subparagraph (A)(iv)(II).
`(III) DEADLINE- Criteria shall first be established under this
clause by July 1, 2001. The Secretary may establish in compelling
circumstances categories under this clause before the date such
criteria are established.
`(IV) ADDING CATEGORIES- The Secretary shall promptly establish a
new category of medical device under this clause for any medical
device that meets the requirements of subparagraph (A)(iv) and for
which none of the categories in effect (or that were previously in
effect) is appropriate.
`(iii) PERIOD FOR WHICH CATEGORY IS IN EFFECT- A category of medical
devices established under clause (i) or clause (ii) shall be in effect
for a period of at least 2 years, but not more than 3 years, that
begins--
`(I) in the case of a category established under clause (i), on
the first date on which payment was made under this paragraph for any
device described by such category (including payments made during the
period before April 1, 2001); and
`(II) in the case of any other category, on the first date on
which payment is made under this paragraph for any medical device that
is described by such category.
`(iv) REQUIREMENTS TREATED AS MET- A medical device shall be treated
as meeting the requirements of subparagraph (A)(iv) if--
`(I) the device is described by a category established and in
effect under clause (i); or
`(II) the device is described by a category established and in
effect under clause (ii) and an application under section 515 of the
Federal Food, Drug, and Cosmetic Act has been approved with respect to
the device, or the device has been cleared for market under section
510(k) of such Act, or the device is exempt from the requirements of
section 510(k) of such Act pursuant to subsection (l) or (m) of
section 510 of such Act or section 520(g) of such Act.
Nothing in this clause shall be construed as requiring an
application or prior approval (other than that described in subclause
(II)) in order for a device to qualify for payment under this
paragraph.
`(C) LIMITED PERIOD OF PAYMENT-
`(i) DRUGS AND BIOLOGICALS- The payment under this paragraph with
respect to a drug or biological shall only apply during a period of at
least 2 years, but not more than 3 years, that begins--
`(I) on the first date this subsection is implemented in the case
of a drug or biological described in clause (i), (ii), or (iii) of
subparagraph (A) and in the case of a drug or biological described in
subparagraph (A)(iv) and for which payment under
this part is made as an outpatient hospital service before such first date;
or
`(II) in the case of a drug or biological described in
subparagraph (A)(iv) not described in subclause (I), on the first date
on which payment is made under this part for the drug or biological as
an outpatient hospital service.
`(ii) MEDICAL DEVICES- Payment shall be made under this paragraph
with respect to a medical device only if such device--
`(I) is described by a category of medical devices established and
in effect under subparagraph (B); and
`(II) is provided as part of a service (or group of services) paid
for under this subsection and provided during the period for which
such category is in effect under such subparagraph.'.
(b) CONFORMING AMENDMENTS- Section 1833(t) (42 U.S.C. 1395l(t))
amended--
(1) in paragraph (6)(A)(iv)(II), by striking `the cost of the device,
drug, or biological' and inserting `the cost of the drug or biological or
the average cost of the category of devices';
(2) in paragraph (6)(D) (as redesignated by subsection (a)(1)), by
striking `subparagraph (D)(iii)' in the matter preceding clause (i) and
inserting `subparagraph (E)(iii)'; and
(3) in paragraph (12)(E), by striking `additional payments (consistent
with paragraph (6)(B))' and inserting `additional payments, the
determination and deletion of initial and new categories (consistent with
subparagraphs (B) and (C) of paragraph (6))'.
(c) EFFECTIVE DATE- The amendments made by this section take effect on the
date of the enactment of this Act.
(d) TRANSITION- In the case of a medical device provided as part of a
service (or group of services) furnished during the period beginning on the
date that is 30 days after the date of the enactment of this Act and ending on
the day before the initial categories are implemented under subparagraph
(B)(i) of section 1833(t)(6) of the Social Security Act (as amended by
subsection (a)), payment shall be made for such device under such section in
accordance with the provisions in effect before the date of the enactment of
this Act, except that (notwithstanding subparagraph (C)(ii) of such section,
as so amended) payment shall also be made for such a device that is not
included in a program memorandum described in such subparagraph if the
Secretary determines that the device is likely to be described by such an
initial category.
SEC. 403. CONTRAST ENHANCED DIAGNOSTIC PROCEDURES UNDER HOSPITAL PROSPECTIVE
PAYMENT SYSTEM.
(a) SEPARATE CLASSIFICATION- Section 1833(t)(2) (42 U.S.C. 1395l(t)(2)) is
amended--
(1) by striking `and' at the end of subparagraph (E);
(2) by striking the period at the end of subparagraph (F) and inserting
`; and'; and
(3) by inserting after subparagraph (F) the following new
subparagraph:
`(G) the Secretary shall create additional groups of covered OPD
services that classify separately those procedures that utilize contrast
media from those that do not.'.
(b) EFFECTIVE DATE- The amendments made by this section shall be effective
as if included in the enactment of BBA.
SEC. 404. TRANSITIONAL PASS-THROUGH FOR CONTRAST AGENTS.
(a) IN GENERAL- Section 1833(t)(6) (42 U.S.C. 1395l(t)(6)), as amended by
section 402, is amended--
(1) in subparagraph (A)(iv)--
(A) in the heading, by striking `AND BIOLOGICALS' and inserting
`BIOLOGICALS, AND CONTRAST AGENTS';
(B) in the matter preceding subclause (I), by striking `or biological'
and inserting `biological, or contrast agent';
(C) in subclause (I), by striking `or biological' and inserting
`biological, or contrast agent'; and
(D) in subclause (II), by striking `or biological' and inserting `,
biological, or contrast agent';
(2) in subparagraph (C)--
(A) in the heading, by striking `AND BIOLOGICALS' and inserting
`BIOLOGICALS, AND CONTRAST AGENTS'; and
(B) by striking `or biological' the first, third, fourth, and fifth
place it appears and inserting `, biological, or contrast agent';
and
(3) in subparagraph (D)--
(A) in the matter preceding clause (i), by striking `or biological'
and inserting `biological, or contrast agent'; and
(B) in clause (i), by striking `or biological' each place it appears
and inserting `, biological, or contrast agent'.
(b) EFFECTIVE DATE- The amendments made by subsection (a) shall take
effect on January 1, 2001.
Subtitle B--Provisions Relating to Physicians
SEC. 411. MEDPAC STUDY ON THE RESOURCE-BASED PRACTICE EXPENSE SYSTEM.
(a) 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 on the refinements to the
practice expense relative value units during the transition to a
resource-based practice expense system for physician payments under the
medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395
et seq.) (in this section referred to as the `medicare program').
(b) REPORT- Not later than July 1, 2001, MedPAC shall submit a report to
the Secretary of Health and Human Services and Congress on the study
conducted
under subsection (a) together with recommendations regarding--
(1) any change or adjustment that is appropriate to ensure full access
to a spectrum of care for beneficiaries under the medicare program;
and
(2) the appropriateness of payments to physicians.
SEC. 412. GAO STUDIES AND REPORTS ON MEDICARE PAYMENTS.
(a) GAO STUDY ON HCFA POST-PAYMENT AUDIT PROCESS-
(1) STUDY- The Comptroller General of the United States shall conduct a
study on the post-payment audit process under the medicare program under
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) (in this
section referred to as the `medicare program') as such process applies to
physicians, including the proper level of resources that the Health Care
Financing Administration should devote to educating physicians
regarding--
(B) documentation requirements; and
(C) the calculation of overpayments.
(2) REPORT- Not later than 18 months after the date of enactment of this
Act, the Comptroller General shall submit a report to the Secretary of
Health and Human Services and Congress on the study conducted under
paragraph (1) together with specific recommendations for changes or
improvements in the post-payment audit process described in such
paragraph.
(b) GAO STUDY ON ADMINISTRATION AND OVERSIGHT-
(1) STUDY- The Comptroller General of the United States shall conduct a
study on the aggregate effects of regulatory, audit, oversight, and
paperwork burdens on physicians and other health care providers
participating in the medicare program.
(2) REPORT- Not later than 18 months after the date of enactment of this
Act, the Comptroller General shall submit a report to the Secretary of
Health and Human Services and Congress on the study conducted under
paragraph (1) together with recommendations regarding any area in
which--
(A) a reduction in paperwork, an ease of administration, or an
appropriate change in oversight and review may be accomplished;
or
(B) additional payments or education are needed to assist physicians
and other health care providers in understanding and complying with any
legal or regulatory requirements.
SEC. 413. GAO STUDY ON GASTROINTESTINAL ENDOSCOPIC SERVICES FURNISHED IN
PHYSICIANS' OFFICES AND HOSPITAL OUTPATIENT DEPARTMENT SERVICES.
(a) STUDY- The Comptroller General of the United States shall conduct a
study on the appropriateness of furnishing gastrointestinal endoscopic
physicians' services in physicians' offices. In conducting this study, the
Comptroller General shall--
(1) review available scientific and clinical evidence regarding the
safety of performing procedures in physicians' offices and hospital
outpatient departments;
(2) assess whether resource-based practice expense relative values
established by the Secretary of Health and Human Services under the medicare
physician fee schedule under section 1848 of the Social Security Act (42
U.S.C. 1395w-4) for gastrointestinal endoscopic services furnished in
physicians' offices and hospital outpatient departments create an incentive
to furnish such services in physicians' offices instead of hospital
outpatient departments; and
(3) assess the implications for access to care for medicare
beneficiaries if gastrointestinal endoscopic services in physicians' offices
were not covered under the medicare program. -
(b) REPORT- Not later than July 1, 2002, the Comptroller General of the
United States shall submit a report to the Secretary of Health and Human
Services and Congress on the study conducted under subsection (a) together
with such recommendations for legislation and administrative action as the
Comptroller General determines appropriate.
Subtitle C--Ambulance Services
SEC. 421. ELIMINATION OF REDUCTION IN INFLATION ADJUSTMENTS FOR AMBULANCE
SERVICES.
Subparagraphs (A) and (B) of section 1834(l)(3) (42 U.S.C. 1395m(l)(3)(A))
are each amended by striking `reduced in the case of 2001 and 2002 by 1.0
percentage points' and inserting `increased in the case of 2001 by 1.0
percentage point'.
SEC. 422. ELECTION TO FOREGO PHASE-IN OF FEE SCHEDULE FOR AMBULANCE
SERVICES.
Section 1834(l) (42 U.S.C. 1395m(l)) is amended by adding at the end the
following new paragraph:
`(8) ELECTION TO FOREGO PHASE-IN OF FEE SCHEDULE-
`(A) IN GENERAL- If the Secretary provides for a phase-in of the fee
schedule established under this subsection, a supplier of ambulance
services may make an election to receive payments at any time during such
phase-in based only on such fee schedule as in effect after such phase-in,
and the Secretary shall begin to make payments to the supplier based only
on such fee schedule not later than the date that is 60 days after the
date on which the supplier notifies the Secretary of such
election.
`(B) WAIVER OF BUDGET NEUTRALITY- The Secretary shall apply paragraph
(3)(A) as if this paragraph had not been enacted.'.
SEC. 423. STUDY AND REPORT ON THE COSTS OF RURAL AMBULANCE SERVICES.
(a) STUDY- The Secretary of Health and Human Services (in this section
referred to as the `Secretary'), in consultation with the Office of Rural
Health Policy, shall conduct a study on the means by which rural areas with
low population densities can be identified for the purpose of designating
areas in which the cost of providing ambulance services would be expected to
be higher than similar services provided in more heavily populated areas
because of low usage. Such study shall also include an
analysis of the additional costs of providing ambulance services in areas
designated under the previous sentence.
(b) REPORT- Not later than June 30, 2001, the Secretary shall submit a
report to Congress on the study conducted under subsection (a), together with
a regulation based on that study which adjusts the fee schedule payment rates
for ambulance services provided in low density rural areas based on the
increased cost of providing such services in such areas.
SEC. 424. GAO STUDY AND REPORT ON THE COSTS OF EMERGENCY AND MEDICAL
TRANSPORTATION SERVICES.
(a) STUDY- The Comptroller General of the United States shall conduct a
study on the costs of providing emergency and medical transportation services
across the range of acuity levels of conditions for which such transportation
services are provided.
(b) REPORT- Not later than 18 months after the date of enactment of this
Act, the Comptroller General shall submit a report to the Secretary of Health
and Human Services and Congress on the study conducted under subsection (a),
together with recommendations for any changes in methodology or payment level
necessary to fairly compensate suppliers of emergency and medical
transportation services and to ensure the access of beneficiaries under the
medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395
et seq.) to such services.
Subtitle D--Other Services
SEC. 431. REVISION OF MORATORIUM IN CAPS FOR THERAPY SERVICES.
(a) EXTENSION OF MORATORIUM- Section 1833(g)(4) (42 U.S.C. 1395l(g)(4)) is
amended by striking `during 2000 and 2001' and inserting `during the period
beginning on January 1, 2000, and ending on the date that is 18 months after
the date on which the Secretary submits the report required under section
4541(d)(2) of the Balanced Budget Act of 1997 to Congress'.
(b) EXTENSION OF REPORTING DATE- Section 4541(d)(2) of BBA (42 U.S.C.
1395l note), as amended by section 221(c) of BBRA (113 Stat. 1501A-351), is
amended by striking `January 1, 2001' and inserting `January 1, 2002' in the
matter preceding subparagraph (A).
SEC. 432. UPDATE IN RENAL DIALYSIS COMPOSITE RATE.
The last sentence of section 1881(b)(7) (42 U.S.C. 1395rr(b)(7)) is
amended by striking `for such services furnished on or after January 1, 2001,
by 1.2 percent' and inserting `for such services furnished on or after January
1, 2001, by 2.4 percent'.
SEC. 433. FULL UPDATE IN 2001 FOR DURABLE MEDICAL EQUIPMENT, OXYGEN, AND
OXYGEN EQUIPMENT.
(a) UPDATE FOR COVERED ITEMS- Section 1834(a)(14) (42 U.S.C. 1395m(a)(14))
is amended--
(1) by redesignating subparagraph (D) as subparagraph (F);
(2) in subparagraph (C)--
(A) by striking `through 2002' and inserting `through 2000';
and
(B) by striking ` and' at the end; and
(3) by inserting after subparagraph (C) the following new
subparagraphs:
`(D) for 2001, the percentage increase in the consumer price index for
all urban consumers (U.S. urban average) for the 12-month period ending
with June 2000;
`(E) for 2002, 0 percentage points; and'.
(b) ORTHOTICS AND PROSTHETICS- Section 1834(h)(4)(A) (42 U.S.C.
1395m(h)(4)(A)) is amended--
(1) by redesignating clause (vi) as clause (viii);
(A) by striking `through 2002' and inserting `through 2000';
and
(B) by striking ` and' at the end; and
(3) by inserting after clause (v) the following new clauses:
`(vi) for 2001, the percentage increase in the consumer price index
for all urban consumers (United States City average) for the 12-month
period ending with June 2000;
`(vi) for 2002, 1 percent; and'.
(c) PARENTERAL AND ENTERAL NUTRIENTS, SUPPLIES, AND EQUIPMENT- Section
4551(b) of BBA (42 U.S.C. 1395m note) is amended by striking `through 2002'
and inserting `, 1999, 2000, and 2002'.
(d) OXYGEN AND OXYGEN EQUIPMENT- Section 1834(a)(9)(B) (42 U.S.C.
1395m(a)(9)(B)) is amended--
(1) in clause (v), by striking `and' at the end;
(A) by striking `each subsequent year' and inserting `2000';
and
(B) by striking the period at the end and inserting a semicolon;
and
(3) by adding at the end the following new clauses:
`(vii) for 2001, the amount determined under this subparagraph for
2000 increased by the covered item update for 2001;
`(viii) for 2002, 70 percent of the amount determined under this
subparagraph for 1997; and
`(ix) for 2003 and each subsequent year, the amount determined under
this subparagraph for the preceding year increased by the covered item
update for such subsequent year.'.
(e) CONFORMING AMENDMENT- Section 228 of BBRA (113 Stat. 1501A-356) is
repealed.
SEC. 434. NATIONAL LIMITATION AMOUNT EQUAL TO 100 PERCENT OF NATIONAL MEDIAN
FOR NEW PAP SMEAR TECHNOLOGIES AND OTHER NEW CLINICAL LABORATORY TEST
TECHNOLOGIES.
Section 1833(h)(4)(B)(viii) (42 U.S.C. 1395l(h)(4)(B)(viii)) is amended by
inserting before the period at the end the following: `(or 100 percent of such
median in the case of a clinical diagnostic laboratory test performed on or
after January 1, 2001, that the Secretary determines is a new test for which
no limitation amount
has previously been established under this subparagraph)'.
SEC. 435. DELAY AND REVISION OF PPS FOR AMBULATORY SURGICAL CENTERS.
(a) DELAY IN IMPLEMENTATION OF PROSPECTIVE PAYMENT SYSTEM- The Secretary
of Health and Human Services may not implement a revised prospective payment
system for services of ambulatory surgical facilities under section 1833(i) of
the Social Security Act (42 U.S.C. 1395l(i)) before January 1, 2002.
(b) EXTENDING PHASE-IN TO 4 YEARS- Section 226 of the BBRA (113 Stat.
1501A-354) is amended by striking paragraphs (1) and (2) and inserting the
following:
`(1) in the first year of its implementation, only a proportion
(specified by the Secretary and not to exceed 1/4 ) of the payment for such
services shall be made in accordance with such system and the remainder
shall be made in accordance with current regulations; and
`(2) in each of the following 2 years a proportion (specified by the
Secretary and not to exceed 1/2 , and 3/4 , respectively) of the payment for
such services shall be made under such system and the remainder shall be
made in accordance with current regulations.'.
(c) DEADLINE FOR USE OF 1999 OR LATER COST SURVEYS- Section 226 of BBRA
(113 Stat. 1501A-354) is amended by adding at the end the following:
`By not later than January 1, 2003, the Secretary shall incorporate data
from a 1999 Medicare cost survey or a subsequent cost survey for purposes of
implementing or revising such system.'.
SEC. 436. TREATMENT OF CERTAIN PHYSICIAN PATHOLOGY SERVICES.
(a) IN GENERAL- Section 1848(i) (42 U.S.C. 1395w-4(i)) is amended by
adding at the end the following new paragraph:
`(4) TREATMENT OF CERTAIN PHYSICIAN PATHOLOGY SERVICES-
`(A) IN GENERAL- Notwithstanding any other provision of law, when an
independent laboratory furnishes the technical component of a physician
pathology service with respect to a fee-for-service medicare beneficiary
who is a patient of a grandfathered hospital, such component shall be
treated as a service for which payment shall be made to the laboratory
under this section and not as--
`(i) an inpatient hospital service for which payment is made to the
hospital under section 1886(d); or
`(ii) a hospital outpatient service for which payment is made to the
hospital under the prospective payment system under section
1834(t).
`(B) DEFINITIONS- In this paragraph:
`(i) GRANDFATHERED HOSPITAL- The term `grandfathered hospital' means
a hospital that had an arrangement with an independent
laboratory--
`(I) that was in effect as of July 22, 1999; and
`(II) under which the laboratory furnished the technical component
of physician pathology services with respect to patients of the
hospital and submitted a claim for payment for such component to a
carrier with a contract under section 1842 (and not to the
hospital).
`(ii) FEE-FOR-SERVICE MEDICARE BENEFICIARY- The term
`fee-for-service medicare beneficiary' means an individual who is not
enrolled--
`(I) in a Medicare+Choice plan under part C;
`(II) in a plan offered by an eligible organization under section
1876;
`(III) with a PACE provider under section 1894;
`(IV) in a medicare managed care demonstration project;
or
`(V) in the case of a service furnished to an individual on an
outpatient basis, in a health care prepayment plan under section
1833(a)(1)(A).'.
(b) EFFECTIVE DATE- The amendment made by this section shall apply to
services furnished on or after January 1, 2001.
SEC. 437. MODIFICATION OF MEDICARE BILLING REQUIREMENTS FOR CERTAIN INDIAN
PROVIDERS.
(a) IN GENERAL- Section 1880(a) (42 U.S.C. 1395qq(a)) is amended by adding
at the end the following new sentence: `A hospital or a free-standing
ambulatory care clinic (as defined by the Secretary), whether operated by the
Indian Health Service or by an Indian tribe or tribal organization (as those
terms are defined in section 4 of the Indian Health Care Improvement Act),
shall be eligible for payments for services for which payment is made pursuant
to section 1848, notwithstanding sections 1814(c) and 1835(d), if and for so
long as it meets all of the requirements which are applicable generally to
such payments, services, hospitals, and clinics.'.
(b) EFFECTIVE DATE- The amendments made by this section shall apply to
services furnished on or after January 1, 2001.
SEC. 438. REPLACEMENT OF PROSTHETIC DEVICES AND PARTS.
(a) IN GENERAL- Section 1834(h)(1) of the Social Security Act (42 U.S.C.
1395m(h)(1)) is amended by adding at the end the following new
subparagraph:
`(F) REPLACEMENT OF PROSTHETIC DEVICES AND PARTS-
`(i) IN GENERAL- Payment shall be made for the replacement of
prosthetic devices which are artificial limbs, or for the replacement of
any part of such devices, without regard to continuous use or useful
lifetime restrictions if an ordering physician determines that the
provision of a replacement device, or a replacement part of
such a device, is necessary because of any of the following:
`(I) A change in the physiological condition of the
patient.
`(II) An irreparable change in the condition of the device, or in
a part of the device.
`(III) The condition of the device, or the part of the device,
requires repairs and the cost of such repairs would be more than 60
percent of the cost of a replacement device, or, as the case may be,
of the part being replaced.
`(ii) CONFIRMATION MAY BE REQUIRED IF REPLACEMENT DEVICE OR PART IS
LESS THAN 2 YEARS OLD- If a physician determines that a replacement
device, or a replacement part, is necessary pursuant to clause
(i)--
`(I) such determination shall be controlling; and
`(II) such replacement device or part shall be deemed to be
reasonable and necessary for purposes of section
1862(a)(1)(A);
except that if the device, or part, being replaced is less than 2
years old (calculated from the date on which the beneficiary began to
use the device or part), the Secretary may also require the beneficiary
to provide confirmation of necessity of the replacement device, or, as
the case may be, the replacement part, by a prosthetist selected by the
beneficiary.'.
(b) PREEMPTION OF RULE- The provisions of section 1834(h)(1)(F) of the
Social Security Act (42 U.S.C. 1395m(h)(1)(F)), as added by subsection (a),
shall supersede any rule that as of the date of enactment of this Act may have
applied a 5-year replacement rule with regard to prosthetic devices.
(c) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to
items furnished on or after the date of enactment of this Act.
SEC. 439. MEDPAC STUDY AND REPORT ON MEDICARE REIMBURSEMENT FOR SERVICES
PROVIDED BY CERTAIN PROVIDERS.
(a) STUDY- The Medicare Payment Advisory Commission (referred to in this
section as `MedPAC') shall conduct a study on the appropriateness of the
current payment rates under the medicare program under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.) for services provided by a--
(1) certified nurse-midwife (as defined in subsection (gg)(2) of section
1861 of the Social Security Act (42 U.S.C. 1395x);
(2) physician assistant (as defined in subsection (aa)(5)(A) of such
section);
(3) nurse practitioner (as defined in such subsection); and
(4) clinical nurse specialist (as defined in subsection (aa)(5)(B) of
such section).
(b) REPORT- Not later than 18 months after the date of enactment of this
Act, MedPAC shall submit a report to the Secretary of Health and Human
Services and Congress on the study conducted under subsection (a), together
with any recommendations for legislation that MedPAC determines to be
appropriate as a result of such study.
SEC. 440. MEDPAC STUDY AND REPORT ON MEDICARE COVERAGE OF SERVICES PROVIDED
BY CERTAIN NON-PHYSICIAN PROVIDERS.
(1) IN GENERAL- The Medicare Payment Advisory Commission (referred to in
this section as `MedPAC') shall conduct a study to determine the
appropriateness of providing coverage under the medicare program under title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) for services
provided by a--
(A) certified first nurse assistant;
(C) pastoral care counselor; and
(D) licensed professional counselor of mental health.
(2) COSTS TO PROGRAM- The study shall consider the short-term and
long-term benefits, and costs to the medicare program, of providing the
coverage described in paragraph (1).
(b) REPORT- Not later than 18 months after the date of enactment of this
Act, MedPAC shall submit a report to the Secretary of Health and Human
Services and Congress on the study conducted under subsection (a), together
with any recommendations for legislation that MedPAC determines to be
appropriate as a result of such study.
TITLE V--PROVISIONS RELATING TO PARTS A AND B
Subtitle A--Home Health Services
SEC. 501. 1-YEAR ADDITIONAL DELAY IN APPLICATION OF 15 PERCENT REDUCTION ON
PAYMENT LIMITS FOR HOME HEALTH SERVICES.
(a) IN GENERAL- Section 1895(b)(3)(A)(i) (42 U.S.C. 1395fff(b)(3)(A)(i))
is amended--
(1) by redesignating subclause (II) as subclause (III);
(2) in subclause (III), as redesignated, by striking `described in
subclause (I)' and inserting `described in subclause (II)'; and
(3) by inserting after subclause (I) the following new subclause:
`(II) For the 12-month period beginning after the period described
in subclause (I), such amount (or amounts) shall be equal to the
amount (or amounts) determined under subclause (I), updated under
subparagraph (B).'.
(b) CHANGE IN REPORT- Section 302(c) of BBRA is amended by striking `Not
later than' and all that follows through `(42 U.S.C. 1395fff)' and inserting
`Not later than October 1, 2001'.
SEC. 502. RESTORATION OF FULL HOME HEALTH MARKET BASKET UPDATE FOR HOME
HEALTH SERVICES FOR FISCAL YEAR 2001.
(a) IN GENERAL- Section 1861(v)(1)(L)(x) (42 U.S.C. 1395x(v)(1)(L)(x)) is
amended--
(1) by striking `2001,'; and
(2) by adding at the end the following: `With respect to cost reporting
periods beginning during fiscal year 2001, the update to any limit under
this subparagraph shall be the home health market basket index.'.
(b) SPECIAL RULE FOR PAYMENT FOR FISCAL YEAR 2001 BASED ON ADJUSTED
PROSPECTIVE PAYMENT AMOUNTS-
(1) IN GENERAL- Notwithstanding the amendments made by subsection (a),
for purposes of making payments under section 1895(b) of the Social Security
Act (42 U.S.C. 1395fff(b)) for home health services for fiscal year 2001,
the Secretary of Health and Human Services shall--
(A) with respect to episodes and visits ending on or after October 1,
2000, and before April 1, 2001, use the final standardized and
budget neutral prospective payment amounts for 60 day episodes and
standardized average per visit amounts for fiscal year 2001 as published by the
Secretary in Federal Register of the July 3, 2000 (65 Federal Register
41128-41214); and
(B) with respect to episodes and visits ending on or after April 1,
2001, and before October 1, 2001, use such amounts increased by an
actuarially determined amount that represents the different distributions
of episodes and visits in the first and second 6 month periods of fiscal
year 2001 due to implementation of the home health prospective payment
system under section 1895 of such Act (42 U.S.C. 1395fff).
(2) NO EFFECT ON OTHER PAYMENTS OR DETERMINATIONS- The Secretary shall
not take the provisions of paragraph (1) into account for purposes of
payments, determinations, or budget neutrality adjustments under section
1895 of the Social Security Act.
(c) ADJUSTMENT FOR CASE MIX CHANGES-
(1) IN GENERAL- Section 1895(b)(3)(B) (42 U.S.C. 1395fff(b)(3)(B)) is
amended by adding at the end the following new clause:
`(vi) ADJUSTMENT FOR CASE MIX CHANGES- Insofar as the Secretary
determines that the adjustments under paragraph (4)(A)(i) for a previous
fiscal year (or estimates that such adjustments for a future fiscal
year) did (or are likely to) result in a change in aggregate payments
under this subsection during the fiscal year that are a result of
changes in the coding or classification of different units of services
that do not reflect real changes in case mix, the Secretary may adjust
the standard prospective payment amount (or amounts) under paragraph (3)
for subsequent fiscal years so as to eliminate the effect of such coding
or classification changes.'.
(2) EFFECTIVE DATE- The amendment made by paragraph (1) applies to
episodes concluding on or after October 1, 2001.
SEC. 503. EXCLUSION OF CERTAIN NONROUTINE MEDICAL SUPPLIES UNDER THE PPS FOR
HOME HEALTH SERVICES.
(1) IN GENERAL- Section 1895 (42 U.S.C. 1395fff) is amended by adding at
the end the following new subsection:
`(e) EXCLUSION OF NONROUTINE MEDICAL SUPPLIES-
`(1) IN GENERAL- Notwithstanding the preceding provisions of this
section, in the case of all nonroutine medical supplies (as defined by the
Secretary) furnished by a home health agency during a year (beginning with
2001) for which payment is otherwise made on the basis of the prospective
payment amount under this section, payment under this section shall be based
instead on the lesser of--
`(A) the actual charge for the nonroutine medical supply; or
`(B) the amount determined under the fee schedule established by the
Secretary for purposes of making payment for such items under part B for
nonroutine medical supplies furnished during that year.
`(2) BUDGET NEUTRALITY ADJUSTMENT- The Secretary shall provide for an
appropriate proportional reduction in payments under this section so that,
beginning with fiscal year 2001, the aggregate amount of such reductions is
equal to the aggregate increase in payments attributable to the exclusion
effected under paragraph (1).'.
(2) CONFORMING AMENDMENT- Section 1895(b)(1) of the Social Security Act
(42 U.S.C. 1395fff(b)(1)) is amended by striking `The Secretary' and
inserting `Subject to subsection (e), the Secretary'.
(3) EFFECTIVE DATE- The amendments made by this subsection shall apply
to supplies furnished on or after January 1, 2001.
(b) EXCLUSION FROM CONSOLIDATED BILLING-
(1) IN GENERAL- For items provided during the applicable period, the
Secretary of Health and Human Services shall administer the medicare program
under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) as
if--
(A) section 1842(b)(6)(F) of such Act (42 U.S.C. 1395u(b)(6)(F)) was
amended by striking `(including medical supplies described in section
1861(m)(5), but excluding durable medical equipment to the extent provided
for in such section)' and inserting `(excluding medical supplies and
durable medical equipment described in section 1861(m)(5))'; and
(B) section 1862(a)(21) of such Act (42 U.S.C. 1395y(a)(21)) was
amended by striking `(including medical supplies described in section
1861(m)(5), but excluding durable medical equipment to the extent provided
for in such section)' and inserting `(excluding medical supplies and
durable medical equipment described in section 1861(m)(5))'.
(2) APPLICABLE PERIOD DEFINED- For purposes of paragraph (1), the term
`applicable period' means the period beginning on January 1, 2001, and
ending on the later of--
(A) the date that is 18 months after the date of enactment of this
Act; or
(B) the date determined appropriate by the Secretary of Health and
Human Services.
(c) STUDY ON EXCLUSION OF CERTAIN NONROUTINE MEDICAL SUPPLIES UNDER THE
PPS FOR HOME HEALTH SERVICES-
(1) STUDY- The Secretary of Health and Human Services (in this
subsection referred to as the `Secretary') shall conduct a study to identify
any nonroutine medical supply that may be appropriately and cost-effectively
excluded from the prospective payment system for home health services
under section 1895 of the Social Security Act (42 U.S.C. 1395fff).
Specifically, the Secretary shall consider whether wound care and ostomy
supplies should be excluded from such prospective payment system.
(2) REPORT- Not later than 18 months after the date of enactment of this
Act, the Secretary shall submit to Congress a report on the study conducted
under paragraph (1), including a list of any nonroutine medical supplies
that should be excluded from the prospective payment system for home health
services under section 1895 of the Social Security Act (42 U.S.C.
1395fff).
(d) EXCLUSION OF OTHER NONROUTINE MEDICAL SUPPLIES- Upon submission of the
report under subsection (c)(2), the Secretary shall (if necessary) revise the
definition of nonroutine medical supply, as defined for purposes of section
1895(e) (as added by subsection (a)), based on the list of nonroutine medical
supplies included in such report.
SEC. 504. TREATMENT OF BRANCH OFFICES; GAO STUDY ON SUPERVISION OF HOME
HEALTH CARE PROVIDED IN ISOLATED RURAL AREAS.
(a) TREATMENT OF BRANCH OFFICES-
(1) IN GENERAL- Notwithstanding any other provision of law, in
determining for purposes of title XVIII of the Social Security Act 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.
(2) CONSIDERATION OF FORMS OF TECHNOLOGY IN DEFINITION OF SUPERVISION-
The Secretary of Health and Human Services may include forms of technology
in determining what constitutes `supervision' for purposes of determining a
home heath agency's branch office status under paragraph (1).
(1) STUDY- The Comptroller General of the United States shall conduct a
study of the provision of adequate supervision to maintain quality of home
health services delivered under the medicare program in isolated rural
areas. The study shall evaluate the methods that home health agency branches
and subunits use to maintain adequate supervision in the delivery of
services to clients residing in those areas, how these methods of
supervision compare to requirements that subunits independently meet
medicare conditions of participation, and the resources utilized by subunits
to meet such conditions.
(2) REPORT- Not later than January 1, 2002, the Comptroller General
shall submit to Congress a report on the study conducted under paragraph
(1). The report shall include recommendations on whether exceptions are
needed for subunits and branches of home health agencies under the medicare
program to maintain access to the home health benefit or whether alternative
policies should be developed to assure adequate supervision and access and
recommendations on whether a national standard for supervision is
appropriate.
SEC. 505. TEMPORARY ADDITIONAL PAYMENTS FOR HIGH-COST PATIENTS.
(a) INCREASE FOR FISCAL YEARS 2001 AND 2002- For each of fiscal years 2001
and 2002, the Secretary of Health and Human Services shall increase the
addition or adjustment for outliers under section 1895(b)(5) of the Social
Security Act (42 U.S.C. 1395fff(b)(5)) applicable to home health services
furnished during a fiscal year by such proportion as will result in an
aggregate increase in such addition or adjustment for the fiscal year
estimated to equal $150,000,000.
(b) ADDITIONAL PAYMENT NOT BUILT INTO THE BASE- The Secretary of Health
and Human Services shall not include any additional payment made under
subsection (a) in updating the standard prospective payment amount (or
amounts) applicable to units of home health services furnished during a
period, as increased by the home health applicable increase percentage for the
fiscal year involved under section 1895(b)(3)(B) of the Social Security Act
(42 U.S.C. 1395fff(b)(3)(B)).
(c) WAIVING BUDGET NEUTRALITY- The Secretary of Health and Human Services
shall not reduce the standard prospective payment amount (or amounts) under
section 1895 of the Social Security Act (42 U.S.C. 1395fff), including under
subsection (b)(3)(C) of such Act, applicable to units of home health services
furnished during a period to offset the increase in payments resulting from
the application of subsection (a).
SEC. 506. CLARIFICATION OF THE HOMEBOUND DEFINITION UNDER THE MEDICARE HOME
HEALTH BENEFIT.
(a) IN GENERAL- Sections 1814(a) and 1835(a) (42 U.S.C. 1395f(a) and
1395n(a)) are each amended--
(1) in the last sentence, by striking `, and that absences of the
individual from home are infrequent or of relatively short duration, or are
attributable to the need to receive medical treatment'; and
(2) by adding at the end the following new sentences: `Any absence of an
individual from the home attributable to the need to receive health care
treatment, including regular absences for the purpose of participating in
therapeutic, psychosocial, or medical treatment in an adult day-care program
that is licensed or certified by a State, or accredited, to furnish adult
day-care services in the State shall not disqualify an individual from being
considered to be `confined to his home'. Any other absence of an individual
from the home shall not so disqualify an individual if the absence is of
infrequent or short duration. For purposes of the preceding sentence, any
absence for the purpose of visiting a family member who is unable to visit
the individual or for the purpose of attending a religious service shall be
deemed to be an absence of infrequent and short duration.'.
(b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply to
items and services provided on or after the date of enactment of this Act.
Subtitle B--Direct Graduate Medical Education
SEC. 511. AUTHORITY TO INCLUDE COSTS OF TRAINING OF CLINICAL PSYCHOLOGISTS
IN PAYMENTS TO HOSPITALS.
Effective for cost reporting periods beginning on or after October 1,
1999, for purposes of payments to hospitals under the medicare program under
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) for costs of
approved educational activities (as defined in section 413.85 of title 42 of
the Code of Federal Regulations), such approved educational activities shall
include the clinical portion of professional educational training programs,
recognized by the Secretary, for clinical psychologists.
TITLE VI--PROVISIONS RELATING TO PART C (MEDICARE+CHOICE PROGRAM) AND
OTHER MEDICARE MANAGED CARE PROVISIONS
Subtitle A--Medicare+Choice Payment Reforms
SEC. 601. INCREASE IN NATIONAL PER CAPITA MEDICARE+CHOICE GROWTH PERCENTAGE
IN 2001 AND 2002.
Section 1853(c)(6)(B) (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. 602. REMOVING APPLICATION OF BUDGET NEUTRALITY FOR 2002.
Section 1853(c) (42 U.S.C. 1395w-23(c)) is amended--
(1) in paragraph (1)(A), in the matter following clause (ii), by
inserting `(except for 2002)' after `multiplied'; and
(2) in paragraph (5), by inserting `(except for 2002)' after `for each
year'.
SEC. 603. INCREASE IN MINIMUM PAYMENT AMOUNT.
Section 1853(c)(1)(B)(ii) (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 2001 for any area in any Metropolitan Statistical Area
with a population of more than 250,000, $475 (and for any area outside
such an area, $425).'.
SEC. 604. ALLOWING MOVEMENT TO 50:50 PERCENT BLEND IN 2002.
Section 1853(c)(2) (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 after and below subparagraph (F) the following:
`except that a Medicare+Choice organization may elect to apply
subparagraph (F) (rather than subparagraph (E)) for 2002.'.
SEC. 605. INCREASED UPDATE FOR PAYMENT AREAS WITH ONLY ONE OR NO
MEDICARE+CHOICE CONTRACTS.
(a) IN GENERAL- Section 1853(c)(1)(C)(ii) (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 and 2003, in the case of a Medicare+Choice payment
area in which there is no more than 1 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) shall 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. 606. 10-YEAR PHASE-IN OF RISK ADJUSTMENT AND NEW METHODOLOGY.
Section 1853(a)(3)(C)(ii) (42 U.S.C. 1395w-23(c)(1)(C)(ii)) is
amended--
(1) in subclause (I), by striking `and' at the end;
(2) in subclause (II), by striking `2002.' and inserting `2002 and
2003.'; and
(3) by adding at the end the following:
`(IV) 30 percent of such capitation rate in 2004 (in which such
methodology should reflect a blend of 20 percent of only data from
inpatient settings and 10 percent of data from all
settings);
`(V) 40 percent of such amount in 2005 (in which such methodology
should reflect a blend of 10 percent of only data from inpatient
settings and 30 percent of data from all settings);
`(VI) 50 percent of such amount in 2006 (in which such methodology
should reflect data from all settings);
`(VII) 60 percent of such amount in 2007 (in which such
methodology should reflect data from all settings);
`(VIII) 70 percent of such amount in 2008 (in which such
methodology should reflect data from all settings);
`(IX) 80 percent of such amount in 2009 (in which such methodology
should reflect data from all settings);
`(X) 90 percent of such amount in 2010 (in which such methodology
should reflect data from all settings); and
`(XI) 100 percent of such amount in any subsequent year (in which
such methodology should reflect data from all
settings).'.
SEC. 607. PERMITTING PREMIUM REDUCTIONS AS ADDITIONAL BENEFITS UNDER
MEDICARE+CHOICE PLANS.
(1) AUTHORIZATION OF PART B PREMIUM REDUCTIONS- Section 1854(f)(1) (42
U.S.C. 1395w-24(f)(1)) is amended by adding at the end the following new
subparagraph:
`(i) IN GENERAL- Subject to clause (ii), as part of providing any
additional benefits required under subparagraph (A), a Medicare+Choice
organization may elect a reduction in its payments under section
1853(a)(1)(A) with respect to a Medicare+Choice plan and the Secretary
shall apply such reduction to reduce the premium under section 1839 of
each enrollee in such plan as provided in section 1840(i).
`(ii) AMOUNT OF REDUCTION- The amount of the reduction under clause
(i) with respect to any enrollee in a Medicare+Choice plan--
`(I) may not exceed 120 percent of the premium described under
section 1839(a)(3); and
`(II) shall apply uniformly to each enrollee of the
Medicare+Choice plan to which such reduction applies.'.
(2) CONFORMING AMENDMENTS-
(A) ADJUSTMENT OF PAYMENTS TO MEDICARE+CHOICE ORGANIZATIONS- Section
1853(a)(1)(A) (42 U.S.C. 1395w-23(a)(1)(A)) is amended by inserting
`reduced by the amount of any reduction elected under section
1854(f)(1)(F) and' after `for that area,'.
(B) ADJUSTMENT AND PAYMENT OF PART B PREMIUMS-
(i) ADJUSTMENT OF PREMIUMS- Section 1839(a)(2) (42 U.S.C.
1395r(a)(2)) is amended by striking `shall' and all that follows and
inserting the following: `shall be the amount determined under paragraph
(3), adjusted as required in accordance with subsections (b), (c), and
(f), and to reflect 80 percent of any reduction elected under section
1854(f)(1)(F).'.
(ii) PAYMENT OF PREMIUMS- Section 1840 (42 U.S.C. 1395s) is amended
by adding at the end the following new subsection:
`(i) In the case of an individual enrolled in a Medicare+Choice plan, the
Secretary shall provide for necessary adjustments of the monthly beneficiary
premium to reflect 80 percent of any reduction elected under section
1854(f)(1)(F). This premium adjustment may be provided directly or as an
adjustment to any social security, railroad retirement, and civil service
retirement benefits, to the extent which the Secretary determines that such an
adjustment is appropriate and feasible with the concurrence of the agencies
responsible for the administration of such benefits.'.
(C) INFORMATION COMPARING PLAN PREMIUMS UNDER PART C- Section
1851(d)(4)(B) (42 U.S.C. 1395w-21(d)(4)(B)) is amended--
(i) by striking `PREMIUMS- The' and inserting `PREMIUMS-
`(i) IN GENERAL- The'; and
(ii) by adding at the end the following new clause:
`(ii) REDUCTIONS- The reduction in premiums, if any.'.
(b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply to
years beginning with 2002.
SEC. 608. 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 15, 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 15, 2000.
SEC. 609. REVISION OF PAYMENT RATES FOR ESRD PATIENTS ENROLLED IN
MEDICARE+CHOICE PLANS.
(a) IN GENERAL- Section 1853(a)(1)(B) (42 U.S.C. 1395w-23(a)(1)(B)) is
amended by adding at the end the following: `In establishing such rates the
Secretary shall provide for appropriate adjustments to increase each rate to
reflect the demonstration rate (including the risk-adjustment methodology
associated with such rate) of the social health maintenance organization
end-stage renal disease demonstrations established by section 2355 of the
Deficit Reduction Act of 1984 (Public Law 98-369; 98 Stat. 1103), as amended
by section 13567(b) of the Omnibus Budget Reconciliation Act of 1993 (Public
Law 103-66; 107 Stat. 608), and shall compute such rates by taking into
account such factors as renal treatment modality, age, and the underlying
cause of the end-stage renal disease.'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to
payments for months beginning with January 2002.
(c) PUBLICATION- The Secretary of Health and Human Services, not later
than 6 months after the date of enactment of this Act, shall publish for
public comment a description of the appropriate adjustments described in the
last sentence of section 1853(a)(1)(B) of the Social Security Act (42 U.S.C.
1395w-23(a)(1)(B)), as added by subsection (a). The Secretary shall publish
such adjustments in final form by not later than July 1, 2001, so that the
amendment made by subsection (a) is implemented on a timely basis consistent
with subsection (b).
SEC. 610. MODIFICATION OF PAYMENT RULES FOR CERTAIN FRAIL ELDERLY MEDICARE
BENEFICIARIES.
(a) MODIFICATION OF PAYMENT RULES- Section 1853 (42 U.S.C. 1395w-23) is
amended--
(A) in paragraph (1)(A), by striking `subsections (e), (g), and (i)'
and inserting `subsections (e), (g), (i), and (j)';
(B) in paragraph (3)(D), by inserting `paragraph (4) and' after
`Subject to'; and
(C) by adding at the end the following new paragraph:
`(4) EXEMPTION FROM RISK-ADJUSTMENT SYSTEM FOR FRAIL ELDERLY
BENEFICIARIES ENROLLED IN SPECIALIZED PROGRAMS-
`(A) IN GENERAL- In applying the risk-adjustment factors established
under paragraph (3) during the period described in subparagraph (B), the
limitation under paragraph (3)(C)(ii)(I) shall apply to a frail elderly
Medicare+Choice beneficiary (as defined in subsection (j)(3)) who is
enrolled in a Medicare+Choice plan under a specialized program for the
frail elderly (as defined in subsection (j)(2)) during the entire
period.
`(B) PERIOD OF APPLICATION- The period described in this subparagraph
begins with January 2001, and ends with the first month for which the
Secretary certifies to Congress that a comprehensive risk adjustment
methodology under paragraph (3)(C) that takes into account the factors
described in subsection (j)(1)(B) is being fully implemented.';
and
(2) by adding at the end the following new subsection:
`(j) SPECIAL RULES FOR FRAIL ELDERLY ENROLLED IN SPECIALIZED PROGRAMS FOR
THE FRAIL ELDERLY-
`(1) DEVELOPMENT AND IMPLEMENTATION OF NEW PAYMENT SYSTEM-
`(A) IN GENERAL- The Secretary shall develop and implement (as soon as
possible after the date of enactment of the Medicare, Medicaid, and SCHIP
Balanced Budget Refinement Act of 2000) a payment methodology for frail
elderly Medicare+Choice beneficiaries enrolled in a Medicare+Choice plan
under a specialized program for the frail elderly (as defined in paragraph
(2)(A)).
`(B) FACTORS DESCRIBED- The methodology developed and implemented
under subparagraph (A) shall take into account the prevalence, mix, and
severity of chronic conditions among frail elderly Medicare+Choice
beneficiaries and shall include--
`(i) medical diagnostic factors from all provider settings
(including hospital and nursing facility settings);
`(ii) functional indicators of health status; and
`(iii) such other factors as may be necessary to achieve appropriate
payments for plans serving such beneficiaries.
`(2) SPECIALIZED PROGRAM FOR THE FRAIL ELDERLY DEFINED-
`(A) IN GENERAL- In this part, the term `specialized program for the
frail elderly' means a program that the Secretary determines--
`(i) is offered under this part as a distinct part of a
Medicare+Choice plan;
`(ii) primarily enrolls frail elderly Medicare+Choice beneficiaries;
and
`(iii) has a clinical delivery system that is specifically designed
to serve the special needs of such beneficiaries and to coordinate
short-term and long-term care for such beneficiaries through the use of
a team described in subparagraph (B) and through the provision of
primary care services to such beneficiaries by means of such a team at
the nursing facility involved.
`(B) SPECIALIZED TEAM DESCRIBED- A team described in this
subparagraph--
`(II) a nurse practitioner or geriatric care manager;
and
`(ii) has as members individuals who--
`(I) have special training in the care and management of the frail
elderly beneficiaries; and
`(II) specialize in the care and management of such
beneficiaries.
`(3) FRAIL ELDERLY MEDICARE+CHOICE BENEFICIARY DEFINED- In this part,
the term `frail elderly Medicare+Choice beneficiary' means a Medicare+Choice
eligible individual who--
`(A) is residing in a skilled nursing facility (as defined in section
1819(a)) or a nursing facility (as defined in section 1919(a)) for an
indefinite period and without any intention of residing outside the
facility; and
`(B) has a severity of condition that makes the individual frail (as
determined under guidelines approved by the Secretary).'.
(b) EFFECTIVE DATE- The amendments made by this section shall take effect
on the date of enactment of this Act.
SEC. 611. FULL IMPLEMENTATION OF RISK ADJUSTMENT FOR CONGESTIVE HEART
FAILURE ENROLLEES FOR 2001.
(a) IN GENERAL- Section 1853(a)(3)(C) (42 U.S.C. 1395w-23(a)(3)(C)) is
amended--
(1) in clause (ii), by striking `Such risk adjustment' and inserting
`Except as provided in clause (iii), such risk adjustment'; and
(2) by adding at the end the following new clause:
`(iii) FULL IMPLEMENTATION OF RISK ADJUSTMENT FOR CONGESTIVE HEART
FAILURE ENROLLEES FOR 2001-
`(I) EXEMPTION FROM PHASE-IN- Subject to subclause (II), the
Secretary shall fully implement the risk adjustment methodology
described in clause (i) with respect to each individual who has had a
qualifying congestive heart failure inpatient diagnosis (as determined
by the Secretary under such risk adjustment
methodology) during the period beginning on July 1, 1999, and ending on June
30, 2000, and who is enrolled in a coordinated care plan that is the only
coordinated care plan offered on January 1, 2001, in the service area of the
individual.
`(II) PERIOD OF APPLICATION- Subclause (I) shall only apply during
the 1-year period beginning on January 1, 2001.'.
(b) EXCLUSION FROM DETERMINATION OF THE BUDGET NEUTRALITY FACTOR- Section
1853(c)(5) (42 U.S.C. 1395w-23(c)(5)) is amended by striking `subsection (i)'
and inserting `subsections (a)(3)(C)(iii) and (i)'.
SEC. 612. INCLUSION OF COSTS OF DOD MILITARY TREATMENT FACILITY SERVICES TO
MEDICARE-ELIGIBLE BENEFICIARIES IN CALCULATION OF MEDICARE+CHOICE PAYMENT
RATES.
Section 1853(c)(3) (42 U.S.C. 1395w-23(c)(3)) is amended--
(1) in subparagraph (A), by striking `subparagraph (B)' and inserting
`subparagraphs (B) and (E)'; and
(2) by adding at the end the following new subparagraph:
`(E) INCLUSION OF COSTS OF CERTAIN DOD MILITARY TREATMENT FACILITY
SERVICES TO MEDICARE-ELIGIBLE BENEFICIARIES-
`(i) IN GENERAL- In determining the area-specific Medicare+Choice
capitation rate under subparagraph (A) for a year (beginning with 2001),
the annual per capita rate of payment for 1997 determined under section
1876(a)(1)(C) for a Medicare+Choice payment area that is within 1 or
more MTF affected areas (as defined in clause (ii)) shall be increased
by the sum of the MTF percentages (as described in clause (iii)) for the
MTF affected area or areas. The increase under this subparagraph shall
not be taken into account in computing the national standardized annual
Medicare+Choice capitation rate under paragraph (4)(B).
`(ii) MTF AFFECTED AREA DEFINED- In this subparagraph, the term `MTF
affected area' means, with respect to a military treatment facility (as
defined in subsection (a)(6) of section 1896), an area that includes the
following:
`(I) The Medicare+Choice payment area in which a military
treatment facility that was part of the medicare subvention
demonstration project under such section as of July 1, 2000, is
located.
`(II) Any Medicare+Choice payment area which is contiguous to the
area described in subclause (I) and located not farther than 40 miles
from the facility.
`(iii) MTF PERCENTAGE- For purposes of clause (i), the MTF
percentage for an MTF affected area is equal to the ratio
of--
`(I) the aggregate amount of costs incurred by the Department of
Defense in furnishing items and services to individuals entitled to
benefits under this title who received services from the military
treatment facility described in clause (ii) for that area in 1996 (as
determined pursuant to section 1896(j)(1)(A)), increased by the
national per capita Medicare+Choice growth percentage under paragraph
(6) for 1997, to
`(II) the average number of individuals residing in such area in
1996 entitled to benefits under part A and enrolled under part
B.'.
Subtitle B--Other Medicare+Choice Reforms
SEC. 621. AMOUNTS IN MEDICARE TRUST FUNDS AVAILABLE FOR SECRETARY'S SHARE OF
MEDICARE+CHOICE EDUCATION AND ENROLLMENT-RELATED COSTS.
(a) RELOCATION OF PROVISIONS- 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 Medicare+Choice
organization shall pay the fee established by the Secretary under section
1851(j)(3)(A).'.
(b) FUNDING FOR EDUCATION AND ENROLLMENT ACTIVITIES- Section 1851 (42
U.S.C. 1395w-21) is amended by adding at the end the following new
subsection:
`(j) FUNDING FOR BENEFICIARY EDUCATION AND ENROLLMENT ACTIVITIES-
`(1) SECRETARY'S ESTIMATE OF TOTAL COSTS- The Secretary shall annually
estimate the total cost for a fiscal year of carrying out this section,
section 4360 of the Omnibus Budget Reconciliation Act of 1990 (relating to
the health insurance counseling and assistance program), and related
activities.
`(2) TOTAL AMOUNT AVAILABLE- The total amount available to the Secretary
for a fiscal year for the costs of the activities described in paragraph (1)
shall be equal to the lesser of--
`(A) the amount estimated for such fiscal year under paragraph (1);
or
`(i) fiscal year 2001, $115,000,000; and
`(ii) fiscal year 2002 and each subsequent fiscal year, the amount
for the previous fiscal year, adjusted to account for inflation, any
change in the number of beneficiaries under this title, and any other
relevant factors.
`(3) COST-SHARING IN ENROLLMENT-RELATED COSTS-
`(A) AMOUNTS FROM MEDICARE+CHOICE ORGANIZATIONS-
`(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 Medicare+Choice portion (as defined in clause (ii)) of
the total amount available under paragraph (2) for a fiscal year. Any
amounts collected shall be available without further appropriation to
the Secretary for the costs of the activities described in paragraph
(1).
`(ii) MEDICARE+CHOICE PORTION DEFINED- For purposes of clause (i),
the term `Medicare+Choice portion' means, for a fiscal year, the ratio,
as estimated by the Secretary, of--
`(I) the average number of individuals enrolled in Medicare+Choice
plans during the fiscal year; to
`(II) the average number of individuals entitled to benefits under
part A, and enrolled under part B, during the fiscal
year.
`(i) AMOUNTS AVAILABLE FROM TRUST FUNDS- The Secretary's share of
expenses shall be payable from funds in the Federal Hospital Insurance
Trust Fund and the Federal Supplementary Medical Insurance Trust Fund,
in such proportion as the Secretary shall deem to be fair and equitable
after taking into consideration the expenses attributable to the
administration of this part with respect to parts A and B. The Secretary
shall make such transfers of moneys between such Trust Funds as may be
appropriate to settle accounts between the Trust Funds in cases where
expenses properly payable from one such Trust Fund have been paid from
the other such Trust Fund.
`(ii) SECRETARY'S SHARE OF EXPENSES DEFINED- For purposes of clause
(i), the term `Secretary's share of expenses' means, for a fiscal year,
an amount equal to--
`(I) the total amount available to the Secretary under paragraph
(2) for the fiscal year; less
`(II) the amount collected under subparagraph (A) for the fiscal
year.'.
SEC. 622. SPECIAL MEDIGAP ENROLLMENT ANTIDISCRIMINATION PROVISION FOR
CERTAIN BENEFICIARIES.
(a) DISENROLLMENT WINDOW IN ACCORDANCE WITH BENEFICIARY'S CIRCUMSTANCE-
Section 1882(s)(3) (42 U.S.C. 1395ss(s)(3)) is amended--
(1) in subparagraph (A), in the matter following clause (iii), by
striking `, subject to subparagraph (E), seeks to enroll under the policy
not later than 63 days after the date of termination of enrollment described
in such subparagraph' and inserting `seeks to enroll under the policy during
the period specified in subparagraph (E)'; and
(2) by striking subparagraph (E) and inserting the following new
subparagraph:
`(E) For purposes of subparagraph (A), the time period specified in this
subparagraph is--
`(i) in the case of an individual described in subparagraph (B)(i), the
period beginning on the date the individual receives a notice of termination
or cessation of all supplemental health benefits (or, if no such notice is
received, notice that a claim has been denied because of such a termination
or cessation) and ending on the date that is 63 days after the applicable
notice;
`(ii) in the case of an individual described in clause (ii), (iii), (v),
or (vi) of subparagraph (B) whose enrollment is terminated involuntarily,
the period beginning on the date that the individual receives a notice of
termination and ending on the date that is 63 days after the date the
applicable coverage is terminated;
`(iii) in the case of an individual described in subparagraph
(B)(iv)(I), the period beginning on the earlier of (I) the date that the
individual receives a notice of termination, a notice of the issuer's
bankruptcy or insolvency, or other such similar notice, if any, and (II) the
date that the applicable coverage is terminated, and ending on the date that
is 63 days after the date the coverage is terminated;
`(iv) in the case of an individual described in clause (ii), (iii),
(iv)(II), (iv)(III), (v), or (vi) of subparagraph (B) who disenrolls
voluntarily, the period beginning on the date that is 60 days before the
effective date of the disenrollment and ending on the date that is 63 days
after such effective date; and
`(v) in the case of an individual described in subparagraph (B) but not
described in the preceding provisions of this subparagraph, the period
beginning on the effective date of the disenrollment and ending on the date
that is 63 days after such effective date.'.
(b) EXTENDED MEDIGAP ACCESS FOR INTERRUPTED TRIAL PERIODS- Section
1882(s)(3) (42 U.S.C. 1395ss(s)(3)), as amended by subsection (a), is amended
by adding at the end the following new subparagraph:
`(F)(i) Subject to clause (ii), for purposes of this paragraph--
`(I) in the case of an individual described in subparagraph (B)(v) (or
deemed to be so described, pursuant to this subparagraph) whose enrollment
with an organization or provider described in subclause (II) of such
subparagraph is involuntarily terminated within the first 12 months of such
enrollment, and who, without an intervening enrollment, enrolls with another
such organization or provider, such subsequent enrollment shall be deemed to
be an
initial enrollment described in such subparagraph; and
`(II) in the case of an individual described in clause (vi) of
subparagraph (B) (or deemed to be so described, pursuant to this
subparagraph) whose enrollment with a plan or in a program described in such
clause is involuntarily terminated within the first 12 months of such
enrollment, and who, without an intervening enrollment, enrolls in another
such plan or program, such subsequent enrollment shall be deemed to be an
initial enrollment described in such clause.
`(ii) For purposes of clauses (v) and (vi) of subparagraph (B), no
enrollment of an individual with an organization or provider described in
clause (v)(II), or with a plan or in a program described in clause (vi), may
be deemed to be an initial enrollment under this clause after the 2-year
period beginning on the date on which the individual first enrolled with such
an organization, provider, plan, or program.'.
SEC. 623. RESTORING EFFECTIVE DATE OF ELECTIONS AND CHANGES OF ELECTIONS OF
MEDICARE+CHOICE PLANS.
(a) OPEN ENROLLMENT- Section 1851(f)(2) (42 U.S.C. 1395w-21(f)(2)) is
amended by striking `, except that if such election or change is made after
the 10th day of any calendar month, then the election or change shall not take
effect until the first day of the second calendar month following the date on
which the election or change is made'.
(b) EFFECTIVE DATE- The amendment made by this section shall apply to
elections and changes of coverage made on or after January 1, 2001.
SEC. 624. PERMITTING ESRD BENEFICIARIES TO ENROLL IN ANOTHER MEDICARE+CHOICE
PLAN IF THE PLAN IN WHICH THEY ARE ENROLLED IS TERMINATED.
(a) IN GENERAL- Section 1851(a)(3)(B) (42 U.S.C. 1395w-21(a)(3)(B)) is
amended by striking `except that' and all that follows and inserting the
following: `except that--
`(i) an individual who develops end-stage renal disease while
enrolled in a Medicare+Choice plan may continue to be enrolled in that
plan; and
`(ii) in the case of such an individual who is enrolled in a
Medicare+Choice plan under clause (i) (or subsequently under this
clause), if the enrollment is discontinued under circumstances described
in section 1851(e)(4)(A), then the individual will be treated as a
`Medicare+Choice eligible individual' for purposes of electing to
continue enrollment in another Medicare+Choice plan.'.
(1) IN GENERAL- The amendment made by subsection (a) shall apply to
terminations and discontinuations occurring on or after the date of
enactment of this Act.
(2) APPLICATION TO PRIOR PLAN TERMINATIONS- Clause (ii) of section
1851(a)(3)(B) of the Social Security Act (as inserted by subsection (a))
also shall apply to individuals whose enrollment in a Medicare+Choice plan
was terminated or discontinued after December 31, 1997, and before the date
of enactment of this Act. In applying this paragraph, such an individual
shall be treated, for purposes of part C of title XVIII of the Social
Security Act, as having discontinued enrollment in such a plan as of the
date of enactment of this Act.
SEC. 625. ELECTION OF UNIFORM LOCAL COVERAGE POLICY FOR MEDICARE+CHOICE PLAN
COVERING MULTIPLE LOCALITIES.
Section 1852(a)(2) (42 U.S.C. 1395w-22(a)(2)) is amended by adding at the
end the following new subparagraph:
`(C) ELECTION OF UNIFORM COVERAGE POLICY- With respect to each item or
service furnished by a Medicare+Choice organization that offers a
Medicare+Choice plan in a geographic area that includes at least 15 States
and in which more than 1 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 affords the broadest
coverage to Medicare+Choice enrollees (as determined by the Secretary)
with respect to such item or service apply with respect to all
Medicare+Choice enrollees enrolled in the plan.'.
Subtitle C--Other Managed Care Reforms
SEC. 631. REVISED TERMS AND CONDITIONS FOR EXTENSION OF MEDICARE COMMUNITY
NURSING ORGANIZATION (CNO) DEMONSTRATION PROJECT.
(a) IN GENERAL- Section 532 of BBRA (42 U.S.C. 1395mm note) is
amended--
(1) in subsection (a), by striking the second sentence; and
(2) by striking subsection (b) and inserting the following new
subsections:
`(b) TERMS AND CONDITIONS-
`(1) JANUARY THROUGH SEPTEMBER 2000- For the 9-month period beginning
with January 2000, any such demonstration project shall be conducted under
the same terms and conditions as applied to such project during 1999.
`(2) OCTOBER 2000 THROUGH DECEMBER 2001- For the 15-month period
beginning with October 2000, any such demonstration project shall be
conducted under the same terms and conditions as applied to such project
during 1999, except that the following modifications shall apply:
`(A) BASIC CAPITATION RATE- The basic capitation rate paid for
services covered under the project (other than case management services)
per enrollee per month shall be the basic capitation rate paid for such
services for 1999, reduced by 10 percent in the case of the demonstration
sites located in Arizona, Minnesota, and Illinois, and 15 percent for the
demonstration site located in New York.
`(B) TARGETED CASE MANAGEMENT FEE- A case management fee shall be paid
only for enrollees who are classified as `moderate' or `at risk' through a
baseline health assessment (as required for Medicare+Choice plans under
section 1852(e) of the Social Security Act (42 U.S.C.
1395ww-22(e)).
`(C) GREATER UNIFORMITY IN CLINICAL FEATURES AMONG SITES- The project
shall implement for each site--
`(i) protocols for periodic telephonic contact with enrollees based
on--
`(I) the results of such standardized written health assessment;
and
`(II) the application of appropriate care planning
approaches;
`(ii) disease management programs for targeted diseases (such as
congestive heart failure, arthritis, diabetes, and hypertension) that
are highly prevalent in the enrolled populations;
`(iii) systems and protocols to track enrollees through
hospitalizations, including preadmission planning, concurrent management
during inpatient hospital stays, and post-discharge assessment,
planning, and followup; and
`(iv) standardized patient educational materials for specified
diseases and health conditions.
`(D) QUALITY IMPROVEMENT- The project shall implement at each site
once during the 15-month period--
`(i) surveys on enrollee satisfaction; and
`(ii) reports on specified quality indicators for the enrolled
population.
`(1) PRELIMINARY REPORT- Not later than July 1, 2001, the Secretary of
Health and Human Services shall submit to the Committees on Ways and Means
and Commerce of the House of Representatives and the Committee on Finance of
the Senate a preliminary report that--
`(A) evaluates such demonstration projects for the period beginning
July 1, 1997, and ending December 31, 1999, on a site-specific basis with
respect to the impact on per beneficiary spending, specific health
utilization measures, and enrollee satisfaction; and
`(B) includes a similar evaluation of such projects for the portion of
the extension period that occurs after September 30, 2000.
`(2) FINAL REPORT- The Secretary shall submit a final report to such
Committees on such demonstration projects not later than July 1, 2002. Such
report shall include the same elements as the preliminary report required by
paragraph (1), but for the period after December 31, 1999.
`(3) METHODOLOGY FOR SPENDING COMPARISONS- Any evaluation of the impact
of the demonstration projects on per beneficiary spending included in such
reports shall be based on a comparison of--
`(A) data for all individuals who--
`(i) were enrolled in such demonstration projects as of the first
day of the period under evaluation; and
`(ii) were enrolled for a minimum of 6 months thereafter;
with
`(B) data for a matched sample of individuals who are enrolled under
part B of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.)
and who are not enrolled in such a project, in a Medicare+Choice plan
under part C of such title (42 U.S.C. 1395w-21 et seq.), a plan offered by
an eligible organization under section 1876 of such Act (42 U.S.C.
1395mm), or a health care prepayment plan under section 1833(a)(1)(A) of
such Act (42 U.S.C. 1395l(a)(1)(A)).'.
(b) EFFECTIVE DATE- The amendments made by subsection (a) shall be
effective as if included in the enactment of section 532 of BBRA (42 U.S.C.
1395mm note).
SEC. 632. SERVICE AREA EXPANSION FOR MEDICARE COST CONTRACTS DURING
TRANSITION PERIOD.
Section 1876(h)(5) (42 U.S.C. 1395mm(h)(5)) is amended--
(1) by redesignating subparagraph (B) as subparagraph (C); and
(2) by inserting after subparagraph (A), the following new
subparagraph:
`(B) Subject to subparagraph (C), the Secretary shall approve an
application for a modification to a reasonable cost contract under this
section in order to expand the service area of such contract if--
`(i) such application is submitted to the Secretary on or before
September 1, 2003; and
`(ii) the Secretary determines that the organization with the contract
continues to meet the requirements applicable to such organizations and
contracts under this section.'.
TITLE VII--MEDICAID
SEC. 701. NEW PROSPECTIVE PAYMENT SYSTEM FOR FEDERALLY-QUALIFIED HEALTH
CENTERS AND RURAL HEALTH CLINICS.
(a) IN GENERAL- Section 1902(a) (42 U.S.C. 1396a(a)) is amended--
(A) in subparagraph (A), by adding `and' at the end;
(B) in subparagraph (B), by striking `and' at the end; and
(C) by striking subparagraph (C); and
(2) by inserting after paragraph (14) the following new paragraph:
`(15) provide for payment for services described in subparagraph (B) or
(C) of section 1905(a)(2) under the plan in accordance with subsection
(aa);'.
(b) NEW PROSPECTIVE PAYMENT SYSTEM- Section 1902 (42 U.S.C. 1396a) is
amended by adding at the end the following:
`(aa) PAYMENT FOR SERVICES PROVIDED BY FEDERALLY-QUALIFIED HEALTH CENTERS
AND RURAL HEALTH CLINICS-
`(1) IN GENERAL- Beginning with fiscal year 2001 and each succeeding
fiscal year, the State plan shall provide for payment for services described
in section 1905(a)(2)(C) furnished by a Federally-qualified health center
and services described in section 1905(a)(2)(B) furnished by a rural health
clinic in accordance with the provisions of this subsection.
`(2) FISCAL YEAR 2001- Subject to paragraph (4), for services furnished
during fiscal year 2001, the State plan shall provide for payment for such
services in an amount (calculated on a per visit basis) that is equal to 100
percent of the average of the costs of the center or clinic of furnishing
such services during fiscal years 1999 and 2000 which are reasonable and
related to the cost of furnishing such services, or based on such other
tests of reasonableness as the Secretary prescribes in regulations under
section 1833(a)(3), or, in the case of services to which such regulations do
not apply, the same methodology used under section 1833(a)(3), adjusted to
take into account any increase or decrease in the scope of such services
furnished by the center or clinic during fiscal year 2001.
`(3) FISCAL YEAR 2002 AND SUCCEEDING FISCAL YEARS- Subject to paragraph
(4), for services furnished during fiscal year 2002 or a succeeding fiscal
year, the State plan shall provide for payment for such services in an
amount (calculated on a per visit basis) that is equal to the amount
calculated for such services under this subsection for the preceding fiscal
year--
`(A) increased by the percentage increase in the MEI (as defined in
section 1842(i)(3)) applicable to primary care services (as defined in
section 1842(i)(4)) for that fiscal year; and
`(B) adjusted to take into account any increase or decrease in the
scope of such services furnished by the center or clinic during that
fiscal year.
`(4) ESTABLISHMENT OF INITIAL YEAR PAYMENT AMOUNT FOR NEW CENTERS OR
CLINICS- In any case in which an entity first qualifies as a
Federally-qualified health center or rural health clinic after fiscal year
2000, the State plan shall provide for payment for services described in
section 1905(a)(2)(C) furnished by the center or services described in
section 1905(a)(2)(B) furnished by the clinic in the first fiscal year in
which the center or clinic so qualifies in an amount (calculated on a per
visit basis) that is equal to 100 percent of the costs of furnishing such
services during such fiscal year based on the rates established under this
subsection for the fiscal year for other such centers or clinics located in
the same or adjacent area with a similar case load or, in the absence of
such a center or clinic, in accordance with the regulations and methodology
referred to in paragraph (2) or based on such other tests of reasonableness
as the Secretary may specify. For each fiscal year following the fiscal year
in which the entity first qualifies as a Federally-qualified health center
or rural health clinic, the State plan shall provide for the payment amount
to be calculated in accordance with paragraph (3).
`(5) ADMINISTRATION IN THE CASE OF MANAGED CARE-
`(A) IN GENERAL- In the case of services furnished by a
Federally-qualified health center or rural health clinic pursuant to a
contract between the center or clinic and a managed care entity (as
defined in section 1932(a)(1)(B)), the State plan shall provide for
payment to the center or clinic by the State of a supplemental payment
equal to the amount (if any) by which the amount determined under
paragraphs (2), (3), and (4) of this subsection exceeds the amount of the
payments provided under the contract.
`(B) PAYMENT SCHEDULE- The supplemental payment required under
subparagraph (A) shall be made pursuant to a payment schedule agreed to by
the State and the Federally-qualified health center or rural health
clinic.
`(6) ALTERNATIVE PAYMENT METHODOLOGIES- Notwithstanding any other
provision of this section, the State plan may provide for payment in any
fiscal year to a Federally-qualified health center for services described in
section 1905(a)(2)(C) or to a rural health clinic for services described in
section 1905(a)(2)(B) in an amount which is determined under an alternative
payment methodology that--
`(A) is agreed to by the State and the center or clinic; and
`(B) results in payment to the center or clinic of an amount which is
at least equal to the amount otherwise required to be paid to the center
or clinic under this section.'.
(c) CONFORMING AMENDMENTS-
(1) Section 4712 of the BBA (Public Law 105-33; 111 Stat. 508) is
amended by striking subsection (c).
(2) Section 1915(b) (42 U.S.C. 1396n(b)) is amended by striking
`1902(a)(13)(E)' and inserting `1902(a)(15), 1902(aa),'.
(d) GAO STUDY OF FUTURE REBASING- The Comptroller General of the United
States shall provide for a study on the need for, and how to, rebase or refine
costs for making payment under the medicaid program for services provided by
Federally-qualified health centers and rural health centers (as provided under
the amendments made by this section). The Comptroller General shall provide
for submittal of a report on such study to Congress
by not later than 4 years after the date of the enactment of this Act.
(e) EFFECTIVE DATE- The amendments made by this section take effect on
October 1, 2000, and apply to services furnished on or after such date.
SEC. 702. MEDICAID DSH ALLOTMENTS.
(a) ONE-YEAR FREEZE IN MEDICAID DSH ALLOTMENTS- Section 1923(f)(2) (42
U.S.C. 1396r-4(f)(2)) is amended--
(1) in the matter preceding the table, by inserting `(and the DSH
allotment for a State for fiscal year 2001 is the same as the DSH allotment
for the State for fiscal year 2000, as determined under the following
table)' after `2002'; and
(A) by striking the column in the table relating to FY 01 (fiscal year
2001); and
(B) by striking the heading in such table relating to FY 00 (fiscal
year 2000) and inserting `FYS 00, 01'.
(b) EFFECTIVE DATE- The amendments made by this section take effect on
October 1, 2000.
SEC. 703. PERMANENT EXTENSION OF PAYMENT OF MEDICARE PART B PREMIUMS FOR
QUALIFIED MEDICARE BENEFICIARIES WITH INCOME UP TO 135 PERCENT OF POVERTY.
(a) IN GENERAL- Section 1902(a)(10)(E)(iv) (42 U.S.C. 1396a(a)(10)(E)(iv))
is amended--
(1) in the matter preceding subclause (I), by striking `(but only for
premiums payable with respect to months during the period beginning with
January 1998, and ending with December 2002)';
(2) in subclause (I), by inserting `only for premiums payable with
respect to months beginning with January 1998,' after `(I)'; and
(3) in subclause (II), by inserting `only for premiums payable with
respect to months during the period beginning with January 1998, and ending
with December 2002,' after `(II)'.
(b) CONFORMING AMENDMENT- Section 1933(c)(1) (42 U.S.C. 1396u-3(c)(1)) is
amended--
(1) in subparagraph (D), by striking `and' at the end;
(2) in subparagraph (E), by striking the period and inserting `; and';
and
(3) by adding at the end the following new subparagraph:
`(F) fiscal year 2003 and each fiscal year thereafter, the amount
specified under this paragraph for the preceding fiscal year increased by
the percentage increase (if any) in the medical care expenditure category
of the Consumer Price Index for All Urban Consumers (United States city
average).'.
SEC. 704. STREAMLINED APPROVAL OF CONTINUED STATE-WIDE SECTION 1115 MEDICAID
WAIVERS.
(a) IN GENERAL- Section 1115 (42 U.S.C. 1315) is amended by adding at the
end the following new subsection:
`(f) An application by the chief executive officer of a State for an
extension of a waiver project the State is operating under an extension under
subsection (e) (in this subsection referred to as the `waiver project') shall
be submitted and approved or disapproved in accordance with the following:
`(1) The application for an extension of the waiver project shall be
submitted to the Secretary at least 120 days prior to the expiration of the
current period of the waiver project.
`(2) Not later than 45 days after the date such application is received
by the Secretary, the Secretary shall notify the State if the Secretary
intends to review the existing terms and conditions of the waiver project. A
failure to provide such notification shall be deemed to be an approval of
the application.
`(3) Not later than 45 days after the date of a notification made in
accordance with paragraph (2), the Secretary shall inform the State of
proposed changes in the terms and conditions of the waiver project. A
failure to provide such information shall be deemed to be an approval of the
application.
`(4) During the 30-day period that begins on the date information
described in paragraph (3) is provided to a State, the Secretary shall
negotiate revised terms and conditions of the waiver project with the
State.
`(5)(A) Not later than 120 days after the date an application for an
extension of the waiver project is submitted to the Secretary (or such later
date agreed to by the chief executive officer of the State), the Secretary
shall--
`(i) approve the application subject to such modifications in the
terms and conditions--
`(I) as have been agreed to by the Secretary and the State;
or
`(II) in the absence of such agreement, as are determined by the
Secretary to be reasonable consistent with the overall objectives of the
waiver project; or
`(ii) disapprove the application.
`(B) A failure by the Secretary to approve or disapprove an application
submitted under this subsection in accordance with the requirements of
subparagraph (A) shall be deemed to be an approval of the application
subject to such modifications in the terms and conditions as have been
agreed to (if any) by the Secretary and the State.
`(6) An approval of an application for an extension of a waiver project
under this subsection shall be for a period requested by the State, not to
exceed 3 years.
`(7) An extension of a waiver project under this subsection shall be
subject to the final reporting and evaluation requirements of paragraphs (4)
and (5) of subsection (e).'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) applies to
requests for extensions of demonstration projects pending or submitted on or
after the date of enactment of this Act.
SEC. 705. ALASKA FMAP.
(a) IN GENERAL- The first sentence of section 1905(b) (42 U.S.C. 1396d(b))
is amended--
(1) by striking `and (3)' and inserting `(3)'; and
(2) by striking the period and inserting `, and (4) only with respect to
each of fiscal years 2001 through 2005, for purposes of this title and title
XXI, the State percentage used to determine the Federal medical assistance
percentage for Alaska shall be that percentage which bears the same ratio to
45 percent as the square of the adjusted per capita income of Alaska
(determined by dividing the State's 3-year average per capita income by
1.05) bears to the square of the per capita income of the 50 States.'.
(b) EFFECTIVE DATE- The amendments made by subsection (a) take effect
October 1, 2000.
TITLE VIII--STATE CHILDREN'S HEALTH INSURANCE PROGRAM
(SCHIP)
SEC. 801. SPECIAL RULE FOR REDISTRIBUTION AND AVAILABILITY OF UNUSED FISCAL
YEAR 1998 AND 1999 SCHIP ALLOTMENTS.
(a) CHANGE IN RULES FOR REDISTRIBUTION AND RETENTION OF UNUSED SCHIP
ALLOTMENTS FOR FISCAL YEARS 1998 AND 1999- Section 2104 (42 U.S.C. 1397dd) is
amended by adding at the end the following new subsection:
`(g) RULE FOR REDISTRIBUTION AND EXTENDED AVAILABILITY OF FISCAL YEARS
1998 AND 1999 ALLOTMENTS-
`(1) AMOUNT REDISTRIBUTED-
`(A) IN GENERAL- In the case of a State that expends all of its
allotment under subsection (b) or (c) for fiscal year 1998 by the end of
fiscal year 2000, or for fiscal year 1999 by the end of fiscal year 2001,
the Secretary shall redistribute to the State under subsection (f) (from
the fiscal year 1998 or 1999 allotments of other States, respectively, as
determined by the application of paragraphs (2) and (3) with respect to
the respective fiscal year)) the following amount:
`(i) STATE- In the case of 1 of the 50 States or the District of
Columbia, with respect to--
`(I) the fiscal year 1998 allotment, the amount by which the
State's expenditures under this title in fiscal years 1998, 1999, and
2000 exceed the State's allotment for fiscal year 1998 under
subsection (b); or
`(II) the fiscal year 1999 allotment, the amount by which the
State's expenditures under this title in fiscal years 1999, 2000, and
2001 exceed the State's allotment for fiscal year 1999 under
subsection (b).
`(ii) TERRITORY- In the case of a commonwealth or territory
described in subsection (c)(3), an amount that bears the same ratio to
1.05 percent of the total amount described in paragraph (2)(B)(i)(I) as
the ratio of the commonwealth's or territory's fiscal year 1998 or 1999
allotment under subsection (c) (as the case may be) bears to the total
of all such allotments for such fiscal year under such
subsection.
`(B) EXPENDITURE RULES- An amount redistributed to a State under this
paragraph with respect to fiscal year 1998 or 1999--
`(i) shall not be included in the determination of the State's
allotment for any fiscal year under this section;
`(ii) notwithstanding subsection (e), shall remain available for
expenditure by the State through the end of fiscal year 2002;
and
`(iii) shall be counted as being expended with respect to a fiscal
year allotment in accordance with applicable regulations of the
Secretary.
`(2) EXTENSION OF AVAILABILITY OF PORTION OF UNEXPENDED FISCAL YEARS
1998 AND 1999 ALLOTMENTS-
`(A) IN GENERAL- Notwithstanding subsection (e):
`(i) FISCAL YEAR 1998 ALLOTMENT- Of the amounts allotted to a State
pursuant to this section for fiscal year 1998 that were not expended by
the State by the end of fiscal year 2000, the amount specified in
subparagraph (B) for fiscal year 1998 for such State shall remain
available for expenditure by the State through the end of fiscal year
2002.
`(ii) FISCAL YEAR 1999 ALLOTMENT- Of the amounts allotted to a State
pursuant to this subsection for fiscal year 1999 that were not expended
by the State by the end of fiscal year 2001, the amount specified in
subparagraph (B) for fiscal year 1999 for such State shall remain
available for expenditure by the State through the end of fiscal year
2002.
`(B) AMOUNT REMAINING AVAILABLE FOR EXPENDITURE- The amount specified
in this subparagraph for a State for a fiscal year is equal to--
`(i) the amount by which (I) the total amount available for
redistribution under subsection (f) from the allotments for that fiscal
year, exceeds (II) the total amounts redistributed under paragraph (1)
for that fiscal year; multiplied by
`(ii) the ratio of the amount of such State's unexpended allotment
for that fiscal year to the total amount described in clause (i)(I) for
that fiscal year.
`(C) USE OF UP TO 10 PERCENT OF RETAINED 1998 ALLOTMENTS FOR OUTREACH
ACTIVITIES- Notwithstanding section 2105(c)(2)(A), with respect to any
State described in subparagraph (A)(i), the State may
use up to 10 percent of the amount specified in subparagraph (B) for fiscal
year 1998 for expenditures for outreach activities approved by the Secretary.
`(3) DETERMINATION OF AMOUNTS- For purposes of calculating the amounts
described in paragraphs (1) and (2) relating to the allotment for fiscal
year 1998 or fiscal year 1999, the Secretary shall use the amounts reported
by the States not later than November 30, 2000, or November 30, 2001,
respectively, on HCFA Form 64 or HCFA Form 21, as approved by the
Secretary.'.
(b) EFFECTIVE DATE- The amendments made by this section shall take effect
as if included in the enactment of section 4901 of BBA (111 Stat. 552).
SEC. 802. PRESUMPTIVE ELIGIBILITY UNDER SCHIP.
(a) APPLICATION UNDER SCHIP- Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1))
is amended by adding at the end the following new subparagraph:
`(D) Section 1920A (relating to presumptive eligibility).'.
(b) TECHNICAL AMENDMENTS- Section 1920A (42 U.S.C. 1396r-1a) is
amended--
(1) in subsection (b)(3)(A)(ii), by striking `paragraph (1)(A)' and
inserting `paragraph (2)'; and
(2) in subsection (c)(2), in the matter preceding subparagraph (A), by
striking `subsection (b)(1)(A)' and inserting `subsection (b)(2)'.
(1) IN GENERAL- The amendment made by subsection (a) takes effect
October 1, 2000, and applies to allotments under title XXI of the Social
Security Act (42 U.S.C. 1397aa et seq.) for fiscal year 2001 and each
succeeding fiscal year thereafter.
(2) TECHNICAL AMENDMENTS- The amendments made by subsection (b) take
effect as if included in the enactment of section 4912 of BBA (111 Stat.
571).
SEC. 803. AUTHORITY TO PAY MEDICAID EXPANSION SCHIP COSTS FROM TITLE XXI
APPROPRIATION.
(a) AUTHORITY TO PAY MEDICAID EXPANSION SCHIP COSTS FROM TITLE XXI
APPROPRIATION- Section 2105(a) (42 U.S.C. 1397ee(a)) is amended--
(1) by redesignating subparagraphs (A) through (D) of paragraph (2) as
clauses (i) through (iv), respectively, and indenting appropriately;
(2) by redesignating paragraph (1) as subparagraph (B), and indenting
appropriately;
(3) by redesignating paragraph (2) as subparagraph (C), and indenting
appropriately;
(4) by striking `(a) IN GENERAL- ' and the remainder of the text that
precedes subparagraph (B), as so redesignated, and inserting the
following:
`(1) IN GENERAL- Subject to the succeeding provisions of this section,
the Secretary shall pay to each State with a plan approved under this title,
from its allotment under section 2104, an amount for each quarter equal to
the enhanced FMAP of expenditures in the quarter--
`(A) for child health assistance under the plan for targeted
low-income children in the form of providing medical assistance for which
payment is made on the basis of an enhanced FMAP under the fourth sentence
of section 1905(b);'; and
(5) by adding after subparagraph (C), as so redesignated, the following
new paragraph:
`(2) ORDER OF PAYMENTS- Payments under paragraph (1) from a State's
allotment shall be made in the following order:
`(A) First, for expenditures for items described in paragraph
(1)(A).
`(B) Second, for expenditures for items described in paragraph
(1)(B).
`(C) Third, for expenditures for items described in paragraph
(1)(C).'.
(b) ELIMINATION OF REQUIREMENT TO REDUCE TITLE XXI ALLOTMENT BY MEDICAID
EXPANSION SCHIP COSTS- Section 2104 (42 U.S.C. 1397dd) is amended by striking
subsection (d).
(c) AUTHORITY TO TRANSFER TITLE XXI APPROPRIATIONS TO TITLE XIX
APPROPRIATION ACCOUNT AS REIMBURSEMENT FOR MEDICAID EXPENDITURES FOR MEDICAID
EXPANSION SCHIP SERVICES- Notwithstanding any other provision of law, all
amounts appropriated under title XXI and allotted to a State pursuant to
subsection (b) or (c) of section 2104 of the Social Security Act (42 U.S.C.
1397dd) for fiscal years 1998 through 2000 (including any amounts that, but
for this provision, would be considered to have expired) and not expended in
providing child health assistance or related services for which payment may be
made pursuant to subparagraph (B) or (C) of section 2105(a)(1) of such Act (42
U.S.C. 1397ee(a)(1)) (as amended by subsection (a)), shall be available to
reimburse the Grants to States for Medicaid account in an amount equal to the
total payments made to such State under section 1903(a) of such Act (42 U.S.C.
1396b(a)) for expenditures in such years for medical assistance described in
subparagraph (A) of section 2105(a)(1) of such Act (42 U.S.C. 1397ee(a)(1))
(as so amended).
(d) CONFORMING AMENDMENTS-
(1) Section 1905(b) (42 U.S.C. 1396d(b)) is amended in the fourth
sentence by striking `the State's allotment under section 2104 (not taking
into account reductions under section 2104(d)(2)) for the fiscal year
reduced by the amount of any payments made under section 2105 to the State
from such allotment for such fiscal year' and inserting `the State's
available allotment under section 2104'.
(2) Section 1905(u)(1)(B) (42 U.S.C. 1396d(u)(1)(B)) is amended by
striking `and section 2104(d)'.
(3) Section 2104 (42 U.S.C. 1397dd), as amended by subsection (b), is
further amended--
(A) in subsection (b)(1), by striking `and subsection (d)';
and
(B) in subsection (c)(1), by striking `subject to subsection
(d),'.
(4) Section 2105(c) (42 U.S.C. 1397ee(c)) is amended--
(A) in paragraph (2)(A), by striking all that follows `Except as
provided in this paragraph,' and inserting `the amount of payment that may
be made under subsection (a) for a fiscal year for expenditures for items
described in paragraph (1)(C) of such subsection shall not exceed 10
percent of the total amount of expenditures for which payment is made
under subparagraphs (A), (B), and (C) of paragraph (1) of such
subsection.';
(B) in paragraph (2)(B), by striking `described in subsection (a)(2)'
and inserting `described in subsection (a)(1)(C)'; and
(C) in paragraph (6)(B), by striking `Except as otherwise provided by
law,' and inserting `Except as provided in subsection (a)(1)(A) or any
other provision of law,'.
(5) Section 2110(a) (42 U.S.C. 1397jj(a)) is amended by striking
`section 2105(a)(2)(A)' and inserting `section 2105(a)(1)(C)(i)'.
(e) TECHNICAL AMENDMENT- Section 2105(d)(2)(B)(ii) (42 U.S.C.
1397ee(d)(2)(B)(ii)) is amended by striking `enhanced FMAP under section
1905(u)' and inserting `enhanced FMAP under the fourth sentence of section
1905(b)'.
(f) EFFECTIVE DATE- The amendments made by this section shall be effective
as if included in the enactment of section 4901 of the BBA (111 Stat. 552).
TITLE IX--OTHER PROVISIONS
SEC. 901. INCREASE IN AUTHORIZATION OF APPROPRIATIONS FOR THE MATERNAL AND
CHILD HEALTH SERVICES BLOCK GRANT.
(a) IN GENERAL- Section 501(a) (42 U.S.C. 701(a)) is amended in the matter
preceding paragraph (1) by striking `$705,000,000 for fiscal year 1994' and
inserting `$1,000,000,000 for fiscal year 2001'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) takes effect on
October 1, 2000.
SEC. 902. INCREASE IN APPROPRIATIONS FOR SPECIAL DIABETES PROGRAMS FOR
CHILDREN WITH TYPE I DIABETES AND INDIANS.
(a) SPECIAL DIABETES PROGRAMS FOR CHILDREN WITH TYPE I DIABETES- Section
330B(b) of the Public Health Service Act (42 U.S.C. 254c-2(b)) is amended--
(1) by striking `Notwithstanding' and inserting the following:
`(1) TRANSFERRED FUNDS- Notwithstanding'; and
(2) by adding at the end the following:
`(2) APPROPRIATIONS- For the purpose of making grants under this
section, there is appropriated, out of any funds in the Treasury not
otherwise appropriated $70,000,000 for each of fiscal years 2001 and 2002
(which shall be combined with amounts transferred under paragraph (1) for
each such fiscal years).'.
(b) SPECIAL DIABETES PROGRAMS FOR INDIANS- Section 330C(c) of the Public
Health Service Act (42 U.S.C. 254c-3(c)) is amended--
(1) by striking `Notwithstanding' and inserting the following:
`(1) TRANSFERRED FUNDS- Notwithstanding'; and
(2) by adding at the end the following:
`(2) APPROPRIATIONS- For the purpose of making grants under this
section, there is appropriated, out of any money in the Treasury not
otherwise appropriated $70,000,000 for each of fiscal years 2001 and 2002
(which shall be combined with amounts transferred under paragraph (1) for
each such fiscal years).'.
END