SUMMARY AS OF:
10/26/1999--Introduced.
TABLE OF CONTENTS:
- Title I: Provisions Relating to Part A Only
- Subtitle A: Skilled Nursing Facility Services
- Subtitle B: Hospice Services
- Subtitle C: Other Provisions
- Title II: Provisions Relating to Part B Only
- Subtitle A: Hospital Outpatient Department Services
- Subtitle B: Physicians' Services
- Title III: Provisions Relating to Parts A and B
- Subtitle A: Home Health Services
- Subtitle B: Graduate Medical Education
- Title IV: Rural Initiatives
- Title V: Provisions Relating to Part C (Medicare+Choice Program)
- Subtitle A: Provisions to Accommodate and Protect Medicare Beneficiaries
- Subtitle B: Provisions to Facilitate Implementation of the Medicare+Choice
- Program
- Subtitle C: Provisions Regarding Special Medicare Populations
- Subtitle D: Studies and Reports to Assist in Making Future Improvements in
the
- Medicare Program
- Title VI: Other Medicare Provisions
- Title VII: Provisions Relating to Medicaid and SCHIP
Medicare, Medicaid, and SCHIP Adjustment Act of 1999 - Title I: Provisions
Relating to Part A Only - Subtitle A: Skilled Nursing Facility
Services - Provides for an increase in payment for skilled nursing facility
services to certain high cost patients under Medicare part A (Hospital
Insurance).
(Sec. 102) Amends title XVIII (Medicare) of the Social Security Act (SSA) to
provide for part B add-ons for facilities participating in the Nursing Home
Case-Mix and Quality Demonstration Project.
(Sec. 103) Provides for the exemption of facilities from the three-year
transition period under the prospective payment system (PPS) for skilled nursing
facilities.
(Sec. 104) Requires the Secretary of Health and Human Services to study and
report to Congress on State licensure and certification standards and
respiratory therapy competency examinations.
(Sec. 105) Requires the Secretary to study and report to Congress on State
licensure and certification standards and respiratory therapy competency
examinations.
Subtitle B: Hospice Services - Amends SSA title XVIII with regard to
payment for hospice care.
(Sec. 122) Directs the Comptroller General to study and report to Congress on
the feasibility and advisability of updating the payment rates for hospice care.
Subtitle C: Other Provisions - Requires the Secretary to study and
report to Congress on a PPS for psychiatric hospitals.
(Sec. 142) Revises the Medicare PPS for inpatient rehabilitation services.
Directs the Secretary to study and report to Congress on the impact of such
PPS with regard to utilization of services, beneficiary access to services,
non-therapy ancillary services, and other factors that the Secretary determines
are appropriate as a result of such study.
(Sec. 143) Deems the Northwest Mississippi Regional Medical Center located in
Clarksdale, Mississippi to have satisfied the case mix index criteria for
classification as a rural referral center.
(Sec. 144) Provides for reclassification of certain counties in North
Carolina and New York for reimbursement under Medicare.
(Sec. 145) Directs the Secretary to: (1) recalculate the Hattiesburg
Mississippi Metropolitan Statistical Area (MSA) wage index for FY 2000 using FY
1996 wage and hour data for Wesley Medical Center; (2) issue a wage index
correction for FY 2000; and (3) make such adjustments to the PPS for determining
the operating costs of inpatient hospital services of a disproportionate share
(DSH) hospital.
(Sec. 146) Requires the Secretary to consider an application by a certain
entity for Medicare certification as an application by a new provider.
(Sec. 147) Requires the Secretary to study and report to Congress on whether:
(1) the PPS rates are an adequate proxy for the costs of inpatient hospital
services; and (2) the standard for county-wide geographic reclassification needs
to be updated or revised.
Title II: Provisions Relating to Part B Only - Subtitle A: Hospital
Outpatient Department Services - Amends SSA title XVIII part B
(Supplementary Medical Insurance) to provide for a multiyear transition to PPS
for hospital outpatient department services.
(Sec. 202) Directs the Medicare Payment Advisory Commission (MEDPAC) to study
and report to the Secretary and Congress on the feasibility and advisability of
providing payments to rural and cancer hospitals in the PPS for hospital
outpatient department services.
(Sec. 203) Amends SSA title XVIII to provide for outlier adjustment,
transitional pass-through for certain medical devices, drugs, and biologicals,
and transitional pass-through for additional costs of innovative medical
devices, drugs, and biologicals.
Subtitle B: Physicians' Services - Amends SSA title XVIII to provide
for modifications of update adjustment factor provisions to reduce oscillations
and allow for estimate revisions.
(Sec. 221) Directs the Secretary, acting through the Administrator of the
Agency for Health Care Policy and Research, to study and report to MEDPAC, for
submission to Congress, on utilization of physicians' services by Medicare
beneficiaries.
Title III: Provisions Relating to Parts A and B - Subtitle A: Home
Health Services - Amends the Balanced Budget Act of 1997, as amended by the
Tax and Trade Relief Extension Act of 1998, to provide for a delay in the 15
percent reduction in payments under the PPS for home health services.
(Sec. 302) Amends SSA title XVIII to provide for an increase in per visit and
per beneficiary limits.
(Sec. 304) Eliminates the 15-minute billing requirement for prospective
payment for home health services.
(Sec. 305) Revises requirements for home health agency consolidated billing
to include medical supplies but not durable medical equipment.
(Sec. 306) Directs MEDPAC to study and report to Congress on the exemption of
rural agencies and populations from inclusion in the home health PPS.
(Sec. 307) Amends SSA title XVIII to provide for an extension of interim
payments for home health agencies.
Subtitle B: Graduate Medical Education - Amends SSA title XVIII to
revise the multiyear reduction of indirect graduate medical education (GME)
payments.
(Sec. 322) Increases certain limitations on the number of residents or
interns with respect to GME payments for certain interns and residents who
transferred from Department of Veterans' Affairs (VA) hospitals to non-VA
hospitals in order to maintain residency program accreditation.
Title IV: Rural Initiatives - Prescribes or revises requirements for:
(1) sole community hospitals and Medicare dependent hospitals; (2) revision of
criteria for designation as a critical access hospital; (3) Medicare waivers for
hospitals in rural areas; (4) two-year extension of Medicare dependent hospital
(MDH) program; and (5) assistance to rural GME residency programs.
Title V: Provisions Relating to Part C (Medicare+Choice Program) -
Subtitle A: Provisions to Accommodate and Protect Medicare Beneficiaries
- Amends SSA title XVIII part C (Medicare+Choice) : (1) permit enrollment in
alternative Medicare+Choice plans and Medicare supplemental insurance (Medigap)
coverage in case of involuntary termination of Medicare+Choice enrollment; (2)
revise the effective date of elections and changes of elections of
Medicare+Choice plans; (3) provide for an extension of reasonable cost
contracts; (4) provide for revision of notice by hospitals on coverage of
inpatient hospital services; and (5) provide for an extended disenrollment
window for certain involuntarily terminated enrollees.
Subtitle B: Provisions to Facilitate Implementation of the Medicare+Choice
Program - Amends Medicare part C to provide for phase-in of Medicare+Choice
risk adjustment methodology implementation.
(Sec. 522) Delays the deadline for submission of adjusted community rates
under Medicare+Choice program.
(Sec. 523) Bases the user fee for Medicare+Choice organizations on the number
of enrolled beneficiaries.
(Sec. 524) Revises the time period for the exclusion of Medicare+Choice
organizations that have had a contract terminated.
(Sec. 525) Provides for flexibility to tailor benefits under Medicare+Choice
plans.
(Sec. 526) Makes the Quality Improvement System for Managed Care inapplicable
to preferred provider organizations.
(Sec. 527) Changes the timing of Medicare+Choice health information fairs.
(Sec. 528) Amends Medicare part D (Miscellaneous Provisions) to exempt from
certain ownership and compensation arrangement prohibitions applicable to
prepaid plans any services furnished by a Medicare+Choice organization offering
a coordinated care plan to an organization enrollee.
(Sec. 529) Amends Medicare part C regarding the ability of a religious
fraternal benefit society to operate a Medicare+Choice private fee-for-service
plan.
Subtitle C: Provisions Regarding Special Medicare Populations - Amends
the Omnibus Budget Reconciliation Act of 1987 to extend the Social Health
Maintenance Organization Demonstration Project authority.
(Sec. 542) Amends SSA titles XVIII and XIX (Medicare) to provide for the
inapplicability of the Outcome and Assessment Information Set to the PACE
(program of all-inclusive care for the elderly) program.
(Sec. 543) Outlines Medigap protections for PACE program enrollees.
(Sec. 544) Requires the Secretary to extend the EverCare demonstration
project for the frail elderly.
Subtitle D: Studies and Reports to Assist in Making Future Improvements in
the Medicare Program - Directs the Comptroller General to: (1) study and
report to Congress on Medigap policies; and (2) conduct an annual audit for a
report to Congress on the expenditures by the Secretary during the preceding
year in providing information on the Medicare+Choice program to eligible
Medicare beneficiaries.
(Sec. 562) Directs MEDPAC to study and report to Congress on: (1) the
Secretary's methodology in developing the risk factors used in adjusting the
Medicare+Choice capitation rate paid to Medicare+Choice organizations; and (2)
the development of special payment rules under the Medicare+Choice program for
frail elderly enrolled in specialized programs.
(Sec. 563) Directs the Secretary to compute the expenditures under the
original Medicare fee-for-service program under Medicare parts A and B on a
county-by-county basis.
(Sec. 564) Directs the Secretary to study and report to Congress on the
effects, costs, and feasibility of requiring Medicare original fee-for-service
entities and Medicare+Choice coordinated care plans to comply with uniform
quality standards and related reporting requirements.
(Sec. 565) Directs the Secretary to study and report to Congress on data
submission used to establish risk adjustment methodology under the
Medicare+Choice program.
Title VI: Other Medicare Provisions - Amends SSA title VI to provide
for a two-year moratorium on caps for certain physical therapy services.
(Sec. 601) Amends the Balanced Budget Act of 1997 (BBA '97) to revise
requirements for the report on outpatient physical therapy services and
outpatient occupational therapy services with respect to prospective payment for
outpatient rehabilitation services.
Directs the Secretary to study and report to Congress on utilization patterns
of such therapy services.
(Sec. 602) Amends SSA title XVIII to provide for: (1) an increase in the
Medicare payment amount for renal dialysis services; (2) an increase in payment
amount for pap smear and laboratory tests; and (3) a limitation in the reduction
of payments to DSH hospitals.
(Sec. 605) Prohibits the Secretary from using, or permitting fiscal
intermediaries or carriers to use, the inherent reasonableness authority under
Medicare part B until a certain date after the Comptroller General of the United
States releases a report on the impact of the Secretary's fiscal intermediaries'
and carriers' use of such authority.
(Sec. 608) Prohibits any net deficit increase resulting from enactment of
this Act from being counted for purposes of the paygo scorecard under the
Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings
Act).
Title VII: Provisions Relating to Medicaid and SCHIP - Amends SSA
title XIX to make technical corrections related to BBA '97.
(Sec. 702) Increases the DSH allotment for Minnesota, New Mexico, Wyoming,
and the District of Columbia.
(Sec. 703) Amends BBA '97 to make the Medicaid DSH transition rule permanent.
(Sec. 704) Amends SSA title XIX (State Children's Health Insurance) (SCHIP)
to increase allotments for territories under SCHIP.
(Sec. 705) Amends SSA title XIX to remove fiscal year limitation on certain
transitional administrative costs assistance.
(Sec. 706) Amends SSA title XIX to revise floors and ceilings in the SCHIP
allotment formula.
(Sec. 707) Requires the Secretary to adjust the annual Current Population
Survey to include State-by-State data relating to children without health
insurance coverage. Makes appropriations.
Requires the Secretary, acting through the National Center for Health
Statistics, to collect children's health care access and utilization State-level
data. Makes appropriations.
Requires the Secretary, directly or through contracts or interagency
agreements, to conduct an independent evaluation of State SCHIP programs.
Provides funding.
Directs the Secretary to conduct an audit with regard to SCHIP enrollees who
are Medicaid-eligible. Requires the Comptroller General to monitor such audits
and submit a report on them to Congress.
(Sec. 708) Provides for grants to States for items and services provided by
federally-qualified health centers and rural health clinics. Makes
appropriations.