Calendar No. 345
106th CONGRESS
1st Session
S. 1788
[Report No. 106-199]
A BILL
To amend titles XVIII, XIX, and XXI of the Social Security Act to make
corrections and refinements in the medicare, medicaid, and SCHIP programs, as
revised and added by the Balanced Budget Act of 1997.
October 26, 1999
Read twice and placed on the calendar
S 1788 PCS
Calendar No. 345
106th CONGRESS
1st Session
S. 1788
[Report No. 106-199]
To amend titles XVIII, XIX, and XXI of the Social Security Act to
make corrections and refinements in the medicare, medicaid, and SCHIP programs,
as revised and added by the Balanced Budget Act of 1997.
IN THE SENATE OF THE UNITED STATES
October 26, 1999
Mr. ROTH, from the Committee on Finance, reported the following original
bill; which was read twice and placed on the calendar
A BILL
To amend titles XVIII, XIX, and XXI of the Social Security Act to
make corrections and refinements in the medicare, medicaid, and SCHIP programs,
as revised and added by the Balanced Budget Act of 1997.
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; TABLE OF
CONTENTS.
(a) SHORT TITLE- This Act may be cited as the `Medicare, Medicaid, and
SCHIP Adjustment Act of 1999'.
(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) TABLE OF CONTENTS- The table of contents of this Act is as follows:
Sec. 1. Short title; amendments to Social Security Act; table of
contents.
TITLE I--PROVISIONS RELATING TO PART A ONLY
Subtitle A--Skilled Nursing Facility Services
Sec. 101. Increase in payment for certain high cost patients.
Sec. 102. Provision for part B add-ons for facilities participating in
the NHCMQ demonstration project.
Sec. 103. Exemption of facilities from 3-year transition period under
the prospective payment system for skilled nursing facility services.
Sec. 104. Study and report regarding State licensure and certification
standards and respiratory therapy competency examinations.
Sec. 105. Study and report on alternative payment methods for skilled
nursing facilities specializing in care of high cost, chronically ill
beneficiaries.
Subtitle B--Hospice Services
Sec. 121. Payment for hospice care.
Sec. 122. Study and report to Congress regarding modification of the
payment rates for hospice care.
Subtitle C--Other Provisions
Sec. 141. Study and report regarding prospective payment system for
psychiatric hospitals.
Sec. 142. Revision of prospective payment system for inpatient
rehabilitation services.
Sec. 143. Exception to CMI qualifier for one year.
Sec. 144. Reclassification of certain counties for purposes of
reimbursement under the medicare program.
Sec. 145. Wage index correction.
Sec. 146. Consideration of an application by a certain entity for
medicare certification as an application by a new provider.
Sec. 147. Study and report on county-wide geographic
reclassification.
TITLE II--PROVISIONS RELATING TO PART B ONLY
Subtitle A--Hospital Outpatient Department Services
Sec. 201. Multiyear transition to prospective payment system for
hospital outpatient department services.
Sec. 202. Study and report to Congress regarding the inclusion of rural
and cancer hospitals in prospective payment system for hospital outpatient
department services.
Sec. 203. Outlier adjustment and transitional pass-through for certain
medical devices, drugs, and biologicals.
Subtitle B--Physicians' Services
Sec. 221. Modifications of update adjustment factor provisions to reduce
oscillations and allow for estimate revisions.
TITLE III--PROVISIONS RELATING TO PARTS A AND B
Subtitle A--Home Health Services
Sec. 301. Delay in the 15 percent reduction in payments under the PPS
for home health services.
Sec. 302. Increase in per visit limit.
Sec. 303. Increase in per beneficiary limits.
Sec. 304. Elimination of 15-minute billing requirement.
Sec. 305. Refinement of home health agency consolidated billing.
Sec. 306. Study and report to Congress regarding the exemption of rural
agencies and populations from inclusion in the home health prospective
payment system.
Sec. 307. Extension of periodic interim payments for home health
agencies.
Subtitle B--Graduate Medical Education
Sec. 321. Revision of multiyear reduction of indirect graduate medical
education payments.
Sec. 322. GME payments for certain interns and residents.
TITLE IV--RURAL INITIATIVES
Sec. 401. Sole community hospitals and medicare dependent
hospitals.
Sec. 402. Revision of criteria for designation as a critical access
hospital.
Sec. 403. Medicare waivers for hospitals in rural areas.
Sec. 404. 2-year extension of medicare dependent hospital (MDH)
program.
Sec. 405. Assisting rural graduate medical education residency
programs.
TITLE V--PROVISIONS RELATING TO PART C (MEDICARE+CHOICE PROGRAM)
Subtitle A--Provisions To Accommodate and Protect Medicare
Beneficiaries
Sec. 501. Permitting enrollment in alternative Medicare+Choice plans and
medigap coverage in case of involuntary termination of Medicare+Choice
enrollment.
Sec. 502. Change in effective date of elections and changes of elections
of Medicare+Choice plans.
Sec. 503. Extension of reasonable cost contracts.
Sec. 504. Revision of notice by hospitals regarding coverage of
inpatient hospital services.
Sec. 505. Extended disenrollment window for certain involuntarily
terminated enrollees.
Subtitle B--Provisions To Facilitate Implementation of the Medicare+Choice
Program
Sec. 521. Moderation of Medicare+Choice risk adjustment
implementation.
Sec. 522. Delay in deadline for submission of adjusted community rates
under Medicare+Choice program and related modifications.
Sec. 523. User fee for Medicare+Choice organizations based on number of
enrolled beneficiaries.
Sec. 524. Change in time period for exclusion of Medicare+Choice
organizations that have had a contract terminated.
Sec. 525. Flexibility to tailor benefits under Medicare+Choice
plans.
Sec. 526. Inapplicability of QISMC to preferred provider
organizations.
Sec. 527. Timing of Medicare+Choice health information fairs.
Sec. 528. Rules regarding physician referrals for Medicare+Choice
program.
Sec. 529. Clarification 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
Sec. 541. Extension of social health maintenance organization
demonstration project authority.
Sec. 542. Inapplicability of OASIS to PACE.
Sec. 543. Medigap protections for PACE program enrollees.
Sec. 544. Continuation of the frail elderly demonstration project.
Subtitle D--Studies and Reports To Assist in Making Future Improvements in
the Medicare Program
Sec. 561. GAO studies, audits, and reports.
Sec. 562. Medicare Payment Advisory Commission studies and
reports.
Sec. 563. Computation and report on medicare original fee-for-service
expenditures on a county-by-county basis.
Sec. 564. Study and report on the effects, costs, and feasibility of
requiring medicare original fee-for-service entities and Medicare+Choice
coordinated care plans to comply with uniform quality standards and related
reporting requirements.
Sec. 565. Study and report to Congress regarding data submission used to
establish risk adjustment methodology under the Medicare+Choice
program.
TITLE VI--OTHER PROVISIONS
Sec. 601. 2-year moratorium on therapy caps.
Sec. 602. Increase in payment amount for renal dialysis services
furnished under the medicare program.
Sec. 603. Increase in payment amount for pap smear laboratory
tests.
Sec. 604. Limitation in reduction of payments to disproportionate share
hospitals.
Sec. 605. Clarification of the inherent reasonableness (IR)
authority.
Sec. 606. Technical amendments relating to BBA provisions.
Sec. 607. Exclusion from PAYGO scorecard.
TITLE VII--PROVISIONS RELATING TO MEDICAID AND SCHIP
Sec. 701. Medicaid-related BBA technicals.
Sec. 702. Increase in disproportionate share hospital allotment for
certain States and the District of Columbia.
Sec. 703. Making medicaid DSH transition rule permanent.
Sec. 704. Increased allotments for territories under the State
children's health insurance program.
Sec. 705. Removal of fiscal year limitation on certain transitional
administrative costs assistance.
Sec. 706. Stabilizing the SCHIP allotment formula.
Sec. 707. Improved data collection and evaluations of the SCHIP
program.
Sec. 708. Grants to States for items and services provided by
Federally-qualified health centers and rural health clinics.
Sec. 709. Additional technical corrections.
TITLE I--PROVISIONS RELATING TO PART A ONLY
Subtitle A--Skilled Nursing Facility Services
SEC. 101. INCREASE IN PAYMENT FOR CERTAIN HIGH COST PATIENTS.
(a) EXTENSIVE SERVICES AND SPECIAL CARE RUGS-
(1) IN GENERAL- For purposes of computing payments for covered skilled
nursing facility services under paragraph (1) of section 1888(e) of the
Social Security Act (42 U.S.C. 1395yy(e)) for such services furnished on or
after April 1, 2000, and before October 1, 2001, the Secretary of Health and
Human Services (in this section referred to as the `Secretary') shall
increase by 25 percent the adjusted Federal per diem rate otherwise
determined under paragraph (4) of such section for such services furnished
to any individual entitled to benefits under part A of title XVIII of such
Act (42 U.S.C. 1395 et seq.) during the period in which the individual is
classified under an applicable RUG III category (as defined in paragraph
(2)).
(2) APPLICABLE RUG III CATEGORY DEFINED- In this subsection, the term
`applicable RUG III category' means the RUG III categories identified as
SE3, SE2, SE1, SSC, SSB, and SSA in tables 3 and 4 of the final rule
published in the Federal Register by the Health Care Financing
Administration on July 30, 1999 (64 Fed. Reg. 41684).
(b) REHABILITATION THERAPY RUGS- For purposes of computing payments for
covered skilled nursing facility services under paragraph (1) of section
1888(e) of the Social Security Act (42 U.S.C. 1395yy(e)) for such services
furnished on or after April 1, 2000, and before October 1, 2001, the Secretary
shall increase the adjusted Federal per diem rate otherwise determined under
paragraph (4) of such section for such services furnished to any individual
entitled to benefits under part A of title XVIII of such Act (42 U.S.C. 1395
et seq.) during the period in which the individual is classified under a RUGS
III category (as identified in tables 3 and 4 of the final rule described in
subsection (a)(2)) by the applicable payment add-on determined in accordance
with the following table:
RUGS III category
Applicable paymentadd-on
RUC
$73.57
RVC
$76.25
RHC
$54.09
RMC
$69.98
RMB
$30.09.
(c) RULE OF CONSTRUCTION- Nothing in this section shall be construed as
permitting the Secretary of Health and Human Services to include the amount of
the increase in the payment under subsection (a) or the amount of the add-on
under subsection (b) in updating the Federal per diem rate under section
1888(e)(4) of the Social Security Act (42 U.S.C. 1395yy(e)(4)).
SEC. 102. PROVISION FOR PART B ADD-ONS FOR FACILITIES PARTICIPATING IN THE
NHCMQ DEMONSTRATION PROJECT.
(a) IN GENERAL- Section 1888(e)(3) (42 U.S.C. 1395yy(e)(3)) is
amended--
(1) in subparagraph (A)--
(A) in clause (i), by inserting `or, in the case of a facility
participating in the Nursing Home Case-Mix and Quality Demonstration
(RUGS-III), the RUGS-III rate received by the facility during the cost
reporting period beginning in calendar year 1997' after `to non-settled
cost reports';
(B) in clause (ii), by striking `furnished during such period' and
inserting `furnished during the applicable cost reporting period described
in clause (i)'; and
(C) in the second sentence, by striking `with respect to exemptions,'
and inserting `with respect to exemptions for facilities (other than for a
facility participating in the Nursing Home Case-Mix and Quality
Demonstration (RUGS-III)),'; and
(2) in subparagraph (B), to read as follows:
`(B) UPDATE TO FIRST COST REPORTING PERIOD- The Secretary shall update
the amount determined under subparagraph (A), for each cost reporting
period after the applicable cost reporting period described in
subparagraph (A)(i) and up to the first cost reporting period by a factor
equal to the skilled nursing facility market basket percentage increase
minus 1 percentage point.'.
(b) EFFECTIVE DATE- The amendments made by this section shall take effect
as if included in the amendments made by section 4432 of the Balanced Budget
Act of 1997 (Public Law 105-33; 111 Stat. 414).
SEC. 103. EXEMPTION OF FACILITIES FROM 3-YEAR TRANSITION PERIOD UNDER THE
PROSPECTIVE PAYMENT SYSTEM FOR SKILLED NURSING FACILITY SERVICES.
(a) IN GENERAL- Section 1888(e) (42 U.S.C. 1395yy(e)) is amended--
(1) in paragraph (1), in the matter preceding subparagraph (A), by
striking `paragraph (7)' and inserting `paragraphs (7) and (11)'; and
(2) by adding at the end the following:
`(11) EXEMPTION OF FACILITIES FROM 3-YEAR TRANSITION- A facility may
elect to have paragraph (1)(B) apply in determining the amount of the
payment for all costs of covered skilled nursing facility services for each
day of such services furnished in cost reporting periods beginning after the
date of such election.'.
(b) EFFECTIVE DATE- The amendments made by this section shall apply to
elections made on or after the date of enactment of this Act.
SEC. 104. STUDY AND REPORT REGARDING STATE LICENSURE AND CERTIFICATION
STANDARDS AND RESPIRATORY THERAPY COMPETENCY EXAMINATIONS.
(a) STUDY- The Secretary of Health and Human Services shall conduct a
study that--
(1) identifies variations in State licensure and certification standards
for health care providers (including nursing and allied health
professionals) and other individuals providing respiratory therapy in
skilled nursing facilities;
(2) examines State requirements relating to respiratory therapy
competency examinations for such providers and individuals; and
(3) determines whether regular respiratory therapy competency
examinations or certifications should be required under the medicare program
under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) for
such providers and individuals.
(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 results of the study conducted under this section, together with any
recommendations for legislation that the Secretary determines to be
appropriate as a result of such study.
SEC. 105. STUDY AND REPORT ON ALTERNATIVE PAYMENT METHODS FOR SKILLED
NURSING FACILITIES SPECIALIZING IN CARE OF HIGH COST, CHRONICALLY ILL
BENEFICIARIES.
(a) STUDY- The Secretary of Health and Human Services shall conduct a
study on the feasibility and advisability of--
(1) modifying the prospective payment system established under section
1888(e) of the Social Security Act (42 U.S.C. 1395yy(e)) for skilled nursing
facilities that specialize in providing care to high cost, chronically ill
medicare beneficiaries; or
(2) exempting such facilities from such system and developing and
implementing alternative payment methods for such facilities.
(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 determines to be appropriate as a result of
such study.
Subtitle B--Hospice Services
SEC. 121. PAYMENT FOR HOSPICE CARE.
(a) IN GENERAL- Section 1814(i)(1)(C)(ii) (42 U.S.C. 1395f(i)(1)(C)(ii))
is amended--
(A) by striking `through 2002' and inserting `and 1999'; and
(B) by striking `and' at the end;
(2) by redesignating subclause (VII) as subclause (VIII); and
(3) by inserting after subclause (VI), the following:
`(VII) for each of fiscal years 2000 through 2002, the market basket
percentage increase for the fiscal year involved minus 0.5 percentage point;
and'.
(b) EFFECTIVE DATE- The amendments made by this section shall take effect
on October 1, 1999.
SEC. 122. STUDY AND REPORT TO CONGRESS REGARDING MODIFICATION OF THE PAYMENT
RATES FOR HOSPICE CARE.
(a) STUDY- The Comptroller General of the United States shall conduct a
study to determine the feasibility and advisability of updating the payment
rates and the cap amount determined with respect to a fiscal year under
section 1814(i) of the Social Security Act (42 U.S.C. 1395f(i)) for routine
home care and other services included in hospice care. Such study shall
examine the cost factors used to determine such rates and such amount and
shall evaluate whether such factors should be modified, eliminated, or
supplemented with additional cost factors.
(b) REPORT- Not later than 1 year after the date of enactment of this Act,
the Comptroller General of the United States shall submit a report to Congress
on the study conducted under subsection (a), together with any recommendations
for legislation that the Comptroller General determines to be appropriate as a
result of such study.
Subtitle C--Other Provisions
SEC. 141. STUDY AND REPORT REGARDING PROSPECTIVE PAYMENT SYSTEM FOR
PSYCHIATRIC HOSPITALS.
(a) STUDY- The Secretary of Health and Human Services shall conduct a
study on the feasibility and advisability of developing and implementing a
prospective payment system for items and services provided by psychiatric
hospitals (as defined in section 1861(f) of the Social Security Act (42 U.S.C.
1395x(f))) to beneficiaries under the medicare program under title XVIII of
such Act (42 U.S.C. 1395 et seq.). In conducting such study, the Secretary
should take into consideration the unique circumstances affecting psychiatric
hospitals that are located in rural areas (as defined in section 1886(d)(2)(D)
of such Act (42 U.S.C. 1395ww(d)(2)(D))).
(b) REPORT- Not later than 2 years 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 determines to be
appropriate as a result of such study.
SEC. 142. REVISION OF PROSPECTIVE PAYMENT SYSTEM FOR INPATIENT
REHABILITATION SERVICES.
(a) PAYMENT UNIT- Section 1886(j)(1)(D) of the Social Security Act (42
U.S.C. 1395ww(j)(1)(D)) is amended to read as follows:
`(D) For purposes of this subsection, the term `payment unit' means a
discharge.'.
(b) PATIENT CASE MIX GROUPS- Section 1886(j)(2)(A)(i) of the Social
Security Act (42 U.S.C. 1395ww(j)(2)(A)(i)) is amended to read as follows:
`(i) classes of patient discharges of rehabilitation facilities by
functional-related groups (each in this subsection referred to as a
`case mix group'), based on impairment, age, comorbidities, and
functional capability of the patient and such other factors as the
Secretary deems appropriate to improve the explanatory power of
functional independence measure-function related groups;
and'.
(1) STUDY- The Secretary of Health and Human Services shall conduct a
study on the impact that the prospective payment system for inpatient
rehabilitation services under section 1886(j) of the Social Security Act (42
U.S.C. 1395ww(j)) has on utilization of services, beneficiary access to
services, non-therapy ancillary services, and other factors that the
Secretary determines are appropriate.
(2) REPORT- Not later than 2 years after implementation of the
prospective payment system described in paragraph (1), the Secretary of
Health and Human Services shall submit a report to the appropriate
committees of Congress on the study conducted under such paragraph, together
with any recommendations for legislation regarding adjustments to the
payment amounts under such system that the Secretary determines are
appropriate as a result of such study.
SEC. 143. EXCEPTION TO CMI QUALIFIER FOR ONE YEAR.
Notwithstanding any other provision of law, for purposes of fiscal year
2000, the Northwest Mississippi Regional Medical Center located in Clarksdale,
Mississippi shall be deemed to have satisfied the case mix index criteria
under section 1886(d)(5)(C)(ii) of the Social Security Act (42 U.S.C.
1395ww(d)(5)(C)(ii)) for classification as a rural referral center.
SEC. 144. RECLASSIFICATION OF CERTAIN COUNTIES FOR PURPOSES OF REIMBURSEMENT
UNDER THE MEDICARE PROGRAM.
(a) IN GENERAL- For purposes of receiving reimbursement under the medicare
program under title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.)--
(1) Iredell County, North Carolina is deemed to be located in the
Charlotte-Gastonia-Rock Hill-N.C.-S.C. Metropolitan Statistical Area;
and
(2) the large urban area of New York, New York is deemed to include
Orange County, New York.
(b) EFFECTIVE DATE- This section shall apply with respect to discharges
occurring on or after October 1, 1999.
SEC. 145. WAGE INDEX CORRECTION.
Notwithstanding any other provision of law, the Secretary of Health and
Human Services shall--
(1) recalculate the Hattiesburg Mississippi Metropolitan Statistical
Area (MSA) wage index for fiscal year 2000 using fiscal year 1996 wage and
hour data for Wesley Medical Center;
(2) issue a wage index correction for fiscal year 2000; and
(3) make such adjustments to the prospective payment system determined
under section 1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)) as
may be necessary to take into account such corrected wage index.
SEC. 146. CONSIDERATION OF AN APPLICATION BY A CERTAIN ENTITY FOR MEDICARE
CERTIFICATION AS AN APPLICATION BY A NEW PROVIDER.
Notwithstanding any other provision of law, the Secretary of Health and
Human Services shall consider an application (or a reapplication) for
certification of a long-term care facility under the medicare program under
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) that is, or
was, submitted after January 1, 1994, by a subsidiary of a not-for-profit,
municipally-owned, and medicare-certified hospital, where such long-term care
facility has had a change of management from the previous owner prior to
acquisition by such subsidiary, as an application by a prospective
provider.
SEC. 147. STUDY AND REPORT ON COUNTY-WIDE GEOGRAPHIC RECLASSIFICATION.
(a) STUDY- The Secretary of Health and Human Services, in consultation
with the Medicare Geographic Classification Review Board, shall conduct a
study to determine--
(1) whether the prospective payment rates established under section
1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)) are an adequate
proxy for the costs of inpatient hospital services; and
(2) whether the standard for county-wide geographic reclassification
needs to be updated or revised.
(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 determines to be appropriate as a result of
such study.
TITLE II--PROVISIONS RELATING TO PART B ONLY
Subtitle A--Hospital Outpatient Department Services
SEC. 201. MULTIYEAR TRANSITION TO PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL
OUTPATIENT DEPARTMENT SERVICES.
(a) IN GENERAL- Section 1833(t) (42 U.S.C. 1395(t)) is amended by adding
at the end the following:
`(10) MULTIYEAR TRANSITION-
`(A) IN GENERAL- In the case of covered OPD services furnished by a
hospital during a transition year, the Secretary shall increase the
payments for such services under the prospective payment system
established under this subsection by the amount (if any) that the
Secretary determines is necessary to ensure that the payment to cost ratio
of the hospital for the transition year (as defined in subparagraph
(D)(iii)) equals the applicable percentage (as defined in subparagraph
(D)(i)) of the payment to cost ratio of the hospital for 1996.
`(B) PAYMENT TO COST RATIO-
`(i) IN GENERAL- The payment to cost ratio of a hospital for any
year is the ratio which--
`(I) the hospital's reimbursement under this part for covered OPD
services furnished during the year, including any reimbursement for
such services through cost-sharing described in subparagraph (D)(ii);
bears to
`(II) the cost of such services.
`(ii) CALCULATION OF 1996 PAYMENT TO COST RATIO- The Secretary shall
determine each hospital's payment to cost ratio for 1996 as if the
amendments made by section 4521 of the Balanced Budget Act of 1997 were
in effect in 1996.
`(iii) TRANSITION YEARS- The Secretary shall estimate the payment to
cost ratio of each hospital for each transition year before the
beginning of such year.
`(i) IN GENERAL- The Secretary shall make interim payments to a
hospital during any transition year for which the Secretary estimates a
payment is required under subparagraph (A).
`(ii) ADJUSTMENTS- If the Secretary makes payments under clause (i)
for any transition year, the Secretary shall make retrospective
adjustments to each hospital based on its settled cost report so that
the amount of any additional payment to a hospital for such year equals
the amount described in subparagraph (A).
`(D) DEFINITIONS- In this paragraph:
`(i) APPLICABLE PERCENTAGE- The term `applicable percentage' means,
with respect to covered OPD services furnished during--
`(I) the first full calendar year (and any portion of the
immediately preceding calendar year) for which the prospective payment
system under this subsection is in effect, 90 percent;
`(II) the second full calendar year for which such system is in
effect, 85 percent; and
`(III) the third full calendar year for which such system is in
effect, 80 percent.
`(ii) COST-SHARING- The term `cost-sharing' includes--
`(I) copayment amounts described in paragraph (5);
`(II) coinsurance described in section 1866(a)(2)(A)(ii);
and
`(III) the deductible described under section
1833(b).
`(iii) TRANSITION YEAR- The term `transition year' means any year
(or portion thereof) described in clause (i).
`(E) EFFECT ON COPAYMENTS- Nothing in this paragraph shall be
construed as affecting the unadjusted copayment amount described in
paragraph (3)(B).
`(F) APPLICATION WITHOUT REGARD TO BUDGET NEUTRALITY- The transitional
payments made under this paragraph--
`(i) shall not be considered an adjustment under paragraph (2)(E);
and
`(ii) shall not be implemented in a budget neutral
manner.'.
(b) SPECIAL RULE FOR RURAL AND CANCER HOSPITALS- Section 1833(t) (42
U.S.C. 1395(t)), as amended by subsection (a), is amended by adding at the end
the following:
`(11) SPECIAL RULE FOR RURAL AND CANCER HOSPITALS-
`(A) IN GENERAL- For each calendar year or portion thereof (beginning
with 2000), in the case of covered OPD services furnished by a
medicare-dependent, small rural hospital (as defined in section
1886(d)(5)(G)(iv)), a sole community hospital (as defined in section
1886(d)(5)(D)(iii)), or in a hospital described in section
1886(d)(1)(B)(v), the Secretary shall increase the payments for such
services under the prospective payment system established under this
subsection by the amount (if any) that the Secretary determines is
necessary to ensure that the payment to cost ratio of the hospital (as
determined pursuant to paragraph (10)(B)) for the year equals the payment
to cost ratio of the hospital for 1996 (as calculated under clause (ii) of
such paragraph).
`(i) IN GENERAL- The Secretary shall make interim payments to a
hospital during any year for which the Secretary estimates a payment is
required under subparagraph (A).
`(ii) ADJUSTMENTS- If the Secretary makes payments under clause (i)
for any year, the Secretary shall make retrospective adjustments to each
hospital based on its settled cost report so that the amount of any
additional payment to a hospital for such year equals the amount
described in subparagraph (A).
`(C) EFFECT ON COPAYMENTS- Nothing in this paragraph shall be
construed as affecting the unadjusted copayment amount described in
paragraph (3)(B).
`(D) APPLICATION WITHOUT REGARD TO BUDGET NEUTRALITY- The payments
made under this paragraph--
`(i) shall not be considered an adjustment under paragraph (2)(E);
and
`(ii) shall not be implemented in a budget neutral
manner.'.
(c) EFFECTIVE DATE- The amendments made by this section shall take effect
on the date of enactment of this Act.
SEC. 202. STUDY AND REPORT TO CONGRESS REGARDING THE INCLUSION OF RURAL AND
CANCER HOSPITALS IN PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT
DEPARTMENT SERVICES.
(1) IN GENERAL- The Medicare Payment Advisory Commission (referred to in
this section as `MedPAC') shall conduct a study to determine the feasibility
and advisability of providing payments to hospitals described in paragraph
(2) for covered OPD services (as defined in paragraph (1)(B) of section
1833(t) of the Social Security Act (42 U.S.C. 1395l(t))) based on the
prospective payment system established by the Secretary in accordance with
such section.
(2) HOSPITALS DESCRIBED- The hospitals described in this paragraph are
the following:
(A) A medicare-dependent, small rural hospital (as defined in section
1886(d)(5)(G)(iv) of the Social Security Act (42 U.S.C.
1395ww(d)(5)(G)(iv))).
(B) A sole community hospital (as defined in section
1886(d)(5)(D)(iii) of such Act (42 U.S.C. 1395ww(d)(5)(D)(iii))).
(C) A hospital described in section 1886(d)(1)(B)(v) of such Act (42
U.S.C. 1395ww(d)(1)(B)(v)).
(b) REPORT- Not later than 2 years 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.
(c) COMMENTS- Not later than 60 days after the date on which MedPAC
submits the report under subsection (b) to the Secretary of Health and Human
Services, the Secretary shall submit comments on such report to Congress.
SEC. 203. OUTLIER ADJUSTMENT AND TRANSITIONAL PASS-THROUGH FOR CERTAIN
MEDICAL DEVICES, DRUGS, AND BIOLOGICALS.
(a) OUTLIER ADJUSTMENT- Section 1833(t) (42 U.S.C. 1395l(t)), as amended
by section 201, is amended--
(1) by redesignating paragraphs (5) through (11) as paragraphs (7)
through (13), respectively; and
(2) by inserting after paragraph (4) the following:
`(A) IN GENERAL- The Secretary shall provide for an additional payment
for each covered OPD service (or group of services) for which a hospital's
charges, adjusted to cost, exceed--
`(i) a fixed multiple of the sum of--
`(I) the applicable medicare OPD fee schedule amount determined
under paragraph (3)(D), as adjusted under paragraph (4)(A) (other than
for adjustments under this paragraph or paragraph (6));
and
`(II) any transitional pass-through payment under paragraph (6);
and
`(ii) at the option of the Secretary, such fixed dollar amount as
the Secretary may establish.
`(B) AMOUNT OF ADJUSTMENT- The amount of the additional payment under
subparagraph (A) shall be determined by the Secretary and shall
approximate the marginal cost of care beyond the applicable cutoff point
under such subparagraph.
`(C) LIMIT ON AGGREGATE OUTLIER ADJUSTMENTS-
`(i) IN GENERAL- The total of the additional payments made under
this paragraph for covered OPD services furnished in a year (as
estimated by the Secretary before the beginning of the year) may not
exceed the applicable percentage (specified in clause (ii)) of the total
program payments estimated to be made under this subsection for all
covered OPD services furnished in that year. If this paragraph is first
applied to less than a full year, the previous sentence shall apply only
to the portion of such year.
`(ii) APPLICABLE PERCENTAGE- For purposes of clause (i), the term
`applicable percentage' means a percentage specified
by the Secretary up to (but not to exceed)--
`(I) for a year (or portion of a year) before 2004, 2.5 percent;
and
`(II) for 2004 and thereafter, 3.0 percent.'.
(b) TRANSITIONAL PASS-THROUGH FOR ADDITIONAL COSTS OF INNOVATIVE MEDICAL
DEVICES, DRUGS, AND BIOLOGICALS- Such section is further amended by inserting
after paragraph (5) the following:
`(6) TRANSITIONAL PASS-THROUGH FOR ADDITIONAL COSTS OF INNOVATIVE
MEDICAL DEVICES, DRUGS, AND BIOLOGICALS-
`(A) IN GENERAL- The Secretary shall provide for an additional payment
under this paragraph for a covered OPD service (or group of services) that
includes the provision of any of the following:
`(i) CURRENT ORPHAN DRUGS- A drug or biological that is used for a
rare disease or condition with respect to which the drug or biological
has been designated as an orphan drug under section 526 of the Federal
Food, Drug and Cosmetic Act if payment for the drug or biological as an
outpatient hospital service under this part was being made on the first
date that the system under this subsection is implemented.
`(ii) CURRENT CANCER THERAPY DRUGS AND BIOLOGICALS- A drug or
biological that is used in cancer therapy, including a chemotherapeutic
agent, antiemetic, hematopoietic growth factor, colony stimulating
factor, and a biological response modifier, if payment for the drug or
biological as an outpatient hospital service under this part was being
made on such first date.
`(iii) RADIOPHARMACEUTICAL DRUGS AND BIOLOGICAL PRODUCTS-
Radiopharmaceutical drugs or biological products used in diagnostic,
monitoring, and therapeutic nuclear medicine procedures.
`(iv) NEW MEDICAL DEVICES, DRUGS, AND BIOLOGICALS- A medical device,
drug, or biological not described in clause (i), (ii), or (iii)
if--
`(I) payment for the device, drug, or biological as an outpatient
hospital services under this part was not being made as of December
31, 1996; and
`(II) the cost of the device, drug, or biological is not
insignificant in relation to the OPD fee schedule amount (as
calculated under paragraph (3)(D)) payable for the service (or group
of services) involved.
`(B) LIMITED PERIOD OF PAYMENT- The payment under this paragraph with
respect to a medical device, 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), (iii) of
subparagraph (A) and in the case of a device, drug, or biological
described in clause (iv) of such subparagraph for which payment under
this part is made as an outpatient hospital service before such first
date; or
`(ii) in the case of a device, drug, or biological described in
subparagraph (A)(iv) not described in clause (i), on the first date on
which payment is made under this part for the device, drug, or
biological as an outpatient hospital service.
`(C) AMOUNT OF ADDITIONAL PAYMENT- Subject to subparagraph (D)(iii),
the amount of the payment under this paragraph with respect to a device,
drug, or biological provided as part of a covered OPD service
is--
`(i) in the case of a drug or biological, the amount by which the
amount determined under section 1842(o) for the drug or biological
exceeds the portion of the otherwise applicable medicare OPD fee
schedule that the Secretary determines is associated with the drug or
biological; or
`(ii) in the case of a medical device, the amount by which the
hospital's charges for the device, adjusted to cost, exceeds the portion
(described in clause (i)) associated with the device.
`(D) LIMIT ON AGGREGATE ANNUAL ADJUSTMENT-
`(i) IN GENERAL- The total of the additional payments made under
this paragraph for covered OPD services furnished in a year (as
estimated by the Secretary before the beginning of the year) may not
exceed the applicable percentage (specified in clause (ii)) of the total
program payments estimated to be made under this subsection for all
covered OPD services furnished in that year. If this paragraph is first
applied to less than a full year, the previous sentence shall apply only
to the portion of such year.
`(ii) APPLICABLE PERCENTAGE- For purposes of clause (i), the term
`applicable percentage' means--
`(I) for a year (or portion of a year) before 2004, 2.5 percent;
and
`(II) for 2004 and thereafter, a percentage specified by the
Secretary up to (but not to exceed) 2.0 percent.
`(iii) UNIFORM PROSPECTIVE REDUCTION IF AGGREGATE LIMIT PROJECTED TO
BE EXCEEDED- If the Secretary projects or estimates before the beginning
of a year
that the amount of the additional payments under this paragraph for the year
(or portion thereof) (as determined under clause (i) without regard to this
clause) will exceed the limit established under such clause, the Secretary shall
reduce pro rata the amount of each of the additional payments under this
paragraph for that year (or portion thereof) in order to ensure that the
aggregate additional payments under this paragraph (as so estimated) do not
exceed such limit.'.
(c) APPLICATION OF NEW ADJUSTMENTS ON A BUDGET NEUTRAL BASIS- Section
1833(t)(2)(E) (42 U.S.C. 1395l(t)(2)(E)) is amended by striking `other
adjustments, in a budget neutral manner, as determined to be necessary to
ensure equitable payments, such outlier adjustments or' and inserting `, in a
budget neutral manner, outlier adjustments under paragraph (5) and
transitional pass-through payments under paragraph (6) and other adjustments
as determined to be necessary to ensure equitable payments, such as'.
(d) LIMITATION ON JUDICIAL REVIEW FOR NEW ADJUSTMENTS- Section 1833(t)(11)
(42 U.S.C. 1395l(t)(11)), as redesignated by subsection (a)(1), is
amended--
(1) by striking `and' at the end of subparagraph (C);
(2) by striking the period at the end of subparagraph (D) and inserting
`; and'; and
(3) by adding at the end the following:
`(E) the determination of the fixed multiple or a fixed dollar cutoff
amount, the marginal cost of care, or applicable percentage under
paragraph (5), or the determination of insignificance of cost, the period
and amount of the additional payments, the portion of the medicare OPD fee
schedule amount associated with particular devices, drugs, or biologicals,
and the application of any pro rata reduction under paragraph
(6).'.
(e) INCLUSION OF MEDICAL DEVICES UNDER SYSTEM- Section 1833(t)(1)(B) (42
U.S.C. 1395l(t)(1)(B)) is amended--
(1) in clause (ii), by striking `clause (iii)' and inserting `clause
(iv)' and by striking `but'; and
(2) by redesignating clause (iii) as clause (iv) and inserting after
clause (ii) the following:
`(iii) includes medical devices (such as implantable medical
devices); but'.
(f) AUTHORIZING PAYMENT WEIGHTS BASED ON MEAN HOSPITAL COSTS- Section
1833(t)(2)(C) (42 U.S.C. 1395l(t)(2)(C)) is amended by inserting `(or, at the
election of the Secretary, mean)' after `median'.
(g) LIMITING VARIATION OF COSTS OF SERVICES CLASSIFIED WITH A GROUP-
Section 1833(t)(2) (42 U.S.C. 1395l(t)(2)) is amended by adding at the end the
following: `For purposes of subparagraph (B), items and services within a
group shall not be treated as `comparable with respect to the use of
resources' if the highest median cost (or mean cost, if elected by the
Secretary under subparagraph (C)) for an item or service within the group is
more than 2 times greater than the lowest median cost (or mean cost, if so
elected) for an item or service within the group; except that the Secretary
may make exceptions in unusual cases, such as low volume items and
services.'.
(h) ANNUAL REVIEW OF OPD PPS COMPONENTS-
(1) IN GENERAL- Section 1833(t)(8)(A) (42 U.S.C. 1395l(t)(8)(A)) (as
redesignated by subsection (a)(1)) is amended by striking `may periodically
review' and inserting `shall review not less often than annually'.
(2) EFFECTIVE DATE- The amendment made by paragraph (1) applies
beginning with 2002.
(i) EFFECTIVE DATE- Except as provided in this section, the amendments
made by this section shall be effective as if included in the amendments made
by section 4523 of the Balanced Budget Act of 1997 (Public Law 105-33; 111
Stat. 445).
Subtitle B--Physicians' Services
SEC. 221. MODIFICATIONS OF UPDATE ADJUSTMENT FACTOR PROVISIONS TO REDUCE
OSCILLATIONS AND ALLOW FOR ESTIMATE REVISIONS.
(a) UPDATE ADJUSTMENT FACTOR-
(1) IN GENERAL- Section 1848(d) (42 U.S.C. 1395w-4(d)) is
amended--
(i) in the heading, by inserting `FOR 1999 AND 2000' after
`UPDATE';
(ii) in subparagraph (A), by striking `a year beginning with 1999'
and inserting `1999 and 2000'; and
(iii) in subparagraph (C), by inserting `and paragraph (4)' after
`For purposes of this paragraph'; and
(B) by adding at the end the following:
`(4) UPDATE FOR YEARS BEGINNING WITH 2001-
`(A) IN GENERAL- Unless otherwise provided by law, subject to the
budget-neutrality factor determined by the Secretary under subsection
(c)(2)(B)(ii) and subject to adjustment under subparagraph (F), the update
to the single conversion factor established in paragraph (1)(C) for a year
beginning with 2001 is equal to the product of--
`(i) 1 plus the Secretary's estimate of the percentage increase in
the MEI (as defined in section 1842(i)(3)) for the year (divided by
100); and
`(ii) 1 plus the Secretary's estimate of the update adjustment
factor under subparagraph (B) for the year.
`(B) UPDATE ADJUSTMENT FACTOR- For purposes of subparagraph (A)(ii),
subject to subparagraph (D), the `update adjustment factor' for a year is
equal (as estimated by the Secretary) to the sum of the
following:
`(i) PRIOR YEAR ADJUSTMENT COMPONENT- An amount determined
by--
`(I) computing the difference (which may be positive or negative)
between the amount of the allowed expenditures for physicians'
services for the prior year (as determined under subparagraph (C)) and
the amount of the actual expenditures for such services for that
year;
`(II) dividing that difference by the amount of the actual
expenditures for such services for that year; and
`(III) multiplying that quotient by 0.75.
`(ii) CUMULATIVE ADJUSTMENT COMPONENT- An amount determined
by--
`(I) computing the difference (which may be positive or negative)
between the amount of the allowed expenditures for physicians'
services (as determined under subparagraph (C)) from April 1, 1996,
through the end of the prior year and the amount of the actual
expenditures for such services during that period;
`(II) dividing that difference by actual expenditures for such
services for the prior year as increased by the sustainable growth
rate under subsection (f) for the year for which the update adjustment
factor is to be determined; and
`(III) multiplying that quotient by 0.33.
`(C) DETERMINATION OF ALLOWED EXPENDITURES- For purposes of this
paragraph:
`(i) PERIOD UP TO APRIL 1, 1999- The allowed expenditures for
physicians' services for a period before April 1, 1999, shall be the
amount of the allowed expenditures for such period as determined under
paragraph (3)(C).
`(ii) TRANSITION TO CALENDAR YEAR ALLOWED EXPENDITURES- Subject to
subparagraph (E), the allowed expenditures for--
`(I) the 9-month period beginning April 1, 1999, shall be the
Secretary's estimate of the amount of the allowed expenditures that
would be permitted under paragraph (3)(C) for such period;
and
`(II) the year of 1999, shall be the Secretary's estimate of the
amount of the allowed expenditures that would be permitted under
paragraph (3)(C) for such year.
`(iii) YEARS BEGINNING WITH 2000- The allowed expenditures for a
year (beginning with 2000) is equal to the allowed expenditures for
physicians' services for the previous year, increased by the sustainable
growth rate under subsection (f) for the year involved.
`(D) RESTRICTION ON UPDATE ADJUSTMENT FACTOR- The update adjustment
factor determined under subparagraph (B) for a year may not be less than
-0.07 or greater than 0.03.
`(E) RECALCULATION OF ALLOWED EXPENDITURES FOR UPDATES BEGINNING WITH
2001- For purposes of determining the update adjustment factor for a year
beginning with 2001, the Secretary shall recompute the allowed
expenditures for previous periods beginning on or after April 1, 1999,
consistent with subsection (f)(3).
`(F) TRANSITIONAL ADJUSTMENT DESIGNED TO PROVIDE FOR BUDGET
NEUTRALITY- Under this subparagraph the Secretary shall provide for an
adjustment to the update under subparagraph (A)--
`(i) for each of 2001, 2002, 2003, and 2004, of -0.2 percent;
and
`(ii) for 2005 of +0.8 percent.'.
(A) IN GENERAL- Section 1848(d)(1)(E) (42 U.S.C. 1395w-4(d)(1)(E)) is
amended to read as follows:
`(E) PUBLICATION AND DISSEMINATION OF INFORMATION- The Secretary
shall--
`(i) cause to have published in the Federal Register not later than
November 1 of each year (beginning with 2000) the conversion factor
which will apply to physicians' services for the succeeding year, the
update determined under paragraph (4) for such succeeding year, and the
allowed expenditures under such paragraph for such succeeding year;
and
`(ii) make available to the Medicare Payment Advisory Commission and
the public by March 1 of each year (beginning with 2000) an estimate of
the conversion factor which will apply to physicians' services for the
succeeding year and data used in making such estimate.'.
(B) MEDPAC REVIEW OF CONVERSION FACTOR ESTIMATES- Section
1805(b)(1)(D) (42 U.S.C. 1395b-6(b)(1)(D)) is amended by inserting `and
including a review of the estimate of the conversion factor submitted
under section 1848(d)(1)(E)(ii)' before the period at the end.
(C) 1-TIME PUBLICATION OF INFORMATION ON TRANSITION- The Secretary of
Health and Human Services shall cause to have published in the Federal
Register, not later than 90 days after the date of the enactment of this
section, the Secretary's determination, based upon the best available
data, of--
(i) the allowed expenditures under subclauses (I) and (II) of
section 1848(d)(4)(C)(ii) of the Social Security Act, as added by
subsection (a)(1)(B), for
the 9-month period beginning on April 1, 1999, and for 1999;
(ii) the estimated actual expenditures described in section 1848(d)
of such Act for 1999; and
(iii) the sustainable growth rate under section 1848(f) of such Act
(42 U.S.C. 1395w-4(f)) for 2000.
(3) CONFORMING AMENDMENTS-
(A) Section 1848 (42 U.S.C. 1395w-4) is amended--
(i) in subsection (d)(1)(A), by inserting `(for years before 2001)
and, for years beginning with 2001, multiplied by the update
(established under paragraph (4)) for the year involved' after `for the
year involved'; and
(ii) in subsection (f)(2)(D), by inserting `or (d)(4)(B), as the
case may be' after `(d)(3)(B)'.
(B) Section 1833(l)(4)(A)(i)(VII) (42 U.S.C. 1395l(l)(4)(A)(i)(VII))
is amended by striking `1848(d)(3)' and inserting `1848(d)'.
(b) SUSTAINABLE GROWTH RATES- Section 1848(f) (42 U.S.C. 1395w-4(f)) is
amended--
(1) by striking paragraph (1) and inserting the following:
`(1) PUBLICATION- The Secretary shall cause to have published in the
Federal Register not later than--
`(A) November 1, 2000, the sustainable growth rate for 2000 and 2001;
and
`(B) November 1 of each succeeding year the sustainable growth rate
for such succeeding year and each of the preceding 2 years.';
(A) in the matter before subparagraph (A), by striking `fiscal year
1998)' and inserting `fiscal year 1998 and ending with fiscal year 2000)
and a year beginning with 2000'; and
(B) in subparagraphs (A) through (D), by striking `fiscal year' and
inserting `applicable period' each place it appears;
(3) in paragraph (3), by adding at the end the following:
`(C) APPLICABLE PERIOD- The term `applicable period' means--
`(i) a fiscal year, in the case of fiscal year 1998, fiscal year
1999, and fiscal year 2000; or
`(ii) a calendar year with respect to a year beginning with
2000;
(4) by redesignating paragraph (3) as paragraph (4); and
(5) by inserting after paragraph (2) the following:
`(3) DATA TO BE USED- For purposes of determining the update adjustment
factor under subsection (d)(4)(B) for a year beginning with 2001, the
sustainable growth rates taken into consideration in the determination under
paragraph (2) shall be determined as follows:
`(A) FOR 2001- For purposes of such calculations for 2001, the
sustainable growth rates for fiscal year 2000 and the years 2000 and 2001
shall be determined on the basis of the best data available to the
Secretary as of September 1, 2000.
`(B) FOR 2002- For purposes of such calculations for 2002, the
sustainable growth rates for fiscal year 2000 and for years 2000, 2001,
and 2002 shall be determined on the basis of the best data available to
the Secretary as of September 1, 2001.
`(C) FOR 2003 AND SUCCEEDING YEARS- For purposes of such calculations
for a year after 2002--
`(i) the sustainable growth rates for that year and the preceding 2
years shall be determined on the basis of the best data available to the
Secretary as of September 1 of the year preceding the year for which the
calculation is made; and
`(ii) the sustainable growth rate for any year before a year
described in clause (i) shall be the rate as most recently determined
for that year under this subsection.
Nothing in this paragraph shall be construed as affecting the
sustainable growth rates established for fiscal year 1998 or fiscal year
1999.'.
(c) STUDY AND REPORT REGARDING THE UTILIZATION OF PHYSICIANS' SERVICES BY
MEDICARE BENEFICIARIES-
(1) STUDY BY SECRETARY- The Secretary, acting through the Administrator
of the Agency for Health Care Policy and Research, shall conduct a study of
the issues specified in paragraph (2).
(2) ISSUES TO BE STUDIED- The issues specified in this paragraph are the
following:
(A) The various methods for accurately estimating the economic impact
on expenditures for physicians' services under the original medicare
fee-for-service program under parts A and B of title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.) resulting from--
(i) improvements in medical capabilities;
(ii) advancements in scientific technology;
(iii) demographic changes in the types of medicare beneficiaries
that receive benefits under such program; and
(iv) geographic changes in locations where medicare beneficiaries
receive benefits under such program.
(B) The rate of usage of physicians' services under the original
medicare fee-for-service program under parts A and B of title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.) among beneficiaries between
ages 65 and 74, 75 and 84, 85 and over, and disabled beneficiaries under
age 65.
(C) Other factors that may be reliable predictors of beneficiary
utilization of physicians'
services under the original medicare fee-for-service program under parts A
and B of title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
(3) REPORT TO MEDPAC- Not later than 3 years after the date of enactment
of this Act, the Secretary of Health and Human Services shall submit a
report to MedPAC setting forth the results of the study conducted pursuant
to paragraph (1), together with any recommendations the Secretary determines
are appropriate.
(4) MEDPAC REPORT TO CONGRESS- Not later than 180 days after receipt of
the report submitted to MedPAC under paragraph (1), MedPAC shall submit a
copy of such report to the committees of jurisdiction in Congress, together
with an analysis and evaluation of such report and any recommendations that
it determines are appropriate.
(d) EFFECTIVE DATE- The amendments made by this section shall be effective
in determining the conversion factor under section 1848(d) of the Social
Security Act (42 U.S.C. 1395w-4(d)) for years beginning with 2001 and shall
not apply to or affect any update (or any update adjustment factor) for any
year before 2001.
TITLE III--PROVISIONS RELATING TO PARTS A AND B
Subtitle A--Home Health Services
SEC. 301. DELAY IN THE 15 PERCENT REDUCTION IN PAYMENTS UNDER THE PPS FOR
HOME HEALTH SERVICES.
(a) CONTINGENCY REDUCTION- Section 4603(e) of the Balanced Budget Act of
1997 (42 U.S.C. 1395fff note), as amended by section 5101(c)(3) of the Tax and
Trade Relief Extension Act of 1998 (contained in division J of Public Law
105-277), is repealed.
(b) DELAY IN REDUCTION UNDER THE PPS- Section 1895(b)(3)(A)(i) (42 U.S.C.
1395fff(b)(3)(A)(i)), as amended by section 5101 of the Tax and Trade Relief
Extension Act of 1998 (contained in division J of Public Law 105-277), is
amended to read as follows:
`(i) IN GENERAL- Under such system the Secretary shall provide for
computation of a standard prospective payment amount (or amounts) as
follows:
`(I) Such amount (or amounts) shall initially be based on the most
current audited cost report data available to the Secretary and shall
be computed in a manner so that the total amounts payable under the
system for fiscal year 2001 shall be equal to the total amount that
would have been made if the system had not been in effect, but if the
reduction in limits described in clause (ii) (applied by substituting
`5' for `15') had been in effect.
`(II) For fiscal year 2002, such amount (or amounts) shall be
equal to the amount (or amounts) that would have been determined under
subclause (I) if the reduction in limits described in clause (ii)
(applied by substituting `10' for `15') had been in effect for fiscal
year 2001, and updated under subparagraph (B) for fiscal year
2002.
`(III) For fiscal year 2003, such amount (or amounts) shall be
equal to the amount (or amounts) that would have been determined under
subclause (I) if the reduction in limits described in clause (ii) had
been in effect for fiscal year 2001, and updated under subparagraph
(B) for fiscal years 2002 and 2003.
Each such amount shall be standardized in a manner that eliminates
the effect of variations in relative case mix and wage levels among
different home health agencies in a budget neutral manner consistent
with the case mix and wage level adjustments provided under paragraph
(4)(A). Under the system, the Secretary may recognize regional
differences or differences based upon whether or not the services or
agency are in an urbanized area.'.
SEC. 302. INCREASE IN PER VISIT LIMIT.
(a) IN GENERAL- Section 1861(v)(1)(L)(i) (42 U.S.C. 1395x(v)(1)(L)(i)) is
amended--
(1) in subclause (IV), by striking `or' at the end;
(A) by inserting `and before October 1, 1999,' after `October 1,
1998,'; and
(B) by striking the period at the end and inserting `, or';
and
(3) by adding at the end the following:
`(VI) October 1, 1999, 112 percent of such median.'.
(b) INCREASE NOT INCLUDED IN PPS BASE- The second sentence of section
1895(b)(3)(A)(i) (42 U.S.C. 1395fff(b)(3)(A)(i)), as amended by section
5101(c)(1)(B) of the Tax and Trade Relief Extension Act of 1998 (contained in
division J of Public Law 105-277) and section 301, is amended--
(1) in subclause (I), by inserting `and if the reference in section
1861(v)(1)(L)(i)(VI) to 112 percent were a reference to 106 percent' before
the period; and
(2) in each of subclauses (II) and (III), by inserting `and if the
reference in section 1861(v)(1)(L)(i)(VI) to 112 percent were a reference to
106 percent' after `had been in effect for fiscal year 2001'.
(c) EFFECTIVE DATE- The amendments made by this section shall apply to
services provided on or after October 1, 1999.
SEC. 303. INCREASE IN PER BENEFICIARY LIMITS.
(a) INCREASE IN PER BENEFICIARY LIMITS- Section 1861(v)(1)(L) of the
Social Security Act (42 U.S.C. 1395x(v)(1)(L)), as amended by section 5101 of
the Tax
and Trade Relief Extension Act of 1998 (contained in Division J of Public Law
105-277), is amended--
(1) by redesignating clause (ix) as clause (x); and
(2) by inserting after clause (viii) the following:
`(ix) Notwithstanding the applicable per beneficiary limit under clause
(v), (vi), or (viii), for services furnished by home health agencies for cost
reporting periods beginning during fiscal year 2000, the per beneficiary limit
applicable under such clause is the per beneficiary limit otherwise applicable
under such clause increased by 1 percent. Such increase shall not affect the
determination or application of the per visit limit under clause (i).'.
(b) INCREASE NOT INCLUDED IN PPS BASE- The second sentence of section
1895(b)(3)(A)(i) (42 U.S.C. 1395fff(b)(3)(A)(i)), as amended by section
5101(c)(1)(B) of the Tax and Trade Relief Extension Act of 1998 (contained in
division J of Public Law 105-277) and section 302, is amended--
(1) in subclause (I), by striking `and if the reference in section
1861(v)(1)(L)(i)(VI) to 112 percent were a reference to 106 percent' and
inserting `, if the reference in section 1861(v)(1)(L)(i)(VI) to 112 percent
were a reference to 106 percent, and if section 1861(v)(1)(L)(ix) had not
been enacted'; and
(2) in each of subclauses (II) and (III), by striking `and if the
reference in section 1861(v)(1)(L)(i)(VI) to 112 percent were a reference to
106 percent' and inserting `, if the reference in section
1861(v)(1)(L)(i)(VI) to 112 percent were a reference to 106 percent, and if
section 1861(v)(1)(L)(ix) had not been enacted'.
(c) EFFECTIVE DATE- The amendments made by this section shall apply to
services furnished by home health agencies for cost reporting periods
beginning on or after October 1, 1999.
SEC. 304. ELIMINATION OF 15-MINUTE BILLING REQUIREMENT.
(a) IN GENERAL- Section 1895(c) (42 U.S.C. 1395fff(c)) is amended, to read
as follows:
`(c) REQUIREMENTS FOR PAYMENT INFORMATION- With respect to home health
services furnished on or after October 1, 1998, no claim for such a service
may be paid under this title unless the claim has the unique identifier
(provided under section 1842(r)) for the physician who prescribed the services
or made the certification described in section 1814(a)(2) or
1835(a)(2)(A).'.
(b) EFFECTIVE DATE- The amendment made by this section shall apply to
claims submitted on or after the date of enactment of this Act.
SEC. 305. REFINEMENT OF HOME HEALTH AGENCY CONSOLIDATED BILLING.
(a) IN GENERAL- Section 1842(b)(6)(F) (42 U.S.C. 1395u(b)(6)(F)) is
amended by inserting `(including medical supplies described in section
1861(m)(5), but excluding durable medical equipment to the extent provided for
in such section)' after `home health services'.
(b) CONFORMING AMENDMENT- Section 1862(a)(21) (42 U.S.C. 1395y(a)(21)) is
amended by inserting `(including medical supplies described in section
1861(m)(5), but excluding durable medical equipment to the extent provided for
in such section)' after `home health services'.
(c) EFFECTIVE DATE- The amendments made by this section shall apply to
payments for services provided on or after the date of enactment of this
Act.
SEC. 306. STUDY AND REPORT TO CONGRESS REGARDING THE EXEMPTION OF RURAL
AGENCIES AND POPULATIONS FROM INCLUSION IN THE HOME HEALTH PROSPECTIVE PAYMENT
SYSTEM.
(a) STUDY- The Medicare Payment Advisory Commission (referred to in this
section as `MedPAC') shall conduct a study to determine the feasibility and
advisability of exempting home health services provided by a home health
agency (or by others under arrangements with such agency) located in a rural
area, or to an individual residing in a rural area, from payment under the
prospective payment system for such services established by the Secretary of
Health and Human Services in accordance with section 1895 of the Social
Security Act (42 U.S.C. 1395fff).
(b) REPORT- Not later than 2 years after the date of enactment of this
Act, MedPAC shall submit a report to 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. 307. EXTENSION OF PERIODIC INTERIM PAYMENTS FOR HOME HEALTH
AGENCIES.
(a) IN GENERAL- Section 1815(e)(2)(D) of the Social Security Act (42
U.S.C. 1395g(e)(2)(D)) is amended by inserting `(until the end of the 12-month
period following the date that the prospective payment system for such
services is implemented pursuant to section 1895)' before the semicolon.
(b) CONFORMING AMENDMENT- Section 4603(b) of the Balanced Budget Act of
1997 (Public Law 105-33; 111 Stat. 470) is repealed.
(c) EFFECTIVE DATE- The amendments made by this section shall take effect
on the date of enactment of this Act.
Subtitle B--Graduate Medical Education
SEC. 321. REVISION OF MULTIYEAR REDUCTION OF INDIRECT GRADUATE MEDICAL
EDUCATION PAYMENTS.
(a) IN GENERAL- Section 1886(d)(5)(B)(ii) (42 U.S.C. 1395ww(d)(5)(B)(ii))
is amended by striking subclauses (III), (IV), and (V) and inserting the
following:
`(III) during each of fiscal years 1999 through 2003, `c' is equal
to 1.6; and
`(IV) on or after October 1, 2003, `c' is equal to
1.35.'.
(b) EFFECTIVE DATE- The amendment made by this section shall take effect
on October 1, 1999.
SEC. 322. GME PAYMENTS FOR CERTAIN INTERNS AND RESIDENTS.
(a) INDIRECT AND DIRECT MEDICAL EDUCATION- Each limitation regarding the
number of residents or interns for which payment may be made under section
1886 of the Social Security Act (42 U.S.C. 1395ww) is increased by the number
of applicable residents (as defined in subsection (b)).
(b) APPLICABLE RESIDENT DEFINED- For purposes of this section, the term
`applicable resident' means a resident or intern that--
(1) participated in graduate medical education at a facility of the
Department of Veterans Affairs;
(2) was subsequently transferred on or after January 1, 1997, and before
July 31, 1998, to a hospital and the hospital was not a Department of
Veterans Affairs facility; and
(3) was transferred because the approved medical residency program in
which the resident or intern participated would lose accreditation by the
Accreditation Council on Graduate Medical Education if such program
continued to train residents at the Department of Veterans Affairs
facility.
(1) IN GENERAL- This section shall take effect as if included in the
enactment of the Balanced Budget Act of 1997 (Public Law 105-33; 111 Stat.
251).
(2) RETROACTIVE PAYMENTS- If the Secretary of Health and Human Services
determines that a hospital operating an approved medical residency program
is owed payments as a result of enactment of this section, the Secretary
shall make such payments not later than 60 days after the date of enactment
of this section.
TITLE IV--RURAL INITIATIVES
SEC. 401. SOLE COMMUNITY HOSPITALS AND MEDICARE DEPENDENT HOSPITALS.
(a) IN GENERAL- Section 1886(b)(3)(B)(iv) (42 U.S.C. 1395ww(b)(3)(B)(iv))
is amended--
(1) in subclause (III), by striking `and' at the end;
(A) by striking `fiscal year 1996 and each subsequent fiscal year' and
inserting `fiscal years 1996 through 1999'; and
(B) by striking the period at the end and inserting `, and';
and
(3) by adding at the end the following:
`(V) for fiscal year 2000 and each subsequent fiscal year, the market
basket percentage increase.'.
(b) EFFECTIVE DATE- The amendments made by this section shall take effect
on October 1, 1999.
SEC. 402. REVISION OF CRITERIA FOR DESIGNATION AS A CRITICAL ACCESS
HOSPITAL.
(a) CRITERIA FOR DESIGNATION- Section 1820(c)(2)(B)(iii) (42 U.S.C.
1395i-4(c)(2)(B)(iii)) is amended by striking `to exceed 96 hours' and all
that follows before the semicolon and inserting `to exceed, on average, 96
hours per patient'.
(b) EFFECTIVE DATE- The amendment made by this section shall take effect
on October 1, 1999.
SEC. 403. MEDICARE WAIVERS FOR HOSPITALS IN RURAL AREAS.
Notwithstanding section 1886(d)(2)(D) of the Social Security Act (42
U.S.C. 1395ww(d)(2)(D)), by not later than 180 days after the date of
enactment of this Act, the Secretary of Health and Human Services shall
establish a waiver process in which hospitals under the medicare program under
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) that are
determined by the Office of Management and Budget to be located in an urban or
large urban area for purposes of reimbursement under the medicare program may
apply to the Secretary to be considered to be located in a rural area for such
purposes if such hospital is located--
(1) in a rural area within a metropolitan county, as defined by the most
recent update of the Goldsmith Modification; or
(2) in a rural area as determined by using a census tract definition of
a rural area adopted by the Office of Rural Health Policy in awarding
grants.
SEC. 404. 2-YEAR EXTENSION OF MEDICARE DEPENDENT HOSPITAL (MDH)
PROGRAM.
(a) EXTENSION OF PAYMENT METHODOLOGY- Section 1886(d)(5)(G) (42 U.S.C.
1395ww(d)(5)(G)) is amended--
(1) in clause (i), by striking `and before October 1, 2001,' and
inserting `and before October 1, 2003'; and
(2) in clause (ii)(II), by striking `and before October 1, 2001,' and
inserting `and before October 1, 2003'.
(b) CONFORMING AMENDMENTS-
(1) EXTENSION OF TARGET AMOUNT- Section 1886(b)(3)(D) (42 U.S.C.
1395ww(b)(3)(D)) is amended--
(A) in the matter preceding clause (i), by striking `and before
October 1, 2001,' and inserting `and before October 1, 2003'; and
(B) in clause (iv), by striking `during fiscal year 1998 through
fiscal year 2000' and inserting `during fiscal year 1998 through fiscal
year 2002'.
(2) PERMITTING HOSPITALS TO DECLINE RECLASSIFICATION- Section
13501(e)(2) of Omnibus Budget Reconciliation Act of 1993 (42 U.S.C. 1395ww
note) is amended by striking `or fiscal year 2000' and inserting `or fiscal
years 2000 through 2002'.
SEC. 405. ASSISTING RURAL GRADUATE MEDICAL EDUCATION RESIDENCY
PROGRAMS.
(a) INDIRECT GRADUATE MEDICAL EDUCATION ADJUSTMENT-
(1) IN GENERAL- Section 1886(d)(5)(B)(v) of the Social Security Act (42
U.S.C. 1395ww(d)(5)(B)(v)) (as added by section 4621(b) of the Balanced
Budget Act of 1997) is amended--
(A) by striking `(v) In determining' and inserting `(v)(I) Subject to
subclause (II), in determining';
(B) by striking `in the hospital with respect to the hospital's most
recent cost reporting period ending on or before December 31, 1996'; and
inserting `who were appointed by the
hospital's approved medical residency training programs for the hospital's
most recent cost reporting period ending on or before December 31, 1996'; and
(C) by adding at the end the following:
`(II) Beginning on or after January 1, 1997, in the case of a hospital
that sponsors only 1 allopathic or osteopathic residency program, the limit
determined for such hospital under subclause (I) may, at the hospital's
discretion, be increased by 1 for each calendar year but shall not exceed a
total of 3 more than the limit determined for the hospital under subclause
(I).'.
(2) TECHNICAL AMENDMENTS- Section 1886(d)(5)(B) of the Social Security
Act (42 U.S.C. 1395ww(d)(5)(B)) is amended by realigning the left margin of
clauses (ii), (v), and (vi) so as to align with the left margin of clause
(i).
(b) DIRECT GRADUATE MEDICAL EDUCATION ADJUSTMENT-
(1) LIMITATION ON NUMBER OF RESIDENTS- Section 1886(h)(4)(F) of the
Social Security Act (42 U.S.C. 1395ww(h)(4)(F)) (as added by section 4623 of
the Balanced Budget Act of 1997) is amended by inserting `who were appointed
by the hospital's approved medical residency training programs' after `may
not exceed the number of such full-time equivalent residents'.
(2) FUNDING FOR NEW PROGRAMS- The first sentence of section
1886(h)(4)(H)(i) of the Social Security Act (42 U.S.C. 1395ww(h)(4)(H)(i))
(as added by section 4623 of the Balanced Budget Act of 1997) is amended by
inserting `and before September 30, 1999' after `January 1, 1995'.
(3) FUNDING FOR PROGRAMS MEETING RURAL NEEDS- The second sentence of
section 1886(h)(4)(H)(i) of the Social Security Act (42 U.S.C.
1395ww(h)(4)(H)(i)) (as added by section 4623 of the Balanced Budget Act of
1997) is amended by striking the period at the end and inserting `,
including facilities that are not located in an underserved rural area but
have established separately accredited rural training tracks.'.
(c) EFFECTIVE DATE- The amendments made by this Act shall take effect as
if included in the enactment of the Balanced Budget Act of 1997.
TITLE V--PROVISIONS RELATING TO PART C (MEDICARE+CHOICE
PROGRAM)
Subtitle A--Provisions To Accommodate and Protect Medicare
Beneficiaries
SEC. 501. PERMITTING ENROLLMENT IN ALTERNATIVE MEDICARE+CHOICE PLANS AND
MEDIGAP COVERAGE IN CASE OF INVOLUNTARY TERMINATION OF MEDICARE+CHOICE
ENROLLMENT.
(a) MEDICARE+CHOICE PLANS- Section 1851(e)(4) (42 U.S.C. 1395w-21(e)(4))
is amended by striking subparagraph (A) and inserting the following:
`(A)(i) the certification of the organization or plan under this part
has been terminated, or the organization or plan has notified the
individual of an impending termination of such certification; or
`(ii) the organization has terminated or otherwise discontinued
providing the plan in the area in which the individual resides, or has
notified the individual of an impending termination or discontinuation of
such plan;'.
(b) MEDIGAP PLANS- Section 1882(s)(3)(A) (42 U.S.C. 1395ss(s)(3)(A)) is
amended, in the matter following clause (iii)--
(1) by inserting `(or, if elected by the individual, the date of
notification of the individual by the plan or organization of the impending
termination or discontinuance of the plan in the area in which the
individual resides)' after `the date of the termination of enrollment
described in such subparagraph'; and
(2) by inserting `(or the date of such notification)' after `the date of
termination or disenrollment'.
(c) EFFECTIVE DATE- The amendments made by this section shall apply to
notices of impending terminations or discontinuances made by group health
plans and Medicare+Choice organizations on or after the date of enactment of
this Act.
SEC. 502. CHANGE IN 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--
(1) by inserting `or change' before `is made'; and
(2) by inserting `, 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' before the period.
(b) EFFECTIVE DATE- The amendments made by this section shall apply to
elections and changes of coverage made on or after the date of enactment of
this Act.
SEC. 503. EXTENSION OF REASONABLE COST CONTRACTS.
Section 1876(h)(5)(B) (42 U.S.C. 1395mm(h)(5)(B)) is amended to read as
follows:
`(B) The Secretary may not extend or renew a reasonable cost reimbursement
contract under this subsection for any period beyond December 31, 2004, and an
individual may not be enrolled in a plan offered by an organization pursuant
to such a contract after December 31, 2003, unless such individual was
enrolled in such plan on such date.'.
SEC. 504. REVISION OF NOTICE BY HOSPITALS REGARDING COVERAGE OF INPATIENT
HOSPITAL SERVICES.
(a) IN GENERAL- Section 1866(a)(1)(M) (42 U.S.C. 1395cc(a)(1)(M)) is
amended--
(1) in the matter preceding clause (i), by striking `at or about the
time of the individual's admission as an inpatient to the hospital' and
inserting `at least 16 but not more than 24 hours before the hospital
proposes to discharge the individual from the hospital';
(i) by inserting `to the appropriate peer review organization' after
`hospital services'; and
(ii) by striking `and' at the end;
(3) by redesignating clause (iv) as clause (v); and
(4) by inserting the following after clause (iii):
`(iv) in the case of an individual enrolled in a Medicare+Choice plan
offered by a Medicare+Choice organization under part C, such information, as
determined by the Secretary, regarding the individual's appeal rights that
is in addition to the information described in clause (iii), and'.
(b) EFFECTIVE DATE- The amendments made by this section shall apply to
admissions occurring on or after the date of enactment of this Act.
SEC. 505. EXTENDED DISENROLLMENT WINDOW FOR CERTAIN INVOLUNTARILY TERMINATED
ENROLLEES.
(a) IN GENERAL- Section 1882(s)(3)(B) (42 U.S.C. 1395ss(s)(3)(B)) is
amended by adding at the end the following flush sentence:
`If any individual is enrolled with any Medicare+Choice organization under
clause (v), or in any Medicare+Choice plan under clause (vi), and the
Medicare+Choice plan in which the individual is enrolled is terminated or such
individual is disenrolled from such plan under the circumstances described in
section 1851(e)(4)(A), such individual may reenroll for a 12-month period
(beginning on the date of such enrollment) with a Medicare+Choice organization
in a Medicare+Choice plan, and such reenrollment shall be considered an
enrollment under clause (v) or (vi) (as applicable).'.
(b) EFFECTIVE DATE- The amendments made by this section shall apply to
terminations or disenrollments occurring on or after the date of enactment of
this Act.
Subtitle B--Provisions To Facilitate Implementation of the
Medicare+Choice Program
SEC. 521. MODERATION OF MEDICARE+CHOICE RISK ADJUSTMENT IMPLEMENTATION.
Section 1853(a)(3)(C) (42 U.S.C. 1395w-23(a)(3)(C)) is amended--
(1) by redesignating the first sentence as clause (i) with the heading
`IN GENERAL- ' and appropriate indentation; and
(2) by adding at the end the following:
`(ii) PHASE-IN- Such risk adjustment methodology shall be
implemented in a phased-in manner so that the new methodology applies
only to--
`(I) 10 percent of the payment amount in 2000 and 2001 (in which
the risk adjustment methodology should reflect only data from
inpatient settings);
`(II) 20 percent of such amount in 2002 (in which such methodology
should reflect only data from inpatient settings);
`(III) 30 percent of such amount in 2003 (in which such
methodology should reflect only data from inpatient
settings);
`(IV) 55 percent of such amount in 2004 (in which such methodology
should reflect a blend of 67 percent of only data from inpatient
settings and 33 percent of data from inpatient and other
settings);
`(V) 80 percent of such amount in 2005 (in which such methodology
should reflect a blend of 33 percent of only data from inpatient
settings and 67 percent of data from inpatient and other settings);
and
`(VI) 100 percent of such amount in any subsequent year (in which
such methodology should reflect data from inpatient and other
settings).'.
SEC. 522. DELAY IN DEADLINE FOR SUBMISSION OF ADJUSTED COMMUNITY RATES UNDER
MEDICARE+CHOICE PROGRAM AND RELATED MODIFICATIONS.
(a) DELAY IN DEADLINE FOR SUBMISSION OF ADJUSTED COMMUNITY RATES- Section
1854(a)(1) (42 U.S.C. 1395w-24(a)(1)) is amended by striking `May 1' and
inserting `July 1' in the matter preceding subparagraph (A).
(b) ADJUSTMENT IN INFORMATION DISCLOSURE PROVISIONS TO CONFORM TO DELAY IN
DEADLINE FOR ACR SUBMISSION- Section 1851(d)(2)(A)(ii) (42 U.S.C.
1395w-21(d)(2)(A)(ii)) is amended--
(1) by inserting after `information described in paragraph (4)
concerning such plans' the following: `, to the extent such information is
available at the time of preparation of the material for mailing'; and
(2) by adding at the end the following: `If any item described in
paragraph (4) is not available at the time of preparation of the material
for mailing, the Secretary shall provide general information concerning such
item.'.
(c) MEDICARE+CHOICE ORGANIZATION REQUIRED TO PROVIDE TERMINATION NOTICE BY
DATE FOR ACR SUBMISSION- Section 1857(c)(1) (42 U.S.C. 1395w-27(c)(1)) is
amended--
(1) by striking `Each contract' and inserting the following:
`(A) IN GENERAL- Each contract'; and
(2) by adding at the end the following:
`(B) TERMINATION NOTICE- If a Medicare+Choice organization intends to
terminate a contract under this section at the end of the current term of
the contract, the organization shall notify the Secretary of such intent
by not later than July 1 of such term.'.
(1) ACR AND INFORMATION DISCLOSURE- The amendments made by subsections
(a) and (b) shall apply to submissions required to be made on or after the
date of enactment of this Act.
(2) TERMINATION NOTICE- The amendment made by subsection (c) shall apply
to contract years beginning on or after the date of enactment of this
Act.
SEC. 523. USER FEE FOR MEDICARE+CHOICE ORGANIZATIONS BASED ON NUMBER OF
ENROLLED BENEFICIARIES.
(a) DETERMINATION- Section 1857(e)(2) (42 U.S.C. 1395w-27(e)(2)) is
amended to read as follows:
`(2) COST-SHARING IN ENROLLMENT-RELATED COSTS-
`(A) IN GENERAL- A Medicare+Choice organization shall pay the fee
established by the Secretary under subparagraph (B)(i).
`(i) IN GENERAL- The Secretary is authorized to charge a fee to each
Medicare+Choice organization with a contract under this part that is
equal to the organization's pro rata share (as determined by the
Secretary) of the aggregate amount of fees which the Secretary is
directed to collect in a fiscal year (as determined under clause
(ii)).
`(ii) AGGREGATE AMOUNT OF FEES TO BE COLLECTED- For purposes of
clause (i), the aggregate amount of fees which the Secretary is directed
to collect in a fiscal year is an amount equal to the applicable
percentage of the aggregate expenses incurred by the Secretary in
carrying out the sections described in clause (iii)(I) in such year. For
purposes of the preceding sentence, the applicable percentage in a
fiscal year is equal to the ratio (expressed as a percentage)
of--
`(I) the total number of individuals enrolled in Medicare+Choice
plans in such year; to
`(II) the total number of individuals enrolled in part A or B in
such year.
`(iii) FEES COLLECTED- For any fiscal year, the fees authorized to
be collected under this subparagraph shall be available to the
Secretary--
`(I) only for the purpose of carrying out section 1851 (relating
to enrollment and dissemination of information) and section 4360 of
the Omnibus Budget Reconciliation Act of 1990 (relating to the health
insurance counseling and assistance program); and
`(II) without further appropriation.
`(C) AMOUNTS FROM PART A TRUST FUND-
`(i) IN GENERAL- Subject to clause (ii), amounts in the Federal
Hospital Insurance Trust Fund shall be available to the Secretary in a
fiscal year (beginning in fiscal year 2000) to cover the expenses
associated with carrying out the sections described in subparagraph
(B)(iii)(I).
`(ii) LIMITATION- The total amount available to the Secretary from
the Federal Hospital Insurance Trust Fund under clause (i) in any fiscal
year shall not exceed $100,000,000 minus an amount equal to the amount
authorized to be collected under subparagraph (B)(i) for the fiscal
year.'.
(b) EFFECTIVE DATE- The amendment made by this section shall apply to fees
charged on or after October 1, 1999.
SEC. 524. CHANGE IN TIME PERIOD FOR EXCLUSION OF MEDICARE+CHOICE
ORGANIZATIONS THAT HAVE HAD A CONTRACT TERMINATED.
(a) IN GENERAL- Section 1857(c)(4) (42 U.S.C. 1395w-27(c)(4)) is amended
by striking `5-year period' and inserting `2-year period'.
(b) EFFECTIVE DATE- The amendment made by this section shall apply to
contract years beginning on or after January 1, 1999.
SEC. 525. FLEXIBILITY TO TAILOR BENEFITS UNDER MEDICARE+CHOICE PLANS.
(a) IN GENERAL- Section 1854 (42 U.S.C. 1395w-24) is amended--
(1) in subsection (a)(1), by inserting `(or segment of such an area if
permitted under subsection (h))' after `service area' in the matter
preceding subparagraph (A); and
(2) by adding at the end the following:
`(h) PERMITTING USE OF SEGMENTS OF SERVICE AREAS- The Secretary shall
permit a Medicare+Choice organization to elect to apply the provisions of this
section uniformly to separate segments of a service area (rather than
uniformly to an entire service area) as long as such segments are composed of
1 or more counties.'.
(b) EFFECTIVE DATE- The amendments made by this section shall apply to
contract years beginning on or after January 1, 2000.
SEC. 526. INAPPLICABILITY OF QISMC TO PREFERRED PROVIDER ORGANIZATIONS.
(a) IN GENERAL- A Medicare+Choice plan that is operating as a preferred
provider organization plan shall
not be subject to the requirements of the Quality Improvement System for
Managed Care (QISMC) established by the Secretary of Health and Human Services
to carry out section 1852(e) of the Social Security Act (42 U.S.C. 1395w-22(e))
.
(b) APPLICATION OF FEE-FOR-SERVICE QUALITY SYSTEM TO PPOS- If the
Secretary of Health and Human Services establishes a system that is--
(1) applicable to providers under the original fee-for-service program
under parts A and B of title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.); and
(2) similar to the system described in subsection (a);
a Medicare+Choice plan that is operating as a preferred provider
organization plan shall comply with the requirements of that system.
(c) EFFECTIVE DATE- This section shall apply to contract years beginning
on or after January 1, 2000.
SEC. 527. TIMING OF MEDICARE+CHOICE HEALTH INFORMATION FAIRS.
(a) IN GENERAL- Section 1851(e)(3) (42 U.S.C. 1395w-21(e)(3)) is amended
in subparagraph (C), by striking `In the month of November' and inserting
`During the fall season'.
(b) EFFECTIVE DATE- The amendment made by this section shall take effect
on the date of enactment of this Act.
SEC. 528. RULES REGARDING PHYSICIAN REFERRALS FOR MEDICARE+CHOICE
PROGRAM.
(a) IN GENERAL- Section 1877(b)(3) (42 U.S.C. 1395nn(b)(3)) is
amended--
(1) in subparagraph (C), by striking `or' at the end;
(2) in subparagraph (D), by striking the period at the end and inserting
`, or'; and
(3) by adding at the end the following:
`(E) that is a Medicare+Choice organization under part C that is
offering a coordinated care plan described in section 1851(a)(2)(A) to an
individual enrolled with the organization.'.
(b) EFFECTIVE DATE- The amendment made by this section shall take effect
on the date of enactment of this Act.
SEC. 529. CLARIFICATION REGARDING THE ABILITY OF A RELIGIOUS FRATERNAL
BENEFIT SOCIETY TO OPERATE A MEDICARE+CHOICE PRIVATE FEE-FOR-SERVICE PLAN.
(a) IN GENERAL- Section 1859(e)(2) (42 U.S.C. 1395w-28(e)(2)) is amended
by striking `section 1851(a)(2)(A)' and inserting `subparagraphs (A) and (C)
of section 1851(a)(2)'.
(b) EFFECTIVE DATE- The amendment made by this section shall apply to
contract years beginning on or after the date of enactment of this Act.
Subtitle C--Provisions Regarding Special Medicare
Populations
SEC. 541. EXTENSION OF SOCIAL HEALTH MAINTENANCE ORGANIZATION DEMONSTRATION
PROJECT AUTHORITY.
Section 4018(b) of the Omnibus Budget Reconciliation Act of 1987 is
amended--
(1) in paragraph (1), by striking `December 31, 2000' and inserting `the
date that is 1 year after the date on which the Secretary submits to
Congress the report described in section 4014(c) of the Balanced Budget Act
of 1997'; and
(2) in paragraph (4), by striking `March 31, 2001' and inserting `the
date that is 1 year after the date on which Secretary submits to Congress
the report described in section 4014(c) of the Balanced Budget Act of
1997'.
SEC. 542. INAPPLICABILITY OF OASIS TO PACE.
Sections 1894(e)(3) and 1934(e)(3) (42 U.S.C. 1395eee(e)(3) and
1396u-4(e)(3)) are each amended by adding at the end the following:
`(C) INAPPLICABILITY OF OASIS TO PACE- Notwithstanding the previous
provisions of this paragraph, with respect to any home health service
provided under a PACE program under this section, the Secretary shall not
apply the data collection and reporting requirements under the Outcome and
Assessment Information Set (OASIS) to such program or to any enrollee of
such program, regardless of whether such service is provided by a PACE
program directly or through a contract with a home health
agency.'.
SEC. 543. MEDIGAP PROTECTIONS FOR PACE PROGRAM ENROLLEES.
(a) IN GENERAL- Section 1882(s)(3)(B) (42 U.S.C. 1395ss(s)(3)(B)) is
amended--
(1) in clause (ii), by inserting `or the individual is enrolled with a
PACE provider under section 1894, and there are circumstances that would
permit the discontinuance of the individual's enrollment with such provider
under circumstances that are similar to the circumstances that would permit
discontinuance of the individual's election under the first sentence of such
section if such individual were enrolled in a Medicare+Choice plan' before
the period;
(2) in clause (v)(II), by inserting `any PACE provider under section
1894,' after `demonstration project authority,'; and
(A) by inserting `or in a PACE program under section 1894' after `part
C'; and
(B) by striking `such plan' and inserting `such plan or such
program'.
(b) EXTENDED DISENROLLMENT WINDOW FOR INVOLUNTARILY TERMINATED ENROLLEES-
Section 1882(s)(3)(B) (42 U.S.C. 1395ss(s)(3)(B)), as amended by section 505,
is amended by adding at the end the following: `If any individual is enrolled
with any PACE provider under clause (v), or in any PACE program under clause
(vi), and the PACE program in which the individual is enrolled is terminated
or such individual is disenrolled from such program under circumstances that
are similar to the circumstances described in section 1851(e)(4)(A), such
individual may reenroll for a 12-month period (beginning on the date of such
enrollment) with a PACE provider in a PACE program and such reenrollment shall
be
considered to be an enrollment under clause (v) or (vi) (as applicable).'.
(c) EFFECTIVE DATE- The amendments made by this section shall apply to
terminations or discontinuances made on or after the date of enactment of this
Act.
SEC. 544. CONTINUATION OF THE FRAIL ELDERLY DEMONSTRATION PROJECT.
With respect to the demonstration project (known as the `EverCare'
project) to demonstrate the application of capitation payment rates for frail
elderly medicare beneficiaries under a specialized program that utilizes a
specialized interdisciplinary team, the Secretary of Health and Human Services
shall--
(1) extend the project for an additional 2-year period from the
termination date of the project (as in effect on the date of enactment of
this Act); and
(2) not apply with respect to a frail elderly medicare beneficiary who
is receiving services under the demonstration project--
(A) during 2000, the risk-adjustment described in section 1853(c)(3)
of the Social Security Act (42 U.S.C. 1395w-23(c)(3)); or
(B) during any year in which the demonstration project is in effect,
the rules under subparagraphs (B) and (C) of section 1851(e)(2) of such
Act (42 U.S.C. 1395w-21(e)(2)) applicable to open enrollment and
disenrollment opportunities under the Medicare+Choice program.
Subtitle D--Studies and Reports To Assist in Making Future Improvements
in the Medicare Program
SEC. 561. GAO STUDIES, AUDITS, AND REPORTS.
(a) STUDY OF MEDIGAP POLICIES-
(1) IN GENERAL- The Comptroller General of the United States (in this
section referred to as the `Comptroller General') shall conduct a study of
the issues described in paragraph (2) regarding medicare supplemental
policies described in section 1882(g)(1) of the Social Security Act (42
U.S.C. 1395ss(g)(1)).
(2) ISSUES TO BE STUDIED- The issues described in this paragraph are the
following:
(A) The level of coverage provided by each type of medicare
supplemental policy.
(B) The current enrollment levels in each type of medicare
supplemental policy.
(C) The availability of each type of medicare supplemental policy to
medicare beneficiaries over age 65 1/2 .
(D) The number of States that offer each type of medicare supplemental
policy.
(E) The average out-of-pocket costs (including premiums) per
beneficiary under each type of medicare supplemental policy.
(3) REPORT- Not later than July 31, 2001, the Comptroller General shall
submit a report to Congress on the results of the study conducted under this
subsection, together with any recommendations for legislation that the
Comptroller General determines to be appropriate as a result of such
study.
(b) GAO AUDIT AND REPORTS ON THE PROVISION OF MEDICARE+CHOICE HEALTH
INFORMATION TO BENEFICIARIES-
(1) IN GENERAL- Beginning in 2000, the Comptroller General shall conduct
an annual audit of the expenditures by the Secretary of Health and Human
Services during the preceding year in providing information regarding the
Medicare+Choice program under part C of title XVIII of the Social Security
Act (42 U.S.C. 1395w-21 et seq.) to eligible medicare beneficiaries.
(3) REPORTS- Not later than March 31 of 2001, 2004, 2007, and 2010, the
Comptroller General shall submit a report to Congress on the results of the
audit of the expenditures of the preceding 3 years conducted pursuant to
subsection (a), together with an evaluation of the effectiveness of the
means used by the Secretary of Health and Human Services in providing
information regarding the Medicare+Choice program under part C of title
XVIII of the Social Security Act (42 U.S.C. 1395w-21 et seq.) to eligible
medicare beneficiaries.
SEC. 562. MEDICARE PAYMENT ADVISORY COMMISSION STUDIES AND REPORTS.
(1) STUDY- The Medicare Payment Advisory Commission established under
section 1805 of the Social Security Act (42 U.S.C. 1395b-6) (in this section
referred to as `MedPAC') shall conduct a study that evaluates the
methodology used by the Secretary of Health and Human Services in developing
the risk factors used in adjusting the Medicare+Choice capitation rate paid
to Medicare+Choice organizations under section 1853 of the Social Security
Act (42 U.S.C. 1395w-23) and includes the issues described in paragraph
(2).
(2) ISSUES TO BE STUDIED- The issues described in this paragraph are the
following:
(A) The ability of the average risk adjustment factor applied to a
Medicare+Choice plan to explain variations in plans' average per capita
medicare costs, as reported by Medicare+Choice plans in the plans'
adjusted community rate filings.
(B) The year-to-year stability of the risk factors applied to each
Medicare+Choice plan and the potential for substantial changes in payment
for small Medicare+Choice plans.
(C) For medicare beneficiaries newly enrolled in Medicare+Choice plans
in a given year, the correspondence between the average risk factor
calculated from medicare fee-for-service data for those individuals from
the period prior to their enrollment in a Medicare+Choice plan and the
average risk factor calculated for such individuals during their initial
year of enrollment in a Medicare+Choice plan.
(D) For medicare beneficiaries disenrolling from or switching among
Medicare+Choice plans in a given year, the correspondence between the
average risk factor calculated from data pertaining to the period prior to
their disenrollment from a Medicare+Choice plan and the average risk
factor calculated from data pertaining to the period after
disenrollment.
(E) An evaluation of the exclusion of `discretionary' hospitalizations
from consideration in the risk adjustment methodology.
(F) Suggestions for changes or improvements in the risk adjustment
methodology.
(3) REPORT- Not later than December 1, 2000, MedPAC shall submit a
report to Congress on the study conducted under paragraph (1), together with
any recommendations for legislation that MedPAC determines to be appropriate
as a result of such study.
(b) DEVELOPMENT OF SPECIAL PAYMENT RULES UNDER THE MEDICARE+CHOICE PROGRAM
FOR FRAIL ELDERLY ENROLLED IN SPECIALIZED PROGRAMS-
(1) STUDY- MedPAC shall conduct a study on the development of a payment
methodology under the Medicare+Choice program for frail elderly
Medicare+Choice beneficiaries enrolled in a Medicare+Choice plan under a
specialized program for the frail elderly that--
(A) accounts for the prevalence, mix, and severity of chronic
conditions among such frail elderly Medicare+Choice
beneficiaries;
(B) includes medical diagnostic factors from all provider settings
(including hospital and nursing facility settings); and
(C) includes functional indicators of health status and such other
factors as may be necessary to achieve appropriate payments for plans
serving such beneficiaries.
(2) REPORT- Not later than 1 year after the date of enactment of this Act,
MedPAC shall submit a report to Congress on the study conducted under
paragraph (1), together with any recommendations for legislation that MedPAC
determines to be appropriate as a result of such study.
SEC. 563. COMPUTATION AND REPORT ON MEDICARE ORIGINAL FEE-FOR-SERVICE
EXPENDITURES ON A COUNTY-BY-COUNTY BASIS.
(a) COMPUTATION- The Secretary of Health and Human Services shall compute
the expenditures under the original medicare fee-for-service program under
parts A and B of title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) on a county-by-county basis.
(b) REPORT- Not later than January 1, 2000, and annually thereafter, the
Secretary of Health and Human Services shall submit a report to Congress on
the computation performed under subsection (a), together with any
recommendations for legislation that the Secretary determines to be
appropriate as a result of such computation.
SEC. 564. STUDY AND REPORT ON THE EFFECTS, COSTS, AND FEASIBILITY OF
REQUIRING MEDICARE ORIGINAL FEE-FOR-SERVICE ENTITIES AND MEDICARE+CHOICE
COORDINATED CARE PLANS TO COMPLY WITH UNIFORM QUALITY STANDARDS AND RELATED
REPORTING REQUIREMENTS.
(a) STUDY- The Secretary of Health and Human Services shall conduct a
study on the effects, costs, and feasibility of--
(1) requiring entities, physicians, and other health care providers that
provide items and services under the original medicare fee-for-service
program under parts A and B of title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) to comply with quality standards and related reporting
requirements that are comparable to the quality standards and related
reporting requirements that are applicable to Medicare+Choice organizations
under part C of such title; and
(2) developing specific quality standards for different types of
Medicare+Choice coordinated care plans (as defined in section 1851(a)(2)(A)
of the Social Security Act (42 U.S.C. 1395w-21(a)(2)(A))).
(b) REPORT- Not later than March 1, 2000, the Secretary of Health and
Human Services shall submit a report to Congress on the study conducted under
subsection (a), together with any recommendations for legislation that the
Secretary determines to be appropriate as a result of such study.
SEC. 565. STUDY AND REPORT TO CONGRESS REGARDING DATA SUBMISSION USED TO
ESTABLISH RISK ADJUSTMENT METHODOLOGY UNDER THE MEDICARE+CHOICE PROGRAM.
(a) STUDY- The Secretary of Health and Human Services shall conduct a
study on reducing the amount of data that is required to be submitted by
Medicare+Choice organizations in order for the Secretary to establish a risk
adjustment methodology used in making payments to such organizations under
section 1853 of the Social Security Act (42 U.S.C. 1395w-23) and that includes
the issues described in subsection (b).
(b) ISSUES TO BE STUDIED- The issues described in this subsection are the
following:
(1) In consultation with representatives of Medicare+Choice plans,
identification of modifications of Health Care Financing Administration
administrative systems that would reduce the costs or burden on such plans
for reporting encounter data from all sites of service.
(2) Evaluation of alternative risk adjustment methods that would require
submission from Medicare+Choice plans of data only from limited sites of
services.
(3) The potential for Medicare+Choice plans to misreport, overreport, or
underreport prevalence of diagnoses in outpatient sites of care, the
potential for increases in payments to Medicare+Choice plans from changes in
Medicare+Choice plan coding practices (commonly known as `coding creep') and
proposed methods for detecting and adjusting for such variations in
diagnosis coding as part of the risk adjustment methodology using encounter
data from all sites of care.
(4) The impact of the requirement to report complete encounter data on
the willingness of insurers to offer high deductible medical savings account
plans to medicare beneficiaries, and options for modifying data reporting
requirements to accommodate such plans.
(5) Differences in the ability of Medicare+Choice plans to report
complete encounter data, and the potential for adverse competitive impacts
on group and staff model health maintenance organizations or other
integrated providers of care based on data reporting capabilities.
(c) REPORT- Not later than January 1, 2001, the Secretary of Health and
Human Services shall submit a report to Congress on the study conducted under
this section, together with any recommendations for legislation that the
Secretary determines to be appropriate as a result of such study.
TITLE VI--OTHER MEDICARE PROVISIONS
SEC. 601. 2-YEAR MORATORIUM ON THERAPY CAPS.
(1) IN GENERAL- Section 1833(g) of the Social Security Act (42 U.S.C.
1395l(g)) is amended--
(A) in paragraphs (1) and (3), by striking `In the case' each place it
appears and inserting `Subject to paragraph (4), in the case';
and
(B) by adding at the end the following:
`(4) This subsection shall not apply in 2000 and 2001.'.
(2) EFFECTIVE DATE- The amendments made by paragraph (1) shall apply to
expenses incurred on or after January 1, 2000.
(1) IN GENERAL- Section 4541(d)(2) of the Balanced Budget Act of 1997
(42 U.S.C. 1395l note) is amended to read as follows:
`(2) REPORT- By not later than January 1, 2001, the Secretary of Health
and Human Services shall submit to Congress a report that includes
recommendations on--
`(A) the establishment of a mechanism for assuring appropriate
utilization of outpatient physical therapy services, outpatient
occupational therapy services, and speech-language pathology services that
are covered under the medicare program under title XVIII of the Social
Security Act (42 U.S.C. 1395); and
`(B) the establishment of an alternative payment policy for such
services based on classification of individuals by diagnostic category,
functional status, prior use of services (in both inpatient and outpatient
settings), and such other criteria as the Secretary determines
appropriate, in place of the uniform dollar limitations specified in
section 1833(g) of such Act, as amended by paragraph (1).
The recommendations shall include how such a mechanism or policy might
be implemented in a budget-neutral manner.'.
(2) EFFECTIVE DATE- The amendment made by paragraph (1) shall take
effect as if included in the enactment of section 4541 of the Balanced
Budget Act of 1997 (Public Law 105-33; 111 Stat. 454).
(c) STUDY AND REPORT ON UTILIZATION-
(A) IN GENERAL- The Secretary of Health and Human Services shall
conduct a study which compares--
(i) utilization patterns (including nationwide patterns, and
patterns by region, types of settings, and diagnosis or condition) of
outpatient physical therapy services, outpatient occupational therapy
services, and speech-language pathology services that are covered under
the medicare program under title XVIII of the Social Security Act (42
U.S.C. 1395) and provided on or after January 1, 2000; with
(ii) such patterns for such services that were provided in 1998 and
1999.
(B) REVIEW OF CLAIMS- In conducting the study under this subsection
the Secretary of Health and Human Services shall review a statistically
significant number of claims for reimbursement for the services described
in subparagraph (A).
(2) REPORT- Not later than March 31, 2001, the Secretary of Health and
Human Services shall submit a report to Congress on the study conducted
under paragraph (1), together with any recommendations for legislation that
the Secretary determines to be appropriate as a result of such study.
SEC. 602. INCREASE IN PAYMENT AMOUNT FOR RENAL DIALYSIS SERVICES FURNISHED
UNDER THE MEDICARE PROGRAM.
(a) IN GENERAL- Section 1881(b)(7) (42 U.S.C. 1395rr(b)(7)) is amended by
adding at the end the following flush sentence:
`The amount of each composite rate payment for dialysis services furnished
on or after October 1, 2000, shall be equal to 102 percent of each such
composite rate payment amount for such services furnished on December 31,
1999.'.
(b) CONFORMING AMENDMENT-
(1) IN GENERAL- Section 9335(a) of the Omnibus Budget Reconciliation Act
of 1986 (42 U.S.C. 1395rr note) is amended by striking paragraph (1).
(2) EFFECTIVE DATE- The amendment made by paragraph (1) shall take
effect on October 1, 2000.
SEC. 603. INCREASE IN PAYMENT AMOUNT FOR PAP SMEAR LABORATORY TESTS.
(a) PAP SMEAR PAYMENT INCREASE- Section 1833(h) (42 U.S.C. 1395l(h)) is
amended by adding at the end the following:
`(7) Notwithstanding paragraphs (1) and (4), the Secretary shall establish
a minimum payment amount under this subsection for all areas for a diagnostic
or
screening pap smear laboratory test (including all cervical cancer screening
technologies that have been approved by the Food and Drug Administration) of not
less than $14.60.'.
(b) EFFECTIVE DATE- The amendment made by this subsection shall apply with
respect to laboratory tests furnished on or after January 1, 2000 and before
January 1, 2002.
SEC. 604. LIMITATION IN REDUCTION OF PAYMENTS TO DISPROPORTIONATE SHARE
HOSPITALS.
(a) IN GENERAL- Section 1886(d)(5)(F)(ix) (42 U.S.C. 1395ww(d)(5)(F)(ix))
is amended--
(1) in subclause (III), by striking `fiscal year 2000' and inserting
`fiscal years 2000 and 2001';
(2) by striking subclauses (IV); and
(3) by redesignating subclauses (V) and (VI) as subclauses (IV) and (V),
respectively.
(b) EFFECTIVE DATE- The amendments made by this section shall take effect
as if included in the amendments made by section 4403 of the Balanced Budget
Act of 1997 (Public Law 105-33; 111 Stat. 398).
SEC. 605. CLARIFICATION OF THE INHERENT REASONABLENESS (IR) AUTHORITY.
The Secretary of Health and Human Services may not use, or permit fiscal
intermediaries or carriers to use, the inherent reasonableness authority under
part B of title XVIII of such Act until the date that is 90 days after the
date that the Comptroller General of the United States releases a report
regarding the impact of the Secretary's, fiscal intermediaries', and carriers'
use of such authority.
SEC. 606. TECHNICAL AMENDMENTS RELATING TO BBA PROVISIONS.
(a) MEDICARE RURAL HOSPITAL FLEXIBILITY PROGRAM- Section 1820(c)(2)(B)(i)
(42 U.S.C. 1395i-4(c)(2)(B)(i)) is amended by striking `and is located in a
county (or equivalent unit of local government) in a rural area (as defined in
section 1886(d)(2)(D))' and inserting `that is located in a rural area (as
defined in section 1886(d)(2)(D)) and'.
(b) RURAL HEALTH CLINIC SERVICES- Section 4205(a)(1)(B) of the Balanced
Budget Act of 1997 (42 U.S.C. 1395l note) is amended by striking `services
furnished' and inserting `cost reporting periods beginning'.
(c) PPS HOSPITAL PAYMENT UPDATE- Section 4401(b)(1)(B) of the Balanced
Budget Act of 1997 (42 U.S.C. 1395ww note) is amended by striking `section
1886(b)(3)(B)(i)(XIII) of the Social Security Act (42 U.S.C.
1395ww(b)(3)(B)(i)(XIII))' and inserting `section 1886(b)(3)(B)(i)(XIV) of the
Social Security Act (42 U.S.C. 1395ww(b)(3)(B)(i)(XIV))'.
(d) MAINTAINING SAVINGS FROM TEMPORARY REDUCTION IN CAPITAL PAYMENTS FOR
PPS HOSPITALS- The last sentence of section 1886(g)(1)(A) (42 U.S.C.
1395ww(g)(1)(A)) is amended by striking `September 30, 2002' and inserting
`October 1, 2002'.
(e) PROSPECTIVE PAYMENT FOR SKILLED NURSING FACILITY SERVICES- Section
1888(e)(8)(B) (42 U.S.C. 1395yy(e)(8)(B)) is amended by striking `January 1,
1999,' and inserting `July 1, 1999'.
(f) TRANSFER OF CRIMINAL FINES RECOVERED AS A RESULT OF A FEDERAL HEALTH
CARE OFFENSE TO FEDERAL HOSPITAL INSURANCE TRUST FUND-
(1) IN GENERAL- Section 1817(k)(2)(C)(i) (42 U.S.C. 1395i(k)(2)(C)(i))
is amended by striking `section 982(a)(6)(B)' and inserting `section
24(a)'.
(2) EFFECTIVE DATE- The amendment made by this subsection shall take
effect as if included in the amendment made by section 201 of the Health
Insurance Portability and Accountability Act of 1996 (Public Law 104-191;
110 Stat. 1992).
(g) MEDICARE PAYMENTS TO NEWLY ESTABLISHED PPS EXEMPT PROVIDERS- Section
1886(b)(7)(A)(i)(II) (42 U.S.C. 1395ww(b)(7)(A)(i)(II)) is amended by
inserting `(as estimated by the Secretary)' after `median'.
(h) OTHER TECHNICAL AMENDMENTS-
(1) Section 1812(b) (42 U.S.C. 1395d(b)) is amended in the matter
following paragraph (3) by inserting `during' after `100 visits'.
(2) Section 1833(a)(1)(O) (42 U.S.C. 1395l(a)(1)(O)) is amended by
striking the semicolon and inserting a comma.
(3) Section 1834(h)(4)(A) (42 U.S.C. 1395m(h)(4)(A)) is amended--
(A) in clause (i), by striking the comma at the end and inserting a
semicolon; and
(B) in clause (v), by striking `, and' and inserting `; and'.
(4) Section 1842(s)(2)(E) (42 U.S.C. 1395u(s)(2)(E)) is amended by
inserting a period at the end.
(5) Section 1848(j)(3) (42 U.S.C. 1395w-4(j)(3)) is amended--
(A) by striking `1861(oo)(2),' and inserting `1861(oo)(2))';
(B) by striking `(B) ,' and inserting `(B),'; and
(C) by striking `and (15)' and inserting `, and (15)'.
(6) Section 1851(i)(2) (42 U.S.C. 1395w-21(i)(2)) is amended by striking
`and' after `1857(f)(2),'.
(7) Section 1852 (42 U.S.C. 1395w-22) is amended--
(A) in subsection (a)(3)(A)--
(i) by striking the comma after `MSA plan'; and
(ii) by inserting a comma after `the coverage)';
(i) in paragraph (1)(B), by inserting `or' after `in whole';
and
(ii) in paragraph (3)(B)(ii), by inserting a period at the
end;
(C) in subsection (h)(2), by striking the comma and inserting a
semicolon; and
(D) in subsection (k)(2)(C)(ii), by striking `balancing' and inserting
`balance'.
(8) Section 1854(a) (42 U.S.C. 1395w-24(a)) is amended--
(i) in subparagraph (A), in the matter preceding clause (i), by
inserting `section' before `1852(a)(1)(A)'; and
(ii) in subparagraph (B), in the matter preceding clause (i), by
inserting `section' after `described in';
(i) in subparagraph (A), by inserting `section' after `described
in'; and
(ii) in subparagraph (B), by inserting `section' after `described
in'; and
(i) in the matter preceding subparagraph (A), by inserting `section'
after `described in';
(ii) in subparagraph (A), in the matter preceding clause (i), by
inserting `section' after `described in'; and
(iii) in subparagraph (B), by inserting `section' after `described
in'.
(9) Section 1861 (42 U.S.C. 1395x) is amended--
(A) in subsection (s)(2)(T)(ii), by striking the period and inserting
a semicolon;
(B) in subsection (aa)(2)--
(i) in subparagraph (I), by striking the comma at the end and
inserting a semicolon; and
(ii) by realigning subparagraph (I) so as to align the left margin
of such subparagraph with the left margin of subparagraph (H);
and
(C) in subsection (ss)(1)(G)(i)--
(i) by striking `owed' and inserting `owned'; and
(ii) by striking `of' and inserting `or'.
(10) Section 1862(a)(7) (42 U.S.C. 1395y(a)(7)) is amended by striking
`subparagraphs' and inserting `subparagraph'.
(11) Section 1866(a)(1) (42 U.S.C. 1395cc(a)(1)) is amended--
(A) in subparagraph (I)(iii), by striking the semicolon and inserting
a comma;
(B) in subparagraph (N)(iv), by striking `and' at the end;
(C) in subparagraph (O), by striking the semicolon at the end and
inserting a comma;
(D) in subparagraph (Q), by striking the semicolon at the end and
inserting a comma; and
(E) in subparagraph (R), by inserting `, and' at the end.
(12) Section 1882 (42 U.S.C. 1395ss) is amended--
(A) in subsection (g)(1), by striking `or' after `does not include';
and
(B) in subsection (s)(2)(D), in the matter preceding clause (i), by
inserting `section' after `as defined in'.
(13) Section 1886 (42 U.S.C. 1395ww) is amended--
(i) in paragraph (1), in the matter following subparagraph (C), by
inserting a comma after `paragraph (2)'; and
(ii) in paragraph (3)(B)(ii)--
(I) in subclause (VI) is amended by striking the semicolon and
inserting a comma; and
(II) in subclause (VII) is amended by striking the semicolon and
inserting a comma; and
(i) in paragraph (5)(F), by inserting a comma after `1986';
and
(ii) in paragraph (9)(A)(ii), by inserting a comma after
`1987'.
(14) Section 1888(e)(4)(E) (42 U.S.C. 1395yy(e)(4)(E)) is
amended--
(A) in clause (i) by striking `federal' and inserting `Federal';
and
(B) in clause (ii), in the matter preceding subclause (I), by striking
`federal' each place it appears and inserting `Federal'.
(15) Section 1895(b)(1) (42 U.S.C. 1395fff(b)(1)) is amended by striking
`the this section' and inserting `this section'.
(i) EFFECTIVE DATE- Except as otherwise provided, the amendments made by
this section shall take effect as if included in the enactment of the Balanced
Budget Act of 1997 (Public Law 105-33; 111 Stat. 251).
SEC. 607. EXCLUSION FROM PAYGO SCORECARD.
Any net deficit increase resulting from the enactment of this Act shall
not be counted for purposes of section 252 of the Balanced Budget and
Emergency Deficit Control Act of 1985 (2 U.S.C. 902).
TITLE VII--PROVISIONS RELATING TO MEDICAID AND SCHIP
SEC. 701. MEDICAID-RELATED BBA TECHNICALS.
(a) CROSS-REFERENCE CORRECTIONS-
(1) Section 1902(a)(10)(A)(ii)(XIV) (42 U.S.C. 1396a(a)(10)(A)(ii)(XIV))
is amended by striking `1905(u)(2)(C)' and inserting `1905(u)(2)(B)'.
(2) Section 1903(f)(4) (42 U.S.C. 1396b(f)(4)) is amended, in the matter
preceding subparagraph (A), by striking `1905(p)(1), or 1905(u)' and
inserting `1902(a)(10)(A)(ii)(XIII), 1902(a)(10)(A)(ii)(XIV), or
1905(p)(1)'.
(3) Section 1905(a)(15) (42 U.S.C. 1396d(a)(15)) is amended by striking
`1902(a)(31)(A)' and inserting `1902(a)(31)'.
(4) The amendments made by this subsection shall take effect as if
included in the enactment of the Balanced Budget Act of 1997 (Public Law
105-33; 111 Stat. 251).
(b) ELIMINATION OF DUPLICATIVE REQUIREMENTS FOR EXTERNAL QUALITY REVIEW OF
MEDICAID MANAGED CARE ORGANIZATIONS-
(1) Section 1902(a)(30) (42 U.S.C. 1396a(a)(30)) is amended--
(A) in subparagraph (A), by adding `and' at the end;
(B) in subparagraph (B)(ii), by striking `and' at the end;
and
(C) by striking subparagraph (C).
(2) Section 1902(d) (42 U.S.C. 1396a(d)) is amended--
(A) by striking `an entity which meets the requirements of section
1152, as determined by the Secretary, for the performance of the quality
review functions described in subsection (a)(30)(C), or';
(B) by striking `(including quality review functions described in
subsection (a)(30)(C))'; and
(C) by striking `entity or' each place it appears.
(3) Section 1903 (42 U.S.C. 1396b) is amended--
(A) in subsection (a)(3)(C)(i)--
(i) by striking `or quality review'; and
(ii) by striking `or by an entity which meets the requirements of
section 1152, as determined by the Secretary,'; and
(B) in subsection (m)(6)(B)--
(i) in clause (ii), by adding `and' at the end;
(ii) in clause (iii), by striking `; and' and inserting a period;
and
(iii) by striking clause (iv).
(4) The amendments made by this subsection apply as of such date as the
Secretary of Health and Human Services certifies to Congress that it is
fully implementing section 1932(c)(2) of the Social Security Act (42 U.S.C.
1396u-2(c)(2)).
(c) MAKING ENHANCED MATCH UNDER SCHIP PROGRAM INAPPLICABLE TO MEDICAID DSH
PAYMENTS-
(1) The last sentence of section 1905(b) (42 U.S.C. 1396d(b)) is amended
by inserting `(other than expenditures under section 1923)' after `with
respect to expenditures'.
(2) The amendment made by paragraph (1) takes effect on October 1, 1999,
and applies to expenditures made on or after such date.
(d) MAKING DEFERMENT OF THE EFFECTIVE DATE FOR OUTPATIENT DRUG AGREEMENTS
OPTIONAL FOR STATES-
(1) Section 1927(a)(1) (42 U.S.C. 1396r-8(a)(1)) is amended by striking
`shall not be effective until' and inserting `shall become effective as of
the date on which the agreement is entered into or, at State option, on any
date thereafter on or before'.
(2) The amendment made by paragraph (1) applies to agreements entered
into on or after the date of enactment of this Act.
SEC. 702. INCREASE IN DISPROPORTIONATE SHARE HOSPITAL ALLOTMENT FOR CERTAIN
STATES AND THE DISTRICT OF COLUMBIA.
(a) IN GENERAL- The table included in section 1923(f)(2) (42 U.S.C.
1396r-4(f)(2)) is amended under each of the columns for FY 00, FY 01, and FY
02--
(1) at the line for the District of Columbia, by striking `23' and
inserting `32';
(2) at the line for Minnesota, by striking `16' and inserting
`33';
(3) at the line for New Mexico, by striking `5' and inserting `9';
and
(4) at the line for Wyoming, by striking `0' and inserting `.100'.
(b) EFFECTIVE DATE- The amendments made by this section shall take effect
on October 1, 1999, and applies to expenditures made on or after such date.
SEC. 703. MAKING MEDICAID DSH TRANSITION RULE PERMANENT.
(a) IN GENERAL- Section 4721(e) of the Balanced Budget Act of 1997 (42
U.S.C. 1396r-4 note) is amended--
(1) in the matter before paragraph (1), by striking `1923(g)(2)(A)' and
`1396r-4(g)(2)(A)' and inserting `1923(g)(2)' and `1396r-4(g)(2)',
respectively;
(2) in paragraphs (1) and (2)--
(A) by striking `, and before July 1, 1999'; and
(B) by striking `in such section' and inserting `in subparagraph (A)
of such section'; and
(3) by striking `and' at the end of paragraph (1), by striking the
period at the end of paragraph (2) and inserting `; and', and by adding at
the end the following:
`(3) effective for State fiscal years that begin on or after July 1,
1999, `or (b)(1)(B)' were inserted in section 1923(g)(2)(B)(ii)(I) after
`(b)(1)(A)'.'.
(b) EFFECTIVE DATE- The amendments made by this section shall take effect
as if included in the enactment of section 4721(e) of the Balanced Budget Act
of 1997 (Public Law 105-33; 110 Stat. 514).
SEC. 704. INCREASED ALLOTMENTS FOR TERRITORIES UNDER THE STATE CHILDREN'S
HEALTH INSURANCE PROGRAM.
Section 2104(c)(4)(B) (42 U.S.C. 1397dd(c)(4)(B)) is amended by inserting
`, $34,200,000 for each of fiscal years 2000 and 2001, $25,200,000 for each of
fiscal years 2002 through 2004, $32,400,000 for each of fiscal years 2005 and
2006, and $40,000,000 for fiscal year 2007' before the period.
SEC. 705. REMOVAL OF FISCAL YEAR LIMITATION ON CERTAIN TRANSITIONAL
ADMINISTRATIVE COSTS ASSISTANCE.
(a) IN GENERAL- Section 1931(h) (42 U.S.C. 1396u-1(h)) is amended--
(1) in paragraph (3), by striking `and ending with fiscal year 2000';
and
(2) by striking paragraph (4).
(b) EFFECTIVE DATE- The amendments made by this section shall take effect
as if included in the enactment of section 114 of the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996 (Public Law 104-193; 110 Stat.
2177).
SEC. 706. STABILIZING THE SCHIP ALLOTMENT FORMULA.
(a) IN GENERAL- Section 2104(b) (42 U.S.C. 1397dd(b)) is amended--
(1) in paragraph (2)(A)--
(A) in clause (i), by striking `through 2000' and inserting `and
1999'; and
(B) in clause (ii), by striking `2001' and inserting `2000';
(2) by amending paragraph (4) to read as follows:
`(4) FLOORS AND CEILINGS IN STATE ALLOTMENTS-
`(A) IN GENERAL- The proportion of the allotment under this subsection
for a subsection (b) State (as defined in subparagraph (D)) for fiscal
year 2000 and each fiscal year thereafter shall be subject to the
following floors and ceilings:
`(i) FLOOR OF $2,000,000- A floor equal to $2,000,000 divided by the
total of the amount available under this subsection for all such
allotments for the fiscal year.
`(ii) ANNUAL FLOOR OF 10 PERCENT BELOW PRECEDING FISCAL YEAR'S
PROPORTION- A floor of 90 percent of the proportion for the State for
the preceding fiscal year.
`(iii) CUMULATIVE FLOOR OF 30 PERCENT BELOW THE FY 1999 PROPORTION-
A floor of 70 percent of the proportion for the State for fiscal year
1999.
`(iv) CUMULATIVE CEILING OF 45 PERCENT ABOVE FY 1999 PROPORTION- A
ceiling of 145 percent of the proportion for the State for fiscal year
1999.
`(i) ELIMINATION OF ANY DEFICIT BY ESTABLISHING A PERCENTAGE
INCREASE CEILING FOR STATES WITH HIGHEST ANNUAL PERCENTAGE INCREASES- To
the extent that the application of subparagraph (A) would result in the
sum of the proportions of the allotments for all subsection (b) States
exceeding 1.0, the Secretary shall establish a maximum percentage
increase in such proportions for all subsection (b) States for the
fiscal year in a manner so that such sum equals 1.0.
`(ii) ALLOCATION OF SURPLUS THROUGH PRO RATA INCREASE- To the extent
that the application of subparagraph (A) would result in the sum of the
proportions of the allotments for all subsection (b) States being less
than 1.0, the proportions of such allotments (as computed before the
application of floors under clauses (i), (ii), and (iii) of subparagraph
(A)) for all subsection (b) States shall be increased in a pro rata
manner (but not to exceed the ceiling established under subparagraph
(A)(iv)) so that (after the application of such floors and ceiling) such
sum equals 1.0.
`(C) CONSTRUCTION- This paragraph shall not be construed as applying
to (or taking into account) amounts of allotments redistributed under
subsection (f).
`(D) DEFINITIONS- In this paragraph:
`(i) PROPORTION OF ALLOTMENT- The term `proportion' means, with
respect to the allotment of a subsection (b) State for a fiscal year,
the amount of the allotment of such State under this subsection for the
fiscal year divided by the total of the amount available under this
subsection for all such allotments for the fiscal year.
`(ii) SUBSECTION (b) STATE- The term `subsection (b) State' means
one of the 50 States or the District of Columbia.';
(3) in paragraph (2)(B), by striking `the fiscal year' and inserting
`the calendar year in which such fiscal year begins'; and
(4) in paragraph (3)(B), by striking `the fiscal year involved' and
inserting `the calendar year in which such fiscal year begins'.
(b) EFFECTIVE DATE- The amendments made by this section apply to
allotments determined under title XXI of the Social Security Act (42 U.S.C.
1397aa et seq.) for fiscal year 2000 and each fiscal year thereafter.
SEC. 707. IMPROVED DATA COLLECTION AND EVALUATIONS OF THE SCHIP
PROGRAM.
(a) FUNDING FOR RELIABLE ANNUAL STATE-BY-STATE ESTIMATES ON THE NUMBER OF
CHILDREN WHO DO NOT HAVE HEALTH INSURANCE COVERAGE- Section 2108 (42 U.S.C.
1397hh) is amended by adding at the end the following:
`(c) ADJUSTMENT TO CURRENT POPULATION SURVEY TO INCLUDE STATE-BY-STATE
DATA RELATING TO CHILDREN WITHOUT HEALTH INSURANCE COVERAGE-
`(1) IN GENERAL- The Secretary of Commerce shall make appropriate
adjustments to the annual Current Population Survey conducted by the Bureau
of the Census in order to produce statistically reliable annual State data
on the number of low-income children who do not have health insurance
coverage, so that real changes in the uninsurance rates of children can
reasonably be detected. The Current Population Survey should produce data
under this subsection that categorizes such children by family income, age,
and race or ethnicity. The adjustments made to produce such data shall
include, where appropriate, expanding the sample size used in the State
sampling units, expanding the number of sampling units in a State, and an
appropriate verification element.
`(2) APPROPRIATION- Out of any money in the Treasury of the United
States not otherwise appropriated, there are appropriated $10,000,000 for
fiscal year 2000 and each fiscal year thereafter for the purpose of carrying
out this subsection.'.
(b) FUNDING FOR CHILDREN'S HEALTH CARE ACCESS AND UTILIZATION
STATE-BY-STATE DATA- Section 2108 (42 U.S.C. 1397hh), as amended by subsection
(a), is amended by adding at the end the following:
`(d) COLLECTION OF CHILDREN'S HEALTH CARE ACCESS AND UTILIZATION
STATE-LEVEL DATA-
`(1) IN GENERAL- The Secretary, acting through the National Center for
Health Statistics (in this subsection referred to as the `Center'), shall
collect data on children's health insurance through the State and Local Area
Integrated Telephone Survey (SLAITS) for the 50 States and the District of
Columbia. Sufficient data shall be collected so as to provide reliable,
annual, State-by-State information on the health care access and utilization
of children in low-income households, and to allow for comparisons between
demographic subgroups categorized with respect to family income, age, and
race or ethnicity.
`(2) SURVEY DESIGN AND CONTENT-
`(A) IN GENERAL- In carrying out paragraph (1), the Secretary, acting
through the Center--
`(i) shall obtain input from appropriate sources, including States,
in designing the survey and making content decisions; and
`(ii) at the request of a State, may collect additional data to
assist with a State's evaluation of the program established under this
title.
`(B) REIMBURSEMENT OF COSTS OF ADDITIONAL DATA- A State shall
reimburse the Center for services provided under subparagraph
(A)(ii).
`(3) APPROPRIATION- Out of any money in the Treasury of the United
States not otherwise appropriated, there are appropriated $9,000,000 for
fiscal year 2000 and each fiscal year thereafter for the purpose of carrying
out this subsection.'.
(c) FEDERAL EVALUATION OF STATE CHILDREN'S HEALTH INSURANCE PROGRAMS-
Section 2108 (42 U.S.C. 1397hh), as amended by subsections (a) and (b), is
amended--
(1) by redesignating subsections (c) and (d) as subsections (d) and (e),
respectively; and
(2) by inserting after subsection (b) the following:
`(1) IN GENERAL- The Secretary, directly or through contracts or
interagency agreements, shall conduct an independent evaluation of 10 States
with approved child health plans.
`(2) SELECTION OF STATES- In selecting States for the evaluation
conducted under this subsection, the Secretary shall choose 10 States that
utilize diverse approaches to providing child health assistance, represent
various geographic areas (including a mix of rural and urban areas), and
contain a significant portion of uncovered children.
`(3) MATTERS INCLUDED- In addition to the elements described in
subsection (b)(1), the evaluation conducted under this subsection shall
include, but is not limited to, the following:
`(A) Surveys of the target population (enrollees, disenrollees, and
individuals eligible for but not enrolled in the program under this
title).
`(B) Evaluation of effective and ineffective outreach and enrollment
practices with respect to children (for both the program under this title
and the medicaid program under title XIX), and identification of
enrollment barriers and key elements of effective outreach and enrollment
practices, including practices that have successfully enrolled
hard-to-reach populations such as children who are eligible for medical
assistance under title XIX but have not been enrolled previously in the
medicaid program under that title.
`(C) Evaluation of the extent to which State medicaid eligibility
practices and procedures under the medicaid program under title XIX are a
barrier to the enrollment of children under that program, and the extent
to which coordination (or lack of coordination) between that program and
the program under this title affects the enrollment of children under both
programs.
`(D) An assessment of the effect of cost-sharing on utilization,
enrollment, and coverage retention.
`(E) Evaluation of disenrollment or other retention issues, such as
switching to private coverage, failure to pay premiums, or barriers in the
recertification process.
`(4) SUBMISSION TO CONGRESS- Not later than December 31, 2001, the
Secretary shall submit to Congress the results of the evaluation conducted
under this subsection.
`(5) FUNDING- Out of any money in the Treasury of the United States not
otherwise appropriated, there are appropriated $10,000,000 for fiscal year
2000 for the purpose of conducting the evaluation authorized under this
subsection. Amounts appropriated under this paragraph shall remain available
without fiscal year limitation.'.
(d) INSPECTOR GENERAL AUDIT AND GAO REPORT ON ENROLLEES ELIGIBLE FOR
MEDICAID- Section 2108 (42 U.S.C. 1397hh), as amended by subsection (c), is
amended by adding at the end the following:
`(f) INSPECTOR GENERAL AUDIT AND GAO REPORT-
`(1) AUDIT- Beginning with fiscal year 2000, and every third fiscal year
thereafter, the Secretary, through the Inspector General of the Department
of Health and Human Services, shall audit a sample from among the States
described in paragraph (2) in order to--
`(A) determine the number, if any, of enrollees under the plan under
this title who are eligible for medical assistance under title XIX (other
than as optional targeted low-income children under section
1902(a)(10)(A)(ii)(XIV)); and
`(B) assess the progress made in reducing the number of targeted
uncovered low-income children relative to the goals established in the
State child health plan, as reported to the Secretary in accordance with
subsection (a)(2).
`(2) STATE DESCRIBED- A State described in this paragraph is a State
with an approved State child health plan under this title that does not, as
part of such plan, provide health benefits coverage under the State's
medicaid program under title XIX.
`(3) MONITORING AND REPORT FROM GAO- The Comptroller General of the
United States shall monitor the audits conducted under this subsection and,
not later than March 1 of each fiscal year after a fiscal year in which an
audit is conducted under this subsection, shall submit a report to Congress
on the results of the audit conducted during the prior fiscal year.'.
(e) COORDINATION OF DATA COLLECTION WITH DATA REQUIREMENTS UNDER THE
MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT- Subparagraphs (C)(ii) and
(D)(ii) of section 506(a)(2) (42 U.S.C. 706(a)(2)) are each amended by
inserting `or the State plan under title XXI' after `title XIX'.
(f) COORDINATION OF DATA SURVEYS AND REPORTS- The Secretary of Health and
Human Services, through the Assistant Secretary for Planning and Evaluation,
shall establish a clearinghouse for the consolidation and coordination of all
Federal databases and reports regarding children's health.
SEC. 708. GRANTS TO STATES FOR ITEMS AND SERVICES PROVIDED BY
FEDERALLY-QUALIFIED HEALTH CENTERS AND RURAL HEALTH CLINICS.
(1) IN GENERAL- Beginning with fiscal year 2001, the Secretary shall
award a grant to a State described in paragraph (2) for payment for items
and services provided by Federally-qualified health centers and rural health
clinics located in the State--
(A) to individuals who are not eligible for medical assistance under
the State plan under title XIX of the Social Security Act (42 U.S.C. 1396
et seq.); and
(B) that would be considered medical assistance under the State plan
under such title if such items and services were provided to an individual
eligible for such assistance.
(A) IN GENERAL- A State described in this paragraph is a State that
has not elected to provide payment for Federally-qualified health center
services and rural health clinic services provided under the State plan
under title XIX of the Social Security Act, or under a waiver of such plan
approved under section 1115 of that Act (42 U.S.C. 1315), in accordance
with the phase-out of the reasonable cost basis for payment for such
services provided in section 1902(a)(13)(C) of the Social Security Act (42
U.S.C. 1396a(a)(13)(C)), as amended by section 4712(a) of the Balanced
Budget Act of 1997 (Public Law 105-33; 111 Stat. 508).
(B) EXCEPTION- In the case of a State that, as of October 1, 1999, has
elected to provide payment for 95 percent of the costs of
Federally-qualified health center services and rural health clinic
services furnished during fiscal year 2000 under such State plan or
waiver, in accordance with section 1902(a)(13)(C) of the Social Security
Act (as so amended), the State shall be considered to be a State described
in subparagraph (A) if the State reverts to providing payment for 100
percent of the costs of such services under such State plan or waiver
during fiscal years 2001 through 2003.
(3) APPLICATION- A State shall submit an application for a grant under
this section at such time, in such manner, and containing, in addition to
the methodology required under subsection (c)(1), such information as the
Secretary may determine.
(1) BASED ON NUMBER OF LOW-INCOME INDIVIDUALS-
(A) IN GENERAL- Out of funds appropriated under subsection (d) for
each of fiscal years 2001 through 2003, the Secretary shall, subject to
paragraphs (2) and (3), allot to each State eligible for a grant under
this section for the fiscal year an amount equal to the ratio
of--
(i) the number of low-income individuals in the State for the fiscal
year; to
(ii) the total number of such individuals in all such States for the
fiscal year.
(B) DETERMINATION OF NUMBER OF LOW-INCOME INDIVIDUALS- For purposes of
subparagraph (A), a determination of the number of low-income individuals
for a State for a fiscal year shall be made on the basis of the arithmetic
average of the number of such individuals, as reported and defined in the
3 most recent March supplements to the Current Population Survey of the
Bureau of the Census before the beginning of the calendar year in which
such fiscal year begins.
(2) MINIMUM AMOUNT- In no case shall the amount of a grant to a State
under this section for any fiscal year be less than $400,000.
(3) RECONCILIATION- The Secretary shall make pro rata adjustments as
necessary to the allotments determined under this subsection in order to
comply with the requirement of paragraph (2).
(4) NO MATCHING REQUIREMENT- Nothing in this section shall be construed
as requiring a State to expend or provide funds in order to receive funds
under a grant made under this section.
(5) 3-YEAR AVAILABILITY OF AMOUNTS ALLOTTED- Amounts allotted to a State
under a grant made under this section for a fiscal year shall remain
available for expenditure by the State through the end of the second
succeeding fiscal year.
(c) LIMITATIONS ON USE OF FUNDS-
(1) IN GENERAL- Subject to paragraph (2), funds provided to a State
under a grant made under this section for any fiscal year--
(A) shall be distributed among all the Federally-qualified health
centers and rural health clinics located in the State in accordance
with
a methodology approved in advance by the Secretary that imposes a uniform
criteria for such distribution, based on factors such as size of caseload and
treatment costs; and
(B) may only be used for payment for items and services described in
subsection (a)(1).
(2) STATE OPTION TO RETAIN FUNDS FOR ADMINISTRATIVE COSTS- A State that
receives a grant under this section for a fiscal year may retain up to 15
percent of the amount allotted to the State for the fiscal year for
administrative expenditures incurred by the State with respect to
Federally-qualified health centers and rural health clinics located in the
State.
(d) APPROPRIATION- Out of any funds in the Treasury not otherwise
appropriated, there is authorized to be appropriated and there is appropriated
to make grants under this section $25,000,000 for each of fiscal years 2001
through 2003.
(e) DEFINITIONS- In this section:
(1) FEDERALLY-QUALIFIED HEALTH CENTER; FEDERALLY-QUALIFIED HEALTH CENTER
SERVICES- The terms `Federally-qualified health center' and
`Federally-qualified health center services' have the meanings given those
terms in section 1905(l)(2) of the Social Security Act (42 U.S.C.
1396d(l)(2)).
(2) RURAL HEALTH CLINIC; RURAL HEALTH CLINIC SERVICES- The terms `rural
health clinic' and `rural health clinic services' have the meanings given
those terms in section 1905(l)(1) of the Social Security Act (42 U.S.C.
1396d(l)(1)).
(3) SECRETARY- The term `Secretary' means the Secretary of Health and
Human Services.
(f) GAO STUDY AND REPORT-
(1) STUDY- The Comptroller General of the United States shall conduct a
study to determine the impact on Federally-qualified health centers and
rural health clinics of the phase-out of the reasonable cost basis for
payment for Federally-qualified health center services and rural health
clinic services provided in section 1902(a)(13)(C) of the Social Security
Act (42 U.S.C. 1396a(a)(13)(C)), as amended by section 4712(a) of the
Balanced Budget Act of 1997 (Public Law 105-33; 111 Stat. 508).
(2) REPORT- Beginning with November 1, 2000, and anuually thereafter
through November 1, 2003, the Comptroller General shall submit a report to
Congress on the results of the study conducted under this subsection,
together with any recommendations for legislation that the Comptroller
General determines to be appropriate as a result of such study.
SEC. 709. ADDITIONAL TECHNICAL CORRECTIONS.
(a) Section 1902(a)(64) (42 U.S.C. 1396a(a)(64)) is amended by adding
`and' at the end.
(b) Section 1902(j) (42 U.S.C. 1396a(j)) is amended by striking `of of'
and inserting `of'.
(c) Section 1902(l) (42 U.S.C. 1396a(l)) is amended--
(1) in paragraph (1)(C), by striking `children children' and inserting
`children';
(2) in paragraph (3), in the matter preceding subparagraph (A), by
striking the first comma after `(a)(10)(A)(i)(VII)'; and
(3) in paragraph (4)(B), by inserting a comma after
`(a)(10)(A)(i)(IV)'.
(d) Section 1902(v) (42 U.S.C. 1396a(v)) is amended by striking `(1)'.
(e) Section 1903(b)(4) (42 U.S.C. 1396b(b)(4)) is amended, in the matter
preceding subparagraph (A), by inserting `of' after `for the use'.
(f) The left margins of clauses (i) and (ii) of section 1903(d)(3)(B) (42
U.S.C. 1396b(d)(3)(B)) are each realigned so as to align with the left margin
of section 1903(d)(3)(A).
(g) Section 1903(f)(2) (42 U.S.C. 1396b(f)(2)) is amended by striking the
extra period at the end.
(h) Section 1903(i)(14) (1396b(i)(14)) is amended by adding `or' after the
semicolon.
(i) Section 1903(m)(2)(A) (42 U.S.C. 1396b(m)(2)(A)) is amended--
(1) in clause (vi), by striking the semicolon the first place it
appears; and
(2) by redesignating the clause (xi) added by section 4701(c)(3) of the
Balanced Budget Act of 1997 (Public Law 105-33; 111 Stat. 493) as clause
(xii).
(j) Section 1903(o) (42 U.S.C. 1396b(o)) is amended by striking `1974))'
and inserting `1974)'.
(k) Section 1903(w) (42 U.S.C. 1396b(w)) is amended--
(1) in paragraph (1)(B), by striking `puroses' and inserting
`purposes';
(2) in paragraph (3)(B), by inserting a comma after `(D)'; and
(3) by realigning the left margin of clause (viii) in paragraph (7)(A)
so as to align with the left margin of clause (vii) of that
paragraph.+
(l) Section 1905(b)(1) (42 U.S.C. 1396d(b)(1)) is amended by striking `per
centum,,' and inserting `per centum,'.
(m) Section 1905(l)(2)(B) (42 U.S.C. 1936d(l)(2)(B)) is amended by
striking `a entity' and inserting `an entity'.
(n) The heading for section 1910 (42 U.S.C. 1396i) is amended by striking
`OF' the first place it appears.
(o) Section 1915 (42 U.S.C. 1396n) is amended--
(1) in subsection (b), by striking `1902(a)(13)(E)' and inserting
`1902(a)(13)(C)';
(2) in the last sentence of subsection (d)(5)(B)(iii), by striking `75'
and inserting `65'; and
(3) in subsection (h), by striking `90 day' and inserting `90
days'.
(p) Section 1919 (42 U.S.C. 1396r) is amended--
(1) in subsection (b)(3)(C)(i)(I), by striking `not later than' the
first place it appears; and
(2) in subsection (d)(4)(A), by striking `1124' and inserting
`1124)'.
(q) Section 1920(b)(2)(D)(i)(I) (42 U.S.C. 1396r-1(b)(2)(D)(i)(I)) is
amended by striking `329, 330, or 340' and inserting `330 or 330A'.
(r) Section 1920A(d)(1)(B) (42 U.S.C. 1396r-1a(d)(1)(B)) is amended by
striking `a entity' and inserting `an entity'.
(s) Section 1923(c)(3)(B) (42 U.S.C. 1396r-4(c)(3)(B)) is amended by
striking `patients.' and inserting `patients,'.
(t) Section 1925 (42 U.S.C. 1396r-6) is amended--
(1) in subsection (a)(3)(C), by striking `(i)(VI) (i)(VII),,' and
inserting `(i)(VI), (i)(VII),'; and
(2) in subsection (b)(3)(C)(i), by striking `(i)(IV) (i)(VI) (i)(VII),,'
and inserting `(i)(IV), (i)(VI), (i)(VII),'.
(u) Section 1927 (42 U.S.C. 1396r-8) is amended--
(1) in subsection (g)(2)(A)(ii)(II)(cc), by striking `individuals' and
inserting `individual's';
(2) in subsection (i)(1), by striking `the the' and inserting `the';
and
(3) in subsection (k)(7)--
(A) in subparagraph (A)(iv), by striking `distributers' and inserting
`distributors'; and
(B) in subparagraph (C)(i), by striking `pharmaceuutically' and
inserting `pharmaceutically'.
(v) Section 1929 (42 U.S.C. 1396t) is amended--
(1) in subsection (c)(2), by realigning the left margins of clauses (i)
and (ii) of subparagraph (E) so as to align with the left margins of clauses
(i) and (ii) of subparagraph (F) of that subsection;
(2) in subsection (k)(1)(A)(i), by striking `settings,' and inserting
`settings),'; and
(3) in subsection (l), by striking `State wideness' and inserting
`Statewideness'.
(w) Section 1932 (42 U.S.C. 1396u-2) is amended--
(1) in subsection (c)(2)(C), by inserting `part' before `C of title
XVIII'; and
(A) in paragraph (1)(C)(ii), by striking `Act' and inserting
`Regulation'; and
(B) in paragraph (2)(B), by striking `1903(t)(3)' and inserting
`1905(t)(3)'.
(x) Section 1933(b)(4) (42 U.S.C. 1396u-3(b)(4)) is amended by inserting
`a' after `for a month in'.
(y) Section 2104(b)(3)(B) (42 U.S.C. 1397dd(b)(3)(B)) is amended by
striking `States.' and inserting `States,'.
(z) Section 2105(d)(2)(B)(iii) (42 U.S.C. 1397ee(d)(2)(B)(iii)) is amended
by inserting `in' after `described'.
(aa) Section 2109(a) (42 U.S.C.1397ii(a)) is amended--
(1) in paragraph (1), by striking `title II' and inserting `title I';
and
(2) in paragraph (2), by inserting `)' before the period.
(bb)(1) The section 1908 (42 U.S.C. 1396g-1) that relates to required laws
relating to medical child support is redesignated as section 1908A.
(2) Section 1902(a)(60) (42 U.S.C. 1396b(a)(60)) is amended by striking
`1908' and inserting `1908A'.
(cc) Effective October 1, 2003, section 1915(b) (42 U.S.C. 1396n(b)) is
amended, in the matter preceding paragraph (1), by striking `sections
1902(a)(13)(C) and' and inserting `section'.
(dd) Except as otherwise provided, the amendments made by this section
shall take effect on the date of enactment of this Act.
END