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.

SECTION 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

Subtitle B--Hospice Services

Subtitle C--Other Provisions

TITLE II--PROVISIONS RELATING TO PART B ONLY

Subtitle A--Hospital Outpatient Department Services

Subtitle B--Physicians' Services

TITLE III--PROVISIONS RELATING TO PARTS A AND B

Subtitle A--Home Health Services

Subtitle B--Graduate Medical Education

TITLE IV--RURAL INITIATIVES

TITLE V--PROVISIONS RELATING TO PART C (MEDICARE+CHOICE PROGRAM)

Subtitle A--Provisions To Accommodate and Protect Medicare Beneficiaries

Subtitle B--Provisions To Facilitate Implementation of the Medicare+Choice Program

Subtitle C--Provisions Regarding Special Medicare Populations

Subtitle D--Studies and Reports To Assist in Making Future Improvements in the Medicare Program

TITLE VI--OTHER PROVISIONS

TITLE VII--PROVISIONS RELATING TO MEDICAID AND SCHIP

TITLE I--PROVISIONS RELATING TO PART A ONLY

Subtitle A--Skilled Nursing Facility Services

SEC. 101. INCREASE IN PAYMENT FOR CERTAIN HIGH COST PATIENTS.

RUGS III category

Applicable paymentadd-on

RUC

$73.57

RVC

$76.25

RHC

$54.09

RMC

$69.98

RMB

$30.09.

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.

by the Secretary up to (but not to exceed)--

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.'.

Subtitle B--Physicians' Services

SEC. 221. MODIFICATIONS OF UPDATE ADJUSTMENT FACTOR PROVISIONS TO REDUCE OSCILLATIONS AND ALLOW FOR ESTIMATE REVISIONS.

the 9-month period beginning on April 1, 1999, and for 1999;

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.).

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.

and Trade Relief Extension Act of 1998 (contained in Division J of Public Law 105-277), is amended--

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.

hospital's approved medical residency training programs for the hospital's most recent cost reporting period ending on or before December 31, 1996'; and

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.

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)) .

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.

considered to be an enrollment under clause (v) or (vi) (as applicable).'.

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 MEDICARE 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.

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.'.

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.

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

SEC. 709. ADDITIONAL TECHNICAL CORRECTIONS.

END