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S.1788
Medicare, Medicaid, and SCHIP Adjustment Act of 1999 (Placed on the
Calendar in the Senate)
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.
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