| Committee/Subcommittee: | Activity: | |
| Senate Finance | Referral | |
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TABLE OF CONTENTS:
Medicare Beneficiary Access to Care Act of 1999 - Title I: Hospitals - Amends title XVIII (Medicare) of the Social Security Act (SSA) with respect to: (1) multiyear transition to prospective payment system (PPS) for hospital outpatient department services and a special rule for rural and cancer hospitals; (2) limitation in reduction of payments to disproportionate share (DSH) hospitals; (3) revision of criteria for designation as a critical access hospital; and (4) sole community and Medicare-dependent, small rural hospitals and the applicable percentage increase for FY 2000 and each subsequent fiscal year.
(Sec. 103) Amends SSA title XIX (Medicaid) to increase DSH hospital allotments for Minnesota, New Mexico, and Wyoming.
Amends the Balanced Budget Act of 1997 (BBA '97) to make the Medicaid DSH transition rule permanent.
Title II: Graduate Medical Education - Amends SSA title XVIII with respect to revision of multiyear reduction of indirect graduate medical education (GME) payments.
(Sec. 202) Amends SSA title XVIII parts D (Miscellaneous) and C (Medicare+Choice) with respect to acceleration of payment to hospitals of indirect and direct GME costs for Medicare+Choice enrollees.
(Sec. 203) Amends SSA title XVIII part C with respect to the exclusion of nursing and allied health education costs in calculating the Medicare+Choice payment rate.
Amends SSA title XVIII with respect to: (1) payment to hospitals of nursing and allied health education program costs for Medicare+Choice enrollees; and (2) adjustments to limitations on the number of interns and residents and GME payments for certain interns and residents.
Title III: Hospice Care - Amends SSA title XVIII to increase payments for routine home care and other services included in hospice care for a fiscal year after FY 1999.
Title IV: Skilled Nursing Facilities - Provides that, for purposes of applying any formula under the PPS for covered skilled nursing facility services (SNFs) for services provided between April 1, 2000, and the end of FY 2001, the Secretary shall increase, by a specified applicable payment add-on, the adjusted Federal per diem rate otherwise determined for services provided to any individual during the period in which such individual is in a RUG III case mix category.
(Sec. 402) Amends SSA title XVIII to exclude clinical social worker services and services performed under a contract with a rural health clinic or a Federally-qualified health center from the PPS for SNFs, as well as certain ambulance services, chemotherapy administration services, and other specified items, services, and devices, including swing beds in critical access hospitals.
Title V: Outpatient Rehabilitation Services - Amends title XVIII to repeal for three years a specified financial limitation on outpatient physical therapy services, outpatient occupational therapy services, and outpatient speech-language pathology services covered under Medicare and furnished on or after January 1, 2000. Directs the Secretary to implement by January 1, 2003, a payment system for such services that takes into account the needs of Medicare beneficiaries for differing amounts of therapy based on certain factors.
Title VI: Physicians' Services - Amends SSA title XVIII with respect to payment for physicians' services to revise the formula for determining the update adjustment factor and the formula for determining the sustainable growth rate for all physicians' services.
(Sec. 602) Directs the Secretary to publish in the Federal Register an estimate of the single conversion factor to be used in the next calendar year for reimbursement of physicians' services, and data on which such estimate is based.
Directs the Medicare Payment Advisory Commission (MEDPac) to review annually and report to the Secretary and specified congressional committees on such estimates and data.
Title VII: Home Health - Amends BBA '97 and SSA title XVIII to delay application of the 15 percent reduction in payment rates for home health services until one year after implementation of the PPS for home health services.
(Sec. 702) Amends SSA title XVIII to increase the FY 2000 per visit limit for home health agencies furnishing home health services, but in such a way that has no effect on the PPS for home health services.
(Sec. 703) Requires the Secretary to pay such excess reasonable cost to a home health services provider that furnishes services appropriate to an individual's condition at a reasonable cost which significantly exceeds the applicable per beneficiary limit because of unusual variations in the type or amount of medically necessary care required.
(Sec. 704) Eliminates the 15-minute billing requirement for the payment of claims for home health services furnished on or after October 1, 1998.
(Sec. 705) Provides that, in the case of an overpayment by the Secretary to a home health agency for services furnished during a cost reporting period beginning on or after October 1, 1997, as a result of certain payment limitations, the home health agency may elect to repay the amount of such overpayment ratably over a 36-month period beginning on the overpayment notification date.
(Sec. 706) Amends SSA title XVIII to include medical supplies (but not durable medical equipment) as home health services for purposes of home health consolidated billing.
Title VIII: Medicare+Choice - Amends Medicare part C to delay the submission of proposed premiums, adjusted community rates, and related information each Medicare+Choice organization is required to submit to the Secretary for each Medicare+Choice plan for the service area in which it is intended to be offered in the following year.
(Sec. 802) Reduces from five years to three years the general exclusion period for Medicare+Choice organizations whose contract has been terminated.
(Sec. 803) Authorizes enrollment in alternative Medicare+Choice plans and Medigap coverage in the event of an involuntary termination of Medicare+Choice enrollment.
Guarantees access for certain Medicare beneficiaries to Medigap policies in case of such an involuntary termination.
(Sec. 804) Removes certain age-related restrictions with respect to Medigap protection against medical condition or pre-existing condition discrimination.
Permits an individual who develops end-stage renal disease while enrolled in a Medicare+Choice plan and remains so enrolled to elect to continue enrollment in another Medicare+Choice plan if the original enrollment is discontinued.
(Sec. 805) Extends the Medicare+Choice disenrollment window for certain involuntarily terminated enrollees.
(Sec. 806) Provides under the Medicare+Choice program for continuation of any State law that requires the comprehensive coverage of prescription drugs, or any regulation that carries out such a law if: (1) the State has a waiver in effect with respect to requiring such coverage under Medigap policies; or (2) the Secretary provides for a waiver for the State to impose such a requirement.
(Sec. 807) Exempts certain frail elderly Medicare+Choice beneficiaries from the risk-adjustment system if they are enrolled in a specialized program for the frail elderly.
Sets forth special rules for frail elderly Medicare+Choice beneficiaries enrolled in such specialized programs. Provides for continuous open enrollment for certain such beneficiaries.
Directs the Secretary to develop and implement a program to measure the quality of care provided in specialized programs for the frail elderly in order to reflect their unique health aspects and needs.
(Sec. 808) Extends for an additional three years Medicare community nursing and ambulatory care demonstration projects under the Omnibus Budget Reconciliation Act of 1987.
Title IX: Clinics - Amends SSA title XIX to establish a new PPS for Federally-qualified health centers and rural health clinics under which the State Medicaid plan may provide for payment in any fiscal year to such a center or clinic for certain services in an amount exceeding the amount otherwise required to be paid under the PPS.