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