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H.R.3075
Medicare Balanced Budget Refinement Act of 1999 (Introduced in the
House)
SEC. 406. INCREASED FLEXIBILITY IN PROVIDING GRADUATE PHYSICIAN TRAINING IN RURAL
AREAS.
(a) PERMITTING 30 PERCENT EXPANSION IN CURRENT GME TRAINING PROGRAMS FOR
HOSPITALS LOCATED IN RURAL AREAS-
(1) PAYMENT FOR DIRECT GRADUATE MEDICAL EDUCATION COSTS- Section
1886(h)(4)(F) (42 U.S.C. 1395ww(h)(4)(F)), as added by section 4623 of BBA,
is
amended by inserting `(or, 130 percent of such number in the case of a
hospital located in a rural area)' after `may not exceed the number'.
(2) PAYMENT FOR INDIRECT GRADUATE MEDICAL EDUCATION COSTS- Section
1886(d)(5)(B)(v) (42 U.S.C. 1395ww(d)(5)(B)(v)), as added by section
4621(b)(1) of BBA, is amended by inserting `(or, 130 percent of such number
in the case of a hospital located in a rural area)' after `may not exceed
the number'.
(3) EFFECTIVE DATES- (A) The amendment made by paragraph (1) applies to
cost reporting periods beginning on or after October 1, 1999.
(B) The amendment made by paragraph (2) applies to discharges occurring
during cost reporting periods beginning on or after October 1, 1999.
(b) SPECIAL RULE FOR NON-RURAL FACILITIES SERVING RURAL AREAS-
(1) IN GENERAL- Section 1886(h)(4)(H) (42 U.S.C. 1395ww(h)(4)(H)), as
added by section 4623 of BBA, is amended by adding at the end the following
new clause:
`(iv) NON-RURAL HOSPITALS OPERATING TRAINING PROGRAMS IN UNDERSERVED
RURAL AREAS- In the case of a hospital that is not located in a rural
area but establishes separately accredited approved medical residency training
programs (or rural tracks) in an underserved rural area, the Secretary
shall adjust the limitation under subparagraph (F) in an appropriate
manner insofar as it applies to such programs in such underserved rural
areas in order to encourage the training of physicians in underserved
rural areas.'.
(2) EFFECTIVE DATE- The amendment made by paragraph (1) apply with
respect to payments to hospitals for cost reporting periods beginning on or
after October 1, 1999.
SEC. 407. ELIMINATION OF CERTAIN RESTRICTIONS WITH RESPECT TO HOSPITAL SWING
BED PROGRAM.
(a) ELIMINATION OF REQUIREMENT FOR STATE CERTIFICATE OF NEED- Section
1883(b) (42 U.S.C. 1395tt(b)) is amended to read as follows:
`(b) The Secretary may not enter into an agreement under this section with
any hospital unless, except as provided under subsection (g), the hospital is
located in a rural area and has less than 100 beds.'.
(b) ELIMINATION OF SWING BED RESTRICTIONS ON CERTAIN HOSPITALS WITH MORE
THAN 49 BEDS- Section 1883(d) (42 U.S.C. 1395tt(d)) is amended--
(1) by striking paragraphs (2) and (3); and
(2) by striking `(d)(1)' and inserting `(d)'.
(c) EFFECTIVE DATE- The amendments made by this section take effect on the
date that is the first day after the expiration of the transition period under
section 1888(e)(2)(E) of the Social Security Act (42 U.S.C. 1395yy(e)(2)(E)),
as added by section 4432(a) of BBA, for payments for covered skilled nursing
facility services under the medicare program.
SEC. 408. GRANT PROGRAM FOR RURAL HOSPITAL TRANSITION TO PROSPECTIVE
PAYMENT.
Section 1820(g) (42 U.S.C. 1395i-4(g)), as added by section 4201(a) of
BBA, is amended by adding at the end the following new paragraph:
`(3) UPGRADING DATA SYSTEMS-
`(A) GRANTS TO HOSPITALS- The Secretary may award grants to hospitals
that have submitted applications in accordance with subparagraph (C) to
assist eligible small rural hospitals in meeting the costs of implementing
data systems required to meet requirements established under the medicare
program pursuant to amendments made by the Balanced Budget Act of
1997.
`(B) ELIGIBLE SMALL RURAL HOSPITAL DEFINED- For purposes of this
paragraph, the term `eligible small rural hospital' means a non-Federal,
short-term general acute care hospital that--
`(i) is located in a rural area (as defined for purposes of section
1886(d)); and
`(ii) has less than 50 beds.
`(C) APPLICATION- A hospital seeking a grant under this paragraph
shall submit an application to the Secretary on or before such date and in
such form and manner as the Secretary specifies.
`(D) AMOUNT OF GRANT- A grant to a hospital under this paragraph may
not exceed $50,000.
`(E) USE OF FUNDS- A hospital receiving a grant under this paragraph
may use the funds for the purchase of computer software and hardware and
for the education and
training of hospital staff on computer information systems and costs
related to the implementation of prospective payment systems.
`(i) INFORMATION- A hospital receiving a grant under this section
shall furnish the Secretary with such information as the Secretary may
require to evaluate the project for which the grant is made and to
ensure that the grant is expended for the purposes for which it is
made.
`(I) INTERIM REPORTS- The Secretary shall report to the Committee
on Ways and Means of the House of Representatives and the Committee on
Finance of the Senate at least annually on the grant program
established under this section, including in such report information
on the number of grants made, the nature of the projects involved, the
geographic distribution of grant recipients, and such other matters as
the Secretary deems appropriate.
`(II) FINAL REPORT- The Secretary shall submit a final report to
such committees not later than 180 days after the completion of all of
the projects for which a grant is made under this
section.'.
SEC. 409. MEDPAC STUDY OF RURAL PROVIDERS.
(a) STUDY- The Medicare Payment Advisory Commission shall conduct a study
on rural providers furnishing items and services for which payment is made
under title XVIII of the Social Security Act. Such study shall examine and
evaluate the adequacy and appropriateness of the categories of special
payments (and payment methodologies) established for rural hospitals under the
medicare program, and their impact on beneficiary access and quality of health
care services.
(b) REPORT- By not later than 18 months after the date of the enactment of
this Act, the Medicare Payment Advisory Commission shall submit a report to
Congress on the study conducted under subsection (a).
TITLE V--PROVISIONS RELATING TO PART C (MEDICARE+CHOICE
PROGRAM)
Subtitle A--Medicare+Choice
SEC. 501. PHASE-IN OF NEW RISK ADJUSTMENT METHODOLOGY.
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 new clause:
`(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;
`(II) 20 percent of such amount in 2002;
`(III) 30 percent of such amount in 2003; and
`(IV) 100 percent of such amount in any subsequent year (in which
the risk adjustment methodology should reflect data from all
settings).'.
SEC. 502. ENCOURAGING OFFERING OF MEDICARE+CHOICE PLANS IN AREAS WITHOUT
PLANS.
Section 1853 (42 U.S.C. 1395w-23) is amended--
(1) in subsection (a)(1), by striking `subsections (e) and (f)' and
inserting `subsections (e), (g), and (i)';
(2) in subsection (c)(5), by inserting `(other than those attributable
to subsection (i))' after `payments under this part'; and
(3) by adding at the end the following new subsection:
`(1) IN GENERAL- Subject to paragraphs (2) and (3), in the case of
Medicare+Choice payment area in which a Medicare+Choice plan has not been
offered since 1997 (or in which any organization that offered a plan since
such date has announced, as of October 13, 1999, that it will not be
offering such plan as of January 1, 2000), the amount of the monthly payment
otherwise made under this subsection shall be increased--
`(A) only for the first 12 months in which any Medicare+Choice plan is
offered in the area, by 5 percent of the payment rate otherwise computed;
and
`(B) only for the subsequent 12 months, by 3 percent of the payment
rate otherwise computed.
If such 12 months are not a calendar year, the Secretary shall provide
for an appropriate blend of such percentage increases for the second and
third calendar years in which months described in subparagraph (B) occur to
reflect the proportion of such months in each such year.
`(2) PERIOD OF APPLICATION- Paragraph (1) shall only apply to payment
for Medicare+Choice plans which are first offered in a Medicare+Choice
payment area during the 2-year period beginning with January 1, 2000.
`(3) LIMITATION TO ORGANIZATION OFFERING FIRST PLAN IN AN AREA-
Paragraph (1) shall only apply to payment to the first Medicare+Choice
organization that offers a Medicare+Choice plan in each Medicare+Choice
payment area, except that if more than one such organization first offers
such a plan in an area on the same date, paragraph (1) shall apply to
payment for such organizations.
`(4) CONSTRUCTION- Nothing in paragraph (1) shall be construed as
affecting the Medicare+Choice capitation rate for any area or as applying to
payment for any period not described in such paragraph.'.
SEC. 503. MODIFICATION OF 5-YEAR RE-ENTRY RULE FOR CONTRACT
TERMINATIONS.
(a) IN GENERAL- Section 1857(c)(4) (42 U.S.C. 1395w-27(c)(4)) is
amended--
(1) by inserting `as provided in paragraph (2) and except' after `except
as provided';
(2) by redesignating the first sentence as a subparagraph (A) with an
appropriate indentation and the heading `IN GENERAL- '; and
(3) by adding at the end the following new subparagraph:
`(B) EARLIER RE-ENTRY PERMITTED WHERE CHANGE IN PAYMENT POLICY AND NO
MORE THAN ONE OTHER PLAN AVAILABLE- Subparagraph (A) shall not apply with
respect to the offering by a Medicare+Choice organization of a
Medicare+Choice plan in a Medicare+Choice payment area if--
`(i) during the 6-month period beginning on the date the
organization notified the Secretary of the intention to terminate the
most recent previous contract, there was a legislative change enacted
(or a regulatory change adopted) that has the effect of increasing
payment rates under section 1853 for that Medicare+Choice payment area;
and
`(ii) at the time the organization notifies the Secretary of its
intent to enter into a contract to offer such a plan in the area, there
is no more than one
Medicare+Choice plan offered in the area.'.
(b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply to
contract terminations occurring before, on, or after the date of the enactment
of this Act.
SEC. 504. CONTINUED COMPUTATION AND PUBLICATION OF AAPCC DATA.
(a) IN GENERAL- Section 1853(b) (42 U.S.C. 1395w-23(b)) is amended by
adding at the end the following new paragraph:
`(4) CONTINUED COMPUTATION AND PUBLICATION OF COUNTY-SPECIFIC PER CAPITA
FEE-FOR-SERVICE EXPENDITURE INFORMATION- The Secretary, through the Chief
Actuary of the Health Care Financing Administration, shall provide for the
computation and publication, on an annual basis at the time of publication
of the annual Medicare+Choice capitation rates, of information on the level
of the average annual per capita costs (described in section 1876(a)(4)) for
each Medicare+Choice payment area.'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) shall take effect
on the date of the enactment of this Act and apply to publications of the
annual Medicare+Choice capitation rates made on or after such date.
SEC. 505. PERMITTING ENROLLMENT IN ALTERNATIVE MEDICARE+CHOICE PLANS AND
MEDIGAP COVERAGE IN CASE OF INVOLUNTARY TERMINATION OF MEDICARE+CHOICE
ENROLLMENT.
(a) IN GENERAL- 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 or the Secretary 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 or Secretary of an impending termination or
discontinuation of such plan;'.
(b) CONFORMING MEDIGAP AMENDMENT- 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 or the Secretary 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 subsection shall apply to
notices of impending terminations or discontinuances made before, on, or after
the date of the enactment of this Act, except that, for purposes of applying
such amendments with respect to a notice of a termination or discontinuance
that was made before such date and for which the termination or discontinuance
occurs after such date, such notice shall be treated as having occurred on the
date of the enactment of this Act.
SEC. 506. ALLOWING VARIATION IN PREMIUM WAIVERS WITHIN A SERVICE AREA IF
MEDICARE+CHOICE PAYMENT RATES VARY WITHIN THE AREA.
(a) IN GENERAL- Section 1854(c) (42 U.S.C. 1395w-24(c)) is amended--
(1) by striking `The' and inserting `Subject to paragraph (2),
the';
(2) by redesignating the first sentence as a paragraph (1) with an
appropriate indentation and the heading `IN GENERAL- '; and
(3) by adding at the end the following new paragraph:
`(2) VARIATION IN PREMIUM WAIVER PERMITTED- A Medicare+Choice
organization may waive part or all of a premium described in paragraph (1)
for one or more Medicare+Choice payment areas within its service area if the
annual Medicare+Choice capitation rates under section 1853(c) vary between
such payment area and other payment areas within such service area.'.
(b) EFFECTIVE DATE- The amendments made by subsection (a) apply to
premiums for contract years beginning on or after January 1, 2001.
SEC. 507. DELAY IN DEADLINE FOR SUBMISSION OF ADJUSTED COMMUNITY RATES AND
RELATED INFORMATION.
(a) DELAY IN DEADLINE FOR SUBMISSION OF ADJUSTED COMMUNITY RATES AND
RELATED INFORMATION- Section 1854(a)(1) (42 U.S.C. 1395w-24(a)(1)) is amended
by striking `May 1' and inserting `July 1'.
(b) ADJUSTMENT IN INFORMATION DISCLOSURE PROVISIONS- Section
1851(d)(2)(A)(ii) (42 U.S.C. 1395w-21(d)(2)(A)(ii)) is amended 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'.
SEC. 508. 2 YEAR EXTENSION OF MEDICARE COST CONTRACTS.
Section 1876(h)(5)(B) (42 U.S.C. 1395mm(h)(5)(B)) is amended by striking
`2002' and inserting `2004'.
SEC. 509. MISCELLANEOUS CHANGES.
(a) PERMITTING RELIGIOUS FRATERNAL BENEFIT SOCIETIES TO OFFER A RANGE OF
MEDICARE+CHOICE PLANS- Section 1859(e)(2)(A) (42 U.S.C. 1395w-29(e)(2)(A)) is
amended by striking `section 1851(a)(2)(A)' and inserting `section
1851(a)(2)'.
SEC. 510. MEDPAC REPORT ON MEDICARE MSA (MEDICAL SAVINGS ACCOUNT) PLANS.
Not later than 1 year after the date of the enactment of this Act, the
Medicare Payment Advisory Commission shall submit to Congress a report on
specific legislative changes that should be made to make MSA plans a viable
option under the Medicare+Choice program.
Subtitle B--Social Health Maintenance Organizations
(SHMOs)
SEC. 511. EXTENSION OF SOCIAL HEALTH MAINTENANCE ORGANIZATION DEMONSTRATION
PROJECT AUTHORITY.
(a) EXTENSION- Section 4018(b) of the Omnibus Budget Reconciliation Act of
1987, as amended by section 4014(a)(1) of BBA, is amended--
(1) in paragraph (1), by striking `December 31, 2000' and inserting `the
date that is 18 months after the date that Secretary submits to Congress the
report described in section 4014(c) of the Balanced Budget Act of 1997';
and
(2) by adding at the end of paragraph (4) the following: `Not later than
6 months after the date the Secretary submits such final report, the
Medicare Payment Advisory Commission shall submit to Congress a report
containing recommendations regarding such project.'.
(b) SUBSTITUTION OF AGGREGATE CAP- Section 13567(c) of the Omnibus Budget
Reconciliation Act of 1993, as amended by section 4014(b) of BBA, is amended
to read as follows:
`(c) AGGREGATE LIMIT ON NUMBER OF MEMBERS- The Secretary of Health and
Human Services may not impose a limit on the number of individuals that may
participate in a project conducted under section 2355 of the Deficit Reduction
Act of 1984, other than an aggregate limit of not less than 324,000 for all
sites.'.
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