SUMMARY AS OF:
11/17/1999--Introduced.
TABLE OF CONTENTS:
- Title I: Provisions Relating to Part A
- Subtitle A: Adjustments to PPS Payments for Skilled Nursing Facilities
- Subtitle B: PPS Hospitals
- Subtitle C: PPS-Exempt Hospitals
- Subtitle D: Hospice Care
- Subtitle E: Other Provisions
- Subtitle F: Transitional Provisions
- Title II: Provisions Relating to Part B
- Subtitle A: Hospital Outpatient Services
- Subtitle B: Physician Services
- Subtitle C: Other Services
- Title III: Provisions Relating to Parts A and B
- Subtitle A: Home Health Services
- Subtitle B: Direct Graduate Medical Education
- Subtitle C: Technical Corrections
- Title IV: Rural Provider Provisions
- Subtitle A: Rural Hospitals
- Subtitle B: Other Rural Provisions
- Title V: Provisions Relating to Part C (Medicare+Choice Program) and Other
Medicare
- Managed Care Provisions
- Subtitle A: Provisions to Accommodate and Protect Medicare Beneficiaries
- Subtitle B: Provisions to Facilitate Implementation of the Medicare+Choice
- Program
-
- Subtitle C: Demonstration Projects and Special Medicare Populations
- Subtitle D: Medicare+Choice Nursing and Allied Health Professional
Education
- Payments
- Subtitle E: Studies and Reports
- Title VI: Medicaid
- Title VII: State Children's Health Insurance Program (SCHIP)
Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 -
Title I: Provisions Relating to Part A - Subtitle A: Adjustments to
PPS Payments for Skilled Nursing Facilities - Provides that, for computing
payments for covered skilled nursing facility (SNF) services furnished under
title XVIII (Medicare) of the Social Security Act (SSA) on or after April 1,
2000, and before a described date, the Secretary of Health and Human Services
(HHS) shall increase by 20 percent the adjusted Federal per diem rate otherwise
determined for covered SNF services for certain RUG-III groups furnished to an
individual during the period in which such individual is classified in such an
RUG-III category.
(Sec. 101) Provides that for purposes of computing Medicare payments for
covered SNF services furnished during FY 2001 and 2002, the Secretary shall
increase by four percent for each such fiscal year the adjusted Federal per diem
rate. Prohibits the Secretary from including such additional payment in updating
the Federal per diem rate.
(Sec. 102) Permits a SNF to elect to have the amount of the payment for all
costs of covered SNF services for each day of such services furnished in cost
reporting periods beginning no earlier than 30 days before the date of such
election.
(Sec. 103) Amends title XVIII to exclude the following items and services
from the definition of covered SNF services: (1) ambulance services furnished to
an individual in conjunction with renal dialysis services; (2) chemotherapy
items identified by the Secretary; (3) chemotherapy administration services; (4)
radioisotope services; and (5) customized prosthetic devices.
Directs the Secretary to provide for an appropriate proportional reduction in
payments so that beginning with FY 2001, the aggregate amount of such reductions
is equal to the aggregate increase in payments.
(Sec. 104) Amends title XVIII to revise provisions on determination of
facility specific per diem rates under the prospective payment system (PPS) for
SNFs, including adding a specified payment rule for certain facilities.
(Sec. 105) Directs the Secretary to assess the resource use of patients of
SNFs furnishing services under Medicare who are immuno-compromised secondary to
an infectious disease, with specific diagnoses as specified by the Secretary to
determine whether any permanent adjustments are needed to the RUGs to take into
account the resource uses and costs of these patients.
(Sec. 106) Directs the Medicare Payment Advisory Commission (MEDPac) to study
and report to Congress on SNFs furnishing covered services to determine the need
for an additional Medicare payment amount to take into account the unique
circumstances of SNFs in Alaska and Hawaii.
(Sec. 107) Directs the Secretary to 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 SNFs; (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
Medicare for such providers and individuals.
Subtitle B: PPS Hospitals - Amends title XVIII to: (1) modify the
formula for the Secretary to provide for an additional payment amount for a
disproportionate share hospital (DSH) with indirect costs of medical education;
and (2) direct the Secretary to make one or more payments to DSH hospitals which
receive payment for the direct costs of medical education for discharges
occurring in FY 2000, in an amount according to a specified formula.
(Sec. 112) Decreases reductions in additional payments for DSH and certain
other hospitals for FY 2001 and 2002.
Directs the Secretary to require DSH hospitals to submit to the Secretary in
their discharge cost reports for a fiscal year data on the costs incurred by the
hospital for providing inpatient and outpatient hospital services for which the
hospital is not compensated, including non-Medicare bad debt, charity care, and
charges for Medicaid (SSA title XIX) and indigent care.
Subtitle C: PPS-Exempt Hospitals - Amends SSA title XVIII to revise
provisions on payment to hospitals for inpatient hospital services with respect
to the following: (1) a hospital or unit that is within a class of hospital and
estimates concerning the target amounts for such hospitals within such class to
require the Secretary to provide for an appropriate wage adjustment; (2)
determination of the increase in the amount of payment on a per discharge basis
for an eligible hospital to alter such determination for psychiatric and
long-term care hospitals for specified cost reporting periods beginning on or
after October 1, 2000; and (3) PPS for inpatient rehabilitation services.
(Sec. 123) Directs the Secretary to: (1) develop a per discharge PPS for
payment for inpatient hospital services of long-term care hospitals; (2) develop
a per diem PPS for payment for inpatient hospital services of psychiatric
hospitals and units; and (3) study and report to Congress on the impact on
utilization and beneficiary access to services of the implementation of the PPS
for inpatient hospital services or a rehabilitation hospital or unit.
Subtitle D: Hospice Care - Directs the Secretary to increase the
payment rate in effect for hospice care for FY 2001 and 2002. Prohibits the
Secretary from using such temporary payment increase when updating the payment
rate.
(Sec. 132) Directs the Comptroller General to study and report to Congress on
updating the payment rates and the cap for routine home care and other services
included in hospice care.
Subtitle E: Other Provisions - Directs MEDPac to study and report to
Congress on Medicare policy with respect to professional clinical training of
different classes of nonphysician health care professionals and the basis for
any differences in treatment among such classes.
Subtitle F: Transitional Provisions - Outlines various transitional
provisions applicable to specified geographic areas of the United States and
certain health care entities pertaining to: (1) an exception to the Medicare
hospital payment case mix index qualifier criteria for classification as a rural
referral center; (2) reclassification of certain counties and areas for purposes
of Medicare reimbursement; (3) wage index correction; (4) calculation and
application of wage index floor; and (5) a special rule for certain SNFs.
Title II: Provisions Relating to Part B - Subtitle A: Hospital
Outpatient Services - Revises Medicare requirements for payments to
hospitals for inpatient hospital services, among other changes, modifying the
following: (1) the PPS for hospital outpatient department (OPD) services with
respect to outlier adjustment, transitional pass-through for additional costs of
innovative medical devices, transitional adjustment to limit decline, drugs, and
biologicals, transitional adjustment to limit decline in payment, the inclusion
of certain implantable items under the PPS, and a limitation on outpatient
hospital copayment for a procedure to the hospital deductible amount; and (2)
amendments by the Balanced Budget Act of 1997 (BBA '97) to provide for an
extension of reductions in payments for costs of hospital outpatient services
under Medicare.
(Sec. 201) Provides that with respect to determining the total amounts of
copayments estimated to be paid to hospitals by Medicare beneficiaries under the
PPS for covered OPD services in 1999, as though the deductible did not apply,
Congress finds: (1) that such amount should be determined in a budget neutral
manner with respect to aggregate payments to hospitals; and (2) that the
Secretary has the authority to determine such amount.
Directs the Secretary to study and report to Congress on the extent to which
intravenous immune globulin (IVIG) could be delivered and reimbursed under the
Medicare program outside of a hospital or a physician's office.
(Sec. 203) Directs MedPAC to study and report to Congress on the
appropriateness of providing payments to specified rural and cancer hospitals
for covered OPD services based on the PPS established by the Secretary.
Subtitle B: Physician Services - Revises update adjustment factor
requirements to reduce update oscillations and mandate estimate revisions for
payments for physicians' services.
Directs the Secretary, acting through the Administrator of the Agency for
Health Care Policy and Research, to study and report to Congress on specified
issues, which include the various methods for accurately estimating the economic
impact on expenditures for physicians' services under the original
fee-for-service program under Medicare parts A (Hospital Insurance) and B
(Supplementary Medical Insurance) resulting from improvements in medical
capabilities as well as certain other technological advancements, and
demographic and geographic changes.
(Sec. 212) Directs the Secretary to establish by regulation a process
(including data collection standards) under which the Secretary will accept for
use and will use data collected or developed by non-HHS entities and
organizations to supplement the data normally collected by HHS in determining
the practice expense component for determining relative values for payment for
physicians' services under the Medicare fee schedule.
(Sec. 213) Directs the Comptroller General to study and report to Congress on
the physician and non-physician clinical resources necessary to provide safe
outpatient cancer therapy services and the appropriate payment rates for them
under Medicare.
Subtitle C: Other Services - Revises requirements for payment of
benefits certain physical and occupational therapy services under Medicare part
B to exempt expenses considered as incurred by an individual from the cap on
such expenses for calendar years 2000 and 2001.
(Sec. 221) Directs the Secretary to conduct focused medical reviews of claims
for certain services provided to residents of SNFs.
Directs the Secretary to study and to report to Congress on utilization
policies for outpatient physical and occupational therapy services.
(Sec. 222) Amends SSA title XVIII to direct the Secretary to increase the
amount of each composite rate payment for dialysis services: (1) furnished
during 2000 by 1.2 percent above such composite rate payment amounts for such
services furnished on December 31, 1999; and (2) for such services furnished on
or after January 2001, by 1.2 percent above such composite rate payment amounts
for such services furnished on December 31, 2000.
Requires MEDPac to study and report to Congress on the appropriateness of the
differential in payment under Medicare for hemodialysis services furnished in a
facility and for such services furnished in a home.
(Sec. 223) Prohibits the Secretary from using, or permitting fiscal
intermediaries or carriers to use, certain inherent reasonableness authority
with respect to use of carriers for administration of benefits until after: (1)
the Comptroller General releases a specified report on the impact of the
Secretary's, fiscal intermediaries', and carriers' use of such authority; and
(2) the Secretary has published in the Federal register a notice of final
rulemaking relating to such authority in response to such report.
(Sec. 224) Amends SSA title XVIII to direct the Secretary to establish a
national minimum payment amount of $14.60, adjusted annually, for a diagnostic
or screening pap smear laboratory test.
Expresses the sense of Congress that: (1) the Health Care Financing
Administration (HCFA) has been slow to incorporate or provide incentives for
providers to use new screening diagnostic health care technologies in the area
of cervical cancer; (2) some new technologies have been developed which optimize
the effectiveness of pap smear screening; and (3) HCFA should institute an
appropriate increase in the payment rate for such technologies that have been
approved by the Food and Drug Administration, and that are significantly more
effective than a conventional pap smear.
(Sec. 225) Amends BBA '97 to with respect to demonstration of Medicare
coverage of ambulance services through contracts with units of local government,
revising the definition of capitated payment rate.
(Sec. 226) Provides for the phase-in of a PPS for ambulatory surgical
centers.
(Sec. 227) Amends SSA title XVIII to provide for the extension of
immunosuppressive drug coverage for individuals who would otherwise exhaust
their Medicare benefits for prescription drugs used in immunosuppressive
therapy.
Provides that national coverage determinations under Medicare part C
(Medicare+Choice) benefits and beneficiary protections provisions shall apply
with respect to the coverage of additional benefits for immunosuppressive drugs
for drugs furnished in 2000 in the same manner as if the amendments of this Act
constituted a national coverage determination.
(Sec. 228) Directs the Secretary to increase the payment amount for durable
medical equipment and medical supplies (including oxygen) for 2001 and 2002.
(Sec. 229) Directs MEDPac to study and report to Congress on: (1)
post-surgical recovery care center services; and (2) regulatory burdens placed
on all classes of health care providers under Medicare parts A and B, and on the
costs these burdens impose on the nation's health care system.
Requires the Administrator for Health Care Policy and Research to provide for
a study and report to Congress on the effect of credentialing of technologists
and sonographers on the quality of ultrasound under Medicare and Medicaid.
Direct the Comptroller General to continue monitoring Department of Justice
compliance with certain guidelines on the use of the False Claims Act in civil
health care matters for reports to Congress.
Title III: Provisions Relating to Parts A and B - Subtitle A: Home
Health Services - Provides that, in the case of a home health agency that
furnishes home health services to a Medicare beneficiary, for each such
beneficiary to whom the agency furnished such services during the agency's cost
reporting period beginning in FY 2000, the Secretary shall pay the agency for
the beneficiary and only for such cost reporting period, an aggregate additional
amount of $10 to defray costs attributable to data collection and reporting
requirements under the Outcome and Assessment Information Set (OASIS) required
by BBA '97. Requires: (1) the Secretary to pay to a home health agency an amount
estimated to be 50 percent of the aggregate amount payable to the agency by
reason of this subtitle; and (2) payments under this subtitle to be made, in
appropriate part as specified by the Secretary, from Medicare trust funds.
(Sec. 301) Requires the Comptroller General to: (1) report to Congress on
specified matters with respect to the data collection requirement of patients of
home health agencies under the OASIS standard as part of the comprehensive
assessment of patients; and (2) conduct an independent audit of, and report to
Congress on, the costs incurred by Medicare home health agencies in complying
with such data collection requirement.
(Sec. 302) Amends BBA' 97 to eliminate the scheduled automatic 15 percent
reduction in payment amounts to home health agencies furnishing home health
services under the Medicare program.
Amends SSA title XVIII to provide for a delay in 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.
Requires the Secretary to report to Congress on the need for the 15 percent
reduction or for any reduction in the computation of the base payments under
such PPS.
(Sec. 303) Amends SSA title XVIII to provide for an increase in the
agency-specific per beneficiary annual limitation under the interim system of
limits for home health agencies furnishing home health services. Excludes such
increase from the home health services PPS base.
(Sec. 304) Revises surety bond requirements under home health agencies
provisions, requiring such agencies to provide the Secretary with a surety bond:
(1) that is effective for a period of four years; and (2) for a year in such
period in an amount that is equal to the lesser of $50,000 or ten percent of the
aggregate amount of payments to the agency under Medicare and Medicaid for that
year, as estimated by the Secretary.
Amends part A (General Provisions) of SSA title XI to provide for
coordination of surety bonds under Medicare and Medicaid.
(Sec. 305) Amends SSA title XVIII to include medical supplies as home health
services for purposes of consolidated billing.
(Sec. 307) Directs MEDPac to study and report to Congress on the feasibility
and advisability of exempting from payment under the PPS for such services any
home health services provided by a home health agency (or by others under
arrangements with such agency) located in a rural area, or to an individual
residing in a rural area.
Subtitle B: Direct Graduate Medical Education - Amends SSA title XVIII
to provide for the use of national average payment methodology in computing
direct graduate medical education (DGME) payments.
(Sec. 312) Makes the initial residency period for child neurology residency
training programs the period of board eligibility for pediatrics plus two years.
Directs MEDPac to include in its report to Congress in March of 2001
recommendations regarding the appropriateness of the initial residency period
used for other residency training programs in a specialty that require
preliminary years of study in another specialty.
Subtitle C: Technical Corrections - Makes various specified technical
corrections to BBA '97 and the Health Insurance Portability and Accountability
Act of 1996 codified in SSA title XVIII.
(Sec. 321) Amends SSA title XI to repeal provisions on the development of
model prospective rate methodology.
Title IV: Rural Provider Provisions - Subtitle A: Rural
Hospitals - Amends SSA title XVIII with respect to payment to hospitals for
inpatient hospital services to: (1) permit reclassification of certain urban
hospitals as rural hospitals; and (2) add standards applied for geographic
reclassification for certain hospitals for cost reporting periods beginning in a
fiscal year before FY 2003 and after FY 2002.
(Sec. 403) Revises requirements for the Medicare critical access hospital
program to: (1) apply on an annual, average basis the 96-hour limit on providing
inpatient care; (2) permit for-profit hospitals to qualify for designation as a
critical access hospital; (3) allow closed or downsized hospitals to convert to
critical access hospitals; (4) provide for election of cost-based payment option
for outpatient critical access hospital services; and (5) eliminate coinsurance
for clinical diagnostic laboratory tests furnished by a critical access hospital
on an outpatient basis.
(Sec. 404) Provides, with respect to payment to hospitals for inpatient
hospital services, for: (1) extending for five years the payment methodology for
Medicare-dependent, small rural DSH hospitals; (2) rebasing for certain sole
community hospitals; (3) providing for a full market basket percentage increase
for FY 2001 for sole community hospitals; and (4) increasing flexibility in
providing graduate physician training in rural and other areas.
(Sec. 408) Amends SSA title XVIII with regard to hospital providers of
extended care services to eliminate: (1) the requirement for the hospital to
have a certificate of need from the State in order to provide long-term care
services; and (2) eliminate "swing bed" restrictions on certain hospitals with
more than 49 beds.
(Sec. 409) Amends SSA title XVIII with regard to the Medicare rural hospital
flexibility program to authorize the Secretary to assist eligible small rural
hospitals in meeting the costs of implementing data systems required to meet
requirements established under Medicare pursuant to BBA '97 requirements for
implementation of PPSs.
(Sec. 410) Directs the Comptroller General to study and report to Congress on
the current laws and regulations for geographic reclassification of hospitals to
determine if such reclassification: (1) is appropriate for applying wage indices
under Medicare; and (2) results in more accurate payments for all hospitals.
Subtitle B: Other Rural Provisions - Directs MEDPac to study and
report to Congress on rural providers furnishing items and services for which
payment is made under Medicare.
(Sec. 412) Amends BBA '97 to provide for: (1) expanding access to paramedic
intercept services in rural areas; and (2) promoting prompt implementation of
the informatics, telemedicine, and education demonstration project.
Title V: Provisions Relating to Part C (Medicare+Choice Program) and Other
Medicare Managed Care Provisions - Subtitle A: Provisions to Accommodate
and Protect Medicare Beneficiaries - Amends SSA title XVIII parts C and D
(Miscellaneous) with respect to Medicare+Choice enrollment rules to permit
enrollment in alternative Medicare+Choice plans and Medicare supplemental health
insurance (Medigap) policies coverage in case of involuntary termination of
Medicare+Choice enrollment.
(Sec. 502) Amends SSA title XVIII part C to revise the effective date of
elections and changes of elections of Medicare+Choice eligible individuals who
make such elections after the tenth day of the month.
(Sec. 503) Amends SSA title XVIII part D to extend Medicare cost contracts by
two years.
Subtitle B: Provisions to Facilitate Implementation of the Medicare+Choice
Program - Amends title XVIII part C to require the Secretary to phase-in,
according to a specified schedule, the implementation of a risk adjustment
methodology (in calculating payments to Medicare+Choice organizations) that
accounts for variations in per capita costs based on health status and other
demographic factors for payments.
(Sec. 511) Directs MEDPac to study specified related issues and report to
Congress on the methodology used by the Secretary in developing the risk factors
used in adjusting the Medicare+Choice capitation rate paid to Medicare+Choice
organizations.
Directs the Secretary to study and report to Congress on how to reduce the
costs and burdens on Medicare+Choice organizations of compliance with reporting
requirements for encounter data imposed by the Secretary in establishing and
implementing a risk adjustment methodology.
(Sec. 512) Amends SSA title XVIII part C to: (1) provide for a new entry
bonus increasing the amount of monthly payment otherwise made to Medicare+Choice
organizations in order to encourage the offering of Medicare+Choice plans in
certain payment areas without plans; (2) reduce from five to two years the
general exclusion period following a Medicare+Choice organization's contract
termination; (3) require the continued computation and annual publication of
Medicare original fee-for-service expenditures for each Medicare+Choice payment
area; (4) direct the Secretary to permit a Medicare+Choice organization to elect
to apply Medicare+Choice premiums provisions uniformly to separate segments of a
service area (rather than uniformly to an entire service area) as long as such
segments are composed of one or more Medicare+Choice payment areas; (5) delay
the deadline for submission of proposed premiums 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 intends to be offered in
the following year; (6) reduce the adjustment in the national per capita
Medicare+Choice growth percentage for 2002 with respect to calculation of annual
Medicare+Choice capitation rates; (7) make additional requirements that a
Medicare+Choice organization may be deemed to meet under specified circumstances
if it is privately accredited; (8) change the timing of Medicare+Choice health
information fairs; (9) require preferred provider organization plans to meet
certain of the quality assurance requirements currently applicable to
Medicare+Choice plans; and (10) include the average number of individuals
enrolled in Medicare+Choice plans during the fiscal year within the formula
limiting the amount of user fees collected by the Secretary in any fiscal year
from each Medicare+Choice organization under contract with the Secretary.
(Sec. 520) Directs MEDPac to study and report to Congress on appropriate
quality improvement standards that should apply to: (1) described
Medicare+Choice plans, including coordinated care plans; and (2) the original
Medicare fee-for-service program under Medicare parts A and B.
(Sec. 521) Amends SSA title XVIII part D to provide that, in the case of a
discharge plan for an individual enrolled with a Medicare+Choice organization
under a Medicare+Choice plan who is furnished inpatient hospital services by a
hospital under a contract with the organization, the discharge planning
evaluation is not required to include information on the availability of home
health services through individuals and entities which do not have a contract
with the organization. Allows the plan to specify or limit the provider or
providers of post-hospital home health services or other post-hospital services
under the plan.
(Sec. 524) Amends SSA title XVIII part D to exempt a Medicare+Choice
organization offering a coordinate care plan from the limitation on certain
physician referrals.
Subtitle C: Demonstration Projects and Special Medicare Populations -
Amends the Omnibus Budget Reconciliation Acts of 1987 and of 1993 to: (1) extend
the authority for the social health maintenance organizations (SHMOs)
demonstration project; and (2) authorize the Secretary to impose an aggregate
limit of not less than 324,000 for all sites (currently, the Secretary is
prohibited from imposing a limit of less than 12,000 on the number of
individuals that may participate in a single project site.)
(Sec. 532) Extends certain Medicare community nursing organization
demonstration projects an additional two years.
(Sec. 533) Amends BBA '97 to provide for a delay in implementation of the
Medicare+Choice competitive bidding demonstration project.
(Sec. 534) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985
(COBRA), as amended by BBA '97 and other specified Acts, to extend for two years
the Medicare municipal health services demonstration projects.
(Sec. 535) Amends BBA '97 with regard to Medicare coordinated care
demonstration projects to direct the Secretary to provide for the transfer from
the Medicare trust funds, in appropriate proportions, of such funds as necessary
to cover costs of the project in a cancer hospital. (Currently amounts shall be
available for such hospitals only as provided in any Federal law making
appropriations for the District of Columbia).
(Sec. 536) Amends SSA title XVIII part D to extend to enrollees in programs
of all-inclusive care for the elderly (PACE programs) the Medigap prohibitions
on denial of issuance of Medigap policies, discrimination in policy pricing, and
imposition of an exclusion of benefits based on a pre-existing condition.
Subtitle D: Medicare+Choice Nursing and Allied Health Professional
Education Payments - Amends SSA title XVIII part D to provide for: (1)
payment for nursing and allied health education for managed care enrollees; and
(2) adjustments in payments for direct graduate medical education. Directs the
Secretary to estimate a proportional adjustment in payments for nursing and
allied health education.
Subtitle E: Studies and Reports - Directs the Secretary, jointly with
the Secretaries of Defense and of Veterans Affairs, to report to Congress on the
estimated use of health care services furnished to Medicare beneficiaries by the
Departments of Defense and of Veterans Affairs, including beneficiaries under
the original Medicare fee-for-service program and under the Medicare+Choice
program.
(Sec. 552) Directs MEDPac to study and report to Congress on the development
of a payment methodology under the Medicare+Choice program for frail elderly
beneficiaries enrolled in a Medicare+Choice plan under a specialized program.
Directs MEDPac to report to Congress on specific legislative changes that
should be made to make Medical Savings Account plans a viable option under the
Medicare+Choice program.
(Sec. 553) Directs the Comptroller General to study and report to Congress on
each type of Medigap policy with respect to: (1) the level of coverage provided;
(2) current enrollment levels; (3) policy availability to Medicare beneficiaries
over age 65 <; (4) the number and type of Medigap policies offered in each
State; and (5) the average out-of-pocket costs (including premiums) per
beneficiary.
Directs the Comptroller General to: (1) conduct an annual audit of the
Secretary's expenditures during the preceding year in providing information
regarding the Medicare+Choice program to eligible Medicare beneficiaries; and
(2) report to Congress on the results of such audits of the preceding three
years, together with an evaluation of the effectiveness of the means used by the
Secretary in providing such information.
Title VI: Medicaid - Amends SSA title XIX (Medicaid) to: (1) increase
the DSH allotment for the District of Columbia, Minnesota, New Mexico, and
Wyoming; (2) remove the fiscal year limitation on certain transitional
administrative costs assistance; (3) modify the phase-out of payment for
Federally-qualified health center services and rural health clinic services
based on reasonable costs; (6) provide for parity in reimbursement for certain
utilization and quality control services; (7) eliminate duplicative requirements
for external quality review of Medicaid managed care organizations; (8) make the
enhanced match under the State Children's Health Insurance Program (SCHIP)
inapplicable to Medicaid DSH payments; and (9) provide for the optional
deferment of the effective date for outpatient drug agreements.
(Sec. 603) Directs the Comptroller General to report to Congress on the
effect on Federally-qualified health centers and rural health clinics and on the
populations served by such centers and clinics of the phase-out and elimination
of the reasonable cost basis for payment for Federally-qualified health center
services and rural health clinic services provided.
Amends BBA '97 to make the Medicaid DSH transition rule permanent.
Title VII: State Children's Health Insurance Program (SCHIP) - Amends
SSA title XXI (State Children's Health Insurance Program) (SCHIP) to revise the
SCHIP allotment formula, among other changes revising the floor for State
allotments and adding ceilings.
(Sec. 702) Increases appropriations for FY 2000 through 2007 for U.S.
territories with approved SCHIP plans.
(Sec. 703) Directs the Secretary of Commerce to make appropriate adjustments
to the annual Current Population Survey conducted by the Bureau of the Census in
order to produce statistically reliable annual State data on the number of
low-income children without health insurance coverage, so that real changes in
the uninsurance rates of children can reasonably be detected. Makes
appropriations.
Requires the HHS Secretary to conduct an independent evaluation of ten select
States with approved child health plans, including surveys of enrollees,
disenrollees, and individuals eligible for but not enrolled in SCHIP, and
evaluation of effective and ineffective outreach and enrollment practices with
respect to children. Makes appropriations for FY 2000. Directs the Secretary to
audit a sample from among States with an approved State child health plan to:
(1) determine the number of plan enrollees eligible under Medicaid (other than
as optional targeted low-income children; and (2) assess the progress made in
reducing the number of uncovered low-income children, including the progress
made to achieve the strategic objectives and performance goals in the State
child health plan.
Amends SSA title V (Maternal and Child Health Services) to require each
State's annual reports to the Secretary on its activities under such title to
include information (by racial and ethnic group) on the number of infants in the
State under one year of age who were entitled to benefits under the State SCHIP
plan at any time during the year.
Directs the Secretary to establish a clearinghouse for the consolidation and
the coordination of all Federal databases and reports regarding children's
health.
(Sec. 704) Directs the Secretary or any other Federal officer or employee,
with respect to any reference to the program under SSA title XXI in any
publication or other official communication to use the term "SCHIP" instead of
"CHIP" and the term "State's children's health insurance program" instead of the
term "children's health insurance program."