THIS SEARCH THIS DOCUMENT GO TO
Next Hit Forward New Bills Search
Prev Hit Back HomePage
Hit List Best Sections Help
Doc Contents
H.R.3426
Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999
(Introduced in the House)
Subtitle D--Medicare+Choice Nursing and Allied Health Professional Education Payments
SEC. 541. MEDICARE+CHOICE NURSING AND ALLIED HEALTH PROFESSIONAL EDUCATION PAYMENTS.
(a) ADDITIONAL PAYMENTS FOR NURSING AND ALLIED HEALTH EDUCATION - Section 1886 (42 U.S.C.
1395ww) is amended by adding at the end the following new subsection:
`(l) PAYMENT FOR NURSING AND ALLIED HEALTH EDUCATION FOR MANAGED CARE
ENROLLEES-
`(1) IN GENERAL- For portions of cost reporting periods occurring in a
year (beginning with 2000), the Secretary shall provide for an additional
payment amount for any hospital that receives payments for the costs of
approved educational activities for nurse and allied health professional
training under section 1861(v)(1).
`(2) PAYMENT AMOUNT- The additional payment amount under this subsection
for each hospital for portions of cost reporting periods occurring in a year
shall be an amount specified by the Secretary in a manner consistent with
the following:
`(A) DETERMINATION OF MANAGED CARE ENROLLEE PAYMENT RATIO FOR GRADUATE MEDICAL EDUCATION PAYMENTS- The Secretary
shall estimate the ratio of payments for all hospitals for portions of
cost reporting periods occurring in the year under subsection (h)(3)(D) to
total direct graduate medical education payments estimated for
such portions of periods under subsection (h)(3).
`(B) APPLICATION TO FEE-FOR-SERVICE NURSING AND ALLIED HEALTH EDUCATION PAYMENTS- Such ratio
shall be applied to the Secretary's estimate of total payments for nursing
and allied health education
determined under section 1861(v) for portions of cost reporting periods
occurring in the year to determine a total amount of additional payments
for nursing and allied health education to be distributed to
hospitals under this subsection for portions of cost reporting periods
occurring in the year; except that in no case shall such total amount
exceed $60,000,000 in any year.
`(C) APPLICATION TO HOSPITAL- The amount of payment under this
subsection to a hospital for portions of cost reporting periods occurring
in a year is equal to the total amount of payments determined under
subparagraph (B) for the year multiplied by the Secretary's estimate of
the ratio of the amount of payments made under section 1861(v) to the
hospital for nursing and allied health education activities for the
hospital's cost reporting period ending in the second preceding fiscal
year to the total of such amounts for all hospitals for such cost
reporting periods.'.
(b) ADJUSTMENTS IN PAYMENTS FOR DIRECT GRADUATE MEDICAL EDUCATION - Section 1886(h)(3)(D) (42
U.S.C. 1395ww(h)(3)(D)) is amended--
(1) in clause (i), by inserting `, subject to clause (iii),' after
`shall equal';
(2) by redesignating clause (iii) as clause (iv); and
(3) by inserting after clause (ii) the following new clause:
`(iii) PROPORTIONAL REDUCTION FOR NURSING AND ALLIED HEALTH EDUCATION - The Secretary shall
estimate a proportional adjustment in payments to all hospitals
determined under clauses (i) and (ii) for portions of cost reporting
periods beginning in a year (beginning with 2000) such that the
proportional adjustment reduces payments in an amount for such year
equal to the total additional payment amounts for nursing and allied
health education
determined under subsection (l) for portions of cost reporting periods
occurring in that year.'.
Subtitle E--Studies and Reports
SEC. 551. REPORT ON ACCOUNTING FOR VA AND DOD EXPENDITURES FOR MEDICARE
BENEFICIARIES.
Not later April 1, 2001, the Secretary of Health and Human Services,
jointly with the Secretaries of Defense and of Veterans Affairs, shall submit
to Congress a report on the estimated use of health care services furnished by
the Departments of Defense and of Veterans Affairs to medicare beneficiaries,
including both beneficiaries under the original medicare fee-for-service
program and under the Medicare+Choice program. The report shall include an
analysis of how best to properly account for expenditures for such services in
the computation of Medicare+Choice capitation rates.
SEC. 552. MEDICARE PAYMENT ADVISORY COMMISSION STUDIES AND REPORTS.
(a) DEVELOPMENT OF SPECIAL PAYMENT RULES UNDER THE MEDICARE+CHOICE PROGRAM
FOR FRAIL ELDERLY ENROLLED IN SPECIALIZED PROGRAMS-
(1) STUDY- The Medicare Payment Advisory Commission shall conduct a
study on the development of a payment methodology under the Medicare+Choice
program for frail elderly Medicare+Choice beneficiaries enrolled in a
Medicare+Choice plan under a specialized program for the frail elderly
that--
(A) accounts for the prevalence, mix, and severity of chronic
conditions among such frail elderly Medicare+Choice
beneficiaries;
(B) includes medical
diagnostic factors from all provider settings (including hospital and
nursing facility settings); and
(C) includes functional indicators of health status and such other
factors as may be necessary to achieve appropriate payments for plans
serving such beneficiaries.
(2) REPORT- Not later than 1 year after the date of the enactment of
this Act, the Commission shall submit a report to Congress on the study
conducted under paragraph (1), together with any recommendations for
legislation that the Commission determines to be appropriate as a result of
such study.
(b) 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 Assessment Commission shall submit to Congress a report on specific
legislative changes that should be made to make MSA plans (as defined in
section 1859(b)(3) of the Social Security Act, 42 U.S.C. 1395w-29(b)(3)) a
viable option under the Medicare+Choice program.
SEC. 553. GAO STUDIES, AUDITS, AND REPORTS.
(a) STUDY OF MEDIGAP POLICIES-
(1) IN GENERAL- The Comptroller General of the United States (in this
section referred to as the `Comptroller General') shall conduct a study of
the issues described in paragraph (2) regarding medicare supplemental
policies described in section 1882(g)(1) of the Social Security Act (42
U.S.C. 1395ss(g)(1)).
(2) ISSUES TO BE STUDIED- The issues described in this paragraph are the
following:
(A) The level of coverage provided by each type of medicare
supplemental policy.
(B) The current enrollment levels in each type of medicare
supplemental policy.
(C) The availability of each type of medicare supplemental policy to
medicare beneficiaries over age 65 1/2 .
(D) The number and type of medicare supplemental policies offered in
each State.
(E) The average out-of-pocket costs (including premiums) per
beneficiary under each type of medicare supplemental policy.
(2) REPORT- Not later than July 31, 2001, the Comptroller General shall
submit a report to Congress on the results of the study conducted under this
subsection, together with any recommendations for legislation that the
Comptroller General determines to be appropriate as a result of such
study.
(b) GAO AUDIT AND REPORTS ON THE PROVISION OF MEDICARE+CHOICE HEALTH
INFORMATION TO BENEFICIARIES-
(1) IN GENERAL- Beginning in 2000, the Comptroller General shall conduct
an annual audit of the expenditures by the Secretary of Health and Human
Services during the preceding year in providing information regarding the
Medicare+Choice program under part C of title XVIII of the Social Security
Act (42 U.S.C. 1395w-21 et seq.) to eligible medicare beneficiaries.
(3) REPORTS- Not later than March 31 of 2001, 2004, 2007, and 2010, the
Comptroller General shall submit a report to Congress on the results of the
audit of the expenditures of the preceding 3 years conducted pursuant to
subsection (a), together with an evaluation of the effectiveness of the
means used by the Secretary of Health and Human Services in providing
information regarding the Medicare+Choice program under part C of title
XVIII of the Social Security Act (42 U.S.C. 1395w-21 et seq.) to eligible
medicare beneficiaries.
TITLE VI--MEDICAID
SEC. 601. INCREASE IN DSH ALLOTMENT FOR CERTAIN STATES AND THE DISTRICT OF
COLUMBIA.
(a) IN GENERAL- The table 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) in the entry for the District of Columbia, by striking `23' and
inserting `32';
(2) in the entry for Minnesota, by striking `16' and inserting
`33';
(3) in the entry for New Mexico, by striking `5' and inserting `9';
and
(4) in the entry for Wyoming, by striking `0' and inserting `0.1'.
(b) EFFECTIVE DATE- The amendments made by subsection (a) take effect on
October 1, 1999, and applies to expenditures made on or after such date.
SEC. 602. 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. 603. MODIFICATION OF THE PHASE-OUT OF PAYMENT FOR FEDERALLY-QUALIFIED
HEALTH CENTER SERVICES AND RURAL HEALTH CLINIC SERVICES BASED ON REASONABLE
COSTS.
(a) MODIFICATION OF PHASE-OUT-
(1) IN GENERAL- Section 1902(a)(13)(C)(i) (42 U.S.C. 1396a(a)(13)(C)(i))
is amended by striking `90 percent for services furnished during fiscal year
2001, 85 percent for services furnished during fiscal year 2002, or 70
percent for services furnished during fiscal year 2003' and inserting
`fiscal year 2001, or fiscal year 2002, 90 percent for services furnished
during fiscal year 2003, or 85 percent for services furnished during fiscal
year 2004'.
(2) CONFORMING AMENDMENT TO END OF TRANSITIONAL PAYMENT RULES- Section
4712(c) of BBA (111 Stat. 509) is amended by striking `2003' and inserting
`2004'.
(3) EFFECTIVE DATE- The amendments made by this subsection shall take
effect as if included in the enactment of section 4712 of BBA (111 Stat.
508).
(b) GAO STUDY AND REPORT- Not later than 1 year after the date of the
enactment of this Act, the Comptroller General of the United States shall
submit a report to Congress that evaluates 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 under section 1902(a)(13)(C)(i) of the Social
Security Act (42 U.S.C. 1396a(a)(13)(C)(i)), as amended by section 4712 of BBA
(111 Stat. 508) and subsection (a) of this section. Such report shall include
an analysis of the amount, method, and impact of payments made by States that
have provided for payment under title XIX of such Act for such services on a
basis other than payment of costs which are reasonable and related to the cost
of furnishing such services, together with any recommendations for
legislation, including whether a new payment system is needed, that the
Comptroller General determines to be appropriate as a result of the study.
SEC. 604. PARITY IN REIMBURSEMENT FOR CERTAIN UTILIZATION AND QUALITY
CONTROL SERVICES; ELIMINATION OF DUPLICATIVE REQUIREMENTS FOR EXTERNAL QUALITY
REVIEW OF MEDICAID MANAGED CARE ORGANIZATIONS.
(a) PARITY IN REIMBURSEMENT FOR CERTAIN UTILIZATION AND QUALITY CONTROL
SERVICES-
(1) INTERIM AMENDMENT TO REMOVE REFERENCES TO QUALITY REVIEW- Section
1902(d) (42 U.S.C. 1396a(d)) is amended by striking `for the performance of
the quality review functions described in subsection (a)(30)(C),'.
(2) FINAL AMENDMENTS TO REMOVE REFERENCES TO QUALITY REVIEW-
(A) SECTION 1902- Section 1902(d) (42 U.S.C. 1396a(d)) is amended by
striking `(including quality review functions described in subsection
(a)(30)(C))'.
(B) SECTION 1903- Section 1903(a)(3)(C)(i) (42 U.S.C.
1396b(a)(3)(C)(i)) is amended by striking `or quality review'.
(b) ELIMINATION OF DUPLICATIVE REQUIREMENTS FOR EXTERNAL QUALITY REVIEW OF
MEDICAID MANAGED CARE ORGANIZATIONS-
(1) IN GENERAL- 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) CONFORMING AMENDMENT- Section 1903(m)(6)(B) (42 U.S.C.
1396b(m)(6)(B)) is amended--
(A) in clause (ii), by adding `and' at the end;
(B) in clause (iii), by striking `; and' and inserting a period;
and
(C) by striking clause (iv).
(1) The amendment made by subsection (a)(1) applies to expenditures made
on and after the date of the enactment of this Act.
(2) The amendments made by subsections (a)(2) and (b) apply as of such
date as the Secretary of Health and Human Services certifies to Congress
that the Secretary is fully implementing section 1932(c)(2) of the Social
Security Act (42 U.S.C. 1396u-2(c)(2)).
SEC. 605. INAPPLICABILITY OF ENHANCED MATCH UNDER THE STATE CHILDREN'S
HEALTH INSURANCE PROGRAM TO MEDICAID DSH PAYMENTS.
(a) IN GENERAL- 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'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) takes effect on
October 1, 1999, and applies to expenditures made on or after such date.
SEC. 606. OPTIONAL DEFERMENT OF THE EFFECTIVE DATE FOR OUTPATIENT DRUG
AGREEMENTS.
(a) IN GENERAL- 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'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) applies to
agreements entered into on or after the date of enactment of this Act.
SEC. 607. MAKING MEDICAID DSH TRANSITION RULE PERMANENT.
(a) IN GENERAL- Section 4721(e) of BBA (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 new paragraph:
`(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 subsection (a) shall take
effect as if included in the enactment of section 4721(e) of BBA.
SEC. 608. MEDICAID TECHNICAL CORRECTIONS.
(a) Section 1902(a)(64) (42 U.S.C. 1396a(a)(64)) is amended by adding
`and' at the end.
(b) Section 1902(j) (42 U.S.C. 1396a(j)) is amended by striking `of of'
and inserting `of'.
(c) Section 1902(l) (42 U.S.C. 1396a(l)) is amended--
(1) in paragraph (1)(C), by striking `children children' and inserting
`children';
(2) in paragraph (3), in the matter preceding subparagraph (A), by
striking the first comma after `(a)(10)(A)(i)(VII)'; and
(3) in paragraph (4)(B), by inserting a comma after
`(a)(10)(A)(i)(IV)'.
(d) Section 1902(v) (42 U.S.C. 1396a(v)) is amended by striking `(1)'.
(e) Section 1903(b)(4) (42 U.S.C. 1396b(b)(4)) is amended, in the matter
preceding subparagraph (A), by inserting `of' after `for the use'.
(f) The left margins of clauses (i) and (ii) of section 1903(d)(3)(B) (42
U.S.C. 1396b(d)(3)(B)) are each realigned so as to align with the left margin
of section 1903(d)(3)(A).
(g) Section 1903(f)(2) (42 U.S.C. 1396b(f)(2)) is amended by striking the
extra period at the end.
(h) Section 1903(i)(14) (1396b(i)(14)) is amended by adding `or' after the
semicolon.
(i) Section 1903(m)(2)(A) (42 U.S.C. 1396b(m)(2)(A)) is amended--
(1) in clause (vi), by striking the semicolon the first place it
appears; and
(2) by redesignating the clause (xi) added by section 4701(c)(3) of BBA
(111 Stat. 493) as clause (xii).
(j) Section 1903(o) (42 U.S.C. 1396b(o)) is amended by striking `1974))'
and inserting `1974)'.
(k) Section 1903(w) (42 U.S.C. 1396b(w)) is amended--
(1) in paragraph (1)(B), by striking `puroses' and inserting
`purposes';
(2) in paragraph (3)(B), by inserting a comma after `(D)'; and
(3) by realigning the left margin of clause (viii) in paragraph (7)(A)
so as to align with the left margin of clause (vii) of that paragraph.
(l) Section 1905(b)(1) (42 U.S.C. 1396d(b)(1)) is amended by striking `per
centum,,' and inserting `per centum,'.
(m) Section 1905(l)(2)(B) (42 U.S.C. 1936d(l)(2)(B)) is amended by
striking `a entity' and inserting `an entity'.
(n) The heading for section 1910 (42 U.S.C. 1396i) is amended by striking
`OF' the first place it appears.
(o) Section 1915 (42 U.S.C. 1396n) is amended--
(1) in subsection (b), by striking `1902(a)(13)(E)' and inserting
`1902(a)(13)(C)';
(2) in the last sentence of subsection (d)(5)(B)(iii), by striking `75'
and inserting `65'; and
(3) in subsection (h), by striking `90 day' and inserting `90
days'.
(p) Section 1919 (42 U.S.C. 1396r) is amended--
(1) in subsection (b)(3)(C)(i)(I), by striking `not later than' the
first place it appears; and
(2) in subsection (d)(4)(A), by striking `1124' and inserting
`1124)'.
THIS SEARCH THIS DOCUMENT GO TO
Next Hit Forward New Bills Search
Prev Hit Back HomePage
Hit List Best Sections Help
Doc Contents