HR 5296 IH

To amend title XVIII of the Social Security Act to revise and improve the Medicare Program.

September 26, 2000

Mr. ENGLISH introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committees on Commerce, the Budget, and Rules, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

To amend title XVIII of the Social Security Act to revise and improve the Medicare Program.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the `Medicare Quality Assurance Act of 2000'.

TITLE I--MEDICARE FEE FOR SERVICE PAYMENT IMPROVEMENTS

SEC. 101. REVISION OF PPS HOSPITAL PAYMENT UPDATE.

Section 1886(b)(3)(B)(i) of the Social Security Act (42 U.S.C. 1395ww(b)(3)(B)(i)) is amended--

(1) in subclause (XV), by adding `and' at the end;

(2) by striking subclauses (XVI) and (XVII);

(3) by redesignating subclause (XVIII) as subclause (XVI); and

(4) in subclause (XVI), as so redesignated, by striking `fiscal year 2003' and inserting `fiscal year 2001'.

SEC. 102. REVISION OF REDUCTION OF INDIRECT GRADUATE MEDICAL EDUCATION PAYMENTS.

(a) IN GENERAL- Section 1886(d)(5)(B)(ii) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(ii)) is amended--

(1) in subclause (IV), by striking `fiscal year 2000' and inserting `each of fiscal years 2000 and 2001'; and

(2) in each of subclauses (V) and (VI), by striking `2001' and inserting `2002'.

(b) TECHNICAL AMENDMENTS- Section 1886(d)(5)(B) of such Act (42 U.S.C. 1395ww(d)(5)(B)), as amended by paragraph (1), is amended--

(1) by realigning the left margins of clauses (ii) and (v) so as to align with the left margin of clause (i); and

(2) by realigning the left margins of subclauses (I) through (V) of clause (ii) appropriately.

SEC. 103. INCREASE IN MARKET BASKET PERCENTAGE INCREASE FOR FISCAL YEAR 2001.

(a) IN GENERAL- Section 1888(e)(4)(E)(ii) of the Social Security Act (42 U.S.C. 1395yy(e)(4)(E)(ii)) is amended--

(1) by redesignating subclause (III) as subclause (IV);

(2) by striking subclause (II); and

(3) by inserting after subclause (I) the following new subclauses:

`(II) for fiscal year 2001, the rate computed for fiscal year 2000 increased by the skilled nursing facility market basket percentage change for fiscal year 2000 plus 4 percentage points;

`(III) for fiscal year 2002, the rate computed for fiscal year 2001 increased by the skilled nursing facility market basket percentage change for fiscal year 2001 minus 1 percentage point; and'.

(b) REVISED DEFINITION OF SKILLED NURSING FACILITY MARKET BASKET INDEX; ANNUAL WAGE SURVEY FOR PERIODS AFTER 1998-

(1) REQUIRING USE OF ACTUAL COSTS INCURRED BY FACILITIES- Section 1888(e)(5)(A) of such Act (42 U.S.C. 1395yy(e)(5)(A)) is amended by adding at the end the following: `Such index shall be based, in appropriate part, on actual increases in the cost of wages incurred by skilled nursing facilities in furnishing covered skilled nursing facility services.

(2) REQUIRING ANNUAL SURVEYS OF COSTS- For purposes of determining (under the second sentence of section 1888(e)(5)(A)) the actual increases in the cost of wages incurred by skilled nursing facilities in furnishing covered skilled nursing facility services the Secretary of Health and Human Services shall conduct annual surveys of such costs for

purposes of revising and updating the skilled nursing facility market basket index under such section.

SEC. 104. ELIMINATION OF 15 PERCENT REDUCTION IN PAYMENT RATES UNDER THE MEDICARE PROSPECTIVE PAYMENT SYSTEM FOR HOME HEALTH SERVICES.

(a) IN GENERAL- Section 1895(b)(3)(A) of the Social Security Act (42 U.S.C. 1395fff(b)(3)(A)), as amended by sections 302(b) and 303(f) of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (113 Stat. 1501A-359, 361), as enacted into law by section 1000(a)(6) of Public Law 106-113, is amended to read as follows:

`(A) INITIAL BASIS- Under such system the Secretary shall provide for computation of a standard prospective payment amount (or amounts). Such amount (or amounts) shall initially be based on the most current audited cost report data available to the Secretary and shall be computed in a manner so that the total amounts payable under the system for the 12-month period beginning on the date the Secretary implements the system shall be equal to the total amount that would have been made if the system had not been in effect and if section 1861(v)(1)(L)(ix) had not been enacted. Each such amount shall be standardized in a manner that eliminates the effect of variations in relative case mix and area wage adjustments among different home health agencies in a budget neutral manner consistent with the case mix and wage level adjustments provided under paragraph (4)(A). Under the system, the Secretary may recognize regional differences or differences based upon whether or not the services or agency are in an urbanized area.'.

(b) EFFECTIVE DATE- The amendment made by subsection (a) shall take effect as if included in the enactment of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (Public Law 106-113).

SEC. 105. TWO-YEAR EXTENSION OF MORATORIUM IN CAPS FOR THERAPY SERVICES.

(a) EXTENSION OF MORATORIUM- Section 1833(g)(4) of the Social Security Act (42 U.S.C. 1395l(g)(4)), as added by section 221(a) of Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (113 Stat. 1501A-351), is amended by striking `and 2001' and inserting `through 2003'.

(b) EXTENSION OF REPORT- Section 4541(d)(2) of Balanced Budget Act of 1997, as amended by section 221(c) of Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (113 Stat. 1501A-351), is amended by striking `January 1, 2001' and inserting `January 1, 2002'.

TITLE II--MEDICARE+CHOICE PROGRAM IMPROVEMENTS

SEC. 201. ELIMINATION OF BUDGET NEUTRALITY ADJUSTMENT FOR 2001 AND 2002.

Section 1853(c) of the Social Security Act (42 U.S.C. 1395w-23(c)) is amended--

(1) in paragraph (1)(A) in the matter following clause (ii), by inserting `for a year (other than 2001 or 2002)' after `multiplied'; and

(2) in paragraph (5), by inserting `(other than 2001 or 2002)' after `for each year'.

SEC. 202. INCREASING MINIMUM PAYMENT AMOUNT.

(a) IN GENERAL- Section 1853(c)(1)(B)(ii) of the Social Security Act (42 U.S.C. 1395w-23(c)(1)(B)(ii)) is amended--

(1) by striking `(ii) For a succeeding year' and inserting `(ii)(I) Subject to subclause (II), for a succeeding year'; and

(2) by adding at the end the following new subclause:

`(II) For 2001 for any of the 50 States and the District of Columbia, $450.'.

(b) EFFECTIVE DATE- The amendments made by subsection (a) apply to years beginning with 2001.

SEC. 203. ALLOWING MOVEMENT TO 50:50 PERCENT BLEND IN 2002.

Section 1853(c)(2) of the Social Security Act (42 U.S.C. 1395w-23(c)(2)) is amended--

(1) by striking the period at the end of subparagraph (F) and inserting a semicolon; and

(2) by adding after and below subparagraph (F) the following:

`except that a Medicare+Choice organization may elect to apply subparagraph (F) (rather than subparagraph (E)) for 2001 and for 2002.'.

SEC. 204. INCREASED UPDATE FOR PAYMENT AREAS WITH ONLY ONE OR NO MEDICARE+CHOICE CONTRACTS.

(a) IN GENERAL- Section 1853(c)(1)(C)(ii) of the Social Security Act (42 U.S.C. 1395w-23(c)(1)(C)(ii)) is amended--

(1) by striking `(ii) For a subsequent year' and inserting `(ii)(I) Subject to subclause (II), for a subsequent year'; and

(2) by adding at the end the following new subclause:

`(II) During 2001, 2002, 2003, 2004, and 2005, in the case of a Medicare+Choice payment area in which there is no more than one contract entered into under this part as of July 1 before the beginning of the year, 102.5 percent of the annual Medicare+Choice capitation rate under this paragraph for the area for the previous year.'.

(b) CONSTRUCTION- The amendments made by subsection (a) do not affect the payment of a first time bonus under section 1853(i) of the Social Security Act (42 U.S.C. 1395w-23(i)).

SEC. 205. PERMITTING HIGHER NEGOTIATED RATES IN CERTAIN MEDICARE+CHOICE PAYMENT AREAS BELOW NATIONAL AVERAGE.

Section 1853(c)(1) of the Social Security Act (42 U.S.C. 1395w-23(c)(1)) is amended--

(1) in the matter before subparagraph (A), by striking `or (C)' and inserting `(C), or (D)'; and

(2) by adding at the end the following new subparagraph:

`(D) PERMITTING HIGHER RATES THROUGH NEGOTIATION-

`(i) IN GENERAL- For each year beginning with 2004, in the case of a Medicare+Choice payment area for which the Medicare+Choice capitation rate under this paragraph would otherwise be less than the United States per capita cost (USPCC), as calculated by the Secretary, a Medicare+Choice organization may negotiate with the Secretary an annual per capita rate that--

`(I) reflects an annual rate of increase up to the rate of increase specified in clause (ii);

`(II) takes into account audited current data supplied by the organization on its adjusted community rate (as defined in section 1854(f)(3)); and

`(III) does not exceed the United States per capita cost, as projected by the Secretary for the year involved.

`(ii) MAXIMUM RATE DESCRIBED- The rate of increase specified in this clause for a year is the rate of inflation in private health insurance for the year involved, as projected by the Secretary, and includes such adjustments as may be necessary--

`(I) to reflect the demographic characteristics in the population under this title; and

`(II) to eliminate the costs of prescription drugs.

`(iii) ADJUSTMENTS FOR OVER OR UNDER PROJECTIONS- If subparagraph is applied to an organization and payment area for a year, in applying this subparagraph for a subsequent year the provisions of paragraph (6)(C) shall apply in the same manner as such provisions apply under this paragraph.'.

TITLE III--SOCIAL SECURITY AND MEDICARE LOCK-BOX

SEC. 301. SHORT TITLE.

This title may be cited as the `Social Security and Medicare Lock-box Act of 2000'.

SEC. 302. PROTECTION OF SOCIAL SECURITY SURPLUSES.

(a) POINTS OF ORDER TO PROTECT SOCIAL SECURITY SURPLUSES- Section 312 of the Congressional Budget Act of 1974 is amended by adding at the end the following new subsection:

`(g) POINTS OF ORDER TO PROTECT SOCIAL SECURITY SURPLUSES-

`(1) CONCURRENT RESOLUTIONS ON THE BUDGET- It shall not be in order in the House of Representatives or the Senate to consider any concurrent resolution on the budget, or conference report thereon or amendment thereto, that would set forth an on-budget deficit for any fiscal year.

`(2) SUBSEQUENT LEGISLATION- Except as provided by paragraph (3), it shall not be in order in the House of Representatives or the Senate to consider any bill, joint resolution, amendment, motion, or conference report if--

`(A) the enactment of that bill or resolution as reported;

`(B) the adoption and enactment of that amendment; or

`(C) the enactment of that bill or resolution in the form recommended in that conference report,

would cause or increase an on-budget deficit for any fiscal year.

`(3) EXCEPTION- Paragraph (2) shall not apply to social security reform legislation as defined in section 304(1) or Medicare reform legislation as defined by section 304(2).

`(4) DEFINITION- For purposes of this section, the term `on-budget deficit', when applied to a fiscal year, means the deficit in the budget as set forth in the most recently agreed to concurrent resolution on the budget pursuant to section 301(a)(3) for that fiscal year.'.

(b) CONTENT OF CONCURRENT RESOLUTION ON THE BUDGET- Section 301(a) of the Congressional Budget Act of 1974 is amended by redesignating paragraphs (6) and (7) as paragraphs (7) and (8), respectively, and by inserting after paragraph (5) the following new paragraph:

`(6) the receipts, outlays, and surplus or deficit in the Federal Old-Age and Survivors Insurance Trust Fund and the Federal Disability Insurance Trust Fund, combined, established by title II of the Social Security Act;'.

(c) SUPER MAJORITY REQUIREMENT- (1) Section 904(c)(1) of the Congressional Budget Act of 1974 is amended by inserting `312(g),' after `310(d)(2),'.

(2) Section 904(d)(2) of the Congressional Budget Act of 1974 is amended by inserting `312(g),' after `310(d)(2),'.

SEC. 303. PROTECTION OF MEDICARE SURPLUSES.

(a) POINTS OF ORDER TO PROTECT MEDICARE SURPLUSES- Section 312 of the Congressional Budget Act of 1974, as amended by section 301, is further amended by adding at the end the following new subsection:

`(h) POINTS OF ORDER TO PROTECT MEDICARE SURPLUSES-

`(1) CONCURRENT RESOLUTIONS ON THE BUDGET- It shall not be in order in the House of Representatives or the Senate to consider any concurrent resolution on the budget, or conference report thereon or amendment thereto, that would set forth an on-budget surplus for any fiscal year that is less than the projected surplus of the Federal Hospital Insurance Trust Fund for that fiscal year (as assumed in that resolution).

`(2) SUBSEQUENT LEGISLATION- Except as provided by paragraph (3), it shall not be in order in the House of Representatives or the Senate to consider any bill, joint resolution, amendment, motion, or conference report if--

`(A) the enactment of that bill or resolution as reported;

`(B) the adoption and enactment of that amendment; or

`(C) the enactment of that bill or resolution in the form recommended in that conference report,

would cause the on-budget surplus for any fiscal year to be less than the projected surplus of the Federal Hospital Insurance Trust Fund (as assumed in the most recently agreed to concurrent resolution on the budget) for that fiscal year or increase the amount by which the on-budget surplus for any fiscal year would be less than such trust fund surplus for that fiscal year.

`(3) EXCEPTION- Paragraph (2) shall not apply to Medicare reform legislation as defined in section 304(2) of the Social Security and Medicare Lock-box Act of 2000.

`(4) DEFINITION- For purposes of this section, the term `on-budget surplus', when applied to a fiscal year, means the surplus in the budget as set forth in the most recently agreed to concurrent resolution on the budget pursuant to section 301(a)(3) for that fiscal year.'.

(b) SUPER MAJORITY REQUIREMENT-

(1) POINT OF ORDER- Section 904(c)(1) of the Congressional Budget Act of 1974 (as amended by section 3) is further amended by inserting `312(h),' after `312(g),'.

(2) WAIVER- Section 904(d)(2) of the Congressional Budget Act of 1974 (as amended by section 3) is further amended by inserting `312(h),' after `312(g),'.

SEC. 304. DEFINITIONS.

As used in this Act:

(1) SOCIAL SECURITY REFORM LEGISLATION- The term `social security reform legislation' means a bill or a joint resolution to save social security and includes a provision stating the following: `For purposes of the Social Security and Medicare Lock-box Act of 2000, this Act constitutes social security reform legislation to save social security.'.

(2) MEDICARE REFORM LEGISLATION- The term `Medicare reform legislation' means a bill or a joint resolution to save Medicare and includes a provision stating the following: `For purposes of the Social Security and Medicare Lock-box Act of 2000, this Act constitutes Medicare reform legislation to save Medicare.'.

SEC. 305. EFFECTIVE DATE.

(a) IN GENERAL- This Act shall take effect upon the date of its enactment and the amendments made by this Act shall apply to fiscal year 2001 and subsequent fiscal years.

(b) EXPIRATION- (1) Sections 301(a)(6) and 312(g) of the Congressional Budget Act of 1974 shall expire upon the enactment of social security reform legislation.

(2) Section 312(h) of the Congressional Budget Act of 1974 shall expire upon the enactment of Medicare reform legislation.

END