SUMMARY AS OF:
9/14/1999--Introduced.
TABLE OF CONTENTS:
- Title I: Teaching Hospitals
- Title II: Rural Hospitals
- Title III: Safety Net Providers
- Title IV: Other Hospital Provisions
- Title V: Skilled Nursing Facilities
- Title VI: Cost-Efficient Home Health Providers
- Title VII: Medicare+Choice and Medigap Protections for Seniors and the
Disabled
- Title VIII: Medicare Preservation Through Fraud Prevention
Health Care Preservation Act of 1999 - Title I: Teaching Hospitals -
Amends title XVIII (Medicare) of the Social Security Act (SSA) with respect to
the following: (1) termination of multiyear reduction of indirect graduate
medical education payments; and (2) exclusion of nursing and allied health
education costs in calculating payments to Medicare+Choice organizations under
Medicare part C.
Title II: Rural Hospitals - Amends SSA title XVIII to: (1) revise the
criteria for designation as a critical access hospital under provisions for the
Medicare rural hospital flexibility program; (2) provide authority under
Medicare part B (Supplementary Medical Insurance) provisions for payment of
benefits for the establishment of a prospective payment system (PPS) for rural
health clinic services; (3) require consideration of rural issues in
establishing the fee schedule for ambulance services under Medicare part B; and
(4) set the applicable percentage at 100 percent with respect to covered
outpatient department (OPD) services furnished during a transition year in a
rural hospital pursuant to the provisions below in title IV of this Act that
provide for a multiyear transition to the PPS for hospital OPD services under
Medicare part B.
Title III: Safety Net Providers - Amends SSA title XIX (Medicaid) to
establish a new PPS for federally-qualified health centers and rural health
clinics under Medicaid.
(Sec. 302) Amends SSA title XVIII to: (1) provide for the removal of payments
attributable to disproportionate share (DSH) payments from calculation of
adjusted average per capita cost in determining payments to Medicare+Choice
organizations; (2) provide additional payments for managed care enrollees under
Medicare part D (Miscellaneous) provisions for payment to hospitals for
inpatient hospital services; and (3) place a limitation on the reduction of
payments to DSH hospitals.
Title IV: Other Hospital Provisions - Amends SSA title XVIII to
provide for: (1) delay of the financial limitation on rehabilitation services
under Medicare part B provisions for the payment of benefits; and (2) multiyear
transition to the PPS for hospital OPD services under Medicare part B.
Title V: Skilled Nursing Facilities - Directs the Secretary of Health
and Human Services (HHS), for purposes of applying the formula under the PPS for
determining the amount of payment for the costs of covered skilled nursing
facility (SNF) services provided on or after a certain time period, to increase
the adjusted Federal per diem rate under such PPS for services provided to any
individual in a RUG III category by the applicable payment add-on determined in
accordance with an outlined table.
(Sec. 502) Excludes ambulance services furnished to an individual in
conjunction with a renal dialysis service, and prosthetic and orthotic devices
from the PPS for SNFs.
(Sec. 503) Directs the Secretary to: (1) cover under extended care services
provisions of Medicare part A (Hospital Insurance) individuals with a condition
classifiable within a specified diagnosis-related group; (2) study and report to
Congress on extended care services provided in SNFs for which coverage is
provided under the Medicare select program; (3) establish certain extended care
services demonstration programs; (4) require the application of any deductibles
and coinsurance under Medicare part A upon waiver of the three day
hospitalization stay requirement and beginning with the first day of extended
care services in a SNF; (5) reduce the amount of any deductible or coinsurance
applied based on certain criteria; and (6) reduce amounts otherwise payable
under Medicare part A for post-hospital extended care services under specified
conditions.
Provides that in the case of an individual eligible for Medicaid nursing
facility service assistance, Medicaid shall apply as if this title had not been
enacted.
(Sec. 504) Authorizes the extension of certain Medicare community nursing
organization demonstration projects under the Omnibus Budget Reconciliation Act
of 1987.
Title VI: Cost-Efficient Home Health Providers - Amends the Balanced
Budget Act of 1997 (BBA '97), as amended by the Tax and Trade Relief Extension
Act of 1998, to delay for an additional year the contingency reduction scheduled
under BBA '97 with regard to payment for home health services.
(Sec. 602) Amends SSA title XVIII to eliminate the 15-minute reporting
requirement under the PPS for home health services with regard to the length of
time of the service visit.
(Sec. 603) Outlines provisions for recoupment by the Secretary of
overpayments to home health agencies for certain home health services.
(Sec. 604) Amends SSA title XVIII to provide for an increase in the per visit
cost limit with respect to payment for services furnished by home health
agencies.
Title VII: Medicare+Choice and Medigap Protections for Seniors and the
Disabled - Amends SSA title XVIII to provide for: (1) a two year (currently,
one year) period during which an individual may be enrolled in a Medicare+Choice
plan under Medicare part C and then terminate such enrollment for enrollment in
a Medicare supplemental (Medigap) policy; (2) modification of coverage
enrollment periods for such plans and policies with regard to individual
notification of plan or policy termination; (3) guaranteed issuance of certain
Medigap policies in cases of a substantial change in benefits under a
Medicare+Choice plan, of certain Medigap policies to disabled Medicare+Choice
disenrollees, and of the same Medigap benefit package for certain
Medicare+Choice disenrollees; and (4) prohibition of attained-age rating of
premiums for Medigap policies.
Title VIII: Medicare Preservation through Fraud Prevention - Amends
SSA title XVIII to provide for: (1) site inspections for suppliers of durable
medical equipment (DME), community mental health centers, and other provider
groups as determined by the Secretary; (2) background checks on applicants for
provider numbers; and (3) registration of billing agencies and individuals.
(Sec. 803) Amends SSA title XI to provide for exclusion of applicable persons
from participation in Federal health care programs if such a person submitted a
fraudulent claim for reimbursement under Medicare.
Provides for: (1) expanded access to the database maintained through the
national health care fraud and abuse data collection program; and (2) a criminal
penalty for misuse of database information.
(Sec. 804) Amends SSA title XVIII to make Medicare carriers and fiscal
intermediaries liable for claims submitted by excluded providers.
(Sec. 805) Revises Medicare provisions on community mental health centers.
(Sec. 806) Amends SSA title XI to: (1) limit the discharge of debts in
bankruptcy proceedings in cases where a health care provider or a supplier
engages in fraudulent activity; and (2) impose a criminal penalty for the
selling or distribution of two or more Medicare or Medicaid beneficiary
identification or provider numbers.
(Sec. 808) Amends the Federal criminal code to provide for the treatment of
certain SSA crimes as Federal health care offenses.
(Sec. 809) Authorizes any criminal investigator of the HHS' Inspector
General's (IG's) Office, upon designation, to execute a variety of specified
duties, including obtaining and executing any warrant or other process issued
under the authority of the United States, while engaged in activities within the
lawful jurisdiction of the IG. Provides that the HHS IG may receive and expend
funds that represent the equitable share from the forfeiture of property in
investigations in which the HHS IG participated, and that are transferred to the
HHS IG by the Departments of Justice or the Treasury or the U.S. Postal Service.
Requires such equitable sharing funds to be deposited in a separate account and
to remain available until expended.
(Sec. 810) Outlines requirements for universal product numbers (UPN's, or bar
codes) on claims forms for Medicare reimbursement of any UPN covered item.
Authorizes appropriations.