THIS SEARCH     THIS DOCUMENT     GO TO
Next Hit        Forward           New Bills Search
Prev Hit        Back              HomePage
Hit List        Best Sections     Help
                Doc Contents      

TITLE II--GRADUATE MEDICAL EDUCATION

SEC. 201. REVISION OF MULTIYEAR REDUCTION OF INDIRECT GRADUATE MEDICAL EDUCATION PAYMENTS.

(a) IN GENERAL- Section 1886(d)(5)(B)(ii) (42 U.S.C. 1395ww(d)(5)(B)(ii)) is amended by striking subclauses (III), (IV), and (V) and inserting the following:

`(III) during each of fiscal years 1999 through 2007, `c' is equal to 1.6; and

`(IV) on or after October 1, 2007, `c' is equal to 1.35.'.

(b) EFFECTIVE DATE- The amendments made by subsection (a) shall take effect as if included in section 4621 of the Balanced Budget Act of 1997 (Public Law 105-33; 111 Stat. 475).

SEC. 202. ACCELERATION OF GME PHASE-IN.

(a) ACCELERATION OF PAYMENT TO HOSPITALS OF INDIRECT AND DIRECT MEDICAL EDUCATION COSTS FOR MEDICARE+CHOICE ENROLLEES-

(1) IN GENERAL- Section 1886(h)(3)(D)(ii) (42 U.S.C. 1395ww(h)(3)(D)(ii)) is amended by striking subclauses (IV) and (V) and inserting the following:

`(IV) 100 percent in 2001 and subsequent years.'.

(2) ACCELERATION OF CARVE-OUT- Section 1853(c)(3)(B)(ii) (42 U.S.C. 1395w-23(c)(3)(B)(ii)) is amended--

(A) in subclause (III), by inserting `and' at the end;

(B) by striking subclause (IV); and

(C) by redesignating subclause (V) as subclause (IV).

(b) EFFECTIVE DATE- The amendments made by subsection (a) shall take effect as if included in the enactment of the Balanced Budget Act of 1997 (Public Law 105-33; 111 Stat. 251).

SEC. 203. EXCLUSION OF NURSING AND ALLIED HEALTH EDUCATION COSTS IN CALCULATING MEDICARE+CHOICE PAYMENT RATE.

(a) EXCLUDING COSTS IN CALCULATING PAYMENT RATE-

(1) IN GENERAL- Section 1853(c)(3)(C)(i) (42 U.S.C. 1395w-23(c)(3)(C)(i)) is amended--

(A) in subclause (I), by striking `and' at the end;

(B) in subclause (II), by striking the period at the end and inserting `, and'; and

(C) by adding at the end the following:

`(III) for costs attributable to approved nursing and allied health education programs under section 1861(v).'.

(2) EFFECTIVE DATE- The amendments made by paragraph (1) shall apply in determining the annual per capita rate of payment for years beginning with 2001.

(b) PAYMENT TO HOSPITALS OF NURSING AND ALLIED HEALTH EDUCATION PROGRAM COSTS FOR MEDICARE+CHOICE ENROLLEES- Section 1861(v)(1) (42 U.S.C. 1395x(v)(1)) is amended by adding at the end the following:

`(V)(i) In determining the amount of payment to a hospital for portions of cost reporting periods occurring on or after January 1, 2001, with respect to the reasonable costs for approved nursing and allied health education programs, individuals who are enrolled with a Medicare+Choice organization under part C shall be treated as if they were not so enrolled.

`(ii) The Secretary shall establish rules for applying clause (i) to a hospital reimbursed under a reimbursement system authorized under section 1814(b)(3) in the same manner as it would apply to the hospital if it were not reimbursed under such section.'.

SEC. 204. ADJUSTMENTS TO LIMITATIONS ON NUMBER OF INTERNS AND RESIDENTS.

(a) INDIRECT GRADUATE MEDICAL EDUCATION ADJUSTMENT- Section 1886(d)(5)(B)(v) (42 U.S.C. 1395ww(d)(5)(B)(v)) is amended--

(1) by striking `(v) In determining' and inserting `(v)(I) Subject to subclause (II), in determining';

(2) by striking `in the hospital with respect to the hospital's most recent cost reporting period ending on or before December 31, 1996' and inserting `who were appointed by the hospital's approved medical residency training programs for the hospital's most recent cost reporting period ending on or before December 31, 1996'; and

(3) by adding at the end the following:

`(II) Beginning on or after January 1, 1997, in the case of a hospital that sponsors only 1 allopathic or osteopathic residency program, the limit determined for such hospital under subclause (I) may, at the hospital's discretion, be increased by 1 for each calendar year but shall not exceed a total of 3 more than the limit determined for the hospital under subclause (I).'.

(b) DIRECT GRADUATE MEDICAL EDUCATION ADJUSTMENT-

(1) LIMITATION ON NUMBER OF RESIDENTS- Section 1886(h)(4)(F) (42 U.S.C. 1395ww(h)(4)(F)) is amended by inserting `who were appointed by the hospital's approved medical residency training programs' after `may not exceed the number of such full-time equivalent residents'.

(2) FUNDING FOR PROGRAMS- Section 1886(h)(4)(H)(i) (42 U.S.C. 1395ww(h)(4)(H)(i)) is amended in the second sentence, by inserting `, including facilities that are not located in an underserved rural area but have established separately accredited rural training tracks' before the period.

(c) GME PAYMENTS FOR CERTAIN INTERNS AND RESIDENTS-

(1) INDIRECT AND DIRECT MEDICAL EDUCATION - Each limitation regarding the number of residents or interns for which payment may be made under section 1886 of the Social Security Act (42 U.S.C. 1395ww) is increased by the number of applicable residents (as defined in paragraph (2)).

(2) APPLICABLE RESIDENT DEFINED- In this subsection, the term `applicable resident' means a resident or intern that--

(A) participated in graduate medical education at a facility of the Department of Veterans Affairs;

(B) was subsequently transferred on or after January 1, 1997, and before July 31, 1998, to a hospital and the hospital was not a Department of Veterans Affairs facility; and

(C) was transferred because the approved medical residency program in which the resident or intern participated would lose accreditation by the Accreditation Council on Graduate Medical Education if such program continued to train residents at the Department of Veterans Affairs facility.

(d) EFFECTIVE DATE- This section shall take effect as if included in the enactment of the Balanced Budget Act of 1997 (Public Law 105-33; 111 Stat. 251).

TITLE III--HOSPICE CARE

SEC. 301. INCREASE IN PAYMENTS FOR HOSPICE CARE.

(a) IN GENERAL- Section 1814(i)(1)(C)(ii)(VI) (42 U.S.C. 1395f(i)(1)(C)(ii)(VI)) is amended by striking `through 2002' and inserting `and 1999'.

(b) EFFECTIVE DATE- The amendments made by this section shall take effect as if included in the amendments made by section 4441 of the Balanced Budget Act of 1997 (Public Law 105-33; 111 Stat. 422).

TITLE IV--SKILLED NURSING FACILITIES

SEC. 401. MODIFICATION OF CASE MIX CATEGORIES FOR CERTAIN CONDITIONS.

(a) IN GENERAL- For purposes of applying any formula under paragraph (1) of section 1888(e) of the Social Security Act (42 U.S.C. 1395yy(e)), for services provided on or after April 1, 2000, and before the earlier of October 1, 2001, or the date described in subsection (d), the Secretary of Health and Human Services shall increase the adjusted Federal per diem rate otherwise determined under paragraph (4) of such section for services provided to any individual during the period in which such individual is in a RUG III category by the applicable payment add-on as determined in accordance with the following table:

$23.06

$76.25

$30.36

$54.07

$27.28

$69.98

$30.09

$98.41

$89.05

$46.80

$55.56

$59.94.

(b) UPDATE- The Secretary shall update the applicable payment add-on under subsection (a) for fiscal year 2001 by the skilled nursing facility market basket percentage change (as defined under section 1888(e)(5)(B) of the Social Security Act (42 U.S.C. 1395yy(e)(5)(B))) applicable to such fiscal year.

(c) RULE OF CONSTRUCTION- Nothing in this section shall be construed as permitting the Secretary of Health and Human Services to include any applicable payment add-on determined under subsection (a) in updating the Federal per diem rate under section 1888(e)(4) of the Social Security Act (42 U.S.C. 1395yy(e)(4)).

(d) DATE DESCRIBED- The date described in this subsection is the date that the Secretary of Health and Human Services--

(1) refines the case mix classification system under section 1888(e)(4)(G)(i) of the Social Security Act (42 U.S.C. 1395yy(e)(4)(G)(i)) to better account for medically complex patients; and

(2) implements such refined system.

SEC. 402. EXCLUSION OF CLINICAL SOCIAL WORKER SERVICES AND SERVICES PERFORMED UNDER A CONTRACT WITH A RURAL HEALTH CLINIC OR FEDERALLY QUALIFIED HEALTH CENTER FROM THE PPS FOR SNFs.

(a) IN GENERAL- Section 1888(e)(2)(A)(ii) (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended--

(1) in the first sentence, by inserting `clinical social worker services,' after `qualified psychologist services,'; and

(2) by inserting after the first sentence the following: `Services described in this clause also include services that are provided by a physician, a physician assistant, a nurse practitioner, a qualified psychologist, or a clinical social worker who is employed, or otherwise under contract, with a rural health clinic or a Federally qualified health center.'.

(b) CONFORMING AMENDMENT- Section 1861(hh)(2) (42 U.S.C. 1395x(hh)(2)) is amended by striking `and other than services furnished to an inpatient of a skilled nursing facility which the facility is required to provide as a requirement for participation'.

(c) EFFECTIVE DATE- The amendments made by this section shall apply to services provided on or after the date which is 60 days after the date of enactment of this Act.

SEC. 403. EXCLUSION OF CERTAIN SERVICES FROM THE PPS FOR SNFs.

(a) IN GENERAL- Section 1888(e)(2)(A)(ii) (42 U.S.C. 1395yy(e)(2)(A)(ii)), as amended by section 402, is amended--

(1) in the first sentence, by inserting `ambulance services, services identified by HCPCS code in Program Memorandum Transmittal No. A-98-37 issued in November 1998 (but without regard to the setting in which such services are furnished),' after `subparagraphs (F) and (O) of section 1861(s)(2),'; and

(2) by inserting after the second sentence the following: `In addition to the services described in the previous sentences, services described in this clause include chemotherapy items (identified as of July 1, 1999, by HCPCS codes J9000-J9020, J9040-J9151, J9170-J9185, J9200-J9201, J9206-J9208, J9211, J9230-J9245, and J9265-J9600), chemotherapy administration services (identified as of July 1, 1999, by HCPCS codes 36260-36262, 36489, 36530-36535, 36640, 36823, and 96405-96542), radioisotope services (identified as of July 1, 1999, by HCPCS codes 79030-79440), and customized prosthetic devices (identified as of July 1, 1999, by HCPCS codes L5050-L5340, L5500-L5610, L5613-L5986, L5988, L6050-L6370, L6400-L6880, L6920-L7274, and L7362-L7366).'.

(b) EFFECTIVE DATE- The amendments made by this section shall apply to services furnished on or after the date which is 60 days after the date of enactment of this Act.

SEC. 404. EXCLUSION OF SWING BEDS IN CRITICAL ACCESS HOSPITALS FROM THE PPS FOR SNFs.

(a) IN GENERAL- Section 1888(e)(7) of the Social Security Act (42 U.S.C. 1395yy(e)(7)) is amended--

(1) in the heading, by striking `TRANSITION' and inserting `SPECIAL RULES';

(2) in subparagraph (A), by striking `IN GENERAL- The' and inserting `TRANSITION- Except as provided in subparagraph (C), the'; and

(3) by adding at the end the following:

`(C) EXEMPTION OF SWING BEDS IN CRITICAL ACCESS HOSPITALS FROM PPS- The prospective payment system under this subsection shall not apply (and section 1834(g) shall apply) to services provided by a critical access hospital under an agreement described in subparagraph (B).'.

(b) EFFECTIVE DATE- The amendments made by this section shall apply to services provided on or after October 1, 1999.

TITLE V--OUTPATIENT REHABILITATION SERVICES

SEC. 501. MODIFICATION OF FINANCIAL LIMITATION ON REHABILITATION SERVICES.

(a) 3-YEAR REPEAL- Section 1833(g) (42 U.S.C. 1395l(g)) is amended by adding at the end the following:

`(4) Subject to paragraph (6), the provisions of paragraphs (1) through (3) shall not apply to outpatient physical therapy services, outpatient occupational therapy services, and outpatient speech-language pathology services covered under this title and furnished on or after January 1, 2000.

`(5)(A) Notwithstanding the preceding provisions of this subsection and subject to subparagraph (B), with respect to services described in paragraph (4) that are furnished on or after January 1, 2003, the Secretary shall implement, by not later than January 1, 2003, a payment system for such services that takes into account the needs of beneficiaries under this title for differing amounts of therapy based on factors such as diagnosis, functional status, and prior use of services.

`(B) The payment system established under subparagraph (A) shall be designed so that the system shall not result in any increase or decrease in the expenditures under this title on a fiscal year basis, determined as if paragraph (4) had not been enacted.

`(6) If the Secretary for any reason does not implement the payment system described in paragraph (5) on or before January 1, 2003, paragraph (4) shall not apply with respect to services described in such paragraph that are furnished on or after such date and before the date on which the Secretary implements such payment system.'.

(b) EFFECTIVE DATE- The amendment made by this section shall take effect as if included in the enactment of the Balanced Budget Act of 1997 (Public Law 105-33; 111 Stat. 251).

TITLE VI--PHYSICIANS' SERVICES

SEC. 601. TECHNICAL AMENDMENT TO UPDATE ADJUSTMENT FACTOR AND PHYSICIAN SUSTAINABLE GROWTH RATE.

(a) UPDATE ADJUSTMENT FACTOR-

(1) CHANGE TO CALENDAR YEAR BASIS- Section 1848(d) (42 U.S.C. 1395w-4(d)) is amended--

(A) in paragraph (1), by striking subparagraph (E) and inserting the following:

`(E) PUBLICATION- The Secretary shall publish in the Federal Register--

`(i) not later than November 1 of each year (beginning with 1999), the conversion factor that will apply to physicians' services for the succeeding year and the update determined under paragraph (3) for such year; and

`(ii) not later than November 1 of 1999--

`(I) the special update for the year 2000 under paragraph (3)(E)(i); and

`(II) the estimated special adjustments for years 2001 through 2006 under paragraph (3)(E)(ii).'; and

(B) in paragraph (3)(C)--

(i) in the matter preceding clause (i), by striking `the 12-month period ending with March 31 of';

(ii) in clause (i)--

(I) by striking `1997' and inserting `1996,'; and

(II) by striking `such 12-month period' and inserting `1996'; and

(iii) in clause (ii)--

(I) by inserting a comma after `subsequent year'; and

(II) by striking `fiscal year which begins during such 12-month period' and inserting `year involved'.

(2) FORMULA FOR DETERMINING THE UPDATE ADJUSTMENT FACTOR- Section 1848(d)(3) (42 U.S.C. 1395w-4(d)(3)) is amended--

(A) in subparagraph (A)--

(i) in clause (ii), by striking `(divided by 100),' and inserting a period; and

(ii) by striking the matter following clause (ii);

(B) in subparagraph (B)--

(i) in the matter preceding clause (i), by inserting `the sum of' after `Secretary) to'; and

(ii) by striking clauses (i) and (ii) and inserting the following:

`(i) the figure arrived at by--

`(I) determining the difference between the allowed expenditures for physicians' services for the prior year (as determined under subparagraph (C)) and the actual expenditures for such services for that year;

`(II) dividing that difference by the actual expenditures for such services in that year; and

`(III) multiplying that quotient by 0.75; and

`(ii) the figure arrived at by--

`(I) determining the difference between the allowed expenditures for physicians' services (as determined under subparagraph (C)) from 1996 through the prior year and the actual expenditures for such services during that period, corrected with the best available data;

`(II) dividing that difference by actual expenditures for such services for the prior year as increased by the sustainable growth rate under subsection (f) for the year whose update

adjustment factor is to be determined; and

`(III) multiplying that quotient by 0.33.'; and

(C) by amending subparagraph (D) to read as follows:

`(D) RESTRICTION ON UPDATE ADJUSTMENT FACTOR- The update adjustment factor determined under subparagraph (B) for a year may not be less than negative 0.07 or greater than 0.03.'.

(3) SPECIAL PROVISIONS- Section 1848(d)(3) (42 U.S.C. 1395w-4(d)(3)) is amended--

(A) in subparagraph (A), in the matter preceding clause (i), by striking `subparagraph (D)' and inserting `subparagraphs (D) and (E)'; and

(B) by adding at the end the following:

`(E) SPECIAL UPDATE AND ADJUSTMENTS-

`(i) YEAR 2000- For the year 2000, the update under this paragraph shall be the percentage that the Secretary estimates will, without regard to any otherwise applicable restriction, result in expenditures equal to the expenditures that would have occurred in that year in the absence of the amendments made by section 601 of the Medicare Beneficiary Access to Care Act of 1999.

THIS SEARCH     THIS DOCUMENT     GO TO
Next Hit        Forward           New Bills Search
Prev Hit        Back              HomePage
Hit List        Best Sections     Help
                Doc Contents