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S.1788
Medicare, Medicaid, and SCHIP Adjustment Act of 1999 (Placed on the
Calendar in the Senate)
Subtitle B--Graduate Medical Education
SEC. 321. 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 2003, `c' is equal
to 1.6; and
`(IV) on or after October 1, 2003, `c' is equal to
1.35.'.
(b) EFFECTIVE DATE- The amendment made by this section shall take effect
on October 1, 1999.
SEC. 322. GME PAYMENTS FOR CERTAIN INTERNS AND RESIDENTS.
(a) 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 subsection (b)).
(b) APPLICABLE RESIDENT DEFINED- For purposes of this section, the term
`applicable resident' means a resident or intern that--
(1) participated in graduate medical education at a facility of the
Department of Veterans Affairs;
(2) 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
(3) 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.
(1) IN GENERAL- 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).
(2) RETROACTIVE PAYMENTS- If the Secretary of Health and Human Services
determines that a hospital operating an approved medical residency program is owed
payments as a result of enactment of this section, the Secretary shall make
such payments not later than 60 days after the date of enactment of this
section.
TITLE IV--RURAL INITIATIVES
SEC. 401. SOLE COMMUNITY HOSPITALS AND MEDICARE DEPENDENT HOSPITALS.
(a) IN GENERAL- Section 1886(b)(3)(B)(iv) (42 U.S.C. 1395ww(b)(3)(B)(iv))
is amended--
(1) in subclause (III), by striking `and' at the end;
(A) by striking `fiscal year 1996 and each subsequent fiscal year' and
inserting `fiscal years 1996 through 1999'; and
(B) by striking the period at the end and inserting `, and';
and
(3) by adding at the end the following:
`(V) for fiscal year 2000 and each subsequent fiscal year, the market
basket percentage increase.'.
(b) EFFECTIVE DATE- The amendments made by this section shall take effect
on October 1, 1999.
SEC. 402. REVISION OF CRITERIA FOR DESIGNATION AS A CRITICAL ACCESS
HOSPITAL.
(a) CRITERIA FOR DESIGNATION- Section 1820(c)(2)(B)(iii) (42 U.S.C.
1395i-4(c)(2)(B)(iii)) is amended by striking `to exceed 96 hours' and all
that follows before the semicolon and inserting `to exceed, on average, 96
hours per patient'.
(b) EFFECTIVE DATE- The amendment made by this section shall take effect
on October 1, 1999.
SEC. 403. MEDICARE WAIVERS FOR HOSPITALS IN RURAL AREAS.
Notwithstanding section 1886(d)(2)(D) of the Social Security Act (42
U.S.C. 1395ww(d)(2)(D)), by not later than 180 days after the date of
enactment of this Act, the Secretary of Health and Human Services shall
establish a waiver process in which hospitals under the medicare program under
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) that are
determined by the Office of Management and Budget to be located in an urban or
large urban area for purposes of reimbursement under the medicare program may
apply to the Secretary to be considered to be located in a rural area for such
purposes if such hospital is located--
(1) in a rural area within a metropolitan county, as defined by the most
recent update of the Goldsmith Modification; or
(2) in a rural area as determined by using a census tract definition of
a rural area adopted by the Office of Rural Health Policy in awarding
grants.
SEC. 404. 2-YEAR EXTENSION OF MEDICARE DEPENDENT HOSPITAL (MDH)
PROGRAM.
(a) EXTENSION OF PAYMENT METHODOLOGY- Section 1886(d)(5)(G) (42 U.S.C.
1395ww(d)(5)(G)) is amended--
(1) in clause (i), by striking `and before October 1, 2001,' and
inserting `and before October 1, 2003'; and
(2) in clause (ii)(II), by striking `and before October 1, 2001,' and
inserting `and before October 1, 2003'.
(b) CONFORMING AMENDMENTS-
(1) EXTENSION OF TARGET AMOUNT- Section 1886(b)(3)(D) (42 U.S.C.
1395ww(b)(3)(D)) is amended--
(A) in the matter preceding clause (i), by striking `and before
October 1, 2001,' and inserting `and before October 1, 2003'; and
(B) in clause (iv), by striking `during fiscal year 1998 through
fiscal year 2000' and inserting `during fiscal year 1998 through fiscal
year 2002'.
(2) PERMITTING HOSPITALS TO DECLINE RECLASSIFICATION- Section
13501(e)(2) of Omnibus Budget Reconciliation Act of 1993 (42 U.S.C. 1395ww
note) is amended by striking `or fiscal year 2000' and inserting `or fiscal
years 2000 through 2002'.
SEC. 405. ASSISTING RURAL GRADUATE MEDICAL EDUCATION RESIDENCY PROGRAMS.
(a) INDIRECT GRADUATE MEDICAL EDUCATION ADJUSTMENT-
(1) IN GENERAL- Section 1886(d)(5)(B)(v) of the Social Security Act (42
U.S.C. 1395ww(d)(5)(B)(v)) (as added by section 4621(b) of the Balanced
Budget Act of 1997) is amended--
(A) by striking `(v) In determining' and inserting `(v)(I) Subject to
subclause (II), in determining';
(B) 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
(C) 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).'.
(2) TECHNICAL AMENDMENTS- Section 1886(d)(5)(B) of the Social Security
Act (42 U.S.C. 1395ww(d)(5)(B)) is amended by realigning the left margin of
clauses (ii), (v), and (vi) so as to align with the left margin of clause
(i).
(b) DIRECT GRADUATE MEDICAL EDUCATION ADJUSTMENT-
(1) LIMITATION ON NUMBER OF RESIDENTS- Section 1886(h)(4)(F) of the
Social Security Act (42 U.S.C. 1395ww(h)(4)(F)) (as added by section 4623 of
the Balanced Budget Act of 1997) 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 NEW PROGRAMS- The first sentence of section
1886(h)(4)(H)(i) of the Social Security Act (42 U.S.C. 1395ww(h)(4)(H)(i))
(as added by section 4623 of the Balanced Budget Act of 1997) is amended by
inserting `and before September 30, 1999' after `January 1, 1995'.
(3) FUNDING FOR PROGRAMS MEETING RURAL NEEDS- The second sentence of
section 1886(h)(4)(H)(i) of the Social Security Act (42 U.S.C.
1395ww(h)(4)(H)(i)) (as added by section 4623 of the Balanced Budget Act of
1997) is amended by striking the period at the end and inserting `,
including facilities that are not located in an underserved rural area but
have established separately accredited rural training tracks.'.
(c) EFFECTIVE DATE- The amendments made by this Act shall take effect as
if included in the enactment of the Balanced Budget Act of 1997.
TITLE V--PROVISIONS RELATING TO PART C (MEDICARE+CHOICE
PROGRAM)
Subtitle A--Provisions To Accommodate and Protect Medicare
Beneficiaries
SEC. 501. PERMITTING ENROLLMENT IN ALTERNATIVE MEDICARE+CHOICE PLANS AND
MEDIGAP COVERAGE IN CASE OF INVOLUNTARY TERMINATION OF MEDICARE+CHOICE
ENROLLMENT.
(a) MEDICARE+CHOICE PLANS- Section 1851(e)(4) (42 U.S.C. 1395w-21(e)(4))
is amended by striking subparagraph (A) and inserting the following:
`(A)(i) the certification of the organization or plan under this part
has been terminated, or the organization or plan has notified the
individual of an impending termination of such certification; or
`(ii) the organization has terminated or otherwise discontinued
providing the plan in the area in which the individual resides, or has
notified the individual of an impending termination or discontinuation of
such plan;'.
(b) MEDIGAP PLANS- Section 1882(s)(3)(A) (42 U.S.C. 1395ss(s)(3)(A)) is
amended, in the matter following clause (iii)--
(1) by inserting `(or, if elected by the individual, the date of
notification of the individual by the plan or organization of the impending
termination or discontinuance of the plan in the area in which the
individual resides)' after `the date of the termination of enrollment
described in such subparagraph'; and
(2) by inserting `(or the date of such notification)' after `the date of
termination or disenrollment'.
(c) EFFECTIVE DATE- The amendments made by this section shall apply to
notices of impending terminations or discontinuances made by group health
plans and Medicare+Choice organizations on or after the date of enactment of
this Act.
SEC. 502. CHANGE IN EFFECTIVE DATE OF ELECTIONS AND CHANGES OF ELECTIONS OF
MEDICARE+CHOICE PLANS.
(a) OPEN ENROLLMENT- Section 1851(f)(2) (42 U.S.C. 1395w-21(f)(2)) is
amended--
(1) by inserting `or change' before `is made'; and
(2) by inserting `, except that if such election or change is made after
the 10th day of any calendar month, then the election or change shall not
take effect until the first day of the second calendar month following the
date on which the election or change is made' before the period.
(b) EFFECTIVE DATE- The amendments made by this section shall apply to
elections and changes of coverage made on or after the date of enactment of
this Act.
SEC. 503. EXTENSION OF REASONABLE COST CONTRACTS.
Section 1876(h)(5)(B) (42 U.S.C. 1395mm(h)(5)(B)) is amended to read as
follows:
`(B) The Secretary may not extend or renew a reasonable cost reimbursement
contract under this subsection for any period beyond December 31, 2004, and an
individual may not be enrolled in a plan offered by an organization pursuant
to such a contract after December 31, 2003, unless such individual was
enrolled in such plan on such date.'.
SEC. 504. REVISION OF NOTICE BY HOSPITALS REGARDING COVERAGE OF INPATIENT
HOSPITAL SERVICES.
(a) IN GENERAL- Section 1866(a)(1)(M) (42 U.S.C. 1395cc(a)(1)(M)) is
amended--
(1) in the matter preceding clause (i), by striking `at or about the
time of the individual's admission as an inpatient to the hospital' and
inserting `at least 16 but not more than 24 hours before the hospital
proposes to discharge the individual from the hospital';
(i) by inserting `to the appropriate peer review organization' after
`hospital services'; and
(ii) by striking `and' at the end;
(3) by redesignating clause (iv) as clause (v); and
(4) by inserting the following after clause (iii):
`(iv) in the case of an individual enrolled in a Medicare+Choice plan
offered by a Medicare+Choice organization under part C, such information, as
determined by the Secretary, regarding the individual's appeal rights that
is in addition to the information described in clause (iii), and'.
(b) EFFECTIVE DATE- The amendments made by this section shall apply to
admissions occurring on or after the date of enactment of this Act.
SEC. 505. EXTENDED DISENROLLMENT WINDOW FOR CERTAIN INVOLUNTARILY TERMINATED
ENROLLEES.
(a) IN GENERAL- Section 1882(s)(3)(B) (42 U.S.C. 1395ss(s)(3)(B)) is
amended by adding at the end the following flush sentence:
`If any individual is enrolled with any Medicare+Choice organization under
clause (v), or in any Medicare+Choice plan under clause (vi), and the
Medicare+Choice plan in which the individual is enrolled is terminated or such
individual is disenrolled from such plan under the circumstances described in
section 1851(e)(4)(A), such individual may reenroll for a 12-month period
(beginning on the date of such enrollment) with a Medicare+Choice organization
in a Medicare+Choice plan, and such reenrollment shall be considered an
enrollment under clause (v) or (vi) (as applicable).'.
(b) EFFECTIVE DATE- The amendments made by this section shall apply to
terminations or disenrollments occurring on or after the date of enactment of
this Act.
Subtitle B--Provisions To Facilitate Implementation of the
Medicare+Choice Program
SEC. 521. MODERATION OF MEDICARE+CHOICE RISK ADJUSTMENT IMPLEMENTATION.
Section 1853(a)(3)(C) (42 U.S.C. 1395w-23(a)(3)(C)) is amended--
(1) by redesignating the first sentence as clause (i) with the heading
`IN GENERAL- ' and appropriate indentation; and
(2) by adding at the end the following:
`(ii) PHASE-IN- Such risk adjustment methodology shall be
implemented in a phased-in manner so that the new methodology applies
only to--
`(I) 10 percent of the payment amount in 2000 and 2001 (in which
the risk adjustment methodology should reflect only data from
inpatient settings);
`(II) 20 percent of such amount in 2002 (in which such methodology
should reflect only data from inpatient settings);
`(III) 30 percent of such amount in 2003 (in which such
methodology should reflect only data from inpatient
settings);
`(IV) 55 percent of such amount in 2004 (in which such methodology
should reflect a blend of 67 percent of only data from inpatient
settings and 33 percent of data from inpatient and other
settings);
`(V) 80 percent of such amount in 2005 (in which such methodology
should reflect a blend of 33 percent of only data from inpatient
settings and 67 percent of data from inpatient and other settings);
and
`(VI) 100 percent of such amount in any subsequent year (in which
such methodology should reflect data from inpatient and other
settings).'.
SEC. 522. DELAY IN DEADLINE FOR SUBMISSION OF ADJUSTED COMMUNITY RATES UNDER
MEDICARE+CHOICE PROGRAM AND RELATED MODIFICATIONS.
(a) DELAY IN DEADLINE FOR SUBMISSION OF ADJUSTED COMMUNITY RATES- Section
1854(a)(1) (42 U.S.C. 1395w-24(a)(1)) is amended by striking `May 1' and
inserting `July 1' in the matter preceding subparagraph (A).
(b) ADJUSTMENT IN INFORMATION DISCLOSURE PROVISIONS TO CONFORM TO DELAY IN
DEADLINE FOR ACR SUBMISSION- Section 1851(d)(2)(A)(ii) (42 U.S.C.
1395w-21(d)(2)(A)(ii)) is amended--
(1) by inserting after `information described in paragraph (4)
concerning such plans' the following: `, to the extent such information is
available at the time of preparation of the material for mailing'; and
(2) by adding at the end the following: `If any item described in
paragraph (4) is not available at the time of preparation of the material
for mailing, the Secretary shall provide general information concerning such
item.'.
(c) MEDICARE+CHOICE ORGANIZATION REQUIRED TO PROVIDE TERMINATION NOTICE BY
DATE FOR ACR SUBMISSION- Section 1857(c)(1) (42 U.S.C. 1395w-27(c)(1)) is
amended--
(1) by striking `Each contract' and inserting the following:
`(A) IN GENERAL- Each contract'; and
(2) by adding at the end the following:
`(B) TERMINATION NOTICE- If a Medicare+Choice organization intends to
terminate a contract under this section at the end of the current term of
the contract, the organization shall notify the Secretary of such intent
by not later than July 1 of such term.'.
(1) ACR AND INFORMATION DISCLOSURE- The amendments made by subsections
(a) and (b) shall apply to submissions required to be made on or after the
date of enactment of this Act.
(2) TERMINATION NOTICE- The amendment made by subsection (c) shall apply
to contract years beginning on or after the date of enactment of this
Act.
SEC. 523. USER FEE FOR MEDICARE+CHOICE ORGANIZATIONS BASED ON NUMBER OF
ENROLLED BENEFICIARIES.
(a) DETERMINATION- Section 1857(e)(2) (42 U.S.C. 1395w-27(e)(2)) is
amended to read as follows:
`(2) COST-SHARING IN ENROLLMENT-RELATED COSTS-
`(A) IN GENERAL- A Medicare+Choice organization shall pay the fee
established by the Secretary under subparagraph (B)(i).
`(i) IN GENERAL- The Secretary is authorized to charge a fee to each
Medicare+Choice organization with a contract under this part that is
equal to the organization's pro rata share (as determined by the
Secretary) of the aggregate amount of fees which the Secretary is
directed to collect in a fiscal year (as determined under clause
(ii)).
`(ii) AGGREGATE AMOUNT OF FEES TO BE COLLECTED- For purposes of
clause (i), the aggregate amount of fees which the Secretary is directed
to collect in a fiscal year is an amount equal to the applicable
percentage of the aggregate expenses incurred by the Secretary in
carrying out the sections described in clause (iii)(I) in such year. For
purposes of the preceding sentence, the applicable percentage in a
fiscal year is equal to the ratio (expressed as a percentage)
of--
`(I) the total number of individuals enrolled in Medicare+Choice
plans in such year; to
`(II) the total number of individuals enrolled in part A or B in
such year.
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