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S.3165
Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 2000
(Introduced in the Senate)
SEC. 302. REVISION OF REDUCTION OF INDIRECT GRADUATE MEDICAL EDUCATION PAYMENTS.
(a) REVISION- Section 1886(d)(5)(B)(ii) (42 U.S.C. 1395ww(d)(5)(B)(ii)) is
amended--
(A) by striking `fiscal year 2001' and inserting `each of fiscal years
2001 and 2002'; and
(B) by striking `equal to 1.54' and inserting `equal to 1.6';
and
(2) in subclause (VI), by striking `2001' and inserting `2002'.
(b) SPECIAL RULE FOR PAYMENT FOR FISCAL YEAR 2001- Notwithstanding
paragraph (5)(B)(ii)(V) of section 1886(d) of the Social Security Act (42
U.S.C. 1395ww(d)(5)(B)(ii)(V)) (as amended by subsection (a)), for purposes of
making payments for fiscal year 2001 for subsection (d) hospitals (as defined
in paragraph (1)(B) of such section) with indirect costs of medical education , the indirect teaching
adjustment factor referred to in paragraph (5)(B)(ii) of such section shall be
determined--
(1) for discharges occurring on or after October 1, 2000, and before
April 1, 2001, in accordance with paragraph (5)(B)(ii)(V) of such section as
in effect on the day before the date of enactment of this Act; and
(2) for discharges occurring on or after April 1, 2001, and before
October 1, 2001, as if `c' in such paragraph equalled 1.66.
(c) CONFORMING AMENDMENT RELATING TO DETERMINATION OF STANDARDIZED AMOUNT-
Section 1886(d)(2)(C)(i) (42 U.S.C. 1395ww(d)(2)(C)(i)) is amended--
(1) by striking `1997' and inserting `1997,'; and
(2) by inserting `, or any additional payments under such paragraph
resulting from the application of section 302 of the Medicare, Medicaid, and
SCHIP Balanced Budget Refinement Act of 2000' after `Balanced Budget
Refinement Act of 1999'.
(d) CLERICAL AMENDMENTS- Section 1886(d)(5)(B) (42 U.S.C.
1395ww(d)(5)(B)), as amended by subsection (a), is amended by moving the
indentation of each of the following 2 ems to the left:
(1) Clauses (ii), (v), and (vi).
(2) Subclauses (I) through (VI) of clause (ii).
(3) Subclauses (I) and (II) of clause (vi) and the flush sentence at the
end of such clause.
SEC. 303. DECREASE IN REDUCTIONS FOR DISPROPORTIONATE SHARE HOSPITAL
PAYMENTS.
(a) IN GENERAL- Section 1886(d)(5)(F)(ix) (42 U.S.C. 1395ww(d)(5)(F)(ix))
is amended--
(1) in subclause (III), by striking `each of fiscal years 2000 and 2001'
and inserting `fiscal year 2000';
(2) by redesignating subclauses (IV) and (V) as subclauses (V) and (IV),
respectively;
(3) in subclause (V), as redesignated, by striking `4 percent' and
inserting `3 percent'; and
(4) by inserting after subclause (III) the following new
subclause:
`(IV) during fiscal year 2001, such additional payment amount shall be
reduced by 2 percent;'.
(b) SPECIAL RULE FOR DSH PAYMENT- Notwithstanding the amendments made by
subsection (a), for purposes of making disproportionate share payments for
subsection (d) hospitals (as defined in section 1886(d)(1)(B) of the Social
Security Act (42 U.S.C. 1395ww(d)(1)(B)) for fiscal year 2001, the additional
payment amount otherwise determined under clause (ii) of section 1886(d)(5)(F)
of the Social Security Act (42 U.S.C. 1395ww(d)(5)(F))--
(1) for discharges occurring on or after October 1, 2000, and before
April 1, 2001, shall be adjusted as provided by clause (ix)(III) of such
section as in effect on the day before the date of enactment of this Act;
and
(2) for discharges occurring on or after April 1, 2001, and before
October 1, 2001, shall, instead of being adjusted as provided by clause
(ix)(IV) of such section as in effect after the date of enactment of this
Act, shall be decreased by 1 percent.
(c) CONFORMING AMENDMENTS RELATING TO DETERMINATION OF STANDARDIZED
AMOUNT- Section 1886(d)(2)(C)(iv) (42 U.S.C. 1395ww(d)(2)(C)(iv)), is
amended--
(1) by striking `1989 or' and inserting `1989,'; and
(2) by inserting `, or the enactment of section 303 of the Medicare,
Medicaid, and SCHIP Balanced Budget Further Refinement Act of 2000' after
`Omnibus Budget Reconciliation Act of 1990'.
SEC. 304. MODIFICATION OF PAYMENT RATE FOR PUERTO RICO HOSPITALS.
(a) MODIFICATION OF PAYMENT RATE- Section 1886(d)(9)(A) (42 U.S.C.
1395ww(d)(9)(A)) is amended--
(1) in clause (i), by striking `October 1, 1997, 50 percent (' and
inserting `October 1, 2000, 25 percent (for discharges between October 1,
1997, and September 30, 2000, 50 percent,'; and
(2) in clause (ii), in the matter preceding subclause (I), by striking
`after October 1, 1997, 50 percent (' and inserting `after October 1, 2000,
75 percent (for discharges between October 1, 1997, and September 30, 2000,
50 percent,'.
(b) SPECIAL RULE FOR PAYMENT FOR FISCAL YEAR 2001-
(1) IN GENERAL- Notwithstanding the amendment made by subsection (a),
for purposes of making payments for the operating costs of inpatient
hospital services of a section 1886(d) Puerto Rico hospital for fiscal year
2001, the amount referred to in the matter preceding clause (i) of section
1886(d)(9)(A) of the Social Security Act (42 U.S.C. 1395ww(d)(9)(A))--
(A) for discharges occurring on or after October 1, 2000, and before
April 1, 2001, shall be determined in accordance with such section as in
effect on the day before the date of enactment of this Act; and
(B) for discharges occurring on or after April 1, 2001, and before
October 1, 2001, shall be determined--
(i) using 0 percent of the Puerto Rico adjusted DRG prospective
payment rate referred to in clause (i) of such section; and
(ii) using 100 percent of the discharge-weighted average referred to
in clause (ii) of such section.
(2) SECTION 1886(d) PUERTO RICO HOSPITAL- For purposes of this
subsection, the term `section 1886(d) Puerto Rico hospital' has the meaning
given the term `subsection (d) Puerto Rico hospital' in the last sentence of
section 1886(d)(9)(A) of the Social Security Act (42 U.S.C.
1395ww(d)(9)(A)).
SEC. 305. MEDPAC STUDY AND REPORT ON HOSPITAL AREA WAGE INDEXES.
(1) IN GENERAL- The Medicare Payment Advisory Commission established
under section 1805 of the Social Security Act (42 U.S.C. 1395b-6) (in this
section referred to as `MedPAC') shall conduct a study on the hospital area
wage indexes used in making payments to hospitals under section 1886(d) of
the Social Security Act (42 U.S.C. 1395ww(d)), including an assessment of
the accuracy of those indexes in reflecting geographic differences in wage
and wage-related costs of hospitals.
(2) CONSIDERATIONS- In conducting the study under paragraph (1), MedPAC
shall consider--
(A) the appropriate method for determining hospital area wage
indexes;
(B) the appropriate portion of hospital payments that should be
adjusted by the applicable area wage index;
(C) the appropriate method for adjusting the wage index by
occupational mix; and
(D) the feasibility and impact of making changes (as determined
appropriate by MedPAC) to the methods used to determine such indexes,
including the need for a data system required to implement such
changes.
(b) REPORT- Not later than 18 months after the date of enactment of this
Act, MedPAC shall submit a report to the Secretary of Health and Human
Services and Congress on the study conducted under subsection (a) together
with such recommendations for legislation and administrative action as MedPAC
determines appropriate.
SEC. 306. MEDPAC STUDY AND REPORT REGARDING CERTAIN HOSPITAL COSTS.
(1) IN GENERAL- The Medicare Payment Advisory Commission established
under section 1805 of the Social Security Act (42 U.S.C. 1395b-6) (in this
section referred to as `MedPAC') shall conduct a study on--
(A) any increased costs incurred by subsection (d) hospitals (as
defined in paragraph (1)(B) of section 1886(d) of the Social Security Act
(42 U.S.C. 1395ww(d))) in providing inpatient hospital services to
medicare beneficiaries under title XVIII of such Act during the period
beginning on October 1, 1983, and ending on September 30, 1999, that were
attributable to--
(i) complying with new blood safety measure requirements;
and
(ii) providing such services using new technologies;
(B) the extent to which the prospective payment system for such
services under such
section provides adequate and timely recognition of such increased costs;
(C) the prospects for (and to the extent practicable, the magnitude
of) cost increases that hospitals will incur in providing such services
that are attributable to complying with new blood safety measure
requirements and providing such services using new technologies during the
10 years after the date of enactment of this Act; and
(D) the feasibility and advisability of establishing mechanisms under
such payment system to provide for more timely and accurate recognition of
such cost increases in the future.
(2) CONSULTATION- In conducting the study under this section, MedPAC
shall consult with representatives of the blood community, including
(B) organizations involved in the collection, processing, and delivery
of blood; and
(C) organizations involved in the development of new blood safety
technologies.
(b) REPORT- Not later than 1 year after the date of enactment of this Act,
MedPAC shall submit a report to the Secretary of Health and Human Services and
Congress on the study conducted under subsection (a) together with such
recommendations for legislation and administrative action as MedPAC determines
appropriate.
Subtitle B--PPS Exempt Hospitals
SEC. 311. PERMANENT GUARANTEE OF PRE-BBA PAYMENT LEVELS FOR OUTPATIENT
SERVICES FURNISHED BY CHILDREN'S HOSPITALS.
(a) IN GENERAL- Section 1833(t) (42 U.S.C. 1395l(t)) is amended--
(1) in the heading of paragraph (7)(D)(ii), by inserting `AND CHILDREN'S
HOSPITALS' after `CANCER HOSPITALS'; and
(2) in paragraphs (7)(D)(ii) and (11), by striking `section
1886(d)(1)(B)(v)' and inserting `clause (iii) or (v) of section
1886(d)(1)(B)'.
(b) EFFECTIVE DATE- The amendments made by subsection (a) apply as if
included in the enactment of section 202 of BBRA.
SEC. 312. PAYMENT FOR INPATIENT SERVICES OF REHABILITATION HOSPITALS.
(a) ASSISTANCE WITH ADMINISTRATIVE COSTS ASSOCIATED WITH COMPLETION OF
PATIENT ASSESSMENT- Section 1886(j)(3)(B) (42 U.S.C. 1395ww(j)(3)(B)) is
amended by striking `98 percent' and inserting `100 percent for fiscal year
2001 and 98 percent for fiscal year 2002'.
(b) ELECTION TO APPLY FULL PROSPECTIVE PAYMENT RATE WITHOUT PHASE-IN-
(1) IN GENERAL- Paragraph (1) of section 1886(j) (42 U.S.C. 1395ww(j))
is amended--
(A) in subparagraph (A), by inserting `other than a facility making an
election under subparagraph (F)' before `, in a cost reporting
period';
(B) in subparagraph (B), by inserting `or, in the case of a facility
making an election under subparagraph (F), for any cost reporting period
described in such subparagraph,' after `2002,'; and
(C) by adding at the end the following new subparagraph:
`(F) ELECTION TO APPLY FULL PROSPECTIVE PAYMENT SYSTEM- A
rehabilitation facility may elect, at least 30 days before the first date
on which the payment methodology under this subsection applies, to have
payment made to the facility under this subsection under the provisions of
subparagraph (B) (rather than subparagraph (A)) for each cost reporting
period to which such payment methodology applies.'.
(2) CLARIFICATION- Paragraph (3)(B) of such section is amended by
inserting `but not taking into account any payment adjustment resulting from
an election permitted under paragraph (1)(F)' after `paragraphs (4) and
(6)'.
(c) EFFECTIVE DATE- The amendments made by this section take effect as if
included in the enactment of BBA.
SEC. 313. IMPLEMENTATION OF PROSPECTIVE PAYMENT SYSTEM FOR LONG-TERM CARE
HOSPITALS.
(a) MODIFICATION OF REQUIREMENT- In developing the prospective payment
system required under section 123 of BBRA (113 Stat. 1501A-331), the Secretary
of Health and Human Services shall examine the feasibility and the impact of
basing payment under such system on the use of existing (or refined) hospital
diagnosis-related groups (DRGs) and the use of the most recently available
hospital discharge data.
(b) DEFAULT IMPLEMENTATION OF SYSTEM BASED ON EXISTING DRG METHODOLOGY- If
the Secretary is unable to implement the prospective payment system described
in subsection (a) by October 1, 2002, the Secretary shall implement a
prospective payment system for long-term care hospitals that bases payment
under such a system using existing hospital diagnosis-related groups (DRGs),
consistent with subsection (a), for such services furnished on or after that
date.
Subtitle C--Skilled Nursing Facilities
SEC. 321. REVISION TO THE SKILLED NURSING FACILITY (SNF) MARKET BASKET
UPDATE FOR FISCAL YEARS 2001 AND 2002.
(a) REVISION- Section 1888(e)(4)(E)(ii)(II) of the Social Security Act (42
U.S.C. 1395yy(e)(4)(E)(ii)(II)) is amended by striking `minus 1 percentage
point' and inserting `plus 1 percentage point'.
(b) SPECIAL RULE FOR PAYMENT FOR SKILLED NURSING FACILITY SERVICES FOR
FISCAL YEAR 2001- Notwithstanding the amendment made by subsection (a), for
purposes of making payments for covered skilled nursing facility services
under section 1888(e) of the Social Security Act (42 U.S.C. 1395yy(e)) for
fiscal year 2001, the Federal per diem rate referred to in paragraph
(4)(E)(ii) of such section--
(1) for the period beginning on October 1, 2000, and ending on March 31,
2001, shall be the rate determined in accordance with subclause (II)
of
such paragraph as in effect on the day before the date of enactment of this
Act; and
(2) for the period beginning on April 1, 2001, and ending on September
30, 2001, shall be the rate computed for fiscal year 2000 pursuant to
subclause (I) of such paragraph increased by the skilled nursing facility
market basket percentage change for fiscal year 2001 plus 3 percentage
points.
SEC. 322. APPLICATION OF SNF CONSOLIDATED BILLING REQUIREMENT LIMITED TO
PART A COVERED STAYS.
(a) IN GENERAL- Section 1862(a)(18) (42 U.S.C. 1395y(a)(18)) is amended by
inserting after `(as determined under regulations)' the following: `during a
period in which the resident is provided covered post-hospital extended care
services'.
(b) CONFORMING AMENDMENTS- (1) Section 1842(b)(6)(E) (42 U.S.C.
1395u(b)(6)(E)) is amended by striking `in the case of an item or service
(other than services described in section 1888(e)(2)(A)(ii))' and inserting
`in the case of services described in section 1861(s)(2)(D)'.
(2) Section 1866(a)(1)(H)(ii)(I) (42 U.S.C. 1395cc(a)(1)(H)(ii)(I)) is
amended by inserting after `who is a resident of the skilled nursing facility'
the following: `during a period in which the resident is provided covered
post-hospital extended care services (or, for services described in section
1861(s)(2)(D), that are furnished to such an individual without regard to such
period)'.
(c) EFFECTIVE DATE- The amendment made by subsection (a) applies to
services furnished on or after January 1, 2001.
(d) OVERSIGHT- The Secretary of Health and Human Services, through the
Office of the Inspector General in the Department of Health and Human Services
or otherwise, shall monitor payments made under part B of the title XVIII of
the Social Security Act for items and services furnished to residents of
skilled nursing facilities during a time in which the residents are not being
provided medicare covered post-hospital extended care services to ensure that
there is not duplicate billing for services or excessive services provided.
SEC. 323. REEXAMINATION OF, AND AUTHORITY TO REVISE, THE SKILLED NURSING
FACILITY MARKET BASKET PERCENTAGE INCREASE.
(1) IN GENERAL- The Secretary of Health and Human Services shall
reexamine the skilled nursing facility market basket percentage (as defined
in paragraph (5)(B) of section 1888(e) of the Social Security Act (42 U.S.C.
1395yy(e)) that was used in making the update to the first fiscal year under
paragraph (4)(B) of such section under the prospective payment system for
skilled nursing facility services.
(2) SPECIFIC ELEMENTS- In conducting the reexamination under paragraph
(1), the Secretary of Health and Human Services shall account for costs
based on actual data and actual medicare skilled nursing facility cost
increases.
(b) AUTHORITY- Notwithstanding any other provision of law, the Secretary
of Health and Human Services shall make adjustments to payments under the
prospective payment system under section 1888(e) of the Social Security Act
(42 U.S.C. 1395yy(e)) for covered skilled nursing facility services furnished
in fiscal year 2002 to reflect any necessary adjustments to such payments as
is appropriate as a result of the reexamination conducted under subsection
(a).
(1) IN GENERAL- Not later than April 1, 2001, the Secretary of Health
and Human Services shall publish for public comment a description of--
(A) whether the Secretary will make any adjustments pursuant to this
section; and
(B) if so, the form of such adjustments.
(2) FINAL FORM- Not later than August 1, 2001, the Secretary of Health
and Human Services shall publish the description described in paragraph (1)
in final form.
Subtitle D--Hospice Care
SEC. 331. REVISION OF MARKET BASKET INCREASE FOR 2001 AND 2002.
(a) IN GENERAL- Section 1814(i)(1)(C)(ii) (42 U.S.C. 1395f(i)(1)(C)(ii))
is amended--
(1) by redesignating subclause (VII) as subclause (VIII);
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