3.0.0 1307 2023-01-11T13:18:36Z 2023-01-11T13:18:36Z Senate S S 2009-06-19 111 ssfi00 Finance Committee Senate Standing Referred to 2009-06-19T15:27:29Z Medicare Specialty Care Improvement and Protection Act of 2009 111 2758 HR 2009-06-09 Referred to the Subcommittee on Health. Related bill CRS 2009-06-19 ssfi00 Finance Committee Senate Read twice and referred to the Committee on Finance. IntroReferral 2009-06-19 Introduced in Senate IntroReferral 10000 9 Library of Congress F000061 Sen. Feingold, Russell D. [D-WI] RUSSELL FEINGOLD D WI D. N K000367 Sen. Klobuchar, Amy [D-MN] Amy Klobuchar D MN 2009-06-19 True Health Department of Health and Human Services Disability and paralysis Executive agency funding and structure Government studies and investigations Health care quality Long-term, rehabilitative, and terminal care Medicaid Medicare Prescription drugs Health 00 2009-06-19 Introduced in Senate 2009-07-15T20:02:16Z Medicare Specialty Care Improvement and Protection Act of 2009 - Amends part C (Medicare+Choice) of title XVIII (Medicare) of the Social Security Act (SSA) to extend through December 31, 2013, the authority to restrict enrollment for specialized Medicare Advantage (MA) plans for special needs individuals (SNPs).

Extends such authority through December 31, 2015, in the case of a SNP designated as a Fully Integrated Dual Eligible Special Needs Plan..

Directs the Secretary of Health and Human Services (HHS) to evaluate the MA and the health status risk adjustment payment mechanisms in order to resolve plan payment inequities relative to Medicare fee-for-service payments for high-risk, high cost beneficiaries. Directs the Secretary, using the results of the evaluation, to refine the risk adjustment payment mechanism for such beneficiaries.

Requires the Secretary to provide bonus payments to account for added SNP costs associated with additional benefit, care management, reporting, and other requirements established by Congress and the Secretary in excess of other MA plans.

Requires the Secretary to take into account specified factors, including dual eligibility (for both Medicare and SSA title XIX [Medicaid] benefits) and geographic cost differences, with respect to the bid structure for SNPs.

Requires the Secretary to have in place a process under which the Secretary designates dual eligible SNPs as Fully Integrated Dual Eligible Special Needs Plans for the purpose of advancing fully integrated Medicare and Medicaid benefits and services for dual eligible beneficiaries, including state-designated Dual subsets.

Directs the Secretary to establish or designate an Office on Medicare/Medicaid Integration.

Authorizes a plan, at state option, to provide for a period of presumptive eligibility for an individual who has attained age 65, who has 12 or more consecutive months of Medicaid eligibility, and who the state has reason to believe will be determined to be a full-benefit dual eligible individual.

Conditions such presumptive eligibility, however, on the state's: (1) agreement to randomly conducted eligibility audits by the Secretary; and (2) ensuring that any individual enrolled under the state plan who is determined ineligible for medical assistance as a result of such an audit is notified at least 30 days before disenrollment.

Extends prescription drug discounts to enrollees of Medicaid managed care organizations.


]]> Medicare Specialty Care Improvement and Protection Act of 2009 Display Title Medicare Specialty Care Improvement and Protection Act of 2009 Official Title as Introduced A bill to amend part C of title XVIII of the Social Security Act with respect to Medicare special needs plans and the alignment of Medicare and Medicaid for dually eligible individuals, and for other purposes. Introduced in Senate IS Short Titles as Introduced Medicare Specialty Care Improvement and Protection Act of 2009 Introduced in Senate 2009-06-19T04:00:00Z https://www.govinfo.gov/content/pkg/BILLS-111s1307is/xml/BILLS-111s1307is.xml 2009-06-19 Read twice and referred to the Committee on Finance. text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain. Congressional Research Service, Library of Congress This file contains bill summaries and statuses for federal legislation. A bill summary describes the most significant provisions of a piece of legislation and details the effects the legislative text may have on current law and federal programs. Bill summaries are authored by the Congressional Research Service (CRS) of the Library of Congress. As stated in Public Law 91-510 (2 USC 166 (d)(6)), one of the duties of CRS is "to prepare summaries and digests of bills and resolutions of a public general nature introduced in the Senate or House of Representatives". For more information, refer to the User Guide that accompanies this file.