[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4653 Introduced in House (IH)]







105th CONGRESS
  2d Session
                                H. R. 4653

   To amend title XVIII of the Social Security Act to prevent sudden 
disruption of Medicare beneficiary enrollment in Medicare+Choice Plans.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 28, 1998

Mr. Gejdenson (for himself and Mrs. Kennelly of Connecticut) introduced 
  the following bill; which was referred to the Committee on Ways and 
Means, and in addition to the Committee on Commerce, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL


 
   To amend title XVIII of the Social Security Act to prevent sudden 
disruption of Medicare beneficiary enrollment in Medicare+Choice plans.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare HMO Improvement Act of 
1998''.

SEC. 2. EXTENSION OF INITIAL MEDICARE+CHOICE CONTRACT PERIOD TO 3 
              YEARS.

    (a) In General.--Section 1857(c)(1) of the Social Security Act (42 
U.S.C. 1395w-27(c)(1)) is amended--
            (1) by striking ``a term of at least 1 year'' and inserting 
        ``an initial term of at least 3 years''; and
            (2) by striking ``from term to term'' and inserting ``for 
        additional 1-year periods thereafter''.
    (b) Effective Date.--The amendments made by subsection (a) apply to 
contracts entered into on or after the date of the enactment of this 
Act.

SEC. 3. AUTHORITY TO DELAY TERMINATION.

    Section 1851(g)(3) of the Social Security Act (42 U.S.C. 1395w-
21(g)(3)) is amended by adding at the end the following new 
subparagraph:
                    ``(E) Authority to delay effectiveness of a 
                termination.--
                            (i) In general.--If a Medicare+Choice 
                        organization terminates a plan under 
                        subparagraph (B)(iii), the Secretary may delay 
                        the effectiveness of such termination for up to 
                        1 year if the Secretary finds that--
                                    ``(I) the termination would cause 
                                an imminent and serious risk to health 
                                to individuals enrolled under the plan 
                                under this part;
                                    ``(II) the termination would result 
                                in a significant reduction in the 
                                Medicare+Choice plans that are 
                                available in the area affected by the 
                                termination; or
                                    ``(III) the chief executive officer 
                                of the State in which the termination 
                                occurs requests such a delay.
                            ``(ii) End of delay.--The Secretary may end 
                        a delay under clause (i), before the end of the 
                        1-year period, if the Secretary finds that an 
                        adequate provider network has been established 
                        which will provide at least an equal level of 
                        insurance coverage as existed on the date the 
                        Medicare+Choice organization informed its 
                        enrollees of its intention to terminate the 
                        plan.''.

SEC. 4. RESTRICTION ON TERMINATION OF MEDICARE+CHOICE PLANS IN SELECTED 
              AREAS WITHIN A METROPOLITAN STATISTICAL AREA.

    (a) In General.--Section 1857(c) of the Social Security Act (42 
U.S.C. 1395w-27(c)) is amended by redesignating paragraph (5) as 
paragraph (6) and by inserting after paragraph (4) the following new 
paragraph:
            ``(5) Limitation on selective termination of contracts.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), if a Medicare+Choice organization 
                offers a Medicare+Choice plan that provides coverage in 
                a metropolitan statistical area (or a New England 
                County Metropolitan Area) in a State and terminates 
                such coverage for any part of such area (or Area) in 
                the State, the Secretary shall terminate any contract 
                with the organization for coverage of any part of that 
                area (or Area) in that State.
                    ``(B) Exception.--The Secretary may waive the 
                requirement of subparagraph (A) if the Secretary finds 
                that terminating contracts for coverage in all parts of 
                a metropolitan statistical area (or New England County 
                Metropolitan Area) in the State would pose an imminent 
                and serious risk to the health of individuals enrolled 
                with the organization under this part in the area (or 
                Area).''.
    (b) Effective Date.--The amendments made by subsection (a) apply to 
terminations for which notice is provided on or after the date of the 
enactment of this Act.

SEC. 5. CONTINUITY OF CARE IN CASE OF INVOLUNTARY TERMINATION.

    (a) In General.--Section 1852(d) of the Social Security Act (42 
U.S.C. 1395w-22(d)) is amended by adding at the end the following new 
paragraph:
            ``(5) Continuity of care.--
                    ``(A) In general.--If--
                            ``(i) an individual's enrollment with a 
                        Medicare+Choice plan offered by a 
                        Medicare+Choice organization under this part is 
                        terminated by the organization (other than for 
                        cause with respect to that individual), and
                            ``(ii) on the effective date of such 
                        termination of enrollment the individual is in 
                        a course of treatment for which coverage is 
                        available under the plan and the individual is 
                        not at that time covered under another 
                        Medicare+Choice plan,
                notwithstanding such termination the organization shall 
                continue to provide coverage for the covered course of 
                treatment for a period of 90 days after such effective 
                date.
                    ``(B) Permissible terms and conditions.--The 
                coverage provided under subparagraph (A) shall be under 
                the same terms and conditions (including applicable 
                policies, procedures, and quality assurance standards) 
                as existed on the date before the effective date of the 
                termination.
                    ``(C) Terminate defined.--In this paragraph, the 
                term `terminate' includes the termination of a 
                Medicare+Choice plan as a result of the expiration or 
                nonrenewal of a contract by the organization under this 
                part.
                    ``(D) Construction.--Nothing in this paragraph 
                shall be construed to require the coverage of benefits 
                which would not have been covered on the effective date 
                of the termination involved.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to contracts entered into or renewed on or after the date of the 
enactment of this Act.
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