[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4726 Introduced in House (IH)]







105th CONGRESS
  2d Session
                                H. R. 4726

 To amend title XVIII of the Social Security Act to reduce the maximum 
       financial risk permitted for physicians participating in 
                         Medicare+Choice plans.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 7, 1998

  Mr. Stark 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 reduce the maximum 
       financial risk permitted for physicians participating 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. REDUCING THE MAXIMUM FINANCIAL RISK FOR PHYSICIANS 
              PARTICIPATING IN MEDICARE+CHOICE PLANS.

    Section 1852(j)(4)(A) of the Social Security Act (42 U.S.C. 1395w-
22(j)(4)(A)) is amended--
            (1) by redesignating clause (iii) as clause (iv); and
            (2) by inserting after clause (ii) the following new 
        clauses:
                            ``(iii) The organization does not operate 
                        the plan in a manner that places a physician or 
                        physician group at a financial risk that 
                        exceeds 20 percent as of January 1, 2001, 15 
                        percent as of January 1, 2002, and 10 percent 
                        as of January 1, 2003, of potential payments.
                            ``(iv) Potential payments mean the maximum 
                        payments possible to physicians or physician 
                        groups including payments for services they 
                        furnish directly, and additional payments based 
                        on use and costs of referral services, such as 
                        withholds, bonuses, capitation, or any other 
                        compensation to the physician or physician 
                        group.
                            ``(v) Potential payments are not bonuses 
                        and other compensation that are based on the 
                        use of referrals, such as quality care 
                        furnished, patient satisfaction or committee 
                        participation, and are not considered payments 
                        in the determination of substantial financial 
                        risk.''.
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