[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[S. 1908 Introduced in Senate (IS)]







105th CONGRESS
  2d Session
                                S. 1908

   To amend title XVIII of the Social Security Act to carve out from 
   payments to Medicare+Choice organizations amounts attributable to 
disproportionate share hospital payments and pay such amounts directly 
  to those disproportionate share hospitals in which their enrollees 
                             receive care.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 2, 1998

 Mr. Moynihan (for himself, and Mr. D'Amato) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
   To amend title XVIII of the Social Security Act to carve out from 
   payments to Medicare+Choice organizations amounts attributable to 
disproportionate share hospital payments and pay such amounts directly 
  to those disproportionate share hospitals in which their enrollees 
                             receive care.

    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 ``Managed Care Fair Payment Act of 
1998''.

SEC. 2. CARVING OUT DSH PAYMENTS FROM PAYMENTS TO MEDICARE+CHOICE 
              ORGANIZATIONS AND PAYING THE AMOUNTS DIRECTLY TO DSH 
              HOSPITALS ENROLLING MEDICARE+CHOICE ENROLLEES.

    (a) In General.--Section 1853(c)(3) of the Social Security Act (42 
U.S.C. 1395w-23(c)(3)), as inserted by section 4001 of the Balanced 
Budget Act of 1997, is amended--
            (1) in subparagraph (A), by striking ``subparagraph (B)'' 
        and inserting ``subparagraphs (B) and (D)'',
            (2) by redesignating subparagraph (D) as subparagraph (E), 
        and
            (3) by inserting after subparagraph (C) the following:
                    ``(D) Removal of payments attributable to 
                disproportionate share payments from calculation of 
                adjusted average per capita cost.--
                            ``(i) In general.--In determining the area-
                        specific Medicare+Choice capitation rate under 
                        subparagraph (A) for a year (beginning with 
                        1999), the annual per capita rate of payment 
                        for 1997 determined under section 1876(a)(1)(C) 
                        shall be adjusted, subject to clause (ii), to 
                        exclude from the rate the additional payments 
                        that the Secretary estimates were payment 
                        during 1997 for additional payments described 
                        in section 1886(d)(5)(F).
                            ``(ii) Treatment of payments covered under 
                        state hospital reimbursement system.--To the 
                        extent that the Secretary estimates that an 
                        annual per capita rate of payment for 1997 
                        described in clause (i) reflects payments to 
                        hospitals reimbursed under section 1814(b)(3), 
                        the Secretary shall estimate a payment 
                        adjustment that is comparable to the payment 
                        adjustment that would have been made under 
                        clause (i) if the hospitals had not been 
                        reimbursed under such section.''.
    (b) Additional Payments for Managed Care Enrollees.--Section 
1886(d)(5)(F) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(F)) is 
amended--
            (1) in clause (ii), by striking ``clause (ix)'' and 
        inserting ``clauses (ix) and (x)'', and
            (2) by adding at the end the following:
    ``(ix)(I) For portions of cost reporting periods occurring on or 
after January 1, 1999, the Secretary shall provide for an additional 
payment amount for each applicable discharge of any subsection (d) 
hospital that is a disproportionate share hospital (as described in 
clause (i)).
    ``(II) For purposes of this clause, the term `applicable discharge' 
means the discharge of any individual who is enrolled under a risk-
sharing contract with an eligible organization under section 1876 and 
who is entitled to benefits under part A or any individual who is 
enrolled with a Medicare+Choice organization under part C.
    ``(III) The amount of the payment under this clause with respect to 
any applicable discharge shall be equal to the estimated average per 
discharge amount that would otherwise have been paid under this 
subparagraph if the individuals had not been enrolled as described in 
subclause (II).
    ``(IV) The Secretary shall establish rules for an additional 
payment amount, for any hospital reimbursed under a reimbursement 
system authorized under section 1814(b)(3) if such hospital would 
qualify as a disproportionate share hospital under clause (i) were it 
not so reimbursed. Such payment shall be determined in the same manner 
as the amount of payment is determined under this clause for 
disproportionate share hospitals.''.
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