[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[S. 789 Introduced in Senate (IS)]







105th CONGRESS
  1st Session
                                 S. 789

  To amend title XVIII of the Social Security Act to provide medicare 
 beneficiaries with additional information regarding medicare managed 
                care plans and medicare select policies.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 22, 1997

  Mr. Grassley (for himself, Mr. Breaux, Mr. D'Amato, Mr. Wyden, Mr. 
  Jeffords, Mr. Kohl, and Mr. Chafee) 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 provide medicare 
 beneficiaries with additional information regarding medicare managed 
                care plans and medicare select policies.

    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 Beneficiary Information Act 
of 1997''.

SEC. 2. MEDICARE BENEFICIARY INFORMATION.

    (a) In General.--Section 1876(c)(3)(E) of the Social Security Act 
(42 U.S.C. 1395mm(c)(3)(E)) is amended to read as follows:
    ``(E)(i) Each eligible organization shall provide in any marketing 
materials distributed to individuals eligible to enroll under this 
section and to each enrollee at the time of enrollment and not less 
frequently than annually thereafter, an explanation of the individual's 
rights and responsibilities under this section and a copy of the most 
recent comparative report (as established by the Secretary under clause 
(ii)) for that organization.
    ``(ii)(I) The Secretary shall develop an understandable 
standardized comparative report on the plans offered by eligible 
organizations, that will assist beneficiaries under this title in their 
decisionmaking regarding medical care and treatment by allowing the 
beneficiaries to compare the organizations that the beneficiaries are 
eligible to enroll with. In developing such report the Secretary shall 
consult with outside organizations, including groups representing the 
elderly, eligible organizations under this section, providers of 
services, and physicians and other health care professionals, in order 
to assist the Secretary in developing the report.
    ``(II) The report described in subclause (I) shall include a 
comparison for each plan of--
            ``(aa) the premium for the plan;
            ``(bb) the benefits offered by the plan, including any 
        benefits that are additional to the benefits offered under 
        parts A and B;
            ``(cc) the amount of any deductibles, coinsurance, or any 
        monetary limits on benefits;
            ``(dd) the number of individuals who disenrolled from the 
        plan within 3 months of enrollment and during the previous 
        fiscal year, stated as percentages of the total number of 
        individuals in the plan;
            ``(ee) the procedures used by the plan to control 
        utilization of services and expenditures, including any 
        financial incentives;
            ``(ff) the number of applications during the previous 
        fiscal year requesting that the plan cover certain medical 
        services that were denied by the plan (and the number of such 
        denials that were subsequently reversed by the plan), stated as 
        a percentage of the total number of applications during such 
        period requesting that the plan cover such services;
            ``(gg) the number of times during the previous fiscal year 
        (after an appeal was filed with the Secretary) that the 
        Secretary upheld or reversed a denial of a request that the 
        plan cover certain medical services;
            ``(hh) the restrictions (if any) on payment for services 
        provided outside the plan's health care provider network;
            ``(ii) the process by which services may be obtained 
        through the plan's health care provider network;
            ``(jj) coverage for out-of-area services;
            ``(kk) any exclusions in the types of health care providers 
        participating in the plan's health care provider network; and
            ``(ll) any additional information that the Secretary 
        determines would be helpful for beneficiaries to compare the 
        organizations that the beneficiaries are eligible to enroll 
        with.
    ``(III) The comparative report shall also include--
            ``(aa) a comparison of each plan to the fee-for-service 
        program under parts A and B; and
            ``(bb) an explanation of medicare supplemental policies 
        under section 1882 and how to obtain specific information 
        regarding such policies.
    ``(IV) The Secretary shall, not less than annually, update each 
comparative report.
    ``(iii) Each eligible organization shall disclose to the Secretary, 
as requested by the Secretary, the information necessary to complete 
the comparative report.
    ``(iv) In this subparagraph--
            ``(I) the term `health care provider' means anyone licensed 
        under State law to provide health care services under part A or 
        B;
            ``(II) the term `network' means, with respect to an 
        eligible organization, the health care providers who have 
        entered into a contract or agreement with the organization 
        under which such providers are obligated to provide items, 
        treatment, and services under this section to individuals 
        enrolled with the organization under this section; and
            ``(III) the term `out-of-network' means services provided 
        by health care providers who have not entered into a contract 
        agreement with the organization under which such providers are 
        obligated to provide items, treatment, and services under this 
        section to individuals enrolled with the organization under 
        this section.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to contracts entered into or renewed under section 1876 of the 
Social Security Act (42 U.S.C. 1395mm) after the expiration of the 1-
year period that begins on the date of enactment of this Act.

SEC. 3. APPLICATION OF ADDITIONAL INFORMATION TO MEDICARE SELECT 
              POLICIES.

    (a) In General.--Section 1882(t) of the Social Security Act (42 
U.S.C. 1395ss(t)) is amended--
            (1) in paragraph (1)--
                    (A) by striking ``and'' at the end of subparagraph 
                (E);
                    (B) by striking the period at the end of 
                subparagraph (F) and inserting a semicolon; and
                    (C) by adding at the end the following:
                    ``(G) notwithstanding any other provision of this 
                section to the contrary, the issuer of the policy meets 
                the requirements of section 1876(c)(3)(E)(i) with 
                respect to individuals enrolled under the policy, in 
                the same manner such requirements apply with respect to 
                an eligible organization under such section with 
                respect to individuals enrolled with the organization 
                under such section; and
                    ``(H) the issuer of the policy discloses to the 
                Secretary, as requested by the Secretary, the 
                information necessary to complete the report described 
                in paragraph (4).''; and
            (2) by adding at the end the following:
    ``(4) The Secretary shall develop an understandable standardized 
comparative report on the policies offered by entities pursuant to this 
subsection. Such report shall contain information similar to the 
information contained in the report developed by the Secretary pursuant 
to section 1876(a)(3)(E)(ii).''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to policies issued or renewed on or after the expiration of the 
1-year period that begins on the date of enactment of this Act.

SEC. 4. NATIONAL INFORMATION CLEARINGHOUSE.

    (a) In General.--Not later than 18 months after the date of 
enactment of this Act, the Secretary shall establish and operate, out 
of funds otherwise appropriated to the Secretary, a clearinghouse and 
(if the Secretary determines it to be appropriate) a 24-hour toll-free 
telephone hotline, to provide for the dissemination of the comparative 
reports created pursuant to section 1876(c)(3)(E)(ii) of the Social 
Security Act (42 U.S.C. 1395mm(c)(3)(E)(ii)) (as amended by section 2 
of this Act) and section 1882(t)(4) of the Social Security Act (42 
U.S.C. 1395ss(t)(4)) (as added by section 3 of this Act). In order to 
assist in the dissemination of the comparative reports, the Secretary 
may also utilize medicare offices open to the general public, the 
beneficiary assistance program established under section 4359 of the 
Omnibus Budget Reconciliation Act of 1990 (42 U.S.C. 1395b-3), and the 
health insurance information counseling and assistance grants under 
section 4359 of that Act (42 U.S.C. 1395b-4).
                                 <all>