[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4356 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 4356

 To amend title XVIII of the Social Security Act to provide additional 
   protections for Medicare beneficiaries under the Medicare+Choice 
                                Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 2, 2000

Mr. LaTourette 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 provide additional 
   protections for Medicare beneficiaries under the Medicare+Choice 
                                Program.

    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 ``Senior Health Insurance Pull Out 
Prevention Act of 2000''.

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. ADVANCE NOTICE OF TERMINATION.

    (a) Requiring 1 Year Advance Notice by Medicare+Choice 
Organization.--Section 1857(c)(1) of the Social Security Act (42 U.S.C. 
1395w-27(c)(1)) is amended by striking ``by either party of intention 
to terminate at the end of the current term'' and inserting ``by the 
Secretary before the end of the current term or by the organization at 
least one year before the end of the current term''.
    (b) Timely Notification of Beneficiaries of Physician 
Terminations.--Section 1852(j) of such Act Social Security Act (42 
U.S.C. 1395w-22(j)) is amended--
            (1) in paragraph (1)--
                    (A) by striking ``and'' at the end of subparagraph 
                (B);
                    (B) by striking the period at the end of 
                subparagraph (C) and inserting ``, and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(D) termination procedures consistent with 
                paragraph (7).''; and
            (2) by adding at the end the following new paragraph:
            ``(7) Timely notice of physician terminations.--Under an 
        agreement described in paragraph (1) between a Medicare+Choice 
        organization and a physician (or group of physicians)--
                    ``(A) the agreement shall be automatically 
                renewable between the parties unless there has been 
                notice by the physician or group to the plan (or by the 
                plan to the physician or group) at least 120 days 
                before the date the agreement would otherwise expire; 
                and
                    ``(B) in the case such an agreement is not renewed, 
                the physician or group of physicians shall provide 
                notice at least 90 days before such expiration date to 
                enrollees who are Medicare+Choice enrollees and are 
                current patients (as defined in regulations) of the 
                physician or group at the time of the notice provided 
                under clause (i).''.
    (c) Effective Date.--The amendments made by this section apply--
            (1) to contracts between the Secretary and Medicare+Choice 
        organizations entered into more than 6 months after the date of 
        the enactment of this Act; and
            (2) to agreements between Medicare+Choice organizations and 
        physicians (and groups of physicians) with respect to 
        expirations of such agreements occurring after the end of the 
        9-month period beginning on the date of the enactment of this 
        Act.

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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