[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4555 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 4555

To provide for a 6-year demonstration project to stabilize coverage and 
              benefits under the Medicare+Choice Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 25, 2000

Mr. Brown of Ohio 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 provide for a 6-year demonstration project to stabilize coverage and 
              benefits 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 ``Medicare+Choice Reliability Act of 
2000''.

SEC. 2. ESTABLISHMENT OF 6-YEAR DEMONSTRATION PROJECT TO STABILIZE 
              COVERAGE AND BENEFITS UNDER THE MEDICARE+CHOICE PROGRAM.

    (a) In General.--The Secretary of Health and Human Services shall 
establish under this section a demonstration project under which 
Medicare+Choice organizations under part C of title XVIII of the Social 
Security Act may elect to provide Medicare+Choice plans in accordance 
with the special provisions of the project.
    (b) Duration.--The project shall extend over a period of 6 years.
    (c) General Description of Special Terms.--Under the project:
            (1) Payment amount based on payments under traditional fee-
        for-service program.--There shall be substituted for the annual 
        Medicare+Choice capitation rate under section 1853(a) the fee-
        for-service-related amount described in subsection (d). Payment 
        of such amount is subject to risk-adjustment in the manner 
        described in section 1853(a)(3) of the Social Security Act (42 
        U.S.C. 1395w-23(a)(3)).
            (2) 3-year contract.--The period of the contract under 
        section 1857(c)(1) of such Act (42 U.S.C. 1395w-27(c)(1)) shall 
        be for a term of 3 years. For the duration of the contract the 
        Medicare+Choice organization--
                    (A) may not modify premiums and benefits, unless 
                the Secretary determines that such modifications would 
                increase the value of the coverage; and
                    (B) may not withdraw from any part of the service 
                area.
            (3) Service area.--
                    (A) Establishment.--Taking into account factors 
                such as commercial rating patterns, the Secretary shall 
                designate geographic areas as service areas for 
                purposes of the project. Such areas may be portions of 
                a State or an entire State. Each county or equivalent 
                area shall be in one, and only one, service area. No 
                Medicare+Choice plan under the project may serve any 
                part of a service area without serving all parts of 
                that service area.
                    (B) Uniform benefits in a service area.--
                            (i) In general.--Subject to clause (i), a 
                        Medicare+Choice plan shall provide the same 
                        benefits to all enrollees in a service area.
                            (ii) Adaption by health maintenance 
                        organizations.--In applying clause (i) in the 
                        case of a plan that is a health maintenance 
                        organization, if limitations in provider 
                        contracts prevent the plan from maintaining the 
                        provider contracts in certain parts of a 
                        service area, the plan may establish a 
                        preferred provider network or fee-for-service 
                        plan in those parts of the service area, but 
                        only if the cost-sharing applicable to such a 
                        network or plan is not established in a manner 
                        that discourages enrollment of residents in 
                        those parts of the service area.
            (4) No requirement for supplemental benefits.--The 
        provisions of sections 1852(a)(1)(B), 1854(e), and 
        1854(f)(1)(A) (relating to requirement for supplemental 
        benefits) of the Social Security Act (42 U.S.C. 1395w-
        22(a)(1)(B), 1395w-24(e), 1395w-24(f)) shall not apply.
    (d) Fee-for-Service-Related Payment Amount.--
            (1) In general.--The amount described in this subsection 
        for a service area is the Secretary's estimate of the adjusted 
        average per capita cost (as determined under section 1876(a)(4) 
of the Social Security Act, 42 U.S.C. 1395mm(a)(4)) for the service 
area for the contract year.
            (2) Exclusion of medical education costs.--In determining 
        the amounts under paragraph (1), the Secretary shall not take 
        into account payments attributable to--
                    (A) graduate medical education payments under 
                section 1886(h) of the Social Security Act (42 U.S.C. 
                1395ww(h));
                    (B) disproportionate share hospital payments 
                described in section 1886(d)(5)(F) of such Act (42 
                U.S.C. 1395ww(d)(5)(F)); or
                    (C) indirect costs of medical education described 
                in section 1886(d)(5)(B) of such Act (42 U.S.C. 
                1395ww(d)(5)(B)).
    (e) Sanctions for Violation of Project Terms.--
            (1) In general.--The Secretary may provide for such 
        sanctions as may be appropriate to assure that Medicare+Choice 
        organizations that elect to participate in the project meet the 
        contractual terms of the contract, including maintaining 
        benefits and coverage during the entire period of the contract.
            (2) Construction.--Nothing in this subsection shall be 
        construed as preventing the Secretary from terminating a 
        Medicare+Choice organization's participation in the project for 
        cause or for other conditions for which a contract under 
        section 1857 of the Social Security Act (42 U.S.C. 1395w-27) 
        could be terminated.
    (f) Relation to Medicare Part C.--Medicare+Choice organizations 
participating in the project shall comply with the provisions of the 
Medicare+Choice program except to the extent that such provisions are 
superseded by the provisions in the project.
    (g) Evaluation and Report.--The Secretary shall continuously assess 
the effectiveness of the project in stabilizing coverage and benefits 
under the Medicare+Choice program. The Secretary shall submit a report 
to Congress on such evaluation after the completion of 4 years of the 
project.
    (h) Definitions.--For purposes of this section:
            (1) Medicare+Choice organization; medicare+choice plan.--
        The terms ``Medicare+Choice organization'' and 
        ``Medicare+Choice plan'' have the meanings given such terms 
        under the Medicare+Choice program.
            (2) Medicare+Choice program.--The term ``Medicare+Choice 
        program'' means the program under part C of title XVIII of the 
        Social Security Act.
            (3) Project.--The term ``project'' means the demonstration 
        project established under this section.
            (4) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services .
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