[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4753 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 4753

   To establish a demonstration project to create Medicare Consumer 
    Coalitions to provide Medicare beneficiaries with accurate and 
understandable information with respect to managed care health benefits 
   under the Medicare Program and to negotiate with Medicare+Choice 
  organizations offering Medicare+Choice plans to improve and expand 
                       benefits under the plans.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 26, 2000

  Mrs. Kelly 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 establish a demonstration project to create Medicare Consumer 
    Coalitions to provide Medicare beneficiaries with accurate and 
understandable information with respect to managed care health benefits 
   under the Medicare Program and to negotiate with Medicare+Choice 
  organizations offering Medicare+Choice plans to improve and expand 
                       benefits under the plans.

    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 ``Seniors Health Care Empowerment Act 
of 2000''.

SEC. 2. MEDICARE CONSUMER COALITION DEMONSTRATION PROJECTS.

    (a) Establishment of Projects.--The Secretary of Health and Human 
Services (hereinafter in this section referred to as the ``Secretary'') 
shall establish demonstration projects (hereinafter in this section 
referred to as the ``projects'') under which a Medicare Consumer 
Coalition (hereinafter in this section referred to as an ``MCC'') is 
formed to carry out the following functions:
            (1) To conduct programs to prepare, make available, and 
        disseminate to Medicare beneficiaries comprehensive and 
        understandable information (described in subsection (f)) with 
        respect to enrollment in the following:
                    (A) A Medicare+Choice plan, as defined in 
                subsection (j)(1).
                    (B) A medigap plan, as defined in subsection 
                (j)(2).
            (2) For the purpose of improving benefits and reducing 
        premiums for members of the MCC, to negotiate with 
        Medicare+Choice plans and, to the extent practicable, medigap 
        plans.
    (b) MCC Described.--For purposes of this section, an MCC is a legal 
entity that meets the following requirements:
            (1) Organization and operation.--The entity is a nonprofit 
        organization that is--
                    (A) organized and maintained in good faith, with a 
                constitution and bylaws specifically stating its 
                purpose and providing for periodic meetings on at least 
                an annual basis,
                    (B) established as a permanent entity which 
                receives the active support of its members and, subject 
                to paragraph (3), collects from its members on a 
                periodic basis dues or payments necessary to maintain 
                eligibility for membership in the sponsor, and
                    (C) is operated under the direction of a board of 
                directors the members of which are Medicare 
                beneficiaries, such board comprised of a majority of 
                such beneficiaries who live in the Medicare market area 
                designated under subsection (c) in which the MCC 
                carries out its functions and providers of services.
            (2) Open membership.--The entity makes all Medicare 
        beneficiaries who live in the Medicare market area eligible to 
        enroll in the MCC.
            (3) Fees.--
                    (A) In general.--Subject to subparagraph (B), the 
                entity may charge Medicare beneficiaries a nominal 
                enrollment fee, in no case to exceed $25.
                    (B) Exception.--No enrollment fee may be charged in 
                the case of the following qualified Medicare 
                beneficiaries:
                            (i) Individuals described in section 
                        1905(p)(1) of the Social Security Act (42 
                        U.S.C. 1396d(p)(1)) (QMBs).
                            (ii) Individuals described in section 
                        1902(a)(10)(E)(iii) of such Act (42 U.S.C. 
                        1396a(a)(10)(E)(iii)) (specified low-income 
                        Medicare beneficiaries (SLMBs).
                            (iii) Individuals described in section 
                        1902(a)(10)(E)(iv) of such Act (42 U.S.C. 
                        1396a(a)(10)(E)(iv)) (qualifying individuals 
                        (QIs)).
            (4) Authority to enter into contracts to carry out 
        administrative functions.--The entity may enter into contracts 
        with private agencies or persons to carry out administrative 
        functions of the entity.
    (c) Designation of Medicare Market Areas Covered by Projects.--
            (1) In general.--The Secretary shall designate areas in 
        which the project under this section is conducted as Medicare 
        market areas.
            (2) Designation of 6 areas.--
                    (A) In general.--The Secretary, consistent with 
                subparagraph (B), shall designate 6 specific areas as 
                Medicare market areas. Such designations shall be made 
                in a manner so as to ensure that enrollment under the 
                projects will begin on January 1, 2002.
                    (B) Minimum area.--A Medicare market area shall be 
                comprised of at least one entire county or equivalent 
                area (as determined by the Secretary). In the case of 
                an MCC that serves more than one State, such equivalent 
                area may be include areas in two or more contiguous 
                States.
    (d) Project Implementation.--For each Medicare market area, the 
Secretary shall--
            (1) develop and disseminate a request for proposals for the 
        establishment of MCCs in the 6 designated Medicare market 
        areas, and
            (2) structure the method for selecting a coalition in such 
        area, with a preference for broad participation by nonprofit 
        community organizations with experience representing and 
        providing information to Medicare beneficiaries in the area.
    (e) Monitoring and Report.--
            (1) Monitoring.--The Secretary shall closely monitor and 
        analyze the impact of the project in the Medicare market areas 
        on the price and quality of, and access to, Medicare covered 
        services, choice of Medicare+Choice plans and medigap plans, 
        changes in enrollment, and other relevant factors.
            (2) Report.--Not later than December 31, 2005, the 
        Secretary shall submit to Congress a report on the progress 
        under the project under this section, including a comparison of 
        the matters monitored under paragraph (1) and subsection (g)(4) 
        among the different Medicare market areas. The report may 
        include any legislative recommendations for extending the 
        project to all Medicare beneficiaries.
    (f) Information.--
            (1) Contents.--The information described in subsection 
        (a)(1) shall include at least a comparison of contracts and 
        policies available under Medicare+Choice plans and medigap 
        plans, including a comparison of the benefits, quality and 
        performance, costs to enrollees, results of consumer 
        satisfaction surveys on such contracts and policies, and such 
        additional information as the Secretary may prescribe.
            (2) Information standards.--The Secretary shall develop 
        standards and criteria to ensure that the information provided 
        to Medicare beneficiaries under the projects is complete, 
        accurate, and uniform.
            (3) Review of information.--The Secretary may prescribe the 
        procedures and conditions under which an MCC may furnish 
        information to Medicare beneficiaries. Such information shall 
        be submitted to the Secretary not later than 45 days before the 
        date the information is first furnished to such beneficiaries.
            (4) Consultation.--
                    (A) Advisory groups.--In order to provide the 
                information described in subsection (a)(1), an MCC 
                shall consult with an advisory group. Each advisory 
                group shall be comprised of members who are 
                representatives of each of the persons described in 
                subparagraph (B) who are located in or offering 
                services in the Medicare market area.
                    (B) Persons described.--The persons referred to in 
                subparagraph (A) are private insurers, managed care 
                plan providers, other health care providers, and public 
                and private purchasers of health care benefits.
                    (C) Prohibition of compensation.--Members of an 
                advisory group established under this paragraph may not 
                receive additional pay, allowances, or benefits by 
                reason of their service on the advisory group.
    (g) Group Purchasing.--
            (1) In general.--For purposes of carrying out the 
        objectives described in subsection (a)(2), the Secretary shall 
        provide authority and establish methods for an MCC to negotiate 
        with Medicare+Choice plans and medigap plans to provide 
        coalition members with any or all of the following:
                    (A) Enhanced benefits.
                    (B) Lower premiums.
                    (C) Lower cost-sharing.
            (2) Multiyear contracts.--
                    (A) In general.--Contracts entered into with 
                Medicare+Choice plans and medigap plans under the 
                projects shall be for periods of not less than one and 
                not more than three years.
                    (B) Provisions for open enrollment and 
                disenrollment.--Any contract entered into under 
                subparagraph (A) shall include provisions for annual 
                open enrollment and disenrollment, and, in the case of 
                disenrollment, provisions for reenrollment in other 
                Medicare+Choice plans or a medigap plan under which the 
                Medicare beneficiary was previously enrolled.
                    (C) Payment differential.--With respect to 
                different payment rates applicable to Medicare+Choice 
                plans under part C of title XVIII of the Social 
                Security Act for plans offered in different regions in 
                a Medicare market area, an MCC may only enter into 
                contracts with such plans offered in regions within 
                such area in which such payments rates are the same or 
                similar.
            (3) No financial underwriting.--An MCC shall provide 
        Medicare benefits coverage only through Medicare+Choice plans 
        and medigap plans, as appropriate, and shall not assume 
        insurance risk with respect to such coverage.
            (4) Minimum coverage.--An MCC may not contract for health 
        care coverage for members of the coalition unless that coverage 
        provides, at a minimum, the same items and services as what is 
        available to Medicare beneficiaries enrolled in the fee-for-
        service program under parts A and B of title XVIII of the 
        Social Security Act.
            (5) Contracts.--An MCC may enter into contracts with other 
        organizations, including pharmacy benefit managers, to assist 
        in carrying out the functions described in subsection (a)(2).
            (6) Oversight.--The Secretary may monitor and approve 
        contracts between an MCC and Medicare+Choice plans and medigap 
        plans to ensure compliance with relevant consumer protections 
        and regulations applicable under title XVIII of the Social 
        Security Act.
    (h) Waiver Authority.--The Secretary may waive such requirements of 
title XVIII of the Social Security Act as may be necessary for the 
purposes of carrying out the project.
    (i) Definitions.--In this section:
            (1) The term ``Medicare+Choice plan'' means a 
        Medicare+Choice plan offered by a Medicare+Choice organization 
        under part C of title XVIII of the Social Security Act (42 
        U.S.C. 1395w-21 et seq.).
            (2) The term ``medigap plan'' means a Medicare supplemental 
        policy certified by the Secretary under section 1882 of the 
        Social Security Act (42 U.S.C. 1395ss).
            (3) The term ``Medicare beneficiary'' means an individual 
        entitled to benefits under parts A, B, or C of title XVIII of 
        the Social Security Act.
            (4) The terms ``Medicare+Choice organization'' and 
        ``Medicare+Choice plan'' have the meaning given those terms 
        under subsections (a)(1) and (b)(1), respectively, of section 
        1859 of the Social Security Act (42 U.S.C. 1395w-29).
            (5) The term ``Medicare market area'' means an area 
        designated by the Secretary under subsection (c) in which an 
        MCC shall carry out its functions under the project.
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