[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5039 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 5039

To amend part C of title XVIII of the Social Security Act to revise and 
                  improve the Medicare+Choice Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 27, 2000

 Mr. Hayworth 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 part C of title XVIII of the Social Security Act to revise and 
                  improve 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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare Choice 
Preservation Act of 2000''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
                   TITLE I--IMPROVEMENTS IN PAYMENTS

Sec. 101. Increase in national per capita medicare+choice growth 
                            percentage in 2001 and 2002.
Sec. 102. Increasing minimum payment amount.
Sec. 103. Allowing movement to 50:50 percent blend in 2002.
Sec. 104. Increasing the minimum percentage increase in 2001.
Sec. 105. Increased update for payment areas with only one or no 
                            Medicare+Choice contracts.
Sec. 106. Elimination of budget neutrality adjustment for 2001 and 
                            2002.
Sec. 107. Revising calculation of area-specific rate.
Sec. 108. 10-year phase in of risk adjustment based on data from all 
                            settings.
                   TITLE II--ADDITIONAL IMPROVEMENTS

Sec. 201. Delay from July to November, 15, 2000, in deadline for 
                            offering and withdrawing Medicare+Choice 
                            plans for 2001.
Sec. 202. Miscellaneous regulatory changes.
Sec. 203. Effectiveness of elections and changes of elections.
Sec. 204. Uniform premium and benefits.
Sec. 205. Medicare+Choice program compatibility with employer group or 
                            union group health plans.

                   TITLE I--IMPROVEMENTS IN PAYMENTS

SEC. 101. INCREASE IN NATIONAL PER CAPITA MEDICARE+CHOICE GROWTH 
              PERCENTAGE IN 2001 AND 2002.

    Section 1853(c)(6)(B) of the Social Security Act (42 U.S.C. 1395w-
23(c)(6)(B)) is amended--
            (1) in clause (iv), by striking ``for 2001, 0.5 percentage 
        points'' and inserting ``for 2001, 0 percentage points''; and
            (2) in clause (v), by striking ``for 2002, 0.3 percentage 
        points'' and inserting ``for 2002, 0 percentage points''.

SEC. 102. INCREASING MINIMUM PAYMENT AMOUNT.

    (a) In General.--Section 1853(c)(1)(B)(ii) of the Social Security 
Act (42 U.S.C. 1395w-23(c)(1)(B)(ii)) is amended--
            (1) by striking ``(ii) For a succeeding year'' and 
        inserting ``(ii)(I) Subject to subclause (II), for a succeeding 
        year''; and
            (2) by adding at the end the following new subclause:
                            ``(II) For 2001 for any of the 50 States 
                        and the District of Columbia, $475.''.
    (b) Effective Date.--The amendments made by subsection (a) apply to 
years beginning with 2001.

SEC. 103. ALLOWING MOVEMENT TO 50:50 PERCENT BLEND IN 2002.

    Section 1853(c)(2) of the Social Security Act (42 U.S.C. 1395w-
23(c)(2)) is amended--
            (1) by striking the period at the end of subparagraph (F) 
        and inserting a semicolon; and
            (2) by adding after and below subparagraph (F) the 
        following:
        ``except that a Medicare+Choice organization may elect to apply 
        subparagraph (F) (rather than subparagraph (E)) for 2002.''.

SEC. 104. INCREASING THE MINIMUM PERCENTAGE INCREASE IN 2001.

    Section 1853(c)(1)(C) of the Social Security Act (42 U.S.C. 1395w-
23(c)(1)(C)) is amended--
            (1) in clause (i) by striking ``For 1998'' and inserting 
        ``For 1998, 1999, and 2000''; and
            (2) in clause (ii) by striking ``102'' and inserting 
        ``104''.

SEC. 105. INCREASED UPDATE FOR PAYMENT AREAS WITH ONLY ONE OR NO 
              MEDICARE+CHOICE CONTRACTS.

    (a) In General.--Section 1853(c)(1)(C)(ii) of the Social Security 
Act (42 U.S.C. 1395w-23(c)(1)(C)(ii)) is amended--
            (1) by striking ``(ii) For a subsequent year'' and 
        inserting ``(ii)(I) Subject to subclause (II), for a subsequent 
        year''; and
            (2) by adding at the end the following new subclause:
                            ``(II) During 2002, 2003, 2004, and 2005, 
                        in the case of a Medicare+Choice payment area 
                        in which there is no more than one contract 
                        entered into under this part as of July 1 
                        before the beginning of the year, 104.5 percent 
                        of the annual Medicare+Choice capitation rate 
                        under this paragraph for the area for the 
                        previous year.''.
    (b) Construction.--The amendments made by subsection (a) do not 
affect the payment of a first-time bonus under section 1853(i) of the 
Social Security Act (42 U.S.C. 1395w-23(i)).

SEC. 106. ELIMINATION OF BUDGET NEUTRALITY ADJUSTMENT FOR 2001 AND 
              2002.

    Section 1853(c) of the Social Security Act (42 U.S.C. 1395w-23(c)) 
is amended--
            (1) in paragraph (1)(A) in the matter following clause 
        (ii), by inserting ``for a year (other than 2001 or 2002)'' 
        after ``multiplied''; and
            (2) in paragraph (5), by inserting ``(other than 2001 or 
        2002)'' after ``for each year''.

SEC. 107. REVISING CALCULATION OF AREA-SPECIFIC RATE.

    (a) In General.--Section 1853(c)(5) of the Social Security Act (42 
U.S.C. 1395w-23(c)(5)) is amended--
            (1) by striking ``for each year'' and inserting ``for each 
        year after 2000''; and
            (2) by adding at the end the following: ``Such area-
        specific capitation rates shall be calculated without regard to 
        paragraphs (3)(B) and (3)(C).''.
    (b) Effective Date.--The amendments made by subsection (a) apply 
with respect to years beginning on or after January 1, 2001.

SEC. 108. 10-YEAR PHASE IN OF RISK ADJUSTMENT BASED ON DATA FROM ALL 
              SETTINGS.

    Section 1853(a)(3)(C)(ii) of the Social Security Act (42 U.S.C. 
1395w-23(c)(1)(C)(ii)) is amended--
            (1) by striking the period at the end of subclause (II) and 
        inserting a semicolon; and
            (2) by adding after and below subclause (II) the following:
                        ``and, beginning in 2004, insofar as such risk 
                        adjustment is based on data from all (or 
                        substantially all) settings, the methodology 
                        shall be phased in equal increments over a 10 
                        year period, beginning with 2004 or (if later) 
                        the first year in which such data is used.''.

                   TITLE II--ADDITIONAL IMPROVEMENTS

SEC. 201. DELAY FROM JULY TO NOVEMBER, 15, 2000, IN DEADLINE FOR 
              OFFERING AND WITHDRAWING MEDICARE+CHOICE PLANS FOR 2001.

    Notwithstanding any other provision of law, the deadline for a 
Medicare+Choice organization to withdraw the offering of a 
Medicare+Choice plan under part C of title XVIII of the Social Security 
Act (or otherwise to submit information required for the offering of 
such a plan) for 2001 is delayed from July 1, 2000, to November 15, 
2000, and any such organization that provided notice of withdrawal of 
such a plan during 2000 before the date of the enactment of this Act 
may rescind such withdrawal at any time before November 15, 2000.

SEC. 202. MISCELLANEOUS REGULATORY CHANGES.

    (a) Prohibition on Requirement To Submit Encounter Data.--Section 
1853(a)(3)(B) of the Social Security Act (42 U.S.C. 1395w-23(a)(3)(B)) 
is amended--
            (1) by designating the matter following ``Data 
        collection.--'' as clause (i) with appropriate indentation and 
        the heading ``In general.--''; and
            (2) by adding at the end the following new clauses:
                            ``(ii) Issuance of data submission 
                        requirements.--The Secretary may not require 
                        under clause (i) the submission of encounter 
                        data to support a risk adjustment methodology 
                        based on all (or substantially all) settings 
                        until a reasonable time after the Secretary 
                        issues the complete requirements for data 
                        submission. Such requirements shall be limited 
                        to the minimum data elements necessary to 
                        support the risk adjustment methodology. Such 
                        system shall be designed to accept the required 
                        minimum data elements in a form and manner 
                        compatible with Medicare+Choice organizations' 
                        operations.
                            ``(iii) Evaluation.--In issuing such data 
                        submission requirements, the Secretary must 
                        include an evaluation by an outside, 
                        independent actuary of whether the proposed 
                        data elements are the minimum necessary to 
                        support the risk adjustment methodology.''.
    (b) Post-Stabilization Guidelines.--Section 1852(d)(2) of such Act 
(42 U.S.C. 1395w-22(d)(2)) is amended by adding at the end the 
following: ``In prescribing such guidelines--
                    ``(A) post-stabilization care shall be limited to 
                care related to treatment of the condition that 
                precipitated the provision of emergency services; and
                    ``(B) the provider of emergency services is not 
                authorized to provide post-stabilization care unless--
                            ``(i) the Medicare+Choice organization has 
                        been notified as soon as practicable, but not 
                        later than 2 hours after stabilization, in 
                        advance of the request to provide such care;
                            ``(ii) the organization has either approved 
                        the request or not responded to such request 
                        within a reasonable period (of at least 3 
                        hours) after it has been notified; and
                            ``(iii) the emergency services provider 
                        maintains a written documentation concerning 
                        the notice and the organization's response to 
                        such notice.''.

SEC. 203. EFFECTIVENESS OF ELECTIONS AND CHANGES OF ELECTIONS.

    (a) In General.--Section 1851(f)(2) of the Social Security Act (42 
U.S.C. 1395w-21(f)(2)) is amended by striking ``made,'' and all that 
follows and inserting ``made.''.
    (b) Effective Date.--The amendment made by subsection (a) applies 
with respect to years beginning on or after on January 1, 2001.

SEC. 204. UNIFORM PREMIUM AND BENEFITS.

    (a) In General.--Subsections (c) and (f)(1)(D) of section 1854 of 
the Social Security Act (42 U.S.C. 1395w-24) are each amended by 
inserting before the period at the end the following: ``, except across 
counties as approved by the Secretary''.
    (b) Effective Date.--The amendments made by subsection (a) apply 
with respect to years beginning on or after January 1, 2001.

SEC. 205. MEDICARE+CHOICE PROGRAM COMPATIBILITY WITH EMPLOYER OR UNION 
              GROUP HEALTH PLANS.

    (a) In General.--Section 1857 of the Social Security Act (42 U.S.C. 
1395w-27) is amended by adding at the end the following new subsection:
    ``(i) M+C Program Compatibility With Employer or Union Group Health 
Plans.--To facilitate the offering of Medicare+Choice plans under 
contracts between Medicare+Choice organizations and employers, labor 
organizations, or the trustees of a fund established by 1 or more 
employers or labor organizations (or combination thereof) to furnish 
benefits to the entity's employees, former employees (or combination 
thereof) or members or former members (or combination thereof) of the 
labor organizations, the Secretary shall waive or modify requirements 
that hinder the design of, the offering of, or the enrollment in such 
Medicare+Choice plans.''.
    (b) Effective Date.--The amendment made by subsection (a) applies 
with respect to years beginning on or after January 1, 2001.
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