[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5099 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 5099

To amend title XVIII of the Social Security Act to make improvements to 
   the Medicare+Choice Program under part C of the Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 27, 2000

   Mr. Udall of New Mexico 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 make improvements to 
   the Medicare+Choice Program under part C of the Medicare 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 
Program Improvement Act of 2000''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Increase in national per capita Medicare+Choice growth 
                            percentage in 2001 and 2002.
Sec. 3. Increasing minimum payment amount.
Sec. 4. Allowing movement to 50:50 percent blend in 2002.
Sec. 5. Increased update for payment areas with only one or no 
                            Medicare+Choice contracts.
Sec. 6. Permitting higher negotiated rates in certain Medicare+Choice 
                            payment areas below national average.
Sec. 7. 10-year phase-in of risk adjustment based on data from all 
                            settings.
Sec. 8. Delay from July to November 2000 in deadline for offering and 
                            withdrawing Medicare+Choice plans for 2001.

SEC. 2. 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 (iii), by adding ``and'' at the end;
            (2) by striking clauses (iv) and (v);
            (3) by redesignating clause (vi) as clause (iv); and
            (4) in clause (iv), as so redesignated, by striking ``after 
        2002'' and inserting ``after 2000''.

SEC. 3. 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 2002 for any of the 50 States 
                        and the District of Columbia, $500.''.
    (b) Effective Date.--The amendments made by subsection (a) apply to 
years beginning with 2002.

SEC. 4. 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 at the end the following flush matter:
        ``except that a Medicare+Choice organization may elect to apply 
        subparagraph (F) (rather than subparagraph (E)) for 2002.''.

SEC. 5. 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, 102.5 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. 6. PERMITTING HIGHER NEGOTIATED RATES IN CERTAIN MEDICARE+CHOICE 
              PAYMENT AREAS BELOW NATIONAL AVERAGE.

    Section 1853(c)(1) of the Social Security Act (42 U.S.C. 1395w-
23(c)(1)) is amended--
            (1) in the matter preceding subparagraph (A), by striking 
        ``or (C)'' and inserting ``(C), or (D)''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Permitting higher rates through 
                negotiation.--
                            ``(i) In general.--For each year beginning 
                        with 2001, in the case of a Medicare+Choice 
                        payment area for which the Medicare+Choice 
                        capitation rate under this paragraph would 
                        otherwise be less than the United States per 
                        capita cost (USPCC), as calculated by the 
                        Secretary, a Medicare+Choice organization may 
                        negotiate with the Secretary an annual per 
                        capita rate that--
                                    ``(I) reflects an annual rate of 
                                increase up to the rate of increase 
                                specified in clause (ii);
                                    ``(II) takes into account audited 
                                current data supplied by the 
                                organization on its adjusted community 
                                rate (as defined in section 
                                1854(f)(3)); and
                                    ``(III) does not exceed the United 
                                States per capita cost, as projected by 
                                the Secretary for the year involved.
                            ``(ii) Maximum rate described.--The rate of 
                        increase specified in this clause for a year is 
                        the rate of inflation in private health 
                        insurance for the year involved, as projected 
                        by the Secretary, and includes such adjustments 
                        as may be necessary--
                                    ``(I) to reflect the demographic 
                                characteristics in the population under 
                                this title; and
                                    ``(II) to eliminate the costs of 
                                prescription drugs.
                            ``(iii) Adjustments for over or under 
                        projections.--If this subparagraph is applied 
                        to an organization and payment area for a year, 
                        in applying this subparagraph for a subsequent 
                        year the provisions of paragraph (6)(C) shall 
                        apply in the same manner as such provisions 
                        apply under this paragraph.
                            ``(iv) Deadline for completion of 
                        negotiations.--The Secretary shall complete 
                        negotiations with a Medicare+Choice 
                        organization under clause (i) for a year by not 
                        later than 90 days after the date the 
                        organization entered into negotiations with the 
                        Secretary.''.

SEC. 7. 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 at the end the following flush matter:
                        ``and, beginning in 2004, insofar as such risk 
                        adjustment is based on data from all settings, 
                        the methodology shall be phased-in in equal 
                        increments over a 10-year period, beginning 
                        with 2004 or (if later) the first year in which 
                        such data is used.''.

SEC. 8. DELAY FROM JULY TO NOVEMBER 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 1, 
2000, and any such organization that provided notice of withdrawal of 
such a plan during 2000 before the date of enactment of this Act may 
rescind such withdrawal at any time before November 1, 2000.
                                 <all>