[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5291 Introduced in House (IH)]
106th CONGRESS
2d Session
H. R. 5291
To amend titles XVIII, XIX, and XXI of the Social Security Act to make
additional corrections and refinements in the Medicare, Medicaid, and
State children's health insurance programs, as revised by the Balanced
Budget Act of 1997.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 26, 2000
Mr. Bliley (for himself, Mr. Dingell, Mr. Bilirakis, Mr. Brown of Ohio,
Mr. Tauzin, Mr. Oxley, Mr. Upton, Mr. Stearns, Mr. Gillmor, Mr.
Greenwood, Mr. Burr of North Carolina, Mr. Norwood, Mr. Rogan, Mr.
Shimkus, Mrs. Wilson, Mr. Pickering, Mr. Bryant, Mr. Blunt, Mr.
Ehrlich, Ms. McCarthy of Missouri, Mr. Luther, Mr. Allen, Mr. Weygand,
Mr. Waxman, Mr. Markey, Mr. Hall of Texas, Mr. Boucher, Mr. Towns, Mr.
Pallone, Mr. Gordon, Ms. Eshoo, Mr. Klink, Mr. Stupak, Mr. Engel, Mr.
Wynn, Mr. Barrett of Wisconsin, and Mr. Hoeffel) introduced the
following bill; which was referred to the Committee on Commerce, and in
addition to the Committee on Ways and Means, 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 titles XVIII, XIX, and XXI of the Social Security Act to make
additional corrections and refinements in the Medicare, Medicaid, and
State children's health insurance programs, as revised by the Balanced
Budget Act of 1997.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT; REFERENCES
TO OTHER ACTS; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Beneficiary
Improvement and Protection Act of 2000''.
(b) Amendments to Social Security Act.--Except as otherwise
specifically provided, whenever in this Act an amendment is expressed
in terms of an amendment to or repeal of a section or other provision,
the reference shall be considered to be made to that section or other
provision of the Social Security Act.
(c) References to Other Acts.--In this Act:
(1) Balanced budget act of 1997.--The term ``BBA'' means
the Balanced Budget Act of 1997 (Public Law 105-33).
(2) Medicare, medicaid, and schip balanced budget
refinement act of 1999.--The term ``BBRA'' means the Medicare,
Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, as
enacted into law by section 1000(a)(6) of Public Law 106-113
(Appendix F).
(d) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; amendments to Social Security Act; references to
other Acts; table of contents.
TITLE I--BENEFICIARY IMPROVEMENTS
Sec. 101. Improving availability of QMB/SLMB application forms.
Sec. 102. Study on limitation on State payment for medicare cost-
sharing affecting access to services for
qualified medicare beneficiaries.
Sec. 103. Election of periodic colonoscopy.
Sec. 104. Waiver of 24-month waiting period for medicare coverage of
individuals disabled with amyotrophic
lateral sclerosis (ALS).
Sec. 105. Elimination of time limitation on medicare benefits for
immunosuppressive drugs.
Sec. 106. Preservation of coverage of drugs and biologicals under part
B of the medicare program.
Sec. 107. Demonstration of medicare coverage of medical nutrition
therapy services.
TITLE II--OTHER MEDICARE PART B PROVISIONS
Subtitle A--Access to Technology
Sec. 201. Annual reports on national coverage determinations.
Sec. 202. National limitation amount equal to 100 percent of national
median for new clinical laboratory test
technologies; fee schedule for new clinical
laboratory tests.
Sec. 203. Clarifying process and standards for determining eligibility
of devices for pass-through payments under
hospital outpatient PPS.
Sec. 204. Access to new technologies applied to screening mammography
to enhance breast cancer detection.
Subtitle B--Provisions Relating to Physicians Services
Sec. 211. GAO study of gastrointestinal endoscopic services furnished
in physicians offices and hospital
outpatient department services.
Sec. 212. Treatment of certain physician pathology services.
Sec. 213. Physician group practice demonstration.
Sec. 214. Designation of separate category for interventional pain
management physicians.
Sec. 215. Evaluation of enrollment procedures for medical groups that
retain independent contractor physicians.
Subtitle C--Other Services
Sec. 221. 3-year moratorium on SNF part B consolidated billing
requirements.
Sec. 222. Ambulatory surgical centers.
Sec. 223. 1-year extension of moratorium on therapy caps.
Sec. 224. Revision of medicare reimbursement for telehealth services.
Sec. 225. Payment for ambulance services.
Sec. 226. Contrast enhanced diagnostic procedures under hospital
prospective payment system.
Sec. 227. 10-year phased-in increase from 55 percent to 80 percent in
the proportion of hospital bad debt
recognized.
Sec. 228. State accreditation of diabetes self-management training
programs.
Sec. 229. Update in renal dialysis composite rate.
TITLE III--MEDICARE PART A AND B PROVISIONS
Sec. 301. Home health services.
Sec. 302. Advisory opinions.
Sec. 303. Hospital geographic reclassification for labor costs for
other PPS systems.
Sec. 304. Reclassification of a metropolitan statistical area for
purposes of reimbursement under the
medicare program.
Sec. 305. Making the medicare dependent, small rural hospital program
permanent.
Sec. 306. Option to base eligibility on discharges during any of the 3
most recent audited cost reporting periods.
Sec. 307. Identification and reduction of medical errors by peer review
organizations.
Sec. 308. GAO report on impact of the Emergency Medical Treatment and
Active Labor Act (EMTALA) on hospital
emergency departments.
TITLE IV--MEDICARE+CHOICE PROGRAM STABILIZATION AND IMPROVEMENTS
Subtitle A--Payment Reforms
Sec. 401. Increasing minimum payment amount.
Sec. 402. 3 percent minimum percentage update in 2001.
Sec. 403. 10-year phase in of risk adjustment based on data from all
settings.
Sec. 404. Transition to revised Medicare+Choice payment rates.
Subtitle B--Administrative Reforms
Sec. 411. Effectiveness of elections and changes of elections.
Sec. 412. Medicare+Choice program compatibility with employer or union
group health plans.
Sec. 413. Uniform premium and benefits.
TITLE V--MEDICAID
Sec. 501. DSH payments.
Sec. 502. New prospective payment system for Federally-qualified health
centers and rural health clinics.
Sec. 503. Optional coverage of legal immigrants under the medicaid
program.
Sec. 504. Additional entities qualified to determine medicaid
presumptive eligibility for low-income
children.
Sec. 505. Improving welfare-to-work transition.
Sec. 506. Medicaid county-organized health systems.
Sec. 507. Medicaid recognition for services of physician assistants.
TITLE VI--STATE CHILDREN'S HEALTH INSURANCE PROGRAM
Sec. 601. Special rule for availability and redistribution of unused
fiscal year 1998 and 1999 SCHIP allotments.
Sec. 602. Optional coverage of certain legal immigrants under SCHIP.
TITLE VII--EXTENSION OF SPECIAL DIABETES GRANT PROGRAMS
Sec. 701. Extension of juvenile and Indian diabetes grant programs.
TITLE I--BENEFICIARY IMPROVEMENTS
SEC. 101. IMPROVING AVAILABILITY OF QMB/SLMB APPLICATION FORMS.
(a) Through Local Social Security Offices.--
(1) In general.--Section 1804 (42 U.S.C. 1395b-2) is
amended by adding at the end the following new subsection:
``(d) Availability of Application Forms for Medical Assistance for
Medicare Cost-Sharing.--The Secretary shall make available to the
Administrator of the Social Security Administration appropriate forms
for applying for medical assistance for medicare cost-sharing under a
State plan under title XIX. Such Administrator, through local offices
of the Social Security Administration shall--
``(1) notify applicants and beneficiaries who present at a
local office orally of the availability of such forms and make
such forms available to such individuals upon request; and
``(2) provide assistance to such individuals in completing
such forms and, upon request, in submitting such forms to the
appropriate State agency.''.
(2) Conforming amendment.--Section 1902(a)(8) (42 U.S.C.
1396a(a)(8)) is amended by inserting before the semicolon at
the end the following: ``and provide application forms for
medical assistance for medicare cost-sharing under the plan to
the Secretary in order to make them available through Federal
offices under section 1804(d) within the State''.
(b) Streamlining Application Process.--
(1) Requirement.--Section 1902(a)(8) (42 U.S.C.
1396a(a)(8)) is amended by striking ``, and that'' and
inserting ``permit individuals to apply for and obtain medical
assistance for medicare cost-sharing using the simplified
uniform application form developed under section 1905(p)(5),
make available such forms to such individuals, permit such
individuals to apply for such assistance by mail (and, at the
State option, by telephone or other electronic means) and not
require them to apply in person, and provide that''.
(2) Simplified application form.--Section 1905(p) (42
U.S.C. 1396d(p)) is amended by adding at the end the following
new paragraph:
``(5)(A) The Secretary shall develop a simplified application form
for use by individuals (including both qualified medicare beneficiaries
and specified low-income medicare beneficiaries) in applying for
medical assistance for medicare cost-sharing under this title. Such
form shall be easily readable by applicants and uniform nationally.
``(B) In developing such form, the Secretary shall consult with
beneficiary groups and the States.
``(C) The Secretary shall make such application forms available--
``(i) to the Administrator of the Social Security
Administration for distribution through local social security
offices;
``(ii) at such other sites as the Secretary determines
appropriate; and
``(iii) to persons upon request.''.
(c) Effective Dates.--
(1) The amendments made by subsection (a) take effect on
January 1, 2004.
(2) Effective date.--The amendments made by subsection (b)
take effect 1 year after the date of the enactment of this Act,
regardless of whether regulations have been promulgated to
carry out such amendments by such date. Secretary of Health and
Human Services shall develop the uniform application form under
the amendment made by subsection (b)(2) by not later than 9
months after the date of the enactment of this Act.
SEC. 102. STUDY ON LIMITATION ON STATE PAYMENT FOR MEDICARE COST-
SHARING AFFECTING ACCESS TO SERVICES FOR QUALIFIED
MEDICARE BENEFICIARIES.
(a) In General.--The Secretary of Health and Human Services shall
conduct a study to determine if access to certain services (including
mental health services) for qualified medicare beneficiaries has been
affected by limitations on a State's payment for medicare cost-sharing
for such beneficiaries under section 1902(n) of the Social Security Act
(42 U.S.C. 1396a(n)). As part of such study, the Secretary shall
analyze the effect of such payment limitation on providers who serve a
disproportionate share of such beneficiaries.
(b) Report.--Not later than 1 year after the date of the enactment
of this Act the Secretary shall submit to Congress a report on the
study under subsection (a). The report shall include recommendations
regarding any changes that should be made to the State payment limits
under section 1902(n) for qualified medicare beneficiaries to ensure
appropriate access to services.
SEC. 103. ELECTION OF PERIODIC COLONOSCOPY.
(a) Coverage.--Section 1861(pp)(1)(C) (42 U.S.C. 1395x(pp)(1)(C))
is amended by inserting ``and in the case of an individual making the
election described in section 1834(d)(4)'' after ``high risk for
colorectal cancer''.
(b) Election.--Section 1834(d) (42 U.S.C. 1395m(d)) is amended--
(1) in paragraph (2)(E)--
(A) by striking ``or'' at the end of clause (i);
(B) by striking the period at the end of clause
(ii) and inserting ``; or''; and
(C) by adding at the end the following new clause:
``(iii) if the procedure is performed
within 119 months after a screening colonoscopy
under paragraph (4).'';
(2) in paragraph (3)(A), by inserting ``and for individuals
making the election described in paragraph (4)'' after
``1861(pp)(2))'';
(3) in paragraph (3)(E), by adding at the end the
following: ``No payment may be made under this part for a
colorectal cancer screening test consisting of a screening
colonoscopy for individuals making the election described in
paragraph (4) if the procedure is performed within the 119
months after a previous screening colonoscopy or within 47
months after a screening flexible sigmoidoscopy.''; and
(4) by adding at the end the following new paragraph:
``(4) Election of screening colonoscopy instead of
screening sigmoidoscopy.--An individual may elect, in a manner
specified by the Secretary, to receive a screening colonoscopy
instead of a screening sigmoidoscopy.''.
(c) Effective Date.--The amendments made by this section take
effect on January 1, 2001.
SEC. 104. WAIVER OF 24-MONTH WAITING PERIOD FOR MEDICARE COVERAGE OF
INDIVIDUALS DISABLED WITH AMYOTROPHIC LATERAL SCLEROSIS
(ALS).
(a) In General.--Section 226 (42 U.S.C. 426) is amended--
(1) by redesignating subsection (h) as subsection (j) and
by moving such subsection to the end of the section, and
(2) by inserting after subsection (g) the following new
subsection:
``(h) For purposes of applying this section in the case of an
individual medically determined to have amyotrophic lateral sclerosis
(ALS), the following special rules apply:
``(1) Subsection (b) shall be applied as if there were no
requirement for any entitlement to benefits, or status, for a
period longer than 1 month.
``(2) The entitlement under such subsection shall begin
with the first month (rather than twenty-fifth month) of
entitlement or status.
``(3) Subsection (f) shall not be applied.''.
(b) Conforming Amendment.--Section 1837 (42 U.S.C. 1395p) is
amended by adding at the end the following new subsection:
``(j) In applying this section in the case of an individual who is
entitled to benefits under part A pursuant to the operation of section
226(h), the following special rules apply:
``(1) The initial enrollment period under subsection (d)
shall begin on the first day of the first month in which the
individual satisfies the requirement of section 1836(1).
``(2) In applying subsection (g)(1), the initial enrollment
period shall begin on the first day of the first month of
entitlement to disability insurance benefits referred to in
such subsection.''.
(c) Effective Date.--The amendments made by this section apply to
benefits for months beginning after the date of the enactment of this
Act.
SEC. 105. ELIMINATION OF TIME LIMITATION ON MEDICARE BENEFITS FOR
IMMUNOSUPPRESSIVE DRUGS.
(a) In General.--Section 1861(s)(2)(J) (42 U.S.C. 1395x(s)(2)(J))
is amended by striking ``, but only'' and all that follows up to the
semicolon at the end.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to drugs furnished on or after the date of the enactment of this
Act.
SEC. 106. PRESERVATION OF COVERAGE OF DRUGS AND BIOLOGICALS UNDER PART
B OF THE MEDICARE PROGRAM.
(a) In General.--Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is
amended, in each of subparagraphs (A) and (B), by striking ``(including
drugs and biologicals which cannot, as determined in accordance with
regulations, be self-administered)'' and inserting ``(including drugs
and biologicals which are not usually self-administered by the
patient)''.
(b) Effective Date.--The amendment made by subsection (a) applies
to drugs and biologicals administered on or after October 1, 2000.
SEC. 107. DEMONSTRATION OF MEDICARE COVERAGE OF MEDICAL NUTRITION
THERAPY SERVICES.
(a) In General.--The Secretary of Health and Human Services shall
conduct a demonstration project (in this section referred to as the
``project'') to examine the cost-effectiveness of providing medical
nutrition therapy services under the medicare program and the financial
impact of providing such services under the program.
(b) Scope of Services.--
(1) Time period and locations.--The project shall be
conducted--
(A) during a period of 5 fiscal years; and
(B) in the 5 States which have the highest
proportion of the population who are 65 years of age or
older.
(2) Funding.--The total amount of the payments that may be
made under this section shall not exceed $60,000,000 for each
of the 5 fiscal years of the project. Funding for the project
shall be made from the Federal Supplementary Medical Insurance
Trust Fund established under section 1841 of the Social
Security Act (42 U.S.C. 1395t).
(c) Coverage as Medicare Part B Services.--
(1) In general.--Subject to the succeeding provisions of
this subsection, medical nutrition therapy services furnished
under the project shall be considered to be services covered
under part B of title XVIII of the Social Security Act.
(2) Payment.--Payment for such services shall be made at a
rate of 80 percent of the lesser of the actual charge for the
services or 85 percent of the amount determined under the fee
schedule established under section 1848(b) of the Social
Security Act (42 U.S.C. 1395w-4(b)) for the same services if
furnished by a physician.
(3) Application of limits on billing.--The provisions of
section 1842(b)(18) of the Social Security Act (42 U.S.C.
1395u(b)(18)) shall apply to a registered dietitian or
nutrition professional furnishing services under the project in
the same manner as they to a practitioner described in
subparagraph (C) of such section furnishing services under
title XVIII of such Act.
(d) Reports.--The Secretary shall submit to the Committee on Ways
and Means and the Committee on Commerce of the House of Representatives
and the Committee on Finance of the Senate interim reports on the
project and a final report on the project within 6 months after the
conclusion of the project. The final report shall include an evaluation
of the impact of the use of medical nutrition therapy services on
medicare beneficiaries and on the medicare program, including any
impact on reducing costs under the program and improving the health of
beneficiaries.
(e) Definitions.--For purposes of this section:
(1) Medical nutrition therapy services.--The term ``medical
nutrition therapy services'' means nutritional diagnostic,
therapy, and counseling services for the purpose of disease
management which are furnished by a registered dietitian or
nutrition professional (as defined in paragraph (2)) pursuant
to a referral by a physician (as defined in section 1861(r)(1)
of the Social Security Act, 42 U.S.C. 1395x(r)(1)).
(2) Registered dietitian or nutrition professional.--
(A) In general.--Subject to subparagraph (B), the
term ``registered dietitian or nutrition professional''
means an individual who--
(i) holds a baccalaureate or higher degree
granted by a regionally accredited college or
university in the United States (or an
equivalent foreign degree) with completion of
the academic requirements of a program in
nutrition or dietetics, as accredited by an
appropriate national accreditation organization
recognized by the Secretary for this purpose;
(ii) has completed at least 900 hours of
supervised dietetics practice under the
supervision of a registered dietitian or
nutrition professional; and
(iii)(I) is licensed or certified as a
dietitian or nutrition professional by the
State in which the services are performed, or
(II) in the case of an individual in a
State which does not provide for such licensure
or certification, meets such other criteria as
the Secretary establishes.
(B) Exception.--Clauses (i) and (ii) of
subparagraph (A) shall not apply in the case of an
individual who as of the date of the enactment of this
Act is licensed or certified as a dietitian or
nutrition professional by the State in which medical
nutrition therapy services are performed.
(3) Secretary.--The term ``Secretary'' means Secretary of
Health and Human Services.
TITLE II--OTHER MEDICARE PART B PROVISIONS
Subtitle A--Access to Technology
SEC. 201. ANNUAL REPORTS ON NATIONAL COVERAGE DETERMINATIONS.
(a) Annual Reports.--Not later than December 1 of each year,
beginning in 2001, the Secretary of Health and Human Services shall
submit to Congress a report that sets forth a detailed compilation of
the actual time periods that were necessary to complete and fully
implement any national coverage determinations that were made in the
previous fiscal year for items, services, or medical devices not
previously covered as a benefit under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.), including, with respect to each
new item, service, or medical device, a statement of the time taken by
the Secretary to make the necessary coverage, coding, and payment
determinations, including the time taken to complete each significant
step in the process of making such determinations.
(b) Publication of Reports on the Internet.--The Secretary of
Health and Human Services shall publish each report submitted under
subsection (a) on the medicare Internet site of the Department of
Health and Human Services.
SEC. 202. NATIONAL LIMITATION AMOUNT EQUAL TO 100 PERCENT OF NATIONAL
MEDIAN FOR NEW CLINICAL LABORATORY TEST TECHNOLOGIES; FEE
SCHEDULE FOR NEW CLINICAL LABORATORY TESTS.
(a) In General.--Section 1833(h)(4)(B)(viii) (42 U.S.C.
1395l(h)(4)(B)(viii)) is amended by inserting before the period the
following: ``(or 100 percent of such median in the case of a clinical
diagnostic laboratory test performed on or after January 1, 2001, that
the Secretary determines is a new test for which no limitation amount
has previously been established under this subparagraph)''.
(b) Fee Schedule for New Clinical Lab Tests.--
(1) Establishment of fee schedule for new tests.--Section
1833(h)(1) (42 U.S.C. 1395l(h)(1)) is amended--
(A) in subparagraph (B), by striking ``In'' and
inserting ``Except for tests described in subparagraph
(E), in''; and
(B) by inserting at the end the following new
subparagraph:
``(E) In the case of a clinical diagnostic laboratory test which is
described by a new code in the Health Care Financing Administration
Common Procedure Coding System (commonly referred to as `HCPCS'), for
which the Secretary is not able to crosswalk with a similar test with
an established schedule amount, the Secretary shall establish for
purposes of subparagraph (A) a single fee schedule amount for all areas
in the following manner:
``(i) By not later than December 1 of each year, beginning
with 2001, the Secretary shall cause to have published in the
Federal Register (which may include publication on an interim
final rule basis with a comment period) an interim fee schedule
amount for each such new test which shall apply for such new
tests furnished during the following year.
``(ii) The interim fee schedule amount for each such new
test shall be subject to a comment period of 60 days. The
Secretary shall review comments and data received and make
appropriate adjustments to the fee schedule for each test
applicable beginning with the following calendar year.
``(iii) For years beginning with 2002, the Secretary shall
also cause to have published in the Federal Register by not
later than December 1 of the year prior to its application, the
adjustments to the interim fee schedule amount described in
clause (ii) for each such new test for which an interim fee
schedule amount was established for a year, including
adjustments to such fee schedule amounts in response to
comments.''.
(2) Conforming amendment to update provision.--Section
1833(h)(2)(A) (42 U.S.C. 1395l(h)(2)(A)) is amended by striking
``July 1, 1984,'' and inserting the following: ``July 1, 1984.
The fee schedules established under the previous sentence and
paragraph (1)(E)(3) shall be''.
SEC. 203. CLARIFYING PROCESS AND STANDARDS FOR DETERMINING ELIGIBILITY
OF DEVICES FOR PASS-THROUGH PAYMENTS UNDER HOSPITAL
OUTPATIENT PPS.
(a) In General.--Section 1833(t)(6) (42 U.S.C. 1395l(t)(6)) is
amended--
(1) by redesignating subparagraphs (C) and (D) as
subparagraphs (D) and (E), respectively; and
(2) by striking subparagraph (B) and inserting the
following:
``(B) Use of categories in determining eligibility
of a device for pass-through payments.--The Secretary
shall determine whether a medical device meets the
requirements of subparagraph (A)(iv) as follows:
``(i) Establishment of categories.--The
Secretary shall establish categories of medical
devices based on type of medical device as
follows:
``(I) In general.--The Secretary
shall establish criteria that will be
used for creation of categories through
rulemaking (which may include use of an
interim final rule with comment
period). Such categories shall be
established in a manner such that no
medical device is described by more
than one category. Such criteria shall
include a test of whether the average
cost of devices that would be included
in a category, as estimated by the
Secretary, is not insignificant as
described in paragraph (A)(iv)(II).
``(II) Initial categories.--The
categories to be applied as of the
category-based pass-through
implementation date specified pursuant
to subclause (V) shall be established
in a manner such that each medical
device that meets the requirements of
clause (ii) or (iv) of subparagraph (A)
as of such date is included in a such a
category. For purposes of the preceding
sentence, whether a medical device
meets the requirements of clause (ii)
or (iv) of subparagraph (A) as of such
date shall be determined without regard
to clause (ii) of this subparagraph and
on the basis of the program memoranda
issued before such date identifying
medical devices that meet such
requirements.
``(III) Adding categories.--The
Secretary shall promptly establish a
new category of medical device under
this clause for any medical device that
meets the requirements of subparagraph
(A)(iv) and for which none of the
categories in effect or that were
previously in effect (as described in
subparagraph (C)(iii)) is appropriate.
The Secretary shall only establish a
new category for a medical device that
is described by a category that was
previously in effect if the Secretary
determines, in accord with criteria
established under subclause (I) of this
clause, that the device represents a
significant advance in medical
technology that is expected to
significantly improve the treatment of
Medicare beneficiaries.
(IV) Deleting categories.--The
Secretary shall delete a category at
the close of the period for which the
category is in effect (as described in
subparagraph (C)(iii)).
``(V) Category-based pass-through
implementation date.--For purposes of
this subparagraph and subparagraph (C),
the `category-based pass-through
implementation date' is a date
specified by the Secretary as of which
the categories established under this
clause are first used for purposes of
clause (ii)(I). Such date may not be
later than July 1, 2000.
``(ii) Requirements treated as met.--A
medical device shall be treated as meeting the
requirements of subparagraph (A)(iv) if--
``(I) the device is described by a
category established under clause (i),
and
``(II) an application under section
515 of the Federal Food, Drug, and
Cosmetic Act has been approved with
respect to the device, or the device
has been cleared for market under
section 510(k) of such Act, or the
device is exempt from the requirements
of section 510(k) of such Act pursuant
to subsection (l) or (m) of section 510
of such Act or section 520(g) of such
Act, without an additional requirement
for application or prior approval.---
``(C) Limited period of payment.--
``(i) Drugs and biologicals.--The payment
under this paragraph with respect to a drug or
biological shall only apply during a period of
at least 2 years, but not more than 3 years,
that begins--
``(I) on the first date this
subsection is implemented in the case
of a drug or biological described in
clause (i), (ii), or (iii) of
subparagraph (A) and in the case of a
drug or biological described in
subparagraph (A)(iv) and for which
payment under this part is made as an
outpatient hospital service before such
first date; or
``(II) in the case of a drug or
biological described in subparagraph
(A)(iv) not described in subclause (I),
on the first date on which payment is
made under this part for the drug or
biological as an outpatient hospital
service.
``(ii) Medical devices.--Except as provided
in clause (iv), payment shall be made under
this paragraph with respect to a medical device
only if such device--
``(I) is described by a category of
medical devices established under
subparagraph (B)(i); and
``(II) is provided as part of a
service (or group of services) paid for
under this subsection and provided
during the period for which such
category is in effect (as described in
clause (iii)).
``(iii) Period for which category is in
effect.--For purposes of this subparagraph and
subparagraph (B), a category of medical devices
established under subparagraph (B)(i) shall be
in effect for a period of at least 2 years, but
not more than 3 years, that begins--
``(I) in the case of a category
established under subparagraph
(B)(i)(II), on the first date on which
payment was made under this paragraph
for any device described by such
category (including payments made
during the period before the category-
based pass-through implementation
date); and
``(II) in the case of a category
established under subparagraph
(B)(i)(III), on the first date on which
payment is made under this paragraph
for any medical device that is
described by such category.
``(iv) Payments made before category-based
pass-through implementation date.--
``(I) in the case of a medical
device provided as part of a service
(or group of services) paid for under
this subsection and provided during the
period beginning on the first date on
which the system under this subsection
is implemented and ending on (and
including) the day before the category-
based pass-through implementation date
specified pursuant to subparagraph
(B)(i)(V), payment shall be made in
accordance with the provisions of this
paragraph as in effect on the day
before the date of the enactment of
this subparagraph; and
``(II) notwithstanding subclause
(I), the Secretary shall make payments
under this paragraph during the period
beginning one month after the date of
enactment of the Beneficiary
Improvement and Protection Act of 2000
and ending on the same ending date in
subclause (I) with respect to any
medical device that is not included in
a program memorandum referred to in
subparagraph (B)(i)(II) but that is
substantially similar (other than with
respect to the restriction in
subparagraph (A)(iv)(I)) to devices
that are so included and that the
Secretary determines is likely to be
described by a initial category
established under such subparagraph.''.
(b) Conforming Amendments.--Section 1833(t) is further amended--
(1) in paragraph (6)(D) (as redesignated by subsection
(a)(1)), by striking ``subparagraph (D)(iii)'' in the matter
preceding clause (i) and inserting ``subparagraph (E)(iii)'';
(2) in paragraph (12)(E), by striking ``paragraph (6)(B)''
and inserting ``paragraph (6)(C)'';
(3) in paragraph (11)(E), by striking ``additional payments
(consistent with paragraph (6)(B))'' and inserting ``additional
payments, the determination and deletion of initial and new
categories (consistent with subparagraphs (B) and (C) of
paragraph (6))''; and
(4) in paragraph (6)(A), by striking ``the cost of the
device, drug, or biological'' and inserting ``the cost of the
drug or biological or the average cost of the category of
devices''.
(c) Effective Date.--The amendments made by this section shall
become effective on the date of the enactment of this Act.
SEC. 204. ACCESS TO NEW TECHNOLOGIES APPLIED TO SCREENING MAMMOGRAPHY
TO ENHANCE BREAST CANCER DETECTION.
(a) $15 Initial Increase in Payment Limit.--Section 1834(c)(3) (42
U.S.C. 1395m(c)(3)) is amended--
(1) in subparagraph (A)--
(A) by striking ``subparagraph (B)'' and inserting
``subparagraphs (B) and (D)''; and
(B) in clause (ii), by inserting ``(taking into
account, if applicable, subparagraph (D))'' after ``for
the preceding year''; and
(2) by adding at the end the following new subparagraph:
``(D) Increase in payment limit for new
technologies.--In the case of new technologies applied
to screening mammography performed beginning in 2001
and determined by the Secretary to enhance the
detection of breast cancer, the limit applied under
this paragraph for 2001 shall be increased by $15.''.
(b) Change in Revision of Limit.--Subparagraph (B) of such section
is amended--
(1) by striking ``Reduction of'' and inserting ``Revisions
to'',
(2) by inserting ``or new technologies described in
paragraph (1)(D)'' after ``1992'', and
(3) by inserting ``increase or'' before ``reduce''.
(c) Inclusion of New Technology.--Section 1861(jj) (42 U.S.C.
1395x(jj)) is amended by inserting before the period at the end the
following: ``, as well as new technology applied to such a procedure
that the Secretary determines enhances the detection of breast
cancer''.
(d) Effective Date.--The amendments made by this section apply to
mammography performed on or after January 1, 2001.
Subtitle B--Provisions Relating to Physicians Services
SEC. 211. GAO STUDY OF GASTROINTESTINAL ENDOSCOPIC SERVICES FURNISHED
IN PHYSICIANS OFFICES AND HOSPITAL OUTPATIENT DEPARTMENT
SERVICES.
(a) Study.--The Comptroller General of the United States shall
conduct a study on the appropriateness of furnishing gastrointestinal
endoscopic physicians services in physicians offices. In conducting
this study, the Comptroller General shall--
(1) review available scientific and clinical evidence about
the safety of performing procedures in physicians offices and
hospital outpatient departments;
(2) assess whether resource-based practice expense relative
values established by the Secretary of Health and Human
Services under the Medicare physician fee schedule under
section 1848 of the Social Security Act (42 U.S.C. 1395w-4) for
gastrointestinal endoscopic services furnished in physicians
offices and hospital outpatient departments create an incentive
to furnish such services in physicians offices instead of
hospital outpatient departments; and
(3) assess the implications for access to care for Medicare
beneficiaries if Medicare were not to cover gastrointestinal
endoscopic services in physicians offices. -
(b) Report.--The Comptroller General shall submit a report to
Congress on such study no later than July 1, 2002 and include such
recommendations as the Comptroller General determines to be
appropriate.
SEC. 212. TREATMENT OF CERTAIN PHYSICIAN PATHOLOGY SERVICES.
(a) In General.--When an independent laboratory furnishes the
technical component of a physician pathology service to a fee-for-
service medicare beneficiary who is a patient of a grandfathered
hospital, the Secretary of Health and Human Services shall treat such
component as a service for which payment shall be made to the
laboratory under section 1848 of the Social Security Act (42 U.S.C.
1395w-4) and not as an inpatient hospital service for which payment is
made to the hospital under section 1886(d) of such Act (42 U.S.C.
1395ww(d)) or as an outpatient hospital service for which payment is
made to the hospital under section 1834(t) of such Act (42 U.S.C.
1395l(t)).
(b) Definitions.--For purposes of this section:
(1) Grandfathered hospital.--The term ``grandfathered
hospital'' means a hospital that had an arrangement with an
independent laboratory that was in effect as of July 22, 1999,
under which a laboratory furnished the technical component of
physician pathology services to fee-for-service medicare
beneficiaries who were hospital patients and submitted claims
for payment for such component to a medicare carrier (and not
to the hospital).
(2) Fee-for-service medicare beneficiary.--The term ``fee-
for-service medicare beneficiary'' means an individual who--
(A) is entitled to benefits under part A, or
enrolled under part B, of title XVIII of the Social
Security Act (42 U.S.C. 1395c et seq.); and
(B) is not enrolled in (i) a Medicare+Choice plan
under part C of such title (42 U.S.C. 1395w-21 et
seq.), (ii) a plan offered by an eligible organization
under section 1876 of such Act (42 U.S.C. 1395mm),
(iii) a program of all-inclusive care for the elderly
(PACE) under section 1898 of such Act, or (iv) a social
health maintenance organization (SHMO) demonstration
project established under section 4018(b) of the
Omnibus Budget Reconciliation Act of 1987 (Public Law
100-203).
(3) Medicare carrier.--The term ``medicare carrier'' means
an organization with a contract under section 1842 of such Act
(42 U.S.C. 1395u).
(c) Effective Date.--Subsection (a) applies to services furnished
during the 2-year period beginning on January 1, 2001.
(d) GAO Report.--
(1) Study.--The Comptroller General of the United States
shall--
(A) analyze the types of hospitals that are
grandfathered under subsection (a); and
(B) study the effects of subsection (a) on
hospitals, laboratories, and medicare beneficiaries
access to physician pathology services.
(2) Report.--The Comptroller General shall submit a report
to Congress on such analysis and study no later than July 1,
2002. The report shall include recommendations about whether
the provisions of subsection (a) should apply after the 2-year
period under subsection (c) for grandfathered hospitals for
either (or both) inpatient and outpatient hospital services and
whether such subsection should be extended to apply to other
hospitals that have similar characteristics to grandfathered
hospitals.
SEC. 213. PHYSICIAN GROUP PRACTICE DEMONSTRATION.
Title XVIII is amended by inserting after section 1866 the
following new sections:
``demonstration of application of physician volume increases to group
practices
``Sec. 1866A. (a) Demonstration Program Authorized.--
``(1) In general.--The Secretary shall conduct
demonstration projects to test and, if proven effective, expand
the use of incentives to health care groups participating in
the program under this title that--
``(A) encourage coordination of the care furnished
to individuals under the programs under parts A and B
by institutional and other providers, practitioners,
and suppliers of health care items and services;
``(B) encourage investment in administrative
structures and processes to ensure efficient service
delivery; and
``(C) reward physicians for improving health
outcomes.
``(2) Administration by contract.--Except as otherwise
specifically provided, the Secretary may administer the program
under this section in accordance with section 1866B.
``(3) Definitions.--For purposes of this section, terms
have the following meanings:
``(A) Physician.--Except as the Secretary may
otherwise provide, the term `physician' means any
individual who furnishes services which may be paid for
as physicians' services under this title .
``(B) Health care group.--The term `health care
group' means a group of physicians (as defined in
subparagraph (A)) organized at least in part for the
purpose of providing physicians' services under this
title. As the Secretary finds appropriate, a health
care group may include a hospital and any other
individual or entity furnishing items or services for
which payment may be made under this title that is
affiliated with the health care group under an
arrangement structured so that such individual or
entity participates in a demonstration under this
section and will share in any bonus earned under
subsection (d).
``(b) Eligibility Criteria.--
``(1) In general.--The Secretary is authorized to establish
criteria for health care groups eligible to participate in a
demonstration under this section, including criteria relating
to numbers of health care professionals in, and of patients
served by, the group, scope of services provided, and quality
of care.
``(2) Payment method.--A health care group participating in
the demonstration under this section shall agree with respect
to services furnished to beneficiaries within the scope of the
demonstration (as determined under subsection (c))--
``(A) to be paid on a fee-for-service basis; and
``(B) that payment with respect to all such
services furnished by members of the health care group
to such beneficiaries shall (where determined
appropriate by the Secretary) be made to a single
entity.
``(3) Data reporting.--A health care group participating in
a demonstration under this section shall report to the
Secretary such data, at such times and in such format as the
Secretary require, for purposes of monitoring and evaluation of
the demonstration under this section.
``(c) Patients Within Scope of Demonstration.--
``(1) In general.--The Secretary shall specify, in
accordance with this subsection, the criteria for identifying
those patients of a health care group who shall be considered
within the scope of the demonstration under this section for
purposes of application of subsection (d) and for assessment of
the effectiveness of the group in achieving the objectives of
this section.
``(2) Other criteria.--The Secretary may establish
additional criteria for inclusion of beneficiaries within a
demonstration under this section, which may include frequency
of contact with physicians in the group or other factors or
criteria that the Secretary finds to be appropriate.
``(3) Notice requirements.--In the case of each beneficiary
determined to be within the scope of a demonstration under this
section with respect to a specific health care group, the
Secretary shall ensure that such beneficiary is notified of the
incentives, and of any waivers of coverage or payment rules,
applicable to such group under such demonstration.
``(d) Incentives.--
``(1) Performance target.--The Secretary shall establish
for each health care group participating in a demonstration
under this section--
``(A) a base expenditure amount, equal to the
average total payments under parts A and B for patients
served by the health care group on a fee-for-service
basis in a base period determined by the Secretary; and
``(B) an annual per capita expenditure target for
patients determined to be within the scope of the
demonstration, reflecting the base expenditure amount
adjusted for risk and expected growth rates.
``(2) Incentive bonus.--The Secretary shall pay to each
participating health care group (subject to paragraph (4)) a
bonus for each year under the demonstration equal to a portion
of the Medicare savings realized for such year relative to the
performance target.
``(3) Additional bonus for process and outcome
improvements.--At such time as the Secretary has established
appropriate criteria based on evidence the Secretary determines
to be sufficient, the Secretary shall also pay to a
participating health care group (subject to paragraph (4)) an
additional bonus for a year, equal to such portion as the
Secretary may designate of the saving to the program under this
title resulting from process improvements made by and patient
outcome improvements attributable to activities of the group.
``(4) Limitation.--The Secretary shall limit bonus payments
under this section as necessary to ensure that the aggregate
expenditures under this title (inclusive of bonus payments)
with respect to patients within the scope of the demonstration
do not exceed the amount which the Secretary estimates would be
expended if the demonstration projects under this section were
not implemented.
``provisions for administration of demonstration program
``Sec. 1866B. (a) General Administrative Authority.--
``(1) Beneficiary eligibility.--Except as otherwise
provided by the Secretary, an individual shall only be eligible
to receive benefits under the program under section 1866A (in
this section referred to as the `demonstration program') if
such individual--
``(A) is enrolled in under the program under part B
and entitled to benefits under part A; and
``(B) is not enrolled in a Medicare+Choice plan
under part C, an eligible organization under a contract
under section 1876 (or a similar organization operating
under a demonstration project authority), an
organization with an agreement under section
1833(a)(1)(A), or a PACE program under section 1894.
``(2) Secretary's discretion as to scope of program.--The
Secretary may limit the implementation of the demonstration
program to--
``(A) a geographic area (or areas) that the
Secretary designates for purposes of the program, based
upon such criteria as the Secretary finds appropriate;
``(B) a subgroup (or subgroups) of beneficiaries or
individuals and entities furnishing items or services
(otherwise eligible to participate in the program),
selected on the basis of the number of such
participants that the Secretary finds consistent with
the effective and efficient implementation of the
program;
``(C) an element (or elements) of the program that
the Secretary determines to be suitable for
implementation; or
``(D) any combination of any of the limits
described in subparagraphs (A) through (C).
``(3) Voluntary receipt of items and services.--Items and
services shall be furnished to an individual under the
demonstration program only at the individual's election.
``(4) Agreements.--The Secretary is authorized to enter
into agreements with individuals and entities to furnish health
care items and services to beneficiaries under the
demonstration program.
``(5) Program standards and criteria.--The Secretary shall
establish performance standards for the demonstration program
including, as applicable, standards for quality of health care
items and services, cost-effectiveness, beneficiary
satisfaction, and such other factors as the Secretary finds
appropriate. The eligibility of individuals or entities for the
initial award, continuation, and renewal of agreements to
provide health care items and services under the program shall
be conditioned, at a minimum, on performance that meets or
exceeds such standards.
``(6) Administrative review of decisions affecting
individuals and entities furnishing services.--An individual or
entity furnishing services under the demonstration program
shall be entitled to a review by the program administrator (or,
if the Secretary has not contracted with a program
administrator, by the Secretary) of a decision not to enter
into, or to terminate, or not to renew, an agreement with the
entity to provide health care items or services under the
program.
``(7) Secretary's review of marketing materials.--An
agreement with an individual or entity furnishing services
under the demonstration program shall require the individual or
entity to guarantee that it will not distribute materials
marketing items or services under the program without the
Secretary's prior review and approval;
``(8) Payment in full.--
``(A) In general.--Except as provided in
subparagraph (B), an individual or entity receiving
payment from the Secretary under a contract or
agreement under the demonstration program shall agree
to accept such payment as payment in full, and such
payment shall be in lieu of any payments to which the
individual or entity would otherwise be entitled under
this title.
``(B) Collection of deductibles and coinsurance.--
Such individual or entity may collect any applicable
deductible or coinsurance amount from a beneficiary.
``(b) Contracts for Program Administration.--
``(1) In general.--The Secretary may administer the
demonstration program through a contract with a program
administrator in accordance with the provisions of this
subsection.
``(2) Scope of program administrator contracts.--The
Secretary may enter into such contracts for a limited
geographic area, or on a regional or national basis.
``(3) Eligible contractors.--The Secretary may contract for
the administration of the program with--
``(A) an entity that, under a contract under
section 1816 or 1842, determines the amount of and
makes payments for health care items and services
furnished under this title; or
``(B) any other entity with substantial experience
in managing the type of program concerned.
``(4) Contract award, duration, and renewal.--
``(A) In general.--A contract under this
subsection shall be for an initial term of up to three
years, renewable for additional terms of up to three
years.
``(B) Noncompetitive award and renewal for entities
administering part a or part b payments.--The Secretary
may enter or renew a contract under this subsection
with an entity described in paragraph (3)(A) without
regard to the requirements of section 5 of title 41,
United States Code.
``(5) Applicability of federal acquisition regulation.--The
Federal Acquisition Regulation shall apply to program
administration contracts under this subsection.
``(6) Performance standards.--The Secretary shall establish
performance standards for the program administrator including,
as applicable, standards for the quality and cost-effectiveness
of the program administered, and such other factors as the
Secretary finds appropriate. The eligibility of entities for
the initial award, continuation, and renewal of program
administration contracts shall be conditioned, at a minimum, on
performance that meets or exceeds such standards.
``(7) Functions of program administrator.--A program
administrator shall perform any or all of the following
functions, as specified by the Secretary:
``(A) Agreements with entities furnishing health
care items and services.--Determine the qualifications
of entities seeking to enter or renew agreements to
provide services under the program, and as appropriate
enter or renew (or refuse to enter or renew) such
agreements on behalf of the Secretary.
``(B) Establishment of payment rates.--Negotiate or
otherwise establish, subject to the Secretary's
approval, payment rates for covered health care items
and services.
``(C) Payment of claims or fees.--Administer
payments for health care items or services furnished
under the program.
``(D) Payment of bonuses.--Using such guidelines as
the Secretary shall establish, and subject to the
approval of the Secretary, make bonus payments as
described in subsection (c)(2)(A)(ii) to entities
furnishing items or services for which payment may be
made under the program.
``(E) Oversight.--Monitor the compliance of
individuals and entities with agreements under the
program with the conditions of participation.
``(F) Administrative review.--Conduct reviews of
adverse determinations specified in subsection (a)(6).
``(G) Review of marketing materials.--Conduct a
review of marketing materials proposed by an entity
furnishing services under the program.
``(H) Additional functions.--Perform such other
functions as the Secretary may specify.
``(8) Limitation of liability.--The provisions of section
1157(b) shall apply with respect to activities of contractors
and their officers, employees, and agents under a contract
under this subsection.
``(9) Information sharing.--Notwithstanding section 1106
and section 552a of title 5, United States Code, the Secretary
is authorized to disclose to an entity with a program
administration contract under this subsection such information
(including medical information) on individuals receiving health
care items and services under the program as the entity may
require to carry out its responsibilities under the contract.
``(c) Rules Applicable to Both Program Agreements and Program
Administration Contracts.--
``(1) Records, reports, and audits.--The Secretary is
authorized to require entities with agreements to provide
health care items or services under the demonstration program,
and entities with program administration contracts under
subsection (b), to maintain adequate records, to afford the
Secretary access to such records (including for audit
purposes), and to furnish such reports and other materials
(including audited financial statements and performance data)
as the Secretary may require for purposes of implementation,
oversight, and evaluation of the program and of individuals'
and entities' effectiveness in performance of such agreements
or contracts.
``(2) Bonuses.--Notwithstanding any other provision of law,
but subject to subparagraph (B)(ii), the Secretary may make
bonus payments under the program from the Federal Health
Insurance Trust Fund and the Federal Supplementary Medical
Insurance Trust Fund in amounts that do not exceed the amounts
authorized under the program in accordance with the following:
``(A) Payments to program administrators.--The
Secretary may make bonus payments under the program to
program administrators.
``(B) Payments to entities furnishing services.--
``(i) In general.--Subject to clause (ii),
the Secretary may make bonus payments to
individuals or entities furnishing items or
services for which payment may be made under
the program, or may authorize the program
administrator to make such bonus payments in
accordance with such guidelines as the
Secretary shall establish and subject to the
Secretary's approval.
``(ii) Limitations.--The Secretary may
condition such payments on the achievement of
such standards related to efficiency,
improvement in processes or outcomes of care,
or such other factors as the Secretary
determines to be appropriate.
``(3) Antidiscrimination limitation.--The Secretary shall
not enter into an agreement with an entity to provide health
care items or services under the program, or with an entity to
administer the program, unless such entity guarantees that it
will not deny, limit, or condition the coverage or provision of
benefits under the program, for individuals eligible to be
enrolled under such program, based on any health status-related
factor described in section 2702(a)(1) of the Public Health
Service Act.
``(d) Limitations on Judicial Review.--The following actions and
determinations with respect to the demonstration program shall not be
subject to review by a judicial or administrative tribunal:
``(1) Limiting the implementation of the program under
subsection (a)(2).
``(2) Establishment of program participation standards
under subsection (a)(5) or the denial or termination of, or
refusal to renew, an agreement with an entity to provide health
care items and services under the program.
``(3) Establishment of program administration contract
performance standards under subsection (b)(6), the refusal to
renew a program administration contract, or the noncompetitive
award or renewal of a program administration contract under
subsection (b)(4)(B).
``(4) Establishment of payment rates, through negotiation
or otherwise, under a program agreement or a program
administration contract.
``(5) A determination with respect to the program (where
specifically authorized by the program authority or by
subsection (c)(2))--
``(A) as to whether cost savings have been
achieved, and the amount of savings; or
``(B) as to whether, to whom, and in what amounts
bonuses will be paid.
``(e) Application Limited to Parts A and B.--None of the provisions
of this section or of the demonstration program shall apply to the
programs under part C.
``(f) Reports to Congress.--Not later than two years after the date
of enactment of this section, and biennially thereafter for six years,
the Secretary shall report to the Congress on the use of authorities
under the demonstration program. Each report shall address the impact
of the use of those authorities on expenditures, access, and quality
under the programs under this title.''.
SEC. 214. DESIGNATION OF SEPARATE CATEGORY FOR INTERVENTIONAL PAIN
MANAGEMENT PHYSICIANS.
With respect to services furnished on or after January 1, 2002, the
Secretary of Health and Human Services shall provide for the
designation under section 1848(c)(3)(A) of the Social Security Act (42
U.S.C. 1395w-4(c)(3)(A)) of interventional pain management physicians
as a separate category of physician specialists.
SEC. 215. EVALUATION OF ENROLLMENT PROCEDURES FOR MEDICAL GROUPS THAT
RETAIN INDEPENDENT CONTRACTOR PHYSICIANS.
(a) In General.--The Secretary of Health and Human Services shall
conduct an evaluation of the current medicare enrollment process for
medical groups that retain independent contractor physicians with
particular emphasis on hospital-based physicians, such as emergency
department staffing groups. In conducting the evaluation, the Secretary
shall--
(1) review the increase of individual medicare provider
numbers issued and the possible medicare program integrity
vulnerabilities of the current process;
(2) assess how program integrity could be enhanced by the
enrollment of groups that retain independent contractor
hospital-based physicians; and
(3) develop suggested procedures for the enrollment of
these groups.
(b) Report.--Not later than 1 year after the date of the enactment
of this Act, the Secretary shall submit to Congress a report on the
evaluation conducted under subsection (a).
Subtitle C--Other Services
SEC. 221. 3-YEAR MORATORIUM ON SNF PART B CONSOLIDATED BILLING
REQUIREMENTS.
(a) Moratorium in Application of Consolidated Billing to SNF
Residents in Non-covered Stays.--Section 1842(b)(6)(E) (42 U.S.C.
1395u(b)(6)(E)) is amended by inserting ``(on or after October 1,
2003)'' after ``furnished to an individual''.
(b) Moratorium in Provider Agreement Provision.--Section
1866(a)(1)(H)(ii)(I) (42 U.S.C. 1395cc(a)(1)(H)(ii)(I) is amended by
inserting ``in the case of a resident who is in a stay covered under
part A, and for services furnished on or after October 1, 2003, in the
case of a resident who is not in a stay covered under such part''
before the comma.
(c) Moratorium in Requirement for SNF Billing of Part B Services.--
Section 1862(a)(18) (42 U.S.C. 1395y(a)(18)) is amended to read as
follows:
``(18) which are covered skilled nursing facility services
described in section 1888(e)(2)(A)(i) and which are furnished
to an individual who is a resident--
``(A) of a skilled nursing facility in the case of
a resident who is in a stay covered under part A; or
``(B) of a skilled nursing facility or of a part of
a facility that includes a skilled nursing facility (as
determined under regulations) for services furnished on
or after October 1, 2003, in the case of a resident who
is not in a stay covered under such part,
by an entity other than the skilled nursing facility, unless
the services are furnished under arrangements (as defined in
section 1861(w)(1)) with the entity made by the skilled nursing
facility;''.
(d) Effective Date.--The amendments made by subsections (a), (b)
and (c) are effective as if included in the enactment of BBA.
(e) Report.--Not later than October 1, 2002, the Comptroller
General of the United States shall submit to Congress a report that
includes an analysis and recommendations on--
(1) alternatives, if any, to consolidated billing for part
B items and services described in section 1842(b)(6) of the
Social Security Act (42 U.S.C. 1395u(b)(6)) to ensure
accountability by skilled nursing facilities and accuracy in
claims submitted for all services and items provided to skilled
nursing facility residents under part B of the medicare
program;
(2) the costs expected to be incurred by skilled nursing
facilities under such alternative approaches, compared with the
costs associated with the implementation of consolidated
billing; and
(3) the costs incurred by the medicare program in
implementing such alternative approaches and their effect on
utilization review, compared with the costs and effect on
utilization review expected with consolidated billing.
SEC. 222. AMBULATORY SURGICAL CENTERS.
(a) Delay in Implementation of Prospective Payment System.--The
Secretary of Health and Human Services may not implement a revised
prospective payment system for services of ambulatory surgical
facilities under section 1833(i) of the Social Security Act (42 U.S.C.
1395l(i)) before January 1, 2002.
(b) Extending Phase-In to 4 Years.--Section 226 of the BBRA is
amended by striking paragraphs (1) and (2) and inserting the following:
``(1) in the first year of its implementation, only a
proportion (specified by the Secretary and not to exceed \1/4\)
of the payment for such services shall be made in accordance
with such system and the remainder shall be made in accordance
with current regulations; and
``(2) in each of the following 2 years a proportion
(specified by the Secretary and not to exceed \1/2\, and \3/4\,
respectively) of the payment for such services shall be made
under such system and the remainder shall be made in accordance
with current regulations.''.
(c) Deadline for Use of 1999 or Later Cost Surveys.--Section 226(c)
of BBRA is amended by adding at the end the following:
``By not later than January 1, 2003, the Secretary shall incorporate
data from a 1999 Medicare cost survey or a subsequent cost survey for
purposes of implementing or revising such system.''.
SEC. 223. 1-YEAR EXTENSION OF MORATORIUM ON THERAPY CAPS.
(a) In General.--Section 1833(g)(4) (42 U.S.C. 1395l(g)), as added
by section 221(a) of BBRA, is amended by striking ``and 2001'' and
inserting ``, 2001, and 2002''.
(b) Conforming Amendment To Continue Focused Medical Reviews of
Claims During Moratorium Period.--Section 221(a)(2) of BBRA is amended
by striking ``(under the amendment made by paragraph (1)(B))''.
SEC. 224. REVISION OF MEDICARE REIMBURSEMENT FOR TELEHEALTH SERVICES.
Section 4206 of the Balanced Budget Act of 1997 (42 U.S.C. 1395l
note) is amended to read as follows:
``(a) Telehealth Services Reimbursed.--
``(1) In general.--Not later than April 1, 2001, the
Secretary of Health and Human Services shall make payments from
the Federal Supplementary Medical Insurance Trust Fund in
accordance with the methodology described in subsection (b) for
services for which payment may be made under part B of title
XVIII of the Social Security Act (42 U.S.C. 1395j et seq.) that
are furnished via a telecommunications system by a physician or
practitioner to an eligible telehealth beneficiary.
``(2) Use of store-and-forward technologies.--For purposes
of paragraph (1), in the case of any Federal telemedicine
demonstration program in Alaska or Hawaii, the term
`telecommunications system' includes store-and-forward
technologies that provide for the asynchronous transmission of
health care information in single or multimedia formats.
``(b) Methodology for Determining Amount of Payments.--
``(1) In general.--The Secretary shall make payment under
this section as follows:
``(A) Subject to subparagraph (B), with respect to
a physician or practitioner located at a distant site
that furnishes a service to an eligible medicare
beneficiary under subsection (a), an amount equal to
the amount that such physician or practitioner would
have been paid had the service been furnished without
the use of a telecommunications system.
``(B) With respect to an originating site, a
facility fee equal to--
``(i) for 2001 (beginning with April 1,
2001) and 2002, $20; and
``(ii) for a subsequent year, the facility
fee under this subsection for the previous year
increased by the percentage increase in the MEI
(as defined in section 1842(i)(3)) for such
subsequent year.
``(2) Application of part b coinsurance and deductible.--
Any payment made under this section shall be subject to the
coinsurance and deductible requirements under subsections
(a)(1) and (b) of section 1833 of the Social Security Act (42
U.S.C. 1395l).
``(3) Application of nonparticipating physician payment
differential and balance billing limits.--The payment
differential of section 1848(a)(3) of such Act (42 U.S.C.
1395w-4(a)(3)) shall apply to services furnished by non-
participating physicians. The provisions of section 1848(g) of
such Act (42 U.S.C. 1395w-4(g)) and section 1842(b)(18) of such
Act (42 U.S.C. 1395u(b)(18)) shall apply. Payment for such
service shall be increased annually by the update factor for
physicians' services determined under section 1848(d) of such
Act (42 U.S.C. 1395w-4(d)).
``(c) Telepresenter Not Required.--Nothing in this section shall be
construed as requiring an eligible telehealth beneficiary to be
presented by a physician or practitioner at the originating site for
the furnishing of a service via a telecommunications system, unless it
is medically necessary as determined by the physician or practitioner
at the distant site.
``(d) Coverage of Additional Services.--
``(1) Study and report on additional services.--
``(A) Study.--The Secretary of Health and Human
Services shall conduct a study to identify services in
addition to those described in subsection (a)(1) that
are appropriate for payment under this section.
``(B) Report.--Not later than 2 years after the
date of enactment of this Act, the Secretary shall
submit to Congress a report on the study conducted
under subparagraph (A) together with such
recommendations for legislation that the Secretary
determines are appropriate.
``(2) In general.--The Secretary shall provide for payment
under this section for services identified in paragraph (1).
``(e) Construction Relating to Home Health Services.--
``(1) In general.--Nothing in this section or in section
1895 of the Social Security Act (42 U.S.C. 1395fff) shall be
construed as preventing a home health agency furnishing a home
health unit of service for which payment is made under the
prospective payment system established in such section for such
units of service from furnishing the service.
``(2) Limitation.--The Secretary shall not consider a home
health service provided in the manner described in paragraph
(1) to be a home health visit for purposes of--
``(A) determining the amount of payment to be made
under such prospective payment system; or
``(B) any requirement relating to the certification
of a physician required under section 1814(a)(2)(C) of
such Act (42 U.S.C. 1395f(a)(2)(C)).
``(f) Coverage of Items and Services.--
``(1) In general.--Subject to paragraph (2), payment for
items and services provided pursuant to subsection (a) shall
include payment for professional consultations, office visits,
office psychiatry services, including any service identified as
of July 1, 2000, by HCPCS codes 99241-99275, 99201-99215,
90804-90809, and 90862, and any additional item or service
specified by the Secretary.
``(2) Yearly update.--The Secretary shall provide a process
that provides, on at least an annual basis, for the review and
revision of services (and HCPCS codes) to those specified in
paragraph (1) for authorized payment under subsection (a).
``(g) Definitions.--In this section:
``(1) Eligible telehealth beneficiary.--The term `eligible
telehealth beneficiary' means an individual enrolled under part
B of title XVIII of the Social Security Act (42 U.S.C. 1395j et
seq.) that receives a service originating--
``(A) in an area that is designated as a health
professional shortage area under section 332(a)(1)(A)
of the Public Health Service Act (42 U.S.C.
254e(a)(1)(A));
``(B) in a county that is not included in a
Metropolitan Statistical Area;
``(C) effective January 1, 2002, in an inner-city
area that is medically underserved (as defined in
section 330(b)(3) of the Public Health Service Act (42
U.S.C. 254b(b)(3))); or
``(D) in a service which originated in a facility
which participates in a Federal telemedicine
demonstration project.
``(2) Physician.--The term `physician' has the meaning
given that term in section 1861(r) of the Social Security Act
(42 U.S.C. 1395x(r))
``(3) Practitioner.--The term `practitioner' means a
practitioner described in section 1842(b)(18)(C) of the Social
Security Act (42 U.S.C. 1395u(b)(18)(C)).
``(4) Distant site.--The term `distant site' means the site
at which the physician or practitioner is located at the time
the service is provided via a telecommunications system.
``(5) Originating site.--
``(A) In general.--The term `originating site'
means any site described in subparagraph (B) at which
the eligible telehealth beneficiary is located at the
time the service is furnished via a telecommunications
system.
``(B) Sites described.--The sites described in this
subparagraph are as follows:
``(i) On or after April 1, 2001--
``(I) the office of a physician or
a practitioner,
``(II) a critical access hospital
(as defined in section 1861(mm)(1) of
the Social Security Act (42 U.S.C.
1395x(mm)(1))),
``(III) a rural health clinic (as
defined in section 1861(aa)(2) of such
Act (42 U.S.C. 1395x(aa)(2))), and
``(IV) a Federally qualified health
center (as defined in section
1861(aa)(4) of such Act (42 U.S.C.
1395x(aa)(4))).
``(ii) On or after January 1, 2002--
``(I) a hospital (as defined in
section 1861(e) of such Act (42 U.S.C.
1395x(e))),
``(II) a skilled nursing facility
(as defined in section 1861(j) of such
Act (42 U.S.C. 1395x(j))),
``(III) a comprehensive outpatient
rehabilitation facility (as defined in
section 1861(cc)(2) of such Act (42
U.S.C. 1395x(cc)(2))),
``(IV) a renal dialysis facility
(described in section 1881(b)(1) of
such Act (42 U.S.C. 1395rr(b)(1))),
``(V) an ambulatory surgical center
(described in section 1833(i)(1)(A) of
such Act (42 U.S.C. 1395l(i)(1)(A))),
``(VI) a hospital or skilled
nursing facility of the Indian Health
Service (under section 1880 of such Act
(42 U.S.C. 1395qq)), and
``(VII) a community mental health
center (as defined in section
1861(ff)(3)(B) of such Act (42 U.S.C.
1395x(ff)(3)(B))).
``(6) Federal supplementary medical insurance trust fund.--
The term `Federal Supplementary Medical Insurance Trust Fund'
means the trust fund established under section 1841 of the
Social Security Act (42 U.S.C. 1395t).''.
SEC. 225. PAYMENT FOR AMBULANCE SERVICES.
(a) Eliminating BBA Reduction.--Section 1834(l)(3) (42 U.S.C.
1395m(l)(3)) is amended, in subparagraphs (A) and (B), by striking ``
reduced in the case of 2001 and 2002 by 1.0 percentage points'' both
places it appears.
(b) Mileage Payments.--Section 1834(l)(2)(E) (42 U.S.C.
1395m(l)(2)(E)) is amended by inserting before the period at the end
the following: ``, except that such phase-in shall provide for full
payment of any national mileage rate beginning with the effective date
of the fee schedule for ambulance services provided by suppliers in any
State where payment for such services did not include a separate amount
for all mileage prior to the implementation of the fee schedule''.
(c) GAO Study on Costs of Ambulance Services.--
(1) Study.--The Comptroller General of the United States
shall conduct a study of the costs of providing ambulance
services covered under the medicare program under title XVIII
of the Social Security Act across the range of service levels
for which such services are provided.
(2) Report.--Not later than 18 months after the date of the
enactment of this Act, the Comptroller General shall submit a
report to the Secretary of Health and Human Services and
Congress on the study conducted under paragraph (1). Such
report shall include recommendations for any changes in
methodology or payment levels necessary to fairly compensate
suppliers of ambulance services and to ensure the access of
medicare beneficiaries to such services under the medicare
program.
SEC. 226. CONTRAST ENHANCED DIAGNOSTIC PROCEDURES UNDER HOSPITAL
PROSPECTIVE PAYMENT SYSTEM.
(a) Separate Classification.--Section 1833(t)(2) (42 U.S.C.
1395l(t)(2)) is amended--
(1) by striking ``and'' at the end of subparagraph (E);
(2) by striking the period at the end of subparagraph (F)
and inserting ``; and''; and
(3) by inserting after subparagraph (F) the following new
subparagraph:
``(G) the Secretary shall create additional groups
of covered OPD services that classify separately those
procedures that utilize contrast media from those that
do not.''.
(b) Conforming Amendment.--Section 1861(t)(1) (42 U.S.C.
1395x(t)(1)) is amended by inserting ``(including contrast agents)''
after ``only such drugs''.
(c) Effective Date.--The amendments made by this section shall be
effective as if included in the enactment of BBA.
SEC. 227. 10-YEAR PHASED IN INCREASE FROM 55 PERCENT TO 80 PERCENT IN
THE PROPORTION OF HOSPITAL BAD DEBT RECOGNIZED.
Section 1861(v)(1)(T) (42 U.S.C. 1395x(v)(1)(T)) is amended--
(1) by striking ``and'' at the end of clause (ii);
(2) in clause (iii) by striking ``a subsequent fiscal
year'' and inserting ``fiscal year 2000'' and by striking the
period at the end and inserting a semicolon; and
(3) by adding at the end the following new clauses:
``(iv) for cost reporting periods beginning during fiscal
year 2001 and each subsequent fiscal year (before fiscal year
2011), by the percent specified in clause (iii) or this clause
for the preceding fiscal year reduced by 2.5 percentage points,
of such amount otherwise allowable; and
``(v) for cost reporting periods beginning during fiscal
year 2011 or a subsequent fiscal year, by 20 percent of such
amount otherwise allowable.''.
SEC. 228. STATE ACCREDITATION OF DIABETES SELF-MANAGEMENT TRAINING
PROGRAMS.
Section 1861(qq)(2) (42 U.S.C. 1395x(qq)(2)) is amended--
(1) in the matter preceding subparagraph (A) by striking
``paragraph (1)--'' and inserting ``paragraph (1):'';
(2) in subparagraph (A)--
(A) by striking ``a `certified provider''' and
inserting ``A `certified provider'''; and
(B) by striking ``; and'' and inserting a period;
and
(3) in subparagraph (B)--
(A) by striking ``a physician, or such other
individual'' and inserting ``(i) A physician, or such
other individual'';
(B) by inserting ``(I)'' before ``meets applicable
standards'';
(C) by inserting ``(II)'' before ``is recognized'';
(D) by inserting ``, or by a program described in
clause (ii),'' after ``recognized by an organization
that represents individuals (including individuals
under this title) with diabetes''; and
(E) by adding at the end the following:
``(ii) Notwithstanding any reference to `a national
accreditation body' in section 1865(b), for purposes of clause
(i), a program described in this clause is a program operated
by a State for the purposes of accrediting diabetes self-
management training programs, if the Secretary determines that
such State program has established quality standards that meet
or exceed the standards established by the Secretary under
clause (i) or the standards originally established by the
National Diabetes Advisory Board and subsequently revised as
described in clause (i).''.
SEC. 229. UPDATE IN RENAL DIALYSIS COMPOSITE RATE.
(a) In General.--The last sentence of section 1881(b)(7) (42 U.S.C.
1395rr(b)(7)) is amended by striking ``2001, by 1.2 percent'' and
inserting ``2001, by 2.4 percent''.
(b) Report on Literature Review.--The Secretary of Health and Human
Services shall conduct a literature review of studies on the impact of
oral self-administered prescription non-calcium phosphate binding drugs
in reducing the incidence of hospitalization under the medicare program
for medicare beneficiaries with end stage renal disease. Not later than
6 months after the date of the enactment of this Act, the Secretary
shall transmit to the Committees on Commerce and Ways and Means of the
House of Representatives and the Committee on Finance of the Senate a
summary of the literature review conducted under this subsection.
TITLE III--MEDICARE PART A AND B PROVISIONS
SEC. 301. HOME HEALTH SERVICES.
(a) 1-Year Delay in 15 Percent Reduction in Payment Rates Under the
Medicare Prospective Payment System for Home Health Services.--Section
1895(b)(3)(A)(i) (42 U.S.C. 1395fff(b)(3)(A)(i)) is amended--
(1) by redesignating subparagraph (II) as subparagraph
(III);
(2) in subparagraph (III), as redesignated, by striking
``described in subclause (I)'' and inserting ``described in
subclause (II)''; and
(3) by inserting after subclause (I) the following new
subclause:
``(II) For the 12-month period
beginning after the period described in
subclause (I), such amount (or amounts)
shall be equal to the amount (or
amounts) determined under subclause
(I), updated under subparagraph (B).''.
(b) Treatment of Branch Offices.--
(1) In general.--Notwithstanding any other provision of
law, in determining for purposes of title XVIII of the Social
Security Act whether an office of a home health agency
constitutes a branch office or a separate home health agency,
neither the time nor distance between a parent office of the
home health agency and a branch office shall be the sole
determinant of a home health agency's branch office status.
(2) Consideration of forms of technology in definition of
supervision.--The Secretary of Health and Human Services shall
include forms of technology in determining what constitutes
``supervision'' for purposes of determining a home heath
agency's branch office status under paragraph (1).
(c) Clarification of the Definition of Homebound.--
(1) In general.--The last sentence of sections 1814(a) and
1835(a) (42 U.S.C. 1395f(a); 1395n(a)) are each amended by
striking the period and inserting ``including participating in
an adult day care program licensed by a State to furnish adult
day care services in the State for the purposes of therapeutic
treatment for Alzheimer's disease or a related dementia, or for
medical treatment furnished in an adult day care program.''.
(2) Effective date.--The amendments made by paragraph (1)
apply to items and services provided on or after October 1,
2001.
(d) 1-Year Delay in Report.--Section 302(c) of the the Medicare,
Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (113 Stat.
1501A-360), as enacted into law by section 1000(a)(6) of Public Law
106-113, is amended by striking ``six months'' and inserting ``18
months''.
SEC. 302. ADVISORY OPINIONS.
(a) Making Permanent Existing Advisory Opinion Authority.--Section
1128D(b)(6) (42 U.S.C. 1320a-7d(b)(6)) is amended by striking ``and
before the date which is 4 years after such date of enactment''.
(b) Nondisclosure of Requests and Supporting Materials.--
(1) In general.--Section 1128D(b) (42 U.S.C. 1320a-7d(b))
is amended by adding at the end the following new paragraph:
``(7) Nondisclosure of requests and supporting materials.--
A request for an advisory opinion under this subsection and any
supporting written materials submitted by the party requesting
the opinion shall not be subject to disclosure under section
552 of title 5, United States Code.''.
(2) Effective date.--The amendment made by paragraph (1)
applies to requests made before, on, or after the date of the
enactment of this Act.
SEC. 303. HOSPITAL GEOGRAPHIC RECLASSIFICATION FOR LABOR COSTS FOR
OTHER PPS SYSTEMS.
(a) Hospital Geographic Reclassification for Labor Costs Applicable
to Other PPS Systems.--
(1) In general.--Notwithstanding the geographic adjustment
factor otherwise established under title XVIII of the Social
Security Act for items and services paid under a prospective
payment system described in paragraph (2), in the case of a
hospital with an application that has been approved by the
Medicare Geographic Classification Review Board under section
1886(d)(10)(C) of such Act (42 U.S.C. 1395ww(d)(10)(C)) to
change the hospital's geographic classification for a fiscal
year for purposes of the factor used to adjust the prospective
payment rate for area differences in hospital wage levels that
applies to such hospital under section 1886(d)(3)(E) of such
Act, the Secretary shall substitute such change in the
hospital's geographic adjustment that would otherwise be
applied to an entity or department of the hospital that is
provider based to account for variations in costs which are
attributable to wages and wage-related costs for items and
services paid under the prospective payment systems described
in paragraph (2).
(2) Prospective payment systems covered.--For purposes of
this section, items and services furnished under the following
prospective payment systems are covered:
(A) SNF prospective payment system.--The
prospective payment system for covered skilled nursing
facility services under section 1888(e) of the Social
Security Act (42 U.S.C. 1395yy(e)).
(B) Home health services prospective payment
system.--The prospective payment system for home health
services under section 1895(b) of such Act (42 U.S.C.
1395fff(b)).
(C) Inpatient rehabilitation hospital services.--
The prospective payment system for inpatient
rehabilitation services under section 1888(j) of such
Act (42 U.S.C. 1395ww(j)).
(D) Inpatient long-term care hospital services.--
The prospective payment system for inpatient hospital
services of long-term care hospitals under section 123
of the BBRA.
(E) Inpatient psychiatric hospital services.--The
prospective payment system for inpatient hospital
services of psychiatric hospitals and units under
section 124 of the BBRA.
(b) Effective Date.--Subsection (a) applies to fiscal years
beginning with fiscal year 2002.
SEC. 304. RECLASSIFICATION OF A METROPOLITAN STATISTICAL AREA FOR
PURPOSES OF REIMBURSEMENT UNDER THE MEDICARE PROGRAM.
Notwithstanding any other provision of law, effective for
discharges occurring and services furnished during fiscal year 2001 and
subsequent fiscal years, for purposes of making payments under title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) to hospitals
in the Mansfield, Ohio Metropolitan Statistical Area, such Metropolitan
Statistical Area is deemed to be located in the Cleveland-Loraine-
Elyria, Ohio Metropolitan Statistical Area. The reclassification made
under the previous sentence shall be treated as a decision of the
Medicare Geographic Classification Review Board under section
1886(d)(10) of such Act (42 U.S.C. 1395ww(d)(10)).
SEC. 305. MAKING THE MEDICARE DEPENDENT, SMALL RURAL HOSPITAL PROGRAM
PERMANENT.
(a) Payment Methodology.--Section 1886(d)(5)(G) of the Social
Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amended--
(1) in clause (i), by striking ``and before October 1,
2006,''; and
(2) in clause (ii)(II), by striking ``and before October 1,
2006,''.
(b) Conforming Amendments.--
(1) Target amount.--Section 1886(b)(3)(D) (42 U.S.C.
1395ww(b)(3)(D)) is amended--
(A) in the matter preceding clause (i), by striking
``and before October 1, 2006,''; and
(B) in clause (iv), by striking ``through fiscal
year 2005,'' and inserting ``or any subsequent fiscal
year,''.
(2) Permitting hospitals to decline reclassification.--
Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of
1993 (42 U.S.C. 1395ww note) is amended by striking ``or fiscal
year 2000 through fiscal year 2005'' and inserting ``fiscal
year 2000, or any subsequent fiscal year,''.
SEC. 306. OPTION TO BASE ELIGIBILITY ON DISCHARGES DURING ANY OF THE 3
MOST RECENT AUDITED COST REPORTING PERIODS.
(a) Option To Base Eligibility on Discharges During Any of the 3
Most Recent Audited Cost Reporting Periods.--Section
1886(d)(5)(G)(iv)(IV) (42 U.S.C. 1395ww(d)(5)(G)(iv)(IV)) is amended by
inserting ``, or any of the 3 most recent audited cost reporting
periods,'' after ``1987''.
(b) Effective Date.--The amendments made by this section shall
apply with respect to cost reporting periods beginning on or after the
date of enactment of this Act.
SEC. 307. IDENTIFICATION AND REDUCTION OF MEDICAL ERRORS BY PEER REVIEW
ORGANIZATIONS.
(a) In General.--Section 1154(a) (42 U.S.C. 1320c-3(a)) is amended
by inserting after paragraph (11) the following new paragraph:
``(12) The organization shall assist providers,
practitioners, and Medicare+Choice organizations in identifying
and developing strategies to reduce the incidence of actual and
potential medical errors and problems related to patient safety
affecting individuals entitled to benefits under title XVIII.
For the purposes of this part and title XVIII, the functions
described in this paragraph shall be treated as a review
function.''.
(b) Effective Date.--The amendments made by this section take
effect on January 1, 2001.
SEC. 308. GAO REPORT ON IMPACT OF THE EMERGENCY MEDICAL TREATMENT AND
ACTIVE LABOR ACT (EMTALA) ON HOSPITAL EMERGENCY
DEPARTMENTS.
(a) Congressional Findings.--The Congress makes the following
findings:
(1) The Emergency Medical Treatment and Active Labor Act
(EMTALA) requires that hospitals and the emergency physicians
as well as doctors on call at hospital emergency departments
screen and stabilize patients who go to emergency departments
for treatment.
(2) Physicians who refuse to treat emergency department
patients or fail to respond to hospital emergency department
requests when on call face significant fines and are exposed to
liability under EMTALA.
(3) The Balanced Budget Act of 1997 made many changes in
hospital and physician reimbursement that appear to have had
unintended consequences that have hampered the ability of
hospitals, emergency physicians, and physicians covering
emergency department call to comply with the requirements of
EMTALA.
(4) Estimates indicate that EMTALA costs emergency
department physicians $426,000,000 per year and leads to at
least $10,000,000,000 more in uncompensated inpatient services.
(5) Emergency departments, emergency physicians, and
physicians covering emergency department call have become the
de facto providers of indigent health care in America.
(6) 27 percent of the over 4,300,000 people living in
Arizona are uninsured.
(7) Many physicians covering emergency department call in
Phoenix, Arizona, are resigning from the medical staff at
hospitals due to burdensome on-call requirements and
uncompensated care.
(8) Significant concern exists as to whether downtown
Phoenix hospitals can keep their emergency departments open.
(9) The cumulative effect of potential hospital closings
and staff resignations threatens the quality of health care in
Phoenix, Arizona.
(b) Report.--The Comptroller General of the United States shall
submit a report to the Subcommittee on Health and Environment of the
Committee on Commerce of the House of Representatives by May 1, 2001,
on the effect of the Emergency Medical Treatment and Active Labor Act
on hospitals, emergency physicians, and physicians covering emergency
department call, focusing on those in Arizona (including Phoenix) and
California (including Los Angeles).
(c) Report Requirements.--The report should evaluate--
(1) the extent to which hospitals, emergency physicians,
and physicians covering emergency department call provide
uncompensated services in relation to the requirements of
EMTALA;
(2) the extent to which the requirements of EMTALA are
having a deleterious effect on the legislation's original
intent;
(3) any possible estimates for the total dollar amount
EMTALA-related care costs emergency physicians, physicians
covering emergency department call, and hospital emergency
departments;
(4) the extent to which different portions of the country
may be experiencing similar uncompensated EMTALA-related care;
(5) the extent to which EMTALA would be classified as an
unfunded mandate;
(6) the extent to which States have programs to provide
financial support for uncompensated care;
(7) the extent to which funds under medicare hospital bad
debt accounts are available to underwrite the cost of
uncompensated EMTALA-related care; and
(8) the financial strain that illegal immigration
populations place on hospital emergency departments.
(d) Definition.--In this section, the terms ``Emergency Medical
Treatment and Active Labor Act'' and ``EMTALA'' mean section 1867 of
the Social Security Act (42 U.S.C. 1395dd).
TITLE IV--MEDICARE+CHOICE PROGRAM STABILIZATION AND IMPROVEMENTS
Subtitle A--Payment Reforms
SEC. 401. INCREASING MINIMUM PAYMENT AMOUNT.
Section 1853(c)(1)(B)(ii) (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 area in a
Metropolitan Statistical Area with a population
of more than 250,000, $525 (and for any other
area, $475).''.
SEC. 402. 3 PERCENT MINIMUM PERCENTAGE UPDATE FOR 2001.
Section 1853(c)(1)(C)(ii) (42 U.S.C. 1395w-23(c)(1)(C)(ii)) is
amended by inserting ``(or 103 percent in the case of 2001)'' after
``102 percent''.
SEC. 403. 10-YEAR PHASE IN OF RISK ADJUSTMENT BASED ON DATA FROM ALL
SETTINGS.
Section 1853(a)(3)(C)(ii) (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 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 are used.''.
SEC. 404. TRANSITION TO REVISED MEDICARE+CHOICE PAYMENT RATES.
(a) Announcement of Revised Medicare+Choice Payment Rates.--Within
2 weeks after the date of the enactment of this Act, the Secretary of
Health and Human Services shall determine, and shall announce (in a
manner intended to provide notice to interested parties)
Medicare+Choice capitation rates under section 1853 of the Social
Security Act (42 U.S.C. 1395w-23) for 2001, revised in accordance with
the provisions of this Act.
(b) Reentry Into Program Permitted for Medicare+Choice Programs in
2000.--A Medicare+Choice organization that provided notice to the
Secretary of Health and Human Services as of July 3, 2000, that it was
terminating its contract under part C of title XVIII of the Social
Security Act or was reducing the service area of a Medicare+Choice plan
offered under such part shall be permitted to continue participation
under such part, or to maintain the service area of such plan, for 2001
if it provides the Secretary with the information described in section
1854(a)(1) of the Social Security Act (42 U.S.C. 1395w-24(a)(1)) within
four weeks after the date of the enactment of this Act.
(c) Revised Submission of Proposed Premiums and Related
Information.--If--
(1) a Medicare+Choice organization provided notice to the
Secretary of Health and Human Services as of July 3, 2000, that
it was renewing its contract under part C of title XVIII of the
Social Security Act for all or part of the service area or
areas served under its current contract, and
(2) any part of the service area or areas addressed in such
notice includes a county for which the Medicare+Choice
capitation rate under section 1853(c) of such Act (42 U.S.C.
1395w-23(c)) for 2001, as determined under subsection (a), is
higher than the rate previously determined for such year,
such organization shall revise its submission of the information
described in section 1854(a)(1) of the Social Security Act (42 U.S.C.
1395w-24(a)(1)), and shall submit such revised information to the
Secretary, within four weeks after the date of the enactment of this
Act.
Subtitle B--Administrative Reforms
SEC. 411. EFFECTIVENESS OF ELECTIONS AND CHANGES OF ELECTIONS.
(a) In General.--Section 1851(f)(2) (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 January 1, 2001.
SEC. 412. MEDICARE+CHOICE PROGRAM COMPATIBILITY WITH EMPLOYER OR UNION
GROUP HEALTH PLANS.
(a) In General.--Section 1857 (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 may 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 with 2001.
SEC. 413. UNIFORM PREMIUM AND BENEFITS.
(a) In General.--Subsections (c) and (f)(1)(D) of section 1854 (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.
TITLE V--MEDICAID
SEC. 501. DSH PAYMENTS.
(a) Continuation of Medicaid DSH Allotments at Fiscal Year 2000
Levels for Fiscal Years 2001 and 2002.--Section 1923(f) (42 U.S.C.
1396r-4(f)), as amended by section 601 of the Medicare, Medicaid, and
SCHIP Balanced Budget Refinement Act of 1999 (as enacted into law by
section 1000(a)(6) of Public Law 106-113), is amended--
(1) in paragraph (2)--
(A) in the matter preceding the table, by striking
``2002'' and inserting ``2000'';
(B) in the table in such paragraph, by striking the
columns labeled ``FY 01'' and ``FY 02'' relating to
fiscal years 2001 and 2002; and
(2) in paragraph (3)--
(A) by striking ``2003'' in the heading and
inserting ``2001''; and
(B) by striking ``2003'' and inserting ``2001''.
(b) Higher Rate of Increase in Medicaid DSH Allotment for Extremely
Low DSH States.--Section 1923(f)(3) (42 U.S.C. 1396r-4(f)(3)) is
amended--
(1) in subparagraph (A), by striking ``subparagraph (B)''
and inserting ``subparagraphs (B) and (C)''; and
(2) by adding at the end the following new subparagraph:
``(C) Higher update rate for extremely low dsh
states.--In the case of a State in which the total
expenditures under the State plan (including Federal
and State shares) for disproportionate share hospital
adjustments under this section for fiscal year 1999, as
reported to the Administrator of the Health Care
Financing Administration as of August 31, 2000, is less
than 1 percent of the State's total amount of
expenditures under the State plan for medical
assistance during the fiscal year, the DSH allotment
for fiscal year 2001 shall be increased to 1 percent of
the State's total amount of expenditures under such
plan for such assistance during such fiscal year.''.
(c) District of Columbia.--Effective beginning with fiscal year
2001, the item in the table in section 1923(f) (42 U.S.C. 1396r-4(f))
relating to District of Columbia for FY 2000, is amended by striking
``32'' and inserting ``49''.
(d) Contingent Allotment for Tennessee.--Section 1923(f) (42 U.S.C.
1396r-4(f)) is amended--
(1) in paragraph (3)(A), by striking ``or this paragraph''
and inserting ``, this paragraph, or paragraph (4)''; and
(2) by adding at the end the following new paragraph:
``(4) Contingent allotment adjustment for tennessee.--If
the State-wide waiver approved under section 1115 for the State
of Tennessee with respect to requirements under this title as
in effect on the date of the enactment of this subsection is
revoked or terminated, the DSH allotment for Tennessee for
fiscal year 2001 is deemed to be equal to $286,442,437.''.
(e) Assuring Identification of Medicaid Managed Care Patients.--
(1) In general.--Section 1932 (42 U.S.C. 1396u-2) is
amended by adding at the end the following:
``(g) Identification of Patients for Purposes of Making DSH
Payments.--Each contract with a managed care entity under section
1903(m) or under section 1905(t)(3) shall require the entity either--
``(1) to report to the State information necessary to
determine the hospital services provided under the contract
(and the identity of hospitals providing such services) for
purposes of applying sections 1886(d)(5)(F) and 1923; or
``(2) to include a sponsorship code in the identification
card issued to individuals covered under this title in order
that a hospital may identify a patient as being entitled to
benefits under this title.''.
(2) Clarification of counting managed care medicaid
patients.--Section 1923(a)(2)(D) (42 U.S.C. 1396r-4(a)(2)(D))
is amended--
(A) in subsection (a)(2)(D), by inserting after
``the proportion of low-income and medicaid patients''
the following: ``(including such patients who receive
benefits through a managed care entity)'';
(B) in subsection (b)(2), by inserting after ``a
State plan approved under this title in a period'' the
following: ``(regardless of whether they receive
benefits on a fee-for-service basis or through a
managed care entity)''; and
(C) in subsection (b)(3)(A)(i), by inserting after
``under a State plan under this title'' the following:
``(regardless of whether the services were furnished on
a fee-for-service basis or through a managed care
entity)''.
(3) Effective date.--The amendments made by paragraph (1)
apply to payments made for periods on or after January 1, 2001.
SEC. 502. NEW PROSPECTIVE PAYMENT SYSTEM FOR FEDERALLY-QUALIFIED HEALTH
CENTERS AND RURAL HEALTH CLINICS.
(a) In General.--Section 1902(a) (42 U.S.C. 1396a(a)) is amended--
(1) in paragraph (13)--
(A) in subparagraph (A), by adding ``and'' at the
end;
(B) in subparagraph (B), by striking ``and'' at the
end; and
(C) by striking subparagraph (C); and
(2) by inserting after paragraph (14) the following new
paragraph:
``(15) for payment for services described in clause (B) or
(C) of section 1905(a)(2) under the plan in accordance with
subsection (aa);''.
(b) New Prospective Payment System.--Section 1902 (42 U.S.C. 1396a)
is amended by adding at the end the following:
``(aa) Payment for Services Provided by Federally-Qualified Health
Centers and Rural Health Clinics.--
``(1) In general.--Beginning with fiscal year 2001 and each
succeeding fiscal year, the State plan shall provide for
payment for services described in section 1905(a)(2)(C)
furnished by a Federally-qualified health center and services
described in section 1905(a)(2)(B) furnished by a rural health
clinic in accordance with the provisions of this subsection.
The payment rate under this subsection shall not vary based
upon the site services provided in the case of the same center
or clinic entity.
``(2) Fiscal year 2001.--Subject to paragraph (4), for
services furnished during fiscal year 2001, the State plan
shall provide for payment for such services in an amount
(calculated on a per visit basis) that is equal to 100 percent
of the average of the costs of the center or clinic of
furnishing such services during fiscal years 1999 and 2000
which are reasonable and related to the cost of furnishing such
services, or based on such other tests of reasonableness as the
Secretary prescribes in regulations under section 1833(a)(3),
or, in the case of services to which such regulations do not
apply, the same methodology used under section 1833(a)(3),
adjusted to take into account any increase in the scope of such
services furnished by the center or clinic during fiscal year
2001.
``(3) Fiscal year 2002 and succeeding fiscal years.--
Subject to paragraph (4), for services furnished during fiscal
year 2002 or a succeeding fiscal year, the State plan shall
provide for payment for such services in an amount (calculated
on a per visit basis) that is equal to the amount calculated
for such services under this subsection for the preceding
fiscal year--
``(A) increased by the percentage increase in the
MEI (as defined in section 1842(i)(3)) applicable to
primary care services (as defined in section
1842(i)(4)) for that fiscal year; and
``(B) adjusted to take into account any increase in
the scope of such services furnished by the center or
clinic during that fiscal year.
``(4) Establishment of initial year payment amount for new
centers or clinics.--In any case in which an entity first
qualifies as a Federally-qualified health center or rural
health clinic after fiscal year 2000, the State plan shall
provide for payment for services described in section
1905(a)(2)(C) furnished by the center or services described in
section 1905(a)(2)(B) furnished by the clinic in the first
fiscal year in which the center or clinic so qualifies in an
amount (calculated on a per visit basis) that is equal to 100
percent of the costs of furnishing such services during such
fiscal year based on the rates established under this
subsection for the fiscal year for other such centers or
clinics located in the same or adjacent area with a similar
case load or, in the absence of such a center or clinic, in
accordance with the regulations and methodology referred to in
paragraph (2) or based on such other tests of reasonableness as
the Secretary may specify. For each fiscal year following the
fiscal year in which the entity first qualifies as a Federally-
qualified health center or rural health clinic, the State plan
shall provide for the payment amount to be calculated in
accordance with paragraph (3).
``(5) Administration in the case of managed care.--In the
case of services furnished by a Federally-qualified health
center or rural health clinic pursuant to a contract between
the center or clinic and a managed care entity (as defined in
section 1932(a)(1)(B)), the State plan shall provide for
payment to the center or clinic (at least quarterly) by the
State of a supplemental payment equal to the amount (if any) by
which the amount determined under paragraphs (2), (3), and (4)
of this subsection exceeds the amount of the payments provided
under the contract.
``(6) Alternative payment methodologies.--Notwithstanding
any other provision of this section, the State plan may provide
for payment in any fiscal year to a Federally-qualified health
center for services described in section 1905(a)(2)(C) or to a
rural health clinic for services described in section
1905(a)(2)(B) in an amount which is determined under an
alternative payment methodology that--
``(A) is agreed to by the State and the center or
clinic; and
``(B) results in payment to the center or clinic of
an amount which is at least equal to the amount
otherwise required to be paid to the center or clinic
under this section.''.
(c) Conforming Amendments.--
(1) Section 4712 of the Balanced Budget Act of 1997 (Public
Law 105-33; 111 Stat. 508) is amended by striking subsection
(c).
(2) Section 1915(b) (42 U.S.C. 1396n(b)) is amended by
striking ``1902(a)(13)(E)'' and inserting ``1902(a)(15),
1902(aa),''.
(d) GAO Study of Future Rebasing.--The Comptroller General of the
United States shall provide for a study on the need for, and how to,
rebase or refine costs for making payment under the medicaid program
for services provided by Federally-qualified health centers and rural
health centers (as provided under the amendments made by this section).
The Comptroller General shall provide for submittal of a report on such
study to the Congress by not later than 4 years after the date of the
enactment of this Act.
(e) Effective Date.--The amendments made by this section take
effect on October 1, 2000, and apply to services furnished on or after
such date.
SEC. 503. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS UNDER THE MEDICAID
PROGRAM.
(a) In General.--Section 1903(v) (42 U.S.C. 1396b(v)) is amended--
(1) in paragraph (1), by striking ``paragraph (2)'' and
inserting ``paragraphs (2) and (4)''; and
(2) by adding at the end the following new paragraph:
``(4)(A) A State may elect (in a plan amendment under this title)
to provide medical assistance under this title, notwithstanding
sections 401(a), 402(b), 403, and 421 of the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996, for aliens who are
lawfully residing in the United States (including battered aliens
described in section 431(c) of such Act) and who are otherwise eligible
for such assistance, within either or both of the following eligibility
categories, but only if they have lawfully resided in the United States
for 2 years:
``(i) Pregnant women.--Women during pregnancy (and during
the 60-day period beginning on the last day of the pregnancy).
``(ii) Children.--Children (as defined under such plan),
including optional targeted low-income children described in
section 1905(u)(2)(B).
``(B) In the case of a State that has elected to provide medical
assistance to a category of aliens under subparagraph (A), no action
may be brought under an affidavit of support against any sponsor of
such an alien who has lawfully resided in the United State for 2 years
on the basis of provision of assistance to such category.''.
(b) Effective Date.--The amendments made by subsection (a) take
effect on October 1, 2000, and apply to medical assistance and child
health assistance furnished on or after such date.
SEC. 504. ADDITIONAL ENTITIES QUALIFIED TO DETERMINE MEDICAID
PRESUMPTIVE ELIGIBILITY FOR LOW-INCOME CHILDREN.
(a) In General.--Section 1920A(b)(3)(A)(i) (42 U.S.C. 1396r-
1a(b)(3)(A)(i)) is amended--
(1) by striking ``or (II)'' and inserting ``, (II)''; and
(2) by inserting ``eligibility of a child for medical
assistance under the State plan under this title, or
eligibility of a child for child health assistance under the
program funded under title XXI, (III) is an elementary school
or secondary school, as such terms are defined in section 14101
of the Elementary and Secondary Education Act of 1965 (20
U.S.C. 8801), an elementary or secondary school operated or
supported by the Bureau of Indian Affairs, a State or tribal
child support enforcement agency, a child care resource and
referral agency, an organization that is providing emergency
food and shelter under a grant under the Stewart B. McKinney
Homeless Assistance Act, or a State or tribal office or entity
involved in enrollment in the program under this title, under
part A of title IV, under title XXI, or that determines
eligibility for any assistance or benefits provided under any
program of public or assisted housing that receives Federal
funds, including the program under section 8 or any other
section of the United States Housing Act of 1937 (42 U.S.C.
1437 et seq.) or under the Native American Housing Assistance
and Self-Determination Act of 1996 (25 U.S.C. 4101 et seq.), or
(IV) any other entity the State so deems, as approved by the
Secretary'' before the semicolon.
(b) Technical Amendments.--Section 1920A (42 U.S.C. 1396r-1a) is
amended--
(1) in subsection (b)(3)(A)(ii)--
(A) by striking ``paragraph (1)(A)'' and inserting
``paragraph (2)'', and
(B) by striking ``42 U.S.C. 9821'' and inserting
``42 U.S.C. 9831''; and
(2) in subsection (c)(2), in the matter preceding
subparagraph (A), by striking ``subsection (b)(1)(A)'' and
inserting ``subsection (b)(2)''.
(c) Application to Presumptive Eligibility for Pregnant Women Under
Medicaid.--Section 1920(b) (42 U.S.C. 1396r-1(b)) is amended by adding
at the end after and below paragraph (2) the following flush sentence:
``The term `qualified provider' includes a qualified entity as defined
in section 1920A(b)(3).''.
(d) Application Under Title XXI.--Section 2107(e)(1) (42 U.S.C.
1397gg(e)(1)) is amended by adding at the end the following new
subparagraph:
``(D) Section 1920A (relating to presumptive
eligibility).''.
SEC. 505. IMPROVING WELFARE-TO-WORK TRANSITION.
(a) 1 Year Extension.--Section 1925(f) (42 U.S.C. 1396r-6(f)) is
amended by striking ``2001'' and inserting ``2002''.
(b) Simplification Options.--
(1) Removal of administrative reporting requirements for
additional 6-month extension.--Section 1925(b)(2) of such Act
(42 U.S.C. 1396r-6(b)(2)) is amended by adding at the end the
following new subparagraph:
``(C) State option to waive reporting
requirements.--A State may elect to waive the reporting
requirements under subparagraph (B) and, in the case of
such a waiver for purposes of notices required under
subparagraph (A), to exclude from such notices any
reference to any requirement under subparagraph (B).''.
(2) Exemption for states covering needy families up to 185
percent of poverty.--Section 1925 (42 U.S.C. 1396r-6) is
amended--
(A) in each of subsections (a)(1) and (b)(1), by
inserting ``but subject to subsection (g),'' after
``Notwithstanding any other provision of this title,'';
and
(B) by adding at the end the following new
subsection:
``(g) Exemption for State Covering Needy Families Up to 185 Percent
of Poverty.--
``(1) In general.--At State option, the provisions of this
section shall not apply to a State that uses the authority
under section 1931(b)(2)(C) to make medical assistance
available under the State plan under this title, at a minimum,
to all individuals described in section 1931(b)(1) in families
with gross incomes (determined without regard to work-related
child care expenses of such individuals) at or below 185
percent of the income official poverty line (as defined by the
Office of Management and Budget, and revised annually in
accordance with section 673(2) of the Omnibus Budget
Reconciliation Act of 1981) applicable to a family of the size
involved.
``(2) Application to other provisions of this title.--The
State plan of a State described in paragraph (1) shall be
deemed to meet the requirements of sections
1902(a)(10)(A)(i)(I) and 1902(e)(1).''.
(3) Effective date.--The amendments made by this subsection
take effect on October 1, 2000.
SEC. 506. MEDICAID COUNTY-ORGANIZED HEALTH SYSTEMS.
Section 9517(c)(3)(C) of the Comprehensive Omnibus Budget
Reconciliation Act of 1985 is amended by striking ``10 percent'' and
inserting ``14 percent''.
SEC. 507. MEDICAID RECOGNITION FOR SERVICES OF PHYSICIAN ASSISTANTS.
(a) In General.--Section 1905(a) (42 U.S.C. 1396d(a)) is amended--
(1) by redesignating paragraphs (22) through (27) as
paragraphs (23) through (28), and
(2) by inserting after paragraph (21) the following new
paragraph:
``(22) services furnished by an physician assistant (as
defined in section 1861(aa)(5)) which the assistant is legally
authorized to perform under State law and with the supervision
of a physician;''.
(b) Conforming Amendments.--(1) Section 1902(a)(10)(C)(iv) (42
U.S.C. 1396a(a)(10)(C)(iv)) is amended by striking ``(24)'' and
inserting ``(25)''.
(2) Section 1929(e)(2)(A) (42 U.S.C. 1396t(e)(2)(A)) is amended by
striking ``1905(a)(23)'' and inserting ``1905(a)(24)''.
(3) Section 1917(c)(1)(C)(ii) (42 U.S.C. 1396p(c)(1)(C)(ii)) is
amended by striking ``(22), or (24)'' and inserting ``(23), or (25)''.
TITLE VI--STATE CHILDREN'S HEALTH INSURANCE PROGRAM
SEC. 601. SPECIAL RULE FOR AVAILABILITY AND REDISTRIBUTION OF UNUSED
FISCAL YEAR 1998 AND 1999 SCHIP ALLOTMENTS.
(a) Change in Rules for Retention and Redistribution of Unused
SCHIP Allotments for Fiscal Years 1998 and 1999.--Section 2104 (42
U.S.C. 1397dd) is amended by adding at the end the following new
subsection:
``(g) Rule for Extended Availability and Redistribution of Fiscal
Years 1998 and 1999 Allotments.--
``(1) Amount redistributed.--In the case of a State that
expends all of its allotment under this section for fiscal year
1998 by the end of fiscal year 2000, and for fiscal year 1999
by the end of fiscal year 2001, the Secretary shall
redistribute to the State under subsection (f) (from the
unexpended portion of fiscal year 1998 or 1999 allotments of
other States (as applicable and determined by the application
of paragraph (2) with respect to such fiscal year)) the
following amount:
``(A) State.--In the case of one of the 50 States
or the District of Columbia, the amount of the State's
expenditures in excess of the State's allotment for
fiscal year 1998 or 1999 (as applicable).
``(B) Territory.--In the case of a commonwealth or
territory described in subsection (c)(3), an amount
that bears the same ratio to 1.05 percent of the total
amount described in paragraph (2)(B)(i)(I) as the ratio
of its fiscal year 1998 or 1999 allotment under
subsection (c) (as applicable) bears to the total of
all such allotments for such fiscal year under such
subsection.
``(2) Extension of availability of portion of fiscal years
1998 and 1999 allotments.--
``(A) In general.--Notwithstanding subsection (e)--
``(i) of the amounts allotted to a State
pursuant to this section for fiscal year 1998
that were not expended by the State by the end
of fiscal year 2000; and
``(ii) of the amounts allotted to a State
pursuant to this section for fiscal year 1999
that were not expended by the State by the end
of fiscal year 2001,
the amount specified in subparagraph (B) with respect
to fiscal year 1998 or 1999 (as applicable) for such
State shall remain available for expenditure by the
State through the end of fiscal year 2002.
``(B) Amount remaining available for expenditure.--
With respect to any State described in subparagraph
(A), the amount specified in this subparagraph is equal
to--
``(i) the amount by which (I) the total
amount available for redistribution under
subsection (f) from the allotments for fiscal
year 1998 or 1999 (as applicable and determined
without regard to this subsection), exceeds
(II) the total amounts redistributed under
paragraph (1); multiplied by
``(ii) the ratio of such State's unexpended
fiscal year 1998 or 1999 allotment (as
applicable) to the total amount described in
clause (i)(I) for such fiscal year.
``(C) Use of up to 10 percent of retained 1998
allotments for outreach activities.--Notwithstanding
section 2105(c)(2)(A), with respect to any State
described in subparagraph (A), the State may use up to
10 percent of the amount specified in subparagraph (B)
for fiscal year 1998 for expenditures for outreach
activities made consistent with section 2102(c)(1).
``(3) Determination of amounts.--For purposes of
calculating the amounts described in paragraphs (1) and (2),
the Secretary shall use the amounts reported by the States not
later than November 30 of the appropriate year on HCFA Form 64
or HCFA Form 21, as approved by the Secretary.''.
(b) Effective Date.--The amendments made by this section shall take
effect as if included in the enactment of section 4901 of BBA (111
Stat. 552).
SEC. 602. OPTIONAL COVERAGE OF CERTAIN LEGAL IMMIGRANTS UNDER SCHIP.
(a) In General.--Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)) is
amended by adding at the end the following new subparagraph:
``(D) Section 1903(v)(4) (relating to optional
coverage of categories of permanent resident alien
children), but only if the State has elected to apply
such section to the category of children under title
XIX.''.
(b) Effective Date.--The amendment made by this section takes
effect on October 1, 2000, and applies to medical assistance and child
health assistance furnished on or after such date.
TITLE VII--EXTENSION OF SPECIAL DIABETES GRANT PROGRAMS
SEC. 701. EXTENSION OF JUVENILE AND INDIAN DIABETES GRANT PROGRAMS.
(a) Juvenile Diabetes Research Program.--Section 330B of the Public
Health Service Act (42 U.S.C. 254c-2) is amended by adding at the end
the following new subsection:
``(c) Extension of Funding.--There are hereby appropriated, from
any amounts in the Treasury not otherwise appropriated, for each of
fiscal years 2003 through 2007, $50,000,000 for grants under this
section, to remain available until expended. Nothing in this subsection
shall be construed as providing for such amounts to be derived or
deducted from appropriations made under section 2104(a) of the Social
Security Act.''.
(b) Indian Diabetes Grant Program.----Section 330C of the Public
Health Service Act (42 U.S.C. 254c-3) is amended by adding at the end
the following new subsection:
``(d) Extension of Funding.--There are hereby appropriated, from
any amounts in the Treasury not otherwise appropriated, for each of
fiscal years 2003 through 2007, $50,000,000 for grants under this
section, to remain available until expended. Nothing in this subsection
shall be construed as providing for such amounts to be derived or
deducted from appropriations made under section 2104(a) of the Social
Security Act.''.
(c) Extension of Reports on Grant Programs.--Section 4923(b) of BBA
is amended--
(1) in paragraph (1), by striking ``an interim report'' and
inserting ``interim reports'';
(2) in paragraph (1), by striking ``, 2000'' and inserting
``in each of 2000, 2002, and 2004''; and
(3) in paragraph (2), by striking ``2002'' and inserting
``2007''.
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