[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5296 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 5296

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 26, 2000

 Mr. English introduced the following bill; which was referred to the 
   Committee on Ways and Means, and in addition to the Committees on 
   Commerce, the Budget, and Rules, for a period to be subsequently 
   determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


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

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Quality Assurance Act of 
2000''.

         TITLE I--MEDICARE FEE FOR SERVICE PAYMENT IMPROVEMENTS

SEC. 101. REVISION OF PPS HOSPITAL PAYMENT UPDATE.

    Section 1886(b)(3)(B)(i) of the Social Security Act (42 U.S.C. 
1395ww(b)(3)(B)(i)) is amended--
            (1) in subclause (XV), by adding ``and'' at the end;
            (2) by striking subclauses (XVI) and (XVII);
            (3) by redesignating subclause (XVIII) as subclause (XVI); 
        and
            (4) in subclause (XVI), as so redesignated, by striking 
        ``fiscal year 2003'' and inserting ``fiscal year 2001''.

SEC. 102. REVISION OF REDUCTION OF INDIRECT GRADUATE MEDICAL EDUCATION 
              PAYMENTS.

    (a) In General.--Section 1886(d)(5)(B)(ii) of the Social Security 
Act (42 U.S.C. 1395ww(d)(5)(B)(ii)) is amended--
            (1) in subclause (IV), by striking ``fiscal year 2000'' and 
        inserting ``each of fiscal years 2000 and 2001''; and
            (2) in each of subclauses (V) and (VI), by striking 
        ``2001'' and inserting ``2002''.
    (b) Technical Amendments.--Section 1886(d)(5)(B) of such Act (42 
U.S.C. 1395ww(d)(5)(B)), as amended by paragraph (1), is amended--
            (1) by realigning the left margins of clauses (ii) and (v) 
        so as to align with the left margin of clause (i); and
            (2) by realigning the left margins of subclauses (I) 
        through (V) of clause (ii) appropriately.

SEC. 103. INCREASE IN MARKET BASKET PERCENTAGE INCREASE FOR FISCAL YEAR 
              2001.

    (a) In General.--Section 1888(e)(4)(E)(ii) of the Social Security 
Act (42 U.S.C. 1395yy(e)(4)(E)(ii)) is amended--
            (1) by redesignating subclause (III) as subclause (IV);
            (2) by striking subclause (II); and
            (3) by inserting after subclause (I) the following new 
        subclauses:
                                    ``(II) for fiscal year 2001, the 
                                rate computed for fiscal year 2000 
                                increased by the skilled nursing 
                                facility market basket percentage 
                                change for fiscal year 2000 plus 4 
                                percentage points;
                                    ``(III) for fiscal year 2002, the 
                                rate computed for fiscal year 2001 
                                increased by the skilled nursing 
                                facility market basket percentage 
                                change for fiscal year 2001 minus 1 
                                percentage point; and''.
    (b) Revised Definition of Skilled Nursing Facility Market Basket 
Index; Annual Wage Survey for Periods After 1998.--
            (1) Requiring use of actual costs incurred by facilities.--
        Section 1888(e)(5)(A) of such Act (42 U.S.C. 1395yy(e)(5)(A)) 
        is amended by adding at the end the following: ``Such index 
        shall be based, in appropriate part, on actual increases in the 
        cost of wages incurred by skilled nursing facilities in 
        furnishing covered skilled nursing facility services.
            (2) Requiring annual surveys of costs.--For purposes of 
        determining (under the second sentence of section 
        1888(e)(5)(A)) the actual increases in the cost of wages 
        incurred by skilled nursing facilities in furnishing covered 
        skilled nursing facility services the Secretary of Health and 
        Human Services shall conduct annual surveys of such costs 
for purposes of revising and updating the skilled nursing facility 
market basket index under such section.

SEC. 104. ELIMINATION OF 15 PERCENT REDUCTION IN PAYMENT RATES UNDER 
              THE MEDICARE PROSPECTIVE PAYMENT SYSTEM FOR HOME HEALTH 
              SERVICES.

    (a) In General.--Section 1895(b)(3)(A) of the Social Security Act 
(42 U.S.C. 1395fff(b)(3)(A)), as amended by sections 302(b) and 303(f) 
of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 
1999 (113 Stat. 1501A-359, 361), as enacted into law by section 
1000(a)(6) of Public Law 106-113, is amended to read as follows:
                    ``(A) Initial basis.--Under such system the 
                Secretary shall provide for computation of a standard 
                prospective payment amount (or amounts). Such amount 
                (or amounts) shall initially be based on the most 
                current audited cost report data available to the 
                Secretary and shall be computed in a manner so that the 
                total amounts payable under the system for the 12-month 
                period beginning on the date the Secretary implements 
                the system shall be equal to the total amount that 
                would have been made if the system had not been in 
                effect and if section 1861(v)(1)(L)(ix) had not been 
                enacted. Each such amount shall be standardized in a 
                manner that eliminates the effect of variations in 
                relative case mix and area wage adjustments among 
                different home health agencies in a budget neutral 
                manner consistent with the case mix and wage level 
                adjustments provided under paragraph (4)(A). Under the 
                system, the Secretary may recognize regional 
                differences or differences based upon whether or not 
                the services or agency are in an urbanized area.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect as if included in the enactment of the Medicare, Medicaid, 
and SCHIP Balanced Budget Refinement Act of 1999 (Public Law 106-113).

SEC. 105. TWO-YEAR EXTENSION OF MORATORIUM IN CAPS FOR THERAPY 
              SERVICES.

    (a) Extension of Moratorium.--Section 1833(g)(4) of the Social 
Security Act (42 U.S.C. 1395l(g)(4)), as added by section 221(a) of 
Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 
(113 Stat. 1501A-351), is amended by striking ``and 2001'' and 
inserting ``through 2003''.
    (b) Extension of Report.--Section 4541(d)(2) of Balanced Budget Act 
of 1997, as amended by section 221(c) of Medicare, Medicaid, and SCHIP 
Balanced Budget Refinement Act of 1999 (113 Stat. 1501A-351), is 
amended by striking ``January 1, 2001'' and inserting ``January 1, 
2002''.

             TITLE II--MEDICARE+CHOICE PROGRAM IMPROVEMENTS

SEC. 201. ELIMINATION OF BUDGET NEUTRALITY ADJUSTMENT FOR 2001 AND 
              2002.

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

SEC. 202. INCREASING MINIMUM PAYMENT AMOUNT.

    (a) In General.--Section 1853(c)(1)(B)(ii) of the Social Security 
Act (42 U.S.C. 1395w-23(c)(1)(B)(ii)) is amended--
            (1) by striking ``(ii) For a succeeding year'' and 
        inserting ``(ii)(I) Subject to subclause (II), for a succeeding 
        year''; and
            (2) by adding at the end the following new subclause:
                            ``(II) For 2001 for any of the 50 States 
                        and the District of Columbia, $450.''.
    (b) Effective Date.--The amendments made by subsection (a) apply to 
years beginning with 2001.

SEC. 203. ALLOWING MOVEMENT TO 50:50 PERCENT BLEND IN 2002.

    Section 1853(c)(2) of the Social Security Act (42 U.S.C. 1395w-
23(c)(2)) is amended--
            (1) by striking the period at the end of subparagraph (F) 
        and inserting a semicolon; and
            (2) by adding after and below subparagraph (F) the 
        following:
        ``except that a Medicare+Choice organization may elect to apply 
        subparagraph (F) (rather than subparagraph (E)) for 2001 and 
        for 2002.''.

SEC. 204. INCREASED UPDATE FOR PAYMENT AREAS WITH ONLY ONE OR NO 
              MEDICARE+CHOICE CONTRACTS.

    (a) In General.--Section 1853(c)(1)(C)(ii) of the Social Security 
Act (42 U.S.C. 1395w-23(c)(1)(C)(ii)) is amended--
            (1) by striking ``(ii) For a subsequent year'' and 
        inserting ``(ii)(I) Subject to subclause (II), for a subsequent 
        year''; and
            (2) by adding at the end the following new subclause:
                            ``(II) During 2001, 2002, 2003, 2004, and 
                        2005, in the case of a Medicare+Choice payment 
                        area in which there is no more than one 
                        contract entered into under this part as of 
                        July 1 before the beginning of the year, 102.5 
                        percent of the annual Medicare+Choice 
                        capitation rate under this paragraph for the 
                        area for the previous year.''.
    (b) Construction.--The amendments made by subsection (a) do not 
affect the payment of a first time bonus under section 1853(i) of the 
Social Security Act (42 U.S.C. 1395w-23(i)).

SEC. 205. PERMITTING HIGHER NEGOTIATED RATES IN CERTAIN MEDICARE+CHOICE 
              PAYMENT AREAS BELOW NATIONAL AVERAGE.

    Section 1853(c)(1) of the Social Security Act (42 U.S.C. 1395w-
23(c)(1)) is amended--
            (1) in the matter before subparagraph (A), by striking ``or 
        (C)'' and inserting ``(C), or (D)''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Permitting higher rates through 
                negotiation.--
                            ``(i) In general.--For each year beginning 
                        with 2004, in the case of a Medicare+Choice 
                        payment area for which the Medicare+Choice 
                        capitation rate under this paragraph would 
                        otherwise be less than the United States per 
                        capita cost (USPCC), as calculated by the 
                        Secretary, a Medicare+Choice organization may 
                        negotiate with the Secretary an annual per 
                        capita rate that--
                                    ``(I) reflects an annual rate of 
                                increase up to the rate of increase 
                                specified in clause (ii);
                                    ``(II) takes into account audited 
                                current data supplied by the 
                                organization on its adjusted community 
                                rate (as defined in section 
                                1854(f)(3)); and
                                    ``(III) does not exceed the United 
                                States per capita cost, as projected by 
                                the Secretary for the year involved.
                            ``(ii) Maximum rate described.--The rate of 
                        increase specified in this clause for a year is 
                        the rate of inflation in private health 
                        insurance for the year involved, as projected 
                        by the Secretary, and includes such adjustments 
                        as may be necessary--
                                    ``(I) to reflect the demographic 
                                characteristics in the population under 
                                this title; and
                                    ``(II) to eliminate the costs of 
                                prescription drugs.
                            ``(iii) Adjustments for over or under 
                        projections.--If subparagraph is applied to an 
                        organization and payment area for a year, in 
                        applying this subparagraph for a subsequent 
                        year the provisions of paragraph (6)(C) shall 
                        apply in the same manner as such provisions 
                        apply under this paragraph.''.

            TITLE III--SOCIAL SECURITY AND MEDICARE LOCK-BOX

SEC. 301. SHORT TITLE.

    This title may be cited as the ``Social Security and Medicare Lock-
box Act of 2000''.

SEC. 302. PROTECTION OF SOCIAL SECURITY SURPLUSES.

    (a) Points of Order To Protect Social Security Surpluses.--Section 
312 of the Congressional Budget Act of 1974 is amended by adding at the 
end the following new subsection:
    ``(g) Points of Order To Protect Social Security Surpluses.--
            ``(1) Concurrent resolutions on the budget.--It shall not 
        be in order in the House of Representatives or the Senate to 
        consider any concurrent resolution on the budget, or conference 
        report thereon or amendment thereto, that would set forth an 
        on-budget deficit for any fiscal year.
            ``(2) Subsequent legislation.--Except as provided by 
        paragraph (3), it shall not be in order in the House of 
        Representatives or the Senate to consider any bill, joint 
        resolution, amendment, motion, or conference report if--
                    ``(A) the enactment of that bill or resolution as 
                reported;
                    ``(B) the adoption and enactment of that amendment; 
                or
                    ``(C) the enactment of that bill or resolution in 
                the form recommended in that conference report,
        would cause or increase an on-budget deficit for any fiscal 
        year.
            ``(3) Exception.--Paragraph (2) shall not apply to social 
        security reform legislation as defined in section 304(1) or 
        Medicare reform legislation as defined by section 304(2).
            ``(4) Definition.--For purposes of this section, the term 
        `on-budget deficit', when applied to a fiscal year, means the 
        deficit in the budget as set forth in the most recently agreed 
        to concurrent resolution on the budget pursuant to section 
        301(a)(3) for that fiscal year.''.
    (b) Content of Concurrent Resolution on the Budget.--Section 301(a) 
of the Congressional Budget Act of 1974 is amended by redesignating 
paragraphs (6) and (7) as paragraphs (7) and (8), respectively, and by 
inserting after paragraph (5) the following new paragraph:
            ``(6) the receipts, outlays, and surplus or deficit in the 
        Federal Old-Age and Survivors Insurance Trust Fund and the 
        Federal Disability Insurance Trust Fund, combined, established 
        by title II of the Social Security Act;''.
    (c) Super Majority Requirement.--(1) Section 904(c)(1) of the 
Congressional Budget Act of 1974 is amended by inserting ``312(g),'' 
after ``310(d)(2),''.
    (2) Section 904(d)(2) of the Congressional Budget Act of 1974 is 
amended by inserting ``312(g),'' after ``310(d)(2),''.

SEC. 303. PROTECTION OF MEDICARE SURPLUSES.

    (a) Points of Order To Protect Medicare Surpluses.--Section 312 of 
the Congressional Budget Act of 1974, as amended by section 301, is 
further amended by adding at the end the following new subsection:
    ``(h) Points of Order To Protect Medicare Surpluses.--
            ``(1) Concurrent resolutions on the budget.--It shall not 
        be in order in the House of Representatives or the Senate to 
        consider any concurrent resolution on the budget, or conference 
        report thereon or amendment thereto, that would set forth an 
        on-budget surplus for any fiscal year that is less than the 
        projected surplus of the Federal Hospital Insurance Trust Fund 
        for that fiscal year (as assumed in that resolution).
            ``(2) Subsequent legislation.--Except as provided by 
        paragraph (3), it shall not be in order in the House of 
        Representatives or the Senate to consider any bill, joint 
        resolution, amendment, motion, or conference report if--
                    ``(A) the enactment of that bill or resolution as 
                reported;
                    ``(B) the adoption and enactment of that amendment; 
                or
                    ``(C) the enactment of that bill or resolution in 
                the form recommended in that conference report,
        would cause the on-budget surplus for any fiscal year to be 
        less than the projected surplus of the Federal Hospital 
        Insurance Trust Fund (as assumed in the most recently agreed to 
        concurrent resolution on the budget) for that fiscal year or 
        increase the amount by which the on-budget surplus for any 
        fiscal year would be less than such trust fund surplus for that 
        fiscal year.
            ``(3) Exception.--Paragraph (2) shall not apply to Medicare 
        reform legislation as defined in section 304(2) of the Social 
        Security and Medicare Lock-box Act of 2000.
            ``(4) Definition.--For purposes of this section, the term 
        `on-budget surplus', when applied to a fiscal year, means the 
        surplus in the budget as set forth in the most recently agreed 
        to concurrent resolution on the budget pursuant to section 
        301(a)(3) for that fiscal year.''.
    (b) Super Majority Requirement.--
            (1) Point of order.--Section 904(c)(1) of the Congressional 
        Budget Act of 1974 (as amended by section 3) is further amended 
        by inserting ``312(h),'' after ``312(g),''.
            (2) Waiver.--Section 904(d)(2) of the Congressional Budget 
        Act of 1974 (as amended by section 3) is further amended by 
        inserting ``312(h),'' after ``312(g),''.

SEC. 304. DEFINITIONS.

    As used in this Act:
            (1) Social security reform legislation.--The term ``social 
        security reform legislation'' means a bill or a joint 
        resolution to save social security and includes a provision 
        stating the following: ``For purposes of the Social Security 
        and Medicare Lock-box Act of 2000, this Act constitutes social 
        security reform legislation to save social security.''.
            (2) Medicare reform legislation.--The term ``Medicare 
        reform legislation'' means a bill or a joint resolution to save 
        Medicare and includes a provision stating the following: ``For 
        purposes of the Social Security and Medicare Lock-box Act of 
        2000, this Act constitutes Medicare reform legislation to save 
        Medicare.''.

SEC. 305. EFFECTIVE DATE.

    (a) In General.--This Act shall take effect upon the date of its 
enactment and the amendments made by this Act shall apply to fiscal 
year 2001 and subsequent fiscal years.
    (b) Expiration.--(1) Sections 301(a)(6) and 312(g) of the 
Congressional Budget Act of 1974 shall expire upon the enactment of 
social security reform legislation.
    (2) Section 312(h) of the Congressional Budget Act of 1974 shall 
expire upon the enactment of Medicare reform legislation.
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