[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5614 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 5614

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            November 1, 2000

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

_______________________________________________________________________

                                 A BILL


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

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Seniors' Health Care Restoration Act 
of 2000''.

SEC. 2. INCREASED PAYMENT FOR AREAS WITH TWO OR FEWER MEDICARE+CHOICE 
              CONTRACTS.

    Section 1853 of the Social Security Act (42 U.S.C. 1395w-23) is 
amended--
            (1) in subsection (a)(1)(A), by striking ``and (i)'' and 
        inserting ``(i), and (j)''; and
            (2) by adding at the end the following new subsection:
    ``(j) Increased Payment for Areas With 2 or Fewer Medicare+Choice 
Contracts.--For months during 2002 and 2003, in the case of a 
Medicare+Choice payment area in which there is no more than two 
contracts entered into under this part as of July 1 before the 
beginning of the year involved, the amount of the monthly payment 
otherwise made under this section (taking into account, if applicable, 
subsection (i)) shall be increased by \1/2\ percentage point of the 
total monthly payment otherwise computed for such payment area.''.

SEC. 3. INCREASE IN MINIMUM PERCENTAGE UPDATE.

    Section 1853(c)(1)(C)(ii) of the Social Security Act (42 U.S.C. 
1395w-23(c)(1)(C)(ii)) is amended by inserting ``(or 104 percent in the 
case of 2001, 2002, and 2003)'' after ``102 percent''.

SEC. 4. 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 
4 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 4 weeks after the date of the enactment of this Act.

SEC. 5. PROVISION OF EMERGENCY OUTPATIENT PRESCRIPTION DRUG COVERAGE 
              FOR MEDICARE BENEFICIARIES LOSING DRUG COVERAGE UNDER 
              MEDICARE+CHOICE PLANS.

    (a) Temporary Coverage of Outpatient Prescription Drugs for 
Medicare Beneficiaries Losing Prescription Drug Coverage Under 
Medicare+Choice Plans.--
            (1) In general.--The Secretary of Health and Human Services 
        shall provide for coverage of outpatient prescription drugs to 
        eligible medicare beneficiaries under this section. The 
        Secretary shall provide for such coverage by entering into 
        agreements with eligible organizations to furnish such 
        coverage.
            (2) Term of emergency coverage.--The Secretary shall 
        provide coverage of outpatient prescription drugs to an 
        eligible medicare beneficiary under this section for the 24-
        month period beginning on the date the eligible medicare 
        beneficiary loses coverage of outpatient prescription drugs 
        under the Medicare+Choice plan in which the beneficiary is 
        enrolled.
            (3) Cost-sharing.--With respect to coverage of outpatient 
        prescription drugs furnished under this section, benefits under 
        this section shall not begin until the eligible medicare 
        beneficiary has met a $50 deductible.
            (4) Payment.--The Secretary shall provide for payment for 
        such coverage under this section from the Emergency Reserve 
        Outpatient Prescription Drug Account established under 
        subsection (b).
    (b) Account for Emergency Outpatient Prescription Drug Benefit in 
SMI Trust Fund.--
            (1) Establishment.--There is hereby established in the 
        Federal Supplementary Medical Insurance Trust Fund under 
        section 1841 of the Social Security Act (42 U.S.C. 1395t) an 
        expenditure account to be known as the ``Emergency Reserve 
        Outpatient Prescription Drug Account''.
            (2) Crediting of funds.--The Managing Trustee shall credit 
        to the Emergency Reserve Outpatient Prescription Drug Account 
        such amounts as may be deposited in the Federal Supplementary 
        Medical Insurance Trust Fund as follows:
                    (A) Amounts appropriated to the account.
                    (B) Amounts equal to the annual outstanding balance 
                of the Health Care Fraud and Abuse Control Account 
                under section 1817(k) of the Social Security Act (42 
                U.S.C. 1395i(k)) at the end of each fiscal year that 
                the Secretary determines may be made available to the 
                Emergency Reserve Outpatient Prescription Drug Account.
            (3) Use of funds.--Funds credited to the Outpatient 
        Prescription Drug Account may only be used to pay for 
        outpatient prescription drugs (and associated administrative 
        costs) furnished under this section.
            (4) Conforming amendment.--Section 1817(k)(3)(C) of such 
        Act (42 U.S.C. 1395i(k)(3)(C)) is amended--
                    (A) by striking ``and'' at the end of clause (iv);
                    (B) by striking the period at the end of clause (v) 
                and inserting ``; and''; and
                    (C) by adding at the end the following new clause:
                            ``(vi) providing temporary emergency 
                        coverage of outpatient prescription drugs for 
                        eligible beneficiaries under section 5 of the 
                        Seniors' Health Care Restoration Act of 
                        2000.''.
    (c) Definitions.--In this section:
            (1) Eligible medicare beneficiary.--The term ``eligible 
        medicare beneficiary'' means an individual--
                    (A) who is enrolled in a Medicare+Choice plan under 
                part C of title XVIII of the Social Security Act; and
                    (B)(i) whose enrollment in such plan is terminated 
                or may not be renewed or whose service area has been 
                reduced for the next contract year because the plan has 
                been terminated or will not be offered in such contract 
                year; or
                    (ii) whose coverage of outpatient prescription 
                drugs under such plan has been terminated, 
                significantly reduced, or no longer provides for the 
                coverage of a particular outpatient prescription drug 
                required.
            (2) Covered outpatient drug.--
                    (A) In general.--Except as provided in subparagraph 
                (B), the term ``covered outpatient drug'' means any of 
                the following products:
                            (i) A drug which may be dispensed only upon 
                        prescription, and--
                                    (I) which is approved for safety 
                                and effectiveness as a prescription 
                                drug under section 505 of the Federal 
                                Food, Drug, and Cosmetic Act;
                                    (II)(aa) which was commercially 
                                used or sold in the United States 
                                before the date of enactment of the 
                                Drug Amendments of 1962 or which is 
                                identical, similar, or related (within 
                                the meaning of section 310.6(b)(1) of 
                                title 21 of the Code of Federal 
                                Regulations) to such a drug, and (bb)  
which has not been the subject of a final determination by the 
Secretary that it is a ``new drug'' (within the meaning of section 
201(p) of the Federal Food, Drug, and Cosmetic Act) or an action 
brought by the Secretary under section 301, 302(a), or 304(a) of such 
Act to enforce section 502(f) or 505(a) of such Act; or
                                    (III)(aa) which is described in 
                                section 107(c)(3) of the Drug 
                                Amendments of 1962 and for which the 
                                Secretary has determined there is a 
                                compelling justification for its 
                                medical need, or is identical, similar, 
                                or related (within the meaning of 
                                section 310.6(b)(1) of title 21 of the 
                                Code of Federal Regulations) to such a 
                                drug, and (bb) for which the Secretary 
                                has not issued a notice of an 
                                opportunity for a hearing under section 
                                505(e) of the Federal Food, Drug, and 
                                Cosmetic Act on a proposed order of the 
                                Secretary to withdraw approval of an 
                                application for such drug under such 
                                section because the Secretary has 
                                determined that the drug is less than 
                                effective for all conditions of use 
                                prescribed, recommended, or suggested 
                                in its labeling.
                            (ii) A biological product which--
                                    (I) may only be dispensed upon 
                                prescription;
                                    (II) is licensed under section 351 
                                of the Public Health Service Act; and
                                    (III) is produced at an 
                                establishment licensed under such 
                                section to produce such product.
                            (iii) Insulin approved under appropriate 
                        Federal law.
                            (iv) A prescribed drug or biological 
                        product that would meet the requirements of 
                        clause (i) or (ii) but that is available over-
                        the-counter in addition to being available upon 
                        prescription.
                    (B) Exclusion.--The term ``covered outpatient 
                drug'' does not include any product--
                            (i) except as provided in subparagraph 
                        (A)(iv), which may be distributed to 
                        individuals without a prescription;
                            (ii) when furnished as part of, or as 
                        incident to, a diagnostic service or any other 
                        item or service for which payment may be made 
                        under title XVIII of the Social Security Act; 
                        or
                            (iii) that is a therapeutically equivalent 
                        replacement for a product described in clause 
                        (i) or (ii), as determined by the Secretary.
            (3) Eligible organization.--The term ``eligible 
        organization'' means any organization that the Secretary 
        determines to be appropriate, including--
                    (A) pharmaceutical benefit management companies;
                    (B) wholesale and retail pharmacist delivery 
                systems;
                    (C) insurers;
                    (D) other organizations; or
                    (E) any combination of the entities described in 
                subparagraphs (A) through (D).
            (4) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
                                 <all>