[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 1459 Introduced in Senate (IS)]







106th CONGRESS
  1st Session
                                S. 1459

To amend title XVIII of the Social Security Act to protect the right of 
 a medicare beneficiary enrolled in a Medicare+Choice plan to receive 
  services at a skilled nursing facility selected by that individual.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 29, 1999

    Mr. Mack (for himself, Mrs. Feinstein, Mr. Helms, and Mr. Robb) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to protect the right of 
 a medicare beneficiary enrolled in a Medicare+Choice plan to receive 
  services at a skilled nursing facility selected by that individual.

    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 Return To Home Act of 
1999''.

SEC. 2. ENSURING CHOICE FOR SKILLED NURSING FACILITY SERVICES UNDER THE 
              MEDICARE+CHOICE PROGRAM.

    (a) In General.--Section 1852 of the Social Security Act (42 U.S.C. 
1395w-22) is amended by adding at the end the following:
    ``(l) Ensuring Choice of Skilled Nursing Facility Services.--
            ``(1) Coverage of services provided at a snf located in 
        enrollee's continuing care retirement community or at a snf in 
        which enrollee previously resided.--Subject to paragraph (2), a 
        Medicare+Choice organization may not deny coverage for any 
        service provided to an enrollee of a Medicare+Choice plan 
        (offered by such organization) by--
                    ``(A) a skilled nursing facility located within the 
                continuing care retirement community in which the 
                enrollee resided prior to being admitted to a hospital; 
                or
                    ``(B) a skilled nursing facility in which the 
                enrollee resided immediately prior to being admitted to 
                a hospital.
        The requirement described in the preceding sentence shall apply 
        whether or not the Medicare+Choice organization has a contract 
        with such skilled nursing facility to provide such services.
            ``(2) Required factors.--Paragraph (1) shall not apply 
        unless the following factors exist:
                    ``(A) The Medicare+Choice organization would be 
                required to provide reimbursement for the service under 
                the Medicare+Choice plan in which the individual is 
                enrolled if the skilled nursing facility was under 
                contract with the Medicare+Choice organization.
                    ``(B) The individual--
                            ``(i) had a contractual or other right to 
                        return, after hospitalization, to the 
                        continuing care retirement community described 
                        in paragraph (1)(A) or the skilled nursing 
                        facility described in paragraph (1)(B); and
                            ``(ii) elects to receive services from the 
                        skilled nursing facility after the 
                        hospitalization, whether or not, in the case of 
                        a skilled nursing facility described in 
                        paragraph (1)(A), the individual resided in 
                        such facility before entering the hospital.
                    ``(C) The skilled nursing facility has the capacity 
                to provide the services the individual requires.
                    ``(D) The skilled nursing facility agrees to accept 
                substantially similar payment under the same terms and 
                conditions that apply to similarly situated skilled 
                nursing facilities that are under contract with the 
                Medicare+Choice organization.
            ``(3) Coverage of snf services to prevent 
        hospitalization.--A Medicare+Choice organization may not deny 
        payment for services provided to an enrollee of a 
        Medicare+Choice plan (offered by such organization) by a 
        skilled nursing facility in which the enrollee resides, without 
        a preceding hospital stay, regardless of whether the 
        Medicare+Choice organization has a contract with such facility 
        to provide such services, if--
                    ``(A) the Medicare+Choice organization has 
                determined that the service is necessary to prevent the 
                hospitalization of the enrollee; and
                    ``(B) the factors specified in subparagraphs (A), 
                (C), and (D) of paragraph (2) exist.
            ``(4) Coverage of services provided in snf where spouse 
        resides.--A Medicare+Choice organization may not deny payment 
        for services provided to an enrollee of a Medicare+Choice plan 
        (offered by such organization) by a skilled nursing facility in 
        which the enrollee resides, regardless of whether the 
        Medicare+Choice organization has a contract with such facility 
        to provide such services, if the spouse of the enrollee is a 
        resident of such facility and the factors specified in 
        subparagraphs (A), (C), and (D) of paragraph (2) exist.
            ``(5) Skilled nursing facility must meet medicare 
        participation requirements.--This subsection shall not apply 
        unless the skilled nursing facility involved meets all 
        applicable participation requirements under this title.
            ``(6) Prohibitions.--A Medicare+Choice organization 
        offering a Medicare+Choice plan may not--
                    ``(A) deny to an individual eligibility, or 
                continued eligibility, to enroll or to renew coverage 
                under such plan, solely for the purpose of avoiding the 
                requirements of this subsection;
                    ``(B) provide monetary payments or rebates to 
                enrollees to encourage such enrollees to accept less 
                than the minimum protections available under this 
                subsection;
                    ``(C) penalize or otherwise reduce or limit the 
                reimbursement of a health care provider or organization 
                because such provider or organization provided services 
                to the individual in accordance with this subsection; 
                or
                    ``(D) provide incentives (monetary or otherwise) to 
                a health care provider or organization to induce such 
                provider or organization to provide care to a 
                participant or beneficiary in a manner inconsistent 
                with this subsection.
            ``(7) Cost-sharing.--Nothing in this subsection shall be 
        construed as preventing a Medicare+Choice organization offering 
        a Medicare+Choice plan from imposing deductibles, coinsurance, 
        or other cost-sharing for services covered under this 
        subsection if such deductibles, coinsurance, or other cost-
        sharing would have applied if the skilled nursing facility in 
        which the enrollee received such services was under contract 
        with the Medicare+Choice organization.
            ``(8) Nonpreemption of state law.--The provisions of this 
        subsection shall not be construed to preempt any provision of 
        State law that affords greater protections to beneficiaries 
        with regard to coverage of items and services provided by a 
        skilled nursing facility than is afforded by such provisions of 
        this subsection.
            ``(9) Definitions.--In this subsection:
                    ``(A) Continuing care retirement community.--The 
                term `continuing care retirement community' means an 
                organization that provides or arranges for the 
                provision of housing and health-related services to an 
                older person under an agreement.
                    ``(B) Skilled nursing facility.--The term `skilled 
                nursing facility' has the meaning given such term in 
                section 1819(a).''.
    (b) Effective Date.--The amendments made by this section shall 
apply with respect to contracts entered into or renewed on or after the 
date of enactment of this Act.
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