[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3584 Introduced in House (IH)]
107th CONGRESS
1st Session
H. R. 3584
To amend title XVIII of the Social Security Act to improve payments and
regulation under the Medicare+Choice Program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 20, 2001
Mrs. Johnson of Connecticut (for herself, Mr. Cardin, Mr. Israel, Mr.
Smith of New Jersey, Mr. Hayworth, Mr. Ramstad, Mr. Sam Johnson of
Texas, Mr. Shaw, Mr. English, Mr. LoBiondo, Mr. Ferguson, Ms. Dunn of
Washington, Mr. Crane, Mr. Saxton, Mr. Camp, Mrs. McCarthy of New York,
Mr. Pascrell, Mr. Herger, Mr. Simmons, Mr. McCrery, Mr. Larsen of
Washington, and Mr. Dicks) introduced the following bill; which was
referred to the Committee on Ways and Means, and in addition to the
Committee on Energy and Commerce, for a period to be subsequently
determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to improve payments and
regulation under 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; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Medicare+Choice
Improvement and Stabilization Act of 2001''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Payment reforms for 2003.
Sec. 3. Change in Medicare+Choice reporting deadlines and annual,
coordinated election period and delay in
lock-in provisions.
Sec. 4. Avoiding duplicative State regulation.
Sec. 5. Demonstration projects for preferred provider organizations,
point-of-service plans, MSA plans, and
disease management programs.
Sec. 6. Suspension of limitation for program reentry for 2003 and 2004.
Sec. 7. Specialized Medicare+Choice plans for special needs
beneficiaries.
SEC. 2. PAYMENT REFORMS FOR 2003.
(a) Payment Based on 100 Percent of Fee-for-Service Costs.--
(1) In general.--Section 1853(c)(1) of the Social Security
Act (42 U.S.C. 1395w-23(c)(1)) is amended by adding at the end
the following:
``(D) Based on 100 percent of fee-for-service costs
for 2003.--For 2003 only, the adjusted average per
capita cost for that year, determined under section
1876(a)(4) for the Medicare+Choice payment area for
services covered under parts A and B for individuals
entitled to benefits under part A and enrolled under
part B who are not enrolled in a Medicare+Choice plan
under this part for the year, subject to the same
adjustment as is provided to the annual per capita rate
payment under paragraph (3)(B).''.
(2) Conforming amendment.--Such section is further amended
in the matter before subparagraph (A), by striking ``or (C)''
and inserting ``(C), or (D)''.
(b) Revision of National Average Used in Calculation of Blend.--
Section 1853(c)(4)(B)(i)(II) of such Act (42 U.S.C. 1395w-
23(c)(4)(B)(i)(II)) is amended by inserting ``who (with respect to
determinations for 2003) are enrolled in a Medicare+Choice plan'' after
``the average number of medicare beneficiaries''.
(c) Elimination of Budget Neutrality.--Section 1853(c) of such Act
(42 U.S.C. 1395w-23(c)) is amended--
(1) in paragraph (1)(A), by inserting ``(for a year other
than 2003)'' after ``multiplied''; and
(2) in paragraph (5), by inserting ``(other than 2003)''
after ``for each year''.
SEC. 3. CHANGE IN MEDICARE+CHOICE REPORTING DEADLINES AND ANNUAL,
COORDINATED ELECTION PERIOD AND DELAY IN LOCK-IN
PROVISIONS.
(a) Change in Reporting Deadline.--Section 1854(a)(1) of the Social
Security Act (42 U.S.C. 1395w-24(a)(1)) is amended by striking ``July
1'' and inserting ``the third Monday in September''.
(b) Delay in Annual, Coordinated Election Period.--Section
1851(e)(3)(B) of such Act (42 U.S.C. 1395w-21(e)(3)(B)) is amended by
striking ``(beginning with 2000), the month of November before such
year'' and inserting ``, the period beginning on November 15 and ending
on December 31 of the year before such year''.
(c) 1-Year Delay in Lock-In.--Section 1851(e) of such Act (42
U.S.C. 1395w-21(e)) is amended--
(1) in paragraph (2)(A)--
(A) by striking ``and 2001,'' and inserting ``,
2001, and 2002''; and
(B) in the heading, by striking ``2001'' and
inserting ``2002'';
(2) in paragraph (2)(B)--
(A) in clause (i), by striking ``2002'' each place
it appears and inserting ``2003''; and
(B) in the heading that precedes clause (i), by
striking ``2002'' and inserting ``2003'';
(3) in paragraph (2)(C)(i), by striking ``2002'' each place
it appears and inserting ``2003''; and
(4) in paragraph (4)--
(A) in the matter preceding subparagraph (A), by
striking ``2002'' and inserting ``2003''; and
(B) in the second sentence, by striking ``2002''
and inserting ``2003''.
(d) Effective Date.--The amendments made by this section shall take
effect on January 1, 2002.
SEC. 4. AVOIDING DUPLICATIVE STATE REGULATION.
(a) In General.--Section 1856(b)(3) of the Social Security Act (42
U.S.C. 1395w-26(b)(3)) is amended to read as follows:
``(3) Relation to state laws.--The standards established
under this subsection shall supersede any State law or
regulation (other than State licensing laws or State laws
relating to plan solvency) with respect to Medicare+Choice
plans which are offered by Medicare+Choice organizations under
this part.''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on the date of the enactment of this Act.
SEC. 5. DEMONSTRATION PROJECTS FOR PREFERRED PROVIDER ORGANIZATIONS,
POINT-OF-SERVICE PLANS, MSA PLANS, AND DISEASE MANAGEMENT
PROGRAMS.
(a) In General.--The Secretary of Health and Human Services shall
conduct a demonstration program (in this section referred to as the
``demonstration program'') under which payment rules to Medicare+Choice
organizations under section 1853 of the Social Security Act are
modified in order to promote the offering of Medicare+Choice plans by
preferred provider organizations under the Medicare+Choice program, the
offering of Medicare+Choice plans that provide point-of-service
coverage for other than participating providers, and the offering of
MSA plans and to promote the use of disease management programs by
Medicare+Choice plans.
(b) Projects.--Under the demonstration program, the Secretary shall
provide for 10 demonstration projects. Each project shall extend over a
period of not to exceed 3 years. Of the demonstration projects
conducted under the demonstration, to the extent feasible, at least one
such project shall promote the offering of a Medicare+Choice plan by a
preferred provider organization, at least one project shall promote the
offering of a Medicare+Choice plan that provides point-of-service
coverage for other than participating providers, and at least two
projects shall promote the offering of a MSA plan.
(c) Risk-Sharing Arrangements.--Under the demonstration program,
the Secretary may provide for the assumption of portions of the
financial risk under a split or partial risk-sharing arrangement.
(d) Waiver Authority.--The Secretary is authorized to waive such
provisions of section 1853 of the Social Security Act (and related
provisions of part C of title XVIII of such Act) as the Secretary
determines to be necessary to conduct the demonstration program under
this section.
(e) Evaluation and Report.--
(1) Evaluation.--The Secretary shall provide for an
evaluation of the demonstration program conducted under this
section and its impact on enrollment, particularly in areas not
previously served by Medicare+Choice plans.
(2) Report.--The Secretary shall submit to Congress a
report on the demonstration program and its evaluation. Such
report shall include an assessment of the costs and savings to
the medicare program as a result of the demonstration program
and may include such recommendations for changes in the
Medicare+Choice program as the Secretary deems appropriate.
SEC. 6. SUSPENSION OF LIMITATION FOR PROGRAM REENTRY FOR 2003 AND 2004.
Section 1857(c)(4) of the Social Security Act (42 U.S.C. 1395w-
27(c)(4)) 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) Applicability in certain years.--Subparagraph
(A) shall not apply for contracts entered into for
contract year 2003 or 2004.''.
SEC. 7. SPECIALIZED MEDICARE+CHOICE PLANS FOR SPECIAL NEEDS
BENEFICIARIES.
(a) Treatment as Coordinated Care Plan.--Section 1851(a)(2)(A) of
the Social Security Act (42 U.S.C. 1395w-21(a)(2)(A)) is amended by
adding at the end the following new sentence: ``Specialized
Medicare+Choice plans for special needs beneficiaries (as defined in
section 1859(b)(4)) may be any type of coordinated care plan.''.
(b) Specialized Medicare+Choice Plan for Special Needs
Beneficiaries Defined.--Section 1859(b) of such Act (42 U.S.C. 1395w-
29(b)) is amended by adding at the end the following new paragraph:
``(4) Specialized medicare+choice plans for special needs
beneficiaries.--
``(A) In general.--The term `specialized
Medicare+Choice plan for special needs beneficiaries'
means a Medicare+Choice plan that exclusively serves
special needs beneficiaries (as defined in subparagraph
(B)).
``(B) Special needs beneficiary.--The term `special
needs beneficiary' means a Medicare+Choice eligible
individual who--
``(i) is institutionalized (as defined by
the Secretary);
``(ii) is entitled to medical assistance
under a State plan under title XIX; or
``(iii) meets such requirements as the
Secretary may determine would benefit from
enrollment in such a specialized
Medicare+Choice plan described in subparagraph
(A) for individuals with severe or disabling
chronic conditions.''.
(c) Restriction on Enrollment Permitted.--Section 1859 of such Act
(42 U.S.C. 1395w-29) is amended by adding at the end the following new
subsection:
``(f) Restriction on Enrollment for Specialized Medicare+Choice
Plans for Special Needs Beneficiaries.--In the case of a specialized
Medicare+Choice plan (as defined in subsection (b)(4)), notwithstanding
any other provision of this part and in accordance with regulations of
the Secretary and for periods before January 1, 2007, the plan may
restrict the enrollment of individuals under the plan to individuals
who are within one or more classes of special needs beneficiaries.''.
(d) Report to Congress.--Not later than December 31, 2005, the
Secretary of Health and Human Services shall submit to Congress a
report that assesses the impact of specialized Medicare+Choice plans
for special needs beneficiaries on the cost and quality of services
provided to enrollees. Such report shall include an assessment of the
costs and savings to the medicare program as a result of amendments
made by subsections (a), (b), and (c).
(e) Effective Dates.--
(1) In general.--The amendments made by subsections (a),
(b), and (c) shall take effect upon the date of the enactment
of this Act.
(2) Deadline for issuance of requirements for special needs
beneficiaries; transition.--No later than September 1, 2002,
the Secretary of Health and Human Services shall issue final
regulations to establish requirements for special needs
beneficiaries under section 1859(b)(4)(B)(iii) of the Social
Security Act, as added by subsection (b).
(f) Extension of Municipal Health Service Demonstration Projects.--
The last sentence of section 9215(a) of the Consolidated Omnibus Budget
Reconciliation Act of 1985 (42 U.S.C. 1395b-1 note), as previously
amended, is amended by striking ``December 31, 2004, but only with
respect to'' and all that follows and inserting ``December 31, 2009,
but only with respect to individuals who reside in the city in which
the project is operated and so long as the total number of individuals
participating in the project does not exceed the number of such
individuals participating as of January 1, 1996.''.
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