[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1220 Introduced in Senate (IS)]







108th CONGRESS
  1st Session
                                S. 1220

 To amend title XVIII of the Social Security Act to extend reasonable 
cost contracts under the medicare program, to expand the area in which 
   plans offered under such contracts may operate, to apply certain 
provisions of the Medicare+Choice program to such plans, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 10, 2003

 Mr. Allard (for himself, Mr. Wyden, Mr. Smith, Mr. Inouye, Mr. Akaka, 
Mr. Coleman, Mrs. Hutchison, and Mr. Campbell) 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 extend reasonable 
cost contracts under the medicare program, to expand the area in which 
   plans offered under such contracts may operate, to apply certain 
provisions of the Medicare+Choice program to such plans, and for other 
                               purposes.

    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 Cost Contract Extension and 
Refinement Act of 2003''.

SEC. 2. EXTENSION OF REASONABLE COST CONTRACTS.

    (a) Ten-Year Extension.--Section 1876(h)(5)(C) of the Social 
Security Act (42 U.S.C. 1395mm(h)(5)(C)) is amended by striking 
``2004'' and inserting ``2014''.
    (b) Ten-Year Extension of Period During Which Cost Contracts May 
Expand Service Areas.--Section 1876(h)(5)(B)(i) of the Social Security 
Act (42 U.S.C. 1395mm(h)(5)(B)(i)) is amended by striking ``2003'' and 
inserting ``2013''.

SEC. 3. APPLICATION OF CERTAIN MEDICARE+CHOICE REQUIREMENTS TO COST 
              CONTRACTS EXTENDED OR RENEWED AFTER 2003.

    Section 1876(h) of the Social Security Act (42 U.S.C. 1395mm(h)), 
as amended by subsections (a) and (b), is amended--
            (1) by redesignating paragraph (5) as paragraph (6); and
            (2) by inserting after paragraph (4) the following new 
        paragraph:
    ``(5)(A) Any reasonable cost reimbursement contract with an 
eligible organization under this subsection that is extended or renewed 
on or after the date of enactment of the Medicare Cost Contract 
Extension and Refinement Act of 2003 or that is entered into pursuant 
to paragraph (6)(C) for plan years beginning on or after January 1, 
2004, shall provide that the provisions of the Medicare+Choice program 
under part C described in subparagraph (B) shall apply to such 
organization and such contract in a substantially similar manner as 
such provisions apply to Medicare+Choice organizations and 
Medicare+Choice plans under such part.
    ``(B) The provisions described in this subparagraph are as follows:
            ``(i) Section 1851(d) (relating to the provision of 
        information to promote informed choice).
            ``(ii) Section 1851(h) (relating to the approval of 
        marketing material and application forms).
            ``(iii) Section 1852(a)(3)(A) (regarding the authority of 
        organizations to include supplemental health care benefits 
        under the plan subject to the approval of the Secretary).
            ``(iv) Paragraph (1) of section 1852(e) (relating to the 
        requirement of having an ongoing quality assurance program) and 
        paragraph (2)(B) of such section (relating to the required 
        elements for such a program).
            ``(v) Section 1852(e)(4) (relating to treatment of 
        accreditation).
            ``(vi) Section 1852(j)(4) (relating to limitations on 
        physician incentive plans).
            ``(vii) Section 1854(c) (relating to the requirement of 
        uniform premiums among individuals enrolled in the plan).
            ``(viii) Section 1854(g) (relating to restrictions on 
        imposition of premium taxes with respect to payments to 
        organizations).
            ``(ix) Section 1856(b)(3) (relating to relation to State 
        laws).
            ``(x) Section 1857(i) (relating to Medicare+Choice program 
        compatibility with employer or union group health plans).
            ``(xi) The provisions of part C relating to timelines for 
        contract renewal and beneficiary notification.''.

SEC. 4. PERMITTING DEDICATED GROUP PRACTICE HEALTH MAINTENANCE 
              ORGANIZATIONS TO PARTICIPATE IN THE MEDICARE COST 
              CONTRACT PROGRAM.

    Section 1876(h)(6) of the Social Security Act (42 U.S.C. 
1395mm(h)(6)), as redesignated and amended by section 2, is amended--
            (1) in subparagraph (A), by striking ``After the date of 
        the enactment'' and inserting ``Except as provided in 
        subparagraph (C), after the date of the enactment'';
            (2) in subparagraph (B), by striking ``subparagraph (C)'' 
        and inserting ``subparagraph (D)'';
            (3) by redesignating subparagraph (C) as subparagraph (D); 
        and
            (4) by inserting after subparagraph (B), the following new 
        subparagraph:
    ``(C) Subject to paragraph (5) and subparagraph (D), the Secretary 
shall approve an application to enter into a reasonable cost contract 
under this section if--
            ``(i) the application is submitted to the Secretary by a 
        health maintenance organization (as defined in section 1301(a) 
        of the Public Health Service Act) that, as of January 1, 2004, 
        and except as provided in section 1301(b)(3)(B) of such Act, 
        provides at least 85 percent of the services of a physician 
        which are provided as basic health services through a medical 
        group (or groups), as defined in section 1302(4) of such Act; 
        and
            ``(ii) the Secretary determines that the organization meets 
        the requirements applicable to such organizations and contracts 
        under this section.''.
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