[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 338 Introduced in Senate (IS)]







109th CONGRESS
  1st Session
                                 S. 338

    To provide for the establishment of a Bipartisan Commission on 
                               Medicaid.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            February 9, 2005

  Mr. Smith (for himself, Mr. Bingaman, Ms. Snowe, Mr. Jeffords, Mr. 
Santorum, Mr. Kerry, Mr. DeWine, Mr. Durbin, Mr. Chafee, Mrs. Lincoln, 
 Ms. Collins, Mr. Nelson of Nebraska, Mr. Voinovich, Mr. Corzine, and 
 Mr. Coleman) introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
    To provide for the establishment of a Bipartisan Commission on 
                               Medicaid.

    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 ``Bipartisan Commission on Medicaid 
Act of 2005''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The medicaid program under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.) (in this Act referred to 
        as ``Medicaid'') provides essential health care and long-term 
        care coverage to low-income children, pregnant women and 
        families, individuals with disabilities, and senior citizens 
        constituting 1 in 6 Americans.
            (2) State participation in Medicaid is voluntary, and all 
        States have elected to participate, administering the program 
        within broad Federal guidelines.
            (3) The Federal Government matches the costs of delivering 
        covered services by participating providers to individuals 
        entitled to benefits that are incurred by State Medicaid 
        programs at rates ranging from 50 percent to 77 percent, 
        depending upon a State's per capita income.
            (4) Medicaid pays for health care services for over \1/4\ 
        of America's children, including children who live in poverty.
            (5) Medicaid is America's largest single purchaser of 
        maternity care, paying for over \1/3\ of all the births in the 
        Nation each year.
            (6) Although low-income children and their parents make up 
        \3/4\ of the recipients of benefits under Medicaid, they 
        account for only 30 percent of Medicaid spending.
            (7) Medicaid is America's single largest purchaser of 
        nursing home services and other long-term care, covering the 
        majority of nursing home residents.
            (8) Medicaid is an essential supplement to the medicare 
        program under title XVIII of the Social Security Act (42 U.S.C. 
        1395 et seq.) (in this Act referred to as ``Medicare'') for 
        over 6,000,000 low-income elderly and disabled Medicare 
        beneficiaries, assisting them with their Medicare premiums and 
        co-insurance and, in most cases, the costs of nursing home care 
        that Medicare does not cover.
            (9) The elderly and individuals with disabilities comprise 
        \1/4\ of the recipients of benefits under Medicaid and 70 
        percent of Medicaid spending on services.
            (10) States will be required, beginning in 2006, to 
        contribute billions of dollars to the Federal Government to 
        help finance the Medicare prescription drug benefit established 
        under part D of title XVIII of the Social Security Act.
            (11) Medicaid pays for personal care and other supportive 
        services necessary to enable individuals with disabilities to 
        remain in the community, to work, and to maintain independence.
            (12) Medicaid is the single largest source of revenue for 
        the Nation's safety net hospitals and health centers and is 
        critical to the ability of these providers to continue to serve 
        medicaid enrollees and uninsured Americans.
            (13) Medicaid is the single largest Federal grant-in-aid 
        program to the States, accounting for over 40 percent of all 
        Federal grants to States.
            (14) Medicaid serves a major role in ensuring that the 
        number of Americans without health insurance, approximately 
        45,000,000, is not substantially higher.
            (15) Medicaid finances services for many special health 
        care needs populations, providing health care for 55 percent of 
        all individuals living with HIV/AIDS and 60 percent of all 
        public mental health care for people with severe mental 
        illnesses.
            (16) Medicaid's multiple roles present financial challenges 
        for Federal, and State governments that warrant a comprehensive 
        review in light of the increasing number of uninsured Americans 
        and the increasing number of low-income Americans in need of 
        long-term care services.

SEC. 3. BIPARTISAN COMMISSION ON MEDICAID.

    (a) Establishment.--There is established a commission to be known 
as the Bipartisan Commission on Medicaid (in this section referred to 
as the ``Commission''). The Commission shall locate its headquarters in 
the District of Columbia.
    (b) Membership.--
            (1) Appointment.--The Commission shall be composed of 23 
        members to be appointed as follows:
                    (A) One member shall be appointed by the President.
                    (B) Three members shall be appointed by the 
                majority leader of the Senate of whom--
                            (i) one shall be a Member or former Member 
                        of Congress;
                            (ii) one shall be an advocate for 
                        populations who are served by Medicaid; and
                            (iii) one shall be a health care provider 
                        that provides a disproportionate share of care 
                        to recipients of benefits under Medicaid or a 
                        representative of an organization that 
                        represent such providers.
                    (C) Three members shall be appointed by the 
                minority leader of the Senate of whom--
                            (i) one shall be a Member or former Member 
                        of Congress;
                            (ii) one shall be an advocate for 
                        populations who are served by Medicaid; and
                            (iii) one shall be a health care provider 
                        that provides a disproportionate share of care 
                        to recipients of benefits under Medicaid or a 
                        representative of an organization that 
                        represent such providers.
                    (D) Three members shall be appointed by the Speaker 
                of the House of Representatives of whom--
                            (i) one shall be a Member or former Member 
                        of Congress;
                            (ii) one shall be an advocate for 
                        populations who are served by Medicaid; and
                            (iii) one shall be a health care provider 
                        that provides a disproportionate share of care 
                        to recipients of benefits under Medicaid or a 
                        representative of an organization that 
                        represent such providers.
                    (E) Three members shall be appointed by the 
                minority leader of the House of Representatives of 
                whom--
                            (i) one shall be a Member or former Member 
                        of Congress;
                            (ii) one shall be an advocate for 
                        populations who are served by Medicaid; and
                            (iii) one shall be a health care provider 
                        that provides a disproportionate share of care 
                        to recipients of benefits under Medicaid or a 
                        representative of an organization that 
                        represent such providers.
                    (F) Two members shall be appointed by the National 
                Governors Association and shall be chief executive 
                officers of a State who are not of the same political 
                party.
                    (G) Two members shall be appointed by the National 
                Conference of State Legislatures and shall be members 
                of a State legislature who are not of the same 
                political party.
                    (H) Two members shall be appointed by the National 
                Association of State Medicaid Directors and shall be 
                chief officials responsible for administering Medicaid 
                in a State who are not of the same political party.
                    (I) Two members shall be appointed by the National 
                Association of Counties and shall be officials of a 
                local government involved in Medicaid financing or that 
                directly provides medical services to Medicaid 
                beneficiaries and uninsured individuals who are not of 
                the same political party.
                    (J) Two members shall be appointed by the 
                Comptroller General of the United States and shall be 
                health policy experts with special expertise regarding 
                Medicaid or the populations served by Medicaid who are 
                not of the same political party.
            (2) Qualifications.--The members of the Commission 
        appointed under paragraph (1), shall reflect--
                    (A) a broad geographic representation; and
                    (B) a balance between urban and rural 
                representation.
            (3) Deadline for appointment.--Members of the Commission 
        shall be appointed by not later than the 60th day after the 
        date of enactment of this Act.
    (c) Duties of Commission.--
            (1) In general.--The Commission shall--
                    (A) review and make recommendations with respect to 
                each of Medicaid's major functional responsibilities, 
                including being--
                            (i) a source of coverage for low-income 
                        children, pregnant women, and some parents;
                            (ii) a payer for a complex range of acute 
                        and long-term care services for the frail 
                        elderly and individuals with disabilities, 
                        including the medically needy;
                            (iii) the source of wrap-around coverage or 
                        assistance for low-income seniors and 
                        individuals with disabilities on Medicare, 
                        including coverage of additional benefits and 
                        assistance with Medicare premiums and 
                        copayments; and
                            (iv) the primary source of funding to 
                        safety net providers that serve both Medicaid 
                        patients and the 45,000,000 uninsured;
                    (B) review and make recommendations for a clearer 
                delineation of--
                            (i) the Federal and State roles and 
                        responsibilities under Medicaid; and
                            (ii) the interaction of Medicaid with 
                        Medicare and other Federal health programs;
                    (C) review and identify issues that either threaten 
                or could improve the long-term financial condition of 
                Medicaid, including forthcoming demographic changes, 
                Federal and State revenue options, private sector 
                health coverage, and health care information;
                    (D) review the Federal matching payments and 
                requirements under Medicaid, and issues related to such 
                payments and requirements, and make recommendations on 
                how to make such payments more equitable with respect 
                to the populations served and the States, and on how to 
                improve the program's responsiveness to changes in 
                economic conditions;
                    (E) review and make recommendations with respect to 
                health care for individuals dually eligible for both 
                Medicare and Medicaid, including issues related to 
                Federal, State, provider, and beneficiary 
                responsibilities, coordination, and outcomes;
                    (F) review research and data with respect to health 
                disparities for populations served by Medicaid, 
                particularly with respect to individuals with 
                disabilities or special health care needs, and make 
                recommendations on how to improve health quality, 
coordination of services and providers, and access to health care for 
vulnerable populations, including the implementation of managed care 
protections for Medicaid enrollees with special health care needs;
                    (G) review Federal and State policies for 
                enrollment (including enrollment sites), income 
                eligibility (including methodology and length of 
                eligibility periods), outreach, and documentation with 
                respect to Medicaid and Medicare and make 
                recommendations on how to simplify such policies and 
                improve enrollment and retention in such programs and 
                coordination with other Federal and State programs to 
                improve service delivery and coverage;
                    (H) review the operation and effectiveness of 
                Medicaid premium assistance programs, including the 
                payment of premiums under section 1906(a)(3) of the 
                Social Security Act (42 U.S.C. 1396e(a)(3)) and payment 
                waivers under section 1115 of such Act (42 U.S.C. 
                1315), and the adequacy of covered benefits, 
                affordability of cost-sharing and premiums, and access 
                to care under such programs;
                    (I) review and make recommendations regarding 
                payment policies under Medicaid, including the adequacy 
                of such policies with respect to--
                            (i) managed care plans (including payment 
                        policies for single benefit managed care 
                        arrangements, such as managed behavioral health 
                        and dental care);
                            (ii) providers in managed care, fee-for-
                        service, long-term care, and primary care case 
                        management settings; and
                            (iii) measures to assure and reward quality 
                        and access to care for Medicaid enrollees;
                    (J) review how Medicare payment policies impact 
                Medicaid and make recommendations on ways to address 
                specific payment problems that such policies may create 
                in service delivery to populations typically not 
                covered by Medicare, such as children and pregnant 
                women;
                    (K) review payments to safety net providers, 
                including a review of--
                            (i) the adjustments to payments under 
                        Medicaid--
                                    (I) under section 1923 of the 
                                Social Security Act (42 U.S.C. 1396r-4) 
                                for inpatient hospital services 
                                furnished by disproportionate share 
                                hospitals; and
                                    (II) under section 1902(bb) of such 
                                Act (42 U.S.C. 1396a(bb)) for payments 
                                to federally-qualified health centers 
                                and rural health clinics; and
                            (ii) other payments that impact the 
                        capacity of the health care safety net to care 
                        for uninsured individuals, recipients of 
                        benefits under Medicaid, and other vulnerable 
                        populations;
                    (L) review interstate payment, enrollment, access, 
                and quality concerns with respect to recipients of 
                benefits under Medicaid that are served by interstate 
                providers, and make recommendations on ways to improve 
                interstate health care delivery;
                    (M) review and make recommendations with respect to 
                financing and other issues impacting Commonwealth and 
                territorial programs as compared to other States; and
                    (N) review and make recommendations on such other 
                matters related to Medicaid as the Commission deems 
                appropriate.
            (2) Analysis of effect of each recommendation.--Each 
        recommendation required under paragraph (1) shall include an 
        analysis of the effect of the recommendation under Medicaid 
        and, if applicable, Medicare and other Federal health programs, 
        on--
                    (A) Federal and State expenditures;
                    (B) provider payment rates;
                    (C) beneficiary out-of-pocket expenditures;
                    (D) beneficiary access to covered items and 
                services; and
                    (E) coverage of items and services.
            (3) Expert advice.--The Comptroller General of the United 
        States and the Director of the Congressional Research Service 
        shall advise the Commission on the methodology to be used in 
        identifying problems and analyzing potential solutions in 
        accordance with the duties of the Commission described in 
        paragraph (1).
    (d) General Administrative Provisions.--
            (1) Terms of appointment.--The members of the Commission 
        shall be appointed for the life of the Commission.
            (2) Vacancies.--A vacancy on the Commission shall be 
        filled, not later than 30 days after the date on which the 
        Commission is given notice of the vacancy, in the same manner 
        in which the original appointment was made.
            (3) Chairperson and vice chairperson.--The Commission shall 
        designate 2 of its members to serve as the chairperson and vice 
        chairperson of the Commission.
            (4) Meetings.--The Commission shall meet at the call of the 
        chairperson of the Commission.
            (5) Quorum.--Twelve members of the Commission shall 
        constitute a quorum for purposes of voting, but a lesser number 
        of members may meet and hold hearings.
            (6) Compensation and expenses.--
                    (A) Compensation.--Except as provided in 
                subparagraph (B), members of the Commission shall 
                receive no additional pay, allowances, or benefits by 
                reason of their service on the Commission.
                    (B) Expenses.--While away from their homes or 
                regular places of business in the performance of 
                services for the Commission, members of the Commission 
                shall be allowed travel expenses, including per diem in 
                lieu of subsistence, at rates authorized for employees 
                of agencies under subchapter I of chapter 57 of title 
                5, United States Code.
            (7) Ethical disclosure.--The Comptroller General of the 
        United States shall establish and implement a system for public 
        disclosure of financial and other potential conflicts of 
        interest by members of the Commission.
    (e) Staff and Support Services.--
            (1) Executive director.--The chairperson and vice-chair 
        shall appoint an executive director of the Commission.
            (2) Staff.--With the approval of the Commission, the 
        executive director may appoint such personnel as the executive 
        director determines to be appropriate.
            (3) Applicability of civil service law; etc.--The executive 
        director and staff of the Commission shall be appointed without 
        regard to the provisions of title 5, United States Code, 
        governing appointment in the competitive service, and shall be 
        paid without regard to chapter 51 and subchapter III of chapter 
        53 of title 5, United States Code, relating to classification 
        of positions and General Schedule pay rates, except that the 
        rate of pay for the executive director and other personnel may 
        not exceed the rate payable for level V of the Executive 
        Schedule under section 5316 of such title.
            (4) Experts and consultants.--With the approval of the 
        Commission, the executive director may procure temporary and 
        intermittent services under section 3109(b) of title 5, United 
        States Code.
            (5) Federal agencies.--
                    (A) Staff of other federal agencies.--Upon the 
                request of the Commission, the head of any Federal 
                agency may detail, without reimbursement, any of the 
                personnel of such agency to the Commission to assist in 
                carrying out the duties of the Commission. Any such 
                detail shall not interrupt or otherwise affect the 
                civil service status or privileges of the Federal 
                employee.
                    (B) Technical assistance.--Upon the request of the 
                Commission, the head of a Federal agency shall provide 
                such technical assistance to the Commission as the 
                Commission determines to be necessary to carry out its 
                duties.
            (6) Other resources.--The Commission shall have reasonable 
        access to materials, resources, statistical data, and other 
        information from the Library of Congress and agencies and 
        elected representatives of the executive and legislative 
        branches of the Federal Government. The chairperson or vice-
        chair of the Commission shall make requests for such access in 
        writing when necessary.
            (7) GAO services.--
                    (A) Physical facilities.--The Administrator of 
                General Services shall locate suitable office space for 
                the operation of the Commission. The facilities shall 
                serve as the headquarters of the Commission and shall 
                include all necessary equipment and incidentals 
                required for the proper functioning of the Commission.
                    (B) Administrative support services.--Upon the 
                request of the Commission, the Administrator of General 
                Services shall provide to the Commission, on a 
                reimbursable basis, such administrative support 
                services as the Commission may request.
    (f) Powers of the Commission.--
            (1) Hearings.--The Commission shall conduct public hearings 
        or forums at the discretion of the Commission, at any time and 
        place the Commission is able to secure facilities and 
        witnesses, for the purpose of carrying out the duties of the 
        Commission.
            (2) Studies or investigations.--Upon the request of the 
        Commission, the Comptroller General of the United States, the 
        Medicare Payment Advisory Commission, or the Director of the 
        Congressional Research Service shall conduct such studies or 
        investigations as the Commission determines to be necessary to 
        carry out its duties.
            (3) Cost estimates.--The Director of the Congressional 
        Budget Office, the Chief Actuary of the Centers for Medicare & 
        Medicaid Services, the Medicare Payment Advisory Commission, or 
        all three, shall provide to the Commission, upon the request of 
        the Commission and without reimbursement, such cost estimates 
        as the Commission determines to be necessary to carry out its 
        duties.
            (4) Gifts.--The Commission may accept, use, and dispose of 
        gifts or donations of services or property.
            (5) Mails.--The Commission may use the United States mails 
        in the same manner and under the same conditions as Federal 
        agencies.
    (g) Report.--
            (1) In general.--Not later than 14 months after the date of 
        enactment of this Act, the Commission shall prepare and submit 
        a report that contains a detailed statement of the 
        recommendations, findings, and conclusions of the Commission 
        (as determined in accordance with paragraph (3)) to each of the 
        following:
                    (A) The President.
                    (B) The Committee on Finance of the Senate.
                    (C) The Committee on Energy and Commerce of the 
                House of Representatives.
                    (D) The chief executive officer of each State.
            (2) Availability.--The report shall be made available to 
        the public.
            (3) Recommendations, findings, and conclusions.--The 
        recommendations, findings, and conclusions of the Commission 
        shall be included in the report under paragraph (1) only if--
                    (A) each member of the Commission has had an 
                opportunity to vote on such recommendation, finding, or 
                conclusion;
                    (B) the results of the vote are printed in the 
                report, including a record of how each member voted; 
                and
                    (C) at least 14 of the 23 members of the Commission 
                voted in favor of such recommendation, finding, or 
                conclusion.
    (h) Authorization of Appropriations.--There is authorized to be 
appropriated to the Commission such sums as may be necessary to carry 
out this section.
    (i) Definition of State.--In this Act, the term ``State'' has the 
meaning given such term for purposes of title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.).
    (j) Termination.--The Commission shall terminate on the date that 
is 30 days after the date on which the Commission submits the report 
under subsection (g) to the President, Congress, and the chief 
executive officer of each State.
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