1.
This Act may be cited as the
MediFair Act of
2005
.
2.
Congress makes the following
findings:
(1)
Regional inequities in medicare reimbursement has created
barriers to care for seniors and the disabled.
(2)
The regional inequities in medicare reimbursement penalize States
that have cost-effective health care delivery systems and rewards those States
with high utilization rates and that provide inefficient care.
(3)
Over a lifetime, those inequities can mean as much as a $50,000
difference in the cost of care provided per beneficiary.
(4)
Regional inequities have resulted in creating very different
medicare programs for seniors and the disabled based on where they live.
(5)
Because the Medicare+Choice rate is based on the fee-for-service
reimbursement rate, regional inequities have allowed some medicare
beneficiaries access to plans with significantly more benefits including
prescription drugs. Beneficiaries in States with lower reimbursement rates have
not benefitted to the same degree as beneficiaries in other parts of the
country.
(6)
Regional inequities in medicare reimbursement have created an
unfair competitive advantage for hospitals and other health care providers in
States that receive above average payments. Higher payments mean that those
providers can pay higher salaries in a tight, competitive market.
(7)
Regional inequities in medicare reimbursement can limit timely
access to new technology for beneficiaries in States with lower reimbursement
rates.
(8)
Regional inequities in medicare reimbursement, if left unchecked,
will reduce access to medicare services and impact healthy outcomes for
beneficiaries.
(9)
Regional inequities in medicare reimbursement are not just a
rural versus urban problem. Many States with large urban centers are at the
bottom of the national average for per beneficiary costs.
3.
Improving fairness of payments to providers under the Medicare
fee-for-service program
Title XVIII of the
Social Security Act (42 U.S.C. 1395 et
seq.) is amended by adding at the end the following new section:
1898.Improving payment equity under the original Medicare
fee-for-service program(a)
Notwithstanding any other provision of law, the Secretary shall
establish a system for making adjustments to the amount of payment made to
entities and individuals for items and services provided under the original
medicare fee-for-service program under parts A and B.
(b)
(1)
Increase for States below the national average
Under the system established under subsection (a), if a State
average per beneficiary amount for a year is less than the national average per
beneficiary amount for such year, then the Secretary (beginning in 2006) shall
increase the amount of applicable payments in such a manner as will result (as
estimated by the Secretary) in the State average per beneficiary amount for the
subsequent year being equal to the national average per beneficiary amount for
such subsequent year.
(2)
Reduction for certain States above the national average to
enhance quality care and maintain budget neutrality
(A)
The Secretary shall ensure that the increase in payments under
paragraph (1) does not cause the estimated amount of expenditures under this
title for a year to increase or decrease from the estimated amount of
expenditures under this title that would have been made in such year if this
section had not been enacted by reducing the amount of applicable payments in
each State that the Secretary determines has—
(i)
a State average per beneficiary amount for a year that is
greater than the national average per beneficiary amount for such year;
and
(ii)
healthy outcome measurements or quality care measurements that
indicate that a reduction in applicable payments would encourage more efficient
use of, and reduce overuse of, items and services for which payment is made
under this title.
(B)
The Secretary shall not reduce applicable payments under
subparagraph (A) to a State that—
(i)
has a State average per beneficiary amount for a year that is
greater than the national average per beneficiary amount for such year;
and
(ii)
has healthy outcome measurements or quality care measurements
that indicate that the applicable payments are being used to improve the access
of beneficiaries to quality care.
(3)
Determination of averages
(A)
State average per beneficiary amount
Each year (beginning in 2005), the Secretary shall determine a
State average per beneficiary amount for each State which shall be equal to the
Secretary’s estimate of the average amount of expenditures under the original
medicare fee-for-service program under parts A and B for the year for a
beneficiary enrolled under such parts that resides in the State.
(B)
National average per beneficiary amount
Each year (beginning in 2005), the Secretary shall determine
the national average per beneficiary amount which shall be equal to the average
of the State average per beneficiary amount determined under subparagraph (A)
for the year.
(4)
In this section:
(A)
The term applicable payments means payments made
to entities and individuals for items and services provided under the original
medicare fee-for-service program under parts A and B to beneficiaries enrolled
under such parts that reside in the State.
(B)
The term State has the meaning given such term in
section 210(h).
(c)
Beneficiaries held harmlessThe provisions of
this section shall not affect—
(1)
the entitlement to items and services of a beneficiary under
this title, including the scope of such items and services; or
(2)
any liability of the beneficiary with respect to such items and
services.
(d)
(1)
The Secretary, in consultation with the Medicare Payment
Advisory Commission, shall promulgate regulations to carry out this
section.
(2)
Protecting rural communities
In promulgating the regulations pursuant to paragraph (1), the
Secretary shall give special consideration to rural areas.
.
4.
Medpac recommendations on healthy outcomes and quality
care
(a)
The Medicare Payment Advisory Commission established under
section
1805 of the Social Security
Act (42 U.S.C. 1395b–6) shall develop
recommendations on policies and practices that, if implemented, would
encourage—
(1)
healthy outcomes and quality care under the medicare program in
States with respect to which payments are reduced under section 1898(b)(2) of
such Act (as added by section 3); and
(2)
the efficient use of payments made under the medicare program in
such States.
(b)Not
later than the date that is 9 months after the date of enactment of this Act,
the Commission shall submit to Congress the recommendations developed under
subsection (a).