[Congressional Record Volume 143, Number 69 (Thursday, May 22, 1997)]
[Senate]
[Pages S5007-S5009]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GRASSLEY (for himself, Mr. Breaux, Mr. D'Amato, Mr. Wyden, 
        Mr. Jeffords, Mr. Kohl and Mr. Chafee):
  S. 789. A bill to amend title XVIII of the Social Security Act to 
provide Medicare beneficiaries with additional information regarding 
Medicare managed care plans and Medicare select policies; to the 
Committee on Finance.


              MEDICARE BENEFICIARY INFORMATION ACT OF 1997

  Mr. GRASSLEY. Mr. President, I rise today with my colleague, Senator 
Breaux, to introduce the Medicare Beneficiary Information Act of 1997. 
Medicare is a Federal program paid for with taxpayer dollars. 
Therefore, Congress has the duty and obligation to ensure beneficiaries 
have access to necessary information to select an appropriate health 
plan for their individual health care needs.
  This legislation is based upon many of the recommendations made to 
members of the Senate Special Committee on Aging at a hearing we held 
on April 10, 1997. This bill will improve competition among Medicare 
health plans and provide Medicare beneficiaries with the useful 
information they need to make an informed choice when selecting a 
health plan. Good, reliable information that allows consumers to select 
among competing options is essential for any market to work. The health 
care market is no exception. Under Medicare, accurate, widely-available 
comparative information does not exist. The Medicare Beneficiary 
Information Act of 1997 addresses this problem by including the 
following provisions:
  While beneficiaries now have to call all the health plans in their 
area, wait for the marketing materials to come, and then try and 
compare all the different brochures with no standard terminology 
required, this bill instructs the Secretary to develop comparison 
charts for each Medicare HMO market and for Medicare Select plans. The 
Secretary has discretion to utilize existing mechanisms in place, such 
as regional Health Care Financing Administration [HCFA] offices and 
Insurance Counseling Assistance [ICA's] programs, to develop and 
distribute these charts.
  Comparison charts would be distributed by Medicare health plans in 
their marketing materials and at the time of enrollment and annually 
thereafter. In addition, the charts would be available upon request 
through HCFA. The charts would help beneficiaries understand the 
difference between the HMO's in their market. The charts would also 
contain a description of standard fee-for-service Medicare, so 
beneficiaries have a reference point.
  The charts will tell beneficiaries about, for example, the health 
plans' additional benefits; additional premiums; out-of-pocket 
expenses; disenrollment rates, as recommended by the General Accounting 
Office at the Aging Committee hearing; appeal rates, reversed and 
denied; coverage for out-of-area services.
  The bill also requires plans to inform beneficiaries about their 
rights and responsibilities using understandable, standard terminology 
regarding benefits; appeals and grievance procedures; restrictions on 
payments for services not provided by the plan; out-of-area coverage; 
coverage of emergency services and urgently needed care; coverage of 
out-of-network services; and any other rights the Secretary determines 
to be helpful to beneficiaries.
  These provisions are also included in the bill I introduced on May 6, 
entitled the ``Medicare Patient Choice and Access Act of 1997,'' or S. 
701. Senator Breaux and I believe that providing Medicare beneficiaries 
with proper information to select the health plan that best meets their 
individual health care needs is so important, we decided to introduce 
this free-standing bill. Increasing choices within the Medicare program 
has strong bipartisan support, but this approach is meaningless if 
beneficiaries cannot make an informed choice. Our bill can be enacted 
and implemented quickly. HCFA is already collecting this data and plans 
to start

[[Page S5008]]

distributing comparative information this summer through the Internet. 
However, Internet access is not enough. We need to provide this 
information in written form and through Medicare counseling programs as 
well. Medicare beneficiaries, as research has shown, prefer reviewing 
written materials and having someone with which to talk. Our bill would 
enable beneficiaries to obtain a user-friendly chart utilizing existing 
Medicare counseling programs, local Medicare offices and through health 
plans participating in the Medicare program.

  We ask our colleagues on both side of the aisle to join us in 
cosponsoring this important legislation. I ask unanimous consent that a 
copy of the bill be submitted for the Record. I also ask unanimous 
consent that a news column by Senator Breaux be included in the Record.
  There being no objection, the material was ordered to be printed in 
the the Record, as follows:

                                 S. 789

       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 Beneficiary 
     Information Act of 1997''.

     SEC. 2. MEDICARE BENEFICIARY INFORMATION.

       (a) In General.--Section 1876(c)(3)(E) of the Social 
     Security Act (42 U.S.C. 1395mm(c)(3)(E)) is amended to read 
     as follows:
       ``(E)(i) Each eligible organization shall provide in any 
     marketing materials distributed to individuals eligible to 
     enroll under this section and to each enrollee at the time of 
     enrollment and not less frequently than annually thereafter, 
     an explanation of the individual's rights and 
     responsibilities under this section and a copy of the most 
     recent comparative report (as established by the Secretary 
     under clause (ii)) for that organization.
       ``(ii)(I) The Secretary shall develop an understandable 
     standardized comparative report on the plans offered by 
     eligible organizations, that will assist beneficiaries under 
     this title in their decisionmaking regarding medical care and 
     treatment by allowing the beneficiaries to compare the 
     organizations that the beneficiaries are eligible to enroll 
     with. In developing such report the Secretary shall consult 
     with outside organizations, including groups representing the 
     elderly, eligible organizations under this section, providers 
     of services, and physicians and other health care 
     professionals, in order to assist the Secretary in developing 
     the report.
       ``(II) The report described in subclause (I) shall include 
     a comparison for each plan of--
       ``(aa) the premium for the plan;
       ``(bb) the benefits offered by the plan, including any 
     benefits that are additional to the benefits offered under 
     parts A and B;
       ``(cc) the amount of any deductibles, coinsurance, or any 
     monetary limits on benefits;
       ``(dd) the number of individuals who disenrolled from the 
     plan within 3 months of enrollment and during the previous 
     fiscal year, stated as percentages of the total number of 
     individuals in the plan;
       ``(ee) the procedures used by the plan to control 
     utilization of services and expenditures, including any 
     financial incentives;
       ``(ff) the number of applications during the previous 
     fiscal year requesting that the plan cover certain medical 
     services that were denied by the plan (and the number of such 
     denials that were subsequently reversed by the plan), stated 
     as a percentage of the total number of applications during 
     such period requesting that the plan cover such services;
       ``(gg) the number of times during the previous fiscal year 
     (after an appeal was filed with the Secretary) that the 
     Secretary upheld or reversed a denial of a request that the 
     plan cover certain medical services;
       ``(hh) the restrictions (if any) on payment for services 
     provided outside the plan's health care provider network;
       ``(ii) the process by which services may be obtained 
     through the plan's health care provider network;
       ``(jj) coverage for out-of-area services;
       ``(kk) any exclusions in the types of health care providers 
     participating in the plan's health care provider network; and
       ``(ll) any additional information that the Secretary 
     determines would be helpful for beneficiaries to compare the 
     organizations that the beneficiaries are eligible to enroll 
     with.
       ``(III) The comparative report shall also include--
       ``(aa) a comparison of each plan to the fee-for-service 
     program under parts A and B; and
       ``(bb) an explanation of medicare supplemental policies 
     under section 1882 and how to obtain specific information 
     regarding such policies.
       ``(IV) The Secretary shall, not less than annually, update 
     each comparative report.
       ``(iii) Each eligible organization shall disclose to the 
     Secretary, as requested by the Secretary, the information 
     necessary to complete the comparative report.
       ``(iv) In this subparagraph--
       ``(I) the term `health care provider' means anyone licensed 
     under State law to provide health care services under part A 
     or B;
       ``(II) the term `network' means, with respect to an 
     eligible organization, the health care providers who have 
     entered into a contract or agreement with the organization 
     under which such providers are obligated to provide items, 
     treatment, and services under this section to individuals 
     enrolled with the organization under this section; and
       ``(III) the term `out-of-network' means services provided 
     by health care providers who have not entered into a contract 
     agreement with the organization under which such providers 
     are obligated to provide items, treatment, and services under 
     this section to individuals enrolled with the organization 
     under this section.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to contracts entered into or renewed under 
     section 1876 of the Social Security Act (42 U.S.C. 1395mm) 
     after the expiration of the 1-year period that begins on the 
     date of enactment of this Act.

     SEC. 3. APPLICATION OF ADDITIONAL INFORMATION TO MEDICARE 
                   SELECT POLICIES.

       (a) In General.--Section 1882(t) of the Social Security Act 
     (42 U.S.C. 1395ss(t)) is amended--
       (1) in paragraph (1)--
       (A) by striking ``and'' at the end of subparagraph (E);
       (B) by striking the period at the end of subparagraph (F) 
     and inserting a semicolon; and
       (C) by adding at the end the following:
       ``(G) notwithstanding any other provision of this section 
     to the contrary, the issuer of the policy meets the 
     requirements of section 1876(c)(3)(E)(i) with respect to 
     individuals enrolled under the policy, in the same manner 
     such requirements apply with respect to an eligible 
     organization under such section with respect to individuals 
     enrolled with the organization under such section; and
       ``(H) the issuer of the policy discloses to the Secretary, 
     as requested by the Secretary, the information necessary to 
     complete the report described in paragraph (4).''; and
       (2) by adding at the end the following:
       ``(4) The Secretary shall develop an understandable 
     standardized comparative report on the policies offered by 
     entities pursuant to this subsection. Such report shall 
     contain information similar to the information contained in 
     the report developed by the Secretary pursuant to section 
     1876(a)(3)(E)(ii).''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply to policies issued or renewed on or after the 
     expiration of the 1-year period that begins on the date of 
     enactment of this Act.

     SEC. 4. NATIONAL INFORMATION CLEARINGHOUSE.

       (a) In General.--Not later than 18 months after the date of 
     enactment of this Act, the Secretary shall establish and 
     operate, out of funds otherwise appropriated to the 
     Secretary, a clearinghouse and (if the Secretary determines 
     it to be appropriate) a 24-hour toll-free telephone hotline, 
     to provide for the dissemination of the comparative reports 
     created pursuant to section 1876(c)(3)(E)(ii) of the Social 
     Security Act (42 U.S.C. 1395mm(c)(3)(E)(ii)) (as amended by 
     section 2 of this Act) and section 1882(t)(4) of the Social 
     Security Act (42 U.S.C. 1395ss(t)(4)) (as added by section 3 
     of this Act). In order to assist in the dissemination of the 
     comparative reports, the Secretary may also utilize medicare 
     offices open to the general public, the beneficiary 
     assistance program established under section 4359 of the 
     Omnibus Budget Reconciliation Act of 1990 (42 U.S.C. 1395b-
     3), and the health insurance information counseling and 
     assistance grants under section 4359 of that Act (42 U.S.C. 
     1395b-4).
                                                                    ____


       Giving Older Consumers Better Info on Health Care Benefits

               (John Breaux, U.S. Senator for Louisiana)

       The federal government needs to provide older Americans 
     with better information about all their health care options. 
     That was the conclusion of a senate hearing I recently 
     cochaired as the new ranking Democrat on the Senate Special 
     Aging Committee. We called in a number of health care experts 
     to talk about the quality of information provided to millions 
     of Medicare beneficiaries, including nearly 600,000 in 
     Louisiana.
       Many who testified said that right now Medicare 
     beneficiaries are not being given all the information they 
     need to adequately compare the costs and benefits of their 
     health care coverage.
       We learned that many beneficiaries simply do not know how 
     managed care is different from standard fee-for-service 
     Medicare. And they are not getting simple explanations of the 
     differences among the Medicare Health Maintenance 
     Organizations (HMO's) in their local areas. Because it is 
     generally agreed that HMO's best serve their enrollees when 
     they compete on factors other than just price, providing 
     Medicare beneficiaries with more and better information is 
     essential.
       Consumers ideally need simple, readable comparison charts 
     so they are able to readily understand the differences 
     between plans. Currently, the Health Care Financing 
     Administration (HCFA), which administers Medicare, does not 
     provide beneficiaries with any comparative data. This means 
     older people who want to learn about managed care options 
     must call a toll-free number to see what HMO's are in their 
     area and then call each company one-by-one and request their 
     health care information. The problem is that each local plan 
     with a Medicare contract presents information using different 
     formats and language, so it's difficult or even impossible to 
     make cost and benefit comparisons.

[[Page S5009]]

       And while the vast majority of Medicare beneficiaries--87 
     percent nationally--remain enrolled in traditional fee-for-
     service Medicare, this is changing rapidly. The number of 
     beneficiaries nationwide who enroll in HMO's is growing by 
     about 30 percent a year. In Louisiana, the growth rate is 
     more than 50 percent. The number of health plans with 
     Medicare contracts is also increasing rapidly. In 1993, there 
     were 110 such plans. Last year, the number more than doubled 
     to 241.
       In a recent report to the Congress, the General Accounting 
     Office (GAO) was critical of the type of information older 
     Americans get on their health care options. The Prospective 
     Payment Assessment Commission also said in a recent report 
     that ``cost and benefit definitions should be standardized so 
     that beneficiaries can better compare plans.''
       And the Institute of Medicine last year reported that 
     ``current information available to Medicare beneficiaries 
     lags far behind the kinds of assistance provided by 
     progressive private employers to their employees.''
       One way to begin addressing these disturbing structural 
     problems is to provide more and better information so that 
     beneficiaries can make informed choices. It is really a 
     fairly simple concept, but one that government often loses 
     sight of--people make wiser and less costly decisions for 
     themselves and their families if they have the right kind of 
     information.
       In fact, in its October 1996 report, GAO recommended that 
     the federal government require plans to use standard formats 
     and terminology; produce benefit and cost comparison charts 
     with all Medicare options available for all areas; and 
     analyze, compare and widely distribute certain statistics 
     about HMO's, including their disenrollment rates and rate of 
     complaints.
       Clearly, we must find a better way to inform Medicare 
     consumers about their choices because good information is the 
     key to making the right health care choices for ourselves and 
     our loved ones.
                                 ______