[Congressional Record Volume 143, Number 90 (Tuesday, June 24, 1997)]
[Senate]
[Pages S6191-S6195]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          AMENDMENTS SUBMITTED

                                 ______
                                 

                    THE BALANCED BUDGET ACT OF 1997

                                 ______
                                 

                 ROTH (AND MOYNIHAN) AMENDMENT NO. 431

  Mr. ROTH (for himself and Mr. Moynihan) proposed an amendment to the 
bill (S. 947) to provide for reconciliation pursuant to section 104(a) 
of the concurrent resolution on the budget for fiscal year 1998; as 
follows:

       On page 169, between lines 24 and 25, insert:
       ``(5) Satisfaction of requirement.--
       ``(A) In general.--A MedicarePlus plan offered by a 
     MedicarePlus organization satisfies paragraph (1)(A), with 
     respect to benefits for items and services furnished other 
     than through a provider that has a contract with the 
     organization offering the plan, if the plan provides (in 
     addition to any cost sharing provided for under the plan) for 
     at least the total dollar amount of payment for such items 
     and services as would otherwise be authorized under parts A 
     and B (including any balance billing permitted under such 
     parts).
       ``(B) Exception for msa plans and unrestricted fee-for-
     service plans.--Subparagraph (A) shall not apply to an MSA 
     plan or an unrestricted fee-for-service plan.''
       On page 188, between lines 18 and 19, insert:
       ``(k) Treatment of Services Furnished by Certain 
     Providers.--
       ``(1) In general.--A physician or other entity (other than 
     a provider of services) that does not have a contract 
     establishing payment amounts for services furnished to an 
     individual enrolled under this part with a MedicarePlus 
     organization shall accept as payment in full for covered 
     services under this title that are furnished to such an 
     individual the amounts that the physician or other entity 
     could collect if the individual were not so enrolled. Any 
     penalty or other

[[Page S6192]]

     provision of law that applies to such a payment with respect 
     to an individual entitled to benefits under this title (but 
     not enrolled with a MedicarePlus organization under this 
     part) also applies with respect to an individual so enrolled.
       ``(2) Exception for msa plans and unrestricted fee-for-
     service plans.--Paragraph (1) shall not apply to an MSA plan 
     or an unrestricted fee-for-service plan.''
       On page 203, beginning with line 13, strike all through 
     page 204, line 11, and insert:
       ``(8) Adjustments to minimum amounts and minimum percentage 
     increases.--After computing all amounts under this subsection 
     (without regard to this paragraph) for any year, the 
     Secretary shall--
       ``(A) redetermine the amount under paragraph (1)(C) for 
     such year by substituting `100 percent' for `101 percent' 
     each place it appears, and
       ``(B) increase the minimum amount under paragraph (1)(B) to 
     an amount equal to the lesser of--
       ``(i) the amount the Secretary estimates will result in 
     increased payments under such paragraph equal to the decrease 
     in payments by reason of the redetermination under 
     subparagraph (A), or
       ``(ii) an amount equal to 85 percent of the annual national 
     Medicare Choice capitation rate determined under paragraph 
     (4).''
       On page 222, strike lines 18 through 21 and insert:

       ``(II) the date on which the Secretary determines that the 
     State has in effect solvency standards identical to the 
     standards established under section 1856(a).''

       On page 226, beginning with line 17, strike all through 
     page 227, line 3, and insert:
       ``(d) Certification of Provision Against Risk of Insolvency 
     for PSOs.--
       ``(1) In general.--Each Medicare Choice organization that 
     is a provider-sponsored organization with a waiver in effect 
     under subsection (a)(2) shall meet the standards established 
     under section 1856(a) with respect to the financial solvency 
     and capital adequacy of the organization.''
       On page 309, line 17, insert ``, including the extent to 
     which current medicare update indexes do not accurately 
     reflect inflation'' after ``1395t)''.
       On page 309, line 22, beginning with ``, including'' strike 
     all through ``inflation'' on line 24.
       On page 335, beginning with line 24, strike through page 
     336, line 2, and insert:
       (3) Nonelderly medicare beneficiaries.--
       (A) In general.--The amendment made by subsection (c) shall 
     apply to policies issued on and after July 1, 1998.
       (B) Transition rule.--In the case of an individual who 
     first became eligible for benefits under part A of title 
     XVIII of the Social Security Act pursuant to section 226(b) 
     of such Act and enrolled for benefits under part B of such 
     title before July 1, 1998, the 6-month period described in 
     section 1882(s)(2)(A) of such Act shall begin on July 1, 
     1998. Before July 1, 1998, the Secretary of Health and Human 
     Services shall notify any individual described in the 
     previous sentence of their rights in connection with medicare 
     supplemental policies under section 1882 of such Act, by 
     reason of the amendment made by subsection (c).
       On page 340, between lines 21 and 22, insert:

                           PART I--IN GENERAL

       On page 341, line 11, strike ``and''.
       On page 341, between lines 11 and 12, insert:
       ``(3) applying the information and quality programs under 
     part II; and''
       On page 341, line 12, strike ``(3)'' and insert ``(4)''.
       On page 357, between lines 2 and 3, insert:

               PART II--INFORMATION AND QUALITY STANDARDS

                         Subpart A--Information

     SEC. 5044. INFORMATION REQUIREMENTS.

       (a) In General.--The Secretary shall provide that in the 
     case of a demonstration plan conducted under part I, the 
     information and comparative reports described in this section 
     shall be used in lieu of that provided under part C of title 
     XVIII of the Social Security Act.
       (b) Secretary's Materials; Contents.--The notice and 
     informational materials mailed by the Secretary under this 
     part shall be written and formatted in the most easily 
     understandable manner possible, and shall include, at a 
     minimum, the following:
       (1) General information.--General information with respect 
     to coverage under this part during the next calendar year, 
     including--
       (A) the part B premium rates that will be charged for part 
     B coverage, and a statement of the fact that enrollees in 
     demonstration plans are not required to pay such premium,
       (B) the deductible, copayment, and coinsurance amounts for 
     coverage under the traditional medicare program,
       (C) a description of the coverage under the traditional 
     medicare program and any changes in coverage under the 
     program from the prior year,
       (D) a description of the individual's medicare payment 
     area, and the standardized medicare payment amount available 
     with respect to such individual,
       (E) information and instructions on how to enroll in a 
     demonstration plan,
       (F) the right of each demonstration plan sponsor by law to 
     terminate or refuse to renew its contract and the effect the 
     termination or nonrenewal of its contract may have on 
     individuals enrolled with the demonstration plan under this 
     part,
       (G) appeal rights of enrollees, including the right to 
     address grievances to the Secretary or the applicable 
     external review entity, and
       (H) the benefits offered by plans in basic benefit plans 
     under section 1895H(a), and how those benefits differ from 
     the benefits offered under parts A and B.
       (2) Comparative report.--A copy of the most recent 
     comparative report (as established by the Secretary under 
     subsection (c)) for the demonstration plans in the 
     individual's medicare payment area.
       (c) Comparative Report.--
       (1) In general.--The Secretary shall develop an 
     understandable standardized comparative report on the 
     demonstration plans offered by demonstration plan sponsors, 
     that will assist demonstration eligible individuals in their 
     decisionmaking regarding medical care and treatment by 
     allowing such individuals to compare the demonstration plans 
     that such individuals are eligible to enroll with. In 
     developing such report the Secretary shall consult with 
     outside organizations, including groups representing the 
     elderly, demonstration plan sponsors, providers of services, 
     and physicians and other health care professionals, in order 
     to assist the Secretary in developing the report.
       (2) Report.--The report described in paragraph (1) shall 
     include a comparison for each demonstration plan of--
       (A) the plan's medicare service area;
       (B) coverage by the plan of emergency services and urgently 
     needed care;
       (C) the amount of any deductibles, coinsurance, or any 
     monetary limits on benefits;
       (D) the number of individuals who disenrolled from the plan 
     within 3 months of enrollment during the previous fiscal year 
     (excluding individuals whose disenrollment was due to death 
     or moving outside of the plan's service area) stated as 
     percentages of the total number of individuals in the plan;
       (E) process, outcome, and enrollee satisfaction measures, 
     as recommended by the Quality Advisory Institute as 
     established under section 5044B;
       (F) information on access and quality of services obtained 
     from the analysis described in section 5044B;
       (G) the procedures used by the plan to control utilization 
     of services and expenditures, including any financial 
     incentives;
       (H) the number of applications during the previous fiscal 
     year requesting that the plan cover or pay for 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;
       (I) 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;
       (J) the restrictions (if any) on payment for services 
     provided outside the plan's health care provider network;
       (K) the process by which services may be obtained through 
     the plan's health care provider network;
       (L) coverage for out-of-area services;
       (M) any exclusions in the types of health care providers 
     participating in the plan's health care provider network;
       (N) whether the plan is, or has within the past two years 
     been, out-of-compliance with any requirements of this part 
     (as determined by the Secretary);
       (O) the plan's premium price for the basic benefit plan 
     submitted under part C of title XVIII of the Social Security 
     Act, an indication of the difference between such premium 
     price and the standardized medicare payment amount, and the 
     portion of the premium an individual must pay out of pocket;
       (P) whether the plan offers any of the optional 
     supplemental benefit plans, and if so, the plan's premium 
     price for such benefits; and
       (Q) any additional information that the Secretary 
     determines would be helpful for demonstration eligible 
     individuals to compare the demonstration plans that such 
     individuals are eligible to enroll with.
       (3) Additional information.--The comparative report shall 
     also include--
       (A) a comparison of each demonstration plan to the fee-for-
     service program under parts A and B of title XVIII of the 
     Social Security Act;
       (B) an explanation of medicare supplemental policies under 
     section 1882 of such Act and how to obtain specific 
     information regarding such policies; and
       (C) a phone number for each demonstration plan that will 
     enable demonstration eligible individuals to call to receive 
     a printed listing of all health care providers participating 
     in the plan's health care provider network.
       (4) Update.--The Secretary shall, not less than annually, 
     update each comparative report.
       (5) Definitions.--In this subsection--
       (A) Health care provider.--The term ``health care 
     provider'' means anyone licensed under State law to provide 
     health care services under part A or B.
       (B) Network.--The term ``network'' means, with respect to a 
     demonstration plan sponsor, the health care providers who 
     have entered into a contract or agreement with the plan 
     sponsor under which such providers are obligated to provide 
     items, treatment, and services under this section to 
     individuals enrolled with the plan sponsor under this part.
       (C) Out-of-network.--The term ``out-of-network'' means 
     services provided by health

[[Page S6193]]

     care providers who have not entered into a contract agreement 
     with the demonstration plan sponsor under which such 
     providers are obligated to provide items, treatment, and 
     services under this section to individuals enrolled with the 
     plan sponsor under this part.
       (6) Cost sharing.--Each demonstration plan sponsor shall 
     pay to the Secretary its pro rata share of the estimated 
     costs incurred by the Secretary in carrying out the 
     requirements of this section and section 4360 of the Omnibus 
     Reconciliation Act of 1990. There are hereby appropriated to 
     the Secretary the amount of the payments under this paragraph 
     for purposes of defraying the cost described in the preceding 
     sentence. Such amounts shall remain available until expended.

               Subpart B--Quality in Demonstration Plans

     SEC. 5044A. DEFINITIONS.

       In this subpart:
       (1) Comparative report.--The term ``comparative report'' 
     means the comparative report developed under section 5044.
       (2) Director.--The term ``Director'' means the Director of 
     the Office of Competition within the Department of Health and 
     Human Services as established under part I.
       (3) Medicare program.--The term ``medicare program'' means 
     the program of health care benefits provided under title 
     XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
       (4) Demonstration plan.--The term ``demonstration plan'' 
     means a plan established under part I.
       (5) Demonstration plan sponsor.--The term ``demonstration 
     plan sponsor'' means a sponsor of a demonstration plan.

     SEC. 5044B. QUALITY ADVISORY INSTITUTE.

       (a) Establishment.--There is established an Institute to be 
     known as the ``Quality Advisory Institute'' (in this subpart 
     referred to as the ``Institute'') to make recommendations to 
     the Director concerning licensing and certification criteria 
     and comparative measurement methods under this subpart.
       (b) Membership.--
       (1) Composition.--The Institute shall be composed of 5 
     members to be appointed by the Director from among 
     individuals who have demonstrable expertise in--
       (A) health care quality measurement;
       (B) health plan certification criteria setting;
       (C) the analysis of information that is useful to consumers 
     in making choices regarding health coverage options, health 
     plans, health care providers, and decisions regarding health 
     treatments; and
       (D) the analysis of health plan operations.
       (2) Terms and vacancies.--The members of the Institute 
     shall be appointed for 5-year terms with the terms of the 
     initial members staggered as determined appropriate by the 
     Director. Vacancies shall be filled in a manner provided for 
     by the Director.
       (c) Duties.--The Institute shall--
       (1) not later than 1 year after the date on which all 
     members of the Institute are appointed under subsection 
     (b)(2), provide advice to the Director concerning the initial 
     set of criteria for the certification of demonstration plans;
       (2) analyze the use of the criteria for the certification 
     of demonstration plans implemented by the Director under this 
     subpart and recommend modifications in such criteria as 
     needed;
       (3) analyze the use of the comparative measurements 
     implemented by the Director in developing comparative reports 
     and recommend modifications in such measurements as needed;
       (4) perform, or enter into contracts with other entities 
     for the performance of, an analysis of access to services and 
     clinical outcomes based on patient encounter data;
       (5) enter into contracts with other entities for the 
     development of such criteria and measurements and to 
     otherwise carry out its duties under this section; and
       (6) carry out any other activities determined appropriate 
     by the Institute to carry out its duties under this section.

     The analysis described in paragraph (4) should focus on 
     conditions and procedures of significance to beneficiaries 
     under the medicare program, as determined by the Institute, 
     and should be designed, and the results summarized, in a 
     manner that facilitates comparisons across health plans.

     SEC. 5044C. DUTIES OF DIRECTOR.

       (a) In General.--The Director shall--
       (1) adopt, adapt, or develop criteria in accordance with 
     sections 5044F through 5044I to be used in the licensing of 
     certifying entities and in the certification of demonstration 
     plans, including any minimum criteria needed for the 
     operation of demonstration plans during the transition period 
     described in section 5044F(c);
       (2) issue licenses to certifying entities that meet the 
     criteria developed under paragraph (1) for the purpose of 
     enabling such entities to certify demonstration plans in 
     accordance with this subpart;
       (3) develop comparative health care measures in addition to 
     those implemented by the Director in developing comparative 
     reports in order to guide consumer choice under the medicare 
     program and to improve the delivery of quality health care 
     under such program;
       (4) develop procedures, consistent with section 5044A, for 
     the dissemination of certification and comparative quality 
     information provided to the Director;
       (5) contract with an independent entity for the conduct of 
     audits concerning certification and quality measurement and 
     require that as part of the certification process performed 
     by licensed certification entities that there include an 
     onsite evaluation, using performance-based standards, of the 
     providers of items and services under a demonstration plan;
       (6) at least quarterly, meet jointly with the Agency for 
     Health Care Policy and Research to review innovative health 
     outcomes measures, new measurement processes, and other 
     matters determined appropriate by the Director;
       (7) at least annually, meet with the Institute concerning 
     certification criteria;
       (8) not later than January 1, 1999, and each January 1 
     thereafter, prepare and submit to demonstration plan sponsors 
     and to Congress, a report concerning the activities of the 
     Director for the previous year;
       (9) advise the President and Congress concerning health 
     insurance and health care provided under demonstration plans 
     and make recommendations concerning measures that may be 
     implemented to protect the health of all enrollees in 
     demonstration plans; and
       (10) carry out other activities determined appropriate by 
     the Director.
       (b) Rule of Construction.--Nothing in this section shall be 
     construed to limit the authority of the Director or the 
     Secretary of Health and Human Services with respect to 
     requirements other than those applied under this subpart with 
     respect to demonstration plans.

     SEC. 5044D. COMPLIANCE.

       (a) In General.--Not later than January 1, 1999, the 
     Director shall ensure that a demonstration plan may not be 
     offered unless it has been certified in accordance with this 
     subpart.
       (b) Contracts or Reimbursements.--In carrying out 
     subsection (a), the Director--
       (1) may not enter into a contract with a demonstration plan 
     sponsor for the provision of a demonstration plan unless the 
     demonstration plan is certified in accordance with this 
     subpart;
       (2) may not reimburse a demonstration plan sponsor for 
     items and services provided under a demonstration plan unless 
     the demonstration plan is certified in accordance with this 
     subpart; and
       (3) shall, after providing notice to the demonstration plan 
     sponsor operating a demonstration plan and an opportunity for 
     such demonstration plan to be certified, and in accordance 
     with any applicable grievance and appeals procedures under 
     section 5044I, terminate any contract with a demonstration 
     plan sponsor for the operation of a demonstration plan if 
     such demonstration plan is not certified in accordance with 
     this subpart.

     SEC. 5044E. PAYMENTS FOR VALUE.

       (a) Establishment of Program.--The Director shall establish 
     a program under which payments are made to various 
     demonstration plans to reward such plans for meeting or 
     exceeding quality targets.
       (b) Performance Measures.--In carrying out the program 
     under subsection (a), the Director shall establish broad 
     categories of quality targets and performance measures. Such 
     targets and measures shall be designed to permit the Director 
     to determine whether a demonstration plan is being operated 
     in a manner consistent with this subpart.
       (c) Use of Funds.--
       (1) In general.--The Secretary shall withhold 0.50 percent 
     from any payment that a demonstration plan sponsor receives 
     with respect to an individual enrolled with such plan under 
     part I.
       (2) Payments.--The Director shall use amounts collected 
     under paragraph (1) to make annual payments to those 
     demonstration plans that have been determined by the Director 
     to meet or exceed the quality targets and performance 
     measures established under subsection (b). Any amounts 
     collected under such paragraph for a fiscal year and 
     remaining available after payments are made under subsection 
     (d), shall be used for deficit reduction.
       (d) Amount of Payment.--
       (1) Formula.--The amount of any payment made to a 
     demonstration plan under this section shall be determined in 
     accordance with a formula to be developed by the Director. 
     The formula shall ensure that a payment made to a 
     demonstration plan under this section be in an amount equal 
     to--
       (A) with respect to a demonstration plan that is determined 
     to be in the first quintile, 1 percent of the amount 
     allocated to the plan under this subpart;
       (B) with respect to a demonstration plan that is determined 
     to be in the second quintile, 0.75 percent of the amount 
     allocated to the plan under this subpart;
       (C) with respect to a demonstration plan that is determined 
     to be in the third quintile, 0.50 percent of the amount 
     allocated by the plan under this subpart; and
       (D) with respect to a demonstration plan that is determined 
     to be in the fourth quintile, 0.25 percent of the amount 
     allocated by the plan under this subpart.
       (2) No payment.--A demonstration plan that is determined by 
     the Director to be in the fifth quintile shall not be 
     eligible to receive a payment under this section.
       (3) Determination of quintiles.--Not later than April 30 of 
     each calendar year, the Director shall rank each 
     demonstration plan based on the performance of the plan 
     during the preceding year as determined using the quality 
     targets and performance measures established under subsection 
     (b). Such rankings shall be divided into quintiles with the 
     first quintile containing the highest ranking plans and the 
     fifth quintile containing the lowest ranking plans. Each such

[[Page S6194]]

     quintile shall contain plans that in the aggregate cover an 
     equal number of beneficiaries as compared to another 
     quintile.

     SEC. 5044F. CERTIFICATION REQUIREMENT.

       (a) In General.--To be eligible to enter into a contract 
     with the Director to enroll individuals in a demonstration 
     plan, a demonstration plan sponsor shall participate in the 
     certification process and have the demonstration plans 
     offered by such plan sponsor certified in accordance with 
     this subpart.
       (b) Effect of Mergers or Purchase.--
       (1) Certified plans.--Where 2 or more demonstration plan 
     sponsors offering certified demonstration plans are merged or 
     where 1 such plan sponsor is purchased by another plan 
     sponsor, the resulting plan sponsor may continue to operate 
     and enroll individuals for coverage under the demonstration 
     plan as if the demonstration plan involved were certified. 
     The certification of any resulting demonstration plan shall 
     be reviewed by the applicable certifying entity to ensure the 
     continued compliance of the contract with the certification 
     criteria.
       (2) Noncertified plans.--The certification of a 
     demonstration plan shall be terminated upon the merger of the 
     demonstration plan sponsor involved or the purchase of the 
     plan sponsor by another entity that does not offer any 
     certified demonstration plans. Any demonstration plans 
     offered through the resulting plan sponsor may reapply for 
     certification after the completion of the merger or purchase.
       (c) Transition for New Plans.--
       (1) In general.--A demonstration plan that has not provided 
     health insurance coverage to individuals prior to the 
     effective date of this Act shall be permitted to contract 
     with the Director and operate and enroll individuals under a 
     demonstration plan without being certified for the 2-year 
     period beginning on the date on which such demonstration plan 
     sponsor enrolls the first individual in the demonstration 
     plan. Such demonstration plan must be certified in order to 
     continue to provide coverage under the contract after such 
     period.
       (2) Limitation.--A new demonstration plan described in 
     paragraph (1) shall, during the period referred to in 
     paragraph (1) prior to certification, comply with the minimum 
     criteria developed by the Director under section 5044F(a)(1).

     SEC. 5044G. LICENSING OF CERTIFICATION ENTITIES.

       (a) In General.--The Director shall develop procedures for 
     the licensing of entities to certify demonstration plans 
     under this subpart.
       (b) Requirements.--The procedures developed under 
     subsection (a) shall ensure that--
       (1) to be licensed under this section a certification 
     entity shall apply the requirements of this subpart to 
     demonstration plans seeking certification;
       (2) a certification entity has procedures in place to 
     suspend or revoke the certification of a demonstration plan 
     that is failing to comply with the certification 
     requirements; and
       (3) the Director will give priority to licensing entities 
     that are accrediting health plans that contract with the 
     Director on the date of enactment of this Act.

     SEC. 5044H. CERTIFICATION CRITERIA.

       (a) Establishment.--The Director shall establish minimum 
     criteria under this section to be used by licensed certifying 
     entities in the certification of demonstration plans under 
     this subpart.
       (b) Requirements.--Criteria established by the Director 
     under subsection (a) shall require that, in order to be 
     certified, a demonstration plan shall comply at a minimum 
     with the following:
       (1) Quality improvement plan.--The demonstration plan shall 
     implement a total quality improvement plan that is designed 
     to improve the clinical and administrative processes of the 
     demonstration plan on an ongoing basis and demonstrate that 
     improvements in the quality of items and services provided 
     under the demonstration plan have occurred as a result of 
     such improvement plan.
       (2) Provider credentials.--The demonstration plan shall 
     compile and annually provide to the licensed certifying 
     entity documentation concerning the credentials of the 
     hospitals, physicians, and other health care professionals 
     reimbursed under the demonstration plan.
       (3) Comparative Information.--The demonstration plan shall 
     compile and provide, as requested by the Secretary of Health 
     and Human Services, to the such Secretary the information 
     necessary to develop a comparative report.
       (4) Encounter data.--The demonstration plan shall maintain 
     patient encounter data in accordance with standards 
     established by the Institute, and shall provide these data, 
     as requested by the Institute, to the Institute in support of 
     conducting the analysis described in section 5044B(c)(4).
       (5) Other requirements.--The demonstration plan shall 
     comply with other requirements authorized under this subpart 
     and implemented by the Director.

     SEC. 5044I. GRIEVANCE AND APPEALS.

       The Director shall develop grievance and appeals procedures 
     under which a demonstration plan that is denied certification 
     under this subpart may appeal such denial to the Director.
       On page 434, line 17, insert ``county in a'' after 
     ``residing in a''.
       On page 434, line 21, insert ``or a rural county that is 
     not adjacent to a Metropolitan Statistical Area'' after 
     ``254e(a)(1)(A))''.
       On page 515, strike line 5 through 7, and insert the 
     following:

     SEC. 5331. EXTENSION OF COST LIMITS.

       On page 515, line 14, beginning with ``, increased by'' 
     strike all through ``data'' on line 18.
       On page 519, line 7, strike ``October'' and insert 
     ``July''.
       On page 527, lines 22 and 23, strike ``, percentage, and 
     historical trend factor'' and insert `` and percentage''.
       On page 578, line 20, insert ``V66.2,'' after ``V66.1,''.
       On page 636, strike lines 1 and 2, and insert:

     SEC. 5505. IMPLEMENTATION OF RESOURCE-BASED METHODOLOGIES.

       On page 636, lines 18 through 20, strike ``primary care 
     services provided in an office setting'' and insert ``office 
     visit procedure codes''.
       On page 637, beginning with line 19, strike all through 
     page 638, line 14, and insert:
       (b) Delay of Implementation to 1999; Phasein of 
     Implementation.--Section 1848(c)(2) (42 U.S.C. 1395w-
     4(c)(2)), as amended by subsection (a), is amended--
       (1) in subparagraph (C)(ii)--
       (A) by striking ``1998'' each place it appears and 
     inserting ``1999'', and
       (B) by inserting ``, to the extent provided under 
     subparagraph (H),'' after ``based'' in the matter following 
     subclause (II), and
       (2) by adding at the end the following new subparagraph:
       ``(H) 3-year additional phasein of resource-based practice 
     expense units.--Notwithstanding subparagraph (C)(ii), the 
     Secretary shall implement the resource-based practice expense 
     unit methodology described in such subparagraph ratably over 
     the 3-year period beginning with 1999 such that such 
     methodology is fully implemented for 2001 and succeeding 
     years.''.
       On page 640, between lines 12 and 13, insert:
       (e) Application of Resource-Based Methodology to 
     Malpractice Relative Value Units.--Section 1848(c)(2)(C)(iii) 
     (42 U.S.C. 1395w-4(c)(2)(C)(iii)) is amended--
       (1) by inserting ``for years before 1999'' before 
     ``equal'', and
       (2) by striking the period at the end and inserting a comma 
     and by adding at the end the following flush matter:
     ``and for years beginning with 1999 based on the malpractice 
     expense resources involved in furnishing the service''.
       On page 640, line 13, strike lines 13 through 15, and 
     insert:
       (f) Effective Dates.--
       (1) In general.--The amendments made by this section shall 
     apply to years beginning on and after January 1, 1998.
       (2) Malpractice.--The amendments made by subsection (e) 
     shall apply to years beginning on and after January 1, 1999.
       On page 647, beginning with line 6, strike all through page 
     653, line 19.
       On page 668, beginning with line 24, strike all through 
     page 669, line 3, and insert:
       ``(2)(A) In the case of a drug or biological for which 
     payment was under this part on May 1, 1997, the amount 
     determined under paragraph (1) for any drug or biological 
     shall not exceed--
       ``(i) in the case of 1998, the amount of the payment under 
     this part on May 1, 1997, and
       ``(ii) in the case of 1999 and each succeeding year, the 
     amount determined under this subparagraph for the previous 
     year, increased by the percentage increase in the consumer 
     price index for all urban consumers (U.S. city average) for 
     the 12-month period ending with June of the previous year.
       ``(B) In the case of a drug or biological not described in 
     subparagraph (A), the amount determined under paragraph (1) 
     for any year following the first year for which payment is 
     made under this part for such drug or biological shall not 
     exceed the amount payable under this part (after application 
     of this subparagraph) for the previous year, increased by the 
     percentage increase in the consumer price index for all urban 
     consumers (U.S. city average) for the 12-month period ending 
     with June of the previous year.''
       On page 669, line 9, strike the end quotation marks.
       On page 669, between lines 9 and 10, insert:
       ``(4) The Secretary shall conduct such studies or surveys 
     as are necessary to determine the average wholesale price 
     (and such other price as the Secretary determines 
     appropriate) of any drug or biological for purposes of 
     paragraph (1). The Secretary shall, not later than 6 months 
     after the date of the enactment of this subsection, report to 
     the appropriate committees of Congress the results of the 
     studies and surveys conducted under this paragraph.''
       On page 669, line 12, strike ``1999'' and insert ``1998''.
       On page 768, line 2, strike ``the provider'' and insert ``a 
     provider or managed care entity (as defined in section 
     1950(a)(1)''.
       On page 768, line 5, insert ``or managed care entity (as 
     defined in section 1950(a)(1)'' after ``a provider''.
       On page 771, line 9, insert ``, and as approved by the 
     Secretary'' after ``DSH''.
       On page 771, line 14, strike ``services provided by'' and 
     insert ``payments to''.
       On page 771, line 18, insert ``, and as approved by the 
     Secretary'' after ``DSH''.
       On page 773, line 9, insert ``, and as approved by the 
     Secretary'' after ``DSH''.
       On page 773, line 17, strike ``services provided by'' and 
     insert ``payments to''.
       On page 773, line 22, insert ``, and as approved by the 
     Secretary'' after ``DSH''.
       On page 775, line 2, strike ``services provided by'' and 
     insert ``payments to''.

[[Page S6195]]

       On page 775, line 6, insert ``, and as approved by the 
     Secretary'' after ``health DSH''.
       On page 777, line 13, strike ``during fiscal year 1995'' 
     and insert ``that are attributable to the fiscal year 1995 
     DSH allotment,''.
       On page 778, strike lines 14 through 18 and insert the 
     following:
       ``(A) the total State DSH expenditures that are 
     attributable to fiscal year 1995 for payments to institutions 
     for mental diseases and other mental health facilities (based 
     on reporting data specified by the State on HCFA Form 64 as 
     mental health DSH, and as approved by the Secretary); or''
       On page 778, line 24, strike ``services provided by'' and 
     insert ``payments to''.
       On page 779, line 3, insert ``, and as approved by the 
     Secretary'' after ``DSH''.
       On page 779, line 20, strike ``services provided by'' and 
     insert ``payments to''.
       On page 820, strike lines 21 through 24 and insert the 
     following:
       ``(6) Any cost-sharing imposed under this subsection may 
     not be included in determining the amount of the State 
     percentage required for reimbursement of expenditures under a 
     State plan under this title.
       ``(7) In this subsection, the term `cost-sharing' includes 
     copayments, deductibles, coinsurance, enrollment fees, 
     premiums, and other charges for the provision of health care 
     services.''.
       On page 846, line 2, strike ``and''.
       On page 846, line 13, strike the period and insert ``; 
     and''.
       On page 846, between lines 13 and 14, insert the following:
       ``(C) satisfies the maintenance of effort requirement 
     described in section 2105(c)(5).''.
       On page 849, strike lines 13 through 15, and insert the 
     following:
       ``(B) for each of fiscal years 1999 and 2000, 
     $3,200,000,000;
       ``(C) for fiscal year 2001, $3,600,000,000;
       ``(D) for fiscal year 2002, $3,500,000,000;''
       On page 849, line 17, strike ``(D)'' and insert ``(E)''.
       On page 856, line 11, insert ``Federal and State incurred'' 
     after ``the''.
       On page 856, line 18, insert ``Federal and State incurred'' 
     after ``the''.
       On page 856, line 20, insert ``children covered at State 
     option among'' after ``for''.
       On page 856, line 23, insert ``Federal and State incurred'' 
     after ``the''.
       On page 856, line 25, insert ``children covered at State 
     option among'' after ``for''.
       On page 860, strike lines 1 through 10 and insert the 
     following:
       ``(c) Prohibition On Use of Funds.--No funds provided under 
     this title may be used to provide health insurance coverage 
     for--
       ``(1) families of State public employees; or
       ``(2) children who are committed to a penal institution.''
       On page 860, line 14, strike ``title.'' and insert ``title 
     (as described in section 2101), and any health insurance 
     coverage provided with such funds may include coverage of 
     abortion only if necessary to save the life of the mother or 
     if the pregnancy is the result of an act of rape or incest.''
       On page 863, strike lines 1 through 23 and insert the 
     following:
       ``(4) Section 1128 (relating to exclusion from individuals 
     and entities from participation in State health care plans).
       ``(5) Section 1128A (relating to civil monetary penalties).
       ``(6) Section 1128B (relating to criminal penalties for 
     certain additional charges).
       ``(7) Section 1132 (relating to periods within which claims 
     must be filed).
       ``(8) Section 1902(a)(4)(C) (relating to conflict of 
     interest standards).
       ``(9) Section 1903(i) (relating to limitations on payment).
       ``(10) Section 1903(w) (relating to limitations on provider 
     taxes and donations).
       ``(11) Subparagraph (B) in the matter following section 
     1905(a)(25) (relating to the exclusion of care or services 
     for any individual who has not attained 65 years of age and 
     who is a patient in an institution for mental diseases from 
     the definition of medical assistance).
       ``(12) Section 1921 (relating to state licensure 
     authorities).
       ``(13) Sections 1902(a)(25), 1912(a)(1)(A), and 1903(o) 
     (insofar as such sections relate to third party liability).''
       Section 403(a)(5) of the Social Security Act, as added by 
     section 5821, is amended--
       (1) by striking ``amounts reserved pursuant to 
     subparagraphs (F) and (G)'' each place it appears and 
     inserting ``amounts reserved pursuant to subparagraphs (E), 
     (F), and (G)''; and
       (2) in subparagraph (A)(i), by adding at the end the 
     following flush sentence:

     ``The Secretary shall make pro rata reductions in the amounts 
     otherwise payable to States under this paragraph as necessary 
     so that grants under this paragraph do not exceed the 
     available amount, as defined in clause (iv).''
       On page 834, strike ``and'' on lines 6, 18 and 25, and 
     strike lines 7 and 19.
       On page 835, strike lines 1, 9 and 17, and strike ``and'' 
     on lines 8 and 16.
                                 ______
                                 

                        KERREY AMENDMENT NO. 432

  (Ordered to lie on the table.)
  Mr. KERREY submitted an amendment intended to be proposed by him to 
the bill, S. 947, supra; as follows:

       At the appropriate place in the bill insert the following:

     SEC.   . RESERVE PRICE.

       In any auction conducted or supervised by the Federal 
     Communications Commission (hereinafter the Commission) for 
     any license, permit or right which has value, a reasonable 
     reserve price shall be set by the Commission for each unit in 
     the auction. The reserve price shall establish a minimum bid 
     for the unit to be auctioned. If no bid is received above the 
     reserve price for a unit, the unit shall be retained. The 
     Commission shall re-assess the reserve price for that unit 
     and place the unit in the next scheduled or next appropriate 
     auction.

                          ____________________