[Congressional Record Volume 145, Number 109 (Thursday, July 29, 1999)]
[Senate]
[Pages S9748-S9749]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. MACK (for himself, Mrs. Feinstein, Mr. Helms, and Mr. 
        Robb):
  S. 1459. A bill to amend title XVIII of the Social Security Act to 
protect the right of a Medicare beneficiary enrolled in a 
Medicare+Choice plan to receive services at a skilled nursing facility 
selected by that individual; to the Committee on Finance.


                  MEDICARE RETURN TO HOME ACT OF 1999

  Mr. MACK. Mr. President, today I am pleased to join my colleagues, 
Mrs. Feinstein, Mr. Helms and Mr. Robb, in sponsoring the Medicare 
Return to Home Act of 1999.
  This legislation will ensure that senior citizens enrolled in 
Medicare+Choice health plans who normally reside in continuing care 
retirement communities or nursing homes have the opportunity to return 
to the same facility after a period of hospitalization. Many of the 
retirement communities contain fully licensed facilities established to 
provide skilled nursing services to their residents when required them. 
Often, people choose a continuing care retirement community because of 
the different levels of care that will be available to them as they age 
in that community. These living arrangements allow couples and 
individuals to maintain their independence by having the ability to 
move in and out of various levels of care according to their needs over 
time. People who are fully independent when they move into a 
residential community often require assisted living, skilled nursing 
care or some other assistance over the course of their lifetime in 
residence.
  An increasing number of seniors have chosen Medicare+Choice plans as 
the way that they wish to receive health care services under Medicare. 
These plans reduce the potential for substantial out-of-pocket costs 
for the very sick which might be the experience with the traditional 
original Medicare plan.
  One unfortunate consequence of the Medicare+Choice option involves 
the inability of seniors to return to their chosen community or nursing 
home where they resided following a period of hospitalization. Some 
Medicare+Choice plans will only permit patients to be discharged from 
the hospital to a facility with which the Medicare+Choice plan has a 
contract. Then, patients cannot return to the residential community 
that they selected, which may have been chosen because it included a 
skilled nursing facility. Nor can they return to the nursing home in 
which they had previously resided. This can be traumatic for frail 
elderly patients and may contribute to their disorientation and impede 
their recovery. It places them in an unfamiliar setting away from home, 
possibly separating them from a spouse and friends. Staff at their 
chosen retirement community or nursing home may also be familiar with 
their individual needs and habits which could only assist in their 
return to wellness. It makes little sense for them to be sent elsewhere 
upon discharge from a hospital.
  Passage of this legislation ensures the ability of Medicare+Choice 
beneficiaries to return to the residential home facility of their 
choice or nursing home in which they previously resided following 
hospitalization under the following conditions:
  1. The enrollee chooses to return to the residential community 
facility where they had been living.
  2. The facility is licensed and qualified under state and federal law 
to provide the required services.
  3. The residential community or nursing home agrees to accept the 
managed care plan's payment which must be similar to the payment made 
to contracted facilities.
  This legislation provides for continuity in the lives of the elderly 
following a period of hospitalization. It does not increase costs to 
Medicare+Choice plans or to beneficiaries.
  It allows people to return to their loved ones in the facility where 
they have chosen to live.
  Mr. President, I ask unanimous consent that a copy of the legislation 
be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1459

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Medicare Return To Home Act 
     of 1999''.

     SEC. 2. ENSURING CHOICE FOR SKILLED NURSING FACILITY SERVICES 
                   UNDER THE MEDICARE+CHOICE PROGRAM.

       (a) In General.--Section 1852 of the Social Security Act 
     (42 U.S.C. 1395w-22) is amended by adding at the end the 
     following:
       ``(l) Ensuring Choice of Skilled Nursing Facility 
     Services.--
       ``(1) Coverage of services provided at a snf located in 
     enrollee's continuing care retirement community or at a snf 
     in which enrollee previously resided.--Subject to paragraph 
     (2), a Medicare+Choice organization may not deny coverage for 
     any service provided to an enrollee of a Medicare+Choice plan 
     (offered by such organization) by--
       ``(A) a skilled nursing facility located within the 
     continuing care retirement community in which the enrollee 
     resided prior to being admitted to a hospital; or
       ``(B) a skilled nursing facility in which the enrollee 
     resided immediately prior to being admitted to a hospital.
     The requirement described in the preceding sentence shall 
     apply whether or not the Medicare+Choice organization has a 
     contract with such skilled nursing facility to provide such 
     services.
       ``(2) Required factors.--Paragraph (1) shall not apply 
     unless the following factors exist:
       ``(A) The Medicare+Choice organization would be required to 
     provide reimbursement for the service under the 
     Medicare+Choice plan in which the individual is enrolled if 
     the skilled nursing facility was under contract with the 
     Medicare+Choice organization.
       ``(B) The individual--
       ``(i) had a contractual or other right to return, after 
     hospitalization, to the continuing care retirement community 
     described in

[[Page S9749]]

     paragraph (1)(A) or the skilled nursing facility described in 
     paragraph (1)(B); and
       ``(ii) elects to receive services from the skilled nursing 
     facility after the hospitalization, whether or not, in the 
     case of a skilled nursing facility described in paragraph 
     (1)(A), the individual resided in such facility before 
     entering the hospital.
       ``(C) The skilled nursing facility has the capacity to 
     provide the services the individual requires.
       ``(D) The skilled nursing facility agrees to accept 
     substantially similar payment under the same terms and 
     conditions that apply to similarly situated skilled nursing 
     facilities that are under contract with the Medicare+Choice 
     organization.
       ``(3) Coverage of snf services to prevent 
     hospitalization.--A Medicare+Choice organization may not deny 
     payment for services provided to an enrollee of a 
     Medicare+Choice plan (offered by such organization) by a 
     skilled nursing facility in which the enrollee resides, 
     without a preceding hospital stay, regardless of whether the 
     Medicare+Choice organization has a contract with such 
     facility to provide such services, if--
       ``(A) the Medicare+Choice organization has determined that 
     the service is necessary to prevent the hospitalization of 
     the enrollee; and
       ``(B) the factors specified in subparagraphs (A), (C), and 
     (D) of paragraph (2) exist.
       ``(4) Coverage of services provided in snf where spouse 
     resides.--A Medicare+Choice organization may not deny payment 
     for services provided to an enrollee of a Medicare+Choice 
     plan (offered by such organization) by a skilled nursing 
     facility in which the enrollee resides, regardless of whether 
     the Medicare+Choice organization has a contract with such 
     facility to provide such services, if the spouse of the 
     enrollee is a resident of such facility and the factors 
     specified in subparagraphs (A), (C), and (D) of paragraph (2) 
     exist.
       ``(5) Skilled nursing facility must meet medicare 
     participation requirements.--This subsection shall not apply 
     unless the skilled nursing facility involved meets all 
     applicable participation requirements under this title.
       ``(6) Prohibitions.--A Medicare+Choice organization 
     offering a Medicare+Choice plan may not--
       ``(A) deny to an individual eligibility, or continued 
     eligibility, to enroll or to renew coverage under such plan, 
     solely for the purpose of avoiding the requirements of this 
     subsection;
       ``(B) provide monetary payments or rebates to enrollees to 
     encourage such enrollees to accept less than the minimum 
     protections available under this subsection;
       ``(C) penalize or otherwise reduce or limit the 
     reimbursement of a health care provider or organization 
     because such provider or organization provided services to 
     the individual in accordance with this subsection; or
       ``(D) provide incentives (monetary or otherwise) to a 
     health care provider or organization to induce such provider 
     or organization to provide care to a participant or 
     beneficiary in a manner inconsistent with this subsection.
       ``(7) Cost-sharing.--Nothing in this subsection shall be 
     construed as preventing a Medicare+Choice organization 
     offering a Medicare+Choice plan from imposing deductibles, 
     coinsurance, or other cost-sharing for services covered under 
     this subsection if such deductibles, coinsurance, or other 
     cost-sharing would have applied if the skilled nursing 
     facility in which the enrollee received such services was 
     under contract with the Medicare+Choice organization.
       ``(8) Nonpreemption of state law.--The provisions of this 
     subsection shall not be construed to preempt any provision of 
     State law that affords greater protections to beneficiaries 
     with regard to coverage of items and services provided by a 
     skilled nursing facility than is afforded by such provisions 
     of this subsection.
       ``(9) Definitions.--In this subsection:
       ``(A) Continuing care retirement community.--The term 
     `continuing care retirement community' means an organization 
     that provides or arranges for the provision of housing and 
     health-related services to an older person under an 
     agreement.
       ``(B) Skilled nursing facility.--The term `skilled nursing 
     facility' has the meaning given such term in section 
     1819(a).''.
       (b) Effective Date.--The amendments made by this section 
     shall apply with respect to contracts entered into or renewed 
     on or after the date of enactment of this Act.
                                 ______