[Congressional Record (Bound Edition), Volume 149 (2003), Part 11]
[Senate]
[Pages 15353-15355]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 929. Mr. NELSON of Nebraska submitted an amendment intended to be 
proposed by him to the bill S. 1, to amend title XVIII of the Social 
Security Act to make improvements in the Medicare program, to provide 
prescription drug coverage under the Medicare program, and for other 
purposes; which was ordered to lie on the table; as follows:

       At the end of title VI, insert the following:

     SEC. __. MEDICARE BENEFICIARY ACCESS TO REHABILITATION 
                   FACILITIES.

       (a) Definitions of Rehabilitation Hospital; Rehabilitation 
     Unit.--Section 1886(j) (42 U.S.C. 1395ww(j)) is amended by 
     adding at the end the following new subsection:
       ``(8) Definitions of rehabilitation hospital; 
     rehabilitation unit.--
       ``(A) In general.--The Secretary shall by regulation define 
     the terms `rehabilitation hospital' and `rehabilitation unit' 
     in a manner fully consistent with all the rehabilitation 
     impairment categories (except miscellaneous) used to classify 
     patients into case-mix groups pursuant to paragraph (2).
       ``(B) Periodic update required.--The Secretary shall update 
     the regulations promulgated under subparagraph (A) 
     periodically to ensure that such definitions remain fully 
     consistent with the rehabilitation impairment categories used 
     to classify patients into case-mix groups pursuant to 
     paragraph (2).''.
       (b) Prohibition on retroactive enforcement.--
     Notwithstanding any other provision of law, the Secretary of 
     Health and Human Services shall not seek to recoup any 
     overpayment, take any enforcement action, or impose any 
     sanction or penalty, with respect to a rehabilitation 
     hospital, or a converted rehabilitation unit, (as such terms 
     are defined for purposes of the medicare program under title 
     XVIII of the Social Security Act) insofar as such 
     overpayment, enforcement action, sanction or penalty, is for 
     failure to satisfy the requirement of section 412.23(b)(2) of 
     title 42, Code of Federal Regulations, that 75 percent of the 
     patients of the rehabilitation hospital or converted 
     rehabilitation unit are in 1 or more of 10 listed treatment

[[Page 15354]]

     categories (commonly referred to as the ``75 Percent Rule'').
                                 ______
                                 
  SA 930. Mrs. HUTCHISON submitted an amendment intended to be proposed 
by her to the bill S. 1, to amend title XVIII of the Social Security 
Act to make improvements in the Medicare program, to provide 
prescription drug coverage under the Medicare program, and for other 
purposes; which was ordered to lie on the table; as follows:

       At the end of subtitle A of title IV, add the following:

     SEC. __. FREEZING INDIRECT MEDICAL EDUCATION (IME) ADJUSTMENT 
                   PERCENTAGE AT 6.5 PERCENT.

       (a) In General.--Section 1886(d)(5)(B)(ii) (42 U.S.C. 
     1395ww(d)(5)(B)(ii)) is amended--
       (1) in subclause (V), by inserting ``and'' at the end; and
       (2) by striking subclauses (VI) and (VII) and inserting the 
     following new subclause:
       ``(VI) on or after October 1, 2001, `c' is equal to 1.6.''.
       (b) Conforming Amendment Relating to Determination of 
     Standardized Amount.--Section 1886(d)(2)(C)(i) (42 U.S.C. 
     1395ww(d)(2)(C)(i)) is amended--
       (1) by striking ``1999 or'' and inserting ``1999,''; and
       (2) by inserting ``, or the Prescription Drug and Medicare 
     Improvement Act of 2003'' after ``2000''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to discharges occurring on or after October 1, 
     2002.
                                 ______
                                 
  SA 931. Ms. STABENOW (for herself, Mrs. Boxer, Mr. Graham of Florida, 
Mr. Rockefeller, Mr. Harkin, Ms. Cantwell, Mr. Kerry, Mr. Bingaman, Mr. 
Reed, Mrs. Clinton, Ms. Mikulski, Mr. Levin, Mr. Kohl, Mr. Dodd, Mr. 
Lieberman, Mr. Reid, Mr. Dayton, and Mr. Johnson) proposed an amendment 
to the bill S. 1, to amend title XVIII of the Social Security Act to 
make improvements in the medicare program, to provide prescription drug 
coverage under the medicare program, and for other purposes; as 
follows:

       ``(e) Medicare Guaranteed Option.--
       ``(1) Access.--
       ``(A) In general.--The Administrator shall enter into a 
     contract with an entity in each area (established under 
     section 1860D-10) to provide eligible beneficiaries enrolled 
     under this part (and not, except for an MSA plan or a private 
     fee-for-service plan that does not provide qualified 
     prescription drug coverage, enrolled in a MedicareAdvantage 
     plan) and residing in the area with standard prescription 
     drug coverage (including access to negotiated prices for such 
     beneficiaries pursuant to section 1860D-6(e)). An entity may 
     be awarded a contract for more than 1 area but the 
     Administrator may enter into only 1 such contract in each 
     such area.
       ``(B) Entity required to meet beneficiary protection and 
     other requirements.--An entity with a contract under 
     subparagraph (A) shall meet the requirements described in 
     section 1860D-5 and such other requirements determined 
     appropriate by the Administrator.
       ``(C) Competitive procedures.--Competitive procedures (as 
     defined in section 4(5) of the Office of Federal Procurement 
     Policy Act (41 U.S.C. 403(5))) shall be used to enter into a 
     contract under subparagraph (A).
       ``(D) Same timeframe as medicare prescription drug plans.--
     The Administrator shall apply similar timeframes for the 
     submission of bids and entering into to contracts under this 
     subsection as the Administrator applies to Medicare 
     Prescription Drug plans.
       ``(2) Monthly beneficiary obligation for enrollment.--In 
     the case of an eligible beneficiary receiving access to 
     qualified prescription drug coverage through enrollment with 
     an entity with a contract under paragraph (1)(A), the monthly 
     beneficiary obligation of such beneficiary for such 
     enrollment shall be an amount equal to the applicable percent 
     (as determined under section 1860D-17(c) before any 
     adjustment under paragraph (2) of such section) of the 
     monthly national average premium (as computed under section 
     1860D-15 before any adjustment under subsection (b) of such 
     section) for the year.
       ``(3) Payments under the contract.--
       ``(A) In general.--A contract entered into under paragraph 
     (1)(A) shall provide for--
       ``(i) payment for the negotiated costs of covered drugs 
     provided to eligible beneficiaries enrolled with the entity; 
     and
       ``(ii) payment of prescription management fees that are 
     tied to performance requirements established by the 
     Administrator for the management, administration, and 
     delivery of the benefits under the contract.
       ``(B) Performance requirements.--The performance 
     requirements established by the Administrator pursuant to 
     subparagraph (A)(ii) shall include the following:
       ``(i) The entity contains costs to the Prescription Drug 
     Account and to eligible beneficiaries enrolled under this 
     part and with the entity.
       ``(ii) The entity provides such beneficiaries with quality 
     clinical care.
       ``(iii) The entity provides such beneficiaries with quality 
     services.
       ``(C) Entity only at risk to the extent of the fees tied to 
     performance requirements.--An entity with a contract under 
     paragraph (1)(A) shall only be at risk for the provision of 
     benefits under the contract to the extent that the management 
     fees paid to the entity are tied to performance requirements 
     under subparagraph (A)(ii).
       ``(4) Term of contract.--A contract entered into under 
     paragraph (1)(A) shall be for a period of at least 2 years 
     but not more than 5 years.
       ``(5) No effect on access requirements.--The contract 
     entered into under subparagraph (1)(A) shall be in addition 
     to the plans required under subsection (d)(1).
       ``(6) Authority to prevent increased costs.--If the 
     Administrator determines that Federal payments made with 
     respect to eligible beneficiaries enrolled in a contract 
     under paragraph (1)(A) exceed on average the Federal payments 
     made with respect to eligible beneficiaries enrolled in a 
     Medicare Prescription Drug plan or a MedicareAdvantage plan 
     (with respect to qualified prescription drug coverage), the 
     Administrator may adjust the requirements or payments under 
     such a contract to eliminate such excess.
                                 ______
                                 
  SA 932. Mr. ENZI (for himself, Mr. Reed, and Mr. Pryor) proposed an 
amendment to the bill S. 1, to amend title XVIII of the Social Security 
Act to make improvements in the Medicare program, to provide 
prescription drug coverage under the Medicare program, and for other 
purposes; as follows:

       On page 57, between lines 21 and 22, insert the following:
       ``(3) Disclosure.--The eligible entity offering a Medicare 
     Prescription Drug plan and the MedicareAdvantage organization 
     offering a MedicareAdvantage plan shall disclose to the 
     Administrator (in a manner specified by the Administrator) 
     the extent to which discounts, direct or indirect subsidies, 
     rebates, or other price concessions or direct or indirect 
     remunerations made available to the entity or organization by 
     a manufacturer are passed through to enrollees through 
     pharmacies and other dispensers or otherwise. The provisions 
     of section 1927(b)(3)(D) shall apply to information disclosed 
     to the Administrator under this paragraph in the same manner 
     as such provisions apply to information disclosed under such 
     section.
       ``(4) Audits and reports.--To protect against fraud and 
     abuse and to ensure proper disclosures and accounting under 
     this part, in addition to any protections against fraud and 
     abuse provided under section 1860D-7(f)(1), the Administrator 
     may periodically audit the financial statements and records 
     of an eligible entity offering a Medicare Prescription Drug 
     plan and a MedicareAdvantage organization offering a 
     MedicareAdvantage plan.

       On page 37, between lines 20 and 21, insert the following:
       ``(C) Level playing field.--An eligible entity offering a 
     Medicare Prescription Drug plan shall permit enrollees to 
     receive benefits (which may include a 90-day supply of drugs 
     or biologicals) through a community pharmacy, rather than 
     through mail order, with any differential in cost paid by 
     such enrollees.
       ``(D) Participating pharmacies not required to accept 
     insurance risk.--An eligible entity offering a Medicare 
     Prescription Drug plan may not require participating 
     pharmacies to accept insurance risk as a condition of 
     participation.
                                 ______
                                 
  SA 933. Mr. BINGAMAN proposed an amendment to the bill S. 1, to amend 
title XVIII of the Social Security Act to make improvements in the 
Medicare program, to provide prescription drug coverage under the 
Medicare program, and for other purposes; as follows:

       On page 120, between lines 16 and 17, insert the following:
       ``(I) Elimination of application of asset test.--With 
     respect to eligibility determinations for premium and cost-
     sharing subsidies under this section made on or after October 
     1, 2008, such determinations shall be made without regard to 
     subparagraph (C) of section 1905(p)(1) (to the extent a 
     State, as of such date, has not already eliminated the 
     application of such subparagraph).
                                 ______
                                 
  SA 934. Mrs. LINCOLN submitted an amendment intended to be proposed 
by her to the bill S. 1, to amend title XVIII of the Social Security 
Act to make improvements in the Medicare program, to provide 
prescription drug coverage under the Medicare program, and for other 
purposes; which was ordered to lie on the table; as follows:

       On page 9, line 7, insert ``(including syringes, and 
     necessary medical supplies associated with the administration 
     of insulin, as defined by the Administrator)'' before the 
     semicolon.
       On page 170, line 10, insert ``(including syringes, and 
     necessary medical supplies associated with the administration 
     of insulin, as defined by the Secretary)'' before the comma.

[[Page 15355]]


                                 ______
                                 
  SA 935. Mrs. LINCOLN submitted an amendment intended to be proposed 
by her to the bill S. 1, to amend title XVIII of the Social Security 
Act to make improvements in the Medicare program, to provide 
prescription drug coverage under the Medicare program, and for other 
purposes; which was ordered to lie on the table; as follows:

       Strike section 410 and insert the following:

     SEC. 410. EXCEPTION TO INITIAL RESIDENCY PERIOD FOR GERIATRIC 
                   RESIDENCY OR FELLOWSHIP PROGRAMS.

       (a) Clarification of Congressional Intent.--Congress 
     intended section 1886(h)(5)(F)(ii) of the Social Security Act 
     (42 U.S.C. 1395ww(h)(5)(F)(ii)), as added by section 9202 of 
     the Consolidated Omnibus Budget Reconciliation Act of 1985 
     (Public Law 99-272), to provide an exception to the initial 
     residency period for geriatric residency or fellowship 
     programs such that, where a particular approved geriatric 
     training program requires a resident to complete 2 years of 
     training to initially become board eligible in the geriatric 
     specialty, the 2 years spent in the geriatric training 
     program are treated as part of the resident's initial 
     residency period, but are not counted against any limitation 
     on the initial residency period.
       (b) Interim Final Regulatory Authority and Effective 
     Date.--The Secretary shall promulgate interim final 
     regulations consistent with the congressional intent 
     expressed in this section after notice and pending 
     opportunity for public comment to be effective for cost 
     reporting periods beginning on or after October 1, 2003.

                          ____________________