[House Report 104-80]
[From the U.S. Government Publishing Office]
104th Congress Rept. 104-80
HOUSE OF REPRESENTATIVES
1st Session Part 1
_______________________________________________________________________
MEDICARE PRESIDENTIAL BUDGET SAVINGS EXTENSION ACT OF 1995
_______
March 15, 1995.--Ordered to be printed
_______________________________________________________________________
Mr. Archer, from the Committee on Ways and Means, submitted the
following
R E P O R T
[To accompany H.R. 1134]
[Including cost estimate of the Congressional Budget Office]
The Committee on Ways and Means, to whom was referred the
bill (H.R. 1134) to amend title XVIII of the Social Security
Act to extend certain savings provisions under the medicare
program, as incorporated in the budget submitted by the
President for fiscal year 1996, having considered the same,
report favorably thereon without amendment and recommend that
the bill do pass.
CONTENTS
Page
I. Introduction......................................................2
A. Purpose and summary................................... 2
B. Background and need for legislation................... 2
C. Legislative history................................... 2
II. Explanation of the bill...........................................3
A. Maintaining savings resulting from temporary freeze on 3
payment increases for skilled nursing facilities
(sec. 101).
B. Setting the part B premium at 25 percent of program 3
expenditures permanently (sec. 201).
C. Permanent extension of certain secondary payer 4
provisions (sec. 301).
D. Maintaining savings resulting from temporary freeze on 4
payment increases for home health services (sec.
302).
III.
Votes of the committee............................................5
IV. Budget effects of the bill........................................5
A. Committee estimate of budgetary effects............... 5
B. Statement regarding new budget authority and tax 6
expenditures.
C. Cost estimate prepared by the Congressional Budget 6
Office.
V. Other matters to be discussed under the rules of the House........8
A. Committee oversight findings and recommendations...... 8
B. Summary of findings and recommendations of the 9
Government Operations Committee.
C. Inflationary impact statement......................... 9
VI. Changes in existing law made by the bill, as reported.............9
I. INTRODUCTION
A. Purpose and Summary
H.R. 1134: (1) maintains the savings resulting from the
temporary freeze on payment increases for Skilled Nursing
Facility (``SNF'') services; (2) sets the part B premium at 25
percent of program expenditures permanently; (3) permanently
extends certain Medicare secondary payer (``MSP'') provisions;
and (4) maintains the savings resulting from the temporary
freeze on payment increases for Home Health services.
B. Background and Need for Legislation
These proposals are extensions of Medicare law which would
otherwise expire or not continue
The Committee on Ways and Means marked up the bill on March
8, 1995, and ordered H.R. 1134 favorably reported, by voice
vote, without amendment.
C. Legislative History
Committee bill
H.R. 1134 was introduced on March 6, 1995, by Mr. Thomas of
California and referred to the Committee on Ways and Means and,
in addition, to the Committee on Commerce. The bill as
introduced contained four provisions: (1) maintaining the
savings resulting from the temporary freeze on payment
increases for Skilled Nursing Facility services; (2) setting
the Part B premium at 25 percent of program expenditures
permanently; (3) permanently extending certain Medicare
secondary payer provisions; and (4) maintaining the savings
resulting from the temporary freeze on payment increases for
Home Health services.
The Committee on Ways and Means marked up the bill on March
8, 1995, and ordered H.R. 1134 favorably reported, by voice
vote, without amendment.
Legislative hearings
The Subcommittee on Health of the Committee on Ways and
Means held two public hearings which reviewed several aspects
of the provisions included in H.R. 1134. The hearing on
February 6, 1995, focused on areas of extraordinary growth in
Medicare costs, including home health and skilled nursing
facility costs. The hearing on February 23, 1995, reviewed the
Medicare provisions included in the President's fiscal year
1996 Budget.
Further, the Committee on Ways and Means held four public
hearings on February 7, 1995, February 8, 1995, and February 9,
1995. The subject of the hearings was the Administration's
fiscal year 1996 revenue and budget proposals, including the
Medicare provisions of H.R. 1134.
II. EXPLANATION OF THE BILL
A. Maintaining Savings Resulting from Temporary Freeze on Payment
Increases for Skilled Nursing Facilities (sec. 101 of the bill and 42
U.S.C. sec. 1395yy(a))
Present law
Payments for SNF services are made on a reasonable cost
basis, subject to per diem cost limits. The limits are applied
to the per diem routine service costs (nursing, room and board,
administrative, and other overhead) of a facility. Freestanding
SNF limits are set at 112 percent of the mean per diem labor-
related and nonlabor costs. Hospital-based SNF cost limits are
set at the limit for freestanding SNFs, plus 50 percent of the
difference between the freestanding limit and 112 percent of
the mean per diem routine service costs of hospital-based SNFs.
Certain SNFs can be paid at a prospective rate at 105 percent
of the regional mean for all SNFs in the region. OBRA 93
eliminated the update for SNF limits for cost reporting periods
beginning in FY 1994 and FY 1995. Beginning in FY 1996, new
cost limits would be established that do not reflect the
effects of the freeze.
Explanation of provision
The provision would permanently extend the savings stream
(but not the freeze) in setting future SNF limits by not
allowing for the inflation that occurred during the freeze
years (FY 1994 and FY 1995). Without new legislation, the
baseline would revert to pre-freeze levels.
Reason for change
The provision savings would otherwise not continue.
Effective date
The provision is effective upon enactment.
B. Setting the Part B Premium at 25 Percent of Program Expenditures
Permanently (sec. 201 of the bill and 42 U.S.C. 1395(a)(3))
Present law
Premiums under the supplementary medical insurance
(``SMI'') program are specified in the Medicare law for years
1991 through 1995, will be set at 25 percent of SMI program
costs for 1996 through 1998, and will increase only by the
Social Security cost of living adjustment (``COLA'') percentage
for subsequent years.
Explanation of provision
This provision would permanently set Part B premiums at 25
percent of SMI program costs.
Reason for change
The provision would otherwise expire.
Effective date
The provision would be effective upon enactment.
C. Permanent Extension of Certain Secondary Payer Provisions (sec. 301
of the bill and 42 U.S.C. sec. 1395y(b)(5)(C))
Present law
Under current law, Medicare is a secondary payer under
specified circumstances when beneficiaries are covered by other
third-party payers. Medicare is secondary payer to workers'
compensation, automobile, medical, no-fault, and liability
insurance. In order to identify primary payers, under these
provisions, a data match was authorized through fiscal year
1998, between the Health Care Financing Administration
(``HCFA''), the Social Security Administration (``SSA''), and
the Internal Revenue Service (``IRS''). Medicare is secondary
payer for large group health plans in the case of disabled
beneficiaries, and Medicare is secondary payer for
beneficiaries with end stage renal disease (``ESRD'') for 18
months.
Explanation of provision
The Medicare secondary payer provisions that would
otherwise expire in fiscal year 1998 are extended permanently.
Reason for change
The provision would otherwise expire.
Effective date
The provision would be effective upon enactment.
d. maintaining savings resulting from temporary freeze on payment
increases for home health services (sec. 302 of the bill and 42 u.s.c.
sec. 1395x(v)(1)(l)(iii))
Present law
Medicare pays for covered home health services on a
reasonable cost basis, subject to cost limits that are updated
annually. These limits are set at 112% of the mean labor-
related and nonlabor-related per visit costs for freestanding
home health care agencies. The Omnibus Budget Reconciliation
Act of 1993 (``OBRA '93'') eliminated the update for home
health cost limits for cost reporting periods beginning on or
after July 1, 1994, and before July 1, 1996. Beginning July 1,
1996, new cost limits would be established that do not reflect
the effects of the freeze.
Explanation of provision
The provision would permanently extend the-savings stream
(but not the freeze) in setting future home health limits by
not allowing for the inflation that occurred during the freeze
years (FY 1994 and FY 1995). Without new legislation, the
baseline would revert to pre-freeze levels.
Reason for change
The provision savings would otherwise not continue.
Effective date
The provision would be effective upon enactment.
III. VOTES OF THE COMMITTEE
In compliance with clause 2(l)(2)(B) of rule XI of the
Rules of the House of Representatives, the following statements
are made concerning the votes of the Committee in its
consideration of the bill, H.R. 1134.
Motion to report the bill
The bill, H.R. 1134, was ordered favorably reported,
without amendment, by voice vote on March 8, 1995, with a
quorum present.
Votes on amendment
The Committee defeated an amendment (13 yeas and 21 nays)
offered by Mr. Stark to dedicate amounts equal to the
reductions in spending resulting from the provisions of H.R.
1134 to the Deficit Reduction Fund established by Executive
Order 12858 (58 Fed. Reg. 42185). The roll call vote was as
follows:
YEAS NAYS
Mr. Stark Mr. Archer
Mr. Jacobs Mr. Crane
Mr. Ford Mr. Thomas
Mr. Matsui Mr. Shaw
Mrs. Kennelly Mrs. Johnson
Mr. Coyne Mr. Bunning
Mr. Levin Mr. Houghton
Mr. Cardin Mr. Herger
Mr. McDermott Mr. McCrery
Mr. Kleczka Mr. Hancock
Mr. Lewis Mr. Camp
Mr. Payne Mr. Ramstad
Mr. Neal Mr. Zimmer
Mr. Nussle
Mr. Johnson
Ms. Dunn
Mr. Collins
Mr. Portman
Mr. English
Mr. Ensign
Mr. Christensen
IV. BUDGET EFFECTS
a. committee estimate of budgetary effects
In compliance with clause 7(a) of rule XIII of the Rules of
the House of Representatives, the following statement is made
concerning the effects on the budget of this bill, H.R. 1134,
as reported:
The Committee agrees with the estimate prepared by CBO,
which is included below.
b. statement regarding new budget authority and tax expenditures
In compliance with subdivision (B) of clause 2(l)(3) of
rule XI of the Rules of the House of Representatives, the
Committee states that the bill, H.R. 1134, extends current
budget authority.
The Committee further states that the bill, H.R. 1134, has
no effect on tax expenditures.
c. cost estimate prepared by the congressional budget office
In compliance with subdivision (C) of clause 2(l)(3) of
rule XI of the Rules of the House of Representatives, requiring
a cost estimate prepared by the Congressional Budget Office,
the following report prepared by CBO is provided.
U.S. Congress,
Congressional Budget Office,
Washington, DC, March 13, 1995.
Hon. Bill Archer,
Chairman, Committee on Ways and Means,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 1134, as ordered
reported by the House Committee on Ways and Means on March 8,
1995. Enactment of H.R. 1134 would affect direct spending and
thus would be subject to pay-as-you-go procedures under section
252 of the Balanced Budget and Emergency Deficit Control Act of
1985.
If you wish further details on this estimate, we will be
pleased to provide them.
Sincerely,
James L. Blum
(For June E. O'Neill, Director).
CONGRESSIONAL BUDGET OFFICE COST ESTIMATE
1. Bill number: H.R.1134.
2. Bill title: Medicare Presidential Budget Savings
Extension Act of 1995.
3. Bill status: As ordered reported by the House Committee
on Ways and Means on March 8, 1995.
4. Bill purpose: To amend title XVIII of the Social
Security Act to extend certain savings provisions under the
Medicare program, as incorporated in the budget submitted by
the President for fiscal year 1996.
5. Estimated cost to the Federal Government: The bill would
affect Medicare benefits, Medicare premiums, and Medicaid. The
following table shows projected outlays for these programs
under current law, the changes that would stem from the bill,
and the projected outlays for each program if the bill were
enacted.
----------------------------------------------------------------------------------------------------------------
1995 1996 1997 1998 1999 2000
----------------------------------------------------------------------------------------------------------------
Projected spending under current law:
Medicare mandatory outlays \1\............ 178,155 199,066 219,411 240,412 263,397 288,095
Medicare premium receipts................. -20,090 -20,321 -21,956 -24,494 -26,057 -27,337
Federal Medicaid outlays.................. 89,216 99,292 110,021 122,060 134,830 148,116
-----------------------------------------------------------------
Total................................... 247,281 278,037 307,475 337,977 372,170 408,874
=================================================================
Proposed changes:
Medicare mandatory outlays \1\............ 0 -95 -514 -741 -2,083 -2,311
Medicare premium receipts................. 0 0 0 0 -1,325 -3,883
Federal Medicaid outlays.................. 0 0 0 0 106 310
-----------------------------------------------------------------
Total................................... 0 -95 -514 -741 -3,302 -5,884
=================================================================
Projected spending under H.R. 1134:
Medicare mandatory outlays \1\............ 178,155 198,971 218,897 239,671 261,315 285,784
Medicare premium receipts................. -20,090 -20,321 -21,956 -24,494 -27,382 -31,220
Federal Medicaid outlays.................. 89,216 99,292 110,021 122,060 134,936 148,426
-----------------------------------------------------------------
Total................................... 247,281 277,942 306,961 337,237 368,869 402,990
----------------------------------------------------------------------------------------------------------------
\1\ Primarily payments for benefits.
The costs of this bill fall within budget functions 550 and
570.
6. Basis of estimate: Four provisions of the bill would
have a significant budgetary impact. Their effects are
described below and itemized in the table at the end of this
section.
SNF Cost Limits.--Section 101 of H.R. 1134 would maintain
the savings from the provision in the Omnibus Budget
Reconciliation Act of 1993 (OBRA-93) that froze the cost limits
for Medicare payments to skilled nursing facilities (SNFs).
Medicare's routine service payments to most SNFs are based on
the facility's cost, subject to specified limits. Usually, the
cost limits are computed each year so that they reflect the
average growth in costs among skilled nursing providers. A
provision in OBRA-93, however, froze the limits for two years
ending on October 1, 1995. H.R. 1134 would maintain the savings
from the freeze by ignoring cost growth during those two years
when setting cost limits for future years.
Home Health Cost Limits.--Section 302 would maintain the
savings from the provision in OBRA-93 that froze the cost
limits for Medicare payments to home health agencies (HHAs).
Medicare's payments to HHAs are based on the agency's cost,
subject to specified limits. Usually, the cost limits are
computed each year so that they reflect the average growth in
costs among home health providers. A provision in OBRA-93,
however, froze the limits for two years ending on July 1, 1996.
H.R. 1134 would maintain the savings from the freeze by
ignoring cost growth during those two years when setting cost
limits for future years.
Medicare Secondary Payer.--Section 301 would permanently
extend certain Medicare Secondary Payer (MSP) provisions from
OBRA-93. Under current law, MSP for the disabled, MSP for End
Stage Renal Disease (ESRD) patients, and the MSP data match
would expire in 1998. These provisions make Medicare the
secondary payer for disabled beneficiaries and those with ESRD.
The data match provision authorizes a link between Medicare,
Social Security, and the Internal Revenue Service to obtain
information about cases where another primary payer exists.
Extension of 25 Percent SMI Premium.--Section 201 would
permanently extend the 25 percent Supplementary Medical
Insurance premium. Under current law, the premium is set to
cover 25 percent of the costs of the aged population in
calendar years 1996 through 1998; in 1999 and beyond, the SMI
premium will increase by the amount of the Social Security
cost-of-living adjustment (COLA). Basing the premium on program
costs, which are projected to grow much more rapidly than the
COLA, will increase receipts from premiums in 1999 and 2000.
Extending the 25-percent SMI premium increases costs to the
Medicaid program, which pays the premium for the approximately
15 percent of the Medicare population with low income.
------------------------------------------------------------------------
1996 1997 1998 1999 2000
------------------------------------------------------------------------
SNF cost limits.. -85 -214 -284 -317 -347
Home health cost
limits.......... -10 -299 -457 -515 -564
Medicare
Secondary Payer. 0 0 0 -1,250 -1,400
Extension of 25
percent SMI
premium:
Medicare
premium
receipts.... 0 0 0 -1,325 -3,883
Medicaid
offset...... 0 0 0 106 310
------------------------------------------------------
Total...... -95 -514 -741 -3,302 -5,884
------------------------------------------------------------------------
7. Pay-as-you-go considerations: Section 252 of the
Balanced Budget and Emergency Deficit Control Act of 1985 sets
up pay-as-you-go procedures for legislation affecting direct
spending or receipts through 1998. The pay-as-you-go effects of
the bill are as follows:
------------------------------------------------------------------------
1995 1996 1997 1998
------------------------------------------------------------------------
Outlays..................... 0 -95 -514 -741
Receipts.................... (1) (1) (1) (1)
------------------------------------------------------------------------
\1\ Not applicable.
8. Estimated cost to state and local governments: The
Medicaid program is financed jointly by the federal and state
governments. The extension of the 25 percent SMI premium would
require state and local governments to spend an additional $80
million in 1999 and $234 million in 2000 to help pay the
premiums of low-income beneficiaries.
9. Estimate comparison: None.
10. Previous CBO estimate: None.
11. Estimate prepared by: Scott Harrison and Lori Housman.
12. Estimate approved by: Paul N. Van de Water, Assistant
Director for Budget Analysis.
V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE
a. committee oversight findings and recommendations
With respect to subdivision (A) of clause 2(l)(3) of rule
XI of the Rules of the House of Representatives (relating to
oversight findings), the Committee advises that it was as a
result of the Committee's oversight activities concerning the
expiration of certain Medicare provisions that the Committee
concluded that it is appropriate to enact the provisions
contained in the bill.
b. summary of findings and recommendations of the committee on
government reform and oversight
With respect to subdivision (D) of clause 2(l)(3) of rule
XI of the Rules of the House of Representatives (relating to
oversight findings), the Committee advises that no oversight
findings or recommendations have been submitted to this
Committee by the Committee on Government Reform and Oversight
with respect to the provisions contained in this bill.
c. inflationary impact statement
In compliance with clause 2(l)(4) of rule XI of the Rules
of the House of Representatives, the Committee states that the
provisions of the bill are not expected to have an overall
inflationary impact on prices and cost in the operation of the
national economy. As is indicated above (in Part IV of this
report), the bill is projected to reduce federal outlays by
$10.536 billion over fiscal years 1995-2000.
VI. CHANGES IN EXISTING LAW MADE BY THE BILL AS REPORTED
In compliance with clause 3 of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, existing law in which no change
is proposed is shown in roman):
SOCIAL SECURITY ACT
* * * * * * *
TITLE XVIII--HEALTH INSURANCE FOR THE AGED AND DISABLED
* * * * * * *
Part B--Supplementary Medical Insurance Benefits for the Aged and
Disabled
* * * * * * *
enrollment periods
Sec. 1837 (a) * * *
* * * * * * *
(i)(1) In the case of an individual who--
(A) at the time the individual first satisfies
paragraph (1) or (2) of section 1836, is enrolled in a
group health plan described in section 1862(b)(1)(A)(v)
by reason of the individual's (or the individual's
spouse's) current employment status, and
(B) has elected not to enroll (or to be deemed
enrolled) under this section during the individual's
initial enrollment period,
there shall be a special enrollment period described in
paragraph (3). In the case of an individual not described in
the previous sentence who has not attained the age of 65, at
the time the individual first satisfies paragraph (1) of
section 1836, is enrolled in a large group health plan (as that
term is defined in section 1862(b)(1)(B)[(iv)](iii)) by reason
of the individual's current employment status (or the current
employment status of a family member of the individual), and
has elected not to enroll (or to be deemed enrolled) under this
section during the individual's initial enrollment period,
there shall be a special enrollment period described in
paragraph (3)(B).
(2) In the case of an individual who--
(A)(i) has enrolled (or has been deemed to have
enrolled) in the medical insurance program established
under this part during the individual's initial
enrollment period, or (ii) is an individual described
in paragraph (1)(A);
(B) has enrolled in such program during any
subsequent special enrollment period under this
subsection during which the individual was not enrolled
in a group health plan described in section
1862(b)(1)(A)(v) by reason of the individual's (or
individual's spouse's) current employment status; and
(C) has not terminated enrollment under this section
at any time at which the individual is not enrolled in
such a group health plan by reason of the individual's
(or individual's spouse's) current employment status,
there shall be a special enrollment period described in
paragraph (3). In the case of an individual not described in
the previous sentence who has not attained the age of 65, has
enrolled (or has been deemed to have enrolled) in the medical
insurance program established under this part during the
individual's initial enrollment period, or is an individual
described in the second sentence of paragraph (1), has enrolled
in such program during any subsequent special enrollment period
under this subsection during which the individual was not
enrolled in a large group health plan (as that term is defined
in section 1862(b)(1)(B)[(iv)](iii)) by reason of the
individual's current employment status (or the current
employment status of a family member of the individual), and
has not terminated enrollment under this section at any time at
which the individual is not enrolled in such a large group
health plan by reason of the individual's current employment
status (or the current employment status of a family member of
the individual), there shall be a special enrollment period
described in paragraph (3)(B).
(3)(A) * * *
(B) The special enrollment period referred to in the second
sentences of paragraphs (1) and (2) is the period including
each month during any part of which the individual is enrolled
in a large group health plan (as that term is defined in
section 1862(b)(1)(B)[(iv)](iii)) by reason of the individual's
current employment status (or the current employment status of
a family member of the individual) ending with the last day of
the eighth consecutive month in which the individual is at no
time so enrolled.
* * * * * * *
AMOUNTS OF PREMIUMS
Sec. 1839. (a)(1) * * *
(2) The monthly premium of each individual enrolled under
this part of each month after December 1983 shall, except as
provided in subsections [(b) and (e)] (b), (c), (e), and (f),
be the amount determined under paragraph (3).
(3) The Secretary shall, during September of 1983 and of
each year thereafter, determine and promulgate the monthly
premium applicable for individuals enrolled under this part for
the succeeding calendar year. [The monthly premium shall
(except as otherwise provided in subsection (e)) be equal to
the smaller of--
[(A) the monthly actuarial rate for enrollees age 65
and over, determined according to paragraph (1) of this
subsection, for that calendar year, or
[(B) the monthly premium rate most recently
promulgated by the Secretary under this paragraph,
increased by a percentage determined as follows: The
Secretary shall ascertain the primary insurance amount
computed under section 215(a)(1), based upon average
indexed monthly earnings of $900, that applied to
individuals who became eligible for and entitled to
old-age insurance benefits on November 1 of the year
before the year of the promulgation. He shall increase
the monthly premium rate by the same percentage by
which that primary insurance amount is increased when,
by reason of the law in effect at the time the
promulgation is made, it is so computed to apply to
those individuals for the following November 1.] The
monthly premium shall be equal to 50 percent of the
monthly actuarial rate for enrollees age 65 and over,
as determined according to paragraph (1), for that
succeeding calendar year.
Whenever the Secretary promulgates the dollar amount which
shall be applicable as the monthly premium for any period, he
shall, at the time such promulgation is announced, issue a
public statement setting forth the actuarial assumptions and
bases employed by him in arriving at the amount of an adequate
actuarial rate for enrollees age 65 and older as provided in
paragraph (1) [and the derivation of the dollar amounts
specified in this paragraph].
* * * * * * *
(b) In the case of an individual whose coverage period
began pursuant to an enrollment after his initial enrollment,
period (determined pursuant to subsection (c) or (d) of section
1837), the monthly premium determined under subsection (a) or
(e) shall be increased by 10 percent of the monthly premium so
determined for each full 12 months (in the same continuous
period of eligibility) in which he could have been but was not
enrolled. For purposes of the preceding sentence, there shall
be taken into account (1) the months which elapsed between the
close of his initial enrollment period and the close of the
enrollment period in which he enrolled, plus (in the case of an
individual who reenrolls) (2) the months which elapsed between
the date of termination of a previous coverage period an the
close of the enrollment period in which he reenrolled, but
there shall not be taken into account months for which the
individual can demonstrate that the individual was enrolled in
a group health plan described in section 1862(b)(1)(A)(v) by
reason of the individual's (or the individual's spouse's)
current employment status or months during which the individual
has not attained the age of 65 and for which the individual can
demonstrate that the individual was enrolled in a large group
health plan (as that term is defined in section
1862(b)(1)(B)[(iv)](iii)) by reason of the individual's current
employment status (or the current employment status of a family
member of the individual). Any increase in an individual's
monthly premium under the first sentence of this subsection
with respect to a particular continuous period of eligibility
shall not be applicable with respect to any other continuous
period of eligibility which such individual may have.
* * * * * * *
(e)[(1)(A) Notwithstanding the provisions of subsection
(a), the monthly premium for each individual enrolled under
this part for each month after December 1995 and prior to
January 1999 shall be an amount equal to 50 percent of the
monthly actuarial rate for enrollees age 65 and over, as
determined under subsection (a)(1) and applicable to such
month.
(B)] Notwithstanding the provisions of subsection (a), the
monthly premium for each individual enrolled under this part
for each month in--
[(i)](1) 1991 shall be $29.90,
[(ii)](2) 1992 shall be $31.80,
[(iii)](3) 1993 shall be $36.60,
[(iv)](4) 1994 shall be $41.10, and
[(v)](5) 1995 shall be $46.10.
[(2) Any increases in premium amounts taking effect prior
to January 1998 by reason of paragraph (1) shall be taken into
account for purposes of determining increases thereafter under
subsection (a)(3).]
* * * * * * *
Part C--Miscellaneous Provisions
definitions of services, institutions, etc.
Sec. 1861. For purposes of this title--
Spell of Illness
(a) * * *
* * * * * * *
Reasonable Cost
(v)(1)(A) * * *
* * * * * * *
(L)(i) * * *
* * * * * * *
(iii) Not later than July 1, 1991, and annually thereafter
(but not for cost reporting periods beginning on or after July
1, 1994, and before July 1, 1996), the Secretary shall
establish limits under this subparagraph for cost reporting
periods beginning on or after such date by utilizing the area
wage index applicable under section 1886(d)(3)(E) and
determined using the survey of the most recent available wages
and wage-related costs of hospitals located in the geographic
area in which the home health agency is located (determined
without regard to whether such hospitals have been reclassified
to a new geographic area pursuant to section 1886(d)(8)(B), a
decision of the Medical Geographic Classification Review Board
under section 1886(d)(10), or a decision of the Secretary). In
establishing limits under this subparagraph, the Secretary may
not take into account any changes in the costs of the provision
of services furnished by home health agencies with respect to
cost reporting periods which began on or after July 1, 1994,
and before July 1, 1996.
* * * * * * *
exclusion from coverage and medicare as secondary payer
Sec. 1862. (a) * * *
(b) Medicare as Secondary Payer.--
(1) Requirements of group health plans.--
(A) * * *
(B) Disabled individuals in large group
health plans.--
(i) In general.--A large group health
plan (as defined in clause [(iv)](iii)
may not take into account that an
individual (or a member of the
individual's family) who is covered
under the plan by virtue of the
individual's current employment status
with an employer is entitled to
benefits under this title under section
226(b).
(ii) Exception for individuals with
end stage renal disease.--Subparagraph
(C) shall apply instead of clause (i)
to an item or service furnished in a
month to an individual if for the month
the individual is, or (without regard
to entitlement under section 226) would
upon application be, entitled to
benefits under section 226A.
[(iii) Sunset.--Clause (i) shall only
apply to items and services furnished
on or after January 1, 1987, and before
October 1, 1998.
[(iv)](iii) Larger group health plan
defined.--In this subparagraph, the
term ``large group health plan'' has
the meaning given such term in section
5000(b)(2) of the Internal Revenue Code
of 1986, without regard to section
5000(d) of such Code.
(C) Individuals with end stage renal
disease.--A group health plan (as defined in
subparagraph (A)(v))--
(i) may not take into account that an
individual is entitled to or eligible
for benefits under this title under
section 226A during the [12-month] 18-
month period which begins with the
first month in which the individual
becomes entitled to benefits under part
A under the provisions of section 226A,
or if earlier, the first month in which
the individual would have been entitled
to benefits under such part under the
provisions of section 226A if the
individual had filed an application of
such benefits; and
(ii) may not differentiate in the
benefits it provides between
individuals having end stage renal
disease and other individuals covered
by such plan on the basis of the
existence of end stage renal disease,
the need for renal dialysis, or in any
other manner;
except that clause (ii) shall not prohibit a
plan from paying benefits secondary to this
title when an individual is entitled to or
eligible for benefits under this title under
section 226A after the end of the [12-month]
18-month period described in clause (i).
[Effective for items and services furnished on
or after February 1, 1991, and before October
1, 1998 (with respect to periods beginning on
or after February 1, 1990), this subparagraph
shall be applied by substituting ``18- month''
for ``12-month'' each place it appears.]
* * * * * * *
(5) Identification of secondary payer situations.--
(A) * * *
* * * * * * *
(C) Contacting employers.--
(i) * * *
* * * * * * *
[(iii) Sunset on requirement.--Clause
(ii) shall not apply to inquiries made
after September 30, 1998.]
* * * * * * *
Sec. 1888. (a) The Secretary, in determining the amount of
the payments which may be made under this title with respect to
routine service costs of extended care services shall not
recognize as reasonable (in the efficient delivery of health
services) per diem costs of such services to the extent that
such per diem costs exceed the following per diem limits,
except as otherwise provided in this section:
(1) * * *
* * * * * * *
(4) With respect to hospital-based skilled nursing
facilities located in rural areas, the limit shall be
equal to the sum of the limit for freestanding skilled
nursing facilities located in rural areas, plus 50
percent of the amount by which 112 percent of the mean
per diem routine service costs for hospital-based
skilled nursing facilities located in rural areas
exceeds the limit for freestanding skilled nursing
facilities located in rural areas.
In applying this subsection the Secretary shall make
appropriate adjustments to the labor related portion of the
costs based upon an appropriate wage index, and shall, for cost
reporting periods beginning on or after October 1, 1992, on or
after October 1, 1995,\488\ and every 2 years thereafter,
provide for an update to the per diem cost limits described in
this subsection (except that such updates may not take into
account any changes in the routine service costs of skilled
nursing facilities occurring during cost reporting periods
which began during fiscal year 1994 or fiscal year 1995).
* * * * * * *
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SECTION 6103 OF THE INTERNAL REVENUE CODE OF 1986
SEC. 6103. CONFIDENTIALITY AND DISCLOSURE OF RETURNS AND RETURN
INFORMATION.
(a) * * *
* * * * * * *
(l) Disclosure of Returns and Return Information for
Purposes Other Than Tax Administration.--
(1) * * *
* * * * * * *
(12) Disclosure of certain taxpayer identity
information for verification of employment status of
medicare beneficiary and spouse of medicare
beneficiary.--
(A) * * *
* * * * * * *
[(F) Termination.--Subparagraphs (A) and (B)
shall not apply to--
[(i) any request made after September
30, 1998, and
[(ii) any request made before such
date for information relating to--
[(I) 1997 or thereafter in
the case of subparagraph (A),
or
[(II) 1998 or thereafter in
the case of subparagraph (B).]
* * * * * * *