Medicare HMO Improvement Act of 1999 - Amends part C (Medicare+Choice) of title XVIII (Medicare) of the Social Security Act with regard to contracts with Medicare+Choice organizations to: (1) provide for extension of the initial Medicare+Choice contract period from one year to three years; and (2) require termination of any contract with an organization that terminates coverage for any part of a metropolitan statistical area (or a New England County Metropolitan Area).
Authorizes the Secretary of Health and Human Services to delay the effectiveness of a Medicare+Choice organization's termination of its plan with respect to all individuals in an area, if: (1) the termination would cause an imminent and serious health risk to enrollees; (2) the termination would result in a significant reduction in the Medicare+Choice plans available in the area affected; or (3) the chief executive officer of the State in which the termination occurs requests such a delay.
Provides for continuity of care, for a limited period, in certain cases of involuntary termination (other than for cause) of an individual's enrollment with a Medicare+Choice plan.
[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 141 Introduced in House (IH)]
106th CONGRESS
1st Session
H. R. 141
To amend title XVIII of the Social Security Act to prevent sudden
disruption of Medicare beneficiary enrollment in Medicare+Choice plans.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 6, 1999
Mr. Gejdenson (for himself, Ms. DeLauro, Mr. Sandlin, Mrs. Capps, Mr.
Baldacci, Ms. Kilpatrick, Mr. Filner, and Mr. Hinchey) introduced the
following bill; which was referred to the Committee on Ways and Means,
and in addition to the Committee on Commerce, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to prevent sudden
disruption of Medicare beneficiary enrollment in Medicare+Choice plans.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare HMO Improvement Act of
1999''.
SEC. 2. EXTENSION OF INITIAL MEDICARE+CHOICE CONTRACT PERIOD TO 3
YEARS.
(a) In General.--Section 1857(c)(1) of the Social Security Act (42
U.S.C. 1395w-27(c)(1)) is amended--
(1) by striking ``a term of at least 1 year'' and inserting
``an initial term of at least 3 years''; and
(2) by striking ``from term to term'' and inserting ``for
additional 1-year periods thereafter''.
(b) Effective Date.--The amendments made by subsection (a) apply to
contracts entered into on or after the date of the enactment of this
Act.
SEC. 3. AUTHORITY TO DELAY TERMINATION.
Section 1851(g)(3) of the Social Security Act (42 U.S.C. 1395w-
21(g)(3)) is amended by adding at the end the following new
subparagraph:
``(E) Authority to delay effectiveness of a
termination.--
(i) In general.--If a Medicare+Choice
organization terminates a plan under
subparagraph (B)(iii), the Secretary may delay
the effectiveness of such termination for up to
1 year if the Secretary finds that--
``(I) the termination would cause
an imminent and serious risk to health
to individuals enrolled under the plan
under this part;
``(II) the termination would result
in a significant reduction in the
Medicare+Choice plans that are
available in the area affected by the
termination; or
``(III) the chief executive officer
of the State in which the termination
occurs requests such a delay.
``(ii) End of delay.--The Secretary may end
a delay under clause (i), before the end of the
1-year period, if the Secretary finds that an
adequate provider network has been established
which will provide at least an equal level of
insurance coverage as existed on the date the
Medicare+Choice organization informed its
enrollees of its intention to terminate the
plan.''.
SEC. 4. RESTRICTION ON TERMINATION OF MEDICARE+CHOICE PLANS IN SELECTED
AREAS WITHIN A METROPOLITAN STATISTICAL AREA.
(a) In General.--Section 1857(c) of the Social Security Act (42
U.S.C. 1395w-27(c)) is amended by redesignating paragraph (5) as
paragraph (6) and by inserting after paragraph (4) the following new
paragraph:
``(5) Limitation on selective termination of contracts.--
``(A) In general.--Except as provided in
subparagraph (B), if a Medicare+Choice organization
offers a Medicare+Choice plan that provides coverage in
a metropolitan statistical area (or a New England
County Metropolitan Area) in a State and terminates
such coverage for any part of such area (or Area) in
the State, the Secretary shall terminate any contract
with the organization for coverage of any part of that
area (or Area) in that State.
``(B) Exception.--The Secretary may waive the
requirement of subparagraph (A) if the Secretary finds
that terminating contracts for coverage in all parts of
a metropolitan statistical area (or New England County
Metropolitan Area) in the State would pose an imminent
and serious risk to the health of individuals enrolled
with the organization under this part in the area (or
Area).''.
(b) Effective Date.--The amendments made by subsection (a) apply to
terminations for which notice is provided on or after the date of the
enactment of this Act.
SEC. 5. CONTINUITY OF CARE IN CASE OF INVOLUNTARY TERMINATION.
(a) In General.--Section 1852(d) of the Social Security Act (42
U.S.C. 1395w-22(d)) is amended by adding at the end the following new
paragraph:
``(5) Continuity of care.--
``(A) In general.--If--
``(i) an individual's enrollment with a
Medicare+Choice plan offered by a
Medicare+Choice organization under this part is
terminated by the organization (other than for
cause with respect to that individual), and
``(ii) on the effective date of such
termination of enrollment the individual is in
a course of treatment for which coverage is
available under the plan and the individual is
not at that time covered under another
Medicare+Choice plan,
notwithstanding such termination the organization shall
continue to provide coverage for the covered course of
treatment for a period of 90 days after such effective
date.
``(B) Permissible terms and conditions.--The
coverage provided under subparagraph (A) shall be under
the same terms and conditions (including applicable
policies, procedures, and quality assurance standards)
as existed on the date before the effective date of the
termination.
``(C) Terminate defined.--In this paragraph, the
term `terminate' includes the termination of a
Medicare+Choice plan as a result of the expiration or
nonrenewal of a contract by the organization under this
part.
``(D) Construction.--Nothing in this paragraph
shall be construed to require the coverage of benefits
which would not have been covered on the effective date
of the termination involved.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to contracts entered into or renewed on or after the date of the
enactment of this Act.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsor introductory remarks on measure. (CR E53-54)
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health and Environment, for a period to be subsequently determined by the Chairman.
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