Directs the Secretary of Health and Human Services to correct for misestimates in the national per capita Medicare+Choice growth rate by providing for an increase by 3.6 percent in the amount of payment otherwise applicable to Medicare+Choice organizations offering Medicare+Choice plans in 2001. Limits retroactive adjustments.
Amends Medicare part C to provide for: (1) continuous open enrollment and disenrollment under Medicare+Choice and Medicare supplemental policy (Medigap) provisions on coverage election periods; and (2) variations in premiums and benefits under Medicare+Choice within counties.
Directs the Secretary of Health and Human Services to provide that risk-adjustment methodology under Medicare+Choice, insofar as it makes adjustments to capitation rates for health status, shall not only apply to ten percent of 1/12 of the annual Medicare+Choice capitation rate in the case of an eligible individual who is institutionalized until the first year in which the Secretary implements a modification of such methodology based on health status so that such methodology includes medical diagnostic factors from all provider settings (including hospital and nursing facility settings).
[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5320 Introduced in House (IH)]
106th CONGRESS
2d Session
H. R. 5320
To amend part C of title XVIII of the Social Security Act to revise and
improve the Medicare+Choice Program, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 27, 2000
Mr. Kolbe 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 part C of title XVIII of the Social Security Act to revise and
improve the Medicare+Choice Program, and for other purposes.
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+Choice Rescue Act of
2000''.
SEC. 2. INCREASE IN NATIONAL PER CAPITA MEDICARE+CHOICE GROWTH
PERCENTAGE IN 2001 AND 2002.
Section 1853(c)(6)(B) of the Social Security Act (42 U.S.C. 1395w-
23(c)(6)(B)) is amended--
(1) in clause (iv), by striking ``for 2001, 0.5 percentage
points'' and inserting ``for 2001, 0 percentage points''; and
(2) in clause (v), by striking ``for 2002, 0.3 percentage
points'' and inserting ``for 2002, 0 percentage points''.
SEC. 3. ELIMINATION OF REDUCTION IN MEDICARE+CHOICE PAYMENT RATES BY
BUDGET NEUTRALITY ADJUSTMENTS.
(a) In General.--Section 1853(c)(1)(A) of the Social Security Act
(42 U.S.C. 1395w-23(c)(1)(A)) is amended by adding at the end the
following: ``With respect to years beginning on or after January 1,
2001, in no case shall the budget neutrality adjustment provided for in
the previous sentence result in a reduction of the payment amount that
would otherwise be made under this subparagraph but for such
adjustment.''.
SEC. 4. PAYMENT FLOOR FOR MEDICARE+CHOICE PLANS.
(a) In General.--Section 1853(c)(1) of the Social Security Act (42
U.S.C. 1395w-23(c)(1)) is amended--
(1) in the matter before subparagraph (A), by striking ``or
(C)'' and inserting ``(C), or (D)''; and
(2) by adding at the end the following new subparagraph:
``(D) True floor based on 90 percent of the fee-
for-service per capita expenditures for medicare+choice
plans.--In the case of a plan, 90 percent of an amount
equal to the annual per capita rate of payment
described in section 1876(a)(1)(C) for the area
involved.''.
(b) Effective Date.--The amendments made by subsection (a) apply to
payments for months beginning on or after January 2001.
SEC. 5. CORRECTING FOR MISESTIMATES IN THE GROWTH RATE; LIMITING
RETROACTIVE ADJUSTMENTS.
(a) In General.--Notwithstanding any other provision of law, for
purposes of payments under section 1853(c) of the Social Security Act
(42 U.S.C. 1395w-23(c)) to Medicare+Choice organizations offering
Medicare+Choice plans for 2001, the Secretary of Health and Human
Services shall provide for an increase by 3.6 percent the amount of
payment otherwise applicable to such plans under that section in 2001.
(b) Hold Harmless for Errors in Estimates.--Section 1853(c)(6) of
such Act (42 U.S.C. 1395w-23(c)(6)) is amended--
(1) in subparagraph (C), by striking ``Beginning with
rates'' and inserting ``Subject to subparagraph (D), beginning
with rates''; and
(2) by adding at the end the following new subparagraph:
``(D) Hold harmless for over projections.--
Beginning with rates calculated for 2002, in making
adjustments under subparagraph (C), in no case may the
Secretary provide for an adjustment in a year for that
results in a reduction of the national per capita
Medicare+Choice growth percentage that is greater than
0.5 percent.''.
SEC. 6. ADDITIONAL FLOOR FOR ANNUAL INCREASE IN MEDICARE+CHOICE
CAPITATION RATES.
Section 1853(c)(3)(C) of the Social Security Act (42 U.S.C. 1395w-
23(c)(3)(C)) is amended--
(1) in clause (ii), by inserting ``(before 2002)'' after
``For a subsequent year''; and
(2) by adding at the end the following new clause:
``(iii) For 2002 and each subsequent year,
the greater of (I) 102 percent of the annual
Medicare+Choice capitation rate under this
paragraph for the area for the previous year,
or (II) such rate for the previous year
increased by the national per capita
Medicare+Choice growth percentage, described in
paragraph (6)(A) for the succeeding year.''.
SEC. 7. APPLICATION OF BUDGET NEUTRALITY PRINCIPLE TO THE NEW
MEDICARE+CHOICE RISK ADJUSTMENT METHODOLOGY.
(a) In General.--Section 1853(a)(3) of the Social Security Act (42
U.S.C. 1395w-23(a)(3)) is amended by adding at the end the following
new subparagraph:
``(E) Implementation in a budget neutral manner.--
The methodology under this paragraph shall be designed
and implemented in a manner so that it does not result
in any material change in the aggregate level of
expenditures under this title compared to the level
that would have occurred if such methodology had not
been implemented (and if the previous risk adjustment
methodology used in 1998 had continued to be
implemented).''.
(b) Effective Date.--The amendment made by subsection (a) takes
effect on the date of the enactment of this Act and applies to payments
for months beginning on or after January 2001.
SEC. 8. PROVIDING FOR CONTINUOUS OPEN ENROLLMENT AND DISENROLLMENT.
(a) In General.--Section 1851(e)(2) of the Social Security Act (42
U.S.C. 1395w-21(e)(2)) is amended to read as follows:
``(2) Continuous open enrollment and disenrollment.--
Subject to paragraph (5), a Medicare+Choice eligible individual
may change the election under subsection (a)(1) at any time.''.
(b) Conforming Amendments.--
(1) Medicare+choice.--Section 1851(e) of such Act (42
U.S.C. 1395w-21(e)) is amended--
(A) in paragraph (4)--
(i) by striking ``Effective as of January
1, 2002, an'' and inserting ``An'';
(ii) by striking ``other than during an
annual, coordinated election period'';
(iii) by inserting ``in a special election
period for such purpose'' after ``make a new
election under this section''; and
(iv) by striking the second sentence; and
(B) in paragraphs (5)(B) and (6)(A), by striking
``the first sentence of''.
(2) Medigap.--Section 1882(s)(3)(B) of such Act (42 U.S.C.
1395ss(s)(3)(B)) is amended--
(A) in clause (ii), by striking ``permitting
discontinuance of the individual's election of the plan
under the first sentence of section 1851(e)(4)'' and
inserting ``providing the individual a special election
period under section 1851(e)(4)''; and
(B) in clause (iii), by striking ``permit
discontinuance of an individual's election of coverage
under the first sentence of section 1851(e)(4)'' and
inserting ``provide the individual a special election
period under section 1851(e)(4)''.
(c) Effective Date.--The amendments made by this section apply with
respect to plan years beginning on or after January 1, 2002.
SEC. 9. ALLOWING VARIATION IN PREMIUMS AND BENEFITS WITHIN COUNTIES.
(a) In General.--Subsections (c) and (f)(1)(D) of section 1854 of
the Social Security Act (42 U.S.C. 1395w-24) are each amended by
inserting before the period at the end the following: ``, expect that
the Secretary shall provide for exceptions based on provider catchment
area that may be a geographic area that is smaller than a county or a
catchment area that crosses the boundaries of two or more counties''.
(b) Effective Date.--The amendments made by subsection (a) apply
with respect to years beginning on or after January 1, 2001.
SEC. 10. MODIFYING PHASE-IN OF MEDICARE+CHOICE RISK-ADJUSTMENT
METHODOLOGY FOR INSTITUTIONALIZED MEDICARE BENEFICIARIES.
The Secretary of Health and Human Services shall provide that the
risk-adjustment methodology applied under section 1853(a) of the Social
Security Act (42 U.S.C. 1395w-23(a)), insofar as it makes adjustments
to capitation rates for health status, shall only apply to 10 percent
of \1/12\ of the annual Medicare+Choice capitation rate in the case of
an eligible individual who is institutionalized (as defined for
purposes of section 1851(e)(2)(D) of such Act (42 U.S.C. 1395w-
21(e)(2)(D))) until the first year in which the Secretary implements a
modification of such methodology based on health status so that such
methodology includes medical diagnostic factors from all provider
settings (including hospital and nursing facility settings).
<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.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health and Environment.
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