Amends Medicare+Choice to add additional Medicare+Choice contract requirements.
Amends SSA title XI with respect to criminal penalties for acts involving Federal health care programs, particularly illegal remunerations (kickbacks). Exempts from the prohibition against such remunerations any remuneration: (1) between a FQHC (or an entity controlled by such a health center) and a Medicare+Choice organization pursuant to a specified written agreement; and (2) between a certain kind of public or nonprofit private health center entity and any individual or entity providing goods, items, services, donations, loans, or a combination, to such health center entity pursuant to an agreement, if such agreement produces a community benefit that will be used by the health center entity to maintain or increase the availability or accessibility, or enhance the quality, of services provided to a medically underserved population served by the health center entity.
Amends Medicare to provide for coverage of additional FQHC services.
Directs the Secretary of Health and Human Services to establish standards relating to the exception for health center entity arrangements to described anti-kickback penalties.
[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4000 Introduced in House (IH)]
107th CONGRESS
2d Session
H. R. 4000
To amend title XVIII of the Social Security Act to enhance the access
of Medicare beneficiaries who live in medically underserved areas to
critical primary and preventive health care benefits, to improve the
Medicare+Choice program, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 19, 2002
Mr. Weller (for himself, Mr. Lewis of Georgia, Mr. Bereuter, Mr.
Hinchey, Mr. Foley, Mr. McNulty, Mr. Deal of Georgia, Ms. Carson of
Indiana, Mr. Bonilla, Mrs. Christensen, Mr. Sessions, Mrs. Jones of
Ohio, Mr. LaTourette, and Mr. Davis of Illinois) introduced the
following bill; which was referred to the Committee on Ways and Means,
and in addition to the Committee on Energy and 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 enhance the access
of Medicare beneficiaries who live in medically underserved areas to
critical primary and preventive health care benefits, to 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; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Medicare Safety
Net Access Act of 2002''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Supplemental reimbursement for Federally qualified health
centers participating in medicare managed
care.
Sec. 3. Revision of Federally qualified health center payment limits.
Sec. 4. Coverage of additional Federally qualified health center
services.
Sec. 5. Providing safe harbor for certain collaborative efforts that
benefit medically underserved populations.
SEC. 2. SUPPLEMENTAL REIMBURSEMENT FOR FEDERALLY QUALIFIED HEALTH
CENTERS PARTICIPATING IN MEDICARE MANAGED CARE.
(a) Supplemental Reimbursement.--Section 1833(a)(3) of the Social
Security Act (42 U.S.C. 1395l(a)(3)) is amended to read as follows:
``(3) in the case of services described in section
1832(a)(2)(D)--
``(A) except as provided in subparagraph (B), the
costs which are reasonable and related to the cost of
furnishing such services or which are based on such
other tests of reasonableness as the Secretary may
prescribe in regulations, including those authorized
under section 1861(v)(1)(A), less the amount a provider
may charge as described in clause (ii) of section
1866(a)(2)(A), but in no case may the payment for such
services (other than for items and services described
in section 1861(s)(10)(A)) exceed 80 percent of such
costs; or
``(B) with respect to the services described in
clause (ii) of section 1832(a)(2)(D) that are furnished
to an individual enrolled with a Medicare+Choice
organization under part C pursuant to a written
agreement described in section 1853(j), the amount by
which--
``(i) the amount of payment that would have
otherwise been provided under subparagraph (A)
(calculated as if `100 percent' were
substituted for `80 percent' in such
subparagraph) for such services if the
individual had not been so enrolled; exceeds
``(ii) the amount of the payments received
under such written agreement for such services
(not including any financial incentives
provided for in such agreement such as risk
pool payments, bonuses, or withholds),
less the amount the Federally qualified health center
may charge as described in section 1857(e)(3)(C);''.
(b) Continuation of Medicare+Choice Monthly Payments.--
(1) In general.--Section 1853 of the Social Security Act
(42 U.S.C. 1395w-23) is amended by adding at the end the
following new subsection:
``(j) Special Payment Rule for Federally Qualified Health Center
Services.--If an individual who is enrolled with a Medicare+Choice
organization under this part receives a service from a Federally
qualified health center that has a written agreement with such
organization for providing such a service (including any agreement
required under section 1857(e)(3))--
``(1) the Secretary shall pay the amount determined under
section 1833(a)(3)(B) directly to the Federally qualified
health center not less frequently than quarterly; and
``(2) the Secretary shall not reduce the amount of the
monthly payments to the Medicare+Choice organization made under
section 1853(a) as a result of the application of paragraph
(1).''.
(2) Conforming amendments.--
(A) Paragraphs (1) and (2) of section 1851(i) of
the Social Security Act (42 U.S.C. 1395w-21(i)(1)) are
each amended by inserting ``1853(j),'' after
``1853(h),''.
(B) Section 1853(c)(5) is amended by striking
``subsections (a)(3)(C)(iii) and (i)'' and inserting
``subsections (a)(3)(C)(iii), (i), and (j)(1)''.
(c) Additional Medicare+Choice Contract Requirements.--Section
1857(e) of the Social Security Act (42 U.S.C. 1395w-27(e)) is amended
by adding at the end the following new paragraph:
``(3) Agreements with federally qualified health centers.--
``(A) Ensuring equal access to services of fqhcs.--
A contract under this part shall require the
Medicare+Choice organization to enter into (and to
demonstrate to the Secretary that it has entered into)
a sufficient number of written agreements with
Federally qualified health centers providing Federally
qualified health center services for which payment may
be made under this title in the service area of each
Medicare+Choice plan offered by such organization so
that such services are reasonably available to
individuals enrolled in the plan.
``(B) Ensuring equal payment levels and amounts.--A
contract under this part shall require the
Medicare+Choice organization to provide a level and
amount of payment to each Federally qualified health
center for services provided by such health center that
are covered under the written agreement described in
subparagraph (A) that is not less than the level and
amount of payment that the organization would make for
such services if the services had been furnished by a
provider of services that was not a Federally qualified
health center.
``(C) Cost-sharing.--Under the written agreement
described in subparagraph (A), a Federally qualified
health center must accept the Medicare+Choice contract
price plus the Federal payment as payment in full for
services covered by the contract, except that such a
health center may collect any amount of cost-sharing
permitted under the contract under this part, so long
as the amounts of any deductible, coinsurance, or
copayment comply with the requirements under section
1854(e) and do not result in a total payment to the
center in excess of the amount determined under section
1833(a)(3)(A) (calculated as if `100 percent' were
substituted for `80 percent' in such section).''.
(d) Safe Harbor From Antikickback Prohibition.--Section 1128B(b)(3)
of the Social Security Act (42 U.S.C. 1320a-7b(b)(3)) is amended--
(1) in subparagraph (E), by striking ``and'' after the
semicolon at the end;
(2) in subparagraph (F), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(G) any remuneration between a Federally
qualified health center (or an entity controlled by
such a health center) and a Medicare+Choice
organization pursuant to the written agreement
described in section 1853(j).''.
(e) Effective Date.--The amendments made by this section shall
apply to services provided on or after January 1, 2003, and contract
years beginning on or after such date.
SEC. 3. REVISION OF FEDERALLY QUALIFIED HEALTH CENTER PAYMENT LIMITS.
(a) Per Visit Payment Requirements for FQHCs.--Section
1833(a)(3)(A) of the Social Security Act (42 U.S.C. 1395l(a)(3)(A)), as
amended by section 2(a), is amended by adding ``(which regulations may
not limit the per visit payment amount, or a component of such amount,
for services described in section 1832(a)(2)(D)(ii))'' after ``the
Secretary may prescribe in regulations''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to services provided on or after January 1, 2003.
SEC. 4. COVERAGE OF ADDITIONAL FEDERALLY QUALIFIED HEALTH CENTER
SERVICES.
(a) Coverage for FQHC Ambulatory Services.--Section 1861(aa)(3) of
the Social Security Act (42 U.S.C. 1395x(aa)(3)) is amended to read as
follows:
``(3) The term `Federally qualified health center services' means--
``(A) services of the type described in subparagraphs (A)
through (C) of paragraph (1), and such other services furnished
by a Federally qualified health center for which payment may
otherwise be made under this title if such services were
furnished by a health care provider or health care professional
other than a Federally qualified health center; and
``(B) preventive primary health services that a center is
required to provide under section 330 of the Public Health
Service Act,
when furnished to an individual as a patient of a Federally qualified
health center.''.
(b) Offsite FQHC Services.--
(1) Patients of hospitals and critical access hospitals.--
Section 1862(a)(14) of the Social Security Act (42 U.S.C.
1395y(a)) is amended by inserting ``Federally qualified health
center services,'' after ``qualified psychologist services,''.
(2) Exclusion of federally qualified health center services
from the pps for skilled nursing facilities.--Section 1888(e)
of the Social Security Act (42 U.S.C. 1395yy(e)) is amended--
(A) in paragraph (2)(A)(i)(II), by striking
``clauses (ii) and (iii)'' and inserting ``clauses (ii)
through (iv)''; and
(B) by adding at the end of paragraph (2)(A) the
following new clause:
``(iv) Exclusion of federally qualified
health center services.--Services described in
this clause are Federally qualified health
center services (as defined in section
1861(aa)(3)).''.
(c) Technical Corrections.--
(1) Section 1861(aa)(1)(B) of the Social Security Act (42
U.S.C. 1395x(aa)(1)(B)) is amended by striking ``subsection
(hh)(1)),,'' and inserting ``subsection (hh)(1)),''.
(2) Clauses (i) and (ii)(II) of section 1861(aa)(4)(A) of
the Social Security Act (42 U.S.C. 1395x(aa)(4)(A)) are each
amended by striking ``(other than subsection (h))''.
(d) Effective Dates.--The amendments made--
(1) by subsections (a) and (b) shall apply to services
furnished on or after January 1, 2003; and
(2) by subsection (c) shall take effect on the date of
enactment of this Act.
SEC. 5. PROVIDING SAFE HARBOR FOR CERTAIN COLLABORATIVE EFFORTS THAT
BENEFIT MEDICALLY UNDERSERVED POPULATIONS.
(a) In General.--Section 1128B(b)(3) of the Social Security Act (42
U.S.C. 1320a-7(b)(3)), as amended by section 2(d), is amended--
(1) in subparagraph (F), by striking ``and'' after the
semicolon at the end;
(2) in subparagraph (G), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(H) any remuneration between a public or
nonprofit private health center entity described under
clauses (i) and (ii) of section 1905(l)(2)(B) and any
individual or entity providing goods, items, services,
donations or loans, or a combination thereof, to such
health center entity pursuant to a contract, lease,
grant, loan, or other agreement, if such agreement
produces a community benefit that will be used by the
health center entity to maintain or increase the
availability or accessibility, or enhance the quality,
of services provided to a medically underserved
population served by the health center entity.''.
(b) Rulemaking for Exception for Health Center Entity
Arrangements.--
(1) Establishment.--
(A) In general.--The Secretary of Health and Human
Services (in this subsection referred to as the
``Secretary'') shall establish, on an expedited basis,
standards relating to the exception for health center
entity arrangements to the antikickback penalties
described in section 1128B(b)(3)(F) of the Social
Security Act, as added by subsection (a).
(B) Factors to consider.--In establishing standards
relating to the exception for health center entity
arrangements under subparagraph (A), the Secretary--
(i) shall extend the exception where the
arrangement between the health center entity
and the other party--
(I) results in savings of Federal
grant funds or increased revenues to
the health center entity;
(II) does not limit or restrict a
patient's freedom of choice; and
(III) does not interfere with a
health care professional's independent
medical judgment regarding medically
appropriate treatment; and
(ii) may include other standards and
criteria that are consistent with the intent of
Congress in enacting the exception established
under this subsection.
(2) Interim final effect.--No later than 60 days after the
date of enactment of this Act, the Secretary shall publish a
rule in the Federal Register consistent with the factors under
paragraph (1)(B). Such rule shall be effective and final
immediately on an interim basis, subject to change and revision
after public notice and opportunity (for a period of not more
than 60 days) for public comment, provided that any change or
revision shall be consistent with this subsection.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and 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 Energy and 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 Energy and 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, for a period to be subsequently determined by the Chairman.
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