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 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 contributes to the ability of the health center entity to maintain or increase the availability, or enhance the quality, of services provided to a medically underserved population served by the health center entity; and (2) between a FQHC (or an entity controlled by such a health center) and a Medicare+Choice organization pursuant to a specified written agreement.
Directs the Secretary of Health and Human Services to establish standards relating to the exception for health center entity arrangements to specified anti-kickback penalties.
Amends SSA title XVIII to revise the payment for certain FQHC services furnished to an individual enrolled with a Medicare+Choice organization under Medicare part C (Medicare+Choice), allowing for supplemental reimbursement, among other changes.
Amends Medicare+Choice to add additional Medicare+Choice contract requirements.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1377 Introduced in House (IH)]
108th CONGRESS
1st Session
H. R. 1377
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 20, 2003
Mr. Weller (for himself, Mr. Lewis of Georgia, Mr. Houghton, Mr.
McNulty, Mr. Farr, Mr. Stupak, and Mr. Hinchey) 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 2003''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Coverage of additional Federally qualified health center
services.
Sec. 3. Providing safe harbor for certain collaborative efforts that
benefit medically underserved populations.
Sec. 4. Supplemental reimbursement for Federally qualified health
centers participating in medicare managed
care.
SEC. 2. DELIVERY OF MEDICARE-COVERED PRIMARY AND PREVENTIVE SERVICES AT
FEDERALLY QUALIFIED HEALTH CENTERS.
(a) Coverage of Medicare-Covered Ambulatory Services by FQHCs.--
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 and such services when provided by a health care provider
or health care professional employed by or under contract with a
Federally qualified health center shall be treated as billable visits
for purposes of payment to the Federally qualified health center.''.
(b) Ensuring FQHC Reimbursement Under Hospital and Skilled Nursing
Facility Prospective Payment Systems.--
(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) Patients of skilled nursing facilities.--Section
1888(e)(2)(A) of the Social Security Act (42 U.S.C.
1395yy(e)(2)(A)) is amended--
(A) in clause (i)(II), by striking ``clauses (ii)
and (iii)'' and inserting ``clauses (ii) through
(iv)''; and
(B) by adding at the end 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.--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, 2004; and
(2) by subsection (c) shall take effect on the date of
enactment of this Act.
SEC. 3. PROVIDING SAFE HARBOR FOR CERTAIN COLLABORATIVE EFFORTS THAT
BENEFIT MEDICALLY UNDERSERVED POPULATIONS.
(a) In General.--Section 1128B(b)(3) (42 U.S.C. 1320a-7(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 public or
nonprofit private health center entity described under
clause (i) or (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
contributes to the ability of the health center entity
to maintain or increase the availability, 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 described in
section 1128B(b)(3)(G) of the Social Security Act, as
added by subsection (a), for health center entity
arrangements to the antikickback penalties.
(B) Factors to consider.--The Secretary shall
consider the following factors, among others, in
establishing standards relating to the exception for
health center entity arrangements under subparagraph
(A):
(i) Whether the arrangement between the
health center entity and the other party
results in savings of Federal grant funds or
increased revenues to the health center entity.
(ii) Whether the arrangement between the
health center entity and the other party
restricts or limits a patient's freedom of
choice.
(iii) Whether the arrangement between the
health center entity and the other party
protects a health care professional's
independent medical judgment regarding
medically appropriate treatment.
The Secretary may also include other standards and
criteria that are consistent with the intent of
Congress in enacting the exception established under
this section.
(2) Interim final effect.--No later than 180 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 such change and
revision, after public notice and opportunity (for a period of
not more than 60 days) for public comment, as is consistent
with this subsection.
SEC. 4. REIMBURSEMENT FOR FEDERALLY QUALIFIED HEALTH CENTERS
PARTICIPATING IN MEDICARE MANAGED CARE.
(a) Reimbursement.--
(1) In general.--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) 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) Payment levels and amounts.--A contract under
this part shall require the Medicare+Choice
organization to provide, in any contract between the
organization and a Federally qualified health center,
for a level and amount of payment to the Federally
qualified health center for services provided by such
health center 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.
``(B) 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 provided for in section
1833(a)(3)(B) 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)), as amended by
section 3(a), 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 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, 2004, and contract
years beginning on or after such date.
<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.
Referred to the Subcommittee on Health, for a period to be subsequently determined by the Chairman.
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