Defense of Medicare Act - Directs the Secretary of Health and Human Services, in applying risk adjustment factors to payments to Medicare+Choice organizations under part C (Medicare+Choice) of title XVIII (Medicare) of the Social Security Act (SSA), to ensure that payments to such organizations are adjusted based on factors that ensure that the health status of the enrollee is reflected in such adjusted payments, including adjusting for the difference between the health status of the enrollee and individuals enrolled under the original Medicare fee-for-service program under Medicare parts A (Hospital Insurance) and part B (Supplementary Medical Insurance). Requires payments to such organizations, in the aggregate, to reflect such differences.
Amends SSA title XVIII part C, as amended by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, to: (1) revise the formula for determination of the minimum annual Medicare+Choice (Medicare Advantage) capitation rate for 2005 and subsequent years (making it the same as the minimum rate for 2004); and (2) eliminate the Medicare Advantage (MA) Regional Plan Stabilization Fund.
Repeals the Comparative Cost Adjustment Program.
Amends SSA title XVIII, as amended by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, to require the Secretary to ensure that each individual eligible for such program has available a choice of enrollment in at least two prescription drug plans (currently, at least two qualifying plans, which may be a prescription drug plan or a specified Medicare Advantage-Prescription Drug (MA-PD) plan).
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 2300 Introduced in Senate (IS)]
108th CONGRESS
2d Session
S. 2300
To amend the Medicare Prescription Drug, Improvement, and Modernization
Act of 2003 to eliminate privatization of the medicare program and to
reduce excessive payments to health maintenance organizations and other
private sector insurance plans.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 7, 2004
Mr. Kennedy (for himself, Mr. Bingaman, Mrs. Boxer, Mr. Pryor, Mr.
Hollings, Mr. Corzine, Mr. Edwards, Ms. Mikulski, Mr. Lautenberg, Mr.
Durbin, and Ms. Stabenow) introduced the following bill; which was read
twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend the Medicare Prescription Drug, Improvement, and Modernization
Act of 2003 to eliminate privatization of the medicare program and to
reduce excessive payments to health maintenance organizations and other
private sector insurance plans.
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 ``Defense of
Medicare Act''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Application of risk adjustment reflecting characteristics for
the entire medicare population in payments
to Medicare Advantage organizations.
Sec. 3. Annual Medicare Advantage capitation rate at 100 percent of
fee-for-service rate with a hold harmless.
Sec. 4. Elimination of MA Regional Plan Stabilization Fund (slush
fund).
Sec. 5. Repeal of premium support program.
Sec. 6. Requiring two prescription drug plans to avoid Federal
fallback.
SEC. 2. APPLICATION OF RISK ADJUSTMENT REFLECTING CHARACTERISTICS FOR
THE ENTIRE MEDICARE POPULATION IN PAYMENTS TO MEDICARE
ADVANTAGE ORGANIZATIONS.
Effective January 1, 2005, in applying risk adjustment factors to
payments to organizations under section 1853 of the Social Security Act
(42 U.S.C. 1395w-23), the Secretary of Health and Human Services shall
ensure that payments to such organizations are adjusted based on such
factors to ensure that the health status of the enrollee is reflected
in such adjusted payments, including adjusting for the difference
between the health status of the enrollee and individuals enrolled
under the original medicare fee-for-service program under parts A and B
of title XVIII of such Act. Payments to such organizations must, in
aggregate, reflect such differences.
SEC. 3. ANNUAL MEDICARE ADVANTAGE CAPITATION RATE AT 100 PERCENT OF
FEE-FOR-SERVICE RATE WITH A HOLD HARMLESS.
Section 1853(c)(1) of the Social Security Act (42 U.S.C. 1395w-
23(c)(1)), as amended by section 211 of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (Public Law 108-173; 117
Stat. 2176) is amended--
(1) in subparagraph (B), by adding at the end the following
new clause:
``(v) For 2005 and each subsequent year,
the amount specified in clause (iv) for the
area for 2004.''; and
(2) in subparagraph (C)(v), in the matter preceding
subclause (I), by striking ``and each succeeding year''.
SEC. 4. ELIMINATION OF MA REGIONAL PLAN STABILIZATION FUND (SLUSH
FUND).
Subsection (e) of section 1858 of the Social Security Act, as added
by section 221(c) of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173), is repealed.
SEC. 5. REPEAL OF PREMIUM SUPPORT PROGRAM.
Effective as if included in the enactment of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 (Public
Law 108-173), subtitle E of title II of such Act is repealed and any
provisions of law amended by such subtitle are restored as if such
subtitle had not been enacted.
SEC. 6. REQUIRING TWO PRESCRIPTION DRUG PLANS TO AVOID FEDERAL
FALLBACK.
Section 1860D-3(a) of the Social Security Act, as added by section
101(a) of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, is amended--
(1) in paragraph (1)--
(A) by striking ``qualifying plans (as defined in
paragraph (3))'' and inserting ``prescription drug
plans''; and
(B) by striking ``, at least one of which is a
prescription drug plan'';
(2) in paragraph (2), by striking ``qualifying plans'' and
inserting ``prescription drug plans''; and
(3) by striking paragraph (3).
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S3937)
Read twice and referred to the Committee on Finance.
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