Patients Before Profits Act of 2006

Patients Before Profits Act of 2006 - Amends title XVIII (Medicare) of the Social Security Act (SSA), as amended by the Deficit Reduction Act of 2005, with respect to the health status adjustment to certain monthly payments to Medicare+Choice organizations. Repeals the limitation to 2008, 2009, and 2010 of the requirement that, in applying such adjustment to payment amounts, the Secretary of Health and Human Services ensure that it reflects changes in treatment and coding practices in the fee-for-service sector, and reflects any differences in coding patterns between Medicare Advantage (MA) plans and Medicare providers under parts A and B. Requires the Secretary's analysis of such differences to be completed in time to ensure that the results are incorporated into the risk scores for 2008 and subsequent years (currently, only the risk scores for 2008, 2009, and 2010).

Amends SSA title XVIII to repeal the requirement that the Secretary establish an MA Regional Plan Stabilization Fund.

Amends SSA title XVIII, as amended by the Deficit Reduction Act of 2005, to repeal: (1) the state option for alternative premiums and cost sharing; (2) certain special rules for cost sharing for prescription drugs; (3) a state option for permitting hospitals to impose cost sharing for non-emergency care furnished in an emergency department; (2) the state option to provide benchmark benefit packages; and (3) the authority and mandate to establish Health Opportunity Accounts demonstrations.

[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4719 Introduced in House (IH)]







109th CONGRESS
  2d Session
                                H. R. 4719

   To amend titles XVIII and XIX of the Social Security Act to make 
 improvements to payments to Medicare Advantage plans and to reinstate 
    protections in the Medicaid program for working families, their 
   children, and the disabled against excessive out-of-pocket costs, 
          inadequate benefits, and health care coverage loss.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            February 8, 2006

 Mr. Dingell (for himself, Mr. Waxman, Mr. Rangel, Mr. Stark, and Mr. 
Brown of Ohio) introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, 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 titles XVIII and XIX of the Social Security Act to make 
 improvements to payments to Medicare Advantage plans and to reinstate 
    protections in the Medicaid program for working families, their 
   children, and the disabled against excessive out-of-pocket costs, 
          inadequate benefits, and health care coverage loss.

    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 ``Patients Before Profits Act of 
2006''.

SEC. 2. ELIMINATION OF CERTAIN MEDICARE ADVANTAGE OVERPAYMENTS.

    (a) In General.--Section 1853(a)(1)(C)(ii) of the Social Security 
Act (42 U.S.C. 1395w-23(a)(1)(C)(ii)), as added by section 5301 of the 
Deficit Reduction Act of 2005, is amended--
            (1) in the heading, by striking ``during phase-out of 
        budget neutrality factor'';
            (2) in the matter preceding subclause (I), by striking 
        ``through 2010'' and inserting ``and subsequent years''; and
            (3) in subclause (II), by striking ``only for 2008, 2009, 
        and 2010'' and inserting ``for 2008 and subsequent years''.
    (b) Effective Date.--The amendments made by this section shall take 
effect as if included in the enactment of section 5301 of the Deficit 
Reduction Act of 2005.

SEC. 3. ELIMINATION OF PRIVATE INSURANCE SLUSH FUND.

    (a) Elimination.--Subsection (e) of section 1858 of the Social 
Security Act (42 U.S.C. 1395w-27a) is repealed.
    (b) Conforming Amendment.--Section 1858(f)(1) of the Social 
Security Act (42 U.S.C. 1395w-27a(f)(1)) is amended by striking 
``subject to subsection (e),''.
    (c) Effective Date.--The amendments made by this section shall take 
effect as if included in the enactment of section 221(c) of the 
Medicare Prescription Drug, Improvement, and Modernization Act of 2003 
(Public Law 108-173; 117 Stat. 2181).

SEC. 4. REINSTATING PROTECTIONS FOR ADEQUATE BENEFITS AND AFFORDABLE 
              COST SHARING.

    (a) Repeal of State Option for Alternative Premiums and Cost 
Sharing.--
            (1) Repeal.--Section 1916A of the Social Security Act, as 
        added by sections 6041(a), 6042(a), and 6043(a) of the Deficit 
        Reduction Act of 2005, is repealed.
            (2) Conforming amendments.--
                    (A) Subsection (y) of section 1903 of the Social 
                Security Act (42 U.S.C. 1396b), as added by section 
                6043(b) of the Deficit Reduction Act of 2005, is 
                repealed.
                    (B) Section 1916 of the Social Security Act (42 
                U.S.C. 1396o) is amended--
                            (i) in subsection (f), by striking ``and 
                        section 1916A'' after ``(b)(3)''; and
                            (ii) by striking subsection (h).
    (b) Repeal of State Option of Providing Benchmark Benefit 
Packages.--Section 1937 of the Social Security Act, as added by section 
6044(a) of the Deficit Reduction Act of 2005, is repealed.
    (c) Repeal of Health Opportunity Accounts Demonstration.--Section 
1938 of the Social Security Act, as added by section 6082 of the 
Deficit Reduction Act of 2005, is repealed.
    (d) Additional Conforming Amendment.--Section 1939 of the Social 
Security Act, as redesignated by section 6082 of the Deficit Reduction 
Act of 2005, is redesignated as section 1937 of the Social Security 
Act.
    (e) Effective Date.--The repeals and amendments made by subsections 
(a) through (d) shall take effect as if included in the enactment of 
the Deficit Reduction Act of 2005.
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