Bipartisan Commission on Medicaid Act of 2005 - Establishes the Bipartisan Commission on Medicaid to review: (1) each of Medicaid's major functional responsibilities; (2) issues that either threaten or improve the long-term financial condition of Medicaid; (3) Federal and State policies for Medicaid and Medicare enrollment (including enrollment sites), income eligibility, outreach, and documentation; (4) the operation and effectiveness of Medicaid premium assistance programs; and (5) Medicaid payment policies.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 338 Introduced in Senate (IS)]
109th CONGRESS
1st Session
S. 338
To provide for the establishment of a Bipartisan Commission on
Medicaid.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 9, 2005
Mr. Smith (for himself, Mr. Bingaman, Ms. Snowe, Mr. Jeffords, Mr.
Santorum, Mr. Kerry, Mr. DeWine, Mr. Durbin, Mr. Chafee, Mrs. Lincoln,
Ms. Collins, Mr. Nelson of Nebraska, Mr. Voinovich, Mr. Corzine, and
Mr. Coleman) introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To provide for the establishment of a Bipartisan Commission on
Medicaid.
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 ``Bipartisan Commission on Medicaid
Act of 2005''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) The medicaid program under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) (in this Act referred to
as ``Medicaid'') provides essential health care and long-term
care coverage to low-income children, pregnant women and
families, individuals with disabilities, and senior citizens
constituting 1 in 6 Americans.
(2) State participation in Medicaid is voluntary, and all
States have elected to participate, administering the program
within broad Federal guidelines.
(3) The Federal Government matches the costs of delivering
covered services by participating providers to individuals
entitled to benefits that are incurred by State Medicaid
programs at rates ranging from 50 percent to 77 percent,
depending upon a State's per capita income.
(4) Medicaid pays for health care services for over \1/4\
of America's children, including children who live in poverty.
(5) Medicaid is America's largest single purchaser of
maternity care, paying for over \1/3\ of all the births in the
Nation each year.
(6) Although low-income children and their parents make up
\3/4\ of the recipients of benefits under Medicaid, they
account for only 30 percent of Medicaid spending.
(7) Medicaid is America's single largest purchaser of
nursing home services and other long-term care, covering the
majority of nursing home residents.
(8) Medicaid is an essential supplement to the medicare
program under title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.) (in this Act referred to as ``Medicare'') for
over 6,000,000 low-income elderly and disabled Medicare
beneficiaries, assisting them with their Medicare premiums and
co-insurance and, in most cases, the costs of nursing home care
that Medicare does not cover.
(9) The elderly and individuals with disabilities comprise
\1/4\ of the recipients of benefits under Medicaid and 70
percent of Medicaid spending on services.
(10) States will be required, beginning in 2006, to
contribute billions of dollars to the Federal Government to
help finance the Medicare prescription drug benefit established
under part D of title XVIII of the Social Security Act.
(11) Medicaid pays for personal care and other supportive
services necessary to enable individuals with disabilities to
remain in the community, to work, and to maintain independence.
(12) Medicaid is the single largest source of revenue for
the Nation's safety net hospitals and health centers and is
critical to the ability of these providers to continue to serve
medicaid enrollees and uninsured Americans.
(13) Medicaid is the single largest Federal grant-in-aid
program to the States, accounting for over 40 percent of all
Federal grants to States.
(14) Medicaid serves a major role in ensuring that the
number of Americans without health insurance, approximately
45,000,000, is not substantially higher.
(15) Medicaid finances services for many special health
care needs populations, providing health care for 55 percent of
all individuals living with HIV/AIDS and 60 percent of all
public mental health care for people with severe mental
illnesses.
(16) Medicaid's multiple roles present financial challenges
for Federal, and State governments that warrant a comprehensive
review in light of the increasing number of uninsured Americans
and the increasing number of low-income Americans in need of
long-term care services.
SEC. 3. BIPARTISAN COMMISSION ON MEDICAID.
(a) Establishment.--There is established a commission to be known
as the Bipartisan Commission on Medicaid (in this section referred to
as the ``Commission''). The Commission shall locate its headquarters in
the District of Columbia.
(b) Membership.--
(1) Appointment.--The Commission shall be composed of 23
members to be appointed as follows:
(A) One member shall be appointed by the President.
(B) Three members shall be appointed by the
majority leader of the Senate of whom--
(i) one shall be a Member or former Member
of Congress;
(ii) one shall be an advocate for
populations who are served by Medicaid; and
(iii) one shall be a health care provider
that provides a disproportionate share of care
to recipients of benefits under Medicaid or a
representative of an organization that
represent such providers.
(C) Three members shall be appointed by the
minority leader of the Senate of whom--
(i) one shall be a Member or former Member
of Congress;
(ii) one shall be an advocate for
populations who are served by Medicaid; and
(iii) one shall be a health care provider
that provides a disproportionate share of care
to recipients of benefits under Medicaid or a
representative of an organization that
represent such providers.
(D) Three members shall be appointed by the Speaker
of the House of Representatives of whom--
(i) one shall be a Member or former Member
of Congress;
(ii) one shall be an advocate for
populations who are served by Medicaid; and
(iii) one shall be a health care provider
that provides a disproportionate share of care
to recipients of benefits under Medicaid or a
representative of an organization that
represent such providers.
(E) Three members shall be appointed by the
minority leader of the House of Representatives of
whom--
(i) one shall be a Member or former Member
of Congress;
(ii) one shall be an advocate for
populations who are served by Medicaid; and
(iii) one shall be a health care provider
that provides a disproportionate share of care
to recipients of benefits under Medicaid or a
representative of an organization that
represent such providers.
(F) Two members shall be appointed by the National
Governors Association and shall be chief executive
officers of a State who are not of the same political
party.
(G) Two members shall be appointed by the National
Conference of State Legislatures and shall be members
of a State legislature who are not of the same
political party.
(H) Two members shall be appointed by the National
Association of State Medicaid Directors and shall be
chief officials responsible for administering Medicaid
in a State who are not of the same political party.
(I) Two members shall be appointed by the National
Association of Counties and shall be officials of a
local government involved in Medicaid financing or that
directly provides medical services to Medicaid
beneficiaries and uninsured individuals who are not of
the same political party.
(J) Two members shall be appointed by the
Comptroller General of the United States and shall be
health policy experts with special expertise regarding
Medicaid or the populations served by Medicaid who are
not of the same political party.
(2) Qualifications.--The members of the Commission
appointed under paragraph (1), shall reflect--
(A) a broad geographic representation; and
(B) a balance between urban and rural
representation.
(3) Deadline for appointment.--Members of the Commission
shall be appointed by not later than the 60th day after the
date of enactment of this Act.
(c) Duties of Commission.--
(1) In general.--The Commission shall--
(A) review and make recommendations with respect to
each of Medicaid's major functional responsibilities,
including being--
(i) a source of coverage for low-income
children, pregnant women, and some parents;
(ii) a payer for a complex range of acute
and long-term care services for the frail
elderly and individuals with disabilities,
including the medically needy;
(iii) the source of wrap-around coverage or
assistance for low-income seniors and
individuals with disabilities on Medicare,
including coverage of additional benefits and
assistance with Medicare premiums and
copayments; and
(iv) the primary source of funding to
safety net providers that serve both Medicaid
patients and the 45,000,000 uninsured;
(B) review and make recommendations for a clearer
delineation of--
(i) the Federal and State roles and
responsibilities under Medicaid; and
(ii) the interaction of Medicaid with
Medicare and other Federal health programs;
(C) review and identify issues that either threaten
or could improve the long-term financial condition of
Medicaid, including forthcoming demographic changes,
Federal and State revenue options, private sector
health coverage, and health care information;
(D) review the Federal matching payments and
requirements under Medicaid, and issues related to such
payments and requirements, and make recommendations on
how to make such payments more equitable with respect
to the populations served and the States, and on how to
improve the program's responsiveness to changes in
economic conditions;
(E) review and make recommendations with respect to
health care for individuals dually eligible for both
Medicare and Medicaid, including issues related to
Federal, State, provider, and beneficiary
responsibilities, coordination, and outcomes;
(F) review research and data with respect to health
disparities for populations served by Medicaid,
particularly with respect to individuals with
disabilities or special health care needs, and make
recommendations on how to improve health quality,
coordination of services and providers, and access to health care for
vulnerable populations, including the implementation of managed care
protections for Medicaid enrollees with special health care needs;
(G) review Federal and State policies for
enrollment (including enrollment sites), income
eligibility (including methodology and length of
eligibility periods), outreach, and documentation with
respect to Medicaid and Medicare and make
recommendations on how to simplify such policies and
improve enrollment and retention in such programs and
coordination with other Federal and State programs to
improve service delivery and coverage;
(H) review the operation and effectiveness of
Medicaid premium assistance programs, including the
payment of premiums under section 1906(a)(3) of the
Social Security Act (42 U.S.C. 1396e(a)(3)) and payment
waivers under section 1115 of such Act (42 U.S.C.
1315), and the adequacy of covered benefits,
affordability of cost-sharing and premiums, and access
to care under such programs;
(I) review and make recommendations regarding
payment policies under Medicaid, including the adequacy
of such policies with respect to--
(i) managed care plans (including payment
policies for single benefit managed care
arrangements, such as managed behavioral health
and dental care);
(ii) providers in managed care, fee-for-
service, long-term care, and primary care case
management settings; and
(iii) measures to assure and reward quality
and access to care for Medicaid enrollees;
(J) review how Medicare payment policies impact
Medicaid and make recommendations on ways to address
specific payment problems that such policies may create
in service delivery to populations typically not
covered by Medicare, such as children and pregnant
women;
(K) review payments to safety net providers,
including a review of--
(i) the adjustments to payments under
Medicaid--
(I) under section 1923 of the
Social Security Act (42 U.S.C. 1396r-4)
for inpatient hospital services
furnished by disproportionate share
hospitals; and
(II) under section 1902(bb) of such
Act (42 U.S.C. 1396a(bb)) for payments
to federally-qualified health centers
and rural health clinics; and
(ii) other payments that impact the
capacity of the health care safety net to care
for uninsured individuals, recipients of
benefits under Medicaid, and other vulnerable
populations;
(L) review interstate payment, enrollment, access,
and quality concerns with respect to recipients of
benefits under Medicaid that are served by interstate
providers, and make recommendations on ways to improve
interstate health care delivery;
(M) review and make recommendations with respect to
financing and other issues impacting Commonwealth and
territorial programs as compared to other States; and
(N) review and make recommendations on such other
matters related to Medicaid as the Commission deems
appropriate.
(2) Analysis of effect of each recommendation.--Each
recommendation required under paragraph (1) shall include an
analysis of the effect of the recommendation under Medicaid
and, if applicable, Medicare and other Federal health programs,
on--
(A) Federal and State expenditures;
(B) provider payment rates;
(C) beneficiary out-of-pocket expenditures;
(D) beneficiary access to covered items and
services; and
(E) coverage of items and services.
(3) Expert advice.--The Comptroller General of the United
States and the Director of the Congressional Research Service
shall advise the Commission on the methodology to be used in
identifying problems and analyzing potential solutions in
accordance with the duties of the Commission described in
paragraph (1).
(d) General Administrative Provisions.--
(1) Terms of appointment.--The members of the Commission
shall be appointed for the life of the Commission.
(2) Vacancies.--A vacancy on the Commission shall be
filled, not later than 30 days after the date on which the
Commission is given notice of the vacancy, in the same manner
in which the original appointment was made.
(3) Chairperson and vice chairperson.--The Commission shall
designate 2 of its members to serve as the chairperson and vice
chairperson of the Commission.
(4) Meetings.--The Commission shall meet at the call of the
chairperson of the Commission.
(5) Quorum.--Twelve members of the Commission shall
constitute a quorum for purposes of voting, but a lesser number
of members may meet and hold hearings.
(6) Compensation and expenses.--
(A) Compensation.--Except as provided in
subparagraph (B), members of the Commission shall
receive no additional pay, allowances, or benefits by
reason of their service on the Commission.
(B) Expenses.--While away from their homes or
regular places of business in the performance of
services for the Commission, members of the Commission
shall be allowed travel expenses, including per diem in
lieu of subsistence, at rates authorized for employees
of agencies under subchapter I of chapter 57 of title
5, United States Code.
(7) Ethical disclosure.--The Comptroller General of the
United States shall establish and implement a system for public
disclosure of financial and other potential conflicts of
interest by members of the Commission.
(e) Staff and Support Services.--
(1) Executive director.--The chairperson and vice-chair
shall appoint an executive director of the Commission.
(2) Staff.--With the approval of the Commission, the
executive director may appoint such personnel as the executive
director determines to be appropriate.
(3) Applicability of civil service law; etc.--The executive
director and staff of the Commission shall be appointed without
regard to the provisions of title 5, United States Code,
governing appointment in the competitive service, and shall be
paid without regard to chapter 51 and subchapter III of chapter
53 of title 5, United States Code, relating to classification
of positions and General Schedule pay rates, except that the
rate of pay for the executive director and other personnel may
not exceed the rate payable for level V of the Executive
Schedule under section 5316 of such title.
(4) Experts and consultants.--With the approval of the
Commission, the executive director may procure temporary and
intermittent services under section 3109(b) of title 5, United
States Code.
(5) Federal agencies.--
(A) Staff of other federal agencies.--Upon the
request of the Commission, the head of any Federal
agency may detail, without reimbursement, any of the
personnel of such agency to the Commission to assist in
carrying out the duties of the Commission. Any such
detail shall not interrupt or otherwise affect the
civil service status or privileges of the Federal
employee.
(B) Technical assistance.--Upon the request of the
Commission, the head of a Federal agency shall provide
such technical assistance to the Commission as the
Commission determines to be necessary to carry out its
duties.
(6) Other resources.--The Commission shall have reasonable
access to materials, resources, statistical data, and other
information from the Library of Congress and agencies and
elected representatives of the executive and legislative
branches of the Federal Government. The chairperson or vice-
chair of the Commission shall make requests for such access in
writing when necessary.
(7) GAO services.--
(A) Physical facilities.--The Administrator of
General Services shall locate suitable office space for
the operation of the Commission. The facilities shall
serve as the headquarters of the Commission and shall
include all necessary equipment and incidentals
required for the proper functioning of the Commission.
(B) Administrative support services.--Upon the
request of the Commission, the Administrator of General
Services shall provide to the Commission, on a
reimbursable basis, such administrative support
services as the Commission may request.
(f) Powers of the Commission.--
(1) Hearings.--The Commission shall conduct public hearings
or forums at the discretion of the Commission, at any time and
place the Commission is able to secure facilities and
witnesses, for the purpose of carrying out the duties of the
Commission.
(2) Studies or investigations.--Upon the request of the
Commission, the Comptroller General of the United States, the
Medicare Payment Advisory Commission, or the Director of the
Congressional Research Service shall conduct such studies or
investigations as the Commission determines to be necessary to
carry out its duties.
(3) Cost estimates.--The Director of the Congressional
Budget Office, the Chief Actuary of the Centers for Medicare &
Medicaid Services, the Medicare Payment Advisory Commission, or
all three, shall provide to the Commission, upon the request of
the Commission and without reimbursement, such cost estimates
as the Commission determines to be necessary to carry out its
duties.
(4) Gifts.--The Commission may accept, use, and dispose of
gifts or donations of services or property.
(5) Mails.--The Commission may use the United States mails
in the same manner and under the same conditions as Federal
agencies.
(g) Report.--
(1) In general.--Not later than 14 months after the date of
enactment of this Act, the Commission shall prepare and submit
a report that contains a detailed statement of the
recommendations, findings, and conclusions of the Commission
(as determined in accordance with paragraph (3)) to each of the
following:
(A) The President.
(B) The Committee on Finance of the Senate.
(C) The Committee on Energy and Commerce of the
House of Representatives.
(D) The chief executive officer of each State.
(2) Availability.--The report shall be made available to
the public.
(3) Recommendations, findings, and conclusions.--The
recommendations, findings, and conclusions of the Commission
shall be included in the report under paragraph (1) only if--
(A) each member of the Commission has had an
opportunity to vote on such recommendation, finding, or
conclusion;
(B) the results of the vote are printed in the
report, including a record of how each member voted;
and
(C) at least 14 of the 23 members of the Commission
voted in favor of such recommendation, finding, or
conclusion.
(h) Authorization of Appropriations.--There is authorized to be
appropriated to the Commission such sums as may be necessary to carry
out this section.
(i) Definition of State.--In this Act, the term ``State'' has the
meaning given such term for purposes of title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(j) Termination.--The Commission shall terminate on the date that
is 30 days after the date on which the Commission submits the report
under subsection (g) to the President, Congress, and the chief
executive officer of each State.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S1208-1211)
Read twice and referred to the Committee on Finance.
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