II

106TH CONGRESS

1ST SESSION S. 1026

To amend title XVIII of the Social Security Act to prevent sudden disruption

of medicare beneficiary enrollment in Medicare+Choice plans.

IN THE SENATE OF THE UNITED STATES

MAY 12, 1999

Mr. DODD introduced the following bill; which was read twice and referred to

the Committee on Finance

A BILL

To amend title XVIII of the Social Security Act to prevent

sudden disruption of medicare beneficiary enrollment in

Medicare+Choice plans.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Medicare HMO Protec5 tion Act of 1999’’.

6 SEC. 2. AUTHORITY TO EVALUATE AND ALTER TERMI7 NATION DECISIONS.

8 Section 1851(g)(3) of the Social Security Act (42

9 U.S.C. 1395w–21(g)(3)) is amended by adding at the end

10 the following:
2

•S 1026 IS

1 ‘‘(E) AUTHORITY TO DELAY TERMINATION

2 DATE.—

3 ‘‘(i) IN GENERAL.—If a

4 Medicare+Choice organization terminates

5 a plan under subparagraph (B)(iii), the

6 Secretary may delay the effectiveness of

7 such termination if the Secretary deter8 mines that—

9 ‘‘(I) the termination would cause

10 an imminent and serious risk to the

11 health of individuals enrolled under

12 the plan under this part;

13 ‘‘(II) the termination would re14 sult in a significant reduction in the

15 Medicare+Choice plans that are avail16 able in the area affected by the termi17 nation; or

18 ‘‘(III) the organization termi19 nating coverage is offering

20 Medicare+Choice plans in contract

21 areas that are in close proximity to

22 the area affected by the termination

23 without suffering considerable finan24 cial losses.
3

•S 1026 IS

1 In making the determination described in

2 subclause (III), the Secretary may audit

3 and inspect any books or records of the or4 ganization pursuant to the authority pro5 vided to the Secretary under section

6 1857(d).

7 ‘‘(ii) END OF DELAY.—The Secretary

8 may end a delay under clause (i), prior to

9 the end of the period established by the

10 Secretary under such clause, if the Sec11 retary determines that an adequate pro12 vider network has been established that

13 will provide at least an equal level of insur14 ance coverage as existed in the area af15 fected by the termination on the date the

16 Medicare+Choice organization informed

17 the Secretary of its intention to terminate

18 the contract.

19 ‘‘(F) AUTHORITY TO RENEGOTIATE CON20 TRACT.—If the Secretary delays the effective21 ness of a termination for a period pursuant to

22 subparagraph (E), the Secretary and the

23 Medicare+Choice organization terminating cov24 erage pursuant to subparagraph (B)(iii) may

25 negotiate during such period for a new contract
4

•S 1026 IS

1 under section 1857 that will enable such orga2 nization to continue such coverage. In negoti3 ating such contract, the Secretary shall ensure

4 that beneficiaries are not adversely affected by

5 such contract.’’.

6 SEC. 3. EXTENSION OF INITIAL MEDICARE+CHOICE CON7 TRACT PERIOD TO 3 YEARS.

8 (a) IN GENERAL.—Section 1857(c)(1) of the Social

9 Security Act (42 U.S.C. 1395w–27(c)(1)) is amended by

10 striking ‘‘a term of at least 1 year’’ and inserting ‘‘a term

11 of at least 3 years’’.

12 (b) EFFECTIVE DATE.—The amendment made by

13 subsection (a) applies to contracts entered into on or after

14 the date of enactment of this Act.

15 SEC. 4. NOTICE OF TERMINATION.

16 (a) IN GENERAL.—Section 1857(d)(3) of the Social

17 Security Act (42 U.S.C. 1395w–27(d)(3)) is amended to

18 read as follows:

19 ‘‘(3) ENROLLEE NOTICE AT TIME OF TERMI20 NATION.—

21 ‘‘(A) IN GENERAL.—Each contract under

22 this section shall require the organization to

23 provide (and pay for) written notice at least

24 120 days prior to the termination of the con25 tract, as well as a description of alternatives for
5

•S 1026 IS

1 obtaining benefits under this title, to each indi2 vidual enrolled with the organization under this

3 part.

4 ‘‘(B) DESCRIPTION.—The description of

5 alternatives referred to in subparagraph (A)

6 shall include a description of—

7 ‘‘(i) all Medicare+Choice plans and

8 medicare supplemental policies available in

9 the area where the contract that is being

10 terminated is serving beneficiaries and the

11 costs of such plans and policies; and

12 ‘‘(ii) the telephone number of local so13 cial service agencies providing assistance to

14 medicare beneficiaries in such area.’’.

15 (b) EFFECTIVE DATE.—The amendment made by

16 subsection (a) applies to any notice of termination that

17 is provided on or after the date of enactment of this Act.

Æ