I

106TH CONGRESS

2D SESSION H. R. 4968

To amend title XVIII of the Social Security Act to provide for equitable

reimbursement rates under the Medicare Program to Medicare+Choice

organizations.

IN THE HOUSE OF REPRESENTATIVES

JULY 26, 2000

Ms. DUNN (for herself, Mr. KLECZKA, and Mr. MCDERMOTT) introduced the

following bill; which was referred to the Committee on Ways and Means,

and in addition to the Committee on 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 provide

for equitable reimbursement rates under the Medicare

Program to Medicare+Choice organizations.

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 Equity and

5 Access Act of 2000’’.
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1 SEC. 2. ELIMINATION OF REDUCTION IN

2 MEDICARE+CHOICE PAYMENT RATES BY

3 BUDGET NEUTRALITY ADJUSTMENTS.

4 (a) IN GENERAL.—Section 1853(c)(1)(A) of the So5 cial Security Act (42 U.S.C. 1395w–23(c)(1)(A)) is

6 amended by adding at the end the following: ‘‘With respect

7 to years beginning on or after January 1, 2001, in no case

8 shall the budget neutrality adjustment provided for in the

9 previous sentence result in a reduction of the payment

10 amount that would otherwise be made under this subpara11 graph but for such adjustment.’’.

12 (b) TRANSITIONAL RULE IN 2000 FOR SUBMISSION

13 OF REQUIRED INFORMATION.—Notwithstanding section

14 1854(a)(1) of the Social Security Act (42 U.S.C. 1395w–

15 24(a)(1)), the deadline for a Medicare+Choice organiza16 tion offering of a Medicare+Choice plan under part C of

17 title XVIII of the Social Security Act to submit informa18 tion, including the adjusted community rate (as defined

19 in subsection (f)(3) of that section), required for the offer20 ing of such a plan for 2001 is delayed from July 1, 2000,

21 to December 1, 2000.

22 SEC. 3. ACCELERATION OF MOVEMENT TO 50:50 PERCENT

23 BLEND IN 2001.

24 Section 1853(c)(2) of the Social Security Act (42

25 U.S.C. 1395w–23(c)(2)) is amended—
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1 (1) by adding ‘‘and’’ at the end of subpara2 graph (C);

3 (2) by striking subparagraphs (D) and (E);

4 (3) by redesignating subparagraph (F) as sub5 paragraph (D); and

6 (4) in subparagraph (D), as so redesignated, by

7 striking ‘‘2002’’ and inserting ‘‘2000’’.

8 SEC. 4. INCREASE IN BASELINE OF NATIONAL PER CAPITA

9 MEDICARE+CHOICE GROWTH PERCENTAGE

10 FOR YEARS AFTER 2000.

11 (a) IN GENERAL.—Section 1853(c)(6)(B) of the So12 cial Security Act (42 U.S.C. 1395w–23(c)(6)(B)) is

13 amended—

14 (1) in clause (i), by striking ‘‘0.8 percentage

15 points’’ and inserting ‘‘0 percentage points’’; and

16 (2) in clause (ii), by striking ‘‘0.5 percentage

17 points’’ and inserting ‘‘0 percentage points’’.

18 (b) EFFECTIVE DATE.—The amendments made by

19 subsection (a) shall apply with respect to payment rates

20 calculated for months beginning on or after January 1,

21 2001.
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1 SEC. 5. INCLUSION OF COSTS OF DOD MILITARY TREAT2 MENT FACILITY SERVICES TO MEDICARE-ELI3 GIBLE BENEFICIARIES IN CALCULATION OF

4 MEDICARE+CHOICE PAYMENT RATES.

5 Section 1853(c)(3) of the Social Security Act (42

6 U.S.C. 1395w–23(c)(3)) is amended—

7 (1) in subparagraph (A), by striking ‘‘subpara8 graph (B)’’ and inserting ‘‘subparagraphs (B) and

9 (E)’’, and

10 (2) by adding at the end the following new sub11 paragraph:

12 ‘‘(E) INCLUSION OF COSTS OF CERTAIN

13 DOD MILITARY TREATMENT FACILITY SERVICES

14 TO MEDICARE-ELIGIBLE BENEFICIARIES.—

15 ‘‘(i) IN GENERAL.—In determining

16 the area-specific Medicare+Choice capita17 tion rate under subparagraph (A) for a

18 year (beginning with 2001), the annual per

19 capita rate of payment for 1997 deter20 mined under section 1876(a)(1)(C) for a

21 Medicare+Choice payment area that is

22 within one or more MTF affected areas (as

23 defined in clause (ii)) shall be increased by

24 the sum of the MTF percentages (as de25 scribed in clause (iii)) for the MTF af26 fected area or areas. The increase under
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1 this subparagraph shall not be taken into

2 account in computing the national stand3 ardized annual Medicare+Choice capita4 tion rate under paragraph (4)(B).

5 ‘‘(ii) MTF AFFECTED AREA DE6 FINED.—In this subparagraph, the term

7 ‘MTF affected area’ means, with respect to

8 a military treatment facility (as defined in

9 subsection (a)(6) of section 1896), an area

10 that includes the following:

11 ‘‘(I) The Medicare+Choice pay12 ment area in which a military treat13 ment facility is located.

14 ‘‘(II) Any Medicare+Choice pay15 ment area which is contiguous to the

16 area described in subclause (I) and lo17 cated not farther than 40 miles from

18 the facility.

19 ‘‘(iii) MTF PERCENTAGE.—For pur20 poses of clause (i), the MTF percentage

21 for an MTF affected area is equal to the

22 ratio of—

23 ‘‘(I) the aggregate amount of

24 costs incurred by the Department of

25 Defense in furnishing items and serv-
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1 ices to individuals entitled to benefits

2 under this title who received services

3 from the military treatment facility

4 described in clause (ii) for that area

5 in 1996 (as determined pursuant to

6 section 1896(j)(1)(A)), increased by

7 the national per capita

8 Medicare+Choice growth percentage

9 under paragraph (6) for 1997, to

10 ‘‘(II) the average number of indi11 viduals residing in such area in 1996

12 entitled to benefits under part A and

13 enrolled under part B.’’.

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