I

106TH CONGRESS

2D SESSION H. R. 5042

To amend title XVIII of the Social Security Act to protect the right of

a Medicare beneficiary enrolled in a Medicare+Choice plan to receive

services at a skilled nursing facility selected by that individual.

IN THE HOUSE OF REPRESENTATIVES

JULY 27, 2000

Mr. HOBSON (for himself and Ms. PRYCE of Ohio) 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 protect

the right of a Medicare beneficiary enrolled in a

Medicare+Choice plan to receive services at a skilled

nursing facility selected by that individual.

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 ‘‘Seniors Healing at

5 Home Act of 2000’’.
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1 SEC. 2. PROVIDING CHOICE FOR SKILLED NURSING FACIL2 ITY SERVICES UNDER THE

3 MEDICARE+CHOICE PROGRAM.

4 (a) IN GENERAL.—Section 1852 of the Social Secu5 rity Act (42 U.S.C. 1395w–22) is amended by adding at

6 the end the following new subsection:

7 ‘‘(l) RETURN TO HOME SKILLED NURSING FACILI8 TIES FOR COVERED POST-HOSPITAL EXTENDED CARE

9 SERVICES.—

10 ‘‘(1) ENSURING RETURN TO HOME SNF.—

11 ‘‘(A) IN GENERAL.—A Medicare+Choice

12 organization offering a Medicare+Choice plan

13 that provides for coverage of post-hospital ex14 tended care services shall provide for such cov15 erage through a home skilled nursing facility if

16 the following conditions are met:

17 ‘‘(i) ENROLLEE ELECTION.—The en18 rollee elects to receive such coverage

19 through such facility.

20 ‘‘(ii) SNF AGREEMENT.—The facility

21 has a contract with the Medicare+Choice

22 organization for the provision of such serv23 ices, or the facility agrees to accept sub24 stantially similar payment under the same

25 terms and conditions that apply to simi26 larly situated skilled nursing facilities that
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1 are under contract with the

2 Medicare+Choice organization for the pro3 vision of such services and through which

4 the enrollee would otherwise receive such

5 services.

6 ‘‘(B) MANNER OF PAYMENT TO HOME

7 SNF.—The organization shall provide payment

8 to the home skilled nursing facility consistent

9 with the contract or the agreement described in

10 subparagraph (A)(ii), as the case may be.

11 ‘‘(2) NO LESS FAVORABLE COVERAGE.—The

12 coverage provided under paragraph (1) (including

13 scope of services, cost-sharing, and other criteria of

14 coverage) shall be no less favorable to the enrollee

15 than the coverage that would be provided to the en16 rollee with respect to a skilled nursing facility the

17 post-hospital extended care services of which are

18 otherwise covered under the Medicare+Choice plan.

19 ‘‘(3) RULE OF CONSTRUCTION.—Nothing in

20 this subsection shall be construed to do the fol21 lowing:

22 ‘‘(A) To require coverage through a skilled

23 nursing facility that is not otherwise qualified

24 to provide benefits under part A for medicare
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1 beneficiaries not enrolled in a Medicare+Choice

2 plan.

3 ‘‘(B) To prevent a skilled nursing facility

4 from refusing to accept, or imposing conditions

5 upon the acceptance of, an enrollee for the re6 ceipt of post-hospital extended care services.

7 ‘‘(4) DEFINITIONS.—In this subsection:

8 ‘‘(A) HOME SKILLED NURSING FACIL9 ITY.—The term ‘home skilled nursing facility’

10 means, with respect to an enrollee who is enti11 tled to receive post-hospital extended care serv12 ices under a Medicare+Choice plan, any of the

13 following skilled nursing facilities:

14 ‘‘(i) SNF RESIDENCE AT TIME OF AD15 MISSION.—The skilled nursing facility in

16 which the enrollee resided at the time of

17 admission to the hospital preceding the re18 ceipt of such post-hospital extended care

19 services.

20 ‘‘(ii) SNF IN CONTINUING CARE RE21 TIREMENT COMMUNITY.—A skilled nursing

22 facility that is providing such services

23 through a continuing care retirement com24 munity (as defined in subparagraph (B))
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1 which provided residence to the enrollee at

2 the time of such admission.

3 ‘‘(iii) SNF RESIDENCE OF SPOUSE AT

4 TIME OF DISCHARGE.—The skilled nursing

5 facility in which the spouse of the enrollee

6 is residing at the time of discharge from

7 such hospital.

8 ‘‘(B) CONTINUING CARE RETIREMENT

9 COMMUNITY DEFINED.—The term ‘continuing

10 care retirement community’ means, with respect

11 to an enrollee in a Medicare+Choice plan, an

12 arrangement under which housing and health13 related services are provided (or arranged)

14 through an organization for the enrollee under

15 an agreement that is effective for the life of the

16 enrollee or for a specified period.’’.

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

18 subsection (a) applies with respect to contracts entered

19 into or renewed on or after the date of enactment of this

20 Act.

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