I

106TH CONGRESS

2D SESSION H. R. 5039

To amend part C of title XVIII of the Social Security Act to revise and

improve the Medicare+Choice Program.

IN THE HOUSE OF REPRESENTATIVES

JULY 27, 2000

Mr. HAYWORTH 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 part C of title XVIII of the Social Security Act

to revise and improve the Medicare+Choice Program.

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; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Medicare Choice Preservation Act of 2000’’.

6 (b) TABLE OF CONTENTS.—The table of contents of

7 this Act is as follows:

Sec. 1. Short title; table of contents.

TITLE I—IMPROVEMENTS IN PAYMENTS
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Sec. 101. Increase in national per capita medicare+choice growth percentage in

2001 and 2002.

Sec. 102. Increasing minimum payment amount.

Sec. 103. Allowing movement to 50:50 percent blend in 2002.

Sec. 104. Increasing the minimum percentage increase in 2001.

Sec. 105. Increased update for payment areas with only one or no

Medicare+Choice contracts.

Sec. 106. Elimination of budget neutrality adjustment for 2001 and 2002.

Sec. 107. Revising calculation of area-specific rate.

Sec. 108. 10-year phase in of risk adjustment based on data from all settings.

TITLE II—ADDITIONAL IMPROVEMENTS

Sec. 201. Delay from July to November, 15, 2000, in deadline for offering and

withdrawing Medicare+Choice plans for 2001.

Sec. 202. Miscellaneous regulatory changes.

Sec. 203. Effectiveness of elections and changes of elections.

Sec. 204. Uniform premium and benefits.

Sec. 205. Medicare+Choice program compatibility with employer group or

union group health plans.

1 TITLE I—IMPROVEMENTS IN

2 PAYMENTS

3 SEC. 101. INCREASE IN NATIONAL PER CAPITA

4 MEDICARE+CHOICE GROWTH PERCENTAGE

5 IN 2001 AND 2002.

6 Section 1853(c)(6)(B) of the Social Security Act (42

7 U.S.C. 1395w–23(c)(6)(B)) is amended—

8 (1) in clause (iv), by striking ‘‘for 2001, 0.5

9 percentage points’’ and inserting ‘‘for 2001, 0 per10 centage points’’; and

11 (2) in clause (v), by striking ‘‘for 2002, 0.3 per12 centage points’’ and inserting ‘‘for 2002, 0 percent13 age points’’.
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1 SEC. 102. INCREASING MINIMUM PAYMENT AMOUNT.

2 (a) IN GENERAL.—Section 1853(c)(1)(B)(ii) of the

3 Social Security Act (42 U.S.C. 1395w–23(c)(1)(B)(ii)) is

4 amended—

5 (1) by striking ‘‘(ii) For a succeeding year’’ and

6 inserting ‘‘(ii)(I) Subject to subclause (II), for a suc7 ceeding year’’; and

8 (2) by adding at the end the following new sub9 clause:

10 ‘‘(II) For 2001 for any of the 50

11 States and the District of Columbia,

12 $475.’’.

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

14 subsection (a) apply to years beginning with 2001.

15 SEC. 103. ALLOWING MOVEMENT TO 50:50 PERCENT BLEND

16 IN 2002.

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

18 U.S.C. 1395w–23(c)(2)) is amended—

19 (1) by striking the period at the end of sub20 paragraph (F) and inserting a semicolon; and

21 (2) by adding after and below subparagraph

22 (F) the following:

23 ‘‘except that a Medicare+Choice organization may

24 elect to apply subparagraph (F) (rather than sub25 paragraph (E)) for 2002.’’.
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1 SEC. 104. INCREASING THE MINIMUM PERCENTAGE IN2 CREASE IN 2001.

3 Section 1853(c)(1)(C) of the Social Security Act (42

4 U.S.C. 1395w–23(c)(1)(C)) is amended—

5 (1) in clause (i) by striking ‘‘For 1998’’ and in6 serting ‘‘For 1998, 1999, and 2000’’; and

7 (2) in clause (ii) by striking ‘‘102’’ and insert8 ing ‘‘104’’.

9 SEC. 105. INCREASED UPDATE FOR PAYMENT AREAS WITH

10 ONLY ONE OR NO MEDICARE+CHOICE CON11 TRACTS.

12 (a) IN GENERAL.—Section 1853(c)(1)(C)(ii) of the

13 Social Security Act (42 U.S.C. 1395w–23(c)(1)(C)(ii)) is

14 amended—

15 (1) by striking ‘‘(ii) For a subsequent year’’

16 and inserting ‘‘(ii)(I) Subject to subclause (II), for

17 a subsequent year’’; and

18 (2) by adding at the end the following new sub19 clause:

20 ‘‘(II) During 2002, 2003, 2004, and

21 2005, in the case of a Medicare+Choice

22 payment area in which there is no more

23 than one contract entered into under this

24 part as of July 1 before the beginning of

25 the year, 104.5 percent of the annual

26 Medicare+Choice capitation rate under
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1 this paragraph for the area for the pre2 vious year.’’.

3 (b) CONSTRUCTION.—The amendments made by sub4 section (a) do not affect the payment of a first-time bonus

5 under section 1853(i) of the Social Security Act (42

6 U.S.C. 1395w–23(i)).

7 SEC. 106. ELIMINATION OF BUDGET NEUTRALITY ADJUST8 MENT FOR 2001 AND 2002.

9 Section 1853(c) of the Social Security Act (42 U.S.C.

10 1395w–23(c)) is amended—

11 (1) in paragraph (1)(A) in the matter following

12 clause (ii), by inserting ‘‘for a year (other than 2001

13 or 2002)’’ after ‘‘multiplied’’; and

14 (2) in paragraph (5), by inserting ‘‘(other than

15 2001 or 2002)’’ after ‘‘for each year’’.

16 SEC. 107. REVISING CALCULATION OF AREA-SPECIFIC

17 RATE.

18 (a) IN GENERAL.—Section 1853(c)(5) of the Social

19 Security Act (42 U.S.C. 1395w–23(c)(5)) is amended—

20 (1) by striking ‘‘for each year’’ and inserting

21 ‘‘for each year after 2000’’; and

22 (2) by adding at the end the following: ‘‘Such

23 area-specific capitation rates shall be calculated

24 without regard to paragraphs (3)(B) and (3)(C).’’.
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1 (b) EFFECTIVE DATE.—The amendments made by

2 subsection (a) apply with respect to years beginning on

3 or after January 1, 2001.

4 SEC. 108. 10-YEAR PHASE IN OF RISK ADJUSTMENT BASED

5 ON DATA FROM ALL SETTINGS.

6 Section 1853(a)(3)(C)(ii) of the Social Security Act

7 (42 U.S.C. 1395w–23(c)(1)(C)(ii)) is amended—

8 (1) by striking the period at the end of sub9 clause (II) and inserting a semicolon; and

10 (2) by adding after and below subclause (II) the

11 following:

12 ‘‘and, beginning in 2004, insofar as such

13 risk adjustment is based on data from all

14 (or substantially all) settings, the method15 ology shall be phased in equal increments

16 over a 10 year period, beginning with 2004

17 or (if later) the first year in which such

18 data is used.’’.
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1 TITLE II—ADDITIONAL

2 IMPROVEMENTS

3 SEC. 201. DELAY FROM JULY TO NOVEMBER, 15, 2000, IN

4 DEADLINE FOR OFFERING AND WITH5 DRAWING MEDICARE+CHOICE PLANS FOR

6 2001.

7 Notwithstanding any other provision of law, the dead8 line for a Medicare+Choice organization to withdraw the

9 offering of a Medicare+Choice plan under part C of title

10 XVIII of the Social Security Act (or otherwise to submit

11 information required for the offering of such a plan) for

12 2001 is delayed from July 1, 2000, to November 15, 2000,

13 and any such organization that provided notice of with14 drawal of such a plan during 2000 before the date of the

15 enactment of this Act may rescind such withdrawal at any

16 time before November 15, 2000.

17 SEC. 202. MISCELLANEOUS REGULATORY CHANGES.

18 (a) PROHIBITION ON REQUIREMENT TO SUBMIT EN19 COUNTER DATA.—Section 1853(a)(3)(B) of the Social Se20 curity Act (42 U.S.C. 1395w–23(a)(3)(B)) is amended—

21 (1) by designating the matter following ‘‘DATA

22 COLLECTION.—’’ as clause (i) with appropriate in23 dentation and the heading ‘‘IN GENERAL.—’’; and

24 (2) by adding at the end the following new

25 clauses:
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1 ‘‘(ii) ISSUANCE OF DATA SUBMISSION

2 REQUIREMENTS.—The Secretary may not

3 require under clause (i) the submission of

4 encounter data to support a risk adjust5 ment methodology based on all (or sub6 stantially all) settings until a reasonable

7 time after the Secretary issues the com8 plete requirements for data submission.

9 Such requirements shall be limited to the

10 minimum data elements necessary to sup11 port the risk adjustment methodology.

12 Such system shall be designed to accept

13 the required minimum data elements in a

14 form and manner compatible with

15 Medicare+Choice organizations’ oper16 ations.

17 ‘‘(iii) EVALUATION.—In issuing such

18 data submission requirements, the Sec19 retary must include an evaluation by an

20 outside, independent actuary of whether

21 the proposed data elements are the min22 imum necessary to support the risk adjust23 ment methodology.’’.

24 (b) POST-STABILIZATION GUIDELINES.—Section

25 1852(d)(2) of such Act (42 U.S.C. 1395w–22(d)(2)) is
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1 amended by adding at the end the following: ‘‘In pre2 scribing such guidelines—

3 ‘‘(A) post-stabilization care shall be limited

4 to care related to treatment of the condition

5 that precipitated the provision of emergency

6 services; and

7 ‘‘(B) the provider of emergency services is

8 not authorized to provide post-stabilization care

9 unless—

10 ‘‘(i) the Medicare+Choice organiza11 tion has been notified as soon as prac12 ticable, but not later than 2 hours after

13 stabilization, in advance of the request to

14 provide such care;

15 ‘‘(ii) the organization has either ap16 proved the request or not responded to

17 such request within a reasonable period (of

18 at least 3 hours) after it has been notified;

19 and

20 ‘‘(iii) the emergency services provider

21 maintains a written documentation con22 cerning the notice and the organization’s

23 response to such notice.’’.
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1 SEC. 203. EFFECTIVENESS OF ELECTIONS AND CHANGES

2 OF ELECTIONS.

3 (a) IN GENERAL.—Section 1851(f)(2) of the Social

4 Security Act (42 U.S.C. 1395w–21(f)(2)) is amended by

5 striking ‘‘made,’’ and all that follows and inserting

6 ‘‘made.’’.

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

8 subsection (a) applies with respect to years beginning on

9 or after on January 1, 2001.

10 SEC. 204. UNIFORM PREMIUM AND BENEFITS.

11 (a) IN GENERAL.—Subsections (c) and (f)(1)(D) of

12 section 1854 of the Social Security Act (42 U.S.C.

13 1395w–24) are each amended by inserting before the pe14 riod at the end the following: ‘‘, except across counties

15 as approved by the Secretary’’.

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

17 subsection (a) apply with respect to years beginning on

18 or after January 1, 2001.

19 SEC. 205. MEDICARE+CHOICE PROGRAM COMPATIBILITY

20 WITH EMPLOYER OR UNION GROUP HEALTH

21 PLANS.

22 (a) IN GENERAL.—Section 1857 of the Social Secu23 rity Act (42 U.S.C. 1395w–27) is amended by adding at

24 the end the following new subsection:

25 ‘‘(i) M+C PROGRAM COMPATIBILITY WITH EM26 PLOYER OR UNION GROUP HEALTH PLANS.—To facilitate
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1 the offering of Medicare+Choice plans under contracts be2 tween Medicare+Choice organizations and employers,

3 labor organizations, or the trustees of a fund established

4 by 1 or more employers or labor organizations (or com5 bination thereof) to furnish benefits to the entity’s employ6 ees, former employees (or combination thereof) or mem7 bers or former members (or combination thereof) of the

8 labor organizations, the Secretary shall waive or modify

9 requirements that hinder the design of, the offering of,

10 or the enrollment in such Medicare+Choice plans.’’.

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

12 subsection (a) applies with respect to years beginning on

13 or after January 1, 2001.

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