I

106TH CONGRESS

2D SESSION H. R. 5324

To amend the Social Security Act to make corrections and refinements in

the Medicare, Medicaid, and SCHIP health insurance programs, as revised by the Balanced Budget Act of 1997 and the Medicare, Medicaid,

and SCHIP Balanced Budget Refinement Act of 1999, and for other

purposes.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 27, 2000

Mr. MARKEY (for himself, Mr. FRANK of Massachusetts, Mr. MOAKLEY, Mr.

NEAL of Massachusetts, Mr. MEEHAN, Mr. OLVER, Mr. TIERNEY, Mr.

DELAHUNT, Mr. MCGOVERN, Mr. CAPUANO, Ms. MILLENDER-MCDONALD, Mr. DOYLE, Mr. BLUMENAUER, Mr. HILLIARD, Mr. ABERCROMBIE,

Mr. MASCARA, Mr. PAYNE, Mr. ROMERO-BARCELO ́

, Ms. LEE, Mr. CONYERS, Mr. SANDERS, Mr. CLEMENT, Ms. MCKINNEY, Mr. BLAGOJEVICH,

Mr. BARCIA, Mr. DAVIS of Illinois, Mr. HINOJOSA, Mrs. MEEK of Florida, Mr. SANDLIN, Ms. BROWN of Florida, Ms. KILPATRICK, Mr. PICKETT, Ms. WATERS, Mr. REYES, Mrs. JONES of Ohio, Mr. GREEN of

Texas, Mr. BERMAN, Mr. SERRANO, and Mr. MCNULTY) introduced the

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

in addition to the Committees on Ways and Means, Rules, and Education

and the Workforce, 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 the Social Security Act to make corrections and

refinements in the Medicare, Medicaid, and SCHIP

health insurance programs, as revised by the Balanced

Budget Act of 1997 and the Medicare, Medicaid, and
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SCHIP Balanced Budget Refinement Act of 1999, and

for other purposes.

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; AMENDMENTS TO SOCIAL SECU4 RITY ACT; REFERENCES TO OTHER ACTS;

5 TABLE OF CONTENTS.

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

7 ‘‘Medicare, Medicaid, and SCHIP Balanced Budget Re8 finement Act of 2000’’.

9 (b) AMENDMENTS TO SOCIAL SECURITY ACT.—Ex10 cept as otherwise specifically provided, whenever in this

11 Act an amendment is expressed in terms of an amendment

12 to or repeal of a section or other provision, the reference

13 shall be considered to be made to that section or other

14 provision of the Social Security Act.

15 (c) REFERENCES TO OTHER ACTS.—In this Act:

16 (1) THE BALANCED BUDGET ACT OF 1997.—

17 The term ‘‘BBA’’ means the Balanced Budget Act

18 of 1997 (Public Law 105–33; 111 Stat. 251).

19 (2) THE MEDICARE, MEDICAID, AND SCHIP

20 BALANCED BUDGET REFINEMENT ACT OF 1999.—

21 The term ‘‘BBRA’’ means the Medicare, Medicaid,

22 and SCHIP Balanced Budget Refinement Act of

23 1999 (113 Stat. 1501A–321), as enacted into law by

24 section 1000(a)(6) of Public Law 106–113.
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1 (d) TABLE OF CONTENTS.—The table of contents of

2 this Act is as follows:

Sec. 1. Short title; amendments to Social Security Act; references to other Acts;

table of contents.

TITLE I—PROVISIONS RELATING TO PART A

Subtitle A—Skilled Nursing Facilities

Sec. 101. Eliminating reduction in skilled nursing facility (SNF) market basket

update.

Sec. 102. Revision of BBRA increase for skilled nursing facilities in fiscal years

2001 and 2002.

Sec. 103. MedPAC study on payment updates for skilled nursing facilities; authority of Secretary to make adjustments.

Subtitle B—PPS Hospitals

Sec. 111. Revision of reduction of indirect graduate medical education payments.

Sec. 112. Eliminating reduction in PPS hospital payment update.

Sec. 113. Eliminating reduction in disproportionate share hospital (DSH) payments.

Sec. 114. Equalizing the threshold and updating payment formulas for disproportionate share hospitals.

Sec. 115. Care for low-income patients.

Sec. 116. Modification of payment rate for Puerto Rico hospitals.

Sec. 117. MedPAC study on hospital area wage indexes.

Subtitle C—PPS Exempt Hospitals

Sec. 121. Treatment of certain cancer hospitals.

Sec. 122. Payment adjustment for inpatient services in rehabilitation hospitals.

Subtitle D—Hospice Care

Sec. 131. Revision in payments for hospice care.

Subtitle E—Other Provisions

Sec. 141. Hospitals required to comply with bloodborne pathogens standard.

Sec. 142. Informatics and data systems grant program.

Sec. 143. Relief from medicare part A late enrollment penalty for group buyin for State and local retirees.

Subtitle F—Transitional Provisions

Sec. 151. Reclassification of certain counties and areas for purposes of reimbursement under the medicare program.

Sec. 152. Calculation and application of wage index floor for a certain area.

Sec. 153. Reclassification of a certain county for purposes of reimbursement

under the medicare program.

TITLE II—PROVISIONS RELATING TO PART B

Subtitle A—Hospital Outpatient Services
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Sec. 201. Reduction of effective HOPD coinsurance rate to 20 percent by 2014.

Sec. 202. Application of transitional corridor to certain hospitals that did not

submit a 1996 cost report.

Sec. 203. Permanent guarantee of pre-BBA payment levels for outpatient services furnished by children’s hospitals.

Subtitle B—Provisions Relating to Physicians

Sec. 211. Loan deferment for residents.

Sec. 212. GAO studies and reports on medicare payments.

Sec. 213. MedPAC study on the resource-based practice expense system.

Subtitle C—Ambulance Services

Sec. 221. Election to forego phase-in of fee schedule for ambulance services.

Sec. 222. Prudent layperson standard for emergency ambulance services.

Sec. 223. Elimination of reduction in inflation adjustments for ambulance services.

Sec. 224. Study and report on the costs of rural ambulance services.

Sec. 225. Interim payments for rural ground ambulance services until regulation implemented.

Sec. 226. GAO study and report on the costs of emergency and medical transportation services.

Subtitle D—Preventive Services

Sec. 231. Elimination of deductibles and coinsurance for preventive benefits.

Sec. 232. Counseling for cessation of tobacco use.

Sec. 233. Coverage of glaucoma detection tests.

Sec. 234. Medical nutrition therapy services for beneficiaries with diabetes, a

cardiovascular disease, or a renal disease.

Sec. 235. Studies on preventive interventions in primary care for older Americans.

Sec. 236. Institute of Medicine 5-year medicare prevention benefit study and

report.

Sec. 237. Fast-track consideration of prevention benefit legislation.

Subtitle E—Other Services

Sec. 241. Revision of moratorium in caps for therapy services.

Sec. 242. Revision of coverage of immunosuppressive drugs.

Sec. 243. State accreditation of diabetes self-management training programs.

Sec. 244. Elimination of reduction in payment amounts for durable medical

equipment and oxygen and oxygen equipment.

Sec. 245. Standards regarding payment for certain orthotics and prosthetics.

Sec. 246. National limitation amount equal to 100 percent of national median

for new pap smear technologies and other new clinical laboratory test technologies.

Sec. 247. Increased medicare payments for certified nurse-midwife services.

Sec. 248. Payment for administration of drugs.

Sec. 249. MedPAC study on in-home infusion therapy nursing services.

Sec. 250. Coverage of vision rehabilitation services.

Sec. 251. Limiting medicare late enrollment penalty to 10 percent and twice

the period of no enrollment.

TITLE III—PROVISIONS RELATING TO PARTS A AND B
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Subtitle A—Home Health Services

Sec. 301. Elimination of 15 percent reduction in payment rates under the prospective payment system for home health services.

Sec. 302. Additional payments for outliers.

Sec. 303. Additional payments under the prospective payment system for services furnished in rural areas and security services.

Sec. 304. Exclusion of certain nonroutine medical supplies under the PPS for

home health services.

Sec. 305. Clarification of the homebound definition for the home health benefit.

Sec. 306. Standards for home health branch offices.

Sec. 307. Treatment of home health services provided in certain counties.

Sec. 308. Rule of construction relating to telehomehealth services.

Subtitle B—Direct Graduate Medical Education

Sec. 311. Not counting certain geriatric residents against graduate medical

education limitations.

Sec. 312. Program of payments to children’s hospitals that operate graduate

medical education programs.

Sec. 313. Authority to include costs of training of clinical psychologists in payments to hospitals.

Sec. 314. Treatment of certain newly established residency programs in computing medicare payments for the costs of medical education.

Sec. 315. Exception to establishing the number of residents for certain hospitals.

Subtitle C—Miscellaneous Provisions

Sec. 321. Waiver of 24-month waiting period for medicare coverage of individuals disabled with amyotrophic lateral sclerosis (ALS).

TITLE IV—RURAL PROVIDER PROVISIONS

Subtitle A—Critical Access Hospitals

Sec. 401. Payments to critical access hospitals for clinical diagnostic laboratory

tests.

Sec. 402. Revision of payment for professional services provided by a critical

access hospital.

Sec. 403. Permitting critical access hospitals to operate PPS exempt distinct

part psychiatric and rehabilitation units.

Subtitle B—Medicare Dependent, Small Rural Hospital Program

Sec. 411. Making the medicare dependent, small rural hospital program permanent.

Sec. 412. Option to base eligibility for medicare dependent, small rural hospital

program on discharges during any of the 3 most recent audited

cost reporting periods.

Subtitle C—Sole Community Hospitals

Sec. 421. Extension of option to use rebased target amounts to all sole community hospitals.

Sec. 422. Deeming a certain hospital as a sole community hospital.

Subtitle D—Other Rural Hospital Provisions
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Sec. 431. Exemption of hospital swing-bed program from the PPS for skilled

nursing facilities.

Sec. 432. Permanent guarantee of pre-BBA payment levels for outpatient services furnished by rural hospitals.

Sec. 433. Treatment of certain physician pathology services.

Subtitle E—Other Rural Provisions

Sec. 441. Revision of bonus payments for services furnished in health professional shortage areas.

Sec. 442. Provider-based rural health clinic cap exemption.

Sec. 443. Payment for certain physician assistant services.

Sec. 444. Exclusion of clinical social worker services and services performed

under a contract with a rural health clinic or federally qualified

health center from the PPS for SNFs.

Sec. 445. Coverage of marriage and family therapist services provided in rural

health clinics.

Sec. 446. Capital infrastructure revolving loan program.

Sec. 447. Grants for upgrading data systems.

Sec. 448. Relief for financially distressed rural hospitals.

Sec. 449. Refinement of medicare reimbursement for telehealth services.

Sec. 450. MedPAC study on low-volume, isolated rural health care providers.

TITLE V—PROVISIONS RELATING TO PART C

(MEDICARE+CHOICE PROGRAM) AND OTHER MEDICARE MANAGED CARE PROVISIONS

Sec. 501. Restoring effective date of elections and changes of elections of

Medicare+Choice plans.

Sec. 502. Special Medigap enrollment antidiscrimination provision for certain

beneficiaries.

Sec. 503. Increase in national per capita Medicare+Choice growth percentage

in 2001 and 2002.

Sec. 504. Allowing movement to 50:50 percent blend in 2002.

Sec. 505. Delay from July to November 2000, in deadline for offering and

withdrawing Medicare+Choice plans for 2001.

Sec. 506. Amounts in medicare trust funds available for Secretary’s share of

Medicare+Choice education and enrollment-related costs.

Sec. 507. Revised terms and conditions for extension of medicare community

nursing organization (CNO) demonstration project.

Sec. 508. Modification of payment rules for certain frail elderly medicare beneficiaries.

TITLE VI—PROVISIONS RELATING TO INDIVIDUALS WITH ENDSTAGE RENAL DISEASE

Sec. 601. Update in renal dialysis composite rate.

Sec. 602. Revision of payment rates for ESRD patients enrolled in

Medicare+Choice plans.

Sec. 603. Permitting ESRD beneficiaries to enroll in another Medicare+Choice

plan if the plan in which they are enrolled is terminated.

Sec. 604. Coverage of certain vascular access services for ESRD beneficiaries

provided by ambulatory surgical centers.

Sec. 605. Collection and analysis of information on the satisfaction of ESRD

beneficiaries with the quality of and access to health care

under the medicare program.
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TITLE VII—ACCESS TO CARE IMPROVEMENTS THROUGH

MEDICAID AND SCHIP

Sec. 701. New prospective payment system for Federally-qualified health centers and rural health clinics.

Sec. 702. Transitional medical assistance.

Sec. 703. Application of simplified SCHIP procedures under the medicaid program.

Sec. 704. Presumptive eligibility.

Sec. 705. Improvements to the maternal and child health services block grant.

Sec. 706. Improving access to medicare cost-sharing assistance for low-income

beneficiaries.

Sec. 707. Breast and cervical cancer prevention and treatment.

TITLE VIII—OTHER PROVISIONS

Sec. 801. Appropriations for Ricky Ray Hemophilia Relief Fund.

Sec. 802. Increase in appropriations for special diabetes programs for children

with type I diabetes and Indians.

Sec. 803. Demonstration grants to improve outreach, enrollment, and coordination of programs and services to homeless individuals and families.

Sec. 804. Protection of an HMO enrollee to receive continuing care at a facility

selected by the enrollee.

Sec. 805. Grants to develop and establish real choice systems change initiatives.

1 TITLE I—PROVISIONS RELATING

2 TO PART A

3 Subtitle A—Skilled Nursing

4 Facilities

5 SEC. 101. ELIMINATING REDUCTION IN SKILLED NURSING

6 FACILITY (SNF) MARKET BASKET UPDATE.

7 (a) ELIMINATION OF REDUCTION.—Section

8 1888(e)(4)(E)(ii) (42 U.S.C. 1395yy(e)(4)(E)(ii)) is

9 amended—

10 (1) in subclause (I), by adding ‘‘and’’ at the

11 end;

12 (2) by striking subclause (II); and

13 (3) by redesignating subclause (III) as sub14 clause (II).
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1 (b) SPECIAL RULE FOR PAYMENT FOR SKILLED

2 NURSING FACILITY SERVICES FOR FISCAL YEAR 2001.—

3 Notwithstanding the amendments made by subsection (a),

4 for purposes of making payments for covered skilled nurs5 ing facility services under section 1888(e) of the Social

6 Security Act (42 U.S.C. 1395yy(e)) for fiscal year 2001,

7 the Federal per diem rate referred to in paragraph

8 (4)(E)(ii) of such section—

9 (1) for the period beginning on October 1,

10 2000, and ending on March 31, 2001, shall be the

11 rate determined in accordance with subclause (II) of

12 such paragraph as in effect on the day before the

13 date of enactment of this Act; and

14 (2) for the period beginning on April 1, 2001,

15 and ending on September 30, 2001, shall be the rate

16 computed for fiscal year 2000 pursuant to subclause

17 (I) of such paragraph increased by the skilled nurs18 ing facility market basket percentage change for fis19 cal year 2001 plus 1 percentage point.

20 SEC. 102. REVISION OF BBRA INCREASE FOR SKILLED

21 NURSING FACILITIES IN FISCAL YEARS 2001

22 AND 2002.

23 (a) REVISION.—Section 101(d) of BBRA (113 Stat.

24 1501A–325) is amended—

25 (1) in paragraph (1)—
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1 (A) by striking ‘‘4.0 percent for each such

2 fiscal year’’ and inserting ‘‘the applicable per3 cent (as defined in paragraph (3)) for each

4 such fiscal year (or portion of such year)’’; and

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

6 paragraph:

7 ‘‘(3) APPLICABLE PERCENT DEFINED.—For

8 purposes of this subsection, the term ‘applicable per9 cent’ means, with respect to services provided

10 during—

11 ‘‘(A) the period beginning on October 1,

12 2000, and ending on March 31, 2001, 4.0 per13 cent;

14 ‘‘(B) the period beginning on April 1,

15 2001, and ending on September 30, 2001, 8.0

16 percent; and

17 ‘‘(C) fiscal year 2002, 6.0 percent.

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

19 subsection (a) shall take effect as if included in the enact20 ment of section 101 of BBRA (113 Stat. 1501A–324).

21 SEC. 103. MEDPAC STUDY ON PAYMENT UPDATES FOR

22 SKILLED NURSING FACILITIES; AUTHORITY

23 OF SECRETARY TO MAKE ADJUSTMENTS.

24 (a) STUDY.—The Medicare Payment Advisory Com25 mission established under section 1805 of the Social Secu-
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1 rity Act (42 U.S.C. 1395b–6) (in this section referred to

2 as ‘‘MedPAC’’) shall conduct a study of nursing home

3 costs to determine the adequacy of payment rates (includ4 ing updates to such rates) under the medicare program

5 under title XVIII of such Act (42 U.S.C. 1395 et seq.)

6 (in this section referred to as the ‘‘medicare program’’)

7 for items and services furnished by skilled nursing facili8 ties. In conducting such study, MedPAC shall use data

9 on actual costs and cost increases.

10 (b) REPORT.—Not later than 12 months after the

11 date of enactment of this Act, MedPAC shall submit a

12 report to the Secretary of Health and Human Services and

13 Congress on the study conducted under subsection (a), in14 cluding a description of the methodology and calculations

15 used by the Health Care Financing Administration to es16 tablish the original payment level under the prospective

17 payment system for skilled nursing facility services under

18 section 1888(e) of the Social Security Act (42 U.S.C.

19 1395yy(e)) and to annually update payments under the

20 medicare program for items and services furnished by

21 skilled nursing facilities, together with recommendations

22 regarding methods to ensure that all input variables, in23 cluding the labor costs, the intensity of services, and the

24 changes in science and technology that are specific to such

25 facilities, are adequately accounted for.
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1 (c) AUTHORITY OF SECRETARY TO MAKE ADJUST2 MENTS.—Notwithstanding any other provision of law, the

3 Secretary of Health and Human Services may make ad4 justments to payments under the prospective payment sys5 tem under section 1888(e) of the Social Security Act (42

6 U.S.C. 1395yy(e)) for covered skilled nursing facility serv7 ices to reflect any necessary adjustments to such payments

8 as is appropriate as a result of the study conducted under

9 subsection (a).

10 (d) PUBLICATION.—

11 (1) IN GENERAL.—Not later than April 1,

12 2002, the Secretary of Health and Human Services

13 shall publish for public comment a description of—

14 (A) whether the Secretary will make any

15 adjustments pursuant to subsection (c); and

16 (B) if so, the form of such adjustments.

17 (2) FINAL FORM.—Not later than August 1,

18 2002, the Secretary of Health and Human Services

19 shall publish the description described in paragraph

20 (1) in final form.

21 Subtitle B—PPS Hospitals

22 SEC. 111. REVISION OF REDUCTION OF INDIRECT GRAD23 UATE MEDICAL EDUCATION PAYMENTS.

24 (a) REVISION.—
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1 (1) IN GENERAL.—Section 1886(d)(5)(B)(ii)

2 (42 U.S.C. 1395ww(d)(5)(B)(ii)) is amended—

3 (A) in subclause (IV), by adding ‘‘and’’ at

4 the end; and

5 (B) by striking subclauses (V) and (VI)

6 and inserting the following new subclause:

7 ‘‘(V) on or after October 1, 2000, ‘c’

8 is equal to 1.6.’’.

9 (2) TECHNICAL AMENDMENTS.—Section

10 1886(d)(5)(B) (42 U.S.C. 1395ww(d)(5)(B)), as

11 amended by paragraph (1), is amended—

12 (A) by realigning the left margins of

13 clauses (ii) and (v) so as to align with the left

14 margin of clause (i); and

15 (B) by realigning the left margins of sub16 clauses (I) through (V) of clause (ii) appro17 priately.

18 (b) SPECIAL ADJUSTMENT FOR PURPOSES OF MAIN19 TAINING 6.5 PERCENT IME PAYMENT FOR FISCAL YEAR

20 2001.—Notwithstanding paragraph (5)(B)(ii)(V) of sec21 tion 1886(d) of the Social Security Act (42 U.S.C.

22 1395ww(d)(5)(B)(ii)(V)), as amended by subsection (a),

23 for purposes of making payments for subsection (d) hos24 pitals (as defined in paragraph (1)(B) of such section)

25 with indirect costs of medical education, the indirect
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1 teaching adjustment factor referred to in paragraph

2 (5)(B)(ii) of such section shall be determined—

3 (1) for discharges occurring on or after October

4 1, 2000, and before April 1, 2001, pursuant to such

5 paragraph as in effect on the day before the date of

6 enactment of this Act; and

7 (2) for discharges occurring on or after April 1,

8 2001, and before October 1, 2001, by substituting

9 ‘‘1.66’’ for ‘‘1.6’’ in subclause (V) of such paragraph

10 (as so amended).

11 (c) CONFORMING AMENDMENT RELATING TO DE12 TERMINATION OF STANDARDIZED AMOUNT.—Section

13 1886(d)(2)(C)(i) (42 U.S.C. 1395ww(d)(2)(C)(i)) is

14 amended—

15 (1) by inserting a comma after ‘‘Balanced

16 Budget Act of 1997’’; and

17 (2) by inserting ‘‘, or any payment under such

18 paragraph resulting from the application of section

19 111(b) of the Medicare, Medicaid, and SCHIP Bal20 anced Budget Refinement Act of 2000’’ after ‘‘Bal21 anced Budget Refinement Act of 1999’’.

22 SEC. 112. ELIMINATING REDUCTION IN PPS HOSPITAL PAY23 MENT UPDATE.

24 (a) IN GENERAL.—Section 1886(b)(3)(B)(i) (42

25 U.S.C. 1395ww(b)(3)(B)(i)) is amended—
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1 (1) in subclause (XV), by adding ‘‘and’’ at the

2 end;

3 (2) by striking subclauses (XVI) and (XVII);

4 (3) by redesignating subclause (XVIII) as sub5 clause (XVI); and

6 (4) in subclause (XVI), as so redesignated, by

7 striking ‘‘fiscal year 2003’’ and inserting ‘‘fiscal year

8 2001’’.

9 (b) SPECIAL RULE FOR PAYMENT FOR INPATIENT

10 HOSPITAL SERVICES FOR FISCAL YEAR 2001.—Notwith11 standing the amendments made by subsection (a), for pur12 poses of making payments for fiscal year 2001 for inpa13 tient hospital services furnished by subsection (d) hos14 pitals (as defined in section 1886(d)(1)(B) of the Social

15 Security Act (42 U.S.C. 1395ww(d)(1)(B))), the ‘‘applica16 ble percentage increase’’ referred to in section

17 1886(b)(3)(B)(i) of such Act (42 U.S.C.

18 1395ww(b)(3)(B)(i))—

19 (1) for discharges occurring on or after October

20 1, 2000, and before April 1, 2001, shall be deter21 mined in accordance with subclause (XVI) of such

22 section as in effect on the day before the date of en23 actment of this Act; and
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1 (2) for discharges occurring on or after April 1,

2 2001, and before October 1, 2001, shall be equal

3 to—

4 (A) the market basket percentage increase

5 plus 1.1 percentage points for hospitals (other

6 than sole community hospitals) in all areas; and

7 (B) the market basket percentage increase

8 for sole community hospitals.

9 SEC. 113. ELIMINATING REDUCTION IN DISPROPOR10 TIONATE SHARE HOSPITAL (DSH) PAYMENTS.

11 (a) ELIMINATION OF REDUCTION.—

12 (1) IN GENERAL.—Section 1886(d)(5)(F)(ix)

13 (42 U.S.C. 1395ww(d)(5)(F)(ix)) is amended—

14 (A) in subclause (III), by striking ‘‘during

15 each of fiscal years 2000 and 2001’’ and insert16 ing ‘‘during fiscal year 2000’’;

17 (B) by striking subclause (IV);

18 (C) by redesignating subclause (V) as sub19 clause (IV); and

20 (D) in subclause (IV), as so redesignated,

21 by striking ‘‘during fiscal year 2003’’ and in22 serting ‘‘during fiscal year 2001’’.

23 (2) EFFECTIVE DATE.—The amendments made

24 by this subsection shall apply to discharges occur25 ring on or after October 1, 2000.
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1 (b) SPECIAL RULE FOR DSH PAYMENT FOR FISCAL

2 YEAR 2001.—Notwithstanding the amendments made by

3 subsection (a)(1), for purposes of making disproportionate

4 share payments for subsection (d) hospitals (as defined

5 in section 1886(d)(1)(B) of the Social Security Act (42

6 U.S.C. 1395ww(d)(1)(B))) for fiscal year 2001, the addi7 tional payment amount otherwise determined under clause

8 (ii) of section 1886(d)(5)(F) of the Social Security Act

9 (42 U.S.C. 1395ww(d)(5)(F))—

10 (1) for discharges occurring on or after October

11 1, 2000, and before April 1, 2001, shall be adjusted

12 as provided by clause (ix)(III) of such section as in

13 effect on the day before the date of enactment of

14 this Act; and

15 (2) for discharges occurring on or after April 1,

16 2001, and before October 1, 2001, shall be increased

17 by 3 percent.

18 (c) CONFORMING AMENDMENTS RELATING TO DE19 TERMINATION OF STANDARDIZED AMOUNT.—Section

20 1886(d)(2)(C)(iv) (42 U.S.C. 1395ww(d)(2)(C)(iv)), is

21 amended—

22 (1) by striking ‘‘Act of 1989 or’’ and inserting

23 ‘‘Act of 1989,’’; and

24 (2) by inserting ‘‘, or the enactment of section

25 113(b) of the Medicare, Medicaid, and SCHIP Bal-
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1 anced Budget Refinement Act of 2000’’ after ‘‘Om2 nibus Budget Reconciliation Act of 1990’’.

3 SEC. 114. EQUALIZING THE THRESHOLD AND UPDATING

4 PAYMENT FORMULAS FOR DISPROPOR5 TIONATE SHARE HOSPITALS.

6 (a) APPLICATION OF UNIFORM 15 PERCENT

7 THRESHOLD.—Section 1886(d)(5)(F)(v) (42 U.S.C.

8 1395ww(d)(5)(F)(v)) is amended by striking ‘‘exceeds—

9 ’’ and all that follows and inserting ‘‘exceeds 15 percent.’’.

10 (b) CHANGE IN PAYMENT PERCENTAGE FOR11 MULAS.—Section 1886(d)(5)(F)(viii) (42 U.S.C.

12 1395ww(d)(5)(F)(viii)) is amended to read as follows:

13 ‘‘(viii) The formula used to determine the dispropor14 tionate share adjustment percentage for a cost reporting

15 period for a hospital described in subclause (II), (III), or

16 (IV) of clause (iv) is—

17 ‘‘(I) in the case of such a hospital with a dis18 proportionate patient percentage (as defined in

19 clause (vi)) that does not exceed 20.2, (P–15)(.65)

20 + 2.5;

21 ‘‘(II) in the case of such a hospital with a dis22 proportionate patient percentage (as so defined) that

23 exceeds 20.2 but does not exceed 25.2, (P–

24 20.2)(.825) + 5.88;
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1 ‘‘(III) except as provided in subclause (IV), in

2 the case of such a hospital with a disproportionate

3 patient percentage (as so defined) that exceeds 25.2,

4 the disproportionate share adjustment percentage =

5 10; and

6 ‘‘(IV) in the case of such a hospital with a dis7 proportionate patient percentage (as so defined) that

8 exceeds 30.0 and that is described in clause (iv)(III),

9 (P–30)(.6) + 10;

10 where ‘P’ is the hospital’s disproportionate patient per11 centage (as so defined).’’.

12 (c) CONFORMING AMENDMENTS.—Section

13 1886(d)(5)(F)(iv) (42 U.S.C. 1395ww(d)(5)(F)(iv)) is

14 amended—

15 (1) in subclause (I), by striking ‘‘is described in

16 the second sentence of clause (v)’’ and inserting ‘‘is

17 located in a rural area and has 500 or more beds’’;

18 (2) by amending subclause (II) to read as fol19 lows:

20 ‘‘(II) is located in an urban area and has less

21 than 100 beds, or is located in a rural area and has

22 less than 500 beds and is not described in subclause

23 (III) or (IV), is equal to the percent determined in

24 accordance with the applicable formula described in

25 clause (viii);’’;
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1 (3) by striking subclauses (III) and (IV);

2 (4) by redesignating subclauses (V) and (VI) as

3 subclauses (III) and (IV), respectively;

4 (5) in subclause (III) (as so redesignated), by

5 striking ‘‘and is not classified as a sole community

6 hospital under subparagraph (D),’’; and

7 (6) in subclause (IV) (as so redesignated), by

8 striking ‘‘10 percent’’ and inserting ‘‘equal to the

9 percent determined in accordance with the applicable

10 formula described in clause (viii)’’.

11 (d) EFFECTIVE DATE.—The amendments made by

12 this section shall apply to discharges occurring on or after

13 April 1, 2001.

14 SEC. 115. CARE FOR LOW-INCOME PATIENTS.

15 (a) FREEZE IN MEDICAID DSH ALLOTMENTS.—

16 (1) IN GENERAL.—Section 1923(f) (42 U.S.C.

17 1396r–4(f)) is amended—

18 (A) by redesignating paragraph (4) as

19 paragraph (5); and

20 (B) by inserting after paragraph (3), the

21 following new paragraph:

22 ‘‘(4) SPECIAL RULE FOR FISCAL YEARS 2001

23 THROUGH 2008.—With respect to each of fiscal years

24 2001 through 2008—

25 ‘‘(A) paragraph (2) shall be applied—
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1 ‘‘(i) by substituting—

2 ‘‘(I) in the heading, ‘2001’ for

3 ‘2002’;

4 ‘‘(II) in the matter preceding the

5 table, ‘2001 (and the DSH allotment

6 for a State for fiscal year 2001 is the

7 same as the DSH allotment for the

8 State for fiscal year 2000, as deter9 mined under the following table)’ for

10 ‘2002’; and

11 ‘‘(ii) without regard to the columns in

12 the table relating to FY 01 and FY 02

13 (fiscal years 2001 and 2002); and

14 ‘‘(B) paragraph (3) shall be applied by

15 substituting—

16 ‘‘(i) in the heading, ‘2002’ for ‘2003’;

17 ‘‘(ii) in subparagraph (A), ‘2002’ for

18 ‘2003’.’’.

19 (2) REPEAL; APPLICABILITY.—Effective Octo20 ber 1, 2008, the amendments made by paragraph

21 (1) are repealed and section 1923(f) of the Social

22 Security Act (42 U.S.C. 1396r–4(f)) shall be applied

23 and administered as if such amendments had not

24 been enacted.
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1 (b) INCREASE IN DSH ALLOTMENTS FOR THE DIS2 TRICT OF COLUMBIA.—

3 (1) IN GENERAL.—Each of the entries in the

4 table in section 1923(f)(2) (42 U.S.C. 1396r–

5 4(f)(2)) relating to the District of Columbia for FY

6 98 (fiscal year 1998), for FY 99 (fiscal year 1999),

7 for FY 00 (fiscal year 2000), for FY 01 (fiscal year

8 2001), and for FY 02 (fiscal year 2002) are amend9 ed by striking the amount otherwise specified and

10 inserting ‘‘43.4’’.

11 (2) EFFECTIVE DATE.—The amendments made

12 by paragraph (1) shall take effect as if included in

13 the enactment of section 4721(a) of BBA (111 Stat.

14 511).

15 (c) OPTIONAL ELIGIBILITY OF CERTAIN ALIEN

16 PREGNANT WOMEN AND CHILDREN FOR MEDICAID AND

17 SCHIP.—

18 (1) MEDICAID.—Section 1903(v) (42 U.S.C.

19 1396b(v)) is amended—

20 (A) in paragraph (1), by striking ‘‘para21 graph (2)’’ and inserting ‘‘paragraphs (2) and

22 (4)’’; and

23 (B) by adding at the end the following new

24 paragraph:
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1 ‘‘(4)(A) A State may elect (in a plan amendment

2 under this title) to provide medical assistance under this

3 title, notwithstanding sections 401(a), 402(b), 403, and

4 421 of the Personal Responsibility and Work Opportunity

5 Reconciliation Act of 1996, for aliens who are lawfully re6 siding in the United States (including battered aliens de7 scribed in section 431(c) of such Act) and who are other8 wise eligible for such assistance, within any of the fol9 lowing eligibility categories:

10 ‘‘(i) PREGNANT WOMEN.—Women during preg11 nancy (and during the 60-day period beginning on

12 the last day of the pregnancy).

13 ‘‘(ii) CHILDREN.—Children (as defined under

14 such plan), including optional targeted low-income

15 children described in section 1905(u)(2)(B).

16 ‘‘(B) In the case of a State that has elected to provide

17 medical assistance to a category of aliens under subpara18 graph (A), no action may be brought under an affidavit

19 of support against any sponsor of such an alien on the

20 basis of provision of assistance to such category.’’.

21 (2) SCHIP.—Section 2107(e)(1) (42 U.S.C.

22 1397gg(e)(1)) is amended by adding at the end the

23 following new subparagraph:

24 ‘‘(D) Section 1903(v)(4)(A)(ii) (relating to

25 optional coverage of permanent resident alien
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1 children), but only if the State has in effect an

2 election under that same eligibility category for

3 purposes of title XIX.’’.

4 (3) EFFECTIVE DATE.—The amendments made

5 by this section take effect on October 1, 2000, and

6 apply to medical assistance and child health assist7 ance furnished on or after such date.

8 SEC. 116. MODIFICATION OF PAYMENT RATE FOR PUERTO

9 RICO HOSPITALS.

10 (a) MODIFICATION OF PAYMENT RATE.—Section

11 1886(d)(9)(A) (42 U.S.C. 1395ww(d)(9)(A)) is

12 amended—

13 (1) in clause (i), by striking ‘‘October 1, 1997,

14 50 percent (’’ and inserting ‘‘October 1, 2000, 25

15 percent (for discharges between October 1, 1997,

16 and September 30, 2000, 50 percent,’’; and

17 (2) in clause (ii), in the matter preceding sub18 clause (I), by striking ‘‘after October 1, 1997, 50

19 percent (’’ and inserting ‘‘after October 1, 2000, 75

20 percent (for discharges between October 1, 1997,

21 and September 30, 2000, 50 percent,’’.

22 (b) SPECIAL RULE FOR PAYMENT FOR FISCAL YEAR

23 2001.—

24 (1) IN GENERAL.—Notwithstanding the amend25 ment made by subsection (a), for purposes of mak-
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1 ing payments for the operating costs of inpatient

2 hospital services of a section 1886(d) Puerto Rico

3 hospital for fiscal year 2001, the amount referred to

4 in the matter preceding clause (i) of section

5 1886(d)(9)(A) of the Social Security Act (42 U.S.C.

6 1395ww(d)(9)(A))—

7 (A) for discharges occurring on or after

8 October 1, 2000, and before April 1, 2001,

9 shall be determined in accordance with such

10 section as in effect on the day before the date

11 of enactment of this Act; and

12 (B) for discharges occurring on or after

13 April 1, 2001, and before October 1, 2001,

14 shall be determined—

15 (i) using 0 percent of the Puerto Rico

16 adjusted DRG prospective payment rate

17 referred to in clause (i) of such section;

18 and

19 (ii) using 100 percent of the dis20 charge-weighted average referred to in

21 clause (ii) of such section.

22 (2) SECTION 1886(d) PUERTO RICO HOSPITAL.—

23 For purposes of this subsection, the term ‘‘section

24 1886(d) Puerto Rico hospital’’ has the meaning

25 given the term ‘‘subsection (d) Puerto Rico hospital’’
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1 in the last sentence of section 1886(d)(9)(A) of the

2 Social Security Act (42 U.S.C. 1395ww(d)(9)(A)).

3 SEC. 117. MEDPAC STUDY ON HOSPITAL AREA WAGE IN4 DEXES.

5 (a) STUDY.—

6 (1) IN GENERAL.—The Medicare Payment Ad7 visory Commission established under section 1805 of

8 the Social Security Act (42 U.S.C. 1395b–6) (in this

9 section referred to as ‘‘MedPAC’’) shall conduct a

10 study on the hospital area wage indexes used in

11 making payments to hospitals under section 1886(d)

12 of the Social Security Act (42 U.S.C. 1395ww(d)),

13 including an assessment of the accuracy of those in14 dexes in reflecting geographic differences in wage

15 and wage-related costs of hospitals.

16 (2) CONSIDERATIONS.—In conducting the study

17 under paragraph (1), MedPAC shall consider—

18 (A) the appropriate method for deter19 mining hospital area wage indexes;

20 (B) the appropriate portion of hospital

21 payments that should be adjusted by the appli22 cable area wage index;

23 (C) the appropriate method for adjusting

24 the wage index by occupational mix; and
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1 (D) the feasibility and impact of making

2 changes (as determined appropriate by

3 MedPAC) to the methods used to determine

4 such indexes, including the need for a data sys5 tem required to implement such changes.

6 (b) REPORT.—Not later than 18 months after the

7 date of enactment of this Act, MedPAC shall submit a

8 report to the Secretary of Health and Human Services and

9 Congress on the study conducted under subsection (a) to10 gether with such recommendations for legislation and ad11 ministrative action as MedPAC determines appropriate.

12 Subtitle C—PPS Exempt Hospitals

13 SEC. 121. TREATMENT OF CERTAIN CANCER HOSPITALS.

14 (a) IN GENERAL.—Section 1886(d)(1)(B)(v) of the

15 Social Security Act (42 U.S.C. 1395ww(d)(1)(B)(v)) is

16 amended—

17 (1) in subclause (I), by striking ‘‘or’’ at the

18 end;

19 (2) in subclause (II), by striking the semicolon

20 at the end and inserting ‘‘, or’’; and

21 (3) by adding at the end the following:

22 ‘‘(III) a hospital that was recognized as a clin23 ical cancer research center by the National Cancer

24 Institute of the National Institutes of Health as of

25 February 18, 1998, that has never been reimbursed
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1 for inpatient hospital services pursuant to a reim2 bursement system under a demonstration project

3 under section 1814(b), that is a freestanding facility

4 organized primarily for treatment of and research on

5 cancer and is not a unit of another hospital, that as

6 of the date of enactment of this subclause, is li7 censed for 162 acute care beds, and that dem8 onstrates for the 4-year period ending on June 30,

9 1999, that at least 50 percent of its total discharges

10 have a principal finding of neoplastic disease, as de11 fined in subparagraph (E);’’.

12 (b) CONFORMING AMENDMENT.—Section

13 1886(d)(1)(E) of the Social Security Act (42 U.S.C.

14 1395ww(d)(1)(E)) is amended by striking ‘‘For purposes

15 of subparagraph (B)(v)(II)’’ and inserting ‘‘For purposes

16 of subclauses (II) and (III) of subparagraph (B)(v)’’.

17 (c) PAYMENT.—

18 (1) APPLICATION TO COST REPORTING PERI19 ODS.—Any classification by reason of section

20 1886(d)(1)(B)(v)(III) of the Social Security Act (as

21 added by subsection (a)) shall apply to 12-month

22 cost reporting periods beginning on or after July 1,

23 1999.

24 (2) BASE YEAR.—Notwithstanding the provi25 sions of section 1886(b)(3)(E) of such Act (42
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1 U.S.C. 1395ww(b)(3)(E)) or other provisions to the

2 contrary, the base cost reporting period for purposes

3 of determining the target amount for any hospital

4 classified by reason of section 1886(d)(1)(B)(v)(III)

5 of such Act (as added by subsection (a)) shall be the

6 12-month cost reporting period beginning on July 1,

7 1995.

8 (3) DEADLINE FOR PAYMENTS.—Any payments

9 owed to a hospital by reason of this subsection shall

10 be made expeditiously, but in no event later than 1

11 year after the date of enactment of this Act.

12 SEC. 122. PAYMENT ADJUSTMENT FOR INPATIENT SERV13 ICES IN REHABILITATION HOSPITALS.

14 (a) OPTION TO APPLY PROSPECTIVE PAYMENT SYS15 TEM DURING TRANSITION PERIOD.—Section

16 1886(j)(1)(A) (42 U.S.C. 1395ww(j)(1)(A)) is amended in

17 the matter preceding subclause (i) by inserting ‘‘the great18 er of the prospective payment rate determined in para19 graph (3)(A) or’’ after ‘‘is equal to’’.

20 (b) INCREASE IN PROSPECTIVE PAYMENT PERCENT21 AGE DURING TRANSITION PERIOD.—Section

22 1886(j)(1)(A)(ii)(I) (42 U.S.C. 1395ww(j)(1)(A)(ii)(I)) is

23 amended by inserting ‘‘102 percent of’’ before ‘‘the per

24 unit’’.
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1 (c) EFFECTIVE DATE.—The amendments made by

2 this section shall take effect as if included in the enact3 ment of section 4421 of BBA (111 Stat. 410).

4 Subtitle D—Hospice Care

5 SEC. 131. REVISION IN PAYMENTS FOR HOSPICE CARE.

6 (a) INCREASE.—Section 1814(i)(1)(C) of the Social

7 Security Act (42 U.S.C. 1395f(i)(1)(C)) is amended—

8 (1) in clause (i), by adding at the end the fol9 lowing new sentence: ‘‘With respect to routine home

10 care and other services included in hospice care fur11 nished during fiscal year 2001, the payment rates

12 for such care and services for such fiscal year shall

13 be 110 percent of such rates as would otherwise be

14 in effect for such fiscal year (taking into account the

15 increase under clause (ii) but not taking into ac16 count the increase under section 131 of the Medi17 care, Medicaid, and SCHIP Balanced Budget Re18 finement Act of 1999), and such payment rates shall

19 be used in determining payments for such care and

20 services furnished in a subsequent fiscal year under

21 clause (ii).’’; and

22 (2) in clause (ii), by striking ‘‘during a subse23 quent fiscal year’’ and inserting ‘‘during a fiscal

24 year beginning after September 30, 1990’’.
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1 (b) ELIMINATING REDUCTION IN UPDATE.—Section

2 1814(i)(1)(C)(ii) of the Social Security Act (42 U.S.C.

3 1395f(i)(1)(C)(ii)) is amended—

4 (1) in subclause (VI), by striking ‘‘through

5 2002’’ and inserting ‘‘through 2000’’; and

6 (2) in subclause (VII), by striking ‘‘for a subse7 quent fiscal year’’ and inserting ‘‘for fiscal year

8 2001 and each subsequent fiscal year’’.

9 (c) SPECIAL RULE FOR PAYMENT FOR HOSPICE

10 CARE FOR FISCAL YEAR 2001.—Notwithstanding the

11 amendments made by subsections (a) and (b), for pur12 poses of making payments under section 1814(i)(1)(C) of

13 the Social Security Act (42 U.S.C. 1395f(i)(1)(C)) for

14 routine home care and other services included in hospice

15 care furnished during fiscal year 2001, such payment

16 rates shall be determined—

17 (1) for the period beginning on October 1,

18 2000, and ending on March 31, 2001, in accordance

19 with such section as in effect on the day before the

20 date of enactment of this Act; and

21 (2) for the period beginning on April 1, 2001,

22 and ending on September 30, 2001—

23 (A) by substituting ‘‘120 percent’’ for

24 ‘‘110 percent’’ in the second sentence of clause
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1 (i) of such section (as added by subsection

2 (a)(1)); and

3 (B) as if the increase under subclause

4 (ii)(VII) (as amended by subsection (b)) for fis5 cal year 2001 was equal to the market basket

6 increase for the fiscal year plus 1.0 percentage

7 point.

8 Subtitle E—Other Provisions

9 SEC. 141. HOSPITALS REQUIRED TO COMPLY WITH

10 BLOODBORNE PATHOGENS STANDARD.

11 (a) AGREEMENTS WITH HOSPITALS.—Section

12 1866(a)(1) (42 U.S.C. 1395cc(a)(1)) is amended—

13 (1) in subparagraph (R), by striking ‘‘and’’ at

14 the end;

15 (2) in subparagraph (S), by striking the period

16 at the end and inserting ‘‘, and’’; and

17 (3) by inserting after subparagraph (S) the fol18 lowing new subparagraph:

19 ‘‘(T) in the case of hospitals that are not other20 wise subject to regulation by the Occupational Safe21 ty and Health Administration, to comply with the

22 Bloodborne Pathogens standard under section

23 1910.1030 of title 29 of the Code of Federal Regula24 tions.’’.
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1 (b) EFFECTIVE DATE.—The amendments made by

2 this section shall apply to agreements in effect on or after

3 the date that is 1 year after the date of enactment of this

4 Act.

5 SEC. 142. INFORMATICS AND DATA SYSTEMS GRANT PRO6 GRAM.

7 (a) GRANTS TO HOSPITALS.—

8 (1) IN GENERAL.—The Secretary of Health and

9 Human Services (in this section referred to as the

10 ‘‘Secretary’’) shall establish a program to make

11 grants to hospitals that have submitted applications

12 in accordance with subsection (c) to assist such hos13 pitals in offsetting the costs related to—

14 (A) developing and implementing standard15 ized clinical health care informatics systems de16 signed to improve medical care and reduce ad17 verse events and health care complications re18 sulting from medication errors; and

19 (B) establishing data systems to comply

20 with the administrative simplification require21 ments under part C of title XI of the Social Se22 curity Act (42 U.S.C. 1320d et seq.).

23 (2) COSTS.—For purposes of paragraph (1),

24 the term ‘‘costs’’ shall include costs associated

25 with—
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1 (A) purchasing computer software and

2 hardware; and

3 (B) providing education and training to

4 hospital staff on computer information systems.

5 (3) DURATION.—The authority of the Secretary

6 to make grants under this section shall terminate on

7 September 30, 2011.

8 (4) LIMITATION.—A hospital that has received

9 a grant under section 1611 of the Public Health

10 Service Act (as added by section 447 of this Act) is

11 not eligible to receive a grant under this section.

12 (b) SPECIAL CONSIDERATION FOR LARGE URBAN

13 HOSPITALS.—In awarding grants under this section, the

14 Secretary shall give special consideration to hospitals lo15 cated in large urban areas (as defined for purposes of sec16 tion 1886(d) of the Social Security Act (42 U.S.C.

17 1395ww(d)).

18 (c) APPLICATION.—A hospital seeking a grant under

19 this section shall submit an application to the Secretary

20 at such time and in such form and manner as the Sec21 retary specifies.

22 (d) REPORTS.—

23 (1) INFORMATION.—A hospital receiving a

24 grant under this section shall furnish the Secretary
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1 with such information as the Secretary may require

2 to—

3 (A) evaluate the project for which the

4 grant is made; and

5 (B) ensure that the grant is expended for

6 the purposes for which it is made.

7 (2) TIMING OF SUBMISSION.—

8 (A) INTERIM REPORTS.—The Secretary

9 shall report to the Committee on Ways and

10 Means of the House of Representatives and the

11 Committee on Finance of the Senate at least

12 annually on the grant program established

13 under this section, including in such report in14 formation on the number of grants made, the

15 nature of the projects involved, the geographic

16 distribution of grant recipients, and such other

17 matters as the Secretary deems appropriate.

18 (B) FINAL REPORT.—The Secretary shall

19 submit a final report to such committees not

20 later than 180 days after the completion of all

21 of the projects for which a grant is made under

22 this section.

23 (e) AUTHORIZATION OF APPROPRIATIONS.—There

24 are authorized to be appropriated from the Federal Hos25 pital Insurance Trust Fund under section 1817 of the So-
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1 cial Security Act (42 U.S.C. 1395i) $25,000,000 for each

2 of the fiscal years 2001 through 2011 for the purposes

3 of making grants under this section.

4 SEC. 143. RELIEF FROM MEDICARE PART A LATE ENROLL5 MENT PENALTY FOR GROUP BUY-IN FOR

6 STATE AND LOCAL RETIREES.

7 Section 1818(d) (42 U.S.C. 1395i–2(d)) is amended

8 by adding at the end the following new paragraph:

9 ‘‘(6)(A) In the case where a State, a political

10 subdivision of a State, or an agency or instrumen11 tality of a State or political subdivision thereof de12 termines to pay, for the life of each individual, the

13 monthly premiums due under paragraph (1) on be14 half of each of the individuals in a qualified State

15 or local government retiree group who meets the

16 conditions of subsection (a), the amount of any in17 crease otherwise applicable under section 1839(b)

18 (as modified by subsection (c)(6) of this section)

19 with respect to the monthly premium for benefits

20 under this part for an individual who is a member

21 of such group shall be reduced by the total amount

22 of taxes paid under section 3101(b) of the Internal

23 Revenue Code of 1986 by such individual and under

24 section 3111(b) by the employers of such individual
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1 on behalf of such individual with respect to employ2 ment (as defined in section 3121(b) of such Code).

3 ‘‘(B) For purposes of this paragraph, the term

4 ‘qualified State or local government retiree group’

5 means all of the individuals who retire prior to a

6 specified date that is before January 1, 2002, from

7 employment in 1 or more occupations or other broad

8 classes of employees of—

9 ‘‘(i) the State;

10 ‘‘(ii) a political subdivision of the State; or

11 ‘‘(iii) an agency or instrumentality of the

12 State or political subdivision of the State.’’.

13 Subtitle F—Transitional Provisions

14 SEC. 151. RECLASSIFICATION OF CERTAIN COUNTIES AND

15 AREAS FOR PURPOSES OF REIMBURSEMENT

16 UNDER THE MEDICARE PROGRAM.

17 (a) FISCAL YEARS 2002 THROUGH 2004.—Notwith18 standing any other provision of law, effective for dis19 charges occurring during fiscal years 2002, 2003, and

20 2004, for purposes of making payments under section

21 1886(d) of the Social Security Act (42 U.S.C.

22 1395ww(d))—

23 (1) Iredell County, North Carolina is deemed to

24 be located in the Charlotte-Gastonia-Rock Hill,
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1 North Carolina-South Carolina Metropolitan Statis2 tical Area; and

3 (2) the large urban area of New York, New

4 York is deemed to include Orange County, New

5 York (including hospitals that have been reclassified

6 into such county).

7 For purposes of that section, any reclassification under

8 this subsection shall be treated as a decision of the Medi9 care Geographic Classification Review Board under para10 graph (10) of that section.

11 (b) FISCAL YEARS 2001 THROUGH 2003.—Notwith12 standing any other provision of law, effective for dis13 charges occurring during fiscal years 2001, 2002, and

14 2003, for purposes of making payments under section

15 1886(d) of the Social Security Act (42 U.S.C.

16 1395ww(d))—

17 (1) the Jackson, Michigan Metropolitan Statis18 tical Area is deemed to be located in the Ann Arbor,

19 Michigan Metropolitan Statistical Area;

20 (2) Tangipahoa Parish, Louisiana is deemed to

21 be located in the New Orleans, Louisiana Metropoli22 tan Statistical Area; and

23 (3) the large urban area of New York, New

24 York is deemed to include Duchess County, New

25 York.
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1 For purposes of that section, any reclassification under

2 this subsection shall be treated as a decision of the Medi3 care Geographic Classification Review Board under para4 graph (10) of that section.

5 (c) TECHNICAL CORRECTION TO BBRA.—

6 (1) IN GENERAL.—Section 152 of BBRA (113

7 Stat. 1501A–334) is amended—

8 (A) in subsection (a)(2), by inserting ‘‘(in9 cluding hospitals that have been reclassified

10 into such county)’’ after ‘‘such county’’; and

11 (B) in subsection (b)(2), by inserting ‘‘(in12 cluding hospitals that have been reclassified

13 into such county)’’ after ‘‘Orange County, New

14 York’’; and

15 (2) EFFECTIVE DATE.—The amendments made

16 by paragraph (1) shall take effect as if included in

17 the enactment of section 152 of BBRA (113 Stat.

18 1501A–334).

19 SEC. 152. CALCULATION AND APPLICATION OF WAGE

20 INDEX FLOOR FOR A CERTAIN AREA.

21 Notwithstanding any other provision of section

22 1886(d) of the Social Security Act (42 U.S.C.

23 1395ww(d)), for discharges occurring during fiscal year

24 2000, the Secretary of Health and Human Services shall

25 calculate and apply the wage index for the Barnstable-
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1 Yarmouth Metropolitan Statistical Area under that sec2 tion as if the Jordan Hospital were classified in such area

3 for purposes of payment under that section for such fiscal

4 year. Such recalculation shall not affect the wage index

5 for any other area.

6 SEC. 153. RECLASSIFICATION OF A CERTAIN COUNTY FOR

7 PURPOSES OF REIMBURSEMENT UNDER THE

8 MEDICARE PROGRAM.

9 (a) IN GENERAL.—Notwithstanding any other provi10 sion of law, effective for discharges occurring on or after

11 October 1, 2000, for purposes of making payments under

12 section 1886(d) of the Social Security Act (42 U.S.C.

13 1395ww(d)) to a covered hospital in Boston, Metropolitan

14 Statistical Area, such covered hospital is deemed to be lo15 cated in the Barnstable-Yarmouth, Metropolitan Statis16 tical Area.

17 (b) COVERED HOSPITAL DEFINED.—In subsection

18 (a), the term ‘‘covered hospital’’ means a subsection (d)

19 hospital (as defined in paragraph (1)(B) of such section

20 1886(d)) that—

21 (1) for discharges occurring during fiscal year

22 1999—

23 (A) received additional payments under

24 paragraph (5)(F) of such section (relating to
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1 serving a significantly disproportionate number

2 of low-income patients); and

3 (B) received no additional payments under

4 paragraph (5)(B) of such section (relating to

5 indirect costs of medical education); and

6 (2) is located in Fall River, Massachusetts, New

7 Bedford, Massachusetts, or Wareham, Massachu8 setts.

9 (c) CONSTRUCTION.—For purposes of such section

10 1886(d), the reclassification under subsection (a) shall be

11 treated as a decision of the Medicare Geographic Classi12 fication Review Board under paragraph (10) of that sec13 tion.

14 TITLE II—PROVISIONS

15 RELATING TO PART B

16 Subtitle A—Hospital Outpatient

17 Services

18 SEC. 201. REDUCTION OF EFFECTIVE HOPD COINSURANCE

19 RATE TO 20 PERCENT BY 2019.

20 Section 1833(t)(3)(B)(ii) (42 U.S.C.

21 1395l(t)(3)(B)(ii)) is amended—

22 (1) by striking ‘‘If the’’ and inserting:

23 ‘‘(I) IN GENERAL.—If the’’; and

24 (2) by adding at the end the following new sub25 clause:
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1 ‘‘(II) ACCELERATED PHASE-IN.—

2 The Secretary shall estimate, prior to

3 January 1, 2002, the unadjusted co4 payment amount for each such service

5 (or groups of such services). If the

6 Secretary estimates such unadjusted

7 copayment amount to be greater than

8 20 percent for any such service (or

9 group of such services) on or after

10 January 1, 2019, the Secretary shall,

11 for services furnished beginning on or

12 after January 1, 2002, reduce the

13 unadjusted copayment amount for

14 such service (or group of such serv15 ices) in equal increments each year,

16 from the amount applicable in 2001,

17 by an amount estimated by the Sec18 retary such that the unadjusted co19 payment amount shall equal 20 per20 cent beginning on or after January 1,

21 2019.’’.
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1 SEC. 202. APPLICATION OF TRANSITIONAL CORRIDOR TO

2 CERTAIN HOSPITALS THAT DID NOT SUBMIT

3 A 1996 COST REPORT.

4 (a) IN GENERAL.—Section 1833(t)(7)(F)(ii)(I) (42

5 U.S.C. 1395l(t)(7)(F)(ii)(I)) is amended by inserting ‘‘(or,

6 in the case of a hospital that did not submit a cost report

7 for such period, during the first cost reporting period end8 ing in a year after 1996 and before 2001 for which the

9 hospital submitted a cost report)’’ after ‘‘1996’’.

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

11 subsection (a) shall take effect as if included in the enact12 ment of section 202 of BBRA.

13 SEC. 203. PERMANENT GUARANTEE OF PRE-BBA PAYMENT

14 LEVELS FOR OUTPATIENT SERVICES FUR15 NISHED BY CHILDREN’S HOSPITALS.

16 (a) IN GENERAL.—Section 1833(t)(7)(D) (42 U.S.C.

17 1395l(t)(7)(D)), as amended by section 432, is

18 amended—

19 (1) in the heading, by inserting ‘‘, CHIL20 DREN’S,’’ after ‘‘SMALL RURAL’’; and

21 (2) by striking ‘‘section 1886(d)(1)(B)(v)’’ and

22 inserting ‘‘clause (iii) or (v) of section

23 1886(d)(1)(B)’’.

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

25 subsection (a) shall apply to services provided on or after
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1 the date that is 1 year after the date of enactment of this

2 Act.

3 Subtitle B—Provisions Relating to

4 Physicians

5 SEC. 211. LOAN DEFERMENT FOR RESIDENTS.

6 (a) FAIRNESS IN MEDICAL STUDENT LOAN FINANC7 ING.—

8 (1) ELIGIBILITY REQUIREMENTS.—Section

9 427(a)(2)(C)(iii) of the Higher Education Act of

10 1965 (20 U.S.C. 1077(a)(2)(C)(iii)) is amended by

11 inserting before the semicolon the following: ‘‘, ex12 cept that for a medical student such period shall not

13 exceed the full initial residency period’’.

14 (2) INSURANCE PROGRAM AGREEMENTS.—Sec15 tion 428(b)(1)(M)(iii) of the Higher Education Act

16 of 1965 (20 U.S.C. 1078(b)(1)(M)(iii)) is amended

17 by inserting before the semicolon the following: ‘‘,

18 except that for a medical student such period shall

19 not exceed the full initial residency period’’.

20 (3) DEFERMENT ELIGIBILITY.—Section

21 455(f)(2)(C) of the Higher Education Act of 1965

22 (20 U.S.C. 1087e(f)(2)(C)) is amended by inserting

23 before the period the following: ‘‘, except that for a

24 medical student such period shall not exceed the full

25 initial residency period’’.
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1 (4) CONTENTS OF LOAN AGREEMENT.—Section

2 464(c)(2)(A)(iii) of the Higher Education Act of

3 1965 (20 U.S.C. 1087dd(c)(2)(A)(iii)) is amended

4 by inserting before the semicolon the following: ‘‘,

5 except that for a medical student such period shall

6 not exceed the full initial residency period’’.

7 (b) FAIRNESS IN ECONOMIC HARDSHIP DETERMINA8 TION.—Section 435(o)(1)(B) of the Higher Education Act

9 of 1965 (20 U.S.C. 1085(o)(1)(B)) is amended to read

10 as follows:

11 ‘‘(B) such borrower is working full time

12 and has a Federal educational debt burden that

13 equals or exceeds 20 percent of such borrower’s

14 adjusted gross income, and the difference be15 tween such borrower’s adjusted gross income

16 minus such burden is less than 250 percent of

17 the greater of—

18 ‘‘(i) the annual earnings of an indi19 vidual earning the minimum wage under

20 section 6 of the Fair Labor Standards Act

21 of 1938; or

22 ‘‘(ii) the income official poverty line

23 (as defined by the Office of Management

24 and Budget, and revised annually in ac25 cordance with section 673(2) of the Com-
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1 munity Service Block Grant Act) applica2 ble to a family of 2; or’’.

3 SEC. 212. GAO STUDIES AND REPORTS ON MEDICARE PAY4 MENTS.

5 (a) GAO STUDY ON HCFA POST-PAYMENT AUDIT

6 PROCESS.—

7 (1) STUDY.—The Comptroller General of the

8 United States shall conduct a study of the post-pay9 ment audit process under the medicare program

10 under title XVIII of the Social Security Act (42

11 U.S.C. 1395 et seq.) (in this section referred to as

12 the ‘‘medicare program’’) as such process applies to

13 physicians, including the proper level of resources

14 that the Health Care Financing Administration

15 should devote to educating physicians regarding—

16 (A) coding and billing;

17 (B) documentation requirements; and

18 (C) the calculation of overpayments.

19 (2) REPORT.—Not later than 18 months after

20 the date of enactment of this Act, the Comptroller

21 General shall submit a report to the Secretary of

22 Health and Human Services and Congress on the

23 study conducted under paragraph (1) together with

24 specific recommendations for changes or improve-
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1 ments in the post-payment audit process described

2 in such paragraph.

3 (b) GAO STUDY ON ADMINISTRATION AND OVER4 SIGHT.—

5 (1) STUDY.—The Comptroller General of the

6 United States shall conduct a study on the aggre7 gate effects of regulatory, audit, oversight, and pa8 perwork burdens on physicians and other health care

9 providers participating in the medicare program.

10 (2) REPORT.—Not later than 18 months after

11 the date of enactment of this Act, the Comptroller

12 General shall submit a report to the Secretary of

13 Health and Human Services and Congress on the

14 study conducted under paragraph (1) together with

15 recommendations regarding any area in which—

16 (A) a reduction in paperwork, an ease of

17 administration, or an appropriate change in

18 oversight and review may be accomplished; or

19 (B) additional payments or education are

20 needed to assist physicians and other health

21 care providers in understanding and complying

22 with any legal or regulatory requirements.
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1 SEC. 213. MEDPAC STUDY ON THE RESOURCE-BASED PRAC2 TICE EXPENSE SYSTEM.

3 (a) STUDY.—The Medicare Payment Advisory Com4 mission established under section 1805 of the Social Secu5 rity Act (42 U.S.C. 1395b–6) (in this section referred to

6 as ‘‘MedPAC’’) shall conduct a study of the refinements

7 to the practice expense relative value units during the

8 transition to a resource-based practice expense system for

9 physician payments under the medicare program under

10 title XVIII of the Social Security Act (42 U.S.C. 1395

11 et seq.) (in this section referred to as the ‘‘medicare pro12 gram’’).

13 (b) REPORT.—Not later than July 1, 2001, MedPAC

14 shall submit a report to the Secretary of Health and

15 Human Services and Congress on the study conducted

16 under subsection (a) together with recommendations

17 regarding—

18 (1) any change or adjustment that is appro19 priate to ensure full access to a spectrum of care for

20 beneficiaries under the medicare program; and

21 (2) the appropriateness of payments to physi22 cians.
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1 Subtitle C—Ambulance Services

2 SEC. 221. ELECTION TO FOREGO PHASE-IN OF FEE SCHED3 ULE FOR AMBULANCE SERVICES.

4 Section 1834(l) (42 U.S.C. 1395m(l)) is amended by

5 adding at the end the following new paragraph:

6 ‘‘(8) ELECTION TO FOREGO PHASE-IN OF FEE

7 SCHEDULE.—

8 ‘‘(A) IN GENERAL.—If the Secretary pro9 vides for a phase-in of the fee schedule estab10 lished under this subsection, a supplier of am11 bulance services may make an election to re12 ceive payments based only on such fee schedule

13 at any time during such phase-in, and the Sec14 retary shall begin to make payments to the sup15 plier based only on such fee schedule not later

16 than the date that is 60 days after the date on

17 which the supplier notifies the Secretary of such

18 election.

19 ‘‘(B) WAIVER OF BUDGET NEUTRALITY.—

20 The Secretary shall apply paragraph (3)(A) as

21 if this paragraph had not been enacted.’’.

22 SEC. 222. PRUDENT LAYPERSON STANDARD FOR EMER23 GENCY AMBULANCE SERVICES.

24 (a) IN GENERAL.—Section 1861(s)(7) (42 U.S.C.

25 1395x(s)(7)) is amended by inserting before the semicolon
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1 at the end the following: ‘‘, except that such regulations

2 shall not fail to treat ambulance services as medical and

3 other health services solely because the ultimate diagnosis

4 of the individual receiving the ambulance services results

5 in a conclusion that ambulance services were not nec6 essary, as long as the request for ambulance services is

7 made after the sudden onset of a medical condition that

8 would be classified as an emergency medical condition (as

9 defined in section 1852(d)(3)(B)).’’.

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

11 this section shall apply with respect to ambulance services

12 provided on or after October 1, 2000.

13 SEC. 223. ELIMINATION OF REDUCTION IN INFLATION AD14 JUSTMENTS FOR AMBULANCE SERVICES.

15 Subparagraphs (A) and (B) of section 1834(l)(3) (42

16 U.S.C. 1395m(l)(3)(A)) are each amended by striking ‘‘re17 duced in the case of 2001 and 2002 by 1.0 percentage

18 points’’ and inserting ‘‘increased in the case of 2001 by

19 1.0 percentage point’’.

20 SEC. 224. STUDY AND REPORT ON THE COSTS OF RURAL

21 AMBULANCE SERVICES.

22 (a) STUDY.—The Secretary of Health and Human

23 Services (in this section referred to as the ‘‘Secretary’’),

24 in consultation with the Office of Rural Health Policy,

25 shall conduct a study of the means by which rural areas
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1 with low population densities can be identified for the pur2 pose of designating areas in which the cost of providing

3 ambulance services would be expected to be higher than

4 similar services provided in more heavily populated areas

5 because of low usage. Such study shall also include an

6 analysis of the additional costs of providing ambulance

7 services in areas designated under the previous sentence.

8 (b) REPORT.—Not later than June 30, 2001, the

9 Secretary shall submit a report to Congress on the study

10 conducted under subsection (a), together with a regulation

11 based on that study which adjusts the fee schedule pay12 ment rates for ambulance services provided in low density

13 rural areas based on the increased cost of providing such

14 services in such areas.

15 SEC. 225. INTERIM PAYMENTS FOR RURAL GROUND AMBU16 LANCE SERVICES UNTIL REGULATION IMPLE17 MENTED.

18 (a) INTERIM PAYMENTS.—Section 1834(l) (42

19 U.S.C. 1395m(l)), as amended by section 221, is amended

20 by adding at the end the following new paragraph:

21 ‘‘(9) INTERIM PAYMENTS FOR RURAL GROUND

22 AMBULANCE SERVICES.—Until such time as the fee

23 schedule established under this subsection is modi24 fied by the regulation described in section 224(b) of

25 the Medicare, Medicaid, and SCHIP Balanced
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1 Budget Refinement Act of 2000, the amount of pay2 ment under this subsection for ground ambulance

3 services provided in a rural area (as defined in sec4 tion 1886(d)(2)(D)) shall be the greater of—

5 ‘‘(A) the amount determined under the fee

6 schedule established under this subsection

7 (without regard to any phase-in established pur8 suant to paragraph (2)(E)); or

9 ‘‘(B) the amount that would have been

10 paid for such services if the amendments made

11 by section 4531(b) of the Balanced Budget Act

12 of 1997 had not been enacted;

13 as adjusted for inflation in the manner described in

14 paragraph (3)(B). For purposes of this paragraph,

15 an ambulance trip shall be considered to have been

16 provided in a rural area only if the transportation of

17 the patient originated in a rural area.’’.

18 (b) CONFORMING AMENDMENTS.—Section

19 1833(a)(1) (42 U.S.C. 1395l(a)(1)) is amended—

20 (1) in subparagraph (R)—

21 (A) by inserting ‘‘except as provided in

22 subparagraph (T),’’ before ‘‘with respect’’; and

23 (B) by striking ‘‘and’’ at the end; and

24 (2) in subparagraph (S), by striking the semi25 colon at the end and inserting ‘‘, and (T) with re-
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1 spect to ambulance services described in section

2 1834(l)(9), the amount paid shall be 80 percent of

3 the lesser of the actual charge for the services or the

4 amount determined under such section;’’.

5 (c) EFFECTIVE DATE.—The amendments made by

6 this section shall apply with respect to services provided

7 on and after January 1, 2001.

8 SEC. 226. GAO STUDY AND REPORT ON THE COSTS OF

9 EMERGENCY AND MEDICAL TRANSPOR10 TATION SERVICES.

11 (a) STUDY.—The Comptroller General of the United

12 States shall conduct a study of the costs of providing

13 emergency and medical transportation services across the

14 range of acuity levels of conditions for which such trans15 portation services are provided.

16 (b) REPORT.—Not later than 18 months after the

17 date of enactment of this Act, the Comptroller General

18 shall submit a report to the Secretary of Health and

19 Human Services and Congress on the study conducted

20 under subsection (a), together with recommendations for

21 any changes in methodology or payment level necessary

22 to fairly compensate suppliers of emergency and medical

23 transportation services and to ensure the access of bene24 ficiaries under the medicare program under title XVIII of
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1 the Social Security Act (42 U.S.C. 1395 et seq.) to such

2 services.

3 Subtitle D—Preventive Services

4 SEC. 231. ELIMINATION OF DEDUCTIBLES AND COINSUR5 ANCE FOR PREVENTIVE BENEFITS.

6 (a) IN GENERAL.—Section 1833 (42 U.S.C. 1395l)

7 is amended by inserting after subsection (o) the following

8 new subsection:

9 ‘‘(p) DEDUCTIBLES AND COINSURANCE WAIVED FOR

10 PREVENTIVE BENEFITS.—The Secretary may not require

11 the payment of any deductible or coinsurance under sub12 section (a) or (b) of any individual enrolled for coverage

13 under this part for any of the following preventive health

14 care items and services:

15 ‘‘(1) Blood-testing strips, lancets, and blood

16 glucose monitors for individuals with diabetes de17 scribed in section 1861(n).

18 ‘‘(2) Diabetes outpatient self-management

19 training services (as defined in section 1861(qq)(1)).

20 ‘‘(3) Pneumococcal, influenza, and hepatitis B

21 vaccines and administration described in section

22 1861(s)(10).

23 ‘‘(4) Screening mammography (as defined in

24 section 1861(jj)).
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1 ‘‘(5) Screening pap smear and screening pelvic

2 exam (as defined in paragraphs (1) and (2) of sec3 tion 1861(nn), respectively).

4 ‘‘(6) Bone mass measurement (as defined in

5 section 1861(rr)(1)).

6 ‘‘(7) Prostate cancer screening test (as defined

7 in section 1861(oo)(1)).

8 ‘‘(8) Colorectal cancer screening test (as de9 fined in section 1861(pp)(1)).’’.

10 (b) WAIVER OF COINSURANCE.—Section

11 1833(a)(1)(B) (42 U.S.C. 1395l(a)(1)(B)) is amended to

12 read as follows: ‘‘(B) with respect to preventive health care

13 items and services described in subsection (p), the

14 amounts paid shall be 100 percent of the fee schedule or

15 other basis of payment under this title,’’.

16 (c) WAIVER OF DEDUCTIBLE.—Section 1833(b)(1)

17 (42 U.S.C. 1395l(b)(1)) is amended to read as follows:

18 ‘‘(1) such deductible shall not apply with respect to pre19 ventive health care items and services described in sub20 section (p),’’.

21 (d) ADDING ‘‘LANCET’’ TO DEFINITION OF DME.—

22 Section 1861(n) (42 U.S.C. 1395x(n)) is amended by

23 striking ‘‘blood-testing strips and blood glucose monitors’’

24 and inserting ‘‘blood-testing strips, lancets, and blood glu25 cose monitors’’.
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1 (e) CONFORMING AMENDMENTS.—

2 (1) ELIMINATION OF COINSURANCE FOR CLIN3 ICAL DIAGNOSTIC LABORATORY TESTS.—Paragraphs

4 (1)(D)(i) and (2)(D)(i) of section 1833(a) (42

5 U.S.C. 1395l(a)) are each amended—

6 (A) by striking ‘‘basis or which’’ and in7 serting ‘‘basis, which’’; and

8 (B) by inserting ‘‘, or which are described

9 in subsection (p)’’ after ‘‘critical access hos10 pital’’.

11 (2) ELIMINATION OF COINSURANCE FOR CER12 TAIN DME.—Section 1834(a)(1)(A) (42 U.S.C.

13 1395m(a)(1)(A)) is amended by inserting ‘‘(or 100

14 percent, in the case of such an item described in sec15 tion 1833(p))’’ after ‘‘80 percent’’.

16 (3) ELIMINATION OF COINSURANCE FOR

17 SCREENING MAMMOGRAPHY.—Section 1834(c)(1)(C)

18 (42 U.S.C. 1395m(c)(1)(C)) is amended by striking

19 ‘‘80 percent’’ and inserting ‘‘100 percent’’.

20 (4) ELIMINATION OF DEDUCTIBLES AND COIN21 SURANCE FOR COLORECTAL CANCER SCREENING

22 TESTS.—Section 1834(d) (42 U.S.C. 1395m(d)) is

23 amended—

24 (A) in paragraph (2)(C)—

25 (i) by striking clause (ii);
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1 (ii) by striking ‘‘FACILITY PAYMENT

2 LIMIT.—’’ and all that follows through

3 ‘‘Notwithstanding’’ and inserting ‘‘FACIL4 ITY PAYMENT LIMIT.—Notwithstanding’’;

5 and

6 (iii) by redesignating subclauses (I)

7 and (II) as clauses (i) and (ii), respec8 tively; and

9 (B) in paragraph (3)(C)—

10 (i) by striking clause (ii); and

11 (ii) by striking ‘‘FACILITY PAYMENT

12 LIMIT.—’’ and all that follows through

13 ‘‘Notwithstanding’’ and inserting ‘‘FACIL14 ITY PAYMENT LIMIT.—Notwithstanding’’.

15 (f) EFFECTIVE DATE.—The amendments made by

16 this section shall apply to items and services furnished on

17 or after July 1, 2001.

18 SEC. 232. COUNSELING FOR CESSATION OF TOBACCO USE.

19 (a) COVERAGE.—Section 1861(s)(2) (42 U.S.C.

20 1395x(s)(2)) is amended—

21 (1) in subparagraph (S), by striking ‘‘and’’ at

22 the end;

23 (2) in subparagraph (T), by inserting ‘‘and’’ at

24 the end; and
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1 (3) by adding at the end the following new sub2 paragraph:

3 ‘‘(U) counseling for cessation of tobacco use (as

4 defined in subsection (uu)) for individuals who have

5 a history of tobacco use;’’.

6 (b) SERVICES DESCRIBED.—Section 1861 (42 U.S.C.

7 1395x) is amended by adding at the end the following new

8 subsection:

9 ‘‘Counseling for Cessation of Tobacco Use

10 ‘‘(uu)(1) Except as provided in paragraph (2), the

11 term ‘counseling for cessation of tobacco use’ means diag12 nostic, therapy, and counseling services for cessation of

13 tobacco use which are furnished—

14 ‘‘(A) by or under the supervision of a physician;

15 or

16 ‘‘(B) by any other health care professional who

17 is legally authorized to furnish such services under

18 State law (or the State regulatory mechanism pro19 vided by State law) of the State in which the serv20 ices are furnished, as would otherwise be covered if

21 furnished by a physician or as an incident to a phy22 sician’s professional service.

23 ‘‘(2) The term ‘counseling for cessation of tobacco

24 use’ does not include coverage for drugs or biologicals that

25 are not otherwise covered under this title.’’.
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1 (c) ELIMINATION OF COST-SHARING.—

2 (1) ELIMINATION OF COINSURANCE.—Section

3 1833(a)(1) (42 U.S.C. 1395l(a)(1)), as amended by

4 section 225(b), is amended—

5 (A) by striking ‘‘and’’ before ‘‘(T)’’; and

6 (B) by inserting before the semicolon at

7 the end the following: ‘‘, and (U) with respect

8 to counseling for cessation of tobacco use (as

9 defined in section 1861(uu)), the amount paid

10 shall be 100 percent of the lesser of the actual

11 charge for the services or the amount deter12 mined by a fee schedule established by the Sec13 retary for the purposes of this subparagraph’’.

14 (2) ELIMINATION OF DEDUCTIBLE.—The first

15 sentence of section 1833(b) (42 U.S.C. 1395l(b)) is

16 amended—

17 (A) by striking ‘‘and’’ before ‘‘(6)’’; and

18 (B) by inserting before the period the fol19 lowing: ‘‘, and (7) such deductible shall not

20 apply with respect to counseling for cessation of

21 tobacco use (as defined in section 1861(uu))’’.

22 (d) EFFECTIVE DATE.—The amendments made by

23 this section shall apply to services furnished on or after

24 July 1, 2001.
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1 SEC. 233. COVERAGE OF GLAUCOMA DETECTION TESTS.

2 (a) IN GENERAL.—Section 1861 (42 U.S.C. 1395x),

3 as amended by section 232, is amended—

4 (1) in subsection (s)(2)—

5 (A) in subparagraph (T), by striking

6 ‘‘and’’ at the end;

7 (B) in subparagraph (U), by inserting

8 ‘‘and’’ at the end; and

9 (C) by adding at the end the following new

10 subparagraph:

11 ‘‘(V) glaucoma detection tests (as defined in

12 subsection (vv));’’; and

13 (2) by adding at the end the following new sub14 section:

15 ‘‘Glaucoma Detection Tests

16 ‘‘(vv) The term ‘glaucoma detection test’ means all

17 of the following conducted for the purpose of early detec18 tion of glaucoma:

19 ‘‘(1) A dilated eye examination with an intra20 ocular pressure measurement.

21 ‘‘(2) Direct ophthalmoscopy or slit-lamp bio22 microscopic examination.’’.

23 (b) LIMITATION ON ELIGIBILITY AND FREQUENCY.—

24 Section 1834 (42 U.S.C. 1395m) is amended by adding

25 at the end the following new subsection:
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1 ‘‘(m) LIMITATION ON COVERAGE OF GLAUCOMA DE2 TECTION TESTS.—

3 ‘‘(1) IN GENERAL.—Notwithstanding any other

4 provision of this part, with respect to expenses in5 curred for glaucoma detection tests (as defined in

6 section 1861(vv)), payment may be made only for

7 glaucoma detection tests conducted—

8 ‘‘(A) for individuals described in paragraph

9 (2); and

10 ‘‘(B) consistent with the frequency per11 mitted under paragraph (3).

12 ‘‘(2) INDIVIDUALS ELIGIBLE FOR BENEFIT.—

13 Individuals described in this paragraph are as fol14 lows:

15 ‘‘(A) Individuals who are 60 years of age

16 or older and who have a family history of glau17 coma.

18 ‘‘(B) Other individuals who are at high

19 risk (as determined by the Secretary) of devel20 oping glaucoma.

21 ‘‘(3) FREQUENCY LIMIT.—

22 ‘‘(A) IN GENERAL.—Subject to subpara23 graph (B), payment may not be made under

24 this part for a glaucoma detection test per25 formed for an individual within 23 months fol-
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1 lowing the month in which a glaucoma detection

2 test was performed under this part for the indi3 vidual.

4 ‘‘(B) EXCEPTION.—The Secretary may

5 permit a glaucoma detection test to be covered

6 on a more frequent basis than that provided

7 under subparagraph (A) under such cir8 cumstances as the Secretary determines to be

9 appropriate.’’.

10 (c) NO APPLICATION OF DEDUCTIBLE.—Section

11 1833(b)(5) (42 U.S.C. 1395l(b)(5)) is amended by insert12 ing ‘‘or with respect to glaucoma detection tests (as de13 fined in section 1861(vv))’’ after ‘‘1861(jj))’’.

14 (d) CONFORMING AMENDMENTS.—Section 1862(a)

15 (42 U.S.C. 1395y(a)) is amended—

16 (1) in paragraph (1)—

17 (A) in subparagraph (H), by striking

18 ‘‘and’’ at the end;

19 (B) in subparagraph (I), by striking the

20 semicolon at the end and inserting ‘‘, and’’; and

21 (C) by adding at the end the following new

22 subparagraph:

23 ‘‘(J) in the case of glaucoma detection tests (as

24 defined in section 1861(vv)), which are furnished to

25 an individual not described in paragraph (2) of sec-
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1 tion 1834(m) or which are performed more fre2 quently than is covered under paragraph (3) of such

3 section;’’; and

4 (2) in paragraph (7), by striking ‘‘or (H)’’ and

5 inserting ‘‘(H), or (I)’’.

6 (e) EFFECTIVE DATE.—The amendments made by

7 this section apply to tests provided on or after July 1,

8 2001.

9 SEC. 234. MEDICAL NUTRITION THERAPY SERVICES FOR

10 BENEFICIARIES WITH DIABETES, A CARDIO11 VASCULAR DISEASE, OR A RENAL DISEASE.

12 (a) COVERAGE.—Section 1861(s)(2) (42 U.S.C.

13 1395x(s)(2)), as amended by section 233(a), is amended—

14 (1) in subparagraph (U) by striking ‘‘and’’ at

15 the end;

16 (2) in subparagraph (V) by inserting ‘‘and’’ at

17 the end; and

18 (3) by adding at the end the following new sub19 paragraph:

20 ‘‘(W) medical nutrition therapy services (as de21 fined in subsection (ww)(1)) in the case of a bene22 ficiary with diabetes, a cardiovascular disease (in23 cluding congestive heart failure, arteriosclerosis,

24 hyperlipidemia, hypertension, and

25 hypercholesterolemia), or a renal disease;’’.
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1 (b) SERVICES DESCRIBED.—Section 1861 (42 U.S.C.

2 1395x), as amended by section 233(a), is amended by add3 ing at the end the following new subsection:

4 ‘‘Medical Nutrition Therapy Services; Registered

5 Dietitian or Nutrition Professional

6 ‘‘(ww)(1) The term ‘medical nutrition therapy serv7 ices’ means nutritional diagnostic, therapy, and counseling

8 services for the purpose of disease management which are

9 furnished by a registered dietitian or nutrition profes10 sional (as defined in paragraph (2)) pursuant to a referral

11 by a physician (as defined in subsection (r)(1)).

12 ‘‘(2) Subject to paragraph (3), the term ‘registered

13 dietitian or nutrition professional’ means an individual

14 who—

15 ‘‘(A) holds a baccalaureate or higher degree

16 granted by a regionally accredited college or univer17 sity in the United States (or an equivalent foreign

18 degree) with completion of the academic require19 ments of a program in nutrition or dietetics, as ac20 credited by an appropriate national accreditation or21 ganization recognized by the Secretary for this pur22 pose;

23 ‘‘(B) has completed at least 900 hours of super24 vised dietetics practice under the supervision of a

25 registered dietitian or nutrition professional; and
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1 ‘‘(C)(i) is licensed or certified as a dietitian or

2 nutrition professional by the State in which the serv3 ices are performed; or

4 ‘‘(ii) in the case of an individual in a State that

5 does not provide for such licensure or certification,

6 meets such other criteria as the Secretary estab7 lishes.

8 ‘‘(3) Subparagraphs (A) and (B) of paragraph (2)

9 shall not apply in the case of an individual who, as of the

10 date of enactment of this subsection, is licensed or cer11 tified as a dietitian or nutrition professional by the State

12 in which medical nutrition therapy services are per13 formed.’’.

14 (c) PAYMENT.—Section 1833(a)(1) (42 U.S.C.

15 1395l(a)(1)), as amended by section 232(c)(1), is

16 amended—

17 (1) by striking ‘‘and’’ before ‘‘(U)’’; and

18 (2) by inserting before the semicolon at the end

19 the following: ‘‘, and (V) with respect to medical nu20 trition therapy services (as defined in section

21 1861(ww)), the amount paid shall be 85 percent of

22 the lesser of the actual charge for the services or the

23 amount determined under the fee schedule estab24 lished under section 1848(b) for the same services if

25 furnished by a physician’’.
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1 (d) EFFECTIVE DATE.—The amendments made by

2 this section apply to services furnished on or after July

3 1, 2001.

4 SEC. 235. STUDIES ON PREVENTIVE INTERVENTIONS IN

5 PRIMARY CARE FOR OLDER AMERICANS.

6 (a) STUDIES.—The Secretary of Health and Human

7 Services, acting through the United States Preventive

8 Services Task Force, shall conduct a series of studies de9 signed to identify preventive interventions that can be de10 livered in the primary care setting that are most valuable

11 to older Americans.

12 (b) MISSION STATEMENT.—The mission statement of

13 the United States Preventive Services Task Force is

14 amended to include the evaluation of services that are of

15 particular relevance to older Americans.

16 (c) REPORT.—Not later than 1 year after the date

17 of enactment of this Act, and annually thereafter, the Sec18 retary of Health and Human Services shall submit a re19 port to Congress on the conclusions of the studies con20 ducted under subsection (a), together with recommenda21 tions for such legislation and administrative actions as the

22 Secretary considers appropriate.

23 SEC. 236. INSTITUTE OF MEDICINE 5-YEAR MEDICARE PRE24 VENTION BENEFIT STUDY AND REPORT.

25 (a) STUDY.—
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1 (1) IN GENERAL.—The Secretary of Health and

2 Human Services shall contract with the Institute of

3 Medicine of the National Academy of Sciences to

4 conduct a comprehensive study of current literature

5 and best practices in the field of health promotion

6 and disease prevention among medicare beneficiaries

7 including the issues described in paragraph (2) and

8 to submit the report described in subsection (b).

9 (2) ISSUES STUDIED.—The study required

10 under paragraph (1) shall include an assessment

11 of—

12 (A) whether each covered benefit is—

13 (i) medically effective; and

14 (ii) a cost-effective benefit or a cost15 saving benefit;

16 (B) utilization of covered benefits (includ17 ing any barriers to or incentives to increase uti18 lization); and

19 (C) quality of life issues associated with

20 both health promotion and disease prevention

21 benefits covered under the medicare program

22 and those that are not covered under such pro23 gram that would affect all medicare bene24 ficiaries.

25 (b) REPORT.—
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1 (1) IN GENERAL.—Not later than 5 years after

2 the date of enactment of this section, and every fifth

3 year thereafter, the Institute of Medicine of the Na4 tional Academy of Sciences shall submit to the

5 President a report that contains a detailed state6 ment of the findings and conclusions of the study

7 conducted under subsection (a) and the rec8 ommendations for legislation described in paragraph

9 (2).

10 (2) RECOMMENDATIONS FOR LEGISLATION.—

11 The Institute of Medicine of the National Academy

12 of Sciences, in consultation with the Partnership for

13 Prevention, shall develop recommendations in legis14 lative form that—

15 (A) prioritize the preventive benefits under

16 the medicare program; and

17 (B) modify preventive benefits offered

18 under the medicare program based on the study

19 conducted under subsection (a).

20 (c) TRANSMISSION TO CONGRESS.—

21 (1) IN GENERAL.—On the day on which the re22 port described in subsection (b) is submitted to the

23 President, the President shall transmit the report

24 and recommendations in legislative form described in

25 subsection (b)(2) to Congress.
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1 (2) DELIVERY.—Copies of the report and rec2 ommendations in legislative form required to be

3 transmitted to Congress under paragraph (1) shall

4 be delivered—

5 (A) to both Houses of Congress on the

6 same day;

7 (B) to the Clerk of the House of Rep8 resentatives if the House is not in session; and

9 (C) to the Secretary of the Senate if the

10 Senate is not in session.

11 (d) DEFINITIONS.—In this section:

12 (1) COST-EFFECTIVE BENEFIT.—The term

13 ‘‘cost-effective benefit’’ means a benefit or technique

14 that has—

15 (A) been subject to peer review;

16 (B) been described in scientific journals;

17 and

18 (C) demonstrated value as measured by

19 unit costs relative to health outcomes achieved.

20 (2) COST-SAVING BENEFIT.—The term ‘‘cost21 saving benefit’’ means a benefit or technique that

22 has—

23 (A) been subject to peer review;

24 (B) been described in scientific journals;

25 and
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1 (C) caused a net reduction in health care

2 costs for medicare beneficiaries.

3 (3) MEDICALLY EFFECTIVE.—The term ‘‘medi4 cally effective’’ means, with respect to a benefit or

5 technique, that the benefit or technique has been—

6 (A) subject to peer review;

7 (B) described in scientific journals; and

8 (C) determined to achieve an intended goal

9 under normal programmatic conditions.

10 (4) MEDICARE BENEFICIARY.—The term

11 ‘‘medicare beneficiary’’ means any individual who is

12 entitled to benefits under part A or enrolled under

13 part B of the medicare program, including any indi14 vidual enrolled in a Medicare+Choice plan offered

15 by a Medicare+Choice organization under part C of

16 such program.

17 (5) MEDICARE PROGRAM.—The term ‘‘medicare

18 program’’ means the health benefits program under

19 title XVIII of the Social Security Act (42 U.S.C.

20 1395 et seq.).

21 SEC. 237. FAST-TRACK CONSIDERATION OF PREVENTION

22 BENEFIT LEGISLATION.

23 (a) RULES OF HOUSE OF REPRESENTATIVES AND

24 SENATE.—This section is enacted by Congress—
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1 (1) as an exercise of the rulemaking power of

2 the House of Representatives and the Senate, re3 spectively, and is deemed a part of the rules of each

4 House of Congress, but—

5 (A) is applicable only with respect to the

6 procedure to be followed in that House of Con7 gress in the case of an implementing bill (as de8 fined in subsection (d)); and

9 (B) supersedes other rules only to the ex10 tent that such rules are inconsistent with this

11 section; and

12 (2) with full recognition of the constitutional

13 right of either House of Congress to change the

14 rules (so far as relating to the procedure of that

15 House of Congress) at any time, in the same man16 ner and to the same extent as in the case of any

17 other rule of that House of Congress.

18 (b) INTRODUCTION AND REFERRAL.—

19 (1) INTRODUCTION.—

20 (A) IN GENERAL.—Subject to paragraph

21 (2), on the day on which the President trans22 mits the report pursuant to section 236(c) to

23 the House of Representatives and the Senate,

24 the recommendations in legislative form trans25 mitted by the President with respect to such re-
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1 port shall be introduced as a bill (by request)

2 in the following manner:

3 (i) HOUSE OF REPRESENTATIVES.—In

4 the House of Representatives, by the Ma5 jority Leader, for himself and the Minority

6 Leader, or by Members of the House of

7 Representatives designated by the Majority

8 Leader and Minority Leader.

9 (ii) SENATE.—In the Senate, by the

10 Majority Leader, for himself and the Mi11 nority Leader, or by Members of the Sen12 ate designated by the Majority Leader and

13 Minority Leader.

14 (B) SPECIAL RULE.—If either House of

15 Congress is not in session on the day on which

16 such recommendations in legislative form are

17 transmitted, the recommendations in legislative

18 form shall be introduced as a bill in that House

19 of Congress, as provided in subparagraph (A),

20 on the first day thereafter on which that House

21 of Congress is in session.

22 (2) REFERRAL.—Such bills shall be referred by

23 the presiding officers of the respective Houses to the

24 appropriate committee, or, in the case of a bill con25 taining provisions within the jurisdiction of 2 or
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1 more committees, jointly to such committees for con2 sideration of those provisions within their respective

3 jurisdictions.

4 (c) CONSIDERATION.—After the recommendations in

5 legislative form have been introduced as a bill and referred

6 under subsection (b), such implementing bill shall be con7 sidered in the same manner as an implementing bill is con8 sidered under subsections (d), (e), (f), and (g) of section

9 151 of the Trade Act of 1974 (19 U.S.C. 2191).

10 (d) IMPLEMENTING BILL DEFINED.—In this section,

11 the term ‘‘implementing bill’’ means only the recommenda12 tions in legislative form of the Institute of Medicine of the

13 National Academy of Sciences described in section

14 236(b)(2), transmitted by the President to the House of

15 Representatives and the Senate under section 236(c), and

16 introduced and referred as provided in subsection (b) as

17 a bill of either House of Congress.

18 (e) COUNTING OF DAYS.—For purposes of this sec19 tion, any period of days referred to in section 151 of the

20 Trade Act of 1974 shall be computed by excluding—

21 (1) the days on which either House of Congress

22 is not in session because of an adjournment of more

23 than 3 days to a day certain or an adjournment of

24 Congress sine die; and
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1 (2) any Saturday and Sunday, not excluded

2 under paragraph (1), when either House is not in

3 session.

4 Subtitle E—Other Services

5 SEC. 241. REVISION OF MORATORIUM IN CAPS FOR THER6 APY SERVICES.

7 (a) EXTENSION OF MORATORIUM.—Section

8 1833(g)(4) (42 U.S.C. 1395l(g)(4)) is amended by strik9 ing ‘‘during 2000 and 2001’’ and inserting ‘‘during the

10 period beginning on January 1, 2000, and ending on the

11 date that is 18 months after the date the Secretary sub12 mits the report required under section 4541(d)(2) of the

13 Balanced Budget Act of 1997 to Congress’’.

14 (b) EXTENSION OF REPORTING DATE.—Section

15 4541(d)(2) of BBA (42 U.S.C. 1395l note), as amended

16 by section 221(c) of BBRA (113 Stat. 1501A–351), is

17 amended by striking ‘‘January 1, 2001’’ and inserting

18 ‘‘January 1, 2002’’.

19 SEC. 242. REVISION OF COVERAGE OF IMMUNO20 SUPPRESSIVE DRUGS.

21 (a) REVISION.—

22 (1) IN GENERAL.—Section 1861(s)(2)(J) (42

23 U.S.C. 1395x(s)(2)(J)) is amended to read as fol24 lows:
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1 ‘‘(J) prescription drugs used in immuno2 suppressive therapy furnished—

3 ‘‘(i) on or after the date of enactment of

4 the Medicare, Medicaid, and SCHIP Balanced

5 Budget Refinement Act of 2000 and before

6 January 1, 2004, to an individual who has re7 ceived an organ transplant; and

8 ‘‘(ii) on or after January 1, 2004, to an in9 dividual who receives an organ transplant for

10 which payment is made under this title, but

11 only in the case of drugs furnished within 36

12 months after the date of the transplant proce13 dure.’’.

14 (2) CONFORMING AMENDMENTS.—

15 (A) EXTENDED COVERAGE.—Section 1832

16 (42 U.S.C. 1395k) is amended—

17 (i) by striking subsection (b); and

18 (ii) by redesignating subsection (c) as

19 subsection (b).

20 (B) PASS-THROUGH; REPORT.—Sub21 sections (c) and (d) of section 227 of BBRA

22 (113 Stat. 1501A–355) are repealed.

23 (3) EFFECTIVE DATE.—The amendments made

24 by this subsection shall apply to drugs furnished on

25 or after the date of enactment of this Act.
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1 (b) EXTENSION OF CERTAIN SECONDARY PAYER RE2 QUIREMENTS.—Section 1862(b)(1)(C) (42 U.S.C.

3 1395y(b)(1)(C)) is amended by adding at the end the fol4 lowing: ‘‘With regard to immunosuppressive drugs fur5 nished on or after the date of enactment of the Medicare,

6 Medicaid, and SCHIP Balanced Budget Refinement Act

7 of 2000 and before January 1, 2004, this subparagraph

8 shall be applied without regard to any time limitation.’’.

9 SEC. 243. STATE ACCREDITATION OF DIABETES SELF-MAN10 AGEMENT TRAINING PROGRAMS.

11 Section 1861(qq)(2) of the Social Security Act (42

12 U.S.C. 1395xx(qq)(2)) is amended—

13 (1) in the matter preceding subparagraph (A),

14 by striking ‘‘paragraph (1)—’’ and inserting ‘‘para15 graph (1):’’;

16 (2) in subparagraph (A)—

17 (A) by striking ‘‘a ‘certified provider’ ’’ and

18 inserting ‘‘A ‘certified provider’ ’’; and

19 (B) by striking ‘‘; and’’ and inserting a pe20 riod; and

21 (3) in subparagraph (B)—

22 (A) by striking ‘‘a physician, or such other

23 individual’’ and inserting ‘‘(i) A physician, or

24 such other individual’’;
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1 (B) by inserting ‘‘(I)’’ before ‘‘meets appli2 cable standards’’;

3 (C) by inserting ‘‘(II)’’ before ‘‘is recog4 nized’’;

5 (D) by inserting ‘‘, or by a program de6 scribed in clause (ii),’’ after ‘‘recognized by an

7 organization that represents individuals (includ8 ing individuals under this title) with diabetes’’;

9 and

10 (E) by adding at the end the following new

11 clause:

12 ‘‘(ii) Notwithstanding any reference to ‘a na13 tional accreditation body’ in section 1865(b), for

14 purposes of clause (i), a program described in this

15 clause is a program operated by a State for the pur16 poses of accrediting diabetes self-management train17 ing programs, if the Secretary determines that such

18 State program has established quality standards

19 that meet or exceed the standards established by the

20 Secretary under clause (i) or the standards origi21 nally established by the National Diabetes Advisory

22 Board and subsequently revised as described in

23 clause (i).’’.
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1 SEC. 244. ELIMINATION OF REDUCTION IN PAYMENT

2 AMOUNTS FOR DURABLE MEDICAL EQUIP3 MENT AND OXYGEN AND OXYGEN EQUIP4 MENT.

5 (a) UPDATE FOR COVERED ITEMS.—Section

6 1834(a)(14)(C) (42 U.S.C. 1395m(a)(14)(C)) is amended

7 by striking ‘‘through 2002’’ and inserting ‘‘through

8 2000’’.

9 (b) ORTHOTICS AND PROSTHETICS.—Section

10 1834(h)(4)(A)(v) (42 U.S.C. 1395m(h)(4)(A)(v)) is

11 amended by striking ‘‘through 2002’’ and inserting

12 ‘‘through 2000’’.

13 (c) PARENTERAL AND ENTERAL NUTRIENTS, SUP14 PLIES, AND EQUIPMENT.—Section 4551(b) of BBA (42

15 U.S.C. 1395m note) is amended by striking ‘‘through

16 2002’’ and inserting ‘‘through 2000’’.

17 (d) OXYGEN AND OXYGEN EQUIPMENT.—Section

18 1834(a)(9)(B) (42 U.S.C. 1395m(a)(9)(B)) is amended—

19 (1) in clause (v), by striking ‘‘and’’ at the end;

20 (2) in clause (vi)—

21 (A) by striking ‘‘each subsequent year’’

22 and inserting ‘‘2000’’; and

23 (B) by striking the period at the end and

24 inserting ‘‘; and’’; and

25 (3) by adding at the end the following new

26 clause:
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1 ‘‘(vii) for 2001 and each subsequent

2 year, the amount determined under this

3 subparagraph for the preceding year in4 creased by the covered item update for

5 such subsequent year.’’.

6 (e) CONFORMING AMENDMENT.—Section 228 of

7 BBRA (113 Stat. 1501A–356) is repealed.

8 SEC. 245. STANDARDS REGARDING PAYMENT FOR CERTAIN

9 ORTHOTICS AND PROSTHETICS.

10 (a) STANDARDS.—

11 (1) IN GENERAL.—Section 1834(h)(1) (42

12 U.S.C. 1395m(h)(1)) is amended by adding at the

13 end the following:

14 ‘‘(F) ESTABLISHMENT OF STANDARDS FOR

15 CERTAIN ITEMS.—

16 ‘‘(i) IN GENERAL.—No payment shall

17 be made for an applicable item unless such

18 item is provided by a qualified practitioner

19 or a qualified supplier under the system es20 tablished by the Secretary under clause

21 (iii). For purposes of the preceding sen22 tence, if a qualified practitioner or a quali23 fied supplier contracts with an entity to

24 provide an applicable item, then no pay-
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1 ment shall be made for such item unless

2 the entity is also a qualified supplier.

3 ‘‘(ii) DEFINITIONS.—In this

4 subparagraph—

5 ‘‘(I) APPLICABLE ITEM.—The

6 term ‘applicable item’ means orthotics

7 and prosthetics that require edu8 cation, training, and experience to

9 custom fabricate such item. Such

10 term does not include shoes and shoe

11 inserts.

12 ‘‘(II) QUALIFIED PRACTI13 TIONER.—The term ‘qualified practi14 tioner’ means a physician or health

15 professional who meets any of the fol16 lowing requirements:

17 ‘‘(aa) The physician or

18 health professional is specifically

19 trained and educated to provide

20 or manage the provision of cus21 tom-designed, fabricated, modi22 fied, and fitted orthotics and

23 prosthetics, and is either certified

24 by the American Board for Cer25 tification in Orthotics and Pros-
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1 thetics, Inc., certified by the

2 Board for Orthotist/Prosthetist

3 Certification, or credentialed and

4 approved by a program that the

5 Secretary determines, in con6 sultation with appropriate ex7 perts in orthotics and prosthetics,

8 has training and education stand9 ards that are necessary to pro10 vide applicable items.

11 ‘‘(bb) The physician or

12 health professional is licensed in

13 orthotics or prosthetics by the

14 State in which the applicable

15 item is supplied, but only if the

16 Secretary determines that the

17 mechanisms used by the State to

18 provide such licensure meet

19 standards determined appropriate

20 by the Secretary.

21 ‘‘(cc) The physician or

22 health professional has completed

23 at least 10 years practice in the

24 provision of applicable items. A

25 physician or health professional
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1 may not qualify as a qualified

2 practitioner under the preceding

3 sentence with respect to an appli4 cable item if the item was pro5 vided on or after January 1,

6 2005.

7 ‘‘(III) QUALIFIED SUPPLIER.—

8 The term ‘qualified supplier’ means

9 any entity that is—

10 ‘‘(aa) accredited by the

11 American Board for Certification

12 in Orthotics and Prosthetics, Inc.

13 or the Board for Orthotist/Pros14 thetist Certification; or

15 ‘‘(bb) accredited and ap16 proved by a program that the

17 Secretary determines has accredi18 tation and approval standards

19 that are essentially equivalent to

20 those of such Board.

21 ‘‘(iii) SYSTEM.—The Secretary, in

22 consultation with appropriate experts in

23 orthotics and prosthetics, shall establish a

24 system under which the Secretary shall—
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1 ‘‘(I) determine which items are

2 applicable items and formulate a list

3 of such items;

4 ‘‘(II) review the applicable items

5 billed under the coding system estab6 lished under this title; and

7 ‘‘(III) limit payment for applica8 ble items pursuant to clause (i).’’.

9 (2) EFFECTIVE DATE.—The amendment made

10 by paragraph (1) shall apply to items provided on or

11 after January 1, 2003.

12 (b) REVISION OF DEFINITION OF ORTHOTICS.—

13 (1) IN GENERAL.—Section 1861(s)(9) (42

14 U.S.C. 1395x(s)(9)) is amended by inserting ‘‘(in15 cluding such braces that are used in conjunction

16 with, or as components of, other medical or non17 medical equipment when provided by a qualified

18 practitioner (as defined in subclause (II) of section

19 1834(h)(1)(F))) or a qualified supplier (as defined

20 in subclause (III) of such section)’’ after ‘‘braces’’.

21 (2) EFFECTIVE DATE.—The amendment made

22 by paragraph (1) shall apply to items provided on or

23 after January 1, 2003.
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1 SEC. 246. NATIONAL LIMITATION AMOUNT EQUAL TO 100

2 PERCENT OF NATIONAL MEDIAN FOR NEW

3 PAP SMEAR TECHNOLOGIES AND OTHER NEW

4 CLINICAL LABORATORY TEST TECH5 NOLOGIES.

6 Section 1833(h)(4)(B)(viii) (42 U.S.C.

7 1395l(h)(4)(B)(viii)) is amended by inserting before the

8 period at the end the following: ‘‘(or 100 percent of such

9 median in the case of a clinical diagnostic laboratory test

10 performed on or after January 1, 2001, that the Secretary

11 determines is a new test for which no limitation amount

12 has previously been established under this subpara13 graph)’’.

14 SEC. 247. INCREASED MEDICARE PAYMENTS FOR CER15 TIFIED NURSE-MIDWIFE SERVICES.

16 (a) AMOUNT OF PAYMENT.—Section 1833(a)(1)(K)

17 (42 U.S.C. 1395l(a)(1)(K)) is amended by striking ‘‘65

18 percent of the prevailing charge that would be allowed for

19 the same service performed by a physician, or, for services

20 furnished on or after January 1, 1992, 65 percent’’ and

21 inserting ‘‘85 percent’’.

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

23 subsection (a) shall apply to services furnished on or after

24 January 1, 2001.
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1 SEC. 248. PAYMENT FOR ADMINISTRATION OF DRUGS.

2 (a) REVIEW OF CHEMOTHERAPY ADMINISTRATION

3 PRACTICE EXPENSES RVUS.—The Secretary of Health

4 and Human Services shall review the resource-based prac5 tice expense component of relative value units under the

6 physician fee schedule under section 1848 of the Social

7 Security Act (42 U.S.C. 1395w–4) for chemotherapy ad8 ministration services to determine if such units should be

9 increased.

10 (b) MORE ACCURATE CHEMOTHERAPY DRUG PAY11 MENTS TIED TO INCREASES IN CHEMOTHERAPY ADMINIS12 TRATION PAYMENTS.—If the Secretary of Health and

13 Human Services determines, as a result of the review

14 under subsection (a), that the resource-based practice ex15 pense relative value units for chemotherapy administration

16 services should be increased, the Secretary—

17 (1) may implement such increases for such

18 services, but only if the Secretary simultaneously im19 plements more accurate average wholesale prices for

20 chemotherapy drugs (but in no case shall such si21 multaneous implementation occur prior to January

22 1, 2002); and

23 (2) if the Secretary implements such increases

24 for such services, shall do so without taking into ac25 count the requirement under the physician fee

26 schedule under section 1848(c)(2)(B)(ii)(II) of the
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1 Social Security Act (42 U.S.C. 1395w–

2 4(c)(2)(B)(ii)(II)).

3 (c) BLOOD CLOTTING DRUG-RELATED ACTIVI4 TIES.—

5 (1) COVERAGE.—Section 1861(s)(2)(I) (42

6 U.S.C. 1395x(s)(2)(I)) is amended—

7 (A) by striking ‘‘and’’ after ‘‘supervision,’’;

8 and

9 (B) by inserting the following before the

10 semicolon: ‘‘, and the costs (pursuant to section

11 1834(n)) incurred by suppliers of such factors’’.

12 (2) PAYMENTS.—Section 1834 (42 U.S.C.

13 1395m), as amended by section 233(b), is amended

14 by adding at the end the following new subsection:

15 ‘‘(n) PAYMENT FOR BLOOD CLOTTING DRUG-RE16 LATED ACTIVITIES.—

17 ‘‘(1) IN GENERAL.—The Secretary shall make

18 payments in accordance with paragraph (2) to sup19 pliers of blood clotting factors (as described in sec20 tion 1861(s)(2)(I)) to cover the costs (such as ship21 ping, storage, inventory control, or other costs speci22 fied by the Secretary) incurred by such suppliers in

23 furnishing such factors to individuals enrolled under

24 this part.
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1 ‘‘(2) PAYMENT AMOUNT.—The amount of pay2 ment for furnishing such blood clotting factors (as

3 so described) shall be an amount equal to 80 percent

4 of the lesser of—

5 ‘‘(A) the actual charge for the furnishing

6 of such factors; or

7 ‘‘(B) an amount equal to 10 cents (or such

8 other amount determined appropriate by the

9 Secretary) per unit of such factor furnished.’’.

10 (3) EFFECTIVE DATE.—The amendments made

11 by this subsection shall apply to blood clotting fac12 tors (as described in section 1861(s)(2)(I) of the So13 cial Security Act (42 U.S.C. 1395x(s)(2)(I))) fur14 nished on or after the date that the Secretary of

15 Health and Human Services implements more accu16 rate average wholesale prices for such factors.

17 SEC. 249. MEDPAC STUDY ON IN-HOME INFUSION THERAPY

18 NURSING SERVICES.

19 (a) STUDY.—The Medicare Payment Advisory Com20 mission established under section 1805 of the Social Secu21 rity Act (42 U.S.C. 1395b–6) (in this section referred to

22 as ‘‘MedPAC’’) shall conduct a study on the provision of

23 in-home infusion therapy nursing services, including a re24 view of any documentation of clinical efficacy for those
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1 services and any costs associated with providing those

2 services.

3 (b) REPORT.—Not later than 18 months after the

4 date of enactment of this Act, MedPAC shall submit a

5 report to the Secretary of Health and Human Services and

6 Congress on the study and review conducted under sub7 section (a) together with recommendations regarding the

8 establishment of a payment methodology for in-home infu9 sion therapy nursing services that ensures the continuing

10 access of beneficiaries under the medicare program under

11 title XVIII of the Social Security Act (42 U.S.C. 1395

12 et seq.) to those services.

13 SEC. 250. COVERAGE OF VISION REHABILITATION SERV14 ICES.

15 (a) COVERAGE.—Section 1861(s)(2) (42 U.S.C.

16 1395x(s)(2)) is amended—

17 (1) by striking ‘‘and’’ at the end of subpara18 graph (S);

19 (2) by striking the period at the end of (T) and

20 inserting ‘‘; and’’; and

21 (3) by adding at the end the following new sub22 paragraph:

23 ‘‘(U) vision rehabilitation services (as defined in

24 subsection (uu)(1)).’’.
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1 (b) SERVICES DESCRIBED.—Section 1861 (42 U.S.C.

2 1395x), as amended by sections 232, 233(a), and 234(b),

3 is further amended by adding at the end the following new

4 subsection:

5 ‘‘Vision Rehabilitation Services; Vision Rehabilitation

6 Professional

7 ‘‘(xx)(1) The term ‘vision rehabilitation services’

8 means a program of restorative services (as determined

9 by the Secretary in regulations) furnished by a vision re10 habilitation professional (as defined in paragraph (2)) to

11 an individual diagnosed with a vision impairment (as de12 fined in paragraph (6)) to promote the independence and

13 safety of the individual notwithstanding such impairment,

14 such services furnished pursuant to a plan of care estab15 lished by a physician (as defined in paragraph (1) or (4)

16 of subsection (r)).

17 ‘‘(2) The term ‘vision rehabilitation professional’

18 means any of the following individuals:

19 ‘‘(A) An orientation and mobility specialist (as

20 defined in paragraph (3)).

21 ‘‘(B) A rehabilitation teacher (as defined in

22 paragraph (4)).

23 ‘‘(C) A low vision therapist (as defined in para24 graph (5)).
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1 ‘‘(3)(A) The term ‘orientation and mobility specialist’

2 means an individual—

3 ‘‘(i) who holds a baccalaureate or higher degree

4 granted by a regionally accredited college or univer5 sity in the United States (or an equivalent foreign

6 degree) in rehabilitation, special education, or a

7 health field with a university-based program of study

8 and clinical experience in orientation and mobility

9 (as defined in subparagraph (B)); and

10 ‘‘(ii)(I) who is licensed or certified as an ori11 entation and mobility specialist by the State in

12 which the orientation and mobility services are per13 formed; or

14 ‘‘(II) in the case of an individual furnishing ori15 entation and mobility services in a State which does

16 not provide for licensure or certification—

17 ‘‘(aa) who has successfully completed 350

18 hours of clinical practicum under the super19 vision of an orientation and mobility specialist

20 holding a master’s degree or higher, and who

21 has furnished not less than 9 months of super22 vised full-time orientation and mobility services

23 after obtaining a degree described in clause (i);

24 and
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1 ‘‘(bb) who has successfully completed a na2 tional examination in orientation and mobility

3 administered by a national organization specifi4 cally dedicated to performing credentialing of

5 orientation and mobility specialists that is rec6 ognized by the Secretary, and who meets such

7 other criteria as the Secretary establishes.

8 ‘‘(B) The term ‘orientation and mobility’ means the

9 following services:

10 ‘‘(i) Assessment of needs of an individual who

11 has a vision impairment for skills training in meth12 ods of safe movement and in strategies to gather re13 quired environmental and spatial information.

14 ‘‘(ii) Development of appropriate integrated

15 service plans tailored to meet such needs identified

16 pursuant to an assessment under clause (i).

17 ‘‘(iii) Provision of training in and utilization

18 of—

19 ‘‘(I) equipment and adaptive devices in20 tended and designed for use by such an indi21 vidual; and

22 ‘‘(II) specialized techniques adapted for

23 such individuals, including orientation, sensory

24 development, systems of safe movement (includ25 ing long cane techniques), resource identifica-
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1 tion, professional referrals (as appropriate),

2 and, in applied settings reinforcing instruction

3 for the use of optical devices as prescribed by

4 optometrists and ophthalmologists.

5 ‘‘(iv) Evaluation of the progress in performance

6 of such an individual receiving training under clause

7 (iii).

8 ‘‘(4)(A) The term ‘rehabilitation teacher’ means an

9 individual—

10 ‘‘(i) who holds a baccalaureate or higher degree

11 granted by a regionally accredited college or univer12 sity in the United States (or an equivalent foreign

13 degree) in rehabilitation, special education, or a

14 health field with a university-based program of study

15 and clinical experience in rehabilitation teaching (as

16 defined in subparagraph (B)); and

17 ‘‘(ii)(I) who is licensed or certified as a rehabili18 tation teacher by the State in which the rehabilita19 tion teaching services are performed; or

20 ‘‘(II) in the case of an individual furnishing re21 habilitation teaching services in a State which does

22 not provide for licensure or certification—

23 ‘‘(aa) who has successfully completed 350

24 hours of clinical practicum under the super25 vision of a rehabilitation teacher holding a mas-
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1 ter’s degree or higher, and who has furnished

2 not less than 9 months of supervised full-time

3 rehabilitation teaching services after obtaining a

4 degree described in clause (i); and

5 ‘‘(bb) who has successfully completed a na6 tional examination in rehabilitation teaching ad7 ministered by a national organization specifi8 cally dedicated to performing credentialing of

9 rehabilitation teachers that is recognized by the

10 Secretary, and who meets such other criteria as

11 the Secretary establishes.

12 ‘‘(B) The term ‘rehabilitation teaching’ means the

13 following services:

14 ‘‘(i) Assessment of needs of an individual with

15 a vision impairment for skills training in inde16 pendent living and communications.

17 ‘‘(ii) Development of appropriate integrated

18 service plans tailored to meet such needs identified

19 pursuant to an assessment under clause (i).

20 ‘‘(iii) Provision of training in, and utilization

21 of—

22 ‘‘(I) equipment and adaptive devices in23 tended and designed for use by such an indi24 vidual, including, in applied settings, reinforcing

25 instruction for the use of optical devices as pre-
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1 scribed by optometrists or ophthalmologists;

2 and

3 ‘‘(II) specialized techniques adapted for

4 such an individual, including braille and other

5 communication skills, personal self-care skills,

6 and home management skills.

7 ‘‘(iv) Evaluation of the progress in performance

8 of such an individual receiving training under clause

9 (iii).

10 ‘‘(5)(A) The term ‘low vision therapist’ means an

11 individual—

12 ‘‘(i) who holds—

13 ‘‘(I) a baccalaureate or higher degree

14 granted by a regionally accredited college or

15 university in the United States (or an equiva16 lent foreign degree) in rehabilitation, special

17 education, or a health field with a university18 based program of study and clinical experience

19 in orientation and mobility, rehabilitation teach20 ing, or teaching the visually impaired;

21 ‘‘(II) a master’s of science degree granted

22 by a regionally accredited college or university

23 in the United States (or an equivalent foreign

24 degree) in low vision rehabilitation; or
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1 ‘‘(III) a baccalaureate or higher degree

2 granted by a regionally accredited college or

3 university in the United States (or an equiva4 lent foreign degree) in occupational therapy;

5 ‘‘(ii) who after obtaining a degree described in

6 clause (i) has performed at least 2 years of low vi7 sion therapy (as defined in subparagraph (B)) under

8 the supervision of an optometrist or ophthalmologist

9 in an appropriate setting (as determined by the Sec10 retary); and

11 ‘‘(iii)(I) who is licensed or certified as a low vi12 sion therapist by the State in which the services are

13 performed; or

14 ‘‘(II) in the case of an individual in a State

15 which does not provide for licensure or certification,

16 who has successfully completed a national examina17 tion in low vision therapy administered by a national

18 organization specifically dedicated to performing

19 credentialing of low vision therapists that is recog20 nized by the Secretary, and who meets such other

21 criteria as the Secretary establishes.

22 ‘‘(B) The term ‘low vision therapy’ means the fol23 lowing services furnished to an individual and based upon

24 the clinical findings of a low vision examination conducted

25 on the individual by an optometrist or an ophthalmologist:
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1 ‘‘(i) Assessment of the performance of an indi2 vidual diagnosed with a vision impairment with pre3 scribed optical and adaptive nonoptical devices.

4 ‘‘(ii) In order to promote safety and maximize

5 use of visual ability of the individual diagnosed with

6 vision impairment, the provision of training in and

7 use of the following:

8 ‘‘(I) Visual abilities in daily living and

9 other tasks.

10 ‘‘(II) Optical devices prescribed by an op11 tometrist or ophthalmologist.

12 ‘‘(III) Adaptive non-optical and electronic

13 devices.

14 ‘‘(IV) Environmental cues and modifica15 tions.

16 ‘‘(iii) Evaluation of the progress in performance

17 of such an individual receiving the training and use

18 under clause (ii).

19 ‘‘(6)(A) The term ‘vision impairment’ means that an

20 individual is blind or partially sighted.

21 ‘‘(B) The term ‘blind’ means blind within the mean22 ing of ‘blindness’ as that term is defined in section

23 216(i)(1).

24 ‘‘(C) The term ‘partially sighted’ means functional vi25 sion impairment that constitutes a significant limitation
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1 of visual capability resulting from disease, trauma, or con2 genital or degenerative condition, that cannot be fully

3 ameliorated by standard refractive correction, medication,

4 or surgery, and that is manifested by one or more of the

5 following:

6 ‘‘(i) Insufficient visual resolution.

7 ‘‘(ii) Inadequate field of vision.

8 ‘‘(iii) Reduced peak contrast sensitivity.’’.

9 (c) PAYMENT.—Section 1833(a)(1) (42 U.S.C.

10 1395l(a)(1)) is amended—

11 (1) by striking ‘‘and’’ before ‘‘(S)’’; and

12 (2) by inserting before the semicolon at the end

13 the following: ‘‘, and (T) with respect to vision reha14 bilitation services (as defined in section 1861(xx))

15 furnished by a vision rehabilitation professional, the

16 amount paid shall be 80 percent of the lesser of the

17 actual charge for the services or 85 percent of the

18 amount determined under the fee schedule estab19 lished under section 1848(b) for the same services if

20 furnished by a physician’’.

21 (d) EFFECTIVE DATE.—The amendments made by

22 this section shall apply to services furnished on or after

23 the date of the enactment of this Act.

24 (e) CONSULTATION.—The Secretary shall consult

25 with the National Vision Rehabilitation Cooperative, the
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1 Association for Education and Rehabilitation of the Blind

2 and Visually Impaired, the Academy for Certification of

3 Vision Rehabilitation and Education Professionals, and

4 such other qualified professional and consumer organiza5 tions as the Secretary determines appropriate in promul6 gating regulations to carry out this Act.

7 SEC. 251. LIMITING MEDICARE LATE ENROLLMENT PEN8 ALTY TO 10 PERCENT AND TWICE THE PE9 RIOD OF NO ENROLLMENT.

10 (a) IN GENERAL.—The first sentence of section

11 1839(b) (42 U.S.C. 1395r(b)) is amended by striking ‘‘10

12 percent of the monthly premium so determined for each

13 full 10 months’’ and inserting ‘‘10 percent of the monthly

14 premium so determined for premiums paid during a period

15 equal to twice the number of months in each of the full

16 periods of 12 months’’.

17 (b) CONFORMING AMENDMENTS.—

18 (1) Section 1818(c) (42 U.S.C. 1395i–2(c)) is

19 amended—

20 (A) by striking paragraph (6); and

21 (B) by redesignating paragraphs (7)

22 through (9) as paragraphs (6) through (8), re23 spectively.

24 (2) Section 1818(g)(2)(B) (42 U.S.C. 1395i–

25 2(g)(2)(B)) is amended by striking ‘‘by sub-
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1 stituting’’ and all that follows and inserting the fol2 lowing: ‘‘by substituting ‘section 1818 (without any

3 increase resulting from the application of section

4 1839(b) to such section)’ for ‘section 1839 (without

5 any increase under subsection (b) thereof)’.’’.

6 (c) EFFECTIVE DATE.—

7 (1) The amendments made by this section shall

8 apply to premiums paid for months beginning after

9 the end of the 90-day period beginning on the date

10 of the enactment of this Act.

11 (2) In applying these amendments, months (be12 fore, during, or after the month in which this Act

13 is enacted) in which an individual was or is required

14 to pay an increased premium shall be taken into ac15 count in determining the month in which the pre16 mium will no longer be subject to an increase.

17 TITLE III—PROVISIONS

18 RELATING TO PARTS A AND B

19 Subtitle A—Home Health Services

20 SEC. 301. ELIMINATION OF 15 PERCENT REDUCTION IN

21 PAYMENT RATES UNDER THE PROSPECTIVE

22 PAYMENT SYSTEM FOR HOME HEALTH SERV23 ICES.

24 (a) IN GENERAL.—Section 1895(b)(3)(A) (42 U.S.C.

25 1395fff(b)(3)(A)) is amended to read as follows:
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1 ‘‘(A) INITIAL BASIS.—Under such system

2 the Secretary shall provide for computation of

3 a standard prospective payment amount (or

4 amounts). Such amount (or amounts) shall ini5 tially be based on the most current audited cost

6 report data available to the Secretary and shall

7 be computed in a manner so that the total

8 amounts payable under the system for the 12-

9 month period beginning on the date the Sec10 retary implements the system shall be equal to

11 the total amount that would have been made if

12 the system had not been in effect and if section

13 1861(v)(1)(L)(ix) had not been enacted. Each

14 such amount shall be standardized in a manner

15 that eliminates the effect of variations in rel16 ative case mix and area wage adjustments

17 among different home health agencies in a

18 budget neutral manner consistent with the case

19 mix and wage level adjustments provided under

20 paragraph (4)(A). Under the system, the Sec21 retary may recognize regional differences or dif22 ferences based upon whether or not the services

23 or agency are in an urbanized area.’’.
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1 (b) EFFECTIVE DATE.—The amendment made by

2 subsection (a) shall take effect as if included in the enact3 ment of BBRA.

4 SEC. 302. ADDITIONAL PAYMENTS FOR OUTLIERS.

5 (a) IN GENERAL.—Section 1895(b)(5) (42 U.S.C.

6 1395fff(b)(5)) is amended—

7 (1) by striking ‘‘OUTLIERS.—The Secretary’’

8 and inserting the following (and conforming the in9 dentation of the succeeding matter accordingly):

10 ‘‘OUTLIERS.—

11 ‘‘(A) IN GENERAL.—The Secretary’’; and

12 (2) by adding at the end the following new sub13 paragraph:

14 ‘‘(B) TEMPORARY ADDITIONAL PAYMENTS

15 FOR OUTLIERS.—For the purposes described in

16 the first sentence of subparagraph (A), there

17 are authorized to be appropriated from the

18 trust funds (as defined in section 1896(a)(8))

19 in appropriate part, as determined by the Sec20 retary, for each of fiscal years 2001 through

21 2005 an amount equal to $500,000,000. Such

22 amounts shall be in addition to amounts avail23 able for payment under this section and shall

24 not result in a reduction of the standard pro25 spective payment amount (or amounts). In
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1 making payments under this subparagraph, the

2 Secretary shall use a loss-sharing ratio of 90

3 percent.’’.

4 (b) CONFORMING AMENDMENT.—Section

5 1895(b)(3)(C) (42 U.S.C. 1395fff(b)(3)(C)) is amended

6 by striking ‘‘paragraph (5)’’ and inserting ‘‘paragraph

7 (5)(A)’’.

8 SEC. 303. ADDITIONAL PAYMENTS UNDER THE PROSPEC9 TIVE PAYMENT SYSTEM FOR SERVICES FUR10 NISHED IN RURAL AREAS AND SECURITY

11 SERVICES.

12 (a) INCREASE IN PAYMENT RATES FOR RURAL

13 AGENCIES.—Section 1895(b) (42 U.S.C. 1395fff(b)) is

14 amended by adding at the end the following new para15 graph:

16 ‘‘(7) ADDITIONAL PAYMENT AMOUNT FOR

17 SERVICES FURNISHED IN RURAL AREAS.—In the

18 case of home health services furnished in a rural

19 area (as defined in section 1886(d)(2)(D)), notwith20 standing any other provision of this subsection, the

21 amount of payment for such services is equal to 110

22 percent of the payment amount otherwise made

23 under this section (but for this paragraph) for serv24 ices furnished in a rural area.’’.
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1 (b) ADDITIONAL PAYMENT FOR SECURITY SERV2 ICES.—Section 1895(b) (42 U.S.C. 1395fff(b)(3)), as

3 amended by subsection (a), is further amended by adding

4 at the end the following paragraph:

5 ‘‘(8) ADDITIONAL PAYMENT FOR SECURITY

6 SERVICES.—The Secretary shall provide for an addi7 tion or adjustment to the payment amount otherwise

8 made under this section for the reasonable cost (as

9 defined in section 1861(v)(1)(A)) of furnishing pro10 tective services to individuals furnishing home health

11 services under this title in areas where such individ12 uals are at risk of physical harm, as determined by

13 the Secretary.’’.

14 (c) INAPPLICABILITY OF ADJUSTMENTS FOR BUDG15 ET NEUTRALITY.—Section 1895(b)(3) (42 U.S.C.

16 1395fff(b)(3)) is amended by adding at the end the fol17 lowing new subparagraph:

18 ‘‘(D) NO ADJUSTMENT FOR ADDITIONAL

19 PAYMENTS FOR RURAL SERVICES AND SECU20 RITY SERVICES.—The Secretary shall not re21 duce the standard prospective payment amount

22 (or amounts) under this paragraph applicable

23 to home health services furnished during a pe24 riod to offset the increase in payments resulting

25 from the application of paragraph (7) (relating
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1 to services furnished in rural areas) and para2 graph (8) (relating to costs of security serv3 ices).’’.

4 (d) EFFECTIVE DATE.—The amendments made by

5 this section apply with respect to items and services fur6 nished on or after October 1, 2000.

7 SEC. 304. EXCLUSION OF CERTAIN NONROUTINE MEDICAL

8 SUPPLIES UNDER THE PPS FOR HOME

9 HEALTH SERVICES.

10 (a) EXCLUSION.—

11 (1) IN GENERAL.—Section 1895 (42 U.S.C.

12 1395fff) is amended by adding at the end the fol13 lowing new subsection:

14 ‘‘(e) EXCLUSION OF NONROUTINE MEDICAL SUP15 PLIES.—

16 ‘‘(1) IN GENERAL.—Notwithstanding the pre17 ceding provisions of this section, in the case of all

18 nonroutine medical supplies (as defined by the Sec19 retary) furnished by a home health agency during a

20 year (beginning with 2001) for which payment is

21 otherwise made on the basis of the prospective pay22 ment amount under this section, payment under this

23 section shall be based instead on the lesser of—

24 ‘‘(A) the actual charge for the nonroutine

25 medical supply; or
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1 ‘‘(B) the amount determined under the fee

2 schedule established by the Secretary for pur3 poses of making payment for such items under

4 part B for nonroutine medical supplies fur5 nished during that year.

6 ‘‘(2) BUDGET NEUTRALITY ADJUSTMENT.—The

7 Secretary shall provide for an appropriate propor8 tional reduction in payments under this section so

9 that beginning with fiscal year 2001, the aggregate

10 amount of such reductions is equal to the aggregate

11 increase in payments attributable to the exclusion ef12 fected under paragraph (1).’’.

13 (2) CONFORMING AMENDMENT.—Section

14 1895(b)(1) (42 U.S.C. 1395fff(b)(1)) is amended by

15 striking ‘‘The Secretary’’ and inserting ‘‘Subject to

16 subsection (e), the Secretary’’.

17 (3) EFFECTIVE DATE.—The amendments made

18 by this subsection shall apply to supplies furnished

19 on or after January 1, 2001.

20 (b) EXCLUSION FROM CONSOLIDATED BILLING.—

21 (1) IN GENERAL.—For items provided during

22 the applicable period, the Secretary of Health and

23 Human Services shall administer the medicare pro24 gram under title XVIII of the Social Security Act

25 (42 U.S.C. 1395 et seq.) as if—
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1 (A) section 1842(b)(6)(F) of such Act (42

2 U.S.C. 1395u(b)(6)(F)) was amended by strik3 ing ‘‘(including medical supplies described in

4 section 1861(m)(5), but excluding durable med5 ical equipment to the extent provided for in

6 such section)’’ and inserting ‘‘(excluding med7 ical supplies and durable medical equipment de8 scribed in section 1861(m)(5))’’; and

9 (B) section 1862(a)(21) of such Act (42

10 U.S.C. 1395y(a)(21)) was amended by striking

11 ‘‘(including medical supplies described in sec12 tion 1861(m)(5), but excluding durable medical

13 equipment to the extent provided for in such

14 section)’’ and inserting ‘‘(excluding medical

15 supplies and durable medical equipment de16 scribed in section 1861(m)(5))’’.

17 (2) APPLICABLE PERIOD DEFINED.—For pur18 poses of paragraph (1), the term ‘‘applicable period’’

19 means the period beginning on January 1, 2001,

20 and ending on the later of—

21 (A) the date that is 18 months after the

22 date of enactment of this Act; or

23 (B) the date determined appropriate by the

24 Secretary of Health and Human Services.
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1 (c) STUDY ON EXCLUSION OF CERTAIN NONROUTINE

2 MEDICAL SUPPLIES UNDER THE PPS FOR HOME

3 HEALTH SERVICES.—

4 (1) STUDY.—The Secretary of Health and

5 Human Services (in this subsection referred to as

6 the ‘‘Secretary’’) shall conduct a study to identify

7 any nonroutine medical supply that may be appro8 priately and cost-effectively excluded from the pro9 spective payment system for home health services

10 under section 1895 of the Social Security Act (42

11 U.S.C. 1395fff). Specifically, the Secretary shall

12 consider whether wound care and ostomy supplies

13 should be excluded from such prospective payment

14 system.

15 (2) REPORT.—Not later than 18 months after

16 the date of enactment of this Act, the Secretary

17 shall submit to the committees of jurisdiction of the

18 House of Representatives and the Senate a report on

19 the study conducted under paragraph (1), including

20 a list of any nonroutine medical supplies that should

21 be excluded from the prospective payment system for

22 home health services under section 1895 of the So23 cial Security Act (42 U.S.C. 1395fff).

24 (d) EXCLUSION OF OTHER NONROUTINE MEDICAL

25 SUPPLIES.—Upon submission of the report under sub-
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1 section (c)(2), the Secretary shall (if necessary) revise the

2 definition of nonroutine medical supply, as defined for

3 purposes of section 1895(e) (as added by subsection (a)),

4 based on the list of nonroutine medical supplies included

5 in such report.

6 SEC. 305. CLARIFICATION OF THE HOMEBOUND DEFINI7 TION FOR THE HOME HEALTH BENEFIT.

8 (a) IN GENERAL.—Sections 1814(a) and 1835(a) (42

9 U.S.C. 1395f(a) and 1395n(a)) are each amended—

10 (1) in the last sentence, by striking ‘‘, and that

11 absences of the individual from home are infrequent

12 or of relatively short duration, or are attributable to

13 the need to receive medical treatment’’; and

14 (2) by adding at the end the following new sen15 tences: ‘‘Any absence of an individual from the home

16 attributable to the need to receive health care treat17 ment, including regular absences for the purpose of

18 participating for therapeutic, psychosocial, or med19 ical treatment in an adult day-care program that is

20 licensed or certified by a State, or accredited to fur21 nish adult day-care services in the State shall not

22 disqualify an individual from being considered to be

23 ‘confined to his home’. Any other absence of an indi24 vidual from the home shall not so disqualify an indi25 vidual if the absence is of infrequent or short dura-
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1 tion. For purposes of the preceding sentence, any

2 absence for the purpose of visiting a family member

3 who is unable to visit the individual or for the pur4 pose of attending a religious service shall be deemed

5 to be an absence of infrequent and short duration.’’.

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

7 subsection (a) shall apply to items and services provided

8 on or after the date of enactment of this Act.

9 SEC. 306. STANDARDS FOR HOME HEALTH BRANCH OF10 FICES.

11 (a) IN GENERAL.—Section 1861(o) (42 U.S.C.

12 1395x(o)) is amended by adding at the end the following

13 new sentences: ‘‘For purposes of this subsection, a home

14 health agency may provide services through a single site

15 or through a branch office. For purposes of the preceding

16 sentence, the term ‘branch office’ means a service site for

17 home health services that is controlled and supervised by

18 a home health agency.’’.

19 (b) ESTABLISHMENT OF STANDARDS.—

20 (1) IN GENERAL.—The Secretary of Health and

21 Human Services (in this subsection referred to as

22 the ‘‘Secretary’’) shall establish, using a negotiated

23 rulemaking process under subchapter III of chapter

24 5 of title 5, United States Code, standards for the

25 operation of a branch office (as defined in the last
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1 sentence of section 1861(o) of the Social Security

2 Act (42 U.S.C. 1395x(o)), as added by subsection

3 (a)).

4 (2) REQUIREMENTS.—In establishing standards

5 under paragraph (1), the Secretary shall—

6 (A) provide for the special treatment of

7 any home health agency or branch office—

8 (i) that is located in a frontier area;

9 or

10 (ii) with any other special cir11 cumstance that the Secretary determines is

12 appropriate; and

13 (B) allow the use of technology used by the

14 home health agency to supervise the branch of15 fice.

16 (3) CONSULTATION.—The Secretary shall es17 tablish the regulations under this subsection in con18 sultation with representatives of the home health in19 dustry.

20 SEC. 307. TREATMENT OF HOME HEALTH SERVICES PRO21 VIDED IN CERTAIN COUNTIES.

22 (a) IN GENERAL.—Notwithstanding any other provi23 sion of law, effective for home health services provided

24 under the prospective payment system under section 1895

25 of the Social Security Act (42 U.S.C. 1395fff) during fis-
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1 cal year 2001 in an applicable county, the geographic ad2 justment factors applicable in such year to hospitals phys3 ically located in such county under section 1886(d) of such

4 Act (42 U.S.C. 1395ww(d)) (including the factors applica5 ble to such hospitals by reason of any reclassification or

6 deemed reclassification) shall be deemed to apply to such

7 services instead of the area wage adjustment factors that

8 would otherwise be applicable to such services under sec9 tion 1895(b)(4)(C) of such Act (42 U.S.C.

10 1395fff(b)(4)(C)).

11 (b) APPLICABLE COUNTY DEFINED.—For purposes

12 of subsection (a), the term ‘‘applicable county’’ means any

13 of the following counties:

14 (1) Duchess County, New York.

15 (2) Orange County, New York.

16 (3) Clinton County, New York.

17 (4) Ulster County, New York.

18 (5) Otsego County, New York.

19 (6) Cayuga County, New York.

20 (7) St. Jefferson County, New York.

21 SEC. 308. RULE OF CONSTRUCTION RELATING TO

22 TELEHOMEHEALTH SERVICES.

23 (a) IN GENERAL.—Section 1895(b) (42 U.S.C.

24 1395fff(b)(3)), as amended by section 3, is further amend25 ed by adding at the end the following paragraph:
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1 ‘‘(9) RULE OF CONSTRUCTION RELATING TO

2 TELEHOMEHEALTH SERVICES.—

3 ‘‘(A) IN GENERAL.—Nothing in this sec4 tion, or in section 4206(a) of the Balanced

5 Budget Act of 1997 (42 U.S.C. 1395l note),

6 shall be construed as preventing a home health

7 agency receiving payment under this section

8 from furnishing a home health service via a

9 telecommunications system. Each home health

10 agency that submits a cost report to the Sec11 retary under this section shall include, in such

12 cost report, data with respect to the costs in13 curred in furnishing home health services to

14 medicare beneficiaries via such telecommuni15 cations systems.

16 ‘‘(B) LIMITATION.—The Secretary shall

17 not consider a home health service provided in

18 the manner described in subparagraph (A) to

19 be a home health visit for purposes of—

20 ‘‘(i) determining the amount of pay21 ment to be made under this section; or

22 ‘‘(ii) any requirement relating to the

23 certification of a physician required under

24 section 1814(a)(2)(C).’’.
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1 (b) REPORT.—Not later than one year after the date

2 of the enactment of this Act, the Secretary of Health and

3 Human Services shall submit to Congress a report con4 taining the recommendations of the Secretary with respect

5 to the feasibility and advisability of including home health

6 services furnished by telecommunications systems as a

7 home health service for purposes of—

8 (1) payment for such services under section

9 1895 of the Social Security Act (42 U.S.C. 1395fff),

10 and

11 (2) requirements with respect to physician cer12 tification of the need for home health services under

13 section 1814(a)(2)(C) of such Act (42 U.S.C.

14 1395f(a)(2)(C)).

15 Subtitle B—Direct Graduate

16 Medical Education

17 SEC. 311. NOT COUNTING CERTAIN GERIATRIC RESIDENTS

18 AGAINST GRADUATE MEDICAL EDUCATION

19 LIMITATIONS.

20 For cost reporting periods beginning on or after Oc21 tober 1, 2000, and before October 1, 2005, in applying

22 the limitations regarding the total number of full-time

23 equivalent interns and residents in the field of allopathic

24 or osteopathic medicine under subsections (d)(5)(B)(v)

25 and (h)(4)(F) of section 1886 of the Social Security Act
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1 (42 U.S.C. 1395ww) for a hospital, the Secretary of

2 Health and Human Services shall not take into account

3 a maximum of 3 interns or residents in the field of geri4 atric medicine to the extent the hospital increases the

5 number of geriatric interns or residents above the number

6 of such interns or residents for the hospital’s most recent

7 cost reporting period ending before October 1, 2000.

8 SEC. 312. PROGRAM OF PAYMENTS TO CHILDREN’S HOS9 PITALS THAT OPERATE GRADUATE MEDICAL

10 EDUCATION PROGRAMS.

11 Part A of title XI (42 U.S.C. 1301 et seq.) is amend12 ed by adding after section 1150 the following new section:

13 ‘‘PROGRAM OF PAYMENTS TO CHILDREN’S HOSPITALS

14 THAT OPERATE GRADUATE MEDICAL EDUCATION

15 PROGRAMS

16 ‘‘SEC. 1150A. (a) PAYMENTS.—The Secretary shall

17 make 2 payments under this section to each children’s

18 hospital for each of fiscal years 2002 through 2005, 1 for

19 the direct expenses and the other for the indirect expenses

20 associated with operating approved graduate medical resi21 dency training programs.

22 ‘‘(b) AMOUNT OF PAYMENTS.—

23 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

24 the amounts payable under this section to a chil25 dren’s hospital for an approved graduate medical
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1 residency training program for a fiscal year are each

2 of the following amounts:

3 ‘‘(A) DIRECT EXPENSE AMOUNT.—The

4 amount determined under subsection (c) for di5 rect expenses associated with operating ap6 proved graduate medical residency training pro7 grams.

8 ‘‘(B) INDIRECT EXPENSE AMOUNT.—The

9 amount determined under subsection (d) for in10 direct expenses associated with the treatment of

11 more severely ill patients and the additional

12 costs relating to teaching residents in such pro13 grams.

14 ‘‘(2) CAPPED AMOUNT.—

15 ‘‘(A) IN GENERAL.—The total of the pay16 ments made to children’s hospitals under sub17 paragraph (A) or (B) of paragraph (1) in a fis18 cal year shall not exceed the funds appropriated

19 under paragraph (1) or (2), respectively, of sub20 section (f) for such payments for that fiscal

21 year.

22 ‘‘(B) PRO RATA REDUCTIONS OF PAY23 MENTS FOR DIRECT EXPENSES.—If the Sec24 retary determines that the amount of funds ap25 propriated under subsection (f)(1) for a fiscal
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1 year is insufficient to provide the total amount

2 of payments otherwise due for such periods

3 under paragraph (1)(A), the Secretary shall re4 duce the amounts so payable on a pro rata

5 basis to reflect such shortfall.

6 ‘‘(c) AMOUNT OF PAYMENT FOR DIRECT GRADUATE

7 MEDICAL EDUCATION.—

8 ‘‘(1) IN GENERAL.—The amount determined

9 under this subsection for payments to a children’s

10 hospital for direct graduate expenses relating to ap11 proved graduate medical residency training pro12 grams for a fiscal year is equal to the product of—

13 ‘‘(A) the updated per resident amount for

14 direct graduate medical education, as deter15 mined under paragraph (2); and

16 ‘‘(B) the average number of full-time

17 equivalent residents in the hospital’s graduate

18 approved medical residency training programs

19 (as determined under section 1886(h)(4)) dur20 ing the fiscal year.

21 ‘‘(2) UPDATED PER RESIDENT AMOUNT FOR DI22 RECT GRADUATE MEDICAL EDUCATION.—The up23 dated per resident amount for direct graduate med24 ical education for a hospital for a fiscal year is an

25 amount determined as follows:
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1 ‘‘(A) DETERMINATION OF HOSPITAL SIN2 GLE PER RESIDENT AMOUNT.—The Secretary

3 shall compute for each hospital operating an

4 approved graduate medical education program

5 (regardless of whether or not it is a children’s

6 hospital) a single per resident amount equal to

7 the average (weighted by number of full-time

8 equivalent residents) of the primary care per

9 resident amount and the non-primary care per

10 resident amount computed under section

11 1886(h)(2) for cost reporting periods ending

12 during fiscal year 1997.

13 ‘‘(B) DETERMINATION OF WAGE AND NON14 WAGE-RELATED PROPORTION OF THE SINGLE

15 PER RESIDENT AMOUNT.—The Secretary shall

16 estimate the average proportion of the single

17 per resident amounts computed under subpara18 graph (A) that is attributable to wages and

19 wage-related costs.

20 ‘‘(C) STANDARDIZING PER RESIDENT

21 AMOUNTS.—The Secretary shall establish a

22 standardized per resident amount for each such

23 hospital—

24 ‘‘(i) by dividing the single per resident

25 amount computed under subparagraph (A)
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1 into a wage-related portion and a non2 wage-related portion by applying the pro3 portion determined under subparagraph

4 (B);

5 ‘‘(ii) by dividing the wage-related por6 tion by the factor applied under section

7 1886(d)(3)(E) for discharges occurring

8 during fiscal year 1999 for the hospital’s

9 area; and

10 ‘‘(iii) by adding the non-wage-related

11 portion to the amount computed under

12 clause (ii).

13 ‘‘(D) DETERMINATION OF NATIONAL AV14 ERAGE.—The Secretary shall compute a na15 tional average per resident amount equal to the

16 average of the standardized per resident

17 amounts computed under subparagraph (C) for

18 such hospitals, with the amount for each hos19 pital weighted by the average number of full20 time equivalent residents at such hospital.

21 ‘‘(E) APPLICATION TO INDIVIDUAL HOS22 PITALS.—The Secretary shall compute for each

23 such hospital that is a children’s hospital a per

24 resident amount—
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1 ‘‘(i) by dividing the national average

2 per resident amount computed under sub3 paragraph (D) into a wage-related portion

4 and a non-wage-related portion by applying

5 the proportion determined under subpara6 graph (B);

7 ‘‘(ii) by multiplying the wage-related

8 portion by the factor described in subpara9 graph (C)(ii) for the hospital’s area; and

10 ‘‘(iii) by adding the non-wage-related

11 portion to the amount computed under

12 clause (ii).

13 ‘‘(F) UPDATING RATE.—The Secretary

14 shall update such per resident amount for each

15 such children’s hospital by the estimated per16 centage increase in the Consumer Price Index

17 for all urban consumers (U.S. city average)

18 during the period beginning October 1997, and

19 ending with the midpoint of the Federal fiscal

20 year for which payments are made.

21 ‘‘(d) AMOUNT OF PAYMENT FOR INDIRECT MEDICAL

22 EDUCATION.—

23 ‘‘(1) IN GENERAL.—The amount determined

24 under this subsection for payments to a children’s

25 hospital for indirect expenses associated with the
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1 treatment of more severely ill patients and the addi2 tional costs related to the teaching of residents for

3 a fiscal year is equal to an amount determined ap4 propriate by the Secretary.

5 ‘‘(2) FACTORS.—In determining the amount

6 under paragraph (1), the Secretary shall—

7 ‘‘(A) take into account variations in case

8 mix and regional wage levels among children’s

9 hospitals and the number of full-time equivalent

10 residents in the hospitals’ approved graduate

11 medical residency training programs; and

12 ‘‘(B) assure that the aggregate of the pay13 ments for indirect expenses associated with the

14 treatment of more severely ill patients and the

15 additional costs related to the teaching of resi16 dents under this section in a fiscal year are

17 equal to the amount appropriated for such ex18 penses for the fiscal year involved under sub19 section (f)(2).

20 ‘‘(e) MAKING OF PAYMENTS.—

21 ‘‘(1) INTERIM PAYMENTS.—The Secretary shall

22 determine, before the beginning of each fiscal year

23 involved for which payments may be made for a hos24 pital under this section, the amounts of the pay25 ments for direct graduate medical education and in-
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1 direct medical education for such fiscal year and

2 shall (subject to paragraph (2)) make the payments

3 of such amounts in 26 equal interim installments

4 during such period. Such interim payments to each

5 individual hospital shall be based on the number of

6 residents reported in the hospital’s most recently

7 filed medicare cost report prior to the application

8 date for the Federal fiscal year for which the interim

9 payment amounts are established.

10 ‘‘(2) WITHHOLDING.—

11 ‘‘(A) IN GENERAL.—Subject to subpara12 graph (B), the Secretary shall withhold 25 per13 cent from each interim installment for direct

14 and indirect graduate medical education paid

15 under paragraph (1).

16 ‘‘(B) REDUCTION OF WITHHOLDING.—The

17 Secretary shall reduce the percent withheld

18 from each installment pursuant to subpara19 graph (A) if the Secretary determines that such

20 reduced percent will provide the Secretary with

21 a reasonable level of assurance that most hos22 pitals will not be overpaid on an interim basis.

23 ‘‘(3) RECONCILIATION.—Prior to the end of

24 each fiscal year, the Secretary shall determine any

25 changes to the number of residents reported by a
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1 hospital and shall use that number of residents to

2 determine the final amount payable to the hospital

3 for the current fiscal year for both direct expense

4 and indirect expense amounts. Based on such deter5 mination, the Secretary shall recoup any overpay6 ments made or pay any balance due to the extent

7 possible. In the event that a hospital’s interim pay8 ments were greater than the final amount to which

9 it is entitled, the Secretary shall have the option of

10 recouping that excess amount in determining the

11 amount to be paid in the subsequent year to that

12 hospital. The final amount so determined shall be

13 considered a final intermediary determination for

14 purposes of applying section 1878 and shall be sub15 ject to review under that section in the same manner

16 as the amount of payment under section 1886(d) is

17 subject to review under such section.

18 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—

19 ‘‘(1) DIRECT GRADUATE MEDICAL EDU20 CATION.—

21 ‘‘(A) IN GENERAL.—There are appro22 priated, out of any money in the Treasury not

23 otherwise appropriated, for payments under

24 subsection (b)(1)(A) for each of fiscal years

25 2002 through 2005, $95,000,000.
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1 ‘‘(B) CARRYOVER OF EXCESS.—The

2 amounts appropriated under subparagraph (A)

3 for each fiscal year shall remain available for

4 obligation through the end of the subsequent

5 fiscal year.

6 ‘‘(2) INDIRECT MEDICAL EDUCATION.—There

7 are appropriated, out of any money in the Treasury

8 not otherwise appropriated, for payments under sub9 section (b)(1)(A) for each of fiscal years 2002

10 through 2005, $190,000,000.

11 ‘‘(g) DEFINITIONS.—In this section:

12 ‘‘(1) APPROVED GRADUATE MEDICAL RESI13 DENCY TRAINING PROGRAM.—The term ‘approved

14 graduate medical residency training program’ has

15 the meaning given the term ‘approved medical resi16 dency training program’ in section 1886(h)(5)(A).

17 ‘‘(2) CHILDREN’S HOSPITAL.—The term ‘chil18 dren’s hospital’ means a hospital with a medicare

19 payment agreement and which is excluded from the

20 medicare inpatient prospective payment system pur21 suant to section 1886(d)(1)(B)(iii) and its accom22 panying regulations.

23 ‘‘(3) DIRECT GRADUATE MEDICAL EDUCATION

24 COSTS.—The term ‘direct graduate medical edu-
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1 cation costs’ has the meaning given such term in

2 section 1886(h)(5)(C).’’.

3 SEC. 313. AUTHORITY TO INCLUDE COSTS OF TRAINING OF

4 CLINICAL PSYCHOLOGISTS IN PAYMENTS TO

5 HOSPITALS.

6 Effective for cost reporting periods beginning on or

7 after October 1, 1999, for purposes of payments to hos8 pitals under the medicare program under title XVIII of

9 the Social Security Act (42 U.S.C. 1395 et seq.) for costs

10 of approved educational activities (as defined in section

11 413.85 of title 42 of the Code of Federal Regulations),

12 such approved educational activities shall include the clin13 ical portion of professional educational training programs,

14 recognized by the Secretary, for clinical psychologists.

15 SEC. 314. TREATMENT OF CERTAIN NEWLY ESTABLISHED

16 RESIDENCY PROGRAMS IN COMPUTING

17 MEDICARE PAYMENTS FOR THE COSTS OF

18 MEDICAL EDUCATION.

19 (a) IN GENERAL.—Section 1886(h)(4)(H) (42

20 U.S.C. 1395ww(h)(4)(H)) is amended by adding at the

21 end the following new clause:

22 ‘‘(v) TREATMENT OF CERTAIN NEWLY

23 ESTABLISHED PROGRAMS.—Any hospital

24 that has received payments under this sub25 section for a cost reporting period ending
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1 before January 1, 1995, and that operates

2 an approved medical residency training

3 program established on or after August 5,

4 1997, shall be treated as meeting the re5 quirements for an adjustment under the

6 rules prescribed pursuant to clause (i) with

7 respect to such program if—

8 ‘‘(I) such program received ac9 creditation from the American Council

10 of Graduate Medical Education not

11 later than August 5, 1998;

12 ‘‘(II) such program was in oper13 ation (with 1 or more residents in

14 training) as of January 1, 2000;

15 ‘‘(III) such hospital is located in

16 an area that is contiguous to a rural

17 area and serves individuals from such

18 rural area; and

19 ‘‘(IV) such hospital serves a med20 ical service area with a population

21 that is less than 500,000.’’.

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

23 subsection (a) shall take effect as if included in the enact24 ment of section 4623 of BBA (111 Stat. 477).
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1 SEC. 315. EXCEPTION TO ESTABLISHING THE NUMBER OF

2 RESIDENTS FOR CERTAIN HOSPITALS.

3 (a) AMENDMENT TO LIMITATION ON RESIDENTS FOR

4 INDIRECT GRADUATE MEDICAL EDUCATION.—Section

5 1886(d)(5)(B)(v) (42 U.S.C. 1395ww(d)(5)(B)(v)) is

6 amended—

7 (1) by adding the following after ‘‘December

8 31, 1996’’ and before the period: ‘‘(except in the

9 case where a community health center held the ac10 creditation for an approved medical residency train11 ing program of a hospital during fiscal year 1997

12 and the hospital incurred all or substantially all of

13 the costs of training those residents at the commu14 nity health center, the total number of full-time

15 equivalent interns and residents for the hospital with

16 respect to such training program in the fields of

17 allopathic and osteopathic medicine may not exceed

18 the number of such full-time equivalent interns and

19 residents that trained at such hospital and such

20 community health center during the hospital’s cost

21 reporting period ending on or before December 31,

22 1997)’’.

23 (b) AMENDMENT TO LIMITATION ON RESIDENTS FOR

24 DIRECT GRADUATE MEDICAL EDUCATION.—Section

25 1886(h)(4)(F) (42 U.S.C. 1395ww(h)(4)(F)) is

26 amended—
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1 (1) in clause (i), by striking ‘‘Such rules’’ and

2 inserting ‘‘Subject to clause (iii), such rules’’; and

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

4 clause:

5 ‘‘(iii) SPECIAL RULE.—In the case

6 where a community health center held the

7 accreditation for an approved medical resi8 dency training program of a hospital dur9 ing fiscal year 1997 and the hospital in10 curred all or substantially all of the costs

11 of training those residents at the commu12 nity health center, the total number of full13 time equivalent residents before application

14 of weighting factors for the hospital (as de15 termined under this paragraph) with re16 spect to such training program in the

17 fields of allopathic medicine and osteo18 pathic medicine may not exceed the num19 ber of such full-time equivalent residents

20 that trained at such hospital and such

21 community health center during the hos22 pital’s cost reporting period ending on or

23 before December 31, 1997.’’.

24 (c) DEFINITION OF COMMUNITY HEALTH CENTER.—

25 For the purposes of this section, the term ‘‘community
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1 health center’’ has the meaning given the term ‘‘health

2 center’’ in section 330(a) of the Public Health Service Act

3 (42 U.S.C. 254b(a)).

4 (d) EFFECTIVE DATE.—The amendments made by

5 subsections (a) and (b) shall take effect as if included in

6 the enactment of the Balanced Budget Act of 1997 (Pub7 lic Law 105–33).

8 Subtitle C—Miscellaneous

9 Provisions

10 SEC. 321. WAIVER OF 24-MONTH WAITING PERIOD FOR

11 MEDICARE COVERAGE OF INDIVIDUALS DIS12 ABLED WITH AMYOTROPHIC LATERAL SCLE13 ROSIS (ALS).

14 (a) IN GENERAL.—Section 226 (42 U.S.C. 426) is

15 amended—

16 (1) by redesignating subsection (h) as sub17 section (j) and by moving such subsection to the end

18 of the section; and

19 (2) by inserting after subsection (g) the fol20 lowing new subsection:

21 ‘‘(h) For purposes of applying this section in the case

22 of an individual medically determined to have amyotrophic

23 lateral sclerosis (ALS), the following special rules apply:
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1 ‘‘(1) Subsection (b) shall be applied as if there

2 were no requirement for any entitlement to benefits,

3 or status, for a period longer than 1 month.

4 ‘‘(2) The entitlement under such subsection

5 shall begin with the first month (rather than twenty6 fifth month) of entitlement or status.

7 ‘‘(3) Subsection (f) shall not be applied.’’.

8 (b) CONFORMING AMENDMENT.—Section 1837 (42

9 U.S.C. 1395p) is amended by adding at the end the fol10 lowing new subsection:

11 ‘‘(j) In applying this section in the case of an indi12 vidual who is entitled to benefits under part A pursuant

13 to the operation of section 226(h), the following special

14 rules apply:

15 ‘‘(1) The initial enrollment period under sub16 section (d) shall begin on the first day of the first

17 month in which the individual satisfies the require18 ment of section 1836(1).

19 ‘‘(2) In applying subsection (g)(1), the initial

20 enrollment period shall begin on the first day of the

21 first month of entitlement to disability insurance

22 benefits referred to in such subsection.’’.

23 (c) EFFECTIVE DATE.—The amendments made by

24 this section shall apply to benefits for months beginning

25 after the date of enactment of this Act.
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1 TITLE IV—RURAL PROVIDER

2 PROVISIONS

3 Subtitle A—Critical Access

4 Hospitals

5 SEC. 401. PAYMENTS TO CRITICAL ACCESS HOSPITALS FOR

6 CLINICAL DIAGNOSTIC LABORATORY TESTS.

7 (a) PAYMENT ON COST BASIS WITHOUT BENE8 FICIARY COST-SHARING.—

9 (1) IN GENERAL.—Section 1833(a)(6) (42

10 U.S.C. 1395l(a)(6)) is amended by inserting ‘‘(in11 cluding clinical diagnostic laboratory services fur12 nished by a critical access hospital)’’ after ‘‘out13 patient critical access hospital services’’.

14 (2) NO BENEFICIARY COST-SHARING.—

15 (A) IN GENERAL.—Section 1834(g) (42

16 U.S.C. 1395m(g)) is amended by inserting

17 ‘‘(except that in the case of clinical diagnostic

18 laboratory services furnished by a critical access

19 hospital the amount of payment shall be equal

20 to 100 percent of the reasonable costs of the

21 critical access hospital in providing such serv22 ices)’’ before the period at the end.

23 (B) BBRA AMENDMENT.—Section 1834(g)

24 (42 U.S.C. 1395m(g)), as amended by section
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1 403(d) of BBRA (113 Stat. 1501A–371), is

2 amended—

3 (i) in paragraph (1), by inserting

4 ‘‘(except that in the case of clinical diag5 nostic laboratory services furnished by a

6 critical access hospital the amount of pay7 ment shall be equal to 100 percent of the

8 reasonable costs of the critical access hos9 pital in providing such services)’’ after

10 ‘‘such services’’; and

11 (ii) in paragraph (2)(A), by inserting

12 ‘‘(except that in the case of clinical diag13 nostic laboratory services furnished by a

14 critical access hospital the amount of pay15 ment shall be equal to 100 percent of the

16 reasonable costs of the critical access hos17 pital in providing such services)’’ before

18 the period at the end.

19 (b) CONFORMING AMENDMENTS.—Paragraphs

20 (1)(D)(i) and (2)(D)(i) of section 1833(a) (42 U.S.C.

21 1395l(a)(1)(D)(i); 1395l(a)(2)(D)(i)) are each amended

22 by striking ‘‘or which are furnished on an outpatient basis

23 by a critical access hospital’’.
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1 (c) TECHNICAL AMENDMENT.—Section 403(d)(2) of

2 BBRA (113 Stat. 1501A–371) is amended by striking

3 ‘‘subsection (a)’’ and inserting ‘‘paragraph (1)’’.

4 (d) EFFECTIVE DATES.—

5 (1) IN GENERAL.—Except as provided in para6 graph (2), the amendments made by this section

7 shall apply to services furnished on or after Novem8 ber 29, 1999.

9 (2) BBRA AND TECHNICAL AMENDMENTS.—

10 The amendments made by subsections (a)(2)(B) and

11 (c) shall take effect as if included in the enactment

12 of section 403(d) of BBRA (113 Stat. 1501A–371).

13 SEC. 402. REVISION OF PAYMENT FOR PROFESSIONAL

14 SERVICES PROVIDED BY A CRITICAL ACCESS

15 HOSPITAL.

16 (a) IN GENERAL.—Section 1834(g)(2)(B) (42 U.S.C.

17 1395m(g)(2)(B)), as amended by section 403(d) of BBRA

18 (113 Stat. 1501A–371), is amended by inserting ‘‘120

19 percent of’’ after ‘‘hospital services,’’.

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

21 subsection (a) shall take effect as if included in the enact22 ment of section 403(d) of BBRA (113 Stat. 1501A–371).
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1 SEC. 403. PERMITTING CRITICAL ACCESS HOSPITALS TO

2 OPERATE PPS EXEMPT DISTINCT PART PSY3 CHIATRIC AND REHABILITATION UNITS.

4 (a) CRITERIA FOR DESIGNATION AS A CRITICAL AC5 CESS HOSPITAL.—Section 1820(c)(2)(B)(iii) (42 U.S.C.

6 1395i–4(c)(2)(B)(iii)) is amended by inserting ‘‘excluding

7 any psychiatric or rehabilitation unit of the facility which

8 is a distinct part of the facility,’’ before ‘‘provides not’’.

9 (b) DEFINITION OF PPS EXEMPT DISTINCT PART

10 PSYCHIATRIC AND REHABILITATION UNITS.—Section

11 1886(d)(1)(B) (42 U.S.C. 1395ww(d)(1)(B)) is amended

12 by inserting before the last sentence the following new sen13 tence: ‘‘In establishing such definition, the Secretary may

14 not exclude from such definition a psychiatric or rehabili15 tation unit of a critical access hospital which is a distinct

16 part of such hospital solely because such hospital is ex17 empt from the prospective payment system under this sec18 tion.’’.

19 (c) EFFECTIVE DATE.—The amendments made by

20 this section shall take effect on the date of enactment of

21 this Act.
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1 Subtitle B—Medicare Dependent,

2 Small Rural Hospital Program

3 SEC. 411. MAKING THE MEDICARE DEPENDENT, SMALL

4 RURAL HOSPITAL PROGRAM PERMANENT.

5 (a) PAYMENT METHODOLOGY.—Section

6 1886(d)(5)(G) (42 U.S.C. 1395ww(d)(5)(G)) is

7 amended—

8 (1) in clause (i), by striking ‘‘and before Octo9 ber 1, 2006,’’; and

10 (2) in clause (ii)(II), by striking ‘‘and before

11 October 1, 2006,’’.

12 (b) CONFORMING AMENDMENTS.—

13 (1) TARGET AMOUNT.—Section 1886(b)(3)(D)

14 (42 U.S.C. 1395ww(b)(3)(D)) is amended—

15 (A) in the matter preceding clause (i), by

16 striking ‘‘and before October 1, 2006,’’; and

17 (B) in clause (iv), by striking ‘‘through fis18 cal year 2005,’’ and inserting ‘‘or any subse19 quent fiscal year,’’.

20 (2) PERMITTING HOSPITALS TO DECLINE RE21 CLASSIFICATION.—Section 13501(e)(2) of the Omni22 bus Budget Reconciliation Act of 1993 (42 U.S.C.

23 1395ww note), as amended by section 404(b)(2) of

24 BBRA (113 Stat. 1501A–372), is amended by strik25 ing ‘‘or fiscal year 2000 through fiscal year 2005’’
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1 and inserting ‘‘fiscal year 2000, or any subsequent

2 fiscal year,’’.

3 SEC. 412. OPTION TO BASE ELIGIBILITY FOR MEDICARE DE4 PENDENT, SMALL RURAL HOSPITAL PRO5 GRAM ON DISCHARGES DURING ANY OF THE

6 3 MOST RECENT AUDITED COST REPORTING

7 PERIODS.

8 (a) IN GENERAL.—Section 1886(d)(5)(G)(iv)(IV)

9 (42 U.S.C. 1395ww(d)(5)(G)(iv)(IV)) is amended by in10 serting ‘‘, or any of the 3 most recent audited cost report11 ing periods,’’ after ‘‘1987’’.

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

13 this section shall apply with respect to cost reporting peri14 ods beginning on or after the date of enactment of this

15 Act.

16 Subtitle C—Sole Community

17 Hospitals

18 SEC. 421. EXTENSION OF OPTION TO USE REBASED TARGET

19 AMOUNTS TO ALL SOLE COMMUNITY HOS20 PITALS.

21 (a) IN GENERAL.—Section 1886(b)(3)(I)(i) (42

22 U.S.C. 1395ww(b)(3)(I)(i)) is amended—

23 (1) in the matter preceding subclause (I)—

24 (A) by striking ‘‘that for its cost reporting

25 period beginning during 1999 is paid on the
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1 basis of the target amount applicable to the

2 hospital under subparagraph (C) and that

3 elects (in a form and manner determined by the

4 Secretary) this subparagraph to apply to the

5 hospital’’; and

6 (B) by striking ‘‘substituted for such tar7 get amount’’ and inserting ‘‘substituted, if such

8 substitution results in a greater payment under

9 this section for such hospital, for the amount

10 otherwise determined under subsection

11 (d)(5)(D)(i)’’;

12 (2) in subclause (I), by striking ‘‘target amount

13 otherwise applicable’’ and all that follows through

14 ‘‘target amount’)’’ and inserting ‘‘the amount other15 wise applicable to the hospital under subsection

16 (d)(5)(D)(i) (referred to in this clause as the ‘sub17 section (d)(5)(D)(i) amount’)’’; and

18 (3) in each of subclauses (II) and (III), by

19 striking ‘‘subparagraph (C) target amount’’ and in20 serting ‘‘subsection (d)(5)(D)(i) amount’’.

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

22 this section shall take effect as if included in the enact23 ment of section 405 of BBRA (113 Stat. 1501A–372).
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1 SEC. 422. DEEMING A CERTAIN HOSPITAL AS A SOLE COM2 MUNITY HOSPITAL.

3 Notwithstanding any other provision of law, for pur4 poses of discharges occurring on or after October 1, 2000,

5 the Greensville Memorial Hospital located in Emporia,

6 Virginia shall be deemed to have satisfied the travel and

7 time criteria under section 1886(d)(5)(D)(iii)(II) of the

8 Social Security Act (42 U.S.C. 1395ww(d)(5)(D)(iii)(II))

9 for classification as a sole community hospital.

10 Subtitle D—Other Rural Hospital

11 Provisions

12 SEC. 431. EXEMPTION OF HOSPITAL SWING-BED PROGRAM

13 FROM THE PPS FOR SKILLED NURSING FA14 CILITIES.

15 (a) EXEMPTION FOR MEDICARE SWING-BED HOS16 PITALS.—

17 (1) IN GENERAL.—Section 1888(e)(7) (42

18 U.S.C. 1395yy(e)(7)(A)) is amended—

19 (A) in the heading, by striking ‘‘TRANSI20 TION’’ and inserting ‘‘EXEMPTION’’;

21 (B) by striking subparagraph (A) and in22 serting the following new subparagraph:

23 ‘‘(A) IN GENERAL.—The prospective pay24 ment system under this subsection shall not

25 apply to items and services provided by a facil26 ity described in subparagraph (B).’’; and
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1 (C) in subparagraph (B), by striking ‘‘, for

2 which payment’’ and all that follows before the

3 period.

4 (2) EFFECTIVE DATE.—The amendments made

5 by paragraph (1) shall take effect as if included in

6 the enactment of section 4432 of BBA (111 Stat.

7 414).

8 (b) CHANGE IN EFFECTIVE DATE OF BBRA AMEND9 MENTS.—

10 (1) IN GENERAL.—Section 408(c) of BBRA

11 (113 Stat. 1501A–375) is amended by striking ‘‘the

12 date that is’’ and all that follows and inserting

13 ‘‘January 1, 2001.’’.

14 (2) EFFECTIVE DATE.—The amendment made

15 by paragraph (1) shall take effect as if included in

16 the enactment of section 408 of BBRA (113 Stat.

17 1501A–375).

18 SEC. 432. PERMANENT GUARANTEE OF PRE-BBA PAYMENT

19 LEVELS FOR OUTPATIENT SERVICES FUR20 NISHED BY RURAL HOSPITALS.

21 (a) IN GENERAL.—Section 1833(t)(7)(D), as amend22 ed by section 203, is amended to read as follows:

23 ‘‘(D) HOLD HARMLESS PROVISIONS FOR

24 SMALL RURAL AND CANCER HOSPITALS.—In

25 the case of a hospital located in a rural area
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1 and that has not more than 100 beds or a hos2 pital described in section 1886(d)(1)(B)(v), for

3 covered OPD services for which the PPS

4 amount is less than the pre-BBA amount, the

5 amount of payment under this subsection shall

6 be increased by the amount of such dif7 ference.’’.

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

9 subsection (a) shall take effect as if included in the enact10 ment of section 202 of BBRA (111 Stat. 1501A–342).

11 SEC. 433. TREATMENT OF CERTAIN PHYSICIAN PATHOLOGY

12 SERVICES.

13 (a) IN GENERAL.—Section 1848(i) (42 U.S.C.

14 1395w–4(i)) is amended by adding at the end the fol15 lowing new paragraph:

16 ‘‘(4) TREATMENT OF CERTAIN PHYSICIAN PA17 THOLOGY SERVICES.—

18 ‘‘(A) IN GENERAL.—Notwithstanding any

19 other provision of law, when an independent

20 laboratory furnishes the technical component of

21 a physician pathology service with respect to a

22 fee-for-service medicare beneficiary who is a pa23 tient of a grandfathered hospital, such compo24 nent shall be treated as a service for which pay-
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1 ment shall be made to the laboratory under this

2 section and not as—

3 ‘‘(i) an inpatient hospital service for

4 which payment is made to the hospital

5 under section 1886(d); or

6 ‘‘(ii) a hospital outpatient service for

7 which payment is made to the hospital

8 under the prospective payment system

9 under section 1834(t).

10 ‘‘(B) DEFINITIONS.—In this paragraph:

11 ‘‘(i) GRANDFATHERED HOSPITAL.—

12 The term ‘grandfathered hospital’ means a

13 hospital that had an arrangement with an

14 independent laboratory—

15 ‘‘(I) that was in effect as of July

16 22, 1999; and

17 ‘‘(II) under which the laboratory

18 furnished the technical component of

19 physician pathology services with re20 spect to patients of the hospital and

21 submitted a claim for payment for

22 such component to a carrier with a

23 contract under section 1842 (and not

24 to the hospital).
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1 ‘‘(ii) FEE-FOR-SERVICE MEDICARE

2 BENEFICIARY.—The term ‘fee-for-service

3 medicare beneficiary’ means an individual

4 who is not enrolled—

5 ‘‘(I) in a Medicare+Choice plan

6 under part C;

7 ‘‘(II) in a plan offered by an eli8 gible organization under section 1876;

9 ‘‘(III) with a PACE provider

10 under section 1894;

11 ‘‘(IV) in a medicare managed

12 care demonstration project; or

13 ‘‘(V) in the case of a service fur14 nished to an individual on an out15 patient basis, in a health care prepay16 ment plan under section

17 1833(a)(1)(A).’’.

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

19 this section shall apply to services furnished on or after

20 January 1, 2001.
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1 Subtitle E—Other Rural Provisions

2 SEC. 441. REVISION OF BONUS PAYMENTS FOR SERVICES

3 FURNISHED IN HEALTH PROFESSIONAL

4 SHORTAGE AREAS.

5 (a) EXPANSION OF BONUS PAYMENTS TO INCLUDE

6 PHYSICIAN ASSISTANT AND NURSE PRACTITIONER SERV7 ICES.—Section 1833(m) (42 U.S.C. 1395l(m)) is

8 amended—

9 (1) by inserting ‘‘(or services furnished by a

10 physician assistant or nurse practitioner that would

11 be physicians’ services if furnished by a physician)’’

12 after ‘‘physicians’ services’’;

13 (2) by inserting ‘‘, physician assistant (in the

14 case of a physician assistant described in subpara15 graph (C)(ii) of section 1842(b)(6)), or nurse practi16 tioner’’ after ‘‘physician’’; and

17 (3) by striking ‘‘clause (A) of section

18 1842(b)(6)’’ and inserting ‘‘subparagraphs (A) and

19 (C)(i) of such section’’.

20 (b) ELIMINATION OF REQUIREMENT TO MAKE

21 BONUS PAYMENTS ON MONTHLY OR QUARTERLY

22 BASIS.—Section 1833(m) (42 U.S.C. 1395l(m)) is amend23 ed by striking ‘‘(on a monthly or quarterly basis)’’.

24 (c) EFFECTIVE DATES.—
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1 (1) IN GENERAL.—The amendments made by

2 subsection (a) shall apply to services furnished on or

3 after July 1, 2001.

4 (2) MONTHLY OR QUARTERLY PAYMENTS.—The

5 amendment made by subsection (b) shall apply to

6 services furnished on or after the first day of the

7 first calendar quarter beginning at least 240 days

8 after the date of enactment of this Act.

9 SEC. 442. PROVIDER-BASED RURAL HEALTH CLINIC CAP

10 EXEMPTION.

11 (a) IN GENERAL.—The matter in section 1833(f) (42

12 U.S.C. 1395l(f)) preceding paragraph (1) is amended by

13 striking ‘‘with less than 50 beds’’ and inserting ‘‘with an

14 average daily patient census that does not exceed 50’’.

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

16 subparagraph (A) shall apply to services furnished on or

17 after January 1, 2001.

18 SEC. 443. PAYMENT FOR CERTAIN PHYSICIAN ASSISTANT

19 SERVICES.

20 (a) PAYMENT FOR CERTAIN PHYSICIAN ASSISTANT

21 SERVICES.—Section 1842(b)(6)(C) (42 U.S.C.

22 1395u(b)(6)(C)) is amended by striking ‘‘for such services

23 provided before January 1, 2003,’’.
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1 (b) EFFECTIVE DATE.—The amendment made by

2 subsection (a) shall take effect on the date of enactment

3 of this Act.

4 SEC. 444. EXCLUSION OF CLINICAL SOCIAL WORKER SERV5 ICES AND SERVICES PERFORMED UNDER A

6 CONTRACT WITH A RURAL HEALTH CLINIC

7 OR FEDERALLY QUALIFIED HEALTH CENTER

8 FROM THE PPS FOR SNFs.

9 (a) IN GENERAL.—Section 1888(e)(2)(A)(ii) (42

10 U.S.C. 1395yy(e)(2)(A)(ii)) is amended—

11 (1) in the first sentence, by inserting ‘‘clinical

12 social worker services,’’ after ‘‘qualified psychologist

13 services,’’; and

14 (2) by inserting after the first sentence the fol15 lowing: ‘‘Services described in this clause also in16 clude services that are provided by a physician, a

17 physician assistant, a nurse practitioner, a certified

18 nurse midwife, a qualified psychologist, or a clinical

19 social worker who is employed, or otherwise under

20 contract, with a rural health clinic or a Federally

21 qualified health center.’’.

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

23 this section shall apply to services provided on or after

24 the date which is 60 days after the date of enactment of

25 this Act.
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1 SEC. 445. COVERAGE OF MARRIAGE AND FAMILY THERA2 PIST SERVICES PROVIDED IN RURAL HEALTH

3 CLINICS.

4 (a) COVERAGE OF MARRIAGE AND FAMILY THERA5 PIST SERVICES.—

6 (1) PROVISION OF SERVICES IN RURAL HEALTH

7 CLINICS.—Section 1861(aa)(1)(B) (42 U.S.C.

8 1395x(aa)(1)(B)) is amended by striking ‘‘Sec9 retary)’’ and inserting ‘‘Secretary), by a marriage

10 and family therapist (as defined in subsection

11 (xx)(2)),’’.

12 (2) MARRIAGE AND FAMILY THERAPIST SERV13 ICES DEFINED.—Section 1861 (42 U.S.C. 1395x),

14 as amended by section 232, 233(a), 234(b), and

15 250(b), is further amended by adding at the end the

16 following new subsection:

17 ‘‘Marriage and Family Therapist Services

18 ‘‘(yy)(1) The term ‘marriage and family therapist

19 services’ means services performed by a marriage and

20 family therapist (as defined in paragraph (2)) for the diag21 nosis and treatment of mental illnesses, which the mar22 riage and family therapist is legally authorized to perform

23 under State law (or the State regulatory mechanism pro24 vided by State law) of the State in which such services

25 are performed, as would otherwise be covered if furnished

26 by a physician or as an incident to a physician’s profes-
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1 sional service, but only if no facility or other provider

2 charges or is paid any amounts with respect to the fur3 nishing of such services.

4 ‘‘(2) The term ‘marriage and family therapist’ means

5 an individual who—

6 ‘‘(A) possesses a master’s or doctoral degree

7 which qualifies for licensure or certification as a

8 marriage and family therapist pursuant to State

9 law;

10 ‘‘(B) after obtaining such degree has performed

11 at least 2 years of clinical supervised experience in

12 marriage and family therapy; and

13 ‘‘(C)(i) is licensed or certified as a marriage

14 and family therapist in the State in which marriage

15 and family therapist services are performed; or

16 ‘‘(ii) in the case of a State that does not pro17 vide for such licensure or certification, meets such

18 other criteria as the Secretary establishes.’’.

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

20 this section shall apply with respect to services furnished

21 on or after January 1, 2002.
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1 SEC. 446. CAPITAL INFRASTRUCTURE REVOLVING LOAN

2 PROGRAM.

3 (a) IN GENERAL.—Part A of title XVI of the Public

4 Health Service Act (42 U.S.C. 300q et seq.) is amended

5 by adding at the end the following new section:

6 ‘‘CAPITAL INFRASTRUCTURE REVOLVING LOAN PROGRAM

7 ‘‘SEC. 1603. (a) AUTHORITY TO MAKE AND GUAR8 ANTEE LOANS.—

9 ‘‘(1) AUTHORITY TO MAKE LOANS.—The Sec10 retary may make loans from the fund established

11 under section 1602(d) to any rural entity for

12 projects for capital improvements, including—

13 ‘‘(A) the acquisition of land necessary for

14 the capital improvements;

15 ‘‘(B) the renovation or modernization of

16 any building;

17 ‘‘(C) the acquisition or repair of fixed or

18 major movable equipment; and

19 ‘‘(D) such other project expenses as the

20 Secretary determines appropriate.

21 ‘‘(2) AUTHORITY TO GUARANTEE LOANS.—

22 ‘‘(A) IN GENERAL.—The Secretary may

23 guarantee the payment of principal and interest

24 for loans to rural entities for projects for cap25 ital improvements described in paragraph (1) to

26 non-Federal lenders.
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1 ‘‘(B) INTEREST SUBSIDIES.—In the case

2 of a guarantee of any loan to a rural entity

3 under subparagraph (A)(i), the Secretary may

4 pay to the holder of such loan and for and on

5 behalf of the project for which the loan was

6 made, amounts sufficient to reduce by not more

7 than 3 percentage points of the net effective in8 terest rate otherwise payable on such loan.

9 ‘‘(b) AMOUNT OF LOAN.—The principal amount of

10 a loan directly made or guaranteed under subsection (a)

11 for a project for capital improvement may not exceed

12 $5,000,000.

13 ‘‘(c) FUNDING LIMITATIONS.—

14 ‘‘(1) GOVERNMENT CREDIT SUBSIDY EXPO15 SURE.—The total of the Government credit subsidy

16 exposure under the Credit Reform Act of 1990 scor17 ing protocol with respect to the loans outstanding at

18 any time with respect to which guarantees have been

19 issued, or which have been directly made, under sub20 section (a) may not exceed $50,000,000 per year.

21 ‘‘(2) TOTAL AMOUNTS.—Subject to paragraph

22 (1), the total of the principal amount of all loans di23 rectly made or guaranteed under subsection (a) may

24 not exceed $250,000,000 per year.

25 ‘‘(d) ADDITIONAL ASSISTANCE.—
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1 ‘‘(1) NONREPAYABLE GRANTS.—Subject to

2 paragraph (2), the Secretary may make a grant to

3 a rural entity, in an amount not to exceed $50,000,

4 for purposes of capital assessment and business

5 planning.

6 ‘‘(2) LIMITATION.—The cumulative total of

7 grants awarded under this subsection may not ex8 ceed $2,500,000 per year.

9 ‘‘(e) TERMINATION OF AUTHORITY.—The Secretary

10 may not directly make or guarantee any loan under sub11 section (a) or make a grant under subsection (d) after

12 September 30, 2005.’’.

13 (b) RURAL ENTITY DEFINED.—Section 1624 of the

14 Public Health Service Act (42 U.S.C. 300s–3) is amended

15 by adding at the end the following new paragraph:

16 ‘‘(15)(A) The term ‘rural entity’ includes—

17 ‘‘(i) a rural health clinic, as defined in sec18 tion 1861(aa)(2) of the Social Security Act;

19 ‘‘(ii) any medical facility with at least 1,

20 but less than 50, beds that is located in—

21 ‘‘(I) a county that is not part of a

22 metropolitan statistical area; or

23 ‘‘(II) a rural census tract of a metro24 politan statistical area (as determined

25 under the most recent modification of the
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1 Goldsmith Modification, originally pub2 lished in the Federal Register on February

3 27, 1992 (57 Fed. Reg. 6725));

4 ‘‘(iii) a hospital that is classified as a

5 rural, regional, or national referral center under

6 section 1886(d)(5)(C) of the Social Security

7 Act; and

8 ‘‘(iv) a hospital that is a sole community

9 hospital (as defined in section

10 1886(d)(5)(D)(iii) of the Social Security Act).

11 ‘‘(B) For purposes of subparagraph (A), the

12 fact that a clinic, facility, or hospital has been geo13 graphically reclassified under the medicare program

14 under title XVIII of the Social Security Act shall not

15 preclude a hospital from being considered a rural en16 tity under clause (i) or (ii) of subparagraph (A).’’.

17 (c) CONFORMING AMENDMENTS.—Section 1602 of

18 the Public Health Service Act (42 U.S.C. 300q–2) is

19 amended—

20 (1) in subsection (b)(2)(D), by inserting ‘‘or

21 1603(a)(2)(B)’’ after ‘‘1601(a)(2)(B)’’; and

22 (2) in subsection (d)—

23 (A) in paragraph (1)(C), by striking ‘‘sec24 tion 1601(a)(2)(B)’’ and inserting ‘‘sections

25 1601(a)(2)(B) and 1603(a)(2)(B)’’; and
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1 (B) in paragraph (2)(A), by inserting ‘‘or

2 1603(a)(2)(B)’’ after ‘‘1601(a)(2)(B)’’.

3 SEC. 447. GRANTS FOR UPGRADING DATA SYSTEMS.

4 (a) IN GENERAL.—Part B of title XVI of the Public

5 Health Service Act (42 U.S.C. 300r et seq.) is amended

6 by adding at the end the following new section:

7 ‘‘GRANTS FOR UPGRADING DATA SYSTEMS

8 ‘‘SEC. 1611. (a) GRANTS TO HOSPITALS.—

9 ‘‘(1) IN GENERAL.—The Secretary shall estab10 lish a program to make grants to hospitals that have

11 submitted applications in accordance with subsection

12 (c) to assist eligible small rural hospitals in offset13 ting the costs of establishing data systems—

14 ‘‘(A) required to—

15 ‘‘(i) implement prospective payment

16 systems under title XVIII of the Social Se17 curity Act; and

18 ‘‘(ii) comply with the administrative

19 simplification requirements under part C

20 of title XI of such Act; or

21 ‘‘(B) to reduce medication errors.

22 ‘‘(2) COSTS.—For purposes of paragraph (1),

23 the term ‘costs’ shall include costs associated with—

24 ‘‘(A) purchasing computer software and

25 hardware; and
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1 ‘‘(B) providing education and training to

2 hospital staff on computer information systems.

3 ‘‘(3) LIMITATION.—A hospital that has received

4 a grant under section 142 of the Medicare, Med5 icaid, and SCHIP Balanced Budget Refinement Act

6 of 2000 is not eligible to receive a grant under this

7 section.

8 ‘‘(b) ELIGIBLE SMALL RURAL HOSPITAL DE9 FINED.—For purposes of this section, the term ‘eligible

10 small rural hospital’ means a non-Federal, short-term gen11 eral acute care hospital that—

12 ‘‘(1) is located in a rural area, as defined for

13 purposes of section 1886(d) of the Social Security

14 Act; and

15 ‘‘(2) has less than 50 beds.

16 ‘‘(c) APPLICATION.—A hospital seeking a grant

17 under this section shall submit an application to the Sec18 retary at such time and in such form and manner as the

19 Secretary specifies.

20 ‘‘(d) AMOUNT OF GRANT.—A grant to a hospital

21 under this section may not exceed $100,000.

22 ‘‘(e) REPORTS.—

23 ‘‘(1) INFORMATION.—A hospital receiving a

24 grant under this section shall furnish the Secretary
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1 with such information as the Secretary may require

2 to—

3 ‘‘(A) evaluate the project for which the

4 grant is made; and

5 ‘‘(B) ensure that the grant is expended for

6 the purposes for which it is made.

7 ‘‘(2) TIMING OF SUBMISSION.—

8 ‘‘(A) INTERIM REPORTS.—The Secretary

9 shall report to the Committee on Commerce of

10 the House of Representatives and the Com11 mittee on Health, Education, Labor, and Pen12 sions of the Senate at least annually on the

13 grant program established under this section,

14 including in such report information on the

15 number of grants made, the nature of the

16 projects involved, the geographic distribution of

17 grant recipients, and such other matters as the

18 Secretary deems appropriate.

19 ‘‘(B) FINAL REPORT.—The Secretary shall

20 submit a final report to such committees not

21 later than 180 days after the completion of all

22 of the projects for which a grant is made under

23 this section.
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1 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There

2 are authorized to be appropriated such sums as may be

3 necessary for grants under this section.’’.

4 (b) CONFORMING AMENDMENT.—Section 1820(g)(3)

5 (42 U.S.C. 1395i–4(g)(3)) is repealed.

6 SEC. 448. RELIEF FOR FINANCIALLY DISTRESSED RURAL

7 HOSPITALS.

8 Title III of the Public Health Service Act (42 U.S.C.

9 241 et seq.) is amended by inserting after section 330D

10 the following new section:

11 ‘‘SEC. 330E. RELIEF FOR FINANCIALLY DISTRESSED RURAL

12 HOSPITALS.

13 ‘‘(a) GRANTS TO SMALL RURAL HOSPITALS.—The

14 Secretary, acting through the Health Resources and Serv15 ices Administration, may award grants to eligible small

16 rural hospitals that have submitted applications in accord17 ance with subsection (c) to provide relief for financial dis18 tress that has a negative impact on access to care for

19 beneficiaries under the medicare program under title

20 XVIII of the Social Security Act (42 U.S.C. 1395 et seq.)

21 that reside in a rural area.

22 ‘‘(b) ELIGIBLE SMALL RURAL HOSPITAL DE23 FINED.—For purposes of this paragraph, the term ‘eligi24 ble small rural hospital’ means a non-Federal, short-term

25 general acute care hospital that—
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1 ‘‘(1) is located in a rural area (as defined for

2 purposes of section 1886(d) of the Social Security

3 Act (42 U.S.C. 1395ww(d))); and

4 ‘‘(2) has less than 50 beds.

5 ‘‘(c) APPLICATION AND APPROVAL.—

6 ‘‘(1) APPLICATION.—Each eligible small rural

7 hospital that desires to receive a grant under this

8 paragraph shall submit an application to the Sec9 retary, at such time, in such form and manner, and

10 accompanied by such additional information as the

11 Secretary may reasonably require.

12 ‘‘(2) APPROVAL.—The Secretary shall approve

13 applications submitted under paragraph (1) based

14 on a methodology developed by the Secretary in con15 sultation with the Office of Rural Health Policy.

16 ‘‘(d) AMOUNT OF GRANT.—A grant to an eligible

17 small rural hospital under this paragraph may not exceed

18 $250,000.

19 ‘‘(e) USE OF FUNDS.—

20 ‘‘(1) IN GENERAL.—Except as provided in para21 graph (2), an eligible small rural hospital may use

22 amounts received under a grant under this section to

23 temporarily offset financial operating losses, with

24 emphasis on those losses attributable to reimburse25 ment formula changes that resulted from the Bal-
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1 anced Budget Act of 1997, in order to ensure con2 tinued operation and short-term sustainability or to

3 address emergency physical capital needs that might

4 otherwise result in closure.

5 ‘‘(2) PROHIBITED USES.—A hospital may not

6 use funds received under a grant under this section

7 for new construction, the purchase of medical equip8 ment, or for computer software or hardware.

9 ‘‘(f) REPORT.—

10 ‘‘(1) INFORMATION.—A hospital receiving a

11 grant under this section shall furnish the Secretary

12 with such information as the Secretary may require

13 to evaluate the project for which the grant is made

14 and to ensure that the grant is expended for the

15 purposes for which it is made.

16 ‘‘(2) REPORTING.—

17 ‘‘(A) ANNUAL REPORTS.—

18 ‘‘(i) IN GENERAL.—Not later than

19 December 31 of each year (beginning with

20 2001), the Secretary shall submit a report

21 to the committees of jurisdiction of the

22 House of Representatives and the Senate

23 on the grant program established under

24 this section.
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1 ‘‘(ii) INFORMATION INCLUDED.—The

2 report submitted under clause (i) shall in3 clude information on the number of grants

4 made, the nature of the projects involved,

5 the geographic distribution of grant recipi6 ents, and such other information as the

7 Secretary determines is appropriate.

8 ‘‘(B) FINAL REPORT.—Not later than 180

9 days after the completion of all of the projects

10 for which a grant is made under this section,

11 the Secretary shall submit a final report on the

12 grant program established under this section to

13 the committees described in subparagraph (A).

14 ‘‘(g) APPROPRIATIONS.—There are appropriated, out

15 of any money in the Treasury not otherwise appropriated,

16 for making grants under this section $25,000,000 for each

17 of the fiscal years 2001 through 2005.’’.

18 SEC. 449. REFINEMENT OF MEDICARE REIMBURSEMENT

19 FOR TELEHEALTH SERVICES.

20 (a) REVISION OF TELEHEALTH PAYMENT METHOD21 OLOGY AND ELIMINATION OF FEE-SHARING REQUIRE22 MENT.—Section 4206(b) of the Balanced Budget Act of

23 1997 (42 U.S.C. 1395l note) is amended to read as fol24 lows:
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1 ‘‘(b) METHODOLOGY FOR DETERMINING AMOUNT OF

2 PAYMENTS.—

3 ‘‘(1) IN GENERAL.—The Secretary shall pay

4 to—

5 ‘‘(A) the physician or practitioner at a dis6 tant site that provides an item or service under

7 subsection (a) an amount equal to the amount

8 that such physician or provider would have been

9 paid had the item or service been provided with10 out the use of a telecommunications system;

11 and

12 ‘‘(B) the originating site a facility fee for

13 facility services furnished in connection with

14 such item or service.

15 ‘‘(2) APPLICATION OF PART B COINSURANCE

16 AND DEDUCTIBLE.—Any payment made under this

17 section shall be subject to the coinsurance and de18 ductible requirements under subsections (a)(1) and

19 (b) of section 1833 of the Social Security Act (42

20 U.S.C. 1395l).

21 ‘‘(3) DEFINITIONS.—In this subsection:

22 ‘‘(A) DISTANT SITE.—The term ‘distant

23 site’ means the site at which the physician or

24 practitioner is located at the time the item or
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1 service is provided via a telecommunications

2 system.

3 ‘‘(B) FACILITY FEE.—The term ‘facility

4 fee’ means an amount equal to—

5 ‘‘(i) for 2000 and 2001, $20; and

6 ‘‘(ii) for a subsequent year, the facil7 ity fee under this subsection for the pre8 vious year increased by the percentage in9 crease in the MEI (as defined in section

10 1842(i)(3)) for such subsequent year.

11 ‘‘(C) ORIGINATING SITE.—

12 ‘‘(i) IN GENERAL.—The term ‘origi13 nating site’ means the site described in

14 clause (ii) at which the eligible telehealth

15 beneficiary under the medicare program is

16 located at the time the item or service is

17 provided via a telecommunications system.

18 ‘‘(ii) SITES DESCRIBED.—The sites

19 described in this paragraph are as follows:

20 ‘‘(I) On or before January 1,

21 2002, the office of a physician or a

22 practitioner, a critical access hospital,

23 a rural health clinic, and a Federally

24 qualified health center.
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1 ‘‘(II) On or before January 1,

2 2003, a hospital, a skilled nursing fa3 cility, a comprehensive outpatient re4 habilitation facility, a renal dialysis

5 facility, an ambulatory surgical center,

6 an Indian Health Service facility, and

7 a community mental health center.’’.

8 (b) ELIMINATION OF REQUIREMENT FOR TELEPRE9 SENTER.—Section 4206 of the Balanced Budget Act of

10 1997 (42 U.S.C. 1395l note) is amended—

11 (1) in subsection (a), by striking ‘‘, notwith12 standing that the individual physician’’ and all that

13 follows before the period at the end; and

14 (2) by adding at the end the following new sub15 section:

16 ‘‘(e) TELEPRESENTER NOT REQUIRED.—Nothing in

17 this section shall be construed as requiring an eligible tele18 health beneficiary to be presented by a physician or practi19 tioner for the provision of an item or service via a tele20 communications system.’’.

21 (c) REIMBURSEMENT FOR MEDICARE BENE22 FICIARIES WHO DO NOT RESIDE IN A HPSA.—Section

23 4206(a) of the Balanced Budget Act of 1997 (42 U.S.C.

24 1395l note), as amended by subsection (b), is amended—
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1 (1) by striking ‘‘IN GENERAL.—Not later than’’

2 and inserting the following: ‘‘TELEHEALTH SERV3 ICES REIMBURSED.—

4 ‘‘(1) IN GENERAL.—Not later than’’;

5 (2) by striking ‘‘furnishing a service for which

6 payment’’ and all that follows before the period and

7 inserting ‘‘to an eligible telehealth beneficiary’’; and

8 (3) by adding at the end the following new

9 paragraph:

10 ‘‘(2) ELIGIBLE TELEHEALTH BENEFICIARY DE11 FINED.—In this section, the term ‘eligible telehealth

12 beneficiary’ means a beneficiary under the medicare

13 program under title XVIII of the Social Security Act

14 (42 U.S.C. 1395 et seq.) that resides in—

15 ‘‘(A) an area that is designated as a health

16 professional shortage area under section

17 332(a)(1)(A) of the Public Health Service Act

18 (42 U.S.C. 254e(a)(1)(A));

19 ‘‘(B) a county that is not included in a

20 Metropolitan Statistical Area; or

21 ‘‘(C) an inner-city area that is medically

22 underserved (as defined in section 330(b)(3) of

23 the Public Health Service Act (42 U.S.C.

24 254b(b)(3))).’’.
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1 (d) TELEHEALTH COVERAGE FOR DIRECT PATIENT

2 CARE.—

3 (1) IN GENERAL.—Section 4206 of the Bal4 anced Budget Act of 1997 (42 U.S.C. 1395l note),

5 as amended by subsection (c), is amended—

6 (A) in subsection (a)(1), by striking ‘‘pro7 fessional consultation via telecommunications

8 systems with a physician’’ and inserting ‘‘items

9 and services for which payment may be made

10 under such part that are furnished via a tele11 communications system by a physician’’; and

12 (B) by adding at the end the following new

13 subsection:

14 ‘‘(f) COVERAGE OF ITEMS AND SERVICES.—Payment

15 for items and services provided pursuant to subsection (a)

16 shall include payment for professional consultations, office

17 visits, office psychiatry services, including any service

18 identified as of July 1, 2000, by HCPCS codes 99241–

19 99275, 99201–99215, 90804–90815, and 90862.’’.

20 (2) STUDY AND REPORT REGARDING ADDI21 TIONAL ITEMS AND SERVICES.—

22 (A) STUDY.—The Secretary of Health and

23 Human Services shall conduct a study to iden24 tify items and services in addition to those de25 scribed in section 4206(f) of the Balanced
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1 Budget Act of 1997 (as added by paragraph

2 (1)) that would be appropriate to provide pay3 ment under title XVIII of the Social Security

4 Act (42 U.S.C. 1395 et seq.).

5 (B) REPORT.—Not later than 2 years after

6 the date of enactment of this Act, the Secretary

7 shall submit a report to Congress on the study

8 conducted under subparagraph (A) together

9 with such recommendations for legislation that

10 the Secretary determines are appropriate.

11 (e) ALL PHYSICIANS AND PRACTITIONERS ELIGIBLE

12 FOR TELEHEALTH REIMBURSEMENT.—Section 4206(a)

13 of the Balanced Budget Act of 1997 (42 U.S.C. 1395l

14 note), as amended by subsection (d), is amended—

15 (1) in paragraph (1), by striking ‘‘(described in

16 section 1842(b)(18)(C) of such Act (42 U.S.C.

17 1395u(b)(18)(C))’’; and

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

19 paragraph:

20 ‘‘(3) PRACTITIONER DEFINED.—For purposes

21 of paragraph (1), the term ‘practitioner’ includes—

22 ‘‘(A) a practitioner described in section

23 1842(b)(18)(C) of the Social Security Act (42

24 U.S.C. 1395u(b)(18)(C)); and
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1 ‘‘(B) a physical, occupational, or speech

2 therapist.’’.

3 (f) TELEHEALTH SERVICES PROVIDED USING

4 STORE-AND-FORWARD TECHNOLOGIES.—Section

5 4206(a)(1) of the Balanced Budget Act of 1997 (42

6 U.S.C. 1395l note), as amended by subsection (e), is

7 amended by adding at the end the following new para8 graph:

9 ‘‘(4) USE OF STORE-AND-FORWARD TECH10 NOLOGIES.—For purposes of paragraph (1), in the

11 case of any Federal telemedicine demonstration pro12 gram in Alaska or Hawaii, the term ‘telecommuni13 cations system’ includes store-and-forward tech14 nologies that provide for the asynchronous trans15 mission of health care information in single or multi16 media formats.’’.

17 (g) FIVE-YEAR APPLICATION.—The amendments

18 made by this section shall apply to items and services pro19 vided on or after April 1, 2001, and before April 1, 2006.

20 SEC. 450. MEDPAC STUDY ON LOW-VOLUME, ISOLATED

21 RURAL HEALTH CARE PROVIDERS.

22 (a) STUDY.—The Medicare Payment Advisory Com23 mission established under section 1805 of the Social Secu24 rity Act (42 U.S.C. 1395b–6) (in this section referred to

25 as ‘‘MedPAC’’) shall conduct a study on the effect of low
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1 patient and procedure volume on the financial status of

2 low-volume, isolated rural health care providers partici3 pating in the medicare program under title XVIII of the

4 Social Security Act (42 U.S.C. 1395 et seq.).

5 (b) REPORT.—Not later than 18 months after the

6 date of enactment of this Act, MedPAC shall submit a

7 report to the Secretary of Health and Human Services and

8 Congress on the study conducted under subsection (a)

9 indicating—

10 (1) whether low-volume, isolated rural health

11 care providers are having, or may have, significantly

12 decreased medicare margins or other financial dif13 ficulties resulting from any of the payment meth14 odologies described in subsection (c);

15 (2) whether the status as a low-volume, isolated

16 rural health care provider should be designated

17 under the medicare program and any criteria that

18 should be used to qualify for such a status; and

19 (3) any changes in the payment methodologies

20 described in subsection (c) that are necessary to pro21 vide appropriate reimbursement under the medicare

22 program to low-volume, isolated rural health care

23 providers (as designated pursuant to paragraph (2)).
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1 (c) PAYMENT METHODOLOGIES DESCRIBED.—The

2 payment methodologies described in this subsection are

3 the following:

4 (1) The prospective payment system for hos5 pital outpatient department services under section

6 1833(t) of the Social Security Act (42 U.S.C.

7 1395l).

8 (2) The fee schedule for ambulance services

9 under section 1834(l) of such Act (42 U.S.C.

10 1395m(l)).

11 (3) The prospective payment system for inpa12 tient hospital services under section 1886 of such

13 Act (42 U.S.C. 1395ww).

14 (4) The prospective payment system for routine

15 service costs of skilled nursing facilities under sec16 tion 1888(e) of such Act (42 U.S.C. 1395yy(e)).

17 (5) The prospective payment system for home

18 health services under section 1895 of such Act (42

19 U.S.C. 1395fff).
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1 TITLE V—PROVISIONS RELAT2 ING TO PART C

3 (MEDICARE+CHOICE PRO4 GRAM) AND OTHER MEDI5 CARE MANAGED CARE PROVI6 SIONS

7 SEC. 501. RESTORING EFFECTIVE DATE OF ELECTIONS AND

8 CHANGES OF ELECTIONS OF

9 MEDICARE+CHOICE PLANS.

10 (a) OPEN ENROLLMENT.—Section 1851(f)(2) (42

11 U.S.C. 1395w–21(f)(2)) is amended by striking ‘‘, except

12 that if such election or change is made after the 10th day

13 of any calendar month, then the election or change shall

14 not take effect until the first day of the second calendar

15 month following the date on which the election or change

16 is made’’.

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

18 this section shall apply to elections and changes of cov19 erage made on or after January 1, 2001.

20 SEC. 502. SPECIAL MEDIGAP ENROLLMENT ANTIDISCRIMI21 NATION PROVISION FOR CERTAIN BENE22 FICIARIES.

23 (a) DISENROLLMENT WINDOW IN ACCORDANCE

24 WITH BENEFICIARY’S CIRCUMSTANCE.—Section

25 1882(s)(3) (42 U.S.C. 1395ss(s)(3)) is amended—
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1 (1) in subparagraph (A), in the matter fol2 lowing clause (iii), by striking ‘‘, subject to subpara3 graph (E), seeks to enroll under the policy not later

4 than 63 days after the date of termination of enroll5 ment described in such subparagraph’’ and inserting

6 ‘‘seeks to enroll under the policy during the period

7 specified in subparagraph (E)’’; and

8 (2) by striking subparagraph (E) and inserting

9 the following new subparagraph:

10 ‘‘(E) For purposes of subparagraph (A), the time pe11 riod specified in this subparagraph is—

12 ‘‘(i) in the case of an individual described in

13 subparagraph (B)(i), the period beginning on the

14 date the individual receives a notice of termination

15 or cessation of all supplemental health benefits (or,

16 if no such notice is received, notice that a claim has

17 been denied because of such a termination or ces18 sation) and ending on the date that is 63 days after

19 the applicable notice;

20 ‘‘(ii) in the case of an individual described in

21 clause (ii), (iii), (v), or (vi) of subparagraph (B)

22 whose enrollment is terminated involuntarily, the pe23 riod beginning on the date that the individual re24 ceives a notice of termination and ending on the
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1 date that is 63 days after the date the applicable

2 coverage is terminated;

3 ‘‘(iii) in the case of an individual described in

4 subparagraph (B)(iv)(I), the period beginning on the

5 earlier of (I) the date that the individual receives a

6 notice of termination, a notice of the issuer’s bank7 ruptcy or insolvency, or other such similar notice, if

8 any, and (II) the date that the applicable coverage

9 is terminated, and ending on the date that is 63

10 days after the date the coverage is terminated;

11 ‘‘(iv) in the case of an individual described in

12 clause (ii), (iii), (iv)(II), (iv)(III), (v), or (vi) of sub13 paragraph (B) who disenrolls voluntarily, the period

14 beginning on the date that is 60 days before the ef15 fective date of the disenrollment and ending on the

16 date that is 63 days after such effective date; and

17 ‘‘(v) in the case of an individual described in

18 subparagraph (B) but not described in the preceding

19 provisions of this subparagraph, the period begin20 ning on the effective date of the disenrollment and

21 ending on the date that is 63 days after such effec22 tive date.’’.

23 (b) EXTENDED MEDIGAP ACCESS FOR INTERRUPTED

24 TRIAL PERIODS.—Section 1882(s)(3) (42 U.S.C.
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1 1395ss(s)(3)), as amended by subsection (a), is amended

2 by adding at the end the following new subparagraph:

3 ‘‘(F) For purposes of this paragraph—

4 ‘‘(i) in the case of an individual described in

5 subparagraph (B)(v) (or deemed to be so described,

6 pursuant to this subparagraph) whose enrollment

7 with an organization or provider described in sub8 clause (II) of such subparagraph is involuntarily ter9 minated within the first 12 months of such enroll10 ment, and who, without an intervening enrollment,

11 enrolls with another such organization or provider,

12 such subsequent enrollment shall be deemed to be an

13 initial enrollment described in such subparagraph;

14 and

15 ‘‘(ii) in the case of an individual described in

16 clause (vi) of subparagraph (B) (or deemed to be so

17 described, pursuant to this subparagraph) whose en18 rollment with a plan or in a program described in

19 clause (v)(II) of such subparagraph is involuntarily

20 terminated within the first 12 months of such enroll21 ment, and who, without an intervening enrollment,

22 enrolls in another such plan or program, such subse23 quent enrollment shall be deemed to be an initial en24 rollment described in clause (vi) of such subpara25 graph.’’.
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1 SEC. 503. INCREASE IN NATIONAL PER CAPITA

2 MEDICARE+CHOICE GROWTH PERCENTAGE

3 IN 2001 AND 2002.

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

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

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

7 percentage points’’ and inserting ‘‘for 2001, 0 per8 centage points’’; and

9 (2) in clause (v), by striking ‘‘for 2002, 0.3 per10 centage points’’ and inserting ‘‘for 2002, 0 percent11 age points’’.

12 SEC. 504. ALLOWING MOVEMENT TO 50:50 PERCENT BLEND

13 IN 2002.

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

15 U.S.C. 1395w–23(c)(2)) is amended—

16 (1) by striking the period at the end of sub17 paragraph (F) and inserting a semicolon; and

18 (2) by adding after and below subparagraph

19 (F) the following:

20 ‘‘except that a Medicare+Choice organization may

21 elect to apply subparagraph (F) (rather than sub22 paragraph (E)) for 2002.’’.
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1 SEC. 505. DELAY FROM JULY TO NOVEMBER 2000, IN DEAD2 LINE FOR OFFERING AND WITHDRAWING

3 MEDICARE+CHOICE PLANS FOR 2001.

4 Notwithstanding any other provision of law, the dead5 line for a Medicare+Choice organization to withdraw the

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

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

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

9 2001 is delayed from July 1, 2000, to November 1, 2000,

10 and any such organization that provided notice of with11 drawal of such a plan during 2000 before the date of en12 actment of this Act may rescind such withdrawal at any

13 time before November 1, 2000.

14 SEC. 506. AMOUNTS IN MEDICARE TRUST FUNDS AVAIL15 ABLE FOR SECRETARY’S SHARE OF

16 MEDICARE+CHOICE EDUCATION AND EN17 ROLLMENT-RELATED COSTS.

18 (a) RELOCATION OF PROVISIONS.—Section

19 1857(e)(2) (42 U.S.C. 1395w–27(e)(2)) is amended to

20 read as follows:

21 ‘‘(2) COST-SHARING IN ENROLLMENT-RELATED

22 COSTS.—A Medicare+Choice organization shall pay

23 the fee established by the Secretary under section

24 1851(j)(3)(A).’’.

25 (b) FUNDING FOR EDUCATION AND ENROLLMENT

26 ACTIVITIES.—Section 1851 (42 U.S.C. 1395w–21) is
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1 amended by adding at the end the following new sub2 section:

3 ‘‘(j) FUNDING FOR BENEFICIARY EDUCATION AND

4 ENROLLMENT ACTIVITIES.—

5 ‘‘(1) SECRETARY’S ESTIMATE OF TOTAL

6 COSTS.—The Secretary shall annually estimate the

7 total cost for a fiscal year of carrying out this sec8 tion, section 4360 of the Omnibus Budget Reconcili9 ation Act of 1990 (relating to the health insurance

10 counseling and assistance program), and related ac11 tivities.

12 ‘‘(2) TOTAL AMOUNT AVAILABLE.—The total

13 amount available to the Secretary for a fiscal year

14 for the costs of the activities described in paragraph

15 (1) shall be equal to the lesser of—

16 ‘‘(A) the amount estimated for such fiscal

17 year under paragraph (1); or

18 ‘‘(B) for—

19 ‘‘(i) fiscal year 2001, $130,000,000;

20 and

21 ‘‘(ii) fiscal year 2002 and each subse22 quent fiscal year, the amount for the pre23 vious fiscal year, adjusted to account for

24 inflation, any change in the number of
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1 beneficiaries under this title, and any other

2 relevant factors.

3 ‘‘(3) COST-SHARING IN ENROLLMENT-RELATED

4 COSTS.—

5 ‘‘(A) AMOUNTS FROM MEDICARE+CHOICE

6 ORGANIZATIONS.—

7 ‘‘(i) IN GENERAL.—The Secretary is

8 authorized to charge a fee to each

9 Medicare+Choice organization with a con10 tract under this part that is equal to the

11 organization’s pro rata share (as deter12 mined by the Secretary) of the

13 Medicare+Choice portion (as defined in

14 clause (ii)) of the total amount available

15 under paragraph (2) for a fiscal year. Any

16 amounts collected shall be available with17 out further appropriation to the Secretary

18 for the costs of the activities described in

19 paragraph (1).

20 ‘‘(ii) MEDICARE+CHOICE PORTION

21 DEFINED.—For purposes of clause (i), the

22 term ‘Medicare+Choice portion’ means, for

23 a fiscal year, the ratio, as estimated by the

24 Secretary, of—
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1 ‘‘(I) the average number of indi2 viduals enrolled in Medicare+Choice

3 plans during the fiscal year; to

4 ‘‘(II) the average number of indi5 viduals entitled to benefits under

6 parts A, and enrolled under part B,

7 during the fiscal year.

8 ‘‘(B) SECRETARY’S SHARE.—

9 ‘‘(i) AMOUNTS AVAILABLE FROM

10 TRUST FUNDS.—The Secretary’s share of

11 expenses shall be payable from funds in

12 the Federal Hospital Insurance Trust

13 Fund and the Federal Supplementary

14 Medical Insurance Trust Fund, in such

15 proportion as the Secretary shall deem to

16 be fair and equitable after taking into con17 sideration the expenses attributable to the

18 administration of this part with respect to

19 part A and B. The Secretary shall make

20 such transfers of moneys between such

21 Trust Funds as may be appropriate to set22 tle accounts between the Trust Funds in

23 cases where expenses properly payable

24 from one such Trust Fund have been paid

25 from the other such Trust Fund.
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1 ‘‘(ii) SECRETARY’S SHARE OF EX2 PENSES DEFINED.—For purposes of clause

3 (i), the term ‘Secretary’s share of ex4 penses’ means, for a fiscal year, an amount

5 equal to—

6 ‘‘(I) the total amount available to

7 the Secretary under paragraph (2) for

8 the fiscal year; less

9 ‘‘(II) the amount collected under

10 subparagraph (A) for the fiscal

11 year.’’.

12 SEC. 507. REVISED TERMS AND CONDITIONS FOR EXTEN13 SION OF MEDICARE COMMUNITY NURSING

14 ORGANIZATION (CNO) DEMONSTRATION

15 PROJECT.

16 (a) IN GENERAL.—Section 532 of BBRA (42 U.S.C.

17 1395mm note) is amended—

18 (1) in subsection (a), by striking the second

19 sentence; and

20 (2) by striking subsection (b) and inserting the

21 following new subsections:

22 ‘‘(b) TERMS AND CONDITIONS.—

23 ‘‘(1) JANUARY THROUGH SEPTEMBER 2000.—

24 For the 9-month period beginning with January

25 2000, any such demonstration project shall be con-
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1 ducted under the same terms and conditions as ap2 plied to such demonstration during 1999.

3 ‘‘(2) OCTOBER 2000 THROUGH DECEMBER

4 2001.—For the 15-month period beginning with Oc5 tober 2000, any such demonstration project shall be

6 conducted under the same terms and conditions as

7 applied to such demonstration during 1999, except

8 that the following modifications shall apply:

9 ‘‘(A) BASIC CAPITATION RATE.—The basic

10 capitation rate paid for services covered under

11 the project (other than case management serv12 ices) per enrollee per month shall be basic capi13 tation rate paid for such services for 1999, re14 duced by 10 percent in the case of the dem15 onstration sites located in Arizona, Minnesota,

16 and Illinois, and 15 percent for the demonstra17 tion site located in New York.

18 ‘‘(B) TARGETED CASE MANAGEMENT

19 FEE.—A case management fee shall be paid

20 only for enrollees who are classified as ‘mod21 erate’ or ‘at risk’ through a baseline health as22 sessment (as required for Medicare+Choice

23 plans under section 1852(e) of the Social Secu24 rity Act (42 U.S.C. 1395ww–22(e)).
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1 ‘‘(C) GREATER UNIFORMITY IN CLINICAL

2 FEATURES AMONG SITES.—Each project shall

3 implement for each site—

4 ‘‘(i) protocols for periodic telephonic

5 contact with enrollees based on—

6 ‘‘(I) the results of such standard7 ized written health assessment; and

8 ‘‘(II) the application of appro9 priate care planning approaches;

10 ‘‘(ii) disease management programs

11 for targeted diseases (such as congestive

12 heart failure, arthritis, diabetes, and hy13 pertension) that are highly prevalent in the

14 enrolled populations;

15 ‘‘(iii) systems and protocols to track

16 enrollees through hospitalizations, includ17 ing pre-admission planning, concurrent

18 management during inpatient hospital

19 stays, and post-discharge assessment, plan20 ning, and follow-up; and

21 ‘‘(iv) standardized patient educational

22 materials for specified diseases and health

23 conditions.
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1 ‘‘(D) QUALITY IMPROVEMENT.—Each

2 project shall implement at each site once during

3 the 15-month period—

4 ‘‘(i) enrollee satisfaction surveys; and

5 ‘‘(ii) reporting on specified quality in6 dicators for the enrolled population.

7 ‘‘(c) EVALUATION.—

8 ‘‘(1) PRELIMINARY REPORT.—Not later than

9 July 1, 2001, the Secretary of Health and Human

10 Services shall submit to the Committees on Ways

11 and Means and Commerce of the House of Rep12 resentatives and the Committee on Finance of the

13 Senate a preliminary report that—

14 ‘‘(A) evaluates such demonstration projects

15 for the period beginning July 1, 1997, and end16 ing December 31, 1999, on a site-specific basis

17 with respect to the impact on per beneficiary

18 spending, specific health utilization measures,

19 and enrollee satisfaction; and

20 ‘‘(B) includes a similar evaluation of such

21 projects for the portion of the extension period

22 that occurs after September 30, 2000.

23 ‘‘(2) FINAL REPORT.—Not later than July 1,

24 2002, the Secretary shall submit a final report to

25 such Committees on such demonstration projects.
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1 Such report shall include the same elements as the

2 preliminary report required by paragraph (1), but

3 for the period after December 31, 1999.

4 ‘‘(3) METHODOLOGY FOR SPENDING COMPARI5 SONS.—Any evaluation of the impact of the dem6 onstration projects on per beneficiary spending in7 cluded in such reports shall be based on a compari8 son of—

9 ‘‘(A) data for all individuals who—

10 ‘‘(i) were enrolled in such demonstra11 tion projects as of the first day of the pe12 riod under evaluation; and

13 ‘‘(ii) were enrolled for a minimum of

14 6 months thereafter; with

15 ‘‘(B) data for a matched sample of individ16 uals who are enrolled under part B of title

17 XVIII of the Social Security Act (42 U.S.C.

18 1395j et seq.) and who are not enrolled in such

19 a project, in a Medicare+Choice plan under

20 part C of such title (42 U.S.C. 1395w–21 et

21 seq.), a plan offered by an eligible organization

22 under section 1876 of such Act (42 U.S.C.

23 1395mm), or a health care prepayment plan

24 under section 1833(a)(1)(A) of such Act (42

25 U.S.C. 1395l(a)(1)(A)).’’.
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1 (b) EFFECTIVE DATE.—The amendments made by

2 subsection (a) shall be effective as if included in the enact3 ment of section 532 of BBRA (42 U.S.C. 1395mm note).

4 SEC. 508. MODIFICATION OF PAYMENT RULES FOR CER5 TAIN FRAIL ELDERLY MEDICARE BENE6 FICIARIES.

7 (a) MODIFICATION OF PAYMENT RULES.—Section

8 1853 (42 U.S.C. 1395w–23) is amended—

9 (1) in subsection (a)—

10 (A) in paragraph (1)(A), by striking ‘‘sub11 sections (e), (g), and (i)’’ and inserting ‘‘sub12 sections (e), (g), (i), and (j)’’;

13 (B) in paragraph (3)(D), by inserting

14 ‘‘paragraph (4) and’’ after ‘‘Subject to’’; and

15 (C) by adding at the end the following new

16 paragraph:

17 ‘‘(4) EXEMPTION FROM RISK-ADJUSTMENT SYS18 TEM FOR FRAIL ELDERLY BENEFICIARIES EN19 ROLLED IN SPECIALIZED PROGRAMS.—

20 ‘‘(A) IN GENERAL.—In applying the risk21 adjustment factors established under paragraph

22 (3) during the period described in subparagraph

23 (B), the limitation under paragraph

24 (3)(C)(ii)(I) shall apply to a frail elderly

25 Medicare+Choice beneficiary (as defined in
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1 subsection (j)(3)) who is enrolled in a

2 Medicare+Choice plan under a specialized pro3 gram for the frail elderly (as defined in sub4 section (j)(2)) during the entire period.

5 ‘‘(B) PERIOD OF APPLICATION.—The pe6 riod described in this subparagraph begins with

7 January 2001, and ends with the first month

8 for which the Secretary certifies to Congress

9 that a comprehensive risk adjustment method10 ology under paragraph (3)(C) that takes into

11 account the factors described in subsection

12 (j)(1)(B) is being fully implemented.’’; and

13 (2) by adding at the end the following new sub14 section:

15 ‘‘(j) SPECIAL RULES FOR FRAIL ELDERLY EN16 ROLLED IN SPECIALIZED PROGRAMS FOR THE FRAIL EL17 DERLY.—

18 ‘‘(1) DEVELOPMENT AND IMPLEMENTATION OF

19 NEW PAYMENT SYSTEM.—

20 ‘‘(A) IN GENERAL.—The Secretary shall

21 develop and implement (as soon as possible

22 after the date of enactment of the Medicare,

23 Medicaid, and SCHIP Balanced Budget Refine24 ment Act of 2000), during the period described

25 in subsection (a)(4)(B), a payment methodology
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1 for frail elderly Medicare+Choice beneficiaries

2 enrolled in a Medicare+Choice plan under a

3 specialized program for the frail elderly (as de4 fined in paragraph (2)(A)).

5 ‘‘(B) FACTORS DESCRIBED.—The method6 ology developed and implemented under sub7 paragraph (A) shall take into account the prev8 alence, mix, and severity of chronic conditions

9 among frail elderly Medicare+Choice bene10 ficiaries and shall include—

11 ‘‘(i) medical diagnostic factors from

12 all provider settings (including hospital

13 and nursing facility settings);

14 ‘‘(ii) functional indicators of health

15 status; and

16 ‘‘(iii) such other factors as may be

17 necessary to achieve appropriate payments

18 for plans serving such beneficiaries.

19 ‘‘(2) SPECIALIZED PROGRAM FOR THE FRAIL

20 ELDERLY DEFINED.—

21 ‘‘(A) IN GENERAL.—In this part, the term

22 ‘specialized program for the frail elderly’ means

23 a program that the Secretary determines—

24 ‘‘(i) is offered under this part as a

25 distinct part of a Medicare+Choice plan;
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1 ‘‘(ii) primarily enrolls frail elderly

2 Medicare+Choice beneficiaries; and

3 ‘‘(iii) has a clinical delivery system

4 that is specifically designed to serve the

5 special needs of such beneficiaries and to

6 coordinate short-term and long-term care

7 for such beneficiaries through the use of a

8 team described in subparagraph (B) and

9 through the provision of primary care serv10 ices to such beneficiaries by means of such

11 a team at the nursing facility involved.

12 ‘‘(B) SPECIALIZED TEAM DESCRIBED.—A

13 team described in this subparagraph—

14 ‘‘(i) includes—

15 ‘‘(I) a physician; and

16 ‘‘(II) a nurse practitioner or geri17 atric care manager; and

18 ‘‘(ii) has as members individuals

19 who—

20 ‘‘(I) have special training in the

21 care and management of the frail el22 derly beneficiaries; and

23 ‘‘(II) specialize in the care and

24 management of such beneficiaries.
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1 ‘‘(3) FRAIL ELDERLY MEDICARE+CHOICE BEN2 EFICIARY DEFINED.—In this part, the term ‘frail el3 derly Medicare+Choice beneficiary’ means a

4 Medicare+Choice eligible individual who—

5 ‘‘(A) is residing in a skilled nursing facility

6 (as defined in section 1819(a)) or a nursing fa7 cility (as defined in section 1919(a)) for an in8 definite period and without any intention of re9 siding outside the facility; and

10 ‘‘(B) has a severity of condition that

11 makes the individual frail (as determined under

12 guidelines approved by the Secretary).’’.

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

14 this section shall take effect on the date of enactment of

15 this Act.

16 TITLE VI—PROVISIONS RELAT17 ING TO INDIVIDUALS WITH

18 END-STAGE RENAL DISEASE

19 SEC. 601. UPDATE IN RENAL DIALYSIS COMPOSITE RATE.

20 (a) IN GENERAL.—The last sentence of section

21 1881(b)(7) (42 U.S.C. 1395rr(b)(7)) is amended by strik22 ing ‘‘, and for such services’’ and all that follows before

23 the period at the end and inserting the following: ‘‘, for

24 such services furnished during 2001, by 2.4 percent above

25 such composite rate payment amounts for such services
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1 furnished on December 31, 2000, for such services fur2 nished during 2002 and 2003, by the percentage increase

3 in the Consumer Price Index for all urban consumers

4 (U.S. city average) for the 12-month period ending with

5 June of the previous year above such composite rate pay6 ment amounts for such services furnished on December

7 31 of the previous year, and for such services furnished

8 during a subsequent year, by the ESRD market basket

9 percentage increase above such composite rate payment

10 amounts for such services furnished on December 31 of

11 the previous year’’.

12 (b) ESRD MARKET BASKET PERCENTAGE INCREASE

13 DEFINED.—Section 1881(b) (42 U.S.C. 1395rr(b)) is

14 amended by adding at the end the following new para15 graph:

16 ‘‘(12)(A) For purposes of this title, the term ‘ESRD

17 market basket percentage increase’ means, with respect to

18 a calendar year, the percentage (estimated by the Sec19 retary before the beginning of such year) by which—

20 ‘‘(i) the cost of the mix of goods and services

21 included in the provision of dialysis services (which

22 may include the costs described in subparagraph (D)

23 as determined appropriate by the Secretary) that is

24 determined based on an index of appropriately

25 weighted indicators of changes in wages and prices
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1 which are representative of the mix of goods and

2 services included in such dialysis services for the cal3 endar year; exceeds

4 ‘‘(ii) the cost of such mix of goods and services

5 for the preceding calendar year.

6 ‘‘(B) In determining the percentage under subpara7 graph (A), the Secretary may take into account any in8 crease in the costs of furnishing the mix of goods and serv9 ices described in such subparagraph resulting from—

10 ‘‘(i) the adoption of scientific and technological

11 innovations used to provide dialysis services; and

12 ‘‘(ii) changes in the manner or method of deliv13 ering dialysis services.

14 ‘‘(C) The Secretary shall periodically review and up15 date (as necessary) the items and services included in the

16 mix of goods and services used to determine the percent17 age under subparagraph (A).

18 ‘‘(D) The costs described in this subparagraph

19 include—

20 ‘‘(i) labor, including direct patient care costs

21 and administrative labor costs, vacation and holiday

22 pay, payroll taxes, and employee benefits;

23 ‘‘(ii) other direct costs, including drugs, sup24 plies, and laboratory fees;
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1 ‘‘(iii) overhead, including medical director fees,

2 temporary services, general and administrative costs,

3 interest expenses, and bad debt;

4 ‘‘(iv) capital, including rent, real estate taxes,

5 depreciation, utilities, repairs, and maintenance; and

6 ‘‘(v) such other allowable costs as the Secretary

7 may specify.’’.

8 SEC. 602. REVISION OF PAYMENT RATES FOR ESRD PA9 TIENTS ENROLLED IN MEDICARE+CHOICE

10 PLANS.

11 (a) IN GENERAL.—Section 1853(a)(1)(B) (42 U.S.C.

12 1395w–23(a)(1)(B)) is amended by adding at the end the

13 following: ‘‘In establishing such rates the Secretary shall

14 provide for appropriate adjustments to increase each rate

15 to reflect the demonstration rate (including any risk-ad16 justment associated with such rate) of the social health

17 maintenance organization end-stage renal disease dem18 onstrations established by section 2355 of the Deficit Re19 duction Act of 1984 (Public Law 98–369; 98 Stat. 1103),

20 as amended by section 13567(b) of the Omnibus Budget

21 Reconciliation Act of 1993 (Public Law 103–66; 107 Stat.

22 608), and shall compute such rates by not taking into ac23 count individuals with kidney transplants and individuals

24 in which the program under this title is a secondary payer
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1 to another payer (or payers) pursuant to section

2 1862(b).’’.

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

4 subsection (a) shall apply to payments for months begin5 ning with January 2002.

6 (c) PUBLICATION.—The Secretary of Health and

7 Human Services, not later than 6 months after the date

8 of enactment of this Act, shall publish for public comment

9 a description of the appropriate adjustments described in

10 the last sentence of section 1853(a)(1)(B) of the Social

11 Security Act (42 U.S.C. 1395w–23(a)(1)(B)), as added by

12 subsection (a). The Secretary shall publish in final form

13 such adjustments by not later than July 1, 2001, so that

14 the amendment made by subsection (a) is implemented on

15 a timely basis consistent with subsection (b).

16 SEC. 603. PERMITTING ESRD BENEFICIARIES TO ENROLL

17 IN ANOTHER MEDICARE+CHOICE PLAN IF

18 THE PLAN IN WHICH THEY ARE ENROLLED IS

19 TERMINATED.

20 (a) IN GENERAL.—Section 1851(a)(3)(B) (42 U.S.C.

21 1395w–21(a)(3)(B)) is amended by striking ‘‘except that’’

22 and all that follows and inserting the following: ‘‘except

23 that—

24 ‘‘(i) an individual who develops end25 stage renal disease while enrolled in a
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1 Medicare+Choice plan may continue to be

2 enrolled in that plan; and

3 ‘‘(ii) in the case of such an individual

4 who is enrolled in a Medicare+Choice plan

5 under clause (i) (or subsequently under

6 this clause), if the enrollment is discon7 tinued under circumstances described in

8 section 1851(e)(4)(A) then the individual

9 will be treated as a ‘Medicare+Choice eli10 gible individual’ for purposes of electing to

11 continue enrollment in another

12 Medicare+Choice plan.’’.

13 (b) EFFECTIVE DATE.—

14 (1) IN GENERAL.—The amendment made by

15 subsection (a) shall apply to terminations and

16 discontinuations occurring on or after the date of

17 enactment of this Act.

18 (2) APPLICATION TO PRIOR PLAN TERMI19 NATIONS.—Clause (ii) of section 1851(a)(3)(B) of

20 the Social Security Act (as inserted by subsection

21 (a)) also shall apply to individuals whose enrollment

22 in a Medicare+Choice plan was terminated or dis23 continued after December 31, 1997, and before the

24 date of enactment of this Act. In applying this para25 graph, such an individual shall be treated, for pur-
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1 poses of part C of title XVIII of the Social Security

2 Act, as having discontinued enrollment in such a

3 plan as of the date of enactment of this Act.

4 SEC. 604. COVERAGE OF CERTAIN VASCULAR ACCESS SERV5 ICES FOR ESRD BENEFICIARIES PROVIDED

6 BY AMBULATORY SURGICAL CENTERS.

7 (a) IN GENERAL.—The matter following subpara8 graph (B) of section 1833(i)(1) (42 U.S.C. 1395l(i)(1))

9 is amended by adding at the end the following new sen10 tence: ‘‘Such lists shall include the procedures identified

11 as of July 30, 1999, by vascular access codes 34101,

12 34111, 34490, 35190, 35458, 35460, 35475, 35476,

13 35903, 36005, 36010, 36011, 36120, 36140, 36145,

14 36215–36218, 36831–36834, 37201, 37204–37208,

15 37250, 37251, and 49423.’’.

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

17 subsection (a) shall apply to vascular access services fur18 nished on or after January 1, 2000.

19 SEC. 605. COLLECTION AND ANALYSIS OF INFORMATION

20 ON THE SATISFACTION OF ESRD BENE21 FICIARIES WITH THE QUALITY OF AND AC22 CESS TO HEALTH CARE UNDER THE MEDI23 CARE PROGRAM.

24 (a) COLLECTION OF INFORMATION.—The Secretary

25 shall collect information on the satisfaction of each ESRD
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1 medicare beneficiary with the quality of health care under

2 the original fee-for-service medicare program and the

3 Medicare+Choice program, and the access of each bene4 ficiary to that care.

5 (b) ANALYSIS OF COLLECTED INFORMATION.—

6 (1) IN GENERAL.—The Secretary shall conduct

7 an analysis of the information collected under sub8 section (a) to determine—

9 (A) the kinds of health care that each non10 dialysis health care provider provides to each

11 ESRD medicare beneficiary for the treatment

12 of end-stage renal disease and each comor13 bidity;

14 (B) the effect of the availability of supple15 mental insurance on the use by beneficiary of

16 health care;

17 (C) the perceptions of each beneficiary re18 garding the access of that beneficiary to health

19 care; and

20 (D) the quality of health care provided to

21 each ESRD medicare beneficiary enrolled under

22 the Medicare+Choice program compared to

23 each beneficiary enrolled under the original fee24 for-service medicare program.
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1 (2) CONSIDERATIONS.—In conducting the anal2 ysis under paragraph (1), the Secretary shall

3 consider—

4 (A) the feasibility of routinely collecting in5 formation on the satisfaction of each ESRD

6 medicare beneficiary with dialysis and non-di7 alysis health care;

8 (B) whether to collect information using

9 disease specific questions or generic questions

10 (similar to those used in conducting the Medi11 care Current Beneficiary Survey);

12 (C) how well collected information detects

13 access problems within each specific group of

14 ESRD medicare beneficiaries, including bene15 ficiaries without supplemental insurance and

16 beneficiaries that reside in a rural area; and

17 (D) each obstacle that a health care pro18 vider may face in offering each type of dialysis

19 service.

20 (c) AVAILABILITY OF INFORMATION AND ANAL21 YSIS.—Not later than January 1 of each year (beginning

22 in 2002) the Secretary shall make the information col23 lected under subsection (a) and the analysis conducted

24 under subsection (b) available to the public.

25 (d) DEFINITIONS.—In this section:
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1 (1) ESRD MEDICARE BENEFICIARY.—The term

2 ‘‘ESRD medicare beneficiary’’ means an individual

3 eligible for benefits under the medicare program that

4 has end-stage renal disease (including an individual

5 enrolled in a Medicare+Choice plan offered by a

6 Medicare+Choice organization under the

7 Medicare+Choice program).

8 (2) MEDICARE+CHOICE PROGRAM.—The term

9 ‘‘Medicare+Choice program’’ means the program es10 tablished under part C of title XVIII of the Social

11 Security Act (42 U.S.C. 1395w–21 et seq.).

12 (3) ORIGINAL FEE-FOR-SERVICE MEDICARE

13 PROGRAM.—The term ‘‘original fee-for-service medi14 care program’’ means the health benefits program

15 under parts A and B title XVIII of the Social Secu16 rity Act (42 U.S.C. 1395 et seq.).

17 (4) SECRETARY.—The term ‘‘Secretary’’ means

18 the Secretary of Health and Human Services, acting

19 through the Administrator of the Health Care Fi20 nancing Administration.
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1 TITLE VII—ACCESS TO CARE IM2 PROVEMENTS THROUGH

3 MEDICAID AND SCHIP

4 SEC. 701. NEW PROSPECTIVE PAYMENT SYSTEM FOR FED5 ERALLY-QUALIFIED HEALTH CENTERS AND

6 RURAL HEALTH CLINICS.

7 (a) IN GENERAL.—Section 1902(a) (42 U.S.C.

8 1396a(a)) is amended—

9 (1) in paragraph (13)—

10 (A) in subparagraph (A), by adding ‘‘and’’

11 at the end;

12 (B) in subparagraph (B), by striking

13 ‘‘and’’ at the end; and

14 (C) by striking subparagraph (C); and

15 (2) by inserting after paragraph (14) the fol16 lowing new paragraph:

17 ‘‘(15) for payment for services described in sub18 paragraph (B) or (C) of section 1905(a)(2) under

19 the plan in accordance with subsection (aa);’’.

20 (b) NEW PROSPECTIVE PAYMENT SYSTEM.—Section

21 1902 (42 U.S.C. 1396a) is amended by adding at the end

22 the following:

23 ‘‘(aa) PAYMENT FOR SERVICES PROVIDED BY FED24 ERALLY-QUALIFIED HEALTH CENTERS AND RURAL

25 HEALTH CLINICS.—
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1 ‘‘(1) IN GENERAL.—Beginning with fiscal year

2 2001 and each succeeding fiscal year, the State plan

3 shall provide for payment for services described in

4 section 1905(a)(2)(C) furnished by a Federally5 qualified health center and services described in sec6 tion 1905(a)(2)(B) furnished by a rural health clinic

7 in accordance with the provisions of this subsection.

8 ‘‘(2) FISCAL YEAR 2001.—Subject to paragraph

9 (4), for services furnished during fiscal year 2001,

10 the State plan shall provide for payment for such

11 services in an amount (calculated on a per visit

12 basis) that is equal to 100 percent of the costs of

13 the center or clinic of furnishing such services dur14 ing fiscal year 2000 which are reasonable and re15 lated to the cost of furnishing such services, or

16 based on such other tests of reasonableness as the

17 Secretary prescribes in regulations under section

18 1833(a)(3), or, in the case of services to which such

19 regulations do not apply, the same methodology used

20 under section 1833(a)(3), adjusted to take into ac21 count any increase in the scope of such services fur22 nished by the center or clinic during fiscal year

23 2001.

24 ‘‘(3) FISCAL YEAR 2002 AND SUCCEEDING FIS25 CAL YEARS.—Subject to paragraph (4), for services
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1 furnished during fiscal year 2002 or a succeeding

2 fiscal year, the State plan shall provide for payment

3 for such services in an amount (calculated on a per

4 visit basis) that is equal to the amount calculated for

5 such services under this subsection for the preceding

6 fiscal year—

7 ‘‘(A) increased by the percentage increase

8 in the MEI (as defined in section 1842(i)(3))

9 applicable to primary care services (as defined

10 in section 1842(i)(4)) for that fiscal year; and

11 ‘‘(B) adjusted to take into account any in12 crease in the scope of such services furnished by

13 the center or clinic during that fiscal year.

14 ‘‘(4) ESTABLISHMENT OF INITIAL YEAR PAY15 MENT AMOUNT FOR NEW CENTERS OR CLINICS.—In

16 any case in which an entity first qualifies as a Fed17 erally-qualified health center or rural health clinic

18 after fiscal year 2000, the State plan shall provide

19 for payment for services described in section

20 1905(a)(2)(C) furnished by the center or services

21 described in section 1905(a)(2)(B) furnished by the

22 clinic in the first fiscal year in which the center or

23 clinic so qualifies in an amount (calculated on a per

24 visit basis) that is equal to 100 percent of the costs

25 of furnishing such services during such fiscal year in
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1 accordance with the regulations and methodology re2 ferred to in paragraph (2). For each fiscal year fol3 lowing the fiscal year in which the entity first quali4 fies as a Federally-qualified health center or rural

5 health clinic, the State plan shall provide for the

6 payment amount to be calculated in accordance with

7 paragraph (3).

8 ‘‘(5) ADMINISTRATION IN THE CASE OF MAN9 AGED CARE.—In the case of services furnished by a

10 Federally-qualified health center or rural health clin11 ic pursuant to a contract between the center or clinic

12 and a managed care entity (as defined in section

13 1932(a)(1)(B)), the State plan shall provide for pay14 ment to the center or clinic (at least quarterly) by

15 the State of a supplemental payment equal to the

16 amount (if any) by which the amount determined

17 under paragraphs (2), (3), and (4) of this subsection

18 exceeds the amount of the payments provided under

19 the contract.

20 ‘‘(6) ALTERNATIVE PAYMENT METHODOLO21 GIES.—Notwithstanding any other provision of this

22 section, the State plan may provide for payment in

23 any fiscal year to a Federally-qualified health center

24 for services described in section 1905(a)(2)(C) or to

25 a rural health clinic for services described in section
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1 1905(a)(2)(B) in an amount which is determined

2 under an alternative payment methodology that—

3 ‘‘(A) is agreed to by the State and the cen4 ter or clinic; and

5 ‘‘(B) results in payment to the center or

6 clinic of an amount which is at least equal to

7 the amount otherwise required to be paid to the

8 center or clinic under this section.’’.

9 (c) CONFORMING AMENDMENTS.—

10 (1) Section 4712 of BBA (111 Stat. 508) is

11 amended by striking subsection (c).

12 (2) Section 1915(b) (42 U.S.C. 1396n(b)) is

13 amended by striking ‘‘1902(a)(13)(E)’’ and insert14 ing ‘‘1902(a)(15), 1902(aa),’’.

15 (d) EFFECTIVE DATE.—The amendments made by

16 this section take effect on October 1, 2000, and apply to

17 services furnished on or after such date.

18 SEC. 702. TRANSITIONAL MEDICAL ASSISTANCE.

19 (a) MAKING PROVISION PERMANENT.—

20 (1) IN GENERAL.—Subsection (f) of section

21 1925 (42 U.S.C. 1396r–6) is repealed.

22 (2) CONFORMING AMENDMENT.—Section

23 1902(e)(1) (42 U.S.C. 1396a(e)(1)) is repealed.
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1 (b) STATE OPTION OF INITIAL 12-MONTH ELIGI2 BILITY.—Section 1925 (42 U.S.C. 1396r–6) is

3 amended—

4 (1) in subsection (a), by adding at the end the

5 following new paragraph:

6 ‘‘(5) OPTION OF 12-MONTH INITIAL ELIGIBILITY

7 PERIOD.—A State may elect to treat any reference

8 in this subsection to a 6-month period (or 6 months)

9 as a reference to a 12-month period (or 12 months).

10 In the case of such an election, subsection (b) shall

11 not apply.’’; and

12 (2) in subsection (b)(1), by inserting ‘‘and sub13 section (a)(5)’’ after ‘‘paragraph (3)’’.

14 (c) SIMPLIFICATION OPTIONS.—

15 (1) REMOVAL OF ADMINISTRATIVE REPORTING

16 REQUIREMENTS FOR ADDITIONAL 6-MONTH EXTEN17 SION.—Section 1925(b) (42 U.S.C. 1396r–6(b)) is

18 amended—

19 (A) in paragraph (2)—

20 (i) in the heading, by striking ‘‘AND

21 REPORTING’’;

22 (ii) by striking subparagraph (B);

23 (iii) in subparagraph (A)(i)—
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1 (I) by striking ‘‘(I)’’ and all that

2 follows through ‘‘(II)’’ and inserting

3 ‘‘(i)’’;

4 (II) by striking ‘‘, and (III)’’ and

5 inserting ‘‘and (ii)’’; and

6 (III) by redesignating such sub7 paragraph as subparagraph (A) (with

8 appropriate indentation); and

9 (iv) in subparagraph (A)(ii)—

10 (I) by striking ‘‘notify the family

11 of the reporting requirement under

12 subparagraph (B)(ii) and a statement

13 of’’ and inserting ‘‘provide the family

14 with notification of’’; and

15 (II) by redesignating such sub16 paragraph as subparagraph (B) (with

17 appropriate indentation);

18 (B) in paragraph (3)(A)—

19 (i) in clause (iii)—

20 (I) in the heading, by striking

21 ‘‘REPORTING AND TEST’’;

22 (II) by striking subclause (I);

23 and
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1 (III) by redesignating subclauses

2 (II) and (III) as subclauses (I) and

3 (II), respectively; and

4 (ii) by striking the last 3 sentences;

5 and

6 (C) in paragraph (3)(B), by striking ‘‘sub7 paragraph (A)(iii)(II)’’ and inserting ‘‘subpara8 graph (A)(iii)(I)’’.

9 (2) EXEMPTION FOR STATES COVERING NEEDY

10 FAMILIES UP TO 185 PERCENT OF POVERTY.—Sec11 tion 1925 (42 U.S.C. 1396r–6), as amended by sub12 section (a), is amended—

13 (A) in each of subsections (a)(1) and

14 (b)(1), by inserting ‘‘but subject to subsection

15 (f),’’ after ‘‘Notwithstanding any other provi16 sion of this title,’’; and

17 (B) by adding at the end the following new

18 subsection:

19 ‘‘(f) EXEMPTION FOR STATE COVERING NEEDY

20 FAMILIES UP TO 185 PERCENT OF POVERTY.—At State

21 option, the provisions of this section shall not apply to a

22 State that uses the authority under section 1931(b)(2)(C)

23 to make medical assistance available under the State plan

24 under this title, at a minimum, to all individuals described

25 in section 1931(b)(1) in families with gross incomes (de-
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1 termined without regard to work-related child care ex2 penses of such individuals) at or below 185 percent of the

3 income official poverty line (as defined by the Office of

4 Management and Budget, and revised annually in accord5 ance with section 673(2) of the Omnibus Budget Rec6 onciliation Act of 1981) applicable to a family of the size

7 involved.’’.

8 (3) STATE OPTION TO ELECT SHORTER PERIOD

9 FOR REQUIREMENT FOR RECEIPT OF MEDICAL AS10 SISTANCE AS A CONDITION OF ELIGIBILITY FOR

11 TRANSITIONAL MEDICAL ASSISTANCE.—Section

12 1925(a)(1) (42 U.S.C. 1396r–6(a)(1)) is amended

13 by inserting ‘‘(or such shorter period as the State

14 may elect)’’ after ‘‘3’’.

15 (d) APPLICATION OF NOTICE OF ELIGIBILITY TO

16 ALL FAMILIES LEAVING WELFARE.—Section 1925(a) (42

17 U.S.C. 1396r–6(a)), as amended by subsection (b)(1), is

18 amended by adding at the end the following new para19 graph:

20 ‘‘(6) NOTICE OF ELIGIBILITY FOR MEDICAL AS21 SISTANCE TO ALL FAMILIES LEAVING TANF.—Each

22 State shall notify each family which was receiving

23 assistance under the State program funded under

24 part A of title IV and which is no longer eligible for

25 such assistance, of the potential eligibility of the
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1 family and any individual members of such family

2 for medical assistance under this title or child health

3 assistance under title XXI. Such notice shall include

4 a statement that the family does not have to be re5 ceiving assistance under the State program funded

6 under part A of title IV in order to be eligible for

7 such medical assistance or child health assistance.’’.

8 (e) ENROLLMENT DATA.—Section 1925 (42 U.S.C.

9 1396r–6), as amended by subsection (c)(2)(B), is amend10 ed by adding at the end the following new subsection:

11 ‘‘(g) ENROLLMENT DATA.—The Secretary annually

12 shall obtain from each State with a State plan approved

13 under this title enrollment data regarding—

14 ‘‘(1) the number of adults and children who—

15 ‘‘(A) receive medical assistance under this

16 title based on eligibility under section 1931;

17 ‘‘(B) at the time they were first deter18 mined to be eligible for such medical assistance,

19 also received cash assistance under the State

20 program funded under part A of title IV; and

21 ‘‘(C) subsequently ceased to receive assist22 ance under such State program due to in23 creased earnings or increased child support in24 come;
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1 ‘‘(2) the percentage of the adults and children

2 described in paragraph (1) who receive transitional

3 medical assistance under this section or otherwise

4 remain enrolled in the program under this title; and

5 ‘‘(3) the percentage of such adults and children

6 that receive such transitional medical assistance for

7 more than 6 months or that remain enrolled in the

8 program under this title for more than 6 months

9 after such adults or children ceased to receive assist10 ance under the State program funded under part A

11 of title IV.’’.

12 (f) EFFECTIVE DATE.—The amendments made by

13 this section take effect on October 1, 2000.

14 SEC. 703. APPLICATION OF SIMPLIFIED SCHIP PROCE15 DURES UNDER THE MEDICAID PROGRAM.

16 (a) COORDINATION WITH MEDICAID.—

17 (1) IN GENERAL.—Section 1902(l) (42 U.S.C.

18 1396a(l)) is amended—

19 (A) in paragraph (3), by inserting ‘‘subject

20 to paragraph (5)’’, after ‘‘Notwithstanding sub21 section (a)(17),’’; and

22 (B) by adding at the end the following new

23 paragraph:

24 ‘‘(5) With respect to determining the eligibility of in25 dividuals under 19 years of age for medical assistance
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1 under subsection (a)(10)(A)(i)(IV), (a)(10)(A)(i)(VI),

2 (a)(10)(A)(i)(VII), (a)(10)(A)(ii)(IX), or

3 (a)(10)(A)(ii)(XIV), notwithstanding any other provision

4 of this title, if the State has established a State child

5 health plan under title XXI, or expanded coverage beyond

6 the income eligibility standards required for such individ7 uals under this title under a waiver granted under section

8 1115—

9 ‘‘(A) the State may not apply a resource stand10 ard if the State does not apply such a standard

11 under such child health plan or section 1115 waiver

12 with respect to such individuals;

13 ‘‘(B) the State shall use the same simplified eli14 gibility form (including, if applicable, permitting ap15 plication other than in person) as the State uses

16 under such State child health plan or section 1115

17 waiver with respect to such individuals;

18 ‘‘(C) the State shall provide for initial eligibility

19 determinations and redeterminations of eligibility

20 using the same verification policies, forms, and fre21 quency as the State uses for such purposes under

22 such State child health plan or section 1115 waiver

23 with respect to such individuals; and

24 ‘‘(D) the State shall not require a face-to-face

25 interview for purposes of initial eligibility determina-
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1 tions and redeterminations unless the State required

2 such an interview for such purposes under such child

3 health plan or section 1115 waiver with respect to

4 such individuals.’’.

5 (2) EFFECTIVE DATE.—The amendments made

6 by paragraph (1) take effect on October 1, 2000,

7 and apply to eligibility determinations and redeter8 minations made on or after such date.

9 (b) AUTOMATIC REASSESSMENT OF ELIGIBILITY FOR

10 TITLE XXI AND MEDICAID BENEFITS FOR CHILDREN

11 LOSING MEDICAID OR TITLE XXI ELIGIBILITY.—

12 (1) LOSS OF MEDICAID ELIGIBILITY.—Section

13 1902(a) of the Social Security Act (42 U.S.C.

14 1396a(a)) is amended—

15 (A) by striking the period at the end of

16 paragraph (65) and inserting ‘‘; and’’, and

17 (B) by inserting after paragraph (65) the

18 following new paragraph:

19 ‘‘(66) provide, by not later than the first day of

20 the first month that begins more than 1 year after

21 the date of the enactment of this paragraph and in

22 the case of a State with a State child health plan

23 under title XXI, that before medical assistance to a

24 child (or a parent of a child) is discontinued under

25 this title, a determination of whether the child (or
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1 parent) is eligible for benefits under title XXI shall

2 be made and, if determined to be so eligible, the

3 child (or parent) shall be automatically enrolled in

4 the program under such title without the need for a

5 new application and without being asked to provide

6 any information that is already available to the

7 State.’’.

8 (2) LOSS OF TITLE XXI ELIGIBILITY.—Section

9 2102(b)(3) (42 U.S.C. 1397bb(b)(3)) is amended by

10 redesignating subparagraphs (D) and (E) as sub11 paragraphs (E) and (F), respectively, and by insert12 ing after subparagraph (C) the following new sub13 paragraph:

14 ‘‘(D) that before health assistance to a

15 child (or a parent of a child) is discontinued

16 under this title, a determination of whether the

17 child (or parent) is eligible for benefits under

18 title XIX is made and, if determined to be so

19 eligible, the child (or parent) is automatically

20 enrolled in the program under such title with21 out the need for a new application and without

22 being asked to provide any information that is

23 already available to the State;’’.

24 (3) EFFECTIVE DATE.—The amendments made

25 by paragraphs (1) and (2) apply to individuals who
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1 lose eligibility under the medicaid program under

2 title XIX, or under a State child health insurance

3 plan under title XXI, respectively, of the Social Se4 curity Act (42 U.S.C. 1396 et seq.; 1397aa et seq.)

5 on or after the date that is 60 days after the date

6 of the enactment of this Act.

7 SEC. 704. PRESUMPTIVE ELIGIBILITY.

8 (a) ADDITIONAL ENTITIES QUALIFIED TO DETER9 MINE PRESUMPTIVE ELIGIBILITY FOR LOW-INCOME

10 CHILDREN.—

11 (1) MEDICAID.—Section 1920A(b)(3)(A)(i) (42

12 U.S.C. 1396r–1a(b)(3)(A)(i)) is amended—

13 (A) by striking ‘‘or (II)’’ and inserting ‘‘,

14 (II)’’; and

15 (B) by inserting ‘‘eligibility of a child for

16 medical assistance under the State plan under

17 this title, or eligibility of a child for child health

18 assistance under the program funded under

19 title XXI, (III) is an elementary school or sec20 ondary school, as such terms are defined in sec21 tion 14101 of the Elementary and Secondary

22 Education Act of 1965 (20 U.S.C. 8801), an el23 ementary or secondary school operated or sup24 ported by the Bureau of Indian Affairs, a State

25 child support enforcement agency, a child care
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1 resource and referral agency, an organization

2 that is providing emergency food and shelter

3 under a grant under the Stewart B. McKinney

4 Homeless Assistance Act, or a State office or

5 entity involved in enrollment in the program

6 under this title, under part A of title IV, under

7 title XXI, or that determines eligibility for any

8 assistance or benefits provided under any pro9 gram of public or assisted housing that receives

10 Federal funds, including the program under

11 section 8 or any other section of the United

12 States Housing Act of 1937 (42 U.S.C. 1437 et

13 seq.), or (IV) any other entity the State so

14 deems, as approved by the Secretary’’ before

15 the semicolon.

16 (2) APPLICATION UNDER SCHIP.—

17 (A) IN GENERAL.—Section 2107(e)(1) (42

18 U.S.C. 1397gg(e)(1)) is amended by adding at

19 the end the following new subparagraph:

20 ‘‘(D) Section 1920A (relating to presump21 tive eligibility).’’.

22 (B) EXCEPTION FROM LIMITATION ON AD23 MINISTRATIVE EXPENSES.—Section 2105(c)(2)

24 (42 U.S.C. 1397ee(c)(2)) is amended by adding

25 at the end the following new subparagraph:
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1 ‘‘(C) EXCEPTION FOR PRESUMPTIVE ELI2 GIBILITY EXPENDITURES.—The limitation

3 under subparagraph (A) on expenditures shall

4 not apply to expenditures attributable to the

5 application of section 1920A (pursuant to sec6 tion 2107(e)(1)(D)), regardless of whether the

7 child is determined to be ineligible for the pro8 gram under this title or title XIX.’’.

9 (3) TECHNICAL AMENDMENTS.—Section 1920A

10 (42 U.S.C. 1396r–1a) is amended—

11 (A) in subsection (b)(3)(A)(ii), by striking

12 ‘‘paragraph (1)(A)’’ and inserting ‘‘paragraph

13 (2)(A)’’; and

14 (B) in subsection (c)(2), in the matter pre15 ceding subparagraph (A), by striking ‘‘sub16 section (b)(1)(A)’’ and inserting ‘‘subsection

17 (b)(2)(A)’’.

18 (b) ELIMINATION OF SCHIP FUNDING OFFSET FOR

19 EXERCISE OF PRESUMPTIVE ELIGIBILITY OPTION.—

20 (1) IN GENERAL.—Section 2104(d) (42 U.S.C.

21 1397dd(d)) is amended by striking ‘‘the sum of—’’

22 and all that follows through ‘‘(2)’’ and conforming

23 the margins of all that remains accordingly.

24 (2) EFFECTIVE DATE.—The amendment made

25 by paragraph (1) takes effect October 1, 2000, and
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1 applies to allotments under title XXI of the Social

2 Security Act (42 U.S.C. 1397aa et seq.) for fiscal

3 year 2001 and each succeeding fiscal year there4 after.

5 SEC. 705. IMPROVEMENTS TO THE MATERNAL AND CHILD

6 HEALTH SERVICES BLOCK GRANT.

7 (a) INCREASE IN AUTHORIZATION OF APPROPRIA8 TIONS.—Section 501(a) (42 U.S.C. 701(a)) is amended in

9 the matter preceding paragraph (1) by striking

10 ‘‘$705,000,000 for fiscal year 1994’’ and inserting

11 ‘‘$1,000,000,000 for fiscal year 2001’’.

12 (b) COORDINATION WITH MEDICAID AND SCHIP.—

13 (1) SCHIP.—Section 505(a)(5)(F) (42 U.S.C.

14 705(a)(5)(F)) is amended—

15 (A) in clause (ii), by inserting ‘‘and in the

16 coordination of the administration of the State

17 program under title XXI with the care and

18 services available under this title, as required

19 under subsections (b)(3)(G) and (c)(2) of sec20 tion 2102’’ before the comma; and

21 (B) in clause (iv), by striking ‘‘and infants

22 who are eligible for medical assistance under

23 subparagraph (A) or (B) of section 1902(l)(1)’’

24 and inserting ‘‘, infants, and children who are

25 eligible for medical assistance under section
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1 1902(l)(1), and children who are eligible for

2 child health assistance under the State program

3 under title XXI’’.

4 (2) CONFORMING AMENDMENTS TO SCHIP.—

5 Section 2102(b)(3) (42 U.S.C. 1397bb(b)(3)), as

6 amended by section 703(b)(2), is amended—

7 (A) by striking ‘‘and’’ at the end of sub8 paragraph (E);

9 (B) by striking the period at the end of

10 subparagraph (F) and inserting ‘‘; and’’; and

11 (C) by adding at the end the following new

12 subparagraph:

13 ‘‘(G) that operations and activities under

14 this title are developed and implemented in con15 sultation and coordination with the program op16 erated by the State under title V with respect

17 to outreach and enrollment, benefits and serv18 ices, service delivery standards, public health

19 and social service agency relationships, and

20 quality assurance and data reporting.’’.

21 (c) EFFECTIVE DATE.—The amendments made by

22 this section take effect on October 1, 2000.
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1 SEC. 706. IMPROVING ACCESS TO MEDICARE COST-SHAR2 ING ASSISTANCE FOR LOW-INCOME BENE3 FICIARIES.

4 (a) INCREASE IN SLMB ELIGIBILITY.—

5 (1) IN GENERAL.—Section 1902(a)(10)(E) (42

6 U.S.C. 1396a(a)(10)(E)) is amended—

7 (A) in clause (iii), by striking ‘‘and 120

8 percent in 1995’’ and inserting ‘‘, 120 percent

9 in 1995 through 2000, and 135 percent in

10 2001’’; and

11 (B) in clause (iv), by striking ‘‘2002)—’’

12 and all that follows through ‘‘(II) for’’ and in13 serting ‘‘2002) for’’.

14 (2) CONFORMING AMENDMENT.—Section

15 1933(c)(2)(A) (42 U.S.C. 1396u–3(c)(2)(A)) is

16 amended by striking ‘‘sum of—’’ and all that follows

17 through ‘‘(ii) the’’’’.

18 (3) EFFECTIVE DATE.—The amendments made

19 by this subsection take effect on January 1, 2001,

20 and with respect to the amendment made by para21 graph (2), applies to allocations determined under

22 section 1933(c) of the Social Security Act (42

23 U.S.C. 1396u–3(c)) for the last 3 quarters of fiscal

24 year 2001 and all of fiscal year 2002.

25 (b) INDEX OF ASSETS TEST TO INFLATION.—Section

26 1905(p)(1)(C) (42 U.S.C. 1396d(p)(1)(C)) is amended by
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1 inserting ‘‘, increased (beginning with 2001 and each year

2 thereafter) by the percentage increase (if any) in the Con3 sumer Price Index for All Urban Consumers (United

4 States city average)’’ before the period.

5 (c) INCREASED EFFORT TO PROVIDE MEDICARE

6 BENEFICIARIES WITH MEDICARE COST-SHARING UNDER

7 THE MEDICAID PROGRAM.—

8 (1) IN GENERAL.—Section 1902(a) (42 U.S.C.

9 1396a(a)), as amended by section 703(b)(1)(A), is

10 amended—

11 (A) in paragraph (65), by striking ‘‘and’’

12 at the end;

13 (B) in paragraph (66), by striking the pe14 riod and inserting ‘‘; and’’; and

15 (C) by inserting after paragraph (66) the

16 following new paragraph:

17 ‘‘(67) provide for the determination of eligibility

18 for medicare cost-sharing (as defined in section

19 1905(p)(3)) for individuals described in paragraph

20 (10)(E) and, if eligible for such medicare cost-shar21 ing, for the enrollment of such individuals at any

22 hospital, clinic, or similar entity at which State or

23 local agency personnel are stationed for the purpose

24 of determining the eligibility of individuals for med25 ical assistance under the State plan or providing
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1 outreach services to eligible or potentially eligible in2 dividuals.’’.

3 (2) EFFECTIVE DATE.—The amendments made

4 by this paragraph shall take effect on the date of en5 actment of this Act.

6 (d) PRESUMPTIVE ELIGIBILITY OF CERTAIN LOW-IN7 COME INDIVIDUALS FOR MEDICARE COST-SHARING

8 UNDER THE QMB OR SLMB PROGRAM.—Title XIX (42

9 U.S.C. 1396 et seq.) is amended by inserting after section

10 1920A the following new section:

11 ‘‘PRESUMPTIVE ELIGIBILITY OF CERTAIN LOW-INCOME

12 INDIVIDUALS

13 ‘‘SEC. 1920B. (a) A State plan approved under sec14 tion 1902 shall provide for making medical assistance with

15 respect to medicare cost-sharing covered under the State

16 plan available to a low-income individual on the date the

17 low-income individual becomes entitled to benefits under

18 part A of title XVIII during a presumptive eligibility pe19 riod.

20 ‘‘(b) For purposes of this section:

21 ‘‘(1) The term ‘low-income individual’ means an

22 individual who at the age of 65 years is described—

23 ‘‘(A) in section 1902(a)(10)(E)(i), or

24 ‘‘(B) in section 1902(a)(10)(E)(iii).

25 ‘‘(2) The term ‘medicare cost-sharing’—
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1 ‘‘(A) with respect to an individual de2 scribed in paragraph (1)(A), has the meaning

3 given such term in section 1905(p)(3); and

4 ‘‘(B) with respect to an individual de5 scribed in paragraph (1)(B), has the meaning

6 given such term in section 1905(p)(3)(A).

7 ‘‘(3) The term ‘presumptive eligibility period’

8 means, with respect to a low-income individual, the

9 period that—

10 ‘‘(A) begins with the date on which a

11 qualified entity determines, on the basis of pre12 liminary information, that the income and re13 sources of the individual do not exceed the ap14 plicable income and resource level of eligibility

15 under the State plan, and

16 ‘‘(B) ends with (and includes) the earlier

17 of—

18 ‘‘(i) the day on which a determination

19 is made with respect to the eligibility of

20 the low-income individual for medical as21 sistance for medical cost-sharing under the

22 State plan, or

23 ‘‘(ii) in the case of a low-income indi24 vidual on whose behalf an application is

25 not filed by the last day of the month fol-
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1 lowing the month during which the entity

2 makes the determination referred to in

3 subparagraph (A), such last day.

4 ‘‘(4)(A) Subject to subparagraph (B), the term

5 ‘qualified entity’ means any of the following:

6 ‘‘(i) Qualified individuals within the Social

7 Security Administration.

8 ‘‘(ii) An entity determined by the State

9 agency to be capable of making determinations

10 of the type described in paragraph (3).

11 ‘‘(B) The Secretary may issue regulations fur12 ther limiting those entities that may become quali13 fied entities in order to prevent fraud and abuse and

14 for other reasons.

15 ‘‘(c)(1) The State agency, after consultation with the

16 Secretary, shall provide qualified entities with—

17 ‘‘(A) such forms as are necessary for an appli18 cation to be made on behalf of a low-income indi19 vidual for medical assistance for medical cost-shar20 ing under the State plan, and

21 ‘‘(B) information on how to assist low-income

22 individuals and other persons in completing and fil23 ing such forms.

24 ‘‘(2) A qualified entity that determines under sub25 section (b)(2)(A) that a low-income individual is presump-
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1 tively eligible for medical assistance for medical cost-shar2 ing under a State plan shall—

3 ‘‘(A) notify the State agency of the determina4 tion within 5 working days after the date on which

5 the determination is made, and

6 ‘‘(B) inform the low-income individual at the

7 time the determination is made that an application

8 for medical assistance for medical cost-sharing under

9 the State plan is required to be made by not later

10 than the last day of the month following the month

11 during which the determination is made.

12 ‘‘(3) In the case of a low-income individual who is

13 determined by a qualified entity to be presumptively eligi14 ble for medical assistance for medical cost-sharing under

15 a State plan, the low-income individual shall make applica16 tion for medical assistance for medical cost-sharing under

17 such plan by not later than the last day of the month fol18 lowing the month during which the determination is made.

19 ‘‘(d) Notwithstanding any other provision of this title,

20 medical assistance for medicare cost-sharing that—

21 ‘‘(1) is furnished to a low-income individual

22 during a presumptive eligibility period under the

23 State plan; and

24 ‘‘(2) is included in the services covered by a

25 State plan;
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1 shall be treated as medical assistance provided by such

2 plan for purposes of section 1903.’’.

3 SEC. 707. BREAST AND CERVICAL CANCER PREVENTION

4 AND TREATMENT.

5 (a) COVERAGE AS OPTIONAL CATEGORICALLY

6 NEEDY GROUP.—

7 (1) IN GENERAL.—Section 1902(a)(10)(A)(ii)

8 (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended—

9 (A) in subclause (XVI), by striking ‘‘or’’ at

10 the end;

11 (B) in subclause (XVII), by adding ‘‘or’’ at

12 the end; and

13 (C) by adding at the end the following:

14 ‘‘(XVIII) who are described in

15 subsection (aa) (relating to certain

16 breast or cervical cancer patients);’’.

17 (2) GROUP DESCRIBED.—Section 1902 (42

18 U.S.C. 1396a) is amended by adding at the end the

19 following:

20 ‘‘(aa) Individuals described in this subsection are in21 dividuals who—

22 ‘‘(1) are not described in subsection

23 (a)(10)(A)(i);

24 ‘‘(2) have not attained age 65;
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1 ‘‘(3) have been screened for breast and cervical

2 cancer under the Centers for Disease Control and

3 Prevention breast and cervical cancer early detection

4 program established under title XV of the Public

5 Health Service Act (42 U.S.C. 300k et seq.) in ac6 cordance with the requirements of section 1504 of

7 that Act (42 U.S.C. 300n) and need treatment for

8 breast or cervical cancer; and

9 ‘‘(4) are not otherwise covered under creditable

10 coverage, as defined in section 2701(c) of the Public

11 Health Service Act (42 U.S.C. 300gg(c)).’’.

12 (3) LIMITATION ON BENEFITS.—Section

13 1902(a)(10) (42 U.S.C. 1396a(a)(10)) is amended

14 in the matter following subparagraph (G)—

15 (A) by striking ‘‘and (XIII)’’ and inserting

16 ‘‘(XIII)’’; and

17 (B) by inserting ‘‘, and (XIV) the medical

18 assistance made available to an individual de19 scribed in subsection (aa) who is eligible for

20 medical assistance only because of subpara21 graph (A)(10)(ii)(XVIII) shall be limited to

22 medical assistance provided during the period in

23 which such an individual requires treatment for

24 breast or cervical cancer’’ before the semicolon.
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1 (4) CONFORMING AMENDMENTS.—Section

2 1905(a) (42 U.S.C. 1396d(a)) is amended in the

3 matter preceding paragraph (1)—

4 (A) in clause (xi), by striking ‘‘or’’ at the

5 end;

6 (B) in clause (xii), by adding ‘‘or’’ at the

7 end; and

8 (C) by inserting after clause (xii) the fol9 lowing:

10 ‘‘(xiii) individuals described in section

11 1902(aa),’’.

12 (b) PRESUMPTIVE ELIGIBILITY.—

13 (1) IN GENERAL.—Title XIX (42 U.S.C. 1396

14 et seq.) is amended by inserting after section 1920A

15 the following:

16 ‘‘PRESUMPTIVE ELIGIBILITY FOR CERTAIN BREAST OR

17 CERVICAL CANCER PATIENTS

18 ‘‘SEC. 1920B. (a) STATE OPTION.—A State plan ap19 proved under section 1902 may provide for making med20 ical assistance available to an individual described in sec21 tion 1902(aa) (relating to certain breast or cervical cancer

22 patients) during a presumptive eligibility period.

23 ‘‘(b) DEFINITIONS.—For purposes of this section:

24 ‘‘(1) PRESUMPTIVE ELIGIBILITY PERIOD.—The

25 term ‘presumptive eligibility period’ means, with re-
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1 spect to an individual described in subsection (a),

2 the period that—

3 ‘‘(A) begins with the date on which a

4 qualified entity determines, on the basis of pre5 liminary information, that the individual is de6 scribed in section 1902(aa); and

7 ‘‘(B) ends with (and includes) the earlier

8 of—

9 ‘‘(i) the day on which a determination

10 is made with respect to the eligibility of

11 such individual for services under the State

12 plan; or

13 ‘‘(ii) in the case of such an individual

14 who does not file an application by the last

15 day of the month following the month dur16 ing which the entity makes the determina17 tion referred to in subparagraph (A), such

18 last day.

19 ‘‘(2) QUALIFIED ENTITY.—

20 ‘‘(A) IN GENERAL.—Subject to subpara21 graph (B), the term ‘qualified entity’ means

22 any entity that—

23 ‘‘(i) is eligible for payments under a

24 State plan approved under this title; and
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1 ‘‘(ii) is determined by the State agen2 cy to be capable of making determinations

3 of the type described in paragraph (1)(A).

4 ‘‘(B) REGULATIONS.—The Secretary may

5 issue regulations further limiting those entities

6 that may become qualified entities in order to

7 prevent fraud and abuse and for other reasons.

8 ‘‘(C) RULE OF CONSTRUCTION.—Nothing

9 in this paragraph shall be construed as pre10 venting a State from limiting the classes of en11 tities that may become qualified entities, con12 sistent with any limitations imposed under sub13 paragraph (B).

14 ‘‘(c) ADMINISTRATION.—

15 ‘‘(1) IN GENERAL.—The State agency shall pro16 vide qualified entities with—

17 ‘‘(A) such forms as are necessary for an

18 application to be made by an individual de19 scribed in subsection (a) for medical assistance

20 under the State plan; and

21 ‘‘(B) information on how to assist such in22 dividuals in completing and filing such forms.

23 ‘‘(2) NOTIFICATION REQUIREMENTS.—A quali24 fied entity that determines under subsection

25 (b)(1)(A) that an individual described in subsection
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1 (a) is presumptively eligible for medical assistance

2 under a State plan shall—

3 ‘‘(A) notify the State agency of the deter4 mination within 5 working days after the date

5 on which the determination is made; and

6 ‘‘(B) inform such individual at the time

7 the determination is made that an application

8 for medical assistance under the State plan is

9 required to be made by not later than the last

10 day of the month following the month during

11 which the determination is made.

12 ‘‘(3) APPLICATION FOR MEDICAL ASSIST13 ANCE.—In the case of an individual described in

14 subsection (a) who is determined by a qualified enti15 ty to be presumptively eligible for medical assistance

16 under a State plan, the individual shall apply for

17 medical assistance under such plan by not later than

18 the last day of the month following the month dur19 ing which the determination is made.

20 ‘‘(d) PAYMENT.—Notwithstanding any other provi21 sion of this title, medical assistance that—

22 ‘‘(1) is furnished to an individual described in

23 subsection (a)—

24 ‘‘(A) during a presumptive eligibility pe25 riod; and
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1 ‘‘(B) by a entity that is eligible for pay2 ments under the State plan; and

3 ‘‘(2) is included in the care and services covered

4 by the State plan,

5 shall be treated as medical assistance provided by such

6 plan for purposes of clause (4) of the first sentence of

7 section 1905(b).’’.

8 (2) CONFORMING AMENDMENTS.—

9 (A) Section 1902(a)(47) (42 U.S.C.

10 1396a(a)(47)) is amended by inserting before

11 the semicolon at the end the following: ‘‘and

12 provide for making medical assistance available

13 to individuals described in subsection (a) of sec14 tion 1920B during a presumptive eligibility pe15 riod in accordance with such section’’.

16 (B) Section 1903(u)(1)(D)(v) (42 U.S.C.

17 1396b(u)(1)(D)(v)) is amended—

18 (i) by striking ‘‘or for’’ and inserting

19 ‘‘, for’’; and

20 (ii) by inserting before the period the

21 following: ‘‘, or for medical assistance pro22 vided to an individual described in sub23 section (a) of section 1920B during a pre24 sumptive eligibility period under such sec25 tion’’.
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1 (c) ENHANCED MATCH.—The first sentence of sec2 tion 1905(b) (42 U.S.C. 1396d(b)) is amended—

3 (1) by striking ‘‘and’’ before ‘‘(3)’’; and

4 (2) by inserting before the period at the end the

5 following: ‘‘, and (4) the Federal medical assistance

6 percentage shall be equal to the enhanced FMAP de7 scribed in section 2105(b) with respect to medical

8 assistance provided to individuals who are eligible

9 for such assistance only on the basis of section

10 1902(a)(10)(A)(ii)(XVIII)’’.

11 (d) EFFECTIVE DATE.—The amendments made by

12 this section apply to medical assistance for items and serv13 ices furnished on or after October 1, 2000, without regard

14 to whether final regulations to carry out such amendments

15 have been promulgated by such date.

16 SEC. 708. MEDICAID COVERAGE OF SERVICES FURNISHED

17 BY CERTIFIED NURSE PRACTITIONERS AND

18 CLINICAL NURSE SPECIALISTS.

19 (a) IN GENERAL.—Section 1905(a)(21) (42 U.S.C.

20 1396d(a)(21)) is amended to read as follows:

21 ‘‘(21) services furnished by a certified nurse

22 practitioner (as defined by the Secretary) or a clin23 ical nurse specialist (as defined in subsection (x)

24 which the certified nurse practitioner or clinical

25 nurse specialist is legally authorized to perform
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1 under State law (or the State regulatory mechanism

2 provided by State law), whether or not the certified

3 nurse practitioner or clinical nurse specialist is

4 under the supervision of, or associated with, a physi5 cian or other health care provider;’’.

6 (b) DEFINITION OF CLINICAL NURSE SPECIALIST.—

7 Section 1905 of such Act (42 U.S.C. 1396d) is amended

8 by adding at the end the following new subsection:

9 ‘‘(x) The term ‘clinical nurse specialist’ means an in10 dividual who has earned a master’s degree in a clinical

11 area of nursing from an accredited institution and who

12 is a registered nurse licensed to practice nursing in the

13 State in which the individual furnishes services.’’.

14 (c) EFFECTIVE DATE.—The amendments made by

15 subsections (a) and (b) apply to calendar quarters begin16 ning on or after October 1, 2000, without regard to wheth17 er or not final regulations to carry out such amendments

18 have been promulgated by such date.

19 TITLE VIII—OTHER PROVISIONS

20 SEC. 801. APPROPRIATIONS FOR RICKY RAY HEMOPHILIA

21 RELIEF FUND.

22 Section 101(e) of the Ricky Ray Hemophilia Relief

23 Fund Act of 1998 (42 U.S.C. 300c–22 note) is amended

24 by adding at the end the following: ‘‘There is appropriated
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1 to the Fund $475,000,000 for fiscal year 2001, to remain

2 available until expended.’’.

3 SEC. 802. INCREASE IN APPROPRIATIONS FOR SPECIAL DI4 ABETES PROGRAMS FOR CHILDREN WITH

5 TYPE I DIABETES AND INDIANS.

6 (a) SPECIAL DIABETES PROGRAMS FOR CHILDREN

7 WITH TYPE I DIABETES.—Section 330B(b) of the Public

8 Health Service Act (42 U.S.C. 254c–2(b)) is amended—

9 (1) by striking ‘‘Notwithstanding’’ and insert10 ing the following:

11 ‘‘(1) TRANSFERRED FUNDS.—Notwith12 standing’’; and

13 (2) by adding at the end the following:

14 ‘‘(2) APPROPRIATIONS.—For the purpose of

15 making grants under this section, there are appro16 priated, out of any money in the Treasury not other17 wise appropriated—

18 ‘‘(A) $70,000,000 for each of fiscal years

19 2001 and 2002 (which shall be combined with

20 amounts transferred under paragraph (1) for

21 each such fiscal years); and

22 ‘‘(B) $100,000,000 for each of fiscal years

23 2003 through 2005.’’.
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1 (b) SPECIAL DIABETES PROGRAMS FOR INDIANS.—

2 Section 330C(c) of the Public Health Service Act (42

3 U.S.C. 254c–3(c)) is amended—

4 (1) by striking ‘‘Notwithstanding’’ and insert5 ing the following:

6 ‘‘(1) TRANSFERRED FUNDS.—Notwith7 standing’’;

8 (2) by adding at the end the following:

9 ‘‘(2) APPROPRIATIONS.—For the purpose of

10 making grants under this section, there are appro11 priated, out of any money in the Treasury not other12 wise appropriated—

13 ‘‘(A) $70,000,000 for each of fiscal years

14 2001 and 2002 (which shall be combined with

15 amounts transferred under paragraph (1) for

16 each such fiscal years); and

17 ‘‘(B) $100,000,000 for each of fiscal years

18 2003 through 2005.’’.

19 SEC. 803. DEMONSTRATION GRANTS TO IMPROVE OUT20 REACH, ENROLLMENT, AND COORDINATION

21 OF PROGRAMS AND SERVICES TO HOMELESS

22 INDIVIDUALS AND FAMILIES.

23 (a) AUTHORITY.—The Secretary of Health and

24 Human Services may award demonstration grants to not

25 more than 7 States (or other qualified entities) to conduct
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1 innovative programs that are designed to improve out2 reach to homeless individuals and families under the pro3 grams described in subsection (b) with respect to enroll4 ment of such individuals and families under such pro5 grams and the provision of services (and coordinating the

6 provision of such services) under such programs.

7 (b) PROGRAMS FOR HOMELESS DESCRIBED.—The

8 programs described in this subsection are as follows:

9 (1) MEDICAID.—The program under title XIX

10 of the Social Security Act (42 U.S.C. 1396 et seq.).

11 (2) SCHIP.—The program under title XXI of

12 such Act (42 U.S.C. 1397aa et seq.).

13 (3) TANF.—The program under part of A of

14 title IV of such Act (42 U.S.C. 601 et seq.).

15 (4) MATERNAL AND CHILD HEALTH BLOCK

16 GRANTS.—The program under title V of the Social

17 Security Act (42 U.S.C. 701 et seq.).

18 (5) MENTAL HEALTH AND SUBSTANCE ABUSE

19 BLOCK GRANTS.—The program under part B of title

20 XIX of the Public Health Service Act (42 U.S.C.

21 300x–1 et seq.).

22 (6) HIV/AIDS CARE GRANTS.—The program

23 under part B of title XXVI of the Public Health

24 Service Act (42 U.S.C. 300ff–21 et seq.).
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1 (7) FOOD STAMP PROGRAM.—The program

2 under the Food Stamp Act of 1977 (7 U.S.C. 2011

3 et seq.).

4 (8) WORKFORCE INVESTMENT ACT.—The pro5 gram under the Workforce Investment Act of 1999

6 (29 U.S.C. 2801 et seq.).

7 (9) WELFARE-TO-WORK.—The welfare-to-work

8 program under section 403(a)(5) of the Social Secu9 rity Act (42 U.S.C. 603(a)(5)).

10 (10) OTHER PROGRAMS.—Other public and pri11 vate benefit programs that serve low-income individ12 uals.

13 (c) APPROPRIATIONS.—For the purposes of carrying

14 out this section, there are appropriated, out of any funds

15 in the Treasury not otherwise appropriated, $10,000,000,

16 to remain available until expended.

17 SEC. 804. PROTECTION OF AN HMO ENROLLEE TO RECEIVE

18 CONTINUING CARE AT A FACILITY SELECTED

19 BY THE ENROLLEE.

20 (a) AMENDMENTS TO THE EMPLOYEE RETIREMENT

21 INCOME SECURITY ACT OF 1974.—

22 (1) IN GENERAL.—Subpart B of part 7 of sub23 title B of title I of the Employee Retirement Income

24 Security Act of 1974 (29 U.S.C. 1185 et seq.) is
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1 amended by adding at the end the following new sec2 tion:

3 ‘‘SEC. 714. ENSURING CHOICE FOR CONTINUING CARE.

4 ‘‘(a) IN GENERAL.—With respect to health insurance

5 coverage provided to participants or beneficiaries through

6 a managed care organization under a group health plan,

7 or through a health insurance issuer providing health in8 surance coverage in connection with a group health plan,

9 such plan or issuer may not deny coverage for services

10 provided to such participant or beneficiary by a continuing

11 care retirement community, skilled nursing facility, or

12 other qualified facility in which the participant or bene13 ficiary resided prior to a hospitalization, regardless of

14 whether such organization is under contract with such

15 community or facility if the requirements described in sub16 section (b) are met.

17 ‘‘(b) REQUIREMENTS.—The requirements of this sub18 section are that—

19 ‘‘(1) the service involved is a service for which

20 the managed care organization involved would be re21 quired to provide or pay for under its contract with

22 the participant or beneficiary if the continuing care

23 retirement community, skilled nursing facility, or

24 other qualified facility were under contract with the

25 organization;
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1 ‘‘(2) the participant or beneficiary involved—

2 ‘‘(A) resided in the continuing care retire3 ment community, skilled nursing facility, or

4 other qualified facility prior to being hospital5 ized;

6 ‘‘(B) had a contractual or other right to

7 return to the facility after hospitalization; and

8 ‘‘(C) elects to return to the facility after

9 hospitalization, whether or not the residence of

10 the participant or beneficiary after returning

11 from the hospital is the same part of the facility

12 in which the beneficiary resided prior to hos13 pitalization;

14 ‘‘(3) the continuing care retirement community,

15 skilled nursing facility, or other qualified facility has

16 the capacity to provide the services the participant

17 or beneficiary needs; and

18 ‘‘(4) the continuing care retirement community,

19 skilled nursing facility, or other qualified facility is

20 willing to accept substantially similar payment under

21 the same terms and conditions that apply to simi22 larly situated health care facility providers under

23 contract with the organization involved.

24 ‘‘(c) SERVICES TO PREVENT HOSPITALIZATION.—A

25 group health plan or health insurance issuer to which this
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1 section applies may not deny payment for a skilled nursing

2 service provided to a participant or beneficiary by a con3 tinuing care retirement community, skilled nursing facil4 ity, or other qualified facility in which the participant or

5 beneficiary resides, without a preceding hospital stay, re6 gardless of whether the organization is under contract

7 with such community or facility, if—

8 ‘‘(1) the plan or issuer has determined that the

9 service is necessary to prevent the hospitalization of

10 the participant or beneficiary; and

11 ‘‘(2) the service to prevent hospitalization is

12 provided as an additional benefit as described in sec13 tion 417.594 of title 42, Code of Federal Regula14 tions, and would otherwise be covered as provided

15 for in subsection (b)(1).

16 ‘‘(d) RIGHTS OF SPOUSES.—A group health plan or

17 health insurance issuer to which this section applies shall

18 not deny payment for services provided by a skilled nurs19 ing facility for the care of a participant or beneficiary, re20 gardless of whether the plan or issuer is under contract

21 with such facility, if the spouse of the participant or bene22 ficiary is already a resident of such facility and the re23 quirements described in subsection (b) are met.

24 ‘‘(e) EXCEPTIONS.—Subsection (a) shall not apply—
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1 ‘‘(1) where the attending acute care provider

2 and the participant or beneficiary (or a designated

3 representative of the participant or beneficiary where

4 the participant or beneficiary is physically or men5 tally incapable of making an election under this

6 paragraph) do not elect to pursue a course of treat7 ment necessitating continuing care; or

8 ‘‘(2) unless the community or facility involved—

9 ‘‘(A) meets all applicable licensing and cer10 tification requirements of the State in which it

11 is located; and

12 ‘‘(B) agrees to reimbursement for the care

13 of the participant or beneficiary at a rate simi14 lar to the rate negotiated by the managed care

15 organization with similar providers of care for

16 similar services.

17 ‘‘(f) PROHIBITIONS.—A group health plan and a

18 health insurance issuer providing health insurance cov19 erage in connection with a group health plan may not—

20 ‘‘(1) deny to an individual eligibility, or contin21 ued eligibility, to enroll or to renew coverage with a

22 managed care organization under the plan, solely for

23 the purpose of avoiding the requirements of this sec24 tion;
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1 ‘‘(2) provide monetary payments or rebates to

2 enrollees to encourage such enrollees to accept less

3 than the minimum protections available under this

4 section;

5 ‘‘(3) penalize or otherwise reduce or limit the

6 reimbursement of an attending physician because

7 such physician provided care to a participant or ben8 eficiary in accordance with this section; or

9 ‘‘(4) provide incentives (monetary or otherwise)

10 to an attending physician to induce such physician

11 to provide care to a participant or beneficiary in a

12 manner inconsistent with this section.

13 ‘‘(g) RULES OF CONSTRUCTION.—

14 ‘‘(1) HMO NOT OFFERING BENEFITS.—This

15 section shall not apply with respect to any managed

16 care organization under a group health plan, or

17 through a health insurance issuer providing health

18 insurance coverage in connection with a group health

19 plan, that does not provide benefits for stays in a

20 continuing care retirement community, skilled nurs21 ing facility, or other qualified facility.

22 ‘‘(2) COST-SHARING.—Nothing in this section

23 shall be construed as preventing a managed care or24 ganization under a group health plan, or through a

25 health insurance issuer providing health insurance
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1 coverage in connection with a group health plan,

2 from imposing deductibles, coinsurance, or other

3 cost-sharing in relation to benefits for care in a con4 tinuing care facility.

5 ‘‘(h) PREEMPTION; EXCEPTION FOR HEALTH INSUR6 ANCE COVERAGE IN CERTAIN STATES.—

7 ‘‘(1) IN GENERAL.—The requirements of this

8 section shall not apply with respect to health insur9 ance coverage to the extent that a State law (as de10 fined in section 2723(d)(1) of the Public Health

11 Service Act) applies to such coverage and is de12 scribed in any of the following subparagraphs:

13 ‘‘(A) Such State law requires such cov14 erage to provide for referral to a continuing

15 care retirement community, skilled nursing fa16 cility, or other qualified facility in a manner

17 that is more protective of participants or bene18 ficiaries than the provisions of this section.

19 ‘‘(B) Such State law expands the range of

20 services or facilities covered under this section

21 and is otherwise more protective of the rights of

22 participants or beneficiaries than the provisions

23 of this section.

24 ‘‘(2) CONSTRUCTION.—Section 731(a)(1) shall

25 not be construed to provide that any requirement of
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1 this section applies with respect to health insurance

2 coverage, to the extent that a State law described

3 in paragraph (1) applies to such coverage.

4 ‘‘(i) PENALTIES.—A participant or beneficiary may

5 enforce the provisions of this section in an appropriate

6 Federal district court. An action for injunctive relief or

7 damages may be commenced on behalf of the participant

8 or beneficiary by the participant’s or beneficiary’s legal

9 representative. The court may award reasonable attorneys’

10 fees to the prevailing party. If a beneficiary dies before

11 conclusion of an action under this section, the action may

12 be maintained by a representative of the participant’s or

13 beneficiary’s estate.

14 ‘‘(j) DEFINITIONS.—In this section:

15 ‘‘(1) ATTENDING ACUTE CARE PROVIDER.—The

16 term ‘attending acute care provider’ means anyone

17 licensed or certified under State law to provide

18 health care services who is operating within the

19 scope of such license and who is primarily respon20 sible for the care of the enrollee.

21 ‘‘(2) CONTINUING CARE RETIREMENT COMMU22 NITY.—The term ‘continuing care retirement com23 munity’ means an organization that provides or ar24 ranges for the provision of housing and health-re25 lated services to an older person under an agreement
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1 effective for the life of the person or for a specified

2 period greater than 1 year.

3 ‘‘(3) MANAGED CARE ORGANIZATION.—The

4 term ‘managed care organization’ means an organi5 zation that provides comprehensive health services to

6 participants or beneficiaries, directly or under con7 tract or other agreement, on a prepayment basis to

8 such individuals. For purposes of this section, the

9 following shall be considered as managed care orga10 nizations:

11 ‘‘(A) A Medicare+Choice plan authorized

12 under section 1851(a) of the Social Security

13 Act (42 U.S.C. 1395w–21(a)).

14 ‘‘(B) Any other entity that manages the

15 cost, utilization, and delivery of health care

16 through the use of predetermined periodic pay17 ments to health care providers employed by or

18 under contract or other agreement, directly or

19 indirectly, with the entity.

20 ‘‘(4) OTHER QUALIFIED FACILITY.—The term

21 ‘other qualified facility’ means any facility that can

22 provide the services required by the participant or

23 beneficiary consistent with State and Federal law.

24 ‘‘(5) SKILLED NURSING FACILITY.—The term

25 ‘skilled nursing facility’ means a facility that meets
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1 the requirements of section 1819 of the Social Secu2 rity Act (42 U.S.C. 1395i–3).’’.

3 (2) CLERICAL AMENDMENT.—The table of con4 tents in section 1 of the Employee Retirement In5 come Security Act of 1974 is amended by inserting

6 after the items relating to subpart B of part 7 of

7 subtitle B of title I the following new item:

‘‘Sec. 714. Ensuring choice for continuing care.’’.

8 (3) EFFECTIVE DATE.—The amendments made

9 by this section shall apply with respect to plan years

10 beginning on or after January 1, 2001.

11 (b) AMENDMENT TO THE PUBLIC HEALTH SERVICE

12 ACT RELATING TO THE GROUP MARKET.—

13 (1) IN GENERAL.—Subpart 2 of part A of title

14 XXVII of the Public Health Service Act (42 U.S.C.

15 300gg–4 et seq.) is amended by adding at the end

16 the following new section:

17 ‘‘SEC. 2707. ENSURING CHOICE FOR CONTINUING CARE.

18 ‘‘(a) IN GENERAL.—With respect to health insurance

19 coverage provided to enrollees through a managed care or20 ganization under a group health plan, or through a health

21 insurance issuer providing health insurance coverage in

22 connection with a group health plan, such plan or issuer

23 may not deny coverage for services provided to such en24 rollee by a continuing care retirement community, skilled

25 nursing facility, or other qualified facility in which the en-
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1 rollee resided prior to a hospitalization, regardless of

2 whether such organization is under contract with such

3 community or facility if the requirements described in sub4 section (b) are met.

5 ‘‘(b) REQUIREMENTS.—The requirements of this sub6 section are that—

7 ‘‘(1) the service involved is a service for which

8 the managed care organization involved would be re9 quired to provide or pay for under its contract with

10 the enrollee if the continuing care retirement com11 munity, skilled nursing facility, or other qualified fa12 cility were under contract with the organization;

13 ‘‘(2) the enrollee involved—

14 ‘‘(A) resided in the continuing care retire15 ment community, skilled nursing facility, or

16 other qualified facility prior to being hospital17 ized;

18 ‘‘(B) had a contractual or other right to

19 return to the facility after hospitalization; and

20 ‘‘(C) elects to return to the facility after

21 hospitalization, whether or not the residence of

22 the enrollee after returning from the hospital is

23 the same part of the facility in which the bene24 ficiary resided prior to hospitalization;
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1 ‘‘(3) the continuing care retirement community,

2 skilled nursing facility, or other qualified facility has

3 the capacity to provide the services the enrollee

4 needs; and

5 ‘‘(4) the continuing care retirement community,

6 skilled nursing facility, or other qualified facility is

7 willing to accept substantially similar payment under

8 the same terms and conditions that apply to simi9 larly situated health care facility providers under

10 contract with the organization involved.

11 ‘‘(c) SERVICES TO PREVENT HOSPITALIZATION.—A

12 group health plan or health insurance issuer to which this

13 section applies may not deny payment for a skilled nursing

14 service provided to an enrollee by a continuing care retire15 ment community, skilled nursing facility, or other quali16 fied facility in which the enrollee resides, without a pre17 ceding hospital stay, regardless of whether the plan or

18 issuer is under contract with such community or facility,

19 if—

20 ‘‘(1) the plan or issuer has determined that the

21 service is necessary to prevent the hospitalization of

22 the enrollee; and

23 ‘‘(2) the service to prevent hospitalization is

24 provided as an additional benefit as described in sec25 tion 417.594 of title 42, Code of Federal Regula-
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1 tions, and would be covered as provided for in sub2 section (b)(1).

3 ‘‘(d) RIGHTS OF SPOUSES.—A group health plan or

4 health insurance issuer to which this section applies shall

5 not deny payment for services provided by a skilled nurs6 ing facility for the care of an enrollee, regardless of wheth7 er the plan or issuer is under contract with such facility,

8 if the spouse of the enrollee is already a resident of such

9 facility and the requirements described in subsection (b)

10 are met.

11 ‘‘(e) EXCEPTIONS.—Subsection (a) shall not apply—

12 ‘‘(1) where the attending acute care provider

13 and the enrollee (or a designated representative of

14 the enrollee where the enrollee is physically or men15 tally incapable of making an election under this

16 paragraph) do not elect to pursue a course of treat17 ment necessitating continuing care; or

18 ‘‘(2) unless the community or facility involved—

19 ‘‘(A) meets all applicable licensing and cer20 tification requirements of the State in which it

21 is located; and

22 ‘‘(B) agrees to reimbursement for the care

23 of the enrollee at a rate similar to the rate ne24 gotiated by the managed care organization with

25 similar providers of care for similar services.
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1 ‘‘(f) PROHIBITIONS.—A group health plan and a

2 health insurance issuer providing health insurance cov3 erage in connection with a group health plan may not—

4 ‘‘(1) deny to an individual eligibility, or contin5 ued eligibility, to enroll or to renew coverage with a

6 managed care organization under the plan, solely for

7 the purpose of avoiding the requirements of this sec8 tion;

9 ‘‘(2) provide monetary payments or rebates to

10 enrollees to encourage such enrollees to accept less

11 than the minimum protections available under this

12 section;

13 ‘‘(3) penalize or otherwise reduce or limit the

14 reimbursement of an attending physician because

15 such physician provided care to an enrollee in ac16 cordance with this section; or

17 ‘‘(4) provide incentives (monetary or otherwise)

18 to an attending physician to induce such physician

19 to provide care to an enrollee in a manner incon20 sistent with this section.

21 ‘‘(g) RULES OF CONSTRUCTION.—

22 ‘‘(1) HMO NOT OFFERING BENEFITS.—This

23 section shall not apply with respect to any managed

24 care organization under a group health plan, or

25 through a health insurance issuer providing health
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1 insurance coverage in connection with a group health

2 plan, that does not provide benefits for stays in a

3 continuing care retirement community, skilled nurs4 ing facility, or other qualified facility.

5 ‘‘(2) COST-SHARING.—Nothing in this section

6 shall be construed as preventing a managed care or7 ganization under a group health plan, or through a

8 health insurance issuer providing health insurance

9 coverage in connection with a group health plan,

10 from imposing deductibles, coinsurance, or other

11 cost-sharing in relation to benefits for care in a con12 tinuing care facility.

13 ‘‘(h) PREEMPTION; EXCEPTION FOR HEALTH INSUR14 ANCE COVERAGE IN CERTAIN STATES.—

15 ‘‘(1) IN GENERAL.—The requirements of this

16 section shall not apply with respect to health insur17 ance coverage to the extent that a State law (as de18 fined in section 2723(d)(1)) applies to such coverage

19 and is described in any of the following subpara20 graphs:

21 ‘‘(A) Such State law requires such cov22 erage to provide for referral to a continuing

23 care retirement community, skilled nursing fa24 cility, or other qualified facility in a manner
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1 that is more protective of the enrollee than the

2 provisions of this section.

3 ‘‘(B) Such State law expands the range of

4 services or facilities covered under this section

5 and is otherwise more protective of enrollee

6 rights than the provisions of this section.

7 ‘‘(2) CONSTRUCTION.—Section 2723(a)(1) shall

8 not be construed to provide that any requirement of

9 this section applies with respect to health insurance

10 coverage, to the extent that a State law described in

11 paragraph (1) applies to such coverage.

12 ‘‘(i) PENALTIES.—An enrollee may enforce the provi13 sions of this section in an appropriate Federal district

14 court. An action for injunctive relief or damages may be

15 commenced on behalf of the enrollee by the enrollee’s legal

16 representative. The court may award reasonable attorneys’

17 fees to the prevailing party. If a beneficiary dies before

18 conclusion of an action under this section, the action may

19 be maintained by a representative of the enrollee’s estate.

20 ‘‘(j) DEFINITIONS.—In this section:

21 ‘‘(1) ATTENDING ACUTE CARE PROVIDER.—The

22 term ‘attending acute care provider’ means anyone

23 licensed or certified under State law to provide

24 health care services who is operating within the
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1 scope of such license and who is primarily respon2 sible for the care of the enrollee.

3 ‘‘(2) CONTINUING CARE RETIREMENT COMMU4 NITY.—The term ‘continuing care retirement com5 munity’ means an organization that provides or ar6 ranges for the provision of housing and health-re7 lated services to an older person under an agreement

8 effective for the life of the person or for a specified

9 period greater than 1 year.

10 ‘‘(3) MANAGED CARE ORGANIZATION.—The

11 term ‘managed care organization’ means an organi12 zation that provides comprehensive health services to

13 enrollees, directly or under contract or other agree14 ment, on a prepayment basis to such individuals.

15 For purposes of this section, the following shall be

16 considered as managed care organizations:

17 ‘‘(A) A Medicare+Choice plan authorized

18 under section 1851(a) of the Social Security

19 Act (42 U.S.C. 1395w–21(a)).

20 ‘‘(B) Any other entity that manages the

21 cost, utilization, and delivery of health care

22 through the use of predetermined periodic pay23 ments to health care providers employed by or

24 under contract or other agreement, directly or

25 indirectly, with the entity.
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1 ‘‘(4) OTHER QUALIFIED FACILITY.—The term

2 ‘other qualified facility’ means any facility that can

3 provide the services required by the enrollee con4 sistent with State and Federal law.

5 ‘‘(5) SKILLED NURSING FACILITY.—The term

6 ‘skilled nursing facility’ means a facility that meets

7 the requirements of section 1819 of the Social Secu8 rity Act (42 U.S.C. 1395i–3).’’.

9 (2) EFFECTIVE DATE.—The amendment made

10 by this section shall apply with respect to group

11 health plans for plan years beginning on or after

12 January 1, 2001.

13 (c) AMENDMENTS TO THE PUBLIC HEALTH SERVICE

14 ACT RELATING TO THE INDIVIDUAL MARKET.—

15 (1) IN GENERAL.—The first subpart 3 of part

16 B of title XXVII of the Public Health Service Act

17 (42 U.S.C. 300gg–51 et seq.) (relating to other re18 quirements) is amended—

19 (A) by redesignating such subpart as sub20 part 2; and

21 (B) by adding at the end the following new

22 section:

23 ‘‘SEC. 2753. ENSURING CHOICE FOR CONTINUING CARE.

24 ‘‘The provisions of section 2707 shall apply to health

25 maintenance organization coverage offered by a health in-
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1 surance issuer in the individual market in the same man2 ner as they apply to such coverage offered by a health

3 insurance issuer in connection with a group health plan

4 in the small or large group market.’’.

5 (2) EFFECTIVE DATE.—The amendment made

6 by this section shall apply with respect to health in7 surance coverage offered, sold, issued, renewed, in

8 effect, or operated in the individual market on or

9 after January 1, 2001.

10 SEC. 805. GRANTS TO DEVELOP AND ESTABLISH REAL

11 CHOICE SYSTEMS CHANGE INITIATIVES.

12 (a) ESTABLISHMENT.—

13 (1) IN GENERAL.—The Secretary of Health and

14 Human Services (in this section referred to as the

15 ‘‘Secretary’’) shall award grants described in sub16 section (b) to States to support real choice systems

17 change initiatives that establish specific action steps

18 and specific timetables to achieve enduring system

19 improvements and to provide consumer-responsive

20 long-term services and supports to eligible individ21 uals in the most integrated setting appropriate based

22 on the unique strengths and needs of the individual,

23 the priorities and concerns of the individual (or, as

24 appropriate, the individual’s representative), and the
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1 individual’s desires with regard to participation in

2 community life.

3 (2) ELIGIBILITY.—To be eligible for a grant

4 under this section, a State shall—

5 (A) establish a Consumer Task Force in

6 accordance with subsection (d); and

7 (B) submit an application at such time, in

8 such manner, and containing such information

9 as the Secretary may determine. The applica10 tion shall be jointly developed and signed by the

11 designated State official and the chairperson of

12 such Task Force, acting on behalf of and at the

13 direction of the Task Force.

14 (3) DEFINITION OF STATE.—In this section,

15 the term ‘‘State’’ means each of the 50 States, the

16 District of Columbia, Puerto Rico, Guam, the

17 United States Virgin Islands, American Samoa, and

18 the Commonwealth of the Northern Mariana Is19 lands.

20 (b) GRANTS FOR REAL CHOICE SYSTEMS CHANGE

21 INITIATIVES.—

22 (1) IN GENERAL.—From funds appropriated

23 under subsection (f), the Secretary shall award

24 grants to States to—
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1 (A) support the establishment, implemen2 tation, and operation of the State real choice

3 systems change initiatives described in sub4 section (a); and

5 (B) conduct outreach campaigns regarding

6 the existence of such initiatives.

7 (2) DETERMINATION OF AWARDS; STATE AL8 LOTMENTS.—The Secretary shall develop a formula

9 for the distribution of funds to States for each fiscal

10 year under subsection (a). Such formula shall give

11 preference to States that have a higher need for as12 sistance, as determined by the Secretary, based on

13 indicators such as a relatively higher proportion of

14 long-term services and supports furnished to individ15 uals in an institutional setting but who have a plan

16 described in an application submitted under sub17 section (a)(2).

18 (c) AUTHORIZED ACTIVITIES.—A State that receives

19 a grant under this section shall use the funds made avail20 able through the grant to accomplish the purposes de21 scribed in subsection (a) and, in accomplishing such pur22 poses, may carry out any of the following systems change

23 activities:

24 (1) NEEDS ASSESSMENT AND DATA GATH25 ERING.—The State may use funds to conduct a
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1 statewide needs assessment that may be based on

2 data in existence on the date on which the assess3 ment is initiated and may include information about

4 the number of individuals within the State who are

5 receiving long-term services and supports in unnec6 essarily segregated settings, the nature and extent to

7 which current programs respond to the preferences

8 of individuals with disabilities to receive services in

9 home and community-based settings as well as in in10 stitutional settings, and the expected change in de11 mand for services provided in home and community

12 settings as well as institutional settings.

13 (2) INSTITUTIONAL BIAS: REMEDIES AND PRO14 MOTION OF COMMUNITY PARTICIPATION.—The State

15 may use funds to identify, develop, and implement

16 strategies for modifying policies, practices, and pro17 cedures that unnecessarily bias the provision of long18 term services and supports toward institutional set19 tings and away from home and community-based

20 settings, including policies, practices, and procedures

21 governing statewideness, comparability in amount,

22 duration, and scope of services, financial eligibility,

23 individualized functional assessments and screenings

24 (including individual and family involvement), knowl25 edge about service options, and promotion of self-di-
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1 rection of services and community-integrated living

2 and service arrangements that facilitate participa3 tion in community life to the fullest extent possible

4 and desired by the individual.

5 (3) OVER MEDICALIZATION OF SERVICES.—The

6 State may use funds to identify, develop, and imple7 ment strategies for modifying policies, practices, and

8 procedures that unnecessarily bias the provision of

9 long-term services and supports by health care pro10 fessionals to the extent that quality services and

11 supports can be provided by other qualified individ12 uals, including policies, practices, and procedures

13 governing service authorization, case management,

14 and service coordination, service delivery options,

15 quality controls, and supervision and training.

16 (4) INTERAGENCY COORDINATION; SINGLE

17 POINT OF ENTRY.—The State may support activities

18 to identify and coordinate Federal and State poli19 cies, resources, and services, relating to the provision

20 of long-term services and supports, including the

21 convening of interagency work groups and the enter22 ing into of interagency agreements that provide for

23 a single point of entry with one-stop access for long24 term support services and the design and implemen25 tation of a coordinated screening and assessment
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1 system for all persons eligible for long-term services

2 and supports.

3 (5) TRAINING AND TECHNICAL ASSISTANCE.—

4 The State may carry out directly, or may provide

5 support to a public or private entity to carry out

6 training and technical assistance activities that are

7 provided for individuals with disabilities, and, as ap8 propriate, their representatives, attendants, and

9 other personnel (including professionals, paraprofes10 sionals, volunteers, and other members of the com11 munity).

12 (6) PUBLIC AWARENESS.—The State may sup13 port a public awareness program that is designed to

14 provide information relating to the availability of

15 choices available to individuals with disabilities for

16 receiving long-term services and support in the most

17 integrated setting appropriate.

18 (7) TRANSITIONAL COSTS.—The State may use

19 funds to provide transitional costs such as rent and

20 utility deposits, first months’s rent and utilities, bed21 ding, basic kitchen supplies, and other necessities re22 quired for an individual to make the transition from

23 an institutional facility to a community-based home

24 setting where the individual resides.
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1 (8) TASK FORCE.—The State may use funds to

2 support the operation of the Consumer Task Force

3 established under subsection (d).

4 (9) DEMONSTRATIONS OF NEW APPROACHES.—

5 The State may use funds to conduct, on a time-lim6 ited basis, the demonstration of new approaches to

7 accomplishing the purposes described in subsection

8 (a)(1).

9 (10) IMPROVEMENT IN THE QUALITY OF SERV10 ICES AND SUPPORTS.—The State may use funds to

11 improve the quality of services and supports pro12 vided to individuals with disabilities and their fami13 lies.

14 (11) OTHER ACTIVITIES.—The State may use

15 funds for any systems change activities that are not

16 described in any of the preceding paragraphs of this

17 subsection and that are necessary for developing, im18 plementing, or evaluating the comprehensive state19 wide system of community-integrated long-term serv20 ices and supports.

21 (d) CONSUMER TASK FORCE.—

22 (1) ESTABLISHMENT AND DUTIES.—To be eli23 gible to receive a grant under this section, each

24 State shall establish a Consumer Task Force (re25 ferred to in this section as the ‘‘Task Force’’) to as-
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1 sist the State in the development, implementation,

2 and evaluation of real choice systems change initia3 tives.

4 (2) APPOINTMENT.—Members of the Task

5 Force shall be appointed by the Chief Executive Of6 ficer of the State in accordance with the require7 ments of paragraph (3), after the solicitation of rec8 ommendations from representatives of organizations

9 representing a broad range of individuals with dis10 abilities and organizations interested in individuals

11 with disabilities.

12 (3) COMPOSITION.—

13 (A) IN GENERAL.—The Task Force shall

14 represent a broad range of individuals with dis15 abilities from diverse backgrounds and shall in16 clude representatives from Developmental Dis17 abilities Councils, Mental Health Councils,

18 State Independent Living Centers and Councils,

19 Commissions on Aging, organizations that pro20 vide services to individuals with disabilities and

21 consumers of long-term services and supports.

22 (B) INDIVIDUALS WITH DISABILITIES.—A

23 majority of the members of the Task Force

24 shall be individuals with disabilities or the rep25 resentatives of such individuals.
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1 (C) LIMITATION.—The Task Force shall

2 not include employees of any State agency pro3 viding services to individuals with disabilities

4 other than employees of agencies described in

5 the Developmental Disabilities Assistance and

6 Bill of Rights Act (42 U.S.C. 6000 et seq.) or

7 the Protection and Advocacy for Mentally Ill

8 Individuals Act of 1986 (42 U.S.C. 10801 et

9 seq.).

10 (e) AVAILABILITY OF FUNDS.—

11 (1) FUNDS ALLOTTED TO STATES.—Funds al12 lotted to a State under a grant made under this sec13 tion for a fiscal year shall remain available until ex14 pended.

15 (2) FUNDS NOT ALLOTTED TO STATES.—Funds

16 not allotted to States in the fiscal year for which

17 they are appropriated shall remain available in suc18 ceeding fiscal years for allotment by the Secretary

19 using the allotment formula established by the Sec20 retary under subsection (b)(2).

21 (f) ANNUAL REPORT.—A State that receives a grant

22 under this section shall submit an annual report to the

23 Secretary on the use of funds provided under the grant.

24 Each report shall include the number and percentage in25 crease in the number of eligible individuals in the State
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1 who receive long-term services and supports in the most

2 integrated setting appropriate, including through commu3 nity attendant services and supports and other commu4 nity-based settings.

5 (g) FUNDING.—

6 (1) FISCAL YEAR 2001.—For the purpose of

7 making grants under this section, there are appro8 priated, out of any funds in the Treasury not other9 wise appropriated, $50,000,000 for fiscal year 2001.

10 (2) FISCAL YEAR 2002 AND THEREAFTER.—

11 There is authorized to be appropriated such sums as

12 may be necessary to carry out this section for fiscal

13 year 2002 and each fiscal year thereafter.

Æ