II

106TH CONGRESS

2D SESSION S. 3077

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 SENATE OF THE UNITED STATES

SEPTEMBER 20, 2000

Mr. MOYNIHAN (for himself, Mr. DASCHLE, Mr. ROCKEFELLER, Mr. BREAUX,

Mr. GRAHAM, Mr. KERREY, Mr. ROBB, Mr. KENNEDY, Mr. AKAKA, Mr.

BINGAMAN, Mrs. BOXER, Mr. CLELAND, Mr. DODD, Mr. DORGAN, Mr.

EDWARDS, Mr. HOLLINGS, Mr. INOUYE, Mr. JOHNSON, Mr. KERRY, Ms.

LANDRIEU, Mr. LEAHY, Mr. LEVIN, Mrs. LINCOLN, Ms. MIKULSKI, Mr.

MILLER, Mrs. MURRAY, Mr. REED, Mr. SARBANES, Mr. SCHUMER, Mr.

TORRICELLI, and Mr. WELLSTONE) introduced the following bill; which

was read twice and referred to the Committee on Finance

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

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,
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1 SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECU2 RITY ACT; REFERENCES TO OTHER ACTS;

3 TABLE OF CONTENTS.

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

5 ‘‘Medicare, Medicaid, and SCHIP Balanced Budget Re6 finement Act of 2000’’.

7 (b) AMENDMENTS TO SOCIAL SECURITY ACT.—Ex8 cept as otherwise specifically provided, whenever in this

9 Act an amendment is expressed in terms of an amendment

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

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

12 provision of the Social Security Act.

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

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

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

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

17 (2) THE MEDICARE, MEDICAID, AND SCHIP

18 BALANCED BUDGET REFINEMENT ACT OF 1999.—

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

20 and SCHIP Balanced Budget Refinement Act of

21 1999 (113 Stat. 1501A–321), as enacted into law by

22 section 1000(a)(6) of Public Law 106–113.

23 (d) TABLE OF CONTENTS.—The table of contents of

24 this Act is as follows:

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

table of contents.
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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.

TITLE II—PROVISIONS RELATING TO PART B

Subtitle A—Hospital Outpatient Services

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.
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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.

TITLE III—PROVISIONS RELATING TO PARTS A AND B

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. Exclusion of certain nonroutine medical supplies under the PPS for

home health services.

Sec. 303. Permitting home health patients with Alzheimer’s disease or a related

dementia to attend adult day-care.

Sec. 304. Standards for home health branch offices.

Sec. 305. Treatment of home health services provided in certain counties.

Subtitle B—Direct Graduate Medical Education
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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.

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

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. Bonus payments for rural home health agencies in 2001 and 2002.

Sec. 445. 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.
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Sec. 446. Coverage of marriage and family therapist services provided in rural

health clinics.

Sec. 447. Capital infrastructure revolving loan program.

Sec. 448. Grants for upgrading data systems.

Sec. 449. Relief for financially distressed rural hospitals.

Sec. 450. Refinement of medicare reimbursement for telehealth services.

Sec. 451. 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.

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
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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).

15 (b) SPECIAL RULE FOR PAYMENT FOR SKILLED

16 NURSING FACILITY SERVICES FOR FISCAL YEAR 2001.—

17 Notwithstanding the amendments made by subsection (a),

18 for purposes of making payments for covered skilled nurs19 ing facility services under section 1888(e) of the Social

20 Security Act (42 U.S.C. 1395yy(e)) for fiscal year 2001,
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1 the Federal per diem rate referred to in paragraph

2 (4)(E)(ii) of such section—

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

4 2000, and ending on March 31, 2001, shall be the

5 rate determined in accordance with subclause (II) of

6 such paragraph as in effect on the day before the

7 date of enactment of this Act; and

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

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

10 computed for fiscal year 2000 pursuant to subclause

11 (I) of such paragraph increased by the skilled nurs12 ing facility market basket percentage change for fis13 cal year 2001 plus 1 percentage point.

14 SEC. 102. REVISION OF BBRA INCREASE FOR SKILLED

15 NURSING FACILITIES IN FISCAL YEARS 2001

16 AND 2002.

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

18 1501A–325) is amended—

19 (1) in paragraph (1)—

20 (A) by striking ‘‘4.0 percent for each such

21 fiscal year’’ and inserting ‘‘the applicable per22 cent (as defined in paragraph (3)) for each

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

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

25 paragraph:
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1 ‘‘(3) APPLICABLE PERCENT DEFINED.—For

2 purposes of this subsection, the term ‘applicable per3 cent’ means, with respect to services provided

4 during—

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

6 2000, and ending on March 31, 2001, 4.0 per7 cent;

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

9 2001, and ending on September 30, 2001, 8.0

10 percent; and

11 ‘‘(C) fiscal year 2002, 6.0 percent.’’.

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

13 subsection (a) shall take effect as if included in the enact14 ment of section 101 of BBRA (113 Stat. 1501A–324).

15 SEC. 103. MEDPAC STUDY ON PAYMENT UPDATES FOR

16 SKILLED NURSING FACILITIES; AUTHORITY

17 OF SECRETARY TO MAKE ADJUSTMENTS.

18 (a) STUDY.—The Medicare Payment Advisory Com19 mission established under section 1805 of the Social Secu20 rity Act (42 U.S.C. 1395b–6) (in this section referred to

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

22 costs to determine the adequacy of payment rates (includ23 ing updates to such rates) under the medicare program

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

25 (in this section referred to as the ‘‘medicare program’’)
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1 for items and services furnished by skilled nursing facili2 ties. In conducting such study, MedPAC shall use data

3 on actual costs and cost increases.

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

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

6 report to the Secretary of Health and Human Services and

7 Congress on the study conducted under subsection (a), in8 cluding a description of the methodology and calculations

9 used by the Health Care Financing Administration to es10 tablish the original payment level under the prospective

11 payment system for skilled nursing facility services under

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

13 1395yy(e)) and to annually update payments under the

14 medicare program for items and services furnished by

15 skilled nursing facilities, together with recommendations

16 regarding methods to ensure that all input variables, in17 cluding the labor costs, the intensity of services, and the

18 changes in science and technology that are specific to such

19 facilities, are adequately accounted for.

20 (c) AUTHORITY OF SECRETARY TO MAKE ADJUST21 MENTS.—Notwithstanding any other provision of law, the

22 Secretary of Health and Human Services may make ad23 justments to payments under the prospective payment sys24 tem under section 1888(e) of the Social Security Act (42

25 U.S.C. 1395yy(e)) for covered skilled nursing facility serv-
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1 ices to reflect any necessary adjustments to such payments

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

3 subsection (a).

4 (d) PUBLICATION.—

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

6 2002, the Secretary of Health and Human Services

7 shall publish for public comment a description of—

8 (A) whether the Secretary will make any

9 adjustments pursuant to subsection (c); and

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

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

12 2002, the Secretary of Health and Human Services

13 shall publish the description described in paragraph

14 (1) in final form.

15 Subtitle B—PPS Hospitals

16 SEC. 111. REVISION OF REDUCTION OF INDIRECT GRAD17 UATE MEDICAL EDUCATION PAYMENTS.

18 (a) REVISION.—

19 (1) IN GENERAL.—Section 1886(d)(5)(B)(ii)

20 (42 U.S.C. 1395ww(d)(5)(B)(ii)) is amended—

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

22 the end; and

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

24 and inserting the following new subclause:
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1 ‘‘(V) on or after October 1, 2000, ‘c’

2 is equal to 1.6.’’.

3 (2) TECHNICAL AMENDMENTS.—Section

4 1886(d)(5)(B) (42 U.S.C. 1395ww(d)(5)(B)), as

5 amended by paragraph (1), is amended—

6 (A) by realigning the left margins of

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

8 margin of clause (i); and

9 (B) by realigning the left margins of sub10 clauses (I) through (V) of clause (ii) appro11 priately.

12 (b) SPECIAL ADJUSTMENT FOR PURPOSES OF MAIN13 TAINING 6.5 PERCENT IME PAYMENT FOR FISCAL YEAR

14 2001.—Notwithstanding paragraph (5)(B)(ii)(V) of sec15 tion 1886(d) of the Social Security Act (42 U.S.C.

16 1395ww(d)(5)(B)(ii)(V)), as amended by subsection (a),

17 for purposes of making payments for subsection (d) hos18 pitals (as defined in paragraph (1)(B) of such section)

19 with indirect costs of medical education, the indirect

20 teaching adjustment factor referred to in paragraph

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

22 (1) for discharges occurring on or after October

23 1, 2000, and before April 1, 2001, pursuant to such

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

25 enactment 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, by substituting

3 ‘‘1.66’’ for ‘‘1.6’’ in subclause (V) of such paragraph

4 (as so amended).

5 (c) CONFORMING AMENDMENT RELATING TO DE6 TERMINATION OF STANDARDIZED AMOUNT.—Section

7 1886(d)(2)(C)(i) (42 U.S.C. 1395ww(d)(2)(C)(i)) is

8 amended—

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

10 Budget Act of 1997’’; and

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

12 paragraph resulting from the application of section

13 111(b) of the Medicare, Medicaid, and SCHIP Bal14 anced Budget Refinement Act of 2000’’ after ‘‘Bal15 anced Budget Refinement Act of 1999’’.

16 SEC. 112. ELIMINATING REDUCTION IN PPS HOSPITAL PAY17 MENT UPDATE.

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

19 U.S.C. 1395ww(b)(3)(B)(i)) is amended—

20 (1) in subclause (XV), by adding ‘‘and’’ at the

21 end;

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

23 (3) by redesignating subclause (XVIII) as sub24 clause (XVI); and
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1 (4) in subclause (XVI), as so redesignated, by

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

3 2001’’.

4 (b) SPECIAL RULE FOR PAYMENT FOR INPATIENT

5 HOSPITAL SERVICES FOR FISCAL YEAR 2001.—Notwith6 standing the amendments made by subsection (a), for pur7 poses of making payments for fiscal year 2001 for inpa8 tient hospital services furnished by subsection (d) hos9 pitals (as defined in section 1886(d)(1)(B) of the Social

10 Security Act (42 U.S.C. 1395ww(d)(1)(B))), the ‘‘applica11 ble percentage increase’’ referred to in section

12 1886(b)(3)(B)(i) of such Act (42 U.S.C.

13 1395ww(b)(3)(B)(i))—

14 (1) for discharges occurring on or after October

15 1, 2000, and before April 1, 2001, shall be deter16 mined in accordance with subclause (XVI) of such

17 section as in effect on the day before the date of en18 actment of this Act; and

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

20 2001, and before October 1, 2001, shall be equal

21 to—

22 (A) the market basket percentage increase

23 plus 1.1 percentage points for hospitals (other

24 than sole community hospitals) in all areas; and
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1 (B) the market basket percentage increase

2 for sole community hospitals.

3 SEC. 113. ELIMINATING REDUCTION IN DISPROPOR4 TIONATE SHARE HOSPITAL (DSH) PAYMENTS.

5 (a) ELIMINATION OF REDUCTION.—

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

7 (42 U.S.C. 1395ww(d)(5)(F)(ix)) is amended—

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

9 each of fiscal years 2000 and 2001’’ and insert10 ing ‘‘during fiscal year 2000’’;

11 (B) by striking subclause (IV);

12 (C) by redesignating subclause (V) as sub13 clause (IV); and

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

15 by striking ‘‘during fiscal year 2003’’ and in16 serting ‘‘during fiscal year 2001’’.

17 (2) EFFECTIVE DATE.—The amendments made

18 by this subsection shall apply to discharges occur19 ring on or after October 1, 2000.

20 (b) SPECIAL RULE FOR DSH PAYMENT FOR FISCAL

21 YEAR 2001.—Notwithstanding the amendments made by

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

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

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

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

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

3 (42 U.S.C. 1395ww(d)(5)(F))—

4 (1) for discharges occurring on or after October

5 1, 2000, and before April 1, 2001, shall be adjusted

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

7 effect on the day before the date of enactment of

8 this Act; and

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

10 2001, and before October 1, 2001, shall be increased

11 by 3 percent.

12 (c) CONFORMING AMENDMENTS RELATING TO DE13 TERMINATION OF STANDARDIZED AMOUNT.—Section

14 1886(d)(2)(C)(iv) (42 U.S.C. 1395ww(d)(2)(C)(iv)), is

15 amended—

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

17 ‘‘Act of 1989,’’; and

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

19 113(b) of the Medicare, Medicaid, and SCHIP Bal20 anced Budget Refinement Act of 2000’’ after ‘‘Om21 nibus Budget Reconciliation Act of 1990’’.
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1 SEC. 114. EQUALIZING THE THRESHOLD AND UPDATING

2 PAYMENT FORMULAS FOR DISPROPOR3 TIONATE SHARE HOSPITALS.

4 (a) APPLICATION OF UNIFORM 15 PERCENT

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

6 1395ww(d)(5)(F)(v)) is amended by striking ‘‘exceeds—

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

8 (b) CHANGE IN PAYMENT PERCENTAGE FOR9 MULAS.—Section 1886(d)(5)(F)(viii) (42 U.S.C.

10 1395ww(d)(5)(F)(viii)) is amended to read as follows:

11 ‘‘(viii) The formula used to determine the dispropor12 tionate share adjustment percentage for a cost reporting

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

14 (IV) of clause (iv) is—

15 ‘‘(I) in the case of such a hospital with a dis16 proportionate patient percentage (as defined in

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

18 + 2.5;

19 ‘‘(II) in the case of such a hospital with a dis20 proportionate patient percentage (as so defined) that

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

22 20.2)(.825) + 5.88;

23 ‘‘(III) except as provided in subclause (IV), in

24 the case of such a hospital with a disproportionate

25 patient percentage (as so defined) that exceeds 25.2,
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1 the disproportionate share adjustment percentage =

2 10; and

3 ‘‘(IV) in the case of such a hospital with a dis4 proportionate patient percentage (as so defined) that

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

6 (P–30)(.6) + 10;

7 where ‘P’ is the hospital’s disproportionate patient per8 centage (as so defined).’’.

9 (c) CONFORMING AMENDMENTS.—Section

10 1886(d)(5)(F)(iv) (42 U.S.C. 1395ww(d)(5)(F)(iv)) is

11 amended—

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

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

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

15 (2) by amending subclause (II) to read as fol16 lows:

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

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

19 less than 500 beds and is not described in subclause

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

21 accordance with the applicable formula described in

22 clause (viii);’’;

23 (3) by striking subclauses (III) and (IV);

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

25 subclauses (III) and (IV), respectively;
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1 (5) in subclause (III) (as so redesignated), by

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

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

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

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

6 percent determined in accordance with the applicable

7 formula described in clause (viii)’’.

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

9 this section shall apply to discharges occurring on or after

10 April 1, 2001.

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

12 (a) FREEZE IN MEDICAID DSH ALLOTMENTS.—

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

14 1396r–4(f)) is amended—

15 (A) by redesignating paragraph (4) as

16 paragraph (5); and

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

18 following new paragraph:

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

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

21 2001 through 2008—

22 ‘‘(A) paragraph (2) shall be applied—

23 ‘‘(i) by substituting—

24 ‘‘(I) in the heading, ‘2001’ for

25 ‘2002’;
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1 ‘‘(II) in the matter preceding the

2 table, ‘2001 (and the DSH allotment

3 for a State for fiscal year 2001 is the

4 same as the DSH allotment for the

5 State for fiscal year 2000, as deter6 mined under the following table)’ for

7 ‘2002’; and

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

9 the table relating to FY 01 and FY 02

10 (fiscal years 2001 and 2002); and

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

12 substituting—

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

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

15 ‘2003’.’’.

16 (2) REPEAL; APPLICABILITY.—Effective Octo17 ber 1, 2008, the amendments made by paragraph

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

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

20 and administered as if such amendments had not

21 been enacted.

22 (b) INCREASE IN DSH ALLOTMENTS FOR THE DIS23 TRICT OF COLUMBIA.—

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

25 table in section 1923(f)(2) (42 U.S.C. 1396r–
21

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1 4(f)(2)) relating to the District of Columbia for FY

2 98 (fiscal year 1998), for FY 99 (fiscal year 1999),

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

4 2001), and for FY 02 (fiscal year 2002) are amend5 ed by striking the amount otherwise specified and

6 inserting ‘‘43.4’’.

7 (2) EFFECTIVE DATE.—The amendments made

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

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

10 511).

11 (c) OPTIONAL ELIGIBILITY OF CERTAIN ALIEN

12 PREGNANT WOMEN AND CHILDREN FOR MEDICAID AND

13 SCHIP.—

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

15 1396b(v)) is amended—

16 (A) in paragraph (1), by striking ‘‘para17 graph (2)’’ and inserting ‘‘paragraphs (2) and

18 (4)’’; and

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

20 paragraph:

21 ‘‘(4)(A) A State may elect (in a plan amendment

22 under this title) to provide medical assistance under this

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

24 421 of the Personal Responsibility and Work Opportunity

25 Reconciliation Act of 1996, for aliens who are lawfully re-
22

•S 3077 IS

1 siding in the United States (including battered aliens de2 scribed in section 431(c) of such Act) and who are other3 wise eligible for such assistance, within any of the fol4 lowing eligibility categories:

5 ‘‘(i) PREGNANT WOMEN.—Women during preg6 nancy (and during the 60-day period beginning on

7 the last day of the pregnancy).

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

9 such plan), including optional targeted low-income

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

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

12 medical assistance to a category of aliens under subpara13 graph (A), no action may be brought under an affidavit

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

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

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

17 1397gg(e)(1)) is amended by adding at the end the

18 following new subparagraph:

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

20 optional coverage of permanent resident alien

21 children), but only if the State has in effect an

22 election under that same eligibility category for

23 purposes of title XIX.’’.

24 (3) EFFECTIVE DATE.—The amendments made

25 by this section take effect on October 1, 2000, and
23

•S 3077 IS

1 apply to medical assistance and child health assist2 ance furnished on or after such date.

3 SEC. 116. MODIFICATION OF PAYMENT RATE FOR PUERTO

4 RICO HOSPITALS.

5 (a) MODIFICATION OF PAYMENT RATE.—Section

6 1886(d)(9)(A) (42 U.S.C. 1395ww(d)(9)(A)) is

7 amended—

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

9 50 percent (’’ and inserting ‘‘October 1, 2000, 25

10 percent (for discharges between October 1, 1997,

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

12 (2) in clause (ii), in the matter preceding sub13 clause (I), by striking ‘‘after October 1, 1997, 50

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

15 percent (for discharges between October 1, 1997,

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

17 (b) SPECIAL RULE FOR PAYMENT FOR FISCAL YEAR

18 2001.—

19 (1) IN GENERAL.—Notwithstanding the amend20 ment made by subsection (a), for purposes of mak21 ing payments for the operating costs of inpatient

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

23 hospital for fiscal year 2001, the amount referred to

24 in the matter preceding clause (i) of section
24

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1 1886(d)(9)(A) of the Social Security Act (42 U.S.C.

2 1395ww(d)(9)(A))—

3 (A) for discharges occurring on or after

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

5 shall be determined in accordance with such

6 section as in effect on the day before the date

7 of enactment of this Act; and

8 (B) for discharges occurring on or after

9 April 1, 2001, and before October 1, 2001,

10 shall be determined—

11 (i) using 0 percent of the Puerto Rico

12 adjusted DRG prospective payment rate

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

14 and

15 (ii) using 100 percent of the dis16 charge-weighted average referred to in

17 clause (ii) of such section.

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

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

20 1886(d) Puerto Rico hospital’’ has the meaning

21 given the term ‘‘subsection (d) Puerto Rico hospital’’

22 in the last sentence of section 1886(d)(9)(A) of the

23 Social Security Act (42 U.S.C. 1395ww(d)(9)(A)).
25

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1 SEC. 117. MEDPAC STUDY ON HOSPITAL AREA WAGE IN2 DEXES.

3 (a) STUDY.—

4 (1) IN GENERAL.—The Medicare Payment Ad5 visory Commission established under section 1805 of

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

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

8 study on the hospital area wage indexes used in

9 making payments to hospitals under section 1886(d)

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

11 including an assessment of the accuracy of those in12 dexes in reflecting geographic differences in wage

13 and wage-related costs of hospitals.

14 (2) CONSIDERATIONS.—In conducting the study

15 under paragraph (1), MedPAC shall consider—

16 (A) the appropriate method for deter17 mining hospital area wage indexes;

18 (B) the appropriate portion of hospital

19 payments that should be adjusted by the appli20 cable area wage index;

21 (C) the appropriate method for adjusting

22 the wage index by occupational mix; and

23 (D) the feasibility and impact of making

24 changes (as determined appropriate by

25 MedPAC) to the methods used to determine
26

•S 3077 IS

1 such indexes, including the need for a data sys2 tem required to implement such changes.

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 conducted under subsection (a) to7 gether with such recommendations for legislation and ad8 ministrative action as MedPAC determines appropriate.

9 Subtitle C—PPS Exempt Hospitals

10 SEC. 121. TREATMENT OF CERTAIN CANCER HOSPITALS.

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

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

13 amended—

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

15 end;

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

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

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

19 ‘‘(III) a hospital that was recognized as a clin20 ical cancer research center by the National Cancer

21 Institute of the National Institutes of Health as of

22 February 18, 1998, that has never been reimbursed

23 for inpatient hospital services pursuant to a reim24 bursement system under a demonstration project

25 under section 1814(b), that is a freestanding facility
27

•S 3077 IS

1 organized primarily for treatment of and research on

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

3 of the date of enactment of this subclause, is li4 censed for 162 acute care beds, and that dem5 onstrates for the 4-year period ending on June 30,

6 1999, that at least 50 percent of its total discharges

7 have a principal finding of neoplastic disease, as de8 fined in subparagraph (E);’’.

9 (b) CONFORMING AMENDMENT.—Section

10 1886(d)(1)(E) of the Social Security Act (42 U.S.C.

11 1395ww(d)(1)(E)) is amended by striking ‘‘For purposes

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

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

14 (c) PAYMENT.—

15 (1) APPLICATION TO COST REPORTING PERI16 ODS.—Any classification by reason of section

17 1886(d)(1)(B)(v)(III) of the Social Security Act (as

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

19 cost reporting periods beginning on or after July 1,

20 1999.

21 (2) BASE YEAR.—Notwithstanding the provi22 sions of section 1886(b)(3)(E) of such Act (42

23 U.S.C. 1395ww(b)(3)(E)) or other provisions to the

24 contrary, the base cost reporting period for purposes

25 of determining the target amount for any hospital
28

•S 3077 IS

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

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

3 12-month cost reporting period beginning on July 1,

4 1995.

5 (3) DEADLINE FOR PAYMENTS.—Any payments

6 owed to a hospital by reason of this subsection shall

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

8 year after the date of enactment of this Act.

9 SEC. 122. PAYMENT ADJUSTMENT FOR INPATIENT SERV10 ICES IN REHABILITATION HOSPITALS.

11 (a) OPTION TO APPLY PROSPECTIVE PAYMENT SYS12 TEM DURING TRANSITION PERIOD.—Section

13 1886(j)(1)(A) (42 U.S.C. 1395ww(j)(1)(A)) is amended in

14 the matter preceding subclause (i) by inserting ‘‘the great15 er of the prospective payment rate determined in para16 graph (3)(A) or’’ after ‘‘is equal to’’.

17 (b) INCREASE IN PROSPECTIVE PAYMENT PERCENT18 AGE DURING TRANSITION PERIOD.—Section

19 1886(j)(1)(A)(ii)(I) (42 U.S.C. 1395ww(j)(1)(A)(ii)(I)) is

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

21 unit’’.

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

23 this section shall take effect as if included in the enact24 ment of section 4421 of BBA (111 Stat. 410).
29

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1 Subtitle D—Hospice Care

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

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

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

5 (1) in clause (i), by adding at the end the fol6 lowing new sentence: ‘‘With respect to routine home

7 care and other services included in hospice care fur8 nished during fiscal year 2001, the payment rates

9 for such care and services for such fiscal year shall

10 be 110 percent of such rates as would otherwise be

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

12 increase under clause (ii) but not taking into ac13 count the increase under section 131 of the Medi14 care, Medicaid, and SCHIP Balanced Budget Re15 finement Act of 1999), and such payment rates shall

16 be used in determining payments for such care and

17 services furnished in a subsequent fiscal year under

18 clause (ii).’’; and

19 (2) in clause (ii), by striking ‘‘during a subse20 quent fiscal year’’ and inserting ‘‘during a fiscal

21 year beginning after September 30, 1990’’.

22 (b) ELIMINATING REDUCTION IN UPDATE.—Section

23 1814(i)(1)(C)(ii) of the Social Security Act (42 U.S.C.

24 1395f(i)(1)(C)(ii)) is amended—
30

•S 3077 IS

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

2 2002’’ and inserting ‘‘through 2000’’; and

3 (2) in subclause (VII), by striking ‘‘for a subse4 quent fiscal year’’ and inserting ‘‘for fiscal year

5 2001 and each subsequent fiscal year’’.

6 (c) SPECIAL RULE FOR PAYMENT FOR HOSPICE

7 CARE FOR FISCAL YEAR 2001.—Notwithstanding the

8 amendments made by subsections (a) and (b), for pur9 poses of making payments under section 1814(i)(1)(C) of

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

11 routine home care and other services included in hospice

12 care furnished during fiscal year 2001, such payment

13 rates shall be determined—

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

15 2000, and ending on March 31, 2001, in accordance

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

17 date of enactment of this Act; and

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

19 and ending on September 30, 2001—

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

21 ‘‘110 percent’’ in the second sentence of clause

22 (i) of such section (as added by subsection

23 (a)(1)); and

24 (B) as if the increase under subclause

25 (ii)(VII) (as amended by subsection (b)) for fis-
31

•S 3077 IS

1 cal year 2001 was equal to the market basket

2 increase for the fiscal year plus 1.0 percentage

3 point.

4 Subtitle E—Other Provisions

5 SEC. 141. HOSPITALS REQUIRED TO COMPLY WITH

6 BLOODBORNE PATHOGENS STANDARD.

7 (a) AGREEMENTS WITH HOSPITALS.—Section

8 1866(a)(1) (42 U.S.C. 1395cc(a)(1)) is amended—

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

10 the end;

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

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

13 (3) by inserting after subparagraph (S) the fol14 lowing new subparagraph:

15 ‘‘(T) in the case of hospitals that are not other16 wise subject to regulation by the Occupational Safe17 ty and Health Administration, to comply with the

18 Bloodborne Pathogens standard under section

19 1910.1030 of title 29 of the Code of Federal Regula20 tions.’’.

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

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

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

24 Act.
32

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1 SEC. 142. INFORMATICS AND DATA SYSTEMS GRANT PRO2 GRAM.

3 (a) GRANTS TO HOSPITALS.—

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

5 Human Services (in this section referred to as the

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

7 grants to hospitals that have submitted applications

8 in accordance with subsection (c) to assist such hos9 pitals in offsetting the costs related to—

10 (A) developing and implementing standard11 ized clinical health care informatics systems de12 signed to improve medical care and reduce ad13 verse events and health care complications re14 sulting from medication errors; and

15 (B) establishing data systems to comply

16 with the administrative simplification require17 ments under part C of title XI of the Social Se18 curity Act (42 U.S.C. 1320d et seq.).

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

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

21 with—

22 (A) purchasing computer software and

23 hardware; and

24 (B) providing education and training to

25 hospital staff on computer information systems.
33

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

2 to make grants under this section shall terminate on

3 September 30, 2011.

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

5 a grant under section 1611 of the Public Health

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

7 not eligible to receive a grant under this section.

8 (b) SPECIAL CONSIDERATION FOR LARGE URBAN

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

10 Secretary shall give special consideration to hospitals lo11 cated in large urban areas (as defined for purposes of sec12 tion 1886(d) of the Social Security Act (42 U.S.C.

13 1395ww(d)).

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

15 this section shall submit an application to the Secretary

16 at such time and in such form and manner as the Sec17 retary specifies.

18 (d) REPORTS.—

19 (1) INFORMATION.—A hospital receiving a

20 grant under this section shall furnish the Secretary

21 with such information as the Secretary may require

22 to—

23 (A) evaluate the project for which the

24 grant is made; and
34

•S 3077 IS

1 (B) ensure that the grant is expended for

2 the purposes for which it is made.

3 (2) TIMING OF SUBMISSION.—

4 (A) INTERIM REPORTS.—The Secretary

5 shall report to the Committee on Ways and

6 Means of the House of Representatives and the

7 Committee on Finance of the Senate at least

8 annually on the grant program established

9 under this section, including in such report in10 formation on the number of grants made, the

11 nature of the projects involved, the geographic

12 distribution of grant recipients, and such other

13 matters as the Secretary deems appropriate.

14 (B) FINAL REPORT.—The Secretary shall

15 submit a final report to such committees not

16 later than 180 days after the completion of all

17 of the projects for which a grant is made under

18 this section.

19 (e) AUTHORIZATION OF APPROPRIATIONS.—There

20 are authorized to be appropriated from the Federal Hos21 pital Insurance Trust Fund under section 1817 of the So22 cial Security Act (42 U.S.C. 1395i) $25,000,000 for each

23 of the fiscal years 2001 through 2011 for the purposes

24 of making grants under this section.
35

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1 SEC. 143. RELIEF FROM MEDICARE PART A LATE ENROLL2 MENT PENALTY FOR GROUP BUY-IN FOR

3 STATE AND LOCAL RETIREES.

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

5 by adding at the end the following new paragraph:

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

7 subdivision of a State, or an agency or instrumen8 tality of a State or political subdivision thereof de9 termines to pay, for the life of each individual, the

10 monthly premiums due under paragraph (1) on be11 half of each of the individuals in a qualified State

12 or local government retiree group who meets the

13 conditions of subsection (a), the amount of any in14 crease otherwise applicable under section 1839(b)

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

16 with respect to the monthly premium for benefits

17 under this part for an individual who is a member

18 of such group shall be reduced by the total amount

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

20 Revenue Code of 1986 by such individual and under

21 section 3111(b) by the employers of such individual

22 on behalf of such individual with respect to employ23 ment (as defined in section 3121(b) of such Code).

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

25 ‘qualified State or local government retiree group’

26 means all of the individuals who retire prior to a
36

•S 3077 IS

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

2 employment in 1 or more occupations or other broad

3 classes of employees of—

4 ‘‘(i) the State;

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

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

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

8 Subtitle F—Transitional Provisions

9 SEC. 151. RECLASSIFICATION OF CERTAIN COUNTIES AND

10 AREAS FOR PURPOSES OF REIMBURSEMENT

11 UNDER THE MEDICARE PROGRAM.

12 (a) FISCAL YEARS 2002 THROUGH 2004.—Notwith13 standing any other provision of law, effective for dis14 charges occurring during fiscal years 2002, 2003, and

15 2004, for purposes of making payments under section

16 1886(d) of the Social Security Act (42 U.S.C.

17 1395ww(d))—

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

19 be located in the Charlotte-Gastonia-Rock Hill,

20 North Carolina-South Carolina Metropolitan Statis21 tical Area; and

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

23 York is deemed to include Orange County, New

24 York (including hospitals that have been reclassified

25 into such county).
37

•S 3077 IS

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 (b) FISCAL YEARS 2001 THROUGH 2003.—Notwith6 standing any other provision of law, effective for dis7 charges occurring during fiscal years 2001, 2002, and

8 2003, for purposes of making payments under section

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

10 1395ww(d))—

11 (1) the Jackson, Michigan Metropolitan Statis12 tical Area is deemed to be located in the Ann Arbor,

13 Michigan Metropolitan Statistical Area;

14 (2) Tangipahoa Parish, Louisiana is deemed to

15 be located in the New Orleans, Louisiana Metropoli16 tan Statistical Area; and

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

18 York is deemed to include Duchess County, New

19 York.

20 For purposes of that section, any reclassification under

21 this subsection shall be treated as a decision of the Medi22 care Geographic Classification Review Board under para23 graph (10) of that section.

24 (c) TECHNICAL CORRECTION TO BBRA.—
38

•S 3077 IS

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

2 Stat. 1501A–334) is amended—

3 (A) in subsection (a)(2), by inserting ‘‘(in4 cluding hospitals that have been reclassified

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

6 (B) in subsection (b)(2), by inserting ‘‘(in7 cluding hospitals that have been reclassified

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

9 York’’.

10 (2) EFFECTIVE DATE.—The amendments made

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

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

13 1501A–334).

14 SEC. 152. CALCULATION AND APPLICATION OF WAGE

15 INDEX FLOOR FOR A CERTAIN AREA.

16 Notwithstanding any other provision of section

17 1886(d) of the Social Security Act (42 U.S.C.

18 1395ww(d)), for discharges occurring during fiscal year

19 2000, the Secretary of Health and Human Services shall

20 calculate and apply the wage index for the Barnstable21 Yarmouth Metropolitan Statistical Area under that sec22 tion as if the Jordan Hospital were classified in such area

23 for purposes of payment under that section for such fiscal

24 year. Such recalculation shall not affect the wage index

25 for any other area.
39

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1 TITLE II—PROVISIONS

2 RELATING TO PART B

3 Subtitle A—Hospital Outpatient

4 Services

5 SEC. 201. REDUCTION OF EFFECTIVE HOPD COINSURANCE

6 RATE TO 20 PERCENT BY 2019.

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

8 1395l(t)(3)(B)(ii)) is amended—

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

10 ‘‘(I) IN GENERAL.—If the’’; and

11 (2) by adding at the end the following new sub12 clause:

13 ‘‘(II) ACCELERATED PHASE-IN.—

14 The Secretary shall estimate, prior to

15 January 1, 2002, the unadjusted co16 payment amount for each such service

17 (or groups of such services). If the

18 Secretary estimates such unadjusted

19 copayment amount to be greater than

20 20 percent for any such service (or

21 group of such services) on or after

22 January 1, 2019, the Secretary shall,

23 for services furnished beginning on or

24 after January 1, 2002, reduce the

25 unadjusted copayment amount for
40

•S 3077 IS

1 such service (or group of such serv2 ices) in equal increments each year,

3 from the amount applicable in 2001,

4 by an amount estimated by the Sec5 retary such that the unadjusted co6 payment amount shall equal 20 per7 cent beginning on or after January 1,

8 2019.’’.

9 SEC. 202. APPLICATION OF TRANSITIONAL CORRIDOR TO

10 CERTAIN HOSPITALS THAT DID NOT SUBMIT

11 A 1996 COST REPORT.

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

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

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

15 for such period, during the first cost reporting period end16 ing in a year after 1996 and before 2001 for which the

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

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

19 subsection (a) shall take effect as if included in the enact20 ment of section 202 of BBRA.
41

•S 3077 IS

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

2 LEVELS FOR OUTPATIENT SERVICES FUR3 NISHED BY CHILDREN’S HOSPITALS.

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

5 1395l(t)(7)(D)), as amended by section 432, is

6 amended—

7 (1) in the heading, by inserting ‘‘, CHIL8 DREN’S,’’ after ‘‘SMALL RURAL’’; and

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

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

11 1886(d)(1)(B)’’.

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

13 subsection (a) shall apply to services provided on or after

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

15 Act.

16 Subtitle B—Provisions Relating to

17 Physicians

18 SEC. 211. LOAN DEFERMENT FOR RESIDENTS.

19 (a) FAIRNESS IN MEDICAL STUDENT LOAN FINANC20 ING.—

21 (1) ELIGIBILITY REQUIREMENTS.—Section

22 427(a)(2)(C)(iii) of the Higher Education Act of

23 1965 (20 U.S.C. 1077(a)(2)(C)(iii)) is amended by

24 inserting before the semicolon the following: ‘‘, ex25 cept that for a medical student such period shall not

26 exceed the full initial residency period’’.
42

•S 3077 IS

1 (2) INSURANCE PROGRAM AGREEMENTS.—Sec2 tion 428(b)(1)(M)(iii) of the Higher Education Act

3 of 1965 (20 U.S.C. 1078(b)(1)(M)(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 (3) DEFERMENT ELIGIBILITY.—Section

8 455(f)(2)(C) of the Higher Education Act of 1965

9 (20 U.S.C. 1087e(f)(2)(C)) is amended by inserting

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

11 medical student such period shall not exceed the full

12 initial residency period’’.

13 (4) CONTENTS OF LOAN AGREEMENT.—Section

14 464(c)(2)(A)(iii) of the Higher Education Act of

15 1965 (20 U.S.C. 1087dd(c)(2)(A)(iii)) is amended

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

17 except that for a medical student such period shall

18 not exceed the full initial residency period’’.

19 (b) FAIRNESS IN ECONOMIC HARDSHIP DETERMINA20 TION.—Section 435(o)(1)(B) of the Higher Education Act

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

22 as follows:

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

24 and has a Federal educational debt burden that

25 equals or exceeds 20 percent of such borrower’s
43

•S 3077 IS

1 adjusted gross income, and the difference be2 tween such borrower’s adjusted gross income

3 minus such burden is less than 250 percent of

4 the greater of—

5 ‘‘(i) the annual earnings of an indi6 vidual earning the minimum wage under

7 section 6 of the Fair Labor Standards Act

8 of 1938; or

9 ‘‘(ii) the income official poverty line

10 (as defined by the Office of Management

11 and Budget, and revised annually in ac12 cordance with section 673(2) of the Com13 munity Service Block Grant Act) applica14 ble to a family of 2; or’’.

15 SEC. 212. GAO STUDIES AND REPORTS ON MEDICARE PAY16 MENTS.

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

18 PROCESS.—

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

20 United States shall conduct a study of the post-pay21 ment audit process under the medicare program

22 under title XVIII of the Social Security Act (42

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

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

25 physicians, including the proper level of resources
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1 that the Health Care Financing Administration

2 should devote to educating physicians regarding—

3 (A) coding and billing;

4 (B) documentation requirements; and

5 (C) the calculation of overpayments.

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

7 the date of enactment of this Act, the Comptroller

8 General shall submit a report to the Secretary of

9 Health and Human Services and Congress on the

10 study conducted under paragraph (1) together with

11 specific recommendations for changes or improve12 ments in the post-payment audit process described

13 in such paragraph.

14 (b) GAO STUDY ON ADMINISTRATION AND OVER15 SIGHT.—

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

17 United States shall conduct a study on the aggre18 gate effects of regulatory, audit, oversight, and pa19 perwork burdens on physicians and other health care

20 providers participating in the medicare program.

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

22 the date of enactment of this Act, the Comptroller

23 General shall submit a report to the Secretary of

24 Health and Human Services and Congress on the
45

•S 3077 IS

1 study conducted under paragraph (1) together with

2 recommendations regarding any area in which—

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

4 administration, or an appropriate change in

5 oversight and review may be accomplished; or

6 (B) additional payments or education are

7 needed to assist physicians and other health

8 care providers in understanding and complying

9 with any legal or regulatory requirements.

10 SEC. 213. MEDPAC STUDY ON THE RESOURCE-BASED PRAC11 TICE EXPENSE SYSTEM.

12 (a) STUDY.—The Medicare Payment Advisory Com13 mission established under section 1805 of the Social Secu14 rity Act (42 U.S.C. 1395b–6) (in this section referred to

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

16 to the practice expense relative value units during the

17 transition to a resource-based practice expense system for

18 physician payments under the medicare program under

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

20 et seq.) (in this section referred to as the ‘‘medicare pro21 gram’’).

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

23 shall submit a report to the Secretary of Health and

24 Human Services and Congress on the study conducted
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•S 3077 IS

1 under subsection (a) together with recommendations

2 regarding—

3 (1) any change or adjustment that is appro4 priate to ensure full access to a spectrum of care for

5 beneficiaries under the medicare program; and

6 (2) the appropriateness of payments to physi7 cians.

8 Subtitle C—Ambulance Services

9 SEC. 221. ELECTION TO FOREGO PHASE-IN OF FEE SCHED10 ULE FOR AMBULANCE SERVICES.

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

12 adding at the end the following new paragraph:

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

14 SCHEDULE.—

15 ‘‘(A) IN GENERAL.—If the Secretary pro16 vides for a phase-in of the fee schedule estab17 lished under this subsection, a supplier of am18 bulance services may make an election to re19 ceive payments based only on such fee schedule

20 at any time during such phase-in, and the Sec21 retary shall begin to make payments to the sup22 plier based only on such fee schedule not later

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

24 which the supplier notifies the Secretary of such

25 election.
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1 ‘‘(B) WAIVER OF BUDGET NEUTRALITY.—

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

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

4 SEC. 222. PRUDENT LAYPERSON STANDARD FOR EMER5 GENCY AMBULANCE SERVICES.

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

7 1395x(s)(7)) is amended by inserting before the semicolon

8 at the end the following: ‘‘, except that such regulations

9 shall not fail to treat ambulance services as medical and

10 other health services solely because the ultimate diagnosis

11 of the individual receiving the ambulance services results

12 in a conclusion that ambulance services were not nec13 essary, as long as the request for ambulance services is

14 made after the sudden onset of a medical condition that

15 would be classified as an emergency medical condition (as

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

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

18 this section shall apply with respect to ambulance services

19 provided on or after October 1, 2000.

20 SEC. 223. ELIMINATION OF REDUCTION IN INFLATION AD21 JUSTMENTS FOR AMBULANCE SERVICES.

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

23 U.S.C. 1395m(l)(3)(A)) are each amended by striking ‘‘re24 duced in the case of 2001 and 2002 by 1.0 percentage
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•S 3077 IS

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

2 1.0 percentage point’’.

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

4 AMBULANCE SERVICES.

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

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

7 in consultation with the Office of Rural Health Policy,

8 shall conduct a study of the means by which rural areas

9 with low population densities can be identified for the pur10 pose of designating areas in which the cost of providing

11 ambulance services would be expected to be higher than

12 similar services provided in more heavily populated areas

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

14 analysis of the additional costs of providing ambulance

15 services in areas designated under the previous sentence.

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

17 Secretary shall submit a report to Congress on the study

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

19 based on that study which adjusts the fee schedule pay20 ment rates for ambulance services provided in low density

21 rural areas based on the increased cost of providing such

22 services in such areas.
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1 SEC. 225. INTERIM PAYMENTS FOR RURAL GROUND AMBU2 LANCE SERVICES UNTIL REGULATION IMPLE3 MENTED.

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

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

6 by adding at the end the following new paragraph:

7 ‘‘(9) INTERIM PAYMENTS FOR RURAL GROUND

8 AMBULANCE SERVICES.—Until such time as the fee

9 schedule established under this subsection is modi10 fied by the regulation described in section 224(b) of

11 the Medicare, Medicaid, and SCHIP Balanced

12 Budget Refinement Act of 2000, the amount of pay13 ment under this subsection for ground ambulance

14 services provided in a rural area (as defined in sec15 tion 1886(d)(2)(D)) shall be the greater of—

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

17 schedule established under this subsection

18 (without regard to any phase-in established pur19 suant to paragraph (2)(E)); or

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

21 paid for such services if the amendments made

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

23 of 1997 had not been enacted;

24 as adjusted for inflation in the manner described in

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

26 an ambulance trip shall be considered to have been
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1 provided in a rural area only if the transportation of

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

3 (b) CONFORMING AMENDMENTS.—Section

4 1833(a)(1) (42 U.S.C. 1395l(a)(1)) is amended—

5 (1) in subparagraph (R)—

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

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

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

9 (2) in subparagraph (S), by striking the semi10 colon at the end and inserting ‘‘, and (T) with re11 spect to ambulance services described in section

12 1834(l)(9), the amount paid shall be 80 percent of

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

14 amount determined under such section;’’.

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

16 this section shall apply with respect to services provided

17 on and after January 1, 2001.

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

19 EMERGENCY AND MEDICAL TRANSPOR20 TATION SERVICES.

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

22 States shall conduct a study of the costs of providing

23 emergency and medical transportation services across the

24 range of acuity levels of conditions for which such trans25 portation services are provided.
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•S 3077 IS

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

2 date of enactment of this Act, the Comptroller General

3 shall submit a report to the Secretary of Health and

4 Human Services and Congress on the study conducted

5 under subsection (a), together with recommendations for

6 any changes in methodology or payment level necessary

7 to fairly compensate suppliers of emergency and medical

8 transportation services and to ensure the access of bene9 ficiaries under the medicare program under title XVIII of

10 the Social Security Act (42 U.S.C. 1395 et seq.) to such

11 services.

12 Subtitle D—Preventive Services

13 SEC. 231. ELIMINATION OF DEDUCTIBLES AND COINSUR14 ANCE FOR PREVENTIVE BENEFITS.

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

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

17 new subsection:

18 ‘‘(p) DEDUCTIBLES AND COINSURANCE WAIVED FOR

19 PREVENTIVE BENEFITS.—The Secretary may not require

20 the payment of any deductible or coinsurance under sub21 section (a) or (b) of any individual enrolled for coverage

22 under this part for any of the following preventive health

23 care items and services:
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•S 3077 IS

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

2 glucose monitors for individuals with diabetes de3 scribed in section 1861(n).

4 ‘‘(2) Diabetes outpatient self-management

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

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

7 vaccines and administration described in section

8 1861(s)(10).

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

10 section 1861(jj)).

11 ‘‘(5) Screening pap smear and screening pelvic

12 exam (as defined in paragraphs (1) and (2) of sec13 tion 1861(nn), respectively).

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

15 section 1861(rr)(1)).

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

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

18 ‘‘(8) Colorectal cancer screening test (as de19 fined in section 1861(pp)(1)).’’.

20 (b) WAIVER OF COINSURANCE.—Section

21 1833(a)(1)(B) (42 U.S.C. 1395l(a)(1)(B)) is amended to

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

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

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

25 other basis of payment under this title,’’.
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1 (c) WAIVER OF DEDUCTIBLE.—Section 1833(b)(1)

2 (42 U.S.C. 1395l(b)(1)) is amended to read as follows:

3 ‘‘(1) such deductible shall not apply with respect to pre4 ventive health care items and services described in sub5 section (p),’’.

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

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

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

9 and inserting ‘‘blood-testing strips, lancets, and blood glu10 cose monitors’’.

11 (e) CONFORMING AMENDMENTS.—

12 (1) ELIMINATION OF COINSURANCE FOR CLIN13 ICAL DIAGNOSTIC LABORATORY TESTS.—Paragraphs

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

15 U.S.C. 1395l(a)) are each amended—

16 (A) by striking ‘‘basis or which’’ and in17 serting ‘‘basis, which’’; and

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

19 in subsection (p)’’ after ‘‘critical access hos20 pital’’.

21 (2) ELIMINATION OF COINSURANCE FOR CER22 TAIN DME.—Section 1834(a)(1)(A) (42 U.S.C.

23 1395m(a)(1)(A)) is amended by inserting ‘‘(or 100

24 percent, in the case of such an item described in sec25 tion 1833(p))’’ after ‘‘80 percent’’.
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1 (3) ELIMINATION OF COINSURANCE FOR

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

3 (42 U.S.C. 1395m(c)(1)(C)) is amended by striking

4 ‘‘80 percent’’ and inserting ‘‘100 percent’’.

5 (4) ELIMINATION OF DEDUCTIBLES AND COIN6 SURANCE FOR COLORECTAL CANCER SCREENING

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

8 amended—

9 (A) in paragraph (2)(C)—

10 (i) by striking clause (ii);

11 (ii) by striking ‘‘FACILITY PAYMENT

12 LIMIT.—’’ and all that follows through

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

15 and

16 (iii) by redesignating subclauses (I)

17 and (II) as clauses (i) and (ii), respec18 tively; and

19 (B) in paragraph (3)(C)—

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

21 (ii) by striking ‘‘FACILITY PAYMENT

22 LIMIT.—’’ and all that follows through

23 ‘‘Notwithstanding’’ and inserting ‘‘FACIL24 ITY PAYMENT LIMIT.—Notwithstanding’’.
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1 (f) EFFECTIVE DATE.—The amendments made by

2 this section shall apply to items and services furnished on

3 or after July 1, 2001.

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

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

6 1395x(s)(2)) is amended—

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

8 the end;

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

10 the end; and

11 (3) by adding at the end the following new sub12 paragraph:

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

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

15 a history of tobacco use;’’.

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

17 1395x) is amended by adding at the end the following new

18 subsection:

19 ‘‘Counseling for Cessation of Tobacco Use

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

21 term ‘counseling for cessation of tobacco use’ means diag22 nostic, therapy, and counseling services for cessation of

23 tobacco use which are furnished—

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

25 or
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1 ‘‘(B) by any other health care professional who

2 is legally authorized to furnish such services under

3 State law (or the State regulatory mechanism pro4 vided by State law) of the State in which the serv5 ices are furnished, as would otherwise be covered if

6 furnished by a physician or as an incident to a phy7 sician’s professional service.

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

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

10 are not otherwise covered under this title.’’.

11 (c) ELIMINATION OF COST-SHARING.—

12 (1) ELIMINATION OF COINSURANCE.—Section

13 1833(a)(1) (42 U.S.C. 1395l(a)(1)), as amended by

14 section 225(b), is amended—

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

16 (B) by inserting before the semicolon at

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

18 to counseling for cessation of tobacco use (as

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

20 shall be 100 percent of the lesser of the actual

21 charge for the services or the amount deter22 mined by a fee schedule established by the Sec23 retary for the purposes of this subparagraph’’.
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1 (2) ELIMINATION OF DEDUCTIBLE.—The first

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

3 amended—

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

5 (B) by inserting before the period the fol6 lowing: ‘‘, and (7) such deductible shall not

7 apply with respect to counseling for cessation of

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

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

10 this section shall apply to services furnished on or after

11 July 1, 2001.

12 SEC. 233. COVERAGE OF GLAUCOMA DETECTION TESTS.

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

14 as amended by section 232, is amended—

15 (1) in subsection (s)(2)—

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

17 ‘‘and’’ at the end;

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

19 ‘‘and’’ at the end; and

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

21 subparagraph:

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

23 subsection (vv));’’; and

24 (2) by adding at the end the following new sub25 section:
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1 ‘‘Glaucoma Detection Tests

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

3 of the following conducted for the purpose of early detec4 tion of glaucoma:

5 ‘‘(1) A dilated eye examination with an intra6 ocular pressure measurement.

7 ‘‘(2) Direct ophthalmoscopy or slit-lamp bio8 microscopic examination.’’.

9 (b) LIMITATION ON ELIGIBILITY AND FREQUENCY.—

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

11 at the end the following new subsection:

12 ‘‘(m) LIMITATION ON COVERAGE OF GLAUCOMA DE13 TECTION TESTS.—

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

15 provision of this part, with respect to expenses in16 curred for glaucoma detection tests (as defined in

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

18 glaucoma detection tests conducted—

19 ‘‘(A) for individuals described in paragraph

20 (2); and

21 ‘‘(B) consistent with the frequency per22 mitted under paragraph (3).

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

24 Individuals described in this paragraph are as fol25 lows:
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1 ‘‘(A) Individuals who are 60 years of age

2 or older and who have a family history of glau3 coma.

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

5 risk (as determined by the Secretary) of devel6 oping glaucoma.

7 ‘‘(3) FREQUENCY LIMIT.—

8 ‘‘(A) IN GENERAL.—Subject to subpara9 graph (B), payment may not be made under

10 this part for a glaucoma detection test per11 formed for an individual within 23 months fol12 lowing the month in which a glaucoma detection

13 test was performed under this part for the indi14 vidual.

15 ‘‘(B) EXCEPTION.—The Secretary may

16 permit a glaucoma detection test to be covered

17 on a more frequent basis than that provided

18 under subparagraph (A) under such cir19 cumstances as the Secretary determines to be

20 appropriate.’’.

21 (c) NO APPLICATION OF DEDUCTIBLE.—Section

22 1833(b)(5) (42 U.S.C. 1395l(b)(5)) is amended by insert23 ing ‘‘or with respect to glaucoma detection tests (as de24 fined in section 1861(vv))’’ after ‘‘1861(jj))’’.
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1 (d) CONFORMING AMENDMENTS.—Section 1862(a)

2 (42 U.S.C. 1395y(a)) is amended—

3 (1) in paragraph (1)—

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

5 ‘‘and’’ at the end;

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

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

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

9 subparagraph:

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

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

12 an individual not described in paragraph (2) of sec13 tion 1834(m) or which are performed more fre14 quently than is covered under paragraph (3) of such

15 section;’’; and

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

17 inserting ‘‘(H), or (I)’’.

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

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

20 2001.

21 SEC. 234. MEDICAL NUTRITION THERAPY SERVICES FOR

22 BENEFICIARIES WITH DIABETES, A CARDIO23 VASCULAR DISEASE, OR A RENAL DISEASE.

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

25 1395x(s)(2)), as amended by section 233(a), is amended—
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1 (1) in subparagraph (U) by striking ‘‘and’’ at

2 the end;

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

4 the end; and

5 (3) by adding at the end the following new sub6 paragraph:

7 ‘‘(W) medical nutrition therapy services (as de8 fined in subsection (ww)(1)) in the case of a bene9 ficiary with diabetes, a cardiovascular disease (in10 cluding congestive heart failure, arteriosclerosis,

11 hyperlipidemia, hypertension, and hypercholester12 olemia), or a renal disease;’’.

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

14 1395x), as amended by section 233(a), is amended by add15 ing at the end the following new subsection:

16 ‘‘Medical Nutrition Therapy Services; Registered

17 Dietitian or Nutrition Professional

18 ‘‘(ww)(1) The term ‘medical nutrition therapy serv19 ices’ means nutritional diagnostic, therapy, and counseling

20 services for the purpose of disease management which are

21 furnished by a registered dietitian or nutrition profes22 sional (as defined in paragraph (2)) pursuant to a referral

23 by a physician (as defined in subsection (r)(1)).
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1 ‘‘(2) Subject to paragraph (3), the term ‘registered

2 dietitian or nutrition professional’ means an individual

3 who—

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

5 granted by a regionally accredited college or univer6 sity in the United States (or an equivalent foreign

7 degree) with completion of the academic require8 ments of a program in nutrition or dietetics, as ac9 credited by an appropriate national accreditation or10 ganization recognized by the Secretary for this pur11 pose;

12 ‘‘(B) has completed at least 900 hours of super13 vised dietetics practice under the supervision of a

14 registered dietitian or nutrition professional; and

15 ‘‘(C)(i) is licensed or certified as a dietitian or

16 nutrition professional by the State in which the serv17 ices are performed; or

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

19 does not provide for such licensure or certification,

20 meets such other criteria as the Secretary estab21 lishes.

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

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

24 date of enactment of this subsection, is licensed or cer25 tified as a dietitian or nutrition professional by the State
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1 in which medical nutrition therapy services are per2 formed.’’.

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

4 1395l(a)(1)), as amended by section 232(c)(1), is

5 amended—

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

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

8 the following: ‘‘, and (V) with respect to medical nu9 trition therapy services (as defined in section

10 1861(ww)), the amount paid shall be 85 percent of

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

12 amount determined under the fee schedule estab13 lished under section 1848(b) for the same services if

14 furnished by a physician’’.

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

16 this section apply to services furnished on or after July

17 1, 2001.

18 SEC. 235. STUDIES ON PREVENTIVE INTERVENTIONS IN

19 PRIMARY CARE FOR OLDER AMERICANS.

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

21 Services, acting through the United States Preventive

22 Services Task Force, shall conduct a series of studies de23 signed to identify preventive interventions that can be de24 livered in the primary care setting that are most valuable

25 to older Americans.
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1 (b) MISSION STATEMENT.—The mission statement of

2 the United States Preventive Services Task Force is

3 amended to include the evaluation of services that are of

4 particular relevance to older Americans.

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

6 of enactment of this Act, and annually thereafter, the Sec7 retary of Health and Human Services shall submit a re8 port to Congress on the conclusions of the studies con9 ducted under subsection (a), together with recommenda10 tions for such legislation and administrative actions as the

11 Secretary considers appropriate.

12 SEC. 236. INSTITUTE OF MEDICINE 5-YEAR MEDICARE PRE13 VENTION BENEFIT STUDY AND REPORT.

14 (a) STUDY.—

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

16 Human Services shall contract with the Institute of

17 Medicine of the National Academy of Sciences to

18 conduct a comprehensive study of current literature

19 and best practices in the field of health promotion

20 and disease prevention among medicare beneficiaries

21 including the issues described in paragraph (2) and

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

23 (2) ISSUES STUDIED.—The study required

24 under paragraph (1) shall include an assessment

25 of—
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1 (A) whether each covered benefit is—

2 (i) medically effective; and

3 (ii) a cost-effective benefit or a cost4 saving benefit;

5 (B) utilization of covered benefits (includ6 ing any barriers to or incentives to increase uti7 lization); and

8 (C) quality of life issues associated with

9 both health promotion and disease prevention

10 benefits covered under the medicare program

11 and those that are not covered under such pro12 gram that would affect all medicare bene13 ficiaries.

14 (b) REPORT.—

15 (1) IN GENERAL.—Not later than 5 years after

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

17 year thereafter, the Institute of Medicine of the Na18 tional Academy of Sciences shall submit to the

19 President a report that contains a detailed state20 ment of the findings and conclusions of the study

21 conducted under subsection (a) and the rec22 ommendations for legislation described in paragraph

23 (2).

24 (2) RECOMMENDATIONS FOR LEGISLATION.—

25 The Institute of Medicine of the National Academy
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1 of Sciences, in consultation with the Partnership for

2 Prevention, shall develop recommendations in legis3 lative form that—

4 (A) prioritize the preventive benefits under

5 the medicare program; and

6 (B) modify preventive benefits offered

7 under the medicare program based on the study

8 conducted under subsection (a).

9 (c) TRANSMISSION TO CONGRESS.—

10 (1) IN GENERAL.—On the day on which the re11 port described in subsection (b) is submitted to the

12 President, the President shall transmit the report

13 and recommendations in legislative form described in

14 subsection (b)(2) to Congress.

15 (2) DELIVERY.—Copies of the report and rec16 ommendations in legislative form required to be

17 transmitted to Congress under paragraph (1) shall

18 be delivered—

19 (A) to both Houses of Congress on the

20 same day;

21 (B) to the Clerk of the House of Rep22 resentatives if the House is not in session; and

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

24 Senate is not in session.

25 (d) DEFINITIONS.—In this section:
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1 (1) COST-EFFECTIVE BENEFIT.—The term

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

3 that has—

4 (A) been subject to peer review;

5 (B) been described in scientific journals;

6 and

7 (C) demonstrated value as measured by

8 unit costs relative to health outcomes achieved.

9 (2) COST-SAVING BENEFIT.—The term ‘‘cost10 saving benefit’’ means a benefit or technique that

11 has—

12 (A) been subject to peer review;

13 (B) been described in scientific journals;

14 and

15 (C) caused a net reduction in health care

16 costs for medicare beneficiaries.

17 (3) MEDICALLY EFFECTIVE.—The term ‘‘medi18 cally effective’’ means, with respect to a benefit or

19 technique, that the benefit or technique has been—

20 (A) subject to peer review;

21 (B) described in scientific journals; and

22 (C) determined to achieve an intended goal

23 under normal programmatic conditions.

24 (4) MEDICARE BENEFICIARY.—The term

25 ‘‘medicare beneficiary’’ means any individual who is
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1 entitled to benefits under part A or enrolled under

2 part B of the medicare program, including any indi3 vidual enrolled in a Medicare+Choice plan offered

4 by a Medicare+Choice organization under part C of

5 such program.

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

7 program’’ means the health benefits program under

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

9 1395 et seq.).

10 SEC. 237. FAST-TRACK CONSIDERATION OF PREVENTION

11 BENEFIT LEGISLATION.

12 (a) RULES OF HOUSE OF REPRESENTATIVES AND

13 SENATE.—This section is enacted by Congress—

14 (1) as an exercise of the rulemaking power of

15 the House of Representatives and the Senate, re16 spectively, and is deemed a part of the rules of each

17 House of Congress, but—

18 (A) is applicable only with respect to the

19 procedure to be followed in that House of Con20 gress in the case of an implementing bill (as de21 fined in subsection (d)); and

22 (B) supersedes other rules only to the ex23 tent that such rules are inconsistent with this

24 section; and
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•S 3077 IS

1 (2) with full recognition of the constitutional

2 right of either House of Congress to change the

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

4 House of Congress) at any time, in the same man5 ner and to the same extent as in the case of any

6 other rule of that House of Congress.

7 (b) INTRODUCTION AND REFERRAL.—

8 (1) INTRODUCTION.—

9 (A) IN GENERAL.—Subject to paragraph

10 (2), on the day on which the President trans11 mits the report pursuant to section 236(c) to

12 the House of Representatives and the Senate,

13 the recommendations in legislative form trans14 mitted by the President with respect to such re15 port shall be introduced as a bill (by request)

16 in the following manner:

17 (i) HOUSE OF REPRESENTATIVES.—In

18 the House of Representatives, by the Ma19 jority Leader, for himself and the Minority

20 Leader, or by Members of the House of

21 Representatives designated by the Majority

22 Leader and Minority Leader.

23 (ii) SENATE.—In the Senate, by the

24 Majority Leader, for himself and the Mi25 nority Leader, or by Members of the Sen-
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•S 3077 IS

1 ate designated by the Majority Leader and

2 Minority Leader.

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

4 Congress is not in session on the day on which

5 such recommendations in legislative form are

6 transmitted, the recommendations in legislative

7 form shall be introduced as a bill in that House

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

9 on the first day thereafter on which that House

10 of Congress is in session.

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

12 the presiding officers of the respective Houses to the

13 appropriate committee, or, in the case of a bill con14 taining provisions within the jurisdiction of 2 or

15 more committees, jointly to such committees for con16 sideration of those provisions within their respective

17 jurisdictions.

18 (c) CONSIDERATION.—After the recommendations in

19 legislative form have been introduced as a bill and referred

20 under subsection (b), such implementing bill shall be con21 sidered in the same manner as an implementing bill is con22 sidered under subsections (d), (e), (f), and (g) of section

23 151 of the Trade Act of 1974 (19 U.S.C. 2191).

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

25 the term ‘‘implementing bill’’ means only the recommenda-
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1 tions in legislative form of the Institute of Medicine of the

2 National Academy of Sciences described in section

3 236(b)(2), transmitted by the President to the House of

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

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

6 a bill of either House of Congress.

7 (e) COUNTING OF DAYS.—For purposes of this sec8 tion, any period of days referred to in section 151 of the

9 Trade Act of 1974 shall be computed by excluding—

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

11 is not in session because of an adjournment of more

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

13 Congress sine die; and

14 (2) any Saturday and Sunday, not excluded

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

16 session.

17 Subtitle E—Other Services

18 SEC. 241. REVISION OF MORATORIUM IN CAPS FOR THER19 APY SERVICES.

20 (a) EXTENSION OF MORATORIUM.—Section

21 1833(g)(4) (42 U.S.C. 1395l(g)(4)) is amended by strik22 ing ‘‘during 2000 and 2001’’ and inserting ‘‘during the

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

24 date that is 18 months after the date the Secretary sub-
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1 mits the report required under section 4541(d)(2) of the

2 Balanced Budget Act of 1997 to Congress’’.

3 (b) EXTENSION OF REPORTING DATE.—Section

4 4541(d)(2) of BBA (42 U.S.C. 1395l note), as amended

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

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

7 ‘‘January 1, 2002’’.

8 SEC. 242. REVISION OF COVERAGE OF IMMUNO9 SUPPRESSIVE DRUGS.

10 (a) REVISION.—

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

12 U.S.C. 1395x(s)(2)(J)) is amended to read as fol13 lows:

14 ‘‘(J) prescription drugs used in immuno15 suppressive therapy furnished—

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

17 the Medicare, Medicaid, and SCHIP Balanced

18 Budget Refinement Act of 2000 and before

19 January 1, 2004, to an individual who has re20 ceived an organ transplant; and

21 ‘‘(ii) on or after January 1, 2004, to an in22 dividual who receives an organ transplant for

23 which payment is made under this title, but

24 only in the case of drugs furnished within 36
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1 months after the date of the transplant proce2 dure.’’.

3 (2) CONFORMING AMENDMENTS.—

4 (A) EXTENDED COVERAGE.—Section 1832

5 (42 U.S.C. 1395k) is amended—

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

7 (ii) by redesignating subsection (c) as

8 subsection (b).

9 (B) PASS-THROUGH; REPORT.—Sub10 sections (c) and (d) of section 227 of BBRA

11 (113 Stat. 1501A–355) are repealed.

12 (3) EFFECTIVE DATE.—The amendments made

13 by this subsection shall apply to drugs furnished on

14 or after the date of enactment of this Act.

15 (b) EXTENSION OF CERTAIN SECONDARY PAYER RE16 QUIREMENTS.—Section 1862(b)(1)(C) (42 U.S.C.

17 1395y(b)(1)(C)) is amended by adding at the end the fol18 lowing: ‘‘With regard to immunosuppressive drugs fur19 nished on or after the date of enactment of the Medicare,

20 Medicaid, and SCHIP Balanced Budget Refinement Act

21 of 2000 and before January 1, 2004, this subparagraph

22 shall be applied without regard to any time limitation.’’.
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1 SEC. 243. STATE ACCREDITATION OF DIABETES SELF-MAN2 AGEMENT TRAINING PROGRAMS.

3 Section 1861(qq)(2) of the Social Security Act (42

4 U.S.C. 1395xx(qq)(2)) is amended—

5 (1) in the matter preceding subparagraph (A),

6 by striking ‘‘paragraph (1)—’’ and inserting ‘‘para7 graph (1):’’;

8 (2) in subparagraph (A)—

9 (A) by striking ‘‘a ‘certified provider’ ’’ and

10 inserting ‘‘A ‘certified provider’ ’’; and

11 (B) by striking ‘‘; and’’ and inserting a pe12 riod; and

13 (3) in subparagraph (B)—

14 (A) by striking ‘‘a physician, or such other

15 individual’’ and inserting ‘‘(i) A physician, or

16 such other individual’’;

17 (B) by inserting ‘‘(I)’’ before ‘‘meets appli18 cable standards’’;

19 (C) by inserting ‘‘(II)’’ before ‘‘is recog20 nized’’;

21 (D) by inserting ‘‘, or by a program de22 scribed in clause (ii),’’ after ‘‘recognized by an

23 organization that represents individuals (includ24 ing individuals under this title) with diabetes’’;

25 and
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1 (E) by adding at the end the following new

2 clause:

3 ‘‘(ii) Notwithstanding any reference to ‘a na4 tional accreditation body’ in section 1865(b), for

5 purposes of clause (i), a program described in this

6 clause is a program operated by a State for the pur7 poses of accrediting diabetes self-management train8 ing programs, if the Secretary determines that such

9 State program has established quality standards

10 that meet or exceed the standards established by the

11 Secretary under clause (i) or the standards origi12 nally established by the National Diabetes Advisory

13 Board and subsequently revised as described in

14 clause (i).’’.

15 SEC. 244. ELIMINATION OF REDUCTION IN PAYMENT

16 AMOUNTS FOR DURABLE MEDICAL EQUIP17 MENT AND OXYGEN AND OXYGEN EQUIP18 MENT.

19 (a) UPDATE FOR COVERED ITEMS.—Section

20 1834(a)(14)(C) (42 U.S.C. 1395m(a)(14)(C)) is amended

21 by striking ‘‘through 2002’’ and inserting ‘‘through

22 2000’’.

23 (b) ORTHOTICS AND PROSTHETICS.—Section

24 1834(h)(4)(A)(v) (42 U.S.C. 1395m(h)(4)(A)(v)) is
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•S 3077 IS

1 amended by striking ‘‘through 2002’’ and inserting

2 ‘‘through 2000’’.

3 (c) PARENTERAL AND ENTERAL NUTRIENTS, SUP4 PLIES, AND EQUIPMENT.—Section 4551(b) of BBA (42

5 U.S.C. 1395m note) is amended by striking ‘‘through

6 2002’’ and inserting ‘‘through 2000’’.

7 (d) OXYGEN AND OXYGEN EQUIPMENT.—Section

8 1834(a)(9)(B) (42 U.S.C. 1395m(a)(9)(B)) is amended—

9 (1) in clause (v), by striking ‘‘and’’ at the end;

10 (2) in clause (vi)—

11 (A) by striking ‘‘each subsequent year’’

12 and inserting ‘‘2000’’; and

13 (B) by striking the period at the end and

14 inserting ‘‘; and’’; and

15 (3) by adding at the end the following new

16 clause:

17 ‘‘(vii) for 2001 and each subsequent

18 year, the amount determined under this

19 subparagraph for the preceding year in20 creased by the covered item update for

21 such subsequent year.’’.

22 (e) CONFORMING AMENDMENT.—Section 228 of

23 BBRA (113 Stat. 1501A–356) is repealed.
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1 SEC. 245. STANDARDS REGARDING PAYMENT FOR CERTAIN

2 ORTHOTICS AND PROSTHETICS.

3 (a) STANDARDS.—

4 (1) IN GENERAL.—Section 1834(h)(1) (42

5 U.S.C. 1395m(h)(1)) is amended by adding at the

6 end the following:

7 ‘‘(F) ESTABLISHMENT OF STANDARDS FOR

8 CERTAIN ITEMS.—

9 ‘‘(i) IN GENERAL.—No payment shall

10 be made for an applicable item unless such

11 item is provided by a qualified practitioner

12 or a qualified supplier under the system es13 tablished by the Secretary under clause

14 (iii). For purposes of the preceding sen15 tence, if a qualified practitioner or a quali16 fied supplier contracts with an entity to

17 provide an applicable item, then no pay18 ment shall be made for such item unless

19 the entity is also a qualified supplier.

20 ‘‘(ii) DEFINITIONS.—In this

21 subparagraph—

22 ‘‘(I) APPLICABLE ITEM.—The

23 term ‘applicable item’ means orthotics

24 and prosthetics that require edu25 cation, training, and experience to

26 custom fabricate such item. Such
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•S 3077 IS

1 term does not include shoes and shoe

2 inserts.

3 ‘‘(II) QUALIFIED PRACTI4 TIONER.—The term ‘qualified practi5 tioner’ means a physician or health

6 professional who meets any of the fol7 lowing requirements:

8 ‘‘(aa) The physician or

9 health professional is specifically

10 trained and educated to provide

11 or manage the provision of cus12 tom-designed, fabricated, modi13 fied, and fitted orthotics and

14 prosthetics, and is either certified

15 by the American Board for Cer16 tification in Orthotics and Pros17 thetics, Inc., certified by the

18 Board for Orthotist/Prosthetist

19 Certification, or credentialed and

20 approved by a program that the

21 Secretary determines, in con22 sultation with appropriate ex23 perts in orthotics and prosthetics,

24 has training and education stand-
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1 ards that are necessary to pro2 vide applicable items.

3 ‘‘(bb) The physician or

4 health professional is licensed in

5 orthotics or prosthetics by the

6 State in which the applicable

7 item is supplied, but only if the

8 Secretary determines that the

9 mechanisms used by the State to

10 provide such licensure meet

11 standards determined appropriate

12 by the Secretary.

13 ‘‘(cc) The physician or

14 health professional has completed

15 at least 10 years practice in the

16 provision of applicable items. A

17 physician or health professional

18 may not qualify as a qualified

19 practitioner under the preceding

20 sentence with respect to an appli21 cable item if the item was pro22 vided on or after January 1,

23 2005.
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1 ‘‘(III) QUALIFIED SUPPLIER.—

2 The term ‘qualified supplier’ means

3 any entity that is—

4 ‘‘(aa) accredited by the

5 American Board for Certification

6 in Orthotics and Prosthetics, Inc.

7 or the Board for Orthotist/Pros8 thetist Certification; or

9 ‘‘(bb) accredited and ap10 proved by a program that the

11 Secretary determines has accredi12 tation and approval standards

13 that are essentially equivalent to

14 those of such Board.

15 ‘‘(iii) SYSTEM.—The Secretary, in

16 consultation with appropriate experts in

17 orthotics and prosthetics, shall establish a

18 system under which the Secretary shall—

19 ‘‘(I) determine which items are

20 applicable items and formulate a list

21 of such items;

22 ‘‘(II) review the applicable items

23 billed under the coding system estab24 lished under this title; and
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1 ‘‘(III) limit payment for applica2 ble items pursuant to clause (i).’’.

3 (2) EFFECTIVE DATE.—The amendment made

4 by paragraph (1) shall apply to items provided on or

5 after January 1, 2003.

6 (b) REVISION OF DEFINITION OF ORTHOTICS.—

7 (1) IN GENERAL.—Section 1861(s)(9) (42

8 U.S.C. 1395x(s)(9)) is amended by inserting ‘‘(in9 cluding such braces that are used in conjunction

10 with, or as components of, other medical or non11 medical equipment when provided by a qualified

12 practitioner (as defined in subclause (II) of section

13 1834(h)(1)(F))) or a qualified supplier (as defined

14 in subclause (III) of such section)’’ after ‘‘braces’’.

15 (2) EFFECTIVE DATE.—The amendment made

16 by paragraph (1) shall apply to items provided on or

17 after January 1, 2003.

18 SEC. 246. NATIONAL LIMITATION AMOUNT EQUAL TO 100

19 PERCENT OF NATIONAL MEDIAN FOR NEW

20 PAP SMEAR TECHNOLOGIES AND OTHER NEW

21 CLINICAL LABORATORY TEST TECH22 NOLOGIES.

23 Section 1833(h)(4)(B)(viii) (42 U.S.C.

24 1395l(h)(4)(B)(viii)) is amended by inserting before the

25 period at the end the following: ‘‘(or 100 percent of such
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1 median in the case of a clinical diagnostic laboratory test

2 performed on or after January 1, 2001, that the Secretary

3 determines is a new test for which no limitation amount

4 has previously been established under this subpara5 graph)’’.

6 SEC. 247. INCREASED MEDICARE PAYMENTS FOR CER7 TIFIED NURSE-MIDWIFE SERVICES.

8 (a) AMOUNT OF PAYMENT.—Section 1833(a)(1)(K)

9 (42 U.S.C. 1395l(a)(1)(K)) is amended by striking ‘‘65

10 percent of the prevailing charge that would be allowed for

11 the same service performed by a physician, or, for services

12 furnished on or after January 1, 1992, 65 percent’’ and

13 inserting ‘‘85 percent’’.

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

15 subsection (a) shall apply to services furnished on or after

16 January 1, 2001.

17 SEC. 248. PAYMENT FOR ADMINISTRATION OF DRUGS.

18 (a) REVIEW OF CHEMOTHERAPY ADMINISTRATION

19 PRACTICE EXPENSES RVUS.—The Secretary of Health

20 and Human Services shall review the resource-based prac21 tice expense component of relative value units under the

22 physician fee schedule under section 1848 of the Social

23 Security Act (42 U.S.C. 1395w–4) for chemotherapy ad24 ministration services to determine if such units should be

25 increased.
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1 (b) MORE ACCURATE CHEMOTHERAPY DRUG PAY2 MENTS TIED TO INCREASES IN CHEMOTHERAPY ADMINIS3 TRATION PAYMENTS.—If the Secretary of Health and

4 Human Services determines, as a result of the review

5 under subsection (a), that the resource-based practice ex6 pense relative value units for chemotherapy administration

7 services should be increased, the Secretary—

8 (1) may implement such increases for such

9 services, but only if the Secretary simultaneously im10 plements more accurate average wholesale prices for

11 chemotherapy drugs (but in no case shall such si12 multaneous implementation occur prior to January

13 1, 2002); and

14 (2) if the Secretary implements such increases

15 for such services, shall do so without taking into ac16 count the requirement under the physician fee

17 schedule under section 1848(c)(2)(B)(ii)(II) of the

18 Social Security Act (42 U.S.C. 1395w–

19 4(c)(2)(B)(ii)(II)).

20 (c) BLOOD CLOTTING DRUG-RELATED ACTIVI21 TIES.—

22 (1) COVERAGE.—Section 1861(s)(2)(I) (42

23 U.S.C. 1395x(s)(2)(I)) is amended—

24 (A) by striking ‘‘and’’ after ‘‘supervision,’’;

25 and
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1 (B) by inserting the following before the

2 semicolon: ‘‘, and the costs (pursuant to section

3 1834(n)) incurred by suppliers of such factors’’.

4 (2) PAYMENTS.—Section 1834 (42 U.S.C.

5 1395m), as amended by section 233(b), is amended

6 by adding at the end the following new subsection:

7 ‘‘(n) PAYMENT FOR BLOOD CLOTTING DRUG-RE8 LATED ACTIVITIES.—

9 ‘‘(1) IN GENERAL.—The Secretary shall make

10 payments in accordance with paragraph (2) to sup11 pliers of blood clotting factors (as described in sec12 tion 1861(s)(2)(I)) to cover the costs (such as ship13 ping, storage, inventory control, or other costs speci14 fied by the Secretary) incurred by such suppliers in

15 furnishing such factors to individuals enrolled under

16 this part.

17 ‘‘(2) PAYMENT AMOUNT.—The amount of pay18 ment for furnishing such blood clotting factors (as

19 so described) shall be an amount equal to 80 percent

20 of the lesser of—

21 ‘‘(A) the actual charge for the furnishing

22 of such factors; or

23 ‘‘(B) an amount equal to 10 cents (or such

24 other amount determined appropriate by the

25 Secretary) per unit of such factor furnished.’’.
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1 (3) EFFECTIVE DATE.—The amendments made

2 by this subsection shall apply to blood clotting fac3 tors (as described in section 1861(s)(2)(I) of the So4 cial Security Act (42 U.S.C. 1395x(s)(2)(I))) fur5 nished on or after the date that the Secretary of

6 Health and Human Services implements more accu7 rate average wholesale prices for such factors.

8 SEC. 249. MEDPAC STUDY ON IN-HOME INFUSION THERAPY

9 NURSING SERVICES.

10 (a) STUDY.—The Medicare Payment Advisory Com11 mission established under section 1805 of the Social Secu12 rity Act (42 U.S.C. 1395b–6) (in this section referred to

13 as ‘‘MedPAC’’) shall conduct a study on the provision of

14 in-home infusion therapy nursing services, including a re15 view of any documentation of clinical efficacy for those

16 services and any costs associated with providing those

17 services.

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

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

20 report to the Secretary of Health and Human Services and

21 Congress on the study and review conducted under sub22 section (a) together with recommendations regarding the

23 establishment of a payment methodology for in-home infu24 sion therapy nursing services that ensures the continuing

25 access of beneficiaries under the medicare program under
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1 title XVIII of the Social Security Act (42 U.S.C. 1395

2 et seq.) to those services.

3 TITLE III—PROVISIONS

4 RELATING TO PARTS A AND B

5 Subtitle A—Home Health Services

6 SEC. 301. ELIMINATION OF 15 PERCENT REDUCTION IN

7 PAYMENT RATES UNDER THE PROSPECTIVE

8 PAYMENT SYSTEM FOR HOME HEALTH SERV9 ICES.

10 (a) IN GENERAL.—Section 1895(b)(3)(A) (42 U.S.C.

11 1395fff(b)(3)(A)) is amended to read as follows:

12 ‘‘(A) INITIAL BASIS.—Under such system

13 the Secretary shall provide for computation of

14 a standard prospective payment amount (or

15 amounts). Such amount (or amounts) shall ini16 tially be based on the most current audited cost

17 report data available to the Secretary and shall

18 be computed in a manner so that the total

19 amounts payable under the system for the 12-

20 month period beginning on the date the Sec21 retary implements the system shall be equal to

22 the total amount that would have been made if

23 the system had not been in effect and if section

24 1861(v)(1)(L)(ix) had not been enacted. Each

25 such amount shall be standardized in a manner
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1 that eliminates the effect of variations in rel2 ative case mix and area wage adjustments

3 among different home health agencies in a

4 budget neutral manner consistent with the case

5 mix and wage level adjustments provided under

6 paragraph (4)(A). Under the system, the Sec7 retary may recognize regional differences or dif8 ferences based upon whether or not the services

9 or agency are in an urbanized area.’’.

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

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

13 SEC. 302. EXCLUSION OF CERTAIN NONROUTINE MEDICAL

14 SUPPLIES UNDER THE PPS FOR HOME

15 HEALTH SERVICES.

16 (a) EXCLUSION.—

17 (1) IN GENERAL.—Section 1895 (42 U.S.C.

18 1395fff) is amended by adding at the end the fol19 lowing new subsection:

20 ‘‘(e) EXCLUSION OF NONROUTINE MEDICAL SUP21 PLIES.—

22 ‘‘(1) IN GENERAL.—Notwithstanding the pre23 ceding provisions of this section, in the case of all

24 nonroutine medical supplies (as defined by the Sec25 retary) furnished by a home health agency during a
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1 year (beginning with 2001) for which payment is

2 otherwise made on the basis of the prospective pay3 ment amount under this section, payment under this

4 section shall be based instead on the lesser of—

5 ‘‘(A) the actual charge for the nonroutine

6 medical supply; or

7 ‘‘(B) the amount determined under the fee

8 schedule established by the Secretary for pur9 poses of making payment for such items under

10 part B for nonroutine medical supplies fur11 nished during that year.

12 ‘‘(2) BUDGET NEUTRALITY ADJUSTMENT.—The

13 Secretary shall provide for an appropriate propor14 tional reduction in payments under this section so

15 that beginning with fiscal year 2001, the aggregate

16 amount of such reductions is equal to the aggregate

17 increase in payments attributable to the exclusion ef18 fected under paragraph (1).’’.

19 (2) CONFORMING AMENDMENT.—Section

20 1895(b)(1) of the Social Security Act (42 U.S.C.

21 1395fff(b)(1)) is amended by striking ‘‘The Sec22 retary’’ and inserting ‘‘Subject to subsection (e), the

23 Secretary’’.
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1 (3) EFFECTIVE DATE.—The amendments made

2 by this subsection shall apply to supplies furnished

3 on or after January 1, 2001.

4 (b) EXCLUSION FROM CONSOLIDATED BILLING.—

5 (1) IN GENERAL.—For items provided during

6 the applicable period, the Secretary of Health and

7 Human Services shall administer the medicare pro8 gram under title XVIII of the Social Security Act

9 (42 U.S.C. 1395 et seq.) as if—

10 (A) section 1842(b)(6)(F) of such Act (42

11 U.S.C. 1395u(b)(6)(F)) was amended by strik12 ing ‘‘(including medical supplies described in

13 section 1861(m)(5), but excluding durable med14 ical equipment to the extent provided for in

15 such section)’’ and inserting ‘‘(excluding med16 ical supplies and durable medical equipment de17 scribed in section 1861(m)(5))’’; and

18 (B) section 1862(a)(21) of such Act (42

19 U.S.C. 1395y(a)(21)) was amended by striking

20 ‘‘(including medical supplies described in sec21 tion 1861(m)(5), but excluding durable medical

22 equipment to the extent provided for in such

23 section)’’ and inserting ‘‘(excluding medical

24 supplies and durable medical equipment de25 scribed in section 1861(m)(5))’’.
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1 (2) APPLICABLE PERIOD DEFINED.—For pur2 poses of paragraph (1), the term ‘‘applicable period’’

3 means the period beginning on January 1, 2001,

4 and ending on the later of—

5 (A) the date that is 18 months after the

6 date of enactment of this Act; or

7 (B) the date determined appropriate by the

8 Secretary of Health and Human Services.

9 (c) STUDY ON EXCLUSION OF CERTAIN NONROUTINE

10 MEDICAL SUPPLIES UNDER THE PPS FOR HOME

11 HEALTH SERVICES.—

12 (1) STUDY.—The Secretary of Health and

13 Human Services (in this subsection referred to as

14 the ‘‘Secretary’’) shall conduct a study to identify

15 any nonroutine medical supply that may be appro16 priately and cost-effectively excluded from the pro17 spective payment system for home health services

18 under section 1895 of the Social Security Act (42

19 U.S.C. 1395fff). Specifically, the Secretary shall

20 consider whether wound care and ostomy supplies

21 should be excluded from such prospective payment

22 system.

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

24 the date of enactment of this Act, the Secretary

25 shall submit to the committees of jurisdiction of the
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1 House of Representatives and the Senate a report on

2 the study conducted under paragraph (1), including

3 a list of any nonroutine medical supplies that should

4 be excluded from the prospective payment system for

5 home health services under section 1895 of the So6 cial Security Act (42 U.S.C. 1395fff).

7 (d) EXCLUSION OF OTHER NONROUTINE MEDICAL

8 SUPPLIES.—Upon submission of the report under sub9 section (c)(2), the Secretary shall (if necessary) revise the

10 definition of nonroutine medical supply, as defined for

11 purposes of section 1895(e) (as added by subsection (a)),

12 based on the list of nonroutine medical supplies included

13 in such report.

14 SEC. 303. PERMITTING HOME HEALTH PATIENTS WITH ALZ15 HEIMER’S DISEASE OR A RELATED DEMENTIA

16 TO ATTEND ADULT DAY-CARE.

17 (a) IN GENERAL.—Sections 1814(a) and 1835(a) of

18 the Social Security Act (42 U.S.C. 1395f(a); 1395n(a))

19 are each amended in the last sentence by inserting ‘‘(in20 cluding regularly participating, for the purpose of thera21 peutic treatment for Alzheimer’s disease or a related de22 mentia, in an adult day-care program that is licensed, cer23 tified, or accredited by a State to furnish adult day-care

24 services in the State)’’ before the period.
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1 (b) EFFECTIVE DATE.—The amendments made by

2 subsection (a) shall apply to items and services provided

3 on or after October 1, 2001.

4 SEC. 304. STANDARDS FOR HOME HEALTH BRANCH OF5 FICES.

6 (a) IN GENERAL.—Section 1861(o) (42 U.S.C.

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

8 new sentences: ‘‘For purposes of this subsection, a home

9 health agency may provide services through a single site

10 or through a branch office. For purposes of the preceding

11 sentence, the term ‘branch office’ means a service site for

12 home health services that is controlled and supervised by

13 a home health agency.’’.

14 (b) ESTABLISHMENT OF STANDARDS.—

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

16 Human Services (in this subsection referred to as

17 the ‘‘Secretary’’) shall establish, using a negotiated

18 rulemaking process under subchapter III of chapter

19 5 of title 5, United States Code, standards for the

20 operation of a branch office (as defined in the last

21 sentence of section 1861(o) of the Social Security

22 Act (42 U.S.C. 1395x(o)), as added by subsection

23 (a)).

24 (2) REQUIREMENTS.—In establishing standards

25 under paragraph (1), the Secretary shall—
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1 (A) provide for the special treatment of

2 any home health agency or branch office—

3 (i) that is located in a frontier area;

4 or

5 (ii) with any other special cir6 cumstance that the Secretary determines is

7 appropriate; and

8 (B) allow the use of technology used by the

9 home health agency to supervise the branch of10 fice.

11 (3) CONSULTATION.—The Secretary shall es12 tablish the regulations under this subsection in con13 sultation with representatives of the home health in14 dustry.

15 SEC. 305. TREATMENT OF HOME HEALTH SERVICES PRO16 VIDED IN CERTAIN COUNTIES.

17 (a) IN GENERAL.—Notwithstanding any other provi18 sion of law, effective for home health services provided

19 under the prospective payment system under section 1895

20 of the Social Security Act (42 U.S.C. 1395fff) during fis21 cal year 2001 in an applicable county, the geographic ad22 justment factors applicable in such year to hospitals phys23 ically located in such county under section 1886(d) of such

24 Act (42 U.S.C. 1395ww(d)) (including the factors applica25 ble to such hospitals by reason of any reclassification or
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1 deemed reclassification) shall be deemed to apply to such

2 services instead of the area wage adjustment factors that

3 would otherwise be applicable to such services under sec4 tion 1895(b)(4)(C) of such Act (42 U.S.C.

5 1395fff(b)(4)(C)).

6 (b) APPLICABLE COUNTY DEFINED.—For purposes

7 of subsection (a), the term ‘‘applicable county’’ means any

8 of the following counties:

9 (1) Duchess County, New York.

10 (2) Orange County, New York.

11 (3) Clinton County, New York.

12 (4) Ulster County, New York.

13 (5) Otsego County, New York.

14 (6) Cayuga County, New York.

15 (7) St. Jefferson County, New York.

16 Subtitle B—Direct Graduate

17 Medical Education

18 SEC. 311. NOT COUNTING CERTAIN GERIATRIC RESIDENTS

19 AGAINST GRADUATE MEDICAL EDUCATION

20 LIMITATIONS.

21 For cost reporting periods beginning on or after Oc22 tober 1, 2000, and before October 1, 2005, in applying

23 the limitations regarding the total number of full-time

24 equivalent interns and residents in the field of allopathic

25 or osteopathic medicine under subsections (d)(5)(B)(v)
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1 and (h)(4)(F) of section 1886 of the Social Security Act

2 (42 U.S.C. 1395ww) for a hospital, the Secretary of

3 Health and Human Services shall not take into account

4 a maximum of 3 interns or residents in the field of geri5 atric medicine to the extent the hospital increases the

6 number of geriatric interns or residents above the number

7 of such interns or residents for the hospital’s most recent

8 cost reporting period ending before October 1, 2000.

9 SEC. 312. PROGRAM OF PAYMENTS TO CHILDREN’S HOS10 PITALS THAT OPERATE GRADUATE MEDICAL

11 EDUCATION PROGRAMS.

12 Part A of title XI (42 U.S.C. 1301 et seq.) is amend13 ed by adding after section 1150 the following new section:

14 ‘‘PROGRAM OF PAYMENTS TO CHILDREN’S HOSPITALS

15 THAT OPERATE GRADUATE MEDICAL EDUCATION

16 PROGRAMS

17 ‘‘SEC. 1150A. (a) PAYMENTS.—The Secretary shall

18 make 2 payments under this section to each children’s

19 hospital for each of fiscal years 2002 through 2005, 1 for

20 the direct expenses and the other for the indirect expenses

21 associated with operating approved graduate medical resi22 dency training programs.

23 ‘‘(b) AMOUNT OF PAYMENTS.—

24 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

25 the amounts payable under this section to a chil26 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 Subtitle C—Miscellaneous

2 Provisions

3 SEC. 321. WAIVER OF 24-MONTH WAITING PERIOD FOR

4 MEDICARE COVERAGE OF INDIVIDUALS DIS5 ABLED WITH AMYOTROPHIC LATERAL SCLE6 ROSIS (ALS).

7 (a) IN GENERAL.—Section 226 (42 U.S.C. 426) is

8 amended—

9 (1) by redesignating subsection (h) as sub10 section (j) and by moving such subsection to the end

11 of the section; and

12 (2) by inserting after subsection (g) the fol13 lowing new subsection:

14 ‘‘(h) For purposes of applying this section in the case

15 of an individual medically determined to have amyotrophic

16 lateral sclerosis (ALS), the following special rules apply:

17 ‘‘(1) Subsection (b) shall be applied as if there

18 were no requirement for any entitlement to benefits,

19 or status, for a period longer than 1 month.

20 ‘‘(2) The entitlement under such subsection

21 shall begin with the first month (rather than twenty22 fifth month) of entitlement or status.

23 ‘‘(3) Subsection (f) shall not be applied.’’.
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1 (b) CONFORMING AMENDMENT.—Section 1837 (42

2 U.S.C. 1395p) is amended by adding at the end the fol3 lowing new subsection:

4 ‘‘(j) In applying this section in the case of an indi5 vidual who is entitled to benefits under part A pursuant

6 to the operation of section 226(h), the following special

7 rules apply:

8 ‘‘(1) The initial enrollment period under sub9 section (d) shall begin on the first day of the first

10 month in which the individual satisfies the require11 ment of section 1836(1).

12 ‘‘(2) In applying subsection (g)(1), the initial

13 enrollment period shall begin on the first day of the

14 first month of entitlement to disability insurance

15 benefits referred to in such subsection.’’.

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

17 this section shall apply to benefits for months beginning

18 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. BONUS PAYMENTS FOR RURAL HOME HEALTH

5 AGENCIES IN 2001 AND 2002.

6 (a) INCREASE IN PAYMENT RATES FOR RURAL

7 AGENCIES IN 2001 AND 2002.—Section 1895(b) (42

8 U.S.C. 1395fff(b)) is amended by adding at the end the

9 following new paragraph:

10 ‘‘(7) ADDITIONAL PAYMENT AMOUNT FOR

11 SERVICES FURNISHED IN RURAL AREAS IN 2001 AND

12 2002.—In the case of home health services furnished

13 in a rural area (as defined in section 1886(d)(2)(D))

14 during 2001 or 2002, the Secretary shall provide for

15 an addition or adjustment to the payment amount

16 otherwise made under this section for services fur17 nished in a rural area in an amount equal to 10 per18 cent of the amount otherwise determined under this

19 subsection.’’.

20 (b) WAIVING BUDGET NEUTRALITY.—Section

21 1895(b)(3) (42 U.S.C. 1395fff(b)(3)) is amended by add22 ing at the end the following new subparagraph:

23 ‘‘(D) NO ADJUSTMENT FOR ADDITIONAL

24 PAYMENTS FOR RURAL SERVICES.—The Sec25 retary shall not reduce the standard prospective
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1 payment amount (or amounts) under this para2 graph applicable to home health services fur3 nished during a period to offset the increase in

4 payments resulting from the application of

5 paragraph (7) (relating to services furnished in

6 rural areas).’’.

7 SEC. 445. EXCLUSION OF CLINICAL SOCIAL WORKER SERV8 ICES AND SERVICES PERFORMED UNDER A

9 CONTRACT WITH A RURAL HEALTH CLINIC

10 OR FEDERALLY QUALIFIED HEALTH CENTER

11 FROM THE PPS FOR SNFs.

12 (a) IN GENERAL.—Section 1888(e)(2)(A)(ii) (42

13 U.S.C. 1395yy(e)(2)(A)(ii)) is amended—

14 (1) in the first sentence, by inserting ‘‘clinical

15 social worker services,’’ after ‘‘qualified psychologist

16 services,’’; and

17 (2) by inserting after the first sentence the fol18 lowing: ‘‘Services described in this clause also in19 clude services that are provided by a physician, a

20 physician assistant, a nurse practitioner, a certified

21 nurse midwife, a qualified psychologist, or a clinical

22 social worker who is employed, or otherwise under

23 contract, with a rural health clinic or a Federally

24 qualified health center.’’.
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1 (b) EFFECTIVE DATE.—The amendments made by

2 this section shall apply to services provided on or after

3 the date which is 60 days after the date of enactment of

4 this Act.

5 SEC. 446. COVERAGE OF MARRIAGE AND FAMILY THERA6 PIST SERVICES PROVIDED IN RURAL HEALTH

7 CLINICS.

8 (a) COVERAGE OF MARRIAGE AND FAMILY THERA9 PIST SERVICES.—

10 (1) PROVISION OF SERVICES IN RURAL HEALTH

11 CLINICS.—Section 1861(aa)(1)(B) (42 U.S.C.

12 1395x(aa)(1)(B)) is amended by striking ‘‘Sec13 retary)’’ and inserting ‘‘Secretary), by a marriage

14 and family therapist (as defined in subsection

15 (xx)(2)),’’.

16 (2) MARRIAGE AND FAMILY THERAPIST SERV17 ICES DEFINED.—Section 1861 (42 U.S.C. 1395x),

18 as amended by section 234(b), is amended by adding

19 at the end the following new subsection:

20 ‘‘Marriage and Family Therapist Services

21 ‘‘(xx)(1) The term ‘marriage and family therapist

22 services’ means services performed by a marriage and

23 family therapist (as defined in paragraph (2)) for the diag24 nosis and treatment of mental illnesses, which the mar25 riage and family therapist is legally authorized to perform
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1 under State law (or the State regulatory mechanism pro2 vided by State law) of the State in which such services

3 are performed, as would otherwise be covered if furnished

4 by a physician or as an incident to a physician’s profes5 sional service, but only if no facility or other provider

6 charges or is paid any amounts with respect to the fur7 nishing of such services.

8 ‘‘(2) The term ‘marriage and family therapist’ means

9 an individual who—

10 ‘‘(A) possesses a master’s or doctoral degree

11 which qualifies for licensure or certification as a

12 marriage and family therapist pursuant to State

13 law;

14 ‘‘(B) after obtaining such degree has performed

15 at least 2 years of clinical supervised experience in

16 marriage and family therapy; and

17 ‘‘(C)(i) is licensed or certified as a marriage

18 and family therapist in the State in which marriage

19 and family therapist services are performed; or

20 ‘‘(ii) in the case of a State that does not pro21 vide for such licensure or certification, meets such

22 other criteria as the Secretary establishes.’’.

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

24 this section shall apply with respect to services furnished

25 on or after January 1, 2002.
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1 SEC. 447. 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. 448. 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. 449. 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. 450. 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) CONSTRUCTION RELATING TO HOME HEALTH

18 SERVICES.—Section 4206(a) of the Balanced Budget Act

19 of 1997 (42 U.S.C. 1395l note), as amended by subsection

20 (f), is amended by adding at the end the following new

21 paragraph:

22 ‘‘(5) CONSTRUCTION RELATING TO HOME

23 HEALTH SERVICES.—

24 ‘‘(A) IN GENERAL.—Nothing in this sec25 tion or in section 1895 of the Social Security
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1 Act (42 U.S.C. 1395fff) shall be construed as

2 preventing a home health agency that is receiv3 ing payment under the prospective payment

4 system described in such section from fur5 nishing a home health service via a tele6 communications system.

7 ‘‘(B) LIMITATION.—The Secretary shall

8 not consider a home health service provided in

9 the manner described in subparagraph (A) to

10 be a home health visit for purposes of—

11 ‘‘(i) determining the amount of pay12 ment to be made under the prospective

13 payment system established under section

14 1895 of the Social Security Act (42 U.S.C.

15 1395fff); or

16 ‘‘(ii) any requirement relating to the

17 certification of a physician required under

18 section 1814(a)(2)(C) of such Act (42

19 U.S.C. 1395f(a)(2)(C)).’’.

20 (h) FIVE-YEAR APPLICATION.—The amendments

21 made by this section shall apply to items and services pro22 vided on or after April 1, 2001, and before April 1, 2006.
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1 SEC. 451. MEDPAC STUDY ON LOW-VOLUME, ISOLATED

2 RURAL HEALTH CARE PROVIDERS.

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 on the effect of low

7 patient and procedure volume on the financial status of

8 low-volume, isolated rural health care providers partici9 pating in the medicare program under title XVIII of the

10 Social Security Act (42 U.S.C. 1395 et seq.).

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

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

13 report to the Secretary of Health and Human Services and

14 Congress on the study conducted under subsection (a)

15 indicating—

16 (1) whether low-volume, isolated rural health

17 care providers are having, or may have, significantly

18 decreased medicare margins or other financial dif19 ficulties resulting from any of the payment meth20 odologies described in subsection (c);

21 (2) whether the status as a low-volume, isolated

22 rural health care provider should be designated

23 under the medicare program and any criteria that

24 should be used to qualify for such a status; and

25 (3) any changes in the payment methodologies

26 described in subsection (c) that are necessary to pro-
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1 vide appropriate reimbursement under the medicare

2 program to low-volume, isolated rural health care

3 providers (as designated pursuant to paragraph (2)).

4 (c) PAYMENT METHODOLOGIES DESCRIBED.—The

5 payment methodologies described in this subsection are

6 the following:

7 (1) The prospective payment system for hos8 pital outpatient department services under section

9 1833(t) of the Social Security Act (42 U.S.C.

10 1395l).

11 (2) The fee schedule for ambulance services

12 under section 1834(l) of such Act (42 U.S.C.

13 1395m(l)).

14 (3) The prospective payment system for inpa15 tient hospital services under section 1886 of such

16 Act (42 U.S.C. 1395ww).

17 (4) The prospective payment system for routine

18 service costs of skilled nursing facilities under sec19 tion 1888(e) of such Act (42 U.S.C. 1395yy(e)).

20 (5) The prospective payment system for home

21 health services under section 1895 of such Act (42

22 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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•S 3077 IS

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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•S 3077 IS

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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•S 3077 IS

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
191

•S 3077 IS

1 child support enforcement agency, a child care

2 resource and referral agency, an organization

3 that is providing emergency food and shelter

4 under a grant under the Stewart B. McKinney

5 Homeless Assistance Act, or a State office or

6 entity involved in enrollment in the program

7 under this title, under part A of title IV, under

8 title XXI, or that determines eligibility for any

9 assistance or benefits provided under any pro10 gram of public or assisted housing that receives

11 Federal funds, including the program under

12 section 8 or any other section of the United

13 States Housing Act of 1937 (42 U.S.C. 1437 et

14 seq.), or (IV) any other entity the State so

15 deems, as approved by the Secretary’’ before

16 the semicolon.

17 (2) APPLICATION UNDER SCHIP.—

18 (A) IN GENERAL.—Section 2107(e)(1) (42

19 U.S.C. 1397gg(e)(1)) is amended by adding at

20 the end the following new subparagraph:

21 ‘‘(D) Section 1920A (relating to presump22 tive eligibility).’’.

23 (B) EXCEPTION FROM LIMITATION ON AD24 MINISTRATIVE EXPENSES.—Section 2105(c)(2)
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•S 3077 IS

1 (42 U.S.C. 1397ee(c)(2)) is amended by adding

2 at the end the following new subparagraph:

3 ‘‘(C) EXCEPTION FOR PRESUMPTIVE ELI4 GIBILITY EXPENDITURES.—The limitation

5 under subparagraph (A) on expenditures shall

6 not apply to expenditures attributable to the

7 application of section 1920A (pursuant to sec8 tion 2107(e)(1)(D)), regardless of whether the

9 child is determined to be ineligible for the pro10 gram under this title or title XIX.’’.

11 (3) TECHNICAL AMENDMENTS.—Section 1920A

12 (42 U.S.C. 1396r–1a) is amended—

13 (A) in subsection (b)(3)(A)(ii), by striking

14 ‘‘paragraph (1)(A)’’ and inserting ‘‘paragraph

15 (2)(A)’’; and

16 (B) in subsection (c)(2), in the matter pre17 ceding subparagraph (A), by striking ‘‘sub18 section (b)(1)(A)’’ and inserting ‘‘subsection

19 (b)(2)(A)’’.

20 (b) ELIMINATION OF SCHIP FUNDING OFFSET FOR

21 EXERCISE OF PRESUMPTIVE ELIGIBILITY OPTION.—

22 (1) IN GENERAL.—Section 2104(d) (42 U.S.C.

23 1397dd(d)) is amended by striking ‘‘the sum of—’’

24 and all that follows through ‘‘(2)’’ and conforming

25 the margins of all that remains accordingly.
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•S 3077 IS

1 (2) EFFECTIVE DATE.—The amendment made

2 by paragraph (1) takes effect October 1, 2000, and

3 applies to allotments under title XXI of the Social

4 Security Act (42 U.S.C. 1397aa et seq.) for fiscal

5 year 2001 and each succeeding fiscal year there6 after.

7 SEC. 705. IMPROVEMENTS TO THE MATERNAL AND CHILD

8 HEALTH SERVICES BLOCK GRANT.

9 (a) INCREASE IN AUTHORIZATION OF APPROPRIA10 TIONS.—Section 501(a) (42 U.S.C. 701(a)) is amended in

11 the matter preceding paragraph (1) by striking

12 ‘‘$705,000,000 for fiscal year 1994’’ and inserting

13 ‘‘$1,000,000,000 for fiscal year 2001’’.

14 (b) COORDINATION WITH MEDICAID AND SCHIP.—

15 (1) SCHIP.—Section 505(a)(5)(F) (42 U.S.C.

16 705(a)(5)(F)) is amended—

17 (A) in clause (ii), by inserting ‘‘and in the

18 coordination of the administration of the State

19 program under title XXI with the care and

20 services available under this title, as required

21 under subsections (b)(3)(G) and (c)(2) of sec22 tion 2102’’ before the comma; and

23 (B) in clause (iv), by striking ‘‘and infants

24 who are eligible for medical assistance under

25 subparagraph (A) or (B) of section 1902(l)(1)’’
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1 and inserting ‘‘, infants, and children who are

2 eligible for medical assistance under section

3 1902(l)(1), and children who are eligible for

4 child health assistance under the State program

5 under title XXI’’.

6 (2) CONFORMING AMENDMENTS TO SCHIP.—

7 Section 2102(b)(3) (42 U.S.C. 1397bb(b)(3)), as

8 amended by section 703(b)(2), is amended—

9 (A) by striking ‘‘and’’ at the end of sub10 paragraph (E);

11 (B) by striking the period at the end of

12 subparagraph (F) and inserting ‘‘; and’’; and

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

14 subparagraph:

15 ‘‘(G) that operations and activities under

16 this title are developed and implemented in con17 sultation and coordination with the program op18 erated by the State under title V with respect

19 to outreach and enrollment, benefits and serv20 ices, service delivery standards, public health

21 and social service agency relationships, and

22 quality assurance and data reporting.’’.

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

24 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
196

•S 3077 IS

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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•S 3077 IS

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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•S 3077 IS

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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•S 3077 IS

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-
204

•S 3077 IS

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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•S 3077 IS

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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•S 3077 IS

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)—
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•S 3077 IS

1 ‘‘(A) during a presumptive eligibility pe2 riod; and

3 ‘‘(B) by a entity that is eligible for pay4 ments under the State plan; and

5 ‘‘(2) is included in the care and services covered

6 by the State plan,

7 shall be treated as medical assistance provided by such

8 plan for purposes of clause (4) of the first sentence of

9 section 1905(b).’’.

10 (2) CONFORMING AMENDMENTS.—

11 (A) Section 1902(a)(47) (42 U.S.C.

12 1396a(a)(47)) is amended by inserting before

13 the semicolon at the end the following: ‘‘and

14 provide for making medical assistance available

15 to individuals described in subsection (a) of sec16 tion 1920B during a presumptive eligibility pe17 riod in accordance with such section’’.

18 (B) Section 1903(u)(1)(D)(v) (42 U.S.C.

19 1396b(u)(1)(D)(v)) is amended—

20 (i) by striking ‘‘or for’’ and inserting

21 ‘‘, for’’; and

22 (ii) by inserting before the period the

23 following: ‘‘, or for medical assistance pro24 vided to an individual described in sub25 section (a) of section 1920B during a pre-
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•S 3077 IS

1 sumptive eligibility period under such sec2 tion’’.

3 (c) ENHANCED MATCH.—The first sentence of sec4 tion 1905(b) (42 U.S.C. 1396d(b)) is amended—

5 (1) by striking ‘‘and’’ before ‘‘(3)’’; and

6 (2) by inserting before the period at the end the

7 following: ‘‘, and (4) the Federal medical assistance

8 percentage shall be equal to the enhanced FMAP de9 scribed in section 2105(b) with respect to medical

10 assistance provided to individuals who are eligible

11 for such assistance only on the basis of section

12 1902(a)(10)(A)(ii)(XVIII)’’.

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

14 this section apply to medical assistance for items and serv15 ices furnished on or after October 1, 2000, without regard

16 to whether final regulations to carry out such amendments

17 have been promulgated by such date.

18 TITLE VIII—OTHER PROVISIONS

19 SEC. 801. APPROPRIATIONS FOR RICKY RAY HEMOPHILIA

20 RELIEF FUND.

21 Section 101(e) of the Ricky Ray Hemophilia Relief

22 Fund Act of 1998 (42 U.S.C. 300c–22 note) is amended

23 by adding at the end the following: ‘‘There is appropriated

24 to the Fund $475,000,000 for fiscal year 2001, to remain

25 available until expended.’’.
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1 SEC. 802. INCREASE IN APPROPRIATIONS FOR SPECIAL DI2 ABETES PROGRAMS FOR CHILDREN WITH

3 TYPE I DIABETES AND INDIANS.

4 (a) SPECIAL DIABETES PROGRAMS FOR CHILDREN

5 WITH TYPE I DIABETES.—Section 330B(b) of the Public

6 Health Service Act (42 U.S.C. 254c–2(b)) is amended—

7 (1) by striking ‘‘Notwithstanding’’ and insert8 ing the following:

9 ‘‘(1) TRANSFERRED FUNDS.—Notwith10 standing’’; and

11 (2) by adding at the end the following:

12 ‘‘(2) APPROPRIATIONS.—For the purpose of

13 making grants under this section, there are appro14 priated, out of any money in the Treasury not other15 wise appropriated—

16 ‘‘(A) $70,000,000 for each of fiscal years

17 2001 and 2002 (which shall be combined with

18 amounts transferred under paragraph (1) for

19 each such fiscal years); and

20 ‘‘(B) $100,000,000 for each of fiscal years

21 2003 through 2005.’’.

22 (b) SPECIAL DIABETES PROGRAMS FOR INDIANS.—

23 Section 330C(c) of the Public Health Service Act (42

24 U.S.C. 254c–3(c)) is amended—

25 (1) by striking ‘‘Notwithstanding’’ and insert26 ing the following:
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•S 3077 IS

1 ‘‘(1) TRANSFERRED FUNDS.—Notwith2 standing’’;

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

4 ‘‘(2) APPROPRIATIONS.—For the purpose of

5 making grants under this section, there are appro6 priated, out of any money in the Treasury not other7 wise appropriated—

8 ‘‘(A) $70,000,000 for each of fiscal years

9 2001 and 2002 (which shall be combined with

10 amounts transferred under paragraph (1) for

11 each such fiscal years); and

12 ‘‘(B) $100,000,000 for each of fiscal years

13 2003 through 2005.’’.

14 SEC. 803. DEMONSTRATION GRANTS TO IMPROVE OUT15 REACH, ENROLLMENT, AND COORDINATION

16 OF PROGRAMS AND SERVICES TO HOMELESS

17 INDIVIDUALS AND FAMILIES.

18 (a) AUTHORITY.—The Secretary of Health and

19 Human Services may award demonstration grants to not

20 more than 7 States (or other qualified entities) to conduct

21 innovative programs that are designed to improve out22 reach to homeless individuals and families under the pro23 grams described in subsection (b) with respect to enroll24 ment of such individuals and families under such pro-
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1 grams and the provision of services (and coordinating the

2 provision of such services) under such programs.

3 (b) PROGRAMS FOR HOMELESS DESCRIBED.—The

4 programs described in this subsection are as follows:

5 (1) MEDICAID.—The program under title XIX

6 of the Social Security Act (42 U.S.C. 1396 et seq.).

7 (2) SCHIP.—The program under title XXI of

8 such Act (42 U.S.C. 1397aa et seq.).

9 (3) TANF.—The program under part A of title

10 IV of such Act (42 U.S.C. 601 et seq.).

11 (4) MATERNAL AND CHILD HEALTH BLOCK

12 GRANTS.—The program under title V of the Social

13 Security Act (42 U.S.C. 701 et seq.).

14 (5) MENTAL HEALTH AND SUBSTANCE ABUSE

15 BLOCK GRANTS.—The program under part B of title

16 XIX of the Public Health Service Act (42 U.S.C.

17 300x–1 et seq.).

18 (6) HIV/AIDS CARE GRANTS.—The program

19 under part B of title XXVI of the Public Health

20 Service Act (42 U.S.C. 300ff–21 et seq.).

21 (7) FOOD STAMP PROGRAM.—The program

22 under the Food Stamp Act of 1977 (7 U.S.C. 2011

23 et seq.).
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1 (8) WORKFORCE INVESTMENT ACT.—The pro2 gram under the Workforce Investment Act of 1999

3 (29 U.S.C. 2801 et seq.).

4 (9) WELFARE-TO-WORK.—The welfare-to-work

5 program under section 403(a)(5) of the Social Secu6 rity Act (42 U.S.C. 603(a)(5)).

7 (10) OTHER PROGRAMS.—Other public and pri8 vate benefit programs that serve low-income individ9 uals.

10 (c) APPROPRIATIONS.—For the purposes of carrying

11 out this section, there are appropriated, out of any funds

12 in the Treasury not otherwise appropriated, $10,000,000,

13 to remain available until expended.

14 SEC. 804. PROTECTION OF AN HMO ENROLLEE TO RECEIVE

15 CONTINUING CARE AT A FACILITY SELECTED

16 BY THE ENROLLEE.

17 (a) AMENDMENTS TO THE EMPLOYEE RETIREMENT

18 INCOME SECURITY ACT OF 1974.—

19 (1) IN GENERAL.—Subpart B of part 7 of sub20 title B of title I of the Employee Retirement Income

21 Security Act of 1974 (29 U.S.C. 1185 et seq.) is

22 amended by adding at the end the following new sec23 tion:
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1 ‘‘SEC. 714. ENSURING CHOICE FOR CONTINUING CARE.

2 ‘‘(a) IN GENERAL.—With respect to health insurance

3 coverage provided to participants or beneficiaries through

4 a managed care organization under a group health plan,

5 or through a health insurance issuer providing health in6 surance coverage in connection with a group health plan,

7 such plan or issuer may not deny coverage for services

8 provided to such participant or beneficiary by a continuing

9 care retirement community, skilled nursing facility, or

10 other qualified facility in which the participant or bene11 ficiary resided prior to a hospitalization, regardless of

12 whether such organization is under contract with such

13 community or facility if the requirements described in sub14 section (b) are met.

15 ‘‘(b) REQUIREMENTS.—The requirements of this sub16 section are that—

17 ‘‘(1) the service involved is a service for which

18 the managed care organization involved would be re19 quired to provide or pay for under its contract with

20 the participant or beneficiary if the continuing care

21 retirement community, skilled nursing facility, or

22 other qualified facility were under contract with the

23 organization;

24 ‘‘(2) the participant or beneficiary involved—

25 ‘‘(A) resided in the continuing care retire26 ment community, skilled nursing facility, or
214

•S 3077 IS

1 other qualified facility prior to being hospital2 ized;

3 ‘‘(B) had a contractual or other right to

4 return to the facility after hospitalization; and

5 ‘‘(C) elects to return to the facility after

6 hospitalization, whether or not the residence of

7 the participant or beneficiary after returning

8 from the hospital is the same part of the facility

9 in which the beneficiary resided prior to hos10 pitalization;

11 ‘‘(3) the continuing care retirement community,

12 skilled nursing facility, or other qualified facility has

13 the capacity to provide the services the participant

14 or beneficiary needs; and

15 ‘‘(4) the continuing care retirement community,

16 skilled nursing facility, or other qualified facility is

17 willing to accept substantially similar payment under

18 the same terms and conditions that apply to simi19 larly situated health care facility providers under

20 contract with the organization involved.

21 ‘‘(c) SERVICES TO PREVENT HOSPITALIZATION.—A

22 group health plan or health insurance issuer to which this

23 section applies may not deny payment for a skilled nursing

24 service provided to a participant or beneficiary by a con25 tinuing care retirement community, skilled nursing facil-
215

•S 3077 IS

1 ity, or other qualified facility in which the participant or

2 beneficiary resides, without a preceding hospital stay, re3 gardless of whether the organization is under contract

4 with such community or facility, if—

5 ‘‘(1) the plan or issuer has determined that the

6 service is necessary to prevent the hospitalization of

7 the participant or beneficiary; and

8 ‘‘(2) the service to prevent hospitalization is

9 provided as an additional benefit as described in sec10 tion 417.594 of title 42, Code of Federal Regula11 tions, and would otherwise be covered as provided

12 for in subsection (b)(1).

13 ‘‘(d) RIGHTS OF SPOUSES.—A group health plan or

14 health insurance issuer to which this section applies shall

15 not deny payment for services provided by a skilled nurs16 ing facility for the care of a participant or beneficiary, re17 gardless of whether the plan or issuer is under contract

18 with such facility, if the spouse of the participant or bene19 ficiary is already a resident of such facility and the re20 quirements described in subsection (b) are met.

21 ‘‘(e) EXCEPTIONS.—Subsection (a) shall not apply—

22 ‘‘(1) where the attending acute care provider

23 and the participant or beneficiary (or a designated

24 representative of the participant or beneficiary where

25 the participant or beneficiary is physically or men-
216

•S 3077 IS

1 tally incapable of making an election under this

2 paragraph) do not elect to pursue a course of treat3 ment necessitating continuing care; or

4 ‘‘(2) unless the community or facility involved—

5 ‘‘(A) meets all applicable licensing and cer6 tification requirements of the State in which it

7 is located; and

8 ‘‘(B) agrees to reimbursement for the care

9 of the participant or beneficiary at a rate simi10 lar to the rate negotiated by the managed care

11 organization with similar providers of care for

12 similar services.

13 ‘‘(f) PROHIBITIONS.—A group health plan and a

14 health insurance issuer providing health insurance cov15 erage in connection with a group health plan may not—

16 ‘‘(1) deny to an individual eligibility, or contin17 ued eligibility, to enroll or to renew coverage with a

18 managed care organization under the plan, solely for

19 the purpose of avoiding the requirements of this sec20 tion;

21 ‘‘(2) provide monetary payments or rebates to

22 enrollees to encourage such enrollees to accept less

23 than the minimum protections available under this

24 section;
217

•S 3077 IS

1 ‘‘(3) penalize or otherwise reduce or limit the

2 reimbursement of an attending physician because

3 such physician provided care to a participant or ben4 eficiary in accordance with this section; or

5 ‘‘(4) provide incentives (monetary or otherwise)

6 to an attending physician to induce such physician

7 to provide care to a participant or beneficiary in a

8 manner inconsistent with this section.

9 ‘‘(g) RULES OF CONSTRUCTION.—

10 ‘‘(1) HMO NOT OFFERING BENEFITS.—This

11 section shall not apply with respect to any managed

12 care organization under a group health plan, or

13 through a health insurance issuer providing health

14 insurance coverage in connection with a group health

15 plan, that does not provide benefits for stays in a

16 continuing care retirement community, skilled nurs17 ing facility, or other qualified facility.

18 ‘‘(2) COST-SHARING.—Nothing in this section

19 shall be construed as preventing a managed care or20 ganization under a group health plan, or through a

21 health insurance issuer providing health insurance

22 coverage in connection with a group health plan,

23 from imposing deductibles, coinsurance, or other

24 cost-sharing in relation to benefits for care in a con25 tinuing care facility.
218

•S 3077 IS

1 ‘‘(h) PREEMPTION; EXCEPTION FOR HEALTH INSUR2 ANCE COVERAGE IN CERTAIN STATES.—

3 ‘‘(1) IN GENERAL.—The requirements of this

4 section shall not apply with respect to health insur5 ance coverage to the extent that a State law (as de6 fined in section 2723(d)(1) of the Public Health

7 Service Act) applies to such coverage and is de8 scribed in any of the following subparagraphs:

9 ‘‘(A) Such State law requires such cov10 erage to provide for referral to a continuing

11 care retirement community, skilled nursing fa12 cility, or other qualified facility in a manner

13 that is more protective of participants or bene14 ficiaries than the provisions of this section.

15 ‘‘(B) Such State law expands the range of

16 services or facilities covered under this section

17 and is otherwise more protective of the rights of

18 participants or beneficiaries than the provisions

19 of this section.

20 ‘‘(2) CONSTRUCTION.—Section 731(a)(1) shall

21 not be construed to provide that any requirement of

22 this section applies with respect to health insurance

23 coverage, to the extent that a State law described in

24 paragraph (1) applies to such coverage.
219

•S 3077 IS

1 ‘‘(i) PENALTIES.—A participant or beneficiary may

2 enforce the provisions of this section in an appropriate

3 Federal district court. An action for injunctive relief or

4 damages may be commenced on behalf of the participant

5 or beneficiary by the participant’s or beneficiary’s legal

6 representative. The court may award reasonable attorneys’

7 fees to the prevailing party. If a beneficiary dies before

8 conclusion of an action under this section, the action may

9 be maintained by a representative of the participant’s or

10 beneficiary’s estate.

11 ‘‘(j) DEFINITIONS.—In this section:

12 ‘‘(1) ATTENDING ACUTE CARE PROVIDER.—The

13 term ‘attending acute care provider’ means anyone

14 licensed or certified under State law to provide

15 health care services who is operating within the

16 scope of such license and who is primarily respon17 sible for the care of the enrollee.

18 ‘‘(2) CONTINUING CARE RETIREMENT COMMU19 NITY.—The term ‘continuing care retirement com20 munity’ means an organization that provides or ar21 ranges for the provision of housing and health-re22 lated services to an older person under an agreement

23 effective for the life of the person or for a specified

24 period greater than 1 year.
220

•S 3077 IS

1 ‘‘(3) MANAGED CARE ORGANIZATION.—The

2 term ‘managed care organization’ means an organi3 zation that provides comprehensive health services to

4 participants or beneficiaries, directly or under con5 tract or other agreement, on a prepayment basis to

6 such individuals. For purposes of this section, the

7 following shall be considered as managed care orga8 nizations:

9 ‘‘(A) A Medicare+Choice plan authorized

10 under section 1851(a) of the Social Security

11 Act (42 U.S.C. 1395w–21(a)).

12 ‘‘(B) Any other entity that manages the

13 cost, utilization, and delivery of health care

14 through the use of predetermined periodic pay15 ments to health care providers employed by or

16 under contract or other agreement, directly or

17 indirectly, with the entity.

18 ‘‘(4) OTHER QUALIFIED FACILITY.—The term

19 ‘other qualified facility’ means any facility that can

20 provide the services required by the participant or

21 beneficiary consistent with State and Federal law.

22 ‘‘(5) SKILLED NURSING FACILITY.—The term

23 ‘skilled nursing facility’ means a facility that meets

24 the requirements of section 1819 of the Social Secu25 rity Act (42 U.S.C. 1395i–3).’’.
221

•S 3077 IS

1 (2) CLERICAL AMENDMENT.—The table of con2 tents in section 1 of the Employee Retirement In3 come Security Act of 1974 is amended by inserting

4 after the items relating to subpart B of part 7 of

5 subtitle B of title I the following new item:

‘‘Sec. 714. Ensuring choice for continuing care.’’.

6 (3) EFFECTIVE DATE.—The amendments made

7 by this section shall apply with respect to plan years

8 beginning on or after January 1, 2001.

9 (b) AMENDMENT TO THE PUBLIC HEALTH SERVICE

10 ACT RELATING TO THE GROUP MARKET.—

11 (1) IN GENERAL.—Subpart 2 of part A of title

12 XXVII of the Public Health Service Act (42 U.S.C.

13 300gg–4 et seq.) is amended by adding at the end

14 the following new section:

15 ‘‘SEC. 2707. ENSURING CHOICE FOR CONTINUING CARE.

16 ‘‘(a) IN GENERAL.—With respect to health insurance

17 coverage provided to enrollees through a managed care or18 ganization under a group health plan, or through a health

19 insurance issuer providing health insurance coverage in

20 connection with a group health plan, such plan or issuer

21 may not deny coverage for services provided to such en22 rollee by a continuing care retirement community, skilled

23 nursing facility, or other qualified facility in which the en24 rollee resided prior to a hospitalization, regardless of

25 whether such organization is under contract with such
222

•S 3077 IS

1 community or facility if the requirements described in sub2 section (b) are met.

3 ‘‘(b) REQUIREMENTS.—The requirements of this sub4 section are that—

5 ‘‘(1) the service involved is a service for which

6 the managed care organization involved would be re7 quired to provide or pay for under its contract with

8 the enrollee if the continuing care retirement com9 munity, skilled nursing facility, or other qualified fa10 cility were under contract with the organization;

11 ‘‘(2) the enrollee involved—

12 ‘‘(A) resided in the continuing care retire13 ment community, skilled nursing facility, or

14 other qualified facility prior to being hospital15 ized;

16 ‘‘(B) had a contractual or other right to

17 return to the facility after hospitalization; and

18 ‘‘(C) elects to return to the facility after

19 hospitalization, whether or not the residence of

20 the enrollee after returning from the hospital is

21 the same part of the facility in which the bene22 ficiary resided prior to hospitalization;

23 ‘‘(3) the continuing care retirement community,

24 skilled nursing facility, or other qualified facility has
223

•S 3077 IS

1 the capacity to provide the services the enrollee

2 needs; and

3 ‘‘(4) the continuing care retirement community,

4 skilled nursing facility, or other qualified facility is

5 willing to accept substantially similar payment under

6 the same terms and conditions that apply to simi7 larly situated health care facility providers under

8 contract with the organization involved.

9 ‘‘(c) SERVICES TO PREVENT HOSPITALIZATION.—A

10 group health plan or health insurance issuer to which this

11 section applies may not deny payment for a skilled nursing

12 service provided to an enrollee by a continuing care retire13 ment community, skilled nursing facility, or other quali14 fied facility in which the enrollee resides, without a pre15 ceding hospital stay, regardless of whether the plan or

16 issuer is under contract with such community or facility,

17 if—

18 ‘‘(1) the plan or issuer has determined that the

19 service is necessary to prevent the hospitalization of

20 the enrollee; and

21 ‘‘(2) the service to prevent hospitalization is

22 provided as an additional benefit as described in sec23 tion 417.594 of title 42, Code of Federal Regula24 tions, and would be covered as provided for in sub25 section (b)(1).
224

•S 3077 IS

1 ‘‘(d) RIGHTS OF SPOUSES.—A group health plan or

2 health insurance issuer to which this section applies shall

3 not deny payment for services provided by a skilled nurs4 ing facility for the care of an enrollee, regardless of wheth5 er the plan or issuer is under contract with such facility,

6 if the spouse of the enrollee is already a resident of such

7 facility and the requirements described in subsection (b)

8 are met.

9 ‘‘(e) EXCEPTIONS.—Subsection (a) shall not apply—

10 ‘‘(1) where the attending acute care provider

11 and the enrollee (or a designated representative of

12 the enrollee where the enrollee is physically or men13 tally incapable of making an election under this

14 paragraph) do not elect to pursue a course of treat15 ment necessitating continuing care; or

16 ‘‘(2) unless the community or facility involved—

17 ‘‘(A) meets all applicable licensing and cer18 tification requirements of the State in which it

19 is located; and

20 ‘‘(B) agrees to reimbursement for the care

21 of the enrollee at a rate similar to the rate ne22 gotiated by the managed care organization with

23 similar providers of care for similar services.
225

•S 3077 IS

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
226

•S 3077 IS

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
227

•S 3077 IS

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
228

•S 3077 IS

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.
229

•S 3077 IS

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-
230

•S 3077 IS

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
231

•S 3077 IS

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—
232

•S 3077 IS

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
233

•S 3077 IS

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-
234

•S 3077 IS

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
235

•S 3077 IS

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 month’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.
236

•S 3077 IS

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-
237

•S 3077 IS

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.
238

•S 3077 IS

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