II

106TH CONGRESS

1ST SESSION S. 915

To amend title XVIII of the Social Security Act to expand and make permanent the medicare subvention demonstration project for military retirees

and dependents.

IN THE SENATE OF THE UNITED STATES

APRIL 29, 1999

Mr. GRAMM (for himself, Mrs. HUTCHISON, Mr. MACK, and Mr. COVERDELL)

introduced the following bill; which was read twice and referred to the

Committee on Finance

A BILL

To amend title XVIII of the Social Security Act to expand

and make permanent the medicare subvention demonstration project for military retirees and dependents.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. MEDICARE SUBVENTION FOR MILITARY RETIR4 EES AND DEPENDENTS.

5 (a) EXPANSION OF SITES.—

6 (1) EXPANSION TO 16 SITES.—Effective Janu7 ary 1, 2000, subsection (b)(2) of section 1896 of the

8 Social Security Act (42 U.S.C. 1395ggg) is amended

9 by striking ‘‘6’’ and inserting ‘‘16’’.
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1 (2) FUTURE REPEAL OF LIMITATION ON NUM2 BER OF SITES.—Effective October 1, 2002, para3 graph (2) of section 1896(b) of such Act is amended

4 to read as follows:

5 ‘‘(2) LOCATION OF SITES.—

6 ‘‘(A) IN GENERAL.—Subject to subpara7 graph (B), the program shall be conducted in

8 any site designated jointly by the administering

9 Secretaries.

10 ‘‘(B) FEE-FOR-SERVICE.—If feasible, at

11 least 1 of the sites designated under subpara12 graph (A) shall be conducted using the fee-for13 service reimbursement method described in sub14 section (l).’’.

15 (b) MAKING PROJECT PERMANENT; CHANGES IN

16 PROJECT REFERENCES.—

17 (1) ELIMINATION OF TIME LIMITATION.—Para18 graph (4) of section 1896(b) of such Act is repealed.

19 (2) CONFORMING CHANGES OF REFERENCES TO

20 DEMONSTRATION PROJECT.—Section 1896 of such

21 Act is further amended—

22 (A) in the heading, by striking ‘‘DEM23 ONSTRATION PROJECT’’ and inserting ‘‘PRO24 GRAM’’;
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1 (B) by amending subsection (a)(2) to read

2 as follows:

3 ‘‘(2) PROGRAM.—The term ‘program’ means

4 the program carried out under this section.’’;

5 (C) in the heading to subsection (b), by

6 striking ‘‘DEMONSTRATION PROJECT’’ and in7 serting ‘‘PROGRAM’’;

8 (D) by striking ‘‘demonstration project’’ or

9 ‘‘project’’ each place either appears and insert10 ing ‘‘program’’; and

11 (E) in subsection (k)(2)—

12 (i) in the heading, by striking ‘‘EX13 TENSION AND EXPANSION OF DEMONSTRA14 TION PROJECT’’ and inserting ‘‘PROGRAM’’;

15 and

16 (ii) by striking subparagraphs (A)

17 through (C) and inserting the following:

18 ‘‘(A) whether there is a cost to the health

19 care program under this title in conducting the

20 program under this section; and

21 ‘‘(B) whether the terms and conditions of

22 the program should be modified.’’.

23 (3) REPEAL OF OBSOLETE REPORTING RE24 QUIREMENT.—Paragraph (5) of section 1896(b) of

25 such Act is repealed.
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1 (c) PERMITTING PAYMENT ON A FEE-FOR-SERVICE

2 BASIS.—

3 (1) IN GENERAL.—Section 1896 of the Social

4 Security Act is further amended by adding at the

5 end the following new subsection:

6 ‘‘(l) REIMBURSEMENT ON FEE-FOR-SERVICE BASIS

7 FOR SERVICES PROVIDED TO UNENROLLED INDIVID8 UALS.—Notwithstanding subsection (i), in the case of

9 medicare-eligible military retirees or dependents who are

10 not enrolled in the program under this section, the Sec11 retary may reimburse the Secretary of Defense for medi12 care health care services provided to such retirees or de13 pendents at a military treatment facility under the pro14 gram at a rate that does not exceed the rate of payment

15 that would otherwise be made under this title for such

16 services if sections 1814(c) and 1835(d), and paragraphs

17 (2) and (3) of section 1862(a), did not apply.’’.

18 (2) CONFORMING AMENDMENTS.—Such section

19 is further amended—

20 (A) in subsections (b)(1)(B)(v) and

21 (b)(1)(B)(viii)(I), by inserting ‘‘or subsection

22 (l)’’ after ‘‘subsection (i)’’;

23 (B) in subsection (b)(2), by adding at the

24 end the following: ‘‘If feasible, at least 1 of the

25 sites shall be conducted using the fee-for-service
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1 reimbursement method described in subsection

2 (l).’’;

3 (C) in subsection (d)(1)(A), by inserting

4 ‘‘(insofar as it provides for the enrollment of in5 dividuals and payment on the basis described in

6 subsection (i))’’ before ‘‘shall meet’’;

7 (D) in subsection (d)(1)(A), by inserting

8 ‘‘and the program (insofar as it provides for

9 payment for medicare health care services pro10 vided at a military treatment facility on the

11 basis described in subsection (l)) shall meet all

12 requirements that are applicable to facilities

13 that provide such services under this title’’ after

14 ‘‘medicare payments’’;

15 (E) in subsection (d)(2), by inserting ‘‘, in16 sofar as it provides for the enrollment of indi17 viduals and payment on the basis described in

18 subsection (i),’’ before ‘‘shall comply’’;

19 (F) in subsection (g)(1), by inserting ‘‘, in20 sofar as it provides for the enrollment of indi21 viduals and payment on the basis described in

22 subsection (i),’’ before ‘‘the Secretary of De23 fense’’;

24 (G) in subsection (i)(1), by inserting ‘‘and

25 subsection (l)’’ after ‘‘of this subsection’’;
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1 (H) in subsection (i)(4), by inserting ‘‘and

2 subsection (l)’’ after ‘‘under this subsection’’;

3 and

4 (I) in subsection (j)(2)(B)(ii), by inserting

5 ‘‘or subsection (l)’’ after ‘‘subsection (i)(1)’’.

6 (3) EFFECTIVE DATE.—The amendments made

7 by this subsection take effect on January 1, 2000,

8 and apply to services furnished on or after such

9 date.

10 (d) ELIMINATION OF RESTRICTION ON ELIGI11 BILITY.—Section 1896(b)(1) of such Act is amended by

12 adding at the end the following new subparagraph:

13 ‘‘(C) ELIMINATION OF RESTRICTIVE POL14 ICY.—If the enrollment capacity in the program

15 has been reached at a particular site designated

16 under paragraph (2) and the Secretary there17 fore limits enrollment at the site to medicare18 eligible military retirees and dependents who

19 are enrolled in TRICARE Prime (as defined for

20 purposes of chapter 55 of title 10, United

21 States Code) at the site immediately before at22 taining 65 years of age, participation in the

23 program by a retiree or dependent at such site

24 shall not be restricted based on whether the re25 tiree or dependent has a civilian primary care
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1 manager instead of a military primary care

2 manager.’’.

3 (e) MEDIGAP PROTECTION FOR ENROLLEES.—Sec4 tion 1896 of such Act is further amended by adding at

5 the end the following new subsection:

6 ‘‘(m) MEDIGAP PROTECTION FOR ENROLLEES.—

7 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

8 the provisions of section 1882(s)(3) (other than

9 clauses (i) through (iv) of subparagraph (B)) and

10 1882(s)(4) shall apply to any enrollment (and termi11 nation of enrollment) in the program (for which pay12 ment is made on the basis described in subsection

13 (i)) in the same manner as they apply to enrollment

14 (and termination of enrollment) with a

15 Medicare+Choice organization in a

16 Medicare+Choice plan.

17 ‘‘(2) RULE OF CONSTRUCTION.—In applying

18 paragraph (1)—

19 ‘‘(A) in the case of enrollments occurring before

20 January 1, 2000, any reference in clause (v) or (vi)

21 of section 1882(s)(3)(B) to 12 months is deemed a

22 reference to the period ending on December 31,

23 2000; and

24 ‘‘(B) the notification required under section

25 1882(s)(3)(D) shall be provided in a manner speci-
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1 fied by the Secretary of Defense in consultation with

2 the Director of the Office of Personnel Manage3 ment.’’.

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