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106TH CONGRESS

1ST SESSION H. R. 1413

To amend title XVIII of the Social Security Act to expand and make permanent the Medicare demonstration project for military retirees and dependents.

IN THE HOUSE OF REPRESENTATIVES

APRIL 14, 1999

Mr. HEFLEY (for himself, Mr. ACKERMAN, Mr. BALDACCI, Mr. BARTLETT of

Maryland, Mr. BEREUTER, Mr. BOEHLERT, Mr. BOUCHER, Mr. BRYANT,

Mr. CHAMBLISS, Mr. CLEMENT, Mr. COLLINS, Mr. CONDIT, Mr.

COOKSEY, Mr. DEFAZIO, Ms. DEGETTE, Mr. DEUTSCH, Mr. DIAZBALART, Mr. DICKEY, Mrs. EMERSON, Mr. ENGLISH, Mr. FARR of California, Mr. FILNER, Mr. FRELINGHUYSEN, Mr. FROST, Mr. GALLEGLY,

Mr. GOODLATTE, Mr. GOODLING, Mr. HANSEN, Mr. HILLEARY, Mrs.

KELLY, Mr. LAHOOD, Mr. LUCAS of Oklahoma, Mr. LUTHER, Mr.

MCCOLLUM, Mr. MCGOVERN, Mr. MCHUGH, Mr. MCKEON, Mr.

METCALF, Mr. GARY MILLER of California, Mr. NORWOOD, Mr. OBERSTAR, Mr. OLVER, Mr. PACKARD, Mr. PALLONE, Mr. PASCRELL, Mr. PETERSON of Pennsylvania, Mr. PICKERING, Mr. SAXTON, Mr. SENSENBRENNER, Mr. SHOWS, Mr. SMITH of Washington, Mr. SPRATT, Mr.

TANCREDO, Mr. TANNER, Mr. TAYLOR of North Carolina, Mr. TAYLOR

of Mississippi, Mrs. THURMAN, Mr. TRAFICANT, Mr. UNDERWOOD, Mr.

WAMP, Mr. WATTS of Oklahoma, Mr. WELLER, Mr. WHITFIELD, Ms.

WOOLSEY, Mr. YOUNG of Alaska, Mr. STUPAK, Mr. STUMP, and Mr.

CAPUANO) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Commerce, for a period to be subsequently determined by the Speaker, in

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

A BILL

To amend title XVIII of the Social Security Act to expand
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and make permanent the Medicare 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 PROJECT FOR MILI4 TARY RETIREES 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’’.

10 (2) FUTURE REPEAL OF LIMITATION ON NUM11 BER OF SITES.—Effective October 1, 2002, para12 graph (2) of section 1896(b) of such Act is amended

13 to read as follows:

14 ‘‘(2) LOCATION OF SITES.—The program shall be

15 conducted in any site designated jointly by the admin16 istering Secretaries.’’.

17 (b) MAKING PROJECT PERMANENT; CHANGES IN

18 PROJECT REFERENCES.—

19 (1) ELIMINATION OF TIME LIMITATION.—Para20 graph (4) of section 1896(b) of such Act is repealed.

21 (2) TREATMENT OF CAPS.—Subsection (i)(4) of

22 section 1896 of such Act is amended by adding at

23 the end the following:
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1 ‘‘This paragraph shall not apply after calendar

2 year 2000.’’.

3 (3) CONFORMING CHANGES OF REFERENCES TO

4 DEMONSTRATION PROJECT.—Section 1896 of such

5 Act is further amended—

6 (A) in the heading, by striking ‘‘DEM7 ONSTRATION PROJECT’’ and inserting ‘‘PRO8 GRAM’’;

9 (B) by amending subsection (a)(2) to read

10 as follows:

11 ‘‘(2) PROGRAM.—The term ‘program’ means the pro12 gram carried out under this section.’’;

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

14 striking ‘‘DEMONSTRATION PROJECT’’ and in15 serting ‘‘PROGRAM’’;

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

17 ‘‘project’’ each place either appears and insert18 ing ‘‘program’’;

19 (E) in subsection (k)(2)—

20 (i) by striking ‘‘EXTENSION AND EX21 PANSION OF DEMONSTRATION PROJECT’’

22 and inserting ‘‘PROGRAM’’; and

23 (ii) by striking subparagraphs (A)

24 through (C) and inserting the following:
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1 ‘‘(A) whether there is a cost to the health

2 care program under this title in conducting the

3 program under this section; and

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

5 the program should be modified.’’.

6 (4) ADDITIONAL CONFORMING AMENDMENT.—

7 Paragraph (5) of section 1896(b) of such Act is re8 pealed.

9 (c) PERMITTING PAYMENT ON A FEE-FOR-SERVICE

10 BASIS.—

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

12 Security Act is further amended by adding at the

13 end the following new subsection:

14 ‘‘(l) PAYMENT ON A FEE-FOR-SERVICE BASIS.—In15 stead of the payment method described in subsection (i)(1)

16 and in the case of individuals who are not enrolled in the

17 program in the manner described in subsection (d)(1), the

18 Secretary may reimburse the Secretary of Defense for

19 services provided under the program at a rate that does

20 not exceed the rate of payment that would otherwise be

21 made under this title for such services if sections 1814(c)

22 and 1835(d), and paragraphs (2) and (3) of section

23 1862(a), did not apply.’’.

24 (2) CONFORMING AMENDMENTS.—Such section

25 is further amended—
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1 (A) in subsections (b)(1)(B)(v) and

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

3 (l)’’ after ‘‘subsection (i)’;

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

5 end the following: ‘‘If feasible, at least one of

6 the sites shall be conducted using the fee-for7 service reimbursement method described in sub8 section (l).’’;

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

10 ‘‘(insofar as it provides for the enrollment of in11 dividuals and payment on the basis described in

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

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

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

15 payment for facility services on the basis de16 scribed in subsection (l)) shall meet all require17 ments for such facilities under this title’’ after

18 ‘‘medicare payments’’;

19 (E) in subsection (d)(2), by inserting ‘‘, in20 sofar as it provides for the enrollment of indi21 viduals and payment on the basis described in

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

23 (F) in subsection (g)(1), by inserting ‘‘, in24 sofar as it provides for the enrollment of indi25 viduals and payment on the basis described in
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1 subsection (i),’’ before ‘‘the Secretary of De2 fense’’;

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

4 subsection (l)’’ after ‘‘of this subsection’’;

5 (H) in subsection (i)(4), by inserting ‘‘and

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

7 and

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

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

10 (3) EFFECTIVE DATE.—The amendments made

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

12 and apply to services furnished on or after such

13 date.

14 (d) ELIMINATION OF RESTRICTION ON ELIGI15 BILITY.—Section 1896(b)(1) of such Act is amended by

16 adding at the end the following new subparagraph:

17 ‘‘(C) ELIMINATION OF RESTRICTIVE POL18 ICY.—If the enrollment capacity in the program

19 has been reached at a particular site designated

20 under paragraph (2) and the Secretary there21 fore limits enrollment at the site to medicare22 eligible military retirees and dependents who

23 are enrolled in TRICARE Prime (as defined for

24 purposes of chapter 55 of title 10, United

25 States Code) at the site immediately before at-
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1 taining 65 years of age, participation in the

2 program by a retiree or dependent at such site

3 shall not be restricted based on whether the re4 tiree or dependent has a civilian primary care

5 manager instead of a military primary care

6 manager.’’.

7 (e) MEDIGAP PROTECTION FOR ENROLLEES.—Sec8 tion 1896 of such Act is further amended by adding at

9 the end the following new subsection:

10 ‘‘(m) MEDIGAP PROTECTION FOR ENROLLEES.—(1)

11 Subject to paragraph (2), the provisions of section

12 1882(s)(3) (other than clauses (i) through (iv) of subpara13 graph (B)) and 1882(s)(4) of the Social Security Act shall

14 apply to any enrollment (and termination of enrollment)

15 in the program (for which payment is made on the basis

16 described in subsection (i)) in the same manner as they

17 apply to enrollment (and termination of enrollment) with

18 a Medicare+Choice organization in a Medicare+Choice

19 plan.

20 ‘‘(2) In applying paragraph (1)—

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

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

23 of section 1882(s)(3)(B) of such Act to 12 months

24 is deemed a reference to the period ending on De25 cember 31, 2000; and
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1 ‘‘(B) the notification required under section

2 1882(s)(3)(D) of such Act shall be provided in a

3 manner specified by the Secretary of Defense in con4 sultation with the Director of the Office of Per5 sonnel Management.’’.

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