I

106TH CONGRESS

1ST SESSION H. R. 141

To amend title XVIII of the Social Security Act to prevent sudden disruption

of Medicare beneficiary enrollment in Medicare+Choice plans.

IN THE HOUSE OF REPRESENTATIVES

JANUARY 6, 1999

Mr. GEJDENSON (for himself, Ms. DELAURO, Mr. SANDLIN, Mrs. CAPPS, Mr.

BALDACCI, Ms. KILPATRICK, Mr. FILNER, and Mr. HINCHEY) 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 prevent

sudden disruption of Medicare beneficiary enrollment in

Medicare+Choice plans.

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

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Medicare HMO Im5 provement Act of 1999’’.
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1 SEC. 2. EXTENSION OF INITIAL MEDICARE+CHOICE CON2 TRACT PERIOD TO 3 YEARS.

3 (a) IN GENERAL.—Section 1857(c)(1) of the Social

4 Security Act (42 U.S.C. 1395w–27(c)(1)) is amended—

5 (1) by striking ‘‘a term of at least 1 year’’ and

6 inserting ‘‘an initial term of at least 3 years’’; and

7 (2) by striking ‘‘from term to term’’ and insert8 ing ‘‘for additional 1-year periods thereafter’’.

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

10 subsection (a) apply to contracts entered into on or after

11 the date of the enactment of this Act.

12 SEC. 3. AUTHORITY TO DELAY TERMINATION.

13 Section 1851(g)(3) of the Social Security Act (42

14 U.S.C. 1395w–21(g)(3)) is amended by adding at the end

15 the following new subparagraph:

16 ‘‘(E) AUTHORITY TO DELAY EFFECTIVE17 NESS OF A TERMINATION.—

18 (i) IN GENERAL.—If a

19 Medicare+Choice organization terminates

20 a plan under subparagraph (B)(iii), the

21 Secretary may delay the effectiveness of

22 such termination for up to 1 year if the

23 Secretary finds that—

24 ‘‘(I) the termination would cause

25 an imminent and serious risk to
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1 health to individuals enrolled under

2 the plan under this part;

3 ‘‘(II) the termination would re4 sult in a significant reduction in the

5 Medicare+Choice plans that are avail6 able in the area affected by the termi7 nation; or

8 ‘‘(III) the chief executive officer

9 of the State in which the termination

10 occurs requests such a delay.

11 ‘‘(ii) END OF DELAY.—The Secretary

12 may end a delay under clause (i), before

13 the end of the 1-year period, if the Sec14 retary finds that an adequate provider net15 work has been established which will pro16 vide at least an equal level of insurance

17 coverage as existed on the date the

18 Medicare+Choice organization informed its

19 enrollees of its intention to terminate the

20 plan.’’.
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1 SEC. 4. RESTRICTION ON TERMINATION OF

2 MEDICARE+CHOICE PLANS IN SELECTED

3 AREAS WITHIN A METROPOLITAN STATIS4 TICAL AREA.

5 (a) IN GENERAL.—Section 1857(c) of the Social Se6 curity Act (42 U.S.C. 1395w–27(c)) is amended by redes7 ignating paragraph (5) as paragraph (6) and by inserting

8 after paragraph (4) the following new paragraph:

9 ‘‘(5) LIMITATION ON SELECTIVE TERMINATION

10 OF CONTRACTS.—

11 ‘‘(A) IN GENERAL.—Except as provided in

12 subparagraph (B), if a Medicare+Choice orga13 nization offers a Medicare+Choice plan that

14 provides coverage in a metropolitan statistical

15 area (or a New England County Metropolitan

16 Area) in a State and terminates such coverage

17 for any part of such area (or Area) in the

18 State, the Secretary shall terminate any con19 tract with the organization for coverage of any

20 part of that area (or Area) in that State.

21 ‘‘(B) EXCEPTION.—The Secretary may

22 waive the requirement of subparagraph (A) if

23 the Secretary finds that terminating contracts

24 for coverage in all parts of a metropolitan sta25 tistical area (or New England County Metro26 politan Area) in the State would pose an immi-
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1 nent and serious risk to the health of individ2 uals enrolled with the organization under this

3 part in the area (or Area).’’.

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

5 subsection (a) apply to terminations for which notice is

6 provided on or after the date of the enactment of this Act.

7 SEC. 5. CONTINUITY OF CARE IN CASE OF INVOLUNTARY

8 TERMINATION.

9 (a) IN GENERAL.—Section 1852(d) of the Social Se10 curity Act (42 U.S.C. 1395w–22(d)) is amended by adding

11 at the end the following new paragraph:

12 ‘‘(5) CONTINUITY OF CARE.—

13 ‘‘(A) IN GENERAL.—If—

14 ‘‘(i) an individual’s enrollment with a

15 Medicare+Choice plan offered by a

16 Medicare+Choice organization under this

17 part is terminated by the organization

18 (other than for cause with respect to that

19 individual), and

20 ‘‘(ii) on the effective date of such ter21 mination of enrollment the individual is in

22 a course of treatment for which coverage is

23 available under the plan and the individual

24 is not at that time covered under another

25 Medicare+Choice plan,
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1 notwithstanding such termination the organiza2 tion shall continue to provide coverage for the

3 covered course of treatment for a period of 90

4 days after such effective date.

5 ‘‘(B) PERMISSIBLE TERMS AND CONDI6 TIONS.—The coverage provided under subpara7 graph (A) shall be under the same terms and

8 conditions (including applicable policies, proce9 dures, and quality assurance standards) as ex10 isted on the date before the effective date of the

11 termination.

12 ‘‘(C) TERMINATE DEFINED.—In this para13 graph, the term ‘terminate’ includes the termi14 nation of a Medicare+Choice plan as a result

15 of the expiration or nonrenewal of a contract by

16 the organization under this part.

17 ‘‘(D) CONSTRUCTION.—Nothing in this

18 paragraph shall be construed to require the cov19 erage of benefits which would not have been

20 covered on the effective date of the termination

21 involved.’’.

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

23 subsection (a) shall apply to contracts entered into or re24 newed on or after the date of the enactment of this Act.

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