II

106TH CONGRESS

2D SESSION S. 2610

To amend title XVIII of the Social Security Act to improve the provision

of items and services provided to medicare beneficiaries residing in rural

areas.

IN THE SENATE OF THE UNITED STATES

MAY 23, 2000

Mr. HARKIN (for himself, Mr. THOMAS, Mr. CRAIG, and Mr. FEINGOLD) 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 improve

the provision of items and services provided to medicare

beneficiaries residing in rural areas.

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 Fairness in

5 Reimbursement Act of 2000’’.
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1 SEC. 2. IMPROVING FAIRNESS OF PAYMENTS UNDER THE

2 MEDICARE FEE-FOR-SERVICE PROGRAM.

3 (a) Title XVIII of the Social Security Act (42 U.S.C.

4 1395 et seq.) is amended by adding at the end the fol5 lowing new sections:

6 ‘‘IMPROVING FAIRNESS OF PAYMENTS UNDER THE

7 ORIGINAL MEDICARE FEE-FOR-SERVICE PROGRAM

8 ‘‘SEC. 1897. (a) ESTABLISHMENT OF SYSTEM.—Not9 withstanding any other provision of law, the Secretary

10 shall establish a system for making adjustments to the

11 amount of payment made to entities and individuals for

12 items and services provided under the original medicare

13 fee-for-service program under parts A and B.

14 ‘‘(b) SYSTEM REQUIREMENTS.—

15 ‘‘(1) ADJUSTMENTS.—Under the system de16 scribed in subsection (a), the Secretary (beginning in

17 2001) shall make the following adjustments:

18 ‘‘(A) CERTAIN STATES ABOVE NATIONAL

19 AVERAGE.—If a State average per beneficiary

20 amount for a year is greater than 105 percent

21 (or 110 percent in the case of the determination

22 made in 2000) of the national average per ben23 eficiary amount for such year, then the Sec24 retary shall reduce the amount of applicable

25 payments in such a manner as will result (as

26 estimated by the Secretary) in the State aver-
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1 age per beneficiary amount for the subsequent

2 year being at 105 percent (or 110 percent in

3 the case of payments made in 2001) of the na4 tional average per beneficiary amount for such

5 subsequent year.

6 ‘‘(B) CERTAIN STATES BELOW NATIONAL

7 AVERAGE.—If a State average per beneficiary

8 amount for a year is less than 95 percent (or

9 90 percent in the case of the determination

10 made in 2000) of the national average per ben11 eficiary amount for such year, then the Sec12 retary shall increase the amount of applicable

13 payments in such a manner as will result (as

14 estimated by the Secretary) in the State aver15 age per beneficiary amount for the subsequent

16 year being at 95 percent (or 90 percent in the

17 case of payments made in 2001) of the national

18 average per beneficiary amount for such subse19 quent year.

20 ‘‘(2) DETERMINATION OF AVERAGES.—

21 ‘‘(A) STATE AVERAGE PER BENEFICIARY

22 AMOUNT.—Each year (beginning in 2000), the

23 Secretary shall determine a State average per

24 beneficiary amount for each State which shall

25 be equal to the Secretary’s estimate of the aver-
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1 age amount of expenditures under the original

2 medicare fee-for-service program under parts A

3 and B for the year for a beneficiary enrolled

4 under such parts that resides in the State

5 ‘‘(B) NATIONAL AVERAGE PER BENE6 FICIARY AMOUNT.—Each year (beginning in

7 2000), the Secretary shall determine the na8 tional average per beneficiary amount which

9 shall be equal to the average of the State aver10 age per beneficiary amounts determined under

11 subparagraph (B) for the year.

12 ‘‘(3) DEFINITIONS.—In this section:

13 ‘‘(A) APPLICABLE PAYMENTS.—The term

14 ‘applicable payments’ means payments made to

15 entities and individuals for items and services

16 provided under the original medicare fee-for17 service program under parts A and B to bene18 ficiaries enrolled under such parts that reside in

19 the State.

20 ‘‘(B) STATE.—The term ‘State’ has the

21 meaning given such term in section 210(h).

22 ‘‘(c) BENEFICIARIES HELD HARMLESS.—The provi23 sions of this section shall not effect—
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1 ‘‘(1) the entitlement to items and services of a

2 beneficiary under this title, including the scope of

3 such items and services; or

4 ‘‘(2) any liability of the beneficiary with respect

5 to such items and services.

6 ‘‘(d) REGULATIONS.—

7 ‘‘(1) IN GENERAL.—The Secretary, in consulta8 tion with the Medicare Payment Advisory Commis9 sion, shall promulgate regulations to carry out this

10 section.

11 ‘‘(2) PROTECTING RURAL COMMUNITIES.—In

12 promulgating the regulations pursuant to paragraph

13 (1), the Secretary shall give special consideration to

14 rural areas.

15 ‘‘(e) BUDGET NEUTRALITY.—The Secretary shall en16 sure that the provisions contained in this section do not

17 cause the estimated amount of expenditures under this

18 title for a year to increase or decrease from the estimated

19 amount of expenditures under this title that would have

20 been made in such year if this section had not been en21 acted.

22 ‘‘IMPROVEMENTS IN COLLECTION AND USE OF HOSPITAL

23 WAGE DATA

24 ‘‘SEC. 1898. (a) COLLECTION OF DATA.—

25 ‘‘(1) IN GENERAL.—The Secretary shall estab26 lish procedures for improving the methods used by
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1 the Secretary to collect data on employee compensa2 tion and paid hours of employment for hospital em3 ployees by occupational category.

4 ‘‘(2) TIMEFRAME.—The Secretary shall imple5 ment the procedures described in paragraph (1) by

6 not later than 180 days after the date of enactment

7 of the Rural Health Protection and Improvement

8 Act of 2000.

9 ‘‘(b) ADJUSTMENT TO HOSPITAL WAGE LEVEL.—By

10 not later than 1 year after the date of enactment of the

11 Rural Health Protection and Improvement Act of 2000,

12 the Secretary shall make necessary revisions to the meth13 ods used to adjust payments to hospitals for different area

14 wage levels under section 1886(d)(3)(E) to ensure that

15 such methods take into account the data described in sub16 section (a)(1).

17 ‘‘(c) LIMITATION.—To the extent possible, in making

18 the revisions described in subsection (b), the Secretary

19 shall ensure that current rules regarding which hospital

20 employees are included in, or excluded from, the deter21 mination of the hospital wage levels are not effected by

22 such revisions.

23 ‘‘(d) BUDGET NEUTRALITY.—The Secretary shall en24 sure that any revisions made under subsection (b) do not

25 cause the estimated amount of expenditures under this
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1 title for a year to increase or decrease from the estimated

2 amount of expenditures under this title that would have

3 been made in such year if the Secretary had not made

4 such revisions.’’.

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