I

107TH CONGRESS

1ST SESSION H. R. 2127

To amend part C of title XVIII to require Medicare+Choice organizations

to offer Medicare+Choice plans for a minimum period of three years,

and to permit Medicare beneficiaries to enroll and disenroll from such

plans at any time.

IN THE HOUSE OF REPRESENTATIVES

JUNE 12, 2001

Mr. BROWN of Ohio (for himself, Mr. STARK, Mr. LATOURETTE, Mr. GONZALEZ, Mr. KILDEE, and Mr. BRADY of Pennsylvania) introduced the following bill; which was referred to the Committee on Ways and Means,

and in addition to the Committee on Energy and 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 part C of title XVIII to require Medicare+Choice

organizations to offer Medicare+Choice plans for a minimum period of three years, and to permit Medicare

beneficiaries to enroll and disenroll from such plans at

any time.

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+Choice Ac5 countability Act of 2001’’.
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1 SEC. 2. EXTENSION OF INITIAL MEDICARE+CHOICE CON2 TRACT PERIOD TO 3 YEARS.

3 (a) REQUIREMENT FOR 3-YEAR CONTRACTS.—Sec4 tion 1857(c)(1) of the Social Security Act (42 U.S.C.

5 1395w–27(c)(1)) is amended—

6 (1) by redesignating the matter following the

7 heading as subparagraph (A) and inserting ‘‘IN

8 GENERAL.—’’ after ‘‘(A)’’;

9 (2) in subparagraph (A), as so redesignated—

10 (A) by striking ‘‘a term of at least 1 year’’

11 and inserting ‘‘an initial term of at least 3

12 years’’; and

13 (B) by striking ‘‘from term to term’’ and

14 inserting ‘‘for additional 3-year periods there15 after’’; and

16 (3) by adding at the end the following new sub17 paragraphs:

18 ‘‘(B) LIMITATION ON MODIFICATION OF

19 BENEFITS AND PREMIUMS DURING THE CON20 TRACT PERIOD.—A Medicare+Choice organiza21 tion under a contract with the Secretary under

22 this section may not modify premiums and ben23 efits under the Medicare+Choice plan offered

24 by the organization for the duration of that

25 contract unless the Secretary determines that
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1 such modifications would increase the value of

2 the coverage under the plan.

3 ‘‘(C) PROHIBITION ON WITHDRAWING

4 FROMPARTS OF A SERVICE AREA.—A

5 Medicare+Choice organization under a contract

6 with the Secretary under this section may not

7 withdraw from any part of the service area in

8 which it offers a Medicare+Choice plan.’’.

9 (b) PAYMENT AMOUNT.—Section 1853(c) of such Act

10 (42 U.S.C. 1395w–23(c)) is amended to read as follows:

11 ‘‘(c) CALCULATION OF ANNUAL MEDICARE+CHOICE

12 CAPITATION RATES.—

13 ‘‘(1) ADJUSTED AVERAGE PER CAPITA

14 AMOUNT.—For purposes of this part, subject to

15 paragraph (2), each annual Medicare+Choice capi16 tation rate, for a Medicare+Choice payment area for

17 a contract year consisting of a calendar year, is

18 equal to the Secretary’s estimate of the adjusted av19 erage per capita cost (as determined under section

20 1876(a)(4)) for the payment area and contract year.

21 ‘‘(2) EXCLUSION OF MEDICAL EDUCATION

22 COSTS.—In determining the amounts under para23 graph (1), the Secretary shall not take into account

24 payments attributable to—
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1 ‘‘(A) graduate medical education payments

2 under section 1886(h);

3 ‘‘(B) disproportionate share hospital pay4 ments described in section 1886(d)(5)(F); or

5 ‘‘(C) indirect costs of medical education

6 described in section 1886(d)(5)(B).’’.

7 (c) SERVICE AREAS REQUIREMENTS.—Section 1852

8 of such Act (42 U.S.C. 1395w–22) is amended by adding

9 at the end the following new subsection:

10 ‘‘(m) SERVICE AREAS.—

11 ‘‘(1) DESIGNATION BY SECRETARY.—Taking

12 into account factors such as commercial rating pat13 terns, the Secretary shall designate geographic areas

14 as service areas for purposes of this part. Such areas

15 may be portions of a State or an entire State.

16 ‘‘(2) PROHIBITION ON COUNTIES BEING IN

17 MULTIPLE SERVICE AREAS.—In no case may a coun18 ty or equivalent area, or portion thereof, be included

19 in more than one service area designated by the Sec20 retary under paragraph (1).’’.

21 (d) BENEFITS.—

22 (1) REQUIREMENT FOR UNIFORM BENEFITS

23 FOR ALL ENROLLEES RESIDING IN THE SERVICE

24 AREA.—
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1 (A) IN GENERAL.—Section 1852(a) of

2 such Act (42 U.S.C. 1395w–22(a)) is

3 amended—

4 (i)(I) in paragraph (2)(C), by striking

5 ‘‘may elect to’’ and inserting ‘‘shall’’; and

6 (II) in the heading of such paragraph by

7 striking ‘‘ELECTION OF’’ and inserting ‘‘RE8 QUIREMENT FOR’’; and

9 (ii) by adding at the end the following new

10 paragraph:

11 ‘‘(6) REQUIREMENT FOR UNIFORM BENEFITS

12 IN A SERVICE AREA.—

13 ‘‘(A) IN GENERAL.—Subject to subpara14 graph (B), a Medicare+Choice plan shall pro15 vide the same benefits to all enrollees in a serv16 ice area (designated by the Secretary under

17 subsection (m)).

18 ‘‘(B) ADAPTION BY HEALTH MAINTE19 NANCE ORGANIZATIONS.—In applying subpara20 graph (A) in the case of a plan that is a health

21 maintenance organization, if limitations in pro22 vider contracts prevent the plan from maintain23 ing the provider contracts in certain parts of a

24 service area, the plan may establish a preferred

25 provider network or fee-for-service plan in those
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1 parts of the service area, but only if the cost2 sharing applicable to such a network or plan is

3 not established in a manner that discourages

4 enrollment of residents in those parts of the

5 service area.’’.

6 (B) CONFORMING REPEAL OF AUTHORITY

7 TO USE OF SEGMENTS OF SERVICE AREAS.—

8 Section 1854 of such Act (42 U.S.C. 1395w–

9 24) is amended by striking subsection (h).

10 (2) NO REQUIREMENT FOR SUPPLEMENTAL

11 BENEFITS.—

12 (A) IN GENERAL.—Section 1854(f)) of

13 such Act (42 U.S.C. 1395w–24(f))) is amended

14 by adding at the end the following new para15 graph:

16 ‘‘(5) APPLICATION OF PROVISION.—The provi17 sions of this subsection shall not apply for any year

18 with respect to which a Medicare+Choice organiza19 tion has entered into a 3-year contract with the Sec20 retary under section 1857(c)(1).’’.

21 (B) CONFORMING AMENDMENT.—Section

22 1852(a)(1)(B) of such Act (42 U.S.C. 1395w–

23 22(a)(1)(B)) is amended by inserting before the

24 period the following: ‘‘for any year with respect

25 to which a Medicare+Choice organization has
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1 entered into a 3-year contract with the Sec2 retary under section 1857(c)(1)’’.

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

4 this section shall apply to contracts entered into on or

5 after January 1, 2002.

6 SEC. 3. CONTINUOUS OPEN ENROLLMENT AND

7 DISENROLLMENT.

8 (a) IN GENERAL.—Section 1851(e)(2) of the Social

9 Security Act (42 U.S.C. 1395w–21(e)(2)) is amended to

10 read as follows:

11 ‘‘(2) CONTINUOUS OPEN ENROLLMENT AND

12 DISENROLLMENT.—Subject to paragraph (5), a

13 Medicare+Choice eligible individual may change the

14 election under subsection (a)(1) at any time.’’.

15 (b) CONFORMING AMENDMENTS.—

16 (1) MEDICARE+CHOICE.—Section 1851(e) of

17 such Act (42 U.S.C. 1395w–21(e)) is amended—

18 (A) in paragraph (4)—

19 (i) by striking ‘‘Effective as of Janu20 ary 1, 2002, an’’ and inserting ‘‘An’’;

21 (ii) by striking ‘‘other than during an

22 annual, coordinated election period’’;

23 (iii) by inserting ‘‘in a special election

24 period for such purpose’’ after ‘‘make a

25 new election under this section’’; and
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1 (iv) by striking the second sentence;

2 and

3 (B) in paragraphs (5)(B) and (6)(A), by

4 striking ‘‘the first sentence of’’.

5 (2) PERMITTING REENROLLMENT IN MEDIGAP

6 WHEN M+C PLANS REDUCE BENEFITS.—

7 (A) IN GENERAL.—Clause (ii) of section

8 1882(s)(3)(B) of such Act (42 U.S.C.

9 1395ss(s)(3)(B)) is amended—

10 (i) by striking ‘‘under the first sen11 tence of’’ each place it appears and insert12 ing ‘‘during a special election period pro13 vided for under’’; and

14 (ii) by inserting ‘‘(including a reduc15 tion in benefits offered under a

16 Medicare+Choice plan from year to year)’’

17 after ‘‘section 1851(e)(4)’’.

18 (B) CONFORMING AMENDMENT.—Clause

19 (iii) of such section is amended—

20 (i) by striking ‘‘under the first sen21 tence of’’ and inserting ‘‘during a special

22 election period provided for under’’; and

23 (ii) by inserting ‘‘(including a reduc24 tion in benefits offered under a
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1 Medicare+Choice plan from year to year)’’

2 after ‘‘section 1851(e)(4)’’.

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

4 this section shall apply with respect to plan years begin5 ning on or after January 1, 2002.

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