IV 

House Calendar No. 74

108TH CONGRESS 

1ST SESSION H. RES. 299

[Report No. 108–181] 

Providing for consideration of the bill (H.R. 1) to amend title XVIII of 

the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program, and for other purposes, and for consideration of the 

bill (H.R. 2596) to amend the Internal Revenue Code of 1986 to allow 

a deduction to individuals for amounts contributed to health savings 

security accounts and health savings accounts, to provide for the disposition of unused health benefits in cafeteria plans and flexible spending 

arrangements, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 25, 2003

Ms. PRYCE, from the Committee on Rules, reported the following resolution; 

which was referred to the House Calendar and ordered to be printed 

RESOLUTION

Providing for consideration of the bill (H.R. 1) to amend 

title XVIII of the Social Security Act to provide for 

a voluntary program for prescription drug coverage 

under the Medicare Program, to modernize the Medicare 

Program, and for other purposes, and for consideration 

of the bill (H.R. 2596) to amend the Internal Revenue 

Code of 1986 to allow a deduction to individuals for 

amounts contributed to health savings security accounts 
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and health savings accounts, to provide for the disposition of unused health benefits in cafeteria plans and 

flexible spending arrangements, and for other purposes.

1 Resolved, That upon the adoption of this resolution 

2 it shall be in order without intervention of any point of 

3 order to consider in the House the bill (H.R. 1) to amend 

4 title XVIII of the Social Security Act to provide for a vol5 untary program for prescription drug coverage under the 

6 Medicare Program, to modernize the Medicare Program, 

7 and for other purposes. The bill shall be considered as 

8 read for amendment. The previous question shall be con9 sidered as ordered on the bill and on any amendment 

10 thereto to final passage without intervening motion except: 

11 (1) three hours of debate on the bill equally divided among 

12 and controlled by the chairmen and ranking minority 

13 members of the Committee on Energy and Commerce and 

14 the Committee on Ways and Means; (2) the amendment 

15 printed in the report of the Committee on Rules accom16 panying this resolution, if offered by Representative Ran17 gel of New York or his designee, which shall be in order 

18 without intervention of any point of order, shall be consid19 ered as read, and shall be separately debatable for one 

20 hour equally divided and controlled by the proponent and 

21 an opponent; and (3) one motion to recommit with or 

22 without instructions. 
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1 SEC. 2. Upon the adoption of this resolution it shall 

2 be in order on the legislative day of June 26 or June 27, 

3 2003, without intervention of any point of order to con4 sider in the House the bill (H.R. 2596) to amend the In5 ternal Revenue Code of 1986 to allow a deduction to indi6 viduals for amounts contributed to health savings security 

7 accounts and health savings accounts, to provide for the 

8 disposition of unused health benefits in cafeteria plans and 

9 flexible spending arrangements, and for other purposes. 

10 The bill shall be considered as read for amendment. The 

11 previous question shall be considered as ordered on the 

12 bill to final passage without intervening motion except: (1) 

13 one hour of debate on the bill equally divided and con14 trolled by the chairman and ranking minority member of 

15 the Committee on Ways and Means; and (2) one motion 

16 to recommit. 

17 SEC. 3. (a) In the engrossment of H.R. 1, the Clerk 

18 shall await the disposition of H.R. 2596 under section 2. 

19 (b) If H.R. 2596 is passed by the House, the Clerk 

20 shall—

21 (1) add the text of H.R. 2596 as new matter 

22 at the end of H.R. 1; 

23 (2) conform the title of H.R. 1 to reflect the 

24 addition of the text of H.R. 2596 of the engross25 ment; 
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1 (3) assign appropriate designations to provi2 sions within the engrossment; and 

3 (4) conform provisions for short titles within 

4 the engrossment. 

5 (c) Upon the addition of the text of H.R. 2596 to 

6 the engrossment of H.R. 1, H.R. 2596 shall be laid on 

7 the table. 

8 SEC. 4. During consideration of H.R. 1 and H.R. 

9 2596 pursuant to this resolution, notwithstanding the op10 eration of the previous question, the Chair may postpone 

11 further consideration of either bill to a time designated 

12 by the Speaker. 

13 SEC. 5. Upon the adoption of this resolution it shall 

14 be in order, any rule of House to the contrary notwith15 standing, to consider concurrent resolutions providing for 

16 adjournment of the House and Senate during the month 

17 of July. 

18 SEC. 6. The Committee on Appropriations may have 

19 until midnight on Thursday, July 3, 2003, to file a report 

20 to accompany a bill making appropriations for the Depart21 ment of Defense for the fiscal year ending September 30, 

22 2004, and for the other purposes. 

23 SUMMARY OF AMENDMENT MADE IN ORDER

24 Rangel/Dingell: Amendment in the Nature of a Sub25 stitute. Title I—Medicare Prescription Medicine Benefit. 

26 Adds new Part D in Medicare that provides voluntary 
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1 prescription drug coverage for all Medicare beneficiaries 

2 beginning in 2006. Provides a $25 a month premium, a 

3 $100 a year deductible, a co-insurance of 20/40 (Bene4 ficiaries/Medicare), and a $2,000 out-of-pocket limit per 

5 beneficiary per year. Beneficiaries with incomes between 

6 150 percent of poverty pay no premium or cost sharing. 

7 Beneficiaries with incomes between 150 percent and 175 

8 percent of poverty pay no cost-sharing and receive assist9 ance with the Part D premium on a sliding scale. Medi10 care contractors will obtain guaranteed reductions in 

11 prices, and the Secretary of Health and Human Services 

12 will have the authority to use the collective purchasing 

13 power of Medicare’s 40 million beneficiaries to negotiate 

14 lower drug prices, taking into account prices paid in 

15 other countries and by other payers in the U.S. The Sec16 retary could also implement measures that will further 

17 reduce costs and improve quality for beneficiaries, such 

18 as: encouraging use of generic drugs, lowering co-insur19 ance for preferred drugs, disease management, and bene20 ficiary and provider education. Medicare would also re21 quire contractors to put in place safeguards to check for 

22 adverse drug interactions and proper use of medications. 

23 Title II—Medicare+Choice. Includes a two-year payment 

24 enhancement for Medicare+Choice plans (2004 and 

25 2005) as well as provisions pertaining to specialized plans 
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1 for special needs beneficiaries and the extension of Medi2 care cost-contracts. Title III—Combating Waste, Fraud, 

3 and Abuse. Improves payments for oncology providers to 

4 administer cancer drugs and also directs the Centers for 

5 Medicare and Medicaid Services to pay for drug adminis6 tration services, chemotherapy support services, therapy 

7 management services and related services. Reimburses for 

8 the cost of oncology drugs by not involving a new bu9 reaucracy and middle-man and paying 105 percent of the 

10 average sales price of medicines. Protects beneficiaries 

11 from undue consequences of competitive bidding for dura12 ble medical equipment (DME) by delaying the start of 

13 DME competitive bidding until 2009 and phasing it in 

14 over three years. Title IV—Rural Health Care Improve15 ments. Includes all of the provisions from the Ways and 

16 Means reported bill pertaining to rural providers. In ad17 dition, it: eliminates the 10 percent cap on dispropor18 tionate share hospital payments to rural hospitals; adds 

19 a provision providing up to 25 percent increase in low20 volume adjustment for small hospitals; increases rural 

21 home health payments by 10 percent (rather than 5 per22 cent); allows lab payments on reasonable costs for sole 

23 community hospitals; increases the floors for physician 

24 work in rural areas to 1.0; eliminates the 35-mile rule for 

25 critical access hospital ambulance services; increases the 
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1 ground ambulance payment rate; and increases the crit2 ical access hospital bed limit to 25. Title V—Provisions 

3 Relating to Medicare Part A. Includes all the provisions 

4 from Ways and Means reported bill pertaining to Part A 

5 (hospitals) except it eliminate the 3-year cut in hospital 

6 inpatient reimbursement and adds a boost for indirect 

7 medical education (IME) to 6.5 percent for two years. It 

8 also replaces the MedPac study on specialty hospitals 

9 with the Senate provision that limits physician self-refer10 ral to these facilities. Title VI—Provisions Relating to 

11 Medicare Part B. Includes all of the provisions from the 

12 Ways and Means and Energy and Commerce reported 

13 bills except it does not increase the deductible that sen14 iors must pay in order to receive Part B (primarily physi15 cians) services. Title VII—Provisions Relating to Medi16 care Parts A and B. Includes all of the provisions from 

17 the Ways and Means and Energy and Commerce re18 ported bills except it does not include a co-payment for 

19 home health care and does not continue the cap on pay20 ments for direct graduate medical education for facilities 

21 above 140 percent. Title VIII—Medicaid. Includes 

22 Whitfield-DeGette Medicaid DSH legislation that in23 cludes full restoration of funding for DSH and improve24 ments for low-DSH States. Title IX—Regulatory Reduc25 tion and Contracting Reform. Includes the Energy and 
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1 Commerce reported provision on Medicare contractor and 

2 regulatory reform. Title X—Importation of Prescription 

3 Drugs. Incorporates reimportation amendments adopted 

4 on the Senate Floor on June 19, 2003, which will allow 

5 access to low-cost Canadian Drugs if the Secretary of the 

6 Department of Health and Human Services certifies that 

7 they are safe. Title XI—Access to Affordable Pharma8 ceuticals. Incorporates text of S. 1225 as adopted by the 

9 Senate, which will make lower cost generic drugs avail10 able more quickly. 

House Calendar No. 74

108TH CONGRESS 

1ST SESSION H. RES. 299

[Report No. 108–181] 

RESOLUTION

Providing for consideration of the bill (H.R. 1) to 

amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program, and for other purposes, and for consideration of the bill (H.R. 2596) to amend the Internal Revenue Code of 1986 to allow a deduction to individuals for amounts contributed to health savings security accounts and health savings accounts, to provide for the disposition of unused health benefits in cafeteria plans and flexible spending arrangements, and for other purposes. 

JUNE 25, 2003

Referred to the House Calendar and ordered to be 

printed