I
105TH CONGRESS
1ST SESSION
H. R. 2726
To amend title XVIII of the Social Security Act to direct the Secretary
of Health and Human Services to contract with certain hospitals for
the provision of certain surgical procedures and related services under
the Medicare Program.
IN THE HOUSE OF REPRESENTATIVES
OCTOBER 23, 1997
Mr. STARK (for himself and Mr. BECERRA) introduced the following bill;
which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Commerce, for a period to be subsequently de-
termined 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 direct
the Secretary of Health and Human Services to contract
with certain hospitals for the provision of certain surgical
procedures and related services under the Medicare Pro-
gram.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION. 1. PROVISION FOR NEGOTIATED ALL-INCLUSIVE
RATES.
(a) IN GENERAL.—Title XVIII of the Social Security
Act is amended by inserting after section 1888 the follow-
ing:
‘‘NEGOTIATED ALL-INCLUSIVE RATES
‘‘SEC. 1889. (a) IN GENERAL.—The Secretary shall
use a competitive process to contract with specific hos-
pitals or other entities for furnishing services related to
surgical procedures, and for furnishing services (unrelated
to surgical procedures) to hospital inpatients that the Sec-
retary determines to be appropriate. The services may in-
clude any services covered under this title that the Sec-
retary determines to be appropriate, including post-hos-
pital services.
‘‘(b) QUALITY STANDARDS.—Only entities that meet
quality standards established by the Secretary shall be eli-
gible to contract under this section. In considering quality,
the Secretary shall take into account the quality, experi-
ence, and quantity of services of providers who provide
services in more than one entity. Contracting entities shall
implement a quality improvement plan approved by the
Secretary.
‘‘(c) PAYMENT.—Payment under this section shall be
made on the basis of negotiated all-inclusive rates. The
amount of payment made by the Secretary to an entity
under this title for services covered under a contract shall
be less than the aggregate amount of the payments that
the Secretary would have otherwise made for the services.
‘‘(d) CONTRACT PERIOD.—A contract period shall be
3 years (subject to renewal), so long as the entity contin-
ues to meet quality and other contractual standards.
‘‘(e) INCENTIVES FOR USE OF CONTRACTING ENTI-
TIES.—Entities under a contract under this section may
furnish additional services (at no cost to an individual en-
titled to benefits under this title) or waive cost-sharing,
subject to the approval of the Secretary.
‘‘(f) LIMIT ON NUMBER OF CONTRACTING ENTI-
TIES.—The Secretary shall limit the number of contract-
ing entities in a geographic area to the number needed
to meet projected demand for contracted services.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) applies to services furnished on or after Oc-
tober 1, 1997.
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