SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Seniors Health Care
Empowerment Act of 2000’’.
SEC. 2. MEDICARE CONSUMER COALITION DEMONSTRA-
TION PROJECTS.
(a) ESTABLISHMENT OF PROJECTS.—The Secretary
of Health and Human Services (hereinafter in this section
referred to as the ‘‘Secretary’’) shall establish demonstra-
tion projects (hereinafter in this section referred to as the
‘‘projects’’) under which a Medicare Consumer Coalition
(hereinafter in this section referred to as an ‘‘MCC’’) is
formed to carry out the following functions:
(1) To conduct programs to prepare, make
available, and disseminate to Medicare beneficiaries
comprehensive and understandable information (de-
scribed in subsection (f)) with respect to enrollment
in the following:
(A) A Medicare+Choice plan, as defined in
subsection (j)(1).
(B) A medigap plan, as defined in sub-
section (j)(2).
(2) For the purpose of improving benefits and
reducing premiums for members of the MCC, to ne-
gotiate with Medicare+Choice plans and, to the ex-
tent practicable, medigap plans.
(b) MCC DESCRIBED.—For purposes of this section,
an MCC is a legal entity that meets the following require-
ments:
(1) ORGANIZATION AND OPERATION.—The enti-
ty is a nonprofit organization that is—
(A) organized and maintained in good
faith, with a constitution and bylaws specifically
stating its purpose and providing for periodic
meetings on at least an annual basis,
(B) established as a permanent entity
which receives the active support of its mem-
bers and, subject to paragraph (3), collects
from its members on a periodic basis dues or
payments necessary to maintain eligibility for
membership in the sponsor, and
(C) is operated under the direction of a
board of directors the members of which are
Medicare beneficiaries, such board comprised of
a majority of such beneficiaries who live in the
Medicare market area designated under sub-
section (c) in which the MCC carries out its
functions and providers of services.
(2) OPEN MEMBERSHIP.—The entity makes all
Medicare beneficiaries who live in the Medicare mar-
ket area eligible to enroll in the MCC.
(3) FEES.—
(A) IN
GENERAL.—Subject to subpara-
graph (B), the entity may charge Medicare
beneficiaries a nominal enrollment fee, in no
case to exceed $25.
(B) EXCEPTION.—No enrollment fee may
be charged in the case of the following qualified
Medicare beneficiaries:
(i) Individuals described in section
1905(p)(1) of the Social Security Act (42
U.S.C. 1396d(p)(1)) (QMBs).
(ii) Individuals described in section
1902(a)(10)(E)(iii) of such Act (42 U.S.C.
1396a(a)(10)(E)(iii)) (specified low-income
Medicare beneficiaries (SLMBs).
(iii) Individuals described in section
1902(a)(10)(E)(iv) of such Act (42 U.S.C.
1396a(a)(10)(E)(iv)) (qualifying individ-
uals (QIs)).
(4) AUTHORITY TO ENTER INTO CONTRACTS TO
CARRY OUT ADMINISTRATIVE FUNCTIONS.—The en-
tity may enter into contracts with private agencies
or persons to carry out administrative functions of
the entity.
(c) DESIGNATION
OF MEDICARE MARKET AREAS
COVERED BY PROJECTS.—
(1) IN
GENERAL.—The Secretary shall des-
ignate areas in which the project under this section
is conducted as Medicare market areas.
(2) DESIGNATION OF 6 AREAS.—
(A) IN
GENERAL.—The Secretary, con-
sistent with subparagraph (B), shall designate
6 specific areas as Medicare market areas. Such
designations shall be made in a manner so as
to ensure that enrollment under the projects
will begin on January 1, 2002.
(B) MINIMUM AREA.—A Medicare market
area shall be comprised of at least one entire
county or equivalent area (as determined by the
Secretary). In the case of an MCC that serves
more than one State, such equivalent area may
be include areas in two or more contiguous
States.
(d) PROJECT IMPLEMENTATION.—For each Medicare
market area, the Secretary shall—
(1) develop and disseminate a request for pro-
posals for the establishment of MCCs in the 6 des-
ignated Medicare market areas, and
(2) structure the method for selecting a coali-
tion in such area, with a preference for broad par-
ticipation by nonprofit community organizations
with experience representing and providing informa-
tion to Medicare beneficiaries in the area.
(e) MONITORING AND REPORT.—
(1) MONITORING.—The Secretary shall closely
monitor and analyze the impact of the project in the
Medicare market areas on the price and quality of,
and access to, Medicare covered services, choice of
Medicare+Choice plans and medigap plans, changes
in enrollment, and other relevant factors.
(2) REPORT.—Not later than December 31,
2005, the Secretary shall submit to Congress a re-
port on the progress under the project under this
section, including a comparison of the matters mon-
itored under paragraph (1) and subsection (g)(4)
among the different Medicare market areas. The re-
port may include any legislative recommendations
for extending the project to all Medicare bene-
ficiaries.
(f) INFORMATION.—
(1) CONTENTS.—The information described in
subsection (a)(1) shall include at least a comparison
of 
contracts 
and 
policies 
available 
under
Medicare+Choice plans and medigap plans, includ-
ing a comparison of the benefits, quality and per-
formance, costs to enrollees, results of consumer sat-
isfaction surveys on such contracts and policies, and
such additional information as the Secretary may
prescribe.
(2) INFORMATION STANDARDS.—The Secretary
shall develop standards and criteria to ensure that
the information provided to Medicare beneficiaries
under the projects is complete, accurate, and uni-
form.
(3) REVIEW OF INFORMATION.—The Secretary
may prescribe the procedures and conditions under
which an MCC may furnish information to Medicare
beneficiaries. Such information shall be submitted to
the Secretary not later than 45 days before the date
the information is first furnished to such bene-
ficiaries.
(4) CONSULTATION.—
(A) ADVISORY GROUPS.—In order to pro-
vide the information described in subsection
(a)(1), an MCC shall consult with an advisory
group. Each advisory group shall be comprised
of members who are representatives of each of
the persons described in subparagraph (B) who
are located in or offering services in the Medi-
care market area.
(B) PERSONS
DESCRIBED.—The persons
referred to in subparagraph (A) are private in-
surers, managed care plan providers, other
health care providers, and public and private
purchasers of health care benefits.
(C) PROHIBITION
OF
COMPENSATION.—
Members of an advisory group established
under this paragraph may not receive additional
pay, allowances, or benefits by reason of their
service on the advisory group.
(g) GROUP PURCHASING.—
(1) IN GENERAL.—For purposes of carrying out
the objectives described in subsection (a)(2), the
Secretary shall provide authority and establish meth-
ods for an MCC to negotiate with Medicare+Choice
plans and medigap plans to provide coalition mem-
bers with any or all of the following:
(A) Enhanced benefits.
(B) Lower premiums.
(C) Lower cost-sharing.
(2) MULTIYEAR CONTRACTS.—
(A) IN GENERAL.—Contracts entered into
with Medicare+Choice plans and medigap plans
under the projects shall be for periods of not
less than one and not more than three years.
(B) PROVISIONS FOR OPEN ENROLLMENT
AND
DISENROLLMENT.—Any contract entered
into under subparagraph (A) shall include pro-
visions 
for 
annual 
open 
enrollment 
and
disenrollment, and, in the case of disenrollment,
provisions 
for 
reenrollment 
in 
other
Medicare+Choice plans or a medigap plan
under which the Medicare beneficiary was pre-
viously enrolled.
(C) PAYMENT
DIFFERENTIAL.—With re-
spect to different payment rates applicable to
Medicare+Choice plans under part C of title
XVIII of the Social Security Act for plans of-
fered in different regions in a Medicare market
area, an MCC may only enter into contracts
with such plans offered in regions within such
area in which such payments rates are the same
or similar.
(3) NO FINANCIAL UNDERWRITING.—An MCC
shall provide Medicare benefits coverage only
through Medicare+Choice plans and medigap plans,
as appropriate, and shall not assume insurance risk
with respect to such coverage.
(4) MINIMUM COVERAGE.—An MCC may not
contract for health care coverage for members of the
coalition unless that coverage provides, at a min-
imum, the same items and services as what is avail-
able to Medicare beneficiaries enrolled in the fee-for-
service program under parts A and B of title XVIII
of the Social Security Act.
(5) CONTRACTS.—An MCC may enter into con-
tracts with other organizations, including pharmacy
benefit managers, to assist in carrying out the func-
tions described in subsection (a)(2).
(6) OVERSIGHT.—The Secretary may monitor
and approve contracts between an MCC and
Medicare+Choice plans and medigap plans to ensure
compliance with relevant consumer protections and
regulations applicable under title XVIII of the Social
Security Act.
(h) WAIVER AUTHORITY.—The Secretary may waive
such requirements of title XVIII of the Social Security Act
as may be necessary for the purposes of carrying out the
project.
(i) DEFINITIONS.—In this section:
(1) The term ‘‘Medicare+Choice plan’’ means a
Medicare+Choice 
plan 
offered 
by 
a
Medicare+Choice organization under part C of title
XVIII of the Social Security Act (42 U.S.C. 1395w–
21 et seq.).
(2) The term ‘‘medigap plan’’ means a Medi-
care supplemental policy certified by the Secretary
under section 1882 of the Social Security Act (42
U.S.C. 1395ss).
(3) The term ‘‘Medicare beneficiary’’ means an
individual entitled to benefits under parts A, B, or
C of title XVIII of the Social Security Act.
(4) The terms ‘‘Medicare+Choice organization’’
and ‘‘Medicare+Choice plan’’ have the meaning
given those terms under subsections (a)(1) and
(b)(1), respectively, of section 1859 of the Social Se-
curity Act (42 U.S.C. 1395w–29).
(5) The term ‘‘Medicare market area’’ means
an area designated by the Secretary under sub-
section (c) in which an MCC shall carry out its func-
tions under the project.
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