I
106TH CONGRESS
2D SESSION
H. R. 5320
To amend part C of title XVIII of the Social Security Act to revise and
improve the Medicare+Choice Program, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 27, 2000
Mr. KOLBE introduced the following bill; which was referred to the Committee
on Ways and Means, and in addition to the Committee on 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 of the Social Security Act
to revise and improve the Medicare+Choice Program,
and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Medicare+Choice Res-
cue Act of 2000’’.
(b) HOLD HARMLESS FOR ERRORS IN ESTIMATES.—
Section 1853(c)(6) of such Act (42 U.S.C. 1395w–
23(c)(6)) is amended—
(1) in subparagraph (C), by striking ‘‘Begin-
ning with rates’’ and inserting ‘‘Subject to subpara-
graph (D), beginning with rates’’; and
(2) by adding at the end the following new sub-
paragraph:
‘‘(D) HOLD HARMLESS FOR OVER PROJEC-
TIONS.—Beginning with rates calculated for
2002, in making adjustments under subpara-
graph (C), in no case may the Secretary provide
for an adjustment in a year for that results in
a 
reduction 
of 
the 
national 
per 
capita
Medicare+Choice growth percentage that is
greater than 0.5 percent.’’.
SEC. 6. ADDITIONAL FLOOR FOR ANNUAL INCREASE IN
MEDICARE+CHOICE CAPITATION RATES.
Section 1853(c)(3)(C) of the Social Security Act (42
U.S.C. 1395w–23(c)(3)(C)) is amended—
(1) in clause (ii), by inserting ‘‘(before 2002)’’
after ‘‘For a subsequent year’’; and
(2) by adding at the end the following new
clause:
‘‘(iii) For 2002 and each subsequent
year, the greater of (I) 102 percent of the
annual Medicare+Choice capitation rate
under this paragraph for the area for the
previous year, or (II) such rate for the pre-
vious year increased by the national per
capita Medicare+Choice growth percent-
age, described in paragraph (6)(A) for the
succeeding year.’’.
SEC. 7. APPLICATION OF BUDGET NEUTRALITY PRINCIPLE
TO THE NEW MEDICARE+CHOICE RISK AD-
JUSTMENT METHODOLOGY.
(a) IN GENERAL.—Section 1853(a)(3) of the Social
Security Act (42 U.S.C. 1395w–23(a)(3)) is amended by
adding at the end the following new subparagraph:
‘‘(E) IMPLEMENTATION IN A BUDGET NEU-
TRAL
MANNER.—The methodology under this
paragraph shall be designed and implemented
in a manner so that it does not result in any
material change in the aggregate level of ex-
penditures under this title compared to the level
that would have occurred if such methodology
had not been implemented (and if the previous
risk adjustment methodology used in 1998 had
continued to be implemented).’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) takes effect on the date of the enactment
of this Act and applies to payments for months beginning
on or after January 2001.
SEC. 8. PROVIDING FOR CONTINUOUS OPEN ENROLLMENT
AND DISENROLLMENT.
(a) IN GENERAL.—Section 1851(e)(2) of the Social
Security Act (42 U.S.C. 1395w–21(e)(2)) is amended to
read as follows:
‘‘(2) CONTINUOUS
OPEN
ENROLLMENT
AND
DISENROLLMENT.—Subject to paragraph (5), a
Medicare+Choice eligible individual may change the
election under subsection (a)(1) at any time.’’.
(b) CONFORMING AMENDMENTS.—
(1) MEDICARE+CHOICE.—Section 1851(e) of
such Act (42 U.S.C. 1395w–21(e)) is amended—
(A) in paragraph (4)—
(i) by striking ‘‘Effective as of Janu-
ary 1, 2002, an’’ and inserting ‘‘An’’;
(ii) by striking ‘‘other than during an
annual, coordinated election period’’;
(iii) by inserting ‘‘in a special election
period for such purpose’’ after ‘‘make a
new election under this section’’; and
(iv) by striking the second sentence;
and
(B) in paragraphs (5)(B) and (6)(A), by
striking ‘‘the first sentence of’’.
(2) MEDIGAP.—Section 1882(s)(3)(B) of such
Act (42 U.S.C. 1395ss(s)(3)(B)) is amended—
(A) in clause (ii), by striking ‘‘permitting
discontinuance of the individual’s election of the
plan under the first sentence of section
1851(e)(4)’’ and inserting ‘‘providing the indi-
vidual a special election period under section
1851(e)(4)’’; and
(B) in clause (iii), by striking ‘‘permit dis-
continuance of an individual’s election of cov-
erage under the first sentence of section
1851(e)(4)’’ and inserting ‘‘provide the indi-
vidual a special election period under section
1851(e)(4)’’.
(c) EFFECTIVE DATE.—The amendments made by
this section apply with respect to plan years beginning on
or after January 1, 2002.
SEC. 9. ALLOWING VARIATION IN PREMIUMS AND BENE-
FITS WITHIN COUNTIES.
(a) IN GENERAL.—Subsections (c) and (f)(1)(D) of
section 1854 of the Social Security Act (42 U.S.C.
1395w–24) are each amended by inserting before the pe-
riod at the end the following: ‘‘, expect that the Secretary
shall provide for exceptions based on provider catchment
area that may be a geographic area that is smaller than
a county or a catchment area that crosses the boundaries
of two or more counties’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) apply with respect to years beginning on
or after January 1, 2001.
SEC. 10. MODIFYING PHASE-IN OF MEDICARE+CHOICE
RISK-ADJUSTMENT METHODOLOGY FOR IN-
STITUTIONALIZED 
MEDICARE 
BENE-
FICIARIES.
The Secretary of Health and Human Services shall
provide that the risk-adjustment methodology applied
under section 1853(a) of the Social Security Act (42
U.S.C. 1395w–23(a)), insofar as it makes adjustments to
capitation rates for health status, shall only apply to 10
percent of 1⁄12 of the annual Medicare+Choice capitation
rate in the case of an eligible individual who is institu-
tionalized 
(as 
defined 
for 
purposes 
of 
section
1851(e)(2)(D) 
of 
such 
Act 
(42 
U.S.C. 
1395w–
21(e)(2)(D))) until the first year in which the Secretary
implements a modification of such methodology based on
health status so that such methodology includes medical
diagnostic factors from all provider settings (including
hospital and nursing facility settings).
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