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. GON-
ZALEZ, Mr. KILDEE, and Mr. BRADY of Pennsylvania) introduced the fol-
lowing 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 consider-
ation 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 min-
imum period of three years, and to permit Medicare
beneficiaries to enroll and disenroll from such plans at
any time.
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 Ac-
countability Act of 2001’’.
SEC. 2. EXTENSION OF INITIAL MEDICARE+CHOICE CON-
TRACT PERIOD TO 3 YEARS.
(a) REQUIREMENT FOR 3-YEAR CONTRACTS.—Sec-
tion 1857(c)(1) of the Social Security Act (42 U.S.C.
1395w–27(c)(1)) is amended—
(1) by redesignating the matter following the
heading as subparagraph (A) and inserting ‘‘IN
GENERAL.—’’ after ‘‘(A)’’;
(2) in subparagraph (A), as so redesignated—
(A) by striking ‘‘a term of at least 1 year’’
and inserting ‘‘an initial term of at least 3
years’’; and
(B) by striking ‘‘from term to term’’ and
inserting ‘‘for additional 3-year periods there-
after’’; and
(3) by adding at the end the following new sub-
paragraphs:
‘‘(B) LIMITATION
ON
MODIFICATION
OF
BENEFITS AND PREMIUMS DURING THE CON-
TRACT PERIOD.—A Medicare+Choice organiza-
tion under a contract with the Secretary under
this section may not modify premiums and ben-
efits under the Medicare+Choice plan offered
by the organization for the duration of that
contract unless the Secretary determines that
such modifications would increase the value of
the coverage under the plan.
‘‘(C) 
PROHIBITION
ON
WITHDRAWING
FROM
PARTS
OF
A
SERVICE
AREA.—A
Medicare+Choice organization under a contract
with the Secretary under this section may not
withdraw from any part of the service area in
which it offers a Medicare+Choice plan.’’.
(b) PAYMENT AMOUNT.—Section 1853(c) of such Act
(42 U.S.C. 1395w–23(c)) is amended to read as follows:
‘‘(c) CALCULATION OF ANNUAL MEDICARE+CHOICE
CAPITATION RATES.—
‘‘(1) 
ADJUSTED
AVERAGE
PER
CAPITA
AMOUNT.—For purposes of this part, subject to
paragraph (2), each annual Medicare+Choice capi-
tation rate, for a Medicare+Choice payment area for
a contract year consisting of a calendar year, is
equal to the Secretary’s estimate of the adjusted av-
erage per capita cost (as determined under section
1876(a)(4)) for the payment area and contract year.
‘‘(2) EXCLUSION
OF
MEDICAL
EDUCATION
COSTS.—In determining the amounts under para-
graph (1), the Secretary shall not take into account
payments attributable to—
‘‘(A) graduate medical education payments
under section 1886(h);
‘‘(B) disproportionate share hospital pay-
ments described in section 1886(d)(5)(F); or
‘‘(C) indirect costs of medical education
described in section 1886(d)(5)(B).’’.
(c) SERVICE AREAS REQUIREMENTS.—Section 1852
of such Act (42 U.S.C. 1395w–22) is amended by adding
at the end the following new subsection:
‘‘(m) SERVICE AREAS.—
‘‘(1) DESIGNATION
BY SECRETARY.—Taking
into account factors such as commercial rating pat-
terns, the Secretary shall designate geographic areas
as service areas for purposes of this part. Such areas
may be portions of a State or an entire State.
‘‘(2) PROHIBITION
ON
COUNTIES
BEING
IN
MULTIPLE SERVICE AREAS.—In no case may a coun-
ty or equivalent area, or portion thereof, be included
in more than one service area designated by the Sec-
retary under paragraph (1).’’.
(d) BENEFITS.—
(1) REQUIREMENT
FOR
UNIFORM
BENEFITS
FOR
ALL
ENROLLEES
RESIDING
IN
THE
SERVICE
AREA.—
parts of the service area, but only if the cost-
sharing applicable to such a network or plan is
not established in a manner that discourages
enrollment of residents in those parts of the
service area.’’.
(B) CONFORMING REPEAL OF AUTHORITY
TO USE OF SEGMENTS OF SERVICE AREAS.—
Section 1854 of such Act (42 U.S.C. 1395w–
24) is amended by striking subsection (h).
(2) NO
REQUIREMENT
FOR
SUPPLEMENTAL
BENEFITS.—
(A) IN
GENERAL.—Section 1854(f)) of
such Act (42 U.S.C. 1395w–24(f))) is amended
by adding at the end the following new para-
graph:
‘‘(5) APPLICATION OF PROVISION.—The provi-
sions of this subsection shall not apply for any year
with respect to which a Medicare+Choice organiza-
tion has entered into a 3-year contract with the Sec-
retary under section 1857(c)(1).’’.
(B) CONFORMING
AMENDMENT.—Section
1852(a)(1)(B) of such Act (42 U.S.C. 1395w–
22(a)(1)(B)) is amended by inserting before the
period the following: ‘‘for any year with respect
to which a Medicare+Choice organization has
entered into a 3-year contract with the Sec-
retary under section 1857(c)(1)’’.
(e) EFFECTIVE DATE.—The amendments made by
this section shall apply to contracts entered into on or
after January 1, 2002.
SEC. 
3. 
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) PERMITTING REENROLLMENT IN MEDIGAP
WHEN M+C PLANS REDUCE BENEFITS.—
(A) IN GENERAL.—Clause (ii) of section
1882(s)(3)(B) 
of 
such 
Act 
(42 
U.S.C.
1395ss(s)(3)(B)) is amended—
(i) by striking ‘‘under the first sen-
tence of’’ each place it appears and insert-
ing ‘‘during a special election period pro-
vided for under’’; and
(ii) by inserting ‘‘(including a reduc-
tion 
in 
benefits 
offered 
under 
a
Medicare+Choice plan from year to year)’’
after ‘‘section 1851(e)(4)’’.
(B) CONFORMING
AMENDMENT.—Clause
(iii) of such section is amended—
(i) by striking ‘‘under the first sen-
tence of’’ and inserting ‘‘during a special
election period provided for under’’; and
(ii) by inserting ‘‘(including a reduc-
tion 
in 
benefits 
offered 
under 
a
Medicare+Choice plan from year to year)’’
after ‘‘section 1851(e)(4)’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply with respect to plan years begin-
ning on or after January 1, 2002.
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