I
106TH CONGRESS
2D SESSION
H. R. 5099
To amend title XVIII of the Social Security Act to make improvements
to the Medicare+Choice Program under part C of the Medicare Program.
IN THE HOUSE OF REPRESENTATIVES
JULY 27, 2000
Mr. UDALL of New Mexico 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 juris-
diction of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to make
improvements to the Medicare+Choice Program under
part C of the Medicare Program.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Medicare+Choice Program Improvement Act of 2000’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Increase in national per capita Medicare+Choice growth percentage in
2001 and 2002.
Sec. 3. Increasing minimum payment amount.
Sec. 4. Allowing movement to 50:50 percent blend in 2002.
Sec. 5. Increased 
update 
for 
payment 
areas 
with 
only 
one 
or 
no
Medicare+Choice contracts.
Sec. 6. Permitting higher negotiated rates in certain Medicare+Choice payment
areas below national average.
Sec. 7. 10-year phase-in of risk adjustment based on data from all settings.
Sec. 8. Delay from July to November 2000 in deadline for offering and with-
drawing Medicare+Choice plans for 2001.
SEC. 
2. 
INCREASE 
IN 
NATIONAL 
PER 
CAPITA
MEDICARE+CHOICE GROWTH PERCENTAGE
IN 2001 AND 2002.
Section 1853(c)(6)(B) of the Social Security Act (42
U.S.C. 1395w–23(c)(6)(B)) is amended—
(1) in clause (iii), by adding ‘‘and’’ at the end;
(2) by striking clauses (iv) and (v);
(3) by redesignating clause (vi) as clause (iv);
and
(4) in clause (iv), as so redesignated, by strik-
ing ‘‘after 2002’’ and inserting ‘‘after 2000’’.
SEC. 3. INCREASING MINIMUM PAYMENT AMOUNT.
(a) IN GENERAL.—Section 1853(c)(1)(B)(ii) of the
Social Security Act (42 U.S.C. 1395w–23(c)(1)(B)(ii)) is
amended—
(1) by striking ‘‘(ii) For a succeeding year’’ and
inserting ‘‘(ii)(I) Subject to subclause (II), for a suc-
ceeding year’’; and
(2) by adding at the end the following new sub-
clause:
‘‘(II) For 2002 for any of the 50
States and the District of Columbia,
$500.’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) apply to years beginning with 2002.
SEC. 4. ALLOWING MOVEMENT TO 50:50 PERCENT BLEND IN
2002.
Section 1853(c)(2) of the Social Security Act (42
U.S.C. 1395w–23(c)(2)) is amended—
(1) by striking the period at the end of sub-
paragraph (F) and inserting a semicolon; and
(2) by adding at the end the following flush
matter:
‘‘except that a Medicare+Choice organization may
elect to apply subparagraph (F) (rather than sub-
paragraph (E)) for 2002.’’.
SEC. 5. INCREASED UPDATE FOR PAYMENT AREAS WITH
ONLY ONE OR NO MEDICARE+CHOICE CON-
TRACTS.
(a) IN GENERAL.—Section 1853(c)(1)(C)(ii) of the
Social Security Act (42 U.S.C. 1395w–23(c)(1)(C)(ii)) is
amended—
(1) by striking ‘‘(ii) For a subsequent year’’
and inserting ‘‘(ii)(I) Subject to subclause (II), for
a subsequent year’’; and
(2) by adding at the end the following new sub-
clause:
‘‘(II) During 2002, 2003, 2004, and
2005, in the case of a Medicare+Choice
payment area in which there is no more
than one contract entered into under this
part as of July 1 before the beginning of
the year, 102.5 percent of the annual
Medicare+Choice capitation rate under
this paragraph for the area for the pre-
vious year.’’.
(b) CONSTRUCTION.—The amendments made by sub-
section (a) do not affect the payment of a first time bonus
under section 1853(i) of the Social Security Act (42
U.S.C. 1395w–23(i)).
SEC. 6. PERMITTING HIGHER NEGOTIATED RATES IN CER-
TAIN MEDICARE+CHOICE PAYMENT AREAS
BELOW NATIONAL AVERAGE.
Section 1853(c)(1) of the Social Security Act (42
U.S.C. 1395w–23(c)(1)) is amended—
(1) in the matter preceding subparagraph (A),
by striking ‘‘or (C)’’ and inserting ‘‘(C), or (D)’’;
and
(2) by adding at the end the following new sub-
paragraph:
‘‘(D) 
PERMITTING
HIGHER
RATES
THROUGH NEGOTIATION.—
‘‘(i) IN GENERAL.—For each year be-
ginning with 2001, in the case of a
Medicare+Choice payment area for which
the Medicare+Choice capitation rate under
this paragraph would otherwise be less
than the United States per capita cost
(USPCC), as calculated by the Secretary,
a Medicare+Choice organization may ne-
gotiate with the Secretary an annual per
capita rate that—
‘‘(I) reflects an annual rate of in-
crease up to the rate of increase speci-
fied in clause (ii);
‘‘(II) takes into account audited
current data supplied by the organiza-
tion on its adjusted community rate
(as defined in section 1854(f)(3)); and
‘‘(III) does not exceed the United
States per capita cost, as projected by
the Secretary for the year involved.
‘‘(ii) MAXIMUM
RATE
DESCRIBED.—
The rate of increase specified in this clause
for a year is the rate of inflation in private
health insurance for the year involved, as
projected by the Secretary, and includes
such adjustments as may be necessary—
‘‘(I) to reflect the demographic
characteristics in the population under
this title; and
‘‘(II) to eliminate the costs of
prescription drugs.
‘‘(iii) ADJUSTMENTS
FOR
OVER
OR
UNDER
PROJECTIONS.—If this subpara-
graph is applied to an organization and
payment area for a year, in applying this
subparagraph for a subsequent year the
provisions of paragraph (6)(C) shall apply
in the same manner as such provisions
apply under this paragraph.
‘‘(iv) DEADLINE FOR COMPLETION OF
NEGOTIATIONS.—The Secretary shall com-
plete negotiations with a Medicare+Choice
organization under clause (i) for a year by
not later than 90 days after the date the
organization entered into negotiations with
the Secretary.’’.
SEC. 7. 10-YEAR PHASE-IN OF RISK ADJUSTMENT BASED ON
DATA FROM ALL SETTINGS.
Section 1853(a)(3)(C)(ii) of the Social Security Act
(42 U.S.C. 1395w–23(c)(1)(C)(ii)) is amended—
(1) by striking the period at the end of sub-
clause (II) and inserting a semicolon; and
(2) by adding at the end the following flush
matter:
‘‘and, beginning in 2004, insofar as such
risk adjustment is based on data from all
settings, the methodology shall be phased-
in in equal increments over a 10-year pe-
riod, beginning with 2004 or (if later) the
first year in which such data is used.’’.
SEC. 8. DELAY FROM JULY TO NOVEMBER 2000 IN DEAD-
LINE FOR OFFERING AND WITHDRAWING
MEDICARE+CHOICE PLANS FOR 2001.
Notwithstanding any other provision of law, the dead-
line for a Medicare+Choice organization to withdraw the
offering of a Medicare+Choice plan under part C of title
XVIII of the Social Security Act (or otherwise to submit
information required for the offering of such a plan) for
2001 is delayed from July 1, 2000, to November 1, 2000,
and any such organization that provided notice of with-
drawal of such a plan during 2000 before the date of en-
actment of this Act may rescind such withdrawal at any
time before November 1, 2000.
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