I
106TH CONGRESS
2D SESSION
H. R. 5296
To amend title XVIII of the Social Security Act to revise and improve
the Medicare Program.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 26, 2000
Mr. ENGLISH introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committees on Com-
merce, the Budget, and Rules, 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 title XVIII of the Social Security Act to revise
and improve 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.
This Act may be cited as the ‘‘Medicare Quality As-
surance Act of 2000’’.
TITLE I—MEDICARE FEE FOR
SERVICE PAYMENT IMPROVE-
MENTS
SEC. 101. REVISION OF PPS HOSPITAL PAYMENT UPDATE.
Section 1886(b)(3)(B)(i) of the Social Security Act
(42 U.S.C. 1395ww(b)(3)(B)(i)) is amended—
(1) in subclause (XV), by adding ‘‘and’’ at the
end;
(2) by striking subclauses (XVI) and (XVII);
(3) by redesignating subclause (XVIII) as sub-
clause (XVI); and
(4) in subclause (XVI), as so redesignated, by
striking ‘‘fiscal year 2003’’ and inserting ‘‘fiscal year
2001’’.
SEC. 102. REVISION OF REDUCTION OF INDIRECT GRAD-
UATE MEDICAL EDUCATION PAYMENTS.
(a) IN GENERAL.—Section 1886(d)(5)(B)(ii) of the
Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(ii)) is
amended—
(1) in subclause (IV), by striking ‘‘fiscal year
2000’’ and inserting ‘‘each of fiscal years 2000 and
2001’’; and
(2) in each of subclauses (V) and (VI), by strik-
ing ‘‘2001’’ and inserting ‘‘2002’’.
(b) 
TECHNICAL
AMENDMENTS.—Section
1886(d)(5)(B) of such Act (42 U.S.C. 1395ww(d)(5)(B)),
as amended by paragraph (1), is amended—
(1) by realigning the left margins of clauses (ii)
and (v) so as to align with the left margin of clause
(i); and
(2) by realigning the left margins of subclauses
(I) through (V) of clause (ii) appropriately.
SEC. 103. INCREASE IN MARKET BASKET PERCENTAGE IN-
CREASE FOR FISCAL YEAR 2001.
(a) IN GENERAL.—Section 1888(e)(4)(E)(ii) of the
Social Security Act (42 U.S.C. 1395yy(e)(4)(E)(ii)) is
amended—
(1) by redesignating subclause (III) as sub-
clause (IV);
(2) by striking subclause (II); and
(3) by inserting after subclause (I) the fol-
lowing new subclauses:
‘‘(II) for fiscal year 2001, the
rate computed for fiscal year 2000 in-
creased by the skilled nursing facility
market basket percentage change for
fiscal year 2000 plus 4 percentage
points;
‘‘(III) for fiscal year 2002, the
rate computed for fiscal year 2001 in-
creased by the skilled nursing facility
market basket percentage change for
fiscal year 2001 minus 1 percentage
point; and’’.
(b) REVISED DEFINITION OF SKILLED NURSING FA-
CILITY MARKET BASKET INDEX; ANNUAL WAGE SURVEY
FOR PERIODS AFTER 1998.—
(1) REQUIRING
USE
OF
ACTUAL
COSTS
IN-
CURRED BY FACILITIES.—Section 1888(e)(5)(A) of
such Act (42 U.S.C. 1395yy(e)(5)(A)) is amended
by adding at the end the following: ‘‘Such index
shall be based, in appropriate part, on actual in-
creases in the cost of wages incurred by skilled nurs-
ing facilities in furnishing covered skilled nursing fa-
cility services.
(2) REQUIRING ANNUAL SURVEYS OF COSTS.—
For purposes of determining (under the second sen-
tence of section 1888(e)(5)(A)) the actual increases
in the cost of wages incurred by skilled nursing fa-
cilities in furnishing covered skilled nursing facility
services the Secretary of Health and Human Serv-
ices shall conduct annual surveys of such costs for
purposes of revising and updating the skilled nurs-
ing facility market basket index under such section.
SEC. 104. ELIMINATION OF 15 PERCENT REDUCTION IN
PAYMENT RATES UNDER THE MEDICARE
PROSPECTIVE PAYMENT SYSTEM FOR HOME
HEALTH SERVICES.
(a) IN GENERAL.—Section 1895(b)(3)(A) of the So-
cial Security Act (42 U.S.C. 1395fff(b)(3)(A)), as amend-
ed by sections 302(b) and 303(f) of the Medicare, Med-
icaid, and SCHIP Balanced Budget Refinement Act of
1999 (113 Stat. 1501A–359, 361), as enacted into law
by section 1000(a)(6) of Public Law 106–113, is amended
to read as follows:
‘‘(A) INITIAL BASIS.—Under such system
the Secretary shall provide for computation of
a standard prospective payment amount (or
amounts). Such amount (or amounts) shall ini-
tially be based on the most current audited cost
report data available to the Secretary and shall
be computed in a manner so that the total
amounts payable under the system for the 12-
month period beginning on the date the Sec-
retary implements the system shall be equal to
the total amount that would have been made if
the system had not been in effect and if section
1861(v)(1)(L)(ix) had not been enacted. Each
such amount shall be standardized in a manner
that eliminates the effect of variations in rel-
ative case mix and area wage adjustments
among different home health agencies in a
budget neutral manner consistent with the case
mix and wage level adjustments provided under
paragraph (4)(A). Under the system, the Sec-
retary may recognize regional differences or dif-
ferences based upon whether or not the services
or agency are in an urbanized area.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall take effect as if included in the enact-
ment of the Medicare, Medicaid, and SCHIP Balanced
Budget Refinement Act of 1999 (Public Law 106–113).
SEC. 105. TWO-YEAR EXTENSION OF MORATORIUM IN CAPS
FOR THERAPY SERVICES.
(a) 
EXTENSION
OF
MORATORIUM.—Section
1833(g)(4) of the Social Security Act (42 U.S.C.
1395l(g)(4)), as added by section 221(a) of Medicare,
Medicaid, and SCHIP Balanced Budget Refinement Act
of 1999 (113 Stat. 1501A–351), is amended by striking
‘‘and 2001’’ and inserting ‘‘through 2003’’.
(b) EXTENSION OF REPORT.—Section 4541(d)(2) of
Balanced Budget Act of 1997, as amended by section