I
106TH CONGRESS
1ST SESSION
H. R. 2419
To amend title XVIII of the Social Security Act to reflect original Congres-
sional intent by requiring that the new risk adjustment methodology
for Medicare+Choice payment rates be implemented in a budget neutral
manner, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JULY 1, 1999
Mr. BILIRAKIS (for himself, Mr. DEUTSCH, Mr. LATOURETTE, Mr. TAUZIN,
Ms. BROWN of Florida, Mr. GREENWOOD, Mr. TOWNS, Mr. MCCOLLUM,
Mr. CANADY of Florida, Mr. GILCHREST, Mr. KOLBE, Mr. BASS, Mrs.
FOWLER, Mr. WALDEN of Oregon, and Mr. STEARNS) introduced the fol-
lowing bill; which was referred to the Committee on Ways and Means,
and in addition to the Committee on Commerce, for a period to be subse-
quently 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 reflect
original Congressional intent by requiring that the new
risk adjustment methodology for Medicare+Choice pay-
ment rates be implemented in a budget neutral manner,
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; FINDINGS AND PURPOSE.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Medicare+Choice Risk Adjustment Amendments of
1999’’.
(b) FINDINGS.—Congress finds as follows:
(1) The enactment of the Balanced Budget Act
of 1997 provided for development and implementa-
tion of a new, more sophisticated risk adjustment
methodology under the Medicare+Choice program,
to assure a better match between payment rates for
individuals 
with 
different 
risks 
enrolled 
in
Medicare+Choice plans. This was in addition to
changes in the underlying payment system that was
designed to provide for savings to the medicare pro-
gram.
(2) The Congressional Budget Office did not es-
timate that this new risk adjustment system would
change the overall payment levels for such plans or
the 
participation 
of 
such 
plans 
in 
the
Medicare+Choice program.
(3) The Health Care Financing Administration
has proposed implementation of a new risk adjust-
ment methodology that not only results in substan-
tial reductions in payments to Medicare+Choice
plans beyond those contemplated in the Balanced
Budget Act of 1997, but also would result in a de-
crease in the participation of such plans in the pro-
gram, directly against the intent of Congress and
the projections made at the time of the enactment
of that Act.
(c) PURPOSE.—It is the purpose of section 2 of this
Act to restore the original intent of Congress when it re-
quired implementation of a new risk adjustment method-
ology for Medicare+Choice payment rates by assuring
that such methodology is established in a budget neutral
manner that does not affect overall spending levels under
the medicare program using the current risk adjustment
methodology.
SEC. 2. 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