I
106TH CONGRESS
1ST SESSION
H. R. 141
To amend title XVIII of the Social Security Act to prevent sudden disruption
of Medicare beneficiary enrollment in Medicare+Choice plans.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 6, 1999
Mr. GEJDENSON (for himself, Ms. DELAURO, Mr. SANDLIN, Mrs. CAPPS, Mr.
BALDACCI, Ms. KILPATRICK, Mr. FILNER, and Mr. HINCHEY) 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 consider-
ation of such provisions as fall within the jurisdiction of the committee
concerned
A BILL
To amend title XVIII of the Social Security Act to prevent
sudden disruption of Medicare beneficiary enrollment in
Medicare+Choice plans.
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 HMO Im-
provement Act of 1999’’.
SEC. 2. EXTENSION OF INITIAL MEDICARE+CHOICE CON-
TRACT PERIOD TO 3 YEARS.
(a) IN GENERAL.—Section 1857(c)(1) of the Social
Security Act (42 U.S.C. 1395w–27(c)(1)) is amended—
(1) by striking ‘‘a term of at least 1 year’’ and
inserting ‘‘an initial term of at least 3 years’’; and
(2) by striking ‘‘from term to term’’ and insert-
ing ‘‘for additional 1-year periods thereafter’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) apply to contracts entered into on or after
the date of the enactment of this Act.
SEC. 3. AUTHORITY TO DELAY TERMINATION.
Section 1851(g)(3) of the Social Security Act (42
U.S.C. 1395w–21(g)(3)) is amended by adding at the end
the following new subparagraph:
‘‘(E) AUTHORITY TO DELAY EFFECTIVE-
NESS OF A TERMINATION.—
(i) 
IN
GENERAL.—If 
a
Medicare+Choice organization terminates
a plan under subparagraph (B)(iii), the
Secretary may delay the effectiveness of
such termination for up to 1 year if the
Secretary finds that—
‘‘(I) the termination would cause
an imminent and serious risk to
health to individuals enrolled under
the plan under this part;
‘‘(II) the termination would re-
sult in a significant reduction in the
Medicare+Choice plans that are avail-
able in the area affected by the termi-
nation; or
‘‘(III) the chief executive officer
of the State in which the termination
occurs requests such a delay.
‘‘(ii) END OF DELAY.—The Secretary
may end a delay under clause (i), before
the end of the 1-year period, if the Sec-
retary finds that an adequate provider net-
work has been established which will pro-
vide at least an equal level of insurance
coverage as existed on the date the
Medicare+Choice organization informed its
enrollees of its intention to terminate the
plan.’’.
SEC. 
4. 
RESTRICTION 
ON 
TERMINATION 
OF
MEDICARE+CHOICE 
PLANS 
IN 
SELECTED
AREAS WITHIN A METROPOLITAN STATIS-
TICAL AREA.
(a) IN GENERAL.—Section 1857(c) of the Social Se-
curity Act (42 U.S.C. 1395w–27(c)) is amended by redes-
ignating paragraph (5) as paragraph (6) and by inserting
after paragraph (4) the following new paragraph:
‘‘(5) LIMITATION ON SELECTIVE TERMINATION
OF CONTRACTS.—
‘‘(A) IN GENERAL.—Except as provided in
subparagraph (B), if a Medicare+Choice orga-
nization offers a Medicare+Choice plan that
provides coverage in a metropolitan statistical
area (or a New England County Metropolitan
Area) in a State and terminates such coverage
for any part of such area (or Area) in the
State, the Secretary shall terminate any con-
tract with the organization for coverage of any
part of that area (or Area) in that State.
‘‘(B) EXCEPTION.—The Secretary may
waive the requirement of subparagraph (A) if
the Secretary finds that terminating contracts
for coverage in all parts of a metropolitan sta-
tistical area (or New England County Metro-
politan Area) in the State would pose an immi-
nent and serious risk to the health of individ-
uals enrolled with the organization under this
part in the area (or Area).’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) apply to terminations for which notice is
provided on or after the date of the enactment of this Act.
SEC. 5. CONTINUITY OF CARE IN CASE OF INVOLUNTARY
TERMINATION.
(a) IN GENERAL.—Section 1852(d) of the Social Se-
curity Act (42 U.S.C. 1395w–22(d)) is amended by adding
at the end the following new paragraph:
‘‘(5) CONTINUITY OF CARE.—
‘‘(A) IN GENERAL.—If—
‘‘(i) an individual’s enrollment with a
Medicare+Choice 
plan 
offered 
by 
a
Medicare+Choice organization under this
part is terminated by the organization
(other than for cause with respect to that
individual), and
‘‘(ii) on the effective date of such ter-
mination of enrollment the individual is in
a course of treatment for which coverage is
available under the plan and the individual
is not at that time covered under another
Medicare+Choice plan,
notwithstanding such termination the organiza-
tion shall continue to provide coverage for the
covered course of treatment for a period of 90
days after such effective date.
‘‘(B) PERMISSIBLE
TERMS
AND
CONDI-
TIONS.—The coverage provided under subpara-
graph (A) shall be under the same terms and
conditions (including applicable policies, proce-
dures, and quality assurance standards) as ex-
isted on the date before the effective date of the
termination.
‘‘(C) TERMINATE DEFINED.—In this para-
graph, the term ‘terminate’ includes the termi-
nation of a Medicare+Choice plan as a result
of the expiration or nonrenewal of a contract by
the organization under this part.
‘‘(D) CONSTRUCTION.—Nothing in this
paragraph shall be construed to require the cov-
erage of benefits which would not have been
covered on the effective date of the termination
involved.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply to contracts entered into or re-
newed on or after the date of the enactment of this Act.
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