HRES 299 RH 
SEC. 2. Upon the adoption of this resolution it shall 
be in order on the legislative day of June 26 or June 27, 
2003, without intervention of any point of order to con-
sider in the House the bill (H.R. 2596) to amend the In-
ternal Revenue Code of 1986 to allow a deduction to indi-
viduals for amounts contributed to health savings security 
accounts and health savings accounts, to provide for the 
disposition of unused health benefits in cafeteria plans and 
flexible spending arrangements, and for other purposes. 
The bill shall be considered as read for amendment. The 
previous question shall be considered as ordered on the 
bill to final passage without intervening motion except: (1) 
one hour of debate on the bill equally divided and con-
trolled by the chairman and ranking minority member of 
the Committee on Ways and Means; and (2) one motion 
to recommit. 
SEC. 3. (a) In the engrossment of H.R. 1, the Clerk 
shall await the disposition of H.R. 2596 under section 2. 
(b) If H.R. 2596 is passed by the House, the Clerk 
shall—
(1) add the text of H.R. 2596 as new matter 
at the end of H.R. 1; 
(2) conform the title of H.R. 1 to reflect the 
addition of the text of H.R. 2596 of the engross-
ment;
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(3) assign appropriate designations to provi-
sions within the engrossment; and 
(4) conform provisions for short titles within 
the engrossment. 
(c) Upon the addition of the text of H.R. 2596 to 
the engrossment of H.R. 1, H.R. 2596 shall be laid on 
the table. 
SEC. 4. During consideration of H.R. 1 and H.R. 
2596 pursuant to this resolution, notwithstanding the op-
eration of the previous question, the Chair may postpone 
further consideration of either bill to a time designated 
by the Speaker. 
SEC. 5. Upon the adoption of this resolution it shall 
be in order, any rule of House to the contrary notwith-
standing, to consider concurrent resolutions providing for 
adjournment of the House and Senate during the month 
of July. 
SEC. 6. The Committee on Appropriations may have 
until midnight on Thursday, July 3, 2003, to file a report 
to accompany a bill making appropriations for the Depart-
ment of Defense for the fiscal year ending September 30, 
2004, and for the other purposes. 
SUMMARY OF AMENDMENT MADE IN ORDER 
Rangel/Dingell: Amendment in the Nature of a Sub-
stitute. Title I—Medicare Prescription Medicine Benefit. 
Adds new Part D in Medicare that provides voluntary
HRES 299 RH 
prescription drug coverage for all Medicare beneficiaries 
beginning in 2006. Provides a $25 a month premium, a 
$100 a year deductible, a co-insurance of 20/40 (Bene-
ficiaries/Medicare), and a $2,000 out-of-pocket limit per 
beneficiary per year. Beneficiaries with incomes between 
150 percent of poverty pay no premium or cost sharing. 
Beneficiaries with incomes between 150 percent and 175 
percent of poverty pay no cost-sharing and receive assist-
ance with the Part D premium on a sliding scale. Medi-
care contractors will obtain guaranteed reductions in 
prices, and the Secretary of Health and Human Services 
will have the authority to use the collective purchasing 
power of Medicare’s 40 million beneficiaries to negotiate 
lower drug prices, taking into account prices paid in 
other countries and by other payers in the U.S. The Sec-
retary could also implement measures that will further 
reduce costs and improve quality for beneficiaries, such 
as: encouraging use of generic drugs, lowering co-insur-
ance for preferred drugs, disease management, and bene-
ficiary and provider education. Medicare would also re-
quire contractors to put in place safeguards to check for 
adverse drug interactions and proper use of medications. 
Title II—Medicare+Choice. Includes a two-year payment 
enhancement for Medicare+Choice plans (2004 and 
2005) as well as provisions pertaining to specialized plans
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for special needs beneficiaries and the extension of Medi-
care cost-contracts. Title III—Combating Waste, Fraud, 
and Abuse. Improves payments for oncology providers to 
administer cancer drugs and also directs the Centers for 
Medicare and Medicaid Services to pay for drug adminis-
tration services, chemotherapy support services, therapy 
management services and related services. Reimburses for 
the cost of oncology drugs by not involving a new bu-
reaucracy and middle-man and paying 105 percent of the 
average sales price of medicines. Protects beneficiaries 
from undue consequences of competitive bidding for dura-
ble medical equipment (DME) by delaying the start of 
DME competitive bidding until 2009 and phasing it in 
over three years. Title IV—Rural Health Care Improve-
ments. Includes all of the provisions from the Ways and 
Means reported bill pertaining to rural providers. In ad-
dition, it: eliminates the 10 percent cap on dispropor-
tionate share hospital payments to rural hospitals; adds 
a provision providing up to 25 percent increase in low-
volume adjustment for small hospitals; increases rural 
home health payments by 10 percent (rather than 5 per-
cent); allows lab payments on reasonable costs for sole 
community hospitals; increases the floors for physician 
work in rural areas to 1.0; eliminates the 35-mile rule for 
critical access hospital ambulance services; increases the
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ground ambulance payment rate; and increases the crit-
ical access hospital bed limit to 25. Title V—Provisions 
Relating to Medicare Part A. Includes all the provisions 
from Ways and Means reported bill pertaining to Part A 
(hospitals) except it eliminate the 3-year cut in hospital 
inpatient reimbursement and adds a boost for indirect 
medical education (IME) to 6.5 percent for two years. It 
also replaces the MedPac study on specialty hospitals 
with the Senate provision that limits physician self-refer-
ral to these facilities. Title VI—Provisions Relating to 
Medicare Part B. Includes all of the provisions from the 
Ways and Means and Energy and Commerce reported 
bills except it does not increase the deductible that sen-
iors must pay in order to receive Part B (primarily physi-
cians) services. Title VII—Provisions Relating to Medi-
care Parts A and B. Includes all of the provisions from 
the Ways and Means and Energy and Commerce re-
ported bills except it does not include a co-payment for 
home health care and does not continue the cap on pay-
ments for direct graduate medical education for facilities 
above 140 percent. Title VIII—Medicaid. Includes 
Whitfield-DeGette Medicaid DSH legislation that in-
cludes full restoration of funding for DSH and improve-
ments for low-DSH States. Title IX—Regulatory Reduc-
tion and Contracting Reform. Includes the Energy and
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Commerce reported provision on Medicare contractor and 
regulatory reform. Title X—Importation of Prescription 
Drugs. Incorporates reimportation amendments adopted 
on the Senate Floor on June 19, 2003, which will allow 
access to low-cost Canadian Drugs if the Secretary of the 
Department of Health and Human Services certifies that 
they are safe. Title XI—Access to Affordable Pharma-
ceuticals. Incorporates text of S. 1225 as adopted by the 
Senate, which will make lower cost generic drugs avail-
able more quickly.
House Calendar No. 74
108TH CONGRESS 
1ST SESSION 
H. RES. 299
[Report No. 108–181] 
RESOLUTION 
Providing for consideration of the bill (H.R. 1) to 
amend title XVIII of the Social Security Act to 
provide for a voluntary program for prescription 
drug coverage under the Medicare Program, to 
modernize the Medicare Program, and for other 
purposes, and for consideration of the bill (H.R. 
2596) to amend the Internal Revenue Code of 
1986 to allow a deduction to individuals for 
amounts contributed to health savings security 
accounts and health savings accounts, to provide 
for the disposition of unused health benefits in 
cafeteria plans and flexible spending arrange-
ments, and for other purposes. 
JUNE 25, 2003
Referred to the House Calendar and ordered to be 
printed