I
106TH CONGRESS
2D SESSION
H. R. 4555
To provide for a 6-year demonstration project to stabilize coverage and
benefits under the Medicare+Choice Program.
IN THE HOUSE OF REPRESENTATIVES
MAY 25, 2000
Mr. BROWN of Ohio 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 provide for a 6-year demonstration project to stabilize
coverage and benefits under the Medicare+Choice 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+Choice Reli-
ability Act of 2000’’.
SEC. 2. ESTABLISHMENT OF 6-YEAR DEMONSTRATION
PROJECT TO STABILIZE COVERAGE AND BEN-
EFITS UNDER THE MEDICARE+CHOICE PRO-
GRAM.
(a) IN GENERAL.—The Secretary of Health and
Human Services shall establish under this section a dem-
onstration project under which Medicare+Choice organi-
zations under part C of title XVIII of the Social Security
Act may elect to provide Medicare+Choice plans in ac-
cordance with the special provisions of the project.
(b) DURATION.—The project shall extend over a pe-
riod of 6 years.
(c) GENERAL DESCRIPTION OF SPECIAL TERMS.—
Under the project:
(1) PAYMENT AMOUNT BASED ON PAYMENTS
UNDER
TRADITIONAL
FEE-FOR-SERVICE
PRO-
GRAM.—There shall be substituted for the annual
Medicare+Choice capitation rate under section
1853(a) the fee-for-service-related amount described
in subsection (d). Payment of such amount is sub-
ject to risk-adjustment in the manner described in
section 1853(a)(3) of the Social Security Act (42
U.S.C. 1395w–23(a)(3)).
(2) 3-YEAR CONTRACT.—The period of the con-
tract under section 1857(c)(1) of such Act (42
U.S.C. 1395w–27(c)(1)) shall be for a term of 3
years. For the duration of the contract the
Medicare+Choice organization—
(A) may not modify premiums and bene-
fits, unless the Secretary determines that such
modifications would increase the value of the
coverage; and
(B) may not withdraw from any part of
the service area.
(3) SERVICE AREA.—
(A) ESTABLISHMENT.—Taking into ac-
count factors such as commercial rating pat-
terns, the Secretary shall designate geographic
areas as service areas for purposes of the
project. Such areas may be portions of a State
or an entire State. Each county or equivalent
area shall be in one, and only one, service area.
No Medicare+Choice plan under the project
may serve any part of a service area without
serving all parts of that service area.
(B) UNIFORM
BENEFITS
IN
A
SERVICE
AREA.—
(i) IN
GENERAL.—Subject to clause
(i), a Medicare+Choice plan shall provide
the same benefits to all enrollees in a serv-
ice area.
(ii) ADAPTION BY HEALTH MAINTE-
NANCE
ORGANIZATIONS.—In 
applying
clause (i) in the case of a plan that is a
health maintenance organization, if limita-
tions in provider contracts prevent the plan
from maintaining the provider contracts in
certain parts of a service area, the plan
may establish a preferred provider network
or fee-for-service plan in those parts of the
service area, but only if the cost-sharing
applicable to such a network or plan is not
established in a manner that discourages
enrollment of residents in those parts of
the service area.
(4) NO
REQUIREMENT
FOR
SUPPLEMENTAL
BENEFITS.—The 
provisions 
of 
sections
1852(a)(1)(B), 1854(e), and 1854(f)(1)(A) (relating
to requirement for supplemental benefits) of the So-
cial Security Act (42 U.S.C. 1395w–22(a)(1)(B),
1395w–24(e), 1395w–24(f)) shall not apply.
(d) 
FEE-FOR-SERVICE-RELATED
PAYMENT
AMOUNT.—
(1) IN
GENERAL.—The amount described in
this subsection for a service area is the Secretary’s
estimate of the adjusted average per capita cost (as
determined under section 1876(a)(4) of the Social
Security Act, 42 U.S.C. 1395mm(a)(4)) for the serv-
ice area for the contract year.
(2) 
EXCLUSION
OF
MEDICAL
EDUCATION
COSTS.—In determining the amounts under para-
graph (1), the Secretary shall not take into account
payments attributable to—
(A) graduate medical education payments
under section 1886(h) of the Social Security
Act (42 U.S.C. 1395ww(h));
(B) disproportionate share hospital pay-
ments described in section 1886(d)(5)(F) of
such Act (42 U.S.C. 1395ww(d)(5)(F)); or
(C) indirect costs of medical education de-
scribed in section 1886(d)(5)(B) of such Act
(42 U.S.C. 1395ww(d)(5)(B)).
(e) SANCTIONS
FOR
VIOLATION
OF
PROJECT
TERMS.—
(1) IN GENERAL.—The Secretary may provide
for such sanctions as may be appropriate to assure
that Medicare+Choice organizations that elect to
participate in the project meet the contractual terms
of the contract, including maintaining benefits and
coverage during the entire period of the contract.
(2) CONSTRUCTION.—Nothing in this sub-
section shall be construed as preventing the Sec-
retary from terminating a Medicare+Choice organi-
zation’s participation in the project for cause or for
other conditions for which a contract under section
1857 of the Social Security Act (42 U.S.C. 1395w–
27) could be terminated.
(f) 
RELATION
TO
MEDICARE
PART
C.—
Medicare+Choice organizations participating in the
project shall comply with the provisions of the
Medicare+Choice program except to the extent that such
provisions are superseded by the provisions in the project.
(g) EVALUATION AND REPORT.—The Secretary shall
continuously assess the effectiveness of the project in sta-
bilizing coverage and benefits under the Medicare+Choice
program. The Secretary shall submit a report to Congress
on such evaluation after the completion of 4 years of the
project.
(h) DEFINITIONS.—For purposes of this section:
(1) 
MEDICARE+CHOICE
ORGANIZATION;
MEDICARE+CHOICE
PLAN.—The 
terms
‘‘Medicare+Choice 
organization’’ 
and
‘‘Medicare+Choice plan’’ have the meanings given
such terms under the Medicare+Choice program.
(2) MEDICARE+CHOICE PROGRAM.—The term
‘‘Medicare+Choice program’’ means the program
under part C of title XVIII of the Social Security
Act.
(3) PROJECT.—The term ‘‘project’’ means the
demonstration project established under this section.
(4) SECRETARY.—The term ‘‘Secretary’’ means
the Secretary of Health and Human Services .
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