1238
[HVAC Reconciliation]
‘‘(II) BASE
DIFFERENCE.—The
base difference described in this sub-
clause for a hospital is the amount by
which the hospital’s overhead GME
amount in the base period exceeded
the 75th percentile of such amounts
(as described in clause (i)).
‘‘(iv) MAXIMUM REDUCTION TO 75TH
PERCENTILE.—In no case shall the reduc-
tion under this subparagraph effected for a
hospital for a period (below the amount
that would otherwise apply for the period
if this subparagraph did not apply for any
period) exceed the reference reduction
amount for the hospital for the period.
‘‘(v) BASE PERIOD.—For purposes of
this subparagraph, the term ‘base period’
means the cost reporting period beginning
in fiscal year 1984 or the period used to
establish the hospital’s approved FTE resi-
dent amount for hospitals that did not
have approved residency training programs
in fiscal year 1984.
‘‘(vi) RULES FOR HOSPITALS INITIAT-
ING
RESIDENCY
TRAINING
PROGRAMS.—
1239
[HVAC Reconciliation]
The Secretary shall establish rules for the
application of this subparagraph in the
case of a hospital that initiates medical
residency training programs during or
after the base period.’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to per resident payment
amounts attributable to periods beginning on or after Oc-
tober 1, 1997.
SEC. 10733. PERMITTING PAYMENT TO NON-HOSPITAL PRO-
VIDERS.
(a) IN
GENERAL.— Section 1886 (42 U.S.C.
1395ww) is amended by adding at the end the following:
‘‘(k) PAYMENT TO NON-HOSPITAL PROVIDERS.—
‘‘(1) REPORT.—The Secretary shall submit to
Congress, not later than 18 months after the date
of the enactment of this subsection, a proposal for
payment to qualified non-hospital providers for their
direct costs of medical education, if those costs are
incurred in the operation of an approved medical
residency training program described in subsection
(h). Such proposal shall specify the amounts, form,
and manner in which such payments will be made
and the portion of such payments that will be made
from each of the trust funds under this title.
1240
[HVAC Reconciliation]
‘‘(2) EFFECTIVENESS.—Except as otherwise
provided in law, the Secretary may implement such
proposal for residency years beginning not earlier
than 6 months after the date of submittal of the re-
port under paragraph (1).
‘‘(3) QUALIFIED NON-HOSPITAL PROVIDERS.—
For purposes of this subsection, the term ‘qualified
non-hospital provider’ means—
‘‘(A) a Federally qualified health center, as
defined in section 1861(aa)(4);
‘‘(B) a rural health clinic, as defined in
section 1861(aa)(2);
‘‘(C) MedicarePlus organizations; and
‘‘(D) such other providers (other than hos-
pitals) as the Secretary determines to be appro-
priate.’’.
(b) PROHIBITION ON DOUBLE PAYMENTS; BUDGET
NEUTRALITY ADJUSTMENT.—Section 1886(h)(3)(B) (42
U.S.C. 1395ww(h)(3)(B)) is amended by adding at the
end the following:
‘‘The Secretary shall reduce the aggregate ap-
proved amount to the extent payment is made
under subsection (k) for residents included in
the hospital’s count of full-time equivalent resi-
dents and, in the case of residents not included
1241
[HVAC Reconciliation]
in any such count, the Secretary shall provide
for such a reduction in aggregate approved
amounts under this subsection as will assure
that the application of subsection (k) does not
result in any increase in expenditures under
this title in excess of those that would have oc-
curred if subsection (k) were not applicable.’’.
SEC. 10734. INCENTIVE PAYMENTS UNDER PLANS FOR VOL-
UNTARY REDUCTION IN NUMBER OF RESI-
DENTS.
(a) IN
GENERAL.—Section 1886(h) (42 U.S.C.
1395ww(h)) is further amended by adding at the end the
following new paragraph:
‘‘(6) INCENTIVE PAYMENT UNDER PLANS FOR
VOLUNTARY
REDUCTION
IN
NUMBER
OF
RESI-
DENTS.—
‘‘(A) IN GENERAL.—In the case of a vol-
untary residency reduction plan for which an
application is approved under subparagraph
(B), the qualifying entity submitting the plan
shall be paid an applicable hold harmless per-
centage (as specified in subparagraph (E)) of
the sum of—
‘‘(i) amount (if any) by which—
1242
[HVAC Reconciliation]
‘‘(I) the amount of payment
which would have been made under
this subsection if there had been a 5
percent reduction in the number of
full-time equivalent residents in the
approved medical education training
programs of the qualifying entity as of
June 30, 1997, exceeds
‘‘(II) the amount of payment
which is made under this subsection,
taking into account the reduction in
such number effected under the re-
duction plan; and
‘‘(ii) the amount of the reduction in
payment under 1886(d)(5)(B) (for hos-
pitals participating in the qualifying entity)
that is attributable to the reduction in
number of residents effected under the
plan below 95 percent of the number of
full-time equivalent residents in such pro-
grams of such entity as of June 30, 1997.
‘‘(B) 
APPROVAL
OF
PLAN
APPLICA-
TIONS.—The Secretary may not approve the ap-
plication of an qualifying entity unless—
1243
[HVAC Reconciliation]
‘‘(i) the application is submitted in a
form and manner specified by the Sec-
retary and by not later than March 1,
2000,
‘‘(ii) the application provides for the
operation of a plan for the reduction in the
number of full-time equivalent residents in
the approved medical residency training
programs of the entity consistent with the
requirements of subparagraph (D);
‘‘(iii) the entity elects in the applica-
tion whether such reduction will occur
over—
‘‘(I) a period of not longer than
5 residency training years, or
‘‘(II) a period of 6 residency
training years,
except that a qualifying entity described in
subparagraph (C)(i)(III) may not make the
election described in subclause (II); and
‘‘(iv) the Secretary determines that
the application and the entity and such
plan meet such other requirements as the
Secretary specifies in regulations.
‘‘(C) QUALIFYING ENTITY.—
1244
[HVAC Reconciliation]
‘‘(i) IN
GENERAL.—For purposes of
this paragraph, any of the following may
be a qualifying entity:
‘‘(I) Individual hospitals operat-
ing one or more approved medical
residency training programs.
‘‘(II) Subject to clause (ii), two
or more hospitals that operate such
programs and apply for treatment
under this paragraph as a single
qualifying entity.
‘‘(III) Subject to clause (iii), a
qualifying consortium (as described in
section 10735 of the Balanced Budget
Act of 1997).
‘‘(ii) ADDITIONAL REQUIREMENT FOR
JOINT PROGRAMS.—In the case of an ap-
plication by a qualifying entity described in
clause (i)(II), the Secretary may not ap-
prove the application unless the application
represents that the qualifying entity ei-
ther—
‘‘(I) in the case of an entity that
meets the requirements of clause (v)
of subparagraph (D) will not reduce
1245
[HVAC Reconciliation]
the number of full-time equivalent
residents in primary care during the
period of the plan, or
‘‘(II) in the case of another en-
tity will not reduce the proportion of
its residents in primary care (to the
total number of residents) below such
proportion as in effect as of the appli-
cable time described in subparagraph
(D)(vi).
‘‘(iii) ADDITIONAL REQUIREMENT FOR
CONSORTIA.—In the case of an application
by a qualifying entity described in clause
(i)(III), the Secretary may not approve the
application unless the application rep-
resents that the qualifying entity will not
reduce the proportion of its residents in
primary care (to the total number of resi-
dents) below such proportion as in effect
as of the applicable time described in sub-
paragraph (D)(vi).
‘‘(D) RESIDENCY
REDUCTION
REQUIRE-
MENTS.—
‘‘(i) INDIVIDUAL
HOSPITAL
APPLI-
CANTS.—In the case of a qualifying entity
1246
[HVAC Reconciliation]
described in subparagraph (C)(i)(I), the
number of full-time equivalent residents in
all the approved medical residency training
programs operated by or through the en-
tity shall be reduced as follows:
‘‘(I) If base number of residents
exceeds 750 residents, by a number
equal to at least 20 percent of such
base number.
‘‘(II) Subject to subclause (IV),
if base number of residents exceeds
500, but is less than 750, residents,
by 150 residents.
‘‘(III) Subject to subclause (IV),
if base number of residents does not
exceed 500 residents, by a number
equal to at least 25 percent of such
base number.
‘‘(IV) In the case of a qualifying
entity which is described in clause (v)
and which elects treatment under this
subclause, by a number equal to at
least 20 percent of such base number.
‘‘(ii) JOINT APPLICANTS.—In the case
of a qualifying entity described in subpara-
1247
[HVAC Reconciliation]
graph (C)(i)(II), the number of full-time
equivalent residents in all the approved
medical residency training programs oper-
ated by or through the entity shall be re-
duced as follows:
‘‘(I) Subject to subclause (II), by
a number equal to at least 25 percent
of such base number.
‘‘(II) In the case of a qualifying
entity which is described in clause (v)
and which elects treatment under this
subclause, by a number equal to at
least 20 percent of such base number.
‘‘(iii) CONSORTIA.—In the case of a
qualifying entity described in subparagraph
(C)(i)(III), the number of full-time equiva-
lent residents in all the approved medical
residency training programs operated by or
through the entity shall be reduced by a
number equal to at least 20 percent of
such base number.
‘‘(iv) MANNER OF REDUCTION.—The
reductions specified under the preceding
provisions of this subparagraph for a quali-
fying entity shall be below the base number
1248
[HVAC Reconciliation]
of residents for that entity and shall be
fully effective not later than—
‘‘(I) the 5th residency training
year in which the application under
subparagraph (B) is effective, in the
case of an entity making the election
described in subparagraph (B)(iii)(I),
or
‘‘(II) the 6th such residency
training year, in the case of an entity
making the election described in sub-
paragraph (B)(iii)(II).
‘‘(v) ENTITIES PROVIDING ASSURANCE
OF MAINTENANCE OF PRIMARY CARE RESI-
DENTS.—An entity is described in this
clause if—
‘‘(I) the base number of residents
for the entity is less than 750;
‘‘(II) the number of full-time
equivalent residents in primary care
included in the base number of resi-
dents for the entity is at least 10 per-
cent of such base number; and
‘‘(III) the entity represents in its
application under subparagraph (B)
1249
[HVAC Reconciliation]
that there will be no reduction under
the plan in the number of full-time
equivalent residents in primary care.
If a qualifying entity fails to comply with
the representation described in subclause
(III), the entity shall be subject to repay-
ment of all amounts paid under this para-
graph, in accordance with procedures es-
tablished to carry out subparagraph (F).
‘‘(vi) BASE
NUMBER
OF
RESIDENTS
DEFINED.—For purposes of this para-
graph, the term ‘base number of residents’
means, with respect to a qualifying entity
operating 
approved 
medical 
residency
training programs, the number of full-time
equivalent residents in such programs (be-
fore application of weighting factors) of
the entity as of the most recent cost re-
porting period ending before June 30,
1997, or, if less, for any subsequent cost
reporting period that ends before the date
the entity makes application under this
paragraph.
‘‘(E) APPLICABLE HOLD HARMLESS PER-
CENTAGE.—
1250
[HVAC Reconciliation]
‘‘(i) IN
GENERAL.—For purposes of
subparagraph (A), the ‘applicable hold
harmless percentage’ is the percentages
specified in clause (ii) or clause (iii), as
elected by the qualifying entity in the ap-
plication submitted under subparagraph
(B).
‘‘(ii) 5-YEAR
REDUCTION
PLAN.—In
the case of an entity making the election
described in subparagraph (B)(iii)(I), the
percentages specified in this clause are, for
the—
‘‘(I) first and second residency
training years in which the reduction
plan is in effect, 100 percent,
‘‘(II) third such year, 75 percent,
‘‘(III) fourth such year, 50 per-
cent, and
‘‘(IV) fifth such year, 25 percent.
‘‘(iii) 6-YEAR
REDUCTION
PLAN.—In
the case of an entity making the election
described in subparagraph (B)(iii)(II), the
percentages specified in this clause are, for
the—
1251
[HVAC Reconciliation]
‘‘(I) first residency training year
in which the reduction plan is in ef-
fect, 100 percent,
‘‘(II) second such year, 95 per-
cent,
‘‘(III) third such year, 85 per-
cent,
‘‘(IV) fourth such year, 70 per-
cent,
‘‘(V) fifth such year, 50 percent,
and
‘‘(VI) sixth such year, 25 per-
cent.
‘‘(F) PENALTY FOR INCREASE IN NUMBER
OF
RESIDENTS
IN
SUBSEQUENT
YEARS.—If
payments are made under this paragraph to a
qualifying entity, if the entity (or any hospital
operating as part of the entity) increases the
number of full-time equivalent residents above
the number of such residents permitted under
the reduction plan as of the completion of the
plan, then, as specified by the Secretary, the
entity is liable for repayment to the Secretary
of the total amounts paid under this paragraph
to the entity.
1252
[HVAC Reconciliation]
‘‘(G) TREATMENT
OF
ROTATING
RESI-
DENTS.—In applying this paragraph, the Sec-
retary shall establish rules regarding the count-
ing of residents who are assigned to institutions
the medical residency training programs in
which are not covered under approved applica-
tions under this paragraph.’’.
(b) RELATION TO DEMONSTRATION PROJECTS AND
AUTHORITY.—
(1) Section 1886(h)(6) of the Social Security
Act, added by subsection (a), shall not apply to any
residency training program with respect to which a
demonstration project described in paragraph (3)
has been approved by the Health Care Financing
Administration as of May 27, 1997. The Secretary
of Health and Human Services shall take such ac-
tions as may be necessary to assure that (in the
manner described in subparagraph (A) of such sec-
tion) in no case shall payments be made under such
a project with respect to the first 5 percent reduc-
tion in the base number of full-time equivalent resi-
dents otherwise used under the project.
(2) Effective May 27, 1997, the Secretary of
Health and Human Services is not authorized to ap-
prove any demonstration project described in para-
1253
[HVAC Reconciliation]
graph (3) for any residency training year beginning
before July 1, 2006.
(3) A demonstration project described in this
paragraph is a project that provides for additional
payments under title XVIII of the Social Security
Act in connection with reduction in the number of
residents in a medical residency training program.
(c) INTERIM, FINAL REGULATIONS.—In order to
carry out the amendment made by subsection (a) in a
timely manner, the Secretary of Health and Human Serv-
ices may first promulgate regulations, that take effect on
an interim basis, after notice and pending opportunity for
public comment, by not later than 6 months after the date
of the enactment of this Act.
SEC. 10735. DEMONSTRATION PROJECT ON USE OF CON-
SORTIA.
(a) IN GENERAL.—The Secretary of Health and
Human Services (in this section referred to as the Sec-
retary) shall establish a demonstration project under
which, instead of making payments to teaching hospitals
pursuant to section 1886(h) of the Social Security Act,
the Secretary shall make payments under this section to
each consortium that meets the requirements of subsection
(b).
1254
[HVAC Reconciliation]
(b) QUALIFYING CONSORTIA.—For purposes of sub-
section (a), a consortium meets the requirements of this
subsection if the consortium is in compliance with the fol-
lowing:
(1) The consortium consists of an approved
medical residency training program in a teaching
hospital and one or more of the following entities:
(A) A school of allopathic medicine or os-
teopathic medicine.
(B) Another teaching hospital, which may
be a children’s hospital.
(C) Another approved medical residency
training program.
(D) A Federally qualified health center.
(E) A medical group practice.
(F) A managed care entity.
(G) An entity furnishing outpatient serv-
ices.
(H) Such other entity as the Secretary de-
termines to be appropriate.
(2) The members of the consortium have agreed
to participate in the programs of graduate medical
education that are operated by the entities in the
consortium.
1255
[HVAC Reconciliation]
(3) With respect to the receipt by the consor-
tium of payments made pursuant to this section, the
members of the consortium have agreed on a method
for allocating the payments among the members.
(4) The consortium meets such additional re-
quirements as the Secretary may establish.
(c) AMOUNT AND SOURCE OF PAYMENT.—The total
of payments to a qualifying consortium for a fiscal year
pursuant to subsection (a) shall not exceed the amount
that would have been paid under section 1886(h) of the
Social Security Act for the teaching hospital (or hospitals)
in the consortium. Such payments shall be made in such
proportion from each of the trust funds established under
title XVIII of such Act as the Secretary specifies.
SEC. 10736. RECOMMENDATIONS ON LONG-TERM PAYMENT
POLICIES REGARDING FINANCING TEACHING
HOSPITALS AND GRADUATE MEDICAL EDU-
CATION.
(a) IN GENERAL.—The Medicare Payment Advisory
Commission (established under section 1805 of the Social
Security Act and in this section referred to as the ‘‘Com-
mission’’) shall examine and develop recommendations on
whether and to what extent medicare payment policies and
other Federal policies regarding teaching hospitals and
graduate medical education should be reformed. Such rec-
1256
[HVAC Reconciliation]
ommendations shall include recommendations regarding
each of the following:
(1) The financing of graduate medical edu-
cation, including consideration of alternative broad-
based sources of funding for such education and
models for the distribution of payments under any
all-payer financing mechanism.
(2) The financing of teaching hospitals, includ-
ing consideration of the difficulties encountered by
such hospitals as competition among health care en-
tities increases. Matters considered under this para-
graph shall include consideration of the effects on
teaching hospitals of the method of financing used
for the MedicarePlus program under part C of title
XVIII of the Social Security Act.
(3) Possible methodologies for making pay-
ments for graduate medical education and the selec-
tion of entities to receive such payments. Matters
considered under this paragraph shall include—
(A) issues regarding children’s hospitals
and approved medical residency training pro-
grams in pediatrics, and
(B) whether and to what extent payments
are being made (or should be made) for train-
1257
[HVAC Reconciliation]
ing in the various nonphysician health profes-
sions.
(4) Federal policies regarding international
medical graduates.
(5) The dependence of schools of medicine on
service-generated income.
(6) Whether and to what extent the needs of
the United States regarding the supply of physi-
cians, in the aggregate and in different specialties,
will change during the 10-year period beginning on
October 1, 1997, and whether and to what extent
any such changes will have significant financial ef-
fects on teaching hospitals.
(7) Methods for promoting an appropriate num-
ber, mix, and geographical distribution of health
professionals.
(c) CONSULTATION.—In conducting the study under
subsection (a), the Commission shall consult with the
Council on Graduate Medical Education and individuals
with expertise in the area of graduate medical education,
including—
(1) deans from allopathic and osteopathic
schools of medicine;
(2) chief executive officers (or equivalent ad-
ministrative heads) from academic health centers,
1258
[HVAC Reconciliation]
integrated health care systems, approved medical
residency training programs, and teaching hospitals
that sponsor approved medical residency training
programs;
(3) chairs of departments or divisions from
allopathic and osteopathic schools of medicine,
schools of dentistry, and approved medical residency
training programs in oral surgery;
(4) individuals with leadership experience from
representative fields of non-physician health profes-
sionals;
(5) individuals with substantial experience in
the study of issues regarding the composition of the
health care workforce of the United States; and
(6) individuals with expertise on the financing
of health care.
(d) REPORT.—Not later than 2 years after the date
of the enactment of this Act, the Commission shall submit
to the Congress a report providing its recommendations
under this section and the reasons and justifications for
such recommendations.
1259
[HVAC Reconciliation]
SEC. 10737. MEDICARE SPECIAL REIMBURSEMENT RULE
FOR CERTAIN COMBINED RESIDENCY PRO-
GRAMS.
(a) IN GENERAL.—Section 1886(h)(5)(G) (42 U.S.C.
1395ww(h)(5)(G)) is amended—
(1) in clause (i), by striking ‘‘and (iii)’’ and in-
serting ‘‘, (iii), and (iv)’’; and
(2) by adding at the end the following:
‘‘(iv) SPECIAL
RULE
FOR
CERTAIN
COMBINED RESIDENCY PROGRAMS.—(I) In
the case of a resident enrolled in a com-
bined medical residency training program
in which all of the individual programs
(that are combined) are for training a pri-
mary care resident (as defined in subpara-
graph (H)), the period of board eligibility
shall be the minimum number of years of
formal training required to satisfy the re-
quirements for initial board eligibility in
the longest of the individual programs plus
one additional year.
‘‘(II) A resident enrolled in a com-
bined medical residency training program
that includes an obstetrics and gynecology
program shall qualify for the period of
board eligibility under subclause (I) if the
1260
[HVAC Reconciliation]
other programs such resident combines
with such obstetrics and gynecology pro-
gram are for training a primary care resi-
dent.’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) apply to combined medical residency pro-
grams for residency years beginning on or after July 1,
1998.
CHAPTER 5—OTHER PROVISIONS
SEC. 10741. CENTERS OF EXCELLENCE.
(a) IN GENERAL.—Title XVIII is amended by insert-
ing after section 1888 the following:
‘‘CENTERS OF EXCELLENCE
‘‘SEC. 1889. (a) IN GENERAL.—The Secretary shall
use a competitive process to contract with specific hos-
pitals or other entities for furnishing services related to
surgical procedures, and for furnishing services (unrelated
to surgical procedures) to hospital inpatients that the Sec-
retary determines to be appropriate. The services may in-
clude any services covered under this title that the Sec-
retary determines to be appropriate, including post-hos-
pital services.
‘‘(b) QUALITY STANDARDS.—Only entities that meet
quality standards established by the Secretary shall be eli-
gible to contract under this section. Contracting entities
1261
[HVAC Reconciliation]
shall implement a quality improvement plan approved by
the Secretary.
‘‘(c) PAYMENT.—Payment under this section shall be
made on the basis of negotiated all-inclusive rates. The
amount of payment made by the Secretary to an entity
under this title for services covered under a contract shall
be less than the aggregate amount of the payments that
the Secretary would have otherwise made for the services.
‘‘(d) CONTRACT PERIOD.—A contract period shall be
3 years (subject to renewal), so long as the entity contin-
ues to meet quality and other contractual standards.
‘‘(e) INCENTIVES FOR USE OF CENTERS.—Entities
under a contract under this section may furnish additional
services (at no cost to an individual entitled to benefits
under this title) or waive cost-sharing, subject to the ap-
proval of the Secretary.
‘‘(f) LIMIT ON NUMBER OF CENTERS.—The Sec-
retary shall limit the number of centers in a geographic
area to the number needed to meet projected demand for
contracted services.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) applies to services furnished on or after Oc-
tober 1, 1997.
1262
[HVAC Reconciliation]
SEC. 10742. MEDICARE PART B SPECIAL ENROLLMENT PE-
RIOD AND WAIVER OF PART B LATE ENROLL-
MENT 
PENALTY 
AND 
MEDIGAP 
SPECIAL
OPEN ENROLLMENT PERIOD FOR CERTAIN
MILITARY RETIREES AND DEPENDENTS.
(a) MEDICARE PART B SPECIAL ENROLLMENT PE-
RIOD; WAIVER OF PART B PENALTY FOR LATE ENROLL-
MENT.—
(1) IN GENERAL.—In the case of any eligible
individual (as defined in subsection (c)), the Sec-
retary of Health and Human Services shall provide
for a special enrollment period during which the in-
dividual may enroll under part B of title XVIII of
the Social Security Act. Such period shall be for a
period of 6 months and shall begin with the first
month that begins at least 45 days after the date of
the enactment of this Act.
(2) COVERAGE PERIOD.—In the case of an eli-
gible individual who enrolls during the special enroll-
ment period provided under paragraph (1), the cov-
erage period under part B of title XVIII of the So-
cial Security Act shall begin on the first day of the
month following the month in which the individual
enrolls.
(3) WAIVER
OF
PART
B
LATE
ENROLLMENT
PENALTY.—In the case of an eligible individual who
1263
[HVAC Reconciliation]
enrolls during the special enrollment period provided
under paragraph (1), there shall be no increase pur-
suant to section 1839(b) of the Social Security Act
in the monthly premium under part B of title XVIII
of such Act.
(b) MEDIGAP SPECIAL OPEN ENROLLMENT PE-
RIOD.—Notwithstanding any other provision of law, an is-
suer of a medicare supplemental policy (as defined in sec-
tion 1882(g) of the Social Security Act)—
(1) may not deny or condition the issuance or
effectiveness of a medicare supplemental policy that
has a benefit package classified as ‘‘A’’, ‘‘B’’, ‘‘C’’,
or ‘‘F’’ under the standards established under sec-
tion 1882(p)(2) of the Social Security Act (42
U.S.C. 1395rr(p)(2)); and
(2) may not discriminate in the pricing of the
policy on the basis of the individual’s health status,
medical condition (including both physical and men-
tal illnesses), claims experience, receipt of health
care, medical history, genetic information, evidence
of insurability (including conditions arising out of
acts of domestic violence), or disability;
in the case of an eligible individual who seeks to enroll
(and is enrolled) during the 6-month period described in
subsection (a)(1).
1264
[HVAC Reconciliation]
(c) ELIGIBLE INDIVIDUAL DEFINED.—In this sec-
tion, the term ‘‘eligible individual’’ means an individual—
(1) who, as of the date of the enactment of this
Act, has attained 65 years of age and was eligible
to enroll under part B of title XVIII of the Social
Security Act, and
(2) who at the time the individual first satisfied
paragraph (1) or (2) of section 1836 of the Social
Security Act—
(A) was a covered beneficiary (as defined
in section 1072(5) of title 10, United States
Code), and
(B) did not elect to enroll (or to be deemed
enrolled) under section 1837 of the Social Secu-
rity Act during the individual’s initial enroll-
ment period.
The Secretary of Health and Human Services shall con-
sult with the Secretary of Defense in the identification of
eligible individuals.
SEC. 10743. PROTECTIONS UNDER THE MEDICARE PRO-
GRAM FOR DISABLED WORKERS WHO LOSE
BENEFITS UNDER A GROUP HEALTH PLAN.
(a) NO PREMIUM PENALTY
FOR LATE ENROLL-
MENT.—The second sentence of section 1839(b) (42
U.S.C. 1395r(b)) is amended by inserting ‘‘and not pursu-
1265
[HVAC Reconciliation]
ant to a special enrollment period under section
1837(i)(4)’’ after ‘‘section 1837)’’.
(b) SPECIAL MEDICARE ENROLLMENT PERIOD.—
(1) IN GENERAL.—Section 1837(i) (42 U.S.C.
1395p(i)) is amended by adding at the end the fol-
lowing new paragraph:
‘‘(4)(A) In the case of an individual who is entitled
to benefits under part A pursuant to section 226(b) and—
‘‘(i) who at the time the individual first satisfies
paragraph (1) or (2) of section 1836—
‘‘(I) is enrolled in a group health plan de-
scribed in section 1862(b)(1)(A)(v) by reason of
the individual’s (or the individual’s spouse’s)
current employment or otherwise, and
‘‘(II) has elected not to enroll (or to be
deemed enrolled) under this section during the
individual’s initial enrollment period; and
‘‘(ii) whose continuous enrollment under such
group health plan is involuntarily terminated at a
time when the enrollment under the plan is not by
reason of the individual’s (or the individual’s
spouse’s) current employment,
there shall be a special enrollment period described in sub-
paragraph (B).