I
105TH CONGRESS
2D SESSION
H. R. 4653
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
SEPTEMBER 28, 1998
Mr. GEJDENSON (for himself and Mrs. KENNELLY of Connecticut) 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 1998’’.
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-