under this paragraph for the area for the
previous year.’’.
(b) CONSTRUCTION.—The amendments made by sub-
section (a) do not affect the payment of a first time bonus
under section 1853(i) of the Social Security Act (42
U.S.C. 1395w–23(i)).
SEC. 8. PERMITTING HIGHER NEGOTIATED RATES IN CER-
TAIN MEDICARE+CHOICE PAYMENT AREAS
BELOW NATIONAL AVERAGE.
Section 1853(c)(1) of the Social Security Act (42
U.S.C. 1395w–23(c)(1)) is amended—
(1) in the matter before subparagraph (A), by
striking ‘‘or (C)’’ and inserting ‘‘(C), or (D)’’; and
(2) by adding at the end the following new sub-
paragraph:
‘‘(D) 
PERMITTING
HIGHER
RATES
THROUGH NEGOTIATION.—
‘‘(i) IN GENERAL.—For each year be-
ginning with 2004, in the case of a
Medicare+Choice payment area for which
the Medicare+Choice capitation rate under
this paragraph would otherwise be less
than the United States per capita cost
(USPCC), as calculated by the Secretary,
a Medicare+Choice organization may ne-
gotiate with the Secretary an annual per
capita rate that—
‘‘(I) reflects an annual rate of in-
crease up to the rate of increase speci-
fied in clause (ii);
‘‘(II) takes into account audited
current data supplied by the organiza-
tion on its adjusted community rate
(as defined in section 1854(f)(3)); and
‘‘(III) does not exceed the United
States per capita cost, as projected by
the Secretary for the year involved.
‘‘(ii) MAXIMUM
RATE
DESCRIBED.—
The rate of increase specified in this clause
for a year is the rate of inflation in private
health insurance for the year involved, as
projected by the Secretary, and includes
such adjustments as may be necessary—
‘‘(I) to reflect the demographic
characteristics in the population under
this title; and
‘‘(II) to eliminate the costs of
prescription drugs.
‘‘(iii) ADJUSTMENTS
FOR
OVER
OR
UNDER PROJECTIONS.—If subparagraph is
applied to an organization and payment
area for a year, in applying this subpara-
graph for a subsequent year the provisions
of paragraph (6)(C) shall apply in the
same manner as such provisions apply
under this paragraph.’’.
SEC. 9. 10-YEAR PHASE IN OF RISK ADJUSTMENT BASED ON
DATA FROM ALL SETTINGS.
Section 1853(a)(3)(C)(ii) of the Social Security Act
(42 U.S.C. 1395w–23(c)(1)(C)(ii)) is amended—
(1) by striking the period at the end of sub-
clause (II) and inserting a semicolon; and
(2) by adding after and below subclause (II) the
following:
‘‘and, beginning in 2004, insofar as such
risk adjustment is based on data from all
(or substantially all) settings, the method-
ology shall be phased in equal increments
over a 10 year period, beginning with 2004
or (if later) the first year in which such
data is used.’’.
SEC. 10. DELAY FROM JULY TO NOVEMBER, 2000 IN DEAD-
LINE FOR OFFERING AND WITHDRAWING
MEDICARE+CHOICE PLANS FOR 2001.
Notwithstanding any other provision of law, the dead-
line for a Medicare+Choice organization to withdraw the
offering of a Medicare+Choice plan under part C of title
XVIII of the Social Security Act (or otherwise to submit
information required for the offering of such a plan) for
2001 is delayed from July 1, 2000, to November 1, 2000,
and any such organization that provided notice of with-
drawal of such a plan during 2000 before the date of the
enactment of this Act may rescind such withdrawal at any
time before November 1, 2000.
SEC. 11. MISCELLANEOUS REGULATORY CHANGES.
(a) PROHIBITION ON REQUIREMENT TO SUBMIT EN-
COUNTER DATA.—Section 1853(a)(3)(B) of the Social Se-
curity Act (42 U.S.C. 1395w–23(a)(3)(B)) is amended—
(1) by designating the matter following ‘‘DATA
COLLECTION’’ as a clause (i) with appropriate inden-
tation and the heading ‘‘IN GENERAL’’; and
(2) by adding at the end the following new
clauses:
‘‘(ii) ISSUANCE OF DATA SUBMISSION
REQUIREMENTS.—The Secretary may not
require under clause (i) the submission of
encounter data to support a risk adjust-
ment methodology based on all (or sub-
stantially all) settings until a reasonable
time after the Secretary issues the com-
plete requirements for data submission.
Such requirements shall be limited to the
minimum data elements necessary to sup-
port the risk adjustment methodology.
Such system shall be designed to accept
the required minimum data elements in a
form 
and 
manner 
compatible 
with
Medicare+Choice 
organizations’ 
oper-
ations.
‘‘(iii) EVALUATION.—In issuing such
data submission requirements, the Sec-
retary must include an evaluation by an
outside, independent actuary of whether
the proposed data elements are the min-
imum necessary to support the risk adjust-
ment methodology.’’.
(b) 
POST-STABILIZATION
GUIDELINES.—Section
1852(d)(2) of such Act (42 U.S.C. 1395w–22(d)(2)) is
amended by adding at the end the following: ‘‘In pre-
scribing such guidelines—
‘‘(A) post-stabilization care shall be limited
to care related to treatment of the condition
that precipitated the provision of emergency
services; and
‘‘(B) the provider of emergency services is
not authorized to provide post-stabilization care
unless—
‘‘(i) the Medicare+Choice organiza-
tion has been notified as soon as prac-
ticable, but not later than 2 hours after
stabilization, in advance of the request to
provide such care;
‘‘(ii) the organization has either ap-
proved the request or not responded to
such request within a reasonable period (of
at least 3 hours) after it has been notified;
and
‘‘(iii) the emergency services provider
maintains a written documentation con-
cerning the notice and the organization’s
response to such notice.’’.
(c) ENROLLMENT PROCESS.—
(1) ALLOWING
ON-LINE
ENROLLMENT.—Sec-
tion 1851(c)(2) of such Act (42 U.S.C. 1395w–
21(c)(2)) is amended by adding at the end the fol-
lowing:
‘‘(C) ON-LINE APPLICATIONS.—Such proc-
ess shall permit the filing of appropriate elec-
tion forms under subparagraphs (A) and (B) to
be done through electronic means (including use
of the Internet).’’.
(2) 
MORATORIUM
ON
CHANGES
IN
MEDICARE+CHOICE
ENROLLMENT
RULES.—The
Secretary of Health and Human Services shall not
make 
any 
changes 
in 
the 
enrollment 
and
disenrollment instructions and related materials (in-
cluding operational policy letters and evidence of
coverage) under the Medicare+Choice program
under part C of title XVIII of the Social Security
Act between the date of the enactment of this Act
and January 1, 2002, except as may be specifically
and only required to comply with a change in stat-
ute.
Æ