I
106TH CONGRESS
2D SESSION
H. R. 5614
To amend part C of title XVIII of the Social Security Act to improve
the Medicare+Choice Program.
IN THE HOUSE OF REPRESENTATIVES
NOVEMBER 1, 2000
Mr. ACKERMAN introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committee on Com-
merce, for a period to be subsequently determined by the Speaker, in
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned
A BILL
To amend part C of title XVIII of the Social Security Act
to improve 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 ‘‘Seniors’ Health Care
Restoration Act of 2000’’.
SEC. 2. INCREASED PAYMENT FOR AREAS WITH TWO OR
FEWER MEDICARE+CHOICE CONTRACTS.
Section 1853 of the Social Security Act (42 U.S.C.
1395w–23) is amended—
(1) in subsection (a)(1)(A), by striking ‘‘and
(i)’’ and inserting ‘‘(i), and (j)’’; and
(2) by adding at the end the following new sub-
section:
‘‘(j) INCREASED PAYMENT FOR AREAS WITH 2 OR
FEWER MEDICARE+CHOICE CONTRACTS.—For months
during 2002 and 2003, in the case of a Medicare+Choice
payment area in which there is no more than two contracts
entered into under this part as of July 1 before the begin-
ning of the year involved, the amount of the monthly pay-
ment otherwise made under this section (taking into ac-
count, if applicable, subsection (i)) shall be increased by
1⁄2 percentage point of the total monthly payment other-
wise computed for such payment area.’’.
SEC. 3. INCREASE IN MINIMUM PERCENTAGE UPDATE.
Section 1853(c)(1)(C)(ii) of the Social Security Act
(42 U.S.C. 1395w–23(c)(1)(C)(ii)) is amended by insert-
ing ‘‘(or 104 percent in the case of 2001, 2002, and
2003)’’ after ‘‘102 percent’’.
SEC. 4. TRANSITION TO REVISED MEDICARE+CHOICE PAY-
MENT RATES.
(a) 
ANNOUNCEMENT
OF
REVISED
MEDICARE+CHOICE PAYMENT RATES.—Within 2 weeks
after the date of the enactment of this Act, the Secretary
of Health and Human Services shall determine, and shall
announce (in a manner intended to provide notice to inter-
ested parties) Medicare+Choice capitation rates under
section 1853 of the Social Security Act (42 U.S.C.
1395w–23) for 2001, revised in accordance with the provi-
sions of this Act.
(b) REENTRY
INTO
PROGRAM
PERMITTED
FOR
MEDICARE+CHOICE
PROGRAMS
IN
2000.—A
Medicare+Choice organization that provided notice to the
Secretary of Health and Human Services as of July 3,
2000, that it was terminating its contract under part C
of title XVIII of the Social Security Act or was reducing
the service area of a Medicare+Choice plan offered under
such part shall be permitted to continue participation
under such part, or to maintain the service area of such
plan, for 2001 if it provides the Secretary with the infor-
mation described in section 1854(a)(1) of the Social Secu-
rity Act (42 U.S.C. 1395w–24(a)(1)) within 4 weeks after
the date of the enactment of this Act.
(c) REVISED SUBMISSION OF PROPOSED PREMIUMS
AND RELATED INFORMATION.—If—
(1) a Medicare+Choice organization provided
notice to the Secretary of Health and Human Serv-
ices as of July 3, 2000, that it was renewing its con-
tract under part C of title XVIII of the Social Secu-
rity Act for all or part of the service area or areas
served under its current contract, and
(2) any part of the service area or areas ad-
dressed in such notice includes a county for which
the Medicare+Choice capitation rate under section
1853(c) of such Act (42 U.S.C. 1395w–23(c)) for
2001, as determined under subsection (a), is higher
than the rate previously determined for such year,
such organization shall revise its submission of the infor-
mation described in section 1854(a)(1) of the Social Secu-
rity Act (42 U.S.C. 1395w–24(a)(1)), and shall submit
such revised information to the Secretary, within 4 weeks
after the date of the enactment of this Act.
SEC. 5. PROVISION OF EMERGENCY OUTPATIENT PRE-
SCRIPTION DRUG COVERAGE FOR MEDICARE
BENEFICIARIES LOSING DRUG COVERAGE
UNDER MEDICARE+CHOICE PLANS.
(a) TEMPORARY COVERAGE OF OUTPATIENT PRE-
SCRIPTION DRUGS FOR MEDICARE BENEFICIARIES LOS-
ING
PRESCRIPTION
DRUG
COVERAGE
UNDER
MEDICARE+CHOICE PLANS.—
(1) IN GENERAL.—The Secretary of Health and
Human Services shall provide for coverage of out-
patient prescription drugs to eligible medicare bene-
ficiaries under this section. The Secretary shall pro-
vide for such coverage by entering into agreements
with eligible organizations to furnish such coverage.
(2) TERM
OF
EMERGENCY
COVERAGE.—The
Secretary shall provide coverage of outpatient pre-
scription drugs to an eligible medicare beneficiary
under this section for the 24-month period beginning
on the date the eligible medicare beneficiary loses
coverage of outpatient prescription drugs under the
Medicare+Choice plan in which the beneficiary is
enrolled.
(3) COST-SHARING.—With respect to coverage
of outpatient prescription drugs furnished under this
section, benefits under this section shall not begin
until the eligible medicare beneficiary has met a $50
deductible.
(4) PAYMENT.—The Secretary shall provide for
payment for such coverage under this section from
the Emergency Reserve Outpatient Prescription
Drug Account established under subsection (b).
(b) ACCOUNT FOR EMERGENCY OUTPATIENT PRE-
SCRIPTION DRUG BENEFIT IN SMI TRUST FUND.—
(1) ESTABLISHMENT.—There is hereby estab-
lished in the Federal Supplementary Medical Insur-
ance Trust Fund under section 1841 of the Social
Security Act (42 U.S.C. 1395t) an expenditure ac-
count to be known as the ‘‘Emergency Reserve Out-
patient Prescription Drug Account’’.
(2) CREDITING
OF
FUNDS.—The Managing
Trustee shall credit to the Emergency Reserve Out-
patient Prescription Drug Account such amounts as
may be deposited in the Federal Supplementary
Medical Insurance Trust Fund as follows:
(A) Amounts appropriated to the account.
(B) Amounts equal to the annual out-
standing balance of the Health Care Fraud and
Abuse Control Account under section 1817(k)
of the Social Security Act (42 U.S.C. 1395i(k))
at the end of each fiscal year that the Secretary
determines may be made available to the Emer-
gency Reserve Outpatient Prescription Drug
Account.
(3) USE
OF
FUNDS.—Funds credited to the
Outpatient Prescription Drug Account may only be
used to pay for outpatient prescription drugs (and
associated administrative costs) furnished under this
section.
(4) 
CONFORMING
AMENDMENT.—Section
1817(k)(3)(C) 
of 
such 
Act 
(42 
U.S.C.
1395i(k)(3)(C)) is amended—
(A) by striking ‘‘and’’ at the end of clause
(iv);
(B) by striking the period at the end of
clause (v) and inserting ‘‘; and’’; and
(C) by adding at the end the following new
clause:
‘‘(vi) providing temporary emergency
coverage of outpatient prescription drugs
for eligible beneficiaries under section 5 of
the Seniors’ Health Care Restoration Act
of 2000.’’.
(c) DEFINITIONS.—In this section:
(1) ELIGIBLE
MEDICARE
BENEFICIARY.—The
term ‘‘eligible medicare beneficiary’’ means an
individual—
(A) who is enrolled in a Medicare+Choice
plan under part C of title XVIII of the Social
Security Act; and
(B)(i) whose enrollment in such plan is
terminated or may not be renewed or whose
service area has been reduced for the next con-
tract year because the plan has been terminated
or will not be offered in such contract year; or
(ii) whose coverage of outpatient prescrip-
tion drugs under such plan has been termi-
nated, significantly reduced, or no longer pro-
vides for the coverage of a particular outpatient
prescription drug required.
(2) COVERED OUTPATIENT DRUG.—
(A) IN GENERAL.—Except as provided in
subparagraph (B), the term ‘‘covered outpatient
drug’’ means any of the following products:
(i) A drug which may be dispensed
only upon prescription, and—
(I) which is approved for safety
and effectiveness as a prescription
drug under section 505 of the Federal
Food, Drug, and Cosmetic Act;
(II)(aa) which was commercially
used or sold in the United States be-
fore the date of enactment of the
Drug Amendments of 1962 or which
is identical, similar, or related (within
the meaning of section 310.6(b)(1) of
title 21 of the Code of Federal Regu-
lations) to such a drug, and (bb)
which has not been the subject of a
final determination by the Secretary
that it is a ‘‘new drug’’ (within the
meaning of section 201(p) of the Fed-
eral Food, Drug, and Cosmetic Act)
or an action brought by the Secretary
under section 301, 302(a), or 304(a)
of such Act to enforce section 502(f)
or 505(a) of such Act; or
(III)(aa) which is described in
section 107(c)(3) of the Drug Amend-
ments of 1962 and for which the Sec-
retary has determined there is a com-
pelling justification for its medical
need, or is identical, similar, or re-
lated (within the meaning of section
310.6(b)(1) of title 21 of the Code of
Federal Regulations) to such a drug,
and (bb) for which the Secretary has
not issued a notice of an opportunity
for a hearing under section 505(e) of
the Federal Food, Drug, and Cos-
metic Act on a proposed order of the
Secretary to withdraw approval of an
application for such drug under such
section because the Secretary has de-
termined that the drug is less than ef-
fective for all conditions of use pre-
scribed, recommended, or suggested in
its labeling.
(ii) A biological product which—
(I) may only be dispensed upon
prescription;
(II) is licensed under section 351
of the Public Health Service Act; and
(III) is produced at an establish-
ment licensed under such section to
produce such product.
(iii) Insulin approved under appro-
priate Federal law.
(iv) A prescribed drug or biological
product that would meet the requirements
of clause (i) or (ii) but that is available
over-the-counter in addition to being avail-
able upon prescription.
(B) EXCLUSION.—The term ‘‘covered out-
patient drug’’ does not include any product—
(i) except as provided in subparagraph
(A)(iv), which may be distributed to indi-
viduals without a prescription;
(ii) when furnished as part of, or as
incident to, a diagnostic service or any
other item or service for which payment
may be made under title XVIII of the So-
cial Security Act; or
(iii) that is a therapeutically equiva-
lent replacement for a product described in
clause (i) or (ii), as determined by the Sec-
retary.
(3) ELIGIBLE ORGANIZATION.—The term ‘‘eligi-
ble organization’’ means any organization that the
Secretary determines to be appropriate, including—
(A) pharmaceutical benefit management
companies;
(B) wholesale and retail pharmacist deliv-
ery systems;
(C) insurers;
(D) other organizations; or
(E) any combination of the entities de-
scribed in subparagraphs (A) through (D).
(4) SECRETARY.—The term ‘‘Secretary’’ means
the Secretary of Health and Human Services.
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