I
106TH CONGRESS
1ST SESSION
H. R. 3086
To direct the Secretary of Health and Human Services to make changes
in payment methodologies under the Medicare Program under title XVIII
of the Social Security Act, and to provide for short-term coverage of
outpatient prescription drugs to Medicare beneficiaries who lose drug
coverage under Medicare+Choice plans.
IN THE HOUSE OF REPRESENTATIVES
OCTOBER 14, 1999
Mrs. THURMAN (for herself and Mr. MCDERMOTT) 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 provi-
sions as fall within the jurisdiction of the committee concerned
A BILL
To direct the Secretary of Health and Human Services to
make changes in payment methodologies under the Medi-
care Program under title XVIII of the Social Security
Act, and to provide for short-term coverage of outpatient
prescription drugs to Medicare beneficiaries who lose
drug coverage under 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 Benefit Eq-
uity and Emergency Access to Prescription Drugs Act of
1999’’.
SEC. 2. FINDINGS.
Congress finds as follows:
(1) American taxpayers should receive equal
Medicare services regardless of place of residence.
(2) Medicare managed care plans play a funda-
mental role in the health of our Nation’s seniors,
often providing coordinated care and access to phar-
maceuticals. The loss of Medicare managed care
plans and their services can be devastating to our
Nation’s Medicare-eligible seniors.
(3) For the second consecutive year, Medicare
managed care plans are abandoning hundreds of
thousands of medicare beneficiaries. The most recent
announcement of plan cancellations means that
within the past two years, 734,000 of the Nation’s
6,200,000 Medicare beneficiaries enrolled in man-
aged care plans will have been dropped from those
plans.
(4) In 1999, Medicare managed care plan with-
drawals affected nearly 407,000 Medicare bene-
ficiaries, and 51,276 beneficiaries in 79 counties
were left with no other Medicare managed care op-
tion.
(5) Beginning January 2000, another 327,000
enrollees will need to find alternative coverage, and
79,000 of these Medicare managed care participants
will have no other Medicare+Choice plan available.
(6) Medicare beneficiaries who have lost their
managed care option can enroll in Medicare fee-for-
service; however, Medicare fee-for-service does not
currently provide comprehensive outpatient pharma-
ceutical coverage.
(7) While all beneficiaries pay the same medi-
care part B premium as other program participants,
Medicare beneficiaries regularly pay managed care
plans varied amounts and receive very unequal serv-
ices and benefits.
(8) A growing body of data suggests that med-
ical practice and Medicare spending vary substan-
tially among the Nation’s hospital referral regions,
even after adjustments for differences in regional
prices and illness rates, but there is little evidence
that greater spending brings better health.
(9) By adjusting Medicare reimbursement pay-
ment rates (adjusted for age, sex, severity of illness,
etc.,) and lowering Medicare reimbursement pay-
ment to providers and regions where there are more
costly patterns of practice without better health out-
comes, Congress can provide more equitable and ef-
ficient health care for our Nation’s 39,000,000
Medicare beneficiaries.
(10) Such a strategy will encourage a more re-
sponsible practice of medicine at the lowest cost to
the taxpayer and Medicare beneficiary, and will free
resources for improvements to the medicare pro-
gram.
SEC. 3. MEDICARE CLINICAL PRACTICE AND PAYMENT PAT-
TERN ADJUSTMENT.
(a) ESTABLISHMENT OF PRACTICE PROFILES.—
(1) IN GENERAL.—By not later than January
1, 2002, the Secretary of Health and Human Serv-
ices shall establish clinical profiles of the practice
and payment patterns of health care providers (in-
cluding both institutional providers and health care
professionals) furnishing items and services under
the medicare program under title XVIII of the So-
cial Security Act in order to determine how their
practice and payment patterns compare to each
other on a local, State, and national basis. In estab-
lishing such profiles, the Secretary shall take into
account differences in the case mix and severity of