I
106TH CONGRESS
2D SESSION
H. R. 5039
To amend part C of title XVIII of the Social Security Act to revise and
improve the Medicare+Choice Program.
IN THE HOUSE OF REPRESENTATIVES
JULY 27, 2000
Mr. HAYWORTH 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 revise and 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; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Medicare Choice Preservation Act of 2000’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—IMPROVEMENTS IN PAYMENTS
Sec. 101. Increase in national per capita medicare+choice growth percentage in
2001 and 2002.
Sec. 102. Increasing minimum payment amount.
Sec. 103. Allowing movement to 50:50 percent blend in 2002.
Sec. 104. Increasing the minimum percentage increase in 2001.
Sec. 105. Increased update for payment areas with only one or no
Medicare+Choice contracts.
Sec. 106. Elimination of budget neutrality adjustment for 2001 and 2002.
Sec. 107. Revising calculation of area-specific rate.
Sec. 108. 10-year phase in of risk adjustment based on data from all settings.
TITLE II—ADDITIONAL IMPROVEMENTS
Sec. 201. Delay from July to November, 15, 2000, in deadline for offering and
withdrawing Medicare+Choice plans for 2001.
Sec. 202. Miscellaneous regulatory changes.
Sec. 203. Effectiveness of elections and changes of elections.
Sec. 204. Uniform premium and benefits.
Sec. 205. Medicare+Choice program compatibility with employer group or
union group health plans.
TITLE I—IMPROVEMENTS IN
PAYMENTS
SEC. 
101. 
INCREASE 
IN 
NATIONAL 
PER 
CAPITA
MEDICARE+CHOICE GROWTH PERCENTAGE
IN 2001 AND 2002.
Section 1853(c)(6)(B) of the Social Security Act (42
U.S.C. 1395w–23(c)(6)(B)) is amended—
(1) in clause (iv), by striking ‘‘for 2001, 0.5
percentage points’’ and inserting ‘‘for 2001, 0 per-
centage points’’; and
(2) in clause (v), by striking ‘‘for 2002, 0.3 per-
centage points’’ and inserting ‘‘for 2002, 0 percent-
age points’’.
SEC. 102. INCREASING MINIMUM PAYMENT AMOUNT.
(a) IN GENERAL.—Section 1853(c)(1)(B)(ii) of the
Social Security Act (42 U.S.C. 1395w–23(c)(1)(B)(ii)) is
amended—
(1) by striking ‘‘(ii) For a succeeding year’’ and
inserting ‘‘(ii)(I) Subject to subclause (II), for a suc-
ceeding year’’; and
(2) by adding at the end the following new sub-
clause:
‘‘(II) For 2001 for any of the 50
States and the District of Columbia,
$475.’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) apply to years beginning with 2001.
SEC. 103. ALLOWING MOVEMENT TO 50:50 PERCENT BLEND
IN 2002.
Section 1853(c)(2) of the Social Security Act (42
U.S.C. 1395w–23(c)(2)) is amended—
(1) by striking the period at the end of sub-
paragraph (F) and inserting a semicolon; and
(2) by adding after and below subparagraph
(F) the following:
‘‘except that a Medicare+Choice organization may
elect to apply subparagraph (F) (rather than sub-
paragraph (E)) for 2002.’’.
SEC. 104. INCREASING THE MINIMUM PERCENTAGE IN-
CREASE IN 2001.
Section 1853(c)(1)(C) of the Social Security Act (42
U.S.C. 1395w–23(c)(1)(C)) is amended—
(1) in clause (i) by striking ‘‘For 1998’’ and in-
serting ‘‘For 1998, 1999, and 2000’’; and
(2) in clause (ii) by striking ‘‘102’’ and insert-
ing ‘‘104’’.
SEC. 105. INCREASED UPDATE FOR PAYMENT AREAS WITH
ONLY ONE OR NO MEDICARE+CHOICE CON-
TRACTS.
(a) IN GENERAL.—Section 1853(c)(1)(C)(ii) of the
Social Security Act (42 U.S.C. 1395w–23(c)(1)(C)(ii)) is
amended—
(1) by striking ‘‘(ii) For a subsequent year’’
and inserting ‘‘(ii)(I) Subject to subclause (II), for
a subsequent year’’; and
(2) by adding at the end the following new sub-
clause:
‘‘(II) During 2002, 2003, 2004, and
2005, in the case of a Medicare+Choice
payment area in which there is no more
than one contract entered into under this
part as of July 1 before the beginning of
the year, 104.5 percent of the annual
Medicare+Choice capitation rate under
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) apply with respect to years beginning on
or after January 1, 2001.
SEC. 108. 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.’’.
TITLE II—ADDITIONAL
IMPROVEMENTS
SEC. 201. DELAY FROM JULY TO NOVEMBER, 15, 2000, IN
DEADLINE 
FOR 
OFFERING 
AND 
WITH-
DRAWING 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 15, 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 15, 2000.
SEC. 202. 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 clause (i) with appropriate in-
dentation 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.’’.
SEC. 203. EFFECTIVENESS OF ELECTIONS AND CHANGES
OF ELECTIONS.
(a) IN GENERAL.—Section 1851(f)(2) of the Social
Security Act (42 U.S.C. 1395w–21(f)(2)) is amended by
striking ‘‘made,’’ and all that follows and inserting
‘‘made.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) applies with respect to years beginning on
or after on January 1, 2001.
SEC. 204. UNIFORM PREMIUM AND BENEFITS.
(a) IN GENERAL.—Subsections (c) and (f)(1)(D) of
section 1854 of the Social Security Act (42 U.S.C.
1395w–24) are each amended by inserting before the pe-
riod at the end the following: ‘‘, except across counties
as approved by the Secretary’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) apply with respect to years beginning on
or after January 1, 2001.
SEC. 205. MEDICARE+CHOICE PROGRAM COMPATIBILITY
WITH EMPLOYER OR UNION GROUP HEALTH
PLANS.
(a) IN GENERAL.—Section 1857 of the Social Secu-
rity Act (42 U.S.C. 1395w–27) is amended by adding at
the end the following new subsection:
‘‘(i) M+C PROGRAM COMPATIBILITY WITH EM-
PLOYER OR UNION GROUP HEALTH PLANS.—To facilitate
the offering of Medicare+Choice plans under contracts be-
tween Medicare+Choice organizations and employers,
labor organizations, or the trustees of a fund established
by 1 or more employers or labor organizations (or com-
bination thereof) to furnish benefits to the entity’s employ-
ees, former employees (or combination thereof) or mem-
bers or former members (or combination thereof) of the
labor organizations, the Secretary shall waive or modify
requirements that hinder the design of, the offering of,
or the enrollment in such Medicare+Choice plans.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) applies with respect to years beginning on
or after January 1, 2001.
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