Medicare Beneficiary Access to Quality Nursing Home Care Act of 1999

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Beneficiary Access to 
Quality Nursing Home Care Act of 1999''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Beneficiaries under the Medicare Program under title 
        XVIII of the Social Security Act are experiencing decreased 
        access to skilled nursing facility services due to inadequate 
        reimbursement under the prospective payment system for such 
        services under section 1888(e) of such Act.
            (2) Such inadequate reimbursement may force skilled nursing 
        facilities to file for bankruptcy and close their doors, 
        resulting in reduced access to skilled nursing facility 
        services for Medicare beneficiaries.
            (3) The methodology under the prospective payment system 
        for skilled nursing facility services has made it more 
        difficult for Medicare beneficiaries to find nursing home care. 
        Some beneficiaries are remaining in hospitals for extended 
        stays due to reduced access to nursing homes. Others are placed 
        in nursing homes that are hours away from family and friends.
            (4) The Health Care Financing Administration has indicated 
        that the prospective payment system for skilled nursing 
        facility services does not accurately account for the costs 
        associated with providing medically complex care (non-therapy 
        ancillary services and supplies). Due to Year 2000 problems, 
        the Health Care Financing Administration claims that it will be 
        unable to properly account for such costs under such system.
            (5) The Medicare Payment Advisory Commission (MedPAC) has 
        indicated that payments to skilled nursing facilities under the 
        Medicare Program may not be adequate for beneficiaries who need 
        relatively high levels of non-therapy ancillary services and 
        supplies. According to MedPAC, such inadequate funding could 
        result in access problems for beneficiaries with medically 
        complex conditions.
            (6) In order to provide adequate payment under the 
        prospective payment system for skilled nursing facility 
        services, such system must take into account the costs 
        associated with providing 1 or more of the following services:
                    (A) Ventilator care.
                    (B) Tracheostomy care.
                    (C) Care for pressure ulcers.
                    (D) Care associated with individuals that have 
                experienced a stroke or a hip fracture.
                    (E) Care for non-vent, non-trach pneumonia.
                    (F) Dialysis.
                    (G) Infusion therapy.
                    (H) Deep vein thrombosis.
                    (I) Care associated with individuals with transient 
                peripheral neuropathy, a chronic obstructive pulmonary 
                disease, congestive heart failure, diabetes, a wound 
                infection, a respiratory infection, sepsis, 
                tuberculosis, HIV, or cancer.
            (7) A temporary legislative solution is necessary in order 
        to ensure that Medicare beneficiaries with complex conditions 
        continue to receive access to appropriate skilled nursing 
        facility services.
            (8) The skilled nursing facility market basket increase 
        over the last 3 years evidences a critical payment gap that 
        exists between the actual cost of providing services to 
        Medicare beneficiaries residing in a skilled nursing facility 
        and the reimbursement levels for such services under the 
        prospective payment system. In addition, the Health Care 
        Financing Administration, in establishing the skilled nursing 
        facility market basket index under section 1888(e)(5)(A) of the 
        Social Security Act only accounted for the cost of goods, but 
        not for the cost of services, as such section requires.

SEC. 3. MODIFICATION OF CASE MIX CATEGORIES FOR CERTAIN CONDITIONS.

    (a) In General.--For purposes of applying any formula under 
paragraph (1) of section 1888(e) of the Social Security Act (42 U.S.C. 
1395yy(e)), for services provided on or after October 1, 1999, and 
before the earlier of October 1, 2001, or the date described in 
subsection (c), the Secretary of Health and Human Services shall 
increase the adjusted Federal per diem rate otherwise determined under 
paragraph (4) of such section for services provided to any individual 
during the period in which such individual is in a RUGS III category by 
the applicable payment add-on as determined in accordance with the 
following table:

RUGS III Category                             Applicable Payment Add-On
    RUC...........................................               $73.57
    RUB...........................................               $23.06
    RUA...........................................               $17.04
    RVC...........................................               $76.25
    RVB...........................................               $30.36
    RVA...........................................               $20.93
    RHC...........................................               $54.07
    RHB...........................................               $27.28
    RHA...........................................               $25.07
    RMC...........................................               $69.98
    RMB...........................................               $30.09
    RMA...........................................               $24.24
    SE3...........................................               $98.41
    SE2...........................................               $89.05
    CA1...........................................              $27.02.
    (b) Update.--The Secretary shall update the applicable payment add-
on under subsection (a) for fiscal year 2001 by the skilled nursing 
facility market basket percentage change (as defined under section 
1888(e)(5)(B) of the Social Security Act (42 U.S.C. 1395yy(e)(5)(B))) 
applicable to such fiscal year.
    (c) Date Described.--The date described in this subsection is the 
date that the Secretary of Health and Human Services implements a case 
mix methodology under section 1888(e)(4)(G)(i) of the Social Security 
Act (42 U.S.C. 1395yy(e)(4)(G)(i)) that takes into account adjustments 
for the provision of non-therapy ancillary services and supplies such 
as drugs and respiratory therapy.

SEC. 4. MODIFICATION TO THE SNF UPDATE TO FIRST COST REPORTING PERIOD.

    (a) In General.--Section 1888(e) of the Social Security Act (42 
U.S.C. 1395yy(e)) is amended--
            (1) in paragraph (3)(B)(i), by striking ``minus 1 
        percentage point''; and
            (2) in paragraph (4)(B), by striking ``reduced (on an 
        annualized basis) by 1 percentage point''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to services provided on or after October 1, 1999.

Summary: Directs the Secretary of Health and Human Services to increase the adjusted Federal per diem rate otherwise determined for services provided to any individual during the period in which such individual is in a Nursing Home Case-Mix and Quality Demonstration resource utilization group (RUGS III) category of care, by the applicable payment add-on (updated for FY 2001 by the applicable SNF market basket percentage change), according to a specified table of such categories (especially for high-acuity and medically complex patients). Limits the application of this Act to services provided on or after October 1, 1999, and before the earlier of October 1, 2001, or the date on which the Secretary implements a case-mix methodology that takes into account adjustments for the provision of non-therapy ancillary services and supplies such as drugs and respiratory therapy.
Amends title XVIII (Medicare) of the Social Security Act to revise the formula for facility specific per diem rates with respect to the market basket update (inflation adjuster) to repeal the mandatory annualized one percent reduction in basket amount.