[Pages S12250-S12251]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

  SA 2838. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 182, strike line 20 and all that follows 
     through line 11 on page 183, and insert the following:
       (b) Establishment of Community Health Insurance Option.--
       (1) Establishment.--The Secretary shall establish a 
     community health insurance option to offer, through the 
     Exchanges established under this title, health
       Beginning on page 187, strike line 17 and all that follows 
     through line 8 on page 188, and insert the following:
       (6) Reimbursement rates.--
       (A) Rates established by secretary.--
       (i) In general.--The Secretary shall establish payment 
     rates for the community health insurance option for services 
     and health care providers consistent with this section and 
     may change such payment rates.
       (ii) Initial payment rules.--

       (I) In general.--Except as provided in subclause (II), 
     during the first 3 years in which the community health 
     insurance option if offered, the Secretary shall base the 
     payment rates under this section for services and providers 
     described in subparagraph (A) on the payment rates for 
     similar services and providers under parts A and B of 
     Medicare under title XVIII of the Social Security Act.
       (II) Exceptions.--

       (aa) Payment rates for practitioners services.--Payment 
     rates for practitioners services otherwise established under 
     the fee schedule under section 1848 of the Social Security 
     Act shall be applied without regard to the provisions under 
     subsection (f) of such section and the update under 
     subsection (d)(4) under such section for a year as applied 
     under this subparagraph shall be not less than 1 percent.
       (bb) Adjustments.--The Secretary may determine the extent 
     to which Medicare adjustments applicable to base payment 
     rates under parts A and B of Medicare shall apply under this 
     section.
       (iii) For new services.--The Secretary shall modify payment 
     rates described in clause (ii) in order to accommodate 
     payments for services, such as well-child visits, that are 
     not otherwise covered under Medicare.
       (iv) Prescription drugs.--Payment rates under this 
     paragraph for prescription drugs that are not paid for under 
     part A or part B of Medicare shall be at rates negotiated by 
     the Secretary.
       (B) Incentives for participating providers.--
       (i) Initial incentive period.--

       (I) In general.--The Secretary shall provide, in the case 
     of services described in subclause (II) furnished during the 
     first 3 years in which a community health insurance option is 
     offered, for payment rates that are 5 percent greater than 
     the rates established under subparagraph (A).
       (II) Services described.--The services described in this 
     subclause are items and professional services, under the 
     community health insurance option by a physician or other 
     health care practitioner who participates in both Medicare 
     and the community health insurance option.
       (III) Special rules.--A pediatrician and any other health 
     care practitioner who is a type of practitioner that does not 
     typically participate in Medicare (as determined by

[[Page S12251]]

     the Secretary) shall also be eligible for the increased 
     payment rates under subclause (I).

       (ii) Subsequent periods.--Beginning with the fourth year in 
     which the community health insurance option is offered, and 
     for subsequent years, the Secretary shall continue to use an 
     administrative process to set such rates in order to promote 
     payment accuracy, to ensure adequate beneficiary access to 
     providers, and to promote affordability and the efficient 
     delivery of medical care. Such rates shall not be set at 
     levels expected to increase overall medical costs under the 
     option beyond what would be expected if the process under 
     subparagraph (A)(ii) and clause (i) of this subparagraph were 
     continued.
       (iii) Establishment of a provider network.--Health care 
     providers participating under Medicare are participating 
     providers in the community health insurance option unless 
     they opt out in a process established by the Secretary.
       (C) Administrative process for setting rates.--Chapter 5 of 
     title 5, United States Code shall apply to the process for 
     the initial establishment of payment rates under this 
     paragraph but not to the specific methodology for 
     establishing such rates or the calculation of such rates.
       (D) Construction.--Nothing in this subtitle shall be 
     construed--
       (i) as limiting the Secretary's authority to correct for 
     payments that are excessive or deficient, taking into account 
     the amounts paid for similar health care providers and 
     services under other Exchange-participating qualified health 
     plans.
       (ii) as affecting the authority of the Secretary to 
     establish payment rates, including payments to provide for 
     the more efficient delivery of services.
       (E) Limitation on review.--There shall be no administrative 
     or judicial review of a payment rate or methodology 
     established under this paragraph.
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