Summary: H.R.5291 — 106th Congress (1999-2000)All Information (Except Text)

Bill summaries are authored by CRS.

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Reported to House with amendment(s) (10/30/2000)

Beneficiary Improvement and Protection Act of 2000 - Title I: Beneficiary Improvements - Amends title XVIII (Medicare) of the Social Security Act (SSA) to provide for: (1) availability of and assistance in completing qualified Medicare beneficiary and specified low-income Medicare beneficiary application forms; (2) election of colonoscopy instead of a screening sigmoidoscopy, but only once every 119 months; (3) elimination of time limitation on Medicare benefits for immunosuppressive drugs; and (4) preservation of coverage of drugs and biologicals (even if occasionally, but not usually, self-administered) under Medicare part B (Supplementary Medical Insurance).

(Sec. 102) Directs the Secretary of Health and Human Services (HHS) to study and report to Congress on whether limitations on State payment for Medicare cost-sharing have affected access to services for qualified Medicare beneficiaries.

(Sec. 104) Amends SSA title II (Old Age, Survivors and Disability Insurance) (OASDI) to provide for Medicare coverage of individuals disabled with amyotrophic lateral sclerosis (ALS), without a 24-month waiting period.

(Sec. 107) Directs the Secretary to conduct a demonstration project on Medicare coverage of medical nutrition therapy services.

Title II: Other Medicare Part B Provisions - Subtitle A: Access to Technology - Directs the Secretary to report to Congress (for publication on the HHS Medicare Internet site) a detailed compilation of the actual time periods necessary to complete and fully implement any national coverage determinations that were made in the previous fiscal year for items, services, or medical devices not previously covered as a Medicare benefit.

(Sec. 202) Amends SSA title XVIII part B with regard to the payment of benefits to: (1) make the national limitation amount for clinical diagnostic laboratory test fee schedules equal to 100 percent of national median for new clinical laboratory test technologies; (2) require the Secretary to establish a fee schedule for new clinical laboratory tests in a specified manner; and (3) require the Secretary to establish the use of categories in determining eligibility of a device for pass-through payments under the hospital outpatient prospective payment system (PPS).

(Sec. 204) Amends SSA title XVIII part B to provide for an increase in the payment limit for new technologies applied to screening mammography performed beginning in 2001 and determined by the Secretary to enhance the detection of breast cancer.

Subtitle B: Provisions Relating to Physicians Services - Directs the Comptroller General to study and report to Congress on the appropriateness of furnishing gastrointestinal endoscopic physicians services in physicians offices.

(Sec. 212) Provides for payment to a laboratory instead of to a hospital for certain physician pathology services.

(Sec. 213) Amends SSA title XVIII to mandate demonstration projects to test and, if proven effective, expand the use of incentives to participating health care groups that: (1) encourage coordination of the care furnished to individuals under Medicare parts A (Hospital Insurance) and B by institutional and other providers, practitioners, and suppliers of health care items and services; (2) encourage investment in administrative structures and processes to ensure efficient service delivery; and (3) reward physicians for improving health outcomes.

(Sec. 214) Directs the Secretary to provide for designation of interventional pain management physicians as a separate category of physician specialists.

(Sec. 215) Directs the Secretary to evaluate and report to Congress on the current Medicare enrollment process for medical groups that retain independent contractor physicians with particular emphasis on hospital-based physicians (such as emergency department staffing groups).

Subtitle C: Other Services - Amends SSA title XVIII to provide for a three-year moratorium on application of certain skilled nursing facility (SNF) Medicare part B consolidated billing requirements.

(Sec. 222) Prohibits the Secretary from implementing a revised PPS for services of ambulatory surgical facilities before January 1, 2002.

Amends the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 to revise provisions on contrast enhanced diagnostic procedures under the hospital PPS, including with regard to the deadline for use of 1999 or later cost surveys.

(Sec. 223) Amends SSA title XVIII with respect to the payment of benefits to provide for a one year extension of the moratorium on certain physical therapy caps.

(Sec. 224) Amends the Balanced Budget Act of 1997 (BBA '97) to revise requirements for Medicare reimbursement for telehealth services.

(Sec. 225) Amends SSA title XVIII with respect to payment for ambulance services to eliminate certain reductions for 2001 and 2002 enacted under BBA '97.

Directs the Comptroller General to study and report to Congress on costs of providing ambulance services covered under the Medicare program across the range of service levels for which such services are provided.

(Sec. 226) Amends SSA title XVIII with respect to PPS hospital outpatient department (OPD) services system requirements to direct the Secretary to create additional groups of covered OPD services that classify separately those procedures that utilize contrast media from those that do not.

(Sec. 227) Amends SSA title XVIII to provide for a ten-year phased in increase from 55 percent to 80 percent in the proportion of hospital bad debt recognized.

(Sec. 228) Amends SSA title XVIII with regard to State accreditation of diabetes self-management training programs.

(Sec. 229) Amends SSA title XVIII with regard to Medicare coverage for end stage renal disease patients to provide for an increase in the update for renal dialysis composite rate for dialysis services furnished on or after January 1, 2001.

Directs the Secretary to report to Congress on a literature review of studies on the impact of oral self-administered prescription non-calcium phosphate binding drugs in reducing the incidence of hospitalization under the Medicare program for Medicare beneficiaries with end stage renal disease.

Title III: Medicare Part A and B Provisions - Amends SSA title XVIII to provide for a one year delay in the 15 percent reduction in payment rates under the Medicare PPS for home health services.

(Sec. 302) Amends SSA title XI with regard to guidance on application of health care fraud and abuse sanctions to make permanent existing advisory opinion authority, among other changes.

(Sec. 303) Provides for: (1) hospital geographic reclassification for labor costs applicable to other PPS systems; and (2) reclassification of a certain Ohio metropolitan statistical area for purposes of Medicare reimbursement.

(Sec. 305) Amends SSA title XVIII to: (1) make the Medicare dependent, small rural hospital program permanent; and (2) include as a Medicare dependent, small rural disproportionate share (DSH) hospital one with discharges during any of the three most recent audited cost reporting periods.

(Sec. 307) Amends SSA title XI to require a peer review organization to assist providers, practitioners, and Medicare+Choice organizations in identifying and developing strategies to reduce the incidence of actual and potential errors and problems related to patient safety affecting individuals entitled to Medicare benefits.

(Sec. 308) Directs the Comptroller General to submit a report to Congress on the effect of the Emergency Medical Treatment and Active Labor Act on hospitals, emergency physicians, and physicians covering emergency department call throughout the United States, focusing on those in Arizona (including Phoenix) and California (including Los Angeles).

Title IV: Medicare+Choice Program Stabilization and Improvements - Subtitle A: Payment Reforms - Amends part C (Medicare+Choice) of SSA title XVIII with regard to calculation of annual Medicare+Choice capitation rates increasing the minimum payment amount and the minimum percentage update for 2001.

(Sec. 403) Provides for a ten-year phase-in of risk adjustment methodology for payments to Medicare+Choice organizations based on data from all settings.

(Sec. 404) Provides for transition to revised Medicare+Choice payment rates.

Subtitle B: Administrative Reforms - Amends part C (Medicare+Choice) of SSA title XVIII with regard to: (1) eligibility, election, and enrollment effectiveness of elections and changes of elections; (2) Medicare+Choice program compatibility with employer or union group health plans; and (3) uniform premium and benefits.

Title V: Medicaid - Amends SSA title XIX (Medicaid), as amended by the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, with regard to DSH payments to, among other changes, provide for: (1) continuation of Medicaid DSH allotments at FY 2000 levels for fiscal years 2001 and 2002; (2) a special rule for the Medicaid DSH allotment for extremely low DSH States; and (3) assuring identification of Medicaid managed care patients for purposes of making DSH payments.

(Sec. 502) Amends SSA title XIX to establish a PPS for Federally-qualified health centers and rural health clinics.

Directs the Comptroller General to provide for a study and report to Congress on the need for, and how to, rebase or refine costs for making Medicaid payment for services provided by such centers and clinics.

(Sec. 503) Authorizes a State to elect to provide Medicaid assistance to children and pregnant women who are aliens lawfully residing in the United States for at least two years and otherwise eligible for such assistance.

(Sec. 504) Amends SSA title XIX to provide for additional entities qualified to determine Medicaid presumptive eligibility for low-income children.

(Sec. 505) Amends SSA title XIX to: (1) extend for one year provisions on eligibility for medical assistance; (2) give States the option to waive administrative reporting requirements for an additional six month extension; and (3) give States the option to exempt themselves from such provisions on eligibility for medical assistance if the State provides Medicaid coverage to needy families with incomes of up to 185 percent of the official poverty line.

(Sec. 506) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to increase from ten percent to 14 percent the percentage of all Medicaid beneficiaries in certain California counties a county-organized health insuring organization in such a county may enroll and remain exempt from specified Federal requirements for Medicaid health maintenance organization contracts.

(Sec. 507) Amends SSA title XIX to provide for Medicaid recognition for services of physician assistants.

Title VI: State Children's Health Insurance Program - Amends SSA title XXI (State Children's Health Insurance Program) with regard to allotments to: (1) add a rule for extended availability and redistribution of FY 1998 and 1999 allotments; and (2) provide for State coverage of children who are aliens lawfully residing in the United States and otherwise eligible for such assistance, but only if the State has elected to do so.

Title VII: Extension of Special Diabetes Grant Programs - Amends the Public Health Service Act to extend the funding for juvenile and Indian diabetes grant programs.