Summary: H.R.5324 — 106th Congress (1999-2000)All Information (Except Text)

There is one summary for H.R.5324. Bill summaries are authored by CRS.

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Introduced in House (09/27/2000)

Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 2000 - Title I: Provisions Relating to Part A - Subtitle A: Skilled Nursing Facilities - Amends title XVIII (Medicare) of the Social Security Act (SSA) with regard to eliminating the reduction in the skilled nursing facility (SNF) market basket update.

(Sec. 102) Amends the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA) to revise the BBRA increase for SNFs in FY 2001 and 2002.

(Sec. 103) Requires a Medicare Payment Advisory Commission (MedPAC) study and report to the Secretary of Health and Human Services (HHS) and Congress on nursing home costs to determine the adequacy of Medicare payment rates for items and services furnished by SNFs. Grants the Secretary the authority to make payment adjustments for covered SNF services if appropriate as a result of the study.

Subtitle B: PPS Hospitals - Amends SSA title XVIII to: (1) revise the reduction of indirect graduate medical education payments; (2) eliminate the reduction in the Prospective Payment System (PPS) hospital payment update; (3) eliminate the reduction in disproportionate share hospital (DSH) payments; and (4) change the payment formulas for DSH hospitals; and (5) modify the payment rate for Puerto Rico hospitals.

(Sec. 115) Increases the DSH allotments under Medicaid for the District of Columbia.

Amends SSA title XIX (Medicaid) and XXI (State Children's Health Insurance) (SCHIP) to provide for the optional eligibility of certain alien pregnant women and children for Medicaid and SCHIP.

(Sec. 117) Requires a MedPAC study on hospital area wage indexes for a report to the Secretary and Congress.

Subtitle C: PPS Exempt Hospitals - Amends SSA title XVIII to provide for the treatment of certain cancer hospitals (Sec. 122) Makes certain changes with regard to the PPS for inpatient rehabilitation services and payment during the transition period under current law.

Subtitle D: Hospice Care - Amends SSA title XVIII to revise payments for hospice care.

Subtitle E: Other Provisions - Amends SSA title XVIII to outline various provisions concerned with: (1) hospital compliance with the Bloodborne Pathogens standard; (2) an Informatics and Data Systems Grant Program; and (3) relief from the Medicare part A (Hospital Insurance) late enrollment penalty for a group buy-in for State and local retirees. Authorizes appropriations.

Subtitle F: Transitional Provisions - Reclassifies certain counties and areas in specified States (including the Boston and Barnstable-Yarmouth Metropolitan Statistical Areas) for purposes of reimbursement under the Medicare program.

Title II: Provisions Relating to Part B - Subtitle A: Hospital Outpatient Services - Amends SSA title XVIII to provide for reduction of the effective hospital outpatient department (HOPD) coinsurance rate to 20 percent by 2019.

(Sec. 202) Revises the formula for calculating the base payment-to-cost-ratio component of HOPD PPS transitional corridor payments to include in such formula (and so cover) certain hospitals that did not submit cost reports for 1996.

(Sec. 203) Provides a permanent guarantee of pre-Balanced Budget Act of 1997 (BBA '97) payment levels for HOPD services furnished by children's hospitals.

Subtitle B: Provisions Relating to Physicians - Amends the Higher Education Act of 1965 to grant medical students a deferment on their student loans for a period not to exceed the length of their full initial residency period.

(Sec. 212) Directs the Comptroller General to study and report to the Secretary and Congress on: (1) the post-payment audit process under Medicare as it applies to physicians; and (2) the aggregate effects of regulatory, audit, oversight, and paperwork burdens on physicians and other health care providers participating in Medicare.

(Sec. 213) Directs MEDPAC to study and report to the Secretary and Congress on the refinements to the practice expense relative value units during the transition to a resource-based practice expense system for physician payments under Medicare.

Subtitle C: Ambulance Services - Amends SSA title XVIII with regard to the establishment of a fee schedule for ambulance services to allow a supplier of ambulance services to elect to forego phase-in of such schedule and receive payments based only upon it.

(Sec. 222) Establishes a prudent layperson standard for emergency ambulance services.

(Sec. 223) Eliminates the reduction in inflation adjustments for ambulance services.

(Sec. 224) Directs the Secretary to study and report to Congress on the means by which rural areas with low population densities can be identified for the purpose of designating areas in which the cost of providing ambulance services would be expected to be higher than similar services provided in more heavily populated areas because of low usage.

(Sec. 225) Outlines provisions for interim payments for rural ground ambulance services until such time as the established fee schedule is modified by a specified regulation.

(Sec. 226) Directs the Comptroller General to study and report to the Secretary and Congress on the costs of providing emergency and medical transportation services across the range of acuity levels of conditions for which such transportation services are provided.

Subtitle D: Preventive Services - Amends SSA title XVIII to: (1) prohibit deductibles and coinsurance for various specified preventive benefits; (2) add lancets to the definition of durable medical equipment; and (3) provide coverage of counseling for cessation of tobacco use, glaucoma detection tests, and medical nutrition therapy services for beneficiaries with diabetes, a cardiovascular disease, or a renal disease.

(Sec. 235) Directs the Secretary to: (1) conduct a series of studies, for an annual report to the Congress, designed to identify preventive interventions that can be delivered in the primary care setting that are most valuable to older Americans; and (2) contract with the Institute of Medicine of the National Academy of Sciences to study and report periodically to the President on current literature and best practices in the field of health promotion and disease prevention among Medicare beneficiaries.

(Sec. 237) Provides for fast-track consideration of preventive benefit legislation resulting from recommendations accompanying such study reports.

Subtitle E: Other Services - Amends SSA title XVIII with regard to: (1) revision of the moratorium on caps for therapy services; (2) revision of coverage of immunosuppressive drugs; (3) extension of certain secondary payer requirements; (4) State accreditation of diabetes self-management training programs; (5) elimination of the reduction in payment amounts for orthotics and prosthetics, parenteral and enteral nutrients, supplies, and equipment and oxygen and oxygen equipment; (6) standards regarding payment for certain orthotics and prosthetics; (7) revision of the definition of orthotics; (8) new pap smear technologies and other new clinical laboratory test technologies; (9) increase in payments for certified nurse-midwife services; and (10) payment for administration services associated with chemotherapy and for blood clotting drug-related activities.

(Sec. 249) Directs MEDPAC to study and report to the Secretary and Congress on the provision of in-home infusion therapy nursing services.

(Sec. 250) Amends SSA title XVIII to provide for Medicare coverage of vision rehabilitation services.

(Sec. 251) Amends SSA title XVIII part B (Supplementary Medical Insurance) with respect to the amounts of part B premiums to limit the Medicare late enrollment penalty to ten percent and twice the period of no enrollment.

Title III: Provisions Relating to Parts A and B - Subtitle A: Home Health Services - Amends SSA title XVIII to eliminate a specified 15 percent reduction in cost and per beneficiary limits with respect to payment rates for home health services under the Medicare PPS.

(Sec. 302) Provides for additional payments: (1) for outliers; and (2) under the PPS for services furnished in rural areas and security services.

(Sec. 304) Excludes from the Medicare PPS certain nonroutine medical supplies furnished by a home health agency. Details certain study and reporting requirements with regard to such exclusion.

(Sec. 305) Declares that, with regard to eligibility for Medicare home health benefits, any absence of an individual from the home attributable to health care treatment, including regular absences for such treatment in an adult day-care program, shall not disqualify the individual from being considered confined to home.

(Sec. 306) Directs the Secretary to establish standards for the operation of a branch office, a service site for home health services controlled and supervised by a home health agency.

(Sec. 307) Provides for the treatment of home health services provided in certain counties in the State of New York.

(Sec. 308) Permits a home health agency to receive Medicare payments for a home health service furnished via a telecommunications system.

Subtitle B: Direct Graduate Medical Education - Provides that, for cost reporting periods between October 1, 2000, and October 1, 2005, in applying the limitations regarding the total number of full-time equivalent interns and residents in the field of allopathic or osteopathic medicine under Medicare for a hospital, the Secretary shall not take into account a maximum of three interns or residents in the field of geriatric medicine to the extent the hospital increases the number of geriatric interns or residents above the number of such interns or residents for the hospital's most recent cost reporting period ending before October 1, 2000.

(Sec. 312) Amends SSA title XI part A (General Provisions) to establish a program of payments to children's hospitals that operate graduate medical education programs. Authorizes appropriations.

(Sec. 313) Provides that, effective for cost reporting periods beginning on or after October 1, 1999, for purposes of Medicare payments to hospitals for costs of approved educational activities, such activities shall include the clinical portion of professional educational training programs recognized by the Secretary for clinical psychologists.

(Sec. 314) Amends SSA title XVIII to provide for the treatment of certain newly established residency programs in computing Medicare payments for the costs of medical education.

(Sec. 315) Revises the limitation during FY 1997 on allopathic and osteopathic residents for payment of both the indirect and direct costs of graduate medical education at an accredited community health center, if the hospital conducting the residency program incurred all or substantially all of the training costs.

Subtitle C: Miscellaneous Provisions - Amends SSA title II (Old Age, Survivors and Disability Insurance) (OASDI) to provide for a waiver of the 24-month waiting period for Medicare coverage of individuals disabled with amyotrophic lateral sclerosis.

Title IV: Rural Provider Provisions - Subtitle A: Critical Access Hospitals - Amends SSA title XVIII with regard to payments to critical access hospitals for clinical diagnostic laboratory tests.

(Sec. 402) Amends SSA title XVIII, as amended by BBRA, to revise the payment for professional services provided by a critical access hospital.

(Sec. 403) Amends SSA title XVIII to permit critical access hospitals to operate PPS-exempt distinct part psychiatric and rehabilitation units.

Subtitle B: Medicare Dependent, Small Rural Hospital Program - Amends SSA title XVIII to: (1) make the Medicare-dependent, small rural hospital program permanent; and (2) give any hospital under such program the option of basing eligibility for payment on discharges during any of the three most recent audited cost reporting periods in lieu of the current basing of eligibility for payment on discharges during the cost reporting period beginning in FY 1987.

Subtitle C: Sole Community Hospitals - Amends SSA title XVIII to extend the option to use rebased target amounts to all sole community hospitals.

(Sec. 422) States that, for purposes of discharges occurring on or after October 1, 2000, the Greensville Memorial Hospital located in Emporia, Virginia, shall be deemed to have satisfied the travel time criteria under applicable Medicare provisions for classification as a sole community hospital.

Subtitle D: Other Rural Hospital Provisions - Amends SSA title XVIII to exempt Medicare swing bed hospitals from the PPS for skilled nursing facilities (SNFs).

(Sec. 431) Amends BBRA to make January 1, 2001, the effective date of the elimination of certain restrictions with respect to the hospital swing bed program.

(Sec. 432) Amends SSA title XVIII to mandate pre-BBA '97 payment levels for outpatient services furnished by rural hospitals.

(Sec. 433) Provides for the treatment of certain physician pathology services under Medicare.

Subtitle E: Other Rural Provisions - Amends SSA title XVIII with regard to bonus payments in the case of physicians' services furnished to an individual who is covered under Medicare part B (Supplementary Medical Insurance) and who incurs expenses for such services in a health professional shortage area. Extends such bonus payments to physician assistant and nurse practitioner services. Eliminates the requirement to make such payments on a monthly or a quarterly basis.

(Sec. 442) Modifies: (1) the exemption to the limits established on payment for provider-based rural health clinic services in the case of such clinics in rural hospitals with less than 50 beds; and (2) payment for certain physician assistant services.

(Sec. 444) Excludes clinical social worker services and worker services performed under a contract with a rural health clinic or a Federally-qualified health center from the PPS for SNFs.

(Sec. 445) Covers marriage and family therapist services provided in rural health clinics under Medicare.

(Sec. 446) Amends the Public Health Service Act (PHSA) to: (1) create a capital infrastructure revolving loan program for rural entities for projects for capital improvements; (2) provide for grants to assist eligible small rural hospitals in offsetting the costs of establishing data systems to implement PPSs under Medicare, and to comply with administrative simplification requirements under Medicare part C (Medicare+Choice), or to reduce medication errors; (3) provide for grants to eligible small rural hospitals to provide relief for financial distress that has a negative impact on access to care for Medicare beneficiaries who reside in a rural area. Authorizes appropriations.

(Sec. 449) Amends BBA '97 to revise provisions for Medicare reimbursement for telehealth services with respect to: (1) the methodology for determining the amount of payments; (2) reimbursement for Medicare beneficiaries who do not reside in a health professional shortage area; (3) telehealth coverage for direct patient care; (4) eligibility for telehealth reimbursement for all physicians and practitioners; and (5) telehealth services provided using store-and-forward technologies.

(Sec. 450) Directs MEDPAC to study and report to the Secretary and Congress on the effect of low patient and procedure volume on the financial status of low-volume, isolated rural health care providers participating in Medicare.

Title V: Provisions Relating to Part C (Medicare+Choice Program) and Other Medicare Managed Care Provisions - Amends SSA title XVIII part C (Medicare+Choice) with regard to eligibility, election, and enrollment to provide for restoring the effective date of elections and changes of elections of Medicare+Choice plans.

(Sec. 502) Amends SSA title XVIII part D (Miscellaneous) with regard to certification of Medicare supplemental health insurance (Medigap) policies. Sets forth a special Medigap enrollment anti-discrimination provision for certain beneficiaries.

(Sec. 503) Amends SSA title XVIII part C with regard to payments to Medicare+Choice organizations to: (1) increase the national per capita Medicare+Choice growth percentage in 2001 and 2002; and (2) modify area-specific and national percentages provisions with respect to calculation of annual Medicare+Choice capitation rates.

(Sec. 505) Delays from July 1, 2000, to November 1, 2000, the deadline for a Medicare+Choice organization to withdraw the offering of a Medicare+Choice plan under part C (or otherwise to submit information required for the offering of such a plan) for 2001.

(Sec. 506) Amends SSA title XVIII to make certain amounts in the Medicare trust funds available for the Secretary's share of Medicare+Choice education and enrollment-related costs.

(Sec. 507) Amends BBRA to revise terms and conditions for extension of Medicare community nursing organization demonstration projects.

(Sec. 508) Amends SSA title XVIII part C with regard to payments to Medicare+Choice organizations to modify payment rules for certain frail elderly Medicare beneficiaries.

Title VI: Provisions Relating to Individuals with End-Stage Renal Disease - Amends SSA title XVIII part D with respect to Medicare coverage for end-stage renal disease (ESRD) patients to change the methodology for determining the update in the renal dialysis composite rate for end state renal dialysis services furnished after January 1, 2001.

(Sec. 602) Amends SSA title XVIII part C with regard to payments to Medicare+Choice organizations to provide for revision of payment rates for ESRD patients enrolled in Medicare+Choice plans.

(Sec. 603) Permits ESRD beneficiaries to enroll in another Medicare+Choice plan if the plan in which they are enrolled is terminated.

(Sec. 604) Amends SSA title XVIII part B to provide for the coverage of certain vascular access services for ESRD beneficiaries provided by ambulatory surgical centers.

(Sec. 605) Directs the Secretary to: (1) collect information on the satisfaction of each ESRD Medicare beneficiary with the quality of health care under the original fee-for-service Medicare program and the Medicare+Choice program, and the access of each beneficiary to that care; (2) analyze such information to determine, among other things, the kinds of health care that each nondialysis health care provider provides to each ESRD Medicare beneficiary for the treatment of ESRD and each comorbidity and the quality of health care provided to each such beneficiary enrolled under the Medicare+Choice program compared to each beneficiary enrolled under the original fee-for-service Medicare program; and (3) make such information collected and analysis conducted available to the public each year.

Title VII: Access to Care Improvements Through Medicaid and SCHIP - Amends SSA title XIX (Medicaid) to create a new PPS for federally-qualified health centers and rural health clinics.

(Sec. 702) Amends SSA title XIX to make permanent the extension of eligibility for medical assistance, and give States the option of electing a 12-month initial eligibility period in lieu of the current six month initial eligibility period.

(Sec. 703) Amends SSA title XIX with regard to State Medicaid plans to provide for coordination with Medicaid and the State Children's Health Insurance Program (SCHIP) under SSA title XXI of the application of resource and income eligibility standards for certain Medicaid-eligible individuals under certain conditions, as well as providing for the automatic reassessment of eligibility for Medicaid and SCHIP benefits for children losing Medicaid- or SCHIP-eligibility.

(Sec. 704) Amends SSA titles XIX and XXI to qualify additional entities to determine presumptive eligibility for low-income children under Medicaid and SCHIP.

(Sec. 705) Amends SSA title V (Maternal and Child Health Services) to: (1) increase the authorization of appropriations; and (2) provide for coordination with Medicaid and SCHIP.

(Sec. 706) Amends SSA title XIX to provide for increased access to Medicare cost-sharing assistance for low-income beneficiaries.

(Sec. 707) Provides for: (1) optional State Medicaid coverage of breast and cervical cancer prevention and treatment coverage for certain breast and cervical cancer patients; (2) optional State Medicaid presumptive eligibility for certain breast or cervical cancer patients; and (3) an enhanced Federal match to be used under SCHIP with respect to medical assistance provided to such breast and cervical cancer patients receiving such optional State Medicaid coverage.

(Sec. 708) Revises Medicaid coverage of services furnished by certified nurse practitioners, including coverage of services furnished by clinical nurse specialists.

Title VIII: Other Provisions - Amends the Ricky Ray Hemophilia Relief Fund Act of 1998 to make appropriations to the Ricky Ray Hemophilia Relief Fund for FY 2001.

(Sec. 802) Amends the Public Health Service Act (PHSA) to increase appropriations for special diabetes programs for children with type 1 diabetes and for Indians.

(Sec. 803) Directs the Secretary to award demonstration grants to up to seven States to conduct innovative programs designed to improve outreach to homeless individuals and families under specified Social Security programs with respect to enrollment and the provision of services under such programs. Makes appropriations.

(Sec. 804) Amends the Employee Retirement Income Security Act of 1974 (ERISA) and PHSA to prohibit health insurance provided through a managed care organization under a group health plan, or through a health insurance issuer providing coverage in connection with a group health plan, (and, for the PHSA, health insurance in the individual market) from denying coverage of services provided by a continuing care retirement community or other qualified facility if they are: (1) post-hospitalization services in the same community or facility as in pre-hospitalization; (2) skilled nursing services, without a preceding hospitalization, which are necessary to prevent hospitalization; or (3) furnished in the same facility the participant's or beneficiary's spouse already resides in. Makes the prohibition: (1) depend on whether such services are otherwise covered; and (2) regardless of whether the organization is under contract with the community or facility. Prohibits related denial of enrollment or renewal, incentives to enrollees, and penalties or incentives to physicians. Declares that State laws are not preempted which meet certain requirements, including any more protective of participants or beneficiaries than those of this Act. Provides for enforcement.

(Sec. 805) Directs the Secretary to award grants to eligible States to support real choice systems change initiatives that establish specific action steps and specific timetables to: (1) achieve enduring system improvements; and (2) provide consumer-responsive long-term services and supports to eligible individuals in the most integrated setting appropriate based on the unique strengths and needs of the individual, the priorities and concerns of the individual (or, as appropriate, the individual's representative), and the individual's desires with regard to participation in community life.

Requires each State, in order to receive such a grant, to establish a Consumer Task Force to assist in the development, implementation, and evaluation of real choice systems change initiatives.

Provides funding.