H.R.5612 - Medicare, Medicaid, and SCHIP Benefits Improvement and Beneficiary Protection Act of 2000106th Congress (1999-2000)
|Sponsor:||Rep. Rangel, Charles B. [D-NY-15] (Introduced 11/01/2000)|
|Committees:||House - Ways and Means; Commerce|
|Latest Action:||House - 11/09/2000 Referred to the Subcommittee on Health and Environment. (All Actions)|
This bill has the status Introduced
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Summary: H.R.5612 — 106th Congress (1999-2000)All Information (Except Text)
Medicare, Medicaid, and SCHIP Benefits Improvement and Beneficiary Protection Act of 2000 - Title I: Medicare Beneficiary Improvements - Subtitle A: Improved Preventive Benefits - Amends title XVIII (Medicare) of the Social Security Act (SSA) to provide for: (1) coverage of biennial screening pap smear and pelvic exams; (2) coverage of screening for glaucoma; (3) coverage of screening colonoscopy for average risk individuals; (4) revision of payments and standards for screening mammography; (5) coverage of medical nutrition therapy services for beneficiaries with diabetes or a renal disease; and (6) extension of Medicare part A (Hospital Insurance) coverage for workers with disabilities.
Introduced in House (11/01/2000)
Subtitle B: Other Beneficiary Improvements - Amends SSA title XVIII to provide for: (1) acceleration of reduction of beneficiary copayment for hospital outpatient department (OPD) services; (2) preservation of coverage of drugs and biologicals under Medicare part B (Supplementary Medical Insurance); (3) elimination of time limitation on Medicare benefits for immunosuppressive drugs; (4) imposition of billing limits on drugs; and (5) availability of application forms for medical assistance for Medicare cost-sharing.
(Sec. 116) Amends SSA title II (Old Age, Survivors and Disability Insurance) (OASDI) to provide for a waiver of 24-month waiting period for Medicare coverage of individuals disabled with amyotrophic lateral sclerosis.
Subtitle C: Demonstration Projects and Studies - Outlines: (1) a Health and Human Services (HHS) demonstration project for disease management for severely chronically ill Medicare beneficiaries; (2) HHS demonstration projects for cancer prevention and treatment for ethnic and racial minorities; (3) a National Academy of Sciences study on the addition of coverage of routine thyroid screening using a thyroid stimulating hormone test as a preventive benefit provided to Medicare beneficiaries; (4) a Medicare Payment Advisory Commission (MEDPAC) study on consumer coalitions in marking Medicare+Choice (SSA title XVIII part C) plans; (5) an HHS study on the effect of limitations on State payment for Medicare cost-sharing on access to services for qualified Medicare beneficiaries; (6) HHS studies on preventive interventions in primary care for older Americans; and (7) a MEDPAC study on Medicare coverage of cardiac and pulmonary rehabilitation therapy services.
Title II: Rural Health Care Improvements - Subtitle A: Critical Access Hospital Provisions - Amends SSA title XVII to: (1) prohibit beneficiary cost-sharing for clinical diagnostic laboratory tests furnished by critical access hospitals; (2) increase the amount a critical access hospital may elect to be paid for outpatient critical access hospital (OCAH) services with respect to the fee schedule payment for OCAH professional services; (3) exempt critical access hospital swing beds from the skilled nursing facility (SNF) prospective payment system (PPS); (4) provide for payment in critical access hospitals for emergency room on-call physicians; and (5) provide for the treatment of ambulance services furnished by certain critical access hospitals.
(Sec. 206) Requires the General Accounting Office (GAO) to conduct a study on certain eligibility requirements for critical access hospitals.
Subtitle B: Other Rural Hospitals Provisions - Amends SSA title XVIII with regard to payment to hospitals for inpatient hospital services to provide for: (1) application of a uniform threshold for urban and rural hospitals to be classified as disproportionate share hospitals (DSHs) for discharges occurring on or after October 1, 2001; (2) adjustment of payment formulas for various specified hospitals, including hospitals that are both sole community hospitals and rural referral centers for discharges occurring during such period; (3) an option to base eligibility for the Medicare dependent, small rural hospital program on discharges during two of the three most recently audited cost reporting periods; and (4) extension of the option to use rebased target amounts to all sole community hospitals.
(Sec. 214) Directs MEDPAC, in its study and report to Congress on rural providers under the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, to analyze the impact of volume on the per unit cost of rural hospitals with psychiatric units, and recommend whether special treatment for such hospitals may be warranted.
Subtitle C: Other Rural Provisions - Amends SSA title XVIII with regard to special payment rules for particular items and services to provide transitional assistance for providers of ambulance services in rural areas.
(Sec. 222) Amends SSA title XVIII part B with regard to the use of carriers for administration of benefits concerning payment for certain physician assistant services.
(Sec. 223) Amends BBA'97 to: (1) set a time limit for Medicare reimbursement for telehealth services; and (2) provide for an expansion of Medicare payment for such services.
(Sec. 224) Amends SSA title XVIII part B to provide for expanding access to rural health clinics.
(Sec. 225) Directs MEDPAC to study the effect of low patient and procedure volume on the financial status of low-volume, isolated rural health care providers participating in Medicare.
Title III: Provisions Relating to Part A - Subtitle A: Inpatient Hospital Services - Amends SSA title XVIII to provide for elimination of the reduction in the PPS hospital payment update.
(Sec. 301) Directs the Secretary, when rebasing and revising the hospital market basket index, to consider the prices of blood and blood products purchased by hospitals and to determine whether those prices are adequately reflected in such index.
Amends SSA title XVIII with respect to payment to hospitals for inpatient hospital services and updating previous standardized amounts to provide for: (1) an adjustment for inpatient case mix changes; (2) modification of the transition for indirect medical education percentage adjustment for DSHs; and (3) decreases in reductions for DSH payments.
(Sec. 304) Provides for a three-year effective period for any decision of the Medicare Geographic Classification Review Board to reclassify a DSH for purposes of adjusting the diagnosis-related group (DRG) prospective payment rate for hospital wage level area differences for FY 2001 or any fiscal year thereafter. Requires the Secretary to establish procedures under which a DSH hospital may elect to terminate such reclassification before the end of such period.
Directs the Secretary to: (1) establish a process under which an appropriate statewide entity may apply to have all the geographic areas in a State treated as a single geographic area for purposes of computing and applying the area wage index; and (2) provide for the collection of data every three years on occupational mix for employees of each DSH in the provision of inpatient hospital services in order to construct an occupational mix adjustment in the applicable hospital area wage index.
(Sec. 305) Amends SSA title XVIII with respect to prospective payment for inpatient rehabilitation hospital services and: (1) assistance with administrative costs associated with completion of patient assessment; as well as (2) a rehabilitation facility election to apply full prospective payment rate without phase-in.
(Sec. 306) Provides that, with respect to the inpatient services of psychiatric hospitals and certain psychiatric units, in making incentive payments to such hospitals for cost reporting periods from October 1, 2000, through October 1, 2001, the Secretary shall increase the percent of the target amount used in determining such payments.
(Sec. 307) Amends SSA title XVIII to provide for: (1) increased target amounts and caps for long-term care hospitals before implementation of the PPS required under the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 for payment for inpatient hospital services provided in long-term care hospitals; (2) alternative implementation of such PPS by the Secretary based on the use of existing hospital DRGs that have been modified; and (3) increase in the base payment for Puerto Rico DSH hospitals.
Subtitle B: Adjustments to PPS Payments for Skilled Nursing Facilities - Amends SSA title XVIII with respect to payment to SNFs for routine service costs to revise updating requirements, among other changes eliminating the reduction in the skilled nursing facility market basket update in 2001.
(Sec. 311) Directs the Comptroller General to report to Congress on the adequacy of Medicare payment rates to SNFs and the extent to which Medicare contributes to the financial viability of such facilities.
(Sec. 312) Directs the Secretary to increase the nursing component of the case-mix adjusted Federal prospective payment rate specified in the final rule published in the Federal Register by the Health Care Financing Administration on July 31, 2000, effective for services furnished on or after April 1, 2001, and before October 1, 2002.
Requires the Comptroller General to conduct an audit for Congress of nursing staffing ratios in a representative sample of Medicare SNFs.
(Sec. 313) Amends SSA title XVIII to limit application of the SNF consolidated billing requirement to a period during which the resident is provided Medicare part A (Hospital Insurance) covered post-hospital extended care services.
Requires the Secretary to monitor payments made under Medicare part B for items and services furnished to SNF residents during a time in which they are not being provided Medicare covered post-hospital extended care services, in order to ensure that there is not duplicate billing for services or excessive services provided.
(Sec. 314) Provides that, for purposes of computing payments for certain covered SNF services, the Secretary shall increase the adjusted Federal per diem rate for covered SNF services for specified RUG-III (resource utilization group) rehabilitation groups furnished to an individual during the period in which such individual is classified in such a RUG-III category.
Directs the HHS Inspector General to review the Medicare payment structure for services classified within RUGs and report to Congress on whether payment incentives exist for the delivery of inadequate care.
(Sec. 315) Authorizes the Secretary to establish a procedure for the geographic reclassification of a SNF for purposes of payment for covered SNF services under the PPS for SNFs for routine service costs.
Subtitle C: Hospice Care - Amends SSA title XVIII to provide for a full market basket increase for hospice care for FY 2001 and 2002.
(Sec. 322) Requires that the certification regarding an individual's terminal illness be based on the physician's or medical director's clinical judgment regarding the normal course of the illness.
(Sec. 323) Directs MEDPAC to conduct a study on the factors affecting the use of hospice benefits under Medicare program and differences in such use between urban and rural hospice programs and based upon the presenting condition of the patient.
Subtitle D: Other Provisions - Amends SSA title XVIII to provide for a reduction in Medicare part A late enrollment premium increases (penalty) for a qualified State or local government retiree group in the case where a State, a local government, or an agency or instrumentality of a State or local government, determines to pay, for the life of each individual in such a group, the monthly premiums due.
(Sec. 332) Outlines provisions for hospital geographic reclassification for labor costs applicable to other PPS systems and for grants to States for improvements in nursing home staffing and quality.
Title IV: Provisions Relating to Part B - Subtitle A: Hospital Outpatient Services - Amends SSA title XVIII with respect to the PPS for hospital OPD services to provide for: (1) a full market basket increase for such services for 2001; (2) adjustment for service mix changes; (3) use of categories in determining eligibility of a device for pass-through payments; (4) application of OPD PPS transitional corridor payments to certain hospitals that did not submit a 1996 cost report; (5) treatment of children's hospitals under the PPS; (6) inclusion of temperature monitored cryoablation in transitional pass-through for certain medical devices, drugs, and biologicals under the PPS; and (7) 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. 404) Provides that, for purposes of making determinations of provider-based status under Medicare on or after October 1, 2000, any facility or organization that is treated as provider-based in relation to a hospital or critical access hospital under Medicare as of October 1, 2000: (1) shall continue to be treated as provider-based in relation to such hospital or critical access hospital under Medicare during the two year period beginning on October 1, 2000; and (2) the requirements, limitations, and exclusions specified in appropriate Federal regulations detailing requirements for a determination that a facility or an organization has provider-based status shall not apply to such facility or organization in relation to such hospital or critical access hospital until after the end of such two- year period.
Prohibits a facility or organization for which a determination of provider-based status in relation to a hospital or critical access hospital is requested during FY 2001 or 2002 from being treated as not having such status in relation to such a hospital for any period before a determination is made with respect to such status pursuant to such request and in making a determination with respect to such status for any facility or organization in relationship to such a hospital on or after October 1, 2000, the facility or organization shall be treated as satisfying any requirements and standards for geographic location in relation to such a hospital if the facility or organization: (1) satisfies appropriate Federal regulations pertaining to location in immediate vicinity or is located not more than 35 miles from the main campus of the hospital or critical access hospital; and (2) is owned and operated by a hospital or critical access hospital that meets specified criteria.
Subtitle B: Provisions Relating to Physicians' Services - Directs the Comptroller General to conduct a study on: (1) the appropriateness of furnishing in physicians' offices specialist physicians' services which are ordinarily furnished in hospital outpatient departments; and (2) the refinements to the practice expense relative value units during the transition to a resource-based practice expense system for physician payments under Medicare.
(Sec. 412) Amends SSA title XVIII to require the Secretary to conduct demonstration projects to test and, if proven effective, expand the use of incentives to health care groups participating in Medicare that: (1) encourage coordination of the care furnished to individuals under Medicare parts A 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. 413) Directs the Comptroller General to study the current Medicare enrollment process for groups that retain independent contractor physicians with particular emphasis on hospital-based physicians.
Subtitle C: Other Services - Amends SSA title XVIII to provide for a one-year extension of the moratorium on certain physical therapy services caps.
(Sec. 421) Directs the Secretary to study the implications: (1) of eliminating the "in the room" supervision requirement for Medicare payment for services of physical therapy assistants supervised by physical therapists; and (2) of such requirement on the cap imposed under Medicare on physical therapy services.
(Sec. 422) Amends SSA title XVIII with respect to Medicare coverage for end stage renal disease (ESRD) patients to increase the update for dialysis services furnished on or after January 1, 2001.
Directs the Secretary to: (1) collect data and develop an ESRD market basket whereby the Secretary can estimate, before the beginning of a year, the percentage by which the costs for the year of the mix of labor and nonlabor goods and services included in the ESRD composite rate will exceed the costs of such mix for the preceding year; and (2) develop a system which includes in such composite rate, to the maximum extent feasible, payment for clinical diagnostic laboratory tests and drugs that are routinely used in furnishing dialysis services to Medicare beneficiaries, but which are currently separately billable by renal dialysis facilities.
(Sec. 423) Amends SSA title XVIII with respect to payment for ambulance services to provide for: (1) restoration of the full consumer price index (CPI) increase for 2001; and (2) continued phase-in of the application of the payment rates under the ambulance services fee schedule in an efficient and fair manner; except that when the Secretary implements such fee schedule, such phase-in shall provide for full payment of any national mileage rate for ambulance services provided by suppliers that are paid by carriers in any of the 50 States where payment by a carrier for such services for all such suppliers in such State, before the fee schedule's implementation, did not include a separate amount for all mileage within the county from which the beneficiary is transported.
(Sec. 424) 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 with respect to the phase-in of the PPS for ambulatory surgical centers to: (1) extend the phase-in to four years; and (2) direct the Secretary, by January 1, 2003, to incorporate data from a 1999 Medicare cost survey or a subsequent cost survey for purposes of implementing or revising such PPS.
(Sec. 425) Amends SSA title XVIII, with respect to special payment rules for particular items and services, to provide for: (1) the full update for durable medical equipment, orthotics, and prosthetics in 2001; and (2) addition of special payment provisions and requirements for prosthetics and certain custom fabricated orthotic items.
(Sec. 428) Amends SSA title XVIII to provide for the replacement of, and payment for, prosthetic devices and parts.
(Sec. 429) Directs the Comptroller General to study the reimbursement for drugs and biologicals under the current Medicare payment methodology and for related services under Medicare part B, with recommendations for revised payment methodologies. Directs the Secretary to revise such payment methodology based on such recommendations.
(Sec. 430) Amends SSA title XVIII part D (Miscellaneous) to revise the qualifications for community mental health centers under provisions defining partial hospitalization services.
(Sec. 431) Makes a hospital or a free-standing ambulatory care clinic, whether operated by the Indian Health Service or by an Indian tribe or tribal organization, eligible for payments for services for which payment is made under Medicare part B for physicians' services if and for so long as it meets all of the requirements which are applicable generally to such payments, services, hospitals, and clinics.
(Sec. 432) Directs the Comptroller General to study the effect on Medicare and on Medicare beneficiaries of coverage of surgical first assisting services of certified registered nurse first assistants.
(Sec. 433) Directs MEDPAC to study the appropriateness of: (1) the current Medicare payment rates for services provided by a certified nurse-midwife, a physician assistant, a nurse practitioner, and a clinical nurse specialist; and (2) Medicare coverage for services provided by a surgical technologist, a marriage counselor, a marriage and family therapist, a pastoral care counselor, and a licensed professional counselor of mental health.
(Sec. 435) Directs the Comptroller General to study: (1) the costs of providing emergency and medical transportation services across the range of acuity levels of conditions for which such transportation services are provided; (2) the post-payment audit process under Medicare as such process applies to physicians; and (3) the aggregate effects of regulatory, audit, oversight, and paperwork burdens on physicians and other health care providers participating in Medicare.
(Sec. 437) Directs MEDPAC to study the barriers to coverage and payment for outpatient interventional pain medicine procedures under Medicare.
Title V: Provisions Relating to Parts A and B - Subtitle A: Home Health Services - Amends SSA title XVIII to provide for a two-year additional delay in the application of the 15 percent reduction on payment limits for home health services.
(Sec. 501) Amends the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 to delay for an additional year the 15 percent reduction in payment rates for home health services after implementation of the PPS. Requires the Comptroller General, instead of the Secretary (as currently required), to report to Congress an analysis of the need for such a reduction.
Amends SSA title XVIII with regard to the PPS for home health services concerning the annual update to provide for an adjustment for case mix changes.
(Sec. 502) Amends SSA title XVIII to provide for restoration of the full home health market basket update for home health services for FY 2001.
Establishes a special rule for payment under the PPS for home health services for FY 2001 based on adjusted prospective payment amounts.
(Sec. 503) Provides for a temporary two-month extension of periodic interim payments under BBA '97 in the case of a home health agency receiving periodic interim payments as of September 30, 2000.
(Sec. 504) Amends SSA title XVIII to provide for the use of telehealth in the delivery of home health services.
(Sec. 505) Directs the Comptroller General to study variations in prices paid by home health agencies furnishing home health services under Medicare in purchasing nonroutine medical supplies and volumes if such supplies used determine the effect (if any) of variations on prices and volumes in the provision of such services.
(Sec. 506) Provides that, in determining for Medicare purposes whether an office of a home health agency constitutes a branch office or a separate home health agency, neither the time nor distance between a parent office of the home health agency and a branch office shall be the sole determinant of a home health agency's branch office status.
(Sec. 507) Amends SSA title XVIII with regard to the Medicare home health benefit to declare that absences from home to receive medical treatment shall not disqualify an individual from such benefit.
(Sec. 508) Provides for a temporary payment increase for home health services furnished in a rural area for2001 and 2002.
Subtitle B: Direct Graduate Medical Education - Amends SSA title XVIII to provide for an increase in the floor for direct graduate medical education payments for FY 2002.
(Sec. 512) Changes the distribution formula for Medicare+Choice-related nursing and allied health education costs.
Subtitle C: Changes in Medicare Coverage and Appeals Process - Amends SSA title XVIII to revise the Medicare appeals process. Provides for initial determinations of entitlement and benefits by the Secretary, by a utilization and quality control peer review organization, or by an independent contractor. Provides for redeterminations of denied benefit claims. Specifies appeal rights, including the right of an individual to request a medically exigent review from the contractor who made the initial determination.
(Sec. 522) Provides for the review of coverage determinations under the Medicare appeals process.
Amends SSA title XI to require any advisory committee on certain Medicare coverage exclusions to: (1) assure the full participation of a nonvoting member in its deliberations; and (2) provide such nonvoting member access to all information and data (with certain exceptions) made available to the committee's voting members. Provides that, if such committee organizes into panels of experts according to types of items or services, any such panel may report directly to the Secretary without prior approval.
Subtitle D: Improving Access to New Technologies - Amends SSA title XVIII to establish a new payment rule for any clinical diagnostic laboratory test performed on or after January 1, 2001, that is a new test for which no limitation amount has previously been established.
(Sec. 531) Directs the Secretary to: (1) establish procedures for coding and payment determinations for the categories of new clinical diagnostic laboratory tests and new durable medical equipment under Medicare part B that permit public consultation in a manner consistent with the procedures established for implementing coding modifications for ICD-9-CM; and (2) report to Congress on the specific procedures used under Medicare part B to adjust payments for clinical diagnostic laboratory tests and durable medical equipment which are classified to existing codes where, because of a technology advance, there has been a significant increase or decrease in the resources used in the test or in the manufacture of the equipment, and a significant improvement in test or equipment performance.
(Sec. 532) Directs the Secretary to: (1) maintain and continue through December 31, 2003, the use of level III codes of the HCPCS (Health Care Financing Administration (HCFA) Common Procedure Coding System) coding system (as such system was in effect on August 16, 2000); and (2) make such codes publicly available.
(Sec. 533) Directs the Secretary to: (1) report to Congress on methods of expeditiously incorporating new medical services and technologies into the clinical coding system used with respect to Medicare payment for inpatient hospital services, together with a detailed description of the Secretary's preferred methods to achieve this purpose; and (2) implement such preferred methods.
Amends SSA title XVIII to direct the Secretary to establish a mechanism to recognize the costs of new medical services and technologies with respect to inpatient hospital services under the hospital reimbursement control system.
Subtitle E: Other Provisions - Amends SSA title XVIII to reduce from 45 percent to 30 percent the reduction in the amount of bad debts otherwise treated as allowable costs attributable to the deductibles and coinsurance amounts under Medicare for FY 2001 and subsequent fiscal years in determining the reasonable costs of outpatient hospital services (thus increasing by 15 percent the amount that may be reimbursed).
(Sec. 542) Provides for the treatment of certain physician pathology services under Medicare.
(Sec. 543) Amends SSA title XI to make permanent the authority for the Secretary to issue written advisory opinions under provisions for guidance regarding application of health care fraud and abuse sanctions.
(Sec. 544) Amends SSA title XVIII to make various specified changes in annual MEDPAC reporting with regard to revision of deadlines for submission of reports and on the record votes on recommendations.
(Sec. 545) Directs the Secretary to report to specified congressional committees on the development of standard instruments for the assessment of the health and functional status of patients, for whom specified items and services are furnished.
(Sec. 546) Directs the Comptroller General to report to specified congressional committees 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.
(Sec. 547) Amends SSA title XVIII with respect to agreements with providers of services to provide for the application of the bloodborne pathogen standard to certain hospitals.
Title VI: Provisions Relating to Part C (Medicare+Choice Program) and Other Medicare Managed Care Provisions - Subtitle A: Medicare+Choice Payment Reforms - Amends SSA title XVIII part C with regard to payments to Medicare+Choice organizations to: (1) increase the payment amount for 2001 through 2003 for accountable Medicare+Choice coordinated care plans; and (2) provide for a ten-year phase-in of risk adjustment.
(Sec. 603) Provides for a transition to revised Medicare+Choice payment rates.
(Sec. 604) Amends SSA title XVIII part C to provide for revision of payment rates for ESRD patients enrolled in Medicare+Choice plans.
(Sec. 605) Amends SSA title XVIII part C with regard to premiums to permit Medicare part B premium reductions as additional benefits under Medicare+Choice plans.
(Sec. 606) Amends SSA title XVIII part C with regard to payments to Medicare+Choice organizations to: (1) ensure full implementation of risk adjustment methodology for congestive heart failure enrollees for 2001; and (2) provide for the expansion of the application of Medicare+Choice's new entry bonus.
(Sec. 608) Directs the Secretary to report to Congress on a method to phase-in the costs of military facility services furnished by the Department of Veterans Affairs, and those furnished by the Department of Defense, to Medicare-eligible beneficiaries in the calculation of an area's Medicare+Choice capitation payment.
Subtitle B: Other Medicare+Choice Reforms - Amends SSA title XVIII part C to provide for payment of additional amounts for new Medicare+Choice benefits covered during a contract term.
(Sec. 612) Prohibits the Secretary from implementing, other than at the beginning of a calendar year, regulations that impose significant regulatory requirements on a Medicare+Choice organization or plan.
(Sec. 613) Provides for timely approval of marketing material that follows model marketing language, and for avoiding duplicative regulation with respect to plan requirements.
(Sec. 615) Provides that, in the case of a Medicare+Choice organization that offers a Medicare+Choice plan in an area in which more than one local coverage policy is applied with respect to different parts of the area, the organization may elect to have the local coverage policy for the part of the area that is most beneficial to Medicare+Choice enrollees apply with respect to all Medicare+Choice enrollees enrolled in the plan.
(Sec. 616) Requires: (1) the quality assurance program under the Medicare+Choice program to include a separate focus on racial and ethnic minorities; and (2) the Secretary to submit to Congress a report regarding how such quality assurance programs focus on racial and ethnic minorities.
(Sec. 617) Authorizes the Secretary to waive or to modify requirements that hinder the design of, the offering of, or enrollment in Medicare+Choice plans under contracts between Medicare+Choice organizations and employers, labor organizations, or the trustees of a fund established by one or more employers or labor organizations (or combination thereof) to furnish benefits to the entity's employees, former employees (or combination thereof) or to members or former members (or combination thereof) of the labor organizations.
(Sec. 618) Amends SSA title XVIII part D with regard to special Medicare supplemental health insurance enrollment anti-discrimination provision for certain beneficiaries.
(Sec. 619) Amends SSA title XVIII part C to restore the effective date of elections and changes of elections of Medicare+Choice plans.
(Sec. 620) Permits ESRD beneficiaries to enroll in another Medicare+Choice plan if the plan in which they are enrolled is terminated.
(Sec. 621) Provides that, in covering post-hospital extended care services, a Medicare+Choice plan shall provide for such coverage through a home SNF if: (1) the enrollee elects to receive such coverage through such SNF; and (2) the SNF has a contract with the Medicare+Choice organization for the provision of such services, or the SNF agrees to accept substantially similar payment under the same terms and conditions that apply to similarly situated SNFs under contract with the Medicare+Choice organization through which the enrollee would otherwise receive such services.
(Sec. 622) Directs HCFA's Chief Actuary to review the actuarial assumptions and data used by the Medicare+Choice organization with respect to such rates, amounts, and values to determine the appropriateness of such assumptions and data.
(Sec. 623) Amends SSA title XVIII to provide for civil monetary penalties for contract default by a Medicare+Choice organization.
Subtitle C: Other Managed Care Reforms - Amends the Omnibus Budget Reconciliation Act of 1987 to provide for a one-year extension of the social health maintenance organization demonstration project authority.
(Sec. 632) Amends the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 to provide for revised terms and conditions for extension of Medicare community nursing organization demonstration project.
(Sec. 633) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to provide for a two-year extension of Medicare municipal health services demonstration projects.
(Sec. 634) Amends SSA title XVIII part D with regard to payments to health maintenance organizations and competitive medical plans and service area expansion for Medicare cost contracts during transition period.
Title VII: Medicaid - Amends SSA title XIX with respect to DSH payments and: (1) continuation of Medicaid DSH allotments at FY 2000 levels for FY 2001 and 2002; and (2) a special rule for Medicaid DSH allotment for extremely low DSH States.
(Sec. 701) Outlines provisions for: (1) assuring identification of Medicaid managed care patients for purposes of making DSH payments; (2) application of the Medicaid DSH transition rule to public hospitals in all States; (3) assistance for certain public hospitals; and (4) DSH payment accountability standards.
(Sec. 702) Amends SSA title XIX to create a new PPS for Federally-qualified health centers and rural health clinics.
(Sec. 703) Amends SSA XI to establish an approval process for a State's application for an extension of any State-wide comprehensive demonstration project for which a waiver of compliance with Medicaid requirements is granted.
(Sec. 704) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 with respect to Medicaid county-organized health systems.
(Sec. 705) Directs the Secretary to issue a final regulation based on the proposed rule announced on October 5, 2000, that: (1) modifies the upper payment limit test applied to State Medicaid spending for inpatient hospital services, outpatient hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services by applying an aggregate upper payment limit to payments made to government facilities that are not State-owned or operated facilities; and (2) provides for a specified transition period.
(Sec. 706) Prescribes a formula for the Federal medical assistance percentage for Alaska for purposes of SSA titles XIX and XXI (State Children's Health Insurance Program) (SCHIP), which shall apply only for FY 2001 through 2005.
(Sec. 707) Amends SSA title XIX to provide for optional coverage of legal immigrants under Medicaid.
(Sec. 708) Makes additional entities qualified to determine Medicaid presumptive eligibility for low-income children.
(Sec. 709) Provides for a one year extension of provisions on eligibility for medical assistance under Medicaid.
(Sec. 710) Includes as Medicaid medical assistance any services furnished by a physician assistant which the assistant is legally authorized to perform under State law and with the supervision of a physician.
(Sec. 711) Gives States the option of allowing families of disabled children to purchase Medicaid coverage for such children.
Title VIII: State Children's Health Insurance Program - Amends SSA title XXI to: (1) establish a rule for redistribution and extended availability of unused FY 1998 and 1999 SCHIP allotments; (2) provide authority to pay Medicaid expansion SCHIP costs from SCHIP appropriations; (3) eliminate requirement to reduce a SCHIP allotment by Medicaid expansion SCHIP costs; (4) provide authority to transfer SCHIP appropriations to the Medicaid appropriation account as reimbursement for Medicaid expenditures for Medicaid expansion SCHIP services; and (5) provide optional coverage of certain legal immigrants under SCHIP.
Title IX: Other Provisions - Subtitle A: PACE Program - Amends BBA '97 with respect to programs of all-inclusive care for the elderly (PACE programs) to provide for an extension of transition for the current PACE demonstration project waiver authority.
(Sec. 902) Amends SSA title XVIII with respect to payments to, and coverage of benefits under, PACE programs, and regulations and use of PACE protocol to provide for the continuation of modifications or waivers of operational requirements under demonstration status.
(Sec. 903) Directs the Secretary to approve or deny a request for a modification or a waiver of provisions of the PACE protocol not later than 90 days after the Secretary receives the request, in order to provide flexibility in exercising waiver authority.
Permits the Secretary to exercise authority to modify or to waive such provisions in a manner that responds promptly to the needs of PACE programs relating to areas of employment and the use of community-based primary care physicians in order to provide flexibility in exercising waiver authority.
Subtitle B: Outreach to Eligible Low-Income Medicare Beneficiaries - Amends SSA title XI to direct the Commissioner of Social Security to: (1) conduct outreach efforts to identify individuals entitled to Medicare benefits who may be eligible for medical assistance for payment of the cost of Medicare cost-sharing under Medicaid; and (2) notify such individuals of the availability of such medical assistance.
(Sec. 911) Directs the Comptroller General to study the impact of such outreach efforts on the enrollment of individuals for Medicare cost-sharing under Medicaid.
Subtitle C: Maternal and Child Health Block Grant - Amends SSA title V (Maternal and Child Health Services) to increase the authorization of appropriations for the Maternal and Child Health Services block grant for FY 2001 and each fiscal year thereafter.
Subtitle D: Diabetes - Amends the Public Health Service Act to increase FY 2001 through 2003 appropriations for special diabetes programs for children with type I diabetes and for special diabetes programs for Indians.
(Sec. 931) Amends BBA '97 to extend the final report on diabetes grant programs.
(Sec. 932) Amends the Ricky Ray Hemophilia Relief Fund Act of 1998 to make appropriations to the Ricky Ray Hemophilia Relief Fund for FY 2001.