Summary: S.2807 — 106th Congress (1999-2000)All Information (Except Text)

There is one summary for S.2807. Bill summaries are authored by CRS.

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Introduced in Senate (06/28/2000)

Medicare Prescription Drug and Modernization Act of 2000 - Title I: Medicare Management and Administration - Subtitle A: Establishment of the Competitive Medicare Agency - Amends the Social Security Act (SSA) to add a new title XXII (Medicare Competition and Prescription Drugs) to establish, as an independent agency in the executive branch, a Medicare Competition Agency, headed by a Commissioner, to administer the Medicare Prescription Drug and Supplemental Benefit Program (program) under part B (established by title II of this Act) and the Medicare+Choice program under part C (Medicare+Choice) of SSA title XVIII (Medicare).

(Sec. 101) Establishes a Medicare Competition and Prescription Drug Advisory Board. Authorizes appropriations.

(Sec. 102) Amends SSA title XVIII to make the Commissioner a member of the Board of Trustees of the Medicare trust funds.

(Sec. 103) Amends Federal civil service law to provide for a salary increase for the Administrator of the Health Care Financing Administration (HCFA).

Subtitle B: Redefined Medicare Solvency Measures - Amends SSA title XVIII to require the Board of Trustees to make a separate annual report on the operation and status of the Federal Hospital Insurance Trust Fund under Medicare part A (Hospital Insurance) and on the Federal Supplementary Medical Insurance Trust Fund under Medicare part B (Supplementary Insurance), including the Medicare Prescription Drug Account (created by title II of this Act) within it.

(Sec. 151) Expresses the sense of Congress that the committees of jurisdiction shall hold hearings on such reports.

Title II: Medicare Prescription Drug and Supplemental Benefit Program - Amends SSA title XXII to add a new part B (Medicare Prescription Drug and Supplemental Benefit Program) requiring the Commissioner to establish the Medicare Prescription Drug and Supplemental Benefit Program under which an eligible beneficiary may voluntarily enroll in, and receive access to covered outpatient prescription drugs and other benefits through, a Medicare Prescription Plus plan (plan) offered by a private entity or by a Medicare+Choice plan. Makes the costs of providing program benefits payable from the Medicare Prescription Drug Account.

(Sec. 201) Outlines program procedures, including procedures for: (1) enrollment; (2) a Commissioner study and report to Congress on permitting individuals enrolled under Medicare part B but not entitled to benefits under Medicare part A to buy into the program; (3) plan election; (4) beneficiary outreach; (5) application of Medicare+Choice secondary payor requirements to the program in the same manner as they apply under the Medicare+Choice program; (5) alternative coverage requirements; (6) access to negotiated prices; (7) actuarial valuation and determination of annual percentage increases; (8) beneficiary protections, including grievance resolution; (9) requirements for entities offering plans, including licensure; (10) submission and approval of plans; (11) payments to plans for benefits; (12) computation and collection of beneficiary share of premium; (13) additional prescription drug subsidies through reinsurance; (14) plan fees for administrative costs; and (15) creation and use of the Medicare Prescription Drug Account.

(Sec. 202) Revises requirements for the Federal Supplementary Medical Insurance Trust Fund to comply with this Act.

(Sec. 203) Amends SSA title XVIII part C to prohibit a Medicare+Choice organization from offering prescription drug coverage to a Medicare+Choice plan enrollee unless such drug coverage is at least qualified prescription drug coverage under this Act, and unless specified requirements for such coverage are met.

(Sec. 204) Amends SSA title XIX (Medicaid) to require a State, as a condition for receiving Federal financial assistance for its Medicaid plan, to make Medicare prescription drug benefit eligibility determinations for low-income premium and cost-sharing subsidies. Mandates specified increases in applicable Federal matching rates for State expenditures for additional administrative costs.

Provides for phased-in Federal assumption of Medicaid prescription drug costs in the case of an individual dually entitled to qualified prescription drug coverage under a Medicaid plan or under a Medicare+Choice plan under Medicare part C.

(Sec. 205) Prohibits any new Medigap policy covering prescription drugs from being issued, on or after January 1, 2003, to an individual unless it replaces a Medigap policy that was issued to that individual and that provided some coverage of expenses for prescription drugs.

Prohibits the issuer of a Medigap policy from denying or conditioning Medigap coverage for an individual who terminates certain kinds of Medigap policies and applies for certain other kinds.

Amends SSA title XVIII (Medicare) to establish Medigap protections for individuals who lose Medicare prescription plus plan coverage.

(Sec. 206) Directs the Comptroller General to study and report to Congress on the extent to which reimbursement for drugs and biologicals under the current Medicare payment methodology overpays for the cost of such drugs and biologicals compared to the average acquisition cost paid by physicians or other drug suppliers.

Title III: Medicare+Choice Reforms - Amends Medicare part C with respect to: (1) increasing in national per capita Medicare+Choice growth percentage in 2001 and 2002; (2) removing application of budget neutrality beginning in 2002; (3) payments to Medicare+Choice organizations based on risk-adjusted bids; (4) premium reduction and Medicare+Choice monthly supplemental beneficiary premium; (5) rules relating to premiums owed by Medicare+Choice enrollees; (6) allowing plans to include described reductions and other benefits in their basic benefits; (7) a special rule for end-stage renal disease; (8) information comparing plan premiums; (9) national coverage determinations; (10) disclosure requirements; (11) geographic adjustment; (12) Medicare+Choice monthly basic beneficiary premium; (13) a freeze of the health risk adjuster at 20 percent after 2002; and (14) adjustment in payment to include the Commissioner's estimate of the amount of additional payments that would have been made in the area involved if individuals entitled to Medicare+Choice benefits had not received services from facilities of the Departments of Veterans Affairs or of Defense for purposes of calculating annual Medicare+Choice capitation rates.

Title IV: Medicare Beneficiary Outreach and Education - Amends SSA title XXII to add a new part C (Medicare Consumer Coalitions) authorizing the Commissioner of the Competitive Medicare Agency to establish Medicare Consumer Coalitions to conduct information programs comparing the original Medicare fee-for-service program, available Medicare+Choice plans, and available Medicare Prescription Plus plans. Authorizes appropriations.