S.3165 - Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 2000106th Congress (1999-2000)
|Sponsor:||Sen. Roth Jr., William V. [R-DE] (Introduced 10/05/2000)|
|Latest Action:||Senate - 10/05/2000 Introduced in the Senate. Read the first time. Placed on Senate Legislative Calendar under Read the First Time. (All Actions)|
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Summary: S.3165 — 106th Congress (1999-2000)All Information (Except Text)
Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 2000 - Title I: Benefit Improvements - Subtitle A: Beneficiary Assistance - Amends title XVIII (Medicare) of the Social Security Act (SSA) with regard to: (1) limiting the copayment amount for hospital outpatient department (OPD) services under Medicare part B (Supplementary Medical Insurance); (2) elimination of time limitation for coverage of immunosuppressive drugs and continued entitlement for immunosuppressive drugs for certain individuals after Medicare benefits end; and (3) preservation of coverage of drugs and biologicals under Medicare part B.
Introduced in Senate (10/05/2000)
(Sec. 104) Prohibits the Secretary of Health and Human Services from implementing any reduction in the rate of reimbursement for any outpatient drug or biological under Medicare between enactment of this Act and September 15, 2001.
Directs the Comptroller General to study and report to the Secretary and Congress on the reasonableness of the Medicare reimbursement policy for such drugs and biologicals based on their average wholesale price.
Subtitle B: Improved Preventive Benefits - Amends SSA title XVIII with regard to coverage of: (1) biannual screening pap smear and pelvic exams; (2) screening colonoscopy for average risk individuals; and (3) medical nutrition therapy services.
(Sec. 114) Makes changes concerning State accreditation for diabetes outpatient self-management training services.
(Sec. 115) Directs the Secretary to conduct for reports to Congress a series of studies designed to identify preventive interventions that can be delivered in the primary care setting and that are most valuable to older Americans.
Amends the mission statement of the United States Preventive Services Task Force to include the evaluation of services that are of particular relevance to older Americans.
(Sec. 116) Directs the Secretary to contract with the Institute of Medicine of the National Academy of Sciences to study and report to the Secretary and Congress on current literature and best practices in the field of health promotion and disease prevention among Medicare beneficiaries.
(Sec. 117) Directs the Medicare Payment Advisory Commission (MEDPAC) to study and report to the Secretary and Congress 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 XVIII with regard to payment for outpatient critical access hospital services to prohibit Medicare beneficiary cost-sharing otherwise applicable under Medicare part B with respect to clinical diagnostic laboratory services furnished as an outpatient critical access hospital service.
(Sec. 202) Provides for revision of payment for professional services provided by a critical access hospital.
(Sec. 203) Permits critical access hospitals to operate any psychiatric or rehabilitation unit which is: (1) a distinct part of the hospital; as well as (2) prospective payment system (PPS)-exempt.
(Sec. 204) Exempts critical access hospital swing beds from the skilled nursing facility (SNF) PPS.
Subtitle B: Other Rural Hospital Provisions - Outlines provisions for various payment adjustment, eligibility, and rebased target amounts treatment in relation to, respectively, rural disproportionate share (DSH) hospitals, Medicare dependent, small rural hospital program, and sole community hospitals.
(Sec. 214) Directs MEDPAC, in its study of rural providers under the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA) to include: (1) in such study an analysis of the impact of volume on the per unit cost of rural hospitals with psychiatric units; and (2) in its report on such study a recommendation on whether special treatment for such hospitals may be warranted.
Subtitle C: Other Rural Provisions - Sets out provisions relating to: (1) the provider-based rural health clinic cap exemption under Medicare part B provisions concerned with payment of benefits; and (2) payment for certain physician assistant services under such provisions for use of carriers for administration of benefits.
(Sec. 223) Directs the Secretary, during 2001 or 2002, to increase the payment amount in the case of a unit of home health service furnished in a rural area.
(Sec. 224) Revises Medicare reimbursement for telehealth services under the Balanced Budget Act of 1997 (BBA '97) and makes other telehealth-related changes, including making all physicians and practitioners eligible for telehealth reimbursement.
(Sec. 225) 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 III: Provisions Relating to Part A - Subtitle A: PPS Hospitals -.Amends SSA title XVIII to delay reduction in the PPS hospital payment update under Medicare provisions for payment to hospitals for inpatient hospital services.
(Sec. 301) Sets forth a special rule for payment for inpatient hospital services for FY 2001.
(Sec. 302) Amends SSA title XVIII to revise the reduction made in the indirect graduate medical education payments for DSH hospitals.
Sets forth a special rule for payment for indirect graduate medical education costs for DSH hospitals for FY 2001.
(Sec. 303) Amends SSA title XVIII to decrease reductions for DSH hospital payments.
Sets forth a special rule for payment for DSH hospitals for FY 2001.
(Sec. 304) Amends SSA title XVIII to modify the payment rate with respect to the operating costs of inpatient hospital services of DSH Puerto Rico hospitals for inpatient hospital discharges.
Sets forth a special rule for payment for the operating costs of inpatient hospital services of DSH Puerto Rico hospitals for FY 2001.
(Sec. 305) Directs MEDPAC to study and report to the Secretary and Congress on: (1) the hospital area wage indexes used in making payments to hospitals for payment amounts with respect to the operating costs of inpatient hospital services of a DSH hospital; and (2) any increased costs incurred by DSH hospitals in providing inpatient hospital services to Medicare beneficiaries during the period from FY 1983 through FY 1999 that were attributable to complying with new blood safety measure requirements and providing such services using new technologies.
Subtitle B: PPS Exempt Hospitals - Amends SSA title XVIII with regard to the OPD PPS to mandate pre-BBRA payment levels permanently for outpatient services furnished by children's hospitals.
(Sec. 312) Modifies payment for inpatient services of rehabilitation hospitals, including authority for a rehabilitation facility to elect to apply the full PPS rate without a phase-in.
(Sec. 313) Requires the Secretary, in developing the PPS required under BBRA for long-term care hospitals, to examine the feasibility and the impact of basing payment under such PPS on the use of existing (or refined) hospital diagnosis-related groups (DRGs) and the use of the most recently available hospital discharge data. Provides that if the Secretary is unable to implement such PPS by October 1, 2002, the Secretary shall implement a PPS for long-term care hospitals that bases payment under such a system using existing hospital DRGs for such services furnished on or after that date.
Subtitle C: Skilled Nursing Facilities - Amends SSA title XVIII to provide for revision to the SNF market basket update for FY 2001 and 2002.
(Sec. 321) Sets forth a special rule for payment for covered SNF services under Medicare for FY 2001.
(Sec. 322) Amends SSA title XVIII to limit the application of the SNF consolidated billing requirement to Medicare part A (Hospital Insurance) covered stays.
Directs the Secretary to monitor payments made under Medicare part B for items and services furnished to residents of SNFs during a time in which the residents are not being provided Medicare-covered post-hospital extended care services to ensure that there is not duplicate billing for services or excessive services provided.
(Sec. 323) Directs the Secretary to: (1) reexamine the SNF market basket percentage used in making the update to the first fiscal year under the PPS for SNFs; and (2) make adjustments to payments under the PPS for covered SNF services furnished in FY 2002 to reflect any necessary and appropriate adjustments to such payments.
Subtitle D: Hospice Care - Amends SSA title XVIII with regard to payment for hospice care to revise the market basket increase with respect to routine home care and other services included in hospice care furnished during each of FY 2001 and 2002.
(Sec. 331) Repeals BBRA provisions requiring the Secretary to provide for a temporary increase in payment for hospice care.
(Sec. 332) Directs the Secretary to study and report to Congress on the appropriateness of the Medicare certification regarding terminal illness of an individual required in order for such individual to receive Medicare hospice benefits.
(Sec. 333) Directs the Secretary to: (1) establish a Hospice Demonstration Program to increase the utility of hospice care for seriously ill Medicare beneficiaries; and (2) establish a Hospice Education Grant Program for hospice programs participating in such demonstration program for the purpose of providing information about Medicare hospice care and the benefits available to Medicare beneficiaries under such program. Provides for funding.
Subtitle E : Other Provisions - Prohibits the Secretary from implementing the provider-based criteria contained in the final rule published in the Federal Register by the Health Care Financing Administration on April 7, 2000 until after July 9, 2001.
Title IV: Provisions Relating to Part B - Subtitle A: Hospital Outpatient Services - Amends SSA title XVIII with regard to the OPD PPS concerning: (1) the transitional adjustment to limit decline in payment to make certain changes with regard to the pre-BBA amount for application to certain hospitals that did not submit a 1996 cost report; (2) the transitional pass-through for additional costs of innovative medical devices, drugs, and biologicals to make certain changes with regard to the eligibility of devices for pass-through payments under the OPD PPS; (3) system requirements to require the Secretary to create additional groups of covered OPD services that classify separately those procedures that utilize contrast media from those that do not; and (4) the transitional pass-through for additional costs of innovative medical devices, drugs, and biologicals to include contrast agents in the pass-through.
Subtitle B: Provisions Relating to Physicians - 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.
(Sec. 412) Directs the Comptroller General to study and report to the Secretary and Congress on the: (1) Medicare post-payment audit process as it applies to physicians; (2) the aggregate effects of regulatory, audit, oversight, and paperwork burdens on physicians and other health care providers participating in Medicare; and (3) the appropriateness of furnishing gastrointestinal endoscopic physicians' services in physicians' offices.
Subtitle C: Ambulance Services - Amends SSA title XVIII to provide for the elimination of the reduction in inflation adjustments for ambulance services.
(Sec. 422) Amends SSA title XVIII with regard to the establishment of a fee schedule for ambulance services to allow a supplier of ambulance services to make an election to forego phase-in of such fee schedule for ambulance services and receive payments based only on such fee schedule as in effect after such phase-in..
(Sec. 423) 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. 424) 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: Other Services - Amends SSA title XVIII part B with regard to payment of benefits and BBA '97 to extend the moratorium on caps for certain therapy services and the deadline for the Secretary to report to Congress any recommendations on establishment of a revised coverage policy of outpatient physical therapy services and outpatient occupational therapy services under SSA.
(Sec. 432) Amends SSA title XVIII part D with respect to Medicare coverage for end stage renal disease (ESRD) patients to provide for an increased update in the renal dialysis composite rate for end state renal dialysis services furnished on or after January 1, 2001.
(Sec. 433) Amends SSA title XVIII part B with respect to special payment rules for particular items and services to provide for a full update in 2001 for durable medical equipment, prosthetic devices and orthotics and prosthetics, and oxygen and oxygen equipment.
Amends BBA '97 to provide for a full update in 2001 for parenteral and enteral nutrients, supplies, and equipment.
(Sec. 434) Amends SSA title XVIII part B with regard to benefit payments to set the national limitation amount clinical diagnostic laboratory tests for new pap smear technologies (and other new test technologies) at 100 percent of the national median for such a test performed on or after January 1, 2001, that the Secretary determines is a new test for which no limitation amount has previously been established.
(Sec. 435) Prohibits the Secretary from implementing a revised PPS for services of ambulatory surgical facilities under Medicare before January 1, 2002.
Amends BBRA to provide for: (1) extending the phase-in of the PPS for ambulatory surgical centers to four years; and (2) establishing a deadline of January 1, 2003, for the Secretary to incorporate data from a 1999 or subsequent Medicare cost survey for purposes of implementing or revising such PPS.
(Sec. 436) Amends SSA title XVIII part B with regard to payment for physicians' services to provide for treatment of certain physician pathology services.
(Sec. 437) Amends SSA title XVIII part D with regard to Indian health service facilities to allow for the modification of Medicare billing requirements for the Indian Health Service or an Indian tribe or tribal organization operating such a facility.
(Sec. 438) Amends SSA title XVIII part B with respect to special payment rules for particular items and services concerning replacement of prosthetic devices which are artificial limbs and parts of any such devices.
(Sec. 439) Directs MEDPAC to study and report to the Secretary and Congress on the appropriateness of: (1) the current Medicare payment rates for services provided by a certified nurse-midwife, a physician assistant, nurse practitioner; and a clinical nurse specialist; and (2) providing Medicare coverage for services provided by a certified first nurse assistant, marriage counselor, pastoral care counselor; and licensed professional counselor of mental health.
Title V: Provisions Relating to Parts A and B - Subtitle A: Home Health Services - Amends SSA title XVIII part D (Miscellaneous Provisions) with regard to the PPS for home health services to provide for a one-year additional delay in application of the 15 percent reduction on payment limits for such services.
(Sec. 502) Amends SSA title XVIII part D to provide for restoration of the full home health market basket update for home health services for FY 2001.
Sets out a special rule for payment for home health services for FY 2001 based on adjusted prospective payment amounts.
(Sec. 503) Amends SSA title XVIII part D with regard to the PPS for home health services to exclude certain nonroutine medical supplies. Excludes certain medical supplies from Medicare consolidated billing during the applicable period.
Directs the Secretary to study and report to Congress on any nonroutine medical supply that may be appropriately and cost-effectively excluded from the PPS for home health services.
(Sec. 504) 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 the home health agency's parent office and a branch office shall be the sole determinant of a home health agency's branch office status.
Directs the Comptroller General to study and report to Congress on the provision of adequate supervision to maintain quality of home health services delivered under Medicare in isolated rural areas.
(Sec. 505) Directs the Secretary, for FY 2001 and 2002, to increase the addition or adjustment for outliers under the PPS for home health services by such proportion as will result in an aggregate increase in such addition or adjustment for the fiscal year estimated to equal $150,000,000.
Prohibits the Secretary from: (1) including any such additional payment in updating the standard prospective payment amount (or amounts) as increased by the home health applicable increase percentage for the fiscal year involved; and (2) reducing the standard prospective payment amount (or amounts) applicable to units of home health services furnished during a period to offset any such increase in payments.
(Sec. 506) Amends SSA title XVIII part A with regard to conditions of and limitations on payment for services and part B with regard to the procedure for payment of claims of providers of services making changes with regard to the definition of homebound under the Medicare home health benefit.
Subtitle B: Direct Graduate Medical Education - Provides that, effective for cost-reporting periods beginning on or after October 1, 1999, for purposes of Medicare payments to hospitals approved educational activities shall include the clinical portion of professional educational training programs, recognized by the Secretary, for clinical psychologists.
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 (Medicare+Choice) with regard to payments to Medicare+Choice organizations to: (1) increase the national per capita Medicare+Choice growth percentage in 2001 and 2002; (2) remove application of the budget neutrality adjustment factor for 2002 under provisions for calculation of annual Medicare+Choice capitation rates; (3) increase the minimum payment amount for 2001 for certain areas; and (4) modify area-specific and national percentages provisions with respect to calculation of annual Medicare+Choice capitation rates.
(Sec. 605) Amends SSA title XVIII part C with regard to payments to Medicare+Choice organizations to provide for: (1) an increased update for payment areas with only one or no Medicare+Choice contracts; and (2) a ten-year phase-in of risk adjustment and new methodology for establishment of risk adjustment factors.
(Sec. 607) 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. 608) Delays from July 1, 2000, to November 15, 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. 609) Amends SSA title XVIII part C with regard to payments to Medicare+Choice organizations to: (1) provide for revision of payment rates for ESRD patients enrolled in Medicare+Choice plans; (2) modify payment rules for certain frail elderly Medicare beneficiaries; (3) ensure full implementation of risk adjustment methodology for congestive heart failure enrollees for 2001; and (4) provide for inclusion of costs of certain Department of Defense military treatment facility services to Medicare-eligible beneficiaries in calculation of Medicare+Choice payment rates.
Subtitle B: Other Medicare+Choice Reforms - Amends SSA title XVIII part C with regard to contracts with Medicare+Choice organizations and amounts in Medicare trust funds available for the Secretary's share of Medicare+Choice education and enrollment-related costs and part D with regard to certification of Medicare supplemental health insurance (Medigap) policies and special Medigap enrollment anti-discrimination provision for certain beneficiaries.
(Sec. 623) Amends XVIII part C with regard to eligibility, election, and enrollment to: (1) provide for restoring the effective date of elections and changes of elections of Medicare+Choice plans; and (2) permit ESRD beneficiaries to enroll in another Medicare+Choice plan if the plan in which they are enrolled is terminated.
(Sec. 625) Amends SSA part C with regard to benefits and beneficiary protections to allow election of uniform local coverage policy for a Medicare+Choice plan covering multiple localities.
Subtitle C: Other Managed Care Reforms - Amends BBRA to provide for revised terms and conditions for extension of Medicare community nursing organization demonstration projects.
(Sec. 632) 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 title XIX (Medicaid) of the Social Security Act to create a new PPS for federally-qualified health centers and rural health clinics.
(Sec. 701) 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 federally-qualified health centers and rural health centers.
(Sec. 702) Amends SSA title XIX to provide for a: (1) one-year freeze in State Medicaid DSH allotments; and (2) permanent extension of payment of Medicare part B premiums for qualified Medicare beneficiaries with income up to 135 percent of the official poverty line.
(Sec. 704) 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. 705) Amends SSA title XIX, with regard to the Alaska Federal medical assistance percentage (FMAP), to establish the State percentage used to determine such FMAP with respect to FY 2001 through 2005 for purposes of SSA titles XIX and XXI (Children's Health Insurance) (CHIP).
Title VIII: State Children's Health Insurance Program (SCHIP) - Amends SSA title XXI (State Children's Health Insurance Program (SCHIP)) to: (1) establish a rule for redistribution and extended availability of unused FY 1998 and 1999 SCHIP allotments; (2) provide for the application under SCHIP of Medicaid provisions on presumptive eligibility for children; (3) provide authority to pay Medicaid expansion SCHIP costs from SCHIP appropriation; (4) eliminate requirement to reduce SCHIP allotment by Medicaid expansion SCHIP costs; and (5) provide authority to transfer SCHIP appropriations to Medicaid appropriation account as reimbursement for Medicaid expenditures for Medicaid expansion SCHIP services.
Title IX: Other Provisions - Amends SSA title V (Maternal and Child Health Services) to increase the authorization of appropriations for the Maternal and Child Health Services Block Grant program for FY 2001.
(Sec. 902) Amends the Public Health Service Act to increase FY 2001 and 2002 appropriations for special diabetes programs for children with type I diabetes and for special diabetes programs for Indians.