Conference Report Explanation of Small Business Research, 'Pain Relief' Tax Provisions in H.R. 2614
H. Rept. 106-1004 for H.R. 2614
- AuthorsArmey, Rep. Richard K.
- Institutional AuthorsHouse of Representatives
- Cross-ReferenceFor text of H.R. 5542's provisions, see Doc 2000-27538 (286 original
pages); 2000 TNT 209-8
and 2000 TNT 209-9 ; or H&D, Special
Supplement, Oct. 27, 2000. For related coverage, see Doc 2000-27773
(7 original pages), 2000 TNT 209-1, or H&D, Oct. 27, 2000, p. 1059. - Subject Area/Tax Topics
- Index Termsbudget, federallegislation, taxhealth care and insurancesmall business
- Jurisdictions
- LanguageEnglish
- Tax Analysts Document NumberDoc 2000-28631 (474 original pages)
- Tax Analysts Electronic Citation2000 TNT 221-31
=============== FULL TEXT ===============
JOINT COMMITTEE ON TAXATION
October 26, 2000
JCX-109-00
ESTIMATED REVENUE EFFECTS OF THE "TAXPAYER RELIEF ACT OF 2000"
Fiscal Years 2001 - 2010
[Millions of Dollars]
______________________________________________________________________
Provision
[Effective] 2001 2002 2003 2004
______________________________________________________________________
EXTRATERRITORIAL INCOME
EXCLUSION; FSC REPEAL
(H.R. 4986)
[generally Ta 9/30/00] -153 -315 -348 -384
SMALL BUSINESS TAX RELIEF
PROVISIONS
A. Extend the Work Opportunity
Tax Credit Through 6/30/04 1
[wpoifibwa 12/31/01] --- -119 -317 -379
B. Increase Maximum Reforestation
Expenses Qualifying for
Amortization and Credit from
$10,000 to $25,000; Remove Cap
on Amortization of Reforestation
Costs in 2001 Through 2003;
Clarify Capital Gains Treatment
of Sales of Timber
[tyba 12/31/00 & sa DOE] -5 -15 -22 -27
C. Increase Section 179 Expensing
to $35,000
[tyba 12/31/00] -558 -866 -561 -473
D. Increase Business Meals
Deduction (Excluding Entertain-
ment Expenses) to 70% in 2001
and Thereafter
[tyba 12/31/00] -1,129 -2,207 -2,304 -2,404
E. 80% Business Meals Deduction
for Workers Subject to DOT
Hours of Service Limitation
[tyba 12/31/00] -39 -70 -64 -55
F. Permit Installment Method for
Accrual Basis Taxpayers
[iso/a 12/17/99] -1,120 -394 -249 -70
G. Coordinate Farmer Income
Averaging and the AMT and
Provide the Same Income
Averaging Relief to Commercial
Fishermen
[tyba 12/31/00] -1 -2 -2 -2
H. Repeal the Occupational Taxes
Relating to Distilled
Spirits, Wine, and Beer
[7/1/01] -64 -75 -75 -75
I. Exclusion from Gross Income
for Certain Forgiven Mortgage
Obligations
[doia 12/31/00] -2 -6 -6 -6
J. Clarification of Cash
Accounting Rules for Small
Businesses
[tyba DOE] -61 -212 -224 -289
K. Authorize Payment of Interest
on Business Checking Accounts
[DOE & 2ya DOE] Negligible Effect
TOTAL OF SMALL BUSINESS TAX
RELIEF PROVISIONS -2,979 -3,966 -3,824 -3,780
HEALTH INSURANCE AND LONG-TERM
CARE PROVISIONS
A. Accelerate 100% Self-Employed
Health Insurance Deduction
and Extend Eligibility to
Those Who Choose Not to
Participate in Employer-
Subsidized Health Plans
[tyba 12/31/00] -274 -1,053 -697 2
B. Provide an Above-the-Line
Deduction for Health
Insurance Expenses for Which
the Taxpayer Pays At Least
50%, Phased in as Follows:
25% in 2001 through 2003,
35% in 2004, 65% in 2005,
and 100% thereafter
[tyba 12/31/00] -456 -1,555 -1,667 -2,000
C. Provide an Above-the-Line
Deduction for Long-Term
Care Insurance Expenses for
Which the Taxpayer Pays At
Least 50%, Phased in as
Follows: 25% in 2001 through
2003, 35% in 2004, 65% in 2005,
and 100% thereafter
[tyba 12/31/00] -41 -280 -333 -394
D. Two-Year Extension of
Medical Savings Accounts
[DOE] 2 -3 -4 -4
E. Additional Consumer Protections
for Long-Term Care Insurance
[pimt 1ya DOE] Negligible Revenue Effect
F. Provide an Additional Personal
Deduction to Caretakers of
Family Members - $3,000 in 2001
increasing by $1,000 per year to
a maximum of $10,000 in 2008
[tyba 12/31/00] -447 -899 -1,208 -1,492
TOTAL OF HEALTH INSURANCE
AND LONG-TERM CARE PROVISIONS -1,218 -3,790 -3,909 -3,890
PENSIONS AND INDIVIDUAL RETIREMENT
ARRANGEMENT PROVISIONS
A. Individual Retirement
Arrangement Provisions
1. Modification of IRA
Contribution Limits -
increase the maximum contri-
bution limit for traditional
and Roth IRAs to: $3,000 in
2001, $4,000 in 2002, $5,000
in 2003, and index for
inflation thereafter
[tyba 12/31/00] -395 -1,194 -2,013 -2,726
2. IRA Catch-Up Contributions --
increase maximum contribution
limits for traditional and
Roth IRAs for individuals age
50 and above; the catch-up
amount is $500 in 2001,
$1,000 in 2002, and $1,500
in 2003, with indexing
thereafter in $500
increments
[tyba 12/31/00] -71 -154 -163 -155
3. Increase AGI limits for
deductible IRA contributions,
including for married filing
separately
[tyba 12/31/00] -103 -357 -475 -411
4. Increase income limits for
contributions to Roth IRAs
for joint filers to twice
the limits for single filers
[tyba 12/31/00] -9 -54 -128 -216
5. Increase the income limit
for conversions of an IRA
to a Roth IRA to $200,000
for joint filers
[tyba 12/31/00] 400 1,046 719 166
6. Deemed IRAs under employer
plans
[tyba 12/31/01] Negligible Revenue Effect
7. Allow tax-free withdrawals
from IRAs for charitable
purposes; the exclusion is
available only with respect
to distributions made to an
organization to which deduct-
ible contributions can be
made
[tyba 12/31/00] -133 -267 -270 -273
Total of Individual Retirement
Arrangement Provisions -311 -980 -2,330 -3,615
B. Provisions for Expanding
Coverage
1. Increase contribution and
benefit limits:
a. Increase limitation on
exclusion for elective
deferrals to: $11,000 in
2001, $12,000 in 2002,
$13,000 in 2003, $14,000
in 2004, and $15,000 in
2005; index thereafter
3 /4/
[yba 12/31/00] -130 -310 -452 -557
b. Increase limitation on
SIMPLE elective contribu-
tions to: $7,000 in 2001,
$8,000 in 2002, $9,000 in
2003, and $10,000 in 2004;
index thereafter 3 /4/
[yba 12/31/00] -4 -14 -21 -26
c. Increase defined benefit
dollar limit to $160,000
[yba 12/31/00] -18 -31 -40 -45
d. Lower early retirement age
to 62; lower normal
retirement age to 65
[yba 12/31/00] -3 -4 -4 -4
e. Increase limitation for
defined contribution
plans to $40,000 with
indexing in $1,000
increments 3
[yba 12/31/00] -6 -12 -14 -15
f. Increase qualified plan
compensation limit to
$200,000 3
[yba 12/31/00] -43 -74 -84 -91
g. Increase limits on defer-
rals under deferred compen-
sation plans of State and
local governments and tax-
exempt organizations to:
$11,000 in 2001, $12,000 in
2002, $13,000 in 2003,
$14,000 in 2004, and
$15,000 in 2005; index
thereafter 3 /4/
[yba 12/31/00] -52 -91 -104 -114
2. Plan loans for S corporation
owners, partners, and
sole proprietors
[yba 12/31/00] -18 -30 -33 -35
3. Modification of top-heavy
rules; compensation limit
for officers is $115,000
(indexed)
[yba 12/31/00] -3 -7 -9 -10
4. Elective deferrals not taken
into account for purposes of
deduction limits
[yba 12/31/00] -40 -75 -87 -94
5. Repeal of coordination
requirements for deferred
compensation plans of State
and local governments
and tax-exempt organizations
[yba 12/31/00] -16 -22 -22 -22
6. Elimination of user fee for
certain requests regarding
small employer pension plans;
waiver applies only for
request made during first 5
plan years or the remedial
amendment period beginning
within the first 5 plan
years 5
[rma 12/31/00] -7 -8 -9 ---
7. Definition of compensation
for purposes of deduction
limits 3
[yba 12/31/00] -1 -2 -3 -3
8. Option to treat elective
deferrals as after-tax
contributions
[tyba 12/31/00] 50 100 131 144
9. Increase stock bonus and
profit sharing plan deduction
limit from 15% to 25%
[tyba 12/31/00] -6 -12 -14 -15
Total of Provisions for
Expanding Coverage -297 -592 -765 -887
C. Provisions for Enhancing
Fairness for Women
1. Additional catch-up
contributions for indivi-
duals age 50 and above -
increase the otherwise
applicable contribution limit
phased in by $1,000 a year
until it is $5,000 in 2005,
with indexing thereafter in
$500 increments; nondiscri-
mination rules apply
[tyba 12/31/00] -13 -32 -45 -53
2. Equitable treatment for
contributions of employees
to defined contribution
plans 3
[yba 12/31/00] -51 -78 -84 -91
3. Faster vesting of certain
employer matching
contributions
[ci pyba 12/31/00] Negligible Revenue Effect
4. Simplify and update the
minimum distribution rules -
modify post-death distribu-
tion rules, reduce the excise
tax on failures to make
minimum distributions to 10%,
and direct the Treasury to
simplify and finalize regula-
tions relating to the
minimum distribution rules
[yba 12/31/00] -118 -212 -239 -268
5. Clarification of tax treatment
of division of section 457
plan benefits upon divorce
tdapma 12/31/00] Negligible Revenue Effect
6. Modification of safe harbor
relief for hardship
withdrawals from 401(k)
plans; modify definition
of hardship for rollover
purposes
[yba 12/31/00] Negligible Revenue Effect
7. Eliminate the excise tax on
employers who make nondeduc-
tible contributions to all
types of plans on behalf of
domestic and similar workers
[tyba 12/31/00] 2 /2/ -1 -3
Total of Provisions for
Enhancing Fairness for Women -182 -322 -369 -415
D. Provisions for Increasing
Portability for Participants
1. Rollovers allowed among
governmental section 457
plans, section 403(b) plans,
and qualified plans
[dma 12/31/00] 26 -5 -5 -5
2. Rollovers of IRAs to work-
place retirement plans
[dma 12/31/00] Negligible Revenue Effect
3. Rollovers of after-tax
retirement plan contributions
[dma 12/31/01] Negligible Revenue Effect
4. Waiver of 60-day rule
[dma 12/31/00] Negligible Revenue Effect
5. Treatment of forms of
qualified plan distributions
[yba 12/31/00] Negligible Revenue Effect
6. Rationalization of restric-
tions on distributions
[da 12/31/00] Negligible Revenue Effect
7. Purchase of service credit in
governmental defined
benefit plans
[ta 12/31/00] Negligible Revenue Effect
8. Employers may disregard
rollovers for cash-out
amounts
[da 12/31/00] Negligible Revenue Effect
9. Minimum distribution and
inclusion requirements for
section 457 plans
[da 12/31/00] Considered in Other Provisions
Total of Provisions for
Increasing Portability for
Participants 26 -5 -5 -5
E. Provisions for Strengthening
Pension Security and Enforcement
1. Phase in repeal of 155% of
current liability funding
limit; extend maximum
deduction rule
[pyba 12/31/00] --- -14 -20 -36
2. Excise tax relief for sound
pension funding
[yba 12/31/00] -2 -3 -3 -3
3. Notice of significant
reduction in plan benefit
accruals; notice is required
with respect to the elimina-
tion or reduction of early
retirement benefit or
retirement-type subsidy
[pateo/a DOE] Negligible Revenue Effect
4. Repeal 100% of compensation
limit for multiemployer plans
[yba 12/31/00] -2 -4 -4 -4
5. Modification of section 415
aggregation rules for
multiemployer plans
[yba 12/31/00] -1 -1 -1 -1
6. Prohibited allocations of
stock in an ESOP of an S
corporation
[/6/] 1 4 5 6
7. Investment of employee
contributions in 401(k) plans
[aiii TRA'97] Negligible Revenue Effect
8. Periodic pension benefit
statements
[pyba 12/31/00] No Revenue Effect
Total of Provisions for
Strengthening Pension
Security and Enforcement -4 -18 -23 -38
F. Provisions for Reducing
Regulatory Burdens
1. Modification of timing of
plan valuations
[pyba 12/31/00] Negligible Revenue Effect
2. ESOP dividends may be
reinvested without loss of
dividend deduction; modify
present-law antiabuse rule
to permit the Secretary to
disallow the deduction in
the case of any dividend that
constitutes the avoidance or
evasion of taxation
[tyba 12/31/00] -19 -44 -56 -61
3. Repeal transition rule
relating to certain highly
compensated employees
[pyba 12/31/00] -2 -3 -3 -3
4. Employees of tax-exempt
entities
[DOE] Negligible Revenue Effect
5. Treatment of employer-
provided retirement advice
[tyba 12/31/00] Negligible Revenue Effect
6. Pension plan reporting
simplification 7
[1/1/01] Negligible Revenue Effect
7. Improvement to Employee
Plans Compliance Resolution
System 7
[DOE] Negligible Revenue Effect
8. Repeal of the multiple use
test
[yba 12/31/00] Considered in Other Provisions
9. Flexibility in nondiscri-
mination, coverage, and line
of business rules 7
[DOE] Negligible Revenue Effect
10. Extension to all governmental
plans of moratorium on
application of certain
nondiscrimination rules
applicable to State and local
government plans
[yba 12/31/00] Negligible Revenue Effect
11. Notice and consent period
regarding distributions; and
notice regarding optional
forms of benefit
[yba 12/31/00] No Revenue Effect
12. Annual report dissemination
[yba 12/31/99] No Revenue Effect
13. Amendments to the SAVER Act
[DOE] No Revenue Effect
14. Require Secretary of Treasury
to study and report on the
effect of the bill on pension
coverage
[DOE] No Revenue Effect
Total of Provisions for
Reducing Regulatory Burdens -21 -47 -59 -64
G. ERISA Provisions
1. Extension of PBGC missing
plan participants program 5
[/8/] --- 9 /9/ 9
2. Reduce PBGC premium for new
plans of small employers 5
[pea 12/31/00] --- 2 /2/ 2
3. Phase-in additional PBGC
premium for new plans;
include additional variable
premium relief for small
employers 5
[ya 12/31/00] --- -3 -3 -3
4. Authorization for PBGC to
pay interest on premium
overpayment refunds 5
[iafpbo/a DOE] --- -3 -3 -3
5. Rules for substantial owner
benefits in terminated plans
5
[noitta 12/31/00] --- 2 /2/ 2
6. Increase in multiemployer
plan benefits guarantee 5
[bpa DOE] --- --- --- 2
7. Civil penalties for breach
of fiduciary duty 10
[/11/] No Revenue Effect
8. Benefit suspension notice
[pyba 12/31/00] No Revenue Effect
Total of ERISA Provisions --- -7 -7 -7
H. Provisions Relating to Plan
Amendments
[DOE] No Revenue Effect
TOTAL OF PENSIONS AND
INDIVIDUAL RETIREMENT
ARRANGEMENT PROVISIONS -789 -1,971 -3,558 -5,031
SCHOOL CONSTRUCTION PROVISIONS
A. Small Governmental Unit
Arbitrage Rebate Exception -
increase arbitrage rebate
exception for governmental
bonds used to finance qualified
school construction from
$10 million to $15 million
[bia 12/31/00] 2 -3 -5 -6
B. Liberalize Construction Bond
Expenditure Rule for Public
School Bonds - provide new
4-year expenditure schedule for
bonds for public school
construction under the
arbitrage rebate rules
[bia 12/31/00] -16 -139 -262 -296
C. Modify Special Provision for
a Permanent University Fund
[1/1/01] 2 -1 -1 -1
D. Issuance of Private Activity
Bonds for Public School
Facilities - issuance of tax-
exempt private activity bonds
for qualified education facili-
ties with annual volume cap
the greater of $10 per resident
or $5 million
[bia 12/31/00] -6 -19 -37 -57
E. Tax-Credit Bonds
1. Extend authority to issue
QZABs for an additional 2
years (through 2003) at
present-law $400 million per
year authorized issuance
levels; with certain
modifications
[bia 12/31/01] --- 2 -2 -8
2. School Construction QZABs -
authorize issuance of a new
sub-category of QZABs for
construction, renovation, and
repair of public schools of
$5 billion annually for 2001,
2002, and 2003; private
investment not required;
modified targeting criteria
and administrative rules; un-
used bond authority from any
year to carry forward for up
to 2 years, used on a FIFO
basis; additional $200 million
for construction of tribal
schools on Indian reservations
[bia 12/31/00] -14 -68 -181 -335
TOTAL SCHOOL CONSTRUCTION
PROVISIONS -36 -230 -488 -703
COMMUNITY REVITALIZATION PROVISIONS
A. Tax Incentives for Renewal
Communities and Empowerment Zones
1. Designate 40 renewal
communities, 12 of which are
in rural areas, to receive
the following tax benefits: a
wage credit of 15% on first
$10,000 of qualified wages;
an additional $35,000 of
section 179 expensing;
deduction for qualified
revitalization expenditures,
capped at $12 million per
community; and 0% capital
gains tax rate on qualifying
assets held more than
5 years
[DOE /13/] --- -360 -583 -557
2. Designate 9 new empowerment
zones, extend present-law
empowerment zone designations
through 12/31/09, expand the
20% wage credit to all
empowerment zones, increase
the additional section 179
expensing to $35,000 for all
empowerment zones including
D.C. in 2002, and extend the
more favorable round II tax
exempt financing rules to all
existing and new empowerment
zones excluding D.C.
[DOE /14/] --- --243 -470 -470
3. Capital gain rollover of
empowerment zone assets and
increased exclusion of gain
on sale of certain
empowerment zone investments
[ima DOE] 2 -3 -15 -32
B. New Markets Tax Credit -
provide new markets tax
credit with allocation authority
of $1.0 billion in 2001, $1.5
billion in 2002 and 2003,
$2.0 billion in 2004 and 2005,
and $3.5 billion in 2006 and 2007
[ima 12/31/00] -2 -18 -115 -246
C. Increase the Low-Income Housing
Tax Credit and Make Other
Modifications - increase per
capita credit to $1.50 in 2001,
$1.75 in 2002, and indexed
for inflation thereafter;
$2 million small State minimum
in 2001 and 2002 and index for
inflation thereafter; modify
stacking rules and credit
allocation rules; certain Native
American housing assistance
disregarded in determining
whether building is Federally
subsidized for purposes of the
low-income housing credit
[generally cyba 12/31/00] -9 -52 -148 -282
D. Other Provisions
1. Private Activity Bond
State Volume Limits -
increase annual State
volume cap to the greater of:
$62.50 per resident or $187.5
million in 2001, and $75 per
resident or $225 million in
2002; index for inflation
thereafter
[cyba 12/31/00] -16 -95 -195 -284
2. Expensing of Environmental
Remediation Expenditures and
Expansion of Qualifying Sites
- for expenditures incurred
before 2004 ("Brownfields")
[DOE & epoia DOE] -13 -97 -225 -165
3. Extend the D.C. Homebuyer
Credit Through 12/31/03
[DOE] 12 -7 -25 -14
TOTAL OF COMMUNITY
REVITALIZATION PROVISIONS -40 -875 -1,776 -2,050
ADMINISTRATIVE, MISCELLANEOUS,
AND TECHNICAL PROVISIONS
A. Administrative Provisions
1. Exempt Certain Reports
From Elimination Under the
Federal Reports Elimination
And Sunset Act of 1995
[DOE] No Revenue Effect
2. Extension of Deadlines for
IRS Compliance with
Certain Notice Requirements
[DOE] No Revenue Effect
3. 5-Year Extension of Authority
for IRS Undercover Operations
[1/1/01] 15 /15/ 15 /15/
4. Confidentiality of Certain
Documents Relating to Closing
and Similar Agreements and to
Agreements with Foreign
Governments
[DOE] Negligible Revenue Effect
5. Increase in Joint Committee
on Taxation Refund Review
Threshold
[DOE] Negligible Revenue Effect
6. Clarify Dependency Deduction
for Kidnapped Children
[tyea DOE] Negligible Revenue Effect
7. Conforming Changes to
Accommodate Reduced Issuances
of Certain Treasury Securities
[DOE] Negligible Revenue Effect
8. Authorization to Use
Corrected Consumer Price
Index:
a. Tax revenues 18
[DOE] -20 -20 --- ---
b. Outlays 5 /19/ 20
[DOE] -970 -570 -560 -550
9. Prevent Duplication or
Acceleration of Loss
Through Assumption of
Certain Liabilities
[aolo/a 10/19/99] 13 15 17 19
B. Miscellaneous Provisions
1. Repeal the 4.3-Cents-Per-
Gallon Tax on Railroad
Diesel Fuel and Inland
Waterway Fuel Currently
Paid Into the General Fund
[1/1/01] -102 -147 -151 -155
2. Repeal of Reduction of
Deductions for Mutual Life
Insurance Companies and of
Policyholder Surplus Accounts
of Life Insurance Companies
[tyba 12/31/00] -88 -93 -80 -63
3. Tax Credit Bonds for the
National Railroad Passenger
Corporation ("Amtrak") - $1
billion tax credit bonds per
year
[bia 9/30/00] -13 -82 -156 -221
4. Farm, Fishing, and Ranch Risk
Management ("FFARRM") Accounts
[tyba 12/31/00] -3 -73 -136 -179
5. Extend present-law section
170(e)(6) relating to corpo-
rate contributions of
computer equipment through
12/31/03; expand list of
eligible donees to include
public libraries; expand to
include 3-year property
[cma 12/31/00] -60 -112 -120 -60
6. Exemption for Settlement of
Discrimination Claims
Brought by Certain Farmers
Against the Department of
Agriculture
[aoty] -325 -13 --- ---
7. Adoption Credit - extend
through 12/31/05 for non-
special needs adoptions,
with an increase in the
qualified expenses level to
$10,000 for non-special needs
adoptions and $12,000 for
special needs adoption,
phased in by $1,000 a year
and $2,000 a year, respec-
tively; phaseout starting
point increased to $150,000
of AGI, fully phased out at
$190,000 of AGI
[tyba 12/31/00] -21 -156 -386 -480
8. Study on Bermuda Insurance
Companies
[DOE] No Revenue Effect
9. Treatment of Indian tribes
as Non-Profit Organizations
and State or Local Governments
for Purposes of the Federal
Unemployment Tax 5
[/21/] -20 -10 -9 25
C. Technical Correction
Provisions No Revenue Effect
Total of Administrative,
Miscellaneous, and Technical
Provisions -1,609 -1,261 -1,581 -1,664
______________________________________________________________________
NET TOTAL -6,824 -12,407 -15,483 -17,501
______________________________________________________________________
REPEAL THE FEDERAL
COMMUNICATIONS EXCISE TAX
(INCLUDED IN THE TREASURY
APPROPRIATIONS BILL)
[10/1/00] -4,328 -4,562 -4,799 -5,043
______________________________________________________________________
[table continued]
______________________________________________________________________
Provision
[Effective] 2005 2006 2007 2008
______________________________________________________________________
EXTRATERRITORIAL INCOME
EXCLUSION; FSC REPEAL
(H.R. 4986)
[generally Ta 9/30/00] -423 -466 -514 -566
SMALL BUSINESS TAX RELIEF
PROVISIONS
A. Extend the Work Opportunity
Tax Credit Through 6/30/04 1
[wpoifibwa 12/31/01] -267 -126 -45 -12
B. Increase Maximum Reforestation
Expenses Qualifying for
Amortization and Credit from
$10,000 to $25,000; Remove Cap
on Amortization of Reforestation
Costs in 2001 Through 2003;
Clarify Capital Gains Treatment
of Sales of Timber
[tyba 12/31/00 & sa DOE] -29 -32 -34 -33
C. Increase Section 179 Expensing
to $35,000
[tyba 12/31/00] -405 -354 -347 -362
D. Increase Business Meals
Deduction (Excluding Entertain-
ment Expenses) to 70% in 2001
and Thereafter
[tyba 12/31/00] -2,508 -2,620 -2,736 -2,858
E. 80% Business Meals Deduction
for Workers Subject to DOT
Hours of Service Limitation
[tyba 12/31/00] -47 -37 -26 -13
F. Permit Installment Method for
Accrual Basis Taxpayers
[iso/a 12/17/99] -8 -20 -34 -47
G. Coordinate Farmer Income
Averaging and the AMT and
Provide the Same Income
Averaging Relief to Commercial
Fishermen
[tyba 12/31/00] -3 -3 -4 -5
H. Repeal the Occupational Taxes
Relating to Distilled
Spirits, Wine, and Beer
[7/1/01] -75 -75 -75 -75
I. Exclusion from Gross Income
for Certain Forgiven Mortgage
Obligations
[doia 12/31/00] -7 -7 -7 -7
J. Clarification of Cash
Accounting Rules for Small
Businesses
[tyba DOE] -238 -223 -127 -79
K. Authorize Payment of Interest
on Business Checking Accounts
[DOE & 2ya DOE] Negligible Effect
TOTAL OF SMALL BUSINESS TAX
RELIEF PROVISIONS -3,587 -3,497 -3,435 -3,491
HEALTH INSURANCE AND LONG-TERM
CARE PROVISIONS
A. Accelerate 100% Self-Employed
Health Insurance Deduction
and Extend Eligibility to
Those Who Choose Not to
Participate in Employer-
Subsidized Health Plans
[tyba 12/31/00] 2 /2/ 2 /2/
B. Provide an Above-the-Line
Deduction for Health
Insurance Expenses for Which
the Taxpayer Pays At Least
50%, Phased in as Follows:
25% in 2001 through 2003,
35% in 2004, 65% in 2005,
and 100% thereafter
[tyba 12/31/00] -3,410 -6,418 -9,209 -9,743
C. Provide an Above-the-Line
Deduction for Long-Term
Care Insurance Expenses for
Which the Taxpayer Pays At
Least 50%, Phased in as
Follows: 25% in 2001 through
2003, 35% in 2004, 65% in 2005,
and 100% thereafter
[tyba 12/31/00] -641 -1,250 -1,934 -2,055
D. Two-Year Extension of
Medical Savings Accounts
[DOE] -4 -4 -4 -3
E. Additional Consumer Protections
for Long-Term Care Insurance
[pimt 1ya DOE] Negligible Revenue Effect
F. Provide an Additional Personal
Deduction to Caretakers of
Family Members - $3,000 in 2001
increasing by $1,000 per year to
a maximum of $10,000 in 2008
[tyba 12/31/00] -1,813 -2,127 -2,456 -2,769
TOTAL OF HEALTH INSURANCE
AND LONG-TERM CARE PROVISIONS -5,868 -9,799 -13,603 -14,570
PENSIONS AND INDIVIDUAL RETIREMENT
ARRANGEMENT PROVISIONS
A. Individual Retirement
Arrangement Provisions
1. Modification of IRA
Contribution Limits -
increase the maximum contri-
bution limit for traditional
and Roth IRAs to: $3,000 in
2001, $4,000 in 2002, $5,000
in 2003, and index for
inflation thereafter
[tyba 12/31/00] -3,404 -3,983 -4,389 -4,815
2. IRA Catch-Up Contributions --
increase maximum contribution
limits for traditional and
Roth IRAs for individuals age
50 and above; the catch-up
amount is $500 in 2001,
$1,000 in 2002, and $1,500
in 2003, with indexing
thereafter in $500
increments
[tyba 12/31/00] -147 -151 -172 -183
3. Increase AGI limits for
deductible IRA contributions,
including for married filing
separately
[tyba 12/31/00] -276 -160 -124 -103
4. Increase income limits for
contributions to Roth IRAs
for joint filers to twice
the limits for single filers
[tyba 12/31/00] -316 -425 -540 -657
5. Increase the income limit
for conversions of an IRA
to a Roth IRA to $200,000
for joint filers
[tyba 12/31/00] -724 -1,317 -1,060 -614
6. Deemed IRAs under employer
plans
[tyba 12/31/01] Negligible Revenue Effect
7. Allow tax-free withdrawals
from IRAs for charitable
purposes; the exclusion is
available only with respect
to distributions made to an
organization to which deduct-
ible contributions can be
made
[tyba 12/31/00] -276 -279 -282 -285
Total of Individual Retirement
Arrangement Provisions -5,143 -6,315 -6,567 -6,657
B. Provisions for Expanding
Coverage
1. Increase contribution and
benefit limits:
a. Increase limitation on
exclusion for elective
deferrals to: $11,000 in
2001, $12,000 in 2002,
$13,000 in 2003, $14,000
in 2004, and $15,000 in
2005; index thereafter
3 /4/
[yba 12/31/00] -640 -698 -747 -796
b. Increase limitation on
SIMPLE elective contribu-
tions to: $7,000 in 2001,
$8,000 in 2002, $9,000 in
2003, and $10,000 in 2004;
index thereafter 3 /4/
[yba 12/31/00] -28 -28 -29 -31
c. Increase defined benefit
dollar limit to $160,000
[yba 12/31/00] -48 -50 -53 -55
d. Lower early retirement age
to 62; lower normal
retirement age to 65
[yba 12/31/00] -5 -5 -5 -5
e. Increase limitation for
defined contribution
plans to $40,000 with
indexing in $1,000
increments 3
[yba 12/31/00] -16 -17 -19 -20
f. Increase qualified plan
compensation limit to
$200,000 3
[yba 12/31/00] -99 -107 -115 -122
g. Increase limits on defer-
rals under deferred compen-
sation plans of State and
local governments and tax-
exempt organizations to:
$11,000 in 2001, $12,000 in
2002, $13,000 in 2003,
$14,000 in 2004, and
$15,000 in 2005; index
thereafter 3 /4/
[yba 12/31/00] -125 -134 -142 -151
2. Plan loans for S corporation
owners, partners, and
sole proprietors
[yba 12/31/00] -37 -39 -42 -44
3. Modification of top-heavy
rules; compensation limit
for officers is $115,000
(indexed)
[yba 12/31/00] -11 -12 -14 -15
4. Elective deferrals not taken
into account for purposes of
deduction limits
[yba 12/31/00] -101 -108 -115 -122
5. Repeal of coordination
requirements for deferred
compensation plans of State
and local governments
and tax-exempt organizations
[yba 12/31/00] -22 -23 -24 -25
6. Elimination of user fee for
certain requests regarding
small employer pension plans;
waiver applies only for
request made during first 5
plan years or the remedial
amendment period beginning
within the first 5 plan
years 5
[rma 12/31/00] --- --- --- ---
7. Definition of compensation
for purposes of deduction
limits 3
[yba 12/31/00] -3 -3 -3 -3
8. Option to treat elective
deferrals as after-tax
contributions
[tyba 12/31/00] 89 -2 -104 -218
9. Increase stock bonus and
profit sharing plan deduction
limit from 15% to 25%
[tyba 12/31/00] -16 -18 -19 -20
Total of Provisions for
Expanding Coverage -1,062 -1,244 -1,431 -1,627
C. Provisions for Enhancing
Fairness for Women
1. Additional catch-up
contributions for indivi-
duals age 50 and above -
increase the otherwise
applicable contribution limit
phased in by $1,000 a year
until it is $5,000 in 2005,
with indexing thereafter in
$500 increments; nondiscri-
mination rules apply
[tyba 12/31/00] -57 -59 -61 -63
2. Equitable treatment for
contributions of employees
to defined contribution
plans 3
[yba 12/31/00] -97 -104 -111 -118
3. Faster vesting of certain
employer matching
contributions
[ci pyba 12/31/00] Negligible Revenue Effect
4. Simplify and update the
minimum distribution rules -
modify post-death distribu-
tion rules, reduce the excise
tax on failures to make
minimum distributions to 10%,
and direct the Treasury to
simplify and finalize regula-
tions relating to the
minimum distribution rules
[yba 12/31/00] -297 -330 -366 -402
5. Clarification of tax treatment
of division of section 457
plan benefits upon divorce
tdapma 12/31/00] Negligible Revenue Effect
6. Modification of safe harbor
relief for hardship
withdrawals from 401(k)
plans; modify definition
of hardship for rollover
purposes
[yba 12/31/00] Negligible Revenue Effect
7. Eliminate the excise tax on
employers who make nondeduc-
tible contributions to all
types of plans on behalf of
domestic and similar workers
[tyba 12/31/00] -4 -6 -8 -10
Total of Provisions for
Enhancing Fairness for Women -455 -499 -546 -593
D. Provisions for Increasing
Portability for Participants
1. Rollovers allowed among
governmental section 457
plans, section 403(b) plans,
and qualified plans
[dma 12/31/00] -5 -5 -5 -6
2. Rollovers of IRAs to work-
place retirement plans
[dma 12/31/00] Negligible Revenue Effect
3. Rollovers of after-tax
retirement plan contributions
[dma 12/31/01] Negligible Revenue Effect
4. Waiver of 60-day rule
[dma 12/31/00] Negligible Revenue Effect
5. Treatment of forms of
qualified plan distributions
[yba 12/31/00] Negligible Revenue Effect
6. Rationalization of restric-
tions on distributions
[da 12/31/00] Negligible Revenue Effect
7. Purchase of service credit in
governmental defined
benefit plans
[ta 12/31/00] Negligible Revenue Effect
8. Employers may disregard
rollovers for cash-out
amounts
[da 12/31/00] Negligible Revenue Effect
9. Minimum distribution and
inclusion requirements for
section 457 plans
[da 12/31/00] Considered in Other Provisions
Total of Provisions for
Increasing Portability for
Participants -5 -5 -5 -6
E. Provisions for Strengthening
Pension Security and Enforcement
1. Phase in repeal of 155% of
current liability funding
limit; extend maximum
deduction rule
[pyba 12/31/00] -36 -38 -38 -39
2. Excise tax relief for sound
pension funding
[yba 12/31/00] -3 -3 -3 -3
3. Notice of significant
reduction in plan benefit
accruals; notice is required
with respect to the elimina-
tion or reduction of early
retirement benefit or
retirement-type subsidy
[pateo/a DOE] Negligible Revenue Effect
4. Repeal 100% of compensation
limit for multiemployer plans
[yba 12/31/00] -4 -4 -5 -5
5. Modification of section 415
aggregation rules for
multiemployer plans
[yba 12/31/00] -1 -1 -1 -1
6. Prohibited allocations of
stock in an ESOP of an S
corporation
[/6/] 8 8 9 10
7. Investment of employee
contributions in 401(k) plans
[aiii TRA'97] Negligible Revenue Effect
8. Periodic pension benefit
statements
[pyba 12/31/00] No Revenue Effect
Total of Provisions for
Strengthening Pension
Security and Enforcement -36 -38 -38 -38
F. Provisions for Reducing
Regulatory Burdens
1. Modification of timing of
plan valuations
[pyba 12/31/00] Negligible Revenue Effect
2. ESOP dividends may be
reinvested without loss of
dividend deduction; modify
present-law antiabuse rule
to permit the Secretary to
disallow the deduction in
the case of any dividend that
constitutes the avoidance or
evasion of taxation
[tyba 12/31/00] -63 -66 -69 -71
3. Repeal transition rule
relating to certain highly
compensated employees
[pyba 12/31/00] -3 -3 -4 -4
4. Employees of tax-exempt
entities
[DOE] Negligible Revenue Effect
5. Treatment of employer-
provided retirement advice
[tyba 12/31/00] Negligible Revenue Effect
6. Pension plan reporting
simplification 7
[1/1/01] Negligible Revenue Effect
7. Improvement to Employee
Plans Compliance Resolution
System 7
[DOE] Negligible Revenue Effect
8. Repeal of the multiple use
test
[yba 12/31/00] Considered in Other Provisions
9. Flexibility in nondiscri-
mination, coverage, and line
of business rules 7
[DOE] Negligible Revenue Effect
10. Extension to all governmental
plans of moratorium on
application of certain
nondiscrimination rules
applicable to State and local
government plans
[yba 12/31/00] Negligible Revenue Effect
11. Notice and consent period
regarding distributions; and
notice regarding optional
forms of benefit
[yba 12/31/00] No Revenue Effect
12. Annual report dissemination
[yba 12/31/99] No Revenue Effect
13. Amendments to the SAVER Act
[DOE] No Revenue Effect
14. Require Secretary of Treasury
to study and report on the
effect of the bill on pension
coverage
[DOE] No Revenue Effect
Total of Provisions for
Reducing Regulatory Burdens -66 -69 -73 -75
G. ERISA Provisions
1. Extension of PBGC missing
plan participants program 5
[/8/] 9 /9/ 9 /9/
2. Reduce PBGC premium for new
plans of small employers 5
[pea 12/31/00] 2 /2/ 2 /2/
3. Phase-in additional PBGC
premium for new plans;
include additional variable
premium relief for small
employers 5
[ya 12/31/00] -3 -3 -3 -4
4. Authorization for PBGC to
pay interest on premium
overpayment refunds 5
[iafpbo/a DOE] -3 -3 -3 -3
5. Rules for substantial owner
benefits in terminated plans
5
[noitta 12/31/00] 2 /2/ 2 /2/
6. Increase in multiemployer
plan benefits guarantee 5
[bpa DOE] 2 /2/ 2 /2/
7. Civil penalties for breach
of fiduciary duty 10
[/11/] No Revenue Effect
8. Benefit suspension notice
[pyba 12/31/00] No Revenue Effect
Total of ERISA Provisions -7 -7 -7 -8
H. Provisions Relating to Plan
Amendments
[DOE] No Revenue Effect
TOTAL OF PENSIONS AND
INDIVIDUAL RETIREMENT
ARRANGEMENT PROVISIONS -6,774 -8,177 -8,667 -9,004
SCHOOL CONSTRUCTION PROVISIONS
A. Small Governmental Unit
Arbitrage Rebate Exception -
increase arbitrage rebate
exception for governmental
bonds used to finance qualified
school construction from
$10 million to $15 million
[bia 12/31/00] -11 -14 -15 -16
B. Liberalize Construction Bond
Expenditure Rule for Public
School Bonds - provide new
4-year expenditure schedule for
bonds for public school
construction under the
arbitrage rebate rules
[bia 12/31/00] -312 -328 -331 -326
C. Modify Special Provision for
a Permanent University Fund
[1/1/01] -1 12 /2/ -1
D. Issuance of Private Activity
Bonds for Public School
Facilities - issuance of tax-
exempt private activity bonds
for qualified education facili-
ties with annual volume cap
the greater of $10 per resident
or $5 million
[bia 12/31/00] -83 -113 -146 -178
E. Tax-Credit Bonds
1. Extend authority to issue
QZABs for an additional 2
years (through 2003) at
present-law $400 million per
year authorized issuance
levels; with certain
modifications
[bia 12/31/01] -17 -24 -25 -25
2. School Construction QZABs -
authorize issuance of a new
sub-category of QZABs for
construction, renovation, and
repair of public schools of
$5 billion annually for 2001,
2002, and 2003; private
investment not required;
modified targeting criteria
and administrative rules; un-
used bond authority from any
year to carry forward for up
to 2 years, used on a FIFO
basis; additional $200 million
for construction of tribal
schools on Indian reservations
[bia 12/31/00] -470 -542 -558 -558
TOTAL SCHOOL CONSTRUCTION
PROVISIONS -894 -1,021 -1,075 -1,104
COMMUNITY REVITALIZATION PROVISIONS
A. Tax Incentives for Renewal
Communities and Empowerment Zones
1. Designate 40 renewal
communities, 12 of which are
in rural areas, to receive
the following tax benefits: a
wage credit of 15% on first
$10,000 of qualified wages;
an additional $35,000 of
section 179 expensing;
deduction for qualified
revitalization expenditures,
capped at $12 million per
community; and 0% capital
gains tax rate on qualifying
assets held more than
5 years
[DOE /13/] -571 -614 -691 -899
2. Designate 9 new empowerment
zones, extend present-law
empowerment zone designations
through 12/31/09, expand the
20% wage credit to all
empowerment zones, increase
the additional section 179
expensing to $35,000 for all
empowerment zones including
D.C. in 2002, and extend the
more favorable round II tax
exempt financing rules to all
existing and new empowerment
zones excluding D.C.
[DOE /14/] -537 -592 -599 -615
3. Capital gain rollover of
empowerment zone assets and
increased exclusion of gain
on sale of certain
empowerment zone investments
[ima DOE] -52 -71 -93 -118
B. New Markets Tax Credit -
provide new markets tax
credit with allocation authority
of $1.0 billion in 2001, $1.5
billion in 2002 and 2003,
$2.0 billion in 2004 and 2005,
and $3.5 billion in 2006 and 2007
[ima 12/31/00] -365 -531 -725 -813
C. Increase the Low-Income Housing
Tax Credit and Make Other
Modifications - increase per
capita credit to $1.50 in 2001,
$1.75 in 2002, and indexed
for inflation thereafter;
$2 million small State minimum
in 2001 and 2002 and index for
inflation thereafter; modify
stacking rules and credit
allocation rules; certain Native
American housing assistance
disregarded in determining
whether building is Federally
subsidized for purposes of the
low-income housing credit
[generally cyba 12/31/00] -433 -598 -779 -976
D. Other Provisions
1. Private Activity Bond
State Volume Limits -
increase annual State
volume cap to the greater of:
$62.50 per resident or $187.5
million in 2001, and $75 per
resident or $225 million in
2002; index for inflation
thereafter
[cyba 12/31/00] -361 -425 -473 -513
2. Expensing of Environmental
Remediation Expenditures and
Expansion of Qualifying Sites
- for expenditures incurred
before 2004 ("Brownfields")
[DOE & epoia DOE] -39 -1 5 17
3. Extend the D.C. Homebuyer
Credit Through 12/31/03
[DOE] 2 /2/ 2 /2/
TOTAL OF COMMUNITY
REVITALIZATION PROVISIONS -2,358 -2,832 -3,355 -3,917
ADMINISTRATIVE, MISCELLANEOUS,
AND TECHNICAL PROVISIONS
A. Administrative Provisions
1. Exempt Certain Reports
From Elimination Under the
Federal Reports Elimination
And Sunset Act of 1995
[DOE] No Revenue Effect
2. Extension of Deadlines for
IRS Compliance with
Certain Notice Requirements
[DOE] No Revenue Effect
3. 5-Year Extension of Authority
for IRS Undercover Operations
[1/1/01] 15 /15/ 15 /15/
4. Confidentiality of Certain
Documents Relating to Closing
and Similar Agreements and to
Agreements with Foreign
Governments
[DOE] Negligible Revenue Effect
5. Increase in Joint Committee
on Taxation Refund Review
Threshold
[DOE] Negligible Revenue Effect
6. Clarify Dependency Deduction
for Kidnapped Children
[tyea DOE] Negligible Revenue Effect
7. Conforming Changes to
Accommodate Reduced Issuances
of Certain Treasury Securities
[DOE] Negligible Revenue Effect
8. Authorization to Use
Corrected Consumer Price
Index:
a. Tax revenues 18
[DOE] --- --- --- ---
b. Outlays 5 /19/ 20
[DOE] -550 -540 -520 -520
9. Prevent Duplication or
Acceleration of Loss
Through Assumption of
Certain Liabilities
[aolo/a 10/19/99] 21 23 25 27
B. Miscellaneous Provisions
1. Repeal the 4.3-Cents-Per-
Gallon Tax on Railroad
Diesel Fuel and Inland
Waterway Fuel Currently
Paid Into the General Fund
[1/1/01] -159 -164 -168 -173
2. Repeal of Reduction of
Deductions for Mutual Life
Insurance Companies and of
Policyholder Surplus Accounts
of Life Insurance Companies
[tyba 12/31/00] -51 -64 -56 -47
3. Tax Credit Bonds for the
National Railroad Passenger
Corporation ("Amtrak") - $1
billion tax credit bonds per
year
[bia 9/30/00] -290 -360 -429 -499
4. Farm, Fishing, and Ranch Risk
Management ("FFARRM") Accounts
[tyba 12/31/00] -146 -113 -66 -30
5. Extend present-law section
170(e)(6) relating to corpo-
rate contributions of
computer equipment through
12/31/03; expand list of
eligible donees to include
public libraries; expand to
include 3-year property
[cma 12/31/00] -3 --- --- ---
6. Exemption for Settlement of
Discrimination Claims
Brought by Certain Farmers
Against the Department of
Agriculture
[aoty] --- --- --- ---
7. Adoption Credit - extend
through 12/31/05 for non-
special needs adoptions,
with an increase in the
qualified expenses level to
$10,000 for non-special needs
adoptions and $12,000 for
special needs adoption,
phased in by $1,000 a year
and $2,000 a year, respec-
tively; phaseout starting
point increased to $150,000
of AGI, fully phased out at
$190,000 of AGI
[tyba 12/31/00] -567 -469 -113 -96
8. Study on Bermuda Insurance
Companies
[DOE]
9. Treatment of Indian tribes
as Non-Profit Organizations
and State or Local Governments
for Purposes of the Federal
Unemployment Tax 5
[/21/] 2 2 2 2
C. Technical Correction
Provisions
Total of Administrative,
Miscellaneous, and Technical
Provisions -1,743 -1,685 -1,327 -1,336
______________________________________________________________________
NET TOTAL -21,646 -27,476 -31,975 -33,987
______________________________________________________________________
REPEAL THE FEDERAL
COMMUNICATIONS EXCISE TAX
(INCLUDED IN THE TREASURY
APPROPRIATIONS BILL)
[10/1/00] -5,303 -5,578 -5,868 -6,174
______________________________________________________________________
[table continued]
______________________________________________________________________
Provision
[Effective] 2009 2010 2001-05 2001-10
______________________________________________________________________
EXTRATERRITORIAL INCOME
EXCLUSION; FSC REPEAL
(H.R. 4986)
[generally Ta 9/30/00] -623 -687 -1,623 -4,479
SMALL BUSINESS TAX RELIEF
PROVISIONS
A. Extend the Work Opportunity
Tax Credit Through 6/30/04 1
[wpoifibwa 12/31/01] -2 --- -1,081 -1,267
B. Increase Maximum Reforestation
Expenses Qualifying for
Amortization and Credit from
$10,000 to $25,000; Remove Cap
on Amortization of Reforestation
Costs in 2001 Through 2003;
Clarify Capital Gains Treatment
of Sales of Timber
[tyba 12/31/00 & sa DOE] -29 -25 -98 -250
C. Increase Section 179 Expensing
to $35,000
[tyba 12/31/00] -369 -372 -2,863 -4,667
D. Increase Business Meals
Deduction (Excluding Entertain-
ment Expenses) to 70% in 2001
and Thereafter
[tyba 12/31/00] -2,987 -3,124 -10,553 -24,876
E. 80% Business Meals Deduction
for Workers Subject to DOT
Hours of Service Limitation
[tyba 12/31/00] --- --- -276 -351
F. Permit Installment Method for
Accrual Basis Taxpayers
[iso/a 12/17/99] -60 -76 -1,841 -2,078
G. Coordinate Farmer Income
Averaging and the AMT and
Provide the Same Income
Averaging Relief to Commercial
Fishermen
[tyba 12/31/00] -6 -7 -9 -33
H. Repeal the Occupational Taxes
Relating to Distilled
Spirits, Wine, and Beer
[7/1/01] -75 -75 -364 -739
I. Exclusion from Gross Income
for Certain Forgiven Mortgage
Obligations
[doia 12/31/00] -8 -8 -27 -64
J. Clarification of Cash
Accounting Rules for Small
Businesses
[tyba DOE] -58 -44 -1,024 -1,555
K. Authorize Payment of Interest
on Business Checking Accounts
[DOE & 2ya DOE]
TOTAL OF SMALL BUSINESS TAX
RELIEF PROVISIONS -3,594 -3,731 -18,136 -35,880
HEALTH INSURANCE AND LONG-TERM
CARE PROVISIONS
A. Accelerate 100% Self-Employed
Health Insurance Deduction
and Extend Eligibility to
Those Who Choose Not to
Participate in Employer-
Subsidized Health Plans
[tyba 12/31/00] 2 /2/ -2,024 -2,024
B. Provide an Above-the-Line
Deduction for Health
Insurance Expenses for Which
the Taxpayer Pays At Least
50%, Phased in as Follows:
25% in 2001 through 2003,
35% in 2004, 65% in 2005,
and 100% thereafter
[tyba 12/31/00] -10,303 -10,920 -9,088 -55,682
C. Provide an Above-the-Line
Deduction for Long-Term
Care Insurance Expenses for
Which the Taxpayer Pays At
Least 50%, Phased in as
Follows: 25% in 2001 through
2003, 35% in 2004, 65% in 2005,
and 100% thereafter
[tyba 12/31/00] -2,174 -2,295 -1,688 -11,396
D. Two-Year Extension of
Medical Savings Accounts
[DOE] -3 -3 -16 -33
E. Additional Consumer Protections
for Long-Term Care Insurance
[pimt 1ya DOE]
F. Provide an Additional Personal
Deduction to Caretakers of
Family Members - $3,000 in 2001
increasing by $1,000 per year to
a maximum of $10,000 in 2008
[tyba 12/31/00] -2,909 -3,033 -5,859 -19,152
TOTAL OF HEALTH INSURANCE
AND LONG-TERM CARE PROVISIONS -15,389 -16,251 -18,675 -88,287
PENSIONS AND INDIVIDUAL RETIREMENT
ARRANGEMENT PROVISIONS
A. Individual Retirement
Arrangement Provisions
1. Modification of IRA
Contribution Limits -
increase the maximum contri-
bution limit for traditional
and Roth IRAs to: $3,000 in
2001, $4,000 in 2002, $5,000
in 2003, and index for
inflation thereafter
[tyba 12/31/00] -5,289 -5,827 -9,733 -34,037
2. IRA Catch-Up Contributions --
increase maximum contribution
limits for traditional and
Roth IRAs for individuals age
50 and above; the catch-up
amount is $500 in 2001,
$1,000 in 2002, and $1,500
in 2003, with indexing
thereafter in $500
increments
[tyba 12/31/00] -189 -209 -690 -1,595
3. Increase AGI limits for
deductible IRA contributions,
including for married filing
separately
[tyba 12/31/00] -106 -109 -1,621 -2,222
4. Increase income limits for
contributions to Roth IRAs
for joint filers to twice
the limits for single filers
[tyba 12/31/00] -779 -910 -723 -4,033
5. Increase the income limit
for conversions of an IRA
to a Roth IRA to $200,000
for joint filers
[tyba 12/31/00] -142 -150 1,607 -1,676
6. Deemed IRAs under employer
plans
[tyba 12/31/01]
7. Allow tax-free withdrawals
from IRAs for charitable
purposes; the exclusion is
available only with respect
to distributions made to an
organization to which deduct-
ible contributions can be
made
[tyba 12/31/00] -288 -291 -1,217 -2,641
Total of Individual Retirement
Arrangement Provisions -6,793 -7,496 -12,377 -46,204
B. Provisions for Expanding
Coverage
1. Increase contribution and
benefit limits:
a. Increase limitation on
exclusion for elective
deferrals to: $11,000 in
2001, $12,000 in 2002,
$13,000 in 2003, $14,000
in 2004, and $15,000 in
2005; index thereafter
3 /4/
[yba 12/31/00] -846 -895 -2,089 -6,070
b. Increase limitation on
SIMPLE elective contribu-
tions to: $7,000 in 2001,
$8,000 in 2002, $9,000 in
2003, and $10,000 in 2004;
index thereafter 3 /4/
[yba 12/31/00] -32 -34 -93 -246
c. Increase defined benefit
dollar limit to $160,000
[yba 12/31/00] -57 -59 -182 -454
d. Lower early retirement age
to 62; lower normal
retirement age to 65
[yba 12/31/00] -5 -5 -21 -45
e. Increase limitation for
defined contribution
plans to $40,000 with
indexing in $1,000
increments 3
[yba 12/31/00] -21 -23 -63 -163
f. Increase qualified plan
compensation limit to
$200,000 3
[yba 12/31/00] -131 -139 -391 -1,004
g. Increase limits on defer-
rals under deferred compen-
sation plans of State and
local governments and tax-
exempt organizations to:
$11,000 in 2001, $12,000 in
2002, $13,000 in 2003,
$14,000 in 2004, and
$15,000 in 2005; index
thereafter 3 /4/
[yba 12/31/00] -159 -167 -486 -1,238
2. Plan loans for S corporation
owners, partners, and
sole proprietors
[yba 12/31/00] -47 -49 -153 -374
3. Modification of top-heavy
rules; compensation limit
for officers is $115,000
(indexed)
[yba 12/31/00] -17 -18 -40 -116
4. Elective deferrals not taken
into account for purposes of
deduction limits
[yba 12/31/00] -129 -135 -396 -1,004
5. Repeal of coordination
requirements for deferred
compensation plans of State
and local governments
and tax-exempt organizations
[yba 12/31/00] -26 -27 -104 -228
6. Elimination of user fee for
certain requests regarding
small employer pension plans;
waiver applies only for
request made during first 5
plan years or the remedial
amendment period beginning
within the first 5 plan
years 5
[rma 12/31/00] --- --- -24 -24
7. Definition of compensation
for purposes of deduction
limits 3
[yba 12/31/00] -3 -3 -12 -28
8. Option to treat elective
deferrals as after-tax
contributions
[tyba 12/31/00] -345 -485 514 -640
9. Increase stock bonus and
profit sharing plan deduction
limit from 15% to 25%
[tyba 12/31/00] -22 -23 -63 -165
Total of Provisions for
Expanding Coverage -1,840 -2,062 -3,603 -11,799
C. Provisions for Enhancing
Fairness for Women
1. Additional catch-up
contributions for indivi-
duals age 50 and above -
increase the otherwise
applicable contribution limit
phased in by $1,000 a year
until it is $5,000 in 2005,
with indexing thereafter in
$500 increments; nondiscri-
mination rules apply
[tyba 12/31/00] -67 -70 -200 -521
2. Equitable treatment for
contributions of employees
to defined contribution
plans 3
[yba 12/31/00] -124 -131 -401 -989
3. Faster vesting of certain
employer matching
contributions
[ci pyba 12/31/00] Negligible Revenue Effect
4. Simplify and update the
minimum distribution rules -
modify post-death distribu-
tion rules, reduce the excise
tax on failures to make
minimum distributions to 10%,
and direct the Treasury to
simplify and finalize regula-
tions relating to the
minimum distribution rules
[yba 12/31/00] -441 -484 -1,135 -3,157
5. Clarification of tax treatment
of division of section 457
plan benefits upon divorce
tdapma 12/31/00] Negligible Revenue Effect
6. Modification of safe harbor
relief for hardship
withdrawals from 401(k)
plans; modify definition
of hardship for rollover
purposes
[yba 12/31/00] Negligible Revenue Effect
7. Eliminate the excise tax on
employers who make nondeduc-
tible contributions to all
types of plans on behalf of
domestic and similar workers
[tyba 12/31/00] -12 -14 -8 -57
Total of Provisions for
Enhancing Fairness for Women -644 -699 -1,744 -4,724
D. Provisions for Increasing
Portability for Participants
1. Rollovers allowed among
governmental section 457
plans, section 403(b) plans,
and qualified plans
[dma 12/31/00] -6 -6 6 -22
2. Rollovers of IRAs to work-
place retirement plans
[dma 12/31/00] Negligible Revenue Effect
3. Rollovers of after-tax
retirement plan contributions
[dma 12/31/01] Negligible Revenue Effect
4. Waiver of 60-day rule
[dma 12/31/00] Negligible Revenue Effect
5. Treatment of forms of
qualified plan distributions
[yba 12/31/00] Negligible Revenue Effect
6. Rationalization of restric-
tions on distributions
[da 12/31/00] Negligible Revenue Effect
7. Purchase of service credit in
governmental defined
benefit plans
[ta 12/31/00] Negligible Revenue Effect
8. Employers may disregard
rollovers for cash-out
amounts
[da 12/31/00] Negligible Revenue Effect
9. Minimum distribution and
inclusion requirements for
section 457 plans
[da 12/31/00] Considered in Other Provisions
Total of Provisions for
Increasing Portability for
Participants -6 -6 6 -22
E. Provisions for Strengthening
Pension Security and Enforcement
1. Phase in repeal of 155% of
current liability funding
limit; extend maximum
deduction rule
[pyba 12/31/00] -41 -42 -106 -304
2. Excise tax relief for sound
pension funding
[yba 12/31/00] -3 -3 -14 -29
3. Notice of significant
reduction in plan benefit
accruals; notice is required
with respect to the elimina-
tion or reduction of early
retirement benefit or
retirement-type subsidy
[pateo/a DOE] Negligible Revenue Effect
4. Repeal 100% of compensation
limit for multiemployer plans
[yba 12/31/00] -5 -5 -19 -42
5. Modification of section 415
aggregation rules for
multiemployer plans
[yba 12/31/00] -1 -1 -4 -8
6. Prohibited allocations of
stock in an ESOP of an S
corporation
[/6/] 10 10 24 72
7. Investment of employee
contributions in 401(k) plans
[aiii TRA'97]
Negligible Revenue Effect
8. Periodic pension benefit
statements
[pyba 12/31/00] No Revenue Effect
Total of Provisions for
Strengthening Pension
Security and Enforcement -40 -41 -119 -311
F. Provisions for Reducing
Regulatory Burdens
1. Modification of timing of
plan valuations
[pyba 12/31/00] Negligible Revenue Effect
2. ESOP dividends may be
reinvested without loss of
dividend deduction; modify
present-law antiabuse rule
to permit the Secretary to
disallow the deduction in
the case of any dividend that
constitutes the avoidance or
evasion of taxation
[tyba 12/31/00] -74 -77 -243 -600
3. Repeal transition rule
relating to certain highly
compensated employees
[pyba 12/31/00] -4 -4 -13 -32
4. Employees of tax-exempt
entities
[DOE] Negligible Revenue Effect
5. Treatment of employer-
provided retirement advice
[tyba 12/31/00] Negligible Revenue Effect
6. Pension plan reporting
simplification 7
[1/1/01] Negligible Revenue Effect
7. Improvement to Employee
Plans Compliance Resolution
System 7
[DOE] Negligible Revenue Effect
8. Repeal of the multiple use
test
[yba 12/31/00] Considered in Other Provisions
9. Flexibility in nondiscri-
mination, coverage, and line
of business rules 7
[DOE] Negligible Revenue Effect
10. Extension to all governmental
plans of moratorium on
application of certain
nondiscrimination rules
applicable to State and local
government plans
[yba 12/31/00] Negligible Revenue Effect
11. Notice and consent period
regarding distributions; and
notice regarding optional
forms of benefit
[yba 12/31/00] No Revenue Effect
12. Annual report dissemination
[yba 12/31/99] No Revenue Effect
13. Amendments to the SAVER Act
[DOE] No Revenue Effect
14. Require Secretary of Treasury
to study and report on the
effect of the bill on pension
coverage
[DOE] No Revenue Effect
Total of Provisions for
Reducing Regulatory Burdens -78 -81 -256 -632
G. ERISA Provisions
1. Extension of PBGC missing
plan participants program 5
[/8/] 9 /9/ 2 -1
2. Reduce PBGC premium for new
plans of small employers 5
[pea 12/31/00] 2 /2/ -2 -4
3. Phase-in additional PBGC
premium for new plans;
include additional variable
premium relief for small
employers 5
[ya 12/31/00] -4 -4 -13 -30
4. Authorization for PBGC to
pay interest on premium
overpayment refunds 5
[iafpbo/a DOE] -3 -3 -12 -27
5. Rules for substantial owner
benefits in terminated plans
5
[noitta 12/31/00] 2 /2/ -2 -5
6. Increase in multiemployer
plan benefits guarantee 5
[bpa DOE] 2 /2/ -1 -2
7. Civil penalties for breach
of fiduciary duty 10
[/11/] No Revenue Effect
8. Benefit suspension notice
[pyba 12/31/00] No Revenue Effect
Total of ERISA Provisions -8 -8 -30 -68
H. Provisions Relating to Plan
Amendments
[DOE] No Revenue Effect
TOTAL OF PENSIONS AND
INDIVIDUAL RETIREMENT
ARRANGEMENT PROVISIONS -9,409 -10,393 -18,123 -63,760
SCHOOL CONSTRUCTION PROVISIONS
A. Small Governmental Unit
Arbitrage Rebate Exception -
increase arbitrage rebate
exception for governmental
bonds used to finance qualified
school construction from
$10 million to $15 million
[bia 12/31/00] -17 -18 -24 -104
B. Liberalize Construction Bond
Expenditure Rule for Public
School Bonds - provide new
4-year expenditure schedule for
bonds for public school
construction under the
arbitrage rebate rules
[bia 12/31/00] -320 -312 -1,027 -2,644
C. Modify Special Provision for
a Permanent University Fund
[1/1/01] -1 2 -3 -4
D. Issuance of Private Activity
Bonds for Public School
Facilities - issuance of tax-
exempt private activity bonds
for qualified education facili-
ties with annual volume cap
the greater of $10 per resident
or $5 million
[bia 12/31/00] -210 -241 -202 -1,090
E. Tax-Credit Bonds
1. Extend authority to issue
QZABs for an additional 2
years (through 2003) at
present-law $400 million per
year authorized issuance
levels; with certain
modifications
[bia 12/31/01] -25 -25 -28 -154
2. School Construction QZABs -
authorize issuance of a new
sub-category of QZABs for
construction, renovation, and
repair of public schools of
$5 billion annually for 2001,
2002, and 2003; private
investment not required;
modified targeting criteria
and administrative rules; un-
used bond authority from any
year to carry forward for up
to 2 years, used on a FIFO
basis; additional $200 million
for construction of tribal
schools on Indian reservations
[bia 12/31/00] -558 -558 -1,068 -3,843
TOTAL SCHOOL CONSTRUCTION
PROVISIONS -1,131 -1,154 -2,352 -7,839
COMMUNITY REVITALIZATION PROVISIONS
A. Tax Incentives for Renewal
Communities and Empowerment Zones
1. Designate 40 renewal
communities, 12 of which are
in rural areas, to receive
the following tax benefits: a
wage credit of 15% on first
$10,000 of qualified wages;
an additional $35,000 of
section 179 expensing;
deduction for qualified
revitalization expenditures,
capped at $12 million per
community; and 0% capital
gains tax rate on qualifying
assets held more than
5 years
[DOE /13/] -942 -371 -2,070 -5,588
2. Designate 9 new empowerment
zones, extend present-law
empowerment zone designations
through 12/31/09, expand the
20% wage credit to all
empowerment zones, increase
the additional section 179
expensing to $35,000 for all
empowerment zones including
D.C. in 2002, and extend the
more favorable round II tax
exempt financing rules to all
existing and new empowerment
zones excluding D.C.
[DOE /14/] -783 -239 -1,721 -4,548
3. Capital gain rollover of
empowerment zone assets and
increased exclusion of gain
on sale of certain
empowerment zone investments
[ima DOE] -152 -202 -102 -738
B. New Markets Tax Credit -
provide new markets tax
credit with allocation authority
of $1.0 billion in 2001, $1.5
billion in 2002 and 2003,
$2.0 billion in 2004 and 2005,
and $3.5 billion in 2006 and 2007
[ima 12/31/00] -828 -747 -747 -4,391
C. Increase the Low-Income Housing
Tax Credit and Make Other
Modifications - increase per
capita credit to $1.50 in 2001,
$1.75 in 2002, and indexed
for inflation thereafter;
$2 million small State minimum
in 2001 and 2002 and index for
inflation thereafter; modify
stacking rules and credit
allocation rules; certain Native
American housing assistance
disregarded in determining
whether building is Federally
subsidized for purposes of the
low-income housing credit
[generally cyba 12/31/00] -1188 -1416 -924 -5,880
D. Other Provisions
1. Private Activity Bond
State Volume Limits -
increase annual State
volume cap to the greater of:
$62.50 per resident or $187.5
million in 2001, and $75 per
resident or $225 million in
2002; index for inflation
thereafter
[cyba 12/31/00] -557 -600 -951 -3,519
2. Expensing of Environmental
Remediation Expenditures and
Expansion of Qualifying Sites
- for expenditures incurred
before 2004 ("Brownfields")
[DOE & epoia DOE] 17 12 -538 -489
3. Extend the D.C. Homebuyer
Credit Through 12/31/03
[DOE] 2 /2/ -46 -46
TOTAL OF COMMUNITY
REVITALIZATION PROVISIONS -4,433 -3,563 -7,099 -25,199
ADMINISTRATIVE, MISCELLANEOUS,
AND TECHNICAL PROVISIONS
A. Administrative Provisions
1. Exempt Certain Reports
From Elimination Under the
Federal Reports Elimination
And Sunset Act of 1995
[DOE] No Revenue Effect
2. Extension of Deadlines for
IRS Compliance with
Certain Notice Requirements
[DOE] No Revenue Effect
3. 5-Year Extension of Authority
for IRS Undercover Operations
[1/1/01] 15 /15/ 16 /17/
4. Confidentiality of Certain
Documents Relating to Closing
and Similar Agreements and to
Agreements with Foreign
Governments
[DOE] Negligible Revenue Effect
5. Increase in Joint Committee
on Taxation Refund Review
Threshold
[DOE] Negligible Revenue Effect
6. Clarify Dependency Deduction
for Kidnapped Children
[tyea DOE] Negligible Revenue Effect
7. Conforming Changes to
Accommodate Reduced Issuances
of Certain Treasury Securities
[DOE] Negligible Revenue Effect
8. Authorization to Use
Corrected Consumer Price
Index:
a. Tax revenues 18
[DOE] --- --- -40 -40
b. Outlays 5 /19/ 20
[DOE] -510 -500 -3,200 -5,790
9. Prevent Duplication or
Acceleration of Loss
Through Assumption of
Certain Liabilities
[aolo/a 10/19/99] 29 31 85 220
B. Miscellaneous Provisions
1. Repeal the 4.3-Cents-Per-
Gallon Tax on Railroad
Diesel Fuel and Inland
Waterway Fuel Currently
Paid Into the General Fund
[1/1/01] -178 -183 -715 -1,580
2. Repeal of Reduction of
Deductions for Mutual Life
Insurance Companies and of
Policyholder Surplus Accounts
of Life Insurance Companies
[tyba 12/31/00] -49 -55 -375 -645
3. Tax Credit Bonds for the
National Railroad Passenger
Corporation ("Amtrak") - $1
billion tax credit bonds per
year
[bia 9/30/00] -569 -639 -762 -3,259
4. Farm, Fishing, and Ranch Risk
Management ("FFARRM") Accounts
[tyba 12/31/00] -6 -6 -539 -760
5. Extend present-law section
170(e)(6) relating to corpo-
rate contributions of
computer equipment through
12/31/03; expand list of
eligible donees to include
public libraries; expand to
include 3-year property
[cma 12/31/00] --- --- -355 -355
6. Exemption for Settlement of
Discrimination Claims
Brought by Certain Farmers
Against the Department of
Agriculture
[aoty] --- --- -338 -338
7. Adoption Credit - extend
through 12/31/05 for non-
special needs adoptions,
with an increase in the
qualified expenses level to
$10,000 for non-special needs
adoptions and $12,000 for
special needs adoption,
phased in by $1,000 a year
and $2,000 a year, respec-
tively; phaseout starting
point increased to $150,000
of AGI, fully phased out at
$190,000 of AGI
[tyba 12/31/00] -79 -58 -1,610 -2,426
*
8. Study on Bermuda Insurance
Companies
[DOE]
9. Treatment of Indian tribes
as Non-Profit Organizations
and State or Local Governments
for Purposes of the Federal
Unemployment Tax 5
[/21/] 1 12 -14 -9
C. Technical Correction
Provisions
Total of Administrative,
Miscellaneous, and Technical
Provisions -1,361 -1,410 -7,861 -14,977
______________________________________________________________________
NET TOTAL -35,939 -37,188 -73,868 -240,421
______________________________________________________________________
REPEAL THE FEDERAL
COMMUNICATIONS EXCISE TAX
(INCLUDED IN THE TREASURY
APPROPRIATIONS BILL)
[10/1/00] -6,502 -6,852 -24,035 -55,009
______________________________________________________________________
Joint Committee on Taxation
NOTE: Details may not add to totals due to rounding.
Legend for "Effective" column:
aiii TRA'97 = as if included in the Taxpayer Relief Act of 1997
aolo/a = assumption of liabilities on or after
aoty = all open taxable years
bia = bonds issued after
bpa = benefits payable after
ci = contributions in
cma = contributions made after
cyba = calendar years beginning after
da = distributions after
dma = distributions made after
DOE = date of enactment
doia = discharges of indebtedness after
epoia = expenditures paid or incurred after
ima = investments made after
iafpbo/a = interest accruing for periods beginning on or after
iso/a = installment sales on or after
noitta = notice of intent to terminate after
pateo/a = plan amendments taking effect on or after
pea = plans established after
pimt = policies issued more than
pyba = plan years beginning after
rma = requests made after
sa = sales after
ta = transfers after
Ta = transactions after
tdapma = transfers, distributions, and payments made after
tyba = taxable years beginning after
tyea = taxable years ending after
wpoifibwa = wages paid or incurred for individuals beginning
work after
ya = years after
yba = years beginning after
1ya = 1 year after
2ya = 2 years after
FOOTNOTES TO TABLE
1 Estimate includes interaction with certain Tax Incentives
for Renewal Communities and Empowerment Zones provisions.
2 Loss of less than $500,000.
3 Estimate includes interaction with other provisions in
Provisions for Expanding Coverage.
4 Estimate includes interaction with the Individual Retirement
Arrangement provisions.
5 Estimate provided by the Congressional Budget Office.
6 Generally effective with respect to years beginning after
December 31, 2001. In the case of an ESOP established after July 11,
2000, or an ESOP established on or before such date if the employer
maintaining the plan was not an S corporation on such date, the
proposal would be effective with respect to plan years ending after
July 11, 2000.
7 Directs the Secretary of the Treasury to modify rules
through regulations.
8 Effective for distributions from terminating plans that
occur after the PBGC has adopted final regulations implementing
provision.
9 Loss of less than $100,000.
10 Department of Labor penalties.
11 In general, the proposal would apply to any breach of
fiduciary responsibility or other violation of part 4 of Subtitle B.
of the Title I. and ERISA occurring on or after the date of
enactment.
12 Gain of less than $500,000.
13 The Secretary of Housing and Urban Development must
prescribe regulations for the nomination process no later than 4
months after the date of enactment. The tax benefits for the
designated communities generally are effective beginning on 1/1/02,
and terminating on 12/31/09.
14 Area may be designated as an empowerment zone any time
after the date of enactment and before 1/1/02. The tax benefits
generally become effective after 12/31/01 and terminate on 12/31/09.
15 Gain of less than $1 million.
16 Gain of less than $5 million.
17 Gain of less than $10 million.
18 Estimate for fiscal year 2002 includes an increase in EIC
outlays of $17 million.
19 Negative numbers indicate a increase in Federal outlays.
20 Estimate includes a loss of $4,100 million over the Federal
fiscal year period 2001 - 2010 to the Social Security trust fund.
21 The proposal generally would be effective with respect to
service performed beginning on or after the date of enactment. Under
a transition rule, service performed in the employ of an Indian tribe
would not be treated as employment for FUTA purposes if: (1) it is
service which is performed before the date of enactment and with
respect to which FUTA tax has not been paid; and (2) such Indian
tribe reimburses a State unemployment fund for unemployment benefits
paid for service attributable to such tribe for such period.
END OF FOOTNOTES
* * * * *
MEDICARE, MEDICAID, AND SCHIP BENEFITS IMPROVEMENT AND PROTECTION ACT OF 2000
[1,187] The conference agreement would enact the provisions of H.R. 5543, as introduced on October 25, 2000. The text of that bill follows:
SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT;
REFERENCES TO OTHER ACTS; TABLE OF CONTENTS.
(a) Short Title. -- This Act may be cited as the "Medicare,
Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000".
(b) Amendments to Social Security Act. -- Except as otherwise
specifically provided, whenever in this Act an amendment is expressed
in terms of an amendment to or repeal of a section or other
provision, the reference shall be considered to be made to that
section or other provision of the Social Security Act.
(c) References to Other Acts. -- In this Act:
(1) Balanced budget act of 1997. -- The term "BBA" means the
Balanced Budget Act of 1997 (Public Law 105 33; 111 Stat. 251).
(2) Medicare, medicaid, and schip balanced budget refinement
act of 1999. -- The term "BBRA" means the Medicare, Medicaid,
and SCHIP Balanced Budget Refinement Act of 1999 (Appendix F,
113 Stat. 1501A 321), as enacted into law by section 1000(a)(6)
of Public Law 106 113.
(d) Table of Contents. -- The table of contents of this Act is
as follows:
Sec. 1. Short title; amendments to Social Security Act; references to
other Acts; table of contents.
TITLE I -- MEDICARE BENEFICIARY IMPROVEMENTS
SUBTITLE A -- IMPROVED PREVENTIVE BENEFITS
Sec. 101. Coverage of biennial screening pap smear and pelvic exams.
Sec. 102. Coverage of screening for glaucoma.
Sec. 103. Coverage of screening colonoscopy for average risk
individuals.
Sec. 104. Modernization of screening mammography benefit.
Sec. 105. Coverage of medical nutrition therapy services for
beneficiaries with diabetes or a renal disease.
SUBTITLE B -- OTHER BENEFICIARY IMPROVEMENTS
Sec. 111. Acceleration of reduction of beneficiary copayment for
hospital outpatient department services.
Sec. 112. Preservation of coverage of drugs and biologicals under
part B of the medicare program.
Sec. 113. Elimination of time limitation on medicare benefits for
immunosuppressive drugs.
Sec. 114. Imposition of billing limits on prescription drugs.
SUBTITLE C -- DEMONSTRATION PROJECTS AND STUDIES
Sec. 121. Demonstration project for disease management for severely
chronically ill medicare beneficiaries.
Sec. 122. Cancer prevention and treatment demonstration for ethnic
and racial minorities.
Sec. 123. Study on medicare coverage of routine thyroid screening.
Sec. 124. MedPAC study on consumer coalitions.
Sec. 125. Study on limitation on State payment for medicare
cost-sharing affecting access to services for qualified
medicare beneficiaries.
Sec. 126. Institute of Medicine study on waiver of 24-month
waiting period for medicare disability eligibility for
amyotrophic lateral sclerosis (ALS) and other devastating
diseases.
Sec. 127. Studies on preventive interventions in primary care for
older Americans.
Sec. 128. MedPAC study and report on medicare coverage of cardiac
and pulmonary rehabilitation therapy services.
TITLE II -- RURAL HEALTH CARE IMPROVEMENTS
SUBTITLE A -- CRITICAL ACCESS HOSPITAL PROVISIONS
Sec. 201. Clarification of no beneficiary cost-sharing for clinical
diagnostic laboratory tests furnished by critical access
hospitals.
Sec. 202. Assistance with fee schedule payment for professional
services under all-inclusive rate.
Sec. 203. Exemption of critical access hospital swing beds from SNF
PPS.
Sec. 204. Payment in critical access hospitals for emergency room on-
call physicians.
Sec. 205. Treatment of ambulance services furnished by certain
critical access hospitals.
Sec. 206. GAO study on certain eligibility requirements for critical
access hospitals.
SUBTITLE B -- OTHER RURAL HOSPITALS PROVISIONS
Sec. 211. Equitable treatment for rural disproportionate share
hospitals.
Sec. 212. Option to base eligibility for medicare dependent, small
rural hospital program on discharges during 2 of the 3 most
recently audited cost reporting periods.
Sec. 213. Extension of option to use rebased target amounts to all
sole community hospitals.
Sec. 214. MedPAC analysis of impact of volume on per unit cost of
rural hospitals with psychiatric units.
SUBTITLE C -- OTHER RURAL PROVISIONS
Sec. 221. Assistance for providers of ambulance services in rural
areas.
Sec. 222. Payment for certain physician assistant services.
Sec. 223. Revision of medicare reimbursement for telehealth services.
Sec. 224. Expanding access to rural health clinics.
Sec. 225. MedPAC study on low-volume, isolated rural health care
providers.
TITLE III -- PROVISIONS RELATING TO PART A
SUBTITLE A -- INPATIENT HOSPITAL SERVICES
Sec. 301. Revision of acute care hospital payment update for 2001.
Sec. 302. Additional modification in transition for indirect medical
education (IME) percentage adjustment.
Sec. 303. Decrease in reductions for disproportionate share hospital
(DSH) payments. Sec. 304. Wage index improvements.
Sec. 305. Payment for inpatient services of rehabilitation hospitals.
Sec. 306. Payment for inpatient services of psychiatric hospitals.
Sec. 307. Payment for inpatient services of long-term care hospitals.
SUBTITLE B -- ADJUSTMENTS TO PPS PAYMENTS FOR SKILLED
NURSING FACILITIES
Sec. 311. Elimination of reduction in skilled nursing facility (SNF)
market basket update in 2001.
Sec. 312. Increase in nursing component of PPS Federal rate.
Sec. 313. Application of SNF consolidated billing requirement limited
to part A covered stays.
Sec. 314. Adjustment of rehabilitation RUGs to correct anomaly in
payment rates. Sec. 315. Establishment of process for
geographic reclassification.
SUBTITLE C -- HOSPICE CARE
Sec. 321. Full market basket increase for 2001.
Sec. 322. Clarification of physician certification.
Sec. 323. MedPAC report on access to, and use of, hospice benefit.
SUBTITLE D -- OTHER PROVISIONS
Sec. 331. Relief from medicare part A late enrollment penalty for
group buy-in for State and local retirees. Sec.
332. Posting of information on nursing facility staffing.
TITLE IV -- PROVISIONS RELATING TO PART B
SUBTITLE A -- HOSPITAL OUTPATIENT SERVICES
Sec. 401. Revision of hospital outpatient PPS payment update.
Sec. 402. Clarifying process and standards for determining
eligibility of devices for pass-through payments under
hospital outpatient PPS.
Sec. 403. Application of OPD PPS transitional corridor payments to
certain hospitals that did not submit a 1996 cost report.
Sec. 404. Application of rules for determining provider-based status
for certain entities.
Sec. 405. Treatment of children's hospitals under prospective payment
system.
Sec. 406. Inclusion of temperature monitored cryoablation in
transitional pass-through for certain medical devices,
drugs, and biologicals under OPD PPS.
SUBTITLE B -- PROVISIONS RELATING TO PHYSICIANS' SERVICES
Sec. 411. GAO studies relating to physicians' services.
Sec. 412. Physician group practice demonstration.
Sec. 413. Study on enrollment procedures for groups that retain
independent contractor physicians.
SUBTITLE C -- OTHER SERVICES
Sec. 421. 1-year extension of moratorium on therapy caps; report on
standards for supervision of physical therapy assistants.
Sec. 422. Update in renal dialysis composite rate.
Sec. 423. Payment for ambulance services.
Sec. 424. Ambulatory surgical centers.
Sec. 425. Full update for durable medical equipment.
Sec. 426. Full update for orthotics and prosthetics.
Sec. 427. Establishment of special payment provisions and
requirements for prosthetics and certain custom fabricated
orthotic items.
Sec. 428. Replacement of prosthetic devices and parts.
Sec. 429. Revised part B payment for drugs and biologicals and
related services.
Sec. 430. Contrast enhanced diagnostic procedures under hospital
prospective payment system.
Sec. 431. Qualifications for community mental health centers.
Sec. 432. Modification of medicare billing requirements for certain
Indian providers.
Sec. 433. GAO study on coverage of surgical first assisting services
of certified registered nurse first assistants.
Sec. 434. MedPAC study and report on medicare reimbursement for
services provided by certain providers.
Sec. 435. MedPAC study and report on medicare coverage of services
provided by certain nonphysician providers.
Sec. 436. GAO study and report on the costs of emergency and medical
transportation services.
Sec. 437. GAO studies and reports on medicare payments.
Sec. 438. MedPAC study on access to outpatient pain management
services.
TITLE V -- PROVISIONS RELATING TO PARTS A AND B
SUBTITLE A -- HOME HEALTH SERVICES
Sec. 501. 1-year additional delay in application of 15 percent
reduction on payment limits for home health services.
Sec. 502. Restoration of full home health market basket update for
home health services for fiscal year 2001.
Sec. 503. Temporary two-month extension of periodic interim payments.
Sec. 504. Use of telehealth in delivery of home health services.
Sec. 505. Study on costs to home health agencies of purchasing
nonroutine medical supplies.
Sec. 506. Treatment of branch offices; GAO study on supervision of
home health care provided in isolated rural areas.
Sec. 507. Clarification of the homebound definition under the
medicare home health benefit.
SUBTITLE B -- DIRECT GRADUATE MEDICAL EDUCATION
Sec. 511. Increase in floor for direct graduate medical education
payments.
Sec. 512. Change in distribution formula for Medicare+Choice-related
nursing and allied health education costs.
SUBTITLE C -- CHANGES IN MEDICARE COVERAGE AND APPEALS PROCESS
Sec. 521. Revisions to medicare appeals process.
Sec. 522. Revisions to medicare coverage process.
SUBTITLE D -- IMPROVING ACCESS TO NEW TECHNOLOGIES
Sec. 531. Reimbursement improvements for new clinical laboratory
tests and durable medical equipment.
Sec. 532. Retention of HCPCS level III codes.
Sec. 533. Recognition of new medical technologies under inpatient
hospital PPS.
SUBTITLE E -- OTHER PROVISIONS
Sec. 541. Increase in reimbursement for bad debt.
Sec. 542. Treatment of certain physician pathology services under
medicare.
Sec. 543. Extension of advisory opinion authority.
Sec. 544. Change in annual MedPAC reporting.
Sec. 545. Development of patient assessment instruments.
Sec. 546. GAO report on impact of the Emergency Medical Treatment and
Active Labor Act (EMTALA) on hospital emergency
departments.
TITLE VI -- PROVISIONS RELATING TO PART C (MEDICARE+CHOICE
PROGRAM) AND OTHER MEDICARE MANAGED CARE PROVISIONS
SUBTITLE A -- MEDICARE+CHOICE PAYMENT REFORMS
Sec. 601. Increase in minimum payment amount.
Sec. 602. Increase in minimum percentage increase.
Sec. 603. 10-year phase-in of risk adjustment.
Sec. 604. Transition to revised Medicare+Choice payment rates.
Sec. 605. Revision of payment rates for ESRD patients enrolled in
Medicare+Choice plans.
Sec. 606. Permitting premium reductions as additional benefits under
Medicare+Choice plans.
Sec. 607. Full implementation of risk adjustment for congestive heart
failure enrollees for 2001.
Sec. 608. Expansion of application of Medicare+Choice new entry
bonus.
Sec. 609. Report on inclusion of certain costs of the Department of
Veterans Affairs and military facility services in
calculating Medicare+Choice payment rates.
SUBTITLE B -- OTHER MEDICARE+CHOICE REFORMS
Sec. 611. Payment of additional amounts for new benefits covered
during a contract term.
Sec. 612. Restriction on implementation of significant new regulatory
requirements mid-year.
Sec. 613. Timely approval of marketing material that follows model
marketing language.
Sec. 614. Avoiding duplicative regulation.
Sec. 615. Election of uniform local coverage policy for
Medicare+Choice plan covering multiple localities.
Sec. 616. Eliminating health disparities in Medicare+Choice program.
Sec. 617. Medicare+Choice program compatibility with employer or
union group health plans.
Sec. 618. Special medigap enrollment antidiscrimination provision for
certain beneficiaries.
Sec. 619. Restoring effective date of elections and changes of
elections of Medicare+Choice plans.
Sec. 620. Permitting ESRD beneficiaries to enroll in another
Medicare+Choice plan if the plan in which they are enrolled
is terminated.
Sec. 621. Providing choice for skilled nursing facility services
under the Medicare+Choice program.
Sec. 622. Providing for accountability of Medicare+Choice plans.
SUBTITLE C -- OTHER MANAGED CARE REFORMS
Sec. 631. 1-year extension of social health maintenance organization
(SHMO) demonstration project.
Sec. 632. Revised terms and conditions for extension of medicare
community nursing organization (CNO) demonstration project.
Sec. 633. Extension of medicare municipal health services
demonstration projects.
Sec. 634. Service area expansion for medicare cost contracts during
transition period.
TITLE VII -- MEDICAID
Sec. 701. DSH payments.
Sec. 702. New prospective payment system for Federally-qualified
health centers and rural health clinics.
Sec. 703. Streamlined approval of continued State-wide section 1115
Medicaid waivers.
Sec. 704. Medicaid county-organized health systems.
Sec. 705. Deadline for issuance of final regulation relating to
Medicaid upper payment limits.
Sec. 706. Alaska FMAP.
TITLE VIII -- STATE CHILDREN'S HEALTH INSURANCE PROGRAM
Sec. 801. Special rule for redistribution and availability of unused
fiscal year 1998 and 1999 SCHIP allotments.
Sec. 802. Authority to pay Medicaid expansion SCHIP costs from title
XXI appropriation.
TITLE IX -- OTHER PROVISIONS
SUBTITLE A -- PACE PROGRAM
Sec. 901. Extension of transition for current waivers.
Sec. 902. Continuing of certain operating arrangements permitted.
Sec. 903. Flexibility in exercising waiver authority.
SUBTITLE B -- OUTREACH TO ELIGIBLE LOW-INCOME MEDICARE BENEFICIARIES
Sec. 911. Outreach on availability of Medicare cost-sharing
assistance to eligible low-income Medicare beneficiaries.
SUBTITLE C -- MATERNAL AND CHILD HEALTH BLOCK GRANT
Sec. 921. Increase in authorization of appropriations for the
maternal and child health services block grant.
SUBTITLE D -- DIABETES
Sec. 931. Increase in appropriations for special diabetes programs
for type I diabetes and Indians.
Sec. 932. Appropriations for Ricky Ray Hemophilia Relief Fund.
TITLE I -- MEDICARE BENEFICIARY IMPROVEMENTS
Subtitle A -- Improved Preventive Benefits
SEC. 101. COVERAGE OF BIENNIAL SCREENING PAP SMEAR AND PELVIC EXAMS.
(a) In General. --
(1) Biennial screening pap smear. -- Section 1861(nn)(1) (42
U.S.C. 1395x(nn)(1)) is amended by striking "3 years" and
inserting "2 years".
(2) Biennial screening pelvic exam. -- Section 1861(nn)(2)
(42 U.S.C. 1395x(nn)(2)) is amended by striking "3 years" and
inserting "2 years".
(b) Effective Date. -- The amendments made by subsection (a)
apply to items and services furnished on or after July 1, 2001.
SEC. 102. COVERAGE OF SCREENING FOR GLAUCOMA.
(a) Coverage. -- Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is
amended --
(1) by striking "and" at the end of subparagraph (S);
(2) by inserting "and" at the end of subparagraph (T); and
(3) by adding at the end the following:
"(U) screening for glaucoma (as defined in subsection
(uu)) for individuals determined to be at high risk for
glaucoma, individuals with a family history of glaucoma and
individuals with diabetes;".
(b) Services Described. -- Section 1861 (42 U.S.C. 1395x) is
amended by adding at the end the following new subsection:
"SCREENING FOR GLAUCOMA
"(uu) The term 'screening for glaucoma' means a dilated eye
examination with an intraocular pressure measurement, and a direct
ophthalmoscopy or a slit-lamp biomicroscopic examination for the
early detection of glaucoma which is furnished by or under the direct
supervision of an optometrist or ophthalmologist who is legally
authorized to furnish such services under State law (or the State
regulatory mechanism provided by State law) of the State in which the
services are furnished, as would otherwise be covered if furnished by
a physician or as an incident to a physician's professional service,
if the individual involved has not had such an examination in the
preceding year.".
(c) Conforming Amendment. -- Section 1862(a)(1)(F) (42 U.S.C.
1395y(a)(1)(F)) is amended --
(1) by striking "and,"; and
(2) by adding at the end the following: "and, in the case of
screening for glaucoma, which is performed more frequently than
is provided under section 1861(uu),".
(d) Effective Date. -- The amendments made by this section shall
apply to services furnished on or after January 1, 2002.
SEC. 103. COVERAGE OF SCREENING COLONOSCOPY FOR AVERAGE RISK
INDIVIDUALS.
(a) In General. -- Section 1861(pp) (42 U.S.C. 1395x(pp)) is
amended --
(1) in paragraph (1)(C), by striking "In the case of an
individual at high risk for colorectal cancer, screening
colonoscopy" and inserting "Screening colonoscopy"; and
(2) in paragraph (2), by striking "In paragraph (1)(C), an"
and inserting "An".
(b) Frequency Limits for Screening Colonoscopy. -- Section
1834(d) (42 U.S.C. 1395m(d)) is amended --
(1) in paragraph (2)(E)(ii), by inserting before the period
at the end the following: "or, in the case of an individual who
is not at high risk for colorectal cancer, if the procedure is
performed within the 119 months after a previous screening
colonoscopy";
(2) in paragraph (3) --
(A) in the heading by striking " for individuals at high
risk for colorectal cancer";
(B) in subparagraph (A), by striking "for individuals at
high risk for colorectal cancer (as defined in section
1861(pp)(2))";
(C) in subparagraph (E), by inserting before the period
at the end the following: "or for other individuals if the
procedure is performed within the 119 months after a
previous screening colonoscopy or within 47 months after a
previous screening flexible sigmoidoscopy".
(c) Effective Date. -- The amendments made by this section apply
to colorectal cancer screening services provided on or after July 1,
2001.
SEC. 104. MODERNIZATION OF SCREENING MAMMOGRAPHY BENEFIT.
(a) Inclusion in Physician Fee Schedule. -- Section 1848(j)(3)
(42 U.S.C. 1395w 4(j)(3)) is amended by inserting "(13)," after
"(4),".
(b) Conforming Amendment. -- Section 1834(c) (42 U.S.C.
1395m(c)) is amended to read as follows:
"(c) Payment and Standards for Screening Mammography. --
"(1) In general. -- With respect to expenses incurred for
screening mammography (as defined in section 1861(jj)), payment
may be made only --
"(A) for screening mammography conducted consistent with
the frequency permitted under paragraph (2); and
"(B) if the screening mammography is conducted by a
facility that has a certificate (or provisional certificate)
issued under section 354 of the Public Health Service Act.
"(2) Frequency covered. --
"(A) In general. -- Subject to revision by the Secretary
under subparagraph (B) --
"(i) no payment may be made under this part for
screening mammography performed on a woman under 35
years of age;
"(ii) payment may be made under this part for only
one screening mammography performed on a woman over 34
years of age, but under 40 years of age; and
"(iii) in the case of a woman over 39 years of age,
payment may not be made under this part for screening
mammography performed within 11 months following the
month in which a previous screening mammography was
performed.
"(B) Revision of frequency. --
"(i) Review. -- The Secretary, in consultation with
the Director of the National Cancer Institute, shall
review periodically the appropriate frequency for
performing screening mammography, based on age and such
other factors as the Secretary believes to be pertinent.
"(ii) Revision of frequency. -- The Secretary,
taking into consideration the review made under clause
(i), may revise from time to time the frequency with
which screening mammography may be paid for under this
subsection.".
(c) Effective Date. -- The amendments made by subsections (a)
and (b) apply with respect to screening mammographies furnished on or
after January 1, 2002.
(d) Payment for New Technologies. --
(1) Tests furnished in 2001. --
(A) Screening. -- For a screening mammography (as
defined in section 1861(jj) of the Social Security Act (42
U.S.C. 1395(jj))) furnished during the period beginning on
April 1, 2001, and ending on December 31, 2001, that uses a
new technology, payment for such screening mammography shall
be made as follows:
(i) In the case of a technology which directly takes
a digital image (without involving film) and
subsequently analyzes such resulting image with software
to identify possible problem areas, in an amount equal
to 150 percent of the amount of payment under section
1848 of such Act (42 U.S.C. 1395w 4) for a bilateral
diagnostic mammography (under HCPCS code 76091) for such
year.
(ii) In the case of a technology which allows
conversion of a standard film mammogram into a digital
image and subsequently analyzes such resulting image
with software to identify possible problem areas, in an
amount equal to the limit that would otherwise be
applied under section 1834(c)(3) of such Act (42 U.S.C.
1395m(c)(3)) for 2001, increased by $15.
(B) Bilateral diagnostic mammography. -- For a bilateral
diagnostic mammography (under HCPCS code 76091) furnished
during the period beginning on April 1, 2001, and ending on
December 31, 2001, that uses a new technology described in
subparagraph (A)(i), payment for such mammography shall be
the amount of payment provided for under such subparagraph.
The Secretary of Health and Human Services may implement the
provisions of this paragraph by program memorandum or
otherwise.
(2) Consideration of new hcpcs code for new technologies
after 2001. -- The Secretary shall determine, for such screening
mammographies performed after 2001, whether the assignment of a
new HCPCS code is appropriate for screening mammography that
uses a new technology. If the Secretary determines that a new
code is appropriate for such screening mammography, the
Secretary shall provide for such new code for such tests
furnished after 2001.
(3) New technology described. -- For purposes of this
subsection, a new technology with respect to a screening
mammography is an advance in technology with respect to the test
or equipment that results in the following:
(A) A significant increase or decrease in the resources
used in the test or in the manufacture of the equipment.
(B) A significant improvement in the performance of the
test or equipment.
(C) A significant advance in medical technology that is
expected to significantly improve the treatment of medicare
beneficiaries.
(4) HCPCS code defined. -- The term "HCPCS code" means an
alphanumeric code under the Health Care Financing Administration
Common Procedure Coding System (HCPCS).
SEC. 105. COVERAGE OF MEDICAL NUTRITION THERAPY SERVICES FOR
BENEFICIARIES WITH DIABETES OR A RENAL DISEASE.
(a) Coverage. -- Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)), as
amended by section 102(a), is amended --
(1) in subparagraph (T), by striking "and" at the end;
(2) in subparagraph (U), by inserting "and" at the end; and
(3) by adding at the end the following new subparagraph:
"(V) medical nutrition therapy services (as
defined in subsection (vv)(1)) in the case of a
beneficiary with diabetes or a renal disease who --
"(i) has not received diabetes outpatient self-
management training services within a time period
determined by the Secretary; and
"(ii) meets such other criteria determined by the
Secretary after consideration of protocols established
by dietitian or nutrition professional organizations;".
(b) Services Described. -- Section 1861 (42 U.S.C. 1395x), as
amended by section 102(b), is amended by adding at the end the
following:
"MEDICAL NUTRITION THERAPY SERVICES; REGISTERED DIETITIAN OR
NUTRITION PROFESSIONAL
"(vv)(1) The term 'medical nutrition therapy
services' means nutritional diagnostic, therapy, and
counseling services for the purpose of disease
management which are furnished by a registered dietitian
or nutrition professional (as defined in paragraph (2))
pursuant to a referral by a physician (as defined in
subsection (r)(1)).
"(2) Subject to paragraph (3), the term 'registered
dietitian or nutrition professional' means an individual who --
"(A) holds a baccalaureate or higher degree granted by a
regionally accredited college or university in the United
States (or an equivalent foreign degree) with completion of
the academic requirements of a program in nutrition or
dietetics, as accredited by an appropriate national
accreditation organization recognized by the Secretary for
this purpose;
"(B) has completed at least 900 hours of supervised
dietetics practice under the supervision of a registered
dietitian or nutrition professional; and
"(C)(i) is licensed or certified as a dietitian or
nutrition professional by the State in which the services
are performed; or
"(ii) in the case of an individual in a State that
does not provide for such licensure or certification,
meets such other criteria as the Secretary establishes.
"(3) Subparagraphs (A) and (B) of paragraph (2) shall
not apply in the case of an individual who, as of the date of
the enactment of this subsection, is licensed or certified as a
dietitian or nutrition professional by the State in which
medical nutrition therapy services are performed.".
(c) Payment. -- Section 1833(a)(1) (42 U.S.C. 1395l(a)(1)) is
amended --
(1) by striking "and" before "(S)"; and
(2) by inserting before the semicolon at the end the
following: ", and (T) with respect to medical nutrition therapy
services (as defined in section 1861(vv)), the amount paid shall
be 80 percent of the lesser of the actual charge for the
services or 85 percent of the amount determined under the fee
schedule established under section 1848(b) for the same services
if furnished by a physician".
(d) Application of Limits on Billing. -- Section 1842(b)(18)(C)
(42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the
following new clause:
"(vi) A registered dietitian or nutrition
professional.".
(e) Effective Date. -- The amendments made by this section apply
to services furnished on or after January 1, 2002.
(f) Study. -- Not later than July 1, 2003, the Secretary of
Health and Human Services shall submit to Congress a report that
contains recommendations with respect to the expansion to other
medicare beneficiary populations of the medical nutrition therapy
services benefit (furnished under the amendments made by this
section).
Subtitle B -- Other Beneficiary Improvements
SEC. 111. ACCELERATION OF REDUCTION OF BENEFICIARY COPAYMENT FOR
HOSPITAL OUTPATIENT DEPARTMENT SERVICES.
(a) Reducing the Upper Limit on Beneficiary Copayment. --
(1) In general. -- Section 1833(t)(8)(C) (42 U.S.C.
1395l(t)(8)(C)) is amended to read as follows:
"(C) Limitation on copayment amount. --
"(i) To inpatient hospital deductible amount. -- In
no case shall the copayment amount for a procedure
performed in a year exceed the amount of the inpatient
hospital deductible established under section 1813(b)
for that year.
"(ii) To specified percentage. -- The Secretary
shall reduce the national unadjusted copayment amount
for a covered OPD service (or group of such services)
furnished in a year in a manner so that the effective
copayment rate (determined on a national unadjusted
basis) for that service in the year does not exceed the
following percentage:
"(I) For procedures performed in 2001, 60
percent.
"(II) For procedures performed in 2002 or 2003,
55 percent.
"(III) For procedures performed in 2004, 50
percent.
"(IV) For procedures performed in 2005, 45
percent.
"(V) For procedures performed in 2006 and
thereafter, 40 percent.".
(2) Effective date. -- The amendment made by paragraph (1)
applies with respect to services furnished on or after January
1, 2001.
(b) Construction Regarding Limiting Increases in Cost-Sharing. -
- Nothing in this Act or the Social Security Act shall be construed
as preventing a hospital from waiving the amount of any coinsurance
for outpatient hospital services under the medicare program under
title XVIII of the Social Security Act that may have been increased
as a result of the implementation of the prospective payment system
under section 1833(t) of the Social Security Act (42 U.S.C.
1395l(t)).
(c) GAO Study of Reduction in Medigap Premium Levels Resulting
From Reductions in Coinsurance. -- The Comptroller General of the
United States shall work, in concert with the National Association of
Insurance Commissioners, to evaluate the extent to which the premium
levels for medicare supplemental policies reflect the reductions in
coinsurance resulting from the amendment made by subsection (a). Not
later than April 1, 2004, the Comptroller General shall submit to
Congress a report on such evaluation and the extent to which the
reductions in beneficiary coinsurance effected by such amendment have
resulted in actual savings to medicare beneficiaries.
SEC. 112. PRESERVATION OF COVERAGE OF DRUGS AND BIOLOGICALS UNDER
PART B OF THE MEDICARE PROGRAM.
(a) In General. -- Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is
amended, in each of subparagraphs (A) and (B), by striking
"(including drugs and biologicals which cannot, as determined in
accordance with regulations, be self-administered)" and inserting
"(including drugs and biologicals which are not usually self-
administered by the patient)".
(b) Effective Date. -- The amendment made by subsection (a)
applies to drugs and biologicals administered on or after the date of
the enactment of this Act.
SEC. 113. ELIMINATION OF TIME LIMITATION ON MEDICARE BENEFITS FOR
IMMUNOSUPPRESSIVE DRUGS.
(a) In General. -- Section 1861(s)(2)(J) (42 U.S.C.
1395x(s)(2)(J)) is amended by striking ", but only" and all that
follows up to the semicolon at the end.
(b) Conforming Amendments. --
(1) Extended coverage. -- Section 1832 (42 U.S.C. 1395k) is
amended --
(A) by striking subsection (b); and
(B) by redesignating subsection (c) as subsection (b).
(2) Pass-through; report. -- Section 227 of BBRA is amended
by striking subsection (d).
(c) Effective Date. -- The amendment made by subsection (a)
shall apply to drugs furnished on or after the date of the enactment
of this Act.
SEC. 114. IMPOSITION OF BILLING LIMITS ON PRESCRIPTION DRUGS.
(a) In General. -- Section 1842(o) (42 U.S.C. 1395u(o)) is
amended by adding at the end the following new paragraph:
"(3)(A) Payment for a charge for any drug or biological for
which payment may be made under this part may be made under this
part only on an assignment-related basis.
"(B) The provisions of subsection (b)(18)(B) shall apply
to charges for such drugs or biologicals in the same manner
as they apply to services furnished by a practitioner
described in subsection (b)(18)(C).".
(b) Effective Date. -- The amendment made by subsection (a)
shall apply to items furnished on or after January 1, 2001.
Subtitle C -- Demonstration Projects and Studies
SEC. 121. DEMONSTRATION PROJECT FOR DISEASE MANAGEMENT FOR SEVERELY
CHRONICALLY ILL MEDICARE BENEFICIARIES.
(a) In General. -- The Secretary of Health and Human Services
shall conduct a demonstration project under this section (in this
section referred to as the "project") to demonstrate the impact on
costs and health outcomes of applying disease management to medicare
beneficiaries with diagnosed, advanced-stage congestive heart
failure, diabetes, or coronary heart disease. In no case may the
number of participants in the project exceed 30,000 at any time.
(b) Voluntary Participation. --
(1) Eligibility. -- Medicare beneficiaries are eligible to
participate in the project only if --
(A) they meet specific medical criteria demonstrating
the appropriate diagnosis and the advanced nature of their
disease;
(B) their physicians approve of participation in the
project; and
(C) they are not enrolled in a Medicare+Choice plan.
(2) Benefits. -- A beneficiary who is enrolled in the
project shall be eligible --
(A) for disease management services related to their
chronic health condition; and
(B) for payment for all costs for prescription drugs
without regard to whether or not they relate to the chronic
health condition, except that the project may provide for
modest cost-sharing with respect to prescription drug
coverage.
(c) Contracts With Disease Management Organizations. --
(1) In general. -- The Secretary of Health and Human
Services shall carry out the project through contracts with up
to three disease management organizations. The Secretary shall
not enter into such a contract with an organization unless the
organization demonstrates that it can produce improved health
outcomes and reduce aggregate medicare expenditures consistent
with paragraph (2).
(2) Contract provisions. -- Under such contracts --
(A) such an organization shall be required to provide
for prescription drug coverage described in subsection
(b)(2)(B);
(B) such an organization shall be paid a fee negotiated
and established by the Secretary in a manner so that (taking
into account savings in expenditures under parts A and B of
the medicare program under title XVIII of the Social
Security Act) there will be a net reduction in expenditures
under the medicare program as a result of the project; and
(C) such an organization shall guarantee, through an
appropriate arrangement with a reinsurance company or
otherwise, the net reduction in expenditures described in
subparagraph (B).
(3) Payments. -- Payments to such organizations shall be
made in appropriate proportion from the Trust Funds established
under title XVIII of the Social Security Act.
(d) Application of Medigap Protections to Demonstration Project
Enrollees. -- (1) Subject to paragraph (2), the provisions of section
1882(s)(3) (other than clauses (i) through (iv) of subparagraph (B))
and 1882(s)(4) of the Social Security Act shall apply to enrollment
(and termination of enrollment) in the demonstration project under
this section, in the same manner as they apply to enrollment (and
termination of enrollment) with a Medicare+Choice organization in a
Medicare+Choice plan.
(2) In applying paragraph (1) --
(A) any reference in clause (v) or (vi) of section
1882(s)(3)(B) of such Act to 12 months is deemed a reference
to the period of the demonstration project; and
(B) the notification required under section
1882(s)(3)(D) of such Act shall be provided in a manner
specified by the Secretary of Health and Human Services.
(e) Duration. -- The project shall last for not longer than 3
years.
(f) Waiver. -- The Secretary of Health and Human Services shall
waive such provisions of title XVIII of the Social Security Act as
may be necessary to provide for payment for services under the
project in accordance with subsection (c)(3).
(g) Report. -- The Secretary of Health and Human Services shall
submit to Congress an interim report on the project not later than 2
years after the date it is first implemented and a final report on
the project not later than 6 months after the date of its completion.
Such reports shall include information on the impact of the project
on costs and health outcomes and recommendations on the cost-
effectiveness of extending or expanding the project.
SEC. 122. CANCER PREVENTION AND TREATMENT DEMONSTRATION FOR ETHNIC
AND RACIAL MINORITIES.
(a) Demonstration. --
(1) In general. -- The Secretary of Health and Human
Services (in this section referred to as the "Secretary") shall
conduct demonstration projects (in this section referred to as
"demonstration projects") for the purpose of developing models
and evaluating methods that --
(A) improve the quality of items and services provided
to target individuals in order to facilitate reduced
disparities in early detection and treatment of cancer;
(B) improve clinical outcomes, satisfaction, quality of
life, and appropriate use of medicare-covered services and
referral patterns among those target individuals with
cancer;
(C) eliminate disparities in the rate of preventive
cancer screening measures, such as pap smears and prostate
cancer screenings, among target individuals; and
(D) promote collaboration with community-based
organizations to ensure cultural competency of health care
professionals and linguistic access for persons with limited
English proficiency.
(2) Target individual defined. -- In this section, the term
"target individual" means an individual of a racial and ethnic
minority group, as defined by section 1707 of the Public Health
Service Act, who is entitled to benefits under part A, and
enrolled under part B, of title XVIII of the Social Security
Act.
(b) Program Design. --
(1) Initial design. -- Not later than 1 year after the date
of the enactment of this Act, the Secretary shall evaluate best
practices in the private sector, community programs, and
academic research of methods that reduce disparities among
individuals of racial and ethnic minority groups in the
prevention and treatment of cancer and shall design the
demonstration projects based on such evaluation.
(2) Number and project areas. -- Not later than 2 years
after the date of the enactment of this Act, the Secretary shall
implement at least 9 demonstration projects, including the
following:
(A) 2 projects for each of the 4 major racial and ethnic
minority groups (American Indians (including Alaska Natives,
Eskimos, and Aleuts); Asian Americans and Pacific Islanders;
Blacks; and Hispanics. The 2 projects must target different
ethnic subpopulations.
(B) 1 project within the Pacific Islands.
(C) At least 1 project each in a rural area and inner-
city area.
(3) Expansion of projects; implementation of demonstration
project results. -- If the initial report under subsection (c)
contains an evaluation that demonstration projects --
(A) reduce expenditures under the medicare program under
title XVIII of the Social Security Act; or
(B) do not increase expenditures under the medicare
program and reduce racial and ethnic health disparities in
the quality of health care services provided to target
individuals and increase satisfaction of beneficiaries and
health care providers; the Secretary shall continue the
existing demonstration projects and may expand the number of
demonstration projects.
(c) Report to Congress. --
(1) In general. -- Not later than 2 years after the date the
Secretary implements the initial demonstration projects, and
biannually thereafter, the Secretary shall submit to Congress a
report regarding the demonstration projects.
(2) Contents of report. -- Each report under paragraph (1)
shall include the following:
(A) A description of the demonstration projects.
(B) An evaluation of --
(i) the cost-effectiveness of the demonstration
projects;
(ii) the quality of the health care services
provided to target individuals under the demonstration
projects; and
(iii) beneficiary and health care provider
satisfaction under the demonstration projects.
(C) Any other information regarding the demonstration
projects that the Secretary determines to be appropriate.
(d) Waiver Authority. -- The Secretary shall waive compliance
with the requirements of title XVIII of the Social Security Act to
such extent and for such period as the Secretary determines is
necessary to conduct demonstration projects.
(e) Funding. --
(1) Demonstration projects. --
(A) State projects. -- Except as provided in
subparagraph (B), the Secretary shall provide for the
transfer from the Federal Hospital Insurance Trust Fund and
the Federal Supplementary Insurance Trust Fund under title
XVIII of the Social Security Act, in such proportions as the
Secretary determines to be appropriate, of such funds as are
necessary for the costs of carrying out the demonstration
projects.
(B) Territory projects. -- In the case of a
demonstration project described in subsection (b)(2)(B),
amounts shall be available only as provided in any Federal
law making appropriations for the territories.
(2) Limitation. -- In conducting demonstration projects, the
Secretary shall ensure that the aggregate payments made by the
Secretary do not exceed the sum of the amount which the
Secretary would have paid under the program for the prevention
and treatment of cancer if the demonstration projects were not
implemented, plus $25,000,000.
SEC. 123. STUDY ON MEDICARE COVERAGE OF ROUTINE THYROID SCREENING.
(a) Study. -- The Secretary of Health and Human Services shall
request the National Academy of Sciences, and as appropriate in
conjunction with the United States Preventive Services Task Force, to
conduct a study on the addition of coverage of routine thyroid
screening using a thyroid stimulating hormone test as a preventive
benefit provided to medicare beneficiaries under title XVIII of the
Social Security Act for some or all medicare beneficiaries. In
conducting the study, the Academy shall consider the short-term and
long-term benefits, and costs to the medicare program, of such
addition.
(b) Report. -- Not later than 2 years after the date of the
enactment of this Act, the Secretary of Health and Human Services
shall submit a report on the findings of the study conducted under
subsection (a) to the Committee on Ways and Means and the Committee
on Commerce of the House of Representatives and the Committee on
Finance of the Senate.
SEC. 124. MEDPAC STUDY ON CONSUMER COALITIONS.
(a) Study. -- The Medicare Payment Advisory Commission shall
conduct a study that examines the use of consumer coalitions in the
marketing of Medicare+Choice plans under the medicare program under
title XVIII of the Social Security Act. The study shall examine --
(1) the potential for increased efficiency in the medicare
program through greater beneficiary knowledge of their health
care options, decreased marketing costs of Medicare+Choice
organizations, and creation of a group market;
(2) the implications of Medicare+Choice plans and medicare
supplemental policies (under section 1882 of the Social Security
Act (42 U.S.C. 1395ss)) offering medicare beneficiaries in the
same geographic location different benefits and premiums based
on their affiliation with a consumer coalition;
(3) how coalitions should be governed, how they should be
accountable to the Secretary of Health and Human Services, and
how potential conflicts of interest in the activities of
consumer coalitions should be avoided; and
(4) how such coalitions should be funded.
(b) Report. -- Not later than 1 year after the date of the
enactment of this Act, the Commission shall submit to Congress a
report on the study conducted under subsection (a). The report shall
include a recommendation on whether and how a demonstration project
might be conducted for the operation of consumer coalitions under the
medicare program.
(c) Consumer Coalition Defined. -- For purposes of this section,
the term "consumer coalition" means a nonprofit, community-based
group of organizations that --
(1) provides information to medicare beneficiaries about
their health care options under the medicare program; and
(2) negotiates benefits and premiums for medicare
beneficiaries who are members or otherwise affiliated with the
group of organizations with Medicare+Choice organizations
offering Medicare+Choice plans, issuers of medicare supplemental
policies, issuers of long-term care coverage, and pharmacy
benefit managers.
SEC. 125. STUDY ON LIMITATION ON STATE PAYMENT FOR MEDICARE COST-
SHARING AFFECTING ACCESS TO SERVICES FOR QUALIFIED MEDICARE
BENEFICIARIES.
(a) In General. -- The Secretary of Health and Human Services
shall conduct a study to determine if access to certain services
(including mental health services) for qualified medicare
beneficiaries has been affected by limitations on a State's payment
for medicare cost-sharing for such beneficiaries under section
1902(n) of the Social Security Act (42 U.S.C. 1396a(n)). As part of
such study, the Secretary shall analyze the effect of such payment
limitation on providers who serve a disproportionate share of such
beneficiaries.
(b) Report. -- Not later than 1 year after the date of the
enactment of this Act, the Secretary shall submit to Congress a
report on the study under subsection (a). The report shall include
recommendations regarding any changes that should be made to the
State payment limits under section 1902(n) for qualified medicare
beneficiaries to ensure appropriate access to services.
SEC. 126. INSTITUTE OF MEDICINE STUDY ON WAIVER OF 24-MONTH WAITING
PERIOD FOR MEDICARE DISABILITY ELIGIBILITY FOR AMYOTROPHIC
LATERAL SCLEROSIS (ALS) AND OTHER DEVASTATING DISEASES.
(a) Study. -- The Secretary of Health and Human Services shall
enter into a contract with the Institute of Medicine to conduct a
study that examines the appropriateness of waiving the 24-month
waiting period for eligibility for benefits under the medicare
program under title XVIII of the Social Security Act applicable under
section 226(b) of such Act (42 U.S.C. 426(b)) for individuals with a
devastating disease. For purposes of this section, the term
"devastating disease" means amyotrophic lateral sclerosis (ALS) and
includes any other disease that is as rapidly debilitating as ALS.
(b) Report. -- The contract shall provide for the submission to
Congress and the Secretary of a report on the study conducted under
subsection (a) by not later than 18 months after the date of the
enactment of this Act.
SEC. 127. STUDIES ON PREVENTIVE INTERVENTIONS IN PRIMARY CARE FOR
OLDER AMERICANS.
(a) Studies. -- The Secretary of Health and Human Services,
acting through the United States Preventive Services Task Force,
shall conduct 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.
(b) Mission Statement. -- The mission statement of the United
States Preventive Services Task Force is amended to include the
evaluation of services that are of particular relevance to older
Americans.
(c) Report. -- Not later than 1 year after the date of the
enactment of this Act, and annually thereafter, the Secretary of
Health and Human Services shall submit to Congress a report on the
conclusions of the studies conducted under subsection (a), together
with recommendations for such legislation and administrative actions
as the Secretary considers appropriate.
SEC. 128. MEDPAC STUDY AND REPORT ON MEDICARE COVERAGE OF CARDIAC AND
PULMONARY REHABILITATION THERAPY SERVICES.
(a) Study. --
(1) In general. -- The Medicare Payment Advisory Commission
shall conduct a study on coverage of cardiac and pulmonary
rehabilitation therapy services under the medicare program under
title XVIII of the Social Security Act.
(2) Focus. -- In conducting the study under paragraph (1),
the Commission shall focus on the appropriate --
(A) qualifying diagnoses required for coverage of
cardiac and pulmonary rehabilitation therapy services;
(B) level of physician direct involvement and
supervision in furnishing such services; and
(C) level of reimbursement for such services.
(b) Report. -- Not later than 18 months after the date of the
enactment of this Act, the Commission shall submit to Congress a
report on the study conducted under subsection (a) together with such
recommendations for legislation and administrative action as the
Commission determines appropriate.
TITLE II -- RURAL HEALTH CARE IMPROVEMENTS
Subtitle A -- Critical Access Hospital Provisions
SEC. 201. CLARIFICATION OF NO BENEFICIARY COST-SHARING FOR CLINICAL
DIAGNOSTIC LABORATORY TESTS FURNISHED BY CRITICAL ACCESS
HOSPITALS.
(a) Payment Clarification. -- Section 1834(g) (42 U.S.C.
1395m(g)) is amended by adding at the end the following new
paragraph:
"(4) No beneficiary cost-sharing for clinical diagnostic
laboratory services. -- No coinsurance, deductible, copayment,
or other cost-sharing otherwise applicable under this part shall
apply with respect to clinical diagnostic laboratory services
furnished as an outpatient critical access hospital service.
Nothing in this title shall be construed as providing for
payment for clinical diagnostic laboratory services furnished as
part of outpatient critical access hospital services, other than
on the basis described in this subsection.".
(b) Technical and Conforming Amendments. --
(1) Paragraphs (1)(D)(i) and (2)(D)(i) of section 1833(a)
(42 U.S.C. 1395l(a)) are each amended by striking "or which are
furnished on an outpatient basis by a critical access hospital".
(2) Section 403(d)(2) of BBRA (113 Stat. 1501A 371) is
amended by striking "The amendment made by subsection (a) shall
apply" and inserting "Paragraphs (1) through (3) of section
1834(g) of the Social Security Act (as amended by paragraph (1))
apply".
(c) Effective Dates. -- The amendment made --
(1) by subsection (a) applies to services furnished on or
after the date of the enactment of BBRA;
(2) by subsection (b)(1) applies as if included in the
enactment of section 403(e)(1) of BBRA (113 Stat. 1501A 371);
and
(3) by subsection (b)(2) applies as if included in the
enactment of section 403(d)(2) of BBRA (113 Stat. 1501A 371).
SEC. 202. ASSISTANCE WITH FEE SCHEDULE PAYMENT FOR PROFESSIONAL
SERVICES UNDER ALL-INCLUSIVE RATE.
(a) In General. -- Section 1834(g)(2)(B) (42 U.S.C.
1395m(g)(2)(B)) is amended by inserting "115 percent of" before "such
amounts".
(b) Effective Date. -- The amendment made by subsection (a)
applies with respect to items and services furnished on or after
April 1, 2001.
SEC. 203. EXEMPTION OF CRITICAL ACCESS HOSPITAL SWING BEDS FROM SNF
PPS.
(a) In General. -- Section 1888(e)(7) (42 U.S.C. 1395yy(e)(7))
is amended --
(1) in the heading, by striking " Transition for" and
inserting " Treatment of";
(2) in subparagraph (A), by striking " In general. -- The"
and inserting " Transition. -- Subject to subparagraph (C),
the";
(3) in subparagraph (A), by inserting "(other than critical
access hospitals)" after "facilities described in subparagraph
(B)";
(4) in subparagraph (B), by striking ", for which payment"
and all that follows before the period; and
(5) by adding at the end the following new subparagraph:
"(C) Exemption from pps of swing-bed services furnished
in critical access hospitals. -- The prospective payment
system established under this subsection shall not apply to
services furnished by a critical access hospital pursuant to
an agreement under section 1883.".
(b) Payment on a Reasonable Cost Basis for Swing Bed Services
Furnished by Critical Access Hospitals. -- Section 1883(a) (42 U.S.C.
1395tt(a)) is amended --
(1) in paragraph (2)(A), by inserting "(other than a
critical access hospital)" after "any hospital"; and
(2) by adding at the end the following new paragraph:
"(3) Notwithstanding any other provision of this title, a
critical access hospital shall be paid for covered skilled
nursing facility services furnished under an agreement entered
into under this section on the basis of the reasonable costs of
such services (as determined under section 1861(v)).".
(c) Effective Date. -- The amendments made by this section shall
apply to cost reporting periods beginning on or after the date of the
enactment of this Act.
SEC. 204. PAYMENT IN CRITICAL ACCESS HOSPITALS FOR EMERGENCY ROOM ON-
CALL PHYSICIANS.
(a) In General. -- Section 1834(g) (42 U.S.C. 1395m(g)), as
amended by section 201(a), is further amended by adding at the end
the following new paragraph:
"(5) Coverage of costs for emergency room on-call
physicians. -- In determining the reasonable costs of outpatient
critical access hospital services under paragraphs (1) and
(2)(A), the Secretary shall recognize as allowable costs,
amounts (as defined by the Secretary) for reasonable
compensation and related costs for emergency room physicians who
are on-call (as defined by the Secretary) but who are not
present on the premises of the critical access hospital
involved, and are not otherwise furnishing physicians' services
and are not on-call at any other provider or facility.".
(b) Effective Date. -- The amendment made by subsection (a)
applies to cost reporting periods beginning on or after October 1,
2001.
SEC. 205. TREATMENT OF AMBULANCE SERVICES FURNISHED BY CERTAIN
CRITICAL ACCESS HOSPITALS.
(a) In General. -- Section 1834(l) (42 U.S.C. 1395m(l)) is
amended by adding at the end the following new paragraph:
"(8) Services furnished by critical access hospitals. --
Notwithstanding any other provision of this subsection, the
Secretary shall pay the reasonable costs incurred in furnishing
ambulance services if such services are furnished --
"(A) by a critical access hospital (as defined in
section 1861(mm)(1)), or
"(B) by an entity that is owned and operated by a
critical access hospital, but only if the critical access
hospital or entity is the only provider or supplier of
ambulance services that is located within a 35-mile drive of
such critical access hospital.".
(b) Conforming Amendment. -- Section 1833(a)(1)(R) (42 U.S.C.
1395l(a)(1)(R)) is amended --
(1) by striking "ambulance service," and inserting
"ambulance services, (i)"; and
(2) by inserting before the comma at the end the following:
"and (ii) with respect to ambulance services described in
section 1834(l)(8), the amounts paid shall be the amounts
determined under section 1834(g) for outpatient critical access
hospital services".
(c) Effective Date. -- The amendments made by this section apply
to services furnished on or after the date of the enactment of this
Act.
SEC. 206. GAO STUDY ON CERTAIN ELIGIBILITY REQUIREMENTS FOR CRITICAL
ACCESS HOSPITALS.
(a) Study. -- The Comptroller General of the United States shall
conduct a study on the eligibility requirements for critical access
hospitals under section 1820(c) of the Social Security Act (42 U.S.C.
1395i 4(c)) with respect to limitations on average length of stay and
number of beds in such a hospital, including an analysis of --
(1) the feasibility of having a distinct part unit as part
of a critical access hospital for purposes of the medicare
program under title XVIII of such Act, and
(2) the effect of seasonal variations in patient admissions
on critical access hospital eligibility requirements with
respect to limitations on average annual length of stay and
number of beds.
(b) Report. -- Not later than 1 year after the date of the
enactment of this Act, the Comptroller General shall submit to
Congress a report on the study conducted under subsection (a)
together with recommendations regarding --
(1) whether distinct part units should be permitted as part
of a critical access hospital under the medicare program;
(2) if so permitted, the payment methodologies that should
apply with respect to services provided by such units;
(3) whether, and to what extent, such units should be
included in or excluded from the bed limits applicable to
critical access hospitals under the medicare program; and
(4) any adjustments to such eligibility requirements to
account for seasonal variations in patient admissions.
Subtitle B -- Other Rural Hospitals Provisions
SEC. 211. EQUITABLE TREATMENT FOR RURAL DISPROPORTIONATE SHARE
HOSPITALS.
(a) Application of Uniform Threshold. -- Section
1886(d)(5)(F)(v) (42 U.S.C. 1395ww(d)(5)(F)(v)) is amended --
(1) in subclause (II), by inserting "(or 15 percent, for
discharges occurring on or after April 1, 2001)" after "30
percent";
(2) in subclause (III), by inserting "(or 15 percent, for
discharges occurring on or after April 1, 2001)" after "40
percent"; and
(3) in subclause (IV), by inserting "(or 15 percent, for
discharges occurring on or after April 1, 2001)" after "45
percent".
(b) Adjustment of Payment Formulas. --
(1) Sole community hospitals. -- Section 1886(d)(5)(F) (42
U.S.C. 1395ww(d)(5)(F)) is amended --
(A) in clause (iv)(VI), by inserting after "10 percent"
the following: "or, for discharges occurring on or after
April 1, 2001, is equal to the percent determined in
accordance with clause (x)"; and
(B) by adding at the end the following new clause:
"(x) For purposes of clause (iv)(VI) (relating to
sole community hospitals), in the case of a hospital for
a cost reporting period with a disproportionate patient
percentage (as defined in clause (vi)) that --
"(I) is less than 17.3, the disproportionate
share adjustment percentage is determined in
accordance with the following formula: (P 15)(.65) +
2.5;
"(II) is equal to or exceeds 17.3, but is less
than 30.0, such adjustment percentage is equal to 4
percent; or
"(III) is equal to or exceeds 40, such
adjustment percentage is equal to 5 percent, where
'P' is the hospital's disproportionate patient
percentage (as defined in clause (vi)).".
(2) Rural referral centers. -- Such section is further
amended --
(A) in clause (iv)(V), by inserting after "clause
(viii)" the following: "or, for discharges occurring on or
after April 1, 2001, is equal to the percent determined in
accordance with clause (xi)"; and
(B) by adding at the end the following new clause:
"(xi) For purposes of clause (iv)(V) (relating to
rural referral centers), in the case of a hospital for a
cost reporting period with a disproportionate patient
percentage (as defined in clause (vi)) that --
"(I) is less than 17.3, the disproportionate
share adjustment percentage is determined in
accordance with the following formula: (P 15)(.65) +
2.5;
"(II) is equal to or exceeds 17.3, but is less
than 30.0, such adjustment percentage is equal to 4
percent; or
"(III) is equal to or exceeds 30, such
adjustment percentage is determined in accordance
with the following formula: (P 30)(.6) + 4, where
'P' is the hospital's disproportionate patient
percentage (as defined in clause (vi)).".
(3) Small rural hospitals generally. -- Such section is
further amended --
(A) in clause (iv)(III), by inserting after "4 percent"
the following: "or, for discharges occurring on or after
April 1, 2001, is equal to the percent determined in
accordance with clause (xii)"; and
(B) by adding at the end the following new clause:
"(xii) For purposes of clause (iv)(III) (relating to
small rural hospitals generally), in the case of a
hospital for a cost reporting period with a
disproportionate patient percentage (as defined in
clause (vi)) that --
"(I) is less than 17.3, the disproportionate
share adjustment percentage is determined in
accordance with the following formula: (P 15)(.65) +
2.5;
"(II) is equal to or exceeds 17.3, such
adjustment percentage is equal to 4 percent, where
'P' is the hospital's disproportionate patient
percentage (as defined in clause (vi)).".
(4) Hospitals that are both sole community hospitals and
rural referral centers. -- Such section is further amended, in
clause (iv)(IV), by inserting after "clause (viii)" the
following: "or, for discharges occurring on or after April 1,
2001, the greater of the percentages determined under clause (x)
or (xi)".
(5) Urban hospitals with less than 100 beds. -- Such section
is further amended --
(A) in clause (iv)(II), by inserting after "5 percent"
the following: "or, for discharges occurring on or after
April 1, 2001, is equal to the percent determined in
accordance with clause (xiii)"; and
(B) by adding at the end the following new clause:
"(xiii) For purposes of clause (iv)(II) (relating to
urban hospitals with less than 100 beds), in the case of
a hospital for a cost reporting period with a
disproportionate patient percentage (as defined in
clause (vi)) that --
"(I) is less than 17.3, the disproportionate
share adjustment percentage is determined in
accordance with the following formula: (P 15)(.65) +
2.5;
"(II) is equal to or exceeds 17.3, but is less
than 40.0, such adjustment percentage is equal to 4
percent; or
"(III) is equal to or exceeds 40, such
adjustment percentage is equal to 5 percent, where
'P' is the hospital's disproportionate patient
percentage (as defined in clause (vi)).".
SEC. 212. OPTION TO BASE ELIGIBILITY FOR MEDICARE DEPENDENT, SMALL
RURAL HOSPITAL PROGRAM ON DISCHARGES DURING 2 OF THE 3 MOST
RECENTLY AUDITED COST REPORTING PERIODS.
(a) In General. -- Section 1886(d)(5)(G)(iv)(IV) (42 U.S.C.
1395ww(d)(5)(G)(iv)(IV)) is amended by inserting ", or 2 of the 3
most recently audited cost reporting periods for which the Secretary
has a settled cost report," after "1987".
(b) Effective Date. -- The amendment made by this section shall
apply with respect to cost reporting periods beginning on or after
April 1, 2001.
SEC. 213. EXTENSION OF OPTION TO USE REBASED TARGET AMOUNTS TO
ALL SOLE COMMUNITY HOSPITALS.
(a) In General. -- Section 1886(b)(3)(I)(i) (42 U.S.C.
1395ww(b)(3)(I)(i)) is amended --
(1) in the matter preceding subclause (I), by striking "that
for its cost reporting period beginning during 1999" and all
that follows through "for such target amount" and inserting
"there shall be substituted for the amount otherwise determined
under subsection (d)(5)(D)(i), if such substitution results in a
greater amount of payment under this section for the hospital";
(2) in subclause (I), by striking "target amount otherwise
applicable" and all that follows through "target amount')" and
inserting "the amount otherwise applicable to the hospital under
subsection (d)(5)(D)(i) (referred to in this clause as the
'subsection (d)(5)(D)(i) amount')"; and
(3) in each of subclauses (II) and (III), by striking
"subparagraph (C) target amount" and inserting "subsection
(d)(5)(D)(i) amount".
(b) Effective Date. -- The amendments made by this section shall
take effect as if included in the enactment of section 405 of BBRA
(113 Stat. 1501A 372).
SEC. 214. MEDPAC ANALYSIS OF IMPACT OF VOLUME ON PER UNIT COST OF
RURAL HOSPITALS WITH PSYCHIATRIC UNITS.
The Medicare Payment Advisory Commission, in its study conducted
pursuant to subsection (a) of section 411 of BBRA (113 Stat. 1501A
377), shall 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 under subsection (b) of such section a
recommendation on whether special treatment for such hospitals
may be warranted.
Subtitle C -- Other Rural Provisions
SEC. 221. ASSISTANCE FOR PROVIDERS OF AMBULANCE SERVICES IN RURAL
AREAS.
(a) Transitional Assistance in Certain Mileage Rates. -- Section
1834(l) (42 U.S.C. 1395m(l)) is amended by adding at the end the
following new paragraph:
"(8) Transitional assistance for rural providers. -- In the
case of ground ambulance services furnished on or after the date
on which the Secretary implements the fee schedule under this
subsection and before January 1, 2004, for which the
transportation originates in a rural area (as defined in section
1886(d)(2)(D)) or in a rural census tract of a metropolitan
statistical area (as determined under the most recent
modification of the Goldsmith Modification, originally published
in the Federal Register on February 27, 1992 (57 Fed. Reg.
6725)), the fee schedule established under this subsection shall
provide that, with respect to the payment rate for mileage for a
trip above 17 miles, and up to 50 miles, the rate otherwise
established shall be increased by not less than 1/2 of the
additional payment per mile established for the first 17 miles
of such a trip originating in a rural area.".
(b) GAO Studies on the Costs of Ambulance Services Furnished in
Rural Areas. --
(1) Study. -- The Comptroller General of the United States
shall conduct a study on each of the matters described in
paragraph (2).
(2) Matters described. -- The matters referred to in
paragraph (1) are the following:
(A) The cost of efficiently providing ambulance services
for trips originating in rural areas, with special emphasis
on collection of cost data from rural providers.
(B) 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. Such study shall also include an analysis of the
additional costs of providing ambulance services in areas
designated under the previous sentence.
(3) Report. -- Not later than June 30, 2002, the Comptroller
General shall submit to Congress a report on the results of the
studies conducted under paragraph (1) and shall include
recommendations on steps that should be taken to assure access
to ambulance services in rural areas.
(c) Adjustment in Rural Rates. -- In providing for adjustments
under subparagraph (D) of section 1834(l)(2) of the Social Security
Act (42 U.S.C. 1395m(l)(2)) for years beginning with 2004, the
Secretary of Health and Human Services shall take into consideration
the recommendations contained in the report under subsection (b)(2)
and shall adjust the fee schedule payment rates under such section
for ambulance services provided in low density rural areas based on
the increased cost (if any) of providing such services in such areas.
(d) Effective Date. -- The amendment made by subsection (a)
applies to services furnished on or after the date the Secretary
implements the fee schedule under section 1834(l) of the Social
Security Act (42 U.S.C. 1395m(l)). In applying such amendment to
services furnished on or after such date and before January 1, 2002,
the amount of the rate increase provided under such amendment shall
be equal to $1.25 per mile.
SEC. 222. PAYMENT FOR CERTAIN PHYSICIAN ASSISTANT SERVICES.
(a) Payment for Certain Physician Assistant Services. -- Section
1842(b)(6)(C) (42 U.S.C. 1395u(b)(6)(C)) is amended --
(1) by striking "for such services provided before January
1, 2003,"; and
(2) by striking the semicolon at the end and inserting a
comma.
(b) Effective Date. -- The amendments made by subsection (a)
shall take effect on the date of the enactment of this Act.
SEC. 223. REVISION OF MEDICARE REIMBURSEMENT FOR TELEHEALTH SERVICES.
(a) Time Limit for BBA Provision. -- Section 4206(a) of BBA (42
U.S.C. 1395l note) is amended by striking "Not later than January 1,
1999" and inserting "For services furnished on and after January 1,
1999, and before July 1, 2001".
(b) Expansion of Medicare Payment for Telehealth Services. --
Section 1834 (42 U.S.C. 1395m) is amended by adding at the end the
following new subsection: "(m) Payment for Telehealth Services. --
"(1) In general. -- The Secretary shall pay for telehealth
services that are furnished via a telecommunications system by a
physician (as defined in section 1861(r)) or a practitioner
(described in section 1842(b)(18)(C)) to an eligible telehealth
individual enrolled under this part notwithstanding that the
individual physician or practitioner providing the telehealth
service is not at the same location as the beneficiary. For
purposes of the preceding sentence, in the case of any Federal
telemedicine demonstration program conducted in Alaska or
Hawaii, the term 'telecommunications system' includes store-and-
forward technologies that provide for the asynchronous
transmission of health care information in single or multimedia
formats.
"(2) Payment amount. --
"(A) Distant site. -- The Secretary shall pay to a
physician or practitioner located at a distant site that
furnishes a telehealth service to an eligible telehealth
individual an amount equal to the amount that such physician
or practitioner would have been paid under this title had
such service been furnished without the use of a
telecommunications system.
"(B) Facility fee for originating site. -- With respect
to a telehealth service, subject to section 1833(a)(1)(U),
there shall be paid to the originating site a facility fee
equal to --
"(i) for the period beginning on July 1, 2001, and
ending on December 31, 2001, and for 2002, $20; and
"(ii) for a subsequent year, the facility fee
specified in clause (i) or this clause for the preceding
year increased by the percentage increase in the MEI (as
defined in section 1842(i)(3)) for such subsequent year.
"(C) Telepresenter not required. -- Nothing in this
subsection shall be construed as requiring an eligible
telehealth individual to be presented by a physician or
practitioner at the originating site for the furnishing of a
service via a telecommunications system, unless it is
medically necessary (as determined by the physician or
practitioner at the distant site).
"(3) Limitation on beneficiary charges. --
"(A) Physician and practitioner. -- The provisions of
section 1848(g) and subparagraphs (A) and (B) of section
1842(b)(18) shall apply to a physician or practitioner
receiving payment under this subsection in the same manner
as they apply to physicians or practitioners under such
sections.
"(B) Originating site. -- The provisions of section
1842(b)(18) shall apply to originating sites receiving a
facility fee in the same manner as they apply to
practitioners under such section.
"(4) Definitions. -- For purposes of this subsection:
"(A) Distant site. -- The term 'distant site' means the
site at which the physician or practitioner is located at
the time the service is provided via a telecommunications
system.
"(B) Eligible telehealth individual. -- The term
'eligible telehealth individual' means an individual
enrolled under this part who receives a telehealth service
furnished at an originating site.
"(C) Originating site. --
"(i) In general. -- The term 'originating site'
means only those sites described in clause (ii) at which
the eligible telehealth individual is located at the
time the service is furnished via a telecommunications
system and only if such site is located --
"(I) in an area that is designated as a rural
health professional shortage area under section
332(a)(1)(A) of the Public Health Service Act (42
U.S.C. 254e(a)(1)(A));
"(II) in a county that is not included in a
Metropolitan Statistical Area; or
"(III) from an entity that participates in a
Federal telemedicine demonstration project that has
been approved by (or receives funding from) the
Secretary of Health and Human Services as of
December 31, 2000.
"(ii) Sites described. -- The sites referred to in
clause (i) are the following sites:
"(I) The office of a physician or practitioner.
"(II) A critical access hospital (as defined in
section 1861(mm)(1)).
"(III) A rural health clinic (as defined in
section 1861(aa)(s)).
"(IV) A Federally qualified health center (as
defined in section 1861(aa)(4)).
"(V) A hospital (as defined in section 1861(e)).
"(D) Physician. -- The term "physician" has the meaning
given that term in section 1861(r).
"(E) Practitioner. -- The term 'practitioner' has the
meaning given that term in section 1842(b)(18)(C).
"(F) Telehealth service. --
"(i) In general. -- The term 'telehealth service'
means professional consultations, office visits, and
office psychiatry services (identified as of July 1,
2000, by HCPCS codes 99241 99275, 99201 99215, 90804
90809, and 90862 (and as subsequently modified by the
Secretary)), and any additional service specified by the
Secretary.
"(ii) Yearly update. -- The Secretary shall
establish a process that provides, on an annual basis,
for the addition or deletion of services (and HCPCS
codes), as appropriate, to those specified in clause (i)
for authorized payment under paragraph (1).".
(c) Conforming Amendment. -- Section 1833(a)(1) (42 U.S.C.
1395l(1)), as amended by section 105(c), is further amended --
(1) by striking "and (T)" and inserting "(T)"; and
(2) by inserting before the semicolon at the end the
following: ", and (U) with respect to facility fees described in
section 1834(m)(2)(B), the amounts paid shall be 80 percent of
the lesser of the actual charge or the amounts specified in such
section". (d) Study and Report on Additional Coverage. --
(1) Study. -- The Secretary of Health and Human Services
shall conduct a study to identify --
(A) settings and sites for the provision of telehealth
services that are in addition to those permitted under
section 1834(m) of the Social Security Act, as added by
subsection (b);
(B) practitioners that may be reimbursed under such
section for furnishing telehealth services that are in
addition to the practitioners that may be reimbursed for
such services under such section; and
(C) geographic areas in which telehealth services may be
reimbursed that are in addition to the geographic areas
where such services may be reimbursed under such section.
(2) Report. -- Not later than 2 years after the date of the
enactment of this Act, the Secretary shall submit to Congress a
report on the study conducted under paragraph (1) together with
such recommendations for legislation that the Secretary
determines are appropriate.
(e) Effective Date. -- The amendments made by subsections (b)
and (c) shall be effective for services furnished on or after July 1,
2001.
SEC. 224. EXPANDING ACCESS TO RURAL HEALTH CLINICS.
(a) In General. -- The matter in section 1833(f) (42 U.S.C.
1395l(f)) preceding paragraph (1) is amended by striking "rural
hospitals" and inserting "hospitals".
(b) Effective Date. -- The amendment made by subsection (a)
shall apply to services furnished on or after July 1, 2001.
SEC. 225. MEDPAC STUDY ON LOW-VOLUME, ISOLATED RURAL HEALTH CARE
PROVIDERS.
(a) Study. -- The Medicare Payment Advisory Commission shall
conduct a study on the effect of low patient and procedure volume on
the financial status of low-volume, isolated rural health care
providers participating in the medicare program under title XVIII of
the Social Security Act.
(b) Report. -- Not later than 18 months after the date of the
enactment of this Act, the Commission shall submit to Congress a
report on the study conducted under subsection (a) indicating --
(1) whether low-volume, isolated rural health care providers
are having, or may have, significantly decreased medicare
margins or other financial difficulties resulting from any of
the payment methodologies described in subsection (c);
(2) whether the status as a low-volume, isolated rural
health care provider should be designated under the medicare
program and any criteria that should be used to qualify for such
a status; and
(3) any changes in the payment methodologies described in
subsection (c) that are necessary to provide appropriate
reimbursement under the medicare program to low-volume, isolated
rural health care providers (as designated pursuant to paragraph
(2)).
(c) Payment Methodologies Described. -- The payment
methodologies described in this subsection are the following:
(1) The prospective payment system for hospital outpatient
department services under section 1833(t) of the Social Security
Act (42 U.S.C. 1395l(t)).
(2) The fee schedule for ambulance services under section
1834(l) of such Act (42 U.S.C. 1395m(l)).
(3) The prospective payment system for inpatient hospital
services under section 1886 of such Act (42 U.S.C. 1395ww).
(4) The prospective payment system for routine service costs
of skilled nursing facilities under section 1888(e) of such Act
(42 U.S.C. 1395yy(e)).
(5) The prospective payment system for home health services
under section 1895 of such Act (42 U.S.C. 1395fff).
TITLE III -- PROVISIONS RELATING TO PART A
Subtitle A -- Inpatient Hospital Services
SEC. 301. REVISION OF ACUTE CARE HOSPITAL PAYMENT UPDATE FOR 2001.
(a) In General. -- Section 1886(b)(3)(B)(i) (42 U.S.C.
1395ww(b)(3)(B)(i)) is amended --
(1) in subclause (XVI), by striking "minus 1.1 percentage
points for hospitals (other than sole community hospitals) in
all areas, and the market basket percentage increase for sole
community hospitals," and inserting "for hospitals in all
areas,";
(2) in subclause (XVII) --
(A) by striking "minus 1.1 percentage points" and
inserting "minus 0.55 percentage points; and
(B) by striking "and" at the end;
(3) by redesignating subclause (XVIII) as subclause (XIX);
(4) in subclause (XIX), as so redesignated, by striking
"fiscal year 2003" and inserting "fiscal year 2004"; and
(5) by inserting after subclause (XVII) the following new
subclause:
"(XVIII) for fiscal year 2003, the market basket
percentage increase minus 0.55 percentage points for
hospitals in all areas, and".
(b) Special Rule for Payment for Fiscal Year 2001. --
Notwithstanding the amendment made by subsection (a), for purposes of
making payments for fiscal year 2001 for inpatient hospital services
furnished by subsection (d) hospitals (as defined in section
1886(d)(1)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(1)(B)),
the "applicable percentage increase" referred to in section
1886(b)(3)(B)(i) of such Act (42 U.S.C. 1395ww(b)(3)(B)(i)) --
(1) for discharges occurring on or after October 1, 2000,
and before April 1, 2001, shall be determined in accordance with
subclause (XVI) of such section as in effect on the day before
the date of the enactment of this Act; and
(2) for discharges occurring on or after April 1, 2001, and
before October 1, 2001, shall be equal to --
(A) the market basket percentage increase plus 1.1
percentage points for hospitals (other than sole community
hospitals) in all areas; and
(B) the market basket percentage increase for sole
community hospitals.
(c) Consideration of Price of Blood and Blood Products in Market
Basket Index. -- The Secretary of Health and Human Services shall,
when next (after the date of the enactment of this Act) rebasing and
revising the hospital market basket index (as defined in section
1886(b)(3)(B)(iii) of the Social Security Act (42 U.S.C.
1395ww(b)(3)(B)(iii))), consider the prices of blood and blood
products purchased by hospitals and determine whether those prices
are adequately reflected in such index.
(d) MedPAC Study and Report Regarding Certain Hospital Costs. --
(1) Study. -- The Medicare Payment Advisory Commission shall
conduct a study on --
(A) any increased costs incurred by subsection (d)
hospitals (as defined in paragraph (1)(B) of section 1886(d)
of the Social Security Act (42 U.S.C. 1395ww(d))) in
providing inpatient hospital services to medicare
beneficiaries under title XVIII of such Act during the
period beginning on October 1, 1983, and ending on September
30, 1999, that were attributable to --
(i) complying with new blood safety measure
requirements; and
(ii) providing such services using new technologies;
(B) the extent to which the prospective payment system
for such services under such section provides adequate and
timely recognition of such increased costs;
(C) the prospects for (and to the extent practicable,
the magnitude of) cost increases that hospitals will incur
in providing such services that are attributable to
complying with new blood safety measure requirements and
providing such services using new technologies during the 10
years after the date of the enactment of this Act; and
(D) the feasibility and advisability of establishing
mechanisms under such payment system to provide for more
timely and accurate recognition of such cost increases in
the future.
(2) Consultation. -- In conducting the study under this
subsection, the Commission shall consult with representatives of
the blood community, including --
(A) hospitals;
(B) organizations involved in the collection,
processing, and delivery of blood; and
(C) organizations involved in the development of new
blood safety technologies.
(3) Report. -- Not later than 1 year after the date of the
enactment of this Act, the Commission shall submit to Congress a
report on the study conducted under paragraph (1) together with
such recommendations for legislation and administrative action
as the Commission determines appropriate.
(e) Adjustment for Inpatient Case Mix Changes. --
(1) In general. -- Section 1886(d)(3)(A) (42 U.S.C.
1395ww(d)(3)(A)) is amended by adding at the end the following
new clause:
(vi) Insofar as the Secretary determines that the
adjustments under paragraph (4)(C)(i) for a previous
fiscal year (or estimates that such adjustments for a
future fiscal year) did (or are likely to) result in a
change in aggregate payments under this subsection
during the fiscal year that are a result of changes in
the coding or classification of discharges that do not
reflect real changes in case mix, the Secretary may
adjust the average standardized amounts computed under
this paragraph for subsequent fiscal years so as to
eliminate the effect of such coding or classification
changes.".
(2) Effective date. -- The amendment made by paragraph (1)
applies to discharges occurring on or after October 1, 2001.
SEC. 302. ADDITIONAL MODIFICATION IN TRANSITION FOR INDIRECT MEDICAL
EDUCATION (IME) PERCENTAGE ADJUSTMENT.
(a) In General. -- Section 1886(d)(5)(B)(ii) (42 U.S.C.
1395ww(d)(5)(B)(ii)) is amended --
(1) in subclause (V) by striking "and" at the end;
(2) by redesignating subclause (VI) as subclause (VII);
(3) in subclause (VII) as so redesignated, by striking
"2001" and inserting "2002"; and
(4) by inserting after subclause (V) the following new
subclause:
"(VI) during fiscal year 2002, 'c' is equal to
1.57; and".
(b) Special Rule for Payment for Fiscal Year 2001. --
Notwithstanding paragraph (5)(B)(ii)(V) of section 1886(d) of the
Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(ii)(V)), for purposes
of making payments for subsection (d) hospitals (as defined in
paragraph (1)(B) of such section) with indirect costs of medical
education, the indirect teaching adjustment factor referred to in
paragraph (5)(B)(ii) of such section shall be determined, for
discharges occurring on or after April 1, 2001, and before October 1,
2001, as if "c" in paragraph (5)(B)(ii)(V) of such section equalled
1.66 rather than 1.54.
(c) Conforming Amendment Relating to Determination of
Standardized Amount. -- Section 1886(d)(2)(C)(i) (42 U.S.C.
1395ww(d)(2)(C)(i)) is amended by inserting "or of section 302 of the
Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act
of 2000" after "Balanced Budget Refinement Act of 1999".
(d) Clerical Amendments. -- Section 1886(d)(5)(B) (42 U.S.C.
1395ww(d)(5)(B)), as amended by subsection (a), is further amended by
moving the indentation of each of the following 2 ems to the left:
(1) Clauses (ii), (v), and (vi).
(2) Subclauses (I), (II), (III), (IV), (V), and (VII) of
clause (ii).
(3) Subclauses (I) and (II) of clause (vi) and the flush
sentence at the end of such clause.
SEC. 303. DECREASE IN REDUCTIONS FOR DISPROPORTIONATE SHARE HOSPITAL
(DSH) PAYMENTS.
(a) In General. -- Section 1886(d)(5)(F)(ix) (42 U.S.C.
1395ww(d)(5)(F)(ix)) is amended --
(1) in subclause (III), by striking "each of" and by
inserting "and 2 percent, respectively" after "3 percent"; and
(2) in subclause (IV), by striking "4 percent" and inserting
"3 percent".
(b) Special Rule for Payment for Fiscal Year 2001. --
Notwithstanding the amendment made by subsection (a)(1), for purposes
of making disproportionate share payments for subsection (d)
hospitals (as defined in section 1886(d)(1)(B) of the Social Security
Act (42 U.S.C. 1395ww(d)(1)(B))) for fiscal year 2001, the additional
payment amount otherwise determined under clause (ii) of section
1886(d)(5)(F) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(F))
--
(1) for discharges occurring on or after October 1, 2000,
and before April 1, 2001, shall be adjusted as provided by
clause (ix)(III) of such section as in effect on the day before
the date of the enactment of this Act; and
(2) for discharges occurring on or after April 1, 2001, and
before October 1, 2001, shall, instead of being reduced by 3
percent as provided by clause (ix)(III) of such section as in
effect after the date of the enactment of this Act, be reduced
by 1 percent.
(c) Conforming Amendments Relating to Determination of
Standardized Amount. -- Section 1886(d)(2)(C)(iv) (42 U.S.C.
1395ww(d)(2)(C)(iv)), is amended --
(1) by striking "1989 or" and inserting "1989,"; and
(2) by inserting ", or the enactment of section 303 of the
Medicare, Medicaid, and SCHIP Benefits Improvement and
Protection Act of 2000" after "Omnibus Budget Reconciliation Act
of 1990". (d) Technical Amendment. --
(1) In general. -- Section 1886(d)(5)(F)(i) (42 U.S.C.
1395ww(d)(5)(F)(i)) is amended by striking "and before October
1, 1997,".
(2) Effective date. -- The amendment made by paragraph (1)
is effective as if included in the enactment of BBA.
(e) Reference to Changes in DSH for Rural Hospitals. -- For
additional changes in the DSH program for rural hospitals, see
section 211.
SEC. 304. WAGE INDEX IMPROVEMENTS.
(a) Duration of Wage Index Reclassification; Use of 3 -Year Wage
Data. -- Section 1886(d)(10)(D) (42 U.S.C. 1395ww(d)(10)(D)) is
amended by adding at the end the following new clauses:
"(v) Any decision of the Board to reclassify a
subsection (d) hospital for purposes of the adjustment
factor described in subparagraph (C)(i)(II) for fiscal
year 2001 or any fiscal year thereafter shall be
effective for a period of 3 fiscal years, except that
the Secretary shall establish procedures under which a
subsection (d) hospital may elect to terminate such
reclassification before the end of such period.
"(vi) Such guidelines shall provide that, in making
decisions on applications for reclassification for the
purposes described in clause (v) for fiscal year 2003
and any succeeding fiscal year, the Board shall base any
comparison of the average hourly wage for the hospital
with the average hourly wage for hospitals in an area on
--
"(I) an average of the average hourly wage
amount for the hospital from the most recently
published hospital wage survey data of the Secretary
(as of the date on which the hospital applies for
reclassification) and such amount from each of the
two immediately preceding surveys; and
"(II) an average of the average hourly wage
amount for hospitals in such area from the most
recently published hospital wage survey data of the
Secretary (as of the date on which the hospital
applies for reclassification) and such amount from
each of the two immediately preceding surveys.".
(b) Process To Permit Statewide Wage Index Calculation and
Application. --
(1) In general. -- The Secretary of Health and Human
Services shall establish a process (based on the voluntary
process utilized by the Secretary of Health and Human Services
under section 1848 of the Social Security Act (42 U.S.C. 1395w
4) for purposes of computing and applying a statewide geographic
wage index) 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 under section 1886(d)(3)(E) of such Act (42
U.S.C. 1395ww(d)(3)(E)). Such process shall be established by
October 1, 2001, for reclassifications beginning in fiscal year
2003.
(2) Prohibition on individual hospital reclassification. --
Notwithstanding any other provision of law, if the Secretary
applies a statewide geographic wage index under paragraph (1)
with respect to a State, any application submitted by a hospital
in that State under section 1886(d)(10) of the Social Security
Act (42 U.S.C. 1395ww(d)(10)) for geographic reclassification
shall not be considered.
(c) Collection of Information on Occupational Mix. --
(1) In general. -- The Secretary of Health and Human
Services shall provide for the collection of data every 3 years
on occupational mix for employees of each subsection (d)
hospital (as defined in section 1886(d)(1)(D) of the Social
Security Act (42 U.S.C. 1395ww(d)(1)(D))) in the provision of
inpatient hospital services, in order to construct an
occupational mix adjustment in the hospital area wage index
applied under section 1886(d)(3)(E) of such Act (42 U.S.C.
1395ww(d)(3)(E)).
(2) Application. -- The third sentence of section
1886(d)(3)(E) (42 U.S.C. 1395ww(d)(3)(E)) is amended by striking
"To the extent determined feasible by the Secretary, such survey
shall measure" and inserting "Not less often than once every 3
years the Secretary (through such survey or otherwise) shall
measure".
(3) Effective date. -- By not later than September 30, 2003,
for application beginning October 1, 2004, the Secretary shall
first complete --
(A) the collection of data under paragraph (1); and
(B) the measurement under the third sentence of section
1886(d)(3)(E), as amended by paragraph (2).
SEC. 305. PAYMENT FOR INPATIENT SERVICES OF REHABILITATION HOSPITALS.
(a) Assistance With Administrative Costs Associated With
Completion of Patient Assessment. -- Section 1886(j)(3)(B) (42 U.S.C.
1395ww(j)(3)(B)) is amended by striking "98 percent" and inserting
"98 percent for fiscal year 2001 and 100 percent for fiscal year
2002".
(b) Election To Apply Full Prospective Payment Rate Without
Phase-In. --
(1) In general. -- Paragraph (1) of section 1886(j) (42
U.S.C. 1395ww(j)) is amended --
(A) in subparagraph (A), by inserting "other than a
facility making an election under subparagraph (F)" before
"in a cost reporting period";
(B) in subparagraph (B), by inserting "or, in the case
of a facility making an election under subparagraph (F), for
any cost reporting period described in such subparagraph,"
after "2002,"; and
(C) by adding at the end the following new subparagraph:
"(F) Election to apply full prospective payment system.
-- A rehabilitation facility may elect, not later than 30
days before its first cost reporting period for which the
payment methodology under this subsection applies to the
facility, to have payment made to the facility under this
subsection under the provisions of subparagraph (B) (rather
than subparagraph (A)) for each cost reporting period to
which such payment methodology applies.".
(2) Clarification. -- Paragraph (3)(B) of such section is
amended by inserting "but not taking into account any payment
adjustment resulting from an election permitted under paragraph
(1)(F)" after "paragraphs (4) and (6)".
(c) Effective Date. -- The amendments made by this section take
effect as if included in the enactment of BBA.
SEC. 306. PAYMENT FOR INPATIENT SERVICES OF PSYCHIATRIC HOSPITALS.
With respect to hospitals described in clause (i) of section
1886(d)(1)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(1)(B))
and psychiatric units described in the matter following clause (v) of
such section, in making incentive payments to such hospitals under
section 1886(b)(1)(A) of such Act (42 U.S.C. 1395ww(b)(1)(A)) for
cost reporting periods beginning on or after October 1, 2000, and
before October 1, 2001, the Secretary of Health and Human Services,
in clause (ii) of such section, shall substitute "3 percent" for "2
percent".
SEC. 307. PAYMENT FOR INPATIENT SERVICES OF LONG-TERM CARE HOSPITALS.
(a) Increased Target Amounts and Caps for Long-Term Care
Hospitals Before Implementation of the Prospective Payment System. --
(1) In general. -- Section 1886(b)(3) (42 U.S.C.
1395ww(b)(3)) is amended --
(A) in subparagraph (H)(ii)(III), by inserting "subject
to subparagraph (J)," after "2002,"; and
(B) by adding at the end the following new subparagraph:
"(J) For cost reporting periods beginning during fiscal year
2001, for a hospital described in subsection (d)(1)(B)(iv) --
"(i) the limiting or cap amount otherwise determined
under subparagraph (H) shall be increased by 2 percent;
and
"(ii) the target amount otherwise determined under
subparagraph (A) shall be increased by 25 percent
(subject to the limiting or cap amount determined under
subparagraph (H), as increased by clause (i)).".
(2) Application. -- The amendments made by subsection (a)
and by section 122 of BBRA (113 Stat. 1501A 331) shall not be taken
into account in the development and implementation of the prospective
payment system under section 123 of BBRA (113 Stat. 1501A 331).
(b) Implementation of Prospective Payment System for Long-Term
Care Hospitals. --
(1) Modification of requirement. -- In developing the
prospective payment system for payment for inpatient hospital
services provided in long-term care hospitals described in
section 1886(d)(1)(B)(iv) of the Social Security Act (42 U.S.C.
1395ww(d)(1)(B)(iv)) under the medicare program under title
XVIII of such Act required under section 123 of BBRA, the
Secretary of Health and Human Services shall examine the
feasibility and the impact of basing payment under such a system
on the use of existing (or refined) hospital diagnosis-related
groups (DRGs) that have been modified to account for different
resource use of long-term care hospital patients as well as the
use of the most recently available hospital discharge data. The
Secretary shall examine and may provide for appropriate
adjustments to the long-term hospital payment system, including
adjustments to DRG weights, area wage adjustments, geographic
reclassification, outliers, updates, and a disproportionate
share adjustment consistent with section 1886(d)(5)(F) of the
Social Security Act (42 U.S.C. 1395ww(d)(5)(F)).
(2) Default implementation of system based on existing drg
methodology. -- If the Secretary is unable to implement the
prospective payment system under section 123 of the BBRA by
October 1, 2002, the Secretary shall implement a prospective
payment system for such hospitals that bases payment under such
a system using existing hospital diagnosis-related groups
(DRGs), modified where feasible to account for resource use of
long-term care hospital patients using the most recently
available hospital discharge data for such services furnished on
or after that date.
Subtitle B -- Adjustments to PPS Payments for Skilled Nursing
Facilities
SEC. 311. ELIMINATION OF REDUCTION IN SKILLED NURSING FACILITY (SNF)
MARKET BASKET UPDATE IN 2001.
(a) In General. -- Section 1888(e)(4)(E)(ii) (42 U.S.C.
1395yy(e)(4)(E)(ii)) is amended --
(1) by redesignating subclauses (II) and (III) as subclauses
(III) and (IV), respectively;
(2) in subclause (III), as so redesignated --
(A) by striking "each of fiscal years 2001 and 2002" and
inserting "each of fiscal years 2002 and 2003"; and
(B) by striking "minus 1 percentage point" and inserting
"minus 0.5 percentage points"; and
(3) by inserting after subclause (I) the following new
subclause:
"(II) for fiscal year 2001, the rate computed
for the previous fiscal year increased by the
skilled nursing facility market basket percentage
change for the fiscal year;".
(b) Special Rule for Payment for Fiscal Year 2001. --
Notwithstanding the amendments made by subsection (a), for purposes
of making payments for covered skilled nursing facility services
under section 1888(e) of the Social Security Act (42 U.S.C.
1395yy(e)) for fiscal year 2001, the Federal per diem rate referred
to in paragraph (4)(E)(ii) of such section --
(1) for the period beginning on October 1, 2000, and ending
on March 31, 2001, shall be the rate determined in accordance
with the law as in effect on the day before the date of the
enactment of this Act; and
(2) for the period beginning on April 1, 2001, and ending on
September 30, 2001, shall be the rate that would have been
determined under such section if "plus 1 percentage point" had
been substituted for "minus 1 percentage point" under subclause
(II) of such paragraph (as in effect on the day before the date
of the enactment of this Act).
(c) Relation to Temporary Increase in BBRA. -- The increases
provided under section 101 of BBRA (113 Stat. 1501A 325) shall be in
addition to any increase resulting from the amendments made by
subsection (a).
(d) GAO Report on Adequacy of SNF Payment Rates. -- Not later
than July 1, 2002, the Comptroller General of the United States shall
submit to Congress a report on the adequacy of medicare payment rates
to skilled nursing facilities and the extent to which medicare
contributes to the financial viability of such facilities. Such
report shall take into account the role of private payors, medicaid,
and case mix on the financial performance of these facilities, and
shall include an analysis (by specific RUG classification) of the
number and characteristics of such facilities.
(e) HCFA Study of Classification Systems for SNF Residents. --
(1) Study. -- The Secretary of Health and Human Services
shall conduct a study of the different systems for categorizing
patients in medicare skilled nursing facilities in a manner that
accounts for the relative resource utilization of different
patient types.
(2) Report. -- Not later than January 1, 2005, the Secretary
shall submit to Congress a report on the study conducted under
subsection (a). Such report shall include such recommendations
regarding changes in law as may be appropriate.
SEC. 312. INCREASE IN NURSING COMPONENT OF PPS FEDERAL RATE.
(a) In General. -- The Secretary of Health and Human Services
shall increase by 16.66 percent the nursing component of the case-mix
adjusted Federal prospective payment rate specified in Tables 3 and 4
of the final rule published in the Federal Register by the Health
Care Financing Administration on July 31, 2000 (65 Fed. Reg. 46770),
effective for services furnished on or after April 1, 2001, and
before October 1, 2002.
(b) GAO Audit of Nursing Staff Ratios. --
(1) Audit. -- The Comptroller General of the United States
shall conduct an audit of nursing staffing ratios in a
representative sample of medicare skilled nursing facilities.
Such sample shall cover selected States and shall include broad
representation with respect to size, ownership, location, and
medicare volume. Such audit shall include an examination of
payroll records and medicaid cost reports of individual
facilities.
(2) Report. -- Not later than August 1, 2002, the
Comptroller General shall submit to Congress a report on the
audits conducted under paragraph (1). Such report shall include
an assessment of the impact of the increased payments under this
subtitle on increased nursing staff ratios and shall make
recommendations as to whether increased payments under
subsection (a) should be continued.
SEC. 313. APPLICATION OF SNF CONSOLIDATED BILLING REQUIREMENT LIMITED
TO PART A COVERED STAYS.
(a) In General. -- Section 1862(a)(18) (42 U.S.C. 1395y(a)(18))
is amended by striking "or of a part of a facility that includes a
skilled nursing facility (as determined under regulations)," and
inserting "during a period in which the resident is provided covered
post-hospital extended care services (or, for services described in
section 1861(s)(2)(D), which are furnished to such an individual
without regard to such period),".
(b) Conforming Amendments. -- (1) Section 1842(b)(6)(E) (42
U.S.C. 1395u(b)(6)(E)) is amended --
(A) by inserting "by, or under arrangements made by, a
skilled nursing facility" after "furnished";
(B) by striking "or of a part of a facility that
includes a skilled nursing facility (as determined under
regulations)"; and
(C) by striking "(without regard to whether or not the
item or service was furnished by the facility, by others
under arrangement with them made by the facility, under any
other contracting or consulting arrangement, or otherwise)".
(2) Section 1842(t) (42 U.S.C. 1395u(t)) is amended by
striking "by a physician" and "or of a part of a facility that
includes a skilled nursing facility (as determined under
regulations),".
(3) Section 1866(a)(1)(H)(ii)(I) (42 U.S.C.
1395cc(a)(1)(H)(ii)(I)) is amended by inserting after "who is a
resident of the skilled nursing facility" the following: "during
a period in which the resident is provided covered post-hospital
extended care services (or, for services described in section
1861(s)(2)(D), that are furnished to such an individual without
regard to such period)".
(c) Effective Date. -- The amendments made by subsections (a)
and (b) apply to services furnished on or after January 1, 2001.
(d) Oversight. -- The Secretary of Health and Human Services,
through the Office of the Inspector General in the Department of
Health and Human Services or otherwise, shall monitor payments made
under part B of the title XVIII of the Social Security Act for items
and services furnished to residents of skilled nursing facilities
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. 314. ADJUSTMENT OF REHABILITATION RUGS TO CORRECT ANOMALY IN
PAYMENT RATES.
(a) Adjustment for Rehabilitation RUGS. --
(1) In general. -- For purposes of computing payments for
covered skilled nursing facility services under paragraph (1) of
section 1888(e) of the Social Security Act (42 U.S.C. 1395yy(e))
for such services furnished on or after April 1, 2001, and
before the date described in section 101(c)(2) of BBRA (113
Stat. 1501A 324), the Secretary of Health and Human Services
shall increase by 6.7 percent the adjusted Federal per diem rate
otherwise determined under paragraph (4) of such section (but
for this section) for covered skilled nursing facility services
for RUG III rehabilitation groups described in paragraph (2)
furnished to an individual during the period in which such
individual is classified in such a RUG III category.
(2) Rehabilitation groups described. -- The RUG III
rehabilitation groups for which the adjustment described in
paragraph (1) applies are RUC, RUB, RUA, RVC, RVB, RVA, RHC,
RHB, RHA, RMC, RMB, RMA, RLB, and RLA, as specified in Tables 3
and 4 of the final rule published in the Federal Register by the
Health Care Financing Administration on July 31, 2000 (65 Fed.
Reg. 46770). (b) Correction With Respect to Rehabilitation RUGs.
--
(1) In general. -- Section 101(b) of BBRA (113 Stat. 1501A
324) is amended by striking "CA1, RHC, RMC, and RMB" and
inserting "and CA1".
(2) Effective date. -- The amendment made by paragraph (1)
applies to services furnished on or after April 1, 2001.
(c) Review by Office of Inspector General. -- The Inspector
General of the Department of Health and Human Services shall review
the medicare payment structure for services classified within
rehabilitation resource utilization groups (RUGs) (as in effect after
the date of the enactment of the BBRA) to assess whether payment
incentives exist for the delivery of inadequate care. Not later than
October 1, 2001, the Inspector General shall submit to Congress a
report on such review.
SEC. 315. ESTABLISHMENT OF PROCESS FOR GEOGRAPHIC RECLASSIFICATION.
(a) In General. -- The Secretary of Health and Human Services
may establish a procedure for the geographic reclassification of a
skilled nursing facility for purposes of payment for covered skilled
nursing facility services under the prospective payment system
established under section 1888(e) of the Social Security Act (42
U.S.C. 1395yy(e)). Such procedure may be based upon the method for
geographic reclassifications for inpatient hospitals established
under section 1886(d)(10) of the Social Security Act (42 U.S.C.
1395ww(d)(10)).
(b) Requirement for Skilled Nursing Facility Wage Data. -- In no
case may the Secretary implement the procedure under subsection (a)
before such time as the Secretary has collected data necessary to
establish an area wage index for skilled nursing facilities based on
wage data from such facilities.
Subtitle C -- Hospice Care
SEC. 321. FULL MARKET BASKET INCREASE FOR 2001.
(a) In General. -- Section 1814(i)(1)(C)(ii) (42 U.S.C.
1395f(i)(1)(C)(ii)) is amended --
(1) by redesignating subclause (VII) as subclause (IX);
(2) in subclause (VI) --
(A) by striking "through 2002" and inserting "through
2000"; and
(B) by striking "and" at the end; and
(3) by inserting after subclause (VI) the following new
subclauses:
"(VII) for fiscal year 2001, the market basket
percentage increase for the fiscal year;
"(VIII) for fiscal year 2002, the market basket
percentage increase for the fiscal year minus 0.25
percentage points; and".
(b) Transition During Fiscal Year 2001. -- Notwithstanding the
amendments made by subsection (a), for purposes of making payments
for hospice care under section 1814(i) of the Social Security Act (42
U.S.C. 1395f(i)) for fiscal year 2001, the payment rates referred to
in paragraph (1)(C) of such section --
(1) for the period beginning on October 1, 2000, and ending
on March 31, 2001, shall be the rate determined in accordance
with the law as in effect on the day before the date of the
enactment of this Act; and
(2) for the period beginning on April 1, 2001, and ending on
September 30, 2001, shall be the rate that would have been
determined under paragraph (1) if "plus 1.0 percentage points"
were substituted for "minus 1.0 percentage points" under
paragraph (1)(C)(ii)(VI) of such section for fiscal year 2001.
(c) Conforming Amendments to BBRA. --
(1) In general. -- Section 131 of BBRA (113 Stat. 1501A 333)
is repealed.
(2) Effective date. -- The amendment made by paragraph (1)
shall take effect as if included in the enactment of BBRA.
(d) Technical Amendment. -- Section 1814(a)(7)(A)(ii) (42 U.S.C.
1395f(a)(7)(A)(ii)) is amended by striking the period at the end and
inserting a semicolon.
SEC. 322. CLARIFICATION OF PHYSICIAN CERTIFICATION.
(a) Certification Based on Normal Course of Illness. --
(1) In general. -- Section 1814(a) (42 U.S.C. 1395f(a)) is
amended by adding at the end the following new sentence: "The
certification regarding terminal illness of an individual under
paragraph (7) shall be based on the physician's or medical
director's clinical judgment regarding the normal course of the
individual's illness.".
(2) Effective date. -- The amendment made by paragraph (1)
applies to certifications made on or after the date of the
enactment of this Act.
(b) Study and Report on Physician Certification Requirement for
Hospice Benefits. --
(1) Study. -- The Secretary of Health and Human Services
shall conduct a study to examine the appropriateness of the
certification regarding terminal illness of an individual under
section 1814(a)(7) of the Social Security Act (42 U.S.C.
1395f(a)(7)) that is required in order for such individual to
receive hospice benefits under the medicare program under title
XVIII of such Act. In conducting such study, the Secretary shall
take into account the effect of the amendment made by subsection
(a).
(2) Report. -- Not later than 2 years after the date of the
enactment of this Act, the Secretary of Health and Human
Services shall submit to Congress a report on the study
conducted under paragraph (1), together with any recommendations
for legislation that the Secretary deems appropriate.
SEC. 323. MEDPAC REPORT ON ACCESS TO, AND USE OF, HOSPICE BENEFIT.
(a) In General. -- The Medicare Payment Advisory Commission
shall conduct a study to examine the factors affecting the use of
hospice benefits under the medicare program under title XVIII of the
Social Security Act, including a delay in the time (relative to
death) of entry into a hospice program, and differences in such use
between urban and rural hospice programs and based upon the
presenting condition of the patient.
(b) Report. -- Not later than 18 months after the date of the
enactment of this Act, the Commission shall submit to Congress a
report on the study conducted under subsection (a), together with any
recommendations for legislation that the Commission deems
appropriate.
Subtitle D -- Other Provisions
SEC. 331. RELIEF FROM MEDICARE PART A LATE ENROLLMENT PENALTY FOR
GROUP BUY-IN FOR STATE AND LOCAL RETIREES.
(a) In General. -- Section 1818 (42 U.S.C. 1395i 2) is amended -
-
(1) in subsection (c)(6), by inserting before the semicolon
at the end the following: "and shall be subject to reduction in
accordance with subsection (d)(6)"; and
(2) by adding at the end of subsection (d) the following new
paragraph:
"(6)(A) In the case where a State, a political subdivision
of a State, or an agency or instrumentality of a State or
political subdivision thereof determines to pay, for the life of
each individual, the monthly premiums due under paragraph (1) on
behalf of each of the individuals in a qualified State or local
government retiree group who meets the conditions of subsection
(a), the amount of any increase otherwise applicable under
section 1839(b) (as applied and modified by subsection (c)(6) of
this section) with respect to the monthly premium for benefits
under this part for an individual who is a member of such group
shall be reduced by the total amount of taxes paid under section
3101(b) of the Internal Revenue Code of 1986 by such individual
and under section 3111(b) by the employers of such individual on
behalf of such individual with respect to employment (as defined
in section 3121(b) of such Code).
"(B) For purposes of this paragraph, the term 'qualified
State or local government retiree group' means all of the
individuals who retire prior to a specified date that is
before January 1, 2002, from employment in 1 or more
occupations or other broad classes of employees of --
"(i) the State;
"(ii) a political subdivision of the State; or
"(iii) an agency or instrumentality of the State or
political subdivision of the State.".
(b) Effective Date. -- The amendments made by subsection (a)
apply to premiums for months beginning with July 1, 2001.
SEC. 332. POSTING OF INFORMATION ON NURSING FACILITY STAFFING.
(a) Medicare. -- Section 1819(b) (42 U.S.C. 1395i 3(b)) is
amended by adding at the end the following new paragraph:
"(8) Information on nurse staffing. --
"(A) In general. -- A skilled nursing facility shall
post daily for each shift the current number of licensed and
unlicensed nursing staff directly responsible for resident
care in the facility. The information shall be displayed in
a uniform manner (as specified by the Secretary) and in a
clearly visible place.
"(B) Publication of data. -- A skilled nursing facility
shall, upon request, make available to the public the
nursing staff data described in subparagraph (A).".
(b) Medicaid. -- Section 1919(b) (42 U.S.C. 1395r(b)) is amended
by adding at the end the following new paragraph:
"(8) Information on nurse staffing. --
"(A) In general. -- A nursing facility shall post daily
for each shift the current number of licensed and unlicensed
nursing staff directly responsible for resident care in the
facility. The information shall be displayed in a uniform
manner (as specified by the Secretary) and in a clearly
visible place.
"(B) Publication of data. -- A nursing facility shall,
upon request, make available to the public the nursing staff
data described in subparagraph (A).".
TITLE IV -- PROVISIONS RELATING TO PART B
Subtitle A -- Hospital Outpatient Services
SEC. 401. REVISION OF HOSPITAL OUTPATIENT PPS PAYMENT UPDATE.
(a) In General. -- Section 1833(t)(3)(C)(iii) (42 U.S.C.
1395l(t)(3)(C)(iii)) is amended by striking "in each of 2000, 2001,
and 2002" and inserting "in each of 2000 and 2002". (b) Adjustment
for Case Mix Changes. --
(1) In general. -- Section 1833(t)(3)(C) (42 U.S.C.
1395l(t)(3)(C)) is amended --
(A) by redesignating clause (iii) as clause (iv); and
(B) by inserting after clause (ii) the following new
clause:
"(iii) Adjustment for service mix changes. --
Insofar as the Secretary determines that the adjustments
for service mix under paragraph (2) for a previous year
(or estimates that such adjustments for a future year)
did (or are likely to) result in a change in aggregate
payments under this subsection during the year that are
a result of changes in the coding or classification of
covered OPD services that do not reflect real changes in
service mix, the Secretary may adjust the conversion
factor computed under this subparagraph for subsequent
years so as to eliminate the effect of such coding or
classification changes.".
(2) Effective date. -- The amendments made by paragraph (1)
shall take effect as if included in the enactment of BBA.
SEC. 402. CLARIFYING PROCESS AND STANDARDS FOR DETERMINING
ELIGIBILITY OF DEVICES FOR PASS-THROUGH PAYMENTS UNDER HOSPITAL
OUTPATIENT PPS.
(a) In General. -- Section 1833(t)(6) (42 U.S.C. 1395l(t)(6)) is
amended --
(1) by redesignating subparagraphs (C) and (D) as
subparagraphs (D) and (E), respectively; and
(2) by striking subparagraph (B) and inserting the following
new subparagraphs:
"(B) Use of categories in determining eligibility of a
device for pass-through payments. -- The following
provisions apply for purposes of determining whether a
medical device qualifies for additional payments under
clause (ii) or (iv) of subparagraph (A):
"(i) Establishment of initial categories. -- The
Secretary shall initially establish under this clause
categories of medical devices based on type of device by
April 1, 2001. Such categories shall be established in a
manner such that each medical device that meets the
requirements of clause (ii) or (iv) of subparagraph (A)
as of as of January 1, 2001, is included in such a
category and no such device is included in more than one
category. For purposes of the preceding sentence,
whether a medical device meets such requirements as of
such date shall be determined on the basis of the
program memoranda issued before such date or if the
Secretary determines the medical device would have been
included in the program memoranda but for the
requirement of subparagraph (A)(iv)(I). The categories
may be established under this clause by program
memorandum or otherwise, after consultation with groups
representing hospitals, manufacturers of medical
devices, and other affected parties.
"(ii) Establishing criteria for additional
categories. --
"(I) In general. -- The Secretary shall
establish criteria that will be used for creation of
additional categories (other than those established
under clause (i)) through rulemaking (which may
include use of an interim final rule with comment
period).
"(II) Standard. -- Such categories shall be
established under this clause in a manner such that
no medical device is described by more than one
category. Such criteria shall include a test of
whether the average cost of devices that would be
included in a category and are in use at the time
the category is established is not insignificant, as
described in subparagraph (A)(iv)(II).
"(III) Deadline. -- Criteria shall first be
established under this clause by July 1, 2001. The
Secretary may establish in compelling circumstances
categories under this clause before the date such
criteria are established.
"(IV) Adding categories. -- The Secretary shall
promptly establish a new category of medical devices
under this clause for any medical device that meets
the requirements of subparagraph (A)(iv) and for
which none of the categories in effect (or that were
previously in effect) is appropriate.
"(iii) Period for which category is in effect. -- A
category of medical devices established under clause (i)
or clause (ii) shall be in effect for a period of at
least 2 years, but not more than 3 years, that begins --
"(I) in the case of a category established under
clause (i), on the first date on which payment was
made under this paragraph for any device described
by such category (including payments made during the
period before April 1, 2001); and
"(II) in the case of any other category, on the
first date on which payment is made under this
paragraph for any medical device that is described
by such category.
"(iv) Requirements treated as met. -- A medical
device shall be treated as meeting the requirements of
subparagraph (A)(iv) if --
"(I) the device is described by a category
established and in effect under clause (i); or
"(II) the device is described by a category
established and in effect under clause (ii) and an
application under section 515 of the Federal Food,
Drug, and Cosmetic Act has been approved with
respect to the device, or the device has been
cleared for market under section 510(k) of such Act,
or the device is exempt from the requirements of
section 510(k) of such Act pursuant to subsection
(l) or (m) of section 510 of such Act or section
520(g) of such Act. Nothing in this clause shall be
construed as requiring an application or prior
approval (other than that described in subclause
(II)) in order for a covered device to qualify for
payment under this paragraph.
"(C) Limited period of payment. --
"(i) Drugs and biologicals. -- The payment under
this paragraph with respect to a drug or biological
shall only apply during a period of at least 2 years,
but not more than 3 years, that begins --
"(I) on the first date this subsection is
implemented in the case of a drug or biological
described in clause (i), (ii), or (iii) of
subparagraph (A) and in the case of a drug or
biological described in subparagraph (A)(iv) and for
which payment under this part is made as an
outpatient hospital service before such first date;
or
"(II) in the case of a drug or biological
described in subparagraph (A)(iv) not described in
subclause (I), on the first date on which payment is
made under this part for the drug or biological as
an outpatient hospital service.
"(ii) Medical devices. -- Payment shall be made
under this paragraph with respect to a medical device
only if such device --
"(I) is described by a category of medical
devices established and in effect under subparagraph
(B); and
"(II) is provided as part of a service (or group
of services) paid for under this subsection and
provided during the period for which such category
is in effect under such subparagraph.".
(b) Conforming Amendments. -- Section 1833(t) (42 U.S.C.
1395l(t)) is further amended --
(1) in paragraph (6)(A)(iv)(II), by striking "the cost of
the device, drug, or biological" and inserting "the cost of the
drug or biological or the average cost of the category of
devices";
(2) in paragraph (6)(D) (as redesignated by subsection
(a)(1)), by striking "subparagraph (D)(iii)" in the matter
preceding clause (i) and inserting "subparagraph (E)(iii)"; and
(3) in paragraph (12)(E), by striking "additional payments
(consistent with paragraph (6)(B))" and inserting "additional
payments, the determination and deletion of initial and new
categories (consistent with subparagraphs (B) and (C) of
paragraph (6))".
(c) Effective Date. -- The amendments made by this section take
effect on the date of the enactment of this Act. (d) Transition. --
(1) In general. -- In the case of a medical device provided
as part of a service (or group of services) furnished during the
period before initial categories are implemented under
subparagraph (B)(i) of section 1833(t)(6) of the Social Security
Act (as amended by subsection (a)), payment shall be made for
such device under such section in accordance with the provisions
in effect before the date of the enactment of this Act, except
that, beginning on the date that is 30 days after the date of
the enactment of this Act, payment shall also be made for such a
device that is not included in a program memorandum described in
such subparagraph if the Secretary of Health and Human Services
determines that the device is likely to be described by such an
initial category or would have been included in such program
memoranda but for the requirement of subparagraph (A)(iv)(I) of
that section.
(2) Application of current process. -- Notwithstanding any
other provision of law, the Secretary shall continue to accept
applications with respect to medical devices under the process
established pursuant to paragraph (6) of section 1833(t) of the
Social Security Act (as in effect on the day before the date of
the enactment of this Act) through December 1, 2000, and any
device --
(A) with respect to which an application was submitted
(pursuant to such process) on or before such date; and
(B) that meets the requirements of clause (ii) or (iv)
of subparagraph (A) of such paragraph (as determined
pursuant to such process), shall be treated as a device with
respect to which an initial category is required to be
established under subparagraph (B)(i) of such paragraph (as
amended by subsection (a)(2)).
SEC. 403. APPLICATION OF OPD PPS TRANSITIONAL CORRIDOR PAYMENTS TO
CERTAIN HOSPITALS THAT DID NOT SUBMIT A 1996 COST REPORT.
(a) In General. -- Section 1833(t)(7)(F)(ii)(I) (42 U.S.C.
1395l(t)(7)(F)(ii)(I)) is amended by inserting "(or in the case of a
hospital that did not submit a cost report for such period, during
the first subsequent cost reporting period ending before 2001 for
which the hospital submitted a cost report)" after "1996".
(b) Effective Date. -- The amendment made by subsection (a)
shall take effect as if included in the enactment of BBRA.
SEC. 404. APPLICATION OF RULES FOR DETERMINING PROVIDER-BASED STATUS
FOR CERTAIN ENTITIES.
(a) Grandfather. -- Notwithstanding any other provision of law,
for purposes of making determinations of provider-based status under
title XVIII of the Social Security Act 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 such title
as of October 1, 2000 --
(1) shall continue to be treated as provider-based in
relation to such hospital or critical access hospital under such
title during the 2-year period beginning on October 1, 2000; and
(2) the requirements, limitations, and exclusions specified
in paragraphs (d), (e), (f), and (h) of section 413.65 of title
42, Code of Federal Regulations shall not apply to such facility
or organization in relation to such hospital or critical access
hospital until after the end of such 2-year period.
(b) Temporary Criteria. -- For purposes of title XVIII of the
Social Security Act --
(1) a facility or organization for which a determination of
provider-based status in relation to a hospital or critical
access hospital is requested on or after October 1, 2000, and
before October 1, 2002, may not be treated as not having
provider-based 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
(2) 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 following rules apply:
(A) 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 --
(i) satisfies the requirements of section
413.65(d)(7) of title 42, Code of Federal Regulations;
or
(ii) is located not more than 35 miles from the main
campus of the hospital or critical access hospital.
(B) The facility or organization shall be treated as
satisfying any of the requirements and standards for
geographic location in relation to such a hospital if the
facility or organization is owned and operated by a hospital
or critical access hospital that --
(i) is owned or operated by a unit of State or local
government, is a public or private nonprofit corporation
that is formally granted governmental powers by a unit
of State or local government, or is a private hospital
that has a contract with a State or local government
that includes the operation of clinics located off the
main campus of the hospital to assure access in a well-
defined service area to health care services for low-
income individuals who are not entitled to benefits
under title XVIII (or medical assistance under a State
plan under title XIX) of such Act; and
(ii) has a disproportionate share adjustment
percentage (as determined under section 1886(d)(5)(F) of
such Act (42 U.S.C. 1395ww(d)(5)(F))) greater than 11.75
percent or is described in clause (i)(II) of such
section.
(c) Definitions. -- For purposes of this section, the terms
"hospital" and "critical access hospital" have the meanings given
such terms in subsections (e) and (mm)(1), respectively, of section
1861 of the Social Security Act (42 U.S.C. 1395x).
SEC. 405. TREATMENT OF CHILDREN'S HOSPITALS UNDER PROSPECTIVE PAYMENT
SYSTEM.
(a) In General. -- Section 1833(t) (42 U.S.C. 1395l(t)) is
amended --
(1) in the heading of paragraph (7)(D)(ii), by inserting "
and children's hospitals" after " cancer hospitals"; and
(2) in paragraphs (7)(D)(ii) and (11), by striking "section
1886(d)(1)(B)(v)" and inserting "clause (iii) or (v) of section
1886(d)(1)(B)".
(b) Effective Date. -- The amendments made by subsection (a)
apply as if included in the enactment of section 202 of BBRA (113
Stat. 1501A 342).
SEC. 406. INCLUSION OF TEMPERATURE MONITORED CRYOABLATION IN
TRANSITIONAL PASS-THROUGH FOR CERTAIN MEDICAL DEVICES, DRUGS,
AND BIOLOGICALS UNDER OPD PPS.
(a) In General. -- Section 1833(t)(6)(A)(ii) (42 U.S.C.
1395l(t)(6)(A)(ii)) is amended by inserting "or temperature monitored
cryoablation" after "device of brachytherapy".
(b) Effective Date. -- The amendment made by subsection (a)
applies to devices furnished on or after April 1, 2001.
Subtitle B -- Provisions Relating to Physicians' Services
SEC. 411. GAO STUDIES RELATING TO PHYSICIANS' SERVICES.
(a) Study of Specialist Physicians' Services Furnished in
Physicians' Offices and Hospital Outpatient Department Services. --
(1) Study. -- The Comptroller General of the United States
shall conduct a study to examine the appropriateness of
furnishing in physicians' offices specialist physicians'
services (such as gastrointestinal endoscopic physicians'
services) which are ordinarily furnished in hospital outpatient
departments. In conducting this study, the Comptroller General
shall --
(A) review available scientific and clinical evidence
about the safety of performing procedures in physicians'
offices and hospital outpatient departments;
(B) assess whether resource-based practice expense
relative values established by the Secretary of Health and
Human Services under the medicare physician fee schedule
under section 1848 of the Social Security Act (42 U.S.C.
1395w 4) for such specialist physicians' services furnished
in physicians' offices and hospital outpatient departments
create an incentive to furnish such services in physicians'
offices instead of hospital outpatient departments; and
(C) assess the implications for access to care for
medicare beneficiaries if the medicare program were not to
cover such services in physicians' offices.
(2) Report. -- Not later than July 1, 2001, the Comptroller
General shall submit to Congress a report on such study and
include such recommendations as the Comptroller General
determines to be appropriate.
(b) Study of the Resource-Based Practice Expense System. --
(1) Study. -- The Comptroller General of the United States
shall conduct a study on the refinements to the practice expense
relative value units during the transition to a resource-based
practice expense system for physician payments under the
medicare program under title XVIII of the Social Security Act.
Such study shall examine how the Secretary of Health and Human
Services has accepted and used the practice expense data
submitted under section 212 of BBRA (113 Stat. 1501A 350).
(2) Report. -- Not later than July 1, 2001, the Comptroller
General shall submit to Congress a report on the study conducted
under paragraph (1) together with recommendations regarding --
(A) improvements in the process for acceptance and use
of practice expense data under section 212 of BBRA;
(B) any change or adjustment that is appropriate to
ensure full access to a spectrum of care for beneficiaries
under the medicare program; and
(C) the appropriateness of payments to physicians.
SEC. 412. PHYSICIAN GROUP PRACTICE DEMONSTRATION.
(a) In General. -- Title XVIII is amended by inserting after
section 1866 the following new sections: "demonstration of
application of physician volume increases to group practices
"Sec. 1866A. (a) Demonstration Program Authorized. --
"(1) In general. -- The Secretary shall conduct
demonstration projects to test and, if proven effective, expand
the use of incentives to health care groups participating in the
program under this title that --
"(A) encourage coordination of the care furnished to
individuals under the programs under parts A and B by
institutional and other providers, practitioners, and
suppliers of health care items and services;
"(B) encourage investment in administrative structures
and processes to ensure efficient service delivery; and
"(C) reward physicians for improving health outcomes.
Such projects shall focus on the efficiencies of furnishing
health care in a group-practice setting as compared to the
efficiencies of furnishing health care in other health care
delivery systems.
"(2) Administration by contract. -- Except as otherwise
specifically provided, the Secretary may administer the program
under this section in accordance with section 1866B.
"(3) Definitions. -- For purposes of this section, terms
have the following meanings:
"(A) Physician. -- Except as the Secretary may otherwise
provide, the term 'physician' means any individual who
furnishes services which may be paid for as physicians'
services under this title.
"(B) Health care group. -- The term 'health care group'
means a group of physicians (as defined in subparagraph (A))
organized at least in part for the purpose of providing
physicians' services under this title. As the Secretary
finds appropriate, a health care group may include a
hospital and any other individual or entity furnishing items
or services for which payment may be made under this title
that is affiliated with the health care group under an
arrangement structured so that such individual or entity
participates in a demonstration under this section and will
share in any bonus earned under subsection (d).
"(b) Eligibility Criteria. --
"(1) In general. -- The Secretary is authorized to establish
criteria for health care groups eligible to participate in a
demonstration under this section, including criteria relating to
numbers of health care professionals in, and of patients served
by, the group, scope of services provided, and quality of care.
"(2) Payment method. -- A health care group participating in
the demonstration under this section shall agree with respect to
services furnished to beneficiaries within the scope of the
demonstration (as determined under subsection (c)) --
"(A) to be paid on a fee-for-service basis; and
"(B) that payment with respect to all such services
furnished by members of the health care group to such
beneficiaries shall (where determined appropriate by the
Secretary) be made to a single entity.
"(3) Data reporting. -- A health care group participating in
a demonstration under this section shall report to the Secretary
such data, at such times and in such format as the Secretary
requires, for purposes of monitoring and evaluation of the
demonstration under this section.
"(c) Patients Within Scope of Demonstration. --
"(1) In general. -- The Secretary shall specify, in
accordance with this subsection, the criteria for identifying
those patients of a health care group who shall be considered
within the scope of the demonstration under this section for
purposes of application of subsection (d) and for assessment of
the effectiveness of the group in achieving the objectives of
this section.
"(2) Other criteria. -- The Secretary may establish
additional criteria for inclusion of beneficiaries within a
demonstration under this section, which may include frequency of
contact with physicians in the group or other factors or
criteria that the Secretary finds to be appropriate.
"(3) Notice requirements. -- In the case of each beneficiary
determined to be within the scope of a demonstration under this
section with respect to a specific health care group, the
Secretary shall ensure that such beneficiary is notified of the
incentives, and of any waivers of coverage or payment rules,
applicable to such group under such demonstration.
"(d) Incentives. --
"(1) Performance target. -- The Secretary shall establish
for each health care group participating in a demonstration
under this section --
"(A) a base expenditure amount, equal to the average
total payments under parts A and B for patients served by
the health care group on a fee-for-service basis in a base
period determined by the Secretary; and
"(B) an annual per capita expenditure target for
patients determined to be within the scope of the
demonstration, reflecting the base expenditure amount
adjusted for risk and expected growth rates.
"(2) Incentive bonus. -- The Secretary shall pay to each
participating health care group (subject to paragraph (4)) a
bonus for each year under the demonstration equal to a portion
of the medicare savings realized for such year relative to the
performance target.
"(3) Additional bonus for process and outcome improvements.
-- At such time as the Secretary has established appropriate
criteria based on evidence the Secretary determines to be
sufficient, the Secretary shall also pay to a participating
health care group (subject to paragraph (4)) an additional bonus
for a year, equal to such portion as the Secretary may designate
of the saving to the program under this title resulting from
process improvements made by and patient outcome improvements
attributable to activities of the group.
"(4) Limitation. -- The Secretary shall limit bonus payments
under this section as necessary to ensure that the aggregate
expenditures under this title (inclusive of bonus payments) with
respect to patients within the scope of the demonstration do not
exceed the amount which the Secretary estimates would be
expended if the demonstration projects under this section were
not implemented.
"provisions for administration of demonstration program
" Sec. 1866B. (a) General Administrative Authority. --
"(1) Beneficiary eligibility. -- Except as otherwise
provided by the Secretary, an individual shall only be eligible
to receive benefits under the program under section 1866A (in
this section referred to as the 'demonstration program') if such
individual --
"(A) is enrolled in under the program under part B and
entitled to benefits under part A; and
"(B) is not enrolled in a Medicare+Choice plan under
part C, an eligible organization under a contract under
section 1876 (or a similar organization operating under a
demonstration project authority), an organization with an
agreement under section 1833(a)(1)(A), or a PACE program
under section 1894.
"(2) Secretary's discretion as to scope of program. -- The
Secretary may limit the implementation of the demonstration
program to --
"(A) a geographic area (or areas) that the Secretary
designates for purposes of the program, based upon such
criteria as the Secretary finds appropriate;
"(B) a subgroup (or subgroups) of beneficiaries or
individuals and entities furnishing items or services
(otherwise eligible to participate in the program), selected
on the basis of the number of such participants that the
Secretary finds consistent with the effective and efficient
implementation of the program;
"(C) an element (or elements) of the program that the
Secretary determines to be suitable for implementation; or
"(D) any combination of any of the limits described in
subparagraphs (A) through (C).
"(3) Voluntary receipt of items and services. -- Items and
services shall be furnished to an individual under the
demonstration program only at the individual's election.
"(4) Agreements. -- The Secretary is authorized to enter
into agreements with individuals and entities to furnish health
care items and services to beneficiaries under the demonstration
program.
"(5) Program standards and criteria. -- The Secretary shall
establish performance standards for the demonstration program
including, as applicable, standards for quality of health care
items and services, cost-effectiveness, beneficiary
satisfaction, and such other factors as the Secretary finds
appropriate. The eligibility of individuals or entities for the
initial award, continuation, and renewal of agreements to
provide health care items and services under the program shall
be conditioned, at a minimum, on performance that meets or
exceeds such standards.
"(6) Administrative review of decisions affecting
individuals and entities furnishing services. -- An individual
or entity furnishing services under the demonstration program
shall be entitled to a review by the program administrator (or,
if the Secretary has not contracted with a program
administrator, by the Secretary) of a decision not to enter
into, or to terminate, or not to renew, an agreement with the
entity to provide health care items or services under the
program.
"(7) Secretary's review of marketing materials. -- An
agreement with an individual or entity furnishing services under
the demonstration program shall require the individual or entity
to guarantee that it will not distribute materials that market
items or services under the program without the Secretary's
prior review and approval.
"(8) Payment in full. --
"(A) In general. -- Except as provided in subparagraph
(B), an individual or entity receiving payment from the
Secretary under a contract or agreement under the
demonstration program shall agree to accept such payment as
payment in full, and such payment shall be in lieu of any
payments to which the individual or entity would otherwise
be entitled under this title.
"(B) Collection of deductibles and coinsurance. -- Such
individual or entity may collect any applicable deductible
or coinsurance amount from a beneficiary. "(b) Contracts for
Program Administration. --
"(1) In general. -- The Secretary may administer the
demonstration program through a contract with a program
administrator in accordance with the provisions of this
subsection.
"(2) Scope of program administrator contracts. -- The
Secretary may enter into such contracts for a limited geographic
area, or on a regional or national basis.
"(3) Eligible contractors. -- The Secretary may contract for
the administration of the program with --
"(A) an entity that, under a contract under section 1816
or 1842, determines the amount of and makes payments for
health care items and services furnished under this title;
or
"(B) any other entity with substantial experience in
managing the type of program concerned.
"(4) Contract award, duration, and renewal. --
"(A) In general. -- A contract under this subsection
shall be for an initial term of up to three years, renewable
for additional terms of up to three years.
"(B) Noncompetitive award and renewal for entities
administering part a or part b payments. -- The Secretary
may enter or renew a contract under this subsection with an
entity described in paragraph (3)(A) without regard to the
requirements of section 5 of title 41, United States Code.
"(5) Applicability of federal acquisition regulation. -- The
Federal Acquisition Regulation shall apply to program
administration contracts under this subsection.
"(6) Performance standards. -- The Secretary shall establish
performance standards for the program administrator including,
as applicable, standards for the quality and cost-effectiveness
of the program administered, and such other factors as the
Secretary finds appropriate. The eligibility of entities for the
initial award, continuation, and renewal of program
administration contracts shall be conditioned, at a minimum, on
performance that meets or exceeds such standards.
"(7) Functions of program administrator. -- A program
administrator shall perform any or all of the following
functions, as specified by the Secretary:
"(A) Agreements with entities furnishing health care
items and services. -- Determine the qualifications of
entities seeking to enter or renew agreements to provide
services under the demonstration program, and as appropriate
enter or renew (or refuse to enter or renew) such agreements
on behalf of the Secretary.
"(B) Establishment of payment rates. -- Negotiate or
otherwise establish, subject to the Secretary's approval,
payment rates for covered health care items and services.
"(C) Payment of claims or fees. -- Administer payments
for health care items or services furnished under the
program.
"(D) Payment of bonuses. -- Using such guidelines as the
Secretary shall establish, and subject to the approval of
the Secretary, make bonus payments as described in
subsection (c)(2)(A)(ii) to entities furnishing items or
services for which payment may be made under the program.
"(E) Oversight. -- Monitor the compliance of individuals
and entities with agreements under the program with the
conditions of participation.
"(F) Administrative review. -- Conduct reviews of
adverse determinations specified in subsection (a)(6).
"(G) Review of marketing materials. -- Conduct a review
of marketing materials proposed by an entity furnishing
services under the program.
"(H) Additional functions. -- Perform such other
functions as the Secretary may specify.
"(8) Limitation of liability. -- The provisions of section
1157(b) shall apply with respect to activities of contractors
and their officers, employees, and agents under a contract under
this subsection.
"(9) Information sharing. -- Notwithstanding section 1106
and section 552a of title 5, United States Code, the Secretary
is authorized to disclose to an entity with a program
administration contract under this subsection such information
(including medical information) on individuals receiving health
care items and services under the program as the entity may
require to carry out its responsibilities under the contract.
"(c) Rules Applicable to Both Program Agreements and Program
Administration Contracts. --
"(1) Records, reports, and audits. -- The Secretary is
authorized to require entities with agreements to provide health
care items or services under the demonstration program, and
entities with program administration contracts under subsection
(b), to maintain adequate records, to afford the Secretary
access to such records (including for audit purposes), and to
furnish such reports and other materials (including audited
financial statements and performance data) as the Secretary may
require for purposes of implementation, oversight, and
evaluation of the program and of individuals' and entities'
effectiveness in performance of such agreements or contracts.
"(2) Bonuses. -- Notwithstanding any other provision of law,
but subject to subparagraph (B)(ii), the Secretary may make
bonus payments under the demonstration program from the Federal
Health Insurance Trust Fund and the Federal Supplementary
Medical Insurance Trust Fund in amounts that do not exceed the
amounts authorized under the program in accordance with the
following:
"(A) Payments to program administrators. -- The
Secretary may make bonus payments under the program to
program administrators.
"(B) Payments to entities furnishing services. --
"(i) In general. -- Subject to clause (ii), the
Secretary may make bonus payments to individuals or
entities furnishing items or services for which payment
may be made under the demonstration program, or may
authorize the program administrator to make such bonus
payments in accordance with such guidelines as the
Secretary shall establish and subject to the Secretary's
approval.
"(ii) Limitations. -- The Secretary may condition
such payments on the achievement of such standards
related to efficiency, improvement in processes or
outcomes of care, or such other factors as the Secretary
determines to be appropriate.
"(3) Antidiscrimination limitation. -- The Secretary shall
not enter into an agreement with an entity to provide health
care items or services under the demonstration program, or with
an entity to administer the program, unless such entity
guarantees that it will not deny, limit, or condition the
coverage or provision of benefits under the program, for
individuals eligible to be enrolled under such program, based on
any health status-related factor described in section 2702(a)(1)
of the Public Health Service Act.
"(d) Limitations on Judicial Review. -- The following actions
and determinations with respect to the demonstration program shall
not be subject to review by a judicial or administrative tribunal:
"(1) Limiting the implementation of the program under
subsection (a)(2).
"(2) Establishment of program participation standards under
subsection (a)(5) or the denial or termination of, or refusal to
renew, an agreement with an entity to provide health care items
and services under the program.
"(3) Establishment of program administration contract
performance standards under subsection (b)(6), the refusal to
renew a program administration contract, or the noncompetitive
award or renewal of a program administration contract under
subsection (b)(4)(B).
"(5) Establishment of payment rates, through negotiation or
otherwise, under a program agreement or a program administration
contract.
"(6) A determination with respect to the program (where
specifically authorized by the program authority or by
subsection (c)(2)) --
"(A) as to whether cost savings have been achieved, and
the amount of savings; or
"(B) as to whether, to whom, and in what amounts bonuses
will be paid.
"(e) Application Limited to Parts A and B. -- None of the
provisions of this section or of the demonstration program shall
apply to the programs under part C.
"(f) Reports to Congress. -- Not later than two years after the
date of the enactment of this section, and biennially thereafter for
six years, the Secretary shall report to Congress on the use of
authorities under the demonstration program. Each report shall
address the impact of the use of those authorities on expenditures,
access, and quality under the programs under this title.".
(b) GAO Report. -- Not later than 2 years after the date on
which the demonstration project under section 1866A of the Social
Security Act, as added by subsection (a), is implemented, the
Comptroller General of the United States shall submit to Congress a
report on such demonstration project. The report shall include such
recommendations with respect to changes to the demonstration project
that the Comptroller General determines appropriate.
SEC. 413. STUDY ON ENROLLMENT PROCEDURES FOR GROUPS THAT RETAIN
INDEPENDENT CONTRACTOR PHYSICIANS.
(a) In General. -- The Comptroller General of the United States
shall conduct a study of the current medicare enrollment process for
groups that retain independent contractor physicians with particular
emphasis on hospital-based physicians, such as emergency department
staffing groups. In conducting the evaluation, the Comptroller
General shall consult with groups that retain independent contractor
physicians and shall --
(1) review the issuance of individual medicare provider
numbers and the possible medicare program integrity
vulnerabilities of the current process;
(2) review direct and indirect costs associated with the
current process incurred by the medicare program and groups that
retain independent contractor physicians;
(3) assess the effect on program integrity by the enrollment
of groups that retain independent contractor hospital-based
physicians; and
(4) develop suggested procedures for the enrollment of these
groups.
(b) Report. -- Not later than 1 year after the date of the
enactment of this Act, the Comptroller General shall submit to
Congress a report on the study conducted under subsection (a).
Subtitle C -- Other Services
SEC. 421. 1-YEAR EXTENSION OF MORATORIUM ON THERAPY CAPS; REPORT ON
STANDARDS FOR SUPERVISION OF PHYSICAL THERAPY ASSISTANTS.
(a) In General. -- Section 1833(g)(4) (42 U.S.C. 1395l(g)(4)) is
amended by striking "2000 and 2001." and inserting "2000, 2001, and
2002.".
(b) Conforming Amendment To Continue Focused Medical Reviews of
Claims During Moratorium Period. -- Section 221(a)(2) of BBRA (113
Stat. 1501A 351) is amended by striking "(under the amendment made by
paragraph (1)(B))".
(c) Study on Standards for Supervision of Physical Therapist
Assistants. --
(1) Study. -- The Secretary of Health and Human Services
shall conduct a study of the implications --
(A) of eliminating the "in the room" supervision
requirement for medicare payment for services of physical
therapy assistants who are supervised by physical
therapists; and
(B) of such requirement on the cap imposed under section
1833(g) of the Social Security Act (42 U.S.C. 1395l(g)) on
physical therapy services.
(2) Report. -- Not later than 18 months after the date of
the enactment of this Act, the Secretary shall submit to
Congress a report on the study conducted under paragraph (1).
SEC. 422. UPDATE IN RENAL DIALYSIS COMPOSITE RATE.
(a) Update. --
(1) In general. -- The last sentence of section 1881(b)(7)
(42 U.S.C. 1395rr(b)(7)) is amended by striking "for such
services furnished on or after January 1, 2001, by 1.2 percent"
and inserting "for such services furnished on or after January
1, 2001, by 2.4 percent".
(2) Prohibition on Exemptions. --
(A) In general. -- Subject to subparagraph (B), the
Secretary of Health and Human Services may not provide for
an exception under section 1881(b)(7) of the Social Security
Act (42 U.S.C. 1395rr(b)(7)) on or after December 31, 2000.
(B) Special rules for 2000. --
(i) In general. -- Any exemption rate under such
section 1881(b)(7) in effect on December 31, 2000, shall
continue in effect so long as such rate is greater than
the composite rate as updated by the amendment made by
paragraph (1).
(ii) Resubmission of certain applications. -- In the
case of an application for an exemption rate under such
section that was filed by a facility during 2000 that
was not approved by the Secretary of Health and Human
Services, the facility may submit an application for an
exemption rate for that year by not later than July 1,
2001. (b) Development of ESRD Market Basket. --
(1) Development. -- The Secretary of Health and Human
Services shall 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 under section 1881(b)(7) of the Social Security
Act (42 U.S.C. 1395rr(b)(7)) will exceed the costs of such mix
of goods and services for the preceding year. In developing such
index, the Secretary may take into account measures of changes
in --
(A) technology used in furnishing dialysis services;
(B) the manner or method of furnishing dialysis
services; and
(C) the amounts by which the payments under such section
for all services billed by a facility for a year exceed the
aggregate allowable audited costs of such services for such
facility for such year.
(2) Report. -- The Secretary of Health and Human Services
shall submit to Congress a report on the index developed under
paragraph (1) no later than July 1, 2002, and shall include in
the report recommendations on the appropriateness of an annual
or periodic update mechanism for renal dialysis services under
the medicare program under title XVIII of the Social Security
Act based on such index.
(c) Inclusion of Additional Services in Composite Rate. --
(1) Development. -- The Secretary of Health and Human
Services shall develop a system which includes, to the maximum
extent feasible, in the composite rate used for payment under
section 1881(b)(7) of the Social Security Act (42 U.S.C.
1395rr(b)(7)), payment for clinical diagnostic laboratory tests
and drugs (including drugs paid under section 1881(b)(11)(B) of
such Act (42 U.S.C. 1395rr(b)(11)(B)) that are routinely used in
furnishing dialysis services to medicare beneficiaries but which
are currently separately billable by renal dialysis facilities.
(2) Report. -- The Secretary shall include, as part of the
report submitted under subsection (b)(2), a report on the system
developed under paragraph (1) and recommendations on the
appropriateness of incorporating the system into medicare
payment for renal dialysis services. (d) GAO Study on Access to
Services. --
(1) Study. -- The Comptroller General of the United States
shall study access of medicare beneficiaries to renal dialysis
services. Such study shall include whether there is a sufficient
supply of facilities to furnish needed renal dialysis services,
whether medicare payment levels are appropriate, taking into
account audited costs of facilities for all services furnished,
to ensure continued access to such services, and improvements in
access (and quality of care) that may result in the increased
use of long nightly and short daily hemodialysis modalities.
(2) Report. -- Not later than January 1, 2003, the
Comptroller General shall submit to Congress a report on the
study conducted under paragraph (1).
SEC. 423. PAYMENT FOR AMBULANCE SERVICES.
(a) Restoration of Full CPI Increase for 2001. -- Section
1834(l)(3) (42 U.S.C. 1395m(l)(3)) is amended by striking "reduced in
the case of 2001 and 2002" each place it appears and inserting
"reduced in the case of 2002".
(b) Mileage Payments. -- Section 1834(l)(2)(E) (42 U.S.C.
1395m(l)(2)(E)) is amended by inserting before the period at the end
the following: ", except that, beginning on the date on which 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 did not, prior to the implementation of the
fee schedule, include a separate amount for all mileage within the
county from which the beneficiary is transported".
(c) Effective Date. -- The amendment made by subsection (a)
applies to services furnished on or after the date on which the
Secretary of Health and Human Services implements the fee schedule
under section 1834(l) of the Social Security Act (42 U.S.C.
1395m(l)).
SEC. 424. AMBULATORY SURGICAL CENTERS.
(a) Delay in Implementation of Prospective Payment System. --
The Secretary of Health and Human Services may not implement a
revised prospective payment system for services of ambulatory
surgical facilities under section 1833(i) of the Social Security Act
(42 U.S.C. 1395l(i)) before January 1, 2002.
(b) Extending Phase-In to 4 Years. -- Section 226 of the BBRA
(113 Stat. 1501A 354) is amended by striking paragraphs (1) and (2)
and inserting the following:
"(1) in the first year of its implementation, only a
proportion (specified by the Secretary and not to exceed 1/4) of
the payment for such services shall be made in accordance with
such system and the remainder shall be made in accordance with
current regulations; and
"(2) in each of the following 2 years a proportion
(specified by the Secretary and not to exceed 1/2, and 3/4,
respectively) of the payment for such services shall be made
under such system and the remainder shall be made in accordance
with current regulations.".
(c) Deadline for Use of 1999 or Later Cost Surveys. -- Section
226 of BBRA (113 Stat. 1501A 354) is amended by adding at the end the
following: "By not later than January 1, 2003, the Secretary shall
incorporate data from a 1999 medicare cost survey or a subsequent
cost survey for purposes of implementing or revising such system.".
SEC. 425. FULL UPDATE FOR DURABLE MEDICAL EQUIPMENT.
(a) In General. -- Section 1834(a)(14) (42 U.S.C. 1395m(a)(14))
is amended --
(1) by redesignating subparagraph (D) as subparagraph (F);
(2) in subparagraph (C) --
(A) by striking "through 2002" and inserting "through
2000"; and
(B) by striking "and" at the end; and
(3) by inserting after subparagraph (C) the following new
subparagraphs:
"(D) for 2001, the percentage increase in the Consumer
Price Index for all urban consumers (U.S. city average) for
the 12-month period ending with June 2000;
"(E) for 2002, 0 percentage points; and".
(b) Conforming Amendments to BBRA. -- Subsection (a) of section
228 of BBRA (113 Stat. 1501A 356) is amended --
(1) in the matter preceding paragraph (1), by striking "for
such items";
(2) in paragraph (1), by inserting "oxygen and oxygen
equipment for" after "(1)"; and
(3) in paragraph (2), by inserting "all such covered items
for" after "(2)".
(c) Effective Date. -- The amendments made by subsection (b)
shall take effect as if included in the enactment of BBRA.
SEC. 426. FULL UPDATE FOR ORTHOTICS AND PROSTHETICS.
Section 1834(h)(4)(A) (42 U.S.C. 1395m(h)(4)(A)) is amended --
(1) by redesignating clause (vi) as clause (viii);
(2) in clause (v) --
(A) by striking "through 2002" and inserting "through
2000"; and
(B) by striking "and" at the end; and
(3) by inserting after clause (v) the following new clause:
"(vi) for 2001, the percentage increase in the
consumer price index for all urban consumers (U.S. city
average) for the 12-month period ending with June 2000;
"(vii) for 2002, 1 percent; and".
SEC. 427. ESTABLISHMENT OF SPECIAL PAYMENT PROVISIONS AND
REQUIREMENTS FOR PROSTHETICS AND CERTAIN CUSTOM FABRICATED
ORTHOTIC ITEMS.
(a) In General. -- Section 1834(h)(1) (42 U.S.C. 1395m(h)(1)) is
amended by adding at the end the following:
"(F) Special payment rules for certain prosthetics and
custom fabricated orthotics. --
"(i) In general. -- No payment shall be made under
this subsection for an item of custom fabricated
orthotics described in clause (ii) or for an item of
prosthetics unless such item is --
"(I) furnished by a qualified practitioner; and
"(II) fabricated by a qualified practitioner or
a qualified supplier at a facility that meets such
criteria as the Secretary determines appropriate.
"(ii) Description of custom fabricated item. --
"(I) In general. -- An item described in this
clause is an item of custom fabricated orthotics
that requires education, training, and experience to
custom fabricate and that is included in a list
established by the Secretary in subclause (II). Such
an item does not include shoes and shoe inserts.
"(II) List of items. -- The Secretary, in
consultation with appropriate experts in orthotics
(including national organizations representing
manufacturers of orthotics), shall establish and
update as appropriate a list of items to which this
subparagraph applies. No item may be included in
such list unless the item is individually fabricated
for the patient over a positive model of the
patient.
"(iii) Qualified practitioner defined. -- In this
subparagraph, the term 'qualified practitioner' means a
physician or other individual who --
"(I) is a qualified physical therapist or a
qualified occupational therapist;
"(II) in the case of a State that provides for
the licensing of orthotics and prosthetics, is
licensed in orthotics or prosthetics by the State in
which the item is supplied; or
"(III) in the case of a State that does not
provide for the licensing of orthotics and
prosthetics, is specifically trained and educated to
provide or manage the provision of prosthetics and
custom-designed or fabricated orthotics, and is
certified by the American Board for Certification in
Orthotics and Prosthetics, Inc. or by the Board for
Orthotist/Prosthetist Certification, or is
credentialed and approved by a program that the
Secretary determines, in consultation with
appropriate experts in orthotics and prosthetics,
has training and education standards that are
necessary to provide such prosthetics and orthotics.
"(iv) Qualified supplier defined. -- In this
subparagraph, the term 'qualified supplier' means any
entity that is accredited by the American Board for
Certification in Orthotics and Prosthetics, Inc. or by
the Board for Orthotist/Prosthetist Certification, or
accredited and approved by a program that the Secretary
determines has accreditation and approval standards that
are essentially equivalent to those of such Board.".
(b) Effective Date. -- Not later than 1 year after the date of
the enactment of this Act, the Secretary of Health and Human Services
shall promulgate revised regulations to carry out the amendment made
by subsection (a) using a negotiated rulemaking process under
subchapter III of chapter 5 of title 5, United States Code. (c) GAO
Study and Report. --
(1) Study. -- The Comptroller General of the United States
shall conduct a study on HCFA Ruling 96 1, issued on September
1, 1996, with respect to distinguishing orthotics from durable
medical equipment under the medicare program under title XVIII
of the Social Security Act. The study shall assess the following
matters:
(A) The compliance of the Secretary of Health and Human
Services with the Administrative Procedures Act (under
chapter 5 of title 5, United States Code) in making such
ruling.
(B) The potential impact of such ruling on the health
care furnished to medicare beneficiaries under the medicare
program, especially those beneficiaries with degenerative
musculoskeletal conditions.
(C) The potential for fraud and abuse under the medicare
program if payment were provided for orthotics used as a
component of durable medical equipment only when made under
the special payment provision for certain prosthetics and
custom fabricated orthotics under section 1834(h)(1)(F) of
the Social Security Act, as added by subsection (a) and
furnished by qualified practitioners under that section.
(D) The impact on payments under titles XVIII and XIX of
the Social Security Act if such ruling were overturned.
(2) Report. -- Not later than 6 months after the date of the
enactment of this Act, the Comptroller General shall submit to
Congress a report on the study conducted under paragraph (1).
SEC. 428. REPLACEMENT OF PROSTHETIC DEVICES AND PARTS.
(a) In General. -- Section 1834(h)(1) (42 U.S.C. 1395m(h)(1)),
as amended by section 427(a), is further amended by adding at the end
the following new subparagraph:
"(G) Replacement of prosthetic devices and parts. -- 7E
7E 7E
"(i) In general. -- Payment shall be made for the
replacement of prosthetic devices which are artificial
limbs, or for the replacement of any part of such
devices, without regard to continuous use or useful
lifetime restrictions if an ordering physician
determines that the provision of a replacement device,
or a replacement part of such a device, is necessary
because of any of the following:
"(I) A change in the physiological condition of
the patient.
"(II) An irreparable change in the condition of
the device, or in a part of the device.
"(III) The condition of the device, or the part
of the device, requires repairs and the cost of such
repairs would be more than 60 percent of the cost of
a replacement device, or, as the case may be, of the
part being replaced.
"(ii) Confirmation may be required if replacement
device or part is less than 3 years old. -- If a
physician determines that a replacement device, or a
replacement part, is necessary pursuant to clause (i) --
"(I) such determination shall be controlling;
and
"(II) such replacement device or part shall be
deemed to be reasonable and necessary for purposes
of section 1862(a)(1)(A); except that if the device,
or part, being replaced is less than 3 years old
(calculated from the date on which the beneficiary
began to use the device or part), the Secretary may
also require confirmation of necessity of the
replacement device, or, as the case may be, the
replacement part.".
(b) Preemption of Rule. -- The provisions of section
1834(h)(1)(G) as added by subsection (a) shall supersede any rule
that as of the date of the enactment of this Act may have applied a
5-year replacement rule with regard to prosthetic devices.
(c) Effective Date. -- The amendment made by subsection (a)
shall apply to items replaced on or after April 1, 2001.
SEC. 429. REVISED PART B PAYMENT FOR DRUGS AND BIOLOGICALS AND
RELATED SERVICES.
(a) Recommendations for Revised Payment Methodology for Drugs
and Biologicals. --
(1) Study. --
(A) In general. -- The Comptroller General of the United
States shall conduct a study on the reimbursement for drugs
and biologicals under the current medicare payment
methodology (provided under section 1842(o) of the Social
Security Act (42 U.S.C. 1395u(o)) and for related services
under part B of title XVIII of such Act. In the study, the
Comptroller General shall --
(i) identify the average prices at which such drugs
and biologicals are acquired by physicians and other
suppliers;
(ii) quantify the difference between such average
prices and the reimbursement amount under such section;
and
(iii) determine the extent to which (if any) payment
under such part is adequate to compensate physicians,
providers of services, or other suppliers of such drugs
and biologicals for costs incurred in the
administration, handling, or storage of such drugs or
biologicals.
(B) Consultation. -- In conducting the study under
subparagraph (A), the Comptroller General shall consult with
physicians, providers of services, and suppliers of drugs
and biologicals under the medicare program under title XVIII
of such Act, as well as other organizations involved in the
distribution of such drugs and biologicals to such
physicians, providers of services, and suppliers.
(2) Report. -- Not later than 9 months after the date of the
enactment of this Act, the Comptroller General shall submit to
Congress and to the Secretary of Health and Human Services a
report on the study conducted under this subsection, and shall
include in such report recommendations for revised payment
methodologies described in paragraph (3).
(3) Recommendations for revised payment methodologies. --
(A) In general. -- The Comptroller General shall provide
specific recommendations for revised payment methodologies
for reimbursement for drugs and biologicals and for related
services under the medicare program. The Comptroller General
may include in the recommendations --
(i) proposals to make adjustments under subsection
(c) of section 1848 of the Social Security Act (42
U.S.C. 1395w 4) for the practice expense component of
the physician fee schedule under such section for the
costs incurred in the administration, handling, or
storage of certain categories of such drugs and
biologicals, if appropriate; and
(ii) proposals for new payments to providers of
services or suppliers for such costs, if appropriate.
(B) Ensuring patient access to care. -- In making
recommendations under this paragraph, the Comptroller
General shall ensure that any proposed revised payment
methodology is designed to ensure that medicare
beneficiaries continue to have appropriate access to health
care services under the medicare program.
(C) Matters considered. -- In making recommendations
under this paragraph, the Comptroller General shall consider
--
(i) the method and amount of reimbursement for
similar drugs and biologicals made by large group health
plans;
(ii) as a result of any revised payment methodology,
the potential for patients to receive inpatient or
outpatient hospital services in lieu of services in a
physician's office; and
(iii) the effect of any revised payment methodology
on the delivery of drug therapies by hospital outpatient
departments.
(D) Coordination with bbra study. -- In making
recommendations under this paragraph, the Comptroller
General shall conclude and take into account the results of
the study provided for under section 213(a) of BBRA (113
Stat. 1501A 350).
(b) Implementation of New Payment Methodology. --
(1) In general. -- Notwithstanding any other provision of
law, based on the recommendations contained in the report under
subsection (a), the Secretary of Health and Human Services,
subject to paragraph (2), shall revise the payment methodology
under section 1842(o) of the Social Security Act (42 U.S.C.
1395u(o)) for drugs and biologicals furnished under part B of
the medicare program. To the extent the Secretary determines
appropriate, the Secretary may provide for the adjustments to
payments amounts referred to in subsection (a)(3)(A)(i) or
additional payments referred to in subsection (a)(2)(A)(ii).
(2) Limitation. -- In revising the payment methodology under
paragraph (1), in no case may the estimated aggregate payments
for drugs and biologicals under the revised system (including
additional payments referred to in subsection (a)(3)(A)(ii))
exceed the aggregate amount of payment for such drugs and
biologicals, as projected by the Secretary, that would have been
made under the payment methodology in effect under such section
1842(o).
(c) Temporary Injunction Against Reductions in Payment Rates. --
Notwithstanding any other provision of law, the Administrator of the
Health Care Financing Administration may not directly or indirectly
increase or decrease the rates of reimbursement (in effect on
September 1, 2000) for drugs and biologicals under the current
medicare payment methodology (provided under section 1842(o) of such
Act (42 U.S.C. 1395u(o)) until such time as the Secretary has
reviewed the report submitted under subsection (a)(2).
SEC. 430. CONTRAST ENHANCED DIAGNOSTIC PROCEDURES UNDER HOSPITAL
PROSPECTIVE PAYMENT SYSTEM.
(a) Separate Classification. -- Section 1833(t)(2) (42 U.S.C.
1395l(t)(2)) is amended --
(1) by striking "and" at the end of subparagraph (E);
(2) by striking the period at the end of subparagraph (F)
and inserting "; and"; and
(3) by inserting after subparagraph (F) the following new
subparagraph:
"(G) the Secretary shall create additional groups of
covered OPD services that classify separately those
procedures that utilize contrast media from those that do
not.".
(b) Conforming Amendment. -- Section 1861(t)(1) (42 U.S.C.
1395x(t)(1)) is amended by inserting "(including contrast agents)"
after "only such drugs".
(c) Effective Date. -- The amendments made by this section apply
to items and services furnished on or after January 1, 2001.
SEC. 431. QUALIFICATIONS FOR COMMUNITY MENTAL HEALTH CENTERS.
(a) Medicare Program. -- Section 1861(ff)(3)(B) (42 U.S.C.
1395x(ff)(3)(B)) is amended by striking "entity" and all that follows
and inserting the following: "entity that --
"(i)(I) provides the mental health services
described in section 1913(c)(1) of the Public Health
Service Act; or
"(II) in the case of an entity operating in a
State that by law precludes the entity from
providing itself the service described in
subparagraph (E) of such section, provides for such
service by contract with an approved organization or
entity (as determined by the Secretary);
"(ii) meets applicable licensing or certification
requirements for community mental health centers in the
State in which it is located; and
"(iii) meets such additional conditions as the
Secretary shall specify to ensure (I) the health and
safety of individuals being furnished such services,
(II) the effective and efficient furnishing of such
services, and (III) the compliance of such entity with
the criteria described in section 1931(c)(1) of the
Public Health Service Act.".
(b) Effective Date. -- The amendment made by subsection (a)
applies with respect to community mental health centers with respect
to services furnished on or after the first day of the third month
beginning after the date of the enactment of this Act.
SEC. 432. MODIFICATION OF MEDICARE BILLING REQUIREMENTS FOR CERTAIN
INDIAN PROVIDERS.
(a) In General. -- Section 1880(a) (42 U.S.C. 1395qq(a)) is
amended by adding at the end the following new sentence: "A hospital
or a free-standing ambulatory care clinic (as defined by the
Secretary), whether operated by the Indian Health Service or by an
Indian tribe or tribal organization (as those terms are defined in
section 4 of the Indian Health Care Improvement Act), shall be
eligible for payments for services for which payment is made pursuant
to section 1848, notwithstanding sections 1814(c) and 1835(d), if and
for so long as it meets all of the requirements which are applicable
generally to such payments, services, hospitals, and clinics.".
(b) Effective Date. -- The amendment made by this section shall
apply to services furnished on or after January 1, 2001.
SEC. 433. GAO STUDY ON COVERAGE OF SURGICAL FIRST ASSISTING SERVICES
OF CERTIFIED REGISTERED NURSE FIRST ASSISTANTS.
(a) Study. -- The Comptroller General of the United States shall
conduct a study on the effect on the medicare program under title
XVIII of the Social Security Act and on medicare beneficiaries of
coverage under the program of surgical first assisting services of
certified registered nurse first assistants. The Comptroller General
shall consider the following when conducting the study:
(1) Any impact on the quality of care furnished to medicare
beneficiaries by reason of such coverage.
(2) Appropriate education and training requirements for
certified registered nurse first assistants who furnish such
first assisting services.
(3) Appropriate rates of payment under the program to such
certified registered nurse first assistants for furnishing such
services, taking into account the costs of compensation,
overhead, and supervision attributable to certified registered
nurse first assistants.
(b) Report. -- Not later than 1 year after the date of the
enactment of this Act, the Comptroller General shall submit to
Congress a report on the study conducted under subsection (a).
SEC. 434. MEDPAC STUDY AND REPORT ON MEDICARE REIMBURSEMENT FOR
SERVICES PROVIDED BY CERTAIN PROVIDERS.
(a) Study. -- The Medicare Payment Advisory Commission shall
conduct a study on the appropriateness of the current payment rates
under the medicare program under title XVIII of the Social Security
Act for services provided by a --
(1) certified nurse-midwife (as defined in subsection
(gg)(2) of section 1861 of such Act (42 U.S.C. 1395x);
(2) physician assistant (as defined in subsection (aa)(5)(A)
of such section);
(3) nurse practitioner (as defined in such subsection); and
(4) clinical nurse specialist (as defined in subsection
(aa)(5)(B) of such section).
(b) Report. -- Not later than 18 months after the date of the
enactment of this Act, the Commission shall submit to Congress a
report on the study conducted under subsection (a), together with any
recommendations for legislation that the Commission determines to be
appropriate as a result of such study.
SEC. 435. MEDPAC STUDY AND REPORT ON MEDICARE COVERAGE OF SERVICES
PROVIDED BY CERTAIN NONPHYSICIAN PROVIDERS.
(a) Study. --
(1) In general. -- The Medicare Payment Advisory Commission
shall conduct a study to determine the appropriateness of
providing coverage under the medicare program under title XVIII
of the Social Security Act for services provided by a --
(A) surgical technologist;
(B) marriage counselor;
(C) marriage and family therapist;
(D) pastoral care counselor; and
(E) licensed professional counselor of mental health.
(2) Costs to program. -- The study shall consider the short-
term and long-term benefits, and costs to the medicare program,
of providing the coverage described in paragraph (1).
(b) Report. -- Not later than 18 months after the date of the
enactment of this Act, the Commission shall submit to Congress a
report on the study conducted under subsection (a), together with any
recommendations for legislation that the Commission determines to be
appropriate as a result of such study.
SEC. 436. GAO STUDY AND REPORT ON THE COSTS OF EMERGENCY AND MEDICAL
TRANSPORTATION SERVICES.
(a) Study. -- The Comptroller General of the United States shall
conduct a study 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.
(b) Report. -- Not later than 18 months after the date of the
enactment of this Act, the Comptroller General shall submit to
Congress a report on the study conducted under subsection (a),
together with recommendations for any changes in methodology or
payment level necessary to fairly compensate suppliers of emergency
and medical transportation services and to ensure the access of
beneficiaries under the medicare program under title XVIII of the
Social Security Act.
SEC. 437. GAO STUDIES AND REPORTS ON MEDICARE PAYMENTS.
(a) GAO Study on HCFA Post-Payment Audit Process. --
(1) Study. -- The Comptroller General of the United States
shall conduct a study on the post-payment audit process under
the medicare program under title XVIII of the Social Security
Act as such process applies to physicians, including the proper
level of resources that the Health Care Financing Administration
should devote to educating physicians regarding --
(A) coding and billing;
(B) documentation requirements; and
(C) the calculation of overpayments.
(2) Report. -- Not later than 18 months after the date of
the enactment of this Act, the Comptroller General shall submit
to Congress a report on the study conducted under paragraph (1)
together with specific recommendations for changes or
improvements in the post-payment audit process described in such
paragraph. (b) GAO Study on Administration and Oversight. --
(1) Study. -- The Comptroller General of the United States
shall conduct a study on the aggregate effects of regulatory,
audit, oversight, and paperwork burdens on physicians and other
health care providers participating in the medicare program
under title XVIII of the Social Security Act.
(2) Report. -- Not later than 18 months after the date of
the enactment of this Act, the Comptroller General shall submit
to Congress a report on the study conducted under paragraph (1)
together with recommendations regarding any area in which --
(A) a reduction in paperwork, an ease of administration,
or an appropriate change in oversight and review may be
accomplished; or
(B) additional payments or education are needed to
assist physicians and other health care providers in
understanding and complying with any legal or regulatory
requirements.
SEC. 438. MEDPAC STUDY ON ACCESS TO OUTPATIENT PAIN MANAGEMENT
SERVICES.
(a) Study. -- The Medicare Payment Advisory Commission shall
conduct a study on the barriers to coverage and payment for
outpatient interventional pain medicine procedures under the medicare
program under title XVIII of the Social Security Act. Such study
shall examine --
(1) the specific barriers imposed under the medicare program
on the provision of pain management procedures in hospital
outpatient departments, ambulatory surgery centers, and
physicians' offices; and
(2) the consistency of medicare payment policies for pain
management procedures in those different settings.
(b) Report. -- Not later than 1 year after the date of the
enactment of this Act, the Commission shall submit to Congress a
report on the study.
TITLE V -- PROVISIONS RELATING TO PARTS A AND B
Subtitle A -- Home Health Services
SEC. 501. 1-YEAR ADDITIONAL DELAY IN APPLICATION OF 15 PERCENT
REDUCTION ON PAYMENT LIMITS FOR HOME HEALTH SERVICES.
(a) In General. -- Section 1895(b)(3)(A)(i) (42 U.S.C.
1395fff(b)(3)(A)(i)) is amended --
(1) by redesignating subclause (II) as subclause (III);
(2) in subclause (III), as redesignated, by striking
"described in subclause (I)" and inserting "described in
subclause (II)"; and
(3) by inserting after subclause (I) the following new
subclause:
"(II) For the 12-month period beginning after
the period described in subclause (I), such amount
(or amounts) shall be equal to the amount (or
amounts) determined under subclause (I), updated
under subparagraph (B).".
(b) Change in Report. -- Section 302(c) of BBRA (113 Stat. 1501A
360) is amended --
(1) by striking "Not later than" and all that follows
through "(42 U.S.C. 1395fff)" and inserting "Not later than
April 1, 2002"; and
(2) by striking "Secretary" and inserting "Comptroller
General of the United States".
(c) Case Mix Adjustment Corrections. --
(1) In general. -- Section 1895(b)(3)(B) (42 U.S.C.
1395fff(b)(3)(B)) is amended by adding at the end the following
new clause:
"(iv) Adjustment for case mix changes. -- Insofar as
the Secretary determines that the adjustments under
paragraph (4)(A)(i) for a previous fiscal year (or
estimates that such adjustments for a future fiscal
year) did (or are likely to) result in a change in
aggregate payments under this subsection during the
fiscal year that are a result of changes in the coding
or classification of different units of services that do
not reflect real changes in case mix, the Secretary may
adjust the standard prospective payment amount (or
amounts) under paragraph (3) for subsequent fiscal years
so as to eliminate the effect of such coding or
classification changes.".
(2) Effective date. -- The amendment made by paragraph (1)
applies to episodes concluding on or after October 1, 2001.
SEC. 502. RESTORATION OF FULL HOME HEALTH MARKET BASKET UPDATE FOR
HOME HEALTH SERVICES FOR FISCAL YEAR 2001.
(a) In General. -- Section 1861(v)(1)(L)(x) (42 U.S.C.
1395x(v)(1)(L)(x)) is amended --
(1) by striking "2001,"; and
(2) by adding at the end the following: "With respect to
cost reporting periods beginning during fiscal year 2001, the
update to any limit under this subparagraph shall be the home
health market basket index.".
(b) Special Rule for Payment for Fiscal Year 2001 Based on
Adjusted Prospective Payment Amounts. --
(1) In general. -- Notwithstanding the amendments made by
subsection (a), for purposes of making payments under section
1895(b) of the Social Security Act (42 U.S.C. 1395fff(b)) for
home health services for fiscal year 2001, the Secretary of
Health and Human Services shall --
(A) with respect to episodes and visits ending on or
after October 1, 2000, and before April 1, 2001, use the
final standardized and budget neutral prospective payment
amounts for 60 day episodes and standardized average per
visit amounts for fiscal year 2001 as published by the
Secretary in the Federal Register of the July 3, 2000 (65
Federal Register 41128 41214); and
(B) with respect to episodes and visits ending on or
after April 1, 2001, and before October 1, 2001, use such
amounts increased by 2.2 percent.
(2) No effect on other payments or determinations. -- The
Secretary shall not take the provisions of paragraph (1) into
account for purposes of payments, determinations, or budget
neutrality adjustments under section 1895 of the Social Security
Act.
SEC. 503. TEMPORARY TWO-MONTH EXTENSION OF PERIODIC INTERIM PAYMENTS.
(a) Temporary Extension. -- Notwithstanding subsection (d) of
section 4603 of BBA (42 U.S.C. 1395fff note), as amended by section
5101(c)(2) of the Tax and Trade Relief Extension Act of 1998
(contained in division J of Public Law 105 277)), the amendments made
by subsection (b) of such section 4603 shall not take effect until
December 1, 2000, in the case of a home health agency that was
receiving periodic interim payments under section 1815(e)(2) as of
September 30, 2000.
(b) Payment Rule. -- The amount of such periodic interim payment
made to a home health agency by reason of subsection (a) during each
of November and December, 2000, shall be equal to the amount of such
payment made to the agency in their last full monthly periodic
interim payment. Such amount of payment shall be included in the
tentative settlement of the last cost report for the home health
agency under the payment system in effect prior to the implementation
of the prospective payment system under section 1895(b) of the Social
Security Act (42 U.S.C. 1395fff(b)).
SEC. 504. USE OF TELEHEALTH IN DELIVERY OF HOME HEALTH SERVICES.
Section 1895 (42 U.S.C. 1395fff) is amended by adding at the end
the following new subsection:
"(e) Construction Related to Home Health Services. --
"(1) Telecommunications. -- Nothing in this section shall be
construed as preventing a home health agency furnishing a home
health unit of service for which payment is made under the
prospective payment system established by this section for such
units of service from furnishing services via a
telecommunication system if such services --
"(A) do not substitute for in-person home health
services ordered as part of a plan of care certified by a
physician pursuant to section 1814(a)(2)(C) or section
1835(a)(2)(A); and
"(B) are not considered a home health visit for purposes
of eligibility or payment under this title.
"(2) Physician certification. -- Nothing in this section
shall be construed as waiving the requirement for a physician
certification under section 1814(a)(2)(C) or section
1835(a)(2)(A) of such Act (42 U.S.C. 1395f(a)(2)(C),
1395n(a)(2)(A)) for the payment for home health services,
whether or not furnished via a telecommunications system.".
SEC. 505. STUDY ON COSTS TO HOME HEALTH AGENCIES OF PURCHASING
NONROUTINE MEDICAL SUPPLIES.
(a) Study. -- The Comptroller General of the United States shall
conduct a study on variations in prices paid by home health agencies
furnishing home health services under the medicare program under
title XVIII of the Social Security Act in purchasing nonroutine
medical supplies, including ostomy supplies, and volumes if such
supplies used, shall determine the effect (if any) of variations on
prices and volumes in the provision of such services.
(b) Report. -- Not later than October 1, 2001, the Comptroller
General shall submit to Congress a report on the study conducted
under subsection (a), and shall include in the report recommendations
respecting whether payment for nonroutine medical supplies furnished
in connection with home health services should be made separately
from the prospective payment system for such services.
SEC. 506. TREATMENT OF BRANCH OFFICES; GAO STUDY ON SUPERVISION OF
HOME HEALTH CARE PROVIDED IN ISOLATED RURAL AREAS.
(a) Treatment of Branch Offices. --
(1) In general. -- Notwithstanding any other provision of
law, in determining for purposes of title XVIII of the Social
Security Act 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.
(2) Consideration of forms of technology in definition of
supervision. -- The Secretary of Health and Human Services may
include forms of technology in determining what constitutes
"supervision" for purposes of determining a home heath agency's
branch office status under paragraph (1).
(b) GAO Study. --
(1) Study. -- The Comptroller General of the United States
shall conduct a study of the provision of adequate supervision
to maintain quality of home health services delivered under the
medicare program under title XVIII of the Social Security Act in
isolated rural areas. The study shall evaluate the methods that
home health agency branches and subunits use to maintain
adequate supervision in the delivery of services to clients
residing in those areas, how these methods of supervision
compare to requirements that subunits independently meet
medicare conditions of participation, and the resources utilized
by subunits to meet such conditions.
(2) Report. -- Not later than January 1, 2002, the
Comptroller General shall submit to Congress a report on the
study conducted under paragraph (1). The report shall include
recommendations on whether exceptions are needed for subunits
and branches of home health agencies under the medicare program
to maintain access to the home health benefit or whether
alternative policies should be developed to assure adequate
supervision and access and recommendations on whether a national
standard for supervision is appropriate.
SEC. 507. CLARIFICATION OF THE HOMEBOUND DEFINITION UNDER THE
MEDICARE HOME HEALTH BENEFIT.
(a) Clarification. --
(1) In general. -- Sections 1814(a) and 1835(a) (42 U.S.C.
1395f(a) and 1395n(a)) are each amended --
(A) in the last sentence, by striking ", and that
absences of the individual from home are infrequent or of
relatively short duration, or are attributable to the need
to receive medical treatment"; and
(B) by adding at the end the following new sentences:
"Any absence of an individual from the home attributable to
the need to receive health care treatment, including regular
absences for the purpose of participating in therapeutic,
psychosocial, or medical treatment in an adult day-care
program that is licensed or certified by a State, or
accredited, to furnish adult day-care services in the State
shall not disqualify an individual from being considered to
be 'confined to his home'. Any other absence of an
individual from the home shall not so disqualify an
individual if the absence is of infrequent or of relatively
short duration. For purposes of the preceding sentence, any
absence for the purpose of attending a religious service
shall be deemed to be an absence of infrequent or short
duration.".
(2) Effective date. -- The amendments made by paragraph (1)
shall apply to items and services provided on or after the date
of enactment of this Act.
(b) Study. --
(1) In general. -- The Comptroller General of the United
States shall conduct an evaluation of the effect of the
amendment on the cost of and access to home health services
under the medicare program under title XVIII of the Social
Security Act.
(2) Report. -- Not later than 1 year after the date of the
enactment of this Act, the Comptroller General shall submit to
Congress a report on the study conducted under paragraph (1).
Subtitle B -- Direct Graduate Medical Education
SEC. 511. INCREASE IN FLOOR FOR DIRECT GRADUATE MEDICAL EDUCATION
PAYMENTS.
Section 1886(h)(2)(D)(iii) (42 U.S.C. 1395ww(h)(2)(D)(iii)) is
amended --
(1) in the heading, by striking " in fiscal year 2001 at 70
percent of" and inserting " for"; and
(2) by inserting after "70 percent" the following: ", and
for the cost reporting period beginning during fiscal year 2002
shall not be less than 85 percent,".
SEC. 512. CHANGE IN DISTRIBUTION FORMULA FOR MEDICARE+CHOICE-RELATED
NURSING AND ALLIED HEALTH EDUCATION COSTS.
(a) In General. -- Section 1886(l)(2)(C) (42 U.S.C.
1395ww(l)(2)(C)) is amended by striking all that follows "multiplied
by" and inserting the following: "the ratio of --
"(i) the product of (I) the Secretary's estimate of
the ratio of the amount of payments made under section
1861(v) to the hospital for nursing and allied health
education activities for the hospital's cost reporting
period ending in the second preceding fiscal year, to
the hospital's total inpatient days for such period, and
(II) the total number of inpatient days (as established
by the Secretary) for such period which are attributable
to services furnished to individuals who are enrolled
under a risk sharing contract with an eligible
organization under section 1876 and who are entitled to
benefits under part A or who are enrolled with a
Medicare+Choice organization under part C; to
"(ii) the sum of the products determined under
clause (i) for such cost reporting periods.".
(b) Effective Date. -- The amendment made by subsection (a)
applies to portions of cost reporting periods occurring on or after
January 1, 2001.
Subtitle C -- Changes in Medicare Coverage and Appeals Process
SEC. 521. REVISIONS TO MEDICARE APPEALS PROCESS.
(a) Conduct of Reconsiderations of Determinations by Independent
Contractors. -- Section 1869 (42 U.S.C. 1395ff) is amended to read as
follows:
"determinations; appeals
"Sec. 1869. (a) Initial Determinations. --
"(1) Promulgations of regulations. -- The Secretary shall
promulgate regulations and make initial determinations with
respect to benefits under part A or part B in accordance with
those regulations for the following:
"(A) The initial determination of whether an individual
is entitled to benefits under such parts.
"(B) The initial determination of the amount of benefits
available to the individual under such parts.
"(C) Any other initial determination with respect to a
claim for benefits under such parts, including an initial
determination by the Secretary that payment may not be made,
or may no longer be made, for an item or service under such
parts, an initial determination made by a utilization and
quality control peer review organization under section
1154(a)(2), and an initial determination made by an entity
pursuant to a contract (other than a contract under section
1852) with the Secretary to administer provisions of this
title or title XI.
"(2) Deadlines for making initial determinations. --
"(A) In general. -- Subject to subparagraph (B), in
promulgating regulations under paragraph (1), initial
determinations shall be concluded by not later than the 45-
day period beginning on the date the fiscal intermediary or
the carrier, as the case may be, receives a claim for
benefits from an individual as described in paragraph (1).
Notice of such determination shall be mailed to the
individual filing the claim before the conclusion of such
45-day period.
"(B) Clean claims. -- Subparagraph (A) shall not apply
with respect to any claim that is subject to the
requirements of section 1816(c)(2) or section 1842(c)(2).
"(3) Redeterminations. --
"(A) In general. -- In promulgating regulations under
paragraph (1) with respect to initial determinations, such
regulations shall provide for a fiscal intermediary or a
carrier to make a redetermination with respect to a claim
for benefits that is denied in whole or in part.
"(B) Limitations. --
"(i) Appeals rights. -- No initial determination may
be reconsidered or appealed under subsection (b) unless
the fiscal intermediary or carrier has made a
redetermination of that initial determination under this
paragraph.
"(ii) Decision maker. -- No redetermination may be
made by any individual involved in the initial
determination.
"(C) Deadlines. --
"(i) Filing for redetermination. -- A
redetermination under subparagraph (A) shall be
available only if notice is filed with the Secretary to
request the redetermination by not later than the end of
the 120-day period beginning on the date the individual
receives notice of the initial determination under
paragraph (2).
"(ii) Concluding redeterminations. --
Redeterminations shall be concluded by not later than
the 30-day period beginning on the date the fiscal
intermediary or the carrier, as the case may be,
receives a request for a redetermination. Notice of such
determination shall be mailed to the individual filing
the claim before the conclusion of such 30-day period.
"(D) Construction. -- For purposes of the succeeding
provisions of this section a redetermination under this
paragraph shall be considered to be part of the initial
determination.
"(b) Appeal Rights. --
"(1) In general. --
"(A) Reconsideration of initial determination. --
Subject to subparagraph (D), any individual dissatisfied
with any initial determination under subsection (a)(1) shall
be entitled to reconsideration of the determination, and,
subject to subparagraphs (D) and (E), a hearing thereon by
the Secretary to the same extent as is provided in section
205(b) and to judicial review of the Secretary's final
decision after such hearing as is provided in section
205(g). For purposes of the preceding sentence, any
reference to the 'Commissioner of Social Security' or the
'Social Security Administration' in subsection (g) or (l) of
section 205 shall be considered a reference to the
'Secretary' or the 'Department of Health and Human
Services', respectively.
"(B) Representation by provider or supplier. --
"(i) In general. -- Sections 206(a), 1102, and 1871
shall not be construed as authorizing the Secretary to
prohibit an individual from being represented under this
section by a person that furnishes or supplies the
individual, directly or indirectly, with services or
items, solely on the basis that the person furnishes or
supplies the individual with such a service or item.
"(ii) Mandatory waiver of right to payment from
beneficiary. -- Any person that furnishes services or
items to an individual may not represent an individual
under this section with respect to the issue described
in section 1879(a)(2) unless the person has waived any
rights for payment from the beneficiary with respect to
the services or items involved in the appeal.
"(iii) Prohibition on payment for representation. --
If a person furnishes services or items to an individual
and represents the individual under this section, the
person may not impose any financial liability on such
individual in connection with such representation.
"(iv) Requirements for representatives of a
beneficiary. -- The provisions of section 205(j) and
section 206 (other than subsection (a)(4) of such
section) regarding representation of claimants shall
apply to representation of an individual with respect to
appeals under this section in the same manner as they
apply to representation of an individual under those
sections.
"(C) Succession of rights in cases of assignment. -- The
right of an individual to an appeal under this section with
respect to an item or service may be assigned to the
provider of services or supplier of the item or service upon
the written consent of such individual using a standard form
established by the Secretary for such an assignment.
"(D) Time limits for filing appeals. --
"(i) Reconsiderations. -- Reconsideration under
subparagraph (A) shall be available only if the
individual described in subparagraph (A) files notice
with the Secretary to request reconsideration by not
later than the end of the 180-day period beginning on
the date the individual receives notice of the
redetermination under subsection (a)(3), or within such
additional time as the Secretary may allow.
"(ii) Hearings conducted by the secretary. -- The
Secretary shall establish in regulations time limits for
the filing of a request for a hearing by the Secretary
in accordance with provisions in sections 205 and 206.
"(E) Amounts in controversy. --
"(i) In general. -- A hearing (by the Secretary)
shall not be available to an individual under this
section if the amount in controversy is less than $100,
and judicial review shall not be available to the
individual if the amount in controversy is less than
$1,000.
"(ii) Aggregation of claims. -- In determining the
amount in controversy, the Secretary, under regulations,
shall allow two or more appeals to be aggregated if the
appeals involve --
"(I) the delivery of similar or related services
to the same individual by one or more providers of
services or suppliers, or
"(II) common issues of law and fact arising from
services furnished to two or more individuals by one
or more providers of services or suppliers.
"(F) Expedited proceedings. --
"(i) Expedited determination. -- In the case of an
individual who has received notice by a provider of
services that the provider of services plans --
"(I) to terminate services provided to an
individual and a physician certifies that failure to
continue the provision of such services is likely to
place the individual's health at significant risk,
or
"(II) to discharge the individual from the
provider of services, the individual may request, in
writing or orally, an expedited determination or an
expedited reconsideration of an initial
determination made under subsection (a)(1), as the
case may be, and the Secretary shall provide such
expedited determination or expedited
reconsideration.
"(ii) Expedited hearing. -- In a hearing by the
Secretary under this section, in which the moving party
alleges that no material issues of fact are in dispute,
the Secretary shall make an expedited determination as
to whether any such facts are in dispute and, if not,
shall render a decision expeditiously.
"(G) Reopening and revision of determinations. -- The
Secretary may reopen or revise any initial determination or
reconsidered determination described in this subsection
under guidelines established by the Secretary in
regulations. "(c) Conduct of Reconsiderations by Independent
Contractors. --
"(1) In general. -- The Secretary shall enter into contracts
with qualified independent contractors to conduct
reconsiderations of initial determinations made under
subparagraphs (B) and (C) of subsection (a)(1). Contracts shall
be for an initial term of three years and shall be renewable on
a triennial basis thereafter.
"(2) Qualified independent contractor. -- For purposes of
this subsection, the term 'qualified independent contractor'
means an entity or organization that is independent of any
organization under contract with the Secretary that makes
initial determinations under subsection (a)(1), and that meets
the requirements established by the Secretary consistent with
paragraph (3).
"(3) Requirements. -- Any qualified independent contractor
entering into a contract with the Secretary under this
subsection shall meet the all of the following requirements:
"(A) In general. -- The qualified independent contractor
shall perform such duties and functions and assume such
responsibilities as may be required by the Secretary to
carry out the provisions of this subsection, and shall have
sufficient training and expertise in medical science and
legal matters to make reconsiderations under this
subsection.
"(B) Reconsiderations. --
"(i) In general. -- The qualified independent
contractor shall review initial determinations. In the
case an initial determination made with respect to
whether an item or service is reasonable and necessary
for the diagnosis or treatment of illness or injury
(under section 1862(a)(1)(A)), such review shall include
consideration of the facts and circumstances of the
initial determination by a panel of physicians or other
appropriate health care professionals and any decisions
with respect to the reconsideration shall be based on
applicable information, including clinical experience
and medical, technical, and scientific evidence.
"(ii) Effect of national and local coverage
determinations. --
"(I) National coverage determinations. -- If the
Secretary has made a national coverage determination
pursuant to the requirements established under the
third sentence of section 1862(a), such
determination shall be binding on the qualified
independent contractor in making a decision with
respect to a reconsideration under this section.
"(II) Local coverage determinations. -- If the
Secretary has made a local coverage determination,
such determination shall not be binding on the
qualified independent contractor in making a
decision with respect to a reconsideration under
this section. Notwithstanding the previous sentence,
the qualified independent contractor shall consider
the local coverage determination in making such
decision.
"(III) Absence of national or local coverage
determination. -- In the absence of such a national
coverage determination or local coverage
determination, the qualified independent contractor
shall make a decision with respect to the
reconsideration based on applicable information,
including clinical experience and medical,
technical, and scientific evidence.
"(C) Deadlines for decisions. --
"(i) Reconsiderations. -- Except as provided in
clauses (iii) and (iv), the qualified independent
contractor shall conduct and conclude a reconsideration
under subparagraph (B), and mail the notice of the
decision with respect to the reconsideration by not
later than the end of the 30-day period beginning on the
date a request for reconsideration has been timely
filed.
"(ii) Consequences of failure to meet deadline. --
In the case of a failure by the qualified independent
contractor to mail the notice of the decision by the end
of the period described in clause (i) or to provide
notice by the end of the period described in clause
(iii), as the case may be, the party requesting the
reconsideration or appeal may request a hearing before
the Secretary, notwithstanding any requirements for a
reconsidered determination for purposes of the party's
right to such hearing.
"(iii) Expedited reconsiderations. -- The qualified
independent contractor shall perform an expedited
reconsideration under subsection (b)(1)(F) as follows:
"(I) Deadline for decision. -- Notwithstanding
section 216(j) and subject to clause (iv), not later
than the end of the 72-hour period beginning on the
date the qualified independent contractor has
received a request for such reconsideration and has
received such medical or other records needed for
such reconsideration, the qualified independent
contractor shall provide notice (by telephone and in
writing) to the individual and the provider of
services and attending physician of the individual
of the results of the reconsideration. Such
reconsideration shall be conducted regardless of
whether the provider of services or supplier will
charge the individual for continued services or
whether the individual will be liable for payment
for such continued services.
"(II) Consultation with beneficiary. -- In such
reconsideration, the qualified independent
contractor shall solicit the views of the individual
involved.
"(III) Special rule for hospital discharges. --
A reconsideration of a discharge from a hospital
shall be conducted under this clause in accordance
with the provisions of paragraphs (2), (3), and (4)
of section 1154(e) as in effect on the date that
precedes the date of the enactment of this
subparagraph.
"(iv) Extension. -- An individual requesting a
reconsideration under this subparagraph may be granted
such additional time as the individual specifies (not to
exceed 14 days) for the qualified independent contractor
to conclude the reconsideration. The individual may
request such additional time in orally or in writing.
"(D) Limitation on individual reviewing determinations.
--
"(i) Physicians and health care professional. -- No
physician or health care professional under the employ
of a qualified independent contractor may review --
"(I) determinations regarding health care
services furnished to a patient if the physician or
health care professional was directly responsible
for furnishing such services; or
"(II) determinations regarding health care
services provided in or by an institution,
organization, or agency, if the physician or any
member of the family of the physician or health care
professional has, directly or indirectly, a
significant financial interest in such institution,
organization, or agency.
"(ii) Family described. -- For purposes of this
paragraph, the family of a physician or health care
professional includes the spouse (other than a spouse
who is legally separated from the physician or health
care professional under a decree of divorce or separate
maintenance), children (including stepchildren and
legally adopted children), grandchildren, parents, and
grandparents of the physician or health care
professional.
"(E) Explanation of decision. -- Any decision with
respect to a reconsideration of a qualified independent
contractor shall be in writing, and shall include a detailed
explanation of the decision as well as a discussion of the
pertinent facts and applicable regulations applied in making
such decision, and in the case of a determination of whether
an item or service is reasonable and necessary for the
diagnosis or treatment of illness or injury (under section
1862(a)(1)(A)) an explanation of the medical and scientific
rational for the decision.
"(F) Notice requirements. -- Whenever a qualified
independent contractor makes a decision with respect to a
reconsideration under this subsection, the qualified
independent contractor shall promptly notify the entity
responsible for the payment of claims under part A or part B
of such decision.
"(G) Dissemination of decisions on reconsiderations. --
Each qualified independent contractor shall make available
all decisions with respect to reconsiderations of such
qualified independent contractors to fiscal intermediaries
(under section 1816), carriers (under section 1842), peer
review organizations (under part B of title XI),
Medicare+Choice organizations offering Medicare+Choice plans
under part C, other entities under contract with the
Secretary to make initial determinations under part A or
part B or title XI, and to the public. The Secretary shall
establish a methodology under which qualified independent
contractors shall carry out this subparagraph.
"(H) Ensuring consistency in decisions. -- Each
qualified independent contractor shall monitor its decisions
with respect to reconsiderations to ensure the consistency
of such decisions with respect to requests for
reconsideration of similar or related matters.
"(I) Data collection. --
"(i) In general. -- Consistent with the requirements
of clause (ii), a qualified independent contractor shall
collect such information relevant to its functions, and
keep and maintain such records in such form and manner
as the Secretary may require to carry out the purposes
of this section and shall permit access to and use of
any such information and records as the Secretary may
require for such purposes.
"(ii) Type of data collected. -- Each qualified
independent contractor shall keep accurate records of
each decision made, consistent with standards
established by the Secretary for such purpose. Such
records shall be maintained in an electronic database in
a manner that provides for identification of the
following: "(I) Specific claims that give rise to
appeals.
"(II) Situations suggesting the need for
increased education for providers of services,
physicians, or suppliers.
"(III) Situations suggesting the need for
changes in national or local coverage policy.
"(IV) Situations suggesting the need for changes
in local medical review policies.
"(iii) Annual reporting. -- Each qualified
independent contractor shall submit annually to the
Secretary (or otherwise as the Secretary may request)
records maintained under this paragraph for the previous
year.
"(J) Hearings by the secretary. -- The qualified
independent contractor shall (i) prepare such information as
is required for an appeal of a decision of the contractor
with respect to a reconsideration to the Secretary for a
hearing, including as necessary, explanations of issues
involved in the decision and relevant policies, and (ii)
participate in such hearings as required by the Secretary.
"(4) Number of qualified independent contractors. -- The
Secretary shall enter into contracts with not fewer than 12
qualified independent contractors under this subsection.
"(5) Limitation on qualified independent contractor
liability. -- No qualified independent contractor having a
contract with the Secretary under this subsection and no person
who is employed by, or who has a fiduciary relationship with,
any such qualified independent contractor or who furnishes
professional services to such qualified independent contractor,
shall be held by reason of the performance of any duty,
function, or activity required or authorized pursuant to this
subsection or to a valid contract entered into under this
subsection, to have violated any criminal law, or to be civilly
liable under any law of the United States or of any State (or
political subdivision thereof) provided due care was exercised
in the performance of such duty, function, or activity.
"(d) Deadlines for Hearings by the Secretary. --
"(1) Hearing by administrative law judge. --
"(A) In general. -- Except as provided in subparagraph
(B), an administrative law judge shall conduct and conclude
a hearing on a decision of a qualified independent
contractor under subsection (c) and render a decision on
such hearing by not later than the end of the 90-day period
beginning on the date a request for hearing has been timely
filed.
"(B) Waiver of deadline by party seeking hearing. -- The
90-day period under subparagraph (A) shall not apply in the
case of a motion or stipulation by the party requesting the
hearing to waive such period.
"(2) Departmental appeals board review. --
"(A) In general. -- The Departmental Appeals Board of
the Department of Health and Human Services shall conduct
and conclude a review of the decision on a hearing described
in paragraph (1) and make a decision or remand the case to
the administrative law judge for reconsideration by not
later than the end of the 90-day period beginning on the
date a request for review has been timely filed.
"(B) DAB hearing procedure. -- In reviewing a decision
on a hearing under this paragraph, the Departmental Appeals
Board shall review the case de novo.
"(3) Consequences of failure to meet deadlines. --
"(A) Hearing by administrative law judge. -- In the case
of a failure by an administrative law judge to render a
decision by the end of the period described in paragraph
(1), the party requesting the hearing may request a review
by the Departmental Appeals Board of the Department of
Health and Human Services, notwithstanding any requirements
for a hearing for purposes of the party's right to such a
review.
"(B) Departmental appeals board review. -- In the case
of a failure by the Departmental Appeals Board to render a
decision by the end of the period described in paragraph
(2), the party requesting the hearing may seek judicial
review, notwithstanding any requirements for a hearing for
purposes of the party's right to such judicial review.
"(e) Administrative Provisions. --
"(1) Limitation on review of certain regulations. -- A
regulation or instruction that relates to a method for
determining the amount of payment under part B and that was
initially issued before January 1, 1981, shall not be subject to
judicial review.
"(2) Outreach. -- The Secretary shall perform such outreach
activities as are necessary to inform individuals entitled to
benefits under this title and providers of services and
suppliers with respect to their rights of, and the process for,
appeals made under this section. The Secretary shall use the
toll-free telephone number maintained by the Secretary under
section 1804(b) to provide information regarding appeal rights
and respond to inquiries regarding the status of appeals.
"(3) Continuing education requirement for qualified
independent contractors and administrative law judges. -- The
Secretary shall provide to each qualified independent
contractor, and, in consultation with the Commissioner of Social
Security, to administrative law judges that decide appeals of
reconsiderations of initial determinations or other decisions or
determinations under this section, such continuing education
with respect to coverage of items and services under this title
or policies of the Secretary with respect to part B of title XI
as is necessary for such qualified independent contractors and
administrative law judges to make informed decisions with
respect to appeals.
"(4) Reports. --
"(A) Annual report to congress. -- The Secretary shall
submit to Congress an annual report describing the number of
appeals for the previous year, identifying issues that
require administrative or legislative actions, and including
any recommendations of the Secretary with respect to such
actions. The Secretary shall include in such report an
analysis of determinations by qualified independent
contractors with respect to inconsistent decisions and an
analysis of the causes of any such inconsistencies.
"(B) Survey. -- Not less frequently than every 5 years,
the Secretary shall conduct a survey of a valid sample of
individuals entitled to benefits under this title who have
filed appeals of determinations under this section,
providers of services, and suppliers to determine the
satisfaction of such individuals or entities with the
process for appeals of determinations provided for under
this section and education and training provided by the
Secretary with respect to that process. The Secretary shall
submit to Congress a report describing the results of the
survey, and shall include any recommendations for
administrative or legislative actions that the Secretary
determines appropriate.".
(b) Applicability of Requirements and Limitations on Liability
of Qualified Independent Contractors to Medicare+Choice Independent
Appeals Contractors. -- Section 1852(g)(4) (42 U.S.C. 1395w 22(g)(4))
is amended by adding at the end the following: "The provisions of
section 1869(c)(5) shall apply to independent outside entities under
contract with the Secretary under this paragraph.".
(c) Conforming Amendment. -- Section 1154(e) (42 U.S.C. 1320c
3(e)) is amended by striking paragraphs (2), (3), and (4).
(d) Effective Date. -- The amendments made by this section apply
with respect to initial determinations made on or after October 1,
2002.
SEC. 522. REVISIONS TO MEDICARE COVERAGE PROCESS.
(a) Review of Determinations. -- Section 1869 (42 U.S.C.
1395ff), as amended by section 521, is further amended by adding at
the end the following new subsection: "(f) Review of Coverage
Determinations. --
"(1) National coverage determinations. --
"(A) In general. -- Review of any national coverage
determination shall be subject to the following limitations:
"(i) Such a determination shall not be reviewed by
any administrative law judge.
"(ii) Such a determination shall not be held
unlawful or set aside on the ground that a requirement
of section 553 of title 5, United States Code, or
section 1871(b) of this title, relating to publication
in the Federal Register or opportunity for public
comment, was not satisfied.
"(iii) Upon the filing of a complaint by an
aggrieved party, such a determination shall be reviewed
by the Departmental Appeals Board of the Department of
Health and Human Services. In conducting such a review,
the Departmental Appeals Board shall review the record
and shall permit discovery and the taking of evidence to
evaluate the reasonableness of the determination, if the
Board determines that the record is incomplete or lacks
adequate information to support the validity of the
determination. In reviewing such a determination, the
Departmental Appeals Board shall defer only to the
reasonable findings of fact, reasonable interpretations
of law, and reasonable applications of fact to law by
the Secretary.
"(iv) A decision of the Departmental Appeals Board
constitutes a final agency action and is subject to
judicial review.
"(B) Definition of national coverage determination. -- For
purposes of this section, the term 'national coverage
determination' means a determination by the Secretary with
respect to whether or not a particular item or service is
covered nationally under this title, but does not include a
determination of what code, if any, is assigned to a
particular item or service covered under this title or a
determination with respect to the amount of payment made for
a particular item or service so covered.
"(2) Local coverage determination. --
"(A) In general. -- Review of any local coverage
determination shall be subject to the following limitations:
"(i) Upon the filing of a complaint by an aggrieved
party, such a determination shall be reviewed by an
administrative law judge of the Social Security
Administration. The administrative law judge shall
review the record and shall permit discovery and the
taking of evidence to evaluate the reasonableness of the
determination, if the administrative law judge
determines that the record is incomplete or lacks
adequate information to support the validity of the
determination. In reviewing such a determination, the
administrative law judge shall defer only to the
reasonable findings of fact, reasonable interpretations
of law, and reasonable applications of fact to law by
the Secretary.
"(ii) Upon the filing of a complaint by an aggrieved
party, a decision of an administrative law judge under
clause (i) shall be reviewed by the Departmental Appeals
Board of the Department of Health and Human Services.
"(iii) A decision of the Departmental Appeals Board
constitutes a final agency action and is subject to
judicial review.
"(B) Definition of local coverage determination. -- For
purposes of this section, the term 'local coverage
determination' means a determination by a fiscal
intermediary or a carrier under part A or part B, as
applicable, respecting whether or not a particular item or
service is covered on an intermediary- or carrier-wide basis
under such parts, in accordance with section 1862(a)(1)(A).
"(3) No material issues of fact in dispute. -- In the case
of a determination that may otherwise be subject to review under
paragraph (1)(A)(iii) or paragraph (2)(A)(i), where the moving
party alleges that --
"(A) there are no material issues of fact in dispute,
and
"(B) the only issue of law is the constitutionality of a
provision of this title, or that a regulation,
determination, or ruling by the Secretary is invalid, the
moving party may seek review by a court of competent
jurisdiction without filing a complaint under such paragraph
and without otherwise exhausting other administrative
remedies.
"(4) Pending national coverage determinations. --
"(A) In general. -- In the event the Secretary has not
issued a national coverage or noncoverage determination with
respect to a particular type or class of items or services,
an aggrieved person (as described in paragraph (5)) may
submit to the Secretary a request to make such a
determination with respect to such items or services. By not
later than the end of the 90-day period beginning on the
date the Secretary receives such a request (notwithstanding
the receipt by the Secretary of new evidence (if any) during
such 90-day period), the Secretary shall take one of the
following actions:
"(i) Issue a national coverage determination, with
or without limitations.
"(ii) Issue a national noncoverage determination.
"(iii) Issue a determination that no national
coverage or noncoverage determination is appropriate as
of the end of such 90-day period with respect to
national coverage of such items or services.
"(iv) Issue a notice that states that the Secretary
has not completed a review of the request for a national
coverage determination and that includes an
identification of the remaining steps in the Secretary's
review process and a deadline by which the Secretary
will complete the review and take an action described in
subclause (I), (II), or (III).
"(B) In the case of an action described in clause
(i)(IV), if the Secretary fails to take an action referred
to in such clause by the deadline specified by the Secretary
under such clause, then the Secretary is deemed to have
taken an action described in clause (i)(III) as of the
deadline.
"(C) When issuing a determination under clause (i), the
Secretary shall include an explanation of the basis for the
determination. An action taken under clause (i) (other than
subclause (IV)) is deemed to be a national coverage
determination for purposes of review under subparagraph (A).
"(5) Standing. -- An action under this subsection seeking
review of a national coverage determination or local coverage
determination may be initiated only by individuals entitled to
benefits under part A, or enrolled under part B, or both, who
are in need of the items or services that are the subject of the
coverage determination.
"(6) Publication on the internet of decisions of hearings of
the secretary. -- Each decision of a hearing by the Secretary
with respect to a national coverage determination shall be made
public, and the Secretary shall publish each decision on the
Medicare Internet site of the Department of Health and Human
Services. The Secretary shall remove from such decision any
information that would identify any individual, provider of
services, or supplier.
"(7) Annual report on national coverage determinations. --
"(A) In general. -- Not later than December 1 of each
year, beginning in 2001, the Secretary shall submit to
Congress a report that sets forth a detailed compilation of
the actual time periods that were necessary to complete and
fully implement national coverage determinations that were
made in the previous fiscal year for items, services, or
medical devices not previously covered as a benefit under
this title, including, with respect to each new item,
service, or medical device, a statement of the time taken by
the Secretary to make and implement the necessary coverage,
coding, and payment determinations, including the time taken
to complete each significant step in the process of making
and implementing such determinations.
"(B) Publication of reports on the internet. -- The
Secretary shall publish each report submitted under clause
(i) on the medicare Internet site of the Department of
Health and Human Services.
"(8) Construction. -- Nothing in this subsection shall be
construed as permitting administrative or judicial review
pursuant to this section insofar as such review is explicitly
prohibited or restricted under another provision of law.".
(b) Establishment of a Process for Coverage Determinations. --
Section 1862(a) (42 U.S.C. 1395y(a)) is amended by adding at the end
the following new sentence: "In making a national coverage
determination (as defined in paragraph (1)(B) of section 1869(f)) the
Secretary shall ensure that the public is afforded notice and
opportunity to comment prior to implementation by the Secretary of
the determination; meetings of advisory committees established under
section 1114(f) with respect to the determination are made on the
record; in making the determination, the Secretary has considered
applicable information (including clinical experience and medical,
technical, and scientific evidence) with respect to the subject
matter of the determination; and in the determination, provide a
clear statement of the basis for the determination (including
responses to comments received from the public), the assumptions
underlying that basis, and make available to the public the data
(other than proprietary data) considered in making the
determination.".
(c) Improvements to the Medicare Advisory Committee Process. --
Section 1114 (42 U.S.C. 1314) is amended by adding at the end the
following new subsection:
"(i)(1) Any advisory committee appointed under
subsection (f) to advise the Secretary on matters
relating to the interpretation, application, or
implementation of section 1862(a)(1) shall assure the
full participation of a nonvoting member in the
deliberations of the advisory committee, and shall
provide such nonvoting member access to all information
and data made available to voting members of the
advisory committee, other than information that --
"(A) is exempt from disclosure pursuant to subsection
(a) of section 552 of title 5, United States Code, by reason
of subsection (b)(4) of such section (relating to trade
secrets); or
"(B) the Secretary determines would present a conflict
of interest relating to such nonvoting member.
"(2) If an advisory committee described in paragraph (1)
organizes into panels of experts according to types of items or
services considered by the advisory committee, any such panel of
experts may report any recommendation with respect to such items
or services directly to the Secretary without the prior approval
of the advisory committee or an executive committee thereof.".
(d) Effective Date. -- The amendments made by this section apply
with respect to --
(1) a review of any national or local coverage determination
filed,
(2) a request to make such a determination made,
(3) a national coverage determination made, on or after
October 1, 2001.
Subtitle D -- Improving Access to New Technologies
SEC. 531. REIMBURSEMENT IMPROVEMENTS FOR NEW CLINICAL LABORATORY
TESTS AND DURABLE MEDICAL EQUIPMENT.
(a) Payment Rule for New Laboratory Tests. -- Section
1833(h)(4)(B)(viii) (42 U.S.C. 1395l(h)(4)(B)(viii)) is amended by
inserting before the period at the end the following: "(or 100
percent of such median in the case of a clinical diagnostic
laboratory 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 under this subparagraph)".
(b) Establishment of Coding and Payment Procedures for New
Clinical Diagnostic Laboratory Tests and Other Items on a Fee
Schedule. -- Not later than 1 year after the date of the enactment of
this Act, the Secretary of Health and Human Services shall establish
procedures for coding and payment determinations for the categories
of new clinical diagnostic laboratory tests and new durable medical
equipment under part B of the title XVIII of the Social Security Act
that permit public consultation in a manner consistent with the
procedures established for implementing coding modifications for ICD
9 CM.
(c) Report on Procedures Used for Advanced, Improved
Technologies. -- Not later than 1 year after the date of the
enactment of this Act, the Secretary of Health and Human Services
shall submit to Congress a report that identifies the specific
procedures used by the Secretary under part B of title XVIII of the
Social Security Act to adjust payments for clinical diagnostic
laboratory tests and durable medical equipment which are classified
to existing codes where, because of an advance in technology with
respect to the test or equipment, there has been a significant
increase or decrease in the resources used in the test or in the
manufacture of the equipment, and there has been a significant
improvement in the performance of the test or equipment. The report
shall include such recommendations for changes in law as may be
necessary to assure fair and appropriate payment levels under such
part for such improved tests and equipment as reflects increased
costs necessary to produce improved results.
SEC. 532. RETENTION OF HCPCS LEVEL III CODES.
(a) In General. -- The Secretary of Health and Human Services
shall maintain and continue the use of level III codes of the HCPCS
coding system (as such system was in effect on August 16, 2000)
through December 31, 2003, and shall make such codes available to the
public.
(b) Definition. -- For purposes of this section, the term "HCPCS
Level III codes" means the alphanumeric codes for local use under the
Health Care Financing Administration Common Procedure Coding System
(HCPCS).
SEC. 533. RECOGNITION OF NEW MEDICAL TECHNOLOGIES UNDER INPATIENT
HOSPITAL PPS.
(a) Expediting Recognition of New Technologies Into Inpatient
PPS Coding System. --
(1) Report. -- Not later than April 1, 2001, the Secretary
of Health and Human Services shall submit to Congress a report
on methods of expeditiously incorporating new medical services
and technologies into the clinical coding system used with
respect to payment for inpatient hospital services furnished
under the medicare program under title XVIII of the Social
Security Act, together with a detailed description of the
Secretary's preferred methods to achieve this purpose.
(2) Implementation. -- Not later than October 1, 2001, the
Secretary shall implement the preferred methods described in the
report transmitted pursuant to paragraph (1).
(b) Ensuring Appropriate Payments for Hospitals Incorporating
New Medical Services and Technologies. --
(1) Establishment of mechanism. -- Section 1886(d)(5) (42
U.S.C. 1395ww(d)(5)) is amended by adding at the end the
following new subparagraphs:
"(K)(i) Effective for discharges beginning on or after
October 1, 2001, the Secretary shall establish a mechanism
to recognize the costs of new medical services and
technologies under the payment system established under this
subsection. Such mechanism shall be established after notice
and opportunity for public comment (in the publications
required by subsection (e)(5) for a fiscal year or
otherwise).
"(ii) The mechanism established pursuant to clause
(i) shall --
"(I) apply to a new medical service or
technology if, based on the estimated costs incurred
with respect to discharges involving such service or
technology, the DRG prospective payment rate
otherwise applicable to such discharges under this
subsection is inadequate;
"(II) provide for the collection of data with
respect to the costs of a new medical service or
technology described in subclause (I) for a period
of not less than two years and not more than three
years beginning on the date on which an inpatient
hospital code is issued with respect to the service
or technology;
"(III) subject to paragraph (4)(C)(iii), provide
for additional payment to be made under this
subsection with respect to discharges involving a
new medical service or technology described in
subclause (I) that occur during the period described
in subclause (II) in an amount that adequately
reflects the estimated average cost of such service
or technology; and
"(IV) provide that discharges involving such a
service or technology that occur after the close of
the period described in subclause (II) will be
classified within a new or existing diagnosis-
related group with a weighting factor under
paragraph (4)(B) that is derived from cost data
collected with respect to discharges occurring
during such period.
"(iii) For purposes of clause (ii)(II), the term
'inpatient hospital code' means any code that is used
with respect to inpatient hospital services for which
payment may be made under this subsection and includes
an alphanumeric code issued under the International
Classification of Diseases, 9th Revision, Clinical
Modification ('ICD 9 CM') and its subsequent revisions.
"(iv) For purposes of clause (ii)(III), the term
'additional payment' means, with respect to a discharge
for a new medical service or technology described in
clause (ii)(I), an amount that exceeds the prospective
payment rate otherwise applicable under this subsection
to discharges involving such service or technology that
would be made but for this subparagraph.
"(v) The requirement under clause (ii)(III) for an
additional payment may be satisfied by means of a new-
technology group (described in subparagraph (L)), an
add-on payment, a payment adjustment, or any other
similar mechanism for increasing the amount otherwise
payable with respect to a discharge under this
subsection. The Secretary may not establish a separate
fee schedule for such additional payment for such
services and technologies, by utilizing a methodology
established under subsection (a) or (h) of section 1834
to determine the amount of such additional payment, or
by other similar mechanisms or methodologies.
"(vi) For purposes of this subparagraph and
subparagraph (L), a medical service or technology will
be considered a 'new medical service or technology' if
the service or technology meets criteria established by
the Secretary after notice and an opportunity for public
comment.
"(L)(i) In establishing the mechanism under subparagraph
(K), the Secretary may establish new-technology groups into
which a new medical service or technology will be classified
if, based on the estimated average costs incurred with
respect to discharges involving such service or technology,
the DRG prospective payment rate otherwise applicable to
such discharges under this subsection is inadequate.
"(ii) Such groups --
"(I) shall not be based on the costs associated
with a specific new medical service or technology;
but
"(II) shall, in combination with the applicable
standardized amounts and the weighting factors
assigned to such groups under paragraph (4)(B),
reflect such cost cohorts as the Secretary
determines are appropriate for all new medical
services and technologies that are likely to be
provided as inpatient hospital services in a fiscal
year.
"(iii) The methodology for classifying specific
hospital discharges within a diagnosis-related group
under paragraph (4)(A) or a new-technology group shall
provide that a specific hospital discharge may not be
classified within both a diagnosis-related group and a
new-technology group.".
(2) Prior consultation. -- The Secretary of Health and Human
Services shall consult with groups representing hospitals,
physicians, and manufacturers of new medical technologies before
publishing the notice of proposed rulemaking required by section
1886(d)(5)(K)(i) of the Social Security Act (as added by
paragraph (1)).
(3) Conforming amendment. -- Section 1886(d)(4)(C)(i) (42
U.S.C. 1395ww(d)(4)(C)(i)) is amended by striking "technology,"
and inserting "technology (including a new medical service or
technology under paragraph (5)(K)),".
Subtitle E -- Other Provisions
SEC. 541. INCREASE IN REIMBURSEMENT FOR BAD DEBT.
Section 1861(v)(1)(T) (42 U.S.C. 1395x(v)(1)(T)) is amended --
(1) in clause (ii), by striking "and" at the end;
(2) in clause (iii) --
(A) by striking "during a subsequent fiscal year" and
inserting "during fiscal year 2000"; and
(B) by striking the period at the end and inserting ",
and"; and
(3) by adding at the end the following new clause:
"(iv) for cost reporting periods beginning during a
subsequent fiscal year, by 30 percent of such amount
otherwise allowable.".
SEC. 542. TREATMENT OF CERTAIN PHYSICIAN PATHOLOGY SERVICES UNDER
MEDICARE.
(a) In General. -- When an independent laboratory furnishes the
technical component of a physician pathology service to a fee-for-
service medicare beneficiary who is an inpatient or outpatient of a
covered hospital, the Secretary of Health and Human Services shall
treat such component as a service for which payment shall be made to
the laboratory under section 1848 of the Social Security Act (42
U.S.C. 1395w 4) and not as an inpatient hospital service for which
payment is made to the hospital under section 1886(d) of such Act (42
U.S.C. 1395ww(d)) or as an outpatient hospital service for which
payment is made to the hospital under section 1833(t) of such Act (42
U.S.C. 1395l(t)).
(b) Definitions. -- For purposes of this section:
(1) Covered hospital. -- The term "covered hospital" means,
with respect to an inpatient or an outpatient, a hospital that
had an arrangement with an independent laboratory that was in
effect as of July 22, 1999, under which a laboratory furnished
the technical component of physician pathology services to fee-
for-service medicare beneficiaries who were hospital inpatients
or outpatients, respectively, and submitted claims for payment
for such component to a medicare carrier (that has a contract
with the Secretary under section 1842 of the Social Security
Act, 42 U.S.C. 1395u) and not to such hospital.
(2) Fee-for-service medicare beneficiary. -- The term "fee-
for-service medicare beneficiary" means an individual who --
(A) is entitled to benefits under part A, or enrolled
under part B, or both, of such title; and
(B) is not enrolled in any of the following:
(i) A Medicare+Choice plan under part C of such
title.
(ii) A plan offered by an eligible organization
under section 1876 of such Act (42 U.S.C. 1395mm).
(iii) A program of all-inclusive care for the
elderly (PACE) under section 1894 of such Act (42 U.S.C.
1395eee).
(iv) A social health maintenance organization (SHMO)
demonstration project established under section 4018(b)
of the Omnibus Budget Reconciliation Act of 1987 (Public
Law 100 203).
(c) Effective Date. -- This section applies to services
furnished during the 2-year period beginning on January 1, 2001. (d)
GAO Report. --
(1) Study. -- The Comptroller General of the United States
shall conduct a study of the effects of the previous provisions
of this section on hospitals and laboratories and access of fee-
for-service medicare beneficiaries to the technical component of
physician pathology services.
(2) Report. -- Not later than April 1, 2002, the Comptroller
General shall submit to Congress a report on such study. The
report shall include recommendations about whether such
provisions should be extended after the end of the period
specified in subsection (c) for either or both inpatient and
outpatient hospital services, and whether the provisions should
be extended to other hospitals.
SEC. 543. EXTENSION OF ADVISORY OPINION AUTHORITY.
Section 1128D(b)(6) (42 U.S.C. 1320a 7d(b)(6)) is amended by
striking "and before the date which is 4 years after such date of
enactment".
SEC. 544. CHANGE IN ANNUAL MEDPAC REPORTING.
(a) Revision of Deadlines for Submission of Reports. --
(1) In general. -- Section 1805(b)(1)(D) (42 U.S.C. 1395b
6(b)(1)(D)) is amended by striking "June 1 of each year
(beginning with 1998)," and inserting "June 15 of each year,".
(2) Effective date. -- The amendment made by paragraph (1)
applies beginning with 2001.
(b) Requirement for on the Record Votes on Recommendations. --
Section 1805(b) (42 U.S.C. 1395b 6(b)) is amended by adding at the
end the following new paragraph:
"(7) Voting and reporting requirements. -- With respect to
each recommendation contained in a report submitted under
paragraph (1), each member of the Commission shall vote on the
recommendation, and the Commission shall include, by member, the
results of that vote in the report containing the
recommendation.".
SEC. 545. DEVELOPMENT OF PATIENT ASSESSMENT INSTRUMENTS.
(a) Development. --
(1) In general. -- Not later than January 1, 2005, the
Secretary of Health and Human Services shall submit to the
Committee on Ways and Means and the Committee on Commerce of the
House of Representatives and the Committee on Finance of the
Senate a report on the development of standard instruments for
the assessment of the health and functional status of patients,
for whom items and services described in subsection (b) are
furnished, and include in the report a recommendation on the use
of such standard instruments for payment purposes.
(2) Design for comparison of common elements. -- The
Secretary shall design such standard instruments in a manner
such that --
(A) elements that are common to the items and services
described in subsection (b) may be readily comparable and
are statistically compatible;
(B) only elements necessary to meet program objectives
are collected; and
(C) the standard instruments supersede any other
assessment instrument used before that date.
(3) Consultation. -- In developing an assessment instrument
under paragraph (1), the Secretary shall consult with the
Medicare Payment Advisory Commission, the Agency for Healthcare
Research and Quality, and qualified organizations representing
providers of services and suppliers under title XVIII.
(b) Description of Services. -- For purposes of subsection (a),
items and services described in this subsection are those items and
services furnished to individuals entitled to benefits under part A,
or enrolled under part B, or both of title XVIII of the Social
Security Act for which payment is made under such title, and include
the following:
(1) Inpatient and outpatient hospital services.
(2) Inpatient and outpatient rehabilitation services.
(3) Covered skilled nursing facility services.
(4) Home health services.
(5) Physical or occupational therapy or speech-language
pathology services.
(6) Items and services furnished to such individuals
determined to have end stage renal disease.
(7) Partial hospitalization services and other mental health
services.
(8) Any other service for which payment is made under such
title as the Secretary determines to be appropriate.
SEC. 546. GAO REPORT ON IMPACT OF THE EMERGENCY MEDICAL TREATMENT AND
ACTIVE LABOR ACT (EMTALA) ON HOSPITAL EMERGENCY DEPARTMENTS.
(a) Report. -- The Comptroller General of the United States
shall submit a report to the Committee on Commerce and the Committee
on Ways and Means of the House of Representatives and the Committee
on Finance of the Senate by May 1, 2001, 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. (b) Report Requirements. -- The
report should evaluate --
(1) the extent to which hospitals, emergency physicians, and
physicians covering emergency department call provide
uncompensated services in relation to the requirements of
EMTALA;
(2) the extent to which the regulatory requirements and
enforcement of EMTALA have expanded beyond the legislation's
original intent;
(3) estimates for the total dollar amount of EMTALA-related
care uncompensated costs to emergency physicians, physicians
covering emergency department call, hospital emergency
departments, and other hospital services;
(4) the extent to which different portions of the United
States may be experiencing different levels of uncompensated
EMTALA-related care;
(5) the extent to which EMTALA would be classified as an
unfunded mandate if it were enacted today;
(6) the extent to which States have programs to provide
financial support for such uncompensated care;
(7) possible sources of funds, including medicare hospital
bad debt accounts, that are available to hospitals to assist
with the cost of such uncompensated care; and
(8) the financial strain that illegal immigration
populations, the uninsured, and the underinsured place on
hospital emergency departments, other hospital services,
emergency physicians, and physicians covering emergency
department call.
(c) Definition. -- In this section, the terms "Emergency Medical
Treatment and Active Labor Act" and "EMTALA" mean section 1867 of the
Social Security Act (42 U.S.C. 1395dd).
TITLE VI -- PROVISIONS RELATING TO PART C (MEDICARE+CHOICE PROGRAM)
AND OTHER MEDICARE MANAGED CARE PROVISIONS
Subtitle A -- Medicare+Choice Payment Reforms
SEC. 601. INCREASE IN MINIMUM PAYMENT AMOUNT.
Section 1853(c)(1)(B)(ii) (42 U.S.C. 1395w 23(c)(1)(B)(ii)) is
amended --
(1) by striking "(ii) For a succeeding year" and inserting
"(ii)(I) Subject to subclauses (II) and (III), for a succeeding
year"; and
(2) by adding at the end the following new subclauses:
"(II) For 2001, for any area in a Metropolitan
Statistical Area within any of the 50 States and the
District of Columbia with a population of more than
250,000, $525 (and for any other area within any of
the 50 States, $475).
"(III) For 2001, for any area in a Metropolitan
Statistical Area outside the 50 States and the
District of Columbia with a population of more than
250,000, $525 (and for any other area outside the 50
States and the District of Columbia, $475), but not
to exceed 120 percent of the amount determined under
this subparagraph for such area for 2000.".
SEC. 602. INCREASE IN MINIMUM PERCENTAGE INCREASE.
Section 1853(c)(1)(C)(ii) (42 U.S.C. 1395w 23(c)(1)(C)(ii)) is
amended by inserting "(or 103 percent in the case of 2001)" after
"102 percent".
SEC. 603. 10-YEAR PHASE-IN OF RISK ADJUSTMENT.
Section 1853(a)(3)(C)(ii) (42 U.S.C. 1395w 23(a)(3)(C)(ii)) is
amended --
(1) in subclause (I), by striking "and 2001" and inserting
"and each succeeding year through the first year in which risk
adjustment is based on data from inpatient hospital and
ambulatory settings"; and
(2) by amending subclause (II) to read as follows:
"(II) beginning after such first year, insofar
as such risk adjustment is based on data from
inpatient hospital and ambulatory settings, the
methodology shall be phased in equal increments over
a 10-year period that begins with such first year.".
SEC. 604. TRANSITION TO REVISED MEDICARE+CHOICE PAYMENT RATES.
(a) Announcement of Revised Medicare+Choice Payment Rates. --
Within 2 weeks after the date of the enactment of this Act, the
Secretary of Health and Human Services shall determine, and shall
announce (in a manner intended to provide notice to interested
parties) Medicare+Choice capitation rates under section 1853 of the
Social Security Act (42 U.S.C. 1395w 23) for 2001, revised in
accordance with the provisions of this Act.
(b) Reentry Into Program Permitted for Medicare+Choice Programs
in 2000. -- A Medicare+Choice organization that provided notice to
the Secretary of Health and Human Services before the date of the
enactment of this Act that it was terminating its contract under part
C of title XVIII of the Social Security Act or was reducing the
service area of a Medicare+Choice plan offered under such part shall
be permitted to continue participation under such part, or to
maintain the service area of such plan, for 2001 if it provides the
Secretary with the information described in section 1854(a)(1) of the
Social Security Act (42 U.S.C. 1395w 24(a)(1)) within 2 weeks after
the date revised rates are announced by the Secretary under
subsection (a).
(c) Revised Submission of Proposed Premiums and Related
Information. -- If --
(1) a Medicare+Choice organization provided notice to the
Secretary of Health and Human Services as of July 3, 2000, that
it was renewing its contract under part C of title XVIII of the
Social Security Act for all or part of the service area or areas
served under its current contract, and
(2) any part of the service area or areas addressed in such
notice includes a payment area for which the Medicare+Choice
capitation rate under section 1853(c) of such Act (42 U.S.C.
1395w 23(c)) for 2001, as determined under subsection (a), is
higher than the rate previously determined for such year, such
organization shall revise its submission of the information
described in section 1854(a)(1) of the Social Security Act (42
U.S.C. 1395w 24(a)(1)), and shall submit such revised
information to the Secretary, within 2 weeks after the date
revised rates are announced by the Secretary under subsection
(a). In making such submission, the organization may only reduce
premiums, cost-sharing, enhance benefits, or utilize the
stabilization fund described in section 1854(f)(2) of such Act
(42 U.S.C. 1395w 24(f)(2)).
(d) Disregard of New Rate Announcement in Applying Pass-Through
for New National Coverage Determinations. -- For purposes of applying
section 1852(a)(5) of the Social Security Act (42 U.S.C. 1395w
22(a)(5)), the announcement of revised rates under subsection (a)
shall not be treated as an announcement under section 1853(b) of such
Act (42 U.S.C. 1395w 23(b)).
SEC. 605. REVISION OF PAYMENT RATES FOR ESRD PATIENTS ENROLLED IN
MEDICARE+CHOICE PLANS.
(a) In General. -- Section 1853(a)(1)(B) (42 U.S.C. 1395w
23(a)(1)(B)) is amended by adding at the end the following: "In
establishing such rates, the Secretary shall provide for appropriate
adjustments to increase each rate to reflect the demonstration rate
(including the risk adjustment methodology associated with such rate)
of the social health maintenance organization end-stage renal disease
capitation demonstrations (established by section 2355 of the Deficit
Reduction Act of 1984, as amended by section 13567(b) of the Omnibus
Budget Reconciliation Act of 1993), and shall compute such rates by
taking into account such factors as renal treatment modality, age,
and the underlying cause of the end-stage renal disease.".
(b) Effective Date. -- The amendment made by subsection (a)
shall apply to payments for months beginning with January 2002.
(c) Publication. -- Not later than 6 months after the date of
the enactment of this Act, the Secretary of Health and Human Services
shall publish for public comment a description of the appropriate
adjustments described in the last sentence of section 1853(a)(1)(B)
of the Social Security Act (42 U.S.C. 1395w 23(a)(1)(B)), as added by
subsection (a). The Secretary shall publish such adjustments in final
form by not later than July 1, 2001, so that the amendment made by
subsection (a) is implemented on a timely basis consistent with
subsection (b).
SEC. 606. PERMITTING PREMIUM REDUCTIONS AS ADDITIONAL BENEFITS UNDER
MEDICARE+CHOICE PLANS.
(a) In General. --
(1) Authorization of part b premium reductions. -- Section
1854(f)(1) (42 U.S.C. 1395w 24(f)(1)) is amended --
(A) by redesignating subparagraph (E) as subparagraph
(F); and
(B) by inserting after subparagraph (D) the following
new subparagraph:
"(E) Premium reductions. --
"(i) In general. -- Subject to clause (ii), as part
of providing any additional benefits required under
subparagraph (A), a Medicare+Choice organization may
elect a reduction in its payments under section
1853(a)(1)(A) with respect to a Medicare+Choice plan and
the Secretary shall apply such reduction to reduce the
premium under section 1839 of each enrollee in such plan
as provided in section 1840(i).
"(ii) Amount of reduction. -- The amount of the
reduction under clause (i) with respect to any enrollee
in a Medicare+Choice plan --
"(I) may not exceed 125 percent of the premium
described under section 1839(a)(3); and
"(II) shall apply uniformly to each enrollee of
the Medicare+Choice plan to which such reduction
applies.".
(2) Conforming amendments. --
(A) Adjustment of payments to medicare+choice
organizations. -- Section 1853(a)(1)(A) (42 U.S.C. 1395w
23(a)(1)(A)) is amended by inserting "reduced by the amount
of any reduction elected under section 1854(f)(1)(E) and"
after "for that area,".
(B) Adjustment and payment of part b premiums. --
(i) Adjustment of premiums. -- Section 1839(a)(2)
(42 U.S.C. 1395r(a)(2)) is amended by striking "shall"
and all that follows and inserting the following: "shall
be the amount determined under paragraph (3), adjusted
as required in accordance with subsections (b), (c), and
(f), and to reflect 80 percent of any reduction elected
under section 1854(f)(1)(E).".
(ii) Payment of premiums. -- Section 1840 (42 U.S.C.
1395s) is amended by adding at the end the following new
subsection:
"(i) In the case of an individual enrolled in a
Medicare+Choice plan, the Secretary shall provide for
necessary adjustments of the monthly beneficiary premium
to reflect 80 percent of any reduction elected under
section 1854(f)(1)(E). This premium adjustment may be
provided directly or as an adjustment to any social
security, railroad retirement, and civil service
retirement benefits, to the extent which the Secretary
determines that such an adjustment is appropriate with
the concurrence of the agencies responsible for the
administration of such benefits.".
(C) Information comparing plan premiums under part c. --
Section 1851(d)(4)(B) (42 U.S.C. 1395w 21(d)(4)(B)) is
amended --
(i) by striking " Premiums. -- The" and inserting "
Premiums. --
"(i) In general. -- The"; and
(ii) by adding at the end the following new clause:
"(ii) Reductions. -- The reduction in part B
premiums, if any.".
(D) Treatment of reduction for purposes of determining
government contribution under part b. -- Section 1844 (42
U.S.C. 1395w) is amended by adding at the end the following
new subsection:
"(c) The Secretary shall determine the Government contribution
under subparagraphs (A) and (B) of subsection (a)(1) without regard
to any premium reduction resulting from an election under section
1854(f)(1)(E).".
(b) Effective Date. -- The amendments made by subsection (a)
shall apply to years beginning with 2002.
SEC. 607. FULL IMPLEMENTATION OF RISK ADJUSTMENT FOR CONGESTIVE HEART
FAILURE ENROLLEES FOR 2001.
(a) In General. -- Section 1853(a)(3)(C) (42 U.S.C. 1395w
23(a)(3)(C)) is amended --
(1) in clause (ii), by striking "Such risk adjustment" and
inserting "Except as provided in clause (iii), such risk
adjustment"; and
(2) by adding at the end the following new clause:
"(iii) Full implementation of risk adjustment for
congestive heart failure enrollees for 2001. --
"(I) Exemption from phase-in. -- Subject to
subclause (II), the Secretary shall fully implement
the risk adjustment methodology described in clause
(i) with respect to each individual who has had a
qualifying congestive heart failure inpatient
diagnosis (as determined by the Secretary under such
risk adjustment methodology) during the period
beginning on July 1, 1999, and ending on June 30,
2000, and who is enrolled in a coordinated care plan
that is the only coordinated care plan offered on
January 1, 2001, in the service area of the
individual.
"(II) Period of application. -- Subclause (I)
shall only apply during the 1-year period beginning
on January 1, 2001.".
(b) Exclusion From Determination of the Budget Neutrality
Factor. -- Section 1853(c)(5) (42 U.S.C. 1395w 23(c)(5)) is amended
by striking "subsection (i)" and inserting "subsections
(a)(3)(C)(iii) and (i)".
SEC. 608. EXPANSION OF APPLICATION OF MEDICARE+CHOICE NEW ENTRY
BONUS.
(a) In General. -- Section 1853(i)(1) (42 U.S.C. 1395w 23(i)(1))
is amended in the matter preceding subparagraph (A) by inserting ",
or filed notice with the Secretary as of October 3, 2000, that they
will not be offering such a plan as of January 1, 2001" after
"January 1, 2000".
(b) Effective Date. -- The amendment made by subsection (a)
shall apply as if included in the enactment of BBRA.
SEC. 609. REPORT ON INCLUSION OF CERTAIN COSTS OF THE DEPARTMENT OF
VETERANS AFFAIRS AND MILITARY FACILITY SERVICES IN CALCULATING
MEDICARE+CHOICE PAYMENT RATES.
The Secretary of Health and Human Services shall report to
Congress by not later than January 1, 2003, on a method to phase-in
the costs of military facility services furnished by the Department
of Veterans Affairs, and the costs of military facility services
furnished by the Department of Defense, to medicare-eligible
beneficiaries in the calculation of an area's Medicare+Choice
capitation payment. Such report shall include on a county-by-county
basis --
(1) the actual or estimated cost of such services to
medicare-eligible beneficiaries;
(2) the change in Medicare+Choice capitation payment rates
if such costs are included in the calculation of payment rates;
(3) one or more proposals for the implementation of payment
adjustments to Medicare+Choice plans in counties where the
payment rate has been affected due to the failure to calculate
the cost of such services to medicare-eligible beneficiaries;
and
(4) a system to ensure that when a Medicare+Choice enrollee
receives covered services through a facility of the Department
of Veterans Affairs or the Department of Defense there is an
appropriate payment recovery to the medicare program under title
XVIII of the Social Security Act.
Subtitle B -- Other Medicare+Choice Reforms
SEC. 611. PAYMENT OF ADDITIONAL AMOUNTS FOR NEW BENEFITS COVERED
DURING A CONTRACT TERM.
(a) In General. -- Section 1853(c)(7) (42 U.S.C. 1395w 23(c)(7))
is amended to read as follows:
"(7) Adjustment for national coverage determinations and
legislative changes in benefits. -- If the Secretary makes a
determination with respect to coverage under this title or there
is a change in benefits required to be provided under this part
that the Secretary projects will result in a significant
increase in the costs to Medicare+Choice of providing benefits
under contracts under this part (for periods after any period
described in section 1852(a)(5)), the Secretary shall adjust
appropriately the payments to such organizations under this
part. Such projection and adjustment shall be based on an
analysis by the Chief Actuary of the Health Care Financing
Administration of the actuarial costs associated with the new
benefits.".
(b) Conforming Amendment. -- Section 1852(a)(5) (42 U.S.C. 1395w
22(a)(5)) is amended --
(1) in the heading, by inserting " and legislative changes
in benefits" after " National coverage determinations";
(2) by inserting "or legislative change in benefits required
to be provided under this part" after "national coverage
determination";
(3) in subparagraph (A), by inserting "or legislative change
in benefits" after "such determination";
(4) in subparagraph (B), by inserting "or legislative
change" after "if such coverage determination"; and
(5) by adding at the end the following:
"The projection under the previous sentence shall be based on an
analysis by the Chief Actuary of the Health Care Financing
Administration of the actuarial costs associated with the coverage
determination or legislative change in benefits.".
(c) Effective Date. -- The amendments made by this section are
effective on the date of the enactment of this Act and apply to
national coverage determinations and legislative changes in benefits
occurring on or after such date.
SEC. 612. RESTRICTION ON IMPLEMENTATION OF SIGNIFICANT NEW REGULATORY
REQUIREMENTS MIDYEAR.
(a) In General. -- Section 1856(b) (42 U.S.C. 1395w 26(b)) is
amended by adding at the end the following new paragraph:
"(4) Prohibition of midyear implementation of significant
new regulatory requirements. -- The Secretary may not implement,
other than at the beginning of a calendar year, regulations
under this section that impose new, significant regulatory
requirements on a Medicare+Choice organization or plan.".
(b) Effective Date. -- The amendment made by subsection (a)
takes effect on the date of the enactment of this Act.
SEC. 613. TIMELY APPROVAL OF MARKETING MATERIAL THAT FOLLOWS MODEL
MARKETING LANGUAGE.
(a) In General. -- Section 1851(h) (42 U.S.C. 1395w 21(h)) is
amended --
(1) in paragraph (1)(A), by inserting "(or 10 days in the
case described in paragraph (5))" after "45 days"; and
(2) by adding at the end the following new paragraph:
"(5) Special treatment of marketing material following model
marketing language. -- In the case of marketing material of an
organization that uses, without modification, proposed model
language specified by the Secretary, the period specified in
paragraph (1)(A) shall be reduced from 45 days to 10 days.".
(b) Effective Date. -- The amendments made by subsection (a)
apply to marketing material submitted on or after January 1, 2001.
SEC. 614. AVOIDING DUPLICATIVE REGULATION.
(a) In General. -- Section 1856(b)(3)(B) (42 U.S.C. 1395w
26(b)(3)(B)) is amended --
(1) in clause (i), by inserting "(including cost-sharing
requirements)" after "Benefit requirements"; and
(2) by adding at the end the following new clause:
"(iv) Requirements relating to marketing materials
and summaries and schedules of benefits regarding a
Medicare+Choice plan.".
(b) Effective Date. -- The amendments made by subsection (a)
take effect on the date of the enactment of this Act.
SEC. 615. ELECTION OF UNIFORM LOCAL COVERAGE POLICY FOR
MEDICARE+CHOICE PLAN COVERING MULTIPLE LOCALITIES.
Section 1852(a)(2) (42 U.S.C. 1395w 22(a)(2)) is amended by
adding at the end the following new subparagraph:
"(C) Election of uniform coverage policy. -- 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 (as identified by
the Secretary) apply with respect to all Medicare+Choice
enrollees enrolled in the plan.".
SEC. 616. ELIMINATING HEALTH DISPARITIES IN MEDICARE+CHOICE PROGRAM.
(a) Quality Assurance Program Focus on Racial and Ethnic
Minorities. -- Subparagraphs (A) and (B) of section 1852(e)(2) (42
U.S.C. 1395w 22(e)(2)) are each amended by adding at the end the
following: "Such program shall include a separate focus (with respect
to all the elements described in this subparagraph) on racial and
ethnic minorities.".
(b) Report. -- Section 1852(e) (42 U.S.C. 1395w 22(e)) is
amended by adding at the end the following new paragraph:
"(5) Report to congress. --
"(A) In general. -- Not later than 2 years after the
date of the enactment of this paragraph, and biennially
thereafter, the Secretary shall submit to Congress a report
regarding how quality assurance programs conducted under
this subsection focus on racial and ethnic minorities.
"(B) Contents of report. -- Each such report shall
include the following:
"(i) A description of the means by which such
programs focus on such racial and ethnic minorities.
"(ii) An evaluation of the impact of such programs
on eliminating health disparities and on improving
health outcomes, continuity and coordination of care,
management of chronic conditions, and consumer
satisfaction.
"(iii) Recommendations on ways to reduce clinical
outcome disparities among racial and ethnic
minorities.".
SEC. 617. MEDICARE+CHOICE PROGRAM COMPATIBILITY WITH EMPLOYER OR
UNION GROUP HEALTH PLANS.
(a) In General. -- Section 1857 (42 U.S.C. 1395w 27) is amended
by adding at the end the following new subsection:
"(i) Medicare+Choice Program Compatibility With
Employer or Union Group Health Plans. -- To facilitate
the offering of Medicare+Choice plans under contracts
between Medicare+Choice organizations and employers,
labor organizations, or the trustees of a fund
established by 1 or more employers or labor
organizations (or combination thereof) to furnish
benefits to the entity's employees, former employees (or
combination thereof) or members or former members (or
combination thereof) of the labor organizations, the
Secretary may waive or modify requirements that hinder
the design of, the offering of, or the enrollment in
such Medicare+Choice plans.".
(b) Effective Date. -- The amendment made by subsection (a)
applies with respect to years beginning with 2001.
SEC. 618. SPECIAL MEDIGAP ENROLLMENT ANTIDISCRIMINATION PROVISION FOR
CERTAIN BENEFICIARIES.
(a) Disenrollment Window in Accordance With Beneficiary's
Circumstance. -- Section 1882(s)(3) (42 U.S.C. 1395ss(s)(3)) is
amended --
(1) in subparagraph (A), in the matter following clause
(iii), by striking ", subject to subparagraph (E), seeks to
enroll under the policy not later than 63 days after the date of
the termination of enrollment described in such subparagraph"
and inserting "seeks to enroll under the policy during the
period specified in subparagraph (E)"; and
(2) by striking subparagraph (E) and inserting the following
new subparagraph:
"(E) For purposes of subparagraph (A), the time period
specified in this subparagraph is --
"(i) in the case of an individual described in
subparagraph (B)(i), the period beginning on the date
the individual receives a notice of termination or
cessation of all supplemental health benefits (or, if no
such notice is received, notice that a claim has been
denied because of such a termination or cessation) and
ending on the date that is 63 days after the applicable
notice;
"(ii) in the case of an individual described in
clause (ii), (iii), (v), or (vi) of subparagraph (B)
whose enrollment is terminated involuntarily, the period
beginning on the date that the individual receives a
notice of termination and ending on the date that is 63
days after the date the applicable coverage is
terminated;
"(iii) in the case of an individual described in
subparagraph (B)(iv)(I), the period beginning on the
earlier of (I) the date that the individual receives a
notice of termination, a notice of the issuer's
bankruptcy or insolvency, or other such similar notice,
if any, and (II) the date that the applicable coverage
is terminated, and ending on the date that is 63 days
after the date the coverage is terminated;
"(iv) in the case of an individual described in
clause (ii), (iii), (iv)(II), (iv)(III), (v), or (vi) of
subparagraph (B) who disenrolls voluntarily, the period
beginning on the date that is 60 days before the
effective date of the disenrollment and ending on the
date that is 63 days after such effective date; and
"(v) in the case of an individual described in
subparagraph (B) but not described in the preceding
provisions of this subparagraph, the period beginning on
the effective date of the disenrollment and ending on
the date that is 63 days after such effective date.".
(b) Extended Medigap Access for Interrupted Trial Periods. --
Section 1882(s)(3) (42 U.S.C. 1395ss(s)(3)), as amended by subsection
(a), is further amended by adding at the end the following new
subparagraph:
"(F)(i) Subject to clause (ii), for purposes of this
paragraph --
"(I) in the case of an individual described in
subparagraph (B)(v) (or deemed to be so described,
pursuant to this subparagraph) whose enrollment with
an organization or provider described in subclause
(II) of such subparagraph is involuntarily
terminated within the first 12 months of such
enrollment, and who, without an intervening
enrollment, enrolls with another such organization
or provider, such subsequent enrollment shall be
deemed to be an initial enrollment described in such
subparagraph; and
"(II) in the case of an individual described in
clause (vi) of subparagraph (B) (or deemed to be so
described, pursuant to this subparagraph) whose
enrollment with a plan or in a program described in
such clause is involuntarily terminated within the
first 12 months of such enrollment, and who, without
an intervening enrollment, enrolls in another such
plan or program, such subsequent enrollment shall be
deemed to be an initial enrollment described in such
clause.
"(ii) For purposes of clauses (v) and (vi) of
subparagraph (B), no enrollment of an individual with an
organization or provider described in clause (v)(II), or
with a plan or in a program described in clause (vi),
may be deemed to be an initial enrollment under this
clause after the 2-year period beginning on the date on
which the individual first enrolled with such an
organization, provider, plan, or program.".
SEC. 619. RESTORING EFFECTIVE DATE OF ELECTIONS AND CHANGES OF
ELECTIONS OF MEDICARE+CHOICE PLANS.
(a) Open Enrollment. -- Section 1851(f)(2) (42 U.S.C. 1395w
21(f)(2)) is amended by striking ", except that if such election or
change is made after the 10th day of any calendar month, then the
election or change shall not take effect until the first day of the
second calendar month following the date on which the election or
change is made".
(b) Effective Date. -- The amendment made by this section shall
apply to elections and changes of coverage made on or after January
1, 2001.
SEC. 620. PERMITTING ESRD BENEFICIARIES TO ENROLL IN ANOTHER
MEDICARE+CHOICE PLAN IF THE PLAN IN WHICH THEY ARE ENROLLED IS
TERMINATED.
(a) In General. -- Section 1851(a)(3)(B) (42 U.S.C. 1395w
21(a)(3)(B)) is amended by striking "except that" and all that
follows and inserting the following: "except that --
"(i) an individual who develops end-stage renal
disease while enrolled in a Medicare+Choice plan may
continue to be enrolled in that plan; and
"(ii) in the case of such an individual who is
enrolled in a Medicare+Choice plan under clause (i) (or
subsequently under this clause), if the enrollment is
discontinued under circumstances described in section
1851(e)(4)(A), then the individual will be treated as a
'Medicare+Choice eligible individual' for purposes of
electing to continue enrollment in another
Medicare+Choice plan.".
(b) Effective Date. --
(1) In general. -- The amendment made by subsection (a)
shall apply to terminations and discontinuations occurring on or
after the date of the enactment of this Act.
(2) Application to prior plan terminations. -- Clause (ii)
of section 1851(a)(3)(B) of the Social Security Act (as inserted
by subsection (a)) also shall apply to individuals whose
enrollment in a Medicare+Choice plan was terminated or
discontinued after December 31, 1998, and before the date of the
enactment of this Act. In applying this paragraph, such an
individual shall be treated, for purposes of part C of title
XVIII of the Social Security Act, as having discontinued
enrollment in such a plan as of the date of the enactment of
this Act.
SEC. 621. PROVIDING CHOICE FOR SKILLED NURSING FACILITY SERVICES
UNDER THE MEDICARE+CHOICE PROGRAM.
(a) In General. -- Section 1852 (42 U.S.C. 1395w 22) is amended
by adding at the end the following new subsection:
"(l) Return to Home Skilled Nursing Facilities for Covered Post-
Hospital Extended Care Services. --
"(1) Ensuring return to home snf. --
"(A) In general. -- In providing coverage of post-
hospital extended care services, a Medicare+Choice plan
shall provide for such coverage through a home skilled
nursing facility if the following conditions are met:
"(i) Enrollee election. -- The enrollee elects to
receive such coverage through such facility.
"(ii) SNF agreement. -- The facility has a contract
with the Medicare+Choice organization for the provision
of such services, or the facility agrees to accept
substantially similar payment under the same terms and
conditions that apply to similarly situated skilled
nursing facilities that are under contract with the
Medicare+Choice organization for the provision of such
services and through which the enrollee would otherwise
receive such services.
"(B) Manner of payment to home snf. -- The organization
shall provide payment to the home skilled nursing facility
consistent with the contract or the agreement described in
subparagraph (A)(ii), as the case may be.
"(2) No less favorable coverage. -- The coverage provided
under paragraph (1) (including scope of services, cost-sharing,
and other criteria of coverage) shall be no less favorable to
the enrollee than the coverage that would be provided to the
enrollee with respect to a skilled nursing facility the post-
hospital extended care services of which are otherwise covered
under the Medicare+Choice plan.
"(3) Rule of construction. -- Nothing in this subsection
shall be construed to do the following:
"(A) To require coverage through a skilled nursing
facility that is not otherwise qualified to provide benefits
under part A for medicare beneficiaries not enrolled in a
Medicare+Choice plan.
"(B) To prevent a skilled nursing facility from refusing
to accept, or imposing conditions upon the acceptance of, an
enrollee for the receipt of post-hospital extended care
services.
"(4) Definitions. -- In this subsection:
"(A) Home skilled nursing facility. -- The term 'home
skilled nursing facility' means, with respect to an enrollee
who is entitled to receive post-hospital extended care
services under a Medicare+Choice plan, any of the following
skilled nursing facilities:
"(i) SNF residence at time of admission. -- The
skilled nursing facility in which the enrollee resided
at the time of admission to the hospital preceding the
receipt of such post-hospital extended care services.
"(ii) SNF in continuing care retirement community. -
- A skilled nursing facility that is providing such
services through a continuing care retirement community
(as defined in subparagraph (B)) which provided
residence to the enrollee at the time of such admission.
"(iii) SNF residence of spouse at time of discharge.
-- The skilled nursing facility in which the spouse of
the enrollee is residing at the time of discharge from
such hospital.
"(B) Continuing care retirement community. -- The term
'continuing care retirement community' means, with respect
to an enrollee in a Medicare+Choice plan, an arrangement
under which housing and health-related services are provided
(or arranged) through an organization for the enrollee under
an agreement that is effective for the life of the enrollee
or for a specified period.".
(b) Effective Date. -- The amendment made by subsection (a)
applies with respect to contracts entered into or renewed on or after
the date of the enactment of this Act. (c) MedPAC Study. --
(1) Study. -- The Medicare Payment Advisory Commission shall
conduct a study analyzing the effects of the amendment made by
subsection (a) on Medicare+Choice organizations. In conducting
such study, the Commission shall examine the effects (if any)
such amendment has had on --
(A) the scope of additional benefits provided under the
Medicare+Choice program;
(B) the administrative and other costs incurred by
Medicare+Choice organizations;
(C) the contractual relationships between such
organizations and skilled nursing facilities.
(2) Report. -- Not later than 2 years after the date of the
enactment of this Act, the Commission shall submit to Congress a
report on the study conducted under paragraph (1).
SEC. 622. PROVIDING FOR ACCOUNTABILITY OF MEDICARE+CHOICE PLANS.
(a) Mandatory Review of ACR Submissions by the Chief Actuary of
the Health Care Financing Administration. -- Section 1854(a)(5)(A)
(42 U.S.C. 1395w 24(a)(5)(A)) is amended --
(1) by striking "value" and inserting "values"; and
(2) by adding at the end the following: "The Chief Actuary
of the Health Care Financing Administration shall review the
actuarial assumptions and data used by the Medicare+Choice
organization with respect to such rates, amounts, and values so
submitted to determine the appropriateness of such assumptions
and data.".
(b) Effective Date. -- The amendment made by subsection (a)
applies to submissions made on or after January 1, 2001.
Subtitle C -- Other Managed Care Reforms
SEC. 631. 1-YEAR EXTENSION OF SOCIAL HEALTH MAINTENANCE ORGANIZATION
(SHMO) DEMONSTRATION PROJECT.
Section 4018(b)(1) of the Omnibus Budget Reconciliation Act of
1987, as amended by section 531(a)(1) of BBRA (113 Stat. 1501A 388),
is amended by striking "18 months" and inserting "30 months".
SEC. 632. REVISED TERMS AND CONDITIONS FOR EXTENSION OF MEDICARE
COMMUNITY NURSING ORGANIZATION (CNO) DEMONSTRATION PROJECT.
(a) In General. -- Section 532 of BBRA (113 Stat. 1501A 388) is
amended --
(1) in subsection (a), by striking the second sentence; and
(2) by striking subsection (b) and inserting the following
new subsection: "(b) Terms and Conditions. --
"(1) January through september 2000. -- For the 9-month
period beginning with January 2000, any such demonstration
project shall be conducted under the same terms and conditions
as applied to such demonstration during 1999.
"(2) October 2000 through december 2001. -- For the 15-month
period beginning with October 2000, any such demonstration
project shall be conducted under the same terms and conditions
as applied to such demonstration during 1999, except that the
following modifications shall apply:
"(A) Basic capitation rate. -- The basic capitation rate
paid for services covered under the project (other than case
management services) per enrollee per month and furnished
during --
"(i) the period beginning with October 1, 2000, and
ending with December 31, 2000, shall be determined by
actuarially adjusting the actual capitation rate paid
for such services in 1999 for inflation, utilization,
and other changes to the CNO service package, and by
reducing such adjusted capitation rate by 10 percent in
the case of the demonstration sites located in Arizona,
Minnesota, and Illinois, and 15 percent for the
demonstration site located in New York; and
"(ii) 2001 shall be determined by actuarially
adjusting the capitation rate determined under clause
(i) for inflation, utilization, and other changes to the
CNO service package.
"(B) Targeted case management fee. -- Effective October
1, 2000 --
"(i) the case management fee per enrollee per month
for --
"(I) the period described in subparagraph (A)(i)
shall be determined by actuarially adjusting the
case management fee for 1999 for inflation; and
"(II) 2001 shall be determined by actuarially
adjusting the amount determined under subclause (I)
for inflation; and
"(ii) such case management fee shall be paid only
for enrollees who are classified as moderately frail or
frail pursuant to criteria established by the Secretary.
"(C) Greater uniformity in clinical features among
sites. -- Each project shall implement for each site --
"(i) protocols for periodic telephonic contact with
enrollees based on --
"(I) the results of such standardized written
health assessment; and
"(II) the application of appropriate care
planning approaches;
"(ii) disease management programs for targeted
diseases (such as congestive heart failure, arthritis,
diabetes, and hypertension) that are highly prevalent in
the enrolled populations;
"(iii) systems and protocols to track enrollees
through hospitalizations, including pre-admission
planning, concurrent management during inpatient
hospital stays, and post-discharge assessment, planning,
and follow-up; and
"(iv) standardized patient educational materials for
specified diseases and health conditions.
"(D) Quality improvement. -- Each project shall
implement at each site once during the 15-month period --
"(i) enrollee satisfaction surveys; and
"(ii) reporting on specified quality indicators for
the enrolled population.
"(c) Evaluation. --
"(1) Preliminary report. -- Not later than July 1, 2001, the
Secretary of Health and Human Services shall submit to the
Committees on Ways and Means and Commerce of the House of
Representatives and the Committee on Finance of the Senate a
preliminary report that --
"(A) evaluates such demonstration projects for the
period beginning July 1, 1997, and ending December 31, 1999,
on a site-specific basis with respect to the impact on per
beneficiary spending, specific health utilization measures,
and enrollee satisfaction; and
"(B) includes a similar evaluation of such projects for
the portion of the extension period that occurs after
September 30, 2000.
"(2) Final report. -- The Secretary shall submit a final
report to such Committees on such demonstration projects not
later than July 1, 2002. Such report shall include the same
elements as the preliminary report required by paragraph (1),
but for the period after December 31, 1999.
"(3) Methodology for spending comparisons. -- Any evaluation
of the impact of the demonstration projects on per beneficiary
spending included in such reports shall include a comparison of
--
"(A) data for all individuals who --
"(i) were enrolled in such demonstration projects as
of the first day of the period under evaluation; and
"(ii) were enrolled for a minimum of 6 months
thereafter; with
"(B) data for a matched sample of individuals who are
enrolled under part B of title XVIII of the Social Security
Act and are not enrolled in such a project, or in a
Medicare+Choice plan under part C of such title, a plan
offered by an eligible organization under section 1876 of
such Act, or a health care prepayment plan under section
1833(a)(1)(A) of such Act.".
(b) Effective Date. -- The amendments made by subsection (a)
shall be effective as if included in the enactment of section 532 of
BBRA (113 Stat. 1501A 388).
SEC. 633. EXTENSION OF MEDICARE MUNICIPAL HEALTH SERVICES
DEMONSTRATION PROJECTS.
Section 9215(a) of the Consolidated Omnibus Budget
Reconciliation Act of 1985 (42 U.S.C. 1395b 1 note), as amended by
section 6135 of the Omnibus Budget Reconciliation Act of 1989,
section 13557 of the Omnibus Budget Reconciliation Act of 1993,
section 4017 of BBA, and section 534 of BBRA (113 Stat. 1501A 390),
is amended by striking "December 31, 2002" and inserting "December
31, 2004".
SEC. 634. SERVICE AREA EXPANSION FOR MEDICARE COST CONTRACTS DURING
TRANSITION PERIOD.
Section 1876(h)(5) (42 U.S.C. 1395mm(h)(5)) is amended --
(1) by redesignating subparagraph (B) as subparagraph (C);
and
(2) by inserting after subparagraph (A), the following new
subparagraph:
"(B) Subject to subparagraph (C), the Secretary shall
approve an application for a modification to a reasonable
cost contract under this section in order to expand the
service area of such contract if --
"(i) such application is submitted to the Secretary
on or before September 1, 2003; and
"(ii) the Secretary determines that the organization
with the contract continues to meet the requirements
applicable to such organizations and contracts under
this section.".
TITLE VII -- MEDICAID
SEC. 701. DSH PAYMENTS.
(a) Modifications to DSH Allotments. --
(1) Increased allotments for fiscal years 2001 and 2002. --
(A) In general. -- Section 1923(f) (42 U.S.C. 1396r
4(f)) is amended --
(i) in paragraph (2), by striking "The DSH
allotment" and inserting "Subject to paragraph (4), the
DSH allotment";
(ii) by redesignating paragraph (4) as paragraph
(6); and
(iii) by inserting after paragraph (3) the following
new paragraph:
"(4) Special rule for fiscal years 2001 and 2002. --
"(A) In general. -- Notwithstanding paragraph (2), the
DSH allotment for any State for --
"(i) fiscal year 2001, shall be the DSH allotment
determined under paragraph (2) for fiscal year 2000
increased, subject to subparagraph (B) and paragraph
(5), by the percentage change in the consumer price
index for all urban consumers (all items; U.S. city
average) for fiscal year 2000; and
"(ii) fiscal year 2002, shall be the DSH allotment
determined under clause (i) increased, subject to
subparagraph (B) and paragraph (5), by the percentage
change in the consumer price index for all urban
consumers (all items; U.S. city average) for fiscal year
2001.
"(B) Limitation. -- Subparagraph (B) of paragraph (3)
shall apply to subparagraph (A) of this paragraph in the
same manner as that subparagraph (B) applies to paragraph
(3)(A).
"(C) No application to allotments after fiscal year
2002. -- The DSH allotment for any State for fiscal year
2003 or any succeeding fiscal year shall be determined under
paragraph (3) without regard to the DSH allotments
determined under subparagraph (A) of this paragraph.".
(2) Special rule for medicaid dsh allotment for extremely
low dsh states. --
(A) In general. -- Section 1923(f) (42 U.S.C. 1396r
4(f)), as amended by paragraph (1), is amended by inserting
after paragraph (4) the following new paragraph:
"(5) Special rule for extremely low dsh states. -- In the
case of a State in which the total expenditures under the State
plan (including Federal and State shares) for disproportionate
share hospital adjustments under this section for fiscal year
1999, as reported to the Administrator of the Health Care
Financing Administration as of August 31, 2000, is greater than
O but less than 1 percent of the State's total amount of
expenditures under the State plan for medical assistance during
the fiscal year, the DSH allotment for fiscal year 2001 shall be
increased to 1 percent of the State's total amount of
expenditures under such plan for such assistance during such
fiscal year. In subsequent fiscal years, such increased
allotment is subject to an increase for inflation as provided in
paragraph (3)(A).".
(B) Conforming amendment. -- Section 1923(f)(3)(A) (42
U.S.C. 1396r 4(f)(3)(A)) is amended by inserting "and
paragraph (5)" after "subparagraph (B)".
(3) Effective date. -- The amendments made by paragraphs (1)
and (2) take effect on the date the final regulation required
under section 705(a) (relating to the application of an
aggregate upper payment limit test for State medicaid spending
for inpatient hospital services, outpatient hospital services,
nursing facility services, intermediate care facility services
for the mentally retarded, and clinic services provided by
government facilities that are not State-owned or operated
facilities) is published in the Federal Register.
(b) Assuring Identification of Medicaid Managed Care Patients. -
-
(1) In general. -- Section 1932 (42 U.S.C. 1396u 2) is
amended by adding at the end the following new subsection:
"(g) Identification of Patients for Purposes of Making DSH
Payments. -- Each contract with a managed care entity under section
1903(m) or under section 1905(t)(3) shall require the entity either -
-
"(1) to report to the State information necessary to
determine the hospital services provided under the contract (and
the identity of hospitals providing such services) for purposes
of applying sections 1886(d)(5)(F) and 1923; or
"(2) to include a sponsorship code in the identification
card issued to individuals covered under this title in order
that a hospital may identify a patient as being entitled to
benefits under this title.".
(2) Clarification of counting managed care medicaid
patients. -- Section 1923 (42 U.S.C. 1396r 4) is amended --
(A) in subsection (a)(2)(D), by inserting after "the
proportion of low-income and medicaid patients" the
following: "(including such patients who receive benefits
through a managed care entity)";
(B) in subsection (b)(2), by inserting after "a State
plan approved under this title in a period" the following:
"(regardless of whether such patients receive medical
assistance on a fee-for-service basis or through a managed
care entity)"; and
(C) in subsection (b)(3)(A)(i), by inserting after
"under a State plan under this title" the following:
"(regardless of whether the services were furnished on a
fee-for-service basis or through a managed care entity)".
(3) Effective dates. --
(A) The amendment made by paragraph (1) applies to
contracts as of January 1, 2001.
(B) The amendments made by paragraph (2) apply to
payments made on or after January 1, 2001.
(c) Application of Medicaid DSH Transition Rule to Public
Hospitals in All States. --
(1) In general. -- During the period described in paragraph
(3), with respect to a State, section 4721(e) of the Balanced
Budget Act of 1997 (Public Law 105 33; 111 Stat. 514), as
amended by section 607 of BBRA (113 Stat. 1501A 321) shall be
applied as though --
(A) "September 30, 2002" were substituted for "July 1,
1997" each place it appears;
(B) "hospitals owned or operated by a State (as defined
for purposes of title XIX of such Act), or by an
instrumentality or a unit of government within a State (as
so defined)" were substituted for "the State of California";
(C) paragraph (3) were redesignated as paragraph (4);
(D) "and" were omitted from the end of paragraph (2);
and
(E) the following new paragraph were inserted after
paragraph (2):
"(3) '(as defined in subparagraph (B) but without regard to
clause (ii) of that subparagraph and subject to subsection (d))'
were substituted for '(as defined in subparagraph (B))' in
subparagraph (A) of such section; and".
(2) Special rule. -- With respect to California, section
4721(e) of the Balanced Budget Act of 1997 (Public Law 105 33;
111 Stat. 514) shall be applied without regard to paragraph (1).
(3) Period described. -- The period described in this
paragraph is the period that begins, with respect to a State, on
the first day of the first State fiscal year that begins after
September 30, 2002, and ends on the last day of the succeeding
State fiscal year.
(4) Application to waivers. -- With respect to a State
operating under a waiver of the requirements of title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.) under section 1115
of such Act (42 U.S.C. 1315), the amount by which any payment
adjustment made by the State under title XIX of such Act (42
U.S.C. 1396 et seq.), after the application of section 4721(e)
of the Balanced Budget Act of 1997 under paragraph (1) to such
State, exceeds the costs of furnishing hospital services
provided by hospitals described in such section shall be fully
reflected as an increase in the baseline expenditure limit for
such waiver.
(d) Assistance for Certain Public Hospitals. --
(1) In general. -- Beginning with fiscal year 2002,
notwithstanding section 1923(f) of the Social Security Act (42
U.S.C. 1396r 4(f)) and subject to paragraph (3), with respect to
a State, payment adjustments made under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) to a hospital described in
paragraph (2) shall be made without regard to the DSH allotment
limitation for the State determined under section 1923(f) of
that Act (42 U.S.C. 1396r 4(f)).
(2) Hospital described. -- A hospital is described in this
paragraph if the hospital --
(A) is owned or operated by a State (as defined for
purposes of title XIX of the Social Security Act), or by an
instrumentality or a unit of government within a State (as
so defined);
(B) as of October 1, 2000 --
(i) is in existence and operating as a hospital
described in subparagraph (A); and
(ii) is not receiving disproportionate share
hospital payments from the State in which it is located
under title XIX of such Act; and
(C) has a low-income utilization rate (as defined in
section 1923(b)(3) of the Social Security Act (42 U.S.C.
1396r 4(b)(3))) in excess of 65 percent.
(3) Limitation on expenditures. --
(A) In general. -- With respect to any fiscal year, the
aggregate amount of Federal financial participation that may
be provided for payment adjustments described in paragraph
(1) for that fiscal year for all States may not exceed the
amount described in subparagraph (B) for the fiscal year.
(B) Amount described. -- The amount described in this
subparagraph for a fiscal year is as follows:
(i) For fiscal year 2002, $15,000,000.
(ii) For fiscal year 2003, $176,000,000.
(iii) For fiscal year 2004, $269,000,000.
(iv) For fiscal year 2005, $330,000,000.
(v) For fiscal year 2006 and each fiscal year
thereafter, $375,000,000.
(e) DSH Payment Accountability Standards. -- Not later than
September 30, 2002, the Secretary of Health and Human Services shall
implement accountability standards to ensure that Federal funds
provided with respect to disproportionate share hospital adjustments
made under section 1923 of the Social Security Act (42 U.S.C. 1396r
4) are used to reimburse States and hospitals eligible for such
payment adjustments for providing uncompensated health care to low-
income patients and are otherwise made in accordance with the
requirements of section 1923 of that Act.
SEC. 702. NEW PROSPECTIVE PAYMENT SYSTEM FOR FEDERALLY-QUALIFIED
HEALTH CENTERS AND RURAL HEALTH CLINICS.
(a) In General. -- Section 1902(a) (42 U.S.C. 1396a(a)) is
amended --
(1) in paragraph (13) --
(A) in subparagraph (A), by adding "and" at the end;
(B) in subparagraph (B), by striking "and" at the end;
and
(C) by striking subparagraph (C); and
(2) by inserting after paragraph (14) the following new
paragraph:
"(15) provide for payment for services described in clause
(B) or (C) of section 1905(a)(2) under the plan in accordance
with subsection (aa);".
(b) New Prospective Payment System. -- Section 1902 (42 U.S.C.
1396a) is amended by adding at the end the following:
"(aa) Payment for Services Provided by Federally-Qualified
Health Centers and Rural Health Clinics. --
"(1) In general. -- Beginning with fiscal year 2001 and each
succeeding fiscal year, the State plan shall provide for payment
for services described in section 1905(a)(2)(C) furnished by a
Federally-qualified health center and services described in
section 1905(a)(2)(B) furnished by a rural health clinic in
accordance with the provisions of this subsection.
"(2) Fiscal year 2001. -- Subject to paragraph (4), for
services furnished during fiscal year 2001, the State plan shall
provide for payment for such services in an amount (calculated
on a per visit basis) that is equal to 100 percent of the
average of the costs of the center or clinic of furnishing such
services during fiscal years 1999 and 2000 which are reasonable
and related to the cost of furnishing such services, or based on
such other tests of reasonableness as the Secretary prescribes
in regulations under section 1833(a)(3), or, in the case of
services to which such regulations do not apply, the same
methodology used under section 1833(a)(3), adjusted to take into
account any increase or decrease in the scope of such services
furnished by the center or clinic during fiscal year 2001.
"(3) Fiscal year 2002 and succeeding fiscal years. --
Subject to paragraph (4), for services furnished during fiscal
year 2002 or a succeeding fiscal year, the State plan shall
provide for payment for such services in an amount (calculated
on a per visit basis) that is equal to the amount calculated for
such services under this subsection for the preceding fiscal
year --
"(A) increased by the percentage increase in the MEI (as
defined in section 1842(i)(3)) applicable to primary care
services (as defined in section 1842(i)(4)) for that fiscal
year; and
"(B) adjusted to take into account any increase or
decrease in the scope of such services furnished by the
center or clinic during that fiscal year.
"(4) Establishment of initial year payment amount for new
centers or clinics. -- In any case in which an entity first
qualifies as a Federally-qualified health center or rural health
clinic after fiscal year 2000, the State plan shall provide for
payment for services described in section 1905(a)(2)(C)
furnished by the center or services described in section
1905(a)(2)(B) furnished by the clinic in the first fiscal year
in which the center or clinic so qualifies in an amount
(calculated on a per visit basis) that is equal to 100 percent
of the costs of furnishing such services during such fiscal year
based on the rates established under this subsection for the
fiscal year for other such centers or clinics located in the
same or adjacent area with a similar case load or, in the
absence of such a center or clinic, in accordance with the
regulations and methodology referred to in paragraph (2) or
based on such other tests of reasonableness as the Secretary may
specify. For each fiscal year following the fiscal year in which
the entity first qualifies as a Federally-qualified health
center or rural health clinic, the State plan shall provide for
the payment amount to be calculated in accordance with paragraph
(3).
"(5) Administration in the case of managed care. --
"(A) In general. -- In the case of services furnished by
a Federally-qualified health center or rural health clinic
pursuant to a contract between the center or clinic and a
managed care entity (as defined in section 1932(a)(1)(B)),
the State plan shall provide for payment to the center or
clinic by the State of a supplemental payment equal to the
amount (if any) by which the amount determined under
paragraphs (2), (3), and (4) of this subsection exceeds the
amount of the payments provided under the contract.
"(B) Payment schedule. -- The supplemental payment
required under subparagraph (A) shall be made pursuant to a
payment schedule agreed to by the State and the Federally-
qualified health center or rural health clinic, but in no
case less frequently than every 4 months.
"(6) Alternative payment methodologies. -- Notwithstanding
any other provision of this section, the State plan may provide
for payment in any fiscal year to a Federally-qualified health
center for services described in section 1905(a)(2)(C) or to a
rural health clinic for services described in section
1905(a)(2)(B) in an amount which is determined under an
alternative payment methodology that --
"(A) is agreed to by the State and the center or clinic;
and
"(B) results in payment to the center or clinic of an
amount which is at least equal to the amount otherwise
required to be paid to the center or clinic under this
section.". (c) Conforming Amendments. --
(1) Section 4712 of the BBA (Public Law 105 33; 111 Stat.
508) is amended by striking subsection (c).
(2) Section 1915(b) (42 U.S.C. 1396n(b)) is amended by
striking "1902(a)(13)(C)" and inserting "1902(a)(15),
1902(aa),".
(d) GAO Study of Future Rebasing. -- The Comptroller General of
the United States shall provide for a study on the need for, and how
to, rebase or refine costs for making payment under the medicaid
program for services provided by Federally-qualified health centers
and rural health clinics (as provided under the amendments made by
this section). The Comptroller General shall provide for submittal of
a report on such study to Congress by not later than 4 years after
the date of the enactment of this Act.
(e) Effective Date. -- The amendments made by this section take
effect on October 1, 2000, and apply to services furnished on or
after such date.
SEC. 703. STREAMLINED APPROVAL OF CONTINUED STATE-WIDE SECTION 1115
MEDICAID WAIVERS.
(a) In General. -- Section 1115 (42 U.S.C. 1315) is amended by
adding at the end the following new subsection:
"(f) An application by the chief executive officer of a State
for an extension of a waiver 7E project the State is operating under
an extension under subsection (e) (in this subsection referred to as
the 'waiver project') shall be submitted and approved or disapproved
in accordance with the following:
"(1) The application for an extension of the waiver project
shall be submitted to the Secretary at least 120 days prior to
the expiration of the current period of the waiver project.
"(2) Not later than 45 days after the date such application
is received by the Secretary, the Secretary shall notify the
State if the Secretary intends to review the terms and
conditions of the waiver project. A failure to provide such
notification shall be deemed to be an approval of the
application.
"(3) Not later than 45 days after the date a notification is
made in accordance with paragraph (2), the Secretary shall
inform the State of proposed changes in the terms and conditions
of the waiver project. A failure to provide such information
shall be deemed to be an approval of the application.
"(4) During the 30-day period that begins on the date
information described in paragraph (3) is provided to a State,
the Secretary shall negotiate revised terms and conditions of
the waiver project with the State.
"(5)(A) Not later than 120 days after the date an
application for an extension of the waiver project is submitted
to the Secretary (or such later date agreed to by the chief
executive officer of the State), the Secretary shall --
"(i) approve the application subject to such
modifications in the terms and conditions --
"(I) as have been agreed to by the Secretary and
the State; or
"(II) in the absence of such agreement, as are
determined by the Secretary to be reasonable,
consistent with the overall objectives of the waiver
project, and not in violation of applicable law; or
"(ii) disapprove the application.
"(B) A failure by the Secretary to approve or disapprove
an application submitted under this subsection in accordance
with the requirements of subparagraph (A) shall be deemed to
be an approval of the application subject to such
modifications in the terms and conditions as have been
agreed to (if any) by the Secretary and the State.
"(6) An approval of an application for an extension of a
waiver project under this subsection shall be for a period not
to exceed 3 years.
"(7) An extension of a waiver project under this subsection
shall be subject to the final reporting and evaluation
requirements of paragraphs (4) and (5) of subsection (e) (taking
into account the extension under this subsection with respect to
any timing requirements imposed under those paragraphs).".
(b) Effective Date. -- The amendment made by subsection (a)
applies to requests for extensions of demonstration projects pending
or submitted on or after the date of the enactment of this Act.
SEC. 704. MEDICAID COUNTY-ORGANIZED HEALTH SYSTEMS.
(a) In General. -- Section 9517(c)(3)(C) of the Comprehensive
Omnibus Budget Reconciliation Act of 1985 is amended by striking "10
percent" and inserting "14 percent".
(b) Effective Date. -- The amendment made by subsection (a)
takes effect on the date of the enactment of this Act.
SEC. 705. DEADLINE FOR ISSUANCE OF FINAL REGULATION RELATING TO
MEDICAID UPPER PAYMENT LIMITS.
(a) In General. -- Not later than December 31, 2000, the
Secretary of Health and Human Services (in this section referred to
as the "Secretary"), notwithstanding any requirement of the
Administrative Procedures Act under chapter 5 of title 5, United
States Code, or any other provision of law, shall issue under
sections 447.272, 447.304, and 447.321 of title 42, Code of Federal
Regulations (and any other section of part 447 of title 42, Code of
Federal Regulations that the Secretary determines is appropriate), 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 transition period in accordance with
subsection (b).
(b) Transition Period. --
(1) In general. -- The final regulation required under
subsection (a) shall provide that, with respect to a State
described in paragraph (3), the State shall be considered to be
in compliance with the final regulation required under
subsection (a) so long as, for each State fiscal year during the
period described in paragraph (4), the State reduces payments
under a State medicaid plan payment provision or methodology
described in paragraph (3), or reduces the actual dollar payment
levels described in paragraph (3)(B), so that the amount of the
payments that would otherwise have been made under such
provision, methodology, or payment levels by the State for any
State fiscal year during such period is reduced by 15 percent in
the first such State fiscal year, and by an additional 15
percent in each of next 5 State fiscal years.
(2) Requirement. -- Notwithstanding paragraph (1), the final
regulation required under subsection (a) shall provide that, for
any period (or portion of a period) that occurs on or after
October 1, 2008, medicaid payments made by a State described in
paragraph (3) shall comply with such final regulation.
(3) State described. -- A State described in this paragraph
is a State with a State medicaid plan payment provision or
methodology which --
(A) was approved, deemed to have been approved, or was
in effect on or before October 1, 1992 (including any
subsequent amendments or successor provisions or
methodologies and whether or not a State plan amendment was
made to carry out such provision or methodology after such
date) or under which claims for Federal financial
participation were filed and paid on or before such date;
and
(B) provides for payments that are in excess of the
upper payment limit test established under the final
regulation required under subsection (a) (or which would be
noncompliant with such final regulation if the actual dollar
payment levels made under the payment provision or
methodology in the State fiscal year which begins during
1999 were continued).
(4) Period described. -- The period described in this
paragraph is the period that begins on the first State fiscal
year that begins after September 30, 2002, and ends on September
30, 2008.
SEC. 706. ALASKA FMAP.
Notwithstanding the first sentence of section 1905(b) of the
Social Security Act (42 U.S.C. 1396d(b)), only with respect to each
of fiscal years 2001 through 2005, for purposes of titles XIX and XXI
of the Social Security Act, the State percentage used to determine
the Federal medical assistance percentage for Alaska shall be that
percentage which bears the same ratio to 45 percent as the square of
the adjusted per capita income of Alaska (determined by dividing the
State's 3-year average per capita income by 1.05) bears to the square
of the per capita income of the 50 States.
TITLE VIII -- STATE CHILDREN'S HEALTH INSURANCE PROGRAM
SEC. 801. SPECIAL RULE FOR REDISTRIBUTION AND AVAILABILITY OF UNUSED
FISCAL YEAR 1998 AND 1999 SCHIP ALLOTMENTS.
(a) Change in Rules for Redistribution and Retention of Unused
SCHIP Allotments for Fiscal Years 1998 and 1999. -- Section 2104 (42
U.S.C. 1397dd) is amended by adding at the end the following new
subsection:
"(g) Rule for Redistribution and Extended Availability of Fiscal
Years 1998 and 1999 Allotments. --
"(1) Amount redistributed. --
"(A) In general. -- In the case of a State that expends
all of its allotment under subsection (b) or (c) for fiscal
year 1998 by the end of fiscal year 2000, or for fiscal year
1999 by the end of fiscal year 2001, the Secretary shall
redistribute to the State under subsection (f) (from the
fiscal year 1998 or 1999 allotments of other States,
respectively, as determined by the application of paragraphs
(2) and (3) with respect to the respective fiscal year)) the
following amount:
"(i) State. -- In the case of 1 of the 50 States or
the District of Columbia, with respect to --
"(I) the fiscal year 1998 allotment, the amount
by which the State's expenditures under this title
in fiscal years 1998, 1999, and 2000 exceed the
State's allotment for fiscal year 1998 under
subsection (b); or
"(II) the fiscal year 1999 allotment, the amount
by which the State's expenditures under this title
in fiscal years 1999, 2000, and 2001 exceed the
State's allotment for fiscal year 1999 under
subsection (b).
"(ii) Territory. -- In the case of a commonwealth or
territory described in subsection (c)(3), an amount that
bears the same ratio to 1.05 percent of the total amount
described in paragraph (2)(B)(i)(I) as the ratio of the
commonwealth's or territory's fiscal year 1998 or 1999
allotment under subsection (c) (as the case may be)
bears to the total of all such allotments for such
fiscal year under such subsection.
"(B) Expenditure rules. -- An amount redistributed to a
State under this paragraph with respect to fiscal year 1998
or 1999 --
"(i) shall not be included in the determination of
the State's allotment for any fiscal year under this
section;
"(ii) notwithstanding subsection (e), shall remain
available for expenditure by the State through the end
of fiscal year 2002; and
"(iii) shall be counted as being expended with
respect to a fiscal year allotment in accordance with
applicable regulations of the Secretary.
"(2) Extension of availability of portion of unexpended
fiscal years 1998 and 1999 allotments. --
"(A) In general. -- Notwithstanding subsection (e):
"(i) Fiscal year 1998 allotment. -- Of the amounts
allotted to a State pursuant to this section for fiscal
year 1998 that were not expended by the State by the end
of fiscal year 2000, the amount specified in
subparagraph (B) for fiscal year 1998 for such State
shall remain available for expenditure by the State
through the end of fiscal year 2002.
"(ii) Fiscal year 1999 allotment. -- Of the amounts
allotted to a State pursuant to this subsection for
fiscal year 1999 that were not expended by the State by
the end of fiscal year 2001, the amount specified in
subparagraph (B) for fiscal year 1999 for such State
shall remain available for expenditure by the State
through the end of fiscal year 2002.
"(B) Amount remaining available for expenditure. -- The
amount specified in this subparagraph for a State for a
fiscal year is equal to --
"(i) the amount by which (I) the total amount
available for redistribution under subsection (f) from
the allotments for that fiscal year, exceeds (II) the
total amounts redistributed under paragraph (1) for that
fiscal year; multiplied by
"(ii) the ratio of the amount of such State's
unexpended allotment for that fiscal year to the total
amount described in clause (i)(I) for that fiscal year.
"(C) Use of up to 10 percent of retained 1998 allotments
for outreach activities. -- Notwithstanding section
2105(c)(2)(A), with respect to any State described in
subparagraph (A)(i), the State may use up to 10 percent of
the amount specified in subparagraph (B) for fiscal year
1998 for expenditures for outreach activities approved by
the Secretary.
"(3) Determination of amounts. -- For purposes of
calculating the amounts described in paragraphs (1) and (2)
relating to the allotment for fiscal year 1998 or fiscal year
1999, the Secretary shall use the amounts reported by the States
not later than November 30, 2000, or November 30, 2001,
respectively, on HCFA Form 64 or HCFA Form 21, as approved by
the Secretary.".
(b) Effective Date. -- The amendments made by this section shall
take effect as if included in the enactment of section 4901 of BBA
(111 Stat. 552).
SEC. 802. AUTHORITY TO PAY MEDICAID EXPANSION SCHIP COSTS FROM TITLE
XXI APPROPRIATION.
(a) Authority To Pay Medicaid Expansion SCHIP Costs From Title
XXI Appropriation. -- Section 2105(a) (42 U.S.C. 1397ee(a)) is
amended --
(1) by redesignating subparagraphs (A) through (D) of
paragraph (2) as clauses (i) through (iv), respectively, and
indenting appropriately;
(2) by redesignating paragraph (1) as subparagraph (C), and
indenting appropriately;
(3) by redesignating paragraph (2) as subparagraph (D), and
indenting appropriately;
(4) by striking "(a) In General. -- " and the remainder of
the text that precedes subparagraph (C), as so redesignated, and
inserting the following:
"(a) Payments. --
"(1) In general. -- Subject to the succeeding provisions of
this section, the Secretary shall pay to each State with a plan
approved under this title, from its allotment under section
2104, an amount for each quarter equal to the enhanced FMAP (or,
in the case of expenditures described in subparagraph (B), the
Federal medical assistance percentage (as defined in the first
sentence of section 1905(b))) of expenditures in the quarter --
"(A) for child health assistance under the plan for
targeted low-income children in the form of providing
medical assistance for which payment is made on the basis of
an enhanced FMAP under the fourth sentence of section
1905(b);
"(B) for the provision of medical assistance on behalf
of a child during a presumptive eligibility period under
section 1920A;"; and
(5) by adding after subparagraph (D), as so redesignated,
the following new paragraph:
"(2) Order of payments. -- Payments under paragraph (1) from
a State's allotment shall be made in the following order:
"(A) First, for expenditures for items described in
paragraph (1)(A).
"(B) Second, for expenditures for items described in
paragraph (1)(B).
"(C) Third, for expenditures for items described in
paragraph (1)(C).
"(D) Fourth, for expenditures for items described in
paragraph (1)(D).".
(b) Elimination of Requirement To Reduce Title XXI Allotment by
Medicaid Expansion SCHIP Costs. -- Section 2104 (42 U.S.C. 1397dd) is
amended by striking subsection (d).
(c) Authority To Transfer Title XXI Appropriations to Title XIX
Appropriation Account as Reimbursement for Medicaid Expenditures for
Medicaid Expansion SCHIP Services. -- Notwithstanding any other
provision of law, all amounts appropriated under title XXI and
allotted to a State pursuant to subsection (b) or (c) of section 2104
of the Social Security Act (42 U.S.C. 1397dd) for fiscal years 1998
through 2000 (including any amounts that, but for this provision,
would be considered to have expired) and not expended in providing
child health assistance or related services for which payment may be
made pursuant to subparagraph (C) or (D) of section 2105(a)(1) of
such Act (42 U.S.C. 1397ee(a)(1)) (as amended by subsection (a)),
shall be available to reimburse the Grants to States for Medicaid
account in an amount equal to the total payments made to such State
under section 1903(a) of such Act (42 U.S.C. 1396b(a)) for
expenditures in such years for medical assistance described in
subparagraphs (A) and (B) of section 2105(a)(1) of such Act (42
U.S.C. 1397ee(a)(1) (as so amended).
(d) Conforming Amendments. --
(1) Section 1905(b) (42 U.S.C. 1396d(b)) is amended in the
fourth sentence by striking "the State's allotment under section
2104 (not taking into account reductions under section
2104(d)(2)) for the fiscal year reduced by the amount of any
payments made under section 2105 to the State from such
allotment for such fiscal year" and inserting "the State's
available allotment under section 2104".
(2) Section 1905(u)(1)(B) (42 U.S.C. 1396d(u)(1)(B)) is
amended by striking "and section 2104(d)".
(3) Section 2104 (42 U.S.C. 1397dd), as amended by
subsection (b), is further amended --
(A) in subsection (b)(1), by striking "and subsection
(d)"; and
(B) in subsection (c)(1), by striking "subject to
subsection (d),".
(4) Section 2105(c) (42 U.S.C. 1397ee(c)) is amended --
(A) in paragraph (2)(A), by striking all that follows
"Except as provided in this paragraph," and inserting "the
amount of payment that may be made under subsection (a) for
a fiscal year for expenditures for items described in
paragraph (1)(D) of such subsection shall not exceed 10
percent of the total amount of expenditures for which
payment is made under subparagraphs (A), (C), and (D) of
paragraph (1) of such subsection.";
(B) in paragraph (2)(B), by striking "described in
subsection (a)(2)" and inserting "described in subsection
(a)(1)(D)"; and
(C) in paragraph (6)(B), by striking "Except as
otherwise provided by law," and inserting "Except as
provided in subparagraph (A) or (B) of subsection (a)(1) or
any other provision of law,".
(5) Section 2110(a) (42 U.S.C. 1397jj(a)) is amended by
striking "section 2105(a)(2)(A)" and inserting "section
2105(a)(1)(D)(i)".
(e) Technical Amendment. -- Section 2105(d)(2)(B)(ii) (42 U.S.C.
1397ee(d)(2)(B)(ii)) is amended by striking "enhanced FMAP under
section 1905(u)" and inserting "enhanced FMAP under the fourth
sentence of section 1905(b)".
(f) Effective Date. -- The amendments made by this section shall
be effective as if included in the enactment of section 4901 of the
BBA (111 Stat. 552).
TITLE IX -- OTHER PROVISIONS
Subtitle A -- PACE Program
SEC. 901. EXTENSION OF TRANSITION FOR CURRENT WAIVERS.
Section 4803(d)(2) of BBA is amended --
(1) in subparagraph (A), by striking "24 months" and
inserting "36 months";
(2) in subparagraph (A), by striking "the initial effective
date of regulations described in subsection (a)" and inserting
"July 1, 2000"; and
(3) in subparagraph (B), by striking "3 years" and inserting
"4 years".
SEC. 902. CONTINUING OF CERTAIN OPERATING ARRANGEMENTS PERMITTED.
(a) In General. -- Section 1894(f)(2) (42 U.S.C. 1395eee(f)(2))
is amended by adding at the end the following new subparagraph:
"(C) Continuation of modifications or waivers of
operational requirements under demonstration status. -- If a
PACE program operating under demonstration authority has
contractual or other operating arrangements which are not
otherwise recognized in regulation and which were in effect
on July 1, 2000, the Secretary (in close consultation with,
and with the concurrence of, the State administering agency)
shall permit any such program to continue such arrangements
so long as such arrangements are found by the Secretary and
the State to be reasonably consistent with the objectives of
the PACE program.".
(b) Conforming Amendment. -- Section 1934(f)(2) (42 U.S.C. 1396u
4(f)(2)) is amended by adding at the end the following new
subparagraph:
"(C) Continuation of modifications or waivers of
operational requirements under demonstration status. -- If a
PACE program operating under demonstration authority has
contractual or other operating arrangements which are not
otherwise recognized in regulation and which were in effect
on July 1 2000, the Secretary (in close consultation with,
and with the concurrence of, the State administering agency)
shall permit any such program to continue such arrangements
so long as such arrangements are found by the Secretary and
the State to be reasonably consistent with the objectives of
the PACE program.".
(c) Effective Date. -- The amendments made by this section shall
be effective as included in the enactment of BBA.
SEC. 903. FLEXIBILITY IN EXERCISING WAIVER AUTHORITY.
In applying sections 1894(f)(2)(B) and 1934(f)(2)(B) of the
Social Security Act (42 U.S.C. 1395eee(f)(2)(B), 1396u 4(f)(2)(B)),
the Secretary of Health and Human Services --
(1) shall approve or deny a request for a modification or a
waiver of provisions of the PACE protocol not later than 90 days
after the date the Secretary receives the request; and
(2) may exercise authority to modify or 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.
Subtitle B -- Outreach to Eligible Low-Income Medicare Beneficiaries
SEC. 911. OUTREACH ON AVAILABILITY OF MEDICARE COST-SHARING
ASSISTANCE TO ELIGIBLE LOW-INCOME MEDICARE BENEFICIARIES.
(a) Outreach. --
(1) In general. -- Title XI (42 U.S.C. 1301 et seq.) is
amended by inserting after section 1143 the following new section:
"outreach efforts to increase awareness of the availability of
medicare cost-sharing
"Sec. 1144. (a) Outreach. --
"(1) In general. -- The Commissioner of Social Security (in
this section referred to as the 'Commissioner') shall conduct
outreach efforts to --
"(A) identify individuals entitled to benefits under the
medicare program under title XVIII who may be eligible for
medical assistance for payment of the cost of medicare cost-
sharing under the medicaid program pursuant to sections
1902(a)(10)(E) and 1933; and
"(B) notify such individuals of the availability of such
medical assistance under such sections.
"(2) Content of notice. -- Any notice furnished under
paragraph (1) shall state that eligibility for medicare cost-
sharing assistance under such sections is conditioned upon --
"(A) the individual providing to the State information
about income and resources (in the case of an individual
residing in a State that imposes an assets test for such
eligibility); and
"(B) meeting the applicable eligibility criteria.
"(b) Coordination With States. --
"(1) In general. -- In conducting the outreach efforts under
this section, the Commissioner shall --
"(A) furnish the agency of each State responsible for
the administration of the medicaid program and any other
appropriate State agency with information consisting of the
name and address of individuals residing in the State that
the Commissioner determines may be eligible for medical
assistance for payment of the cost of medicare cost-sharing
under the medicaid program pursuant to sections
1902(a)(10)(E) and 1933; and
"(B) update any such information not less frequently
than once per year.
"(2) Information in periodic updates. -- The periodic
updates described in paragraph (1)(B) shall include information
on individuals who are or may be eligible for the medical
assistance described in paragraph (1)(A) because such
individuals have experienced reductions in benefits under title
II.".
(2) Amendment to title xix. -- Section 1905(p) (42 U.S.C.
1396d(p)) is amended by adding at the end the following new
paragraph:
"(5) For provisions relating to outreach efforts to increase
awareness of the availability of medicare cost-sharing, see
section 1144.".
(b) GAO Report. -- The Comptroller General of the United States
shall conduct a study of the impact of section 1144 of the Social
Security Act (as added by subsection (a)(1)) on the enrollment of
individuals for medicare cost-sharing under the medicaid program. Not
later than 18 months after the date that the Commissioner of Social
Security first conducts outreach under section 1144 of such Act, the
Comptroller General shall submit to Congress a report on such study.
The report shall include such recommendations for legislative changes
as the Comptroller General deems appropriate.
(c) Effective Date. -- The amendments made by subsections (a)
shall take effect one year after the date of the enactment of this
Act.
Subtitle C -- Maternal and Child Health Block Grant
SEC. 921. INCREASE IN AUTHORIZATION OF APPROPRIATIONS FOR THE
MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT.
(a) In General. -- Section 501(a) (42 U.S.C. 701(a)) is amended
in the matter preceding paragraph (1) by striking "$705,000,000 for
fiscal year 1994" and inserting "$850,000,000 for fiscal year 2001".
(b) Effective Date. -- The amendment made by subsection (a)
takes effect on October 1, 2000.
Subtitle D -- Diabetes
SEC. 931. INCREASE IN APPROPRIATIONS FOR SPECIAL DIABETES PROGRAMS
FOR TYPE I DIABETES AND INDIANS.
(a) Special Diabetes Programs for Type I Diabetes. -- Section
330B(b) of the Public Health Service Act (42 U.S.C. 254c 2(b)) is
amended --
(1) by striking "Notwithstanding" and inserting the
following:
"(1) Transferred funds. -- Notwithstanding"; and
(2) by adding at the end the following:
"(2) Appropriations. -- For the purpose of making grants
under this section, there is appropriated, out of any funds in
the Treasury not otherwise appropriated --
"(A) $70,000,000 for each of fiscal years 2001 and 2002
(which shall be combined with amounts transferred under
paragraph (1) for each such fiscal years); and
"(B) $100,000,000 for fiscal year 2003.".
(b) Special Diabetes Programs for Indians. -- Section 330C(c) of
such Act (42 U.S.C. 254c 3(c)) is amended --
(1) by striking "Notwithstanding" and inserting the
following:
"(1) Transferred funds. -- Notwithstanding"; and
(2) by adding at the end the following:
"(2) Appropriations. -- For the purpose of making grants
under this section, there is appropriated, out of any money in
the Treasury not otherwise appropriated --
"(A) $70,000,000 for each of fiscal years 2001 and 2002
(which shall be combined with amounts transferred under
paragraph (1) for each such fiscal years); and
"(B) $100,000,000 for fiscal year 2003.".
(c) Extension of Final Report on Grant Programs. -- Section
4923(b)(2) of BBA is amended by striking "2002" and inserting "2003".
SEC. 932. APPROPRIATIONS FOR RICKY RAY HEMOPHILIA RELIEF FUND.
Section 101(e) of the Ricky Ray Hemophilia Relief Fund Act of
1998 (42 U.S.C. 300c 22 note) is amended by adding at the end the
following: "There is appropriated to the Fund $475,000,000 for fiscal
year 2001, to remain available until expended.".
Following is explanatory language for H.R. 5543 as introduced on
October 25, 2000.
* * * * *
STATEMENT OF MANAGERS FOR THE MEDICARE, MEDICAID, AND SCHIP BENEFITS IMPROVEMENT AND PROTECTION ACT OF 2000
TITLE I -- MEDICARE BENEFICIARY IMPROVEMENTS
SUBTILTE A -- IMPROVED PREVENTIVE BENEFITS
Section 101. Coverage of biennial screening pap smear and pelvic exams
[1,188] The provision modifies current law to provide Medicare coverage for biennial screening pap smears and pelvic exams, effective July 1, 2001.
Section 102. Coverage of screening for glaucoma
[1,189] The provision would add Medicare coverage for annual glaucoma screenings, beginning January 1, 2002, for persons determined to be at high risk for glaucoma, individuals with a family history of glaucoma, and individuals with diabetes. The service would have to be furnished by or under the supervision of an optometrist or ophthalmologist who is legally authorized to perform such services in the state where the services are furnished.
Section 103. Coverage of screening colonoscopy for average risk individuals
[1,190] The provision would authorize coverage for screening colonoscopies, beginning July 1, 2001, for all individuals, not just those at high risk. For persons not at high risk, payments could not be made for such procedures if performed within 10 years of a previous screening colonoscopy or within 4 years of a screening flexible sigmoidoscopy.
Section 104. Modernization of screening mammography benefit
[1,191] Beginning in 2002, the provision would eliminate the statutorily prescribed payment rate for mammography payments and specify that the services are to be paid under the physician fee schedule. The provision would specify two new payment rates for mammographies that utilize advanced new technology for the period April 1, 2001 to December 21, 2001. Payment for technologies that directly take digital images would equal 150% of what would otherwise be paid for a bilateral diagnostic mammography. For technologies that convert standard film images to digital form, an additional payment of fifteen dollars would be authorized. The Secretary would be required to determine whether a new code is required for tests furnished after 2001.
Section 105. Coverage of medical nutrition therapy services for beneficiaries with diabetes or a renal disease
[1,192] The provision would establish, effective January 1, 2002, Medicare coverage for medical nutrition therapy services for beneficiaries who have diabetes or a renal disease. Medical nutrition therapy services would be defined as nutritional diagnostic, therapy and counseling services for the purpose of disease management which are furnished by a registered dietician or nutrition professional, pursuant to a referral by a physician. The provision would specify that the amount paid for medical nutrition therapy services would equal the lesser of the actual charge for the service or 85% of the amount that would be paid under the physician fee schedule if such services were provided by a physician. Assignment would be required for all claims. The Secretary would be required to submit a report to Congress that contains an evaluation of the effectiveness of services furnished under this provision.
SUBTITLE B -- OTHER BENEFICIARY IMPROVEMENTS
Section 111. Acceleration of reduction of beneficiary copayment for hospital outpatient hospital outpatient department services
[1,193] Effective January 1, 2001, the provision would modify current law by limiting the amount of a beneficiary's copayment for a procedure in a hospital outpatient department to the hospital inpatient deductible applicable in that year.
[1,194] In addition, starting in January, 2001, the provision would require the Secretary of HHS to reduce the effective copayment rate for outpatient services to a maximum rate of 60% and then gradually reduce the effective coinsurance rate in 5 percentage point intervals from 2002 through 2006 until the maximum rate is 40% in 2006. As stated in BBA 97, hospitals may waive any increase in coinsurance that may have arisen from the implementation of the outpatient prospective payment system (PPS).
[1,195] The Comptroller General would be required to work with the National Association of Insurance Commissioners (NAIC) to evaluate the extent to which premiums for supplemental policies reflect the acceleration of the reduction in beneficiary coinsurance for hospital outpatient services and result in savings to beneficiaries and to report to the Congress by April 1, 2004.
Section 112. Preservation of coverage of drugs and biologicals under part B of the medicare program
[1,196] The provision would clarify policy with regard to coverage of drugs, provided incident to physicians services, that cannot be self-administered. The provision would specify that such drugs are covered when they are not usually self-administered by the patient.
Section 113. Elimination of time limitation on Medicare benefits for immunosuppressive drugs
[1,197] The provision would eliminate the current time limitations on the coverage of immunosuppressive drugs for beneficiaries who have received a covered organ transplant. The provision would apply to drugs furnished, on or after the date enactment.
Section 114. Imposition of balanced billing limits on prescription drugs
[1,198] The provision would specify that payment for drugs under Part B must be made on the basis of assignment.
SUBTITLE C -- DEMONSTRATION PROJECTS AND STUDIES
Section 121. Demonstration project for disease management for severely chronically ill Medicare beneficiaries
[1,199] The Secretary would be required to conduct a demonstration project to illustrate the impact on costs and health outcomes of applying disease management to Medicare beneficiaries with diagnosed, advanced-stage congestive heart failure, diabetes, or coronary heart disease. Up to 30,000 beneficiaries would be able to enroll, on a voluntary basis, for disease management services related to their chronic health condition. In addition, contractors providing disease management services would be responsible for providing beneficiaries enrolled in the project with prescription drugs.
Section 122. Cancer prevention and treatment demonstration for ethnic and racial minorities
[1,200] The provision would require the Secretary to conduct demonstration projects for the purpose of developing models and evaluating methods that improve the quality of cancer prevention services, improve clinical outcomes, eliminate disparities in the rate of preventive screening measures, and promote collaboration with community-based organizations for ethnic and racial minorities.
Section 123. Study on Medicare coverage of routine thyroid screening
[1,201] The provision would require the Secretary to request the National Academy of Sciences, and as appropriate in conjunction with the United States Preventive Services Task Force, to analyze the addition of routine thyroid screening under Medicare. The analysis would consider the short term and long term benefits, and cost to Medicare, of adding such coverage for some or all beneficiaries.
Section 124. MedPAC study on consumer coalitions
[1,202] The provision would require MedPAC to conduct a study that examines the use of consumer coalitions in the marketing of Medicare+Choice plans. A consumer coalition would be defined as a non-profit community-based organization that provides information to beneficiaries about their health options under Medicare and negotiates with Medicare+Choice plans on benefits and premiums for beneficiaries who are members of the coalition or otherwise affiliated with it.
Section 125. Study on limitation on state payment for medicare cost- sharing affecting access to services for qualified medicare beneficiaries
[1,203] The provision would require the Secretary of HHS to conduct a study to determine if access to certain services (including mental health services) has been affected by a specific provision in law. That provision specifies that states are not required to pay Medicare cost-sharing charges for QMBs to the extent these payments would result in a total payment in excess of the Medicaid level.
Section 126. Institute of Medicine study on waiver of
24-month waiting period for Medicare disability eligibility for
amyotrophic lateral sclerosis (ALS) and other devastating
diseases
[1,204] The provision would provide for an Institute of Medicine study that examines the appropriateness of waiving the 24-month waiting period for Medicare disability eligibility for an individual medically determined to have amyotrophic lateral sclerosis (ALS) or an other disease that is as rapidly debilitating.
Section 127. Studies on preventive interventions in primary care for older Americans
[1,205] The provision would require the secretary, acting through the United States Preventive Services Task Force, to conduct a series of studies designed to identify preventive interventions in primary care for older Americans.
Section 128. MedPAC study and report on Medicare coverage of cardiac and pulmonary rehabilitation and therapy services
[1,206] The provision would require MedPAC to conduct a study on coverage of cardiac and pulmonary rehabilitation therapy services under Medicare.
TITLE II -- RURAL HEALTH CARE IMPROVEMENTS
SUBTITLE A -- CRITICAL ACCESS HOSPITAL PROVISIONS
Section 201. Clarification of no beneficiary cost-sharing for clinical diagnostic laboratory tests furnished by critical access hospitals
[1,207] Effective for services furnished on or after the enactment of BBRA99, Medicare beneficiaries would not be liable for any coinsurance, deductible, copayment, or other cost sharing amount with respect to clinical diagnostic laboratory services furnished as an outpatient critical access hospital (CAH) service. Conforming changes that clarify that CAHs are reimbursed on a reasonable cost basis for outpatient clinical diagnostic laboratory services are also included.
Section 202. Assistance with fee schedule payment for professional services under all-inclusive rate
[1,208] Effective for items and services furnished on or after April 1, 2001, Medicare would pay a CAH for outpatient services based on reasonable costs or, at the election of an entity, would pay the CAH a facility fee based on reasonable costs plus an amount based on 115% of Medicare's fee schedule for professional services.
Section 203. Exemption of critical access hospital swing beds from SNF PPS
[1,209] Swing beds in critical access hospitals (CAHs) would be exempt from the SNF prospective payment system. CAHs would be paid for covered SNF services on a reasonable cost basis.
Section 204. Payment in critical access hospitals for emergency room on-call physicians
[1,210] When determining the allowable, reasonable cost of outpatient CAH services, the Secretary would recognize amounts for the compensation and related costs for on-call emergency room physicians who are not present on the premises, are not otherwise furnishing services, and are not on-call at any other provider or facility. The Secretary would define the reasonable payment amounts and the meaning of the term "on-call." The provision would be effective for cost reporting periods beginning on or after October 1, 2001.
Section 205. Treatment of ambulance services furnished by certain critical access hospitals
[1,211] Ambulance services provided by a critical access hospital (CAH) or provided by an entity that is owned or operated by a CAH would be paid on a reasonable cost basis if the CAH or entity is the only provider or supplier of ambulance services that is located within a 35-mile drive of the CAH. The provision would be effective for cost reporting periods beginning on or after implementation of the fee schedule.
Section 206. GAO study on certain eligibility requirements for critical access hospitals
[1,212] Within one year of enactment, GAO would be required to conduct a study on the eligibility requirements for critical access hospitals (CAHs) with respect to limitations on average length of stay and number of beds, including an analysis of the feasibility of having a distinct part unit as part of a CAH and the effect of seasonal variations in CAH eligibility requirements. GAO also would be required to analyze the effect of seasonal variations in patient admissions on critical access hospital eligibility requirements with respect to limits on average annual length of stay and number of beds.
SUBTITLE B -- OTHER RURAL HOSPITALS PROVISIONS
Section 211. Equitable treatment for rural disproportionate share hospitals
[1,213] For discharges occurring on or after April 1, 2001, all hospitals would be eligible to receive DSH payments when their DSH percentage (threshold amount) exceeds 15%. The DSH payment formulas for sole community hospitals (SCHs), rural referral centers (RRCs), rural hospitals that are both SCHs and RRCs, small rural hospitals and urban hospitals with less than 100 beds would be modified.
Section 212. Option to base eligibility for Medicare dependent, small rural hospital program on discharges during 2 of the 3 most recent audited cost reporting periods
[1,214] An otherwise qualifying small rural hospital would be able to be classified as an MDH if at least 60% of its days or discharges were attributable to Medicare Part A beneficiaries in at least two of the three most recent audited cost reporting periods for which the Secretary has a settled cost report.
Section 213. Extension of option to use rebased target amounts to all sole community hospitals
[1,215] Any SCH would be able to elect payment based on hospital specific, updated FY1996 costs if this target amount resulted in higher Medicare payments. There would be a transition period with Medicare payment based completely on updated FY1996 hospital specific costs for discharges occurring after FY2003.
Section 214. MedPAC analysis of impact of volume on per unit cost of rural hospitals with psychiatric units
[1,216] MedPAC would be required to report on the impact of volume on the per unit cost of rural hospitals with psychiatric units and include in its report a recommendation on whether special treatment is warranted.
SUBTITLE C -- OTHER RURAL PROVISIONS
Section 221. Assistance for providers of ambulance services in rural areas
[1,217] The provision would make additional payments to providers of ground ambulance services for trips, originating in rural areas, that are greater than 17 miles and up to 50 miles. The payments would be made for services furnished on or after implementation of the fee schedule and before January 1, 2004. The provision would require the Comptroller General to conduct a study to examine both the costs of efficiently providing ambulance services for trips originating in rural areas and the means by which rural areas with low population densities can be identified for the purpose of designating areas in which the costs of ambulance services would be expected to be higher. The Comptroller General would submit a report to Congress by June 30, 2002 on the results of the study, together with recommendations on steps that should be taken to assure access to ambulance services for trips originating in rural areas. The Secretary would be required to take these findings into account when establishing the fee schedule, beginning with 2004.
Section 222. Payment for certain physician assistant services
[1,218] This provision would give permanent authority to physician assistants who owned rural health clinics that lost their designation as such to bill Medicare directly.
Section 223. Expansion of Medicare payment for telehealth services
[1,219] The provision would establish revised payment provisions, effective no later than July 1, 2001, for services that are provided via a telecommunications system by a physician or practitioner to an eligible beneficiary in a rural area. The Secretary would be required to make payments for telehealth services to the physician or practitioner at the distant site in an amount equal to the amount that would have been paid to such physician or practitioner if the service had been furnished to the beneficiary without the use of a telecommunications system. A facility fee would be paid to the originating site. Originating sites would include a physician or practitioner office, a critical access hospital, a rural health clinic, a Federally qualified health center or a hospital. The Secretary would be required to conduct a study, and submit recommendations to Congress, that identify additional settings, sites, practitioners and geographic areas that would be appropriate for telehealth services. Entities participating in Federal demonstration projects approved by, or receiving funding from, the Secretary as of December 31, 2000 would be qualified sites.
Section 224. Expanding Access to rural health clinics
[1,220] All hospitals of less than 50 beds that own rural health clinics would be exempt from the per visit limit.
Section 225. MedPAC study on low-volume, isolated rural health providers
[1,221] MedPAC would be required to study the effect of low patient and procedure volume on the financial status and Medicare payment methods for hospital outpatient services, ambulance services, hospital inpatient services, skilled nursing facility services, and home health services in isolated rural health care providers.
TITLE III -- PROVISIONS RELATING TO PART A
SUBTITLE A -- INPATIENT HOSPITAL SERVICES
Section 301. Revision of acute care hospital payment update for 2001
[1,222] All hospitals would receive the full market basket index (MBI) as an update for FY2001. In order to implement this increase for hospitals other than sole community hospitals (SCH), those hospitals would receive the MBI minus 1.1 percentage points (the current statutory provision) for discharges occurring on or after October 1, 2000 and before April 1, 2001; these non-SCH hospitals would receive the MBI plus 1.1 percentage points for discharges occurring on or after April 1, 2001 and before October 1, 2001. For FY2002 and FY2003, hospitals would receive the MBI minus .55 percentage points. For FY2004 and subsequently, hospitals would receive the MBI.
[1,223] The Secretary is directed to consider the prices of blood and blood products purchased by hospitals in the next rebasing and revision of the hospital market basket to determine whether those prices are adequately reflected in the market basket index. MedPAC is directed to conduct a study on increased hospital costs attributable to complying with new blood safety measures and providing such services using new technologies among other issues.
[1,224] For discharges occurring on or after October 1, 2001, the Secretary would be able to adjust the standardized amount in future fiscal years to correct for changes in the aggregate Medicare payments caused by adjustments to the DRG weighting factors in a previous fiscal year (or estimates that such adjustments for a future fiscal year) that did not take into account coding improvements or changes in discharge classifications and did not accurately represent increases in the resource intensity of patients treated by PPS hospitals.
Section 302. Additional modification in transition for indirect medical education (IME) percentage adjustment
[1,225] Teaching hospitals would receive 6.25% IME payment adjustment (for each 10% increase in teaching intensity) for discharges occurring on or after October 1, 2000 and before April 1, 2001. The IME adjustment would increase to 6.75% for discharges on or after April 1, 2001 and before October 1, 2001, for an average of 6.5% for FY2001. The IME adjustment would be 6.375% in FY2002 and 5.5% in FY2003 and in subsequent years.
Section 303. Decrease in reductions for disproportionate share hospital (DSH) payments
[1,226] Reductions in the DSH payment formula amounts would be 2% in FY2001, 3% in FY2002, and 0% in FY2003 and subsequently. To implement the FY2001 provision, DSH amounts for discharges occurring on or after October 1, 2000 and before April 1, 2001, would be reduced by 3% which was the reduction in effect prior to enactment of this provision. DSH amounts for discharges occurring on or after April 1, 2001 and before October 1, 2001 would be reduced by only 1 percentage point.
Section 304. Wage index improvements
[1,227] For FY2001 or any fiscal year thereafter, a Medicare Geographic Classification Review Board (MGCRB) decision to reclassify a prospective payment system hospital for use of a different area's wage index would be effective for 3 fiscal years. The Secretary would establish procedures whereby a hospital could elect to terminate this reclassification decision before the end of such period. For FY2003 and subsequently, MGCRB would base any comparison of the average hourly wage of the hospital with the average hourly wage for hospitals in the area using data from each of the two immediately preceding surveys as well as data from the most recently published hospital wage survey.
[1,228] The Secretary would establish a process which would first be available for discharges occurring on or after October 1, 2001 where a single wage index would be computed for all geographic areas in the state. If the Secretary applies a statewide geographic index, an application by an individual hospital would not be considered. The Secretary would also collect occupational data every three years in order to construct an occupational mix adjustment for the hospital area wage index. The first complete data collection effort would occur no later than September 30, 2003 for application beginning October 1, 2004.
Section 305. Payment for inpatient services in rehabilitation hospitals
[1,229] Total payments for rehabilitation hospitals in FY2002 would equal the amounts of payments that would have been made if the rehabilitation prospective payment system (PPS) had not been enacted. A rehabilitation facility would be able to make a one-time election before the start of the PPS to be paid based on a fully phased-in PPS rate.
Section 306. Payment for inpatient services of psychiatric hospitals
[1,230] The provision would increase the incentive payments for psychiatric hospitals and distinct part units to 3% for cost reporting periods beginning on or after October 1, 2000.
Section 307. Payment for inpatient services of long-term care hospitals
[1,231] For cost reporting periods beginning during FY 2001, long term hospitals would have the national cap increased by 2% and the target amount increased by 25%. Neither these payments nor the increased bonus payments provided by BBRA 99 would be factored into the development of the prospective payment system (PPS) for long term hospitals. When developing the PPS for inpatient long term hospitals, the Secretary would be required to examine the feasibility and impact of basing payment on the existing (or refined) acute hospital DRGs and using the most recently available hospital discharge data. If the Secretary is unable to implement a long term hospital PPS by October 1, 2002, the Secretary would be required to implement a PPS for these hospitals using the existing acute hospital DRGs that have been modified where feasible.
SUBTITLE B -- ADJUSTMENTS TO PPS PAYMENTS FOR SKILLED NURSING FACILITIES
Section 311. Elimination of reduction in skilled nursing facility (SNF) market basket update in 2001
[1,232] The provision would modify the schedule and rates according to which federal per diem payments are updated. In FY 2002 and FY 2003 the updates would be the market basket index increase minus 0.5 percentage point. The update rate for the period October 1, 2000, through March 31, 2001, would be the market basket index increase minus 1 percentage point; the update rate for the period April 1, 2001, through September 30, 2001, would be the market basket index increase plus one percentage point. Temporary increases in the federal per diem rates provided by BBRA 99 would be in addition to the increases in this provision. By July 1, 2002, the Comptroller General would be required to submit a report to Congress on the adequacy of Medicare payments to SNFs, taking into account the role of private payers, medicaid, and case mix on the financial performance of SNFs and including an analysis, by RUG classification, of the number and characteristics of such facilities. By January 1, 2005, the Secretary would be required to submit a report to Congress on alternatives for classification of SNF patients.
Section 312. Increase in nursing component of PPS federal rate
[1,233] The provision would increase the nursing component of each RUG by 16.66 percent over current law for SNF care furnished after April 1, 2001, and before October 1, 2002.
[1,234] The Comptroller General would be required to conduct an audit of nurse staffing ratios in a sample of SNFs and to report to Congress by August 1, 2002, on the results of the audit of nurse staffing ratios and recommend whether the additional 16.66 percent payment should be continued.
Section 313. Application of SNF consolidated billing requirement limited to part A covered stays
[1,235] Effective January 1, 2001, the provision would limit the current law consolidated billing requirement to services and items furnished to SNF residents in a Medicare part A covered stay and to therapy services furnished in part A and part B covered stays.
[1,236] The Inspector General of HHS would be required to monitor part B payments to SNFs on behalf of residents who are not in a part A covered stay.
Section 314. Adjustment of rehabilitation RUGS to correct anomaly in payment rates
[1,237] Effective for skilled nursing facility (SNF) services furnished on or after April 1, 2002, the provision would increase by 6.7 percent certain federal per diem payments to ensure that Medicare payments for SNF residents with "ultra high" and "high" rehabilitation therapy needs are appropriate in relation to payments for residents needing "medium" or "low" levels of therapy. The 20 percent additional payment that was provided in BBRA 99 for certain RUGS is removed to make this provision budget neutral.
[1,238] The Inspector General of HHS would be required to review and report to Congress by October 1, 2001, regarding whether the RUG payment structure as in effect under the BBRA 99 includes incentives for the delivery of inadequate care.
Section 315. Establishment of process for geographic reclassification
[1,239] The provision would permit the Secretary to establish a process for geographic reclassification of skilled nursing facilities based upon the method used for inpatient hospitals. The Secretary may implement the process upon completion of the data collection necessary to calculate an area wage index for workers in skilled nursing facilities.
SUBTITLE C -- HOSPICE CARE
Section 321. Full market basket increase for 2001
[1,240] The provision would modify update procedures for Medicare daily payment rates for hospice care. It would provide an increase in FY 2001 equal to the full increase in the market basket index. (The rates would be lower in the period October 1, 2000, through March 21, 2001, and higher in the period April 1, 2001, through September 30, 2001.) For FY 2002, payments would be updated by the market basket index increase minus .25 percentage point. The temporary increase in payment rates provided in BBRA 99 for FY 2001 and FY 2002 (.5 percent and .75 percent, respectively) would be included in the base on which updates are computed.
Section 322. Clarification of physician certification
[1,241] Effective for certifications of terminal illness made on or after the date of enactment, the provision would modify current law to specify that the physician's or hospice medical director's certification of terminal illness would be based on his/her clinical judgment regarding the normal course of the individual's illness. The Secretary would be required to study and report to Congress within 2 years of enactment on the appropriateness of certification of terminally ill individuals and the effect of this provision on such certification.
Section 323. MedPAC report on access to, and use of, hospice benefit
[1,242] The provision would require MedPAC to examine the factors affecting the use of Medicare hospice benefits, including delay of entry into the hospice program and urban and rural differences in utilization rates. The provision would require a report on the study to be submitted to Congress 18 months after enactment.
Section 331. Relief From Medicare Part A late enrollment penalty for group buy-in for state and local retirees
[1,243] The provision would exempt certain state and local retirees, retiring prior to January 1, 2002, from the Part A delayed enrollment penalties. These would be groups of persons for whom the state or local government elected to pay the delayed Part A enrollment penalty for life. The amount of the delayed enrollment penalty which would otherwise be assessed would be reduced by an amount equal to the total amount of Medicare payroll taxes paid by the employee and the employer on behalf of the employee.
Section 332. Posting of information on nursing facility staffing
[1,244] The provision would require skilled nursing facilities to post nurse staffing information daily for each shift in the facility.
TITLE IV -- PROVISIONS RELATING TO PART B
SUBTITLE A -- HOSPITAL OUTPATIENT SERVICES
Section 401. Revision of hospital outpatient PPS payment update
[1,245] Effective as if enacted with the BBRA 99, the provision would modify the current law update rates applicable to the hospital outpatient PPS by providing in FY 2001 an update equal to the full rate of increase in the market basket index. As under current law, the increase in FY 2002 would be the market basket index increase minus one percentage point.
[1,246] If the Secretary determines that updates to the adjustment factor used to convert the relative utilization weights under the PPS into payment amounts have, or are likely to, result in hospitals' changing their coding or classification of covered services, thereby changing aggregate payments, the Secretary would be authorized to adjust the conversion factor in later years to eliminate the effect of coding or classification changes.
Section 402. Clarifying process and standards for determining eligibility of devices for pass-through payments under hospital outpatient PPS
[1,247] The provision would modify the procedures and standards by which certain medical devices are categorized and determined eligible for pass-through payments under the PPS. Through public rule-making procedures, the Secretary would be required to establish criteria for defining special payment categories under the PPS for new medical devices. The Secretary would be required to promulgate, through the use of a program memorandum, initial categories that would encompass each of the individual devices that the Secretary had designated as qualifying for the pass-through payments to date. In addition, similar devices not so designated because they were payable under Medicare prior to December 31, 1996, would also be included in initial categories. The Secretary would be required to create additional new categories in the future to accommodate new technologies meeting the "not insignificant cost" test established in BBRA 99.
[1,248] Once the categories were established, pass-through payments currently authorized under section 1833(t)(b) of the Social Security Act would proceed on a category-specific, rather than device-specific basis. These payments would be designated as "category-based pass-through payments." These payments would be continued to be made for the 2 to 3 years payment period originally specified in BBRA 99, and, for each given category, would begin when the first such payment is made for any device included in a specified category. At the conclusion of this transitional payment period, categories would sunset and payment for the device would be included in the underlying PPS payment for the related service.
Section 403. Application of OPD PPS transitional corridor payments to certain hospitals that did not submit a 1996 cost report
[1,249] Effective as if enacted with BBRA 99, the provision would modify current law as enacted in BBA 99 to enable all hospitals, not just those hospitals filing 1996 cost reports, to be eligible for transitional payments under the PPS.
Section 404. Application of rules for determining provider-based status for certain entities
[1,250] The provision would grandfather existing arrangements whereby certain entities (such as outpatient clinics, skilled nursing facilities, etc.) are considered "provider-based" entities, meaning they are affiliated financially and clinically with a main hospital. Existing provider-based status designations would continue for two years beginning October 1, 2000. If a facility or organization requests approval for provider-based status during the period October 1, 2000, through September 31, 2002, it could not be treated as if it did not have such status during the period of time the determination is pending. In making such a status determination on or after October 1, 2000, HCFA would treat the applicant as satisfying any requirements or standards for geographic location if it satisfied geographic location requirements in regulations or is located not more than 35 miles from the main campus of the hospital.
[1,251] An applicant facility or organization would be treated as satisfying all requirements for provider-based status if it is owned or operated by a unit of State or local government or is a public or private nonprofit corporation that is formally granted governmental powers by a unit of State or local government, or is a private hospital that, under contract, serves certain low income households or has a certain disproportionate share adjustment.
[1,252] These provisions are in effect during a two-year period beginning on October 1, 2000.
Section 405. Treatment of children's hospitals under prospective payment system
[1,253] The BBRA 99 provides special "hold harmless" payments to ensure that cancer hospitals would receive no less under the hospital outpatient PPS than they would have received, in aggregate, under the "pre-BBA" system, that is, the pre-PPS payment system. Effective as if included in the BBRA 99, the provision would extend this hold harmless protection to children's hospitals.
Sec 406. Inclusion of temperature monitored cryoablation
[1,254] The provision would include temperature monitored cryoablation as part of the transitional pass-through for certain medical devices, drugs, and biologicals under the hospital outpatient prospective payment system, effective April 1, 2001.
SUBTITLE B -- PROVISIONS RELATING TO PHYSICIANS SERVICES
Section 411. GAO studies relating to physicians' services
[1,255] The provision would require the GAO to conduct a study on the appropriateness of furnishing in physicians offices specialist services (such as gastrointestinal endoscopic physicians services) which are ordinarily furnished in hospital outpatient departments. The GAO would also be required to study the refinements to the practice expense relative value units made during the transition to the resource-based system.
Section 412. Physician group practice demonstration
[1,256] The provision would require the Secretary to conduct demonstration projects to test, and if proven effective, expand the use of incentives to health care groups participating under Medicare. Such incentives would be designed to encourage coordination of care furnished under Medicare Parts A and B by institutional and other providers and practitioners; to encourage investment in administrative structures and processes to encourage efficient service delivery; and to reward physicians for improving health outcomes. The Secretary would establish for each group participating in a demonstration, a base expenditure amount and an expenditure target (reflecting base expenditures adjusted for risk and expected growth rates). The Secretary would pay each group a bonus for each year equal to a portion of the savings for the year relative to the target. In addition, at such time as the Secretary had developed appropriate criteria, the Secretary would pay an additional bonus related to process and outcome improvements. Total payments under demonstrations could not exceed what the Secretary estimates would be paid in the absence of the demonstration program.
Section 413. Study on enrollment procedures for groups that retain independent contractor physicians
[1,257] The provision would require the Comptroller General to conduct a study of the current Medicare enrollment process for groups that retain independent contractor physicians; particular emphasis would be placed on hospital-based physicians, such as emergency department staffing groups.
SUBTITLE C -- OTHER SERVICES
Section 421. One-year extension of moratorium on therapy caps; report on standards for supervision of physical therapy assistants
[1,258] The provision would extend the moratorium on the physical therapy and occupational therapy caps for 1 year through 2002; it would also extend the requirement for focused reviews of therapy claims for the same period. The Secretary would be required to conduct a study on the implications of eliminating the "in the room" supervision requirement for Medicare payment for physical therapy assistants who are supervised by physical therapists and the implications of this requirement on the physical therapy cap.
Section 422. Update in renal dialysis composite rate
[1,259] The provision would specify that the composite rate payment for renal dialysis services would be increased by 2.4% for 2001. The provision would require the Secretary to collect data and develop an end-stage renal disease (ESRD) market basket whereby the Secretary could estimate before the beginning of a year the percentage increase in costs for the mix of labor and non-labor goods and services included in the composite rate. The Secretary would report to Congress on the index together with recommendations on the appropriateness of an annual or periodic update mechanism for dialysis services. The Comptroller General would be required to study the access of beneficiaries to dialysis services. There is a hold harmless provision for facilities who received exemptions for their 2000 rates, and for facilities that had their applications denied in 2000 but resubmit them by July 1, 2001 and are approved.
Section 423. Payment for ambulance services
[1,260] The provision would provide for the full inflation update in ambulance payments for 2001. It would also specify that any phase- in of the ambulance fee schedule would provide for full payment of national mileage rates in states where separate mileage payments were not made prior to implementation of the fee schedule.
Section 424. Ambulatory surgical centers
[1,261] The provision would delay implementation of proposed regulatory changes to the ambulatory payment classification system, which are based on 1994 cost data, until January 1, 2002. At that time, such changes would be phased in over 4 years: in the first year the payment amounts would be 25 percent of the revised rates and 75 percent of the prior system rates; in the second year payments would be 50 percent of the revised rates and 50 percent of the prior system rates, etc. The provision also requires that the revised system, based on 1999 (or later) cost data, be implemented January 1, 2003. (The phase-in of the revised system and 1994 data would end when the system with 1999 or later data was implemented.)
Section 425. Full update for durable medical equipment
[1,262] The provision would modify updates to payments for durable medical equipment. For 2001, the payments for covered DME would be increased by the full increase in the consumer price index for urban consumers during the 12-month period ending June 2000. No increase would be authorized for 2002.
Section 426. Full update for orthotics and prosthetics
[1,263] The provision would modify updates to payments for orthotics and prosthetics: in 2000 the rates would be increased by one percent; in 2001, the increase would be equal to the percentage increase in the consumer price index for urban consumers during the 12-month period ending with June, 2000; for 2002, payments would be increased by one percent over the prior year's amounts.
Section 427. Establishment of special payment provisions and requirements for prosthetics and certain custom fabricated orthotic items
[1,264] Under the provision, certain prosthetics or custom fabricated orthotics would be covered by Medicare if furnished by a qualified practitioner and fabricated by a qualified practitioner or qualified supplier. The Secretary would be required to establish a list of such items in consultation with experts. Within one year of enactment, the Secretary would be required to promulgate regulations to provide these items, using negotiated rulemaking procedures.
[1,265] Not later than 6 months from enactment, the Comptroller General would be required to submit to Congress a report on the Secretary's compliance with the Administrative Procedures Act with regard to HCFA Ruling 96-1; certain impacts of that ruling; the potential for fraud and abuse in provision of prosthetics and orthotics under special payment rules and for custom fabricated items; and the effect on Medicare and Medicaid payments if that ruling were overturned.
Section 428. Replacement of prosthetic devices and parts
[1,266] The provision would authorize Medicare coverage for replacement of artificial limbs, or replacement parts for such devices, if ordered by a physician for specified reasons. Effective for items furnished on or after enactment, coverage would apply to prosthetic items 3 or more years old, and would supersede any 5-year age rules for such items under current law.
Section 429. Revised part B payment for drugs and biologicals and related services
[1,267] The provision would require the Comptroller General to study and submit a report to Congress and the Secretary on the reimbursement for drugs and biologicals and for related services under Medicare; the report would include specific recommendations for revised payment methodologies. The Secretary would revise the current payment methodologies for covered drugs and biologicals and related services based on these recommendations; however, total payments under the revised methodologies could not exceed the aggregate payments the Secretary estimates would have been made under the current law. The provision would establish a temporary injunction on changes in payment rates until the Secretary reviewed the GAO report.
Section 430. Contrast enhanced diagnostic procedures under hospital prospective payment system
[1,268] The provision would require the Secretary to create under that hospital outpatient PPS additional and separate groups of covered services which include procedures that utilize contrast media. The provision would take effect January 1, 2001. and separate groups of covered services which include procedures that utilize contrast media.
Section 431. Qualifications for community mental health centers
[1,269] The provision would clarify the qualifications for community mental health centers providing partial hospitalization services under Medicare.
Section 432. Modification of medicare billing requirements for certain indian providers
[1,270] The provision would authorize hospitals and free- standing ambulatory care clinics of the Indian Health Service to bill Medicare for services which are paid for under the physician fee schedule.
Section 433. GAO study on coverage of surgical first assisting services of certified registered nurse first assistants
[1,271] The provision would require the Comptroller General to conduct a study on the effect on both the program and beneficiaries of covering surgical first assisting services of certified registered nurse first assistants.
Section 434. MedPAC study and report on medicare reimbursement for services provided by certain providers
[1,272] The provision would require MedPAC to conduct a study on the appropriateness of current payment rates for services provided by a certified nurse midwife, physician assistant, nurse practitioner, and clinical nurse specialist.
Section 435. MedPAC study and report on medicare coverage of services provided by certain non-physician providers
[1,273] The provision would require MedPAC to conduct a study to determine the appropriateness of Medicare coverage of the services provided by a surgical technologist, marriage counselor, pastoral care counselor, and licensed professional counselor of mental health.
Section 436. GAO study and report on the costs of emergency and medical transportation services
[1,274] The provision would require the Comptroller General to conduct a study 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.
Section 437. GAO studies and reports on medicare payments
[1,275] The provision would require the Comptroller General to conduct a study on the post-payment audit process for physicians services. The study would include the proper level of resources HCFA should devote to educating physicians regarding coding and billing, documentation requirements, and calculation of overpayments. The Comptroller General would also be required to conduct a study of the aggregate effects of regulatory, audit, oversight and paperwork burdens on physicians and other health care providers participating in Medicare.
Section 439. MedPAC study on access to outpatient pain management services
[1,276] The provision would require MedPAC to conduct a study on the barriers to coverage and payment for outpatient interventional pain medicine procedures under Medicare.
TITLE V -- PROVISION RELATING TO PARTS A AND B
SUBTITLE A -- HOME HEALTH SERVICES
Section 501. 1-Year additional delay in application of 15 percent reduction on payment limits fo home health services
[1,277] The provision would require that the aggregate amount of Medicare payments to home health agencies in the second year of the PPS (FY 2002) shall equal the aggregate payments in the first year of the PPS, updated by the market basket index (MBI) increase minus 1.1 percentage points. The 15 percent reduction to aggregate PPS amounts, which, under current law, would go into effect October 1, 2001, would be delayed until October 1, 2002.
[1,278] The Comptroller General (rather than the Secretary) would be required to submit, by April 1, 2002, a report analyzing the need for the 15 percent or other reduction.
[1,279] If the Secretary determines that updates to the PPS system for a previous fiscal year (or estimates of such adjustments for a future fiscal year) did (or are likely to) result in a change in aggregate payments due to changes in coding or classification of beneficiaries' service needs that do not reflect real changes in case mix, effective for home health episodes concluding on or after October 1, 2001, the Secretary may adjust PPS amounts to eliminate the effect of such coding or classification changes.
Section 502. Restoration of full home health market basket update for home health services for fiscal year 2001
[1,280] The provision would modify the home health PPS updates. During the period October 1, 2000, through March 31, 2001, the rates promulgated in the home health PPS regulations on July 3, 2000, would apply for 60-day episodes of care (or visits) ending in that period. For the period April 1, 2001, through September 31, 2001, those rates would be increased by 2.2 percent for 60-day episodes (or visits) ending in that time period.
Section 503. Temporary two-month extension of periodic interim payments
[1,281] The provision would extend applicability of periodic interim payments provided under current law. Home health agencies that were receiving such payments as of September 30, 2000, would continue to receive them until December 1, 2000. The payments in each of November and December 2000 would equal the amount those agencies received in October 2000. The amounts would be included in the agency's last settled cost report before implementation of the PPS.
Section 504. Use of telehealth in delivery of home health services
[1,282] The provision would clarify that the telecommunications provisions should not be construed as preventing a home health agency from providing a service, for which payment is made under the prospective payment system, via a telecommunications system, provided that the services do not substitute for "in-person" home health services ordered by a physician as part of a plan of care or are not considered a home health visit for purposes of eligibility or payment.
Section 505. Study on costs to home health agencies of purchasing nonroutine medical supplies
[1,283] The provision would require that, not later than October 1, 2001, the Comptroller General shall submit to Congress a report regarding the variation in prices home health agencies pay for nonroutine supplies, the volume of supplies used, and what effect the variations have on the provision of services. The Secretary would be required to make recommendations on whether Medicare payment for those supplies should be made separately from the home health PPS.
Section 506. Treatment of branch offices; GAO study on supervision of home health care provided in isolated rural areas
[1,284] The provision would clarify that neither time nor distance between a home health agency parent office and a branch office shall be the sole determinant of a home health agency's branch office status. The Secretary would be authorized to include forms of technology in determining "supervision" for purposes of determining a home health agency's branch office status.
[1,285] Not later than January 1, 2002, the Comptroller General would be required to submit to Congress a report regarding the adequacy of supervision and quality of home health services provided by home health agency branch offices and subunits in isolated rural areas and to make recommendations on whether national standards for supervision would be appropriate in assuring quality.
Section 507. Clarification of the homebound benefit
[1,286] The provision clarifies that the need for adult day care for patient's plan of treatment does not preclude appropriate coverage for home health care for other medical conditions. The provision also clarifies the ability of homebound beneficiaries to attend religious services without being disqualified from receiving home health benefits.
SUBTITLE B -- DIRECT GRADUATE MEDICAL EDUCATION
Section 511. Increase in floor for direct graduate medical education payments
[1,287] A hospital's approved per resident amount for cost reporting periods beginning during FY2002 would not be less than 85% of the locality adjusted national average per resident amount.
Section 512. Change in distribution formula for Medicare+Choice- related nursing and allied health education costs
[1,288] A hospital would receive nursing and allied health payments for Medicare managed care enrollees based on its per day cost of allied and nursing health programs and number of days attributed to Medicare enrollees in comparison to that in all other hospitals. The provision would be effective for portions of cost reporting periods occurring on or after January 1, 2001.
SUBTITLE C -- CHANGES IN MEDICARE COVERAGE AND APPEALS PROCESS
Section 521. Revisions to medicare appeals process
[1,289] The provision would modify the Medicare appeals process. Generally, initial determinations by the Secretary would be concluded no later than 45-days from the date the Secretary received a claim for benefits. Any individual dissatisfied with the initial determination would be entitled to a redetermination by the carrier or fiscal intermediary who made the initial determination. Such redetermination would be required to be completed within 30 days of a beneficiary's request. Beneficiaries could appeal the outcome of a redetermination by seeking a reconsideration. Generally, a request for a reconsideration must be initiated no later than 180 days after the date the individual receives the notice of an adverse redetermination. In addition, if contested amounts are greater than $100, an individual would be able to appeal an adverse reconsideration decision by requesting a hearing by the Secretary (first for a hearing by an administrative law judge, then in certain circumstances, for a hearing before the Department Appeals Board). If the dispute is not satisfactorily resolved through this administrative process, and if contested amounts are greater than $1,000, the individual would be able to request judicial review of the Secretary's final decision. Aggregation of claims to meet these thresholds would be permitted.
[1,290] An expedited determination would be available for a beneficiary who received notice: 1) that a provider plans to terminate services and a physician certifies that failure to continue the provisions of the services is likely to place the beneficiary's health at risk; or 2) that the provider plans to discharge the beneficiary.
[1,291] The Secretary would enter into 3-year contracts with at least 12 qualified independent contractors (QICs) to conduct reconsiderations. A QIC would promptly notify beneficiaries and Medicare claims processing contractors of its determinations. A beneficiary could appeal the decision of a QIC to an ALJ. In cases where the ALJ decision is not rendered within the 90-day deadline, the appealing party would be able to request a DAB hearing.
[1,292] The Secretary would perform outreach activities to inform beneficiaries, providers, and suppliers of their appeal rights and procedures. The Secretary would submit to Congress an annual report including information on the number of appeals for the previous year, identifying issues that require administrative or legislative actions, and including recommendations for change as necessary. The report would also contain an analysis of the consistency of the QIC determinations as well as the cause for any identified inconsistencies.
Section 522. Revisions to medicare coverage process
[1,293] The provision would clarify when and under what circumstances Medicare coverage policy could be challenged. An aggrieved party could file a complaint concerning a national coverage decision. Such complaint would be reviewed by the Department Appeals Board (DAB) of HHS. The provision would also permit an aggrieved party to file a complaint concerning a local coverage determination. In this case, the determination would be reviewed by an administrative law judge. If unsatisfied, complainants could subsequently seek review of such a local policy by the DAB. In both cases, a DAB decision would constitute final HHS action, and would be subject to judicial review. The provision would also permit an affected party to submit a request to the Secretary to issue a national coverage or noncoverage determination if one has not been issued. The Secretary would have 90 days to respond. HHS would be required to prepare an annual report on national coverage determinations.
SUBTITLE D -- IMPROVING ACCESS TO NEW TECHNOLOGIES
Section 531. Reimbursement improvements for new clinical laboratory tests and durable medical equipment
[1,294] The provision would specify that the national limitation amount for a new clinical laboratory test would equal 100% of the national median for such test. The Secretary would be required to establish procedures that permit public consultation for coding and payment determinations for new clinical diagnostic laboratory tests and new durable medical equipment. The Secretary would be required to report to Congress on specific procedures used to adjust payments for advanced technologies; the report would include recommendations for legislative changes needed to assure fair and appropriate payments.
Section 532. Retention of HCPCS level III codes
[1,295] The provision would extend the time for the use of local codes (known as HCPCS level III codes) through December 31, 2003; the Secretary would be required to make the codes available to the public.
Section 533. Recognition of new medical technologies under medicare inpatient hospital PPS
[1,296] The Secretary would be required to submit a report to Congress no later than April 1, 2001, on potential methods for more rapidly incorporating new medical services and technologies used in the inpatient setting in the clinical coding system used with respect to payment for inpatient services. The Secretary would be required to identify the preferred methods for expediting these coding modifications in her report, and to implement such method by October 1, 2001. Additional hospital payments could be made by means of a new technology group (DRG), an add-on payment, payment adjustment or other mechanism. However, separate fee schedules for additional new technology payments would not be permitted. The Secretary would implement the new mechanism on a budget neutral basis. The total amount of projected additional payments under the mechanism would be limited to an amount not greater than the Secretary's annual estimation of the costs attributable to the introduction of new technology in the hospital sector as a whole (as estimated for purposes of the annual hospital update calculation).
SUBTITLE E -- OTHER PROVISIONS
Section 541. Increase in reimbursement for bad debt
[1,297] Effective beginning with cost reports starting in FY2001, the provision would increase the percentage of the reasonable costs associated with beneficiaries' bad debt in hospitals that Medicare would reimburse to 70%.
Section 542. Treatment of certain physician pathology services under medicare
[1,298] The provision would permit independent laboratories, under a grandfather arrangement to continue, for a 2-year period (2001 2002), direct billing for the technical component of pathology services provided to hospital inpatients and hospital outpatients. The Comptroller General would be required to conduct a study of the effect of these provisions on hospitals and laboratories and access of fee-for-service beneficiaries to the technical component of physician pathology services. The report would include recommendations on whether the provisions should continue after the 2-year period for either (or both) inpatient and outpatient hospital services and whether the provision should be extended to other hospitals.
Section 543. Extension of advisory opinion authority
[1,299] The Office of the Inspector General's authority to issue advisory opinions to outside parties who request guidance on the applicability of the anti-kickback statute, safe harbor provisions and other OIG health care fraud and abuse sanctions would be made permanent.
Section 544. Change in annual MedPAC reporting
[1,300] The provision would delay the reporting date for the MedPAC report on issues affecting the Medicare program by 15 days to June 15. The provision would also require record votes on recommendations contained both in this report and the March report on payment policies.
Section 545. Development of patient assessment instruments
[1,301] The provision would require the Secretary to report to the Congress on the development of standard instruments for the assessment of the health and functional status of patients and make recommendations on the use of such standard instruments for payment purposes.
Section 546. GAO report on impact of the emergency medical treatment and Active Labor Act (EMTALA) on hospital emergency departments
[1,302] GAO would be required to evaluate the impact of the Emergency Medical Treatment and Active Labor Act on hospitals, emergency physicians, and on-call physicians covering emergency departments and to submit a report to Congress by May 1, 2001.
TITLE VI -- PROVISIONS RELATING TO PART C (MEDICARE+CHOICE PROGRAM) AND OTHER MEDICARE MANAGED CARE PROVISIONS
SUBTITLE A -- MEDICARE+CHOICE PAYMENT REFORMS
Section 601. Increase in minimum payment amount
[1,303] The provision would set the minimum payment amount for aged enrollees within the 50 states and the District of Columbia in a Metropolitan Statistical Area with a population of more than 250,000 at $525 in 2001. For all other areas within the 50 States and the District of Columbia, the minimum would be $475. For any area outside the 50 States and the District of Columbia, the $525 and $475 minimum amounts would also be applied, except that the 2001 minimum payment amount could not exceed 120% of the 2000 minimum payment amount.
Section 602. Increase in minimum percentage increase
[1,304] This provision would apply a 3% minimum update in 2001 and return to the current law minimum update of 2% thereafter.
Section 603. 10-Year phase in of risk adjustment
[1,305] Until such time that risk adjustment is based on data from inpatient hospital and ambulatory settings, 10% of payments would be based on risk-adjusted inpatient data built on the 15 principal inpatient diagnostic cost groups (PIP DCGs) and 90% would be adjusted solely using the older demographic method. Beginning with the first year that risk adjustment is based on data from inpatient hospitals and ambulatory settings, it would be phased in over 10 years, in equal increments. (The Secretary currently plans to implement this new system in 2004.)
Section 604. Transition to revised Medicare+Choice payment rates
[1,306] Within 2 weeks after the date of enactment of the Act, the Secretary must announce revised M+C capitation rates for 2001, due to changes from this Act. Plans that previously provided notice of their intention to terminate contracts or reduce their service area for 2001 would have 2 weeks after announcement of the revised rates to rescind their notice and submit ACR information. Further, any M+C organization that would receive higher capitation payments as a result of this Act must submit revised ACR information within 2 weeks after announcement of the revised rates. Plans may only reduce premiums, reduce cost sharing, enhance benefits, or utilize stabilization funds. Notwithstanding the issuance of revised rates, M+C organizations would continue to be paid on a fee-for-service basis for costs associated with new national coverage determinations that are made mid-year.
Section 605. Revision of payment rates for ESRD patients enrolled in Medicare+Choice plans
[1,307] This provision would require that the Secretary increase the M+C payment rates for enrollees with ESRD. The revised rates would reflect the demonstration rate (including the risk-adjustment methodology) of social health maintenance organizations' ESRD capitation demonstrations. The revised rates would include adjustments for factors such as renal treatment modality, age, and underlying cause of the disease.
Section 606. Permitting premium reductions as additional benefits under Medicare+Choice plans
[1,308] This provision would permit M+C plans to offer reduced Medicare Part B premiums to their enrollees as part of providing any required additional benefits or reduced cost-sharing. An M+C organization could elect a reduction in its M+C payment up to 125% of the annual Part B premium. However, only 80% of this amount could be used to reduce an enrollee's actual Part B premium. This would have the effect of returning up to 100% of the beneficiary's Part B premium. The reduction would apply uniformly to each enrollee of the M+C plan. Plans would include information about Part B premium reductions as part of the required information that is provided to enrollees for comparing plan options.
Section 607. Full implementation of risk adjustment for congestive heart failure enrollees for 2001
[1,309] This provision would fully implement risk adjustment based on inpatient hospital diagnoses for an individual who had a qualifying congestive heart failure inpatient diagnosis between July 1, 1999 and June 30, 2000, if that individual was enrolled in a coordinated care plan offered on January 1, 2001. This would apply for only 1 year, beginning on January 1, 2001. This payment amount would be excluded from the determination of the budget neutrality factor.
Section 608. Expansion of application of Medicare+Choice new entry bonus
[1,310] This provision would expand the application of the new entry bonus for M+C plans to include areas for which notification had been provided, as of October 3, 2000, that no plans would be available January 1, 2001.
Section 609. Report on inclusion of certain costs of the Department of Veterans Affairs and Military Facility Services in calculating Medicare+Choice payment rates
[1,311] The Secratary shall report to Congress by January 1, 2003, on a method to phase-in the costs of military facility services furnished by the Department of Veterans Affairs or the Department of Defense to Medicare-eligible beneficiaries in the calculation of an area's M+C capitation payment. This report would include, on a county-by-county basis: the actual or estimated costs of such services to Medicare-eligible beneficiaries; the change in M+C capitation payment rates if such costs were included in the calculation of payment rates; one or more proposals for the implementation of payment adjustments to M+C plans in counties where the payment rate has been affected due to failure to account for the cost of such services; and a system to ensure that when a M+C enrollee receives covered services through a facility of these Departments, there is an appropriate payment recovery to the Medicare program.
SUBTITLE B -- OTHER MEDICARE+CHOICE REFORMS
Section 611. Payments of additional amounts for new benefits covered during a contract term
[1,312] The provision would require payment adjustments to M+C plans if a legislative change resulted in significant increased costs, similar to the current law requirements for adjusting payments due to significant increased costs resulting from National Coverage Determination (NCDs). In addition, this provision would require that cost projections and payment adjustments be based on actuarial estimates provided by the Chief Actuary of the Health Care Financing Administration.
Section 612. Restriction on implementation of significant new regulatory requirements mid-year
[1,313] The provision would preclude the Secretary from implementing, other than at the beginning of a calendar year, regulations that impose new, significant regulatory requirements on M+C organizations and plans.
Section 613. Timely approval of marketing material that follows model marketing language
[1,314] The provision would require the Secretary to make decisions, within 10 days, approving or modifying marketing material used by M+C organizations, provided that the organization uses model language specified by the Secretary. This provision would apply to marketing material submitted on or after January 1, 2001.
Section 614. Avoiding duplicative regulation
[1,315] This provision would further stipulate when Medicare law preempts State law or regulation from applying to M+C plans, by specifying that the term benefit requirements includes cost-sharing requirements. Second, the provision would stipulate that State laws and regulations affecting marketing materials, and summaries and schedules of benefits regarding an M+C plan, would also be preempted by Medicare law.
Section 615. election of uniform local coverage policy for Medicare+Choice plan covering multiple localities
[1,316] An M+C organization offering a plan in an area with more than one local coverage policy would be able to elect to have the local coverage policy for the part of the area that is most beneficial to M+C enrollees (as identified by the Secretary) apply to all M+C enrollees enrolled in the plan.
Section 616. Eliminating health disparities in Medicare+Choice Program
[1,317] This provision would expand the M+C quality assurance programs for M+C plans to include a separate focus on racial and ethnic minorities. The Secretary would also be required to report to Congress how the quality assurance programs focus on racial and ethnic minorities, within 2 years after enactment and biannually thereafter.
Section 617. Medicare+Choice Program compatibility with employer or union group health plans
[1,318] In order to make the M+C program compatible with employer or union group health plans, this provision would allow the Secretary to waive or modify requirements that hinder the design of, offering of, or enrollment in certain M+C plans. Plans included in the category are M+C plans under contract between M+C organizations and employers, labor organizations, or trustees of a fund established by employers and/or labor organizations.
Section 618. Special Medigap enrollment anti-discrimination provision for certain beneficiaries
[1,319] This provision would extend the period for Medigap enrollment for certain M+C enrollees affected by termination of coverage. For individuals enrolled in an M+C plan during a 12-month trial period, their trial period would begin again if they re- enrolled in another M+C plan because of an involuntary termination. During this new trial period, they would retain their rights to enroll in a Medigap policy; however, the total time for a trial period could not exceed 2 years from the time they first enrolled in an M+C plan.
Section 619. Restoring effective date of elections and changes of elections of Medicare+Choice plans
[1,320] This provision would allow individuals who enroll in an M+C plan after the 10th day of the month to receive coverage beginning on the first day of the next calendar month, effective January 1, 2001.
Section 620. Permitting ESRD beneficiaries to enroll in another Medicare+Choice plan if the plan in which they are enrolled is terminated
[1,321] This provision would permit ESRD beneficiaries to enroll in another M+C plan if they lost coverage when their plan terminated its contract or reduced its service area. This provision would also be retroactive, to include individuals whose enrollment in an M+C plan was terminated between December 31, 1998 and enactment of this legislation.
Section 621. Providing choice for skilled nursing facility services under the Medicare+Choice program
[1,322] Effective for M+C contracts entered into or renewed on or after the date of enactment, the provision would require an M+C plan to cover post-hospitalization skilled nursing care through an enrollee's "home skilled nursing facility" if the plan has a contract with the facility or if the home facility agrees to accept substantially similar payment under the same terms and conditions that apply to similarly situated SNFs that are under contract with the plan. A "home skilled nursing facility" is defined as (a) one in which the enrollee resided at the time of the hospital admission that triggered eligibility for SNF care upon discharge, or (b) is the facility that is providing such services through the continuing care retirement community in which the enrollee resided at the time of hospital admission, or (c) is the facility in which the spouse of the enrollee is residing at the time of the enrollee's hospital discharge. The beneficiary would be required to receive coverage for SNF care at the home facility that is no less favorable than he or she would receive otherwise in another SNF that has a contract with the plan.
[1,323] Home skilled nursing facilities are permitted to refuse to accept Medicare+Choice enrollees or to impose conditions on their acceptance of such an enrollee.
[1,324] The provision would require the Medicare Payment Advisory Commission (MedPAC) to analyze and, within 2 years of enactment, report to Congress on the effects of this provision on the scope of benefits, administrative and other costs incurred by M+C organizations, and the contractual relationships between those plans and SNFs.
Section 622. Providing for accountability of Medicare+Choice plans
[1,325] The provision would mandate review of ACR submissions by the HCFA Chief Actuary with respect to submissions for ACRs filed for 2001 and thereafter.
SUBTITLE C -- OTHER MANAGED CARE REFORMS
Section 631. 1-Year extension of Social Health Maintenance Organization (SHMO) demonstration project
[1,326] The provision would extend SHMO waivers until 30 months after the Secretary submits a report with a plan for integration and transition of SHMOs into an option under the M+C program. This 30- month extension would supersede the 18-month extension in BBRA 99.
Section 632. Revised terms and conditions for extension of Medicare Community Nursing Organization (CNO) demonstration project
[1,327] Effective as if enacted with BBRA99, the provision would eliminate the requirement that CNO capitated payments be reduced to ensure budget neutrality. Through December 2001, the projects would operate under the same terms and conditions applicable during 1999, but with modification to the capitation rates. From October 1, 2000, through December 31, 2000, the capitation rates would be adjusted for inflation since 1999 and for changes in service packages, but reduced by 10 percent for in projects in Arizona, Minnesota, and Illinois and by 15 percent in New York. In 2001, the rates would be determined by actuarially adjusting the rates in the prior period for inflation, utilization, and changes to the service package. Adjustments would be made to case management fees for certain frail enrollees, and requirements would be imposed to create greater uniformity in clinical features among participating sites and to improve quality and enrollee satisfaction.
[1,328] By July 1, 2001, the Secretary would be required to submit to the House Committees on Ways and Means and Commerce and the Senate Committee on Finance a report evaluating the projects for the period July 1997 through December 1999 and for the extension period after September 30, 2000. A final report would be required by July 1, 2002. The provision would require certain methods to be used to compare spending per beneficiary under the projects.
Section 633. Extension of Medicare municipal health services demonstration projects
[1,329] The provision would extend the Medicare municipal health services demonstration projects for 2 additional years, through December 31, 2004.
Section 634. Service area expansion for Medicare cost contracts during transition period
[1,330] This provision would allow service area expansion for Medicare cost contracts, if the request was submitted to the Secretary before September 1, 2003.
TITLE VII -- MEDICAID
Section 701. DSH payments
(a) Modifications to DSH allotments
[1,331] For FY2001, the provision would set each state's DSH allotment equal to its allotment for FY2000 increased by the percentage change in the consumer price index for that year, subject to a ceiling that would be equal to 12% of that state's total medical assistance payments in that year.
[1,332] For FY2002, the provision would set each state's DSH allotment equal to its allotment for 2001 as determined above, increased by the percentage change in the consumer price index for FY2001, subject to a ceiling equal to 12% of that state's total medical assistance payments in that year.
[1,333] For extremely low DSH states, states whose FY1999 federal and state DSH expenditures (as reported to HCFA on August 31, 2000) are greater than zero but less than one percent of the state's total medical assistance expenditures during that fiscal year, the DSH allotments for FY2001 would be equal to 1 percent of the state's total amount of expenditures under their plan for such assistance during that fiscal year. For subsequent fiscal years, the allotments for extremely low DSH states would be equal to their allotment for the previous year, increased by the percentage change in the consumer price index for the previous year, subject to a ceiling of 12% of that state's total medical assistance payments in that year.
[1,334] Effective on the date that the final regulation for Medicaid upper payment limits is published in the Federal Register.
(b) Assuring identification of Medicaid managed care patients
[1,335] Effective for Medicaid managed care contracts in effect on January 1, 2001, the provision would clarify that Medicaid enrollees of managed care organizations and primary care case management organizations are to be included for the purposes of calculating the Medicaid inpatient utilization rate and the low- income utilization rate. Also effective January 1, 2001, states must include in their MCO contracts information that allows the state to determine which hospital services are provided to Medicaid beneficiaries through managed care, and would also require states to include a sponsorship code for the managed care entity on the Medicaid beneficiary's identification card.
(c) Application of Medicaid DSH transition rule to public hospitals in all states
[1,336] The provision would revise BBA97, as modified by BBRA 99, so that the 175% hospital-specific limit, formerly applied only to certain public hospitals in California, applies to qualifying public hospitals in all states. The higher limit would apply for two state fiscal years beginning on the first day of the state fiscal year that begins after September 30, 2002 and ends on the last day of the succeeding state fiscal year. Hospitals that would qualify for the higher hospital-specific limit would be those owned or operated by a state and meet the minimum federal requirements for disproportionate share hospitals. The permanent ceiling for California would not be affected.
[1,337] For states operating under waivers approved under section 1115 of the Social Security Act, increased payments for public hospitals under this provision would be included in the baseline expenditure limit for the purposes of determining budget neutrality.
(d) Assistance for certain public hospitals
[1,338] The provision would provide additional funds for certain public hospitals that are: owned or operated by a state (or by an instrumentality or unit of government within a state); are not receiving DSH payments as of October 1, 2000; and have a low-income utilization rate in excess of 65% as of the same date. Funds are provided in addition to the DSH allotment for any state with eligible hospitals and the total for all states cannot exceed the following amounts: $15 million for FY 2002; $176 million for 2003; $269 million for 2004; $330 million for 2005; and for FY 2006 and each fiscal year thereafter; $375 million.
(e) DSH payment accountability standards
[1,339] The provision would require the Secretary to implement accountability standards to ensure that DSH payments are used to reimburse States and hospitals that are eligible for such payments and are otherwise in accordance with Medicaid statutory requirements.
Section 702. New prospective payment system for federally-qualified health centers and rural health clinics
[1,340] The provision would create a new Medicaid prospective payment system for federally qualified health centers (FQHCs) and rural health centers (RHCs) beginning in FY2001. In FY2001 existing FQHCs and RHCs would be paid per visit payments equal to 100% of the average costs incurred during 1999 and 2000 adjusted to take into account any increase or decrease in the scope of services furnished. For entities first qualifying as FQHCs or RHCs after 2000, the per visit payments would begin in the first year that the center or clinic attains qualification and would be based on 100% of the costs incurred during that year based on the rates established for similar centers or clinics with similar caseloads in the same adjacent geographic area. In the absence of such similar centers or clinics, the methodology would be based on that used for developing rates for established FQHCs or RHCs or a methodology or reasonable specifications as established by the Secretary. For each fiscal year thereafter, per visit payments for all FQHCs and RHCs would be equal to amounts for the preceding fiscal year increased by the percentage increase in the Medicare Economic Index applicable to primary care services for that fiscal year, and adjusted for any increase or decrease in the scope of services furnished during that fiscal year. In managed care contracts, States must make supplemental payments to the center or clinic that would be equal to the difference between contracted amounts and the cost-based amounts. Those payments would be paid on a schedule mutually agreed to by the State and the FQHC or RHC. Alternative payment methods would be permitted only when payments are at least equal to amounts otherwise provided.
[1,341] The provision would also direct the Comptroller General to provide for a study on how to rebase or refine cost payment methods for the services of FQHCs and RHCs. The report would be due to Congress no later than 4 years after the date of enactment.
Section 703. Streamlined approval of continued state-wide 1115 Medicaid waivers
[1,342] The provision would define the process for submitting requests for and receiving extensions of Medicaid demonstration waivers authorized under Section 1115 of the Social Security Act which have already received initial 3-year extensions. It would require each state requesting such an extension to submit an application at least 120 days prior to the expiration date of the existing waiver. No later than 45 days after the Secretary receives such application, the Secretary would be required to notify the State if she intends to review the existing terms and conditions of the project and would inform the State of proposed changes in the terms and conditions of the waiver. If the Secretary fails to provide such notification, the request would be deemed approved. During the 30-day period beginning after the Secretary provides the proposed terms and conditions to the state, those terms and conditions would be negotiated. No later than 120 days after the date that the request for extension was submitted (or such later date as agreed to by the chief executive officer of the State) the Secretary would be required to approve the application subject to the agreed upon terms and conditions or, in the absence of an agreement, such terms and conditions that are determined by the Secretary to be reasonably consistent with the overall objective of the waiver, or disapprove the application. If the waiver is not approved or disapproved during this period, the request would be deemed approved in the terms and conditions as have been agreed to (if any) by the Secretary and the State. Approvals would be for periods not to exceed 3 years and would be subject to the final reporting and evaluation requirements in current law.
Section 704. Medicaid county-organized health systems
[1,343] The provision would allow the current exemption for certain Health Insuring Organizations (HIOs) from certain Medicaid HMO contracting requirements to apply as long as no more than 14% of all Medicaid beneficiaries in the state are enrolled in those HIOs. This provision would be effective as if included in the enactment of the Consolidated Omnibus Budget Reconciliation Act of 1985.
Sec. 705. Deadline for issuance of final regulation relating to Medicaid upper payment limits
[1,344] The provision would require the Secretary to issue final regulations governing upper payment limits no later than December 31, 2000. It also requires that the final regulation establish a separate UPL for non-state-owned or operated government facilities based on the proposed rule described above.
[1,345] The provision also requires the final regulation to stipulate a third set of rules governing the transition period for certain states. This additional set of rules would apply to states with payment arrangements approved or in effect on or before October 1, 1992, or under which claims for federal matching were paid on or before that date, and for which such payments exceed the UPLs established under the final regulation. For these states, a 6-year transition period would apply, beginning with the period that begins on the first state fiscal year that starts after September 30, 2002 and ends on September 30, 2008. For each year during the transition period, applicable states must reduce excess payments by 15%. Full compliance with final regulations is required by October 1, 2008.
Section 706. Alaska FMAP
[1,346] The provision would change the formula for calculating the state percentage and thus the federal matching percentage for Alaska for fiscal years 2001 through 2005. The state percentage for Alaska would be calculated by using an adjusted per capita income instead of the per capita income generally used. The adjusted per capita income for Alaska would be calculated as the three year average per capita income for the state divided by 1.05.
TITLE VIII -- STATE CHILDREN'S HEALTH INSURANCE PROGRAM
Section 801. Special rule for redistribution and availability of unused fiscal year 1998 and 1999 SCHIP allotments
[1,347] The provision would establish a new method for distributing unspent FY1998 and FY1999 allotments. States that use all their SCHIP allotments (for each of those years) would receive an amount equal to estimated spending in excess of their original exhausted allotment. Each territory that spends its original allotment would receive an amount that bears the same ratio to 1.05% of the total amount available for redistribution as the ratio of its original allotment to the total allotment for all territories.
[1,348] States that do not use all their SCHIP allotment would receive an amount equal to the total amount of unspent funds, less amounts distributed to states that fully exhausted their original allotments, multiplied by the ratio of a state's unspent original allotment to the total amount of unspent funds. States may use up to 10% of the retained FY1998 funds for outreach activities.
[1,349] To calculate the amounts available for redistribution in each formula described above, the Secretary would use amounts reported by states not later than November 30 of the relevant fiscal year on HCFA Form 64 or HCFA Form 21, as approved by the Secretary. Redistributed funds would be available through the end of FY2002.
Section 802. Authority to pay Medicaid expansion SCHIP costs from title XXI appropriation
[1,350] This provision provides a technical accounting clarification requested by the Health Care Financing Administration. It would authorize the payment of the costs of SCHIP Medicaid expansions and costs of benefits provided during periods of presumptive eligibility from the SCHIP appropriation rather than from the Medicaid appropriation, with a subsequent offset. In addition, the provision would codify proposed rules regarding the order of payments for benefits and administrative costs from state-specific SCHIP allotments.
TITLE IX -- OTHER PROVISIONS
SUBTITLE A -- PACE PROGRAM
Section 901. Extension of transition for current waivers
[1,351] The provision would permit the Secretary to continue to operate the Program of All-Inclusive Care for the Elderly (PACE) under waivers for a period of 36 months (rather than 24 months), and States may do so for 4 years (rather than 3 years). OBRA 86 required the Secretary to grant waivers of certain Medicare and Medicaid requirements to not more than 10 public or non-profit private community-based organizations to provide health and long-term care services on a capitated basis to frail elderly persons at risk of institutionalization. BBA 97 established PACE as a permanent provider under Medicare and as a special benefit under Medicaid.
Section 902. Continuing of certain operating arrangements permitted
[1,352] If prior to becoming a permanent component of Medicare, a PACE demonstration project had contractual or other operating arrangements that are not recognized under permanent program regulations, the provision would require the Secretary, in consultation with the state agency, to permit it to continue under such arrangements as long as it is consistent with the objectives of the PACE program.
Section 903. Flexibility in exercising waiver authority
[1,353] The provision would enable the Secretary to exercise authority to modify or waive Medicare or Medicaid requirements to respond to the needs of PACE programs related to employment and the use of community care physicians. The Secretary must approve requests for such waivers within 90 days of the date the request for waiver is received.
SUBTITLE B -- OUTREACH TO ELIGIBLE LOW-INCOME MEDICARE BENEFICIARIES
Section 911. Outreach on availability of medicare cost-sharing assistance to eligible low-income Medicare beneficiaries
[1,354] The provision would require the Commissioner of the Social Security Administration to conduct outreach efforts to identify individuals who may be eligible for Medicaid payment of Medicare cost sharing and to notify these persons of the availability of such assistance. The Commissioner would also be required to furnish, at least annually, a list of such individuals who reside in each state to that state's agency responsible for administering the Medicaid program as well as to any other appropriate state agency. The list should include the name and address, and whether such individuals have experienced reductions in Social Security benefits. The provision would also require the General Accounting Office to conduct a study of the impact of the outreach activities of the Commissioner to submit to Congress no later than 18 months after such outreach begins. The provision would be effective one year after date of enactment.
SUBTITLE C -- MATERNAL AND CHILD HEALTH BLOCK GRANT
Section 921. Increase in authorization of appropriations for the maternal and child health services block grant
[1,355] The provision would increase the authorization of appropriations for the Maternal and Child Health Services Block Grant under Title V from $705,000,000 to $850,000,000 for fiscal year 2001 and each fiscal year thereafter.
SUBTITLE D -- DIABETES
Section 931. Increase in appropriations for special diabetes programs for type I diabetes and Indians
[1,356] The provision would extend for 1 year, to FY2003, the authority for grants to be made for both the Special Diabetes Program for Type I Diabetes and for the Special Diabetes Programs for Indians under the Public Health Service Act. The provision would also expand funding available for these programs. For each grant program, the provision would increase total funding to $100 million each for FY2001, FY2002 and FY2003. For FY2001 and FY2002, $30 million of the $100 million for each program would be transferred from SCHIP as set forth in the Balanced Budget Act of 1997; the remaining $70 million would be drawn from the Treasury out of funds not otherwise appropriated. In FY2003, the entire $100 million would be drawn from the Treasury out of funds not otherwise appropriated. In addition, the provision would extend the due date on final evaluation reports for these two grant programs from January 1, 2002 to January 1, 2003.
Section 932. Appropriations for Ricky Ray Hemophilia Relief Fund
[1,357] This provision provides for a direct appropriation of $475 million for FY 2001. Funds would be available until expended.
- AuthorsArmey, Rep. Richard K.
- Institutional AuthorsHouse of Representatives
- Cross-ReferenceFor text of H.R. 5542's provisions, see Doc 2000-27538 (286 original
pages); 2000 TNT 209-8 and 2000 TNT 209-9 ; or H&D, Special
Supplement, Oct. 27, 2000. For related coverage, see Doc 2000-27773
(7 original pages), 2000 TNT 209-1, or H&D, Oct. 27, 2000, p. 1059. - Subject Area/Tax Topics
- Index Termsbudget, federallegislation, taxhealth care and insurancesmall business
- Jurisdictions
- LanguageEnglish
- Tax Analysts Document NumberDoc 2000-28631 (474 original pages)
- Tax Analysts Electronic Citation2000 TNT 221-31
