Home > 106th Congressional Bills > H.R. 3076 (ih) To provide for the assessment of civil penalties for aliens who illegally enter the United States and for persons smuggling aliens within the United States. [Introduced in House] ...

H.R. 3076 (ih) To provide for the assessment of civil penalties for aliens who illegally enter the United States and for persons smuggling aliens within the United States. [Introduced in House] ...

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  1st Session
                                H. R. 3075



                            November 8, 1999


                           November 19, 1999

          Read twice and referred to the Committee on Finance


                                 AN ACT

To amend titles XVIII, XIX, and XXI of the Social Security Act to make 
   corrections and refinements in the Medicare, Medicaid, and State 
children's health insurance programs, as revised by the Balanced Budget 
                              Act of 1997.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

              TO BBA; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare, 
Medicaid, and SCHIP Balanced Budget Refinement Act of 1999''.
    (b) Amendments to Social Security Act.--Except as otherwise 
specifically provided, whenever in this title 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 Balanced Budget Act of 1997.--In this Act, the 
term ``BBA'' means the Balanced Budget Act of 1997 (Public Law 105-33).
    (d) Table of Contents.--The table of contents of this Act is as 

Sec. 1. Short title; amendments to Social Security Act; references to 
                            BBA; table of contents.

                       Subtitle A--PPS Hospitals

Sec. 101. One-year delay in transition for indirect medical education 
                            (IME) percentage adjustment.
Sec. 102. Decrease in reductions for disproportionate share hospitals; 
                            data collection requirements.
                    Subtitle B--PPS Exempt Hospitals

Sec. 111. Wage adjustment of percentile cap for PPS-exempt hospitals.
Sec. 112. Enhanced payments for long-term care and psychiatric 
                            hospitals until development of prospective 
                            payment systems for those hospitals.
Sec. 113. Per discharge prospective payment system for long-term care 
Sec. 114. Per diem prospective payment system for psychiatric 
Sec. 115. Refinement of prospective payment system for inpatient 
                            rehabilitation services.
 Subtitle C--Adjustments to PPS Payments for Skilled Nursing Facilities

Sec. 121. Temporary increase in payment for certain high cost patients.
Sec. 122. Market basket increase.
Sec. 123. Authorizing facilities to elect immediate transition to 
                            Federal rate.
Sec. 124. Part A pass-through payment for certain ambulance services, 
                            prostheses, and chemotherapy drugs.
Sec. 125. Provision for part B add-ons for facilities participating in 
                            the NHCMQ demonstration project.
Sec. 126. Special consideration for facilities serving specialized 
                            patient populations.
Sec. 127. MedPAC study on special payment for facilities located in 
                            Hawaii and Alaska.
                           Subtitle D--Other

Sec. 131. Part A BBA technical corrections.

          Subtitle A--Adjustments to Physician Payment Updates

Sec. 201. Modification of update adjustment factor provisions to reduce 
                            update oscillations and require estimate 
Sec. 202. Use of data collected by organizations and entities in 
                            determining practice expense relative 
Sec. 203. GAO study on resources required to provide safe and effective 
                            outpatient cancer therapy.
                Subtitle B--Hospital Outpatient Services

Sec. 211. Outlier adjustment and transitional pass-through for certain 
                            medical devices, drugs, and biologicals.
Sec. 212. Establishing a transitional corridor for application of OPD 
Sec. 213. Delay in application of prospective payment system to cancer 
                            center hospitals.
Sec. 214. Limitation on outpatient hospital copayment for a procedure 
                            to the hospital deductible amount.
                           Subtitle C--Other

Sec. 221. Application of separate caps to physical and speech therapy 
Sec. 222. Transitional outlier payments for therapy services for 
                            certain high acuity patients.
Sec. 223. Update in renal dialysis composite rate.
Sec. 224. Temporary update in durable medical equipment and oxygen 
Sec. 225. Requirement for new proposed rulemaking for implementation of 
                            inherent reasonableness policy.
Sec. 226. Increase in reimbursement for pap smears.
Sec. 227. Refinement of ambulance services demonstration project.
Sec. 228. Phase-in of PPS for ambulatory surgical centers.
Sec. 229. Extension of Medicare benefits for immunosuppressive drugs.
Sec. 230. Additional studies.

                    Subtitle A--Home Health Services

Sec. 301. Adjustment to reflect administrative costs not included in 
                            the interim payment system.
Sec. 302. Delay in application of 15 percent reduction in payment rates 
                            for home health services until 1 year after 
                            implementation of prospective payment 
Sec. 303. Clarification of surety bond requirements.
Sec. 304. Technical amendment clarifying applicable market basket 
                            increase for PPS.
             Subtitle B--Direct Graduate Medical Education

Sec. 311. Use of national average payment methodology in computing 
                            direct graduate medical education (DGME) 
Sec. 312. Initial residency period for child neurology residency 
                            training programs.
                           Subtitle C--Other

Sec. 321. GAO study on geographic reclassification.
Sec. 322. MedPAC study on Medicare payment for non-physician health 
                            professional clinical training in 

Sec. 401. Permitting reclassification of certain urban hospitals as 
                            rural hospitals.
Sec. 402. Update of standards applied for geographic reclassification 
                            for certain hospitals.
Sec. 403. Improvements in the critical access hospital (CAH) program.
Sec. 404. Five-year extension of Medicare dependent hospital (MDH) 
Sec. 405. Rebasing for certain sole community hospitals.
Sec. 406. Increased flexibility in providing graduate physician 
                            training in rural areas.
Sec. 407. Elimination of certain restrictions with respect to hospital 
                            swing bed program.
Sec. 408. Grant program for rural hospital transition to prospective 
Sec. 409. MedPAC study of rural providers.
Sec. 410. Expansion of access to paramedic intercept services in rural 

                      Subtitle A--Medicare+Choice

Sec. 501. Phase-in of new risk adjustment methodology.
Sec. 502. Encouraging offering of Medicare+Choice plans in areas 
                            without plans.
Sec. 503. Modification of 5-year re-entry rule for contract 
Sec. 504. Continued computation and publication of AAPCC data.
Sec. 505. Changes in Medicare+Choice enrollment rules.
Sec. 506. Allowing variation in premium waivers within a service area 
                            if Medicare+Choice payment rates vary 
                            within the area.
Sec. 507. Delay in deadline for submission of adjusted community rates 
                            and related information.
Sec. 508. Two-year extension of Medicare cost contracts.
Sec. 509. Medicare+Choice nursing and allied health professional 
                            education payments.
Sec. 510. Reduction in adjustment in national per capita 
                            Medicare+Choice growth percentage for 2002.
Sec. 511. Deeming of Medicare+Choice organization to meet requirements.
Sec. 512. Miscellaneous changes and studies.
Sec. 513. MedPAC report on Medicare MSA (medical savings account) 
Sec. 514. Clarification of nonapplicability of certain provisions of 
                            discharge planning process to 
                            Medicare+Choice plans.
            Subtitle B--Managed Care Demonstration Projects

Sec. 521. Extension of social health maintenance organization 
                            demonstration (SHMO) project authority.
Sec. 522. Extension of Medicare community nursing organization 
                            demonstration project.
Sec. 523. Medicare+Choice competitive bidding demonstration project.
Sec. 524. Extension of Medicare municipal health services demonstration 
Sec. 525. Medicare coordinated care demonstration project.
                           TITLE VI--MEDICAID

Sec. 601. Making Medicaid DSH transition rule permanent.
Sec. 602. Increase in DSH allotment for certain States and the District 
                            of Columbia.
Sec. 603. New prospective payment system for Federally-qualified health 
                            centers and rural health clinics.
Sec. 604. Parity in reimbursement for certain utilization and quality 
                            control services.

Sec. 701. Stabilizing the SCHIP allotment formula.
Sec. 702. Increased allotments for territories under the State 
                            children's health insurance program.


                       Subtitle A--PPS Hospitals


    (a) In General.--Section 1886(d)(5)(B)(ii) (42 U.S.C. 
1395ww(d)(5)(B)(ii)), as amended by section 4621(a)(1) of BBA, is 
            (1) in subclause (IV), by inserting ``and 2001'' after 
        ``2000''; and
            (2) by striking ``2000'' in subclause (V) and inserting 
    (b) Conforming Amendment Relating to Determination of Standardized 
Amount.--Section 1886(d)(2)(C)(i) (42 U.S.C. 1395ww(d)(2)(C)(i)), as 
amended by section 4621(a)(2) of BBA, is amended by inserting ``or any 
additional payments under such paragraph resulting from the amendment 
made by section 101(a) of Medicare, Medicaid, and SCHIP Balanced Budget 
Refinement Act of 1999'' after ``Balanced Budget Act of 1997''.


    (a) In General.--Section 1886(d)(5)(F)(ix) (42 U.S.C. 
1395ww(d)(5)(F)(ix)), as added by section 4403(a) of BBA, is amended--
            (1) in subclause (III), by striking ``during fiscal year 
        2000'' and inserting ``during each of fiscal years 2000 and 
            (2) by striking subclause (IV);
            (3) by redesignating subclauses (V) and (VI) and subclauses 
        (IV) and (V), respectively; and
            (4) in subclause (IV), as so redesignated, by striking 
        ``reduced by 5 percent'' and inserting ``reduced by 4 
    (b) Data Collection.--
            (1) In general.--The Secretary of Health and Human Services 
        shall require any subsection (d) hospital (as defined in 
        section 1886(d)(1)(B) of the Social Security Act (42 U.S.C. 
        1395ww(d)(1)(B)) to submit to the Secretary, in the cost 
        reports submitted to the Secretary by such hospital for 
        discharges occurring during a fiscal year, data on the costs 
        incurred by the hospital for providing inpatient and outpatient 
        hospital services for which the hospital is not compensated, 
        including non-Medicare bad debt, charity care, and charges for 
        Medicaid an indigent care.
            (2) Effective date.--The Secretary shall require the 
        submission of the data described in paragraph (1) in cost 
        reports for cost reporting periods beginning on or after the 
        date of the enactment of this Act.

                    Subtitle B--PPS-Exempt Hospitals


    (a) In General.--Section 1886(b)(3)(H) (42 U.S.C. 1395ww(b)(3)(H)), 
as amended by section 4414 of BBA, is amended--
            (1) in clause (i), by inserting ``, as adjusted under 
        clause (iii)'' before the period;
            (2) in clause (ii), by striking ``clause (i)'' and ``such 
        clause'' and inserting ``subclause (I)'' and ``such subclause'' 
            (3) by striking ``(H)(i)'' and inserting ``(ii)(I)'';
            (4) by redesignating clauses (ii) and (iii) as subclauses 
        (II) and (III);
            (5) by inserting after clause (ii), as so redesignated, the 
        following new clause:
    ``(iii) In applying clause (ii)(I) in the case of a hospital or 
unit, the Secretary shall provide for an appropriate adjustment to the 
labor-related portion of the amount determined under such subparagraph 
to take into account differences between average wage-related costs in 
the area of the hospital and the national average of such costs within 
the same class of hospital.''; and
            (6) by inserting before clause (ii), as so redesignated, 
        the following new clause:
    ``(H)(i) In the case of a hospital or unit that is within a class 
of hospital described in clause (iv), for a cost reporting period 

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