Home > 106th Congressional Bills > H.R. 4680 (rh) To amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program, and for other purposes. [Reported in House] ...

H.R. 4680 (rh) To amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program, and for other purposes. [Reported in House] ...

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                                                       Calendar No. 655
  2d Session
                                H. R. 4680



                             June 29, 2000

                    Received and read the first time

                             June 30, 2000

            Read the second time and placed on the calendar


                                 AN ACT

   To amend title XVIII of the Social Security Act to provide for a 
  voluntary program for prescription drug coverage under the Medicare 
  Program, to modernize the Medicare Program, and for other purposes.

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


    (a) Short Title.--This Act may be cited as the ``Medicare Rx 2000 
    (b) Table of Contents.--The table of contents of this Act is as 

Sec. 1. Short title; table of contents.

Sec. 101. Establishment of a medicare prescription drug benefit.
Sec. 102. Offering of qualified prescription drug coverage under the 
                            Medicare+Choice program.
Sec. 103. Medicaid amendments.
Sec. 104. Medigap transition provisions.
Sec. 105. State Pharmaceutical Assistance Transition Commission.
Sec. 106. Demonstration project for disease management for severely 
                            chronically ill medicare beneficiaries.

              Subtitle A--Medicare Benefits Administration

Sec. 201. Establishment of administration.
Sec. 202. Miscellaneous administrative provisions.
   Subtitle B--Oversight of Financial Sustainability of the Medicare 

Sec. 211. Additional requirements for annual financial report and 
                            oversight on medicare program.
      Subtitle C--Changes in Medicare Coverage and Appeals Process

Sec. 221. Revisions to medicare appeals process.
Sec. 222. Provisions with respect to limitations on liability of 
Sec. 223. Waivers of liability for cost sharing amounts.
Sec. 224. Elimination of motions by the Secretary on decisions of the 
                            Provider Reimbursement Review Board.
Sec. 225. Effective date of subtitle.
                              DRUG BENEFIT

                  Subtitle A--Medicare+Choice Reforms

Sec. 301. Increase in national per capita Medicare+Choice growth 
                            percentage in 2001 and 2002.
Sec. 302. Permanently removing application of budget neutrality 
                            beginning in 2002.
Sec. 303. Increasing minimum payment amount.
Sec. 304. Allowing movement to 50:50 percent blend in 2002.
Sec. 305. Increased update for payment areas with only one or no 
                            Medicare+Choice contracts.
Sec. 306. Permitting higher negotiated rates in certain Medicare+Choice 
                            payment areas below national average.
Sec. 307. 10-year phase in of risk adjustment based on data from all 
Sec. 308. Delay from July to October, 2000 in deadline for offering and 
                            withdrawing Medicare+Choice plans for 2001.
 Subtitle B--Preservation of Medicare Coverage of Drugs and Biologicals

Sec. 311. Preservation of coverage of drugs and biologicals under part 
                            B of the medicare program.
Sec. 312. GAO report on part B payment for drugs and biologicals and 
                            related services.



    (a) In General.--Title XVIII of the Social Security Act is 
            (1) by redesignating part D as part E; and
            (2) by inserting after part C the following new part:

         ``Part D--Voluntary Prescription Drug Benefit Program


    ``(a) Provision of Qualified Prescription Drug Coverage Through 
Enrollment in Plans.--Subject to the succeeding provisions of this 
part, each individual who is enrolled under part B is entitled to 
obtain qualified prescription drug coverage (described in section 
1860B(a)) as follows:
            ``(1) Medicare+choice plan.--If the individual is eligible 
        to enroll in a Medicare+Choice plan that provides qualified 
        prescription drug coverage under section 1851(j), the 
        individual may enroll in the plan and obtain coverage through 
        such plan.
            ``(2) Prescription drug plan.--If the individual is not 
        enrolled in a Medicare+Choice plan that provides qualified 
        prescription drug coverage, the individual may enroll under 
        this part in a prescription drug plan (as defined in section 
Such individuals shall have a choice of such plans under section 
    ``(b) General Election Procedures.--
            ``(1) In general.--An individual may elect to enroll in a 
        prescription drug plan under this part, or elect the option of 
        qualified prescription drug coverage under a Medicare+Choice 
        plan under part C, and change such election only in such manner 
        and form as may be prescribed by regulations of the 
        Administrator of the Medicare Benefits Administration 
        (appointed under section 1807(b)) (in this part referred to as 
        the `Medicare Benefits Administrator') and only during an 
        election period prescribed in or under this subsection.
            ``(2) Election periods.--
                    ``(A) In general.--Except as provided in this 
                paragraph, the election periods under this subsection 
                shall be the same as the coverage election periods 
                under the Medicare+Choice program under section 
                1851(e), including--
                            ``(i) annual coordinated election periods; 
                            ``(ii) special election periods.
                In applying the last sentence of section 1851(e)(4) 
                (relating to discontinuance of a Medicare+Choice 
                election during the first year of eligibility) under 
                this subparagraph, in the case of an election described 
                in such section in which the individual had elected or 
                is provided qualified prescription drug coverage at the 
                time of such first enrollment, the individual shall be 
                permitted to enroll in a prescription drug plan under 
                this part at the time of the election of coverage under 
                the original fee-for-service plan.
                    ``(B) Initial election periods.--
                            ``(i) Individuals currently covered.--In 
                        the case of an individual who is enrolled under 
                        part B as of November 1, 2002, there shall be 
                        an initial election period of 6 months 
                        beginning on that date.
                            ``(ii) Individual covered in future.--In 
                        the case of an individual who is first enrolled 
                        under part B after November 1, 2002, there 
                        shall be an initial election period which is 
                        the same as the initial enrollment period under 
                        section 1837(d).
                    ``(C) Additional special election periods.--The 
                Medicare Benefits Administrator shall establish special 
                election periods--
                            ``(i) in cases of individuals who have and 
                        involuntarily lose prescription drug coverage 
                        described in subsection (c)(2)(C);
                            ``(ii) in cases described in section 
                        1837(h) (relating to errors in enrollment), in 
                        the same manner as such section applies to part 
                        B; and
                            ``(iii) in the case of an individual who 
                        meets such exceptional conditions (including 
                        conditions recognized under section 
                        1851(d)(4)(D)) as the Administrator may 
                    ``(D) One-time enrollment permitted for current 
                part a only beneficiaries.--In the case of an 
                individual who as of November 1, 2002--
                            ``(i) is entitled to benefits under part A; 
                            ``(ii) is not (and has not previously been) 
                        enrolled under part B,
                the individual shall be eligible to enroll in a 
                prescription drug plan under this part but only during 
                the period described in subparagraph (B)(i). If the 
                individual enrolls in such a plan, the individual may 
                change such enrollment under this part, but the 
                individual may not enroll in a Medicare+Choice plan 
                under part C unless the individual enrolls under part 
                B. Nothing in this subparagraph shall be construed as 
                providing for coverage under a prescription drug plan 
                of benefits that are excluded because of the 
                application of section 1860B(f)(2)(B).
    ``(c) Guaranteed Issue; Community Rating; and Nondiscrimination.--
            ``(1) Guaranteed issue.--
                    ``(A) In general.--An eligible individual who is 
                eligible to elect qualified prescription drug coverage 
                under a prescription drug plan or Medicare+Choice plan 
                at a time during which elections are accepted under 
                this part with respect to the plan shall not be denied 
                enrollment based on any health status-related factor 
                (described in section 2702(a)(1) of the Public Health 
                Service Act) or any other factor.
                    ``(B) Medicare+choice limitations permitted.--The 
                provisions of paragraphs (2) and (3) (other than 
                subparagraph (C)(i), relating to default enrollment) of 
                section 1851(g) (relating to priority and limitation on 
                termination of election) shall apply to PDP sponsors 
                under this subsection.
            ``(2) Community-rated premium.--
                    ``(A) In general.--In the case of an individual who 
                maintains (as determined under subparagraph (C)) 
                continuous prescription drug coverage since first 
                qualifying to elect prescription drug coverage under 
                this part, a PDP sponsor or Medicare+Choice 
                organization offering a prescription drug plan or 
                Medicare+Choice plan that provides qualified 
                prescription drug coverage and in which the individual 
                is enrolled may not deny, limit, or condition the 
                coverage or provision of covered prescription drug 
                benefits or increase the premium under the plan based 
                on any health status-related factor described in 
                section 2702(a)(1) of the Public Health Service Act or 
                any other factor.
                    ``(B) Late enrollment penalty.--In the case of an 
                individual who does not maintain such continuous 
                prescription drug coverage, a PDP sponsor or 
                Medicare+Choice organization may (notwithstanding any 
                provision in this title) increase the premium otherwise 
                applicable or impose a pre-existing condition exclusion 
                with respect to qualified prescription drug coverage in 
                a manner that reflects additional actuarial risk 
                involved. Such a risk shall be established through an 
                appropriate actuarial opinion of the type described in 
                subparagraphs (A) through (C) of section 2103(c)(4).
                    ``(C) Continuous prescription drug coverage.--An 
                individual is considered for purposes of this part to 
                be maintaining continuous prescription drug coverage on 
                and after a date if the individual establishes that 
                there is no period of 63 days or longer on and after 
                such date (beginning not earlier than January 1, 2003) 
                during all of which the individual did not have any of 
                the following prescription drug coverage:
                            ``(i) Coverage under prescription drug plan 
                        or medicare+choice plan.--Qualified 
                        prescription drug coverage under a prescription 
                        drug plan or under a Medicare+Choice plan.
                            ``(ii) Medicaid prescription drug 
                        coverage.--Prescription drug coverage under a 
                        medicaid plan under title XIX, including 
                        through the Program of All-inclusive Care for 
                        the Elderly (PACE) under section 1934, through 
                        a social health maintenance organization 
                        (referred to in section 4104(c) of the Balanced 
                        Budget Act of 1997), or through a 
                        Medicare+Choice project that demonstrates the 
                        application of capitation payment rates for 
                        frail elderly medicare beneficiaries through 
                        the use of a interdisciplinary team and through 
                        the provision of primary care services to such 
                        beneficiaries by means of such a team at the 
                        nursing facility involved.
                            ``(iii) Prescription drug coverage under 
                        group health plan.--Any outpatient prescription 
                        drug coverage under a group health plan, 
                        including a health benefits plan under the 
                        Federal Employees Health Benefit Plan under 
                        chapter 89 of title 5, United States Code, and 
                        a qualified retiree prescription drug plan as 
                        defined in section 1860H(f)(1).
                            ``(iv) Prescription drug coverage under 
                        certain medigap policies.--Coverage under a 
                        medicare supplemental policy under section 1882 
                        that provides benefits for prescription drugs 
                        (whether or not such coverage conforms to the 
                        standards for packages of benefits under 
                        section 1882(p)(1)), but only if the policy was 
                        in effect on January 1, 2003, and only until 
                        the date such coverage is terminated.
                            ``(v) State pharmaceutical assistance 
                        program.--Coverage of prescription drugs under 
                        a State pharmaceutical assistance program.
                            ``(vi) Veterans' coverage of prescription 
                        drugs.--Coverage of prescription drugs for 
                        veterans under chapter 17 of title 38, United 
                        States Code.
                    ``(D) Certification.--For purposes of carrying out 
                this paragraph, the certifications of the type 
                described in sections 2701(e) of the Public Health 
                Service Act and in section 9801(e) of the Internal 
                Revenue Code shall also include a statement for the 
                period of coverage of whether the individual involved 

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