| 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] ...
Calendar No. 655 106th CONGRESS 2d Session H. R. 4680 _______________________________________________________________________ IN THE SENATE OF THE UNITED STATES 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, SECTION 1. SHORT TITLE; TABLE OF CONTENTS. (a) Short Title.--This Act may be cited as the ``Medicare Rx 2000 Act''. (b) Table of Contents.--The table of contents of this Act is as follows: Sec. 1. Short title; table of contents. TITLE I--MEDICARE PRESCRIPTION DRUG BENEFIT 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. TITLE II--MODERNIZATION OF ADMINISTRATION OF MEDICARE Subtitle A--Medicare Benefits Administration Sec. 201. Establishment of administration. Sec. 202. Miscellaneous administrative provisions. Subtitle B--Oversight of Financial Sustainability of the Medicare Program 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 beneficiaries. 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. TITLE III--MEDICARE+CHOICE REFORMS; PRESERVATION OF MEDICARE PART B 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 settings. 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. TITLE I--MEDICARE PRESCRIPTION DRUG BENEFIT SEC. 101. ESTABLISHMENT OF A MEDICARE PRESCRIPTION DRUG BENEFIT. (a) In General.--Title XVIII of the Social Security Act is amended-- (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 ``SEC. 1860A. BENEFITS; ELIGIBILITY; ENROLLMENT; AND COVERAGE PERIOD. ``(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 1860C(a)). Such individuals shall have a choice of such plans under section 1860E(d). ``(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; and ``(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 provide. ``(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; and ``(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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