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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