Home > 106th Congressional Bills > S. 2975 (is) To limit the administrative expenses and profits of managed care entities to not more than 15 percent of premium revenues. [Introduced in Senate] ...S. 2975 (is) To limit the administrative expenses and profits of managed care entities to not more than 15 percent of premium revenues. [Introduced in Senate] ...
106th CONGRESS
2d Session
S. 2974
To amend title XVIII of the Social Security Act to provide for
equitable reimbursement rates under the medicare program to
Medicare+Choice organizations.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 27, 2000
Mr. Gorton introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for
equitable reimbursement rates under the medicare program to
Medicare+Choice organizations.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Equity and Access Act of
2000''.
SEC. 2. ELIMINATION OF REDUCTION IN MEDICARE+CHOICE PAYMENT RATES BY
BUDGET NEUTRALITY ADJUSTMENTS.
(a) In General.--Section 1853(c)(1)(A) of the Social Security Act
(42 U.S.C. 1395w-23(c)(1)(A)) is amended by adding at the end the
following: ``With respect to years beginning on or after January 1,
2001, in no case shall the budget neutrality adjustment provided for in
the previous sentence result in a reduction of the payment amount that
would otherwise be made under this subparagraph but for such
adjustment.''.
(b) Transitional Rule in 2000 for Submission of Required
Information.--Notwithstanding section 1854(a)(1) of the Social Security
Act (42 U.S.C. 1395w-24(a)(1)), the deadline for a Medicare+Choice
organization offering of a Medicare+Choice plan under part C of title
XVIII of the Social Security Act to submit information, including the
adjusted community rate (as defined in subsection (f)(3) of that
section), required for the offering of such a plan for 2001 is delayed
from July 1, 2000, to December 1, 2000.
SEC. 3. ACCELERATION OF MOVEMENT TO 50:50 PERCENT BLEND IN 2001.
Section 1853(c)(2) of the Social Security Act (42 U.S.C. 1395w-
23(c)(2)) is amended--
(1) by adding ``and'' at the end of subparagraph (C);
(2) by striking subparagraphs (D) and (E);
(3) by redesignating subparagraph (F) as subparagraph (D);
and
(4) in subparagraph (D), as so redesignated, by striking
``2002'' and inserting ``2000''.
SEC. 4. INCREASE IN BASELINE OF NATIONAL PER CAPITA MEDICARE+CHOICE
GROWTH PERCENTAGE FOR YEARS AFTER 2000.
(a) In General.--Section 1853(c)(6)(B) of the Social Security Act
(42 U.S.C. 1395w-23(c)(6)(B)) is amended--
(1) in clause (i), by striking ``0.8 percentage points''
and inserting ``0 percentage points''; and
(2) in clause (ii), by striking ``0.5 percentage points''
and inserting ``0 percentage points''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply with respect to payment rates calculated for months beginning on
or after January 1, 2001.
SEC. 5. INCLUSION OF COSTS OF DOD MILITARY TREATMENT FACILITY SERVICES
TO MEDICARE-ELIGIBLE BENEFICIARIES IN CALCULATION OF
MEDICARE+CHOICE PAYMENT RATES.
Section 1853(c)(3) of the Social Security Act (42 U.S.C. 1395w-
23(c)(3)) is amended--
(1) in subparagraph (A), by striking ``subparagraph (B)''
and inserting ``subparagraphs (B) and (E)''; and
(2) by adding at the end the following new subparagraph:
``(E) Inclusion of costs of certain dod military
treatment facility services to medicare-eligible
beneficiaries.--
``(i) In general.--In determining the area-
specific Medicare+Choice capitation rate under
subparagraph (A) for a year (beginning with
2001), the annual per capita rate of payment
for 1997 determined under section 1876(a)(1)(C)
for a Medicare+Choice payment area that is
within one or more MTF affected areas (as
defined in clause (ii)) shall be increased by
the sum of the MTF percentages (as described in
clause (iii)) for the MTF affected area or
areas. The increase under this subparagraph
shall not be taken into account in computing
the national standardized annual
Medicare+Choice capitation rate under paragraph
(4)(B).
``(ii) MTF affected area defined.--In this
subparagraph, the term `MTF affected area'
means, with respect to a military treatment
facility (as defined in subsection (a)(6) of
section 1896), an area that includes the
following:
``(I) The Medicare+Choice payment
area in which a military treatment
facility is located.
``(II) Any Medicare+Choice payment
area which is contiguous to the area
described in subclause (I) and located
not farther than 40 miles from the
facility.
``(iii) MTF percentage.--For purposes of
clause (i), the MTF percentage for an MTF
affected area is equal to the ratio of--
``(I) the aggregate amount of costs
incurred by the Department of Defense
in furnishing items and services to
individuals entitled to benefits under
this title who received services from
the military treatment facility
described in clause (ii) for that area
in 1996 (as determined pursuant to
section 1896(j)(1)(A)), increased by
the national per capita Medicare+Choice
growth percentage under paragraph (6)
for 1997, to
``(II) the average number of
individuals residing in such area in
1996 entitled to benefits under part A
and enrolled under part B.''.
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