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106th CONGRESS
2d Session
S. 3077
To amend the Social Security Act to make corrections and refinements in
the Medicare, Medicaid, and SCHIP health insurance programs, as revised
by the Balanced Budget Act of 1997 and the Medicare, Medicaid, and
SCHIP Balanced Budget Refinement Act of 1999, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 20, 2000
Mr. Moynihan (for himself, Mr. Daschle, Mr. Rockefeller, Mr. Breaux,
Mr. Graham, Mr. Kerrey, Mr. Robb, Mr. Kennedy, Mr. Akaka, Mr. Bingaman,
Mrs. Boxer, Mr. Cleland, Mr. Dodd, Mr. Dorgan, Mr. Edwards, Mr.
Hollings, Mr. Inouye, Mr. Johnson, Mr. Kerry, Ms. Landrieu, Mr. Leahy,
Mr. Levin, Mrs. Lincoln, Ms. Mikulski, Mr. Miller, Mrs. Murray, Mr.
Reed, Mr. Sarbanes, Mr. Schumer, Mr. Torricelli, and Mr. Wellstone)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
A BILL
To amend the Social Security Act to make corrections and refinements in
the Medicare, Medicaid, and SCHIP health insurance programs, as revised
by the Balanced Budget Act of 1997 and the Medicare, Medicaid, and
SCHIP Balanced Budget Refinement Act of 1999, 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; AMENDMENTS TO SOCIAL SECURITY ACT; REFERENCES
TO OTHER ACTS; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Medicare,
Medicaid, and SCHIP Balanced Budget Refinement Act of 2000''.
(b) Amendments to Social Security Act.--Except as otherwise
specifically provided, whenever in this Act 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 Other Acts.--In this Act:
(1) The balanced budget act of 1997.--The term ``BBA''
means the Balanced Budget Act of 1997 (Public Law 105-33; 111
Stat. 251).
(2) The medicare, medicaid, and schip balanced budget
refinement act of 1999.--The term ``BBRA'' means the Medicare,
Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (113
Stat. 1501A-321), as enacted into law by section 1000(a)(6) of
Public Law 106-113.
(d) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; amendments to Social Security Act; references to
other Acts; table of contents.
TITLE I--PROVISIONS RELATING TO PART A
Subtitle A--Skilled Nursing Facilities
Sec. 101. Eliminating reduction in skilled nursing facility (SNF)
market basket update.
Sec. 102. Revision of BBRA increase for skilled nursing facilities in
fiscal years 2001 and 2002.
Sec. 103. MedPAC study on payment updates for skilled nursing
facilities; authority of Secretary to make
adjustments.
Subtitle B--PPS Hospitals
Sec. 111. Revision of reduction of indirect graduate medical education
payments.
Sec. 112. Eliminating reduction in PPS hospital payment update.
Sec. 113. Eliminating reduction in disproportionate share hospital
(DSH) payments.
Sec. 114. Equalizing the threshold and updating payment formulas for
disproportionate share hospitals.
Sec. 115. Care for low-income patients.
Sec. 116. Modification of payment rate for Puerto Rico hospitals.
Sec. 117. MedPAC study on hospital area wage indexes.
Subtitle C--PPS Exempt Hospitals
Sec. 121. Treatment of certain cancer hospitals.
Sec. 122. Payment adjustment for inpatient services in rehabilitation
hospitals.
Subtitle D--Hospice Care
Sec. 131. Revision in payments for hospice care.
Subtitle E--Other Provisions
Sec. 141. Hospitals required to comply with bloodborne pathogens
standard.
Sec. 142. Informatics and data systems grant program.
Sec. 143. Relief from medicare part A late enrollment penalty for group
buy-in for State and local retirees.
Subtitle F--Transitional Provisions
Sec. 151. Reclassification of certain counties and areas for purposes
of reimbursement under the medicare
program.
Sec. 152. Calculation and application of wage index floor for a certain
area.
TITLE II--PROVISIONS RELATING TO PART B
Subtitle A--Hospital Outpatient Services
Sec. 201. Reduction of effective HOPD coinsurance rate to 20 percent by
2014.
Sec. 202. Application of transitional corridor to certain hospitals
that did not submit a 1996 cost report.
Sec. 203. Permanent guarantee of pre-BBA payment levels for outpatient
services furnished by children's hospitals.
Subtitle B--Provisions Relating to Physicians
Sec. 211. Loan deferment for residents.
Sec. 212. GAO studies and reports on medicare payments.
Sec. 213. MedPAC study on the resource-based practice expense system.
Subtitle C--Ambulance Services
Sec. 221. Election to forego phase-in of fee schedule for ambulance
services.
Sec. 222. Prudent layperson standard for emergency ambulance services.
Sec. 223. Elimination of reduction in inflation adjustments for
ambulance services.
Sec. 224. Study and report on the costs of rural ambulance services.
Sec. 225. Interim payments for rural ground ambulance services until
regulation implemented.
Sec. 226. GAO study and report on the costs of emergency and medical
transportation services.
Subtitle D--Preventive Services
Sec. 231. Elimination of deductibles and coinsurance for preventive
benefits.
Sec. 232. Counseling for cessation of tobacco use.
Sec. 233. Coverage of glaucoma detection tests.
Sec. 234. Medical nutrition therapy services for beneficiaries with
diabetes, a cardiovascular disease, or a
renal disease.
Sec. 235. Studies on preventive interventions in primary care for older
Americans.
Sec. 236. Institute of Medicine 5-year medicare prevention benefit
study and report.
Sec. 237. Fast-track consideration of prevention benefit legislation.
Subtitle E--Other Services
Sec. 241. Revision of moratorium in caps for therapy services.
Sec. 242. Revision of coverage of immunosuppressive drugs.
Sec. 243. State accreditation of diabetes self-management training
programs.
Sec. 244. Elimination of reduction in payment amounts for durable
medical equipment and oxygen and oxygen
equipment.
Sec. 245. Standards regarding payment for certain orthotics and
prosthetics.
Sec. 246. National limitation amount equal to 100 percent of national
median for new pap smear technologies and
other new clinical laboratory test
technologies.
Sec. 247. Increased medicare payments for certified nurse-midwife
services.
Sec. 248. Payment for administration of drugs.
Sec. 249. MedPAC study on in-home infusion therapy nursing services.
TITLE III--PROVISIONS RELATING TO PARTS A AND B
Subtitle A--Home Health Services
Sec. 301. Elimination of 15 percent reduction in payment rates under
the prospective payment system for home
health services.
Sec. 302. Exclusion of certain nonroutine medical supplies under the
PPS for home health services.
Sec. 303. Permitting home health patients with Alzheimer's disease or a
related dementia to attend adult day-care.
Sec. 304. Standards for home health branch offices.
Sec. 305. Treatment of home health services provided in certain
counties.
Subtitle B--Direct Graduate Medical Education
Sec. 311. Not counting certain geriatric residents against graduate
medical education limitations.
Sec. 312. Program of payments to children's hospitals that operate
graduate medical education programs.
Sec. 313. Authority to include costs of training of clinical
psychologists in payments to hospitals.
Sec. 314. Treatment of certain newly established residency programs in
computing medicare payments for the costs
of medical education.
Subtitle C--Miscellaneous Provisions
Sec. 321. Waiver of 24-month waiting period for medicare coverage of
individuals disabled with amyotrophic
lateral sclerosis (ALS).
TITLE IV--RURAL PROVIDER PROVISIONS
Subtitle A--Critical Access Hospitals
Sec. 401. Payments to critical access hospitals for clinical diagnostic
laboratory tests.
Sec. 402. Revision of payment for professional services provided by a
critical access hospital.
Sec. 403. Permitting critical access hospitals to operate PPS exempt
distinct part psychiatric and
rehabilitation units.
Subtitle B--Medicare Dependent, Small Rural Hospital Program
Sec. 411. Making the medicare dependent, small rural hospital program
permanent.
Sec. 412. Option to base eligibility for medicare dependent, small
rural hospital program on discharges during
any of the 3 most recent audited cost
reporting periods.
Subtitle C--Sole Community Hospitals
Sec. 421. Extension of option to use rebased target amounts to all sole
community hospitals.
Sec. 422. Deeming a certain hospital as a sole community hospital.
Subtitle D--Other Rural Hospital Provisions
Sec. 431. Exemption of hospital swing-bed program from the PPS for
skilled nursing facilities.
Sec. 432. Permanent guarantee of pre-BBA payment levels for outpatient
services furnished by rural hospitals.
Sec. 433. Treatment of certain physician pathology services.
Subtitle E--Other Rural Provisions
Sec. 441. Revision of bonus payments for services furnished in health
professional shortage areas.
Sec. 442. Provider-based rural health clinic cap exemption.
Sec. 443. Payment for certain physician assistant services.
Sec. 444. Bonus payments for rural home health agencies in 2001 and
2002.
Sec. 445. Exclusion of clinical social worker services and services
performed under a contract with a rural
health clinic or federally qualified health
center from the PPS for SNFs.
Sec. 446. Coverage of marriage and family therapist services provided
in rural health clinics.
Sec. 447. Capital infrastructure revolving loan program.
Sec. 448. Grants for upgrading data systems.
Sec. 449. Relief for financially distressed rural hospitals.
Sec. 450. Refinement of medicare reimbursement for telehealth services.
Sec. 451. MedPAC study on low-volume, isolated rural health care
providers.
TITLE V--PROVISIONS RELATING TO PART C (MEDICARE+CHOICE PROGRAM) AND
OTHER MEDICARE MANAGED CARE PROVISIONS
Sec. 501. Restoring effective date of elections and changes of
elections of Medicare+Choice plans.
Sec. 502. Special Medigap enrollment antidiscrimination provision for
certain beneficiaries.
Sec. 503. Increase in national per capita Medicare+Choice growth
percentage in 2001 and 2002.
Sec. 504. Allowing movement to 50:50 percent blend in 2002.
Sec. 505. Delay from July to November 2000, in deadline for offering
and withdrawing Medicare+Choice plans for
2001.
Sec. 506. Amounts in medicare trust funds available for Secretary's
share of Medicare+Choice education and
enrollment-related costs.
Sec. 507. Revised terms and conditions for extension of medicare
community nursing organization (CNO)
demonstration project.
Sec. 508. Modification of payment rules for certain frail elderly
medicare beneficiaries.
TITLE VI--PROVISIONS RELATING TO INDIVIDUALS WITH END-STAGE RENAL
DISEASE
Sec. 601. Update in renal dialysis composite rate.
Sec. 602. Revision of payment rates for ESRD patients enrolled in
Medicare+Choice plans.
Sec. 603. Permitting ESRD beneficiaries to enroll in another
Medicare+Choice plan if the plan in which
they are enrolled is terminated.
Sec. 604. Coverage of certain vascular access services for ESRD
beneficiaries provided by ambulatory
surgical centers.
Sec. 605. Collection and analysis of information on the satisfaction of
ESRD beneficiaries with the quality of and
access to health care under the medicare
program.
TITLE VII--ACCESS TO CARE IMPROVEMENTS THROUGH MEDICAID AND SCHIP
Sec. 701. New prospective payment system for Federally-qualified health
centers and rural health clinics.
Sec. 702. Transitional medical assistance.
Sec. 703. Application of simplified SCHIP procedures under the medicaid
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