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S. 3078 (is) To amend the Reclamation Wastewater and Groundwater Study and Facilities Act to authorize the Secretary of the Interior to participate in the Santa Fe Regional Water Management and River Restoration Project. [Introduced in Senate] %%Filename:...


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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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