(Sec. 102) Amends the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA) to revise the BBRA increase for SNFs in FY 2001 and 2002.
(Sec. 103) Requires a Medicare Payment Advisory Commission (MedPAC) study and report to the Secretary of Health and Human Services (HHS) and Congress on nursing home costs to determine the adequacy of Medicare payment rates for items and services furnished by SNFs. Grants the Secretary the authority to make payment adjustments for covered SNF services if appropriate as a result of the study.
Subtitle B: PPS Hospitals - Amends SSA title XVIII to: (1) revise the reduction of indirect graduate medical education payments; (2) eliminate the reduction in the Prospective Payment System (PPS) hospital payment update; (3) eliminate the reduction in disproportionate share hospital (DSH) payments; and (4) change the payment formulas for DSH hospitals; and (5) modify the payment rate for Puerto Rico hospitals.
(Sec. 115) Increases the DSH allotments under Medicaid for the District of Columbia.
Amends SSA title XIX (Medicaid) and XXI (State Children's Health Insurance) (SCHIP) to provide for the optional eligibility of certain alien pregnant women and children for Medicaid and SCHIP.
(Sec. 117) Requires a MedPAC study on hospital area wage indexes for a report to the Secretary and Congress.
Subtitle C: PPS Exempt Hospitals - Amends SSA title XVIII to provide for the treatment of certain cancer hospitals (Sec. 122) Makes certain changes with regard to the PPS for inpatient rehabilitation services and payment during the transition period under current law.
Subtitle D: Hospice Care - Amends SSA title XVIII to revise payments for hospice care.
Subtitle E: Other Provisions - Amends SSA title XVIII to outline various provisions concerned with: (1) hospital compliance with the Bloodborne Pathogens standard; (2) an Informatics and Data Systems Grant Program; and (3) relief from the Medicare part A (Hospital Insurance) late enrollment penalty for a group buy-in for State and local retirees. Authorizes appropriations.
Subtitle F: Transitional Provisions - Reclassifies certain counties and areas in specified States (including the Boston and Barnstable-Yarmouth Metropolitan Statistical Areas) for purposes of reimbursement under the Medicare program.
Title II: Provisions Relating to Part B - Subtitle A: Hospital Outpatient Services - Amends SSA title XVIII to provide for reduction of the effective hospital outpatient department (HOPD) coinsurance rate to 20 percent by 2019.
(Sec. 202) Revises the formula for calculating the base payment-to-cost-ratio component of HOPD PPS transitional corridor payments to include in such formula (and so cover) certain hospitals that did not submit cost reports for 1996.
(Sec. 203) Provides a permanent guarantee of pre-Balanced Budget Act of 1997 (BBA '97) payment levels for HOPD services furnished by children's hospitals.
Subtitle B: Provisions Relating to Physicians - Amends the Higher Education Act of 1965 to grant medical students a deferment on their student loans for a period not to exceed the length of their full initial residency period.
(Sec. 212) Directs the Comptroller General to study and report to the Secretary and Congress on: (1) the post-payment audit process under Medicare as it applies to physicians; and (2) the aggregate effects of regulatory, audit, oversight, and paperwork burdens on physicians and other health care providers participating in Medicare.
(Sec. 213) Directs MEDPAC to study and report to the Secretary and Congress on the refinements to the practice expense relative value units during the transition to a resource-based practice expense system for physician payments under Medicare.
Subtitle C: Ambulance Services - Amends SSA title XVIII with regard to the establishment of a fee schedule for ambulance services to allow a supplier of ambulance services to elect to forego phase-in of such schedule and receive payments based only upon it.
(Sec. 222) Establishes a prudent layperson standard for emergency ambulance services.
(Sec. 223) Eliminates the reduction in inflation adjustments for ambulance services.
(Sec. 224) Directs the Secretary to study and report to Congress on the means by which rural areas with low population densities can be identified for the purpose of designating areas in which the cost of providing ambulance services would be expected to be higher than similar services provided in more heavily populated areas because of low usage.
(Sec. 225) Outlines provisions for interim payments for rural ground ambulance services until such time as the established fee schedule is modified by a specified regulation.
(Sec. 226) Directs the Comptroller General to study and report to the Secretary and Congress on the costs of providing emergency and medical transportation services across the range of acuity levels of conditions for which such transportation services are provided.
Subtitle D: Preventive Services - Amends SSA title XVIII to: (1) prohibit deductibles and coinsurance for various specified preventive benefits; (2) add lancets to the definition of durable medical equipment; and (3) provide coverage of counseling for cessation of tobacco use, glaucoma detection tests, and medical nutrition therapy services for beneficiaries with diabetes, a cardiovascular disease, or a renal disease.
(Sec. 235) Directs the Secretary to: (1) conduct a series of studies, for an annual report to the Congress, designed to identify preventive interventions that can be delivered in the primary care setting that are most valuable to older Americans; and (2) contract with the Institute of Medicine of the National Academy of Sciences to study and report periodically to the President on current literature and best practices in the field of health promotion and disease prevention among Medicare beneficiaries.
(Sec. 237) Provides for fast-track consideration of preventive benefit legislation resulting from recommendations accompanying such study reports.
Subtitle E: Other Services - Amends SSA title XVIII with regard to: (1) revision of the moratorium on caps for therapy services; (2) revision of coverage of immunosuppressive drugs; (3) extension of certain secondary payer requirements; (4) State accreditation of diabetes self-management training programs; (5) elimination of the reduction in payment amounts for orthotics and prosthetics, parenteral and enteral nutrients, supplies, and equipment and oxygen and oxygen equipment; (6) standards regarding payment for certain orthotics and prosthetics; (7) revision of the definition of orthotics; (8) new pap smear technologies and other new clinical laboratory test technologies; (9) increase in payments for certified nurse-midwife services; and (10) payment for administration services associated with chemotherapy and for blood clotting drug-related activities.
(Sec. 249) Directs MEDPAC to study and report to the Secretary and Congress on the provision of in-home infusion therapy nursing services.
(Sec. 250) Amends SSA title XVIII to provide for Medicare coverage of vision rehabilitation services.
(Sec. 251) Amends SSA title XVIII part B (Supplementary Medical Insurance) with respect to the amounts of part B premiums to limit the Medicare late enrollment penalty to ten percent and twice the period of no enrollment.
Title III: Provisions Relating to Parts A and B - Subtitle A: Home Health Services - Amends SSA title XVIII to eliminate a specified 15 percent reduction in cost and per beneficiary limits with respect to payment rates for home health services under the Medicare PPS.
(Sec. 302) Provides for additional payments: (1) for outliers; and (2) under the PPS for services furnished in rural areas and security services.
(Sec. 304) Excludes from the Medicare PPS certain nonroutine medical supplies furnished by a home health agency. Details certain study and reporting requirements with regard to such exclusion.
(Sec. 305) Declares that, with regard to eligibility for Medicare home health benefits, any absence of an individual from the home attributable to health care treatment, including regular absences for such treatment in an adult day-care program, shall not disqualify the individual from being considered confined to home.
(Sec. 306) Directs the Secretary to establish standards for the operation of a branch office, a service site for home health services controlled and supervised by a home health agency.
(Sec. 307) Provides for the treatment of home health services provided in certain counties in the State of New York.
(Sec. 308) Permits a home health agency to receive Medicare payments for a home health service furnished via a telecommunications system.
Subtitle B: Direct Graduate Medical Education - Provides that, for cost reporting periods between October 1, 2000, and October 1, 2005, in applying the limitations regarding the total number of full-time equivalent interns and residents in the field of allopathic or osteopathic medicine under Medicare for a hospital, the Secretary shall not take into account a maximum of three interns or residents in the field of geriatric medicine to the extent the hospital increases the number of geriatric interns or residents above the number of such interns or residents for the hospital's most recent cost reporting period ending before October 1, 2000.
(Sec. 312) Amends SSA title XI part A (General Provisions) to establish a program of payments to children's hospitals that operate graduate medical education programs. Authorizes appropriations.
(Sec. 313) Provides that, effective for cost reporting periods beginning on or after October 1, 1999, for purposes of Medicare payments to hospitals for costs of approved educational activities, such activities shall include the clinical portion of professional educational training programs recognized by the Secretary for clinical psychologists.
(Sec. 314) Amends SSA title XVIII to provide for the treatment of certain newly established residency programs in computing Medicare payments for the costs of medical education.
(Sec. 315) Revises the limitation during FY 1997 on allopathic and osteopathic residents for payment of both the indirect and direct costs of graduate medical education at an accredited community health center, if the hospital conducting the residency program incurred all or substantially all of the training costs.
Subtitle C: Miscellaneous Provisions - Amends SSA title II (Old Age, Survivors and Disability Insurance) (OASDI) to provide for a waiver of the 24-month waiting period for Medicare coverage of individuals disabled with amyotrophic lateral sclerosis.
Title IV: Rural Provider Provisions - Subtitle A: Critical Access Hospitals - Amends SSA title XVIII with regard to payments to critical access hospitals for clinical diagnostic laboratory tests.
(Sec. 402) Amends SSA title XVIII, as amended by BBRA, to revise the payment for professional services provided by a critical access hospital.
(Sec. 403) Amends SSA title XVIII to permit critical access hospitals to operate PPS-exempt distinct part psychiatric and rehabilitation units.
Subtitle B: Medicare Dependent, Small Rural Hospital Program - Amends SSA title XVIII to: (1) make the Medicare-dependent, small rural hospital program permanent; and (2) give any hospital under such program the option of basing eligibility for payment on discharges during any of the three most recent audited cost reporting periods in lieu of the current basing of eligibility for payment on discharges during the cost reporting period beginning in FY 1987.
Subtitle C: Sole Community Hospitals - Amends SSA title XVIII to extend the option to use rebased target amounts to all sole community hospitals.
(Sec. 422) States that, for purposes of discharges occurring on or after October 1, 2000, the Greensville Memorial Hospital located in Emporia, Virginia, shall be deemed to have satisfied the travel time criteria under applicable Medicare provisions for classification as a sole community hospital.
Subtitle D: Other Rural Hospital Provisions - Amends SSA title XVIII to exempt Medicare swing bed hospitals from the PPS for skilled nursing facilities (SNFs).
(Sec. 431) Amends BBRA to make January 1, 2001, the effective date of the elimination of certain restrictions with respect to the hospital swing bed program.
(Sec. 432) Amends SSA title XVIII to mandate pre-BBA '97 payment levels for outpatient services furnished by rural hospitals.
(Sec. 433) Provides for the treatment of certain physician pathology services under Medicare.
Subtitle E: Other Rural Provisions - Amends SSA title XVIII with regard to bonus payments in the case of physicians' services furnished to an individual who is covered under Medicare part B (Supplementary Medical Insurance) and who incurs expenses for such services in a health professional shortage area. Extends such bonus payments to physician assistant and nurse practitioner services. Eliminates the requirement to make such payments on a monthly or a quarterly basis.
(Sec. 442) Modifies: (1) the exemption to the limits established on payment for provider-based rural health clinic services in the case of such clinics in rural hospitals with less than 50 beds; and (2) payment for certain physician assistant services.
(Sec. 444) Excludes clinical social worker services and worker services performed under a contract with a rural health clinic or a Federally-qualified health center from the PPS for SNFs.
(Sec. 445) Covers marriage and family therapist services provided in rural health clinics under Medicare.
(Sec. 446) Amends the Public Health Service Act (PHSA) to: (1) create a capital infrastructure revolving loan program for rural entities for projects for capital improvements; (2) provide for grants to assist eligible small rural hospitals in offsetting the costs of establishing data systems to implement PPSs under Medicare, and to comply with administrative simplification requirements under Medicare part C (Medicare+Choice), or to reduce medication errors; (3) provide for grants to eligible small rural hospitals to provide relief for financial distress that has a negative impact on access to care for Medicare beneficiaries who reside in a rural area. Authorizes appropriations.
(Sec. 449) Amends BBA '97 to revise provisions for Medicare reimbursement for telehealth services with respect to: (1) the methodology for determining the amount of payments; (2) reimbursement for Medicare beneficiaries who do not reside in a health professional shortage area; (3) telehealth coverage for direct patient care; (4) eligibility for telehealth reimbursement for all physicians and practitioners; and (5) telehealth services provided using store-and-forward technologies.
(Sec. 450) Directs MEDPAC to study and report to the Secretary and Congress on the effect of low patient and procedure volume on the financial status of low-volume, isolated rural health care providers participating in Medicare.
Title V: Provisions Relating to Part C (Medicare+Choice Program) and Other Medicare Managed Care Provisions - Amends SSA title XVIII part C (Medicare+Choice) with regard to eligibility, election, and enrollment to provide for restoring the effective date of elections and changes of elections of Medicare+Choice plans.
(Sec. 502) Amends SSA title XVIII part D (Miscellaneous) with regard to certification of Medicare supplemental health insurance (Medigap) policies. Sets forth a special Medigap enrollment anti-discrimination provision for certain beneficiaries.
(Sec. 503) Amends SSA title XVIII part C with regard to payments to Medicare+Choice organizations to: (1) increase the national per capita Medicare+Choice growth percentage in 2001 and 2002; and (2) modify area-specific and national percentages provisions with respect to calculation of annual Medicare+Choice capitation rates.
(Sec. 505) Delays from July 1, 2000, to November 1, 2000, the deadline for a Medicare+Choice organization to withdraw the offering of a Medicare+Choice plan under part C (or otherwise to submit information required for the offering of such a plan) for 2001.
(Sec. 506) Amends SSA title XVIII to make certain amounts in the Medicare trust funds available for the Secretary's share of Medicare+Choice education and enrollment-related costs.
(Sec. 507) Amends BBRA to revise terms and conditions for extension of Medicare community nursing organization demonstration projects.
(Sec. 508) Amends SSA title XVIII part C with regard to payments to Medicare+Choice organizations to modify payment rules for certain frail elderly Medicare beneficiaries.
Title VI: Provisions Relating to Individuals with End-Stage Renal Disease - Amends SSA title XVIII part D with respect to Medicare coverage for end-stage renal disease (ESRD) patients to change the methodology for determining the update in the renal dialysis composite rate for end state renal dialysis services furnished after January 1, 2001.
(Sec. 602) Amends SSA title XVIII part C with regard to payments to Medicare+Choice organizations to provide for revision of payment rates for ESRD patients enrolled in Medicare+Choice plans.
(Sec. 603) Permits ESRD beneficiaries to enroll in another Medicare+Choice plan if the plan in which they are enrolled is terminated.
(Sec. 604) Amends SSA title XVIII part B to provide for the coverage of certain vascular access services for ESRD beneficiaries provided by ambulatory surgical centers.
(Sec. 605) Directs the Secretary to: (1) collect information on the satisfaction of each ESRD Medicare beneficiary with the quality of health care under the original fee-for-service Medicare program and the Medicare+Choice program, and the access of each beneficiary to that care; (2) analyze such information to determine, among other things, the kinds of health care that each nondialysis health care provider provides to each ESRD Medicare beneficiary for the treatment of ESRD and each comorbidity and the quality of health care provided to each such beneficiary enrolled under the Medicare+Choice program compared to each beneficiary enrolled under the original fee-for-service Medicare program; and (3) make such information collected and analysis conducted available to the public each year.
Title VII: Access to Care Improvements Through Medicaid and SCHIP - Amends SSA title XIX (Medicaid) to create a new PPS for federally-qualified health centers and rural health clinics.
(Sec. 702) Amends SSA title XIX to make permanent the extension of eligibility for medical assistance, and give States the option of electing a 12-month initial eligibility period in lieu of the current six month initial eligibility period.
(Sec. 703) Amends SSA title XIX with regard to State Medicaid plans to provide for coordination with Medicaid and the State Children's Health Insurance Program (SCHIP) under SSA title XXI of the application of resource and income eligibility standards for certain Medicaid-eligible individuals under certain conditions, as well as providing for the automatic reassessment of eligibility for Medicaid and SCHIP benefits for children losing Medicaid- or SCHIP-eligibility.
(Sec. 704) Amends SSA titles XIX and XXI to qualify additional entities to determine presumptive eligibility for low-income children under Medicaid and SCHIP.
(Sec. 705) Amends SSA title V (Maternal and Child Health Services) to: (1) increase the authorization of appropriations; and (2) provide for coordination with Medicaid and SCHIP.
(Sec. 706) Amends SSA title XIX to provide for increased access to Medicare cost-sharing assistance for low-income beneficiaries.
(Sec. 707) Provides for: (1) optional State Medicaid coverage of breast and cervical cancer prevention and treatment coverage for certain breast and cervical cancer patients; (2) optional State Medicaid presumptive eligibility for certain breast or cervical cancer patients; and (3) an enhanced Federal match to be used under SCHIP with respect to medical assistance provided to such breast and cervical cancer patients receiving such optional State Medicaid coverage.
(Sec. 708) Revises Medicaid coverage of services furnished by certified nurse practitioners, including coverage of services furnished by clinical nurse specialists.
Title VIII: Other Provisions - Amends the Ricky Ray Hemophilia Relief Fund Act of 1998 to make appropriations to the Ricky Ray Hemophilia Relief Fund for FY 2001.
(Sec. 802) Amends the Public Health Service Act (PHSA) to increase appropriations for special diabetes programs for children with type 1 diabetes and for Indians.
(Sec. 803) Directs the Secretary to award demonstration grants to up to seven States to conduct innovative programs designed to improve outreach to homeless individuals and families under specified Social Security programs with respect to enrollment and the provision of services under such programs. Makes appropriations.
(Sec. 804) Amends the Employee Retirement Income Security Act of 1974 (ERISA) and PHSA to prohibit health insurance provided through a managed care organization under a group health plan, or through a health insurance issuer providing coverage in connection with a group health plan, (and, for the PHSA, health insurance in the individual market) from denying coverage of services provided by a continuing care retirement community or other qualified facility if they are: (1) post-hospitalization services in the same community or facility as in pre-hospitalization; (2) skilled nursing services, without a preceding hospitalization, which are necessary to prevent hospitalization; or (3) furnished in the same facility the participant's or beneficiary's spouse already resides in. Makes the prohibition: (1) depend on whether such services are otherwise covered; and (2) regardless of whether the organization is under contract with the community or facility. Prohibits related denial of enrollment or renewal, incentives to enrollees, and penalties or incentives to physicians. Declares that State laws are not preempted which meet certain requirements, including any more protective of participants or beneficiaries than those of this Act. Provides for enforcement.
(Sec. 805) Directs the Secretary to award grants to eligible States to support real choice systems change initiatives that establish specific action steps and specific timetables to: (1) achieve enduring system improvements; and (2) provide consumer-responsive long-term services and supports to eligible individuals in the most integrated setting appropriate based on the unique strengths and needs of the individual, the priorities and concerns of the individual (or, as appropriate, the individual's representative), and the individual's desires with regard to participation in community life.
Requires each State, in order to receive such a grant, to establish a Consumer Task Force to assist in the development, implementation, and evaluation of real choice systems change initiatives.
Provides funding.
[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5324 Introduced in House (IH)]
106th CONGRESS
2d Session
H. R. 5324
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 HOUSE OF REPRESENTATIVES
September 27, 2000
Mr. Markey (for himself, Mr. Frank of Massachusetts, Mr. Moakley, Mr.
Neal of Massachusetts, Mr. Meehan, Mr. Olver, Mr. Tierney, Mr.
Delahunt, Mr. McGovern, Mr. Capuano, Ms. Millender-McDonald, Mr. Doyle,
Mr. Blumenauer, Mr. Hilliard, Mr. Abercrombie, Mr. Mascara, Mr. Payne,
Mr. Romero-Barcelo, Ms. Lee, Mr. Conyers, Mr. Sanders, Mr. Clement, Ms.
McKinney, Mr. Blagojevich, Mr. Barcia, Mr. Davis of Illinois, Mr.
Hinojosa, Mrs. Meek of Florida, Mr. Sandlin, Ms. Brown of Florida, Ms.
Kilpatrick, Mr. Pickett, Ms. Waters, Mr. Reyes, Mrs. Jones of Ohio, Mr.
Green of Texas, Mr. Berman, Mr. Serrano, and Mr. McNulty) introduced
the following bill; which was referred to the Committee on Commerce,
and in addition to the Committees on Ways and Means, Rules, and
Education and the Workforce, for a period to be subsequently determined
by the Speaker, in each case for consideration of such provisions as
fall within the jurisdiction of the committee concerned
_______________________________________________________________________
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.
Sec. 153. Reclassification of a certain county for purposes of
reimbursement under the medicare program.
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.
Sec. 250. Coverage of vision rehabilitation services.
Sec. 251. Limiting medicare late enrollment penalty to 10 percent and
twice the period of no enrollment.
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. Additional payments for outliers.
Sec. 303. Additional payments under the prospective payment system for
services furnished in rural areas and
security services.
Sec. 304. Exclusion of certain nonroutine medical supplies under the
PPS for home health services.
Sec. 305. Clarification of the homebound definition for the home health
benefit.
Sec. 306. Standards for home health branch offices.
Sec. 307. Treatment of home health services provided in certain
counties.
Sec. 308. Rule of construction relating to telehomehealth services.
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.
Sec. 315. Exception to establishing the number of residents for certain
hospitals.
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. 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. 445. Coverage of marriage and family therapist services provided
in rural health clinics.
Sec. 446. Capital infrastructure revolving loan program.
Sec. 447. Grants for upgrading data systems.
Sec. 448. Relief for financially distressed rural hospitals.
Sec. 449. Refinement of medicare reimbursement for telehealth services.
Sec. 450. 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
program.
Sec. 704. Presumptive eligibility.
Sec. 705. Improvements to the maternal and child health services block
grant.
Sec. 706. Improving access to medicare cost-sharing assistance for low-
income beneficiaries.
Sec. 707. Breast and cervical cancer prevention and treatment.
TITLE VIII--OTHER PROVISIONS
Sec. 801. Appropriations for Ricky Ray Hemophilia Relief Fund.
Sec. 802. Increase in appropriations for special diabetes programs for
children with type I diabetes and Indians.
Sec. 803. Demonstration grants to improve outreach, enrollment, and
coordination of programs and services to
homeless individuals and families.
Sec. 804. Protection of an HMO enrollee to receive continuing care at a
facility selected by the enrollee.
Sec. 805. Grants to develop and establish real choice systems change
initiatives.
TITLE I--PROVISIONS RELATING TO PART A
Subtitle A--Skilled Nursing Facilities
SEC. 101. ELIMINATING REDUCTION IN SKILLED NURSING FACILITY (SNF)
MARKET BASKET UPDATE.
(a) Elimination of Reduction.--Section 1888(e)(4)(E)(ii) (42 U.S.C.
1395yy(e)(4)(E)(ii)) is amended--
(1) in subclause (I), by adding ``and'' at the end;
(2) by striking subclause (II); and
(3) by redesignating subclause (III) as subclause (II).
(b) Special Rule for Payment for Skilled Nursing Facility Services
for Fiscal Year 2001.--Notwithstanding the amendments made by
subsection (a), for purposes of making payments for covered skilled
nursing facility services under section 1888(e) of the Social Security
Act (42 U.S.C. 1395yy(e)) for fiscal year 2001, the Federal per diem
rate referred to in paragraph (4)(E)(ii) of such section--
(1) for the period beginning on October 1, 2000, and ending
on March 31, 2001, shall be the rate determined in accordance
with subclause (II) of such paragraph as in effect on the day
before the date of enactment of this Act; and
(2) for the period beginning on April 1, 2001, and ending
on September 30, 2001, shall be the rate computed for fiscal
year 2000 pursuant to subclause (I) of such paragraph increased
by the skilled nursing facility market basket percentage change
for fiscal year 2001 plus 1 percentage point.
SEC. 102. REVISION OF BBRA INCREASE FOR SKILLED NURSING FACILITIES IN
FISCAL YEARS 2001 AND 2002.
(a) Revision.--Section 101(d) of BBRA (113 Stat. 1501A-325) is
amended--
(1) in paragraph (1)--
(A) by striking ``4.0 percent for each such fiscal
year'' and inserting ``the applicable percent (as
defined in paragraph (3)) for each such fiscal year (or
portion of such year)''; and
(2) by adding at the end the following new paragraph:
``(3) Applicable percent defined.--For purposes of this
subsection, the term `applicable percent' means, with respect
to services provided during--
``(A) the period beginning on October 1, 2000, and
ending on March 31, 2001, 4.0 percent;
``(B) the period beginning on April 1, 2001, and
ending on September 30, 2001, 8.0 percent; and
``(C) fiscal year 2002, 6.0 percent.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect as if included in the enactment of section 101 of BBRA (113
Stat. 1501A-324).
SEC. 103. MEDPAC STUDY ON PAYMENT UPDATES FOR SKILLED NURSING
FACILITIES; AUTHORITY OF SECRETARY TO MAKE ADJUSTMENTS.
(a) Study.--The Medicare Payment Advisory Commission established
under section 1805 of the Social Security Act (42 U.S.C. 1395b-6) (in
this section referred to as ``MedPAC'') shall conduct a study of
nursing home costs to determine the adequacy of payment rates
(including updates to such rates) under the medicare program under
title XVIII of such Act (42 U.S.C. 1395 et seq.) (in this section
referred to as the ``medicare program'') for items and services
furnished by skilled nursing facilities. In conducting such study,
MedPAC shall use data on actual costs and cost increases.
(b) Report.--Not later than 12 months after the date of enactment
of this Act, MedPAC shall submit a report to the Secretary of Health
and Human Services and Congress on the study conducted under subsection
(a), including a description of the methodology and calculations used
by the Health Care Financing Administration to establish the original
payment level under the prospective payment system for skilled nursing
facility services under section 1888(e) of the Social Security Act (42
U.S.C. 1395yy(e)) and to annually update payments under the medicare
program for items and services furnished by skilled nursing facilities,
together with recommendations regarding methods to ensure that all
input variables, including the labor costs, the intensity of services,
and the changes in science and technology that are specific to such
facilities, are adequately accounted for.
(c) Authority of Secretary to Make Adjustments.--Notwithstanding
any other provision of law, the Secretary of Health and Human Services
may make adjustments to payments under the prospective payment system
under section 1888(e) of the Social Security Act (42 U.S.C. 1395yy(e))
for covered skilled nursing facility services to reflect any necessary
adjustments to such payments as is appropriate as a result of the study
conducted under subsection (a).
(d) Publication.--
(1) In general.--Not later than April 1, 2002, the
Secretary of Health and Human Services shall publish for public
comment a description of--
(A) whether the Secretary will make any adjustments
pursuant to subsection (c); and
(B) if so, the form of such adjustments.
(2) Final form.--Not later than August 1, 2002, the
Secretary of Health and Human Services shall publish the
description described in paragraph (1) in final form.
Subtitle B--PPS Hospitals
SEC. 111. REVISION OF REDUCTION OF INDIRECT GRADUATE MEDICAL EDUCATION
PAYMENTS.
(a) Revision.--
(1) In general.--Section 1886(d)(5)(B)(ii) (42 U.S.C.
1395ww(d)(5)(B)(ii)) is amended--
(A) in subclause (IV), by adding ``and'' at the
end; and
(B) by striking subclauses (V) and (VI) and
inserting the following new subclause:
``(V) on or after October 1, 2000, `c' is
equal to 1.6.''.
(2) Technical amendments.--Section 1886(d)(5)(B) (42 U.S.C.
1395ww(d)(5)(B)), as amended by paragraph (1), is amended--
(A) by realigning the left margins of clauses (ii)
and (v) so as to align with the left margin of clause
(i); and
(B) by realigning the left margins of subclauses
(I) through (V) of clause (ii) appropriately.
(b) Special Adjustment for Purposes of Maintaining 6.5 Percent IME
Payment for Fiscal Year 2001.--Notwithstanding paragraph (5)(B)(ii)(V)
of section 1886(d) of the Social Security Act (42 U.S.C.
1395ww(d)(5)(B)(ii)(V)), as amended by subsection (a), for purposes of
making payments for subsection (d) hospitals (as defined in paragraph
(1)(B) of such section) with indirect costs of medical education, the
indirect teaching adjustment factor referred to in paragraph (5)(B)(ii)
of such section shall be determined--
(1) for discharges occurring on or after October 1, 2000,
and before April 1, 2001, pursuant to such paragraph as in
effect on the day before the date of enactment of this Act; and
(2) for discharges occurring on or after April 1, 2001, and
before October 1, 2001, by substituting ``1.66'' for ``1.6'' in
subclause (V) of such paragraph (as so amended).
(c) Conforming Amendment Relating to Determination of Standardized
Amount.--Section 1886(d)(2)(C)(i) (42 U.S.C. 1395ww(d)(2)(C)(i)) is
amended--
(1) by inserting a comma after ``Balanced Budget Act of
1997''; and
(2) by inserting ``, or any payment under such paragraph
resulting from the application of section 111(b) of the
Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of
2000'' after ``Balanced Budget Refinement Act of 1999''.
SEC. 112. ELIMINATING REDUCTION IN PPS HOSPITAL PAYMENT UPDATE.
(a) In General.--Section 1886(b)(3)(B)(i) (42 U.S.C.
1395ww(b)(3)(B)(i)) is amended--
(1) in subclause (XV), by adding ``and'' at the end;
(2) by striking subclauses (XVI) and (XVII);
(3) by redesignating subclause (XVIII) as subclause (XVI);
and
(4) in subclause (XVI), as so redesignated, by striking
``fiscal year 2003'' and inserting ``fiscal year 2001''.
(b) Special Rule for Payment for Inpatient Hospital Services for
Fiscal Year 2001.--Notwithstanding the amendments made by subsection
(a), for purposes of making payments for fiscal year 2001 for inpatient
hospital services furnished by subsection (d) hospitals (as defined in
section 1886(d)(1)(B) of the Social Security Act (42 U.S.C.
1395ww(d)(1)(B))), the ``applicable percentage increase'' referred to
in section 1886(b)(3)(B)(i) of such Act (42 U.S.C.
1395ww(b)(3)(B)(i))--
(1) for discharges occurring on or after October 1, 2000,
and before April 1, 2001, shall be determined in accordance
with subclause (XVI) of such section as in effect on the day
before the date of enactment of this Act; and
(2) for discharges occurring on or after April 1, 2001, and
before October 1, 2001, shall be equal to--
(A) the market basket percentage increase plus 1.1
percentage points for hospitals (other than sole
community hospitals) in all areas; and
(B) the market basket percentage increase for sole
community hospitals.
SEC. 113. ELIMINATING REDUCTION IN DISPROPORTIONATE SHARE HOSPITAL
(DSH) PAYMENTS.
(a) Elimination of Reduction.--
(1) In general.--Section 1886(d)(5)(F)(ix) (42 U.S.C.
1395ww(d)(5)(F)(ix)) is amended--
(A) in subclause (III), by striking ``during each
of fiscal years 2000 and 2001'' and inserting ``during
fiscal year 2000'';
(B) by striking subclause (IV);
(C) by redesignating subclause (V) as subclause
(IV); and
(D) in subclause (IV), as so redesignated, by
striking ``during fiscal year 2003'' and inserting
``during fiscal year 2001''.
(2) Effective date.--The amendments made by this subsection
shall apply to discharges occurring on or after October 1,
2000.
(b) Special Rule for DSH Payment for Fiscal Year 2001.--
Notwithstanding the amendments made by subsection (a)(1), for purposes
of making disproportionate share payments for subsection (d) hospitals
(as defined in section 1886(d)(1)(B) of the Social Security Act (42
U.S.C. 1395ww(d)(1)(B))) for fiscal year 2001, the additional payment
amount otherwise determined under clause (ii) of section 1886(d)(5)(F)
of the Social Security Act (42 U.S.C. 1395ww(d)(5)(F))--
(1) for discharges occurring on or after October 1, 2000,
and before April 1, 2001, shall be adjusted as provided by
clause (ix)(III) of such section as in effect on the day before
the date of enactment of this Act; and
(2) for discharges occurring on or after April 1, 2001, and
before October 1, 2001, shall be increased by 3 percent.
(c) Conforming Amendments Relating to Determination of Standardized
Amount.--Section 1886(d)(2)(C)(iv) (42 U.S.C. 1395ww(d)(2)(C)(iv)), is
amended--
(1) by striking ``Act of 1989 or'' and inserting ``Act of
1989,''; and
(2) by inserting ``, or the enactment of section 113(b) of
the Medicare, Medicaid, and SCHIP Balanced Budget Refinement
Act of 2000'' after ``Omnibus Budget Reconciliation Act of
1990''.
SEC. 114. EQUALIZING THE THRESHOLD AND UPDATING PAYMENT FORMULAS FOR
DISPROPORTIONATE SHARE HOSPITALS.
(a) Application of Uniform 15 Percent Threshold.--Section
1886(d)(5)(F)(v) (42 U.S.C. 1395ww(d)(5)(F)(v)) is amended by striking
``exceeds--'' and all that follows and inserting ``exceeds 15
percent.''.
(b) Change in Payment Percentage Formulas.--Section
1886(d)(5)(F)(viii) (42 U.S.C. 1395ww(d)(5)(F)(viii)) is amended to
read as follows:
``(viii) The formula used to determine the disproportionate share
adjustment percentage for a cost reporting period for a hospital
described in subclause (II), (III), or (IV) of clause (iv) is--
``(I) in the case of such a hospital with a
disproportionate patient percentage (as defined in clause (vi))
that does not exceed 20.2, (P-15)(.65) + 2.5;
``(II) in the case of such a hospital with a
disproportionate patient percentage (as so defined) that
exceeds 20.2 but does not exceed 25.2, (P-20.2)(.825) + 5.88;
``(III) except as provided in subclause (IV), in the case
of such a hospital with a disproportionate patient percentage
(as so defined) that exceeds 25.2, the disproportionate share
adjustment percentage = 10; and
``(IV) in the case of such a hospital with a
disproportionate patient percentage (as so defined) that
exceeds 30.0 and that is described in clause (iv)(III), (P-
30)(.6) + 10;
where `P' is the hospital's disproportionate patient percentage (as so
defined).''.
(c) Conforming Amendments.--Section 1886(d)(5)(F)(iv) (42 U.S.C.
1395ww(d)(5)(F)(iv)) is amended--
(1) in subclause (I), by striking ``is described in the
second sentence of clause (v)'' and inserting ``is located in a
rural area and has 500 or more beds'';
(2) by amending subclause (II) to read as follows:
``(II) is located in an urban area and has less than 100
beds, or is located in a rural area and has less than 500 beds
and is not described in subclause (III) or (IV), is equal to
the percent determined in accordance with the applicable
formula described in clause (viii);'';
(3) by striking subclauses (III) and (IV);
(4) by redesignating subclauses (V) and (VI) as subclauses
(III) and (IV), respectively;
(5) in subclause (III) (as so redesignated), by striking
``and is not classified as a sole community hospital under
subparagraph (D),''; and
(6) in subclause (IV) (as so redesignated), by striking
``10 percent'' and inserting ``equal to the percent determined
in accordance with the applicable formula described in clause
(viii)''.
(d) Effective Date.--The amendments made by this section shall
apply to discharges occurring on or after April 1, 2001.
SEC. 115. CARE FOR LOW-INCOME PATIENTS.
(a) Freeze in Medicaid DSH Allotments.--
(1) In general.--Section 1923(f) (42 U.S.C. 1396r-4(f)) is
amended--
(A) by redesignating paragraph (4) as paragraph
(5); and
(B) by inserting after paragraph (3), the following
new paragraph:
``(4) Special rule for fiscal years 2001 through 2008.--
With respect to each of fiscal years 2001 through 2008--
``(A) paragraph (2) shall be applied--
``(i) by substituting--
``(I) in the heading, `2001' for
`2002';
``(II) in the matter preceding the
table, `2001 (and the DSH allotment for
a State for fiscal year 2001 is the
same as the DSH allotment for the State
for fiscal year 2000, as determined
under the following table)' for `2002';
and
``(ii) without regard to the columns in the
table relating to FY 01 and FY 02 (fiscal years
2001 and 2002); and
``(B) paragraph (3) shall be applied by
substituting--
``(i) in the heading, `2002' for `2003';
``(ii) in subparagraph (A), `2002' for
`2003'.''.
(2) Repeal; applicability.--Effective October 1, 2008, the
amendments made by paragraph (1) are repealed and section
1923(f) of the Social Security Act (42 U.S.C. 1396r-4(f)) shall
be applied and administered as if such amendments had not been
enacted.
(b) Increase in DSH Allotments for the District of Columbia.--
(1) In general.--Each of the entries in the table in
section 1923(f)(2) (42 U.S.C. 1396r-4(f)(2)) relating to the
District of Columbia for FY 98 (fiscal year 1998), for FY 99
(fiscal year 1999), for FY 00 (fiscal year 2000), for FY 01
(fiscal year 2001), and for FY 02 (fiscal year 2002) are
amended by striking the amount otherwise specified and
inserting ``43.4''.
(2) Effective date.--The amendments made by paragraph (1)
shall take effect as if included in the enactment of section
4721(a) of BBA (111 Stat. 511).
(c) Optional Eligibility of Certain Alien Pregnant Women and
Children for Medicaid and SCHIP.--
(1) Medicaid.--Section 1903(v) (42 U.S.C. 1396b(v)) is
amended--
(A) in paragraph (1), by striking ``paragraph (2)''
and inserting ``paragraphs (2) and (4)''; and
(B) by adding at the end the following new
paragraph:
``(4)(A) A State may elect (in a plan amendment under this title)
to provide medical assistance under this title, notwithstanding
sections 401(a), 402(b), 403, and 421 of the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996, for aliens who are
lawfully residing in the United States (including battered aliens
described in section 431(c) of such Act) and who are otherwise eligible
for such assistance, within any of the following eligibility
categories:
``(i) Pregnant women.--Women during pregnancy (and during
the 60-day period beginning on the last day of the pregnancy).
``(ii) Children.--Children (as defined under such plan),
including optional targeted low-income children described in
section 1905(u)(2)(B).
``(B) In the case of a State that has elected to provide medical
assistance to a category of aliens under subparagraph (A), no action
may be brought under an affidavit of support against any sponsor of
such an alien on the basis of provision of assistance to such
category.''.
(2) SCHIP.--Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)) is
amended by adding at the end the following new subparagraph:
``(D) Section 1903(v)(4)(A)(ii) (relating to
optional coverage of permanent resident alien
children), but only if the State has in effect an
election under that same eligibility category for
purposes of title XIX.''.
(3) Effective date.--The amendments made by this section
take effect on October 1, 2000, and apply to medical assistance
and child health assistance furnished on or after such date.
SEC. 116. MODIFICATION OF PAYMENT RATE FOR PUERTO RICO HOSPITALS.
(a) Modification of Payment Rate.--Section 1886(d)(9)(A) (42 U.S.C.
1395ww(d)(9)(A)) is amended--
(1) in clause (i), by striking ``October 1, 1997, 50
percent ('' and inserting ``October 1, 2000, 25 percent (for
discharges between October 1, 1997, and September 30, 2000, 50
percent,''; and
(2) in clause (ii), in the matter preceding subclause (I),
by striking ``after October 1, 1997, 50 percent ('' and
inserting ``after October 1, 2000, 75 percent (for discharges
between October 1, 1997, and September 30, 2000, 50 percent,''.
(b) Special Rule for Payment for Fiscal Year 2001.--
(1) In general.--Notwithstanding the amendment made by
subsection (a), for purposes of making payments for the
operating costs of inpatient hospital services of a section
1886(d) Puerto Rico hospital for fiscal year 2001, the amount
referred to in the matter preceding clause (i) of section
1886(d)(9)(A) of the Social Security Act (42 U.S.C.
1395ww(d)(9)(A))--
(A) for discharges occurring on or after October 1,
2000, and before April 1, 2001, shall be determined in
accordance with such section as in effect on the day
before the date of enactment of this Act; and
(B) for discharges occurring on or after April 1,
2001, and before October 1, 2001, shall be determined--
(i) using 0 percent of the Puerto Rico
adjusted DRG prospective payment rate referred
to in clause (i) of such section; and
(ii) using 100 percent of the discharge-
weighted average referred to in clause (ii) of
such section.
(2) Section 1886(d) puerto rico hospital.--For purposes of
this subsection, the term ``section 1886(d) Puerto Rico
hospital'' has the meaning given the term ``subsection (d)
Puerto Rico hospital'' in the last sentence of section
1886(d)(9)(A) of the Social Security Act (42 U.S.C.
1395ww(d)(9)(A)).
SEC. 117. MEDPAC STUDY ON HOSPITAL AREA WAGE INDEXES.
(a) Study.--
(1) In general.--The Medicare Payment Advisory Commission
established under section 1805 of the Social Security Act (42
U.S.C. 1395b-6) (in this section referred to as ``MedPAC'')
shall conduct a study on the hospital area wage indexes used in
making payments to hospitals under section 1886(d) of the
Social Security Act (42 U.S.C. 1395ww(d)), including an
assessment of the accuracy of those indexes in reflecting
geographic differences in wage and wage-related costs of
hospitals.
(2) Considerations.--In conducting the study under
paragraph (1), MedPAC shall consider--
(A) the appropriate method for determining hospital
area wage indexes;
(B) the appropriate portion of hospital payments
that should be adjusted by the applicable area wage
index;
(C) the appropriate method for adjusting the wage
index by occupational mix; and
(D) the feasibility and impact of making changes
(as determined appropriate by MedPAC) to the methods
used to determine such indexes, including the need for
a data system required to implement such changes.
(b) Report.--Not later than 18 months after the date of enactment
of this Act, MedPAC shall submit a report to the Secretary of Health
and Human Services and Congress on the study conducted under subsection
(a) together with such recommendations for legislation and
administrative action as MedPAC determines appropriate.
Subtitle C--PPS Exempt Hospitals
SEC. 121. TREATMENT OF CERTAIN CANCER HOSPITALS.
(a) In General.--Section 1886(d)(1)(B)(v) of the Social Security
Act (42 U.S.C. 1395ww(d)(1)(B)(v)) is amended--
(1) in subclause (I), by striking ``or'' at the end;
(2) in subclause (II), by striking the semicolon at the end
and inserting ``, or''; and
(3) by adding at the end the following:
``(III) a hospital that was recognized as a clinical cancer
research center by the National Cancer Institute of the
National Institutes of Health as of February 18, 1998, that has
never been reimbursed for inpatient hospital services pursuant
to a reimbursement system under a demonstration project under
section 1814(b), that is a freestanding facility organized
primarily for treatment of and research on cancer and is not a
unit of another hospital, that as of the date of enactment of
this subclause, is licensed for 162 acute care beds, and that
demonstrates for the 4-year period ending on June 30, 1999,
that at least 50 percent of its total discharges have a
principal finding of neoplastic disease, as defined in
subparagraph (E);''.
(b) Conforming Amendment.--Section 1886(d)(1)(E) of the Social
Security Act (42 U.S.C. 1395ww(d)(1)(E)) is amended by striking ``For
purposes of subparagraph (B)(v)(II)'' and inserting ``For purposes of
subclauses (II) and (III) of subparagraph (B)(v)''.
(c) Payment.--
(1) Application to cost reporting periods.--Any
classification by reason of section 1886(d)(1)(B)(v)(III) of
the Social Security Act (as added by subsection (a)) shall
apply to 12-month cost reporting periods beginning on or after
July 1, 1999.
(2) Base year.--Notwithstanding the provisions of section
1886(b)(3)(E) of such Act (42 U.S.C. 1395ww(b)(3)(E)) or other
provisions to the contrary, the base cost reporting period for
purposes of determining the target amount for any hospital
classified by reason of section 1886(d)(1)(B)(v)(III) of such
Act (as added by subsection (a)) shall be the 12-month cost
reporting period beginning on July 1, 1995.
(3) Deadline for payments.--Any payments owed to a hospital
by reason of this subsection shall be made expeditiously, but
in no event later than 1 year after the date of enactment of
this Act.
SEC. 122. PAYMENT ADJUSTMENT FOR INPATIENT SERVICES IN REHABILITATION
HOSPITALS.
(a) Option To Apply Prospective Payment System During Transition
Period.--Section 1886(j)(1)(A) (42 U.S.C. 1395ww(j)(1)(A)) is amended
in the matter preceding subclause (i) by inserting ``the greater of the
prospective payment rate determined in paragraph (3)(A) or'' after ``is
equal to''.
(b) Increase in Prospective Payment Percentage During Transition
Period.--Section 1886(j)(1)(A)(ii)(I) (42 U.S.C.
1395ww(j)(1)(A)(ii)(I)) is amended by inserting ``102 percent of''
before ``the per unit''.
(c) Effective Date.--The amendments made by this section shall take
effect as if included in the enactment of section 4421 of BBA (111
Stat. 410).
Subtitle D--Hospice Care
SEC. 131. REVISION IN PAYMENTS FOR HOSPICE CARE.
(a) Increase.--Section 1814(i)(1)(C) of the Social Security Act (42
U.S.C. 1395f(i)(1)(C)) is amended--
(1) in clause (i), by adding at the end the following new
sentence: ``With respect to routine home care and other
services included in hospice care furnished during fiscal year
2001, the payment rates for such care and services for such
fiscal year shall be 110 percent of such rates as would
otherwise be in effect for such fiscal year (taking into
account the increase under clause (ii) but not taking into
account the increase under section 131 of the Medicare,
Medicaid, and SCHIP Balanced Budget Refinement Act of 1999),
and such payment rates shall be used in determining payments
for such care and services furnished in a subsequent fiscal
year under clause (ii).''; and
(2) in clause (ii), by striking ``during a subsequent
fiscal year'' and inserting ``during a fiscal year beginning
after September 30, 1990''.
(b) Eliminating Reduction in Update.--Section 1814(i)(1)(C)(ii) of
the Social Security Act (42 U.S.C. 1395f(i)(1)(C)(ii)) is amended--
(1) in subclause (VI), by striking ``through 2002'' and
inserting ``through 2000''; and
(2) in subclause (VII), by striking ``for a subsequent
fiscal year'' and inserting ``for fiscal year 2001 and each
subsequent fiscal year''.
(c) Special Rule for Payment for Hospice Care for Fiscal Year
2001.--Notwithstanding the amendments made by subsections (a) and (b),
for purposes of making payments under section 1814(i)(1)(C) of the
Social Security Act (42 U.S.C. 1395f(i)(1)(C)) for routine home care
and other services included in hospice care furnished during fiscal
year 2001, such payment rates shall be determined--
(1) for the period beginning on October 1, 2000, and ending
on March 31, 2001, in accordance with such section as in effect
on the day before the date of enactment of this Act; and
(2) for the period beginning on April 1, 2001, and ending
on September 30, 2001--
(A) by substituting ``120 percent'' for ``110
percent'' in the second sentence of clause (i) of such
section (as added by subsection (a)(1)); and
(B) as if the increase under subclause (ii)(VII)
(as amended by subsection (b)) for fiscal year 2001 was
equal to the market basket increase for the fiscal year
plus 1.0 percentage point.
Subtitle E--Other Provisions
SEC. 141. HOSPITALS REQUIRED TO COMPLY WITH BLOODBORNE PATHOGENS
STANDARD.
(a) Agreements With Hospitals.--Section 1866(a)(1) (42 U.S.C.
1395cc(a)(1)) is amended--
(1) in subparagraph (R), by striking ``and'' at the end;
(2) in subparagraph (S), by striking the period at the end
and inserting ``, and''; and
(3) by inserting after subparagraph (S) the following new
subparagraph:
``(T) in the case of hospitals that are not otherwise
subject to regulation by the Occupational Safety and Health
Administration, to comply with the Bloodborne Pathogens
standard under section 1910.1030 of title 29 of the Code of
Federal Regulations.''.
(b) Effective Date.--The amendments made by this section shall
apply to agreements in effect on or after the date that is 1 year after
the date of enactment of this Act.
SEC. 142. INFORMATICS AND DATA SYSTEMS GRANT PROGRAM.
(a) Grants to Hospitals.--
(1) In general.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall
establish a program to make grants to hospitals that have
submitted applications in accordance with subsection (c) to
assist such hospitals in offsetting the costs related to--
(A) developing and implementing standardized
clinical health care informatics systems designed to
improve medical care and reduce adverse events and
health care complications resulting from medication
errors; and
(B) establishing data systems to comply with the
administrative simplification requirements under part C
of title XI of the Social Security Act (42 U.S.C. 1320d
et seq.).
(2) Costs.--For purposes of paragraph (1), the term
``costs'' shall include costs associated with--
(A) purchasing computer software and hardware; and
(B) providing education and training to hospital
staff on computer information systems.
(3) Duration.--The authority of the Secretary to make
grants under this section shall terminate on September 30,
2011.
(4) Limitation.--A hospital that has received a grant under
section 1611 of the Public Health Service Act (as added by
section 447 of this Act) is not eligible to receive a grant
under this section.
(b) Special Consideration for Large Urban Hospitals.--In awarding
grants under this section, the Secretary shall give special
consideration to hospitals located in large urban areas (as defined for
purposes of section 1886(d) of the Social Security Act (42 U.S.C.
1395ww(d)).
(c) Application.--A hospital seeking a grant under this section
shall submit an application to the Secretary at such time and in such
form and manner as the Secretary specifies.
(d) Reports.--
(1) Information.--A hospital receiving a grant under this
section shall furnish the Secretary with such information as
the Secretary may require to--
(A) evaluate the project for which the grant is
made; and
(B) ensure that the grant is expended for the
purposes for which it is made.
(2) Timing of submission.--
(A) Interim reports.--The Secretary shall report to
the Committee on Ways and Means of the House of
Representatives and the Committee on Finance of the
Senate at least annually on the grant program
established under this section, including in such
report information on the number of grants made, the
nature of the projects involved, the geographic
distribution of grant recipients, and such other
matters as the Secretary deems appropriate.
(B) Final report.--The Secretary shall submit a
final report to such committees not later than 180 days
after the completion of all of the projects for which a
grant is made under this section.
(e) Authorization of Appropriations.--There are authorized to be
appropriated from the Federal Hospital Insurance Trust Fund under
section 1817 of the Social Security Act (42 U.S.C. 1395i) $25,000,000
for each of the fiscal years 2001 through 2011 for the purposes of
making grants under this section.
SEC. 143. RELIEF FROM MEDICARE PART A LATE ENROLLMENT PENALTY FOR GROUP
BUY-IN FOR STATE AND LOCAL RETIREES.
Section 1818(d) (42 U.S.C. 1395i-2(d)) is amended by adding at the
end the following new paragraph:
``(6)(A) In the case where a State, a political subdivision
of a State, or an agency or instrumentality of a State or
political subdivision thereof determines to pay, for the life
of each individual, the monthly premiums due under paragraph
(1) on behalf of each of the individuals in a qualified State
or local government retiree group who meets the conditions of
subsection (a), the amount of any increase otherwise applicable
under section 1839(b) (as modified by subsection (c)(6) of this
section) with respect to the monthly premium for benefits under
this part for an individual who is a member of such group shall
be reduced by the total amount of taxes paid under section
3101(b) of the Internal Revenue Code of 1986 by such individual
and under section 3111(b) by the employers of such individual
on behalf of such individual with respect to employment (as
defined in section 3121(b) of such Code).
``(B) For purposes of this paragraph, the term `qualified
State or local government retiree group' means all of the
individuals who retire prior to a specified date that is before
January 1, 2002, from employment in 1 or more occupations or
other broad classes of employees of--
``(i) the State;
``(ii) a political subdivision of the State; or
``(iii) an agency or instrumentality of the State
or political subdivision of the State.''.
Subtitle F--Transitional Provisions
SEC. 151. RECLASSIFICATION OF CERTAIN COUNTIES AND AREAS FOR PURPOSES
OF REIMBURSEMENT UNDER THE MEDICARE PROGRAM.
(a) Fiscal Years 2002 Through 2004.--Notwithstanding any other
provision of law, effective for discharges occurring during fiscal
years 2002, 2003, and 2004, for purposes of making payments under
section 1886(d) of the Social Security Act (42 U.S.C. 1395ww(d))--
(1) Iredell County, North Carolina is deemed to be located
in the Charlotte-Gastonia-Rock Hill, North Carolina-South
Carolina Metropolitan Statistical Area; and
(2) the large urban area of New York, New York is deemed to
include Orange County, New York (including hospitals that have
been reclassified into such county).
For purposes of that section, any reclassification under this
subsection shall be treated as a decision of the Medicare Geographic
Classification Review Board under paragraph (10) of that section.
(b) Fiscal Years 2001 Through 2003.--Notwithstanding any other
provision of law, effective for discharges occurring during fiscal
years 2001, 2002, and 2003, for purposes of making payments under
section 1886(d) of the Social Security Act (42 U.S.C. 1395ww(d))--
(1) the Jackson, Michigan Metropolitan Statistical Area is
deemed to be located in the Ann Arbor, Michigan Metropolitan
Statistical Area;
(2) Tangipahoa Parish, Louisiana is deemed to be located in
the New Orleans, Louisiana Metropolitan Statistical Area; and
(3) the large urban area of New York, New York is deemed to
include Duchess County, New York.
For purposes of that section, any reclassification under this
subsection shall be treated as a decision of the Medicare Geographic
Classification Review Board under paragraph (10) of that section.
(c) Technical Correction to BBRA.--
(1) In general.--Section 152 of BBRA (113 Stat. 1501A-334)
is amended--
(A) in subsection (a)(2), by inserting ``(including
hospitals that have been reclassified into such
county)'' after ``such county''; and
(B) in subsection (b)(2), by inserting ``(including
hospitals that have been reclassified into such
county)'' after ``Orange County, New York''; and
(2) Effective date.--The amendments made by paragraph (1)
shall take effect as if included in the enactment of section
152 of BBRA (113 Stat. 1501A-334).
SEC. 152. CALCULATION AND APPLICATION OF WAGE INDEX FLOOR FOR A CERTAIN
AREA.
Notwithstanding any other provision of section 1886(d) of the
Social Security Act (42 U.S.C. 1395ww(d)), for discharges occurring
during fiscal year 2000, the Secretary of Health and Human Services
shall calculate and apply the wage index for the Barnstable-Yarmouth
Metropolitan Statistical Area under that section as if the Jordan
Hospital were classified in such area for purposes of payment under
that section for such fiscal year. Such recalculation shall not affect
the wage index for any other area.
SEC. 153. RECLASSIFICATION OF A CERTAIN COUNTY FOR PURPOSES OF
REIMBURSEMENT UNDER THE MEDICARE PROGRAM.
(a) In General.--Notwithstanding any other provision of law,
effective for discharges occurring on or after October 1, 2000, for
purposes of making payments under section 1886(d) of the Social
Security Act (42 U.S.C. 1395ww(d)) to a covered hospital in Boston,
Metropolitan Statistical Area, such covered hospital is deemed to be
located in the Barnstable-Yarmouth, Metropolitan Statistical Area.
(b) Covered Hospital Defined.--In subsection (a), the term
``covered hospital'' means a subsection (d) hospital (as defined in
paragraph (1)(B) of such section 1886(d)) that--
(1) for discharges occurring during fiscal year 1999--
(A) received additional payments under paragraph
(5)(F) of such section (relating to serving a
significantly disproportionate number of low-income patients); and
(B) received no additional payments under paragraph
(5)(B) of such section (relating to indirect costs of
medical education); and
(2) is located in Fall River, Massachusetts, New Bedford,
Massachusetts, or Wareham, Massachusetts.
(c) Construction.--For purposes of such section 1886(d), the
reclassification under subsection (a) shall be treated as a decision of
the Medicare Geographic Classification Review Board under paragraph
(10) of that section.
TITLE II--PROVISIONS RELATING TO PART B
Subtitle A--Hospital Outpatient Services
SEC. 201. REDUCTION OF EFFECTIVE HOPD COINSURANCE RATE TO 20 PERCENT BY
2019.
Section 1833(t)(3)(B)(ii) (42 U.S.C. 1395l(t)(3)(B)(ii)) is
amended--
(1) by striking ``If the'' and inserting:
``(I) In general.--If the''; and
(2) by adding at the end the following new subclause:
``(II) Accelerated phase-in.--The
Secretary shall estimate, prior to
January 1, 2002, the unadjusted
copayment amount for each such service
(or groups of such services). If the
Secretary estimates such unadjusted
copayment amount to be greater than 20
percent for any such service (or group
of such services) on or after January
1, 2019, the Secretary shall, for
services furnished beginning on or
after January 1, 2002, reduce the
unadjusted copayment amount for such
service (or group of such services) in
equal increments each year, from the
amount applicable in 2001, by an amount
estimated by the Secretary such that
the unadjusted copayment amount shall
equal 20 percent beginning on or after
January 1, 2019.''.
SEC. 202. APPLICATION OF TRANSITIONAL CORRIDOR TO CERTAIN HOSPITALS
THAT DID NOT SUBMIT A 1996 COST REPORT.
(a) In General.--Section 1833(t)(7)(F)(ii)(I) (42 U.S.C.
1395l(t)(7)(F)(ii)(I)) is amended by inserting ``(or, in the case of a
hospital that did not submit a cost report for such period, during the
first cost reporting period ending in a year after 1996 and before 2001
for which the hospital submitted a cost report)'' after ``1996''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect as if included in the enactment of section 202 of BBRA.
SEC. 203. PERMANENT GUARANTEE OF PRE-BBA PAYMENT LEVELS FOR OUTPATIENT
SERVICES FURNISHED BY CHILDREN'S HOSPITALS.
(a) In General.--Section 1833(t)(7)(D) (42 U.S.C. 1395l(t)(7)(D)),
as amended by section 432, is amended--
(1) in the heading, by inserting ``, children's,'' after
``small rural''; and
(2) by striking ``section 1886(d)(1)(B)(v)'' and inserting
``clause (iii) or (v) of section 1886(d)(1)(B)''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to services provided on or after the date that is 1 year after
the date of enactment of this Act.
Subtitle B--Provisions Relating to Physicians
SEC. 211. LOAN DEFERMENT FOR RESIDENTS.
(a) Fairness in Medical Student Loan Financing.--
(1) Eligibility requirements.--Section 427(a)(2)(C)(iii) of
the Higher Education Act of 1965 (20 U.S.C. 1077(a)(2)(C)(iii))
is amended by inserting before the semicolon the following: ``,
except that for a medical student such period shall not exceed
the full initial residency period''.
(2) Insurance program agreements.--Section
428(b)(1)(M)(iii) of the Higher Education Act of 1965 (20
U.S.C. 1078(b)(1)(M)(iii)) is amended by inserting before the
semicolon the following: ``, except that for a medical student
such period shall not exceed the full initial residency
period''.
(3) Deferment eligibility.--Section 455(f)(2)(C) of the
Higher Education Act of 1965 (20 U.S.C. 1087e(f)(2)(C)) is
amended by inserting before the period the following: ``,
except that for a medical student such period shall not exceed
the full initial residency period''.
(4) Contents of loan agreement.--Section 464(c)(2)(A)(iii)
of the Higher Education Act of 1965 (20 U.S.C.
1087dd(c)(2)(A)(iii)) is amended by inserting before the
semicolon the following: ``, except that for a medical student
such period shall not exceed the full initial residency
period''.
(b) Fairness in Economic Hardship Determination.--Section
435(o)(1)(B) of the Higher Education Act of 1965 (20 U.S.C.
1085(o)(1)(B)) is amended to read as follows:
``(B) such borrower is working full time and has a
Federal educational debt burden that equals or exceeds
20 percent of such borrower's adjusted gross income,
and the difference between such borrower's adjusted
gross income minus such burden is less than 250 percent
of the greater of--
``(i) the annual earnings of an individual
earning the minimum wage under section 6 of the
Fair Labor Standards Act of 1938; or
``(ii) the income official poverty line (as
defined by the Office of Management and Budget,
and revised annually in accordance with section
673(2) of the Community Service Block Grant
Act) applicable to a family of 2; or''.
SEC. 212. GAO STUDIES AND REPORTS ON MEDICARE PAYMENTS.
(a) GAO Study on HCFA Post-Payment Audit Process.--
(1) Study.--The Comptroller General of the United States
shall conduct a study of the post-payment audit process under
the medicare program under title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.) (in this section referred to as
the ``medicare program'') as such process applies to
physicians, including the proper level of resources that the
Health Care Financing Administration should devote to educating
physicians regarding--
(A) coding and billing;
(B) documentation requirements; and
(C) the calculation of overpayments.
(2) Report.--Not later than 18 months after the date of
enactment of this Act, the Comptroller General shall submit a
report to the Secretary of Health and Human Services and
Congress on the study conducted under paragraph (1) together
with specific recommendations for changes or improvements in
the post-payment audit process described in such paragraph.
(b) GAO Study on Administration and Oversight.--
(1) Study.--The Comptroller General of the United States
shall conduct a study on the aggregate effects of regulatory,
audit, oversight, and paperwork burdens on physicians and other
health care providers participating in the medicare program.
(2) Report.--Not later than 18 months after the date of
enactment of this Act, the Comptroller General shall submit a
report to the Secretary of Health and Human Services and
Congress on the study conducted under paragraph (1) together
with recommendations regarding any area in which--
(A) a reduction in paperwork, an ease of
administration, or an appropriate change in oversight
and review may be accomplished; or
(B) additional payments or education are needed to
assist physicians and other health care providers in
understanding and complying with any legal or
regulatory requirements.
SEC. 213. MEDPAC STUDY ON THE RESOURCE-BASED PRACTICE EXPENSE SYSTEM.
(a) Study.--The Medicare Payment Advisory Commission established
under section 1805 of the Social Security Act (42 U.S.C. 1395b-6) (in
this section referred to as ``MedPAC'') shall conduct a study of the
refinements to the practice expense relative value units during the
transition to a resource-based practice expense system for physician
payments under the medicare program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.) (in this section referred to as
the ``medicare program'').
(b) Report.--Not later than July 1, 2001, MedPAC shall submit a
report to the Secretary of Health and Human Services and Congress on
the study conducted under subsection (a) together with recommendations
regarding--
(1) any change or adjustment that is appropriate to ensure
full access to a spectrum of care for beneficiaries under the
medicare program; and
(2) the appropriateness of payments to physicians.
Subtitle C--Ambulance Services
SEC. 221. ELECTION TO FOREGO PHASE-IN OF FEE SCHEDULE FOR AMBULANCE
SERVICES.
Section 1834(l) (42 U.S.C. 1395m(l)) is amended by adding at the
end the following new paragraph:
``(8) Election to forego phase-in of fee schedule.--
``(A) In general.--If the Secretary provides for a
phase-in of the fee schedule established under this
subsection, a supplier of ambulance services may make
an election to receive payments based only on such fee
schedule at any time during such phase-in, and the
Secretary shall begin to make payments to the supplier
based only on such fee schedule not later than the date
that is 60 days after the date on which the supplier
notifies the Secretary of such election.
``(B) Waiver of budget neutrality.--The Secretary
shall apply paragraph (3)(A) as if this paragraph had
not been enacted.''.
SEC. 222. PRUDENT LAYPERSON STANDARD FOR EMERGENCY AMBULANCE SERVICES.
(a) In General.--Section 1861(s)(7) (42 U.S.C. 1395x(s)(7)) is
amended by inserting before the semicolon at the end the following: ``,
except that such regulations shall not fail to treat ambulance services
as medical and other health services solely because the ultimate
diagnosis of the individual receiving the ambulance services results in
a conclusion that ambulance services were not necessary, as long as the
request for ambulance services is made after the sudden onset of a
medical condition that would be classified as an emergency medical
condition (as defined in section 1852(d)(3)(B)).''.
(b) Effective Date.--The amendment made by this section shall apply
with respect to ambulance services provided on or after October 1,
2000.
SEC. 223. ELIMINATION OF REDUCTION IN INFLATION ADJUSTMENTS FOR
AMBULANCE SERVICES.
Subparagraphs (A) and (B) of section 1834(l)(3) (42 U.S.C.
1395m(l)(3)(A)) are each amended by striking ``reduced in the case of
2001 and 2002 by 1.0 percentage points'' and inserting ``increased in
the case of 2001 by 1.0 percentage point''.
SEC. 224. STUDY AND REPORT ON THE COSTS OF RURAL AMBULANCE SERVICES.
(a) Study.--The Secretary of Health and Human Services (in this
section referred to as the ``Secretary''), in consultation with the
Office of Rural Health Policy, shall conduct a study of the means by
which rural areas with low population densities can be identified for
the purpose of designating areas in which the cost of providing
ambulance services would be expected to be higher than similar services
provided in more heavily populated areas because of low usage. Such
study shall also include an analysis of the additional costs of
providing ambulance services in areas designated under the previous
sentence.
(b) Report.--Not later than June 30, 2001, the Secretary shall
submit a report to Congress on the study conducted under subsection
(a), together with a regulation based on that study which adjusts the
fee schedule payment rates for ambulance services provided in low
density rural areas based on the increased cost of providing such
services in such areas.
SEC. 225. INTERIM PAYMENTS FOR RURAL GROUND AMBULANCE SERVICES UNTIL
REGULATION IMPLEMENTED.
(a) Interim Payments.--Section 1834(l) (42 U.S.C. 1395m(l)), as
amended by section 221, is amended by adding at the end the following
new paragraph:
``(9) Interim payments for rural ground ambulance
services.--Until such time as the fee schedule established
under this subsection is modified by the regulation described
in section 224(b) of the Medicare, Medicaid, and SCHIP Balanced
Budget Refinement Act of 2000, the amount of payment under this
subsection for ground ambulance services provided in a rural
area (as defined in section 1886(d)(2)(D)) shall be the greater
of--
``(A) the amount determined under the fee schedule
established under this subsection (without regard to
any phase-in established pursuant to paragraph (2)(E));
or
``(B) the amount that would have been paid for such
services if the amendments made by section 4531(b) of
the Balanced Budget Act of 1997 had not been enacted;
as adjusted for inflation in the manner described in paragraph
(3)(B). For purposes of this paragraph, an ambulance trip shall
be considered to have been provided in a rural area only if the
transportation of the patient originated in a rural area.''.
(b) Conforming Amendments.--Section 1833(a)(1) (42 U.S.C.
1395l(a)(1)) is amended--
(1) in subparagraph (R)--
(A) by inserting ``except as provided in
subparagraph (T),'' before ``with respect''; and
(B) by striking ``and'' at the end; and
(2) in subparagraph (S), by striking the semicolon at the
end and inserting ``, and (T) with respect to ambulance
services described in section 1834(l)(9), the amount paid shall
be 80 percent of the lesser of the actual charge for the
services or the amount determined under such section;''.
(c) Effective Date.--The amendments made by this section shall
apply with respect to services provided on and after January 1, 2001.
SEC. 226. GAO STUDY AND REPORT ON THE COSTS OF EMERGENCY AND MEDICAL
TRANSPORTATION SERVICES.
(a) Study.--The Comptroller General of the United States shall
conduct a study of the costs of providing emergency and medical
transportation services across the range of acuity levels of conditions
for which such transportation services are provided.
(b) Report.--Not later than 18 months after the date of enactment
of this Act, the Comptroller General shall submit a report to the
Secretary of Health and Human Services and Congress on the study
conducted under subsection (a), together with recommendations for any
changes in methodology or payment level necessary to fairly compensate
suppliers of emergency and medical transportation services and to
ensure the access of beneficiaries under the medicare program under
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) to such
services.
Subtitle D--Preventive Services
SEC. 231. ELIMINATION OF DEDUCTIBLES AND COINSURANCE FOR PREVENTIVE
BENEFITS.
(a) In General.--Section 1833 (42 U.S.C. 1395l) is amended by
inserting after subsection (o) the following new subsection:
``(p) Deductibles and Coinsurance Waived for Preventive Benefits.--
The Secretary may not require the payment of any deductible or
coinsurance under subsection (a) or (b) of any individual enrolled for
coverage under this part for any of the following preventive health
care items and services:
``(1) Blood-testing strips, lancets, and blood glucose
monitors for individuals with diabetes described in section
1861(n).
``(2) Diabetes outpatient self-management training services
(as defined in section 1861(qq)(1)).
``(3) Pneumococcal, influenza, and hepatitis B vaccines and
administration described in section 1861(s)(10).
``(4) Screening mammography (as defined in section
1861(jj)).
``(5) Screening pap smear and screening pelvic exam (as
defined in paragraphs (1) and (2) of section 1861(nn),
respectively).
``(6) Bone mass measurement (as defined in section
1861(rr)(1)).
``(7) Prostate cancer screening test (as defined in section
1861(oo)(1)).
``(8) Colorectal cancer screening test (as defined in
section 1861(pp)(1)).''.
(b) Waiver of Coinsurance.--Section 1833(a)(1)(B) (42 U.S.C.
1395l(a)(1)(B)) is amended to read as follows: ``(B) with respect to
preventive health care items and services described in subsection (p),
the amounts paid shall be 100 percent of the fee schedule or other
basis of payment under this title,''.
(c) Waiver of Deductible.--Section 1833(b)(1) (42 U.S.C.
1395l(b)(1)) is amended to read as follows: ``(1) such deductible shall
not apply with respect to preventive health care items and services
described in subsection (p),''.
(d) Adding ``Lancet'' to Definition of DME.--Section 1861(n) (42
U.S.C. 1395x(n)) is amended by striking ``blood-testing strips and
blood glucose monitors'' and inserting ``blood-testing strips, lancets,
and blood glucose monitors''.
(e) Conforming Amendments.--
(1) Elimination of coinsurance for clinical diagnostic
laboratory tests.--Paragraphs (1)(D)(i) and (2)(D)(i) of
section 1833(a) (42 U.S.C. 1395l(a)) are each amended--
(A) by striking ``basis or which'' and inserting
``basis, which''; and
(B) by inserting ``, or which are described in
subsection (p)'' after ``critical access hospital''.
(2) Elimination of coinsurance for certain dme.--Section
1834(a)(1)(A) (42 U.S.C. 1395m(a)(1)(A)) is amended by
inserting ``(or 100 percent, in the case of such an item
described in section 1833(p))'' after ``80 percent''.
(3) Elimination of coinsurance for screening mammography.--
Section 1834(c)(1)(C) (42 U.S.C. 1395m(c)(1)(C)) is amended by
striking ``80 percent'' and inserting ``100 percent''.
(4) Elimination of deductibles and coinsurance for
colorectal cancer screening tests.--Section 1834(d) (42 U.S.C.
1395m(d)) is amended--
(A) in paragraph (2)(C)--
(i) by striking clause (ii);
(ii) by striking ``Facility payment
limit.--'' and all that follows through
``Notwithstanding'' and inserting ``Facility
payment limit.--Notwithstanding''; and
(iii) by redesignating subclauses (I) and
(II) as clauses (i) and (ii), respectively; and
(B) in paragraph (3)(C)--
(i) by striking clause (ii); and
(ii) by striking ``Facility payment
Limit.--'' and all that follows through
``Notwithstanding'' and inserting ``Facility
payment limit.--Notwithstanding''.
(f) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after July 1, 2001.
SEC. 232. COUNSELING FOR CESSATION OF TOBACCO USE.
(a) Coverage.--Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is
amended--
(1) in subparagraph (S), by striking ``and'' at the end;
(2) in subparagraph (T), by inserting ``and'' at the end;
and
(3) by adding at the end the following new subparagraph:
``(U) counseling for cessation of tobacco use (as defined
in subsection (uu)) for individuals who have a history of
tobacco use;''.
(b) Services Described.--Section 1861 (42 U.S.C. 1395x) is amended
by adding at the end the following new subsection:
``Counseling for Cessation of Tobacco Use
``(uu)(1) Except as provided in paragraph (2), the term `counseling
for cessation of tobacco use' means diagnostic, therapy, and counseling
services for cessation of tobacco use which are furnished--
``(A) by or under the supervision of a physician; or
``(B) by any other health care professional who is legally
authorized to furnish such services under State law (or the
State regulatory mechanism provided by State law) of the State
in which the services are furnished, as would otherwise be
covered if furnished by a physician or as an incident to a
physician's professional service.
``(2) The term `counseling for cessation of tobacco use' does not
include coverage for drugs or biologicals that are not otherwise
covered under this title.''.
(c) Elimination of Cost-Sharing.--
(1) Elimination of coinsurance.--Section 1833(a)(1) (42
U.S.C. 1395l(a)(1)), as amended by section 225(b), is amended--
(A) by striking ``and'' before ``(T)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (U) with respect to counseling
for cessation of tobacco use (as defined in section
1861(uu)), the amount paid shall be 100 percent of the
lesser of the actual charge for the services or the
amount determined by a fee schedule established by the
Secretary for the purposes of this subparagraph''.
(2) Elimination of deductible.--The first sentence of
section 1833(b) (42 U.S.C. 1395l(b)) is amended--
(A) by striking ``and'' before ``(6)''; and
(B) by inserting before the period the following:
``, and (7) such deductible shall not apply with
respect to counseling for cessation of tobacco use (as
defined in section 1861(uu))''.
(d) Effective Date.--The amendments made by this section shall
apply to services furnished on or after July 1, 2001.
SEC. 233. COVERAGE OF GLAUCOMA DETECTION TESTS.
(a) In General.--Section 1861 (42 U.S.C. 1395x), as amended by
section 232, is amended--
(1) in subsection (s)(2)--
(A) in subparagraph (T), by striking ``and'' at the
end;
(B) in subparagraph (U), by inserting ``and'' at
the end; and
(C) by adding at the end the following new
subparagraph:
``(V) glaucoma detection tests (as defined in subsection
(vv));''; and
(2) by adding at the end the following new subsection:
``Glaucoma Detection Tests
``(vv) The term `glaucoma detection test' means all of the
following conducted for the purpose of early detection of glaucoma:
``(1) A dilated eye examination with an intraocular
pressure measurement.
``(2) Direct ophthalmoscopy or slit-lamp biomicroscopic
examination.''.
(b) Limitation on Eligibility and Frequency.--Section 1834 (42
U.S.C. 1395m) is amended by adding at the end the following new
subsection:
``(m) Limitation on Coverage of Glaucoma Detection Tests.--
``(1) In general.--Notwithstanding any other provision of
this part, with respect to expenses incurred for glaucoma
detection tests (as defined in section 1861(vv)), payment may
be made only for glaucoma detection tests conducted--
``(A) for individuals described in paragraph (2);
and
``(B) consistent with the frequency permitted under
paragraph (3).
``(2) Individuals eligible for benefit.--Individuals
described in this paragraph are as follows:
``(A) Individuals who are 60 years of age or older
and who have a family history of glaucoma.
``(B) Other individuals who are at high risk (as
determined by the Secretary) of developing glaucoma.
``(3) Frequency limit.--
``(A) In general.--Subject to subparagraph (B),
payment may not be made under this part for a glaucoma
detection test performed for an individual within 23
months following the month in which a glaucoma
detection test was performed under this part for the
individual.
``(B) Exception.--The Secretary may permit a
glaucoma detection test to be covered on a more
frequent basis than that provided under subparagraph
(A) under such circumstances as the Secretary
determines to be appropriate.''.
(c) No Application of Deductible.--Section 1833(b)(5) (42 U.S.C.
1395l(b)(5)) is amended by inserting ``or with respect to glaucoma
detection tests (as defined in section 1861(vv))'' after ``1861(jj))''.
(d) Conforming Amendments.--Section 1862(a) (42 U.S.C. 1395y(a)) is
amended--
(1) in paragraph (1)--
(A) in subparagraph (H), by striking ``and'' at the
end;
(B) in subparagraph (I), by striking the semicolon
at the end and inserting ``, and''; and
(C) by adding at the end the following new
subparagraph:
``(J) in the case of glaucoma detection tests (as defined
in section 1861(vv)), which are furnished to an individual not
described in paragraph (2) of section 1834(m) or which are
performed more frequently than is covered under paragraph (3)
of such section;''; and
(2) in paragraph (7), by striking ``or (H)'' and inserting
``(H), or (I)''.
(e) Effective Date.--The amendments made by this section apply to
tests provided on or after July 1, 2001.
SEC. 234. MEDICAL NUTRITION THERAPY SERVICES FOR BENEFICIARIES WITH
DIABETES, A CARDIOVASCULAR DISEASE, OR A RENAL DISEASE.
(a) Coverage.--Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)), as
amended by section 233(a), is amended--
(1) in subparagraph (U) by striking ``and'' at the end;
(2) in subparagraph (V) by inserting ``and'' at the end;
and
(3) by adding at the end the following new subparagraph:
``(W) medical nutrition therapy services (as defined in
subsection (ww)(1)) in the case of a beneficiary with diabetes,
a cardiovascular disease (including congestive heart failure,
arteriosclerosis, hyperlipidemia, hypertension, and
hypercholesterolemia), or a renal disease;''.
(b) Services Described.--Section 1861 (42 U.S.C. 1395x), as amended
by section 233(a), is amended by adding at the end the following new
subsection:
``Medical Nutrition Therapy Services; Registered Dietitian or Nutrition
Professional
``(ww)(1) The term `medical nutrition therapy services' means
nutritional diagnostic, therapy, and counseling services for the
purpose of disease management which are furnished by a registered
dietitian or nutrition professional (as defined in paragraph (2))
pursuant to a referral by a physician (as defined in subsection
(r)(1)).
``(2) Subject to paragraph (3), the term `registered dietitian or
nutrition professional' means an individual who--
``(A) holds a baccalaureate or higher degree granted by a
regionally accredited college or university in the United
States (or an equivalent foreign degree) with completion of the
academic requirements of a program in nutrition or dietetics,
as accredited by an appropriate national accreditation
organization recognized by the Secretary for this purpose;
``(B) has completed at least 900 hours of supervised
dietetics practice under the supervision of a registered
dietitian or nutrition professional; and
``(C)(i) is licensed or certified as a dietitian or
nutrition professional by the State in which the services are
performed; or
``(ii) in the case of an individual in a State that does
not provide for such licensure or certification, meets such
other criteria as the Secretary establishes.
``(3) Subparagraphs (A) and (B) of paragraph (2) shall not apply in
the case of an individual who, as of the date of enactment of this
subsection, is licensed or certified as a dietitian or nutrition
professional by the State in which medical nutrition therapy services
are performed.''.
(c) Payment.--Section 1833(a)(1) (42 U.S.C. 1395l(a)(1)), as
amended by section 232(c)(1), is amended--
(1) by striking ``and'' before ``(U)''; and
(2) by inserting before the semicolon at the end the
following: ``, and (V) with respect to medical nutrition
therapy services (as defined in section 1861(ww)), the amount
paid shall be 85 percent of the lesser of the actual charge for
the services or the amount determined under the fee schedule
established under section 1848(b) for the same services if
furnished by a physician''.
(d) Effective Date.--The amendments made by this section apply to
services furnished on or after July 1, 2001.
SEC. 235. STUDIES ON PREVENTIVE INTERVENTIONS IN PRIMARY CARE FOR OLDER
AMERICANS.
(a) Studies.--The Secretary of Health and Human Services, acting
through the United States Preventive Services Task Force, shall conduct
a series of studies designed to identify preventive interventions that
can be delivered in the primary care setting that are most valuable to
older Americans.
(b) Mission Statement.--The mission statement of the United States
Preventive Services Task Force is amended to include the evaluation of
services that are of particular relevance to older Americans.
(c) Report.--Not later than 1 year after the date of enactment of
this Act, and annually thereafter, the Secretary of Health and Human
Services shall submit a report to Congress on the conclusions of the
studies conducted under subsection (a), together with recommendations
for such legislation and administrative actions as the Secretary
considers appropriate.
SEC. 236. INSTITUTE OF MEDICINE 5-YEAR MEDICARE PREVENTION BENEFIT
STUDY AND REPORT.
(a) Study.--
(1) In general.--The Secretary of Health and Human Services
shall contract with the Institute of Medicine of the National
Academy of Sciences to conduct a comprehensive study of current
literature and best practices in the field of health promotion
and disease prevention among medicare beneficiaries including
the issues described in paragraph (2) and to submit the report
described in subsection (b).
(2) Issues studied.--The study required under paragraph (1)
shall include an assessment of--
(A) whether each covered benefit is--
(i) medically effective; and
(ii) a cost-effective benefit or a cost-
saving benefit;
(B) utilization of covered benefits (including any
barriers to or incentives to increase utilization); and
(C) quality of life issues associated with both
health promotion and disease prevention benefits
covered under the medicare program and those that are
not covered under such program that would affect all
medicare beneficiaries.
(b) Report.--
(1) In general.--Not later than 5 years after the date of
enactment of this section, and every fifth year thereafter, the
Institute of Medicine of the National Academy of Sciences shall
submit to the President a report that contains a detailed
statement of the findings and conclusions of the study
conducted under subsection (a) and the recommendations for
legislation described in paragraph (2).
(2) Recommendations for legislation.--The Institute of
Medicine of the National Academy of Sciences, in consultation
with the Partnership for Prevention, shall develop
recommendations in legislative form that--
(A) prioritize the preventive benefits under the
medicare program; and
(B) modify preventive benefits offered under the
medicare program based on the study conducted under
subsection (a).
(c) Transmission to Congress.--
(1) In general.--On the day on which the report described
in subsection (b) is submitted to the President, the President
shall transmit the report and recommendations in legislative
form described in subsection (b)(2) to Congress.
(2) Delivery.--Copies of the report and recommendations in
legislative form required to be transmitted to Congress under
paragraph (1) shall be delivered--
(A) to both Houses of Congress on the same day;
(B) to the Clerk of the House of Representatives if
the House is not in session; and
(C) to the Secretary of the Senate if the Senate is
not in session.
(d) Definitions.--In this section:
(1) Cost-effective benefit.--The term ``cost-effective
benefit'' means a benefit or technique that has--
(A) been subject to peer review;
(B) been described in scientific journals; and
(C) demonstrated value as measured by unit costs
relative to health outcomes achieved.
(2) Cost-saving benefit.--The term ``cost-saving benefit''
means a benefit or technique that has--
(A) been subject to peer review;
(B) been described in scientific journals; and
(C) caused a net reduction in health care costs for
medicare beneficiaries.
(3) Medically effective.--The term ``medically effective''
means, with respect to a benefit or technique, that the benefit
or technique has been--
(A) subject to peer review;
(B) described in scientific journals; and
(C) determined to achieve an intended goal under
normal programmatic conditions.
(4) Medicare beneficiary.--The term ``medicare
beneficiary'' means any individual who is entitled to benefits
under part A or enrolled under part B of the medicare program,
including any individual enrolled in a Medicare+Choice plan
offered by a Medicare+Choice organization under part C of such
program.
(5) Medicare program.--The term ``medicare program'' means
the health benefits program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.).
SEC. 237. FAST-TRACK CONSIDERATION OF PREVENTION BENEFIT LEGISLATION.
(a) Rules of House of Representatives and Senate.--This section is
enacted by Congress--
(1) as an exercise of the rulemaking power of the House of
Representatives and the Senate, respectively, and is deemed a
part of the rules of each House of Congress, but--
(A) is applicable only with respect to the
procedure to be followed in that House of Congress in
the case of an implementing bill (as defined in
subsection (d)); and
(B) supersedes other rules only to the extent that
such rules are inconsistent with this section; and
(2) with full recognition of the constitutional right of
either House of Congress to change the rules (so far as
relating to the procedure of that House of Congress) at any
time, in the same manner and to the same extent as in the case
of any other rule of that House of Congress.
(b) Introduction and Referral.--
(1) Introduction.--
(A) In general.--Subject to paragraph (2), on the
day on which the President transmits the report
pursuant to section 236(c) to the House of
Representatives and the Senate, the recommendations in
legislative form transmitted by the President with
respect to such report shall be introduced as a bill
(by request) in the following manner:
(i) House of representatives.--In the House
of Representatives, by the Majority Leader, for
himself and the Minority Leader, or by Members
of the House of Representatives designated by
the Majority Leader and Minority Leader.
(ii) Senate.--In the Senate, by the
Majority Leader, for himself and the Minority
Leader, or by Members of the Senate designated
by the Majority Leader and Minority Leader.
(B) Special rule.--If either House of Congress is
not in session on the day on which such recommendations
in legislative form are transmitted, the
recommendations in legislative form shall be introduced
as a bill in that House of Congress, as provided in
subparagraph (A), on the first day thereafter on which
that House of Congress is in session.
(2) Referral.--Such bills shall be referred by the
presiding officers of the respective Houses to the appropriate
committee, or, in the case of a bill containing provisions
within the jurisdiction of 2 or more committees, jointly to
such committees for consideration of those provisions within
their respective jurisdictions.
(c) Consideration.--After the recommendations in legislative form
have been introduced as a bill and referred under subsection (b), such
implementing bill shall be considered in the same manner as an
implementing bill is considered under subsections (d), (e), (f), and
(g) of section 151 of the Trade Act of 1974 (19 U.S.C. 2191).
(d) Implementing Bill Defined.--In this section, the term
``implementing bill'' means only the recommendations in legislative
form of the Institute of Medicine of the National Academy of Sciences
described in section 236(b)(2), transmitted by the President to the
House of Representatives and the Senate under section 236(c), and
introduced and referred as provided in subsection (b) as a bill of
either House of Congress.
(e) Counting of Days.--For purposes of this section, any period of
days referred to in section 151 of the Trade Act of 1974 shall be
computed by excluding--
(1) the days on which either House of Congress is not in
session because of an adjournment of more than 3 days to a day
certain or an adjournment of Congress sine die; and
(2) any Saturday and Sunday, not excluded under paragraph
(1), when either House is not in session.
Subtitle E--Other Services
SEC. 241. REVISION OF MORATORIUM IN CAPS FOR THERAPY SERVICES.
(a) Extension of Moratorium.--Section 1833(g)(4) (42 U.S.C.
1395l(g)(4)) is amended by striking ``during 2000 and 2001'' and
inserting ``during the period beginning on January 1, 2000, and ending
on the date that is 18 months after the date the Secretary submits the
report required under section 4541(d)(2) of the Balanced Budget Act of
1997 to Congress''.
(b) Extension of Reporting Date.--Section 4541(d)(2) of BBA (42
U.S.C. 1395l note), as amended by section 221(c) of BBRA (113 Stat.
1501A-351), is amended by striking ``January 1, 2001'' and inserting
``January 1, 2002''.
SEC. 242. REVISION OF COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.
(a) Revision.--
(1) In general.--Section 1861(s)(2)(J) (42 U.S.C.
1395x(s)(2)(J)) is amended to read as follows:
``(J) prescription drugs used in immunosuppressive therapy
furnished--
``(i) on or after the date of enactment of the
Medicare, Medicaid, and SCHIP Balanced Budget
Refinement Act of 2000 and before January 1, 2004, to
an individual who has received an organ transplant; and
``(ii) on or after January 1, 2004, to an
individual who receives an organ transplant for which
payment is made under this title, but only in the case
of drugs furnished within 36 months after the date of
the transplant procedure.''.
(2) Conforming amendments.--
(A) Extended coverage.--Section 1832 (42 U.S.C.
1395k) is amended--
(i) by striking subsection (b); and
(ii) by redesignating subsection (c) as
subsection (b).
(B) Pass-through; report.--Subsections (c) and (d)
of section 227 of BBRA (113 Stat. 1501A-355) are
repealed.
(3) Effective date.--The amendments made by this subsection
shall apply to drugs furnished on or after the date of
enactment of this Act.
(b) Extension of Certain Secondary Payer Requirements.--Section
1862(b)(1)(C) (42 U.S.C. 1395y(b)(1)(C)) is amended by adding at the
end the following: ``With regard to immunosuppressive drugs furnished
on or after the date of enactment of the Medicare, Medicaid, and SCHIP
Balanced Budget Refinement Act of 2000 and before January 1, 2004, this
subparagraph shall be applied without regard to any time limitation.''.
SEC. 243. STATE ACCREDITATION OF DIABETES SELF-MANAGEMENT TRAINING
PROGRAMS.
Section 1861(qq)(2) of the Social Security Act (42 U.S.C.
1395xx(qq)(2)) is amended--
(1) in the matter preceding subparagraph (A), by striking
``paragraph (1)--'' and inserting ``paragraph (1):'';
(2) in subparagraph (A)--
(A) by striking ``a `certified provider''' and
inserting ``A `certified provider'''; and
(B) by striking ``; and'' and inserting a period;
and
(3) in subparagraph (B)--
(A) by striking ``a physician, or such other
individual'' and inserting ``(i) A physician, or such
other individual'';
(B) by inserting ``(I)'' before ``meets applicable
standards'';
(C) by inserting ``(II)'' before ``is recognized'';
(D) by inserting ``, or by a program described in
clause (ii),'' after ``recognized by an organization
that represents individuals (including individuals
under this title) with diabetes''; and
(E) by adding at the end the following new clause:
``(ii) Notwithstanding any reference to `a national
accreditation body' in section 1865(b), for purposes of clause
(i), a program described in this clause is a program operated
by a State for the purposes of accrediting diabetes self-
management training programs, if the Secretary determines that
such State program has established quality standards that meet
or exceed the standards established by the Secretary under
clause (i) or the standards originally established by the
National Diabetes Advisory Board and subsequently revised as
described in clause (i).''.
SEC. 244. ELIMINATION OF REDUCTION IN PAYMENT AMOUNTS FOR DURABLE
MEDICAL EQUIPMENT AND OXYGEN AND OXYGEN EQUIPMENT.
(a) Update for Covered Items.--Section 1834(a)(14)(C) (42 U.S.C.
1395m(a)(14)(C)) is amended by striking ``through 2002'' and inserting
``through 2000''.
(b) Orthotics and Prosthetics.--Section 1834(h)(4)(A)(v) (42 U.S.C.
1395m(h)(4)(A)(v)) is amended by striking ``through 2002'' and
inserting ``through 2000''.
(c) Parenteral and Enteral Nutrients, Supplies, and Equipment.--
Section 4551(b) of BBA (42 U.S.C. 1395m note) is amended by striking
``through 2002'' and inserting ``through 2000''.
(d) Oxygen and Oxygen Equipment.--Section 1834(a)(9)(B) (42 U.S.C.
1395m(a)(9)(B)) is amended--
(1) in clause (v), by striking ``and'' at the end;
(2) in clause (vi)--
(A) by striking ``each subsequent year'' and
inserting ``2000''; and
(B) by striking the period at the end and inserting
``; and''; and
(3) by adding at the end the following new clause:
``(vii) for 2001 and each subsequent year,
the amount determined under this subparagraph
for the preceding year increased by the covered
item update for such subsequent year.''.
(e) Conforming Amendment.--Section 228 of BBRA (113 Stat. 1501A-
356) is repealed.
SEC. 245. STANDARDS REGARDING PAYMENT FOR CERTAIN ORTHOTICS AND
PROSTHETICS.
(a) Standards.--
(1) In general.--Section 1834(h)(1) (42 U.S.C. 1395m(h)(1))
is amended by adding at the end the following:
``(F) Establishment of standards for certain
items.--
``(i) In general.--No payment shall be made
for an applicable item unless such item is
provided by a qualified practitioner or a
qualified supplier under the system established
by the Secretary under clause (iii). For
purposes of the preceding sentence, if a
qualified practitioner or a qualified supplier
contracts with an entity to provide an
applicable item, then no payment shall be made
for such item unless the entity is also a
qualified supplier.
``(ii) Definitions.--In this subparagraph--
``(I) Applicable item.--The term
`applicable item' means orthotics and
prosthetics that require education,
training, and experience to custom
fabricate such item. Such term does not
include shoes and shoe inserts.
``(II) Qualified practitioner.--The
term `qualified practitioner' means a
physician or health professional who
meets any of the following
requirements:
``(aa) The physician or
health professional is
specifically trained and
educated to provide or manage
the provision of custom-
designed, fabricated, modified,
and fitted orthotics and
prosthetics, and is either
certified by the American Board
for Certification in Orthotics
and Prosthetics, Inc.,
certified by the Board for
Orthotist/Prosthetist
Certification, or credentialed
and approved by a program that
the Secretary determines, in
consultation with appropriate
experts in orthotics and
prosthetics, has training and
education standards that are
necessary to provide applicable
items.
``(bb) The physician or
health professional is licensed
in orthotics or prosthetics by
the State in which the
applicable item is supplied,
but only if the Secretary
determines that the mechanisms
used by the State to provide
such licensure meet standards
determined appropriate by the
Secretary.
``(cc) The physician or
health professional has
completed at least 10 years
practice in the provision of
applicable items. A physician
or health professional may not
qualify as a qualified
practitioner under the
preceding sentence with respect
to an applicable item if the
item was provided on or after
January 1, 2005.
``(III) Qualified supplier.--The
term `qualified supplier' means any
entity that is--
``(aa) accredited by the
American Board for
Certification in Orthotics and
Prosthetics, Inc. or the Board
for Orthotist/Prosthetist
Certification; or
``(bb) accredited and
approved by a program that the
Secretary determines has
accreditation and approval
standards that are essentially
equivalent to those of such
Board.
``(iii) System.--The Secretary, in
consultation with appropriate experts in
orthotics and prosthetics, shall establish a
system under which the Secretary shall--
``(I) determine which items are
applicable items and formulate a list
of such items;
``(II) review the applicable items
billed under the coding system
established under this title; and
``(III) limit payment for
applicable items pursuant to clause
(i).''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to items provided on or after January 1, 2003.
(b) Revision of Definition of Orthotics.--
(1) In general.--Section 1861(s)(9) (42 U.S.C. 1395x(s)(9))
is amended by inserting ``(including such braces that are used
in conjunction with, or as components of, other medical or non-
medical equipment when provided by a qualified practitioner (as
defined in subclause (II) of section 1834(h)(1)(F))) or a
qualified supplier (as defined in subclause (III) of such
section)'' after ``braces''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to items provided on or after January 1, 2003.
SEC. 246. NATIONAL LIMITATION AMOUNT EQUAL TO 100 PERCENT OF NATIONAL
MEDIAN FOR NEW PAP SMEAR TECHNOLOGIES AND OTHER NEW
CLINICAL LABORATORY TEST TECHNOLOGIES.
Section 1833(h)(4)(B)(viii) (42 U.S.C. 1395l(h)(4)(B)(viii)) is
amended by inserting before the period at the end the following: ``(or
100 percent of such median in the case of a clinical diagnostic
laboratory test performed on or after January 1, 2001, that the
Secretary determines is a new test for which no limitation amount has
previously been established under this subparagraph)''.
SEC. 247. INCREASED MEDICARE PAYMENTS FOR CERTIFIED NURSE-MIDWIFE
SERVICES.
(a) Amount of Payment.--Section 1833(a)(1)(K) (42 U.S.C.
1395l(a)(1)(K)) is amended by striking ``65 percent of the prevailing
charge that would be allowed for the same service performed by a
physician, or, for services furnished on or after January 1, 1992, 65
percent'' and inserting ``85 percent''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to services furnished on or after January 1, 2001.
SEC. 248. PAYMENT FOR ADMINISTRATION OF DRUGS.
(a) Review of Chemotherapy Administration Practice Expenses RVUs.--
The Secretary of Health and Human Services shall review the resource-
based practice expense component of relative value units under the
physician fee schedule under section 1848 of the Social Security Act
(42 U.S.C. 1395w-4) for chemotherapy administration services to
determine if such units should be increased.
(b) More Accurate Chemotherapy Drug Payments Tied to Increases in
Chemotherapy Administration Payments.--If the Secretary of Health and
Human Services determines, as a result of the review under subsection
(a), that the resource-based practice expense relative value units for
chemotherapy administration services should be increased, the
Secretary--
(1) may implement such increases for such services, but
only if the Secretary simultaneously implements more accurate
average wholesale prices for chemotherapy drugs (but in no case
shall such simultaneous implementation occur prior to January
1, 2002); and
(2) if the Secretary implements such increases for such
services, shall do so without taking into account the
requirement under the physician fee schedule under section
1848(c)(2)(B)(ii)(II) of the Social Security Act (42 U.S.C.
1395w-4(c)(2)(B)(ii)(II)).
(c) Blood Clotting Drug-Related Activities.--
(1) Coverage.--Section 1861(s)(2)(I) (42 U.S.C.
1395x(s)(2)(I)) is amended--
(A) by striking ``and'' after ``supervision,''; and
(B) by inserting the following before the
semicolon: ``, and the costs (pursuant to section
1834(n)) incurred by suppliers of such factors''.
(2) Payments.--Section 1834 (42 U.S.C. 1395m), as amended
by section 233(b), is amended by adding at the end the
following new subsection:
``(n) Payment for Blood Clotting Drug-Related Activities.--
``(1) In general.--The Secretary shall make payments in
accordance with paragraph (2) to suppliers of blood clotting
factors (as described in section 1861(s)(2)(I)) to cover the
costs (such as shipping, storage, inventory control, or other
costs specified by the Secretary) incurred by such suppliers in
furnishing such factors to individuals enrolled under this
part.
``(2) Payment amount.--The amount of payment for furnishing
such blood clotting factors (as so described) shall be an
amount equal to 80 percent of the lesser of--
``(A) the actual charge for the furnishing of such
factors; or
``(B) an amount equal to 10 cents (or such other
amount determined appropriate by the Secretary) per
unit of such factor furnished.''.
(3) Effective date.--The amendments made by this subsection
shall apply to blood clotting factors (as described in section
1861(s)(2)(I) of the Social Security Act (42 U.S.C.
1395x(s)(2)(I))) furnished on or after the date that the
Secretary of Health and Human Services implements more accurate
average wholesale prices for such factors.
SEC. 249. MEDPAC STUDY ON IN-HOME INFUSION THERAPY NURSING SERVICES.
(a) Study.--The Medicare Payment Advisory Commission established
under section 1805 of the Social Security Act (42 U.S.C. 1395b-6) (in
this section referred to as ``MedPAC'') shall conduct a study on the
provision of in-home infusion therapy nursing services, including a
review of any documentation of clinical efficacy for those services and
any costs associated with providing those services.
(b) Report.--Not later than 18 months after the date of enactment
of this Act, MedPAC shall submit a report to the Secretary of Health
and Human Services and Congress on the study and review conducted under
subsection (a) together with recommendations regarding the
establishment of a payment methodology for in-home infusion therapy
nursing services that ensures the continuing access of beneficiaries
under the medicare program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.) to those services.
SEC. 250. COVERAGE OF VISION REHABILITATION SERVICES.
(a) Coverage.--Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is
amended--
(1) by striking ``and'' at the end of subparagraph (S);
(2) by striking the period at the end of (T) and inserting
``; and''; and
(3) by adding at the end the following new subparagraph:
``(U) vision rehabilitation services (as defined in
subsection (uu)(1)).''.
(b) Services Described.--Section 1861 (42 U.S.C. 1395x), as amended
by sections 232, 233(a), and 234(b), is further amended by adding at
the end the following new subsection:
``Vision Rehabilitation Services; Vision Rehabilitation Professional
``(xx)(1) The term `vision rehabilitation services' means a program
of restorative services (as determined by the Secretary in regulations)
furnished by a vision rehabilitation professional (as defined in
paragraph (2)) to an individual diagnosed with a vision impairment (as
defined in paragraph (6)) to promote the independence and safety of the
individual notwithstanding such impairment, such services furnished
pursuant to a plan of care established by a physician (as defined in
paragraph (1) or (4) of subsection (r)).
``(2) The term `vision rehabilitation professional' means any of
the following individuals:
``(A) An orientation and mobility specialist (as defined in
paragraph (3)).
``(B) A rehabilitation teacher (as defined in paragraph
(4)).
``(C) A low vision therapist (as defined in paragraph (5)).
``(3)(A) The term `orientation and mobility specialist' means an
individual--
``(i) who holds a baccalaureate or higher degree granted by
a regionally accredited college or university in the United
States (or an equivalent foreign degree) in rehabilitation,
special education, or a health field with a university-based
program of study and clinical experience in orientation and
mobility (as defined in subparagraph (B)); and
``(ii)(I) who is licensed or certified as an orientation
and mobility specialist by the State in which the orientation
and mobility services are performed; or
``(II) in the case of an individual furnishing orientation
and mobility services in a State which does not provide for
licensure or certification--
``(aa) who has successfully completed 350 hours of
clinical practicum under the supervision of an
orientation and mobility specialist holding a master's
degree or higher, and who has furnished not less than 9
months of supervised full-time orientation and mobility
services after obtaining a degree described in clause
(i); and
``(bb) who has successfully completed a national
examination in orientation and mobility administered by
a national organization specifically dedicated to
performing credentialing of orientation and mobility
specialists that is recognized by the Secretary, and
who meets such other criteria as the Secretary
establishes.
``(B) The term `orientation and mobility' means the following
services:
``(i) Assessment of needs of an individual who has a vision
impairment for skills training in methods of safe movement and
in strategies to gather required environmental and spatial
information.
``(ii) Development of appropriate integrated service plans
tailored to meet such needs identified pursuant to an
assessment under clause (i).
``(iii) Provision of training in and utilization of--
``(I) equipment and adaptive devices intended and
designed for use by such an individual; and
``(II) specialized techniques adapted for such
individuals, including orientation, sensory
development, systems of safe movement (including long
cane techniques), resource identification, professional
referrals (as appropriate), and, in applied settings
reinforcing instruction for the use of optical devices
as prescribed by optometrists and ophthalmologists.
``(iv) Evaluation of the progress in performance of such an
individual receiving training under clause (iii).
``(4)(A) The term `rehabilitation teacher' means an individual--
``(i) who holds a baccalaureate or higher degree granted by
a regionally accredited college or university in the United
States (or an equivalent foreign degree) in rehabilitation,
special education, or a health field with a university-based
program of study and clinical experience in rehabilitation
teaching (as defined in subparagraph (B)); and
``(ii)(I) who is licensed or certified as a rehabilitation
teacher by the State in which the rehabilitation teaching
services are performed; or
``(II) in the case of an individual furnishing
rehabilitation teaching services in a State which does not
provide for licensure or certification--
``(aa) who has successfully completed 350 hours of
clinical practicum under the supervision of a
rehabilitation teacher holding a master's degree or
higher, and who has furnished not less than 9 months of
supervised full-time rehabilitation teaching services
after obtaining a degree described in clause (i); and
``(bb) who has successfully completed a national
examination in rehabilitation teaching administered by
a national organization specifically dedicated to
performing credentialing of rehabilitation teachers
that is recognized by the Secretary, and who meets such
other criteria as the Secretary establishes.
``(B) The term `rehabilitation teaching' means the following
services:
``(i) Assessment of needs of an individual with a vision
impairment for skills training in independent living and
communications.
``(ii) Development of appropriate integrated service plans
tailored to meet such needs identified pursuant to an
assessment under clause (i).
``(iii) Provision of training in, and utilization of--
``(I) equipment and adaptive devices intended and
designed for use by such an individual, including, in
applied settings, reinforcing instruction for the use
of optical devices as prescribed by optometrists or
ophthalmologists; and
``(II) specialized techniques adapted for such an
individual, including braille and other communication
skills, personal self-care skills, and home management
skills.
``(iv) Evaluation of the progress in performance of such an
individual receiving training under clause (iii).
``(5)(A) The term `low vision therapist' means an individual--
``(i) who holds--
``(I) a baccalaureate or higher degree granted by a
regionally accredited college or university in the
United States (or an equivalent foreign degree) in
rehabilitation, special education, or a health field
with a university-based program of study and clinical
experience in orientation and mobility, rehabilitation
teaching, or teaching the visually impaired;
``(II) a master's of science degree granted by a
regionally accredited college or university in the
United States (or an equivalent foreign degree) in low
vision rehabilitation; or
``(III) a baccalaureate or higher degree granted by
a regionally accredited college or university in the
United States (or an equivalent foreign degree) in
occupational therapy;
``(ii) who after obtaining a degree described in clause (i)
has performed at least 2 years of low vision therapy (as
defined in subparagraph (B)) under the supervision of an
optometrist or ophthalmologist in an appropriate setting (as
determined by the Secretary); and
``(iii)(I) who is licensed or certified as a low vision
therapist by the State in which the services are performed; or
``(II) in the case of an individual in a State which does
not provide for licensure or certification, who has
successfully completed a national examination in low vision
therapy administered by a national organization specifically
dedicated to performing credentialing of low vision therapists
that is recognized by the Secretary, and who meets such other
criteria as the Secretary establishes.
``(B) The term `low vision therapy' means the following services
furnished to an individual and based upon the clinical findings of a
low vision examination conducted on the individual by an optometrist or
an ophthalmologist:
``(i) Assessment of the performance of an individual
diagnosed with a vision impairment with prescribed optical and
adaptive nonoptical devices.
``(ii) In order to promote safety and maximize use of
visual ability of the individual diagnosed with vision
impairment, the provision of training in and use of the
following:
``(I) Visual abilities in daily living and other
tasks.
``(II) Optical devices prescribed by an optometrist
or ophthalmologist.
``(III) Adaptive non-optical and electronic
devices.
``(IV) Environmental cues and modifications.
``(iii) Evaluation of the progress in performance of such
an individual receiving the training and use under clause (ii).
``(6)(A) The term `vision impairment' means that an individual is
blind or partially sighted.
``(B) The term `blind' means blind within the meaning of
`blindness' as that term is defined in section 216(i)(1).
``(C) The term `partially sighted' means functional vision
impairment that constitutes a significant limitation of visual
capability resulting from disease, trauma, or congenital or
degenerative condition, that cannot be fully ameliorated by standard
refractive correction, medication, or surgery, and that is manifested
by one or more of the following:
``(i) Insufficient visual resolution.
``(ii) Inadequate field of vision.
``(iii) Reduced peak contrast sensitivity.''.
(c) Payment.--Section 1833(a)(1) (42 U.S.C. 1395l(a)(1)) is
amended--
(1) by striking ``and'' before ``(S)''; and
(2) by inserting before the semicolon at the end the
following: ``, and (T) with respect to vision rehabilitation
services (as defined in section 1861(xx)) furnished by a vision
rehabilitation professional, the amount paid shall be 80
percent of the lesser of the actual charge for the services or
85 percent of the amount determined under the fee schedule
established under section 1848(b) for the same services if
furnished by a physician''.
(d) Effective Date.--The amendments made by this section shall
apply to services furnished on or after the date of the enactment of
this Act.
(e) Consultation.--The Secretary shall consult with the National
Vision Rehabilitation Cooperative, the Association for Education and
Rehabilitation of the Blind and Visually Impaired, the Academy for
Certification of Vision Rehabilitation and Education Professionals, and
such other qualified professional and consumer organizations as the
Secretary determines appropriate in promulgating regulations to carry
out this Act.
SEC. 251. LIMITING MEDICARE LATE ENROLLMENT PENALTY TO 10 PERCENT AND
TWICE THE PERIOD OF NO ENROLLMENT.
(a) In General.--The first sentence of section 1839(b) (42 U.S.C.
1395r(b)) is amended by striking ``10 percent of the monthly premium so
determined for each full 10 months'' and inserting ``10 percent of the
monthly premium so determined for premiums paid during a period equal
to twice the number of months in each of the full periods of 12
months''.
(b) Conforming Amendments.--
(1) Section 1818(c) (42 U.S.C. 1395i-2(c)) is amended--
(A) by striking paragraph (6); and
(B) by redesignating paragraphs (7) through (9) as
paragraphs (6) through (8), respectively.
(2) Section 1818(g)(2)(B) (42 U.S.C. 1395i-2(g)(2)(B)) is
amended by striking ``by substituting'' and all that follows
and inserting the following: ``by substituting `section 1818
(without any increase resulting from the application of section
1839(b) to such section)' for `section 1839 (without any
increase under subsection (b) thereof)'.''.
(c) Effective Date.--
(1) The amendments made by this section shall apply to
premiums paid for months beginning after the end of the 90-day
period beginning on the date of the enactment of this Act.
(2) In applying these amendments, months (before, during,
or after the month in which this Act is enacted) in which an
individual was or is required to pay an increased premium shall
be taken into account in determining the month in which the
premium will no longer be subject to an increase.
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.
(a) In General.--Section 1895(b)(3)(A) (42 U.S.C. 1395fff(b)(3)(A))
is amended to read as follows:
``(A) Initial basis.--Under such system the
Secretary shall provide for computation of a standard
prospective payment amount (or amounts). Such amount
(or amounts) shall initially be based on the most
current audited cost report data available to the
Secretary and shall be computed in a manner so that the
total amounts payable under the system for the 12-month
period beginning on the date the Secretary implements
the system shall be equal to the total amount that
would have been made if the system had not been in
effect and if section 1861(v)(1)(L)(ix) had not been
enacted. Each such amount shall be standardized in a
manner that eliminates the effect of variations in
relative case mix and area wage adjustments among
different home health agencies in a budget neutral
manner consistent with the case mix and wage level
adjustments provided under paragraph (4)(A). Under the
system, the Secretary may recognize regional
differences or differences based upon whether or not
the services or agency are in an urbanized area.''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect as if included in the enactment of BBRA.
SEC. 302. ADDITIONAL PAYMENTS FOR OUTLIERS.
(a) In General.--Section 1895(b)(5) (42 U.S.C. 1395fff(b)(5)) is
amended--
(1) by striking ``Outliers.--The Secretary'' and inserting
the following (and conforming the indentation of the succeeding
matter accordingly): ``Outliers.--
``(A) In general.--The Secretary''; and
(2) by adding at the end the following new subparagraph:
``(B) Temporary additional payments for outliers.--
For the purposes described in the first sentence of
subparagraph (A), there are authorized to be
appropriated from the trust funds (as defined in
section 1896(a)(8)) in appropriate part, as determined
by the Secretary, for each of fiscal years 2001 through
2005 an amount equal to $500,000,000. Such amounts
shall be in addition to amounts available for payment
under this section and shall not result in a reduction
of the standard prospective payment amount (or
amounts). In making payments under this subparagraph,
the Secretary shall use a loss-sharing ratio of 90
percent.''.
(b) Conforming Amendment.--Section 1895(b)(3)(C) (42 U.S.C.
1395fff(b)(3)(C)) is amended by striking ``paragraph (5)'' and
inserting ``paragraph (5)(A)''.
SEC. 303. ADDITIONAL PAYMENTS UNDER THE PROSPECTIVE PAYMENT SYSTEM FOR
SERVICES FURNISHED IN RURAL AREAS AND SECURITY SERVICES.
(a) Increase in Payment Rates for Rural Agencies.--Section 1895(b)
(42 U.S.C. 1395fff(b)) is amended by adding at the end the following
new paragraph:
``(7) Additional payment amount for services furnished in
rural areas.--In the case of home health services furnished in
a rural area (as defined in section 1886(d)(2)(D)),
notwithstanding any other provision of this subsection, the
amount of payment for such services is equal to 110 percent of
the payment amount otherwise made under this section (but for
this paragraph) for services furnished in a rural area.''.
(b) Additional Payment for Security Services.--Section 1895(b) (42
U.S.C. 1395fff(b)(3)), as amended by subsection (a), is further amended
by adding at the end the following paragraph:
``(8) Additional payment for security services.--The
Secretary shall provide for an addition or adjustment to the
payment amount otherwise made under this section for the
reasonable cost (as defined in section 1861(v)(1)(A)) of
furnishing protective services to individuals furnishing home
health services under this title in areas where such
individuals are at risk of physical harm, as determined by the
Secretary.''.
(c) Inapplicability of Adjustments for Budget Neutrality.--Section
1895(b)(3) (42 U.S.C. 1395fff(b)(3)) is amended by adding at the end
the following new subparagraph:
``(D) No adjustment for additional payments for
rural services and security services.--The Secretary
shall not reduce the standard prospective payment
amount (or amounts) under this paragraph applicable to
home health services furnished during a period to
offset the increase in payments resulting from the
application of paragraph (7) (relating to services
furnished in rural areas) and paragraph (8) (relating
to costs of security services).''.
(d) Effective Date.--The amendments made by this section apply with
respect to items and services furnished on or after October 1, 2000.
SEC. 304. EXCLUSION OF CERTAIN NONROUTINE MEDICAL SUPPLIES UNDER THE
PPS FOR HOME HEALTH SERVICES.
(a) Exclusion.--
(1) In general.--Section 1895 (42 U.S.C. 1395fff) is
amended by adding at the end the following new subsection:
``(e) Exclusion of Nonroutine Medical Supplies.--
``(1) In general.--Notwithstanding the preceding provisions
of this section, in the case of all nonroutine medical supplies
(as defined by the Secretary) furnished by a home health agency
during a year (beginning with 2001) for which payment is
otherwise made on the basis of the prospective payment amount
under this section, payment under this section shall be based
instead on the lesser of--
``(A) the actual charge for the nonroutine medical
supply; or
``(B) the amount determined under the fee schedule
established by the Secretary for purposes of making
payment for such items under part B for nonroutine
medical supplies furnished during that year.
``(2) Budget neutrality adjustment.--The Secretary shall
provide for an appropriate proportional reduction in payments
under this section so that beginning with fiscal year 2001, the
aggregate amount of such reductions is equal to the aggregate
increase in payments attributable to the exclusion effected
under paragraph (1).''.
(2) Conforming amendment.--Section 1895(b)(1) (42 U.S.C.
1395fff(b)(1)) is amended by striking ``The Secretary'' and
inserting ``Subject to subsection (e), the Secretary''.
(3) Effective date.--The amendments made by this subsection
shall apply to supplies furnished on or after January 1, 2001.
(b) Exclusion from Consolidated Billing.--
(1) In general.--For items provided during the applicable
period, the Secretary of Health and Human Services shall
administer the medicare program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.) as if--
(A) section 1842(b)(6)(F) of such Act (42 U.S.C.
1395u(b)(6)(F)) was amended by striking ``(including
medical supplies described in section 1861(m)(5), but
excluding durable medical equipment to the extent
provided for in such section)'' and inserting
``(excluding medical supplies and durable medical
equipment described in section 1861(m)(5))''; and
(B) section 1862(a)(21) of such Act (42 U.S.C.
1395y(a)(21)) was amended by striking ``(including
medical supplies described in section 1861(m)(5), but
excluding durable medical equipment to the extent
provided for in such section)'' and inserting
``(excluding medical supplies and durable medical
equipment described in section 1861(m)(5))''.
(2) Applicable period defined.--For purposes of paragraph
(1), the term ``applicable period'' means the period beginning
on January 1, 2001, and ending on the later of--
(A) the date that is 18 months after the date of
enactment of this Act; or
(B) the date determined appropriate by the
Secretary of Health and Human Services.
(c) Study on Exclusion of Certain Nonroutine Medical Supplies Under
the PPS for Home Health Services.--
(1) Study.--The Secretary of Health and Human Services (in
this subsection referred to as the ``Secretary'') shall conduct
a study to identify any nonroutine medical supply that may be
appropriately and cost-effectively excluded from the
prospective payment system for home health services under
section 1895 of the Social Security Act (42 U.S.C. 1395fff).
Specifically, the Secretary shall consider whether wound care
and ostomy supplies should be excluded from such prospective
payment system.
(2) Report.--Not later than 18 months after the date of
enactment of this Act, the Secretary shall submit to the
committees of jurisdiction of the House of Representatives and
the Senate a report on the study conducted under paragraph (1),
including a list of any nonroutine medical supplies that should
be excluded from the prospective payment system for home health
services under section 1895 of the Social Security Act (42
U.S.C. 1395fff).
(d) Exclusion of Other Nonroutine Medical Supplies.--Upon
submission of the report under subsection (c)(2), the Secretary shall
(if necessary) revise the definition of nonroutine medical supply, as
defined for purposes of section 1895(e) (as added by subsection (a)),
based on the list of nonroutine medical supplies included in such
report.
SEC. 305. CLARIFICATION OF THE HOMEBOUND DEFINITION FOR THE HOME HEALTH
BENEFIT.
(a) In General.--Sections 1814(a) and 1835(a) (42 U.S.C. 1395f(a)
and 1395n(a)) are each amended--
(1) in the last sentence, by striking ``, and that absences
of the individual from home are infrequent or of relatively
short duration, or are attributable to the need to receive
medical treatment''; and
(2) by adding at the end the following new sentences: ``Any
absence of an individual from the home attributable to the need
to receive health care treatment, including regular absences
for the purpose of participating for therapeutic, psychosocial,
or medical treatment in an adult day-care program that is
licensed or certified by a State, or accredited to furnish
adult day-care services in the State shall not disqualify an
individual from being considered to be `confined to his home'.
Any other absence of an individual from the home shall not so
disqualify an individual if the absence is of infrequent or
short duration. For purposes of the preceding sentence, any
absence for the purpose of visiting a family member who is
unable to visit the individual or for the purpose of attending
a religious service shall be deemed to be an absence of
infrequent and short duration.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to items and services provided on or after the date of enactment
of this Act.
SEC. 306. STANDARDS FOR HOME HEALTH BRANCH OFFICES.
(a) In General.--Section 1861(o) (42 U.S.C. 1395x(o)) is amended by
adding at the end the following new sentences: ``For purposes of this
subsection, a home health agency may provide services through a single
site or through a branch office. For purposes of the preceding
sentence, the term `branch office' means a service site for home health
services that is controlled and supervised by a home health agency.''.
(b) Establishment of Standards.--
(1) In general.--The Secretary of Health and Human Services
(in this subsection referred to as the ``Secretary'') shall
establish, using a negotiated rulemaking process under
subchapter III of chapter 5 of title 5, United States Code,
standards for the operation of a branch office (as defined in
the last sentence of section 1861(o) of the Social Security Act
(42 U.S.C. 1395x(o)), as added by subsection (a)).
(2) Requirements.--In establishing standards under
paragraph (1), the Secretary shall--
(A) provide for the special treatment of any home
health agency or branch office--
(i) that is located in a frontier area; or
(ii) with any other special circumstance
that the Secretary determines is appropriate;
and
(B) allow the use of technology used by the home
health agency to supervise the branch office.
(3) Consultation.--The Secretary shall establish the
regulations under this subsection in consultation with
representatives of the home health industry.
SEC. 307. TREATMENT OF HOME HEALTH SERVICES PROVIDED IN CERTAIN
COUNTIES.
(a) In General.--Notwithstanding any other provision of law,
effective for home health services provided under the prospective
payment system under section 1895 of the Social Security Act (42 U.S.C.
1395fff) during fiscal year 2001 in an applicable county, the
geographic adjustment factors applicable in such year to hospitals
physically located in such county under section 1886(d) of such Act (42
U.S.C. 1395ww(d)) (including the factors applicable to such hospitals
by reason of any reclassification or deemed reclassification) shall be
deemed to apply to such services instead of the area wage adjustment
factors that would otherwise be applicable to such services under
section 1895(b)(4)(C) of such Act (42 U.S.C. 1395fff(b)(4)(C)).
(b) Applicable County Defined.--For purposes of subsection (a), the
term ``applicable county'' means any of the following counties:
(1) Duchess County, New York.
(2) Orange County, New York.
(3) Clinton County, New York.
(4) Ulster County, New York.
(5) Otsego County, New York.
(6) Cayuga County, New York.
(7) St. Jefferson County, New York.
SEC. 308. RULE OF CONSTRUCTION RELATING TO TELEHOMEHEALTH SERVICES.
(a) In General.--Section 1895(b) (42 U.S.C. 1395fff(b)(3)), as
amended by section 3, is further amended by adding at the end the
following paragraph:
``(9) Rule of construction relating to telehomehealth
services.--
``(A) In general.--Nothing in this section, or in
section 4206(a) of the Balanced Budget Act of 1997 (42
U.S.C. 1395l note), shall be construed as preventing a
home health agency receiving payment under this section
from furnishing a home health service via a
telecommunications system. Each home health agency that
submits a cost report to the Secretary under this
section shall include, in such cost report, data with
respect to the costs incurred in furnishing home health
services to medicare beneficiaries via such
telecommunications systems.
``(B) Limitation.--The Secretary shall not consider
a home health service provided in the manner described
in subparagraph (A) to be a home health visit for
purposes of--
``(i) determining the amount of payment to
be made under this section; or
``(ii) any requirement relating to the
certification of a physician required under
section 1814(a)(2)(C).''.
(b) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary of Health and Human Services shall
submit to Congress a report containing the recommendations of the
Secretary with respect to the feasibility and advisability of including
home health services furnished by telecommunications systems as a home
health service for purposes of--
(1) payment for such services under section 1895 of the
Social Security Act (42 U.S.C. 1395fff), and
(2) requirements with respect to physician certification of
the need for home health services under section 1814(a)(2)(C)
of such Act (42 U.S.C. 1395f(a)(2)(C)).
Subtitle B--Direct Graduate Medical Education
SEC. 311. NOT COUNTING CERTAIN GERIATRIC RESIDENTS AGAINST GRADUATE
MEDICAL EDUCATION LIMITATIONS.
For cost reporting periods beginning on or after October 1, 2000,
and before October 1, 2005, in applying the limitations regarding the
total number of full-time equivalent interns and residents in the field
of allopathic or osteopathic medicine under subsections (d)(5)(B)(v)
and (h)(4)(F) of section 1886 of the Social Security Act (42 U.S.C.
1395ww) for a hospital, the Secretary of Health and Human Services
shall not take into account a maximum of 3 interns or residents in the
field of geriatric medicine to the extent the hospital increases the
number of geriatric interns or residents above the number of such
interns or residents for the hospital's most recent cost reporting
period ending before October 1, 2000.
SEC. 312. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT OPERATE
GRADUATE MEDICAL EDUCATION PROGRAMS.
Part A of title XI (42 U.S.C. 1301 et seq.) is amended by adding
after section 1150 the following new section:
``program of payments to children's hospitals that operate graduate
medical education programs
``Sec. 1150A. (a) Payments.--The Secretary shall make 2 payments
under this section to each children's hospital for each of fiscal years
2002 through 2005, 1 for the direct expenses and the other for the
indirect expenses associated with operating approved graduate medical
residency training programs.
``(b) Amount of Payments.--
``(1) In general.--Subject to paragraph (2), the amounts
payable under this section to a children's hospital for an
approved graduate medical residency training program for a
fiscal year are each of the following amounts:
``(A) Direct expense amount.--The amount determined
under subsection (c) for direct expenses associated
with operating approved graduate medical residency
training programs.
``(B) Indirect expense amount.--The amount
determined under subsection (d) for indirect expenses
associated with the treatment of more severely ill
patients and the additional costs relating to teaching
residents in such programs.
``(2) Capped amount.--
``(A) In general.--The total of the payments made
to children's hospitals under subparagraph (A) or (B)
of paragraph (1) in a fiscal year shall not exceed the
funds appropriated under paragraph (1) or (2),
respectively, of subsection (f) for such payments for
that fiscal year.
``(B) Pro rata reductions of payments for direct
expenses.--If the Secretary determines that the amount
of funds appropriated under subsection (f)(1) for a
fiscal year is insufficient to provide the total amount
of payments otherwise due for such periods under
paragraph (1)(A), the Secretary shall reduce the
amounts so payable on a pro rata basis to reflect such
shortfall.
``(c) Amount of Payment for Direct Graduate Medical Education.--
``(1) In general.--The amount determined under this
subsection for payments to a children's hospital for direct
graduate expenses relating to approved graduate medical
residency training programs for a fiscal year is equal to the
product of--
``(A) the updated per resident amount for direct
graduate medical education, as determined under
paragraph (2); and
``(B) the average number of full-time equivalent
residents in the hospital's graduate approved medical
residency training programs (as determined under
section 1886(h)(4)) during the fiscal year.
``(2) Updated per resident amount for direct graduate
medical education.--The updated per resident amount for direct
graduate medical education for a hospital for a fiscal year is
an amount determined as follows:
``(A) Determination of hospital single per resident
amount.--The Secretary shall compute for each hospital
operating an approved graduate medical education
program (regardless of whether or not it is a
children's hospital) a single per resident amount equal
to the average (weighted by number of full-time
equivalent residents) of the primary care per resident
amount and the non-primary care per resident amount
computed under section 1886(h)(2) for cost reporting
periods ending during fiscal year 1997.
``(B) Determination of wage and non-wage-related
proportion of the single per resident amount.--The
Secretary shall estimate the average proportion of the
single per resident amounts computed under subparagraph
(A) that is attributable to wages and wage-related
costs.
``(C) Standardizing per resident amounts.--The
Secretary shall establish a standardized per resident
amount for each such hospital--
``(i) by dividing the single per resident
amount computed under subparagraph (A) into a
wage-related portion and a non-wage-related
portion by applying the proportion determined
under subparagraph (B);
``(ii) by dividing the wage-related portion
by the factor applied under section
1886(d)(3)(E) for discharges occurring during
fiscal year 1999 for the hospital's area; and
``(iii) by adding the non-wage-related
portion to the amount computed under clause
(ii).
``(D) Determination of national average.--The
Secretary shall compute a national average per resident
amount equal to the average of the standardized per
resident amounts computed under subparagraph (C) for
such hospitals, with the amount for each hospital
weighted by the average number of full-time equivalent
residents at such hospital.
``(E) Application to individual hospitals.--The
Secretary shall compute for each such hospital that is
a children's hospital a per resident amount--
``(i) by dividing the national average per
resident amount computed under subparagraph (D)
into a wage-related portion and a non-wage-
related portion by applying the proportion
determined under subparagraph (B);
``(ii) by multiplying the wage-related
portion by the factor described in subparagraph
(C)(ii) for the hospital's area; and
``(iii) by adding the non-wage-related
portion to the amount computed under clause
(ii).
``(F) Updating rate.--The Secretary shall update
such per resident amount for each such children's
hospital by the estimated percentage increase in the
Consumer Price Index for all urban consumers (U.S. city
average) during the period beginning October 1997, and
ending with the midpoint of the Federal fiscal year for
which payments are made.
``(d) Amount of Payment for Indirect Medical Education.--
``(1) In general.--The amount determined under this
subsection for payments to a children's hospital for indirect
expenses associated with the treatment of more severely ill
patients and the additional costs related to the teaching of residents
for a fiscal year is equal to an amount determined appropriate by the
Secretary.
``(2) Factors.--In determining the amount under paragraph
(1), the Secretary shall--
``(A) take into account variations in case mix and
regional wage levels among children's hospitals and the
number of full-time equivalent residents in the
hospitals' approved graduate medical residency training
programs; and
``(B) assure that the aggregate of the payments for
indirect expenses associated with the treatment of more
severely ill patients and the additional costs related
to the teaching of residents under this section in a
fiscal year are equal to the amount appropriated for
such expenses for the fiscal year involved under
subsection (f)(2).
``(e) Making of Payments.--
``(1) Interim payments.--The Secretary shall determine,
before the beginning of each fiscal year involved for which
payments may be made for a hospital under this section, the
amounts of the payments for direct graduate medical education
and indirect medical education for such fiscal year and shall
(subject to paragraph (2)) make the payments of such amounts in
26 equal interim installments during such period. Such interim
payments to each individual hospital shall be based on the
number of residents reported in the hospital's most recently
filed medicare cost report prior to the application date for
the Federal fiscal year for which the interim payment amounts
are established.
``(2) Withholding.--
``(A) In general.--Subject to subparagraph (B), the
Secretary shall withhold 25 percent from each interim
installment for direct and indirect graduate medical
education paid under paragraph (1).
``(B) Reduction of withholding.--The Secretary
shall reduce the percent withheld from each installment
pursuant to subparagraph (A) if the Secretary
determines that such reduced percent will provide the
Secretary with a reasonable level of assurance that
most hospitals will not be overpaid on an interim
basis.
``(3) Reconciliation.--Prior to the end of each fiscal
year, the Secretary shall determine any changes to the number
of residents reported by a hospital and shall use that number
of residents to determine the final amount payable to the
hospital for the current fiscal year for both direct expense
and indirect expense amounts. Based on such determination, the
Secretary shall recoup any overpayments made or pay any balance
due to the extent possible. In the event that a hospital's
interim payments were greater than the final amount to which it
is entitled, the Secretary shall have the option of recouping
that excess amount in determining the amount to be paid in the
subsequent year to that hospital. The final amount so
determined shall be considered a final intermediary
determination for purposes of applying section 1878 and shall
be subject to review under that section in the same manner as
the amount of payment under section 1886(d) is subject to
review under such section.
``(f) Authorization of Appropriations.--
``(1) Direct graduate medical education.--
``(A) In general.--There are appropriated, out of
any money in the Treasury not otherwise appropriated,
for payments under subsection (b)(1)(A) for each of
fiscal years 2002 through 2005, $95,000,000.
``(B) Carryover of excess.--The amounts
appropriated under subparagraph (A) for each fiscal
year shall remain available for obligation through the
end of the subsequent fiscal year.
``(2) Indirect medical education.--There are appropriated,
out of any money in the Treasury not otherwise appropriated,
for payments under subsection (b)(1)(A) for each of fiscal
years 2002 through 2005, $190,000,000.
``(g) Definitions.--In this section:
``(1) Approved graduate medical residency training
program.--The term `approved graduate medical residency
training program' has the meaning given the term `approved
medical residency training program' in section 1886(h)(5)(A).
``(2) Children's hospital.--The term `children's hospital'
means a hospital with a medicare payment agreement and which is
excluded from the medicare inpatient prospective payment system
pursuant to section 1886(d)(1)(B)(iii) and its accompanying
regulations.
``(3) Direct graduate medical education costs.--The term
`direct graduate medical education costs' has the meaning given
such term in section 1886(h)(5)(C).''.
SEC. 313. AUTHORITY TO INCLUDE COSTS OF TRAINING OF CLINICAL
PSYCHOLOGISTS IN PAYMENTS TO HOSPITALS.
Effective for cost reporting periods beginning on or after October
1, 1999, for purposes of payments to hospitals under the medicare
program under title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) for costs of approved educational activities (as defined in
section 413.85 of title 42 of the Code of Federal Regulations), such
approved educational activities shall include the clinical portion of
professional educational training programs, recognized by the
Secretary, for clinical psychologists.
SEC. 314. TREATMENT OF CERTAIN NEWLY ESTABLISHED RESIDENCY PROGRAMS IN
COMPUTING MEDICARE PAYMENTS FOR THE COSTS OF MEDICAL
EDUCATION.
(a) In General.--Section 1886(h)(4)(H) (42 U.S.C. 1395ww(h)(4)(H))
is amended by adding at the end the following new clause:
``(v) Treatment of certain newly
established programs.--Any hospital that has
received payments under this subsection for a
cost reporting period ending before January 1,
1995, and that operates an approved medical residency training program
established on or after August 5, 1997, shall be treated as meeting the
requirements for an adjustment under the rules prescribed pursuant to
clause (i) with respect to such program if--
``(I) such program received
accreditation from the American Council
of Graduate Medical Education not later
than August 5, 1998;
``(II) such program was in
operation (with 1 or more residents in
training) as of January 1, 2000;
``(III) such hospital is located in
an area that is contiguous to a rural
area and serves individuals from such
rural area; and
``(IV) such hospital serves a
medical service area with a population
that is less than 500,000.''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect as if included in the enactment of section 4623 of BBA (111
Stat. 477).
SEC. 315. EXCEPTION TO ESTABLISHING THE NUMBER OF RESIDENTS FOR CERTAIN
HOSPITALS.
(a) Amendment to Limitation on Residents for Indirect Graduate
Medical Education.--Section 1886(d)(5)(B)(v) (42 U.S.C.
1395ww(d)(5)(B)(v)) is amended--
(1) by adding the following after ``December 31, 1996'' and
before the period: ``(except in the case where a community
health center held the accreditation for an approved medical
residency training program of a hospital during fiscal year
1997 and the hospital incurred all or substantially all of the
costs of training those residents at the community health
center, the total number of full-time equivalent interns and
residents for the hospital with respect to such training
program in the fields of allopathic and osteopathic medicine
may not exceed the number of such full-time equivalent interns
and residents that trained at such hospital and such community
health center during the hospital's cost reporting period
ending on or before December 31, 1997)''.
(b) Amendment to Limitation on Residents for Direct Graduate
Medical Education.--Section 1886(h)(4)(F) (42 U.S.C. 1395ww(h)(4)(F))
is amended--
(1) in clause (i), by striking ``Such rules'' and inserting
``Subject to clause (iii), such rules''; and
(2) by adding at the end the following new clause:
``(iii) Special rule.--In the case where a
community health center held the accreditation
for an approved medical residency training
program of a hospital during fiscal year 1997
and the hospital incurred all or substantially
all of the costs of training those residents at
the community health center, the total number
of full-time equivalent residents before
application of weighting factors for the
hospital (as determined under this paragraph)
with respect to such training program in the
fields of allopathic medicine and osteopathic
medicine may not exceed the number of such
full-time equivalent residents that trained at
such hospital and such community health center
during the hospital's cost reporting period
ending on or before December 31, 1997.''.
(c) Definition of Community Health Center.--For the purposes of
this section, the term ``community health center'' has the meaning
given the term ``health center'' in section 330(a) of the Public Health
Service Act (42 U.S.C. 254b(a)).
(d) Effective Date.--The amendments made by subsections (a) and (b)
shall take effect as if included in the enactment of the Balanced
Budget Act of 1997 (Public Law 105-33).
Subtitle C--Miscellaneous Provisions
SEC. 321. WAIVER OF 24-MONTH WAITING PERIOD FOR MEDICARE COVERAGE OF
INDIVIDUALS DISABLED WITH AMYOTROPHIC LATERAL SCLEROSIS
(ALS).
(a) In General.--Section 226 (42 U.S.C. 426) is amended--
(1) by redesignating subsection (h) as subsection (j) and
by moving such subsection to the end of the section; and
(2) by inserting after subsection (g) the following new
subsection:
``(h) For purposes of applying this section in the case of an
individual medically determined to have amyotrophic lateral sclerosis
(ALS), the following special rules apply:
``(1) Subsection (b) shall be applied as if there were no
requirement for any entitlement to benefits, or status, for a
period longer than 1 month.
``(2) The entitlement under such subsection shall begin
with the first month (rather than twenty-fifth month) of
entitlement or status.
``(3) Subsection (f) shall not be applied.''.
(b) Conforming Amendment.--Section 1837 (42 U.S.C. 1395p) is
amended by adding at the end the following new subsection:
``(j) In applying this section in the case of an individual who is
entitled to benefits under part A pursuant to the operation of section
226(h), the following special rules apply:
``(1) The initial enrollment period under subsection (d)
shall begin on the first day of the first month in which the
individual satisfies the requirement of section 1836(1).
``(2) In applying subsection (g)(1), the initial enrollment
period shall begin on the first day of the first month of
entitlement to disability insurance benefits referred to in
such subsection.''.
(c) Effective Date.--The amendments made by this section shall
apply to benefits for months beginning after the date of enactment of
this Act.
TITLE IV--RURAL PROVIDER PROVISIONS
Subtitle A--Critical Access Hospitals
SEC. 401. PAYMENTS TO CRITICAL ACCESS HOSPITALS FOR CLINICAL DIAGNOSTIC
LABORATORY TESTS.
(a) Payment on Cost Basis Without Beneficiary Cost-Sharing.--
(1) In general.--Section 1833(a)(6) (42 U.S.C. 1395l(a)(6))
is amended by inserting ``(including clinical diagnostic
laboratory services furnished by a critical access hospital)''
after ``outpatient critical access hospital services''.
(2) No beneficiary cost-sharing.--
(A) In general.--Section 1834(g) (42 U.S.C.
1395m(g)) is amended by inserting ``(except that in the
case of clinical diagnostic laboratory services
furnished by a critical access hospital the amount of
payment shall be equal to 100 percent of the reasonable
costs of the critical access hospital in providing such
services)'' before the period at the end.
(B) BBRA amendment.--Section 1834(g) (42 U.S.C.
1395m(g)), as amended by section 403(d) of BBRA (113
Stat. 1501A-371), is amended--
(i) in paragraph (1), by inserting
``(except that in the case of clinical
diagnostic laboratory services furnished by a
critical access hospital the amount of payment
shall be equal to 100 percent of the reasonable
costs of the critical access hospital in
providing such services)'' after ``such
services''; and
(ii) in paragraph (2)(A), by inserting
``(except that in the case of clinical
diagnostic laboratory services furnished by a
critical access hospital the amount of payment
shall be equal to 100 percent of the reasonable
costs of the critical access hospital in
providing such services)'' before the period at
the end.
(b) Conforming Amendments.--Paragraphs (1)(D)(i) and (2)(D)(i) of
section 1833(a) (42 U.S.C. 1395l(a)(1)(D)(i); 1395l(a)(2)(D)(i)) are
each amended by striking ``or which are furnished on an outpatient
basis by a critical access hospital''.
(c) Technical Amendment.--Section 403(d)(2) of BBRA (113 Stat.
1501A-371) is amended by striking ``subsection (a)'' and inserting
``paragraph (1)''.
(d) Effective Dates.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by this section shall apply to services
furnished on or after November 29, 1999.
(2) BBRA and technical amendments.--The amendments made by
subsections (a)(2)(B) and (c) shall take effect as if included
in the enactment of section 403(d) of BBRA (113 Stat. 1501A-
371).
SEC. 402. REVISION OF PAYMENT FOR PROFESSIONAL SERVICES PROVIDED BY A
CRITICAL ACCESS HOSPITAL.
(a) In General.--Section 1834(g)(2)(B) (42 U.S.C. 1395m(g)(2)(B)),
as amended by section 403(d) of BBRA (113 Stat. 1501A-371), is amended
by inserting ``120 percent of'' after ``hospital services,''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect as if included in the enactment of section 403(d) of BBRA
(113 Stat. 1501A-371).
SEC. 403. PERMITTING CRITICAL ACCESS HOSPITALS TO OPERATE PPS EXEMPT
DISTINCT PART PSYCHIATRIC AND REHABILITATION UNITS.
(a) Criteria for Designation as a Critical Access Hospital.--
Section 1820(c)(2)(B)(iii) (42 U.S.C. 1395i-4(c)(2)(B)(iii)) is amended
by inserting ``excluding any psychiatric or rehabilitation unit of the
facility which is a distinct part of the facility,'' before ``provides
not''.
(b) Definition of PPS Exempt Distinct Part Psychiatric and
Rehabilitation Units.--Section 1886(d)(1)(B) (42 U.S.C.
1395ww(d)(1)(B)) is amended by inserting before the last sentence the
following new sentence: ``In establishing such definition, the
Secretary may not exclude from such definition a psychiatric or
rehabilitation unit of a critical access hospital which is a distinct
part of such hospital solely because such hospital is exempt from the
prospective payment system under this section.''.
(c) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act.
Subtitle B--Medicare Dependent, Small Rural Hospital Program
SEC. 411. MAKING THE MEDICARE DEPENDENT, SMALL RURAL HOSPITAL PROGRAM
PERMANENT.
(a) Payment Methodology.--Section 1886(d)(5)(G) (42 U.S.C.
1395ww(d)(5)(G)) is amended--
(1) in clause (i), by striking ``and before October 1,
2006,''; and
(2) in clause (ii)(II), by striking ``and before October 1,
2006,''.
(b) Conforming Amendments.--
(1) Target amount.--Section 1886(b)(3)(D) (42 U.S.C.
1395ww(b)(3)(D)) is amended--
(A) in the matter preceding clause (i), by striking
``and before October 1, 2006,''; and
(B) in clause (iv), by striking ``through fiscal
year 2005,'' and inserting ``or any subsequent fiscal
year,''.
(2) Permitting hospitals to decline reclassification.--
Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of
1993 (42 U.S.C. 1395ww note), as amended by section 404(b)(2)
of BBRA (113 Stat. 1501A-372), is amended by striking ``or
fiscal year 2000 through fiscal year 2005'' and inserting
``fiscal year 2000, or any subsequent fiscal year,''.
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.
(a) In General.--Section 1886(d)(5)(G)(iv)(IV) (42 U.S.C.
1395ww(d)(5)(G)(iv)(IV)) is amended by inserting ``, or any of the 3
most recent audited cost reporting periods,'' after ``1987''.
(b) Effective Date.--The amendment made by this section shall apply
with respect to cost reporting periods beginning on or after the date
of enactment of this Act.
Subtitle C--Sole Community Hospitals
SEC. 421. EXTENSION OF OPTION TO USE REBASED TARGET AMOUNTS TO ALL SOLE
COMMUNITY HOSPITALS.
(a) In General.--Section 1886(b)(3)(I)(i) (42 U.S.C.
1395ww(b)(3)(I)(i)) is amended--
(1) in the matter preceding subclause (I)--
(A) by striking ``that for its cost reporting
period beginning during 1999 is paid on the basis of
the target amount applicable to the hospital under
subparagraph (C) and that elects (in a form and manner
determined by the Secretary) this subparagraph to apply
to the hospital''; and
(B) by striking ``substituted for such target
amount'' and inserting ``substituted, if such
substitution results in a greater payment under this
section for such hospital, for the amount otherwise
determined under subsection (d)(5)(D)(i)'';
(2) in subclause (I), by striking ``target amount otherwise
applicable'' and all that follows through ``target amount')''
and inserting ``the amount otherwise applicable to the hospital
under subsection (d)(5)(D)(i) (referred to in this clause as
the `subsection (d)(5)(D)(i) amount')''; and
(3) in each of subclauses (II) and (III), by striking
``subparagraph (C) target amount'' and inserting ``subsection
(d)(5)(D)(i) amount''.
(b) Effective Date.--The amendments made by this section shall take
effect as if included in the enactment of section 405 of BBRA (113
Stat. 1501A-372).
SEC. 422. DEEMING A CERTAIN HOSPITAL AS A SOLE COMMUNITY HOSPITAL.
Notwithstanding any other provision of law, for purposes of
discharges occurring on or after October 1, 2000, the Greensville
Memorial Hospital located in Emporia, Virginia shall be deemed to have
satisfied the travel and time criteria under section
1886(d)(5)(D)(iii)(II) of the Social Security Act (42 U.S.C.
1395ww(d)(5)(D)(iii)(II)) for classification 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.
(a) Exemption for Medicare Swing-Bed Hospitals.--
(1) In general.--Section 1888(e)(7) (42 U.S.C.
1395yy(e)(7)(A)) is amended--
(A) in the heading, by striking ``Transition'' and
inserting ``Exemption'';
(B) by striking subparagraph (A) and inserting the
following new subparagraph:
``(A) In general.--The prospective payment system
under this subsection shall not apply to items and
services provided by a facility described in
subparagraph (B).''; and
(C) in subparagraph (B), by striking ``, for which
payment'' and all that follows before the period.
(2) Effective date.--The amendments made by paragraph (1)
shall take effect as if included in the enactment of section
4432 of BBA (111 Stat. 414).
(b) Change in Effective Date of BBRA Amendments.--
(1) In general.--Section 408(c) of BBRA (113 Stat. 1501A-
375) is amended by striking ``the date that is'' and all that
follows and inserting ``January 1, 2001.''.
(2) Effective date.--The amendment made by paragraph (1)
shall take effect as if included in the enactment of section
408 of BBRA (113 Stat. 1501A-375).
SEC. 432. PERMANENT GUARANTEE OF PRE-BBA PAYMENT LEVELS FOR OUTPATIENT
SERVICES FURNISHED BY RURAL HOSPITALS.
(a) In General.--Section 1833(t)(7)(D), as amended by section 203,
is amended to read as follows:
``(D) Hold harmless provisions for small rural and
cancer hospitals.--In the case of a hospital located in
a rural area and that has not more than 100 beds or a
hospital described in section 1886(d)(1)(B)(v), for covered OPD
services for which the PPS amount is less than the pre-BBA amount, the
amount of payment under this subsection shall be increased by the
amount of such difference.''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect as if included in the enactment of section 202 of BBRA (111
Stat. 1501A-342).
SEC. 433. TREATMENT OF CERTAIN PHYSICIAN PATHOLOGY SERVICES.
(a) In General.--Section 1848(i) (42 U.S.C. 1395w-4(i)) is amended
by adding at the end the following new paragraph:
``(4) Treatment of certain physician pathology services.--
``(A) In general.--Notwithstanding any other
provision of law, when an independent laboratory
furnishes the technical component of a physician
pathology service with respect to a fee-for-service
medicare beneficiary who is a patient of a
grandfathered hospital, such component shall be treated
as a service for which payment shall be made to the
laboratory under this section and not as--
``(i) an inpatient hospital service for
which payment is made to the hospital under
section 1886(d); or
``(ii) a hospital outpatient service for
which payment is made to the hospital under the
prospective payment system under section
1834(t).
``(B) Definitions.--In this paragraph:
``(i) Grandfathered hospital.--The term
`grandfathered hospital' means a hospital that
had an arrangement with an independent
laboratory--
``(I) that was in effect as of July
22, 1999; and
``(II) under which the laboratory
furnished the technical component of
physician pathology services with
respect to patients of the hospital and
submitted a claim for payment for such
component to a carrier with a contract
under section 1842 (and not to the
hospital).
``(ii) Fee-for-service medicare
beneficiary.--The term `fee-for-service
medicare beneficiary' means an individual who
is not enrolled--
``(I) in a Medicare+Choice plan
under part C;
``(II) in a plan offered by an
eligible organization under section
1876;
``(III) with a PACE provider under
section 1894;
``(IV) in a medicare managed care
demonstration project; or
``(V) in the case of a service
furnished to an individual on an
outpatient basis, in a health care
prepayment plan under section
1833(a)(1)(A).''.
(b) Effective Date.--The amendment made by this section shall apply
to services furnished on or after January 1, 2001.
Subtitle E--Other Rural Provisions
SEC. 441. REVISION OF BONUS PAYMENTS FOR SERVICES FURNISHED IN HEALTH
PROFESSIONAL SHORTAGE AREAS.
(a) Expansion of Bonus Payments To Include Physician Assistant and
Nurse Practitioner Services.--Section 1833(m) (42 U.S.C. 1395l(m)) is
amended--
(1) by inserting ``(or services furnished by a physician
assistant or nurse practitioner that would be physicians'
services if furnished by a physician)'' after ``physicians'
services'';
(2) by inserting ``, physician assistant (in the case of a
physician assistant described in subparagraph (C)(ii) of
section 1842(b)(6)), or nurse practitioner'' after
``physician''; and
(3) by striking ``clause (A) of section 1842(b)(6)'' and
inserting ``subparagraphs (A) and (C)(i) of such section''.
(b) Elimination of Requirement To Make Bonus Payments on Monthly or
Quarterly Basis.--Section 1833(m) (42 U.S.C. 1395l(m)) is amended by
striking ``(on a monthly or quarterly basis)''.
(c) Effective Dates.--
(1) In general.--The amendments made by subsection (a)
shall apply to services furnished on or after July 1, 2001.
(2) Monthly or quarterly payments.--The amendment made by
subsection (b) shall apply to services furnished on or after
the first day of the first calendar quarter beginning at least
240 days after the date of enactment of this Act.
SEC. 442. PROVIDER-BASED RURAL HEALTH CLINIC CAP EXEMPTION.
(a) In General.--The matter in section 1833(f) (42 U.S.C. 1395l(f))
preceding paragraph (1) is amended by striking ``with less than 50
beds'' and inserting ``with an average daily patient census that does
not exceed 50''.
(b) Effective Date.--The amendment made by subparagraph (A) shall
apply to services furnished on or after January 1, 2001.
SEC. 443. PAYMENT FOR CERTAIN PHYSICIAN ASSISTANT SERVICES.
(a) Payment for Certain Physician Assistant Services.--Section
1842(b)(6)(C) (42 U.S.C. 1395u(b)(6)(C)) is amended by striking ``for
such services provided before January 1, 2003,''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on the date of enactment of this Act.
SEC. 444. 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.
(a) In General.--Section 1888(e)(2)(A)(ii) (42 U.S.C.
1395yy(e)(2)(A)(ii)) is amended--
(1) in the first sentence, by inserting ``clinical social
worker services,'' after ``qualified psychologist services,'';
and
(2) by inserting after the first sentence the following:
``Services described in this clause also include services that
are provided by a physician, a physician assistant, a nurse
practitioner, a certified nurse midwife, a qualified
psychologist, or a clinical social worker who is employed, or
otherwise under contract, with a rural health clinic or a
Federally qualified health center.''.
(b) Effective Date.--The amendments made by this section shall
apply to services provided on or after the date which is 60 days after
the date of enactment of this Act.
SEC. 445. COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES PROVIDED
IN RURAL HEALTH CLINICS.
(a) Coverage of Marriage and Family Therapist Services.--
(1) Provision of services in rural health clinics.--Section
1861(aa)(1)(B) (42 U.S.C. 1395x(aa)(1)(B)) is amended by
striking ``Secretary)'' and inserting ``Secretary), by a
marriage and family therapist (as defined in subsection
(xx)(2)),''.
(2) Marriage and family therapist services defined.--
Section 1861 (42 U.S.C. 1395x), as amended by section 232,
233(a), 234(b), and 250(b), is further amended by adding at the
end the following new subsection:
``Marriage and Family Therapist Services
``(yy)(1) The term `marriage and family therapist services' means
services performed by a marriage and family therapist (as defined in
paragraph (2)) for the diagnosis and treatment of mental illnesses,
which the marriage and family therapist is legally authorized to
perform under State law (or the State regulatory mechanism provided by
State law) of the State in which such services are performed, as would
otherwise be covered if furnished by a physician or as an incident to a
physician's professional service, but only if no facility or other
provider charges or is paid any amounts with respect to the furnishing
of such services.
``(2) The term `marriage and family therapist' means an individual
who--
``(A) possesses a master's or doctoral degree which
qualifies for licensure or certification as a marriage and
family therapist pursuant to State law;
``(B) after obtaining such degree has performed at least 2
years of clinical supervised experience in marriage and family
therapy; and
``(C)(i) is licensed or certified as a marriage and family
therapist in the State in which marriage and family therapist
services are performed; or
``(ii) in the case of a State that does not provide for
such licensure or certification, meets such other criteria as
the Secretary establishes.''.
(b) Effective Date.--The amendments made by this section shall
apply with respect to services furnished on or after January 1, 2002.
SEC. 446. CAPITAL INFRASTRUCTURE REVOLVING LOAN PROGRAM.
(a) In General.--Part A of title XVI of the Public Health Service
Act (42 U.S.C. 300q et seq.) is amended by adding at the end the
following new section:
``capital infrastructure revolving loan program
``Sec. 1603. (a) Authority To Make and Guarantee Loans.--
``(1) Authority to make loans.--The Secretary may make
loans from the fund established under section 1602(d) to any
rural entity for projects for capital improvements, including--
``(A) the acquisition of land necessary for the
capital improvements;
``(B) the renovation or modernization of any
building;
``(C) the acquisition or repair of fixed or major
movable equipment; and
``(D) such other project expenses as the Secretary
determines appropriate.
``(2) Authority to guarantee loans.--
``(A) In general.--The Secretary may guarantee the
payment of principal and interest for loans to rural
entities for projects for capital improvements
described in paragraph (1) to non-Federal lenders.
``(B) Interest subsidies.--In the case of a
guarantee of any loan to a rural entity under
subparagraph (A)(i), the Secretary may pay to the
holder of such loan and for and on behalf of the
project for which the loan was made, amounts sufficient
to reduce by not more than 3 percentage points of the
net effective interest rate otherwise payable on such
loan.
``(b) Amount of Loan.--The principal amount of a loan directly made
or guaranteed under subsection (a) for a project for capital
improvement may not exceed $5,000,000.
``(c) Funding Limitations.--
``(1) Government credit subsidy exposure.--The total of the
Government credit subsidy exposure under the Credit Reform Act
of 1990 scoring protocol with respect to the loans outstanding
at any time with respect to which guarantees have been issued,
or which have been directly made, under subsection (a) may not
exceed $50,000,000 per year.
``(2) Total amounts.--Subject to paragraph (1), the total
of the principal amount of all loans directly made or
guaranteed under subsection (a) may not exceed $250,000,000 per
year.
``(d) Additional Assistance.--
``(1) Nonrepayable grants.--Subject to paragraph (2), the
Secretary may make a grant to a rural entity, in an amount not
to exceed $50,000, for purposes of capital assessment and
business planning.
``(2) Limitation.--The cumulative total of grants awarded
under this subsection may not exceed $2,500,000 per year.
``(e) Termination of Authority.--The Secretary may not directly
make or guarantee any loan under subsection (a) or make a grant under
subsection (d) after September 30, 2005.''.
(b) Rural Entity Defined.--Section 1624 of the Public Health
Service Act (42 U.S.C. 300s-3) is amended by adding at the end the
following new paragraph:
``(15)(A) The term `rural entity' includes--
``(i) a rural health clinic, as defined in section
1861(aa)(2) of the Social Security Act;
``(ii) any medical facility with at least 1, but
less than 50, beds that is located in--
``(I) a county that is not part of a
metropolitan statistical area; or
``(II) a rural census tract of a
metropolitan statistical area (as determined
under the most recent modification of the
Goldsmith Modification, originally published in
the Federal Register on February 27, 1992 (57
Fed. Reg. 6725));
``(iii) a hospital that is classified as a rural,
regional, or national referral center under section
1886(d)(5)(C) of the Social Security Act; and
``(iv) a hospital that is a sole community hospital
(as defined in section 1886(d)(5)(D)(iii) of the Social
Security Act).
``(B) For purposes of subparagraph (A), the fact that a
clinic, facility, or hospital has been geographically
reclassified under the medicare program under title XVIII of
the Social Security Act shall not preclude a hospital from
being considered a rural entity under clause (i) or (ii) of
subparagraph (A).''.
(c) Conforming Amendments.--Section 1602 of the Public Health
Service Act (42 U.S.C. 300q-2) is amended--
(1) in subsection (b)(2)(D), by inserting ``or
1603(a)(2)(B)'' after ``1601(a)(2)(B)''; and
(2) in subsection (d)--
(A) in paragraph (1)(C), by striking ``section
1601(a)(2)(B)'' and inserting ``sections 1601(a)(2)(B)
and 1603(a)(2)(B)''; and
(B) in paragraph (2)(A), by inserting ``or
1603(a)(2)(B)'' after ``1601(a)(2)(B)''.
SEC. 447. GRANTS FOR UPGRADING DATA SYSTEMS.
(a) In General.--Part B of title XVI of the Public Health Service
Act (42 U.S.C. 300r et seq.) is amended by adding at the end the
following new section:
``grants for upgrading data systems
``Sec. 1611. (a) Grants to Hospitals.--
``(1) In general.--The Secretary shall establish a program
to make grants to hospitals that have submitted applications in
accordance with subsection (c) to assist eligible small rural
hospitals in offsetting the costs of establishing data
systems--
``(A) required to--
``(i) implement prospective payment systems
under title XVIII of the Social Security Act;
and
``(ii) comply with the administrative
simplification requirements under part C of
title XI of such Act; or
``(B) to reduce medication errors.
``(2) Costs.--For purposes of paragraph (1), the term
`costs' shall include costs associated with--
``(A) purchasing computer software and hardware;
and
``(B) providing education and training to hospital
staff on computer information systems.
``(3) Limitation.--A hospital that has received a grant
under section 142 of the Medicare, Medicaid, and SCHIP Balanced
Budget Refinement Act of 2000 is not eligible to receive a
grant under this section.
``(b) Eligible Small Rural Hospital Defined.--For purposes of this
section, the term `eligible small rural hospital' means a non-Federal,
short-term general acute care hospital that--
``(1) is located in a rural area, as defined for purposes
of section 1886(d) of the Social Security Act; and
``(2) has less than 50 beds.
``(c) Application.--A hospital seeking a grant under this section
shall submit an application to the Secretary at such time and in such
form and manner as the Secretary specifies.
``(d) Amount of Grant.--A grant to a hospital under this section
may not exceed $100,000.
``(e) Reports.--
``(1) Information.--A hospital receiving a grant under this
section shall furnish the Secretary with such information as
the Secretary may require to--
``(A) evaluate the project for which the grant is
made; and
``(B) ensure that the grant is expended for the
purposes for which it is made.
``(2) Timing of submission.--
``(A) Interim reports.--The Secretary shall report
to the Committee on Commerce of the House of
Representatives and the Committee on Health, Education,
Labor, and Pensions of the Senate at least annually on
the grant program established under this section,
including in such report information on the number of
grants made, the nature of the projects involved, the
geographic distribution of grant recipients, and such
other matters as the Secretary deems appropriate.
``(B) Final report.--The Secretary shall submit a
final report to such committees not later than 180 days
after the completion of all of the projects for which a
grant is made under this section.
``(f) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary for grants under this
section.''.
(b) Conforming Amendment.--Section 1820(g)(3) (42 U.S.C. 1395i-
4(g)(3)) is repealed.
SEC. 448. RELIEF FOR FINANCIALLY DISTRESSED RURAL HOSPITALS.
Title III of the Public Health Service Act (42 U.S.C. 241 et seq.)
is amended by inserting after section 330D the following new section:
``SEC. 330E. RELIEF FOR FINANCIALLY DISTRESSED RURAL HOSPITALS.
``(a) Grants to Small Rural Hospitals.--The Secretary, acting
through the Health Resources and Services Administration, may award
grants to eligible small rural hospitals that have submitted
applications in accordance with subsection (c) to provide relief for
financial distress that has a negative impact on access to care for
beneficiaries under the medicare program under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.) that reside in a rural
area.
``(b) Eligible Small Rural Hospital Defined.--For purposes of this
paragraph, the term `eligible small rural hospital' means a non-
Federal, short-term general acute care hospital that--
``(1) is located in a rural area (as defined for purposes
of section 1886(d) of the Social Security Act (42 U.S.C.
1395ww(d))); and
``(2) has less than 50 beds.
``(c) Application and Approval.--
``(1) Application.--Each eligible small rural hospital that
desires to receive a grant under this paragraph shall submit an
application to the Secretary, at such time, in such form and
manner, and accompanied by such additional information as the
Secretary may reasonably require.
``(2) Approval.--The Secretary shall approve applications
submitted under paragraph (1) based on a methodology developed
by the Secretary in consultation with the Office of Rural
Health Policy.
``(d) Amount of Grant.--A grant to an eligible small rural hospital
under this paragraph may not exceed $250,000.
``(e) Use of Funds.--
``(1) In general.--Except as provided in paragraph (2), an
eligible small rural hospital may use amounts received under a
grant under this section to temporarily offset financial
operating losses, with emphasis on those losses attributable to
reimbursement formula changes that resulted from the Balanced
Budget Act of 1997, in order to ensure continued operation and
short-term sustainability or to address emergency physical
capital needs that might otherwise result in closure.
``(2) Prohibited uses.--A hospital may not use funds
received under a grant under this section for new construction,
the purchase of medical equipment, or for computer software or
hardware.
``(f) Report.--
``(1) Information.--A hospital receiving a grant under this
section shall furnish the Secretary with such information as
the Secretary may require to evaluate the project for which the
grant is made and to ensure that the grant is expended for the
purposes for which it is made.
``(2) Reporting.--
``(A) Annual reports.--
``(i) In general.--Not later than December
31 of each year (beginning with 2001), the
Secretary shall submit a report to the
committees of jurisdiction of the House of
Representatives and the Senate on the grant
program established under this section.
``(ii) Information included.--The report
submitted under clause (i) shall include
information on the number of grants made, the
nature of the projects involved, the geographic
distribution of grant recipients, and such
other information as the Secretary determines
is appropriate.
``(B) Final report.--Not later than 180 days after
the completion of all of the projects for which a grant
is made under this section, the Secretary shall submit
a final report on the grant program established under
this section to the committees described in
subparagraph (A).
``(g) Appropriations.--There are appropriated, out of any money in
the Treasury not otherwise appropriated, for making grants under this
section $25,000,000 for each of the fiscal years 2001 through 2005.''.
SEC. 449. REFINEMENT OF MEDICARE REIMBURSEMENT FOR TELEHEALTH SERVICES.
(a) Revision of Telehealth Payment Methodology and Elimination of
Fee-Sharing Requirement.--Section 4206(b) of the Balanced Budget Act of
1997 (42 U.S.C. 1395l note) is amended to read as follows:
``(b) Methodology for Determining Amount of Payments.--
``(1) In general.--The Secretary shall pay to--
``(A) the physician or practitioner at a distant
site that provides an item or service under subsection
(a) an amount equal to the amount that such physician
or provider would have been paid had the item or
service been provided without the use of a
telecommunications system; and
``(B) the originating site a facility fee for
facility services furnished in connection with such
item or service.
``(2) Application of part b coinsurance and deductible.--
Any payment made under this section shall be subject to the
coinsurance and deductible requirements under subsections
(a)(1) and (b) of section 1833 of the Social Security Act (42
U.S.C. 1395l).
``(3) Definitions.--In this subsection:
``(A) Distant site.--The term `distant site' means
the site at which the physician or practitioner is
located at the time the item or service is provided via
a telecommunications system.
``(B) Facility fee.--The term `facility fee' means
an amount equal to--
``(i) for 2000 and 2001, $20; and
``(ii) for a subsequent year, the facility
fee under this subsection for the previous year
increased by the percentage increase in the MEI
(as defined in section 1842(i)(3)) for such
subsequent year.
``(C) Originating site.--
``(i) In general.--The term `originating
site' means the site described in clause (ii)
at which the eligible telehealth beneficiary
under the medicare program is located at the
time the item or service is provided via a
telecommunications system.
``(ii) Sites described.--The sites
described in this paragraph are as follows:
``(I) On or before January 1, 2002,
the office of a physician or a
practitioner, a critical access
hospital, a rural health clinic, and a
Federally qualified health center.
``(II) On or before January 1,
2003, a hospital, a skilled nursing
facility, a comprehensive outpatient
rehabilitation facility, a renal
dialysis facility, an ambulatory
surgical center, an Indian Health
Service facility, and a community
mental health center.''.
(b) Elimination of Requirement for Telepresenter.--Section 4206 of
the Balanced Budget Act of 1997 (42 U.S.C. 1395l note) is amended--
(1) in subsection (a), by striking ``, notwithstanding that
the individual physician'' and all that follows before the
period at the end; and
(2) by adding at the end the following new subsection:
``(e) Telepresenter Not Required.--Nothing in this section shall be
construed as requiring an eligible telehealth beneficiary to be
presented by a physician or practitioner for the provision of an item
or service via a telecommunications system.''.
(c) Reimbursement for Medicare Beneficiaries Who Do Not Reside in a
HPSA.--Section 4206(a) of the Balanced Budget Act of 1997 (42 U.S.C.
1395l note), as amended by subsection (b), is amended--
(1) by striking ``In General.--Not later than'' and
inserting the following: ``Telehealth Services Reimbursed.--
``(1) In general.--Not later than'';
(2) by striking ``furnishing a service for which payment''
and all that follows before the period and inserting ``to an
eligible telehealth beneficiary''; and
(3) by adding at the end the following new paragraph:
``(2) Eligible telehealth beneficiary defined.--In this
section, the term `eligible telehealth beneficiary' means a
beneficiary under the medicare program under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.) that resides in--
``(A) an area that is designated as a health
professional shortage area under section 332(a)(1)(A)
of the Public Health Service Act (42 U.S.C.
254e(a)(1)(A));
``(B) a county that is not included in a
Metropolitan Statistical Area; or
``(C) an inner-city area that is medically
underserved (as defined in section 330(b)(3) of the
Public Health Service Act (42 U.S.C. 254b(b)(3))).''.
(d) Telehealth Coverage for Direct Patient Care.--
(1) In general.--Section 4206 of the Balanced Budget Act of
1997 (42 U.S.C. 1395l note), as amended by subsection (c), is
amended--
(A) in subsection (a)(1), by striking
``professional consultation via telecommunications
systems with a physician'' and inserting ``items and
services for which payment may be made under such part
that are furnished via a telecommunications system by a
physician''; and
(B) by adding at the end the following new
subsection:
``(f) Coverage of Items and Services.--Payment for items and
services provided pursuant to subsection (a) shall include payment for
professional consultations, office visits, office psychiatry services,
including any service identified as of July 1, 2000, by HCPCS codes
99241-99275, 99201-99215, 90804-90815, and 90862.''.
(2) Study and report regarding additional items and
services.--
(A) Study.--The Secretary of Health and Human
Services shall conduct a study to identify items and
services in addition to those described in section
4206(f) of the Balanced Budget Act of 1997 (as added by
paragraph (1)) that would be appropriate to provide
payment under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.).
(B) Report.--Not later than 2 years after the date
of enactment of this Act, the Secretary shall submit a
report to Congress on the study conducted under
subparagraph (A) together with such recommendations for
legislation that the Secretary determines are
appropriate.
(e) All Physicians and Practitioners Eligible for Telehealth
Reimbursement.--Section 4206(a) of the Balanced Budget Act of 1997 (42
U.S.C. 1395l note), as amended by subsection (d), is amended--
(1) in paragraph (1), by striking ``(described in section
1842(b)(18)(C) of such Act (42 U.S.C. 1395u(b)(18)(C))''; and
(2) by adding at the end the following new paragraph:
``(3) Practitioner defined.--For purposes of paragraph (1),
the term `practitioner' includes--
``(A) a practitioner described in section
1842(b)(18)(C) of the Social Security Act (42 U.S.C.
1395u(b)(18)(C)); and
``(B) a physical, occupational, or speech
therapist.''.
(f) Telehealth Services Provided Using Store-and-Forward
Technologies.--Section 4206(a)(1) of the Balanced Budget Act of 1997
(42 U.S.C. 1395l note), as amended by subsection (e), is amended by
adding at the end the following new paragraph:
``(4) Use of store-and-forward technologies.--For purposes
of paragraph (1), in the case of any Federal telemedicine
demonstration program in Alaska or Hawaii, the term
`telecommunications system' includes store-and-forward
technologies that provide for the asynchronous transmission of
health care information in single or multimedia formats.''.
(g) Five-Year Application.--The amendments made by this section
shall apply to items and services provided on or after April 1, 2001,
and before April 1, 2006.
SEC. 450. MEDPAC STUDY ON LOW-VOLUME, ISOLATED RURAL HEALTH CARE
PROVIDERS.
(a) Study.--The Medicare Payment Advisory Commission established
under section 1805 of the Social Security Act (42 U.S.C. 1395b-6) (in
this section referred to as ``MedPAC'') shall conduct a study on the
effect of low patient and procedure volume on the financial status of
low-volume, isolated rural health care providers participating in the
medicare program under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.).
(b) Report.--Not later than 18 months after the date of enactment
of this Act, MedPAC shall submit a report to the Secretary of Health
and Human Services and Congress on the study conducted under subsection
(a) indicating--
(1) whether low-volume, isolated rural health care
providers are having, or may have, significantly decreased
medicare margins or other financial difficulties resulting from
any of the payment methodologies described in subsection (c);
(2) whether the status as a low-volume, isolated rural
health care provider should be designated under the medicare
program and any criteria that should be used to qualify for
such a status; and
(3) any changes in the payment methodologies described in
subsection (c) that are necessary to provide appropriate
reimbursement under the medicare program to low-volume,
isolated rural health care providers (as designated pursuant to
paragraph (2)).
(c) Payment Methodologies Described.--The payment methodologies
described in this subsection are the following:
(1) The prospective payment system for hospital outpatient
department services under section 1833(t) of the Social
Security Act (42 U.S.C. 1395l).
(2) The fee schedule for ambulance services under section
1834(l) of such Act (42 U.S.C. 1395m(l)).
(3) The prospective payment system for inpatient hospital
services under section 1886 of such Act (42 U.S.C. 1395ww).
(4) The prospective payment system for routine service
costs of skilled nursing facilities under section 1888(e) of
such Act (42 U.S.C. 1395yy(e)).
(5) The prospective payment system for home health services
under section 1895 of such Act (42 U.S.C. 1395fff).
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.
(a) Open Enrollment.--Section 1851(f)(2) (42 U.S.C. 1395w-21(f)(2))
is amended by striking ``, except that if such election or change is
made after the 10th day of any calendar month, then the election or
change shall not take effect until the first day of the second calendar
month following the date on which the election or change is made''.
(b) Effective Date.--The amendment made by this section shall apply
to elections and changes of coverage made on or after January 1, 2001.
SEC. 502. SPECIAL MEDIGAP ENROLLMENT ANTIDISCRIMINATION PROVISION FOR
CERTAIN BENEFICIARIES.
(a) Disenrollment Window in Accordance With Beneficiary's
Circumstance.--Section 1882(s)(3) (42 U.S.C. 1395ss(s)(3)) is amended--
(1) in subparagraph (A), in the matter following clause
(iii), by striking ``, subject to subparagraph (E), seeks to
enroll under the policy not later than 63 days after the date
of termination of enrollment described in such subparagraph''
and inserting ``seeks to enroll under the policy during the
period specified in subparagraph (E)''; and
(2) by striking subparagraph (E) and inserting the
following new subparagraph:
``(E) For purposes of subparagraph (A), the time period specified
in this subparagraph is--
``(i) in the case of an individual described in
subparagraph (B)(i), the period beginning on the date the
individual receives a notice of termination or cessation of all
supplemental health benefits (or, if no such notice is
received, notice that a claim has been denied because of such a
termination or cessation) and ending on the date that is 63
days after the applicable notice;
``(ii) in the case of an individual described in clause
(ii), (iii), (v), or (vi) of subparagraph (B) whose enrollment
is terminated involuntarily, the period beginning on the date
that the individual receives a notice of termination and ending
on the date that is 63 days after the date the applicable
coverage is terminated;
``(iii) in the case of an individual described in
subparagraph (B)(iv)(I), the period beginning on the earlier of
(I) the date that the individual receives a notice of
termination, a notice of the issuer's bankruptcy or insolvency,
or other such similar notice, if any, and (II) the date that
the applicable coverage is terminated, and ending on the date
that is 63 days after the date the coverage is terminated;
``(iv) in the case of an individual described in clause
(ii), (iii), (iv)(II), (iv)(III), (v), or (vi) of subparagraph
(B) who disenrolls voluntarily, the period beginning on the
date that is 60 days before the effective date of the
disenrollment and ending on the date that is 63 days after such
effective date; and
``(v) in the case of an individual described in
subparagraph (B) but not described in the preceding provisions
of this subparagraph, the period beginning on the effective
date of the disenrollment and ending on the date that is 63
days after such effective date.''.
(b) Extended Medigap Access for Interrupted Trial Periods.--Section
1882(s)(3) (42 U.S.C. 1395ss(s)(3)), as amended by subsection (a), is
amended by adding at the end the following new subparagraph:
``(F) For purposes of this paragraph--
``(i) in the case of an individual described in
subparagraph (B)(v) (or deemed to be so described, pursuant to
this subparagraph) whose enrollment with an organization or
provider described in subclause (II) of such subparagraph is
involuntarily terminated within the first 12 months of such
enrollment, and who, without an intervening enrollment, enrolls
with another such organization or provider, such subsequent
enrollment shall be deemed to be an initial enrollment
described in such subparagraph; and
``(ii) in the case of an individual described in clause
(vi) of subparagraph (B) (or deemed to be so described,
pursuant to this subparagraph) whose enrollment with a plan or
in a program described in clause (v)(II) of such subparagraph
is involuntarily terminated within the first 12 months of such
enrollment, and who, without an intervening enrollment, enrolls
in another such plan or program, such subsequent enrollment
shall be deemed to be an initial enrollment described in clause
(vi) of such subparagraph.''.
SEC. 503. INCREASE IN NATIONAL PER CAPITA MEDICARE+CHOICE GROWTH
PERCENTAGE IN 2001 AND 2002.
Section 1853(c)(6)(B) of the Social Security Act (42 U.S.C. 1395w-
23(c)(6)(B)) is amended--
(1) in clause (iv), by striking ``for 2001, 0.5 percentage
points'' and inserting ``for 2001, 0 percentage points''; and
(2) in clause (v), by striking ``for 2002, 0.3 percentage
points'' and inserting ``for 2002, 0 percentage points''.
SEC. 504. ALLOWING MOVEMENT TO 50:50 PERCENT BLEND IN 2002.
Section 1853(c)(2) of the Social Security Act (42 U.S.C. 1395w-
23(c)(2)) is amended--
(1) by striking the period at the end of subparagraph (F)
and inserting a semicolon; and
(2) by adding after and below subparagraph (F) the
following:
``except that a Medicare+Choice organization may elect to apply
subparagraph (F) (rather than subparagraph (E)) for 2002.''.
SEC. 505. DELAY FROM JULY TO NOVEMBER 2000, IN DEADLINE FOR OFFERING
AND WITHDRAWING MEDICARE+CHOICE PLANS FOR 2001.
Notwithstanding any other provision of law, the deadline for a
Medicare+Choice organization to withdraw the offering of a
Medicare+Choice plan under part C of title XVIII of the Social Security
Act (or otherwise to submit information required for the offering of
such a plan) for 2001 is delayed from July 1, 2000, to November 1,
2000, and any such organization that provided notice of withdrawal of
such a plan during 2000 before the date of enactment of this Act may
rescind such withdrawal at any time before November 1, 2000.
SEC. 506. AMOUNTS IN MEDICARE TRUST FUNDS AVAILABLE FOR SECRETARY'S
SHARE OF MEDICARE+CHOICE EDUCATION AND ENROLLMENT-RELATED
COSTS.
(a) Relocation of Provisions.--Section 1857(e)(2) (42 U.S.C. 1395w-
27(e)(2)) is amended to read as follows:
``(2) Cost-sharing in enrollment-related costs.--A
Medicare+Choice organization shall pay the fee established by
the Secretary under section 1851(j)(3)(A).''.
(b) Funding for Education and Enrollment Activities.--Section 1851
(42 U.S.C. 1395w-21) is amended by adding at the end the following new
subsection:
``(j) Funding for Beneficiary Education and Enrollment
Activities.--
``(1) Secretary's estimate of total costs.--The Secretary
shall annually estimate the total cost for a fiscal year of
carrying out this section, section 4360 of the Omnibus Budget
Reconciliation Act of 1990 (relating to the health insurance
counseling and assistance program), and related activities.
``(2) Total amount available.--The total amount available
to the Secretary for a fiscal year for the costs of the
activities described in paragraph (1) shall be equal to the
lesser of--
``(A) the amount estimated for such fiscal year
under paragraph (1); or
``(B) for--
``(i) fiscal year 2001, $130,000,000; and
``(ii) fiscal year 2002 and each subsequent
fiscal year, the amount for the previous fiscal
year, adjusted to account for inflation, any
change in the number of beneficiaries under
this title, and any other relevant factors.
``(3) Cost-sharing in enrollment-related costs.--
``(A) Amounts from medicare+choice organizations.--
``(i) In general.--The Secretary is
authorized to charge a fee to each
Medicare+Choice organization with a contract
under this part that is equal to the
organization's pro rata share (as determined by
the Secretary) of the Medicare+Choice portion
(as defined in clause (ii)) of the total amount
available under paragraph (2) for a fiscal
year. Any amounts collected shall be available
without further appropriation to the Secretary
for the costs of the activities described in
paragraph (1).
``(ii) Medicare+choice portion defined.--
For purposes of clause (i), the term
`Medicare+Choice portion' means, for a fiscal
year, the ratio, as estimated by the Secretary,
of--
``(I) the average number of
individuals enrolled in Medicare+Choice
plans during the fiscal year; to
``(II) the average number of
individuals entitled to benefits under
parts A, and enrolled under part B,
during the fiscal year.
``(B) Secretary's share.--
``(i) Amounts available from trust funds.--
The Secretary's share of expenses shall be
payable from funds in the Federal Hospital
Insurance Trust Fund and the Federal
Supplementary Medical Insurance Trust Fund, in
such proportion as the Secretary shall deem to
be fair and equitable after taking into
consideration the expenses attributable to the
administration of this part with respect to
part A and B. The Secretary shall make such
transfers of moneys between such Trust Funds as
may be appropriate to settle accounts between
the Trust Funds in cases where expenses
properly payable from one such Trust Fund have
been paid from the other such Trust Fund.
``(ii) Secretary's share of expenses
defined.--For purposes of clause (i), the term
`Secretary's share of expenses' means, for a
fiscal year, an amount equal to--
``(I) the total amount available to
the Secretary under paragraph (2) for
the fiscal year; less
``(II) the amount collected under
subparagraph (A) for the fiscal
year.''.
SEC. 507. REVISED TERMS AND CONDITIONS FOR EXTENSION OF MEDICARE
COMMUNITY NURSING ORGANIZATION (CNO) DEMONSTRATION
PROJECT.
(a) In General.--Section 532 of BBRA (42 U.S.C. 1395mm note) is
amended--
(1) in subsection (a), by striking the second sentence; and
(2) by striking subsection (b) and inserting the following
new subsections:
``(b) Terms and Conditions.--
``(1) January through september 2000.--For the 9-month
period beginning with January 2000, any such demonstration
project shall be conducted under the same terms and conditions
as applied to such demonstration during 1999.
``(2) October 2000 through december 2001.--For the 15-month
period beginning with October 2000, any such demonstration
project shall be conducted under the same terms and conditions
as applied to such demonstration during 1999, except that the
following modifications shall apply:
``(A) Basic capitation rate.--The basic capitation
rate paid for services covered under the project (other
than case management services) per enrollee per month
shall be basic capitation rate paid for such services
for 1999, reduced by 10 percent in the case of the
demonstration sites located in Arizona, Minnesota, and
Illinois, and 15 percent for the demonstration site
located in New York.
``(B) Targeted case management fee.--A case
management fee shall be paid only for enrollees who are
classified as `moderate' or `at risk' through a
baseline health assessment (as required for
Medicare+Choice plans under section 1852(e) of the
Social Security Act (42 U.S.C. 1395ww-22(e)).
``(C) Greater uniformity in clinical features among
sites.--Each project shall implement for each site--
``(i) protocols for periodic telephonic
contact with enrollees based on--
``(I) the results of such
standardized written health assessment;
and
``(II) the application of
appropriate care planning approaches;
``(ii) disease management programs for
targeted diseases (such as congestive heart
failure, arthritis, diabetes, and hypertension)
that are highly prevalent in the enrolled
populations;
``(iii) systems and protocols to track
enrollees through hospitalizations, including
pre-admission planning, concurrent management
during inpatient hospital stays, and post-
discharge assessment, planning, and follow-up;
and
``(iv) standardized patient educational
materials for specified diseases and health
conditions.
``(D) Quality improvement.--Each project shall
implement at each site once during the 15-month
period--
``(i) enrollee satisfaction surveys; and
``(ii) reporting on specified quality
indicators for the enrolled population.
``(c) Evaluation.--
``(1) Preliminary report.--Not later than July 1, 2001, the
Secretary of Health and Human Services shall submit to the
Committees on Ways and Means and Commerce of the House of
Representatives and the Committee on Finance of the Senate a
preliminary report that--
``(A) evaluates such demonstration projects for the
period beginning July 1, 1997, and ending December 31,
1999, on a site-specific basis with respect to the
impact on per beneficiary spending, specific health
utilization measures, and enrollee satisfaction; and
``(B) includes a similar evaluation of such
projects for the portion of the extension period that
occurs after September 30, 2000.
``(2) Final report.--Not later than July 1, 2002, the
Secretary shall submit a final report to such Committees on
such demonstration projects. Such report shall include the same
elements as the preliminary report required by paragraph (1),
but for the period after December 31, 1999.
``(3) Methodology for spending comparisons.--Any evaluation
of the impact of the demonstration projects on per beneficiary
spending included in such reports shall be based on a
comparison of--
``(A) data for all individuals who--
``(i) were enrolled in such demonstration
projects as of the first day of the period
under evaluation; and
``(ii) were enrolled for a minimum of 6
months thereafter; with
``(B) data for a matched sample of individuals who
are enrolled under part B of title XVIII of the Social
Security Act (42 U.S.C. 1395j et seq.) and who are not
enrolled in such a project, in a Medicare+Choice plan
under part C of such title (42 U.S.C. 1395w-21 et
seq.), a plan offered by an eligible organization under
section 1876 of such Act (42 U.S.C. 1395mm), or a
health care prepayment plan under section 1833(a)(1)(A)
of such Act (42 U.S.C. 1395l(a)(1)(A)).''.
(b) Effective Date.--The amendments made by subsection (a) shall be
effective as if included in the enactment of section 532 of BBRA (42
U.S.C. 1395mm note).
SEC. 508. MODIFICATION OF PAYMENT RULES FOR CERTAIN FRAIL ELDERLY
MEDICARE BENEFICIARIES.
(a) Modification of Payment Rules.--Section 1853 (42 U.S.C. 1395w-
23) is amended--
(1) in subsection (a)--
(A) in paragraph (1)(A), by striking ``subsections
(e), (g), and (i)'' and inserting ``subsections (e),
(g), (i), and (j)'';
(B) in paragraph (3)(D), by inserting ``paragraph
(4) and'' after ``Subject to''; and
(C) by adding at the end the following new
paragraph:
``(4) Exemption from risk-adjustment system for frail
elderly beneficiaries enrolled in specialized programs.--
``(A) In general.--In applying the risk-adjustment
factors established under paragraph (3) during the
period described in subparagraph (B), the limitation
under paragraph (3)(C)(ii)(I) shall apply to a frail
elderly Medicare+Choice beneficiary (as defined in
subsection (j)(3)) who is enrolled in a Medicare+Choice
plan under a specialized program for the frail elderly
(as defined in subsection (j)(2)) during the entire
period.
``(B) Period of application.--The period described
in this subparagraph begins with January 2001, and ends
with the first month for which the Secretary certifies
to Congress that a comprehensive risk adjustment
methodology under paragraph (3)(C) that takes into
account the factors described in subsection (j)(1)(B)
is being fully implemented.''; and
(2) by adding at the end the following new subsection:
``(j) Special Rules for Frail Elderly Enrolled in Specialized
Programs for the Frail Elderly.--
``(1) Development and implementation of new payment
system.--
``(A) In general.--The Secretary shall develop and
implement (as soon as possible after the date of
enactment of the Medicare, Medicaid, and SCHIP Balanced
Budget Refinement Act of 2000), during the period
described in subsection (a)(4)(B), a payment
methodology for frail elderly Medicare+Choice
beneficiaries enrolled in a Medicare+Choice plan under
a specialized program for the frail elderly (as defined
in paragraph (2)(A)).
``(B) Factors described.--The methodology developed
and implemented under subparagraph (A) shall take into
account the prevalence, mix, and severity of chronic
conditions among frail elderly Medicare+Choice
beneficiaries and shall include--
``(i) medical diagnostic factors from all
provider settings (including hospital and
nursing facility settings);
``(ii) functional indicators of health
status; and
``(iii) such other factors as may be
necessary to achieve appropriate payments for
plans serving such beneficiaries.
``(2) Specialized program for the frail elderly defined.--
``(A) In general.--In this part, the term
`specialized program for the frail elderly' means a
program that the Secretary determines--
``(i) is offered under this part as a
distinct part of a Medicare+Choice plan;
``(ii) primarily enrolls frail elderly
Medicare+Choice beneficiaries; and
``(iii) has a clinical delivery system that
is specifically designed to serve the special
needs of such beneficiaries and to coordinate
short-term and long-term care for such
beneficiaries through the use of a team
described in subparagraph (B) and through the
provision of primary care services to such
beneficiaries by means of such a team at the
nursing facility involved.
``(B) Specialized team described.--A team described
in this subparagraph--
``(i) includes--
``(I) a physician; and
``(II) a nurse practitioner or
geriatric care manager; and
``(ii) has as members individuals who--
``(I) have special training in the
care and management of the frail
elderly beneficiaries; and
``(II) specialize in the care and
management of such beneficiaries.
``(3) Frail elderly medicare+choice beneficiary defined.--
In this part, the term `frail elderly Medicare+Choice
beneficiary' means a Medicare+Choice eligible individual who--
``(A) is residing in a skilled nursing facility (as
defined in section 1819(a)) or a nursing facility (as
defined in section 1919(a)) for an indefinite period
and without any intention of residing outside the
facility; and
``(B) has a severity of condition that makes the
individual frail (as determined under guidelines
approved by the Secretary).''.
(b) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act.
TITLE VI--PROVISIONS RELATING TO INDIVIDUALS WITH END-STAGE RENAL
DISEASE
SEC. 601. UPDATE IN RENAL DIALYSIS COMPOSITE RATE.
(a) In General.--The last sentence of section 1881(b)(7) (42 U.S.C.
1395rr(b)(7)) is amended by striking ``, and for such services'' and
all that follows before the period at the end and inserting the
following: ``, for such services furnished during 2001, by 2.4 percent
above such composite rate payment amounts for such services furnished
on December 31, 2000, for such services furnished during 2002 and 2003,
by the percentage increase in the Consumer Price Index for all urban
consumers (U.S. city average) for the 12-month period ending with June
of the previous year above such composite rate payment amounts for such
services furnished on December 31 of the previous year, and for such
services furnished during a subsequent year, by the ESRD market basket
percentage increase above such composite rate payment amounts for such
services furnished on December 31 of the previous year''.
(b) ESRD Market Basket Percentage Increase Defined.--Section
1881(b) (42 U.S.C. 1395rr(b)) is amended by adding at the end the
following new paragraph:
``(12)(A) For purposes of this title, the term `ESRD market basket
percentage increase' means, with respect to a calendar year, the
percentage (estimated by the Secretary before the beginning of such
year) by which--
``(i) the cost of the mix of goods and services included in
the provision of dialysis services (which may include the costs
described in subparagraph (D) as determined appropriate by the
Secretary) that is determined based on an index of
appropriately weighted indicators of changes in wages and
prices which are representative of the mix of goods and
services included in such dialysis services for the calendar
year; exceeds
``(ii) the cost of such mix of goods and services for the
preceding calendar year.
``(B) In determining the percentage under subparagraph (A), the
Secretary may take into account any increase in the costs of furnishing
the mix of goods and services described in such subparagraph resulting
from--
``(i) the adoption of scientific and technological
innovations used to provide dialysis services; and
``(ii) changes in the manner or method of delivering
dialysis services.
``(C) The Secretary shall periodically review and update (as
necessary) the items and services included in the mix of goods and
services used to determine the percentage under subparagraph (A).
``(D) The costs described in this subparagraph include--
``(i) labor, including direct patient care costs and
administrative labor costs, vacation and holiday pay, payroll
taxes, and employee benefits;
``(ii) other direct costs, including drugs, supplies, and
laboratory fees;
``(iii) overhead, including medical director fees,
temporary services, general and administrative costs, interest
expenses, and bad debt;
``(iv) capital, including rent, real estate taxes,
depreciation, utilities, repairs, and maintenance; and
``(v) such other allowable costs as the Secretary may
specify.''.
SEC. 602. REVISION OF PAYMENT RATES FOR ESRD PATIENTS ENROLLED IN
MEDICARE+CHOICE PLANS.
(a) In General.--Section 1853(a)(1)(B) (42 U.S.C. 1395w-
23(a)(1)(B)) is amended by adding at the end the following: ``In
establishing such rates the Secretary shall provide for appropriate
adjustments to increase each rate to reflect the demonstration rate
(including any risk-adjustment associated with such rate) of the social
health maintenance organization end-stage renal disease demonstrations
established by section 2355 of the Deficit Reduction Act of 1984
(Public Law 98-369; 98 Stat. 1103), as amended by section 13567(b) of
the Omnibus Budget Reconciliation Act of 1993 (Public Law 103-66; 107
Stat. 608), and shall compute such rates by not taking into account
individuals with kidney transplants and individuals in which the
program under this title is a secondary payer to another payer (or
payers) pursuant to section 1862(b).''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to payments for months beginning with January 2002.
(c) Publication.--The Secretary of Health and Human Services, not
later than 6 months after the date of enactment of this Act, shall
publish for public comment a description of the appropriate adjustments
described in the last sentence of section 1853(a)(1)(B) of the Social
Security Act (42 U.S.C. 1395w-23(a)(1)(B)), as added by subsection (a).
The Secretary shall publish in final form such adjustments by not later
than July 1, 2001, so that the amendment made by subsection (a) is
implemented on a timely basis consistent with subsection (b).
SEC. 603. PERMITTING ESRD BENEFICIARIES TO ENROLL IN ANOTHER
MEDICARE+CHOICE PLAN IF THE PLAN IN WHICH THEY ARE
ENROLLED IS TERMINATED.
(a) In General.--Section 1851(a)(3)(B) (42 U.S.C. 1395w-
21(a)(3)(B)) is amended by striking ``except that'' and all that
follows and inserting the following: ``except that--
``(i) an individual who develops end-stage
renal disease while enrolled in a
Medicare+Choice plan may continue to be
enrolled in that plan; and
``(ii) in the case of such an individual
who is enrolled in a Medicare+Choice plan under
clause (i) (or subsequently under this clause),
if the enrollment is discontinued under
circumstances described in section
1851(e)(4)(A) then the individual will be
treated as a `Medicare+Choice eligible
individual' for purposes of electing to
continue enrollment in another Medicare+Choice
plan.''.
(b) Effective Date.--
(1) In general.--The amendment made by subsection (a) shall
apply to terminations and discontinuations occurring on or
after the date of enactment of this Act.
(2) Application to prior plan terminations.--Clause (ii) of
section 1851(a)(3)(B) of the Social Security Act (as inserted
by subsection (a)) also shall apply to individuals whose
enrollment in a Medicare+Choice plan was terminated or
discontinued after December 31, 1997, and before the date of
enactment of this Act. In applying this paragraph, such an
individual shall be treated, for purposes of part C of title
XVIII of the Social Security Act, as having discontinued
enrollment in such a plan as of the date of enactment of this
Act.
SEC. 604. COVERAGE OF CERTAIN VASCULAR ACCESS SERVICES FOR ESRD
BENEFICIARIES PROVIDED BY AMBULATORY SURGICAL CENTERS.
(a) In General.--The matter following subparagraph (B) of section
1833(i)(1) (42 U.S.C. 1395l(i)(1)) is amended by adding at the end the
following new sentence: ``Such lists shall include the procedures
identified as of July 30, 1999, by vascular access codes 34101, 34111,
34490, 35190, 35458, 35460, 35475, 35476, 35903, 36005, 36010, 36011,
36120, 36140, 36145, 36215-36218, 36831-36834, 37201, 37204-37208,
37250, 37251, and 49423.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to vascular access services furnished on or after January 1,
2000.
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.
(a) Collection of Information.--The Secretary shall collect
information on the satisfaction of each ESRD medicare beneficiary with
the quality of health care under the original fee-for-service medicare
program and the Medicare+Choice program, and the access of each
beneficiary to that care.
(b) Analysis of Collected Information.--
(1) In general.--The Secretary shall conduct an analysis of
the information collected under subsection (a) to determine--
(A) the kinds of health care that each non-dialysis
health care provider provides to each ESRD medicare
beneficiary for the treatment of end-stage renal
disease and each comorbidity;
(B) the effect of the availability of supplemental
insurance on the use by beneficiary of health care;
(C) the perceptions of each beneficiary regarding
the access of that beneficiary to health care; and
(D) the quality of health care provided to each
ESRD medicare beneficiary enrolled under the
Medicare+Choice program compared to each beneficiary
enrolled under the original fee-for-service medicare
program.
(2) Considerations.--In conducting the analysis under
paragraph (1), the Secretary shall consider--
(A) the feasibility of routinely collecting
information on the satisfaction of each ESRD medicare
beneficiary with dialysis and non-dialysis health care;
(B) whether to collect information using disease
specific questions or generic questions (similar to
those used in conducting the Medicare Current
Beneficiary Survey);
(C) how well collected information detects access
problems within each specific group of ESRD medicare
beneficiaries, including beneficiaries without
supplemental insurance and beneficiaries that reside in
a rural area; and
(D) each obstacle that a health care provider may
face in offering each type of dialysis service.
(c) Availability of Information and Analysis.--Not later than
January 1 of each year (beginning in 2002) the Secretary shall make the
information collected under subsection (a) and the analysis conducted
under subsection (b) available to the public.
(d) Definitions.--In this section:
(1) ESRD medicare beneficiary.--The term ``ESRD medicare
beneficiary'' means an individual eligible for benefits under
the medicare program that has end-stage renal disease
(including an individual enrolled in a Medicare+Choice plan
offered by a Medicare+Choice organization under the
Medicare+Choice program).
(2) Medicare+choice program.--The term ``Medicare+Choice
program'' means the program established under part C of title
XVIII of the Social Security Act (42 U.S.C. 1395w-21 et seq.).
(3) Original fee-for-service medicare program.--The term
``original fee-for-service medicare program'' means the health
benefits program under parts A and B title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.).
(4) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services, acting through the Administrator
of the Health Care Financing Administration.
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.
(a) In General.--Section 1902(a) (42 U.S.C. 1396a(a)) is amended--
(1) in paragraph (13)--
(A) in subparagraph (A), by adding ``and'' at the
end;
(B) in subparagraph (B), by striking ``and'' at the
end; and
(C) by striking subparagraph (C); and
(2) by inserting after paragraph (14) the following new
paragraph:
``(15) for payment for services described in subparagraph
(B) or (C) of section 1905(a)(2) under the plan in accordance
with subsection (aa);''.
(b) New Prospective Payment System.--Section 1902 (42 U.S.C. 1396a)
is amended by adding at the end the following:
``(aa) Payment for Services Provided by Federally-Qualified Health
Centers and Rural Health Clinics.--
``(1) In general.--Beginning with fiscal year 2001 and each
succeeding fiscal year, the State plan shall provide for
payment for services described in section 1905(a)(2)(C)
furnished by a Federally-qualified health center and services
described in section 1905(a)(2)(B) furnished by a rural health
clinic in accordance with the provisions of this subsection.
``(2) Fiscal year 2001.--Subject to paragraph (4), for
services furnished during fiscal year 2001, the State plan
shall provide for payment for such services in an amount
(calculated on a per visit basis) that is equal to 100 percent
of the costs of the center or clinic of furnishing such
services during fiscal year 2000 which are reasonable and
related to the cost of furnishing such services, or based on
such other tests of reasonableness as the Secretary prescribes
in regulations under section 1833(a)(3), or, in the case of
services to which such regulations do not apply, the same
methodology used under section 1833(a)(3), adjusted to take
into account any increase in the scope of such services
furnished by the center or clinic during fiscal year 2001.
``(3) Fiscal year 2002 and succeeding fiscal years.--
Subject to paragraph (4), for services furnished during fiscal
year 2002 or a succeeding fiscal year, the State plan shall
provide for payment for such services in an amount (calculated
on a per visit basis) that is equal to the amount calculated
for such services under this subsection for the preceding
fiscal year--
``(A) increased by the percentage increase in the
MEI (as defined in section 1842(i)(3)) applicable to
primary care services (as defined in section
1842(i)(4)) for that fiscal year; and
``(B) adjusted to take into account any increase in
the scope of such services furnished by the center or
clinic during that fiscal year.
``(4) Establishment of initial year payment amount for new
centers or clinics.--In any case in which an entity first
qualifies as a Federally-qualified health center or rural
health clinic after fiscal year 2000, the State plan shall
provide for payment for services described in section
1905(a)(2)(C) furnished by the center or services described in
section 1905(a)(2)(B) furnished by the clinic in the first
fiscal year in which the center or clinic so qualifies in an
amount (calculated on a per visit basis) that is equal to 100
percent of the costs of furnishing such services during such
fiscal year in accordance with the regulations and methodology
referred to in paragraph (2). For each fiscal year following
the fiscal year in which the entity first qualifies as a
Federally-qualified health center or rural health clinic, the
State plan shall provide for the payment amount to be
calculated in accordance with paragraph (3).
``(5) Administration in the case of managed care.--In the
case of services furnished by a Federally-qualified health
center or rural health clinic pursuant to a contract between
the center or clinic and a managed care entity (as defined in
section 1932(a)(1)(B)), the State plan shall provide for
payment to the center or clinic (at least quarterly) by the
State of a supplemental payment equal to the amount (if any) by
which the amount determined under paragraphs (2), (3), and (4)
of this subsection exceeds the amount of the payments provided
under the contract.
``(6) Alternative payment methodologies.--Notwithstanding
any other provision of this section, the State plan may provide
for payment in any fiscal year to a Federally-qualified health
center for services described in section 1905(a)(2)(C) or to a
rural health clinic for services described in
section 1905(a)(2)(B) in an amount which is determined under an
alternative payment methodology that--
``(A) is agreed to by the State and the center or
clinic; and
``(B) results in payment to the center or clinic of
an amount which is at least equal to the amount
otherwise required to be paid to the center or clinic
under this section.''.
(c) Conforming Amendments.--
(1) Section 4712 of BBA (111 Stat. 508) is amended by
striking subsection (c).
(2) Section 1915(b) (42 U.S.C. 1396n(b)) is amended by
striking ``1902(a)(13)(E)'' and inserting ``1902(a)(15),
1902(aa),''.
(d) Effective Date.--The amendments made by this section take
effect on October 1, 2000, and apply to services furnished on or after
such date.
SEC. 702. TRANSITIONAL MEDICAL ASSISTANCE.
(a) Making Provision Permanent.--
(1) In general.--Subsection (f) of section 1925 (42 U.S.C.
1396r-6) is repealed.
(2) Conforming amendment.--Section 1902(e)(1) (42 U.S.C.
1396a(e)(1)) is repealed.
(b) State Option of Initial 12-Month Eligibility.--Section 1925 (42
U.S.C. 1396r-6) is amended--
(1) in subsection (a), by adding at the end the following
new paragraph:
``(5) Option of 12-month initial eligibility period.--A
State may elect to treat any reference in this subsection to a
6-month period (or 6 months) as a reference to a 12-month
period (or 12 months). In the case of such an election,
subsection (b) shall not apply.''; and
(2) in subsection (b)(1), by inserting ``and subsection
(a)(5)'' after ``paragraph (3)''.
(c) Simplification Options.--
(1) Removal of administrative reporting requirements for
additional 6-month extension.--Section 1925(b) (42 U.S.C.
1396r-6(b)) is amended--
(A) in paragraph (2)--
(i) in the heading, by striking ``and
reporting'';
(ii) by striking subparagraph (B);
(iii) in subparagraph (A)(i)--
(I) by striking ``(I)'' and all
that follows through ``(II)'' and
inserting ``(i)'';
(II) by striking ``, and (III)''
and inserting ``and (ii)''; and
(III) by redesignating such
subparagraph as subparagraph (A) (with
appropriate indentation); and
(iv) in subparagraph (A)(ii)--
(I) by striking ``notify the family
of the reporting requirement under
subparagraph (B)(ii) and a statement
of'' and inserting ``provide the family
with notification of''; and
(II) by redesignating such
subparagraph as subparagraph (B) (with
appropriate indentation);
(B) in paragraph (3)(A)--
(i) in clause (iii)--
(I) in the heading, by striking
``reporting and test'';
(II) by striking subclause (I); and
(III) by redesignating subclauses
(II) and (III) as subclauses (I) and
(II), respectively; and
(ii) by striking the last 3 sentences; and
(C) in paragraph (3)(B), by striking ``subparagraph
(A)(iii)(II)'' and inserting ``subparagraph
(A)(iii)(I)''.
(2) Exemption for states covering needy families up to 185
percent of poverty.--Section 1925 (42 U.S.C. 1396r-6), as
amended by subsection (a), is amended--
(A) in each of subsections (a)(1) and (b)(1), by
inserting ``but subject to subsection (f),'' after
``Notwithstanding any other provision of this title,'';
and
(B) by adding at the end the following new
subsection:
``(f) Exemption for State Covering Needy Families Up to 185 Percent
of Poverty.--At State option, the provisions of this section shall not
apply to a State that uses the authority under section 1931(b)(2)(C) to
make medical assistance available under the State plan under this
title, at a minimum, to all individuals described in section 1931(b)(1)
in families with gross incomes (determined without regard to work-
related child care expenses of such individuals) at or below 185
percent of the income official poverty line (as defined by the Office
of Management and Budget, and revised annually in accordance with
section 673(2) of the Omnibus Budget Reconciliation Act of 1981)
applicable to a family of the size involved.''.
(3) State option to elect shorter period for requirement
for receipt of medical assistance as a condition of eligibility
for transitional medical assistance.--Section 1925(a)(1) (42
U.S.C. 1396r-6(a)(1)) is amended by inserting ``(or such
shorter period as the State may elect)'' after ``3''.
(d) Application of Notice of Eligibility to All Families Leaving
Welfare.--Section 1925(a) (42 U.S.C. 1396r-6(a)), as amended by
subsection (b)(1), is amended by adding at the end the following new
paragraph:
``(6) Notice of eligibility for medical assistance to all
families leaving tanf.--Each State shall notify each family
which was receiving assistance under the State program funded
under part A of title IV and which is no longer eligible for
such assistance, of the potential eligibility of the family and
any individual members of such family for medical assistance under this
title or child health assistance under title XXI. Such notice shall
include a statement that the family does not have to be receiving
assistance under the State program funded under part A of title IV in
order to be eligible for such medical assistance or child health
assistance.''.
(e) Enrollment Data.--Section 1925 (42 U.S.C. 1396r-6), as amended
by subsection (c)(2)(B), is amended by adding at the end the following
new subsection:
``(g) Enrollment Data.--The Secretary annually shall obtain from
each State with a State plan approved under this title enrollment data
regarding--
``(1) the number of adults and children who--
``(A) receive medical assistance under this title
based on eligibility under section 1931;
``(B) at the time they were first determined to be
eligible for such medical assistance, also received
cash assistance under the State program funded under
part A of title IV; and
``(C) subsequently ceased to receive assistance
under such State program due to increased earnings or
increased child support income;
``(2) the percentage of the adults and children described
in paragraph (1) who receive transitional medical assistance
under this section or otherwise remain enrolled in the program
under this title; and
``(3) the percentage of such adults and children that
receive such transitional medical assistance for more than 6
months or that remain enrolled in the program under this title
for more than 6 months after such adults or children ceased to
receive assistance under the State program funded under part A
of title IV.''.
(f) Effective Date.--The amendments made by this section take
effect on October 1, 2000.
SEC. 703. APPLICATION OF SIMPLIFIED SCHIP PROCEDURES UNDER THE MEDICAID
PROGRAM.
(a) Coordination With Medicaid.--
(1) In general.--Section 1902(l) (42 U.S.C. 1396a(l)) is
amended--
(A) in paragraph (3), by inserting ``subject to
paragraph (5)'', after ``Notwithstanding subsection
(a)(17),''; and
(B) by adding at the end the following new
paragraph:
``(5) With respect to determining the eligibility of individuals
under 19 years of age for medical assistance under subsection
(a)(10)(A)(i)(IV), (a)(10)(A)(i)(VI), (a)(10)(A)(i)(VII),
(a)(10)(A)(ii)(IX), or (a)(10)(A)(ii)(XIV), notwithstanding any other
provision of this title, if the State has established a State child
health plan under title XXI, or expanded coverage beyond the income
eligibility standards required for such individuals under this title
under a waiver granted under section 1115--
``(A) the State may not apply a resource standard if the
State does not apply such a standard under such child health
plan or section 1115 waiver with respect to such individuals;
``(B) the State shall use the same simplified eligibility
form (including, if applicable, permitting application other
than in person) as the State uses under such State child health
plan or section 1115 waiver with respect to such individuals;
``(C) the State shall provide for initial eligibility
determinations and redeterminations of eligibility using the
same verification policies, forms, and frequency as the State
uses for such purposes under such State child health plan or
section 1115 waiver with respect to such individuals; and
``(D) the State shall not require a face-to-face interview
for purposes of initial eligibility determinations and
redeterminations unless the State required such an interview
for such purposes under such child health plan or section 1115
waiver with respect to such individuals.''.
(2) Effective date.--The amendments made by paragraph (1)
take effect on October 1, 2000, and apply to eligibility
determinations and redeterminations made on or after such date.
(b) Automatic Reassessment of Eligibility for Title XXI and
Medicaid Benefits for Children Losing Medicaid or Title XXI
Eligibility.--
(1) Loss of medicaid eligibility.--Section 1902(a) of the
Social Security Act (42 U.S.C. 1396a(a)) is amended--
(A) by striking the period at the end of paragraph
(65) and inserting ``; and'', and
(B) by inserting after paragraph (65) the following
new paragraph:
``(66) provide, by not later than the first day of the
first month that begins more than 1 year after the date of the
enactment of this paragraph and in the case of a State with a
State child health plan under title XXI, that before medical
assistance to a child (or a parent of a child) is discontinued
under this title, a determination of whether the child (or
parent) is eligible for benefits under title XXI shall be made
and, if determined to be so eligible, the child (or parent)
shall be automatically enrolled in the program under such title
without the need for a new application and without being asked
to provide any information that is already available to the
State.''.
(2) Loss of title xxi eligibility.--Section 2102(b)(3) (42
U.S.C. 1397bb(b)(3)) is amended by redesignating subparagraphs
(D) and (E) as subparagraphs (E) and (F), respectively, and by
inserting after subparagraph (C) the following new
subparagraph:
``(D) that before health assistance to a child (or
a parent of a child) is discontinued under this title,
a determination of whether the child (or parent) is
eligible for benefits under title XIX is made and, if
determined to be so eligible, the child (or parent) is
automatically enrolled in the program under such title
without the need for a new application and without
being asked to provide any information that is already
available to the State;''.
(3) Effective date.--The amendments made by paragraphs (1)
and (2) apply to individuals who lose eligibility under the
medicaid program under title XIX, or under a State child health
insurance plan under title XXI, respectively, of the Social Security
Act (42 U.S.C. 1396 et seq.; 1397aa et seq.) on or after the date that
is 60 days after the date of the enactment of this Act.
SEC. 704. PRESUMPTIVE ELIGIBILITY.
(a) Additional Entities Qualified To Determine Presumptive
Eligibility for Low-Income Children.--
(1) Medicaid.--Section 1920A(b)(3)(A)(i) (42 U.S.C. 1396r-
1a(b)(3)(A)(i)) is amended--
(A) by striking ``or (II)'' and inserting ``,
(II)''; and
(B) by inserting ``eligibility of a child for
medical assistance under the State plan under this
title, or eligibility of a child for child health
assistance under the program funded under title XXI,
(III) is an elementary school or secondary school, as
such terms are defined in section 14101 of the
Elementary and Secondary Education Act of 1965 (20
U.S.C. 8801), an elementary or secondary school
operated or supported by the Bureau of Indian Affairs,
a State child support enforcement agency, a child care
resource and referral agency, an organization that is
providing emergency food and shelter under a grant
under the Stewart B. McKinney Homeless Assistance Act,
or a State office or entity involved in enrollment in
the program under this title, under part A of title IV,
under title XXI, or that determines eligibility for any
assistance or benefits provided under any program of
public or assisted housing that receives Federal funds,
including the program under section 8 or any other
section of the United States Housing Act of 1937 (42
U.S.C. 1437 et seq.), or (IV) any other entity the
State so deems, as approved by the Secretary'' before
the semicolon.
(2) Application under schip.--
(A) In general.--Section 2107(e)(1) (42 U.S.C.
1397gg(e)(1)) is amended by adding at the end the
following new subparagraph:
``(D) Section 1920A (relating to presumptive
eligibility).''.
(B) Exception from limitation on administrative
expenses.--Section 2105(c)(2) (42 U.S.C. 1397ee(c)(2))
is amended by adding at the end the following new
subparagraph:
``(C) Exception for presumptive eligibility
expenditures.--The limitation under subparagraph (A) on
expenditures shall not apply to expenditures
attributable to the application of section 1920A
(pursuant to section 2107(e)(1)(D)), regardless of
whether the child is determined to be ineligible for
the program under this title or title XIX.''.
(3) Technical amendments.--Section 1920A (42 U.S.C. 1396r-
1a) is amended--
(A) in subsection (b)(3)(A)(ii), by striking
``paragraph (1)(A)'' and inserting ``paragraph
(2)(A)''; and
(B) in subsection (c)(2), in the matter preceding
subparagraph (A), by striking ``subsection (b)(1)(A)''
and inserting ``subsection (b)(2)(A)''.
(b) Elimination of SCHIP Funding Offset for Exercise of Presumptive
Eligibility Option.--
(1) In general.--Section 2104(d) (42 U.S.C. 1397dd(d)) is
amended by striking ``the sum of--'' and all that follows
through ``(2)'' and conforming the margins of all that remains
accordingly.
(2) Effective date.--The amendment made by paragraph (1)
takes effect October 1, 2000, and applies to allotments under
title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.)
for fiscal year 2001 and each succeeding fiscal year
thereafter.
SEC. 705. IMPROVEMENTS TO THE MATERNAL AND CHILD HEALTH SERVICES BLOCK
GRANT.
(a) Increase in Authorization of Appropriations.--Section 501(a)
(42 U.S.C. 701(a)) is amended in the matter preceding paragraph (1) by
striking ``$705,000,000 for fiscal year 1994'' and inserting
``$1,000,000,000 for fiscal year 2001''.
(b) Coordination With Medicaid and SCHIP.--
(1) Schip.--Section 505(a)(5)(F) (42 U.S.C. 705(a)(5)(F))
is amended--
(A) in clause (ii), by inserting ``and in the
coordination of the administration of the State program
under title XXI with the care and services available
under this title, as required under subsections
(b)(3)(G) and (c)(2) of section 2102'' before the
comma; and
(B) in clause (iv), by striking ``and infants who
are eligible for medical assistance under subparagraph
(A) or (B) of section 1902(l)(1)'' and inserting ``,
infants, and children who are eligible for medical
assistance under section 1902(l)(1), and children who
are eligible for child health assistance under the
State program under title XXI''.
(2) Conforming amendments to schip.--Section 2102(b)(3) (42
U.S.C. 1397bb(b)(3)), as amended by section 703(b)(2), is
amended--
(A) by striking ``and'' at the end of subparagraph
(E);
(B) by striking the period at the end of
subparagraph (F) and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(G) that operations and activities under this
title are developed and implemented in consultation and
coordination with the program operated by the State
under title V with respect to outreach and enrollment,
benefits and services, service delivery standards,
public health and social service agency relationships,
and quality assurance and data reporting.''.
(c) Effective Date.--The amendments made by this section take
effect on October 1, 2000.
SEC. 706. IMPROVING ACCESS TO MEDICARE COST-SHARING ASSISTANCE FOR LOW-
INCOME BENEFICIARIES.
(a) Increase in SLMB Eligibility.--
(1) In general.--Section 1902(a)(10)(E) (42 U.S.C.
1396a(a)(10)(E)) is amended--
(A) in clause (iii), by striking ``and 120 percent
in 1995'' and inserting ``, 120 percent in 1995 through
2000, and 135 percent in 2001''; and
(B) in clause (iv), by striking ``2002)--'' and all
that follows through ``(II) for'' and inserting ``2002)
for''.
(2) Conforming amendment.--Section 1933(c)(2)(A) (42 U.S.C.
1396u-3(c)(2)(A)) is amended by striking ``sum of--'' and all
that follows through ``(ii) the''''.
(3) Effective date.--The amendments made by this subsection
take effect on January 1, 2001, and with respect to the
amendment made by paragraph (2), applies to allocations
determined under section 1933(c) of the Social Security Act (42
U.S.C. 1396u-3(c)) for the last 3 quarters of fiscal year 2001
and all of fiscal year 2002.
(b) Index of Assets Test to Inflation.--Section 1905(p)(1)(C) (42
U.S.C. 1396d(p)(1)(C)) is amended by inserting ``, increased (beginning
with 2001 and each year thereafter) by the percentage increase (if any)
in the Consumer Price Index for All Urban Consumers (United States city
average)'' before the period.
(c) Increased Effort To Provide Medicare Beneficiaries With
Medicare Cost-Sharing Under the Medicaid Program.--
(1) In general.--Section 1902(a) (42 U.S.C. 1396a(a)), as
amended by section 703(b)(1)(A), is amended--
(A) in paragraph (65), by striking ``and'' at the
end;
(B) in paragraph (66), by striking the period and
inserting ``; and''; and
(C) by inserting after paragraph (66) the following
new paragraph:
``(67) provide for the determination of eligibility for
medicare cost-sharing (as defined in section 1905(p)(3)) for
individuals described in paragraph (10)(E) and, if eligible for
such medicare cost-sharing, for the enrollment of such
individuals at any hospital, clinic, or similar entity at which
State or local agency personnel are stationed for the purpose
of determining the eligibility of individuals for medical
assistance under the State plan or providing outreach services
to eligible or potentially eligible individuals.''.
(2) Effective date.--The amendments made by this paragraph
shall take effect on the date of enactment of this Act.
(d) Presumptive Eligibility of Certain Low-Income Individuals for
Medicare Cost-Sharing Under the QMB or SLMB Program.--Title XIX (42
U.S.C. 1396 et seq.) is amended by inserting after section 1920A the
following new section:
``presumptive eligibility of certain low-income individuals
``Sec. 1920B. (a) A State plan approved under section 1902 shall
provide for making medical assistance with respect to medicare cost-
sharing covered under the State plan available to a low-income
individual on the date the low-income individual becomes entitled to
benefits under part A of title XVIII during a presumptive eligibility
period.
``(b) For purposes of this section:
``(1) The term `low-income individual' means an individual
who at the age of 65 years is described--
``(A) in section 1902(a)(10)(E)(i), or
``(B) in section 1902(a)(10)(E)(iii).
``(2) The term `medicare cost-sharing'--
``(A) with respect to an individual described in
paragraph (1)(A), has the meaning given such term in
section 1905(p)(3); and
``(B) with respect to an individual described in
paragraph (1)(B), has the meaning given such term in
section 1905(p)(3)(A).
``(3) The term `presumptive eligibility period' means, with
respect to a low-income individual, the period that--
``(A) begins with the date on which a qualified
entity determines, on the basis of preliminary
information, that the income and resources of the
individual do not exceed the applicable income and
resource level of eligibility under the State plan, and
``(B) ends with (and includes) the earlier of--
``(i) the day on which a determination is
made with respect to the eligibility of the
low-income individual for medical assistance
for medical cost-sharing under the State plan,
or
``(ii) in the case of a low-income
individual on whose behalf an application is
not filed by the last day of the month
following the month during which the entity
makes the determination referred to in
subparagraph (A), such last day.
``(4)(A) Subject to subparagraph (B), the term `qualified
entity' means any of the following:
``(i) Qualified individuals within the Social
Security Administration.
``(ii) An entity determined by the State agency to
be capable of making determinations of the type
described in paragraph (3).
``(B) The Secretary may issue regulations further limiting
those entities that may become qualified entities in order to
prevent fraud and abuse and for other reasons.
``(c)(1) The State agency, after consultation with the Secretary,
shall provide qualified entities with--
``(A) such forms as are necessary for an application to be
made on behalf of a low-income individual for medical
assistance for medical cost-sharing under the State plan, and
``(B) information on how to assist low-income individuals
and other persons in completing and filing such forms.
``(2) A qualified entity that determines under subsection (b)(2)(A)
that a low-income individual is presumptively eligible for medical
assistance for medical cost-sharing under a State plan shall--
``(A) notify the State agency of the determination within 5
working days after the date on which the determination is made,
and
``(B) inform the low-income individual at the time the
determination is made that an application for medical
assistance for medical cost-sharing under the State plan is
required to be made by not later than the last day of the month
following the month during which the determination is made.
``(3) In the case of a low-income individual who is determined by a
qualified entity to be presumptively eligible for medical assistance
for medical cost-sharing under a State plan, the low-income individual
shall make application for medical assistance for medical cost-sharing
under such plan by not later than the last day of the month following
the month during which the determination is made.
``(d) Notwithstanding any other provision of this title, medical
assistance for medicare cost-sharing that--
``(1) is furnished to a low-income individual during a
presumptive eligibility period under the State plan; and
``(2) is included in the services covered by a State plan;
shall be treated as medical assistance provided by such plan for
purposes of section 1903.''.
SEC. 707. BREAST AND CERVICAL CANCER PREVENTION AND TREATMENT.
(a) Coverage as Optional Categorically Needy Group.--
(1) In general.--Section 1902(a)(10)(A)(ii) (42 U.S.C.
1396a(a)(10)(A)(ii)) is amended--
(A) in subclause (XVI), by striking ``or'' at the
end;
(B) in subclause (XVII), by adding ``or'' at the
end; and
(C) by adding at the end the following:
``(XVIII) who are described in
subsection (aa) (relating to certain
breast or cervical cancer patients);''.
(2) Group described.--Section 1902 (42 U.S.C. 1396a) is
amended by adding at the end the following:
``(aa) Individuals described in this subsection are individuals
who--
``(1) are not described in subsection (a)(10)(A)(i);
``(2) have not attained age 65;
``(3) have been screened for breast and cervical cancer
under the Centers for Disease Control and Prevention breast and
cervical cancer early detection program established under title
XV of the Public Health Service Act (42 U.S.C. 300k et seq.) in
accordance with the requirements of section 1504 of that Act
(42 U.S.C. 300n) and need treatment for breast or cervical
cancer; and
``(4) are not otherwise covered under creditable coverage,
as defined in section 2701(c) of the Public Health Service Act
(42 U.S.C. 300gg(c)).''.
(3) Limitation on benefits.--Section 1902(a)(10) (42 U.S.C.
1396a(a)(10)) is amended in the matter following subparagraph
(G)--
(A) by striking ``and (XIII)'' and inserting
``(XIII)''; and
(B) by inserting ``, and (XIV) the medical
assistance made available to an individual described in
subsection (aa) who is eligible for medical assistance
only because of subparagraph (A)(10)(ii)(XVIII) shall
be limited to medical assistance provided during the
period in which such an individual requires treatment
for breast or cervical cancer'' before the semicolon.
(4) Conforming amendments.--Section 1905(a) (42 U.S.C.
1396d(a)) is amended in the matter preceding paragraph (1)--
(A) in clause (xi), by striking ``or'' at the end;
(B) in clause (xii), by adding ``or'' at the end;
and
(C) by inserting after clause (xii) the following:
``(xiii) individuals described in section 1902(aa),''.
(b) Presumptive Eligibility.--
(1) In general.--Title XIX (42 U.S.C. 1396 et seq.) is
amended by inserting after section 1920A the following:
``presumptive eligibility for certain breast or cervical cancer
patients
``Sec. 1920B. (a) State Option.--A State plan approved under
section 1902 may provide for making medical assistance available to an
individual described in section 1902(aa) (relating to certain breast or
cervical cancer patients) during a presumptive eligibility period.
``(b) Definitions.--For purposes of this section:
``(1) Presumptive eligibility period.--The term
`presumptive eligibility period' means, with respect to an
individual described in subsection (a), the period that--
``(A) begins with the date on which a qualified
entity determines, on the basis of preliminary
information, that the individual is described in
section 1902(aa); and
``(B) ends with (and includes) the earlier of--
``(i) the day on which a determination is
made with respect to the eligibility of such
individual for services under the State plan;
or
``(ii) in the case of such an individual
who does not file an application by the last
day of the month following the month during
which the entity makes the determination
referred to in subparagraph (A), such last day.
``(2) Qualified entity.--
``(A) In general.--Subject to subparagraph (B), the
term `qualified entity' means any entity that--
``(i) is eligible for payments under a
State plan approved under this title; and
``(ii) is determined by the State agency to
be capable of making determinations of the type
described in paragraph (1)(A).
``(B) Regulations.--The Secretary may issue
regulations further limiting those entities that may
become qualified entities in order to prevent fraud and
abuse and for other reasons.
``(C) Rule of construction.--Nothing in this
paragraph shall be construed as preventing a State from
limiting the classes of entities that may become
qualified entities, consistent with any limitations
imposed under subparagraph (B).
``(c) Administration.--
``(1) In general.--The State agency shall provide qualified
entities with--
``(A) such forms as are necessary for an
application to be made by an individual described in
subsection (a) for medical assistance under the State
plan; and
``(B) information on how to assist such individuals
in completing and filing such forms.
``(2) Notification requirements.--A qualified entity that
determines under subsection (b)(1)(A) that an individual
described in subsection (a) is presumptively eligible for
medical assistance under a State plan shall--
``(A) notify the State agency of the determination
within 5 working days after the date on which the
determination is made; and
``(B) inform such individual at the time the
determination is made that an application for medical
assistance under the State plan is required to be made
by not later than the last day of the month following
the month during which the determination is made.
``(3) Application for medical assistance.--In the case of
an individual described in subsection (a) who is determined by
a qualified entity to be presumptively eligible for medical
assistance under a State plan, the individual shall apply for
medical assistance under such plan by not later than the last
day of the month following the month during which the
determination is made.
``(d) Payment.--Notwithstanding any other provision of this title,
medical assistance that--
``(1) is furnished to an individual described in subsection
(a)--
``(A) during a presumptive eligibility period; and
``(B) by a entity that is eligible for payments
under the State plan; and
``(2) is included in the care and services covered by the
State plan,
shall be treated as medical assistance provided by such plan for
purposes of clause (4) of the first sentence of section 1905(b).''.
(2) Conforming amendments.--
(A) Section 1902(a)(47) (42 U.S.C. 1396a(a)(47)) is
amended by inserting before the semicolon at the end
the following: ``and provide for making medical
assistance available to individuals described in
subsection (a) of section 1920B during a presumptive
eligibility period in accordance with such section''.
(B) Section 1903(u)(1)(D)(v) (42 U.S.C.
1396b(u)(1)(D)(v)) is amended--
(i) by striking ``or for'' and inserting
``, for''; and
(ii) by inserting before the period the
following: ``, or for medical assistance
provided to an individual described in
subsection (a) of section 1920B during a
presumptive eligibility period under such
section''.
(c) Enhanced Match.--The first sentence of section 1905(b) (42
U.S.C. 1396d(b)) is amended--
(1) by striking ``and'' before ``(3)''; and
(2) by inserting before the period at the end the
following: ``, and (4) the Federal medical assistance
percentage shall be equal to the enhanced FMAP described in
section 2105(b) with respect to medical assistance provided to
individuals who are eligible for such assistance only on the
basis of section 1902(a)(10)(A)(ii)(XVIII)''.
(d) Effective Date.--The amendments made by this section apply to
medical assistance for items and services furnished on or after October
1, 2000, without regard to whether final regulations to carry out such
amendments have been promulgated by such date.
SEC. 708. MEDICAID COVERAGE OF SERVICES FURNISHED BY CERTIFIED NURSE
PRACTITIONERS AND CLINICAL NURSE SPECIALISTS.
(a) In General.--Section 1905(a)(21) (42 U.S.C. 1396d(a)(21)) is
amended to read as follows:
``(21) services furnished by a certified nurse practitioner
(as defined by the Secretary) or a clinical nurse specialist
(as defined in subsection (x) which the certified nurse
practitioner or clinical nurse specialist is legally authorized
to perform under State law (or the State regulatory mechanism
provided by State law), whether or not the certified nurse
practitioner or clinical nurse specialist is under the
supervision of, or associated with, a physician or other health
care provider;''.
(b) Definition of Clinical Nurse Specialist.--Section 1905 of such
Act (42 U.S.C. 1396d) is amended by adding at the end the following new
subsection:
``(x) The term `clinical nurse specialist' means an individual who
has earned a master's degree in a clinical area of nursing from an
accredited institution and who is a registered nurse licensed to
practice nursing in the State in which the individual furnishes
services.''.
(c) Effective Date.--The amendments made by subsections (a) and (b)
apply to calendar quarters beginning on or after October 1, 2000,
without regard to whether or not final regulations to carry out such
amendments have been promulgated by such date.
TITLE VIII--OTHER PROVISIONS
SEC. 801. APPROPRIATIONS FOR RICKY RAY HEMOPHILIA RELIEF FUND.
Section 101(e) of the Ricky Ray Hemophilia Relief Fund Act of 1998
(42 U.S.C. 300c-22 note) is amended by adding at the end the following:
``There is appropriated to the Fund $475,000,000 for fiscal year 2001,
to remain available until expended.''.
SEC. 802. INCREASE IN APPROPRIATIONS FOR SPECIAL DIABETES PROGRAMS FOR
CHILDREN WITH TYPE I DIABETES AND INDIANS.
(a) Special Diabetes Programs for Children With Type I Diabetes.--
Section 330B(b) of the Public Health Service Act (42 U.S.C. 254c-2(b))
is amended--
(1) by striking ``Notwithstanding'' and inserting the
following:
``(1) Transferred funds.--Notwithstanding''; and
(2) by adding at the end the following:
``(2) Appropriations.--For the purpose of making grants
under this section, there are appropriated, out of any money in
the Treasury not otherwise appropriated--
``(A) $70,000,000 for each of fiscal years 2001 and
2002 (which shall be combined with amounts transferred
under paragraph (1) for each such fiscal years); and
``(B) $100,000,000 for each of fiscal years 2003
through 2005.''.
(b) Special Diabetes Programs for Indians.--Section 330C(c) of the
Public Health Service Act (42 U.S.C. 254c-3(c)) is amended--
(1) by striking ``Notwithstanding'' and inserting the
following:
``(1) Transferred funds.--Notwithstanding'';
(2) by adding at the end the following:
``(2) Appropriations.--For the purpose of making grants
under this section, there are appropriated, out of any money in
the Treasury not otherwise appropriated--
``(A) $70,000,000 for each of fiscal years 2001 and
2002 (which shall be combined with amounts transferred
under paragraph (1) for each such fiscal years); and
``(B) $100,000,000 for each of fiscal years 2003
through 2005.''.
SEC. 803. DEMONSTRATION GRANTS TO IMPROVE OUTREACH, ENROLLMENT, AND
COORDINATION OF PROGRAMS AND SERVICES TO HOMELESS
INDIVIDUALS AND FAMILIES.
(a) Authority.--The Secretary of Health and Human Services may
award demonstration grants to not more than 7 States (or other
qualified entities) to conduct innovative programs that are designed to
improve outreach to homeless individuals and families under the
programs described in subsection (b) with respect to enrollment of such
individuals and families under such programs and the provision of
services (and coordinating the provision of such services) under such
programs.
(b) Programs for Homeless Described.--The programs described in
this subsection are as follows:
(1) Medicaid.--The program under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(2) SCHIP.--The program under title XXI of such Act (42
U.S.C. 1397aa et seq.).
(3) TANF.--The program under part of A of title IV of such
Act (42 U.S.C. 601 et seq.).
(4) Maternal and child health block grants.--The program
under title V of the Social Security Act (42 U.S.C. 701 et
seq.).
(5) Mental health and substance abuse block grants.--The
program under part B of title XIX of the Public Health Service
Act (42 U.S.C. 300x-1 et seq.).
(6) HIV/AIDS care grants.--The program under part B of
title XXVI of the Public Health Service Act (42 U.S.C. 300ff-21
et seq.).
(7) Food stamp program.--The program under the Food Stamp
Act of 1977 (7 U.S.C. 2011 et seq.).
(8) Workforce investment act.--The program under the
Workforce Investment Act of 1999 (29 U.S.C. 2801 et seq.).
(9) Welfare-to-work.--The welfare-to-work program under
section 403(a)(5) of the Social Security Act (42 U.S.C.
603(a)(5)).
(10) Other programs.--Other public and private benefit
programs that serve low-income individuals.
(c) Appropriations.--For the purposes of carrying out this section,
there are appropriated, out of any funds in the Treasury not otherwise
appropriated, $10,000,000, to remain available until expended.
SEC. 804. PROTECTION OF AN HMO ENROLLEE TO RECEIVE CONTINUING CARE AT A
FACILITY SELECTED BY THE ENROLLEE.
(a) Amendments to the Employee Retirement Income Security Act of
1974.--
(1) In general.--Subpart B of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1185 et seq.) is amended by adding at the end the
following new section:
``SEC. 714. ENSURING CHOICE FOR CONTINUING CARE.
``(a) In General.--With respect to health insurance coverage
provided to participants or beneficiaries through a managed care
organization under a group health plan, or through a health insurance
issuer providing health insurance coverage in connection with a group
health plan, such plan or issuer may not deny coverage for services
provided to such participant or beneficiary by a continuing care
retirement community, skilled nursing facility, or other qualified
facility in which the participant or beneficiary resided prior to a
hospitalization, regardless of whether such organization is under
contract with such community or facility if the requirements described
in subsection (b) are met.
``(b) Requirements.--The requirements of this subsection are that--
``(1) the service involved is a service for which the
managed care organization involved would be required to provide
or pay for under its contract with the participant or
beneficiary if the continuing care retirement community,
skilled nursing facility, or other qualified facility were
under contract with the organization;
``(2) the participant or beneficiary involved--
``(A) resided in the continuing care retirement
community, skilled nursing facility, or other qualified
facility prior to being hospitalized;
``(B) had a contractual or other right to return to
the facility after hospitalization; and
``(C) elects to return to the facility after
hospitalization, whether or not the residence of the
participant or beneficiary after returning from the
hospital is the same part of the facility in which the
beneficiary resided prior to hospitalization;
``(3) the continuing care retirement community, skilled
nursing facility, or other qualified facility has the capacity
to provide the services the participant or beneficiary needs;
and
``(4) the continuing care retirement community, skilled
nursing facility, or other qualified facility is willing to
accept substantially similar payment under the same terms and
conditions that apply to similarly situated health care
facility providers under contract with the organization
involved.
``(c) Services To Prevent Hospitalization.--A group health plan or
health insurance issuer to which this section applies may not deny
payment for a skilled nursing service provided to a participant or
beneficiary by a continuing care retirement community, skilled nursing
facility, or other qualified facility in which the participant or
beneficiary resides, without a preceding hospital stay, regardless of
whether the organization is under contract with such community or
facility, if--
``(1) the plan or issuer has determined that the service is
necessary to prevent the hospitalization of the participant or
beneficiary; and
``(2) the service to prevent hospitalization is provided as
an additional benefit as described in section 417.594 of title
42, Code of Federal Regulations, and would otherwise be covered
as provided for in subsection (b)(1).
``(d) Rights of Spouses.--A group health plan or health insurance
issuer to which this section applies shall not deny payment for
services provided by a skilled nursing facility for the care of a
participant or beneficiary, regardless of whether the plan or issuer is
under contract with such facility, if the spouse of the participant or
beneficiary is already a resident of such facility and the requirements
described in subsection (b) are met.
``(e) Exceptions.--Subsection (a) shall not apply--
``(1) where the attending acute care provider and the
participant or beneficiary (or a designated representative of
the participant or beneficiary where the participant or
beneficiary is physically or mentally incapable of making an
election under this paragraph) do not elect to pursue a course
of treatment necessitating continuing care; or
``(2) unless the community or facility involved--
``(A) meets all applicable licensing and
certification requirements of the State in which it is
located; and
``(B) agrees to reimbursement for the care of the
participant or beneficiary at a rate similar to the
rate negotiated by the managed care organization with
similar providers of care for similar services.
``(f) Prohibitions.--A group health plan and a health insurance
issuer providing health insurance coverage in connection with a group
health plan may not--
``(1) deny to an individual eligibility, or continued
eligibility, to enroll or to renew coverage with a managed care
organization under the plan, solely for the purpose of avoiding
the requirements of this section;
``(2) provide monetary payments or rebates to enrollees to
encourage such enrollees to accept less than the minimum
protections available under this section;
``(3) penalize or otherwise reduce or limit the
reimbursement of an attending physician because such physician
provided care to a participant or beneficiary in accordance
with this section; or
``(4) provide incentives (monetary or otherwise) to an
attending physician to induce such physician to provide care to
a participant or beneficiary in a manner inconsistent with this
section.
``(g) Rules of Construction.--
``(1) HMO not offering benefits.--This section shall not
apply with respect to any managed care organization under a
group health plan, or through a health insurance issuer
providing health insurance coverage in connection with a group
health plan, that does not provide benefits for stays in a
continuing care retirement community, skilled nursing facility,
or other qualified facility.
``(2) Cost-sharing.--Nothing in this section shall be
construed as preventing a managed care organization under a
group health plan, or through a health insurance issuer
providing health insurance coverage in connection with a group
health plan, from imposing deductibles, coinsurance, or other
cost-sharing in relation to benefits for care in a continuing
care facility.
``(h) Preemption; Exception for Health Insurance Coverage in
Certain States.--
``(1) In general.--The requirements of this section shall
not apply with respect to health insurance coverage to the
extent that a State law (as defined in section 2723(d)(1) of
the Public Health Service Act) applies to such coverage and is
described in any of the following subparagraphs:
``(A) Such State law requires such coverage to
provide for referral to a continuing care retirement
community, skilled nursing facility, or other qualified
facility in a manner that is more protective of
participants or beneficiaries than the provisions of
this section.
``(B) Such State law expands the range of services
or facilities covered under this section and is
otherwise more protective of the rights of participants
or beneficiaries than the provisions of this section.
``(2) Construction.--Section 731(a)(1) shall not be
construed to provide that any requirement of this section
applies with respect to health insurance coverage, to the extent that a
State law described in paragraph (1) applies to such coverage.
``(i) Penalties.--A participant or beneficiary may enforce the
provisions of this section in an appropriate Federal district court. An
action for injunctive relief or damages may be commenced on behalf of
the participant or beneficiary by the participant's or beneficiary's
legal representative. The court may award reasonable attorneys' fees to
the prevailing party. If a beneficiary dies before conclusion of an
action under this section, the action may be maintained by a
representative of the participant's or beneficiary's estate.
``(j) Definitions.--In this section:
``(1) Attending acute care provider.--The term `attending
acute care provider' means anyone licensed or certified under
State law to provide health care services who is operating
within the scope of such license and who is primarily
responsible for the care of the enrollee.
``(2) Continuing care retirement community.--The term
`continuing care retirement community' means an organization
that provides or arranges for the provision of housing and
health-related services to an older person under an agreement
effective for the life of the person or for a specified period
greater than 1 year.
``(3) Managed care organization.--The term `managed care
organization' means an organization that provides comprehensive
health services to participants or beneficiaries, directly or
under contract or other agreement, on a prepayment basis to
such individuals. For purposes of this section, the following
shall be considered as managed care organizations:
``(A) A Medicare+Choice plan authorized under
section 1851(a) of the Social Security Act (42 U.S.C.
1395w-21(a)).
``(B) Any other entity that manages the cost,
utilization, and delivery of health care through the
use of predetermined periodic payments to health care
providers employed by or under contract or other
agreement, directly or indirectly, with the entity.
``(4) Other qualified facility.--The term `other qualified
facility' means any facility that can provide the services
required by the participant or beneficiary consistent with
State and Federal law.
``(5) Skilled nursing facility.--The term `skilled nursing
facility' means a facility that meets the requirements of
section 1819 of the Social Security Act (42 U.S.C. 1395i-3).''.
(2) Clerical amendment.--The table of contents in section 1
of the Employee Retirement Income Security Act of 1974 is
amended by inserting after the items relating to subpart B of
part 7 of subtitle B of title I the following new item:
``Sec. 714. Ensuring choice for continuing care.''.
(3) Effective date.--The amendments made by this section
shall apply with respect to plan years beginning on or after
January 1, 2001.
(b) Amendment to the Public Health Service Act Relating to the
Group Market.--
(1) In general.--Subpart 2 of part A of title XXVII of the
Public Health Service Act (42 U.S.C. 300gg-4 et seq.) is
amended by adding at the end the following new section:
``SEC. 2707. ENSURING CHOICE FOR CONTINUING CARE.
``(a) In General.--With respect to health insurance coverage
provided to enrollees through a managed care organization under a group
health plan, or through a health insurance issuer providing health
insurance coverage in connection with a group health plan, such plan or
issuer may not deny coverage for services provided to such enrollee by
a continuing care retirement community, skilled nursing facility, or
other qualified facility in which the enrollee resided prior to a
hospitalization, regardless of whether such organization is under
contract with such community or facility if the requirements described
in subsection (b) are met.
``(b) Requirements.--The requirements of this subsection are that--
``(1) the service involved is a service for which the
managed care organization involved would be required to provide
or pay for under its contract with the enrollee if the
continuing care retirement community, skilled nursing facility,
or other qualified facility were under contract with the
organization;
``(2) the enrollee involved--
``(A) resided in the continuing care retirement
community, skilled nursing facility, or other qualified
facility prior to being hospitalized;
``(B) had a contractual or other right to return to
the facility after hospitalization; and
``(C) elects to return to the facility after
hospitalization, whether or not the residence of the
enrollee after returning from the hospital is the same
part of the facility in which the beneficiary resided
prior to hospitalization;
``(3) the continuing care retirement community, skilled
nursing facility, or other qualified facility has the capacity
to provide the services the enrollee needs; and
``(4) the continuing care retirement community, skilled
nursing facility, or other qualified facility is willing to
accept substantially similar payment under the same terms and
conditions that apply to similarly situated health care
facility providers under contract with the organization
involved.
``(c) Services To Prevent Hospitalization.--A group health plan or
health insurance issuer to which this section applies may not deny
payment for a skilled nursing service provided to an enrollee by a
continuing care retirement community, skilled nursing facility, or
other qualified facility in which the enrollee resides, without a
preceding hospital stay, regardless of whether the plan or issuer is
under contract with such community or facility, if--
``(1) the plan or issuer has determined that the service is
necessary to prevent the hospitalization of the enrollee; and
``(2) the service to prevent hospitalization is provided as
an additional benefit as described in section 417.594 of title
42, Code of Federal Regulations, and would be covered as
provided for in subsection (b)(1).
``(d) Rights of Spouses.--A group health plan or health insurance
issuer to which this section applies shall not deny payment for
services provided by a skilled nursing facility for the care of an
enrollee, regardless of whether the plan or issuer is under contract
with such facility, if the spouse of the enrollee is already a resident
of such facility and the requirements described in subsection (b) are
met.
``(e) Exceptions.--Subsection (a) shall not apply--
``(1) where the attending acute care provider and the
enrollee (or a designated representative of the enrollee where
the enrollee is physically or mentally incapable of making an
election under this paragraph) do not elect to pursue a course
of treatment necessitating continuing care; or
``(2) unless the community or facility involved--
``(A) meets all applicable licensing and
certification requirements of the State in which it is
located; and
``(B) agrees to reimbursement for the care of the
enrollee at a rate similar to the rate negotiated by
the managed care organization with similar providers of
care for similar services.
``(f) Prohibitions.--A group health plan and a health insurance
issuer providing health insurance coverage in connection with a group
health plan may not--
``(1) deny to an individual eligibility, or continued
eligibility, to enroll or to renew coverage with a managed care
organization under the plan, solely for the purpose of avoiding
the requirements of this section;
``(2) provide monetary payments or rebates to enrollees to
encourage such enrollees to accept less than the minimum
protections available under this section;
``(3) penalize or otherwise reduce or limit the
reimbursement of an attending physician because such physician
provided care to an enrollee in accordance with this section;
or
``(4) provide incentives (monetary or otherwise) to an
attending physician to induce such physician to provide care to
an enrollee in a manner inconsistent with this section.
``(g) Rules of Construction.--
``(1) HMO not offering benefits.--This section shall not
apply with respect to any managed care organization under a
group health plan, or through a health insurance issuer
providing health insurance coverage in connection with a group
health plan, that does not provide benefits for stays in a
continuing care retirement community, skilled nursing facility,
or other qualified facility.
``(2) Cost-sharing.--Nothing in this section shall be
construed as preventing a managed care organization under a
group health plan, or through a health insurance issuer
providing health insurance coverage in connection with a group
health plan, from imposing deductibles, coinsurance, or other
cost-sharing in relation to benefits for care in a continuing
care facility.
``(h) Preemption; Exception for Health Insurance Coverage in
Certain States.--
``(1) In general.--The requirements of this section shall
not apply with respect to health insurance coverage to the
extent that a State law (as defined in section 2723(d)(1))
applies to such coverage and is described in any of the
following subparagraphs:
``(A) Such State law requires such coverage to
provide for referral to a continuing care retirement
community, skilled nursing facility, or other qualified
facility in a manner that is more protective of the
enrollee than the provisions of this section.
``(B) Such State law expands the range of services
or facilities covered under this section and is
otherwise more protective of enrollee rights than the
provisions of this section.
``(2) Construction.--Section 2723(a)(1) shall not be
construed to provide that any requirement of this section
applies with respect to health insurance coverage, to the
extent that a State law described in paragraph (1) applies to
such coverage.
``(i) Penalties.--An enrollee may enforce the provisions of this
section in an appropriate Federal district court. An action for
injunctive relief or damages may be commenced on behalf of the enrollee
by the enrollee's legal representative. The court may award reasonable
attorneys' fees to the prevailing party. If a beneficiary dies before
conclusion of an action under this section, the action may be
maintained by a representative of the enrollee's estate.
``(j) Definitions.--In this section:
``(1) Attending acute care provider.--The term `attending
acute care provider' means anyone licensed or certified under
State law to provide health care services who is operating
within the scope of such license and who is primarily
responsible for the care of the enrollee.
``(2) Continuing care retirement community.--The term
`continuing care retirement community' means an organization
that provides or arranges for the provision of housing and
health-related services to an older person under an agreement
effective for the life of the person or for a specified period
greater than 1 year.
``(3) Managed care organization.--The term `managed care
organization' means an organization that provides comprehensive
health services to enrollees, directly or under contract or
other agreement, on a prepayment basis to such individuals. For
purposes of this section, the following shall be considered as
managed care organizations:
``(A) A Medicare+Choice plan authorized under
section 1851(a) of the Social Security Act (42 U.S.C.
1395w-21(a)).
``(B) Any other entity that manages the cost,
utilization, and delivery of health care through the
use of predetermined periodic payments to health care
providers employed by or under contract or other
agreement, directly or indirectly, with the entity.
``(4) Other qualified facility.--The term `other qualified
facility' means any facility that can provide the services
required by the enrollee consistent with State and Federal law.
``(5) Skilled nursing facility.--The term `skilled nursing
facility' means a facility that meets the requirements of
section 1819 of the Social Security Act (42 U.S.C. 1395i-3).''.
(2) Effective date.--The amendment made by this section
shall apply with respect to group health plans for plan years
beginning on or after January 1, 2001.
(c) Amendments to the Public Health Service Act Relating to the
Individual Market.--
(1) In general.--The first subpart 3 of part B of title
XXVII of the Public Health Service Act (42 U.S.C. 300gg-51 et
seq.) (relating to other requirements) is amended--
(A) by redesignating such subpart as subpart 2; and
(B) by adding at the end the following new section:
``SEC. 2753. ENSURING CHOICE FOR CONTINUING CARE.
``The provisions of section 2707 shall apply to health maintenance
organization coverage offered by a health insurance issuer in the
individual market in the same manner as they apply to such coverage
offered by a health insurance issuer in connection with a group health
plan in the small or large group market.''.
(2) Effective date.--The amendment made by this section
shall apply with respect to health insurance coverage offered,
sold, issued, renewed, in effect, or operated in the individual
market on or after January 1, 2001.
SEC. 805. GRANTS TO DEVELOP AND ESTABLISH REAL CHOICE SYSTEMS CHANGE
INITIATIVES.
(a) Establishment.--
(1) In general.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall award
grants described in subsection (b) to States to support real
choice systems change initiatives that establish specific
action steps and specific timetables to achieve enduring system
improvements and to provide consumer-responsive long-term
services and supports to eligible individuals in the most
integrated setting appropriate based on the unique strengths
and needs of the individual, the priorities and concerns of the
individual (or, as appropriate, the individual's
representative), and the individual's desires with regard to
participation in community life.
(2) Eligibility.--To be eligible for a grant under this
section, a State shall--
(A) establish a Consumer Task Force in accordance
with subsection (d); and
(B) submit an application at such time, in such
manner, and containing such information as the
Secretary may determine. The application shall be
jointly developed and signed by the designated State
official and the chairperson of such Task Force, acting
on behalf of and at the direction of the Task Force.
(3) Definition of state.--In this section, the term
``State'' means each of the 50 States, the District of
Columbia, Puerto Rico, Guam, the United States Virgin Islands,
American Samoa, and the Commonwealth of the Northern Mariana
Islands.
(b) Grants for Real Choice Systems Change Initiatives.--
(1) In general.--From funds appropriated under subsection
(f), the Secretary shall award grants to States to--
(A) support the establishment, implementation, and
operation of the State real choice systems change
initiatives described in subsection (a); and
(B) conduct outreach campaigns regarding the
existence of such initiatives.
(2) Determination of awards; state allotments.--The
Secretary shall develop a formula for the distribution of funds
to States for each fiscal year under subsection (a). Such
formula shall give preference to States that have a higher need
for assistance, as determined by the Secretary, based on
indicators such as a relatively higher proportion of long-term
services and supports furnished to individuals in an
institutional setting but who have a plan described in an
application submitted under subsection (a)(2).
(c) Authorized Activities.--A State that receives a grant under
this section shall use the funds made available through the grant to
accomplish the purposes described in subsection (a) and, in
accomplishing such purposes, may carry out any of the following systems
change activities:
(1) Needs assessment and data gathering.--The State may use
funds to conduct a statewide needs assessment that may be based
on data in existence on the date on which the assessment is
initiated and may include information about the number of
individuals within the State who are receiving long-term
services and supports in unnecessarily segregated settings, the
nature and extent to which current programs respond to the
preferences of individuals with disabilities to receive
services in home and community-based settings as well as in
institutional settings, and the expected change in demand for
services provided in home and community settings as well as
institutional settings.
(2) Institutional bias: remedies and promotion of community
participation.--The State may use funds to identify, develop,
and implement strategies for modifying policies, practices, and
procedures that unnecessarily bias the provision of long-term
services and supports toward institutional settings and away
from home and community-based settings, including policies,
practices, and procedures governing statewideness,
comparability in amount, duration, and scope of services,
financial eligibility, individualized functional assessments
and screenings (including individual and family involvement),
knowledge about service options, and promotion of self-
direction of services and community-integrated living and
service arrangements that facilitate participation in community
life to the fullest extent possible and desired by the
individual.
(3) Over medicalization of services.--The State may use
funds to identify, develop, and implement strategies for
modifying policies, practices, and procedures that
unnecessarily bias the provision of long-term services and
supports by health care professionals to the extent that
quality services and supports can be provided by other
qualified individuals, including policies, practices, and
procedures governing service authorization, case management,
and service coordination, service delivery options, quality
controls, and supervision and training.
(4) Interagency coordination; single point of entry.--The
State may support activities to identify and coordinate Federal
and State policies, resources, and services, relating to the
provision of long-term services and supports, including the
convening of interagency work groups and the entering into of
interagency agreements that provide for a single point of entry
with one-stop access for long-term support services and the
design and implementation of a coordinated screening and
assessment system for all persons eligible for long-term
services and supports.
(5) Training and technical assistance.--The State may carry
out directly, or may provide support to a public or private
entity to carry out training and technical assistance
activities that are provided for individuals with disabilities,
and, as appropriate, their representatives, attendants, and
other personnel (including professionals, paraprofessionals,
volunteers, and other members of the community).
(6) Public awareness.--The State may support a public
awareness program that is designed to provide information
relating to the availability of choices available to
individuals with disabilities for receiving long-term services
and support in the most integrated setting appropriate.
(7) Transitional costs.--The State may use funds to provide
transitional costs such as rent and utility deposits, first
months's rent and utilities, bedding, basic kitchen supplies,
and other necessities required for an individual to make the
transition from an institutional facility to a community-based
home setting where the individual resides.
(8) Task force.--The State may use funds to support the
operation of the Consumer Task Force established under
subsection (d).
(9) Demonstrations of new approaches.--The State may use
funds to conduct, on a time-limited basis, the demonstration of
new approaches to accomplishing the purposes described in
subsection (a)(1).
(10) Improvement in the quality of services and supports.--
The State may use funds to improve the quality of services and
supports provided to individuals with disabilities and their
families.
(11) Other activities.--The State may use funds for any
systems change activities that are not described in any of the
preceding paragraphs of this subsection and that are necessary
for developing, implementing, or evaluating the comprehensive
statewide system of community-integrated long-term services and
supports.
(d) Consumer Task Force.--
(1) Establishment and duties.--To be eligible to receive a
grant under this section, each State shall establish a Consumer
Task Force (referred to in this section as the ``Task Force'')
to assist the State in the development, implementation, and
evaluation of real choice systems change initiatives.
(2) Appointment.--Members of the Task Force shall be
appointed by the Chief Executive Officer of the State in
accordance with the requirements of paragraph (3), after the
solicitation of recommendations from representatives of
organizations representing a broad range of individuals with
disabilities and organizations interested in individuals with
disabilities.
(3) Composition.--
(A) In general.--The Task Force shall represent a
broad range of individuals with disabilities from
diverse backgrounds and shall include representatives
from Developmental Disabilities Councils, Mental Health
Councils, State Independent Living Centers and
Councils, Commissions on Aging, organizations that
provide services to individuals with disabilities and
consumers of long-term services and supports.
(B) Individuals with disabilities.--A majority of
the members of the Task Force shall be individuals with
disabilities or the representatives of such
individuals.
(C) Limitation.--The Task Force shall not include
employees of any State agency providing services to
individuals with disabilities other than employees of
agencies described in the Developmental Disabilities
Assistance and Bill of Rights Act (42 U.S.C. 6000 et
seq.) or the Protection and Advocacy for Mentally Ill
Individuals Act of 1986 (42 U.S.C. 10801 et seq.).
(e) Availability of Funds.--
(1) Funds allotted to states.--Funds allotted to a State
under a grant made under this section for a fiscal year shall
remain available until expended.
(2) Funds not allotted to states.--Funds not allotted to
States in the fiscal year for which they are appropriated shall
remain available in succeeding fiscal years for allotment by
the Secretary using the allotment formula established by the
Secretary under subsection (b)(2).
(f) Annual Report.--A State that receives a grant under this
section shall submit an annual report to the Secretary on the use of
funds provided under the grant. Each report shall include the number
and percentage increase in the number of eligible individuals in the
State who receive long-term services and supports in the most
integrated setting appropriate, including through community attendant
services and supports and other community-based settings.
(g) Funding.--
(1) Fiscal year 2001.--For the purpose of making grants
under this section, there are appropriated, out of any funds in
the Treasury not otherwise appropriated, $50,000,000 for fiscal
year 2001.
(2) Fiscal year 2002 and thereafter.--There is authorized
to be appropriated such sums as may be necessary to carry out
this section for fiscal year 2002 and each fiscal year
thereafter.
<all>
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR E1615-1616)
Referred to the Committee on Commerce, and in addition to the Committees on Ways and Means, Rules, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Commerce, and in addition to the Committees on Ways and Means, Rules, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Commerce, and in addition to the Committees on Ways and Means, Rules, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Commerce, and in addition to the Committees on Ways and Means, Rules, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Commerce, and in addition to the Committees on Ways and Means, Rules, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
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Referred to the Subcommittee on Health and Environment.
Referred to the Subcommittee on Employer-Employee Relations.