Medicare, Medicaid, and SCHIP Adjustment Act of 1999

Medicare, Medicaid, and SCHIP Adjustment Act of 1999 - Title I: Provisions Relating to Part A Only - Subtitle A: Skilled Nursing Facility Services - Provides for an increase in payment for skilled nursing facility services to certain high cost patients under Medicare part A (Hospital Insurance).

(Sec. 102) Amends title XVIII (Medicare) of the Social Security Act (SSA) to provide for part B add-ons for facilities participating in the Nursing Home Case-Mix and Quality Demonstration Project.

(Sec. 103) Provides for the exemption of facilities from the three-year transition period under the prospective payment system (PPS) for skilled nursing facilities.

(Sec. 104) Requires the Secretary of Health and Human Services to study and report to Congress on State licensure and certification standards and respiratory therapy competency examinations.

(Sec. 105) Requires the Secretary to study and report to Congress on State licensure and certification standards and respiratory therapy competency examinations.

Subtitle B: Hospice Services - Amends SSA title XVIII with regard to payment for hospice care.

(Sec. 122) Directs the Comptroller General to study and report to Congress on the feasibility and advisability of updating the payment rates for hospice care.

Subtitle C: Other Provisions - Requires the Secretary to study and report to Congress on a PPS for psychiatric hospitals.

(Sec. 142) Revises the Medicare PPS for inpatient rehabilitation services.

Directs the Secretary to study and report to Congress on the impact of such PPS with regard to utilization of services, beneficiary access to services, non-therapy ancillary services, and other factors that the Secretary determines are appropriate as a result of such study.

(Sec. 143) Deems the Northwest Mississippi Regional Medical Center located in Clarksdale, Mississippi to have satisfied the case mix index criteria for classification as a rural referral center.

(Sec. 144) Provides for reclassification of certain counties in North Carolina and New York for reimbursement under Medicare.

(Sec. 145) Directs the Secretary to: (1) recalculate the Hattiesburg Mississippi Metropolitan Statistical Area (MSA) wage index for FY 2000 using FY 1996 wage and hour data for Wesley Medical Center; (2) issue a wage index correction for FY 2000; and (3) make such adjustments to the PPS for determining the operating costs of inpatient hospital services of a disproportionate share (DSH) hospital.

(Sec. 146) Requires the Secretary to consider an application by a certain entity for Medicare certification as an application by a new provider.

(Sec. 147) Requires the Secretary to study and report to Congress on whether: (1) the PPS rates are an adequate proxy for the costs of inpatient hospital services; and (2) the standard for county-wide geographic reclassification needs to be updated or revised.

Title II: Provisions Relating to Part B Only - Subtitle A: Hospital Outpatient Department Services - Amends SSA title XVIII part B (Supplementary Medical Insurance) to provide for a multiyear transition to PPS for hospital outpatient department services.

(Sec. 202) Directs the Medicare Payment Advisory Commission (MEDPAC) to study and report to the Secretary and Congress on the feasibility and advisability of providing payments to rural and cancer hospitals in the PPS for hospital outpatient department services.

(Sec. 203) Amends SSA title XVIII to provide for outlier adjustment, transitional pass-through for certain medical devices, drugs, and biologicals, and transitional pass-through for additional costs of innovative medical devices, drugs, and biologicals.

Subtitle B: Physicians' Services - Amends SSA title XVIII to provide for modifications of update adjustment factor provisions to reduce oscillations and allow for estimate revisions.

(Sec. 221) Directs the Secretary, acting through the Administrator of the Agency for Health Care Policy and Research, to study and report to MEDPAC, for submission to Congress, on utilization of physicians' services by Medicare beneficiaries.

Title III: Provisions Relating to Parts A and B - Subtitle A: Home Health Services - Amends the Balanced Budget Act of 1997, as amended by the Tax and Trade Relief Extension Act of 1998, to provide for a delay in the 15 percent reduction in payments under the PPS for home health services.

(Sec. 302) Amends SSA title XVIII to provide for an increase in per visit and per beneficiary limits.

(Sec. 304) Eliminates the 15-minute billing requirement for prospective payment for home health services.

(Sec. 305) Revises requirements for home health agency consolidated billing to include medical supplies but not durable medical equipment.

(Sec. 306) Directs MEDPAC to study and report to Congress on the exemption of rural agencies and populations from inclusion in the home health PPS.

(Sec. 307) Amends SSA title XVIII to provide for an extension of interim payments for home health agencies.

Subtitle B: Graduate Medical Education - Amends SSA title XVIII to revise the multiyear reduction of indirect graduate medical education (GME) payments.

(Sec. 322) Increases certain limitations on the number of residents or interns with respect to GME payments for certain interns and residents who transferred from Department of Veterans' Affairs (VA) hospitals to non-VA hospitals in order to maintain residency program accreditation.

Title IV: Rural Initiatives - Prescribes or revises requirements for: (1) sole community hospitals and Medicare dependent hospitals; (2) revision of criteria for designation as a critical access hospital; (3) Medicare waivers for hospitals in rural areas; (4) two-year extension of Medicare dependent hospital (MDH) program; and (5) assistance to rural GME residency programs.

Title V: Provisions Relating to Part C (Medicare+Choice Program) - Subtitle A: Provisions to Accommodate and Protect Medicare Beneficiaries - Amends SSA title XVIII part C (Medicare+Choice) : (1) permit enrollment in alternative Medicare+Choice plans and Medicare supplemental insurance (Medigap) coverage in case of involuntary termination of Medicare+Choice enrollment; (2) revise the effective date of elections and changes of elections of Medicare+Choice plans; (3) provide for an extension of reasonable cost contracts; (4) provide for revision of notice by hospitals on coverage of inpatient hospital services; and (5) provide for an extended disenrollment window for certain involuntarily terminated enrollees.

Subtitle B: Provisions to Facilitate Implementation of the Medicare+Choice Program - Amends Medicare part C to provide for phase-in of Medicare+Choice risk adjustment methodology implementation.

(Sec. 522) Delays the deadline for submission of adjusted community rates under Medicare+Choice program.

(Sec. 523) Bases the user fee for Medicare+Choice organizations on the number of enrolled beneficiaries.

(Sec. 524) Revises the time period for the exclusion of Medicare+Choice organizations that have had a contract terminated.

(Sec. 525) Provides for flexibility to tailor benefits under Medicare+Choice plans.

(Sec. 526) Makes the Quality Improvement System for Managed Care inapplicable to preferred provider organizations.

(Sec. 527) Changes the timing of Medicare+Choice health information fairs.

(Sec. 528) Amends Medicare part D (Miscellaneous Provisions) to exempt from certain ownership and compensation arrangement prohibitions applicable to prepaid plans any services furnished by a Medicare+Choice organization offering a coordinated care plan to an organization enrollee.

(Sec. 529) Amends Medicare part C regarding the ability of a religious fraternal benefit society to operate a Medicare+Choice private fee-for-service plan.

Subtitle C: Provisions Regarding Special Medicare Populations - Amends the Omnibus Budget Reconciliation Act of 1987 to extend the Social Health Maintenance Organization Demonstration Project authority.

(Sec. 542) Amends SSA titles XVIII and XIX (Medicare) to provide for the inapplicability of the Outcome and Assessment Information Set to the PACE (program of all-inclusive care for the elderly) program.

(Sec. 543) Outlines Medigap protections for PACE program enrollees.

(Sec. 544) Requires the Secretary to extend the EverCare demonstration project for the frail elderly.

Subtitle D: Studies and Reports to Assist in Making Future Improvements in the Medicare Program - Directs the Comptroller General to: (1) study and report to Congress on Medigap policies; and (2) conduct an annual audit for a report to Congress on the expenditures by the Secretary during the preceding year in providing information on the Medicare+Choice program to eligible Medicare beneficiaries.

(Sec. 562) Directs MEDPAC to study and report to Congress on: (1) the Secretary's methodology in developing the risk factors used in adjusting the Medicare+Choice capitation rate paid to Medicare+Choice organizations; and (2) the development of special payment rules under the Medicare+Choice program for frail elderly enrolled in specialized programs.

(Sec. 563) Directs the Secretary to compute the expenditures under the original Medicare fee-for-service program under Medicare parts A and B on a county-by-county basis.

(Sec. 564) Directs the Secretary to study and report to Congress on the effects, costs, and feasibility of requiring Medicare original fee-for-service entities and Medicare+Choice coordinated care plans to comply with uniform quality standards and related reporting requirements.

(Sec. 565) Directs the Secretary to study and report to Congress on data submission used to establish risk adjustment methodology under the Medicare+Choice program.

Title VI: Other Medicare Provisions - Amends SSA title VI to provide for a two-year moratorium on caps for certain physical therapy services.

(Sec. 601) Amends the Balanced Budget Act of 1997 (BBA '97) to revise requirements for the report on outpatient physical therapy services and outpatient occupational therapy services with respect to prospective payment for outpatient rehabilitation services.

Directs the Secretary to study and report to Congress on utilization patterns of such therapy services.

(Sec. 602) Amends SSA title XVIII to provide for: (1) an increase in the Medicare payment amount for renal dialysis services; (2) an increase in payment amount for pap smear and laboratory tests; and (3) a limitation in the reduction of payments to DSH hospitals.

(Sec. 605) Prohibits the Secretary from using, or permitting fiscal intermediaries or carriers to use, the inherent reasonableness authority under Medicare part B until a certain date after the Comptroller General of the United States releases a report on the impact of the Secretary's fiscal intermediaries' and carriers' use of such authority.

(Sec. 608) Prohibits any net deficit increase resulting from enactment of this Act from being counted for purposes of the paygo scorecard under the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act).

Title VII: Provisions Relating to Medicaid and SCHIP - Amends SSA title XIX to make technical corrections related to BBA '97.

(Sec. 702) Increases the DSH allotment for Minnesota, New Mexico, Wyoming, and the District of Columbia.

(Sec. 703) Amends BBA '97 to make the Medicaid DSH transition rule permanent.

(Sec. 704) Amends SSA title XIX (State Children's Health Insurance) (SCHIP) to increase allotments for territories under SCHIP.

(Sec. 705) Amends SSA title XIX to remove fiscal year limitation on certain transitional administrative costs assistance.

(Sec. 706) Amends SSA title XIX to revise floors and ceilings in the SCHIP allotment formula.

(Sec. 707) Requires the Secretary to adjust the annual Current Population Survey to include State-by-State data relating to children without health insurance coverage. Makes appropriations.

Requires the Secretary, acting through the National Center for Health Statistics, to collect children's health care access and utilization State-level data. Makes appropriations.

Requires the Secretary, directly or through contracts or interagency agreements, to conduct an independent evaluation of State SCHIP programs. Provides funding.

Directs the Secretary to conduct an audit with regard to SCHIP enrollees who are Medicaid-eligible. Requires the Comptroller General to monitor such audits and submit a report on them to Congress.

(Sec. 708) Provides for grants to States for items and services provided by federally-qualified health centers and rural health clinics. Makes appropriations.