Directs the Secretary of Health and Human Services to: (1) establish a program to provide financial incentive awards to Medicare+Choice organizations offering plans that demonstrate the provision of superior quality health care to enrollees; (2) only award a National Performance Quality Award to Medicare+Choice organizations for plans that demonstrate superior quality in health care; (3) only award a State Performance Quality Award to Medicare+Choice organizations for plans that demonstrate the highest quality in health care furnished in the State; and (4) enter into an arrangement for the Institute of Medicine of the National Academy of Sciences to study clinical outcomes, performance, and quality of care under the Medicare+Choice program.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2033 Introduced in House (IH)]
108th CONGRESS
1st Session
H. R. 2033
To amend title XVIII of the Social Security Act to increase the minimum
percentage increase under the Medicare+Choice program, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 8, 2003
Ms. Dunn (for herself, Mr. McDermott, and Mr. Rush) introduced the
following bill; which was referred to the Committee on Ways and Means,
and in addition to the Committee on Energy and Commerce, 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 title XVIII of the Social Security Act to increase the minimum
percentage increase under the Medicare+Choice program, 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.
This Act may be cited as the ``Medicare Equity and Access Act''.
SEC. 2. 2-YEAR INCREASE IN MINIMUM PERCENTAGE INCREASE.
Section 1853(c)(1)(C) of the Social Security Act (42 U.S.C. 1395w-
23(c)(1)(C)) is amended--
(1) in clause (iv), by striking ``and each succeeding
year'' and inserting ``and 2003''; and
(2) by inserting at the end the following new clauses:
``(v) For 2004 and 2005, 106.5 percent of
the annual Medicare+Choice capitation rate
under this paragraph for the area for the
previous year.
``(vi) For 2006 and each succeeding year,
102 percent of the annual Medicare+Choice
capitation rate under this paragraph for the
area for the previous year.''.
SEC. 3. INCLUSION OF COSTS OF DOD AND VA MILITARY FACILITY SERVICES TO
MEDICARE-ELIGIBLE BENEFICIARIES IN CALCULATION OF
MEDICARE+CHOICE PAYMENT RATES.
Section 1853(c)(3) of the Social Security Act (42 U.S.C. 1395w-
23(c)(3)) is amended--
(1) in subparagraph (A), by striking ``subparagraph (B)''
and inserting ``subparagraphs (B) and (E)'', and
(2) by adding at the end the following new subparagraph:
``(E) Inclusion of costs of dod and va military
facility services to medicare-eligible beneficiaries.--
In determining the area-specific Medicare+Choice
capitation rate under subparagraph (A) for a year
(beginning with 2004), the annual per capita rate of
payment for 1997 determined under section 1876(a)(1)(C)
shall be adjusted to include in the rate the
Secretary's estimate, on a per capita basis, of the
amount of additional payments that would have been made
in the area involved under this title if individuals
entitled to benefits under this title had not received
services from facilities of the Department of Defense
or the Department of Veterans Affairs.''.
SEC. 4. AVOIDING DUPLICATIVE STATE REGULATION.
(a) In General.--Section 1856(b)(3) of the Social Security Act (42
U.S.C. 1395w-26(b)(3)) is amended to read as follows:
``(3) Relation to state laws.--The standards established
under this subsection shall supersede any State law or
regulation (other than State licensing laws or State laws
relating to plan solvency) with respect to Medicare+Choice
plans which are offered by Medicare+Choice organizations under
this part.''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on the date of the enactment of this Act.
SEC. 5. MEDICARE+CHOICE QUALITY PERFORMANCE PAYMENT INCENTIVE PROGRAM.
(a) Establishment of Program.--
(1) In general.--The Secretary of Health and Human Services
shall establish a program to provide financial incentive awards
to Medicare+Choice organizations offering Medicare+Choice plans
under part C of title XVIII of the Social Security Act that
demonstrate the provision of superior quality health care to
enrollees under the plan.
(2) Period of program.--Awards under the program shall be
made during 2005 and 2006, and shall be based upon the most
recent available quality data.
(b) Awards.--
(1) In general.--Of the amounts provided for the program
under subsection (f) in each year, the Secretary shall
allocate--
(A) 75 percent of such amounts for National
Performance Quality Awards (described in subsection
(c)), and
(B) 25 percent of such amounts for State
Performance Quality Awards (described in subsection
(d)).
(2) Limitations on Awards.--A Medicare+Choice organization
offering a Medicare+Choice plan may not receive both a National
and State Performance Quality Award in a year. No
Medicare+Choice organization offering a Medicare+Choice plan is
eligible for an award under this section unless it offers
benefits throughout the year in which the award is paid.
(3) Amount of award.--The amount of an award to a
Medicare+Choice organization offering a Medicare+Choice plan
eligible for the award shall be determined by multiplying the
number of beneficiaries enrolled under the plan on the first
day of the year for which the award is paid times a uniform
dollar amount established by the Secretary. In no case may the
uniform dollar amount for a State Performance Quality Award
exceed the dollar amount for a National Performance Quality
Award for the year involved.
(4) Use of Awards.--Financial incentives received under an
award under this section may only be used for the following
purposes:
(A) To reduce any beneficiary cost-sharing
applicable under the plan.
(B) To reduce any beneficiary premiums applicable
under the plan.
(C) To initiate, continue, or enhance a
comprehensive disease management program or health care
quality programs for beneficiaries.
(D) To enhance beneficiary benefits under the plan.
(E) To utilize the stabilization fund described in
section 1854(f)(2) of the Social Security Act (42
U.S.C. 1395w-24(f)(2)).
(5) Comprehensive disease management program described.--A
comprehensive disease management program referred to in
paragraph (4)(C) is a comprehensive program to manage chronic
disease that includes the following:
(A) A population identification process.
(B) Evidence based practice guidelines.
(C) Collaborative practice models that include
physician and providers of support services.
(D) Patient self-management education which may
include primary prevention, behavior modification
programs, and compliance and surveillance.
(E) Process and outcome measurement, evaluation,
and management.
(F) Routine reporting among health care providers
concerned and procedures for feedback.
(G) Such other components that the Secretary
determines reasonably improve health care outcomes.
(c) National Performance Quality Awards.--
(1) In general.--The Secretary shall only award a National
Performance Quality Award to Medicare+Choice organizations with
respect to the Medicare+Choice plans offered by the
organizations that demonstrate superior quality in the health
care furnished to its enrollees.
(2) Mandatory awards.--National Performance Quality Awards
shall be given to the Medicare+Choice organizations with
respect to the Medicare+Choice plans that receive ratings in
the top 25th percentile of all plans rated by the Secretary
pursuant to subsection (e).
(d) State Performance Quality Awards.--
(1) In general.--The Secretary shall only award a State
Performance Quality Award to Medicare+Choice organizations with
respect to the Medicare+Choice plans offered by the
organizations in that State that demonstrate the highest
quality in the health care furnished to its enrollees.
(2) Requirement for 2 plans.--A State Performance Quality
Award may not be awarded in a State that has less than two
Medicare+Choice organizations offering Medicare+Choice plans.
(3) Minimum rating required.--A State Performance Quality
Award shall be awarded to Medicare+Choice organizations
offering Medicare+Choice plans in a State that receive a rating
by the Secretary pursuant to subsection (e) in the 60th
percentile, or higher, of the national ranking of all eligible
plans.
(4) Special consideration.--The Secretary may provide
special consideration to Medicare+Choice organizations offering
Medicare+Choice plans that serve predominantly rural areas or
that demonstrate significant quality care improvements.
(e) Rating Methodology.--In determining which Medicare+Choice
organization offering Medicare+Choice plans qualify for an award under
this section, the Secretary shall develop a scoring and ranking system
using--
(1) the 2003 MCO standards and guideline methodology of the
National Committee for Quality Assurance for awarding total
HEDIS points (based on HEDIS and CAHPS measures) with an
adjustment to incorporate the following three HEDIS outcome
measures--
(A) cholesterol control after acute cardiovascular
events,
(B) HbA1c control for comprehensive diabetes care,
and
(C) cholesterol control for comprehensive diabetes
care), and
(2) audited HEDIS outcomes and process measures and CAHPS
data as reported to the Department of Health and Human
Services.
(f) Payment From Medicare Trust Funds.--The Secretary shall provide
for the transfer from the Federal Hospital Insurance Trust Fund and the
Federal Supplementary Insurance Trust Fund under title XVIII of the
Social Security Act (42 U.S.C. 1395i, 1395t), in such proportions as
the Secretary determines to be appropriate, of $500,000,000 for each of
2005 and 2006 for the costs of carrying out the project under this
section.
SEC. 6. INSTITUTE OF MEDICINE REPORT ON PAYMENT INCENTIVES AND
PERFORMANCE UNDER THE MEDICARE+CHOICE PROGRAM.
(a) Study.--The Secretary of Health and Human Services shall enter
into an arrangement with the Institute of Medicine of the National
Academy of Sciences under which the Institute shall conduct a study on
clinical outcomes, performance, and quality of care under the
Medicare+Choice program under part C of title XVIII of the Social
Security Act.
(b) Matters Studied.--
(1) In general.--In conducting the study under subsection
(a), the Institute shall review and evaluate the public and
private sector experience related to the establishment of
performance measures and payment incentives. The review shall
include an evaluation of the success, efficiency, and utility
of structural process and performance measurements, and
different methodologies that link performance to payment
incentives. The review shall include the use of incentives--
(A) aimed at plans and their enrollees;
(B) aimed at providers and their patients;
(C) to encourage consumers to purchase based on
quality and value; and
(D) to encourage multiple purchasers, providers,
beneficiaries, and plans within a community to work
together to improve performance.
(2) Identification of options.--As part of the study, the
Institute shall identify options for providing incentives and
rewarding performance, improve quality, outcomes, and
efficiency in the delivery of programs and services under the
Medicare+Choice program, including--
(A) periodic updates of performance measurements to
continue rewarding outstanding performance and
encourage improvements;
(B) payments that vary by type of plan, such as
preferred provider organization plans and MSA plans;
(C) extension of incentives in the Medicare+Choice
program to the fee for service program under title
XVIII of the Social Security Act; and
(D) performance measures needed to implement
alternative methodologies to align payments with
performance.
(c) Report.--Not later than 18 months after the date of the
enactment of this Act, the Institute shall submit to Congress and the
Secretary a report on the study conducted under subsection (a).
<all>
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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 Ways and Means, and in addition to the Committee on Energy and Commerce, 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 Ways and Means, and in addition to the Committee on Energy and Commerce, 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 Subcommittee on Health.
Referred to the Subcommittee on Health.
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