A bill to provide for voluntary private alternative coverage for Medicare beneficiaries, and for other purposes.
Medicare Voucher Act of 1983 - Amends title XVIII (Medicare) of the Social Security Act to revise the method of reimbursement to health maintenance organizations (HMO's). Provides instead for payments to health benefits organizations (HBO's).
Directs the Secretary of Health and Human Services to determine annually a per capita rate of payment for each class of individuals enrolled with a HBO under this Act with which the Secretary has a contract. Directs the Secretary to define appropriate classes of members on the basis of such factors as age, sex, disability status, and place of residence. Provides that the payment rate for each class shall be equal to 95 percent of the adjusted average per capita cost for that class, and that the rate shall be paid monthly in advance.
Defines adjusted average per capita cost to mean the average per capita amount estimated in advance that would be payable in any contract year for services covered under parts A (Hospital Insurance) and B (Supplementary Medical Insurance), and types of expenses otherwise reimbursable under parts A and B, if payment for the services were to be made other than as provided for under this Act.
Provides that payment to a HBO under this Act for individuals enrolled with a HBO shall be made from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund.
Defines a HBO as a voluntary association, corporation, partnership, or other organization which is lawfully engaged in providing, paying for, or reimbursing the cost of, health services under insurance policies or contracts, medical or hospital agreements, membership or subscription contracts, or similar arrangements, and includes a health benefits plan duly sponsored or underwritten by an employer or an employee organization. Requires the employer under an employment based plan to pay at least 25 percent of the premium for every current or former employee.
Requires a HBO to: (1) provide, pay for, or reimburse the cost of at least all the services to which a Medicare enrollee is entitled and the inpatient hospital services for every day the individual is an inpatient; and (2) provide, pay for, or reimburse the cost of emergency services, if they would otherwise be covered under Medicare. Permits a HBO to offer one or more combinations of benefits, as long as the benefits are offered to all enrollees.
Provides that all individuals entitled to benefits under part A shall be eligible to enroll with an HBO, except individuals with end-stage renal disease.
Entitles an individual enrolled with a HBO who is dissatisfied because of failure to receive benefits to a hearing before the Secretary, and judicial review of the Secretary's determination if the amount in controversy exceeds a specified sum.
Prohibits the actuarial value of the amounts (other than premiums) that an individual enrolled with a HBO is required to pay for Medicare covered services from exceeding the actuarial value of the amounts (other than premiums) the individual would be required to pay if the individual were not enrolled with a HBO. Authorizes HBO's to charge premiums.
Directs the Secretary to enter into a contract with any HBO that meets specified requirements. Provides that each contract shall be for a term of at least one year. Requires each contract to provide: (1) that the Secretary shall have the right to inspect the quality and appropriateness of a HBO's services; (2) that the Secretary shall have the right to audit and inspect a HBO's books and records; and (3) that the HBO furnish required information.
Makes conforming amendments. Sets forth effective date and transitional provisions.
Referred to Subcommittee on Health.
Introduced in Senate
Read twice and referred to the Committee on Finance.
Committee on Finance requested executive comment from OMB, Treasury Department, Health and Human Services Department.
checking server…
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line