H.R. 5070 (106th): Medicare Fairness in Reimbursement Act of 2000

106th Congress, 1999–2000. Text as of Jul 27, 2000 (Introduced).

Status & Summary | PDF | Source: GPO

HR 5070 IH

106th CONGRESS

2d Session

H. R. 5070

To amend title XVIII of the Social Security Act to improve geographic fairness in Medicare+Choice payments and hospital payments under the Medicare Program.

IN THE HOUSE OF REPRESENTATIVES

July 27, 2000

Mr. Minge (for himself, Mr. Baird, Ms. Hooley of Oregon, Mr. Kind, Mr. McIntyre, Mr. Luther, Mr. Kanjorski, Ms. Baldwin, Mr. Kolbe, and Mr. Sabo) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on 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 improve geographic fairness in Medicare+Choice payments and hospital payments under the Medicare Program.

    Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) SHORT TITLE- This Act may be cited as the ‘Medicare Fairness in Reimbursement Act of 2000’.

    (b) TABLE OF CONTENTS- The table of contents of this Act is as follows:

      Sec. 1. Short title; table of contents.

      Sec. 2. Fairness in payments under the Medicare+Choice program.

      Sec. 3. New hospital wage survey.

      Sec. 4. Reduction in proportion of payments subject to wage-related geographic adjustments.

      Sec. 5. Permanently removing application of budget neutrality under the Medicaid+Choice program beginning in 2002.

      Sec. 6. Allowing movement to 50:50 percent blend in 2002.

      Sec. 7. MedPAC review of impact of wage and other cost adjustments.

SEC. 2. FAIRNESS IN PAYMENTS UNDER THE MEDICARE+CHOICE PROGRAM.

    Section 1853(c) of the Social Security Act (42 U.S.C. 1395w-23(c)) is amended--

      (1) in paragraph (1), by striking ‘and (7)’ and inserting ‘, (7), and (8)’;

      (2) in paragraph (4), by striking ‘paragraph (1)(A)’ and inserting ‘paragraphs (1)(A) and (8)’; and

      (3) by adding at the end the following new paragraph:

      ‘(8) FAIRNESS IN PAYMENTS- The annual Medicare+Choice capitation rate for a Medicare+Choice payment area for--

        ‘(A) 2002, shall not exceed 150 percent (or be less than 82 percent) of the input-price-adjusted annual national Medicare+Choice capitation rate (as computed under paragraph (4)) for the year;

        ‘(B) 2003, shall not exceed 140 percent (or be less than 86 percent) of the input-price-adjusted annual national Medicare+Choice capitation rate for the year;

        ‘(C) 2004, shall not exceed 130 percent (or be less than 90 percent) of the input-price-adjusted annual national Medicare+Choice capitation rate for the year;

        ‘(D) 2005, shall not exceed 120 percent (or be less than 94 percent) of the input-price-adjusted annual national Medicare+Choice capitation rate for the year;

        ‘(E) 2006, shall not exceed 110 percent (or be less than 98 percent) of the input-price-adjusted annual national Medicare+Choice capitation rate for the year; or

        ‘(F) 2007 or any subsequent year, shall be equal to the input-price-adjusted annual national Medicare+Choice capitation rate for the year.’.

SEC. 3. NEW HOSPITAL WAGE SURVEY.

    (a) IN GENERAL- The Secretary of Health and Human Services shall promptly conduct a new survey of levels of wages and wage-related costs for different occupational categories of hospital employees.

    (b) APPLICATION TO HOSPITAL WAGE INDEX- The Secretary shall use the data derived from the survey conducted under subsection (a) in computing the hospital wage index applied under section 1886(d)(3)(E) of the Social Security Act (42 U.S.C. 1395ww(d)(3)(E)) for discharges occurring on or after October 1, 2001.

SEC. 4. REDUCTION IN PROPORTION OF PAYMENTS SUBJECT TO WAGE-RELATED GEOGRAPHIC ADJUSTMENTS.

    (a) IN GENERAL- Notwithstanding any other provision of law, in applying any wage-related geographic area adjustment (as defined in subsection (b)) to a portion of a payment amount or rate under title XVIII of the Social Security Act, the portion to which the adjustment is applied shall be 75 percent of the portion otherwise computed and 25 percent of such portion shall not be subject to any such geographic area adjustment.

    (b) WAGE-RELATED GEOGRAPHIC AREA ADJUSTMENT DEFINED- For purposes of this section, the term ‘wage-related geographic area adjustment’ means an adjustment in a payment rate by geographic area that is based on a geographic variation in wages or wage-related costs or similar costs.

    (c) SPECIFIC APPLICATION- Subsection (a) applies to geographic adjustments made under the following provisions

of law (as well as other provisions identified by the Secretary of Health and Human Services):

      (1) INPATIENT HOSPITAL WAGE INDICES- The area wage adjustment made for inpatient hospital services under section 1886(d)(3)(E) of the Social Security Act (42 U.S.C. 1395ww(d)(3)(E)) and under section 1886(b)(3)(H)(iii) of such Act (42 U.S.C. 1395ww(b)(3)(H)(iii)).

      (2) OUTPATIENT HOSPITAL SERVICES- The wage adjustment factors under section 1833(t)(2)(D) of such Act (42 U.S.C. 1395l(t)(2)(D)).

      (3) HOME HEALTH SERVICES- The area wage adjustment under section 1895(b)(4)(A)(ii) of such Act (42 U.S.C. 1395fff(b)(4)(A)(ii)).

      (4) ROUTINE COSTS OF SKILLED NURSING SERVICES- The wage cost adjustment under section 1888(e)(4)(G)(ii) of such Act (42 U.S.C. 1395yy(e)(4)(G)(ii)).

      (5) PHYSICIANS’ SERVICES- The geographic physician work adjustment factor under section 1848(e)(5) of such Act (42 U.S.C. 1395w-4(e)(5)).

      (6) MEDICARE+CHOICE INPUT-PRICE-ADJUSTED ANNUAL NATIONAL MEDICARE+CHOICE CAPITATION RATES- The relative input prices relating to wages and wage-related expenses for input-price-adjusted annual national Medicare+Choice capitation rates under section 1853(c)(4)(A)(iii) of such Act (42 U.S.C. 1395w-23(c)(4)(A)(iii)).

      (7) CLINICAL LABORATORY SERVICES- The wage adjustment under section 1833(h)(4)(A) of such Act (42 U.S.C. 1395l(h)(4)(A)).

    (c) EFFECTIVE DATE- Subsection (a) first applies in the case of items and services for which payment adjustments under title XVIII of the Social Security Act are updated on a--

      (1) fiscal year basis, to the update made for fiscal year 2002; or

      (2) calendar year basis, to the update made for 2002.

SEC. 5. PERMANENTLY REMOVING APPLICATION OF BUDGET NEUTRALITY UNDER THE MEDICAID+CHOICE PROGRAM BEGINNING IN 2002.

    Section 1853(c) of the Social Security Act (42 U.S.C. 1395w-23(c)) is amended--

      (1) in paragraph (1)(A), in the matter following clause (ii), by inserting ‘(for years before 2002)’ after ‘multiplied’; and

      (2) in paragraph (5), by inserting ‘(before 2002)’ after ‘for each year’.

SEC. 6. 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. 7. MEDPAC REVIEW OF IMPACT OF WAGE AND OTHER COST ADJUSTMENTS.

    (a) IN GENERAL- Section 1805(b)(2)(B) of the Social Security Act (42 U.S.C. 1395b-6(b)(2)(B)) is amended--

      (1) by striking ‘and’ at the end of clause (ii);

      (2) by striking the period at the end of clause (iii) and inserting ‘; and’; and

      (3) by adding at the end the following new clause:

          ‘(iv) the extent to which the adjustments made (through wage indices and other measures) in payment rates on a geographic basis for variations in costs accurately reflect the actual costs of items and services in low reimbursement areas and the impact of such adjustments on the health infrastructure in such areas.’.

    (b) EFFECTIVE DATE- The amendments made by subsection (a) take effect on the date of the enactment of this Act and the Medicare Payment Advisory Commission shall first report on the review conducted pursuant to such amendments in its report submitting in June 2001.