S. 3187 (106th): Medicaid Protection Act

106th Congress, 1999–2000. Text as of Oct 11, 2000 (Introduced).

Status & Summary | PDF | Source: GPO

S 3187 IS

106th CONGRESS

2d Session

S. 3187

To require the Secretary of Health and Human Services to apply aggregate upper payment limits to non-State publicly owned or operated facilities under the medicaid program.

IN THE SENATE OF THE UNITED STATES

October 11 (legislative day, SEPTEMBER 22), 2000

Mr. ROTH introduced the following bill; which was read the first time


A BILL

To require the Secretary of Health and Human Services to apply aggregate upper payment limits to non-State publicly owned or operated facilities under the medicaid program.

    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 ‘Medicaid Protection Act’.

SEC. 2. APPLICATION OF AGGREGATE UPPER PAYMENT LIMITS TO NON-STATE PUBLICLY OWNED OR OPERATED FACILITIES.

    (a) ISSUANCE OF FINAL REGULATION- Not later than 30 days after the date of enactment of this Act, the Secretary of Health and Human Services (in this section referred to as the ‘Secretary’), notwithstanding any requirement of the Administrative Procedures Act under chapter 5 of title 5, United States Code, or any other provision of law, shall issue a final regulation that provides as follows (in addition to any other limitations established under part 447 of title 42, Code of Federal Regulations):

      (1) APPLICATION OF UPPER PAYMENT LIMITS- Except as provided in paragraph (3), aggregate payments to each group of non-State publicly owned or operated facilities described in paragraph (2) under the medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) (in this section referred to as the ‘medicaid program’) may not exceed the amount that can reasonably be estimated would have been paid under medicare reasonable cost payment principles under title XVIII of such Act (42 U.S.C. 1395 et seq.).

      (2) GROUPS DESCRIBED- For purposes of this subsection, each of the following is a group of facilities:

        (A) Hospitals with respect to their provision of inpatient hospital services (as such terms are used for purposes of the medicaid program).

        (B) Hospitals with respect to their provision of outpatient hospital services (as so used).

        (C) Nursing facilities (as so used).

        (D) Intermediate care facilities for the mentally retarded (as so used).

      (3) DISPROPORTIONATE SHARE- The upper payment limitation established under paragraph (1) does not apply to payment adjustments made under a State plan to hospitals found to serve a disproportionate number of low-income patients with special needs as provided in section 1923 of the Social Security Act (42 U.S.C.1396r-4).

      (4) IMMEDIATE APPLICATION- Except as provided in paragraph (5), the regulation is effective upon publication, applies to services furnished on or after that date, and requires States to immediately apply payment rates under the medicaid program to each group of non-State publicly owned or operated facilities described in paragraph (2) in compliance with the regulation.

      (5) TRANSITION PERIOD FOR PRIOR APPROVED AMENDMENTS- In the case of any State plan amendment under the medicaid program that, as of the date of enactment of this section, has been approved on a basis other than a deemed approval basis as a result of an expired deadline for approval by the Secretary, and that provides for payments that are in excess of the payment limitation established under the regulation, the regulation provides that a State shall be considered to be in compliance with the regulation so long as the State makes specific payment reductions on a timeline specified in the regulation so that, for any period (or portion of a period) that occurs on or after October 1, 2002, payments made by the State under the medicaid program comply with the regulation.

    (b) DISAPPROVAL OF PLAN AMENDMENTS- Upon the publication of the final regulation under subsection (a), the Secretary shall disapprove any pending proposed State plan amendment under the medicaid program insofar as such amendment would permit payments under the medicaid program in excess of payments permitted under the final regulation required under subsection (a).