< Back to H.R. 3081 (108th Congress, 2003–2004)

Text of the ProMISE Act

This bill was introduced on September 11, 2003, in a previous session of Congress, but was not enacted. The text of the bill below is as of Sep 11, 2003 (Introduced).

Source: GPO

HR 3081 IH

108th CONGRESS

1st Session

H. R. 3081

To amend title XVIII of the Social Security Act to provide additional reimbursements for Medicare providers in low-reimbursement States and to provide financial incentives for high quality, low-cost health care.

IN THE HOUSE OF REPRESENTATIVES

September 11, 2003

Mr. GEPHARDT (for himself and Mr. BOSWELL) 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 provide additional reimbursements for Medicare providers in low-reimbursement States and to provide financial incentives for high quality, low-cost health care.

    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 ‘Protecting Medicare Investments for Seniors Everywhere Act (ProMISE Act)’.

SEC. 2. ADDITIONAL REIMBURSEMENTS FOR MEDICARE PROVIDERS IN LOW-REIMBURSEMENT STATES.

    Title XVIII of the Social Security Act is amended by adding at the end the following new section:

‘ADDITIONAL REIMBURSEMENTS FOR PROVIDERS IN LOW-REIMBURSEMENT STATES

    ‘SEC. 1897. (a) ADDITIONAL REIMBURSEMENT-

      ‘(1) IN GENERAL- Subject to section 1898(c), in the case of an affected health care provider (as defined in subsection (c)) that is located in a low-reimbursement State (as defined in subsection (b)) and that furnishes items or services for which payment may be made under part A or part B, in addition to the amount otherwise paid under such part, there also shall be paid to the provider under such part from the Federal Hospital Insurance Trust Fund (in the case of payments under part A) or from the Federal Supplementary Medical Insurance Fund (in the case of payments under part B) an amount equal to the payment adjustment percentage (specified in paragraph (2)) of the payment amount for the service under such part.

      ‘(2) PAYMENT ADJUSTMENT PERCENTAGE- In the case of a provider located in a State for which the medicare reimbursement ratio--

        ‘(A) is at least 94 percent, the payment adjustment percentage is 1 percent;

        ‘(B) is at least 93 percent, but less than 94 percent, the payment adjustment percentage is 2 percent;

        ‘(C) is at least 92 percent, but less than 93 percent, the payment adjustment percentage is 3 percent;

        ‘(D) is at least 91 percent, but less than 92 percent, the payment adjustment percentage is 4 percent; or

        ‘(E) is less than 91 percent, the payment adjustment percentage is 5 percent.

    ‘(b) LOW-REIMBURSEMENT STATE; MEDICARE REIMBURSEMENT RATIO DEFINED- For purposes of this section:

      ‘(1) LOW-REIMBURSEMENT STATE- The term ‘low-reimbursement State’ means one of the 50 States or the District of Columbia in which the medicare reimbursement ratio (as defined in paragraph (2)) is less than 95 percent.

      ‘(2) MEDICARE REIMBURSEMENT RATIO- The term ‘medicare reimbursement ratio’ means, with respect to a State or the District of Columbia, the ratio (expressed as a percentage) of--

        ‘(A) the adjusted average per capita cost (as determined under section 1876(a)(4)) for benefits under parts A and B of this title (without regard to any payment under this section) in the State or District; to

        ‘(B) the United States per capita cost (as so determined) for the 50 States and the District of Columbia.

    ‘(c) AFFECTED HEALTH CARE PROVIDERS COVERED- For purposes of this section the term ‘affected health care provider’ means a facility or professional that is within one of the following classes of health care providers or organizations:

      ‘(1) Hospitals.

      ‘(2) Physicians.

      ‘(3) Skilled nursing facilities.

      ‘(4) Home health agencies.

      ‘(5) Medicare+Choice organizations offering Medicare+Choice plans.

    ‘(d) EFFECTIVE PERIOD- This section shall apply to payments--

      ‘(1) for hospitals, skilled nursing facilities, and home health agencies, for fiscal years beginning with fiscal year 2004; or

      ‘(2) for physicians and Medicare+Choice organizations, for calendar years beginning with 2004.

    ‘(e) RELATION TO MANAGED CARE: AVOIDING DUPLICATION OF INCREASES- Payments under this section to affected health care providers other than Medicare+Choice organizations in an area shall not be taken into account for purposes of applying part C in that area.’.

SEC. 3. MEDICARE FINANCIAL INCENTIVE PROGRAM FOR HIGH QUALITY, LOW-COST HEALTH CARE.

    Title XVIII of the Social Security Act is further amended by adding at the end the following new section:

‘FINANCIAL INCENTIVE PROGRAM FOR HIGH QUALITY, LOW-COST HEALTH CARE

    ‘SEC. 1898. (a) RANKING OF STATES BY QUALITY AND COST-

      ‘(1) IN GENERAL- The Secretary shall provide for the ranking of States on measures of both quality and cost of health care services under this title.

      ‘(2) PROCESS-

        ‘(A) IN GENERAL- Within 1 year after the date of the enactment of this section, the Secretary shall submit to Congress a proposal for establishing such measures of quality. The Secretary shall consult with stakeholders in developing such proposal.

        ‘(B) ACTION- If the Congress does not enact a law within 90 legislative days after receiving such proposal, the proposal shall become effective.

      ‘(3) COST- In developing the measure based on cost, the Secretary shall rely on the Secretary’s measure of average medicare spending per recipient in each State.

      ‘(4) ANNUAL EVALUATIONS- The Secretary shall conduct annually evaluations of States quality and cost of health care services under this title.

    ‘(b) ADDITIONAL BONUS PAYMENT-

      ‘(1) IN GENERAL- Subject to subsection (c), in the case of a hospital or physician that is located in a State that is ranked under subsection (a) among the top quartile of States in quality and cost and that furnishes items or services for which payment may be made under part A or part B, in addition to the amount otherwise paid under such part, there also shall be paid to the provider under such part from the Federal Hospital Insurance Trust Fund (in the case of payments under part A) or from the Federal Supplementary Medical Insurance Fund (in the case of payments under part B) an amount equal to 5 percent of the payment amount for the service under such part.

      ‘(2) AUTHORITY TO COVER OTHER PROVIDERS- The Secretary may expand paragraph (1) to apply to other health care providers and practitioners under this title, but shall not effect such an expansion without reporting to Congress.

    ‘(c) AGGREGATE PERCENTAGE ADJUSTMENT LIMITATION- In no case shall the sum of the percentage increase under subsection (b) and the payment adjustment percentage under section 1897(a)(2) with respect to a State exceed 100 percent minus the medicare reimbursement ratio (as defined in section 1897(b)(2)) for that State. Any such percentage increase or adjustment shall be reduced on a pro-rata basis to the extent required to comply with the previous sentence.’.