A bill to amend title XVIII of the Social Security Act to provide additional protections for Medicare beneficiaries under the Medicare+Choice Program

8 Pages·2000·0.31 MB·English

by  United States. Congress. House

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ToamendtitleXMIIoftheSocialSecurit}'Acttoprovideadditional
protectionsforjMedicarebeneficiariesundertheMedicare+ChoiceProgi-am.
IN THE HOUSE OF REPRESENTATIVES
>Uv2,2000
'Sir. LaTourette introduced the follo^^^ngbill; ivhich was referred to the
CommitteeonWaysand Means, and in additiontothe Committee on
Commerce, foraperiodtobesubsequentlydeterminedbytheSpeaker,
ineachcaseforconsiderationofsuchpronsionsasfall%\-ithinthejuris-
dictionofthecommitteeconcerned
A
BILL
To amend title X\T:II ofthe Social SecurityAct to pro\ide
additional protections for Medicare beneficiaries under
theMedicare+ChoiceProgTam.
1 BeitenactedhytheSenateandHouseofRepresenta-
2 tivesoftheUnitedStatesofAmericainCongressassembled,
3 SECTION1.SHORTTITLE.
4 ThisActmaybe cited asthe "SeniorHealthInsur-
5 ancePullOutPreventionActof2000".
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2
1 SEC. 2. EXTENSION OF INITIAL MEDICARE+CHOICE CON-
2 TRACTPERIODTO3YEARS.
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3 (a) Ix General. Section 1857(e)(1) ofthe Social
4 Security Act (42 U.S.C. 1395\\--27(c)(l)) is amended—
5 (1) bystriking"aterm ofatleast 1 year" and
6 inserting "an initial term ofat least 3 years"; and
7 (2)bystriking"fromtermtoterm" andinsert-
8 ing"foradditionall-3'earperiodsthereafter".
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9 (b) Effectr^ Date. The amendments made by
10 subsection (a) applytocontractsenteredintoonorafter
11 thedateoftheenactmentofthisAct.
12 SEC.3.ADVANCENOTICEOFTERMINATION.
13 (a) Requiring 1 Year Advance Notice by
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14 Medicare+ChoiceOrganization. Section1857(c)(1)
15 oftheSocial SecurityAct (42 U.S.C. 1395w-27(c)(l)) is
16 amendedbystriking"byeitherpartyofintentiontotermi-
17 nate at the end ofthe current term" and inserting "bv
18 the Secretary' before the end ofthe current term or bv
19 the organization at least one year before the end ofthe
20 currentterm".
21 (b) Timely Notification of Beneficl\ries of
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22 Pm^siciAXTerminations. Section 1852(j) ofsuchAct
23 Social Security Act (42 U.S.C. 1395w-22(j)) is
24 amended
25 (1)inparagraph (1)
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1 (A) by striking "and" at the end of sub-
2 paragraph(B);
3 (B) by striking the period at the end of
4 subparagraph(C)andinserting and";and
5 (C)byaddingattheendthefollowingnew
6 subparagraph:
7 "(D) termination procedures consistent
8 withparagraph(7).";and
9 (2) by adding at the end the following new
10 paragraph: I
11 "(7) Timely notice of pm^siciAX termi-
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12 NATION'S. Under an agreement described in para-
13 graph (1) between a Medicare+Choice organization
14 andaphysician(orgroupofphysicians)
15 "(A) the agreement shall be automatically
16 renewable between the parties unless there has
17 been notice by the physician or group to the
18 plan (orbytheplan tothephysician orgroup)
19 atleast 120daysbeforethedatetheagreement
20 wouldotherwiseexpire; and
21 "(B) inthecase such an agreement is not
22 renewed, the physician or group of physicians
23 shallprovidenoticeatleast90daysbeforesuch
24 expiration date to enroUees who are
25 Medicare+Choice enrollees and are currentpa-
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1 tients (as defined in regulations) ofthe physi-
2 eianorgroupatthetimeofthenoticeprovided
3 underclause (i).". ,
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4 (c) Effectr^ Date. The amendments made by
5 thissectionapply
6 (1) to contracts between the Secretarj^ and
7 Medicare+Choice organizations entered into more
8 than 6 months after the date of the enactment of
9 thisAct;and
10 (2) to agreements between Medicares-Choice
11 organizations and physicians (and groups ofphysi-
12 cians)withrespecttoexpirationsofsuchagreements
13 occurringaftertheendofthe 9-monthperiodbegin-
14 ningonthedateoftheenactmentofthisAct.
15 SEC. 4. RESTRICTION ON TERMINATION OF
16 MEDICARE+CHOICE PLANS IN SELECTED
17 AREAS WITHIN A METROPOLITAN STATIS-
18 TICALAREA-
19 (a) IxGeneral.—Section 1857(c) oftheSocialSe-
20 curityAct(42U.S.C. 1395^\^27(c))isamendedbyredes-
21 ignatingparagraph (5) asparagraph (6) andbyinserting
22 afterparagraph(4)thefoIloA\ingnewparagraph:
23 "(5) Llmitation ox selective termixatiox
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24 ofcoxtracts. >
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1 "(A) Ix GENERAL. Except aspro\-ided in
2 subparagraph (B), ifa Medicare+Choice org-a-
3 nization offers a Medicare+Choice plan that
4 pro\ides coverage in a metropohtan statistical
5 area (or a New England County Metropolitan
6 Area) in a State and terminates such coverage
7 for any part of such area (or Area) in the
8 State, the Secretan,^ shall terminate any con-
9 tract^vith the organization for coverage ofany
10 partofthatarea(orArea)inthatState.
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11 "(B) Exception. The Secretary may
12 waive the requirement of subparagraph (A) if
13 the Secretar}' finds that terminating contracts
14 for coverage in all parts ofa metropolitan sta-
15 tistical area (or New England County Metro-
16 politanArea) inthe Statewouldpose an immi-
17 nent and serious risk to the health ofindi^^d-
18 uals enrolled \nth the organization under this
19 partinthearea(orArea).".
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20 (b) Effectr^ Date. The amendments made by
21 subsection (a) apply to terminations for which notice is
22 pro\idedonorafterthedateoftheenactmentofthisAct.
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1 SEC.5.CONTDWITYOF CAREINCASEOF mVOLUNTARY
2 TERMINATION.
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3 (a) IxGeneral. Section 1852(d) oftheSocialSe-
4 curityAct(42U.S.C.1395w-22(d))isamendedbyadding
5 attheendthefollowingnewparagraph:
6 "(5)COXTI.XUITYOFCARE.
7 "(A)IxGEXERAL.—If—
8 "(i) an indiAidual's enrollment with a
9 Medicare+Choice plan offered by a
10 Medicare+Choice organization under this
11 part is terminated by the organization
12 (otherthan for cause with respect to that
13 individual), and
14 "(ii) ontheeffective date ofsuchter-
15 mination ofenrollmentthe individual is in
16 acourseoftreatmentforwhichcoverageis
17 availableundertheplanandtheindividual
18 is not at that time covered under another
19 Medicare+Choiceplan,
20 notwithstandingsuchtermination the organiza-
21 tion shall continue to provide cov^erage for the
22 covered course oftreatment for a period of 90
23 dav'^aftersucheffectivedate.
24 "(B) Permissible terms and coxdi-
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25 TIOXS. The coverage provided under subpara-
26 graph (A) shall be under the same terms and
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1 conditions (including applicable policies, proce-
2 dures, and quality assurance standards) as ex-
3 istedonthedatebeforetheeffectivedateofthe
4 termination.
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5 "(C) Terminate defined. Inthispara-
6 graph, the term 'terminate' includes the termi-
7 nation of a Medicare+Choice plan as a result
8 oftheexpirationornIonrenewalofacontractby
9 theorganizationunderthispart.
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10 "(D) Construction. Nothing in this
11 paragraphshallbeconstruedtorequirethecov-
12 erage of benefits which would not have been
13 covered ontheeffective dateofthetermination
14 involved.".
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15 (b) Effectr^ Date. The amendment made by
16 subsection (a) shallapplyto contractsenteredintoorre-
17 newed on orafterthedate ofthe enactment ofthisAct.
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