CMSLibrary C2-07-13 r-xurltyBlvd. . I'jre, Maryiend 21244 raCONGRESS fHf. TKJ. 4A0*i«S>t0* 2DSession 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". — — 2 1 SEC. 2. EXTENSION OF INITIAL MEDICARE+CHOICE CON- 2 TRACTPERIODTO3YEARS. — 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". — 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 — 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 — 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) m •HR4356 — 3 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- — 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- m >HR4356 — 4 1 tients (as defined in regulations) ofthe physi- 2 eianorgroupatthetimeofthenoticeprovided 3 underclause (i).". , — 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 — 24 ofcoxtracts. > m >HR4356 5 — 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. — 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).". — 20 (b) Effectr^ Date. The amendments made by 21 subsection (a) apply to terminations for which notice is 22 pro\idedonorafterthedateoftheenactmentofthisAct. m >HR4356 — 6 1 SEC.5.CONTDWITYOF CAREINCASEOF mVOLUNTARY 2 TERMINATION. — 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- — 25 TIOXS. The coverage provided under subpara- 26 graph (A) shall be under the same terms and •HR4356m I rCC2M-S07L-i1br3ary 7 750GSGCU'ityBlvd. < iUn-.o-ro,. Ma'yicr.'.i 2124j 1 conditions (including applicable policies, proce- 2 dures, and quality assurance standards) as ex- 3 istedonthedatebeforetheeffectivedateofthe 4 termination. — 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. — 10 "(D) Construction. Nothing in this 11 paragraphshallbeconstruedtorequirethecov- 12 erage of benefits which would not have been 13 covered ontheeffective dateofthetermination 14 involved.". — 15 (b) Effectr^ Date. The amendment made by 16 subsection (a) shallapplyto contractsenteredintoorre- 17 newed on orafterthedate ofthe enactment ofthisAct. O m >HR4356 ensLIBKARy ams L054L 7