text: SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
  
      (a) Short Title.--This Act may be cited as the ``Medicare 
  Beneficiaries' Choice Stabilization 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. Establishment of payment floor for Medicare+Choice payment 
                              rates after applying risk-adjustment 
                              methodology.
  Sec. 3. Change in application of budget neutrality adjustment for 2001 
                              and 2002.
  Sec. 4. Increase in national per capita Medicare+Choice growth 
                              percentage in 2001 and 2002.
  Sec. 5. Increasing minimum payment amount.
  Sec. 6. Allowing movement to 50:50 percent blend in 2002.
  Sec. 7. Increased update for payment areas with only one or no 
                              Medicare+Choice contracts.
  Sec. 8. Permitting higher negotiated rates in certain Medicare+Choice 
                              payment areas below national average.
  Sec. 9. 10-year phase in of risk adjustment based on data from all 
                              settings.
  Sec. 10. Delay from July to November, 2000 in deadline for offering and 
                              withdrawing Medicare+Choice plans for 2001.
  Sec. 11. Miscellaneous regulatory changes.
  
  SEC. 2. ESTABLISHMENT OF PAYMENT FLOOR FOR MEDICARE+CHOICE PAYMENT 
                RATES AFTER APPLYING RISK-ADJUSTMENT METHODOLOGY.
  
      (a) In General.--Section 1853(c)(1) of the Social Security Act (42 
  U.S.C. 1395w-23(c)(1)) is amended--
              (1) in the matter preceding subparagraph (A), by striking 
          `or (C)' and inserting `(C), or (D)'; and
              (2) by adding at the end the following new subparagraph:
                      ``(D) Demographically adjusted fee-for-service per 
                  capita expenditures.--
                              ``(i) In general.--For 2001 and each 
                          subsequent year, 90 percent of the adjusted 
                          average per capita cost for the year for the 
                          Medicare+Choice payment area determined by the 
                          Secretary based upon the rule specified under 
                          paragraph (4) of section 1876(a) and calculated 
                          without regard to the adjustment under 
                          paragraph (1)(C) of such section.
                              ``(ii) Special rule for risk adjustment.--
                          For purposes of applying risk adjustment to the 
                          payment amount determined under this 
                          subparagraph for a demographic class, the risk 
                          adjustment for such demographic class shall be 
                          determined under the methodology applied by the 
                          Secretary under section 1876(a)(4) without 
                          regard to subsection (a)(3) of this section.''.
      (b) Continuation of Computation of AAPCC Data.--Section 1853(b) of 
  such Act (42 U.S.C. 1395w-23(b)) is amended by adding at the end the 
  following new paragraph:
              ``(4) Continued computation and publication of county-
          specific per capita fee-for-service expenditure information.--
          Using the most recent data available, the Secretary shall 
          provide for the computation and publication, on an annual basis 
          at the time of publication of the annual Medicare+Choice 
          capitation rates, of information on the level of the average 
          annual per capita costs (described in section 1876(a)(4)) for 
          each Medicare+Choice payment area.''.
  
  SEC. 3. ELIMINATION OF BUDGET NEUTRALITY ADJUSTMENT FOR 2001 AND 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 a year (other than 2001 or 2002)'' 
          after ``multiplied''; and
              (2) in paragraph (5), by inserting ``(other than 2001 or 
          2002)'' after ``for each year''.
  
  SEC. 4. INCREASE IN NATIONAL PER CAPITA MEDICARE+CHOICE GROWTH 
                PERCENTAGE IN 2001 AND 2002.
  
      Section 1853(c)(6)(B) of the Social Security Act (42 U.S.C. 1395w-
  23(c)(6)(B)) is amended--
              (1) in clause (iv), by striking ``for 2001, 0.5 percentage 
          points'' and inserting ``for 2001, 0 percentage points''; and
              (2) in clause (v), by striking ``for 2002, 0.3 percentage 
          points'' and inserting ``for 2002, 0 percentage points''.
  
  SEC. 5. INCREASING MINIMUM PAYMENT AMOUNT.
  
      (a) In General.--Section 1853(c)(1)(B)(ii) of the Social Security 
  Act (42 U.S.C. 1395w-23(c)(1)(B)(ii)) is amended--
              (1) by striking ``(ii) For a succeeding year'' and 
          inserting ``(ii)(I) Subject to subclause (II), for a succeeding 
          year''; and
              (2) by adding at the end the following new subclause:
                              ``(II) For 2001 for any of the 50 States 
                          and the District of Columbia, $450.''.
      (b) Effective Date.--The amendments made by subsection (a) apply to 
  years beginning with 2001.
  
  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 2001 and 
          for 2002.''.
  
  SEC. 7. INCREASED UPDATE FOR PAYMENT AREAS WITH ONLY ONE OR NO 
                MEDICARE+CHOICE CONTRACTS.
  
      (a) In General.--Section 1853(c)(1)(C)(ii) of the Social Security 
  Act (42 U.S.C. 1395w-23(c)(1)(C)(ii)) is amended--
              (1) by striking ``(ii) For a subsequent year'' and 
          inserting ``(ii)(I) Subject to subclause (II), for a subsequent 
          year''; and
              (2) by adding at the end the following new subclause:
                              ``(II) During 2001, 2002, 2003, 2004, and 
                          2005, in the case of a Medicare+Choice payment 
                          area in which there is no more than one 
                          contract entered into under this part as of 
                          July 1 before the beginning of the year, 102.5 
                          percent of the annual Medicare+Choice 
                          capitation rate under this paragraph for the 
                          area for the previous year.''.
      (b) Construction.--The amendments made by subsection (a) do not 
  affect the payment of a first time bonus under section 1853(i) of the 
  Social Security Act (42 U.S.C. 1395w-23(i)).
  
  SEC. 8. PERMITTING HIGHER NEGOTIATED RATES IN CERTAIN MEDICARE+CHOICE 
                PAYMENT AREAS BELOW NATIONAL AVERAGE.
  
      Section 1853(c)(1) of the Social Security Act (42 U.S.C. 1395w-
  23(c)(1)) is amended--
              (1) in the matter before subparagraph (A), by striking ``or 
          (C)'' and inserting ``(C), or (D)''; and
              (2) by adding at the end the following new subparagraph:
                      ``(D) Permitting higher rates through 
                  negotiation.--
                              ``(i) In general.--For each year beginning 
                          with 2004, in the case of a Medicare+Choice 
                          payment area for which the Medicare+Choice 
                          capitation rate under this paragraph would 
                          otherwise be less than the United States per 
                          capita cost (USPCC), as calculated by the 
                          Secretary, a Medicare+Choice organization may 
                          negotiate with the Secretary an annual per 
                          capita rate that--
                                      ``(I) reflects an annual rate of 
                                  increase up to the rate of increase 
                                  specified in clause (ii);
                                      ``(II) takes into account audited 
                                  current data supplied by the 
                                  organization on its adjusted community 
                                  rate (as defined in section 
                                  1854(f)(3)); and
                                      ``(III) does not exceed the United 
                                  States per capita cost, as projected by 
                                  the Secretary for the year involved.
                              ``(ii) Maximum rate described.--The rate of 
                          increase specified in this clause for a year is 
                          the rate of inflation in private health 
                          insurance for the year involved, as projected 
                          by the Secretary, and includes such adjustments 
                          as may be necessary--
                                      ``(I) to reflect the demographic 
                                  characteristics in the population under 
                                  this title; and
                                      ``(II) to eliminate the costs of 
                                  prescription drugs.
                              ``(iii) Adjustments for over or under 
                          projections.--If subparagraph is applied to an 
                          organization and payment area for a year, in 
                          applying this subparagraph for a subsequent 
                          year the provisions of paragraph (6)(C) shall 
                          apply in the same manner as such provisions 
                          apply under this paragraph.''.
  
  SEC. 9. 10-YEAR PHASE IN OF RISK ADJUSTMENT BASED ON DATA FROM ALL 
                SETTINGS.
  
      Section 1853(a)(3)(C)(ii) of the Social Security Act (42 U.S.C. 
  1395w-23(c)(1)(C)(ii)) is amended--
              (1) by striking the period at the end of subclause (II) and 
          inserting a semicolon; and
              (2) by adding after and below subclause (II) the following:
                          ``and, beginning in 2004, insofar as such risk 
                          adjustment is based on data from all (or 
                          substantially all) settings, the methodology 
                          shall be phased in equal increments over a 10 
                          year period, beginning with 2004 or (if later) 
                          the first year in which such data is used.''.
  
  SEC. 10. DELAY FROM JULY TO NOVEMBER, 2000 IN DEADLINE FOR OFFERING AND 
                WITHDRAWING MEDICARE+CHOICE PLANS FOR 2001.
  
      Notwithstanding any other provision of law, the deadline for a 
  Medicare+Choice organization to withdraw the offering of a 
  Medicare+Choice plan under part C of title XVIII of the Social Security 
  Act (or otherwise to submit information required for the offering of 
  such a plan) for 2001 is delayed from July 1, 2000, to November 1, 
  2000, and any such organization that provided notice of withdrawal of 
  such a plan during 2000 before the date of the enactment of this Act 
  may rescind such withdrawal at any time before November 1, 2000.
  
  SEC. 11. MISCELLANEOUS REGULATORY CHANGES.
  
      (a) Prohibition on Requirement To Submit Encounter Data.--Section 
  1853(a)(3)(B) of the Social Security Act (42 U.S.C. 1395w-23(a)(3)(B)) 
  is amended--
              (1) by designating the matter following ``Data collection'' 
          as a clause (i) with appropriate indentation and the heading 
          ``In general''; and
              (2) by adding at the end the following new clauses:
                              ``(ii) Issuance of data submission 
                          requirements.--The Secretary may not require 
                          under clause (i) the submission of encounter 
                          data to support a risk adjustment methodology 
                          based on all (or substantially all) settings 
                          until a reasonable time after the Secretary 
                          issues the complete requirements for data 
                          submission. Such requirements shall be limited 
                          to the minimum data elements necessary to 
                          support the risk adjustment methodology. Such 
                          system shall be designed to accept the required 
                          minimum data elements in a form and manner 
                          compatible with Medicare+Choice organizations' 
                          operations.
                              ``(iii) Evaluation.--In issuing such data 
                          submission requirements, the Secretary must 
                          include an evaluation by an outside, 
                          independent actuary of whether the proposed 
                          data elements are the minimum necessary to 
                          support the risk adjustment methodology.''.
      (b) Post-Stabilization Guidelines.--Section 1852(d)(2) of such Act 
  (42 U.S.C. 1395w-22(d)(2)) is amended by adding at the end the 
  following: ``In prescribing such guidelines--
                      ``(A) post-stabilization care shall be limited to 
                  care related to treatment of the condition that 
                  precipitated the provision of emergency services; and
                      ``(B) the provider of emergency services is not 
                  authorized to provide post-stabilization care unless--
                              ``(i) the Medicare+Choice organization has 
                          been notified as soon as practicable, but not 
                          later than 2 hours after stabilization, in 
                          advance of the request to provide such care;
                              ``(ii) the organization has either approved 
                          the request or not responded to such request 
                          within a reasonable period (of at least 3 
                          hours) after it has been notified; and
                              ``(iii) the emergency services provider 
                          maintains a written documentation concerning 
                          the notice and the organization's response to 
                          such notice.''.
      (c) Enrollment Process.--
              (1) Allowing on-line enrollment.--Section 1851(c)(2) of 
          such Act (42 U.S.C. 1395w-21(c)(2)) is amended by adding at the 
          end the following:
                      ``(C) On-line applications.--Such process shall 
                  permit the filing of appropriate election forms under 
                  subparagraphs (A) and (B) to be done through electronic 
                  means (including use of the Internet).''.
              (2) Moratorium on changes in medicare+choice enrollment 
          rules.--The Secretary of Health and Human Services shall not 
          make any changes in the enrollment and disenrollment 
          instructions and related materials (including operational 
          policy letters and evidence of coverage) under the 
          Medicare+Choice program under part C of title XVIII of the 
          Social Security Act between the date of the enactment of this 
          Act and January 1, 2002, except as may be specifically and only 
          required to comply with a change in statute.
target: Delays from July to November 2000 the deadline for withdrawing the offer, or rescinding the withdrawal, of Medicare+Choice plans for 2001.
  Amends SSA title XVIII part C to Medicare+Choice program data collection requirements with regard to: (1) issuance of encounter data submission requirements; (2) post- stabilization guidelines; and (3) on-line enrollment.
  Prohibits the Secretary from making any changes in the enrollment and disenrollment instructions and related materials (including operational policy letters and evidence of coverage) under Medicare+Choice between enactment of this Act and January 1, 2002, except as may be specifically and only required to comply with a change in statute.
feat_title: Medicare Beneficiaries' Choice Stabilization Act of 2000