To provide for equitable reimbursement rates in 2004 and 205 for Medicare+Choice organizations making the transition to MedicareAdvantage organization.
What it does: 8 changes: replaces text in 3 places, inserts text in 5 places
Sen. Charles E. Schumer (D-NY)What it changes
8 changes to S. 1
Change 1: Replaces “or (C)” with “(C), or (D)”
[struck: or (C)][inserted: (C), or (D)]Original wording
On page 294, line 6, strike “or (C)” and insert “(C), or (D)”.
Change 2: Inserts “(other than in 2004 and 2005)” after “multiplied”
…multiplied[inserted: (other than in 2004 and 2005)]…
Original wording
On page 294, line 21, insert “(other than in 2004 and 2005)” after “multiplied”.
Change 3: Rewrites page 297, lines 5–9
ReplacesPrinted pageRemoves page 297, lines 5–9 of the printed bill. See that page
Inserted: (iv) For 2002 and 2003, 102 percent of the annual Medicare+Choice capitation rate under this paragraph for the area for the previous year.
Inserted: (v) For 2004 and 2005, 103 percent of the annual Medicare+Choice capitation rate under this paragraph for the area for the previous year.
Inserted: (vi) For 2006 and each succeeding year, 102 percent of the annual Medicare+Choice capitation rate under this paragraph for the area for the previous year.
Inserted: (D) Annual fee-for-service costs in 2004 and 2005.--For 2004 and 2005, the adjusted average per capita cost for the year, as determined under section 1876(a)(4) for the Medicare+Choice payment area for items and services covered under parts A and B for individuals entitled to benefits under part A and enrolled under part B and not enrolled in a Medicare+Choice plan under this part for the year, except that such amount shall be adjusted--
Inserted: (i) to exclude costs attributable to payment adjustments described in subsection (a)(5)(B)(ii), and
Inserted: (ii) to include an amount equal to the Secretary's estimate, on a per capita basis, of the amount of additional payments that would have been made in the area involved under this title if individuals entitled to benefits under this title had not received services from facilities of the Department of Defense or the Department of Veterans Affairs.
Original wording
On page 297, strike lines 5 through 9, and insert the following:
Change 4: Replaces “subparagraph (B)” with “subparagraphs (B) and (E)”
[struck: subparagraph (B)][inserted: subparagraphs (B) and (E)]Original wording
On page 298, line 10, strike “subparagraph (B)” and insert “subparagraphs (B) and (E)”.
Change 5: Inserts new text on page 301, between lines 8 and 9
InsertsPrinted pageInserted: (E) Inclusion of costs of dod and va military facility services to medicare-eligible beneficiaries.--In determining the area-specific Medicare+Choice capitation rate under subparagraph (A) for 2004 and 2005, the annual per capita rate of payment for 1997 determined under section 1876(a)(1)(C) shall be adjusted to include in the rate the Secretary's estimate, on a per capita basis, of the amount of additional payments that would have been made in the area involved under this title if individuals entitled to benefits under this title had not received services from facilities of the Department of Defense or the Department of Veterans Affairs.
Original wording
On page 301, between lines 8 and 9, insert the following:
Change 6: Inserts “(or, in the case of calculations for payments for months beginning on or after January 1,…” after “medicare beneficiaries”
…medicare beneficiaries[inserted: (or, in the case of calculations for payments for months beginning on or after January 1, 2004, and before December 31, 2005, the average number of medicare beneficiaries enrolled in a Medicare+Choice plan that are)]…
Original wording
On page 302, line 23, insert “(or, in the case of calculations for payments for months beginning on or after January 1, 2004, and before December 31, 2005, the average number of medicare beneficiaries enrolled in a Medicare+Choice plan that are)” after “medicare beneficiaries”.
Change 7: Inserts “other than 2004 and 2005” after “for each year”
…for each year[inserted: other than 2004 and 2005]…
Original wording
On page 303, line 9, insert “other than 2004 and 2005” after “for each year”.
Change 8: Inserts new text on page 349, between lines 4 and 5
InsertsPrinted pageInserted: (3) Payment rates based on 100 percent of fee-for-service costs in 2004 and 2005.--
Inserted: (A) Change in budget neutrality.--Section 1853(c) (42 U.S.C. 1395w-23(c)) is amended--
Inserted: (i) in paragraph (1)(A), in the flush matter following clause (ii), by inserting "(other than in 2004 and 2005)" after "multiplied"; and
Inserted: (ii) in paragraph (5), by inserting "other than 2004 and 2005" after "for each year".
Inserted: (B) Inclusion of costs of dod and va military facility services to medicare-eligible beneficiaries.--Section 1853(c)(3) (42 U.S.C. 1395w-23(c)(3)) is amended--
Inserted: (A) in subparagraph (A), by striking "subparagraph (B)" and inserting "subparagraphs (B) and (E)"; and
Inserted: (B) by adding at the end the following new subparagraph:
Inserted: "(E) Inclusion of costs of dod and va military facility services to medicare-eligible beneficiaries.--In determining the area-specific Medicare+Choice capitation rate under subparagraph (A) for 2004 and 2005, the annual per capita rate of payment for 1997 determined under section 1876(a)(1)(C) shall be adjusted to include in the rate the Secretary's estimate, on a per capita basis, of the amount of additional payments that would have been made in the area involved under this title if individuals entitled to benefits under this title had not received services from facilities of the Department of Defense or the Department of Veterans Affairs.".
Inserted: (C) Revision of national average used in calculation of blend.--Section 1853(c)(4)(B)(i)(II) (42 U.S.C. 1395w-23(c)(4)(B)(i)(II)) is amended by inserting "(or, in the case of calculations for payments for months beginning on or after January 1, 2004, and before December 31, 2005, the average number of medicare beneficiaries enrolled in a Medicare+Choice plan that are)" after "medicare beneficiaries".
Inserted: (D) Update in minimum percentage increase.--Section 1853(c)(1)(C) (42 U.S.C. 1395w-23(c)(1)(C)) is amended by striking clause (iv) and inserting the following new clauses:
Inserted: "(iv) For 2002 and 2003, 102 percent of the annual Medicare+Choice capitation rate under this paragraph for the area for the previous year.
Inserted: "(v) For 2004 and 2005, 103 percent of the annual Medicare+Choice capitation rate under this paragraph for the area for the previous year.
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Inserted: "(vi) For 2006 and each succeeding year, 102 percent of the annual Medicare+Choice capitation rate under this paragraph for the area for the previous year.".
Original wording
On page 349, between lines 4 and 5, insert the following:
Read automatically from the Congressional Record. Check the original before relying on it.
As printed
SA 1040. Mr. SCHUMER (for himself, Mr. Corzine, Mrs. Clinton, and Mr. Lautenberg) submitted an amendment intended to be proposed by him to the bill S. 1, to amend title XVIII of the Social Security Act to make improvements in the medicare program, to provide prescription drug coverage under the medicare program, and for other purposes; which was ordered to lie on the table; as follows:
On page 294, line 6, strike “or (C)” and insert “(C), or (D)”.
On page 294, line 21, insert “(other than in 2004 and 2005)” after “multiplied”.
On page 297, strike lines 5 through 9, and insert the following:
“(iv) For 2002 and 2003, 102 percent of the annual Medicare+Choice capitation rate under this paragraph for the area for the previous year.
“(v) For 2004 and 2005, 103 percent of the annual Medicare+Choice capitation rate under this paragraph for the area for the previous year.
“(vi) For 2006 and each succeeding year, 102 percent of the annual Medicare+Choice capitation rate under this paragraph for the area for the previous year.
“(D) Annual fee-for-service costs in 2004 and 2005.--For 2004 and 2005, the adjusted average per capita cost for the year, as determined under section 1876(a)(4) for the Medicare+Choice payment area for items and services covered under parts A and B for individuals entitled to benefits under part A and enrolled under part B and not enrolled in a Medicare+Choice plan under this part for the year, except that such amount shall be adjusted--
“(i) to exclude costs attributable to payment adjustments described in subsection (a)(5)(B)(ii), and
“(ii) to include an amount equal to the Secretary's estimate, on a per capita basis, of the amount of additional payments that would have been made in the area involved under this title if individuals entitled to benefits under this title had not received services from facilities of the Department of Defense or the Department of Veterans Affairs.
On page 298, line 10, strike “subparagraph (B)” and insert “subparagraphs (B) and (E)”.
On page 301, between lines 8 and 9, insert the following:
“(E) Inclusion of costs of dod and va military facility services to medicare-eligible beneficiaries.--In determining the area-specific Medicare+Choice capitation rate under subparagraph (A) for 2004 and 2005, the annual per capita rate of payment for 1997 determined under section 1876(a)(1)(C) shall be adjusted to include in the rate the Secretary's estimate, on a per capita basis, of the amount of additional payments that would have been made in the area involved under this title if individuals entitled to benefits under this title had not received services from facilities of the Department of Defense or the Department of Veterans Affairs.
On page 302, line 23, insert “(or, in the case of calculations for payments for months beginning on or after January 1, 2004, and before December 31, 2005, the average number of medicare beneficiaries enrolled in a Medicare+Choice plan that are)” after “medicare beneficiaries”.
On page 303, line 9, insert “other than 2004 and 2005” after “for each year”.
On page 349, between lines 4 and 5, insert the following:
(3) Payment rates based on 100 percent of fee-for-service costs in 2004 and 2005.--
(A) Change in budget neutrality.--Section 1853(c) (42 U.S.C. 1395w-23(c)) is amended--
(i) in paragraph (1)(A), in the flush matter following clause (ii), by inserting “(other than in 2004 and 2005)” after “multiplied”; and
(ii) in paragraph (5), by inserting “other than 2004 and 2005” after “for each year”.
(B) Inclusion of costs of dod and va military facility services to medicare-eligible beneficiaries.--Section 1853(c)(3) (42 U.S.C. 1395w-23(c)(3)) is amended--
(A) in subparagraph (A), by striking “subparagraph (B)” and inserting “subparagraphs (B) and (E)”; and
(B) by adding at the end the following new subparagraph:
“(E) Inclusion of costs of dod and va military facility services to medicare-eligible beneficiaries.--In determining the area-specific Medicare+Choice capitation rate under subparagraph (A) for 2004 and 2005, the annual per capita rate of payment for 1997 determined under section 1876(a)(1)(C) shall be adjusted to include in the rate the Secretary's estimate, on a per capita basis, of the amount of additional payments that would have been made in the area involved under this title if individuals entitled to benefits under this title had not received services from facilities of the Department of Defense or the Department of Veterans Affairs.”.
(C) Revision of national average used in calculation of blend.--Section 1853(c)(4)(B)(i)(II) (42 U.S.C. 1395w-23(c)(4)(B)(i)(II)) is amended by inserting “(or, in the case of calculations for payments for months beginning on or after January 1, 2004, and before December 31, 2005, the average number of medicare beneficiaries enrolled in a Medicare+Choice plan that are)” after “medicare beneficiaries”.
(D) Update in minimum percentage increase.--Section 1853(c)(1)(C) (42 U.S.C. 1395w-23(c)(1)(C)) is amended by striking clause (iv) and inserting the following new clauses:
“(iv) For 2002 and 2003, 102 percent of the annual Medicare+Choice capitation rate under this paragraph for the area for the previous year.
“(v) For 2004 and 2005, 103 percent of the annual Medicare+Choice capitation rate under this paragraph for the area for the previous year.
“(vi) For 2006 and each succeeding year, 102 percent of the annual Medicare+Choice capitation rate under this paragraph for the area for the previous year.”.
Legislative Activity
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Senate amendment proposed (on the floor): Amendment SA 1040 proposed by Senator Schumer.(consideration: CR S8500-8502, S8506-8512; text: CR S8500-8501)
June 25, 2003
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Senate amendment proposed (on the floor): Amendment SA 1040 proposed by Senator Schumer.(consideration: CR S8500-8502, S8506-8512; text: CR S8500-8501)
June 25, 2003
Amendment SA 1040 proposed by Senator Schumer. (consideration: CR S8500-8502, S8506-8512; text: CR S8500-8501) To provide for equitable reimbursement rates in 2004 and 205 for Medicare+Choice organizations making the transition to MedicareAdvantage organization.
June 25, 2003
Proposed amendment SA 1040 withdrawn in Senate.
June 25, 2003
Senate amendment submitted
June 24, 2003