S.Amdt. 599

1. 1

   Change 1: Adds TITLE ____--MEDICARE AND MEDICAID PROVISIONS at the end of the bill

   Adds a title

   In S. 1054 · Placed on Calendar Senate

   (2) Title III (other than section 362).

   Inserted: TITLE ____--MEDICARE AND MEDICAID PROVISIONS

   Inserted: SEC. ____00. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT; REFERENCES TO BIPA; TABLE OF CONTENTS.

   Inserted: (a) Short Title.--This title may be cited as the "Health Care Improvement Act of 2003".

   Inserted: (b) Amendments to Social Security Act.--Except as otherwise specifically provided, whenever in this title an amendment is expressed in terms of an amendment to or repeal of a section or other provision, the reference shall be considered to be made to that section or other provision of the Social Security Act.

   Inserted: (c) BIPA.--In this title, the term "BIPA" means the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, as enacted into law by section 1(a)(6) of Public Law 106-554.

   Inserted: (d) Table of Contents.--The table of contents of this title is as follows:

   Inserted: TITLE ____--MEDICARE AND MEDICAID PROVISIONS

   Inserted: Sec. ____00. Short title; amendments to Social Security Act; references to BIPA; table of contents.

   Inserted: Subtitle A--Medicare Provisions

   Inserted: Sec. ____01. Revision of acute care hospital payment updates.

   Inserted: Sec. ____02. Extension of level of adjustment for Indirect Costs of Medical Education (IME).

   Inserted: Sec. ____03. Hospital outpatient department outlier payments.

   Show 120 more inserted paragraphsShow less

   Inserted: Sec. ____04. Hospital outpatient department transitional payments.

   Inserted: Sec. ____05. Application of rules for determining provider-based status for certain entities.

   Inserted: Sec. ____06. Extension of treatment of certain physician pathology services.

   Inserted: Sec. ____07. Extension of the authorization for appropriations for Medicare Rural Grant Program.

   Inserted: Sec. ____08. Extension of enhanced payments for psychiatric hospitals.

   Inserted: Sec. ____09. Additional delay in application of 15 percent reduction on payment limits for home health services.

   Inserted: Sec. ____10. Extension of temporary increase for home health services furnished in a rural area.

   Inserted: Sec. ____11. Extension of temporary increase in adjusted Federal per diem rate under PPS for skilled nursing facilities.

   Inserted: Sec. ____12. Extension of increase in nursing component of PPS Federal rate under PPS for skilled nursing facilities.

   Inserted: Sec. ____13. Increase in renal dialysis composite rate for services furnished in 2003.

   Inserted: Sec. ____14. Extension of the authorization for appropriations for vaccines outreach expansion.

   Inserted: Sec. ____15. Extension of moratorium on therapy caps.

   Inserted: Sec. ____16. Increase in the conversion factor for payments under the medicare physician fee schedule.

   Inserted: Sec. ____17. Revision of Medicare+Choice minimum percentage increase.

   Inserted: Subtitle B--Medicaid Provisions

   Inserted: Sec. ____21. Extension of medicare cost-sharing for part B premium for certain additional low-income medicare beneficiaries.

   Inserted: Sec. ____22. Medicaid DSH allotments.

   Inserted: Subtitle C--Application and Budget Scorekeeping

   Inserted: Sec. ____31. Application of provisions of title.

   Inserted: Subtitle A--Medicare Provisions SEC. ____01. REVISION OF ACUTE CARE HOSPITAL PAYMENT UPDATES.

   Inserted: Subclause (XVIII) of section 1886(b)(3)(B)(i) (42 U.S.C. 1395ww(b)(3)(B)(i)) is amended by striking "minus 0.55 percentage points".

   Inserted: SEC. ____02. EXTENSION OF LEVEL OF ADJUSTMENT FOR INDIRECT COSTS OF MEDICAL EDUCATION (IME).

   Inserted: (a) In General.--Section 1886(d)(5)(B)(ii) (42 U.S.C. 1395ww(d)(5)(B)(ii)) is amended--

   Inserted: (1) in subclause (VI) by inserting "and fiscal year 2003" after "2002"; and

   Inserted: (2) in subclause (VII), by striking "2002" and inserting "2003".

   Inserted: (b) Conforming Amendment Relating to Determination of Standardized Amount.--Section 1886(d)(2)(C)(i) (42 U.S.C. 1395ww(d)(2)(C)(i)) is amended--

   Inserted: (1) by striking "1999 or" and inserting "1999,"; and

   Inserted: (2) by inserting ", or of section ____02 of the Health Care Improvement Act of 2003" after "2000".

   Inserted: SEC. ____03. HOSPITAL OUTPATIENT DEPARTMENT OUTLIER PAYMENTS.

   Inserted: (a) In General.--Section 1833(t)(5) (42 U.S.C. 1395l(t)(5)) is amended--

   Inserted: (1) in subparagraph (C)--

   Inserted: (A) in clause (i), by striking "exceed the applicable" and inserting "exceed a percentage specified by the Secretary that is not less than the applicable minimum percentage or greater than the applicable maximum"; and

   Inserted: (B) by striking clause (ii) and inserting the following new clause:

   Inserted: "(ii) Applicable percentages.--For purposes of clause (i)--

   Inserted: "(I) the term 'applicable minimum percentage' for a year means zero percent for years before 2003 and 2.0 percent for years after 2002; and

   Inserted: "(II) the term 'applicable maximum percentage' for a year means 2.5 percent for years before 2003 and 3.0 percent for years after 2002."; and

   Inserted: (2) in subparagraph (D)--

   Inserted: (A) in the heading, by striking "Transitional authority" and inserting "Flexibility"; and

   Inserted: (B) in the matter preceding clause (i), by striking "for covered OPD services furnished before January 1, 2002,".

   Inserted: SEC. ____04. HOSPITAL OUTPATIENT DEPARTMENT TRANSITIONAL PAYMENTS.

   Inserted: Section 1833(t)(7) (42 U.S.C. 1395l(t)(7)) is amended--

   Inserted: (1) in subparagraph (B)--

   Inserted: (A) in the heading, by inserting "and 2003" after "2002"; and

   Inserted: (B) by inserting "and 2003" after "furnished during 2002" in the matter preceding clause (i); and

   Inserted: (2) in subparagraph (C)--

   Inserted: (A) in the heading, by striking "2003" and inserting "2004"; and

   Inserted: (B) by striking "2003" and inserting "2004" in the matter preceding clause (i); and

   Inserted: (3) in subparagraph (D)(i), by striking "2004" and inserting "2005".

   Inserted: SEC. ____05. APPLICATION OF RULES FOR DETERMINING PROVIDER-BASED STATUS FOR CERTAIN ENTITIES.

   Inserted: Section 404 of BIPA (114 Stat. 2763A-506) is amended by striking "2002" and inserting "2003" each place it appears.

   Inserted: SEC. ____06. EXTENSION OF TREATMENT OF CERTAIN PHYSICIAN PATHOLOGY SERVICES.

   Inserted: Section 542(c) of BIPA (114 Stat. 2763A-550) is amended by striking "2-year period" and inserting "3-year period".

   Inserted: SEC. ____07. EXTENSION OF THE AUTHORIZATION FOR APPROPRIATIONS FOR MEDICARE RURAL GRANT PROGRAM.

   Inserted: Section 1820(j) (42 U.S.C. 1395i-4(j)) is amended by striking "2002" and inserting "2003".

   Inserted: SEC. ____08. EXTENSION OF ENHANCED PAYMENTS FOR PSYCHIATRIC HOSPITALS.

   Inserted: Section 1886(b)(2)(E)(i) (42 U.S.C. 1395ww(b)(2)(E)(i)) is amended--

   Inserted: (1) in subclause (I), by striking "and" at the end;

   Inserted: (2) in subclause (II), by striking the period at the end and inserting "; and"; and

   Inserted: (3) by adding at the end the following new subclause:

   Inserted: "(III) only in the case of a hospital or unit described in clause (ii)(I), for a cost reporting period beginning on or after October 1, 2002, and before September 30, 2003, 2 percent.".

   Inserted: SEC. ____09. ADDITIONAL DELAY IN APPLICATION OF 15 PERCENT REDUCTION ON PAYMENT LIMITS FOR HOME HEALTH SERVICES.

   Inserted: Section 1895(b)(3)(A)(i) (42 U.S.C. 1395fff(b)(3)(A)(i)) is amended--

   Inserted: (1) by redesignating subclause (III) as subclause (IV);

   Inserted: (2) in subclause (IV), as redesignated, by striking "described in subclause (II)" and inserting "described in subclause (III)"; and

   Inserted: (3) by inserting after subclause (II) the following new subclause:

   Inserted: "(III) For the 12-month period beginning after the period described in subclause (II), such amount (or amounts) shall be equal to the amount (or amounts) determined under subclause (II), updated under subparagraph (B).".

   Inserted: SEC. ____10. EXTENSION OF TEMPORARY INCREASE FOR HOME HEALTH SERVICES FURNISHED IN A RURAL AREA.

   Inserted: (a) In General.--Section 508(a) BIPA (114 Stat. 2763A-533) is amended--

   Inserted: (1) by striking "24-Month Increase Beginning April 1, 2001" and inserting "In General"; and

   Inserted: (2) by striking "April 1, 2003" and inserting "October 1, 2003".

   Inserted: (b) Conforming Amendment.--Section 547(c)(2) of BIPA (114 Stat. 2763A-553) is amended by striking "the period beginning on April 1, 2001, and ending on September 30, 2002," and inserting "a period under such section".

   Inserted: SEC. ____11. EXTENSION OF TEMPORARY INCREASE IN ADJUSTED FEDERAL PER DIEM RATE UNDER PPS FOR SKILLED NURSING FACILITIES.

   Inserted: Section 101(d)(1) of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (Appendix F, 113 Stat. 1501A-325), as enacted into law by section 1000(a)(6) of Public Law 106-113, is amended--

   Inserted: (1) in the heading, by striking "and 2002" and inserting ", 2002, and 2003"; and

   Inserted: (2) by striking "and 2002" and inserting ", 2002, and 2003".

   Inserted: SEC. ____12. EXTENSION OF INCREASE IN NURSING COMPONENT OF PPS FEDERAL RATE UNDER PPS FOR SKILLED NURSING FACILITIES.

   Inserted: Section 312(a) of BIPA (114 Stat. 2763A-498) is amended by striking "October 1, 2002" and inserting "October 1, 2003".

   Inserted: SEC. ____13. INCREASE IN RENAL DIALYSIS COMPOSITE RATE FOR SERVICES FURNISHED IN 2003.

   Inserted: Notwithstanding any other provision of law, with respect to payment under part B of title XVIII of the Social Security Act for renal dialysis services furnished in 2003, the composite payment rate otherwise established under section 1881(b)(7) of such Act (42 U.S.C. 1395rr(b)(7)) shall be increased by 1.2 percent.

   Inserted: SEC. ____14. EXTENSION OF THE AUTHORIZATION FOR APPROPRIATIONS FOR VACCINES OUTREACH EXPANSION.

   Inserted: Section 4107(b) of the Balanced Budget Act of 1997 (42 U.S.C. 1395x note) is amended by striking "2002" and inserting "2003".

   Inserted: SEC. ____15. EXTENSION OF MORATORIUM ON THERAPY CAPS.

   Inserted: Section 1833(g)(4) (42 U.S.C. 1395l(g)(4)) is amended by striking "and 2002" and inserting "2002, and 2003".

   Inserted: SEC. ____16. INCREASE IN THE CONVERSION FACTOR FOR PAYMENTS UNDER THE MEDICARE PHYSICIAN FEE SCHEDULE.

   Inserted: (a) In General.--Section 1848(d)(5)(A) of the Social Security Act (42 U.S.C. 1395w-4(d)(5)(A)), as added by section 402 of the Miscellaneous Appropriations Act, 2003 (Public Law 108-7), is amended by inserting "increased by 2 percent" after "2002".

   Inserted: (b) Effective Date.--The amendment made by subsection (a) shall take effect as if included in the enactment of such section 402.

   Inserted: SEC. ____17. REVISION OF MEDICARE+CHOICE MINIMUM PERCENTAGE INCREASE.

   Inserted: Section 1853(c)(1)(C) (42 U.S.C. 1395w-23(c)(1)(C)) is amended by striking clause (iv) and inserting the following:

   Inserted: "(iv) For 2002, 102 percent of the annual Medicare+Choice capitation rate under this paragraph for the area for 2001.

   Inserted: "(v) For 2003, 104 percent of the annual Medicare+Choice capitation rate under this paragraph for the area for 2002.

   Inserted: "(vii) For 2004 and each succeeding year, 102 percent of the annual Medicare+Choice capitation rate under this paragraph for the area for the previous year.".

   Inserted: Subtitle B--Medicaid Provisions SEC. ____21. EXTENSION OF MEDICARE COST-SHARING FOR PART B PREMIUM FOR CERTAIN ADDITIONAL LOW-INCOME MEDICARE BENEFICIARIES.

   Inserted: Section 136 of Public Law 107-229, as added by section 5 of Public Law 107-240, is amended by striking "60 days after the date specified in section 107(c) of Public Law 107-229, as amended" and inserting "September 30, 2003".

   Inserted: SEC. ____22. MEDICAID DSH ALLOTMENTS.

   Inserted: (a) Continuation of BIPA Rule for Determination of Allotments for Fiscal Year 2003.--

   Inserted: (1) In general.--Section 1923(f)(4) (42 U.S.C. 1396r-4(f)(4)) is amended--

   Inserted: (A) in the paragraph heading, by striking "and 2002" and inserting "through 2003";

   Inserted: (B) in subparagraph (A)--

   Inserted: (i) in clause (i), by striking "and" at the end;

   Inserted: (ii) in clause (ii), by striking the period and inserting "; and"; and

   Inserted: (iii) by adding at the end the following:

   Inserted: "(iii) fiscal year 2003, shall be the DSH allotment determined under clause (ii) increased, subject to subparagraph (B) and paragraph (5), by the percentage change in the consumer price index for all urban consumers (all items; U.S. city average) for fiscal year 2002."; and

   Inserted: (C) in subparagraph (C)--

   Inserted: (i) in the subparagraph heading, by striking "2002" and inserting "2003"; and

   Inserted: (ii) by striking "2003" and inserting "2004".

   Inserted: (2) Conforming amendments.--Section 1923(f)(3) (42 U.S.C. 1396r-4(f)(3)) is amended--

   Inserted: (A) in the paragraph heading, by striking "2003" and inserting "2004"; and

   Inserted: (B) by striking subparagraph (A) and inserting the following:

   Inserted: "(A) In general.--The DSH allotment for any State--

   Inserted: "(i) for fiscal year 2004, is equal to the DSH allotment determined for the State for fiscal year 2002 under the table set forth in paragraph (2), increased, subject to subparagraph (B) and paragraph (5), by the percentage change in the Consumer Price Index for all urban consumers (all items; U.S. city average), for fiscal year 2004; and

   Inserted: "(ii) for fiscal year 2005 and each succeeding fiscal year, is equal to the DSH allotment determined for the State for the preceding fiscal year under this paragraph, increased, subject to subparagraph (B) and paragraph (5), by the percentage change in the Consumer Price Index for all urban consumers (all items; U.S. city average), for the previous fiscal year.".

   Inserted: (b) Increase in Floor for Treatment as an Extremely Low DSH State to 3 Percent in Fiscal Year 2003.--Section 1923(f)(5) (42 U.S.C. 1396r-4(f)(5)) is amended--

   Inserted: (1) by striking "fiscal year 1999" and inserting "fiscal year 2001";

   Inserted: (2) by striking "Health Care Financing Administration" and inserting "Centers for Medicare & Medicaid Services";

   Inserted: (3) by striking "August 31, 2000" and inserting "August 31, 2002";

   Inserted: (4) by striking "1 percent" each place it appears and inserting "3 percent"; and

   Inserted: (5) by striking "fiscal year 2001" and inserting "fiscal year 2003 (as determined under paragraph (4)(A)(iii))".

   Inserted: Subtitle C--Application and Budget Scorekeeping SEC. ____31. APPLICATION OF PROVISIONS OF TITLE.

   Inserted: (a) Application Only to Last 6 Months of Fiscal Year 2003.--Except for the amendments made by sections ____16 and ____21, the provisions of, and amendments made by, this title shall only apply to the Social Security Act, the Balanced Budget Act of 1997, the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (Appendix F, 113 Stat. 1501A-321), as enacted into law by section 1000(a)(6) of Public Law 106-113, and BIPA during the period that begins on April 1, 2003, and ends on September 30, 2003.

   Inserted: (b) No Effect on Periods Beyond September 30, 2003.--All provisions of, and amendments made by, this title shall not apply after September 30, 2003, and, after such date, the Social Security Act, the Balanced Budget Act of 1997, the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (Appendix F, 113 Stat. 1501A-321), as enacted into law by section 1000(a)(6) of Public Law 106-113, and BIPA shall be applied and administered as if the provisions of, and amendments made by, this title had not been enacted.

   Original wording

   At the end, add the following:

2. 2

   Change 2: Rewrites page 19, lines 7–15

   ReplacesPrinted page

   Removes page 19, lines 7–15 of the printed bill. See that page

   Inserted: (2) Limitation.--Paragraph (1) shall apply to qualified dividend income of a taxpayer only to the extent such income does not exceed the sum of $500 ($250 in the case of a married individual filing a separate return).

   Original wording

   On page 19, strike lines 7 through 15, and insert the following:

3. 3

   Change 3: Strikes page 26, lines 17–22

   StrikesPrinted page

   Removes page 26, lines 17–22 of the printed bill. See that page

   Original wording

   On page 26, strike lines 17 through 22.

Read automatically from the Congressional Record. Check the original before relying on it.

As printed