S.Amdt. 3044

1. Adds SEC. _. PAYMENT OF MEDICARE LIABILITY TO STATES AS A RESULT OF THE SPECIAL DISABILITY WORKLOAD PROJECT wherever appropriate

   Adds a section

   Inserted: SEC. _. PAYMENT OF MEDICARE LIABILITY TO STATES AS A RESULT OF THE SPECIAL DISABILITY WORKLOAD PROJECT.

   Inserted: (a) In General.--The Secretary, in consultation with the Commissioner, shall work with each State to reach an agreement, not later than 6 months after the date of enactment of this Act, on the amount of a payment for the State related to the Medicare program liability as a result of the Special Disability Workload project, subject to the requirements of subsection (c).

   Inserted: (b) Payments.--

   Inserted: (1) Deadline for making payments.--Not later than 30 days after reaching an agreement with a State under subsection (a), the Secretary shall pay the State, from the amounts appropriated under paragraph (2), the payment agreed to for the State.

   Inserted: (2) Appropriation.--Out of any money in the Treasury not otherwise appropriated, there is appropriated $4,000,000,000 for fiscal year 2010 for making payments to States under paragraph (1).

   Inserted: (3) Limitations.--In no case may the aggregate amount of payments made by the Secretary to States under paragraph (1) exceed $4,000,000,000.

   Inserted: (c) Requirements.--The requirements of this subsection are the following:

   Inserted: (1) Federal data used to determine amount of payments.--The amount of the payment under subsection (a) for each State is determined on the basis of the most recent Federal data available, including the use of proxies and reasonable estimates as necessary, for determining expeditiously the amount of the payment that shall be made to each State that enters into an agreement under this section. The payment methodology shall consider the following factors:

   Inserted: (A) The number of SDW cases found to have been eligible for benefits under the Medicare program and the month of the initial Medicare program eligibility for such cases.

   Inserted: (B) The applicable non-Federal share of expenditures made by a State under the Medicaid program during the time period for SDW cases.

   Inserted: (C) Such other factors as the Secretary and the Commissioner, in consultation with the States, determine appropriate.

   Inserted: (2) Conditions for payments.--A State shall not receive a payment under this section unless the State--

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   Inserted: (A) waives the right to file a civil action (or to be a party to any action) in any Federal or State court in which the relief sought includes a payment from the United States to the State related to the Medicare liability under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) as a result of the Special Disability Workload project; and

   Inserted: (B) releases the United States from any further claims for reimbursement of State expenditures as a result of the Special Disability Workload project (other than reimbursements being made under agreements in effect on the date of enactment of this Act as a result of such project, including payments made pursuant to agreements entered into under section 1616 of the Social Security Act or section 211(1)(1)(A) of Public Law 93-66).

   Inserted: (3) No individual state claims data required.--No State shall be required to submit individual claims evidencing payment under the Medicaid program as a condition for receiving a payment under this section.

   Inserted: (4) Ineligible states.--No State that is a party to a civil action in any Federal or State court in which the relief sought includes a payment from the United States to the State related to the Medicare liability under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) as a result of the Special Disability Workload project shall be eligible to receive a payment under this section while such an action is pending or if such an action is resolved in favor of the State.

   Inserted: (d) Definitions.--In this section:

   Inserted: (1) Commissioner.--The term "Commissioner" means the Commissioner of Social Security.

   Inserted: (2) Medicaid program.--The term "Medicaid program" means the program of medical assistance established under title XIX of the Social Security Act (42 U.S.C. 1396a et seq.) and includes medical assistance provided under any waiver of that program approved under section 1115 or 1915 of such Act (42 U.S.C. 1315, 1396n) or otherwise.

   Inserted: (3) Medicare program.--The term "Medicare program" means the program established under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).

   Inserted: (4) Secretary.--The term "Secretary" means the Secretary of Health and Human Services.

   Inserted: (5) Sdw case.--The term "SDW case" means a case in the Special Disability Workload project involving an individual determined by the Commissioner to have been eligible for benefits under title II of the Social Security Act (42 U.S.C. 401 et seq.) for a period during which such benefits were not provided to the individual and who was, during all or part of such period, enrolled in a State Medicaid program.

   Inserted: (6) Special disability workload project.--The term "Special Disability Workload project" means the project described in the 2008 Annual Report of the Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds, H.R. Doc. No. 110-104, 110th Cong. (2008).

   Inserted: (7) State.--The term "State" means each of the 50 States and the District of Columbia.

   Inserted: SEC. _. REQUIREMENTS FOR MEDICAID PROVIDERS TO ACCEPT IN-NETWORK PAYMENT RATES FOR SERVICES PROVIDED TO MEDICAID MANAGED CARE ENROLLEES.

   Inserted: (a) In General.--Section 1932(b) of the Social Security Act (42 U.S.C. 1396u-2(b)) is amended by adding at the end the following

   Inserted: "(9) Assuring access to services furnished by non-contract providers.--Any provider of items or services for which medical assistance is provided under the State plan or under a waiver of the plan that does not have in effect a contract with a Medicaid managed care entity that establishes payment amounts for items or services furnished to a beneficiary enrolled in the entity's Medicaid managed care plan shall accept as payment in full no more than the amounts (less any payments for indirect costs of medical education and direct costs of graduate medical education) that it could collect if the beneficiary received medical assistance under this title other than through enrollment in such an entity. In a State where rates paid to hospitals under the State plan are negotiated by contract and not publicly released, the payment amount applicable under this subparagraph shall be the average contract rate that would apply under the State plan for general acute care hospitals or the average contract rate that would apply under such plan for tertiary hospitals.".

   Inserted: (b) Effective Date.--The amendment made by subsection (a) takes effect on January 1, 2010.

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