ProMISE Act

        [Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3081 Introduced in House (IH)]

108th CONGRESS
1st Session
H. R. 3081

To amend title XVIII of the Social Security Act to provide additional
reimbursements for Medicare providers in low-reimbursement States and
to provide financial incentives for high quality, low-cost health care.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

September 11, 2003

Mr. Gephardt (for himself and Mr. Boswell) introduced the following
bill; which was referred to the Committee on Ways and Means, and in
addition to the Committee on Energy and Commerce, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned

_______________________________________________________________________

A BILL

To amend title XVIII of the Social Security Act to provide additional
reimbursements for Medicare providers in low-reimbursement States and
to provide financial incentives for high quality, low-cost health care.

Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Protecting Medicare Investments for
Seniors Everywhere Act (ProMISE Act)''.

SEC. 2. ADDITIONAL REIMBURSEMENTS FOR MEDICARE PROVIDERS IN LOW-
REIMBURSEMENT STATES.

Title XVIII of the Social Security Act is amended by adding at the
end the following new section:

``additional reimbursements for providers in low-reimbursement states

``Sec. 1897. (a) Additional Reimbursement.--
``(1) In general.--Subject to section 1898(c), in the case
of an affected health care provider (as defined in subsection
(c)) that is located in a low-reimbursement State (as defined
in subsection (b)) and that furnishes items or services for
which payment may be made under part A or part B, in addition
to the amount otherwise paid under such part, there also shall
be paid to the provider under such part from the Federal
Hospital Insurance Trust Fund (in the case of payments under
part A) or from the Federal Supplementary Medical Insurance
Fund (in the case of payments under part B) an amount equal to
the payment adjustment percentage (specified in paragraph (2))
of the payment amount for the service under such part.
``(2) Payment adjustment percentage.--In the case of a
provider located in a State for which the medicare
reimbursement ratio--
``(A) is at least 94 percent, the payment
adjustment percentage is 1 percent;
``(B) is at least 93 percent, but less than 94
percent, the payment adjustment percentage is 2
percent;
``(C) is at least 92 percent, but less than 93
percent, the payment adjustment percentage is 3
percent;
``(D) is at least 91 percent, but less than 92
percent, the payment adjustment percentage is 4
percent; or
``(E) is less than 91 percent, the payment
adjustment percentage is 5 percent.
``(b) Low-Reimbursement State; Medicare Reimbursement Ratio
Defined.--For purposes of this section:
``(1) Low-reimbursement state.--The term `low-reimbursement
State' means one of the 50 States or the District of Columbia
in which the medicare reimbursement ratio (as defined in
paragraph (2)) is less than 95 percent.
``(2) Medicare reimbursement ratio.--The term `medicare
reimbursement ratio' means, with respect to a State or the
District of Columbia, the ratio (expressed as a percentage)
of--
``(A) the adjusted average per capita cost (as
determined under section 1876(a)(4)) for benefits under
parts A and B of this title (without regard to any
payment under this section) in the State or District;
to
``(B) the United States per capita cost (as so
determined) for the 50 States and the District of
Columbia.
``(c) Affected Health Care Providers Covered.--For purposes of this
section the term `affected health care provider' means a facility or
professional that is within one of the following classes of health care
providers or organizations:
``(1) Hospitals.
``(2) Physicians.
``(3) Skilled nursing facilities.
``(4) Home health agencies.
``(5) Medicare+Choice organizations offering
Medicare+Choice plans.
``(d) Effective Period.--This section shall apply to payments--
``(1) for hospitals, skilled nursing facilities, and home
health agencies, for fiscal years beginning with fiscal year
2004; or
``(2) for physicians and Medicare+Choice organizations, for
calendar years beginning with 2004.
``(e) Relation to Managed Care: Avoiding Duplication of
Increases.--Payments under this section to affected health care
providers other than Medicare+Choice organizations in an area shall not
be taken into account for purposes of applying part C in that area.''.

SEC. 3. MEDICARE FINANCIAL INCENTIVE PROGRAM FOR HIGH QUALITY, LOW-COST
HEALTH CARE.

Title XVIII of the Social Security Act is further amended by adding
at the end the following new section:

``financial incentive program for high quality, low-cost health care

``Sec. 1898. (a) Ranking of States by Quality and Cost.--
``(1) In general.--The Secretary shall provide for the
ranking of States on measures of both quality and cost of
health care services under this title.
``(2) Process.--
``(A) In general.--Within 1 year after the date of
the enactment of this section, the Secretary shall
submit to Congress a proposal for establishing such
measures of quality. The Secretary shall consult with
stakeholders in developing such proposal.
``(B) Action.--If the Congress does not enact a law
within 90 legislative days after receiving such
proposal, the proposal shall become effective.
``(3) Cost.--In developing the measure based on cost, the
Secretary shall rely on the Secretary's measure of average
medicare spending per recipient in each State.
``(4) Annual evaluations.--The Secretary shall conduct
annually evaluations of States quality and cost of health care
services under this title.
``(b) Additional Bonus Payment.--
``(1) In general.--Subject to subsection (c), in the case
of a hospital or physician that is located in a State that is
ranked under subsection (a) among the top quartile of States in
quality and cost and that furnishes items or services for which
payment may be made under part A or part B, in addition to the
amount otherwise paid under such part, there also shall be paid
to the provider under such part from the Federal Hospital
Insurance Trust Fund (in the case of payments under part A) or
from the Federal Supplementary Medical Insurance Fund (in the
case of payments under part B) an amount equal to 5 percent of
the payment amount for the service under such part.
``(2) Authority to cover other providers.--The Secretary
may expand paragraph (1) to apply to other health care
providers and practitioners under this title, but shall not
effect such an expansion without reporting to Congress.
``(c) Aggregate Percentage Adjustment Limitation.--In no case shall
the sum of the percentage increase under subsection (b) and the payment
adjustment percentage under section 1897(a)(2) with respect to a State
exceed 100 percent minus the medicare reimbursement ratio (as defined
in section 1897(b)(2)) for that State. Any such percentage increase or
adjustment shall be reduced on a pro-rata basis to the extent required
to comply with the previous sentence.''.
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