HR 279 IH

To amend title XVIII of the Social Security Act to prevent sudden disruption of Medicare beneficiary enrollment in Medicare+Choice plans.

January 30, 2001

Mr. KENNEDY of Rhode Island (for himself, Mr. FROST, Ms. DELAURO, Mr. BARCIA, Mr. FILNER, Mr. BALDACCI, Mr. HINCHEY, and Mr. OLVER) 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

To amend title XVIII of the Social Security Act to prevent sudden disruption of Medicare beneficiary enrollment in Medicare+Choice plans.

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 `Medicare HMO Improvement Act of 2001'.

SEC. 2. EXTENSION OF INITIAL MEDICARE+CHOICE CONTRACT PERIOD TO 2 YEARS.

(a) IN GENERAL- Section 1857(c)(1) of the Social Security Act (42 U.S.C. 1395w-27(c)(1)) is amended--

(1) by striking `a term of at least 1 year' and inserting `an initial term of at least 2 years'; and

(2) by striking `from term to term' and inserting `for additional 1-year periods thereafter'.

(b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply to contracts entered into on or after the date of the enactment of this Act.

SEC. 3. AUTHORITY TO DELAY TERMINATION.

Section 1851(g)(3) of the Social Security Act (42 U.S.C. 1395w-21(g)(3)), as added by section 623(a) of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, is amended by adding at the end the following new subparagraph:

`(E) AUTHORITY TO DELAY EFFECTIVENESS OF A TERMINATION-

`(i) IN GENERAL- If a Medicare+Choice organization terminates a plan under subparagraph (B)(iii), the Secretary may delay the effectiveness of such termination for up to 1 year if the Secretary finds that--

`(I) the termination would cause an imminent and serious risk to health to individuals enrolled under the plan under this part;

`(II) the termination would result in a significant reduction in the Medicare+Choice plans that are available in the area affected by the termination; or

`(III) the chief executive officer of the State in which the termination occurs requests such a delay.

`(ii) END OF DELAY- The Secretary may end a delay under clause (i), before the end of the 1-year period, if the Secretary finds that an adequate provider network has been established which will provide at least an equal level of insurance coverage as existed on the date the Medicare+Choice organization informed its enrollees of its intention to terminate the plan.'.

SEC. 4. RESTRICTION ON TERMINATION OF MEDICARE+CHOICE PLANS IN SELECTED AREAS WITHIN A METROPOLITAN STATISTICAL AREA.

(a) IN GENERAL- Section 1857(c) of the Social Security Act (42 U.S.C. 1395w-27(c)) is amended by redesignating paragraph (5) as paragraph (6) and by inserting after paragraph (4) the following new paragraph:

`(5) LIMITATION ON SELECTIVE TERMINATION OF CONTRACTS-

`(A) IN GENERAL- Except as provided in subparagraph (B), if a Medicare+Choice organization offers a Medicare+Choice plan that provides coverage in a metropolitan statistical area (or a New England County Metropolitan Area) in a State and terminates such coverage for any part of such area (or Area) in the State, the Secretary shall terminate any contract with the organization for coverage of any part of that area (or Area) in that State.

`(B) EXCEPTION- The Secretary may waive the requirement of subparagraph (A) if the Secretary finds that terminating contracts for coverage in all parts of a metropolitan statistical area (or New England County Metropolitan Area) in the State would pose an imminent and serious risk to the health of individuals enrolled with the organization under this part in the area (or Area).'.

(b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply to terminations for which notice is provided on or after the date of the enactment of this Act.

SEC. 5. CONTINUITY OF CARE IN CASE OF INVOLUNTARY TERMINATION.

(a) IN GENERAL- Section 1852(d) of the Social Security Act (42 U.S.C. 1395w-22(d)) is amended by adding at the end the following new paragraph:

`(5) CONTINUITY OF CARE-

`(A) IN GENERAL- If--

`(i) an individual's enrollment with a Medicare+Choice plan offered by a Medicare+Choice organization under this part is terminated by the organization (other than for cause with respect to that individual), and

`(ii) on the effective date of such termination of enrollment the individual is in a course of treatment for which coverage is available under the plan and the individual is not at that time covered under another Medicare+Choice plan,

notwithstanding such termination the organization shall continue to provide coverage for the covered course of treatment for a period of 90 days after such effective date.

`(B) PERMISSIBLE TERMS AND CONDITIONS- The coverage provided under subparagraph (A) shall be under the same terms and conditions (including applicable policies, procedures, and quality assurance standards) as existed on the date before the effective date of the termination.

`(C) TERMINATE DEFINED- In this paragraph, the term `terminate' includes the termination of a Medicare+Choice plan as a result of the expiration or nonrenewal of a contract by the organization under this part.

`(D) CONSTRUCTION- Nothing in this paragraph shall be construed to require the coverage of benefits which would not have been covered on the effective date of the termination involved.'.

(b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to contracts entered into or renewed on or after the date of the enactment of this Act.

END