-
https://clinton.presidentiallibraries.us/files/original/bb1a1f8cf2ec7acd9f3034e293d41f7e.pdf
7ce6984f5ea450b4a7b945302fd490e9
PDF Text
Text
"
0: \JEN\JEN94.671·,· .
(
STAFF' DISCUSSION DRAFT
"
S.L.C.
, ,
" YIl>-2 . '
\
','
.,
1
·. (b$_~_ _ _--,-, for outlays
2
· descrIbed ip subparagr~ph (A)(i),;. and
'.
"
.
,.".
· (II)' $~~_ _ _ _ .for reve
,'·3'
,
4.
..
\
· ilues ". described "
;.
'subparagr~ph
III
1
. , . ~- (A)(ii).·
5
'..
·
6
..
..
.'
, i
, (1) .$_ _ _ _ _..:....' for
-.
,
;,'
.',
·9
-'
10
.", D.ues,
,~
.subj>aragraph ..
··(A)'(ii)'..
12
'
.,
(in,) Forfisc~,l year 1997-.,',
..
..
.
"
I'
14
,,'~'
','
,
\~
'
"
i
. 15
I
~
(II) '$_"_~_.......--~" for· reve- .
,
16
• I
\
17
.jA.)'(ii) .. "
,
.
•.
.
... ,
\
,
· Ov) .F~r fiscaJ year 199s:-.: .
,,'.
.
(1) :$ .
" . i for :otitlays
.'
19
•
.I . •
\
,-'~',
•
,'~
20
..
'
".
18
.'",
• 1
..
nues' . . d:escribed i' in·. .'subparRgTaph
•
.
,
~
. \.
described in subparagraph (A)(i);an~l'
.
,
.\
".
(1) $.______-'-,..,.-.'_' for' outlays
'
.
,
.
.
\
13,
.' ..
de~~ribed' -'in
. i
.
,·'n
.'
' , '
: (II) $_,_'~._ _.......;......~. 'for reve-'
..
I
o~tlays,
"
· described' in 'subp~ragraph {A)(ihand "
,
'.
"
)
.
8
"
"
.
'(ii)' Fqr fiscal year . .
1996-:- .. '. '
.
~7
'.
"
, d:escribed jn subparAgTaph (A)(i);, and
21
"
,
,(IT) $_"_:_--,..........----.-_.·for· re~e-
>'.,'
".,
.\
nues . described' iIi 'subparagr~ph
22
./
i3
,
'
· (A)(ii) .. -.' .
.
24
;-
,
(v) For fiscal year 199.9-' . ~
'
~.
.
.
,
· . -'.
. \
. September 1.6; 1994 (3:58
. '
,
.
p.m.) . ..
"
'.
/
.
,
\,
�')
.
.
•
i '
, , .
,
~·O:\JEN\JEN94.671
"STAFFDISClJSSION' DR.A.Fr
.
I
,
',,'
.
S.L:C.
,
I
, \'11-3,,'
, '(1)1 '$_'--.,-~____'_'.:....'.;.;,.. Jor ,outlays
,
,
,
,
.
described'in subparagraph' '(A)(i)~ and,
.
.
'.,
.
.
\:,
t .
,-
',5
,~
"
.
., '
"
\ ,
'
I ,
\~.
,"."
: . (vi) For 'fis~al ,year200k "
,
,,'(1)',$"
, .8
\
.
~,
'
;.1
"
"
10
'for o~tla~' , '
'.
,', !(ll')$_'~'_'_ _ _ _'......, ·for. reve' '
, "
,
I
'
"
{'
"
"
••
I.
(I). $,_'_'_;'_.....:.----:._" fdtoutlays" . :
\
','.,
•
" ': ,15 '
'• • - ' "
,
i~,sUbparagr~ph',(AJ(i);
••
. ' . ,
\',
,
.
,
I"
"
.
for' 4utlays,
i, '"
. .
.
~
.:
. \
.1'
r,
.. (ll)'$_'... ;. .,_'....;.1--,"...,..-_ _ _ _ · fO,r' reve-'
'.
J'
',,{
n,ues, (descJ?bedm
,}
,
.
...
I'
22
'.'
20()2~ , " ','"
'.-
, ',describe~ in~~bparagraph' (A)(i);~:and '
',21"
,
i
,J
.'
,
'
.
,
,
, (I) $ " , ,,'
20
and, ' ,
\ .
.
,
. '(viii)' For'.'fiscaL year
19
, "
•
subp~ragraph' ,,:
m
. \,
~
i'.
. !
"
, t
',I
" for·:reve- '/'
(A)(ii). '
18'.
:
,
nue~.descrlbed"
,
.
,
I
.' 17,
~:'.
.
" " ,'16,.'
.'
I
.
,,{Il}$ ,
;!.
"
described
•
',\
\ ,
I.'
.'
. \.,
i
~
,\.
" (vii), For 'fiscal year 2001-,.. . ",
'14
-:
"
(A){ii). '
','.
13', ",
I' _
'I
..nues 'described', m., " subparagraph' '. " '.
12
"
,
'
, I
,
.
,
,
,',
11
,.
,
'-
. ,'0 .
,
'<
d~scribed 'in. subparagraph. ' . ,~nd '
(A){i);
.
.
.
"
.I . .
'~, ,",' ,
'~-.
7
'
',:
!. '
.. \
I,
.',
• -'v
·'·,(A){ii).: '
,
.
,
.
,
6 ','
.,
•
~ues: ' , 'described~ i'n:' 8ubparagrap:h'"
,,'.
\
'
.,for rev~-
: .( l l ) $ "
.•>
..
"
,,'
. '. .
",'
\
.,
,
.'
"
], ,
J
'
':' '
.
subparagraph
,
23,
,
"
,
,
'
,.' ,
.
"
"
\
.
.
. ,','.,
I
September 16,;994
'j,
'
'
"
(3:58p.~.) ,
.'
\
.....
' '
,I .
.
';
, .\
.
.',',
.
.
�, S'FAFF
O:\JEN\JEN94.671
" S,L.C.
DISPU$SIONDR.A.Fr '
\1:1-4·'
,
,
(,
J
",
. described in s~bpar~graph C~)(i);and - ,
2
,3
~\
$_._""'"-----:...-_~
, (II)
nu~sde~cfibed"
..
4
,
.l
'1
'
.
'
'.
,for, ,teve:' , '. ,
,
"
.
",
subparagraph' ,
III
"
5
'(A)(ii). '
,
)
,
(
,,~"(x) For , : , ''year. 200~'
fis'cal , . . .
6'
,:
,
'
8
,
.
,
, 'describ~di~:'subparagraph (A)(i); and
,
9'
(IT) $,.,....,.'_-'--~-:-..
10·
.
nues, , ,'described . Ill'. subparairaph,'"
. '
,
:'II
.-
,
(I}$_ _--:---:--"""'-~ for outlays:
,
7"
"
,
"
.
"
,
.(A)(ip.','
"
(~i) Fot .'each .fiscal <year after 2004;,
12
.....
,
"
I
.
.
"
,
.' th~ initialheaith.care estimate for the pre:.
13
~
14
i
'\ .
• .
fisc,~l' year, . modified
vious
by an annual'
,.
'~
15:
.
"
. 17.
•
\
,,',
,
.
'd~nt'submits the'bl.i(iget'fo~ fl scalyear '1997 (as re- ' ,
",
".',;
' , '
,
"
"
t"..,
"
•
":
'"
2D
(';....
.'
'.
R'EKT HEALTH' CARE: ·ESTI~T~.-·'Vhen',: the' Presi-',
,
j
'~,
•
:
"
.. '
l .
quired by section 110,5 ' of title 31, United States
t
' .
)
'.
\,
22,
, , ,", (A)\ a' CUITent ,health care.. estima~e , (as,
.
·24
September 16,1994 '(3~58 p.m,) "
'. '"
'\
dent' shall in~lud~
:23 '
:
,
,
~
'.
~,
, Code), andf.or 'ea~h~scal year thereafter, the Presi:. ,
'21
,
.
(2) PRESIDENT'S 'BUDGET TO INCLUDE A CUR-'
J,
, 18
,
.
.dent's,budget for such fis¢al year.
,
j'
"
'\
" 16
,'19,
"
'.
.
"
'.
,I
.
"specified in paragraph'
(3)}~t~~
.
respect to
,',
~he
f
_,'
,
.
:.
�..
'
'
l,'
,",
'
.
'0: \JEN \JEN94.67:1 ' ,
"
1
i
"3
.
~,
,
A
'
.
"
,
.
,
,
'
"
total, net,.revenues resulting from this',
. ;
,
". '
,
, .< C)
_,( " 'l
,
M,
,.'
""
.
/"
,"
'
"
.
,
'
,
,",
\'
, ,
",'
, ployee exclusion of ',e,mployer-provided
"
",1,.,
.,
~
.'
"
,
~
,"
,
I..
"
"
•
,
l '
,,
('
\
'
,
'fiscal years~ ': ':,
15
"16',
' '
"
c~' ESTTh1ATE.~The'"
.' "(3);,CURRENT,tPiALTH"
I
.'
"
17' ' ' 'current health 'car~ estiriuite' shall;,fo,rthe' appli~abl~ ,
. ;,
.
", fi~cal yeal\cdnsist of~ , "
,18
, I
,:
•
;
19
.
'
"(.R)':updated 'spending
'
",
/'
,
1 \
,
,
"
'
,
, '21
"
,i ,
\ ' ,
22
23, "
,,
and 'revenue"
•
,alllouilts' contained in the initial' projection (as", '
20
,
'set,forth mparagraph(l»; ,plus 0\ rOmus;', '",
~,
.
,
" " . '
.
,
~
':(B) '.o,ther ,outlays o~. revenue changes ,con-.
tained oip legislation· ~nacted . after' the' date of
,.1
'enac~ment (,f this Act offsetting .outlays .or reve
,
'.--,
,~
,','
,
'\'
.
.
. j
,
.
\
..
,
,1
,
s6ptembSr 16,1994 (3:58 p.rn:)
"
,
\,
- ,.
,
'
",the UPC,OIni~g fis~al ,ye~r;': and "the' 4 : following
,;'14
,
.
,
~'the'curre~t\h~alth 'ca:re.'esti~ate ami,the'initial"
l'
•
I
,
\
,
,he~lth'cl;lre estimate'for the 6urrent 'fiscal year,
"I
"
,
,
,
13
.'
a~cident,
',(E) anesiimate'of 'the difference between
.
.
""
12 '
"
'
,"llno. health c~verage; and'
:",1'1
,
"
,
(D) revenue .los~es 8§sociated with the em:'"
10,
,
i'
'.
Act;, "
, ,,9
I'.
'[
'
,
'8'
"
'
~total 'net direct spending' outlay" restilf- ,
ic~idprogTams;
, f·
7
.'f, ,
.
"ing' from' this Actan~ under medicare ,al1d ~e.d~ ,
"
6,,'
,
'
..
" " '(B)
5
)'
"
,
'",
"
,.
"
,
,
'. ,and the 4 ,~ollowlng fiscal 'years~, "
.
"
S.L-C,
,
,
'current 'fiscal' 'year, theupcormIlg:5scal' year," "
"
, lir
,
DISCU~SION DRAFT, "
,
,'VII-5,
,
,
,
STAFF
,
'
,
,
'"
"',
,
.'.
,
"\
•
't
\,
j
•
•
�,
,
',STAFF DISCUSSIONbRAFT.'
, , ,O;\JEN\JEN94.671
S.L.C.
Vll-6' ,
'1
, 'nues resUiting from this Act, 'including' legiMai
'
2
,
r.
.
'
,
_.
'
,
tion enacted under subsection (f) .:,'
OFF~E;TIN~' 'UK~IKANcEDIiEALrH S~EKD-
, (d)"
'3
\
I
4 ING.-·:
,.'
"
,
·6
:
8'
, ,r
'
subpar~graph
~ludes, a
T,
9
10
..
,
,
...
'
..
'
~.
.
(AS "~N '~E'NE~.~Except 'as provided in
•I
,!
.'
'
'7
,
,',
, ,
DFFSET' U?>.TFINANCED HEALTH SPENnING.-'
!
,
': -
\}
';
1(1'-) l\.EQ'UffiEMENT FOR R~Dpd.rIONS TO 'FULLY
5,
,
....
, .~'
'
"
11
(B), ~lf-'the..President's,
dete;Ininatibn
i '
'-
"
th~t
"
the current' he~I'th
care' estimate exceeds . initial' 'health care 'es
the
'. '.
I··.
. '.
,
,ti:mate
p~rsu'ant
to '~ub~ection
""
"\
(c), for the cur-,"
,>rent fis~al_'year, , the upcoming fis~alyear,,' or,
,
,12'
.13,
"
~udget in~" ;',
. 'i,
,
,
':both,
such~ det.ermination shall' be. accompanied
" bJ~' a ProPQsed order to \become 'eff~ctive, on' Oc~ ,"
1'4
'..1
.
,
,
.'
,,; ~ober 1 of that calendar year whichful.ly offsets' '/, "
,15
/
'16,
\ ,in the, upcoming ":fls¢al year and the following
.
,
,"
"
.
' - .
\
,
.
fiscaf year sucb' excess (fo~ the upcoming'fiscal' ,"
.
17
,
18
"
'I'
, , '
",,'.'
"year and the cu'rrent fiscal year)'
•
',1
•
.
"
in 'the manner
.:
,
,"proVided . ~,: this subsection. ',.Such proposed
19.
\-".
,
:20,
-,
,'order, shall
,
'b~
.
'.
,
"
~.
'
:accompan.ied ' by, such proposed
,'regulations ~s ,the 'President deems necessary' to,'
21
,-f
,'\
22
,23'
.
..
o(B) AD~NISTRATIVE EFFICIENCY;-.If, for ,.'
,
r
,
,
,,~"
\
, ' 'any ye'a~, the Direcior of the .'Office ~f M~nage- "
24
,
"
'.
';"
'.,
\'
' .
.
: ment', and Bridget det~rmines
..
25
.
}
,
f '
.
that' the:. offsets,
~
."T'
.
"
, ,Septemoer 16, 1994 (3:58 p.m.).
I,
,
"
9/0·'
�,
."
i '
"
, ,0: \JEN\JEN94.671 '
S.L.~, '.
"
I
"
•
~
\.
-, I
:
,'.
t
:
2'
'.,
~
• "
"
'
t
•
j
r
'
: ' :
.
,
-
.
•
. " '
,
I,
:
•
I
,
•
would not be ad..
,
,
1
"
,
...
\
'
'
'
I
"
'.
\
"
'.
'
"
described:in 'suhpa~agraph {Al-)s: such-~ -small
,
,
•
'''.
",'
"
•
"I
,
.5
- year~", '
,
.
,
~,
J
~motint,such offse~s' shall rt~t beiitade to~' t~ati
4
, ,
~'
{'
"
J ' .
, ministrativel,:, cost 'efficiEmt' ,because 'the ' excess
(
, >~,
"
:".",
,,'
:
,
, 'VIJ-7
1..'
',des~rib~d' in subp,aragr~ph. (A),
1
,
~,:',
I
'",
.
'"
'
",-'
'-
(2)"O~FSETS.-,'," ';
'.' (A) IN, GE~~~.-'The' 'ofisetstequired by
,
'r ,
'8 :,:
combiDation -of-'
:: 9' '
" ' f " , ' , ,"
,I
~"'
,
"J
,-
I
\,
10
'.. '
_
~.
pa~agTaph
11
','
,
"
;
"
"
!
th~, case' of. the premium ~
(B), in
"':-""
,
:;
,
"
,
", ,,13
l'
'
'.'
•
,
" ,15, ':,'
,
'I.
,
!
""}6
'If'
,.
'"
' . , '
,
J
'~
•
'
,
,
!
:.
".:
,
"
'\
r
"
I,
,
.'I
\,
,
,'" (ill reducing, 'the ,percentage under'
s~ction '213{f) ',of the' Internal' Reyenue
,
,17
"
•
section 2102(a)(2) of thisiAct;
,
,
"
"Unde~ subparagraphs (A),' (~), arid (C)"or",
'1'4' , '
1',,"-,
"
",
, ages, otherwise, in effect for the, fiscal year
,
'l
.
," . .
",1
.
.
"
~
' : , 'Code; ,of J986 (relatin'g ,io'd~ducti6n :fQ~':
.
.
18
~
19, ~
,'
,
,
",
'
. '
, . '
.'
'
"
,div.iduals);;a~d·' '
20:,
,
'.
!
,', ' , '(iii) redu~ingari ,other'di~ect'spendIDg
.
,~
".
•
"
,
,,'
1
"resUlting from' thi~ ,Act ',by a _~Diform ,p~r.,
1,
,.,'
~'"
"
"
.
,
',' \ :he~lthinsutance costs of self-employed in
,
~
"
"
,
'
, :23;,
t6"
';,24,
.
'.',
)
,
the exteh({subject 'to paragraph '(3}) 'nee
.
,25 '
\
.
,
I'
'-
,
'
'\..
,
,
I
,,'
,
" ' .
,essary' to 'accomplishallQf the
.
.
,.
i,. '
.
I
assis1inc~pr~gra~,' _red~cirig .' the' percent;.
.
j
12
'J
.
, '(i): subject(to iheprovisions 'or' sub~ ,
:
,
"
>",
.'
. '
"
'~
,
.
'
"
~
'.
'
""
"
':
;' ,
-- /
{
,~
',&'Ptamber,16. 1994 (3:58 p.m,)
..
,
,
.
reductionsnec~,
.
-',
, i
,
:'
,/',
'
'.
.
,
\'
, \
\
�" STAFF DISCUSSION DRAFT '
" O:\JEN\JEN94.671
,,:-.:
,
, 8.L,C, ,
,.'
.
, essaryto offset .'fully . the amounts'req~lred' d,uI'· '
.'
.
.
" 1'
"'.
,
'
~,'
:
'
'
:
, (B)ELiGIBILrr-r PERqE~TAGE FOR PR~G·
'3,
NA.;~T' ,WO:MEK
A.'\"D' ','CHILDREK
,
.
,
"
'ing the, upcoming and following fiscal year., " "
...
2
.'
,
,
"
,'~'I',;-jAny'
L
REDUCED,'
'f
: reduction ,,~nder.,: ~ubpanigraph ' '
(A)(i)- "',
6
"
,
f
, ""
,
~',
, , .' (i) shall ,be made first, by reducing the,
.
7
"8"
,percentages 'upd~~,se.ction ,2102(a)(2)(A), of
.,
,
,
,9"
t~ '.
,
-
'
'.10
,
'"
'\
:' not b~· made under subparagraph (A), sh811 ,'. '
,
~
,then be ,made by reducing th~ percentages
'
'"
.
" 13
\ .
'"
14
.
,se~tion2102(a)(2.) (Bf
,under
,
~of
'and (C)
'
this'AcL"
'I
15
"
_
" (ii} to' thee:Ktent sufficient offsets may
12 '"
,
1\
, this .ACt; ,and,
11'
"
.
,
.'
" ,
','
,(3) PROPQRTIONALITY.-'The ,<President shall" '
,
,
,
,
,
16 '
"
,
"
,
.
' \ '
17
:
.
, ' .
~.
:
•
\, ,,'
,',"
{
"
.'
'
"
I'
: .•
,
.
provided :in 'paragraph, (2)(A) (i)'" (ii), a.nd .(iii) pro
,
,..18
"
:.
"
,"
'
,
.
"'
'
•'
,
I'",','
portionallY,(based ,on the,ra~io"oftheoutlays
,",
ca..lls~d
~oy each program t6 the'total ,outlays ofB.l1 programs ~' '
19 ' "
,
"
'21
, ,upcoming.fisc8J year'and the follo\\ing
,
22
,
,
•
"\
'"
'.,
J.,
,
'
,',
."
•
:'"
0
,
#
•
, .. ' .
,
.'
I
_
less than the amo~:t required,byparagraph . '(l)."
.
,
,
"
,
'(.4) EFFECTIVE PERIOD.-For
24.
25,
fiscalye~r"
j.,.
,
'.
"
,
\
'but'in no' case shall the 'total amount of offsets be, '
,
,23
.'
;8ubject to reduction under para~aph (2)(A))in the,
20
~
·t·
to the' extent possible: apply the offset nie,chamsms
,
{'
,
ptii-po~es,of a,fis·- ,
,'cal year not subject: to an order under' thissectio'h··
.'
.! '
.
.
.
,
"
I
?12 .'
.
\
"
'
�. , Of\JEN\JEN94.671
,r
,STAFFI>ISCUSSION 'DRAFT
'
"!II~-"9'
. :'
"
.,' /
,
.i
':.
, ,follQv.~ng,afiscal ...
vear"subject :to an order under thi~'
1
,
,
c'
,,"
,
•
;/
')
\
"d'
•
,section, this' Act·and" the, amendments made~y :this ,
2
..
,
•
!
,1'
.'
•
'I
•
, '
•
, ~ Act 'shall be assu'inedto continlie as/if the order had'
,.\"
.
3
,
,
,"
'
(.
4
, not been'issued.·
,;
5.
J
, '.. ' (5)CONSULT.A:rIO:r-;.-·TheP~~~ident shall cOli-"
'
1
fer, ~ith the N ationaLHeaiih Beliefits Board and 'the
"
.6'
.
/....
I'
,
"
' .
)
.
,
9
..
.
'.,
\'
"
.
,
.\
,";,
(e)' FINAL REDUCTION nETERMINAT-ION.-:-Using the'
' . .
•
,
\
~
.
.
\
I
•
•
••
,10 . sa~'e. econ~mic and, technicala~sumptions.as usedin
.
.
I.
.
sion in carrying. out thissubse~tion. ,', .~
8
;
'\
National 'Health qare Cost and ¢over~ge Co~s-
:7
'i
.'
.
.
.
~
'
.
.
'\.'.,
. '.
"
','
"
'j
,
'.
'th~ President .shall ~~estiinate the' curi-ent health care ~s~i-
.' 12
.
I
.
.
su~sectibn,(c),
.' . . J I' ing the Iprelirhlnary, determination' under
~.
fuak-
i
'
13: mates 'onSepte~ber "15 based P.ri legislation in effect as . ~
"
. "
~
:
.'.
'
,
,...
I'
.
",
I·
.
"
,'"
14' 'ofSeptember 10.' If thePresident,·deterniines·that the, cu~-, .', '
..
'.'
15, :rent esti~a:tes:ex~eeds th~initialestimates ~.the current
....
'( .../
"fi~eaI' y~a~, ,theuP~()ming' fiscai 'year,~' or
16
'-J
.~',,'
':.
"
'
'17· ·'dent shall
:
'.
issu~
"
.',
'.
',.
,
,"
.'
both, the' Pre'si-':
.",
r',
...
•
:
a·final order (andaccompan:ving final reg- '.
t.
18
,ulations) following, the procedure set forth in 'subsection
.
.'
(
"
.
0'
r,'
.
,L.
,
-
,',
.,."
i'
\
.
,
.
'/
•
"
,
"
\
-:
'
,19 (d) (including,paragraph (l)(B) thereof).
....
•
I,
,
"
.'
•
,
,
' , ' , '
,
'.(f>. ~SIDE~T'SiBUDGE·T. To~INCLUDE'AMEDICARE
.' ,",' in'
·21
.,
\
.
/ ~'1), ,MEDICAID EXCESS. SPENDING ESTIMATE ,AND RE- .
"
.
,
,
.
,
'
,
.'
'.
'"
'
~
"
'\
.
\,
'
22· DUCTIONPROPOSALS.-'·\\7hen the. 'President :submits the
".,
.
',{
.
'..
!
I,
\
",
"
23 " ~udget' for .fiscal year 1997 (a's required by:'sectiori'1105
. ~4 of title 31)"ancifor. each fiscal.Ye~r thereafter, the Presi~.
. " 25 dent shall 'includ~
.
.
"
''.
.
..
.
,
,
)
,
..
. '.
,
,,0'
'.
':
.
�,
)
0: \JEN"JE~94.67i '
,
STAFF" UISCU$SIQN ,J)RAFT '
S.L,C,
,(
\"'Il...,lO,
(1) ,a' notificatibn.Jo ,Con'gress .ofan~r "increase in,
.
,.'
.
"1 ,
'"
'Z ' "
'~,
or,il:)edic~id' spending
medicare
4
,
",
"
'..,'.
.
' "
,'''1-
8 GROWTH.-'"
. .
,
l
(1)
:10,
t
Low
,
'I
,
..... '
f
• j'
'..
j
",
:'
GRO\V1'H...:-,;The
President shall not '
,
\
"
';
.•
WAR OR, Low,',
r , '
i' "
, .
9,
,
m~,':
,
,
7 ' ( g ) SUSPENSION 11\ THE'E,\"ENTOF
•
,
,
~'
. ~.'
,"
,'~
~
, (2 ),Je~siativepr.op.o~als . to, eli.'Ininatethe
.
5
I
~h~. 'l~vels se~', ' '
above,
and medicaid in the illiti~rhealth,care,
, J.
.
,
.
.
.
, estimate i~Sl.ibsecti,.on(c)(l){A); and,
.
,./
~.'
'.
~
f.o~ D1edi~~re
, 3'
.
•
f
or tinal .order, under this sec:-,
,',' issue either'a:pr.op.osed
,
,
'
tionif the Office ,..of ~anageIt1ent and~Bud~et ,noti
",12 ':~ ,
,ties the ,Congress thaf-,
'
':"
,
:
13:
I
. '
"
quarter ,du~gwhi~h
", 14
'15 '
.
s~ch,Iiotitication is, given,: '
, ! ,
"','
, ,"16
t
, .
,I.
"
"'"
Of~
"
;..
, thatr~al.. economjc', groWth is ;projected or . esti~ :'"
.
.
18
,'
,
.
"
"
, '/, mated to be le'ss'than'zero wi,th respect t(j'ea~h',
'1:9
, <'.
I
"
_.
•
~
:
,
•
"~o(any:2 conse¢utive' quarters withiti such pe:..,
.20,
':
'
4'quarters .following such notification, ,the.
"
"
. , '
"
\;fice6f Management a,rid' Budg~thasdetermined ,
17
"'21
'
,
the quarter, preceding such, notificatiQn,' and the ,. !:
I
~,
't"
"
, '~od;: or' "
,: " , (B)' tlie"most~ecent
22" "
~ I
•
,
of th~ \D~partmfmt, or', '
"
,
"
23
, Commerce's ;advance 'ptelirci~ary or' final' reo.
",24
• ports of ,: actual realecononllc 'groWth 'indicate
,
"
':25 "
',that the rate' of 'reaI' economic groWth: for e~ch", :,','
,
,
~".
"
-"
.:'
,
'"
;,
.
.
'
-
,
,
. ..! ..
, I
september 16. 1£HM
\
(A):during:the',;pen:6dconsisting of the'
.
~
,
.
(3:58 p.m.)'
.
"
,. '
,
'\
/ ' ,
.'
\,
'
'
�DRAFT .
.
. STAFF, DISCUSSION
., ,
'
"
'I.
I'
!
.
.
"
S.L.C.' .
.
•
..
."
\
V1I~11, ';,
..:".'
.
.'
.. .
.
,..,:, "
'.
.
.
,of the .m~st recently:: rep<?rted . quarter a.nd the...
,
('
1
" , "I
:im:mediately 'preceding qua:rt~r is' le~s . than 1
. ,
..
.
percent. .
2"
1\
;.
""
.
\
.'
. ~\
•
>
..
.,
''5
'
..
•• j
. " ..
~
... \
'
", j3Y: ·bONGRES~IO~ALACTIO!\.-···Co~gTess. may
7
\'
8:
s~spend ~he applic~tion
.'
'J
•
.
.;
-'
,,\
•
'- '
\
resolu~ion~:.'
9
I
':
~~bsecti~n
l
by 'jomt :
" ' j '
•
.
,
,.
-
· 10:
of this
' "
•
j
,','
,
.
'
RECOM:~mNDATIIONS FOR ,ALiER!\ATrV~ REDUC··
. (h)
;\
,I
.,~.'
"
. "
.'
,.1 }. TIONS,~If. the Pre~ident's ,budget foia fiscal year isac;.· . .
"~.
I
"
,','
.
/
.. ,
,','I
i
,
j
.~.
'.,
,,"./
' , , ' ,
"','!.
,".
;
~':"
'1\
'
.
I'
· 12 cpmpanied by an .order under subsection -(d)(l),. th,e 'Na··
·
I••
,
, ,
_
'
'
"
,
',"
r ~
.
'
'
' "
L: 'I
•
. '
,
:
'v
reaso~able:
\ ' 13'. tionaJ ,Health Benefits Board. ,shall, within, a
.~
. ",
'
.
, '14. . time, trarismitto the President, the. Speaker of the House' ..
•
"
.'
'
:.
"
•
.
....
..
:,'
,
".,.'"
\',' "
j
,
'
.
. . "
' . ' ,
r'-'
• \
,
'
,
' .
I .
:' 15 of' &preseritatives,~nd the, President of .the Se~ate a r~·
"...' .'}6
.'
.
li~e~cess.set'forthin subsectiori(d}(l)',':
:
.
.
-.'
,
·18
i
"
"
.:~'.
..'
'.
".
,
;
/ :,
.
) .
"j
...
,
,port including alternative., proposals t90ffsetthe projected:
-, '
I
.
\:
. (ih GAO.·AuDIT. 'OF' REDUCTIONS:-If the' President·
..
. . . . .
.
'
"
".'
~
":.
I
.,'
"
,"
i'>'.
.'
,,'
I,!
,',
. f"
. ,
".
",
'19 has. issued anorder'under:subsection (4),(1)" the General
.• 20· ACGounti~g Offic.eshall·repon,: to CO~gTess, as soon ,ther~::I.
. : .. ,./
.
.f·'....
. ....... '.. " "
. '.
.,
".
'.
".,.
. .
. ... {21: after' as' possible following the date of transmittal of the
"
.
•
,
,
•
'
,
I
of whether the order 'has '.
,'.
" , , '
.'
'
.. 22Presi~ent's' budget,"an analysis
.
.
.. ,
'
"
. '
"
.
I,
-23 . fully complied with th~.require~ents· of this section.
'
~
"
,
;
.,
:
,
'
I
ADDiTI~'~~"OM2B 1ti:p6RTIN~ R~QUIR~~Nr~' ~,-
24· , .(j)'
.
.',
"j,
"
.
', . .
'l,'
,
'.
2SToBE INcLuDEP.' INTHEPRE$IDENT'S 'BUDGET.-' ... :
.
- '.
.September1S,1.994 (3:58 p.m.)
",',
.
. J
.
.'\
"'
..
.
.
.,
'/
,I
\,:,.?
'l"
'"
"
, .'
~
'1 .
•
I
.~.
./
,
t
"
\
.
.
.
,
.'
:'.'
.
···,"?/~-"
�0: ~JEN \JEN94.6~1
STAFF DISCUSSION DRAFT'"
,
",' \7JI~12
' .
,
2
,:"
HEALTH CARE 'COSTS.-'
(A) , ~k
,
'"
5
,',
.'
,
,
I
'
J
,
.GEKE~.-\'llen
.'
,the President
, each $scal ,tnereaft~r through 2004,. th~ Presi-' ,
"
I
"
' , _
'
'
"
: \
dent shall' include an' e'stimate of' total Pederaf'
6
,
(
.
"
-,
8,
'9
, (B) "TOTAL
10
"
,
.
"
~
\
health ,care costs 'as' des~ribed
' ,
7
"
,
.-. '.t
submi:ts the bud~t for, fiscal year ,,1997, and
4
,
'\
1 '
'3
.'
.
, :: (1) AD.n:~!EDESTDIATE, OF TOTAL FEDERAL
1,
'
,
" S.L,C,
"
\
,
In, subparagraph
'
'.
FEDERAL
"
HEALTH ' CARE,
C'OSTS.-'Total Federal health care, costs' are- '
.
.
.
,
"
'I
,-
,
11'
,
'
:",{i),'Fecleral' spending' in the current,
.12
'j
, health care estimate ,(as <;leternlined tinder
"
'.
.
.
\
.
13.
,
' :
-;.
'
.
,
~
'.
-
,
.
,
" subsection (c)(3));plus,
.
"
14" :'
"
'
"
(ii)' <liscre~iona~health 'care speh~ng ,
"
·15
,on
,
16
.'
)
'(I) the health ' care program for
I
~
I
"
,
'
. ,,'
'
t
"
I
"
. (II) the veterans,healt~ care pro:., ,
19
,
~am und~r chapte,r' "1 T of title ,38,
20,
.
\
21
'22
'
,10" UnjtedSta~es' Code;'
18"
. \ ...
\ . ,
"United States Code, "
,
"
,
'(ill), the 'Civilian Health' and '
,
\
23
,
.
active milit~ty:,' persormel under,'title
17
,
"
" Me<licatProgr~m of ,the Unifo~ed
'24
:, Senices' (CHAMPu'S)',,'(lS, -defined' in" .
"
:;.,
,
;
, ,.
f
,
"
",,'
.... ,
/ .
, September 16,'199:4 (3:58 p.m.).
,\
'.
'
"
�,~
STAFF 'DISCUSSION:D~
,
. I
Ylt~,13' ,','
.
'"
\
" I ' .
' . , '1
.
",'
'.
.S,L.C.' ,
I
I
" section 1073(4) of title , 10,,'United .
\
,
,
\
,
"2,J
States Code;
, .
,
, ',(rV)':~ the,
,3'
"
Federal',E~ploy~e,
:;,
,
"
"
~
4
" H~alth B~nefi.t·Plan '~~der chapter 89
t·
'\
,
of . tjtle, 5,;United' , States, . Cod~'
" 5,
, ,
,
, '
(FEHB); and
6
'\.~.,
.
'\
./
'-
,
7
•
.'
'8'
.
'
,
".
•
•
. ,
.......
.
.~.
,
,
(2)
.,
')
.
under ~he: Indian Health,' Ca;e,
~
,
,
;
'
,
'
,
\
:('
REVE-'
:COST' AS A' PERCEN,T' OF ,TOTAL
"
!
:N1JES.-,', "
.'
GENERAL;-:The President shalli,n- • "
elude, with; the estimate required .', by' thisslip-:,
':section' a calculatio~by 'th~, Director of the 'Of- \ .,
. , " " ,,(A) IN
"
14 '
'.
'. ;'"
15
.
,".
:.,
'
.
1 , ' :
,
/
"
'..
,
,
"
17
.'.
,
... '
.
- '
18
'1'9 '
.'
,age of personal ,and corporate' income Jaxes
\
.
"
,
.
',' , flce'of Management an(i Budget of the percent~"
16
,
.....
/
'.
"
.13, '
.
< .
.,
' " 11:'
!.,
,
"
improvenie~t Act (25 U.S.C.1601 et
. .
....
. .
12 '
"
..
10 '
',~.
:.
:
gram
\
9, '
".'
'
. fV)'the Indian health service:pro-
•
'
I.
neede$1 to p,Eiyfor total 'Federal ,health care:" '
......
, •
. I,',
...,
\ •
*
>, ' ....
. ' -:'
1
j,'
"'.'
I
inexce~s
, costs (as defiriedin paragraph (1)(B))
I,
,
, . , ' ) , . ':.-".
\','
I
<
'
;
~
_
.
'
•
, ·of dedic~ted :h~aithrevenues.The Director' shall'. '
, 20
I'
" , \ assume 'Ithat all dedica.t~d 'health re~en~esre,..
.
21
22
23
,
I
"
.: ", stilting from, amendments 'made by this. Act "vill'"
1
,be
< .'
\
24,
•
,
,~llocated ,for ,su~h' t~tal
,.
•
costs.
: \
Federal health care,
"
"
r,
'
, "J,'
'I,
\ '
<
,
,
,
j
,
, ,
'l,
,
~
\.
'j
~
~
.
.. .
I
.
"
\
. .,i
'
Septein~r 16; 1994 (3:58 p:m:)
,
........
,
/,'
,
,
,.
�"
.
/
(B)
'.2
, ,
"Secretarv, :oLth~~ T~eas~r..-shiti'
,
. ;
6!
' , ' , , '
, .. ,
\,
"
."
FORMS.-,The
iricl~de the in'·
' "
\ ' ,
•
I
•
.formation referred', t9in subparagraph (A) in
3
"
, Federal p~rsonal income :taxrettirns. , ,'~'
',' 4 '
~:
."
\
•
j
1
•
: ,
'
(C) JOIKT,ECONOI\UC COM~MIT'I'EE.-The
•
,
?
",',
,
,
,
"
,t
,
,?,
,
,
,
8
'
•
•
, ' , '
"
:
\
\,
.
hold· hearings
",.,'
.
;
,
,
,
' , ' ;.,
~
,
.
:_:
',' '
I'
'.
•
. '.'
, '"
"'
~.~
;
I
.,
'(D y-, CONGRESSIONAL IPENTlFICATION .-, ,
..
9
, I '
'10'
'
'
,'estimate req~r~d bythis§ubsection.
, i,
, I
..
,
each',~earon the economic imp~c~tron~ .ofth~'/' '
."
...
.
7"
' ..
'.'
~haij,
\J oint, Economic Committee
,
'
'
"
I:\Cq~rE ~TA..X
'PERSO;-':AL;
.',
I,
,
: \TU-14,'
,I
\ '
'!::l,L,C.: .'
". STAFFDI$CtrSSION ,DIL\FT - ,
0: \JEN\JEN94.671 " ' "
"
....
"
)f; , for:any fiscal year,! total' Federal health care
,
",
".
','
:,'
"
~
,
"
.
,Congress sh~U identify the" amohnt of additional. '
12
13
. . , '
',.,.
,
•
"
• .'
•
~
.',.'
f
•
~.'
•
.'
i,
"
.
,Federal 'personal, and,' corporate 'income :taxes ' "
.,
,'.
I
j',
.
"
,14
,that are attributableto:such increase: .
15
.
,(k),:.ADDITIONAL COMMISSION REpORTING REQUIRE' ,
' . ,
. .
'"
;
, '1.6' MENTK-Effective: beginning in 1997;. 'the ,'National
.
.
;"
.
,
'
.'costs (as define~jn 'par~graph (1)(B)) i,ncrease," '
,11 '
,~~
'
,". .
"
'.
• ,
I'
•
. ', ...
,
'
.'.',
,
~'.,',....
"
' "
,:
,
'17"',Health'Care 'Cost, ~nd Coverage'Corn:m:issiori ',shall',repprt :'
'
;'
.
I '
',~-,I',
".".
~'I
.
.
,
.
'
:" .... "
>
.
',:~
,,-,'~
• .'
,""
18 'a,nnually on: how health care expenses are being financed. ,',"
,
.
•
19- 'Th~rep~rt ~hall
, I
20
21
"
",
'. -
I
"
,
mclud~: I:~",
'\, (I)' h.owmuchis'
spent~nnuauy in ,primiiums,",
and
/
"
"
;'
.,
"
(2) the', n~ber, qf busine~ses ' that" ,provide "
,23
l
!'
24
.
,healthinsurai!ce ,and
,
a profile' pf businesses that do
) "
.t
,-
,", t
1
"
, ;\
,
,
\
-
.' "
, o,ut-of-pocket ,expellses, 'and .third" party,e},:pensesj
, 22
/
f
,
September 16:1994 (3:58 p,m.)
'
'(fr"
.
�O:\;rEN\JEN94..671
STAI<;F DISCUSSION DR.A..FT
.,"
,
S.L:C.·
~
.·'1:I~j5
not ·p~ovide health:jnf?l.lI~anc·e·, including the earnings
1
;'
of such businesses ..
.2
.
,
.
" .
.,',
,
j
,.
",
.'-
.',
.
;
t.
..
'.'
I'
,,
/
\.'
.\
J'
'.'
\
i.'
\
"
\.
" '
,
I
,
~
. ,1.
f
\
-,'
/"
".
-
\
�,O:\SIM\SIM94.599
,
~,:STAFF DISCUSSION D:ri..A:FT,
'.
, f$,L,C.'
. ',VIII~,,:L\..-l:
J
,I,
"VIII---MISCELLANEOUS
'.
'TITLE
' .
,TECHN-tCAL' 'MEDICARE)·
, :3 '
AND MEDICAID' AMENDMENTS
4 SEC~ SOOO., REFERENCES IN TITLE.
,~,,'AND
,
i
•
.
5
\.
,
1.,
'
\'
,
"','--r',,
.
'._
,Except 'as otherwise specifically provided, whenever 'in
,
.1
1
,
•
,6 this titl~.ari' aniendme~t is' e>.:pressed'in, ,term.s' of ':an
'.
'7' amendrhent
to, ()r repe~l' of a section or '~other,'provision,'
' "
.
\
8 the reference-shall be considered to be :rriade to'thats~c ..
,
,
~
#
.'
'~.
,,"
,
' . .
.'
,'.
'
I
-
'
'.,'
Subtitl~ A~Medicare
,
, lO
/'
.'
. 9' tion or other' prmrision of the Social, Securit~rAct.) ,
,
"
','
, f
"
,
11'
PART 1-'PROVISIONS''RELATING TO PART:A
/ 12 ,SEC. SiOl. L.~TED SERVICE HOSPITALPRQGRAM. "
,13,
'(aY LIMITED
14 tion 1820'
,
,
(42'~U.S.C. 139;5~4)js'.aInendedto 'read:as'f~l-'
"
17
"
\
,15 lo,,~s:'"
," '1'6
,
SER'~CE HO'~PITALPR6GRAl\1.-''S~e-
"
"'LiMITED SER-\7JCEHOSPITAL PROGRAM,
""S~C. ::1820'; (a) PY~P6SE.-'
,The pu~ose of this sec- " . ,.
18 tion is to---
",
'
, '19 " " ' ( 1 ) 'makeavah~ble'alternative ~ospital mod~ls
sni~n'ruralor i~olated rural.commU:~tie~ ill which'
20 '
to
11,
facilities, are relieved' of the b':lrdenof selected regU-'
~
"'22 '
'23
"
.'
,:,
"',
i
",'
; '\:
, , t~ent ~cutesenrices required to
, 24
.'25
'
la~orjr ~equirements by limiting' the scope of' "inpa- " '
.
I,
(-.
f
be offered;,'
,"
':(2) alter, medJcare' reimbursement policy to
.\
,
, sUPPQft ,th~financi~l vi'ability' of alt~rna'ti;ve facilitIes '
.
..
~,
. '
'
f,
,
,
\
'
,
;"
,
'
(
�STAFF DISCUSSION'DRAFT
'Q:\SIM\SIM94.599 '
,
,
"
"S,hC',
, " "
"
"
1 ,',' '. b~~ 'limiti'ng the, ~mincialrisk'facedby such ,srilalL'>
'h~sPltal~: throug~
2 ' ."
, "3
the'
~se
of
re,a,son~ble eostreim- ' . "
bursement . and ~,,'
','
'''(3)' promote ,Unkages betv:'e€!ll facilities' des-" ';
,
\
,.
.,,'
\
, I
,
. ,
" ;
'.
,,'
",
, . '
'"
•
.
'i
,-,
ignated by the State tinder· this' sec,tion and broader
,
I,
"
.' 'pr()gra~s supporting
.
•
.
'.",,r,'..
'.,
..; ,
?th~' develop~ent'of and transi-,
:
•
"
. '
1'.,
",
),
(,
,
.-.
','
, ' , ' - ' "
'8
.
I
. , .'
,
'.'
'/
\
'"
~.' -
1
'"
".:'
-:
•
'
','Jb)'IK GENERAL.-Any State that submits an appli-'
.
r
I-
.
,
'
.
,
I
'
~
"
,
•
'
.'
, 10 limited seT.vi,ce'hosI?ita~; program described in subsection
\'.
'
I
'II (d),·
)!,
•
~'(CrAPpLICATiQN,-~ State may/establish ali~ted
12,..
,
,/
.,'
"
/'
,
'
13 senice hospltaliprogram descr~bed in, subsection (d) ifthe
.
I,
:. .
".
"
,
,'.>:.
.:',
_'.. . ',\ ;'\,
,-
' " '~
, ' .... ,' ,:
~., .:. ,
'14 State submits to the: Secretary atsuch time ,and in such '
~
"
,I.
-,
.
- '. •
.
;'
,
..
,j
,
15 f~rirr 'as' iheSecretB.'rmay req~re: an 'application" , ,
.
:
,
, 16, ,con~aining~ .
17 "
,., -"(I)'
, ."
18,
assur~ce,s thattheStat~
", t',
..'
,
.;,<
I'
,
,
,
\'
, "
'~(i)
21
,
:
, '.
that,-'
.23
24
,
<
•
, , f
,
c
,
l
r .
,
•
j
'
in ,the ' c~se'of a .State .applYi~g to, ,.. "
..
provides for'
;
. .
.
'.
-. .
(describ~d in subsectio~ (d)(l)(A)),
gram
"
.
, ,est~blish.a ~alptimar-y c~re ho~pital. pr~~
.
"
,22,,'
;,
_"
,. "developing, ' a .State rural health' care \ plan ..
20
,',
\ ' ,
,"'''(A), has d~veloped; 9r isin,t~e--process .of '
.\
19,,'"
,J,
the
,
.
creation. !or' .one or mo're
�, " S.L.C, ,
• STAFF DISCUSSION DRAFT
!
'
,
/
.
"
\lII-A-:-3
rural hea:Ith 'netv,Tprks (as defined
1, '
•. 1
'
,.. ','(ii) prol1iotes regionalizatiOl~ of rural
/
" 3
f
\"
\
:.
l"
,.
('
' " ,
. , ' .
,
" heaJth' sen;ces in the State, and
4,
5
"(iii).' imp,roves ~cc-ess to hospital, arid'· ,
, ' ,J.,'
.
,,', 6
•
,t.
other' health 'servjces for rnral residents of
.
' !
'
.
!,
sub-:
section (e'») in the $tate, '
2
,
.1
111
,
,-
.
"
"".'
"
'
, ,/ the State", ';' ,
'.",
7
,
,
: "(B)-has. devel:~ped 't~e' ~ralhealthcare
8
\
, '~lan'described:in ~ubpa,ragraph
" 9
t~on ,)\rith the h6~pital' associatio~,of the Stat~,
'10 '
/,
"\
"
"
" " t'1,'
'. rural' hospit~ls . located . lin.' the :State,' and the
,
.
'
.
(A.) in~onsulta~ ", '
'/
"
;
, State Office of Rural Health (ori'in the:'case 6f '
12
• I
•
•
m\1
.I
~
~
'~·State. in the ,process.of developing such 'plan,
. "
."
'"
.
13
\
\
that~ss~tes the' .S~~retary that -it ~~i'con~uit,'
,
'1,4
'
15
\\;t11 its' State ,hosphal associati~n;~ra.l " hos-,
.
,
,
16
,
. ' , '
'
pitals located in the State" an'd the' State Office'
• ;
17,
/
,
"
I '
.of RuraLHealth in :developing such :plan); and:' .
".'
18
'
'.
.
. I:
;, '
/<,
'"
'.
'
).
r.
, . '
" "(2) assurances that the State, has, designated
,
,
,
,,19
(con~istent
,
20
'
~
-
\
r :
.'
.
"',
,'"
.
,,-;ththe rural health care plan described
•
,
./
•
>.
in . p'aragTaph~ (1 )(A)), or is in the. ,proce$s of des-, '
.
.
,
'
ignating,- ~ral nonprofit ' public hospital~ or f~~ili- .
or . . . .
.
, .
21
,
1
,
,
'
,~
,
23
'
'
"
.
"
\.
,"
'
"
pitals', facilities or \medical'assistaIice' facilities; and
' ,
"
,
"
.
,
'C'
.
,
'''(-3)' such other information and assurances as '
24
"
'",\
" ,25"
'
'
,
•
,
'.
•
<"
' .
\,
'.
,<
" the Secretary may require.
,
'"
, -\
"
"
,
22,'
\
"
'
•
c
,
J'
,
'
'
,
"
"
�,
"
\
•
"I
I
,
0:.\ SIM \ $IM94.599
\
.'
"
',vrll-AL4 , '
, \
\
'.
'!"
"
\'
'
:
"
":,'''(d)' LIl\IITE~D :,SERY1CE HOSPITAL' P'R 0 GR.A:\ I DE
1"
"'"
,
, ,2 : SCRIBED;-: ...
'\.
,
'i.
.
,
"
",
,3"
,4
'\
\
/
'
"an '. applica:tion'in 'accord~nce 'witn., 'subsection (c),"
I,'
"
:, 5'
'c',
6
. 7
. I.
,
I
I
, . warn v.n:der "~hi~h-,,'
,
.
.
,
,
.
'.
,h,o~pital in<~<;cior,darice
.
,"
•
,>: and
"
.
,
I
~'.
:. \
.
13, ;,
;
'at ,least ,one facility in theSta~e
, .:' sh~~.be desIgnated aSia ruraJprirnary care" '
~
12, '
",
.
"'(i)"
I','
, , 1'1
1
\\1ithparagraph (2);',
.
\
I
,
" .
.
'.' .
,rie~ork (as defined' in '
\.
.'
.
", ~,
.. .'.
"
,,'
'~CB)
-16 '
17
a
" •. '
18
,
~t .least
' .
:\"
' '.
fac~lity
one
~', '
",
in t1e 'State
"
niedica~
shaij be designated tasa
,
,"
'I
"
..
'.
,
/
,
..
\
~r':.'··
",
"(C), both:'
.
.
20
/
,21 '",
'22
:'
(
.~
~
.
•
~
.
.'
.
,~.
. '
I
I
,"
J
"
",
prlrnarycare hospital' ~r' medical a~sis~ance facility
'.
:'
'
.
'
!
I
j '
,
. "i ',',
,,'
•
""
'.
<
:.'
f·
.
24' ,'.' ,iiI accord~mce wi~hsuppara~aph (A) or (B).,'
\;
'J,
I, '
',,"
"
'
c,
" Stat~may desigfiate o~e~or ~ore facilitie's,a~ a'i-tiral '
.23' ','
•
.
'FACILITIES:~A,
"
..
"
:1' , '
"(2)' STATE' nESIGNATIOK'JOF
,
v' .
,
' '
'
,
:,.
'" I .,'
assistance, fa-' , "
. ~ility" in accordan~e' wi~h"para~aph(2);
·,1'9
,
niedi~~l' as~istance,~fa~ility: p~ogr~m
"'wider which,
.
,:,'
',,", '
, subsection' (e)) :in 'the, State;
'"
.
,)
~
, . " , . . 1 , ,I
, o1:J.erti'ral . 'hea'lth
, 15,.....
,
"~
':(~) the ,State.. shaij de,~elop ~t least,
;
"'.
14
"
.
" , ','(,f\), ,a ~ra:i 'primary" ~care' . hospital pro~, ' ,
\ 10"
I'
','
f
\',
"
,
,inclu'des-'" ",
, ,9
I
'
',
.
'8
.
,
.,
may establish a linPted se~vfc~ ~ospital' progr~m that
'
"
'
" ":"(1) I:\"GEKE~.-':A~S,tate·that ha~ 'submitted,
"
v
'.'
•
•
.'
>,-
, I
I
�'0: \SIM \SIM94.599
STAFF' DISCUSSION DRAFT '
·SL.C', , .
, \7JII-A-5
1
DESIG;":ATIO~:'
"(A)' 'CRITERIA ,'FOR
,
)
.
,
l
"
\
. R"GRAL' ',PIUI\rARY' 'CARE' 'HOSPITAL.-'A,
2
AS
~
.'
State'
,!.
-
.
may designate' a facility as anl~al prirnary care'
.,
3
,
>',
4'
'
•
,
t
"
':(i)- i~ 'located in.. a
5
•
rural'ar~a
" "
.'
:;"'
(as 'de-,
..
I
.
-,'
'.
..
'
fjned)n section'1-886(d)(t2){D)),.'or,is 10-,
6
.
•
I
,;
'-
,
"
"
T
hospital 0Illyif the facility-"" :
'.
"
"
7
,
'"
I
;.
.
".cated in ,a countiwliose' geographic area is
.
.
,',
-
,!
'
'
"
. substantiallv·larger than the ,average' geo-,
8
,'9
~
'.
.
".'
1,:
.
'\
, ,: graphic, area for urban '. ~o~nties in, the
1O'
\ ' '" iUnjted States" and
area·
11 '
12
J
.
is :characteri.~tic
hpspitals
13
I
'\?ho~e :hospltal '~~rvice
locate~
'
of service ar~(is, of
in rural areas;
H{ii) , at the!' time
•
..
su~h' facility applies
'"
,
,
14
to the State for,designation as,amral pri-'
15
mary care hospital, is ~. hospit~L (or, iri: the
.
•
I
~
'
,
•
•
'.' .
'"
,
,
.. t
J6
, case of a facilitytl).at' closed during the 12-,
17
. ,'month period that ends on the dB;tethe fa
"
~, '
-.
19
2O,,'
"
.
~.
23
24
•
"
•
.
I
•
•
'~""
•
,'.
, time the facility closed), .'",ith a participa- ,
/
I
•
•
.
,
~
,
•
"
.'
tIon,' 'agreem,ent in effect.' ··under.section
,
.
',21.
22
for: such, desi~atio~, ,at· the
cility applies
18
186{r(~)j
:
.
'''(iii) has.in effectari agreement. to .
i'
.
.
"
"
,'participate with other hospitals and fa¢ili
,
~.
. '. 'ties
.
'
. ,
'
in' ii' ru'~al health network;
• j.
,
.',
··.9~
�O}SIM\SIM94.S99,
Sl'AFFDISCU~SION'D~
/
'--,
,
.\
,
,
'"
'.
'services; :t() ,'ill' ~or' i~ured, persons, prior to
2
.',3
:
, ",adniis'sion ' to .•the facility or prior to their'.',',
- . '
.'
..
'.,
'
•
5,
.,J
•
"
"
,
;
"
'.
','
.,'
,
'r;Y :.
l .
'.
~
"
, . :.
\.
"
"
b~d~{~eeiing\~mch~~onditions~s the
'.. ', tient
I
.
,~' "(v), provides ,riot; morethan'15 -inpa
".
•
'
'~
7
',',
",
\.
tt~hspo1"tatio~ to ,a fun-sel\jcehospitalj , "
4
J .,' .
,J
"'(h~)" prmides., 24-hou'r " emergency,,'
,
"
,
~'
.
' 1, " :
"
,
",1n-A"':6'
. 1 ",
,
;:'S.LC. "
II
,I,
,\
;. 8ecret~Ty' may< establish) 'for, pr.oviding,
"
~cute 'inpatifmt care;, '
,
\
,
:.
,
/'("i)pr()Yides inpatientca:r:e for a1?e
t'
,
\
, riod not to exceed an average length of 96
,
,
','
., hours (ucless a 'longerpefiod,' is required •
,
" ,
','
"
' ,
,',.
,
,",'
,','
,
. "
"I,
",-'. J
"
,,'
,
/
,
,
.
b,ecause trans(er to a nospital is"precluded'
i '
because'o(, inclement' 'weather or-: oJher ' ,
"
e~~rge~cy ~onditions);,
, 14 '
'
,,:, , 15
, "16
, ,'\ ,,:, " "'(vii) '~eets', such\,s~affing , reqUlre~' '
,"
,'ments, as ,wortld " apply, under ,section
, i· .
,
•
•
: ' .
"<
. •
'
I
•
~
"
.
.~:"
,
1'"
•
•
.;.,
.
1861(e),' to,'ahospital.lo~ated,', in :a' rura]
17
",18
•
,area, except'ihat-'.",'
'.If •
"(1)' the facility' ne~d 'not meet:,
19'., "
hosp~tal ,stan4ards relating; to, . -"th~, "
..
',number ,of "ho~lrs "during '!i'day,' ;or,
'" 20'
" 21
"
" 22',"
"
,.'"
',' 1
.
,
{
J
'
\,
,
'
"
"',,"
"
. days during a week; in which the fa
'~ " , .
,
'23
.
' , < ' .'.,
\
"
.
,'cilitimust 'be open and fiilly staffe,d"
, r
•
i"
_
,;',.,
,';'1,
;
....."~ ~"".
",'
.
,'.
"1."',' "
'...
'. except insofar .as the' facility, is re.
. ....
',.. .
' . ' .
~
-
.'
'.
qriired, to provide emergency care oli a', ",
,
,
,
.
•
' . . , ! ,
.
,.'
"
~
i
"
,
{,
.
I.
"
'
"
;
',:"
';
,
, ;
,
,
,
.
.
.
,.;
�, ():~SIM\SIM94.599
srAFF DISCUSSION
. ''"III -A-7
D:RArT
' ..
,mllsthav~ n~rsing' services ayailahle. ,',
I
I
2
':' on a'24.-hour 'basis, but
/
;';
4V
5
I
I,
•
.' ,"(II) the facilit)~ maypro~rideariy
6
.
\
seI"\~cesotherwise: required ',to' be pro
7
"
~'
\
•
I
',9
,
\
I
\.
,/
.
a:part-tiIIfe,'
•
..
"
'. ,",'fll)
14
,~
offs~te'
!
"
•
,
I
de~
the' inpatient care
scribed in clmise (Vi,i) maibe pr()~ded
15 :
•
_ ' .
j
-
.
' .
. '
I
'
(
by"a phy~ician'sassistant, nurse prac~ ,
·16
/'
titibner,.'or. cljriical, n~rse specialist
, 1'7
18
~subj ect to' the' ov~rsi~4t of' a ,~h)~sician"
whb neeQ notbe present iIi the facil
.
,
'19
.,'
"
"
'.
.
~
,
, ity; ,and '.
. .
'·20
,
(' . 21
~
~eets.the requirements.Qf,sub~ .
,"(viii)
,'i.
22
"
, par~graphs ,(C) 'thro~gh' (I) of .Pllr;,tWaph,·
/ . " (2): of se~tion; i861(aa),'~nd of
..
.23
I
,,'
' . ' "
~lau~es' (ii)'
.
'
,"
24
y
.:
in'sectic)n 1861(,,-)(l}, and .
/,'
,
I.
.' basi~" under' arra~gements as, <iefjned
13
I,
, '
"
),
technologist on ,.
1,12·
•
'
" . '
\
'"
.
' ,
medical. 'tec4nologist;andradiological
.
.
.
'11
\
,
-
.
,.
..
laborat~ry;', technician;'.,
.
.
',pharmacist,
10
~.
fuli~ti~e, onsite di~tician,
. '" 'vided by a
8
,
ne~'d hot '6th- .
, 'r' erv\rise' staff' the' 'facilitY ·except whel).
.' , '- . "
.
"
.:'
4
...
, and.
(i~)
!
.of the. secorid sentence .of. that,
'"j."
,
p;,tr~gTaph,.
25
except·· that in (determining
,
I
.
. 24-hourbasis under .clause ',(Y) and"
1'··
'.
";
,. .
:, .
3.
. S,L.C,
!",
.
'
•
:
~'
,
'\
i
/'
'.
":
'.
'I
.
". .:":f-"7;'
).. eX.t?
�",
.:,' 0: \S,IM\SIM94.599
"
/
S.L.C.
"
,
..' .' ,1' :
~vheth~r
.1
.:.,'
.
(
/
.'
,
\
\
,
3
'
.
\
.'
,<'
;
,
,
I
•
' ' .
.
"
-'
-'
'
~
•
is a iref
,
:
',;'."
•
,
',:
','
,",
•
'.
'
,
,
.
'
, . ' ,
'
,N,
\
•
.'
•
•
"",
. ' . '
\\,
"
,
'"
",'
I
,
, ',' f:
I'
\
" " , '
,/',
:
'
:'
":,'
'
,
I,
'j
/ ' .
,
, ,; ",'",' ,"(1) with fewer than 6 residents,', , .
.13
"
,\,
.•
'.
~
~'.
.
, per Square mile, or
14
I'
' ;,
, " I.
" .
.'
',
, '.'(II)' ill' a rural 'area (~s ~defined'
.
15····
-,"
','
.
\'
'
, ',' .' in sect,ion 1886(d)(2)(P)). that is
16
i .
• •;
io-,
.<
,
','
,.17
" ,catedmor"e thana,35.:...mile' or 45:"':i
•
'\.
,
:
,minute 'drive from: a hospital,. a rural
18
[,
,
lent unit of local' governmen~)-, ~:. ,.
,
!
"
'.
,."(iJ.,is Jocated in a, county (or eqUiya
\
,12
J
').
a' 'rftedicafassistance' fac,ility,
'i
J'
'"
•
.
,
,FACILITY:-A State, ma:y des~
' .
,:·only if the facilit)~-'~ "
"
/.
,ll
j
.,'.
.. ' ,
'igIiate ·a· facility as
'9
,
:
(
'/
,leAL 'ASSISTA.~CE
.
.'
10
"
" "(B) ,CRITERIA, F(>R.DESIGKATIO~AS MED-,,~,
,
'"
,
'
'
\,'
18,6i(r)(1).", '
i
,
I
'
. :.
7
"
I
'... ererice to ,a" physi~ian as defined in' sectio~ \
,
;-
6.
8
",
a,s if., anyreferencetJ)' 'physician~'
,4',
~
"
\
.
,
":
.' 'of this" subparagraph, ~ubp~ra~:l'aphs' (E),'
. .
.
2
,\
requir~nient's,
a facility meets' the"
'
'
.
I
'
:'". primary' care, hospital, lor .another .fa- (
~
,
'
,
t;
"!'
'":
'"
~
" '-
~•
I,
:
'
•
cility.described'in this. subsection;
." :"(1), at
,
th~, ~icie"'such"facility applies
:'
.
\
, \1
'
,'.
_,:',tothe'State"for 'desigtlation ,as ~ktn~dical "
, 22
.
,.
\.
"
'23'
•
"
-
"
'. a~sistance facility-'", '
~,;-
:
'
,I
. ,
!
, ; "CI) isa hospit~l,,(or iii ,~he .c~&e,
"
,: ,/
:.', '., ' '<', \,. ;
. ',of 'afi1cilitjr'~at closed quring the .12~
".
"
..
~
,
r,'"
'9J7i '
"
j
'0,,:
I
• .'
,
�~', "STA.Fy DISCt.iSSION~DRAFT
'O:\SIM\SIM94.599.
S,L,C',
',""", "\:rIII-A-9 c
, mOl)th period that ends 'on the' date
1
..
2
.
.
, the, facility applies for such design,a-','
",
,i
tion,' at the'.' ~ime .the facility closed),'"
",,',
J
i
,
,
,
,
"
,', fect under'/~ectionI866(a); or ,: '
5
,
'
.7 "
,
,
J
'and regulations';",
,8
I,
'
"
, "(iii) " meets 'the
9
,i
'
"(II) is licensed' in' ,accordance
6
':
requirem,ents ' of'"
I
,
\
clauses (iv),(vi); ahq (\ii),ofsubparagraph
10
.
,"
1
','
J
(A); and
'II'
.
~
.' i .
" ,
"(iv) 'm~ets the requirements of sub- , '
12
13,
paragraph (I)' of. paragraph' (2) of ,section
(
.
'."
1861(aa).', ,
14
"(e) ,RURAL HEALTH, NETWORK ,DEFI:N~D.-·For
,,1'5
16 ,purposes of this. sectioll , the term "rural health network',
,
,
\
'\\iih a 'partic'ipa,tion 'agreement In' ef
4
,
,
' \
( ' . ,
..
,'",'
\
.
'.
,
"
:..
.
.,
.,'
,
'
-
,
.
'17 , ineans~ "ith respect to a State, an organization-. ' ''
!
"(I). consisting' of-' ,~,
18
"
,
19
,
,I
.. , , '
",
",
.
" ,"(A). at least 1: facilitvthat the 'State has'
.... "
. .
, I t{.
,
.
",
,
."
•
'.
T
. ,
,
I
designated or -pl~ns: to' designate' as a ,rural pri
,
20
\
,
\
\
"21
,
',mary care h6spital,'and
22
. ,"(B)', at least 1, hospital~hat, furnishe~
23,
'se~ices ,that a ;rural primary care 'h~spital can-'
24
I}ot ,furni~h, and'
/
"
,i
\:
•
J
~
\
,
'
,
,
�SrAFF DISCUSSION,' DR..An' ,:
, '
"
,
,
,
~
, ,
" ,1'
"(2) the' inembers· of whlch ha\:e entered into',
'.
.\
~greenie~tsregarding~~'
2· ','
.,'
,
.
.
,
.'
,;",
"
'",
,.3,'
,';
':.
..,:..
'.',
.
;.
.'
"
, .', ".(A) patient referral and, hansfe:r, ,
., "(B), ;the'd~velopmerit 'and use of co~:u- ..
.4
.
' .
'
,.
,
6'
•
I
.
.
J
' .
•
,
. ..1emetry syst~ms : .and, syst~ms,. for' electronic '
.
•
"
"
, 7' .
.sharing of 'patient d,llta, .
,
,
",'''(C)theprovisioIi 'of emerge~cy and ~no~-
8
,
,J
'.
•
I
",
t.
,,'
9
,', .emergency' ,tr~~sp.~rt~tiop
-.
"
~mong t~e ,ine~be~s,
.
"
' . ' "
10'. ,
,
,
'IL
,, ,
•
,p:icati~ns.~ystems, irlcluding(where f~asible} te-:"·
'5' . '
"
,\
. "(D) 'credentialing and qualityas,surance. ", .
,
'r
v
•
:'~
•
.'
I,.
,
' "(f) CERTrFI6ATI0~ ~Y THE'SECRETARy.-,The S~c- '
.'"
12.
,
,
'
'
, ',.' \3retary 'shall·.certifj~ a facilitjr.as a~rural primary/care ho~-." .
"
'
, ~4pitalormedical assistanc~ fa:~ility (Asth~ca:se ma)r be)
,1,
,'."
'.
'
•••
'
I
'.
'..
'f'
•
•
,: 15 'if the facilitV-,
,'.'
,
,.'
, ,'16
,',"(1) is located in' aStafe:thathas .established ,',
,
18
'
•• :
.:'
_"
\.'.
,
' ' ' ,
,
;
,
•
'.
I:'"
,
.
,.
,
'.,
:pital' or. medic~l ,assistance facility by th~ State ,Ill
20
"
<.
'.
;;
,
."
.
.,'
'"
\
\ .
. '.'
"
:
)
.
,
.;' which it i~ located; and
2}
i
."
,
\.,
i':
. ,\
, '
,
'"
. "(3) nieets s~chother critetiaas the Secretary..
. .
22
'/
J
"ith subsection (d);
t'·
,
"
,
,.a limited ~ervice,' hospital ,program ;maccQrdance
,17,
., .
,; ,
,fill'
,
23,'
~
. '
,
'
",may, reqUire.
,
~'(g)'PERMITTING' MAlNTENA.l\CE
'..
'.
.
24
~
"
~,
"
.
OF
S\\YINGBEDS.-",
25 Nothing inthis.sectionshaUbe c~nstrued, to'prohibit a
,',
.
\
,'.
'
,
',,,
I
.
,
,
"
.
.~
,
,\,
'.
{
"
.
"
,
"',
.
"
I
%'"
,~,
'
�S.T~DlSCUSS10N'
DRAFT .
" SL,e,
,\liI·A':"'ll .'
d~signatingor
, . I 'State from
'"
,.
"
•
'\
-.,
~
.
.,,'
I
'
','"
•
'.".
•
• •
"
'.
t.i
w
...
' .
"
..
,
hospital or me~cal ,as:', "
. \,
~
.
•
'
','
•
"
"
-
at the time· therfacility ap- ..
'
.
~
" ' .
,
plies to the: Statef~r desighatiori· as,a rur.al prirllaryr ca~~
l "
'.
~,
i
.
" ,
•
\
.'
",
5 hospitalor'~eclical assistance .facility, there ,is in 'effect,
I,'
,
_
,
"
~.
",',
3 sistance facility solely because,
•
S~cre~ary~ ,from~ertifyirig'
the
'
as a ·rural. prima6' 'care
2 ~a; facility
.
I
"
,.".
••
'
I.
j
..'
.....
.·6 ~ri agreement benveen the facility and the Secretary under
•
\.
.
.
, :',
.'
\.
"l.
l
': . ,
I' _
.",,'
:.' :
~\
" .
•
7 section 1883' uIlderwhich thefaGility's'inpatient'hospital
, , 8 . facilities
, I"
"
9'
~
. I
.
.
•
a~,~~sed for, the furnishi~g of e}..-tended c~re serv
\..
J
•
,
•
~
,
'
" f
j
• •
.... \
_
,
i~es, 'except'that the, ~umb~r of 'be~s 'used for 'the furiush-:,
\ .
.'
-,,~,
:.
,
,'
-10 'ing of such 'services may not exceed the total' number of ., .'
I
'.
.
I
. 11 licerised'iJ:~patient ~edsat:!he ti~~the facility, applies to "
. , 12' the State f~r ,such designat~on (~~us the number
of' inpa~, ..
.'
:13 tieIit~ beds.used for provi'ding inpatIent Gare ina rural pri":,:,
,'14., marv care facility ',pursuant' to subsectIon (dY(2)(A)(vi))~' .
-
41-..
•
. . '
.)
" ' ,
'
•
'15. The Secr~tarY"may~stab~sh additiorial.con,clitiohsof pa~16 ticipation for 'rural 'prima~y~~re hospitais with a
'.
,
sub~tan~
,11 tial Ii\lmber of such .bedS.. For' piirposesof.the .mst"' sen":
.,
; ' . '
: .
'.
I
~...
...
"
./
i 8 tence, ,the' hu~ber of" beds' of the 'facility used 'for, the fur-"
,
. .
'.
~-
I?
. ;"'}I
'
-,
\,
•
,
,
;
J
•
,,' .
'
•
rushing of. e}..-tended care' se~ces :s,hall not· include .any
;0 .b~d~ot all!lit of the facmty th~i is ~cense~ a~" adlstinct-' .
" . ',,'
\
,'-
.
"I'
'
21 .part skilled nursing facility at the 'time thefacilitjT applies
,
I,
•
...
"
•
22 to \he' State for' des{gnation a's a rural primary ca~e hos,": " .
.
,
23 "pital or ~edical, assistaJ;lce~acility.: '
,
"
"
.'
'f,
:'
. '24,'
,""(h) GRANTS;
.
.
".
\
.
,~
/
i '
;
"j
,
'i
\
',I
,>
\,
.
. • '.
.,'
�' .. STAFF :QISCUSSIONDRAFr •
0: \SIM \SIM94.599- . '.
,
-
\ .~
,
S.L,C, ,
,
".
;
, .. VIU·A-12'"
1
"
,
.....~
,
I
'
.
'
. ,
,I
t
'
,
,
)
.
.?
'
.. _
',.
"
'1
"
,
. "
'>
:-
".
.
(
,
.1
'
'
..
'
'
,:
'
~
,
,
7.
hospitaJprogr~~ ,'described,". i~ " ~ubs~ction .',
~: .
'{
, . '(d)(l)(AJ;engagiiig , in 'icti\1tiesrelating to,.
,9.
~
,
t.
"
_ , ' . , _i
-
'"
.'
'.
-'
: \
,
.'
-
impleln~nting. rur~l
10
,,'planning a;nd
-I 1
:~~rksj and, ".' .
,
,\
-:
'
,
.'
hea:lth.::net
'
.,',
,
,
',,(C) designation of 'facilities :as" rrira,.l',pri-'
12
.
·1~.
",
" , ,,"
-
,
\
,- "
'.'
i
" I
!; .
'.
. . . ',
~:
'.:
- '.
:
'
\
ElffiAL 'EMERGENCY, MEDIC.AL SEItvic~s.-'
"(2)
•
.'
:17
I,
-
,
•
'
,.": pli'cations' in accordance with subparagraph' (B) -.,
.
,18:'
i
.,'.
,
'
-
.
,".
'
'
,gr~m forthe',pr~vision ''Of
'20, '
"
-,
,':'
,\
,,','
'.
"
,"
"
'
,"CB.) bPLIC~Tl~N '-,Ail 'applic~tioh )~.in,
~2
.
',;
.
"
:1
1",'.
f
, "
0
rural emergertcy:,m~di~,
'I,
.-
21
,
,'for .the est~blisbment or exPan~ioI,l of a pro
•
,
23- ",
\:
" 'ac~ordance '\\1tb this'subparagr'aph if the ,State
•
,
I
I
'
•
"'"
. s~brriits 'to the Secretary 'at ,such' tim'e and iIi
.
",
,
.
"
(
.1
,
....,
\
.. ,
. I'
' •
'
'.
..
.
.'
.~.
.
{,
t"
a:\vard' gTant~L~o 'States that· have ~ubmitted: ap- ,.' ,
I
.19 .' "
,
,
•.
':
,
t
" -:, ~'(A)I:K ,GE~"ERAL~-'
'The, .Sec~etal"Y·'may
. ·16
,
,
,'~
",
15
,",
. I
mary 'car~ hospitals ormedi<wl, ass~staD:ce facili
14, ' " .
,
...
.'
,
/
'.:
","(B )~n' th~. case' of, a rural-primary , car~
8
,
\ ,.'
;'
'rung and':,
inmlementinga rural,health~are plan;', ,,
.
.
.
6
,; ,
.
.'
","(A) engaging in, acthitie~'relatii).g to plan- ,
" .. .. ' .
"
S
.
\
.
.
\
,
•
,~
',\
'
,
I
,
:(c) for-,"
"
.
..
,-,
.
,
,
,
;
: :'The' Secfeta~-y inayaw~rd ,grant~. to' $tates 'that' have'
,
.4·
'"
P,ROGRAl\I:-. ",
,
, 'subini~tedappli~ation's 'in 'accordahce' ~\1th,subsectio'~
3.
~,} .
I~nnTEDSERYICE:HOSPITAL
"(1)
,
,
"
\
,~
r..... .'
,
.
'
,
�'I
'. ;
O:\~IM\SIM94.599
S.L.C~
'.
..
, :' "1:it~A7-13 /.
-.
... ' p1Ication .contairung'the assurances described . in
.
.
,1'
,
~'
". subparagraphs' (A)(ii),(AHiii),.and ,(Br of sub
. ,(-.
'3
.'
.
.
'.
,
I
"(i) STlJDYOK CLINICALLY BA$E.D ALTERXATri~TO.
,5.
,
')
.
.
6 96··-HouRRULE.-.·The Secretary shaH conduct a.study on
"
/
,
'
,. section (c)(I) .and paragraph (3) of such sub- .
,
.
section.
,
~.
,
(
.
:
.7. th~ feasibility of adrpitting patients to.' niral primary care'.
,
I
1
.
'-
8· hospitals and .medical assistance -facilities:. on. 'a'limited
. .
,
,
'.,
,"
'
"
: 9. ,DRG b~sis instead. of using ·the 9S·hour 'average 'length
I
.10
..
.~
,
.
I;
of.stay criteriadescribedinsubsecti9ll (d)(2)(A)(vii).-·
.
".
, "
'.'(j) "rAIVER .OF·'COKFLICTI~G . PART ,A PROVI~ ..
'11 .'
/.
•
,
. , ' .
,.!
(
12 . SION,S.-.·The.8ecretary is authorized tOwaivet.such prQvi·
. -13:'
sio~s' ~f'thl~part and part' C as are.necessa~r to .conduct,'
.
.
..-
"
\
,,~,
14 the program \established·rt~dei' this section.'
. "(k) AUTHoRIZATIoN OF APPROPRIATION·S.-'
'The~e
.
.'
.
.
.'
'
"
'
,
",' 16 'are.' arttlmriied to·.be approPriated' from.the 'Federal Ho~.·
.
. •.,17 pital ~nsut~nce Trust 'F'und-", .
. ,18"
, ,: "(1) 'for making'irants under
f..
s~bsection (h)O)
I
-,'
,
,',
,
19
'.
..
t~Sta!es that hav.eestablished a rural ,primary' c~r~.
20 .
,
hospital' pro,gram . in ···the ,state. ·;under , sub~ection.
.
21
" (d)(1)(A),$15;OOO,000 for.each 'offiscal years 1993'
'
.'
,\\
22
)'
"through 1995; ,and,
,
,
23,
"
"
.
~.
•
'-,
·... 24·
I
'25,
-
I
"
"(2) fqr making"grants loall States :under sub-, .
..
,
,
,
.
,
section (h), $25,000,000 in each :of thefiscalyear~
19~6through.1999.'l: .
,.
.
,
"
,1
. i
,4
'.
\
'
�, : ' O:'\SIM\SIM94;599',
"
I
"
,
'
. ',-.
'1
3 CILiTIE$.-'
,
•
"
-:
j"
.:
, ,1395x) is amende~ by ad,ding at 'the e}l.d the follow-,
5
, I
..
6. ','" ,ing~ew subsection: "',
v
f
7
"
.
,
,
"
"
'
•
.~
, ,"MEDIC.A.L:ASl?ISTANCE FACILITY; MEDICAL As$ISTANCE
8
,
'"
FACILITY' SERVICES ','
,
(, (00) (1), The term 'medic~1 assistance facility'" means, ' ,
9,
,
,
j
"
•
'
"
16 a facilitJr'certified by the Secretary as a~edlGal assistance ,';
"
,
.
11" facility und,er section 1820(f).,: '
'
,
,
'J2 .:' '"
' , f .
.
.
"
~
,.
J'
.
J
' .
•
" . '
',13 ,'m~ans 'items and,servic~s,'furnished to 'an ,inp~ti(hit for',' , .,
.
..
.
.
.,'.
"
,/',
,
"
,','(2fThe, .term ,'medictllassistance facility services':,
.
,
,
,
,~
,
,"
"
'
, , ",14, a, m~dical'assista~ce\f~~ility by, ~uch, ~acility, that' ~qu1d
,
',: :"
: I "
'
"
"
, ,
15 :be iilpatienthospi,tal. services: i(fu~nished to an inpati~Iit
•
i
',.
'
,
'.
..,'
'
' , . " ,'
:, •
.
'
16 :of a hospital by a hospital.".' ": "
I\
•
l'
I •
.
~
"
'>:,(~) 9'0VEfu\~E ANn,' PAYM~Nt.-'(A)(i),Sectiqn .
"'~812(a')(1) (42U.S~C ... '1~95:d(aHl)) i~ ame~d~d,'by::
.
"
~
17,.'
.18
,
'19
i
-
' ,
,
:;22 ,"
y
• ,
. '
',l
'
. .'."
t
,..,
. ' '.
•
'
••
.it app~ars a~d, inse,rting ", ihpatlEmt 'hospit~~ sery.;
., .
"
'
"strikini' ~inpatient' hospital service,s'" the' firstplac( ,
20 "
21
" , . "
.,
~';
'. ":
;/ .
'.
u;
,
,II
•
, ,ices ,andin:patie~t, medical: assi~tan,ce facilitY, senv;.
',~ces";'
and
.'
'\
"
'
'
..
'
23"
:. ' ,,: (ii) by striking ",inpatient 'ho'~pital services~' the'
24,
,secoh<i place it 'appears an9' inserting','''such serV~
I'
,
!
,
i,
25 ,'.'
,
"
'
....
'iGes" ~ , "
~
,
~
,
,!
'.
\
'
,,
I"
'.'
~.
.
'
Ii
,
'
.
�J?RAFl'
$TAFF DISCUSSH)N
, 0: \SIMXSIM94;599
.
s,L.c,
, \lII-A-15
\.'
'\'.
•
,
I,
'
,
l'
(:8), 'lSectiOll, ,1814
, ,
J
"
{42
V.S.C. ( 1395f),
,',
amended-',
,
,
IS"'
,
Ii
"
' ~,(i) in,subsectioh'(b)"by'striking "inpatie~t
, 3"
,
,
'
1.
"
rural primary c~re'hospitai service's;" and in"':
4
.
,5 ,'
"serting ','inpatient, ~ral' primary care hospital
. . . . . .
.
.
I . .
.
•
,,~
•
•
T
,~.
.'
. "
~ Ir
"
'
. ,6
" services,oilier than a medical' assist~nce, facility,
7
" . pr(nriding 'inp~tient," medical 'ass4stance faciijt)T,
' /'
"
J,8
'\
services, "; ami,
,(ii) 'by amendi~g sub~~ction" (l)' to read as'
9'
'
, , '
.
,.follows:, .'
10
.'
,
.
'11
" :12
,
..
,
,
SERVIC~S' ~l\D'IK~ATIE~T' MEDIC~,.As~ISTANCE,
,CARE
13' FJ\.CI~ITY SER\iCE'S'.-'The amount of payment unc;ler
I'."
:,14-'
'L
,
'
,_.
.
,"
'"
tlti~, ,
:,',
/'
,
inpatie~t rural pri~~ry c~n'e:servi~,e$' '~nd inpa
part for
15', tient ,medical ~ssistance" facility services is the, reasonable
•
.
,
'1
:
•
•
•
",
,. (
,
.
\
"
'16 "costs of the ruratprimary care hospital or medical: assist- ,,'
,
I.
• ".
",
'
\
: 17 "ance f;;tC~ty.irii proyi'ding' such serVices~",
,:'
\.
'''- CILITIES 'As PROVIDEttS, OFSER\iJCES.-, (A) Se~tion
,
.
20 '
"
.'
. .
'"
,
.
•
.'<
" .
l
•
,
1861(u}(42 U.S.C:1395x(u)) is amended by insert:,"
.
.
. /
-- 'ing:~'triedical, assistance facility,"after "'rural. :Rrimary
.'.
,':41,
,
,
.. :
•
•
. . . . , .
", 'r
22',
t
.1;
,,',' '(B) The ,fir~t ,sentence of section 1864(a) :,(42' '
.
'I
.
.'
'
"
i,~ amend~d byi~&erting "a rnedi.
U.S.C. 1395aa(a))
,
' .
I
,
"
,
, care hospital,'\ '
23
,'24
I,
'
\"
/
'
., I"
,
"
'
I ,
••.•J
,
, ",
"
�"j
.
•
-
\
...S.L,C. .
.,\ i861'(o~)(1)," after;'~86i'(mm){1),",.· ..
2'
.. '
I
,:ear. ,"ass~\stance ".. facility', '.. as " ,defin~d""" iIi . section
..1'
'
.
':,\"'III-A-16
:' "
,
.
STA,FF DIs,ctrssJoN D~: .'
O:\'SIM\SIM94:59.9 \
,
.
I
(6): The third ~'sentence oJ s~ction'i865(a)
.
".
3
~
. 4 ,:-
~uclt Act (42 .ti~KC..1395bb(a)) :isamend,~d'by:
i.,:,
. )
'~triking'.: "or ,186'1(ID;IIi)(1)'"
.
and
.
•
....
..,
.-'
!
.
!
II
..
\
.~,
9.···
I
.
.amended-·
, , .
,
-',
.
.f
•
,
1~
•
\. .
,
,
\
.
.
'.
.hlg", a 'nir~l primary ¢are hospital, ·or' a medi~
··12
'I
, ... i3
.
"
pospit~l'" the first .pla~ec it'.·appears and \ ins~rt~'
,
,
I
. (i) by 's~~ilring "o~ ~'rura] primary 'ca~e .
. " . 11'
;.
'.
'"
'
,
"'Section'
.,
1:320a~7a(b)(1))
w"'
.
. "'10:
"
,
CO!'-.""FORl\lING i-'"
. .tUrE!\"DMENTS;-.·(A)
"
..
,
,
"
.
."
,
·1128A(b)(1)·'(42.· V.Re.,
8"
'
"
~
.,
•
.
';.
•
,"
''''''"
. ' ,
; '
{.
. ':",..;' ;cala:ss~stance' facility" ; and .
'
,
1
I
..
:
,
"
t
'f
j'
..
";
\
I
j6
\
,:\
.'
'
',;,
,
"
'
.
"serting ",' the rural' primary 'care ..
hospital,o:r',
'.1'7 ' . ,;
\
~
"
,
' , ' "
.
,'.
'
,
,
,
'.
•
,
,
"'
"; ~, .: (~? )y ,~tril~ng"or,a ruralp~IPary ·ca~e '
'\'.
. :hospital" the' second place it. appears . and, in
.,"
.
,
.
.
\
,
"',
,
.,
. inserting'
'. 6 .... '.' ,,",1861(mm)(1),.or)861(:oo)(1),":
'7'. .' \:' '(4)
\,
':
.'"
! ..'
'of
.,
"
'
,
",,,
( . ,'the'ypeqJcal'assistance 'facility"."',' : , ..'
. I.
t<
(B) Sectiop. 1128B(c) (42 U·:S.C.~320a::"'7b(c))
. .18, ..
,
.js . ~inended
"19,'
'.,
·bY· insertIng, ~'medical . assistance 'facil
.
.
'"'
'
I,
•
,
'
I
.
,
,
. '21
,amended" by ~triling"'or Dlral primary: care '. h6s-' .
'22
;
,
,"
,
•
I ,
'
• .
"
•
_
•
:( pit~ils" "each: ,place/it' appears~.~~d: inserting ".', 'rural
. 23
,
',"
!,
,
,
'\,1\
•
,
"
:
,
\
24 . :;'. primary care.hospitals, or' medi,calassisiance facili:-,
"
"
,
'
",
"i
'
'
I'
.,'
ties" .
25
.
I
,
"
.'
.'
",
..
.' .
",
'.
'0.'"
.735·,
�$TAFF DISCUSSION DRAFT
,O:\SIM\SIM94.599 '
S.L.C,
\"1II-A-II
1
(D), :Section ' l138(a)'C).) (42r.S~C. "13200-:-",' .
,i
" ,
, 8(~)(i)) is aIl1ended-': "
.
.
.
2
."
, (i)' ,in them3;tter.: p'receding, subparagraph, '
.
. .
3
'", (A); by striking , '''ot ; rural', ~nmar.v ' ca~~ hos·'
4
'.
;
"
'
~"".
"
•
'
i
pital", 'and insertiy{g ~(, ,rural primary' care ~os-,
5
'
.'
I
"
,pita,l, .or medical, as,~is~ance facility", and
"6
:,: 7
8
'.
'
~
'W) -in -the matter preceding clause (i) of'
,subpar~graplr' (A),; bystrilarig. "or 'rUralpri~'
",
~a:ry care hospItal" and inserting "; rural pri
'9
;-
10.
",'
,
"
mary care hospital,' or'medical assistance. facil-'
,;
, .
,
' .
11 '.'
"
I'
,
;
,
13,,'
;
(E) Section 1164(e) (42 U.S.~. 1320c-13(e)) i's, '
·12
, atnenpedby: 'inserting "in~dic~l assistance facilities," ,
..
.'"
.
,
-
,'\
,
•
"14
. ~ ., '.'
' .
,
• I
•
after,':'ruralprirnary car~,. ho~pitals,". '
'
, .
,
,
"
IS'
16':
(F) : Se'ction. :1816/(c)(2)(C)
13'95h(c)(2)(C)) is' '~mended by:
-
\
17
U.RC.
Inserting-~;"medi~al"
,facility," )tfter, "rural' primary care hos-, ,
. '
,
"
(42 ..
assistance
,
,
;
,
~
,
.
-
;.
">;
,
'
. '"
"
\
"
,
;
I
18
19
>:20
-
,
"/'
"
1833 ,(42,', V.RC. ,1395l)
(G,)Section
'IS.
'
,
'amended-'"
(i) in subsection (h) (5) (A) (iiI )-"
-.
2l
,
,
'22
)
; ':. '(1), by 'striking "or'I1lral primarY care
23
'hospit~l" ,~nd inserting '~rural:" primary
','
"
24.
,
, care ,hospital, or, medical assistance facil'··
,
"
~
~,
25
"
'
-'.
I
"
I,.
�0: \ 81M \ 81M9:4'.599
"
:
'
< ) .STAFF ,DisCUSSION DRAFT"
,
.
,
-
"
,
'.
~
J'
: S,L.c, '
.
"
'
.' YIII-A-18 , '
1
,
'2
','
ins~rting ,'~t()' the' ~ospital or the, facility~' i"
,(ii) , in' ~ubse~tion'(l)(1)(A), . by:.' inserting :
',',\
3
~
)
,
'4,'
!
'
..
\
'
"
,
/ mary 'care'h~spital,";
..,'
6
.
,,'.
w'
•
l
'
•
,
'''m,edical assistance facility," after "rural pri..
5
.
,1 ,
"
"
~
.')'
."
,"
,'
.
'
\.
.'
..
'
(iii) in su?sectioh. (i)(3)(A), by striking' "or
~ral: prim,ary:' , 'h'ospital' s~r\rices" and' in- \
care' ,
'..,
..
7
'
'
..·.S· ,I
'serting ','rural primary· care: hospital .ser\ri~~·s" or,"
',!
"
I,
'
' .
"',
.'
"
"
.
.
,..•. ',m~dical assistancefacili.ty senrices"; , , '
9."
,10
11'
.
"
';niedical assistance facility," after "~ral pd-,
,,'
'13., , ',.
,
,
\
..
.
:,'./
I
" ,J5
i
,"
.
.~.
",'
ho~pital,", each
'.
,
'
.
,
\',',
place it appears; a,nd'
' , ' (v) in . subsection (l){5){C)~ bv
.'.
.
st~ilrihg"br
"
" ' . '
\
,
,
t
,
"'ruratprimary' c~re hospital" each, place it ap- ..
.' '14.,'
"
"
mary. care
'12
'. ~"
:
,
",
p~arsand inserting :",.~ral primary, care" hos~
.
~
"
,
, '~pital,' or medi~al assi~tance facility".
1'6
'"
,,'"
,
/.,
).
\
'.
~
1"
i
:, ,- (Hl Section 1835(c),(42 U.S.C .. :1395n(c))!is
'17:
"
':
!,.
"'1'
"
amended .by addi~g at the' ~nd . the following: ,~'A
IS '
. , medical assistance f~cility' shaH 'be.c~Iisidered,a· hqs
:19
,
.
"
\
,
'r
'.
. (I) . S~ction 1842(b){6).(A)(ii)~,.( 42 ',' U .S.;C.. ,
,
.
, 22 '. ... 1395u(b){6)(A)(ii)) is' 'amended - . iilserti~g "niedi.;' "
by ' .
'
21
.I
'
"'
, - '
,
"
'
,
; ' ..' 2 3 ' cal: as!sist~mce . facility:" 'after "rur~ prImary care
\
24
, hospital,".':'
"
.
, .!
"
.
",
.\
"
'93.7,
�.
i'
,. 0; \SIM\SIM94.599
\
. S,L.e.
STAFF DISCUSSI,ON, DRAFT
.
.'
'. :,' , VIII~A-19 ", .
.
1
Sectiorl<,'1861
'.(J)
.amellded-.'
,
(42"U.S.C.'·1395x),lS
".',
\
.,
,
,
. , .
• I
.
.
.
'.
,
.
•.
. and,:' inserting' ,
•
f
(li) in' subsection' (~r) (1)
f
.
carehospital,~',
,10
"
,
:,'
~,
j
by ins¢rting"med.;, .
.
'
. '
.
.'
....
,
.
' .
'.'
.'
'
1862(a)(14)'
.•.
"I
.';
'17
r'
•
• J
>
'
•
, 18
•
.
,
.'
.
,
'
,
.
,I
Section '\1866(a)(1)'
, (,L)',
,
~,.
" . : ' , , ' '. i
,'. . , 1 . '.
(42U:S.C.
j
'(i)in . subparagraph (F)'(ii),' b)<i,nsertirig ;
. ','
'.
',.
~
.
'.
"
'
. -
"",
. .\
' . ,
. "m~dical' ~ssistance. facilities," ..after "rural pri.::'
.
-,'
.
..'
mary care, ho~pltals,"j:,
'
"
. / . 24
(ii)in
,
,
subpara~aph (H)-.:, '
,
\ .
"';'
" 1
,(
,.'
"
,
,
.1
"
'.
"
"
. "
'139,5ec(a)(1)J is' amended-. "
21 :
·23
.
~sistance facility".
.
.'.1
\
,setting '\ rriral prhnary car~ hospital, ormedicaJ as·, .
. .
'19
22.'
U.S:·C.
'" , . mary .care . . each ~place it, aPpears. 'and in
hos~ita:l'" .
.
,
,
·',20
'
'",.,..
(42
.
'"
\
,
"
,i'395y(a)(14'» is 'amende;d 'by stnking "or rural pri
.
j
'.
\
I
'Section
'\ "','. (K)
,
"
I
pit~l, oT"medical assistance facility". ",
13
'16
_.'
.'
'
\
and'
.!
. pears ,and inserting,."",' rural primary. care 'hos~ ", ..
.
. ',.l~
,.
,
rural/primary care '~ospital" each place it 'a,p;' .• '
1.1
14
'.
(ii~Linsubsectlon, (w)(2),'by striking "or'
• 1
12
.'.
•
,-
.
/,
:';
I'
,.' \
9
~.
.
,'.ical ' ~ssista~ce· facility," after. "rural::primary
8:
"
"
(as defined In"~ecdon 1861(00)(1»):':',,', .
7
~,,"~.'
./
, ' "1861(mrriHl)) or·a'·medicala~sistance facility, "
,.
6
.
.
. striking' . "~861(mm)(l»'"
4
.
..
.... (i.) 'in the last sentence of. &ubsection (e), by .
\
\
5
',:
\
,
':
t ..
\,'
j
.',
./
J
,
'
'
�I
.
"
. ,-,\
', ..
,.
"'STAFF,DiSGU~SIONI>1iAFr
.
O:\SIl'yHSIM94.599
\.
"
,
ro'
,8.L,C," ,
\
",;,'1:II-A~20, ',:
'
'.
'.
,
.. ,
:.'
':
".,
'~t) in the ,mattetprecedlngClause ,(i)',
I
,
' .
•
'
!
, :. ~" by: insertIng' "and in the case'of'~edica:l:
, ',2
:,
,
, 3,
I,
,
.'"
'"' . ',.,.
,",
.
\
,;"
:
,
~
"
-,
.
',"
'~ assistance fa<;ili~i,es which pro"ide~hipatient,' " ,
,
\
,
,
,
,)
4:
,
,': '.m~dical assi'stancefacilitv ' . . after'"
..
. . . . se:n"ices';
,.\ ,
'
"
~,\
,
{1J) in 'clausesqr and (ll)~ bY:strilong,
6
'"
"hospitat' each' place ~t:appe~rs:anQ i~·
7
,'\8
,
,
1
serting ~'hosI>it~l or facility";
'
.
,
•
if
'
.
"
.'
'<'\,
'
'
':'
":
I
i
• •
". (n in 'them~tterpreceding,clause' (i),
.
, 1,0
"
,
-
"
' . '
.....,
(iii) in subparagraph (1)-' , .
"
,9
~,
"
.,'...,
' .
,
"
.
,"
,'!,'
'}
pita!" ~nd' 'i~serting ,',\ a .,ru:ral'prj~ary ,
"I:
, . 1
,,' 'c~re, hospit~l, or ,a medical' assistance facil- , " ,
'13.
•
"\".
'"
,
14
..
\
b~; r stnking ,"or ~ral primary ,Clire ' hos·
J'
"j2 '
'
,',
•
,
."
..
'
,
"
'.
"
'I,J
~,'
I
"; ity'\and' (
"
,
,15 "
'1',1"
,
'
,,' ' ' :', " (II) in ~l~p.se (ii)" by:~t~ng, ','the,
,':
'.
, I, '
,
',: 16
,
,
,
,
",hospita:l"and ins,ertin:g~'the, hospital or.'the
.
C,'
" .
,\ f'i ','
,
,I , facilitY";
~
, ,18
,
"
,
'
,
'. .
'
• '>
,
~
,,"
,',
~,
,
•.
\",
,
.)'
,~'
.
' , '!'
"
;
21
, 22,
,
"
'
"
'<'
'
i
'
!
,
. ,;,
'
',' i',
,
. , '.
'
"
,
'
,
I
~
\
~.
.,
(
,
,
\ '
1
" , '
.
)'
,'"
, 'pitals~ 'and medical assistance 'facilities";
,
'
'
'-and 'in,serting ''', 'JUra( pri~ary care hos
,
, ';
"
"
,by strikipg "and rural primB;ry, hosp~tals"
\"
"
,
, (1) in' the 'matter preceding clause "(i)"
. . . '
20
'"
'
,(iv)in'subparagraph' (N)-',
"
'
19
1
,'"
and, ,', ' . " ,
", '1"
"
"
, (n)in clause '(~), b; stri~ng "or 'rural',
. 23.
.
'
"
,
'
'-
'
\'P!lmary ca.re' hospit~~"jand ii1s~rtlng",
, 24
,
"
, "
.
"!:' .
:'
'J
' . '-,
,\
,
'
\,
.
~
....
'
"!
"
'
'
~ ',:.
" : . '
r"
"
,
.,",
'.'
'
'9'
9 } '
. "
�.
.
.
.STAFF . DISCUSSION.DRAFT .
O:\SIM\SIM94,599
S.L.C:' .
,1_'
"
. VIII;.A'7'21 :
. 'I
."':rural primary c,are hospital, or medical as-, ,'.
_,
•
1
'. _ . .
-
_"
I
,
sistance facility,"; 'and .
,-
'
(III) in, Clause (ii), .by strilcing"hos-,'
f~cilit~~",'
.
. . pital' '. and inserting. ."hospital' or
.
".','
\
I'
SeGtion'
(IV!) .
6
'. 1395cc(a)(3})
.1866(a)(3)
,
U,S~C·
(42'
IS ame·nded- , ' " ···
. ··i,
..
: (i) by striking ~'rur,~i primaiycare hos J .
7
.
.
~.
,
"
: ": 8
'. pital, ,,: ,each place it appe~rs.in subparagraphs:
,9
. '. (A) a~d;(B) and in~erting "~r8J.primary 'care:'
)
(
12· '
. "rural prima'ry care;;h,ospitals," each' place. it
appears and ins~rting "rural primar"ycare'h~s:- ..
13
14
"
I"
'\
\.
Cii) in subpar~graph, (C)(ii)(II),bystftiking
"11 .
,
hospital, medical a~sistance .faCilit~;!", .B;nd .
10
.
,
,pitals, medical assistance facilities"',:
..
,\
. I,
'
•
J5, ;
(N)
Section
~.
.'
"
.
.
16
.
(42, .'. U.S.C..
1867(e)(5 )
.,',
, 1395dd(e)(5)). •
,by,
. amended
,IS·
/'
'striking' .
.
,
"
.
~
17 '
..'
.
•
•
•
,
'18
.
I
"
.
"1861(mriI)(l) )'" ,and inserting "1861(mm)(I)) .or a
i
"
"
•
,"j
'.', medical. :assist8:n~e' facilitY .(as 'defined
III .section.
, , I .
., ,19
18()1'(00)(1) ).".,
." 20
,
"
,
, '22 CILITIES..
,43
., 24
,
)
"
"
,",
'
.
, Jl)COVERAGE.-,·(A)' Sect.ion· 1861(~0) . (42 .
i. '
'. U.S.C.)395x(00)) as addeq bY,subse'ction (b)(l).,is'
, 'r
. ,I
,
,
,
. (
..
.
,
,
\
,
'
�•
1\
.-'
O:\SI~ \SIM94,599
,
.,-,'.
I"~
\,
, ,S.L.C.
" STAFF 'DISCUSSION, DRAFT .
'.
"
'
,
, , .' "rrrI-A-'"22 " ,
,
,
I ,"
;itn,end~d by ad~n!g ?t,. the" end: the, f6~owing neVi'
, , " ,1.
.,
"2
'.",
,
,
"
" paragraph:1
"
'~.
,
3
.
~
.
"
('
-
,
~
',t']
-
"..
,
.
'.
'
.
~acili~y
,"(3) ,The term -''outpatient medical, assis,tance
.
.!.
','
•
I
'
.
'
.4 services' ,~ean~ ,medicaland 'other 'health' serrices fur
5 ' nishedby' a 'medic81, assistB:n~e,; fa~ility 011 a'n outpatie~t
,
I.
, 6 'basis.".
"
,
7
8,
"
-
, " •139'5k(a)(2))' is amended-,', ',."
,
,
'Sectib'n, " 1832(a)(2)
;(13)
• 1.1
~.
I
,u~S.C.
(42 ."
,
'"
, (i) in ~ubparagraph(I)," by stIjlQng '''~nd''
.
9
'.
~
'.
~
'
"
,!
10
'at the end;
,
:;
j
..
11
'"
I
,12
,
'
..
.
".
"
-
"
'15
.'
,
\, , "
'..
,
,
~"
"
•
"
" , ,t
,
•
,14 . "
, '.
_.....
',.
.
I
\
' ' ' ,
"
,
" subparagraph;
,\
,"'CK)' outp~tient medi~al assistahce .facility .'
,
,'16'
'senrices (~s defi~ed iri~ection 1861 (00) (3) ).".
, 17 , .::'
,,(~) 'PA1~iENT.-'(A) Sebtion'1833(a) (42 U.S.C.'
\ r
-:,
"
I'
.'
"
\'.
.'
I
, 19
(
,
' . '
,
18 ' , '1? 95l( a) ) -is amended-.
"
:..
,
,"(iii) byadcling -at the end ,the, f'ollo\\ring; new' ,
,
~
~.
"
.!.
"
',;'
, 13 '- '....
",
'
'~
"'period at.the~rid' and 'inserting '~; and"; and
,,' ,"
"
""
, '
,(ii) in ,subparagraph' (J); by ,striking the
,
I,,'
1
.
•
....
,
"
I
;(".
,,,,' (ii)
.
'
23 '
25
I,
,and'Inserting "(I), and (Kr'i
22
24-
'..,
.
"
\,
"
ing:subpa'ragrap~' (A), by" striking' "and· (IF' '
.
.
.
20
,21
"
(i) ipparagraph(2), i~ 't~ematter'preced- , .
.
,m par~graph' (6),' b~~ striki~g' "and"
'.
'
"
at .
,
, ,the ,end; ,
,
.,'
I
"(ill), in ,paragTaph (7), by, striking the'pe
•
i.
I
(
'f
..."..-'
<'"
".
riod at the ~nd and 'inserti~g '.";~ and~'; and
' -
)
,
,
,\"
.: i
,
~/
t
"
.
"',
I,
,
, I
. ,.
.
'.
'.
"
:', ·'?IfI,
'
�'''' .
':,
\'
.'
STAFFDISCPSSION DRAFT
, O:\SIM\SIM94.599,'
S.L.,C.' ,
\JII::A-23
.)
,
1
2'
paragraph:'
, "(8) ,inth~ ca~e, of outpatient ;tnedicalassist-, ,.".
:'.
- ...
"~,
,. ,
, 3',
, i
ance facility sen'ices, the amounts described) ih secI
;...
,
.
\
'
I.
'.,.,
-,
,"
,
,5
)
'-"\.','
,",
·,4 '
iion
183~(g).".'
I
_', "(B) Section 1834(g)' (42, U.S.C.' 1395m(g))
,
f.,
, . 6
,
-amended~
" -7
IS
'
,
,
\.
(i) in 'the subsection -heading, by inserting
8
I , . '
...
\
,
\'
:
'crLI~· SERVIC~S'~ after
-,
-
,
I
I,
I
~
I,
"SER\'CES"" ' '\-,
.\
,
, , (ii)' in' pa~agraph /(1 )', by striking "provided ' '
r"
-
',12
'
durir:tg a, year be,fore 1993 in
'
: 13, '
,
' - '
'
I' '
,J
-'
, \ . "
. "AJ\~OUTPATIENT, ,:MEDICAL ASSISTANcE _FA~ ..
, ,9
,
,
,',
'"
ll;
.
rural ,primary
-" ,_care, ,hospital '~n<l~r ,~hls, part: shall, pe deter:,,\
, " , ~n~d b)~. one ,of the' foll6win~r methods' is -elect,
\14
, ~
,
,
,
'
ed by the'rural pri~ary car~ hospital"a~d in-,: "
'-I5
'1\:"
J6,
:
.. ..
~
'serling "in a ~ral primary ca~e: hospital or
•
•
•
\
,
' . . . ' .
I
1T
': medical' assistlince facility:under thi's part 'shall
18
be 'deternii~ed by ,one, of th~ foll~"wg: methods
" 20
'.......
'.
.'
"
facility~';
medicaJ assistance
(iii) 'in p~r,agraph '(l)(A)(li),~ by -strikin.g"
.
',22
, \,23"
'
i
"
f '
•
ices"'ea~h place
.
.
..'
•
.
' \
' ..
"
•
.
,
'
.'
it' appear's ,and 'inserting' "out~'
"
\
24
"
"outpatient' ,rural, {primary ,c'~re hospital, serv
,
,
'
.
,
I
,',
·
'
~'
.;;:-,
....
,
patjent,.ruraJ.':primary care" hospital' services or
:;"
• I:
,"
, as -elected' by ,~he 'rural primary care hospital or.
.
,.
-
:21' .
.-
,
',-.
,
i9
.
I'
- t'
"
I
,
'
,
,,'
.
"
'
.
"
�I
I. ~
'<
•
,STAFF'DISCUSSION
'Q:\SIM\SIM94.599 '
,
•
J-...
•
DRAFT
•
S,L,C,
•
.
' ! '\
'\
~.,' I
\
,
J'
"
.
"
,
"~utpatient'm~rucaj ,assistanc~ 'facilit~~"ser\'c~s;);
.
.'
"
'\,
"
2 '
!!
,
;'
"
.
,."
"
;"
~
,
,
'.
't
I
:
•
:, pi~ar' 'and'rrtsert,ing ~'hospital or fa:cilitY~. I',: .','
(d) ; ':PA"i~iE;N'T' CONTI!\-t~ED"'TO' "DESIGKATED' '\,
,\
'5 ,)'
1.'
"
•
•
"
7,
. '
I
"I
'
.
',9" ;
,
,.'
"~
,
.
, .
'.
'
>.
,'"
".'
I.
,
'
'.
.
'j
Jlush sentepce:, '
1'0 '
,
(~
'
'
:
,/'. ~
.
,
,
"
"
,
.
.,,'
...
,
"
. ,
1",
",
"
•
"
,.
'"
,
.'
,.
, '
,"
•
\
'r .
,(2} P~R:~UTTING :,PA1'1\1ENT,T0 PRIOR: DES,;: '
"
.IGNATED
.16'
V',S,C.
17 '
.
":
•
,
•
" ,,' 19
'EACHs.-Section '1886{d),(5)(D).'," (42'
1395ww(d)(5)(~'» is.'a~ended-'"
" su~h ,section' \v~s' in effect as of Jrily:l: ,1994"
•
•
,
>
',"-
,
,l.
.
,
"t
1 ;
l
before the"period at tht} 'end;' and,
,
,
,
,',
, i
}
, 18
,20
"
.
!,
'
15
. i:
.
'.
•
'"
",
'
;
22
,
• f,
"
:.,
J
'
" : , (3),EFFECTIV~ DA'rE.-'
,'The: amen~ents htade
: ,,'23
"
,
,
, ,,', ; 24"" ',:' by,this~bsectio~ ,l?l1aU' take effect6ri. Ju1J~'l" . . .
1994:~:
.
"
"I
..'
.
,.,'
\'_
• ',-'
//'
'I
j'
,J
'.
, I
\
"
'.
,
(B) in clause (v), by-' inserting "as such/ , '
"
.
..
, ' :: 'section'was in, effect as of July I? 1994" a~er
".
, ',21'
,
. \.. '
"
.•
July~ 1"199,4..
13' "
,
',"';"
" an, es'sential 'access 'c6m~riruty 'hp:spitalon" or after ",,'
, . 12,
'
.
\"The,S~cretary 'shall, not designa~e a~y:h~spital~s ','
',11
.
..
','
,
,
,
'.!
.'
'
.
,'is: amended by inserting, ~t the end the follo'wing' new
. ,~.
14
.. ' , '
,(1)' 'TERMIKATIOK' OF EACH DESIGNATIOK.
.',
!
.
•
, ":8 ' ',' Section '1820(i){1)(A).(42, 'U',S.C~ )3'95l(4)(i)(1)(A»
.
,
\'
'
.
.
, t
,
6':,~CHS:-:i:
"
.
,
,
,
I'
'/'"
"
,
, '
',c,
i
4
,
\.
'Ov) inparagraph,(1){B); by~trikipg' "hos'" " ,
'3'
,
\
and,
.
',-.
'.,'
'.'
,
�,
'
, 'S;L,C,
STAFF DISCUSSION DR.AFT
'"1II-A-25,; ,
, '2 DE'D1:CTIBLE, 'COI~SrRA.~CE '~'\'D SPELL,'QF 'I~L!\ESS'..
.
,
.
'
. '
3 '(1)', Section', 1812(a)(1) (42':U.S.C., 1395d(~)(l)), a~
"
"
4 amended by sub~ecti6n'(b)(2){A),' is amended-, '
.
.,
,
,5:'
,'CA.} b}; striking '''inpatient medical assistance' fa- ,
,
,
6
cHity 'serVices" and i~$erting' '''inpatient medical as- '
7
Ststa!lce facility" services, ' inpatient
'.',
J
.
"
"
, '
.
,
9 , ,,' , 'ancef~~ilit}~ seryices'';, and
:"
"
rural'
primary'
.
-,
. .
care hosph'ai services,' 'or inpatient m~dical ',assist- "
8
,
'.
•
•
,
,
.,
'- 1
(~) bjr' strikin'g ,,"alid' inpatientrnral primB:!-Y:,
.10
·',', care hospital se~1c~s';.
11
12,
" (2) Sections f'813 (a) and" 1813(b)(3)(A.) (42 U.S.C.
"
t
"
,
'
.
"
13 '1395e(a)~ 1395e,(b)(3}(A)) areea~h amended by striking
.
..
,
.
~
'
.
,
,
'
, 14 ,,';inpatiel1t hospital services'; e~ch 'place it appears and in
•
<'
- ' ,
~
: •
,,'
•
'
\
.'
"
l5, ,serting "inp'a:tie~t. hospital services, inpati~nt ~tal ,pn.
.
,
\!
"
~
' .
J , ' , ' .
16 mary, care hospital services,or
j~patient, ~~dical
i 7, ance facility services,".'
assist>
,, '
,
"
18
(3)
'19 'I39:5e(b)(3)(Bj), is
.
'
(42 ,'V.S.C:'
18i3(b)(3)(B)
: Sectiol)
:~me~dedby,~t;iking' "ihpatie~t' hos- ,
,20', pitalserVices" 'and·, ins~rting "inpatient
.
'.:
"
'
hospit'ar'senic~s"
,
""
,
'
,21 ,Inpatient rural primary",care hospital se~ces,inp~ti~nt
,"
22m~dical,assistance
.
'23
.
.
,
facility: - '
services," ..,'
,
(
(4) , Section ,1861(a) ,: (42
'
, /
V.S.C.
1395x(a)) , is
24 amended-'
,
"
"
\
'r
.
"-,'
,
: I,
\
.,
�,l' ,
STAFF
DISCUSSION DRA.r7 '
,
.\
':,
: ·S.Le.
~
,.'
•
,
,
)
. ," ,'TII-A.,...26
,
..
,
j,
I,
"
'
, L ' .' (A) , in,; paragraph '(1),; by strikin~ "inpatient
hospital ser\j~es" 'and insertin'g "inpatient hospital'
2 ,
3
'.,
.4
1,
" ',sertrices,inp'atientrural'primary 'carehbspital serv~ ,
ices', 'inpatient ~medical ':assistance' ,facility ,services,' '; , '
:
'
.
.
'
,5
,
~
,
'. '
and·:
.
.'
':,
6 ( B j inpa'ragraph -(2), b);striking~ "hospital;' ,
,': 7
,,
~nd inserting '''hospital, ruralpri~a~ ca~e l;losp~tal,
.
,
"
'
.
'"
\.'
. '
,~
or medicalassi~tance facility"" '
,'8. ,
,
';-
<
,,~r"·,, (f) ,REPEAL OFDEVELOPl\IEKT oFPfS SY$TEl\lfOH
.
,
•
.
"
,.
,
,
"
I
.
!
"
, 10'I!\"PATIENT" RURAL' PRI~14RY , CARE' HOSPITA;L 'SERV
'.
/' i
11 ICES-'"
..
,
,.
. ' , . ' l' 2" . "
"
~.
,\-,
" l:'
"
i395f(l»:isamended by striking par~graph(2»
13 ' '
i,
,
':
',:
-14
15: '
"
' . '
':
,(2)
,
./
.
'
.
'.
.')',.
"
',"
.'
••
'
.'
,1,
'
.•
,,:' ,
""" I
':
,
" . ' ,"
,".
''\ -
'.'
I
"
. '
\
t,
' , '
~
I
"
\.,
'
"
'
r
:
(
'
i
•
redesignating'subpa:t;a~aphs
, '.
"
.
"
'.~
(A), .
.
.
•
20
)
\,"
,
"
( ,
.(C), in para.graph ,(2\. as ,redesignated, by ,
\
~"paragraph':" and.: insertin~' "sub,
.
21
striking
,
,22'·
sect lOn' ; an ,',:'
'
,,' 'd ' ,
'
,
,
,
23'
"
'"
. '''24
.
'
:
graph" and
,/',
;
' , '
\
.
'
"
insertiilg"subsectio~".
.
\
"
i'
1
, r
,
,,
'
I'
I
/,-
.
•
f'
~
./
, . l
'and,(B) 'as paragraphs, (1) ,and .(?),'respectively; ,
t
...
,
\
"
, (B) by
19.
"
,
,
J
, i
'.
'
•
,
'
\
"
,
",
. 18 '
• '.
1
"(l)"·' .
,
,
",
('
eA)by striking. ' "\(l)(1)", and .: inserting
.
,
, 17 "
I'
•
1814(1)(1) (42 U,S.C; 1395F(1)(1», is amended
'16 '
'I'
"
•
.,' '
CONFOR!vIING ' ", AMENPME,NTS.-,Section · ,
:
,
,
l'
(}El\~RAL~-,Sectlon 1814(l)' "( 42, U.S,C,'; , ,
:,' (1) 11\
.'
,
,
.
.
.
"
'
!...
.
:
,
\
�,
, O:\SIM\SIM94.599 '
,
.
,
"
STAFF DISCUSSION DRAFT
\...
,
,
S,L.C'.
,,
"
~,' :
•
.
1
•
I'
(g) 'REPEAL' OF.'bEyELOP)IE:\T A.'\'P
"
','I
' \ ' ,
,
"
'
.
,.,.'.
l:\IPL~::\IE:\TA"
"I,
.
•
'
,
" "
F:'OR OrTPATIE);,T
2 TIOI\' OF ALL !I\'CLCSIYE PP,S SYSTE?ll .,t:
, " 3 ", RliRAL PRniARY' CARE
~
:,
'
,,,-1,
SERY1CES.-' ,:,','
"
.~
I
'-
' , ' .
I
"(1)'!I\' GE;-\ERAL.'-Sectibn1834(g) . (42U:.S.C-':' ,,'
.
. 4·
I.
,,'
, 13g'5~(g)), 'as'amended bj~ subse~tion: (c) (2)(B');is
.
I'
, (2),; ~CONFORMI:\G"
,7 '
, ,1'834(g)(1) (42
9
,
i '.
a~e~d~d by striking' paragraph (2)."
\ ,'6
~8
'
"
AliE!\J)l\mNTS.-.$ecti~n.'
·U~S'.G.1395m(g)(1})· lis ame~ded-,.
!K ·GE~"ERAL.-,"
striking '''(1)
',(A) 'by
I
,
I
'
, ,(B) by ~edesign{iting subparagraph' (A)',
.. 01
1
, andc'Iauses (i) and' (ii) ~fsuch subpara'graph B.S'
'II
,
,
'12 '
.
'
!
I",'
."
"'. _. . . • "
_
•
"
'
paragraph. (l)~and sU'bparagraphs ,(A) and (B)
.,
'
.
~
..
"
bf.$rich p~ra~aph, ~espectively; " .
:
';
,
:;
'
I
(Cl by redesi~ating subparagraph '(B) : ~s
\
t·
,paragraph (2);
,', i
'. , .
.
"',
.'
"
,
-.
I
( , , ' ,
j
,
,
,
.'
-
".
"
redesigp.~ted,
. (D) in paragraph (l)(A)" as
.'
"
'
,
by stri~n:g ','subparagraph' (B)':'; and"
....
',' (E) in,par~graph '(1)(,:8), 'as: so .redesig.
,
•
'.
1"
'
,
"f.,
'
. nated, bystriking.,,"subparagraph" and i,nsert- .
","
';
ing ,"paragraph;'. """,
"
,
-,
'21 '
(h) .EF~ECTIVE DATE.-.Except as' otherwise .pro-"
'421 ,ided,
I
t~e,aIllendmentsm~de
,
•
."
1"
."
("'
by this<s'~~~ioIi: shall apply':
,""" i .
'
r;
2~ . to sernces furnished on, or:after Octoher . '1994.
/ , , '
,
"
"
'"
'"
,
'
"
)
I
)
..
"
,
",
,~
.
--,
.,
'
I
�.'
,
,.
-"
'
,
•
<
,.
•
STAFF·DISCUSSION, ,DRAFT ,
,
<'
,VIII-A-28
",',
i
,·S.L.C.
,
"
"
1 ' SEC•• ~l02. MEDICARE-DEPFtNDENr;' S~ . RURAL HOS· "
..
',I
2,
\
,
'
,
3
:
,
\'
.'PITALS.
' 1
I
•
,
,
,
'
•
,',
'
(a) , C~ip~,CATIO?\' OP'APDITI()~Ai' P~Yr\'~,~T:~,
,
":4' Sectio~ ',' . ,1886(d)(5)(G)(H)(1)" ',(42
."'
"c.
,
:
,
I .
.'
I,
....
'.
,
.
,
'
<,,5' '1395ww(d)(5)(G)(ii)COr iS08:mended bj· striking:"thefi~st'"
"
, '6' 3 12-month cost reporting periods t~Hif be~~" and, insert~ "
"",
\ -
"
","
'
' . . , . ' ! . ' .-, ,,", "
;? ' iug "the
,
':
"
:
"!':.
..',
/
'
,
I
36:m(mt4 period beginning "oith,the first d~~' of
I\. •
I ' , ; , .'
I
,
'
.
_.
'.
,
'
.'
.
S th~, co&{reponi.ng p~ribd that begins" .
, ,I
, ", ""
;
,
"
, •
•
" ,/
",:.
,'I'
,9
"
.)'.
:
i
,
"
,(b) " SPE,CIAL',' TREATMENT" EA""TEl\.:.nED,-',S ection
',:
".
't,
. I
,.'
•
10 1886(d)(5)(G)
•
""'; 1\
'"
,,,'
.'
• ",
(42U.S.C.
.""" ..~.
"
:.
1
.
.•
"
t
.
,;
I
•
\
"
,.,.
/.
,
"
I
'
an,iended7 , .
.
"
'.'
12,
'.
"
,
.
.'
and jns~rtirig"October '1,. 1 ~99" ; and :
,:'J3
, ,':
)
,
.
,I
,"
,
I
,
\
'\ ('2) i~ clause' (li)(ll) ,"by striking ".october 1,
-,.14
",'..
,
'
' 1994',,. ~nd iriserting"October 1;1999"., , ,
... ',15
•
. .
'
.
.
'
",
\l
',:,.
....)"
,
I .
,16. · ':(c( EXTENSION '~OFTARGET ·'.Ai\fdtrNT.~Section '
1~~6'(b)(3j(D)' (42'~:\, U:S.Q.:: '"
,IT
,
,\
"
:
"
1395ww(h)(3)(D))',' is
f •.
, ',' 18· amende<;l-·:· , \ '/
"
.\'
'!
;
~
.,
, '.'. 19 ", "'"
.' I
20 '.:
'J
,
:
,'
'",
,
,
!.
'
"
. (1j in
.'
the 'matter.preceding clause
....
..
,
I
"
'
.
,.
OH by strlk
.
\
ing "March 31, 1~93.'" and -inserting."September, 30', "
"
. '
I
.
•
.
.
\.
.
11'
f., .
,
"
, r
"", (2) byainending~i~u~e(ili} to ~ead as ,~?U?ws: '
',22 '
',\
;,,'
,23
"
I,"
"
'
,25'
~'(ili)'\\ith; resp~ct to "discharges occurring in fis_,'
·'c~l year~
,24. ...
-. '1
,,:
:
'..
. ':. ;
"
:1
'/
'
,.f·
".'
. ,
199:4 through '1999;
<.
':,'
"; \
,
,
" . : ' .,' '. , ..'
t'
.
f
" , ' -,
\
'
'
.
,'
\
,
,
I
~.
'
.
"
the'target.~mo~rit for,
J
\'
.
: ,
,
'
;.
"
,the cost reporting'period beginmng,' in' ·t~e previous"
!
.
)
i
1395'ww(d)(B)(G))> is
.1' -
"
•
.
~
•
.~,';'
•
/
I
,
\
I'
.
'I
�,
, "
I
0; \SIM\SIM94.599
,
,.
S:L.C:
SrAFF DISCUSSION.DRAFT '
J ....
'.
fisca!year in'cr~~sedb~· th~ applicable'percehtagein-: '
l'
•
,
'
'.:' creaseunde~' s~bparairaph' (H),{h·).":.
•2
'.
'.
\
..
J
i
•
•
•
-
J
•
' .
'"
•
\
f
3 SEC. 8103; PROVISIONS .RELATING.. TO RURALHEA1.TH
'
.,
,(
,4
..
,
5
,
(a) "ELIGllULITY " :"RURAL ' PRIM41n:. ,CARE Hos
OF
.
.
"
.'
6 'PITAL~FOR G~
,,\TS.-·'·
(1): !I\'GENERAL;-"Section 4005(~H2)
7
"
•
'.
'\,"
" . ,
,8
.,
of the'
! '
.
~,
'
"
,
"
Omnibus Budget ,Reconciliation' Actr of .1987 'is
i.
,9
{
, atnended in the matter preceding subparagraph, (A) .. '
I '
by inserting ','any rural pririH~rycare hospital, as de~.
10
.1
",
11'
,
,
" ,
12·
'.,~
' . ' " \;
,.
. .'
"
",
' : " . ' i...
"
, '" " .
\ " .'
"
(2) EFFECTIVE DATE.-".The amendment made,
;
.
')3 '"
"
.;
Jined In section'f861(mm)(1), o~" ,after "means". ' '
"
,', :
"
'
"
'.
j,.
.
' :
.
,
\
•
by paragraph '~(1) shaliapplYI to. grantsmad~.on' ~r '
, a~er,Oct~oer 1,'1993.'
·14
, IS',! \(b) E}"~ENSION OF AUTHORIzATION OF APPROPRIA-'
',> ..
",1.6 'TIONS.-"Section 4;005(e)(9) of .Omnibus B~dget Reconcili
,
.
.
,
"'"
.
,
'.
.
,..,
'
'
-'
,
,17 'ation Actof1987 is'amended- ' .
18
~
, 19~,
,
I
: (1) : by striking. "19,89 and" and' 'inserting "
.'
' , ' .
,
"1989/'; 'and"
,
'
"..
I
...
•
.• .
J •
:
,,20
and $~O,O~O,OOO for each 'of the"fiscaL yea~ 1993', '
>21 '
,
, ,22.
.
.'
, t ,
'
", throug41999"..
.
eel" fREQUENCY
23,"
24
'
'
,
..
.
~
J
"
.
qF REQU:m.ED REPORTS.-,
,Section
4008(e) C8)(B) 'of,the Pmn.ibus Budget Reconciiiation Act,' ' , '.' "
.
.
.
.
.
I
..',
'
,
,
- , "
\
,
,1
,
I,
'.
..
'".
;
"\
,
. ...,
.'
�STAf'FDIS,cUSSION DRAFT' '
,O:\SIM\SIM94.599 "
- -.
S.L.C. ,
.c
'VIII.:A,,:a 0
" ;
I
"1 '0(1987 ,is ame~ded by, striking "e;very6 months" and iri~'
'/
. ,.,
,
'
•
I
OJ
,
2'serting "every 12 months". '
,
:
\
'
.,
"
'
"
,
"
'I,
,
, ,3 SEC. 8104., sUBACUTE c~.sTupy~ ,
,I
(~)'8T"GDY:-The ~Secretar.Y shal1-, \
,
•
,
;,
' .
\
"
"
" . ) •
~
,
(I) aefi~e the level ~nd type of carethat 'should , '
c
,
,
6'
I I "
,
.. ' 'coY{stitute subacut~ car~;:
"
"
"
,"
,
,
i",
,
','
(2) determine the appropriatene~s of furillshing " ..
..
."
.
.,",
,
I,
\,
\
,
'
I
I
'.
9,.
'1'
•
,'..
"
.
; ,
-
.,
I
,',
"
'-.1,.:
'
. ; '
.
,,'\.
,ll
:12
,
, under' title 'ArvIII ,of
:13
"
· ~ligible f~~' b~riefits under part A of s~ch title;,
,
'.
,
\
•
-14
.'
,
;
,15
'
,
t
"
,
:."
suc~ Act 'to individual~, who ~re, ','
' ':,
.
,
'
•
' ,'
, I '
\
v'"
,',
.
't
"
';
"
'
.
;
.'
" ,
',- 16, ",such,Act (42 U.S.C .. 1395ww(d}) are appropriate for
17"
!.
,':prospective ,payment' rates ~nder, 'seGtio~ :i 886( d)' of ",
/'
.""
,
' . , , '
.' _,
, .' "', ~: (4)' determine ~he e}.-tent 'to \\~hich hospital DRG
'f
,
.
.\
.
(3,)· determine the..' cost and effectiveness of pro- ,
.
i. ~,
.
t" yiding ,,subacute careuti,der the 'mediGa're program',
10
I,
'L
.
" .
,
'
.subacute citre' in' different settir,lgs oy evaluating th~, "
. .
.
.
.
,quaqty qf·care and'p~tie~t olltc~)Ines;'
.8
,
(
,-
'
,
·
-
'"
'the;l~ss r~strictive 'jnstittitionaI' set~in~that pro~de
. , . '
·
','
. .
"
."
'
.
'
.
_,""
' .
• • I
"j
I
i
.
" 18·, ' ',subacute care; and .,'
.
20
.(5) study, the relationshlps between' in.stitutions
21'
I"".
,
"
'
'
!
~
. ! .
"
,',"';
'. '
.
~
t,"
;';"
, each patient episode in which
,\.
,'23
•
...
,
•
'
•
\
"
'.
"
stib~cute
.".
,
.'"
care is
-,
f
,.
fur~
'
nished. '
,
"
f
"
.',
,
\
• I
. \ .
"
,
/,
\
,
I'
. 'ways' in which, to maximiz~ the continUity 6f care, for
'.
/ '22
,
" ' and their 'payment methodologies ihord~r' to develop',
•
"
-, ..
'.
/
",19 '
.'
~,
•• '
I"
I
,
�"
'
'"
\ '
>
','
,
STAFF DISCUSSION DRAfT
,.
'lII~A-31
'
,,'
'(b) REPORT.-'Not' .later than: October 1,1996, the
.
, , "1.
2'
".:
'..
'.
Secret~ry ..:shall subinit to'tl~'e :Congress a"r~porton
.
.'.
.:'
'
,
-
.
,
,
,
;,
,:
/
~,"
the' ":'
'
'
'3' matters 'studi~d u~der subsection (a).,
'"
'.
j
:,""
•
;
I
'
,
•
I
,
I)
4 SEC. 8105~PsYCHOi.OqYSER~CES IN HOSPriALS~
,
5
"
S~etion' 1861(e)(4) (42'
,_
,
:
'
,
,
'b.s,c.
'c'
_ '
I
,
1395x(e)(4)) is'
.~
I.
.
,
6aniended by ~triking "physicianjnand ins~rting "physi~
,
,
J,
."
'."
,
,
"
•
•
f'
"-
'".'
"
I
,
...
..'
-,
c ,
"
7, cian,:except that a
'I?atieJ?t r,eceiyingqualifiedpsychologist '.
;
:
-,
,
8se~ces (as defined.in subs~ction (ii)) ,may be linderthe
1 ,
,
9 ' car~of'a ~lirucal' psychologist, With respect to, such services ' .
'
"
'
'
, ,
,~.
\ , '
'
,,11· SEC., 8106.MEDICARE~DEPENDENT,R~, SECONDARY'
I... · ,
,.'
.'
:;
"," .
" 12
, SPECIALT)'"
13 )
,CENTER
/-DEMONSTRATION"
PROJECT. "
...
,
"{a);ESTABLISlI~1EJ\"T~-,'The.
Se~~et~ry shall, en,te~:into
..
-,
-:
14'
I.
' .
"
'
\
' .
.
" .
,)
"
'
•
,
15 ,an ,agre~ment with not ,more' tpan, 2" 'eligible eptiti¢s" for
"
,
16 j;he pu~ose ,of 'conducting a, rural'secondary specia.lty cen~"
•
.'
-
.
I
•
\
"
".
17 . ter, clemt:mstration pt<;>ject ,lHIder-,which ~ eligible entity
" .
."
, - "
, 18desc~il)ed in s~bsection (c) receives payID€mt for i~patiEmt "
19, hospital serVices
$d~r. part A of 'title ~"Vlri' of the Social ' ' '
,,20-$ecurityAct in accoraa.nce·iith:~ubsection (d).
,
.f
~:,
(b), APPLICATIOK.-,,Each eligible ,entity desi~ng, to,
: 21:', '
"
."
'
," 22 "participate in the demonstration p~oject und'er this section, .
I
,
'
,~
"
"
'.
.'.
,
•
"'
•
,
'
:: 23 ,shall 'prepare and submit to theSecreta~ ' .
an application,'"
.
.
~
24 ,at ,such time,'
.
.
"
,
in such manner," and containing s~cb illfor.-"
.
' .
'.
.
"
.
23 matiort astheSe~retary ~a~ req1lire. ,:,'
\
,
,
,
'
'.
,
,;
,',
"
�t ': ,~, '
'
.'
.'~
'STAFF DISClJSSiON DRAFT
,,:
.,
O:\SIM\SIM94.5~9
.
"
,,\.,
"
'~,
"
'.
',.1"
"
' \,
::,
"
. "
I'
t",
'
, I
'TII-A-32
'.~'
..
S.L.C, '
, : ..:
,
'.,
",'
"
",
\.""
,
.
j
\
.'
"'.'
•
::
,
(C) ELI,GIBLE EXTITY.-~
'For'purposes of this ,section, ' '
'1
•
.'
,<.
'
"
" ,2 the term ,"eligible:entity'·' ,~eans, a'hospital that-·'" ' \
'!
3 ,'\ ..... o:('l} ~eets'th~ 'criteri~of
(
.
(
l'
',~"
'.
4:
,\
•
,',.
\.
',',"
,
,~\)
\
,
\
,' age: weight, of,
7-
,
,.;"'.
"',
"
c
:
,8
"
..',
f",...
_
\
"~_,
/
"
J
'.
. ' ,
'
,
"',
t
•
,.'
•
\
11,
.,'
all cases ih: t~ehospital for ali'" diag.; ,
.,
"
':.'
":"
,I
.
.,'
"
\
"
, , '
, "
'
,j
,
I'''~
.':'
,
...
,.1
.
. hospitalsj'
.•
, ' ,'
,
;
,l.,' ';
. \ .
.
'.:" .• (3), is 19cated in 'a-'coun·ty.'.thatis<,ad~acenLt~·:a'
,~etrop'o~tan"S~atistical' Area cO\lntYi'
\,
..
'
"
,
,~
,
14, .. ". 'c(4) .has·between·~·9· and '130 lice~sed acute.care . '
','1
: (5)(A), , had ,been named ,as
,
','
'
I
,
I
"\,
"
,
.'
,
, \
,,,,
r,.,
:;'
•
I.
1'8
I'
\
,
'
,
,
.
'
~
'
.......
.
",
\.
.'
,
"
'
. ,
':
'
.
'-
:.
s~condary, '
1
"
.':
'
•
,
, ,
,
,
\
\
,
'.
'
,
,.('.
.
,;'
" ' , '; •
\
'
'. )
' , ;
,
'.
"
,
'.
"
'\'
.'
....
'
"
)
~
'
"
.
~,
'
, ... ,
.
.
\::
.," .
"
Th~: Sec~et~ry'shall' :pro~de that·
·PAYMENtS.-·,
, . " " ,
,
.
,
"
24 payfuent under
.
'
. , '·,ter as part ofsuclld~monstration'project.'
.
.
23' , ;:(d)
.
'-,
\ ,
-
.
.. ... ',.
,
22
,-~,
,"
',had been ,named as:a,rurals~c~ndary specialty ceri.~' .
-
\,
'
a rural
", ,(B) ~s 10catedwit~n60'iniles'of a hospitar~hat . ,,'
21
I ' -I
,,:,.
,
,
~
" ,
\,
"
,. l.
'20';
"
,
.
..
.',
{<Budget.Re'co~cili~tionAct :of 1986;'~r:I-' ','
"
,.
,
, ,pursuant to section 9302(d)(,4)of the Omn.jbus,
"
19'
, "
. i
'.
, specialty ,ceIi~~ras.part o(a demon~tration project"
'17
"
,
."
beds;, and.
.16
.'
:'
"
\
"'15.·
'I
"
"I
"
, '12
,
'
J :.
"
, ,
;:
,I
percento~'the natiomiJ average case-mixi~dexofal}' . '
. 10"
:
".
-
~t~ ,s~cti~nl~86(d)(4)'9f,such'Act)" of~t lea~t 90.',.:"
"
,
.
.. ,
"
,,-,'
,1
nosis..:related ,'groups: ~s:' deter~nined in ,accordance .'
'. '9' ,'"
"
'"
, ' ... (2)' .has ',acase:'nllX,iiulex "(defined 'as the aver:':';' ",
,
-
6
"
subclaus~s(i);(m);
".
1886(d)(5)(G)(iv)., of ,the· 86di~1
.
"
SeCm1tY4~t(42·U.:S.C.' 139?,,~r~d)(5)(G)(iV));~~ahd"
.' 5, '.
,
"
.'
,','
and, (IV) of 'section,
f, '
\' ,."
':
",
'.,
.',
I . " "
'i'
,
~~ctio~ 188b'(d)(lJ)(A) of theS~ci~ISecu~"
. ',:
.'
.. '
.'... , ' .
.' .....
..'
I , '.
' :
25 rity Act (42,U.S.C~ 139.5ww(d)(1){A)) 'to 'an eligible entity ,
)
.'
,
'. f
'
•
,
.,:
.. '
•
'!,
'
"
,
,
,I
,
."
j
; " , . '
,
,
,
~\
.
,
,
"
t.,
','
'I.
~,:
"
J
i.
'
:}
'~
.",
.
.I
. I.
\
'
'"
,
\
I'
• •
~
,
,95/"
�,
I
.
~
\1
.; STAFF DISCUSSION
.
0: \,SIM \ SIM94.599"
, ,
(
bR.AF"'.i'
S.L.C.,
~
",\lII-A-33
1 'participating in the demonstration
."
, .
under ;this sec
~ade using tl~e 'wage"inde~ of th~ M~trbpoli-
'2 'tipn', shall he.
.'
pr~j:~~t
"',. .
'f
l · ·
~. ,,,'
-'"
.:
•
~'.
"
•
',. 3 tan StatisticaJ ,Area described ill subsection. (cH3).
£'
'4-.' ,'(e)DuRATIOK:-' del!lonstration project'under"this
5~ection 'shall be; cbndu'ct~d,for a period not to exceed 3
.
,
.'. '6.years. ; ,
(f) REPORT TO CONGRESS.-'Not later than' Qmo~ths
,
,
: '7
'
,
,(
,
"
"
, ,8 after, the completion of all of
thed~Il1Qnstratjon
,
projects, .
, . ,9 conducted under' this, section; the .Secreta!"v shallsubI11.lt
i
. . ' ,
•
•
•
"
..
•
.
, 10 'a finai' report to Congressevahiating. . . . , such dem:., . ,
',,'hether
.
.
'
r
, , ,', 11 onstrationprojects-,
, 12
, 13
"
',\
" (1) reduced' the cost of medical care under part
..
,
,! '
14 <', ~
,.'
,
.',
1"
"
' , '
j..
.
'
.. '
, A'of title XVIII of the Social Security ~ct; "
I
(2) irhproved.theaccessof 'medicare 'bene
,;:
.. ' ..
, '15
'..',
..
.:
'
'.
"
"
\
,."
•ficiaries located ill, rural areas to quality' he~lth .cafe;
,I
, 16
r
18'
19
'J
'and
17 ,
t
"
(3) 'aided'
ill
the'
,(levelopm,en~
of integrated
'health deliverV svsteni~ iil~ral ar~as: ' " ,
,
.
~
(g) EFFECTIVE DATE.-'This section shall.take 'effect.,
'
,
"
"
,
r
,
"
,
-..
.20 on January 1,'·1995.
'. 21 ' SEC.8107~ PROVIDERSTAluS FOR BLOOD CENTERS.'
<.
,'22
.23 •
,f
',- '(a) IN GEl\~RAL.-·'Section '1861.- .(42, V'.S.C. 1395x).
.
.
,
'
, . '
,
.
is amended-'
"
'
\
\
.:
-,
'.
I
I,'.
"
,
,
,
.
I
;
/'
\.
''\
'
�. O~\SIM\SIM94.59~
'.
,
': 1
I,
"
'"
:VIn-A-734
. .'
.'.
,
.
'(1) ins~bsection (~), by, inserting "ari~.'FDA li- ,
..
: censed' .or regis~ered' blood . ,esta:blishin~nt,;" 'after ...
-2 '
'
,
"hospice.. program,"; and',
.,
'3
"
.
'5 ",
.'
,6,
"
-'
,'.
, '(2) 'by addirigat ~he' end the' following ne\~· ,sub- ':
.
4, ,
'
,
f
,
'
sectio~: "
I
,
.
"
,
.'
,i "
, ,
,
"
' "-FDA Licensed, 'or Re'gisteredBlood Establishment
."
..
.
"
,
' " ( 00 )
,
The. t~rm 'FDA licensed or registered blood' es~
"
''}'
'
"
.'"
','"
,
:'.:
I
'
.'
,"
"
','
~:.,"
:9 . ices, a: h~althcare' Pto~der
~hich
'r
se~~-
8: tablis4menf means',forthepurposes 'of direct patient
I
,
is'a' privat~'.non-profit'
. '10' COIru!lUnit~ .blood ~~nter 'li<;,ensed ,und~r. se~tion,'315(d). of '
II', the, PUblic HeaJth SerVice ,Act: or ~egist¢red,und~~ sectio~
12 51{) of the Fede'raJ Food, Drug, and Oosmetic Act. "~., ' "
•
",
,
\
\.
I,'
"
"
.
.
, , ' \ " . '
•
':'
,
\'
•
"
-;"
'
.'
"
\ ' .
sel"\~ces furmshed on or after·
;1 4 this :section shall ,apply' to
" I,
.,
. "
"OJ) 'EFFECT~r;E DATE.-Thea~endments ~ade, ,by
, " 13 ,'"
.
I
~
,
~."
,
1
•
'.
"
,
•
.15 ,January 1/1996.
'16
I,
',-17
:0
,
':. ,PART2--PROVISIONS RELATING TO pART B
" .
".
."
,
",
SEC>~201 ..riEvELOPMENT ~"J:MpLEMENTATION
.
.,"
r'
.
\
'
RE~ ','
OF
I
,'SOURCE-BASED /METHODOLOGYFOR PRAC-'
, TICE EXPENSES.
"
'
'.
,
'
20,\ ",'(a)DEVELOPMENT.-,
,
~"."
21 '
'.1
"
'(I) IN GENERAL.":'::Th~:' Secretary shall de~elop ,
.
.
, "
22'
" :a', methodology .for implementing ,lin 19978.
'.;
,
, I
_23 ' '
','
.
'
"
"
"
res~urce-:.
','
"
'based, system for deternuning practice ,expense reI.;, .."
.
, . ' ,
".,'
'
'
'
,
"
24
.
ative. value units for eac~ physician's service. The
i
I
"
25 , .. , ,:'m~thodology utilized shall recogniz~ the staff','equip-:'
,
.
"
,
"
...
;
(
,
\'
,,'
.
.
1 "
"
",
\
'.
i
/
"
\'.
\
�.
(
0: \ siM\SIM94.599
~
DISCUSSIO~
'STAFF
,
, .(5:.... ,
,
..
, ,S,L,C,'
DRAFT
,
, ,~II-A-:35
';'
, " 1
", ,merii,: arid ~llpplies tlsed-' in the prm1~ion,'of yarious
.!fed;cal a~ a surgical~el"\1ces invariollsseHings.•.
(2)
REPORT.-'
'The
,
I
,."
"Secretary. shall' transmit' a. '
.
, ..
..
'".
,
4~/" "repon,,'by, Jaln~ary 1, 1996,~.on the met~odology·d~- '
' v~16ped, \uI.1der paragraph (1) t~' the Committee 'on'
,
.
" ' 5"
,
."
'.
6 ' , , ' \Vays and l\fea~~
'_.
''''';
"
a~d' the C~mmitt~e/ on Ener!i:r ~ and '
Conimerce . of' the' House of Representativ~s,' imd: ,th~ ,
, '7,
I
,
.'
'.,"
"
Co~t~~e' on' Finance of the Senate.' The, report "
,8
"
~.
,9
' ...
'\
'
.'
: 12. '
.,'
,
,
'
' (b) IMPLEMENTATJON.-,
..
, ,13
.
.
"
, :,' 14
','-:
.'
I
.
-.
•
'
J
•
\'
•
'
..
.
'
~
I,
,
.
••
, (A) by' inserting '''fQr the service for years '
. \
,
'
,\ ;b~f?re ~997'~bef6re"equ~1 to'\;
'(B)','by", striking, th'e"period'at the ~nd'or,'
r.
·17,
,
I·
(42 U;S.C., ~395w-4(.c)(2)(C)(ii)) is 'amended-',
, , 16 '
(;
•
(1) II\" GE~~RAL.-, Section" 1848(c)(2)(C)(ii)
". .
. .
, 15
,
.
" ,'"
,
., .
. : .
'
, .'\
.'~
"
'\
.
, 'method~lo~~.
J I'
"
.
oping ,th~ methodol~gy' and, an explanation' of the,'
•
"
,
~
.'
.
",
, shall iil~l~dea' prese~tatib~ofdata utilized iridevel~
-
.
'.
.
,10
"
r
'-,",-
"
,,',
',,' sv.bclause '(II) and in~erting:a' comma, and'
,
r
"
'
~
.a~d "below, subclause',
," (C) )?y' adding· after
"
.
<
~,
,
." :' (II) the "foliowing:
,
.' '20'
-
,
,"
,
.
.
,
,
,'..', '
\"
,
,\
"
.
,J,:
. ':'an d;for years- ,beginning' with 1997 ba~ed .' "
\
: :21
. , .: on' the . relative' practice' e},.1l~nse' resources ,,' ,"
'22 '
involved in furnishing the~ervic~,".,
.
.
, 23
~,
. , . . '
...
,I'
I
.
"
(2)
,24
,
"
, ' CON"FORl\lING,
,25 . ", ;t848(c)(a)(C)(ii) ~(42 U
.
•
<.;,
,
.'
- '
: .Al\iE!\~MEN.T .-,Section
,
,
,
.Re., 1395w~(c)(3)(C)(ii))
.
' ..
/'
,
.'
\'
,
-
"
,
"
t,',
'
�q:\S~M\SIlI194.599'
,
•
_
,.
"
,'~For years'before 1997, the. practice','.
'2
<'.
~"
\.
, 3
('
4:
, j
' '
,,'
,'J",'
, ,
"
'
..
impiementinfthe'ameridni~nt.,niade
"i
'1,'
\.,
1
,.
"
l.·
:,
,
.,' . .
' ,
,
,
\
'\
'\ ' .
\ '
J,
,
'. (l)(C), the'. provisions of clauses (ii){II) and (iii) of
5.
'
,r
(
,
" 6' '
""
.
'
"
'by ;paragraph
~.:
',.
'
'
"
/
:
'(3) APPLICATIO?\"OF CERTAl!\ PRO-\'1SIOXS';--'.In
,
/
,
.
"
'
'I',
j
'
;, ',': 'is am'epd~d'by strikinK' "Tile pra~tice"'and ins~rti~g
1
'
t
",
,S.L.C.
:' 'Y'hI~A736'
'j
. '. ';
,
I
STAFFDISCU~~ION DRAFT .
,
('
section, 1848(c)(2) (B) of the Social Securitv ,Act
"
,
,~r
.
~
,...,
" ',7 ~ ,', shall apply in' the ~sa~e ma~~r as they apply to ',ad
•
I.
'
,.
':'.'
_"
"
iI, ,\'
•. '
<,
'/
"
,8 ,',-- justmenis-'unqer:clause (ii)(l) of suc4 section. ,
.
.
,.
.
"
•
I
\
MEDICARE
FOR,
, . '
. •
,"
10
','
,
"
')"
,II
RATE OF JNCREAsE~ ,
, '
)
,
,
12, ,",
,
.:
\
.
'U.S:C. 13'9~w-4(f)):is
Sectioh'1848(fY(42
"
•
. " ,
•
•
".
.
.-
I
I '
,~
.
,
, :15'
.
,.'
.,
.'
-
,:,The Se,cr~tary shall establish defuonstratio~ projects, ' '
,
'
'
"
'.
'
"....
•
•
I'
,
/.f
,
,
.~
19
.
,
/
o ,:
•
I. '
21
~'
r',1
s~bstitute
" \ r
:for:
,
..
<', " . '
.
" '"
'"..'
.'
'
the~' inational' 'perf9rmance
'
,staild~rd, rate~'of 'incre~~~es~blish¢d' fo~: the, yea~ , '
I,
,",
under,
.
,
:';,
-'.'
,p~aragraph
'
'22,
:'
_ ';'
\ ,crease to
'
:20'
\<:,
,
'.
:
:.-,.'
t
'
:'.
~".
.
",
v
•
' (2): The ,'~ecretary shall·' develop'
....
'
,
, criteria for: the establishment:, of 'such demonstration'
.
,
,
"
, r 23 "
,
"
.
24
--
;"
I '
.
".'.
,
' . ' . . "".
'
'.
,..'
.
.
"'
(
budget-neutrality for payments:' . under this' part
made
. .
.
,'.
,
"
.,.
I
,( ,
'\ ,
",
I
',.
,
l
," '
,
.,.
I
,
(
j,
,
"
,
,
,"
,
"
'~
,
"
!
I
,elects$tate.:base9.perfo~ance'8tandard 'rates ofj'in~
,18
~
~
RATES, OF 'INCREASE DEMONSTRATION' PROJECTS.-" ,
.
,
.
.
:
: 16' ,
.
\
'; I
, .'~(6) 'STATE:-BA8ED PERFORM.A..~CE STA.1'\DARD
.' , ',.. ' . ,
-
, ,:'14
:
amended
,..
1'3 "byadding'at the,end the follo~vi~g new paragraph:'
.
:
."
'\ '9 : SEC.) 8202. "-DEMONSTRATION, "PROJECTs
,
,
'.'
'
'
\
"
.
I,
�~TAFF
0: \SIM\SIM94.599
•
f
"
, "
I,
resp~ct toph~;siclans' se~ices furnished
.
"Sth
,f'
.VIII-A.. . 37
'
S.L.C.>
. .
~
'f"
,
DISCUSSION DR.A.F'r
'
in
a ",
'
\
3 SEC.' 8203. EXPANDED COVERAGE FOR PHYSICIAN ASsisT.'
,"
"
4,
. ANTS AND NURSE PRACTITIONERS.
(a)Co'~RAGEI?\ Ot:TPATIEXT SETTIKGS; DIRECT,
5
"
.
6 PA1'lmKTS TO NURSE PRACTITIONERS.-'
.
,
,
"'
"
'I.
~.
!'
,: 7 ' "
'(1) 11\ _GE1\EfuU.;-"Section' 1861(s)(2)(K) (42
,
.
-.
l' ,
.
,
8
"
"
9,
(A)
'\
.
.
;
"
1
-
•
in clause (i)-'
~(~r ,by strilring '''?r'' at the end' 'of'
10 '
,
.
'~,
,',U.S;C.1395x(s)(2)(K))ls' amended-, ":'
,
,
,I
-".
, subcfause (II);' and' ~ .
11
,
.
,
12
"
" . "
,
,(ii)bj' ipserting"or :(I\T) in,
.
.
\"
.:"
.
i
I
.
\
art. out~
,
.
patie~f. setting: as.}detlned by' the " S~c.:
,
. 13
'
,,' "retary" f~llo~'ing ,"shortage' ar~a,"; and
14
, ,
',15, '
. (B) inclause{ii)-',,
,.', ,. ,0) by striking ','ina~ skilled", and in
" 16' .
serting ':'in (i)a:skilled~'; and
:'
.
,
'17 ;
,
,
", (ii)by :inserting ", or (ll) :in' ap' out
,',; 18
, :19
, ' patient, setting, (as, defined by the, Sec
,
'", I
' ...
20,
,retary)," after "(as' defined' 'in section
,
'1919(a))".' '
21
"
\
"
t
r
., ..
, I,
, , :(2)' DIRECT PAYMEKTS TO
22
,..123,
./
,
ERS: IN ' 'OUtPATIENT ',SETTINGS.-'(A)" I~ection " ' '
•
, , ~ 24
l\uRsi( PRACTI'rION
".'
) .
.
I
' . '
.
.
.
'1833(r)(1) (42 V.Re. 1395l(r)(l)) is amended by,'
",25"
' inserting "or 'for services 'described jn ' section
I
I
I
,J• .
,. ,
,.. .
;,,"
�, STAFF DISCUSSION,' DRAFT
, 0: \SIM\SIM94.599
','/
.
.
..
\
, I
I'
S.L.C..
•
\
1861 (s)(2)(K) (ii)'(II) '(relating to nurse' prac,titiol1e'r "
,
-" ,
"
,I
,
•
sen'lces in 'outpatient:, settings)," 'after, ,!'rural ,
,3 '
,
.
"
,',I .
),,'
.'
~rea.,
, ,', '
,
,
\
I
!
,"
.. ;
, (B)." 'Seetio'n,' ,1842{b)(B)(C) ',{42 'U.S.C:
,', 4
, 5, "'" , IS95u(b)(6)(¢)is,amendeCi{by'striking,:'cla.~~es' (i),"
'6'.'
br (iv)"an(i,ihseTti~~, ',"Clauses", (i')"
"(ti),
,
• 'r ~
•(iv)"., '
\'
\
"
\'
,
"
\,
,
'
'
':
.
(b) PA1"MEN'T:,BASED'O!'\' PHYSI(~lA..'FEE: SCHED-',
"
i
•
J'
,
•
';-. I
1,1
12
/
.. '
, \" 1,(1) , " Sect~o~ " 188S(a)(I)(O), (42: U .S.C"
..10
r
'
•
"';, -
"
'
'
(relating ,to nur~e pr~ctitioner' ana clinical nurse , ',' '"
13
)4
"" :' ,'speciaJ.lst :senrices"proVided in 'a rural '"
.
.
,
.
'"
•
I
15
'I,
,
,
"
!.
•
'~rea}';,
"I
•
and~inserting' "section 1861(8)(2)(K)~";
"
16
F
,
"
'
,
,
',,'
...'
.'
,'\ 22
'.'
•
'
"
foI
l
".
-
,
I
",
'\,
','
'~
' .
-
,
•
,
'
,
.
",
"
,
"
"1
.
on
, sectiori' 1861(s)(2)(K)·. furnished'
.
",
"',
I
. 'Jap.uary'l,}997,"; 'arid
,
.
'
,
,
.
'
or,after
..
','
",,'
i
,
"
{C)· bY~triking~~'subsection(r)(2)"·i'and
, .:
'.
,,23
I
, ' I '
.
', .. 24,
"
s~rvi~es descrlbedin Cla~ses', (i), (ii),and ,(iv) ,of.
.
.
.
"
'
~
,
',',
"
~
""",
,
furnished 'on or after Januanr 1,,' 1992, and for
20
, '21 '
,
;'
' . "
.
,
'.', ,
r,
'.
, 'services described i~ section' 186 i (s)(f)(K)(iii) '" "
19,
,\"
I
or after January,l, 1992,'"and' inserting, "fof'
o
18., "
•
(B) by "striking "for services furnished ,'on
17., "
i"1
I
\
"
,/'
,
'",
, '.:
,
(
(ii)(I), or
1\
.'
.
",'
"
,.',
in- .,
",
,
'. ser:ting l~:subsectio'n ,(t)(2)o;subparagTaph(A):
.
.
.
.
'
~
\.
'. 1 .
'·25
.'or'(B).'ofsectiop 1842(b'.)(12f':
,
...
~
,
-',
" "',
, I,' ,
,
:i'..
...
':..
'
::.
\
\".
,
957
...._ _~_ _~..-....;_____.......--.:...~;..;...._.......;........i.._..;.._......._ _.;.._ _ _......_ _ _ _ __
�,
" " STA;FF'DIscussioNDRAF'r
0: '81M \SIM94.S99
, \'III-A-39
,,2
,
'
v
,I
_."!.it
U.S.C~
r
.",.
"
'\
, ' ',--.(A) by striking "and" at the encf 'of. clause': '
.
.
.
" ,
'
"
.
(i)j'
,
,
".
,/,
,.1
M,
5,
6
•
(B) in' clause (Ii) in the matte'r. pr~ceding ,
','
.
subclause' (1), b~, striking "the prevailing" and
" I
7,
.
" inserting "for servicesfurnishedhefore, January,
.
.
.
,
".
','
"
.'
'.
'
"
1,1997, the prevailing"'; , ,,'
8
,
I
.
"
1395u(b)(i2).(A) )'is .amended- "
3
4"
,
Sect1~n( 1842(b)(12)(A), ',(42
'" (2)
I,
>
S,L,C', "
"
,
"
"
.
\
I
I,
,',
,9
"
(C) ,by' striking the peri,od at the, end of,' ' , ,
i
...
",'clause (ii)(II) and ',inserting' "; and"; and,
.
(1)) by in'~erting at the end the following'
10
.
11
"
,
,,
~
,
,
,
\.,,'
. '
-
,
.
\
.'
:
\
,
'\
,
,'''(iii) in the case o{'services'fQrnished'
j
•
•
~,
•.
,
,
•
,
;14
•
1
•
" on or
~
\
i5'
,'ule
•
'.
/'
'
f ,
•
'
beeq~aI
shall
.. _
,'. "(1)'
,
fee sched-'
<;
,.
,
" ,
in
the~ case
,r
.
-',
't
1· ,
,
of, servic~s' per- ':
.
\'
'
'
to- '
..,'
",
'.
"
~s,an ,as~istant~t
formed
surge.ry,65'
, percent of the' amo~nt: that· would 9th- "
18""
" 19 .;
~
" ernis'ebe ~~cognized if. p'erform~d'by 'a
,
,
<
'
~
'"
'~
/'
•
physiCian vt~hois, serving as an a~sist.
,2p.
,',
,
.
' . . .
17,'," '
",
'
,I,
~
,
"
am~unt
.;16
'
aft~r:January ,1,,1997,' th~
"
~
,Y
'
, 13 "
,,
,
, \
'
, clause:'
12
.,'
"
'
,
'.'
21 '
22
"
,I
',23'
24
.
"
"
,
"
.
'
.surgeiy)in .
.. '-,"
l
"
a hospital,
7; 5." percent: of
,.
,"
. \-
'
\'
.
'9S5:',
�.
"
,
.
.
"
" , '
.,'
O;\SiM\~imd94:599 .""
.,
-:
. STAFF DISCUSSION D~'.'
.. ,;
>,
S.L.C... ··
"
"
,.~'
.1,
, • ~
"
,
I
,
r,
'
:ihe ',fee ; s,chedule' , ·amo~nt speCified'"
.
I
,"'.
,
,
"'2
',I
.:
" .' 3'
.•
'I
I'
'"
-
.
,',
,
"
\.
j
,
.
,\
under section.18,48,Ctnd :', ".
\
"
~
.'
",
~,', (III), in: the. case of: othe'r se~~v.~,
',I
I
,
•
,
'
,
, ices;' 85 percent of. 'the·. fee schedule
':
",,4
,~.\
,
" ' ,
,
'
j'
:'5 '
~ ,
'I
1
•
,
, .\ ~ni1ount, , specified', ' under- ','section
,: '
"
•
,
,I
\
1848."., . '"
-I
_'
.
,
,
,I
','
.
"
,
,,'"
:.
, I
, . '.s,
.:>' 9 '186,l(s)'(2)(K){iiY{42
.
"
I ,
,U~8.C. '1395x(s)(2){K)(ii)),as :
"
<,.
.'
,
' _ " ,
, , _
1,
.'
.-!
'
."
.,
, 10.' amen.ded by . ,
subsectioil~ (a}{1)(B),)s .further . amended b,y'
'
.
.
-
,,I
{.
.
,-
•
"
,
I ' ,
" i
"
"
. (~) :'RURAL NURS~' PRACTI.i;H)~~~S. As .AsSIST~,,\!~S"
...
,
.,
,,'
.
.
l
I
'an: assistant' at surgetj1 furnished,
i2 "by' ,"a nu~selpraqtitioner \\~hose',pd~ary p~a~tice lo6~tiQn'
'. '.. 11, addiI)g "Qr ~etvi~es as
•
.
I
,
I
'(asde~~ed by the secr~tary) is''i~' a~ralarea'(as define~
13
I,
. , "',
14 hi'section 1886(d){2)(D)) to
,
'I'"
,
I
. . '
, c ,
•
•
"
"
'
'I
:
!
•
•
all:i~(ijviduaI-,vho,:resides
.
, 15 <·a. rural iarea ~henthe serviceis furnished
(.
"
to
,
in ",
such individ- ' . ,'"
7.
'
16 ,uaI'in an '~rban are~ by s;uchpra~titioner'when,suchp~ac-:
I,
. . .i,'
17 ,~itioner;ref~rs' such .individual to ~n tirban area for the '
'!
! ' , \,
'.
.(.
·18,., funrlshing ,of·" servic~s" "'after, '.~ as defined, bjr the. Sec- "
"
"
I
'"
:
",
•
'
.'
"
,
"
~
;"
,
,
','
'
,
,
, '20
!
(d): C6NFoR1\nNGAMEi-.'DMENTS~. .
.
.
.
~.
, ;'21
\,
,
,
n
\...
~
\..'
~
'
,
"
'.
I I '
~,
,,' iI):'See~ionJ861(b)(4Y:(42 U,.S.C .. 1395x(b}(4)',
.
,
,
'.
'
\
'
'..-'
".
"
" f42
'./' iIiserting",'s~bsectio~(s)(2)(K)". '
, '23
. \
' '" ,I
",
'
'
,
",
,.'
.
, ,
I,:,. ,:
. 2 4 , : "(2). , Section >1862'(a)(i4) ,.(~2
",
~'"
25
I,
"
f
":,
'
'..'
"
'
,
..
'U.S.C.
,
1395)r(a)(14») ;'is' . amended 'by" strilPrlg'" "section,'
,,"
>
! '
\
,.\
",
':, '. '
.
"
;
1,'"
�,
'
.
,
2
,
"l
\lII-A--41
,.
1861(s)(2)(K)'(i)'; "
1
.S,L.C'.
,
.,:. ;.,
~
",
DRAFT
· S'l'A.FF· DISCUSSION
'0: \ SIM \ SIM94;599 '
il1~ertil1g ,
and'·
~'se.ctiol1
'
1861(s)(2)(K}".· " '
"
"
I
.\
,
',(3)
3
'
,Section'. 1866(a)(1)'(H)
...
(42
U.S.C.
4
. 1395cc(a)(1)(Ibj , is further :amendedb,~ 'striking . ,
.
....,.
5
','section ...1861(s)(2)(K){i)".'and: ins,erting : "'section,
-
' .
.
,,"
'.
/'
,
"
I
.
'.
'6
. 1861,(s)(2 )(K)"'. ' :': ,- , ' .
:
,'"
,
,(eY EFFECTf\>E DATE.-The 'a~~ndm~nts made- by .
..
.
7
"
,
~'
"
"
"
~',
, ' .
~•
/'
I,'
,',
'.
'
,
.
\
~.
:."
T'
, '
,
,
•
i
\
l
,8, this section shall apply to. '
services furnished on , Or after
..
,
'
.
'
,
.
.9 January 1,199.7::, ' .
, 10' SEC. 8204.' DmECT,' PAYMENT '~OR 'SERVICES OF' REG- '
,
,
I
;
'
"
ISTERED
11
"
,NURSES, WHO ARE. CERTIFIED ,AS
.
' . ,
, . .
~
,
.
\
"
,
'
ASSISTANts AT SuRGERY. '
12
(a) ,SERVICES CovElmD.-:-SectiOIii86~(s)(2){K). (42. '
13
"
'
.'
~
.
. 14 U.S.C~'1395x(s)(~)(K.» is',aIilended-'
" 15
~n clau~e(m),by striking" "and"
, (1)
at the'end;
(~) in clatise(iy)', by. striking "'cianse OLor (ii);' ,
,16\ '
l
17.
. . . . ' ,
,
'.
. and inserting "clause (i), (ii); ,or(iv:)"; ..'
(3) b~7' redesignating' clause, (iv) ,as elau~e ,(v),;.
,
;'18 .
"
I
, "19
"
,.anq.
"
,20
,
, ' (4) by inserting after Clause (m)' the -following',
.'
,
.
'.'
•.
•
"
".
'.,
,
. ,.
•
'.,;r
,"
.
· ·cians' sernces if furnished by' a physician
,
.'
'
\.
,
'
'
,
"
(as defined in subsection (r)(l)) and Which .'
, " .
,
'
'.
25
!
,
'
'\
I
.
'i'(h~)sernces which would ~e'Rhysi-
f
·
'23'·
24
"
ne,,; clause: .'
21
22
"
,
'. are'performed bya registered:nurse.under
.
, ' .
' - ' - , ' )
( ,
.,
.
�;,
. ,STAFF'D~scussioN DRAFT'
,O;\SIM\SIM94.59'9· .
. '.
S..L.C.'; .
,." "
.
"
the .'supervision., of .~'physician .(as so. de.-. '
.
,
;,
1
.
. ,
.. '.. fined). as ,an :a~sis.tatit. at surgery and:which
.2
.'
':
\.,
th~ .register~d nurse is 'tertified and . legally . '.
3 ..
J
'
1
~
"
\
:
.... inithorized
4. '
, '
·.to 'peifornrby· the...State In .
, which. t~e se~c~sa~e;. p~rloimed, .'and~< .
.
. .
.5· .'
~
(b)'P.A\'1\~NT.
6
J'
,
Ail0vNr.-Section·1842(b)(.1~)' (42 .
..
:', 7 U.S:C.1395u(b)(;2))is
;'
,
a~ended-: . "
.
. '
,
'
"
~,.
'!,
,
,
.
"
'
,
•
"
~
.
.',
,
•
•
'
.
,
'
.
'11
).
,
.
<
•
,
••
.,:'
\
'.. ,(2) . in subparagr~ph (A),by.striki~g "physician
"
.' a~s~stants
i2 ~
.
.
\
~nd . nurse' . practitioners" ; and i~serting·.· .'
.
-
'
\
"physiciari~ssi~tantsl,; n~rse ,practitioners, and 'reg~'
i3
.1'
..
I
.
, "
14 ...
·f
istere~nrirse~" ..
.
. •
"\
"
P.A.\'1\m·NTs· :
(c)."
)5' ;
_
,,"
•
'
\,
,
TO:-"EMPLOYERs.-·Section, ".
.'
~ 'r
. . :
,.
'
, . : ' ,
•
,.'
•
.
.
•
,16 .,1842(b)(6)(C) ,(42 U:S;C .. 1395u(b}(6)(C» is ameIJded-.·' ... · .'
'
•
' .
\,"
j,
•
I
",
.i
:
--.
•
•
. ' .
. '
.
'
' . '
,
.18 .,
r
, .!(2) by'.strikin~
',19,'
,
20 :.,
.
'practitioner~'
'.
'~physician :'as~istant'or :nurse:,
:
'
.
.and, inserting. "physician'. assistant, .
.'. nurse, practitIoner ,'~r regi~tere.d imrse" .. •
.
.21,
,
.
,-'.
~.
'22 •
"
.
.
.
"
, '
,
.
(d)REDUGTION IN' PAYMENTS TO AVOID DUPLICATE'.
.
,
.
,
.'
,
'
.•..
"','
'.
23PA\~Ni.-Not\yithst~p.ding
'
'
•
',;
,
•
Is\~rting ."clauses (i),(ii),"(~y),'~or, (v)"; and:'
.
,
',<.
\'
. (1) b;y striking "clauses>(i);, (ii),:or. (iv)" and in- " ,
·11'
I
..
.
. Inserting "clauses (i),. (ii), (iy), or' (v)"; and
"11
I
'.
,
''10
"
.'
'
. "clauses.(i), (u),· qr (iv)" each placeit appears. and
'9 '
.'
'. \
.
'
~,
(1) ·-in s~bparagraplis'(A), ahd.'(C),. by/striking
:8
'
'"
(,
\
' .
~
.
.•
I~
',"
J''',.!.
,
"
)
.
any.·other provision of la\\:,
It
.
j
"
24 the Secretarymay,redu~e the' amortnt'of pajrinents other~'.
-',"
. .' 25 .·wisemade to' 'hospi~ls"und~r tltle'i'VIIIpf th~: Social Se
..
.
.
"
.
.
•
"
, '.
.
,":
\
'
j
i
.
.
.t .
'
'
~..
.
,."
�, " ,
,
I'" ,
.:
I
1_'
,
.I
,
"
:
~
\"
"
STAFFDISCUSSION,DRAFT~
,
,
'\ "
'"
S,L.C:
'\
'
'
, . YIII·A':"'43 ,
.1 curity Act to eliminate estimated duplicate payments ,for'
.
,.
,.\.
,.;
(
2historical~r current, costs 'att;ibutable to": sen'ices, de·
,','3 sc~ibed 'iIi 'section :1861(s)(2)(K)(h~)
•
.1
"
" ,
"
.1.,
'of ',such' Act - (as,
,,' .4 ,amendeq by 'subsection, (a)).
,
"
"i
·OFP.Al~~KT,
,(e)" STrl:ry
5
"
'
.",
,',,'
'
. ':.
'
RATES.-N ot' -later than,
'
"
6 Apri11,i995, the 'Secretary shall submit a report to 'Coii~' '
'Ti",gres~ 'c~'nt~icing ~eco~~ndation:s'f~r adjustm~nts to, the, "
,
-
unde~"part
8 paymenLamounts-established
0"
.
~'.'
.
.'
B c,ftitle XVIII ,'.
, :
, ' .
, 9; of .the Social Securit:\r Act fo~' ser.Vicesdescribed in section,
:
'
.1
.' •
".
•
•
~
,'"
,
.'.
.
'"
":
""
',:'.
io.-j86J(s)(2),{:K)(iv-) ,of. such ~ct(as amended bysub~ection '\
l'
,.'
",
•
\
'
'
,t '
,'\,
'
pa~rment
,
,
,"
.' ,"
,
11 . ' ).to ensure that the
(a)
.
I
,
"
.:
'"
,~
' "
,',
,
'f
,
amounts reflect the ap
" ,
".-
.
..'
"
,
•
.
1
12 ' proXimate, costs of furnishing the services, taking intQac
"
~,
,
,
'\
"
•
'.,
"
, I , '
13 count ,the costs, of cpmpensation, _overhead, and,
-super~
" '.14 ,,~sion attributable to registered nurses. "
1~,;
"(f)ErFECTf\~ DATE.-'
-The ,amendineI\ts made by,
,16 this section shall apply'to services fur¢shed on or after.:', '
.
,
"
'.
,
17 ,January 1,
,
19~5.
\
'
,j
18, SEC. 8205: PAYMENT,FO.ftANESTBESIA SE~VICES.'
"
'J
~. "
"I.
t',
I
,
.
" ,19
20, TO
}....~~~THiSlA, SER'1:CES ,FUR~~SHED> By(CERTIFIED
I
'
'
,21 REGISTERED NURSE'M"ESTHETISTS.- •
,
22
,23
if
.
,
(1), REVIEW OF REGULATIONS.-'The 'Secretarv '
"
\
~
'
" shall r~view and
if
"
I
j'
. " describing "the 'collditions' under \vhicnpayment ~ay
"
,,-,25
,
necessary 'revise, any r'e~lations ",,'
'"
,24
t ..
.
',\,
~
.
\..'
'
',be madefQr ane~the~ia serVices under the medicare
,
F
"
,
,
. ,.
-\,
'/".
:.,
,
"
I
/'
,(
,
"
�STAFF, 'DISCU~SION,DR.AF:r
0: \SIM\SIM94.599"
"
progTanj'
..
,> '
.
\
\' i
~\
, 'TIII-:A-44
,',.
"
\
,S.L.C.' '
under;'title:A'1:Il,~f the ,Soci~i Securitr~Act,
'
:
'
,"
....
'
..
'.
,:' "..
I'
\
'.
so that" :,certified' regi~tered':' n~rse anesthetists ,are '.' "','
.. .
,'.:
"
..
' .'
"
.
• al:He,to,perfo~, and rec~h~e'pa)'Il1e!lf fo~~ thos'e:' an-':'::' .'
3, '
!
, ~-,'
'.
, '
.
'''5 "
':
•.
!
".'
•
•
,
' ,
. "" . "
-"
\
.
.
' .
....
, " .
' : , ' \'
:
.'
\'
.
.
.
thorized to' perform: Jnthe> State in which·the ,serv
"
I
:'
'1"
,,,
•
J
"
ices a~e . furrushed. ,
,"
'::6
"
~',
.'
.
','
','
•
,
"
,'esthesia~~d related sen-ices thatthey'arelega11y,au-, "
'4 "
, I
~
'
',-
;
>,1
•
,
"
\
I
"
,
,
"
•
..
.\
\ , '
•
,
,
,
1
I
,
.',
,
.
."
'
·f
•
'"
,/ (2), CONSUl.:f,ATION .REQUIRED;-'The ~S'ecretarj1
7'
..
'
"
"'.
.
, , '
8' .., shall review and, revise the regulatiQn's referred, to in '
~, '
I'
,
.
,
~,
... ,
"
'
'"
"
;'.
'
I
,
'.,
w
, \ :
...
'~tiJes '£r~ll1 :national profession~lassoci~tions of~er~
1(j',",
"
i,"
•
, "tified,' t:egister~d .,nurse a:qesthetists and, a:nesthesiol~' '
"-:'
11
,
"
,
-'
" ,
' .
.
'OgIsts. ,
'
',13 " ': ': " ~:(3). BFFECTl\TE, b~TES:---AnY'
~.
j
,
'".
,-
\ 1'4
\',
· 15
" , ,
. ,
•
'
.
••" .
, \
re~slons to' th~
-'~':
j . '
~"
•
' , '
. " , ' , '
,
"
,
to aI\esthesia
,
'.16' '
' .
'.
~
'
'>,
. j
','
\ •
},
,". '
'
:
. regUlations' referred, to in' paragraph (1) shall .apply
.
•
. 1'.'
h
•.
, 9,' . " paragraph' (1)',6nly:after co~sultationwith ~epresent-"
1'2" '
."
,
.', >
•
s~rVicesfurilished
,
"
•
I'
"
on or, after, .-July-l,;
. . ,"
.,,'
1995', , .
. . . .
. (b}ENSURING' PAYMENT FOR':PIfySIC!A."/\ A.~b GER-,
,
l7
.
.'
~
\
'\'
\,
,',I.
" t"
-
.
"
19 .FtrRN1SlrnDAhrESTHESIA SER~bES.-,
,',
\,
,
• -20",'
...
,
'
.
,
21-
'
,
• \
I,
,..
<,
"
"._'
,
,
,
,
.• ')
. '.....
:
"
~,
".
,,'.,1,
(',
,
. 'I
(42, ,)U~f?G~ ,139'?w-4(i)(4))',as:
i
','
,
,
(
\:
,
'/'
~
lidded 'bysecti.on 13516(3.) of'OBRA~1993,~is','
,I
,
,
,"
"
," , ,'1848(a)(4)
,:24
. .:;.
....
' '
,
'23
.'
,
, /A)' PAYMENT; TO, PHYSIclAN:-'SeGtion..
,
,
,
,",
."
,CAS;E.-,
22",
\'
,
'~.
/"
:
J'OINTL~ FURNISHED SIN~LE'
(i) 'PA1.-kNT FOR
,'-
,'," ,
, ,,
'
,
..
'
.
,
f
'
,
,
',I,
•
"
",
,'"
.
"f"
,
. ,"'.
.. . :
1:
,
,
;
"
'I
�,"STAFF DISCUSSION'DRAFT
'O;\SIM\SIM94.599 '
,
,
\
,
'}
i
'
,
amended~byaddihg ~t' the, end of the f~llO\'ing ,
.
2
'\C) PA,\~IE~T
3
4
':
,
,
,
,5
"7
:FOR SIXGLE CASE.-Notoo;
, the 'furnisping of ~nesthesia se~vices for a
,
single' case are furni~hed jointlj~ v;11th acet- '.,'" '
"
'£.
'8
~,
'.
'
. '
~"
"
,
'
" . "
..
.'
(
"
'.
'.
,
' . "
, ,- . the , carrier' det~r~nesJhat ,1.
','(ii)
the
, . '
.
.
9
10
, uSe of both the, physiciB;n and the'certified,
....
"",registered .nurse', anesthetist was :no~'Inedi,-
11
,12, '
,
, \:. 'callv necessarv, ,"
.
.,
...
"
"'\
"
"
\
13
the, fee schedule amount for the;phys~ci~m~'"
:14 '
services' 'shall be equal to 50 percer;t of the fee '
.
J5
.
".',
I'
,
.'
,
.
, 'schedule amount applicable under this section
"
, ',16.
foranesthe~ia ser:vices 'personallyj)erform~d' by ,
.. : 17
, "the physician alone (d~terniin~dwitho~t regard, ", ' '
,.
.
\'
\
" tified. regi~tered. hurse anesthetist; and /
"
'.
I
,
",(i) physicians' services ,consisting of
('
,
~:
v;ithstanding,section 18f)2{a)(1)(A), if-'j: '
"
6
;
,
"
\
,
r
,",
.' >
:,
'. ':,<
,
'
.'
.
.' ,,' : , "
I
.
"
, to, this subparagraph). Nothing in this subpara
18
, ,graph shall be',deemed to~ prevent the physician
,"19
..
"
,20 \ ,,',
' : ' , '
,
1,
, ,from billirig tnepatient on a
' \
. ,
nonassigne~
.
-,
basis,
.. .
-
j
~
, 'to the, e}.~ent othe~i~e p~rnritted i b:v"law.". :
21 ,
, 22
I:'
','
(B)
PAl'1v1E~T'·' FOR
CRNA.-"Section ' '
1833(l)(4)(B) {42 'U.S.C.' i3:951(l)(4)(B)); 'as
23
•
•
••
, ' addedb;' ,secti~n 135H3(h) of OBRA~1993, is
, 24
"
'
J
\
•
'I,
'
'I
"
\
�. STAFFDISCUSSIONDR.A.F.r
" O:\SIM\SI¥94.599
S.L.C,
:
,
'
'
1
,
,
,
'\
, new clause: "
2
,: "(h')" NOt\,i.thstariding ",
~
4'"
t· .
1862(a)(1)(A), ,if-'
.
.
~
·6
'esthetisfse~rjces', consisting' of the fur- ,';
i,
•
'7'
;''i,
i
•
•
F'
'8
·l '
i
_
,"
'.'
"
"
.
•
I
.,
\"
:
'
,
,
',"
.
.,
"
j
,
'.
,
.
,
,
,
..•
'.
..,
\
nurse~nesthetist
',':'
".'
,
'
..."
•
.
an,d" th¢ physician,
.
· w~s not medically ~ecessary, '
"'}3 .
14
".'
"J
'"
. ,the fee ,schedule amount fortheservi'ces. :
','
IS'
'.
.
'
.
. , ' ,"
fu.rI~ished 'by the
.'
,
,
. f
,\_
,
.
.
certified registered nurse
.
.
~
,;.
. '.' anest4etist'~hap 'be' equal to 50 p~rc~nt"6f, .
,
.
.
.
.
16
"
'17' ' '
'.'
f
I'
".
i,~' the fee schedule' a~ount applicable 'u~der
.'
section 1$48:, for ' an~sthesia' services per~
,'18
,
\
,
19
\ I
'
,
,;'1
,20
""
f
' . .. ;,\
"\".
,~
'
,,,'
,
.
;
I
" ,
'.,
,
'~22
"
•
, 1848(a)'( 4)(C)).".,:
.'.
,
j'
. I
• '> '
_
~.
\
I.'
"
21
-
sOl1;ally perfol11led by the phySiciap' alone .
rc;let~rmined, '"ithout :',regar{i .' to' sectipn"
I
.-
~;,'
. ,",
~
(C) .' ,EFFECTIVE ,DATE:-'
,rheamendments '
•
•
f
•
'.
made,hy:supparagraphs (A) and' Ca)
·
23· ,
.~
'
,
_
,,',
\
:..••.
,./"
"
-.J
,
shall apply.
,
,-.
,,'
,
./
•
, , . to services :ftirnished, on or after July !1, '1995. ',' ,':,\ " '
,24·
•
•
f
. ,
'"
•
•
1
,r'. '
,
,
< ./.
'
,
"
'.',
,
"
,
,tqe use of.bot,hthe'certified registered :':.:
.;' ",,12'
I'
•
, ' "(II)" the ,carrier determines that
•
.
''-~,
.,
.
11,' ,
I
,"
a physician;' anq,
,
.
10
"
..
. ,'single case· are ,fur.b.ishedjointly witl1 .
. ,.,'9
'. 't
'
· rushing of !ine~th'esia': ~e:rVices -for' a' "
,
,'
~
\
I,
"
,
"
\,
,
, ',:"(1) certified registel"~d nurse 'an-',"
5
"
section, . ,
'.
,
I.
"
,
.
"
,>.,
';'
(
�,
I
.
.
'
',\
\.;S.L.C ...
t',
".:
.,
..
,
"
"
,
<
'/
•
/"
. '.
"
1\
.
•
,,~.
..' ,
0
.,,-'
_
"
,
. '
'.
. " ' ,
•
~
"
j
•
I
,
,
'.
.~
I
'
, "
.
',"
,""
,
'
\
,resentati\res ,from' natio~al professiona\l associations
',,3'
~4'
.
r~gistered ,nurse
of certified
anesthetists arid. anes
thesioI6gis~s"the Secreta~,.shan d~fine in,re~latioh,
r
.
i
CALLY'-KECESSARY.-.After consultation· with, rep- .
-
2
/
"
'
(2)' PRo::\lrLGATIO~ OF'DEFI~ITIO~ OF :\1EDI'"
.
.,."
"I·
,
'
STAFF'DISCUSSION DR.AFT,'
·O:\SIM\SIM94.599
. ,
• •
, ' ' ' . '
, 1
,. '
•
'not later- than JUly 1, 1995,·those.procedures where,' .:
I
•
-
",
t
•
,
,'having due 'regard 'for 'the anesthesia:related com
~
"
.
"
.
an~sthesia. pro~rjders to joiiltlyperforin the procedure
"
"
.
1 ,
'
.
•
. '
'.--
.
"
•
":,
,
•••
I',
may be deemed necessarybj~c the:clinician. "
(C)R~VIE\\·OFANESTHESIA PA).~ENT UNDER Pin"
•
,/.
•
' J : "
12 . . , .
SIGIA.T\' FEE .SCHEDULE.-TheSecretary ,shalLreview, 'in
.
13" consUlt~tion ,with' representatives "fro~ ~atio~al'.' profes~
" - ,
J
,
,
"
'
.
I,
•
I
,'.
. '
·14 sion'al a~sociations of anesthesiologists and; certified reg.. ·. '
,I,
",,"
, ' .
."
.
15 istered'nurse anesthetists, ,the.basis by Which the a~esthe.; .'
'. 16 . slacon~ersionfactor 'under the ph)rsicia:p. fee schedule ,was:
.
,
'
, \ ,
.
\ . "
-,"
,',
..
\
" ,
"17 established'l.'Qlder:, .th~regulations issued in 56: ,Federal
.
,'.
,
"
.
'"
18 .Register,5950~ on November '25, 1991,', to"determin~ the,'
"
,
,
,
•
_
•
'
•
I
."
. ?
, : "
1 ,
,
J 9 e},.'tenf·to w~ch :anesthesi,a procedures' w~re 'unde~alued' '
, \
i
20: in comparisori .tC>.other pp.y~ician services, and shall de>·
2 f ,velop,' recomnierdations ,to correct such unQ.erValuation by"
.
,"
,
"
,
" . .
. . 'I
: .'
~.
~\
~
,
,
•
•
-
"
.
'.
I
"
•
'
'" '
"
I,
" •
"
.' '
.
'
.','
.
-
, ;
.
22 regulation, ''all(f report its f:Indings to the;' CdngTess, riot'
• I
,
,
: .
'" -:23 . later'than JUly l, '1995.
/. >.',;
,
,
, , I
J
,
,
,
... '
,
\'
.
,
"
I
,
.
',,/
�./,
O:\SIM\SIM94.599
.!
,', ,STAFF DISCUSSION, DR.A.Fr
"
S.L,C,
, ,: YIll-A~8'" :':.: ' '
1 ~EC. 8206: EYE OR EYE ANi>, EARHOSPITALs~"
•
",
r
<'
, "
".
i, \.:
j
:",.Section 1~3'3(i)(4)(A){42 U:S.C: iS9'5l(i)t4)(A)) is
.
2
. '
' .'
'~. '. r
"
,
,
I ,
'3 ,~mended in ~the'matterfoll(m'1ng Clau~e\' (iii) 'b:\~ striking'
.
,I,
." .
, .
"
.
.
4 "January 1~' H)95". and inserti!lg "September 30, 1,997"'.'
.
P.t\R~3-PROVISIONSRELA~.ING'TO'P,ARTS A,
.
',' ",', 5}
,
,'';'
,6 '
,
"
"
,
'
,
, " " " 7 ",SEC~830L
"
,
'.,
"
,
.
"
i"
'1",
: ' ,'"
",
"
'
.',
'..
,
.,
"
,I
' , '
"
•
','
.I,
"
'-"'.',
.
'
"
"
, , ' :,,',
1987~,
10, ation Act' of
"
';.
•
"
'"
'"
,;'
"
"
"
,
','
'.'
.•
/ ' ...
, •
,:",~'
"
•
. :.
'.
'.
,
.'
'\
,
"
'
"
' I "
'
I
,"
'I
as a,mended by section 4207(h) (4)(B) , "
.
- ' , . '
","
.\
'
:,',,'
"
I'
t
'\;
.
11 'of 'the0mnibus Budget Reconciliation Act of·1990 and,
.
\
"
\ ' ", ,12 section 135'67(a)' of the: 'Omnibl.is 'Budget Reconciliation, '
,', .
.
.
;
, , " 13 Acfo(1993, isam~nded-" ,
"
•
. '
, i
J
,'(,
I!"
';",
'
,
~
.
..':' .",
,"
"
, ,."
,
" . 'cember.31, 19,97,"; and',~ " ,', '
,
,
. '\
~.
~
,
,
"
.• . ',,'" (2) by striking 'paiag;~p'h (4).
,.16
,
,
:" '
,
",
"
.
"
"
\'
.
,."
",
'
~'"
i
'
',1_
,
'~,
'\'. ,
,
",'
'
. , ' ,\"
.'
.
"
,' .
r'
f
17 ' SEC. ~02~ STlmY ON MEDICARE SPENDING~
"
,,'.'
(1) in paragraph (1)" by ,striking ,"'through 'De
'",'
",
. .
,....
.
. 18' ,; ,The Prospective,'Payment 'Assessment Commission
"
' .
\'
",
'
",
~
><
"
'
.~'
' •
,
>~'.","
"
",
-'
•
'~
,
"
"
' , .
,!.
-,)
. '''19 :(establishe¢l, ~der'section ,1886(e)(2)of the Social SeCli~~ ,
, ,C
'\,
',"
" ,"
..
'~"":-
'.'.:,"
",j,I','.
~'"
'_
'U~S.C~
20 rity Act: (42
'
, .'
'\,
.'/',",
,. . .
'~'.
:,
,~"
",
,
,
,
1395'\v\\r(e)(2))) and the Physician
\
'
,
,,'
,
L
:
21 '- Pa:~ent ,Review Commis~ion (established under' section
,
\
,
'"
.'
...-,
"
'., "
. '
' .
" , '
,
~
" ,
_'
t
'
"
.'
'.'>..
,
" '.
'
~
\
":27 1845,o(such ,Act (42U.S.C.'1395w~1}) shall each ,con.,
.'
"
23 duct
,
'a~tudy;of ,the' .rat~. ,
of increase, inspendi+tg under
.
-",
)
,
,
.,',I,.
/
.
'"
.
,',
,','
....
~
. '/
.
-'
,
'
recom:rnendations· to
. . ...
,,'
,
'
,'(
'-
,
\
"25 Congress\on strategies' to 'slO'\v, the: rate' ofgro~h,.·:Such
,
"
,
"
'\,
,
,'"
'.
24 ,'titleA"VIIl or' such 'Act' a~d~ake
"',; ."
. ,~
!
OF socIAL'H.EALm,MA.INTENANcE
:Secti'on '4JH8(b) ~f the Omhlbus Budget RecoIi~ili-
<'
, ,
,
"
ORGANIZATlONDEMONSTRATlONS.' ",
,9'
f
,
,
:EXuNsION'
'
,
,
,8
.
',i
,
I
-,','
'
.'
_
.'
;
-,
,
,
,
.'
"
"
,t',
,26studiesshali mchld~'
'-'
,
.
"""
,I-
\,'
\
, <'
,'"
(,
,',
./
'.
, i
" r
'(
,'"
i
'
•
,
,!.'
,
,
, ,j
,
;
,
',,:-
',-
..
'
"
I
�STAFF~DISCtJSSION , DR.AFT,
, ,..'
, O:\SIM\SIM94:599
,
f"
L
','
(1) an examination of "';.irS to slo"',,both the l1a- '
,
.
"
.
, "
tionat rat'e of growth and,~herate :of growth 'in COnl
2, '
'-.
\
.·munity~rating
3
,
f
areas; and
(2). an asses'sment of ,,'hether, setting 'iocal'.ex~'
4'
., ~.
,
,
'
•
•
.
.\'
:
~\"
I
penditure targets or lo~al volume perform;;mce,stand-',
.
.
, 5
.
_
,
:;
"
\'
' , ards . .
wo:uld be' successful a~ ,part ~f t~s effort.'"
.
.
6
,
7 .SEC. 8303. STiiEAM:uN:ED PROCESSING SYSiEMS." '
(BJ'I;K ,GENE~.":":"The Secretary may' develop a '
'8 ',:
, ;',.
. , 9 . process to~eri.sure that claims fors~rvices urtde.r title XVIIi '
'. '
10., o~ the such Aci~re' sub~tted first by th~ medicar~ pro..
.
,i
:
~
. ":
.
'11 gTaJll1lnder,such~itle, piedlcare ~uppl~mental p'olicies (de- "
,
'\
,
'
',"
. '.
"
"
.
-
12. 'scribed in section 1886(g)(1) of such, A(!t
,
"
.
(42 U.S.C:,
13: 1395ww(g)(1) ),.'and' other polici~s' -that: provide ~up'pl~.;,
,J
",
','
. ,
",
_"',
,
.
'. 14 ,men.tatbenefitsirndersuch title before providers (!an sub-'
, ,15 nlit claini~ to medicare b~neficiaties.
,16
' (b)" SUPERSEDING' CONFLICTING' REQUffiE'MENTS.-" "
•
,
,
,
\
•
'
'
••
'
,,'" "17 , T4e ,proVisions" of: sections"1:816' 'and
"
.
i 842.
/
.i
"
of the, Social "
. 18' Secu~itY Act (42 U~S.C. i395h aI;ld 1395u)'(ip.cluding pro- "
,
"
. 1,
"
Y
'"
•
•
~
•
I,
"
•
.
'
,
. '
"
19 ,,vider' nOrrllnating proVisionsip ,such '~ectiori 1 fH 6, of such
.
.'
'..
{'"
' .
"'20 ,Act) are superseded to, tb~. e}..1;etit,r~quired to carry ,out, '
'.
, 21' this
•
f
sectio~.'
•
( ' ,
'
.;
•
,'" "
/
f·
,""
'
'
, '"22'< SEC. 8304:PAYMENT FOn-CERTAIN MEDICAL DEVICES.'
"
.'
',23 :
,
.
,".,'
~
Section186~
.
,-'
,
. •
.','
~"
/
.
(42,U.S.C. 1395aa) is amended.by'add
.
"
'. 24, ing:'at the end thefollowiI~gnew'subsection:
. • ' i',
: t
I,
'"
.
J',
'
�0: \SIM \ SIM94.999
"
':',
,
..
;: .;:"
"
YIII:·A-50
'I
..
, "(0)' Pa)11'ient shall be made ~foril'lpatien( .hospit~L
, _' 1
•
.
-
r
,
' .
,
•
'
'
2' sen;ces,\\~hich are' subject 'to paymenLunder 'section
'.
. ' ','
.:'
",'
,,'
~
. , • ' "
,
.
! ",",
,
~"
:',
..'
.
. . 1"
' , ' .,'
,,' : 3 1886(d), andph:';sicians's~nj'ees,related t~( such hospital
/
.
/'
,
.,'
""
'".,
'
•
t
!
•
'
.'
.
•
1
-'
•
"
-
'.
",
;
.': '\ •
'I
'.
" ,
'.
_;,
'
:
. ' "
:'
I,
~
/'
i,
" . ' "
,
•
,~
,
, "
Ie
"d)'the: de,rice
.
"
r '.
. , , I
-10,
.
:
• . .'
.
';:'.
t
'
.'
"
'
.
•
"
,
"
1
.
','
.
','
TREATMENT" EOR "' '
8305. 'NECESSARY STABll.JZING,
"
'
.
'
,
"
"
" ,13 SEC.'
:
I
'vlCe had'beenfurnished."~
': 12 "
~
I
.
',"(2), paymentwbtlld, bemflde" if,tlie~leared de:. "
11
\
,
510(k) :of such Act (21U.S':C. 3,60j(g)); 'and. "
,
-',
. , '
'
'approval ,,applicatio~ , or notice ' pu.rsu~nt 'to, section
.
-"'.
,
"
had; 'been cleared, for m~rketing u~9.~r a prel!lar~et'
';9
360fk))·\wher~
"
i'"
, ",8
\
"
used in ,place .of a device,' that
.
..'
I '
__
,
i~
J.
'
"
.
.,
i
,,6 ,Drug, and Cosmetic Act ,(21 U.S.C.
"
'
j..
, "5 •under the' authorit)rof section 520(g) of th~' :Federal Food,
, .
,
,
, 4 ',senrices,: which ,il1Yolve. th~ . use of. a devicedistribufed ' "
"
I,'
_ ., , , "
,"'"
,
.
_
EMERGENCY. MEPICAL' CONDmONS·. AND :
.
"
,j
',,'
,
15
,~OR.
,
Se~tion'1867(b){i)(A) (42 'u .S.C. J395dd(h)(1)(A))'
.
.
16
,
.
,
'.,
"
'
1'7 .is amend~({ by inserting'~, ,consi~tent \\rith rea:soriable me,d-:,','
:'
,
" \ "18 ical standards ,',~ ;~fter''treathI~nt" .' ;
,
"
" , ' ,
'
,
.
, , ,', 19 SEC. 'SS06.MEDICAim SELECT.'
,l
, "
20 ' "'{a), 'MfENDMENTS', TO J:"
:PRO,\rISIONS' RELATING TO
:, ,
"
"~
f'
!.' .
. ' ,.'
,
21 :MEDICARE SELECT POLICIES.-', ;
1
/
"
, 22
"
.;'
'24;' ;,
,I: ' , , ' . '
'
.
,'"
"
"
' ___ "
", I'
. \
"
'
.
\,
"
.
,
"
.'.
;',
; \
,
,
,
"
,
'
I ' "
, I
t~eO~bus 13udget'~e~onciliatio~ Act, of 1990 is
~
.
•
". hereby, repealed,.
'.
\
I'
"
'
: 'IN,ALL STATES.-Subsection (c) of' section 4358 of '
.
, 25"
"
,(1) PERMITTING MEDICARE SELECT POLICIES
,
23'
'
,
"
~
,
•
\'
t
,
','
i
.\
'\
.
",
,
\
,
)
'f&9
\'
�,
/.
"
. :
.
'
,",
,
'
.
' . '
\'
.
,
(2) ',REQrIREl\IEX,TS ':OP ·,:'.IEDICARE 'SELECT,',
1
;
S,L,C, '
" STAFF DISCUSSION, DRAFT '
,Q:\SIM\SIM94.599,
;'
, POLICrES.-'Section' " 'lS82(tY(1)
2
',\
"
3"
U.s-c.
f (42
,
'
~"
"
'
c
-1395ss'(t)(ll) is' amended to' read as' follows:., '
4 ' , '1'( 1) CA.) If' a' tnedicare supplemtmtal poli~y' meets the'
5, requirements of the19~1 NAlC M,odel Regulationor 1991
.
"
.
\
,
.'
"
.
'
' . \ 'I
"
,
"
,','
,
•
'.'
'
~.
"
,
6 Federal Regulation and' otherwise complies v;rith the're-·
'.'
.
.
.,
'
, .
:
.',
~
.
.
~
I )
"
,
7 "quir~inents 'of this' section' except that-' '.
\
I '
'.
'
. 8"
"
,
9,
"
10'
It
,
•
'.'
.
I
I"
, .'
"
,
.
~ntities,
.J.
"
~
...' I
"
,
I'
(or reduced Qenefits are pro"ded when items '
,~
.or services are furnishea by other entities),' and'
' , '
" "
"
, , '" (ii) in the case' of ,~ policy desGribed" in .sub~ "
12
"
."
, stricted ,to item~ and, 'seM~ces furnished bv,cert'ajn
,
•
:
' "(i) 'the' b~nefitsunder such "policy 'are r re- .'
:',
'
It'
,1
"
"
.
.
~
'\"
\
"
(
paragraph' (G)(i)-:" .
13
':
,
,
/
.
'
'
"
'
14
. ' .."(1) the benefits u:nder such 'policy are not
15
:one 'of the group/) or, packages, of benefits de-"
.
.
'
16
,
,,~"
{f
: scribed in subsection Jp) (2)(A), ','
,
. "(ll) except' fo~'
17
•
\
,
I)pIl}in~l copayments· Oim- ,
I(
\
,
.'
•
"
-,
19, ,
,
'20"
"
'
!
24'
25'
; ' .. '
'
' I ' ,
.. '
.'
.
'
"
"'(III);anenr~tiee's liaqilitJ;under'~'ch pol-
" ,~' icy, for phYsician's \ serci'ces' cove~~d
'
L
I
.
, ' . '
,
_....
-.,
"
, ',' B,,~f,this 'title --is' limited' ' to' , the :' nominal
.,
\
'
'copaynlents'described In' subcl~~se (II),
,,\
.
, ,
...
,
,
'
,
"
,
, "
~nder pari
./
1/,
"
'.
/ ' (p)(2)(B), and,
,
"
,
'~,
'
"
",;
. '\
,
',22
23,,'
of thls
, ,group' of 'basic ;benefits described in' /)ubsection '
,
~'
,
.'
i {
"
"
','"
:'21.
','
'f'
,title, such benefits include ,at least, the 'core
.
. ':
(
,
l?
, posed, for services ~overedun.der part
.
.
. . '
,-"18
,
\
,
'
,
I
'
�.,
"STAFF DISCtJSSlON !])R.A.Fr,
, O;\SIM \51M94.599: "
I'
,
S-.L.C.'
','
,":
''1II;.A~52
'\
\
.
, . -
"
,
,
~
, ,
;
,
" 4,
l.
.1,
.,
.
.',
'
I
,,': '
"
"
.'.
t~e
., ,,-"
",' .
,
,', :"
.,'
,
-
r'
"
'
,.l.
,
'.. '
1 ' ,',
.r
'
,
•
1','
",,'
I';,
", -
" \
,., . "
A"pp)icyme~ts', the requirep1ents'pf,tltis'.stib~'"
. "(B),
,
,
'"
5"J>arairaph If-" ,
"0), 'fuli :beriefits'a~e, :provided Jor', it~l1ls , and" , ,
'
.
.
'~
"
7
'
,
"\'10
".
I
: ,
./
.
~,.,
.
,\,
"
,.>' (ii)
'e '
,
.
',"
'~ntities
"
,'.'
'
'.
I
.12
,~,
I '
.
!
".,
I
•
~.
",
-
.'
.
"
'
'.
•
,
'"
,I.
<
.
,
"
'
'.
"
,
' .. ' . .' ,16 .
: ,"17'
'.
'.
J,
I
I
,
"
"
,,("
'",
."
",
,
'
,
\
for. an :ongoing" 'qualityassurarice 'ptqgram for Items
.19', ' :',;\~ndse~cesfurnis~~d' throughthe~etWork,"
-
.,!
~
•
'
,
,~
I
, 20
"
'
24
•
:
'
,
•
•
.
' .
,
!,
,.
/.
.
. ,
:
~
.
,
,',
"
"
.
.
,
.
," (v)(I} the. issuer' of. " . PQlicyprovides to, each
the
:
.
.
',"
,
'enrq~ee at the time of' e~oilrrHmt'an,'explan~tion ,
. ,:'21 '
23,
,
"(ivJ the issuer: of 'the ':p'olicy-has' arrangements.
i ,8' .
22'
"
,',
" "(iii) the ..network 'Offers sufficientaccess; ,
.
....'
.
-
,
j
-',
, , obtaill the serVic,es' through the networ~;,
, :15:
'.
is no~ r~8:sonable gi~e~ the'cir~ull1&tancest(), '
it
J'
.;
v' ,of-","..
"
,
,
,f.
,.
, .
';,
.\ .
,
-"
',-
. . '.
)
"'{aa) ,the. restrictions 01} payment" under
'
.'
.' . .
" .
~
\'
'.
~.,
.
, thepolic~ for s~rvicesfurnished: other than by
,,~:or through the network,
.' .'
l
\
ca~se pi,an )urifQrese~h :ffin~ss,injury," or 'condition'
a~d
'14
.-'~
"
necessarJ'\andimmediately' required be'· .
",
,
.
full benefits are' pro'\1ded.' for item~' and
~ed.ically
, r
...
: 13·
,
"'
I··
entered,into contracts' or agTeeri1ent~
r
I
.
.
,1.1 " ,,'., 's~l"\icies!furnished by other entities if"thesernces are, '
. . ,
I'
.
.
'
. \vit4~he: i!isuerof the,POliCY,
, 9.
I
' .
-
~;hich bav~,
,8.
",
"
\
sernces . furnished ,through ',a' networ;k of
,
, .\
,'
'policyu1eets the ,t~quire·
if
,
/
, ,ments'bf' ~ubpar~graph(B).'
,1' , "
,
'.
, " ,,',:
~hose requirements
: "
,',
,','
/ ,'.
:. 3
"f
'
'"
.'2,'
..
,
,.
the,poliyy ~l1,all ne'\'ertheless .be tre,at~d a~meeting'
. ....
.
.
1"
"
~
' .. i
')'
,
'.
\
�,
i
.0:\ S1M \ S1M94.599
'"
"
.
~
..>!" "
, ; ", "(cc) the ,policy's coverage of eiriergericy,'
3.
,',
J
,
icy, '
2'
"
'
"(bb) ',out 'of area . coverage luider,' the .pol~
.
.
,
.
f'.'
, f
.
'
"
'
"
S,L,C,
:YIII-A-53' "
(,
.:
"
.
/
STAFF. D.ISCUSS10N DRAFT
services and 'urgently .ne~ded' care,' and ,,'
\
.
"
,
" " "
"',
a PoiicJ:·'thro~gh "
""(dd)' the' a"ail~~ility ,or'
e~tity' th~t Uleets
'the'
the 19,91 M:odeINA,IC :
,RegUIatiqnor 1991 'FederafRegulati(m ~rithou~
_ .
',_'
I
•.
'
/'
.
..1.,'
' regard " to this ~ub:sectiori 'a~d ~ the" rrelnium
,
·1,.
,8
'
. ~. .
"
,
.'
."
...
'charged for such policy,a,nd'
.
'9
,
"
.
" .
\
.' . ~. "(II) each enroiIeepti~r to etiroll~~nt' aCknowl
..'
.
10
'.
'.
,
\ . '
"
'./
e,}..1>lanatio~ 'prb~rided under
edges "receipt Qf the
·11
.
•
•
•
J
•
•
_
',' subcl~use (1), and
',.12
~
"
" ' .
l,.'
.
'
" 13
" '''(vi) the issuer of the policy makes available to
·14,
individuals, in additio~" to the policy- described in' ~this
•
•
.' . .
IS'
.
I
. '..
'.
f
•
. \
~
..
_""
. ,
I
•
•
,:
.'
" subsection, any policy (othernT:ise, offe;redby "the is-'
•
','
.
.'
' •
.'
"
I
•
'.,
.. '
:'.
,',....
'"
, i6 '
suer"to individuals in the. State) that meets the 1991
. '17: ....
~odelNAICRegulation or;199'lFecieraL Regulatioh'
18
.. -
.
'. 19
. and other reqUirements. of this'. section "rithout re-'
.
.
,
',r
. .
,
~
., '
"
.
"
'
"
."
'-'(C)(i) A poli~y'desc~ibed in this subp~ragraph", ~'(I) is offer'ed by an '~ligibleorganization, (as,
21~,,'
! _
•
"
. ' ,
j
,defined in'section 1876(b)), "
22
o
23
~
,,/. gard 'to this'subsection." \ , '
20
",
.
.
'
/ ' -"{IT)' is not
"
I
\
'
.
i, policy 6~ plan providing 'ben~fits
'."
•
.
I
'.• ,24'
pursuanf to. a contract under section' f87 6'or 'an ap-·
'·25
pr~ved demonstrati~n. project de~cribed ' in' section'
'"
"
~.
,'.
II
'
�\.
> " Q: \SIl\1\SIM94.599 '
;.
-..:'
/
" s.l...c:
, STAFF DISCUSSION DRAFT
J
, i\"11I -A~54 "
" ',- ':'1
~he: S~ciai Sec~rh:' '..~)~ndm~nts 'of 19,83,
603.(c) of
'.~ 1-
,
-f
.
"
'
~,.'
'.
-.
.
'"
,
"
,
.
'.' sectiqn 235o, of the Deficit Reduction Act, of 1984,
2
j
.: - '
-
,,:
•
-
.'
-'
;,'
~
'.
' , '
•
•
"
' , '
-.!
•
, ..
-,'<;
,or section 9412(b), of the Oil1nibus Budget Reconcili 7, '
3
!--.
, ationAct' of 1986, "and" ' ,
",.4,
.
j'
,
",
,
. '
.
:
,
',",
•
.' -
(
,-
•
-;,"
\
.,
:
,;
'.
\
" , i
~
.'
1\
-:'
','
"
,
,I.,
';,'
•
7
"substantially simil~r' tobeneflts ~hderpolicies' of
8
, ;fered to indiViduals Who aren~t entitled to' benefits
.
,
,
•
with benefits/which 'are available under this title, are
6
l'
\
'''(ITl) providesberte5ts "!hlch" when ':combi~ed'
5
"
"
,
'
10 ;,
,;
':1 '
'underthist~tle ..
9
,
I .
,
,
'-,'
',,"(ii) I~'making,~determination un.dersubclause (ill)
-
I
.
\
. .
.
,
" .
, ' . , "
I,
, .'
I
.
•
'11 ,of clause (i) as to whether certain.' benefits, aresubstan
.,12 "tially'similar, ,there shall not b~ taken .i~to' accotrnt,' except
'
13. i~ the case 'of preventive, services, beD;efits pr9vided under
"14., policies
offe~edto: indivi,du~l~:w~o' ~re not entitled to 'bEme
fitsu~der thl'stitl~w~~h' are in' ,a~rutib~ to t~e benefit~
", 15 •
.
,
':
,"1'6: co~eredby, this title.and~whlch', arebe~efits anentit)' must , '
'J
,
..... :
' ,
17 ptovide in order to meet.thedefiniti6n of an' eligible o~ga~,
,
'
•
,
,
j
•
,
"
,
'
,,~ .18 -niza~ion urider"~ection1876(p)(J}.".
.'
.
,
,
1 9 ' '(b),'R,El\'EWAaILITY' 'OF 'MEDICARE', S~LECT POLI
,
j
,20'C~S.-·Se~i~ni882(~)(1')(42
"
.I.
U.S.C. 1395ss(q)(1»)
,
"
22
.......
,
":,' ,(1) ,by'striking "(1) ',Each." , and' inserting
I
r
23
T '/
?/
!",
•
'.
"( l)(A) Exc~pta& provided'"
in
's~bpar~graPh{B),
. ' ,
',:24 '
is
each "·, '
,
I
'~"-,
"
I",
,/ ,
\ :"
,
/'
'
,
.~
.\
'
i ,
".
'
'
, D' , '
,1
,
�"
,
I
J
"
•
.
'j
,,","
"
\lII~A-55
.
,
",
,
'
•
.
I
(2) by redesignatii1g, subparagraphs (...4) and
'1
-'
4
.'
•
\:",:,
,"'~
'_
1', \ .
"
(B) as clauses (i). and. (ii); respectively; and
2
(3) by' addi~gat -:t,he' end the,'following "newsub~ ,
3
,
.
>' " " .
.'
. paragrap~: ",' ' , . ,
\
'.
. \
.
..
5
,
:'
'
"
/ '
,
..
J
,
,
,
"
"STAFF DISCUSSION DRAFT ,
"'(B)(i) ,J~'th~case oLa'policy that meets .the, '
'6
": r~quirements 'ofsub~ection" (t), an'issuermay 'cancel,','
'
~-.
"
',.
"
,
1
'.'
'.,
\
,~'"
"
.
.'
"
\
or nonrene,w stich. policy, "rith , resp~ct: to- an indhrid.< ,\'
7
.
8
_I,'
ua1.who' leaves. the / commulli:ty' rating: . area: of ,suc~,
9.
,
10
..
, j)olicJijexcept that, if, such indh1dual , " . " a geo~
~o-Jes to\
,
, I
,
' .
;
:
, ,graphic area where ,such issuer, "or~rhere,an 'afp.li'ate ,
,
of such issuer, is' is'suing medicare1 supplt?mentat'poli-'
: 11 ' ",
12:
"
-'
"
,'.'
•
, ,20
,',....
.
"
.
.
'
,!,
.'
'
'
"
, ,
.'
,
','
"
,
cailceled 'or nonrenewed. '.A.rt" indivIdual- whose cov· "
"
,". erage ~iscanceled' or rtonr~n~edunder- this subpar~-' ,
~
,I'
~
"
,
,
,
.~
,.'
'",
.
,".'
"
"
.'
"
.'
,
.
\
"
.
.
, graph, shaU, as part, o~ the, notice :of termination or
,,',
.'
, :nonr.en~w~l, be notifi'ed oftheright'.to.. ent6llinother "
.
,
"
. '
. '
~J"
,
"'medicare, supple~entali policiesoffe~ed'by the issuer :',
,
,21'
","
•
,
19
I.
. sue~ or affili~te, thatpro"\rides ,benefits,cbmpirflble' to,
.. ',"';.,
.,"'," ~
..
,~
'-or'less than the benefits provided in the policy, beiI,lg , ,
.
18
'
~edicar~ suppletPe~tal policy offer~d by such_is~
any
.
,17
\
'cies, such indiyidual . 'must be permitt.edto· enroll in
,14,
" 16
.'
.
, ' 13
15
"
•
,
'
,,
,
7/ •.•
"or its affiliates.
:
,',
J'
'~(ii), ' For purposes' ,of this, subparagraph, "the
22 ,
I_
23
,
/'
24'
. , term, '-"affiliat~,' ~sha:~ ,l)a~e' the' meah,ing: given su~h
,
'
,
term by the 199i}N.A.IG Model RegqJa~ion:~', , '
,
"
~'.
.
'
,
.
" I
','
"
,
",
•
,j
�~
i
,'STAFF DISCUSSION
O:'\SIM\SIM94.599
.
.
~:
:
I
DRAFT' "
'S.L.C. "
"
'.'
,i
\1II~A-56'
;\.
" .1 '~ , (c)Cn~LPE~ALT\';-'
'Section 1884(t)(2) (42U.RG."
"
: "~': 1395ss(t)(2))'js amended-', ,
\,'"
'~
'
','
'.
,'.,'
.'
:.
.'
"
'
.,"
,
.,
'.
,
,
I"
, ,
...
I'
'3, .
\
'~
'if,
,. I
.' (l)l?y striio.ng:,'i(~)"'an~:inser;ting "(2)(A)"j,
,
, . " .
'
"
.
'"
'
. i-:
~"
, '" ,
, ,->5/
,
"
'-1
,6'
.
. i .
,I
"
\.
.
.'
:,
,
,
'
i ,
,
" , ' , " ,
,
,
\'""
,10,
',I
'"
"
,
'
'
•
r
" , "
"
.. '
\
,
",'
,
, "
":
'
~.
'
,.,""
;/ " , ,(B), by s.triking',','paragtaph,
.'
",
"~,,
, , '
,
'"'
,'
..
\ ,
14 ','
,I'
,
"
a~d
iIl:-' ,
"~I
"I
'*'
,
. , '
' , , '
'
,t'
,
"
.1
.,'
)
"
. ' ,
,Z
'16: ,'''(BY If' th¢, Secr~tary 'determines thai an issuer
,J, .
"
'.
'para:grapn: ,., ,',
.'
•
and
'
15
'c'
.,
"
",
at ;theend the follo\\ing "new ~ub- '
':.(5Yby .adding
.'
,',
'"
,
\
,,"I'
'
"".
'
"
.!
;, 13'.' , " s~rti~g,' 'this' stibp;aragraph"; anp."
\
1s
.
'
'
"
,
"
,
(l)(E)(ii)'~
, (4L by striking "the previous sentence"
'
'
,~\'
1
,
"', 'in~erting~'paragraph (l)(B)(v)(ll)"; , .
, 11
\
i
. .
,'\
"
1,'
,',
'
(,
inserting,"'paragraph (l)(B)(v)(I); and;
'
"
\
,
'
,'., (A) bY:.striking' "paragraph (l)(E)(i)" and'
/ 9,~ , ' , i
,
,
,
,'"
,
,I
..
,"
'~~-"
-
(3) ill clause OV),as red~sig?1ated-,
"
,
:
"
":1
'
8
'f
,i,.: """
•
,
,
'"',,
, , spectively; ,: '
7 "
,
',"',,'
. (C), and (D)as clauses' (i);(iiL ,(iii); ,and (iv), re~o,
/'
','
,",
of,'
'17a'"poliCY; ~pprov~d'unde: paragr~ph (1): ha'smade a mis- "
,
.
. J'
:
' . , . '
'\',
.., ' ;
.
I
" ..
\
.
,:
'
,18representatioIi, ,to the Secretary or has' provided'the-Sec,;'
I
"
..
,'
.
19
I
/ ' ":
,
',",
,
' ,
\'
,"
,
,
',~eta~, with :false iIlfo~atio~', regarding such policjr~' the'
, 'f'"
;~su~r' is subject'·to 'a"\~ivil rrion~Y penalty iIi,.,an a~o~nt '
,.'
:,'
,: "
, \ 20
"
'"
"
,{
:'
.;
' , '
"
,
,',
,',
'
'
not to',exc'eed '$100~OOO for each such .determination. The
,
"
"
'-
"
"
.. , . ,
•
. ' ,
;.
\
..
>,
'
'.
',I'
",
" : 22, provisions of section .112 8A (other than _the 'firsts~ntence "
,23' 'of~ubsectiop'(a) and' other'than subsection (b)) shall' "
.
"
.~
"
'.
"
"
, 24'" apply tq a:civiLmoney pena1ty.
~nder' this 'subparagTaph'
...
,'
"
'
,
,
.
'
~
.
'
:'"
','
"
,
"
,.'
\
, >:,
~
'....
"
,
'I
"
\
'
.
t'
'
"
"I
•
, I,
,
,
I.
"
'
/
'
.
"'"
.
,
(
�, i
, STAFF DISCVSSION DRAFT ,
O;\SIM\SIM94.599,
"(
"\lH-A~57,
I'
"
S.L.C. "
.
,. : 1 ' in the same mann~r', .as such 'Pfcr6sibns apply' to a penalty'.'
.
\
"
"
'"
, 2 or proce~iling undersecti9P';112'.8A(a).','·" ' "
'
' .
.
"
I
.'
I
r
. ..
(
. (d),EFFECTIVEDATEs.- " .
4 ' ( 1 ) NAIG STA-1'\DARDS,-,'Jf,' 'vrithil!-" '6" months
,
5' ,
.
,
,after' the date of the enactment of this Act; the ·Na
,
~ tional ' Associatibn 'of, ,Insurance : ,Commissioners '
.
6
1,1/' •
,
.
,
.,
" . "
)
•
,.,.'
I,
. ,
"
',7
(hereafter in this' subsection 'referred to' . as the
,8
"NAIC") ·makes changes in' the, 1991 NAIC Model
,
"
.'
.
I'
\
.
'.
'
,
.
)"
j'
••
..
'
,
-
'
.
'
Regulation (as defined in section ·1882(p)(1)(A), of
,
10,,:' "the Social. Security Act) to incorp6r~te the,a~ditio~al
'
,'" J1
, requirements: imposed by ~he 'amendments made by
12
' tllis section,"sectiori.,1~82(g)(2)(A) 'of such Act shall
.
,
,(
. ' .
'be applied in each Stat,e, effective for p~li'cies issu~d
, , 13
' ,'to ",
14
poli~yh6ld~rs .' ~n :and' afte~'the:', ~ate' specified iri '"
,~
•
•
•
'
'I
'
.15
p~ra~aph(3), asifthe reference to the !\Iodel Reg':'
. 16
,
ulationadopted ,on JUne, 6,'1979; were: ~'referenc~
\'
tO,the 1991 NAIC Model Regulation (as so'defined) ,
17
,
: 18
"
,I'
/'i,
,'
.
,".
0"
~
J'
-,
...
I
~
,', "
',.'
•
\
'
.
as changed under' this, paragraph (sucl:l changed
,,
','
"
,
'~.
1{egulation,r,eferred· to,': in this subsection as the
I
. J
20!
,I
'.
21
24
,
,""
25
'
does, not. make changes",in the' 1991' NAIC Model
.'
.
J
,
"
,;"
"
Regulation (as' so 'defined) withi~ the 6-month period
specified' in. paragraph (1), tlle,' S'ecretar.y ,~f, Health
,
~
\
?
"
,23
'.
,
, .:22
I .'
"
".199;5 NAIC M()del Regulati.on").
'i
,....'
. ' . '
,1"'
•
\'
",
•
•
"
and Human, Services '(here~fter In'this subsection r~~ ,
"t'
!
.
. ,"
.
.,>.
'.
,
,
�", (
,
_~".
•. L.
.
'(
,
STAFF DISCUSSION DRAFT.
".
1
,
I'" :." " '
,
..: !
,
'2 '
, VJII-A-p8; '.'
'
" ,
!
:
'S.L.C.
,
,':
"
",'
ferred to ,as ,the' "Secretary") shall promulgate a :beg- .
.\
"
.
'
L
,
.
:,'.
' . .:
;
"
'
,
{oj
I
l.,;,,:
"
,
'
. . ' , : '
I.
,
"
'
.i'
'
•
ulation andsectiol1 1882(g)(2)(A} ,of the Social Se.;
"
.
~,
. .
curfty
3
.:"
I
t
'
.
.
, '
.
in each State, effe~tiv~!'
Act, shall ,be applied
.
.
,
,
, !
'
'
..
•
.' 4· ,,for ,Policies, 'issued to. policyholders ·~n, and after the
~ate
5· ' ':,
,.6'
,
'"
par~graph
speci5eoin
(3); as if the reference "
,·to' the Model Regulation adopted on June 6, 1979;,
,
",7
,
'
'.,'
"
,
'
"
,,'
'
,in'
1 f., ,
r
. t'
atIpn "),," I,'"~"
" ,
'\
:
'
.
',"
'
'
',.
''[j~gul'"
, ,n~ ,
~-!
\
,.
'(3),DAT~ISPECIFIE,D.-'•
',1:2. '
/
,
;, ' ~:
,~ferred to' '. tlris' s~bsecti~nas the ".199:5 Federal,
iO,
,
,
'
, ,
,
;
'·8' ".t,ion (as So den~ed), :as, changed' by the Secreta~·
:
:) ,
"",';
" 9 ,"under this, pari:tgraph (such changed Regulatiort' re-'
"
• ,<>
"
,
: .;
"
,
'"
'
,(A)' I!\ ,'GENERAL.-,Subject to' sU:bpara-,
.. '.., 'graph
,
..
" , 14
'.
(B~, the date specified in
.
.,
,~
"
pa'i·~grapii ."
this
' .
, 15 " ,"
!
.
\,
,16"
.
.'
" ,(i) the date the State adopts the 1995,
,
, 17
.
,
.~. ' "
'
,
,',
\'"
" ' " , '
,
,
'
, . NAI,CModel RegUlation or th:e; 1995 Fed: , '
"
,
, '.'eraIRegulation,· o,r
. ,,-,
"',
'(ii) 1yeal' afterthedat~ theNAICor '
.
,
•
'18
. '
'.
19,
,
l'
,
'
'.
.
'
,1 ,
20 \ .
.
",21
\.,'
I
',the Secretary fir~t adopts ~uch' regulations.
.
,~'
,
.
.'
,~,'
~,.' ;'. :.
'
:
;
, \
.'
,f
\
.
,(B ) A:PDITIONAL LEGISLATIVE :ACTION RE
'.
22
.,,'."',
'
I
'
.
,
," QUIRED-.-',In thec~seofa State which the Sec-,
.
.
.
,
~
"
,
)
'
,.,'
,
. '.
',retary identifies~ in consultation, With the NAIC,
23
.'
,::.'
'
•
.',
'"
24
..
.
,
"
,
.
,
'-
F
'
,
I,
,
'
,
'I
.
"
,
.
"
'
.. ".
"
I
�r'
I
,O:\SIM\SIMf}4.599 .
,
"
, S.L,C.
,
\"III-A-59
"fiY'
''. 1
requiripg . State' '1egisia:tion~othe~ , .
, ,'than legis-Iation ~ppropriating; funds) in
2
".
,
\.:,
'
, ' " , the 19~'5' Federal Regulaiion,.,but '.:,'"
'5," '
,~
~
~\ "
'/
,
, (ii)haying:k legislature, wruch':is not,
6
,
'
'
, ; scheduled 'to rn~et' in 1995 in a"legislative'
7 .
"
,
,"meet th~ i9,95 , N.AIGl\iodel::Re~~ti9n or " : ' .'
4,
'
.
,:
order fQr medica~e supplemEmtal p~licies ,to .
, , 3,
. '.
".
,
,
. "
':
session' in which suqh legislation :may be,·
.
\
','
\'
,:
,\
'.
"
,
,,'
, , 11 ,
da~;,of
-
..
,> .'
!
. .
.
, "12
,
' , .
r!'
J
the first ,calendar quarter beginning 'after
'
\
13
"
"
,
,\'
";
the p.ate ~peCified in, this' paragraph i~,' the, first
'10
,
'.'
.' 'consic;lered, ,
9
,"
.
,'.
,
"
.
,
, ;
'
.
~:
,
.'
'.
, \ ' .~
the. close of the' first legislative sessi?n of the
/
J
, Statelegislatu~e' that begins ,on ,pr ,aft~r J anu ~ ~ ,
"
14"
~
I
,
.'
,.
.
, az:y 1, 1996. For purposes or t~e' previous se~·
.
.
tep.ee, in the case 'of a State,.th~t' has~'a,_2-Year.. '
15.. .'
'
,
, 16
I
'
.
, "
:"'
"
.
'
"',
,".
..'
~
'.
..'. .
shall be'deemed to be a se'parate regular.,session
,
1,7
'"of the State :legislature:
'18
:
"
19 ,SEC. 8307. MEDlGAP.
20' ,: " (a) ,30·DAY O'PEK ,E~'ROLLMENT PERIOD.-,S~ction
"'
:'.
'.'
.
"':'
.
•
~.'.
<"';
• .
~
,'"
~.
': 21 "1882{s') (42,U.RC.,l'395ss(s)) is'ame!lded
)
22,
.
"
,
,
.'
'
'
.
,(1) in pai~graph (3), by~triking '''paragraph~
23",' (I) and (2)'~ and :inserting "paragraph- (l)~ (2)," or
"
.
,'24
',"(3r i ,
I
, i
'
"
legislativ.e session, each year .'of s11ch 'session' ,
,
\
,
"
r "
'."
I
�, STAFFUISCUSSION, DRAFT '
'0: \ SIM \ SIM94';599 ,
,
,.
,
~
" ' :\:rII-A-6D
','
. \ \.... .
\1'
.
,
" ,,(2),.,
"
S:L,C:
'".
}
'
,
.
,.'
,',
,
I
;
.
.
.' .
....
'
b~; 'redesignatii1~(paragrl;lph
'(3)' 'as -para
, .graph ,(4), and "
.
.'
\
'.',(3)'by inserting, after par~agraph (2) the' follow:.
1
,
"
"
\"
,
'
•
•
j
•
'
".
.,
j.
,f'
, \
-.ing newparagraph:" " , '
'," (3): Each, i~suer of amedlcare supplemelltal policy',
5:
, '
....
'
,
~~
",
~
'.'.'
7' dur~tiop.,everyyear (which'
"
/
"':""""
,
'.8
I,
..
,'.'
~hall
:
speci~ed'
be, tl.ie period
by.'the'Sec;etaryu~der's~cti~~1876('~)'(l)), during whldh'
""
,
' "..,,'
'
.'
:
'_.', )'
\,
"
:.~' . .
.
, \ ',,;!
," 9' thei~suer'm~y not deny' or condition the i~su~nce. or effec-, '
,
"
,
:",,'
6"shallha,~e an "open' eDro'l.hD.ent period' of'atJeast30days
,.
.
'.'
"
,,~ '.
'
'
jr
10 tlveness :ofamedicare suppleinental policy, Qr discriminate, ' "
.
'.'
'.
"
" 11 ' i~the pricing ofthe pollcy, be'cause o(age;,health ~tat~s,:. '
',0
'
·f
"
,I
.
Ii, clai~s ~xperie'nce, receipt of health care, or:,medical condi~'
:
,'I
I
1
"1;3
't~o~;; The policy may n9t provide an~~ tinie: ~eriod'applica- "
.:.~
"
,
_",
t
•
",:
~'
'I..:"',
.
,
. .
' ,
J4 hIe to pre~existihg conditions; waiting, p~ri6ds,. elimln~tion, " .. '
:
":
\'
" '.
~,'"
., ' , '
.
,•
,,"
"
:-.:.'.
;,'
,; ,
i~"
,
~
"
"
'
15 ' period~, :~n~ 'probation,ary' p~riop.s (except ,'as, proVided: by,' '
, "16 paragraph (2)(B)).,"; ': '
,"
, 17
....
"":
, (b) EFFEQTrVE ,DATES.-,' ',"
,
(,
'(8
.
\'
,
•
,
'
•
,
"
"
",
" " .
I
\ ' ,
,
I
(I)' NAIC'ST~'DARDS.~If,'within .9' months
.
.
~
\'
.,
I,
.
•
'
19
after theda:te 6f the, eria~tme~t of this: A~t; theN~~ ",'
,'20
,;'
'tional Associ~tiop" of' tnsur~nce': Com;mssioners"'·
'
, theteafter,in this" subsecti~nreferred,to ' as' the'
21
l~'
~
, ~
. . '
•
."
#
,
•
.' Regwatio~' (as) defin~d, in section 1882(p)(1)(A) "of
23
'\
"
I,
,
,
"
"
".,.
.
, " . '
\
',('",
'i
\
"
.
,,:,'
""
"
",
-"
';
'24
\
"
),
t
,', the, S~cial 'Security Act) to incorporate the additional "
25
, '.requiFements ,jmpos'ed by, the amendments mad~ :by, ,
" "
'
,I
"
(
,
I
:
"',"
",
'.
"
",
,
!,
'"....-
':;
.J
,
�,
.'
I
.0: \81M \ 8Ird94.59.9
DRAFT -,
.: STAFF DISCUSSION
,
YIII~A-61.·
",
, S.L.C:
.'
"
1 .•.,' this section; '~ection 1882(g)(2)(A) of' suchAc~ shall, :' .
-
I...
"
":be applied ineach:State,efrectivefor p.olicies is~~ed ..
2
.- .
.'--
,',
'
",,'
,-\;\
...
.
..,
','
'"
"
.' .paragraph (3), as . ' the reference to. .the
if
.
.
4
,
,
,
,
.-
.
~:1odel
5ulation adopted: on·June S, 1979,
,
.('
;'
Reg-·'
'~
'
'
<., .
" :to ,policj;holders on and a.fter: the date' sp~cifi~d in
3,
/
'.
\
"
we~e'a ~e~ereIice: ,.
' .
!
",
.', :
,to ,the' 1991 N.AIC·, l\:1pdel Regulation (as so. defined).
"
,7
as changed. under' this paragraph (such .changed '
,
,,
,
.
"
.
. "
',.,
,
','
,', 'Regulation refe~red. to '~n fhis .subse~tion. 'as"fhe ':
'8"
9 " .'. "1995 NAlC '
:Model·Regul~tion'~).
,,
.'
",
' .
\,
"
.
(2)' SECRET~y·STA.1\j)ARDS.-·,If ·'the·/'N.AIC
10:
does 'not make changes' ,in<tpe 1991. N.AIC Model'
.
11
'
"
,12
'.
'13
"
,
. Regulation (as so defined) within the 9-month period " .' .
.
"'. . ~ .
.
, ',' specified. inparagra.ph (1); the Secretary of Healt,h .
.
,
.
, .
"
"
",
\
"
,
,
:.' '
.
, ferred to as the
"< 1'6
.
.'
"
,
~'Secretary")
subs~ction r~,"
-:
'
shall p.romulgate areg..... '
" ,
,'
ulatiortandsection'1882(g)(2)CA:) " of the' Social'" Se- :
, -',
.
-"for policies issued 'to policyholders on. a.nd. after 'the
aate -specified
:: 19.':
,
. 20
,
,
:,
..
'
inp~ragr~ph{3),
..'
','
\
as if the reference \.: .
,'.
,
...
.
,
',to,th~:Model Regtllation 'ad6pt~d on June,S', 1979;-'
.
. . '
/ '
:',. ~ere a .reference to the 1991 N.AIC M~del' Regula-
21
(a~ ;SQ
•
ti(m
23
unde~-th1~paragraph _(sri'ch ~hangea Regulation ~~- '
defined): as changed- by, the .,Secretary'
::
,
Ie
24
25
"
,
Reg'Wation 1'): :
.
{.'
"-"
";
"
'
.
'.
1
ferred'toin-;this subsection as' the' "i995 Federal·.
~
c
i
~2
/
'i' ".
curit)~ Act -shall b~applied. ill:, each' State, effective , .
17"
: 18
\
'
""",..
'
,
'
'-
,
.;'
IS
,
'
',"
and Htiman Se~~es. (hereafter i~ this
14
,
' .
'
.
,
\1
�STAFF 'ril$CUSSION,DRAFT .
. /O:\SIM\SIM9,4.599.
. ... S.L.C.
"'\TII-:A...:..62·· .. '
. 1 SEC•. 83Q8. FUNDING UND~n DmECT GRADUATE' .MEDICAL
,2
'.'
'.
".3
'\
'EDUCATION FORTnA.:rmNG IN NON·HOS·
I
": .....
"
.,.:
\
" PITAL OWNED FACILITIES.
,,' ,
"
'
..
:,'
1.
.
',.:
:
'!'
" ';
1
,
.'
,...
• .'
" 5 ,'i~anieridedby striking ii, ifthe hospital incurs all, or sub.-.
,
,
. .
,~,.'
•
'~'
,.;' ,,'
~tari.tially all,. the
.
.
.. . of
6'.
,
.'
,
.
..,
~
,
.
,
8 ,SEC.
• ,f
,
',.
_
~,_
,.
,
",
,
,""
'-
\
,.
~....
"
......
,
•
costs for the training'program in that
7setting~:. ,
,.
','~"'".'
,',
:
"
8309,· CLARiFICATI()N OJi'SECONOARY PAYER FQR
,
. 9"
,
,
.
BENEFICIARIES, COVERED
UNDER GROUP
"
,
~.'
• • :, '
10
' \
:.
- r
_
, \ '
I
, 'HEALTH PLANS•.
I',
'·Effective as if included 'in 'the 'enactment ofthe O~·
11
"
'
"
12 bu~' Budget. and Reconciliation Act· ~f 199;3, section
,
"
~
, "t'
."
'.
'
\'
" : ' ,
.
13 .1862(b)(1)(Q) (42·U.S.C; 1395yCb)(I)(C)) ,is amerided, by
14 a:dding~.~ the 'Emd the following ne\\: sentence: "This .sub;. •.
,\.
15
..
"
-'
'
d~o
paragraph shall not apply to retired' individuals who
..
'
;
.
"
'~
"
"
, " ,
. '
"
'~
.:"'
,
"
;..,
.
,~
,
16 ..not· have(~urrent Emiploym~nt stat1l:s ,with an employer
."
"
at·
"
.
. . .1 .
17 the '~eginning"orthe18::"month'p~riod referred; to above.".',
", J8 .,'
"
' '.
'~ART·~OTHE~PR.OVISIONS··· " ',., .
19' . SEC. MoL COOPERA'fIVJ<; cAlm RESEARCH•
. ~ (a) GRA.~T
, 20,
\,'
"
;
'~.'
,
,!
\
, (l)";EsTABLisH~IENT.-·,·,rheSec~etary, "acting'
.
..
21
PROGIW1.-·,'"
22
"
·throllg:h the,A:dmiQistrator for .Health' CarePolicy,
,
.
",
/'
'.
:_.",'
,
,,'.
. "'.'
.
;~ders,that establish'or operate..rese~rch programs
. 24 ,:
: \.'
"
~.
.....
.~
-
1·'
:. \
' I '
-
~ \.
"
,'\
. " .;
'
.
.\
I
• ~A
,
.
.
,
-
•
.
at,
25' ' ..cooperative: care'. facilities' ~'hich . are 'designed ·.to
I,
...
."
. , .~tid:Rese~rch, . shall mal\:e' '~ants to) health/care pro~
, 23
'J",
.~
..
',I
..
"',
,
, . !
.
;
'"I
~,
0
, (]
" . ';.
"
.... ' 7'?/.::, .
i
'"
j'
�..
'.
,
1
STAFF DisCUSSION
O:\SIM\SIM94.599
,
,
~\
3· ,
,
'
.
S.L.C.
~
,
~
,
I"
",'
-'
,
4 .
"
t·
sati~fy the -requirernents of.thls section.:'
..
.' (2)' USE>: of ,'. Fr~Ds.-··:Graritfunds '. recei-\red' ,.
2', '
!
r
.' stud;;~-patie~f recoveries 'at', such 'facilities ,and whi,ch
.
'.
.
.
'1 "
";.,
DRAFT
:
..
~
"
'
. " ,
",'
!. ,
.'
'
J~
'.
'~nder. thls, section '~ayb.e used'~or'th,~ ~~osts o(~s,tablislllng' o.r .operating-a, res~ar.ch program'. at a co~ ,
"I
"
" ...
6'
incl~di~g, costs ,related 'to ~c-'
'operative care facility,
'
" ,
,',
"
,J
,
•
'
..
\
" ,quiring, or.·' maintaining , fo~ the' 'cobperati~e 'care
..
,
.'
. '8
.. facility- ..
,9'i'
!
(A) appropriate 'staff; . /:.
,'
"
'\,
..
'
...
10
(C) physica:Cspace; " '
12· .
(D)inaterials,~to conduct the rese~rch ·pro
" "
,"
13
,
I ,
. .
gram'' 'and'
/. -
,
,
/
,"CE) ame~hanism or procedur~8 for the' dis- '..':
"14 '
.
.
.
. .semination ,of the 'results' of the' resea.rch <pro~
.' 15
"
,I.
'
(B) infqrmation systems;
.
,11 '
,
~
I
•
.j
\ .
"
:J6
:, 17.'
'I.
~ (b) Sui3hrrsslbK OF ,APPLICATIONS:-.To ·be·eligible '.'
18 for .agrarifunde; this section, ,a he~lth care ~proVide'r,must'. ."
.
,.
...
.'
'
,
'
,
'
"
"
",,)
19 subniit an ·'application to the.$ec(etary ~nder such'ter~s _
I·
•
I
'
,
.
. -20 . and, conditions. as are determined appropriate by the 8.ec-·.
.
,"
'.
,
"
, . " ,
\.
,2 f .retary.· ,
.. 22 .' .
(C)~ESEARCH REQUrREMENTS.-' ".
'~"
.
.
.
,
23
24· .'
.....
',(1) IN' GENERAL.-'Research. prograp1s op~rated. "
.
\\1thgrant. fu,nds receiv~d. under this ,~ection shail
-
25
I
.....
;
\
,
":'7
/
•
J
. . - ; - . . . . . . .
•
I
;.--
.~ .
"
I
conduct research, on ~the , . ! . descriQed, under para',:' .. ', "
areas .
"
"
"
' .
\
.......
'
\,
'
, ."
: r -"
';
,
.
�,
.
I
.
\
'
:,
,,'
, ' , "STm,~ISCUssi0N
: 0: \81M\ SIM~4.59~ ,
"
,
graph' (2). and at the stages' describ~d und,er para-,
,'
:
,
.
'
",('
.
'
,2
'.
,:
'
"
'
.
' •.
AREAA
(2)
' i.
'
.
\
)
RES~ARCH.~The' areas 'of re:-.
OF
", (A) '.the,' ,cost-,effectiveness of 'cooperati~e'
5'"",-,
,
,
'6.' ,
,
,
,:
,
.0'
',"
',3
','
),
'
,gTaph(3j.:,· ,;,'
\
,
, ,'. 8.L,C:, ' ,
I·
I
i
DRAFT
"'v
'
'
!,
care; , ' .
"
,
\
"
. (B), ~edi~ation' e~ors occurring tirider c~~ ,
7
•
' 0 ' ,
!
. ,S',
0
,9
,
\
0
'
,I,"
"
"
I
'
.
'
..
'\.'
", operatjve care; , ;
•
'.
,
"
,
'.,
I
'
'
~
.'
,
'
.
" ,,(C)' readmission ,rates 'for related ,illnesses'
..
~"
,
<'.
I
,
•
'
,
, 'iO'
,for .patients ,involved in cooperatiVe care; and "
,
'"
"
11
,
I,
,
.'
,
·,15. '
..,
~
.',
",'
of~e-'
"
,
•
\ ',:
" (8) tr~atm(mt; a~d
,
.
\
18
•
'..,'
19
.
;
-
,'.'"
'
~
,
' \
•
•
I
0
.
:
_
...,
.
OF
I"
•
, 20 proVider receiVIng
.
\
,
~
, . : , ,"
.(d)~,-COLLE.cTION"
,
.,,'
'
,(C)· post.llospitalizatioIl,. recovery.
,,
•
'. '
,
, ,
justment f()t acUity) ( . ':,'
'~
'17
"\ '
"
,,' (A)patiellt intake' (With 'a· 'statistical ,~d~
, .:16
"
'.
to
'.,.,
;....' _
:.
~.
'-
'"
"
INFORMATION.~A
•• '
',.
health
J
'
- \,
(
c~re
,\
"
li grant linderthis ,.
section shall collect, ;,.
'.'
'
,
"
. ' .
'
,
21 t and submit -inforniation 'on the results'of the research con
" .
"
.
,"
" ,
.
.
:
,
in'. this paragraph :are'-the follov;ing: .
'. '. 'searcn described
.
14
.
'.
,
',,< (3)~TAGES/ OF, RESEARCH.~The' ~~tages:
, fS'
l
:. '
"
.
. '.
'
,,\
. :v;ith cooperative ~~re:
:12' , _
,;
"
,
\
"
I
co )'overaII patient, and. famiJy ,satisfaction '
'
..' 22 ~ ducted with s~~h': grant fund's:to the Secretary unp.er such .
,
','
.t
,
t,
"
'\
'\:..-"23· t'erms and conditions as a~e d~termined app~opriate.bY'the
•
,
'
I
I
•
~.
'I. I
,
,
"
,
'j"
,
\
i
"
,~ecretary.
,I
•
'
1.
. ,
.
'.-
.
'.
'
".
,
!
."
."
/
•
,\.
•
,
"
,
i
..
.,
j
.
,
),
,
,-,
,;
\,
I:
','
,
'
�/
\,
"
'
STAFFDISCU~SION DRAFT '
Q:.\SIM\SIM94.599 \
- ,
"
"
",'
S.L.C,
,', ' VIn-A-6 5. '
-,
,.'
\-,
' 1 - (e) COl\IPLrAXCE.-'If the 'SecretaD~ determines, t,hat
care provider ~eceiving grant fund~.under, 'thls
a health
2
,
•
.
. ,
".
\.
, . '
I
,
•
"
3 sectibll has failed to ,operate a 'research program in acc'ord~
"
..
4~
,
.
'.
..
ance With the terms, of its apprO\red
.'
....,.
"
.
\
I
~pplication,
.'
"
.'
.
t4e Sec.;
'.
,"
\
.
"
5 retary' may withhold pavment· of such funds' u'ntiL the
,.
.
. .
-"
':'."
."
"
~
"
-
'\
' . ' ".
"
.
,
i '
.
',' 6 health ,care' provider r.eme4ie~ such noncompliance. ',' ',",
•
,
.
'
.
'
I
•
'
(f) REPORT~-'Not later than D~cember31, . . . .
1997~ the
.
'
7,
.
. . '
" . "
"
(
~.,
\,8 Secretary:. shall 'subil,liFa report to theC~ngress based' on'
, 9 .. the, \ information reqUired. to be collect~d , ' . .subsection
u~der
..
.
.
',TO (d), which de~cribes the results of the research conducted
,
\
J
. '
,,'
>
'.
•
.--
•
\,'
I.'
..
')
"
II' with grants fund~ receIved under:' this'section,together
.
\.
1'·
.
..'
.'
.
;'
.
.
\.
~.
,
.
12 with -any recommendations'for legislation;,if necessary. '/
:
,
' . ' . •
•
' .
'.'
I "
' , '
•
,
/.
.",
••
(g)' DEFIl\"1TIO!\S.-'
,'For puwoses of this section~, '
13
,: 14,
, "(1) the·term"cooperative care"
'me~nsa t~eat-·
15
. ,.'--
16
.
nltmt program: which serVes re~oyering patiemts',who
req~re supervised care .through the use' or' care 'part- '
'1,7
ners; \and'
/
18
, (2), the ,ter'm "'earepa'rtner" means a per~on '
19
who .\\rill assist \\':i~h a patient's supen':ision- and par-' '
r
20
I
~
\
,
.chIdes th~ follo'\\':ing pel sO,ns:
" 21
I
:
'
,ticipate in 8uch'patient'streatment program and in
./
-
, J
22
~:,'
'"
.
•
. .(A) .B." spouse; '\
)
"
•
-
•
/.
,
I
23
24' '
'(G) a ,relative "~f the
'.'
'(B) an adult child;,
,25
patie~t;"or '
,
,
,.
1
;,\
\'
.
'h-t/ '.'
,
�,
,
,
STAFF DISGUSSION DRAFT, "
I
.
'S.L.C"
t,
",'
:YIII-A-66,' .
'
:. (h) ArTHoRlZATIOX.-,.
'," (1) I:\'qEKEM,L.~For the··purpose,6f'carrying
' . .
\,
,
' , .
,I
'J " " : oui this',' section, there are ,authorized to' be', appro.,' ~'
"
. pri'ated
'.
I
o~t of the'Federal ':Hospital Insurance·'Trust,'
.
.
,
,
"
-'
Thnd 'established under section 1817\ of :the Sociaf' ".,','
.
6
,
"SecurityAct not moretha~~"
I,.
j
"
•
"..
7'
,'. (A) $3,000,000 for fisc'al,year 1995; "
"
" .
"
,
,I
. 8:
:
-.~"
,. (C) $1,000,000 'forfiscal:year 1997,' ,
,
" ,
)
:~ . .'
"
·10
'
"
"
,
(2) AVAIL:ABILITY.-,Any amounts' appropriated,
',' ;purshant to'
t~e '~u~~Or.ityo{par~graPh
,
\
,~
"
9
..
forfisc~i year' '199'6;', a~d,
:
'" (13)$1,000,000
.
,
(l-)"shall' re- ,
"
"maiii av8.ilable until expended .. '
.
,
\
. '
.
','
;
\:
'
,
,\
;
' I
,
~
.
'
I
,
,
,I.:
.
'"
,"
. ".
'
"
,
,,'
,
"
'
,
i
"
I,
'
.'
"
, f
,
"
"
,
.
: I
\
!;
',..:
,
.
'J
I .'
.'
"
" J
I
,
'
(,
'.:
, '.
(
(,
'
·',9g.5.,:
�'STAFF DISCUSSlqN DRAFT'
I
Yltli3~I,
"
I
SUbtitle- B~l\i"edicaid'PrograIn
1
,
"
'"
'
,
/,','
"
\
-
1
'
,,','
"
'
"
\'
•
~
,
,3 ',SEC. 8501.ELlMINATION OF RtiLE REGARDING AV~rL~'
I
. ,"r " ' '
,
4,
"\ "ITYOF'BEDSJN,CERTAIN INSTITuTIoNS."
'j
5 "",
(a)'I~' GE\"ERAL.-,The:' fir~tsent~nce of :sectiQn '
6,·19!'5(c)(I),(42~'.S.C~ 1396~(d)(I)') is a~H~nded bY:i~sert.;,
.
.'
,
.'
'
.
"
'
,
"
~,
'
"
,,' '7,:ing, the fQijm~1ng'-bef~)l~e the' end, periQd:, ','(at .the'QptiQn
.
, ._
•
~,
'
•
I
'
.
" ' 8' Q~ th.~,~tate, such determinatiQn may,~e nlilde ,,?thmit 're-
,. "
9 'gard t,Q the, av~ilability. Qf beds i,n su~h a' hQspital,nursing
',10' , " Qr
'facilit\~,
intern;eilia~e
11
care' facility fQr the
.",
,
' , .
,
I
,tarded)Qcat~d
•
I
',/
,
in the State)" . '
ment~lll\·
..
\
'
re':
.\
-
)
I
",.
-
,',
,'._,'
,\
.. '
13 ,subsect'iOIi (a) shidl
.
,
,.
,
,:'
I
-
,
..
'
'.
pe
-
"
'.
'i.
'~..
'.
,i
"
,~b) EFFECTn"E 'PATE.-'"The amendnient ruaaeby'
, 12' "
,
. .',
,
.
effecti"~ "1th' :respect 'to' ,,'ah:ers '
,
_.,
"
•
,
"
("
,
,
,
14' ,granted Qr r'enew~d Qn or after JanualJ~ 1, J995.,
"15 SEC. 8502. CERTAIN DEMONS~TION'PROJEcts PER- " ,
\
16
,MlTI'ED UNnER ,THE MEDIc~ PROGRAM.,
(a) Is'GE~ERAL.-'SectiQn,1917(b)'Qfthe SQcial Se'-,
17
,-
"
i
'
.
',18 c~ritY Act (42U:S.C.1396p(b)j;i'samended~
(i) in p~ragiaph, (1), -by striki~g :sllbpar~graph
19,
t
~ ,
,
,
','
',(C); ,
20
,-
'
"
~,
. '(
,
(2) in 'paragraph (3);' by' stri~ng"(6}her than
. 21
'"
paragr,aph (1)( C) )"; ',and;
22
,
23':
I
, (3) inparagrap4' (4)(B); ,by' striking'-"(and' shall "
_
, .
.
24
incl~ge"
25
in the case of an
individ~al
"
,\
.. ',
"
','
, September, 16; 1994 :
"
,
..... '
"."'
,
\
'
..
'
'
J,
to' whom para:.,:
gtaph.,(l)(C)(i) applies)".- '
!
..
"
~l
,
:
~
(
�',,', O:U'AU\FAU94.6~1 ' ,
, STAFF\DISCUSSION DRAFT,
,S.L,E'.
'VIIIB-2 '
, f
,
,) ,:
,'~
.
EFFECTIYE DATE,.~Sectio!1"1917(b) br the S,o
.'
-.
, (b) .
,
,}
,
, r'.
( '
'(42 l:.,:S:.G. 1396p(b)), shall be 'applled
4.'cialSecurltyAct
. .
-
. '
,
" . '
.
.
3 . and ,adnii~~istered ,as 'if th~ prmisions striGken', by para~; ~
•
',...
,
• .Y,'
<,
"
. 1/
"
, , ' 4 'graph.( 1:) had T,lot b~elle~acted. ;':
"~
\
SEC. 8503~El.IM:INATio~ OF, REQumEMENT OF PRIOR'IN.
," 5
6"',
..
"
.;
:
,,'
,,'
'
, , STITuTION:ALIZATION ,WITH RESPECT TO,'RA-'
,,' ,
1
,,7
f
8
! . . , . "
' .
,
,
• ,
'.
"
.~
'oJ
,1
.
.'
\
"
"
;''',
"
,
,
i
'II ,l$96n(c)(5)) is amended in the matter precedin~(subpara-"
.'
. '.'.
.
12 . graph', (A) by striking ,~, ~it4 respect to .indh'duals ,,~ho" '
:
.. :.'..... .
.
..
.'
.'
...",
"
.'
'
,
,
"
.
'.
,
,
~ ,'14 ",ityo~i~terfuediate ca~efacility(~r the~lentall;' retarded',;.
~
'.,,"
fs
•
{
.
'
.
I3~ rec~ive such senices after dischilrge from 'a nursilig fa~il-' ,
" I'
'
I:'
,1\"
,(a)I~\' ~'EXERAL.-,~ec~ion 1915(c)(5) "(42).];'8.C." "
.
,(
\.
•
,SERVICES.
10
'
,
".
,,',
,
/
,
'.,',
.
i '.
A:, "
, , , WAIVER 'FOR- HOME ,OR ' COMMUNITY-BASED
~
'~
'9
.
:
"
'.
BWTATION,'SERVICES FURNISHED UNDER
'.
\.
"
./';
.r:
', '
I
'(b )EFFECTIYE DATE.-"the, ,amendinenis" made "by'
\
,
"
•
••••
'
~
J .'
"
-,'
"
"
•
,
/
,
'
,
'
.
"
•
,16 this section ~hall,applyto'setvices' furnished :on or 'after
"'.'
..
,
.
"
.
"
'I7Jan~at:\~;1" 1995: "
-
." 18: SE<1.~ \8504. RELIEF FROM
'
'rIiI:R.u
.'
,
,
"
'191': ,
~.
PARTY LIABruTY ,RE- ,
.. -
~.
. ;
'".
'
• • •#
I. "
.... '.".
,
,
,
,
,.-' ' , '
1
24
'
• '
'
'.
•
..J
;
~
, .
"
i$' found
,
,
,
to exist', after.~edical' assistance, has'
,
.'
\
"
,
~.
,
•
"
September 16; 1994
\
I"
'
",
•
"
",
.,,'
\
. j
,
'
i
"
,
"
•
'
,been, !):lade 'availablle,~he 8tateor local' ,a.gencj·"ill"
,
...., "
;
,
,
itji
'
\
•
, 21 U .8.C:1396a(a)(25}(B)) is ,amended to read as','follows-"
22' , ", ,,'
'~
•
"
,
.',
,(a) , 1:\ ','; GE\·ERAL.-,Section 1902(a)(25)(B) (42' , ' '
,
);
/"'"
" QUiREMENTsWHENCOST.EFFECTIVE.':'",
!'.'
20
"
"',
'
. ,
i ~
.
j',
�,
"
, STAFF DISCUSSIOND~
O;\FAU\FAU94,63) ,
S,LC',
, "VIIIB..:.3,'
/
,
-/'"
: se~k reimbursement for such assistance to thee)..1ent,'
',
:of sud;' legal liability,unles~-' ",
2
,
,,
\,,'
,
,
.' State call reaso~abh' e)..-pect to recoverfor,medi
4
•
'5',
•
.','
~,.'
1
".':'.'
,,".
. ' ,
"
"
'
••
'
'
".'not exceed th~'costs'6f such'reeo,very, or ' ' ,
" ' '''(ii), ,with 'respect ';to ,case m~nagenle:n,t ·
7
,
"",
cal assistance,' furriishe& to,an individual does' '
6
,.
.
';(1)' the a'mount of. reimbutsement ,the,
3
\
"
.,
,
'8'
'
,
,
'
.
, " ,
I
.
'
.
.
0
'
'
<
,
•
(as~defined)n ~ection'191~'(g),(2)), t~e'"
services'
I
f .
'
•
.
,.:
"
•
'
"
,'Stat~ demonstrate~'" to 'th~ •s~tisfacti'on of the ",' ,
9
"'Secretary th~t
10,'
"
,,'
,
I
"
.'
it-' is' not' cost-effe~tive iIi, the ag-"
,,'
,
'
' I
'
': "
,
'11', ,
,', gregate ,to' 'seek such, recoverj'with'Tespect to,'
12.,
:s~ch ,services furnished' t~" inili:viduals co\rered'
13
,und,~r
"
!
.
.....'
'
.
'\
~
':.'
""
"'.'
:~
,.'
, ,\
:
,
the State''plan, using, methods, specified
.
"
.
\
)
"'
i
'
14
hr, the' Secretarv which' 'may . ' , . a den}-' ,
.
..
. inchide' .
15
, onstratioIl,that such, services,are not generally ,
.
"
.
, !,
\.
<'
,
'
,
'.
,'"covered, by health insurers in the' State;~';'
16
,,,
...
,,'"
'.
,
!
, / ,/
amendments'made bv
.
, 18 this, ,seGtion )shall become, effective~h ,January 1,' 1995. "
.
17',
(b)
.
EFFECTri"E DATE'.-,The
•
!", . )
' - " "
'
,
"
'.
.
"
.
,
.'
.',
'(
/
',,19' SEC; '~505;' STATE EXPENDITURES :FOR MEDICAL ASSIST·,
20 '
ANCE
, "21
wrm: RESPECT TO B;OME ANn 'COMMlJ.
NlTY-BASED SERVICES 'PROVIDED' UNDER, A
"
' .
,1
,
"
.
I
, WAIVER.,
22
(a) I~
23,
,.1,
GE,NERAL'.-,,Section
1915(d)(5)(B) (42 ,U.S.C, '
~
24
1396n(d)(5)(B)) is'amended-" ,
,
,
,
,
,,',
'
/
I,"
.
I:
,
Septe,mber 16.1994
,
"
..
"
'
'.
(
�"
,
\
I
.STAFF DISCUSSION DRAFT .
. , O:\FAU\FAU94.631
'.
,\'
.
'
"
'\
'
(l):in clause (i), by.s~riking "times the miniber . . " .
:}
Y'
.
'~IIB~
"
i
S.L.0
J
,i
. .~f years"', and 'inserting':'compounded' annuallx Jor'
2.
3., .
,
'4'
". ',(2) in ciause (ii), b~:, striking ,iti~ies' the numbe~
i.
.
,
'
.'
•
, \
~
J.
','
~, ,i
•
6
.
"
'I
"
. ,.
,J,' ,
'vears"-and .
.1.
to
-,'
"c~mpounded
:5·· ' of years", and inserting
1
"t~':
,\
.'
, ", "
,
.
annually..for'
~
,{.
<:
'. j.
'j.
'j
. , •
"
"
7
.
,}
'I::'
.
"
,
.
;
.',:;.'
,
')
)
,
"
'
1
, .
I
J . ,
'
}
theOmnibus·Budge.tReconcili~tion Act of,19~6". ' .
:'9:.
.
,
\
"
'
'
,.
.
'"
(b)EFFECTf\"E'DATE:-'The amendments ·made • b,~' , ' ,...
, '
, ' . '
, ,
f
..
10
'.
/1 l··~ubsection .(a )shaU'be"effective as, if included i~ \:, '~mict~ ,:'
the
.
.
:."
.
,""
l'
"
"
12.- ment
.'
'
~
,
of the,6rrinibtis
,
,.'.,'
,,
:
"
. ).,
.
"
','
"
"
\
,
,
Budget,:~cbncili~tion A~t of .1987.
.:
..
.
:
'
"
,
"
'. }3' SEc.ss66.· EXTENSIONjAND CONSOIPiATION OF'FRAiL:EL-'
," "
. ,. 14
. • . 'DERLY PJl:MON.STRATIONPROJECT WAIVERS.'
.. ,
15
I
.'
.•
r"Il\HTA~IO!\;<O~' NuMi3ER:OFV\TAIVERS..~Sectio~·
(a)
or
. 16 9412(b)(i) of'th~()~busB~dget Re&mciliation Act
'; 17 1986 i~ a~ehd~dbystriking"not.more, th~m
"
.
.
15"
and
,',
,
..
',1
in- .
;
.'
)
'j 8 'serting "riot' more tha '40;."." ,.'
l1
.,'19·, ' ' •. (b) 'IXDEFI,!\ITEE}""E!\~IOK OF 'PAR TI,CIPATIO x' AND
20" S~ATu'S ~. ~ROYI~ERS.-'Se~ii~n 94'}2(b),(2) of the ~m- '.'
, , 1
•
.'
'
.2:1" ,nibU8 Budget ,Reconciliatio~ Act'.of 1986, Js anie~ded.
','
22
\,13'
,
" ',' (1) in subp~iagraph (A), by ~trlking ~'sul;)pa~a,1 '.
It,
,"
,
',',
'(2) ,i'n' ~ubparagrapli, {A}~ by adding·;at.' th~ end·
24
\
"
",
•
I
(
.. the fo1l9wing:
,
.
\
gr~ph. (B)" and, insert~ng"thi8 paragraph' \ ,
(
25
I
/,
1987"a:t;1d: inserting "the date of the' enactment 'Qf.· ':
•
"
h '
.' .... "' (3)' in . claus~'. (iv),. PY:- striking '.'Decemb~r: 2'2,
I
"
. ,"'1
'
.
,
'
' . '
) ' . : , '
'.'E~cept
"
'
as'
ot~e1'\\lse
'
"
.• ;
.J
. September. 16. 1994,
,
j
.
',
..
'
~
,
,
,
p\ovideqby lmr'· .
.
.
,
"
,:.
:
'
:,'
.
�'./'.
f,
STAFF' DIScbsSION DRAFT'
.
O:\FAU\l\AU94,631
,
S,L.C,
','
"lIIB-5
(
,
or. regulation~ such tel~l1lS~lld' coriditions; ",,;th ~e·
.
.. ,'!.
,2
I
'speet to an
"
"
or~aI~~atlbn,'&hail be"substant,ially,- equiY~'
,
.,,:
' .
"
' , '
,
.
\
'"
',','
I
,
,
'the: 'EI.~erly -cI~ACE),as published"b~' On ','Lok, Inc.
5
/
,(a~d, as' recognized by the 'Hea]thCate, Fina~cing,
.'
6 '
,
,
~ndmadt(gen-
' Administration), as of Jm1e'30, 1994,
'7
,
\'
Pro,tocol for;t11e Program ,of All-incluslv~ CaFe ,for
4
./
/
t
, alel1.t' to the terms and eonditions,pro,;ded uiider:' the '
3
!
.!,
"'"
"
,
'.'
"
....
,
,
\'
I
10
,(2J in subparagraph ,(C), by striking "ma~':'ex-:
. .
.
tenq." ,and '.inserting ,"shall, e}..'tehd,for an'irtdefinite
11
Period",' alid'
.
9
,}
. -,
:'
"
.
"
,
"
,'\
.
'.'
,
,
"
.
) (a, 'by. adding at the'end the'follo,,;ng:
\
J~'
13 "
.
\
'
'
'''(D) Upon successful completion bfthe initiaI'period
,
" 14,' o(the
,..-',
,
.
'
i
wa~,~er under ihis.sulJsecti~n, a~ organization shall ,~
" I
_ " ' , ' ,
.
,
,
,15 be afforded .regrilar pro,jcler status under, titles' A\r:In and ,
, 16' XIX of the Social SecuritY,Act in accordance "jth appro
"i
17 priate
~
,
'
!
"~~gul~tion~ ',to :be' pr~~~gated' 'by, t~e 'Secretar.\'.1 '.
"
~
".
',;
'
',".,
'
\:
,~,
'
,
.
'
" ,
, 18 ,This subparagraph shall 'apply to organizations
•
(
~
'.
op~rating.
19 un.der a waivet' on or after,July 1;)997. :' "
,
'
'
,
20
.
\ )
, ,"(E) The, provisions' of
-this
~
\
I
,
paragraphalso 'shall
i
:'.
2,1 , apply ,to theorgaruzatlon under 'the: On ~Lok' waiver de-'
•
'
•
.,.
:
,
>~,
.\
.'
'"
•
)
22" sc'ribed in subparagraph' (i\). "
&
J.'
•
.
,
\,
,"fF)Orgflnlzationsurtder this paragraph shall 'prdj ~ ,
',23 '
,$~
I
r
"
J
,
.,(',
"
"\
" 24, naril.r,"be reimbursed on a capitation basis. The organiza· ', '
,
'~,'
':"
I . . _
'
,
,,; ,
:'..
'
.
'
",
"
.
",' 25 tiops ,may 'pro'\ide adilitio~~i 'se~ices ~~, may, be,d~emed .
. . '
, '
\"',
,
'September 16~ 1994', '
,/
\.
1
.
,
(,
\'
�),
O:\FAU\FAU94'.63.i'
I
"
'
STAFF DISCUSSION DRAFT
"
.
"
.
..
.'
.
''''approp~iat'e 'by 'the 'orgal~zations 'without i~egardto wheth-, '
,
"
. ;:
.. l
'
.
',:.1
.'
,',
;:
,.
t
'
•
"
\'"
, ' ; . "
,
I·
•.
i
. .
.
,',
.
2' , er"such s~nicesa.;e specifically rei~nbur'sable. thro~gh'capi-"
. .. .
,."
"
."
,
,"
,
f,
'.
'
\
f
.
',"
.
.
'}'
'
.
,,'{c)", T~EAT)IE:\T 'OF\APPLIC:A.TIO~S:-',' Seytion'
, ,,4
"
j,
',I'
i
:
.'
)
5 " 9412(b)(1) ,'. such "Act ,is" ','amended !by" addi~g ~i"th'e ~nd ~"
of " ' , " . ' " " I : ' ' , " '
','
"
,
,
.
'
.
,';
.'
-
~
'.
.
\
. . .
'.
,
'
\
'.
,-"
,
.
. , '
"
"
.'
application for
cb~lpleted
, 6 ,the follo",ng:, "An appropriately
.
.
,
,
7" a waiver unde~ thls supsection:isdeemed app~~,~ed',~hless:' "
", \ I
,:8, \he 'Secr~t~ry ,specifically'disappr~ves it in \'~Titin'g\\ithil;
~,.
\ I,
','
,-', . '
••
\
'.
"
l
.'.
'
:'"
'.'
.'
'
•
.',
•
•
•
" , " .
, I
' : " ' , , '
", 9~' 90 days of the date,bf.itsfiling (or,"if the'Secretary re." ,
'10 quests,.rea,son~ble, and subs~antiai~d~ti"Onal',ipfOrh~ation', '.'
da~T period, \\ithin 90 days of the date of . :
'11 ""ithirt, such 90
•
(
•
•
' , '
,.
' . '
" f .
~
_
: '.
\
pro~~dinir suchadaitional jnf~rfuation): ~he ,S~cretary', '
,./ '12
,:
•
\'
t'-' .
-
,
. .
- , '
.,
•
.
l '
,s~all, ha\re ~~le,author~t~:: to ,~pp~ov~ or ,d.isappr?,re 'the ini~, ',' '
14 tial;and" s~bsequ~nt'eligibility of" an ~rganization, for ',~ ,,' ' " '
, ", 13,
1.
,.'
','
.-
'
'.
,
•
.i
. , ' .
"
.~
'.
•
"
>
'
•
•
•
.'
15 'wahrerand· shall make such, determinations in ~ a timely
:~'
"', '"
'1 6,manner.,.
I,
, .'
~.
(
I'
.""
p
,17, "
,
.1·
\'
,
,~
'I.
\
,
,
, (d) ':PRO:\10TIOX',OF
."
.
~
'.
,
.\
,
..
.AnDrrio\·~APPLlcATIOXq.;-. '
. .
'
( '
,
'.
, 18 S~Gtiori: 9412,{b) (jfsuch Act is amended by adding at the '
I,'
.,
,
\ ' "
"
" " ,19 'end'the foilo"ing:'
.
.
.~
,',' , '~(5) 'The Secretarysh~plnstit~te' an orga~i~ed'
,
'
"
"
>
\,'
' , '"
. 21 ';",'" effort' to 'pron~dte the 'deveiopment
.
. ",
.
\ , '
,
• "
'bi 'orga~zations
,
,
I
,
':
,",
,,~
'\
I
"
,,'
. ,1
,
",,l'
",'
'
"
'
,
,'",
.
'
(e) ~ROVISIO!\ OF ,ApIHTIO!\AL SERVIGES.':':':"Section
"
",21
9412(b) 6fs~chAct,
.",
,
,~s'amerid~dby's~bse~tioh (d'), is~fur-'
.....
'
'
"'.
" ,: 2.5, theramended pya.'dding at tl~~endthefollowing:
,
-,
!
,
~".' "..
'~nder thi~~ubsection.:;'. '
,22
'> 23
.'
I '
...
'
"
l
, "
'
'
,
I
,
!
to..
oj'"
,' !
September' 16, 1994,'
,
,
'9?'i
�J,
O;\FAU\FAU94.63i
STAFF DISCUSSION
"
DRAFT,"
S,L,C'.
'1IIB-7
'''''''(6) Kothing iil tIlls suhsectioil shali preyerit'an,
'.
1.
'".~
'
,
"
,,' 2
~'-',
"
"
'
orgaillzatiol1 \,ith 'a w~iver under ,tllls s~b$e,ction'
.
'
, , " " , ,'.'
:'
:
"
' ,
";
.'"
"
3
from', de~..eloping'- and: ,pro\iding apI)rop~'iate' ser\ic~~
4
to frail populations. thatmaY.'llotb~ elderly, except
,5 .'
6
pair't~e abili~y Qf ·the or~anizattol1 t? pro'ide: serv
'\.
. jces' req~ired under th~ waiver: ,',: .
.
7
.. '
.: ...
where the' Secretary fi~ds that such an e},."tension: im~·
,"I,'
,
'.'
,
i,
'
,
,
'8 SEC. 8507. CERTAIN ' IMPRovEMENTS. INMEJ)ICAID, CASE'
9
,MANA.GEMENT 'SERVICES: AND 'HOME AND
, )
10
...
,'(a) 1:\, GEXERA;L.-Secfion 1902(a) J42 U.S~C.
11
\
13
·14
r.,·
'(i)jn.paragraph (23), by inserting "(including
c~seinana~errientseni~es u~der subs~ctions. (c), (d),
,
"
I
15
i'
" ,16 '
'"
'
, ..
,j,/
,
,
(2) in paragr~ph (32)~
, " 17 .
,'(A),b~' strikingth'e "p~riod at the end pf / '
:' -18 '
,subparagraph' (G) ,a'nd inserting, ";and'\an_~,
19 ,
,
" . . . , ' .
'
,.'
..,
X!3) by adding ~t tl;1eend the,following
20
'. '.I
'
and
,
"
,
and (g) 'of.such section)" 'after, "in section' 1915"·,
,
21
.
subparag.raph:~
,"
,Zi "
~~w, .
,
"(D) in ,the case of serVIces arranged
, 'through the. case Ina~age~ent:. age~~y u~der ,
23'
,
,
"\'.
24
25
,
,subsections (c)," (d),or'(g) 'of"section 1915, pay
,
,
,
"
'
,ments made by ~the c~se, mahagement agency to '
.
September 16: ,1994
,
,
"
'
,
'
,
'
,
�'I
"
STAFF, DISCUSSION 'DRAFT
'O;\FAU\F,AU94.631 '
.
\lIIB;.;,."S" '
'",'
S,L.e..
(,
,,'
J "
,: I,
2;
,
" ,that-"
,
,
"(i;) 'th~case mailageplent eritit~·, is a
..
.
.
4
'~, n6nprofit entit~·;, ,.;',
5;
,.
,
,
:..
.:
'\ ,~.
"
3
'
"
"J
"(ii) the i 'ca'se "management, entity> ' '
,
\
'maintains a' cle~r, s~~stemor reco~ds, de~ll,,::
6
/'
" bhstra~i~g' co.nformit~·b~t\\reen; paYl,ll~nts, '
!
7
','I
~ade and,s~r\'ices, requirea ':under'.the' i~di- '
.
,..".
.
8
",
,
,
'
9'
, vidual's plano.f care; )nd ' ' ,
,."','(iii) the'en,titymakes assurarice$ , ' ,
saf
.
.
."
.
.
.
10
"
,
~
,',,-'
"
.'
. ~.
,
12
15'"
,
I,
I
I,
\
.
'j
•
'
. , ' ~. ,',',
.
'.
"
"
,..
,
'
.
,
,
I
'title;;'. ' ,."
I
.. ":.
.
.
(b)' E,FFECTT\"'E.,,:,DATE.-,The amendments .made',',b,r,
,
. ,.....
,.
16' ,
\
"
,
.,
'
.
~ :. : .
"
"
,
' "
,
,''''
,
'
,"
\
: 17,. thissectio..nshal1 apply: to' paymentsfo.r medical-assistance
)
,
.
'.
fo.r' pa~ment~~undeY; thepro.visio.ri~;' :~;( this"'" "
"
I"
.(:~
'
viduals' eligible under this tit~e, ,areeligibh~,'
"
;,}4 ,
,
','.
by the entitY, fo.r co.v¢red services to. in?l-"
"13
f
'
to, the State that prm'iders ,p'aid
,. isfactorv
1'1
"
"
'.
\,
,
"
'
.. '
,,',
"
\
"
"
,18 fo.r' calEmd~r 'q:uarters ' beginliing' <m 'o.r after J aimar:r 1,
!
'19 19~5.
..,
, '20
,
, "
"
,
SEC. 850B. DEMONSTRATION'Prr.OJECTS ON, ACUTE, AND '
'21 '
LONG-TEnMCARE.lNTEGRATION;-' CHRONIC
boo' COMMISSION. : .
22 "
,
',(
,
, " (a)P.ROJECTS At'THORIZED.-",No.tlater,than'Janu~ ,,' '
23
"
'
. ,'
"~!
. w.
'.. (\:'
\
.24,:ary'1, 1996, the' Secretary shalt begin to conductdem.,'
'.
"
" .
i '
I,
' . "
.
".
. ' .
, . ,,' 25 Qllstrati6ri p rojectl:;'funder "1hichqU:~lified entities'test'th'e , ' '
I
•
. . . •
. . . . . , . .
,',
,>'
"I'
.
",
,',
:.
: ,
'",'
'
,
,(
r,
September 16. 1994 ' ,
"
i '
,'/;,
"
. \,
.
,
�,
,
"
,
0: \:FAU \ EAU94.631
, S.L.C,"
- ,.
:
VIIIB-9 " '
1 effectiyeness"of ,:ariOus approaches'to finallcillg and'l)roo;
,
'
,
'"
'
I", "
"
.
'~
"
'..
'
,,'
,
-"
~
,'"
.
/:, I
, .....
,'.
"
~o,ng:'term;
2:. yidipg integrated acute' anp
,~
.
• ",
:' _
.' ,
,
care,' sen-lces .to,
,:3. chronically ill' indh~d~als ~uld indi~iduals "ith disabilities:'
.
.'
.
, ,'4
'
,
" , ' "
(b) DE:\10:\STRATI6~' PROJE,OTS DES.c~IBED.-'
,Dem-,
"
J' ,
,,'
"
,
,
, ,
I
.',
, '
5 onstratiori'projects·conduc~ed under .this ,section, shall es~
.
"
\"
6" tablish 'an' approach to' financing and/pro~iding iI?-tegrafed'"
,
.. "
~~
.
.' _ , " , .
..
1,.
.
t',
.,.
.,
,•
7 'acute and long:.termcare senices 'to' chronically illirtdivid-'
. .
.,
)
"
,.-'.'.
,
,
8 ' uais and individu'als with disabilities \drlch-' •
,
'
i
.
:(1) i~pro'Tes quaJity:ihrough-,
.
,,9
(:A:) managemerit . 9f o~going '~hroni'c condi-, '
.
10
"
~
i· "
, tjons :'rather' thari' treatment 'of ~~pisodes;' ,',
11
12
'.
~
14
('
.
'
I
• I,
uills furrnshing ca~~; and,
'13-
.
~the competenc~T,' of i~cii~-ld~, '
" (B) increasing
,
"
.
'
,
,
.•
'
,
.
'.'
!
,
"'1
•
(Q)' prm-lding, care 'wl)!ch produces the: best
"
15
outcomes' " " '
.'
"
,1'6
'17
"
(2)
'
18-
20
,
,
'
• (A) offering 'unified care 'overthe duratiori
','
.
,
~.
/
\ '
~f~n' ,'iy{ili~ridual's~ condition;"
.
.
, , CB).simplii)ing .access'and 'tr~nsfer: proce':'
'.
\
21,
:
dures; ~and, '
",
.\
"
22
'23
24
,
(CY permitting:'stichincllviduals'to :,partici'"
,
.
"
:
,
/'
!
.'
'"
satisfaction of' indhiduals :re-\ "
, ceiving ~~re by-''
,
,'19
iri~r~ases'the
.
~,
,
'
.
pate in, aecisionmaki~g ,, tegarding 'their 'care;
.
,
and "
,
\,
'.
:.
.
I
,
'
\1 .
,'/
,
25
(3) contains cunlUlative costs by~
I;
"
September 16, ,1994
.'
'.
'.
'
.'
"'/
'\
�,
'
,
DiscusS~ON, I>~'1;'
STAFF
,
.
"
~
:
YIIIB-IO
, ;
"}
nwna~ng eo'sts a$ an indl,;du~rs ~on-',
..
'diti<;>D. progresses;', ':, :
2
"1
.
,,'
,'\ , 4. \,'
-,'
. '
'f"
• '.1
, it.
;
,
•
.
"
.
....
.
financing" an<;l 'fost~ring; preventive '
(C)
:','
,
'J
:'
,.
healthseM1ces and; function~i' indep~nderfce;"
,.. 6 ;
;
I
,.
I" ,
'"
t~ol~nd flexibility;' '
, 5,
"
of care ,to ha,~ecQih'
"
..
~
.,
,
, '-~', ' ''(B)~llow:ing prmiders
3
I"
;,
(A)
"
<,'
"
'.
,l
7,
. .'
/
"' .,..',
"
..
'
and
,', '\'
\,
'
'
8'
" , ( D ) establl.'s,hing, financial mechanisms, for
,joint: risk-sharing> ~mor\g
9
'.
"
~',
.'.
'
, ,
'"
:
:
'
, " '~6rk 'together' to pre,~eIit,' delay, or nrinimize the'
, 11.
,
'
,j
','
'
L
'"
, ' . , " ' "
'.
'I.'
"
,,"
..
'
",
, , ,",: effects'.6fdisability' progr~s,sionand 'to'contain.
, .
.
,
12 '
,
,
'
'
'.J
13'
, , , ,Gumu1ative costs' across, time,' place, ' and' profes.:.,
"
, !
~ ; ,
"
.-,
\
,
.,.
.
' .'
"
"
.} .
,
,,' ,coIJ.tinuum of care, ,'vhich include "incentives to'
,
10
,
:.~
provid~is 'across ',the" ' "
14
:~,
'15/
,
"
sl0n.. ,
l(C)
'"-.1:.
'
APPLICATIO~S~-'Ea~h quallfied'entity:desiringto "
.
,
.;
~',
,
"
',,:
, , ,l(j :,cond~ct a,demonst~ationproject under this" section shall. '
.
'
,f7su~mitai1'appli,cati()n ,at such, time as the Secretary deter-"
,
',l'
"\
18'nrin'~s appropriate, cOlltaining-', .:- :
'(
,\
, ,19,
,
.
t,
\
('
j',
' , , \. \,' ,
<'.'
J
'
,
.'
\ ',(l)a~suraric~s'that, the acute' and long-term
"'1
20
....
:"'"
,
,'\
",21
',' , ' care.; seM1.c~s :furrushed by,the 'entity to c4r6nically ill
,
' ')
:,
'
"
22 :,
,
.
"
.. ,':23
' . "
, i~dividua'ls and individuals with'
:.
."
,
',i,
~
"
,
'
'
,
I,
disabiliti~s,~rider
, "thedemons~ratio~ project will cost less than ir-such
>'seMTj~e.~ 'were' furnished
,
'"
~
>24,' '.' than under the' dem6nstr~tion project;'and
' .
"
'
,i
'
'to "~uch' indi,Tjduals' other
.
,
,
1 •
'"
.'
."'
i:,
'
:.,'
l'
"
, !
September 16, 1994,
,
"
,
)
,
,
'.,
. .\..
. l,.'.'
,
'\
':
,''o
t,
I' '
..
/
'.
�" STAFF,DISCUSSI,ON DRAFT ",
,
,
O:\FAU\FAU94.63I'
B:L,("
'
\
\11113-11
, (2) such ,other inform~tioil as the /Secretar:" 'de~ , '
,1
2
teriliine's ,appropri!lte. '
3
,I,
,
'4,PROJECTS.-' ...
.
(1)
5.
" 6 '
.
.,
,Ntl\1BER.-,The
.'
.
'.
,not more Hum
.
, "
.
'Secretary shall ~uthorize
.
'"
29 d~monstration
.1
projects~n(ler this-:
'section. "
,
'.
Dt'RATIO~.-,A
(2)
,
<
demonstration projecturider
,.
'~
:
'\
9"
',,~his section ,shall 'be conducted fo~ a :per.-iod of '7
•10
yea~s' beginni~g on the,4ate'tlieapi)licati~n ~ol con:.
\
,
,
11 '
,
: j
duct the 'project' is apptoved.
,..
. .
,'12·
,
,
I ,
I··....
"
EYALl7ATI00' A.~D' REPOR,TS.-',The'
',(e),
.'
"
~
' .
,
_ ',-
'
<
'I
Secretary'
13. shalleyalu'ate the,demonstrationprojects conduct~d und~r
,,14 this section,and shall submitt() Gongr~ss-
, '1'5,.'
, [·17
0:
the 'dat~ on .'which the first
-
.
,
,
'
,
,
'd~mO~strati~n project begins, ,8 report .describing the
,16
"
bienni~lly 'from
,':(1)
,I
,
'
,
" status of the demonstration projects; and
"
'"
"
.
.
,
I
" .
,
'
.
,
.
-t,'
/
.
(2) rio~ :later ,than I year after, the, la~~dem-
18
': :19
'
.
•
I
'
'onstrationprojec.t iscompleted,a' final report ~valu-',',
" 20·, "'ating theeffecti~en~ssqf .thedemonst:r:ationprojects
,
'21
", and, the fe'asibility and· cost of st~Iidardizing/ the' fi.
I '
,
,
,22 \na~Ging and delivery"structures
23
,
'
.
~f the d~mon&tration " ,
,projects under' a. reform~d health care sy~tetiI. . "
..
'.
:
"
'24 "
.
Septelilber 16. 1994' ,
(
,"
,
�, ,',
, ,B,Le,
STAFF DISCUSSION DRAFT .
. "
,
"',
,',
'
,
,
Y1HB~12
."
"
,.
i"
" .' .
,.,'
,
,',
'
,
"',' .
(l)EsT+\.BLISHiIE2'\rf,.~There isestabli~hed a.
1
c
"
.
,
.
: 2.
,
' i
,.
"
. ' ,
i
,
.comnlission to;,;~e knm\ll a's 'tl~~ Chrollic .Car'e CO~li:' ..
I
,
. 3 .... .
I
•
4'"
,
f:'
'..
,"
. (2)
,
",
.'."
'.
!\lE~IBERSHIP.~'
. ' , "
; , " ,
':
'
~'
"
.' ;
\.
"
<
."
,
'5
,
,',
. ::-
: 'consist of-, :',
:'
,
,
,"
"'-.,'
,',7 .
'.(i) the, Se~retary; and, .
'.
" '8
"
10
. ,,
"(
inc'~nsultationwjththe
'by' the, President,
9
,
.: r,
:: :'
";.,
! ' "
'12·
~
13
"
.'
L"
' .,
,~
.
•
:
-
~.'
\
. '16'~·,:
'. d7
': '
:
"
,-
'
,
."
,
, "
,
.'
\
i
"..
I
,,
\
:
'
"
. . '
,
'
.'
\.
"
J:
, i:
.
;
I
,CoInmission: ,I appointed 'under,' ·suoparagra,ph,
\
'(A~(ih' shall' incl~de r~pre~entatives of~'
'.'
'.
'.'
"
.
,
'.
.'
-.' (' '
,
,
,
,
, (i) •. acute ,and ·long.,term 'c~re ,dem
,19
,
I"
(C)i:EXPERTISE.-'Tlle: ·,~~nibers'. of the
1""
'/' , 18
.. '
,
,
j.
,
;
the Chai~ or th~' Co~mission. .
'15 ,
"
•
. (B) 'CHAlR.-·The Secretan~shall ,senre as. .
""
14 '
II:
~.
1,
/ enactment,of this Act. ',,,
",.,
,
'
. n~t' later i'han'30 :days after the date of, the
,
:
,
' ,
House o( Representatives alld the: Senate~
"
.'
.J
~Iaj()ritt and :l\1iI;1ori~~" Le~9.ers' of :the' "
" "
. II, ,
',: \:
'
, " , " '{ii)10 .other members t9 be appointed.'
"•
,
"
,
\
'
, 6"
..
,
•
.mission: : " \,
,
,\
•
,
'.
onst~ation 'projects estab~sh~d und~r' this
'20'.
' s~ciion', \
','
21
':'
.
22
, (ii) ehroniGallyjl(individuals and indi>
,',viduals 'with disabilities;' ,"
23
','-
24 '
','
,
.'"~
I",
:'
~
~,
"
(iii)' health.' ca.re:"prm;ders:who<
t')
25
: i
, .furnish-' .'
',',"
1',',
, ,.
'Sept~mber 16,1994.
·'1.
'I
.':'
I
,"'
,
�:
,
I
v
'/,'
I'
•
, ",
~
"
1
, STAFF DISCUSSION DRAF;'T
O:\FAU\FAU94.631 '
,
'
"
.
,
"
"
. /
L (' ,
:'~
, .....
, ',' YIIiB~13 '
(I}prirna'ry·care serrices:' '
1
,.
\
. (III) ,institutional sen1cesjal1d
~
.;
,'(
','
!.
,
.
"
':
,
4'
5
"
. \
'
,(II) acute care :seryicesj' ,
J,
.
~",
""
.2
r
\,
,
.
, '
(iy) th~. health insurance iridustrYi·arid .
,.
6'
'
'.I
sen'lcesj
>
J
\'
\
,
grams. '
8
9
,
•
•
j
,
,shall be :apP9iIited for tpe "life of'the Conimis~, ,
10,
"
11
,
'
, " sion. ,A vacancy on: the: Comrilission shall be
'r
.
•
•
,
'.'
I
'
.,
I
:
•
.
"
•
,
. '
-',
,
I
"
,
.",
,
.
,".
'
J3) :DrTIEs.-'Not late~' than,J l1iyl, 1997, the'
,
,
'
','coIl11l:lission 'sh~ll su bruit to' Congress l~gislative" rec~, . .
.
~
,
."
,
' -
}
',18' ,,' ',: 'onunen,dations ,to simplify' andiniprpve chronic 'care"
'
,
~
'}
!.' "
-;",
"
- , '
",
.
"
"
senices, furnished 'to: chronically ill indi'idui;J.ls artd
'19"
{.:
"
I
r
'
, indhiduals' '~ith ',disabilities. s~~h 'recOJ;nm:endati'ons
20
, J
shall-,"
,21.
,
,
"
22
"
(A)
,
: :
encou~age health c~re prm~ders 't(/es-,
. . . .. .
-'
'
~ ~'
"
,
'nish chronic care: seMices
,
24:
•
I
,,'
11
' , .
.:,
,
I
'
.
to' chronicallvill indi~ "
.
,jd~als a~d ind1vidmils~'ith dlsabjlitiesj,
25
September 16; 1994 ' "
~'.
': iablish" community' based ' tletwo~ksv;:hich ',fur~'
,
::23
,
I
,
' . ,
,
16
17
•
origina:l appointment. '
15
:
.'
, , conditio,ns, ,,:hich'applied 'with re,spect to the
14
.'
" . ?
pointment'\"a~,m~de and.'shall,be'subject' to ~riJ~'
,
,
,
"
\,
; filled 'in 'the manner' ,it?: ' which the ,~rigiIt'al ,ap- "
12
'13
. ' . '
. \,
""
\
"
�,
O:\FA-U\FAU94,631
'STAFF~nISCUSSION
l, .
,iIIB~ 14
.':
,
,I
"
I
'I
': (BY result'i~ll'~ r~d~ctl()ll: in 'the ,g"l'o\'\}h of,
:"
1
S,L,C,
DRAFT
i '
, the curnulafivecosfs ~f"lfurilisl1ing, chronic, cal'e,
" '2
".1.
• ,
~:
' . '
'I'
j
' " . "
,
•
.1'
•
:.
"
f
, senices to such indhiduals across time and'set-
,: 3
I
,~4
-5
. ,.
..
,
.<
'
,
6
'~.
/
(
'.
"',
"
.
'
.
",(D) 'ldentifJ::'barri~rs, to ;integration of .
',' ,
,
.'
;.'
•
'.
,
o~!·
..' ,;.
\
'.
t
•
'
,,'
,
' .
I·
'. "
' .
'
'
.11 '
~.
"legislative, 'regulatory, and. a~ni&ttatlve 'prac
,
\12
L
••
tices; and
','
J
•
"
:a ".private
'
,
15
\ .-.
','
I
" l.'
sectOl!, commu - ,,'
,
rJty~based appr6ach" to furnishirig' chronic care
, 1-4
,,
•
:(E) pto,ide' fo~
,." ,,' 13
I"
,., ", (4') 'Cq:s,sU'L'r~~Io!~'
"
. In de\~elopmgits legislative ,recomIllendati9ns undet-,
',18
. 'paraW'aph.
....
,.
(3~):;
~\'1TH . C~~TAI~ E~TITIES:L
"
.
'the, ~ Commjssion,. '~hall ,consult' .'''ith.
...
"
\ '
,
'
'
19,
qualified epiities; participatin~' in ,the 'demonstration ; '~'"
20
proje~ts on. acute a~d long-term. c~re' i~tegI:ation'
'.
,
" .
."
" 21,," ,
.
\
.•
"
"
i<
. '
'
•
'
!
"
-
-"
,
III
,I
I'
subparagraph . (B), the Commission- shall' meet
,
25.'
'
. ' (A) I~ GE~ERAL.-.Except. as pr<niqed
"
."
~ '\
U», l\1EE~INGS.-.
23
24
" " ,
.
". c()nducted~y t~e Secretary' under tIlts section~.. ::
,,';
22
"
/
senices.to stich'individuals., '
'17
I
.~
,.
,
, 16
I
,
,
. ,." .
"\
,',
, ,
'
•
chro~c care senicesa.s- est~blished' by ,exis,ting ,
10
"::-
.'
('
"
'. ,such indhi9.ual~; ,
'~
9
,
.
""
,
.\
adplinjstra;. . '
~ t10n, ti~anci~~;: and deiiv~~~"of ~UChi seh~ces'to'
. ,""
7
8
.
"
siInplifiessy~tems'. for,
" form . which'
.
'
.
:
,I'
.
'."
, "
,
at the call'of the Chair.,
"
:
"
."
:
",
.
"
'
\
I
'
,
Septemb8r 16; 1994 ' ;'
i/
,
.,
,
,
I(JOO·
'
"
�,- ..
,""""
,,'STA.F.F" DISCUSSION, DRAFT'
O:\F,AU\FAU94.p31,
'
. , S.1:.:.C', '
, 'lIIE-:i5 ,,' .
.
...
, ,
1
, (E') :!:\ITB.L:UEETI:\G.-'~(jt later, tl~ai.l
2
days after the date 011 ;\yhich' all .merilbers of the
3
Com~nission' have been a.ppoint~d, the 'Commis~
,
.
30
'
<4
r
sion shall . its first 'meeting.
, hold
,
majorit3~ of, tIle, m~'r~~bers'
(C),, QrORF:\l.-'.A
5
'6
"
, of the, Cornrills~io~shail constitute 'a,. quorum,:'
.
.
.'.
,
\
',,'
,
.'
7
" but a lesser, u'umberof members 'nla~' hold ;'hear
8-
,"ings~
''')
9
'",
.'
. ,\
,
(6), POWER' ,OF' THE.'CO':\l:\IISSIO:\ TO, HOLD
",.I
I"
j
.,'
~.
.'
"
,
,
:ro,
HEARI:'\GS.-' The 'Co~ll1ission' nuiy ,hold such, hear~
11
,
. illgS, sit and act at such times and places, takesuch '
,.
testim6n~', ,and receive, such eYid~Jl~e as, the Commis- "
,12,
i
~
•
, . ,
• <
'
,','
13. " ,sion .co~siders advisable to carry 'out the' Imrposes of
'.-
t'
,,::.
•
..
'"
,
,-
\.
'
,.
'"
~.
.
...
tbis'subsection. '
14
, • (7) CO)fMISSIOK, PE~SOX~EL, ~1ATTERS.~,"
,15
~,
•
'
., (A),
.
16
C6MPE~SATIO~< OF, ifEMBERs.-Eacll'.
.
.
'
,
,
'18
"
of
~.-
, ,'cer or, employee .
the Federal" Government'
compen~ated
shall be:
19'
,20'
"
"member of the Qommission \\'ho is ;not anoffi-' ;,
17
ra~e
,ata.
equal to the.'
',1
, " daily, equivalent of th~ annlial rate ,of basic 'paj~ ,
'.
21
l
,
pres~rib~d for level.IV '~of the Exec,utive Sched- ' ,
~ ,
•
, \
,.,
_ .
•
1
".".
22
'," qode: for
.!
, 'uM under se,ction 5315 of ti~le5', 'Urrlted, States ,.
23
,
:~a~h d~)~ .fincluqing tr~vel ti~Il1~} ~ur~ . '
.
,
,~
',24
.is engaged' in.theper-:',
ing, ,vruch suchmember.
.
25~
.
•
.
~.
,
'
'
I
.
/'
forma:i'lCe of ·the 'duties of'the ;Con:imission.' All
,',
September 16,. 1994 , '
-
. ",
,
"
,I'
/0'0/'
�.
,
,.
,
>STAFF·
, , O;\FAU\FAU94.631
. .
. '
DISCUSSION DR..A.Fr
.
.'
,
\,
:'~IIIB-16'
.
I.
'
"'
or
, . membe~s of 'the Commissi.Oll,,:ho :are 'offIcers
,1
J,
f"
•
I
. .',employees of the'U~lit~dState,s' shall s~rre '''ith
.
.'
2
" "
. '
.', .~.
ou,t,;(tompen~ati:on' iJ~ addition t~, th~t r~ceived,
5: '
,
"
.
3
',,/
I
'
S,L.C'. '
",
United States. 'I'"
,
I,
"<
of' .
, (B) 'TRAVEL ,EXPEXSES:-,The metnbers '
, ",:"6, '
I
,the GoIIirilission 'shall be 'all,owed tra,~el, "ex-, .' :'
\ /1
'.:
•p,enses; including, p'er diem in,: lieu or' subsist
'"
i
"
'
., \ ence, at rates' authorized foiemploye~s of ageIi~
,
,
'.
"
~
'
"
',.
"
,', ':ci~sundersubchapter lof ~hapter 5'7 of title 5, "
'"
"
' , '
(,
"
"
'
United ',States, 'Code, "'hile ,away . .from' their
,.
.
:....
.
.
-"
, hdrnes :·9r regUlar, places of business In the' per:-'
\,
.
,.
,"
I
,',
_.
'.
.'
-
,,'
"
,
'
'
",
Commission~,'"
fOrlllanCe 'of services for the
I
' .• '
'
"
,
, ' . ' ,: (C),DETAIL ';, GO'~mdv1ENT' 'E~1PLOY,
OF
.,' '
.'
, . . . . , i" ' .
','EES.-'Ally F~deral, Government 'employe~, ma~~'
,
,
'
•
"
",
""
I
,
.
.•
•
'
'.:,
.!
, - :
be detailed to ,the 'Commission ,vitbout'reiin- ~,
'/
'
'bursement~
.
'-.
!
.
• . .:
,
"
,
' , '
sh~ll
'and such detail
.
,
.'
' .
'
'
,
be ·,without·
.
' \
\"
lnte~ptionor ,loss of' ciVil' .sernce status ,or'
,privilege."
{8) TER~H~ATIO?\""OF THE CO!\1l\IISSIO!\.-'The ,
"
"
Cmnnllssiori' shall termi~~te 90 days after the date
.
'
22
~"
:
\"
\
, ., .on which the' Commission submits its legislative'ree;.·', .
~,~...,"
~,
'omme~daiions ~nder paragraph (3). ' ..,.,
',
•
, "
23
I ' a,'
'/.
.
. .'
'
....
.
""
~
•
' :
.
.
\
'~
, .
'.
~
,
!.
'.
,
,.
;
.
.
oj
•
,
"
J
,
'"
,
•
;
I'
,
Septemb~r
,
\
16',1.994'
\
I. '
,
,
tOOl- '
"
�j
O~\FA.U\FAU94.631
•
•
STAFF DIS¢USSION' DRAFT
S.L.C,
VIIIB'-17 '
,
1
.,',
2
indiyiduals and' il~dh1d~al~
,,;thdis~biiities, hlclud-
'
, , " ingprimary care" hospitai, nursiilg home, and ',com-'
4
•
""
j
;,
. , " .
'muriity~bas.ed seryice~
,5
.
,<,
"
,".'
~
"
t "
\thich, satisfy the, functional,.
'"
.
"
·1
"psych~iogic~l, , ep\;~onmerital," so·~i~l,· and mecli'~al' '
•.
.
,
,
full' range 'or'incliyidmilized serTices for~hronical'ly ill
J
'3"
,
,: ,j
'the term' "clll;ohic ,care ..'serviqes n means, a
(1)
7
,
"
•
f
.
,
"
'
, needs, of 'such· in'cliyidlials and which enable' such in.,
"
.'
8'
,
,
..di:viduals "to. optimize functional,' independenc~, and
"
,
" 'well being;
9.
I
\
10
(2) the term "Commission',;' m'eans, the Chrome
,
.1,},
C~re Com~ussi6n'~~tab~shedu~~e~8ubsection (f);
12
(3)' the 'term ','chronically
..'
,
I
" ,
"
III iQdh;dl.lals" 'mea,ns,'·.
,
."
,
'.
",',
•
'
"
'
I
._
health conclitiori j ',
,
.15
~I
!
•
,
'
. ' '
..,
.'
"'indi\;d~a~',
.' ", (4) ,tl?-e,term
,,'ith ',disabilities" '
, ..
16
.' means' ali)" incli,;dual who' is :,,;thin one' or more
"
, I
17
,
-18
\"
•
'
,
"
'- "
•
of"
,.
1
s~ctipn
~303(a) ~of the Health, Refo~ 'Act; !iild'
..' \
,
.(5) '.the term "qualified en,tity",mean&' an entity',
"
' 21
:
~
•
, , graphs' (A) th,rOllgh '(D) of paragraph (,2), ',of
19'
,',
I
.' th~ categorie~ of indh;dua}s) described in subpara
,
20
meeting the
~ligibility criteria ~stablished by the Sec- '
,
\
22
.'retary;'
'23
,
(h) ArTHo~IZA+I6?\
24
(1)' AGEXCY:-'
'-
".
OF. APPROPRIATION$.-'·
,
~
'.
,
.\.
'
,'.
.
'
;"
I
J "
"
,;
"
September 16. 1994
.
"
an indi~;dual ,,;th' a serious and :persistent chro'nic
13
·14
,
,
:
"
!
/003
'.
.
,
�,
"
\
,
" " ,
"
, ),
O:\FAU\FAU94.631
."£
>
,
. ) .
.,'"1II;S~r8,
,
,
\ : . .
,STAFF DISCUSSION DRAFT
•
:,
,
'~2"
'
,
,
"
, ' .
'l""
"
,\
,
~
.
•
"
,J
"
, .• '
'.
-
,F.
I,'
"
,5
,,' '" ,,:~'
:' ~...~'." ','.
.'
">'"
'.,\
.
'.'.'
\
t'
,,'
.
t
"
•
.
""'.'
I'
.
.
•
.11 "
.
"
"
.
,~"
'
:
".I
"
I
•,"
'~"16
'
•
.'
-
~
1
••
, '
"
\
-
'.
•
'
I .
,'r
,
•
.,,'
,
.,,"
1.
,:.
,',
::
,
, 7"
I
:
,(
'
".
,
,',',
,\" , "
'
\! .
, '
. _
,.
"
-
,
,i""
;
': ,',' , ' , ,"
-'
, "
:..:'
",
'" '" ,', ;' ~" '
" "", 'I'"
~
•
"
'
"
!
~
•
~
'. ,I
f
,
•
, year for which applications to copduct demonstration '
,I.
, 18
10,
'
,
'
,,'projects under this section:,:are "approvedr'anq." for,
,,19 " ': > ":o( the,4fiscal years,'thereafter, for',. payment of
~a'ch
, (.,
"
.
,
,~
20
. ,"'
. costs ,of benefits for'\\'hich
/
•
,"
•
'.
.,',.'
.,'
•
I
'~.
no public ,or pri,\;ate 'pro-'
"
: •
~
r
.'
•
•
21 ,",,' gram 'or entityis'legallY obligatepto, pa~·. "' ,
... ~
'.::
:'
;:
. .
,."
:',
,'.
':,
,
"
;:'
.'
',,-
'
,23 '
,24
,
".: .
.
.
, ,!
iti' this' subsecti~n
under the' authoTizationseontained
"
,
"
'"
,'.~
,'.
j '
,
,: 22, ' 'c, " "",(3),,AvAILABJLIT.\~.-Ahy, sums , ~ppropriated
-
'shall remain, ~~raila:bl¢, ,without fiscal year. limitaiion, ",
:.:
,uritil1eA-pendeq.. "
"
;
'25
I
,',
'.-,1:,'
'"
. '
•
• ....:
.
, j
, ,
,
.'
-!
.-
-t
.
',/00:1
.
, September 16. 1994
.
,
, -,
','
\1,
.i,;'.',
\
"'
...
. \.
1,:
';
'~.
to,heappropriated$50;OOO,QOQ, for ,the first 'fiscal
'.'17
"
"
",'
;(2)COVEREDBEKErITs~-''There are authorized'
. J5
..
"'j
,
.','
'~~ction (f) \vith ~espect totheesta:blishme~t of:"
"
,
"
,;:
"
, ' " ,
the Co~ssioIJ". ' '
.'
"
to potential serv-'
,
-
,
_,
::;ayailable "to <~arry,outthe'purposesof sub-",
, 1'3
.:
•
' ,
~
,
.
.,
I'
qe
, "and, 1997, not less,thad,,$liOOO,OOo ,shall , " .
.
"
.
',.,'
'.
.,'
,,
, 12· '
" .
'.'
,', ',!total, amount ',authorized ',to ,be 'appropriatea
,
,
:
. ';' <J ....,,'
" .'. '" :,'under,'s~bparagraph,(A):.for fiscal ,years :i996'
~
10
••••
'.
."
,
o
: . ' .,"
"
.'
'
", .', (:8) CHRO~IC ,'CAE;Ecojl~IISSIO~<-',Of the,
-
, \ 8"
,9
•
'"ice pro,\1.ders" and research 'and evaluation': ' " ,
7·
..
,
assi~tahce,
,
"
"
,'Secretary iIi carrying 'Qut tllis se~tion;including
' t ' "
6' ' , c o s t s for, tech.nical
,
10
1
!.
",
,1991 through 2002"f
I'
,'
"
• . :-
o ,p~~71nenf of costs' of the,'
r
f
',4
f
"
ea~h: of fi~cal~'ears",
19!m;' and $4,500;000 for
t
,
,-
•
-,-,
,be appropriated $i,OOO,OOO for, fiscal year,
,3
(.
I, '
'(A) Is: GE'~ERAL.-';Th~re are autho~izedto
, ',1
,
'
,
'
.
~,
. ,
,
,
/
..
,
~.
�/
,
.c
I'
"STAPF
O:\FAU\FAU94,631"
DISCUSSION DRAFT , ' ','
....
, S:Le.'
Y1IIB-]'9
,1
SEC. 8509.' PREADMISSION SCREENING FOR' MENTALLY HE:
t
-.
.
2
TAJlPED INDIVIDUALS; ,
,(a) . 1:\ GE:\ER1.L;-Sectiol1 1919(b)(3J(F)(ii) ,(42' ~
.
,3
.
"
'
\
4 "U.S.C. ~3,96r(b)(3)(F){ii)') is amend~d 'by '~t~iking "that',""
"
'.
, 5 'because" a'n'd ,all that fOllows'through the ,period at the,
.!
,
"
.
\
:'
"
, 6' e~d and' inserting "tha:t the 'indh'idual) priIllary': ~eed'is' '
'",-
,
,7 for'me4icals,er\'ices t~at~re at the level provided by ,the , ,
,8 nurslIig'facility and that th~ nursing facility has the'ca,pa'. ~ .
,
'
.
"
"
J'
.!
,
'
I,
'
."
•
',. , ' 9" bility to' pro~ide, -i:[( addition to ~ such medicatservices, any
, 10 . specialized.' services necessary' for. habilitatio~ ,of thein~:
.
-
.
,.'
.'
',11 ,'idua).".
l
"
/'
,:
12
REQVIRE~IEXT
,(b)' STATE,
RESII?E~T
FOR A."\·Xt;AL
,
'
'~ , '13 REYIEWFOR l\IE!'TAiI;Y RETARDED RESIDE:\T.S.-'Seq
,14", tion
1919(e)(7)(B)(ii)(I) ,
U.s.c.
(42'
15 ' 1396r(e)(7)('B)(iiJ(T)). is amended to'read asfoIiows;;'
.
.
.
.
"
,
, -
",
. , ;
'
'
/;,
"(1) whether'~r not the residenfs
.'
16- "
,!'
,
"priina~r' need, taking into' account 'the
~7,',
,
"
,~.
.
I
'r~sid~nt's physical aQdm~nial condi
.IS-
•
.,'
,-
,\
\."
•.
•
j
are ,
19
tion, i~ for: medical seI"\~ces that,
20
"'at' the Jevel,proyided'by 'the nursi~g
.
.
,
,
.21
,
/'
'22
,
:24·
'25
J
'
'
,facility 'a~d ~hat the nursing facility
i'
';
"
23:
.
, "has. the capability to provide, ih addi- ,
'
• tion to such medical '~erVices, any "spe~ ,
,
,
! .
" cia~zed;, services· n,ecessary for 'habili.;"
' f
tationorthe individual; and"',
),
'
,September ,16. 1994 "
. ,,
\
'
"
.
. ..'
,(
i,
�,.:.""
.'
i
j , ' .
"
"
'.,
,
J' "
.
STAFF DISCUSSION PRAFT
c·
",
,
.
'.
,
•
I
•
~.'
•
'
,
'
"
2 IXG "FACILITY" SER'nCES, BrT
,'I'"
, "
:
).
' .
r.s.c.
(42
..
'I
'
,
(
I
-~:..
•
'
',' 6
,striking "'nur~ing facility,' but'to require" ~nd in'sert;.
',7,
, i:ng"'~nursinifacility o'r in'the' case of a,ni:p.dividual
8
\
,', o~ :resident.of ,a' nu~sirig ,facility, who, is nientalIy, re·,',
"
.
,
:. \',
'~
'\
,
,
9
'
.'"..".
"
;
,
11 ' ",:, quir~s"; ,and "
"
',-':: (~),'in 'the: matter ,following ~ubcla~se (1V\' by
14' .,
.'
... J
,
"
I ,~. ~ , i .
15
.,
'.
.
.
"
'"
.'
',t~ria' sp~cit;ied
.
,
I;
.: . . .
."
.
>
",
' , : , '
:t ,
',~
4'
.
•
-in subsection (b)(3)(F) or, subsection
:,
\"
'(e)(7){B)'(ii)(I),if;.:' "
17
.;I
' ••
'(dL OTHER RESiDEN~S NOT'REQL'IRING NL'RSI?\G
'18
,"
,"
.
facility 'who is mentalI,r retarded and meets' the cri-'
'. 16
'
'
in ,the 'case of an indlvi4ual. ,or resident of a nursi~g
" .14
. ....
';','
,striking "a ,facilit~;, if" and, inserting "a facilif:\' or
. .
"'.
13
...
"
(b}(3)(?,.) 'orstl?section" (~)(:7)(B)(in(i), , who ' r~- ,
,,10 :
,
,
~
,
,
,
,tarded and, meets the criteria' speCified, in subsection
,
,
"i
'
" ", ,(1)i~ the matter ;preceding ~ubclam~e (1),' :by '. · '
'/ ,5, '
,
.
. '/
4 139,6r(e)(7){C)(i)}is am,ended-. "
'
\
.REQrIRI~,C~ , SPECL.\LI~ED
SE~YtCE'~.-,'Sect~OIL ,,' 1919(ei(7)(C.)~i):·'
'3
"
,,'
, '(C) :LOSG~TER'JrRESIDEXTs:I\OTREQ1:IRIXG KTRS~
, , :
r.'
"
\lIIB"":20 ,,'
•
I
,
,1
I"
,
1',
'S.L.C'.
'., .
,.,,',
' '-,'
' . I' ,',
,
,'!
',,',,'
, 1,9 'FACILITY SERVICES, BUT REQUIRIKG SPEClAL~ZED SERY~
,.
.
''''.
.
,
1919(e)(7)(C)(ii)
"
',," _(42, "
I
,
"
"
'20 ICES:-"Section
,
"
,
,
U.S.C.
, 21 ,139,6r(e)('7)(C)(ii)) ,isa.mended ',in'the matter pre~eding
1
",'1
','
".
,22 ~l1:pcla~se(T); :by,'striking ""nursing facility, but.to ~eq1iire'" "
.
':
.'
'
23 and insert~ng "nursing facility or in the' case~ '~f an individ~
'"
"
j"
1
"
".<, ," ,: . ...
J
"f
:.-
",.
,"
:_',
•
'.
<
,",
~.
. ' . '"
24,ual ot:r.esideni'of a. nursirrg,.facility who is, mentally ,,~e- ,
·L
"
,
c'
. :,
"
,-,
:
,"
'\
t
•
), '~'I(fb0,' .
/'
"
I
:
'c
,
, September 16. 1994'
....
•
"
"~I
','
.
�DRAFT
STAFF DISCUSSION
O:\FAU\FAU94.631. ,
\
, \lIIB..-:21
-
'
S,LC'. '
"
I,
'
,;
" -1 tarded al1d ineets the criteria spe,cified in subsection
,,'
,
.(,
' " ,
".
,"
\'
" .
\
"
'
,
.
,
,,·ho requires".,' " '
.
"
(e) RESIDE~TS KOT HEQrIRI~G"l\rRsI\"G FAC'ILITt
\'
,3
,
"
, ' ,
'
'SE~'~CES
'4
,:
,
"
(e)(i)(B)(ii)(I)~
2 -(b)(3)(F) or subsection
','REQr~RI~G
'X-,\DN.OT
,
.
'-SPE,CULIZED--,SERY- ' ' "
'
,
,
'TT'S"C'.," ',-,
U
.
'1919(e)(7)(C)(iii.) ,',' (4~
5, ICEs.-Section/
~
,' 6 139.6r.(~)(7)(C)(iii)) i~ ameI;lded in the Illatter, preceding, '
I
•
•
•
"
r
.
'
,
,7' sQbclause(I)b~;8tr~king""mir~ing faCility ,arid no~ to_~er
•.
•
.'
~
'..
. .. '
.
~
.
I
•
.
. 8 ' qui~e~' ,~nd ':inserting ','nursing, facilit~· ,or ,in the" case of ' ,"
,
•
'
g' :a 'resident, eif ariursing 'fac~lity, whois mentallf retarded
'I
,.
,
.."
.
.
.'
I'
..... \
.',
I.: .'
'/'
.," ~ "
.
.,.
.'
,
"
\
.
'
,,10 'and meets the c;riteria specified,in subsection (b)( 3 )(F), or
.
.
•
.
.'
."
.~
'.,
.'
. -
\
I
r
'•
'.
\
• ,
:, •
•
•
•
'.
I
.:,
.
. '.
~.
. I
:
..
.
<'
"
101, .subsection'(e)(7)(B)(ii)(1), and does 'not require;'''. " '
. . . .
"
,PER?llITTIXG '.ALTER~ATIYE
,', 12 ' " ' ,{f.)
,
,DISPOSITIOX \ '
"
,
,
l:r' PLAxs.-Section,:
'.( 42' ,
',1919(,e)(7)(E)
<"
,
,
,
U.S.C.
I,
' I
'
"
", 14' 1396r(e)(7)(E)) is ~mended-, ,', ,
- ..
)
'
, " ,
.
, I
,
I.:
"
'..
~
,"
.,',
' .
~ ...........
..,
'
,.",
"
I
•
.
.
,~
-
: , ' .
'.
\'
" r
'
,
'.
•
.'
•• "
.
,
18
"
"
l
.
j
•a, nursing f~cility' who is mentally retarded meets the"
'17
I
'
, inserting, ""a, facility: ,or in ~th~ case of a resident of '
,
.'
.
.
16
ij
,
(l)by striking "a facility, ',but who requlr~~' and
15
"
"
,criteria specified" in, su,bsectioh (b) (3}(F) '.or 'sub-"
19.
,sectipn (e)(7)(B)(ii)(I),; "'ho, reqriire";and'
, "
,.!
20
.."."
,22
i
:~e'~t
• ' •
23
,
.'
.
.
the, "eriteria, of
• • • ,'
~
•
_.
•
•
s:ubs~ction'
."'
'~I.
.
'
'.'
25"
,:
\
{.
:'
(b)(3):(F),' or.
'."
'
\
,
'
,
~ub\.',
"
•
"l
'
I,.
.,
.,'..
. '
.
.
fe,cf on June. 1, 1994,' sUGh additionaL time as 'is
"
'.
.'
.
.
- '
"
"
",
.J
section, (~)P)(B)(ii)(I) as such proVisions,'were in e,f·
\
24'
'
. . '
,
'" '
"residents of a n~rsing facility' ~'ho: weIje' d~emed, t~, '
21
\
,"(2) by insertIng ''', ',except 'that'.in the case of
.
.-
?~emed ,ilecessal~yto' complete such' dl~charges but,
.
,,'
'\
.',
r
S~Ptem~er 1~.1994
,
'
'
-; ,
,
,
\
'
..
"
\'
\: '
.... '
.'
'
�STAFF ,DISCUSSION ,DRAFT ' ,
.
.
,
- - Q;\FAU\FAU94;631
"
' . ,
" S,LoC','
\
,i
'~
\,
•
I
, nof later 'Ulan June 3,0, 1998" before' the period 'at
.'
,
,,'
2""
:
'I,
I"!"··
" ,
,,',
I ,
'.
',1
'
:,,,
',"
the endbf the last sentence. ,,'
"
\
"
'
"
"
"
1·
' (g) EFFE,CTl\~' ,DATE.~The' a1l)endment made by
"3
-:,'
_,
....
,,'
• ,
J
,.
•
, . ,
'or after 'Jul~~' ,
4 :~ubsectiori (CJ.)"shall apply to 'admissions ~n
, ,
I
).'
~"
"
.'
!
.'
.,
':'
:\
"
5', 1,1995. '
'.
,
;,"
I
.
."....
..
•
\'!'
•
.
~t'
>
"
,
, ": PART ~OTImR PROViSI()NS",' .
.'.'
,
1\ j
•
':'
, 7 'SEC~' 8601~
"~
'pF
•
"
' . •
'
",.
"
~:
•
"'.
" , , ' "::
i"
I
•
•
.'
"','. .
'..
".'.
'.
',1
M
'
• •
••
j/
"
,
,
'
...
j
I
"
'
,
f
:
• •
•
~
•
•
•
.,
r.
,.
I
cl~uses (2)' and (3) ,and by inserting~fter: "except
'" ,12'
13 ,
.'
\
'." ',' _, '(1) by redesignating clau's,es (1)., 'and (2): as
, 11
,
,
,
,
\'
"
'\
.'
A1ask~ afi~ ,;Elawaii, the'
'that" the follmving:'''(i) fot
'
"'-',
,
.:,
.:
'/',.'
10 13 96d(b )) is ,amended- '
,
~
,JpERCE:NTAGE FORC~RTAINSTATES.
j
\
•
',.
.'
FEDERAL MEDI,CAL ASSISTANCE '-.,
.
,-'
•
(a), IKGE~JtRAL.-,',Section' 19Q5(b) , (42"tr.S.c.
• 9',
'j
,',
\
,
,
~SION
.
.-
:8
:
'
,
, Sta~e; pe,rce~ta~e shall ,be thCJ.~,percE;Iit~ge ,,,~~cho' '
',14·
15~, '," ,', bears the,saIl!'e ratio to ~5' per centum;asthe.squ~re
,'.."
,:> ,,' 6f' the adjusted per
,\ 16
.
.'
, ..
,',.
,
."
.
"
'.
" 17,'
.
..
. '.
'
,UIiiteQ:States;"; and
•
~
• f
,
,
.'
" ,
c~pita in~ome
, ·be'ars to the square of the per
18
St~ te',. '
capita :,' incomeo( such
'
,
~,
,
of the, .'
,,'
\
.'
"
, "
,(2) by inserting after 'the. first sentence the fol
19
1
,
,. 1o,,{ng: "rhe'taQjust~d per 'capita income', for Alaska
20'"
" I
.
i,
.'
',~'
' .. '
I,
•. "
'
~'
,j
"
' .
..., '
,,'
• ". •
'
"
'
,
'21,; ",shall'be d~t~rinlped by'diViding, the, State 3\.yearav-,'
- "*'"
-,
.'"
-'
"'.
'
, . '
..
j
\.
22, ,:' 'erageper'capit~"income by L25,'and for,I.Ia~ai,i,bY'
~' •
.•
, 23<
~,__~':
. •
,'oj
.' '
'.
,.,
:' bvl.15~".
24
,
..
I
~'.'_,
.
•
f
:-',
'.
.,.'
~
.
1
. .
' .
.
:
"
.
,
,
\'
\
"
'/
)
,I
, !
"
t.,
, ,
'I,
.,:'
i'
.'"
,September16. ,1994 "'"
•
' " ,\ "
. -r"
"
/"
;,
diViding the State,'3-year average per capita ',income'
"';
,
'"
..
:
i
'
"
,
i
"
,
.
'
�i
STAFF ",DISCtJSSI()N'DR,AfT '"
O:\FAU\FAU94.631'
, S,L,C, •
,
,
,
,
"
"-.,
,
(,
l
. r
,
".J',
r
'
(b) EFFECTf.YE DATE.-' The' amendmerits .111adeJjy
1
2 "this sectiDn :sl~all become'effectiye OIl ,October 1, 1995.,'
.
,3', ' SEC. 8602. CRITERIA FOR DETERMiNING TlIEAMOUNT OF " "
,
,
'
"
.
,,
\
t..
"
-.
".
,,
"
dO
DISALLOWANCES.'
1
: '
(
,
5
(1) CRITERIA FOR I!\ITlAL DETEK\n~ATIO:\S.-' ','
.
'.
'.
6
"
7
,
'Section 1903' (42 U.S.C. 1396b) is'amended})v add
.'
.
":
"
'
ing at the, end the"following~ne,,~ su~/s~ction: " '
8
.
, ,,9
.
."
'
"
.
, I,
/'
,
. f
'~(x) If the Secreta~~ determines thAt a, disallowance
, ,t
"
,
i
,.',
..
,~O of Federal fin~nciar "P!lrt1Cipationshoulq , be 'mad,e under,
'11., thistitie' wiili respect toaY{j· item' or 'class 'of items~ ,.' the " ' /,' , '
.~
"
.
.
,~
"
~ ,
",
.
\
'
,
,
'I:'
, J:i '_Secretar:\~ sha~,,'. in making, a' determinatioll , \\;th' respe~t ,;
"
"
.
:
, 13 to the amount of such disa1l6wance, take int6acco~nt (to'
.
.
".
',,! 14 , the ei~e'nt the 'State makes a sho\\;ng) factors\\'hich shall"
.
tI
. •
, "
r ,
.
.
.
,
'
'~
•
'I
I5includ~,
,'
'~"(1) whetn~r the, amount ofthe, disaJlowance is
,'16,
\
"
, 17
're'asonably related to the' act' or "omission by th~
,18'
'State~\Thlch is the ~a'sis' fprthe dls~llowan,~e;an(r '
"(2),"whether.,the . .
acto~ . omissloh
,.
..
, 19"
''-,
. .I
"
,
,.
J'
,
b,;
,',"
the State,
which' is, the' h~s~s for the ~ ~sallowance\\:as 'based ,on'
....
..
.20
,'.
a ,reas~nable interp~etfltion. of; Federal 'statutes,' 'Fed- '
21
,
,
,
':
. ' "
,-,
,22
.:,'
'24 '
,
".
"
, '" ,(2)
'CRITERIA'
•
,
,
,
!
-
, . ' :
"
-
'
,
,
" ,
" \the Secretary.". "
,
'<
FC)R' REbETER:.\n~ATIO~S;-·'Se~'
,
tion 1116(d),(42 'D.-S.C.
September 16. 1994'
'
'
", eraYregul~tions"o~ any written gUi4~u;lce provided;lhJ~,
~'
73
"
t'
.'
"
.
.'
,"
I
.
1316(d)}i~ arilended-"'
'.
.
.
'.'.,
'.'
'
.
"
\,'
�~:rAFF DISCUSSION DRAFT
'.0: \FAU\FAu94.6:31
.
"
"
,
'.
,
. ! .
,
"
,
,
I
S,L"C·,
,
",'
YIIIB:"'24'
I"
<. (d)'!
\
": (A) 'b~"
\,
{
"
striking
.
\
,
.'
al}d ,~ illserting
.
"',;
.
/
,
,2' ,
j'
.
'
.
\)
at the eild 'the foll~"ln.g pew,' ,
,
(B) ,byaddiilg
3
,
, 4 ' , paragraph:,
.,"
,
,
'
•
.'
,
.',
.' 1
'.""
,.,......
,,'{(2) In 'conductipg any reconside~ati011of a disallow..
.
.
'
I'
,6 ,ance 'of. FeCieral fina~~ial ~participatlon' by the' 'Secretary, ,"
':, .
'.
'.
'
•
..
i
"
",
'.'
:
•
,:
•
•
•
.,'
-
,(
"
.
'
\
'
"
,;
\
-7 uiIder ti~le~, the pepartrrtental Appeai~ Board, bf the
•
•
. ,
f
'.
/
•
" ,
'
;,
\.,
8 DepartIl)ent' of Health a~d Human 8~rvic~s (oran:other
"
','
" f ,
j.
'
,.
,~ ,ebtitjr'de~igllated by theS~cr~t~Qr);:shall, ifsuch Board
..
'
, I
,
;",
" \
!,
lQ! br, entity ~pholds the basis .for,th~ disallow~nce, determi~e
.
,
.
,r
. '
, ,":' '11 ,,'hetner the, amo:unt.or' the di~allowarl(ie, pro.perly takes '
.. .
,
~
:.
_.
,"
.'
'.'
\
.
. . ' . . , . , J '.'
£
•
12 into. account the ,factors listed in section 1903(x). If the'
;
, i
",
;,
,
,,'
'
i 3 'amount .of,thep.isallowa~ce ,does· not 'properl~'
take, iIlto., !
,,'
: 14 ",~cc9unt skch factors,' the Board, shall"adjust such' amount "
\'
•
,
'/'
'.
.'
- I
"
.,'~ 1
•
'
,.. , '
"
:':
, ,
•
')6
~,
. '
."
-c'"
'
,IS 'in accordance \\lth such factors:". ", ': , /
\
,
'
' " . i.
" '(b)'
•
.
-,
'
,.
•
\
:
>
"
'
EFFEC:T~~DATE.-"The'· ameI{dIi;ent ' made' by
. '
'
,,"
1
",I
',"-'
, J7s~b'sectiob'(a)' shall.apply 'to' disallow~~ces
,
,"
"
"
~ade afterthe
, " " ",18 'date,' of the ~en~ctment' of' this~ 'Act ,and: shall. take ,. effect
,
,
,
"
,
,
,
,
'
-
,
..
I
J 9 ',withQut re,g~r(l to~he ,promulg~tion of intplementing ~egll~ , '
,'"
"
)
,
. "20 ,hitio~s. '
• -'j
( 22,
r
'
, "
,
/
.
'\'
"
.
,TlON 4752 ,oF "OBRA-1990 (PHYSICIANS·, SERV. ' """
.'
"
",-';,
,
-..,',
'
'.
•
:
I,
,',
•
,
iCES)~ ,
,,23. '
.
,
,
, (a), Par~graph '(59) of. section '1902 (a) !, (42, U .8:0.
,24,'
25 1396a(a)), as . . " by section 4752(c)(1)(C)' ot-the Om~",
added .
,
.
~
,
,
-
(
,
~
,',
, /'
,
','
I ,
September',S, 1994' ' ': ,
10/0' '
"
�, .
""
0: \FAU\FAU~4.631
,
YIIIB-25
'
'\
I'
S,L:0,i',:
j
"
,
llibu~ Bridget Reconciliation ,Apt of'1~90' and,'as' redesig~ ,
,}
\
j
~.
,
2 nated by sectiop '13,623(a)(6)of th~ Oml1ibus BudgetRec~
,
"{
Act'ori993,: is amended by striking "sub
3 onciliatioil' .
..
,
-"
'
'
"
'4 sectiorr (y)" and insetting "s'ubsection(x)". ,
,
.
.'
,
"
i.
5 -\ ' ' : (b), Seetion1903(n(l~) ,(42 :u:S,.C.1396b(i)(12j),,'as
. '.
:.
6, inserted by"section 4752{e):of the D~nibus,Budget R~c~
.
.
,
.
.
"
, " .
~"
'~
.
l!m'O
7 ,onciliationAct"ol
,.4 , .'
- '.'
.~'
. . /
i,
.
.'
'
'.".'
/
,
\
,
"
and as ·redesignated by 'section
, .-:,
! t.
8 ' 13631(c)(3) of the Omnibp.s Blidget'Recoqciliation Act 'of
'
,."
,', 9, 1,~93;
.
",;
'is 'amended-
-,
.',
;, " '
<',
"
10
J
•
'\'
'II .
/
,
\
- to r~ad ~s follows::"
'.
\ ' "(i) 'is ':certi~ed in
12. ,
i
.
.. ' '
-i
~amily practice or'
pediatrics' by' -th~\,medjc~l. speci~lty b~ard",
' \ '
,
13
,
I.
,, 'icai
15 .
. _.'
•
.'
•
'.
;.
j
'
",'
~.'
l...
,
/
.
'
.
•
"
Specialti~s for: family practic~ 'or, pedi:'
,
19,"
21
,
'.'
',\
,r,',
",""
.I
.'
:
\_
,
,.
'. _
-..
,
•
"re~ognizedby the ,~e,ri~an' Osteopathic
i8 '"
-,
,
'. .' 'perna'trics" oy the medical' specialty board.:
,1'7:·
.2()-
.
"atrics"oris:certified in general practice p'r"
I
.
.)
'.
'.
i'
f
,",'
,',
';"
-'
,
Assqciation,"; "
'"
,
{2} byamendiri'gclause (i) ~f s~b:paragraph (B): ,
-to read' as f~llows:
, j
" •"(i) 'jscertified :,in fanilly practice,:,or ','
22
,it
"
, , obstetrics' bJ~, the 'hlecllcar "spe~ialt)T board
'23
"
)
I
,:
l
,
"
1,\
,
"
,I
, ,
,
tecogrPzed by the Affierican -Board of~led~',
,14' "
16
"
'
'\
'r~cognizedby the AmericariBoard,ofMed~ ,.
24
"
/
, :ical spec~aitles for' famil)? ,practice '~r ob~ ,
,,25,
,
,
,
,,:.'
.
"
\
,1..
September 16, 1994
,
"
,I
'/61/
"
'
�STAFF DISCUSSION -DR.A.FT·
.,
,~,
.'
.' .....
,
',ow
" .
',' S.11.C'.'
.
,
,
\
'
. ';.
····stetrics l,ot' is certified in· ,general .practice o~> ,
1
•
. 2 " \:::',
':'"
.'
';d
>
J
,(
•
'
i
"
,
,..'9'
{ '
'-
•
" , " ,
'
'F
.l.,
.
"
'
. 1\
!',
, .!
~
'..
"
'
. ' .
,
•••
,,'
,.'
",,'
,"
<.'
'.
./
.
,
..:
:
,j
.,
"
~
.
,,
~.
'
\
•
l
., .
'..
"
12' .-'.,:'~) ~~- j~.
.{ ..'.~~:~. ,~:~ ,';',
,
\
, "
'
'
. '.
"
~
'
,.
. . ;".'
•
'
,
"
'J
,\, H(yi),· delivers su'chsenices 'in the.'
,
" K~l;;:ticipating in
,
<
TECHNICAL
'J ,'; ,
~
I
,
,
,
,",'
.
•
,"
:.
,
'
\
,
.COruimCTIbN'RE~TING
".
"
"
"
'.'
-{
T9"
,
'
,.
S~C.
(coMM"liNrrY SUP."
..
-
'," . "TION: 4712 OF' OBRA-1990
1
~,
l,.
•
'f
...
the,.St~teplan ap~roved 'unde~
: this '~itle, or" ~' ,"
'", . 16'·:TsEcr:a:6104:
, ."
•
.
,
."
,
I,
,
'.j
,
".
. 1'7"("
.
'
',' ... (C) by inse,rtin'g after claus,e'(v} the' .fonol"~\ .
,
1.5. '
I·
'.
,"
""
,-'
\;'
'
' ., ,18 :" .',
td
,I' .':. ' . '
PORTED ,LiVING' .AlmANGEMENTS SERVICES).
\
'.
•
I'
_ • "f
~.
":.,"'."
.
"
'_ '.
,_
-
•
'
'.
\'1
• .
" ,
,
,\
,',
"
"
I.
. Section 193Q(j) .(42 U.RC. '1396ri(j)).isamem;led by
''}9'.
",
'-
'.'
,
,
.
' .
' .
.
, I .
'
~Oflstrikihg"~fo.r tl:scaJ~year 1995'" and all that. follows a'nd
"
j'
' .
. ' . '.
:
"'.
,\
,:-
-'
-
','
"
,',
"
..
21 . iri~ert' ~'aiid for,:fiscal year' 1995; '$35,000,0:00."., ./.
.
.
.'
,
.;
,
'.
,
}.
. '.'
(
e.
•
),
" ,
-.,'
,',
"
I,
•
"
I~ GE~ERAL.-Section,
, (a)
.
. '
I
\.
507', of the Family Sup·'
,. _
. , : : ,.'
1 "
,
' .. 25 :portAct ~f 1988 (Public~aw~;IOO-485),. ,asamerided by
i
"~e~le~b~r 16; 1~94
-, ":-,'
I
\"
.... '
\
'
/,
'
./ .
,~
.
,',
\
•
.
,~..
.
\
,
. DEMONSTRATION PROJECT. '
24
,'.\
,
'
.
.,
.
';
,
SEC.8605~ EXTENSION OF MlNNESOTAPREPAq) MEDI~AID'.
22
'j
.
~'./
:)
. " .
,
t
'
."
;. ·13 . !:.~i;' <'2' :: . ~ . emergency department: of a', hospital .par~
'"
',
\
. .
,
'"
I
'.
' .
{I ~(i. J>,,·,:':ing new ' cla'use:.
,
.•
.
,
,
'
. .. ("i)j,and
. 'I 0 ,..:."
.
.
:
");I.',~(:B)i b~~ ~edt~signating el,anse.. (vi) ,as claus~',
'"
:
, J. "::
.
,
...
( )'.
.
", 8
\-
!
. ;(3lin! s~bparagr:~phs (A) ~nd,.{B)-·, .,
'7
'.
• 1 .'
-
-~
..
.
• • • • •
. Association,"; -:alld. . .
4
5
.
'
.:recognized. ,'b:' ,the . Al)1erlc~l}' Osteopatillc '
.
~;r( ".
\
'.
.,
obstetri~s; b~·tl?e'~Iedic~1 '8pecialt~: ;Bbarq. . .' . '
.
'.'
"
/.
"'/
.
,
".
!
,
"
"
I,
I
'\
'
". ~ ~- .. /
'F'
•
·Ia/~'
",
'
.
�STAFF
0: \FAU\FAU94.631
riisCUSS](:>N :DRAFT
Y1IIB-2·j· ~..'.
sectio'n 6411 (j) of the Omnibus Budget Heconciliation .Act
~
2 of 1989 and by section 4733 of thEi Omnibus Budget Ree
3 onciliation Act of 1990,
IS
amended by strikirig
"199G~)
4 . and inserting" 1998".
5
6
(b) ACTHORITY To ll\IPOSEPRE-l\IIC.:\I.
(1)
1:\
GE:\ERAl.J.-·Notwithstanding
section
7
1916 of the Social Security Act and subject to pat'u
8
graph (2), the State of Mirmes:otaihay impose a pre-'
9
mium on individuals receiving medical assistance',
10
under the :M1nne80ta Prepaid Demonstration Project
11
operated under a waiver granted by the. Secretary of·
,12
'13
\
.
Health and Human Services under section 1115(a)' ,:
of the Social Security Act and other indi\;duals eligi
.14
bie under the State's plan for nledical assistance
'15
under title XIX of such Act.
16
• i
(2) LDIITATIOX 0:\ AJI0C:\T OF.
PRE:\nrM';~In:'!,
.17
no case may the amount of any premium imposed on
18
an inclividual receidng medical assistance under the
State plan or under the Demonstration Project de
.percept~-of· the
.20
scribed ill paragraph (1)' exceed·' TO
. 21
amount by which the family income (less e}..-penses
22
for the care of a dependent child) of the individual
; 23
exceeds 110 percent of the income official poverty
: 24
line (as defined by ·the Office of Management and
25
Septembor 16. 1994
Budget, and re,;sed annually in accordance 'with sec- .
�STAFF DISCUSSION DRAFT
\FAU\FAU94.631
\lIIB-28
tion 673(2) of the Omnibus Budget Reconciliation,
2
Act of 1981) applicable to a family of the size in
3
yol'\'ed.
4 . SEC. 8606. EXTENSION OF MORATORlUM ON TREATMENT
5
OF CERTAIN FACILITIES AS INSTITUTIONS
6
FOR MENTAL DISEASES.
7
Section 6408(a)(3) of the Omnibus Budget Reeoncili
8 atiop ..Act of 1989, as amended b~' section 13642 of the
:g Omnibus Budget Reconciliation Act of 1993, is amended
10 by striking "December 31, 1995" and inserting "the year
11 described itl section 1923(h)(2) of the Social Security
12 Act".
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Chris Jennings - Health Securities Act
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Chris Jennings
Health Securities Act
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36173" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/647904" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
The Health Security Act (HSA) was an effort by the Clinton Administration to provide universal health care in the form of a comprehensive national health care bill which emphasized managed care and called for the creation of regional health care alliances. This series contains material which provides a detailed analysis of the Health Security Act. A chronological subseries within this file focuses on legislative strategies to enact the HSA, as well as efforts on the part of the Clinton Administration and its supporters to counter intense opposition to the legislation from opponents in Congress and powerful interest groups. This file also contains material which examines in detail the alternatives to the Health Security Act, particularly single-payer plans and a compromise proposal from a bipartisan group of moderates in Congress called the Mainstream Coalition. This series contains memoranda, correspondence, reports, press releases, briefing papers, statistical data, graphs, legislative drafts, publications, and news clippings related to the Health Security Act.
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
Clinton Presidential Library & Museum
Extent
The size or duration of the resource.
293 folders in 16 boxes
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Mainstream [Bill Draft] [10]
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Chris Jennings
Health Securities Act
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 34
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/Systematic/JenningsHSA.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/647904" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Publisher
An entity responsible for making the resource available
Clinton Presidential Library & Museum
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
10/26/2011
Source
A related resource from which the described resource is derived
647904-mainstream-bill-draft-10.pdf
647904