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201 records in US in 1999
United States · United States Congress · 16 September 1999
Small Rural Provider Act of 1999 - Amends title XVIII (Medicare) of the Social Security Act to exclude small rural providers from the prospective payment system (PPS) for hospital outpatient department services. Makes this Act retroactive to the enactment of the Balanced Budget Act of 1997.
United States · United States Congress · 15 September 1999
Medical Privacy in the Age of New Technologies Act of 1999 - Defines "health information trustee" (HIT) to mean a person or entity that creates, receives, obtains, maintains, uses, or transmits protected health information (PHI) and any employee, agent, or contractor of such a person. Title I: Individuals' Rights - Subtitle A: Review of Protected Health Information by Subjects of the Information - Requires a HIT to permit an individual who is the subject of PHI to inspect and copy the information, subject to cost reimbursement and exceptions. Subtitle B: Establishment of Safeguards - Requires a HIT to maintain: (1) administrative, technical, and physical confidentiality and accuracy safeguards; and (2) a record of any PHI disclosure not related to treatment. Prohibits HIT retaliation for actions under this Act. Title II: Restrictions on Use and Disclosure - Prohibits disclosures except: (1) as allowed under this title; (2) as compatible with the purposes for which the information was obtained or for the specific purpose for which an individual authorized disclosure; and (3) in the minimum amount necessary to accomplish the disclosure's purpose. (Sec. 202) Regulates disclosure authorizations, the disclosure of nonidentifiable information, and the creation of coded information. (Sec. 205) Specifies the criteria for disclosure: (1) to an individual's next of kin; (2) regarding directory information to any person; (3) in emergencies placing the information subject or another individual at serious risk; (4) to a health oversight agency; (5) to an accrediting body; (6) by a health care provider to a public health authority; (7) by a HIT to a health researcher; (8) by specified entities in connection with certain judicial and administrative proceedings; (9) by specified entities pursuant to a subpoena; and (10) by specified entities regarding subpoenas and warrants. Title III: Sanctions - Subtitle A: Civil Sanctions - Establishes a civil penalty for material failure to comply with this Act. Provides, if the violations have occurred with such frequency as to constitute a general business practice, for a higher civil penalty or exclusion from Medicare and Medicaid (titles XVIII and XIX of the Social Security Act) or any other federally funded health care programs. (Sec. 302) Allows an individual aggrieved by a violation of this Act to bring a civil action for preliminary and equitable relief, actual or liquidated damages, and punitive damages. Allows assessment of attorney's fees. Subtitle B: Criminal Sanctions - Provides for criminal fines, imprisonment, or exclusion from Medicare, Medicaid, or any other federally funded health care program (or some combination of those penalties) for violations of this Act or this title. Title IV: Miscellaneous - Provides for: (1) the promulgation of regulations (and establishment of a related advisory group); and (2) the relationship of this Act to other laws.
United States · United States Congress · 15 September 1999
Medicare Vision Rehabilitation Coverage Act of 1999 - Amends title XVIII (Medicare) of the Social Security Act to provide for coverage of vision rehabilitation services under the Medicare program.
United States · United States Congress · 14 September 1999
Health Care Preservation Act of 1999 - Title I: Teaching Hospitals - Amends title XVIII (Medicare) of the Social Security Act (SSA) with respect to the following: (1) termination of multiyear reduction of indirect graduate medical education payments; and (2) exclusion of nursing and allied health education costs in calculating payments to Medicare+Choice organizations under Medicare part C. Title II: Rural Hospitals - Amends SSA title XVIII to: (1) revise the criteria for designation as a critical access hospital under provisions for the Medicare rural hospital flexibility program; (2) provide authority under Medicare part B (Supplementary Medical Insurance) provisions for payment of benefits for the establishment of a prospective payment system (PPS) for rural health clinic services; (3) require consideration of rural issues in establishing the fee schedule for ambulance services under Medicare part B; and (4) set the applicable percentage at 100 percent with respect to covered outpatient department (OPD) services furnished during a transition year in a rural hospital pursuant to the provisions below in title IV of this Act that provide for a multiyear transition to the PPS for hospital OPD services under Medicare part B. Title III: Safety Net Providers - Amends SSA title XIX (Medicaid) to establish a new PPS for federally-qualified health centers and rural health clinics under Medicaid. (Sec. 302) Amends SSA title XVIII to: (1) provide for the removal of payments attributable to disproportionate share (DSH) payments from calculation of adjusted average per capita cost in determining payments to Medicare+Choice organizations; (2) provide additional payments for managed care enrollees under Medicare part D (Miscellaneous) provisions for payment to hospitals for inpatient hospital services; and (3) place a limitation on the reduction of payments to DSH hospitals. Title IV: Other Hospital Provisions - Amends SSA title XVIII to provide for: (1) delay of the financial limitation on rehabilitation services under Medicare part B provisions for the payment of benefits; and (2) multiyear transition to the PPS for hospital OPD services under Medicare part B. Title V: Skilled Nursing Facilities - Directs the Secretary of Health and Human Services (HHS), for purposes of applying the formula under the PPS for determining the amount of payment for the costs of covered skilled nursing facility (SNF) services provided on or after a certain time period, to increase the adjusted Federal per diem rate under such PPS for services provided to any individual in a RUG III category by the applicable payment add-on determined in accordance with an outlined table. (Sec. 502) Excludes ambulance services furnished to an individual in conjunction with a renal dialysis service, and prosthetic and orthotic devices from the PPS for SNFs. (Sec. 503) Directs the Secretary to: (1) cover under extended care services provisions of Medicare part A (Hospital Insurance) individuals with a condition classifiable within a specified diagnosis-related group; (2) study and report to Congress on extended care services provided in SNFs for which coverage is provided under the Medicare select program; (3) establish certain extended care services demonstration programs; (4) require the application of any deductibles and coinsurance under Medicare part A upon waiver of the three day hospitalization stay requirement and beginning with the first day of extended care services in a SNF; (5) reduce the amount of any deductible or coinsurance applied based on certain criteria; and (6) reduce amounts otherwise payable under Medicare part A for post-hospital extended care services under specified conditions. Provides that in the case of an individual eligible for Medicaid nursing facility service assistance, Medicaid shall apply as if this title had not been enacted. (Sec. 504) Authorizes the extension of certain Medicare community nursing organization demonstration projects under the Omnibus Budget Reconciliation Act of 1987. Title VI: Cost-Efficient Home Health Providers - Amends the Balanced Budget Act of 1997 (BBA '97), as amended by the Tax and Trade Relief Extension Act of 1998, to delay for an additional year the contingency reduction scheduled under BBA '97 with regard to payment for home health services. (Sec. 602) Amends SSA title XVIII to eliminate the 15-minute reporting requirement under the PPS for home health services with regard to the length of time of the service visit. (Sec. 603) Outlines provisions for recoupment by the Secretary of overpayments to home health agencies for certain home health services. (Sec. 604) Amends SSA title XVIII to provide for an increase in the per visit cost limit with respect to payment for services furnished by home health agencies. Title VII: Medicare+Choice and Medigap Protections for Seniors and the Disabled - Amends SSA title XVIII to provide for: (1) a two year (currently, one year) period during which an individual may be enrolled in a Medicare+Choice plan under Medicare part C and then terminate such enrollment for enrollment in a Medicare supplemental (Medigap) policy; (2) modification of coverage enrollment periods for such plans and policies with regard to individual notification of plan or policy termination; (3) guaranteed issuance of certain Medigap policies in cases of a substantial change in benefits under a Medicare+Choice plan, of certain Medigap policies to disabled Medicare+Choice disenrollees, and of the same Medigap benefit package for certain Medicare+Choice disenrollees; and (4) prohibition of attained-age rating of premiums for Medigap policies. Title VIII: Medicare Preservation through Fraud Prevention - Amends SSA title XVIII to provide for: (1) site inspections for suppliers of durable medical equipment (DME), community mental health centers, and other provider groups as determined by the Secretary; (2) background checks on applicants for provider numbers; and (3) registration of billing agencies and individuals. (Sec. 803) Amends SSA title XI to provide for exclusion of applicable persons from participation in Federal health care programs if such a person submitted a fraudulent claim for reimbursement under Medicare. Provides for: (1) expanded access to the database maintained through the national health care fraud and abuse data collection program; and (2) a criminal penalty for misuse of database information. (Sec. 804) Amends SSA title XVIII to make Medicare carriers and fiscal intermediaries liable for claims submitted by excluded providers. (Sec. 805) Revises Medicare provisions on community mental health centers. (Sec. 806) Amends SSA title XI to: (1) limit the discharge of debts in bankruptcy proceedings in cases where a health care provider or a supplier engages in fraudulent activity; and (2) impose a criminal penalty for the selling or distribution of two or more Medicare or Medicaid beneficiary identification or provider numbers. (Sec. 808) Amends the Federal criminal code to provide for the treatment of certain SSA crimes as Federal health care offenses. (Sec. 809) Authorizes any criminal investigator of the HHS' Inspector General's (IG's) Office, upon designation, to execute a variety of specified duties, including obtaining and executing any warrant or other process issued under the authority of the United States, while engaged in activities within the lawful jurisdiction of the IG. Provides that the HHS IG may receive and expend funds that represent the equitable share from the forfeiture of property in investigations in which the HHS IG participated, and that are transferred to the HHS IG by the Departments of Justice or the Treasury or the U.S. Postal Service. Requires such equitable sharing funds to be deposited in a separate account and to remain available until expended. (Sec. 810) Outlines requirements for universal product numbers (UPN's, or bar codes) on claims forms for Medicare reimbursement of any UPN covered item. Authorizes appropriations.
United States · United States Congress · 14 September 1999
Seniors' Health Care Freedom Act of 1999 - Amends title XVIII (Medicare) of the Social Security Act with regard to the use of private contracts by Medicare beneficiaries to eliminate the requirement that non-Medicare physicians and practitioners file affidavits pledging they will not file any Medicare claims for two years with respect to the Medicare beneficiaries with whom they contract.
United States · United States Congress · 14 September 1999
Amends title XIX (Medicaid) of the Social Security Act to require the prorating of Medicaid beneficiary contributions in the case of partial coverage of nursing facility services during a month.
United States · United States Congress · 14 September 1999
Older Americans Amendments of 1999 - Revises the Older Americans Act of 1965 in toto. Older Americans Act of 1999 - Retains the Administration on Aging in the Office of the Secretary of Health and Human Services, as well as the Assistant Secretary for Aging. Directs the Assistant Secretary to establish: (1) an Office on Native Americans (currently, the Office for American Indian, Alaskan Native, and Native Hawaiian Programs) and (2) an office of long-term care ombudsman programs (currently, the Office of Long-term Care Ombudsman Programs). (Sec. 3) Directs the Assistant Secretary to designate individuals with pertinent expertise who shall be responsible for administration of: (1) grants for Native American programs on aging; (2) Federal activities relating to State long-term care ombudsman programs; and (3) nutrition services. Revises the duties of the Assistant Secretary. Directs the Assistant Secretary to: (1) make education and training grants to institutions of higher education, historically Black colleges or universities, Hispanic Centers of Excellence in Applied Gerontology, and other educational institutions that serve the needs of minority students, to prepare students for careers in the field of aging; (2) establish and carry out pension rights demonstration projects; and (3) make grants to eligible public agencies and nonprofit private organizations for health care service demonstration projects through multipurpose senior centers in rural areas. Authorizes the Assistant Secretary or the Secretary of Labor, as the case may be, to bar recipients from receiving grants under this Act for a maximum five-year period for misuse of such funds. Repeals the specific mandate for the Assistant Secretary to engage in certain activities with respect to policy alternatives for long-term care. Eliminates the National Center on Elder Abuse, the National Aging Information Center, and the Federal Council on the Aging. Authorizes appropriations. Revises and consolidates programs of grants to Native Americans, Alaskan Natives, and Native Hawaiians for the delivery costs of supportive and nutrition services. Prescribes the distribution of funds among the appropriate organizations. Retains the Secretary of the Interior's authority, acting through the Bureau of Indian Affairs, to make surplus educational facilities available for multipurpose senior centers. Authorizes appropriations. Revises the programs of grants for State and community programs on aging. Prescribes the allotment of funds for supportive services, multipurpose senior centers, and nutrition and family care giver services, including additional funds for State long-term care ombudsman programs and for services for the prevention and remediation of elder abuse, neglect, and exploitation. Requires State and area plans to provide an opportunity for older individuals to contribute voluntarily to the cost of services. Expands the scope of such services to include: (1) home delivered nutrition services; (2) disaster relief reimbursements to grant recipients; (3) grants for authorized programs for disease prevention and health promotion services; and (4) family caregiver programs. Retains basic existing requirements for such grants, services, and centers. Eliminates certain rights relating to in-home services for frail older individuals. Repeals authority for: (1) school-based meals for volunteer older individuals and multigenerational programs; (2) specified in-home services for frail older individuals; (3) additional assistance for the special needs of older individuals; (4) specified disease prevention and health promotion services; (5) supportive activities for caretakers who provide in-home services for frail older individuals; (6) specified research; (7) numerous specified demonstration projects, including those concerning ombudsman and advocacy, housing, and pension rights; and (8) numerous specified grant programs, including the neighborhood senior care program, Resource Centers for Native American Elders, and career preparation for the field of aging. Authorizes appropriations. Revises requirements for State long-term care ombudsman programs. Repeals the mandate that a State agency establish an Office of the State Long-Term Care Ombudsman. Requires the State agency to perform the functions of such Office directly, or contract them out to a public agency or nonprofit private organization. Continues the current mandate for State programs for the prevention and remediation of elder abuse, neglect, and exploitation; but repeals all specific requirements except those relating to whistleblower immunity, record confidentiality, training, and the prohibition against involuntary participation by alleged victims, abusers, or members of their households. Repeals mandates for State programs for: (1) development of legal and advocacy assistance as a means for ensuring a comprehensive elder rights system; and (2) outreach, counseling, and assistance for insurance and public benefits. Authorizes appropriations for State long-term care ombudsman programs and programs for the prevention and remediation of elder abuse, neglect, and exploitation. Older American Community Service Employment Act of 1999 - Replaces the current authority of the Secretary of Labor to establish an older American community service employment program with a mandate to make competitive grants to States and public and nonprofit private organizations to provide unemployed low-income older individuals, with otherwise poor employment prospects, employment opportunities in providing community services. Revises grant and employment project requirements. Provides for allotments and reservation of funds for such grants. Requires the Secretary of Labor to: (1) establish objective performance standards for projects; and (2) contract with nongovernmental entities to makes independent evaluations of grant recipient performance. Authorizes appropriations.
United States · United States Congress · 13 September 1999
Children's Asthma Relief Act of 1999 - Amends title V (Maternal and Child Health Services) of the Social Security Act (SSA) to establish an asthma treatment grants program providing comprehensive asthma services for children and other individuals. Authorizes appropriations. Directs the Secretary of Health and Human Services to encourage States to implement plans to carry out activities to assist children with respect to asthma in accordance with the guidelines of the National Asthma Education and Prevention Program and the National Heart, Lung, and Blood Institute (Institute). Provides that if a State CHIP plan under SSA title XXI (Children's Health Insurance) (CHIP) provides for such activities to the Secretary's satisfaction, the Secretary shall make a grant to assist the State in carrying them out. Sets forth certain matching funds requirements. Authorizes appropriations. Amends the Public Health Service Act to include, within the preventive health and health services block grant, any systems for reducing asthma and asthma-related illnesses, especially with regard to children, through urban cockroach pest management in public facilities that minimizes or avoids chemical pesticides through a combination of appropriate practices involving the maintenance, cleaning, and monitoring of such sites. Directs the Institute Director to: (1) identify all Federal programs carrying out asthma-related activities; (2) develop a Federal plan for responding to asthma; and (3) submit recommendations to Congress on ways to strengthen and improve the coordination of such activities. Authorizes appropriations. Requires the Director of the Centers for Disease Control and Prevention to: (1) conduct local asthma surveillance activities to collect data on the prevalence and severity of asthma and the quality of asthma management; and (2) compile and publish annually data on the prevalence of children suffering from asthma in each State, and the childhood mortality rate associated with asthma nationally and in each State.
United States · United States Congress · 10 September 1999
Fairness in Medicare Home Health Access Act of 1999 - Amends title XVIII (Medicare) of the Social Security Act (SSA) with respect to the reasonable cost of services furnished by home health agencies to: (1) require the Secretary of Health and Human Services, under specified conditions, to pay the provider of such services additional, limited payments notwithstanding per beneficiary limits for outliers; and (2) increase the per visit cost limit. Amends the Balanced Budget Act of 1997 to eliminate the 15 percent home health services payment reduction in interim payments which would occur if the Secretary did not establish a prospective payment system (PPS) for such services as provided for in such Act. Amends SSA title XVIII with regard to the PPS for home health services to reduce the current 15 percent reduction in cost and per beneficiary limits to ten percent, establishing a special rule beginning in FY 2004 that restores the reduction back to its original 15 percent. Increases the per visit cost limit to 112 percent of the national median. Provides that in the case of home health services furnished to an individual who (at the time of furnishing) is under a home health agency plan of care, payment for an item of durable medical equipment shall be made to the agency separately from payment for other items and services furnished. Eliminates timekeeping requirements under the PPS for home health agencies. Expresses the sense of the Senate that the Secretary should establish a nationally uniform process that ensures that fiscal intermediaries and carriers under Medicare have the training and ability necessary to provide timely, accurate, and consistent coverage and payment information to each home health agency and to each individual eligible to have payment made under Medicare.
United States · United States Congress · 9 September 1999
Requires the Secretary of Health and Human Services to carry out an independent assessment of the effects of radio frequency emission on human health through grants to appropriate public and private entities. Authorizes appropriations. Directs the Secretary to report to Congress no later than January 1, 2001, on existing research evaluating the biological effects to human health of short term, high-level, as well as long-term, low-level exposures to such emissions.
United States · United States Congress · 9 September 1999
Emergency Medical Services Efficiency Act of 1999 - Title I: Medicare Coverage of Certain Ambulance Services - Amends title XVIII (Medicare) of the Social Security Act to ensure Medicare reimbursement for ambulance services rendered because of the sudden onset of a medical condition manifested by symptoms believed to be serious but whose ultimate diagnosis results in the conclusion that the ambulance services were not necessary. Title II: State Emergency Medical Services Agency Participation in Certain Federal Programs - Amends the Food, Agriculture, Conservation, and Trade Act of 1990 to include State emergency medical services agencies among the entities eligible for financial assistance with regard to telemedicine and distance learning services in rural areas. Amends the Balanced Budget Act of 1997 to allow a State emergency medical services agency to participate in the Informatics, Telemedicine, and Education Demonstration Project as part of an eligible health care provider telemedicine network (consortium). Title III: Federal Commission for Emergency Ambulance Services - Establishes the Federal Commission for Emergency Ambulance Services to study and report to the President and Congress on all matters relating to emergency ambulance services, including any existing or proposed Federal department or agency rules that impact such services, together with recommendations for improving such matters. Provides for Commission funding. Title IV: Study and Report Regarding Consolidation of Federal Authority Over Emergency Medical Services - Directs the Comptroller General to study and report to the President and Congress on the consolidation of Federal authority over emergency medical services in a single Federal agency, together with appropriate recommendations.
United States · United States Congress · 9 September 1999
Amends title XIX (Medicaid) of the Social Security Act to prohibit Medicaid payments to States with approved State Medicaid plans for amounts expended for medical transportation services (other than emergency services) where the contractor has failed to assure the Secretary of Health and Human Services that it has satisfactory arrangements to assure that: (1) any driver providing such services has undergone a criminal background check; and (2) any individual convicted of a felony involving violence or the use, distribution, or manufacture of alcohol or drugs is not an eligible provider.
United States · United States Congress · 9 September 1999
Health Care Quality and Choice Act of 1999 - Title I: Improving Managed Care - Subtitle A: Grievances and Appeals - Requires a group health plan, and a health insurance issuer that provides health insurance coverage, to conduct utilization review activities that monitor or evaluate the use or coverage, clinical necessity, appropriateness, efficacy, or efficiency of health care services, procedures, or settings. (Sec. 102) Requires a plan and an issuer to provide appropriate notices to the participant, beneficiary, or enrollee for benefit claims it has denied that include reasons for denial and instructions for initiating specified internal appeals procedures, which must include procedures for an expedited review process in emergency situations. (Sec. 103) Outlines external appeals procedures for the timely resolution of certain denied claims through the use of qualified external appeal entities, which shall determine whether the plan's or issuer's decision is in accordance with the patient's medical needs. Declares that an external appeal entity's determination is binding on the plan and issuer involved. Provides for court-imposed civil monetary penalties and cease and desist orders against authorized officials of plan or issuers who refuse to timely follow the determination of an external appeal entity to provide a benefit. (Sec. 104) Requires a plan and an issuer to establish a system featuring specified components for the presentation and resolution of grievances brought by participants, beneficiaries, or enrollees, or health care providers or other individuals acting on behalf of an individual either with the individual's consent or without it if the individual is medically unable to provide it. Declares that grievances are not subject to appeal under this subtitle. Subtitle B: Access to Care - Provides that if an issuer offers coverage of services only if they are furnished through members of a network of health care professionals and providers contracting with the issuer, the issuer shall also offer the option of coverage of such services which are not furnished through members of such a network, unless enrollees are offered such non-network coverage through another health insurance issuer. Makes the enrollee bear the cost of any additional premium the issuer charges for such option, and the amount of any additional cost sharing, unless it is paid by the health plan sponsor through agreement with the issuer. (Sec. 112) States that if a plan or an issuer requires or provides for designation of a participating primary care provider by a participant, a beneficiary, or an enrollee, then the plan or issuer shall permit each such person to designate any participating primary care provider available to accept such individual. Requires a plan and an issuer to permit each participant, beneficiary, or enrollee to receive medically necessary or appropriate specialty care, pursuant to appropriate referral procedures, from any qualified participating health care professional available to accept such individual. (Sec. 113) Requires a plan or an issuer providing or covering any emergency hospital benefits to cover emergency services: (1) without the need for any prior authorization determination; (2) whether or not the health care provider furnishing such services is a participating health care provider; and (3) without regard to any other term or condition of such coverage (other than exclusion or coordination of benefits, or an affiliation or waiting period, permitted under the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), or the Internal Revenue Code, and other than applicable cost-sharing). Requires such coverage in a manner so that, if the emergency services are provided by a nonparticipating health care provider with or without prior authorization or by a participating provider without such authorization, the participant, beneficiary, or enrollee is not liable for amounts exceeding the liability that would be incurred if the services were provided by a participating provider with prior authorization. Prescribes the same coverage for maintenance care or post-stabilization care (subject to certain guidelines) by nonparticipating health care providers. Sets out provisions with regard to the coverage of emergency ambulance services. (Sec. 114) Requires plans and issuers to refer participants, beneficiaries, or enrollees who have a serious disease or condition requiring treatment by a specialist, or who require physician pathology services, to an appropriate specialist who is available and accessible (regardless of whether the specialist is participating or nonparticipating), provided the benefits for such treatment are covered by the plan or issuer. Sets forth rules governing referrals and specialists. (Sec. 115) Prohibits a plan or an issuer that requires or provides for designation of a participating primary care professional from requiring authorization or a referral by such primary care professional for routine gynecological care and pregnancy-related services provided by a participating physician who specializes or is trained and experienced in obstetrics and gynecology. Requires the plan or issuer to treat the ordering of other obstetrical or gynecological care by such a participating professional as the authorization of the primary care professional. (Sec. 116) Requires certain plans and issuers to permit an enrollee to designate a pediatrician as a primary care provider for the enrollee's child. (Sec. 117) Prescribes requirements for continuity of care during a transition period for participants, beneficiaries, or enrollees undergoing treatment for an ongoing special condition in the event of a termination of: (1) a contract between the plan or an issuer and a health care provider; or (2) a contract between a plan and an issuer that results in the termination of coverage of services of a health care provider. Prescribes a 90-day basic transition period, with specified extensions in the case of scheduled surgery and organ transplantation, pregnancy, or terminal illness. (Sec. 118) Establishes the Health Care Panel to Establish Network Adequacy Standards to devise standards for plans and issuers to meet to ensure network adequacy (i.e. access of participants, beneficiaries, and enrollees to a sufficient number, mix, and distribution of health care professionals and providers, and availability and accessibility of covered items and services at a variety of sites in the plan or issuer service area) . (Sec. 119) Provides that no use of a prescription drug or medical device shall be considered experimental or investigational under a plan or by an issuer if such use is included in labeling authorized by the U.S. Food and Drug Administration under the Federal Food, Drug, and Cosmetic Act or under the Public Health Service Act, unless such use is demonstrated to be unsafe or ineffective. Subtitle C: Access to Information - Specifies benefits, access, emergency coverage, prior authorization, grievance and appeals, and other pertinent information which plans and issuers shall provide to participants and beneficiaries at the time of initial coverage, annually, within a reasonable period before or after the date of significant changes, and upon request. Subtitle D: Protecting the Doctor-Patient Relationship - Prohibits any contract or agreement between a plan or issuer and a health care provider from prohibiting or otherwise restricting a health care professional from advising a participant, beneficiary, or enrollee who is the professional's patient about his or her health status or medical care or treatment for his or her condition or disease, regardless of whether benefits for such care or treatment are provided under the plan or coverage, if the professional is acting within the lawful scope of practice. Declares null and void any such contract or agreement provisions. (Sec. 132) Prohibits a plan or issuer from discriminating with respect to participation or indemnification as to any provider acting within the scope of the provider's license or certification, solely on the basis of such license or certification. (Sec. 133) Prohibits any plan or issuer from operating any physician incentive plan that does not meet certain requirements under title XVIII (Medicare) of the Social Security Act. (Sec. 134) Requires a plan or issuer to provide for prompt payment of claims in a manner consistent with Medicare clean claims requirements. Subtitle E: Definitions - Sets forth definitions. Title II: Application of Quality Care Standards to Group Health Plans and Health Insurance Coverage Under The Public Health Service Act - Amends the Public Health Service Act to require each plan and issuer to comply with the patient protection requirements of this Act. (Sec. 202) Requires each health insurance issuer to comply with such requirements with respect to individual health insurance coverage. Title III: Amendments to the Employee Retirement Income Security Act of 1974 - Amends ERISA to: (1) require each plan and issuer to comply with the patient protection requirements of this Act; and (2) deem a plan in compliance with subtitle A of title I of this Act to be in compliance with ERISA's claim procedure requirement with respect to claims denial. (Sec. 302) Makes liable to a participant or beneficiary (or his or her estate) for economic and noneconomic damages any fiduciary of a plan, issuer, or an agent of the plan or plan sponsor: (1) who has authority to make final decisions in the internal appeals process established by this Act; and (2) fails to exercise ordinary care in making an incorrect determination that an item or service is excluded from coverage, and such failure is the proximate cause of personal injury to, or wrongful death of, such participant or beneficiary. Exempts employers and other plan sponsors from such liability, unless they participated directly in the final decision that resulted in such injury or death. Specifies maximum noneconomic damages and, in limited circumstances, punitive damages. (Sec. 303) Allows a plan to provide for binding arbitration, at the election of an aggrieved participant or beneficiary, for review of adverse coverage decisions. Title IV: Application to Group Health Plans Under the Internal Revenue Code of 1986 - Amends the Internal Revenue Code to require a group health plan to comply with this Act. Deems the requirements of this Act to be incorporated into the Internal Revenue Code. Title V: Effective Dates; Coordination in Implementation - Sets forth effective dates for provisions of this Act. (Sec. 502) Requires the Secretaries of Labor, of Health and Human Services, and of the Treasury to ensure coordination in the implementation of this Act. Title VI: Other Provisions - Establishes the Health Care Panel to Devise a Uniform Explanation of Benefits to devise a single form for use by third-party health care payers for the remittance of claims to providers. (Sec. 602) Exempts health care response information from any disclosure requirement in connection with a civil or administrative proceeding under Federal or State law, to the same extent as information developed by a health care provider with respect to any of the following: (1) peer review; (2) utilization review; (3) quality management or improvement; (4) quality control; (5) risk management; or (6) internal review for purposes of reducing mortality, morbidity, or for improving patient care or safety. (Sec. 603) Prohibits the Secretary of Health and Human Services from implementing the Medicare Competitive Pricing Demonstration Project under the Balanced Budget Act of 1997 in Kansas City, Missouri, or Kansas City, Kansas, or in any area in Arizona. Prohibits the Secretary from implementing such project in any area before January 1, 2001. Directs the Secretary to study and report to Congress on the different approaches of implementing such project on a voluntary basis.
United States · United States Congress · 8 September 1999
Certified Nurse Midwifery Medicare Services Act of 1999 - Amends title XVIII (Medicare) of the Social Security Act to provide for the coverage of and payment for the following under Medicare part B (Supplementary Medical Insurance): (1) certified midwife services (currently only certified nurse-midwife services are covered); and (2) freestanding birth center services. Declares that nothing precludes certified nurse-midwives and certified midwives from teaching or supervising an intern or resident-in-training.
United States · United States Congress · 8 September 1999
SCHIP Improvement Act of 1999 - Amends the National School Lunch Act (NSLA) and the Child Nutrition Act of 1966 (CNA) to promote identification of children eligible for benefits under, and enrollment of children in, the Medicaid program and State Children's Health Insurance Program (SCHIP) under titles XIX and XXI, respectively, of the Social Security Act. (Sec. 2) Amends NSLA to provide a limited waiver of a confidentiality requirement, for persons directly connected with the administration of a State plan for Medicaid or SCHIP, for the purpose of identifying children eligible for benefits under, and enrolling children in, any such plan. Makes such waiver applicable with respect to the agency from which the information would be obtained only if the State and the agency so elect. (Sec. 3) Amends CNA provisions for the special supplemental nutrition program for women, infants, and children (WIC program) to direct the Secretary of Agriculture (the Secretary) to establish a demonstration project, in not more than 40 local agencies in not fewer than two States, under which costs of nutrition services and administration (under the WIC program) shall include the costs of identification of children eligible for benefits under, and enrollment of children in, State plans for Medicaid and SCHIP. Directs the Comptroller General to evaluate for Congress the costs associated with implementing such project, including Federal and State costs per child enrolled in such State plans. (Sec. 3(sic)) Amends NSLA to direct the Secretary to make grants to States to carry out State plans to involve eligible entities in the identification of children eligible for benefits under, and enrollment of children in, State plans for Medicaid and SCHIP. Provides that the following are eligible entities: (1) a school or school food authority participating in the school lunch program under NSLA; (2) an institution participating in the child and adult care food program under NSLA; (3) a local agency participating in the WIC program under CNA; or (4) any other nongovernmental social service provider. Includes the WIC demonstration project established under this Act among authorized uses of such grant funds. Directs the Secretary of the Treasury to provide a specified amount of funds to the Secretary for each of FY 2000 through 2003. Entitles and directs the Secretary to accept such funds, without further Act of appropriation.
United States · United States Congress · 5 August 1999
Medicare Ensuring Prescription Drugs for Seniors Act of 1999 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to provide for coverage of certain outpatient prescription drugs under Medicare part B (Supplementary Medical Insurance). Outlines provisions for monthly deductible and payment amounts, with the waiver of deductible for low-income individuals. Details provisions on participating pharmacies. Directs the Secretary of Health and Human Services (HHS) to establish, by January 1, 2001, a point-of-sale electronic system for use by carriers and participating pharmacies in the submission of information respecting covered outpatient drugs dispensed to Medicare part B beneficiaries. Amends Medicare part B to require the Director of the Congressional Office of Technology Assessment (sic) to provide for the appointment of a Prescription Drug Payment Review Commission to be composed of individuals with expertise in the provision and financing of covered outpatient drugs approved by the Director. Directs the Secretary to: (1) provide to the Commission, from amounts appropriated to HHS, necessary sums to carry out its duties, while prohibiting the payment of such sums from amounts appropriated to the Medicare trust funds; and (2) develop a standard claims form, and a standard electronic claims format, to be used in requests for payment for covered outpatient drugs under the Medicare program and other third-party payors, and distribute official sample copies of such form and format to pharmacies and other interested parties. Amends SSA title XI to provide for civil monetary penalties for excessive charges for nonparticipating pharmacies and for other specified violations of this Act.
United States · United States Congress · 5 August 1999
Radiation Exposure Compensation Act Amendments of 1999 - Amends the Radiation Exposure Compensation Act to revise eligibility requirements for claims relating to: (1) atmospheric nuclear testing and leukemia; (2) uranium mining as it pertains to individuals employed in the transport of uranium ore or vanadium-uranium ore and additional designated eligible State sites; (3) written documentation of pertinent diagnoses; (4) determination and payment of claims; (5) application of Native American law and Native American considerations to claims; (6) resubmittal of previously denied claims; and (7) reduction of attorney's fees. Directs the General Accounting Office to submit detailed, periodic status reports to Congress. Amends the Public Health Service Act to establish a program of grants (including grants through the Indian Health Service) to certain Federal, State, or local medical centers, or nonprofit organizations for education, prevention, and early detection of radiogenic cancers and diseases. Authorizes appropriations.
United States · United States Congress · 5 August 1999
Medicare Beneficiary Access to Quality Nursing Home Care Act of 1999 - Modifies the case-mix categories for the formula for determination of the payment to skilled nursing facilities (SNFs), under the prospective payment system (PPS), for routine service costs. Directs the Secretary of Health and Human Services to increase the adjusted Federal per diem rate otherwise determined for services provided to any individual during the period in which such individual is in a Nursing Home Case-Mix and Quality Demonstration resource utilization group (RUGS III) category of care, by the applicable payment add-on (updated for FY 2001 by the applicable SNF market basket percentage change), according to a specified table of such categories (especially for high-acuity and medically complex patients). Limits the application of this Act to services provided on or after October 1, 1999, and before the earlier of October 1, 2001, or the date on which the Secretary implements a case-mix methodology that takes into account adjustments for the provision of non-therapy ancillary services and supplies such as drugs and respiratory therapy. Amends title XVIII (Medicare) of the Social Security Act to revise the formula for facility specific per diem rates with respect to the market basket update (inflation adjuster) to repeal the mandatory annualized one percent reduction in basket amount.
United States · United States Congress · 5 August 1999
Public Health Response to Youth Suicide and Violence Act of 1999 - Amends the Public Health Service Act to direct the Director of the National Institute of Mental Health to carry out specified activities to expand and intensify research aimed at better understanding the underlying developmental and other causes of mental disorders that lead to youth suicide and violence. Authorizes appropriations.
United States · United States Congress · 5 August 1999
Medicare's Elderly Receiving Innovative Treatments (MERIT) Act of 1999 - Amends part C (Medicare+Choice) of title XVIII (Medicare) of the Social Security Act with regard to the frail elderly by modifying: (1) payment rules (including requiring the Secretary of Health and Human Services to develop and implement a new payment system); (2) eligibility, election, and enrollment provisions (adding special rules for frail elderly Medicare+Choice beneficiaries enrolling in specialized programs for the frail elderly that establish a continuous open enrollment period for such individuals); and (3) benefits and beneficiary protections provisions (requiring the Secretary to develop and implement a program to measure the quality of care provided in specialized programs for the frail elderly). Exempts Medicare+Choice beneficiaries in a specialized program for the frail elderly from any risk adjustment system until the Secretary certifies to Congress that a comprehensive risk adjustment methodology taking certain factors into account is being fully implemented.
United States · United States Congress · 5 August 1999
Superfund Amendments and Reauthorization Act of 1999 - Title I: Brownfields Revitalization - Amends the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA) to direct the Administrator of the Environmental Protection Agency (EPA) to establish programs to provide grants to eligible entities (including local government units, redevelopment agencies, States, and Indian tribes) for site characterization and assessment of, and performance of response actions at, brownfields facilities. Defines a "brownfield facility," with exceptions, as real property, the expansion or redevelopment of which is complicated by the presence or potential presence of a hazardous substance, including property contaminated with a controlled substance or precursor chemical to such a substance. (Sec. 102) Adds CERCLA provisions governing owner-operator status of persons owning or operating property contiguous to a release site. Absolves such persons of liability as owners or operators, subject to certain conditions. Requires the President to delist up to 20 individual parcels of real property from the National Priorities List (NPL) annually in order to conform with amendments that exclude from the NPL properties at which no release has occurred but to which a hazardous substance has migrated. (Sec. 103) Absolves from liability for response actions bona fide prospective purchasers to the extent liability at a facility for a release or threat thereof is based solely on ownership or operation of a facility. Gives a lien upon a facility to the United States for unrecovered response costs in any case in which there are such unrecovered costs for which the owner is not liable by reason of provisions limiting liability of fiduciaries and the facility's fair market value has increased above that which existed 180 days before the action was taken. (Sec. 104) Deems a person, with respect to defenses to liability of an owner of after-acquired property, to have undertaken appropriate inquiry into the property's previous ownership and uses if the person establishes that inquiries were undertaken in accordance with specified requirements (compliance with an American Society for Testing and Materials standard or with standards issued by the Administrator). Deems the appropriate inquiry requirements to be satisfied by a site inspection and title search that reveal no basis for further investigation in the case of property for residential or similar use purchased by a nongovernmental or noncommercial entity. Title II: State Response Programs - Adds CERCLA provisions requiring the Administrator to provide grants to States to establish and expand qualifying State response programs, comprised of elements including public participation opportunities, oversight and enforcement authorities, and certification mechanisms. Restricts authority to take enforcement actions under CERCLA in cases of hazardous substance releases subject to a State response plan. Authorizes the President to bring enforcement actions in certain instances, including cases where a State requests assistance or is unable to conduct a response action or there is a public health or environmental emergency or migration of contamination across State lines. Authorizes the President, if a State is unwilling or unable to take action to address a health or environmental emergency, to require the State to reimburse the Hazardous Substance Superfund (Superfund) for response costs incurred by the United States, with exceptions. (Sec. 202) Replaces provisions regarding the revision of the National Contingency Plan with those requiring the President to complete the evaluation of facilities classified as awaiting an NPL decision to determine the risk to public health or welfare or the environment posed by each facility as compared with other facilities. Prohibits additions to the NPL without concurrence from the Governor of the State in which the affected facility is located. Directs the Administrator, from amounts appropriated under CERCLA, to fund a cooperative agreement for an independent analysis of the projected ten-year costs for the implementation of the Superfund program. (Sec. 203) Alters the criteria for the continuance of obligations for removal actions to provide that actions shall not continue after $5 million (currently, $2 million) has been obligated or three years (currently, 12 months) have elapsed from the date of initial response to a release or threatened release of hazardous substances. (Sec. 204) Revises conditions for State financial and other assurances with respect to remedial actions to prohibit the Administrator from providing any funding for such actions unless the State enters into an agreement that provides assurances for State payment of ten percent of the costs of the action and operation and maintenance costs. Permits the Administrator to require a State contribution of 50 percent of the costs of any sums expended in response to a release at a facility that was operated by a State or political subdivision at the time of any disposal of hazardous substances. Title III: Fair Share Liability Allocations and Protections - Creates exceptions to liability for response costs at NPL-listed facilities for certain: (1) home owners or renters, small businesses, or small nonprofit organizations with respect to certain arrangements for, or transport of, municipal solid waste (MSW) or sewage sludge; (2) de micromis contributors; and (3) small businesses. Establishes limitations to liability for certain codisposal landfills (certain MSW or sewage sludge landfills that may have received hazardous waste and that contain predominately MSW or sewage sludge transported from outside the facility). Provides for settlements with certain parties whose liability is based on arrangement, transport, or acceptance provisions with respect to MSW or sewage sludge at NPL facilities. Absolves persons (other than owners or operators) who arranged for the recycling of, or transported, recyclable material from liability for environmental response actions. Excludes from the definition of "recyclable material" certain shipping containers having hazardous substances and any material containing polychlorinated biphenyls in excess of 50 parts per million or any new Federal standard. Deems transactions involving scrap paper, plastic, glass, textiles, or rubber (other than whole tires) to be arranging for recycling if the person who arranged the transaction demonstrates that the following criteria were met: (1) the recyclable material met a commercial specification grade and a market existed for the material; (2) a substantial portion of the material was made available for use as a feedstock for the manufacture of a new saleable product; (3) the material (or product to be made from the material) could have been a replacement for a virgin raw material; and (4) with respect to transactions occurring 90 days after this Act's enactment, the person exercised reasonable care to determine that the facility where the material would be managed by another was in compliance with Federal, State, or local environmental laws or regulations. Deems transactions involving scrap metal to be arranging for recycling if the person who arranged the transaction demonstrates that: (1) the criteria for scrap materials were met; (2) he or she complied with applicable standards regarding activities associated with the recycling of scrap metals; and (3) the scrap metal was not melted prior to the transaction. Deems transactions involving spent lead-acid, nickel-cadmium, or other batteries to be arranging for recycling if the person involved demonstrates that: (1) the criteria for scrap materials were met; and (2) he or she complied with applicable Federal environmental regulations or standards regarding such batteries. Makes the exemptions from liability under this Act inapplicable if the person: (1) had an objectively reasonable basis to believe at the time of the recycling transaction that the recyclable material would not be recycled or would be burned as fuel or for energy recovery or incineration or that the consuming facility was not in compliance with Federal, State, or local environmental laws or regulations; (2) had reason to believe that hazardous substances had been added to the material for purposes other than processing for recycling; or (3) failed to exercise reasonable care with respect to the management of the material. Considers transactions involving recyclable material that consists of used oil to be arranging for recycling if the person involved did not mix such material with a hazardous substance following the removal of the oil from service and demonstrates that the material was sent to a facility that recycled used oil by using it as a feedstock for the manufacture of a new saleable product or: (1) demonstrates that the material (or product to be made from the material) could have been a replacement for a virgin raw material; (2) demonstrates that, with respect to transactions occurring 90 days after this Act's enactment, the person exercised reasonable care to determine that the facility where the material would be managed by another was in compliance with Federal, State, or local environmental laws or regulations; and (3) was in compliance with regulations or standards for the management of used oil under the Solid Waste Disposal Act. Exempts from liability certain railroad owners or operators of spur tracks whose tracks meet specified conditions and who did not cause or contribute to the release concerned. Limits liability for certain organizations that hold title to a vessel or facility as a result of a charitable gift. (Sec. 302) Adds to the list of parties eligible for expedited final settlements certain persons, small businesses, or municipalities that demonstrate an inability or limited ability to pay response costs. Revises conditions of eligibility for such settlements for de minimis parties. (Sec. 303) Requires the President to initiate an impartial fair share allocation, conducted by a neutral third party at NPL facilities if: (1) there is more than one potentially responsible party (PRP) that is not eligible for specified exemptions or limitations to liability, eligible for an expedited final settlement, or insolvent, bankrupt, or defunct; and (2) at least one of the PRPs agrees to bear the costs of the allocation under conditions prescribed by the President. Requires the allocator to estimate the fair share of each PRP using specified equitable factors. Includes within such allocations response costs at NPL facilities that are not addressed in an administrative settlement or settlement or judgment approved by a Federal district court. Authorizes a party to settle any liability to the United States for response costs for its allocated fair share. Authorizes the President and the Attorney General to jointly reject an allocation report under certain conditions. Allocates shares attributable to insolvent, defunct, or bankrupt parties, or unattributable shares, among responsible parties, except certain parties with limited liability described by this Act. Sets forth provisions regarding orphan shares. Stays all contribution and cost recovery actions against parties eligible for expedited final settlements and those eligible for settlements based on certain limitations on liability with respect to the arrangement of MSW and sewage sludge until the Administrator offers a settlement. Suspends any statute of limitations applicable to such actions during the period that a stay is in effect. Bars the President from issuing orders with respect to abatement actions at a facility to any non-Federal party or commencing or maintaining any new or existing action to recover response costs if he fails to fund a statutory orphan share, reimburse a party, or include an orphan share estimate in any settlement when required to do so. Declares that settlements under allocation provisions, those regarding expedited final settlements, and settlements for parties with limited liability with respect to the arrangement of MSW and sewage sludge shall provide complete protection from all claims for contribution or cost recovery for response costs addressed in the settlement. Authorizes a party to retain the right to seek cost recovery or contribution for costs outside the scope of an allocation except from certain parties with limited liability described by this Act or those who have settled. Makes persons who commence contribution actions against parties who are not liable or who have resolved liability liable to such persons for all reasonable costs of defending the action. Provides that parties that settle liability under allocation provisions or provisions regarding expedited final settlements or limited liability with respect to the arrangement of MSW or sewage sludge waive rights to seek cost recovery or contribution. Authorizes the President, as a condition of a settlement under allocation provisions or those regarding limited liability for the arrangement of MSW or sewage sludge, to require parties to conduct a response action. Requires the President to reimburse such parties for costs incurred in excess of a party's allocated fair share. Bars a court from approving any settlement under this Act unless it includes an estimate of the statutory orphan share that is fair, reasonable, and consistent. Title IV: Remedy Selection and Natural Resource Damages - Revises provisions regarding selection of remedial actions to require the selection process to include, for any discrete area containing a principal hazardous constituent of a hazardous substance that poses a substantial health or environmental risk because of high toxicity or mobility, a preference for an action that includes treatment that reduces the risk. Authorizes the President, with respect to such a discrete area, to select a final containment remedy at a landfill, mining site, or similar facility under certain conditions. Requires remedial actions to require a level or standard of control for each hazardous substance that at least attains the substantive requirements of all promulgated standards under: (1) each Federal environmental law legally applicable to the action or to the level of cleanup for the substance concerned; (2) any more stringent and legally applicable State environmental or facility siting law that the State demonstrates is of general applicability, is identified to the President as being applicable, and has consistently applied to other remedial actions in the State; and (3) any such State law promulgated after this Act's enactment. Sets forth conditions under which the President may select a remedial action that does not attain such level or standard of control. Requires a remedial action, if no applicable Federal or State standard is established for a specific hazardous substance, to attain a standard protective of human health and the environment. (Sec. 402) Directs the President, in selecting a remedial action, to conduct and utilize a facility-specific risk evaluation. Describes requirements for, and uses of, such evaluations. (Sec. 403) Revises provisions regarding natural resource damages to permit the measure of such damages to include only the reasonable costs of: (1) restoring, replacing, or acquiring the equivalent of an injured, destroyed, or lost natural resource to reinstate its human uses and environmental functions; (2) providing an equivalent resource during the period of any interim lost use to the extent that a substitute is not reasonably available; and (3) assessing the damages. (Sec. 404) Prohibits double recovery for natural resource damages under CERCLA and other laws. Title V: Funding - Revises provisions regarding uses of Superfund. Requires the President to use amounts appropriated out of Superfund only to: (1) enter into mixed funding agreements; (2) reimburse a party for response costs incurred in excess of the allocated share as described in a final settlement; and (3) perform response actions. Authorizes appropriations from Superfund for FY 2000 through 2004. Prohibits claims against Superfund from being valid or paid in excess of the total amount in Superfund at any one time. Authorizes appropriations for: (1) the Agency for Toxic Substances and Disease Registry for health assessments and consultations and related activities; (2) hazardous substance research, demonstration, and training; (3) brownfields grant programs; (4) qualifying State response programs; and (5) the Department of Justice for enforcement.
United States · United States Congress · 5 August 1999
Amends title XVIII (Medicare) of the Social Security Act to increase from 17 to 19 the membership of the Medicare Payment Advisory Commission (MedPAC), staggering the initial terms of the additional members, and to include on MedPAC individuals with national recognition for their expertise in manufacturing and distributing finished medical goods.
United States · United States Congress · 5 August 1999
Medicare Community Nursing Demonstration Extension Act of 1999 - Grants an additional three-year extension for demonstration projects under the Omnibus Budget Reconciliation Act of 1987 that provide payment on a prepaid, capitated basis for community nursing and ambulatory care furnished to beneficiaries under the Medicare program (title XVIII of the Social Security Act).
United States · United States Congress · 5 August 1999
Reprocessed Single Use Medical Device Patient Safety Amendments of 1999 - Amends the Federal Food, Drug, and Cosmetic Act to require every person or establishment (entity) engaged in the reprocessing of a medical device labeled for single use shall: (1) upon first engaging in such reprocessing and for each year in which such entity continues to so engage, register with the Secretary of Health and Human Services and provide all required information; and (2) for each such year, submit to the Secretary a list of devices labeled for single use that the entity is reprocessing, including names of original manufacturers and specific models. Requires each such entity to: (1) provide such information to each person or establishment that uses such device; and (2) demonstrate the device's safety and effectiveness. Requires every person or establishment that uses a class II or III reprocessed medical device for the provision of medical care to individuals to seek informed patient consent for such use, and to include a record of such use in the individual's medical record. Requires a report from the Secretary to specified congressional committees on the safety and efficacy of the reprocessing of devices labeled for single use. Requires the Secretary to modify the MEDWATCH forms to facilitate the reporting of such information.
United States · United States Congress · 5 August 1999
Medicare Managed Care Cost Contract Extension Act of 1999 - Amends title XVIII (Medicare) of the Social Security Act to extend for three years through December 31, 2005, the Medicare managed care reasonable cost contract program.
United States · United States Congress · 5 August 1999
National Fund for Health Research Act - Establishes the National Fund for Health Research in the Treasury. Transfers to the Fund amounts equivalent to certain percentages of all premiums received by each health plan for each calendar year and transferred to the Treasury. Mandates distributions from the Fund to the National Institutes of Health, the National Center for Research Resources, and for carrying out specified Public Health Service Act provisions relating to health information communications. Excludes amounts in the Fund from consideration or enforcement with regard to the Congressional Budget Act of 1974 or the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act).
United States · United States Congress · 5 August 1999
Bipartisan Consensus Managed Care Improvement Act of 1999 - Title I: Improving Managed Care - Subtitle A: Grievances and Appeals - Requires a group health plan, and a health insurance issuer that provides health insurance coverage, to conduct utilization review activities that monitor or evaluate the use or coverage, clinical necessity, appropriateness, efficacy, or efficiency of health care services, procedures, or settings. (Sec. 102) Requires a plan and an issuer to provide appropriate notices to the participant, beneficiary, or enrollee for benefit claims it has denied that include reasons for denial and instructions for initiating specified internal appeals procedures, which must include procedures for an expedited review process in emergency situations. (Sec. 103) Outlines external appeals procedures for the timely resolution of certain denied claims through the use of qualified external appeal entities, which shall determine whether the plan's or issuer's decision is in accordance with the patient's medical needs. Declares that an external appeal entity's determination is binding on the plan and issuer involved. Provides for court-imposed civil monetary penalties and cease and desist orders against authorized officials of plan or issuers who refuse to timely follow the determination of an external appeal entity to provide a benefit. (Sec. 104) Requires a plan and an issuer to establish a system featuring specified components for the presentation and resolution of grievances brought by participants, beneficiaries, or enrollees, or health care providers or other individuals acting on behalf of an individual either with the individual's consent or without it if the individual is medically unable to provide it. Declares that grievances are not subject to appeal under this subtitle. Subtitle B: Access to Care - Provides that if an issuer offers coverage of services only if they are furnished through members of a network of health care professionals and providers contracting with the issuer, the issuer shall also offer the option of coverage of such services which are not furnished through members of such a network, unless enrollees are offered such non-network coverage through another plan or issuer in the group market. Makes the enrollee bear the cost of any additional premium the issuer charges for such option, and the amount of any additional cost sharing, unless it is paid by the health plan sponsor through agreement with the issuer. (Sec. 112) States that if a plan or an issuer requires or provides for designation of a participating primary care provider by a participant, a beneficiary, or an enrollee, then the plan or issuer shall permit each such person to designate any participating primary care provider available to accept such individual. Requires a plan and an issuer to permit each participant, beneficiary, or enrollee to receive medically necessary or appropriate speciality care, pursuant to appropriate referral procedures, from any qualified participating health care professional available to accept such individual. Waives such requirement in the case of specialty care if the plan or issuer clearly informs each participant, beneficiary, and enrollee of the limitations on choice of participating professionals with respect to such care. (Sec. 113) Requires a plan or an issuer providing any emergency hospital benefits to cover emergency services: (1) without the need for any prior authorization determination; (2) whether or not the health care provider furnishing such services is a participating health care provider; and (3) without regard to any other term or condition of such coverage (other than exclusion or coordination of benefits, or an affiliation or waiting period, permitted under the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), or the Internal Revenue Code, and other than applicable cost-sharing). Requires such coverage in a manner so that, if the emergency services are provided by a nonparticipating health care provider with or without prior authorization or by a participating provider without such authorization, the participant, beneficiary, or enrollee is not liable for amounts exceeding the liability that would be incurred if the services were provided by a participating provider with prior authorization. Prescribes the same coverage for maintenance care or post-stabilization care (subject to certain guidelines) by nonparticipating health care providers. (Sec. 114) Requires plans and issuers to refer participants, beneficiaries, or enrollees who have a serious disease or condition requiring treatment by a specialist to an appropriate specialist who is available and accessible (regardless of whether the specialist is participating or nonparticipating), provided the benefits for such treatment are covered by the plan or issuer. Sets forth rules governing referrals and specialists. (Sec. 115) Prohibits a plan or an issuer that requires or provides for designation of a participating primary care professional from requiring authorization or a referral by such primary care professional for gynecological care and pregnancy-related services provided by a participating health care professional (including a specialist). Requires the plan or issuer to treat the ordering of other obstetrical or gynecological care by such a participating professional as the authorization of the primary care professional. (Sec. 116) Requires certain plans and issuers to permit an enrollee to designate a pediatrician as a primary care provider for the enrollee's child. (Sec. 117) Prescribes requirements for continuity of care during a transition period for participants, beneficiaries, or enrollees undergoing treatment for an ongoing special condition in the event of a termination of: (1) a contract between the plan or an issuer and a health care provider; or (2) a contract between a plan and an issuer that results in the termination of coverage of services of a health care provider. Prescribes a 90-day basic transition period, with specified extensions in the case of scheduled surgery and organ transplantation, pregnancy, or terminal illness. (Sec. 118) Provides that a plan or issuer restricting prescription drug benefits to drugs included in a formulary to: (1) ensure participation of participating physicians in development of the formulary; (2) disclose to providers, and upon request to participants, beneficiaries, and enrollees, the nature of the formulary restrictions; and (3) consistent with the standards for a utilization review program, provide for exceptions from the formulary limitation when a non-formulary alternative is medically indicated. (Sec. 119) Prohibits a plan or issuer from: (1) denying individual participation in an approved clinical trial; (2) denying or limiting or imposing additional conditions on the coverage of routine patient costs for items and services furnished in connection with participation in the trial; and (3) discriminating against the individual on the basis of the enrollee's participation in such trial. Subtitle C: Access to Information - Specifies benefits, access, emergency coverage, prior authorization, grievance and appeals, and other pertinent information which plans and issuers shall provide to participants and beneficiaries at the time of initial coverage, annually, within a reasonable period before or after the date of significant changes, and upon request. Subtitle D: Protecting the Doctor-Patient Relationship - Prohibits any contract or agreement between a plan or issuer and a health care provider from prohibiting or otherwise restricting a health care professional from advising a participant, beneficiary, or enrollee who is the professional's patient about his or her health status or medical care or treatment for his or her condition or disease, regardless of whether benefits for such care or treatment are provided under the plan or coverage, if the professional is acting within the lawful scope of practice. Declares null and void any such contract or agreement provisions. (Sec. 132) Prohibits a plan or issuer from discriminating with respect to participation or indemnification as to any provider acting within the scope of the provider's license or certification, solely on the basis of such license or certification. (Sec. 133) Prohibits any plan or issuer from operating any physician incentive plan that does not meet certain requirements under title XVIII (Medicare) of the Social Security Act. (Sec. 134) Requires a plan or issuer to provide for prompt payment of claims in a manner consistent with Medicare clean claims requirements. (Sec. 135) Sets forth prohibitions and requirements for protection of: (1) participants, beneficiaries, enrollees, and health care providers in their use of a utilization review or grievance process; and (2) health care professionals for good faith disclosure of information to an appropriate agency or body in the interest of quality advocacy. Subtitle E: Definitions - Sets forth definitions. Title II: Application of Quality Care Standards to Group Health Plans and Health Insurance Coverage Under The Public Health Service Act - Amends the Public Health Service Act to require each plan and issuer to comply with the patient protection requirements of this Act. (Sec. 202) Requires each health insurance issuer to comply with such requirements with respect to individual health insurance coverage. Title III: Amendments to the Employee Retirement Income Security Act of 1974 - Amends ERISA to: (1) require each plan and issuer to comply with the patient protection requirements of this Act; and (2) deem a plan in compliance with subtitle A of title I of this Act to be in compliance with ERISA's claim procedure requirement with respect to claims denial. (Sec. 302) Declares that nothing in ERISA shall be construed to invalidate, impair, or supersede any cause of action under State law by a participant or beneficiary (or by his or her estate) to recover damages resulting from personal injury or wrongful death against any person (except employers and other plan sponsors) in connection with the provision of insurance, administrative services, or medical services by that person to or for a group health plan, or that arises out of the arrangement by that person for the provision of insurance, administrative services, or medical services by other persons. Denies plan or issuer liability for punitive damages in any cause of action relating to an externally appealable decision when: (1) the appeal has been completed; and (2) the plan or issuer has complied with the determination of the external appeal entity. Allows an action against an employer or other plan sponsor (or an employee of one or the other acting within the scope of employment) if it is based on the employer's or sponsor's exercise of discretionary authority to decide a claim for covered benefits, and such exercise has resulted in personal injury or wrongful death. Title IV: Application to Group Health Plans Under the Internal Revenue Code of 1986 - Amends the Internal Revenue Code to require a group health plan to comply with this Act. Deems the requirements of this Act to be incorporated into the Internal Revenue Code. Title V: Effective Dates; Coordination in Implementation - Sets forth effective dates for provisions of this Act. (Sec. 502) Requires the Secretaries of Labor, of Health and Human Services, and of the Treasury to ensure coordination in the implementation of this Act. Title VI: Health Care Paperwork Simplification - Establishes the Health Care Panel to Devise a Uniform Explanation of Benefits to devise a single form for use by third-party health care payers for the remittance of claims to providers.
United States · United States Congress · 5 August 1999
Seniors Prescription Insurance Coverage Equity (SPICE) Act of 1999 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to add a new part D (SPICE Drug Benefit Program) (SPICE program) (redesigning the current Medicare part D (Miscellaneous Provisions) as Medicare part E (Miscellaneous Provisions) to establish a voluntary SPICE program, administered by the SPICE Board which also operates a Seniors Prescription Insurance Coverage Equity Office established within the Department of Health and Human Services, under which all individuals entitled to Medicare part A (Hospital Insurance) benefits and enrolled in Medicare part B (Supplementary Medical Insurance) shall be provided access to coverage of outpatient prescription drugs that meet specified requirements. Grants such access via either enrollment in a Medicare+Choice (Medicare part C) plan, enrollment in a SPICE Medicare supplemental policy, or enrollment in a group health plan, all as defined by this Act. Provides for described financial assistance for covered beneficiaries for them to obtain enrollment coverage, with such assistance varying depending upon beneficiary income. Vests the Board with outreach and other specified duties, such as establishing procedures for enrollment and enhanced financial assistance with regard to eligible Medicare beneficiaries and the SPICE program, and conducting certain ongoing studies, as well as a study and report to Congress on permitting an alternative outpatient prescription drug benefit package under Medicare supplemental health insurance policies (Medigap) provisions. Outlines requirements for the offering of SPICE program coverage, which include prohibiting pre-existing condition exclusions with respect to coverage and allowing use of reasonable cost containment methods. Establishes in the Treasury the SPICE Trust Fund, consisting in part of amounts from the taxes imposed on tobacco and tobacco-related products and from the on-budget surplus, to be available only for expenditures to carry out the SPICE program. Makes appropriations and authorizes appropriations. Amends the Omnibus Budget Reconciliation Act of 1990 to include with Medigap policy comparison information for Medigap policies, information on the SPICE program for purposes of State grant application plans for State-wide health insurance, counseling, and assistance grants. Amends the Internal Revenue Code to impose a variety of excise taxes on specified tobacco and tobacco-related products, as well as with regard to the manufacture or the importation of roll-your-own tobacco, and to make modifications to certain tobacco excise tax provisions, such as placing a restriction on importation of previously exported tobacco products.
United States · United States Congress · 5 August 1999
Medical Education Trust Fund Act of 1999 - Amends the Social Security Act (SSA) to add a new title XXII (Medical Education Trust Fund) establishing in the Treasury the Medical Education Trust Fund, consisting of various specified accounts. Requires the Secretary of Health and Human Services to make annual payments from the Fund to eligible medical schools and teaching hospitals applying for assistance to: (1) maintain and develop quality educational programs in an increasingly competitive health care system; and (2) meet the indirect and direct costs of graduate medical education. Outlines requirements for Fund investments and determination of payments. Amends SSA titles XVIII (Medicare) and XIX (Medicaid) to provide for annual transfers to the Fund. Makes specified appropriations to the Fund. Amends the Internal Revenue Code to impose a tax equal to 1.5 percent of premiums received under accident or health insurance policies (including applicable self-insured plans), and equal to 1.5 percent of the amount received for certain health-related administrative services, payable by the policy issuer and the service provider, respectively. Makes specified appropriations and transfers of such amounts collected to the Fund for allocation among the various specified accounts. Establishes the Medical Education Advisory Commission to study and report on Fund operations and other specified matters, including recommendations for demonstration projects. Authorizes appropriations. Directs the Secretary to prescribe guidelines for the establishment and operation of such demonstration projects. Provides funding.
United States · United States Congress · 5 August 1999
Internet Pharmacy Consumer Protection Act - Amends the Federal Food, Drug, and Cosmetic Act to prohibit any person from introducing a prescription drug into interstate commerce or delivering such a drug for introduction into commerce pursuant to a sale if: (1) any part of the sales transaction for the drug is conducted through an Internet site; and (2) such site, or any other Internet site used by such person for purposes of sales of a prescription drug, fails to meet specified requirements regarding inclusion of a page (and links thereto) providing the identities of the seller and the persons serving as pharmacists or medical consultants and the States in which the seller and such persons are authorized to dispense drugs or provide consultations. Provides that a State that has in effect requirements for Internet sites that are no less stringent and that has adequate procedures for their enforcement shall have primary enforcement responsibility for any violation involving such a purchase made from within the State.
United States · United States Congress · 5 August 1999
Improved Patient Access to Clinical Studies Act of 1999 - Amends the Public Health Service Act (PHSA), the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code (IRC) to prohibit a group health plan and, except under IRC, a health insurance issuer offering group health insurance coverage from denying, limiting, or imposing additional conditions on coverage if: (1) the participant or beneficiary is participating in an approved clinical study; (2) the items and services are furnished according to the study's design or to treat conditions resulting from study participation; and (3) the items and services would otherwise be covered. Prohibits discrimination against a participant or beneficiary on the basis of the participant's or beneficiary's study participation. Amends PHSA to generally apply that prohibition to coverage offered by an issuer in the individual market.
United States · United States Congress · 5 August 1999
Healthy Start Initiative Continuation Act - Amends title V (Maternal and Child Health Services) of the Social Security Act to mandate continuance of the Healthy Start Initiative of grants to reduce infant mortality. Authorizes carrying out the Initiative on a national basis. Authorizes appropriations.
United States · United States Congress · 5 August 1999
Common Ground Healthcare Security Act of 1999 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to establish new procedures and access to courts for grievances arising under group health plans. (Sec. 2) Requires group health plans to: (1) provide written notice to participants or beneficiaries and providers of adverse coverage decisions; and (2) meet specified time limits for responding to routine and emergency benefit payment requests, coverage advance determinations, and medical necessity determinations. Provides for internal and, in certain circumstances, external review of initial coverage decisions. Sets forth permitted alternatives to required internal or external reviews in certain cases. Provides for expedited Federal court review, in an action to obtain appropriate equitable relief, where an appropriate physician certifies that exhaustion of administrative remedies is not reasonably attainable under the facts and circumstances without undue risk of irreparable harm to the health of the participant or beneficiary. (Sec. 3) Provides for availability of court remedies, establishing a cause of action relating to provision of health benefits. Makes a plan's fiduciary liable for actual damages (including compensatory and consequential damages) for a participant or beneficiary personal injury or wrongful death proximately caused by the fiduciary's failing to exercise ordinary care: (1) in making an incorrect determination that an item or service is excluded from coverage under the terms of the plan based on the fact that the item or service does not meet the plan's requirements for medical appropriateness or necessity, or would constitute experimental treatment or technology; or (2) to ensure that any initial coverage decision on which the cause of action is based, or any decision by the plan on a request, made in writing by a participant or beneficiary for a reversal or modification of an earlier decision of the plan on which the cause of action is based, is issued to the participant or beneficiary before the end of the applicable period. Exempts employers and other plan sponsors from such liability, unless they participate directly in the final decision of the plan on the claim, which decision resulted in the personal injury or wrongful death. Allows such a civil action only after exhaustion of administrative remedies, including external review, except where an appropriate physician certifies that such exhaustion is not reasonably attainable under the facts and circumstances without undue risk of irreparable harm to the health of the participant or beneficiary. Establishes a rebuttable presumption in favor of the decision of the independent expert rendered upon completion of certain reviews. Sets standards for the award of punitive damages in specified cases involving conscious, flagrant indifference to the rights or safety of others. Limits the amount of such awards. Provides for the court to award an additional amount of punitive damages if there is an insufficient award in a case of egregious conduct. Sets time limits for such civil actions. Preempts similar civil actions under State law.
United States · United States Congress · 5 August 1999
Lyme Disease Initiative of 1999 - Directs the Secretaries of Health and Human Services, of Agriculture, of the Interior, and of Defense to: (1) establish specified detection test, improved surveillance and reporting system, and prevention goals to provide for a reduction in the incidence and prevalence of Lyme disease and related tick borne infectious diseases; and (2) establish a five-year plan of activities toward achieving those goals, and carry them out. Establishes the Lyme Disease Taskforce to advise the Secretaries with respect to achieving such goals. Authorizes appropriations.
United States · United States Congress · 5 August 1999
Provides that, for purposes of payments to hospitals under the Medicare program (title XVIII of the Social Security Act) for costs of approved educational activities, such activities shall include professional educational training programs, recognized by the Secretary of Health and Human Services, for psychologists, physician assistants, and nurse practitioners.
United States · United States Congress · 5 August 1999
Amends title XIX (Medicaid) of the Social Security Act to increase the State Medicaid disproportionate share hospital (DSH) payment adjustment allotments for Minnesota (from $16 to $33 million), New Mexico (from $5 to $9 million), and Wyoming (from zero to $0.1 million) for FY 2000 through 2002.
United States · United States Congress · 5 August 1999
Amends Federal civil service law to require any health benefits plan under the Federal Employees Health Benefit Program that provides obstetrical benefits to also provide coverage for the diagnosis and treatment of infertility, including nonexperimental assisted reproductive technology procedures.
United States · United States Congress · 5 August 1999
Debt Reduction Lockbox Act of 1999 - Amends the Congressional Budget Act of 1974 to provide a point of order in the House or the Senate against consideration of any concurrent budget resolution or conference report or amendment pertaining thereto that would set forth an on-budget deficit for any fiscal year. Makes it out of order in the House or the Senate to consider any bill, joint resolution, amendment, motion, or conference report if the enactment of the reported bill or resolution, the adoption and enactment of an amendment, or the enactment of a bill or resolution in the form recommended in the conference report would cause or increase an on-budget deficit for any fiscal year. Includes the receipts, outlays, and surplus or deficit in the Federal Old-Age and Survivors and Disability Insurance Trust Funds within the content of the concurrent budget resolution. (Sec. 3) Requires any official Federal Government statement of the Federal or congressional budget surplus or deficit totals to exclude the outlays and receipts of the Old-Age, Survivors, and Disability Insurance Program under the Social Security Act. Requires such outlays and receipts to be submitted in separate social security budget documents. (Sec. 4) Amends Federal public finance provisions to establish a Debt Reduction Lockbox within the Treasury to retire publicly held debt obligations of the U.S. Government. Appropriates funds to the Lockbox for FY 2000 through 2009. Requires the Director of the Office of Management and Budget (OMB) to: (1) compute the projected budget surplus for the fiscal year using up-to-date economic and technical assumptions; (2) calculate the changes in the projected surplus as a result of differences in economic and technical assumptions contained in a Congressional Budget Office report entitled "The Economic and Budget Outlook: An Update;" and (3) compute any difference in projections as a result of such changes from the assumptions used in the report. Adjusts amounts provided for the Lockbox for FY 2001 through 2004 by an amount equal to the change in the budget surplus for that fiscal year as a result of the changes determined by OMB. Provides that amounts in the Lockbox shall be unavailable for appropriation, obligation, expenditure, or transfer, except as specified, and shall be exempt from reduction under orders issued under part C of the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) and not taken into account for purposes of budget enforcement procedures under such part. Requires the President to include information about the Lockbox in the annual budget submission. (Sec. 5) Provides a point of order in the House and the Senate against consideration of: (1) any concurrent budget resolution (or related conference report or amendment) that would set forth an amount in the Lockbox for any fiscal year that is less than the amount set forth in this Act; or (2) legislation that would cause an on- budget surplus for any fiscal year that is less than the amount set forth in the most recent concurrent budget resolution for the Lockbox. Includes the amount of the Lockbox within the content of the concurrent budget resolution. Authorizes a waiver or suspension in the Senate of points of order under this Act only with a three-fifths majority. Requires the same majority to sustain an appeal on a ruling on such points of order. (Sec. 6) Amends the Social Security Act to require the Secretary of the Treasury to determine, before October 1 of each fiscal year, the debt reduction dividend for such fiscal year. Provides that such dividend is equal to the excess of $229 billion over total net interest expenditures by the Federal Government during the preceding fiscal year. Reserves for social security and Medicare reform for each fiscal year beginning on or after October 1, 1999, amounts equal to 100 percent of such dividend for such fiscal year. Allocates 75 percent to social security reform and 25 percent to Medicare reform. Provides that any transfer of funds to the Old-Age and Survivors and Disability Insurance Trust Funds or to the Federal Hospital Insurance Trust Fund equal to or less than the amount reserved under this section for each such fund that are included in social security or Medicare reform legislation, as applicable, shall not count as an outlay for purposes of a pay-as-you-go requirement under the Gramm-Rudman-Hollings Act and shall be exempt from sequestration. Defines: (1) "social security reform legislation" as legislation that the chief actuary of the Social Security Administration certifies extends the solvency of the Old-Age and Survivors and Disability Insurance Trust Funds, taken together, for 75 years; and (2) "Medicare reform legislation" as legislation that the chief actuary of the Health Care Financing Administration certifies extends the solvency of the Federal Hospital Insurance Trust Fund for 20 years.
United States · United States Congress · 5 August 1999
Home Health Equity Act of 1999 - Amends title XVIII (Medicare) of the Social Security Act and the Balanced Budget Act of 1997 to eliminate the 15 percent home health services payment reduction which would occur if the Secretary of Health and Human Services did not establish a prospective payment system (PPS) for such services as provided for in such Act. Provides for: (1) outlier payments to home health agencies (agencies) in spite of applicable per beneficiary payment limits when a provider demonstrates to the Secretary that an individual was furnished appropriate home health services at a reasonable cost that significantly exceeded such applicable per beneficiary limit because of certain conditions; and (2) recoupment of overpayments by the Secretary to agencies over a 36-month period as specified. Makes various Medicare amendments under reasonable cost provisions with regard to an increase in payment amounts to agencies with limits under the national average and an increase in the per visit limit for cost reporting periods beginning on or after October 1, 1999, with regard to the amount of payments that may be made under Medicare for services furnished by agencies. Eliminates timekeeping requirements under the prospective payment system for home health services. Provides for periodic interim payment for certain agencies under Medicare provisions regarding payment to service providers. Revises surety bond requirements for agencies. Excludes additional Medicare part B (Supplementary Medical Insurance) costs from determination of the Medicare part B premium.
United States · United States Congress · 5 August 1999
Expresses the sense of the House of Representatives that: (1) all Americans, and above all women, should take an active role in the fight against breast cancer by using all the means available to them; (2) the role played by national and community organizations and health care providers in promoting awareness of the importance of regular clinical and self-examinations, regular mammograms, and biopsies (when appropriate), and in providing information, support, and access to services, should be recognized and applauded; and (3) the Federal Government has a responsibility, among other things, to continue to fund research so that the causes of, and improved treatment for, breast cancer may be discovered.
United States · United States Congress · 5 August 1999
Waives points of order against the consideration of the conference report on H.R. 2488 (tax relief).
United States · United States Congress · 4 August 1999
Cardiac Arrest Survival Act of 1999 - Amends the Public Health Service Act to direct the Secretary of Health and Human Services to: (1) assist in providing for an improvement in the survival rates of individuals who experience cardiac arrest in Federal buildings by publishing in the Federal Register for public comment recommendations with respect to placing automatic external defibrillators in such buildings; and (2) assist Federal agencies in implementing programs for such placement. Requires the Secretary to determine criteria for: (1) the selection of the Federal public buildings in which defibrillators should be placed; (2) defibrillator maintenance; and (3) the coordination of the use of the defibrillators in public buildings with emergency medical services providers for the geographic areas in which the buildings are located. Provides that any person who provides emergency medical care through the use of a defibrillator, any person who maintained, tested, or provided training in the use of the device, any physician who provided medical oversight of the device, and the person who acquired the device (if specified conditions have been met) is immune from civil liability for any personal injury or wrongful death resulting from the provision of such care, unless the person engaged in gross negligence or willful or wanton misconduct under the applicable circumstances.
United States · United States Congress · 4 August 1999
Seniors Prescription Insurance Coverage Equity (SPICE) Act of 1999 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to add a new part D (SPICE Drug Benefit Program) (SPICE program) (redesigning the current Medicare part D (Miscellaneous Provisions) as Medicare part E (Miscellaneous Provisions) to establish a voluntary SPICE program, administered by the SPICE Board which also operates a Seniors Prescription Insurance Coverage Equity Office established within the Department of Health and Human Services, under which all individuals entitled to Medicare part A (Hospital Insurance) benefits and enrolled in Medicare part B (Supplementary Medical Insurance) shall be provided access to coverage of outpatient prescription drugs that meet specified requirements. Grants such access via either enrollment in a Medicare+Choice (Medicare part C) plan, enrollment in a SPICE Medicare supplemental policy, or enrollment in a group health plan, all as defined by this Act. Provides for described financial assistance for covered beneficiaries for them to obtain enrollment coverage, with such assistance varying depending upon beneficiary income. Vests the Board with outreach and other specified duties, such as establishing procedures for enrollment and enhanced financial assistance with regard to eligible Medicare beneficiaries and the SPICE program, and conducting certain ongoing studies, as well as a study and report to Congress on permitting an alternative outpatient prescription drug benefit package under Medicare supplemental health insurance policies (Medigap) provisions. Outlines requirements for the offering of SPICE program coverage, which include prohibiting pre-existing condition exclusions with respect to coverage and allowing use of reasonable cost containment methods. Establishes in the Treasury the SPICE Trust Fund, consisting in part of amounts from the taxes imposed on tobacco and tobacco-related products and from the on-budget surplus, to be available only for expenditures to carry out the SPICE program. Makes appropriations and authorizes appropriations. Amends the Omnibus Budget Reconciliation Act of 1990 to include with Medigap policy comparison information for Medigap policies, information on the SPICE program for purposes of State grant application plans for State-wide health insurance, counseling, and assistance grants. Amends the Internal Revenue Code to impose a variety of excise taxes on specified tobacco and tobacco-related products, as well as with regard to the manufacture or the importation of roll-your-own tobacco, and to make modifications to certain tobacco excise tax provisions, such as placing a restriction on importation of previously exported tobacco products.
United States · United States Congress · 4 August 1999
Medicare Paramedic Intercept Service Equity Act of 1999 - Amends the Balanced Budget Act of 1997 to permit payment for advanced life support services (ALS intercept services) furnished by a paramedic intercept service provider in non-rural as well as rural areas. Amends title XVIII (Medicare) of the Social Security Act to exclude from computation of the ambulance fee schedule any payments attributable to this Act.
United States · United States Congress · 4 August 1999
Family Building Act of 1999 - Amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and the Federal Employees Health Benefits Plan to require health plans to provide benefits for treatment of infertility in accord with specified standards.
United States · United States Congress · 4 August 1999
Medicare Puerto Rico Hospital Payment Parity Act of 1999 - Amends title XVIII (Medicare) of the Social Security Act to revise the formula for determining the amount of Medicare payment with respect to the operating costs of inpatient hospital services of certain Puerto Rico hospitals, gradually increasing the national payment rate to 100 percent by FY 2002.
United States · United States Congress · 3 August 1999
Amends title XVIII (Medicare) of the Social Security Act to increase from ten to 20 percent the additional incentive payments for physician services provided in health professional shortage areas in Alaska and Hawaii.
United States · United States Congress · 3 August 1999
Omnibus Long-Term Care Improvement Act of 1999 - Title I: Refundable Credit For Long-Term Care - Amends the Internal Revenue Code to allow as a credit against income tax an amount equal to the sum of $1,000 multiplied by the number of applicable individuals with respect to whom the taxpayer is an eligible caregiver for the taxable year. Title II: Medicare Long-Term Care Improvements - Subtitle A: Medicare SNF, HHA, and Other Improvements - Amends title XVIII (Medicare) of the Social Security Act (SSA) to provide for expanded long-term in-home, community-based, and respite care services under the Medicare program for dependent individuals. (Sec. 202) Provides for coverage of substitute adult day care services as home health services under Medicare. (Sec. 203) Provides for coverage of Medicare home health case management plans established by home health case managers for long-term home health spells of illness. Directs the Secretary of Health and Human Services (Secretary) to establish a fee schedule for payment for home health case manager services. Requires the Secretary to study and report to Congress on the types of Medicare post-acute hospital care services to determine whether use of case managers and case management plans similar to home health case managers and home health case management plans is feasible and appropriate for each such type of service. (Sec. 204) Requires the Secretary to identify at least ten medical conditions, classified by diagnosis-related groups (DRGs), which consistently require an intense level of post-acute care, either by health care providers or by private caregivers. Requires disproportionate share (DSH) hospitals to provide, in the case of an inpatient classified a voluntary discharge classified within a certain medical condition before the date of the discharge, a comprehensive case management plan of care that includes a program of education, training, and assistance to the private caregiver, designed to stabilize or to improve the individual's health and to reduce the likelihood of hospital readmission. Requires a reduction in payment for failure to establish such plan of care. (Sec. 205) Directs the Secretary to pay an additional amount to home health agencies furnishing qualified Medicare home health services during a cost reporting period beginning on or after October 1, 1997, for treatment of conditions within any one of the specified diagnoses classified in St. Anthony's ICD-9-CM Code Book for Physician Payment. Places a limitation of payments. Authorizes appropriations. Bars judicial review. (Sec. 206) Amends SSA title XVIII with respect to the post-hospital referral process and the definition of homebound. Subtitle B: Encouraging Provision of Hospice Care - Amends SSA title XVIII to: (1) provide for hospice information for certain Medicare beneficiaries at time of hospital discharge; and (2) permit payment to hospice programs for costs of medical education. (Sec. 212) Amends the Balanced Budget Act of 1997 (BBA '97) to include hospice programs among qualified consortia for certain demonstration projects. (Sec. 213) Amends Federal civil service law to provide for the inclusion of hospice care under the Federal Employees Health Benefits Program. Subtitle C: QMB Improvements - Amends part A (General Provisions) of SSA title XI to establish a mechanism for promoting Medicare cost-sharing assistance to eligible low-income Medicare beneficiaries. (Sec. 221) Amends the Internal Revenue Code to direct the Secretary of the Treasury, upon written request from the Commissioner of Social Security, to disclose to the Secretary whether with respect to an identified Medicare beneficiary: (1) there has not been filed an income tax return for the most recent period for which the Secretary has information; or (2) such a return has been filed, and the amount of the gross income is below the level (or levels) the Secretary may specify to carry out the Ticket to Work and Self-Sufficiency Program, treating the number of dependents as the size of the family involved; and (3) whether, if the individual qualified for Medicare cost-sharing assistance at any time in the previous year, the individual's gross income is still within the eligibility level for the TWSS Program. Title III: Nursing Home Quality Protections - Amends SSA titles XVIII and XIX (Medicaid) to: (1) require a skilled nursing facility (SNF) or, respectively, a nursing facility, to post for each wing or floor of the facility the names of the licensed and unlicensed nursing staff on duty at any time, and the number of residents on such wing or floor for whom they are responsible; and (2) require each State to assess against a SNF or nursing facility a fee to recover the State's actual costs and expenses in conducting any resurveys or reinspections in addition to the annual standard survey in those cases in which violations are found and deficiencies are cited in the initial survey, and the resurvey or reinspection is required to determine whether the facility has achieved compliance. (Sec. 302) Disallows Medicaid payments to SNFs or nursing facilities to cover fees assessed or any civil money penalty. (Sec. 303) Amends SSA titles XVIII and XIX to provide for a program to prevent abuse of nursing facility and SNF residents, using background checks on employment applicants, and prohibiting the hiring of abusive workers. Prescribes civil penalties for violation of program requirements, and criminal penalties for knowing unauthorized use of worker information. Expands State nurse aid registry requirements under Medicaid and Medicare to include collecting information about nursing facility employees other than nurse aides. Adds Federal and State requirements concerning criminal background checks on nursing facility employees. Applies to other entities providing long-term care services under Medicaid and Medicare the screening and background checks applicable to skilled nursing facilities. (Sec. 304) Amends SSA title XI to provide for inclusion of abusive nursing facility workers in the database established as part of national health care fraud and abuse data collection program. Authorizes appropriations. (Sec. 305) Directs the Secretary to establish a demonstration program to provide grants to develop information on best practices in patient abuse prevention training (including behavior training and interventions) for managers and staff of hospital and health care facilities. Authorizes appropriations. Title IV: Access to Long-Term Care Insurance - Subtitle A: Group Long-Term Care Insurance - Amends Federal civil service law to provide for group long-term care insurance for Federal employees and related eligible individuals. Authorizes appropriations. (Sec. 402) Directs the President to submit to Congress a plan under which employees who are not entitled to purchase long-term care benefits insurance may purchase insurance of the type offered under this subtitle. Subtitle B: Extension of Consumer Protection Standards to All Long-Term Care Insurance Policies - Subjects to a specified civil monetary penalty any issuer of a long-term care insurance contract (other than a qualified long-term care insurance contract) that fails to comply with certain consumer protection standards of the Internal Revenue Code that apply to a qualified long-term care insurance contract, as adjusted to conform with the most recent version available of the long-term care insurance model regulation and the long-term care insurance model Act promulgated by the National Association of Insurance Commissioners. Title V: Addition of National Family Caregiver Program to the Older Americans Act of 1965 - Amends the Older Americans Act of 1965 (OAA) to modify the program for in-home supportive services for older individuals who are victims of Alzheimer's disease and related disorders with neurological and organic brain dysfunction, and to the families of such victims. Provides for supportive activities to meet the special needs of caregivers, including caretakers who provide in-home services to frail older individuals as well as for a National Family Caregiver Support Program. Authorizes appropriations. (Sec. 502) Revises OAA allotments to States with regard to the formula for computation of amount and unused funds. Title VI: Medicare For Caregivers - Subtitle A: Access to Medicare Benefits for Caregivers - Amends SSA title XVIII to add a new part D (Medicare Benefits for Caregivers). Creates for use in such program the Medicare Caregiver Trust Fund, funded by transfers from the Federal Hospital Insurance Trust Fund and from the Federal Supplementary Medical Insurance Trust Fund of amounts equivalent to reductions in expenditures under the respective trust fund attributable to the enactment of the Medicare Fraud and Overpayment Act of 1999. Subtitle B: COBRA Protection for Caregivers - Chapter 1: Amendments to the Employee Retirement Income Security Act of 1974 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to provide for COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) continuation benefits for certain caregivers whose group health plan coverage had been terminated. Chapter 2: Amendments to the Public Health Service Act - Amends the Public Health Service Act to provide for COBRA continuation benefits for certain caregivers whose group health plan coverage had been terminated. Chapter 3: Amendments to the Internal Revenue Code of 1986 - Amends the Internal Revenue Code to provide for COBRA continuation benefits for certain caregivers whose group health plan coverage had been terminated. Subtitle C: Financing - Provides that any increase in Medicare payments that results from enactment of this title shall be offset by reductions in payments under such program pursuant to the anti-fraud and -abuse provisions of the Medicare Fraud and Overpayment Act of 1999. Title VII: Social Security Benefit For Long-Term Caregivers - Amends SSA title II (Old Age, Survivors, and Disability Insurance) to provide for Social Security credit for certain long-term caregivers. Prescribes a formula for the deeming of caregiver wages for entitlement purposes. Authorizes appropriations.
United States · United States Congress · 3 August 1999
Amends the Child Care and Development Block Grant Act of 1990 to establish a program of assistance for child care activities for young children (under age three). Authorizes appropriations. Authorizes the use of such program funds for child care activities for young children, including activities designed to: (1) increase availability of child care services for young children; (2) provide support services for networks of family child care providers; (3) provide or support programs that provide training, services, materials, equipment, or other support to caregivers, eligible child care providers, and family child care providers that provide child care to young children (including purchasing equipment such as cribs and high chairs); (4) provide funds to increase compensation offered and provide bonuses to caregivers, eligible child care providers, and family child care providers who provide child care to children under age three, especially those caregivers and providers who have formal education in early childhood development; (5) provide and support networks between health care providers and caregivers, eligible child care providers, and family child care providers that provide child care to young children; and (6) provide child care services for young children who are enrolled in Head Start programs.
United States · United States Congress · 3 August 1999
Halting HCFA Act of 1999 - Prohibits the Administrator of the Health Care Financing Administration (HCFA) from promulgating any rules or regulations that impose new requirements under the Social Security Act during the year after the enactment of this Act unless the Secretary of Health and Human Services finds that they are needed to preserve individual health and safety.