A bill to amend titles XVIII and XIX of the Social Security Act with respect to payments to health maintenance organizations.

Summary

Amends title XVIII (Medicare) of the Social Security Act to revise provisions relating to payments to and contractual arrangements with health maintenance organizations (HMO) on behalf of individuals eligible for Medicare. Directs the Secretary of Health and Human Services to determine annually a per capita rate of payment for each class of individuals: (1) enrolled with an HMO pursuant to this Act and who are entitled to benefits under part A (Hospital Insurance) of title XVIII and enrolled under part B (Supplementary Medical Insurance) of title XVIII; and (2) enrolled with an HMO and enrolled under part B only. Provides a rate for each class equal to 95 percent of the adjusted average per capita cost for that class. Defines the term "adjusted average per capita cost" to mean the average per capita amount that the Secretary estimates would be payable for services furnished under the Medicare program, if the services were to be furnished by other than an HMO. Directs the Secretary in establishing classes of individuals to take in consideration such factors as age, sex, institutional status, disability status and place of residence. Redefines an HMO. Requires an HMO to meet certain requirements, including limits on premiums, deductibles, coinsurance, and copayments. Provides that individuals enrolled in the Medicare program shall be eligible under this Act with any HMO with which the Secretary has contracted. Prohibits premiums, deductibles, coinsurance, and copayments of an HMO for services in addition to those available to Medicare enrollees from exceeding, for such individuals, the adjusted community rate for such services. Defines the adjusted community rate. Authorizes the Secretary to reimburse an HMO on the basis of reasonable cost if the Secretary is satisfied that the HMO is able to perform its contractual obligations effectively and efficiently and if: (1) the Secretary is not satisfied that an HMO has the capacity to bear the risk of potential losses under a risk-sharing contract under this Act; or (2) the HMO so elects. Amends part A (General Provisions) of title XI of the Social Security Act to prohibit a capital expenditure made by or on behalf of a health care facility from being subject to review pursuant to the limitation on Federal participation for capital expenditures of part A if the obligation of the capital expenditure by the facility would not be reviewed under the Public Health Service Act. Directs the Secretary to conduct a study and report to Congress concerning additional benefits selected by HMO's. Amends title XIX (Medicaid) of the Act to revise the definition of an HMO. Requires an HMO meet the requirements of an HMO as defined in title XVIII, and to meet certain additional requirements. Directs the Secretary to conduct a study and report to Congress concerning the extent of, and reasons for, the termination by Medicare and Medicaid beneficiaries of their membership in HMO's.

This text is taken from the official record. PoliticalRepo does not editorialize.

Timeline

1. 1 May 1981

   Introduced

   Introduced in House

   Source: IntroReferral

2. 1 May 1981

   Introduced

   Introduced in House

   Source: IntroReferral

3. 1 May 1981

   Introduced

   Referred to House Committee on Energy and Commerce.

   Source: IntroReferral

4. 1 May 1981

   Committee

   For Previous Action See H.R.2508.

   Source: Committee

5. 4 May 1981

   Referred

   Referred to Subcommittee on Health.

   Source: Committee

6. 12 May 1981

   Reported

   Ordered to be Reported (Amended).

   Source: Committee

7. 12 May 1981

   Committee

   Committee Consideration and Mark-up Session Held.

   Source: Committee

8. 21 May 1981

   Reported

   Reported to House (Amended) by House Committee on Energy and Commerce. Report No: 97-119 (Part I).

   Source: Committee

9. 21 May 1981

   Reported

   Reported to House (Amended) by House Committee on Energy and Commerce. Report No: 97-119 (Part I).

   Source: Committee

10. 19 August 1982

    Committee

    See H.R.4961.

    Source: Committee

Votes

No vote records are attached yet.

Versions

No version snapshots stored. Document URLs remain at the source.

Documents

2 official files

• Reported to House amended, Part I

  summary · EN · 21 May 1981

  Open at official source

• Introduced in House

  summary · EN · 1 May 1981

  Open at official source

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Sponsors

• Rep. Waxman, Henry A. [D-CA-33] · D · Sponsor
• Rep. Scheuer, James H. [D-NY-8] · D · Sponsor
• Rep. Walgren, Doug [D-PA-18] · D · Sponsor
• Sen. Wyden, Ron [D-OR] · D · Sponsor
• Sen. Shelby, Richard C. [R-AL] · D · Sponsor
• Sen. Gramm, Phil [R-TX] · D · Sponsor
• Rep. Leland, Mickey [D-TX-18] · D · Sponsor
• Rep. Broyhill, James T. [R-NC-10] · R · Sponsor
• Rep. Madigan, Edward R. [R-IL-15] · R · Sponsor
• Rep. Brown, Clarence, Jr. [R-OH-7] · R · Sponsor
• Rep. Ritter, Don [R-PA-15] · R · Sponsor
• Rep. Pepper, Claude [D-FL-18] · D · Cosponsor
• Rep. Frenzel, Bill [R-MN-3] · R · Cosponsor
• · hsif00 · Standing
• · hswm00 · Standing

Related records

• related to → A bill to amend titles XVIII and XIX of the Social Security Act with respect to payments to health maintenance organizations.
• related to ← Tax Equity and Fiscal Responsibility Act of 1982