101st CONGRESS
1st Session
H. R. 3607
AMENDMENT
HR 3607 EAS2
In the Senate of the United States,
November 21 (legislative day, November 6), 1989.
Resolved, That the bill from the House of Representatives (H.R. 3607)
entitled `An Act to repeal medicare provisions in the Medicare Catastrophic
Coverage Act of 1988', do pass with the following
AMENDMENT:
Strike out all after the enacting clause and insert:

e734397a8e1f667df6bab3129afe2135e36c00b9195a1ee01c2e781ce5abc482

This title may be cited as the `Medicare Catastrophic Coverage Reform
Amendments of 1989'.
MEDICARE PREMIUM

38af2236acccbb96b5fdc820d9d0a50663cee0ef3c46281beb4dd015347e40d4

(a) 100 DAYS DURING EACH SPELL OF SNF CARE- Section 1812 of the Social
Security Act (42 U.S.C. 1395d) is amended--
(1) by amending paragraph (2) of subsection (a) to read as follows:
`(2)(A) post-hospital extended care services for up to 100 days during
any spell of snf care, and (B) to the extent provided in subsection (f),
extended care services that are not post-hospital extended care services;';
(2) by amending paragraph (1) of subsection (b) to read as follows:
`(1) post-hospital extended care services furnished to the individual
during a spell of snf care after such services have been furnished to the
individual for 100 days during such spell, or';
(3) in subsection (e), by inserting `post-hospital' before `extended
care'; and
(4) by adding at the end the following new subsection:
`(f)(1) The Secretary shall provide for coverage, under clause (B) of
subsection (a)(2) of this section, of extended care services which are
not post-hospital extended care services at such time and for so long as
the Secretary determines, under such terms and conditions (described in
paragraph (2)) as the Secretary finds appropriate, that the inclusion of
such services will not result in any increase in the total of payments
made under this title and will not alter the acute care nature of the
benefit described in subsection (a)(2).
`(2) The Secretary may provide--
`(A) for such limitations on the scope and extent of such services described
in subsection (a)(2)(B), and on the categories of individuals who may be
eligible to receive such services, and
`(B) notwithstanding sections 1814, 1861(v), and 1886 for such restrictions
and alternatives on the amount and methods of payment for services described
in such subsection,
as may be necessary to carry out paragraph (1).'.
(b) COINSURANCE- Paragraph (3) of section 1813(a) of such Act (42
U.S.C. 1395e(a)) is amended to read as follows:
`(3) The amount payable for post-hospital extended care services furnished
an individual during any spell of snf care shall be reduced by a coinsurance
amount equal to one-eighth of the inpatient hospital deductible for the
first period of hospitalization in a year for each day (before the 101st
day) on which the individual is furnished such services after such services
have been furnished to the individual for 20 days during such spell.'.
(c) CONFORMING AMENDMENTS AND RESTORATION OF LAW-
(1) SPELL OF SNF CARE DEFINED- Section 1861 of such Act (42 U.S.C. 1395x)
is amended by inserting before subsection (b) the following new subsection:
`Spell of SNF Care
`(a) The term `spell of snf care' with respect to any individual means a
period of consecutive days--
`(1) beginning with the first day (not included in a previous spell of snf
care) (A) on which such individual is furnished extended care services,
and (B) which occurs in a month for which the individual is entitled to
benefits under part A, and
`(2) ending with the close of the first period of 60 consecutive days
thereafter on each of which the individual is not an inpatient of a skilled
nursing facility.'.
(2) CONFORMING AMENDMENTS- (A) Except as provided in subparagraph (B)--
(i) the amendments made by subsection (d) of section 104 of the Medicare
Catastrophic Coverage Act of 1988 are repealed, and
(ii) the provisions of the Social Security Act amended by such subsection
shall be restored and revived as if such amendments had not been made.
(B) Subparagraph (A) shall not apply to the amendments made by paragraphs
(2)(C), (2)(D), (3), (4)(A), (4)(B)(iii), (4)(B)(iv), and (7) of section
104(d) of the Medicare Catastrophic Coverage Act of 1988.
(3) ADDITIONAL CONFORMING AMENDMENT- Title XVIII of the Social Security
Act is amended by striking `spell of illness' and `spells of illness'
each place either appears and inserting `spell of snf care' and `spells
of snf care', respectively.
(d) EFFECTIVE DATE AND TRANSITION-
(1) EFFECTIVE DATE- Except as provided in this subsection, the amendments
made by this section shall apply to extended care services furnished in
a spell of snf care (as defined in paragraph (4)) beginning on or after
January 1, 1990.
(2) TRANSITION PROVISIONS FOR POST-HOSPITAL EXTENDED CARE SERVICES- In
applying subsections (a)(2)(A) and (b)(1) of section 1812 and section
1813(a)(3) of the Social Security Act, as restored by this section, with
respect to extended care services provided on or after January 1, 1990--
(A) no day before January 1, 1990, shall be counted in determining the
beginning (or period) of a spell of snf care; and
(B) the limitation of coverage of extended care services to post-hospital
extended care services shall not apply to an individual receiving such
services from a skilled nursing facility during a continuous period
beginning before (and including) January 1, 1990, until the end of the
period of 30-consecutive days in which the individual is not provided
inpatient hospital services or extended care services.
(3) SPELL OF SNF CARE DEFINED- In this subsection, the term `spell of snf
care' has the meaning given such term in section 1861(a) of the Social
Security Act, as amended by subsection (c)(1) of this section. Days before
January 1, 1990, are included in the determination of spells of snf care.
(e) STUDY- The Comptroller General shall study the reasons for the unexpected
increase in cost estimates of the extended care services benefit under
title XVIII of the Social Security Act. Not later than February 1, 1990,
the Comptroller General shall submit a report to Congress describing the
results of the study.

c1188849185acceabe395c4b17b1deab834f0697fcd0ca72969eede3b9fee3a6

TITLE I

-PROVISIONS RELATING TO PART A OF MEDICARE PROGRAM AND SUPPLEMENTAL

(a) IN GENERAL- Section 111 of the Medicare Catastrophic Coverage Act of
1988 is repealed and the provisions of the Internal Revenue Code of 1986
and the Social Security Act amended by such section shall be restored and
revived as if such section had not been enacted.
(b) EFFECTIVE DATE- The repeal of section 111 of the Medicare Catastrophic
Coverage Act of 1988 shall apply to taxable years beginning after December
31, 1988.

3389ca485183ea9506eb2440afd14c69f73963507f10bf5a40c4d57185f30beb

(a) IN GENERAL- Section 1813(a)(1)(A) of the Social Security Act (42
U.S.C. 1395e(a)(1)(A)) is amended--
(1) by striking `first period' and inserting `first and second periods',
(2) by striking `shall be reduced' and inserting `shall each be reduced', and
(3) by adding at the end thereof the following new sentence: `For purposes
of this section, a period of hospitalization shall be considered a second
period of hospitalization if such period begins more than 60 days after
the end of the first period of hospitalization for the calendar year.'.
(b) AMOUNT OF DEDUCTIBLES- Section 1813(b)(1) of the Social Security Act
(42 U.S.C. 1395e(b)(1)) is amended by striking the first sentence and
inserting the following new sentences: `The inpatient hospital deductible
for the first period of hospitalization for 1990 shall be $592. In the case
of a second period of hospitalization beginning in 1990 and any subsequent
year, and for no other purposes, the inpatient hospital deductible shall
be 93 percent of the amount of the inpatient hospital deductible for the
first period of hospitalization for that year.'.
(c) EFFECTIVE DATE- The amendments made by this section shall take effect
with respect to periods of hospitalization beginning after December 31, 1989.

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RESERVE FUND.
(a) CHANGE IN FUNDING SOURCE- Section 1817A(a) of the Social Security Act
(42 U.S.C. 1395t-1a(a)) is amended--
(1) in paragraph (1), by striking `and amounts appropriated under paragraph
(2)' and inserting `and amounts transferred under section 1841(a) and
section 204(e) of the Medicare Catastrophic Coverage Amendments of 1987',
(2) by striking paragraph (2), and
(3) by redesignating paragraph (3) as paragraph (2).
(b) EFFECTIVE DATE- The amendments made by subsection (a) shall take effect
on January 1, 1990.

4d86d5d4cb6a882370d5a2f646d585ff533ee4840138b83c50d32b1329ec19e7

Subsections (a)(4), (b), and (c) of section 201 of the Medicare Catastrophic
Coverage Act of 1988 are repealed and the provisions of the Social Security
Act amended by such subsections shall be restored and revived as if such
subsections had not been enacted.

a61700414f79d1bda912a9eda5d8351d35772a342f18d2727c0f7dd17660e5a9

TITLE II

-PROVISIONS RELATING TO PART B OF THE MEDICARE PROGRAM

BENEFITS.
(a) LIMITATION OF DRUG BENEFITS TO IMMUNOSUPPRESSANTS AND HOME IV DRUGS-
Section 1861(t) of the Social Security Act (42 U.S.C. 1395x(t)) is amended--
(1) in paragraph (3)(B), by striking `in 1990' and inserting `in years
after 1990', and
(2) in paragraph (4)(B), by striking `1990' and inserting `1991'.
(b) DELAY IN DRUG-RELATED BENEFITS-
(1) COVERED OUTPATIENT DRUGS- Section 202(m)(1) of the Medicare Catastrophic
Coverage Act of 1988 is amended by striking `1990' and inserting `1991'.
(2) HOME INTRAVENOUS DRUG THERAPY SERVICES- Section 203(g) of the Medicare
Catastrophic Coverage Act of 1988 is amended by striking `1990' and inserting
`1991'.
(c) CONFORMING AND MISCELLANEOUS AMENDMENTS TO PAYMENT PROVISIONS-
(1) CATASTROPHIC DRUG DEDUCTIBLE AMOUNT- Section 1834(c)(1)(C) of the Social
Security Act, as added by section 202(b)(4) of the Medicare Catastrophic
Coverage Act of 1988, is amended--
(A) by amending clause (i) to read as follows:
`(i) IN GENERAL- The catastrophic drug deductible specified in this
subparagraph for--
`(I) 1990 is $550, and
`(II) any succeeding year, is the catastrophic drug deductible for the
previous year increased by the percentage increase in the MEI (as defined
in section 1842(i)(3)) applicable to physicians' services furnished in
that succeeding year.'; and
(B) in clause (iii), by striking `1992' and inserting `1990'.
(2) COINSURANCE PERCENT- Section 1834(c)(2) of such Act is amended--
(A) in subparagraph (B), by striking `100 percent' and all that follows
and inserting `80 percent', and
(B) by striking subparagraphs (C) and (D).
(3) MISCELLANEOUS DELAYS- Section 1834(c) of such Act is further amended--
(A) in paragraph (3)(A), by striking `1992' and inserting `1993', and
(B) in paragraphs (3)(C)(i) and (3)(C)(ii)(I), by striking `1990' and
inserting `1991'.
(4) ADMINISTRATIVE DISPENSING ALLOWANCE- Clause (i) of section 1834(c)(4)(A)
of such Act is amended to read as follows:
`(i) in 1990 or 1991, the administrative allowance under this paragraph
is $4.50; or'.
(5) REPEAL OF SPECIAL TREATMENT OF PREPAID ORGANIZATIONS AND PHYSICIAN GUIDE-
Section 1834(c) of such Act is further amended by striking paragraphs (6)
and (7).
(6) CHANGE IN REPORTING REQUIREMENTS- Section 1834(c)(8) of such Act
is amended--
(A) in subparagraph (B), by striking `in May and November of 1989 and 1990
and in May of each succeeding year' and inserting `in May of each year
(beginning with 1990)', and
(B) by striking subparagraphs (C) through (F).
(7) DELETION OF EXTRANEOUS DEFINITION- Section 1834(c)(9) of such Act is
further amended by striking subparagraph (D).
(d) DELETION OF PROVISIONS RELATING TO PARTICIPATING PHARMACIES, SPECIAL
ADMINISTRATIVE PROVISIONS, AND MODIFICATION OF HMO/CMP CONTRACTS- Subsections
(c), (e), and (f) of section 202 of the Medicare Catastrophic Coverage Act
of 1988 is repealed and the provisions of the Social Security Act amended
by such subsections shall be restored and revived as if such subsections
had not been enacted.
(e) REPEAL OF REQUIREMENT FOR REESTIMATION OF COSTS, ADDITIONAL STUDIES,
AND DEVELOPMENT OF STANDARD CLAIMS FORM- Paragraph (2) of subsection
(i), subsection (k), and subsection (l) of section 202 of the Medicare
Catastrophic Coverage Act of 1988 are repealed.
(f) REPEAL OF PRESCRIPTION DRUG PAYMENT REVIEW COMMISSION-
(1) IN GENERAL- Section 1847 of the Social Security Act (42 U.S.C. 1395w-3),
as added by section 202(j) of the Medicare Catastrophic Coverage Act of
1988, is repealed.
(2) TRANSITION- The amendment made by subparagraph (A) shall take effect on
the date of the enactment of this Act, but the Prescription Drug Payment
Review Commission is authorized to continue its activities for 30 days
after such date to conclude its business.
(g) CONFORMING DELAYS TO PROVISIONS RELATING TO HOME INTRAVENOUS DRUG
THERAPY SERVICES-
(1) Section 1834(d)(2) of the Social Security Act, as added by section
203(c)(1)(F) of the Medicare Catastrophic Coverage Act of 1988, is amended
by striking `1990' and inserting `1991'.
(2) Section 203(c)(2) of the Medicare Catastrophic Coverage Act of 1988
is amended by striking `1991' and inserting `1992'.
(3) Section 1835(a)(2)(G) of the Social Security Act, as inserted by
section 203(d)(1)(C) of the Medicare Catastrophic Coverage Act of 1988,
is amended by striking `1993' and inserting `1994'.
(4) Section 1154(a)(16) of the Social Security Act, as added by section
203(d)(2) of the Medicare Catastrophic Coverage Act of 1988, is amended
by striking `1993' and inserting `1994'.
(h) EFFECTIVE DATE- The amendments made by this section shall take effect
on the date of the enactment of this Act.

e06998a29718c165602a0b13e9f4b7ccb0fcff8165d36df92a0ae049c156cdec

(a) IN GENERAL- Section 205(f) of the Medicare Catastrophic Coverage Act
of 1988 is amended by striking `1990' and inserting `1991'.
(b) CONFORMING AMENDMENTS- Section 1861(ll) of the Social Security Act (42
U.S.C. 1395x(ll)), as added by section 205(b) of the Medicare Catastrophic
Coverage Act of 1988, is amended--
(1) by amending subparagraph (A) of paragraph (4) to read as follows:
`(A) has incurred out-of-pocket part B cost sharing (as defined in paragraph
(5)(A)) in an amount equal to part B catastrophic limit (as determined
under paragraph (5)(B)) for the year, or'; and
(2) by adding at the end the following new paragraph:
`(5) For purposes of this subsection:
`(A) The term `out-of-pocket part B cost sharing' means, with respect
to an individual covered under part B, the amounts of expenses that the
individual incurs that are attributable to--
`(i) the deductions established under section 1833(b), and
`(ii) the difference between the payment amount provided under part B and
the payment amount that would be provided under part B if `100 percent' and
`0 percent' were substituted for `80 percent' and `20 percent', respectively,
each place either appears in sections 1833(a), 1833(i)(2), 1834(e)(1)(C),
1835(b)(2), 1866(a)(2)(A), 1881(b)(2), and 1881(b)(3).
`(B)(i) The part B catastrophic limit for 1990 is $1,780. The part
B catastrophic limit for any succeeding year shall be such an amount
(rounded to the nearest multiple of $1) as the Secretary estimates, for
that succeeding year, will reflect a level of out-of-pocket part B expenses
that only 5.5 percent of the average number of individuals enrolled under
part B (other than individuals enrolled with an eligible organization
under section 1876 or an organization described in section 1833(a)(1)(A))
will equal or exceed in that succeeding year.
`(ii) Not later than September 1 of each year (beginning with 1990),
the Secretary shall promulgate the part B catastrophic limit under this
subparagraph for the succeeding year.'.
(c) REPORT ON ALTERNATIVE ELIGIBILITY STANDARDS- The Secretary of Health
and Human Services shall submit to the Congress by June 1, 1990, a report
describing alternatives to the standards for determining the eligibility
of individuals for in-home care services contained in section 1861(ll)
of the Social Security Act (as amended by subsection (b)).

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(a) CONSOLIDATION OF CATASTROPHIC MONTHLY PREMIUM-
(1) IN GENERAL- Section 1839(g)(1) of the Social Security Act (42
U.S.C. 1395r(g)(1)) is amended--
(A) in subparagraph (A)--
(i) by striking `paragraphs (4) and (5)' and inserting `paragraphs (3)
and (4)',
(ii) by striking `the sum of the catastrophic coverage monthly premium
and the prescription drug monthly premium' and inserting `the catastrophic
coverage monthly premium',
(iii) by striking `paragraphs (2) and (3)' and inserting `paragraph (2)',
(iv) in the column in the table relating to the catastrophic coverage
monthly premium, by striking `$4.90', `$5.46', `$6.75', and `$7.18' and
inserting `$3.90', `$4.80', `$5.60', and `$6.00', respectively, and
(v) by striking the column in the table relating to the prescription drug
monthly premium; and
(B) by striking subparagraphs (B) through (D) and inserting the following:
`(B) The Secretary shall determine during September of 1990, 1991, and
1992, the monthly actuarial rate for months in the succeeding year which,
if substituted for the catastrophic coverage monthly premium specified
in subparagraph (A) for such months, would assure (taking into account
potential contingencies) a positive balance in the Medicare Catastrophic
Coverage Account at the end of the succeeding year.
`(C) If the monthly actuarial rate determined under subparagraph (B) for
months in a year is less than the catastrophic coverage monthly premium
otherwise specified in the table in subparagraph (A), such monthly actuarial
rate shall be substituted for the catastrophic coverage monthly premium
under subparagraph (A) for months in the year.'.
(2) MONTHLY PREMIUM AFTER 1993- Paragraph (2) of section 1839(g) of such
Act is amended to read as follows:
`(2)(A) The Secretary shall determine during September of each year
(beginning with 1993) the monthly actuarial rate for months in the succeeding
year which, if substituted for the catastrophic coverage monthly premium
specified in subparagraph (A) for such months, would assure a balance in
the Medicare Catastrophic Coverage Account at the end of the succeeding
year equal to 20 percent of the estimated total debits to the Account
during the year.
`(B) In the case of months in a year after 1993, the catastrophic coverage
monthly premium is the monthly actuarial rate determined under subparagraph
(A) for months in the year.'.
(3) ELIMINATION OF SEPARATE PRESCRIPTION DRUG MONTHLY PREMIUM- Section
1839(g) of such Act is further amended by striking paragraph (3).
(4) TREATMENT OF RESIDENTS OF PUERTO RICO AND TERRITORIES- Section 1839(g)(4)
of such Act is amended to read as follows:
`(3)(A) In the case of an individual who is a resident of Puerto Rico or
who is a resident of another U.S. commonwealth or territory during a month,
instead of the premium increase provided under paragraph (1), subject to
subsection (b), the monthly premium for each individual enrolled under
this part (otherwise determined without regard to this subsection) shall
be increased--
`(i) for months in 1989 by $1.30 for residents of Puerto Rico and $2.10
for residents of another U.S. commonwealth or territory,
`(ii) for months in 1990 by $1.40 for residents of Puerto Rico and $2.30
for residents of another U.S. commonwealth or territory, and
`(iii) for months in a succeeding year by a fraction (determined under
subparagraph (B)) of the premium increase determined under paragraph (1) for
residents of Puerto Rico and for residents of the other U.S. commonwealths
and territories, respectively.
`(B) The Secretary shall from time to time establish, separately for Puerto
Rico and for the other U.S. commonwealths and territories, a fraction that
reflects the relative per capita outlays which are accounted for under the
Medicare Catastrophic Coverage Account for residents in such respective
areas compared to such per capita outlays for individuals who are resident
in the 50 States and the District of Columbia.'.
(5) PART B ONLY INDIVIDUALS- Section 1839(g)(5) of such Act is amended to
read as follows:
`(4)(A) In the case of a part B only individual during a month, instead
of any premium increase otherwise provided under paragraph (1), subject
to subsection (b), the monthly premium for each individual enrolled
under this part (otherwise determined without regard to this subsection)
shall be increased for months (beginning with January 1991) by a fraction
(determined under subparagraph (B)) of the premium increase determined
under paragraph (1).
`(B) The Secretary shall from time to time establish a fraction that
reflects the relative per capita outlays which are accounted for under
the Medicare Catastrophic Coverage Account for part B only individuals
compared to such per capita outlays for individuals entitled to benefits
under both part A and this part.'.
(6) CONFORMING AMENDMENTS- Section 1839 of such Act is further amended--
(A) in subsection (b), by striking `(g)(6)' and inserting `(g)(5)',
(B) in subsection (g)(6), by striking `(6)(A)' and inserting `(5)' and by
striking subparagraph (B),
(C) in subsection (g)(7), by striking `(7)(A) The Secretary and the
Secretary of the Treasury' and inserting `(5)(A) The Secretary', and
(D) in subsection (g)(8)--
(i) by striking subparagraphs (A), (B), and (C), and
(ii) by redesignating subparagraphs (D), (E), and (F) as subparagraphs (A),
(B), and (C), respectively.
(b) PAYMENT OF PART OF PREMIUM TO COVER PART A OUTLAYS- Section 1841(a)
of the Social Security Act (42 U.S.C. 1395t(a)), as amended through the
operation of subsection (c), is amended by adding at the end the following:
`There is appropriated from the Trust Fund to the Federal Hospital Insurance
Catastrophic Coverage Reserve Fund, from such amounts in the Trust Fund
as are attributable to premium increases imposed under section 1839(g)
for months after December 1989, amounts equal to the amount by which (1)
the amount of outlays made, from the Federal Hospital Insurance Trust Fund,
that are attributable to the amendments made by the Medicare Catastrophic
Coverage Act of 1988, as amended (other than outlays for extended care
services attributable to such amendments, except with respect to outlays
attributable to section 101(d)(2) of the Medicare Catastrophic Coverage
Reform Amendments of 1989), exceeds (2) amounts transferred under section
204(e) of the Medicare Catastrophic Coverage Reform Amendments of 1989 and
the reductions in outlays from the Federal Hospital Insurance Trust Fund. The
amounts appropriated by the preceding sentence shall be transferred from
time to time (not less frequently than monthly), such amounts to be based
on estimates by the Secretary of premiums and outlays described in such
sentence, and proper adjustments shall be made in amounts subsequently
transferred to the extent prior estimates were in excess of or were less
than appropriate amounts.'.
(c) REPEAL OF FEDERAL CATASTROPHIC DRUG INSURANCE TRUST FUND- Section 212
(other than paragraphs (3) and (4) of subsection (c)) of the Medicare
Catastrophic Coverage Act of 1988 is repealed and the provisions of the
Social Security Act amended by such section (other than such paragraphs)
shall be restored and revived as if such amendments had not been made.
(d) AMENDMENTS TO MEDICARE CATASTROPHIC COVERAGE ACCOUNT- Section 1841B
of the Social Security Act (42 U.S.C. 1395t-2) is amended--
(1) in subsection (a), by striking `, and section 59B of the Internal
Revenue Code of 1986,' and by striking `and for purposes of section 59B
of the Internal Revenue Code of 1986';
(2) by amending paragraph (1) of subsection (b) to read as follows:
`(1) The Account shall be--
`(A) credited for receipts of the Federal Supplementary Medical Insurance
Trust Fund attributable to premiums under section 1839(g) for months
beginning with January 1990,
`(B) debited for outlays under this title that are attributable to
the amendments made by the Medicare Catastrophic Coverage Act of 1988
(as amended) and to the provisions of section 101(d)(2) of the Medicare
Catastrophic Coverage Reform Amendments of 1989 with respect to services
furnished on or after January 1, 1990, and;
`(C) credited for reductions in outlays under this title that are
attributable to section 103 of the Medicare Catastrophic Coverage Reform
Amendments of 1989.';
(3) in subsection (b)(3), by striking `and the Secretary of the Treasury';
and
(4) in subsection (c)(2), by striking `and under section 59B of the Internal
Revenue Code of 1986'.
(e) 1-TIME TRANSFER OF NET ADDITIONAL PREMIUMS IN 1989- There shall be
transferred, as of January 1, 1990, from the Federal Supplementary Medical
Insurance Trust Fund to the Federal Hospital Insurance Catastrophic Coverage
Reserve Fund an amount equal to--
(1) the amount of the premiums collected pursuant to section 1839(g)
of the Social Security Act for months in 1989, minus
(2) the amount of administrative expenses incurred under part B of title
XVIII of such Act before January 1, 1990, relating to implementation of
the amendments made by the Medicare Catastrophic Coverage Act of 1988 and
by this Act, plus
(3) the amount of interest accrued to the Federal Supplementary Medical
Insurance Trust Fund attributable to balance described in paragraphs (1)
and (2).
(f) CONFORMING AMENDMENTS-
(1) Section 1844(a) of the Social Security Act (42 U.S.C. 1395w(a)) is
amended by striking `or section 59B of the Internal Revenue Code of 1986'.
(2) Section 1876(a)(5) of such Act (42 U.S.C. 1395ff(a)(5)) is amended
by striking `, the Federal Supplementary Medical Insurance Trust Fund,
and the Federal Catastrophic Drug Insurance Trust Fund' and inserting
`and the Federal Supplementary Medical Insurance Trust Fund'.
(g) EFFECTIVE DATE- The amendments made by this section shall take effect
on the date of the enactment of this Act.

4ca6c972b8d9ce9e72d92a87615fb9f3d385242cce98106e15f7ad57a8c191fa

ORGANIZATIONS.
Notwithstanding any other provision of this title, the amendments made
by this title (other than repeal of Section 1833(c)(5) and 1834(c)(6)
of the Social Security Act) shall not apply to risk-sharing contracts,
for contract year 1990--
(1) with eligible organizations under section 1876 of the Social Security
Act, or
(2) with health maintenance organizations under section 1876(i)(2)(A)
of such Act (as in effect before February 1, 1985), under section 402(a)
of the Social Security Amendments of 1967, or under section 222(a) of the
Social Security Amendments of 1972.'.

4eb8c678cd07b11a1dc3ad67610a5fe432a5cbfd5ffe7ef66fc276773b55de55

Effective as if included in the Medicare Catastrophic Coverage Act of
1988, section 104(c)(2) of such Act is amended by striking the period at
the end and inserting the following: `, without regard to whether any of
such beneficiaries exhausted medicare inpatient hospital benefits before
January 1, 1989.'.

97347de32f1292bba6aae1cb6101d1ddacd43c1ba3686b438c3eb0d4d9b60967

(a) IN GENERAL- Section 1882 of the Social Security Act (42 U.S.C. 1395ss),
as amended by section 221(d) of the Medicare Catastrophic Coverage Act of
1988, is amended--
(1) in the third sentence of subsection (a) and in subsection (b)(1), by
striking `subsection (k)(3)' and inserting `subsections (k)(3), (k)(4),
(m), and (n)';
(2) in subsection (k)--
(A) in paragraph (1)(A), by inserting `except as provided in subsection
(m),' before `subsection (g)(2)(A)', and
(B) in paragraph (3), by striking `subsection (l)' and inserting `subsections
(l), (m), and (n)'; and
(3) by adding at the end the following new subsections:
`(m)(1)(A) If, within the 90-day period beginning on the date of the
enactment of this subsection, the National Association of Insurance
Commissioners (in this subsection and subsection (n) referred to as the
`Association') revises the amended NAIC Model Regulation (referred to in
subsection (k)(1)(A) and adopted on September 20, 1988) to reflect the
changes in law made by the Medicare Catastrophic Coverage Reform Amendments
of 1989, subsection (g)(2)(A) shall be applied in a State, effective on and
after the date specified in subparagraph (B), as if the reference to the
Model Regulation adopted on June 6, 1979, were a reference to the amended
NAIC Model Regulation (referred to in subsection (k)(1)(A)) as revised by
the Association in accordance with this paragraph (in this subsection and
subsection (n) referred to as the `revised NAIC Model Regulation').
`(B) The date specified in this subparagraph for a State is the earlier of
the date the State adopts standards equal to or more stringent than the
revised NAIC Model Regulation or 1 year after the date the Association
first adopts such revised Regulation.
`(2)(A) If the Association does not revise the amended NAIC Model Regulation,
within the 90-day period specified in paragraph (1)(A), the Secretary
shall promulgate, not later than 60 days after the end of such period,
revised Federal model standards (in this subsection and subsection (n)
referred to as `revised Federal model standards') for medicare supplemental
policies to reflect the changes in law made by the Medicare Catastrophic
Coverage Reform Amendments of 1989, subsection (g)(2)(A) shall be applied
in a State, effective on and after the date specified in subparagraph
(B), as if the reference to the Model Regulation adopted on June 6, 1979,
were a reference to the revised Federal model standards.
`(B) The date specified in this subparagraph for a State is the earlier of
the date the State adopts standards equal to or more stringent than the
revised Federal model standards or 1 year after the date the Secretary
first promulgates such standards.
`(3) Notwithstanding any other provision of this section (except as provided
in subsection (n))--
`(A) no medicare supplemental policy may be certified by the Secretary
pursuant to subsection (a),
`(B) no certification made pursuant to subsection (a) shall remain in
effect, and
`(C) no State regulatory program shall be found to meet (or to continue
to meet) the requirements of subsection (b)(1)(A),
unless such policy meets (or such program provides for the application
of standards equal to or more stringent than) the standards set forth in
the revised NAIC Model Regulation or the revised Federal model standards
(as the case may be) by the date specified in paragraph (1)(B) or (2)(B)
(as the case may be).
`(n)(1) Until the date specified in paragraph (4), in the case of a
qualifying medicare supplemental policy described in paragraph (3) issued
in a State--
`(A) before the transition deadline, the policy is deemed to remain in
compliance with the standards described in subsection (b)(1)(A) only if
the insurer issuing the policy complies with the transition provision
described in paragraph (2), or
`(B) on or after the transition deadline, the policy is deemed to be
in compliance with the standards described in subsection (b)(1)(A) only
if the insurer issuing the policy complies with the revised NAIC Model
Regulation or the revised Federal model standards (as the case may be)
before the date of the sale of the policy.
In this paragraph, the term `transition deadline' means 1 year after the
date the Association adopts the revised NAIC Model Regulation or 1 year
after the date the Secretary promulgates revised Federal model standards
(as the case may be).
`(2) The transition provision described in this paragraph is--
`(A) such transition provision as the Association provides, by not later
than December 15, 1989, so as to provide for an appropriate transition (i)
to restore benefit provisions which are no longer duplicative as a result of
the changes in benefits under this title made by the Medicare Catastrophic
Coverage Reform Amendments of 1989 and (ii) to eliminate the requirement
of payment for the first 8 days of coinsurance for extended care services, or
`(B) if the Association does not provide for a transition provision by
the date described in subparagraph (A), such transition provision as
the Secretary shall provide, by January 1, 1990, so as to provide for an
appropriate transition described in subparagraph (A).
`(3) In paragraph (1), the term `qualifying medicare supplemental policy'
means a medicare supplemental policy which has been issued in compliance
with this section as in effect on the date before the date of the enactment
of this subsection.
`(4)(A) The date specified in this paragraph for a policy issued in a
State is--
`(i) the first date a State adopts, after the date of the enactment of
this subsection, standards equal to or more stringent than the revised NAIC
Model Regulation (or revised Federal model standards), as the case may be, or
`(ii) the date specified in subparagraph (B),
whichever is earlier.
`(B) In the case of a State which the Secretary identifies, in consultation
with the Association, as--
`(i) requiring State legislation (other than legislation appropriating
funds) in order for medicare supplemental policies to meet standards
described in subparagraph (A)(i), but
`(ii) having a legislature which is not scheduled to meet in 1990 in a
legislative session in which such legislation may be considered,
the date specified in this subparagraph is the first day of the first calendar
quarter beginning after the close of the first legislative session of the
State legislature that begins on or after January 1, 1990. For purposes of
the previous sentence, in the case of a State that has a 2-year legislative
session, each year of such session shall be deemed to be a separate regular
session of the State legislature.
`(5) In the case of a medicare supplemental policy in effect on January 1,
1990, the policy shall not be deemed to meet the standards in subsection
(c) unless each individual who is entitled to benefits under this title and
is a policyholder or certificate holder under such policy on such date is
sent a notice in an appropriate form by not later than January 31, 1990,
that explains--
`(A) the changes in benefits under this title effected by the Medicare
Catastrophic Coverage Reform Amendments of 1989, and
`(B) how these changes may affect the benefits contained in such policy
and the premium for the policy.
`(6)(A) Except as provided in subparagraph (B), in the case of an individual
who had in effect, as of December 31, 1988, a medicare supplemental policy
with an insurer (as a policyholder or, in the case of a group policy, as
a certificate holder) and the individual terminated coverage under such
policy before the date of the enactment of this subsection, no medicare
supplemental policy of the insurer shall be deemed to meet the standards
in subsection (c) unless the insurer--
`(i) provides written notice, no earlier than December 15, 1989, and no
later than January 30, 1990, to the policyholder or certificate holder (at
the most recent available address) of the offer described in clause (ii), and
`(ii) offers the individual, during a period of at least 60 days beginning
not later than February 1, 1990, reinstitution of coverage (with coverage
effective as of January 1, 1990), under the terms which (I) do not provide
for any waiting period with respect to treatment of pre-existing conditions,
(II) provides for coverage which is substantially equivalent to coverage
in effect before the date of such termination, and (III) provides for
classification of premiums on which terms are at least as favorable to
the policyholder or certificate holder as the premium classification terms
that would have applied to the policyholder or certificate holder had the
coverage never terminated.
`(B) An insurer is not required to make the offer under subparagraph (A)(ii)
in the case of an individual who is a policyholder or certificate holder
in another medicare supplemental policy as of the date of the enactment
of this subsection, if (as of January 1, 1990) the policy under which
the individual was provided coverage provides for no waiting period with
respect to treatment of a pre-existing condition.'.
(b) SENSE OF CONGRESS- It is the sense of Congress that States should
respond, at the earliest practicable date after the date of enactment of
this Act, to requests by insurers for review and approval of riders and
premium adjustments for medicare supplemental policies in order to comply
with the amendments made by subsection (a) and that all such premium
adjustments be effective January 1, 1990.

ca54db0a7133ca7ccbd76ec05133318ed0c93b7ba64e67a1097b16f43fa7e55b

TITLE III

-MISCELLANEOUS

The Secretary of Health and Human Services shall provide, in the notice of
medicare benefits provided under section 1804 of the Social Security Act
of 1990, for a description of the changes in benefits under title XVIII
of such Act made by the amendments made by this title.

1d52493556e5d4f6ec7915bd26e01d0c1656001421387aefddde7ea8df921210

(a) CORRECTIONS RELATING TO CATASTROPHIC DRUG BENEFIT-
(1) DEFINITION OF COVERED OUTPATIENT DRUGS- Section 1861(t)(3)(A) of the
Social Security Act, as added by section 202(a)(2)(C) of the Medicare
Catastrophic Coverage Act of 1988 (in this section referred to as `MCCA'),
is amended--
(A) by redesignating clauses (iv) through (xiii) as clauses (vi), (vii),
(viii), (ix), (x), (xii), (xiii), (xiv), (xvi), and (xviii), respectively;
(B) by inserting after clause (iii) the following:
`(iv) Diagnostic services under subsections (s)(2)(C) and (s)(3).
`(v) X-ray, radium, and radioactive isotope therapy under subsection
(s)(4).';
(C) by inserting after clause (x), as so redesignated, the following:
`(xi) Parenteral nutrition nutrients under subsection (s)(8).';
(D) by inserting after clause (xvi), as so redesignated, the following:
`(xv) Partial hospitalization services (as defined in subsection (ff)).'; and
(E) by inserting after clause (xvi), as so redesignated, the following:
`(xvii) Qualified psychologist services (as defined in subsection (ii)).'.
(2) COVERED HOME IV DRUGS- Section 1861(t)(4)(A) of such Act (42
U.S.C. 1395x(t)(4)(A)) is amended by striking `dispensed' and inserting
`furnished by a qualified home intravenous drug therapy provider'.
(3) REFERENCES TO CATASTROPHIC DRUG DEDUCTIBLE AMOUNT- Section 1834(c) of
the Social Security Act, as added by section 202(b)(4) of MCCA, is amended--
(A) in paragraph (2)(A), by striking `under paragraph (1)(A) and except
as provided in subparagraph (C)' and inserting `under paragraph (1)', and
(B) in paragraph (8)(E), by striking `paragraph (1)(A)' each place it
appears and inserting `paragraph (1)'.
(b) SCREENING MAMMOGRAPHY-
(1) APPLICATION OF PARTICIPATING PHYSICIAN DIFFERENTIAL- Section 1834(e)(4)
of the Social Security Act, as added by section 204(b)(2) of MCCA, is
amended by adding at the end the following new subparagraph:
`(D) APPLICATION OF PARTICIPATING PHYSICIAN DIFFERENTIAL- In applying the
limit under subparagraph (A) with respect to a nonparticipating physician,
the limit applied shall be the applicable percent (as defined in the second
sentence of section 1842(b)(4)(A)(iv)) of the limit otherwise established
in that subparagraph.'.
(2) FREQUENCY OF SCREENING- Section 1834(e)(2)(A) of the Social Security
Act, as added by section 204(b)(2) of MCCA, is amended--
(A) in clause (iii)(I), by striking `the 11 months of a previous screening
mammography' and inserting `11 months following the month in which a
previous screening mammography was performed',
(B) in clause (iii)(II), by striking `the 23 months of a previous screening
mammography' and inserting `23 months following the month in which a
previous screening mammography was performed',
(C) in clause (iv), by striking `11 months of a previous screening
mammography' and inserting `11 months following the month in which a
previous screening mammography was performed', and
(D) in clause (v), by striking `23 months of a previous screening
mammography' and inserting `23 months following the month in which a
previous screening mammography was performed'.
(c) ROUNDING OF PART B PREMIUM- Section 1839 of the Social Security Act,
as amended by section 211(c)(1)(E) of MCCA, is amended--
(1) in the first sentence of subsection (b), by striking `subsections (f)
and (g)(5)' and inserting `subsection (f)',
(2) in subsection (b), by inserting after the first sentence the following
new sentence: `If the resulting monthly premium is not a multiple of
10 cents, such premium shall be rounded to the nearest multiple of 10
cents.', and
(3) in subsection (c), by striking `the foregoing provisions of this section'
and inserting `subsection (a)(3) or (e)'.
(d) MISCELLANEOUS-
(1) Clause (iii) of section 1814(a)(7)(A) of the Social Security Act,
as added by section 104(d)(2)(C)(iii) of MCCA, is amended by moving its
alignment 2 ems to the left so its alignment is the same as that of clause
(ii) of such section.
(2) Section 1842(p)(3)(B) of the Social Security Act, as added by section
202(g) of MCCA, is amended by striking `section 1842(j)(2)(A)' and inserting
`subsection (j)(2)(A)'.
(3) Section 221(g)(3) of MCCA is amended by striking `subsection (f)'
and inserting `subsection (e)'.
(4) Section 1842(h)(5)(B)(iv) of the Social Security Act, as added by
section 223(b)(4) of MCCA, is amended by striking `paragraph (2)(A)'
and inserting `paragraph (2)'.
(e) MISCELLANEOUS CORRECTIONS RELATING TO THE OMNIBUS BUDGET RECONCILIATION
ACT OF 1987-
(1) Effective as if included in the enactment of the Omnibus Budget
Reconciliation Act of 1987, section 1834(b)(4)(A) of the Social Security
Act, as added by section 4049(a)(2) of the Omnibus Budget Reconciliation
Act of 1987, is amended by striking `insurance and deductibles under
section 1835(a)(1)(I)' and inserting `coinsurance and deductibles under
sections 1833(a)(1)(J)'.
(2) Section 1842(j)(1)(C)(vii) of the Social Security Act, as added by
section 4085(i)(7)(C) of the Omnibus Budget Reconciliation Act of 1987,
is amended by striking `accordingly' and inserting `according'.
(3) Section 1886(g)(3)(A)(iv) of the Social Security Act, as added by
section 4006(a)(2) of the Omnibus Budget Reconciliation Act of 1987,
is amended by striking `may) be' and inserting `may be)'.
(f) OTHER CORRECTIONS-
(1) Section 1866(a)(1)(F)(i)(III) of the Social Security Act is amended
by striking `fiscal year))' and inserting `fiscal year)'.
(2) Section 1875(c)(7) of the Social Security Act, as added by section
9316(a) of the Omnibus Budget Reconciliation Act of 1986, is amended by
striking `date of the enactment of this Act' and inserting `date of the
enactment of this section'.
(3) Section 1842(j)(2)(B) of the Social Security Act, as amended by section
8(c)(2)(A) of the Medicare and Medicaid Fraud and Abuse Patient Protection
Act of 1987, is amended by striking `paragraphs' and inserting `subsections'.

5eb1fe7dc93138b3e2871ff37be0360a40708014de502933f66ee4cef1385632

EMPLOYERS TO COMPENSATE FOR DUPLICATION OF MEDICARE BENEFITS BY HEALTHCARE
BENEFITS PROVIDED BY THE EMPLOYERS.
(a) OLD-AGE SURVIVORS, AND DISABILITY, AND HOSPITAL INSURANCE PROGRAMS-
For purposes of title II of the Social Security Act and chapter 21 of
the Internal Revenue Code of 1986, the term `wages' shall not include the
amount of any refund required under section 421 of the Medicare Catastrophic
Coverage Act of 1988.
(b) RAILROAD RETIREMENT PROGRAM- For purposes of chapter 22 of the Internal
Revenue Code of 1986, the term `compensation' shall not include the amount
of any refund required under section 421 of the Medicare Catastrophic
Coverage Act of 1988.
(c) FEDERAL UNEMPLOYMENT PROGRAMS-
(1) FEDERAL UNEMPLOYMENT TAX- For purposes of chapter 23 of the Internal
Revenue Code of 1986, the term `wages' shall not include the amount of any
refund required under section 421 of the Medicare Catastrophic Coverage
Act of 1988.
(2) RAILROAD UNEMPLOYMENT CONTRIBUTIONS- For purposes of the Railroad
Unemployment Insurance Act, the term `compensation' shall not include the
amount of any refund required under section 421 of the Medicare Catastrophic
Coverage Act of 1988.
(3) RAILROAD UNEMPLOYMENT REPAYMENT TAX- For purposes of chapter 23A of the
Internal Revenue Code of 1986, the term `rail wages: shall not include the
amount of any refund required under section 421 of the Medicare Catastrophic
Coverage Act of 1988.
(d) EFFECTIVE DATE- This section shall apply with respect to refunds
provided on or after January 1, 1989.
Attest:
Secretary.
HR 3607 EAS----2
HR 3607 EAS----3
HR 3607 EAS----4

ca858c3861a024e1c82dde8b9de361ff9dc9d7e65d8c74628b501b54597e61e8

Medicare Catastrophic Coverage Repeal Act of 1989

Other Sections

TITLE I

TITLE II

TITLE III

TITLE IV

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