a rate equal to 95 percent of the amount paid to a Medicare+Choice organization under part D of this title with respect to such an enrollee. In cases in which a payment amount may not otherwise be readily computed, the Secretary shall establish rules for computing equivalent or comparable payment amounts. (2) EXCLUSION OF CERTAIN AMOUNTS.-In computing the amount of payment under paragraph (1), the following shall be excluded: (A) SPECIAL PAYMENTS.—Any amount attributable to an adjustment under subparagraphs (B) and (F) of section 1886(d)(5) and subsection (h) of such section. (B) PERCENTAGE OF CAPITAL PAYMENTS.-An amount determined by the administering Secretaries for amounts attributable to payments for capital-related costs under subsection (g) of such section. (3) PERIODIC PAYMENTS FROM MEDICARE TRUST FUNDS.-Payments under this subsection shall be made (A) on a periodic basis consistent with the periodicity of payments under this title; and (B) in appropriate part, as determined by the Secretary, from the trust funds. (4) CAP ON AMOUNT.-The aggregate amount to be reimbursed under this subsection pursuant to the agreement entered into between the administering Secretaries under subsection (b) shall not exceed a total of (A) $50,000,000 for calendar year 1998; (j) MAINTENANCE OF EFFORT.— (1) MONITORING EFFECT OF DEMONSTRATION PROGRAM ON COSTS TO MEDICARE PROGRAM. (A) IN GENERAL.-The administering Secretaries, in consultation with the Comptroller General, shall closely monitor the expenditures made under the medicare program for medicareeligible military retirees or dependents during the period of the demonstration project compared to the expenditures that would have been made for such medicare- eligible military retirees or dependents during that period if the demonstration project had not been conducted. The agreement entered into by the administering Secretaries under subsection (b) shall require any participating military treatment facility to maintain the level of effort for space available care to medicare eligible military retirees or dependents. (B) ANNUAL REPORT BY THE COMPTROLLER GENERAL.-Not later than December 31 of each year during which the demonstration project is conducted, the Comptroller General shall submit to the administering Secretaries and the appropriate committees of Congress a report on the extent, if any, to which the costs of the Secretary under the medicare program under this title increased during the preceding fiscal year as a result of the demonstration project. (2) REQUIRED RESPONSE IN CASE OF INCREASE IN COSTS.— (A) IN GENERAL.-If the administering Secretaries find, based on paragraph (1), that the expenditures under the medicare program under this title increased (or are expected to increase) during a fiscal year because of the demonstration project, the administering Secretaries shall take such steps as may be needed (i) to recoup for the medicare program the amount of such increase in expenditures; and (ii) to prevent any such increase in the future. (B) STEPS. Such steps (i) under subparagraph (A)(i) shall include payment of the amount of such increased expenditures by the Secretary of Defense from the current medical care appropriation of the Department of Defense to the trust funds; and (ii) under subparagraph (A)(ii) shall include suspending or terminating the demonstration project (in whole or in part) or lowering the amount of payment under subsection (i)(1). ) EVALUATION AND REPORTS. (1) INDEPENDENT EVALUATION.-The Comptroller General of the United States shall conduct an evaluation of the demonstration project, and shall submit annual reports on the demonstration project to the administering Secretaries and to the committees of jurisdiction in the Congress. The first report shall be submitted not later than 12 months after the date on which the demonstration project begins operation, and the final report not later than 32 years after that date. The evaluation and reports shall include an assessment, based on the agreement entered into under subsection (b), of the following: (A) Any savings or costs to the medicare program under this title resulting from the demonstration project. (B) The cost to the Department of Defense of providing care to medicare-eligible military retirees and dependents under the demonstration project. (C) A description of the effects of the demonstration project on military treatment facility readiness and training and the probable effects of the project on overall Department of Defense medical readiness and training. (D) Any impact of the demonstration project on access to care for active duty military personnel and their dependents. (E) An analysis of how the demonstration project affects the overall accessibility of the uniformed services treatment system and the amount of space available for pointof service care, and a description of the unintended effects (if any) upon the normal treatment priority system. (F) Compliance by the Department of Defense with the requirements under this title. (G) The number of medicare eligible military retirees and dependents opting to participate in the demonstration project instead of receiving health benefits through another health insurance plan (including benefits under this title). (H) A list of the health insurance plans and programs that were the primary payers for medicare-eligible military retirees and dependents during the year prior to their participation in the demonstration project and the dis tribution of their previous enrollment in such plans and programs. (I) Any impact of the demonstration project on private health care providers and beneficiaries under this title that are not enrolled in the demonstration project. (J) An assessment of the access to care and quality of care for medicare eligible military retirees and dependents under the demonstration project. (K) An analysis of whether, and in what manner, easier access to the uniformed services treatment system affects the number of medicare eligible military retirees and dependents receiving medicare health care services. (L) Any impact of the demonstration project on the access to care for medicare eligible military retirees and dependents who did not enroll in the demonstration project and for other individuals entitled to benefits under this title. (M) A description of the difficulties (if any) experienced by the Department of Defense in managing the demonstration project and TRICARE contracts. (N) Any additional elements specified in the agreement entered into under subsection (b). (0) Any additional elements that the Comptroller General of the United States determines is appropriate to assess regarding the demonstration project. (2) REPORT ON EXTENSION AND EXPANSION OF DEMONSTRATION PROJECT.-Not later than 6 months after the date of the submission of the final report by the Comptroller General of the United States under paragraph (1), the administering Secretaries shall submit to Congress a report containing their recommendation as to (A) whether there is a cost to the health care program under this title in conducting the demonstration project, and whether the demonstration project could be expanded without there being a cost to such health care program or to the Federal Government; (B) whether to extend the demonstration project or make the project permanent; and (C) whether the terms and conditions of the project should be continued (or modified) if the project is extended or expanded. TITLE XIX-GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS 1 on. itle XIX of the Social Security Act is administered by the Health Care Financing Administle XIX appears in the United States Code as §§1396-1396v, subchapter XIX, chapter 7, egulations relating to Title XIX are contained in chapter IV, Title 42, and subtitle A, Title Code of Federal Regulations. 42. e Vol. II, 31 U.S.Č. 6504-6505 with respect to intergovernmental cooperation. See Vol. II, JU.S.C. 7501-7507 with respect to uniform audit requirements for State and local governts receiving Federal financial assistance. ee Vol. II, P.L. 78-410, §317A(a) and (d), with respect to coordination required in lead poing prevention; §353(i)(3) and (n), with respect to clinical laboratories; and §1301(c)(3), with ect to the requirement that health maintenance organizations enroll individuals entitled to ical assistance under Title XIX. ee Vol. II, P.L. 79-396, §17(p), with respect to proprietary title XIX center. ee Vol. II, P.L. 88-164, §124(b)(3), with respect to the membership of the State Planning ncils. ee Vol. II, P.L. 88-352, §601, for prohibition against discrimination in federally assisted pro ms. ee Vol. II, P.L. 89-73, §§203 and 422(c), with respect to consultation, and §306(c) with rect to agreements with other agencies. ee Vol. II, P.L. 94-566, §503, with respect to preservation of medicaid eligibility for individs who cease to be eligible for supplemental security income benefits on account of cost-ofng increases in social security benefits. See Vol. II, P.L. 95–521, §102(i), with respect to reporting of benefits received under the SoSecurity Act. See Vol. II, P.L. 97-300, §106(e), with respect to performance standards; and §§501-505, with pect to the payment of a bonus for the successful job placement of certain employable dependindividuals. See Vol. II, P.L. 98-369, §2355, as amended by P.L. 101-508, §4207(b)(4)(B), with respect to vers for social health maintenance organizations. See Vol. II, P.L. 99-319, 8105, with respect to requirements for a system established regardthe rights of individuals with mental illness. See Vol. II, P.L. 100-203, §4211(j) with respect to technical assistance with respect to the deopment and implementation of reimbursement methods for nursing facilities. See Vol. II, P.L. 100-204, §724(d), with respect to furnishing information to the United States mmission on Improving the Effectiveness of the United Nations; and §725(b), with respect to detailing of Government personnel. See Vol. II, P.L. 100–235, §§5–8, with respect to responsibilities of each Federal agency for nputer systems security and privacy. See Vol. II, P.L. 100-690, §2306(c)(4), with respect to services covered in the plan of Hawaii; d §5301(aX1XC) and (d)(1)(B), with respect to benefits of drug traffickers and possessors. See Vol. II, P.L. 101-121, with respect to the amounts collected by the Secretary of Health d Human Services under the authority of title IV of the Indian Health Care Improvement t. See Vol. II, P.L. 101-239, §6407, with respect to demonstration projects to study the effect allowing States to extend medicaid to pregnant women and children not otherwise qualified receive medicaid benefits; §6408(a), with respect to medicaid provisions; §6507, with respect research on infant mortality and medicaid services; §6509, with respect to a maternal and ild health handbook; §8015, with respect to demonstration of effectiveness of Minnesota family vestment plan; and §10405, with respect to Agent Orange Settlement payments excluded from untable income and resources under Federal means-tested programs. See Vol. II, P.L. 101-508, §4401(c), with respect to demonstration projects; §4401(d), with reect to an annual report on drug pricing; §4745, with respect to demonstration projects to study e effect of allowing States to extend medicaid coverage to certain low-income families not othwise qualified to receive medicaid benefits; §4801(b)Ï), with respect to preadmission screening id annual resident review; §4801(eX7XB), with respect to a study and report on staffing reirements in nursing facilities; and §13302, with respect to protection of OASDI Trust Funds the House of Representatives. See Vol. II, P.L. 103-432, §233, with respect to the New Hope Demonstration Project. Sec. 1908. State programs for licensing of administrators of nursing 1435 homes. Sec. 1910. Certification and approval of rural health clinics and intermedi- 1438 Sec. 1911. Indian Health Service facilities ate care facilities for the mentally retarded. Assignment of rights of payment Withholding of Federal share of payments for certain medicare 1442 providers. 1439 1440 1441 Sec. 1912. Sec. 1913. Hospital providers of nursing facility services Sec. 1914. Sec. 1915. Provisions respecting inapplicability and waiver of certain re- 1443 quirements of this title. Sec. 1916. Use of enrollment fees, premiums, deductions, cost sharing, and 1452 similar charges. Sec. 1917. Sec. 1918. Liens, adjustments and recoveries, and transfers of assets 1456 1463 1463 1499 1501 Sec. 1920B. Sec. 1921. Sec. 1922. Sec. 1923. Sec. 1924. Presumptive eligibility for certain breast or cervical cancer pa- 1503 tients. Information concerning sanctions taken by State licensing au- 1504 thorities against health care practitioners and providers. Correction and reduction plans for intermediate care facilities 1506 for the mentally retarded. Adjustment in payment for inpatient hospital services fur- 1508 nished by disproportionate share hospitals. Treatment of income and resources for certain institutionalized 1517 Home and community care for functionally disabled elderly in- 1556 dividuals. State coverage of medicare cost-sharing for additional low-in- 1586 come medicare beneficiaries. SEC. 1901. [42 U.S.C. 1396] For the purpose of enabling each State, as far as practicable under the conditions in such State, to furnish (1) medical assistance on behalf of families with dependent 2 This table of contents does not appear in the law. |