legislation: 98-hr-5862

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bill_id congress bill_type bill_number title policy_area introduced_date latest_action_date latest_action_text origin_chamber sponsor_name sponsor_state sponsor_party sponsor_bioguide_id cosponsor_count summary_text update_date url
98-hr-5862 98 hr 5862 A bill to provide for an intra-HMO competition demonstration project. Health 1984-06-14 1984-06-19 Referred to Subcommittee on Health. House Rep. Pepper, Claude [D-FL-18] FL D P000218 16 Directs the Secretary of Health and Human Services to provide for Medicare (title XVIII of the Social Security Act) demonstration projects in at least four States, under which: (1) the Secretary would contract with one or more health maintenance organizations or competitive medical plans (organizations) to perform the functions both of intermediaries under part A (Hospital Insurance) of title XVIII and carriers under part B (Supplementary Medical Insurance) with respect to benefits furnished in a State; (2) if the Secretary contracts with one organization in an area, the Secretary must permit any other organization in the area to enter into such a contract; (3) individuals residing in the State covered by the project and entitled or enrolled under part A or B of title XVIII would be required to enroll with at least one participating organization, but may elect to receive any covered service through any qualified Medicare provider; (4) an organization may offer additional benefits, at no additional cost; (5) an organization will not charge copayments or deductibles if a beneficiary is enrolled with and receives benefits directly from the organization; (6) each organization would receive payment at an annual per capita rate equal to 95 percent of the adjusted per capita cost; and (7) each organization shall have the right of final claim review for necessity and appropriateness of items and services furnished. Directs the Secretary to submit to Congress a protocol report concerning such demonstration projects and annual reports. 2024-02-07T16:32:33Z  

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