Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999

Subtitle B: PPS Exempt Hospitals - Amends SSA title XVIII part D to: (1) limit the target amount for described hospitals that are exempt from PPS payment; and (2) direct the Secretary to provide for an appropriate wage adjustment with regard to such hospitals.

(Sec. 112) Provides for increased target amounts in computing payments for long-term care and psychiatric hospitals until development of a PPS for those hospitals.

(Sec. 113) Directs the Secretary to develop, implement, and report to Congress on: (1) a per discharge PPS for payment for inpatient hospital services of Medicare long-term care hospitals; and (2) develop a per diem PPS for payment for inpatient hospital services of Medicare psychiatric hospitals.

Subtitle C: Adjustments to PPS Payments for Skilled Nursing Facilities - Directs the Secretary, for purposes of computing prospective payments for covered skilled nursing facilities (SNFs), to temporarily increase payments for covered skilled nursing facility services for certain high cost patients.

(Sec. 122) Amends SSA title XVIII part D to revise provisions on payment to hospitals for inpatient hospital services to: (1) increase for FY 2001 the SNF unadjusted federal per diem rate; (2) permit a SNF to waive a three year transition period and elect to have the amount of payment for all covered facility costs determined pursuant to the adjusted Federal per diem rate applicable to it; (3) exclude certain additional items and services from being covered facility items and services (thus providing for Medicare part A (Hospital Insurance) pass-through payment for such items and services, including certain ambulance services and chemotherapy items) while ensuring budget neutrality for FY 2001; (4) apply to facilities participating in the Nursing Home Case-Mix and Quality Demonstration Project requirements for determining base payments on a per diem basis; and (5) modify requirements for the first cost reporting period update that is used in determining facility specific per diem rates.

Title II: Provisions Relating to Part B - Subtitle A: Adjustments to Physician Payment Updates - Amends SSA title XVIII part B (Supplementary Medical Insurance) to modify provisions on: (1) payment for physicians' services with regard to updates to provide for new guidelines for determining updates for years beginning with 2000; and (2) sustainable growth rate with regard to publication and with regard to the data to be used in determining such updates.

Subtitle B: Hospital Outpatient Services - Amends SSA title XVIII part B to revise requirements for the PPS for hospital OPD services to: (1) require the Secretary to provide for a specified outlier adjustment for covered OPD services, as well as transitional pass-through payments for additional costs of "innovative" medical devices, drugs, and biologicals, while ensuring budget neutrality; (3) include medical devices as covered OPD services; (4) allow the Secretary to elect to establish relative payment weights based on mean hospital costs for covered OPD services; (5) limit, generally, the variation of costs of covered OPD services classified within a group for purposes of comparable treatment with respect to the use of resources; (6) change the Secretary's optional periodic review of PPS components to a mandatory annual review; and (7) establish a transitional adjustment in the amount of PPS payment for covered OPD services to limit declining payments under Medicare for such services.

Subtitle C: Other - Amends SSA title XVIII to provide for: (1) application of separate currently existing caps for speech-language pathology and for other outpatient physical therapy services on a per beneficiary, per facility basis; (2) optional, limited exemption of certain therapy services facilities from any applicable caps for 2000 and 2001; (3) mandatory annual increases in end stage renal disease dialysis composite rate payment amounts; and (4) revised annual covered item updates for 2001 and 2002 for certain durable medical equipment.

Title III: Provisions Relating to Parts A and B - Subtitle A: Home Health Services - Provides, in the case of a home health agency that furnishes home health services to a Medicare beneficiary, that for each beneficiary furnished such services during the agency's cost reporting period beginning in FY 2000, the Secretary shall, in accordance with specified restrictions, pay the agency a specified amount out of the Medicare trust funds in addition to any other amount of payment to defray agency costs attributable to data collection and reporting requirements under the Outcome and Assessment Information (OASIS) required under BBA '97.

(Sec. 302) Amends BBA '97 and Medicare with regard to the PPS for home health services to delay for one year the application of the 15 percent reduction in payment rates for home health services.

Subtitle B: Direct Graduate Medical Education - Amends SSA title XVIII to provide for the use of national average per resident payment system in computing payments for direct graduate medical education (DGME) costs.

Title IV: Rural Provider Provisions - Amends SSA title XVIII to permit the reclassification of certain urban hospitals as rural ones.

(Sec. 402) Ties the standards applied for geographic reclassification of certain rural hospitals to the most recently available census data.

(Sec. 403) Revises the critical access hospital program, permitting for-profit hospitals to qualify for designation as a critical access hospital. Provides for an all-inclusive payment option for outpatient critical access hospital services. Eliminates coinsurance payments for clinical diagnostic laboratory tests furnished by a critical access hospital on an outpatient basis. Allows certain currently excluded hospitals to be providers of extended care services.

(Sec. 404) Extends for five years the Medicare-dependent, small rural hospital program.

(Sec. 405) Mandates rebasing for certain sole community hospitals that elect such treatment, in accordance with specified guidelines with respect to select fiscal year discharges.

(Sec. 406) Revises provisions on payments for direct and indirect graduate medical education costs to expand current graduate medical education training programs for hospitals located in rural areas, and to encourage the training of physicians in underserved rural areas.

(Sec. 407) Eliminates the requirement for State certification of need and certain restrictions on a hospital with more than 49 beds that provides extended care services.

(Sec. 408) Authorizes the Secretary to award grants to assist eligible small rural hospitals in meeting the costs of implementing data systems required to meet Medicare requirements established by BBA '97.

(Sec. 409) Directs the Medicare Payment Advisory Commission (MEDPAC) to study and report to Congress on rural providers under Medicare.

Title V: Provisions Relating to Part C (Medicare+Choice Program) - Subtitle A: Medicare+Choice - Amends SSA title XVIII part C (Medicare+Choice) and D (Miscellaneous) to provide for: (1) phased-in new risk adjustment methodology under provisions for payments to Medicare+Choice organizations; (2) increased monthly payments under such provisions for a limited period to encourage the offering of Medicare+Choice plans in certain areas where such a plan has either not been offered or is offered but slated for termination; (3) modification of the five-year reentry rule for Medicare+Choice organizations whose contracts have been terminated; (4) continued annual computation and publication of county-specific per capita fee-for-service expenditure information; (5) enrollment in alternative Medicare+Choice plans and Medicare supplemental health insurance policy (Medigap) coverage in case of involuntary termination of Medicare+Choice enrollment; (6) authorized variation in premium values within a service area if the annual Medicare+Choice capitation rates vary within the area; (7) a delayed deadline for submission of adjusted community rates and related information; (8) extension of Medicare reasonable cost reimbursement contracts under provisions for payments to health maintenance organizations (HMOs) and competitive medical plans; and (9) permission for religious fraternal benefit societies to offer a range of Medicare+Choice plans.

(Sec. 510) Directs MEDPAC to report to Congress on specific legislative changes that should be made to make Medicare medical savings account plans a viable option under the Medicare+Choice program.

Subtitle B: Social Health Maintenance Organizations (SHMOs) - Amends the Omnibus Budget Reconciliation Act of 1987 to: (1) extend social health maintenance organization (SHMO) demonstration project authority; and (2) replace the current limit on the number of individuals who may participate in a SHMO I or II project site with an aggregate limit for all sites.