Committee on Ways and Means, Full Committee, Summary of the Chairman's Amendment in the Nature of a Substitute to H.R. 4954

Committee on Ways and Means

Summary of Changes
Made by Chairman's Amendment in the Nature of a Substitute
to H.R. 4954, "Medicare Modernization and Prescription Drug Act of 2002"

*Title*	*Section*	*Page*	*Explanation of Change*
I	1860B	16	Changes catastrophic limit from $4,500 to $3,800.
I	1860B	17	Changes lines 19 and 20 to clarify that the Medicare Benefits Administrator certifies that variations in benefit design are actuarially equivalent.
I	1860B	19	Adds after subparagraph (d) that the Medicaid best price provision does not apply to qualified prescription drug coverage offered to Medicare beneficiaries.
I	1860B	20	Clarifies on line 3 that Medicare Benefits Administrator determines whether actuarial value of drug benefit meets standardized value.
I	1860C	28	Changes effective date of advisory report on line 6 from July 1, 2004 to January 1, 2005.
I	1860F	37	Clarifies that plans must permit beneficiaries to elect payment of premiums through Social Security withholding, as provided for Part B premiums
I	1860G	40	Adds in (B) the option for Medicare beneficiaries the option of having low-income subsidy eligibility determination made by the Social Security Administration (SSA).
I	1860G	40	Adds appropriation of “such sums” for eligibility determination through SSA.
I	1860H	44	Clarifies paragraph (a) (1) and (2) that the overall subsidy is a combined 65 percent, consisting of 35 percent direct subsidy and 30 percent reinsurance.
I	1860H	46	Clarifies the adjustment paragraph (d) on line 25 applies only to reinsurance.
I	1860H	47	Clarifies on line 30, any application of risk adjustment to the direct subsidy will not change aggregate payments.
I	104	61	Limits Meidigap cost sharing of qualified prescription drug expenses to two new Meidigap policies only.
I	104	61	Clarifies that NAIC changes to model policies shall be limited to the two benefit packages outlined in this section
II	201	68	Addition of section (g) after line 8 adds report on impact of increased financial assistance to Medicare+Choice plans.
III	305	93	Addition of new section (e) after line 7 that prevents recoupments of funds from critical access hospitals created by Centers for Medicare and Medicaid software error.
III	310	95	Strikes on line 31”expands or enhances” and replaces with “restricts or limits.”
IV	403	97	Removes substantially equivalent devices that are implantable from being automatically deemed as meeting substantial improvement.
IV	411	102	On line 27, adds temporary payments at 12% for 2003, 10% for 2004 and 8% for 2005 regarding skilled nursing facility temporary bonus payments for nursing component. On line 34, changes the dates to FY 2003, 2004 and 2005.
IV	431	106	On line 14, strikes “over” and replaces with “inaccurate.” On line 37, removes general language relating to other entities that might have a conflict of interest, continuing on page 107 lines 1-3.
IV	502	110	Change to line 4 alters report due date to 18 months after enactment.
IV	504	110	1 year treatment of certain pathology sections, continuing BIPA provision.
IV	513	117	Change in lines 11-16 to lengthen moratorium on therapy caps to 2 years, through 2004.
IV	513	118	Line 18 adds new item to study of direct access to physical therapists to examine effect of prohibiting physician self-referral for physical therapy services.
IV	513	118	Addition to line 24 includes analysis of eliminating physician certification in the study of direct access to physical therapists.
IV	515	120	Addition after line 6 waives deductible and co-payments for initial preventive physical examination.
V	517	121	Addition of new section 517 after line 37 that improves payment for certain mammography services.
VI	603	125	Replace on line 5, 1.0% with 1.1%. Replace lines 7-9 to clarify the increase is 2.7%.