The Act also required that the previously existing cost-based reimbursementsystem for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) be phasedout over a 6-year period. Includedin that bill by reference was the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Actof 1999 (BBRA 99), a bill largely comprised of Medicare provisions, but which also included anumber of changes to Medicaid and the State Children's Health Insurance Program (SCHIP;described below). H.R. On December 15, 2000, the Consolidated Appropriations Act 2001 ( H.R. 4577 )was passed by the House and Senate; it was signed into law on December 21 ( P.L. 106-554 ). It also included major provisions amendingother health programs. With respect to Medicaid, a number of changes are made to disproportionate share hospital(DSH) funding. Additional funds are provided for certain state public hospitals not receiving DSH payments andhaving a low-income utilization rate in excess of 65%. The are two other major Medicaid provisions in the agreement. The agreement also modifies proposedHHS rules governing upper payment limits on inpatient and outpatient services provided by certaintypes of facilities, and requires that final regulations be issued by the end of 2000. With respect to SCHIP, the agreement extends the availability of unused FY1998 andFY1999 SCHIP allotments. (3) Following specific formulas, these unspent funds are redistributedto both those states that have and those that have not fully exhausted their original allotments withinrequired time frames. Current law redistributes unused funds only to those states that spend theirallotments. With respect to other programs, the agreement requires that outreach efforts be implementedto identify individuals who may be eligible for Medicaid payment of Medicare cost-sharing and thatthose individuals are notified of the availability of such assistance. The agreement increases theauthorization of annual appropriations for the MCH Services Block Grant from $705 million to $850million for FY2001 and thereafter. In addition, the bill extends for 1 year, to FY2003, the authorityfor grants to be made for both the Special Diabetes Programs for Type I Diabetes and the SpecialDiabetes Programs for Indians. Finally, the agreement provides for a direct appropriation of $475 million forFY2001, in addition to funds appropriated in the FY2001 Labor-HHS-Education appropriations bill,for the Ricky Ray Hemophilia Relief Fund. For detailed information on the Medicare provisions contained inthe Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, see CRS Report RL30707(pdf) , Medicare Provisions in H.R. 5661: Medicare, Medicaidand SCHIP Benefits Improvement and Protection Act of 2000 (available upon request).
While largely comprised of Medicare provisions, the Medicare, Medicaid, and SCHIPBenefits Improvement and Protection Act of 2000 ( H.R. 5661 ), a compromiseagreement between House and Senate committees and the leadership, includes a number of importantchanges to Medicaid and the State Children's Health Insurance Program (SCHIP). It also includesmajor provisions amending other programs. The provisions of H.R. 5661 areincorporated, by reference into H.R. 4577 , the Consolidated Appropriations Act 2001. H.R. 4577 was passed by the House and Senate on December 15, 2000 and was signedinto law on December 21 ( P.L. 106-554 ).
Among the major Medicaid modifications are several provisions affecting disproportionateshare hospital (DSH) payments provided to hospitals that treat a disproportionate share of uninsuredand Medicaid enrollees. The agreement increases the disproportionate share hospital allotments forstates. It also extends a special DSH payment rule for public hospitals in California to qualifyingfacilities in all states, and provides additional funds to certain public hospitals not receiving DSHpayments. In addition to these DSH provisions, the bill replaces cost-based reimbursement with aprospective payment system for Federally Qualified Health Centers (FQHCs) and Rural HealthCenters (RHCs). The agreement also modifies proposed rules governing upper payment limits oninpatient and outpatient services provided by certain types of facilities, and requires that the finalregulations be issued by the end of 2000.
One major SCHIP provision extends the availability of unused funds from FY1998 andFY1999 and redistributes these unused funds among both those states that spend and those that donot spend their full original allotments for these years. Current law requires that these unused fundsbe distributed only to those states that spend their allotments.
Among other major provisions, the agreement requires that outreach efforts be implementedto identify individuals who may be eligible for Medicaid payment of Medicare cost-sharing and tonotify these persons of the availability of such assistance. It increases the authorization of annualappropriations for the Maternal and Child Health Services Block Grant under Title V. In addition,the bill extends for 1 year, to FY2003, the authority for grants to be made for both the SpecialDiabetes Program for Type I Diabetes and the Special Diabetes Programs for Indians and increasestotal funding for FY2001 through FY2003. Finally, the agreement provides an additional FY2001direct appropriation for the Ricky Ray Hemophilia Relief Fund.
For information on the Medicare provisions, see CRS Report RL30707(pdf) , Medicare Provisionsin H.R. 5661: Medicare, Medicaid and SCHIP Benefits Improvement and Protection Actof 2000 (available upon request).