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Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999
(Referred in Senate)
SEC. 226. INCREASE IN REIMBURSEMENT FOR PAP SMEARS.
(a) PAP SMEAR PAYMENT INCREASE- Section 1833(h) (42
U.S.C. 1395l(h)) is amended by adding at the end the following new
`(7) Notwithstanding paragraphs (1) and (4), the Secretary shall establish
a minimum payment amount under
this subsection for all areas for a diagnostic or screening pap smear laboratory test (including
all cervical cancer screening technologies that have been approved by the Food
and Drug Administration) of not less than $14.60.'.
(b) SENSE OF THE CONGRESS- It is the sense of the Congress that--
(1) the Health Care Financing Administration has been slow to
incorporate or provide incentives for providers to use new screening
diagnostic health care technologies in the area of cervical cancer;
(2) some new technologies have been developed which optimize the
effectiveness of pap smear
(3) the Health Care Financing Administration should institute an
appropriate increase in the payment rate for new cervical cancer
screening technologies that have been approved by the Food and Drug
Administration as significantly more effective than a conventional pap smear.
(c) EFFECTIVE DATE- The amendments made by subsection (a) apply to
services items and furnished on or after January 1, 2000.
SEC. 227. REFINEMENT OF AMBULANCE SERVICES DEMONSTRATION PROJECT.
Effective as if included in the enactment of BBA, section 4532 of BBA is
(1) in subsection (a), by adding at the end the following: `The
Secretary shall publish by not later than July 1, 2000, a request for
proposals for such projects.'; and
(2) by amending paragraph (2) of subsection (b) to read as
`(2) CAPITATED PAYMENT
RATE DEFINED- In this subsection, the `capitated payment rate' means, with respect to
a demonstration project--
`(A) in its first year, a rate established for the project by the
Secretary, using the most current available data, in a manner that ensures
that aggregate payments under the project will not exceed the aggregate
payment that would have been
made for ambulance services under part B of title XVIII of the Social
Security Act in the local area of government's jurisdiction; and
`(B) in a subsequent year, the capitated payment rate established for the
previous year increased by an appropriate inflation adjustment
SEC. 228. PHASE-IN OF PPS FOR AMBULATORY SURGICAL CENTERS.
If the Secretary of Health and Human Services implements a revised
prospective payment system for
services of ambulatory surgical facilities under part B of title XVIII of the
Social Security Act, prior to incorporating data from the 1999 Medicare cost
survey, such system shall be implemented in a manner so that--
(1) in the first year of its implementation, only a proportion
(specified by the Secretary and not to exceed 1/3 ) of the payment for such services shall be
made in accordance with such system and the remainder shall be made in
accordance with current regulations; and
(2) in the following year a proportion (specified by the Secretary and
not to exceed 2/3 ) of the payment for such services shall be
made under such system and the remainder shall be made in accordance with
SEC. 229. EXTENSION OF MEDICARE BENEFITS FOR IMMUNOSUPPRESSIVE DRUGS.
(a) IN GENERAL- The Secretary of Health and Human Services shall provide
under this section for an extension of the period of coverage of
immunosuppressive drugs under section 1861(s)(2)(J) of the Social Security Act
(42 U.S.C. 1395x(s)(2)(J)) to individuals described in such section under
terms and conditions specified by the Secretary consistent with subsection (c)
and the objectives--
(1) of improving health outcomes by decreasing transplant rejection
rates that are attributable to failure to comply with immunosuppressive drug
(2) of achieving cost saving to the Medicare program by decreasing the
need for secondary transplants and other care relating to post-transplant
(b) AUTHORITY- In carrying out this section--
(1) the Secretary shall provide priority in eligibility to those
Medicare beneficiaries who, because of income or other factors, would be
less likely to maintain an immunosuppressive drug regimen in the absence of
such an extension; and
(2) the Secretary is authorized to vary the beneficiary cost-sharing
otherwise applicable in order to promote the objectives described in
(c) LIMITATIONS- The total amount expended by the Secretary under title
XVIII of the Social Security Act to carry out this section shall not exceed
$200,000,000, and with respect to expenditures in fiscal year 2000 shall not
exceed $40,000,000. The Secretary shall not provide an extension of coverage
under this section for immunosuppressive drugs furnished after September 30,
(d) REPORT- Not later than 36 months after the first month in which the
Secretary provides for extended benefits under this section, the Secretary
shall submit to Congress a report on the operation of this section. The report
(1) an analysis of the impact of this section on meeting the objectives
described in subsection (a); and
(2) recommendations regarding an appropriate cost-effective method for
extending coverage of immunosuppressive drugs under the Medicare program on
a permanent basis.
SEC. 230. ADDITIONAL STUDIES.
(a) MEDPAC STUDY ON POSTSURGICAL RECOVERY CARE CENTER SERVICES-
(1) IN GENERAL- The Medicare Payment Advisory Commission shall
conduct a study on the cost-effectiveness and efficacy of covering under the
Medicare program services of a post-surgical recovery care center (that
provides an intermediate level of recovery care following surgery). In
conducting such study, the Commission shall consider data on these centers
gathered in demonstration projects.
(2) REPORT- Not later than 1 year after the date of the enactment of
this Act, the Commission shall submit to Congress a report on such study and
shall include in the report recommendations on the feasibility, costs, and
savings of covering such services under the Medicare program.
(b) ACHPR STUDY ON EFFECT OF CREDENTIALING OF TECHNOLOGISTS AND
SONOGRAPHERS ON QUALITY OF ULTRASOUND AND IMAGING SERVICES-
(1) STUDY- The Administrator for Health Care Policy and Research shall
provide for a study that compares the differences in quality of ultrasound
and other imaging services (including error rates and resulting
complications) furnished under the Medicare and Medicaid programs between
such services furnished by individuals who are credentialed by private
entities or organizations and by those who are not so credentialed. Such
study shall examine and evaluate differences in error rates and patient
outcomes as a result of the differences in credentialing. In designing the
study, the Administrator shall consult with organizations nationally
recognized for their expertise in ultrasound procedures.
(2) REPORT- By not later than 2 years after the date of the enactment of
this Act, the Administrator shall submit a report to Congress on the study
conducted under paragraph (1).
(c) MEDPAC STUDY ON THE COMPLEXITY OF THE MEDICARE PROGRAM AND THE LEVELS
OF BURDENS PLACED ON PROVIDERS THROUGH FEDERAL REGULATIONS-
(1) STUDY- The Medicare Payment Advisory Commission shall
undertake a comprehensive study to review the regulatory burdens placed on
all classes of health care providers under parts A and B of the Medicare
program under title XVIII of the Social Security Act and to determine the
costs these burdens impose on the nation's health care system. The study
shall also examine the complexity of the current regulatory system and its
impact on providers.
(2) REPORT- not later than December 31, 2001, the Commission shall
submit to Congress a report on the study conducted under paragraph (1). The
report shall include recommendations regarding--
(A) how the Health Care Financing Administration can reduce the
regulatory burdens placed on patients and providers; and
(B) legislation that may be appropriate to reduce the complexity of
the Medicare program, including improvement of the rules regarding
billing, compliance, and fraud and abuse.
(d) GAO CONTINUED MONITORING OF DEPARTMENT OF JUSTICE APPLICATION OF
GUIDELINES ON USE OF FALSE CLAIMS ACT IN CIVIL HEALTH CARE MATTERS- The
Comptroller General of the United States shall--
(1) continue the monitoring, begun under section 118 of the Department
of Justice Appropriations Act, 1999 (included in Public Law 105-277) of the
compliance of the Department of Justice and all United States Attorneys with
the `Guidance on the Use of the False Claims Act in Civil Health Care
Matters' issued by the Department of Justice on June 3, 1998, including any
revisions to that guidance; and
(2) not later than April 1, 2000, and of each of the two succeeding
years, submit a report on such compliance to the appropriate committees of
TITLE III--PROVISIONS RELATING TO PARTS A AND B
Subtitle A--Home Health Services
SEC. 301. ADJUSTMENT TO REFLECT ADMINISTRATIVE COSTS NOT INCLUDED IN THE
INTERIM PAYMENT SYSTEM; GAO REPORT
ON COSTS OF COMPLIANCE WITH OASIS DATA COLLECTION REQUIREMENTS.
(a) ADJUSTMENT TO REFLECT ADMINISTRATIVE COSTS-
(1) IN GENERAL- In the case of a home health agency that furnishes home
health services to a Medicare beneficiary, for each such beneficiary to whom
the agency furnished such services during the agency's cost reporting period
beginning in fiscal year 2000, the Secretary of Health Services shall pay
the agency, in addition to any amount of payment made under subsection
(v)(1)(L) of such section for the beneficiary and only for such cost
reporting period, an aggregate amount of $10 to defray costs incurred by the
agency attributable to data collection and reporting requirements under the
Outcome and Assessment Information Set (OASIS) required by reason of section
4602(e) of the Balanced Budget Act of 1997 (42 U.S.C. 1395fff note).
(A) MIDYEAR PAYMENT - By
not later than April 1, 2000, the Secretary shall pay to a home health
agency an amount that the Secretary estimates to be 50 percent of the
aggregate amount payable to the agency by reason of this
(B) UPON SETTLED COST REPORT- The Secretary shall pay the balance of
amounts payable to an agency under this subsection on the date that the
cost report submitted by the agency for the cost reporting period
beginning in fiscal year 2000 is settled.
(3) PAYMENT FROM TRUST
FUNDS- Payments under this subsection shall be made, in appropriate part as
specified by the Secretary, from the Federal Hospital Insurance Trust Fund
and from the Federal Supplementary Medical Insurance Trust Fund.
(4) DEFINITIONS- in this subsection:
(A) HOME HEALTH AGENCY- The term `home health agency' has the meaning
given that term under section 1861(o) of the Social Security Act (42
(B) HOME HEALTH SERVICES- The term `home health services' has the
meaning given that term under section 1861(m) of such Act (42 U.S.C.
(C) MEDICARE BENEFICIARY- The term `Medicare beneficiary' means a
beneficiary described in section 1861(v)(1)(L)(vi)(II) of the Social
Security Act (42 U.S.C. 1395x(v)(1)(L)(vi)(II)).
(b) GAO REPORT ON COSTS OF COMPLIANCE WITH OASIS DATA COLLECTION
(A) IN GENERAL- Not later than 180 days after the date of the
enactment of this Act, the Comptroller General of the United States shall
submit a report to Congress on matters described in subparagraph (B) with
respect to the data collection requirement of patients of such agencies
under the Outcome and Assessment Information Set (OASIS) standard as part
of the comprehensive assessment of patients.
(B) MATTERS STUDIED- For purposes of subparagraph (A), the matters
described in this subparagraph include the following:
(i) An assessment of the costs incurred by Medicare home health
agencies in complying with such data collection requirement.
(ii) An analysis of the effect of such data collection requirement
on the privacy interests of patients from whom data is
(C) AUDIT- The Comptroller General shall conduct an independent audit
of the costs described in subparagraph (B)(i). Not later than 180 days
after receipt of the report under subparagraph (A), the Comptroller
General shall submit to Congress a report describing the Comptroller
General's findings with respect to such audit, and shall include comments
on the report submitted to Congress by the Secretary of Health and Human
Services under subparagraph (A).
(2) DEFINITIONS- In this subsection:
(A) COMPREHENSIVE ASSESSMENT OF PATIENTS- The term `comprehensive
assessment of patients' means the rule published by the Health Care
Financing Administration that requires, as a condition of participation in
the Medicare program, a home health agency to provide a patient-specific
comprehensive assessment that accurately reflects the patient's current
status and that incorporates the Outcome and Assessment Information Set
(B) OUTCOME AND ASSESSMENT INFORMATION SET- The term `Outcome and
Assessment Information Set' means the standard provided under the rule
relating to data items that must be used in conducting a comprehensive
assessment of patients.
SEC. 302. DELAY IN APPLICATION OF 15 PERCENT REDUCTION IN PAYMENT RATES FOR HOME HEALTH SERVICES
UNTIL 1 YEAR AFTER IMPLEMENTATION OF PROSPECTIVE PAYMENT SYSTEM.
(a) CONTINGENCY REDUCTION- Section 4603(e) of the Balanced Budget Act of
1997 (42 U.S.C. 1395fff note) (as amended by section 5101(c)(3) of the Tax and
Trade Relief Extension Act of 1998 (contained in division J of Public Law
105-277)) is amended by striking `September 30, 2000' and inserting `on the
date that is 12 months after the date the Secretary implements such
(b) PROSPECTIVE PAYMENT
SYSTEM- Section 1895(b)(3)(A)(i) (42 U.S.C. 1395fff(b)(3)(A)(i)) (as amended
by section 5101 of the Tax and Trade Relief Extension Act of 1998 (contained
in division J of Public Law 105-277)) is amended to read as follows:
`(i) IN GENERAL- Under such system the Secretary shall provide for
computation of a standard prospective payment amount (or amounts).
Such amount (or amounts) shall initially be based on the most current
audited cost report data available to the Secretary and shall be
computed in a manner so that the total amounts payable under the
`(I) for the 12-month period beginning on the date the Secretary
implements the system, shall be equal to the total amount that would
have been made if the system had not been in effect;
`(II) for periods beginning after the period described in
subclause (I), shall be equal to the total amount that would have been
made for fiscal year 2001 if the system had not been in effect but if
the reduction in limits described in clause (ii) had been in effect,
and updated under subparagraph (B).
Each such amount shall be standardized in a manner that eliminates
the effect of variations in relative case mix and wage levels among
different home health agencies in a budget neutral manner consistent
with the case mix and wage level adjustments provided under paragraph
(4)(A). Under the system, the Secretary may recognize regional
differences or differences based upon whether or not the services or
agency are in an urbanized area.'.
(1) IN GENERAL- The Secretary of Health and Human Services shall submit
to Congress a report analyzing the need for the 15 percent reduction under
section 1895(b)(3)(A)(ii) of the Social Security Act (42 U.S.C.
1395fff(b)(3)(A)(ii)), or for any reduction, in the computation of the base
payment amounts under the
prospective payment system for
home health services under section 1895 of such Act (42 U.S.C.
(2) DEADLINE- The Secretary shall submit to Congress the report
described in paragraph (1) by not later than the date that is 6 months after
the date the Secretary implements the prospective payment system for home health
services under such section 1895.
SEC. 303. CLARIFICATION OF SURETY BOND REQUIREMENTS.
(a) HOME HEALTH AGENCIES- Section 1861(o)(7) (42 U.S.C. 1395x(o)(7)) is
amended to read as follows:
`(7) provides the Secretary with a surety bond--
`(A) effective for a period of 4 years (as specified by the Secretary)
or in the case of a change in the ownership or control of the agency (as
determined by the Secretary) during or after such 4-year period, an
additional period of time that the Secretary determines appropriate, such
additional period not to exceed 4 years from the date of such change in
ownership or control;
`(B) in a form specified by the Secretary; and
`(C) for a year in the period described in subparagraph (A) in an
amount that is equal to the lesser of $50,000 or 10 percent of the
aggregate amount of payments to the agency under this title and title XIX
for that year, as estimated by the Secretary; and'.
(b) COORDINATION OF SURETY BONDS- Part A of title XI is amended by adding
at the end the following new section:
`COORDINATION OF MEDICARE AND MEDICAID SURETY BOND PROVISIONS
`SEC. 1148. In the case of a home health agency that is subject to a
surety bond under title XVIII and title XIX, the surety bond provided to
satisfy the requirement under one such title shall satisfy the requirement
under the other such title so long as the bond applies to guarantee return of
overpayments under both such titles.'.
(c) EFFECTIVE DATE- The amendments made by this section take effect on the
date of the enactment of this Act and in applying section 1861(o)(7) of the
Social Security Act, as amended by subsection (a), the Secretary of Health and
Human Services may take into account the previous period for which a home
health agency had a surety bond in effect under such section before such
SEC. 304. TECHNICAL AMENDMENT CLARIFYING APPLICABLE MARKET BASKET INCREASE
Section 1895(b)(3)(B)(ii)(I) (42 U.S.C. 1395fff(b)(3)(B)(ii)(I)), as added
by section 4603 of BBA (as amended by section 5101(d)(2) of the Tax and Trade
Relief Extension Act of 1998 (contained in division J of Public Law 105-277))
is amended by striking `fiscal year 2002 or 2003' and inserting `each of
fiscal years 2002 and 2003'.
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