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H.R.5291
Beneficiary Improvement and Protection Act of 2000 (Introduced in the
House)
SEC. 221. 3-YEAR MORATORIUM ON SNF PART B CONSOLIDATED BILLING REQUIREMENTS.
(a) MORATORIUM IN APPLICATION OF CONSOLIDATED BILLING TO SNF RESIDENTS IN
NON-COVERED STAYS- Section 1842(b)(6)(E) (42 U.S.C. 1395u(b)(6)(E)) is amended
by inserting `(on or after October 1, 2003)' after `furnished to an
individual'.
(b) MORATORIUM IN PROVIDER AGREEMENT PROVISION- Section
1866(a)(1)(H)(ii)(I) (42 U.S.C. 1395cc(a)(1)(H)(ii)(I) is amended by inserting
`in the case of a resident who is in a stay covered under part A, and for
services furnished on or after October 1, 2003, in the case of a resident who
is not in a stay covered under such part' before the comma.
(c) MORATORIUM IN REQUIREMENT FOR SNF BILLING OF PART B SERVICES- Section
1862(a)(18) (42 U.S.C. 1395y(a)(18)) is amended to read as follows:
`(18) which are covered skilled nursing facility services described in
section 1888(e)(2)(A)(i) and which are furnished to an individual who is a
resident--
`(A) of a skilled nursing facility in the case of a resident who is in
a stay covered under part A; or
`(B) of a skilled nursing facility or of a part of a facility that
includes a skilled nursing facility (as determined under regulations) for
services furnished on or after October 1, 2003, in the case of a resident
who is not in a stay covered under such part,
by an entity other than the skilled nursing facility, unless the
services are furnished under arrangements (as defined in section 1861(w)(1))
with the entity made by the skilled nursing facility;'.
(d) EFFECTIVE DATE- The amendments made by subsections (a), (b) and (c)
are effective as if included in the enactment of BBA.
(e) REPORT- Not later than October 1, 2002, the Comptroller General of the
United States shall submit to Congress a report that includes an analysis and
recommendations on--
(1) alternatives, if any, to consolidated billing for part B items and
services described in section 1842(b)(6) of the Social Security Act (42
U.S.C. 1395u(b)(6)) to ensure accountability by skilled nursing facilities
and accuracy in claims submitted for all services and items provided to
skilled nursing facility residents under part B of the medicare program;
(2) the costs expected to be incurred by skilled nursing facilities
under such alternative approaches, compared with the costs associated with
the implementation of consolidated billing ; and
(3) the costs incurred by the medicare program in implementing
such alternative approaches and their effect on utilization review, compared
with the costs and effect on utilization review expected with consolidated billing .
SEC. 222. AMBULATORY SURGICAL CENTERS.
(a) DELAY IN IMPLEMENTATION OF PROSPECTIVE PAYMENT SYSTEM- The Secretary
of Health and Human Services may not implement a revised prospective payment
system for services of ambulatory surgical facilities under section 1833(i) of
the Social Security Act (42 U.S.C. 1395l(i)) before January 1, 2002.
(b) EXTENDING PHASE-IN TO 4 YEARS- Section 226 of the BBRA is amended by
striking paragraphs (1) and (2) and inserting the following:
`(1) in the first year of its implementation, only a proportion
(specified by the Secretary and not to exceed 1/4 ) 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 each of the following 2 years a proportion (specified by the
Secretary and not to exceed 1/2 , and 3/4 , respectively) of the payment for
such services shall be made under such system and the remainder shall be
made in accordance with current regulations.'.
(c) DEADLINE FOR USE OF 1999 OR LATER COST SURVEYS- Section 226(c) of BBRA
is amended by adding at the end the following:
`By not later than January 1, 2003, the Secretary shall incorporate data
from a 1999 Medicare cost survey
or a subsequent cost survey for purposes of implementing or revising such
system.'.
SEC. 223. 1-YEAR EXTENSION OF MORATORIUM ON THERAPY CAPS.
(a) IN GENERAL- Section 1833(g)(4) (42 U.S.C. 1395l(g)), as added by
section 221(a) of BBRA, is amended by striking `and 2001' and inserting `,
2001, and 2002'.
(b) CONFORMING AMENDMENT TO CONTINUE FOCUSED MEDICAL REVIEWS OF CLAIMS
DURING MORATORIUM PERIOD- Section 221(a)(2) of BBRA is amended by striking
`(under the amendment made by paragraph (1)(B))'.
SEC. 224. REVISION OF MEDICARE
REIMBURSEMENT FOR TELEHEALTH SERVICES.
Section 4206 of the Balanced Budget Act of 1997 (42 U.S.C. 1395l note) is
amended to read as follows:
`(a) TELEHEALTH SERVICES REIMBURSED-
`(1) IN GENERAL- Not later than April 1, 2001, the Secretary of Health
and Human Services shall make payments from the Federal Supplementary
Medical Insurance Trust Fund in accordance with the methodology described in
subsection (b) for services for which payment may be made under part B of
title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.) that are
furnished via a telecommunications system by a physician or practitioner to
an eligible telehealth beneficiary.
`(2) USE OF STORE-AND-FORWARD TECHNOLOGIES- For purposes of paragraph
(1), in the case of any Federal telemedicine demonstration program in Alaska
or Hawaii, the term `telecommunications system' includes store-and-forward
technologies that provide for the asynchronous transmission of health care
information in single or multimedia formats.
`(b) METHODOLOGY FOR DETERMINING AMOUNT OF PAYMENTS-
`(1) IN GENERAL- The Secretary shall make payment under this section as
follows:
`(A) Subject to subparagraph (B), with respect to a physician or
practitioner located at a distant site that furnishes a service to an
eligible medicare
beneficiary under subsection (a), an amount equal to the amount that such
physician or practitioner would have been paid had the service been
furnished without the use of a telecommunications system.
`(B) With respect to an originating site, a facility fee equal
to--
`(i) for 2001 (beginning with April 1, 2001) and 2002, $20;
and
`(ii) for a subsequent year, the facility fee under this subsection
for the previous year increased by the percentage increase in the MEI
(as defined in section 1842(i)(3)) for such subsequent year.
`(2) APPLICATION OF PART B COINSURANCE AND DEDUCTIBLE- Any payment made
under this section shall be subject to the coinsurance and deductible
requirements under subsections (a)(1) and (b) of section 1833 of the Social
Security Act (42 U.S.C. 1395l).
`(3) APPLICATION OF NONPARTICIPATING PHYSICIAN PAYMENT DIFFERENTIAL AND
BALANCE BILLING LIMITS- The
payment differential of section 1848(a)(3) of such Act (42 U.S.C.
1395w-4(a)(3)) shall apply to services furnished by non-participating
physicians. The provisions of section 1848(g) of such Act (42 U.S.C.
1395w-4(g)) and section 1842(b)(18) of such Act (42 U.S.C. 1395u(b)(18))
shall apply. Payment for such service shall be increased annually by the
update factor for physicians' services determined under section 1848(d) of
such Act (42 U.S.C. 1395w-4(d)).
`(c) TELEPRESENTER NOT REQUIRED- Nothing in this section shall be
construed as requiring an eligible telehealth beneficiary to be presented by a
physician or practitioner at the originating site for the furnishing of a
service via a telecommunications system, unless it is medically necessary as
determined by the physician or practitioner at the distant site.
`(d) COVERAGE OF ADDITIONAL SERVICES-
`(1) STUDY AND REPORT ON ADDITIONAL SERVICES-
`(A) STUDY- The Secretary of Health and Human Services shall conduct a
study to identify services in addition to those described in subsection
(a)(1) that are appropriate for payment under this section.
`(B) REPORT- Not later than 2 years after the date of enactment of
this Act, the Secretary shall submit to Congress a report on the study
conducted under subparagraph (A) together with such recommendations for
legislation that the Secretary determines are appropriate.
`(2) IN GENERAL- The Secretary shall provide for payment under this
section for services identified in paragraph (1).
`(e) CONSTRUCTION RELATING TO HOME HEALTH SERVICES-
`(1) IN GENERAL- Nothing in this section or in section 1895 of the
Social Security Act (42 U.S.C. 1395fff) shall be construed as preventing a
home health agency furnishing a home health unit of service for which
payment is made under the prospective payment system established in such
section for such units of service from furnishing the service.
`(2) LIMITATION- The Secretary shall not consider a home health service
provided in the manner described in paragraph (1) to be a home health visit
for purposes of--
`(A) determining the amount of payment to be made under such
prospective payment system; or
`(B) any requirement relating to the certification of a physician
required under section 1814(a)(2)(C) of such Act (42 U.S.C.
1395f(a)(2)(C)).
`(f) COVERAGE OF ITEMS AND SERVICES-
`(1) IN GENERAL- Subject to paragraph (2), payment for items and
services provided pursuant to subsection (a) shall include payment for
professional consultations, office visits, office psychiatry services,
including any service identified as of July 1, 2000, by HCPCS codes
99241-99275, 99201-99215, 90804-90809, and 90862, and any additional item or
service specified by the Secretary.
`(2) YEARLY UPDATE- The Secretary shall provide a process that provides,
on at least an annual basis, for the review and revision of services (and
HCPCS codes) to those specified in paragraph (1) for authorized payment
under subsection (a).
`(g) DEFINITIONS- In this section:
`(1) ELIGIBLE TELEHEALTH BENEFICIARY- The term `eligible telehealth
beneficiary' means an individual enrolled under part B of title XVIII of the
Social Security Act (42 U.S.C. 1395j et seq.) that receives a service
originating--
`(A) in an area that is designated as a health professional shortage
area under section 332(a)(1)(A) of the Public Health Service Act (42
U.S.C. 254e(a)(1)(A));
`(B) in a county that is not included in a Metropolitan Statistical
Area;
`(C) effective January 1, 2002, in an inner-city area that is
medically underserved (as defined in section 330(b)(3) of the Public
Health Service Act (42 U.S.C. 254b(b)(3))); or
`(D) in a service which originated in a facility which participates in
a Federal telemedicine demonstration project.
`(2) PHYSICIAN- The term `physician' has the meaning given that term in
section 1861(r) of the Social Security Act (42 U.S.C. 1395x(r))
`(3) PRACTITIONER- The term `practitioner' means a practitioner
described in section 1842(b)(18)(C) of the Social Security Act (42 U.S.C.
1395u(b)(18)(C)).
`(4) DISTANT SITE- The term `distant site' means the site at which the
physician or practitioner is located at the time the service is provided via
a telecommunications system.
`(A) IN GENERAL- The term `originating site' means any site described
in subparagraph (B) at which the eligible telehealth beneficiary is
located at the time the service is furnished via a telecommunications
system.
`(B) SITES DESCRIBED- The sites described in this subparagraph are as
follows:
`(i) On or after April 1, 2001--
`(I) the office of a physician or a practitioner,
`(II) a critical access hospital (as defined in section
1861(mm)(1) of the Social Security Act (42 U.S.C.
1395x(mm)(1))),
`(III) a rural health clinic (as defined in section 1861(aa)(2) of
such Act (42 U.S.C. 1395x(aa)(2))), and
`(IV) a Federally qualified health center (as defined in section
1861(aa)(4) of such Act (42 U.S.C. 1395x(aa)(4))).
`(ii) On or after January 1, 2002--
`(I) a hospital (as defined in section 1861(e) of such Act (42
U.S.C. 1395x(e))),
`(II) a skilled nursing facility (as defined in section 1861(j) of
such Act (42 U.S.C. 1395x(j))),
`(III) a comprehensive outpatient rehabilitation facility (as
defined in section 1861(cc)(2) of such Act (42 U.S.C.
1395x(cc)(2))),
`(IV) a renal dialysis facility (described in section 1881(b)(1)
of such Act (42 U.S.C. 1395rr(b)(1))),
`(V) an ambulatory surgical center (described in section
1833(i)(1)(A) of such Act (42 U.S.C. 1395l(i)(1)(A))),
`(VI) a hospital or skilled nursing facility of the Indian Health
Service (under section 1880 of such Act (42 U.S.C. 1395qq)),
and
`(VII) a community mental health center (as defined in section
1861(ff)(3)(B) of such Act (42 U.S.C.
1395x(ff)(3)(B))).
`(6) FEDERAL SUPPLEMENTARY MEDICAL INSURANCE TRUST FUND- The term
`Federal Supplementary Medical Insurance Trust Fund' means the trust fund
established under section 1841 of the Social Security Act (42 U.S.C.
1395t).'.
SEC. 225. PAYMENT FOR AMBULANCE SERVICES.
(a) ELIMINATING BBA REDUCTION- Section 1834(l)(3) (42 U.S.C. 1395m(l)(3))
is amended, in subparagraphs (A) and (B), by striking ` reduced in the case of
2001 and 2002 by 1.0 percentage points' both places it appears.
(b) MILEAGE PAYMENTS- Section 1834(l)(2)(E) (42 U.S.C. 1395m(l)(2)(E)) is
amended by inserting before the period at the end the following: `, except
that such phase-in shall provide for full payment of any national mileage rate
beginning with the effective date of the fee schedule for ambulance services
provided by suppliers in any State where payment for such services did not
include a separate amount for all mileage prior to the implementation of the
fee schedule'.
(c) GAO STUDY ON COSTS OF AMBULANCE SERVICES-
(1) STUDY- The Comptroller General of the United States shall conduct a
study of the costs of providing ambulance services covered under the medicare program under title XVIII
of the Social Security Act across the range of service levels for which such
services are provided.
(2) REPORT- Not later than 18 months after the date of the enactment of
this Act, the Comptroller General shall submit a report to the Secretary of
Health and Human Services and Congress on the study conducted under
paragraph (1). Such report shall include recommendations for any changes in
methodology or payment levels necessary to fairly compensate suppliers of
ambulance services and to ensure the access of medicare beneficiaries to such
services under the medicare
program.
SEC. 226. CONTRAST ENHANCED DIAGNOSTIC PROCEDURES UNDER HOSPITAL PROSPECTIVE
PAYMENT SYSTEM.
(a) SEPARATE CLASSIFICATION- Section 1833(t)(2) (42 U.S.C. 1395l(t)(2)) is
amended--
(1) by striking `and' at the end of subparagraph (E);
(2) by striking the period at the end of subparagraph (F) and inserting
`; and'; and
(3) by inserting after subparagraph (F) the following new
subparagraph:
`(G) the Secretary shall create additional groups of covered OPD
services that classify separately those procedures that utilize contrast
media from those that do not.'.
(b) CONFORMING AMENDMENT- Section 1861(t)(1) (42 U.S.C. 1395x(t)(1)) is
amended by inserting `(including contrast agents)' after `only such drugs'.
(c) EFFECTIVE DATE- The amendments made by this section shall be effective
as if included in the enactment of BBA.
SEC. 227. 10-YEAR PHASED IN INCREASE FROM 55 PERCENT TO 80 PERCENT IN THE
PROPORTION OF HOSPITAL BAD DEBT RECOGNIZED.
Section 1861(v)(1)(T) (42 U.S.C. 1395x(v)(1)(T)) is amended--
(1) by striking `and' at the end of clause (ii);
(2) in clause (iii) by striking `a subsequent fiscal year' and inserting
`fiscal year 2000' and by striking the period at the end and inserting a
semicolon; and
(3) by adding at the end the following new clauses:
`(iv) for cost reporting periods beginning during fiscal year 2001 and
each subsequent fiscal year (before fiscal year 2011), by the percent
specified in clause (iii) or this clause for the preceding fiscal year
reduced by 2.5 percentage points, of such amount otherwise allowable;
and
`(v) for cost reporting periods beginning during fiscal year 2011 or a
subsequent fiscal year, by 20 percent of such amount otherwise
allowable.'.
SEC. 228. STATE ACCREDITATION OF DIABETES SELF-MANAGEMENT TRAINING
PROGRAMS.
Section 1861(qq)(2) (42 U.S.C. 1395x(qq)(2)) is amended--
(1) in the matter preceding subparagraph (A) by striking `paragraph
(1)--' and inserting `paragraph (1):';
(2) in subparagraph (A)--
(A) by striking `a `certified provider' and inserting `A `certified
provider'; and
(B) by striking `; and' and inserting a period; and
(3) in subparagraph (B)--
(A) by striking `a physician, or such other individual' and inserting
`(i) A physician, or such other individual';
(B) by inserting `(I)' before `meets applicable standards';
(C) by inserting `(II)' before `is recognized';
(D) by inserting `, or by a program described in clause (ii),' after
`recognized by an organization that represents individuals (including
individuals under this title) with diabetes'; and
(E) by adding at the end the following:
`(ii) Notwithstanding any reference to `a national accreditation body'
in section 1865(b), for purposes of clause (i), a program described in this
clause is a program operated by a State for the purposes of accrediting
diabetes self-management training programs, if the Secretary determines that
such State program has established quality standards that meet or exceed the
standards established by the Secretary under clause (i) or the standards
originally established by the National Diabetes Advisory Board and
subsequently revised as described in clause (i).'.
SEC. 229. UPDATE IN RENAL DIALYSIS COMPOSITE RATE.
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