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S.1678
Medicare Beneficiary Access to Care Act of 1999 (Introduced in the
Senate)
SEC. 401. MODIFICATION OF CASE MIX CATEGORIES FOR CERTAIN CONDITIONS.
(a) IN GENERAL- For purposes of applying any formula under paragraph (1)
of section 1888(e) of the Social
Security Act (42 U.S.C. 1395yy(e)), for services provided on or after April 1,
2000, and before the earlier of October 1, 2001, or the date described in
subsection (d), the Secretary of Health and Human Services shall increase the
adjusted Federal per diem rate otherwise determined under paragraph (4) of
such section for services provided to any individual during the period in
which such individual is in a RUG III category by the applicable payment
add-on as determined in accordance with the following table:
RUG III category
Applicable paymentadd-on
RUB
$23.06
RVC
$76.25
RVB
$30.36
RHC
$54.07
RHB
$27.28
RMC
$69.98
RMB
$30.09
SE3
$98.41
SE2
$89.05
SSC
$46.80
SSB
$55.56
SSA
$59.94.
(b) UPDATE- The Secretary shall update the applicable payment add-on under
subsection (a) for fiscal year 2001 by the skilled nursing facility market
basket percentage change (as defined under section 1888(e)(5)(B) of the Social Security Act (42 U.S.C.
1395yy(e)(5)(B))) applicable to such fiscal year.
(c) RULE OF CONSTRUCTION- Nothing in this section shall be construed as
permitting the Secretary of Health and Human Services to include any
applicable payment add-on determined under subsection (a) in updating the
Federal per diem rate under section 1888(e)(4) of the Social Security Act (42 U.S.C.
1395yy(e)(4)).
(d) DATE DESCRIBED- The date described in this subsection is the date that
the Secretary of Health and Human Services--
(1) refines the case mix classification system under section
1888(e)(4)(G)(i) of the Social
Security Act (42 U.S.C. 1395yy(e)(4)(G)(i)) to better account for medically
complex patients; and
(2) implements such refined system.
SEC. 402. EXCLUSION OF CLINICAL SOCIAL WORKER SERVICES AND SERVICES PERFORMED
UNDER A CONTRACT WITH A RURAL HEALTH CLINIC OR FEDERALLY QUALIFIED HEALTH CENTER
FROM THE PPS FOR SNFs.
(a) IN GENERAL- Section 1888(e)(2)(A)(ii) (42 U.S.C. 1395yy(e)(2)(A)(ii))
is amended--
(1) in the first sentence, by inserting `clinical social worker services,' after `qualified
psychologist services,'; and
(2) by inserting after the first sentence the following: `Services
described in this clause also include services that are provided by a
physician, a physician assistant, a nurse practitioner, a qualified
psychologist, or a clinical
social worker who is employed, or otherwise
under contract, with a rural health clinic or a Federally qualified health
center.'.
(b) CONFORMING AMENDMENT- Section 1861(hh)(2) (42 U.S.C. 1395x(hh)(2)) is
amended by striking `and other than services furnished to an inpatient of a
skilled nursing facility which the facility is required to provide as a
requirement for participation'.
(c) EFFECTIVE DATE- The amendments made by this section shall apply to
services provided on or after the date which is 60 days after the date of
enactment of this Act.
SEC. 403. EXCLUSION OF CERTAIN SERVICES FROM THE PPS FOR SNFs.
(a) IN GENERAL- Section 1888(e)(2)(A)(ii) (42 U.S.C. 1395yy(e)(2)(A)(ii)),
as amended by section 402, is amended--
(1) in the first sentence, by inserting `ambulance services, services
identified by HCPCS code in Program Memorandum Transmittal No. A-98-37
issued in November 1998 (but without regard to the setting in which such
services are furnished),' after `subparagraphs (F) and (O) of section
1861(s)(2),'; and
(2) by inserting after the second sentence the following: `In addition
to the services described in the previous sentences, services described in
this clause include chemotherapy items (identified as of July 1, 1999, by
HCPCS codes J9000-J9020, J9040-J9151, J9170-J9185, J9200-J9201, J9206-J9208,
J9211, J9230-J9245, and J9265-J9600), chemotherapy administration services
(identified as of July 1, 1999, by HCPCS codes 36260-36262, 36489,
36530-36535, 36640, 36823, and 96405-96542), radioisotope services
(identified as of July 1, 1999, by HCPCS codes 79030-79440), and customized
prosthetic devices (identified as of July 1, 1999, by HCPCS codes
L5050-L5340, L5500-L5610, L5613-L5986, L5988, L6050-L6370, L6400-L6880,
L6920-L7274, and L7362-L7366).'.
(b) EFFECTIVE DATE- The amendments made by this section shall apply to
services furnished on or after the date which is 60 days after the date of
enactment of this Act.
SEC. 404. EXCLUSION OF SWING BEDS IN CRITICAL ACCESS HOSPITALS FROM THE PPS
FOR SNFs.
(a) IN GENERAL- Section 1888(e)(7) of the Social Security Act (42 U.S.C.
1395yy(e)(7)) is amended--
(1) in the heading, by striking `TRANSITION' and inserting `SPECIAL
RULES';
(2) in subparagraph (A), by striking `IN GENERAL- The' and inserting
`TRANSITION- Except as provided in subparagraph (C), the'; and
(3) by adding at the end the following:
`(C) EXEMPTION OF SWING BEDS IN CRITICAL ACCESS HOSPITALS FROM PPS-
The prospective payment system under this subsection shall not apply
(and section 1834(g) shall apply) to services provided by a critical
access hospital under an agreement described in subparagraph
(B).'.
(b) EFFECTIVE DATE- The amendments made by this section shall apply to
services provided on or after October 1, 1999.
TITLE V--OUTPATIENT REHABILITATION SERVICES
SEC. 501. MODIFICATION OF FINANCIAL LIMITATION ON REHABILITATION
SERVICES.
(a) 3-YEAR REPEAL- Section 1833(g) (42 U.S.C. 1395l(g)) is amended by
adding at the end the following:
`(4) Subject to paragraph (6), the provisions of paragraphs (1) through
(3) shall not apply to outpatient physical therapy services, outpatient
occupational therapy services, and outpatient speech-language pathology
services covered under this title and furnished on or after January 1,
2000.
`(5)(A) Notwithstanding the preceding provisions of this subsection and
subject to subparagraph (B), with respect to services described in paragraph
(4) that are furnished on or after January 1, 2003, the Secretary shall
implement, by not later than January 1, 2003, a payment system for such
services that takes into account the needs of beneficiaries under this title
for differing amounts of therapy based on factors such as diagnosis,
functional status, and prior use of services.
`(B) The payment system established under subparagraph (A) shall be
designed so that the system shall not result in any increase or decrease in
the expenditures under this title on a fiscal year basis, determined as if
paragraph (4) had not been enacted.
`(6) If the Secretary for any reason does not implement the payment system
described in paragraph (5) on or before January 1, 2003, paragraph (4) shall
not apply with respect to services described in such paragraph that are
furnished on or after such date and before the date on which the Secretary
implements such payment system.'.
(b) EFFECTIVE DATE- The amendment made by this section shall take effect
as if included in the enactment of the Balanced Budget Act of 1997 (Public Law
105-33; 111 Stat. 251).
TITLE VI--PHYSICIANS' SERVICES
SEC. 601. TECHNICAL AMENDMENT TO UPDATE ADJUSTMENT FACTOR AND PHYSICIAN
SUSTAINABLE GROWTH RATE.
(a) UPDATE ADJUSTMENT FACTOR-
(1) CHANGE TO CALENDAR YEAR BASIS- Section 1848(d) (42 U.S.C.
1395w-4(d)) is amended--
(A) in paragraph (1), by striking subparagraph (E) and inserting the
following:
`(E) PUBLICATION- The Secretary shall publish in the Federal
Register--
`(i) not later than November 1 of each year (beginning with 1999),
the conversion factor that will apply to physicians' services for the
succeeding year and the update determined under paragraph (3) for such
year; and
`(ii) not later than November 1 of 1999--
`(I) the special update for the year 2000 under paragraph
(3)(E)(i); and
`(II) the estimated special adjustments for years 2001 through
2006 under paragraph (3)(E)(ii).'; and
(B) in paragraph (3)(C)--
(i) in the matter preceding clause (i), by striking `the 12-month
period ending with March 31 of';
(I) by striking `1997' and inserting `1996,'; and
(II) by striking `such 12-month period' and inserting `1996';
and
(I) by inserting a comma after `subsequent year';
and
(II) by striking `fiscal year which begins during such 12-month
period' and inserting `year involved'.
(2) FORMULA FOR DETERMINING THE UPDATE ADJUSTMENT FACTOR- Section
1848(d)(3) (42 U.S.C. 1395w-4(d)(3)) is amended--
(A) in subparagraph (A)--
(i) in clause (ii), by striking `(divided by 100),' and inserting a
period; and
(ii) by striking the matter following clause (ii);
(B) in subparagraph (B)--
(i) in the matter preceding clause (i), by inserting `the sum of'
after `Secretary) to'; and
(ii) by striking clauses (i) and (ii) and inserting the
following:
`(i) the figure arrived at by--
`(I) determining the difference between the allowed expenditures
for physicians' services for the prior year (as determined under
subparagraph (C)) and the actual expenditures for such services for
that year;
`(II) dividing that difference by the actual expenditures for such
services in that year; and
`(III) multiplying that quotient by 0.75; and
`(ii) the figure arrived at by--
`(I) determining the difference between the allowed expenditures
for physicians' services (as determined under subparagraph (C)) from
1996 through the prior year and the actual expenditures for such
services during that period, corrected with the best available
data;
`(II) dividing that difference by actual expenditures for such
services for the prior year as increased by the sustainable growth
rate under subsection (f) for the year whose update
adjustment factor is to be determined; and
`(III) multiplying that quotient by 0.33.'; and
(C) by amending subparagraph (D) to read as follows:
`(D) RESTRICTION ON UPDATE ADJUSTMENT FACTOR- The update adjustment
factor determined under subparagraph (B) for a year may not be less than
negative 0.07 or greater than 0.03.'.
(3) SPECIAL PROVISIONS- Section 1848(d)(3) (42 U.S.C. 1395w-4(d)(3)) is
amended--
(A) in subparagraph (A), in the matter preceding clause (i), by
striking `subparagraph (D)' and inserting `subparagraphs (D) and (E)';
and
(B) by adding at the end the following:
`(E) SPECIAL UPDATE AND ADJUSTMENTS-
`(i) YEAR 2000- For the year 2000, the update under this paragraph
shall be the percentage that the Secretary estimates will, without
regard to any otherwise applicable restriction, result in expenditures
equal to the expenditures that would have occurred in that year in the
absence of the amendments made by section 601 of the Medicare
Beneficiary Access to Care Act of 1999.
`(ii) YEARS 2001-2006- For each of the years 2001 through 2006, the
Secretary shall make that adjustment to the update for that year which
the Secretary estimates will, without regard to any otherwise applicable
restriction, result in expenditures equal to the expenditures that would
have occurred for that year in the absence of the amendments made by
section 601 of the Medicare Beneficiary Access to Care Act of
1999.'.
(b) SUSTAINABLE GROWTH RATE- Section 1848(f) (42 U.S.C. 1395w-4(f)) is
amended--
(1) by striking paragraph (1) and inserting the following:
`(1) PUBLICATION- Not later than November 1 of each year (beginning with
1999), the Secretary shall publish in the Federal Register the sustainable
growth rate as determined under this subsection for the succeeding year, the
current year, and each of the preceding 2 years.'; and
(A) by striking `fiscal' each place it appears; and
(B) in the matter preceding subparagraph (A), by striking `year 1998'
and inserting `1997'.
(c) DATA TO BE USED IN DETERMINING THE SUSTAINABLE GROWTH RATE- Section
1848(f) (42 U.S.C. 1395w-4(f)) is amended--
(1) by redesignating paragraph (3) as paragraph (4); and
(2) by inserting after paragraph (2) the following:
`(3) METHODOLOGY- For purposes of determining the update adjustment
factor under subsection (d)(3)(B) and the allowed expenditures under
subsection (d)(3)(C) for a year, the sustainable growth rate for each year
taken into consideration in the determination under paragraph (2) shall be
determined as follows:
`(A) For purposes of such calculations for the year 2000, the
sustainable growth rate shall be determined on the basis of the best data
available to the Secretary as of September 1, 1999.
`(B) For purposes of such calculations for each year after the year
2000--
`(i) the sustainable growth rate for such year and each of the 2
preceding years shall be determined on the basis of the best data
available to the Secretary as of September 1 of such year;
and
`(ii) the sustainable growth rate for each year preceding the years
specified in clause (i) shall be the rate used for such year in such
calculation for the immediately preceding year.'.
(1) IN GENERAL- Subject to paragraph (2), the amendments made by this
section shall take effect as if included in the enactment of the Balanced
Budget Act of 1997 (Public Law 105-33; 111 Stat. 251).
(2) NO EFFECT ON UPDATES FOR 1998 AND 1999- The amendments made by this
section shall have no effect on the updates established by the Secretary for
1998 and 1999, and such established updates may not be changed.
SEC. 602. PUBLICATION OF ESTIMATE OF CONVERSION FACTOR AND MEDPAC
REVIEW.
(a) PUBLICATION- Not later than April 15 of each year (beginning in 2000),
the Secretary of Health and Human Services (in this section referred to as the
`Secretary') shall publish in the Federal Register--
(1) an estimate of the single conversion factor to be used in the next
calendar year for reimbursement of physicians services under section 1848 of
the Social Security Act (42
U.S.C. 1395w-4); and
(2) the data on which such estimate is based.
(b) MEDPAC REVIEW AND REPORT-
(1) REVIEW- The Medicare Payment Advisory Commission (in this section
referred to as `MedPAC') shall annually review the estimates and data
published by the Secretary pursuant to subsection (a).
(2) REPORT- Not later than June 30 of each year (beginning in 2000),
MedPAC shall submit a report to the Secretary and to the committees of
jurisdiction in Congress on the review conducted pursuant to paragraph (1),
together with any recommendations as determined appropriate by MedPAC.
TITLE VII--HOME HEALTH
SEC. 701. DELAY IN THE 15 PERCENT REDUCTION IN PAYMENTS UNDER THE PPS FOR
HOME HEALTH SERVICES.
(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 `September
30, 2002'.
(b) PROSPECTIVE PAYMENT SYSTEM- Section 1895(b)(3)(A) (42 U.S.C.
1395fff(b)(3)(A)), 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 by striking clause (i) and inserting the following:
`(i) IN GENERAL- Under such system the Secretary shall provide for
computation of a standard prospective payment amount (or amounts) as
follows:
`(I) 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
system for fiscal year 2001, shall be equal to the total amount that
would have been made if the system had not been in
effect;
`(II) For fiscal year 2003 such amount (or amounts), shall be
equal to the amount (or amounts) that would have been determined under
subclause (I), if the reduction in limits described in clause (ii) had
been in effect for fiscal year 2001, and updated under subparagraph
(B) for fiscal years 2002 and 2003.
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.'.
SEC. 702. INCREASE IN PER VISIT LIMIT.
(a) INTERIM PAYMENT SYSTEM- Section 1861(v)(1)(L)(i) (42 U.S.C.
1395x(v)(1)(L)(i)), as amended by section 701(b), is amended--
(1) in subclause (IV), by striking `or';
(A) by inserting `and before October 1, 1999,' after `October 1,
1998,'; and
(B) by striking the period and inserting `, or'; and
(3) by adding at the end the following:
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