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H.R.3075
Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999
(Referred in Senate)
SEC. 224. TEMPORARY UPDATE IN DURABLE MEDICAL EQUIPMENT AND OXYGEN RATES.
(a) DURABLE MEDICAL EQUIPMENT AND OXYGEN- Section
1834(a)(14) (42 U.S.C. 1395m(a)(14)), as amended by section 4551(a)(1) of BBA,
is amended--
(1) by redesignating subparagraph (D) as subparagraph (E); and
(2) by striking subparagraph (C) and inserting the following:
`(C) for each of the years 1998 through 2000, 0 percentage
points;
`(D) for each of the years 2001 and 2002, the percentage increase in
the consumer price index for all urban consumers (United States city
average) for the 12-month period ending with June of the previous year
minus 2 percentage points; and'.
(b) CONFORMING AMENDMENTS- Section 1834(a)(9)(B) (42 U.S.C.
1395m(a)(9)(B)), as amended by section 4552(a) of BBA, is amended--
(1) by striking `and' at the end of clause (v);
(2) in clause (vi), by striking `and each subsequent year' and inserting
`and 2000' and by striking the period at the end and inserting `; and';
and
(3) by adding at the end the following new clause:
`(vii) for 2001 and each subsequent year, the amount determined
under this subparagraph for the preceding year increased by the covered
item update for such subsequent year.'.
SEC. 225. REQUIREMENT FOR NEW PROPOSED RULEMAKING FOR IMPLEMENTATION OF
INHERENT REASONABLENESS POLICY.
The Secretary of Health and Human Services shall not exercise inherent
reasonableness authority provided under section 1842(b)(8) of the Social
Security Act (42 U.S.C. 1395u(b)(8)) before such time as--
(1) the Secretary has published in the Federal Register a new notice of
proposed rulemaking to implement subparagraph (A) of such section;
(2) has provided for a period of not less than 60 days for public
comment on such proposed rule; and
(3) the Secretary has published in the Federal Register a final rule
which takes into account comments received during such period.
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 paragraph:
`(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 screening; and
(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
amended--
(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
follows:
`(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
factor.'.
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 current
regulations.
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
regimens; and
(2) of achieving cost saving to the Medicare program by decreasing the
need for secondary transplants and other care relating to post-transplant
complications.
(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
subsection (a).
(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, 2004.
(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
shall include--
(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
Congress.
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 subsection.
(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
U.S.C. 1395x(o)).
(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.
1395x(m)).
(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
REQUIREMENTS-
(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
collected.
(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 (OASIS).
(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
system'.
(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 system--
`(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;
and
`(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. 1395w-29).
(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.
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