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SEC. 244. ELIMINATION OF REDUCTION IN PAYMENT AMOUNTS FOR DURABLE MEDICAL EQUIPMENT AND OXYGEN AND OXYGEN EQUIPMENT .

(a) UPDATE FOR COVERED ITEMS- Section 1834(a)(14)(C) (42 U.S.C. 1395m(a)(14)(C)) is amended by striking `through 2002' and inserting `through 2000'.

(b) ORTHOTICS AND PROSTHETICS- Section 1834(h)(4)(A)(v) (42 U.S.C. 1395m(h)(4)(A)(v)) is amended by striking `through 2002' and inserting `through 2000'.

(c) PARENTERAL AND ENTERAL NUTRIENTS, SUPPLIES, AND EQUIPMENT - Section 4551(b) of BBA (42 U.S.C. 1395m note) is amended by striking `through 2002' and inserting `through 2000'.

(d) OXYGEN AND OXYGEN EQUIPMENT - Section 1834(a)(9)(B) (42 U.S.C. 1395m(a)(9)(B)) is amended--

(1) in clause (v), by striking `and' at the end;

(2) in clause (vi)--

(A) by striking `each subsequent year' and inserting `2000'; and

(B) 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.'.

(e) CONFORMING AMENDMENT- Section 228 of BBRA (113 Stat. 1501A-356) is repealed.

SEC. 245. STANDARDS REGARDING PAYMENT FOR CERTAIN ORTHOTICS AND PROSTHETICS.

(a) STANDARDS-

(1) IN GENERAL- Section 1834(h)(1) (42 U.S.C. 1395m(h)(1)) is amended by adding at the end the following:

`(F) ESTABLISHMENT OF STANDARDS FOR CERTAIN ITEMS-

`(i) IN GENERAL- No payment shall be made for an applicable item unless such item is provided by a qualified practitioner or a qualified supplier under the system established by the Secretary under clause (iii). For purposes of the preceding sentence, if a qualified practitioner or a qualified supplier contracts with an entity to provide an applicable item, then no payment shall be made for such item unless the entity is also a qualified supplier.

`(ii) DEFINITIONS- In this subparagraph--

`(I) APPLICABLE ITEM- The term `applicable item' means orthotics and prosthetics that require education, training, and experience to custom fabricate such item. Such term does not include shoes and shoe inserts.

`(II) QUALIFIED PRACTITIONER- The term `qualified practitioner' means a physician or health professional who meets any of the following requirements:

`(aa) The physician or health professional is specifically trained and educated to provide or manage the provision of custom-designed, fabricated, modified, and fitted orthotics and prosthetics, and is either certified by the American Board for Certification in Orthotics and Prosthetics, Inc., certified by the Board for Orthotist/Prosthetist Certification, or credentialed and approved by a program that the Secretary determines, in consultation with appropriate experts in orthotics and prosthetics, has training and education standards that are necessary to provide applicable items.

`(bb) The physician or health professional is licensed in orthotics or prosthetics by the State in which the applicable item is supplied, but only if the Secretary determines that the mechanisms used by the State to provide such licensure meet standards determined appropriate by the Secretary.

`(cc) The physician or health professional has completed at least 10 years practice in the provision of applicable items. A physician or health professional may not qualify as a qualified practitioner under the preceding sentence with respect to an applicable item if the item was provided on or after January 1, 2005.

`(III) QUALIFIED SUPPLIER- The term `qualified supplier' means any entity that is--

`(aa) accredited by the American Board for Certification in Orthotics and Prosthetics, Inc. or the Board for Orthotist/Prosthetist Certification; or

`(bb) accredited and approved by a program that the Secretary determines has accreditation and approval standards that are essentially equivalent to those of such Board.

`(iii) SYSTEM- The Secretary, in consultation with appropriate experts in orthotics and prosthetics, shall establish a system under which the Secretary shall--

`(I) determine which items are applicable items and formulate a list of such items;

`(II) review the applicable items billed under the coding system established under this title; and

`(III) limit payment for applicable items pursuant to clause (i).'.

(2) EFFECTIVE DATE- The amendment made by paragraph (1) shall apply to items provided on or after January 1, 2003.

(b) REVISION OF DEFINITION OF ORTHOTICS-

(1) IN GENERAL- Section 1861(s)(9) (42 U.S.C. 1395x(s)(9)) is amended by inserting `(including such braces that are used in conjunction with, or as components of, other medical or non-medical equipment when provided by a qualified practitioner (as defined in subclause (II) of section 1834(h)(1)(F))) or a qualified supplier (as defined in subclause (III) of such section)' after `braces'.

(2) EFFECTIVE DATE- The amendment made by paragraph (1) shall apply to items provided on or after January 1, 2003.

SEC. 246. NATIONAL LIMITATION AMOUNT EQUAL TO 100 PERCENT OF NATIONAL MEDIAN FOR NEW PAP SMEAR TECHNOLOGIES AND OTHER NEW CLINICAL LABORATORY TEST TECHNOLOGIES.

Section 1833(h)(4)(B)(viii) (42 U.S.C. 1395l(h)(4)(B)(viii)) is amended by inserting before the period at the end the following: `(or 100 percent of such median in the case of a clinical diagnostic laboratory test performed on or after January 1, 2001, that the Secretary determines is a new test for which no limitation amount has previously been established under this subparagraph)'.

SEC. 247. INCREASED MEDICARE PAYMENTS FOR CERTIFIED NURSE-MIDWIFE SERVICES.

(a) AMOUNT OF PAYMENT- Section 1833(a)(1)(K) (42 U.S.C. 1395l(a)(1)(K)) is amended by striking `65 percent of the prevailing charge that would be allowed for the same service performed by a physician, or, for services furnished on or after January 1, 1992, 65 percent' and inserting `85 percent'.

(b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to services furnished on or after January 1, 2001.

SEC. 248. PAYMENT FOR ADMINISTRATION OF DRUGS.

(a) REVIEW OF CHEMOTHERAPY ADMINISTRATION PRACTICE EXPENSES RVUS- The Secretary of Health and Human Services shall review the resource-based practice expense component of relative value units under the physician fee schedule under section 1848 of the Social Security Act (42 U.S.C. 1395w-4) for chemotherapy administration services to determine if such units should be increased.

(b) MORE ACCURATE CHEMOTHERAPY DRUG PAYMENTS TIED TO INCREASES IN CHEMOTHERAPY ADMINISTRATION PAYMENTS- If the Secretary of Health and Human Services determines, as a result of the review under subsection (a), that the resource-based practice expense relative value units for chemotherapy administration services should be increased, the Secretary--

(1) may implement such increases for such services, but only if the Secretary simultaneously implements more accurate average wholesale prices for chemotherapy drugs (but in no case shall such simultaneous implementation occur prior to January 1, 2002); and

(2) if the Secretary implements such increases for such services, shall do so without taking into account the requirement under the physician fee schedule under section 1848(c)(2)(B)(ii)(II) of the Social Security Act (42 U.S.C. 1395w-4(c)(2)(B)(ii)(II)).

(c) BLOOD CLOTTING DRUG-RELATED ACTIVITIES-

(1) COVERAGE - Section 1861(s)(2)(I) (42 U.S.C. 1395x(s)(2)(I)) is amended--

(A) by striking `and' after `supervision,'; and

(B) by inserting the following before the semicolon: `, and the costs (pursuant to section 1834(n)) incurred by suppliers of such factors'.

(2) PAYMENTS- Section 1834 (42 U.S.C. 1395m), as amended by section 233(b), is amended by adding at the end the following new subsection:

`(n) PAYMENT FOR BLOOD CLOTTING DRUG-RELATED ACTIVITIES-

`(1) IN GENERAL- The Secretary shall make payments in accordance with paragraph (2) to suppliers of blood clotting factors (as described in section 1861(s)(2)(I)) to cover the costs (such as shipping, storage, inventory control, or other costs specified by the Secretary) incurred by such suppliers in furnishing such factors to individuals enrolled under this part.

`(2) PAYMENT AMOUNT- The amount of payment for furnishing such blood clotting factors (as so described) shall be an amount equal to 80 percent of the lesser of--

`(A) the actual charge for the furnishing of such factors; or

`(B) an amount equal to 10 cents (or such other amount determined appropriate by the Secretary) per unit of such factor furnished.'.

(3) EFFECTIVE DATE- The amendments made by this subsection shall apply to blood clotting factors (as described in section 1861(s)(2)(I) of the Social Security Act (42 U.S.C. 1395x(s)(2)(I))) furnished on or after the date that the Secretary of Health and Human Services implements more accurate average wholesale prices for such factors.

SEC. 249. MEDPAC STUDY ON IN-HOME INFUSION THERAPY NURSING SERVICES.

(a) STUDY- The Medicare Payment Advisory Commission established under section 1805 of the Social Security Act (42 U.S.C. 1395b-6) (in this section referred to as `MedPAC') shall conduct a study on the provision of in-home infusion therapy nursing services, including a review of any documentation of clinical efficacy for those services and any costs associated with providing those services.

(b) REPORT- Not later than 18 months after the date of enactment of this Act, MedPAC shall submit a report to the Secretary of Health and Human Services and Congress on the study and review conducted under subsection (a) together with recommendations regarding the establishment of a payment methodology for in-home infusion therapy nursing services that ensures the continuing access of beneficiaries under the medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) to those services.

SEC. 250. COVERAGE OF VISION REHABILITATION SERVICES.

(a) COVERAGE - Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is amended--

(1) by striking `and' at the end of subparagraph (S);

(2) by striking the period at the end of (T) and inserting `; and'; and

(3) by adding at the end the following new subparagraph:

`(U) vision rehabilitation services (as defined in subsection (uu)(1)).'.

(b) SERVICES DESCRIBED- Section 1861 (42 U.S.C. 1395x), as amended by sections 232, 233(a), and 234(b), is further amended by adding at the end the following new subsection:

`Vision Rehabilitation Services; Vision Rehabilitation Professional

`(xx)(1) The term `vision rehabilitation services' means a program of restorative services (as determined by the Secretary in regulations) furnished by a vision rehabilitation professional (as defined in paragraph (2)) to an individual diagnosed with a vision impairment (as defined in paragraph (6)) to promote the independence and safety of the individual notwithstanding such impairment, such services furnished pursuant to a plan of care established by a physician (as defined in paragraph (1) or (4) of subsection (r)).

`(2) The term `vision rehabilitation professional' means any of the following individuals:

`(A) An orientation and mobility specialist (as defined in paragraph (3)).

`(B) A rehabilitation teacher (as defined in paragraph (4)).

`(C) A low vision therapist (as defined in paragraph (5)).

`(3)(A) The term `orientation and mobility specialist' means an individual--

`(i) who holds a baccalaureate or higher degree granted by a regionally accredited college or university in the United States (or an equivalent foreign degree) in rehabilitation, special education, or a health field with a university-based program of study and clinical experience in orientation and mobility (as defined in subparagraph (B)); and

`(ii)(I) who is licensed or certified as an orientation and mobility specialist by the State in which the orientation and mobility services are performed; or

`(II) in the case of an individual furnishing orientation and mobility services in a State which does not provide for licensure or certification--

`(aa) who has successfully completed 350 hours of clinical practicum under the supervision of an orientation and mobility specialist holding a master's degree or higher, and who has furnished not less than 9 months of supervised full-time orientation and mobility services after obtaining a degree described in clause (i); and

`(bb) who has successfully completed a national examination in orientation and mobility administered by a national organization specifically dedicated to performing credentialing of orientation and mobility specialists that is recognized by the Secretary, and who meets such other criteria as the Secretary establishes.

`(B) The term `orientation and mobility' means the following services:

`(i) Assessment of needs of an individual who has a vision impairment for skills training in methods of safe movement and in strategies to gather required environmental and spatial information.

`(ii) Development of appropriate integrated service plans tailored to meet such needs identified pursuant to an assessment under clause (i).

`(iii) Provision of training in and utilization of--

`(I) equipment and adaptive devices intended and designed for use by such an individual; and

`(II) specialized techniques adapted for such individuals, including orientation, sensory development, systems of safe movement (including long cane techniques), resource identification, professional referrals (as appropriate), and, in applied settings reinforcing instruction for the use of optical devices as prescribed by optometrists and ophthalmologists.

`(iv) Evaluation of the progress in performance of such an individual receiving training under clause (iii).

`(4)(A) The term `rehabilitation teacher' means an individual--

`(i) who holds a baccalaureate or higher degree granted by a regionally accredited college or university in the United States (or an equivalent foreign degree) in rehabilitation, special education, or a health field with a university-based program of study and clinical experience in rehabilitation teaching (as defined in subparagraph (B)); and

`(ii)(I) who is licensed or certified as a rehabilitation teacher by the State in which the rehabilitation teaching services are performed; or

`(II) in the case of an individual furnishing rehabilitation teaching services in a State which does not provide for licensure or certification--

`(aa) who has successfully completed 350 hours of clinical practicum under the supervision of a rehabilitation teacher holding a master's degree or higher, and who has furnished not less than 9 months of supervised full-time rehabilitation teaching services after obtaining a degree described in clause (i); and

`(bb) who has successfully completed a national examination in rehabilitation teaching administered by a national organization specifically dedicated to performing credentialing of rehabilitation teachers that is recognized by the Secretary, and who meets such other criteria as the Secretary establishes.

`(B) The term `rehabilitation teaching' means the following services:

`(i) Assessment of needs of an individual with a vision impairment for skills training in independent living and communications.

`(ii) Development of appropriate integrated service plans tailored to meet such needs identified pursuant to an assessment under clause (i).

`(iii) Provision of training in, and utilization of--

`(I) equipment and adaptive devices intended and designed for use by such an individual, including, in applied settings, reinforcing instruction for the use of optical devices as prescribed by optometrists or ophthalmologists; and

`(II) specialized techniques adapted for such an individual, including braille and other communication skills, personal self-care skills, and home management skills.

`(iv) Evaluation of the progress in performance of such an individual receiving training under clause (iii).

`(5)(A) The term `low vision therapist' means an individual--

`(i) who holds--

`(I) a baccalaureate or higher degree granted by a regionally accredited college or university in the United States (or an equivalent foreign degree) in rehabilitation, special education, or a health field with a university-based program of study and clinical experience in orientation and mobility, rehabilitation teaching, or teaching the visually impaired;

`(II) a master's of science degree granted by a regionally accredited college or university in the United States (or an equivalent foreign degree) in low vision rehabilitation; or

`(III) a baccalaureate or higher degree granted by a regionally accredited college or university in the United States (or an equivalent foreign degree) in occupational therapy;

`(ii) who after obtaining a degree described in clause (i) has performed at least 2 years of low vision therapy (as defined in subparagraph (B)) under the supervision of an optometrist or ophthalmologist in an appropriate setting (as determined by the Secretary); and

`(iii)(I) who is licensed or certified as a low vision therapist by the State in which the services are performed; or

`(II) in the case of an individual in a State which does not provide for licensure or certification, who has successfully completed a national examination in low vision therapy administered by a national organization specifically dedicated to performing credentialing of low vision therapists that is recognized by the Secretary, and who meets such other criteria as the Secretary establishes.

`(B) The term `low vision therapy' means the following services furnished to an individual and based upon the clinical findings of a low vision examination conducted on the individual by an optometrist or an ophthalmologist:

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