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S.3077
Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 2000
(Introduced in the Senate)
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;
(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repealed.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.
(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.
TITLE III--PROVISIONS RELATING TO PARTS A AND B
Subtitle A--Home Health Services
SEC. 301. ELIMINATION OF 15 PERCENT REDUCTION IN PAYMENT RATES UNDER THE
PROSPECTIVE PAYMENT SYSTEM FOR HOME HEALTH SERVICES.
(a) IN GENERAL- Section 1895(b)(3)(A) (42 U.S.C. 1395fff(b)(3)(A)) is
amended to read as follows:
`(A) INITIAL BASIS- 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 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 if section 1861(v)(1)(L)(ix) had not been enacted. Each
such amount shall be standardized in a manner that eliminates the effect
of variations in relative case mix and area wage adjustments 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.'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) shall take effect
as if included in the enactment of BBRA.
SEC. 302. EXCLUSION OF CERTAIN NONROUTINE MEDICAL SUPPLIES UNDER THE PPS FOR HOME
HEALTH SERVICES.
(1) IN GENERAL- Section 1895 (42 U.S.C. 1395fff) is amended by adding at
the end the following new subsection:
`(e) EXCLUSION OF NONROUTINE MEDICAL SUPPLIES-
`(1) IN GENERAL- Notwithstanding the preceding provisions of this
section, in the case of all nonroutine medical supplies (as defined by the
Secretary) furnished by a home health agency during a year (beginning with
2001) for which payment is otherwise made on the basis of the prospective
payment amount under this section, payment under this section shall be based
instead on the lesser of--
`(A) the actual charge for the nonroutine medical supply; or
`(B) the amount determined under the fee schedule established by the
Secretary for purposes of making payment for such items under part B for
nonroutine medical supplies
furnished during that year.
`(2) BUDGET NEUTRALITY ADJUSTMENT- The Secretary shall provide for an
appropriate proportional reduction in payments under this section so that
beginning with fiscal year 2001, the aggregate amount of such reductions is
equal to the aggregate increase in payments attributable to the exclusion
effected under paragraph (1).'.
(2) CONFORMING AMENDMENT- Section 1895(b)(1) of the Social Security Act
(42 U.S.C. 1395fff(b)(1)) is amended by striking `The Secretary' and
inserting `Subject to subsection (e), the Secretary'.
(3) EFFECTIVE DATE- The amendments made by this subsection shall apply
to supplies furnished on or after January 1, 2001.
(b) EXCLUSION FROM CONSOLIDATED BILLING-
(1) IN GENERAL- For items provided during the applicable period, the
Secretary of Health and Human Services shall administer the medicare program under title XVIII
of the Social Security Act (42 U.S.C. 1395 et seq.) as if--
(A) section 1842(b)(6)(F) of such Act (42 U.S.C. 1395u(b)(6)(F)) was
amended by striking `(including medical supplies described in
section 1861(m)(5), but excluding durable medical equipment to the extent provided
for in such section)' and inserting `(excluding medical supplies and durable medical equipment described in section
1861(m)(5))'; and
(B) section 1862(a)(21) of such Act (42 U.S.C. 1395y(a)(21)) was
amended by striking `(including medical supplies described in
section 1861(m)(5), but excluding durable medical equipment to the extent provided
for in such section)' and inserting `(excluding medical supplies and durable medical equipment described in section
1861(m)(5))'.
(2) APPLICABLE PERIOD DEFINED- For purposes of paragraph (1), the term
`applicable period' means the period beginning on January 1, 2001, and
ending on the later of--
(A) the date that is 18 months after the date of enactment of this
Act; or
(B) the date determined appropriate by the Secretary of Health and
Human Services.
(c) STUDY ON EXCLUSION OF CERTAIN NONROUTINE MEDICAL SUPPLIES UNDER THE PPS FOR
HOME HEALTH SERVICES-
(1) STUDY- The Secretary of Health and Human Services (in this
subsection referred to as the `Secretary') shall conduct a study to identify
any nonroutine medical supply
that may be appropriately and cost-effectively excluded from the prospective
payment system for home health services under section 1895 of the Social
Security Act (42 U.S.C. 1395fff). Specifically, the Secretary shall consider
whether wound care and ostomy supplies should be excluded from such
prospective payment system.
(2) REPORT- Not later than 18 months after the date of enactment of this
Act, the Secretary shall submit to the committees of jurisdiction of the
House of Representatives and the Senate a report on the study conducted
under paragraph (1), including a list of any nonroutine medical supplies that should be
excluded from the prospective payment system for home health services under
section 1895 of the Social Security Act (42 U.S.C. 1395fff).
(d) EXCLUSION OF OTHER NONROUTINE MEDICAL SUPPLIES- Upon submission of
the report under subsection (c)(2), the Secretary shall (if necessary) revise
the definition of nonroutine medical supply, as defined for
purposes of section 1895(e) (as added by subsection (a)), based on the list of
nonroutine medical supplies
included in such report.
SEC. 303. PERMITTING HOME HEALTH PATIENTS WITH ALZHEIMER'S DISEASE OR A
RELATED DEMENTIA TO ATTEND ADULT DAY-CARE.
(a) IN GENERAL- Sections 1814(a) and 1835(a) of the Social Security Act
(42 U.S.C. 1395f(a); 1395n(a)) are each amended in the last sentence by
inserting `(including regularly participating, for the purpose of therapeutic
treatment for Alzheimer's disease or a related dementia, in an adult day-care
program that is licensed, certified, or accredited by a State to furnish adult
day-care services in the State)' before the period.
(b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply to
items and services provided on or after October 1, 2001.
SEC. 304. STANDARDS FOR HOME HEALTH BRANCH OFFICES.
(a) IN GENERAL- Section 1861(o) (42 U.S.C. 1395x(o)) is amended by adding
at the end the following new sentences: `For purposes of this subsection, a
home health agency may provide services through a single site or through a
branch office. For purposes of the preceding sentence, the term `branch
office' means a service site for home health services that is controlled and
supervised by a home health agency.'.
(b) ESTABLISHMENT OF STANDARDS-
(1) IN GENERAL- The Secretary of Health and Human Services (in this
subsection referred to as the `Secretary') shall establish, using a
negotiated rulemaking process under subchapter III of chapter 5 of title 5,
United States Code, standards for the operation of a branch office (as
defined in the last sentence of section 1861(o) of the Social Security Act
(42 U.S.C. 1395x(o)), as added by subsection (a)).
(2) REQUIREMENTS- In establishing standards under paragraph (1), the
Secretary shall--
(A) provide for the special treatment of any home health agency or
branch office--
(i) that is located in a frontier area; or
(ii) with any other special circumstance that the Secretary
determines is appropriate; and
(B) allow the use of technology used by the home health agency to
supervise the branch office.
(3) CONSULTATION- The Secretary shall establish the regulations under
this subsection in consultation with representatives of the home health
industry.
SEC. 305. TREATMENT OF HOME HEALTH SERVICES PROVIDED IN CERTAIN
COUNTIES.
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