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S.3165
Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 2000
(Introduced in the Senate)
SEC. 433. FULL UPDATE IN 2001 FOR DURABLE MEDICAL EQUIPMENT , OXYGEN, AND OXYGEN EQUIPMENT .
(a) UPDATE FOR COVERED ITEMS- Section 1834(a)(14) (42 U.S.C. 1395m(a)(14))
is amended--
(1) by redesignating subparagraph (D) as subparagraph (F);
(2) in subparagraph (C)--
(A) by striking `through 2002' and inserting `through 2000';
and
(B) by striking ` and' at the end; and
(3) by inserting after subparagraph (C) the following new
subparagraphs:
`(D) for 2001, the percentage increase in the consumer price index for
all urban consumers (U.S. urban average) for the 12-month period ending
with June 2000;
`(E) for 2002, 0 percentage points; and'.
(b) ORTHOTICS AND PROSTHETICS- Section 1834(h)(4)(A) (42 U.S.C.
1395m(h)(4)(A)) is amended--
(1) by redesignating clause (vi) as clause (viii);
(A) by striking `through 2002' and inserting `through 2000';
and
(B) by striking ` and' at the end; and
(3) by inserting after clause (v) the following new clauses:
`(vi) for 2001, the percentage increase in the consumer price index
for all urban consumers (United States City average) for the 12-month
period ending with June 2000;
`(vi) for 2002, 1 percent; and'.
(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 `,
1999, 2000, and 2002'.
(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 a semicolon;
and
(3) by adding at the end the following new clauses:
`(vii) for 2001, the amount determined under this subparagraph for
2000 increased by the covered item update for 2001;
`(viii) for 2002, 70 percent of the amount determined under this
subparagraph for 1997; and
`(ix) for 2003 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repealed.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. 434. 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. 435. DELAY AND REVISION OF PPS FOR 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 (113 Stat.
1501A-354) 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 of BBRA
(113 Stat. 1501A-354) 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. 436. TREATMENT OF CERTAIN PHYSICIAN PATHOLOGY SERVICES.
(a) IN GENERAL- Section 1848(i) (42 U.S.C. 1395w-4(i)) is amended by
adding at the end the following new paragraph:
`(4) TREATMENT OF CERTAIN PHYSICIAN PATHOLOGY SERVICES-
`(A) IN GENERAL- Notwithstanding any other provision of law, when an
independent laboratory furnishes the technical component of a physician
pathology service with respect to a fee-for-service medicare beneficiary who is a
patient of a grandfathered hospital, such component shall be treated as a
service for which payment shall be made to the laboratory under this
section and not as--
`(i) an inpatient hospital service for which payment is made to the
hospital under section 1886(d); or
`(ii) a hospital outpatient service for which payment is made to the
hospital under the prospective payment system under section
1834(t).
`(B) DEFINITIONS- In this paragraph:
`(i) GRANDFATHERED HOSPITAL- The term `grandfathered hospital' means
a hospital that had an arrangement with an independent
laboratory--
`(I) that was in effect as of July 22, 1999; and
`(II) under which the laboratory furnished the technical component
of physician pathology services with respect to patients of the
hospital and submitted a claim for payment for such component to a
carrier with a contract under section 1842 (and not to the
hospital).
`(ii) FEE-FOR-SERVICE MEDICARE BENEFICIARY- The term
`fee-for-service medicare
beneficiary' means an individual who is not enrolled--
`(I) in a Medicare
+Choice plan under part C;
`(II) in a plan offered by an eligible organization under section
1876;
`(III) with a PACE provider under section 1894;
`(IV) in a medicare
managed care demonstration project; or
`(V) in the case of a service furnished to an individual on an
outpatient basis, in a health care prepayment plan under section
1833(a)(1)(A).'.
(b) EFFECTIVE DATE- The amendment made by this section shall apply to
services furnished on or after January 1, 2001.
SEC. 437. MODIFICATION OF MEDICARE BILLING REQUIREMENTS FOR
CERTAIN INDIAN PROVIDERS.
(a) IN GENERAL- Section 1880(a) (42 U.S.C. 1395qq(a)) is amended by adding
at the end the following new sentence: `A hospital or a free-standing
ambulatory care clinic (as defined by the Secretary), whether operated by the
Indian Health Service or by an Indian tribe or tribal organization (as those
terms are defined in section 4 of the Indian Health Care Improvement Act),
shall be eligible for payments for services for which payment is made pursuant
to section 1848, notwithstanding sections 1814(c) and 1835(d), if and for so
long as it meets all of the requirements which are applicable generally to
such payments, services, hospitals, and clinics.'.
(b) EFFECTIVE DATE- The amendments made by this section shall apply to
services furnished on or after January 1, 2001.
SEC. 438. REPLACEMENT OF PROSTHETIC DEVICES AND PARTS.
(a) IN GENERAL- Section 1834(h)(1) of the Social Security Act (42 U.S.C.
1395m(h)(1)) is amended by adding at the end the following new
subparagraph:
`(F) REPLACEMENT OF PROSTHETIC DEVICES AND PARTS-
`(i) IN GENERAL- Payment shall be made for the replacement of
prosthetic devices which are artificial limbs, or for the replacement of
any part of such devices, without regard to continuous use or useful
lifetime restrictions if an ordering physician determines that the
provision of a replacement device, or a replacement part of
such a device, is necessary because of any of the following:
`(I) A change in the physiological condition of the
patient.
`(II) An irreparable change in the condition of the device, or in
a part of the device.
`(III) The condition of the device, or the part of the device,
requires repairs and the cost of such repairs would be more than 60
percent of the cost of a replacement device, or, as the case may be,
of the part being replaced.
`(ii) CONFIRMATION MAY BE REQUIRED IF REPLACEMENT DEVICE OR PART IS
LESS THAN 2 YEARS OLD- If a physician determines that a replacement
device, or a replacement part, is necessary pursuant to clause
(i)--
`(I) such determination shall be controlling; and
`(II) such replacement device or part shall be deemed to be
reasonable and necessary for purposes of section
1862(a)(1)(A);
except that if the device, or part, being replaced is less than 2
years old (calculated from the date on which the beneficiary began to
use the device or part), the Secretary may also require the beneficiary
to provide confirmation of necessity of the replacement device, or, as
the case may be, the replacement part, by a prosthetist selected by the
beneficiary.'.
(b) PREEMPTION OF RULE- The provisions of section 1834(h)(1)(F) of the
Social Security Act (42 U.S.C. 1395m(h)(1)(F)), as added by subsection (a),
shall supersede any rule that as of the date of enactment of this Act may have
applied a 5-year replacement rule with regard to prosthetic devices.
(c) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to
items furnished on or after the date of enactment of this Act.
SEC. 439. MEDPAC STUDY AND REPORT ON MEDICARE REIMBURSEMENT FOR SERVICES
PROVIDED BY CERTAIN PROVIDERS.
(a) STUDY- The Medicare
Payment Advisory Commission (referred to in this section as `MedPAC') shall
conduct a study on the appropriateness of the current payment rates under the
medicare program under title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) for services
provided by a--
(1) certified nurse-midwife (as defined in subsection (gg)(2) of section
1861 of the Social Security Act (42 U.S.C. 1395x);
(2) physician assistant (as defined in subsection (aa)(5)(A) of such
section);
(3) nurse practitioner (as defined in such subsection); and
(4) clinical nurse specialist (as defined in subsection (aa)(5)(B) of
such section).
(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 conducted under subsection (a), together
with any recommendations for legislation that MedPAC determines to be
appropriate as a result of such study.
SEC. 440. MEDPAC STUDY AND REPORT ON MEDICARE COVERAGE OF SERVICES PROVIDED BY CERTAIN
NON-PHYSICIAN PROVIDERS.
(1) IN GENERAL- The Medicare Payment Advisory Commission
(referred to in this section as `MedPAC') shall conduct a study to determine
the appropriateness of providing coverage under the medicare program under title XVIII
of the Social Security Act (42 U.S.C. 1395 et seq.) for services provided by
a--
(A) certified first nurse assistant;
(C) pastoral care counselor; and
(D) licensed professional counselor of mental health.
(2) COSTS TO PROGRAM- The study shall consider the short-term and
long-term benefits, and costs to the medicare program, of providing the
coverage described in
paragraph (1).
(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 conducted under subsection (a), together
with any recommendations for legislation that MedPAC determines to be
appropriate as a result of such study.
TITLE V--PROVISIONS RELATING TO PARTS A AND B
Subtitle A--Home Health Services
SEC. 501. 1-YEAR ADDITIONAL DELAY IN APPLICATION OF 15 PERCENT REDUCTION ON
PAYMENT LIMITS FOR HOME HEALTH SERVICES.
(a) IN GENERAL- Section 1895(b)(3)(A)(i) (42 U.S.C. 1395fff(b)(3)(A)(i))
is amended--
(1) by redesignating subclause (II) as subclause (III);
(2) in subclause (III), as redesignated, by striking `described in
subclause (I)' and inserting `described in subclause (II)'; and
(3) by inserting after subclause (I) the following new subclause:
`(II) For the 12-month period beginning after the period described
in subclause (I), such amount (or amounts) shall be equal to the
amount (or amounts) determined under subclause (I), updated under
subparagraph (B).'.
(b) CHANGE IN REPORT- Section 302(c) of BBRA is amended by striking `Not
later than' and all that follows through `(42 U.S.C. 1395fff)' and inserting
`Not later than October 1, 2001'.
SEC. 502. RESTORATION OF FULL HOME HEALTH MARKET BASKET UPDATE FOR HOME
HEALTH SERVICES FOR FISCAL YEAR 2001.
(a) IN GENERAL- Section 1861(v)(1)(L)(x) (42 U.S.C. 1395x(v)(1)(L)(x)) is
amended--
(1) by striking `2001,'; and
(2) by adding at the end the following: `With respect to cost reporting
periods beginning during fiscal year 2001, the update to any limit under
this subparagraph shall be the home health market basket index.'.
(b) SPECIAL RULE FOR PAYMENT FOR FISCAL YEAR 2001 BASED ON ADJUSTED
PROSPECTIVE PAYMENT AMOUNTS-
(1) IN GENERAL- Notwithstanding the amendments made by subsection (a),
for purposes of making payments under section 1895(b) of the Social Security
Act (42 U.S.C. 1395fff(b)) for home health services for fiscal year 2001,
the Secretary of Health and Human Services shall--
(A) with respect to episodes and visits ending on or after October 1,
2000, and before April 1, 2001, use the final standardized and
budget neutral prospective payment amounts for 60 day episodes and
standardized average per visit amounts for fiscal year 2001 as published by the
Secretary in Federal Register of the July 3, 2000 (65 Federal Register
41128-41214); and
(B) with respect to episodes and visits ending on or after April 1,
2001, and before October 1, 2001, use such amounts increased by an
actuarially determined amount that represents the different distributions
of episodes and visits in the first and second 6 month periods of fiscal
year 2001 due to implementation of the home health prospective payment
system under section 1895 of such Act (42 U.S.C. 1395fff).
(2) NO EFFECT ON OTHER PAYMENTS OR DETERMINATIONS- The Secretary shall
not take the provisions of paragraph (1) into account for purposes of
payments, determinations, or budget neutrality adjustments under section
1895 of the Social Security Act.
(c) ADJUSTMENT FOR CASE MIX CHANGES-
(1) IN GENERAL- Section 1895(b)(3)(B) (42 U.S.C. 1395fff(b)(3)(B)) is
amended by adding at the end the following new clause:
`(vi) ADJUSTMENT FOR CASE MIX CHANGES- Insofar as the Secretary
determines that the adjustments under paragraph (4)(A)(i) for a previous
fiscal year (or estimates that such adjustments for a future fiscal
year) did (or are likely to) result in a change in aggregate payments
under this subsection during the fiscal year that are a result of
changes in the coding or classification of different units of services
that do not reflect real changes in case mix, the Secretary may adjust
the standard prospective payment amount (or amounts) under paragraph (3)
for subsequent fiscal years so as to eliminate the effect of such coding
or classification changes.'.
(2) EFFECTIVE DATE- The amendment made by paragraph (1) applies to
episodes concluding on or after October 1, 2001.
SEC. 503. 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
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