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< Back to current issue of Immigration Daily < Back to current issue of Immigrant's Weekly
[Congressional Record: December 15, 2000 (House)]
[Page H12355-H12405]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]
[DOCID:cr15de00-44]
[[pp. H12355-H12405]] CONFERENCE REPORT ON H.R. 4577, DEPARTMENTS OF LABOR, HEALTH AND HUMAN
SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT, 2001
[[Continued from page H12354]]
[[Page H12355]]
Subtitle B--Adjustments to PPS Payments for Skilled Nursing Facilities
SEC. 311. ELIMINATION OF REDUCTION IN SKILLED NURSING
FACILITY (SNF) MARKET BASKET UPDATE IN 2001.
(a) In General.--Section 1888(e)(4)(E)(ii) (42 U.S.C.
1395yy(e)(4)(E)(ii)) is amended--
(1) by redesignating subclauses (II) and (III) as
subclauses (III) and (IV), respectively;
(2) in subclause (III), as so redesignated--
(A) by striking ``each of fiscal years 2001 and 2002'' and
inserting ``each of fiscal years 2002 and 2003''; and
(B) by striking ``minus 1 percentage point'' and inserting
``minus 0.5 percentage points''; and
(3) by inserting after subclause (I) the following new
subclause:
``(II) for fiscal year 2001, the rate computed for the
previous fiscal year increased by the skilled nursing
facility market basket percentage change for the fiscal
year;''.
(b) Special Rule for Payment for Fiscal Year 2001.--
Notwithstanding the amendments made by subsection (a), for
purposes of making payments for covered skilled nursing
facility services under section 1888(e) of the Social
Security Act (42 U.S.C. 1395yy(e)) for fiscal year 2001, the
Federal per diem rate referred to in paragraph (4)(E)(ii) of
such section--
(1) for the period beginning on October 1, 2000, and ending
on March 31, 2001, shall be the rate determined in accordance
with the law as in effect on the day before the date of the
enactment of this Act; and
(2) for the period beginning on April 1, 2001, and ending
on September 30, 2001, shall be the rate that would have been
determined under such section if ``plus 1 percentage point''
had been substituted for ``minus 1 percentage point'' under
subclause (II) of such paragraph (as in effect on the day
before the date of the enactment of this Act).
(c) Relation to Temporary Increase in BBRA.--The increases
provided under section 101 of BBRA (113 Stat. 1501A-325)
shall be in addition to any increase resulting from the
amendments made by subsection (a).
(d) GAO Report on Adequacy of SNF Payment Rates.--Not later
than July 1, 2002, the Comptroller General of the United
States shall submit to Congress a report on the adequacy of
medicare payment rates to skilled nursing facilities and the
extent to which medicare contributes to the financial
viability of such facilities. Such report shall take into
account the role of private payors, medicaid, and case mix on
the financial performance of these facilities, and shall
include an analysis (by specific RUG classification) of the
number and characteristics of such facilities.
(e) HCFA Study of Classification Systems for SNF
Residents.--
(1) Study.--The Secretary of Health and Human Services
shall conduct a study of the different systems for
categorizing patients in medicare skilled nursing facilities
in a manner that accounts for the relative resource
utilization of different patient types.
(2) Report.--Not later than January 1, 2005, the Secretary
shall submit to Congress a report on the study conducted
under subsection (a). Such report shall include such
recommendations regarding changes in law as may be
appropriate.
SEC. 312. INCREASE IN NURSING COMPONENT OF PPS FEDERAL RATE.
(a) In General.--The Secretary of Health and Human Services
shall increase by 16.66 percent the nursing component of the
case-mix adjusted Federal prospective payment rate specified
in Tables 3 and 4 of the final rule published in the Federal
Register by the Health Care Financing Administration on July
31, 2000 (65 Fed. Reg. 46770) and as subsequently updated,
effective for services furnished on or after April 1, 2001,
and before October 1, 2002.
(b) GAO Audit of Nursing Staff Ratios.--
(1) Audit.--The Comptroller General of the United States
shall conduct an audit of nursing staffing ratios in a
representative sample of medicare skilled nursing facilities.
Such sample shall cover selected States and shall include
broad representation with respect to size, ownership,
location, and medicare volume. Such audit shall include an
examination of payroll records and medicaid cost reports of
individual facilities.
(2) Report.--Not later than August 1, 2002, the Comptroller
General shall submit to Congress a report on the audits
conducted under paragraph (1). Such report shall include an
assessment of the impact of the increased payments under this
subtitle on increased nursing staff ratios and shall make
recommendations as to whether increased payments under
subsection (a) should be continued.
SEC. 313. APPLICATION OF SNF CONSOLIDATED BILLING REQUIREMENT
LIMITED TO PART A COVERED STAYS.
(a) In General.--Section 1862(a)(18) (42 U.S.C.
1395y(a)(18)) is amended by striking ``or of a part of a
facility that includes a skilled nursing facility (as
determined under regulations),'' and inserting ``during a
period in which the resident is provided covered post-
hospital extended care services (or, for services described
in section 1861(s)(2)(D), which are furnished to such an
individual without regard to such period),''.
(b) Conforming Amendments.--(1) Section 1842(b)(6)(E) (42
U.S.C. 1395u(b)(6)(E)) is amended--
(A) by inserting ``by, or under arrangements made by, a
skilled nursing facility'' after ``furnished'';
(B) by striking ``or of a part of a facility that includes
a skilled nursing facility (as determined under
regulations)''; and
(C) by striking ``(without regard to whether or not the
item or service was furnished by the facility, by others
under arrangement with them made by the facility, under any
other contracting or consulting arrangement, or otherwise)''.
(2) Section 1842(t) (42 U.S.C. 1395u(t)) is amended by
striking ``by a physician'' and ``or of a part of a facility
that includes a skilled nursing facility (as determined under
regulations),''.
(3) Section 1866(a)(1)(H)(ii)(I) (42 U.S.C.
1395cc(a)(1)(H)(ii)(I)) is amended by inserting after ``who
is a resident of the skilled nursing facility'' the
following: ``during a period in which the resident is
provided covered post-hospital extended care services (or,
for services described in section 1861(s)(2)(D), that are
furnished to such an individual without regard to such
period)''.
(c) Effective Date.--The amendments made by subsections (a)
and (b) shall apply to services furnished on or after January
1, 2001.
(d) Oversight.--The Secretary of Health and Human Services,
through the Office of the Inspector General in the Department
of Health and Human Services or otherwise, shall monitor
payments made under part B of the title XVIII of the Social
Security Act for items and services furnished to residents of
skilled nursing facilities during a time in which the
residents are not being provided medicare covered post-
hospital extended care services to ensure that there is not
duplicate billing for services or excessive services
provided.
SEC. 314. ADJUSTMENT OF REHABILITATION RUGS TO CORRECT
ANOMALY IN PAYMENT RATES.
(a) Adjustment for Rehabilitation RUGs.--
(1) In general.--For purposes of computing payments for
covered skilled nursing facility services under paragraph (1)
of section 1888(e) of the Social Security Act (42 U.S.C.
1395yy(e)) for such services furnished on or after April 1,
2001, and before the date described in section 101(c)(2) of
BBRA (113 Stat. 1501A-324), the Secretary of Health and Human
Services shall increase by 6.7 percent the adjusted Federal
per diem rate otherwise determined under paragraph (4) of
such section (but for this section) for covered skilled
nursing facility services for RUG-III rehabilitation groups
described in paragraph (2) furnished to an individual during
the period in which such individual is classified in such a
RUG-III category.
(2) Rehabilitation groups described.--The RUG-III
rehabilitation groups for which the adjustment described in
paragraph (1) applies are RUC, RUB, RUA, RVC, RVB, RVA, RHC,
RHB, RHA, RMC, RMB, RMA, RLB, and RLA, as specified in Tables
3 and 4 of the final rule published in the Federal Register
by the Health Care Financing Administration on July 31, 2000
(65 Fed. Reg. 46770).
(b) Correction With Respect to Rehabilitation RUGs.--
(1) In general.--Section 101(b) of BBRA (113 Stat. 1501A-
324) is amended by striking ``CA1, RHC, RMC, and RMB'' and
inserting ``and CA1''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to services furnished on or after April 1, 2001.
(c) Review by Office of Inspector General.--The Inspector
General of the Department of Health and Human Services shall
review the medicare payment structure for services classified
within rehabilitation resource utilization groups (RUGs) (as
in effect after the date of the enactment of the BBRA) to
assess whether payment incentives exist for the delivery of
inadequate care. Not later than October 1, 2001, the
Inspector General shall submit to Congress a report on such
review.
SEC. 315. ESTABLISHMENT OF PROCESS FOR GEOGRAPHIC
RECLASSIFICATION.
(a) In General.--The Secretary of Health and Human Services
may establish a procedure for the geographic reclassification
of a skilled nursing facility for purposes of payment for
covered skilled nursing facility services under the
prospective payment system established under section 1888(e)
of the Social Security Act (42 U.S.C. 1395yy(e)). Such
procedure may be based upon the method for geographic
reclassifications for inpatient hospitals established under
section 1886(d)(10) of the Social Security Act (42 U.S.C.
1395ww(d)(10)).
(b) Requirement for Skilled Nursing Facility Wage Data.--In
no case may the Secretary implement the procedure under
subsection (a) before such time as the Secretary has
collected data necessary to establish an area wage index for
skilled nursing facilities based on wage data from such
facilities.
Subtitle C--Hospice Care
SEC. 321. 5 PERCENT INCREASE IN PAYMENT BASE.
(a) In General.--Section 1814(i)(1)(C)(ii)(VI) (42 U.S.C.
1395f(i)(1)(C)(ii)(VI)) is amended by inserting ``, plus, in
the case of fiscal year 2001, 5.0 percentage points'' before
the semicolon at the end.
(b) Effective Date.--The amendment made by subsection (a)
shall apply to hospice care furnished on or after April 1,
2001. In applying clause (ii) of section 1814(i)(1)(C) of the
Social Security Act (42 U.S.C. 1395f(i)(1)(C)) beginning with
fiscal year 2002, the payment rates in effect under such
section during the period beginning on April 1, 2001, and
ending on September 30, shall be treated as the payment rates
in effect during fiscal year 2001.
(c) No Effect on BBRA Temporary Increase.--The provisions
of this section shall have no effect on the application of
section 131 of BBRA.
(d) Application of Wage Index.--Notwithstanding section
1814(i) of the Social Security Act (42 U.S.C. 1395f(i)), the
Secretary of Health and Human Services shall use 1.0043 as
the hospice wage index value for the Wichita, Kansas
[[Page H12356]]
Metropolitan Statistical Area in calculating payments under
such section for a hospice program providing hospice care in
such area during fiscal year 2000. The Secretary may provide
for an appropriate timely lump sum payment to reflect the
application of the previous sentence.
(e) Technical Amendment.--Section 1814(a)(7)(A)(ii) (42
U.S.C. 1395f(a)(7)(A)(ii)) is amended by striking the period
at the end and inserting a semicolon.
SEC. 322. CLARIFICATION OF PHYSICIAN CERTIFICATION.
(a) Certification Based on Normal Course of Illness.--
(1) In general.--Section 1814(a) (42 U.S.C. 1395f(a)) is
amended by adding at the end the following new sentence:
``The certification regarding terminal illness of an
individual under paragraph (7) shall be based on the
physician's or medical director's clinical judgment regarding
the normal course of the individual's illness.''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to certifications made on or after the date of
the enactment of this Act.
(b) Study and Report on Physician Certification Requirement
for Hospice Benefits.--
(1) Study.--The Secretary of Health and Human Services
shall conduct a study to examine the appropriateness of the
certification regarding terminal illness of an individual
under section 1814(a)(7) of the Social Security Act (42
U.S.C. 1395f(a)(7)) that is required in order for such
individual to receive hospice benefits under the medicare
program under title XVIII of such Act. In conducting such
study, the Secretary shall take into account the effect of
the amendment made by subsection (a).
(2) Report.--Not later than 2 years after the date of the
enactment of this Act, the Secretary of Health and Human
Services shall submit to Congress a report on the study
conducted under paragraph (1), together with any
recommendations for legislation that the Secretary deems
appropriate.
SEC. 323. MEDPAC REPORT ON ACCESS TO, AND USE OF, HOSPICE
BENEFIT.
(a) In General.--The Medicare Payment Advisory Commission
shall conduct a study to examine the factors affecting the
use of hospice benefits under the medicare program under
title XVIII of the Social Security Act, including a delay in
the time (relative to death) of entry into a hospice program,
and differences in such use between urban and rural hospice
programs and based upon the presenting condition of the
patient.
(b) Report.--Not later than 18 months after the date of the
enactment of this Act, the Commission shall submit to
Congress a report on the study conducted under subsection
(a), together with any recommendations for legislation that
the Commission deems appropriate.
Subtitle D--Other Provisions
SEC. 331. RELIEF FROM MEDICARE PART A LATE ENROLLMENT PENALTY
FOR GROUP BUY-IN FOR STATE AND LOCAL RETIREES.
(a) In General.--Section 1818 (42 U.S.C. 1395i-2) is
amended--
(1) in subsection (c)(6), by inserting before the semicolon
at the end the following: ``and shall be subject to reduction
in accordance with subsection (d)(6)''; and
(2) by adding at the end of subsection (d) the following
new paragraph:
``(6)(A) In the case where a State, a political subdivision
of a State, or an agency or instrumentality of a State or
political subdivision thereof determines to pay, for the life
of each individual, the monthly premiums due under paragraph
(1) on behalf of each of the individuals in a qualified State
or local government retiree group who meets the conditions of
subsection (a), the amount of any increase otherwise
applicable under section 1839(b) (as applied and modified by
subsection (c)(6) of this section) with respect to the
monthly premium for benefits under this part for an
individual who is a member of such group shall be reduced by
the total amount of taxes paid under section 3101(b) of the
Internal Revenue Code of 1986 by such individual and under
section 3111(b) by the employers of such individual on behalf
of such individual with respect to employment (as defined in
section 3121(b) of such Code).
``(B) For purposes of this paragraph, the term `qualified
State or local government retiree group' means all of the
individuals who retire prior to a specified date that is
before January 1, 2002, from employment in 1 or more
occupations or other broad classes of employees of--
``(i) the State;
``(ii) a political subdivision of the State; or
``(iii) an agency or instrumentality of the State or
political subdivision of the State.''.
(b) Effective Date.--The amendments made by subsection (a)
shall apply to premiums for months beginning with January 1,
2002.
TITLE IV--PROVISIONS RELATING TO PART B
Subtitle A--Hospital Outpatient Services
SEC. 401. REVISION OF HOSPITAL OUTPATIENT PPS PAYMENT UPDATE.
(a) In General.--Section 1833(t)(3)(C)(iii) (42 U.S.C.
1395l(t)(3)(C)(iii)) is amended by striking ``in each of
2000, 2001, and 2002'' and inserting ``in each of 2000 and
2002''.
(b) Adjustment for Case Mix Changes.--
(1) In general.--Section 1833(t)(3)(C) (42 U.S.C.
1395l(t)(3)(C)) is amended--
(A) by redesignating clause (iii) as clause (iv); and
(B) by inserting after clause (ii) the following new
clause:
``(iii) Adjustment for service mix changes.--Insofar as the
Secretary determines that the adjustments for service mix
under paragraph (2) for a previous year (or estimates that
such adjustments for a future year) did (or are likely to)
result in a change in aggregate payments under this
subsection during the year that are a result of changes in
the coding or classification of covered OPD services that do
not reflect real changes in service mix, the Secretary may
adjust the conversion factor computed under this subparagraph
for subsequent years so as to eliminate the effect of such
coding or classification changes.''.
(2) Effective date.--The amendments made by paragraph (1)
shall take effect as if included in the enactment of BBA.
(c) Special Rule for Payment for 2001.--Notwithstanding the
amendment made by subsection (a), for purposes of making
payments under section 1833(t) of the Social Security Act
(42 U.S.C. 1395l(t)) for covered OPD services furnished
during 2001, the medicare OPD fee schedule amount under
such section--
(1) for services furnished on or after January 1, 2001, and
before April 1, 2001, shall be the medicare OPD fee schedule
amount for 2001 as determined under the provisions of law in
effect on the day before the date of the enactment of this
Act; and
(2) for services furnished on or after April 1, 2001, and
before January 1, 2002, shall be the fee schedule amount (as
determined taking into account the amendment made by
subsection (a)), increased by a transitional percentage
allowance equal to 0.32 percent (to account for the timing of
implementation of the full market basket update).
SEC. 402. CLARIFYING PROCESS AND STANDARDS FOR DETERMINING
ELIGIBILITY OF DEVICES FOR PASS-THROUGH
PAYMENTS UNDER HOSPITAL OUTPATIENT PPS.
(a) In General.--Section 1833(t)(6) (42 U.S.C. 1395l(t)(6))
is amended--
(1) by redesignating subparagraphs (C) and (D) as
subparagraphs (D) and (E), respectively; and
(2) by striking subparagraph (B) and inserting the
following new subparagraphs:
``(B) Use of categories in determining eligibility of a
device for pass-through payments.--The following provisions
apply for purposes of determining whether a medical device
qualifies for additional payments under clause (ii) or (iv)
of subparagraph (A):
``(i) Establishment of initial categories.--
``(I) In general.--The Secretary shall initially establish
under this clause categories of medical devices based on type
of device by April 1, 2001. Such categories shall be
established in a manner such that each medical device that
meets the requirements of clause (ii) or (iv) of subparagraph
(A) as of January 1, 2001, is included in such a category and
no such device is included in more than one category. For
purposes of the preceding sentence, whether a medical device
meets such requirements as of such date shall be determined
on the basis of the program memoranda issued before such
date.
``(II) Authorization of implementation other than through
regulations.--The categories may be established under this
clause by program memorandum or otherwise, after consultation
with groups representing hospitals, manufacturers of medical
devices, and other affected parties.
``(ii) Establishing criteria for additional categories.--
``(I) In general.--The Secretary shall establish criteria
that will be used for creation of additional categories
(other than those established under clause (i)) through
rulemaking (which may include use of an interim final rule
with comment period).
``(II) Standard.--Such categories shall be established
under this clause in a manner such that no medical device is
described by more than one category. Such criteria shall
include a test of whether the average cost of devices that
would be included in a category and are in use at the time
the category is established is not insignificant, as
described in subparagraph (A)(iv)(II).
``(III) Deadline.--Criteria shall first be established
under this clause by July 1, 2001. The Secretary may
establish in compelling circumstances categories under this
clause before the date such criteria are established.
``(IV) Adding categories.--The Secretary shall promptly
establish a new category of medical devices under this clause
for any medical device that meets the requirements of
subparagraph (A)(iv) and for which none of the categories in
effect (or that were previously in effect) is appropriate.
``(iii) Period for which category is in effect.--A category
of medical devices established under clause (i) or (ii) shall
be in effect for a period of at least 2 years, but not more
than 3 years, that begins--
``(I) in the case of a category established under clause
(i), on the first date on which payment was made under this
paragraph for any device described by such category
(including payments made during the period before April 1,
2001); and
``(II) in the case of any other category, on the first date
on which payment is made under this paragraph for any medical
device that is described by such category.
``(iv) Requirements treated as met.--A medical device shall
be treated as meeting the requirements of subparagraph
(A)(iv), regardless of whether the device meets the
requirement of subclause (I) of such subparagraph, if--
``(I) the device is described by a category established and
in effect under clause (i); or
``(II) the device is described by a category established
and in effect under clause (ii) and an application under
section 515 of the Federal Food, Drug, and Cosmetic Act has
been approved with respect to the device, or the device has
been cleared for market under section 510(k) of such Act, or
the device is exempt from the requirements of section 510(k)
of such Act pursuant to subsection (l) or (m) of section 510
of such Act or section 520(g) of such Act.
[[Page H12357]]
Nothing in this clause shall be construed as requiring an
application or prior approval (other than that described in
subclause (II)) in order for a covered device described by a
category to qualify for payment under this paragraph.
``(C) Limited period of payment.--
``(i) Drugs and biologicals.--The payment under this
paragraph with respect to a drug or biological shall only
apply during a period of at least 2 years, but not more than
3 years, that begins--
``(I) on the first date this subsection is implemented in
the case of a drug or biological described in clause (i),
(ii), or (iii) of subparagraph (A) and in the case of a drug
or biological described in subparagraph (A)(iv) and for which
payment under this part is made as an outpatient hospital
service before such first date; or
``(II) in the case of a drug or biological described in
subparagraph (A)(iv) not described in subclause (I), on the
first date on which payment is made under this part for the
drug or biological as an outpatient hospital service.
``(ii) Medical devices.--Payment shall be made under this
paragraph with respect to a medical device only if such
device--
``(I) is described by a category of medical devices
established and in effect under subparagraph (B); and
``(II) is provided as part of a service (or group of
services) paid for under this subsection and provided during
the period for which such category is in effect under such
subparagraph.''.
(b) Conforming Amendments.--Section 1833(t) (42 U.S.C.
1395l(t)) is further amended--
(1) in paragraph (6)(A)(iv)(II), by striking ``the cost of
the device, drug, or biological'' and inserting ``the cost of
the drug or biological or the average cost of the category of
devices'';
(2) in paragraph (6)(D) (as redesignated by subsection
(a)(1)), by striking ``subparagraph (D)(iii)'' in the matter
preceding clause (i) and inserting ``subparagraph (E)(iii)'';
and
(3) in paragraph (12)(E), by striking ``additional payments
(consistent with paragraph (6)(B))'' and inserting
``additional payments, the determination and deletion of
initial and new categories (consistent with subparagraphs (B)
and (C) of paragraph (6))''.
(c) Effective Date.--The amendments made by this section
take effect on the date of the enactment of this Act.
(d) Transition.--
(1) In general.--In the case of a medical device provided
as part of a service (or group of services) furnished during
the period before initial categories are implemented under
subparagraph (B)(i) of section 1833(t)(6) of the Social
Security Act (as amended by subsection (a)), payment shall be
made for such device under such section in accordance with
the provisions in effect before the date of the enactment of
this Act. In addition, beginning on the date that is 30 days
after the date of the enactment of this Act, payment shall be
made for such a device that is not included in a program
memorandum described in such subparagraph if the Secretary of
Health and Human Services determines that the device
(including a device that would have been included in such
program memoranda but for the requirement of subparagraph
(A)(iv)(I) of that section) is likely to be described by such
an initial category.
(2) Application of current process.--Notwithstanding any
other provision of law, the Secretary shall continue to
accept applications with respect to medical devices under the
process established pursuant to paragraph (6) of section
1833(t) of the Social Security Act (as in effect on the day
before the date of the enactment of this Act) through
December 1, 2000, and any device--
(A) with respect to which an application was submitted
(pursuant to such process) on or before such date; and
(B) that meets the requirements of clause (ii) or (iv) of
subparagraph (A) of such paragraph (as determined pursuant to
such process),
shall be treated as a device with respect to which an initial
category is required to be established under subparagraph
(B)(i) of such paragraph (as amended by subsection (a)(2)).
SEC. 403. APPLICATION OF OPD PPS TRANSITIONAL CORRIDOR
PAYMENTS TO CERTAIN HOSPITALS THAT DID NOT
SUBMIT A 1996 COST REPORT.
(a) In General.--Section 1833(t)(7)(F)(ii)(I) (42 U.S.C.
1395l(t)(7)(F)(ii)(I)) is amended by inserting ``(or in the
case of a hospital that did not submit a cost report for such
period, during the first subsequent cost reporting period
ending before 2001 for which the hospital submitted a cost
report)'' after ``1996''.
(b) Effective Date.--The amendment made by subsection (a)
shall take effect as if included in the enactment of BBRA.
SEC. 404. APPLICATION OF RULES FOR DETERMINING PROVIDER-BASED
STATUS FOR CERTAIN ENTITIES.
(a) Grandfather.--Notwithstanding any other provision of
law, effective October 1, 2000, for purposes of provider-
based status under title XVIII of the Social Security Act--
(1) any facility or organization that is treated as
provider-based in relation to a hospital or critical access
hospital under such title as of such date shall continue to
be treated as provider-based in relation to such hospital or
critical access hospital under such title until October 1,
2002; and
(2) the requirements, limitations, and exclusions specified
in subsections (d), (e), (f), and (h) of section 413.65 of
title 42, Code of Federal Regulations, shall not apply to
such facility or organization in relation to such hospital or
critical access hospital until October 1, 2002.
(b) Continuing Criteria for Meeting Geographic Location
Requirement.--Except as provided in subsection (a), in making
determinations of provider-based status on or after October
1, 2000, the following rules shall apply:
(1) The facility or organization shall be treated as
satisfying any requirements and standards for geographic
location in relation to a hospital or a critical access
hospital if the facility or organization--
(A) satisfies the requirements of section 413.65(d)(7) of
title 42, Code of Federal Regulations; or
(B) is located not more than 35 miles from the main campus
of the hospital or critical access hospital.
(2) The facility or organization shall be treated as
satisfying any of the requirements and standards for
geographic location in relation to a hospital or a critical
access hospital if the facility or organization is owned and
operated by a hospital or critical access hospital that--
(A) is owned or operated by a unit of State or local
government, is a public or private nonprofit corporation that
is formally granted governmental powers by a unit of State or
local government, or is a private hospital that has a
contract with a State or local government that includes the
operation of clinics located off the main campus of the
hospital to assure access in a well-defined service area to
health care services for low-income individuals who are not
entitled to benefits under title XVIII (or medical assistance
under a State plan under title XIX) of the Social Security
Act; and
(B) has a disproportionate share adjustment percentage (as
determined under section 1886(d)(5)(F) of such Act (42 U.S.C.
1395ww(d)(5)(F))) greater than 11.75 percent or is described
in clause (i)(II) of such section.
(c) Temporary Criteria.--For purposes of title XVIII of the
Social Security Act, a facility or organization for which a
determination of provider-based status in relation to a
hospital or critical access hospital is requested on or after
October 1, 2000, and before October 1, 2002, shall be treated
as having provider-based status in relation to such a
hospital or a critical access hospital for any period before
a determination is made with respect to such status pursuant
to such request.
(d) Definitions.--For purposes of this section, the terms
``hospital'' and ``critical access hospital'' have the
meanings given such terms in subsections (e) and (mm)(1),
respectively, of section 1861 of the Social Security Act (42
U.S.C. 1395x).
SEC. 405. TREATMENT OF CHILDREN'S HOSPITALS UNDER PROSPECTIVE
PAYMENT SYSTEM.
(a) In General.--Section 1833(t) (42 U.S.C. 1395l(t)) is
amended--
(1) in the heading of paragraph (7)(D)(ii), by inserting
``and children's hospitals'' after ``cancer hospitals''; and
(2) in paragraphs (7)(D)(ii) and (11), by striking
``section 1886(d)(1)(B)(v)'' and inserting ``clause (iii) or
(v) of section 1886(d)(1)(B)''.
(b) Effective Date.--The amendments made by subsection (a)
shall apply as if included in the enactment of section 202 of
BBRA (113 Stat. 1501A-342).
SEC. 406. INCLUSION OF TEMPERATURE MONITORED CRYOABLATION IN
TRANSITIONAL PASS-THROUGH FOR CERTAIN MEDICAL
DEVICES, DRUGS, AND BIOLOGICALS UNDER OPD PPS.
(a) In General.--Section 1833(t)(6)(A)(ii) (42 U.S.C.
1395l(t)(6)(A)(ii)) is amended by inserting ``or temperature
monitored cryoablation'' after ``device of brachytherapy''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply to devices furnished on or after April 1, 2001.
Subtitle B--Provisions Relating to Physicians' Services
SEC. 411. GAO STUDIES RELATING TO PHYSICIANS' SERVICES.
(a) Study of Specialist Physicians' Services Furnished in
Physicians' Offices and Hospital Outpatient Department
Services.--
(1) Study.--The Comptroller General of the United States
shall conduct a study to examine the appropriateness of
furnishing in physicians' offices specialist physicians'
services (such as gastrointestinal endoscopic physicians'
services) which are ordinarily furnished in hospital
outpatient departments. In conducting this study, the
Comptroller General shall--
(A) review available scientific and clinical evidence about
the safety of performing procedures in physicians' offices
and hospital outpatient departments;
(B) assess whether resource-based practice expense relative
values established by the Secretary of Health and Human
Services under the medicare physician fee schedule under
section 1848 of the Social Security Act (42 U.S.C. 1395w-4)
for such specialist physicians' services furnished in
physicians' offices and hospital outpatient departments
create an incentive to furnish such services in physicians'
offices instead of hospital outpatient departments; and
(C) assess the implications for access to care for medicare
beneficiaries if the medicare program were not to cover such
services in physicians' offices.
(2) Report.--Not later than July 1, 2001, the Comptroller
General shall submit to Congress a report on such study and
include such recommendations as the Comptroller General
determines to be appropriate.
(b) Study of the Resource-Based Practice Expense System.--
(1) Study.--The Comptroller General of the United States
shall conduct a study on the refinements to the practice
expense relative value units during the transition to a
resource-based practice expense system for physician payments
under the medicare program under title XVIII of the Social
Security Act. Such study shall examine how the Secretary of
Health and Human Services has accepted and used the practice
expense data submitted under section 212 of BBRA (113 Stat.
1501A-350).
(2) Report.--Not later than July 1, 2001, the Comptroller
General shall submit to Congress a report on the study
conducted under paragraph (1) together with recommendations
regarding--
[[Page H12358]]
(A) improvements in the process for acceptance and use of
practice expense data under section 212 of BBRA;
(B) any change or adjustment that is appropriate to ensure
full access to a spectrum of care for beneficiaries under the
medicare program; and
(C) the appropriateness of payments to physicians.
SEC. 412. PHYSICIAN GROUP PRACTICE DEMONSTRATION.
(a) In General.--Title XVIII is amended by inserting after
section 1866 the following new sections:
``demonstration of application of physician volume increases to group
practices
``Sec. 1866A. (a) Demonstration Program Authorized.--
``(1) In general.--The Secretary shall conduct
demonstration projects to test and, if proven effective,
expand the use of incentives to health care groups
participating in the program under this title that--
``(A) encourage coordination of the care furnished to
individuals under the programs under parts A and B by
institutional and other providers, practitioners, and
suppliers of health care items and services;
``(B) encourage investment in administrative structures and
processes to ensure efficient service delivery; and
``(C) reward physicians for improving health outcomes.
Such projects shall focus on the efficiencies of furnishing
health care in a group-practice setting as compared to the
efficiencies of furnishing health care in other health care
delivery systems.
``(2) Administration by contract.--Except as otherwise
specifically provided, the Secretary may administer the
program under this section in accordance with section 1866B.
``(3) Definitions.--For purposes of this section, terms
have the following meanings:
``(A) Physician.--Except as the Secretary may otherwise
provide, the term `physician' means any individual who
furnishes services which may be paid for as physicians'
services under this title.
``(B) Health care group.--The term `health care group'
means a group of physicians (as defined in subparagraph (A))
organized at least in part for the purpose of providing
physicians' services under this title. As the Secretary finds
appropriate, a health care group may include a hospital and
any other individual or entity furnishing items or services
for which payment may be made under this title that is
affiliated with the health care group under an arrangement
structured so that such individual or entity participates in
a demonstration under this section and will share in any
bonus earned under subsection (d).
``(b) Eligibility Criteria.--
``(1) In general.--The Secretary is authorized to establish
criteria for health care groups eligible to participate in a
demonstration under this section, including criteria relating
to numbers of health care professionals in, and of patients
served by, the group, scope of services provided, and quality
of care.
``(2) Payment method.--A health care group participating in
the demonstration under this section shall agree with respect
to services furnished to beneficiaries within the scope of
the demonstration (as determined under subsection (c))--
``(A) to be paid on a fee-for-service basis; and
``(B) that payment with respect to all such services
furnished by members of the health care group to such
beneficiaries shall (where determined appropriate by the
Secretary) be made to a single entity.
``(3) Data reporting.--A health care group participating in
a demonstration under this section shall report to the
Secretary such data, at such times and in such format as the
Secretary requires, for purposes of monitoring and evaluation
of the demonstration under this section.
``(c) Patients Within Scope of Demonstration.--
``(1) In general.--The Secretary shall specify, in
accordance with this subsection, the criteria for identifying
those patients of a health care group who shall be considered
within the scope of the demonstration under this section for
purposes of application of subsection (d) and for assessment
of the effectiveness of the group in achieving the objectives
of this section.
``(2) Other criteria.--The Secretary may establish
additional criteria for inclusion of beneficiaries within a
demonstration under this section, which may include frequency
of contact with physicians in the group or other factors or
criteria that the Secretary finds to be appropriate.
``(3) Notice requirements.--In the case of each beneficiary
determined to be within the scope of a demonstration under
this section with respect to a specific health care group,
the Secretary shall ensure that such beneficiary is notified
of the incentives, and of any waivers of coverage or payment
rules, applicable to such group under such demonstration.
``(d) Incentives.--
``(1) Performance target.--The Secretary shall establish
for each health care group participating in a demonstration
under this section--
``(A) a base expenditure amount, equal to the average total
payments under parts A and B for patients served by the
health care group on a fee-for-service basis in a base period
determined by the Secretary; and
``(B) an annual per capita expenditure target for patients
determined to be within the scope of the demonstration,
reflecting the base expenditure amount adjusted for risk and
expected growth rates.
``(2) Incentive bonus.--The Secretary shall pay to each
participating health care group (subject to paragraph (4)) a
bonus for each year under the demonstration equal to a
portion of the medicare savings realized for such year
relative to the performance target.
``(3) Additional bonus for process and outcome
improvements.--At such time as the Secretary has established
appropriate criteria based on evidence the Secretary
determines to be sufficient, the Secretary shall also pay to
a participating health care group (subject to paragraph (4))
an additional bonus for a year, equal to such portion as the
Secretary may designate of the saving to the program under
this title resulting from process improvements made by and
patient outcome improvements attributable to activities of
the group.
``(4) Limitation.--The Secretary shall limit bonus payments
under this section as necessary to ensure that the aggregate
expenditures under this title (inclusive of bonus payments)
with respect to patients within the scope of the
demonstration do not exceed the amount which the Secretary
estimates would be expended if the demonstration projects
under this section were not implemented.
``provisions for administration of demonstration program
``Sec. 1866B. (a) General Administrative Authority.--
``(1) Beneficiary eligibility.--Except as otherwise
provided by the Secretary, an individual shall only be
eligible to receive benefits under the program under section
1866A (in this section referred to as the `demonstration
program') if such individual--
``(A) is enrolled under the program under part B and
entitled to benefits under part A; and
``(B) is not enrolled in a Medicare+Choice plan under part
C, an eligible organization under a contract under section
1876 (or a similar organization operating under a
demonstration project authority), an organization with an
agreement under section 1833(a)(1)(A), or a PACE program
under section 1894.
``(2) Secretary's discretion as to scope of program.--The
Secretary may limit the implementation of the demonstration
program to--
``(A) a geographic area (or areas) that the Secretary
designates for purposes of the program, based upon such
criteria as the Secretary finds appropriate;
``(B) a subgroup (or subgroups) of beneficiaries or
individuals and entities furnishing items or services
(otherwise eligible to participate in the program), selected
on the basis of the number of such participants that the
Secretary finds consistent with the effective and efficient
implementation of the program;
``(C) an element (or elements) of the program that the
Secretary determines to be suitable for implementation; or
``(D) any combination of any of the limits described in
subparagraphs (A) through (C).
``(3) Voluntary receipt of items and services.--Items and
services shall be furnished to an individual under the
demonstration program only at the individual's election.
``(4) Agreements.--The Secretary is authorized to enter
into agreements with individuals and entities to furnish
health care items and services to beneficiaries under the
demonstration program.
``(5) Program standards and criteria.--The Secretary shall
establish performance standards for the demonstration program
including, as applicable, standards for quality of health
care items and services, cost-effectiveness, beneficiary
satisfaction, and such other factors as the Secretary finds
appropriate. The eligibility of individuals or entities for
the initial award, continuation, and renewal of agreements to
provide health care items and services under the program
shall be conditioned, at a minimum, on performance that meets
or exceeds such standards.
``(6) Administrative review of decisions affecting
individuals and entities furnishing services.--An individual
or entity furnishing services under the demonstration program
shall be entitled to a review by the program administrator
(or, if the Secretary has not contracted with a program
administrator, by the Secretary) of a decision not to enter
into, or to terminate, or not to renew, an agreement with the
entity to provide health care items or services under the
program.
``(7) Secretary's review of marketing materials.--An
agreement with an individual or entity furnishing services
under the demonstration program shall require the individual
or entity to guarantee that it will not distribute materials
that market items or services under the program without the
Secretary's prior review and approval.
``(8) Payment in full.--
``(A) In general.--Except as provided in subparagraph (B),
an individual or entity receiving payment from the Secretary
under a contract or agreement under the demonstration program
shall agree to accept such payment as payment in full, and
such payment shall be in lieu of any payments to which the
individual or entity would otherwise be entitled under this
title.
``(B) Collection of deductibles and coinsurance.--Such
individual or entity may collect any applicable deductible or
coinsurance amount from a beneficiary.
``(b) Contracts for Program Administration.--
``(1) In general.--The Secretary may administer the
demonstration program through a contract with a program
administrator in accordance with the provisions of this
subsection.
``(2) Scope of program administrator contracts.--The
Secretary may enter into such contracts for a limited
geographic area, or on a regional or national basis.
``(3) Eligible contractors.--The Secretary may contract for
the administration of the program with--
``(A) an entity that, under a contract under section 1816
or 1842, determines the amount of
[[Page H12359]]
and makes payments for health care items and services
furnished under this title; or
``(B) any other entity with substantial experience in
managing the type of program concerned.
``(4) Contract award, duration, and renewal.--
``(A) In general.--A contract under this subsection shall
be for an initial term of up to three years, renewable for
additional terms of up to three years.
``(B) Noncompetitive award and renewal for entities
administering part a or part b payments.--The Secretary may
enter or renew a contract under this subsection with an
entity described in paragraph (3)(A) without regard to the
requirements of section 5 of title 41, United States Code.
``(5) Applicability of federal acquisition regulation.--The
Federal Acquisition Regulation shall apply to program
administration contracts under this subsection.
``(6) Performance standards.--The Secretary shall establish
performance standards for the program administrator
including, as applicable, standards for the quality and cost-
effectiveness of the program administered, and such other
factors as the Secretary finds appropriate. The eligibility
of entities for the initial award, continuation, and renewal
of program administration contracts shall be conditioned, at
a minimum, on performance that meets or exceeds such
standards.
``(7) Functions of program administrator.--A program
administrator shall perform any or all of the following
functions, as specified by the Secretary:
``(A) Agreements with entities furnishing health care items
and services.--Determine the qualifications of entities
seeking to enter or renew agreements to provide services
under the demonstration program, and as appropriate enter or
renew (or refuse to enter or renew) such agreements on behalf
of the Secretary.
``(B) Establishment of payment rates.--Negotiate or
otherwise establish, subject to the Secretary's approval,
payment rates for covered health care items and services.
``(C) Payment of claims or fees.--Administer payments for
health care items or services furnished under the program.
``(D) Payment of bonuses.--Using such guidelines as the
Secretary shall establish, and subject to the approval of the
Secretary, make bonus payments as described in subsection
(c)(2)(A)(ii) to entities furnishing items or services for
which payment may be made under the program.
``(E) Oversight.--Monitor the compliance of individuals and
entities with agreements under the program with the
conditions of participation.
``(F) Administrative review.--Conduct reviews of adverse
determinations specified in subsection (a)(6).
``(G) Review of marketing materials.--Conduct a review of
marketing materials proposed by an entity furnishing services
under the program.
``(H) Additional functions.--Perform such other functions
as the Secretary may specify.
``(8) Limitation of liability.--The provisions of section
1157(b) shall apply with respect to activities of contractors
and their officers, employees, and agents under a contract
under this subsection.
``(9) Information sharing.--Notwithstanding section 1106
and section 552a of title 5, United States Code, the
Secretary is authorized to disclose to an entity with a
program administration contract under this subsection such
information (including medical information) on individuals
receiving health care items and services under the program as
the entity may require to carry out its responsibilities
under the contract.
``(c) Rules Applicable to Both Program Agreements and
Program Administration Contracts.--
``(1) Records, reports, and audits.--The Secretary is
authorized to require entities with agreements to provide
health care items or services under the demonstration
program, and entities with program administration contracts
under subsection (b), to maintain adequate records, to afford
the Secretary access to such records (including for audit
purposes), and to furnish such reports and other materials
(including audited financial statements and performance data)
as the Secretary may require for purposes of implementation,
oversight, and evaluation of the program and of individuals'
and entities' effectiveness in performance of such agreements
or contracts.
``(2) Bonuses.--Notwithstanding any other provision of law,
but subject to subparagraph (B)(ii), the Secretary may make
bonus payments under the demonstration program from the
Federal Health Insurance Trust Fund and the Federal
Supplementary Medical Insurance Trust Fund in amounts that do
not exceed the amounts authorized under the program in
accordance with the following:
``(A) Payments to program administrators.--The Secretary
may make bonus payments under the program to program
administrators.
``(B) Payments to entities furnishing services.--
``(i) In general.--Subject to clause (ii), the Secretary
may make bonus payments to individuals or entities furnishing
items or services for which payment may be made under the
demonstration program, or may authorize the program
administrator to make such bonus payments in accordance with
such guidelines as the Secretary shall establish and subject
to the Secretary's approval.
``(ii) Limitations.--The Secretary may condition such
payments on the achievement of such standards related to
efficiency, improvement in processes or outcomes of care, or
such other factors as the Secretary determines to be
appropriate.
``(3) Antidiscrimination limitation.--The Secretary shall
not enter into an agreement with an entity to provide health
care items or services under the demonstration program, or
with an entity to administer the program, unless such entity
guarantees that it will not deny, limit, or condition the
coverage or provision of benefits under the program, for
individuals eligible to be enrolled under such program, based
on any health status-related factor described in section
2702(a)(1) of the Public Health Service Act.
``(d) Limitations on Judicial Review.--The following
actions and determinations with respect to the demonstration
program shall not be subject to review by a judicial or
administrative tribunal:
``(1) Limiting the implementation of the program under
subsection (a)(2).
``(2) Establishment of program participation standards
under subsection (a)(5) or the denial or termination of, or
refusal to renew, an agreement with an entity to provide
health care items and services under the program.
``(3) Establishment of program administration contract
performance standards under subsection (b)(6), the refusal to
renew a program administration contract, or the
noncompetitive award or renewal of a program administration
contract under subsection (b)(4)(B).
``(4) Establishment of payment rates, through negotiation
or otherwise, under a program agreement or a program
administration contract.
``(5) A determination with respect to the program (where
specifically authorized by the program authority or by
subsection (c)(2))--
``(A) as to whether cost savings have been achieved, and
the amount of savings; or
``(B) as to whether, to whom, and in what amounts bonuses
will be paid.
``(e) Application Limited to Parts A and B.--None of the
provisions of this section or of the demonstration program
shall apply to the programs under part C.
``(f) Reports to Congress.--Not later than two years after
the date of the enactment of this section, and biennially
thereafter for six years, the Secretary shall report to
Congress on the use of authorities under the demonstration
program. Each report shall address the impact of the use of
those authorities on expenditures, access, and quality under
the programs under this title.''.
(b) GAO Report.--Not later than 2 years after the date on
which the demonstration project under section 1866A of the
Social Security Act, as added by subsection (a), is
implemented, the Comptroller General of the United States
shall submit to Congress a report on such demonstration
project. The report shall include such recommendations
with respect to changes to the demonstration project that
the Comptroller General determines appropriate.
SEC. 413. STUDY ON ENROLLMENT PROCEDURES FOR GROUPS THAT
RETAIN INDEPENDENT CONTRACTOR PHYSICIANS.
(a) In General.--The Comptroller General of the United
States shall conduct a study of the current medicare
enrollment process for groups that retain independent
contractor physicians with particular emphasis on hospital-
based physicians, such as emergency department staffing
groups. In conducting the evaluation, the Comptroller General
shall consult with groups that retain independent contractor
physicians and shall--
(1) review the issuance of individual medicare provider
numbers and the possible medicare program integrity
vulnerabilities of the current process;
(2) review direct and indirect costs associated with the
current process incurred by the medicare program and groups
that retain independent contractor physicians;
(3) assess the effect on program integrity by the
enrollment of groups that retain independent contractor
hospital-based physicians; and
(4) develop suggested procedures for the enrollment of
these groups.
(b) Report.--Not later than 1 year after the date of the
enactment of this Act, the Comptroller General shall submit
to Congress a report on the study conducted under subsection
(a).
Subtitle C--Other Services
SEC. 421. 1-YEAR EXTENSION OF MORATORIUM ON THERAPY CAPS;
REPORT ON STANDARDS FOR SUPERVISION OF PHYSICAL
THERAPY ASSISTANTS.
(a) In General.--Section 1833(g)(4) (42 U.S.C. 1395l(g)(4))
is amended by striking ``2000 and 2001.'' and inserting
``2000, 2001, and 2002.''.
(b) Conforming Amendment To Continue Focused Medical
Reviews of Claims During Moratorium Period.--Section
221(a)(2) of BBRA (113 Stat. 1501A-351) is amended by
striking ``(under the amendment made by paragraph (1)(B))''.
(c) Study on Standards for Supervision of Physical
Therapist Assistants.--
(1) Study.--The Secretary of Health and Human Services
shall conduct a study of the implications--
(A) of eliminating the ``in the room'' supervision
requirement for medicare payment for services of physical
therapy assistants who are supervised by physical therapists;
and
(B) of such requirement on the cap imposed under section
1833(g) of the Social Security Act (42 U.S.C. 1395l(g)) on
physical therapy services.
(2) Report.--Not later than 18 months after the date of the
enactment of this Act, the Secretary shall submit to Congress
a report on the study conducted under paragraph (1).
SEC. 422. UPDATE IN RENAL DIALYSIS COMPOSITE RATE.
(a) Update.--
(1) In general.--The last sentence of section 1881(b)(7)
(42 U.S.C. 1395rr(b)(7)) is amended by striking ``for such
services furnished on or after January 1, 2001, by 1.2
percent'' and inserting
[[Page H12360]]
``for such services furnished on or after January 1, 2001, by
2.4 percent''.
(2) Prohibition on exceptions.--
(A) In general.--Subject to subparagraphs (B) and (C), the
Secretary of Health and Human Services may not provide for an
exception under section 1881(b)(7) of the Social Security Act
(42 U.S.C. 1395rr(b)(7)) on or after December 31, 2000.
(B) Deadline for new applications.--In the case of a
facility that during 2000 did not file for an exception rate
under such section, the facility may submit an application
for an exception rate by not later than July 1, 2001.
(C) Protection of approved exception rates.--Any exception
rate under such section in effect on December 31, 2000 (or,
in the case of an application under subparagraph (B), as
approved under such application) shall continue in effect so
long as such rate is greater than the composite rate as
updated by the amendment made by paragraph (1).
(b) Development of ESRD Market Basket.--
(1) Development.--The Secretary of Health and Human
Services shall collect data and develop an ESRD market basket
whereby the Secretary can estimate, before the beginning of a
year, the percentage by which the costs for the year of the
mix of labor and nonlabor goods and services included in the
ESRD composite rate under section 1881(b)(7) of the Social
Security Act (42 U.S.C. 1395rr(b)(7)) will exceed the costs
of such mix of goods and services for the preceding year. In
developing such index, the Secretary may take into account
measures of changes in--
(A) technology used in furnishing dialysis services;
(B) the manner or method of furnishing dialysis services;
and
(C) the amounts by which the payments under such section
for all services billed by a facility for a year exceed the
aggregate allowable audited costs of such services for such
facility for such year.
(2) Report.--The Secretary of Health and Human Services
shall submit to Congress a report on the index developed
under paragraph (1) no later than July 1, 2002, and shall
include in the report recommendations on the appropriateness
of an annual or periodic update mechanism for renal dialysis
services under the medicare program under title XVIII of the
Social Security Act based on such index.
(c) Inclusion of Additional Services in Composite Rate.--
(1) Development.--The Secretary of Health and Human
Services shall develop a system which includes, to the
maximum extent feasible, in the composite rate used for
payment under section 1881(b)(7) of the Social Security Act
(42 U.S.C. 1395rr(b)(7)), payment for clinical diagnostic
laboratory tests and drugs (including drugs paid under
section 1881(b)(11)(B) of such Act (42 U.S.C.
1395rr(b)(11)(B)) that are routinely used in furnishing
dialysis services to medicare beneficiaries but which are
currently separately billable by renal dialysis facilities.
(2) Report.--The Secretary shall include, as part of the
report submitted under subsection (b)(2), a report on the
system developed under paragraph (1) and recommendations on
the appropriateness of incorporating the system into medicare
payment for renal dialysis services.
(d) GAO Study on Access to Services.--
(1) Study.--The Comptroller General of the United States
shall study access of medicare beneficiaries to renal
dialysis services. Such study shall include whether there is
a sufficient supply of facilities to furnish needed renal
dialysis services, whether medicare payment levels are
appropriate, taking into account audited costs of facilities
for all services furnished, to ensure continued access to
such services, and improvements in access (and quality of
care) that may result in the increased use of long nightly
and short daily hemodialysis modalities.
(2) Report.--Not later than January 1, 2003, the
Comptroller General shall submit to Congress a report on the
study conducted under paragraph (1).
(e) Special Rule for Payment for 2001.--Notwithstanding the
amendment made by subsection (a)(1), for purposes of making
payments under section 1881(b) of the Social Security Act (42
U.S.C. 1395rr(b)) for dialysis services furnished during
2001, the composite rate payment under paragraph (7) of such
section--
(1) for services furnished on or after January 1, 2001, and
before April 1, 2001, shall be the composite rate payment
determined under the provisions of law in effect on the day
before the date of the enactment of this Act; and
(2) for services furnished on or after April 1, 2001, and
before January 1, 2002, shall be the composite rate payment
(as determined taking into account the amendment made by
subsection (a)(1)) increased by a transitional percentage
allowance equal to 0.39 percent (to account for the timing of
implementation of the CPI update).
SEC. 423. PAYMENT FOR AMBULANCE SERVICES.
(a) Restoration of Full CPI Increase for 2001.--
(1) In general.--Section 1834(l)(3) (42 U.S.C. 1395m(l)(3))
is amended by striking ``reduced in the case of 2001 and
2002'' each place it appears and inserting ``reduced in the
case of 2002''.
(2) Special rule for payment for 2001.--Notwithstanding the
amendment made by paragraph (1), for purposes of making
payments for ambulance services under part B of title XVIII
of the Social Security Act, for services furnished during
2001, the ``percentage increase in the consumer price index''
specified in section 1834(l)(3)(B) of such Act (42 U.S.C.
1395m(l)(3)(B))--
(A) for services furnished on or after January 1, 2001, and
before July 1, 2001, shall be the percentage increase for
2001 as determined under the provisions of law in effect on
the day before the date of the enactment of this Act; and
(B) for services furnished on or after July 1, 2001, and
before January 1, 2002, shall be equal to 4.7 percent.
(b) Mileage Payments.--
(1) In general.--Section 1834(l)(2)(E) (42 U.S.C.
1395m(l)(2)(E)) is amended by inserting before the period at
the end the following: ``, except that such phase-in shall
provide for full payment of any national mileage rate for
ambulance services provided by suppliers that are paid by
carriers in any of the 50 States where payment by a carrier
for such services for all such suppliers in such State did
not, prior to the implementation of the fee schedule, include
a separate amount for all mileage within the county from
which the beneficiary is transported''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to services furnished on or after July 1, 2001.
SEC. 424. 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. 425. FULL UPDATE FOR DURABLE MEDICAL EQUIPMENT.
(a) In General.--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. city average) for
the 12-month period ending with June 2000;
``(E) for 2002, 0 percentage points; and''.
(b) Special Rule for Payment for 2001.--Notwithstanding the
amendments made by subsection (a), for purposes of making
payments for durable medical equipment under section 1834(a)
of the Social Security Act (42 U.S.C. 1395m(a)), other than
for oxygen and oxygen equipment specified in paragraph (9) of
such section, the payment basis recognized for 2001 under
such section--
(1) for items furnished on or after January 1, 2001, and
before July 1, 2001, shall be the payment basis for 2001 as
determined under the provisions of law in effect on the day
before the date of the enactment of this Act (including the
application of section 228(a)(1) of BBRA); and
(2) for items furnished on or after July 1, 2001, and
before January 1, 2002, shall be the payment basis that is
determined under such section 1834(a) if such section
228(a)(1) did not apply and taking into account the amendment
made by subsection (a), increased by a transitional
percentage allowance equal to 3.28 percent (to account for
the timing of implementation of the CPI update).
SEC. 426. FULL UPDATE FOR ORTHOTICS AND PROSTHETICS.
(a) In General.--Section 1834(h)(4)(A) (42 U.S.C.
1395m(h)(4)(A)) is amended--
(1) by redesignating clause (vi) as clause (viii);
(2) in clause (v)--
(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 clause:
``(vi) for 2001, the percentage increase in the consumer
price index for all urban consumers (U.S. city average) for
the 12-month period ending with June 2000;
``(vii) for 2002, 1 percent; and''.
(b) Special Rule for Payment for 2001.--Notwithstanding the
amendments made by subsection (a), for purposes of making
payments for prosthetic devices and orthotics and prosthetics
(as defined in subparagraphs (B) and (C) of paragraph (4) of
section 1834(h) of the Social Security Act (42 U.S.C.
1395m(h)) under such section, the payment basis recognized
for 2001 under paragraph (2) of such section--
(1) for items furnished on or after January 1, 2001, and
before July 1, 2001, shall be the payment basis for 2001 as
determined under the provisions of law in effect on the day
before the date of the enactment of this Act; and
(2) for items furnished on or after July 1, 2001, and
before January 1, 2002, shall be the payment basis that is
determined under such section taking into account the
amendments made by subsection (a), increased by a
transitional percentage allowance equal to 2.6 percent (to
account for the timing of implementation of the CPI update).
[[Page H12361]]
SEC. 427. ESTABLISHMENT OF SPECIAL PAYMENT PROVISIONS AND
REQUIREMENTS FOR PROSTHETICS AND CERTAIN
CUSTOM-FABRICATED ORTHOTIC ITEMS.
(a) In General.--Section 1834(h)(1) (42 U.S.C. 1395m(h)(1))
is amended by adding at the end the following:
``(F) Special payment rules for certain prosthetics and
custom-fabricated orthotics.--
``(i) In general.--No payment shall be made under this
subsection for an item of custom-fabricated orthotics
described in clause (ii) or for an item of prosthetics unless
such item is--
``(I) furnished by a qualified practitioner; and
``(II) fabricated by a qualified practitioner or a
qualified supplier at a facility that meets such criteria as
the Secretary determines appropriate.
``(ii) Description of custom-fabricated item.--
``(I) In general.--An item described in this clause is an
item of custom-fabricated orthotics that requires education,
training, and experience to custom-fabricate and that is
included in a list established by the Secretary in subclause
(II). Such an item does not include shoes and shoe inserts.
``(II) List of items.--The Secretary, in consultation with
appropriate experts in orthotics (including national
organizations representing manufacturers of orthotics), shall
establish and update as appropriate a list of items to which
this subparagraph applies. No item may be included in such
list unless the item is individually fabricated for the
patient over a positive model of the patient.
``(iii) Qualified practitioner defined.--In this
subparagraph, the term `qualified practitioner' means a
physician or other individual who--
``(I) is a qualified physical therapist or a qualified
occupational therapist;
``(II) in the case of a State that provides for the
licensing of orthotics and prosthetics, is licensed in
orthotics or prosthetics by the State in which the item is
supplied; or
``(III) in the case of a State that does not provide for
the licensing of orthotics and prosthetics, is specifically
trained and educated to provide or manage the provision of
prosthetics and custom-designed or -fabricated orthotics, and
is certified by the American Board for Certification in
Orthotics and Prosthetics, Inc. or by the Board for
Orthotist/Prosthetist Certification, or is 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 such prosthetics and orthotics.
``(iv) Qualified supplier defined.--In this subparagraph,
the term `qualified supplier' means any entity that is
accredited by the American Board for Certification in
Orthotics and Prosthetics, Inc. or by the Board for
Orthotist/Prosthetist Certification, or accredited and
approved by a program that the Secretary determines has
accreditation and approval standards that are essentially
equivalent to those of such Board.''.
(b) Effective Date.--Not later than 1 year after the date
of the enactment of this Act, the Secretary of Health and
Human Services shall promulgate revised regulations to carry
out the amendment made by subsection (a) using a negotiated
rulemaking process under subchapter III of chapter 5 of title
5, United States Code.
(c) GAO Study and Report.--
(1) Study.--The Comptroller General of the United States
shall conduct a study on HCFA Ruling 96-1, issued on
September 1, 1996, with respect to distinguishing orthotics
from durable medical equipment under the medicare program
under title XVIII of the Social Security Act. The study shall
assess the following matters:
(A) The compliance of the Secretary of Health and Human
Services with the Administrative Procedures Act (under
chapter 5 of title 5, United States Code) in making such
ruling.
(B) The potential impact of such ruling on the health care
furnished to medicare beneficiaries under the medicare
program, especially those beneficiaries with degenerative
musculoskeletal conditions.
(C) The potential for fraud and abuse under the medicare
program if payment were provided for orthotics used as a
component of durable medical equipment only when made under
the special payment provision for certain prosthetics and
custom-fabricated orthotics under section 1834(h)(1)(F) of
the Social Security Act, as added by subsection (a) and
furnished by qualified practitioners under that section.
(D) The impact on payments under titles XVIII and XIX of
the Social Security Act if such ruling were overturned.
(2) Report.--Not later than 6 months after the date of the
enactment of this Act, the Comptroller General shall submit
to Congress a report on the study conducted under paragraph
(1).
SEC. 428. REPLACEMENT OF PROSTHETIC DEVICES AND PARTS.
(a) In General.--Section 1834(h)(1) (42 U.S.C.
1395m(h)(1)), as amended by section 427(a), is further
amended by adding at the end the following new subparagraph:
``(G) 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 device or part being
replaced is less than 3 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 3 years old (calculated from the date on which the
beneficiary began to use the device or part), the Secretary
may also require confirmation of necessity of the replacement
device or replacement part, as the case may be.''.
(b) Preemption of Rule.--The provisions of section
1834(h)(1)(G) as added by subsection (a) shall supersede
any rule that as of the date of the 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 replaced on or after April 1, 2001.
SEC. 429. REVISED PART B PAYMENT FOR DRUGS AND BIOLOGICALS
AND RELATED SERVICES.
(a) Recommendations for Revised Payment Methodology for
Drugs and Biologicals.--
(1) Study.--
(A) In general.--The Comptroller General of the United
States shall conduct a study on the reimbursement for drugs
and biologicals under the current medicare payment
methodology (provided under section 1842(o) of the Social
Security Act (42 U.S.C. 1395u(o))) and for related services
under part B of title XVIII of such Act. In the study, the
Comptroller General shall--
(i) identify the average prices at which such drugs and
biologicals are acquired by physicians and other suppliers;
(ii) quantify the difference between such average prices
and the reimbursement amount under such section; and
(iii) determine the extent to which (if any) payment under
such part is adequate to compensate physicians, providers of
services, or other suppliers of such drugs and biologicals
for costs incurred in the administration, handling, or
storage of such drugs or biologicals.
(B) Consultation.--In conducting the study under
subparagraph (A), the Comptroller General shall consult with
physicians, providers of services, and suppliers of drugs and
biologicals under the medicare program under title XVIII of
such Act, as well as other organizations involved in the
distribution of such drugs and biologicals to such
physicians, providers of services, and suppliers.
(2) Report.--Not later than 9 months after the date of the
enactment of this Act, the Comptroller General shall submit
to Congress and to the Secretary of Health and Human Services
a report on the study conducted under this subsection, and
shall include in such report recommendations for revised
payment methodologies described in paragraph (3).
(3) Recommendations for revised payment methodologies.--
(A) In general.--The Comptroller General shall provide
specific recommendations for revised payment methodologies
for reimbursement for drugs and biologicals and for related
services under the medicare program. The Comptroller General
may include in the recommendations--
(i) proposals to make adjustments under subsection (c) of
section 1848 of the Social Security Act (42 U.S.C. 1395w-4)
for the practice expense component of the physician fee
schedule under such section for the costs incurred in the
administration, handling, or storage of certain categories of
such drugs and biologicals, if appropriate; and
(ii) proposals for new payments to providers of services or
suppliers for such costs, if appropriate.
(B) Ensuring patient access to care.--In making
recommendations under this paragraph, the Comptroller General
shall ensure that any proposed revised payment methodology is
designed to ensure that medicare beneficiaries continue to
have appropriate access to health care services under the
medicare program.
(C) Matters considered.--In making recommendations under
this paragraph, the Comptroller General shall consider--
(i) the method and amount of reimbursement for similar
drugs and biologicals made by large group health plans;
(ii) as a result of any revised payment methodology, the
potential for patients to receive inpatient or outpatient
hospital services in lieu of services in a physician's
office; and
(iii) the effect of any revised payment methodology on the
delivery of drug therapies by hospital outpatient
departments.
(D) Coordination with bbra study.--In making
recommendations under this paragraph, the Comptroller General
shall conclude and take into account the results of the study
provided for under section 213(a) of BBRA (113 Stat. 1501A-
350).
(b) Implementation of New Payment Methodology.--
(1) In general.--Notwithstanding any other provision of
law, based on the recommendations contained in the report
under subsection (a), the Secretary of Health and Human
Services, subject to paragraph (2), shall revise the payment
methodology under section 1842(o) of the Social Security Act
(42 U.S.C. 1395u(o)) for drugs and biologicals furnished
under part B of the medicare program. To the extent the
Secretary determines appropriate, the Secretary may provide
for the adjustments to payments amounts referred to in
subsection (a)(3)(A)(i) or additional payments referred to in
subsection (a)(2)(A)(ii).
[[Page H12362]]
(2) Limitation.--In revising the payment methodology under
paragraph (1), in no case may the estimated aggregate
payments for drugs and biologicals under the revised system
(including additional payments referred to in subsection
(a)(3)(A)(ii)) exceed the aggregate amount of payment for
such drugs and biologicals, as projected by the Secretary,
that would have been made under the payment methodology in
effect under such section 1842(o).
(c) Moratorium on Decreases in Payment Rates.--
Notwithstanding any other provision of law, effective for
drugs and biologicals furnished on or after January 1, 2001,
the Secretary may not directly or indirectly decrease the
rates of reimbursement (in effect as of such date) for drugs
and biologicals under the current medicare payment
methodology (provided under section 1842(o) of the Social
Security Act (42 U.S.C. 1395u(o))) until such time as the
Secretary has reviewed the report submitted under subsection
(a)(2).
SEC. 430. CONTRAST ENHANCED DIAGNOSTIC PROCEDURES UNDER
HOSPITAL PROSPECTIVE PAYMENT SYSTEM.
(a) Separate Classification.--Section 1833(t)(2) (42 U.S.C.
1395l(t)(2)) is amended--
(1) by striking ``and'' at the end of subparagraph (E);
(2) by striking the period at the end of subparagraph (F)
and inserting ``; and''; and
(3) by inserting after subparagraph (F) the following new
subparagraph:
``(G) the Secretary shall create additional groups of
covered OPD services that classify separately those
procedures that utilize contrast agents from those that do
not.''.
(b) Conforming Amendment.--Section 1861(t)(1) (42 U.S.C.
1395x(t)(1)) is amended by inserting ``(including contrast
agents)'' after ``only such drugs''.
(c) Effective Date.--The amendments made by this section
apply to items and services furnished on or after July 1,
2001.
SEC. 431. QUALIFICATIONS FOR COMMUNITY MENTAL HEALTH CENTERS.
(a) Medicare Program.--Section 1861(ff)(3)(B) (42 U.S.C.
1395x(ff)(3)(B)) is amended by striking ``entity'' and all
that follows and inserting the following: ``entity that--
``(i)(I) provides the mental health services described in
section 1913(c)(1) of the Public Health Service Act; or
``(II) in the case of an entity operating in a State that
by law precludes the entity from providing itself the service
described in subparagraph (E) of such section, provides for
such service by contract with an approved organization or
entity (as determined by the Secretary);
``(ii) meets applicable licensing or certification
requirements for community mental health centers in the State
in which it is located; and
``(iii) meets such additional conditions as the Secretary
shall specify to ensure (I) the health and safety of
individuals being furnished such services, (II) the effective
and efficient furnishing of such services, and (III) the
compliance of such entity with the criteria described in
section 1931(c)(1) of the Public Health Service Act.''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply with respect to community mental health centers
with respect to services furnished on or after the first day
of the third month beginning after the date of the enactment
of this Act.
SEC. 432. PAYMENT OF PHYSICIAN AND NONPHYSICIAN SERVICES IN
CERTAIN INDIAN PROVIDERS.
(a) In General.--Section 1880 (42 U.S.C. 1395qq) is
amended--
(1) by redesignating subsection (e), as added by section
3(b)(1) of the Alaska Native and American Indian Direct
Reimbursement Act of 2000 (Public Law 106-417), as subsection
(f); and
(2) by inserting after subsection (d) the following new
subsection:
``(e)(1)(A) Notwithstanding section 1835(d), subject to
subparagraph (B), the Secretary shall make payment under part
B to a hospital or an ambulatory care clinic (whether
provider-based or freestanding) that is operated by the
Indian Health Service or by an Indian tribe or tribal
organization (as defined for purposes of subsection (a)) for
services described in paragraph (2) furnished in or at the
direction of the hospital or clinic under the same
situations, terms, and conditions as would apply if the
services were furnished in or at the direction of such a
hospital or clinic that was not operated by such Service,
tribe, or organization.
``(B) Payment shall not be made for services under
subparagraph (A) to the extent that payment is otherwise made
for such services under this title.
``(2) The services described in this paragraph are the
following:
``(A) Services for which payment is made under section
1848.
``(B) Services furnished by a practitioner described in
section 1842(b)(18)(C) for which payment under part B is made
under a fee schedule.
``(C) Services furnished by a physical therapist or
occupational therapist as described in section 1861(p) for
which payment under part B is made under a fee schedule.
``(3) Subsection (c) shall not apply to payments made under
this subsection.''.
(b) Conforming Amendments.--
(1) Coverage amendment.--Section 1862(a)(3) (42 U.S.C.
1395y(a)(3)) is amended--
(A) by striking the second comma after ``1861(aa)(1)''; and
(B) by inserting ``in the case of services for which
payment may be made under section 1880(e),'' after ``as
defined in section 1861(aa)(3),''.
(2) Direct payment amendment.--The first sentence of
section 1842(b)(6) (42 U.S.C. 1395u(b)(6)) is amended--
(A) by striking ``and (F)'' and inserting ``(F)''; and
(B) by inserting before the period the following: ``, and
(G) in the case of services in a hospital or clinic to which
section 1880(e) applies, payment shall be made to such
hospital or clinic''.
(c) Effective Date.--The amendments made by this section
shall apply to services furnished on or after July 1, 2001.
SEC. 433. GAO STUDY ON COVERAGE OF SURGICAL FIRST ASSISTING
SERVICES OF CERTIFIED REGISTERED NURSE FIRST
ASSISTANTS.
(a) Study.--The Comptroller General of the United States
shall conduct a study on the effect on the medicare program
under title XVIII of the Social Security Act and on medicare
beneficiaries of coverage under the program of surgical first
assisting services of certified registered nurse first
assistants. The Comptroller General shall consider the
following when conducting the study:
(1) Any impact on the quality of care furnished to medicare
beneficiaries by reason of such coverage.
(2) Appropriate education and training requirements for
certified registered nurse first assistants who furnish such
first assisting services.
(3) Appropriate rates of payment under the program to such
certified registered nurse first assistants for furnishing
such services, taking into account the costs of compensation,
overhead, and supervision attributable to certified
registered nurse first assistants.
(b) Report.--Not later than 1 year after the date of the
enactment of this Act, the Comptroller General shall submit
to Congress a report on the study conducted under subsection
(a).
SEC. 434. MEDPAC STUDY AND REPORT ON MEDICARE REIMBURSEMENT
FOR SERVICES PROVIDED BY CERTAIN PROVIDERS.
(a) Study.--The Medicare Payment Advisory Commission shall
conduct a study on the appropriateness of the current payment
rates under the medicare program under title XVIII of the
Social Security Act for services provided by a--
(1) certified nurse-midwife (as defined in subsection
(gg)(2) of section 1861 of such 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).
The study shall separately examine the appropriateness of
such payment rates for orthopedic physician assistants,
taking into consideration the requirements for accreditation,
training, and education.
(b) Report.--Not later than 18 months after the date of the
enactment of this Act, the Commission shall submit to
Congress a report on the study conducted under subsection
(a), together with any recommendations for legislation that
the Commission determines to be appropriate as a result of
such study.
SEC. 435. MEDPAC STUDY AND REPORT ON MEDICARE COVERAGE OF
SERVICES PROVIDED BY CERTAIN NONPHYSICIAN
PROVIDERS.
(a) Study.--
(1) In general.--The Medicare Payment Advisory Commission
shall conduct a study to determine the appropriateness of
providing coverage under the medicare program under title
XVIII of the Social Security Act for services provided by a--
(A) surgical technologist;
(B) marriage counselor;
(C) marriage and family therapist;
(D) pastoral care counselor; and
(E) 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 the
enactment of this Act, the Commission shall submit to
Congress a report on the study conducted under subsection
(a), together with any recommendations for legislation that
the Commission determines to be appropriate as a result of
such study.
SEC. 436. GAO STUDY AND REPORT ON THE COSTS OF EMERGENCY AND
MEDICAL TRANSPORTATION SERVICES.
(a) Study.--The Comptroller General of the United States
shall conduct a study on the costs of providing emergency and
medical transportation services across the range of acuity
levels of conditions for which such transportation services
are provided.
(b) Report.--Not later than 18 months after the date of the
enactment of this Act, the Comptroller General shall submit
to Congress a report on the study conducted under subsection
(a), together with recommendations for any changes in
methodology or payment level necessary to fairly compensate
suppliers of emergency and medical transportation services
and to ensure the access of beneficiaries under the medicare
program under title XVIII of the Social Security Act.
SEC. 437. GAO STUDIES AND REPORTS ON MEDICARE PAYMENTS.
(a) GAO Study on HCFA Post-Payment Audit Process.--
(1) Study.--The Comptroller General of the United States
shall conduct a study on the post-payment audit process under
the medicare program under title XVIII of the Social Security
Act as such process applies to physicians, including the
proper level of resources that the Health Care Financing
Administration should devote to educating physicians
regarding--
(A) coding and billing;
(B) documentation requirements; and
(C) the calculation of overpayments.
(2) Report.--Not later than 18 months after the date of the
enactment of this Act, the Comptroller General shall submit
to Congress a report
[[Page H12363]]
on the study conducted under paragraph (1) together with
specific recommendations for changes or improvements in the
post-payment audit process described in such paragraph.
(b) GAO Study on Administration and Oversight.--
(1) Study.--The Comptroller General of the United States
shall conduct a study on the aggregate effects of regulatory,
audit, oversight, and paperwork burdens on physicians and
other health care providers participating in the medicare
program under title XVIII of the Social Security Act.
(2) Report.--Not later than 18 months after the date of the
enactment of this Act, the Comptroller General shall submit
to Congress a report on the study conducted under paragraph
(1) together with recommendations regarding any area in
which--
(A) a reduction in paperwork, an ease of administration, or
an appropriate change in oversight and review may be
accomplished; or
(B) additional payments or education are needed to assist
physicians and other health care providers in understanding
and complying with any legal or regulatory requirements.
SEC. 438. MEDPAC STUDY ON ACCESS TO OUTPATIENT PAIN
MANAGEMENT SERVICES.
(a) Study.--The Medicare Payment Advisory Commission shall
conduct a study on the barriers to coverage and payment for
outpatient interventional pain medicine procedures under the
medicare program under title XVIII of the Social Security
Act. Such study shall examine--
(1) the specific barriers imposed under the medicare
program on the provision of pain management procedures in
hospital outpatient departments, ambulatory surgery centers,
and physicians' offices; and
(2) the consistency of medicare payment policies for pain
management procedures in those different settings.
(b) Report.--Not later than 1 year after the date of the
enactment of this Act, the Commission shall submit to
Congress a report on the 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 (113 Stat.
1501A-360) is amended--
(1) by striking ``Not later than'' and all that follows
through ``(42 U.S.C. 1395fff)'' and inserting ``Not later
than April 1, 2002''; and
(2) by striking ``Secretary'' and inserting ``Comptroller
General of the United States''.
(c) Case Mix Adjustment Corrections.--
(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:
``(iv) 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)
shall apply to episodes concluding on or after 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 furnished during 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
the Federal Register on July 3, 2000 (65 Fed. Reg. 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 2.2 percent.
(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.
SEC. 503. TEMPORARY TWO-MONTH PERIODIC INTERIM PAYMENT.
(a) In General.--Notwithstanding the amendments made by
section 4603(b) of BBA (42 U.S.C. 1395fff note), in the case
of a home health agency that was receiving periodic interim
payments under section 1815(e)(2) of the Social Security Act
(42 U.S.C. 1395g(e)(2)) as of September 30, 2000, and that is
not described in subsection (b), the Secretary of Health and
Human Services shall, as soon as practicable, make a single
periodic interim payment to such agency in an amount equal to
four times the last full fortnightly periodic interim payment
made to such agency under the payment system in effect prior
to the implementation of the prospective payment system under
section 1895(b) of such Act (42 U.S.C. 1395fff(b)). Such
amount of such periodic interim payment shall be included in
the tentative settlement of the last cost report for the home
health agency under the payment system in effect prior to the
implementation of such prospective payment system, regardless
of the ending date of such cost report.
(b) Exceptions.--The Secretary shall not make an additional
periodic interim payment under subsection (a) in the case of
a home health agency (determined as of the day that such
payment would otherwise be made) that--
(1) notifies the Secretary that such agency does not want
to receive such payment;
(2) is not receiving payments pursuant to section 405.371
of title 42, Code of Federal Regulations;
(3) is excluded from the medicare program under title XI of
the Social Security Act;
(4) no longer has a provider agreement under section 1866
of such Act (42 U.S.C. 1395cc);
(5) is no longer in business; or
(6) is subject to a court order providing for the
withholding of medicare payments under title XVIII of such
Act.
SEC. 504. USE OF TELEHEALTH IN DELIVERY OF HOME HEALTH
SERVICES.
Section 1895 (42 U.S.C. 1395fff) is amended by adding at
the end the following new subsection:
``(e) Construction Related to Home Health Services.--
``(1) Telecommunications.--Nothing in this section shall be
construed as preventing a home health agency furnishing a
home health unit of service for which payment is made under
the prospective payment system established by this section
for such units of service from furnishing services via a
telecommunication system if such services--
``(A) do not substitute for in-person home health services
ordered as part of a plan of care certified by a physician
pursuant to section 1814(a)(2)(C) or 1835(a)(2)(A); and
``(B) are not considered a home health visit for purposes
of eligibility or payment under this title.
``(2) Physician certification.--Nothing in this section
shall be construed as waiving the requirement for a physician
certification under section 1814(a)(2)(C) or 1835(a)(2)(A) of
such Act (42 U.S.C. 1395f(a)(2)(C), 1395n(a)(2)(A)) for the
payment for home health services, whether or not furnished
via a telecommunications system.''.
SEC. 505. STUDY ON COSTS TO HOME HEALTH AGENCIES OF
PURCHASING NONROUTINE MEDICAL SUPPLIES.
(a) Study.--The Comptroller General of the United States
shall conduct a study on variations in prices paid by home
health agencies furnishing home health services under the
medicare program under title XVIII of the Social Security Act
in purchasing nonroutine medical supplies, including ostomy
supplies, and volumes of such supplies used, shall determine
the effect (if any) of variations on prices and volumes in
the provision of such services.
(b) Report.--Not later than August 15, 2001, the
Comptroller General shall submit to Congress a report on the
study conducted under subsection (a), and shall include in
the report recommendations respecting whether payment for
nonroutine medical supplies furnished in connection with home
health services should be made separately from the
prospective payment system for such services.
SEC. 506. TREATMENT OF BRANCH OFFICES; GAO STUDY ON
SUPERVISION OF HOME HEALTH CARE PROVIDED IN
ISOLATED RURAL AREAS.
(a) Treatment of Branch Offices.--
(1) In general.--Notwithstanding any other provision of
law, in determining for purposes of title XVIII of the Social
Security Act whether an office of a home health agency
constitutes a branch office or a separate home health agency,
neither the time nor distance between a parent office of the
home health agency and a branch office shall be the sole
determinant of a home health agency's branch office status.
(2) Consideration of forms of technology in definition of
supervision.--The Secretary of Health and Human Services may
include forms of technology in determining what constitutes
``supervision'' for purposes of determining a home heath
agency's branch office status under paragraph (1).
(b) GAO Study.--
(1) Study.--The Comptroller General of the United States
shall conduct a study of |
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