[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2979 Introduced in House (IH)]
106th CONGRESS
1st Session
H. R. 2979
To amend title XVIII of the Social Security Act to make refinements in
the medicare prospective payment system for outpatient hospital
services.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 30, 1999
Mr. Lazio introduced the following bill; which was referred to the
Committee on Commerce, and in addition to the Committee on Ways and
Means, for a period to be subsequently determined by the Speaker, in
each case for consideration of such provisions as fall within the
jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to make refinements in
the medicare prospective payment system for outpatient hospital
services.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Hospital Outpatient Payment
Equality (HOPE) Act of 1999''.
SEC. 2. REFINEMENTS TO MEDICARE PROSPECTIVE PAYMENT SYSTEM FOR
OUTPATIENT HOSPITAL SERVICES.
(a) Special Payment Adjustment for Certain Visits.--Section 1833(t)
of the Social Security Act (42 U.S.C. 1395l(t)) is amended--
(1) by redesignating paragraph (9) as paragraph (10) and
inserting after paragraph (8) the following:
``(9) Special payment adjustment for certain visits.--
``(A) In general.--Notwithstanding the preceding
paragraphs of this subsection, the amount of payment
made under this part for covered OPD services that are
classified within an ambulatory patient classification
group for--
``(i) emergency room visits, or
``(ii) clinic visits,
shall be equal to the product of the amount of payment
determined under paragraph (4) for services classified
within such group and the adjustment factor determined
under subparagraph (B) or (C).
``(B) Adjustment factor for er visits.--The
adjustment factor for covered OPD services that are
classified within ambulatory patient classification
groups for emergency room visits shall be determined as
follows:
``(i) Estimate of aggregate reasonable
costs.--The Secretary shall estimate the total
amount that would be payable under this part
for all covered OPD services that are
classified within such groups and furnished in
2000 if payment for such services was based on
the reasonable costs incurred in furnishing
such services.
``(ii) Estimate of aggregate payments under
opd pps.--The Secretary shall estimate the
total amount that would be payable under this
subsection for all covered OPD services that
are classified within such groups and furnished
in 2000, determined without regard to this
paragraph.
``(iii) Determination of adjustment
factor.--The adjustment factor determined under
this subparagraph shall equal the quotient
obtained by dividing the amount determined
under clause (i) by the amount determined under
clause (ii).
``(C) Adjustment factor for clinic visits.--In
determining the adjustment factor for covered OPD
services that are classified within ambulatory patient
classification groups for clinic visits, subparagraph
(B) shall be applied--
``(i) by substituting `clinic' for `er' and
`emergency room' each place either appears, and
``(ii) by substituting `94.2 percent of
reasonable costs' for `reasonable costs' in
clause (i) of such subparagraph.
``(D) Relation to other rules.--
``(i) Part b, blood deductibles.--In
applying the deductibles described in
subsection (b), the amount of payment
determined under this paragraph for a covered
OPD service shall be substituted for the amount
determined under paragraph (4) for such
service.
``(ii) Inapplicability of budget neutrality
requirement.--The adjustments required by this
paragraph shall not be subject to the budget
neutrality requirements of paragraph (2)(E).
``(iii) No effect on certain
determinations.--The amounts payable by reason
of this paragraph shall not be taken into
account in determining--
``(I) copayment amounts under
paragraph (3)(B),
``(II) medicare OPD fee schedule
amounts under paragraph (3)(D),
``(III) pre-deductible payment
percentages under paragraph (3)(E), or
``(IV) compliance with the volume
control mechanism established pursuant
to paragraph (2)(F).
``(iv) Hold harmless.--The adjustments
required by this paragraph shall be taken into
account in applying the temporary limits on
payment reductions established under subsection
(e) of section 4523 of the Balanced Budget Act
of 1997.''.
(b) Elimination of Reduction in Market Basket.--Section
1833(t)(3)(C)(iii) of the Social Security Act (42 U.S.C.
1395l(t)(3)(C)(iii)) is amended by striking ``, reduced by 1 percentage
point for such factor for services furnished in each of 2000, 2001, and
2002''.
(c) Temporary Limitation on Reductions.--
(1) In general.--Section 4523 of the Balanced Budget Act of
1997 is amended by adding at the end the following:
``(e) Temporary Limit on Reductions in Federal Payments.--
``(1) In general.--Notwithstanding section 1833(t) of the
Social Security Act (42 U.S.C. 1395l(t)), as added by
subsection (a), the amount that is paid from the Federal
Supplementary Medical Insurance Trust Fund for covered OPD
services furnished by a hospital during a calendar year (or
portion thereof) specified in paragraph (2)(A) may not be less
than the applicable percentage of the case mix adjusted average
amount that would have been payable to such hospital for such
services (including cost sharing) if the prospective payment
system established under such section did not apply. Such
average amount may be determined on a prospective basis using
the Secretary's best estimate of the reasonable costs incurred
in furnishing covered OPD services or on a retrospective basis
using cost reports submitted by a hospital.
``(2) Definitions.--For purposes of paragraph (1):
``(A) Applicable percentage.--Subject to paragraph
(3), the term `applicable percentage' means--
``(i) with respect to covered OPD services
furnished during the first full calendar year
(and any portion of the immediately preceding
calendar year) for which the prospective
payment system established under section
1833(t) of such Act is in effect, 95 percent,
``(ii) with respect to the second full calendar
year for which such system is in effect, 90 percent,
and
``(iii) with respect to the third full calendar
year for which such system is in effect, 85 percent.
``(B) Covered opd services.--The term `covered OPD
services' has the meaning given to such term in section
1833(t)(1)(B) of such Act.
``(3) Application to certain hospitals.--In the case of
hospitals described in section 1833(t)(8) of such Act, the
`applicable percentage' for a calendar year (or portion
thereof) shall be the same applicable percentage that applies
to covered OPD services furnished by hospitals that are not
described in such section during such calendar year (or portion
thereof).
``(4) Rule of construction.--Nothing in this subsection
shall be construed as affecting the amount of cost sharing paid
by individuals enrolled under part B of title XVIII of the
Social Security Act for covered OPD services.''.
(2) Conforming amendment.--Section 1833(t)(1)(A) of the
Social Security Act (42 U.S.C. 1395l(t)(1)(A)) is amended by
inserting ``except as provided in section 4523(e) of the
Balanced Budget Act of 1997,'' after ``1999,''.
(d) Effective Date.--
(1) Special adjustments for certain visits.--The amendments
made by subsection (a) shall apply to items and services
furnished on or after January 1, 2000.
(2) Market basket; temporary limits on reductions.--The
amendments made by subsections (b) and (c) are effective as if
included in the enactment of the Balanced Budget Act of 1997.
<all>