Text: H.R.3864 — 101st Congress (1989-1990)All Information (Except Text)

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HR 3864 IH
101st CONGRESS
2d Session
 H. R. 3864
To amend title XVIII of the Social Security Act to provide for coverage of
annual screening mammography under part B of the medicare program.
IN THE HOUSE OF REPRESENTATIVES
January 23, 1990
Ms. OAKAR introduced the following bill; which was referred jointly to the
Committees on Ways and Means and Energy and Commerce
A BILL
To amend title XVIII of the Social Security Act to provide for coverage of
annual screening mammography under part B of the medicare program.
  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 Rose Kushner Medicare Screening Mammography
  Act of 1990'.
SEC. 2. MEDICARE COVERAGE OF ANNUAL SCREENING MAMMOGRAPHY.
  (a) IN GENERAL- Section 1861 of the Social Security Act (42 U.S.C. 1395x),
  as restored by the Medicare Catastrophic Coverage Repeal Act of 1989 and
  as amended by the Omnibus Budget Reconciliation Act of 1989, is amended--
  (1) in subsection(s)--
  (A) in paragraph (11), by striking all that follows `(bb))' and inserting
  a semicolon,
  (B) in paragraph (12)(C), by striking all that follows `area)' and inserting
  `; and', and
  (C) by inserting after paragraph (12) the following new paragraph:
  `(13) screening mammography (as defined in subsection (jj));'; and
  (2) by inserting after subsection (ii) the following new subsection:
`Screening Mammography
  `(jj) The term `screening mammography' means a radiologic procedure provided
  to a woman for the purpose of early detection of breast cancer and includes
  a physician's interpretation of the results of the procedure.'.
  (b) PAYMENT AND COVERAGE- Section 1834 of such Act (42 U.S.C. 1395m),
  as restored by the Medicare Catastrophic Coverage Repeal Act of 1989,
  is amended--
  (1) in subsection (b)(1)(B), by inserting `and subject to subsection
  (c)(1)(A)' after `conversion factors', and
  (2) by inserting after subsection (b) the following new subsection:
  `(c) PAYMENTS AND STANDARDS FOR SCREENING MAMMOGRAPHY-
  `(1) IN GENERAL- Notwithstanding any other provision of this part, with
  respect to expenses incurred for screening mammography (as defined in
  section 1861(jj))--
  `(A) payment may be made only for screening mammography conducted consistent
  with the frequency permitted under paragraph (2);
  `(B) payment may be made only if the screening mammography meets the
  quality standards established under paragraph (3); and
  `(C) the amount of the payment under this part shall, subject to the
  deductible established under section 1833(b), be equal to 80 percent of
  the least of--
  `(i) the actual charge for the screening,
  `(ii) the fee schedule established under subsection (b) with respect to
  both the professional and technical components of the screening mammography,
  in the case of screening mammography subject to such schedule but for this
  paragraph, or
  `(iii) the limit established under paragraph (4) for the screening
  mammography.
  `(2) FREQUENCY COVERED-
  `(A) IN GENERAL- Subject to revision by the Secretary under subparagraph
  (B)--
  `(i) No payment may be made under this part for screening mammography
  performed on a woman under 35 years of age.
  `(ii) Payment may be made under this part for only 1 screening mammography
  performed on a woman over 34 years of age, but under 40 years of age.
  `(iii) In the case of a woman over 39 years of age, but under 50 years of
  age, who--
  `(I) is at a high risk of developing breast cancer (as determined pursuant
  to factors identified by the Secretary), payment may not be made under
  this part for a screening mammography performed within the 11 months of
  a previous screening mammography, or
  `(II) is not at a high risk of developing breast cancer, payment may not
  be made under this part for a screening mammography performed within the
  23 months after a previous screening mammography.
  `(iv) In the case of a woman over 49 years of age, payment may not be made
  under this part for screening mammography performed within 11 months after
  a previous screening mammography.
  `(B) REVISION OF FREQUENCY-
  `(i) REVIEW- The Secretary, in consultation with the Director of the National
  Cancer Institute, shall review periodically the appropriate frequency for
  performing screening mammography, based on age and such other factors as
  the Secretary believes to be pertinent.
  `(ii) REVISION OF FREQUENCY- The Secretary, taking into consideration the
  review made under clause (i), may revise from time to time the frequency
  with which screening mammography may be paid for under this subsection,
  but no such revision shall apply to screening mammography performed before
  January 1, 1993.
  `(3) QUALITY STANDARDS- The Secretary shall establish standards to assure
  the safety and accuracy of screening mammography performed under this
  part. Such standards shall include the requirements that--
  `(A) the equipment used to perform the mammography must be specifically
  designed for mammography and must meet radiologic standards established
  by the Secretary for mammography;
  `(B) the mammography must be performed by an individual who--
  `(i) is licensed by a State to perform radiological procedures, or
  `(ii) is certified as qualified to perform radiological procedures by such
  an appropriate organization as the Secretary specifies in regulations;
  `(C) the results of the mammography must be interpreted by a physician--
  `(i) who is certified as qualified to interpret radiological procedures
  by such an appropriate board as the Secretary specifies in regulations, or
  `(ii) who is certified as qualified to interpret screening mammography
  procedures by such a program as the Secretary recognizes in regulation
  as assuring the qualifications of the individual with respect to such
  interpretation; and
  `(D) with respect to the first screening mammography performed on a woman
  for which payment is made under this part, there are satisfactory assurances
  that the results of the mammography will be placed in permanent medical
  records maintained with respect to the woman.
  `(4) LIMIT-
  `(A) $60, INDEXED- Except as provided by the Secretary under subparagraph
  (B), the limit established under this paragraph--
  `(i) for screening mammography performed in 1991, is $60, and
  `(ii) for screening mammography performed in a subsequent year is the
  limit established under this paragraph for the preceding year increased
  by the percentage increase in the MEI for that subsequent year.
  `(B) REDUCTION OF LIMIT- The Secretary shall review from time to
  time the appropriateness of the amount of the limit established under
  this paragraph. The Secretary may, with respect to screening mammography
  performed in a year after 1992, reduce the amount of such limit as it applies
  nationally or in any area to the amount that the Secretary estimates is
  required to assure that screening mammography of an appropriate quality
  is readily and conveniently available during the year.
  `(C) APPLICATION OF LIMIT IN HOSPITAL OUTPATIENT SETTING- The Secretary
  shall provide for an appropriate allocation of the limit established under
  this paragraph between professional and technical components in the case
  of hospital outpatient screening mammography (and comparable situations)
  where there is a claim for professional services separate from the claim
  for the radiologic procedure.
  `(5) LIMITING CHARGES OF NONPARTICIPATING PHYSICIANS-
  `(A) IN GENERAL- In the case of mammography screening performed on or
  after January 1, 1991, for which payment is made under this subsection,
  if a nonparticipating physician or supplier provides the screening to an
  individual entitled to benefits under this part, the physician or supplier
  may not charge the individual more than the limiting charge (as defined in
  subparagraph (B), or, if applicable and if less, as defined in subsection
  (b)(5)(B) or as established under section 1848(g)(2)).
  `(B) LIMITING CHARGE DEFINED- In subparagraph (A), the term `limiting
  charge' means, with respect to screening mammography performed--
  `(i) in 1991, 125 percent of the limit established under paragraph (4),
  `(ii) in 1992, 120 percent of the limit established under paragraph (4), or
  `(iii) after 1992, 115 percent of the limit established under paragraph (4).
  `(C) ENFORCEMENT- If a physician or supplier knowing and willfully imposes
  a charge in violation of subparagraph (A), the Secretary may apply sanctions
  against such physician or supplier in accordance with section 1842(j)(2).'.
  (c) CERTIFICATION OF SCREENING MAMMOGRAPHY QUALITY STANDARDS-
  (1) Section 1863 of such Act (42 U.S.C. 1395z), as restored by the
  Medicare Catastrophic Coverage Repeal Act of 1989, is amended by inserting
  `or whether screening mammography meets the standards established under
  section 1834(c)(3),' after `1832(a)(2)(F)(i),'.
  (2) The first sentence of section 1864(a) of such Act (42 U.S.C. 1395aa(a)),
  as restored by the Medicare Catastrophic Coverage Repeal Act of 1989, is
  amended by inserting before the period the following: `, or whether screening
  mammography meets the standards established under section 1834(c)(3)'.
  (3) Section 1865(a) of such Act (42 U.S.C. 1395bb(a)), as restored by the
  Medicare Catastrophic Coverage Repeal Act of 1989, is amended by inserting
  `1834(c)(3),' after `1832(a)(2)(F)(i),'.
  (d) FINANCING THROUGH INCREASE IN MEDICARE PART B PREMIUM-
  (1) IN GENERAL- Section 1839 of such Act (42 U.S.C. 1395r), as restored
  by the Medicare Catastrophic Coverage Repeal Act of 1989, is amended by
  adding at the end the following new subsection:
  `(g)(1) Except as provided in subsections (b) and (f), the monthly premium
  for each individual enrolled under this part otherwise determined, without
  regard to this subsection, shall be increased by the screening mammography
  additional premium determined in accordance with paragraph (2).
  `(2)(A) The Secretary shall, during September of 1990 and of each year
  thereafter, determine and promulgate the screening mammography additional
  premium for months in the succeeding year. Such premium amount shall be equal
  to the amount the Secretary estimates to be necessary so that the aggregate
  amount of premium collected under this subsection for months in the year will
  equal the total of the benefits and administrative costs which the Secretary
  estimates will be payable from the Federal Supplementary Medical Insurance
  Trust Fund for screening mammography performed (and related administrative
  costs incurred) in such year. In calculating such additional premium, the
  Secretary shall include an appropriate amount for a contingency margin,
  and shall adjust such premium to take into account the amounts by which
  the additional premiums established under this subsection with respect to
  months in any year are greater or less than the amounts required to pay
  for benefits and such administrative costs under this part for screening
  mammography performed (and costs incurred) in such year.
  `(B) If any premium increase for a month under this paragraph is not
  a multiple of 10 cents, the Secretary shall round the increase to the
  nearest multiple of 10 cents.'.
  (2) CONFORMING AMENDMENTS-
  (A) Section 1839 of such Act (42 U.S.C. 1395r), as restored by the Medicare
  Catastrophic Coverage Repeal Act of 1989, is amended--
  (i) in the second sentence of subsections (a)(1) and (a)(4), by inserting
  `(other than costs relating to the amendments made by the Medicare Screening
  Mammography Amendments of 1990)' before the period;
  (ii) by inserting before the period at the end of the last sentence of
  subsections (a)(1) and (a)(4) the following: `, but shall not take into
  account any amounts in the Trust Fund that may be attributable to receipts
  or outlays relating to the amendments made by the Medicare Screening
  Mammography Amendments of 1990';
  (iii) in subsection (a)(2), by striking `and (e)' and inserting `, (e),
  and (g)';
  (iv) in subsection (a)(3), by striking `subsection (e)' and inserting
  `subsections (e) and (g)';
  (v) in subsection (b), by striking `determined under subsection (a) or (e)'
  and inserting `otherwise determined under this section (without regard to
  subsection (f))'; and
  (vi) in subsection (e)(1), by inserting `except as provided in subsection
  (g),' after `subsection (a)'.
  (B) Section 1844(a) of such Act (42 U.S.C. 1395w(a)), as restored by the
  Medicare Catastrophic Coverage Repeal Act of 1989, is amended by adding
  at the end the following:
`In computing the amount of aggregate premiums and premiums per enrollee under
paragraph (1), there shall not be taken into account premiums attributable
to section 1839(g).'.
  (e) ADDITIONAL CONFORMING AMENDMENTS-
  (1) Section 1833(a)(2)(E) of such Act (42 U.S.C. 1395l(a)(2)(E)), as restored
  by the Medicare Catastrophic Coverage Repeal Act of 1989, is amended by
  inserting `, but excluding screening mammography' after `imaging services'.
  (2) Section 1862(a) of such Act (42 U.S.C. 1395y(a)), as restored by the
  Medicare Catastrophic Coverage Repeal Act of 1989, is amended--
  (A) in paragraph (1)--
  (i) in subparagraph (A), by striking `subparagraph (B), (C), (D), or (E)'
  and inserting `a succeeding subparagraph',
  (ii) in subparagraph (D), by striking `and' at the end,
  (iii) in subparagraph (E), by striking the semicolon at the end and inserting
  `, and', and
  (iv) by adding at the end the following new subparagraph:
  `(F) in the case of screening mammography, which is performed more
  frequently than is covered under section 1834(c)(2) or which does not meet
  the standards established under section 1834(c)(3);'; and
  (B) in paragraph (7), by inserting `or under paragraph (1)(F)' after
  `(1)(B)'.
  (f) EFFECTIVE DATES- (1) The amendments made by this section (other than
  subsection (d)) shall apply to screening mammography performed on or after
  January 1, 1991.
  (2) The amendments made by subsection (d) shall apply to monthly premiums
  for months beginning with January 1991.