The Benefits Improvement and Protection Act of 2000 was introducted
December 21, 2000, and referenced H.R. 5661, and titled "Medicare,
Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000".
(The text of the entire Act can be found at:
http://thomas.loc.gov/cgi-bin/query/C?c106:./temp/~c106DMJr9y
The actual text of Section 104 "Modernization of Screening Mammography
Benefit" is as follows. I trust it is the information you need. Please
let me know if I can be of further service.
SEC. 104. MODERNIZATION OF SCREENING MAMMOGRAPHY BENEFIT.
(a) INCLUSION IN PHYSICIAN FEE SCHEDULE- Section 1848(j)(3) (42 U.S.C.
1395w-4(j)(3)) is amended by inserting `(13),' after `(4),'.
(b) CONFORMING AMENDMENT- Section 1834(c) (42 U.S.C. 1395m(c)) is
amended to read as follows:
`(c) PAYMENT AND STANDARDS FOR SCREENING MAMMOGRAPHY-
`(1) IN GENERAL- With respect to expenses incurred for screening
mammography (as defined in section 1861(jj)), payment may be made
only--
`(A) for screening mammography conducted consistent with the frequency
permitted under paragraph (2); and
`(B) if the screening mammography is conducted by a facility that has
a certificate (or provisional certificate) issued under section 354 of
the Public Health Service Act.
`(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 one screening
mammography performed on a woman over 34 years of age, but under 40
years of age; and
`(iii) in the case of a woman over 39 years of age, payment may not be
made under this part for screening mammography performed within 11
months following the month in which a previous screening mammography
was performed.
`(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.'.
(c) EFFECTIVE DATE- The amendments made by subsections (a) and (b)
shall apply with respect to screening mammographies furnished on or
after January 1, 2002.
(d) PAYMENT FOR NEW TECHNOLOGIES-
(1) TESTS FURNISHED IN 2001-
(A) SCREENING- For a screening mammography (as defined in section
1861(jj) of the Social Security Act (42 U.S.C. 1395x(jj))) furnished
during the period beginning on April 1, 2001, and ending on December
31, 2001, that uses a new technology, payment for such screening
mammography shall be made as follows:
(i) In the case of a technology which directly takes a digital image
(without involving film), in an amount equal to 150 percent of the
amount of payment under section 1848 of such Act (42 U.S.C. 1395w-4)
for a bilateral diagnostic mammography (under HCPCS code 76091) for
such year.
(ii) In the case of a technology which allows conversion of a standard
film mammogram into a digital image and subsequently analyzes such
resulting image with software to identify possible problem areas, in
an amount equal to the limit that would otherwise be applied under
section 1834(c)(3) of such Act (42 U.S.C. 1395m(c)(3)) for 2001,
increased by $15.
(B) BILATERAL DIAGNOSTIC MAMMOGRAPHY- For a bilateral diagnostic
mammography furnished during the period beginning on April 1, 2001,
and ending on December 31, 2001, that uses a new technology described
in subparagraph (A), payment for such mammography shall be the amount
of payment provided for under such subparagraph.
(C) ALLOCATION OF AMOUNTS- The Secretary shall provide for an
appropriate allocation of the amounts under subparagraphs (A) and (B)
between the professional and technical components.
(D) IMPLEMENTATION OF PROVISION- The Secretary of Health and Human
Services may implement the provisions of this paragraph by program
memorandum or otherwise.
(2) CONSIDERATION OF NEW HCPCS CODE FOR NEW TECHNOLOGIES AFTER 2001-
The Secretary shall determine, for such mammographies performed after
2001, whether the assignment of a new HCPCS code is appropriate for
mammography that uses a new technology. If the Secretary determines
that a new code is appropriate for such mammography, the Secretary
shall provide for such new code for such tests furnished after 2001.
(3) NEW TECHNOLOGY DESCRIBED- For purposes of this subsection, a new
technology with respect to a mammography is an advance in technology
with respect to the test or equipment that results in the following:
(A) A significant increase or decrease in the resources used in the
test or in the manufacture of the equipment.
(B) A significant improvement in the performance of the test or
equipment.
(C) A significant advance in medical technology that is expected to
significantly improve the treatment of medicare beneficiaries.
(4) HCPCS CODE DEFINED- The term `HCPCS code' means a code under the
Health Care Financing Administration Common Procedure Coding System
(HCPCS).
SEC. 105. COVERAGE OF MEDICAL NUTRITION THERAPY SERVICES FOR
BENEFICIARIES WITH DIABETES OR A RENAL DISEASE.
(a) COVERAGE- Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)), as amended
by section 102(a), is amended--
(1) in subparagraph (T), by striking `and' at the end;
(2) in subparagraph (U), by inserting `and' at the end; and
(3) by adding at the end the following new subparagraph:
`(V) medical nutrition therapy services (as defined in subsection
(vv)(1)) in the case of a beneficiary with diabetes or a renal disease
who--
`(i) has not received diabetes outpatient self-management training
services within a time period determined by the Secretary;
`(ii) is not receiving maintenance dialysis for which payment is made
under section 1881; and
`(iii) meets such other criteria determined by the Secretary after
consideration of protocols established by dietitian or nutrition
professional organizations;'.
(b) SERVICES DESCRIBED- Section 1861 (42 U.S.C. 1395x), as amended by
section 102(b), is amended by adding at the end the following:
`Medical Nutrition Therapy Services; Registered Dietitian or Nutrition
Professional
`(vv)(1) The term `medical nutrition therapy services' means
nutritional diagnostic, therapy, and counseling services for the
purpose of disease management which are furnished by a registered
dietitian or nutrition professional (as defined in paragraph (2))
pursuant to a referral by a physician (as defined in subsection
(r)(1)).
`(2) Subject to paragraph (3), the term `registered dietitian or
nutrition professional' means an individual who--
`(A) holds a baccalaureate or higher degree granted by a regionally
accredited college or university in the United States (or an
equivalent foreign degree) with completion of the academic
requirements of a program in nutrition or dietetics, as accredited by
an appropriate national accreditation organization recognized by the
Secretary for this purpose;
`(B) has completed at least 900 hours of supervised dietetics practice
under the supervision of a registered dietitian or nutrition
professional; and
`(C)(i) is licensed or certified as a dietitian or nutrition
professional by the State in which the services are performed; or
`(ii) in the case of an individual in a State that does not provide
for such licensure or certification, meets such other criteria as the
Secretary establishes.
`(3) Subparagraphs (A) and (B) of paragraph (2) shall not apply in the
case of an individual who, as of the date of the enactment of this
subsection, is licensed or certified as a dietitian or nutrition
professional by the State in which medical nutrition therapy services
are performed.'.
(c) PAYMENT- Section 1833(a)(1) (42 U.S.C. 1395l(a)(1)) is amended--
(1) by striking `and' before `(S)'; and
(2) by inserting before the semicolon at the end the following: `, and
(T) with respect to medical nutrition therapy services (as defined in
section 1861(vv)), the amount paid shall be 80 percent of the lesser
of the actual charge for the services or 85 percent of the amount
determined under the fee schedule established under section 1848(b)
for the same services if furnished by a physician'.
(d) APPLICATION OF LIMITS ON BILLING- Section 1842(b)(18)(C) (42
U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following
new clause:
`(vi) A registered dietitian or nutrition professional.'.
(e) EFFECTIVE DATE- The amendments made by this section shall apply to
services furnished on or after January 1, 2002.
(f) STUDY- Not later than July 1, 2003, the Secretary of Health and
Human Services shall submit to Congress a report that contains
recommendations with respect to the expansion to other medicare
beneficiary populations of the medical nutrition therapy services
benefit (furnished under the amendments made by this section).
Subtitle B--Other Beneficiary Improvements
SEC. 111. ACCELERATION OF REDUCTION OF BENEFICIARY COPAYMENT FOR
HOSPITAL OUTPATIENT DEPARTMENT SERVICES.
(a) REDUCING THE UPPER LIMIT ON BENEFICIARY COPAYMENT-
(1) IN GENERAL- Section 1833(t)(8)(C) (42 U.S.C. 1395l(t)(8)(C)) is
amended to read as follows:
`(C) LIMITATION ON COPAYMENT AMOUNT-
`(i) TO INPATIENT HOSPITAL DEDUCTIBLE AMOUNT- In no case shall the
copayment amount for a procedure performed in a year exceed the amount
of the inpatient hospital deductible established under section 1813(b)
for that year.
`(ii) TO SPECIFIED PERCENTAGE- The Secretary shall reduce the national
unadjusted copayment amount for a covered OPD service (or group of
such services) furnished in a year in a manner so that the effective
copayment rate (determined on a national unadjusted basis) for that
service in the year does not exceed the following percentage:
`(I) For procedures performed in 2001, on or after April 1, 2001, 57
percent.
`(II) For procedures performed in 2002 or 2003, 55 percent.
`(III) For procedures performed in 2004, 50 percent.
`(IV) For procedures performed in 2005, 45 percent.
`(V) For procedures performed in 2006 and thereafter, 40 percent.'.
(2) EFFECTIVE DATE- The amendment made by paragraph (1) shall apply
with respect to services furnished on or after April 1, 2001.
(b) CONSTRUCTION REGARDING LIMITING INCREASES IN COST-SHARING- Nothing
in this Act or the Social Security Act shall be construed as
preventing a hospital from waiving the amount of any coinsurance for
outpatient hospital services under the medicare program under title
XVIII of the Social Security Act that may have been increased as a
result of the implementation of the prospective payment system under
section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)).
(c) GAO STUDY OF REDUCTION IN MEDIGAP PREMIUM LEVELS RESULTING FROM
REDUCTIONS IN COINSURANCE- The Comptroller General of the United
States shall work, in concert with the National Association of
Insurance Commissioners, to evaluate the extent to which the premium
levels for medicare supplemental policies reflect the reductions in
coinsurance resulting from the amendment made by subsection (a). Not
later than April 1, 2004, the Comptroller General shall submit to
Congress a report on such evaluation and the extent to which the
reductions in beneficiary coinsurance effected by such amendment have
resulted in actual savings to medicare beneficiaries.
SEC. 112. PRESERVATION OF COVERAGE OF DRUGS AND BIOLOGICALS UNDER PART
B OF THE MEDICARE PROGRAM.
(a) IN GENERAL- Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is amended,
in each of subparagraphs (A) and (B), by striking `(including drugs
and biologicals which cannot, as determined in accordance with
regulations, be self-administered)' and inserting `(including drugs
and biologicals which are not usually self-administered by the
patient)'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply
to drugs and biologicals administered on or after the date of the
enactment of this Act.
SEC. 113. ELIMINATION OF TIME LIMITATION ON MEDICARE BENEFITS FOR
IMMUNOSUPPRESSIVE DRUGS.
(a) IN GENERAL- Section 1861(s)(2)(J) (42 U.S.C. 1395x(s)(2)(J)) is
amended by striking `, but only' and all that follows up to the
semicolon at the end.
(b) CONFORMING AMENDMENTS-
(1) EXTENDED COVERAGE- Section 1832 (42 U.S.C. 1395k) is amended--
(A) by striking subsection (b); and
(B) by redesignating subsection (c) as subsection (b).
(2) PASS-THROUGH; REPORT- Section 227 of BBRA is amended by striking
subsection (d).
(c) EFFECTIVE DATE- The amendment made by subsection (a) shall apply
to drugs furnished on or after the date of the enactment of this Act.
SEC. 114. IMPOSITION OF BILLING LIMITS ON DRUGS.
(a) IN GENERAL- Section 1842(o) (42 U.S.C. 1395u(o)) is amended by
adding at the end the following new paragraph:
`(3)(A) Payment for a charge for any drug or biological for which
payment may be made under this part may be made only on an
assignment-related basis.
`(B) The provisions of subsection (b)(18)(B) shall apply to charges
for such drugs or biologicals in the same manner as they apply to
services furnished by a practitioner described in subsection
(b)(18)(C).'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply
to items furnished on or after January 1, 2001.
SEC. 115. WAIVER OF 24-MONTH WAITING PERIOD FOR MEDICARE COVERAGE OF
INDIVIDUALS DISABLED WITH AMYOTROPHIC LATERAL SCLEROSIS (ALS).
(a) IN GENERAL- Section 226 (42 U.S.C. 426) is amended--
(1) by redesignating subsection (h) as subsection (j) and by moving
such subsection to the end of the section; and
(2) by inserting after subsection (g) the following new subsection:
`(h) For purposes of applying this section in the case of an
individual medically determined to have amyotrophic lateral sclerosis
(ALS), the following special rules apply:
`(1) Subsection (b) shall be applied as if there were no requirement
for any entitlement to benefits, or status, for a period longer than 1
month.
`(2) The entitlement under such subsection shall begin with the first
month (rather than twenty-fifth month) of entitlement or status.
`(3) Subsection (f) shall not be applied.'.
(b) CONFORMING AMENDMENT- Section 1837 (42 U.S.C. 1395p) is amended by
adding at the end the following new subsection:
`(j) In applying this section in the case of an individual who is
entitled to benefits under part A pursuant to the operation of section
226(h), the following special rules apply:
`(1) The initial enrollment period under subsection (d) shall begin on
the first day of the first month in which the individual satisfies the
requirement of section 1836(1).
`(2) In applying subsection (g)(1), the initial enrollment period
shall begin on the first day of the first month of entitlement to
disability insurance benefits referred to in such subsection.'.
(c) EFFECTIVE DATE- The amendments made by this section shall apply to
benefits for months beginning July 1, 2001.
Subtitle C--Demonstration Projects and Studies
SEC. 121. DEMONSTRATION PROJECT FOR DISEASE MANAGEMENT FOR SEVERELY
CHRONICALLY ILL MEDICARE BENEFICIARIES.
(a) IN GENERAL- The Secretary of Health and Human Services shall
conduct a demonstration project under this section (in this section
referred to as the `project') to demonstrate the impact on costs and
health outcomes of applying disease management to medicare
beneficiaries with diagnosed, advanced-stage congestive heart failure,
diabetes, or coronary heart disease. In no case may the number of
participants in the project exceed 30,000 at any time.
(b) VOLUNTARY PARTICIPATION-
(1) ELIGIBILITY- Medicare beneficiaries are eligible to participate in
the project only if--
(A) they meet specific medical criteria demonstrating the appropriate
diagnosis and the advanced nature of their disease;
(B) their physicians approve of participation in the project; and
(C) they are not enrolled in a Medicare+Choice plan.
(2) BENEFITS- A beneficiary who is enrolled in the project shall be
eligible--
(A) for disease management services related to their chronic health
condition; and
(B) for payment for all costs for prescription drugs without regard to
whether or not they relate to the chronic health condition, except
that the project may provide for modest cost-sharing with respect to
prescription drug coverage.
(c) CONTRACTS WITH DISEASE MANAGEMENT ORGANIZATIONS-
(1) IN GENERAL- The Secretary of Health and Human Services shall carry
out the project through contracts with up to three disease management
organizations. The Secretary shall not enter into such a contract with
an organization unless the organization demonstrates that it can
produce improved health outcomes and reduce aggregate medicare
expenditures consistent with paragraph (2).
(2) CONTRACT PROVISIONS- Under such contracts--
(A) such an organization shall be required to provide for prescription
drug coverage described in subsection (b)(2)(B);
(B) such an organization shall be paid a fee negotiated and
established by the Secretary in a manner so that (taking into account
savings in expenditures under parts A and B of the medicare program
under title XVIII of the Social Security Act) there will be a net
reduction in expenditures under the medicare program as a result of
the project; and
(C) such an organization shall guarantee, through an appropriate
arrangement with a reinsurance company or otherwise, the net reduction
in expenditures described in subparagraph (B).
(3) PAYMENTS- Payments to such organizations shall be made in
appropriate proportion from the Trust Funds established under title
XVIII of the Social Security Act. |
