A bill to amend title XVIII of the Social Security Act to provide certain Medicare beneficiaries with an exemption to the financial limitations imposed on physical, speech-language pathology, and occupational therapy services under part B of the Medicare

4 Pages·1999·0.17 MB·English

by  United States. Congress. House

I
106t1shtcSoenssgiroenss H. R. 1736
ToamendtitleXVIIIoftheSocialSeeurit\'ActtoprovidecertainMedicare
beneficiaries-with anexemptiontothefinancial limitationsimposedon
physical, speech-language pathology, and occupational therapy services
underpart B ofthe Medicare Program, and to provide for a system
' tovarythose limitationsusingaclassification ofindividualsbased on
diagnosticcategoryandprioruseofservices.
IN THE HOUSE OF REPRESENTATIVES
May6,1999
Mr.Starkintroducedthefollowingbill;whichwasreferredtotheCommittee
onCommerce, and in additiontothe CommitteeonWaysand Means,
foraperiodtobesubsequentlydeterminedbytheSpeaker,ineachcase
forconsiderationofsuchprovisionsasfallwithinthejurisdictionofthe
committeeconcerned
A
BILL
To amend title XVIII ofthe Social SecurityAct to provide
certain Medicare beneficiaries with an exemption to the
financial limitations imposed on physical, speech-lan-
guagepathology, andoccupationaltherapyservicesunder
part B of the Medicare Program, and to provide for
a system to varythose limitations using a classification
of individuals based on diagnostic category and prior
useofservices.
1 BeitenactediytheSenateandHouseofRepresenta-
2 tivesoftheUnitedStatesofAmericainCongressassembled,
1 SECTION1.SHORTTITLE.
2 ThisActmaybe cited asthe "Medicare Rehabihta-
3 tionBenefitEquityActof1999".
4 SEC.2.ESTABLISHMENTOFEXEMPTIONTOCAPONPHYS-
5 ICAL, SPEECH-LANGUAGE PATHOLOGY, AND
6 OCCUPATIONALTHERAPYSERVICES.
7 (a) InGeneral.—Section 1833(g) ofthe SocialSe-
8 curityAct(42 U.S.C. 13951(g)) isamendedbyaddingat
9 theendthefollowing:
10 "(4)(A) For services furnished on or after the date
11 ofthe enactment ofthis paragraph and before January
12 1, 2002,theHmitationsinthis subsectionshallnotapply
13 toanindividualdescribedinsubparagraph(B).
14 "(B)Anindividualdescribedinthissubparagraphis
15 anindividualthatmeetsanyofthefollowingcriteria:
16 "(i) The individual has received services de-
17 scribed in paragraph (1) or (3) in a calendar year
18 and is subsequently diagnosed with an illness, in-
19 jury, ordisabilitythatrequirestheprovisioninsuch
20 year of additional such services that are medically
21 necessary.
22 "(ii) The individual has a diagnosis that re-
23 quires the provision of services described in para-
24 graph (1) or(3) andanadditionaldiagnosisorinci-
25 dent that exacerbates the individual's condition,
-HR1736ra
1 thereby requiring the provision of additional such
2 services.
3 "(iii) The individualwill require hospitalization
4 if the individual does not receive the services de-
5 scribedinparagraph(1)or(3).
6 "(iv) The individual meets other criteria that
7 theSecretarydeterminesareappropriate.
8 "(C)Nothinginthisparagraphshallbeconstruedas
9 affectinganyrequirement for, or limitation on, payment
10 underthistitle (otherthanthefinanciallimitationunder
11 thissubsection).
12 "(D) Anyservice that is coveredunderthis titleby
13 reasonofthisparagraphshallbesubjecttothesamerea-
14 sonable and necessary requirement under section
15 1862(a)(1) that is applicabletothe services describedin
16 paragraph(1)or(3)thatarecoveredunderthistitlewith-
17 outregardtothisparagraph.".
—
18 (b) Conforming Amendments. Paragraphs (1)
19 and (3) of section 1833(g) of such Act (42 U.S.C.
20 13951(g))areeachamendedbystriking"Inthecase"and
21 inserting"Subjecttoparagraph(4),inthecase".
•HR1736IH
ensUIBRflRV
3 flOTS ODDlEHflS 5
1 SEC.3.ESTABLISHMENTOFVARIABLEDURATIONALLIMI-
2 TATIONBASEDONDIAGNOSTICCATEGORIES
3 ANDPRIORUSEOFSERVICES.
—
4 (a) In General. Subpara^aph (B) of section
5 1833(g)(2) of the Social Security Act (42 U.S.C.
6 13951(g)(2))isamendedtoreadasfollows:
7 ''(B) forasubsequentyearisanamountspeci-
8 fiedbytheSecretarypursuanttoasystemwhiches-
9 tablishesdifferenthmitations (butnotdifferentpay-
10 mentratesorfeeschedules)basedonaclassification
11 ofindividualsbydiagnostic categoryand severityof
12 diagnosis, in both inpatient and outpatient set-
13 tings.".
—
14 (b) Budget-Neutral Implementation. The
15 Secretarj^ ofHealth and Human Services shall establish
16 the different limitations under section 1833(g)(2)(B) of
17 the Social SecurityAct, asamendedbysubsection (a),in
18 amannerso thatthe aggregate expendituresundersuch
19 limitationsunderpartBoftitleXVIIIofsuchActisthe
20 sameastheaggregateexpendituresthatwouldhavebeen
21 madeundersuchpartifthissectionhasnotbeenenacted.
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