II

106TH CONGRESS

1ST SESSION S. 1263

To amend the Balanced Budget Act of 1997 to limit the reductions in

medicare payments under the prospective payment system for hospital

outpatient department services.

IN THE SENATE OF THE UNITED STATES

JUNE 22, 1999

Mr. JEFFORDS (for himself, Mr. HATCH, and Mr. GORTON) introduced the

following bill; which was read twice and referred to the Committee on Finance

A BILL

To amend the Balanced Budget Act of 1997 to limit the

reductions in medicare payments under the prospective

payment system for hospital outpatient department services.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Hospital Outpatient

5 Preservation Act of 1999’’.
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1 SEC. 2. LIMITING REDUCTIONS IN MEDICARE PAYMENTS

2 UNDER PPS FOR HOSPITAL OUTPATIENT DE3 PARTMENT SERVICES.

4 (a) IN GENERAL.—Section 4523 of the Balanced

5 Budget Act of 1997 (Public Law 105–33; 111 Stat. 445)

6 is amended by adding at the end the following:

7 ‘‘(e) TEMPORARY LIMIT ON REDUCTIONS IN FED8 ERAL PAYMENTS.—

9 ‘‘(1) IN GENERAL.—Notwithstanding section

10 1833(t) of the Social Security Act (42 U.S.C.

11 1395l(t)) (as added by subsection (a)) the amount

12 that is paid from the Federal Supplementary Med13 ical Insurance Trust Fund for covered OPD services

14 furnished by a hospital during a calendar year (or

15 portion thereof) specified in paragraph (2)(A) may

16 not be less than the applicable percentage of the

17 case mix adjusted average amount that would have

18 been payable to such hospital for such services (in19 cluding cost sharing) if the prospective payment sys20 tem established under such section did not apply.

21 Such average amount may be determined on a pro22 spective basis using the Secretary’s best estimate of

23 the reasonable costs incurred in furnishing covered

24 OPD services or on a retrospective basis using cost

25 reports submitted by a hospital.
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1 ‘‘(2) DEFINITIONS.—For purposes of paragraph

2 (1)—

3 ‘‘(A) subject to paragraph (3), the term

4 ‘applicable percentage’ means—

5 ‘‘(i) with respect to covered OPD

6 services furnished during the first full cal7 endar year (and any portion of the imme8 diately preceding calendar year) for which

9 the prospective payment system established

10 under section 1833(t) of the Social Secu11 rity Act is in effect, 95 percent;

12 ‘‘(ii) with respect to the second full

13 calendar year for which such system is in

14 effect, 90 percent; and

15 ‘‘(iii) with respect to the third full cal16 endar year for which such system is in ef17 fect, 85 percent; and

18 ‘‘(B) the term ‘covered OPD services’ has

19 the meaning given to such term in section

20 1833(t)(1)(B) of the Social Security Act.

21 ‘‘(3) APPLICATION TO CERTAIN HOSPITALS.—In

22 the case of hospitals described in section 1833(t)(8)

23 of the Social Security Act, the ‘applicable percent24 age’ for a calendar year (or portion thereof) shall be

25 the same applicable percentage that applies to cov-
4

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1 ered OPD services furnished by hospitals that are

2 not described in such section during such calendar

3 year (or portion thereof).

4 ‘‘(4) RULE OF CONSTRUCTION.—Nothing in

5 this subsection shall be construed as affecting the

6 amount of cost sharing paid by individuals enrolled

7 under part B of title XVIII of the Social Security

8 Act for covered OPD services.’’.

9 (b) CONFORMING AMENDMENT.—Section

10 1833(t)(1)(A) of the Social Security Act (42 U.S.C.

11 1395l(t)(1)(A)) is amended by inserting ‘‘except as pro12 vided in section 4523(e) of the Balanced Budget Act of

13 1997,’’ after ‘‘1999,’’.

14 (c) EFFECTIVE DATE.—The amendments made by

15 this section shall become effective as if included in the en16 actment of the Balanced Budget Act of 1997.

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