I

106TH CONGRESS

2D SESSION H. R. 5209

To amend title XVIII of the Social Security Act to revise the payments

for certain physician pathology services under the medicare program.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 19, 2000

Mr. FOLEY (for himself and Mr. TANNER) introduced the following bill; which

was referred to the Committee on Ways and Means, and in addition to

the Committee on Commerce, 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 revise

the payments for certain physician pathology services

under the medicare program.

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 ‘‘Physician Pathology

5 Services Fair Payment Act of 2000’’.
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1 SEC. 2. TREATMENT OF CERTAIN PHYSICIAN PATHOLOGY

2 SERVICES UNDER MEDICARE.

3 (a) IN GENERAL.—Notwithstanding any other provi4 sion of law, when an independent laboratory, under a

5 grandfathered arrangement with a hospital, furnishes the

6 technical component of a physician pathology service with

7 respect to—

8 (1) an inpatient fee-for-service medicare bene9 ficiary, such component shall be treated as a service

10 for which payment shall be made to the laboratory

11 under section 1848 of the Social Security Act (42

12 U.S.C. 1395w–4) and not as an inpatient hospital

13 service for which payment is made to the hospital

14 under section 1886(d) of such Act (42 U.S.C.

15 1395ww(d)); and

16 (2) an outpatient fee-for-service medicare bene17 ficiary, such component shall be treated as a service

18 for which payment shall be made to the laboratory

19 under section 1848 of such Act (42 U.S.C. 1395w–

20 4) and not as a hospital outpatient service for which

21 payment is made to the hospital under the prospec22 tive payment system under section 1834(t) of such

23 Act (42 U.S.C. 1395l(d)).

24 (b) DEFINITIONS.—For purposes of this section:

25 (1) GRANDFATHERED ARRANGEMENT.—The

26 term ‘‘grandfathered arrangement’’ means an ar-
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1 rangement between an independent laboratory and a

2 hospital—

3 (A) that was in effect as of July 22, 1999,

4 even if such arrangement is subsequently re5 newed; and

6 (B) under which the laboratory furnishes

7 the technical component of physician pathology

8 services with respect to patients of the hospital

9 and submits a claim for payment for such com10 ponent to a medicare carrier (and not to the

11 hospital).

12 (2) INPATIENT FEE-FOR-SERVICE MEDICARE

13 BENEFICIARY.—The term ‘‘inpatient fee-for-service

14 medicare beneficiary’’ means an individual who—

15 (A) is an inpatient of the hospital involved;

16 (B) is entitled to benefits under part A of

17 title XVIII of the Social Security Act (42

18 U.S.C. 1395c et seq.); and

19 (C) is not enrolled in—

20 (i) a Medicare+Choice plan under

21 part C of such Act (42 U.S.C. 1395w–21

22 et seq.);

23 (ii) a plan offered by an eligible orga24 nization under section 1876 of such Act

25 (42 U.S.C. 1395mm); or
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1 (iii) a medicare managed care dem2 onstration project.

3 (3) OUTPATIENT FEE-FOR-SERVICE MEDICARE

4 BENEFICIARY.—The term ‘‘outpatient fee-for-service

5 medicare beneficiary’’ means an individual who—

6 (A) is an outpatient of the hospital in7 volved;

8 (B) is enrolled under part B of title XVIII

9 of the Social Security Act (42 U.S.C. 1395j et

10 seq.); and

11 (C) is not enrolled in—

12 (i) a plan or project described in para13 graph (2)(C); or

14 (ii) a health care prepayment plan

15 under section 1833(a)(1)(A) of such Act

16 (42 U.S.C. 1395l(a)(1)(A)).

17 (4) MEDICARE CARRIER.—The term ‘‘medicare

18 carrier’’ means an organization with a contract

19 under section 1842 of the Social Security Act (42

20 U.S.C. 1395u).

21 (c) EFFECTIVE DATE.—This section shall apply to

22 services furnished on or after July 22, 1999.

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