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[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3907 Introduced in House (IH)]

103d CONGRESS
  2d Session
                                H. R. 3907

  To direct the Secretary of Health and Human Services to carry out a 
  demonstration project under which physicians providing services to 
   individuals entitled to benefits under the medicare program will 
 receive regular information on charges submitted by and payments made 
      to other providers who furnish services to such individuals.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           February 24, 1994

Mr. Kreidler introduced the following bill; which was referred jointly 
      to the Committees on Ways and Means and Energy and Commerce

_______________________________________________________________________

                                 A BILL

 
  To direct the Secretary of Health and Human Services to carry out a 
  demonstration project under which physicians providing services to 
   individuals entitled to benefits under the medicare program will 
 receive regular information on charges submitted by and payments made 
      to other providers who furnish services to such individuals.

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

SECTION 1. ESTABLISHMENT OF DEMONSTRATION PROJECT ON MEDICARE REFERRAL 
              REPORTS.

    (a) In General.--Not later than January 1, 1995, the Secretary of 
Health and Human Services (hereafter in this Act referred to as the 
``Secretary'') shall establish a demonstration project under which, 
with respect to providers of physicians' services for which payment may 
be made under part B of title XVIII of the Social Security Act within 
the designated area of the project, the Secretary shall periodically 
furnish a medicare referral report (as described in subsection (b)) to 
the provider on any individual entitled to benefits under such title to 
whom the provider furnishes such services during the period the project 
is in effect (subject to subsection (c)). The Secretary shall furnish 
such reports upon the request of a provider of physicians' services 
under such title and at such other times as the Secretary may consider 
appropriate.
    (b) Medicare Referral Report Described.--
            (1) In general.--In this section, a ``medicare referral 
        report'' means, with respect to an individual, a report (in 
        such format as the Secretary may establish) containing the 
        following information:
                    (A) Any item or service furnished to the individual 
                during the period the project is in effect for which 
                payment may be made under title XVIII of the Social 
                Security Act.
                    (B) The identity of the individual or entity 
                furnishing such item or service.
                    (C) The illness, injury, or condition (including 
                any applicable diagnostic code) on which the furnishing 
                of the item or service is based.
                    (D) The amount of payment made for the item or 
                service under such title.
                    (E) The amount of charges submitted to the 
                Secretary with respect to the item or service (if any) 
                by the individual or entity furnishing the item or 
                service.
            (2) Format.--A medicare referral report shall be provided 
        in such electronic and printed formats as the Secretary may 
        establish, and shall be furnished to a provider in the format 
        the provider specifies.
    (c) Patient Consent Required.--
            (1) In general.--No medicare referral report may be 
        furnished under the project with respect to information 
        relating to any individual unless the individual has provided 
        written consent to the Secretary (in such form as the Secretary 
        may require) for the reporting of such information.
            (2) Renewal of consent.--The Secretary may limit the period 
        for which the consent provided pursuant to paragraph (1) shall 
        be effective and establish a process under which an individual 
        may renew the consent for an additional period.
    (d) Consultation Requirement.--In carrying out this Act, including 
the selection of the areas in which the demonstration project will be 
carried out, the development of formats for medicare referral reports, 
and the provision of orientation and training services under section 2, 
the Secretary shall consult with representatives of primary care and 
other health professionals, hospitals and nursing homes, medicare 
beneficiaries, health maintenance organizations and other managed care 
providers, and health data collectors.

SEC. 2. ORIENTATION AND TRAINING ON USE OF REFERRAL REPORTS.

    In carrying out the demonstration project established under section 
1, the Secretary shall provide orientation and training services to 
assist providers of physicians' services who are participating in the 
project in using the medicare referral reports to effectively manage 
patient care, including information regarding limitations on the 
usefulness of such reports in making clinical decisions or evaluating 
the effectiveness of treatments.

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