I

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.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 SECTION 1. ESTABLISHMENT OF DEMONSTRATION

2 PROJECT ON MEDICARE REFERRAL RE3 PORTS.

4 (a) IN GENERAL.—Not later than January 1, 1995,

5 the Secretary of Health and Human Services (hereafter

6 in this Act referred to as the ‘‘Secretary’’) shall establish

7 a demonstration project under which, with respect to pro8 viders of physicians’ services for which payment may be

9 made under part B of title XVIII of the Social Security

10 Act within the designated area of the project, the Sec11 retary shall periodically furnish a medicare referral report

12 (as described in subsection (b)) to the provider on any in13 dividual entitled to benefits under such title to whom the

14 provider furnishes such services during the period the

15 project is in effect (subject to subsection (c)). The Sec16 retary shall furnish such reports upon the request of a

17 provider of physicians’ services under such title and at

18 such other times as the Secretary may consider appro19 priate.

20 (b) MEDICARE REFERRAL REPORT DESCRIBED.—

21 (1) IN GENERAL.—In this section, a ‘‘medicare

22 referral report’’ means, with respect to an individual,

23 a report (in such format as the Secretary may estab24 lish) containing the following information:

25 (A) Any item or service furnished to the

26 individual during the period the project is in ef-
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1 fect for which payment may be made under title

2 XVIII of the Social Security Act.

3 (B) The identity of the individual or entity

4 furnishing such item or service.

5 (C) The illness, injury, or condition (in6 cluding any applicable diagnostic code) on

7 which the furnishing of the item or service is

8 based.

9 (D) The amount of payment made for the

10 item or service under such title.

11 (E) The amount of charges submitted to

12 the Secretary with respect to the item or service

13 (if any) by the individual or entity furnishing

14 the item or service.

15 (2) FORMAT.—A medicare referral report shall

16 be provided in such electronic and printed formats

17 as the Secretary may establish, and shall be fur18 nished to a provider in the format the provider

19 specifies.

20 (c) PATIENT CONSENT REQUIRED.—

21 (1) IN GENERAL.—No medicare referral report

22 may be furnished under the project with respect to

23 information relating to any individual unless the in24 dividual has provided written consent to the Sec-
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1 retary (in such form as the Secretary may require)

2 for the reporting of such information.

3 (2) RENEWAL OF CONSENT.—The Secretary

4 may limit the period for which the consent provided

5 pursuant to paragraph (1) shall be effective and es6 tablish a process under which an individual may

7 renew the consent for an additional period.

8 (d) CONSULTATION REQUIREMENT.—In carrying out

9 this Act, including the selection of the areas in which the

10 demonstration project will be carried out, the development

11 of formats for medicare referral reports, and the provision

12 of orientation and training services under section 2, the

13 Secretary shall consult with representatives of primary

14 care and other health professionals, hospitals and nursing

15 homes, medicare beneficiaries, health maintenance organi16 zations and other managed care providers, and health data

17 collectors.

18 SEC. 2. ORIENTATION AND TRAINING ON USE OF REFER19 RAL REPORTS.

20 In carrying out the demonstration project established

21 under section 1, the Secretary shall provide orientation

22 and training services to assist providers of physicians’

23 services who are participating in the project in using the

24 medicare referral reports to effectively manage patient

25 care, including information regarding limitations on the
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1 usefulness of such reports in making clinical decisions or

2 evaluating the effectiveness of treatments.

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