II

106TH CONGRESS

2D SESSION S. 3055

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

for certain physician pathology services under the medicare program.

IN THE SENATE OF THE UNITED STATES

SEPTEMBER 14, 2000

Mr. JOHNSON (for himself and Mr. HUTCHINSON) introduced the following

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

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’’.

6 SEC. 2. TREATMENT OF CERTAIN PHYSICIAN PATHOLOGY

7 SERVICES UNDER MEDICARE.

8 (a) IN GENERAL.—Notwithstanding any other provi9 sion of law, when an independent laboratory, under a

10 grandfathered arrangement with a hospital, furnishes the
2

•S 3055 IS

1 technical component of a physician pathology service with

2 respect to—

3 (1) an inpatient fee-for-service medicare bene4 ficiary, such component shall be treated as a service

5 for which payment shall be made to the laboratory

6 under section 1848 of the Social Security Act (42

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

8 service for which payment is made to the hospital

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

10 1395ww(d)); and

11 (2) an outpatient fee-for-service medicare bene12 ficiary, such component shall be treated as a service

13 for which payment shall be made to the laboratory

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

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

16 payment is made to the hospital under the prospec17 tive payment system under section 1834(t) of such

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

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

20 (1) GRANDFATHERED ARRANGEMENT.—The

21 term ‘‘grandfathered arrangement’’ means an ar22 rangement between an independent laboratory and a

23 hospital—
3

•S 3055 IS

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

2 even if such arrangement is subsequently re3 newed; and

4 (B) under which the laboratory furnishes

5 the technical component of physician pathology

6 services with respect to patients of the hospital

7 and submits a claim for payment for such com8 ponent to a medicare carrier (and not to the

9 hospital).

10 (2) INPATIENT FEE-FOR-SERVICE MEDICARE

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

12 medicare beneficiary’’ means an individual who—

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

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

15 title XVIII of the Social Security Act (42

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

17 (C) is not enrolled in—

18 (i) a Medicare+Choice plan under

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

20 et seq.);

21 (ii) a plan offered by an eligible orga22 nization under section 1876 of such Act

23 (42 U.S.C. 1395mm); or

24 (iii) a medicare managed care dem25 onstration project.
4

•S 3055 IS

1 (3) OUTPATIENT FEE-FOR-SERVICE MEDICARE

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

3 medicare beneficiary’’ means an individual who—

4 (A) is an outpatient of the hospital in5 volved;

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

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

8 seq.); and

9 (C) is not enrolled in—

10 (i) a plan or project described in para11 graph (2)(C); or

12 (ii) a health care prepayment plan

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

14 (42 U.S.C. 1395l(a)(1)(A)).

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

16 carrier’’ means an organization with a contract

17 under section 1842 of the Social Security Act (42

18 U.S.C. 1395u).

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

20 services furnished on or after July 22, 1999.

Æ