II

105TH CONGRESS

2D SESSION S. 1580

To amend the Balanced Budget Act of 1997 to place an 18-month moratorium on the prohibition of payment under the medicare program for

home health services consisting of venipuncture solely for the purpose

of obtaining a blood sample, and to require the Secretary of Health

and Human Services to study potential fraud and abuse under such

program with respect to such services.

IN THE SENATE OF THE UNITED STATES

JANUARY 28, 1998

Mr. SHELBY 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 place an

18-month moratorium on the prohibition of payment

under the medicare program for home health services

consisting of venipuncture solely for the purpose of obtaining a blood sample, and to require the Secretary

of Health and Human Services to study potential fraud

and abuse under such program with respect to such

services.

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. SHORT TITLE.

2 This Act may be cited as the ‘‘Medicare Venipuncture

3 Assessment Act of 1998’’.

4 SEC. 2. 18-MONTH MORATORIUM ON PROHIBITION ON PAY5 MENT FOR HOME HEALTH SERVICES SOLELY

6 FOR PURPOSES OF OBTAINING A BLOOD SAM7 PLE; REPORT.

8 (a) MORATORIUM.—Section 4615(b) of the Balanced

9 Budget Act of 1997 (Public Law 105–33; 111 Stat. 475)

10 is amended to read as follows:

11 ‘‘(b) EFFECTIVE DATE.—

12 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

13 the amendments made by subsection (a) apply to

14 home health services furnished after the 6-month pe15 riod beginning after the date of enactment of this

16 Act.

17 ‘‘(2) 18-MONTH MORATORIUM.—During the pe18 riod that begins on the date of enactment of the

19 Medicare Venipuncture Assessment Act of 1998 and

20 ends on the date that is 18 months after the date

21 of enactment of that Act, the amendments made by

22 subsection (a) shall not apply to home health serv23 ices furnished during that period. For purposes of

24 calculating the 6-month period described in sub25 section (a), any month (including any portion there26 of) in which the period described in this paragraph
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1 is in effect shall not be included in such calcula2 tion.’’.

3 (b) REPORT TO CONGRESS.—The Balanced Budget

4 Act of 1997 (Public Law 105–33; 111 Stat. 251 et seq.)

5 is amended by inserting after section 4615 the following:

6 ‘‘SEC. 4615A. REPORT TO CONGRESS ON HOME HEALTH

7 BENEFITS BASED SOLELY ON DRAWING

8 BLOOD.

9 ‘‘(a) STUDY.—The Secretary of Health and Human

10 Services shall conduct a study with respect to the provision

11 of home health services consisting of venipuncture under

12 title XVIII of the Social Security Act. In conducting such

13 study, the Secretary, using the most recent data available,

14 shall—

15 ‘‘(1) determine the number of beneficiaries who

16 are provided home health services under the medi17 care program;

18 ‘‘(2) determine the number of beneficiaries who

19 receive such services consisting of venipuncture;

20 ‘‘(3) compare the instances (including the costs)

21 in which the only home health service provided in a

22 home health visit is venipuncture solely for the pur23 poses of obtaining a blood sample and those in24 stances in which venipuncture is provided in such a
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1 visit in conjunction with the provision of other home

2 health services;

3 ‘‘(4) in the case of beneficiaries who qualify for

4 home health services because venipuncture solely for

5 the purposes of obtaining a blood sample is a quali6 fying skill, compare the instances (including the

7 costs) in which the only home health service pro8 vided in a home health visit is venipuncture solely

9 for the purposes of obtaining a blood sample and

10 those instances in which no venipuncture is provided

11 in such a visit;

12 ‘‘(5) determine the costs of providing payment

13 for home health services consisting of venipuncture

14 solely for the purpose of obtaining a blood sample,

15 including in such determination an analysis of the

16 increase in such costs that are attributable to fraud

17 and abuse in the provision of, or billing for, such

18 services under the medicare program;

19 ‘‘(6) determine—

20 ‘‘(A) the costs to beneficiaries if payment

21 under the medicare program is prohibited for

22 home health services consisting of venipuncture

23 solely for the purposes of obtaining a blood

24 sample, and
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1 ‘‘(B) the costs to States through poten2 tially increased use of personal care services

3 and nursing home placements if payment under

4 the medicare program is prohibited for home

5 health services consisting of venipuncture solely

6 for the purposes of obtaining a blood sample;

7 ‘‘(7) determine the number of beneficiaries that

8 will no longer be eligible for home health services be9 cause venipuncture solely for the purpose of obtain10 ing a blood sample is no longer treated as a qualify11 ing skill;

12 ‘‘(8) with respect to the beneficiaries deter13 mined under paragraph (7), determine the number

14 of such beneficiaries that subsequently receive home

15 health benefits because they qualify for such services

16 by reason of a qualifying skill other than

17 venipuncture solely for the purpose of obtaining a

18 blood sample; and

19 ‘‘(9) with respect to the beneficiaries deter20 mined under paragraph (7), particularly those that

21 reside in a rural area, determine the number of such

22 beneficiaries that subsequently—

23 ‘‘(A) are ineligible to receive home health

24 services under this title because they do not

25 qualify for such services by reason of a qualify-
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1 ing skill other than venipuncture solely for the

2 purpose of obtaining a blood sample; but

3 ‘‘(B) become eligible for venipuncture serv4 ices under part B of this title.

5 ‘‘(b) REPORT.—Not later than 1 year after the date

6 of enactment of the Medicare Venipuncture Assessment

7 Act of 1998, the Secretary shall submit to Congress a re8 port consisting of the findings of the study conducted

9 under subsection (a).’’.

10 (c) ADDITIONAL REQUIREMENTS FOR REPORT ON

11 DEFINITION OF HOMEBOUND.—Section 4613(b) of the

12 Balanced Budget Act of 1997 (Public Law 105–33; 111

13 Stat. 474) is amended by adding at the end the following:

14 ‘‘The report shall also include specific legislative rec15 ommendations to reduce waste, fraud, and abuse (if any)

16 in the determination of whether an individual is home17 bound without jeopardizing the services provided under

18 title XVIII of the Social Security Act to beneficiaries that

19 have serious medical conditions.’’.

20 (d) CLERICAL AMENDMENT.—The table of contents

21 of title IV of the Balanced Budget Act of 1998 (Public

22 Law 105–33; 111 Stat. 270 et seq.) is amended by insert23 ing after the item relating to section 4615 the following:

‘‘Sec. 4615A. Report to Congress on home health benefits based solely on drawing blood.’’.
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1 (e) EFFECTIVE DATE.—The amendments made by

2 this section take effect as if included in the enactment of

3 the Balanced Budget Act of 1997 (Public Law 105–33;

4 111 Stat. 251 et seq.).

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