I

106TH CONGRESS

1ST SESSION H. R. 1736

To amend title XVIII of the Social Security Act to provide certain Medicare

beneficiaries with an exemption to the financial limitations imposed on

physical, speech-language pathology, and occupational therapy services

under part B of the Medicare Program, and to provide for a system

to vary those limitations using a classification of individuals based on

diagnostic category and prior use of services.

IN THE HOUSE OF REPRESENTATIVES

MAY 6, 1999

Mr. STARK introduced the following bill; which was referred to the Committee

on Commerce, and in addition to the Committee on Ways and Means,

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 provide

certain Medicare beneficiaries with an exemption to the

financial limitations imposed on physical, speech-language pathology, and occupational therapy services under

part B of the Medicare Program, and to provide for

a system to vary those limitations using a classification

of individuals based on diagnostic category and prior

use of 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 Rehabilita3 tion Benefit Equity Act of 1999’’.

4 SEC. 2. ESTABLISHMENT OF EXEMPTION TO CAP ON PHYS5 ICAL, SPEECH-LANGUAGE PATHOLOGY, AND

6 OCCUPATIONAL THERAPY SERVICES.

7 (a) IN GENERAL.—Section 1833(g) of the Social Se8 curity Act (42 U.S.C. 1395l(g)) is amended by adding at

9 the end the following:

10 ‘‘(4)(A) For services furnished on or after the date

11 of the enactment of this paragraph and before January

12 1, 2002, the limitations in this subsection shall not apply

13 to an individual described in subparagraph (B).

14 ‘‘(B) An individual described in this subparagraph is

15 an individual that meets any of the following criteria:

16 ‘‘(i) The individual has received services de17 scribed in paragraph (1) or (3) in a calendar year

18 and is subsequently diagnosed with an illness, in19 jury, or disability that requires the provision in such

20 year of additional such services that are medically

21 necessary.

22 ‘‘(ii) The individual has a diagnosis that re23 quires the provision of services described in para24 graph (1) or (3) and an additional diagnosis or inci25 dent that exacerbates the individual’s condition,
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1 thereby requiring the provision of additional such

2 services.

3 ‘‘(iii) The individual will require hospitalization

4 if the individual does not receive the services de5 scribed in paragraph (1) or (3).

6 ‘‘(iv) The individual meets other criteria that

7 the Secretary determines are appropriate.

8 ‘‘(C) Nothing in this paragraph shall be construed as

9 affecting any requirement for, or limitation on, payment

10 under this title (other than the financial limitation under

11 this subsection).

12 ‘‘(D) Any service that is covered under this title by

13 reason of this paragraph shall be subject to the same rea14 sonable and necessary requirement under section

15 1862(a)(1) that is applicable to the services described in

16 paragraph (1) or (3) that are covered under this title with17 out regard to this paragraph.’’.

18 (b) CONFORMING AMENDMENTS.—Paragraphs (1)

19 and (3) of section 1833(g) of such Act (42 U.S.C.

20 1395l(g)) are each amended by striking ‘‘In the case’’ and

21 inserting ‘‘Subject to paragraph (4), in the case’’.
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1 SEC. 3. ESTABLISHMENT OF VARIABLE DURATIONAL LIMI2 TATION BASED ON DIAGNOSTIC CATEGORIES

3 AND PRIOR USE OF SERVICES.

4 (a) IN GENERAL.—Subparagraph (B) of section

5 1833(g)(2) of the Social Security Act (42 U.S.C.

6 1395l(g)(2)) is amended to read as follows:

7 ‘‘(B) for a subsequent year is an amount speci8 fied by the Secretary pursuant to a system which es9 tablishes different limitations (but not different pay10 ment rates or fee schedules) based on a classification

11 of individuals by diagnostic category and severity of

12 diagnosis, in both inpatient and outpatient set13 tings.’’.

14 (b) BUDGET-NEUTRAL IMPLEMENTATION.—The

15 Secretary of Health and Human Services shall establish

16 the different limitations under section 1833(g)(2)(B) of

17 the Social Security Act, as amended by subsection (a), in

18 a manner so that the aggregate expenditures under such

19 limitations under part B of title XVIII of such Act is the

20 same as the aggregate expenditures that would have been

21 made under such part if this section has not been enacted.

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