II 

110TH CONGRESS 

1ST SESSION S. 458 

To amend title XVIII of the Social Security Act to provide for the treatment 

of certain physician pathology services under the Medicare program. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 31, 2007 

Mrs. LINCOLN (for herself, Mr. THOMAS, and Mr. PRYOR) 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 provide 

for the treatment of 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 Continuity Act of 2007’’. 

6 SEC. 2. PERMANENT TREATMENT OF CERTAIN PHYSICIAN 

7 PATHOLOGY SERVICES UNDER MEDICARE. 

8 Section 1848(i) of the Social Security Act (42 U.S.C. 

9 1395w–4(i)) is amended by adding at the end the fol10 lowing new paragraph: 


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1 ‘‘(4) TREATMENT OF CERTAIN PHYSICIAN PA2 THOLOGY SERVICES.— 

3 ‘‘(A) IN GENERAL.—With respect to serv4 ices furnished on or after January 1, 2008, if 

5 an independent laboratory furnishes the tech6 nical component of a physician pathology serv7 ice to a fee-for-service medicare beneficiary who 

8 is an inpatient or outpatient of a covered hos9 pital, the Secretary shall treat such component 

10 as a service for which payment shall be made 

11 to the laboratory under this section and not as 

12 an inpatient hospital service for which payment 

13 is made to the hospital under section 1886(d) 

14 or as a hospital outpatient service for which 

15 payment is made to the hospital under section 

16 1833(t). 

17 ‘‘(B) DEFINITIONS.—In this paragraph: 

18 ‘‘(i) COVERED HOSPITAL.— 

19 ‘‘(I) IN GENERAL.—The term 

20 ‘covered hospital’ means, with respect 

21 to an inpatient or outpatient, a hos22 pital that had an arrangement with 

23 an independent laboratory that was in 

24 effect as of July 22, 1999, under 

25 which a laboratory furnished the techVerDate Aug 31 2005 19:49 Feb 05, 2007 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S458.IS S458

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1 nical component of physician pathol2 ogy services to fee-for-service medi3 care beneficiaries who were hospital 

4 inpatients or outpatients, respectively, 

5 and submitted claims for payment for 

6 such component to a carrier with a 

7 contract under section 1842 and not 

8 to the hospital. 

9 ‘‘(II) CHANGE IN OWNERSHIP

10 DOES NOT AFFECT DETERMINA11 TION.—A change in ownership with 

12 respect to a hospital on or after the 

13 date referred to in subclause (I) shall 

14 not affect the determination of wheth15 er such hospital is a covered hospital 

16 for purposes of such subclause. 

17 ‘‘(ii) FEE-FOR-SERVICE MEDICARE

18 BENEFICIARY.—The term ‘fee-for-service 

19 medicare beneficiary’ means an individual 

20 who is entitled to (or enrolled for) benefits 

21 under part A, or enrolled under this part, 

22 or both, but who is not enrolled in any of 

23 the following: 

24 ‘‘(I) A Medicare Advantage plan 

25 under part C. 


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1 ‘‘(II) A plan offered by an eligi2 ble organization under section 1876. 

3 ‘‘(III) A program of all-inclusive 

4 care for the elderly (PACE) under 

5 section 1894. 

6 ‘‘(IV) A social health mainte7 nance organization (SHMO) dem8 onstration project established under 

9 section 4018(b) of the Omnibus 

10 Budget Reconciliation Act of 1987 

11 (Public Law 100–203). 

12 ‘‘(C) REFERENCE.—For the treatment of 

13 certain physician pathology services furnished 

14 prior to January 1, 2008, see section 542 of the 

15 Medicare, Medicaid, and SCHIP Benefits Im16 provement and Protection Act of 2000, as ex17 tended by— 

18 ‘‘(i) Centers for Medicare & Medicaid 

19 Services (CMS) Program Memorandum for 

20 Carriers (transmittal B–03–001), issued 

21 January 17, 2003; 

22 ‘‘(ii) CMS Manual System, Publica23 tion 100–20 One-Time Notification (trans24 mittal 34), issued December 24, 2003; 


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1 ‘‘(iii) section 732 of the Medicare Pre2 scription Drug, Improvement, and Mod3 ernization Act of 2003; and 

4 ‘‘(iv) section 104 of division B of the 

5 Tax Relief and Health Care Act of 2006.’’. 

Æ 


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