I

104TH CONGRESS

2D SESSION H. R. 4248

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

under part B of the Medicare program of certain antibiotics that are

parenterally administered in a home setting.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 27, 1996

Ms. GREENE of Utah 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

for coverage under part B of the Medicare program

of certain antibiotics that are parenterally administered

in a home setting.

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 ‘‘Medicare Antibiotic

5 Coverage Amendments of 1996’’.
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1 SEC. 2. MEDICARE COVERAGE OF CERTAIN PARENTERALLY

2 ADMINISTERED ANTIBIOTICS.

3 (a) IN GENERAL.—Section 1861(s)(2) of the Social

4 Security Act (42 U.S.C. 1395x(s)(2)) is amended—

5 (1) by striking ‘‘and’’ at the end of subpara6 graphs (N) and (O);

7 (2) by redesignating subparagraph (Q) as sub8 paragraph (P), and by adding ‘‘and’’ at the end of

9 such subparagraph; and

10 (3) by adding at the end the following:

11 ‘‘(Q) an antibiotic described in section 1834(k)

12 that is administered parenterally in the patient’s

13 home (including an institution used as his home

14 other than an institution that meets the require15 ments of section 1861(e)(1) of this section or section

16 1819(a)(1));’’.

17 (b) ANTIBIOTICS DESCRIBED.—Section 1834 of such

18 Act (42 U.S.C. 1395m) is amended by adding at the end

19 the following:

20 ‘‘(k) For purposes of section 1861(s)(2)(Q), an anti21 biotic described in this subsection is an antibiotic that can

22 only be administered parenterally and that is being admin23 istered to treat osteomyelitis, infected joint replacements,

24 endocarditis, or a soft tissue infection.’’.
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1 (c) LIMITATION ON COVERAGE OF VANCOMYCIN.—

2 Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is

3 amended—

4 (1) by striking ‘‘or’’ at the end of paragraph

5 (14),

6 (2) by striking the period at the end of para7 graph (15) and inserting ‘‘; or’’, and

8 (3) by inserting after paragraph (15) the fol9 lowing new paragraph:

10 ‘‘(16) where such expenses are for the use of

11 Vancomycin under section 1861(s)(2)(Q) unless such

12 use is in accordance with guidelines established by

13 the Centers for Disease Control and Prevention for

14 the prudent use of such antibiotic.’’.

15 (d) REDUCTION IN HOSPITAL UPDATE FOR IN16 CREASES IN PAYMENTS.—Section 1886(d)(3)(C) of such

17 Act (42 U.S.C. 1395ww(d)(3)(C)) is amended by adding

18 at the end the following new clause:

19 ‘‘(iii) MAINTAINING BUDGET NEUTRALITY FOR

20 COVERAGE OF CERTAIN ANTIBIOTICS.—For dis21 charges occurring in a fiscal year (beginning with

22 fiscal year 1998), the Secretary shall adjust each of

23 such average standardized amounts so as to provide

24 for a reduction in the total amount of the payments

25 (attributable to this paragraph) made for such dis-
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1 charges by the amount (if any) by which net pay2 ments under this title for the previous fiscal year

3 (not taking into account this clause) were increased

4 as a result of the amendments made by the Medi5 care Antibiotic Coverage Amendments of 1996.’’.

6 (e) EFFECTIVE DATE.—The amendments made by

7 this section shall apply to drugs administered on or after

8 April 1, 1998.

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