I

104TH CONGRESS

2D SESSION H. R. 4190

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

of outpatient parenteral antimicrobial therapy under the Medicare program.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 25, 1996

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

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

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 of outpatient parenteral antimicrobial therapy 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 ‘‘Medicare Coverage of

5 Infectious Diseases Therapy Act of 1996’’.
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1 SEC. 2. REPORT TO CONGRESS ON COVERAGE OF OUT2 PATIENT PARENTERAL THERAPY UNDER THE

3 MEDICARE PROGRAM.

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

5 Services shall conduct a study of coverage and payment

6 for parenteral antimicrobial therapy, drugs, and services

7 under the Medicare program. Such study shall include an

8 analysis of—

9 (1) the cost of providing coverage under the

10 Medicare program for outpatient parenteral

11 antimicrobial therapy, drugs, and services;

12 (2) any savings to the Medicare program gen13 erated by the replacement of inpatient parenteral

14 antimicrobial therapy by such outpatient therapy,

15 drugs and services;

16 (3) whether payments under part A of the Med17 icare program for operating costs for inpatient hos18 pital services may be reduced if a Medicare bene19 ficiary is provided parenteral antimicrobial therapy

20 services on an outpatient basis, including an analysis

21 of payments for services under the diagnosis-related

22 groups for endocarditis, osteomyelitis, prosthetic

23 joint infections (status post prosthesis removal), and

24 liver abscess, and other relevant diagnosis-related

25 groups; and
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1 (4) how payment for such outpatient therapy,

2 drugs and services should be made to ensure maxi3 mum cost-savings to the Medicare program.

4 (b) REPORT.—Not later than 6 months after the date

5 of the enactment of this Act, the Secretary shall submit

6 a report to the Congress on the study under subsection

7 (a) and shall include in the report such recommendations

8 with respect to coverage and payment of outpatient paren9 teral antimicrobial therapy, drugs, and services under the

10 Medicare program as the Secretary deems appropriate.

11 SEC. 3. MEDICARE COVERAGE FOR OUTPATIENT PAREN12 TERAL SERVICES AND SUPPLIES.

13 (a) IN GENERAL.—Section 1861(n) of the Social Se14 curity Act (42 U.S.C. 1395x(n)) is amended—

15 (1) by striking ‘‘(n)’’ and inserting ‘‘(n)(1)’’;

16 (2) by inserting ‘‘antimicrobial as described in

17 paragraph (2),’’ after ‘‘beds,’’; and

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

19 ‘‘(2) The antimicrobial described in this paragraph

20 is an antimicrobial which is administered to a patient

21 parenterally, using an access device that is inserted into

22 the body, and which the Secretary has determined in the

23 study provided for in this Act to reduce costs if adminis24 tered on an outpatient basis. The Secretary shall have au-
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1 thority to amend the coverage (and the price paid for such

2 covered items) so as to ensure cost savings.’’.

3 (b) EFFECTIVE DATE.—The amendments made by

4 subsection (a) shall apply with respect to antimicrobials

5 furnished on or after January 1, 1998.

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