I

107TH CONGRESS

1ST SESSION H. R. 1451

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

treatment of certain physician pathology services under the Medicare

Program.

IN THE HOUSE OF REPRESENTATIVES

APRIL 4, 2001

Mr. FOLEY (for himself, Mr. POMEROY, and Mr. TANNER) introduced the following bill; which was referred to the Committee on Ways and Means,

and in addition to the Committee on Energy and 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 the fair 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 Fair Payment Act of 2001’’.
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1 SEC. 2. TREATMENT OF CERTAIN PHYSICIAN PATHOLOGY

2 SERVICES.

3 (a) IN GENERAL.—Section 1848(i) of the Social Se4 curity Act (42 U.S.C. 1395w–4(i)) is amended by adding

5 at the end the following new paragraph:

6 ‘‘(4) TREATMENT OF CERTAIN PHYSICIAN PA7 THOLOGY SERVICES.—

8 ‘‘(A) IN GENERAL.—With respect to serv9 ices furnished on or after January 1, 2001, if

10 an independent laboratory furnishes the tech11 nical component of a physician pathology serv12 ice to a fee-for-service medicare beneficiary who

13 is an inpatient or outpatient of a covered hos14 pital, the Secretary shall treat such component

15 as a service for which payment shall be made

16 to the laboratory under this section and not as

17 an inpatient hospital service for which payment

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

19 or as a hospital outpatient service for which

20 payment is made to the hospital under section

21 1834(t).

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

23 ‘‘(i) COVERED HOSPITAL.—

24 ‘‘(I) IN GENERAL.—The term

25 ‘covered hospital’ means, with respect

26 to an inpatient or outpatient, a hos-
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1 pital that had an arrangement with

2 an independent laboratory that was in

3 effect as of July 22, 1999, under

4 which a laboratory furnished the tech5 nical component of physician pathol6 ogy services to fee-for-service medi7 care beneficiaries who were hospital

8 inpatients or outpatients, respectively,

9 and submitted claims for payment for

10 such component to a carrier with a

11 contract under section 1842 and not

12 to the hospital.

13 ‘‘(II) CHANGE IN OWNERSHIP

14 DOES NOT AFFECT DETERMINA15 TION.—A change in ownership with

16 respect to a hospital on or after the

17 date referred to in subclause (I) shall

18 not affect the determination of wheth19 er such hospital is a covered hospital

20 for purposes of such subclause.

21 ‘‘(ii) FEE-FOR-SERVICE MEDICARE

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

23 medicare beneficiary’ means an individual

24 who is entitled to benefits under part A, or
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1 enrolled under this part, or both, but is not

2 enrolled in any of the following:

3 ‘‘(I) A Medicare+Choice plan

4 under part C.

5 ‘‘(II) A plan offered by an eligi6 ble organization under section 1876.

7 ‘‘(III) A program of all-inclusive

8 care for the elderly (PACE) under

9 section 1894.

10 ‘‘(IV) A social health mainte11 nance organization (SHMO) dem12 onstration project established under

13 section 4018(b) of the Omnibus

14 Budget Reconciliation Act of 1987

15 (Public Law 100–203).’’.

16 (b) CONFORMING AMENDMENT.—Section 542 of the

17 Medicare, Medicaid, and SCHIP Benefits Improvement

18 and Protection Act of 2000 (114 Stat. 2763A–550), as

19 enacted into law by section 1(a)(6) of Public Law 106–

20 554, is repealed.

21 (c) EFFECTIVE DATES.—The amendments made by

22 this section shall take effect as if included in the enact23 ment of the Medicare, Medicaid, and SCHIP Benefits Im24 provement and Protection Act of 2000 (appendix F, 114
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1 Stat. 2763A–463), as enacted into law by section 1(a)(6)

2 of Public Law 106–554.

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