H. R. 1—356
United States Code) who shall serve as the Executive Coordi-
nator for Technology and Innovation. Such executive coordi-
nator shall report to the Administrator of CMS, shall chair
the Council, shall oversee the execution of its duties, and shall
serve as a single point of contact for outside groups and entities
regarding the coverage, coding, and payment processes under
this title.’’.
(b) METHODS FOR DETERMINING PAYMENT BASIS FOR NEW LAB
TESTS.—Section 1833(h) (42 U.S.C. 1395l(h)) is amended by adding
at the end the following:
‘‘(8)(A) The Secretary shall establish by regulation procedures
for determining the basis for, and amount of, payment under this
subsection for any clinical diagnostic laboratory test with respect
to which a new or substantially revised HCPCS code is assigned
on or after January 1, 2005 (in this paragraph referred to as
‘new tests’).
‘‘(B) Determinations under subparagraph (A) shall be made
only after the Secretary—
‘‘(i) makes available to the public (through an Internet
website and other appropriate mechanisms) a list that includes
any such test for which establishment of a payment amount
under this subsection is being considered for a year;
‘‘(ii) on the same day such list is made available, causes
to have published in the Federal Register notice of a meeting
to receive comments and recommendations (and data on which
recommendations are based) from the public on the appropriate
basis under this subsection for establishing payment amounts
for the tests on such list;
‘‘(iii) not less than 30 days after publication of such notice
convenes a meeting, that includes representatives of officials
of the Centers for Medicare & Medicaid Services involved in
determining payment amounts, to receive such comments and
recommendations (and data on which the recommendations
are based);
‘‘(iv) taking into account the comments and recommenda-
tions (and accompanying data) received at such meeting,
develops and makes available to the public (through an Internet
website and other appropriate mechanisms) a list of proposed
determinations with respect to the appropriate basis for estab-
lishing a payment amount under this subsection for each such
code, together with an explanation of the reasons for each
such determination, the data on which the determinations are
based, and a request for public written comments on the pro-
posed determination; and
‘‘(v) taking into account the comments received during the
public comment period, develops and makes available to the
public (through an Internet website and other appropriate
mechanisms) a list of final determinations of the payment
amounts for such tests under this subsection, together with
the rationale for each such determination, the data on which
the determinations are based, and responses to comments and
suggestions received from the public.
‘‘(C) Under the procedures established pursuant to subpara-
graph (A), the Secretary shall—
‘‘(i) set forth the criteria for making determinations under
subparagraph (A); and
H. R. 1—357
‘‘(ii) make available to the public the data (other than
proprietary data) considered in making such determinations.
‘‘(D) The Secretary may convene such further public meetings
to receive public comments on payment amounts for new tests
under this subsection as the Secretary deems appropriate.
‘‘(E) For purposes of this paragraph:
‘‘(i) The term ‘HCPCS’ refers to the Health Care Procedure
Coding System.
‘‘(ii) A code shall be considered to be ‘substantially revised’
if there is a substantive change to the definition of the test
or procedure to which the code applies (such as a new analyte
or a new methodology for measuring an existing analyte-specific
test).’’.
(c) GAO STUDY ON IMPROVEMENTS IN EXTERNAL DATA COLLEC-
TION FOR USE IN THE MEDICARE INPATIENT PAYMENT SYSTEM.—
(1) STUDY.—The Comptroller General of the United States
shall conduct a study that analyzes which external data can
be collected in a shorter timeframe by the Centers for Medicare
& Medicaid Services for use in computing payments for
inpatient hospital services. The study may include an evalua-
tion of the feasibility and appropriateness of using quarterly
samples or special surveys or any other methods. The study
shall include an analysis of whether other executive agencies,
such as the Bureau of Labor Statistics in the Department
of Commerce, are best suited to collect this information.
(2) REPORT.—By not later than October 1, 2004, the Comp-
troller General shall submit a report to Congress on the study
under paragraph (1).
SEC. 943. TREATMENT OF HOSPITALS FOR CERTAIN SERVICES UNDER
MEDICARE SECONDARY PAYOR (MSP) PROVISIONS.
(a) IN GENERAL.—The Secretary shall not require a hospital
(including a critical access hospital) to ask questions (or obtain
information) relating to the application of section 1862(b) of the
Social Security Act (relating to medicare secondary payor provisions)
in the case of reference laboratory services described in subsection
(b), if the Secretary does not impose such requirement in the case
of such services furnished by an independent laboratory.
(b) REFERENCE LABORATORY SERVICES DESCRIBED.—Reference
laboratory services described in this subsection are clinical labora-
tory diagnostic tests (or the interpretation of such tests, or both)
furnished without a face-to-face encounter between the individual
entitled to benefits under part A or enrolled under part B, or
both, and the hospital involved and in which the hospital submits
a claim only for such test or interpretation.
SEC. 944. EMTALA IMPROVEMENTS.
(a) PAYMENT FOR EMTALA-MANDATED SCREENING AND STA-
BILIZATION SERVICES.—
(1) IN
GENERAL.—Section 1862 (42 U.S.C. 1395y) is
amended by inserting after subsection (c) the following new
subsection:
‘‘(d) For purposes of subsection (a)(1)(A), in the case of any
item or service that is required to be provided pursuant to section
1867 to an individual who is entitled to benefits under this title,
determinations as to whether the item or service is reasonable
and necessary shall be made on the basis of the information avail-
able to the treating physician or practitioner (including the patient’s
H. R. 1—358
presenting symptoms or complaint) at the time the item or service
was ordered or furnished by the physician or practitioner (and
not on the patient’s principal diagnosis). When making such deter-
minations with respect to such an item or service, the Secretary
shall not consider the frequency with which the item or service
was provided to the patient before or after the time of the admission
or visit.’’.
(2) EFFECTIVE DATE.—The amendment made by paragraph
(1) shall apply to items and services furnished on or after
January 1, 2004.
(b) NOTIFICATION OF PROVIDERS WHEN EMTALA INVESTIGATION
CLOSED.—Section 1867(d) (42 U.S.C. 42 U.S.C. 1395dd(d)) is
amended by adding at the end the following new paragraph:
‘‘(4) NOTICE UPON CLOSING AN INVESTIGATION.—The Sec-
retary shall establish a procedure to notify hospitals and physi-
cians when an investigation under this section is closed.’’.
(c) PRIOR REVIEW BY PEER REVIEW ORGANIZATIONS IN EMTALA
CASES INVOLVING TERMINATION OF PARTICIPATION.—
(1) 
IN
GENERAL.—Section 
1867(d)(3) 
(42 
U.S.C.
1395dd(d)(3)) is amended—
(A) in the first sentence, by inserting ‘‘or in terminating
a hospital’s participation under this title’’ after ‘‘in imposing
sanctions under paragraph (1)’’; and
(B) by adding at the end the following new sentences:
‘‘Except in the case in which a delay would jeopardize
the health or safety of individuals, the Secretary shall
also request such a review before making a compliance
determination as part of the process of terminating a hos-
pital’s participation under this title for violations related
to the appropriateness of a medical screening examination,
stabilizing treatment, or an appropriate transfer as
required by this section, and shall provide a period of
5 days for such review. The Secretary shall provide a
copy of the organization’s report to the hospital or physician
consistent with confidentiality requirements imposed on
the organization under such part B.’’.
(2) EFFECTIVE DATE.—The amendments made by paragraph
(1) shall apply to terminations of participation initiated on
or after the date of the enactment of this Act.
SEC. 945. EMERGENCY MEDICAL TREATMENT AND LABOR ACT
(EMTALA) TECHNICAL ADVISORY GROUP.
(a) ESTABLISHMENT.—The Secretary shall establish a Technical
Advisory Group (in this section referred to as the ‘‘Advisory Group’’)
to review issues related to the Emergency Medical Treatment and
Labor Act (EMTALA) and its implementation. In this section, the
term ‘‘EMTALA’’ refers to the provisions of section 1867 of the
Social Security Act (42 U.S.C. 1395dd).
(b) MEMBERSHIP.—The Advisory Group shall be composed of
19 members, including the Administrator of the Centers for Medi-
care & Medicaid Services and the Inspector General of the Depart-
ment of Health and Human Services and of which—
(1) 4 shall be representatives of hospitals, including at
least one public hospital, that have experience with the applica-
tion of EMTALA and at least 2 of which have not been cited
for EMTALA violations;
H. R. 1—359
(2) 7 shall be practicing physicians drawn from the fields
of emergency medicine, cardiology or cardiothoracic surgery,
orthopedic surgery, neurosurgery, pediatrics or a pediatric sub-
specialty, obstetrics-gynecology, and psychiatry, with not more
than one physician from any particular field;
(3) 2 shall represent patients;
(4) 2 shall be staff involved in EMTALA investigations
from different regional offices of the Centers for Medicare &
Medicaid Services; and
(5) 1 shall be from a State survey office involved in
EMTALA investigations and 1 shall be from a peer review
organization, both of whom shall be from areas other than
the regions represented under paragraph (4).
In selecting members described in paragraphs (1) through (3), the
Secretary shall consider qualified individuals nominated by
organizations representing providers and patients.
(c) GENERAL RESPONSIBILITIES.—The Advisory Group—
(1) shall review EMTALA regulations;
(2) may provide advice and recommendations to the Sec-
retary with respect to those regulations and their application
to hospitals and physicians;
(3) shall solicit comments and recommendations from hos-
pitals, physicians, and the public regarding the implementation
of such regulations; and
(4) may disseminate information on the application of such
regulations to hospitals, physicians, and the public.
(d) ADMINISTRATIVE MATTERS.—
(1) CHAIRPERSON.—The members of the Advisory Group
shall elect a member to serve as chairperson of the Advisory
Group for the life of the Advisory Group.
(2) MEETINGS.—The Advisory Group shall first meet at
the direction of the Secretary. The Advisory Group shall then
meet twice per year and at such other times as the Advisory
Group may provide.
(e) TERMINATION.—The Advisory Group shall terminate 30
months after the date of its first meeting.
(f) WAIVER
OF ADMINISTRATIVE LIMITATION.—The Secretary
shall establish the Advisory Group notwithstanding any limitation
that may apply to the number of advisory committees that may
be established (within the Department of Health and Human Serv-
ices or otherwise).
SEC. 946. AUTHORIZING USE OF ARRANGEMENTS TO PROVIDE CORE
HOSPICE SERVICES IN CERTAIN CIRCUMSTANCES.
(a) IN GENERAL.—Section 1861(dd)(5) (42 U.S.C. 1395x(dd)(5))
is amended by adding at the end the following:
‘‘(D) In extraordinary, exigent, or other non-routine cir-
cumstances, such as unanticipated periods of high patient loads,
staffing shortages due to illness or other events, or temporary
travel of a patient outside a hospice program’s service area, a
hospice program may enter into arrangements with another hospice
program for the provision by that other program of services
described in paragraph (2)(A)(ii)(I). The provisions of paragraph
(2)(A)(ii)(II) shall apply with respect to the services provided under
such arrangements.
‘‘(E) A hospice program may provide services described in para-
graph (1)(A) other than directly by the program if the services