H. R. 1—257
days after the date of the enactment of this Act, but in no case
may the project extend beyond December 31, 2005.
(d) LIMITATION.—Under the demonstration project over the
duration of the project, the Secretary may not provide—
(1) coverage for more than 50,000 patients; and
(2) more than $500,000,000 in funding.
(e) REPORT.—Not later than July 1, 2006, the Secretary shall
submit to Congress a report on the project. The report shall include
an evaluation of patient access to care and patient outcomes under
the project, as well as an analysis of the cost effectiveness of
the project, including an evaluation of the costs savings (if any)
to the medicare program attributable to reduced physicians’ services
and hospital outpatient departments services for administration
of the biological.
SEC. 642. EXTENSION OF COVERAGE OF INTRAVENOUS IMMUNE GLOB-
ULIN (IVIG) FOR THE TREATMENT OF PRIMARY IMMUNE
DEFICIENCY DISEASES IN THE HOME.
(a) IN GENERAL.—Section 1861 (42 U.S.C. 1395x), as amended
by sections 611(a) and 612(a) is amended—
(1) in subsection (s)(2)—
(A) by striking ‘‘and’’ at the end of subparagraph (X);
(B) by adding ‘‘and’’ at the end of subparagraph (Y);
and
(C) by adding at the end the following new subpara-
graph:
‘‘(Z) intravenous immune globulin for the treatment
of primary immune deficiency diseases in the home (as
defined in subsection (zz));’’; and
(2) by adding at the end the following new subsection:
‘‘Intravenous Immune Globulin
‘‘(zz) The term ‘intravenous immune globulin’ means an
approved pooled plasma derivative for the treatment in the patient’s
home of a patient with a diagnosed primary immune deficiency
disease, but not including items or services related to the adminis-
tration of the derivative, if a physician determines administration
of the derivative in the patient’s home is medically appropriate.’’.
(b) PAYMENT AS A DRUG OR BIOLOGICAL.—Section 1833(a)(1)(S)
(42 U.S.C. 1395l(a)(1)(S)) is amended by inserting ‘‘(including intra-
venous immune globulin (as defined in section 1861(zz)))’’ after
‘‘with respect to drugs and biologicals’’.
(c) EFFECTIVE DATE.—The amendments made by this section
shall apply to items furnished administered on or after January
1, 2004.
SEC. 643. MEDPAC STUDY OF COVERAGE OF SURGICAL FIRST
ASSISTING SERVICES OF CERTIFIED REGISTERED NURSE
FIRST ASSISTANTS.
(a) STUDY.—The Medicare Payment Advisory Commission (in
this section referred to as the ‘‘Commission’’) shall conduct a study
on the feasibility and advisability of providing for payment under
part B of title XVIII of the Social Security Act for surgical first
assisting services furnished by a certified registered nurse first
assistant to medicare beneficiaries.
(b) REPORT.—Not later than January 1, 2005, the Commission
shall submit to Congress a report on the study conducted under
H. R. 1—258
subsection (a) together with recommendations for such legislation
or administrative action as the Commission determines to be appro-
priate.
(c) DEFINITIONS.—In this section:
(1) SURGICAL FIRST ASSISTING SERVICES.—The term ‘‘sur-
gical first assisting services’’ means services consisting of first
assisting a physician with surgery and related preoperative,
intraoperative, and postoperative care (as determined by the
Secretary) furnished by a certified registered nurse first assist-
ant (as defined in paragraph (2)) which the certified registered
nurse first assistant is legally authorized to perform by the
State in which the services are performed.
(2) CERTIFIED REGISTERED NURSE FIRST ASSISTANT.—The
term ‘‘certified registered nurse first assistant’’ means an indi-
vidual who—
(A) is a registered nurse and is licensed to practice
nursing in the State in which the surgical first assisting
services are performed;
(B) has completed a minimum of 2,000 hours of first
assisting a physician with surgery and related preoperative,
intraoperative, and postoperative care; and
(C) is certified as a registered nurse first assistant
by an organization recognized by the Secretary.
SEC. 644. MEDPAC STUDY OF PAYMENT FOR CARDIO-THORACIC SUR-
GEONS.
(a) STUDY.—The Medicare Payment Advisory Commission (in
this section referred to as the ‘‘Commission’’) shall conduct a study
on the practice expense relative values established by the Secretary
of Health and Human Services under the medicare physician fee
schedule under section 1848 of the Social Security Act (42 U.S.C.
1395w–4) for physicians in the specialties of thoracic and cardiac
surgery to determine whether such values adequately take into
account the attendant costs that such physicians incur in providing
clinical staff for patient care in hospitals.
(b) REPORT.—Not later than January 1, 2005, the Commission
shall submit to Congress a report on the study conducted under
subsection (a) together with recommendations for such legislation
or administrative action as the Commission determines to be appro-
priate.
SEC. 645. STUDIES RELATING TO VISION IMPAIRMENTS.
(a) COVERAGE OF OUTPATIENT VISION SERVICES FURNISHED BY
VISION REHABILITATION PROFESSIONALS UNDER PART B.—
(1) STUDY.—The Secretary shall conduct a study to deter-
mine the feasibility and advisability of providing for payment
for vision rehabilitation services furnished by vision rehabilita-
tion professionals.
(2) REPORT.—Not later than January 1, 2005, the Secretary
shall submit to Congress a report on the study conducted under
paragraph (1) together with recommendations for such legisla-
tion or administrative action as the Secretary determines to
be appropriate.
(3) VISION REHABILITATION PROFESSIONAL DEFINED.—In this
subsection, the term ‘‘vision rehabilitation professional’’ means
an orientation and mobility specialist, a rehabilitation teacher,
or a low vision therapist.
H. R. 1—259
(b) REPORT ON APPROPRIATENESS OF A DEMONSTRATION PROJECT
TO TEST FEASIBILITY OF USING PPO NETWORKS TO REDUCE COSTS
OF ACQUIRING EYEGLASSES FOR MEDICARE BENEFICIARIES AFTER
CATARACT SURGERY.—Not later than 1 year after the date of the
enactment of this Act, the Secretary shall submit to Congress
a report on the feasibility of establishing a two-year demonstration
project under which the Secretary enters into arrangements with
vision care preferred provider organization networks to furnish
and pay for conventional eyeglasses subsequent to each cataract
surgery with insertion of an intraocular lens on behalf of Medicare
beneficiaries. In such report, the Secretary shall include an estimate
of potential cost savings to the Medicare program through the
use of such networks, taking into consideration quality of service
and beneficiary access to services offered by vision care preferred
provider organization networks.
SEC. 646. MEDICARE HEALTH CARE QUALITY DEMONSTRATION PRO-
GRAMS.
Title XVIII (42 U.S.C. 1395 et seq.) is amended by inserting
after section 1866B the following new section:
‘‘HEALTH CARE QUALITY DEMONSTRATION PROGRAM
‘‘SEC. 1866C. (a) DEFINITIONS.—In this section:
‘‘(1) BENEFICIARY.—The term ‘beneficiary’ means an indi-
vidual who is entitled to benefits under part A and enrolled
under part B, including any individual who is enrolled in a
Medicare Advantage plan under part C.
‘‘(2) HEALTH CARE GROUP.—
‘‘(A) IN
GENERAL.—The term ‘health care group’
means—
‘‘(i) a group of physicians that is organized at least
in part for the purpose of providing physician’s services
under this title;
‘‘(ii) an integrated health care delivery system that
delivers care through coordinated hospitals, clinics,
home health agencies, ambulatory surgery centers,
skilled nursing facilities, rehabilitation facilities and
clinics, and employed, independent, or contracted
physicians; or
‘‘(iii) an organization representing regional coali-
tions of groups or systems described in clause (i) or
(ii).
‘‘(B) INCLUSION.—As the Secretary determines appro-
priate, a health care group may include a hospital or any
other individual or entity furnishing items or services for
which payment may be made under this title that is affili-
ated with the health care group under an arrangement
structured so that such hospital, individual, or entity
participates in a demonstration project under this section.
‘‘(3) PHYSICIAN.—Except as otherwise provided for by the
Secretary, the term ‘physician’ means any individual who fur-
nishes services that may be paid for as physicians’ services
under this title.
‘‘(b) DEMONSTRATION PROJECTS.—The Secretary shall establish
a 5-year demonstration program under which the Secretary shall
approve demonstration projects that examine health delivery factors
H. R. 1—260
that encourage the delivery of improved quality in patient care,
including—
‘‘(1) the provision of incentives to improve the safety of
care provided to beneficiaries;
‘‘(2) the appropriate use of best practice guidelines by pro-
viders and services by beneficiaries;
‘‘(3) reduced scientific uncertainty in the delivery of care
through the examination of variations in the utilization and
allocation of services, and outcomes measurement and research;
‘‘(4) encourage shared decision making between providers
and patients;
‘‘(5) the provision of incentives for improving the quality
and safety of care and achieving the efficient allocation of
resources;
‘‘(6) the appropriate use of culturally and ethnically sen-
sitive health care delivery; and
‘‘(7) the financial effects on the health care marketplace
of altering the incentives for care delivery and changing the
allocation of resources.
‘‘(c) ADMINISTRATION BY CONTRACT.—
‘‘(1) IN GENERAL.—Except as otherwise provided in this
section, the Secretary may administer the demonstration pro-
gram established under this section in a manner that is similar
to the manner in which the demonstration program established
under section 1866A is administered in accordance with section
1866B.
‘‘(2) ALTERNATIVE PAYMENT SYSTEMS.—A health care group
that receives assistance under this section may, with respect
to the demonstration project to be carried out with such assist-
ance, include proposals for the use of alternative payment sys-
tems for items and services provided to beneficiaries by the
group that are designed to—
‘‘(A) encourage the delivery of high quality care while
accomplishing the objectives described in subsection (b);
and
‘‘(B) streamline documentation and reporting require-
ments otherwise required under this title.
‘‘(3) BENEFITS.—A health care group that receives assist-
ance under this section may, with respect to the demonstration
project to be carried out with such assistance, include modifica-
tions to the package of benefits available under the original
medicare fee-for-service program under parts A and B or the
package of benefits available through a Medicare Advantage
plan under part C. The criteria employed under the demonstra-
tion program under this section to evaluate outcomes and deter-
mine best practice guidelines and incentives shall not be used
as a basis for the denial of medicare benefits under the dem-
onstration program to patients against their wishes (or if the
patient is incompetent, against the wishes of the patient’s surro-
gate) on the basis of the patient’s age or expected length of
life or of the patient’s present or predicted disability, degree
of medical dependency, or quality of life.
‘‘(d) ELIGIBILITY CRITERIA.—To be eligible to receive assistance
under this section, an entity shall—
‘‘(1) be a health care group;
‘‘(2) meet quality standards established by the Secretary,
including—