1834(h) shall not be considered a bona fide employment
relationship for purposes of this subparagraph;’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply with respect to items or services
furnished on or after January 1, 1994.
SEC. 5. PRIOR APPROVAL AUTHORIZED FOR ITEMS FUR-
NISHED BY SUPPLIERS ENGAGED IN FRAUD
OR OTHER ABUSIVE PRACTICES.
(a) IN GENERAL.—Section 1834(a) of the Social Se-
curity Act (42 U.S.C. 1395m(a)), as amended by section
4(a), is further amended by adding at the end the follow-
ing new paragraph:
‘‘(18) CARRIER
DETERMINATIONS
OF
ITEMS
FURNISHED BY CERTAIN SUPPLIERS IN ADVANCE.—
‘‘(A) DEVELOPMENT OF LIST OF SUPPLI-
ERS BY SECRETARY.—The Secretary shall de-
velop and periodically update a list of suppliers
that the Secretary determines (on the basis of
criteria developed and published by the Sec-
retary in consultation with representatives of
suppliers, which may include prior payment ex-
perience)—
‘‘(i) have engaged in activities which
make the suppliers subject to a civil mone-
tary penalty under section 1128A or to a
criminal penalty under section 1128B;
‘‘(ii) have furnished a substantial
number of items for which payment was
not made because of the application of sec-
tion 1862(a)(1); or
‘‘(iii) have engaged in a pattern of
overutilization of items.
‘‘(B) DETERMINATIONS OF COVERAGE IN
ADVANCE.—A carrier shall determine in ad-
vance whether payment for an item furnished
by a supplier included on the list developed by
the Secretary under subparagraph (A) may not
be made because of the application of section
1862(a)(1).’’.
(b) CONFORMING AMENDMENT.—Section 1834(h)(3)
of such Act (42 U.S.C. 1395m(h)(3)), as amended by sec-
tion 4(a)(2), is amended by striking ‘‘(12) and (17)’’ and
inserting ‘‘(12), (15), (17), and (18)’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to items and services furnished on
or after January 1, 1994.
SEC. 6. STUDY OF IMPACT OF REFORMS ON ACCESS TO
AND COSTS OF DURABLE MEDICAL EQUIP-
MENT FOR MEDICARE BENEFICIARIES.
(a) STUDY.—
(1) IN
GENERAL.—The Comptroller General
shall conduct a study of the impact of the amend-
ments made by this Act on the access of individuals
enrolled under part B of the medicare program to
items of durable medical equipment under the pro-
gram and the costs imposed on such individuals
under the program for such items, and shall include
in the study an analysis of the impact of the amend-
ments on individuals enrolled under part B of the
program who reside in rural areas.
(2) 
DURABLE
MEDICAL
EQUIPMENT
DE-
FINED.—For purposes of paragraph (1), the term
‘‘durable medical equipment’’ means covered items
under section 1834(a) of the Social Security Act and
items described in section 1834(h) of such Act.
(b) REPORT.—Not later than January 1, 1995, the
Comptroller General shall submit a report to Congress on
the study conducted under subsection (a), and shall in-
clude in the report any recommendations considered ap-
propriate for legislative or regulatory changes to improve
the access of medicare beneficiaries to items of durable
medical equipment and to control the costs imposed on
beneficiaries for such items under the medicare program,
including recommendations to impose maximum allowable
limits on the amounts suppliers of such items may charge
beneficiaries in the same manner as the limits imposed
under the program on the amounts physicians may charge
beneficiaries for physicians’ services.
SEC. 7. STUDY OF ITEMS FURNISHED TO RESIDENTS OF
NURSING FACILITIES.
(a) STUDY.—
(1) IN
GENERAL.—The Comptroller General
shall conduct a study of the types, volume, and utili-
zation of items of durable medical equipment fur-
nished under part B of the medicare program to in-
dividuals residing in skilled nursing facilities and in-
termediate care facilities, and shall include in the
study an analysis of the need to apply additional
controls on the utilization of such items by such in-
dividuals.
(2) 
DURABLE
MEDICAL
EQUIPMENT
DE-
FINED.—For purposes of paragraph (1), the term
‘‘durable medical equipment’’ means covered items
under section 1834(a) of the Social Security Act and
items described in section 1834(h) of such Act.
(b) REPORT.—Not later than January 1, 1995, the
Comptroller General shall submit a report to Congress on
the study conducted under subsection (a).
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