I
106TH CONGRESS
1ST SESSION
H. R. 2030
To amend title XVIII of the Social Security Act to improve the process
by which the Secretary of Health and Human Services makes coverage
determinations for items and services furnished under the Medicare Pro-
gram, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JUNE 7, 1999
Mr. RAMSTAD introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committee on Com-
merce, for a period to be subsequently determined by the Speaker, in
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to improve
the process by which the Secretary of Health and Human
Services makes coverage determinations for items and
services furnished under the Medicare Program, and for
other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Medicare Patient Access to Technology Act of 1999’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Establishment of medicare advisory committees.
Sec. 4. Annual adjustments to medicare payment systems for changes in tech-
nology and medical practice.
Sec. 5. Process for making and implementing certain coding modifications.
Sec. 6. Retention of HCPCS level III codes.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) In order to assure genuine access of medi-
care beneficiaries to medical technologies, the Sec-
retary of Health and Human Services has an obliga-
tion to integrate and coordinate its medical tech-
nology coverage policy determination process with
agency policies and practices that govern assignment
of procedure codes, establishment and adjustment of
payment levels and groupings, and issuance of time-
ly instructions to contractors.
(2) The effectiveness of the medicare program
in meeting beneficiary needs is compromised if ac-
cess to state-of-the-art medical care is denied as a
result of ineffective agency performance in the cov-
erage, coding, or payment processes, or in the inef-
fective administrative execution of medical tech-
nology decisions.
(3) The Secretary of Health and Human Serv-
ices owes medicare beneficiaries the assurance that
the various medicare payment systems (in both the
fee-for-service and managed care areas) are operated
in a way that reflects developments in, and improve-
ments upon, medical technology by properly setting
and adjusting payment levels and payment groups.
(4) Clear, predictable, and well-functioning cov-
erage, coding, and payment systems are particularly
critical to this country’s small medical technology
companies, which are the originators of most med-
ical product innovations.
(5) Unless medicare’s coverage, coding, and
payment systems review products promptly, apply
standards appropriate for medical technology, and
provide reasonable reimbursement levels, these com-
panies will experience difficulties in bringing the
benefits of medical innovation to medicare bene-
ficiaries.
SEC. 3. ESTABLISHMENT OF MEDICARE ADVISORY COMMIT-
TEES.
(a) IN GENERAL.—Title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.) is amended by adding at
the end the following new section:
‘‘MEDICARE ADVISORY COMMITTEES
‘‘SEC. 1897. (a) ESTABLISHMENT OF MEDICARE AD-
VISORY COMMITTEES.—For the purpose of securing ad-
vice and recommendations on issues related to coverage,
payment, and coding decisions, the Secretary shall estab-
lish, under section 9(a)(1) of the Federal Advisory Com-
mittee Act, the advisory committees described in this sec-
tion.
‘‘(b) MEDICARE PAYMENT AND CODING ADVISORY
COMMITTEE.—
‘‘(1) ESTABLISHMENT.—For the purpose of se-
curing advice and recommendations on payment and
coding issues under this title, not later than January
1, 2000, the Secretary shall establish the Medicare
Payment and Coding Advisory Committee (herein-
after in this subsection referred to as the ‘Com-
mittee’). The Secretary shall consult with the Com-
mittee, and may consult directly with any panel of
the Committee established pursuant to subsection
(d)(1).
‘‘(2) DUTIES.—The Committee, and its panels,
shall provide advice and recommendations to the
Secretary on policies regarding payment and coding
issues under this title, including identification of—
‘‘(A) policies and mechanisms to help en-
sure that payment and coding decisions are—
‘‘(i) made in a way that encourages
access to high-quality medical care under
this title;
‘‘(ii) made through processes that
allow for significant public participation;
and
‘‘(iii) made expeditiously, in accord-
ance with specified time frames for each
significant step in the process of making
such decisions;
‘‘(B) an equitable mechanism for deter-
mining fee schedule payment amounts for items
and services (other than physicians’ services);
and
‘‘(C) processes for reconsideration and ap-
peal of determinations of fee schedule payment
amounts.
‘‘(3) REPORT.—
‘‘(A) ANNUAL
REPORT
TO
THE
SEC-
RETARY.—Not later than December 1 of each
of fiscal years 2000 through 2003, the Com-
mittee shall submit to the Secretary a report on
the progress of the Committee progress during
the preceding fiscal year, in carrying out the
duties under paragraph (2).
‘‘(B) PUBLICATION OF REPORT.—Not later
than 60 days after receipt of the report under
subparagraph (A), the Secretary shall publish
the report, together with any supplemental
views of the Secretary, on the Internet site of
the Department of Health and Human Services.
‘‘(4) TERMINATION.—The Committee shall ter-
minate on September 30, 2003.
‘‘(c) ADVISORY COMMITTEE ON MEDICARE ACCESS
TO TECHNOLOGY.—
‘‘(1) ESTABLISHMENT.—Not later than July 1,
2003, the Secretary shall establish the Medicare Ac-
cess to Technology Advisory Committee (hereinafter
in this subsection referred to as the ‘Committee’).
The Secretary shall consult with the Committee, and
may consult directly with any panel of the Com-
mittee established pursuant to subsection (d)(1).
‘‘(2) DUTIES.—The Committee, and its panels,
shall provide advice and recommendations to the
Secretary with respect to—
‘‘(A) the issues referred to the Medicare
Coverage Advisory Committee (established by
the Secretary on November 24, 1998, notice of
which was printed in the Federal Register on
December 14, 1998, (63 FR 68780));
‘‘(B) the issues referred to the Medicare
Payment and Coding Advisory Committee
under subsection (b); and
‘‘(C) integrating policies on coverage, pay-
ment, and coding under this title into a process
that helps to assure timely access to high-qual-
ity medical care.
‘‘(3) REPORT.—
‘‘(A) ANNUAL
REPORT
TO
THE
SEC-
RETARY.—Not later than December 1 of every
year beginning with 2004, the Committee shall
submit to the Secretary a report on the
progress of the Committee during the preceding
fiscal year, in accomplishing the duty described
in paragraph (2)(C).
‘‘(B) PUBLICATION OF REPORT.—Not later
than 60 days after receipt of the report under
subparagraph (A), the Secretary shall publish
the report, together with any supplemental
views of the Secretary, on the Internet site of
the Department of Health and Human Services.
‘‘(4) DURATION.—Section 14(a)(2)(B) of the
Federal Advisory Committee Act (5 U.S.C. App.; re-
lating to the termination of advisory committees)
shall not apply to the Committee.
‘‘(d) ADVISORY COMMITTEE PROCEDURES.—In ad-
ministering each of the advisory committees under this
section, the Secretary shall—
‘‘(1) organize each advisory committee into pan-
els of experts according to types of items or services;
‘‘(2) solicit nominations as needed from the
public by publishing a notice in the Federal Register
and on the Internet site of the Department of
Health and Human Services;
‘‘(3) ensure participation on each advisory com-
mittee of persons who—
‘‘(A) are experts in a variety of medical
specialties and fields of science, in specific areas
of medical technology (such as clinical and di-
agnostic tests and durable medical equipment),
in medical research generally (such as the study
of treatment outcomes), and in other areas rel-
evant to the duties assigned to the advisory
committee (taking into account, as appropriate,
any affiliations individuals may have with orga-
nizations possessing information, expertise, and
other resources that would contribute signifi-
cantly to the work of the advisory committee
and its panels);
‘‘(B) are qualified by training and experi-
ence to evaluate the matters referred to the ad-
visory committee (including, on each panel, a
representative of consumer interests and a rep-