119
(5) REPORT TO CONGRESS.—(A) Not later than
October 1, 2003, the Secretary shall submit to Con-
gress a report on the results of the study conducted
under paragraph (1).
(B) The Medicare Payment Advisory Commis-
sion shall conduct an analysis of the results of the
study included in the report under subparagraph (A)
and shall submit a report on such analysis to Con-
gress.
(e) STUDY ON APPROPRIATE CODING OF CERTAIN
EXTENDED OFFICE VISITS.—The Secretary shall conduct
a study of the appropriateness of coding in cases of ex-
tended office visits in which there is no diagnosis made.
Not later than October 1, 2003, the Secretary shall submit
a report to Congress on such study and shall include rec-
ommendations on how to code appropriately for such visits
in a manner that takes into account the amount of time
the physician spent with the patient.
(f) DEFINITIONS.—In this section—
(1) the term ‘‘rural area’’ has the meaning
given that term in section 1886(d)(2)(D) of the So-
cial Security Act, 42 U.S.C. 1395ww(d)(2)(D); and
(2) the term ‘‘teaching settings’’ are those set-
tings described in section 415.150 of title 42, Code
of Federal Regulations.
120
SEC. 502. IMPROVEMENT IN OVERSIGHT OF TECHNOLOGY
AND COVERAGE.
(a) IMPROVED COORDINATION BETWEEN FDA AND
CMS ON COVERAGE OF BREAKTHROUGH MEDICAL DE-
VICES.—
(1) IN GENERAL.—Upon request by an appli-
cant and to the extent feasible (as determined by the
Secretary), the Secretary shall, in the case of a class
III medical device that is subject to premarket ap-
proval under section 515 of the Federal Food, Drug,
and Cosmetic Act, ensure the sharing of appropriate
information from the review for application for pre-
market approval conducted by the Food and Drug
Administration for coverage decisions under title
XVIII of the Social Security Act.
(2) PUBLICATION OF PLAN.—Not later than 6
months after the date of the enactment of this Act,
the Secretary shall submit to appropriate Commit-
tees of Congress a report that contains the plan for
improving such coordination and for shortening the
time lag between the premarket approval by the
Food and Drug Administration and coding and cov-
erage decisions by the Centers for Medicare & Med-
icaid Services.
(3) CONSTRUCTION.—Nothing in this sub-
section shall be construed as changing the criteria
121
for coverage of a medical device under title XVIII of
the Social Security Act nor premarket approval by
the Food and Drug Administration and nothing in
this subsection shall be construed to increase pre-
market approval application requirements under the
Federal Food, Drug, and Cosmetic Act.
(b) COUNCIL FOR TECHNOLOGY AND INNOVATION.—
Section 1868 (42 U.S.C. 1395ee), as amended by section
301(a), is amended by adding at the end the following new
subsection:
‘‘(c) COUNCIL
FOR
TECHNOLOGY
AND
INNOVA-
TION.—
‘‘(1) ESTABLISHMENT.—The Secretary shall es-
tablish a Council for Technology and Innovation
within the Centers for Medicare & Medicaid Services
(in this section referred to as ‘CMS’).
‘‘(2) COMPOSITION.—The Council shall be com-
posed of senior CMS staff and clinicians and shall
be chaired by the Executive Coordinator for Tech-
nology and Innovation (appointed or designated
under paragraph (4)).
‘‘(3) DUTIES.—The Council shall coordinate the
activities of coverage, coding, and payment processes
under this title with respect to new technologies and
procedures, including new drug therapies, and shall
122
coordinate the exchange of information on new tech-
nologies between CMS and other entities that make
similar decisions.
‘‘(4) EXECUTIVE
COORDINATOR
FOR
TECH-
NOLOGY AND INNOVATION.—The Secretary shall ap-
point (or designate) a noncareer appointee (as de-
fined in section 3132(a)(7) of title 5, United States
Code) who shall serve as the Executive Coordinator
for Technology and Innovation. Such executive coor-
dinator 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 con-
tact for outside groups and entities regarding the
coverage, coding, and payment processes under this
title.’’.
(c) GAO STUDY ON IMPROVEMENTS IN EXTERNAL
DATA COLLECTION FOR USE IN THE MEDICARE INPA-
TIENT 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
time frame 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
123
of quarterly samples or special surveys or any other
methods. The study shall include an analysis of
whether other executive agencies, such as the Bu-
reau of Labor Statistics in the Department of Com-
merce, are best suited to collect this information.
(2) REPORT.—By not later than October 1,
2002, the Comptroller General shall submit a report
to Congress on the study under paragraph (1).
(d) IOM STUDY ON LOCAL COVERAGE DETERMINA-
TIONS.—
(1) STUDY.—The Secretary shall enter into an
arrangement with the Institute of Medicine of the
National Academy of Sciences under which the Insti-
tute shall conduct a study on local coverage deter-
minations (including the application of local medical
review policies) under the medicare program under
title XVIII of the Social Security Act. Such study
shall examine—
(A) the consistency of the definitions used
in such determinations;
(B) the types of evidence on which such
determinations are based, including medical and
scientific evidence;
(C) the advantages and disadvantages of
local coverage decisionmaking, including the
124
flexibility it offers for ensuring timely patient
access to new medical technology for which data
are still be collected;
(D) the manner in which the local coverage
determination process is used to develop data
needed for a national coverage determination,
including the need for collection of such data
within a protocol and informed consent by indi-
viduals entitled to benefits under part A of title
XVIII of the Social Security Act, or enrolled
under part B of such title, or both; and
(E) the advantages and disadvantages of
maintaining local medicare contractor advisory
committees that can advise on local coverage
decisions based on an open, collaborative public
process.
(2) REPORT.—Such arrangement shall provide
that the Institute shall submit to the Secretary a re-
port on such study by not later than 3 years after
the date of the enactment of this Act. The Secretary
shall promptly transmit a copy of such report to
Congress.
(e) 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:
125
‘‘(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 substan-
tially revised HCPCS code is assigned on or after January
1, 2003 (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 site and other appropriate mechanisms) a
list that includes any such test for which establish-
ment of a payment amount under this subsection is
being considered for a year;
‘‘(ii) on the same day such list is made avail-
able, causes to have published in the Federal Reg-
ister notice of a meeting to receive comments and
recommendations (and data on which recommenda-
tions 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 rep-
resentatives of officials of the Centers for Medicare
& Medicaid Services involved in determining pay-
ment amounts, to receive such comments and rec-
126
ommendations (and data on which the recommenda-
tions are based);
‘‘(iv) taking into account the comments and rec-
ommendations (and accompanying data) received at
such meeting, develops and makes available to the
public (through an Internet site and other appro-
priate mechanisms) a list of proposed determinations
with respect to the appropriate basis for establishing
a payment amount under this subsection for each
such code, together with an explanation of the rea-
sons for each such determination, the data on which
the determinations are based, and a request for pub-
lic written comments on the proposed determination;
and
‘‘(v) taking into account the comments received
during the public comment period, develops and
makes available to the public (through an Internet
site 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 pub-
lic.
127
‘‘(C) Under the procedures established pursuant to
subparagraph (A), the Secretary shall—
‘‘(i) set forth the criteria for making determina-
tions under subparagraph (A); and
‘‘(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 ‘substan-
tially 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).’’.
SEC. 503. TREATMENT OF HOSPITALS FOR CERTAIN SERV-
ICES UNDER MEDICARE SECONDARY PAYOR
(MSP) PROVISIONS.
(a) IN GENERAL.—The Secretary shall not require
a hospital (including a critical access hospital) to ask ques-
tions (or obtain information) relating to the application
128
of section 1862(b) of the Social Security Act (relating to
medicare secondary payor provisions) in the case of ref-
erence laboratory services described in subsection (b), if
the Secretary does not impose such requirement in the
case of such services furnished by an independent labora-
tory.
(b) 
REFERENCE
LABORATORY
SERVICES
DE-
SCRIBED.—Reference laboratory services described in this
subsection are clinical laboratory 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 sub-
mits a claim only for such test or interpretation.
SEC. 504. EMTALA IMPROVEMENTS.
(a) PAYMENT FOR EMTALA-MANDATED SCREEN-
ING AND STABILIZATION 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 pur-
suant 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
129
on the basis of the information available to the treating
physician or practitioner (including the patient’s pre-
senting symptoms or complaint) at the time the item or
service was ordered or furnished by the physician or prac-
titioner (and not on the patient’s principal diagnosis).
When making such determinations 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, 2002.
(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
INVESTIGA-
TION.—The Secretary shall establish a procedure to
notify hospitals and physicians when an investigation
under this section is closed.’’.
(c) PRIOR REVIEW BY PEER REVIEW ORGANIZA-
TIONS IN EMTALA CASES INVOLVING TERMINATION OF
PARTICIPATION.—
130
(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 individ-
uals, the Secretary shall also request such a re-
view before making a compliance determination
as part of the process of terminating a hos-
pital’s participation under this title for viola-
tions related to the appropriateness of a med-
ical screening examination, stabilizing treat-
ment, or an appropriate transfer as required by
this section, and shall provide a period of 5
days for such review. The Secretary shall pro-
vide a copy of the report on 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 par-
131
ticipation initiated on or after the date of the enact-
ment of this Act.
SEC. 505. EMERGENCY MEDICAL TREATMENT AND ACTIVE
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 Active 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 Medicare & Medicaid Services and the In-
spector General of the Department of Health and Human
Services and of which—
(1) 4 shall be representatives of hospitals, in-
cluding at least one public hospital, that have experi-
ence with the application of EMTALA and at least
2 of which have not been cited for EMTALA viola-
tions;
(2) 7 shall be practicing physicians drawn from
the fields of emergency medicine, cardiology or
cardiothoracic surgery, orthopedic surgery, neuro-
132
surgery, pediatrics or a pediatric subspecialty, ob-
stetrics-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 inves-
tigations from different regional offices of the Cen-
ters for Medicare & Medicaid Services; and
(5) 1 shall be from a State survey office in-
volved 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 nom-
inated by organizations representing providers and pa-
tients.
(c) GENERAL
RESPONSIBILITIES.—The Advisory
Group—
(1) shall review EMTALA regulations;
(2) may provide advice and recommendations to
the Secretary with respect to those regulations and
their application to hospitals and physicians;
(3) shall solicit comments and recommendations
from hospitals, physicians, and the public regarding
the implementation of such regulations; and
133
(4) may disseminate information on the applica-
tion of such regulations to hospitals, physicians, and
the public.
(d) ADMINISTRATIVE MATTERS.—
(1) CHAIRPERSON.—The members of the Advi-
sory Group shall elect a member to serve as chair-
person of the Advisory Group for the life of the Ad-
visory 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 termi-
nate 30 months after the date of its first meeting.
(f) WAIVER OF ADMINISTRATIVE LIMITATION.—The
Secretary shall establish the Advisory Group notwith-
standing any limitation that may apply to the number of
advisory committees that may be established (within the
Department of Health and Human Services or otherwise).
134
SEC. 506. AUTHORIZING USE OF ARRANGEMENTS WITH
OTHER HOSPICE PROGRAMS TO PROVIDE
CORE HOSPICE SERVICES IN CERTAIN CIR-
CUMSTANCES.
(a) IN GENERAL.—Section 1861(dd)(5) (42 U.S.C.
1395x(dd)(5)) is amended by adding at the end the fol-
lowing new subparagraph:
‘‘(D) In extraordinary, exigent, or other non-routine
circumstances, such as unanticipated periods of high pa-
tient 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 provi-
sion by that other program of services described in para-
graph 
(2)(A)(ii)(I). 
The 
provisions 
of 
paragraph
(2)(A)(ii)(II) shall apply with respect to the services pro-
vided under such arrangements.’’.
(b) CONFORMING
PAYMENT
PROVISION.—Section
1814(i) (42 U.S.C. 1395f(i)) is amended by adding at the
end the following new paragraph:
‘‘(4) In the case of hospice care provided by a hospice
program 
under 
arrangements 
under 
section
1861(dd)(5)(D) made by another hospice program, the
hospice program that made the arrangements shall bill
and be paid for the hospice care.’’.
135
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to hospice care provided on or after
the date of the enactment of this Act.
SEC. 507. APPLICATION OF OSHA BLOODBORNE PATHO-
GENS STANDARD TO CERTAIN HOSPITALS.
(a) IN GENERAL.—Section 1866 (42 U.S.C. 1395cc)
is amended—
(1) in subsection (a)(1)—
(A) in subparagraph (R), by striking
‘‘and’’ at the end;
(B) in subparagraph (S), by striking the
period at the end and inserting ‘‘, and’’; and
(C) by inserting after subparagraph (S)
the following new subparagraph:
‘‘(T) in the case of hospitals that are not other-
wise subject to the Occupational Safety and Health
Act of 1970, to comply with the Bloodborne Patho-
gens standard under section 1910.1030 of title 29 of
the Code of Federal Regulations (or as subsequently
redesignated).’’; and
(B) by adding at the end of subsection (b)
the following new paragraph:
‘‘(4)(A) A hospital that fails to comply with the re-
quirement of subsection (a)(1)(T) (relating to the
Bloodborne Pathogens standard) is subject to a civil
136
money penalty in an amount described in subparagraph
(B), but is not subject to termination of an agreement
under this section.
‘‘(B) The amount referred to in subparagraph (A) is
an amount that is similar to the amount of civil penalties
that may be imposed under section 17 of the Occupational
Safety and Health Act of 1970 for a violation of the
Bloodborne Pathogens standard referred to in subsection
(a)(1)(T) by a hospital that is subject to the provisions
of such Act.
‘‘(C) A civil money penalty under this paragraph shall
be imposed and collected in the same manner as civil
money penalties under subsection (a) of section 1128A are
imposed and collected under that section.’’.
(b) EFFECTIVE DATE.—The amendments made by
this subsection (a) shall apply to hospitals as of July 1,
2002.
SEC. 508. ONE-YEAR DELAY IN LOCK IN PROCEDURES FOR
MEDICARE+CHOICE 
PLANS; 
CHANGE 
IN
MEDICARE+CHOICE REPORTING DEADLINES
AND ANNUAL, COORDINATED ELECTION PE-
RIOD FOR 2002.
(a) LOCK-IN DELAY.—Section 1851(e) (42 U.S.C.
1395w–21(e)) is amended—
137
(1) in paragraph (2)(A), by striking ‘‘THROUGH
2001’’ and ‘‘and 2001’’ and inserting ‘‘THROUGH
2002’’ and ‘‘2001, and 2002’’, respectively;
(2) in paragraph (2)(B), by striking ‘‘DURING
2002’’ and inserting ‘‘DURING 2003’’;
(3) in paragraphs (2)(B)(i) and (2)(C)(i), by
striking ‘‘2002’’ and inserting ‘‘2003’’ each place it
appears;
(4) in paragraph (2)(D), by striking ‘‘2001’’
and inserting ‘‘2002’’; and
(5) in paragraph (4), by striking ‘‘2002’’ and
inserting ‘‘2003’’ each place it appears.
(b) CHANGE
IN DEADLINES
AND ELECTION PE-
RIOD.—
(1) IN GENERAL.—Notwithstanding any other
provision of law—
(A) the deadline for submittal of informa-
tion under section 1854(a)(1) of the Social Se-
curity Act (42 U.S.C. 1395w–24(a)(1)) for
2002 is changed from July 1, 2002, to the third
Monday in September of 2002; and
(B) the annual, coordinated election period
under section 1851(e)(3)(B) of such Act (42
U.S.C. 1395w–21(e)(3)(B)) with respect to
2003 shall be the period beginning on Novem-
138
ber 15, 2002, and ending on December 31,
2002.
(2) GAO STUDY ON IMPACT OF CHANGE ON
BENEFICIARIES AND PLANS.—The Comptroller Gen-
eral of the United States shall conduct a review of
the Medicare+Choice open enrollment process that
occurred during 2001, including the offering of
Medicare+Choice plans for 2002. By not later than
May 31, 2002, the Comptroller General shall submit
a report to Congress and the Secretary on such re-
view. Such report shall include the following:
(A) An analysis of the effect of allowing
additional time for the submittal of adjusted
community rates and other data on the extent
of participation of Medicare+Choice organiza-
tions and on the benefits offered under
Medicare+Choice plans.
(B) An evaluation of the plan-specific in-
formation provided to beneficiaries, the timeli-
ness of the receipt of such information, the ade-
quacy of the duration of the open enrollment
period, and relevant operational issues that
arise as a result of the timing and duration of
the open enrollment period, including any prob-
139
lems related to the provision services imme-
diately following enrollment.
(C) The results of surveys of beneficiaries
and Medicare+Choice organizations.
(D) Such recommendations regarding the
appropriateness of the changes provided under
paragraph (1) as the Comptroller General finds
appropriate.
SEC. 509. BIPA-RELATED TECHNICAL AMENDMENTS AND
CORRECTIONS.
(a) TECHNICAL AMENDMENTS RELATING TO ADVI-
SORY COMMITTEE UNDER BIPA SECTION 522.—(1) Sub-
section (i) of section 1114 (42 U.S.C. 1314)—
(A) is transferred to section 1862 and added at
the end of such section; and
(B) is redesignated as subsection (j).
(2) Section 1862 (42 U.S.C. 1395y) is amended—
(A) in the last sentence of subsection (a), by
striking ‘‘established under section 1114(f)’’; and
(B) in subsection (j), as so transferred and
redesignated—
(i) by striking ‘‘under subsection (f)’’; and
(ii) by striking ‘‘section 1862(a)(1)’’ and
inserting ‘‘subsection (a)(1)’’.
140
(b) 
TERMINOLOGY
CORRECTIONS.—(1) 
Section
1869(c)(3)(I)(ii) (42 U.S.C. 1395ff(c)(3)(I)(ii)), as
amended by section 521 of BIPA, is amended—
(A) in subclause (III), by striking ‘‘policy’’ and
inserting ‘‘determination’’; and
(B) in subclause (IV), by striking ‘‘medical re-
view policies’’ and inserting ‘‘coverage determina-
tions’’.
(2) Section 1852(a)(2)(C) (42 U.S.C. 1395w–
22(a)(2)(C)) is amended by striking ‘‘policy’’ and ‘‘POL-
ICY’’ and inserting ‘‘determination’’ each place it appears
and ‘‘DETERMINATION’’, respectively.
(c) REFERENCE CORRECTIONS.—Section 1869(f)(4)
(42 U.S.C. 1395ff(f)(4)), as added by section 522 of
BIPA, is amended—
(1) in subparagraph (A)(iv), by striking ‘‘sub-
clause (I), (II), or (III)’’ and inserting ‘‘clause (i),
(ii), or (iii)’’;
(2) in subparagraph (B), by striking ‘‘clause
(i)(IV)’’ and ‘‘clause (i)(III)’’ and inserting ‘‘sub-
paragraph (A)(iv)’’ and ‘‘subparagraph (A)(iii)’’, re-
spectively; and
(3) in subparagraph (C), by striking ‘‘clause
(i)’’, ‘‘subclause (IV)’’ and ‘‘subparagraph (A)’’ and
inserting ‘‘subparagraph (A)’’, ‘‘clause (iv)’’ and
141
‘‘paragraph (1)(A)’’, respectively each place it ap-
pears.
(d) OTHER CORRECTIONS.—Effective as if included
in the enactment of section 521(c) of BIPA, section
1154(e) (42 U.S.C. 1320c–3(e)) is amended by striking
paragraph (5).
(e) EFFECTIVE DATE.—Except as otherwise pro-
vided, the amendments made by this section shall be effec-
tive as if included in the enactment of BIPA.
SEC. 510. CONFORMING AUTHORITY TO WAIVE A PROGRAM
EXCLUSION.
The first sentence of section 1128(c)(3)(B) (42
U.S.C. 1320a–7(c)(3)(B)) is amended to read as follows:
‘‘Subject to subparagraph (G), in the case of an exclusion
under subsection (a), the minimum period of exclusion
shall be not less than five years, except that, upon the
request of the administrator of a Federal health care pro-
gram (as defined in section 1128B(f)) who determines
that the exclusion would impose a hardship on individuals
entitled to benefits under part A of title XVIII or enrolled
under part B of such title, or both, the Secretary may
waive the exclusion under subsection (a)(1), (a)(3), or
(a)(4) with respect to that program in the case of an indi-
vidual or entity that is the sole community physician or
142
sole source of essential specialized services in a commu-
nity.’’.
SEC. 511. TREATMENT OF CERTAIN DENTAL CLAIMS.
(a) IN GENERAL.—Section 1862 (42 U.S.C. 1395y)
is amended by inserting after subsection (c) the following
new subsection:
‘‘(d)(1) Subject to paragraph (2), a group health plan
(as defined in subsection (a)(1)(A)(v)) providing supple-
mental or secondary coverage to individuals also entitled
to services under this title shall not require a medicare
claims determination under this title for dental benefits
specifically excluded under subsection (a)(12) as a condi-
tion of making a claims determination for such benefits
under the group health plan.
‘‘(2) A group health plan may require a claims deter-
mination under this title in cases involving or appearing
to involve inpatient dental hospital services or dental serv-
ices expressly covered under this title pursuant to actions
taken by the Secretary.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall take effect on the date that is 60 days
after the date of the enactment of this Act.
143
SEC. 512. MISCELLANEOUS REPORTS, STUDIES, AND PUBLI-
CATION REQUIREMENTS.
(a) GAO REPORTS ON THE PHYSICIAN COMPENSA-
TION.—
(1) SUSTAINABLE GROWTH RATE
AND UP-
DATES.—Not later than 6 months after the date of
the enactment of this Act, the Comptroller General
of the United States shall submit to Congress a re-
port on the appropriateness of the updates in the
conversion factor under subsection (d)(3) of section
1848 of the Social Security Act (42 U.S.C. 1395w–
4), including the appropriateness of the sustainable
growth rate formula under subsection (f) of such
section for 2002 and succeeding years. Such report
shall examine the stability and predictability of such
updates and rate and alternatives for the use of such
rate in the updates.
(2) PHYSICIAN COMPENSATION GENERALLY.—
Not later than 12 months after the date of the en-
actment of this Act, the Comptroller General shall
submit to Congress a report on all aspects of physi-
cian compensation for services furnished under title
XVIII of the Social Security Act, and how those as-
pects interact and the effect on appropriate com-
pensation for physician services. Such report shall
review alternatives for the physician fee schedule
144
under section 1848 of such title (42 U.S.C. 1395w–
4).
(b) PROMPT SUBMISSION OF OVERDUE REPORTS ON
PAYMENT AND UTILIZATION OF OUTPATIENT THERAPY
SERVICES.—The Secretary shall submit to Congress as ex-
peditiously as practicable the reports required under sec-
tion 4541(d)(2) of the Balanced Budget Act of 1997 (re-
lating to alternatives to a single annual dollar cap on out-
patient therapy) and under section 221(d) of the Medi-
care, Medicaid, and SCHIP Balanced Budget Refinement
Act of 1999 (relating to utilization patterns for outpatient
therapy).
(c) ANNUAL PUBLICATION OF LIST OF NATIONAL
COVERAGE DETERMINATIONS.—The Secretary shall pro-
vide, in an appropriate annual publication available to the
public, a list of national coverage determinations made
under title XVIII of the Social Security Act in the pre-
vious year and information on how to get more informa-
tion with respect to such determinations.
Passed the House of Representatives December 4,
2001.
Attest:
Clerk.