I
104TH CONGRESS
2D SESSION
H. R. 4100
To amend titles XVIII and XIX of the Social Security Act to require hospitals
participating in the Medicare or Medicaid program to provide notice
of availability of Medicare and Medicaid providers as part of discharge
planning and to maintain and disclose information on certain referrals.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 17, 1996
Mr. STARK introduced the following bill; which was referred to the Committee
on Commerce, and in addition to the Committee on Ways and Means,
for a period to be subsequently determined by the Speaker, in each case
for consideration of such provisions as fall within the jurisdiction of the
committee concerned
A BILL
To amend titles XVIII and XIX of the Social Security Act
to require hospitals participating in the Medicare or Med-
icaid program to provide notice of availability of Medi-
care and Medicaid providers as part of discharge plan-
ning and to maintain and disclose information on certain
referrals.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Medicare and Medicaid
Hospital Self-Referral Amendments of 1996’’.
SEC. 2. NOTIFICATION OF AVAILABILITY OF PROVIDERS AS
PART OF DISCHARGE PLANNING PROCESS.
(a) MEDICARE REQUIREMENT.—Section 1861(ee)(2)
of the Social Security Act (42 U.S.C. 1395x(ee)(2)) is
amended—
(1) in subparagraph (D), by inserting before
the period the following: ‘‘, including the availability
of those services through individuals and entities
that participate in the program under this title and
that serve the area in which the patient resides and
that request to be listed by the hospital as avail-
able’’; and
(2) by adding at the end the following:
‘‘(H) Consistent with section 1802, the dis-
charge plan shall—
‘‘(i) not specify or otherwise limit the
qualified provider which may provide post-hos-
pital care, and
‘‘(ii) identify (in a form and manner speci-
fied by the Secretary) any provider (to whom
the individual is referred) in which the hospital
has a disclosable financial interest (as specified
by the Secretary consistent with section
1866(a)(1)(R)) or which has such an interest in
the hospital.’’.
(b) REQUIREMENT FOR MEDICAID FUNDING.—Sec-
tion 1903(i) of such Act (42 U.S.C. 1396b(i)) is amend-
ed—
(1) by striking ‘‘or’’ at the end of paragraph
(14),
(2) by striking the period at the end of para-
graph (15) and inserting ‘‘; or’’, and
(3) by inserting after paragraph (15) the fol-
lowing new paragraph:
‘‘(16) with respect to any amount expended for
inpatient hospital services of a hospital unless the
hospital has in place a discharge planning process
that meets the requirements of section 1861(ee) with
respect to individuals entitled to medical assistance
under this title in the same manner as such require-
ments otherwise apply to individuals entitled to ben-
efits under title XVIII.’’.
(c) EFFECTIVE DATES.—The amendments made by
subsection (a) shall apply to discharges occurring on or
after 90 days after the date of the enactment of this Act.
The amendments made by subsection (b) shall apply to
expenditures for inpatient hospital services with respect to
discharges occurring on or after 90 days after the date
of the enactment of this Act.
SEC. 3. MAINTENANCE AND DISCLOSURE OF INFORMATION
ON POST-HOSPITAL SERVICE PROVIDERS.
(a) MEDICARE REQUIREMENT.—Section 1866(a)(1)
of the Social Security Act (42 U.S.C. 1395cc(a)(1)) is
amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (P),
(2) by striking the period at the end of sub-
paragraph (Q), and
(3) by adding at the end the following:
‘‘(R) in the case of a hospital that has a finan-
cial interest (as specified by the Secretary in regula-
tions) in a provider of post-hospital services (includ-
ing an entity that furnishes durable medical equip-
ment), or in which such a provider has such a finan-
cial interest, or in which another entity has such a
financial interest (directly or indirectly) with such
hospital and such a provider, to maintain and dis-
close to the Secretary (in a form and manner speci-
fied by the Secretary) information on—
‘‘(i) the nature of such financial interest,
‘‘(ii) the number of individuals who were dis-
charged from the hospital and who were identified as
requiring the type of post-hospital services provided
by such provider, and
‘‘(iii) the percentage of such individuals who re-
ceived such services from such provider (or another
such provider).’’.
(b) REQUIREMENT FOR MEDICAID FUNDING.—Sec-
tion 1903(i)(16) of such Act (42 U.S.C. 1396b(i)), as in-
serted by section 2(b), is amended—
(1) by striking ‘‘(A)’’ after ‘‘unless’’, and
(2) by inserting before the period at the end the
following: ‘‘, and (B) the hospital is complying with
the requirements of section 1866(a)(1)(R)’’.
(c) DISCLOSURE
OF INFORMATION
TO
THE PUB-
LIC.—Title XI of such Act is amended by inserting after
section 1145 the following new section:
‘‘PUBLIC
DISCLOSURE
OF
CERTAIN
INFORMATION
ON
HOSPITAL
FINANCIAL
INTEREST
AND
REFERRAL
PATTERNS
‘‘SEC. 1146. The Secretary shall make available to
the public, in a form and manner specified by the Sec-
retary, information disclosed to the Secretary pursuant to
section 1866(a)(1)(R) or section 1903(i)(16).’’.
(d) EFFECTIVE DATE.—The Secretary of Health and
Human Services shall issue regulations by not later than
1 year after the date of the enactment of this Act to carry
out the amendments made by this section and such
amendments shall take effect as of such date (on or after