I
105TH CONGRESS
1ST SESSION
H. R. 2558
To amend title XVIII of the Social Security Act to provide for payment
for hospital outpatient department services equal to payment rates estab-
lished for similar services provided outside the hospital setting.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 25, 1997
Mr. STARK introduced the following bill; which was referred to the Committee
on Ways and Means, and in addition to the Committee on Commerce,
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 title XVIII of the Social Security Act to provide
for payment for hospital outpatient department services
equal to payment rates established for similar services
provided outside the hospital setting.
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 Hospital
Outpatient Payment Fairness Act of 1997’’.
SEC. 2. BASING MEDICARE PAYMENT FOR HOSPITAL OUT-
PATIENT DEPARTMENT SERVICES ON PAY-
MENT RATES FOR SIMILAR SERVICES PRO-
VIDED OUTSIDE THE HOSPITAL SETTING.
(a) IN GENERAL.—Section 1833(t)(1) of the Social
Security Act (42 U.S.C. 1395l(t)(1)), as added by section
4523(a) of the Balanced Budget Act of 1997 (Public Law
105–33), is amended—
(1) in subparagraph (A), by inserting
‘‘subject to subparagraph (C),’’ after ‘‘1999,’’,
and
(2) by adding at the end the following new
subparagraph:
‘‘(C) USE
OF
RATES
IN
NON-HOSPITAL
SETTINGS.—With respect to covered OPD serv-
ices furnished on or after January 1, 2000, if
payment may be made under this part for simi-
lar services (such as physicians’ services) fur-
nished outside the hospital setting, in accord-
ance with regulations of the Secretary, the total
amount of payment under this part for such
covered OPD services (including any facility-re-
lated component to such services) shall be de-
termined on the same basis on which payment
may be made for such similar services furnished
outside the hospital setting.’’.
(b) CONFORMING AMENDMENT.—The fifth sentence
of section 1866(a)(2)(A) of such Act (42 U.S.C.
1395cc(a)(2)(A)), as added by section 4523(b) of the Bal-
anced Budget Act of 1997, is amended by inserting ‘‘, or
in the case described in section 1833(t)(1)(C), the coinsur-
ance amount that would otherwise apply with respect to
the provision of the similar services referred to in such
section’’ before the period at the end.
SEC. 3. MEDICARE PAYMENTS FOR INPATIENT HOSPITAL
SERVICES INVOLVING EMERGENCY CARE.
(a) MEDPAC REPORT ON DRG WEIGHTING FAC-
TORS.—The Medicare Payment Advisory Commission (es-
tablished under section 1805 of the Social Security Act,
as inserted by section 4022(a) of the Balanced Budget Act
of 1997 (Public Law 105–33), shall submit a report to
Congress and the Secretary of Health and Human Serv-
ices, by January 1, 1999, on whether the DRG weighting
factors under section 1886(d)(4)(B) of the Social Security
Act for diagnosis-related groups associated with emer-
gency care are adequate to cover the costs of emergency
room use within discharges classified within such groups.
(b) ADJUSTMENT OF WEIGHTING FACTORS.—Taking
into account the report submitted under subsection (a),
the Secretary of Health and Human Services shall make
appropriate adjustments in the DRG weighting factors de-
scribed in subsection (a) for discharges occurring on or
after January 1, 2000, as may be appropriate to ensure
that hospital emergency room costs attributable to medi-
care patients are appropriately covered.
Æ