I
104TH CONGRESS
2D SESSION
H. R. 4248
To amend title XVIII of the Social Security Act to provide for coverage
under part B of the Medicare program of certain antibiotics that are
parenterally administered in a home setting.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 27, 1996
Ms. GREENE of Utah 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 jurisdic-
tion of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to provide
for coverage under part B of the Medicare program
of certain antibiotics that are parenterally administered
in a home 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 Antibiotic
Coverage Amendments of 1996’’.
SEC. 2. MEDICARE COVERAGE OF CERTAIN PARENTERALLY
ADMINISTERED ANTIBIOTICS.
(a) IN GENERAL.—Section 1861(s)(2) of the Social
Security Act (42 U.S.C. 1395x(s)(2)) is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graphs (N) and (O);
(2) by redesignating subparagraph (Q) as sub-
paragraph (P), and by adding ‘‘and’’ at the end of
such subparagraph; and
(3) by adding at the end the following:
‘‘(Q) an antibiotic described in section 1834(k)
that is administered parenterally in the patient’s
home (including an institution used as his home
other than an institution that meets the require-
ments of section 1861(e)(1) of this section or section
1819(a)(1));’’.
(b) ANTIBIOTICS DESCRIBED.—Section 1834 of such
Act (42 U.S.C. 1395m) is amended by adding at the end
the following:
‘‘(k) For purposes of section 1861(s)(2)(Q), an anti-
biotic described in this subsection is an antibiotic that can
only be administered parenterally and that is being admin-
istered to treat osteomyelitis, infected joint replacements,
endocarditis, or a soft tissue infection.’’.
(c) LIMITATION ON COVERAGE OF VANCOMYCIN.—
Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is
amended—
(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) where such expenses are for the use of
Vancomycin under section 1861(s)(2)(Q) unless such
use is in accordance with guidelines established by
the Centers for Disease Control and Prevention for
the prudent use of such antibiotic.’’.
(d) REDUCTION
IN HOSPITAL UPDATE
FOR IN-
CREASES IN PAYMENTS.—Section 1886(d)(3)(C) of such
Act (42 U.S.C. 1395ww(d)(3)(C)) is amended by adding
at the end the following new clause:
‘‘(iii) MAINTAINING BUDGET NEUTRALITY FOR
COVERAGE
OF
CERTAIN
ANTIBIOTICS.—For dis-
charges occurring in a fiscal year (beginning with
fiscal year 1998), the Secretary shall adjust each of
such average standardized amounts so as to provide
for a reduction in the total amount of the payments
(attributable to this paragraph) made for such dis-
charges by the amount (if any) by which net pay-
ments under this title for the previous fiscal year
(not taking into account this clause) were increased
as a result of the amendments made by the Medi-
care Antibiotic Coverage Amendments of 1996.’’.
(e) EFFECTIVE DATE.—The amendments made by
this section shall apply to drugs administered on or after
April 1, 1998.
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