I
106TH CONGRESS
2D SESSION
H. R. 5209
To amend title XVIII of the Social Security Act to revise the payments
for certain physician pathology services under the medicare program.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 19, 2000
Mr. FOLEY (for himself and Mr. TANNER) 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 revise
the payments for certain physician pathology services
under the medicare program.
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 ‘‘Physician Pathology
Services Fair Payment Act of 2000’’.
SEC. 2. TREATMENT OF CERTAIN PHYSICIAN PATHOLOGY
SERVICES UNDER MEDICARE.
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, when an independent laboratory, under a
grandfathered arrangement with a hospital, furnishes the
technical component of a physician pathology service with
respect to—
(1) an inpatient fee-for-service medicare bene-
ficiary, such component shall be treated as a service
for which payment shall be made to the laboratory
under section 1848 of the Social Security Act (42
U.S.C. 1395w–4) and not as an inpatient hospital
service for which payment is made to the hospital
under section 1886(d) of such Act (42 U.S.C.
1395ww(d)); and
(2) an outpatient fee-for-service medicare bene-
ficiary, such component shall be treated as a service
for which payment shall be made to the laboratory
under section 1848 of such Act (42 U.S.C. 1395w–
4) and not as a hospital outpatient service for which
payment is made to the hospital under the prospec-
tive payment system under section 1834(t) of such
Act (42 U.S.C. 1395l(d)).
(b) DEFINITIONS.—For purposes of this section:
(1) 
GRANDFATHERED
ARRANGEMENT.—The
term ‘‘grandfathered arrangement’’ means an ar-
rangement between an independent laboratory and a
hospital—
(A) that was in effect as of July 22, 1999,
even if such arrangement is subsequently re-
newed; and
(B) under which the laboratory furnishes
the technical component of physician pathology
services with respect to patients of the hospital
and submits a claim for payment for such com-
ponent to a medicare carrier (and not to the
hospital).
(2) INPATIENT
FEE-FOR-SERVICE
MEDICARE
BENEFICIARY.—The term ‘‘inpatient fee-for-service
medicare beneficiary’’ means an individual who—
(A) is an inpatient of the hospital involved;
(B) is entitled to benefits under part A of
title XVIII of the Social Security Act (42
U.S.C. 1395c et seq.); and
(C) is not enrolled in—
(i) a Medicare+Choice plan under
part C of such Act (42 U.S.C. 1395w–21
et seq.);
(ii) a plan offered by an eligible orga-
nization under section 1876 of such Act
(42 U.S.C. 1395mm); or
(iii) a medicare managed care dem-
onstration project.
(3) OUTPATIENT FEE-FOR-SERVICE MEDICARE
BENEFICIARY.—The term ‘‘outpatient fee-for-service
medicare beneficiary’’ means an individual who—
(A) is an outpatient of the hospital in-
volved;
(B) is enrolled under part B of title XVIII
of the Social Security Act (42 U.S.C. 1395j et
seq.); and
(C) is not enrolled in—
(i) a plan or project described in para-
graph (2)(C); or
(ii) a health care prepayment plan
under section 1833(a)(1)(A) of such Act
(42 U.S.C. 1395l(a)(1)(A)).
(4) MEDICARE CARRIER.—The term ‘‘medicare
carrier’’ means an organization with a contract
under section 1842 of the Social Security Act (42
U.S.C. 1395u).
(c) EFFECTIVE DATE.—This section shall apply to
services furnished on or after July 22, 1999.
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