258
(3) LIMITATION ON APPLICATION TO SGR.—For 
purposes of applying section 1848(f)(2)(D) of the 
Social Security Act (42 U.S.C. 1395w–4(f)(2)(D)), 
the amendment made by subsection (a) shall not be 
considered to be a change in law or regulation. 
(c) PROVISIONS RELATING
TO ADVANCE BENE-
FICIARY NOTICES; REPORT ON PRIOR DETERMINATION 
PROCESS.—
(1) DATA
COLLECTION.—The Secretary shall 
establish a process for the collection of information 
on the instances in which an advance beneficiary no-
tice (as defined in paragraph (4)) has been provided 
and on instances in which a beneficiary indicates on 
such a notice that the beneficiary does not intend to 
seek to have the item or service that is the subject 
of the notice furnished. 
(2) OUTREACH
AND
EDUCATION.—The Sec-
retary shall establish a program of outreach and 
education for beneficiaries and providers of services 
and other persons on the appropriate use of advance 
beneficiary notices and coverage policies under the 
medicare program. 
(3) GAO REPORT ON USE OF ADVANCE BENE-
FICIARY NOTICES.—Not later than 18 months after 
the date on which section 1869(g) of the Social Se-
259
curity Act (as added by subsection (a)) takes effect, 
the Comptroller General of the United States shall 
submit to Congress a report on the use of advance 
beneficiary notices under title XVIII of such Act. 
Such report shall include information concerning the 
providers of services and other persons that have 
provided such notices and the response of bene-
ficiaries to such notices. 
(4) GAO REPORT ON USE OF PRIOR DETER-
MINATION
PROCESS.—Not later than 18 months 
after the date on which section 1869(g) of the Social 
Security Act (as added by subsection (a)) takes ef-
fect, the Comptroller General of the United States 
shall submit to Congress a report on the use of the 
prior determination process under such section. Such 
report shall include—
(A) information concerning the types of 
procedures for which a prior determination has 
been sought, determinations made under the 
process, and changes in receipt of services re-
sulting from the application of such process; 
and 
(B) an evaluation of whether the process 
was useful for physicians (and other suppliers) 
and beneficiaries, whether it was timely, and
260
whether the amount of information required 
was burdensome to physicians and beneficiaries. 
(5) 
ADVANCE
BENEFICIARY
NOTICE
DE-
FINED.—In this subsection, the term ‘‘advance bene-
ficiary notice’’ means a written notice provided 
under section 1879(a) of the Social Security Act (42 
U.S.C. 1395pp(a)) to an individual entitled to bene-
fits under part A or B of title XVIII of such Act 
before items or services are furnished under such 
part in cases where a provider of services or other 
person that would furnish the item or service be-
lieves that payment will not be made for some or all 
of such items or services under such title. 
Subtitle E—Miscellaneous 
Provisions 
SEC. 841. POLICY DEVELOPMENT REGARDING EVALUATION 
AND MANAGEMENT (E & M) DOCUMENTATION 
GUIDELINES. 
(a) IN GENERAL.—The Secretary may not implement 
any new documentation guidelines for evaluation and man-
agement physician services under the title XVIII of the 
Social Security Act on or after the date of the enactment 
of this Act unless the Secretary—
(1) has developed the guidelines in collaboration 
with practicing physicians (including both generalists
261
and specialists) and provided for an assessment of 
the proposed guidelines by the physician community; 
(2) has established a plan that contains specific 
goals, including a schedule, for improving the use of 
such guidelines; 
(3) has conducted appropriate and representa-
tive pilot projects under subsection (b) to test modi-
fications to the evaluation and management docu-
mentation guidelines; 
(4) finds that the objectives described in sub-
section (c) will be met in the implementation of such 
guidelines; and 
(5) has established, and is implementing, a pro-
gram to educate physicians on the use of such guide-
lines and that includes appropriate outreach. 
The Secretary shall make changes to the manner in which 
existing evaluation and management documentation guide-
lines are implemented to reduce paperwork burdens on 
physicians. 
(b) PILOT PROJECTS TO TEST EVALUATION AND 
MANAGEMENT DOCUMENTATION GUIDELINES.—
(1) IN GENERAL.—The Secretary shall conduct 
under this subsection appropriate and representative 
pilot projects to test new evaluation and manage-
262
ment documentation guidelines referred to in sub-
section (a). 
(2) LENGTH AND CONSULTATION.—Each pilot 
project under this subsection shall—
(A) be voluntary; 
(B) be of sufficient length as determined 
by the Secretary to allow for preparatory physi-
cian and medicare contractor education, anal-
ysis, and use and assessment of potential eval-
uation and management guidelines; and 
(C) be conducted, in development and 
throughout the planning and operational stages 
of the project, in consultation with practicing 
physicians (including both generalists and spe-
cialists). 
(3) RANGE OF PILOT PROJECTS.—Of the pilot 
projects conducted under this subsection—
(A) at least one shall focus on a peer re-
view method by physicians (not employed by a 
medicare contractor) which evaluates medical 
record information for claims submitted by phy-
sicians identified as statistical outliers relative 
to definitions published in the Current Proce-
dures Terminology (CPT) code book of the 
American Medical Association;
263
(B) at least one shall focus on an alter-
native method to detailed guidelines based on 
physician documentation of face to face encoun-
ter time with a patient; 
(C) at least one shall be conducted for 
services furnished in a rural area and at least 
one for services furnished outside such an area; 
and 
(D) at least one shall be conducted in a 
setting where physicians bill under physicians’ 
services in teaching settings and at least one 
shall be conducted in a setting other than a 
teaching setting. 
(4) 
BANNING
OF
TARGETING
OF
PILOT 
PROJECT PARTICIPANTS.—Data collected under this 
subsection shall not be used as the basis for overpay-
ment demands or post-payment audits. Such limita-
tion applies only to claims filed as part of the pilot 
project and lasts only for the duration of the pilot 
project and only as long as the provider is a partici-
pant in the pilot project. 
(5) STUDY
OF
IMPACT.—Each pilot project 
shall examine the effect of the new evaluation and 
management documentation guidelines on—
264
(A) different types of physician practices, 
including those with fewer than 10 full-time-
equivalent employees (including physicians); 
and 
(B) the costs of physician compliance, in-
cluding education, implementation, auditing, 
and monitoring. 
(6) PERIODIC REPORTS.—The Secretary shall 
submit to Congress periodic reports on the pilot 
projects under this subsection. 
(c) OBJECTIVES FOR EVALUATION AND MANAGE-
MENT GUIDELINES.—The objectives for modified evalua-
tion and management documentation guidelines developed 
by the Secretary shall be to—
(1) identify clinically relevant documentation 
needed to code accurately and assess coding levels 
accurately; 
(2) decrease the level of non-clinically pertinent 
and burdensome documentation time and content in 
the physician’s medical record; 
(3) increase accuracy by reviewers; and 
(4) educate both physicians and reviewers. 
(d) STUDY OF SIMPLER, ALTERNATIVE SYSTEMS OF 
DOCUMENTATION FOR PHYSICIAN CLAIMS.—
265
(1) STUDY.—The Secretary shall carry out a 
study of the matters described in paragraph (2). 
(2) MATTERS
DESCRIBED.—The matters re-
ferred to in paragraph (1) are—
(A) the development of a simpler, alter-
native system of requirements for documenta-
tion accompanying claims for evaluation and 
management physician services for which pay-
ment is made under title XVIII of the Social 
Security Act; and 
(B) consideration of systems other than 
current coding and documentation requirements 
for payment for such physician services. 
(3) CONSULTATION
WITH
PRACTICING
PHYSI-
CIANS.—In designing and carrying out the study 
under paragraph (1), the Secretary shall consult 
with practicing physicians, including physicians who 
are part of group practices and including both gen-
eralists and specialists. 
(4) APPLICATION OF HIPAA UNIFORM CODING 
REQUIREMENTS.—In developing an alternative sys-
tem under paragraph (2), the Secretary shall con-
sider requirements of administrative simplification 
under part C of title XI of the Social Security Act.
266
(5) REPORT TO CONGRESS.—(A) Not later than 
October 1, 2004, 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, 2004, 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.
267
SEC. 842. 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
268
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 
823(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
269
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
270
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, 
2003, 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
271
flexibility it offers for ensuring timely patient 
access to new medical technology for which data 
are still being 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:
272
‘‘(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, 2004 (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-
273
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.
274
‘‘(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. 843. 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
275
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. 844. 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
276
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, 2003. 
(b) NOTIFICATION OF PROVIDERS WHEN EMTALA 
INVESTIGATION CLOSED.—Section 1867(d) (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.—
277
(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 organization’s report to the 
hospital or physician consistent with confiden-
tiality requirements imposed on the organiza-
tion under such part B.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to terminations of par-
278
ticipation initiated on or after the date of the enact-
ment of this Act. 
SEC. 845. EMERGENCY MEDICAL TREATMENT AND 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 
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-
surgery, obstetrics-gynecology, and psychiatry, with
279
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
280
(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).
281
SEC. 846. 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)), as amended by section 
421(b), is amended by adding at the end the following new 
paragraph: 
‘‘(5) 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.’’.
282
(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. 847. 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 
(2) 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
283
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, 
2003.
SEC. 848. 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).
284
(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 re-
designated—
(i) by striking ‘‘under subsection (f)’’; and 
(ii) by striking ‘‘section 1862(a)(1)’’ and 
inserting ‘‘subsection (a)(1)’’. 
(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—
285
(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 
‘‘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. 849. 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
286
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 
sole source of essential specialized services in a commu-
nity.’’. 
SEC. 850. TREATMENT OF CERTAIN DENTAL CLAIMS. 
(a) IN GENERAL.—Section 1862 (42 U.S.C. 1395y) 
is amended by adding after subsection (g) the following 
new subsection: 
‘‘(h)(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
287
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. 
SEC. 851. ANNUAL PUBLICATION OF LIST OF NATIONAL 
COVERAGE DETERMINATIONS. 
The Secretary shall provide, in an appropriate annual 
publication available to the public, a list of national cov-
erage determinations made under title XVIII of the Social 
Security Act in the previous year and information on how 
to get more information with respect to such determina-
tions. 
TITLE IX—MEDICAID 
PROVISIONS 
SEC. 901. NATIONAL BIPARTISAN COMMISSION ON THE FU-
TURE OF MEDICAID. 
(a) ESTABLISHMENT.—There is established a com-
mission to be known as the National Bipartisan Commis-
sion on the Future of Medicaid (in this section referred 
to as the ‘‘Commission’’). 
(b) DUTIES OF THE COMMISSION.—The Commission 
shall—
288
(1) review and analyze the long-term financial 
condition of the medicaid program under title XIX 
of the Social Security Act (42 U.S.C. 1396 et seq.); 
(2) identify the factors that are causing, and 
the consequences of, increases in costs under the 
medicaid program, including—
(A) the impact of these cost increases upon 
State budgets, funding for other State pro-
grams, and levels of State taxes necessary to 
fund growing expenditures under the medicaid 
program; 
(B) the financial obligations of the Federal 
government arising from the Federal matching 
requirement for expenditures under the med-
icaid program; and 
(C) the size and scope of the current pro-
gram and how the program has evolved over 
time;
(3) analyze potential policies that will ensure 
both the financial integrity of the medicaid program 
and the provision of appropriate benefits under such 
program; 
(4) make recommendations for establishing in-
centives and structures to promote enhanced effi-
289
ciencies and ways of encouraging innovative State 
policies under the medicaid program; 
(5) make recommendations for establishing the 
appropriate balance between benefits covered, pay-
ments to providers, State and Federal contributions 
and, where appropriate, recipient cost-sharing obli-
gations; 
(6) make recommendations on the impact of 
promoting increased utilization of competitive, pri-
vate enterprise models to contain program cost 
growth, through enhanced utilization of private 
plans, pharmacy benefit managers, and other meth-
ods currently being used to contain private sector 
health-care costs; 
(7) make recommendations on the financing of 
prescription drug benefits currently covered under 
medicaid programs, including analysis of the current 
Federal manufacturer rebate program, its impact 
upon both private market prices as well as those 
paid by other government purchasers, recent State 
efforts to negotiate additional supplemental manu-
facturer rebates and the ability of pharmacy benefit 
managers to lower drug costs;
290
(8) review and analyze such other matters relat-
ing to the medicaid program as the Commission 
deems appropriate; and 
(9) analyze the impact of impending demo-
graphic changes upon medicaid benefits, including 
long term care services, and make recommendations 
for how best to appropriately divide State and Fed-
eral responsibilities for funding these benefits. 
(c) MEMBERSHIP.—
(1) NUMBER AND APPOINTMENT.—The Com-
mission shall be composed of 17 members, of 
whom—
(A) four shall be appointed by the Presi-
dent; 
(B) six shall be appointed by the Majority 
Leader of the Senate, in consultation with the 
Minority Leader of the Senate, of whom not 
more than 4 shall be of the same political party; 
(C) six shall be appointed by the Speaker 
of the House of Representatives, in consultation 
with the Minority Leader of the House of Rep-
resentatives, of whom not more than 4 shall be 
of the same political party; and 
(D) one, who shall serve as Chairman of 
the Commission, appointed jointly by the Presi-
291
dent, Majority Leader of the Senate, and the 
Speaker of the House of Representatives. 
(2) DEADLINE FOR APPOINTMENT.—Members 
of the Commission shall be appointed by not later 
than December 1, 2002.
(3) TERMS
OF
APPOINTMENT.—The term of 
any appointment under paragraph (1) to the Com-
mission shall be for the life of the Commission. 
(4) MEETINGS.—The Commission shall meet at 
the call of its Chairman or a majority of its mem-
bers. 
(5) QUORUM.—A quorum shall consist of 8 
members of the Commission, except that 4 members 
may conduct a hearing under subsection (e). 
(6) VACANCIES.—A vacancy on the Commission 
shall be filled in the same manner in which the origi-
nal appointment was made not later than 30 days 
after the Commission is given notice of the vacancy 
and shall not affect the power of the remaining 
members to execute the duties of the Commission. 
(7) COMPENSATION.—Members of the Commis-
sion shall receive no additional pay, allowances, or 
benefits by reason of their service on the Commis-
sion.
292
(8) EXPENSES.—Each member of the Commis-
sion shall receive travel expenses and per diem in 
lieu of subsistence in accordance with sections 5702 
and 5703 of title 5, United States Code. 
(d) STAFF AND SUPPORT SERVICES.—
(1) EXECUTIVE DIRECTOR.—
(A) APPOINTMENT.—The Chairman shall 
appoint an executive director of the Commis-
sion. 
(B) COMPENSATION.—The executive direc-
tor shall be paid the rate of basic pay for level 
V of the Executive Schedule. 
(2) STAFF.—With the approval of the Commis-
sion, the executive director may appoint such per-
sonnel as the executive director considers appro-
priate. 
(3) APPLICABILITY OF CIVIL SERVICE LAWS.—
The staff of the Commission shall be appointed with-
out regard to the provisions of title 5, United States 
Code, governing appointments in the competitive 
service, and shall be paid without regard to the pro-
visions of chapter 51 and subchapter III of chapter 
53 of such title (relating to classification and Gen-
eral Schedule pay rates).
293
(4) EXPERTS
AND
CONSULTANTS.—With the 
approval of the Commission, the executive director 
may procure temporary and intermittent services 
under section 3109(b) of title 5, United States Code. 
(5) PHYSICAL FACILITIES.—The Administrator 
of the General Services Administration shall locate 
suitable office space for the operation of the Com-
mission. The facilities shall serve as the head-
quarters of the Commission and shall include all 
necessary equipment and incidentals required for the 
proper functioning of the Commission. 
(e) POWERS OF COMMISSION.—
(1) HEARINGS
AND
OTHER
ACTIVITIES.—For 
the purpose of carrying out its duties, the Commis-
sion may hold such hearings and undertake such 
other activities as the Commission determines to be 
necessary to carry out its duties. 
(2) STUDIES BY GAO.—Upon the request of the 
Commission, the Comptroller General shall conduct 
such studies or investigations as the Commission de-
termines to be necessary to carry out its duties.
(3) COST
ESTIMATES
BY
CONGRESSIONAL 
BUDGET OFFICE AND OFFICE OF THE CHIEF ACTU-
ARY OF CMS.—
294
(A) The Director of the Congressional 
Budget Office or the Chief Actuary of the Cen-
ters for Medicare & Medicaid Services, or both, 
shall provide to the Commission, upon the re-
quest of the Commission, such cost estimates as 
the Commission determines to be necessary to 
carry out its duties. 
(B) The Commission shall reimburse the 
Director of the Congressional Budget Office for 
expenses relating to the employment in the of-
fice of the Director of such additional staff as 
may be necessary for the Director to comply 
with requests by the Commission under sub-
paragraph (A). 
(4) DETAIL OF FEDERAL EMPLOYEES.—Upon 
the request of the Commission, the head of any Fed-
eral agency is authorized to detail, without reim-
bursement, any of the personnel of such agency to 
the Commission to assist the Commission in car-
rying out its duties. Any such detail shall not inter-
rupt or otherwise affect the civil service status or 
privileges of the Federal employee. 
(5) TECHNICAL
ASSISTANCE.—Upon the re-
quest of the Commission, the head of a Federal 
agency shall provide such technical assistance to the
296
fice, the Commission shall be deemed to be a com-
mittee of the Congress. 
(f) REPORT.—Not later than March 1, 2004, the 
Commission shall submit a report to the President and 
Congress which shall contain a detailed statement of the 
recommendations, findings, and conclusions of the Com-
mission. 
(g) TERMINATION.—The Commission shall terminate 
30 days after the date of submission of the report required 
in subsection (f). 
(h) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated $1,500,000 to carry out 
this section. 
SEC. 902. DISPROPORTIONATE SHARE HOSPITAL (DSH) 
PAYMENTS. 
Section 1923(f)(3) (42 U.S.C. 1396r–4(f)(3)) is 
amended—
(1) in subparagraph (A), by amending subpara-
graph (A) to read as follows: 
‘‘(A) IN GENERAL.—The DSH allotment 
for any State—
‘‘(i) for fiscal year 2003 is equal to 
the DSH allotment for the State for fiscal 
year 2001 under the table in paragraph 
(2), without regard to paragraph (4), in-
297
creased, subject to subparagraph (B) and 
paragraph (5), by the percentage change in 
the consumer price index for all urban con-
sumers (all items; U.S. city average), for 
fiscal year 2001; and 
‘‘(ii) for each succeeding fiscal year is 
equal to the DSH allotment for the State 
for the previous fiscal year under this sub-
paragraph increased, subject to subpara-
graph (B) and paragraph (5), by 1.7 per-
cent or, in the case of fiscal years begin-
ning with the fiscal year specified in sub-
paragraph (C) for that State, the percent-
age change in the consumer price index for 
all urban consumers (all items; U.S. city 
average), for the previous fiscal year.’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(C) FISCAL YEAR SPECIFIED.—For pur-
poses of subparagraph (A)(ii), the fiscal year 
specified in this subparagraph for a State is the 
first fiscal year for which the Secretary esti-
mates that the DSH allotment for that State 
will equal (or no longer exceed) the DSH allot-
ment for that State under the law as in effect
298
before the date of the enactment of this sub-
paragraph.’’.
Æ