I
103D CONGRESS
2D SESSION
H. R. 3907
To direct the Secretary of Health and Human Services to carry out a
demonstration project under which physicians providing services to indi-
viduals entitled to benefits under the medicare program will receive
regular information on charges submitted by and payments made to
other providers who furnish services to such individuals.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 24, 1994
Mr. KREIDLER introduced the following bill; which was referred jointly to the
Committees on Ways and Means and Energy and Commerce
A BILL
To direct the Secretary of Health and Human Services to
carry out a demonstration project under which physicians
providing services to individuals entitled to benefits under
the medicare program will receive regular information
on charges submitted by and payments made to other
providers who furnish services to such individuals.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 
1. 
ESTABLISHMENT 
OF 
DEMONSTRATION
PROJECT 
ON 
MEDICARE 
REFERRAL 
RE-
PORTS.
(a) IN GENERAL.—Not later than January 1, 1995,
the Secretary of Health and Human Services (hereafter
in this Act referred to as the ‘‘Secretary’’) shall establish
a demonstration project under which, with respect to pro-
viders of physicians’ services for which payment may be
made under part B of title XVIII of the Social Security
Act within the designated area of the project, the Sec-
retary shall periodically furnish a medicare referral report
(as described in subsection (b)) to the provider on any in-
dividual entitled to benefits under such title to whom the
provider furnishes such services during the period the
project is in effect (subject to subsection (c)). The Sec-
retary shall furnish such reports upon the request of a
provider of physicians’ services under such title and at
such other times as the Secretary may consider appro-
priate.
(b) MEDICARE REFERRAL REPORT DESCRIBED.—
(1) IN GENERAL.—In this section, a ‘‘medicare
referral report’’ means, with respect to an individual,
a report (in such format as the Secretary may estab-
lish) containing the following information:
(A) Any item or service furnished to the
individual during the period the project is in ef-
fect for which payment may be made under title
XVIII of the Social Security Act.
(B) The identity of the individual or entity
furnishing such item or service.
(C) The illness, injury, or condition (in-
cluding any applicable diagnostic code) on
which the furnishing of the item or service is
based.
(D) The amount of payment made for the
item or service under such title.
(E) The amount of charges submitted to
the Secretary with respect to the item or service
(if any) by the individual or entity furnishing
the item or service.
(2) FORMAT.—A medicare referral report shall
be provided in such electronic and printed formats
as the Secretary may establish, and shall be fur-
nished to a provider in the format the provider
specifies.
(c) PATIENT CONSENT REQUIRED.—
(1) IN GENERAL.—No medicare referral report
may be furnished under the project with respect to
information relating to any individual unless the in-
dividual has provided written consent to the Sec-
retary (in such form as the Secretary may require)
for the reporting of such information.
(2) RENEWAL
OF
CONSENT.—The Secretary
may limit the period for which the consent provided
pursuant to paragraph (1) shall be effective and es-
tablish a process under which an individual may
renew the consent for an additional period.
(d) CONSULTATION REQUIREMENT.—In carrying out
this Act, including the selection of the areas in which the
demonstration project will be carried out, the development
of formats for medicare referral reports, and the provision
of orientation and training services under section 2, the
Secretary shall consult with representatives of primary
care and other health professionals, hospitals and nursing
homes, medicare beneficiaries, health maintenance organi-
zations and other managed care providers, and health data
collectors.
SEC. 2. ORIENTATION AND TRAINING ON USE OF REFER-
RAL REPORTS.
In carrying out the demonstration project established
under section 1, the Secretary shall provide orientation
and training services to assist providers of physicians’
services who are participating in the project in using the
medicare referral reports to effectively manage patient
care, including information regarding limitations on the
usefulness of such reports in making clinical decisions or
evaluating the effectiveness of treatments.
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