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each amended by striking ‘‘or (14)’’ each place it ap-
pears and inserting ‘‘(14), or (15)’’.
(d) EFFECTIVE DATE.—The amendments made by
subsections (a) and (b) shall apply to the monthly pre-
mium under section 1839 of the Social Security Act for
months beginning with January 1997.
PART 3—ADMINISTRATION AND BILLING OF
LABORATORY SERVICES
SEC. 15621. ADMINISTRATIVE SIMPLIFICATION FOR LAB-
ORATORY SERVICES.
(a) IN GENERAL.—Not later than 1 year after the
date of the enactment of this Act, the Secretary of Health
and Human Services (in accordance with the process de-
scribed in subsection (b)) shall adopt uniform coverage,
administration, and payment policies for clinical diag-
nostic laboratory tests under part B of the medicare pro-
gram.
(b) PROCESS
FOR ADOPTION
OF POLICIES.—The
Secretary shall adopt uniform policies under subsection
(a) in accordance with the following process:
(1) The Secretary shall select from carriers
with whom the Secretary has a contract under part
B during 1995 15 medical directors, who will meet
and develop recommendations for such uniform poli-
cies. The medical directors selected shall represent
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various geographic areas and have a varied range of
experience in relevant medical fields, including pa-
thology and clinical laboratory practice.
(2) The medical directors selected under para-
graph (1) shall consult with independent experts in
each major discipline of clinical laboratory medicine,
including clinical laboratory personnel, bioanalysts,
pathologists, and practicing physicians. The medical
directors shall also solicit comments from other indi-
viduals and groups who wish to participate, includ-
ing consumers and other affected parties. This proc-
ess shall be conducted as a negotiated rulemaking
under title 5, United States Code.
(3) Under the negotiated rulemaking, the rec-
ommendations for uniform policies shall be designed
to simplify and reduce unnecessary administrative
burdens in connection with the following:
(A) Beneficiary information required to be
submitted with each claim.
(B) Physicians’ obligations regarding docu-
mentation requirements and recordkeeping.
(C) Procedures for filing claims and for
providing remittances by electronic media.
(D) The performance of post-payment re-
view of test claims.
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(E) The prohibition of the documentation
of medical necessity except when determined to
be appropriate after identification of aberrant
utilization pattern through focused medical re-
view.
(F) Beneficiary responsibility for payment.
(4) During the pendency of the adoption by the
Secretary 
of 
the 
uniform 
policies, 
fiscal
intermediaries and carriers under the medicare pro-
gram may not implement any new requirement relat-
ing to the submission of a claim for clinical diag-
nostic laboratory tests retroactive to January 1,
1995, and carriers may not initiate any new cov-
erage, administrative, or payment policy unless the
policy promotes the goal of administrative simplifica-
tion of requirements imposed on clinical laboratories
in accordance with the Secretary’s promulgation of
the negotiated rulemaking.
(5) Not later than 6 months after the date of
the enactment of this Act, the medical directors shall
submit their recommendations to the Secretary, and
the Secretary shall publish the recommendations and
solicit public comment using negotiated rulemaking
in accordance with title 5, United States Code. The
Secretary shall publish final uniform policies for cov-
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erage, administration, and payment of claims for
clinical diagnostic laboratory tests, effective after the
expiration of the 180-day period which begins on the
date of publication.
(6) After the publication of the final uniform
policies, the Secretary shall implement identical uni-
form documentation and processing policies for all
clinical diagnostic laboratory tests paid under the
medicare program through fiscal intermediaries or
carriers.
(c) OPTIONAL SELECTION OF SINGLE CARRIER.—Ef-
fective for claims submitted after the expiration of the 90-
day period which begins on the date of the enactment of
this Act, an independent laboratory may select a single
carrier for the processing of all of its claims for payment
under part B of the medicare program, without regard to
the location where the laboratory or the patient or pro-
vider involved resides or conducts business. Such election
of a single carrier shall be made by the clinical laboratory
and an agreement made between the carrier and the lab-
oratory shall be forwarded to the Secretary of Health and
Human Services. Nothing in this subsection shall be con-
strued to require a laboratory to select a single carrier
under this subsection.