H. R. 2015—213
or biological for which payment may be made under this part
and the drug or biological is not paid on a cost or prospective
payment basis as otherwise provided in this part, the amount
payable for the drug or biological is equal to 95 percent of the
average wholesale price.
‘‘(2) If payment for a drug or biological is made to a licensed
pharmacy approved to dispense drugs or biologicals under this
part, the Secretary may pay a dispensing fee (less the applicable
deductible and coinsurance amounts) to the pharmacy.’’.
(b) CONFORMING AMENDMENT.—Section 1833(a)(1) (42 U.S.C.
1395l(a)(1)), as amended by sections 4315(b) and 4531(b)(1), is
amended—
(1) by striking ‘‘and (R)’’ and inserting ‘‘(R)’’; and
(2) by striking the semicolon at the end and inserting
the following: ‘‘, and (S) with respect to drugs and biologicals
not paid on a cost or prospective payment basis as otherwise
provided in this part (other than items and services described
in subparagraph (B)), the amounts paid shall be 80 percent
of the lesser of the actual charge or the payment amount
established in section 1842(o);’’.
(c) STUDY AND REPORT.—The Secretary of Health and Human
Services shall study the effect on the average wholesale price of
drugs and biologicals of the amendments made by subsection (a)
and shall report to the Committees on Ways and Means and Com-
merce of the House of Representatives and the Committee on
Finance of the Senate the result of such study not later than
July 1, 1999.
(d) EFFECTIVE DATE.—The amendments made by subsections
(a) and (b) shall apply to drugs and biologicals furnished on or
after January 1, 1998.
SEC. 
4557. 
COVERAGE 
OF 
ORAL 
ANTI-NAUSEA 
DRUGS 
UNDER
CHEMOTHERAPEUTIC REGIMEN.
(a) IN GENERAL.—Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)),
as amended by sections 4104 and 4105, is amended—
(1) by striking ‘‘and’’ at the end of subparagraph (R); and
(2) by inserting after subparagraph (S) the following new
subparagraph:
‘‘(T) an oral drug (which is approved by the Federal Food
and Drug Administration) prescribed for use as an acute anti-
emetic used as part of an anticancer chemotherapeutic regimen
if the drug is administered by a physician (or as prescribed
by a physician)—
‘‘(i) for use immediately before, at, or within 48 hours
after the time of the administration of the anticancer
chemotherapeutic agent; and
‘‘(ii) as a full replacement for the anti-emetic therapy
which would otherwise be administered intravenously.’’.
(b) EFFECTIVE DATE.—The amendments made by subsection
(a) shall apply to items and services furnished on or after January
1, 1998.
SEC. 4558. RENAL DIALYSIS-RELATED SERVICES.
(a) AUDITING OF COST REPORTS.—Beginning with cost reports
for 1996, the Secretary shall audit cost reports of each renal dialysis
provider at least once every 3 years.
(b) IMPLEMENTATION OF QUALITY STANDARDS.—The Secretary
of Health and Human Services shall develop, by not later than
H. R. 2015—214
January 1, 1999, and implement, by not later than January 1,
2000, a method to measure and report quality of renal dialysis
services provided under the medicare program under title XVIII
of the Social Security Act.
SEC. 4559. TEMPORARY COVERAGE RESTORATION FOR PORTABLE
ELECTROCARDIOGRAM TRANSPORTATION.
(a) IN GENERAL.—Effective only for electrocardiogram tests fur-
nished during 1998, the Secretary of Health and Human Services
shall restore separate payment, under part B of title XVIII of
the Social Security Act, for the transportation of electrocardiogram
equipment (HCPCS code R0076) based upon payment methods in
effect for such service as of December 31, 1996.
(b) DETERMINATION.—By not later than July 1, 1998, the Sec-
retary of Health and Human Services shall make a recommendation
to the Committees on Commerce and Ways and Means of the
House of Representatives and the Committee on Finance of the
Senate as to whether coverage of portable electrocardiogram
transportation should be provided under part B of title XVIII of
the Social Security Act. In making such recommendation, the Sec-
retary shall take into account the study of coverage of portable
electrocardiogram transportation conducted by the Comptroller Gen-
eral of the United States and other relevant information, including
information submitted by interested parties.
CHAPTER 6—PART B PREMIUM AND RELATED
PROVISIONS
Subchapter A—Determination of Part B Premium Amount
SEC. 4571. PART B PREMIUM.
(a) IN GENERAL.—Section 1839(a)(3) (42 U.S.C. 1395r(a)(3)) is
amended by striking the first 3 sentences and inserting the follow-
ing: ‘‘The Secretary, during September of each year, shall determine
and promulgate a monthly premium rate for the succeeding cal-
endar year that is equal to 50 percent of the monthly actuarial
rate for enrollees age 65 and over, determined according to para-
graph (1), for that succeeding calendar year.’’.
(b) CONFORMING AND TECHNICAL AMENDMENTS.—
(1) SECTION 1839.—Section 1839 (42 U.S.C. 1395r) is
amended—
(A) in subsection (a)(2), by striking ‘‘(b) and (e)’’ and
inserting ‘‘(b), (c), and (f)’’;
(B) in the last sentence of subsection (a)(3)—
(i) by inserting ‘‘rate’’ after ‘‘premium’’, and
(ii) by striking ‘‘and the derivation of the dollar
amounts specified in this paragraph’’;
(C) in the first sentence of subsection (b), by striking
‘‘or (e)’’;
(D) by striking subsection (e); and
(E) by redesignating subsection (g) as subsection (e)
and inserting that subsection after subsection (d).
(2) SECTION 1844.—Subparagraphs (A)(i) and (B)(i) of section
1844(a)(1) (42 U.S.C. 1395w(a)(1)) are each amended by striking
‘‘or 1839(e), as the case may be’’.
H. R. 2015—215
Subchapter B—Other Provisions Related to Part B Premium
SEC. 4581. PROTECTIONS UNDER THE MEDICARE PROGRAM FOR DIS-
ABLED WORKERS WHO LOSE BENEFITS UNDER A GROUP
HEALTH PLAN.
(a) NO PREMIUM PENALTY FOR LATE ENROLLMENT.—The first
sentence of section 1839(b) (42 U.S.C. 1395r(b)) is amended by
inserting ‘‘and not pursuant to a special enrollment period under
section 1837(i)(4)’’ after ‘‘section 1837)’’.
(b) SPECIAL MEDICARE ENROLLMENT PERIOD.—
(1) IN GENERAL.—Section 1837(i) (42 U.S.C. 1395p(i)) is
amended by adding at the end the following new paragraph:
‘‘(4)(A) In the case of an individual who is entitled to benefits
under part A pursuant to section 226(b) and—
‘‘(i) who at the time the individual first satisfies paragraph
(1) of section 1836—
‘‘(I) is enrolled in a group health plan described in
section 1862(b)(1)(A)(v) by reason of the individual’s current
or former employment or by reason of the current or former
employment status of a member of the individual’s family,
and
‘‘(II) has elected not to enroll (or to be deemed enrolled)
under this section during the individual’s initial enrollment
period; and
‘‘(ii) whose continuous enrollment under such group health
plan is involuntarily terminated at a time when the enrollment
under the plan is not by reason of the individual’s current
employment or by reason of the current employment of a mem-
ber of the individual’s family,
there shall be a special enrollment period described in subparagraph
(B).
‘‘(B) The special enrollment period referred to in subparagraph
(A) is the 6-month period beginning on the first day of the month
which includes the date of the enrollment termination described
in subparagraph (A)(ii).’’.
(2) COVERAGE PERIOD.—Section 1838(e) (42 U.S.C. 1395q(e))
is amended—
(A) by inserting ‘‘or 1837(i)(4)(B)’’ after ‘‘1837(i)(3)’’ the
first place it appears, and
(B) by inserting ‘‘or specified in section 1837(i)(4)(A)(i)’’
after ‘‘1837(i)(3)’’ the second place it appears.
(c) EFFECTIVE DATE.—The amendments made by this section
shall apply to involuntary terminations of coverage under a group
health plan occurring on or after the date of the enactment of
this Act.
SEC. 4582. GOVERNMENTAL ENTITIES ELIGIBLE TO ELECT TO PAY
PART B PREMIUMS FOR ELIGIBLE INDIVIDUALS.
Section 1839(e)(1) (as amended by section 4571(b)) is amend-
ed—
(1) by inserting ‘‘(or any appropriate State or local govern-
mental entity specified by the Secretary)’’ after ‘‘State’’ the
first place it appears, and
(2) by inserting ‘‘(or such entity)’’ after ‘‘State’’ the second
and third place it appears.
H. R. 2015—216
Subtitle G—Provisions Relating to Parts A
and B
CHAPTER 1—HOME HEALTH SERVICES AND BENEFITS
Subchapter A—Payments For Home Health Services
SEC. 4601. RECAPTURING SAVINGS RESULTING FROM TEMPORARY
FREEZE ON PAYMENT INCREASES FOR HOME HEALTH
SERVICES.
(a) BASING UPDATES
TO PER VISIT COST LIMITS
ON LIMITS
FOR
FISCAL
YEAR
1993.—Section 
1861(v)(1)(L) 
(42 
U.S.C.
1395x(v)(1)(L)) is amended by adding at the end the following:
‘‘(iv) In establishing limits under this subparagraph for cost
reporting periods beginning after September 30, 1997, the Secretary
shall not take into account any changes in the home health market
basket, as determined by the Secretary, with respect to cost report-
ing periods which began on or after July 1, 1994, and before
July 1, 1996.’’.
(b) NO EXCEPTIONS PERMITTED BASED ON AMENDMENT.—The
Secretary of Health and Human Services shall not consider the
amendment made by subsection (a) in making any exemptions
and exceptions pursuant to section 1861(v)(1)(L)(ii) of the Social
Security Act (42 U.S.C. 1395x(v)(1)(L)(ii)).
SEC. 4602. INTERIM PAYMENTS FOR HOME HEALTH SERVICES.
(a) REDUCTIONS IN COST LIMITS.—Section 1861(v)(1)(L)(i) (42
U.S.C. 1395x(v)(1)(L)(i)) is amended—
(1) by moving the indentation of subclauses (I) through
(III) 2-ems to the left;
(2) in subclause (I), by inserting ‘‘of the mean of the labor-
related and nonlabor per visit costs for freestanding home
health agencies’’ before the comma at the end;
(3) in subclause (II), by striking ‘‘, or’’ and inserting ‘‘of
such mean,’’;
(4) in subclause (III)—
(A) by inserting ‘‘and before October 1, 1997,’’ after
‘‘July 1, 1987,’’, and
(B) by striking the comma at the end and inserting
‘‘of such mean, or’’; and
(5) by striking the matter following subclause (III) and
inserting the following:
‘‘(IV) October 1, 1997, 105 percent of the median of the
labor-related and nonlabor per visit costs for freestanding home
health agencies.’’.
(b) DELAY IN UPDATES.—Section 1861(v)(1)(L)(iii) (42 U.S.C.
1395x(v)(1)(L)(iii)) is amended by inserting ‘‘, or on or after July
1, 1997, and before October 1, 1997’’ after ‘‘July 1, 1996’’.
(c) ADDITIONS TO COST LIMITS.—Section 1861(v)(1)(L) (42 U.S.C.
1395x(v)(1)(L)) (as amended by section 4601(a)) is amended by
adding at the end the following new clauses:
‘‘(v) For services furnished by home health agencies for cost
reporting periods beginning on or after October 1, 1997, the Sec-
retary shall provide for an interim system of limits. Payment shall
not exceed the costs determined under the preceding provisions
of this subparagraph or, if lower, the product of—