434
Subtitle J
Sec. 15604. Reduction in updates to payment amounts for clini-
cal diagnostic laboratory tests.
Sec. 15605. Extension of reductions in payments for costs of
hospital outpatient services.
Sec. 15606. Freeze in payments for ambulatory surgical center
services.
Sec. 15607. Rural emergency access care hospitals.
Sec. 15608. Ensuring payment for physician and nurse for
jointly furnished anesthesia services.
Sec. 15609. Statewide fee schedule area for physicians’ serv-
ices.
PART 2—PART B PREMIUM
Sec. 15611. Extension of part B premium.
Sec. 15612. Income-related reduction in medicare subsidy.
PART 3—BILLING AND ADMINISTRATION OF LABORATORY SERVICES
Sec. 15621. Restrictions on direct billing for laboratory serv-
ices.
Sec. 15622. Administrative simplification.
PART 4—QUALITY STANDARDS FOR DURABLE MEDICAL EQUIPMENT
Sec. 15631. Recommendations for quality standards for dura-
ble medicare equipment.
Subtitle H—Provisions Relating to Medicare Parts A and B
PART 1—HOME HEALTH SERVICES
Sec. 15701. Payment for home health services.
Sec. 15702. Maintaining savings resulting from temporary
freeze on payment increases for home health
services.
Sec. 15703. Extension of waiver of presumption of lack of
knowledge of exclusion from coverage for home
health agencies.
Sec. 15704. Study of coverage of services of Christian Science
providers.
PART 2—MEDICARE SECONDARY PAYER IMPROVEMENTS
Sec. 15711. Extension and expansion of existing requirements.
Sec. 15712. Improvements in recovery of payments.
Sec. 15713. Prohibiting retroactive application of policy re-
garding ESRD beneficiaries enrolled in primary
plans.
PART 3—FAILSAFE
Sec. 15721. Failsafe budget mechanism.
PART 4—ADMINISTRATIVE SIMPLIFICATION
Sec. 15731. Standards for medicare information transactions
and data elements.
435
Subtitle A, Part 1
PART 5—OTHER PROVISIONS RELATING TO PARTS A AND B
Sec. 15741. Clarification of medicare coverage of items and
services associated with certain medical devices
approved for investigational use.
Sec. 15742. Additional exclusion from coverage.
Sec. 15743. Competitive bidding for certain items and services.
Subtitle I—Clinical Laboratories
Sec. 15801. Exemption of physician office laboratories.
Subtitle J—Lock-Box Provisions for Medicare Part B Savings
from Growth Reductions
Sec. 15901. Establishment of Medicare Growth Reduction Trust
Fund for Part B savings.
Subtitle A—MedicarePlus Program
PART 1—INCREASING CHOICE UNDER THE
MEDICARE PROGRAM
SEC. 15001. INCREASING CHOICE UNDER MEDICARE.
(a) IN GENERAL.—Title XVIII is amended
by inserting after section 1804 the following
new section:
‘‘PROVIDING FOR CHOICE OF COVERAGE
‘‘SEC. 1805. (a) CHOICE OF COVERAGE.—
‘‘(1) IN GENERAL.—Subject to the provi-
sions of this section, every individual
who is entitled to benefits under part A
and enrolled under part B shall elect to
receive benefits under this title through
one of the following:
‘‘(A) 
THROUGH
FEE-FOR-SERVICE
SYSTEM.—Through the provisions of
parts A and B.
436
Subtitle A, Part 1
‘‘(B) THROUGH
A
MEDICAREPLUS
PRODUCT.—Through a MedicarePlus
product (as defined in paragraph (2)),
which may be—
‘‘(i) 
a 
high 
deductible/
medisave product (and a con-
tribution 
into 
a 
MedicarePlus
medical savings account (MSA)),
‘‘(ii) a product offered by a
provider-sponsored organization,
‘‘(iii) a product offered by an
organization that is a Taft-Hart-
ley plan or association, or
‘‘(iv) a product providing for
benefits on a fee-for-service or
other basis.
‘‘(2) 
MEDICAREPLUS
PRODUCT
DE-
FINED.—For purposes of this section and
part C, the term ‘MedicarePlus product’
means health benefits coverage offered
under a policy, contract, or plan by a
MedicarePlus organization (as defined in
section 1851(a)) pursuant to and in ac-
cordance with a contract under section
1857.
437
Subtitle A, Part 1
‘‘(3) TERMINOLOGY
RELATING
TO
OP-
TIONS.—For purposes of this section and
part C—
‘‘(A) NON-MEDICARE-PLUS OPTION.—
An individual who has made the elec-
tion described in paragraph (1)(A) is
considered to have elected the ‘Non-
MedicarePlus option’.
‘‘(B) MEDICAREPLUS
OPTION.—An
individual who has made the election
described in paragraph (1)(B) to ob-
tain 
coverage 
through 
a
MedicarePlus product is considered
to have elected the ‘MedicarePlus op-
tion’ for that product.
‘‘(b) SPECIAL RULES.—
‘‘(1) RESIDENCE REQUIREMENT.—Except
as the Secretary may otherwise provide,
an individual is eligible to elect a
MedicarePlus 
product 
offered 
by 
a
MedicarePlus organization only if the or-
ganization in relation to the product
serves the geographic area in which the
individual resides.
438
Subtitle A, Part 1
‘‘(2) AFFILIATION
REQUIREMENTS
FOR
CERTAIN PRODUCTS.—
‘‘(A) IN GENERAL.—Subject to sub-
paragraph (B), an individual is eligi-
ble to elect a MedicarePlus product
offered 
by 
a 
limited 
enrollment
MedicarePlus organization (as de-
fined in section 1852(c)(4)(D)) only
if—
‘‘(i) the individual is eligible
under section 1852(c)(4) to make
such election, and
‘‘(ii) 
in 
the 
case 
of 
a
MedicarePlus organization that is
a Taft-Hartley sponsor (as defined
in section 1852(c)(4)), the individ-
ual elected under this section a
MedicarePlus product offered by
the sponsor during the first en-
rollment period in which the indi-
vidual was eligible to make such
election with respect to such
sponsor.
‘‘(B) 
NO
REELECTION
AFTER
DISENROLLMENT
FOR
CERTAIN
PROD-
440
Subtitle A, Part 1
section (e) and shall become effective as
provided in subsection (f).
‘‘(2) EXPEDITED IMPLEMENTATION.—The
Secretary shall establish the process of
electing coverage under this section dur-
ing the transition period (as defined in
subsection (e)(1)(B)) in such an expedited
manner as will permit such an election
for MedicarePlus products in an area as
soon as such products become available
in that area.
‘‘(3) COORDINATION THROUGH MEDICARE-
PLUS ORGANIZATIONS.—
‘‘(A) ENROLLMENT.—Such process
shall permit an individual who wish-
es to elect a MedicarePlus product of-
fered by a MedicarePlus organization
to make such election through the fil-
ing of an appropriate election form
with the organization.
‘‘(B) DISENROLLMENT.—Such proc-
ess shall permit an individual, who
has elected a MedicarePlus product
offered by a MedicarePlus organiza-
tion and who wishes to terminate
441
Subtitle A, Part 1
such election, to terminate such elec-
tion through the filing of an appro-
priate election form with the organi-
zation.
‘‘(4) DEFAULT.—
‘‘(A) INITIAL ELECTION.—
‘‘(i) IN
GENERAL.—Subject to
clause (ii), an individual who fails
to make an election during an ini-
tial election period under sub-
section (e)(1) is deemed to have
chosen the Non-MedicarePlus op-
tion.
‘‘(ii) SEAMLESS
CONTINUATION
OF
COVERAGE.—The 
Secretary
shall establish procedures under
which individuals who are en-
rolled with a MedicarePlus orga-
nization at the time of the initial
election period and who fail to
elect to receive coverage other
than through the organization are
deemed to have elected an appro-
priate MedicarePlus product of-
fered by the organization.
442
Subtitle A, Part 1
‘‘(B) CONTINUING PERIODS.—An in-
dividual who has made (or deemed to
have made) an election under this
section is considered to have contin-
ued to make such election until such
time as—
‘‘(i) the individual changes the
election under this section, or
‘‘(ii) a MedicarePlus product
is discontinued, if the individual
had elected such product at the
time of the discontinuation.
‘‘(5) AGREEMENTS
WITH
COMMISSIONER
OF SOCIAL SECURITY TO PROMOTE EFFICIENT
ADMINISTRATION.—In order to promote the
efficient administration of this section
and the MedicarePlus program under
part C, the Secretary may enter into an
agreement with the Commissioner of So-
cial Security under which the Commis-
sioner performs administrative respon-
sibilities 
relating 
to 
enrollment 
and
disenrollment in MedicarePlus products
under this section.
443
Subtitle A, Part 1
‘‘(d) PROVISION OF BENEFICIARY INFORMA-
TION TO PROMOTE INFORMED CHOICE.—
‘‘(1) IN GENERAL.—The Secretary shall
provide for activities under this sub-
section to disseminate broadly informa-
tion to medicare beneficiaries (and pro-
spective medicare beneficiaries) on the
coverage options provided under this sec-
tion in order to promote an active, in-
formed selection among such options.
Such information shall be made available
on such a timely basis (such as 6 months
before the date an individual would first
attain eligibility for medicare on the
basis of age) as to permit individuals to
elect the MedicarePlus option during the
initial election period described in sub-
section (e)(1).
‘‘(2) USE
OF
NONFEDERAL
ENTITIES.—
The Secretary shall, to the maximum ex-
tent feasible, enter into contracts with
appropriate non-Federal entities to carry
out activities under this subsection.
‘‘(3) SPECIFIC ACTIVITIES.—In carrying
out this subsection, the Secretary shall
449
Subtitle A, Part 1
‘‘(C) MEDICAREPLUS
HEALTH
FAIR
DURING OCTOBER, 1996.—In the month
of October, 1996, the Secretary shall
provide for a nationally coordinated
educational and publicity campaign
to inform individuals, who are eligi-
ble to elect MedicarePlus products,
about such products and the election
process provided under this section
(including the annual, coordinated
election periods that occur in subse-
quent years).
‘‘(4) SPECIAL 90-DAY DISENROLLMENT OP-
TION.—
‘‘(A) IN
GENERAL.—In the case of
the first time an individual elects a
MedicarePlus option (other than a
high 
deductible/medisave 
product)
under this section, the individual
may 
discontinue 
such 
election
through the filing of an appropriate
notice during the 90-day period be-
ginning on the first day on which the
individual’s 
coverage 
under 
the