H. R. 2015—142
(b) CONFORMING
AMENDMENT.—Section 1834(a)(10)(B) (42
U.S.C. 1395m(a)(10)(B)) is amended—
(1) by striking ‘‘For covered items furnished on or after
January 1, 1991, the’’ and inserting ‘‘The’’;
(2) by striking ‘‘(other than subparagraph (D))’’; and
(3) by striking all that follows ‘‘payments under this sub-
section’’ and inserting a period.
(c) EFFECTIVE DATE.—The amendments made by this section
shall take effect on the date of the enactment of this Act.
SEC. 4317. REQUIREMENT TO FURNISH DIAGNOSTIC INFORMATION.
(a) INCLUSION OF NON-PHYSICIAN PRACTITIONERS IN REQUIRE-
MENT TO PROVIDE DIAGNOSTIC CODES FOR PHYSICIAN SERVICES.—
Paragraphs (1) and (2) of section 1842(p) (42 U.S.C. 1395u(p))
are each amended by inserting ‘‘or practitioner specified in sub-
section (b)(18)(C)’’ after ‘‘by a physician’’.
(b) REQUIREMENT TO PROVIDE DIAGNOSTIC INFORMATION WHEN
ORDERING CERTAIN ITEMS OR SERVICES FURNISHED BY ANOTHER
ENTITY.—Section 1842(p) (42 U.S.C. 1395u(p)), is amended by add-
ing at the end the following new paragraph:
‘‘(4) In the case of an item or service defined in paragraph
(3), (6), (8), or (9) of subsection 1861(s) ordered by a physician
or a practitioner specified in subsection (b)(18)(C), but furnished
by another entity, if the Secretary (or fiscal agent of the Secretary)
requires the entity furnishing the item or service to provide diag-
nostic or other medical information in order for payment to be
made to the entity, the physician or practitioner shall provide
that information to the entity at the time that the item or service
is ordered by the physician or practitioner.’’.
(c) EFFECTIVE DATE.—The amendments made by this section
shall apply to items and services furnished on or after January
1, 1998.
SEC. 4318. REPORT BY GAO ON OPERATION OF FRAUD AND ABUSE
CONTROL PROGRAM.
Section 1817(k)(6) (42 U.S.C. 1395i(k)(6)) is amended by insert-
ing ‘‘June 1, 1998, and’’ after ‘‘Not later than’’.
SEC. 4319. COMPETITIVE BIDDING DEMONSTRATION PROJECTS.
(a) GENERAL RULE.—Part B of title XVIII (42 U.S.C. 1395j
et seq.) is amended by inserting after section 1846 the following
new section:
‘‘SEC. 1847. DEMONSTRATION PROJECTS FOR COMPETITIVE ACQUISI-
TION OF ITEMS AND SERVICES.
‘‘(a) ESTABLISHMENT
OF DEMONSTRATION PROJECT BIDDING
AREAS.—
‘‘(1) IN GENERAL.—The Secretary shall implement not more
than 5 demonstration projects under which competitive acquisi-
tion areas are established for contract award purposes for the
furnishing under this part of the items and services described
in subsection (d).
‘‘(2) PROJECT REQUIREMENTS.—Each demonstration project
under paragraph (1)—
‘‘(A) shall include such group of items and services
as the Secretary may prescribe,
‘‘(B) shall be conducted in not more than 3 competitive
acquisition areas, and
H. R. 2015—143
‘‘(C) shall be operated over a 3-year period.
‘‘(3) CRITERIA FOR ESTABLISHMENT OF COMPETITIVE ACQUISI-
TION
AREAS.—Each competitive acquisition area established
under a demonstration project implemented under paragraph
(1)—
‘‘(A) shall be, or shall be within, a metropolitan statis-
tical area (as defined by the Secretary of Commerce), and
‘‘(B) shall be chosen based on the availability and acces-
sibility of entities able to furnish items and services, and
the probable savings to be realized by the use of competitive
bidding in the furnishing of items and services in such
area.
‘‘(b) AWARDING OF CONTRACTS IN AREAS.—
‘‘(1) IN GENERAL.—The Secretary shall conduct a competi-
tion among individuals and entities supplying items and serv-
ices described in subsection (c) for each competitive acquisition
area established under a demonstration project implemented
under subsection (a).
‘‘(2) CONDITIONS FOR AWARDING CONTRACT.—The Secretary
may not award a contract to any entity under the competition
conducted pursuant to paragraph (1) to furnish an item or
service unless the Secretary finds that the entity meets quality
standards specified by the Secretary that the total amounts
to be paid under the contract are expected to be less than
the total amounts that would otherwise be paid.
‘‘(3) CONTENTS OF CONTRACT.—A contract entered into with
an entity under the competition conducted pursuant to para-
graph (1) is subject to terms and conditions that the Secretary
may specify.
‘‘(4) LIMIT ON NUMBER OF CONTRACTORS.—The Secretary
may limit the number of contractors in a competitive acquisition
area to the number needed to meet projected demand for items
and services covered under the contracts.
‘‘(c) EXPANSION OF PROJECTS.—
‘‘(1) EVALUATIONS.—The Secretary shall evaluate the
impact of the implementation of the demonstration projects
on medicare program payments, access, diversity of product
selection, and quality. The Secretary shall make annual reports
to the Committees on Ways and Means and Commerce of
the House of Representatives and the Committee on Finance
of the Senate on the results of the evaluation described in
the preceding sentence and a final report not later than 6
months after the termination date specified in subsection (e).
‘‘(2) EXPANSION.—If the Secretary determines from the
evaluations under paragraph (1) that there is clear evidence
that any demonstration project—
‘‘(A) results in a decrease in Federal expenditures
under this title, and
‘‘(B) does not reduce program access, diversity of prod-
uct selection, and quality under this title,
the Secretary may expand the project to additional competitive
acquisition areas.
‘‘(d) SERVICES DESCRIBED.—The items and services to which
this section applies are all items and services covered under this
part (except for physicians’ services as defined in section 1861(s)(1))
that the Secretary may specify. At least one demonstration project
shall include oxygen and oxygen equipment.
H. R. 2015—144
‘‘(e) TERMINATION.—Notwithstanding any other provision of this
section, all projects under this section shall terminate not later
than December 31, 2002.’’.
(b) ITEMS AND SERVICES TO BE FURNISHED ONLY THROUGH
COMPETITIVE ACQUISITION.—Section 1862(a) (42 U.S.C. 1395y(a))
is amended—
(1) by striking ‘‘or’’ at the end of paragraph (15),
(2) by striking the period at the end of paragraph (16)
and inserting ‘‘; or’’, and
(3) by inserting after paragraph (16) the following new
paragraph:
‘‘(17) where the expenses are for an item or service fur-
nished in a competitive acquisition area (as established by
the Secretary under section 1847(a)) by an entity other than
an entity with which the Secretary has entered into a contract
under section 1847(b) for the furnishing of such an item or
service in that area, unless the Secretary finds that the
expenses were incurred in a case of urgent need, or in other
circumstances specified by the Secretary.’’.
(c) STUDY
BY GAO.—The Comptroller of the United States
shall study the effectiveness of the establishment of competitive
acquisition areas under section 1847(a) of the Social Security Act,
as added by this section.
SEC. 4320. PROHIBITING UNNECESSARY AND WASTEFUL MEDICARE
PAYMENTS FOR CERTAIN ITEMS.
Section 1861(v) (42 U.S.C. 1395x(v)) is amended by adding
at the end the following new paragraph:
‘‘(8) ITEMS UNRELATED TO PATIENT CARE.—Reasonable costs
do not include costs for the following—
‘‘(i) entertainment, including tickets to sporting and
other entertainment events;
‘‘(ii) gifts or donations;
‘‘(iii) personal use of motor vehicles;
‘‘(iv) costs for fines and penalties resulting from viola-
tions of Federal, State, or local laws; and
‘‘(v) education expenses for spouses or other dependents
of providers of services, their employees or contractors.’’.
SEC. 4321. NONDISCRIMINATION IN POST-HOSPITAL REFERRAL TO
HOME HEALTH AGENCIES AND OTHER ENTITIES.
(a) NOTIFICATION OF AVAILABILITY OF HOME HEALTH AGENCIES
AND OTHER ENTITIES AS PART OF DISCHARGE PLANNING PROCESS.—
Section 1861(ee)(2) (42 U.S.C. 1395x(ee)(2)) is amended—
(1) in subparagraph (D), by inserting before the period
the following: ‘‘, including the availability of home health serv-
ices through individuals and entities that participate in the
program under this title and that serve the area in which
the patient resides and that request to be listed by the hospital
as available’’; and
(2) by adding at the end the following new subparagraph:
‘‘(H) Consistent with section 1802, the discharge plan
shall—
‘‘(i) not specify or otherwise limit the qualified provider
which may provide post-hospital home health services, and
‘‘(ii) identify (in a form and manner specified by the
Secretary) any entity to whom the individual is referred
in which the hospital has a disclosable financial interest
H. R. 2015—145
(as specified by the Secretary consistent with section
1866(a)(1)(S)) or which has such an interest in the hos-
pital.’’.
(b) MAINTENANCE AND DISCLOSURE OF INFORMATION ON POST-
HOSPITAL HOME HEALTH AGENCIES AND OTHER ENTITIES.—Section
1866(a)(1) (42 U.S.C. 1395cc(a)(1)) is amended—
(1) by striking ‘‘and’’ at the end of subparagraph (Q),
(2) by striking the period at the end of subparagraph (R),
and
(3) by adding at the end the following new subparagraph:
‘‘(S) in the case of a hospital that has a financial interest
(as specified by the Secretary in regulations) in an entity to
which individuals are referred as described in section
1861(ee)(2)(H)(ii), or in which such an entity has such a finan-
cial interest, or in which another entity has such a financial
interest (directly or indirectly) with such hospital and such
an entity, to maintain and disclose to the Secretary (in a
form and manner specified by the Secretary) information on—
‘‘(i) the nature of such financial interest,
‘‘(ii) the number of individuals who were discharged
from the hospital and who were identified as requiring
home health services, and
‘‘(iii) the percentage of such individuals who received
such services from such provider (or another such pro-
vider).’’.
(c) DISCLOSURE OF INFORMATION TO THE PUBLIC.—Title XI is
amended by inserting after section 1145 the following new section:
‘‘PUBLIC DISCLOSURE OF CERTAIN INFORMATION ON HOSPITAL
FINANCIAL INTEREST AND REFERRAL PATTERNS
‘‘SEC. 1146. The Secretary shall make available to the public,
in a form and manner specified by the Secretary, information dis-
closed to the Secretary pursuant to section 1866(a)(1)(S).’’.
(d) EFFECTIVE DATES.—
(1) The amendments made by subsection (a) shall apply
to discharges occurring on or after the date which is 90 days
after the date of the enactment of this Act.
(2) The Secretary of Health and Human Services shall
issue regulations by not later than the date which is 1 year
after the date of the enactment of this Act to carry out the
amendments made by subsections (b) and (c) and such amend-
ments shall take effect as of such date (on or after the issuance
of such regulations) as the Secretary specifies in such regula-
tions.
CHAPTER 3—CLARIFICATIONS AND TECHNICAL
CHANGES
SEC. 4331. OTHER FRAUD AND ABUSE RELATED PROVISIONS.
(a) REFERENCE CORRECTION.—(1) Section 1128D(b)(2)(D) (42
U.S.C. 1320a–7d(b)(2)(D)), as added by section 205 of the Health
Insurance Portability and Accountability Act of 1996, is amended
by striking ‘‘1128B(b)’’ and inserting ‘‘1128A(b)’’.
(2) Section 1128E(g)(3)(C) (42 U.S.C. 1320a–7e(g)(3)(C)) is
amended by striking ‘‘Veterans’ Administration’’ and inserting
‘‘Department of Veterans Affairs’’.