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(A) by striking ‘‘(or factors)’’ each place it
appears 
in 
subsection 
(d)(1)(A) 
and
(d)(1)(D)(ii);
(B) in subsection (d)(1)(A), by striking ‘‘or
updates’’;
(C) in subsection (d)(1)(D)(ii), by striking
‘‘(or updates)’’; and
(D) in subsection (i)(1)(C), by striking
‘‘conversion factors’’ and inserting ‘‘the conver-
sion factor’’.
SEC. 15602. ELIMINATION OF FORMULA-DRIVEN OVERPAY-
MENTS FOR CERTAIN OUTPATIENT HOSPITAL
SERVICES.
(a) 
AMBULATORY
SURGICAL
CENTER
PROCE-
DURES.—Section 
1833(i)(3)(B)(i)(II) 
(42 
U.S.C.
1395l(i)(3)(B)(i)(II)) is amended—
(1) by striking ‘‘of 80 percent’’; and
(2) by striking the period at the end and insert-
ing the following: ‘‘, less the amount a provider may
charge as described in clause (ii) of section
1866(a)(2)(A).’’.
(b) RADIOLOGY SERVICES AND DIAGNOSTIC PROCE-
DURES.—Section 
1833(n)(1)(B)(i)(II) 
(42 
U.S.C.
1395l(n)(1)(B)(i)(II)) is amended—
(1) by striking ‘‘of 80 percent’’; and
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(2) by striking the period at the end and insert-
ing the following: ‘‘, less the amount a provider may
charge as described in clause (ii) of section
1866(a)(2)(A).’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished during por-
tions of cost reporting periods occurring on or after Octo-
ber 1, 1995.
SEC. 15603. PAYMENTS FOR DURABLE MEDICAL EQUIP-
MENT.
(a) REDUCTION IN PAYMENT AMOUNTS FOR ITEMS
OF DURABLE MEDICAL EQUIPMENT.—
(1) 
FREEZE
IN
UPDATE
FOR
COVERED
ITEMS.—Section 
1834(a)(14) 
(42 
U.S.C.
1395m(a)(14)) is amended—
(A) by striking ‘‘and’’ at the end of sub-
paragraph (A);
(B) in subparagraph (B)—
(i) by striking ‘‘a subsequent year’’
and inserting ‘‘1993, 1994, and 1995’’,
and
(ii) by striking the period at the end
and inserting a semicolon; and
(C) by adding at the end the following:
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‘‘(C) for each of the years 1996 through
2002, 0 percentage points; and
‘‘(D) for a subsequent year, the percentage
increase in the consumer price index for all
urban consumers (U.S. urban average) for the
12-month period ending with June of the pre-
vious year.’’.
(2) UPDATE FOR ORTHOTICS AND PROSTHET-
ICS.—Section 
1834(h)(4)(A) 
(42 
U.S.C.
1395m(h)(4)(A)) is amended—
(A) by striking ‘‘and’’ at the end of clause
(iii);
(B) by redesignating clause (iv) as clause
(v); and
(C) by inserting after clause (iii) the fol-
lowing new clause:
‘‘(iv) for each of the years 1996
through 2002, 1 percent, and’’.
(b) OXYGEN
AND OXYGEN EQUIPMENT.—Section
1834(a)(9)(C) (42 U.S.C. 1395m(a)(9)(C)) is amended—
(1) by striking ‘‘and’’ at the end of clause (iii);
(2) in clause (iv)—
(A) by striking ‘‘a subsequent year’’ and
inserting ‘‘1993, 1994, and 1995’’, and
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(B) by striking the period at the end and
inserting a semicolon; and
(3) by adding at the end the following new
clauses:
‘‘(v) in 1996, is 80 percent of the na-
tional limited monthly payment rate com-
puted under subparagraph (B) for the item
for the year; and
‘‘(vi) in a subsequent year, is the na-
tional limited monthly payment rate com-
puted under subparagraph (B) for the item
for the year.’’.
(c) PAYMENT FOR UPGRADED DURABLE MEDICAL
EQUIPMENT.—Section 1834(a) (42 U.S.C. 1395m(a)) is
amended by inserting after paragraph (15) the following
new paragraph:
‘‘(16) PAYMENT
FOR
CERTAIN
UPGRADED
ITEMS.—
‘‘(A) INDIVIDUAL’S RIGHT TO CHOOSE UP-
GRADED
ITEM.—Notwithstanding any other
provision of this title, effective on the date on
which the Secretary issues regulations under
subparagraph (C), payment may be made under
this part for an upgraded item of durable medi-
cal equipment in the same manner as payment
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may be made for a standard item of durable
medical equipment.
‘‘(B) PAYMENTS
TO
SUPPLIER.—In the
case of the purchase or rental of an upgraded
item under subparagraph (A)—
‘‘(i) the supplier shall receive payment
under this subsection with respect to such
item as if such item were a standard item;
and
‘‘(ii) the individual purchasing or
renting the item shall pay the supplier an
amount equal to the difference between the
supplier’s charge and the amount under
clause (i).
In no event may the supplier’s charge for an
upgraded item exceed the applicable fee sched-
ule amount (if any) for such item.
‘‘(C) 
CONSUMER
PROTECTION
SAFE-
GUARDS.—The Secretary shall issue regulations
providing for consumer protection standards
with respect to the furnishing of upgraded
equipment under subparagraph (A). Such regu-
lations shall provide for—
‘‘(i) full disclosure by the supplier of
the availability and price of standard items
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and proof of receipt of such disclosure in-
formation by the beneficiary before the fur-
nishing of the upgraded item;
‘‘(ii) conditions of participation for
suppliers of upgraded items, including con-
ditions relating to billing procedures;
‘‘(iii) sanctions (including exclusion)
of suppliers who are determined to have
engaged in coercive or abusive practices;
and
‘‘(iv) such other safeguards as the
Secretary determines are necessary.’’.
(d) PAYMENT FREEZE FOR PARENTERAL AND EN-
TERAL NUTRIENTS, SUPPLIES, AND EQUIPMENT.—In de-
termining the amount of payment under part B of title
XVIII of the Social Security Act with respect to parenteral
and enteral nutrients, supplies, and equipment during
each of the years 1996 through 2002, the charges deter-
mined to be reasonable with respect to such nutrients,
supplies, and equipment may not exceed the charges deter-
mined to be reasonable with respect to such nutrients,
supplies, and equipment during 1993.
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SEC. 
15604. 
REDUCTION 
IN 
UPDATES 
TO 
PAYMENT
AMOUNTS FOR CLINICAL DIAGNOSTIC LAB-
ORATORY TESTS.
(a) 
CHANGE
IN
UPDATE.—Section
1833(h)(2)(A)(ii)(IV) (42 U.S.C. 1395l(h)(2)(A)(ii)(IV))
is amended by striking ‘‘1994 and 1995’’ and inserting
‘‘1994 through 2002’’.
(b) LOWERING CAP ON PAYMENT AMOUNTS.—Sec-
tion 1833(h)(4)(B) (42 U.S.C. 1395l(h)(4)(B)) is amend-
ed—
(1) in clause (vi), by striking ‘‘and’’ at the end;
(2) in clause (vii)—
(A) by inserting ‘‘and before January 1,
1997,’’ after ‘‘1995,’’, and
(B) by striking the period at the end and
inserting ‘‘, and’’; and
(3) by adding at the end the following new
clause:
‘‘(viii) after December 31, 1996, is equal to 65
percent of such median.’’.
SEC. 15605. EXTENSION OF REDUCTIONS IN PAYMENTS FOR
COSTS OF HOSPITAL OUTPATIENT SERVICES.
(a) REDUCTION IN PAYMENTS FOR CAPITAL-RELAT-
ED
COSTS.—Section 1861(v)(1)(S)(ii)(I) (42 U.S.C.
1395x(v)(1)(S)(ii)(I)) is amended by striking ‘‘through
1998’’ and inserting ‘‘through 2002’’.
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(b) REDUCTION IN PAYMENTS FOR OTHER COSTS.—
Section 
1861(v)(1)(S)(ii)(II) 
(42 
U.S.C.
1395x(v)(1)(S)(ii)(II)) is amended by striking ‘‘through
1998’’ and inserting ‘‘through 2002’’.
SEC. 15606. FREEZE IN PAYMENTS FOR AMBULATORY SUR-
GICAL CENTER SERVICES.
The Secretary of Health and Human Services shall
not provide for any inflation update in the payment
amounts under subparagraphs (A) and (B) of section
1833(i)(2) of the Social Security Act for any of the fiscal
years 1996 through 2002.
SEC. 15607. RURAL EMERGENCY ACCESS CARE HOSPITALS.
(a) COVERAGE UNDER PART B.—Section 1832(a)(2)
(42 U.S.C. 1395k(a)(2)) is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (I);
(2) by striking the period at the end of sub-
paragraph (J) and inserting ‘‘; and’’; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(K) rural emergency access care hospital
services (as defined in section 1861(oo)(2)).’’.
(b) PAYMENT BASED ON PAYMENT FOR OUTPATIENT
RURAL PRIMARY CARE HOSPITAL SERVICES.—
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(1) IN
GENERAL.—Section 1833(a)(6) (42
U.S.C. 1395l(a)(6)) is amended by striking ‘‘serv-
ices,’’ and inserting ‘‘services and rural emergency
access care hospital services,’’.
(2) PAYMENT
METHODOLOGY
DESCRIBED.—
Section 1834(g) (42 U.S.C. 1395m(g)) is amend-
ed—
(A) in the heading, by striking ‘‘SERV-
ICES’’ and inserting ‘‘SERVICES
AND RURAL
EMERGENCY ACCESS CARE HOSPITAL SERV-
ICES’’; and
(B) by adding at the end the following new
sentence: ‘‘The amount of payment for rural
emergency access care hospital services provided
during a year shall be determined using the ap-
plicable method provided under this subsection
for determining payment for outpatient rural
primary care hospital services during the
year.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
October 1, 1995.
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SEC. 15608. ENSURING PAYMENT FOR PHYSICIAN AND
NURSE FOR JOINTLY FURNISHED ANESTHE-
SIA SERVICES.
(a) PAYMENT
FOR JOINTLY FURNISHED SINGLE
CASE.—
(1) 
PAYMENT
TO
PHYSICIAN.—Section
1848(a)(4) (42 U.S.C. 1395w–4(a)(4)) is amended
by adding at the end the following new subpara-
graph:
‘‘(C) PAYMENT FOR SINGLE CASE.—Not-
withstanding section 1862(a)(1)(A), with re-
spect to physicians’ services consisting of the
furnishing of anesthesia services for a single
case that are furnished jointly with a certified
registered nurse anesthetist, if the carrier de-
termines that the use of both the physician and
the nurse anesthetist to furnish the anesthesia
service was not medically necessary, the fee
schedule amount for the physicians’ services
shall be equal to 50 percent (or 55 percent, in
the case of services furnished during 1996 or
1997) of the fee schedule amount applicable
under this section for anesthesia services per-
sonally performed by the physician alone (with-
out regard to this subparagraph). Nothing in
this subparagraph may be construed to affect
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the application of any provision of law regard-
ing balance billing.’’.
(2) PAYMENT TO CRNA.—Section 1833(l)(4)(B)
(42 U.S.C. 1395l(l)(4)(B)) is amended by adding at
the end the following new clause:
‘‘(iv) Notwithstanding section 1862(a)(1)(A), in the
case of services of a certified registered nurse anesthetist
consisting of the furnishing of anesthesia services for a
single case that are furnished jointly with a physician, if
the carrier determines that the use of both the physician
and the nurse anesthetist to furnish the anesthesia service
was not medically necessary, the fee schedule amount for
the services furnished by the certified registered nurse an-
esthetist shall be equal to 50 percent (or 40 percent, in
the case of services furnished during 1996 or 1997) of
the fee schedule amount applicable under section 1848 for
anesthesia services personally performed by the physician
alone (without regard to this clause).’’.
(b) EFFECTIVE DATE.—The amendments made by
subsections (a) shall apply to services furnished on or after
July 1, 1996.
SEC. 15609. STATEWIDE FEE SCHEDULE AREA FOR PHYSI-
CIANS’ SERVICES.
(a) 
IN
GENERAL.—Notwithstanding 
section
1848(j)(2) of the Social Security Act, in the case of the
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State of Wisconsin, the Secretary of Health and Human
Services shall treat the State as a single fee schedule area
for purposes of determining the fee schedule amount (as
referred to in section 1848(a) of such Act) for physicians’
services (as defined in section 1848(j)(3) of such Act)
under part B of the medicare program.
(b) BUDGET-NEUTRALITY.—Notwithstanding any
provision of part B of title XVIII of the Social Security
Act, the Secretary shall carry out subsection (a) in a man-
ner that ensures that total payments for physicians’ serv-
ices (as so defined) furnished by physicians in Wisconsin
during a year are not greater or less than total payments
for such services would have been but for this section.
(c) CONSTRUCTION.—Nothing in this section shall be
construed as limiting the availability (to the Secretary, the
appropriate agency or organization with a contract under
section 1842 of such Act, or physicians in the State of
Wisconsin) of otherwise applicable administrative proce-
dures for modifying the fee schedule area or areas in the
State after implementation of subsection (a).
(d) EFFECTIVE DATE.—This section shall apply with
respect to physicians’ services furnished on or after Janu-
ary 1, 1997.
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SEC. 15609A. ESTABLISHMENT OF FEE SCHEDULE FOR AM-
BULANCE SERVICES.
(a) PAYMENT IN ACCORDANCE WITH FEE SCHED-
ULE.—Section 1833(a)(1) (42 U.S.C. 1395l(a)(1)) is
amended—
(1) by striking ‘‘and (P)’’ and inserting ‘‘(P)’’;
and
(2) by striking the semicolon at the end and in-
serting the following: ‘‘, and (Q) with respect to am-
bulance service, the amounts paid shall be 80 per-
cent of the lesser of the actual charge for the serv-
ices or the amount determined by a fee schedule es-
tablished by the Secretary for the purposes of this
subparagraph (in accordance with section 15608(b)
of the Medicare Preservation Act);’’.
(b) REQUIREMENTS FOR ESTABLISHMENT OF FEE
SCHEDULE.—
(1) IN GENERAL.—The Secretary of Health and
Human Services shall establish the fee schedule for
ambulance services under section 1833(a)(1)(Q) of
the Social Security Act (as added by subsection (a))
through a negotiated rulemaking process described
in title 5, United States Code, and in accordance
with the requirements of this subsection.
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(2) CONSIDERATIONS.—In establishing the fee
schedule for ambulance services, the Secretary
shall—
(A) establish mechanisms to control in-
creases in expenditures for ambulance services
under part B of the medicare program which
fairly reflect the changing nature of the ambu-
lance service industry;
(B) establish definitions for ambulance
services which promote efficiency and link pay-
ments (including fees for assessment and treat-
ment services) to the type of service provided;
(C) take into account regional differences
which affect cost and productivity, including
differences in the costs of resources and the
costs of uncompensated care;
(D) apply dynamic adjustments to pay-
ment rates to account for inflation, demo-
graphic changes in the population of medicare
beneficiaries, and changes in the number of
providers of ambulance services participating in
the medicare program; and
(E) phase in the application of the pay-
ment rates under the fee schedule in an effi-
cient and fair manner.
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(3) SAVINGS.—In establishing the fee schedule
for ambulance services, the Secretary shall—
(A) ensure that the aggregate amount of
payments made for ambulance services under
part B of the medicare program during 1998
does not exceed the aggregate amount of pay-
ments which would have been made for such
services under part B of the program during
1998 if the amendments made by this section
were not in effect; and
(B) set the payment amounts provided
under the fee schedule for services furnished in
1999 and each subsequent year at amounts
equal to the payment amounts under the fee
schedule for service furnished during the pre-
vious year, increased by the percentage increase
in the consumer price index for all urban con-
sumers (U.S. city average) for the 12-month
period ending with June of the previous year.
(4) CONSULTATION.—In establishing the fee
schedule for ambulance services, the Secretary shall
consult regularly with the American Ambulance As-
sociation, the National Association of State Medical
Directors, and other national organizations rep-
resenting individuals and entities who furnish or reg-
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ulate ambulance services, and shall share with such
associations and organizations the data and data
analysis used in establishing the fee schedule, includ-
ing data on variations in payments for ambulance
services under part B of the medicare program for
years prior to 1998 among geographic areas and
types of ambulance service providers.
(c) EFFECTIVE DATE.—The amendment made by
subsection (a) and the fee schedule described in subsection
(b) shall apply to ambulance services furnished on or after
January 1, 1998.
SEC. 15609B. STANDARDS FOR PHYSICAL THERAPY SERV-
ICES FURNISHED BY PHYSICIANS.
(a) APPLICATION OF STANDARDS FOR OTHER PRO-
VIDERS OF PHYSICAL THERAPY SERVICES TO SERVICES
FURNISHED
BY
PHYSICIANS.—Section 1862(a) (42
U.S.C. 1395y(a)), as amended by section 15525(a)(2), is
amended
(1) by striking ‘‘or’’ at the end of paragraph
(15);
(2) by striking the period at the end of para-
graph (16) and inserting ‘‘; or’’; and
(3) by inserting after paragraph (16) the fol-
lowing new paragraph:
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‘‘(17) in the case of physicians’ services under
section 1848(j)(3) consisting of outpatient physical
therapy services or outpatient occupational therapy
services, which are furnished by a physician who
does not meet the requirements applicable under sec-
tion 1861(p) to a clinic or rehabilitation agency fur-
nishing such services.’’.
(b) CONFORMING AMENDMENT.—Section 1848(j)(3)
(42 U.S.C. 1395w–4(j)(3)) is amended by inserting ‘‘(sub-
ject to section 1862(a)(17))’’ after ‘‘(2)(D)’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 1996.
PART 2—PART B PREMIUM
SEC. 15611. EXTENSION OF PART B PREMIUM.
(a) IN GENERAL.—Section 1839(e)(1) (42 U.S.C.
1395r(e)(1)) is amended—
(1) in subparagraph (A)—
(A) by striking ‘‘and prior to January
1999’’, and
(B) by inserting ‘‘(or, if higher, the per-
cent described in subparagraph (C))’’ after ‘‘50
percent’’; and
(2) by adding at the end the following new sub-
paragraph:
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‘‘(C) For purposes of subparagraph (A), the percent
described in this subparagraph is the ratio (expressed as
a percentage) of the monthly premium established under
this section for months in 1995 to the monthly actuarial
rate for enrollees age 65 and over applicable to such
months (as specified in the most recent report of the
Board of Trustees of the Federal Supplementary Medical
Insurance Trust Fund published prior to the date of the
enactment of the Medicare Preservation Act of 1995).’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) apply to premiums for months beginning
with January 1996.
SEC. 15612. INCOME-RELATED REDUCTION IN MEDICARE
SUBSIDY.
(a) IN GENERAL.—Section 1839 (42 U.S.C. 1395r)
is amended by adding at the end the following:
‘‘(h)(1) Notwithstanding the previous subsections of
this section, in the case of an individual whose modified
adjusted gross income for a taxable year ending with or
within a calendar year (as initially determined by the Sec-
retary in accordance with paragraph (3)) exceeds the
threshold amount described in paragraph (5)(B), the Sec-
retary shall increase the amount of the monthly premium
for months in the calendar year by an amount equal to
the difference between—
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‘‘(A) 200 percent of the monthly actuarial rate
for enrollees age 65 and over as determined under
subsection (a)(1) for that calendar year; and
‘‘(B) the total of the monthly premiums paid by
the individual under this section (determined without
regard to subsection (b)) during such calendar year.
‘‘(2) In the case of an individual described in para-
graph (1) whose modified adjusted gross income exceeds
the threshold amount by less than $25,000, the amount
of the increase in the monthly premium applicable under
paragraph (1) shall be an amount which bears the same
ratio to the amount of the increase described in paragraph
(1) (determined without regard to this paragraph) as such
excess bears to $25,000. In the case of a joint return filed
under section 6013 of the Internal Revenue Code of 1986
by spouses both of whom are enrolled under this part, the
previous sentence shall be applied by substituting
‘$50,000’ for ‘$25,000’. The preceding provisions of this
paragraph shall not apply to any individual whose thresh-
old amount is zero.
‘‘(3) The Secretary shall make an initial determina-
tion of the amount of an individual’s modified adjusted
gross income for a taxable year ending with or within a
calendar year for purposes of this subsection as follows:
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‘‘(A) Not later than October 1 of the year pre-
ceding the year, the Secretary shall provide notice to
each individual whom the Secretary finds (on the
basis of the individual’s actual modified adjusted
gross income for the most recent taxable year for
which such information is available or other informa-
tion provided to the Secretary by the Secretary of
the Treasury) will be subject to an increase under
this subsection that the individual will be subject to
such an increase, and shall include in such notice
the Secretary’s estimate of the individual’s modified
adjusted gross income for the year.
‘‘(B) If, during the 30-day period beginning on
the date notice is provided to an individual under
subparagraph (A), the individual provides the Sec-
retary with information on the individual’s antici-
pated modified adjusted gross income for the year,
the amount initially determined by the Secretary
under this paragraph with respect to the individual
shall be based on the information provided by the
individual.
‘‘(C) If an individual does not provide the Sec-
retary with information under subparagraph (B), the
amount initially determined by the Secretary under
this paragraph with respect to the individual shall be
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the amount included in the notice provided to the in-
dividual under subparagraph (A).
‘‘(4)(A) If the Secretary determines (on the basis of
final information provided by the Secretary of the Treas-
ury) that the amount of an individual’s actual modified
adjusted gross income for a taxable year ending with or
within a calendar year is less than or greater than the
amount initially determined by the Secretary under para-
graph (3), the Secretary shall increase or decrease the
amount of the individual’s monthly premium under this
section (as the case may be) for months during the follow-
ing calendar year by an amount equal to 1⁄12 of the dif-
ference between—
‘‘(i) the total amount of all monthly premiums
paid by the individual under this section during the
previous calendar year; and
‘‘(ii) the total amount of all such premiums
which would have been paid by the individual during
the previous calendar year if the amount of the indi-
vidual’s modified adjusted gross income initially de-
termined under paragraph (3) were equal to the ac-
tual amount of the individual’s modified adjusted
gross income determined under this paragraph.
‘‘(B) In the case of an individual who is not enrolled
under this part for any calendar year for which the indi-
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vidual’s monthly premium under this section for months
during the year would be increased pursuant to subpara-
graph (A) if the individual were enrolled under this part
for the year, the Secretary may take such steps as the
Secretary considers appropriate to recover from the indi-
vidual the total amount by which the individual’s monthly
premium for months during the year would have been in-
creased under subparagraph (A) if the individual were en-
rolled under this part for the year.
‘‘(C) In the case of a deceased individual for whom
the amount of the monthly premium under this section
for months in a year would have been decreased pursuant
to subparagraph (A) if the individual were not deceased,
the Secretary shall make a payment to the individual’s
surviving spouse (or, in the case of an individual who does
not have a surviving spouse, to the individual’s estate) in
an amount equal to the difference between—
‘‘(i) the total amount by which the individual’s
premium would have been decreased for all months
during the year pursuant to subparagraph (A); and
‘‘(ii) the amount (if any) by which the individ-
ual’s premium was decreased for months during the
year pursuant to subparagraph (A).
‘‘(5) In this subsection, the following definitions
apply:
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‘‘(A) The term ‘modified adjusted gross income’
means adjusted gross income (as defined in section
62 of the Internal Revenue Code of 1986)—
‘‘(i) determined without regard to sections
135, 911, 931, and 933 of such Code, and
‘‘(ii) increased by the amount of interest
received or accrued by the taxpayer during the
taxable year which is exempt from tax under
such Code.
‘‘(B) The term ‘threshold amount’ means—
‘‘(i) except as otherwise provided in this
paragraph, $75,000,
‘‘(ii) $125,000, in the case of a joint re-
turn (as defined in section 7701(a)(38) of such
Code), and
‘‘(iii) zero in the case of a taxpayer who—
‘‘(I) is married at the close of the tax-
able year but does not file a joint return
(as so defined) for such year, and
‘‘(II) does not live apart from his
spouse at all times during the taxable
year.’’.
(b) CONFORMING
AMENDMENT.—Section 1839(f)
(42 U.S.C. 1395r(f)) is amended by striking ‘‘if an indi-
vidual’’ and inserting the following: ‘‘if an individual
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(other than an individual subject to an increase in the
monthly premium under this section pursuant to sub-
section (h))’’.
(c) REPORTING REQUIREMENTS FOR SECRETARY OF
THE TREASURY.—
(1) IN
GENERAL.—Subsection (l) of section
6103 of the Internal Revenue Code of 1986 (relating
to confidentiality and disclosure of returns and re-
turn information) is amended by adding at the end
the following new paragraph:
‘‘(15) DISCLOSURE OF RETURN INFORMATION
TO
CARRY
OUT
INCOME-RELATED
REDUCTION
IN
MEDICARE PART B PREMIUM.—
‘‘(A) IN
GENERAL.—The Secretary may,
upon written request from the Secretary of
Health and Human Services, disclose to officers
and employees of the Health Care Financing
Administration return information with respect
to a taxpayer who is required to pay a monthly
premium under section 1839 of the Social Secu-
rity Act. Such return information shall be lim-
ited to—
‘‘(i) taxpayer identity information
with respect to such taxpayer,
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‘‘(ii) the filing status of such tax-
payer,
‘‘(iii) the adjusted gross income of
such taxpayer,
‘‘(iv) the amounts excluded from such
taxpayer’s gross income under sections 135
and 911,
‘‘(v) the interest received or accrued
during the taxable year which is exempt
from the tax imposed by chapter 1 to the
extent such information is available, and
‘‘(vi) the amounts excluded from such
taxpayer’s gross income by sections 931
and 933 to the extent such information is
available.
‘‘(B) RESTRICTION ON USE OF DISCLOSED
INFORMATION.—Return information disclosed
under subparagraph (A) may be used by offi-
cers and employees of the Health Care Financ-
ing Administration only for the purposes of,
and to the extent necessary in, establishing the
appropriate monthly premium under section
1839 of the Social Security Act.’’
(2) CONFORMING
AMENDMENT.—Paragraphs
(3)(A) and (4) of section 6103(p) of such Code are
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health agency in accordance with this section for
each type of home health service described in para-
graph (2) furnished to an individual who at the time
the service is furnished is under a plan of care by
the home health agency under this title (without re-
gard to whether or not the item or service was fur-
nished by the agency or by others under arrange-
ment with them made by the agency, or otherwise).
‘‘(2) TYPES OF SERVICES.—The types of home
health services described in this paragraph are the
following:
‘‘(A) Part-time or intermittent nursing
care provided by or under the supervision of a
registered professional nurse.
‘‘(B) Physical therapy.
‘‘(C) Occupational therapy.
‘‘(D) Speech-language pathology services.
‘‘(E) Medical social services under the di-
rection of a physician.
‘‘(F) To the extent permitted in regula-
tions, part-time or intermittent services of a
home health aide who has successfully com-
pleted a training program approved by the Sec-
retary.
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‘‘(b) ESTABLISHMENT
OF PER VISIT RATE
FOR
EACH TYPE OF SERVICES.—
‘‘(1) IN GENERAL.—The Secretary shall, sub-
ject to paragraph (3), establish a per visit payment
rate for a home health agency in an area for each
type of home health service described in subsection
(a)(2). Such rate shall be equal to the national per
visit payment rate determined under paragraph (2)
for each such type, except that the labor-related por-
tion of such rate shall be adjusted by the area wage
index applicable under section 1886(d)(3)(E) for the
area in which the agency is located (as determined
without regard to any reclassification of the area
under section 1886(d)(8)(B) or a decision of the
Medicare Geographic Classification Review Board or
the Secretary under section 1886(d)(10) for cost re-
porting periods beginning after October 1, 1995).
‘‘(2) NATIONAL PER VISIT PAYMENT RATE.—
The national per visit payment rate for each type of
service described in subsection (a)(2)—
‘‘(A) for fiscal year 1997, is an amount
equal to the national average amount paid per
visit under this title to home health agencies for
such type of service during the most recent 12-
month cost reporting period ending on or before