341
Subtitle F, Part 1
(C) A school of allied health or a program
for the training of physician assistants (as such
terms are defined in section 799 of the Public
Health Service Act).
(D) A school of nursing (as defined in sec-
tion 853 of the Public Health Service Act).
(3) PRIMARY CARE.—The term ‘‘primary care’’
means family practice, general internal medicine,
general pediatrics, and obstetrics and gynecology.
(4) RESIDENT.—The term ‘‘resident’’ has the
meaning given such term in section 1886(h)(5)(H)
of the Social Security Act.
(5) RURAL AREA.—The term ‘‘rural area’’ has
the 
meaning 
given 
such 
term 
in 
section
1886(d)(2)(D) of the Social Security Act.
SEC. 15507. TELEMEDICINE PAYMENT METHODOLOGY.
The Secretary of Health and Human Services shall
establish a methodology for making payments under part
B of the medicare program for telemedicine services fur-
nished on an emergency basis to individuals residing in
an area designated as a health professional shortage area
(under section 332(a) of the Public Health Service Act).
342
Subtitle F, Part 2
SEC. 15508. DEMONSTRATION PROJECT TO INCREASE
CHOICE IN RURAL AREAS.
The Secretary of Health and Human Services (acting
through the Administrator of the Health Care Financing
Administration) shall conduct a demonstration project to
assess the advantages and disadvantages of requiring
Medicare Choice organizations under part C of title XVIII
of the Social Security Act (as added by section 15002(a))
to market Medicare Choice products in certain under-
served areas which are near the standard service area for
such products.
PART 2—MEDICARE SUBVENTION
SEC. 15511. MEDICARE PROGRAM PAYMENTS FOR HEALTH
CARE SERVICES PROVIDED IN THE MILITARY
HEALTH SERVICES SYSTEM.
(a) PAYMENTS UNDER MEDICARE RISK CONTRACTS
PROGRAM.—
(1) CURRENT
PROGRAM.—Section 1876 (42
U.S.C. 1395mm) is amended by adding at the end
the following new subsection:
‘‘(k) Notwithstanding any other provision of this sec-
tion, a managed health care plan established by the Sec-
retary of Defense under chapter 55 of title 10, United
States Code, shall be considered an eligible organization
under this section, and the Secretary shall make payments
to such a managed health care plan during a year on be-
343
Subtitle F, Part 2
half of any individuals entitled to benefits under this title
who are enrolled in such a managed health care plan dur-
ing the year. Such payments shall be made in the same
amounts and under similar terms and conditions under
which the Secretary makes payments to other eligible
organizations with risk sharing contracts under this
section.’’.
(2) MEDICARE
CHOICE
PROGRAM.—Section
1855, as inserted by section 15002(a), by adding at
the end the following new subsection:
‘‘(h) PAYMENTS TO MILITARY PROGRAM.—Notwith-
standing any other provision of this section, a managed
health care plan established by the Secretary of Defense
under chapter 55 of title 10, United States Code, shall
be considered a Medicare Choice organization under this
part, and the Secretary shall make payments to such a
managed health care plan during a year on behalf of any
individuals entitled to benefits under this title who are en-
rolled in such a managed health care plan during the year.
Such payments shall be made in the same amounts and
under similar terms and conditions under which the Sec-
retary makes payments to other Medicare Choice organi-
zations with contracts in effect under this part.’’.
(b) TEMPORARY PROVISION FOR WAIVER OF PART
B PREMIUM PENALTY.—Section 1839 (42 U.S.C. 1395r)
344
Subtitle F, Part 2
is amended by adding at the end the following new sub-
section:
‘‘(h) The premium increase required by subsection
(b) shall not apply with respect to a person who is enrolled
with a managed care plan that is established by the Sec-
retary of Defense under chapter 55 of title 10, United
States Code, and is recognized as an eligible organization
pursuant to section 1855(h) or section 1876(k), if such
person first enrolled in such plan prior to January 1,
1998.’’.
(c) PAYMENTS UNDER PART A OF MEDICARE.—Sec-
tion 1814(c) (42 U.S.C. 1395f(c)) is amended—
(1) by redesignating the current matter as
paragraph (1); and
(2) by adding at the end the following new
paragraph:
‘‘(2) Paragraph (1) shall not apply to services
provided by facilities of the uniformed services pur-
suant to chapter 55 of title 10, United States Code,
and subject to the provisions of section 1095 of such
title. With respect to such services, payments under
this title shall be made without regard to whether
the beneficiary under this title has paid the deduct-
ible and copayments amounts generally required by
this title.’’.
345
Subtitle F, Part 2
(d) PAYMENTS UNDER PART B OF MEDICARE.—Sec-
tion 1835(d) (42 U.S.C. 1395n(d)) is amended—
(1) by redesignating the current matter as
paragraph (1); and
(2) by adding at the end the following new
paragraph:
‘‘(2) Paragraph (1) shall not apply to services pro-
vided by facilities of the uniformed services pursuant to
chapter 55 of title 10, United States Code, and subject
to the provisions of section 1095 of such title. With respect
to such services, payments under this title shall be made
without regard to whether the beneficiary under this title
has paid the deductible and copayments amounts generally
required by this title.’’.
(e) CONFORMING AMENDMENTS
TO
THE THIRD
PARTY COLLECTION PROGRAM FOR MILITARY MEDICAL
FACILITIES.—(1) Section 1095(d) of title 10, United
States Code, is amended—
(A) by striking ‘‘XVIII or’’; and
(B) by striking ‘‘1395’’ and inserting ‘‘1396’’.
(2) Section 1095(h)(2) of such title is amended by
inserting after ‘‘includes’’ the following: ‘‘plans adminis-
tered under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.),’’.
346
Subtitle G
(f) EFFECTIVE DATE.—The amendments made by
this section shall take effect at the end of the 30-day pe-
riod beginning on the date of the enactment of this Act.
Subtitle G—Other Provisions
SEC. 15601. EXTENSION AND EXPANSION OF EXISTING SEC-
ONDARY PAYER REQUIREMENTS.
(a) DATA MATCH.—
(1) 
Section 
1862(b)(5)(C) 
(42 
U.S.C.
1395y(b)(5)(C)) is amended by striking clause (iii).
(2) Section 6103(l)(12) of the Internal Revenue
Code of 1986 is amended by striking subparagraph
(F).
(b) APPLICATION
TO DISABLED INDIVIDUALS
IN
LARGE GROUP HEALTH PLANS.—
(1) IN GENERAL.—Section 1862(b)(1)(B) (42
U.S.C. 1395y(b)(1)(B)) is amended—
(A) in clause (i), by striking ‘‘clause (iv)’’
and inserting ‘‘clause (iii)’’,
(B) by striking clause (iii), and
(C) by redesignating clause (iv) as clause
(iii).
(2) CONFORMING
AMENDMENTS.—Paragraphs
(1) through (3) of section 1837(i) (42 U.S.C.
1395p(i)) and the second sentence of section
1839(b) (42 U.S.C. 1395r(b)) are each amended by
347
Subtitle G
striking ‘‘1862(b)(1)(B)(iv)’’ each place it appears
and inserting ‘‘1862(b)(1)(B)(iii)’’.
(c) EXPANSION OF PERIOD OF APPLICATION TO IN-
DIVIDUALS WITH END STAGE RENAL DISEASE.—Section
1862(b)(1)(C) (42 U.S.C. 1395y(b)(1)(C)) is amended—
(1) in the first sentence, by striking ‘‘12-
month’’ each place it appears and inserting ‘‘24-
month’’, and
(2) by striking the second sentence.
SEC. 15602. CLARIFICATION OF MEDICARE COVERAGE OF
ITEMS AND SERVICES ASSOCIATED WITH
CERTAIN MEDICAL DEVICES APPROVED FOR
INVESTIGATIONAL USE.
(a) COVERAGE.—Nothing in title XVIII of the Social
Security Act may be construed to prohibit coverage under
part A or part B of the medicare program of items and
services associated with the use of a medical device in the
furnishing of inpatient or outpatient hospital services (in-
cluding outpatient diagnostic imaging services) for which
payment may be made under the program solely on the
grounds that the device is not an approved device, if—
(1) the device is an investigational device; and
(2) the device is used instead of either an ap-
proved device or a covered procedure.
348
Subtitle G
(b) CLARIFICATION
OF PAYMENT AMOUNT.—Not-
withstanding any other provision of title XVIII of the So-
cial Security Act, the amount of payment made under the
medicare program for any item or service associated with
the use of an investigational device in the furnishing of
inpatient or outpatient hospital services (including out-
patient diagnostic imaging services) for which payment
may be made under the program may not exceed the
amount of the payment which would have been made
under the program for the item or service if the item or
service were associated with the use of an approved device
or a covered procedure.
(c) DEFINITIONS.—In this section—
(1) the term ‘‘approved device’’ means a medi-
cal device (or devices) which has been approved for
marketing under pre-market approval under the
Federal Food, Drug, and Cosmetic Act or cleared
for marketing under a 510(k) notice under such Act;
and
(2) the term ‘‘investigational device’’ means—
(A) a medical device or devices (other than
a device described in paragraph (1)) approved
for investigational use under section 520(g) of
the Federal Food, Drug, and Cosmetic Act, or
349
Subtitle G
(B) a product authorized for use under
section 505(i) of the Federal Food, Drug, and
Cosmetic Act which includes the use of a medi-
cal device (or devices) or an investigational
combination product under section 503(g) of
such Act which includes a device (or devices)
authorized for use under section 505(i) of such
Act.
SEC. 15603. ADDITIONAL EXCLUSION FROM COVERAGE.
(a) IN
GENERAL.—Section 1862(a) (42 U.S.C.
1395y(a)) is amended—
(1) by striking ‘‘or’’ at the end of paragraph
(14),
(2) by striking the period at the end of para-
graph (15) and inserting ‘‘; or’’, and
(3) by inserting after paragraph (15) the fol-
lowing new paragraph:
‘‘(16) where such expenses are for items or
services, or to assist in the purchase, in whole or in
part, of health benefit coverage that includes items
or services, for the purpose of causing, or assisting
in causing, the death, suicide, euthanasia, or mercy
killing of a person.’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to payment for items and serv-
350
Subtitle H
ices furnished on or after the date of the enactment of
this Act.
Subtitle 
H—Monitoring 
Achieve-
ment of Medicare Reform Goals
SEC. 15701. ESTABLISHMENT OF BUDGETARY AND PRO-
GRAM GOALS.
(a) IN GENERAL.—The Secretary shall establish pro-
gram budgetary and program goals for the medicare pro-
gram consistent with this section.
(b) BUDGETARY GOALS.—The budgetary goal is to
restrict total outlays under the medicare program as fol-
lows:
(1) For fiscal year 1996, $ll.
(2) For fiscal year 1997, $ll.
(3) For fiscal year 1998, $ll.
(4) For fiscal year 1999, $ll.
(5) For fiscal year 2000, $ll.
(6) For fiscal year 2001, $ll.
(7) For fiscal year 2002, $ll.
(c) PROGRAM GOALS.—The program goals shall be
consistent with the following:
(1) There should be an equitable distribution of
funds between per beneficiary spending on payments
to Medicare Choice organizations under part C of
the medicare program and on payments to providers
351
Subtitle H
on a fee-for-service basis under parts A and B of the
program.
(2) Payments to Medicare Choice organizations
should be established in a manner that promotes the
availability of Medicare Choice products in all re-
gions of the country and that permits such organiza-
tions to offer adequate coverage.
SEC. 15702. MEDICARE REFORM COMMISSION.
(a) ESTABLISHMENT.—There is established a com-
mission to be known as the Medicare Reform Commission
(in this section referred to as the ‘‘Commission’’).
(b) DUTIES.—
(1) IN GENERAL.—The Commission shall exam-
ine how the medicare program has met the budg-
etary and program goals established under section
15701.
(2) PERIODIC REPORTS.—
(A) IN GENERAL.—The Commission shall
issue a report on April 1, 1998, and on March
1 of every third subsequent year, on the status
of the medicare program in relation to the
budgetary and program goals specified in sec-
tion 15601.
(B) CONTENTS.—Each report shall include
the following information about the medicare