Title: Medicare Diagnostic Radiopharmaceutical Payment Equity Act of 2018
Policy area: Health

Summary:
Medicare Diagnostic Radiopharmaceutical Payment Equity Act of 2018
This bill establishes separate payment requirements for diagnostic radiopharmaceuticals under the Medicare prospective payment system for hospital outpatient department services.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6948 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 6948

  To amend title XVIII of the Social Security Act to ensure equitable 
 payment for, and preserve Medicare beneficiary access to, diagnostic 
radiopharmaceuticals under the Medicare hospital outpatient prospective 
                            payment system.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 27, 2018

  Mr. Holding (for himself and Mr. Moulton) introduced the following 
 bill; which was referred to the Committee on Energy and Commerce, and 
  in addition to the Committee on Ways and Means, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL


 
  To amend title XVIII of the Social Security Act to ensure equitable 
 payment for, and preserve Medicare beneficiary access to, diagnostic 
radiopharmaceuticals under the Medicare hospital outpatient prospective 
                            payment system.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Diagnostic 
Radiopharmaceutical Payment Equity Act of 2018''.

SEC. 2. SEPARATE PAYMENT FOR CERTAIN DIAGNOSTIC RADIOPHARMACEUTICALS.

    Section 1833(t)(16) of the Social Security Act (42 U.S.C. 
1395l(t)(16)) is amended by adding at the end the following new 
subparagraph:
                    ``(G) Separate payment for certain diagnostic 
                radiopharmaceuticals.--
                            ``(i) In general.--Notwithstanding any 
                        other provision of this subsection, with 
                        respect to services furnished on or after 
                        January 1, 2019, the Secretary shall not 
                        package, and shall make a separate payment as 
                        specified in clause (ii) for, a diagnostic 
                        radiopharmaceutical with an estimated mean per 
                        day product cost equal to or exceeding the 
                        threshold specified in clause (iii).
                            ``(ii) Separate payment.--For purposes of 
                        clause (i), payment specified in this clause 
                        for a diagnostic radiopharmaceutical described 
                        in clause (i) shall be equal to--
                                    ``(I) the average sales price for 
                                the drug established under section 
                                1847A, to the extent the average sales 
                                price is available, as calculated and 
                                adjusted by the Secretary to the extent 
                                such adjustment is adopted for other 
                                specified covered outpatient drugs 
                                under paragraph (14)(A); or
                                    ``(II) if the data necessary to 
                                calculate the average price for the 
                                drug in the year under the sections 
                                specified in subclause (I) is not 
                                available, the average acquisition cost 
                                for the drug for that year (which, at 
                                the option of the Secretary, may vary 
                                by hospital group (as defined by the 
                                Secretary based on volume of covered 
                                OPD services or other relevant 
                                characteristics)), as determined by the 
                                Secretary taking into account the 
                                hospital acquisition cost survey data 
                                under paragraph (14)(D).
                            ``(iii) Threshold.--For purposes of this 
                        subparagraph, the threshold specified in this 
                        clause--
                                    ``(I) for 2019, is $500; and
                                    ``(II) for subsequent years, is the 
                                amount specified in this clause for the 
                                preceding year increased by the 
                                percentage of the OPD fee schedule 
                                increase factor under paragraph 
                                (3)(C)(iv) for the applicable year.
                            ``(iv) Budget neutrality.--The Secretary 
                        shall make such adjustments as are necessary 
                        under this subsection, with respect to a year, 
                        to ensure that the amount of expenditures under 
                        this subsection for such year with application 
                        of this subparagraph is equal to the amount of 
                        expenditures that would be made under this 
                        subsection for such year without application of 
                        this subparagraph.
                            ``(v) Definition.--For purposes of this 
                        subparagraph, a diagnostic radiopharmaceutical 
                        is a drug or biological that is described in 
                        section 315.2(a) of title 21, Code of Federal 
                        Regulations, or any successor regulation.''.
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