[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4190 Introduced in House (IH)]







104th CONGRESS
  2d Session
                                H. R. 4190

To amend title XVIII of the Social Security Act to provide for coverage 
   of outpatient parenteral antimicrobial therapy under the Medicare 
                                program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 25, 1996

  Mr. Stark introduced the following bill; which was referred to the 
   Committee on Ways and Means, and in addition to the Committee on 
Commerce, 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 provide for coverage 
   of outpatient parenteral antimicrobial therapy under the Medicare 
                                program.

    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 Coverage of Infectious 
Diseases Therapy Act of 1996''.

SEC. 2. REPORT TO CONGRESS ON COVERAGE OF OUTPATIENT PARENTERAL THERAPY 
              UNDER THE MEDICARE PROGRAM.

    (a) Study.--The Secretary of Health and Human Services shall 
conduct a study of coverage and payment for parenteral antimicrobial 
therapy, drugs, and services under the Medicare program. Such study 
shall include an analysis of--
            (1) the cost of providing coverage under the Medicare 
        program for outpatient parenteral antimicrobial therapy, drugs, 
        and services;
            (2) any savings to the Medicare program generated by the 
        replacement of inpatient parenteral antimicrobial therapy by 
        such outpatient therapy, drugs and services;
            (3) whether payments under part A of the Medicare program 
        for operating costs for inpatient hospital services may be 
        reduced if a Medicare beneficiary is provided parenteral 
        antimicrobial therapy services on an outpatient basis, 
        including an analysis of payments for services under the 
        diagnosis-related groups for endocarditis, osteomyelitis, 
        prosthetic joint infections (status post prosthesis removal), 
        and liver abscess, and other relevant diagnosis-related groups; 
        and
            (4) how payment for such outpatient therapy, drugs and 
        services should be made to ensure maximum cost-savings to the 
        Medicare program.
    (b) Report.--Not later than 6 months after the date of the 
enactment of this Act, the Secretary shall submit a report to the 
Congress on the study under subsection (a) and shall include in the 
report such recommendations with respect to coverage and payment of 
outpatient parenteral antimicrobial therapy, drugs, and services under 
the Medicare program as the Secretary deems appropriate.

SEC. 3. MEDICARE COVERAGE FOR OUTPATIENT PARENTERAL SERVICES AND 
              SUPPLIES.

    (a) In General.--Section 1861(n) of the Social Security Act (42 
U.S.C. 1395x(n)) is amended--
            (1) by striking ``(n)'' and inserting ``(n)(1)'';
            (2) by inserting ``antimicrobial as described in paragraph 
        (2),'' after ``beds,''; and
            (3) by adding at the end the following:
    ``(2) The antimicrobial described in this paragraph is an 
antimicrobial which is administered to a patient parenterally, using an 
access device that is inserted into the body, and which the Secretary 
has determined in the study provided for in this Act to reduce costs if 
administered on an outpatient basis. The Secretary shall have authority 
to amend the coverage (and the price paid for such covered items) so as 
to ensure cost savings.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply with respect to antimicrobials furnished on or after January 1, 
1998.
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