[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4248 Introduced in House (IH)]







104th CONGRESS
  2d Session
                                H. R. 4248

To amend title XVIII of the Social Security Act to provide for coverage 
 under part B of the Medicare program of certain antibiotics that are 
              parenterally administered in a home setting.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 27, 1996

Ms. Greene of Utah introduced the following bill; which was referred to 
the Committee on 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 provide for coverage 
 under part B of the Medicare program of certain antibiotics that are 
              parenterally administered in a home setting.

    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 Antibiotic Coverage 
Amendments of 1996''.

SEC. 2. MEDICARE COVERAGE OF CERTAIN PARENTERALLY ADMINISTERED 
              ANTIBIOTICS.

    (a) In General.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) by striking ``and'' at the end of subparagraphs (N) and 
        (O);
            (2) by redesignating subparagraph (Q) as subparagraph (P), 
        and by adding ``and'' at the end of such subparagraph; and
            (3) by adding at the end the following:
            ``(Q) an antibiotic described in section 1834(k) that is 
        administered parenterally in the patient's home (including an 
        institution used as his home other than an institution that 
        meets the requirements of section 1861(e)(1) of this section or 
        section 1819(a)(1));''.
    (b) Antibiotics Described.--Section 1834 of such Act (42 U.S.C. 
1395m) is amended by adding at the end the following:
    ``(k) For purposes of section 1861(s)(2)(Q), an antibiotic 
described in this subsection is an antibiotic that can only be 
administered parenterally and that is being administered to treat 
osteomyelitis, infected joint replacements, endocarditis, or a soft 
tissue infection.''.
    (c) Limitation on Coverage of Vancomycin.--Section 1862(a) of such 
Act (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 paragraph (15) and 
        inserting ``; or'', and
            (3) by inserting after paragraph (15) the following new 
        paragraph:
            ``(16) where such expenses are for the use of Vancomycin 
        under section 1861(s)(2)(Q) unless such use is in accordance 
        with guidelines established by the Centers for Disease Control 
        and Prevention for the prudent use of such antibiotic.''.
    (d) Reduction in Hospital Update for Increases in Payments.--
Section 1886(d)(3)(C) of such Act (42 U.S.C. 1395ww(d)(3)(C)) is 
amended by adding at the end the following new clause:
            ``(iii) Maintaining budget neutrality for coverage of 
        certain antibiotics.--For discharges occurring in a fiscal year 
        (beginning with fiscal year 1998), the Secretary shall adjust 
        each of such average standardized amounts so as to provide for 
        a reduction in the total amount of the payments (attributable 
        to this paragraph) made for such discharges by the amount (if 
        any) by which net payments under this title for the previous 
        fiscal year (not taking into account this clause) were 
        increased as a result of the amendments made by the Medicare 
        Antibiotic Coverage Amendments of 1996.''.
    (e) Effective Date.--The amendments made by this section shall 
apply to drugs administered on or after April 1, 1998.
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