[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2558 Introduced in House (IH)]







105th CONGRESS
  1st Session
                                H. R. 2558

To amend title XVIII of the Social Security Act to provide for payment 
  for hospital outpatient department services equal to payment rates 
established for similar services provided outside the hospital setting.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 25, 1997

  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 payment 
  for hospital outpatient department services equal to payment rates 
established for similar services provided outside the hospital 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 Hospital Outpatient Payment 
Fairness Act of 1997''.

SEC. 2. BASING MEDICARE PAYMENT FOR HOSPITAL OUTPATIENT DEPARTMENT 
              SERVICES ON PAYMENT RATES FOR SIMILAR SERVICES PROVIDED 
              OUTSIDE THE HOSPITAL SETTING.

    (a) In General.--Section 1833(t)(1) of the Social Security Act (42 
U.S.C. 1395l(t)(1)), as added by section 4523(a) of the Balanced Budget 
Act of 1997 (Public Law 105-33), is amended--
                    (1) in subparagraph (A), by inserting ``subject to 
                subparagraph (C),'' after ``1999,'', and
                    (2) by adding at the end the following new 
                subparagraph:
                    ``(C) Use of rates in non-hospital settings.--With 
                respect to covered OPD services furnished on or after 
                January 1, 2000, if payment may be made under this part 
                for similar services (such as physicians' services) 
                furnished outside the hospital setting, in accordance 
                with regulations of the Secretary, the total amount of 
                payment under this part for such covered OPD services 
                (including any facility-related component to such 
                services) shall be determined on the same basis on 
                which payment may be made for such similar services 
                furnished outside the hospital setting.''.
    (b) Conforming Amendment.--The fifth sentence of section 
1866(a)(2)(A) of such Act (42 U.S.C. 1395cc(a)(2)(A)), as added by 
section 4523(b) of the Balanced Budget Act of 1997, is amended by 
inserting ``, or in the case described in section 1833(t)(1)(C), the 
coinsurance amount that would otherwise apply with respect to the 
provision of the similar services referred to in such section'' before 
the period at the end.

SEC. 3. MEDICARE PAYMENTS FOR INPATIENT HOSPITAL SERVICES INVOLVING 
              EMERGENCY CARE.

    (a) MedPAC Report on DRG Weighting Factors.--The Medicare Payment 
Advisory Commission (established under section 1805 of the Social 
Security Act, as inserted by section 4022(a) of the Balanced Budget Act 
of 1997 (Public Law 105-33), shall submit a report to Congress and the 
Secretary of Health and Human Services, by January 1, 1999, on whether 
the DRG weighting factors under section 1886(d)(4)(B) of the Social 
Security Act for diagnosis-related groups associated with emergency 
care are adequate to cover the costs of emergency room use within 
discharges classified within such groups.
    (b) Adjustment of Weighting Factors.--Taking into account the 
report submitted under subsection (a), the Secretary of Health and 
Human Services shall make appropriate adjustments in the DRG weighting 
factors described in subsection (a) for discharges occurring on or 
after January 1, 2000, as may be appropriate to ensure that hospital 
emergency room costs attributable to medicare patients are 
appropriately covered.
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