[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3139 Introduced in House (IH)]







105th CONGRESS
  2d Session
                                H. R. 3139

To amend title XVIII of the Social Security Act to stop overpayment for 
           drugs and biologicals under the Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            February 3, 1998

 Mr. Berry (for himself, Mr. Brown of Ohio, Mr. Neal of Massachusetts, 
 Mr. Stark, Mr. Filner, Mr. Lewis of Georgia, Ms. DeLauro, Mr. Frost, 
Mr. Baesler, Mr. Peterson of Minnesota, Mr. Sandlin, Ms. Slaughter, Mr. 
   Stenholm, Mr. Tanner, Mr. Schumer, Mr. Pascrell, and Mr. Davis of 
  Illinois) 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 stop overpayment for 
           drugs and biologicals 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 ``Stop Medicare Overpayment Act of 
1998''.

SEC. 2. MEDICARE PAYMENT FOR DRUGS AND BIOLOGICALS.

    (a) In General.--Section 1842(o) of the Social Security Act (42 
U.S.C. 1395u(o)), as inserted by section 4556(a) of the Balanced Budget 
Act of 1997, is amended--
            (1) by redesignating paragraph (2) as paragraph (4);
            (2) in paragraph (1), by striking ``95 percent of the 
        average wholesale price.'' and inserting ``the lowest of the 
        following:
            ``(A) The actual acquisition cost, as defined in paragraph 
        (2), to the person submitting the claim for payment for the 
        drug or biological.
            ``(B) 95 percent of the average wholesale price of such 
        drug or biological, as determined by the Secretary.
            ``(C) For payments for drugs or biologicals furnished on or 
        after January 1, 2000, the median actual acquisition cost of 
        all claims for payment for such drugs or biologicals for the 
        12-month period beginning July 1, 1998 (and adjusted annually, 
        as the Secretary determines appropriate, to reflect changes in 
        the cost of such drugs or biologicals due to inflation and such 
        other factors as the Secretary determines appropriate).
            ``(D) The amount otherwise determined under this part.
    ``(2) For purposes of paragraph (1)(A), the term `actual 
acquisition cost' means, with respect to such drugs or biologicals, the 
cost of the drugs or biologicals based on the most economical case size 
in inventory on the date of dispensing or, if less, the most economical 
case size purchased within six months of the date of dispensing whether 
or not that specific drug or biological was furnished to an individual 
whether or not enrolled under this part. Such term includes appropriate 
adjustments, as determined by the Secretary, for all discounts, 
rebates, or any other benefit in cash or in kind (including travel, 
equipment, or free products). The Secretary may include an additional 
payment for administrative, storage, and handling costs.
    ``(3)(A) No payment shall be made under this part for drugs or 
biologicals to a person whose bill or request for payment for such 
drugs or biologicals does not include a statement of the person's 
actual acquisition cost.
    ``(B) A person may not bill an individual enrolled under this 
part--
            ``(i) any amount other than the payment amount specified in 
        paragraph (1) or (4) (plus any applicable deductible and 
        coinsurance amounts), or
            ``(ii) any amount for such drugs or biologicals for which 
        payment may not be made pursuant to subparagraph (A).
    ``(C) If a person knowingly and willfully in repeated cases bills 
one or more individuals in violation of subparagraph (B), the Secretary 
may apply sanctions against that person in accordance with subsection 
(j)(2).''; and
            (3) in paragraph 4, as so redesignated in paragraph (1) of 
        this subsection, by striking ``the Secretary may pay a 
        dispensing fee'' and inserting ``the Secretary shall pay a 
        dispensing fee''.
    (b) Effective Date.--The amendments made by subsection (a) apply to 
drugs and biologicals furnished on or after January 1, 1998.
    (c) Conforming Amendment to Report.--Section 4556(c) of the 
Balanced Budget Act of 1997 is amended by striking ``of the amendments 
made by subsection (a)'' and inserting ``the application of section 
1842(o) of the Social Security Act''.
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