[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1736 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 1736

  To amend title XVIII of the Social Security Act to provide certain 
 Medicare beneficiaries with an exemption to the financial limitations 
   imposed on physical, speech-language pathology, and occupational 
 therapy services under part B of the Medicare Program, and to provide 
   for a system to vary those limitations using a classification of 
  individuals based on diagnostic category and prior use of services.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 6, 1999

  Mr. Stark 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 certain 
 Medicare beneficiaries with an exemption to the financial limitations 
   imposed on physical, speech-language pathology, and occupational 
 therapy services under part B of the Medicare Program, and to provide 
   for a system to vary those limitations using a classification of 
  individuals based on diagnostic category and prior use of services.

    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 Rehabilitation Benefit 
Equity Act of 1999''.

SEC. 2. ESTABLISHMENT OF EXEMPTION TO CAP ON PHYSICAL, SPEECH-LANGUAGE 
              PATHOLOGY, AND OCCUPATIONAL THERAPY SERVICES.

    (a) In General.--Section 1833(g) of the Social Security Act (42 
U.S.C. 1395l(g)) is amended by adding at the end the following:
    ``(4)(A) For services furnished on or after the date of the 
enactment of this paragraph and before January 1, 2002, the limitations 
in this subsection shall not apply to an individual described in 
subparagraph (B).
    ``(B) An individual described in this subparagraph is an individual 
that meets any of the following criteria:
            ``(i) The individual has received services described in 
        paragraph (1) or (3) in a calendar year and is subsequently 
        diagnosed with an illness, injury, or disability that requires 
        the provision in such year of additional such services that are 
        medically necessary.
            ``(ii) The individual has a diagnosis that requires the 
        provision of services described in paragraph (1) or (3) and an 
        additional diagnosis or incident that exacerbates the 
        individual's condition, thereby requiring the provision of 
        additional such services.
            ``(iii) The individual will require hospitalization if the 
        individual does not receive the services described in paragraph 
        (1) or (3).
            ``(iv) The individual meets other criteria that the 
        Secretary determines are appropriate.
    ``(C) Nothing in this paragraph shall be construed as affecting any 
requirement for, or limitation on, payment under this title (other than 
the financial limitation under this subsection).
    ``(D) Any service that is covered under this title by reason of 
this paragraph shall be subject to the same reasonable and necessary 
requirement under section 1862(a)(1) that is applicable to the services 
described in paragraph (1) or (3) that are covered under this title 
without regard to this paragraph.''.
    (b) Conforming Amendments.--Paragraphs (1) and (3) of section 
1833(g) of such Act (42 U.S.C. 1395l(g)) are each amended by striking 
``In the case'' and inserting ``Subject to paragraph (4), in the 
case''.

SEC. 3. ESTABLISHMENT OF VARIABLE DURATIONAL LIMITATION BASED ON 
              DIAGNOSTIC CATEGORIES AND PRIOR USE OF SERVICES.

    (a) In General.--Subparagraph (B) of section 1833(g)(2) of the 
Social Security Act (42 U.S.C. 1395l(g)(2)) is amended to read as 
follows:
            ``(B) for a subsequent year is an amount specified by the 
        Secretary pursuant to a system which establishes different 
        limitations (but not different payment rates or fee schedules) 
        based on a classification of individuals by diagnostic category 
        and severity of diagnosis, in both inpatient and outpatient 
        settings.''.
    (b) Budget-Neutral Implementation.--The Secretary of Health and 
Human Services shall establish the different limitations under section 
1833(g)(2)(B) of the Social Security Act, as amended by subsection (a), 
in a manner so that the aggregate expenditures under such limitations 
under part B of title XVIII of such Act is the same as the aggregate 
expenditures that would have been made under such part if this section 
has not been enacted.
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