[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2069 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 2069

  To permit Secretary of Health and Human Services to adjust Medicare 
  payments to reflect deviations from generally accepted practice in 
          overserving or underserving Medicare beneficiaries.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              June 8, 1999

  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 permit Secretary of Health and Human Services to adjust Medicare 
  payments to reflect deviations from generally accepted practice in 
          overserving or underserving Medicare beneficiaries.

    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 Clinical Practice Patterns 
Act of 1999''.

SEC. 2. MEDICARE PAYMENT ADJUSTMENT TO REFLECT DEVIATIONS FROM 
              GENERALLY ACCEPTED PRACTICE IN OVERSERVING OR 
              UNDERSERVING MEDICARE BENEFICIARIES.

    (a) Establishment of Practice Profiles.--
            (1) In general.--By not later than January 1, 2005, the 
        Secretary of Health and Human Services shall establish clinical 
        profiles of the practice patterns of health care providers 
        (including both institutional providers, health care 
        professionals, and Medicare+Choice organizations) providing 
        items and services under the Medicare program under title XVIII 
        of the Social Security Act in order to determine how their 
        practice patterns compare to each other, on a local, State, and 
        national basis. In establishing such profiles, the Secretary 
        shall take into account differences in the case mix and 
        severity of patients served by such providers and shall take 
        into account, to the extent practicable, the medical outcomes 
        resulting from such practices.
            (2) Dissemination of information.--The Secretary shall 
        establish a method for disseminating summary information to the 
        public on the clinical profiles established under paragraph 
        (1). No information that identifies (or permits the 
        identification of) an individual patient shall be disseminated.
    (b) Authority to Make Payment Adjustments.--For items and services 
furnished on or after January 1, 2011, the Secretary of Health and 
Human Services may adjust the amount of the payments made under the 
Medicare program to health care providers in order to encourage their 
provision of services in a medically appropriate manner and to 
discourage significant deviations in underservice or overservice from 
generally accepted norms of medical practice. Such adjustments shall be 
made on the basis of provider profiles established under subsection (a) 
and shall be made only after taking into account variations among 
providers in the case mix and severity of patients served.
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