[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5209 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 5209

To amend title XVIII of the Social Security Act to revise the payments 
  for certain physician pathology services under the medicare program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 19, 2000

 Mr. Foley (for himself and Mr. Tanner) 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 revise the payments 
  for certain physician pathology services 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 ``Physician Pathology Services Fair 
Payment Act of 2000''.

SEC. 2. TREATMENT OF CERTAIN PHYSICIAN PATHOLOGY SERVICES UNDER 
              MEDICARE.

    (a) In General.--Notwithstanding any other provision of law, when 
an independent laboratory, under a grandfathered arrangement with a 
hospital, furnishes the technical component of a physician pathology 
service with respect to--
            (1) an inpatient fee-for-service medicare beneficiary, such 
        component shall be treated as a service for which payment shall 
        be made to the laboratory under section 1848 of the Social 
        Security Act (42 U.S.C. 1395w-4) and not as an inpatient 
        hospital service for which payment is made to the hospital 
        under section 1886(d) of such Act (42 U.S.C. 1395ww(d)); and
            (2) an outpatient fee-for-service medicare beneficiary, 
        such component shall be treated as a service for which payment 
        shall be made to the laboratory under section 1848 of such Act 
        (42 U.S.C. 1395w-4) and not as a hospital outpatient service 
        for which payment is made to the hospital under the prospective 
        payment system under section 1834(t) of such Act (42 U.S.C. 
        1395l(d)).
    (b) Definitions.--For purposes of this section:
            (1) Grandfathered arrangement.--The term ``grandfathered 
        arrangement'' means an arrangement between an independent 
        laboratory and a hospital--
                    (A) that was in effect as of July 22, 1999, even if 
                such arrangement is subsequently renewed; and
                    (B) under which the laboratory furnishes the 
                technical component of physician pathology services 
                with respect to patients of the hospital and submits a 
                claim for payment for such component to a medicare 
                carrier (and not to the hospital).
            (2) Inpatient fee-for-service medicare beneficiary.--The 
        term ``inpatient fee-for-service medicare beneficiary'' means 
        an individual who--
                    (A) is an inpatient of the hospital involved;
                    (B) is entitled to benefits under part A of title 
                XVIII of the Social Security Act (42 U.S.C. 1395c et 
                seq.); and
                    (C) is not enrolled in--
                            (i) a Medicare+Choice plan under part C of 
                        such Act (42 U.S.C. 1395w-21 et seq.);
                            (ii) a plan offered by an eligible 
                        organization under section 1876 of such Act (42 
                        U.S.C. 1395mm); or
                            (iii) a medicare managed care demonstration 
                        project.
            (3) Outpatient fee-for-service medicare beneficiary.--The 
        term ``outpatient fee-for-service medicare beneficiary'' means 
        an individual who--
                    (A) is an outpatient of the hospital involved;
                    (B) is enrolled under part B of title XVIII of the 
                Social Security Act (42 U.S.C. 1395j et seq.); and
                    (C) is not enrolled in--
                            (i) a plan or project described in 
                        paragraph (2)(C); or
                            (ii) a health care prepayment plan under 
                        section 1833(a)(1)(A) of such Act (42 U.S.C. 
                        1395l(a)(1)(A)).
            (4) Medicare carrier.--The term ``medicare carrier'' means 
        an organization with a contract under section 1842 of the 
        Social Security Act (42 U.S.C. 1395u).
    (c) Effective Date.--This section shall apply to services furnished 
on or after July 22, 1999.
                                 <all>