[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 3042 Introduced in Senate (IS)]







107th CONGRESS
  2d Session
                                S. 3042

 To provide for the recognition of new medical technologies under the 
        medicare inpatient hospital prospective payment system.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            October 3, 2002

   Mr. Hatch introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To provide for the recognition of new medical technologies under the 
        medicare inpatient hospital prospective payment system.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. RECOGNITION OF NEW MEDICAL TECHNOLOGIES UNDER INPATIENT 
              HOSPITAL PPS.

    (a) Improving Timeliness of Data Collection.--Section 1886(d)(5)(K) 
of the Social Security Act (42 U.S.C. 1395ww(d)(5)(K)) is amended by 
adding at the end the following new clause:
    ``(vii) Under the mechanism under this subparagraph, the Secretary 
shall provide for the addition of new diagnosis and procedure codes on 
April 1 of each year (beginning with 2004), but the addition of such 
codes shall not require the Secretary to adjust the payment or 
diagnosis-related group classification (if warranted) under this 
subsection until the Secretary is able to incorporate such an 
adjustment into the annual proposed rule for a fiscal year that begins 
after such date.''.
    (b) Eligibility Standard.--
            (1) Adjustment of threshold.--Section 1886(d)(5)(K)(ii)(I) 
        of the Social Security Act (42 U.S.C. 1395ww(d)(5)(K)(ii)(I)) 
        is amended by inserting ``(applying a threshold specified by 
        the Secretary that is 75 percent of one standard deviation 
        beyond the average standardized charge for the diagnosis-
        related group involved)'' after ``is inadequate''.
            (2) Process for public input.--Section 1886(d)(5)(K) of the 
        Social Security Act (42 U.S.C. 1395ww(d)(5)(K)), as amended by 
        subsection (a), is amended--
                    (A) in clause (i), by adding at the end the 
                following new sentence: ``Such mechanism shall be 
                modified to meet the requirements of clause (viii).''; 
                and
                    (B) by adding at the end the following new clause:
    ``(viii) The mechanism established pursuant to clause (i) shall be 
adjusted to provide, before publication of a proposed rule, for public 
input regarding whether a new service or technology represents an 
advance in medical technology that substantially improves the diagnosis 
or treatment of beneficiaries as follows:
            ``(I) The Secretary shall make public, prior to the meeting 
        provided for under subclause (III), a list of all the services 
        and technologies for which an application for additional 
        payment under this subparagraph is pending.
            ``(II) The Secretary shall accept comments, 
        recommendations, and data from the public regarding whether the 
        service or technology represents a substantial improvement in 
        the diagnosis or treatment of beneficiaries.
            ``(III) The Secretary shall provide for a meeting at which 
        organizations representing hospitals, physicians, medicare 
        beneficiaries, manufacturers, and any other interested party 
        may present comments, recommendations, and data to the clinical 
        staff of the Centers for Medicare & Medicaid Services before 
        publication of a notice of proposed rulemaking regarding 
        whether service or technology represents a substantial 
        improvement in the diagnosis or treatment of beneficiaries.''.
    (c) Improvement in Payment for New Technology.--Section 
1886(d)(5)(K)(ii)(III) of the Social Security Act (42 U.S.C. 
1395ww(d)(5)(K)(ii)(III)) is amended by inserting after ``the estimated 
average cost of such service or technology'' the following: ``(based on 
the marginal rate applied to costs under subparagraph (A))''.
    (d) Effective Date.--
            (1) In general.--The Secretary shall implement the 
        amendments made by this section so that such amendments apply 
        to classifications for fiscal years beginning with fiscal year 
        2004.
            (2) Reconsiderations of applications for fiscal year 2003 
        that are denied.--In the case of an application for a 
        classification of a medical service or technology as a new 
        medical service or technology under section 1886(d)(5)(K) of 
        the Social Security Act (42 U.S.C. 1395ww(d)(5)(K)) that was 
        filed for fiscal year 2003 and that is denied--
                    (A) the Secretary shall automatically reconsider 
                the application as an application for fiscal year 2004 
                under the amendments made by this section; and
                    (B) the maximum time period otherwise permitted for 
                such classification of the service or technology shall 
                be extended by 12 months.
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