[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1206 Introduced in Senate (IS)]







108th CONGRESS
  1st Session
                                S. 1206

To amend title XVIII of the Social Security Act to provide for special 
   treatment for certain drugs and biologicals under the prospective 
 payment system for hospital outpatient department services under the 
                           medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              June 9, 2003

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

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide for special 
   treatment for certain drugs and biologicals under the prospective 
 payment system for hospital outpatient department 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 ``Beneficiary Access to Care Act of 
2003''.

SEC. 2. TREATMENT OF DRUGS AND BIOLOGICALS UNDER THE MEDICARE 
              OUTPATIENT HOSPITAL PROSPECTIVE PAYMENT SYSTEM.

    (a) Separate APCs for Most Drugs and Biologicals.--
            (1) In general.--Section 1833(t)(2) of the Social Security 
        Act (42 U.S.C. 1395l(t)(2)) is amended--
                    (A) by striking ``and'' at the end of subparagraph 
                (F);
                    (B) by striking the period at the end of 
                subparagraph (G) and inserting ``; and''; and
                    (C) by adding at the end the following:
                    ``(H) the Secretary shall treat as a separate group 
                of covered OPD services--
                            ``(i) any drug or biological that was 
                        treated as such a group as of December 31, 
                        2002; and
                            ``(ii) any drug or biological that has 
                        ceased to be eligible for transitional, pass-
                        through payments under paragraph (6) by reason 
                        of the limited period of payment specified in 
                        paragraph (6)(C)(i).''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to items and services furnished on or after January 
        1, 2004.
    (b) Payment Rates for Non-Pass-Through Drugs and Biologicals.--
            (1) Program payments.--Section 1833(t) of the Social 
        Security Act (42 U.S.C. 1395l(t)) is amended--
                    (A) in paragraph (3), by amending subparagraph (D) 
                to read as follows:
                    ``(D) Calculation of medicare opd fee schedule 
                amounts.--
                            ``(i) In general.--The Secretary shall 
                        compute a medicare OPD fee schedule amount for 
                        each covered OPD service (or group of such 
                        services) furnished in a year, in an amount 
                        that (except as provided in clause (ii)) is 
                        equal to the product of--
                                    ``(I) the conversion factor 
                                computed under subparagraph (C) for the 
                                year; and
                                    ``(II) the relative payment weight 
                                (determined under paragraph (2)(C) or 
                                paragraph (9)(A)) for the service or 
                                group.
                            ``(ii) Special rules for 2004.--
                                    ``(I) In general.--Notwithstanding 
                                clause (i), the medicare OPD fee 
                                schedule amount for 2004 for a drug or 
                                biological that is treated as a 
                                separate group of covered OPD services 
                                and is--
                                            ``(aa) a single-source drug 
                                        (as defined in section 
                                        1927(k)(7)(A)(iv));
                                            ``(bb) an innovator 
                                        multiple source drug (as 
                                        defined in section 
                                        1927(k)(7)(A)(ii)); or
                                            ``(cc) a biological product 
                                        approved for marketing under 
                                        section 351 of the Public 
                                        Health Service Act (including 
                                        any such product that is 
                                        marketed by any cross-licensed 
                                        producers or distributors),
                                may not be less than 87.37 percent of 
                                the payment rate for the drug or 
                                biological under paragraph (6) as of 
                                December 31, 2002 (determined without 
                                regard to any reduction under 
                                subparagraph (E)(iii) of such 
                                paragraph).
                                    ``(II) No revision of relative 
                                payment weights.--The relative payment 
                                weights established under paragraph 
                                (9)(A) for 2004 for groups of covered 
                                OPD services other than those to which 
                                subclause (I) applies shall not be 
                                revised to take into account the 
                                application of such subclause (I).'';
                    (B) in paragraph (4)--
                            (i) in subparagraph (A), by striking 
                        ``Secretary, as computed under paragraphs 
                        (2)(D) and (2)(E)'' and inserting ``Secretary 
                        (as computed under paragraphs (2)(D) and 
                        (2)(E)), except that the medicare OPD fee 
                        schedule amount determined under paragraph 
                        (3)(D) for a drug or biological that is treated 
                        as a separate group of covered OPD services 
                        shall not be adjusted for relative differences 
                        in the cost of labor''; and
                            (ii) in subparagraph (B), by striking 
                        ``adjusted''; and
                    (C) in paragraph (9), by adding at the end the 
                following:
                    ``(D) Use of external data.--In determining the 
                relative payment weight for any drug or biological that 
                is treated as a separate group of covered OPD services 
                for any year after 2003, the Secretary shall adjust the 
                weight otherwise determined under this paragraph with 
                respect to the drug or biological to the extent that 
                reliable and valid data collected and submitted by 
                entities and organizations other than the Department of 
                Health and Human Services (including data submitted in 
                public comments on the proposed rule promulgated with 
                respect to the system established under this subsection 
                for 2004) demonstrate that such payment weight is 
                inadequate or inaccurate. In the case of any 
                adjustments made pursuant to the preceding sentence for 
                2004, the Secretary shall not revise the relative 
                payment weights for other groups of covered OPD 
                services for such year to take into account such 
                adjustments, and the medicare OPD fee schedule amount 
                determined under paragraph (3)(D) using a relative 
                weight resulting from such an adjustment shall be 
                subject to the minimum amount described in clause 
(ii)(I) of such paragraph.''.
            (2) Copayments.--Section 1833(t)(8)(E) of the Social 
        Security Act (42 U.S.C. 1395l(t)(8)(E)) is amended--
                    (A) in the heading, by striking ``outlier and pass-
                through'' and inserting ``certain''; and
                    (B) by striking ``paragraphs (5) and (6)'' and 
                inserting ``paragraphs (3)(D)(ii), (5), and (6)''.
            (3) Exceptions to budget neutrality requirement.--Section 
        1833(t)(9)(B) of the Social Security Act (42 U.S.C. 
        1395l(t)(9)(B)) is amended by adding at the end the following: 
        ``In determining the budget neutrality adjustment required by 
        the preceding sentence, the Secretary shall not take into 
        account--
                            ``(i) any expenditures that would not have 
                        been made but for the application of clause 
                        (ii) of paragraph (3)(D); or
                            ``(ii) any expenditures made by reason of 
                        an adjustment required by subparagraph (D) for 
                        2004.''.
    (c) Study of Pharmacy Services Used To Provide Cancer Drug 
Therapies in Hospital Outpatient Setting.--
            (1) In general.--The Comptroller General shall conduct a 
        study of payments under part B of title XVIII of the Social 
        Security Act for pharmacy service costs and related costs that 
        are incurred in acquiring chemotherapy and supportive care 
        drugs and providing these therapies to cancer patients in 
        hospital outpatient departments. The study shall--
                    (A) identify pharmacy costs, including the costs of 
                storage, handling, processing, quality control, 
                disposal, compliance with safety protocols and 
                regulations, establishing dosage regimens that avoid 
                drug interactions and contraindications, and pharmacy 
                overhead;
                    (B) include a review of the adequacy of the current 
                payment methodology for pharmacy service costs and 
                related costs (including the adequacy of the 
                methodology used to estimate costs); and
                    (C) identify any changes to that methodology that 
                are necessary to ensure recognition of, and appropriate 
                payment for, all of the services and functions inherent 
                in the provision of cancer treatment in hospital 
                outpatient settings.
            (2) Report to congress.--Not later than 12 months after the 
        date of enactment of this Act, the Comptroller General shall 
        submit to Congress a report on the results of the study under 
        paragraph (1), including any recommendations for legislation 
        that is necessary to implement the changes identified under 
        paragraph (1)(C).
                                 <all>