[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6380 Introduced in House (IH)]







110th CONGRESS
  2d Session
                                H. R. 6380

  To amend title XVIII of the Social Security Act to provide payments 
    under the Medicare Program for unscheduled physician telephone 
consultation services in the case that such payments are determined to 
                     be cost and quality effective.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 26, 2008

 Mrs. Biggert (for herself, Mr. Emanuel, and Mrs. Emerson) introduced 
 the following bill; which was referred to the Committee on Energy and 
  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 payments 
    under the Medicare Program for unscheduled physician telephone 
consultation services in the case that such payments are determined to 
                     be cost and quality effective.

    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 Physician Telephone 
Consultation Services Coverage Act of 2008''.

SEC. 2. MEDICARE PAYMENT FOR UNSCHEDULED PHYSICIAN TELEPHONE SERVICES.

    (a) Coverage Under Part B.--
            (1) In general.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)) is amended--
                    (A) in subparagraph (Z), by striking ``and'' at the 
                end;
                    (B) in subparagraph (AA), by adding at the end 
                ``and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(BB) subject to section 2(c) of the Medicare 
                Physician Telephone Consultation Services Coverage Act 
                of 2008, unscheduled telephone consultation services 
                (as defined in subsection (ccc)(1)) by a physician, 
                with respect to the treatment of an individual, if--
                            ``(i) the Medicare number of the individual 
                        is associated with the national provider 
                        identifier of the physician;
                            ``(ii) to ensure the quality and 
                        appropriateness of such consultation services, 
                        the utilization of such services by the 
                        individual can be reviewed by a utilization and 
                        quality control peer review organization or 
                        eligible entity with which the Secretary has 
                        entered into a contract under part B of title 
                        XI or section 1893, respectively, by the 
                        organization or entity applying for purposes of 
                        the review under this subparagraph the 
                        processes and standards used by such 
                        organization or entity under such part or 
                        section, respectively, in the same manner that 
                        such processes and standards apply for purposes 
                        of carrying out utilization and quality review 
                        under such part or section, respectively;
                            ``(iii) such consultation services are 
                        securely recorded by the Secretary (or an 
                        entity described in subsection (ccc)(1) with 
                        which the Secretary enters into a contract) for 
                        purposes of appropriate review by peers of the 
                        physician who practice in the same medical 
                        specialty as the physician and Medicare 
                        administrative contractor oversight of such 
                        services; and
                            ``(iv) the physician provides for the 
                        submission to the Secretary (or an entity 
                        described in subsection (ccc)(1) with which the 
                        Secretary enters into a contract) and the 
                        Secretary (or such an entity) records and 
                        maintains a summary of each such consultation 
                        service furnished by the physician that 
                        includes--
                                    ``(I) the date and time (including 
                                duration) of the consultation service;
                                    ``(II) a unique medical record 
                                number specified by the Secretary (or 
                                such entity) to identify the 
                                consultation service;
                                    ``(III) the name of the individual;
                                    ``(IV) the name of the physician; 
                                and
                                    ``(V) a summary of the content of 
                                the consultation service;''.
            (2) Unscheduled telephone consultation services defined.--
        Section 1861 of such Act (42 U.S.C. 1395x) is amended by adding 
        at the end the following new subsection:

             ``Unscheduled Telephone Consultation Services

    ``(ccc)(1) The term `unscheduled telephone consultation service' 
means a consultation conducted by means of telephone or similar 
electronic communication device between a physician and an individual 
(or a representative of such individual), with respect to the treatment 
of such individual, that is not included as a scheduled physician 
service (as defined by the Secretary in regulations), and which is 
initiated by the individual (or representative) contacting a 
communication network operated by the Secretary (or an entity with 
which the Secretary enters into a contract) that connects the 
individual to the physician, securely records the consultation for 
purposes of subsection (s)(2)(BB), and maintains the information 
described in clause (iv) of such subsection with respect to such 
consultation.
    ``(2) For purposes of applying the regulations promulgated pursuant 
to section 264(c) of the Health Insurance Portability and 
Accountability Act of 1996 (Public Law 104-191; 110 Stat. 2033) with 
respect to an unscheduled telephone consultation service furnished by a 
physician--
            ``(A) an entity with which the Secretary contracts under 
        this subsection shall be treated as a health oversight agency; 
        and
            ``(B) activities of such an entity described in 
        subparagraph (A) in relation to such physician and such 
        unscheduled telephone consultation service are deemed to be 
        health oversight activities.''.
    (b) Payment Under Physician Fee Schedule.--Section 1848(j)(3) of 
such Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting ``(2)(BB),'' 
after ``(2)(AA),''.
    (c) Contingent Effective Date, Demonstration Program.--
            (1) Contingent effective date.--The amendments made by this 
        section shall become effective (if at all) in accordance with 
        paragraph (2).
            (2) Demonstration program.--
                    (A) In general.--The Secretary of Health and Human 
                Services (in this paragraph referred to as the 
                ``Secretary'') shall establish a demonstration program 
                to begin not later than 6 months after the date of the 
                enactment of this Act to test the effectiveness of 
                providing coverage under the Medicare Program for 
                unscheduled telephone consultation services (as defined 
                in section 1861(ccc) of the Social Security Act) by 
                physicians to the extent provided under the amendments 
                made by this section to a sample group of Medicare 
                beneficiaries. For purposes of such demonstration 
                program, the Secretary shall find that the provision of 
                such coverage is effective if--
                            (i) the coverage reduces costs to the 
                        Medicare Program (such as through a reduction 
                        in admissions to the emergency departments of 
                        hospitals), whether or not such reduction is 
                        demonstrated in a reduction in the facility 
                        fees of hospital emergency departments, 
                        professional fees of emergency department 
                        physicians, laboratory fees, pathologist fees, 
                        hospital radiology department fees for 
                        technical components of x-rays, radiologist 
                        professional fees for interpreting x-rays, 
                        hospital respiratory department fees for 
                        respiratory treatments, hospital cardiology 
                        department fees for electrocardiograms, 
                        professional fees for interpreting such 
                        electrocardiograms, or any other cost specified 
                        by the Secretary; and
                            (ii) the coverage results in patient health 
                        outcomes that are at least as favorable as 
                        would apply in the absence of such coverage (as 
                        determined in accordance with criteria 
                        established by the Centers for Medicare & 
                        Medicaid Services, in consultation with 
                        physician organizations).
                    (B) Initial period of demonstration program.--The 
                demonstration program under subparagraph (A) shall be 
                conducted for an initial period of 24 months.
                    (C) Report to congress.--
                            (i) In general.--Not later than 30 days 
                        after the last day of the initial period under 
                        subparagraph (B), the Secretary shall submit to 
                        Congress a report on the results of the 
                        demonstration program under this paragraph.
                            (ii) Finding that payments are effective.--
                        If the Secretary finds, on the basis of the 
                        data derived from the demonstration program 
                        under subparagraph (A) and in accordance with 
                        such subparagraph, that providing coverage 
                        under the Medicare Program for unscheduled 
                        telephone consultation services by physicians 
                        (to the extent provided under the amendments 
                        made by this section) is effective, the 
                        amendments made by this section shall become 
                        effective on the first day of the first month 
                        beginning after the date the report under 
                        clause (i) is submitted to Congress.
                            (iii) Finding that payments are not 
                        effective.--If the Secretary finds, on the 
                        basis of the data derived from the 
                        demonstration program under subparagraph (A) 
                        and in accordance with such subparagraph, that 
                        a finding of effectiveness (as described in 
                        clause (ii)) cannot be made, the demonstration 
                        program shall continue for a period of an 
                        additional 24 months. Not later than 30 days 
                        after the last day of such period, the 
                        Secretary shall submit to Congress a final 
                        report on the results of such program. The 
                        amendments made by this section shall become 
                        effective on the first day of the first month 
                        beginning after the date such report is 
                        submitted to Congress unless the report 
                        contains a finding by the Secretary, on the 
                        basis of such data and in accordance with such 
                        subparagraph, that providing coverage under the 
                        Medicare Program for unscheduled telephone 
                        consultation services by physicians (to the 
                        extent provided under the amendments made by 
                        this section) is not effective, in which case 
                        the amendments made by this section shall not 
                        become effective.
    (d) Clarification.--Nothing in the provisions of this section or 
the amendments made by this section shall be construed as authorizing 
the creation of a national reporting system on physician quality.
                                 <all>