[Congressional Record Volume 143, Number 89 (Monday, June 23, 1997)]
[Senate]
[Pages S6100-S6101]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          AMENDMENTS SUBMITTED

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                    THE BALANCED BUDGET ACT OF 1997

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                         DODD AMENDMENT NO. 425

  (Ordered to lie on the table.)
  Mr. DODD submitted an amendment intended to be proposed by him to the 
bill, S. 947, to provide for reconciliation pursuant to section 104(a) 
of the concurrent resolution on the budget for fiscal year 1998; as 
follows:

       On page 874, between lines 7 and 8, insert the following:

     SEC. 5817A. CONTINUATION OF MEDICAID ELIGIBILITY FOR DISABLED 
                   CHILDREN WHO LOSE SSI BENEFITS.

       (a) In General.--Section 1902(a)(10(A)(i)(II) (42 U.S.C. 
     1396a(a)(10(A)(i)(II)) is amended by inserting ``(or were 
     being paid as of the date of enactment of section 211(a) of 
     the Personal Responsibility and Work Opportunity Act of 1996 
     (Public Law 104-193; 110 Stat. 2188) and would continue to be 
     paid but for the enactment of that section)'' after `'title 
     XVI''.
       (b) Effective Date.--The amendment made by subsection (a) 
     applies to medical assistance furnished on or after July 1, 
     1997.
                                 ______
                                 

                        GREGG AMENDMENT NO. 426

  Mr. GREGG proposed an amendment to the bill, S. 947, supra; as 
follows:

       On page 213, strike all of (d) and insert the following:
       ``(d) Terms and Conditions of Imposing Premiums.--Each 
     Medicare Choice organization shall permit the payment of net 
     monthly premiums on a monthly basis and may terminate 
     election of individual for a Medicare Choice plan for failure 
     to make premium payments only in accordance with section 
     1851(g)(3)(B)(i).''
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                        DeWINE AMENDMENT NO. 427

  (Ordered to lie on the table.)
  Mr. DeWINE submitted an amendment intended to be proposed by him to 
the bill, S. 947, supra; as follows:

       At the appropriate place in chapter 3 of subtitle F of 
     division 1 of title V, insert the following:

     SEC.   . MEDICARE SPECIAL REIMBURSEMENT RULE FOR PRIMARY CARE 
                   COMBINED RESIDENCY PROGRAMS.

       (A) In General.--Section 1886(h)(5)(G) of the Social 
     Security Act (42 U.S.C. 1395ww(h)(5)(G)) is amended--
       (1) in clause (i), by striking ``and (iii)'' and inserting 
     ``, (iii), and (iv)''; and
       (2) by adding at the end the following:
       ``(iv) Special rule for primary care combined residency 
     programs.--
       (I) In the case of a resident enrolled in a combined 
     medical residency training program in which all of the 
     individual programs (that are combined) are for training a 
     primary care resident (as defined in subparagraph (H)), the 
     period of board eligibility shall be the minimum number of 
     years of formal training required to satisfy the requirement 
     for initial board eligibility in the longest of the 
     individual programs plus one additional year.
       ``(II) A resident enrolled in a combined medical residency 
     training program that includes an obstetrics and gyhecology 
     and gynecology program qualifies for the period of board 
     eligibility under subclause (I) if the other programs such 
     resident combines with such obstetrics and gynecology program 
     are for training a primary care resident.''.
       (b) Effective Date.--The amendments made by subsection (a) 
     apply to combined medical residency training programs in 
     effect on or after July 1, 1996.
                                 ______
                                 

                        HARKIN AMENDMENT NO. 428

  Mr. HARKIN proposed an amendment to the bill, S. 947, supra; as 
follows:

       At the end of the bill, add the following:

     SEC.  . IMPROVING INFORMATION TO MEDICARE BENEFICIARIES.

       (a) Clarification of Requirement To Provide Explanation of 
     Medicare Benefits.--Section 1804 of the Social Security Act 
     (42 U.S.C. 1393b-2) is amended by adding at the end the 
     following new subsection:
       ``(c)(1) The Secretary shall provide a statement which 
     explains the benefits provided under this title with respect 
     to each item or service for which payment may be made under 
     this title which is furnished to an individual, without 
     regard to whether or not a deductible or coinsurance may be 
     imposed against the individual with respect to such item or 
     service.
       ``(2) Each explanation of benefits provided under paragraph 
     (1) shall include--
       ``(A) a statement which indicates that because errors do 
     occur and because medicare fraud, waste and abuse is a 
     significant problem, beneficiaries should carefully check the 
     statement for accuracy and report any errors or questionable 
     charges by calling the toll-free phone number described in 
     (C)
       (B) a statement of the beneficiary's right to request an 
     itemized bill (as provided in section 1128A(n)); and
       ``(C) a toll-free telephone number for reporting errors, 
     questionable charges or other acts that would constitute 
     medicare fraud, waste, or abuse, which may be the same number 
     as described in subsection (b).''.
       (b) Request for Itemized Bill for Medicare Items and 
     Services.--
       (1) In general.--Section 1128A of the Social Security Act 
     (42 U.S.C. 1320a-7a) is amended by adding at the end the 
     following new subsection:
       ``(m) Written Request for Itemized Bill.--

[[Page S6101]]

       ``(1) In general.--A beneficiary may submit a written 
     request for an itemized bill for medical or other items or 
     services provided to such beneficiary by any person 
     (including an organization, agency, or other entity) that 
     receives payment under title XVIII for providing such items 
     or services to such beneficiary.
       ``(2) 30-day period to receive bill.--
       ``(A) In general.--Not later than 30 days after the date on 
     which a request under paragraph (1) has been received, a 
     person described in such paragraph shall furnish an itemized 
     bill describing each medical or other item or service 
     provided to the beneficiary requesting the itemized bill.
       ``(B) Penalty.--Whoever knowingly fails to furnish an 
     itemized bill in accordance with subparagraph (A) shall be 
     subject to a civil fine of not more than $100 for each such 
     failure.
       ``(3) Review of itemized bill.--
       ``(A) In general.--Not later than 90 days after the receipt 
     of an itemized bill furnished under paragraph (1), a 
     beneficiary may submit a written request for a review of 
     the itemized bill to the appropriate fiscal intermediary 
     or carrier with a contract under section 1816 or 1842.
       ``(B) Specific allegations.--A request for a review of the 
     itemized bill shall identify--
       ``(i) specific medical or other items or services that the 
     beneficiary believes were not provided as claimed, or
       ``(ii) any other billing irregularity (including duplicate 
     billing).
       ``(4) Findings of fiscal intermediary or carrier.--Each 
     fiscal intermediary or carrier with a contract under section 
     1816 or 1842 shall, with respect to each written request 
     submitted to the fiscal intermediary or carrier under 
     paragraph (3), determine whether the itemized bill identifies 
     specific medical or other items or services that were not 
     provided as claimed or any other billing irregularity 
     (including duplicate billing) that has resulted in 
     unnecessary payments under title XVIII.
       ``(5) Recovery of amounts.--The Secretary shall require 
     fiscal intermediaries and carriers to take all appropriate 
     measures to recover amounts unnecessarily paid under title 
     XVIII with respect to a bill described in paragraph (4).''.
       (c) Effective Date.--The amendments made by this section 
     shall apply with respect to medical or other items or 
     services provided on or after January 1, 1998.

     SEC.   . PROHIBITING UNNECESSARY AND WASTEFUL MEDICARE 
                   PAYMENTS FOR CERTAIN ITEMS.

       Notwithstanding any other provision of law, including any 
     regulation or payment policy, the following categories of 
     charges shall not be reimbursable under title XVIII of the 
     Social Security Act:
       (1) Entertainment costs, including the costs of tickets to 
     sporting and other entertainment events.
       (2) Gifts or donations.
       (3) Personal use of motor vehicles.
       (4) Costs for fines and penalties resulting from violations 
     of Federal, State, or local laws.
       (5) Tuition or other education fees for spouses or 
     dependents of providers of services, their employees, or 
     contractors.

     SEC.   . REDUCING EXCESSIVE BILLINGS AND UTILIZATION FOR 
                   CERTAIN ITEMS.

       Section 1834(a)(15) of the Social Security Act (42 U.S.C. 
     1395m(a)(15)) is amended by striking ``Secretary may'' both 
     places it appears and inserting ``Secretary shall''.

     SEC.   . IMPROVED CARRIER AUTHORITY TO REDUCE EXCESSIVE 
                   MEDICARE PAYMENTS.

       Payment for Surgical Dressings.--Section 1834(i) of the 
     Social Security Act (42 U.S.C. 1395m(i)) is amended by adding 
     at the end the following new paragraph:
       ``(3) Grossly excessive payment amounts.--Notwithstanding 
     paragraph (1), the Secretary may apply the provisions of 
     section 1842(b)(8) to payments under this subsection.''.

     SEC.   . ITEMIZATION OF SURGICAL DRESSING BILLS SUBMITTED BY 
                   HOME HEALTH AGENCIES.

       Section 1834(i)(2) (42 U.S.C. 1395m(i)(2)) is amended to 
     read as follows:
       ``(2) Exception.--Paragraph (1) shall not apply to surgical 
     dressings that are furnished as an incident to a physician's 
     professional service.''.
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               KENNEDY (AND WELLSTONE) AMENDMENT NO. 429

  Mr. KENNEDY (for himself and Mr. Wellstone) proposed an amendment to 
the bill, S. 947, supra; as follows:

       Strike section 5362.
                                 ______
                                 

                        GRAMS AMENDMENT NO. 430

  (Ordered to lie on the table.)
  Mr. GRAMS submitted an amendment intended to be proposed by him to 
the bill, S. 947, supra; as follows:

       At the end of chapter 4 of subtitle F of division 1 of 
     title V, insert the following:

     SEC.  .  EXCLUDING GENERAL SERVICE WAGES AND HOURS ASSOCIATED 
                   WITH A SEPARATE SKILLED NURSING FACILITY IN 
                   DETERMINING MEDICARE GEOGRAPHIC 
                   RECLASSIFICATION OF CERTAIN HOSPITALS.

       In the case of a hospital that is owned by a municipality 
     and that has been reclassified as an urban hospital under 
     section 1886(d)(10) of the Social Security Act for fiscal 
     year 1996, in calculating the hospital's average hourly wage 
     for purposes of continued geographic reclassification under 
     such section for subsequent fiscal years, the Secretary of 
     Health and Human Services shall exclude the general service 
     wages and hours of personnel associated with a skilled 
     nursing facility that is owned by the hospital or the same 
     municipality and that is physically separated from the 
     hospital to the extent that such wages and hours of such 
     personnel are not shared with the hospital and are separately 
     documented. A hospital that applied for and was denied 
     reclassification as an urban hospital for fiscal year 1998, 
     but that would have received reclassification had the 
     exclusion required by this section been applied to it, shall 
     be reclassified as an urban hospital for fiscal year 1998.

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