FEE SCHEDULES FOR RADIOLOGIST SERVICES.

SEC. 4049. FEE SCHEDULES FOR RADIOLOGIST SERVICES. (a) In General.— Part B of title XVIII of the Social Security Act is amended— (1) in section 1833(a)(1) (42 U.S.C. 13951(a)(1)), as amended by section 4062(c)(3) of this subtitle by striking “and” before “(I)”, and by adding at the end the following new clause: “and (J) with respect to expenses incurred for radiologist services (as defined in section 1834(b)(5)), the amounts paid shall be 80 percent of the lesser of the actual charge for the services or the amount provided under the fee schedule established under section 1834(b),”; and 101 STAT. 1330–91 (2) by adding at the end of section 1834, as subsequently inserted by section 4062(a) of this subtitle, the following new subsection: “(b) Fee Schedules for Radiologist Services.— “(1) Development.— The Secretary shall develop— “(A) a relative value scale to serve as the basis for the payment for radiologist services under this part, and “(B) using such scale and appropriate conversion factors, fee schedules (on a regional, statewide, or carrier service area basis) for payment for radiologist services under this part, to be implemented for such services furnished during 1989. “(2) Consultation.— In carrying out paragraph (1), the Secretary shall regularly consult closely with the Physician Payment Review Commission, the American College of Radiology, and other organizations representing physicians or suppliers who furnish radiologist services and shall share with them the data and data analysis being used to make the determinations under paragraph (1), including data on variations in current medicare payments by geographic area, and by service and physician specialty. “(3) Considerations.— In developing the relative value scale and fee schedules under paragraph (1), the Secretary— “(A) shall take into consideration variations in the cost of furnishing such services among geographic areas and among different sites where services are furnished, and “(B) may also take into consideration such other factors respecting the manner in which physicians in different specialties furnish such services as may be appropriate to assure that payment amounts are equitable and designed to promote effective and efficient provision of radiologist services by physicians in the different specialties. “(4) Savings.— “(A) Budget neutral fee schedules.— The Secretary shall develop preliminary fee schedules for 1989, which are designed to result in the same amount of aggregate payments (net of any insurance and deductibles under section 1835(a)(1)(I) and 1833(b)) for radiologist services furnished in 1989 as would have been made if this subsection had not been enacted. “(B) Initial savings.— The fee schedules established for payment purposes under this subsection for services furnished in 1989 shall be 97 percent of the amounts permitted under these3030Copy read “this”. preliminary fee schedules developed under subparagraph (A). “(C) Subsequent updating.— Radiologist services furnished in subsequent years, the fee schedules shall be the schedules for the previous year updated by the percentage increase in the MEI (as defined in section 1842(b)(4)(E)(ii)) for the year. “(D) 3131Copy read “(C)”. Nonparticipating physicians.— Each fee schedule so established shall provide that the payment rate101 STAT. 1330–92 recognized for nonparticipating physicians and suppliers is equal to the appropriate percent (as defined in section 1842(b)(4)(A)(iv)) of the payment rate recognized for participating physicians and suppliers. “(5) Limiting charges of nonparticipating physicians.— “(A) In general.— In the case of radiologist services furnished after January 1, 1989, for which payment is made under a fee schedule under this subsection, if a nonparticipating physician or supplier furnishes the service to an individual entitled to benefits under this part, the physician or supplier may not charge the individual more than the limiting charge (as defined in subparagraph (B)). “(B) Limiting charge defined.— In subparagraph (A), the term ‘limiting charge’ means, with respect to a service furnished— “(i) in 1989, 125 percent of the amount specified for the service in the appropriate fee schedule established under paragraph (1), “(ii) in 1990, 120 percent of the amount specified for the service in the appropriate fee schedule established under paragraph (1), and “(iii) after 1990, 115 percent of the amount specified for the service in the appropriate fee schedule established under paragraph (1). “(C) Enforcement.— If a physician or supplier knowingly and willfully imposes a charge in violation of subparagraph (A), the Secretary may apply sanctions against such physician or supplier in accordance with section 1842(j)(2). “(6) 3232Copy read “ ‘( 5 )”. Radiologist Services Defined.— For the purposes of this subsection, section 1833(a)(1)(I), and section 1842(h)(1)(B), the term ‘radiologist services’ only includes radiologic services performed by, or under the direction or supervision of, a physician— “(A) who is certified, or eligible to be certified, by the American Board of Radiology, or “(B) for whom radiologic services account for at least 50 percent of billings made under this part.”. (b) Deadlines and Effective Date.— (1) The Secretary of Health and Human Services shall establish the relative value scale and fee schedules for radiologist services (under section 1834(b) of the Social Security Act) by not later than August 1, 1988, and shall report to Congress on the development of such fee schedules not later than August 1, 1988. (2) The amendments made by this section shall apply to services performed on or after January 1, 1989, and until such time as the Secretary of Health and Human Services implements physician fee schedules based on the relative value scale developed under section 1845(e) of the Social Security Act.