MISCELLANEOUS AND TECHNICAL PROVISIONS.

SEC. 4085. MISCELLANEOUS AND TECHNICAL PROVISIONS. (a) Prompt Submittal of Data By Secretary.— Section 1845 of the Social Security Act (42 U.S.C. 1395w–l) is amended by adding at the end the following new subsection: “(f) (1) Not later than October 1st of each year (beginning with 1988), the Secretary shall transmit to the Physician Payment Review Commission, to the Congressional Budget Office, and to the Congressional Research Service of the Library of Congress national data (known as the Part B Medicare Annual Data System) for the previous year respecting part B of this title. “(2) In order to ensure that the data are available for transmittal under paragraph (1) on a timely basis, the Secretary shall require, in the standards and criteria established under section 1842(b)(2), that carriers submit data for a year under the system referred to in paragraph (1) not later than July 1st of the following year. “(3) The Secretary, in consultation with the Physician Payment Review Commission, the Congressional Budget Office, and the Congressional Research Service of the Library of Congress, shall establish and annually revise standards for the data reporting system described in paragraph (1). “(4) The Secretary shall also provide to the entities described in paragraph (1) additional data respecting the program under this part as may be reasonably requested by them on an agreed-upon schedule. “(5) The Secretary shall develop, in consultation with the Physician Payment Review Commission, the Congressional Budget Office, and the Congressional Research Service of the Library of Congress, a system for providing to each of such entities on a quarterly basis summary data on aggregate expenditures under this part by type of service and by type of provider. Such data shall be provided not later than 90 days after the end of each quarter (for quarters beginning with the calendar quarter ending on March 31, 1989).”. (b) Clarification of Penalties for Unassigned Laboratory Services.— (1) In general.— Section 1833(h)(5) of the Social Security Act (42 U.S.C. 13951(h)(5)) is amended by adding at the end the following new subparagraph: “(D) If a person knowingly and willfully and on a repeated basis bills an individual enrolled under this part for charges for a clinical diagnostic laboratory test for which payment may only be made on an assignment-related basis under subparagraph (C), the Secretary may apply sanctions against the person in the same manner as the Secretary may apply sanctions against a physician in accordance with section 1842(j)(2).”. (2) Effective date.— The amendment made by paragraph (1) shall apply to procedures performed on or after January 1, 1988. (c) Extension of Moratorium on Laboratory Payment Demonstration.— Section 9204(a) of the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended by section 9339(e) of the Omnibus Budget Reconciliation Act of 1986, is amended by striking “January 1, 1988” and inserting “January 1, 1989”. (d) Prompt Payment for Comprehensive Outpatient Rehabilitation Facilities.— (1) Section 1816(c)(2)(C) of the Social Security Act (42 U.S.C. 1395h(c)(2)(C)) is amended by striking “or hospice program” and101 STAT. 1330–131 inserting “hospice program, comprehensive outpatient rehabilitation facility, or rehabilitation agency”. (2) (A) The amendment made by paragraph (1) shall apply to claims received on or after the date of enactment of this Act. (B) The Secretary of Health and Human Services shall provide for such timely amendments to agreements under section 1816, and regulations, to such extent as may be necessary to implement the amendment made by paragraph (1). (e) Capacity to 4545Copy read “to”. Set Geographic Payment Limits.— The Secretary of Health and Human Services shall develop the capability to implement (for services furnished on or after January 1, 1989) geographic limits on charges and payments under part B of title XVIII of the Social Security Act for physicians’ services based on statewide, regional, or national average (or percentile in a distribution) of prevailing charges or payment amounts (weighted by frequency of services). Any such limits shall take into account adjustments for geographic differences in cost of practice and cost of living. (f) Delay in Effective Date for Establishing Physician Identifier System.— Section 9202(g) of the Consolidated Omnibus Budget Reconciliation Act of 1985 is amended by striking “July 1, 1987” and inserting “October 1, 1988”. (g) Date for Applying Civil Penalities for Improper Use of Assistants in Performing Cataract Surgery.— (1) Section 1842(k) of the Social Security Act (42 U.S.C. 1395u(k)) is amended in paragraphs (1) and (2) by striking “(j)(2)” each place it appears and inserting “(j)(2) in the case of surgery performed on or after March 1, 1987”. (2) The amendment made by paragraph (1) shall be effective as if included in section 9307(c) of the Consolidated Omnibus Budget Reconciliation Act of 1985. (h) Utilization Screens for Physician Services Provided to Patients in Rehabiutation Hospitals.— (1) The Secretary of Health and Human Services shall establish (in consultation with appropriate physician groups, including those representing rehabilitative medicine) a separate utilization screen for physician visits to patients in rehabilitation hospitals and rehabilitative units (and patients in long-term care hospitals receiving rehabilitation services) to be used by carriers under section 1842 of the Social Security Act in performing functions under subsection (a) of such section related to the utilization practices of physicians in such hospitals and units. (2) Not later than 12 months after the date of enactment of this Act, the Secretary of Health and Human Services shall take appropriate steps to implement the utilization screen established under paragraph (1). (i) Technical Amendments.— (1) Section 1833(a) of the Social Security Act (42 U.S.C. 13951(a)) is amended— (A) in paragraphs d)(D)(i) and (2)(D)(i), by striking, “on the basis of an assignment described in section 1842(b)(3)(B)(ii), under the procedure described in section 1870(f)(1),” and inserting “on an assignment-related basis”; 101 STAT. 1330–132 (B) in paragraph (1), by striking “and” before “(G)”; and (C) in subsection (b)(3)(A), by striking “on the basis of an assignment described in section 1842(b)(3)(B)(ii), under the procedure described in section 1870(f)(1)" and inserting "on an assignment-related basis”. (2) Section 1833(h)(1)(C) of such Act (42 U.S.C. 13951(h)(1)(C)) is amended by inserting before the period the following: “, and ending on December 31, 1989. For such tests furnished on or after January 1, 1990, the fee schedule shall be established on a nationwide basis”. (3) Section 1833(h)(5)(A) of such Act (42 U.S.C. 13951(h)(5)(A)) is amended by striking “and” at the end of clause (i), by striking the period at the end of clause (ii) and inserting “, and”, and by adding at the end the following new clause: “(iii) in the case of a clinical diagnostic laboratory test provided under an arrangement (as defined in section 1861(w)(1)) made by a hospital, payment shall be made to the hospital.”. (4) Section 1835(a)(2)(C) of such Act (42 U.S.C. 1395n(a)(2)(C)) is amended by striking the second comma at the end of clause (i). (5) Section 1842(b)(3)(C) of such Act (42 U.S.C. 1395u(b)(3)(C)) is amended by striking “not more than” and inserting “less than”. (6) Section 1842(h)(5) of such Act (42 U.S.C. 1395u(h)(5)) is amended by striking “the” before “participation”. (7) Effective as if included in the enactment of the Omnibus Budget Reconciliation Act of 1986, section 1842(j)(1) of the Social Security Act (42 U.S.C. 1395u(j)(1)) is amended— (A) in subparagraph (C)(i), by inserting “maximum allowable” after “If the physician’s”, (B) in subparagraph (C)(v), by striking “1987” and inserting 4646Copy read “insert”. “1986”, and (C) by adding at the end of subparagraph (C) the following new clause: “(vii) In the case of a nonparticipating physician who was a participating physician during a previous period, for the purpose of computing the physician’s maximum allowable actual charge during the physician’s period of nonparticipation, the physician shall be deemed to have had a maximum allowable actual charge during the period of participation, and such deemed maximum allowable actual charge shall be determined accordingly to clauses (i) through (vi).”. (8) Paragraph (4) of section 1845(e) of the Social Security Act (42 U.S.C. 1395w–l(e)) is amended by moving the alignment of each of its provisions (including any clauses therein) 2 ems to the left. (9) Section 1861(b)(4) of such Act (42 U.S.C. 1395x(b)(4)) is amended by striking the comma before “anesthesia” and inserting “and” and by striking “certified” the second place it appears. (10) The heading of subsection (g) of section 1861 of such Act (42 U.S.C. 1395x) is amended to read as follows: “Outpatient Occupational Therapy Services”. (11) Section 1861(s) of such Act (42 U.S.C. 1395x(s)), as amended by section 9367(a) of this Act, is amended by striking “which—” before paragraph (15) and all that follows through101 STAT. 1330–133 the end of paragraph (16) and inserting the following: “which would not be included under subsection (b) if it were furnished to an inpatient of a hospital.”. (12) Section 1861(v)(5)(A) of such Act (42 U.S.C. 1395x(v)(5)(A)) is amended by striking “section 1861(p)” and “section 1861(g)” and inserting “subsection (p)” and “subsection (g)”, respectively. (13) The heading of subsection (bb) of section 1861 of such Act (42 U.S.C. 1395x) is amended to read as follows: “Services of a Certified Registered Nurse Anesthetist”. (14) The heading of subsection (ee) of section 1861 of such Act (42 U.S.C. 1395x) is amended to read as follows: “Discharge Planning Process”. (15) Section 1862(a)(1)(A) of such Act (42 U.S.C. 1395y(a)(1)(A)) is amended by striking “or (D)” and inserting “(D), or (E)”. (16) Section 1862(a)(14) of such Act (42 U.S.C. 1395y(a)(14)) is amended by striking “an patient” and inserting “a patient”. (17) Effective as if included in the enactment of the Omnibus Budget Reconciliation Act of 1986, section 1866(g) of the Social Security Act (42 U.S.C. 1395cc(g)) is amended by striking “for a hospital outpatient service” and all that follows through “subsection (a)(1)(H)” and inserting “inconsistent with an arrangement under subsection (a)(1)(H) or in violation of the requirement for such an arrangement”. (18) Section 1869(a) of the Social Security Act (42 U.S.C. 1395ff(a)) is amended by inserting “or a claim for benefits with respect to home health services under part B” before “shall”. (19) Section 1869(b)(2) of such Act (42 U.S.C. 1395ff(b)(2)) is amended by inserting “and (1)(D)” after “paragraph (1)(C)” each place it appears. (20) Section 1875(c)(3)(B) of such Act (42 U.S.C. 139511(c)(3)(B)) is amended by striking “years 1987” and inserting “year 1987”. (21) Effective as if included in the enactment of the Omnibus Budget Reconciliation Act of 1986— (A) section 9313(d)(3) of such Act is amended by striking “2 years after the date of the enactment of this Act” and inserting “January 1, 1990”; (B) section 9332(a)(3) of such Act is amended by inserting before the period at the end the following: “or in increasing the proportion of total payments for physicians’ services which are payments for such services rendered by participating physicians”; (C) section 9335(j)(2) of such Act is amended by inserting before the period at the end the following: “except that, until network administrative organizations are established under section 1881(c)(1)(A) of the Social Security Act (as amended by subsection (d)(1) of this section), the distribution of payments described in the last sentence of section 1881(b)(7) of such Act shall be made based on the distribution of payments under section 1881 of such Act to network administrative organizations for fiscal year 1986”; and (D) section 9343 of such Act is amended— (i) amending subparagraph (A) of subsection (e)(2) to read as follows: 101 STAT. 1330–134 “(2) (A) Section 1833 (42 U.S.C. 13951) is amended— “(i) in subsection (a)(1)(F), by striking ‘(i)(3)’ and inserting ‘(i)(4)’, and “(ii) in subsection (b)(3), by striking ‘or under subsection (i)(2) or (i)(4)’.”; (ii) in subsection (h)(2), by striking “(d)” and inserting “(c)” and by adding at the end the following: “The amendments made by subsection (c) shall apply to services furnished after June 30, 1987.”; and (iii) in subsection (h)(4), by striking “(c)” and inserting “(d)”.