PROVISIONS RELATING TO ORTHOTICS AND PROSTHETICS.

SEC. 4153. PROVISIONS RELATING TO ORTHOTICS AND PROSTHETICS. (a) Payments fob Prosthetic Devices and Orthotics and Prosthetics.— (1) Maintaining current payment methodology.—Section 1834 (42 U.S.C. 1395m) is amended by adding at the end the following new subsection: “(h) Payment for Prosthetic Devices and Orthotics and Prosthetics.— “(1) General rule for payment.— “(A) In general.— Payment under this subsection for prosthetic devices and orthotics and prosthetics shall be made in a lump-sum amount for the purchase of the item in an amount equal to 80 percent of the payment basis described in subparagraph (B). “(B) Payment basis.—Except as provided in subparagraph (O, the payment basis described in this subparagraph is the lesser of— “(i) the actual charge for the item; or “(ii) the amount recognized under paragraph (2) as the purchase price for the item. “(C) Exception for certain public home health agencies.—Subparagraph (B)(i) shall not apply to an item furnished by a public home health agency (or by another home health agency which demonstrates to the satisfaction of the Secretary that a significant portion of its patients are low income) free of charge or at nominal charges to the public. “(D) Exclusive payment rule.—This subsection shall constitute the exclusive provision of this title for payment for prosthetic devices, orthotics, and prosthetics under this part or under part A to a home health agency. “(2) Purchase price recognized.— For purposes of paragraph (1), the amount that is recognized under this paragraph as the purchase price for prosthetic devices, orthotics, and prosthetics is the amount described in subparagraph (C) of this paragraph, determined as follows: “(A) Computation of local purchase price.— Each carrier under section 1842 shall compute a base local purchase price for the item as follows: “(i) The carrier shall compute a base local purchase price for each item equal to the average reasonable charge in the locality for the purchase of the item for the 12-month period ending with June 1987. “(ii) The carrier shall compute a local purchase price, with respect to the furnishing of each particular item— “(I) in 1989 and 1990, equal to the base local purchase price computed under clause (i) increased by the percentage increase in the consumer price index for all urban consumers (United States city104 STAT. 1388–82 average) for the 6-month period ending with December 1987, or “(II) in 1991, 1992 or 1993, equal to the local purchase price computed under this clause for the previous year increased by the applicable percent-age increase for the year. “(B) Computation of regional purchase price.— With respect to the furnishing of a particular item in each region (as defined by the Secretary), the Secretary shall compute a regional purchase price— “(i) for 1992, equal to the average (weighted by relative volume of all claims among carriers) of the local purchase prices for the carriers in the region computed under subparagraph (A)(ii)(II) for the year, and “(ii) for each subsequent year, equal to the regional purchase price computed under this subparagraph for the previous year increased by the applicable percent-age increase for the year. “(C) Purchase price recognized.— For purposes of paragraph (1) and subject to subparagraph (D), the amount that Is recognized under this paragraph as the purchase price for each item furnished— “(i) in 1989, 1990, or 1991, is 100 percent of the local purchase price computed under subparagraph (A)(ii); “(ii) in 1992, is the sum of (I) 75 percent of the local purchase price computed under subparagraph (A)(ii)(II) for 1992, and (II) 25 percent of the regional purchase price computed under subparagraph (B) for 1992; “(iii) in 1993, is the sum of (I) 50 percent of the local purchase price computed under subparagraph (A)(ii)(II) for 1993, and (II) 50 percent of the regional purchase price computed under subparagraph (B) for 1993; and “(iv) in 1994 or a subsequent year, is the regional purchase price computed under subparagraph (B) for that year. “(D) Range on amount recognized.—The amount that is recognized under subparagraph (C) as the purchase price for an item furnished— “(i) in 1992, may not exceed 125 percent, and may not be lower than 85 percent, of the average of the purchase prices recognized under such subparagraph for all the carrier service areas in the United States in that year; and “(ii) in a subsequent year, may not exceed 120 per-cent, and may not be lower than 90 percent, of the average of the purchase prices recognized under such subparagraph for all the carrier service areas in the United States in that year. “(3) Applicability of certain provisions relating to durable medical equipment.—Paragraph (12) and subparagraphs (A) and (B) of paragraph (10) and paragraph (11) of subsection (a) shall apply to prosthetic devices, orthotics, and prosthetics in the same manner as such provisions apply to covered items under such subsection. “(4) Definitions.— In this subsection— “(A) the term ‘applicable percentage increase’ means— “(i) for 1991, 0 percent, and 104 STAT. 1388–83 “(ii) for a subsequent year, the percentage increase in the consumer price index for all urban consumers (United States city average) for the 12-month period ending with June of the previous year; “(B) the term ‘prosthetic devices’ has the meaning given such term in section 1861(s)(8), except that such term does not include parenteral and enteral nutrition nutrients, sup-plies, and equipment; and “(C) the term ‘orthotics and prosthetics’ has the meaning given such term in section 1861(s)(9), but does not include intraocular lenses or medical supplies (including catheters, catheter supplies, ostomy bags, and supplies related to ostomy care) furnished by a home health agency under section 1861(m)(5).”. (2) Conforming amendments.— (A) Section 1832(a)(2) (42 U.S.C. 1395k(a)(2)) is amended— (i) in subparagraphs (A) and (B), by striking “subparagraph (G)” each place it appears and inserting “subparagraph (G) or subparagraph (I)”; (ii) by striking “and” at the end of subparagraph (G); (iii) by striking the period at the end of subparagraph (H) and inserting “; and”; and (iv) by adding at the end the following new subparagraph: “(I) prosthetic devices and orthotics and prosthetics (described in section 1834(h)(4)) furnished by a provider of services or by others under arrangements with them made by a provider of services.”. (B) Section 1833(a)(D (42 U.S.C. 13951(a)(D is amended— (i) by striking “, and (L)” and inserting “, (L)”; and (ii) by striking “subparagraph and (N)” and inserting the following: “subparagraph, (M) with respect to prosthetic devices and orthotics and prosthetics (as defined in section 1834(h)(4)), the amounts paid shall be the amounts described in section 1834(h)(D, and (N)”. (C) Section 1833(a) (42 U.S.C. 13951(a)) is amended— (i) in paragraph (2), in the matter before subparagraph (A), by striking “and (H)” and inserting “(H), and (I)”; (ii) by striking “and” at the end of paragraph (5); (iii) by striking the period at the end of paragraph (6) and inserting “; and”; and (iv) by adding at the end the following new paragraph: “(7) in the case of prosthetic devices and orthotics and prosthetics (as described in section 1834(h)(4)), the amounts described in section 1834(h).”. (D) Section 1834(a) (42 U.S.C. 1395m(a)), is amended— (i) in the heading, by striking “, Prosthetic Devices, Orthotics, and Prosthetics”; (ii) in paragraph (2)(A), by striking “(13)(A)” and inserting “(13)”; and (iii) in paragraph (13), by striking “means—” and all that follows and inserting the following: “means durable medical equipment (as defined in section 1861(n)), including such equipment described in section 1861(m)(5)).” (3) Effective date.—The amendments made by paragraphs (1) and (2) shall apply to items furnished on or after January 1, 1991. (b) Provisions Relating to Eyeglasses.— 104 STAT. 1388–84 (1) Prohibition on regulations.— (A) Notwithstanding any other provision of law (except as provided in subparagraph (B)) the Secretary of Health and Human Services (referred to in this subsection as the “Secretary”) may not issue any regulation that changes the coverage of conventional eyewear furnished to individuals (enrolled under part B of title XVIII of the Social Security Act) following cataract surgery with insertion of an intraocular lens. (B) Paragraph (1) shall not apply to any regulation issued for the sole purpose of implementing the amendments made by paragraph (2). (2) Clarifying coverage of post-cataract eyeglasses.— (A) Section 1861(s)(8) (42 U.S.C. 1395x(s)(8)} is amended by inserting after “such devices” the following “, and including one pair of conventional eyeglasses or contact lenses-furnished subsequent to each cataract surgery with insertion of an intraocular lens”. (B) Section 1862(a)(7) (42 U.S.C. 1395y(a)(7)) is amended by inserting after “eyeglasses” the first place it appears the following: “(other than eyewear described in section 1861(s)(8))”. (C) The amendments made by subparagraphs (A) and (B) shall apply to items furnished on or after January 1, 1991. (c) GAO Study of Medicare Payments for Prosthetic Devices, Orthotics, and Prosthetics.— (1) Study.—The Comptroller General shall conduct a study of the feasibility and desirability of establishing a separate fee schedule for use in determining the amount of payments for covered items under section 1834(a) of the Social Security Act with respect to suppliers of prosthetic devices, orthotics, and prosthetics who provide professional services that would take into account the costs to such providers of providing such services. (2) Report.—Not later than 1 year after the date of the enactment of this Act, the Comptroller General shall submit a report on the study conducted under subparagraph (A) to the Committees on Energy and Commerce and Ways and Means of the House of Representatives and the Committee on Finance of the Senate, and shall include in such report any recommendations regarding payments for prosthetic devices, orthotics, and prosthetics under the medicare program that the Comptroller General considers appropriate. (d) Clarification of Coverage of Ostomy Supplies.— (1) In general.—Section 1866(a)(D(P) (42 U.S.C. 1395cc(a)(l)(P)) is amended by striking “ostomy supplies” and inserting “catheters, catheter supplies, ostomy bags, and sup-plies related to ostomy care”. (2) Effective date.—The amendment made by paragraph (1) shall take effect as if included in the enactment of the Omnibus Budget Reconiliation1414So in original. Probably should be “Reconciliation”. Act of 1989,