 |
 |
 |
 |
 |
 |
 |
 |
| ||||||||
|
|
Table of Contents: Senate-Passed Medicare Drug Bill Posted 7/13/2003 The Table of Contents of S.1, the Senate-passed Medicare and prescription drug bill, runs to 8 pages. It is a graphic illustration of Congressional micromanagement -- certainly not what Medicare reformers had in mind. S.1Prescription Drug and Medicare Improvement Act of 2003 (Engrossed as Agreed to or Passed by Senate) TITLE I--MEDICARE PRESCRIPTION DRUG BENEFITSubtitle A--Medicare Voluntary Prescription Drug Delivery ProgramSec. 101. Medicare voluntary prescription drug delivery program. `Part D--Voluntary Prescription Drug Delivery Program`Sec. 1860D. Definitions; treatment of references to provisions in MedicareAdvantage program. `Subpart 1--Establishment of Voluntary Prescription Drug Delivery Program`Sec. 1860D-1. Establishment of voluntary prescription drug delivery program. `Sec. 1860D-2. Enrollment under program. `Sec. 1860D-3. Election of a Medicare Prescription Drug plan. `Sec. 1860D-4. Providing information to beneficiaries. `Sec. 1860D-5. Beneficiary protections. `Sec. 1860D-6. Prescription drug benefits. `Sec. 1860D-7. Requirements for entities offering Medicare Prescription Drug plans; establishment of standards. `Subpart 2--Prescription Drug Delivery System`Sec. 1860D-10. Establishment of service areas. `Sec. 1860D-11. Publication of risk adjusters. `Sec. 1860D-12. Submission of bids for proposed Medicare Prescription Drug plans. `Sec. 1860D-13. Approval of proposed Medicare Prescription Drug plans. `Sec. 1860D-14. Computation of monthly standard prescription drug coverage premiums. `Sec. 1860D-15. Computation of monthly national average premium. `Sec. 1860D-16. Payments to eligible entities. `Sec. 1860D-17. Computation of monthly beneficiary obligation. `Sec. 1860D-18. Collection of monthly beneficiary obligation. `Sec. 1860D-19. Premium and cost-sharing subsidies for low-income individuals. `Sec. 1860D-20. Reinsurance payments for expenses incurred in providing prescription drug coverage above the annual out-of-pocket threshold. `Sec. 1860D-21. Direct subsidy for sponsor of a qualified retiree prescription drug plan for plan enrollees eligible for, but not enrolled in, this part. `Sec. 1860D-22. Direct subsidies for qualified State offering a State pharmaceutical assistance program for program enrollees eligible for, but not enrolled in, this part. `Subpart 3--Miscellaneous Provisions`Sec. 1860D-25. Prescription Drug Account in the Federal Supplementary Medical Insurance Trust Fund. `Sec. 1860D-26. Other related provisions. Sec. 102. Study and report on permitting part B only individuals to enroll in medicare voluntary prescription drug delivery program. Sec. 103. Rules relating to medigap policies that provide prescription drug coverage. Sec. 104. Medicaid and other amendments related to low-income beneficiaries. Sec. 105. Expansion of membership and duties of Medicare Payment Advisory Commission (MedPAC). Sec. 106. Study regarding variations in spending and drug utilization. Sec. 107. Limitation on prescription drug benefits of Members of Congress. Sec. 108. Protecting seniors with cancer. Sec. 109. Protecting seniors with cardiovascular disease, cancer, or Alzheimer's disease. Sec. 110. Review and report on current standards of practice for pharmacy services provided to patients in nursing facilities. Sec. 110A. Medication therapy management assessment program. Subtitle B--Medicare Prescription Drug Discount Card and Transitional Assistance for Low-Income BeneficiariesSec. 111. Medicare prescription drug discount card and transitional assistance for low-income beneficiaries. Subtitle C--Standards for Electronic PrescribingSec. 121. Standards for electronic prescribing. Subtitle D--Other ProvisionsSec. 131. Additional requirements for annual financial report and oversight on medicare program. Sec. 132. Trustees' report on medicare's unfunded obligations. Sec. 133. Pharmacy benefit managers transparency requirements. Sec. 134. Office of the Medicare Beneficiary Advocate. TITLE II--MEDICAREADVANTAGESubtitle A--MedicareAdvantage CompetitionSec. 201. Eligibility, election, and enrollment. Sec. 202. Benefits and beneficiary protections. Sec. 203. Payments to MedicareAdvantage organizations. Sec. 204. Submission of bids; premiums. Sec. 205. Special rules for prescription drug benefits. Sec. 206. Facilitating employer participation. Sec. 207. Administration by the Center for Medicare Choices. Sec. 208. Conforming amendments. Sec. 209. Effective date. Sec. 210. Improvements in MedicareAdvantage benchmark determinations. Subtitle B--Preferred Provider OrganizationsSec. 211. Establishment of MedicareAdvantage preferred provider program option. Subtitle C--Other Managed Care ReformsSec. 221. Extension of reasonable cost contracts. Sec. 222. Specialized Medicare+Choice plans for special needs beneficiaries. Sec. 223. Payment by PACE providers for medicare and medicaid services furnished by noncontract providers. Sec. 224. Sec. 225. Expanding the work of medicare quality improvement organizations to include parts C and D. Sec. 226. Extension of demonstration for ESRD managed care. Subtitle D--Evaluation of Alternative Payment and Delivery SystemsSec. 231. Establishment of alternative payment system for preferred provider organizations in highly competitive regions. Sec. 232. Fee-for-service modernization projects. Subtitle E--National Bipartisan Commission on Medicare ReformSec. 241. MedicareAdvantage goal; establishment of Commission. Sec. 242. National bipartisan commission on medicare reform. Sec. 243. Congressional consideration of reform proposals. Sec. 244. Authorization of appropriations. TITLE III--CENTER FOR MEDICARE CHOICESSec. 301. Establishment of the Center for Medicare Choices. Sec. 302. Miscellaneous administrative provisions. TITLE IV--MEDICARE FEE-FOR-SERVICE IMPROVEMENTSSubtitle A--Provisions Relating to Part ASec. 401. Equalizing urban and rural standardized payment amounts under the medicare inpatient hospital prospective payment system. Sec. 402. Adjustment to the medicare inpatient hospital PPS wage index to revise the labor-related share of such index. Sec. 403. Medicare inpatient hospital payment adjustment for low-volume hospitals. Sec. 404. Fairness in the medicare disproportionate share hospital (DSH) adjustment for rural hospitals. Sec. 404A. Medpac study and report regarding medicare Disproportionate Share Hospital (DSH) adjustment payments. Sec. 405. Critical access hospital (CAH) improvements. Sec. 406. Authorizing use of arrangements to provide core hospice services in certain circumstances. Sec. 407. Services provided to hospice patients by nurse practitioners, clinical nurse specialists, and physician assistants. Sec. 408. Authority to include costs of training of psychologists in payments to hospitals under medicare. Sec. 409. Revision of Federal rate for hospitals in Sec. 410. Exception to initial residency period for geriatric residency or fellowship programs. Sec. 411. Clarification of congressional intent regarding the counting of residents in a nonprovider setting and a technical amendment regarding the 3-year rolling average and the IME ratio. Sec. 412. Limitation on charges for inpatient hospital contract health services provided to Indians by medicare participating hospitals. Sec. 413. GAO study and report on appropriateness of payments under the prospective payment system for inpatient hospital services. Sec. 414. Rural community hospital demonstration program. Sec. 415. Critical access hospital improvement demonstration program. Sec. 416. Treatment of grandfathered long-term care hospitals. Sec. 417. Treatment of certain entities for purposes of payments under the medicare program. Sec. 418. Revision of the indirect medical education (IME) adjustment percentage. Sec. 419. Calculation of wage indices for hospitals. Sec. 420. Conforming changes regarding federally qualified health centers. Sec. 420A. Increase for hospitals with disproportionate indigent care revenues. Sec. 420B. Treatment of grandfathered long-term care hospitals. Subtitle B--Provisions Relating to Part BSec. 421. Establishment of floor on geographic adjustments of payments for physicians' services. Sec. 422. Medicare incentive payment program improvements. Sec. 423. Extension of hold harmless provisions for small rural hospitals and treatment of certain sole community hospitals to limit decline in payment under the OPD PPS. Sec. 424. Increase in payments for certain services furnished by small rural and sole community hospitals under medicare prospective payment system for hospital outpatient department services. Sec. 425. Temporary increase for ground ambulance services. Sec. 426. Ensuring appropriate coverage of air ambulance services under ambulance fee schedule. Sec. 427. Treatment of certain clinical diagnostic laboratory tests furnished by a sole community hospital. Sec. 428. Improvement in rural health clinic reimbursement. Sec. 429. Elimination of consolidated billing for certain services under the medicare PPS for skilled nursing facility services. Sec. 430. Freeze in payments for certain items of durable medical equipment and certain orthotics; establishment of quality standards and accreditation requirements for DME providers. Sec. 431. Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432. Basing medicare payments for covered outpatient drugs on market prices. Sec. 433. Indexing part B deductible to inflation. Sec. 434. Revisions to reassignment provisions. Sec. 435. Extension of treatment of certain physician pathology services under medicare. Sec. 436. Adequate reimbursement for outpatient pharmacy therapy under the hospital outpatient PPS. Sec. 437. Limitation of application of functional equivalence standard. Sec. 438. Medicare coverage of routine costs associated with certain clinical trials. Sec. 439. Waiver of part B late enrollment penalty for certain military retirees; special enrollment period. Sec. 440. Demonstration of coverage of chiropractic services under medicare. Sec. 441. Medicare health care quality demonstration programs. Sec. 442. Medicare complex clinical care management payment demonstration. Sec. 443. Medicare fee-for-service care coordination demonstration program. Sec. 444. GAO study of geographic differences in payments for physicians' services. Sec. 445. Improved payment for certain mammography services. Sec. 446. Improvement of outpatient vision services under Part B. Sec. 447. GAO study and report on the propagation of concierge care. Sec. 448. Coverage of marriage and family therapist services and mental health counselor services under Part B of the medicare program. Sec. 449. Medicare demonstration project for direct access to physical therapy services. Sec. 450. Demonstration project to clarify the definition of homebound. Sec. 450A. Demonstration project for exclusion of brachytherapy devices from prospective payment system for outpatient hospital services. Sec. 450B. Reimbursement for total body orthotic management for certain nursing home patients. Sec. 450C. Authorization of reimbursement for all medicare part B services furnished by certain Indian hospitals and clinics. Sec. 450D. Coverage of cardiovascular screening tests. Sec. 450E. Medicare coverage of self-injected biologicals. Sec. 450F. Extension of medicare secondary payer rules for individuals with end-stage renal disease. Sec. 450G. Requiring the Internal Revenue Service to deposit installment agreement and other fees in the Treasury as miscellaneous receipts. Sec. 450H. Increasing types of originating telehealth sites and facilitating the provision of telehealth services across State lines. Sec. 450I. Demonstration project for coverage of surgical first assisting services of certified registered nurse first assistants. Sec. 450J. Equitable treatment for children's hospitals. Sec. 450K. Treatment of physicians' services furnished in Sec. 450L. Demonstration project to examine what weight loss weight management services can cost effectively reach the same result as the NIH Diabetes Primary Prevention Trial study: A 50 percent reduction in the risk for type 2 diabetes for individuals who have impaired glucose tolerance and are obese. Subtitle C--Provisions Relating to Parts A and BSec. 451. Increase for home health services furnished in a rural area. Sec. 452. Limitation on reduction in area wage adjustment factors under the prospective payment system for home health services. Sec. 453. Clarifications to certain exceptions to medicare limits on physician referrals. Sec. 454. Demonstration program for substitute adult day services. Sec. 455. MEDPAC study on medicare payments and efficiencies in the health care system. Sec. 456. Medicare coverage of kidney disease education services. Sec. 457. Frontier extended stay clinic demonstration project. Sec. 458. Improvements in national coverage determination process to respond to changes in technology. Sec. 459. Increase in medicare payment for certain home health services. Sec. 460. Frontier extended stay clinic demonstration project. Sec. 461. Medicare secondary payor (MSP) provisions. Sec. 462. Medicare pancreatic islet cell transplant demonstration project. Sec. 463. Increase in medicare payment for certain home health services. Sec. 464. Sense of the Senate concerning medicare payment update for physicians and other health professionals. TITLE V--MEDICARE APPEALS, REGULATORY, AND CONTRACTING IMPROVEMENTSSubtitle A--Regulatory ReformSec. 501. Rules for the publication of a final regulation based on the previous publication of an interim final regulation. Sec. 502. Compliance with changes in regulations and policies. Sec. 503. Report on legal and regulatory inconsistencies. Sec. 504. Streamlining and simplification of medicare regulations. Subtitle B--Appeals Process ReformSec. 511. Submission of plan for transfer of responsibility for medicare appeals. Sec. 512. Expedited access to judicial review. Sec. 513. Expedited review of certain provider agreement determinations. Sec. 514. Revisions to medicare appeals process. Sec. 515. Hearing rights related to decisions by the Secretary to deny or not renew a medicare enrollment agreement; consultation before changing provider enrollment forms. Sec. 516. Appeals by providers when there is no other party available. Sec. 517. Provider access to review of local coverage determinations. Sec. 518. Revisions to appeals timeframes. Sec. 519. Elimination of requirement to use Social Security Administration Administrative Law Judges. Sec. 520. Elimination of requirement for de novo review by the departmental appeals board. Subtitle C--Contracting ReformSec. 521. Increased flexibility in medicare administration. Subtitle D--Education and Outreach ImprovementsSec. 531. Provider education and technical assistance. Sec. 532. Access to and prompt responses from medicare contractors. Sec. 533. Reliance on guidance. Sec. 534. Medicare provider ombudsman. Sec. 535. Beneficiary outreach demonstration programs. Subtitle E--Review, Recovery, and Enforcement ReformSec. 541. Prepayment review. Sec. 542. Recovery of overpayments. . |
|
|
|
Centrist Policy Network, Inc. |
