Medicare Home Dialysis Staff Assistance Coverage Act of 1990

Medicare Home Dialysis Staff Assistance Coverage Act of 1990 - Amends title XVIII (Medicare) of the Social Security Act to cover the services of a home dialysis aide provided by a renal dialysis facility to persons who: (1) are nonambulatory and have no access to transportation services for travel to and from a dialysis facility; (2) suffer from a serious medical condition which would be exacerbated by travel to and from a dialysis facility; or (3) are eligible for ambulance transportation to and from such facility but at a cost which meets or exceeds the cost of this Act's services. Sets forth payment provisions.

Requires peer review organization review of the services of home dialysis aides.

Directs the Comptroller General to conduct a study and report to the Congress on the costs and effectiveness of Medicare coverage of the services of home dialysis aides.

 
HR 5213 IH
101st CONGRESS
2d Session
 H. R. 5213
To amend title XVIII of the Social Security Act to provide for payment under
the medicare program for the services of home dialysis aides who provide
medical assistance during hemodialysis treatment at the homes of end stage
renal disease patients, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
June 28, 1990
Mr. MOODY (for himself, Mr. CHANDLER, Mr. PICKLE, Mrs. JOHNSON of Connecticut,
Mr. LEVIN of Michigan, and Mr. CARDIN) introduced the following bill; which was
referred jointly to the Committees on Ways and Means and Energy and Commerce
A BILL
To amend title XVIII of the Social Security Act to provide for payment under
the medicare program for the services of home dialysis aides who provide
medical assistance during hemodialysis treatment at the homes of end stage
renal disease patients, and for other purposes.
  Be it enacted by the Senate and House of Representatives of the United
  States of America in Congress assembled,
SECTION 1. SHORT TITLE.
  This Act may be cited as the `Medicare Home Dialysis Staff Assistance
  Coverage Act of 1990'.
SEC. 2. MEDICARE PAYMENT FOR STAFF ASSISTANT FOR HOME DIALYSIS PATIENTS.
  (a) IN GENERAL- Section 1881(b) of the Social Security Act (42
  U.S.C. 1395rr(b)) is amended--
  (1) in the first sentence of paragraph (1)--
  (A) by striking `and (B)' and inserting `(B)', and
  (B) by striking the period at the end and inserting the following: `,
  and (C) in accordance with paragraph (8), payments to or on behalf of such
  individuals for services of a home dialysis aide providing medical assistance
  during hemodialysis treatment at the individual's home, including technical
  assistance with the operation of a hemodialysis machine, administration of
  medications, and other assistance with the individual's care and treatment.';
  (2) by redesignating paragraphs (8) through (11) as paragraphs (9) through
  (12); and
  (3) by inserting after paragraph (7) the following new paragraph:
  `(8)(A) In addition to any other payment that may be made under this title
  for services furnished to individuals determined to have end stage renal
  disease, the Secretary shall make a payment to a provider of services or
  a renal dialysis facility for services of a qualified home dialysis aide
  providing medical assistance to a patient during hemodialysis treatment
  at the patient's home if--
  `(i) in the case of services provided during the 1-year period that
  begins on the first day (beginning after the date of the enactment of
  this subparagraph) on which such services are provided to the patient,
  the patient's attending physician or nephrologist certifies that--
  `(I) the patient is confined to a bed or wheelchair, cannot transfer from the
  bed or wheelchair without assistance, and has no access to transportation
  services for travel to and from a provider of services or renal dialysis
  facility, or
  `(II) the patient suffers from a serious medical condition (as specified by
  the Secretary) which would be exacerbated by travel to and from a provider
  of services or renal dialysis facility;
  `(ii) in the case of services provided during the 1-year period described in
  clause (i) to a patient who meets the eligibility requirements described in
  regulations promulgated under this title for coverage of ambulance service
  for travel to and from a provider of services or renal dialysis facility,
  the cost of providing such services of a home dialysis aide is not greater
  than the cost of providing such ambulance service; and
  `(iii) in the case of services provided during each subsequent 1-year period
  during which such services are provided to the patient on a continuous
  basis, such services have been reviewed and approved by a utilization and
  peer review organization under section 1154(a)(16) not later than 30 days
  after the beginning of such subsequent 1-year period.
  `(B) For purposes of subparagraph (A), a home dialysis aide is qualified
  if the aide--
  `(i) meets requirements developed by the Secretary for home dialysis aides
  providing medical assistance during hemodialysis treatment at an individual
  patient's home; or
  `(ii) meets standards established by the renal dialysis facility at which
  the aide is employed for personnel providing medical assistance during
  hemodialysis treatment at the facility.
  `(C) The amount of a payment made under this paragraph for services of a
  home dialysis aide shall be equal to--
  `(i) an amount not less than $50 per hemodialysis treatment (adjusted for
  regional variations in the cost of providing such services) in the case of
  services furnished by a home dialysis aide who is not a registered nurse; and
  `(ii) an amount not less than $80 per hemodialysis treatment (adjusted for
  regional variations in the cost of providing such services) in the case
  of services furnished by a home dialysis aide who is a registered nurse.'.
  (b) PRO ANNUAL REVIEW AND APPROVAL REQUIRED- Section 1154(a) of such Act
  (42 U.S.C. 1320c-3(a)), as restored by section 201(a)(1) of the Medicare
  Catastrophic Coverage Repeal Act of 1990, is amended by adding at the end
  the following new paragraph:
  `(16) The organization shall perform the review described in paragraph (1)
  with respect to services of a home dialysis aide (as described in section
  1881(b)(8)) within 30 working days of the date of the organization's receipt
  of a request for such review. The Secretary shall establish criteria (based
  upon the eligibility criteria described in section 1881(b)(8)(A)) to be used
  by such an organization in conducting such reviews under this paragraph.'.
  (c) EFFECTIVE DATE- The amendments made by subsections (a) and (b) shall
  apply to services of a home dialysis aide furnished on or after January
  1, 1991.
SEC. 3. GAO STUDY OF MEDICARE COVERAGE OF HOME DIALYSIS AIDE SERVICES.
  (a) STUDY- The Comptroller General shall conduct a study of the costs and
  effectiveness of the coverage provided under the medicare program of the
  services of home dialysis aides.
  (b) REPORT- Not later than July 1, 1992, the Comptroller General shall
  submit a report to Congress on the study conducted under subsection (a),
  and shall include in the report recommendations regarding methods for
  providing appropriate medical services in a cost-effective manner to end
  stage renal disease patients under the medicare program.