Social Security Act Amendments of 1994

TABLE OF CONTENTS:

Title I: Medicare Provisions

Subtitle A: Provisions Relating to Part A

Subtitle B: Provisions Relating to Part B

Subtitle C: Provisions Relating to Parts A and B

Subtitle D: Provisions Relating to Medicare Supplemental

Insurance Policies

Title II: Maternal and Child Health Services Block Grant Program

Subtitle A: Child Welfare, Foster Care, Adoption

Subtitle B: Child Support Enforcement

Subtitle C: Supplemental Security Income

Subtitle D: Aid to Families With Dependent Children

Subtitle E: JOBS Program

Subtitle F: Other Provisions

Social Security Act Amendments of 1994 - Title I: Medicare Provisions - Subtitle A: Provisions Relating to Part A - Amends title XVIII (Medicare) of the Social Security Act (SSA) to: (1) authorize the Secretary of Health and Human Services to take occupational mix into account in developing Medicare Geographic Classification Review Board (MGCRB) guidelines for determining the area wage index; (2) provide that if labor markets are no longer based on Metropolitan Statistical Areas, the method of calculating the wage index for reclassification would not apply and the MGCRB guidelines may be revised; and (3) require the Secretary to set the labor and non-labor portion of each standardized amount equal to the national average beginning in FY 1995.

(Sec. 102) Revises the essential access community hospital (EACH) program, with changes: (1) increasing the number of participating States; (2) providing for treatment of inpatient hospital services provided in rural primary care hospitals; (3) extending the authorization of appropriations for grants to States and hospitals; and (4) addressing adjoining State hospital designation, rural primary care hospital skilled nursing services, payment for inpatient and outpatient hospital services, and physician staffing.

(Sec. 103) Amends the Omnibus Budget Reconciliation Act of 1987 (OMBRA '87) to: (1) authorize appropriations for the rural health transition grant program; and (2) make rural primary care hospitals eligible for program grants.

(Sec. 104) Revises requirements with regard to hospital psychology services, Medicare-dependent, small rural and sole community hospitals, notification of hospice services availability, qualifications for service on the Prospective Payment Assessment Commission, budget neutral adjustments for changes in payment amounts for transfer cases, and DRG payment window expansion.

(Sec. 106) Requires the Secretary to begin collecting the data necessary to compute a wage index based on wages specific to skilled nursing facilities.

Subtitle B: Provisions Relating to Part B - Part I: Physicians' Services - Requires the Secretary to develop and report to the Congress on a methodology for implementing a resource-based system for determining practice expense relative value units for each physicians' service. Repeals the existing payment methodology when the new payment methodology takes effect for services provided in years beginning with 1997.

(Sec. 122) Requires the Secretary to: (1) review and revise the geographic practice cost indices; (2) use the most recent available data on practice and malpractice expenses and physician work effort in establishing such indices; and (3) study and report to the Congress on index construction, data used for indices revision, and other related specified matters.

(Sec. 123) Revises rules for billing Medicare part B (Supplementary Medical Insurance) beneficiaries for physician services in excess of the applicable limiting charge involved (extra-billing limits). Imposes new obligations on carriers before making payment. Provides for refunds of excess amounts billed.

(Sec. 124) Requires the Secretary to: (1) fully develop and refine the relative values for the full range of pediatric physicians' services; and (2) study and report to the Congress on such values to determine whether there are significant variations in the resources used for similar services to different populations.

(Sec. 125) Prohibits the Secretary or a carrier from imposing fees for filing claims for physicians' services, claims errors or denials, administrative appeals, obtaining unique identifiers, or responding to inquiries concerning physicians' services.

Permits the Secretary to recognize substitute billing arrangements between two physicians under specified conditions.

Part II: Durable Medical Equipment - Requires suppliers of medical equipment and supplies to have a certified supplier number, except with regard to medical equipment and supplies furnished as incident to a physician's service, in order to be reimbursed under Medicare. Prohibits a supplier from having a number without meeting prescribed standards. Prohibits the issuance of more than one supplier number, except in certain circumstances.

(Sec. 131) Requires the Secretary to develop one or more standardized certificates of medical necessity for medical equipment and supplies.

Allows suppliers to distribute to physicians or beneficiaries a certificate of medical necessity containing certain limited information. Requires that any supplier distributing a certificate with such information must also list the fee schedule amount and charge involved before distributing it to the physician for completion.

Requires the Secretary to: (1) develop and establish uniform national coverage and utilization review criteria for select items of medical equipment and supplies; (2) review annually and determine whether to subject to such criteria any items not already subject; (3) study and report to the Congress on the effects of the methodology for determining payments for items of durable medical equipment (DME) on the ability of persons entitled to disability benefits to obtain such items; and (4) report to the Congress on prosthetic devices or orthotics and prosthetics that do not require individualized or custom fitting and adjustment.

(Sec. 132) Places restrictions on certain telephone marketing and sales activities by DME suppliers.

(Sec. 133) Specifies the circumstances under which Medicare beneficiaries are not financially liable for covered items furnished by a supplier.

(Sec. 134) Requires the Secretary to: (1) determine whether the payment amounts for decubitus care equipment, transcutaneous electrical nerve stimulators, and any other items considered appropriate are inherently reasonable; and (2) adjust payments for such items if the amounts are not inherently reasonable.

(Sec. 135) Requires the Administrator of the Health Care Financing Administration (HCFA) to collect and report to the Congress on data on DME supplier costs and analyze them to determine costs attributable to service and product components and the extent to which they vary by type of equipment and geographic region.

Part III: Other Items and Services - Addresses payment adjustments for ambulatory surgical center services and new technology intraocular lenses.

(Sec. 142) Requires the Secretary to study and report to the Congress on: (1) patient care costs for Medicare beneficiaries enrolled in clinical trials of new cancer therapies; and (2) continuation of the annual limitation on the payment amount for outpatient services of independently practicing physical and occupational therapists.

(Sec. 144) Authorizes the Secretary to enter into agreements with the States for allowing them to pay the penalties applicable to individuals for late enrollment premium payments under Medicare part B.

(Sec. 145) Requires mammography facilities providing covered screening or diagnostic mammograms to Medicare beneficiaries to hold a certificate (or provisional certificate) issued under the Public Health Service Act.

(Sec. 146) Changes the terms "speech therapy" and "speech pathology services" to "speech-language pathology services."

(Sec. 147) Makes miscellaneous and technical amendments, among other things, to: (1) apply outpatient payment limits to diagnostic services; (2) exclude the services of nurse practitioners and clinical nurse specialists from the definition of inpatient hospital services; and (3) allow individuals who have employer group health coverage to enroll in part B at any time they are enrolled in the group health plan, rather than after they leave the plan.

Subtitle C: Provisions Relating to Parts A and B - Makes various specified changes with regard to Medicare as secondary payer.

(Sec. 152) Modifies reporting requirements under physician ownership and self-referral prohibitions to require physicians to report investment and compensation arrangements (in addition to ownership) with respect to designated health services provided.

Includes magnetic resonance imaging, computerized axial tomography scans, and ultrasound services among those subject to such prohibitions.

(Sec. 153) Allows the Secretary to recognize any successor exam to the Foreign Medical Graduate Examination in the Medical Sciences for payment of direct graduate medical education.

(Sec. 154) Requires the Secretary to establish and implement a method for obtaining information from newly eligible Medicare beneficiaries that may be used to determine eligibility for Medicaid payment of their out-of-pocket Medicare expenses.

(Sec. 155) Amends SSA title XI to require hospitals and rural primary care hospitals to enter into an agreement with the organ procurement agency designated by the Secretary for the service area in which the facility is located, unless it has obtained a waiver, in order to participate in Medicare or Medicaid.

Requires an Office of Technology Assessment study and report to the Congress with respect to such hospital agreements and organ procurement and distribution.

(Sec. 156) Amends SSA title XI to: (1) repeal the requirement that peer review organizations (PROs) precertify selected surgical procedures; and (2) revise provisions on the notification of State licensing boards by PROs.

(Sec. 157) Requires the Secretary to: (1) treat as a separate class Medicare beneficiaries with respect to whom there is a primary group health plan in defining classes to be used in determining the annual per capita rate of payment to an eligible health maintenance organization with a risk-sharing contract; and (2) submit a proposal to the Congress providing for revisions to the payment method. Requires the Comptroller General to report to the Congress on the proposed revisions.

(Sec. 158) Requires use of the most recent hospital wage data in constructing the home health wage index for cost reporting periods beginning July 1, 1996.

Extends the limits on liability under the Consolidated Omnibus Budget Reconciliation Act of 1985 for claims disallowed by a lack of medical necessity.

(Sec. 159) Makes permanent the authority provided under the Deficit Reduction Act of 1984 for the Secretary to enter into agreements with fiscal intermediaries and carriers on other than a cost basis.

(Sec. 160) Provides that user fees imposed under the Clinical Laboratories Improvement Act of 1967 are not subject to Medicare's general ban on user fees.

Modifies the phase-in schedule under the Omnibus Budget Reconciliation Act of 1993 (OMBRA '93) for Medicare beneficiaries who receive immunosuppressive drugs following an organ transplant.

Subtitle D: Provisions Relating to Medicare Supplemental Insurance Policies - Makes various technical corrections to provisions relating to Medicare supplemental policies.

(Sec. 172) Provides for a six month extension of THE period for issuance of such policies.

Title II: Maternal and Child Health Services Block Grant Program - Subtitle A: Child Welfare, Foster Care, Adoption - Amends SSA title IV part B (Child-Welfare Services): (1) to increase the authorization of appropriations for the maternal and child health services block grant program; and (2) to repeal provisions requiring foster care protection for additional Federal payments and require instead that the State part B plan provide for such protections. Requires: (1) State review of its policies and administrative and judicial procedures in effect for children abandoned at or shortly after birth; and (2) implementation of those policies and procedures determined necessary to enable permanent decisions to be made expeditiously regarding the placement of such children.

(Sec. 202) Prohibits reallotment among other States of any funds withheld or recovered from a State due to its failure to provide the above protections.

(Sec. 203) Amends SSA title XI part A to require the Secretary to promulgate regulations to determine whether programs under SSA title IV parts B and E are in substantial conformity with State plan requirements, implementing regulations, and the relevant approved State plans.

(Sec. 204) Requires a State part B plan to describe specific measures taken by the State to comply with the Indian Child Welfare Act.

(Sec. 205) Specifies the assurances that grant applications for child welfare traineeships must provide in order to win approval.

(Sec. 206) Amends SSA title IV part E (Foster Care and Adoption Assistance) to: (1) require each foster child's case plan to be designed not only to achieve placement in the least restrictive (most family-like) setting available, but in the most appropriate setting available as well; (2) require subsequent dispositional hearings to take place not less frequently than every 12 months after the first one, rather than periodically; (3) eliminate foster care ceiling and fund transfer provisions; (4) provide for accountability in cases of children placed in foster care a substantial distance from the home of their parents, or outside the State; and (5) codify the regulations for the treatment of State claims for foster care and adoption assistance.

(Sec. 208) Amends SSA title XI part A to: (1) authorize the Secretary to permit up to ten States to conduct demonstration projects which the Secretary finds likely to promote the objectives of SSA title IV parts B or E; and (2) overturn certain limitations in Suter v. Artist M. on private enforceability of State plan requirements.

Subtitle B: Child Support Enforcement - Amends SSA title IV part D (Child Support and Establishment of Paternity) to require State child support enforcement agencies to report periodically the names of obligors who are at least two months delinquent in support payments as well as the amount of the delinquency to consumer reporting agencies choosing to receive such information. Repeals provisions on payment of fees by consumer reporting agencies.

(Sec. 214) Requires the Secretary to enter into an agreement with the Attorney General under which the services of the Parent Locator Service shall be made available to the Office of Juvenile Justice and Delinquency Prevention, upon request, for the purpose of locating any parent or child.

Subtitle C: Supplemental Security Income - Amends SSA title XVI (Supplemental Security Income) (SSI) to extend the SSI childhood definition of disability to any person under 18.

Subtitle D: Aid to Families with Dependent Children - Amends SSA title XI to allow any adult member of a family or household to sign a declaration, under penalty of perjury, on behalf of other adults in the household for purposes of receiving welfare payments. Provides that in the case of a newborn child, an adult member of the family or household may sign a declaration on behalf of the child no later than the next redetermination of the eligibility of the family or household.

(Sec. 232) Welfare Indicators Act of 1994 - Declares certain policies of the United States, among them: (1) reducing the rate at and the degree to which families depend on welfare and its duration; (2) strengthening families; (3) improving the education and job skills of welfare recipients and individuals at risk of welfare receipt; and (4) providing the public with generally accepted measures of welfare receipt so that it can track it over time and determine whether progress is being made in reducing family dependency on welfare.

Requires the Secretary to develop indicators and predictors of welfare receipt for a report to the Congress.

Creates an Advisory Board on Welfare Indicators to provide advice and recommendations to the Secretary on the development of indicators, and on the development and presentation of annual reports on welfare receipt by the Secretary.

(Sec. 233) Requires the Secretary to provide for a demonstration project for a qualified program in Milwaukee, Wisconsin, operated by The New Hope Project, Inc., a private not-for-profit corporation offering low-income Milwaukee residents employment, wage supplements, health and child care, and counseling and training for job retention or advancement.

(Sec. 234) Amends the Family Support Act of 1988 to delay the requirement for implementation of the Unemployed Parent program in Puerto Rico, Guam, the Virgin Islands, and American Samoa until repeal of the limitations on Federal matching payments to these jurisdictions for making Aid to Families with Dependent Children (AFDC) and other maintenance payments.

(Sec. 235) Gives States the option to decide, with respect to categories of families, whether or not to use monthly reporting, retrospective budgeting, or a combination of the two.

Subtitle E: Jobs Program - Amends SSA title IV part F (Job Opportunities and Basic Skills Training Program) (JOBS) to count all Indians who live on a reservation, regardless of whether they are members of the tribe, in determining the tribe's allocation of JOBS funds.

(Sec. 242) Delays the submission date for the Secretary's recommendations to the Congress with regard to JOBS performance standards. Requires the Secretary to develop criteria for the performance standards, rather than the standards themselves.

Subtitle F: Other Provisions - Amends the Family Support Act of 1988 to reauthorize and extend certain demonstration projects to create employment opportunities for low-income individuals.

(Sec. 262) Authorizes appropriations for early childhood development projects.

(Sec. 263) Reallocates to the States certain funds received by an empowerment zone or enterprise community but not used, for use under SSA title XX (Block Grants to States for Social Services).