A bill to amend title XVIII of the Social Security Act to improve the process by which the Secretary of Health and Human Services makes coverage determinations for items and services furnished under the medicare program, and for other purposes.
Provides for the treatment of new medical technologies under the Medicare prospective payment system (PPS) for hospital outpatient department services. Adds special rules for excluded technologies.
Directs the Secretary of Health and Human Services (HHS) to: (1) make adjustments to the amounts payable under the PPS necessary to ensure that there is no increase or decrease in Medicare expenditures as a result of this Act; and (2) monitor the utilization of medical technology in hospital outpatient departments.
Requires the Medicare Payment Advisory Commission (MedPAC) to report annually to the appropriate congressional committees on the changes in utilization of and access to medical technologies furnished under Medicare, together with recommendations for legislation and administrative actions to improve Medicare beneficiary access to appropriate medical technologies.
Amends SSA title XVIII to prohibit the exclusion of a drug or biological from Medicare coverage because it is not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, if such drug or biological has been approved by the Food and Drug Administration (FDA) and is prescribed for an FDA-approved use or a use supported in medical compendia.
Directs the Secretary to: (1) accept recommendations for Health Care Financing Administration Common Procedure Coding System (HCPCS) level II code modifications yearly from the public; (2) cause determinations on recommendations received during the three months immediately preceding the last month of a calendar quarter to be made not later than the first day of the following calendar quarter; and (3) implement approved modifications to HCPCS level II codes established under Medicare (including the Medicare fee schedule database) with respect to the payment system not later than 180 days after the determination approving a modification was made.
Sets forth a special rule for certain medical technologies with regard to HCPCS level II codes.
Prohibits the Secretary from requiring a minimum period of marketing experience with respect to a drug or device as a condition of consideration or approval of a recommendation for a HCPCS level II code modification for such drug or device.
Requires the Secretary to report to Congress on the feasibility and desirability of opening meetings of the HHS Alpha-Numeric Editorial Panel to the public.
Directs the Secretary to maintain and continue the use of HCPCS level III codes (as in effect on June 1, 1999), and to make them available to the public.
Introduced in Senate
Sponsor introductory remarks on measure. (CR S11363-11365)
Read twice and referred to the Committee on Finance.
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