Directs the Comptroller General to study and report to Congress on pharmacy services used to provide cancer drug therapies in hospital outpatient setting.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1206 Introduced in Senate (IS)]
108th CONGRESS
1st Session
S. 1206
To amend title XVIII of the Social Security Act to provide for special
treatment for certain drugs and biologicals under the prospective
payment system for hospital outpatient department services under the
medicare program.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 9, 2003
Mr. Bond introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for special
treatment for certain drugs and biologicals under the prospective
payment system for hospital outpatient department services under the
medicare program.
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 ``Beneficiary Access to Care Act of
2003''.
SEC. 2. TREATMENT OF DRUGS AND BIOLOGICALS UNDER THE MEDICARE
OUTPATIENT HOSPITAL PROSPECTIVE PAYMENT SYSTEM.
(a) Separate APCs for Most Drugs and Biologicals.--
(1) In general.--Section 1833(t)(2) of the Social Security
Act (42 U.S.C. 1395l(t)(2)) is amended--
(A) by striking ``and'' at the end of subparagraph
(F);
(B) by striking the period at the end of
subparagraph (G) and inserting ``; and''; and
(C) by adding at the end the following:
``(H) the Secretary shall treat as a separate group
of covered OPD services--
``(i) any drug or biological that was
treated as such a group as of December 31,
2002; and
``(ii) any drug or biological that has
ceased to be eligible for transitional, pass-
through payments under paragraph (6) by reason
of the limited period of payment specified in
paragraph (6)(C)(i).''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to items and services furnished on or after January
1, 2004.
(b) Payment Rates for Non-Pass-Through Drugs and Biologicals.--
(1) Program payments.--Section 1833(t) of the Social
Security Act (42 U.S.C. 1395l(t)) is amended--
(A) in paragraph (3), by amending subparagraph (D)
to read as follows:
``(D) Calculation of medicare opd fee schedule
amounts.--
``(i) In general.--The Secretary shall
compute a medicare OPD fee schedule amount for
each covered OPD service (or group of such
services) furnished in a year, in an amount
that (except as provided in clause (ii)) is
equal to the product of--
``(I) the conversion factor
computed under subparagraph (C) for the
year; and
``(II) the relative payment weight
(determined under paragraph (2)(C) or
paragraph (9)(A)) for the service or
group.
``(ii) Special rules for 2004.--
``(I) In general.--Notwithstanding
clause (i), the medicare OPD fee
schedule amount for 2004 for a drug or
biological that is treated as a
separate group of covered OPD services
and is--
``(aa) a single-source drug
(as defined in section
1927(k)(7)(A)(iv));
``(bb) an innovator
multiple source drug (as
defined in section
1927(k)(7)(A)(ii)); or
``(cc) a biological product
approved for marketing under
section 351 of the Public
Health Service Act (including
any such product that is
marketed by any cross-licensed
producers or distributors),
may not be less than 87.37 percent of
the payment rate for the drug or
biological under paragraph (6) as of
December 31, 2002 (determined without
regard to any reduction under
subparagraph (E)(iii) of such
paragraph).
``(II) No revision of relative
payment weights.--The relative payment
weights established under paragraph
(9)(A) for 2004 for groups of covered
OPD services other than those to which
subclause (I) applies shall not be
revised to take into account the
application of such subclause (I).'';
(B) in paragraph (4)--
(i) in subparagraph (A), by striking
``Secretary, as computed under paragraphs
(2)(D) and (2)(E)'' and inserting ``Secretary
(as computed under paragraphs (2)(D) and
(2)(E)), except that the medicare OPD fee
schedule amount determined under paragraph
(3)(D) for a drug or biological that is treated
as a separate group of covered OPD services
shall not be adjusted for relative differences
in the cost of labor''; and
(ii) in subparagraph (B), by striking
``adjusted''; and
(C) in paragraph (9), by adding at the end the
following:
``(D) Use of external data.--In determining the
relative payment weight for any drug or biological that
is treated as a separate group of covered OPD services
for any year after 2003, the Secretary shall adjust the
weight otherwise determined under this paragraph with
respect to the drug or biological to the extent that
reliable and valid data collected and submitted by
entities and organizations other than the Department of
Health and Human Services (including data submitted in
public comments on the proposed rule promulgated with
respect to the system established under this subsection
for 2004) demonstrate that such payment weight is
inadequate or inaccurate. In the case of any
adjustments made pursuant to the preceding sentence for
2004, the Secretary shall not revise the relative
payment weights for other groups of covered OPD
services for such year to take into account such
adjustments, and the medicare OPD fee schedule amount
determined under paragraph (3)(D) using a relative
weight resulting from such an adjustment shall be
subject to the minimum amount described in clause
(ii)(I) of such paragraph.''.
(2) Copayments.--Section 1833(t)(8)(E) of the Social
Security Act (42 U.S.C. 1395l(t)(8)(E)) is amended--
(A) in the heading, by striking ``outlier and pass-
through'' and inserting ``certain''; and
(B) by striking ``paragraphs (5) and (6)'' and
inserting ``paragraphs (3)(D)(ii), (5), and (6)''.
(3) Exceptions to budget neutrality requirement.--Section
1833(t)(9)(B) of the Social Security Act (42 U.S.C.
1395l(t)(9)(B)) is amended by adding at the end the following:
``In determining the budget neutrality adjustment required by
the preceding sentence, the Secretary shall not take into
account--
``(i) any expenditures that would not have
been made but for the application of clause
(ii) of paragraph (3)(D); or
``(ii) any expenditures made by reason of
an adjustment required by subparagraph (D) for
2004.''.
(c) Study of Pharmacy Services Used To Provide Cancer Drug
Therapies in Hospital Outpatient Setting.--
(1) In general.--The Comptroller General shall conduct a
study of payments under part B of title XVIII of the Social
Security Act for pharmacy service costs and related costs that
are incurred in acquiring chemotherapy and supportive care
drugs and providing these therapies to cancer patients in
hospital outpatient departments. The study shall--
(A) identify pharmacy costs, including the costs of
storage, handling, processing, quality control,
disposal, compliance with safety protocols and
regulations, establishing dosage regimens that avoid
drug interactions and contraindications, and pharmacy
overhead;
(B) include a review of the adequacy of the current
payment methodology for pharmacy service costs and
related costs (including the adequacy of the
methodology used to estimate costs); and
(C) identify any changes to that methodology that
are necessary to ensure recognition of, and appropriate
payment for, all of the services and functions inherent
in the provision of cancer treatment in hospital
outpatient settings.
(2) Report to congress.--Not later than 12 months after the
date of enactment of this Act, the Comptroller General shall
submit to Congress a report on the results of the study under
paragraph (1), including any recommendations for legislation
that is necessary to implement the changes identified under
paragraph (1)(C).
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S7543-7544)
Read twice and referred to the Committee on Finance.
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