To amend title XVIII of the Social Security Act to provide for enhanced reimbursement under the medicare program for screening and diagnostic mammography services, and for other purposes.

April 10, 2003

Mr. HARKIN (for himself, Ms. SNOWE, Mr. INOUYE, Mr. GRAHAM of South Carolina, Mrs. MURRAY, Mr. CORZINE, Mr. BIDEN, Mr. SPECTER, Ms. LANDRIEU, Mr. JOHNSON, Mrs. LINCOLN, Mr. HOLLINGS, Ms. MIKULSKI, Mrs. CLINTON, and Ms. COLLINS) introduced the following bill; which was read twice and referred to the Committee on Finance

To amend title XVIII of the Social Security Act to provide for enhanced reimbursement under the medicare program for screening and diagnostic mammography services, 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 `Assure Access to Mammography Act of 2003'.

SEC. 2. ENHANCED REIMBURSEMENT UNDER THE MEDICARE PROGRAM FOR SCREENING AND DIAGNOSTIC MAMMOGRAPHY SERVICES FURNISHED IN 2003.

(a) PAYMENTS TO FACILITIES FOR SCREENING AND DIAGNOSTIC MAMMOGRAPHY-

(1) IN GENERAL- Notwithstanding any other provision of law, with respect to payment for a screening or diagnostic mammography furnished to a medicare beneficiary, the amount of payment made to a hospital-based facility (defined in paragraph (4)) in which such screening or diagnostic mammography is performed during the applicable period described in paragraph (3) is equal to 200 percent of the amount of payment that would otherwise apply under the fee schedule established under section 1848 of the Social Security Act (42 U.S.C. 1395w-4) with respect to the technical component of such screening or diagnostic mammography.

(2) TEMPORARY PAYMENT RULE- With respect to payments to a hospital-based facility for screening or diagnostic mammography described in paragraph (1) during the applicable period, payment shall be made to the facility for such mammography pursuant to this subsection and shall not be made under section 1833(t) of such Act (42 U.S.C. 1395l(t)).

(3) APPLICABLE PERIOD- The applicable period referred to in paragraph (1) is the period beginning on the date of the enactment of this Act and ending on the date the Secretary establishes and implements an appropriate facility payment rate under the prospective payment system for covered outpatient services under such section 1833(t) for a screening or diagnostic mammography furnished to a medicare beneficiary, but in no case less than the amount payment provided for in paragraph (1).

(4) HOSPITAL-BASED FACILITY DEFINED- In this subsection, the term `hospital-based facility' means a facility for which payment is made for a diagnostic or screening mammography under such section 1833(t) but for this subsection.

(b) NOT COUNTING CERTAIN RADIOLOGY RESIDENTS AGAINST GRADUATE MEDICAL EDUCATION LIMITATIONS-

(1) IN GENERAL- For cost reporting periods beginning on or after October 1, 2003, and before October 1, 2008, in applying the limitations regarding the total number of full-time equivalent residents in the field of allopathic or osteopathic medicine under subsections (d)(5)(B)(v) and (h)(4)(F) of section 1886 of the Social Security Act (42 U.S.C. 1395ww) for a hospital, the Secretary of Health and Human Services shall not take into account 1 additional resident in the field of radiology per post-graduate year during each such cost reporting period to the extent the hospital increases the number of radiology residents above the number of such residents for the hospital's most recent cost reporting period ending before October 1, 2003.

(2) TREATMENT FOR ENTIRE PERIOD OF TRAINING PROGRAM- The provisions of paragraph (1) shall apply for each year of the full-time equivalent resident's approved medical residency training program in the field of radiology not taken into account by reason of paragraph (1).

(c) CONSTRUCTION- Nothing in this section shall be construed as affecting the provisions of section 104(d) of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (as enacted into law by section 1(a)(6) of Public Law 106-554) (relating to payment for new technologies).

SEC. 3. IOM STUDY AND REPORT ON MEDICARE REIMBURSEMENT FOR GENDER-SPECIFIC SERVICES.

(a) STUDY- The Secretary of Health and Human Services shall enter into an arrangement with the Institute of Medicine of the National Academy of Sciences to conduct a study of--

(1) the relative value units established by the Secretary under the medicare physician fee schedule under section 1848 of the Social Security Act (42 U.S.C. 1395w-4) for physicians' services that are gender-specific; and

(2) adjustments to payment amounts under the prospective payment systems for inpatient hospital services (under section 1886(d) of such Act (42 U.S.C. 1395ww(d))) and for covered skilled nursing facility services (under section 1888(e) of such Act (42 U.S.C. 1395yy(e))) that are gender specific.

(b) REPORT-

(1) IN GENERAL- Such arrangement shall provide that the Institute shall submit to the Secretary a report on the study conducted under subsection (a) by not later than December 31, 2004.

(2) RECOMMENDATIONS- The report shall include such recommendations regarding the appropriateness of adjusting the relative value units for physicians' services or the prospective payment amounts for inpatient hospital services or covered skilled nursing facility services that are gender-specific, as the Institute determines appropriate.

(3) TRANSMISSION TO CONGRESS- The Secretary shall promptly transmit a copy of such report to Congress.

SEC. 4. MEDPAC STUDY AND REPORT ON MEDICARE REIMBURSEMENT FOR SCREENING SERVICES.

(a) STUDY- The Medicare Payment Advisory Commission shall conduct a study of the relative value units established by the Secretary of Health and Human Services under the medicare physician fee schedule under section 1848 of the Social Security Act (42 U.S.C. 1395w-4) for screening services that are reimbursed under such fee schedule.

(b) REPORT- Not later than March 1, 2004, the Commission shall submit to Congress a report on the study conducted under subsection (a), together with such recommendations regarding the appropriateness of adjusting the relative value units for screening services that are reimbursed under the physician fee schedule as the Commission determines appropriate.

END