II
109th CONGRESS
2d Session
S. 3606
IN THE SENATE OF THE UNITED STATES
June 29, 2006
Mr. Bingaman 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 fair payments for care provided in a hospital emergency department.
Short title; table of contents
Short title
This Act may be cited
as the Save Our Safety Net Act of
2005
.
Table of contents
The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Ensuring adequate physician payment for emergency department visits.
Sec. 3. Ensuring adequate hospital outpatient fee schedule amounts for clinic and emergency department visits.
Sec. 4. Permanent extension of adjustment to limit decline in payments for certain hospitals under hospital outpatient PPS.
Sec. 5. Fairness in the Medicare disproportionate share hospital (DSH) adjustment for rural hospitals.
Ensuring adequate physician payment for emergency department visits
Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended by adding at the end the following new subsection:
Save our safety net payments for physicians’ services provided in an emergency department
In the case of physicians’ services furnished to an individual covered under the insurance program established by this part in an emergency department on or after January 1, 2006, in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid to the physician or other person (or to an employer or entity in the cases described in clause (A) of section 1842(b)(6)) from the Federal Supplementary Insurance Trust Fund an amount equal to 10 percent of the payment amount for the service under this part.
.
Ensuring adequate hospital outpatient fee schedule amounts for clinic and emergency department visits
In general
Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) is amended—
in paragraph
(3)(C)(ii), by striking paragraph (8)(B)
and inserting
paragraphs (8)(B), (11)(B), and (13)(A)(i)
;
in paragraph
(3)(C)(iii), by inserting (but not the conversion factor computed under
paragraph (13)(B))
after this subparagraph
;
in paragraph (3)(D)—
in clause (i), by
striking conversion factor computed under subparagraph (C) for the
year
and inserting applicable conversion factor computed under
subparagraph (C), paragraph (11)(B), or paragraph (13)(B) for the year
;
and
in clause (ii),
by inserting , paragraph (9)(A), or paragraph (13)(C)
after
paragraph (2)(C)
;
in paragraph (9), by amending subparagraph (B) to read as follows:
Budget neutrality adjustment
In general
If the Secretary makes revisions under subparagraph (A), then the revisions for a year may not cause the estimated amount of expenditures under this part for the year to increase or decrease from the estimated amount of expenditures under this part (including expenditures attributable to the special rules specified in paragraph (13)) that would have been made if the revisions had not been made.
Exemption from reduction
The relative payment weights determined under paragraph (13)(C) and the conversion factor computed under paragraph (13)(B) shall not be reduced by any budget neutrality adjustment made pursuant to this subparagraph.
; and
by redesignating paragraphs (13) through (16) as paragraphs (14) through (17), respectively, and by inserting after paragraph (12) the following new paragraph:
Special rules for calculating medicare OPD fee schedule amount for clinic and emergency visits
In general
In computing the medicare OPD fee schedule amount under paragraph (3)(D) for covered OPD services that are furnished on or after January 1, 2006, and classified within a group established or revised under paragraph (2)(B) or (9)(A), respectively, for clinic and emergency visits (as described in subparagraph (D)), the Secretary shall—
substitute for the conversion factor calculated under paragraph (3)(C) the conversion factor calculated under subparagraph (B); and
substitute for the relative payment weight established or revised under paragraph (2)(C) or (9)(A), respectively, the relative payment weight determined under subparagraph (C) for such group.
Calculation of conversion factor
For purposes of subparagraph (A)(i), the conversion factor calculated under this subparagraph is—
for services furnished during 2006, an amount equal to the product of—
the conversion factor specified for such year in the final rule published on November 10, 2005, increased by the percentage by which such conversion factor is reduced for such year pursuant to paragraph (2)(E), and not taking into account any subsequent amendments to such final rule; and
1.10; and
for services furnished in a year beginning on or after January 1, 2007, the conversion factor computed under this subparagraph for the previous year increased by the OPD fee schedule increase factor specified under paragraph (3)(C)(iv) for the year involved.
Determination of relative payment weights
For purposes of subparagraph (A)(ii), the relative payment weight determined under this subparagraph for a covered OPD service that is classified within such a group is—
for services furnished during 2006, the relative payment weight specified for such group for such period in the final rule published November 10, 2005, and not taking into account any subsequent amendments to such final rule; and
for services furnished in a year beginning on or after January 1, 2007—
for ambulatory patient classification group 0601 (relating to mid-level clinic visits), or a successor to such group, the relative payment weight specified for such group in the final rule referred to in clause (i); and
for other ambulatory patient classification groups described in subparagraph (D), the relative payment weight established or revised under paragraph (2)(C) or (9)(A), respectively, for such group for such year (but without regard to any budget neutrality adjustment under paragraph (9)(B)).
Groups for clinic and emergency visits
For purposes of this paragraph, the groups established or revised under paragraph (2)(B) or (9)(A), respectively, for clinic and emergency visits are ambulatory patient classification groups 0600, 0601, 0602, 0610, 0611, 0612, and 0620 as defined for purposes of the final rule referred to in subparagraph (C)(i) (and any successors to such groups).
.
Limitation on secretarial authority
Notwithstanding section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)), as amended by subsection (a), the Secretary of Health and Human Services may not make any adjustment under—
paragraph (2)(F), (3)(C)(iii), (9)(B), or (9)(C) of section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)); or
any other provision of such section;
Permanent extension of adjustment to limit decline in payments for certain hospitals under hospital outpatient PPS
In general
Section 1833(t)(7)(D)(i) of the Social Security Act (42 U.S.C. 1395l(t)(7)(D)(i)), as amended by section 5105 of the Deficit Reduction Act of 2005 (Public Law 109–171), is amended—
in the clause heading—
by striking
Temporary
and inserting
Permanent
; and
by striking
Rural
by striking subclause (II);
by striking
(I) In the case
and inserting In the case
;
by striking
located in a rural area, for
and inserting , for
;
and
by striking
furnished before January 1, 2006
.
Effective date
The amendments made by subsection (a) shall apply to covered OPD services furnished on or after January 1, 2006.
Fairness in the Medicare disproportionate share hospital (DSH) adjustment for rural hospitals
Section 1886(d)(5)(F)(xiv)(II) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(F)(xiv)(II)) is amended—
by striking
or, in the case
and all that follows through subparagraph
(G)(iv)
; and
by inserting at the end the following new
sentence: The preceding sentence shall not apply to any hospital with
respect to discharges occurring on or after October 1, 2006.
.