Medicare Fraud and Reimbursement Reform Act of 1999

Summary

Medicare Fraud and Reimbursement Reform Act of 1999 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to restructure the formula for payment of drugs and biologicals to include the lowest of the actual acquisition cost, 95 percent of the average wholesale price (as under current law), the median actual acquisition cost, or as otherwise determined. Includes parenteral nutrients as reimbursable items. (Sec. 2) Amends the Balanced Budget Act of 1997 to eliminate the study and report to specified congressional committees on the effect of its amendments on the wholesale price of drugs and biologicals. (Sec. 3) Amends SSA title XVIII to revise the payment method for erythropoietin (epogen) for certain patients determined to have end stage renal disease. (Sec. 4) Amends SSA title XVIII with regard to mental health partial hospitalization services. Limits the location where such services can be furnished to places other than in a skilled nursing facility, residential treatment facility, or other residential setting as determined by the Secretary of Health and Human Services. Revises the qualifications for community mental health centers to permit the Secretary to specify certain conditions in addition to State licensing or certification requirements. Directs the Secretary to first adopt national coverage and administrative policies for partial hospitalization services under Medicare using a negotiated rulemaking process. Requires the periodicity of review of individualized, written plans for partial hospitalization services to be at a reasonable rate. Provides for: (1) mandatory periodic recertification of providers of partial hospitalization services; and (2) civil monetary penalties for false certification of eligibility for hospice care or partial hospitalization services. Directs the Secretary to: (1) implement a demonstration project under Medicare part B (Supplementary Medical Insurance) under which community mental health centers may offer wrap around mental health services for purposes of providing for a full continuum of ambulatory behavioral health care services; and (2) establish and make prospective monthly payments of a capitation amount for individuals receiving wrap around mental health services under this project. Provides for necessary funding. (Sec. 5) Requires administrators of group health plans and employers or employee organizations, with respect to Medicare as secondary payer, to provide the Secretary with specified information about individuals, including information about employers and family members with current or former employment status. Sets forth a civil money penalty for noncompliance. (Sec. 6) Directs the Secretary to use a competitive process to contract with specific hospitals or other entities (centers of excellence) meeting certain quality standards for furnishing hospital inpatients with services related to surgical procedures, as well as appropriate services unrelated to surgery. Provides for payment on the basis of negotiated all-inclusive rates. Requires the Secretary, by October 1, 2001, to enter into contracts with centers of excellence in geographic regions nationwide for coronary artery by-pass surgery and other heart procedures, knee replacement surgery, and hip replacement surgery, so that at least 20 percent of the projected number of those procedures can be provided under such contracts.

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3 official files

• Introduced in House (text)

  Introduced in House · EN · 15 June 1999

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• Introduced in House (PDF)

  Introduced in House · EN · 15 June 1999

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• Introduced in House

  summary · EN · 15 June 1999

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