Medicare Waste Tax Reduction Act of 1999

Summary

Medicare Waste Tax Reduction Act of 1999 - Amends titles XI and XVIII (Medicare) of the Social Security Act, the Balanced Budget Act of 1997, and other specified Federal law to mandate various specified measures to combat Medicare fraud, waste, and abuse. (Sec. 2) Includes among such measures: (1) increased medical, utilization, and fraud reviews in a fiscal year; (2) Department of Health and Human Services (HHS) oversight of home health agencies; (3) an information system for ensuring that Medicare does not reimburse claims owed by other payers; (4) civil monetary penalties for services ordered or prescribed by an excluded individual or entity, as well as for false certification of eligibility for partial hospitalization and hospice services; (5) exemption of health plans, plan issuers, and employees from liability for providing information regarding health care fraud; (6) exclusion of skilled nursing facilities (SNFs) and an individual's personal residence from covered locations for the provision of partial hospitalization services; (7) new health, safety, and anti-fraud requirements for community mental health centers with respect to partial hospitalization services; (8) authority for the HHS Secretary to establish a prospective payment system (PPS) for partial hospitalization services provided by a community mental health center or by a hospital; (9) repeal of certain factors required by the Balanced Budget Act of 1997 for determination of the inherent reasonableness of costs for all Medicare part B (Supplementary Medical Insurance) services other than physicians' services; (10) mandatory establishment of standards regarding payment for certain orthotics and prosthetics; (11) authority for the Secretary to contract for Medicare claims processing with agencies and organizations that are not insurance companies, and to renew contracts with fiscal intermediaries meeting performance requirements without competitive procedures; and (12) addition of Y2K compliance to fiscal intermediary contract performance requirements. Makes specified increases in appropriated amounts for Medicare and Medicaid activities, including the Medicare Integrity program. (Sec. 4) Reduces the reimbursement to physicians, suppliers, or other service providers for drugs and biologicals from 95 percent of the average wholesale price to the lowest of 83 percent of such price, the actual acquisition cost, or an even lower amount according to a specified formula. Repeals the mandate of the Balanced Budget Act of 1997 for reports on the average wholesale price of drugs and biologicals. (Sec. 9) Provides that Medicare- and Medicaid-related actions shall not be stayed by bankruptcy proceedings, nor Medicare- and Medicaid-related debt discharged in bankruptcy. (Sec. 11) Authorizes the Secretary to establish a procedure for enrolling and re- enrolling, for an appropriate fee, non-service providers that furnish covered health care items or services. (Sec. 12) Directs the HHS Secretary to: (1) develop and implement a comprehensive plan of activities to increase Medicare compliance, education, and assistance for health care providers; and (2) contract with the Institute of Medicine of the National Academy of Sciences to establish a committee to study Medicare administrative requirements applicable to Medicare health care providers, and make recommendations on how Medicare paperwork and administrative requirements can be minimized. Authorizes appropriations for such study. (Sec. 14) Specifies application of certain sanctions to Federal health care programs. (Sec. 15) Revises alternative criteria for payments for durable medical equipment (DME) to include the least expensive amount that the item supplier is paid by a Medicare+Choice organization or by any Federal health care program. Requires the Secretary to adjust the payment rate for any DME administrative costs exceeding those associated with providing a particular item to a Medicare+Choice organization or another Federal health care program. (Sec. 16) Outlines provisions for implementation of a commercial claims auditing system for Medicare carriers in processing claims under Medicare part B. (Sec. 18) Authorizes appropriations for carrying out and expanding nationwide the Health Care Anti-Fraud, Waste and Abuse Community Volunteer Demonstration Projects (Medicare Senior Waste Patrol) conducted by the Administration on Aging. (Sec. 21) Repeals certain conditions for the termination of agreements with agencies or organizations for the processing of Medicare part A (Hospital Insurance) claims. Revises requirements for performance standards and criteria for fiscal intermediaries. Changes certain cost reimbursement provisions from mandatory to discretionary. Repeals the Secretary's mandate, in determining administration costs, to take into account the reasonable and adequate amount to meet such costs which must be incurred by an efficiently and economically operated carrier in carrying out its contract terms. (Sec. 22) Exempts from requirements of the Paperwork Reduction Act of 1980 any Office of Inspector General established within an agency under the Inspector General Act of 1978.

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3 official files

• Introduced in Senate (text)

  Introduced in Senate · EN · 28 July 1999

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• Introduced in Senate (PDF)

  Introduced in Senate · EN · 28 July 1999

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• Introduced in Senate

  summary · EN · 28 July 1999

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