[Congressional Bills 103th Congress] [From the U.S. Government Publishing Office] [H.R. 3907 Introduced in House (IH)] 103d CONGRESS 2d Session H. R. 3907 To direct the Secretary of Health and Human Services to carry out a demonstration project under which physicians providing services to individuals entitled to benefits under the medicare program will receive regular information on charges submitted by and payments made to other providers who furnish services to such individuals. _______________________________________________________________________ IN THE HOUSE OF REPRESENTATIVES February 24, 1994 Mr. Kreidler introduced the following bill; which was referred jointly to the Committees on Ways and Means and Energy and Commerce _______________________________________________________________________ A BILL To direct the Secretary of Health and Human Services to carry out a demonstration project under which physicians providing services to individuals entitled to benefits under the medicare program will receive regular information on charges submitted by and payments made to other providers who furnish services to such individuals. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. ESTABLISHMENT OF DEMONSTRATION PROJECT ON MEDICARE REFERRAL REPORTS. (a) In General.--Not later than January 1, 1995, the Secretary of Health and Human Services (hereafter in this Act referred to as the ``Secretary'') shall establish a demonstration project under which, with respect to providers of physicians' services for which payment may be made under part B of title XVIII of the Social Security Act within the designated area of the project, the Secretary shall periodically furnish a medicare referral report (as described in subsection (b)) to the provider on any individual entitled to benefits under such title to whom the provider furnishes such services during the period the project is in effect (subject to subsection (c)). The Secretary shall furnish such reports upon the request of a provider of physicians' services under such title and at such other times as the Secretary may consider appropriate. (b) Medicare Referral Report Described.-- (1) In general.--In this section, a ``medicare referral report'' means, with respect to an individual, a report (in such format as the Secretary may establish) containing the following information: (A) Any item or service furnished to the individual during the period the project is in effect for which payment may be made under title XVIII of the Social Security Act. (B) The identity of the individual or entity furnishing such item or service. (C) The illness, injury, or condition (including any applicable diagnostic code) on which the furnishing of the item or service is based. (D) The amount of payment made for the item or service under such title. (E) The amount of charges submitted to the Secretary with respect to the item or service (if any) by the individual or entity furnishing the item or service. (2) Format.--A medicare referral report shall be provided in such electronic and printed formats as the Secretary may establish, and shall be furnished to a provider in the format the provider specifies. (c) Patient Consent Required.-- (1) In general.--No medicare referral report may be furnished under the project with respect to information relating to any individual unless the individual has provided written consent to the Secretary (in such form as the Secretary may require) for the reporting of such information. (2) Renewal of consent.--The Secretary may limit the period for which the consent provided pursuant to paragraph (1) shall be effective and establish a process under which an individual may renew the consent for an additional period. (d) Consultation Requirement.--In carrying out this Act, including the selection of the areas in which the demonstration project will be carried out, the development of formats for medicare referral reports, and the provision of orientation and training services under section 2, the Secretary shall consult with representatives of primary care and other health professionals, hospitals and nursing homes, medicare beneficiaries, health maintenance organizations and other managed care providers, and health data collectors. SEC. 2. ORIENTATION AND TRAINING ON USE OF REFERRAL REPORTS. In carrying out the demonstration project established under section 1, the Secretary shall provide orientation and training services to assist providers of physicians' services who are participating in the project in using the medicare referral reports to effectively manage patient care, including information regarding limitations on the usefulness of such reports in making clinical decisions or evaluating the effectiveness of treatments. <all>