[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6380 Introduced in House (IH)]
110th CONGRESS
2d Session
H. R. 6380
To amend title XVIII of the Social Security Act to provide payments
under the Medicare Program for unscheduled physician telephone
consultation services in the case that such payments are determined to
be cost and quality effective.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 26, 2008
Mrs. Biggert (for herself, Mr. Emanuel, and Mrs. Emerson) introduced
the following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide payments
under the Medicare Program for unscheduled physician telephone
consultation services in the case that such payments are determined to
be cost and quality effective.
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 ``Medicare Physician Telephone
Consultation Services Coverage Act of 2008''.
SEC. 2. MEDICARE PAYMENT FOR UNSCHEDULED PHYSICIAN TELEPHONE SERVICES.
(a) Coverage Under Part B.--
(1) In general.--Section 1861(s)(2) of the Social Security
Act (42 U.S.C. 1395x(s)(2)) is amended--
(A) in subparagraph (Z), by striking ``and'' at the
end;
(B) in subparagraph (AA), by adding at the end
``and''; and
(C) by adding at the end the following new
subparagraph:
``(BB) subject to section 2(c) of the Medicare
Physician Telephone Consultation Services Coverage Act
of 2008, unscheduled telephone consultation services
(as defined in subsection (ccc)(1)) by a physician,
with respect to the treatment of an individual, if--
``(i) the Medicare number of the individual
is associated with the national provider
identifier of the physician;
``(ii) to ensure the quality and
appropriateness of such consultation services,
the utilization of such services by the
individual can be reviewed by a utilization and
quality control peer review organization or
eligible entity with which the Secretary has
entered into a contract under part B of title
XI or section 1893, respectively, by the
organization or entity applying for purposes of
the review under this subparagraph the
processes and standards used by such
organization or entity under such part or
section, respectively, in the same manner that
such processes and standards apply for purposes
of carrying out utilization and quality review
under such part or section, respectively;
``(iii) such consultation services are
securely recorded by the Secretary (or an
entity described in subsection (ccc)(1) with
which the Secretary enters into a contract) for
purposes of appropriate review by peers of the
physician who practice in the same medical
specialty as the physician and Medicare
administrative contractor oversight of such
services; and
``(iv) the physician provides for the
submission to the Secretary (or an entity
described in subsection (ccc)(1) with which the
Secretary enters into a contract) and the
Secretary (or such an entity) records and
maintains a summary of each such consultation
service furnished by the physician that
includes--
``(I) the date and time (including
duration) of the consultation service;
``(II) a unique medical record
number specified by the Secretary (or
such entity) to identify the
consultation service;
``(III) the name of the individual;
``(IV) the name of the physician;
and
``(V) a summary of the content of
the consultation service;''.
(2) Unscheduled telephone consultation services defined.--
Section 1861 of such Act (42 U.S.C. 1395x) is amended by adding
at the end the following new subsection:
``Unscheduled Telephone Consultation Services
``(ccc)(1) The term `unscheduled telephone consultation service'
means a consultation conducted by means of telephone or similar
electronic communication device between a physician and an individual
(or a representative of such individual), with respect to the treatment
of such individual, that is not included as a scheduled physician
service (as defined by the Secretary in regulations), and which is
initiated by the individual (or representative) contacting a
communication network operated by the Secretary (or an entity with
which the Secretary enters into a contract) that connects the
individual to the physician, securely records the consultation for
purposes of subsection (s)(2)(BB), and maintains the information
described in clause (iv) of such subsection with respect to such
consultation.
``(2) For purposes of applying the regulations promulgated pursuant
to section 264(c) of the Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-191; 110 Stat. 2033) with
respect to an unscheduled telephone consultation service furnished by a
physician--
``(A) an entity with which the Secretary contracts under
this subsection shall be treated as a health oversight agency;
and
``(B) activities of such an entity described in
subparagraph (A) in relation to such physician and such
unscheduled telephone consultation service are deemed to be
health oversight activities.''.
(b) Payment Under Physician Fee Schedule.--Section 1848(j)(3) of
such Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting ``(2)(BB),''
after ``(2)(AA),''.
(c) Contingent Effective Date, Demonstration Program.--
(1) Contingent effective date.--The amendments made by this
section shall become effective (if at all) in accordance with
paragraph (2).
(2) Demonstration program.--
(A) In general.--The Secretary of Health and Human
Services (in this paragraph referred to as the
``Secretary'') shall establish a demonstration program
to begin not later than 6 months after the date of the
enactment of this Act to test the effectiveness of
providing coverage under the Medicare Program for
unscheduled telephone consultation services (as defined
in section 1861(ccc) of the Social Security Act) by
physicians to the extent provided under the amendments
made by this section to a sample group of Medicare
beneficiaries. For purposes of such demonstration
program, the Secretary shall find that the provision of
such coverage is effective if--
(i) the coverage reduces costs to the
Medicare Program (such as through a reduction
in admissions to the emergency departments of
hospitals), whether or not such reduction is
demonstrated in a reduction in the facility
fees of hospital emergency departments,
professional fees of emergency department
physicians, laboratory fees, pathologist fees,
hospital radiology department fees for
technical components of x-rays, radiologist
professional fees for interpreting x-rays,
hospital respiratory department fees for
respiratory treatments, hospital cardiology
department fees for electrocardiograms,
professional fees for interpreting such
electrocardiograms, or any other cost specified
by the Secretary; and
(ii) the coverage results in patient health
outcomes that are at least as favorable as
would apply in the absence of such coverage (as
determined in accordance with criteria
established by the Centers for Medicare &
Medicaid Services, in consultation with
physician organizations).
(B) Initial period of demonstration program.--The
demonstration program under subparagraph (A) shall be
conducted for an initial period of 24 months.
(C) Report to congress.--
(i) In general.--Not later than 30 days
after the last day of the initial period under
subparagraph (B), the Secretary shall submit to
Congress a report on the results of the
demonstration program under this paragraph.
(ii) Finding that payments are effective.--
If the Secretary finds, on the basis of the
data derived from the demonstration program
under subparagraph (A) and in accordance with
such subparagraph, that providing coverage
under the Medicare Program for unscheduled
telephone consultation services by physicians
(to the extent provided under the amendments
made by this section) is effective, the
amendments made by this section shall become
effective on the first day of the first month
beginning after the date the report under
clause (i) is submitted to Congress.
(iii) Finding that payments are not
effective.--If the Secretary finds, on the
basis of the data derived from the
demonstration program under subparagraph (A)
and in accordance with such subparagraph, that
a finding of effectiveness (as described in
clause (ii)) cannot be made, the demonstration
program shall continue for a period of an
additional 24 months. Not later than 30 days
after the last day of such period, the
Secretary shall submit to Congress a final
report on the results of such program. The
amendments made by this section shall become
effective on the first day of the first month
beginning after the date such report is
submitted to Congress unless the report
contains a finding by the Secretary, on the
basis of such data and in accordance with such
subparagraph, that providing coverage under the
Medicare Program for unscheduled telephone
consultation services by physicians (to the
extent provided under the amendments made by
this section) is not effective, in which case
the amendments made by this section shall not
become effective.
(d) Clarification.--Nothing in the provisions of this section or
the amendments made by this section shall be construed as authorizing
the creation of a national reporting system on physician quality.
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