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Text of To prohibit application of a payment limit to a drug or biological under part B of the Medicare Program based ...

...Medicare Program based on a less costly alternative for courses of treatment begun before the change in payment.

This bill was introduced on November 6, 1997, in a previous session of Congress, but was not enacted. The text of the bill below is as of Nov 6, 1997 (Introduced).

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Source: GPO

HR 2851 IH

105th CONGRESS

1st Session

H. R. 2851

To prohibit application of a payment limit to a drug or biological under part B of the Medicare Program based on a less costly alternative for courses of treatment begun before the change in payment.

IN THE HOUSE OF REPRESENTATIVES

November 6, 1997

Mrs. KENNELLY of Connecticut introduced the following bill; which was referred to the Committee on 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 prohibit application of a payment limit to a drug or biological under part B of the Medicare Program based on a less costly alternative for courses of treatment begun before the change in payment.

    Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. RESTRICTING CHANGES IN MEDICARE REIMBURSEMENT RATES FOR DRUGS AND BIOLOGICALS BASED ON A LESS COSTLY ALTERNATIVE DURING COURSE OF TREATMENT.

    (a) IN GENERAL- If the Secretary of Health and Human Services or a carrier reduces a recognized rate for a drug or biological under part B of title XVIII of the Social Security Act based solely on the identification of an alternative drug or biological that is less costly for treatment of the same condition, the Secretary shall provide that such reduction shall not apply during a course of treatment to an individual who, as of the effective date of the reduction in payment rate, was entitled to benefits under such part and was in a course of treatment with such drug or biological for which such benefits are available.

    (b) EXCEPTION FOR GENERIC SUBSTITUTION- Subsection (a) shall not apply in the case of substitution of a generic drug for another.

    (c) EFFECTIVE DATE- This section shall apply to payment for drugs or biologicals furnished on or after the date of the enactment of this Act, with respect to courses of treatment beginning before, on, or after such date.

SEC. 2. REPORT ON MEDICARE CARRIER DETERMINATIONS OF COVERAGE.

    The Secretary of Health and Human Services shall submit to Congress, not later than 1 year after the date of the enactment of this Act, a report that--

      (1) describes the types of coverage decisions that are being made by carriers under part B of title XVIII of the Social Security Act;

      (2) describes the legal authority for carriers to make such decisions; and

      (3) specifies whether further Federal guidance is needed to prevent regional disparities in coverage under part B of such title.