PROPERTYOF NOV 16 REC'D HCFALIbriARY 104thcongress H.R.4185 2dSession To amend title XVIII of the Social Security Act to pay for parenteral nutrientsprovidedaspartofrenaldialysisservicesaspartofpayment forrenaldialysisservicesundertheMedicareprogram. IN THE HOUSE OF REPRESENTATIVES September25,1996 Mr.Starkintroducedthefollowingbill;whichwasreferredtotheCommittee onCommerce, andin additionto the CommitteeonWaysandMeans, foraperiodtobesubsequentlydeterminedbytheSpeaker,ineachcase forconsiderationofsuchprovisionsasfallwithinthejurisdictionofthe committeeconcerned A BILL To amend title XVIII of the Social Security Act to pay forparenteralnutrientsprovidedaspartofrenaldialysis services as part of payment for renal dialysis services undertheMedicareprogram. 1 BeitenactedhytheSenateandHouseofRepresenta- 2 tivesoftheUnitedStatesofAmericainCongressassembled, 3 SECTION1.SHORTTITLE. 4 ThisActmaybecitedasthe"MedicareIntradialytic 5 ParenteralNutrientActof1996". — 1 SEC. 2. INTRADIALYTIC PARENTERAL NUTRIENTS REIM- 2 BURSED UNDER COVERAGE FOR RENAL DI- 3 ALYSISSERVICESUNDERMEDICARE. 4 (a) InGeneral.—Section1881(b)(ll) oftheSocial 5 Security Act (42 U.S.C. 1395rr(b)(ll)) is amended by 6 addingattheendthefollowing: 7 "(D)(i) Intradialytic parenteral nutrients (including 8 related services, supplies and equipment), whenprovided 9 to a patient determinedto have end stage renal disease, 10 shall notbeincludedas adialysisserviceforpurposesof 11 paymentunderanyprospectivepayment amount oreom- 12 prehensivefeeestablishedunderthissection,andpayment 13 forsuchitemshallbemadeseparately 14 "(I) in the case of such nutrients provided by 15 aphysician,inaccordancewithsection1833; and 16 "(11) in the case ofsuch nutrients providedby 17 an entity' other than a physician, an amount equal 18 to 80 percent of an amount based on the lesser of 19 the best price available for such nutrients or the 20 arms-length acquisition cost of such nutrients plus 21 an appropriate administrationfee, as determinedby 22 theSecretary. 23 "(ii)(I) BynotlaterthanJanuary 1, 1998, the Sec- 24 retary,inconsultationv^ithmedicalexperts,shallestabhsh 25 criteria to determine medically appropriate uses of such HB4185IH 3 1 nutrientswhenprovidedto apatient determinedto have 2 endstagerenaldisease. 3 "(11) Nopayment shallbe madeunderthistitlefor 4 such nutrients on or after January 1, 1999, unless the 5 useofsuchnutrientsmeetsthe criteriaformedicallyap- 6 propriateusesestabhshedundersubclause(I). 7 "(III)TheSecretary,inconsultationwithmedicalex- 8 perts, shall review and modifysuch criteria as necessary 9 whennewrelevantscientificdatabecomesavailable.". — 10 (b) Effectr^ Date. The amendment made by 11 subsection (a) applies with respect to payments for 12 intradial.^'ticparenteralnutrientsprovidedonorafterJan- 13 uan^1, 1997. O >HR4185IH f