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Pub.L. 108-174 To reauthorize the ban on undetectable firearms. <> ...
MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, AND MODERNIZATION ACT OF 2003
[[Page 117 STAT. 2066]]
Public Law 108-173
To amend title XVIII of the Social Security Act to provide for a
voluntary program for prescription drug coverage under the Medicare
Program, to modernize the Medicare Program, to amend the Internal
Revenue Code of 1986 to allow a deduction to individuals for amounts
contributed to health savings security accounts and health savings
accounts, to provide for the disposition of unused health benefits in
cafeteria plans and flexible spending arrangements, and for other
purposes. <<NOTE: Dec. 8, 2003 - [H.R. 1]>>
Be it enacted by the Senate and House of <<NOTE: Medicare
Prescription Drug, Improvement, and Modernization Act of
2003.>> Representatives of the United States of America in Congress
SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT; REFERENCES TO
BIPA AND SECRETARY; TABLE OF CONTENTS.
(a) Short <<NOTE: 42 USC 1305 note.>> Title.--This Act may be cited
as the ``Medicare Prescription Drug, Improvement, and Modernization Act
(b) Amendments to Social Security Act.--Except as otherwise
specifically provided, whenever in division A of this Act an amendment
is expressed in terms of an amendment to or repeal of a section or other
provision, the reference shall be considered to be made to that section
or other provision of the Social Security Act.
(c) BIPA; <<NOTE: 42 USC 1301 note.>> Secretary.--In this Act:
(1) BIPA.--The term ``BIPA'' means the Medicare, Medicaid,
and SCHIP Benefits Improvement and Protection Act of 2000, as
enacted into law by section 1(a)(6) of Public Law 106-554.
(2) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(d) Table of Contents.--The table of contents for this Act is as
Sec. 1. Short title; amendments to Social Security Act; references to
BIPA and Secretary; table of contents.
TITLE I--MEDICARE PRESCRIPTION DRUG BENEFIT
Sec. 101. Medicare prescription drug benefit.
Sec. 102. Medicare Advantage conforming amendments.
Sec. 103. Medicaid amendments.
Sec. 104. Medigap amendments.
Sec. 105. Additional provisions relating to medicare prescription drug
discount card and transitional assistance program.
Sec. 106. State Pharmaceutical Assistance Transition Commission.
Sec. 107. Studies and reports.
Sec. 108. Grants to physicians to implement electronic prescription drug
Sec. 109. Expanding the work of medicare Quality Improvement
Organizations to include parts C and D.
Sec. 110. Conflict of interest study.
Sec. 111. Study on employment-based retiree health coverage.
[[Page 117 STAT. 2067]]
TITLE II--MEDICARE ADVANTAGE
Subtitle A--Implementation of Medicare Advantage Program
Sec. 201. Implementation of Medicare Advantage program.
Subtitle B--Immediate Improvements
Sec. 211. Immediate improvements.
Subtitle C--Offering of Medicare Advantage (MA) Regional Plans; Medicare
Sec. 221. Establishment of MA regional plans.
Sec. 222. Competition program beginning in 2006.
Sec. 223. Effective date.
Subtitle D--Additional Reforms
Sec. 231. Specialized MA plans for special needs individuals.
Sec. 232. Avoiding duplicative State regulation.
Sec. 233. Medicare MSAs.
Sec. 234. Extension of reasonable cost contracts.
Sec. 235. Two-year extension of municipal health service demonstration
Sec. 236. Payment by PACE providers for medicare and medicaid services
furnished by noncontract providers.
Sec. 237. Reimbursement for federally qualified health centers providing
services under MA plans.
Sec. 238. Institute of Medicine evaluation and report on health care
Subtitle E--Comparative Cost Adjustment (CCA) Program
Sec. 241. Comparative Cost Adjustment (CCA) program.
TITLE III--COMBATTING WASTE, FRAUD, AND ABUSE
Sec. 301. Medicare secondary payor (MSP) provisions.
Sec. 302. Payment for durable medical equipment; competitive acquisition
of certain items and services.
Sec. 303. Payment reform for covered outpatient drugs and biologicals.
Sec. 304. Extension of application of payment reform for covered
outpatient drugs and biologicals to other physician
Sec. 305. Payment for inhalation drugs.
Sec. 306. Demonstration project for use of recovery audit contractors.
Sec. 307. Pilot program for national and State background checks on
direct patient access employees of long-term care facilities
TITLE IV--RURAL PROVISIONS
Subtitle A--Provisions Relating to Part A Only
Sec. 401. Equalizing urban and rural standardized payment amounts under
the medicare inpatient hospital prospective payment system.
Sec. 402. Enhanced disproportionate share hospital (DSH) treatment for
rural hospitals and urban hospitals with fewer than 100 beds.
Sec. 403. Adjustment to the medicare inpatient hospital prospective
payment system wage index to revise the labor-related share
of such index.
Sec. 404. More frequent update in weights used in hospital market
Sec. 405. Improvements to critical access hospital program.
Sec. 406. Medicare inpatient hospital payment adjustment for low-volume
Sec. 407. Treatment of missing cost reporting periods for sole community
Sec. 408. Recognition of attending nurse practitioners as attending
physicians to serve hospice patients.
Sec. 409. Rural hospice demonstration project.
Sec. 410. Exclusion of certain rural health clinic and federally
qualified health center services from the prospective payment
system for skilled nursing facilities.
Sec. 410A. Rural community hospital demonstration program.
Subtitle B--Provisions Relating to Part B Only
Sec. 411. Two-year extension of hold harmless provisions for small rural
hospitals and sole community hospitals under the prospective
payment system for hospital outpatient department services.
Sec. 412. Establishment of floor on work geographic adjustment.
Sec. 413. Medicare incentive payment program improvements for physician
[[Page 117 STAT. 2068]]
Sec. 414. Payment for rural and urban ambulance services.
Sec. 415. Providing appropriate coverage of rural air ambulance
Sec. 416. Treatment of certain clinical diagnostic laboratory tests
furnished to hospital outpatients in certain rural areas.
Sec. 417. Extension of telemedicine demonstration project.
Sec. 418. Report on demonstration project permitting skilled nursing
facilities to be originating telehealth sites; authority to
Subtitle C--Provisions Relating to Parts A and B
Sec. 421. One-year increase for home health services furnished in a
Sec. 422. Redistribution of unused resident positions.
Subtitle D--Other Provisions
Sec. 431. Providing safe harbor for certain collaborative efforts that
benefit medically underserved populations.
Sec. 432. Office of Rural Health Policy improvements.
Sec. 433. MedPAC study on rural hospital payment adjustments.
Sec. 434. Frontier extended stay clinic demonstration project.
TITLE V--PROVISIONS RELATING TO PART A
Subtitle A--Inpatient Hospital Services
Sec. 501. Revision of acute care hospital payment updates.
Sec. 502. Revision of the indirect medical education (IME) adjustment
Sec. 503. Recognition of new medical technologies under inpatient
hospital prospective payment system.
Sec. 504. Increase in Federal rate for hospitals in Puerto Rico.
Sec. 505. Wage index adjustment reclassification reform.
Sec. 506. Limitation on charges for inpatient hospital contract health
services provided to Indians by medicare participating
Sec. 507. Clarifications to certain exceptions to medicare limits on
Sec. 508. One-time appeals process for hospital wage index
Subtitle B--Other Provisions
Sec. 511. Payment for covered skilled nursing facility services.
Sec. 512. Coverage of hospice consultation services.
Sec. 513. Study on portable diagnostic ultrasound services for
beneficiaries in skilled nursing facilities.
TITLE VI--PROVISIONS RELATING TO PART B
Subtitle A--Provisions Relating to Physicians' Services
Sec. 601. Revision of updates for physicians' services.
Sec. 602. Treatment of physicians' services furnished in Alaska.
Sec. 603. Inclusion of podiatrists, dentists, and optometrists under
private contracting authority.
Sec. 604. GAO study on access to physicians' services.
Sec. 605. Collaborative demonstration-based review of physician practice
expense geographic adjustment data.
Sec. 606. MedPAC report on payment for physicians' services.
Subtitle B--Preventive Services
Sec. 611. Coverage of an initial preventive physical examination.
Sec. 612. Coverage of cardiovascular screening blood tests.
Sec. 613. Coverage of diabetes screening tests.
Sec. 614. Improved payment for certain mammography services.
Subtitle C--Other Provisions
Sec. 621. Hospital outpatient department (HOPD) payment reform.
Sec. 622. Limitation of application of functional equivalence standard.
Sec. 623. Payment for renal dialysis services.
Sec. 624. Two-year moratorium on therapy caps; provisions relating to
Sec. 625. Waiver of part B late enrollment penalty for certain military
retirees; special enrollment period.
Sec. 626. Payment for services furnished in ambulatory surgical centers.
Sec. 627. Payment for certain shoes and inserts under the fee schedule
for orthotics and prosthetics.
Sec. 628. Payment for clinical diagnostic laboratory tests.
Sec. 629. Indexing part B deductible to inflation.
[[Page 117 STAT. 2069]]
Sec. 630. Five-year authorization of reimbursement for all medicare part
B services furnished by certain Indian hospitals and clinics.
Subtitle D--Additional Demonstrations, Studies, and Other Provisions
Sec. 641. Demonstration project for coverage of certain prescription
drugs and biologicals.
Sec. 642. Extension of coverage of Intravenous Immune Globulin (IVIG)
for the treatment of primary immune deficiency diseases in
Sec. 643. MedPAC study of coverage of surgical first assisting services
of certified registered nurse first assistants.
Sec. 644. MedPAC study of payment for cardio-thoracic surgeons.
Sec. 645. Studies relating to vision impairments.
Sec. 646. Medicare health care quality demonstration programs.
Sec. 647. MedPAC study on direct access to physical therapy services.
Sec. 648. Demonstration project for consumer-directed chronic outpatient
Sec. 649. Medicare care management performance demonstration.
Sec. 650. GAO study and report on the propagation of concierge care.
Sec. 651. Demonstration of coverage of chiropractic services under
TITLE VII--PROVISIONS RELATING TO PARTS A AND B
Subtitle A--Home Health Services
Sec. 701. Update in home health services.
Sec. 702. Demonstration project to clarify the definition of homebound.
Sec. 703. Demonstration project for medical adult day care services.
Sec. 704. Temporary suspension of OASIS requirement for collection of
data on non-medicare and non-medicaid patients.
Sec. 705. MedPAC study on medicare margins of home health agencies.
Sec. 706. Coverage of religious nonmedical health care institution
services furnished in the home.
Subtitle B--Graduate Medical Education
Sec. 711. Extension of update limitation on high cost programs.
Sec. 712. Exception to initial residency period for geriatric residency
or fellowship programs.
Sec. 713. Treatment of volunteer supervision.
Subtitle C--Chronic Care Improvement
Sec. 721. Voluntary chronic care improvement under traditional fee-for-
Sec. 722. Medicare Advantage quality improvement programs.
Sec. 723. Chronically ill medicare beneficiary research, data,
Subtitle D--Other Provisions
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