To amend part B of title XVIII of the Social Security Act with respect to coverage of, and payment for, seat-lift chairs, and to prohibit suppliers of durable medical equipment from distributing forms for statements of medical necessity.

Amends part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act to reduce the Medicare payment basis for seat-lift chairs by 15 percent. Requires that payments for such chairs be made on an assignment-related basis.

Prohibits suppliers of durable medical equipment from distributing the forms required for showing the medical necessity of covered items.

 
B37 5-11-89 (OC's)
HR 2276 IH
101st CONGRESS
1st Session
 H. R. 2276
To amend part B of title XVIII of the Social Security Act with respect to
coverage of, and payment for, seat-lift chairs, and to prohibit suppliers
of durable medical equipment from distributing forms for statements of
medical necessity.
IN THE HOUSE OF REPRESENTATIVES
May 9, 1989
Mr. DONNELLY introduced the following bill; which was referred jointly to
the Committees on Ways and Means and Energy and Commerce
A BILL
To amend part B of title XVIII of the Social Security Act with respect to
coverage of, and payment for, seat-lift chairs, and to prohibit suppliers
of durable medical equipment from distributing forms for statements of
medical necessity.
  Be it enacted by the Senate and House of Representatives of the United
  States of America in Congress assembled,
SECTION 1. REDUCTION IN MEDICARE PAYMENT AND PROHIBITION AGAINST BALANCED
BILLING FOR SEAT-LIFT CHAIRS.
  (a) REDUCTION IN PAYMENT- Section 1834(a)(1) of the Social Security Act
  (42 U.S.C. 1395m(a)(1)) is amended by adding at the end the following
  new subparagraph:
  `(D) REDUCTION IN PAYMENTS FOR SEAT-LIFT CHAIRS- The Secretary shall
  reduce any payment basis otherwise recognized under this subsection for
  a seat-lift chair by 15 percent.'.
  (b) PAYMENT ON ASSIGNMENT-RELATED BASIS ONLY- Section 1834(a)(11) of such
  Act (42 U.S.C. 1395m(a)(11)) is amended by adding at the end the following
  new subparagraph:
  `(C) PAYMENT FOR SEAT-LIFT CHAIRS ON ASSIGNMENT-RELATED BASIS ONLY-
  `(i) IN GENERAL- Payment for a seat-lift chair under this subsection may
  only be made on an assignment-related basis. A supplier may not bill for
  a seat-lift chair other than on an assignment-related basis.
  `(ii) PENALTY- If a supplier knowingly and willfully bills for a seat-lift
  chair in violation of the second sentence of clause (i), the Secretary may
  apply sanctions against the supplier in the same manner as the Secretary
  may apply sanctions against a physician in accordance with paragraphs (2)
  and (3) of section 1842(j) in the same manner such paragraphs apply with
  respect to a physician.'.
  (c) EFFECTIVE DATE- The amendment made by subsections (a) and (b) shall
  apply with respect to seat-lift chairs furnished on or after October 1, 1989.
SEC. 2. PROHIBITION AGAINST DISTRIBUTION OF FORMS DOCUMENTING MEDICAL
NECESSITY BY EQUIPMENT SUPPLIERS.
  (a) IN GENERAL- Section 1834(a) of the Social Security Act (42
  U.S.C. 1395m(a)) is amended by adding at the end the following new paragraph:
  `(14) PROHIBITION AGAINST DISTRIBUTION OF FORMS BY SUPPLIERS-
  `(A) IN GENERAL- A supplier of a covered item under this subsection may
  not distribute any forms or other documents required by the Secretary to be
  submitted to show that a covered item is reasonable and necessary for the
  diagnosis or treatment of illness or injury or to improve the functioning
  of a malformed body member.
  `(B) PENALTY- Any supplier of a covered item who knowingly and willfully
  distributes a form or other document in violation of subparagraph (A)
  is subject to a civil money penalty in an amount not to exceed $1,000 for
  each such form or document distributed. The provisions of section 1128A
  (other than subsections (a) and (b)) shall apply to civil money penalties
  under this subparagraph in the same manner as they apply to a penalty or
  proceeding under section 1128A(a).'.
  (b) EFFECTIVE DATE- The amendment made by subsection (a) shall take effect
  October 1, 1989.