Provisions of Interest in the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003
SEC. 101 -- Access to Covered Part D Drugs --
Convenient Access in Long- Term Care Facilities
- Requires that the Secretary establish rules for
convenient access that may include standards with respect to enrollees who are
residing in long term care facilities.
- Establishes drug discount card and transitional
assistance program.
SEC. 101 - Eliminates Copay for Dual Eligibles in
an Institutional Setting
- While the legislation requires a copay for the
purchase of prescription drugs by Medicare/Medicaid dual eligibles, those
receiving services in an institutional setting are exempted.
SEC. 107 -- Review And Report On Current Standards
Of Practice For Pharmacy Services Provided To Patients In Nursing Facilities
- Provides that not later than 12 months after
the date of the enactment of this Act, the Secretary shall conduct a thorough
review of the current standards of practice for pharmacy services provided to
patients in nursing facilities; the report must include recommendations
regarding necessary actions and appropriate reimbursement to ensure the
provision of prescription drugs to Medicare beneficiaries residing in nursing
facilities in a manner consistent with existing patient safety and quality of
care standards under applicable state and federal laws.
SEC. 307 -- Pilot Program for National and State
Background Checks on Direct Patient Access Employees of Long Term Care
Facilities or Providers
- Requires the Secretary to establish a pilot
program to identify efficient, effective and economical procedures for long
term care facilities or providers to conduct background checks on prospective
direct patient access employees. The pilot would require prospective employees
to provide rolled fingerprints that would be run through the Integrated
Automated Fingerprint Identification System of the Federal Bureau of
Investigation.
- The pilot allows a provisional period of
employment contingent on the result of the check. At least one state
demonstration would not.
- States could waive certain requirements based
on rural and special-situation facilities.
- States may allow employment labor pool agencies
to conduct background checks on employees.
- States will be reimbursed the costs of
conducting the pilot program.
- No more than 10 states would be eligible for
the pilot and states with existing background check requirements would not be
excluded.
SEC. 418 -- Report on Demonstration Project
Permitting Skilled Nursing Facilities to be Originating Telehealth Sites;
Authority to Implement
- Requires the Secretary to conduct a
demonstration project where SNFs would be designated as a Telehealth
"originating sites." The Secretary is required to report on the demonstration
and is given the authority to expand Telehealth sites to include SNFs.
SEC. 511 -- Payment for Covered Skilled Nursing
Facility Services
- Requires payments for residents with AIDS to be
increased by 128% to reflect increased costs associated with such residents.
SEC. 513 -- Study on Portable Diagnostic
Ultrasound Services for Beneficiaries in Skilled Nursing Facilities
- Requires the Comptroller General of the United
States to conduct a study of ultrasound services furnished in SNFs. The study
will examine types of equipment and training, clinical appropriateness,
financial impact and credentialing requirements. The financial impact analysis
will include the appropriateness of making a separate payment for
transportation and technician services for residents in a Part A stay.
SEC. 624 -- 2-Year Moratorium on Therapy Caps;
Provisions Relating to Reports
- Requires a moratorium of caps imposed on
Medicare Part B therapy services for calendar years 2004 and 2005. Requires
the GAO to report to Congress no later than October 1, 2004, on conditions and
diseases under which a waiver from the caps would apply.
SEC. 735 -- Modifications to MedPAC
- Requires MedPAC to conduct a study and report
to Congress not later than June 1, 2004, on the need for current data, and
sources of current data available, to determine the solvency and financial
circumstances . . .of Medicare providers of services.
SEC. 925 -- Inclusion of Additional Benefits in
Notices to Beneficiaries about Skilled Nursing Facility Benefits
- With respect to Medicare beneficiary notices
provided for post-hospital services, the Secretary is required to include
information on the number of days of coverage of such services remaining and
spell of illness involved.
SEC. 926 -- Information on Medicare-Certified
Skilled Nursing Facilities in Hospital Discharge Plans
- The Secretary shall publicly provide
information that enables hospital discharge planners, Medicare beneficiaries,
and the public to identify SNFs that are participating in Medicare.
SEC. 932 -- Process for Expedited Access to Review
- The Secretary shall establish a process where a
provider may obtain access to judicial review when a review entity determines,
within 60 days of a complete written request, that it does not have the
authority to decide the question of law or regulation and where material facts
are not in dispute. The decision is subject to review by the Secretary. This
provision is effective for appeals filed on or after October 1, 2004.
- The Secretary shall establish a process to
expedite appeals of provider determinations including denial of payment for
new admissions, imposition of temporary management if imposed on an immediate
basis and where the facility has no opportunity to correct the deficiency. An
expedited appeal is also allowed where a finding of substandard quality of
care has resulted in the disapproval of a skilled nursing facility's nurse
aide training program.
- Requires the reduction of 50% the average time
for administrative determination on appeals. Authorizes the allocation of
additional funds for the purposes of increasing the number of administrative
law judges, staff, and the appellate level staff at the DAB and to educate
these judges and their staffs on long term care issues.
SEC. 932 -- Waiver of Disapproval of Nurse-Aide
Training Programs
- The Secretary may waive the termination of a
nurse aide training program if the imposition of the civil monetary penalty
triggering the termination is not related to the quality of care provided to
residents of the facility.
