Sec. 3061. Treatment of certain items and devices
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Section 1861(s)(2) of the Social Security Act ( 42 U.S.C. 1395x(s)(2) ) is amended— in subparagraph (EE), by striking and at the end; in subparagraph (FF), by inserting and at the end; and by adding at the end the following new subparagraph: a durable medical item that administers a drug described in section 1927(k)(2)(C) that would otherwise be self-administered multiple times per day and includes a disposable component and at least one component that can withstand repeated use, and supplies used in conjunction with such item (including the drug administered by such item); .
Section 1834 of the Social Security Act ( 42 U.S.C. 1395m ) is amended by adding at the end the following new subsection: The Secretary shall establish a payment methodology for a durable medical item described in section 1861(s)(2)(GG) and supplies used in conjunction with such item (other than a drug administered by such item) such that the estimated average total payment per individual for such items and supplies does not exceed the estimated average total payment per individual that would otherwise be made (taking into account the application of section 1847) for the durable medical equipment for which it is a substitute and for supplies used in conjunction with such equipment (other than such a drug) as determined appropriate by the Secretary. .
Section 1842(o)(1)(D) of the Social Security Act ( 42 U.S.C. 1395u(o)(1)(D) ) is amended— in clause (i), by inserting or drugs administered by a durable medical item covered under section 1861(s)(2)(GG) on or after January 1, 2017, after after January 1, 2004, ; and in clause (ii), by striking infusion . Section 1847(a)(2) of the Social Security Act ( 42 U.S.C. 1395w–3(a)(2) ) is amended by adding at the end the following new subparagraph: A durable medical item and supplies used in conjunction with such item, described in section 1861(s)(2)(GG). .
Section 1833(a)(1) of the Social Security Act ( 42 U.S.C. 1395l(a)(1) ) is amended— by striking and before
(Z); and by inserting before the semicolon at the end the following: , and
(AA)with respect to durable medical items described in section 1861(s)(2)(GG), the amount paid shall be equal to 80 percent of the lesser of the actual charge or the amount determined under section 1834(r) . The amendments made by this subsection shall apply to items furnished on or after January 1, 2017. Section 1834 of the Social Security Act ( 42 U.S.C. 1395m ), as amended by subsection (a)(2), is further amended by adding at the end the following new subsection: The Secretary shall make separate payment in the amount established under paragraph
(3)to a home health agency for a device described in paragraph
(2)when furnished to an individual who receives home health services for which payment is made under section 1895(b). For purposes of paragraph (1), a device described in this paragraph is a disposable device for which, as of January 1, 2015, there is— a Level I Healthcare Common Procedure Coding System (HCPCS) code for which the description for a professional service includes the furnishing of such device; and a separate Level I HCPCS code for a professional service that uses durable medical equipment instead of such device. The Secretary shall establish the separate payment amount for such a device such that such amount does not exceed the payment that would be made for the HCPCS code described in paragraph (2)(A) under section 1833(t) (relating to payment for covered OPD services). . Section 1861(m)(5) of the Social Security Act ( 42 U.S.C. 1395x(m)(5) ) is amended by inserting and devices described in section 1834(s)(2) after durable medical equipment . The amendments made by this subsection shall apply to devices furnished on or after January 1, 2017.
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- 42 USC 1395w–3(a)(2)
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Sec. 3061
Treatment of certain items and devices
Cite42 USC 1395w–3(a)(2)
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