text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Beneficiary Access to Care Act of 
  2003''.
  
  SEC. 2. TREATMENT OF DRUGS AND BIOLOGICALS UNDER THE MEDICARE 
                OUTPATIENT HOSPITAL PROSPECTIVE PAYMENT SYSTEM.
  
      (a) Separate APCs for Most Drugs and Biologicals.--
              (1) In general.--Section 1833(t)(2) of the Social Security 
          Act (42 U.S.C. 1395l(t)(2)) is amended--
                      (A) by striking ``and'' at the end of subparagraph 
                  (F);
                      (B) by striking the period at the end of 
                  subparagraph (G) and inserting ``; and''; and
                      (C) by adding at the end the following:
                      ``(H) the Secretary shall treat as a separate group 
                  of covered OPD services--
                              ``(i) any drug or biological that was 
                          treated as such a group as of December 31, 
                          2002; and
                              ``(ii) any drug or biological that has 
                          ceased to be eligible for transitional, pass-
                          through payments under paragraph (6) by reason 
                          of the limited period of payment specified in 
                          paragraph (6)(C)(i).''.
              (2) Effective date.--The amendments made by paragraph (1) 
          shall apply to items and services furnished on or after January 
          1, 2004.
      (b) Payment Rates for Non-Pass-Through Drugs and Biologicals.--
              (1) Program payments.--Section 1833(t) of the Social 
          Security Act (42 U.S.C. 1395l(t)) is amended--
                      (A) in paragraph (3), by amending subparagraph (D) 
                  to read as follows:
                      ``(D) Calculation of medicare opd fee schedule 
                  amounts.--
                              ``(i) In general.--The Secretary shall 
                          compute a medicare OPD fee schedule amount for 
                          each covered OPD service (or group of such 
                          services) furnished in a year, in an amount 
                          that (except as provided in clause (ii)) is 
                          equal to the product of--
                                      ``(I) the conversion factor 
                                  computed under subparagraph (C) for the 
                                  year; and
                                      ``(II) the relative payment weight 
                                  (determined under paragraph (2)(C) or 
                                  paragraph (9)(A)) for the service or 
                                  group.
                              ``(ii) Special rules for 2004.--
                                      ``(I) In general.--Notwithstanding 
                                  clause (i), the medicare OPD fee 
                                  schedule amount for 2004 for a drug or 
                                  biological that is treated as a 
                                  separate group of covered OPD services 
                                  and is--
                                              ``(aa) a single-source drug 
                                          (as defined in section 
                                          1927(k)(7)(A)(iv));
                                              ``(bb) an innovator 
                                          multiple source drug (as 
                                          defined in section 
                                          1927(k)(7)(A)(ii)); or
                                              ``(cc) a biological product 
                                          approved for marketing under 
                                          section 351 of the Public 
                                          Health Service Act (including 
                                          any such product that is 
                                          marketed by any cross-licensed 
                                          producers or distributors),
                                  may not be less than 87.37 percent of 
                                  the payment rate for the drug or 
                                  biological under paragraph (6) as of 
                                  December 31, 2002 (determined without 
                                  regard to any reduction under 
                                  subparagraph (E)(iii) of such 
                                  paragraph).
                                      ``(II) No revision of relative 
                                  payment weights.--The relative payment 
                                  weights established under paragraph 
                                  (9)(A) for 2004 for groups of covered 
                                  OPD services other than those to which 
                                  subclause (I) applies shall not be 
                                  revised to take into account the 
                                  application of such subclause (I).'';
                      (B) in paragraph (4)--
                              (i) in subparagraph (A), by striking 
                          ``Secretary, as computed under paragraphs 
                          (2)(D) and (2)(E)'' and inserting ``Secretary 
                          (as computed under paragraphs (2)(D) and 
                          (2)(E)), except that the medicare OPD fee 
                          schedule amount determined under paragraph 
                          (3)(D) for a drug or biological that is treated 
                          as a separate group of covered OPD services 
                          shall not be adjusted for relative differences 
                          in the cost of labor''; and
                              (ii) in subparagraph (B), by striking 
                          ``adjusted''; and
                      (C) in paragraph (9), by adding at the end the 
                  following:
                      ``(D) Use of external data.--In determining the 
                  relative payment weight for any drug or biological that 
                  is treated as a separate group of covered OPD services 
                  for any year after 2003, the Secretary shall adjust the 
                  weight otherwise determined under this paragraph with 
                  respect to the drug or biological to the extent that 
                  reliable and valid data collected and submitted by 
                  entities and organizations other than the Department of 
                  Health and Human Services (including data submitted in 
                  public comments on the proposed rule promulgated with 
                  respect to the system established under this subsection 
                  for 2004) demonstrate that such payment weight is 
                  inadequate or inaccurate. In the case of any 
                  adjustments made pursuant to the preceding sentence for 
                  2004, the Secretary shall not revise the relative 
                  payment weights for other groups of covered OPD 
                  services for such year to take into account such 
                  adjustments, and the medicare OPD fee schedule amount 
                  determined under paragraph (3)(D) using a relative 
                  weight resulting from such an adjustment shall be 
                  subject to the minimum amount described in clause 
  (ii)(I) of such paragraph.''.
              (2) Copayments.--Section 1833(t)(8)(E) of the Social 
          Security Act (42 U.S.C. 1395l(t)(8)(E)) is amended--
                      (A) in the heading, by striking ``outlier and pass-
                  through'' and inserting ``certain''; and
                      (B) by striking ``paragraphs (5) and (6)'' and 
                  inserting ``paragraphs (3)(D)(ii), (5), and (6)''.
              (3) Exceptions to budget neutrality requirement.--Section 
          1833(t)(9)(B) of the Social Security Act (42 U.S.C. 
          1395l(t)(9)(B)) is amended by adding at the end the following: 
          ``In determining the budget neutrality adjustment required by 
          the preceding sentence, the Secretary shall not take into 
          account--
                              ``(i) any expenditures that would not have 
                          been made but for the application of clause 
                          (ii) of paragraph (3)(D); or
                              ``(ii) any expenditures made by reason of 
                          an adjustment required by subparagraph (D) for 
                          2004.''.
      (c) Study of Pharmacy Services Used To Provide Cancer Drug 
  Therapies in Hospital Outpatient Setting.--
              (1) In general.--The Comptroller General shall conduct a 
          study of payments under part B of title XVIII of the Social 
          Security Act for pharmacy service costs and related costs that 
          are incurred in acquiring chemotherapy and supportive care 
          drugs and providing these therapies to cancer patients in 
          hospital outpatient departments. The study shall--
                      (A) identify pharmacy costs, including the costs of 
                  storage, handling, processing, quality control, 
                  disposal, compliance with safety protocols and 
                  regulations, establishing dosage regimens that avoid 
                  drug interactions and contraindications, and pharmacy 
                  overhead;
                      (B) include a review of the adequacy of the current 
                  payment methodology for pharmacy service costs and 
                  related costs (including the adequacy of the 
                  methodology used to estimate costs); and
                      (C) identify any changes to that methodology that 
                  are necessary to ensure recognition of, and appropriate 
                  payment for, all of the services and functions inherent 
                  in the provision of cancer treatment in hospital 
                  outpatient settings.
              (2) Report to congress.--Not later than 12 months after the 
          date of enactment of this Act, the Comptroller General shall 
          submit to Congress a report on the results of the study under 
          paragraph (1), including any recommendations for legislation 
          that is necessary to implement the changes identified under 
          paragraph (1)(C).
target: Beneficiary Access to Care Act of 2003 - Amends title XVIII (Medicare) of the Social Security Act with respect to the prospective payment system for hospital outpatient department services (OPD) to: (1) require the Secretary of Health and Human Services to treat as a separate group of covered OPD services any drug or biological that was treated as such a group as of December 31, 2002, and any drug or biological that has ceased to be eligible for transitional, pass-through payments by reason of the limited period of payment specified; and (2) add special rules for 2004 for the calculation of Medicare OPD fee schedule amounts, among other payment-related changes.Directs the Comptroller General to study and report to Congress on pharmacy services used to provide cancer drug therapies in hospital outpatient setting.
feat_title: A bill to amend title XVIII of the Social Security Act to provide for special treatment for certain drugs and biologicals under the prospective payment system for hospital outpatient department services under the medicare program.