,i  #aaeth ,,congress  #ast ,session    
,h4 ,r4 #dfgi  ,,in ,,the ,,house ,,of  
,,representatives  ,december #ah1       
#bjag,mr4 ,reed 7for himself and ,mr4   
,reichert7 introduced the following     
bill2 which was referred to the         
,committee on ,ways and ,means1 and in  
addition to the ,committee on ,energy   
and ,commerce1 for a period to be       
subsequently determined by the ,speaker1
 in each case for consideration of such 
provisions as fall within the           
jurisdiction of the committee concerned 
,a ,,bill  ,to amend title ,,xviii of   
the ,social ,security ,act to provide   
for improvements to coverage and payment
 under the ,medicare program for new    
drugs1 devices1 and technology4  #a4    
,short title ,this ,act may be cited as 
the ,ensuring ,equal ,access to         
,treatments ,act of #bjag4  #b4         
,coverage and payment for new drugs1    
devices1 and technology under the       
,medicare program  7a7 ,improvements to 
,,ntap payment adjustment under the     

inpatient prospective payment system    
7#a7 ,payment for costs of new          
technologies ,with respect to hospital  
discharges occurring on or after        
,october #a1 #bjah1 for which payment is
 made under section #ahhf7;d7 of the    
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7d771 in calculating the amount  
of the additional payment for a new     
medical service or technology under     
paragraph 7#e77,k7 of such section with 
respect to such a discharge1 the        
,secretary of ,health and ,human        
,services shall apply section #dab4hh of
 title #db1 ,code of ,federal           
,regulations--  7,a7 as if the reference
 to #ej percent each place it appears in
 such section were a reference to #ge   
percent2 and  7,b7 as if paragraph 7b7  
of such section did not include ,unless 
a discharge case qualifies for outlier  
payment under  #dab4hd44  7#b7 ,revision
 to the cost threshold ,section         
#ahhf7;d77#e77,k7 of the ,social        
,security ,act 7#db ,u4,s4,c4           

#acieww7d77#e77,k77 is amended-- 7,a7 in
 clause 7ii7--  7i7 in subclause 7,i71  
by striking #ge percent each place it   
appears and inserting #ej percent2 and  
7ii7 in subclause 7,,ii71 by striking   
not less than two years and not more    
than three years and inserting five     
years2 and  7,b7 in clause 7iii71 by    
striking ,international ,classification 
of ,diseases1 #ith ,revision1 ,clinical 
,modification 7#8#8,,icd-#i-;,,cm''7 and
 inserting ,international               
,classification of ,diseases1 #ajth     
,revision1 ,clinical ,modification      
7#8#8,,icd-#aj-;,,cm''74  7#c7 ,revision
 to the commencement of the period for  
collection of cost data for new         
technologies ,section                   
#ahhf7;d77#e77,k77ii77,,ii7 of the      
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7d77#e77,k77ii77,,ii77 is amended
 by inserting the later of the date that
 is the date of the clearance or        
approval by the ,commissioner of ,food  
and ,drugs of the service or technology 

or after beginning on4  7#d7 ,permitting
 appeals of ntap determinations  7,a7   
,in general ,section #ahhf7;d77#e77,k7  
of the ,social ,security ,act 7#db      
,u4,s4,c4 #acieww7d77#e77,k77 is amended
 by adding at the end the following new 
clause3  7x7  7,i7 ,an individual or    
entity that submits an application for  
additional payment under this           
subparagraph for a new technology shall 
be entitled to administrative review of 
an adverse determination by the         
,secretary with respect to such         
application4  7,,ii7 ,the ,secretary    
shall establish a process for           
administrative review for purposes of   
subclause 7,i74 ,under such process1    
administrative review shall be conducted
 by the ,departmental ,appeals ,board of
 the ,department of ,health and ,human  
,services4 ,under such process1 the     
,departmental ,appeals ,board shall     
complete administrative review within   
#ij days of the date of receipt of the  
request for such review4  4  7,b7       

,conforming amendment ,section          
#ahhf7;d77#g77;,b7 of such ,act 7#db    
,u4,s4,c4 #acieww7d77#g77;,b77 is       
amended by inserting but not including a
 denial by the ,secretary of an         
application for additional payment under
 paragraph 7#e77,k7 after paragraph     
7#d77;,d74  7#e7 ,requiring new ,,drg   
codes for new technologies coming off of
 new technology add-on ,section         
#ahhf7;d77#e77,k77ii77,,iv7 of such ,act
 7#db ,u4,s4,c4                         
#acieww7d77#e77,k77ii77,,iv77 is amended
 by striking or existing4  7#f7 ,limit  
on aggregate annual adjustment ,section 
#ahhf7;d77#e7 of such ,act 7#db         
,u4,s4,c4 #acieww7d77#e77 is amended by 
adding at the end the following new     
subparagraph3  7,m7 ,limit on aggregate 
annual adjustment  7i7 ,in general ,the 
total of the additional payments made   
under subparagraphs 7,k7 and 7,l7 for   
covered services furnished for          
discharges in a fiscal year 7as         
estimated by the ,secretary before the  

beginning of the fiscal year7 may not   
exceed the applicable percentage        
7specified in clause 7ii77 of the total 
program payments estimated to be made   
under this subsection for all covered   
services furnished for discharges in    
that fiscal year4 ,if this clause is    
first applied to less than a full fiscal
 year1 the previous sentence shall apply
 only to the portion of such fiscal     
year4  7ii7 ,applicable percentage ,for 
purposes of clause 7i71 the term        
#8applicable percentage' for fiscal year
 #bjai and each subsequent fiscal year1 
is a percentage specified by the        
,secretary up to 7but not to exceed7    
#b4j percent4  7iii7 ,uniform           
prospective reduction if aggregate limit
 projected to be exceeded ,if the       
,secretary estimates before the         
beginning of a fiscal year that the     
amount of the additional payments under 
subparagraphs 7,k7 and 7,l7 for the     
fiscal year 7or portion thereof7 as     
determined under clause 7i7 without     

regard to this clause will exceed the   
limit established under such clause 7i71
 the ,secretary shall reduce pro rata   
the amount of each of the additional    
payments under this paragraph for that  
fiscal year 7or portion thereof7 in     
order to ensure that the aggregate      
additional payments under subparagraphs 
7,k7 and 7,l7 7as so estimated7 do not  
exceed such limit4  4  7#g7 ,effective  
date ,the amendments made by paragraphs 
7#b71 7#c71 7#d71 7#e71 and 7#f7 shall  
take effect on the date of the enactment
 of this ,act and shall apply with      
respect to hospital discharges occurring
 on or after ,october #a1 #bjah1 for    
inpatient hospital services for which   
payment is made under section #ahhf7;d7 
of the ,social ,security ,act 7#db      
,u4,s4,c4 #acieww74  7b7 ,improvements  
to payment adjustment under the         
,medicare outpatient prospective payment
 system for certain drugs and devices   
eligible or previously eligible for     
pass-,through  7#a7 ,requiring separate 

ambulatory payment classification for   
certain drugs and devices previously    
eligible for pass-through payments      
,section #ahcc7t7 of the ,social        
,security ,act 7#db ,u4,s4,c4 #aciel7t77
 is amended-- 7,a7 in paragraph 7#b7--  
7i7 in subparagraph 7,g71 by striking   
and at the end2  7ii7 in subparagraph   
7,h71 by striking the period at the end 
and inserting 2 and2 and  7iii7 by      
adding at the end the following new     
subparagraph3  7,i7 the ,secretary shall
 create additional groups of covered    
,,opd services that classify separately 
procedures and services that employ     
medical devices and drugs described in a
 subparagraph of paragraph 7#bb71 in    
accordance with such paragraph4  2 and  
7,b7 by adding at the end the following 
new paragraph3  7#bb7 ,separate         
additional payment groups for certain   
drugs and devices previously eligible   
for pass-through payments ,for purposes 
of paragraph 7#b77;,i71 the following   
shall apply3  7,a7 ,in general ,for     

payments under this subsection for      
services furnished on or after ,january 
#a1 #bjbj1 the ,secretary shall1 in     
accordance with subparagraph 7,b71      
create additional groups of covered     
,,opd services to classify separately   
from other covered ,,opd services the   
following3  7i7 ,existing pass-through  
drugs and devices ,medical devices and  
drugs that met the requirements of      
paragraph 7#f77;,a77iv7 and were        
receiving payment under paragraph 7#f7  
by reason of satisfying such            
requirements beginning on or after the  
date of enactment of this paragraph4    
7ii7 ,retired pass-through drugs and    
devices ,medical devices and drugs that 
had met the requirements of paragraph   
7#f77;,a77iv7 and were receiving payment
 under paragraph 7#f7 by reason of      
satisfying such requirements before the 
date of enactment of this paragraph but 
after ,january #a1 #bjaj4  7,b7         
,considerations ,in carrying out        
subparagraph 7,a71 the ,secretary       

shall-- 7i7 bundle procedures and       
services that employ a device to which  
such subparagraph applies with all      
relevant diagnostic tests and surgical  
procedures1 as applicable2  7ii7 bundle 
procedures and services that employ a   
drug1 with respect to which payment is  
not made on or after the date specified 
in subparagraph 7,a7 in accordance with 
the methodology under section #ahdg;,a  
and to which such subparagraph applies1 
with all relevant diagnostic tests and  
surgical procedures1 as applicable2 and 
7iii7 include such relevant diagnostic  
tests and surgical procedures in more   
than one group created under such       
subparagraph1 as necessary4  4  7#b7    
,revision to pass-through period under  
,,opps ,section #ahcc7t77#f7 of the     
,social ,security ,act 7#db ,u4,s4,c4   
#aciel7t77#f77 is amended-- 7,a7 in     
subparagraph 7,b77iii71 by striking at  
least #b years1 but not more than #c    
years and inserting #e years2 and  7,b7 
in subparagraph 7,c77i71 by striking at 

least #b years1 but not more than #c    
years and inserting #e years4  7#c7     
,appeals process ,section #ahcc7t77#f7  
of the ,social ,security ,act 7#db      
,u4,s4,c4 #aciel7t77#f77 is amended by  
adding at the end the following new     
subparagraph3  7,f7 ,appeals process    
7i7 ,in general ,an individual or entity
 that submits an application for        
additional payment under this paragraph 
for a new technology shall be entitled  
to administrative review of an adverse  
determination by the ,secretary with    
respect to such application4  7ii7      
,process ,the ,secretary shall establish
 a process for administrative review for
 purposes of clause 7i74 ,under such    
process1 administrative review shall be 
conducted by the ,departmental ,appeals 
,board of the ,department of ,health and
 ,human ,services4 ,under such process1 
the ,department official involved shall 
complete administrative review within   
#ij days of receipt of a request for    
such review4  4  7#d7 ,effective date   

,the amendments made by paragraphs 7#b7 
and 7#c7 shall take effect on the date  
of enactment of this ,act and shall     
apply with respect to items and services
 furnished on or after ,january #a1     
#bjbj4