,i  #aafth ,,congress  #ast ,session    
,h4 ,r4 #cggb  ,,in ,,the ,,house ,,of  
,,representatives  ,july #af1 #bjai ,mr4
 ,peters 7for himself1 ,mr4 ,rush1 and  
,mr4 ,holding7 introduced the following 
bill2 which was referred to the         
,committee on ,energy and ,commerce1 and
 in addition to the ,committee on ,ways 
and ,means1 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 ensure    
equitable payment for1 and preserve     
,medicare beneficiary access to1        
diagnostic radiopharmaceuticals under   
the ,medicare hospital outpatient       
prospective payment system4  #a4 ,short 
title ,this ,act may be cited as the    
,medicare ,diagnostic                   
,radiopharmaceutical ,payment ,equity   
,act of #bjai4  #b4 ,separate payment   
for certain diagnostic                  

radiopharmaceuticals  7a7 ,in general   
,section #ahcc7t77#af7 of the ,social   
,security ,act 7#db ,u4,s4,c4           
#aciel7t77#af77 is amended by adding at 
the end the following new subparagraph3 
7,g7 ,separate payment for certain      
diagnostic radiopharmaceuticals  7i7 ,in
 general ,notwithstanding any other     
provision of this subsection1 with      
respect to services furnished on or     
after ,january #a1 #bjbj1 the ,secretary
 shall not package1 and shall make a    
separate payment as specified in clause 
7ii7 for1 a diagnostic                  
radiopharmaceutical defined in clause   
7v7 with an estimated mean per day      
product cost equal to or exceeding the  
threshold specified in clause 7iii74    
7ii7 ,separate payment ,for purposes of 
clause 7i71 payment specified in this   
clause for a diagnostic                 
radiopharmaceutical described in clause 
7i7 shall be equal to--  7,i7 the       
average sales price for the drug        
established under section #ahdg;,a1 to  

the extent the average sales price is   
available1 as calculated and adjusted by
 the ,secretary to the extent such      
adjustment is adopted for other         
specified covered outpatient drugs under
 paragraph 7#ad77;,a72 or  7,,ii7 if the
 data necessary to calculate the average
 sales price for the drug in the year   
under the sections specified in         
subclause 7,i7 is not available1 the    
wholesale acquisition cost as defined in
 subsection #ahdg;,a7c77#f77;,b71 or1 if
 the wholesale acquisition cost is not  
available1 the mean unit cost data      
derived from hospital claims data4      
7,,iii7 ,nothing in this subparagraph   
shall be construed as affecting         
eligibility of diagnostic               
radiopharmaceuticals for pass-through   
payments under paragraph 7#f74  7iii7   
,threshold ,for purposes of this        
subparagraph1 the threshold specified in
 this clause--  7,i7 for #bjbj1 is #ejj2
 and  7,,ii7 for subsequent years1 is   
the amount specified in this clause for 

the preceding year increased by the     
percentage of the ,,opd fee schedule    
increase factor under paragraph         
7#c77;,c77iv7 for the applicable year4  
7iv7 ,budget neutrality ,the ,secretary 
shall make such adjustments as are      
necessary under subparagraph #i7;,b7 to 
ensure that the amount of expenditures  
under this subsection for such year with
 application of this subparagraph is    
equal to the amount of expenditures that
 would be made under this subsection for
 such year without application of this  
subparagraph4  7v7 ,definition ,for     
purposes of this subparagraph1 a        
diagnostic radiopharmaceutical is a drug
 or biological that is described in     
section #cae4b7;a7 of title #ba1 ,code  
of ,federal ,regulations1 or any        
successor regulation1 and is approved by
 the ,food and ,drug ,administration on 
or after ,january #a1 #bjjh4  4  7b7 ,no
 impact on copayment ,section #ahcc7t7  
of the ,social ,security ,act 7#db      
,u4,s4,c4 #aciel7t77#h77;,e77 is amended

 by-- 7#a7 inserting ,,and ,,separate   
,,payments ,,for ,,certain ,,diagnostic 
,,radiopharmaceuticals after            
,,pass-,,through ,,adjustments2 and     
7#b7 inserting after such adjustments7  
the phrase and subparagraph 7#af77;,g74