Page:United States Statutes at Large Volume 108 Part 5.djvu/933

 - jT ^' -^ PUBLIC LAW 103-432—OCT. 31, 1994 108 STAT. 4423 update a list of suppliers of items for which payment may be made under this subsection with respect to whom— "(i) the Secretary has found that a substantial number of claims for payment under this part for items furnished by the supplier have been denied on the basis of the appHcation of section 1862(a)(1); or "(ii) the Secretary has identified a pattern of overutilization resulting fix)m the business practice of the supplier. " (C) DETERMINATIONS OF COVERAGE IN ADVANCE. —A carrier shall determine in advance of delivery of an item whether payment for the item may not be made because the item is not covered or because of the appHcation of section 1862(a)(1) if— "(i) the item is included on the Ust developed by the Secretary under subparagraph (A); "(ii) the item is furnished by a suppher included on the Hst developed by the Secretary tmder subparagraph (B); or "(iii) the item is a customized item (other than inexpensive items specified by the Secretary) and the patient to whom the item is to be fiimished or the suppher requests that such advance determination be made.". (2) Effective for standsirds applied for contract years beginning after the date of the enactment of this Act, section 1842(c) (42 U.S.C. 1395u(c)), as amended by section 125(a), is amended by adding at the end the following new paragraph: "(5) Each contract under this section which provides for the disbursement of funds, as described in subsection (a)(1)(B), shall require the carrier to meet criteria developed by the Secretary to measure the timeliness of carrier responses to requests for pay- ment of items described in section 1834(a)(15)(C).". (3) Effective on the date of the enactment of this Act, section Effective date. 1834(h)(3) (42 U.S.C. 1395m(h)(3)), as amended by section 133(b), is amended by striking "(12) and (17)" and inserting "(12), (15), and (17)". (c) STUDY OF VARIATIONS IN DURABLE MEDICAL EQUIPMENT SuppuER COSTS. — (1) COLLECTION AND ANALYSIS OF SUPPLIER COST DATA. — The Administrator of the Health Care Financing Administra- - tion shall, in consultation with appropriate organizations, collect data on supplier costs of diu^ble medical equipment for which payment may be made under part B of me medicare program, and shall analyze such data to determine the proportions of such costs attributable to the service and product components of fiunishing such equipment and the extent to which such proportions vary by type of equipment and by the geographic region in which the supplier is located. (2) DEVELOPMENT OF GEOGRAPHIC ADJUSTMENT INDEX; REPORTS.—Not later than July 1, 1995— (A) the Admioistrator shall submit a report to the Committees on Enei^ and Conunerce and Ways and Means of the House of Representatives and the Committee on Finance of the Senate on the data collected and the smalysis conducted under paragraph (1), and shall include in such report the Administrator's recommendations for

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