How HR 3772 changes current law

Compared against current U.S. Code AI-generated reading aid — verify against the official bill.

The bill adds provisions for separate payment for certain diagnostic radiopharmaceuticals under Medicare.

• Section 1833(t)(16)

  (G) Separate payment for certain diagnostic radiopharmaceuticals.-- (i) In general.--Notwithstanding any other provision of this subsection, with respect to services furnished on or after January 1, 2020, the Secretary shall not package, and shall make a separate payment as specified in clause (ii) for, a diagnostic radiopharmaceutical defined in clause (v) with an estimated mean per day product cost equal to or exceeding the threshold specified in clause (iii). (ii) Separate payment.--For purposes of clause (i), payment specified in this clause for a diagnostic radiopharmaceutical described in clause (i) shall be equal to-- (I) the average sales price for the drug established under section 1847A, to the extent the average sales price is available, as calculated and adjusted by the Secretary to the extent such adjustment is adopted for other specified covered outpatient drugs under paragraph (14)(A); or (II) if the data necessary to calculate the average sales price for the drug in the year under the sections specified in subclause (I) is not available, the wholesale acquisition cost as defined in subsection 1847A(c)(6)(B), or, if the wholesale acquisition cost is not available, the mean unit cost data derived from hospital claims data. (III) Nothing in this subparagraph shall be construed as affecting eligibility of diagnostic radiopharmaceuticals for pass-through payments under paragraph (6). (iii) Threshold.--For purposes of this subparagraph, the threshold specified in this clause-- (I) for 2020, is $500; and (II) for subsequent years, is the amount specified in this clause for the preceding year increased by the percentage of the OPD fee schedule increase factor under paragraph (3)(C)(iv) for the applicable year. (iv) Budget neutrality.--The Secretary shall make such adjustments as are necessary under subparagraph 9(B) 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 subparagraph. (v) Definition.--For purposes of this subparagraph, a diagnostic radiopharmaceutical is a drug or biological that is described in section 315.2(a) of title 21, Code of Federal Regulations, or any successor regulation, and is approved by the Food and Drug Administration on or after January 1, 2008.

  This provision establishes new criteria for separate payments for certain diagnostic radiopharmaceuticals under Medicare, ensuring they are compensated independently based on cost thresholds.

• Section 1833(t)(8)(E)

  AND SEPARATE PAYMENTS FOR CERTAIN DIAGNOSTIC RADIOPHARMACEUTICALS

  This change updates the heading to reflect the addition of separate payments for diagnostic radiopharmaceuticals.

• Section 1833(t)

  and subparagraph (16)(G)

  This addition ensures that the provisions for separate payments for diagnostic radiopharmaceuticals are included in the relevant adjustments.