services and the incidental items, supplies, etc., are rendered by the physician, by a hospital, etc., or by both. D. OPTION TO RECEIVE PAYMENT ON BASIS OF COST INSTEAD OF CHARGES FOR PREPAYMENT ORGANIZATIONS TEXT On page 34, line 22, strike out "and" and insert in lieu except that an organization which provides medical and JUSTIFICATION The present bill provides for payment of the reasonable charges for physicians' services. However, under prepaid group practice plans, covered medical services are provided directly by the physicians associated with the plan to a member without charge other than the membership fee that the patient has paid to the plan. As an alternative to paying such a plan 80 percent of reasonable charges for covered services, the proposed change would permit payment of 80 percent of the reasonable cost of providing the covered services. E. PROVIDE STANDARDS FOR INDEPENDENT LABORATORIES PERFORMING DIAGNOSTIC TESTS UNDER THE SUPPLEMENTARY HEALTH INSURANCE PROGRAM TEXT On page 83, between lines 11 and 12, insert the following new sentence: No diagnostic tests performed in any laboratory which sory (A) if situated in any State in which State or applicable local law provides for licensing of establishments of this nature, (i) is licensed pursuant to such law, or (ii) is approved, by the agency of such State or locality responsible for licensing establishments of this nature, as meeting the standards established for such licensing; and (B) meets such other conditions relating to the health and safety of individuals with respect to whom such tests are performed as the Secretary may find necessary. On page 90, line 12, before the period, insert ", or whether a laboratory meets the requirements of subparagraphs (A) and (B) of section 1861 (s)". JUSTIFICATION Public health authorities have expressed concern about the effects of payment under the supplementary insurance program for diagnostic tests which are not performed in a hospital or in the attending physician's office. In recent years there has been a rapid growth of so-called free standing laboratories specializing in volume testing and mail order operations. Investigation by State health authorities. has produced evidence of unsanitary conditions, errors in tests, faulty records, and subcontracting of work on specimens. Some States have established requirements that these laboratories must meet in order to operate. The proposed change would support State efforts in this direction and would assure that the laboratories meet the same standards essential to the health and safety of beneficiaries as hospital laboratories. F. PROVIDE For the DEDUCTION FROM CSC ANNUITIES OF PREMIUMS UNDER THE SUPPLEMENTARY HEALTH INSURANCE BENEFITS PROGRAM TEXT On page 48, between lines 15 and 16, insert the following new subsection: (e) (1) In the case of an individual receiving an annuity under the Civil Service Retirement Act, or other Act administered by the Civil Service Commission providing retirement or survivorship protection, to whom neither subsection (a) nor subsection (b) applies, his monthly premiums under this part (and the monthly premiums of the spouse of such individual under this part if neither subsection (a) nor subsection (b) applies to such spouse and such individual agrees) shall, upon notice from the Secretary of Health, Education, and Welfare to the Civil Service Commission, be collected by deducting the amount thereof from each installment of such annuity. Such deduction shall be made in such manner and at such times as the Civil Service Commission may determine. The Civil Service Commission shall furnish such information as the Secretary of Health, Education, and Welfare may reasonably request in order to carry out his functions under this part with respect to individuals to whom this subsection applies. (2) The Secretary of the Treasury shall, from time to time, but not less often than quarterly, transfer from the Civil Service Retirement and Disability Fund, or the account (if any) applicable in the case of such other Act administered by the Civil Service Commission, to the Federal Supplementary Health Insurance Benefits Trust Fund the aggregate amount deducted under paragraph (1) for the period to which such transfer relates. Such transfer shall be made on the basis of a certification by the Civil Service Commission and shall be appropriately adjusted to the extent that prior transfers were too great or too small. 48-591-65 On page 48, lines 16 and 23, strike out "(e)" and insert in lieu thereof "(f)". On page 48, line 22, strike out "(f)" and insert in lieu thereof "(g)”. On page 49, line 1, strike out "(g)" and insert "(h)". On page 53, between lines 12 and 13, insert the following new subsection: (h) The Managing Trustee shall pay from time to time from the Trust Fund such amounts as the Secretary of Health, Education, and Welfare certifies are necessary to pay the costs incurred by the Civil Service Commission in making deductions pursuant to section 1840(e). During each fiscal year, or after the close of such fiscal year, the Civil Service Commission shall certify to the Secretary the amount of the costs it incurred in making such deductions and such certified amount shall be the basis for the amount of such costs certified by the Secretary to the Managing Trustee. JUSTIFICATION The amendment would facilitate the collection of premiums under the supplementary health insurance benefits plan. There are several hundred thousand civil service annuitants (and their spouses) who are 65 years or older and who are not insured under the social security or railroad retirement systems. As the bill is now drafted, individual premium collection machinery would have to apply to such individuals. It would be much simpler and more economical if the premiums were deducted automatically from the annuities of civil service annuitants and their spouses each month just as social security and railroad retirement beneficiaries would have the premiums deducted from their monthly cash benefits. The effect of the recommended change is that if a civil service annuitant enrolled under the supplementary health insurance benefits plan his premium amount would be withheld from the monthly installment of his annuity. If the spouse of a civil service annuitant enrolled under the supplementary plan, the premium would be withheld from her husband's annuity if he agreed to it. There is provision for reimbursing the Civil Service Commission for the amounts it would cost them to make the necessary withholdings. G. "PHYSICIAN" LIMITED TO DOCTORS OF MEDICINE OR OSTEOPATHY TEXT On page 82, lines 5 and 6, strike out "an individual" and insert in lieu thereof "a doctor of medicine or osteopathy". JUSTIFICATION The change is needed to make it clear that the term "physician" includes doctors of medicine and doctors of osteopathy but not other practitioners who, under the laws of some States, may be licensed to Practice medicine and surgery. IV. OASDI A. PROVISION TO AUTHORIZE THE FEDERAL COURTS TO PRESCRIBE THE FEES THAT ATTORNEYS MAY CHARGE THEIR CLIENTS FOR REPRESENTING THEM IN COURT CASES ARISING UNDER THE SOCIAL SECURITY PROGRAM TEXT On page 266, between lines 22 and 23, insert the following new section: DETERMINATION OF ATTORNEYS' FEES IN COURT PROCEEDINGS SEC. The heading of section 206 of the Social Security "(b)(1) Whenever a court renders a judgment favorable to a claimant, who was represented before the court by an attorney, the court may determine and allow as part of its judgment a reasonable fee for such representation, not in excess of 25 percent of the total of the past due benefits to which the claimant is entitled by reason of such judgment, and the Secretary may, notwithstanding the provisions of section 205(i), certify the amount of such fee for payment to such attorney out of, and not in addition to, the amount of such pastdue benefits. In case of any such judgment, no other fee may be payable or certified for payment for such representation except as provided in this paragraph. "(2) Any attorney who charges, demands, receives or collects for services rendered in connection with proceedings before a court to which paragraph (1) is applicable any amount in excess of that allowed by the court thereunder shall be guilty of a misdemeanor and upon conviction thereof shall be subject to a fine of not more than $500, or imprisonment for not more than one year, or both." JUSTIFICATION This amendment is designed to alleviate two problems that have arisen with respect to representation of claimants by attorneys. The first relates to the need to encourage effective legal representation of claimants. Under the provisions of section 205(i) of the Social Security Act, accrued amounts of benefits that are due to a claimant as a result of a court decision are to be paid directly to him. Under section 207, assignment of benefits is prohibited. Attorneys have complained that such awards are sometimes made to the claimant without the attorney's knowledge and that some claimants on occasion have not notified the attorney of the receipt of the money, nor have they paid his fee. Another problem that has arisen is that attorneys have on occasion charged what appeared to be inordinately large fees for representing claimants in Federal district court actions arising under the social security program. Usually, these inordinately large fees result from a contingent-fee arrangement under which the attorney is entitled to a percentage (frequently one-third to one-half) of the accrued benefits. Since litigation necessarily involves a considerable lapse of time, in many cases large amounts of accrued benefits, and consequently large legal fees, may be payable if the claimant wins his case. The amendment would provide that whenever a court renders a judgment favorable to a claimant, it would have express authority to allow as part of its judgment a reasonable fee (not in excess of 25 percent of accrued benefits) for services rendered in connection with the claim. Any violation would be made subject to the same penalties as are provided in section 206 of the law for charging more than the maximum fees prescribed in regulations (20 CFR 404.975) for services rendered in proceedings before the Secretary. In addition, as a specific exception to section 205(i), the Secretary would be permitted to certify the amount of the court-approved fee to the attorney out of the amount of accrued benefits. As a result, claimants would be insured more effective legal representation and also would be protected from being charged exorbitant fees. B. PROVISION TO SIMPLIFY PAYMENT OF WIFE'S, WIDOW'S, OR MOTHER'S BENEFITS TO DIVORCED WOMEN TEXT On page 205, lines 6 and 7, and page 208, line 16, strike out "has not remarried" and insert in lieu thereof "is not married". On page 207, strike out lines 5 through 20, and on line 21, strike out "(4)" and insert in in lieu thereof "(3)”. On page 210, strike out lines 14 through 25. On page 211, strike out lines 1 through 14, and insert in lieu thereof: (2) Paragraph (3) of section 202(e) of such Act is repealed. (3) Section 202(e) of such Act is amended by redesignating paragraph (4) as paragraph (3) and such paragraph is further amended by striking out "widow" and inserting in lieu thereof "widow or surviving divorced wife" and by striking out "widow's" and inserting in lieu thereof "widow's or surviving divorced wife's". On page 212, line 23, strike out "(3)" and insert in lieu thereof "(4)". On page 212, between lines 22 and 23, insert the following: (3) Subparagraph (A) of section 202(g) (1) of such Act is amended by striking out "has not remarried" and inserting in lieu thereof "is not married". On page 213, strike out lines 21 through 25, and page 214, strike out lines 1 through 14. On page 215, after line 25, insert: (12) Paragraph (3) of section 202(g) of such Act is repealed. (13) Section 202 (g) of such Act is amended by redesignating paragraph (4) as paragraph (3). |