[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 2425 Enrolled Bill (ENR)]
S.2425
One Hundred Fourteenth Congress
of the
United States of America
AT THE FIRST SESSION
Begun and held at the City of Washington on Tuesday,
the sixth day of January, two thousand and fifteen
An Act
To amend titles XVIII and XIX of the Social Security Act to improve
payments for complex rehabilitation technology and certain radiation
therapy services, to ensure flexibility in applying the hardship
exception for meaningful use for the 2015 EHR reporting period for 2017
payment adjustments, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Patient Access and Medicare
Protection Act''.
SEC. 2. NON-APPLICATION OF MEDICARE FEE SCHEDULE ADJUSTMENTS FOR
WHEELCHAIR ACCESSORIES AND SEAT AND BACK CUSHIONS WHEN FURNISHED IN
CONNECTION WITH COMPLEX REHABILITATIVE POWER WHEELCHAIRS.
(a) Non-application.--
(1) In general.--Notwithstanding any other provision of law,
the Secretary of Health and Human Services shall not, prior to
January 1, 2017, use information on the payment determined under
the competitive acquisition programs under section 1847 of the
Social Security Act (42 U.S.C. 1395w-3) to adjust the payment
amount that would otherwise be recognized under section
1834(a)(1)(B)(ii) of such Act (42 U.S.C. 1395m(a)(1)(B)(ii)) for
wheelchair accessories (including seating systems) and seat and
back cushions when furnished in connection with Group 3 complex
rehabilitative power wheelchairs.
(2) Implementation.--Notwithstanding any other provision of
law, the Secretary may implement this subsection by program
instruction or otherwise.
(b) GAO Study and Report.--
(1) Study.--
(A) In general.--The Comptroller General of the United
States shall conduct a study on wheelchair accessories
(including seating systems) and seat and back cushions
furnished in connection with Group 3 complex rehabilitative
power wheelchairs. Such study shall include an analysis of the
following with respect to such wheelchair accessories and seat
and back cushions in each of the groups described in clauses
(i) through (iii) of subparagraph (B):
(i) The item descriptions and associated HCPCS codes
for such wheelchair accessories and seat and back cushions.
(ii) A breakdown of utilization and expenditures for
such wheelchair accessories and seat and back cushions
under title XVIII of the Social Security Act.
(iii) A comparison of the payment amount under the
competitive acquisition program under section 1847 of such
Act (42 U.S.C. 1395w-3) with the payment amount that would
otherwise be recognized under section 1834 of such Act (42
U.S.C. 1395m), including beneficiary cost sharing, for such
wheelchair accessories and seat and back cushions.
(iv) The aggregate distribution of such wheelchair
accessories and seat and back cushions furnished under such
title XVIII within each of the groups described in
subparagraph (B).
(v) Other areas determined appropriate by the
Comptroller General.
(B) Groups described.--The following groups are described
in this subparagraph:
(i) Wheelchair accessories and seat and back cushions
furnished predominantly with Group 3 complex rehabilitative
power wheelchairs.
(ii) Wheelchair accessories and seat and back cushions
furnished predominantly with power wheelchairs that are not
described in clause (i).
(iii) Other wheelchair accessories and seat and back
cushions furnished with either power wheelchairs described
in clause (i) or (ii).
(2) Report.--Not later than June 1, 2016, the Comptroller
General of the United States shall submit to Congress a report
containing the results of the study conducted under paragraph (1),
together with recommendations for such legislation and
administrative as the Comptroller General determines to be
appropriate.
SEC. 3. TRANSITIONAL PAYMENT RULES FOR CERTAIN RADIATION THERAPY
SERVICES UNDER THE MEDICARE PHYSICIAN FEE SCHEDULE.
(a) In General.--Section 1848 of the Social Security Act (42 U.S.C.
1395w-4) is amended--
(1) in subsection (b), by adding at the end the following new
paragraph:
``(11) Special rule for certain radiation therapy services.--
The code definitions, the work relative value units under
subsection (c)(2)(C)(i), and the direct inputs for the practice
expense relative value units under subsection (c)(2)(C)(ii) for
radiation treatment delivery and related imaging services
(identified in 2016 by HCPCS G-codes G6001 through G6015) for the
fee schedule established under this subsection for services
furnished in 2017 and 2018 shall be the same as such definitions,
units, and inputs for such services for the fee schedule
established for services furnished in 2016.''; and
(2) in subsection (c)(2)(K), by adding at the end the following
new clause:
``(iv) Treatment of certain radiation therapy
services.--Radiation treatment delivery and related imaging
services identified under subsection (b)(11) shall not be
considered as potentially misvalued services for purposes
of this subparagraph and subparagraph (O) for 2017 and
2018.''.
(b) Report to Congress on Alternative Payment Model.--Not later
than 18 months after the date of the enactment of this Act, the
Secretary of Health and Human Services shall submit to Congress a
report on the development of an episodic alternative payment model for
payment under the Medicare program under title XVIII of the Social
Security Act for radiation therapy services furnished in nonfacility
settings.
SEC. 4. ENSURING FLEXIBILITY IN APPLYING HARDSHIP EXCEPTION FOR
MEANINGFUL USE FOR 2015 EHR REPORTING PERIOD FOR 2017 PAYMENT
ADJUSTMENTS.
(a) Eligible Professionals.--Section 1848(a)(7)(B) of the Social
Security Act (42 U.S.C. 1395w-4(a)(7)(B)) is amended, in the first
sentence, by inserting ``(and, with respect to the payment adjustment
under subparagraph (A) for 2017, for categories of eligible
professionals, as established by the Secretary and posted on the
Internet website of the Centers for Medicare & Medicaid Services prior
to December 15, 2015, an application for which must be submitted to the
Secretary by not later than March 15, 2016)'' after ``case-by-case
basis''.
(b) Eligible Hospitals.--Section 1886(b)(3)(B)(ix) of the Social
Security Act (42 U.S.C. 1395ww(b)(3)(B)(ix)) is amended--
(1) in the first sentence of subclause (I), by striking
``(n)(6)(A)'' and inserting ``(n)(6)''; and
(2) in subclause (II), in the first sentence, by inserting
``(and, with respect to the application of subclause (I) for fiscal
year 2017, for categories of subsection (d) hospitals, as
established by the Secretary and posted on the Internet website of
the Centers for Medicare & Medicaid Services prior to December 15,
2015, an application for which must be submitted to the Secretary
by not later than April 1, 2016)'' after ``case-by-case basis''.
(c) Implementation.--Notwithstanding any other provision of law,
the Secretary of Health and Human Services shall implement the
provisions of, and the amendments made by, subsections (a) and (b) by
program instruction, such as through information on the Internet
website of the Centers for Medicare & Medicaid Services.
SEC. 5. MEDICARE IMPROVEMENT FUND.
Section 1898(b)(1) of the Social Security Act (42 U.S.C.
1395iii(b)(1)) is amended by striking ``$5,000,000'' and inserting
``$0''.
SEC. 6. STRENGTHENING MEDICAID PROGRAM INTEGRITY THROUGH FLEXIBILITY.
Section 1936 of the Social Security Act (42 U.S.C. 1396u-6) is
amended--
(1) in subsection (a), by inserting ``, or otherwise,'' after
``entities''; and
(2) in subsection (e)--
(A) in paragraph (1), in the matter preceding subparagraph
(A), by inserting ``(including the costs of equipment, salaries
and benefits, and travel and training)'' after ``Program under
this section''; and
(B) in paragraph (3), by striking ``by 100'' and inserting
``by 100, or such number as determined necessary by the
Secretary to carry out the Program,''.
SEC. 7. ESTABLISHING MEDICARE ADMINISTRATIVE CONTRACTOR ERROR REDUCTION
INCENTIVES.
(a) In General.--Section 1874A(b)(1)(D) of the Social Security Act
(42 U.S.C. 1395kk-1(b)(1)(D)) is amended--
(1) by striking ``quality.--The Secretary'' and inserting
``quality.--
``(i) In general.--Subject to clauses (ii) and (iii),
the Secretary''; and
(2) by inserting after clause (i), as added by paragraph (1),
the following new clauses:
``(ii) Improper payment rate reduction incentives.--The
Secretary shall provide incentives for medicare
administrative contractors to reduce the improper payment
error rates in their jurisdictions.
``(iii) Incentives.--The incentives provided for under
clause (ii)--
``(I) may include a sliding scale of award fee
payments and additional incentives to medicare
administrative contractors that either reduce the
improper payment rates in their jurisdictions to
certain thresholds, as determined by the Secretary, or
accomplish tasks, as determined by the Secretary, that
further improve payment accuracy; and
``(II) may include substantial reductions in award
fee payments under cost-plus-award-fee contracts, for
medicare administrative contractors that reach an upper
end improper payment rate threshold or other threshold
as determined by the Secretary, or fail to accomplish
tasks, as determined by the Secretary, that further
improve payment accuracy.''.
(b) Effective Date.--
(1) In general.--The amendments made by subsection (a) shall
apply to contracts entered into or renewed on or after the date
that is 3 years after the date of enactment of this Act.
(2) Application to existing contracts.--In the case of
contracts in existence on or after the date of the enactment of
this Act and that are not subject to the effective date under
paragraph (1), the Secretary of Health and Human Services shall,
when appropriate and practicable, seek to apply the incentives
provided for in the amendments made by subsection (a) through
contract modifications.
SEC. 8. STRENGTHENING PENALTIES FOR THE ILLEGAL DISTRIBUTION OF A
MEDICARE, MEDICAID, OR CHIP BENEFICIARY IDENTIFICATION OR BILLING
PRIVILEGES.
Section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b))
is amended by adding at the end the following:
``(4) Whoever without lawful authority knowingly and willfully
purchases, sells or distributes, or arranges for the purchase,
sale, or distribution of a beneficiary identification number or
unique health identifier for a health care provider under title
XVIII, title XIX, or title XXI shall be imprisoned for not more
than 10 years or fined not more than $500,000 ($1,000,000 in the
case of a corporation), or both.''.
SEC. 9. IMPROVING THE SHARING OF DATA BETWEEN THE FEDERAL GOVERNMENT
AND STATE MEDICAID PROGRAMS.
(a) In General.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall establish a plan
to encourage and facilitate the participation of States in the
Medicare-Medicaid Data Match Program (commonly referred to as the
``Medi-Medi Program'') under section 1893(g) of the Social Security Act
(42 U.S.C. 1395ddd(g)).
(b) Program Revisions To Improve Medi-Medi Data Match Program
Participation by States.--Section 1893(g)(1)(A) of the Social Security
Act (42 U.S.C. 1395ddd(g)(1)(A)) is amended--
(1) in the matter preceding clause (i), by inserting ``or
otherwise'' after ``eligible entities'';
(2) in clause (i)--
(A) by inserting ``to review claims data'' after
``algorithms''; and
(B) by striking ``service, time, or patient'' and inserting
``provider, service, time, or patient'';
(3) in clause (ii)--
(A) by inserting ``to investigate and recover amounts with
respect to suspect claims'' after ``appropriate actions''; and
(B) by striking ``; and'' and inserting a semicolon;
(4) in clause (iii), by striking the period and inserting`` ;
and''; and
(5) by adding at the end the following new clause:
``(iv) furthering the Secretary's design, development,
installation, or enhancement of an automated data system
architecture--
``(I) to collect, integrate, and assess data for
purposes of program integrity, program oversight, and
administration, including the Medi-Medi Program; and
``(II) that improves the coordination of requests
for data from States.''.
(c) Providing States With Data on Improper Payments Made for Items
or Services Provided to Dual Eligible Individuals.--
(1) In general.--The Secretary shall develop and implement a
plan that allows each State agency responsible for administering a
State plan for medical assistance under title XIX of the Social
Security Act access to relevant data on improper or fraudulent
payments made under the Medicare program under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.) for health care items
or services provided to dual eligible individuals.
(2) Dual eligible individual defined.--In this section, the
term ``dual eligible individual'' means an individual who is
entitled to, or enrolled for, benefits under part A of title XVIII
of the Social Security Act (42 U.S.C. 1395c et seq.), or enrolled
for benefits under part B of title XVIII of such Act (42 U.S.C.
1395j et seq.), and is eligible for medical assistance under a
State plan under title XIX of such Act (42 U.S.C. 1396 et seq.) or
under a waiver of such plan.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.