[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 2425 Considered and Passed Senate (CPS)]
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114th CONGRESS
1st Session
S. 2425
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.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 18, 2015
Mr. Portman (for himself, Mr. Casey, Mr. Burr, Mr. Schumer, Mr. Blunt,
Mr. Bennet, Mr. Wyden, Mrs. Murray, Mr. Blumenthal, Ms. Klobuchar, and
Ms. Hirono) introduced the following bill; which was read twice,
considered, read the third time, and passed
_______________________________________________________________________
A BILL
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.
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