113 HR 2305 IH: Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2013
U.S. House of Representatives
2013-06-10
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of
contents
(a)This Act may be cited
as the Preventing and Reducing
Improper Medicare and Medicaid Expenditures Act of 2013
or the PRIME Act of
2013
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—Curbing improper payments
Sec. 101. Requiring valid prescriber National Provider
Identifiers on pharmacy claims.
Sec. 102. Reforming how CMS tracks and corrects the
vulnerabilities identified by Recovery Audit Contractors.
Sec. 103. Improving Senior Medicare Patrol and fraud reporting
rewards.
Sec. 104. Strengthening Medicaid Program integrity through
flexibility.
Sec. 105. Establishing Medicare administrative contractor error
reduction incentives.
Sec. 106. Strengthening penalties for the illegal distribution
of a Medicare, Medicaid, or CHIP beneficiary identification or billing
privileges.
TITLE II—Improving data sharing
Sec. 201. Access to the National Directory
of New Hires.
Sec. 202. Improving the sharing of data between the Federal
Government and State Medicaid programs.
Sec. 203. Improving claims processing and detection of fraud
within the Medicaid and CHIP programs.
TITLE III—Report on implementation
Sec. 301. Report on implementation.
<enum>I</enum><header>Curbing improper
payments</header>
<section id="HCD1B62F6E87B40DB9558C1E1608409AF"><enum>101.</enum><header>Requiring valid
prescriber National Provider Identifiers on pharmacy claims</header><text display-inline="no-display-inline">Section 1860D–4(c) of the Social Security
Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-104">42 U.S.C. 1395w–104(c)</external-xref>) is amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H11DF11EE7F014D0CB065DDC2E46E2F3D" style="OLC">
<paragraph id="H7B92D79BEB53412C92BC59E84495BB58"><enum>(4)</enum><header>Requiring valid
prescriber National Provider Identifiers on pharmacy claims</header>
<subparagraph id="HA196650640E241A69C48E9EC974743DD"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">For plan year 2015
and subsequent plan years, subject to subparagraph (B), the Secretary shall
prohibit PDP sponsors of prescription drug plans from paying claims for
prescription drugs under this part that do not include a valid prescriber
National Provider Identifier.</text>
</subparagraph><subparagraph id="HD68DD8B233B3485EAC53DCEA1D2F7EFC"><enum>(B)</enum><header>Procedures</header><text display-inline="yes-display-inline">The Secretary shall establish—</text>
<clause id="H7C55B95C97B147BEA4A7BCD9554C5B5D"><enum>(i)</enum><text display-inline="yes-display-inline">procedures for determining the validity of
prescriber National Provider Identifiers under subparagraph (A); and</text>
</clause><clause id="H1C2128D895EF4CEAB5C68C3A4A00B79D"><enum>(ii)</enum><text>procedures for
transferring to the Inspector General of the Department of Health and Human
Services and appropriate law enforcement agencies and other oversight entities
information on those National Provider Identifiers and pharmacy claims,
including records related to such claims, that the Secretary determines are
invalid under clause (i).</text>
</clause></subparagraph><subparagraph id="HB3BB08B53C0A4E72B10BA1A7C0492847"><enum>(C)</enum><header>Report</header><text display-inline="yes-display-inline">Not later than January 1, 2017, the
Inspector General of the Department of Health and Human Services shall submit
to Congress a report on the effectiveness of the procedures established under
subparagraph
(B).</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="HFA75404178A1477993A2BCC97C04E130"><enum>102.</enum><header>Reforming how
CMS tracks and corrects the vulnerabilities identified by Recovery Audit
Contractors</header>
<subsection id="H7CC7F4970A9546CBA31AD2A1ADC48884"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1893(h) of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ddd">42 U.S.C. 1395ddd(h)</external-xref>) is amended—</text>
<paragraph id="H6B8F592430324F18BBA968F06EEA11BA"><enum>(1)</enum><text display-inline="yes-display-inline">in paragraph (8)—</text>
<subparagraph id="H25034CCC7C6E456B931538884D208DE1"><enum>(A)</enum><text display-inline="yes-display-inline">by striking <quote><header-in-text level="paragraph" style="OLC">report</header-in-text>.—The Secretary</quote>
and inserting “<header-in-text level="paragraph" style="OLC">report</header-in-text>.—</text>
<quoted-block display-inline="no-display-inline" id="H0EB2C1AE7C644B46B7FB676F3E02583B" style="OLC">
<subparagraph id="HDDA5D1BA9839455892FD0D1AF976153D"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">Subject to
subparagraph (C), the Secretary</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="HB03CCFFED07041DABE39E813A798C0AD"><enum>(B)</enum><text>by adding after
subparagraph (A), as inserted by subparagraph (A), the following new
subparagraphs:</text>
<quoted-block display-inline="no-display-inline" id="H7628000E95EC4D5A9BF6307B7D127252" style="OLC">
<subparagraph id="H817D337C0E694CE595130C31259B433F"><enum>(B)</enum><header>Inclusion of
improper payment vulnerabilities identified</header><text>Each report submitted
under subparagraph (A) shall, subject to subparagraph (C), include—</text>
<clause id="H8134DFC0EF4446D18684AFF8587EFA0D"><enum>(i)</enum><text>a
description of—</text>
<subclause id="H08CCAEDB3E314F6E8DDB845B77DB2D50"><enum>(I)</enum><text>the types and
financial cost to the program under this title of improper payment
vulnerabilities identified by recovery audit contractors under this subsection;
and</text>
</subclause><subclause id="HADE6C87B2E5541918C416065F4D873B6"><enum>(II)</enum><text>how the Secretary
is addressing such improper payment vulnerabilities; and</text>
</subclause></clause><clause id="H75042D9678AA457889B09B975A776307"><enum>(ii)</enum><text>an assessment of
the effectiveness of changes made to payment policies and procedures under this
title in order to address the vulnerabilities so identified.</text>
</clause></subparagraph><subparagraph id="H4A9E21CB25B148B6BFA8C24FA86E2FF0"><enum>(C)</enum><header>Limitation</header><text>The
Secretary shall ensure that each report submitted under subparagraph (A) does
not include information that the Secretary determines would be sensitive or
would otherwise negatively impact program
integrity.</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H5523A75769294A69B2402EA7481E9A79"><enum>(2)</enum><text display-inline="yes-display-inline">by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H653E0F42203E4C64852A3163C3117C2E" style="OLC">
<paragraph id="H13A976058FD9403E9C995CC878A95B6D"><enum>(10)</enum><header>Addressing
improper payment vulnerabilities</header><text display-inline="yes-display-inline">The Secretary shall address improper
payment vulnerabilities identified by recovery audit contractors under this
subsection in a timely manner, prioritized based on the risk to the program
under this
title.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" id="H846A0F3C222F4AFF81603CA2A14177B9"><enum>(b)</enum><header>Use of Medicare
and Medicaid recovery audit contractor recoveries for provider education and To
prevent improper payments and fraud</header>
<paragraph id="H660E5BDAE54B47B3B1DEFD8CA475335C"><enum>(1)</enum><header>Medicare RAC
program</header><text>Section 1893(h)(1)(C) of the Social Security Act (42
U.S.C. 1395ddd(h)(1)(C)) is amended—</text>
<subparagraph id="H60584D2570904BFCA73CFB8B931D162F"><enum>(A)</enum><text>by striking
<quote>the Secretary shall retain</quote> and inserting “the Secretary—</text>
<quoted-block display-inline="no-display-inline" id="HEDF616A6AAE942CBAE82EC46D5689D83" style="OLC">
<clause id="H3423608F5421454AA9697067F244A999"><enum>(i)</enum><text>shall
retain</text>
</clause><after-quoted-block>;</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="HEC64B881DCEF47498983C8A74DF48D36"><enum>(B)</enum><text>in clause (i), as
added by subparagraph (A)—</text>
<clause id="H09910B73C34544059C6AB0E44AD65E9E"><enum>(i)</enum><text>by
inserting <quote>, in addition to any other funds that may be
available,</quote> after <quote>available</quote>;</text>
</clause><clause id="H96458D09B54A426CA7DF4BD1D9459C2A"><enum>(ii)</enum><text>by
inserting <quote>until expended</quote> after <quote>Services</quote>;
and</text>
</clause><clause id="H0C5A517C20BB413891E779039C778E9E"><enum>(iii)</enum><text>by
striking the period at the end and inserting a semicolon; and</text>
</clause></subparagraph><subparagraph id="H8887A882D4684ABD87AD46328A7D89DA"><enum>(C)</enum><text>by adding at the
end the following new clauses:</text>
<quoted-block display-inline="no-display-inline" id="H6A0C08E60354425C9BA8A27763E89E36" style="OLC">
<clause id="HF2D5FDB636674259AA597F9C1A3F2109"><enum>(ii)</enum><text>may retain an
additional portion of the amounts recovered (not to exceed 25 percent of such
amounts recovered) which shall be available, in addition to any other funds
that may be available, to such program management account until expended for
purposes of activities to address problems that contribute to improper payments
and fraud under this title; and</text>
</clause><clause id="H8D22B3DD2B744A20A2160C0FF993F161"><enum>(iii)</enum><text>shall retain an
additional 5 percent of such amounts recovered to be made available, in
addition to any other funds that may be available, to the Inspector General of
the Department of Health and Human Services until expended for the Inspector
General to carry out activities of the Inspector General relating to
investigating improper payments or auditing internal controls associated with
payments under this
title.</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" id="H556C6F1CAC8F48DEA923910E8305F8A5"><enum>(2)</enum><header>Medicaid RAC
program</header><text>Section 1936 of the Social Security Act (42 U.S.C.
1396u–6) is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HE6F13D88ED8344BBA30D91C9C4EB5E48" style="OLC">
<subsection commented="no" id="HBAA8E0EBDE7A4C409329364FD9CCB8B0"><enum>(f)</enum><header>Amounts
recovered through recovery audit contractors</header><text>Notwithstanding any
other provision of law, the Secretary—</text>
<paragraph commented="no" id="HA0330068CCDE446A8C8DD98D5367750C"><enum>(1)</enum><text>may retain a
portion of the amounts recovered pursuant to the program established under
section 1902(a)(42)(B) (not to exceed 25 percent of the Federal share of such
amounts recovered) which shall be available, in addition to any other funds
that may be available, to the program management account of the Centers for
Medicare & Medicaid Services for purposes of activities to address problems
that contribute to improper payments and fraud under this title; and</text>
</paragraph><paragraph commented="no" id="H032137B3B8D946EE86B268525C2B3854"><enum>(2)</enum><text>shall retain an
additional 5 percent of the Federal share of such amounts recovered to be made
available, in addition to any other funds that may be available, to the
Inspector General of the Department of Health and Human Services until expended
for the Inspector General to carry out activities of the Inspector General
relating to investigating improper payments or auditing internal controls
associated with payments under this
title.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HD07963DCA5A543319D292590942AB809"><enum>(3)</enum><header>Effective
date</header><text>The amendments made by this section shall take effect on
January 1, 2014.</text>
</paragraph></subsection></section><section id="HF0B3499061454C1086C791D8036DC451"><enum>103.</enum><header>Improving
Senior Medicare Patrol and fraud reporting rewards</header>
<subsection id="H0B72F5104A8F4231A288CB0026B97794"><enum>(a)</enum><header>In
general</header><text>The Secretary of Health and Human Services (in this
section referred to as the <quote>Secretary</quote>) shall develop a plan to
revise the incentive program under section 203(b) of the Health Insurance
Portability and Accountability Act of 1996 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395b-5">42 U.S.C. 1395b–5(b)</external-xref>) to encourage
greater participation by individuals to report fraud and abuse in the Medicare
program. Such plan shall include recommendations for—</text>
<paragraph id="H290DBCCEF9214DE89051D3EC5620EA45"><enum>(1)</enum><text>ways to enhance
rewards for individuals reporting under the incentive program, including
rewards based on information that leads to an administrative action; and</text>
</paragraph><paragraph id="HA7765D10C20040B4A01C8D4745EBE0FA"><enum>(2)</enum><text>extending the
incentive program to the Medicaid program.</text>
</paragraph></subsection><subsection id="HDFDDAABECD03437296979E8C935D88CC"><enum>(b)</enum><header>Public awareness
and education campaign</header><text>The plan developed under subsection (a)
shall also include recommendations for the use of the Senior Medicare Patrols
authorized under section 411 of the Older Americans Act of 1965 (42 U.S.C.
3032) to conduct a public awareness and education campaign to encourage
participation in the revised incentive program under subsection (a).</text>
</subsection><subsection id="H477ED4CEFB0944B88D37A9D219040042"><enum>(c)</enum><header>Submission of
plan</header><text>Not later than 180 days after the date of enactment of this
Act, the Secretary shall submit to Congress the plan developed under subsection
(a).</text>
</subsection></section><section id="HC8BA85B5D9A149A39CEA5914FE2E0608"><enum>104.</enum><header>Strengthening
Medicaid Program integrity through flexibility</header><text display-inline="no-display-inline">Section 1936 of the Social Security Act (42
U.S.C. 1396u–6) is amended—</text>
<paragraph id="H864073D442B04A37A29B2E56D5294BAD"><enum>(1)</enum><text>in subsection (a),
by inserting <quote>, or otherwise,</quote> after <quote>entities</quote>;
and</text>
</paragraph><paragraph id="HBEC345CFCA3945D0A983D042832011F4"><enum>(2)</enum><text>in subsection
(e)—</text>
<subparagraph id="H6835D75198A24953BE970A2EB566131C"><enum>(A)</enum><text>in paragraph (1),
in the matter preceding subparagraph (A), by inserting <quote>(including the
costs of equipment, salaries and benefits, and travel and training)</quote>
after <quote>Program under this section</quote>; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HEAD0818F004740ABB1F9E6A89E62B6EA"><enum>(B)</enum><text>in paragraph (3),
by striking <quote>by 100</quote> and inserting <quote>by 100, or such number
as determined necessary by the Secretary to carry out the
Program,</quote>.</text>
</subparagraph></paragraph></section><section id="H6504F1B6AB754C74B7E7EF75388A9E60"><enum>105.</enum><header>Establishing
Medicare administrative contractor error reduction incentives</header>
<subsection id="H27002B3434D8483387603C0E9DD70FBD"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section
1874A(b)(1)(D) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395kk">42 U.S.C. 1395kk(b)(1)(D)</external-xref>) is
amended—</text>
<paragraph id="H837280138ED34A868C08F1A06F9DE956"><enum>(1)</enum><text display-inline="yes-display-inline">by striking <quote><header-in-text level="subparagraph" style="OLC">quality</header-in-text>.—The
Secretary</quote> and inserting “<header-in-text level="subparagraph" style="OLC">quality</header-in-text>.—</text>
<quoted-block display-inline="no-display-inline" id="H95EBC34B8E144C47B91544613C62646D" style="OLC">
<clause id="HF6CBADC16ACD4C09BC1FDFFB8FF06CA8"><enum>(i)</enum><header>In
general</header><text display-inline="yes-display-inline">Subject to clauses
(ii) and (iii), the Secretary</text>
</clause><after-quoted-block>;
and</after-quoted-block></quoted-block>
</paragraph><paragraph id="HA629121E28DC497FA47399D00EB90F43"><enum>(2)</enum><text display-inline="yes-display-inline">by inserting after clause (i), as added by
paragraph (1), the following new clauses:</text>
<quoted-block display-inline="no-display-inline" id="H679521C8FC4D441BB6F3E20CD22F2625" style="OLC">
<clause id="HB8A67327ADAB412789D38D727336E538"><enum>(ii)</enum><header>Improper
payment error rate reduction incentives</header><text>The Secretary shall
provide incentives for medicare administrative contractors to reduce the
improper payment error rates in their jurisdictions.</text>
</clause><clause id="H5270351FC88D465CA8DE2E916BB0B15C"><enum>(iii)</enum><header>Incentives</header><text>The
incentives provided for under clause (ii)—</text>
<subclause id="HF8CCF584F40A4630B615C98E7B1CEDAF"><enum>(I)</enum><text>may include a
sliding scale of bonus payments and additional incentives to medicare
administrative contractors that reduce the improper payment error rates in
their jurisdictions to certain benchmark levels, as determined by the
Secretary; and</text>
</subclause><subclause id="HCDE953D3ADA14DA8834ACAA3C73771AB"><enum>(II)</enum><text>shall include
substantial reductions in award fee payments under award fee contracts, for any
medicare administrative contractor that reaches an upper end error threshold or
other threshold as determined by the
Secretary.</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HDA4CCB95491945399E0BD273B0AC03B6"><enum>(b)</enum><header>Effective
date</header>
<paragraph commented="no" display-inline="no-display-inline" id="HA46C0D68E97D4913ADC108E95D0B0C49"><enum>(1)</enum><header>In
general</header><text>The amendments made by subsection (a) shall apply to
contracts entered into or renewed on or after the date that is 12 months after
the date of enactment of this Act.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HE5E81D13364F4A1DAEC7043E2B04FB23"><enum>(2)</enum><header>Contracts
entered into or renewed prior to effective date</header><text>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.</text>
</paragraph></subsection></section><section id="H07634A2BEF5B4EA6AD2EE8DA327B693C"><enum>106.</enum><header>Strengthening
penalties for the illegal distribution of a Medicare, Medicaid, or CHIP
beneficiary identification or billing privileges</header><text display-inline="no-display-inline">Section 1128B(b) of the Social Security Act
(42 U.S.C. 1320a–7b(b)) is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="HB96DD6C277054962B2B547FBD266EC99" style="OLC">
<paragraph id="H76B49E42703D4AECA58D49BFAB3E21B3"><enum>(4)</enum><text>Whoever knowingly,
intentionally, and with the intent to defraud purchases, sells or distributes,
or arranges for the purchase, sale, or distribution of a Medicare, Medicaid, or
CHIP beneficiary identification number or billing privileges 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.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</section><enum>II</enum><header>Improving data
sharing</header>
<section id="H034A39061F544AD2A1BAABED776802DB"><enum>201.</enum><header>Access to the
National Directory of New Hires</header><text display-inline="no-display-inline">Section 453(j) of the Social Security Act
(42 U.S.C. 653 (j)) is amended by adding at the end of the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HA5492DDA8A3D4024A2564AF98F0FF537" style="OLC">
<paragraph id="H203E7AF86E4A47408444BE92EA3B4F88"><enum>(12)</enum><header>Information
comparisons and disclosures to assist in administration of the Medicare program
and State health subsidy programs</header>
<subparagraph id="H29F735CCD53B4115A8E5102CA2925E6F"><enum>(A)</enum><header>Disclosure to
the Administrator of the Centers for Medicare & Medicaid
Services</header><text>The Administrator of the Centers for Medicare &
Medicaid shall have access to the information in the National Directory of New
Hires for purposes of determining the eligibility of an applicant for, or
enrollee in, the Medicare program under title XVIII or an applicable State
health subsidy program (as defined in section 1413(e) of the Patient Protection
and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18083">42 U.S.C. 18083(e)</external-xref>)).</text>
</subparagraph><subparagraph id="HC027BC09CF324BB69FC39B07D321D991"><enum>(B)</enum><header>Disclosure to
the Inspector General of the Department of Health and Human Services</header>
<clause id="HABC42836754B48DC89632837019E190C"><enum>(i)</enum><header>In
general</header><text>If the Inspector General of the Department of Health and
Human Services transmits to the Secretary the names and social security account
numbers of individuals, the Secretary shall disclose to the Inspector General
information on such individuals and their employers maintained in the National
Directory of New Hires.</text>
</clause><clause id="H58F2D2D08B11428D8B84D6BE05AC58F1"><enum>(ii)</enum><header>Use of
information</header><text>The Inspector General of the Department of Health and
Human Services may use information provided under clause (i) only for purposes
of—</text>
<subclause id="H4308E6DCEC9A4DE48F2A5FBD531608DE"><enum>(I)</enum><text>determining the
eligibility of an applicant for, or enrollee in, the Medicare program under
title XVIII or an applicable State health subsidy program (as defined in
section 1413(e) of the Patient Protection and Affordable Care Act (42 U.S.C.
18083(e))); or</text>
</subclause><subclause id="HD8555E73DFEA4660AA257A8ABFAFFEEA"><enum>(II)</enum><text>evaluating the
integrity of the Medicare program or an applicable State health subsidy program
(as so defined).</text>
</subclause></clause></subparagraph><subparagraph id="HBE191E88C1494AA9B7BB1EAF11423ACA"><enum>(C)</enum><header>Disclosure to
State agencies</header>
<clause id="HB0BF58596237434A84E2C83F752698ED"><enum>(i)</enum><header>In
general</header><text>If, for purposes of administering an applicable State
health subsidy program (as defined in section 1413(e) of the Patient Protection
and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18083">42 U.S.C. 18083(e)</external-xref>)), a State agency responsible for
administering such program transmits to the Secretary the names and social
security account numbers of individuals, the Secretary shall disclose to such
State agency information on such individuals and their employers maintained in
the National Directory of New Hires, subject to this subparagraph.</text>
</clause><clause id="H7F00636B53514CB7A2032B6B1AA74EC3"><enum>(ii)</enum><header>Condition on
disclosure by the Secretary</header><text>The Secretary shall make a disclosure
under clause (i) only to the extent that the Secretary determines that the
disclosure would not interfere with the effective operation of the program
under this part.</text>
</clause><clause id="H1901373164A84BD7922D6D354F1698EE"><enum>(iii)</enum><header>Use and
disclosure of information by State agencies</header>
<subclause id="H3A03FC27BC8747F1BA29C0191F66E8F6"><enum>(I)</enum><header>In
general</header><text>A State agency may not use or disclose information
provided under clause (i) except for purposes of administering a program
referred to in clause (i).</text>
</subclause><subclause id="H74697AEE058143F3BCCBC71D962336AD"><enum>(II)</enum><header>Information
security</header><text>The State agency shall have in effect data security and
control policies that the Secretary finds adequate to ensure the security of
information obtained under clause (i) and to ensure that access to such
information is restricted to authorized persons for purposes of authorized uses
and disclosures.</text>
</subclause><subclause id="H592F4F2BABFC4FA9B4B5591EB15229BD"><enum>(III)</enum><header>Penalty for
misuse of information</header><text>An officer or employee of the State agency
who fails to comply with this clause shall be subject to the sanctions under
subsection (l)(2) to the same extent as if such officer or employee were an
officer or employee of the United States.</text>
</subclause></clause><clause id="HFDCE0FEFF431425391EBE93BC152BE01"><enum>(iv)</enum><header>Procedural
requirements</header><text>State agencies requesting information under clause
(i) shall adhere to uniform procedures established by the Secretary governing
information requests and data matching under this paragraph.</text>
</clause><clause id="H101C0B48A8AF40C1AD7B372309038673"><enum>(v)</enum><header>Reimbursement of
costs</header><text>The State agency shall reimburse the Secretary, in
accordance with subsection (k)(3), for the costs incurred by the Secretary in
furnishing the information requested under this
subparagraph.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="H4CDF43212DD04DEDA9B818796B556981"><enum>202.</enum><header>Improving the
sharing of data between the Federal Government and State Medicaid
programs</header>
<subsection id="HAA963BE1189E4C23B62136983C7ACC27"><enum>(a)</enum><header>In
general</header><text>The Secretary of Health and Human Services (in this
section referred to as the <quote>Secretary</quote>) shall establish a plan to
encourage and facilitate the participation of States in the Medicare-Medicaid
Data Match Program (commonly referred to as the <quote>Medi-Medi
Program</quote>) under section 1893(g) of the Social Security Act (42 U.S.C.
1395ddd(g)).</text>
</subsection><subsection id="H437EADA8A32F4C5B9E8F9E26D776A542"><enum>(b)</enum><header>Program
revisions To improve Medi-Medi Data Match Program participation by
States</header><text>Section 1893(g)(1)(A) of the Social Security Act (42
U.S.C. 1395ddd(g)(1)(A)) is amended—</text>
<paragraph id="HDCC5ABC5F45245BB94E5B0E49B5C7393"><enum>(1)</enum><text>in the matter
preceding clause (i), by inserting <quote>or otherwise</quote> after
<quote>eligible entities</quote>;</text>
</paragraph><paragraph id="H22A7392A6F7344C4A925C915569FC735"><enum>(2)</enum><text>in clause
(i)—</text>
<subparagraph id="H07218B968F15463FB3DB576479AAAC2A"><enum>(A)</enum><text>by inserting
<quote>to review claims data</quote> after <quote>algorithms</quote>;
and</text>
</subparagraph><subparagraph id="H97F1E07247FB4236BD59ACD814F13E67"><enum>(B)</enum><text>by striking
<quote>service, time, or patient</quote> and inserting <quote>provider,
service, time, or patient</quote>;</text>
</subparagraph></paragraph><paragraph id="H37462067BA744A6B971BF8D7F35DBEC1"><enum>(3)</enum><text>in clause
(ii)—</text>
<subparagraph id="HB3C8CC5952484B619B0F7B2B5D8445A7"><enum>(A)</enum><text>by inserting
<quote>to investigate and recover amounts with respect to suspect
claims</quote> after <quote>appropriate actions</quote>; and</text>
</subparagraph><subparagraph id="H8E2A0A3FF7CA4DEDBEB4DAD14F828A94"><enum>(B)</enum><text>by striking
<quote>; and</quote> and inserting a semicolon;</text>
</subparagraph></paragraph><paragraph id="H495BBF55DBDA47738D7990AD1C766DB8"><enum>(4)</enum><text>in clause (iii),
by striking the period and inserting <quote>; and</quote>; and</text>
</paragraph><paragraph id="H15820F29AD3B487A8E143414EF95BC00"><enum>(5)</enum><text>by adding at end
the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="HE7B62BD1931D487AAE57646DFC1D7552" style="OLC">
<clause id="H79B3C5A1B4FC47C4BD6500298FDEA091"><enum>(iv)</enum><text>furthering the
Secretary’s design, development, installation, or enhancement of an automated
data system architecture—</text>
<subclause id="H969B4264C84F4EEBAC71CEECE3E6EA6B"><enum>(I)</enum><text>to collect,
integrate, and assess data for purposes of program integrity, program
oversight, and administration, including the Medi-Medi Program; and</text>
</subclause><subclause id="HD49A50B05F864280BAF9EB98BC4C2F17"><enum>(II)</enum><text>that improves the
coordination of requests for data from
States.</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H564C534F92F444809397DF9DE9B9C78F"><enum>(c)</enum><header>Providing states
with data on improper payments made for items or services provided to dual
eligible individuals</header>
<paragraph id="HB5AE3A41600A445CBA186FCAD032F555"><enum>(1)</enum><header>In
general</header><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>) for health care items
or services provided to dual eligible individuals.</text>
</paragraph><paragraph id="H950BED68B6DB43DC95CDE0D36A6B90CB"><enum>(2)</enum><header>Dual eligible
individual defined</header><text>In this section, the term <term>dual eligible
individual</term> 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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395j">42 U.S.C. 1395j et seq.</external-xref>), and is eligible for medical assistance under a
State plan under title XIX of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>) or under a
waiver of such plan.</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="H23219B35DEF54DB58277FA221BA86FC7"><enum>203.</enum><header>Improving
claims processing and detection of fraud within the Medicaid and CHIP
programs</header>
<subsection id="H7E47D54F3910431FB4AD8877D9BE6318"><enum>(a)</enum><header>Medicaid</header><text>Section
1903(i) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396b">42 U.S.C. 1396b(i)</external-xref>), as amended by section
2001(a)(2)(B) of the Patient Protection and Affordable Care Act (Public Law
111–148), is amended—</text>
<paragraph id="HFDFDD72C8BD043DDB4EE479C6DABC00D"><enum>(1)</enum><text>in paragraph (25),
by striking <quote>or</quote> at the end;</text>
</paragraph><paragraph id="HF725A7F7F7E44707AEA403824108E6E0"><enum>(2)</enum><text>in paragraph (26),
by striking the period and inserting <quote>; or</quote>; and</text>
</paragraph><paragraph id="H156F7DFABE4F4FEE918F7C895A039BA0"><enum>(3)</enum><text>by adding after
paragraph (26), the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HF84CDDFAF2904725B0847648665F84ED" style="OLC">
<paragraph id="H511A399C04A8448C9D0396E71305B906"><enum>(27)</enum><text>with respect to
amounts expended for an item or service for which medical assistance is
provided under the State plan or under a waiver of such plan unless the claim
for payment for such item or service contains a valid beneficiary
identification number that, for purposes of the individual who received such
item or service, has been determined by the State agency to correspond to an
individual who is eligible to receive benefits under the State plan or
waiver.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HF715350CF7F14ABA8504F97C577DE013"><enum>(b)</enum><header>CHIP</header><text>Section
2107(e)(1)(I) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397gg">42 U.S.C. 1397gg(e)(1)(I)</external-xref>) is amended
by striking <quote>and (17)</quote> and inserting <quote>(17), and
(27)</quote>.</text>
</subsection></section><enum>III</enum><header>Report on
implementation</header>
<section id="H8DFCCD67F5364B8A9901D66F2B3D1632"><enum>301.</enum><header>Report on
implementation</header><text display-inline="no-display-inline">Not later than
270 days after the date of the enactment of this Act, the Secretary of Health
and Human Services shall submit to Congress a report on the implementation of
the provisions of, and the amendments made by, this Act.</text>
</section>