114 S861 IS: Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015
U.S. Senate
2015-03-25
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 2015
or the PRIME Act of 2015
.
(b)The table of contents of this Act is as follows:Sec. 1. Short title; table of contents.TITLE I—Curbing improper paymentsSec. 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 sharingSec. 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 implementationSec. 301. Report on implementation. <enum>I</enum><header>Curbing improper payments</header> <section id="idFC92A0D4B3C54E15B0A051396B77F6CC"><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="idA9151E24317F4FFDA0083E6A31FCDC89" style="OLC">
<paragraph id="id8F042A1ED04C4FBEA32FD8E4782EE7D3"><enum>(4)</enum><header>Requiring valid
prescriber National Provider Identifiers on pharmacy claims</header>
<subparagraph id="id6B664D64D83F44EC9A15D101BB1FB0A8"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">For plan year 2016 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="idFDA23967E08641138B1C2471FCD1C38E"><enum>(B)</enum><header>Procedures</header><text display-inline="yes-display-inline">The Secretary shall establish—</text> <clause id="id022294DB01E7400E9F9813EC31410DB8"><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="id9E6F06671EEF4E9FBE14896142D62CE0"><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="idDEC2B9FA731848969A78888B919326E7"><enum>(C)</enum><header>Report</header><text display-inline="yes-display-inline">Not later than January 1, 2018, 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="id66CBD3F60DF0472CB60EF6AC191B029A"><enum>102.</enum><header>Reforming how
CMS tracks and corrects the vulnerabilities identified by Recovery Audit
Contractors</header>
<subsection id="id89A63C56D1D046CDA34664D915D37FCF"><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="idA45F87261B0D407F919288B962A703E6"><enum>(1)</enum><text display-inline="yes-display-inline">in paragraph (8)—</text> <subparagraph id="id6A72CE958807421498AB3453AED0E0E7"><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="idAE9F1B95F4834B5A9B0B92B38A79F927" style="OLC">
<subparagraph id="idA3F3578D415249A2A23F5AF7A949FFCF"><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="idBF01455BEBB7485D9D4632FB46D503DE"><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="id50E0794369CB4AAB8024162DF09C72AE" style="OLC">
<subparagraph id="ID3b032bbf25ee4338b82dc017a17eed02"><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="id4D94941D25A34C75B29DEC6095804BB2"><enum>(i)</enum><text>a description of—</text>
<subclause id="id497436A998A549D18F21C3D09AFAA6A6"><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="id96BC243619084FF1B363CF25F6E87C1C"><enum>(II)</enum><text>how the Secretary is addressing such improper payment vulnerabilities; and</text>
</subclause></clause><clause id="id65CF3D11415249B9B3BEE36320C63106"><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="id63AB8851BAE2485A86762AF13F0F9FB4"><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="id39137A7A5A3B47518A8A24BF6E7C2B7A"><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="id25E554A0AE5A4374896505DF4241C852" style="OLC">
<paragraph id="id09F3C7A27F92479B85E18D4D6CB74E8B"><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="ID0572ae6fcca549ceb14ae7372ad3c18d"><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="ID94b679e6a1e24faa9fd5594704f065b7"><enum>(1)</enum><header>Medicare RAC
program</header><text>Section 1893(h)(1)(C) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ddd">42 U.S.C. 1395ddd(h)(1)(C)</external-xref>) is amended—</text>
<subparagraph id="IDa821279f00204a408becf60212218e34"><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="idA5325A365F414DCAA6869F3A6BC64AAB" style="OLC">
<clause id="id88D0D404B93A4CCE84B8E83089A3271F"><enum>(i)</enum><text>shall retain</text></clause><after-quoted-block>;</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="id0725414502864F04A57A30F7823361EC"><enum>(B)</enum><text>in clause (i), as added by subparagraph (A)—</text>
<clause id="id71D474A77EB64E6C98D4EFC463C4ED4F"><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="idBCE6C6AF7A56444F829AA4933E2B7CF5"><enum>(ii)</enum><text>by inserting <quote>until expended</quote> after <quote>Services</quote>; and</text>
</clause><clause id="id06368D8633324044BD97868B3C2B2A04"><enum>(iii)</enum><text>by striking the period at the end and inserting a semicolon; and</text>
</clause></subparagraph><subparagraph id="ID274075c714014c9f87ac295b222f497f"><enum>(C)</enum><text>by adding at the end the following new clauses:</text>
<quoted-block display-inline="no-display-inline" id="idBDE2B3CAFE864D90889E6F5A307605FA" style="OLC">
<clause id="id2759D3B6A1FC4347BC6F3B08EFEEFD11"><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="idC135D478E044410EB5CD97D3A9D3BDD8"><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="ID7b14d55f69a148688ddccce365f89472"><enum>(2)</enum><header>Medicaid RAC
program</header><text>Section 1936 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396u-6">42 U.S.C. 1396u–6</external-xref>) is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="id30D31059768C4D72ACC581A5B099F123" style="OLC">
<subsection commented="no" id="IDd2e8d4368b8b452887a984e3174df029"><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="idDB931BBE7B184ABF8853F79E1AE07266"><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="idEF2E16BA60A44D85A28797ECD436474B"><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="id8C163ECE9BE041DD931B1E24E43C44F4"><enum>(3)</enum><header>Effective
date</header><text>The amendments made by this section shall take effect on the date that is 1 year after the date of enactment of this Act.</text>
</paragraph></subsection></section><section id="idF3F4CB8B4312434BBFF4EBB64CFC99E1"><enum>103.</enum><header>Improving
Senior Medicare Patrol and fraud reporting rewards</header>
<subsection id="id0E1A72F249E64A9390BB53A3FB2EB38A"><enum>(a)</enum><header>In
general</header><text>The Secretary of Health and Human Services (in this section referred to as the <term>Secretary</term>) 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="idB80504BEFED7454C8798CFA8EF0B37FB"><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="id9D716C8B806147748FB1091B015986B8"><enum>(2)</enum><text>extending the incentive program to the Medicaid program.</text>
</paragraph></subsection><subsection id="id27D77A62FBC64FF2800684C576002CF0"><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 (<external-xref legal-doc="usc" parsable-cite="usc/42/3032">42 U.S.C. 3032</external-xref>) to conduct a public awareness and education campaign to encourage participation in the revised incentive program under subsection (a).</text>
</subsection><subsection id="ID49487b525b474085a5e8794c25eff601"><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="id8ED63D28BD374B6F9654154B597D179C"><enum>104.</enum><header>Strengthening
Medicaid Program integrity through flexibility</header><text display-inline="no-display-inline">Section 1936 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396u-6">42 U.S.C. 1396u–6</external-xref>) is amended—</text>
<paragraph id="id95ED6F4FDB954BDC876A13CCA4178971"><enum>(1)</enum><text>in subsection (a), by inserting <quote>, or otherwise,</quote> after <quote>entities</quote>; and</text>
</paragraph><paragraph id="idE02B766D47024D7ABF8053EB41924B6F"><enum>(2)</enum><text>in subsection (e)—</text>
<subparagraph id="id92329B276517460293B1194D11CC6DAB"><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="id3877FFAA519945AA8CEF2AB479FE4B98"><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="idF52532BF395E4426B29A60D35EFD0BF9"><enum>105.</enum><header>Establishing
Medicare administrative contractor error reduction incentives</header>
<subsection id="id80F40A19AD0145858EA0B14A419A8DAE"><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-1">42 U.S.C. 1395kk–1(b)(1)(D)</external-xref>) is amended—</text>
<paragraph id="id25475D9F3F404DFC873E850CEBA78FF9"><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="idD82DD1A2FD8C4D9F94390D5189B03D70" style="OLC">
<clause id="id55368F215075406392C7A584E43B3205"><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="id5F8F7A65FDC34051AAF1BFD8CF6059BB"><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="id9AEE0A0B02604B168D4BA2C0A21609A5" style="OLC">
<clause id="id25C69916D6D24F88B84F735027A2AB99"><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="id94F031D501454EC6BE609572A981FEA7"><enum>(iii)</enum><header>Incentives</header><text>The incentives provided for under clause (ii)—</text>
<subclause id="id7CC995F3E5B84B78A87E97BA4EDEE314"><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="id0C7962A266614025B943573E00C087AD"><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="idF2FED3CAAED6418E9F074AD4BA95E637"><enum>(b)</enum><header>Effective
date</header>
<paragraph commented="no" display-inline="no-display-inline" id="idA089569A299D490FAEE9C47F29003B83"><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="idE114BA85385745B19EA76F7A1F0D6787"><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="IDd564432678de4d8e8ca35d6a50fd9096"><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="idD40A49E69953401D9C145CC5CD65F48A" style="OLC">
<paragraph id="ID33612082cdb54225b34e6a7efbae0e98"><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="idDB1499ADC3DA4F66B3371A807DA3A6C3"><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 (<external-xref legal-doc="usc" parsable-cite="usc/42/653">42 U.S.C. 653(j)</external-xref>) is amended by adding at the end of the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="id500A96A3D0BE4CF1991F5E9CCF41D7AB" style="OLC">
<paragraph id="id6d38379c18d24b98879eae714618e306"><enum>(12)</enum><header>Information
comparisons and disclosures to assist in administration of the
Medicare program
and State health subsidy programs</header>
<subparagraph id="id54912b00b53944baa5c187ff19787815"><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 Services 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="idecfd27b5fcba43b38e663728970e47df"><enum>(B)</enum><header>Disclosure to
the Inspector General of the Department of Health and Human
Services</header>
<clause id="id2f9f7ae734694e33b34d4b3c314a7260"><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="id7c9926b96e7a457ab93ed150a588896b"><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="id4d2badf0c84641a699e1126eec5f4a79"><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 (<external-xref legal-doc="usc" parsable-cite="usc/42/18083">42 U.S.C. 18083(e)</external-xref>)); or</text>
</subclause><subclause id="id8a1d016310cf4c7e8a80b0e7f2704082"><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="id1ff42b7c308344e2814d989be8fbc59d"><enum>(C)</enum><header>Disclosure to
State agencies</header>
<clause id="id125fc79aa61e41d2ae0d38966f828036"><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="id0272d730546a4fa2915ad250feaa2663"><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="id79045c98c383462eb9467440b0a87a9c"><enum>(iii)</enum><header>Use and
disclosure of information by State agencies</header>
<subclause id="id35c6a65f64f440dea30ed44c7c2c061f"><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="idce675c1450fd4164b4e9fb1bc0156aef"><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="id07430cccda6f4201a080dc82162991ec"><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="idb41549c1da404c62bd9fa3afb7765f40"><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="id3b3a5758e169432296b3089f3cd5b2c4"><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="ID4e86f6eda0144ac4962550bdec38496a"><enum>202.</enum><header>Improving the
sharing of data between the Federal Government and State Medicaid
programs</header>
<subsection id="id4C60B766B69343C9B6A4C00D16823A19"><enum>(a)</enum><header>In
general</header><text>The Secretary of Health and Human Services (in this section referred to as the <term>Secretary</term>) shall establish a plan to encourage and facilitate the participation of States in the Medicare-Medicaid Data Match Program (commonly referred to as the <term>Medi-Medi Program</term>) under section 1893(g) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ddd">42 U.S.C. 1395ddd(g)</external-xref>).</text>
</subsection><subsection id="ID591495a440b64d0baa1180232a3ce9b8"><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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ddd">42 U.S.C. 1395ddd(g)(1)(A)</external-xref>) is amended—</text>
<paragraph id="ID5c81c108deb241639897e6e17f1b2ada"><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="ID67e123ec5fda444091dca778165a10bb"><enum>(2)</enum><text>in clause (i)—</text>
<subparagraph id="ID3abbd50b18774d559f4ae13d0f065f78"><enum>(A)</enum><text>by inserting <quote>to review claims data</quote> after <quote>algorithms</quote>; and</text>
</subparagraph><subparagraph id="IDa46e4d39e5f7492980e24e8e8b793183"><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="ID458aa588377443e39dffe3c757d44dfa"><enum>(3)</enum><text>in clause (ii)—</text>
<subparagraph id="idEDC463C1764C4EB5B4293F91799A7077"><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="id0AB0724F5DC846029683BF958468A40F"><enum>(B)</enum><text>by striking <quote>; and</quote> and inserting a semicolon;</text>
</subparagraph></paragraph><paragraph id="id0C90D9FC540E41B18F2A6912F6EB59B4"><enum>(4)</enum><text>in clause (iii), by striking the period and inserting <quote>; and</quote>; and</text>
</paragraph><paragraph id="ID7bcc8f4037a1421a822fd96d487c0bf7"><enum>(5)</enum><text>by adding at the end the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="id3FE8E2918C0549CEA9EABDBA5B66541A" style="OLC">
<clause id="idDA363B59088445F09A3766E4622A0AAD"><enum>(iv)</enum><text>furthering the Secretary’s design, development, installation, or enhancement of an automated data system architecture—</text>
<subclause id="id338D443F179547EFB9F46069C7859011"><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="idC4ACAAC1A04D4B7B98E08616ECDAFDCD"><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="idDCEC8807BB754352A971215A8DEC6576"><enum>(c)</enum><header>Providing
states with data on improper payments made for items or services provided
to
dual eligible individuals</header>
<paragraph id="id52FD31D98EE54E8D9E6975BA28602D02"><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="id4D5D9F5AD402439E8D8BD2DE8336D753"><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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395c">42 U.S.C. 1395c et seq.</external-xref>), 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="id86140AF510E245BFB5679FE8168995A4"><enum>203.</enum><header>Improving
claims processing and detection of fraud within the Medicaid and CHIP
programs</header>
<subsection id="IDbb20c82d7aea4ca59f02daca9dfc10d4"><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>) is amended (after the application of the amendments made by subsection (c) of this section)—</text>
<paragraph id="ID5a6d544af17e4a5abf4b773b4847a1c9"><enum>(1)</enum><text>in paragraph (25), by striking <quote>or</quote> at the end;</text>
</paragraph><paragraph id="IDd7303e6ac53c4bee9270b08f609415ad"><enum>(2)</enum><text>in paragraph (26), by striking the period and inserting <quote>; or</quote>; and</text>
</paragraph><paragraph id="IDe395e2b290bc4630ac49c23e9e27bf23"><enum>(3)</enum><text>by inserting after paragraph (26), the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="id0F81DDA05718431DA2294880E1D42DC6" style="OLC">
<paragraph id="IDd7136516391d4d2487d947e1bb1b7871"><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="ID571fd83377d84e6696393e1b8b6fcd50"><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><subsection commented="no" display-inline="no-display-inline" id="idF89C4A1D95F146F78B82040C0BED5655"><enum>(c)</enum><header>Technical corrections</header><text>Effective as if included in the enactment of <external-xref legal-doc="public-law" parsable-cite="pl/111/148">Public Law 111–148</external-xref>, the following sections of such Act are amended as follows:</text>
<paragraph commented="no" display-inline="no-display-inline" id="idA76CEEEFF6814FF6BFFF840A30274312"><enum>(1)</enum><text>Section 6402(c)(3) is amended by striking <quote>by adding at the end</quote> and inserting <quote>by inserting after paragraph (24)</quote>.</text> </paragraph><paragraph commented="no" display-inline="no-display-inline" id="id387979124E9E4A70B0A6289E39FD2C7F"><enum>(2)</enum><text>Section 2001(a)(2)(B)(iii) is amended by striking <quote>by adding at the end</quote> and inserting <quote>by inserting after paragraph (25)</quote>.</text>
</paragraph></subsection></section><enum>III</enum><header>Report on
implementation</header>
<section id="ID1ba1dc1e81e64378ae03b789d8c7f6b1"><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>