3.0.0 1526 2023-01-11T13:28:04Z 2023-01-11T13:28:04Z House HR 2015-03-23 114 [Congressional Record Volume 161, Number 48 (Monday, March 23, 2015)]From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]By Mr. MEADOWS:H.R. 1526.Congress has the power to enact this legislation pursuantto the following:Article 1, Section 8, Clause 1[Page H1849]]]> hswm00 Ways and Means Committee House Standing hswm02 Health Subcommittee Referred to 2015-04-07T21:35:47Z Referred to 2015-03-23T16:01:05Z hsif00 Energy and Commerce Committee House Standing hsif14 Health Subcommittee Referred to 2015-03-27T20:27:01Z Referred to 2015-03-23T16:01:10Z 2015-04-07 hswm02 Health Subcommittee 1 House committee actions Referred to the Subcommittee on Health. Committee 2015-03-27 hsif14 Health Subcommittee 1 House committee actions Referred to the Subcommittee on Health. Committee 2015-03-23 Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. IntroReferral H11100 2 House floor actions hsif00 Energy and Commerce Committee 2015-03-23 Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. IntroReferral H11100-A 9 Library of Congress 2015-03-23 Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. IntroReferral H11100 2 House floor actions hswm00 Ways and Means Committee 2015-03-23 Introduced in House IntroReferral Intro-H 9 Library of Congress 2015-03-23 Introduced in House IntroReferral 1000 9 Library of Congress M001187 Rep. Meadows, Mark [R-NC-11] Mark Meadows R NC 11 N A000369 Rep. Amodei, Mark E. [R-NV-2] Mark Amodei R NV E. 2 2015-07-07 False H001055 Rep. Heck, Joseph J. [R-NV-3] Joseph Heck R NV J. 3 2015-09-16 False E000290 Rep. Edwards, Donna F. [D-MD-4] Donna Edwards D MD F. 4 2015-09-16 False M001184 Rep. Massie, Thomas [R-KY-4] Thomas Massie R KY 4 2015-11-02 False S001189 Rep. Scott, Austin [R-GA-8] Austin Scott R GA 8 2016-11-29 False Health Accounting and auditing Administrative remedies Congressional oversight Health information and medical records Health technology, devices, supplies Medicare Health 00 2015-03-23 Introduced in House 2015-05-04T19:58:15Z Medicare Audit Improvement Act of 2015

This bill amends title XVIII (Medicare) of the Social Security Act to require that any records or documentation of an orthotist or prosthetist who furnished an orthotic, prosthetic, or prosthetic device to an individual shall be considered part of the individual's medical record in determining whether the item is reasonable and necessary.

Medicare administrative contractors (MACs) shall determine that payment may not be made to a supplier of durable medical equipment (DME) or of orthotics and prosthetics for which a claim is made because the supplier does not meet requirements for licensing or accreditation by a National Board.

Recovery audit contractors (RACs) shall consider an overpayment that must be recouped any payment for DME, orthotics, or prosthetics that should not have been made because the supplier failed to meet licensing or accreditation criteria.

RACs are prohibited from reviewing payments for certain DME, orthotics, or prosthetics to which prior Medicare authorization applies.

The Secretary of Health and Human Services must report annually to Congress certain information on determinations by MACs that payment cannot be made, and by RACs that payment should not have been made, under Medicare for items and services.

Payment is prohibited under part B (Supplementary Medical Insurance) of Medicare for orthotics and prosthetics furnished by a supplier without a supplier number. To obtain such a number a supplier must meet specified criteria.

The Secretary must: (1) review annually the coverage and utilization of orthotics and prosthetics to determine whether they should be subjected to coverage and utilization review criteria, and if appropriate (2) develop and apply such criteria.

Patients are not liable for payment of furnished orthotics and prosthetics which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Competitive acquisition programs shall not apply to off-the-shelf items and services furnished by certain orthotists or prosthetists who are either licensed or, in a state without licensing requirements, meet specified training, education, certification, or credentialing criteria.

Recoupment of payments to a qualifying provider or supplier may not be made before completion of an administrative law judge appeals process.

Payment under Medicare is denied to suppliers and providers unless they meet certain licensing or other qualifications.

]]> Medicare Audit Improvement Act of 2015 Display Title Medicare Audit Improvement Act of 2015 Official Title as Introduced To amend title XVIII of the Social Security Act to modify policies relating to payment under the Medicare program for durable medical equipment, orthotics and prosthetics, and prosthetic devices, and for other purposes. Introduced in House IH Short Titles as Introduced Medicare Audit Improvement Act of 2015 Introduced in House 2015-03-23T04:00:00Z https://www.govinfo.gov/content/pkg/BILLS-114hr1526ih/xml/BILLS-114hr1526ih.xml 2015-04-07 Referred to the Subcommittee on Health. 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. Congressional Research Service, Library of Congress This file contains bill summaries and statuses for federal legislation. A bill summary describes the most significant provisions of a piece of legislation and details the effects the legislative text may have on current law and federal programs. Bill summaries are authored by the Congressional Research Service (CRS) of the Library of Congress. As stated in Public Law 91-510 (2 USC 166 (d)(6)), one of the duties of CRS is "to prepare summaries and digests of bills and resolutions of a public general nature introduced in the Senate or House of Representatives". For more information, refer to the User Guide that accompanies this file.