[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2437 Introduced in House (IH)]

114th CONGRESS
  1st Session
                                H. R. 2437

  To amend part B of title XVIII of the Social Security Act regarding 
      high cost durable medical equipment, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 19, 2015

Mrs. Blackburn introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, 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

_______________________________________________________________________

                                 A BILL


 
  To amend part B of title XVIII of the Social Security Act regarding 
      high cost durable medical equipment, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SEC. __. PRIOR AUTHORIZATION PROCESS FOR CERTAIN HIGH COST DURABLE 
              MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND SUPPLIES 
              UNDER THE MEDICARE PROGRAM.

    Section 1834(a)(15) of the Social Security Act (42 U.S.C. 
1395m(a)(15)) is amended--
            (1) in the paragraph heading, by striking ``items''and 
        inserting ``items; prior authorization process for certain high 
        cost durable medical equipment, prosthetics, orthotics, and 
        supplies''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Prior authorization process for certain high 
                cost durable medical equipment, prosthetics, orthotics, 
                and supplies.--
                            ``(i) In general.--Not later than 1 year 
                        after the date of the enactment of this 
                        subparagraph, the Secretary shall begin the 
                        process to develop and implement a prior 
                        authorization process for certain durable 
                        medical equipment, prosthetics, orthotics, and 
                        supplies. A claim for an item of durable 
                        medical equipment, a prosthetic, an orthotic, 
                        or a supply that has received prior approval 
                        through the prior authorization process shall 
                        be exempt from subsequent pre- and post-payment 
                        audits and only subject to audits for 
                        systematic fraud and abuse.
                            ``(ii) Consideration of factors.--The 
                        Secretary shall consider the following factors 
                        in developing and implementing the prior 
                        authorization process under this subparagraph:
                                    ``(I) Beneficiary access to timely 
                                care.
                                    ``(II) Alignment with the best 
                                practices of commercial managed care 
                                plans and Medicare Advantage plans 
                                under part C that have expertise in 
                                prior authorization processes.
                                    ``(III) Implementation of standard 
                                medical necessity evaluation prior 
                                authorization requests for physician 
                                and hospital referral agents and non-
                                physician practitioners.
                                    ``(IV) Accounting for same day 
                                delivery expectations by providing for 
                                expedited emergency review for certain 
                                items, including oxygen.
                            ``(iii) Implementation.--The Secretary 
                        shall promulgate a regulation to carry out the 
                        prior authorization process under this 
                        subparagraph. The regulation shall--
                                    ``(I) ensure that stakeholders 
                                participate in the development of the 
                                process; and
                                    ``(II) place priority on prior 
                                authorization of items that are subject 
                                to a high number of contractor audits, 
                                including oxygen.''.
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