[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 2425 Engrossed in Senate (ES)]

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114th CONGRESS
  1st Session
                                S. 2425

_______________________________________________________________________

                                 AN ACT


 
  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.

            Passed the Senate December 18, 2015.

            Attest:

                                                             Secretary.
114th CONGRESS

  1st Session

                                S. 2425

_______________________________________________________________________

                                 AN ACT

  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.