[Congressional Record Volume 161, Number 185 (Friday, December 18, 2015)]
[House]
[Pages H10706-H10707]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               PATIENT ACCESS AND MEDICARE PROTECTION ACT

  Mr. TOM PRICE of Georgia. Mr. Speaker, I ask unanimous consent to 
take from the Speaker's table the bill (S. 2425) 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, and ask for its immediate consideration in the 
House.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Georgia?
  There was no objection.
  The text of the bill is as follows:

                                S. 2425

       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

[[Page H10707]]

     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.

  The bill was ordered to be read a third time, was read the third 
time, and passed, and a motion to reconsider was laid on the table.

                          ____________________