[Congressional Record Volume 164, Number 152 (Wednesday, September 12, 2018)]
[House]
[Pages H8118-H8120]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         FIGHTING FRAUD TO PROTECT CARE FOR SENIORS ACT OF 2018

  Mr. ROSKAM. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 6690) to establish a smart card pilot program to combat 
fraud, waste, and abuse and to protect beneficiary identity under the 
Medicare program, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 6690

       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 ``Fighting Fraud to Protect 
     Care for Seniors Act of 2018''.

     SEC. 2. MEDICARE SMART CARD PILOT PROGRAM.

       Part E of title XVIII of the Social Security Act is amended 
     by inserting after section 1866E the following new section:

     ``SEC. 1866F. SMART CARD PILOT PROGRAM.

       ``(a) Implementation.--
       ``(1) In general.--Not later than 36 months after the date 
     of the enactment of this section, the Secretary shall 
     establish a pilot program (in this section referred to as the 
     `pilot program') to evaluate the feasibility of using smart 
     card technology under this title.
       ``(2) Smart card technology defined.--In this section, the 
     term `smart card technology' means the following:
       ``(A) Beneficiary smart card.--A machine readable, tamper-
     resistant card (in this section referred to as a `smart 
     card') that includes an embedded integrated circuit chip with 
     a secure micro-controller (as defined by the National 
     Institute on Standards and Technology) that enables the 
     verification and secure, electronic authentication of the 
     identity of a Medicare beneficiary at the point of service 
     through a combination of the smart card and a personal 
     identification number known by or associated with such 
     beneficiary.
       ``(B) Card reader technology.--Information technology that 
     enables a supplier and provider to authenticate the identity 
     of a Medicare beneficiary through presentation of such a 
     smart card and such components, with such authentication to 
     be reflected through the use of a modifier or in another 
     appropriate manner, as determined by the Secretary, in the 
     claims adjudication process.
       ``(3) Program design elements.--The pilot program shall be 
     conducted for a period of 3 years consistent with the 
     following:
       ``(A) Selection of area.--In consultation with the 
     Inspector General of the Department of Health and Human 
     Services, the Secretary shall select at least 3 geographic 
     areas in which the pilot program will operate.
       ``(B) Selection of supplier and provider types.--In 
     consultation with the Inspector General of the Department of 
     Health and Human Services, the Secretary shall select 
     supplier and provider types that will be required to 
     participate in the pilot program (referred to in this section 
     as `participating suppliers and providers'). In selecting 
     such supplier and provider types, the Secretary shall--
       ``(i) take into account the risk of fraud, waste, and abuse 
     (as described in section 1866(j)(2)(B)) with respect to the 
     category of provider or supplier) and other factors as 
     determined appropriate by the Secretary; and
       ``(ii) limit the pilot program to no more than 2,000 
     suppliers and providers.
       ``(C) Supplier and provider hardship exemptions.--The 
     Secretary shall exempt from participation in the pilot 
     program a supplier or provider that either--
       ``(i) does not have access to card reader technology (as 
     described in paragraph (2)(B));
       ``(ii) does not have sufficient internet access; or
       ``(iii) has a low volume (as determined by the Secretary) 
     of Medicare claims for which payment is made under this 
     title.
       ``(D) Smart card and smart card reader issuance.--
       ``(i) Beneficiary smart card issuance.--The Secretary shall 
     provide for, at no cost, the issuance (and, if necessary, 
     replacement) of beneficiary smart cards described in 
     paragraph (2)(A) to all Medicare beneficiaries residing in a 
     geographic area in which the pilot program is conducted under 
     subparagraph (A). Information that appears on Medicare cards 
     used outside the pilot program may appear on the face of the 
     beneficiary smart card.
       ``(ii) Supplier and provider smart card reader issuance.--
     At the request of a participating supplier or provider, the 
     Secretary shall provide for, at no cost, the issuance to such 
     supplier or provider of smart card hardware and

[[Page H8119]]

     software necessary to participate in the pilot program.
       ``(E) Information on operation of pilot program.--The 
     Secretary shall provide participating suppliers and providers 
     and Medicare beneficiaries who are furnished items and 
     services by such suppliers and providers, with information on 
     the operation of the pilot program, including privacy 
     protections described in subparagraph (I).
       ``(F) Access to services outside the pilot program.--
       ``(i) Beneficiaries.--Medicare beneficiaries who receive 
     beneficiary smart cards may receive items and services from 
     suppliers and providers not participating in the pilot 
     program.
       ``(ii) Suppliers and provider claims.--

       ``(I) Suppliers and providers not participating in pilot.--
     Suppliers and providers not participating in the pilot 
     program may submit claims under this title for items and 
     services furnished without use of smart card technology to 
     Medicare beneficiaries who receive beneficiary smart cards.
       ``(II) Participating suppliers and providers furnishing 
     services to non-participating beneficiaries.--Supplier and 
     providers participating in the pilot program may submit 
     claims under this title for items and services furnished to 
     Medicare beneficiaries who do not receive beneficiary smart 
     cards.

       ``(G) Clarification on access to services without smart 
     cards.--In the case of a Medicare beneficiary who receives a 
     beneficiary smart card and does not present such card at the 
     time of receipt of items or services from a participating 
     supplier or provider, the participating supplier or 
     provider--
       ``(i) shall furnish such items or services to such Medicare 
     beneficiary as if such beneficiary does present such card;
       ``(ii) may submit claims under this title for such items or 
     services; and
       ``(iii) shall provide, in accordance with such manner, 
     process, and timing as specified by the Secretary, 
     information to the Secretary (through the contractor 
     described in subparagraph (H)) that such beneficiary received 
     such a smart card but did not have the smart card at the time 
     the items or services were furnished.
       ``(H) Private sector implementation.--The Secretary shall 
     select, by using a competitive procurement process in 
     accordance with the provisions of chapter 1 of title 48, Code 
     of Federal Regulations (or any successor regulations), a 
     private sector contractor to implement and operate the pilot 
     program.
       ``(I) Privacy protections.--The Secretary shall ensure that 
     the pilot program complies with applicable Federal laws and 
     regulations concerning individually identifiable health 
     information, including the Privacy Act of 1974 and 
     regulations promulgated under section 264(c) of the Health 
     Insurance Portability and Accountability Act of 1996 and such 
     individually identifiable information shall be exempt from 
     disclosure under section 552(b)(3) of title 5, United States 
     Code.
       ``(J) Mandatory participation.--Subject to subparagraph 
     (C), in the case of items or services furnished by a provider 
     or supplier included in a supplier or provider type selected 
     under subparagraph (B) in a geographic area selected under 
     subparagraph (A), payment may only be made under this title 
     for such items or services during the period of the pilot 
     program if the provider or supplier is participating in the 
     pilot program.
       ``(K) Prohibition of smart card fees.--No transaction, 
     utilization, or other fees may be imposed on Medicare 
     beneficiaries or participating suppliers and providers with 
     respect to the use of smart cards under the pilot program.
       ``(4) Stakeholder input.--
       ``(A) In general.--Not later than 6 months after the date 
     of the enactment of this section, the Secretary shall convene 
     a panel consisting of stakeholders (including representatives 
     of providers, suppliers, technology vendors, Medicare 
     beneficiaries, and claims processing contractors) selected by 
     the Secretary for purposes of providing input to the 
     Secretary on the implementation of the pilot program 
     (including on the selection of areas and participants under 
     subparagraphs (A) and (B) of paragraph (3) and the 
     development of exemptions and requirements described in such 
     paragraph).
       ``(B) Nonapplicability of faca.--The Federal Advisory 
     Committee Act shall not apply to the panel convened pursuant 
     to subparagraph (A).
       ``(5) Definitions.--In this section:
       ``(A) The terms `supplier' and `provider' have the meanings 
     given the terms `supplier' and `provider of services' in 
     subsections (d) and (u), respectively, of section 1861.
       ``(B) The term `Medicare beneficiary' means an individual 
     who is enrolled in the original Medicare fee-for-service 
     program under parts A and B and is not enrolled in an MA plan 
     under part C, an eligible organization under section 1876, or 
     a PACE program under section 1894.
       ``(b) Reports to Congress.--The Secretary shall submit to 
     Congress the following reports:
       ``(1) Interim performance report.--Not later than 2 years 
     after the date the pilot program is implemented, an interim 
     report on the performance of such program.
       ``(2) Final performance report.--Not later than 18 months 
     after the date of the completion of the pilot program, a 
     final evaluation on the effectiveness of the pilot program. 
     The report shall include the following:
       ``(A) An evaluation of the effect of the pilot program on 
     potential fraud under the insurance programs established 
     under this title.
       ``(B) A description of any barriers to implementation of 
     the pilot program.
       ``(C) Participant feedback on the pilot program.
       ``(D) Recommendations regarding the future use of smart 
     cards to address fraud under this title.
       ``(E) Data on the information provided under subsection 
     (a)(3)(G)(iii).''.

  The SPEAKER pro tempore (Mr. Abraham). Pursuant to the rule, the 
gentleman from Illinois (Mr. Roskam) and the gentleman from Michigan 
(Mr. Levin) each will control 20 minutes.
  The Chair recognizes the gentleman from Illinois.


                             General Leave

  Mr. ROSKAM. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
include extraneous material on H.R. 6690, currently under 
consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Illinois?
  There was no objection.
  Mr. ROSKAM. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, we have an opportunity to do something together on a 
bipartisan basis that can bring a level of confidence to a program that 
all of us cherish and all of us want to defend, and that is Medicare. 
Medicare is an incredibly popular program. It is a necessary program, 
and it is a program that needs all of us to defend it, particularly on 
the integrity side.
  If Medicare were to ask CMS today what their fraudulent or erroneous 
payment rate is, those two numbers together, they would come back and 
they would tell them it is about 10 percent. So, in other words, about 
$40 billion a year, Mr. Speaker, is going out the door not to benefit 
seniors, but it is going out the door either fraudulently or 
erroneously.
  I thank Mr. Blumenauer from Oregon because, together, we have been 
working on this concept which would apply the same type of technology 
that we see in so many other parts of the economy right now, and that 
is smart card technology, and use it in a Medicare setting. The 
proposal is this: Let's try it. Let's see how it works. Let's have a 
pilot program.
  Toward that end, what we are hoping and the expectation is that the 
same types of savings that we have seen in the private sector we will 
see in this sector to make sure that seniors are protected, not only 
the funds that seniors have come to rely on, but their identities and 
so forth.
  This is a concept, again, that Mr. Blumenauer and I have worked on.
  I thank Chairman Brady for his work on this bill and the attention 
that this has gotten on a bipartisan basis.

                              {time}  1500

  I think it is particularly interesting to note that AARP has weighed 
in very strongly in favor of it. Let me just read one quick snapshot 
from a letter that they sent to Mr. Blumenauer and me at the end of 
August, and I will just give you a couple of sentences.
  ``While the new cards are more secure than before, `smart cards' 
could provide even greater security, and have the potential to contain 
useful health information and facilitate care. If enacted, this pilot 
program would also help Medicare learn more about the beneficiary 
engagement and education. This technology deserves to be tested and 
evaluated.''
  Mr. Speaker, in a nutshell, this is a proposal to create a pilot 
program. I urge its passage, and I reserve the balance of my time.

                                      Committee on Ways and Means,


                                     House of Representatives,

                                Washington, DC, September 7, 2018.
     Hon. Greg Walden,
     Chairman, Committee on Energy and Commerce,
     Washington, DC.
       Dear Chairman Walden: I write to you regarding several 
     health bills the Committee on Ways and Means ordered 
     favorably reported to the House. The following bills were 
     also referred to the Committee on Energy and Commerce.
       I ask that the Committee on Energy and Commerce waive 
     formal consideration of the following bills so that they may 
     proceed expeditiously to the House Floor:
       H.R. 6662, Empowering Seniors' Enrollment Decision Act of 
     2018;
       H.R. 6690, Fighting Fraud to Protect Care for Seniors Act 
     of 2018;
       H.R. 6561, Comprehensive Care for Seniors Act of 2018; and
       H.R. 3635, Local Coverage Determination Clarification Act 
     of 2018.
       I acknowledge that by waiving formal consideration of the 
     bills, the Committee on Energy and Commerce is in no way 
     waiving its jurisdiction over the subject matter contained in 
     those provisions of the bills that fall within your Rule X 
     jurisdiction. I would support your effort to seek appointment 
     of

[[Page H8120]]

     an appropriate number of conferees on any House-Senate 
     conference involving this legislation.
       I will include a copy of our letters in the Congressional 
     Record during consideration of this legislation on the House 
     floor.
           Sincerely,
                                                      Kevin Brady,
     Chairman.
                                  ____

                                         House of Representatives,


                             Committee on Energy and Commerce,

                                Washington, DC, September 7, 2018.
     Hon. Kevin Brady,
     Chairman, Committee on Ways and Means,
     Washington, DC.
       Dear Chairman Brady: Thank you for your letter regarding 
     H.R. 3635, Local Coverage Determination Clarification Act of 
     2018; H.R. 6561, Comprehensive Care for Seniors Act of 2018; 
     H.R. 6662, Empowering Seniors' Enrollment Decision Act of 
     2018; and H.R. 6690, Fighting Fraud to Protect Care for 
     Seniors Act of 2018.
       The Committee on Energy and Commerce will forgo 
     consideration of both bills so that they may proceed 
     expeditiously to the House Floor.
       I appreciate your assurance that by forgoing action on 
     these bills, the Committee is in no way waiving its 
     jurisdiction over the subject matter contained in the bills. 
     I also appreciate your offer of support for the appointment 
     of conferees from the Committee to any House-Senate 
     conference involving this legislation.
           Sincerely,
                                                      Greg Walden,
                                                         Chairman.

  Mr. LEVIN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, this is the first of four bills that came out of the 
Ways and Means Committee. They came out without much controversy. The 
only one that really had any is this first bill. I am not sure we will 
have any speakers on our side. I will say a few words about this bill 
in a few minutes.
  I first want to talk a bit about bipartisanship. These four bills do 
have some bipartisanship. Unfortunately, what isn't bipartisan is the 
basic dispute about healthcare and about the continuation of the reform 
that we on the Democratic side started some years ago with our 
President.
  It has turned out to be an important piece of legislation--I think 
historic--and the more people look at it and the more they are covered 
by it, the greater the support for it.
  Unfortunately, unlike the bipartisanship in these four bills, ACA 
continues to be hit by the worst kind of partisanship and continued 
efforts to undermine and destroy it.
  In October 2017, the administration ended cost-sharing reduction 
subsidies. That has led to premium increases of 20 to 25 percent across 
the Nation. In June of this year, the Trump administration expanded the 
reach of junk insurance policies that have weakened the risk pool, and 
these policies are not subject to consumer protections.
  In July, we saw the impact of this firsthand in Michigan. The 
administration announced another cut in so-called navigator 
organizations. They slashed the funding from $63 million just 2 years 
ago to $10 million. It had an impact throughout this country, and I saw 
firsthand what it meant in the State of Michigan.
  Essentially, the administration said we are going to cut and 
essentially eliminate help for outreach to people in terms of their 
knowing about the ACA and how, as millions of others have, they can 
obtain coverage.
  I think maybe most disturbing, last week, the Federal court heard 
arguments in Texas v. the United States. It is a lawsuit launched by 
Republicans that could jeopardize healthcare for 130 million patients 
living with preexisting conditions. The Republicans like to point to 
language that says that won't happen. But essentially, I think they 
have their heads in the sand on this if the court were to rule in favor 
of the suit. I think, to the disgrace of the administration, they 
decided not to defend the government's position.
  So we are here today with bipartisan bills, and it is really sad--
indeed, worse than that. We haven't had a single hearing on any of the 
issues I mentioned. And the Republicans, while they come here and talk 
about bipartisanship, which has been so essential until recent years 
when it comes to healthcare, they now essentially are engaging in very 
partisan efforts to undermine healthcare for millions and millions of 
people.
  So let me just say, Mr. Speaker, a brief word about this. Mr. Roskam 
has been working on this for a long time, working with Mr. Blumenauer, 
and I think the gentleman's efforts to strive for some bipartisanship 
have been a positive.
  As I said at the beginning, of all four bills, this one had the most 
discussion in our committee and had some disagreement. The smart card 
idea has been examined by a number of entities, including the 
Government Accountability Office. According to their 2016 report--and I 
have copies of their report of 2016, and there is also another report 
that relates to this--according to that, their estimate was that smart 
cards would help in only a minority of cases. In fact, of the 739 
healthcare fraud cases that the GAO examined, only 18 would have been 
fully addressed had Medicare used these cards. That is only about 2 
percent of the cases.
  Also, transition to smart cards is going to be significant, and the 
estimate is that it is going to cost about $40 million. As we discussed 
in the committee, some thought there might be a better use of this 
money.
  Be that as it may, this has been worked on, and Mr. Roskam and Mr. 
Blumenauer have combined forces to undertake this 3-year pilot program.
  So under those circumstances, wishing we had more bipartisanship on 
healthcare issues that run more deeply and affect the needs of people 
even more broadly, with that caveat, I do not suggest anything but 
support for this bill.
  Mr. Speaker, I have no further conversation, and I yield back the 
balance of my time.
  Mr. ROSKAM. Mr. Speaker, I want to thank Mr. Levin for his 
observations about this bill, that it is created in a spirit of 
bipartisanship, and I appreciate his support for it.
  I think it is interesting, just a little bit of a point of 
clarification, because we were able to discuss in the committee the GAO 
report. There are two facets of it. There are two numbers, and those 
people who are tracking this closely will care about it. There is one 2 
percent representation and then a 22 percent representation.
  Here is the story. The GAO said only 2 percent of cases that they 
evaluated would have been completely changed by this. I think if we 
were talking about any other thing in Medicare as it relates to 2 
percent, we would be chasing it. Be that as it may, 2 percent would be 
completely changed. Twenty-two percent of the cases they evaluated, 
however, would be impacted in some way.
  So the bottom line here is that we have an opportunity to adopt 
technology at a cost of about $40 million, we are told, to pursue $40 
billion in fraud and error. That is good math any day of the week. Both 
sides of the aisle recognize it.
  Mr. Speaker, I urge its passage, and I yield back the balance of my 
time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Illinois (Mr. Roskam) that the House suspend the rules 
and pass the bill, H.R. 6690, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________