[114th Congress Public Law 115]
[From the U.S. Government Publishing Office]



[[Page 129 STAT. 3131]]

Public Law 114-115
114th Congress

                                 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. <<NOTE: Dec. 28, 
                          2015 -  [S. 2425]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, <<NOTE: Patient Access 
and Medicare Protection Act.>> 
SECTION 1. <<NOTE: 42 USC 1305 note.>>  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.

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                          (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) <<NOTE: Recommenda- tions.>>  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)

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                      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) <<NOTE: Deadline.>>  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) <<NOTE: Deadline.>>  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) <<NOTE: 42 USC 1395w-4 note.>>  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

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                    (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) <<NOTE: Applicability. 42 USC 1395kk-1 note.>>  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

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        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. <<NOTE: 42 USC 1395ddd note.>>  IMPROVING THE SHARING OF 
                    DATA BETWEEN THE FEDERAL GOVERNMENT AND STATE 
                    MEDICAID PROGRAMS.

    (a) <<NOTE: Plan.>>  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) <<NOTE: 42 USC 1305ddd note.>>  Providing States With Data on 
Improper Payments Made for Items or Services Provided to Dual Eligible 
Individuals.--
            (1) <<NOTE: Plan.>>  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

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        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.

    Approved December 28, 2015.

LEGISLATIVE HISTORY--S. 2425:
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CONGRESSIONAL RECORD, Vol. 161 (2015):
            Dec. 18, considered and passed Senate and House.

                                  <all>