[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.
[[Page 129 STAT. 3132]]
(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)
[[Page 129 STAT. 3133]]
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
[[Page 129 STAT. 3134]]
(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
[[Page 129 STAT. 3135]]
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
[[Page 129 STAT. 3136]]
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:
---------------------------------------------------------------------------
CONGRESSIONAL RECORD, Vol. 161 (2015):
Dec. 18, considered and passed Senate and House.
<all>