P.L. 114–113, Approved December 18, 2015 (129 Stat. 2241)

Consolidated Appropriations Act, 2016

An Act making appropriations for military construction, the Department of Veterans Affairs, and related agencies for the fiscal year ending September 30, 2016, and for other purposes. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled. This Act may be cited as the “Consolidated Appropriations Act, 2016”.

Approved December 18, 2015.

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Title II — Department of Health and Human Services Appropriations Act, 2016.

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SEC. 231. TEMPORARY EXCEPTION FOR CERTAIN SEVERE WOUND DISCHARGES FROM CERTAIN LONG-TERM CARE HOSPITALS

Section 1886(m)(6) of the Social Security Act (42 U.S.C. 1395ww(m)(6)) is amended —

(1)  in subparagraph (A)(i) by striking ``subparagraph (C)'' and inserting ``subparagraphs (C) and (E)''; and

(2)  by adding at the end the following new subparagraph:

“(E)  Temporary exception for certain severe wound discharges from certain long-term care hospitals. —

“(i)  In general.—In the case of a discharge occurring prior to January 1, 2017, subparagraph (A)(i) shall not apply (and payment shall be made to a long-term care hospital without regard to this paragraph) if such discharge —

“(I)  is from a long-term care hospital that is —

“(aa)  identified by the amendment made by section 4417(a) of the Balanced Budget Act of 1997 (42 U.S.C. 1395ww note, Public Law 105-33); and

“(bb)  located in a rural area (as defined in subsection (d)(2)(D)) or treated as being so located pursuant to subsection (d)(8)(E); and

“(II)  the individual discharged has a severe wound.

“(ii)  Severe wound defined.—In this subparagraph, the term ‘severe wound’ means a stage 3 wound, stage 4 wound, unstageable wound, non-healing surgical wound, infected wound, fistula, osteomyelitis, or wound with morbid obesity, as identified in the claim from the long-term care hospital.”.

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TITLE V — MEDICARE AND MEDICAID PROVISIONS

SEC.501. MEDICARE IMPROVEMENT FUND.

Section 1898(b)(1) of the Social Security Act (42 U.S.C. 1395iii(b)(1)) is amended by striking ``$205,000,000'' and inserting ``$5,000,000''.

SEC. 502. MEDICARE PAYMENT INCENTIVE FOR THE TRANSITION FROM TRADITIONAL X-RAY IMAGING TO DIGITAL RADIOGRAPHY AND OTHER MEDICARE IMAGING PAYMENT PROVISION.

(a) Physician Fee Schedule.—

(1) Payment incentive for transition.—

(A)  In general.—Section 1848(b) of the Social Security Act (42 U.S.C. 1395w-4(b)) is amended by adding at the end the following new paragraph:

“(9) Special rule to incentivize transition from traditional x-ray imaging to digital radiography.—

“(A)  Limitation on payment for film x-ray imaging services.—In the case of an imaging service (including the imaging portion of a service) that is an X-ray taken using film and that is furnished during 2017 or a subsequent year, the payment amount for the technical component (including the technical component portion of a global service) of such service that would otherwise be determined under this section (without application of this paragraph and before application of any other adjustment under this section) for such year shall be reduced by 20 percent.

“(B)  Phased-in limitation on payment for computed radiography imaging services.—In the case of an imaging service (including the imaging portion of a service) that is an X-ray taken using computed radiography technology—

“(i)  in the case of such a service furnished during 2018, 2019, 2020, 2021, or 2022, the payment amount for the technical component (including the technical component portion of a global service) of such service that would otherwise be determined under this section (without application of this paragraph and before application of any other adjustment under this section) for such year shall be reduced by 7 percent; and

“(ii)  in the case of such a service furnished during 2023 or a subsequent year, the payment amount for the technical component (including the technical component portion of a global service) of such service that would otherwise be determined under this section (without application of this paragraph and before application of any other adjustment under this section) for such year shall be reduced by 10 percent.

“(C)  Computed radiography technology defined.—For purposes of this paragraph, the term ‘computed radiography technology’ means cassette-based imaging which utilizes an imaging plate to create the image involved.

“(D)  Implementation.—In order to implement this paragraph, the Secretary shall adopt appropriate mechanisms which may include use of modifiers.”.

(B)  Exemption from budget neutrality.—Section 1848(c)(2)(B)(v) of the Social Security Act (42 U.S.C. 1395w-4(c)(2)(B)(v)) is amended by adding at the end the following new subclause:

“(X)  Reduced expenditures attributable to incentives to transition to digital radiography.—Effective for fee schedules established beginning with 2017, reduced expenditures attributable to subparagraph (A) of subsection (b)(9) and effective for fee schedules established beginning with 2018, reduced expenditures attributable to subparagraph (B) of such subsection.”.

(2) Reduction of discount in payment for professional component of multiple imaging services.—

(A)  In general.—Section 1848(b) of the Social Security Act (42 U.S.C. 1395w-4(b)), as amended by paragraph (1), is amended by adding at the end the following new paragraph:

“(10)  Reduction of discount in payment for professional component of multiple imaging services.—In the case of the professional component of imaging services furnished on or after January 1, 2017, instead of the 25 percent reduction for multiple procedures specified in the final rule published by the Secretary in the Federal Register on November 28, 2011, as amended in the final rule published by the Secretary in the Federal Register on November 16, 2012, the reduction percentage shall be 5 percent.”.

(B)  Exemption from budget neutrality.—Section 1848(c)(2)(B)(v) of the Social Security Act (42 U.S.C. 1395w 4(c)(2)(B)(v)), as amended by paragraph (1), is amended by adding at the end by the following new subclause:

“(XI)  Discount in payment for professional component of imaging services.—Effective for fee schedules established beginning with 2017, reduced expenditures attributable to subsection (b)(10).”.

(C)  Conforming amendment.—Section 220(i) of the Protecting Access to Medicare Act of 2014 (42 U.S.C. 1395w-4 note) is repealed.

(b)  Payment Incentive for Transition Under Hospital Outpatient Prospective Payment System.—Section 1833(t)(16) of the Social Security Act (42 U.S.C. 1395(t)(16)) is amended by adding at the end the following new subparagraph:

“(F)  Payment incentive for the transition from traditional x-ray imaging to digital radiography.—Notwithstanding the previous provisions of this subsection:

“(i)  Limitation on payment for film x-ray imaging services.—In the case of an imaging service that is an X-ray taken using film and that is furnished during 2017 or a subsequent year, the payment amount for such service (including the X- ray component of a packaged service) that would otherwise be determined under this section (without application of this paragraph and before application of any other adjustment under this subsection) for such year shall be reduced by 20 percent.

“(ii)  Phased-in limitation on payment for computed radiography imaging services.—In the case of an imaging service that is an X-ray taken using computed radiography technology (as defined in section 1848(b)(9)(C)) —

“(I)  in the case of such a service furnished during 2018, 2019, 2020, 2021, or 2022, the payment amount for such service (including the X-ray component of a packaged service) that would otherwise be determined under this section (without application of this paragraph and before application of any other adjustment under this subsection) for such year shall be reduced by 7 percent; and

“(II)  in the case of such a service furnished during 2023 or a subsequent year, the payment amount for such service (including the X-ray component of a packaged service) that would otherwise be determined under this section (without application of this paragraph and before application of any other adjustment under this subsection) for such year shall be reduced by 10 percent.

“(iii)  Application without regard to budget neutrality.—The reductions made under this subparagraph—

“(I)  shall not be considered an adjustment under paragraph (2)(E); and

“(II)  shall not be implemented in a budget neutral manner.

“(iv)  Implementation.—In order to implement this subparagraph, the Secretary shall adopt appropriate mechanisms which may include use of modifiers.”.

SEC. 503. LIMITING FEDERAL MEDICAID REIMBURSEMENT TO STATES FOR DURABLE MEDICAL EQUIPMENT (DME) TO MEDICARE PAYMENT RATES.

(a) Medicaid Reimbursement.—

(1)  In general.—Section 1903(i) of the Social Security Act (42 U.S.C. 1396b(i)) is amended—

(A)  in paragraph (25), by striking “or” at the end;

(B)  in paragraph (26), by striking the period at the end and inserting “; or”; and

(C)  by inserting after paragraph (26) the following new paragraph:

“(27)  with respect to any amounts expended by the State on the basis of a fee schedule for items described in section 1861(n) and furnished on or after January 1, 2019, as determined in the aggregate with respect to each class of such items as defined by the Secretary, in excess of the aggregate amount, if any, that would be paid for such items within such class on a fee-for-service basis under the program under part B of title XVIII, including, as applicable, under a competitive acquisition program under section 1847 in an area of the State.”.

(2)  Rule of construction.—Nothing in the amendments made by paragraph (1) shall be construed to prohibit a State Medicaid program from providing medical assistance for durable medical equipment for which payment is denied or not available under the Medicare program under title XVIII of such Act.

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SEC.504. TREATMENT OF DISPOSABLE DEVICES.

(a)  In General.—Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection:

“(s) Payment for Applicable Disposable Devices.—

“(1)  Separate payment.—The Secretary shall make a payment (separate from the payments otherwise made under section 1895) in the amount established under paragraph (3) to a home health agency for an applicable disposable device (as defined in paragraph (2)) when furnished on or after January 1, 2017, to an individual who receives home health services for which payment is made under section 1895(b).

“(2)  Applicable disposable device.—In this subsection, the term applicable disposable device means a disposable device that, as determined by the Secretary, is—

“(A)  a disposable negative pressure wound therapy device that is an integrated system comprised of a non- manual vacuum pump, a receptacle for collecting exudate, and dressings for the purposes of wound therapy; and

“(B)  a substitute for, and used in lieu of, a negative pressure wound therapy durable medical equipment item that is an integrated system of a negative pressure vacuum pump, a separate exudate collection canister, and dressings that would otherwise be covered for individuals for such wound therapy.

“(3)  Payment amount.—The separate payment amount established under this paragraph for an applicable disposable device for a year shall be equal to the amount of the payment that would be made under section 1833(t) (relating to payment for covered OPD services) for the year for the Level I Healthcare Common Procedure Coding System (HCPCS) code for which the description for a professional service includes the furnishing of such device.''.

(b) Conforming Amendments.—

(1)  Coinsurance.—Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—

(A)  by striking “and (Z)” and inserting “(Z)”; and

(B)  by inserting before the semicolon at the end the following:

“, and (AA) with respect to an applicable disposable device (as defined in paragraph (2) of section 1834(s)) furnished to an individual pursuant to paragraph (1) of such section, the amount paid shall be equal to 80 percent of the lesser of the actual charge or the amount determined under paragraph (3) of such section”.

(2)  Home health.—Section 1861(m)(5) of the Social Security Act (42 U.S.C. 1395x(m)(5)) is amended by inserting “and applicable disposable devices (as defined in section 1834(s)(2))” after “durable medical equipment”.

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(d)  Effective Date.—The amendments made by this section shall apply to items furnished on or after January 1, 2017.

 

TITLE VI — PUERTO RICO

sec. 601.  Section 1886(d)(9)(E) of the Social Security Act (42 U.S.C. 1395ww(d)(9)(E)) is amended—

(1)  by striking “and” at the end of clause (iii);

(2)  in clause (iv)—

(A)  by inserting “and before January 1, 2016,” after “2004,”; and

(B)  by striking the period at the end and inserting “; and”; and

(3)  by adding at the end the following new clause:

“(v)  on or after January 1, 2016, the applicable Puerto Rico percentage is 0 percent and the applicable Federal percentage is 100 percent.”.

SEC. 602. APPLICATION OF MEDICARE HITECH PAYMENTS TO HOSPITALS IN PUERTO RICO.

(a)  In General.—Subsection (n)(6)(B) of section 1886 of the Social Security Act (42 U.S.C. 1395ww) is amended by striking “subsection (d) hospital” and inserting “hospital that is a subsection (d) hospital or a subsection (d) Puerto Rico hospital”.

(b) Conforming Amendments.—

(1)  Subsection (b)(3)(B)(ix) of section 1886 of the Social Security Act (42 U.S.C. 1395ww) is amended—

(A)  in subclause (I), by striking “(n)(6)(A)” and inserting “(n)(6)(B)”; and

(B)  in subclause (II), by striking “a subsection (d) hospital” and inserting “an eligible hospital”.

(2)  Paragraphs (2) and (4)(A) of section 1853(m) of the Social Security Act (42 U.S.C. 1395w-23(m)) are each amended by striking “1886(n)(6)(A)” and inserting “1886(n)(6)(B)”.

(c)  Implementation.—Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement the amendments made by this section by program instruction or otherwise.

(d)  Effective Date.—The amendments made by this section shall apply as if included in the enactment of the American Recovery and Reinvestment Act of 2009 (Public Law 111-5), except that, in order to take into account delays in the implementation of this section, in applying subsections (b)(3)(B)(ix), (n)(2)(E)(ii), and (n)(2)(G)(i) of section 1886 of the Social Security Act, as amended by this section, any reference in such subsections to a particular year shall be treated with respect to a subsection (d) Puerto Rico hospital as a reference to the year that is 5 years after such particular year (or 7 years after such particular year in the case of applying subsection (b)(3)(B)(ix) of such section).

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