P.L. 114–115, Approved December 28, 2015 (129 Stat. 3131)

Patient Access and Medicare Protection Act

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SEC 1. [42U.S.C. 1305 note] CLARIFICATION OF WAIVER AUTHORITY REGARDING PACE PROGRAMS.

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. 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 “Patient Access and Medicare Protection Act”.

Approved December 28, 2015.

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SEC. 2. 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) shall not be considered as potentially misvalued services for purposes of this subparagraph and subparagraph (O) for 2017 and 2018.”.

SEC. 4.  ENSURING FLEXIBILITY IN APPLYING HARDSHIP EXCEPTION FOR MEANINGFUL USE FOR 2015 EHR REPORTING PERIODFOR 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.”.

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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.

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(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.”.

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