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Title II — Improving data sharing

H.R. 2305 · 113th Congress · Jun 10, 2013 · Lineage

II Improving data sharing

Sec. 201 Access to the National Directory of New Hires

Section 453(j) of the Social Security Act (42 U.S.C. 653 (j)) is amended by adding at the end of the following new paragraph:

“(12) Information comparisons and disclosures to assist in administration of the Medicare program and State health subsidy programs

“(A) Disclosure to the Administrator of the Centers for Medicare & Medicaid Services—The Administrator of the Centers for Medicare & Medicaid shall have access to the information in the National Directory of New Hires for purposes of determining the eligibility of an applicant for, or enrollee in, the Medicare program under title XVIII or an applicable State health subsidy program (as defined in section 1413(e) of the Patient Protection and Affordable Care Act (42 U.S.C. 18083(e))).

“(B) Disclosure to the Inspector General of the Department of Health and Human Services

“(i) In general—If the Inspector General of the Department of Health and Human Services transmits to the Secretary the names and social security account numbers of individuals, the Secretary shall disclose to the Inspector General information on such individuals and their employers maintained in the National Directory of New Hires.

“(ii) Use of information—The Inspector General of the Department of Health and Human Services may use information provided under clause (i) only for purposes of—

“(I) determining the eligibility of an applicant for, or enrollee in, the Medicare program under title XVIII or an applicable State health subsidy program (as defined in section 1413(e) of the Patient Protection and Affordable Care Act (42 U.S.C. 18083(e))); or

“(II) evaluating the integrity of the Medicare program or an applicable State health subsidy program (as so defined).

“(C) Disclosure to State agencies

“(i) In general—If, for purposes of administering an applicable State health subsidy program (as defined in section 1413(e) of the Patient Protection and Affordable Care Act (42 U.S.C. 18083(e))), a State agency responsible for administering such program transmits to the Secretary the names and social security account numbers of individuals, the Secretary shall disclose to such State agency information on such individuals and their employers maintained in the National Directory of New Hires, subject to this subparagraph.

“(ii) Condition on disclosure by the Secretary—The Secretary shall make a disclosure under clause (i) only to the extent that the Secretary determines that the disclosure would not interfere with the effective operation of the program under this part.

“(iii) Use and disclosure of information by State agencies

“(I) In general—A State agency may not use or disclose information provided under clause (i) except for purposes of administering a program referred to in clause (i).

“(II) Information security—The State agency shall have in effect data security and control policies that the Secretary finds adequate to ensure the security of information obtained under clause (i) and to ensure that access to such information is restricted to authorized persons for purposes of authorized uses and disclosures.

“(III) Penalty for misuse of information—An officer or employee of the State agency who fails to comply with this clause shall be subject to the sanctions under subsection (l)(2) to the same extent as if such officer or employee were an officer or employee of the United States.

“(iv) Procedural requirements—State agencies requesting information under clause (i) shall adhere to uniform procedures established by the Secretary governing information requests and data matching under this paragraph.

“(v) Reimbursement of costs—The State agency shall reimburse the Secretary, in accordance with subsection (k)(3), for the costs incurred by the Secretary in furnishing the information requested under this subparagraph.”

Sec. 202 Improving the sharing of data between the Federal Government and State Medicaid programs

(a)
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 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)
Providing states with data on improper payments made for items or services provided to dual eligible individuals—
(1)
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 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.

Sec. 203 Improving claims processing and detection of fraud within the Medicaid and CHIP programs

(a)
Medicaid— Section 1903(i) of the Social Security Act (42 U.S.C. 1396b(i)), as amended by section 2001(a)(2)(B) of the Patient Protection and Affordable Care Act (Public Law 111–148), is amended—
(1)
in paragraph (25), by striking “or” at the end;
(2)
in paragraph (26), by striking the period and inserting “; or”; and
(3)
by adding after paragraph (26), the following new paragraph:

“(27) with respect to amounts expended for an item or service for which medical assistance is provided under the State plan or under a waiver of such plan unless the claim for payment for such item or service contains a valid beneficiary identification number that, for purposes of the individual who received such item or service, has been determined by the State agency to correspond to an individual who is eligible to receive benefits under the State plan or waiver.”

(b)
CHIP— Section 2107(e)(1)(I) of the Social Security Act (42 U.S.C. 1397gg(e)(1)(I)) is amended by striking “and (17)” and inserting “(17), and (27)”.