Sec. 201 Extension of the work geographic index floor under the Medicare program
Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w–4(e)(1)(E)) is amended by striking “2020” and inserting “2023”.
Title II — Medicare Extenders
II Medicare Extenders
Sec. 202 Extension of funding outreach and assistance for low-income programs
Additional funding for State health insurance programs— Subsection (a)(1)(B) of section 119 of the Medicare Improvements for Patients and Providers Act of 2008 (42 U.S.C. 1395b–3 note), as amended by section 3306 of the Patient Protection and Affordable Care Act (Public Law 111–148), section 610 of the American Taxpayer Relief Act of 2012 (Public Law 112–240), section 1110 of the Pathway for SGR Reform Act of 2013 (Public Law 113–67), section 110 of the Protecting Access to Medicare Act of 2014 (Public Law 113–93), section 208 of the Medicare Access and CHIP Reauthorization Act of 2015 (Public Law 114–10), and section 50207 of the Bipartisan Budget Act of 2018 (Public Law 115–123), is amended—
in clause (vii), by striking “and” at the end;
in clause (viii), by striking “and” at the end;
in clause (ix), by striking the period at the end and inserting “; and”; and
by inserting after clause (ix) the following new clause:
“(x) for each of fiscal years 2020 through 2022, of $15,000,000.”
Additional funding for area agencies on aging— Subsection (b)(1)(B) of such section 119, as so amended, is amended—
in clause (vii), by striking “and” at the end;
in clause (viii), by striking “and” at the end;
in clause (ix), by striking the period at the end and inserting “; and”; and
by inserting after clause (ix) the following new clause:
“(x) for each of fiscal years 2020 through 2022, of $15,000,000.”
Additional funding for aging and disability resource centers— Subsection (c)(1)(B) of such section 119, as so amended, is amended—
in clause (vii), by striking “and” at the end;
in clause (viii), by striking “and” at the end;
in clause (ix), by striking the period at the end and inserting “; and”; and
by inserting after clause (ix) the following new clause:
“(x) for each of fiscal years 2020 through 2022, of $5,000,000.”
Additional funding for contract with the national center for benefits and outreach enrollment— Subsection (d)(2) of such section 119, as so amended, is amended—
in clause (vii), by striking “and” at the end;
in clause (viii), by striking “and” at the end;
in clause (ix), by striking the period at the end and inserting “; and”; and
by inserting after clause (ix) the following new clause:
“(x) for each of fiscal years 2020 through 2022, of $15,000,000.”
Sec. 203 Extension of funding for quality measure endorsement, input, and selection under the Medicare program
by striking “and $7,500,000” and inserting “$7,500,000”; and
by striking “and 2019.” and inserting “and 2019, and $30,000,000 for each of fiscal years 2020 through 2022.”.
Input for removal of measures— Section 1890(b) of the Social Security Act (42 U.S.C. 1395aaa(b)) is amended by inserting after paragraph (3) the following:
“(4) Removal of Measures—The entity may, through the multistakeholder groups convened under paragraph (7)(A), provide input to the Secretary on quality and efficiency measures described in paragraph (7)(B) that could be considered for removal.”
Prioritization of measure endorsement— Section 1890(b) of the Social Security Act (42 U.S.C. 1395aaa(b)), as amended by subsection (b), is further amended by adding at the end the following:
“(9) Prioritization of measure endorsement—The entity—
“(A) during the period beginning on the date of the enactment of this paragraph and ending on December 31, 2023, shall prioritize the endorsement of measures relating to maternal morbidity and mortality by the entity with a contract under subsection (a) in connection with endorsement of measures described in paragraph (2); and
“(B) on and after January 1, 2024, may prioritize the endorsement of such measures by such entity.”
Sec. 204 Extension of the Independence at Home Medical Practice Demonstration Program under the Medicare program
In general— Section 1866E(e)(1) of the Social Security Act (42 U.S.C. 1395cc–5(e)(1)) is amended by striking “7-year” and inserting “10-year”.
Effective date— The amendment made by subsection (a) shall take effect as if included in the enactment of Public Law 111–148.
Sec. 205 Extension of appropriations and transfers to the Patient-Centered Outcomes Research Trust Fund; extension of certain health insurance fees
In general—
in subsection (b)(1)(E), by striking “2014” and all that follows through “2019” and inserting “2014 through 2022”;
in subsection (d)(2)(A), by striking “2019” and inserting “2022”; and
in subsection (f), by striking “2019” and inserting “2022”.
Title XI— Section 1183(a)(2) of the Social Security Act (42 U.S.C. 1320e–2(a)(2)) is amended by striking “2014” and all that follows through “2019” and inserting “2014 through 2022”.
Extension of certain health insurance fees—
Health insurance policies— Section 4375(e) of the Internal Revenue Code of 1986 is amended by striking “2019” and inserting “2022”.
Self-insured health plans— Section 4376(e) of the Internal Revenue Code of 1986 is amended by striking “2019” and inserting “2022”.
Sec. 206 Transitional coverage and retroactive Medicare part D coverage for certain low-income beneficiaries
by redesignating subsection (e) as subsection (f); and
by adding after subsection (d) the following new subsection:
“(e) Limited income newly eligible transition program
“(1) In general—Beginning not later than January 1, 2021, the Secretary shall carry out a program to provide transitional coverage for covered part D drugs for LI NET eligible individuals in accordance with this subsection.
“(2) LI net eligible individual defined—For purposes of this subsection, the term LI NET eligible individual means a part D eligible individual who—
“(A) meets the requirements of clauses (ii) and (iii) of subsection (a)(3)(A); and
“(B) has not yet enrolled in a prescription drug plan or an MA–PD plan, or, who has so enrolled, but with respect to whom coverage under such plan has not yet taken effect.
“(3) Transitional coverage—For purposes of this subsection, the term transitional coverage means, with respect to an LI NET eligible individual—
“(A) immediate access to covered part D drugs at the point of sale during the period that begins on the first day of the month such individual is determined to meet the requirements of clauses (ii) and (iii) of subsection (a)(3)(A) and ends on the date that coverage under a prescription drug plan or MA–PD plan takes effect with respect to such individual; and
“(B) in the case of an LI NET eligible individual who is a full-benefit dual eligible individual (as defined in section 1935(c)(6)) or a recipient of supplemental security income benefits under title XVI, retroactive coverage (in the form of reimbursement of the amounts that would have been paid under this part had such individual been enrolled in a prescription drug plan or MA–PD plan) of covered part D drugs purchased by such individual during the period that begins on the date that is the later of—
“(i) the date that such individual was first eligible for a low-income subsidy under this part; or
“(ii) the date that is 36 months prior to the date such individual enrolls in a prescription drug plan or MA–PD plan,
“(4) Program administration
“(A) Single point of contact—The Secretary shall, to the extent feasible, administer the program under this subsection through a contract with a single program administrator.
“(B) Benefit design—The Secretary shall ensure that the transitional coverage provided to LI NET eligible individuals under this subsection—
“(i) provides access to all covered part D drugs under an open formulary;
“(ii) permits all pharmacies determined by the Secretary to be in good standing to process claims under the program;
“(iii) is consistent with such requirements as the Secretary considers necessary to improve patient safety and ensure appropriate dispensing of medication; and
“(iv) meets such other requirements as the Secretary may establish.
“(5) Relationship to other provisions of this title; waiver authority
“(A) In general—The following provisions shall not apply with respect to the program under this subsection:
“(i) Paragraphs (1) and (3)(B) of section 1860D–4(a) (relating to dissemination of general information; availability of information on changes in formulary through the internet).
“(ii) Subparagraphs (A) and (B) of section 1860D–4(b)(3) (relating to requirements on development and application of formularies; formulary development).
“(iii) Paragraphs (1)(C) and (2) of section 1860D–4(c) (relating to medication therapy management program).
“(B) Waiver authority—The Secretary may waive such other requirements of titles XI and this title as may be necessary to carry out the purposes of the program established under this subsection.”
Sec. 207 Health Equity and Access for Returning Troops and Servicemembers Act of 2019
Modification of requirement for certain former members of the Armed Forces to enroll in Medicare Part B to be eligible for TRICARE for Life—
TRICARE eligibility—
In general— Subsection (d) of section 1086 of title 10, United States Code, is amended by adding at the end the following new paragraph:
“(6)
“(A) The requirement in paragraph (2)(A) to enroll in the supplementary medical insurance program under part B of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.) shall not apply to a person described in subparagraph (B) during any month in which such person is not entitled to a benefit described in subparagraph (A) of section 226(b)(2) of the Social Security Act (42 U.S.C. 426(b)(2)) if such person has received the counseling and information under subparagraph (C).
“(B) A person described in this subparagraph is a person—
“(i) who is under 65 years of age;
“(ii) who is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act pursuant to subparagraph (A) or (C) of section 226(b)(2) of such Act (42 U.S.C. 426(b)(2));
“(iii) whose entitlement to a benefit described in subparagraph (A) of such section has terminated due to performance of substantial gainful activity; and
“(iv) who is retired under chapter 61 of this title.
“(C) The Secretary of Defense shall coordinate with the Secretary of Health and Human Services and the Commissioner of Social Security to notify persons described in subparagraph (B) of, and provide information and counseling regarding, the effects of not enrolling in the supplementary medical insurance program under part B of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.), as described in subparagraph (A).”
Conforming amendment— Paragraph (2)(A) of such subsection is amended by striking “is enrolled” and inserting “except as provided by paragraph (6), is enrolled”.
Identification of persons— Section 1110a of such title is amended by adding at the end the following new subsection:
“(c) Certain individuals not required To enroll in Medicare Part B—In carrying out subsection (a), the Secretary of Defense shall coordinate with the Secretary of Health and Human Services and the Commissioner of Social Security to—
“(1) identify persons described in subparagraph (B) of section 1086(d)(6) of this title; and
“(2) provide information and counseling pursuant to subparagraph (C) of such section.”
Non-Application of Medicare Part B late enrollment penalty— Section 1839(b) of the Social Security Act (42 U.S.C. 1395r(b)) is amended, in the second sentence, by inserting “or months for which the individual can demonstrate that the individual is an individual described in paragraph (6)(B) of section 1086(d) of title 10, United States Code, who is enrolled in the TRICARE program pursuant to such section” after “an individual described in section 1837(k)(3)”.
Report— Not later than October 1, 2024, the Secretary of Defense, the Secretary of Health and Human Services, and the Commissioner of Social Security shall jointly submit to the Committees on Armed Services of the House of Representatives and the Senate, the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives, and the Committee on Finance of the Senate a report on the implementation of section 1086(d)(6) of title 10, United States Code, as added by paragraph (1). Such report shall include, with respect to the period covered by the report—
the number of individuals enrolled in TRICARE for Life who are not enrolled in the supplementary medical insurance program under part B of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.) by reason of such section 1086(d)(6); and
the number of individuals who—
are retired from the Armed Forces under chapter 61 of title 10, United States Code;
are entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act pursuant to receiving benefits for 24 months as described in subparagraph (A) or (C) of section 226(b)(2) of such Act (42 U.S.C. 426(b)(2)); and
because of such entitlement, are no longer enrolled in TRICARE Standard, TRICARE Prime, TRICARE Extra, or TRICARE Select under chapter 55 of title 10, United States Code.
Deposit of savings into Medicare improvement fund— Section 1898(b)(1) of the Social Security Act (42 U.S.C. 1395iii(b)(1)) is amended by striking “during and after fiscal year 2021, $0” and inserting “during and after fiscal year 2024, $5,000,000”.
Application— The amendments made by paragraphs (1) and (2) shall apply with respect to a person who, on or after October 1, 2023, is a person described in section 1086(d)(6)(B) of title 10, United States Code, as added by paragraph (1).
Coverage of certain DNA specimen provenance assay tests under Medicare—
Benefit—
in subsection (s)(2)—
in subparagraph (GG), by striking “and” at the end;
in subparagraph (HH), by striking the period and inserting “; and”; and
by adding at the end the following new subparagraph:
“(II) a prostate cancer DNA Specimen Provenance Assay test (DSPA test) (as defined in subsection (kkk));”
by adding at the end the following new subsection:
“(kkk) Prostate cancer DNA Specimen Provenance Assay Test—The term prostate cancer DNA Specimen Provenance Assay Test (DSPA test) means a test that, after a determination of cancer in one or more prostate biopsy specimens obtained from an individual, assesses the identity of the DNA in such specimens by comparing such DNA with the DNA that was separately taken from such individual at the time of the biopsy.”
Exclusion from coverage— Section 1862(a)(1) of the Social Security Act (42 U.S.C. 1395y(a)(1)) is amended—
in subparagraph (O), by striking “and” at the end;
in subparagraph (P), by striking the semicolon at the end and inserting “, and”; and
by adding at the end the following new subparagraph:
“(Q) in the case of a prostate cancer DNA Specimen Provenance Assay test (DSPA test) (as defined in section 1861(kkk)), unless such test is furnished on or after January 1, 2021, and before January 1, 2026, and such test is ordered by the physician who furnished the prostate cancer biopsy that obtained the specimen tested;”
Payment amount and related requirements— Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection:
“(x) Prostate cancer DNA Specimen Provenance Assay tests
“(1) Payment for covered tests
“(A) In general—Subject to subparagraph (B), the payment amount for a prostate cancer DNA Specimen Provenance Assay test (DSPA test) (as defined in section 1861(kkk)) shall be $200. Such payment shall be payment for all of the specimens obtained from the biopsy furnished to an individual that are tested.
“(B) Limitation—Payment for a DSPA test under subparagraph (A) may only be made on an assignment-related basis.
“(C) Prohibition on separate payment—No separate payment shall be made for obtaining DNA that was separately taken from an individual at the time of a biopsy described in subparagraph (A).
“(2) HCPCS code and modifier assignment
“(A) In general—The Secretary shall assign one or more HCPCS codes to a prostate cancer DNA Specimen Provenance Assay test and may use a modifier to facilitate making payment under this section for such test.
“(B) Identification of DNA match on claim—The Secretary shall require an indication on a claim for a prostate cancer DNA Specimen Provenance Assay test of whether the DNA of the prostate biopsy specimens match the DNA of the individual diagnosed with prostate cancer. Such indication may be made through use of a HCPCS code, a modifier, or other means, as determined appropriate by the Secretary.
“(3) DNA match review
“(A) In general—The Secretary shall review at least three years of claims under part B for prostate cancer DNA Specimen Provenance Assay tests to identify whether the DNA of the prostate biopsy specimens match the DNA of the individuals diagnosed with prostate cancer.
“(B) Posting on internet website—Not later than July 1, 2023, the Secretary shall post on the internet website of the Centers for Medicare & Medicaid Services the findings of the review conducted under subparagraph (A).”
by striking “and (CC)” and inserting “(CC)”; and
by inserting before the semicolon at the end the following: “, and (DD) with respect to a prostate cancer DNA Specimen Provenance Assay test (DSPA test) (as defined in section 1861(kkk)), the amount paid shall be an amount equal to 80 percent of the lesser of the actual charge for the test or the amount specified under section 1834(x)”.
Sec. 208 Exclusion of complex rehabilitative manual wheelchairs from Medicare competitive acquisition program; Non-application of Medicare fee-schedule adjustments for certain wheelchair accessories and cushions
Exclusion of complex rehabilitative manual wheelchairs from competitive acquisition program— Section 1847(a)(2)(A) of the Social Security Act (42 U.S.C. 1395w–3(a)(2)(A)) is amended—
by inserting “, complex rehabilitative manual wheelchairs (as determined by the Secretary), and certain manual wheelchairs (identified, as of October 1, 2018, by HCPCS codes E1235, E1236, E1237, E1238, and K0008 or any successor to such codes)” after “group 3 or higher”; and
by striking “such wheelchairs” and inserting “such complex rehabilitative power wheelchairs, complex rehabilitative manual wheelchairs, and certain manual wheelchairs”.
Non-Application of Medicare fee schedule adjustments for wheelchair accessories and seat and back cushions when furnished in connection with complex rehabilitative manual wheelchairs—
In general— Notwithstanding any other provision of law, the Secretary of Health and Human Services shall not, during the period beginning on January 1, 2020, and ending on December 31, 2020, 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 complex rehabilitative manual wheelchairs (as determined by the Secretary), and certain manual wheelchairs (identified, as of October 1, 2018, by HCPCS codes E1235, E1236, E1237, E1238, and K0008 or any successor to such codes).
Implementation— Notwithstanding any other provision of law, the Secretary may implement this subsection by program instruction or otherwise.