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Pub. L.
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Title V — Miscellaneous

114th Congress · Approved Apr 16, 2015 · 129 Stat. 87 · Lineage

TITLE V Miscellaneous

Subtitle A Protecting the Integrity of Medicare

SEC. 501. Prohibition of Inclusion of Social Security Account Numbers on Medicare Cards.

(a)
In General.— Section 205(c)(2)(C) of the Social Security Act (42 U.S.C. 405(c)(2)(C)) is amended—
(1)
by moving clause (x), as added by section 1414(a)(2) of the Patient Protection and Affordable Care Act, 6 ems to the left;
(2)
by redesignating clause (x), as added by section 2(a)(1) of the Social Security Number Protection Act of 2010, and clause (xi) as clauses (xi) and (xii), respectively; and
(3)
by adding at the end the following new clause:

“(xiii) The Secretary of Health and Human Services, in consultation with the Commissioner of Social Security, shall establish cost-effective procedures to ensure that a Social Security account number (or derivative thereof) is not displayed, coded, or embedded on the Medicare card issued to an individual who is entitled to benefits under part A of title XVIII or enrolled under part B of title XVIII and that any other identifier displayed on such card is not identifiable as a Social Security account number (or derivative thereof).”

(b)
Implementation.— In implementing clause (xiii) of section 205(c)(2)(C) of the Social Security Act (42 U.S.C. 405(c)(2)(C)), as added by subsection (a)(3), the Secretary of Health and Human Services shall do the following:
(1)
In general.— Establish a cost-effective process that involves the least amount of disruption to, as well as necessary assistance for, Medicare beneficiaries and health care providers, such as a process that provides such beneficiaries with access to assistance through a toll-free telephone number and provides outreach to providers.
(2)
Consideration of medicare beneficiary identified.— Consider implementing a process, similar to the process involving Railroad Retirement Board beneficiaries, under which a Medicare beneficiary identifier which is not a Social Security account number (or derivative thereof) is used external to the Department of Health and Human Services and is convertible over to a Social Security account number (or derivative thereof) for use internal to such Department and the Social Security Administration.
(c)
Funding for Implementation.— For purposes of implementing the provisions of and the amendments made by this section, the Secretary of Health and Human Services shall provide for the following transfers from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and from the Federal Supplementary Medical Insurance Trust Fund established under section 1841 of such Act (42 U.S.C. 1395t), in such proportions as the Secretary determines appropriate:
(1)
To the Centers for Medicare & Medicaid Program Management Account, transfers of the following amounts:
(A)
For fiscal year 2015, $65,000,000, to be made available through fiscal year 2018.
(B)
For each of fiscal years 2016 and 2017, $53,000,000, to be made available through fiscal year 2018.
(C)
For fiscal year 2018, $48,000,000, to be made available until expended.
(2)
To the Social Security Administration Limitation on Administration Account, transfers of the following amounts:
(A)
For fiscal year 2015, $27,000,000, to be made available through fiscal year 2018.
(B)
For each of fiscal years 2016 and 2017, $22,000,000, to be made available through fiscal year 2018.
(C)
For fiscal year 2018, $27,000,000, to be made available until expended.
(3)
To the Railroad Retirement Board Limitation on Administration Account, the following amount:
(A)
For fiscal year 2015, $3,000,000, to be made available until expended.
(d)
Effective Date.—
(1)
In general.— Clause (xiii) of section 205(c)(2)(C) of the Social Security Act (42 U.S.C. 405(c)(2)(C)), as added by subsection (a)(3), shall apply with respect to Medicare cards issued on and after an effective date specified by the Secretary of Health and Human Services, but in no case shall such effective date be later than the date that is four years after the date of the enactment of this Act.
(2)
Reissuance.— The Secretary shall provide for the reissuance of Medicare cards that comply with the requirements of such clause not later than four years after the effective date specified by the Secretary under paragraph (1).

SEC. 502. Preventing Wrongful Medicare Payments for Items and Services Furnished to Incarcerated Individuals, Individuals Not Lawfully Present, and Deceased Individuals.

(a)
Requirement for the Secretary To Establish Policies and Claims Edits Relating to Incarcerated Individuals, Individuals Not Lawfully Present, and Deceased Individuals.— Section 1874 of the Social Security Act (42 U.S.C. 1395kk) is amended by adding at the end the following new subsection:

“(f) Requirement for the Secretary To Establish Policies and Claims Edits Relating to Incarcerated Individuals, Individuals Not Lawfully Present, and Deceased Individuals.—The Secretary shall establish and maintain procedures, including procedures for using claims processing edits, updating eligibility information to improve provider accessibility, and conducting recoupment activities such as through recovery audit contractors, in order to ensure that payment is not made under this title for items and services furnished to an individual who is one of the following:

“(1) An individual who is incarcerated.

“(2) An individual who is not lawfully present in the United States and who is not eligible for coverage under this title.

“(3) A deceased individual.”

(b)
Report.— Not later than 18 months after the date of the enactment of this section, and periodically thereafter as determined necessary by the Office of Inspector General of the Department of Health and Human Services, such Office shall submit to Congress a report on the activities described in subsection (f) of section 1874 of the Social Security Act (42 U.S.C. 1395kk), as added by subsection (a), that have been conducted since such date of enactment.

SEC. 503. Consideration of Measures Regarding Medicare Beneficiary Smart Cards.

To the extent the Secretary of Health and Human Services determines that it is cost effective and technologically viable to use electronic Medicare beneficiary and provider cards (such as cards that use smart card technology, including an embedded and secure integrated circuit chip), as presented in the Government Accountability Office report required by the conference report accompanying the Consolidated Appropriations Act, 2014 (Public Law 113–76), the Secretary shall consider such measures as determined appropriate by the Secretary to implement such use of such cards for beneficiary and provider use under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.). In the case that the Secretary considers measures under the preceding sentence, the Secretary shall submit to the Committees on Ways and Means and Energy and Commerce of the House of Representatives, and to the Committee on Finance of the Senate, a report outlining the considerations undertaken by the Secretary under such sentence.

SEC. 504. Modifying Medicare Durable Medical Equipment Face-To-Face Encounter Documentation Requirement.

(a)
In General.— Section 1834(a)(11)(B)(ii) of the Social Security Act (42 U.S.C. 1395m(a)(11)(B)(ii)) is amended—
(1)
by striking “ the physician documenting that”; and
(2)
by striking “ has had a face-to-face encounter” and inserting “ documenting such physician, physician assistant, practitioner, or specialist has had a face-to-face encounter”.
(b)
Implementation.— Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement the amendments made by subsection (a) by program instruction or otherwise.

SEC. 505. Reducing Improper Medicare Payments.

(a)
Medicare Administrative Contractor Improper Payment Outreach and Education Program.— Section 1874A of the Social Security Act (42 U.S.C. 1395kk–1) is amended—
(1)
in subsection (a)(4)—
(A)
by redesignating subparagraph (G) as subparagraph (H); and
(B)
by inserting after subparagraph (F) the following new subparagraph:

“(G) Improper payment outreach and education program.—Having in place an improper payment outreach and education program described in subsection (h).”

; and

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

“(h) Improper Payment Outreach and Education Program.—

“(1) In general.—In order to reduce improper payments under this title, each medicare administrative contractor shall establish and have in place an improper payment outreach and education program under which the contractor, through outreach, education, training, and technical assistance or other activities, shall provide providers of services and suppliers located in the region covered by the contract under this section with the information described in paragraph (2). The activities described in the preceding sentence shall be conducted on a regular basis.

“(2) Information to be provided through activities.—The information to be provided under such payment outreach and education program shall include information the Secretary determines to be appropriate, which may include the following information:

“(A) A list of the providers’ or suppliers’ most frequent and expensive payment errors over the last quarter.

“(B) Specific instructions regarding how to correct or avoid such errors in the future.

“(C) A notice of new topics that have been approved by the Secretary for audits conducted by recovery audit contractors under section 1893(h).

“(D) Specific instructions to prevent future issues related to such new audits.

“(E) Other information determined appropriate by the Secretary.

“(3) Priority.—A medicare administrative contractor shall give priority to activities under such program that will reduce improper payments that are one or more of the following:

“(A) Are for items and services that have the highest rate of improper payment.

“(B) Are for items and service that have the greatest total dollar amount of improper payments.

“(C) Are due to clear misapplication or misinterpretation of Medicare policies.

“(D) Are clearly due to common and inadvertent clerical or administrative errors.

“(E) Are due to other types of errors that the Secretary determines could be prevented through activities under the program.

“(4) Information on improper payments from recovery audit contractors.—

“(A) In general.—In order to assist medicare administrative contractors in carrying out improper payment outreach and education programs, the Secretary shall provide each contractor with a complete list of the types of improper payments identified by recovery audit contractors under section 1893(h) with respect to providers of services and suppliers located in the region covered by the contract under this section. Such information shall be provided on a time frame the Secretary determines appropriate which may be on a quarterly basis.

“(B) Information.—The information described in subparagraph (A) shall include information such as the following:

“(i) Providers of services and suppliers that have the highest rate of improper payments.

“(ii) Providers of services and suppliers that have the greatest total dollar amounts of improper payments.

“(iii) Items and services furnished in the region that have the highest rates of improper payments.

“(iv) Items and services furnished in the region that are responsible for the greatest total dollar amount of improper payments.

“(v) Other information the Secretary determines would assist the contractor in carrying out the program.

“(5) Communications.—Communications with providers of services and suppliers under an improper payment outreach and education program are subject to the standards and requirements of subsection (g).”

(b)
Use of Certain Funds Recovered by RACs.— Section 1893(h) of the Social Security Act (42 U.S.C. 1395ddd(h)) is amended—
(1)
in paragraph (2), by inserting “ or paragraph (10)” after “ paragraph (1)(C)”; and
(2)
by adding at the end the following new paragraph:

“(10) Use of certain recovered funds.—

“(A) In general.—After application of paragraph (1)(C), the Secretary shall retain a portion of the amounts recovered by recovery audit contractors for each year under this section which shall be available to the program management account of the Centers for Medicare & Medicaid Services for purposes of, subject to subparagraph (B), carrying out sections 1833(z), 1834(l)(16), and 1874A(a)(4)(G), carrying out section 514(b) of the Medicare Access and CHIP Reauthorization Act of 2015, and implementing strategies (such as claims processing edits) to help reduce the error rate of payments under this title. The amounts retained under the preceding sentence shall not exceed an amount equal to 15 percent of the amounts recovered under this subsection, and shall remain available until expended.

“(B) Limitation.—Except for uses that support claims processing (including edits) or system functionality for detecting fraud, amounts retained under subparagraph (A) may not be used for technological-related infrastructure, capital investments, or information systems.

“(C) No reduction in payments to recovery audit contractors.—Nothing in subparagraph (A) shall reduce amounts available for payments to recovery audit contractors under this subsection.”

SEC. 506. Improving Senior Medicare Patrol and Fraud Reporting Rewards.

(a)
In General.— The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall develop a plan to revise the incentive program under section 203(b) of the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1395b–5(b)) to encourage greater participation by individuals to report fraud and abuse in the Medicare program. Such plan shall include recommendations for—
(1)
ways to enhance rewards for individuals reporting under the incentive program, including rewards based on information that leads to an administrative action; and
(2)
extending the incentive program to the Medicaid program.
(b)
Public Awareness and Education Campaign.— The plan developed under subsection (a) shall also include recommendations for the use of the Senior Medicare Patrols authorized under section 411 of the Older Americans Act of 1965 (42 U.S.C. 3032) to conduct a public awareness and education campaign to encourage participation in the revised incentive program under subsection (a).
(c)
Submission of Plan.— Not later than 180 days after the date of enactment of this Act, the Secretary shall submit to Congress the plan developed under subsection (a).

SEC. 507. Requiring Valid Prescriber National Provider Identifiers on Pharmacy Claims.

Section 1860D–4(c) of the Social Security Act (42 U.S.C. 1395w–104(c)) is amended by adding at the end the following new paragraph:

“(4) Requiring valid prescriber national provider identifiers on pharmacy claims.—

“(A) In general.—For plan year 2016 and subsequent plan years, the Secretary shall require a claim for a covered part D drug for a part D eligible individual enrolled in a prescription drug plan under this part or an MA–PD plan under part C to include a prescriber National Provider Identifier that is determined to be valid under the procedures established under subparagraph (B)(i).

“(B) Procedures.—

“(i) Validity of prescriber national provider identifiers.—The Secretary, in consultation with appropriate stakeholders, shall establish procedures for determining the validity of prescriber National Provider Identifiers under subparagraph (A).

“(ii) Informing beneficiaries of reason for denial.—The Secretary shall establish procedures to ensure that, in the case that a claim for a covered part D drug of an individual described in subparagraph (A) is denied because the claim does not meet the requirements of this paragraph, the individual is properly informed at the point of service of the reason for the denial.

“(C) Report.—Not later than January 1, 2018, the Inspector General of the Department of Health and Human Services shall submit to Congress a report on the effectiveness of the procedures established under subparagraph (B)(i).”

SEC. 508. Option to Receive Medicare Summary Notice Electronically.

(a)
In General.— Section 1806 of the Social Security Act (42 U.S.C. 1395b–7) is amended by adding at the end the following new subsection:

“(c) Format of Statements From Secretary.—

“(1) Electronic option beginning in 2016.—Subject to paragraph (2), for statements described in subsection (a) that are furnished for a period in 2016 or a subsequent year, in the case that an individual described in subsection (a) elects, in accordance with such form, manner, and time specified by the Secretary, to receive such statement in an electronic format, such statement shall be furnished to such individual for each period subsequent to such election in such a format and shall not be mailed to the individual.

“(2) Limitation on revocation option.—

“(A) In general.—Subject to subparagraph (B), the Secretary may determine a maximum number of elections described in paragraph (1) by an individual that may be revoked by the individual.

“(B) Minimum of one revocation option.—In no case may the Secretary determine a maximum number under subparagraph (A) that is less than one.

“(3) Notification.—The Secretary shall ensure that, in the most cost effective manner and beginning January 1, 2017, a clear notification of the option to elect to receive statements described in subsection (a) in an electronic format is made available, such as through the notices distributed under section 1804, to individuals described in subsection (a).”

(b)
Encouraged Expansion of Electronic Statements.— To the extent to which the Secretary of Health and Human Services determines appropriate, the Secretary shall—
(1)
apply an option similar to the option described in subsection (c)(1) of section 1806 of the Social Security Act (42 U.S.C. 1395b–7) (relating to the provision of the Medicare Summary Notice in an electronic format), as added by subsection (a), to other statements and notifications under title XVIII of such Act (42 U.S.C. 1395 et seq.); and
(2)
provide such Medicare Summary Notice and any such other statements and notifications on a more frequent basis than is otherwise required under such title.

SEC. 509. Renewal of Mac Contracts.

(a)
In General.— Section 1874A(b)(1)(B) of the Social Security Act (42 U.S.C. 1395kk–1(b)(1)(B)) is amended by striking “ 5 years” and inserting “ 10 years”.
(b)
Application.— The amendments made by subsection (a) shall apply to contracts entered into on or after, and to contracts in effect as of, the date of the enactment of this Act.
(c)
Contractor Performance Transparency.— Section 1874A(b)(3)(A) of the Social Security Act (42 U.S.C. 1395kk–1(b)(3)(A)) is amended by adding at the end the following new clause:

“(iv) Contractor performance transparency.—To the extent possible without compromising the process for entering into and renewing contracts with medicare administrative contractors under this section, the Secretary shall make available to the public the performance of each medicare administrative contractor with respect to such performance requirements and measurement standards.”

SEC. 510. Study on Pathway for Incentives to States for State Participation in Medicaid Data Match Program.

Section 1893(g) of the Social Security Act (42 U.S.C. 1395ddd(g)) is amended by adding at the end the following new paragraph:

“(3) Incentives for states.—The Secretary shall study and, as appropriate, may specify incentives for States to work with the Secretary for the purposes described in paragraph (1)(A)(ii). The application of the previous sentence may include use of the waiver authority described in paragraph (2).”

SEC. 511. Guidance on Application of Common Rule to Clinical Data Registries.

Not later than one year after the date of the enactment of this section, the Secretary of Health and Human Services shall issue a clarification or modification with respect to the application of subpart A of part 46 of title 45, Code of Federal Regulations, governing the protection of human subjects in research (and commonly known as the “Common Rule”), to activities, including quality improvement activities, involving clinical data registries, including entities that are qualified clinical data registries pursuant to section 1848(m)(3)(E) of the Social Security Act (42 U.S.C. 1395w–4(m)(3)(E)).

SEC. 512. Eliminating Certain Civil Money Penalties; Gainsharing Study and Report.

(a)
Eliminating Civil Money Penalties for Inducements to Physicians To Limit Services That Are Not Medically Necessary.—
(1)
In general.— Section 1128A(b)(1) of the Social Security Act (42 U.S.C. 1320a–7a(b)(1)) is amended by inserting “ medically necessary” after “ reduce or limit”.
(2)
Effective date.— The amendment made by paragraph (1) shall apply to payments made on or after the date of the enactment of this Act.
(b)
Gainsharing Study and Report.— Not later than 12 months after the date of the enactment of this Act, the Secretary of Health and Human Services, in consultation with the Inspector General of the Department of Health and Human Services, shall submit to Congress a report with options for amending existing fraud and abuse laws in, and regulations related to, titles XI and XVIII of the Social Security Act (42 U.S.C. 301 et seq.), through exceptions, safe harbors, or other narrowly targeted provisions, to permit gainsharing arrangements that otherwise would be subject to the civil money penalties described in paragraphs (1) and (2) of section 1128A(b) of such Act (42 U.S.C. 1320a–7a(b)), or similar arrangements between physicians and hospitals, and that improve care while reducing waste and increasing efficiency. The report shall—
(1)
consider whether such provisions should apply to ownership interests, compensation arrangements, or other relationships;
(2)
describe how the recommendations address accountability, transparency, and quality, including how best to limit inducements to stint on care, discharge patients prematurely, or otherwise reduce or limit medically necessary care; and
(3)
consider whether a portion of any savings generated by such arrangements (as compared to an historical benchmark or other metric specified by the Secretary to determine the impact of delivery and payment system changes under such title XVIII on expenditures made under such title) should accrue to the Medicare program under title XVIII of the Social Security Act.

SEC. 513. Modification of Medicare Home Health Surety Bond Condition of Participation Requirement.

Section 1861(o)(7) of the Social Security Act (42 U.S.C. 1395x(o)(7)) is amended to read as follows:

“(7) provides the Secretary with a surety bond—

“(A) in a form specified by the Secretary and in an amount that is not less than the minimum of $50,000; and

“(B) that the Secretary determines is commensurate with the volume of payments to the home health agency; and”

SEC. 514. Oversight of Medicare Coverage of Manual Manipulation of the Spine to Correct Subluxation.

(a)
In General.— Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended by adding at the end the following new subsection:

“(z) Medical Review of Spinal Subluxation Services.—

“(1) In general.—The Secretary shall implement a process for the medical review (as described in paragraph (2)) of treatment by a chiropractor described in section 1861(r)(5) by means of manual manipulation of the spine to correct a subluxation (as described in such section) of an individual who is enrolled under this part and apply such process to such services furnished on or after January 1, 2017, focusing on services such as—

“(A) services furnished by a such a chiropractor whose pattern of billing is aberrant compared to peers; and

“(B) services furnished by such a chiropractor who, in a prior period, has a services denial percentage in the 85th percentile or greater, taking into consideration the extent that service denials are overturned on appeal.

“(2) Medical review.—

“(A) Prior authorization medical review.—

“(i) In general.—Subject to clause (ii), the Secretary shall use prior authorization medical review for services described in paragraph (1) that are furnished to an individual by a chiropractor described in section 1861(r)(5) that are part of an episode of treatment that includes more than 12 services. For purposes of the preceding sentence, an episode of treatment shall be determined by the underlying cause that justifies the need for services, such as a diagnosis code.

“(ii) Ending application of prior authorization medical review.—The Secretary shall end the application of prior authorization medical review under clause (i) to services described in paragraph (1) by such a chiropractor if the Secretary determines that the chiropractor has a low denial rate under such prior authorization medical review. The Secretary may subsequently reapply prior authorization medical review to such chiropractor if the Secretary determines it to be appropriate and the chiropractor has, in the time period subsequent to the determination by the Secretary of a low denial rate with respect to the chiropractor, furnished such services described in paragraph (1).

“(iii) Early request for prior authorization review permitted.—Nothing in this subsection shall be construed to prevent such a chiropractor from requesting prior authorization for services described in paragraph (1) that are to be furnished to an individual before the chiropractor furnishes the twelfth such service to such individual for an episode of treatment.

“(B) Type of review.—The Secretary may use pre-payment review or post-payment review of services described in section 1861(r)(5) that are not subject to prior authorization medical review under subparagraph (A).

“(C) Relationship to law enforcement activities.—The Secretary may determine that medical review under this subsection does not apply in the case where potential fraud may be involved.

“(3) No payment without prior authorization.—With respect to a service described in paragraph (1) for which prior authorization medical review under this subsection applies, the following shall apply:

“(A) Prior authorization determination.—The Secretary shall make a determination, prior to the service being furnished, of whether the service would or would not meet the applicable requirements of section 1862(a)(1)(A).

“(B) Denial of payment.—Subject to paragraph (5), no payment may be made under this part for the service unless the Secretary determines pursuant to subparagraph (A) that the service would meet the applicable requirements of such section 1862(a)(1)(A).

“(4) Submission of information.—A chiropractor described in section 1861(r)(5) may submit the information necessary for medical review by fax, by mail, or by electronic means. The Secretary shall make available the electronic means described in the preceding sentence as soon as practicable.

“(5) Timeliness.—If the Secretary does not make a prior authorization determination under paragraph (3)(A) within 14 business days of the date of the receipt of medical documentation needed to make such determination, paragraph (3)(B) shall not apply.

“(6) Application of limitation on beneficiary liability.—Where payment may not be made as a result of the application of paragraph (2)(B), section 1879 shall apply in the same manner as such section applies to a denial that is made by reason of section 1862(a)(1).

“(7) Review by contractors.—The medical review described in paragraph (2) may be conducted by medicare administrative contractors pursuant to section 1874A(a)(4)(G) or by any other contractor determined appropriate by the Secretary that is not a recovery audit contractor.

“(8) Multiple services.—The Secretary shall, where practicable, apply the medical review under this subsection in a manner so as to allow an individual described in paragraph (1) to obtain, at a single time rather than on a service-by-service basis, an authorization in accordance with paragraph (3)(A) for multiple services.

“(9) Construction.—With respect to a service described in paragraph (1) that has been affirmed by medical review under this subsection, nothing in this subsection shall be construed to preclude the subsequent denial of a claim for such service that does not meet other applicable requirements under this Act.

“(10) Implementation.—

“(A) Authority.—The Secretary may implement the provisions of this subsection by interim final rule with comment period.

“(B) Administration.—Chapter 35 of title 44, United States Code, shall not apply to medical review under this subsection.”

(b)
Improving Documentation of Services.—
(1)
In general.— The Secretary of Health and Human Services shall, in consultation with stakeholders (including the American Chiropractic Association) and representatives of medicare administrative contractors (as defined in section 1874A(a)(3)(A) of the Social Security Act (42 U.S.C. 1395kk–1(a)(3)(A))), develop educational and training programs to improve the ability of chiropractors to provide documentation to the Secretary of services described in section 1861(r)(5) in a manner that demonstrates that such services are, in accordance with section 1862(a)(1) of such Act (42 U.S.C. 1395y(a)(1)), reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
(2)
Timing.— The Secretary shall make the educational and training programs described in paragraph (1) publicly available not later than January 1, 2016.
(3)
Funding.— The Secretary shall use funds made available under paragraph (10) of section 1893(h) of the Social Security Act (42 U.S.C. 1395ddd(h)), as added by section 505, to carry out this subsection.
(c)
GAO Study and Report.—
(1)
Study.— The Comptroller General of the United States shall conduct a study on the effectiveness of the process for medical review of services furnished as part of a treatment by means of manual manipulation of the spine to correct a subluxation implemented under subsection (z) of section 1833 of the Social Security Act (42 U.S.C. 1395l), as added by subsection (a). Such study shall include an analysis of—
(A)
aggregate data on—
(i)
the number of individuals, chiropractors, and claims for services subject to such review; and
(ii)
the number of reviews conducted under such section; and
(B)
the outcomes of such reviews.
(2)
Report.— Not later than four years after the date of enactment of this Act, the Comptroller General shall submit to Congress a report containing the results of the study conducted under paragraph (1), including recommendations for such legislation and administrative action with respect to the process for medical review implemented under subsection (z) of section 1833 of the Social Security Act (42 U.S.C. 1395l) as the Comptroller General determines appropriate.

SEC. 515. National Expansion of Prior Authorization Model for Repetitive Scheduled Non-Emergent Ambulance Transport.

(a)
Initial Expansion.—
(1)
In general.— In implementing the model described in paragraph (2) proposed to be tested under subsection (b) of section 1115A of the Social Security Act (42 U.S.C. 1315a), the Secretary of Health and Human Services shall revise the testing under subsection (b) of such section to cover, effective not later than January 1, 2016, States located in medicare administrative contractor (MAC) regions L and 11 (consisting of Delaware, the District of Columbia, Maryland, New Jersey, Pennsylvania, North Carolina, South Carolina, West Virginia, and Virginia).
(2)
Model described.— The model described in this paragraph is the testing of a model of prior authorization for repetitive scheduled non-emergent ambulance transport proposed to be carried out in New Jersey, Pennsylvania, and South Carolina.
(3)
Funding.— The Secretary shall allocate funds made available under section 1115A(f)(1)(B) of the Social Security Act (42 U.S.C. 1315a(f)(1)(B)) to carry out this subsection.
(b)
National Expansion.— Section 1834(l) of the Social Security Act (42 U.S.C. 1395m(l)) is amended by adding at the end the following new paragraph:

“(16) Prior authorization for repetitive scheduled non-emergent ambulance transports.—

“(A) In general.—Beginning January 1, 2017, if the expansion to all States of the model of prior authorization described in paragraph (2) of section 515(a) of the Medicare Access and CHIP Reauthorization Act of 2015 meets the requirements described in paragraphs (1) through (3) of section 1115A(c), then the Secretary shall expand such model to all States.

“(B) Funding.—The Secretary shall use funds made available under section 1893(h)(10) to carry out this paragraph.

“(C) Clarification regarding budget neutrality.—Nothing in this paragraph may be construed to limit or modify the application of section 1115A(b)(3)(B) to models described in such section, including with respect to the model described in subparagraph (A) and expanded beginning on January 1, 2017, under such subparagraph.”

SEC. 516. Repealing Duplicative Medicare Secondary Payor Provision.

(a)
In General.— Section 1862(b)(5) of the Social Security Act (42 U.S.C. 1395y(b)(5)) is amended by inserting at the end the following new subparagraph:

“(E) End date.—The provisions of this paragraph shall not apply to information required to be provided on or after July 1, 2016.”

(b)
Effective Date.— The amendment made by subsection (a) shall take effect on the date of the enactment of this Act and shall apply to information required to be provided on or after January 1, 2016.

SEC. 517. Plan for Expanding Data in Annual Cert Report.

Not later than June 30, 2015, the Secretary of Health and Human Services shall submit to the Committee on Finance of the Senate, and to the Committees on Energy and Commerce and Ways and Means of the House of Representatives—
(1)
a plan for including, in the annual report of the Comprehensive Error Rate Testing (CERT) program, data on services (or groupings of services) (other than medical visits) paid under the physician fee schedule under section 1848 of the Social Security Act (42 U.S.C. 1395w–4) where the fee schedule amount is in excess of $250 and where the error rate is in excess of 20 percent; and
(2)
to the extent practicable by such date, specific examples of services described in paragraph (1).

SEC. 518. Removing Funds for Medicare Improvement Fund Added by Impact Act of 2014.

Section 1898(b)(1) of the Social Security Act (42 U.S.C. 1395iii(b)(1)), as amended by section 3(e)(3) of the IMPACT Act of 2014 (Public Law 113–185), is amended by striking “ $195,000,000” and inserting “ $0”.

SEC. 519. Rule of Construction.

Except as explicitly provided in this subtitle, nothing in this subtitle, including the amendments made by this subtitle, shall be construed as preventing the use of notice and comment rulemaking in the implementation of the provisions of, and the amendments made by, this subtitle.

Subtitle B Other Provisions

SEC. 521. Extension of Two-Midnight Pama Rules on Certain Medical Review Activities.

Section 111 of the Protecting Access to Medicare Act of 2014 (Public Law 113–93; 42 U.S.C. 1395ddd note) is amended—
(1)
in subsection (a), by striking “ the first 6 months of fiscal year 2015” and inserting “ through the end of fiscal year 2015”;
(2)
in subsection (b), by striking “ March 31, 2015” and inserting “ September 30, 2015”; and
(3)
by adding at the end the following new subsection:

“(c) Construction.—Except as provided in subsections (a) and (b), nothing in this section shall be construed as limiting the Secretary’s authority to pursue fraud and abuse activities under such section 1893(h) or otherwise.”

SEC. 522. Requiring Bid Surety Bonds and State Licensure for Entities Submitting Bids under the Medicare Dmepos Competitive Acquisition Program.

(a)
Bid Surety Bonds.— Section 1847(a)(1) of the Social Security Act (42 U.S.C. 1395w–3(a)(1)) is amended by adding at the end the following new subparagraphs:

“(G) Requiring bid bonds for bidding entities.—With respect to rounds of competitions beginning under this subsection for contracts beginning not earlier than January 1, 2017, and not later than January 1, 2019, an entity may not submit a bid for a competitive acquisition area unless, as of the deadline for bid submission, the entity has obtained (and provided the Secretary with proof of having obtained) a bid surety bond (in this paragraph referred to as a ‘bid bond’) in a form specified by the Secretary consistent with subparagraph (H) and in an amount that is not less than $50,000 and not more than $100,000 for each competitive acquisition area in which the entity submits the bid.

“(H) Treatment of bid bonds submitted.—

“(i) For bidders that submit bids at or below the median and are offered but do not accept the contract.—In the case of a bidding entity that is offered a contract for any product category for a competitive acquisition area, if—

“(I) the entity’s composite bid for such product category and area was at or below the median composite bid rate for all bidding entities included in the calculation of the single payment amounts for such product category and area; and

“(II) the entity does not accept the contract offered for such product category and area,

“(ii) Treatment of other bidders.—In the case of a bidding entity for any product category for a competitive acquisition area, if the entity does not meet the bid forfeiture conditions in subclauses (I) and (II) of clause (i) for any product category for such area, the bid bond submitted by such entity for such area shall be returned within 90 days of the public announcement of the contract suppliers for such area.”

(b)
State Licensure.—
(1)
In general.— Section 1847(b)(2)(A) of the Social Security Act (42 U.S.C. 1395w–3(b)(2)(A)) is amended by adding at the end the following new clause:

“(v) The entity meets applicable State licensure requirements.”

(2)
Construction.— Nothing in the amendment made by paragraph (1) shall be construed as affecting the authority of the Secretary of Health and Human Services to require State licensure of an entity under the Medicare competitive acquisition program under section 1847 of the Social Security Act (42 U.S.C. 1395w–3) before the date of the enactment of this Act.
(c)
GAO Report on Bid Bond Impact on Small Suppliers.—
(1)
Study.— The Comptroller General of the United States shall conduct a study that evaluates the effect of the bid surety bond requirement under the amendment made by subsection (a) on the participation of small suppliers in the Medicare DMEPOS competitive acquisition program under section 1847 of the Social Security Act (42 U.S.C. 1395w–3).
(2)
Report.— Not later than 6 months after the date contracts are first awarded subject to such bid surety bond requirement, the Comptroller General shall submit to Congress a report on the study conducted under paragraph (1). Such report shall include recommendations for changes in such requirement in order to ensure robust participation by legitimate small suppliers in the Medicare DMEPOS competition acquisition program.

SEC. 523. Payment for Global Surgical Packages.

(a)
In General.— Section 1848(c) of the Social Security Act (42 U.S.C. 1395w–4(c)) is amended by adding at the end the following new paragraph:

“(8) Global surgical packages.—

“(A) Prohibition of implementation of rule regarding global surgical packages.—

“(i) In general.—The Secretary shall not implement the policy established in the final rule published on November 13, 2014 (79 Fed. Reg. 67548 et seq.), that requires the transition of all 10-day and 90-day global surgery packages to 0-day global periods.

“(ii) Construction.—Nothing in clause (i) shall be construed to prevent the Secretary from revaluing misvalued codes for specific surgical services or assigning values to new or revised codes for surgical services.

“(B) Collection of data on services included in global surgical packages.—

“(i) In general.—Subject to clause (ii), the Secretary shall through rulemaking develop and implement a process to gather, from a representative sample of physicians, beginning not later than January 1, 2017, information needed to value surgical services. Such information shall include the number and level of medical visits furnished during the global period and other items and services related to the surgery and furnished during the global period, as appropriate. Such information shall be reported on claims at the end of the global period or in another manner specified by the Secretary. For purposes of carrying out this paragraph (other than clause (iii)), the Secretary shall transfer from the Federal Supplemental Medical Insurance Trust Fund under section 1841 $2,000,000 to the Center for Medicare & Medicaid Services Program Management Account for fiscal year 2015. Amounts transferred under the previous sentence shall remain available until expended.

“(ii) Reassessment and potential sunset.—Every 4 years, the Secretary shall reassess the value of the information collected pursuant to clause (i). Based on such a reassessment and by regulation, the Secretary may discontinue the requirement for collection of information under such clause if the Secretary determines that the Secretary has adequate information from other sources, such as qualified clinical data registries, surgical logs, billing systems or other practice or facility records, and electronic health records, in order to accurately value global surgical services under this section.

“(iii) Inspector general audit.—The Inspector General of the Department of Health and Human Services shall audit a sample of the information reported under clause (i) to verify the accuracy of the information so reported.

“(C) Improving accuracy of pricing for surgical services.—For years beginning with 2019, the Secretary shall use the information reported under subparagraph (B)(i) as appropriate and other available data for the purpose of improving the accuracy of valuation of surgical services under the physician fee schedule under this section.”

(b)
Incentive for Reporting Information on Global Surgical Services.— Section 1848(a) of the Social Security Act (42 U.S.C. 1395w–4(a)) is amended by adding at the end the following new paragraph:

“(9) Information reporting on services included in global surgical packages.—With respect to services for which a physician is required to report information in accordance with subsection (c)(8)(B)(i), the Secretary may through rulemaking delay payment of 5 percent of the amount that would otherwise be payable under the physician fee schedule under this section for such services until the information so required is reported.”

SEC. 524. Extension of Secure Rural Schools and Community Self-Determination Act of 2000.

(a)
Payments for Fiscal Years 2014 and 2015.—
(1)
Payments required.— Section 101 of the Secure Rural Schools and Community Self-Determination Act of 2000 (16 U.S.C. 7111) is amended by striking “ 2013” both places it appears and inserting “ 2015”.
(2)
Prompt payment.— Payments for fiscal year 2014 under title I of the Secure Rural Schools and Community Self-Determination Act of 2000 (16 U.S.C. 7111 et seq.), as amended by this section, shall be made not later than 45 days after the date of the enactment of this Act.
(3)
Reduction in fiscal year 2014 payments on account of previous 25- and 50-percent payments.— Section 101 of the Secure Rural Schools and Community Self-Determination Act of 2000 (16 U.S.C. 7111) is amended by adding at the end the following new subsection:

“(c) Special Rule for Fiscal Year 2014 Payments.—

“(1) State payment.—If an eligible county in a State that will receive a share of the State payment for fiscal year 2014 has already received, or will receive, a share of the 25-percent payment for fiscal year 2014 distributed to the State before the date of the enactment of this subsection, the amount of the State payment shall be reduced by the amount of that eligible county’s share of the 25-percent payment.

“(2) County payment.—If an eligible county that will receive a county payment for fiscal year 2014 has already received a 50-percent payment for that fiscal year, the amount of the county payment shall be reduced by the amount of the 50-percent payment.”

(4)
Shares of california state payment.— Section 103(d)(2) of the Secure Rural Schools and Community Self-Determination Act of 2000 (16 U.S.C. 7113(d)(2)) is amended by striking “ 2013” and inserting “ 2015”.
(b)
Use of Fiscal Year 2013 Elections and Reservations for Fiscal Years 2014 and 2015.— Section 102 of the Secure Rural Schools and Community Self-Determination Act of 2000 (16 U.S.C. 7112) is amended—
(1)
in subsection (b)(1), by adding at the end the following new subparagraph:

“(C) Effect of late payment for fiscal years 2014 and 2015.—The election otherwise required by subparagraph (A) shall not apply for fiscal year 2014 or 2015.”

(2)
in subsection (b)(2)—
(A)
in subparagraph (A), by adding at the end the following new sentence: “ If such two-fiscal year period included fiscal year 2013, the county election to receive a share of the 25-percent payment or 50-percent payment, as applicable, also shall be effective for fiscal years 2014 and 2015.”; and
(B)
in subparagraph (B), by striking “ 2013” the second place it appears and inserting “ 2015”; and
(3)
in subsection (d)—
(A)
by adding at the end of paragraph (1) the following new subparagraph:

“(E) Effect of late payment for fiscal year 2014.—The election made by an eligible county under subparagraph (B), (C), or (D) for fiscal year 2013, or deemed to be made by the county under paragraph (3)(B) for that fiscal year, shall be effective for fiscal years 2014 and 2015.”

; and

(B)
by adding at the end of paragraph (3) the following new subparagraph:

“(C) Effect of late payment for fiscal year 2014.—This paragraph does not apply for fiscal years 2014 and 2015.”

(c)
Special Projects on Federal Land.— Title II of the Secure Rural Schools and Community Self-Determination Act of 2000 (16 U.S.C. 7121 et seq.) is amended—
(1)
in section 203(a)(1) (16 U.S.C. 7123(a)(1)), by striking “ September 30 for fiscal year 2008 (or as soon thereafter as the Secretary concerned determines is practicable), and each September 30 thereafter for each succeeding fiscal year through fiscal year 2013” and inserting “ September 30 of each fiscal year (or a later date specified by the Secretary concerned for the fiscal year)”;
(2)
in section 204(e)(3)(B)(iii) (16 U.S.C. 7124(e)(3)(B)(iii)), by striking “ each of fiscal years 2010 through 2013” and inserting “ fiscal year 2010 and fiscal years thereafter”;
(3)
in section 207(a) (16 U.S.C. 7127(a)), by striking “ September 30, 2008 (or as soon thereafter as the Secretary concerned determines is practicable), and each September 30 thereafter for each succeeding fiscal year through fiscal year 2013” and inserting “ September 30 of each fiscal year (or a later date specified by the Secretary concerned for the fiscal year)”; and
(4)
in section 208 (16 U.S.C. 7128)—
(A)
in subsection (a), by striking “ 2013” and inserting “ 2017”; and
(B)
in subsection (b), by striking “ 2014” and inserting “ 2018”.
(d)
County Funds.— Section 304 of the Secure Rural Schools and Community Self-Determination Act of 2000 (16 U.S.C. 7144) is amended—
(1)
in subsection (a), by striking “ 2013” and inserting “ 2017”; and
(2)
in subsection (b), by striking “ 2014” and inserting “ 2018”.
(e)
Authorization of Appropriations.— Section 402 of the Secure Rural Schools and Community Self-Determination Act of 2000 (16 U.S.C. 7152) is amended by striking “ for each of fiscal years 2008 through 2013”.

SEC. 525. Exclusion from Paygo Scorecards.

(a)
Statutory Pay-As-You-Go Scorecards.— The budgetary effects of this Act shall not be entered on either PAYGO scorecard maintained pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010.
(b)
Senate PAYGO Scorecards.— The budgetary effects of this Act shall not be entered on any PAYGO scorecard maintained for purposes of section 201 of S. Con. Res. 21 (110th Congress).