,i #aacth ,,congress #ast ,session ,h4 ,r4 #cafh ,,in ,,the ,,house ,,of ,,representatives ,september #bj1 #bjac,mr4 ,williams 7for himself1 ,mr4 ,flores1 ,ms4 ,granger1 and ,mr4 ,stockman7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to provide for a ,medicare established provider system under which providers of services and suppliers representing a low risk for submitting fraudulent ,medicare claims are provided certain claim review protections4 #a4 ,short title ,this ,act may be cited as the ,medicare ,established ,provider ,act of #bjac4 #b4 ,medicare established provider system ,title ,,xviii of the ,social ,security ,act is amended by inserting after section #ahic of such ,act 7#db ,u4,s4,c4 #acie;ddd7 the following new section3 #ahic;,a4 ,medicare established provider system 7a7 ,in general ,the ,secretary shall develop and implement a system 7in this section referred to as the ,medicare ,established ,provider ,system7 to designate providers of services and suppliers who represent a low risk for submitting fraudulent claims for payment under this title as established providers for purposes of applying the protections described in subsection 7c74 ,under such system-- 7#a7 the ,secretary shall establish a process1 in accordance with subsection 7c71 under which-- 7,a7 providers of services and suppliers may apply for designation as established providers2 7,b7 such providers and suppliers who qualify1 in accordance with subsection 7b71 as established providers are so designated 7including through the use of entities trained by an ,internet training course of the ,centers for ,medicare ,medicaid ,services or through training provided by other specified organizations72 and 7,c7 such providers and suppliers who no longer qualify as established providers lose such designation2 and 7#b7 the ,secretary shall establish an electronic system for the submission of documentation by providers of services1 suppliers1 or third parties1 with respect to a claim for payment under this title that is under review1 for each level of review applicable to such claim4 7b7 ,qualifying as established providers ,under such system1 to qualify as an established provider for a period with respect to a reporting period 7as specified by the ,secretary71 a provider of services or supplier shall demonstrate1 as specified by the ,secretary1 that-- 7#a7 with respect to the reporting period beginning after the date of the enactment of this section but before the date described in paragraph 7#b71 at least #ge percent of claims for payment under this title for items and services furnished by such provider or supplier for which any review was conducted under section #ahfi were determined to be eligible for payment under this title2 7#b7 with respect to a reporting period beginning after the date that is #b years after the date of enactment of this section1 at least #hj percent of claims for payment under this title for items and services furnished by such provider or supplier for which any review was conducted under section #ahfi were determined to be eligible for payment under this title2 and 7#c7 of all claims for payment under this title for items and services furnished by such provider or supplier for which an initial determination was made that payment may not be made under this title1 at least #ij percent were appealed by such provider or supplier4 7c7 ,designation process ,the process under subsection 7a77#a7-- 7#a7 shall allow a provider of services or supplier designated as an established provider under this section to demonstrate that the provider or supplier maintains compliance with the qualification requirements under subsection 7b7 based on annual updates on the status of claims for payment under this title for items and services furnished by such provider or supplier with respect to each level of review1 including the number of such claims within each such level of review for which a determination was made that payment should be made1 should be partially made1 or should not be made under this title2 7#b7 shall provide a method through which it may be determined whether or not the qualifying requirements under subsection 7b7 have been satisfied and maintained by a provider of services or supplier with respect to a period2 7#c7 provide for the identification of established providers within appropriate systems of the ,centers of ,medicare ,medicaid ,services2 and 7#d7 provide for a global track record of compliance by providers of services and suppliers with the qualifying requirements under subsection 7b71 including by identifying such providers and suppliers by the management company provider number rather than by each individual provider1 supplier1 or facility1 for purposes of efficiency4 7d7 ,protections for established providers ,notwithstanding any other provision of law1 in the case of a provider of services or supplier designated as an established provider under this section with respect to a period the following protections shall apply3 7#a7 ,with respect to a claim submitted during such period for payment under this title for items or services furnished by such provider or supplier1 which is subject to review for whether or not payment should be made under such title and with respect to which an additional documentation request has been issued1 payment under this title for such claim may not be withheld unless a final determination has been made that such payment should not be made4 7#b7 ,in the case that a final determination has been made that payment under this title should not have been made with respect to a claim described in paragraph 7#a71 repayment of such payment shall be made electronically by the provider not later than #de days after notification of such decision4 ,in applying the previous sentence1 if the ,secretary determines that repayment within such #de-;day period would result in a significant hardship to the provider involved1 the ,secretary may1 on a case-by-case basis1 extend the #de-;day period described in such sentence by such number of days as the ,secretary determines appropriate in accordance with a specified repayment plan4 7#c7 ,the ,secretary shall provide for a method to apply section #ahfi with respect to an initial determination of any claim submitted during such period for payment under this title for items and services furnished by such provider or supplier1 without the application of paragraph 7#c7 of section #ahfi7;a7 7relating to redeterminations74 4