,,ib ,union ,calendar ,no4 #bi #aadth ,,congress #ast ,session ,h4 ,r4 #ajba ,report ,no4 #aad-df1 ,part ,i ,,in ,,the ,,house ,,of ,,representatives ,february #bd1 #bjae ,mr4 ,brady of ,texas 7for himself1 ,mr4 ,mc,dermott1 ,mr4 ,levin1 ,mr4 ,rangel1 ,mr4 ,lewis1 ,mr4 ,neal1 ,mr4 ,sam ,johnson of ,texas1 ,mr4 ,doggett1 ,mr4 ,blumenauer1 ,mr4 ,danny ,k4 ,davis of ,illinois1 ,mr4 ,pascrell1 ,mr4 ,tiberi1 ,mr4 ,nunes1 ,ms4 ,linda ,t4 ,snchez of ,california1 ,mr4 ,boustany1 ,mr4 ,reichert1 ,mr4 ,buchanan1 ,mr4 ,roskam1 ,mr4 ,smith of ,nebraska1 ,mr4 ,reed1 ,mrs4 ,black1 ,mr4 ,kelly of ,pennsylvania1 ,mr4 ,renacci1 ,mr4 ,meehan1 ,mr4 ,young of ,indiana1 ,mr4 ,holding1 and ,mr4 ,carney7 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 ,march #ah1 #bjae ,additional sponsors3 ,mr4 ,diaz-,balart1 ,mr4 ,paulsen1 ,mrs4 ,noem1 ,mr4 ,rodney ,davis of ,illinois1 and ,mr4 ,ross ,march #ah1 #bjae ,reported from the ,committee on ,ways and ,means with an amendment ,strike out all after the enacting clause and insert the part printed in italic ,march #ah1 #bjae ,the ,committee on ,energy and ,commerce discharged2 committed to the ,committee of the ,whole ,house on the ,state of the ,union and ordered to be printed ,for text of introduced bill1 see copy of bill as introduced on ,february #bd1 #bjae ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to improve the integrity of the ,medicare program1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,protecting the ,integrity of ,medicare ,act of #bjae4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,prohibition of inclusion of ,social ,security account numbers on ,medicare cards4 ,sec4 #c4 ,preventing wrongful ,medicare payments for items and services furnished to incarcerated individuals1 individuals not lawfully present1 and deceased individuals4 ,sec4 #d4 ,consideration of measures regarding ,medicare beneficiary smart cards4 ,sec4 #e4 ,modifying medicare durable medical equipment face-to-face encounter documentation requirement4 ,sec4 #f4 ,reducing improper ,medicare payments4 ,sec4 #g4 ,improving senior ,medicare patrol and fraud reporting rewards4 ,sec4 #h4 ,requiring valid prescriber ,national ,provider ,identifiers on pharmacy claims4 ,sec4 #i4 ,option to receive ,medicare ,summary ,notice electronically4 ,sec4 #aj4 ,renewal of ,,mac contracts4 ,sec4 #aa4 ,study on pathway for incentives to ,states for ,state participation in medicaid data match program4 ,sec4 #ab4 ,programs to prevent prescription drug abuse under ,medicare part ,d4 ,sec4 #ac4 ,guidance on application of ,common ,rule to clinical data registries4 ,sec4 #ad4 ,eliminating certain civil money penalties2 gainsharing study and report4 ,sec4 #ae4 ,modification of ,medicare home health surety bond condition of participation requirement4 ,sec4 #af4 ,oversight of ,medicare coverage of manual manipulation of the spine to correct subluxation4 ,sec4 #ag4 ,national expansion of prior authorization model for repetitive scheduled non-emergent ambulance transport4 ,sec4 #ah4 ,repealing duplicative ,medicare secondary payor provision4 ,sec4 #ai4 ,plan for expanding data in annual ,,cert report4 ,sec4 #bj4 ,removing funds for ,medicare ,improvement ,fund added by ,,impact ,act of #bjad4 ,sec4 #ba4 ,rule of construction4 #b4 ,prohibition of inclusion of ,social ,security account numbers on ,medicare cards 7a7 ,in general ,section #bje7;c77#b77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dje7;c77#b77;,c77 is amended-- 7#a7 by moving clause 7x71 as added by section #adad7;a77#b7 of the ,patient ,protection and ,affordable ,care ,act1 #f ems to the left2 7#b7 by redesignating clause 7x71 as added by section #b7;a77#a7 of the ,social ,security ,number ,protection ,act of #bjaj1 and clause 7xi7 as clauses 7xi7 and 7xii71 respectively2 and 7#c7 by adding at the end the following new clause3 7xiii7 ,the ,secretary of ,health and ,human ,services1 in consultation with the ,commissioner of ,social ,security1 shall establish cost-effective procedures to ensure that a ,social ,security account number 7or derivative thereof7 is not displayed1 coded1 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 7or derivative thereof74 4 7b7 ,implementation ,in implementing clause 7xiii7 of section #bje7;c77#b77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dje7;c77#b77;,c771 as added by subsection 7a77#c71 the ,secretary of ,health and ,human ,services shall do the following3 7#a7 ,in general ,establish a cost-effective process that involves the least amount of disruption to1 as well as necessary assistance for1 ,medicare beneficiaries and health care providers1 such as a process that provides such beneficiaries with access to assistance through a toll-free telephone number and provides outreach to providers4 7#b7 ,consideration of ,medicare beneficiary identified ,consider implementing a process1 similar to the process involving ,railroad ,retirement ,board beneficiaries1 under which a ,medicare beneficiary identifier which is not a ,social ,security account number 7or derivative thereof7 is used external to the ,department of ,health and ,human ,services and is convertible over to a ,social ,security account number 7or derivative thereof7 for use internal to such ,department and the ,social ,security ,administration4 7c7 ,funding for implementation ,for purposes of implementing the provisions of and the amendments made by this section1 the ,secretary of ,health and ,human ,services shall provide for the following transfers from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i7 and from the ,federal ,supplementary ,medical ,insurance ,trust ,fund established under section #ahda of such ,act 7#db ,u4,s4,c4 #aciet71 in such proportions as the ,secretary determines appropriate3 7#a7 ,to the ,centers for ,medicare ,medicaid ,program ,management ,account1 transfers of the following amounts3 7,a7 ,for fiscal year #bjae1 #fe1jjj1jjj1 to be made available through fiscal year #bjah4 7,b7 ,for each of fiscal years #bjaf and #bjag1 #ec1jjj1jjj1 to be made available through fiscal year #bjah4 7,c7 ,for fiscal year #bjah1 #dh1jjj1jjj1 to be made available until expended4 7#b7 ,to the ,social ,security ,administration ,limitation on ,administration ,account1 transfers of the following amounts3 7,a7 ,for fiscal year #bjae1 #bg1jjj1jjj1 to be made available through fiscal year #bjah4 7,b7 ,for each of fiscal years #bjaf and #bjag1 #bb1jjj1jjj1 to be made available through fiscal year #bjah4 7,c7 ,for fiscal year #bjah1 #bg1jjj1jjj1 to be made available until expended4 7#c7 ,to the ,railroad ,retirement ,board ,limitation on ,administration ,account1 the following amount3 7,a7 ,for fiscal year #bjae1 #c1jjj1jjj1 to be made available until expended4 7d7 ,effective date 7#a7 ,in general ,clause 7xiii7 of section #bje7;c77#b77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dje7;c77#b77;,c771 as added by subsection 7a77#c71 shall apply with respect to ,medicare cards issued on and after an effective date specified by the ,secretary of ,health and ,human ,services1 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 ,act4 7#b7 ,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 7#a74 #c4 ,preventing wrongful ,medicare payments for items and services furnished to incarcerated individuals1 individuals not lawfully present1 and deceased individuals 7a7 ,requirement for the ,secretary to establish policies and claims edits relating to incarcerated individuals1 individuals not lawfully present1 and deceased individuals ,section #ahgd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk7 is amended by adding at the end the following new subsection3 7f7 ,requirement for the ,secretary to establish policies and claims edits relating to incarcerated individuals1 individuals not lawfully present1 and deceased individuals ,the ,secretary shall establish and maintain procedures1 including procedures for using claims processing edits1 updating eligibility information to improve provider accessibility1 and conducting recoupment activities such as through recovery audit contractors1 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 following3 7#a7 ,an individual who is incarcerated4 7#b7 ,an individual who is not lawfully present in the ,united ,states and who is not eligible for coverage under this title4 7#c7 ,a deceased individual4 4 7b7 ,report ,not later than #ah months after the date of the enactment of this section1 and periodically thereafter as determined necessary by the ,office of ,inspector ,general of the ,department of ,health and ,human ,services1 such ,office shall submit to ,congress a report on the activities described in subsection 7f7 of section #ahgd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk71 as added by subparagraph 7a71 that have been conducted since such date of enactment4 #d4 ,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 7such as cards that use smart card technology1 including an embedded and secure integrated circuit chip71 as presented in the ,government ,accountability ,office report required by the conference report accompanying the ,consolidated ,appropriations ,act1 #bjad 7,public ,law #aac-gf71 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 7#db ,u4,s4,c4 #acie et seq474 ,in the case that the ,secretary considers measures under the preceding sentence1 the ,secretary shall submit to the ,committees on ,ways and ,means and on ,energy and ,commerce of the ,house of ,representatives1 and to the ,committee on ,finance of the ,senate1 a report outlining the considerations undertaken by the ,secretary under such sentence4 #e4 ,modifying medicare durable medical equipment face-to-face encounter documentation requirement 7a7 ,in general ,section #ahcd7;a77#aa77;,b77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7a77#aa77;,b77ii77 is amended-- 7#a7 by striking the physician documenting that2 and 7#b7 by striking has had a face-to-face encounter and inserting documenting such physician1 physician assistant1 practitioner1 or specialist has had a face-to-face encounter4 7b7 ,implementation ,notwithstanding any other provision of law1 the ,secretary of ,health and ,human ,services may implement the amendments made by subsection 7a7 by program instruction or otherwise4 #f4 ,reducing improper ,medicare payments 7a7 ,medicare administrative contractor improper payment outreach and education program 7#a7 ,in general ,section #ahgd;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk-#a7 is amended-- 7,a7 in subsection 7a77#d7-- 7i7 by redesignating subparagraph 7,g7 as subparagraph 7,h72 and 7ii7 by inserting after subparagraph 7,f7 the following new subparagraph3 7,g7 ,improper payment outreach and education program ,having in place an improper payment outreach and education program described in subsection 7h74 2 and 7,b7 by adding at the end the following new subsection3 7h7 ,improper payment outreach and education program 7#a7 ,in general ,in order to reduce improper payments under this title1 each medicare administrative contractor shall establish and have in place an improper payment outreach and education program under which the contractor1 through outreach1 education1 training1 and technical assistance or other activities1 shall provide providers of services and suppliers located in the region covered by the contract under this section with the information described in paragraph 7#b74 ,the activities described in the preceding sentence shall be conducted on a regular basis4 7#b7 ,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 information3 7,a7 ,a list of the providers' or suppliers' most frequent and expensive payment errors over the last quarter4 7,b7 ,specific instructions regarding how to correct or avoid such errors in the future4 7,c7 ,a notice of new topics that have been approved by the ,secretary for audits conducted by recovery audit contractors under section #ahic7;h74 7,d7 ,specific instructions to prevent future issues related to such new audits4 7,e7 ,other information determined appropriate by the ,secretary4 7#c7 ,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 following3 7,a7 ,are for items and services that have the highest rate of improper payment4 7,b7 ,are for items and service that have the greatest total dollar amount of improper payments4 7,c7 ,are due to clear misapplication or misinterpretation of ,medicare policies4 7,d7 ,are clearly due to common and inadvertent clerical or administrative errors4 7,e7 ,are due to other types of errors that the ,secretary determines could be prevented through activities under the program4 7#d7 ,information on improper payments from recovery audit contractors 7,a7 ,in general ,in order to assist medicare administrative contractors in carrying out improper payment outreach and education programs1 the ,secretary shall provide each contractor with a complete list of the types of improper payments identified by recovery audit contractors under section #ahic7;h7 with respect to providers of services and suppliers located in the region covered by the contract under this section4 ,such information shall be provided on a time frame the ,secretary determines appropriate which may be on a quarterly basis4 7,b7 ,information ,the information described in subparagraph 7,a7 shall include information such as the following3 7i7 ,providers of services and suppliers that have the highest rate of improper payments4 7ii7 ,providers of services and suppliers that have the greatest total dollar amounts of improper payments4 7iii7 ,items and services furnished in the region that have the highest rates of improper payments4 7iv7 ,items and services furnished in the region that are responsible for the greatest total dollar amount of improper payments4 7v7 ,other information the ,secretary determines would assist the contractor in carrying out the program4 7#e7 ,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 7g74 4 7b7 ,use of certain funds recovered by ,r,a,cs ,section #ahic7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7h77 is amended-- 7#a7 in paragraph 7#b71 by inserting or paragraph 7#aj7 after paragraph 7#a77;,c72 and 7#b7 by adding at the end the following new paragraph3 7#aj7 ,use of certain recovered funds 7,a7 ,in general ,after application of paragraph 7#a77;,c71 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 of1 subject to subparagraph 7,b71 carrying out sections #ahcc7z71 #ahcd7l77#af71 and #ahgd;,a7a77#d77;,g71 carrying out section #af7;b7 of the ,protecting the ,integrity of ,medicare ,act of #bjae1 and implementing strategies 7such as claims processing edits7 to help reduce the error rate of payments under this title4 ,the amounts retained under the preceding sentence shall not exceed an amount equal to #ae percent of the amounts recovered under this subsection1 and shall remain available until expended4 7,b7 ,limitation ,except for uses that support claims processing 7including edits7 or system functionality for detecting fraud1 amounts retained under subparagraph 7,a7 may not be used for technological-related infrastructure1 capital investments1 or information systems4 7,c7 ,no reduction in payments to recovery audit contractors ,nothing in subparagraph 7,a7 shall reduce amounts available for payments to recovery audit contractors under this subsection4 4 #g4 ,improving senior ,medicare patrol and fraud reporting rewards 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall develop a plan to revise the incentive program under section #bjc7;b7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7#db ,u4,s4,c4 #acie;b- #e7;b77 to encourage greater participation by individuals to report fraud and abuse in the ,medicare program4 ,such plan shall include recommendations for-- 7#a7 ways to enhance rewards for individuals reporting under the incentive program1 including rewards based on information that leads to an administrative action2 and 7#b7 extending the incentive program to the ,medicaid program4 7b7 ,public ,awareness and ,education ,campaign ,the plan developed under subsection 7a7 shall also include recommendations for the use of the ,senior ,medicare ,patrols authorized under section #daa of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjcb7 to conduct a public awareness and education campaign to encourage participation in the revised incentive program under subsection 7a74 7c7 ,submission of ,plan ,not later than #ahj days after the date of enactment of this ,act1 the ,secretary shall submit to ,congress the plan developed under subsection 7a74 #h4 ,requiring valid prescriber ,national ,provider ,identifiers on pharmacy claims ,section #ahfj;,d-#d7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;c77 is amended by adding at the end the following new paragraph3 7#d7 ,requiring valid prescriber ,national ,provider ,identifiers on pharmacy claims 7,a7 ,in general ,for plan year #bjaf and subsequent plan years1 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 7,b77i74 7,b7 ,procedures 7i7 ,validity of prescriber ,national ,provider ,identifiers ,the ,secretary1 in consultation with appropriate stakeholders1 shall establish procedures for determining the validity of prescriber ,national ,provider ,identifiers under subparagraph 7,a74 7ii7 ,informing beneficiaries of reason for denial ,the ,secretary shall establish procedures to ensure that1 in the case that a claim for a covered part ,d drug of an individual described in subparagaph 7,a7 is denied because the claim does not meet the requirements of this paragraph1 the individual is properly informed at the point of service of the reason for the denial4 7,c7 ,report ,not later than ,january #a1 #bjah1 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 7,b77i74 4 #i4 ,option to receive ,medicare ,summary ,notice electronically 7a7 ,in general ,section #ahjf of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#g7 is amended by adding at the end the following new subsection3 7c7 ,format of statements from ,secretary 7#a7 ,electronic option beginning in #bjaf ,subject to paragraph 7#b71 for statements described in subsection 7a7 that are furnished for a period in #bjaf or a subsequent year1 in the case that an individual described in subsection 7a7 elects1 in accordance with such form1 manner1 and time specified by the ,secretary1 to receive such statement in an electronic format1 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 individual4 7#b7 ,limitation on revocation option 7,a7 ,in general ,subject to subparagraph 7,b71 the ,secretary may determine a maximum number of elections described in paragraph 7#a7 by an individual that may be revoked by the individual4 7,b7 ,minimum of one revocation option ,in no case may the ,secretary determine a maximum number under subparagraph 7,a7 that is less than one4 7#c7 ,notification ,the ,secretary shall ensure that1 in the most cost effective manner and beginning ,january #a1 #bjag1 a clear notification of the option to elect to receive statements described in subsection 7a7 in an electronic format is made available1 such as through the notices distributed under section #ahjd1 to individuals described in subsection 7a74 4 7b7 ,encouraged expansion of electronic statements ,to the extent to which the ,secretary of ,health and ,human ,services determines appropriate1 the ,secretary shall-- 7#a7 apply an option similar to the option described in subsection 7c77#a7 of section #ahjf of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#g7 7relating to the provision of the ,medicare ,summary ,notice in an electronic format71 as added by subsection 7a71 to other statements and notifications under title ,,xviii of such ,act 7#db ,u4,s4,c4 #acie et seq472 and 7#b7 provide such ,medicare ,summary ,notice and any such other statements and notifications on a more frequent basis than is otherwise required under such title4 #aj4 ,renewal of ,,mac contracts 7a7 ,in general ,section #ahgd;,a7b77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk-#a7;b77#a77;,b77 is amended by striking #e years and inserting #aj years4 7b7 ,application ,the amendments made by subsection 7a7 shall apply to contracts entered into on or after1 and to contracts in effect as of1 the date of the enactment of this ,act4 7c7 ,contractor performance transparency ,section #ahgd;,a7b77#c77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk-#a7;b77#c77;,a77 is amended by adding at the end the following new clause3 7iv7 ,contractor performance transparency ,to the extent possible without compromising the process for entering into and renewing contracts with medicare administrative contractors under this section1 the ,secretary shall make available to the public the performance of each medicare administrative contractor with respect to such performance requirements and measurement standards4 4 #aa4 ,study on pathway for incentives to ,states for ,state participation in medicaid data match program ,section #ahic7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7g77 is amended by adding at the end the following new paragraph3 7#c7 ,incentives for ,states ,the ,secretary shall study and1 as appropriate1 may specify incentives for ,states to work with the ,secretary for the purposes described in paragraph 7#a77;,a77ii74 ,the application of the previous sentence may include use of the waiver authority described in paragraph 7#b74 4 #ab4 ,programs to prevent prescription drug abuse under ,medicare part ,d 7a7 ,drug management program for at-risk beneficiaries 7#a7 ,in general ,section #ahfj;,d-#d7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aj7;c771 as amended by section #h1 is further amended by adding at the end the following3 7#e7 ,drug management program for at-risk beneficiaries 7,a7 ,authority to establish ,a ,,pdp sponsor may establish a drug management program for at-risk beneficiaries under which1 subject to subparagraph 7,b71 the ,,pdp sponsor may1 in the case of an at-risk beneficiary for prescription drug abuse who is an enrollee in a prescription drug plan of such ,,pdp sponsor1 limit such beneficiary's access to coverage for frequently abused drugs under such plan to frequently abused drugs that are prescribed for such beneficiary by a prescriber selected under subparagraph 7,d71 and dispensed for such beneficiary by a pharmacy selected under such subparagraph4 7,b7 ,requirement for notices 7i7 ,in general ,a ,,pdp sponsor may not limit the access of an at-risk beneficiary for prescription drug abuse to coverage for frequently abused drugs under a prescription drug plan until such sponsor-- 7,i7 provides to the beneficiary an initial notice described in clause 7ii7 and a second notice described in clause 7iii72 and 7,,ii7 verifies with the providers of the beneficiary that the beneficiary is an at-risk beneficiary for prescription drug abuse4 7ii7 ,initial notice ,an initial notice described in this clause is a notice that provides to the beneficiary-- 7,i7 notice that the ,,pdp sponsor has identified the beneficiary as potentially being an at-risk beneficiary for prescription drug abuse2 7,,ii7 information describing all ,state and ,federal public health resources that are designed to address prescription drug abuse to which the beneficiary has access1 including mental health services and other counseling services2 7,,iii7 notice of1 and information about1 the right of the beneficiary to appeal such identification under subsection 7h7 and the option of an automatic escalation to external review2 7,,iv7 a request for the beneficiary to submit to the ,,pdp sponsor preferences for which prescribers and pharmacies the beneficiary would prefer the ,,pdp sponsor to select under subparagraph 7,d7 in the case that the beneficiary is identified as an at-risk beneficiary for prescription drug abuse as described in clause 7iii77,i72 7,v7 an explanation of the meaning and consequences of the identification of the beneficiary as potentially being an at-risk beneficiary for prescription drug abuse1 including an explanation of the drug management program established by the ,,pdp sponsor pursuant to subparagraph 7,a72 7,,vi7 clear instructions that explain how the beneficiary can contact the ,,pdp sponsor in order to submit to the ,,pdp sponsor the preferences described in subclause 7,,iv7 and any other communications relating to the drug management program for at-risk beneficiaries established by the ,,pdp sponsor2 and 7,,vii7 contact information for other organizations that can provide the beneficiary with assistance regarding such drug management program 7similar to the information provided by the ,secretary in other standardized notices provided to part ,d eligible individuals enrolled in prescription drug plans under this part74 7iii7 ,second notice ,a second notice described in this clause is a notice that provides to the beneficiary notice-- 7,i7 that the ,,pdp sponsor has identified the beneficiary as an at-risk beneficiary for prescription drug abuse2 7,,ii7 that such beneficiary is subject to the requirements of the drug management program for at-risk beneficiaries established by such ,,pdp sponsor for such plan2 7,,iii7 of the prescriber and pharmacy selected for such individual under subparagraph 7,d72 7,,iv7 of1 and information about1 the beneficiary's right to appeal such identification under subsection 7h7 and the option of an automatic escalation to external review2 7,v7 that the beneficiary can1 in the case that the beneficiary has not previously submitted to the ,,pdp sponsor preferences for which prescribers and pharmacies the beneficiary would prefer the ,,pdp sponsor select under subparagraph 7,d71 submit such preferences to the ,,pdp sponsor2 and 7,,vi7 that includes clear instructions that explain how the beneficiary can contact the ,,pdp sponsor4 7iv7 ,timing of notices 7,i7 ,in general ,subject to subclause 7,,ii71 a second notice described in clause 7iii7 shall be provided to the beneficiary on a date that is not less than #fj days after an initial notice described in clause 7ii7 is provided to the beneficiary4 7,,ii7 ,exception ,in the case that the ,,pdp sponsor1 in conjunction with the ,secretary1 determines that concerns identified through rulemaking by the ,secretary regarding the health or safety of the beneficiary or regarding significant drug diversion activities require the ,,pdp sponsor to provide a second notice described in clause 7iii7 to the beneficiary on a date that is earlier than the date described in subclause 7,,ii71 the ,,pdp sponsor may provide such second notice on such earlier date4 7,c7 ,at-risk beneficiary for prescription drug abuse 7i7 ,in general ,for purposes of this paragraph1 the term at-risk beneficiary for prescription drug abuse means a part ,d eligible individual who is not an exempted individual described in clause 7ii7 and-- 7,i7 who is identified through the use of clinical guidelines developed by the ,secretary in consultation with ,,pdp sponsors and other stakeholders described in section #ab7;f77#b77;,a7 of the ,protecting the ,integrity of ,medicare ,act of #bjae2 or 7,,ii7 with respect to whom the ,,pdp sponsor of a prescription drug plan1 upon enrolling such individual in such plan1 received notice from the ,secretary that such individual was identified under this paragraph to be an at-risk beneficiary for prescription drug abuse under the prescription drug plan in which such individual was most recently previously enrolled and such identification has not been terminated under subparagraph 7,f74 7ii7 ,exempted individual described ,an exempted individual described in this clause is an individual who-- 7,i7 receives hospice care under this title2 or 7,,ii7 the ,secretary elects to treat as an exempted individual for purposes of clause 7i74 7,d7 ,selection of prescribers 7i7 ,in general ,with respect to each at-risk beneficiary for prescription drug abuse enrolled in a prescription drug plan offered by such sponsor1 a ,,pdp sponsor shall1 based on the preferences submitted to the ,,pdp sponsor by the beneficiary pursuant to clauses 7ii77,,iv7 and 7iii77,v7 of subparagraph 7,b71 select-- 7,i7 one or more individuals who are authorized to prescribe frequently abused drugs 7referred to in this paragraph as prescribers7 who may write prescriptions for such drugs for such beneficiary2 and 7,,ii7 one or more pharmacies that may dispense such drugs to such beneficiary4 7ii7 ,reasonable access ,in making the selection under this subparagraph1 a ,,pdp sponsor shall ensure that the beneficiary continues to have reasonable access to drugs described in subparagraph 7,g71 taking into account geographic location1 beneficiary preference1 impact on cost-sharing1 and reasonable travel time4 7iii7 ,beneficiary preferences 7,i7 ,in general ,if an at-risk beneficiary for prescription drug abuse submits preferences for which in-network prescribers and pharmacies the beneficiary would prefer the ,,pdp sponsor select in response to a notice under subparagraph 7,b71 the ,,pdp sponsor shall-- 7aa7 review such preferences2 7bb7 select or change the selection of a prescriber or pharmacy for the beneficiary based on such preferences2 and 7cc7 inform the beneficiary of such selection or change of selection4 7,,ii7 ,exception ,in the case that the ,,pdp sponsor determines that a change to the selection of a prescriber or pharmacy under item 7bb7 by the ,,pdp sponsor is contributing or would contribute to prescription drug abuse or drug diversion by the beneficiary1 the ,,pdp sponsor may change the selection of a prescriber or pharmacy for the beneficiary without regard to the preferences of the beneficiary described in subclause 7,i74 7iv7 ,confirmation ,before selecting a prescriber or pharmacy under this subparagraph1 a ,,pdp sponsor must request and receive confirmation from the prescriber or pharmacy acknowledging and accepting that the beneficiary involved is in the drug management program for at-risk beneficiaries4 7,e7 ,terminations and appeals ,the identification of an individual as an at-risk beneficiary for prescription drug abuse under this paragraph1 a coverage determination made under a drug management program for at-risk beneficiaries1 and the selection of a prescriber or pharmacy under subparagraph 7,d7 with respect to such individual shall be subject to reconsideration and appeal under subsection 7h7 and the option of an automatic escalation to external review to the extent provided by the ,secretary4 7,f7 ,termination of identification 7i7 ,in general ,the ,secretary shall develop standards for the termination of identification of an individual as an at-risk beneficiary for prescription drug abuse under this paragraph4 ,under such standards such identification shall terminate as of the earlier of-- 7,i7 the date the individual demonstrates that the individual is no longer likely1 in the absence of the restrictions under this paragraph1 to be an at-risk beneficiary for prescription drug abuse described in subparagraph 7,c77i72 or 7,,ii7 the end of such maximum period of identification as the ,secretary may specify4 7ii7 ,rule of construction ,nothing in clause 7i7 shall be construed as preventing a plan from identifying an individual as an at-risk beneficiary for prescription drug abuse under subparagraph 7,c77i7 after such termination on the basis of additional information on drug use occurring after the date of notice of such termination4 7,g7 ,frequently abused drug ,for purposes of this subsection1 the term frequently abused drug means a drug that is determined by the ,secretary to be frequently abused or diverted and that is-- 7i7 a ,controlled ,drug ,substance in ,schedule ,,cii2 or 7ii7 within the same class or category of drugs as a ,controlled ,drug ,substance in ,schedule ,,cii1 as determined through notice and comment rulemaking4 7,h7 ,data disclosure ,in the case of an at-risk beneficiary for prescription drug abuse whose access to coverage for frequently abused drugs under a prescription drug plan has been limited by a ,,pdp sponsor under this paragraph1 such ,,pdp sponsor shall disclose data1 including any necessary individually identifiable health information1 in a form and manner specified by the ,secretary1 about the decision to impose such limitations and the limitations imposed by the sponsor under this part4 7,i7 ,education ,the ,secretary shall provide education to enrollees in prescription drug plans of ,,pdp sponsors and providers regarding the drug management program for at-risk beneficiaries described in this paragraph1 including education-- 7i7 provided by medicare administrative contractors through the improper payment outreach and education program described in section #ahgd;,a7h72 and 7ii7 through current education efforts 7such as ,state health insurance assistance programs described in subsection 7a77#a77;,a7 of section #aai of the ,medicare ,improvements for ,patients and ,providers ,act of #bjjh 7#db ,u4,s4,c4 #acie;b-#c note77 and materials directed toward such enrollees4 4 7#b7 ,information for consumers ,section #ahfj;,d-#d7;a77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;a77#a77;,b77 is amended by adding at the end the following3 7v7 ,the drug management program for at-risk beneficiaries under subsection 7c77#e74 4 7b7 ,utilization management programs ,section #ahfj;,d-#d7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;c771 as amended by subsection 7a77#a7 and section #h1 is further amended-- 7#a7 in paragraph 7#a71 by inserting after subparagraph 7,d7 the following new subparagraph3 7,e7 ,a utilization management tool to prevent drug abuse 7as described in paragraph 7#f77;,a774 2 and 7#b7 by adding at the end the following new paragraph3 7#f7 ,utilization management tool to prevent drug abuse 7,a7 ,in general ,a tool described in this paragraph is any of the following3 7i7 ,a utilization tool designed to prevent the abuse of frequently abused drugs by individuals and to prevent the diversion of such drugs at pharmacies4 7ii7 ,retrospective utilization review to identify-- 7,i7 individuals that receive frequently abused drugs at a frequency or in amounts that are not clinically appropriate2 and 7,,ii7 providers of services or suppliers that may facilitate the abuse or diversion of frequently abused drugs by beneficiaries4 7iii7 ,consultation with the ,contractor described in subparagraph 7,b7 to verify if an individual enrolling in a prescription drug plan offered by a ,,pdp sponsor has been previously identified by another ,,pdp sponsor as an individual described in clause 7ii77,i74 7,b7 ,reporting ,a ,,pdp sponsor offering a prescription drug plan in a ,state shall submit to the ,secretary and the ,medicare drug integrity contractor with which the ,secretary has entered into a contract under section #ahic with respect to such ,state a report1 on a monthly basis1 containing information on-- 7i7 any provider of services or supplier described in subparagraph 7,a77ii77,,ii7 that is identified by such plan sponsor during the #cj-;day period before such report is submitted2 and 7ii7 the name and prescription records of individuals described in paragraph 7#e77;,c74 4 7c7 ,expanding ,activities of ,medicare ,drug ,integrity ,contractors 7,m,e,d,i,cs7 ,section #ahic of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7 is amended by adding at the end the following new subsection3 7j7 ,expanding ,activities of ,medicare ,drug ,integrity ,contractors 7,m,e,d,i,cs7 7#a7 ,access to information ,under contracts entered into under this section with ,medicare drug integrity contractors1 the ,secretary shall authorize such contractors to directly accept prescription and necessary medical records from entities such as pharmacies1 prescription drug plans1 and physicians with respect to an individual in order for such contractors to provide information relevant to the determination of whether such individual is an at-risk beneficiary for prescription drug abuse1 as defined in section #ahfj;,d-#d7;c77#e77;,c74 7#b7 ,requirement for acknowledgment of referrals ,if a ,,pdp sponsor refers information to a contractor described in paragraph 7#a7 in order for such contractor to assist in the determination described in such paragraph1 the contractor shall-- 7,a7 acknowledge to the ,,pdp sponsor receipt of the referral2 and 7,b7 in the case that any ,,pdp sponsor contacts the contractor requesting to know the determination by the contractor of whether or not an individual has been determined to be an individual described such paragraph1 shall inform such ,,pdp sponsor of such determination on a date that is not later than #ae days after the date on which the ,,pdp sponsor contacts the contractor4 7#c7 ,making data available to other entities 7,a7 ,in general ,for purposes of carrying out this subsection1 subject to subparagraph 7,b71 the ,secretary shall authorize ,m,e,d,i,cs to respond to requests for information from ,,pdp sponsors1 ,state prescription drug monitoring programs1 and other entities delegated by ,,pdp sponsors using available programs and systems in the effort to prevent fraud1 waste1 and abuse4 7,b7 ,,hipaa compliant information only ,information may only be disclosed by a ,,medic under subparagraph 7,a7 if the disclosure of such information is permitted under the ,federal regulations 7concerning the privacy of individually identifiable health information7 promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7#db ,u4,s4,c4 #acbj;d-#b note74 4 7d7 ,treatment of certain complaints for purposes of quality or performance assessment ,section #ahfj;,d-#db of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aeb7 is amended by adding at the end the following new subsection3 7d7 ,treatment of certain complaints for purposes of quality or performance assessment ,in conducting a quality or performance assessment of a ,,pdp sponsor1 the ,secretary shall develop or utilize existing screening methods for reviewing and considering complaints that are received from enrollees in a prescription drug plan offered by such ,,pdp sponsor and that are complaints regarding the lack of access by the individual to prescription drugs due to a drug management program for at-risk beneficiaries4 4 7e7 ,,gao studies and reports 7#a7 ,studies ,the ,comptroller ,general of the ,united ,states shall conduct a study on each of the following3 7,a7 ,the implementation of the amendments made by this section4 7,b7 ,the effectiveness of the at-risk beneficiaries for prescription drug abuse drug management programs authorized by section #ahfj;,d-#d7;c77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aj7;c77#e771 as added by subsection 7a77#a71 including an analysis of-- 7i7 the impediments1 if any1 that impair the ability of individuals described in subparagraph 7,c7 of such section #ahfj;,d-#d7;c77#e7 to access clinically appropriate levels of prescription drugs2 and 7ii7 the types of-- 7,i7 individuals who1 in the implementation of such section1 are determined to be individuals described in such subparagraph2 and 7,,ii7 prescribers and pharmacies that are selected under subparagraph 7,d7 of such section4 7#b7 ,reports ,not later than ,january #a1 #bjaf1 the ,comptroller ,general of the ,united ,states shall begin work1 with respect to each study described in paragraph 7#a71 on a report that describes the result of such study4 ,upon the completion of each such report1 such ,comptroller ,general shall submit the report to each of the committees described in paragraph 7#c74 7#c7 ,committees described ,the committees described in this paragraph are the following3 7,a7 ,the ,committee on ,ways and ,means of the ,house of ,representatives4 7,b7 ,the ,committee on ,energy and ,commerce of the ,house of ,representatives4 7,c7 ,the ,committee on ,finance of the ,senate4 7,d7 ,the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate4 7,e7 ,the ,special ,committee on ,aging of the ,senate4 7f7 ,effective date 7#a7 ,in general ,the amendments made by this section shall apply to prescription drug plans for plan years beginning on or after ,january #a1 #bjag4 7#b7 ,stakeholder meetings prior to effective date 7,a7 ,in general ,not later than ,january #a1 #bjaf1 the ,secretary shall convene stakeholders1 including individuals entitled to benefits under part ,a of title ,,xviii of the ,social ,security ,act or enrolled under part ,b of such title of such ,act1 advocacy groups representing such individuals1 clinicians1 plan sponsors1 entities delegated by plan sponsors1 and biopharmaceutical manufacturers for input regarding the topics described in subparagraph 7,b74 7,b7 ,topics described ,the topics described in this subparagraph are the topics of-- 7i7 the impact on cost-sharing and ensuring accessibility to prescription drugs for enrollees in prescription drug plans of ,,pdp sponsors who are at-risk beneficiaries for prescription drug abuse 7as defined in paragraph 7#e77;,c7 of section #ahfj;,d-#d7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aj7;c7772 7ii7 the use of an expedited appeals process under which such an enrollee may appeal an identification of such enrollee as an at-risk beneficiary for prescription drug abuse under such paragraph 7similar to the processes established under the ,medicare ,advantage program under part ,c of title ,,xviii of the ,social ,security ,act that allow an automatic escalation to external review of claims submitted under such part72 7iii7 the types of enrollees that should be treated as exempted individuals1 as described in clause 7ii7 of such paragraph2 7iv7 the manner in which terms and definitions in paragraph 7#e7 of such section #ahfj;,d-#d7;c7 should be applied1 such as the use of clinical appropriateness in determining whether an enrollee is an at-risk beneficiary for prescription drug abuse as defined in subparagraph 7,c7 of such paragraph 7#e72 7v7 the information to be included in the notices described in subparagraph 7,b7 of such section and the standardization of such notices2 and 7vi7 with respect to a ,,pdp sponsor that establishes a drug management program for at-risk beneficiaries under such paragraph 7#e71 the responsibilities of such ,,pdp sponsor with respect to the implementation of such program4 7g7 ,rulemaking ,the ,secretary shall promulgate regulations based on the input gathered pursuant to subsection 7f77#b77;,a74 #ac4 ,guidance on application of ,common ,rule to clinical data registries ,not later than one year after the date of the enactment of this section1 the ,secretary of ,health and ,human ,services shall issue a clarification or modification with respect to the application of subpart ,a of part #df of title #de1 ,code of ,federal ,regulations1 governing the protection of human subjects in research 7and commonly known as the ,common ,rule71 to activities1 including quality improvement activities1 involving clinical data registries1 including entities that are qualified clinical data registries pursuant to section #ahdh7m77#c77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7m77#c77;,e774 #ad4 ,eliminating certain civil money penalties2 gainsharing study and report 7a7 ,eliminating civil money penalties for inducements to physicians to limit services that are not medically necessary 7#a7 ,in general ,section #aabh;,a7b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;a7b77#a77 is amended by inserting medically necessary after reduce or limit4 7#b7 ,effective date ,the amendment made by paragraph 7#a7 shall apply to payments made on or after the date of the enactment of this ,act4 7b7 ,gainsharing study and report ,not later than #ab months after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 in consultation with the ,inspector ,general of the ,department of ,health and ,human ,services1 shall submit to ,congress a report with options for amending existing fraud and abuse laws in1 and regulations related to1 titles ,,xi and ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #cja et seq471 through exceptions1 safe harbors1 or other narrowly targeted provisions1 to permit gainsharing arrangements that otherwise would be subject to the civil money penalties described in paragraphs 7#a7 and 7#b7 of section #aabh;,a7b7 of such ,act 7#db ,u4,s4,c4 #acbj;a-#g;a7b771 or similar arrangements between physicians and hospitals1 and that improve care while reducing waste and increasing efficiency4 ,the report shall-- 7#a7 consider whether such provisions should apply to ownership interests1 compensation arrangements1 or other relationships2 7#b7 describe how the recommendations address accountability1 transparency1 and quality1 including how best to limit inducements to stint on care1 discharge patients prematurely1 or otherwise reduce or limit medically necessary care2 and 7#c7 consider whether a portion of any savings generated by such arrangements 7as 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 title7 should accrue to the ,medicare program under title ,,xviii of the ,social ,security ,act4 #ae4 ,modification of ,medicare home health surety bond condition of participation requirement ,section #ahfa7o77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7o77#g77 is amended to read as follows3 7#g7 provides the ,secretary with a surety bond-- 7,a7 in a form specified by the ,secretary and in an amount that is not less than the minimum of #ej1jjj2 and 7,b7 that the ,secretary determines is commensurate with the volume of payments to the home health agency2 and 4 #af4 ,oversight of ,medicare coverage of manual manipulation of the spine to correct subluxation 7a7 ,in general ,section #ahcc of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7 is amended by adding at the end the following new subsection3 7z7 ,medical review of spinal subluxation services 7#a7 ,in general ,the ,secretary shall implement a process for the medical review 7as described in paragraph 7#b77 of treatment by a chiropractor described in section #ahfa7r77#e7 by means of manual manipulation of the spine to correct a subluxation 7as described in such section7 of an individual who is enrolled under this part and apply such process to such services furnished on or after ,january #a1 #bjag1 focusing on services such as-- 7,a7 services furnished by a such a chiropractor whose pattern of billing is aberrant compared to peers2 and 7,b7 services furnished by such a chiropractor who1 in a prior period1 has a services denial percentage in the #heth percentile or greater1 taking into consideration the extent that service denials are overturned on appeal4 7#b7 ,medical review 7,a7 ,prior authorization medical review 7i7 ,in general ,subject to clause 7ii71 the ,secretary shall use prior authorization medical review for services described in paragraph 7#a7 that are furnished to an individual by a chiropractor described in section #ahfa7r77#e7 that are part of an episode of treatment that includes more than #ab services4 ,for purposes of the preceding sentence1 an episode of treatment shall be determined by the underlying cause that justifies the need for services1 such as a diagnosis code4 7ii7 ,ending application of prior authorization medical review ,the ,secretary shall end the application of prior authorization medical review under clause 7i7 to services described in paragraph 7#a7 by such a chiropractor if the ,secretary determines that the chiropractor has a low denial rate under such prior authorization medical review4 ,the ,secretary may subsequently reapply prior authorization medical review to such chiropractor if the ,secretary determines it to be appropriate and the chiropractor has1 in the time period subsequent to the determination by the ,secretary of a low denial rate with respect to the chiropractor1 furnished such services described in paragraph 7#a74 7iii7 ,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 7#a7 that are to be furnished to an individual before the chiropractor furnishes the twelfth such service to such individual for an episode of treatment4 7,b7 ,type of review ,the ,secretary may use pre-payment review or post-payment review of services described in section #ahfa7r77#e7 that are not subject to prior authorization medical review under subparagraph 7,a74 7,c7 ,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 involved4 7#c7 ,no payment without prior authorization ,with respect to a service described in paragraph 7#a7 for which prior authorization medical review under this subsection applies1 the following shall apply3 7,a7 ,prior authorization determination ,the ,secretary shall make a determination1 prior to the service being furnished1 of whether the service would or would not meet the applicable requirements of section #ahfb7;a77#a77;,a74 7,b7 ,denial of payment ,subject to paragraph 7#e71 no payment may be made under this part for the service unless the ,secretary determines pursuant to subparagraph 7,a7 that the service would meet the applicable requirements of such section #ahfb7;a77#a77;,a74 7#d7 ,submission of information ,a chiropractor described in section #ahfa7r77#e7 may submit the information necessary for medical review by fax1 by mail1 or by electronic means4 ,the ,secretary shall make available the electronic means described in the preceding sentence as soon as practicable4 7#e7 ,timeliness ,if the ,secretary does not make a prior authorization determination under paragraph 7#c77;,a7 within #ad business days of the date of the receipt of medical documentation needed to make such determination1 paragraph 7#c77;,b7 shall not apply4 7#f7 ,application of limitation on beneficiary liability ,where payment may not be made as a result of the application of paragraph 7#b77;,b71 section #ahgi shall apply in the same manner as such section applies to a denial that is made by reason of section #ahfb7;a77#a74 7#g7 ,review by contractors ,the medical review described in paragraph 7#b7 may be conducted by medicare administrative contractors pursuant to section #ahgd;,a7a77#d77;,g7 or by any other contractor determined appropriate by the ,secretary that is not a recovery audit contractor4 7#h7 ,multiple services ,the ,secretary shall1 where practicable1 apply the medical review under this subsection in a manner so as to allow an individual described in paragraph 7#a7 to obtain1 at a single time rather than on a service-by-service basis1 an authorization in accordance with paragraph 7#c77;,a7 for multiple services4 7#i7 ,construction ,with respect to a service described in paragraph 7#a7 that has been affirmed by medical review under this subsection1 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 ,act4 7#aj7 ,implementation 7,a7 ,authority ,the ,secretary may implement the provisions of this subsection by interim final rule with comment period4 7,b7 ,administration ,chapter #ce of title #dd1 ,united ,states ,code1 shall not apply to medical review under this subsection4 4 7b7 ,improving documentation of services 7#a7 ,in general ,the ,secretary of ,health and ,human ,services shall1 in consultation with stakeholders 7including the ,american ,chiropractic ,association7 and representatives of medicare administrative contractors 7as defined in section #ahgd;,a7a77#c77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk-#a7;a77#c77;,a7771 develop educational and training programs to improve the ability of chiropractors to provide documentation to the ,secretary of services described in section #ahfa7r77#e7 in a manner that demonstrates that such services are1 in accordance with section #ahfb7;a77#a7 of such ,act 7#db ,u4,s4,c4 #aciey7a77#a771 reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member4 7#b7 ,timing ,the ,secretary shall make the educational and training programs described in paragraph 7#a7 publicly available not later than ,january #a1 #bjaf4 7#c7 ,funding ,the ,secretary shall use funds made available under section #ahic7;h77#aj7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7h77#aj771 as added by section #f1 to carry out this subsection4 7c7 ,,gao study and report 7#a7 ,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 7z7 of section #ahcc of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel71 as added by subsection 7a74 ,such study shall include an analysis of-- 7,a7 aggregate data on-- 7i7 the number of individuals1 chiropractors1 and claims for services subject to such review2 and 7ii7 the number of reviews conducted under such section2 and 7,b7 the outcomes of such reviews4 7#b7 ,report ,not later than four years after the date of enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a71 including recommendations for such legislation and administrative action with respect to the process for medical review implemented under subsection 7z7 of section #ahcc of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7 as the ,comptroller ,general determines appropriate4 #ag4 ,national expansion of prior authorization model for repetitive scheduled non-emergent ambulance transport 7a7 ,initial expansion 7#a7 ,in general ,in implementing the model described in paragraph 7#b7 proposed to be tested under subsection 7b7 of section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a71 the ,secretary of ,health and ,human ,services shall revise the testing under subsection 7b7 of such section to cover1 effective not later than ,january #a1 #bjaf1 ,states located in medicare administrative contractor 7,,mac7 regions ,l and #aa 7consisting of ,delaware1 the ,district of ,columbia1 ,maryland1 ,new ,jersey1 ,pennsylvania1 ,north ,carolina1 ,south ,carolina1 ,west ,virginia1 and ,virginia74 7#b7 ,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 ,jersey1 ,pennsylvania1 and ,south ,carolina4 7#c7 ,funding ,the ,secretary shall allocate funds made available under section #aaae;,a7f77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7f77#a77;,b77 to carry out this subsection4 7b7 ,national expansion ,section #ahcd7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77 is amended by adding at the end the following new paragraph3 7#af7 ,prior authorization for repetitive scheduled non-emergent ambulance transports 7,a7 ,in general ,beginning ,january #a1 #bjag1 if the expansion to all ,states of the model of prior authorization described in paragraph 7#b7 of section #ah7;a7 of the ,protecting the ,integrity of ,medicare ,act of #bjae meets the requirements described in paragraphs 7#a7 through 7#c7 of section #aaae;,a7c71 then the ,secretary shall expand such model to all ,states4 7,b7 ,funding ,the ,secretary shall use funds made available under section #ahic7;h77#aj7 to carry out this paragraph4 7,c7 ,clarification regarding budget neutrality ,nothing in this paragraph may be construed to limit or modify the application of section #aaae;,a7b77#c77;,b7 to models described in such section1 including with respect to the model described in subparagraph 7,a7 and expanded beginning on ,january #a1 #bjag1 under such subparagraph4 4 #ah4 ,repealing duplicative ,medicare secondary payor provision 7a7 ,in general ,section #ahfb7;b77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7b77#e77 is amended by inserting at the end the following new subparagraph3 7,e7 ,end date ,the provisions of this paragraph shall not apply to information required to be provided on or after ,july #a1 #bjaf4 4 7b7 ,effective date ,the amendment made by subsection 7a7 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 #a1 #bjaf4 #ai4 ,plan for expanding data in annual ,,cert report ,not later than ,june #cj1 #bjae1 the ,secretary of ,health and ,human ,services shall submit to the ,committee on ,finance of the ,senate1 and to the ,committees on ,energy and ,commerce and on ,ways and ,means of the ,house of ,representatives-- 7#a7 a plan for including1 in the annual report of the ,comprehensive ,error ,rate ,testing 7,,cert7 program1 data on services 7or groupings of services7 7other than medical visits7 paid under the physician fee schedule under section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 where the fee schedule amount is in excess of #bej dollars and where the error rate is in excess of #bj percent2 and 7#b7 to the extent practicable by such date1 specific examples of services described in paragraph 7#a74 #bj4 ,removing funds for ,medicare ,improvement ,fund added by ,,impact ,act of #bjad ,section #ahih7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;iii7b77#a771 as amended by section #c7;e77#c7 of the ,,impact ,act of #bjad 7,public ,law #aac-ahe71 is amended by striking #aie1jjj1jjj and inserting #j4 #ba4 ,rule of construction ,except as explicitly provided in this ,act1 nothing in this ,act1 including the amendments made by this ,act1 shall be construed as preventing the use of notice and comment rulemaking in the implementation of the provisions of1 and the amendments made by1 this ,act4 ,march #ah1 #bjae,reported from the ,committee on ,ways and ,means with an amendment,march #ah1 #bjae ,the ,committee on ,energy and ,commerce discharged2 committed to the ,committee of the ,whole ,house on the ,state of the ,union and ordered to be printed