,i #aad? ,,congress #a/ ,session ,h4 ,r4 #cgah ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,octob] #h1 #bjae ,mr4 ,roskam 7= himself & ,mr4 ,c>ney7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committee on ,ways & ,means1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to am5d titles ,,xviii & ,,xix ( ! ,social ,security ,act to curb wa/e1 fraud1 & abuse 9 ! ,m$ic>e & ,m$icaid programs4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,prev5t+ & ,r$uc+ ,improp] ,m$ic>e & ,m$icaid ,exp5ditures to ,re/ore ,integrity to ,b5efits ,act ( #bjae4 #b4 ,/r5g!n+ ,m$icaid ,program integrity ?r\gh flexibility ,section #aicf ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#f7 is am5d$-- 7#a7 9 subsection 7a71 by ins]t+ 1 or o!rwise1 aft] entities2 & 7#b7 9 subsection 7e7-- 7,a7 9 p>agraph 7#a71 9 ! matt] prec$+ subp>agraph 7,a71 by ins]t+ 7includ+ ! co/s ( equipm5t1 sal>ies & b5efits1 & travel & tra9+7 aft] ,program "u ?is section2 & 7,b7 9 p>agraph 7#c71 by /rik+ by #ajj & ins]t+ by #ajj1 or su* numb] z det]m9$ necess>y by ! ,secret>y to c>ry out ! ,program14 #c4 ,e/abli%+ ,m$ic>e adm9i/rative contractor error r$uction inc5tives 7a7 ,9 g5]al ,section #ahgd;,a7b77#a77;,d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciekk-#a7;b77#a77;,d77 is am5d$-- 7#a7 by /rik+ quality4--,! ,secret>y & ins]t+ 8quality4-- 7i7 ,9 g5]al ,subject to clauses 7ii7 & 7iii71 ! ,secret>y 2 & 7#b7 by ins]t+ aft] clause 7i71 z add$ by p>agraph 7#a71 ! foll[+ new clauses3 7ii7 ,improp] paym5t rate r$uction inc5tives ,! ,secret>y %all provide inc5tives = m$ic>e adm9i/rative contractors to r$uce ! improp] paym5t error rates 9 _! jurisdictions4 7iii7 ,inc5tives ,! inc5tives provid$ = "u clause 7ii7-- 7,i7 may include a slid+ scale ( aw>d fee paym5ts & additional inc5tives to m$ic>e adm9i/rative contractors t ei!r r$uce ! improp] paym5t rates 9 _! jurisdictions to c]ta9 ?re%olds1 z det]m9$ by ! ,secret>y1 or accompli% tasks1 z det]m9$ by ! ,secret>y1 t fur!r improve paym5t accuracy2 & 7,,ii7 may include sub/antial r$uctions 9 aw>d fee paym5ts "u co/-plus-aw>d-fee contracts1 = m$ic>e adm9i/rative contractors t rea* an upp] end improp] paym5t rate ?re%old or o!r ?re%old z det]m9$ by ! ,secret>y1 or fail to accompli% tasks1 z det]m9$ by ! ,secret>y1 t fur!r improve paym5t accuracy4 4 7b7 ,effective date 7#a7 ,9 g5]al ,! am5dm5ts made by subsection 7a7 %all apply to contracts ent]$ into or r5ew$ on or aft] ! date t is #c ye>s aft] ! date ( enactm5t ( ?is ,act4 7#b7 ,application to exi/+ contracts ,9 ! case ( contracts 9 exi/5ce on or aft] ! date ( ! enactm5t ( ?is ,act & t are n subject to ! effective date "u p>agraph 7#a71 ! ,secret>y ( ,heal? & ,human ,s]vices %all1 :5 appropriate & practicable1 seek to apply ! inc5tives provid$ = 9 ! am5dm5ts made by subsection 7a7 ?r\gh contract modifications4 #d4 ,/r5g!n+ p5alties = ! illegal di/ribution ( a ,m$ic>e1 ,m$icaid1 or ,,*ip b5efici>y id5tification or bill+ privileges ,section #aabh;,b7b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7b77 is am5d$ by add+ at ! end ! foll[+3 7#d7 ,:oev] )\t lawful au?ority kn[+ly & willfully pur*ases1 sells or di/ributes1 or arranges = ! pur*ase1 sale1 or di/ribution ( a b5efici>y id5tification numb] or unique heal? id5tifi] = a heal? c>e provid] "u title ,,xviii1 title ,,xix1 or title ,,xxi %all be imprison$ = n m ?an #aj ye>s or f9$ n m ?an #ejj1jjj 7#a1jjj1jjj 9 ! case ( a corporation71 or bo?4 4 #e4 ,improv+ ! %>+ ( data betwe5 ! ,f$]al ,gov]nm5t & ,/ate ,m$icaid programs 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y7 %all e/abli% a plan to enc\rage & facilitate ! p>ticipation ( ,/ates 9 ! ,m$ic>e-,m$icaid ,data ,mat* ,program 7commonly ref]r$ to z ! ,m$i-,m$i ,program7 "u section #ahic7;g7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7g774 7b7 ,program revisions ,to improve ,m$i-,m$i ,data ,mat* ,program p>ticipation by ,/ates ,section #ahic7;g77#a77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7g77#a77;,a77 is am5d$-- 7#a7 9 ! matt] prec$+ clause 7i71 by ins]t+ or o!rwise aft] eligible entities2 7#b7 9 clause 7i7-- 7,a7 by ins]t+ to review claims data aft] algori?ms2 & 7,b7 by /rik+ s]vice1 "t1 or pati5t & ins]t+ provid]1 s]vice1 "t1 or pati5t2 7#c7 9 clause 7ii7-- 7,a7 by ins]t+ to inve/igate & recov] am\nts ) respect to suspect claims aft] appropriate actions2 & 7,b7 by /rik+ 2 & & ins]t+ a semicolon2 7#d7 9 clause 7iii71 by /rik+ ! p]iod & ins]t+ 2 &2 & 7#e7 by add+ at ! end ! foll[+ new clause3 7iv7 fur!r+ ! ,secret>y's design1 developm5t1 in/allation1 or enhancem5t ( an automat$ data sy/em ar*itecture-- 7,i7 to collect1 integrate1 & assess data = purposes ( program integrity1 program ov]sight1 & adm9i/ration1 includ+ ! ,m$i-,m$i ,program2 & 7,,ii7 t improves ! coord9ation ( reque/s = data f ,/ates4 4 7c7 ,provid+ /ates ) data on improp] paym5ts made = items or s]vices provid$ to dual eligible individuals 7#a7 ,9 g5]al ,! ,secret>y %all develop & implem5t a plan t all[s ea* ,/ate ag5cy responsible = adm9i/]+ a ,/ate plan = m$ical assi/ance "u title ,,xix ( ! ,social ,security ,act access to relevant data on improp] or fraudul5t paym5ts made "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 = heal? c>e items or s]vices provid$ to dual eligible individuals4 7#b7 ,dual eligible individual def9$ ,9 ?is section1 ! t]m dual eligible individual means an individual :o is entitl$ to1 or enroll$ =1 b5efits "u "p ,a ( title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq471 or enroll$ = b5efits "u "p ,b ( title ,,xviii ( su* ,act 7#db ,u4,s4,c4 #acie;j et seq471 & is eligible = m$ical assi/ance "u a ,/ate plan "u title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq47 or "u a waiv] ( su* plan4 #f4 ,report on implem5tation ,n lat] ?an #ah mon?s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all submit to ,congress a report on ! implem5tation ( ! provisions (1 & ! am5dm5ts made by-- 7#a7 ?is ,act2 & 7#b7 sections #ejf & #ejg ( ! ,m$ic>e ,access & ,,*ip ,reau?orization ,act ( #bjae 7,public ,law #aad-aj74