,,ii #aad? ,,congress #a/ ,session ,s4 #bdji ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,decemb] #af1 #bjae,mr4 ,wyd5 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to am5d titles ,,xviii & ,,xix ( ! ,social ,security ,act to improve paym5ts = hospital outpati5t dep>tm5t s]vices & complex rehabilitation te*nology & to improve program integrity1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,m$ic>e & ,m$icaid ,improvem5ts & ,adju/m5ts ,act ( #bjae4 7b7 ,table ( cont5ts ,! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4,title ,i--,corrections to ,outpati5t ,provision,sec4 #aja4 ,cont9u+ ,m$ic>e paym5t "u ,,hopd prospective paym5t sy/em = s]vices furni%$ by (f-campus outpati5t dep>tm5ts ( provid]s "u developm5t4,sec4 #ajb4 ,ma9ta9+ canc] hospital adju/m5t "u ,m$ic>e (f-campus outpati5t dep>tm5ts ( a provid] paym5t policy4,title ,,ii--,provisions ,protect+ ,p ) ,disabilities & ,*ronic ,c>e ,needs,sec4 #bja4 ,non-application ( ,m$ic>e fee s*$ule adju/m5ts = :eel*air accessories & seat & back cu%ions :5 furni%$ 9 connection ) complex rehabilitative p[] :eel*airs4,sec4 #bjb4 ,treatm5t ( infusion drugs furni%$ ?r\gh durable m$ical equipm5t4,sec4 #bjc4 ,transitional paym5t rules = c]ta9 radiation !rapy s]vices "u ! ,m$ic>e physician fee s*$ule4,sec4 #bjd4 ,fairness 9 ,m$icaid supplem5tal ne$s tru/s4,title ,,iii--,program ,integrity1 ,paym5t ,effici5cy1 & ,additional ,m$ic>e ,policies,sec4 #cja4 ,/r5g!n+ p5alties = ! illegal di/ribution ( a ,m$ic>e1 ,m$icaid1 or ,,*ip b5efici>y id5tification or bill+ privileges4,sec4 #cjb4 ,civil monet>y p5alties = violations relat$ to grants1 contracts1 & o!r agreem5ts4,sec4 #cjc4 ,au?oriz+ a blanket mean+ful use significant h>d%ip exception4,sec4 #cjd4 ,limit+ ,f$]al ,m$icaid reimbursem5t to ,/ates = durable m$ical equipm5t 7,,dme7 to ,m$ic>e paym5t rates4,sec4 #cje4 ,treatm5t ( pati5t enc\nt]s 9 ambulatory surgical c5t]s 9 det]m9+ mean+ful ,,ehr use4 ,i ,corrections to ,outpati5t ,provision #aja4 ,cont9u+ ,m$ic>e paym5t "u ,,hopd prospective paym5t sy/em = s]vices furni%$ by (f-campus outpati5t dep>tm5ts ( provid]s "u developm5t ,section #ahcc7t7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77 is am5d$-- 7#a7 9 p>agraph 7#a77;,b77v71 by ins]t+ 1 subject to subp>agraph 7,e7 ( su* p>agraph1 aft] #bjag1 by2 & 7#b7 9 p>agraph 7#ba7-- 7,a7 9 subp>agraph 7,c7 by /rik+ t are describ$ 9 p>agraph 7#a77;,b77v7 %all be made & ins]t+ to :i* p>agraph 7#a77;,b77v7 applies %all be ! am\nt det]m9$2 7,b7 by r$esignat+ subp>agraph 7,e7 z subp>agraph 7,f72 & 7,c7 by ins]t+ aft] subp>agraph 7,d7 ! foll[+ new subp>agraph3 7,e7 ,non-application ) respect to dep>tm5ts "u developm5t 7i7 ,9 g5]al ,p>agraph 7#a77;,b77v7 %all n apply to an (f-campus outpati5t dep>tm5t ( a provid] t is det]m9$ by ! ,secret>y to be "u developm5t z ( ! date ( ! enactm5t ( ! ,bip>tisan ,budget ,act ( #bjae4 7ii7 ,application ,= purposes ( p>agraph 7#a77;,b77v7 & ?is p>agraph1 9 det]m9+ :e!r an (f-campus outpati5t dep>tm5t ( a provid] 0 "u developm5t1 ! ,secret>y %all require t z ( ! date ( ! enactm5t ( su* ,act ! dep>tm5t met-- 7,i7 at lea/ "o ( ! requirem5ts describ$ 9 clause 7iii72 & 7,,ii7 any additional requirem5ts ! ,secret>y det]m9es w\ld indicate :e!r su* (f-campus outpati5t dep>tm5t ( a provid] 0 "u developm5t z ( su* date4 7iii7 ,requirem5ts describ$ ,! foll[+ requirem5ts are describ$ 9 ?is clause3 7,i7 ,ar*itectural plans 7 complet$4 7,,ii7 ,zon+ requirem5ts 7 met or a reque/ = approval ( meet+ su* zon+ requirem5ts 0 submitt$ to appropriate ag5cies4 7,,iii7 ,necess>y approvals f appropriate ,/ate ag5cies 7 appli$ = or receiv$4 4 #ajb4 ,ma9ta9+ canc] hospital adju/m5t "u ,m$ic>e (f-campus outpati5t dep>tm5ts ( a provid] paym5t policy ,section #ahcc7t7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77 is am5d$-- 7#a7 9 p>agraph 7#a77;,b77v71 z am5d$ by section #aja7a71 by /rik+ subp>agraph 7,e7 & ins]t+ subp>agraph 7,f72 & 7#b7 9 p>agraph 7#ba71 z add$ by section #fjc ( ! ,bip>tisan ,budget ,act ( #bjae & z am5d$ by section #aja7b7-- 7,a7 by r$esignat+ subp>agraphs 7,d71 7,e71 & 7,f7 z subp>agraphs 7,e71 7,f71 & 7,g71 respectively2 7,b7 by ins]t+ aft] subp>agraph 7,c7 ! foll[+ new subp>agraph3 7,d7 ,application ( canc] hospital adju/m5t ,! ,secret>y %all apply ! adju/m5t "u p>agraph 7#ah7 to applicable items & s]vices furni%$ on or aft] ,janu>y #a1 #bjag1 by an (f-campus outpati5t dep>tm5t ( a provid] 7z def9$ 9 subp>agraph 7,b77 ( a hospital describ$ 9 section #ahhf7;d77#a77;,b77v7-- 7i7 z if ?is p>agraph 7o!r ?an ?is subp>agraph7 & p>agraph 7#a77;,b77v7 7 n applicable to su* applicable items & s]vices & su* applicable items & s]vices 7 cov]$ ,,opd s]vices & paid "u ?is subsection2 & 7ii7 )\t application ( p>agraphs 7#b77;,e7 & 7#i77;,b74 2 & 7,c7 9 subp>agraph 7,g77iii71 z r$esignat$ by subp>agraph 7,a7 ( ?is p>agraph1 by /rik+ subp>agraph 7,d7 & ins]t+ subp>agraph 7,e74 ,,ii ,provisions ,protect+ ,p ) ,disabilities & ,*ronic ,c>e ,ne$s #bja4 ,non-application ( ,m$ic>e fee s*$ule adju/m5ts = :eel*air accessories & seat & back cu%ions :5 furni%$ 9 connection ) complex rehabilitative p[] :eel*airs 7a7 ,non-,application 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 ! ,secret>y ( ,heal? & ,human ,s]vices %all n1 prior to ,janu>y #a1 #bjag1 use in=mation on ! paym5t det]m9$ "u ! competitive acquisition programs "u section #ahdg ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c77 to adju/ ! paym5t am\nt t w\ld o!rwise be recogniz$ "u section #ahcd7;a77#a77;,b77ii7 ( su* ,act 7#db ,u4,s4,c4 #aciem7a77#a77;,b77ii77 = :eel*air accessories 7includ+ seat+ sy/ems7 & seat & back cu%ions :5 furni%$ 9 connection ) ,gr\p #c complex rehabilitative p[] :eel*airs4 7#b7 ,implem5tation ,not)/&+ any o!r provision ( law1 ! ,secret>y may implem5t ?is subsection by program in/ruction or o!rwise4 7b7 ,,gao /udy & report 7#a7 ,/udy 7,a7 ,9 g5]al ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all conduct a /udy on :eel*air accessories 7includ+ seat+ sy/ems7 & seat & back cu%ions furni%$ 9 connection ) ,gr\p #c complex rehabilitative p[] :eel*airs4 ,su* /udy %all include an analysis ( ! foll[+ ) respect to su* :eel*air accessories & seat & back cu%ions 9 ea* ( ! gr\ps describ$ 9 clauses 7i7 ?r\gh 7iii7 ( subp>agraph 7,b73 7i7 ,! item descriptions & associat$ ,,hcpcs codes = su* :eel*air accessories & seat & back cu%ions4 7ii7 ,a breakd[n ( utilization & exp5ditures = su* :eel*air accessories & seat & back cu%ions "u title ,,xviii ( ! ,social ,security ,act4 7iii7 ,a comp>ison ( ! paym5t am\nt "u ! competitive acquisition program "u section #ahdg ( su* ,act 7#db ,u4,s4,c4 #aciew-#c7 ) ! paym5t am\nt t w\ld o!rwise be recogniz$ "u section #ahcd ( su* ,act 7#db ,u4,s4,c4 #aciem71 includ+ b5efici>y co/ %>+1 = su* :eel*air accessories & seat & back cu%ions4 7iv7 ,! aggregate di/ribution ( su* :eel*air accessories & seat & back cu%ions furni%$ "u su* title ,,xviii )9 ea* ( ! gr\ps describ$ 9 subp>agraph 7,b74 7v7 ,o!r areas det]m9$ appropriate by ! ,comptroll] ,g5]al4 7,b7 ,gr\ps describ$ ,! foll[+ gr\ps are describ$ 9 ?is subp>agraph3 7i7 ,:eel*air accessories & seat & back cu%ions furni%$ pr$om9antly ) ,gr\p #c complex rehabilitative p[] :eel*airs4 7ii7 ,:eel*air accessories & seat & back cu%ions furni%$ pr$om9antly ) p[] :eel*airs t are n describ$ 9 clause 7i74 7iii7 ,o!r :eel*air accessories & seat & back cu%ions furni%$ ) ei!r p[] :eel*airs describ$ 9 clause 7i7 or 7ii74 7#b7 ,report ,n lat] ?an ,june #a1 #bjaf1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress a report conta9+ ! results ( ! /udy conduct$ "u p>agraph 7#a71 toge!r ) recomm5dations = su* legislation & adm9i/rative actions z ! ,comptroll] ,g5]al det]m9es to be appropriate4 #bjb4 ,treatm5t ( infusion drugs furni%$ ?r\gh durable m$ical equipm5t ,section #ahdb7o77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieu7o77#a77 is am5d$-- 7#a7 9 subp>agraph 7,c71 by ins]t+ 7& includ+ a drug or biological describ$ 9 subp>agraph 7,d77i7 furni%$ dur+ ! #f-ye> p]iod beg9n+ on ,janu>y #a1 #bjag7 aft] #bjje2 & 7#b7 9 subp>agraph 7,d7-- 7,a7 by /rik+ infusion drugs & ins]t+ infusion drugs or biologicals ea* place x appe>s2 & 7,b7 9 clause 7i7-- 7i7 by /rik+ #bjjd & ins]t+ #bjjd 7o!r ?an dur+ ! #f-ye> p]iod beg9n+ on ,janu>y #a1 #bjag72 & 7ii7 by /rik+ = su* drug4 #bjc4 ,transitional paym5t rules = c]ta9 radiation !rapy s]vices "u ! ,m$ic>e physician fee s*$ule 7a7 ,9 g5]al ,section #ahdh ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 is am5d$-- 7#a7 9 subsection 7b71 z am5d$ by section #ejb ( division ,o ( ! ,consolidat$ ,appropriations ,act1 #bjaf1 by add+ at ! end ! foll[+ new p>agraph3 7#aa7 ,special rule = c]ta9 radiation !rapy s]vices ,! code def9itions1 ! "w relative value units "u subsection 7c77#b77;,c77i71 & ! direct inputs = ! practice exp5se relative value units "u subsection 7c77#b77;,c77ii7 = radiation treatm5t deliv]y & relat$ imag+ s]vices 7id5tifi$ 9 #bjaf by ,,hcpcs ,g-codes ,g#fjja ?r\gh ,g#fjae7 = ! fee s*$ule e/abli%$ "u ?is subsection = s]vices furni%$ 9 #bjag & #bjah %all be ! same z su* def9itions1 units1 & inputs = su* s]vices = ! fee s*$ule e/abli%$ = s]vices furni%$ 9 #bjaf4 2 & 7#b7 9 subsection 7c77#b77,k71 by add+ at ! end ! foll[+ new clause3 7iv7 ,treatm5t ( c]ta9 radiation !rapy s]vices ,radiation treatm5t deliv]y & relat$ imag+ s]vices id5tifi$ "u subsection 7b77#aa7 %all n be consid]$ z pot5tially misvalu$ s]vices = purposes ( ?is subp>agraph & subp>agraph 7,o7 = #bjag & #bjah4 4 7b7 ,report to ,congress on alt]native paym5t model ,n lat] ?an #ah mon?s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all submit to ,congress a report on ! developm5t ( an episodic alt]native paym5t model = paym5t "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act = radiation !rapy s]vices furni%$ 9 nonfacility sett+s4 #bjd4 ,fairness 9 ,m$icaid supplem5tal ne$s tru/s 7a7 ,9 g5]al ,section #aiag7;d77#d77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifp7d77#d77;,a77 is am5d$ by ins]t+ ! individual1 aft] = ! b5efit ( su* individual by4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all apply to tru/s e/abli%$ on or aft] ! date ( ! enactm5t ( ?is ,act4 ,,iii ,program ,integrity1 ,paym5t ,effici5cy1 & ,additional ,m$ic>e ,policies #cja4 ,/r5g!n+ p5alties = ! illegal di/ribution ( a ,m$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 #cjb4 ,civil monet>y p5alties = violations relat$ to grants1 contracts1 & o!r agreem5ts 7a7 ,9 g5]al ,section #aabh;,a ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;a7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7o7 ,any p]son 7includ+ an organization1 ag5cy1 or o!r entity1 b exclud+ a program b5efici>y1 z def9$ 9 subsection 7r77#d77 t1 ) respect to a grant1 contract1 or o!r agreem5t = :i* ! ,secret>y ( ,heal? & ,human ,s]vices provides fund+-- 7#a7 kn[+ly pres5ts or causes to be pres5t$ a specifi$ claim 7z def9$ 9 subsection 7r77#f77 "u su* grant1 contract1 or o!r agreem5t t ! p]son kn[s or %\ld "k is false or fraudul5t2 7#b7 kn[+ly makes1 uses1 or causes to be made or us$ any false /atem5t1 omission1 or misrepres5tation ( a mat]ial fact 9 any application1 proposal1 bid1 progress report1 or o!r docum5t t is requir$ to be submitt$ 9 ord] to directly or indirectly receive or reta9 funds provid$ 9 :ole or 9 "p by su* ,secret>y pursuant to su* grant1 contract1 or o!r agreem5t2 7#c7 kn[+ly makes1 uses1 or causes to be made or us$1 a false record or /atem5t mat]ial to a false or fraudul5t specifi$ claim "u su* grant1 contract1 or o!r agreem5t2 7#d7 kn[+ly makes1 uses1 or causes to be made or us$1 a false record or /atem5t mat]ial to an obligation to pay or transmit funds or prop]ty to su* ,secret>y ) respect to su* grant1 contract1 or o!r agreem5t1 or kn[+ly conceals or kn[+ly & improp]ly avoids or decreases an obligation to pay or transmit funds or prop]ty to su* ,secret>y ) respect to su* grant1 contract1 or o!r agreem5t2 or 7#e7 fails to grant timely access1 ^u reasonable reque/ 7z def9$ by su* ,secret>y 9 regulations71 to ! ,inspector ,g5]al ( ! ,dep>tm5t1 = ! purpose ( audits1 inve/igations1 evaluations1 or o!r /atutory functions ( su* ,inspector ,g5]al 9 matt]s involv+ su* grants1 contracts1 or o!r agreem5ts1 %all be subject1 9 addition to any o!r p5alties t may be prescrib$ by law1 to a civil money p5alty 9 cases "u p>agraph 7#a71 ( n m ?an #aj1jjj = ea* specifi$ claim2 9 cases "u p>agraph 7#b71 n m ?an #ej1jjj = ea* false /atem5t1 omission1 or misrepres5tation ( a mat]ial fact2 9 cases "u p>agraph 7#c71 n m ?an #ej1jjj = ea* false record or /atem5t2 9 cases "u p>agraph 7#d71 n m ?an #ej1jjj = ea* false record or /atem5t or #aj1jjj = ea* day t ! p]son kn[+ly conceals or kn[+ly & improp]ly avoids or decreases an obligation to pay2 or 9 cases "u p>agraph 7#e71 n m ?an #ae1jjj = ea* day ( ! failure describ$ 9 su* p>agraph4 ,9 addition1 9 cases "u p>agraphs 7#a7 & 7#c71 su* a p]son %all be subject to an assessm5t ( n m ?an #c times ! am\nt claim$ 9 ! specifi$ claim describ$ 9 su* p>agraph 9 lieu ( damages su/a9$ by ! ,unit$ ,/ates or a specifi$ ,/ate ag5cy because ( su* specifi$ claim1 & 9 cases "u p>agraphs 7#b7 & 7#d71 su* a p]son %all be subject to an assessm5t ( n m ?an #c times ! total am\nt ( ! funds describ$ 9 p>agraph 7#b7 or 7#d71 respectively 7or1 9 ! case ( an obligation to transmit prop]ty to ! ,secret>y ,heal? & ,human ,s]vices describ$ 9 p>agraph 7#d71 ( ! value ( ! prop]ty describ$ 9 su* p>agraph7 9 lieu ( damages su/a9$ by ! ,unit$ ,/ates or a specifi$ ,/ate ag5cy because ( su* case4 ,9 addition1 ! ,secret>y ( ,heal? & ,human ,s]vices may make a det]m9ation 9 ! same proce$+ to exclude ! p]son f p>ticipation 9 ! ,f$]al heal? c>e programs 7z def9$ 9 section #aabh;,b7f77#a77 & to direct ! appropriate ,/ate ag5cy to exclude ! p]son f p>ticipation 9 any ,/ate heal? c>e program4 7p7 ,! provisions ( subsections 7c71 7d71 & 7g7 %all apply to a civil money p5alty or assessm5t "u subsection 7o7 9 ! same mann] z su* provisions apply to a p5alty1 assessm5t1 or proce$+ "u subsection 7a74 7q7 ,) respect to a p5alty or assessm5t "u subsection 7o71 ! ,inspector ,g5]al ( ! ,dep>tm5t is au?oriz$ to receive1 & to reta9 = curr5t use1 su* am\nts ( su* p5alty or assessm5t z are necess>y to provide reimbursem5t = ! co/s ( conduct+ inve/igations & audits ) respect to su* subsection & = monitor+ compliance plans ) respect to su* subsection :5 su* p5alty or assessm5t is ord]$ by a c\rt1 volunt>ily agre$ to by ! payor1 or o!rwise4 ,funds receiv$ by su* ,inspector ,g5]al z reimbursem5t "u ! prec$+ s5t5ce %all be deposit$ to ! cr$it ( ! appropriations f :i* initially paid1 or to appropriations = simil> purposes curr5tly available at ! "t ( deposit1 & %all rema9 available = obligation = #a ye> f ! date ( ! deposit ( su* funds4 7r7 ,= purposes ( ?is subsection & subsections 7o71 7p71 & 7q73 7#a7 ,! t]m ,dep>tm5t means ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7#b7 ,! t]m mat]ial means hav+ a natural t5d5cy to influ5ce1 or be capable ( influ5c+1 ! paym5t or receipt ( money or prop]ty4 7#c7 ,! t]m o!r agreem5t includes a coop]ative agreem5t1 s*ol>%ip1 fell[%ip1 loan1 subsidy1 paym5t = a specifi$ use1 donation agreem5t1 aw>d1 or sub-aw>d 7reg>dless ( :e!r "o or m ( ! p]sons ent]+ into ! agreem5t is a contractor or sub-contractor74 7#d7 ,! t]m program b5efici>y means1 9 ! case ( a grant1 contract1 or o!r agreem5t design$ to accompli% ! objective ( aw>d+ or o!rwise furni%+ b5efits or assi/ance to individuals & = :i* ! ,secret>y ( ,heal? & ,human ,s]vices provides fund+1 an individual :o applies =1 or :o receives1 su* b5efits or assi/ance f su* grant1 contract1 or o!r agreem5t4 ,su* t]m does n include1 ) respect to su* grant1 contract1 or o!r agreem5t1 an (fic]1 employee1 or ag5t ( a p]son or entity t receives su* grant or t ent]s into su* contract or o!r agreem5t4 7#e7 ,! t]m recipi5t includes a sub-recipi5t or subcontractor4 7#f7 ,! t]m specifi$ claim means any application1 reque/1 or dem& "u a grant1 contract1 or o!r agreem5t = money or prop]ty1 :e!r or n ! ,unit$ ,/ates or a specifi$ ,/ate ag5cy has title to ! money or prop]ty1 t is n a claim 7z def9$ 9 subsection 7i77#b77 & t-- 7,a7 is pres5t$ or caus$ to be pres5t$ to an (fic]1 employee1 or ag5t ( ! ,dep>tm5t or ag5cy !re(1 or ( any specifi$ ,/ate ag5cy2 or 7,b7 is made to a contractor1 grantee1 or any o!r recipi5t if ! money or prop]ty is to be sp5t or us$ on ! ,dep>tm5t's behalf or to advance a ,dep>tm5t program or int]e/1 & if ! ,dep>tm5t-- 7i7 provides or has provid$ any portion ( ! money or prop]ty reque/$ or dem&$2 or 7ii7 w reimburse su* contractor1 grantee or o!r recipi5t = any portion ( ! money or prop]ty :i* is reque/$ or dem&$4 7#g7 ,! t]m specifi$ ,/ate ag5cy means an ag5cy ( a ,/ate gov]nm5t e/abli%$ or designat$ to adm9i/] or sup]vise ! adm9i/ration ( a grant1 contract1 or o!r agreem5t fund$ 9 :ole or 9 "p by ! ,secret>y ( ,heal? & ,human ,s]vices4 7s7 ,= purposes ( subsection 7o71 ! t]m obligation means an e/abli%$ duty1 :e!r or n fix$1 aris+ f an express or impli$ contractual1 grantor-grantee1 or lic5sor-lic5see relation%ip1 = a fee-bas$ or simil> relation%ip1 f /atute or regulation1 or f ! ret5tion ( any ov]paym5t4 4 7b7 ,con=m+ am5dm5ts ,section #aabh;,a ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;a7 is am5d$-- 7#a7 9 subsection 7d7-- 7,a7 9 p>agraph 7#a71 by ins]t+ or specifi$ claims aft] claims2 & 7,b7 9 p>agraph 7#b71 by ins]t+ or specifi$ claims aft] claims2 7#b7 9 subsection 7e71 by ins]t+ or specifi$ claim aft] claim2 & 7#c7 9 subsection 7f7-- 7,a7 by ins]t+ or specifi$ claim 7z def9$ 9 subsection 7r77#f77 aft] di/rict :]e ! claim2 7,b7 by ins]t+ 7or1 ) respect to a p]son describ$ 9 subsection 7o71 ! p]son7 aft] claimant2 7,c7 by ins]t+ t are n receiv$ by ! ,inspector ,g5]al ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices "u subsection 7q7 z reimbursem5t aft] am\nts recov]$2 & 7,d7 by ins]t+ 7or1 9 ! case ( a p5alty or assessm5t "u subsection 7o71 by a specifi$ ,/ate ag5cy 7z def9$ 9 subsection 7r77#g77 aft] or a ,/ate ag5cy4 #cjc4 ,au?oriz+ a blanket mean+ful use significant h>d%ip exception 7a7 ,physicians' s]vices ,section #ahdh7;a77#g77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;a77#g77;,b77 is am5d$ by ins]t+ 7or ?r\gh a blanket exception ) respect to ! paym5t adju/m5t = #bjag1 b only if a reque/ = su* exception is fil$ no lat] ?an ,june #cj1 #bjaf7 aft] on a case-by-case basis4 7b7 ,hospital s]vices ,section #ahhf7;b77#c77;,b77ix77,,ii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77;,b77ix77,,ii77 is am5d$ by ins]t+ 7or ?r\gh a blanket exception ) respect to ! paym5t adju/m5t = fiscal ye> #bjag1 b only if a reque/ = su* exception is fil$ no lat] ?an ,june #cj1 #bjaf7 aft] on a case-by-case basis4 7c7 ,implem5tation au?ority ,! ,secret>y ( ,heal? & ,human ,s]vices may implem5t ! am5dm5ts made by ?is section by int]im f9al rule ) comm5t p]iod4 #cjd4 ,limit+ ,f$]al ,m$icaid reimbursem5t to ,/ates = durable m$ical equipm5t 7,,dme7 to ,m$ic>e paym5t rates ,section #aijc7;i77#bg7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7i77#bg771 z add$ by section #ejc7;a77#a7 ( division ,o ( ! ,consolidat$ ,appropriations ,act1 #bjaf1 is am5d$ by /rik+ ,janu>y #a1 #bjai & ins]t+ ,octob] #a1 #bjah4 #cje4 ,treatm5t ( pati5t enc\nt]s 9 ambulatory surgical c5t]s 9 det]m9+ mean+ful ,,ehr use ,section #ahdh7o77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#b77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,e7 ,treatm5t ( pati5t enc\nt]s at ambulatory surgical c5t]s 7i7 ,9 g5]al ,subject to clause 7ii71 ) respect to a paym5t adju/m5t appli$ "u subsection 7a77#g77;,a71 = #bjag or a subsequ5t ye>1 any pati5t enc\nt] ( an eligible pr(essional occurr+ at an ambulatory surgical c5t] 7describ$ 9 section #ahcc7;i77#a77;,a77 %all n be treat$ z a pati5t enc\nt] 9 det]m9+ :e!r an eligible pr(essional qualifies z a mean+ful ,,ehr us]4 ,not)/&+ any o!r provision ( law1 ! ,secret>y may implem5t ?is clause by program in/ruction or o!rwise4 7ii7 ,sunset ,clause 7i7 %all no long] apply z ( ! fir/ paym5t ye> t beg9s m ?an #c ye>s aft] ! date ! ,secret>y det]m9es1 ?r\gh notice & comm5t rulemak+1 t c]tifi$ ,,ehr te*nology is applicable to ! ambulatory surgical c5t] sett+4 4