,,ii #aad? ,,congress #a/ ,session ,s4 #bdbe ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,decemb] #ah1 #bjae ,mr4 ,portman 7= himself1 ,mr4 ,casey1 ,mr4 ,burr1 ,mr4 ,s*um]1 ,mr4 ,blunt1 ,mr4 ,b5net1 ,mr4 ,wyd51 ,mrs4 ,murray1 ,mr4 ,blum5?al1 ,ms4 ,klobu*>1 & ,ms4 ,hirono7 introduc$ ! foll[+ bill2 :i* 0 read twice1 consid]$1 read ! ?ird "t1 & pass$ ,a ,,bill ,to am5d titles ,,xviii & ,,xix ( ! ,social ,security ,act to improve paym5ts = complex rehabilitation te*nology & c]ta9 radiation !rapy s]vices1 to ensure flexibility 9 apply+ ! h>d%ip exception = mean+ful use = ! #bjae ,,ehr report+ p]iod = #bjag paym5t adju/m5ts1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,pati5t ,access & ,m$ic>e ,protection ,act4 #b4 ,non-application ( ,m$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 z ! ,comptroll] ,g5]al det]m9es to be appropriate4 #c4 ,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$-- 7#a7 9 subsection 7b71 by add+ at ! end ! foll[+ new p>agraph3 7#aa7 ,special rule = c]ta9 radiation !rapy s]vices ,! code def9itions1 ! "w relative value units "u subsection 7c77#b77;,c77i71 & ! direct inputs = ! practice exp5se relative value units "u subsection 7c77#b77;,c77ii7 = radiation treatm5t deliv]y & relat$ 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 #d4 ,ensur+ flexibility 9 apply+ h>d%ip exception = mean+ful use = #bjae ,,ehr report+ p]iod = #bjag paym5t adju/m5ts 7a7 ,eligible pr(essionals ,section #ahdh7;a77#g77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;a77#g77;,b77 is am5d$1 9 ! fir/ s5t5ce1 by ins]t+ 7&1 ) respect to ! paym5t adju/m5t "u subp>agraph 7,a7 = #bjag1 = categories ( eligible pr(essionals1 z e/abli%$ by ! ,secret>y & po/$ on ! ,int]net website ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices prior to ,decemb] #ae1 #bjae1 an application = :i* mu/ be submitt$ to ! ,secret>y by n lat] ?an ,m>* #ae1 #bjaf7 aft] case-by-case basis4 7b7 ,eligible hospitals ,section #ahhf7;b77#c77;,b77ix7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77;,b77ix77 is am5d$-- 7#a7 9 ! fir/ s5t5ce ( subclause 7,i71 by /rik+ 7n77#f77;,a7 & ins]t+ 7n77#f72 & 7#b7 9 subclause 7,,ii71 9 ! fir/ s5t5ce1 by ins]t+ 7&1 ) respect to ! application ( subclause 7,i7 = fiscal ye> #bjag1 = categories ( subsection 7d7 hospitals1 z e/abli%$ by ! ,secret>y & po/$ on ! ,int]net website ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices prior to ,decemb] #ae1 #bjae1 an application = :i* mu/ be submitt$ to ! ,secret>y by n lat] ?an ,april #a1 #bjaf7 aft] case-by-case basis4 7c7 ,implem5tation ,not)/&+ any o!r provision ( law1 ! ,secret>y ( ,heal? & ,human ,s]vices %all implem5t ! provisions (1 & ! am5dm5ts made by1 subsections 7a7 & 7b7 by program in/ruction1 su* z ?r\gh in=mation on ! ,int]net website ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 #e4 ,m$ic>e ,improvem5t ,fund ,section #ahih7;b77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;iii7b77#a77 is am5d$ by /rik+ #e1jjj1jjj & ins]t+ #j4 #f4 ,/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 #g4 ,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 #h4 ,/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 #i4 ,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