#aadth ,,congress #ast ,session ,s4 #bdbe ,,an ,,act ,to amend titles ,,xviii and ,,xix of the ,social ,security ,act to improve payments for complex rehabilitation technology and certain radiation therapy services1 to ensure flexibility in applying the hardship exception for meaningful use for the #bjae ,,ehr reporting period for #bjag payment adjustments1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,patient ,access and ,medicare ,protection ,act4 #b4 ,non-application of ,medicare fee schedule adjustments for wheelchair accessories and seat and back cushions when furnished in connection with complex rehabilitative power wheelchairs 7a7 ,non-application 7#a7 ,in general ,notwithstanding any other provision of law1 the ,secretary of ,health and ,human ,services shall not1 prior to ,january #a1 #bjag1 use information on the payment determined under the competitive acquisition programs under section #ahdg of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7 to adjust the payment amount that would otherwise be recognized under section #ahcd7;a77#a77;,b77ii7 of such ,act 7#db ,u4,s4,c4 #aciem7a77#a77;,b77ii77 for wheelchair accessories 7including seating systems7 and seat and back cushions when furnished in connection with ,group #c complex rehabilitative power wheelchairs4 7#b7 ,implementation ,notwithstanding any other provision of law1 the ,secretary may implement this subsection by program instruction or otherwise4 7b7 ,,gao study and report 7#a7 ,study 7,a7 ,in general ,the ,comptroller ,general of the ,united ,states shall conduct a study on wheelchair accessories 7including seating systems7 and seat and back cushions furnished in connection with ,group #c complex rehabilitative power wheelchairs4 ,such study shall include an analysis of the following with respect to such wheelchair accessories and seat and back cushions in each of the groups described in clauses 7i7 through 7iii7 of subparagraph 7,b73 7i7 ,the item descriptions and associated ,,hcpcs codes for such wheelchair accessories and seat and back cushions4 7ii7 ,a breakdown of utilization and expenditures for such wheelchair accessories and seat and back cushions under title ,,xviii of the ,social ,security ,act4 7iii7 ,a comparison of the payment amount under the competitive acquisition program under section #ahdg of such ,act 7#db ,u4,s4,c4 #aciew-#c7 with the payment amount that would otherwise be recognized under section #ahcd of such ,act 7#db ,u4,s4,c4 #aciem71 including beneficiary cost sharing1 for such wheelchair accessories and seat and back cushions4 7iv7 ,the aggregate distribution of such wheelchair accessories and seat and back cushions furnished under such title ,,xviii within each of the groups described in subparagraph 7,b74 7v7 ,other areas determined appropriate by the ,comptroller ,general4 7,b7 ,groups described ,the following groups are described in this subparagraph3 7i7 ,wheelchair accessories and seat and back cushions furnished predominantly with ,group #c complex rehabilitative power wheelchairs4 7ii7 ,wheelchair accessories and seat and back cushions furnished predominantly with power wheelchairs that are not described in clause 7i74 7iii7 ,other wheelchair accessories and seat and back cushions furnished with either power wheelchairs described in clause 7i7 or 7ii74 7#b7 ,report ,not later than ,june #a1 #bjaf1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a71 together with recommendations for such legislation and administrative as the ,comptroller ,general determines to be appropriate4 #c4 ,transitional payment rules for certain radiation therapy services under the ,medicare physician fee schedule 7a7 ,in general ,section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 is amended-- 7#a7 in subsection 7b71 by adding at the end the following new paragraph3 7#aa7 ,special rule for certain radiation therapy services ,the code definitions1 the work relative value units under subsection 7c77#b77;,c77i71 and the direct inputs for the practice expense relative value units under subsection 7c77#b77;,c77ii7 for radiation treatment delivery and related imaging services 7identified in #bjaf by ,,hcpcs ,g-codes ,g#fjja through ,g#fjae7 for the fee schedule established under this subsection for services furnished in #bjag and #bjah shall be the same as such definitions1 units1 and inputs for such services for the fee schedule established for services furnished in #bjaf4 2 and 7#b7 in subsection 7c77#b77,k71 by adding at the end the following new clause3 7iv7 ,treatment of certain radiation therapy services ,radiation treatment delivery and related imaging services identified under subsection 7b77#aa7 shall not be considered as potentially misvalued services for purposes of this subparagraph and subparagraph 7,o7 for #bjag and #bjah4 4 7b7 ,report to ,congress on alternative payment model ,not later than #ah months after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall submit to ,congress a report on the development of an episodic alternative payment model for payment under the ,medicare program under title ,,xviii of the ,social ,security ,act for radiation therapy services furnished in nonfacility settings4 #d4 ,ensuring flexibility in applying hardship exception for meaningful use for #bjae ,,ehr reporting period for #bjag payment adjustments 7a7 ,eligible professionals ,section #ahdh7;a77#g77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;a77#g77;,b77 is amended1 in the first sentence1 by inserting 7and1 with respect to the payment adjustment under subparagraph 7,a7 for #bjag1 for categories of eligible professionals1 as established by the ,secretary and posted on the ,internet website of the ,centers for ,medicare ,medicaid ,services prior to ,december #ae1 #bjae1 an application for which must be submitted to the ,secretary by not later than ,march #ae1 #bjaf7 after case-by-case basis4 7b7 ,eligible hospitals ,section #ahhf7;b77#c77;,b77ix7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77;,b77ix77 is amended-- 7#a7 in the first sentence of subclause 7,i71 by striking 7n77#f77;,a7 and inserting 7n77#f72 and 7#b7 in subclause 7,,ii71 in the first sentence1 by inserting 7and1 with respect to the application of subclause 7,i7 for fiscal year #bjag1 for categories of subsection 7d7 hospitals1 as established by the ,secretary and posted on the ,internet website of the ,centers for ,medicare ,medicaid ,services prior to ,december #ae1 #bjae1 an application for which must be submitted to the ,secretary by not later than ,april #a1 #bjaf7 after case-by-case basis4 7c7 ,implementation ,notwithstanding any other provision of law1 the ,secretary of ,health and ,human ,services shall implement the provisions of1 and the amendments made by1 subsections 7a7 and 7b7 by program instruction1 such as through information on the ,internet website of the ,centers for ,medicare ,medicaid ,services4 #e4 ,medicare ,improvement ,fund ,section #ahih7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;iii7b77#a77 is amended by striking #e1jjj1jjj and inserting #j4 #f4 ,strengthening ,medicaid ,program integrity through flexibility ,section #aicf of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#f7 is amended-- 7#a7 in subsection 7a71 by inserting 1 or otherwise1 after entities2 and 7#b7 in subsection 7e7-- 7,a7 in paragraph 7#a71 in the matter preceding subparagraph 7,a71 by inserting 7including the costs of equipment1 salaries and benefits1 and travel and training7 after ,program under this section2 and 7,b7 in paragraph 7#c71 by striking by #ajj and inserting by #ajj1 or such number as determined necessary by the ,secretary to carry out the ,program14 #g4 ,establishing ,medicare administrative contractor error reduction incentives 7a7 ,in general ,section #ahgd;,a7b77#a77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekk-#a7;b77#a77;,d77 is amended-- 7#a7 by striking quality4--,the ,secretary and inserting 8quality4-- 7i7 ,in general ,subject to clauses 7ii7 and 7iii71 the ,secretary 2 and 7#b7 by inserting after clause 7i71 as added by paragraph 7#a71 the following new clauses3 7ii7 ,improper payment rate reduction incentives ,the ,secretary shall provide incentives for medicare administrative contractors to reduce the improper payment error rates in their jurisdictions4 7iii7 ,incentives ,the incentives provided for under clause 7ii7-- 7,i7 may include a sliding scale of award fee payments and additional incentives to medicare administrative contractors that either reduce the improper payment rates in their jurisdictions to certain thresholds1 as determined by the ,secretary1 or accomplish tasks1 as determined by the ,secretary1 that further improve payment accuracy2 and 7,,ii7 may include substantial reductions in award fee payments under cost-plus-award-fee contracts1 for medicare administrative contractors that reach an upper end improper payment rate threshold or other threshold as determined by the ,secretary1 or fail to accomplish tasks1 as determined by the ,secretary1 that further improve payment accuracy4 4 7b7 ,effective date 7#a7 ,in general ,the amendments made by subsection 7a7 shall apply to contracts entered into or renewed on or after the date that is #c years after the date of enactment of this ,act4 7#b7 ,application to existing contracts ,in the case of contracts in existence on or after the date of the enactment of this ,act and that are not subject to the effective date under paragraph 7#a71 the ,secretary of ,health and ,human ,services shall1 when appropriate and practicable1 seek to apply the incentives provided for in the amendments made by subsection 7a7 through contract modifications4 #h4 ,strengthening penalties for the illegal distribution of a ,medicare1 ,medicaid1 or ,,chip beneficiary identification or billing privileges ,section #aabh;,b7b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7b77 is amended by adding at the end the following3 7#d7 ,whoever without lawful authority knowingly and willfully purchases1 sells or distributes1 or arranges for the purchase1 sale1 or distribution of a beneficiary identification number or unique health identifier for a health care provider under title ,,xviii1 title ,,xix1 or title ,,xxi shall be imprisoned for not more than #aj years or fined not more than #ejj1jjj 7#a1jjj1jjj in the case of a corporation71 or both4 4 #i4 ,improving the sharing of data between the ,federal ,government and ,state ,medicaid programs 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall establish a plan to encourage and facilitate the participation of ,states in the ,medicare-,medicaid ,data ,match ,program 7commonly referred to as the ,medi-,medi ,program7 under section #ahic7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7g774 7b7 ,program revisions ,to improve ,medi-,medi ,data ,match ,program participation by ,states ,section #ahic7;g77#a77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7g77#a77;,a77 is amended-- 7#a7 in the matter preceding clause 7i71 by inserting or otherwise after eligible entities2 7#b7 in clause 7i7-- 7,a7 by inserting to review claims data after algorithms2 and 7,b7 by striking service1 time1 or patient and inserting provider1 service1 time1 or patient2 7#c7 in clause 7ii7-- 7,a7 by inserting to investigate and recover amounts with respect to suspect claims after appropriate actions2 and 7,b7 by striking 2 and and inserting a semicolon2 7#d7 in clause 7iii71 by striking the period and inserting 2 and2 and 7#e7 by adding at the end the following new clause3 7iv7 furthering the ,secretary's design1 development1 installation1 or enhancement of an automated data system architecture-- 7,i7 to collect1 integrate1 and assess data for purposes of program integrity1 program oversight1 and administration1 including the ,medi-,medi ,program2 and 7,,ii7 that improves the coordination of requests for data from ,states4 4 7c7 ,providing states with data on improper payments made for items or services provided to dual eligible individuals 7#a7 ,in general ,the ,secretary shall develop and implement a plan that allows each ,state agency responsible for administering a ,state plan for medical assistance under title ,,xix of the ,social ,security ,act access to relevant data on improper or fraudulent payments made under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 for health care items or services provided to dual eligible individuals4 7#b7 ,dual eligible individual defined ,in this section1 the term dual eligible individual means an individual who is entitled to1 or enrolled for1 benefits under part ,a of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq471 or enrolled for benefits under part ,b of title ,,xviii of such ,act 7#db ,u4,s4,c4 #acie;j et seq471 and is eligible for medical assistance under a ,state plan under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq47 or under a waiver of such plan4 ,passed the ,senate ,december #ah1 #bjae4,secretary