,i  #aafth ,,congress  #ast ,session    
,h4 ,r4 #cdbi  ,,in ,,the ,,house ,,of  
,,representatives  ,june #bd1 #bjai,ms4 
,sewell of ,alabama 7for herself and    
,mr4 ,nunes7 introduced the following   
bill2 which was referred to the         
,committee on ,energy and ,commerce1 and
 in addition to the ,committees on ,ways
 and ,means1 and ,armed ,services1 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  ,a ,,bill  ,to     
provide for health equity and access for
 returning troops and servicemembers1 to
 provide for ambulatory surgical payment
 transparency under the ,medicare       
program1 and for other purposes4  #a4   
,short title2 table of contents  7a7    
,short title ,this ,act may be cited as 
the ,,hearts and ,rural ,relief ,act4   
7b7 ,table of contents ,the table of    
contents for this ,act is as follows3   
,sec4 #a4 ,short title2 table of        

contents4 ,sec4 #b4 ,health ,equity and 
,access for ,returning ,troops and      
,servicemembers and ,rural ,relief ,act 
of #bjai4 ,sec4 #c4 ,ambulatory surgical
 center payment transparency4 ,sec4 #d4 
,exclusion of complex rehabilitative    
manual wheelchairs from ,medicare       
competitive acquisition program2        
non-application of ,medicare fee        
schedule adjustments for certain        
wheelchair accessories and cushions4    
,sec4 #e4 ,extension of enforcement     
instruction on supervision requirements 
for outpatient therapeutic services in  
critical access and small rural         
hospitals through #bjba4  #b4 ,health   
,equity and ,access for ,returning      
,troops and ,servicemembers and ,rural  
,relief ,act of #bjai  7a7 ,modification
 of requirement for certain former      
members of the ,armed ,forces ,to enroll
 in ,medicare ,part ,b ,to be eligible  
for ,,tricare for ,life  7#a7 ,,tricare 
eligibility  7,a7 ,in general           
,subsection 7d7 of section #ajhf of     

title #aj1 ,united ,states ,code1 is    
amended by adding at the end the        
following new paragraph3  7#f7  7,a7    
,the requirement in paragraph 7#b77;,a7 
to enroll in the supplementary medical  
insurance program under part ,b of title
 ,,xviii of the ,social ,security ,act  
7#db ,u4,s4,c4 #acie;j et seq47 shall   
not apply to a person described in      
subparagraph 7,b7 during any month in   
which such person is not entitled to a  
benefit described in subparagraph 7,a7  
of section #bbf7;b77#b7 of the ,social  
,security ,act 7#db ,u4,s4,c4           
#dbf7;b77#b77 if such person has        
received the counseling and information 
under subparagraph 7,c74  7,b7 ,a person
 described in this subparagraph is a    
person-- 7i7 who is under #fe years of  
age2  7ii7 who is entitled to hospital  
insurance benefits under part ,a of     
title ,,xviii of the ,social ,security  
,act pursuant to subparagraph 7,a7 or   
7,c7 of section #bbf7;b77#b7 of such    
,act 7#db ,u4,s4,c4 #dbf7;b77#b772      

7iii7 whose entitlement to a benefit    
described in subparagraph 7,a7 of such  
section has terminated due to           
performance of substantial gainful      
activity2 and  7iv7 who is retired under
 chapter #fa of this title4  7,c7 ,the  
,secretary of ,defense shall coordinate 
with the ,secretary of ,health and      
,human ,services and the ,commissioner  
of ,social ,security to notify persons  
described in subparagraph 7,b7 of1 and  
provide information and counseling      
regarding1 the effects of not enrolling 
in the supplementary medical insurance  
program under part ,b of title ,,xviii  
of the ,social ,security ,act 7#db      
,u4,s4,c4 #acie;j et seq471 as described
 in subparagraph 7,a74  4  7,b7         
,conforming amendment ,paragraph        
7#b77;,a7 of such subsection is amended 
by striking is enrolled and inserting   
except as provided by paragraph 7#f71 is
 enrolled4  7,c7 ,identification of     
persons ,section #aaaj;a of such title  
is amended by adding at the end the     

following new subsection3  7c7 ,certain 
individuals not required ,to enroll in  
,medicare ,part ,b ,in carrying out     
subsection 7a71 the ,secretary of       
,defense shall coordinate with the      
,secretary of ,health and ,human        
,services and the ,commissioner of      
,social ,security to--  7#a7 identify   
persons described in subparagraph 7,b7  
of section #ajhf7;d77#f7 of this title2 
and  7#b7 provide information and       
counseling pursuant to subparagraph 7,c7
 of such section4  4  7#b7              
,non-,application of ,medicare ,part ,b 
late enrollment penalty ,section        
#ahci7;b7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #acier7b77 is amended1 in
 the second sentence1 by inserting or   
months for which the individual can     
demonstrate that the individual is an   
individual described in paragraph       
7#f77;,b7 of section #ajhf7;d7 of title 
#aj1 ,united ,states ,code1 who is      
enrolled in the ,,tricare program       
pursuant to such section after an       

individual described in section         
#ahcg7k77#c74  7#c7 ,report ,not later  
than ,october #a1 #bjbd1 the ,secretary 
of ,defense1 the ,secretary of ,health  
and ,human ,services1 and the           
,commissioner of ,social ,security shall
 jointly submit to the ,committees on   
,armed ,services of the ,house of       
,representatives and the ,senate1 the   
,committee on ,ways and ,means and the  
,committee on ,energy and ,commerce of  
the ,house of ,representatives1 and the 
,committee on ,finance of the ,senate a 
report on the implementation of section 
#ajhf7;d77#f7 of title #aj1 ,united     
,states ,code1 as added by paragraph    
7#a74 ,such report shall include1 with  
respect to the period covered by the    
report--  7,a7 the number of individuals
 enrolled in ,,tricare for ,life who are
 not enrolled in the supplementary      
medical insurance program under part ,b 
of title ,,xviii of the ,social         
,security ,act 7#db ,u4,s4,c4 #acie;j et
 seq47 by reason of such section        

#ajhf7;d77#f72 and  7,b7 the number of  
individuals who-- 7i7 are retired from  
the ,armed ,forces under chapter #fa of 
title #aj1 ,united ,states ,code2  7ii7 
are entitled to hospital insurance      
benefits under part ,a of title ,,xviii 
of the ,social ,security ,act pursuant  
to receiving benefits for #bd months as 
described in subparagraph 7,a7 or 7,c7  
of section #bbf7;b77#b7 of such ,act    
7#db ,u4,s4,c4 #dbf7;b77#b772 and  7iii7
 because of such entitlement1 are no    
longer enrolled in ,,tricare ,standard1 
,,tricare ,prime1 ,,tricare ,extra1 or  
,,tricare ,select under chapter #ee of  
title #aj1 ,united ,states ,code4  7#d7 
,deposit of savings into ,medicare      
improvement fund ,section #ahih7;b77#a7 
of the ,social ,security ,act 7#db      
,u4,s4,c4 #acie;iii7b77#a77 is amended  
by striking during and after fiscal year
 #bjba1 #j and inserting during and     
after fiscal year #bjbd1 #e1jjj1jjj4    
7#e7 ,application ,the amendments made  
by paragraphs 7#a7 and 7#b7 shall apply 

with respect to a person who1 on or     
after ,october #a1 #bjbc1 is a person   
described in section #ajhf7;d77#f77;,b7 
of title #aj1 ,united ,states ,code1 as 
added by paragraph 7#a74  7b7 ,coverage 
of certain ,,dna specimen provenance    
assay tests under ,medicare  7#a7       
,benefit  7,a7 ,coverage ,section #ahfa 
of the ,social ,security ,act 7#db      
,u4,s4,c4 #aciex7 is amended-- 7i7 in   
subsection 7s77#b7--  7,i7 in           
subparagraph 7,,gg71 by striking and at 
the end2  7,,ii7 in subparagraph 7,,hh71
 by striking the period and inserting 2 
and2 and  7,,iii7 by adding at the end  
the following new subparagraph3  7,,ii7 
a prostate cancer ,,dna ,specimen       
,provenance ,assay test 7,,dspa test7   
7as defined in subsection 7kkk772  2 and
  7ii7 by adding at the end the         
following new subsection3  7kkk7        
,prostate cancer ,,dna ,specimen        
,provenance ,assay ,test ,the term      
prostate cancer ,,dna ,specimen         
,provenance ,assay ,test 7,,dspa test7  

means a test that1 after a determination
 of cancer in one or more prostate      
biopsy specimens obtained from an       
individual1 assesses the identity of the
 ,,dna in such specimens by comparing   
such ,,dna with the ,,dna that was      
separately taken from such individual at
 the time of the biopsy4  4  7,b7       
,exclusion from coverage ,section       
#ahfb7;a77#a7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #aciey7a77#a77 is   
amended-- 7i7 in subparagraph 7,o71 by  
striking and at the end2  7ii7 in       
subparagraph 7,p71 by striking the      
semicolon at the end and inserting 1    
and2 and  7iii7 by adding at the end the
 following new subparagraph3  7,q7 in   
the case of a prostate cancer ,,dna     
,specimen ,provenance ,assay test       
7,,dspa test7 7as defined in section    
#ahfa7kkk771 unless such test is        
furnished on or after ,january #a1      
#bjbj1 and before ,january #a1 #bjbe1   
and such test is ordered by the         
physician who furnished the prostate    

cancer biopsy that obtained the specimen
 tested2  4  7#b7 ,payment amount and   
related requirements ,section #ahcd of  
the ,social ,security ,act 7#db         
,u4,s4,c4 #aciem7 is amended by adding  
at the end the following new subsection3
  7x7 ,prostate cancer ,,dna ,specimen  
,provenance ,assay tests  7#a7 ,payment 
for covered tests  7,a7 ,in general     
,subject to subparagraph 7,b71 the      
payment amount for a prostate cancer    
,,dna ,specimen ,provenance ,assay test 
7,,dspa test7 7as defined in section    
#ahfa7kkk77 shall be #bjj4 ,such payment
 shall be payment for all of the        
specimens obtained from the biopsy      
furnished to an individual that are     
tested4  7,b7 ,limitation ,payment for a
 ,,dspa test under subparagraph 7,a7 may
 only be made on an assignment-related  
basis4  7,c7 ,prohibition on separate   
payment ,no separate payment shall be   
made for obtaining ,,dna that was       
separately taken from an individual at  
the time of a biopsy described in       

subparagraph 7,a74  7#b7 ,,hcpcs code   
and modifier assignment  7,a7 ,in       
general ,the ,secretary shall assign one
 or more ,,hcpcs codes to a prostate    
cancer ,,dna ,specimen ,provenance      
,assay test and may use a modifier to   
facilitate making payment under this    
section for such test4  7,b7            
,identification of ,,dna match on claim 
,the ,secretary shall require an        
indication on a claim for a prostate    
cancer ,,dna ,specimen ,provenance      
,assay test of whether the ,,dna of the 
prostate biopsy specimens match the     
,,dna of the individual diagnosed with  
prostate cancer4 ,such indication may be
 made through use of a ,,hcpcs code1 a  
modifier1 or other means1 as determined 
appropriate by the ,secretary4  7#c7    
,,dna match review  7,a7 ,in general    
,the ,secretary shall review at least   
three years of claims under part ,b for 
prostate cancer ,,dna ,specimen         
,provenance ,assay tests to identify    
whether the ,,dna of the prostate biopsy

 specimens match the ,,dna of the       
individuals diagnosed with prostate     
cancer4  7,b7 ,posting on internet      
website ,not later than ,july #a1 #bjbc1
 the ,secretary shall post on the       
internet website of the ,centers for    
,medicare  ,medicaid ,services the      
findings of the review conducted under  
subparagraph 7,a74  4  7#c7             
,cost-,sharing ,section #ahcc7;a77#a7 of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #aciel7a77#a77 is amended--   
7,a7 by striking and 7,,cc7 and         
inserting 7,,cc72 and  7,b7 by inserting
 before the semicolon at the end the    
following3 1 and 7,,dd7 with respect to 
a prostate cancer ,,dna ,specimen       
,provenance ,assay test 7,,dspa test7   
7as defined in section #ahfa7kkk771 the 
amount paid shall be an amount equal to 
#hj percent of the lesser of the actual 
charge for the test or the amount       
specified under section #ahcd7x74  #c4  
,ambulatory surgical center payment     
transparency  7a7 ,advisory ,panel on   

,hospital ,outpatient ,payment          
,representation  7#a7 ,,asc             
representative ,the second sentence of  
section #ahcc7t77#i77;,a7 of the ,social
 ,security ,act 7#db ,u4,s4,c4          
#aciel7t77#i77;,a77 is amended by       
inserting and at least one ambulatory   
surgical center representative after an 
appropriate selection of representatives
 of providers4  7#b7 ,effective date    
,the amendment made by paragraph 7#a7   
shall apply with respect to advisory    
panels consulted on or after the date   
that is #a year after the date of the   
enactment of this ,act4  7b7 ,reasons   
for excluding additional procedures from
 ,,asc approved list ,section           
#ahcc7;i77#a7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #aciel7i77#a77 is   
amended by adding at the end the        
following3 ,in updating such lists for  
application in years beginning with the 
second year beginning after the date of 
the enactment of this sentence1 for each
 procedure that was not proposed to be  

included in such lists in the proposed  
rule with respect to such lists and that
 was subsequently requested to be       
included in such lists during the public
 comment period with respect to such    
proposed rule and that is not included  
in the final rule updating such lists1  
the ,secretary shall cite in such final 
rule the specific criteria in paragraph 
7b7 or 7c7 of section #daf4aff of title 
#db1 ,code of ,federal ,regulations 7or 
any successor regulation71 based on     
which the procedure was excluded4 ,if   
paragraph 7b7 of such section is cited  
for exclusion of a procedure1 the       
,secretary shall identify the           
peer-reviewed research1 if any1 or the  
evidence upon which such determination  
is based44  #d4 ,exclusion of complex   
rehabilitative manual wheelchairs from  
,medicare competitive acquisition       
program2 non-application of ,medicare   
fee schedule adjustments for certain    
wheelchair accessories and cushions  7a7
 ,exclusion of complex rehabilitative   

manual wheelchairs from competitive     
acquisition program ,section            
#ahdg7;a77#b77;,a7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#aciew-#c7;a77#b77;,a77 is amended--    
7#a7 by inserting 1 complex             
rehabilitative manual wheelchairs 7as   
determined by the ,secretary71 and      
certain manual wheelchairs 7identified1 
as of ,october #a1 #bjah1 by ,,hcpcs    
codes ,e#abce1 ,e#abcf1 ,e#abcg1        
,e#abch1 and ,k#jjjh or any successor to
 such codes7 after group #c or higher2  
and  7#b7 by striking such wheelchairs  
and inserting such complex              
rehabilitative power wheelchairs1       
complex rehabilitative manual           
wheelchairs1 and certain manual         
wheelchairs4  7b7 ,non-,application of  
,medicare fee schedule adjustments for  
wheelchair accessories and seat and back
 cushions when furnished in connection  
with complex rehabilitative manual      
wheelchairs  7#a7 ,in general           
,notwithstanding any other provision of 

law1 the ,secretary of ,health and      
,human ,services shall not1 during the  
period beginning on ,july #a1 #bjai1 and
 ending on ,december #ca1 #bjbj1 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 complex    
rehabilitative manual wheelchairs 7as   
determined by the ,secretary71 and      
certain manual wheelchairs 7identified1 
as of ,october #a1 #bjah1 by ,,hcpcs    
codes ,e#abce1 ,e#abcf1 ,e#abcg1        
,e#abch1 and ,k#jjjh or any successor to
 such codes74  7#b7 ,implementation     
,notwithstanding any other provision of 
law1 the ,secretary may implement this  

subsection by program instruction or    
otherwise4  #e4 ,extension of           
enforcement instruction on supervision  
requirements for outpatient therapeutic 
services in critical access and small   
rural hospitals through #bjba ,section  
#a of ,public ,law #aac-aih1 as amended 
by section #a of ,public ,law #aad-aab1 
section #afjjd of ,public ,law #aad-bee1
 and section #eajjg of ,public ,law     
#aae-abc1 is amended--  7#a7 in the     
section heading1 by striking #bjag and  
inserting #bjba2 and  7#b7 by striking  
and #bjag and inserting 1 #bjag1 #bjbj1 
and #bjba4