I 

114TH CONGRESS 

1ST SESSION H. R. 4273 

To amend titles XVIII and XIX of the Social Security Act to improve 

payments for hospital outpatient department services and complex rehabilitation technology and to improve program integrity, and for other 

purposes. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 16, 2015 

Mr. GENE GREEN of Texas (for himself and Mr. MCDERMOTT) introduced the 

following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend titles XVIII and XIX of the Social Security Act 

to improve payments for hospital outpatient department 

services and complex rehabilitation technology and to 

improve program integrity, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Medicare and Medicaid Improvements and Adjustments 

6 Act of 2015’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents of 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—CORRECTIONS TO OUTPATIENT PROVISION 

Sec. 101. Continuing Medicare payment under HOPD prospective payment system for services furnished by off-campus outpatient departments of providers under development. 

Sec. 102. Maintaining cancer hospital adjustment under Medicare off-campus 

outpatient departments of a provider payment policy. 

TITLE II—PROVISIONS PROTECTING PEOPLE WITH DISABILITIES 

AND CHRONIC CARE NEEDS 

Sec. 201. Non-application of Medicare fee schedule adjustments for wheelchair 

accessories and seat and back cushions when furnished in connection with complex rehabilitative power wheelchairs. 

Sec. 202. Treatment of infusion drugs furnished through durable medical 

equipment. 

Sec. 203. Transitional payment rules for certain radiation therapy services 

under the Medicare physician fee schedule. 

Sec. 204. Fairness in Medicaid supplemental needs trusts. 

TITLE III—PROGRAM INTEGRITY, PAYMENT EFFICIENCY, AND 

ADDITIONAL MEDICARE POLICIES 

Sec. 301. Strengthening penalties for the illegal distribution of a Medicare, 

Medicaid, or CHIP beneficiary identification or billing privileges. 

Sec. 302. Civil monetary penalties for violations related to grants, contracts, 

and other agreements. 

Sec. 303. Authorizing a blanket meaningful use significant hardship exception. 

Sec. 304. Limiting Federal Medicaid reimbursement to States for durable medical equipment (DME) to Medicare payment rates. 

Sec. 305. Treatment of patient encounters in ambulatory surgical centers in determining meaningful EHR use. 


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1 TITLE I—CORRECTIONS TO 

2 OUTPATIENT PROVISION 

3 SEC. 101. CONTINUING MEDICARE PAYMENT UNDER HOPD 

4 PROSPECTIVE PAYMENT SYSTEM FOR SERV5 ICES FURNISHED BY OFF-CAMPUS OUT6 PATIENT DEPARTMENTS OF PROVIDERS 

7 UNDER DEVELOPMENT. 

8 Section 1833(t) of the Social Security Act (42 U.S.C. 

9 1395l(t)) is amended— 

10 (1) in paragraph (1)(B)(v), by inserting ‘‘, sub11 ject to subparagraph (E) of such paragraph,’’ after 

12 ‘‘2017, by’’; and 

13 (2) in paragraph (21)— 

14 (A) in subparagraph (C) by striking ‘‘that 

15 are described in paragraph (1)(B)(v) shall be 

16 made’’ and inserting ‘‘to which paragraph 

17 (1)(B)(v) applies shall be the amount deter18 mined’’; 

19 (B) by redesignating subparagraph (E) as 

20 subparagraph (F); and 

21 (C) by inserting after subparagraph (D) 

22 the following new subparagraph: 

23 ‘‘(E) NON-APPLICATION WITH RESPECT TO

24 DEPARTMENTS UNDER DEVELOPMENT.— 


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1 ‘‘(i) IN GENERAL.—Paragraph 

2 (1)(B)(v) shall not apply to an off-campus 

3 outpatient department of a provider that is 

4 determined by the Secretary to be under 

5 development as of the date of the enact6 ment of the Bipartisan Budget Act of 

7 2015. 

8 ‘‘(ii) APPLICATION.—For purposes of 

9 paragraph (1)(B)(v) and this paragraph, 

10 in determining whether an off-campus out11 patient department of a provider was 

12 under development, the Secretary shall re13 quire that as of the date of the enactment 

14 of such Act the department met— 

15 ‘‘(I) at least one of the require16 ments described in clause (iii); and 

17 ‘‘(II) any additional requirements 

18 the Secretary determines would indi19 cate whether such off-campus out20 patient department of a provider was 

21 under development as of such date. 

22 ‘‘(iii) REQUIREMENTS DESCRIBED.— 

23 The following requirements are described 

24 in this clause: 


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1 ‘‘(I) Architectural plans were 

2 completed. 

3 ‘‘(II) Zoning requirements were 

4 met or a request for approval of meet5 ing such zoning requirements was 

6 submitted to appropriate agencies. 

7 ‘‘(III) Necessary approvals from 

8 appropriate State agencies were ap9 plied for or received.’’. 

10 SEC. 102. MAINTAINING CANCER HOSPITAL ADJUSTMENT 

11 UNDER MEDICARE OFF-CAMPUS OUTPATIENT 

12 DEPARTMENTS OF A PROVIDER PAYMENT 

13 POLICY. 

14 Section 1833(t) of the Social Security Act (42 U.S.C. 

15 1395l(t)) is amended— 

16 (1) in paragraph (1)(B)(v), as amended by sec17 tion 101(1), by striking ‘‘subparagraph (E)’’ and in18 serting ‘‘subparagraph (F)’’; and 

19 (2) in paragraph (21), as added by section 603 

20 of the Bipartisan Budget Act of 2015 and as 

21 amended by section 101(2)— 

22 (A) by redesignating subparagraphs (D), 

23 (E), and (F) as subparagraphs (E), (F), and 

24 (G), respectively; 


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1 (B) by inserting after subparagraph (C) 

2 the following new subparagraph: 

3 ‘‘(D) APPLICATION OF CANCER HOSPITAL

4 ADJUSTMENT.—The Secretary shall apply the 

5 adjustment under paragraph (18) to applicable 

6 items and services furnished on or after Janu7 ary 1, 2017, by an off-campus outpatient de8 partment of a provider (as defined in subpara9 graph (B)) of a hospital described in section 

10 1886(d)(1)(B)(v)— 

11 ‘‘(i) as if this paragraph (other than 

12 this subparagraph) and paragraph 

13 (1)(B)(v) were not applicable to such ap14 plicable items and services and such appli15 cable items and services were covered OPD 

16 services and paid under this subsection; 

17 and 

18 ‘‘(ii) without application of para19 graphs (2)(E) and (9)(B).’’; and 

20 (C) in subparagraph (G)(iii), as redesig21 nated by subparagraph (A) of this paragraph, 

22 by striking ‘‘subparagraph (D)’’ and inserting 

23 ‘‘subparagraph (E)’’. 


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1 TITLE II—PROVISIONS PRO2 TECTING PEOPLE WITH DIS3 ABILITIES AND CHRONIC 

4 CARE NEEDS 

5 SEC. 201. NON-APPLICATION OF MEDICARE FEE SCHEDULE 

6 ADJUSTMENTS FOR WHEELCHAIR ACCES7 SORIES AND SEAT AND BACK CUSHIONS 

8 WHEN FURNISHED IN CONNECTION WITH 

9 COMPLEX REHABILITATIVE POWER WHEEL10 CHAIRS. 

11 (a) NON-APPLICATION.— 

12 (1) IN GENERAL.—Notwithstanding any other 

13 provision of law, the Secretary of Health and 

14 Human Services shall not, prior to January 1, 2017, 

15 use information on the payment determined under 

16 the competitive acquisition programs under section 

17 1847 of the Social Security Act (42 U.S.C. 1395w– 

18 3)) to adjust the payment amount that would other19 wise be recognized under section 1834(a)(1)(B)(ii) 

20 of such Act (42 U.S.C. 1395m(a)(1)(B)(ii)) for 

21 wheelchair accessories (including seating systems) 

22 and seat and back cushions when furnished in con23 nection with Group 3 complex rehabilitative power 

24 wheelchairs. 


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1 (2) IMPLEMENTATION.—Notwithstanding any 

2 other provision of law, the Secretary may implement 

3 this subsection by program instruction or otherwise. 

4 (b) GAO STUDY AND REPORT.— 

5 (1) STUDY.— 

6 (A) IN GENERAL.—The Comptroller Gen7 eral of the United States shall conduct a study 

8 on wheelchair accessories (including seating sys9 tems) and seat and back cushions furnished in 

10 connection with Group 3 complex rehabilitative 

11 power wheelchairs. Such study shall include an 

12 analysis of the following with respect to such 

13 wheelchair accessories and seat and back cush14 ions in each of the groups described in clauses 

15 (i) through (iii) of subparagraph (B): 

16 (i) The item descriptions and associ17 ated HCPCS codes for such wheelchair ac18 cessories and seat and back cushions. 

19 (ii) A breakdown of utilization and ex20 penditures for such wheelchair accessories 

21 and seat and back cushions under title 

22 XVIII of the Social Security Act. 

23 (iii) A comparison of the payment 

24 amount under the competitive acquisition 

25 program under section 1847 of such Act 


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1 (42 U.S.C. 1395w–3) with the payment 

2 amount that would otherwise be recognized 

3 under section 1834 of such Act (42 U.S.C. 

4 1395m), including beneficiary cost sharing, 

5 for such wheelchair accessories and seat 

6 and back cushions. 

7 (iv) The aggregate distribution of 

8 such wheelchair accessories and seat and 

9 back cushions furnished under such title 

10 XVIII within each of the groups described 

11 in subparagraph (B). 

12 (v) Other areas determined appro13 priate by the Comptroller General. 

14 (B) GROUPS DESCRIBED.—The following 

15 groups are described in this subparagraph: 

16 (i) Wheelchair accessories and seat 

17 and back cushions furnished predominantly 

18 with Group 3 complex rehabilitative power 

19 wheelchairs. 

20 (ii) Wheelchair accessories and seat 

21 and back cushions furnished predominantly 

22 with power wheelchairs that are not de23 scribed in clause (i). 

24 (iii) Other wheelchair accessories and 

25 seat and back cushions furnished with eiVerDate Sep 11 2014 01:09 Dec 22, 2015 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4273.IH H4273

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1 ther power wheelchairs described in clause 

2 (i) or (ii). 

3 (2) REPORT.—Not later than June 1, 2016, the 

4 Comptroller General of the United States shall sub5 mit to Congress a report containing the results of 

6 the study conducted under paragraph (1), together 

7 with recommendations for such legislation and ad8 ministrative as the Comptroller General determines 

9 to be appropriate. 

10 SEC. 202. TREATMENT OF INFUSION DRUGS FURNISHED 

11 THROUGH DURABLE MEDICAL EQUIPMENT. 

12 Section 1842(o)(1) of the Social Security Act (42 

13 U.S.C. 1395u(o)(1)) is amended— 

14 (1) in subparagraph (C), by inserting ‘‘(and in15 cluding a drug or biological described in subpara16 graph (D)(i) furnished during the 6-year period be17 ginning on January 1, 2017)’’ after ‘‘2005’’; and 

18 (2) in subparagraph (D)— 

19 (A) by striking ‘‘infusion drugs’’ and in20 serting ‘‘infusion drugs or biologicals’’ each 

21 place it appears; and 

22 (B) in clause (i)— 

23 (i) by striking ‘‘2004’’ and inserting 

24 ‘‘2004 (other than during the 6-year pe25 riod beginning on January 1, 2017)’’; and 


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1 (ii) by striking ‘‘for such drug’’. 

2 SEC. 203. TRANSITIONAL PAYMENT RULES FOR CERTAIN 

3 RADIATION THERAPY SERVICES UNDER THE 

4 MEDICARE PHYSICIAN FEE SCHEDULE. 

5 (a) IN GENERAL.—Section 1848 of the Social Secu6 rity Act (42 U.S.C. 1395w–4) is amended— 

7 (1) in subsection (b), as amended by section 

8 502 of division O of the Consolidated Appropriations 

9 Act, 2016, by adding at the end the following new 

10 paragraph: 

11 ‘‘(11) SPECIAL RULE FOR CERTAIN RADIATION

12 THERAPY SERVICES.—The code definitions, the work 

13 relative value units under subsection (c)(2)(C)(i), 

14 and the direct inputs for the practice expense rel15 ative value units under subsection (c)(2)(C)(ii) for 

16 radiation treatment delivery and related imaging 

17 services (identified in 2016 by HCPCS G-codes 

18 G6001 through G6015) for the fee schedule estab19 lished under this subsection for services furnished in 

20 2017 and 2018 shall be the same as such defini21 tions, units, and inputs for such services for the fee 

22 schedule established for services furnished in 2016.’’; 

23 and 

24 (2) in subsection (c)(2)(K), by adding at the 

25 end the following new clause: 


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1 ‘‘(iv) TREATMENT OF CERTAIN RADI2 ATION THERAPY SERVICES.—Radiation 

3 treatment delivery and related imaging 

4 services identified under subsection (b)(11) 

5 shall not be considered as potentially 

6 misvalued services for purposes of this sub7 paragraph and subparagraph (O) for 2017 

8 and 2018.’’. 

9 (b) REPORT TO CONGRESS ON ALTERNATIVE PAY10 MENT MODEL.—Not later than 18 months after the date 

11 of the enactment of this Act, the Secretary of Health and 

12 Human Services shall submit to Congress a report on the 

13 development of an episodic alternative payment model for 

14 payment under the Medicare program under title XVIII 

15 of the Social Security Act for radiation therapy services 

16 furnished in nonfacility settings. 

17 SEC. 204. FAIRNESS IN MEDICAID SUPPLEMENTAL NEEDS 

18 TRUSTS. 

19 (a) IN GENERAL.—Section 1917(d)(4)(A) of the So20 cial Security Act (42 U.S.C. 1396p(d)(4)(A)) is amended 

21 by inserting ‘‘the individual,’’ after ‘‘for the benefit of such 

22 individual by’’. 

23 (b) EFFECTIVE DATE.—The amendment made by 

24 subsection (a) shall apply to trusts established on or after 

25 the date of the enactment of this Act. 


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1 TITLE III—PROGRAM INTEG2 RITY, PAYMENT EFFICIENCY, 

3 AND ADDITIONAL MEDICARE 

4 POLICIES 

5 SEC. 301. STRENGTHENING PENALTIES FOR THE ILLEGAL 

6 DISTRIBUTION OF A MEDICARE, MEDICAID, 

7 OR CHIP BENEFICIARY IDENTIFICATION OR 

8 BILLING PRIVILEGES. 

9 Section 1128B(b) of the Social Security Act (42 

10 U.S.C. 1320a–7b(b)) is amended by adding at the end the 

11 following: 

12 ‘‘(4) Whoever without lawful authority know13 ingly and willfully purchases, sells or distributes, or 

14 arranges for the purchase, sale, or distribution of a 

15 beneficiary identification number or unique health 

16 identifier for a health care provider under title 

17 XVIII, title XIX, or title XXI shall be imprisoned 

18 for not more than 10 years or fined not more than 

19 $500,000 ($1,000,000 in the case of a corporation), 

20 or both.’’. 


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1 SEC. 302. CIVIL MONETARY PENALTIES FOR VIOLATIONS 

2 RELATED TO GRANTS, CONTRACTS, AND 

3 OTHER AGREEMENTS. 

4 (a) IN GENERAL.—Section 1128A of the Social Secu5 rity Act (42 U.S.C. 1320a–7a) is amended by adding at 

6 the end the following new subsection: 

7 ‘‘(o) Any person (including an organization, agency, 

8 or other entity, but excluding a program beneficiary, as 

9 defined in subsection (r)(4)) that, with respect to a grant, 

10 contract, or other agreement for which the Secretary of 

11 Health and Human Services provides funding— 

12 ‘‘(1) knowingly presents or causes to be pre13 sented a specified claim (as defined in subsection 

14 (r)(6)) under such grant, contract, or other agree15 ment that the person knows or should know is false 

16 or fraudulent; 

17 ‘‘(2) knowingly makes, uses, or causes to be 

18 made or used any false statement, omission, or mis19 representation of a material fact in any application, 

20 proposal, bid, progress report, or other document 

21 that is required to be submitted in order to directly 

22 or indirectly receive or retain funds provided in 

23 whole or in part by such Secretary pursuant to such 

24 grant, contract, or other agreement; 

25 ‘‘(3) knowingly makes, uses, or causes to be 

26 made or used, a false record or statement material 


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1 to a false or fraudulent specified claim under such 

2 grant, contract, or other agreement; 

3 ‘‘(4) knowingly makes, uses, or causes to be 

4 made or used, a false record or statement material 

5 to an obligation to pay or transmit funds or property 

6 to such Secretary with respect to such grant, con7 tract, or other agreement, or knowingly conceals or 

8 knowingly and improperly avoids or decreases an ob9 ligation to pay or transmit funds or property to such 

10 Secretary with respect to such grant, contract, or 

11 other agreement; or 

12 ‘‘(5) fails to grant timely access, upon reason13 able request (as defined by such Secretary in regula14 tions), to the Inspector General of the Department, 

15 for the purpose of audits, investigations, evaluations, 

16 or other statutory functions of such Inspector Gen17 eral in matters involving such grants, contracts, or 

18 other agreements; 

19 shall be subject, in addition to any other penalties that 

20 may be prescribed by law, to a civil money penalty in cases 

21 under paragraph (1), of not more than $10,000 for each 

22 specified claim; in cases under paragraph (2), not more 

23 than $50,000 for each false statement, omission, or mis24 representation of a material fact; in cases under para25 graph (3), not more than $50,000 for each false record 


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1 or statement; in cases under paragraph (4), not more than 

2 $50,000 for each false record or statement or $10,000 for 

3 each day that the person knowingly conceals or knowingly 

4 and improperly avoids or decreases an obligation to pay; 

5 or in cases under paragraph (5), not more than $15,000 

6 for each day of the failure described in such paragraph. 

7 In addition, in cases under paragraphs (1) and (3), such 

8 a person shall be subject to an assessment of not more 

9 than 3 times the amount claimed in the specified claim 

10 described in such paragraph in lieu of damages sustained 

11 by the United States or a specified State agency because 

12 of such specified claim, and in cases under paragraphs (2) 

13 and (4), such a person shall be subject to an assessment 

14 of not more than 3 times the total amount of the funds 

15 described in paragraph (2) or (4), respectively (or, in the 

16 case of an obligation to transmit property to the Secretary 

17 Health and Human Services described in paragraph (4), 

18 of the value of the property described in such paragraph) 

19 in lieu of damages sustained by the United States or a 

20 specified State agency because of such case. In addition, 

21 the Secretary of Health and Human Services may make 

22 a determination in the same proceeding to exclude the per23 son from participation in the Federal health care pro24 grams (as defined in section 1128B(f)(1)) and to direct 


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1 the appropriate State agency to exclude the person from 

2 participation in any State health care program. 

3 ‘‘(p) The provisions of subsections (c), (d), and (g) 

4 shall apply to a civil money penalty or assessment under 

5 subsection (o) in the same manner as such provisions 

6 apply to a penalty, assessment, or proceeding under sub7 section (a). 

8 ‘‘(q) With respect to a penalty or assessment under 

9 subsection (o), the Inspector General of the Department 

10 is authorized to receive, and to retain for current use, such 

11 amounts of such penalty or assessment as are necessary 

12 to provide reimbursement for the costs of conducting in13 vestigations and audits with respect to such subsection 

14 and for monitoring compliance plans with respect to such 

15 subsection when such penalty or assessment is ordered by 

16 a court, voluntarily agreed to by the payor, or otherwise. 

17 Funds received by such Inspector General as reimburse18 ment under the preceding sentence shall be deposited to 

19 the credit of the appropriations from which initially paid, 

20 or to appropriations for similar purposes currently avail21 able at the time of deposit, and shall remain available for 

22 obligation for 1 year from the date of the deposit of such 

23 funds. 

24 ‘‘(r) For purposes of this subsection and subsections 

25 (o), (p), and (q): 


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1 ‘‘(1) The term ‘Department’ means the Depart2 ment of Health and Human Services. 

3 ‘‘(2) The term ‘material’ means having a nat4 ural tendency to influence, or be capable of influ5 encing, the payment or receipt of money or property. 

6 ‘‘(3) The term ‘other agreement’ includes a co7 operative agreement, scholarship, fellowship, loan, 

8 subsidy, payment for a specified use, donation agree9 ment, award, or sub-award (regardless of whether 

10 one or more of the persons entering into the agree11 ment is a contractor or sub-contractor). 

12 ‘‘(4) The term ‘program beneficiary’ means, in 

13 the case of a grant, contract, or other agreement de14 signed to accomplish the objective of awarding or 

15 otherwise furnishing benefits or assistance to indi16 viduals and for which the Secretary of Health and 

17 Human Services provides funding, an individual who 

18 applies for, or who receives, such benefits or assist19 ance from such grant, contract, or other agreement. 

20 Such term does not include, with respect to such 

21 grant, contract, or other agreement, an officer, em22 ployee, or agent of a person or entity that receives 

23 such grant or that enters into such contract or other 

24 agreement. 


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1 ‘‘(5) The term ‘recipient’ includes a sub-recipi2 ent or subcontractor. 

3 ‘‘(6) The term ‘specified claim’ means any ap4 plication, request, or demand under a grant, con5 tract, or other agreement for money or property, 

6 whether or not the United States or a specified 

7 State agency has title to the money or property, that 

8 is not a claim (as defined in subsection (i)(2)) and 

9 that— 

10 ‘‘(A) is presented or caused to be pre11 sented to an officer, employee, or agent of the 

12 Department or agency thereof, or of any speci13 fied State agency; or 

14 ‘‘(B) is made to a contractor, grantee, or 

15 any other recipient if the money or property is 

16 to be spent or used on the Department’s behalf 

17 or to advance a Department program or inter18 est, and if the Department— 

19 ‘‘(i) provides or has provided any por20 tion of the money or property requested or 

21 demanded; or 

22 ‘‘(ii) will reimburse such contractor, 

23 grantee or other recipient for any portion 

24 of the money or property which is re25 quested or demanded. 


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1 ‘‘(7) The term ‘specified State agency’ means 

2 an agency of a State government established or des3 ignated to administer or supervise the administra4 tion of a grant, contract, or other agreement funded 

5 in whole or in part by the Secretary of Health and 

6 Human Services. 

7 ‘‘(s) For purposes of subsection (o), the term ‘obliga8 tion’ means an established duty, whether or not fixed, aris9 ing from an express or implied contractual, grantor-grant10 ee, or licensor-licensee relationship, for a fee-based or 

11 similar relationship, from statute or regulation, or from 

12 the retention of any overpayment.’’. 

13 (b) CONFORMING AMENDMENTS.—Section 1128A of 

14 the Social Security Act (42 U.S.C. 1320a–7a) is amend15 ed— 

16 (1) in subsection (d)— 

17 (A) in paragraph (1), by inserting ‘‘or 

18 specified claims’’ after ‘‘claims’’; 

19 (B) in paragraph (2), by inserting ‘‘or 

20 specified claims’’ after ‘‘claims’’; 

21 (2) in subsection (e), by inserting ‘‘or specified 

22 claim’’ after ‘‘claim’’; and 

23 (3) in subsection (f)— 


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1 (A) by inserting ‘‘or specified claim (as de2 fined in subsection (r)(6))’’ after ‘‘district 

3 where the claim’’; 

4 (B) by inserting ‘‘(or, with respect to a 

5 person described in subsection (o), the person)’’ 

6 after ‘‘claimant’’; 

7 (C) by inserting ‘‘that are not received by 

8 the Inspector General of the Department of 

9 Health and Human Services under subsection 

10 (q) as reimbursement’’ after ‘‘amounts recov11 ered’’; and 

12 (D) by inserting ‘‘(or, in the case of a pen13 alty or assessment under subsection (o), by a 

14 specified State agency (as defined in subsection 

15 (r)(7))’’ after ‘‘or a State agency’’. 

16 SEC. 303. AUTHORIZING A BLANKET MEANINGFUL USE SIG17 NIFICANT HARDSHIP EXCEPTION. 

18 (a) PHYSICIANS’ SERVICES.—Section 1848(a)(7)(B) 

19 of the Social Security Act (42 U.S.C. 1395w–4(a)(7)(B)) 

20 is amended by inserting ‘‘(or through a blanket exception 

21 with respect to the payment adjustment for 2017, but only 

22 if a request for such exception is filed no later than June 

23 30, 2016)’’ after ‘‘on a case-by-case basis’’. 

24 (b) HOSPITAL SERVICES.—Section 

25 1886(b)(3)(B)(ix)(II) of the Social Security Act (42 


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1 U.S.C. 1395ww(b)(3)(B)(ix)(II)) is amended by inserting 

2 ‘‘(or through a blanket exception with respect to the pay3 ment adjustment for fiscal year 2017, but only if a request 

4 for such exception is filed no later than June 30, 2016)’’ 

5 after ‘‘on a case-by-case basis’’. 

6 (c) IMPLEMENTATION AUTHORITY.—The Secretary 

7 of Health and Human Services may implement the amend8 ments made by this section by interim final rule with com9 ment period. 

10 SEC. 304. LIMITING FEDERAL MEDICAID REIMBURSEMENT 

11 TO STATES FOR DURABLE MEDICAL EQUIP12 MENT (DME) TO MEDICARE PAYMENT RATES. 

13 Section 1903(i)(27) of the Social Security Act (42 

14 U.S.C. 1396b(i)(27)), as added by section 503(a)(1) of di15 vision O of the Consolidated Appropriations Act, 2016, is 

16 amended by striking ‘‘January 1, 2019’’ and inserting 

17 ‘‘October 1, 2018’’. 

18 SEC. 305. TREATMENT OF PATIENT ENCOUNTERS IN AMBU19 LATORY SURGICAL CENTERS IN DETER20 MINING MEANINGFUL EHR USE. 

21 Section 1848(o)(2) of the Social Security Act (42 

22 U.S.C. 1395w–4(o)(2)) is amended by adding at the end 

23 the following new subparagraph: 

24 ‘‘(E) TREATMENT OF PATIENT ENCOUN25 TERS AT AMBULATORY SURGICAL CENTERS.— 


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1 ‘‘(i) IN GENERAL.—Subject to clause 

2 (ii), with respect to a payment adjustment 

3 applied under subsection (a)(7)(A), for 

4 2017 or a subsequent year, any patient en5 counter of an eligible professional occur6 ring at an ambulatory surgical center (de7 scribed in section 1833(i)(1)(A)) shall not 

8 be treated as a patient encounter in deter9 mining whether an eligible professional 

10 qualifies as a meaningful EHR user. Not11 withstanding any other provision of law, 

12 the Secretary may implement this clause 

13 by program instruction or otherwise. 

14 ‘‘(ii) SUNSET.—Clause (i) shall no 

15 longer apply as of the first payment year 

16 that begins more than 3 years after the 

17 date the Secretary determines, through no18 tice and comment rulemaking, that cer19 tified EHR technology is applicable to the 

20 ambulatory surgical center setting.’’. 

Æ 


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