PUBLIC LAW 114–115—DEC. 28, 2015 129 STAT. 3131 

Public Law 114–115 

114th Congress 

An Act 

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

for complex rehabilitation technology and certain radiation therapy services, to 

ensure flexibility in applying the hardship exception for meaningful use for the 

2015 EHR reporting period for 2017 payment adjustments, and for other purposes. 

Be it enacted by the Senate and House of Representatives of 

the United States of America in Congress assembled, 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Patient Access and Medicare 

Protection Act’’. 

SEC. 2. NON-APPLICATION OF MEDICARE FEE SCHEDULE ADJUSTMENTS FOR WHEELCHAIR ACCESSORIES AND SEAT AND 

BACK CUSHIONS WHEN FURNISHED IN CONNECTION WITH 

COMPLEX REHABILITATIVE POWER WHEELCHAIRS. 

(a) NON-APPLICATION.— 

(1) IN GENERAL.—Notwithstanding any other provision of 

law, the Secretary of Health and Human Services shall not, 

prior to January 1, 2017, use information on the payment 

determined under the competitive acquisition programs under 

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

3) to adjust the payment amount that would otherwise be 

recognized under section 1834(a)(1)(B)(ii) of such Act (42 U.S.C. 

1395m(a)(1)(B)(ii)) for wheelchair accessories (including seating 

systems) and seat and back cushions when furnished in connection with Group 3 complex rehabilitative power wheelchairs. 

(2) IMPLEMENTATION.—Notwithstanding any other provision of law, the Secretary may implement this subsection by 

program instruction or otherwise. 

(b) GAO STUDY AND REPORT.— 

(1) STUDY.— 

(A) IN GENERAL.—The Comptroller General of the 

United States shall conduct a study on wheelchair accessories (including seating systems) and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs. 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 (i) through (iii) of subparagraph (B): 

(i) The item descriptions and associated HCPCS 

codes for such wheelchair accessories and seat and 

back cushions. 

42 USC 1305 

note. 

Patient Access 

and Medicare 

Protection Act. 

Dec. 28, 2015 

[S. 2425] 


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129 STAT. 3132 PUBLIC LAW 114–115—DEC. 28, 2015 

(ii) A breakdown of utilization and expenditures 

for such wheelchair accessories and seat and back cushions under title XVIII of the Social Security Act. 

(iii) A comparison of the payment amount under 

the competitive acquisition program under section 1847 

of such Act (42 U.S.C. 1395w–3) with the payment 

amount that would otherwise be recognized under section 1834 of such Act (42 U.S.C. 1395m), including 

beneficiary cost sharing, for such wheelchair accessories and seat and back cushions. 

(iv) 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 (B). 

(v) Other areas determined appropriate by the 

Comptroller General. 

(B) GROUPS DESCRIBED.—The following groups are 

described in this subparagraph: 

(i) Wheelchair accessories and seat and back cushions furnished predominantly with Group 3 complex 

rehabilitative power wheelchairs. 

(ii) Wheelchair accessories and seat and back cushions furnished predominantly with power wheelchairs 

that are not described in clause (i). 

(iii) Other wheelchair accessories and seat and 

back cushions furnished with either power wheelchairs 

described in clause (i) or (ii). 

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

General of the United States shall submit to Congress a report 

containing the results of the study conducted under paragraph 

(1), together with recommendations for such legislation and 

administrative as the Comptroller General determines to be 

appropriate. 

SEC. 3. TRANSITIONAL PAYMENT RULES FOR CERTAIN RADIATION 

THERAPY SERVICES UNDER THE MEDICARE PHYSICIAN FEE 

SCHEDULE. 

(a) IN GENERAL.—Section 1848 of the Social Security Act (42 

U.S.C. 1395w–4) is amended— 

(1) in subsection (b), by adding at the end the following 

new paragraph: 

‘‘(11) SPECIAL RULE FOR CERTAIN RADIATION THERAPY SERVICES.—The code definitions, the work relative value units under 

subsection (c)(2)(C)(i), and the direct inputs for the practice 

expense relative value units under subsection (c)(2)(C)(ii) for 

radiation treatment delivery and related imaging services 

(identified in 2016 by HCPCS G-codes G6001 through G6015) 

for the fee schedule established under this subsection for services furnished in 2017 and 2018 shall be the same as such 

definitions, units, and inputs for such services for the fee 

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

(2) in subsection (c)(2)(K), by adding at the end the following new clause: 

‘‘(iv) TREATMENT OF CERTAIN RADIATION THERAPY

SERVICES.—Radiation treatment delivery and related 

imaging services identified under subsection (b)(11) 

Recommendations. 


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PUBLIC LAW 114–115—DEC. 28, 2015 129 STAT. 3133 

shall not be considered as potentially misvalued services for purposes of this subparagraph and subparagraph (O) for 2017 and 2018.’’. 

(b) REPORT TO CONGRESS ON ALTERNATIVE PAYMENT MODEL.— Not later than 18 months after the date of the enactment of this 

Act, 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 settings. 

SEC. 4. ENSURING FLEXIBILITY IN APPLYING HARDSHIP EXCEPTION 

FOR MEANINGFUL USE FOR 2015 EHR REPORTING PERIOD 

FOR 2017 PAYMENT ADJUSTMENTS. 

(a) ELIGIBLE PROFESSIONALS.—Section 1848(a)(7)(B) of the 

Social Security Act (42 U.S.C. 1395w–4(a)(7)(B)) is amended, in 

the first sentence, by inserting ‘‘(and, with respect to the payment 

adjustment under subparagraph (A) for 2017, for categories of 

eligible professionals, as established by the Secretary and posted 

on the Internet website of the Centers for Medicare & Medicaid 

Services prior to December 15, 2015, an application for which must 

be submitted to the Secretary by not later than March 15, 2016)’’ 

after ‘‘case-by-case basis’’. 

(b) ELIGIBLE HOSPITALS.—Section 1886(b)(3)(B)(ix) of the Social 

Security Act (42 U.S.C. 1395ww(b)(3)(B)(ix)) is amended— 

(1) in the first sentence of subclause (I), by striking 

‘‘(n)(6)(A)’’ and inserting ‘‘(n)(6)’’; and 

(2) in subclause (II), in the first sentence, by inserting 

‘‘(and, with respect to the application of subclause (I) for fiscal 

year 2017, for categories of subsection (d) hospitals, as established by the Secretary and posted on the Internet website 

of the Centers for Medicare & Medicaid Services prior to 

December 15, 2015, an application for which must be submitted 

to the Secretary by not later than April 1, 2016)’’ after ‘‘caseby-case basis’’. 

(c) IMPLEMENTATION.—Notwithstanding any other provision of 

law, the Secretary of Health and Human Services shall implement 

the provisions of, and the amendments made by, subsections (a) 

and (b) by program instruction, such as through information on 

the Internet website of the Centers for Medicare & Medicaid Services. 

SEC. 5. MEDICARE IMPROVEMENT FUND. 

Section 1898(b)(1) of the Social Security Act (42 U.S.C. 1395iii(b)(1)) is amended by striking ‘‘$5,000,000’’ and inserting 

‘‘$0’’. 

SEC. 6. STRENGTHENING MEDICAID PROGRAM INTEGRITY THROUGH 

FLEXIBILITY. 

Section 1936 of the Social Security Act (42 U.S.C. 1396u– 

6) is amended— 

(1) in subsection (a), by inserting ‘‘, or otherwise,’’ after 

‘‘entities’’; and 

(2) in subsection (e)— 

(A) in paragraph (1), in the matter preceding subparagraph (A), by inserting ‘‘(including the costs of equipment, 

salaries and benefits, and travel and training)’’ after ‘‘Program under this section’’; and 

42 USC 1395w–4 

note. 

Deadline. 

Deadline. 


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129 STAT. 3134 PUBLIC LAW 114–115—DEC. 28, 2015 

(B) in paragraph (3), by striking ‘‘by 100’’ and inserting 

‘‘by 100, or such number as determined necessary by the 

Secretary to carry out the Program,’’. 

SEC. 7. ESTABLISHING MEDICARE ADMINISTRATIVE CONTRACTOR 

ERROR REDUCTION INCENTIVES. 

(a) IN GENERAL.—Section 1874A(b)(1)(D) of the Social Security 

Act (42 U.S.C. 1395kk–1(b)(1)(D)) is amended— 

(1) by striking ‘‘QUALITY.—The Secretary’’ and inserting ‘‘QUALITY.— ‘‘(i) IN GENERAL.—Subject to clauses (ii) and (iii), 

the Secretary’’; and 

(2) by inserting after clause (i), as added by paragraph 

(1), the following new clauses: 

‘‘(ii) IMPROPER PAYMENT RATE REDUCTION INCEN- TIVES.—The Secretary shall provide incentives for 

medicare administrative contractors to reduce the 

improper payment error rates in their jurisdictions. 

‘‘(iii) INCENTIVES.—The incentives provided for 

under clause (ii)— 

‘‘(I) 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 thresholds, as determined by the Secretary, 

or accomplish tasks, as determined by the Secretary, that further improve payment accuracy; 

and 

‘‘(II) may include substantial reductions in 

award fee payments under cost-plus-award-fee contracts, for medicare administrative contractors 

that reach an upper end improper payment rate 

threshold or other threshold as determined by the 

Secretary, or fail to accomplish tasks, as determined by the Secretary, that further improve payment accuracy.’’. 

(b) EFFECTIVE DATE.— (1) IN GENERAL.—The amendments made by subsection 

(a) shall apply to contracts entered into or renewed on or 

after the date that is 3 years after the date of enactment 

of this Act. 

(2) 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 (1), the Secretary of Health and Human Services 

shall, when appropriate and practicable, seek to apply the 

incentives provided for in the amendments made by subsection 

(a) through contract modifications. 

SEC. 8. STRENGTHENING PENALTIES FOR THE ILLEGAL DISTRIBUTION 

OF A MEDICARE, MEDICAID, OR CHIP BENEFICIARY IDENTIFICATION OR BILLING PRIVILEGES. 

Section 1128B(b) of the Social Security Act (42 U.S.C. 1320a– 

7b(b)) is amended by adding at the end the following: 

‘‘(4) Whoever without lawful authority knowingly and willfully purchases, sells or distributes, or arranges for the purchase, sale, or distribution of a beneficiary identification 

number or unique health identifier for a health care provider 

Applicability. 

42 USC 

1395kk–1 note. 


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PUBLIC LAW 114–115—DEC. 28, 2015 129 STAT. 3135 

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

for not more than 10 years or fined not more than $500,000 

($1,000,000 in the case of a corporation), or both.’’. 

SEC. 9. IMPROVING THE SHARING OF DATA BETWEEN THE FEDERAL 

GOVERNMENT AND STATE MEDICAID PROGRAMS. 

(a) IN GENERAL.—The Secretary of Health and Human Services 

(in this section referred to as the ‘‘Secretary’’) shall establish a 

plan to encourage and facilitate the participation of States in the 

Medicare-Medicaid Data Match Program (commonly referred to as 

the ‘‘Medi-Medi Program’’) under section 1893(g) of the Social Security Act (42 U.S.C. 1395ddd(g)). 

(b) PROGRAM REVISIONS TO IMPROVE MEDI-MEDI DATA MATCH

PROGRAM PARTICIPATION BY STATES.—Section 1893(g)(1)(A) of the 

Social Security Act (42 U.S.C. 1395ddd(g)(1)(A)) is amended— 

(1) in the matter preceding clause (i), by inserting ‘‘or 

otherwise’’ after ‘‘eligible entities’’; 

(2) in clause (i)— 

(A) by inserting ‘‘to review claims data’’ after ‘‘algorithms’’; and 

(B) by striking ‘‘service, time, or patient’’ and inserting 

‘‘provider, service, time, or patient’’; 

(3) in clause (ii)— 

(A) by inserting ‘‘to investigate and recover amounts 

with respect to suspect claims’’ after ‘‘appropriate actions’’; 

and 

(B) by striking ‘‘; and’’ and inserting a semicolon; 

(4) in clause (iii), by striking the period and inserting‘‘ 

; and’’; and 

(5) by adding at the end the following new clause: 

‘‘(iv) furthering the Secretary’s design, development, installation, or enhancement of an automated 

data system architecture— 

‘‘(I) to collect, integrate, and assess data for 

purposes of program integrity, program oversight, 

and administration, including the Medi-Medi Program; and 

‘‘(II) that improves the coordination of requests 

for data from States.’’. 

(c) PROVIDING STATES WITH DATA ON IMPROPER PAYMENTS

MADE FOR ITEMS OR SERVICES PROVIDED TO DUAL ELIGIBLE INDIVIDUALS.— 

(1) 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 (42 U.S.C. 

1395 et seq.) for health care items or services provided to 

dual eligible individuals. 

(2) DUAL ELIGIBLE INDIVIDUAL DEFINED.—In this section, 

the term ‘‘dual eligible individual’’ means an individual who 

is entitled to, or enrolled for, benefits under part A of title 

XVIII of the Social Security Act (42 U.S.C. 1395c et seq.), 

or enrolled for benefits under part B of title XVIII of such 

Plan. 

42 USC 1305ddd 

note. 

Plan. 

42 USC 1395ddd 

note. 


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129 STAT. 3136 PUBLIC LAW 114–115—DEC. 28, 2015 

LEGISLATIVE HISTORY—S. 2425: 

CONGRESSIONAL RECORD, Vol. 161 (2015): 

Dec. 18, considered and passed Senate and House. 

Æ 

Act (42 U.S.C. 1395j et seq.), and is eligible for medical assistance under a State plan under title XIX of such Act (42 U.S.C. 

1396 et seq.) or under a waiver of such plan. 

Approved December 28, 2015. 


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