I 

116TH CONGRESS 

1ST SESSION H. R. 3416 

To provide for health equity and access for returning troops and 

servicemembers, to provide for ambulatory surgical payment transparency 

under the Medicare program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 21, 2019 

Ms. SEWELL of Alabama (for herself and Mr. SMITH of Nebraska) introduced 

the following bill; which was referred to the Committee on Energy and 

Commerce, and in addition to the Committees on Ways and Means, and 

Armed Services, 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 provide for health equity and access for returning troops 

and servicemembers, to provide for ambulatory surgical 

payment transparency under the Medicare program, 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 ‘‘HEARTS and Rural Relief Act’’. 


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

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Health Equity and Access for Returning Troops and Servicemembers 

and Rural Relief Act of 2019. 

Sec. 3. Ambulatory surgical center payment transparency. 

Sec. 4. Exclusion of complex rehabilitative manual wheelchairs from Medicare 

competitive acquisition program; non-application of Medicare 

fee schedule adjustments for certain wheelchair accessories and 

cushions. 

Sec. 5. Extension of enforcement instruction on supervision requirements for 

outpatient therapeutic services in critical access and small 

rural hospitals through 2021. 

3 SEC. 2. HEALTH EQUITY AND ACCESS FOR RETURNING 

4 TROOPS AND SERVICEMEMBERS AND RURAL 

5 RELIEF ACT OF 2019. 

6 (a) MODIFICATION OF REQUIREMENT FOR CERTAIN

7 FORMER MEMBERS OF THE ARMED FORCES TO ENROLL

8 IN MEDICARE PART B TO BE ELIGIBLE FOR TRICARE 

9 FOR LIFE.— 

10 (1) TRICARE ELIGIBILITY.— 

11 (A) IN GENERAL.—Subsection (d) of sec12 tion 1086 of title 10, United States Code, is 

13 amended by adding at the end the following 

14 new paragraph: 

15 ‘‘(6)(A) The requirement in paragraph (2)(A) 

16 to enroll in the supplementary medical insurance 

17 program under part B of title XVIII of the Social 

18 Security Act (42 U.S.C. 1395j et seq.) shall not 

19 apply to a person described in subparagraph (B) 

20 during any month in which such person is not entiVerDate Sep 11 2014 23:02 Jul 08, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3416.IH H3416

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1 tled to a benefit described in subparagraph (A) of 

2 section 226(b)(2) of the Social Security Act (42 

3 U.S.C. 426(b)(2)) if such person has received the 

4 counseling and information under subparagraph (C). 

5 ‘‘(B) A person described in this subparagraph 

6 is a person— 

7 ‘‘(i) who is under 65 years of age; 

8 ‘‘(ii) who is entitled to hospital insurance 

9 benefits under part A of title XVIII of the So10 cial Security Act pursuant to subparagraph (A) 

11 or (C) of section 226(b)(2) of such Act (42 

12 U.S.C. 426(b)(2)); 

13 ‘‘(iii) whose entitlement to a benefit de14 scribed in subparagraph (A) of such section has 

15 terminated due to performance of substantial 

16 gainful activity; and 

17 ‘‘(iv) who is retired under chapter 61 of 

18 this title. 

19 ‘‘(C) The Secretary of Defense shall coordinate 

20 with the Secretary of Health and Human Services 

21 and the Commissioner of Social Security to notify 

22 persons described in subparagraph (B) of, and pro23 vide information and counseling regarding, the ef24 fects of not enrolling in the supplementary medical 

25 insurance program under part B of title XVIII of 


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1 the Social Security Act (42 U.S.C. 1395j et seq.), as 

2 described in subparagraph (A).’’. 

3 (B) CONFORMING AMENDMENT.—Para4 graph (2)(A) of such subsection is amended by 

5 striking ‘‘is enrolled’’ and inserting ‘‘except as 

6 provided by paragraph (6), is enrolled’’. 

7 (C) IDENTIFICATION OF PERSONS.—Sec8 tion 1110a of such title is amended by adding 

9 at the end the following new subsection: 

10 ‘‘(c) CERTAIN INDIVIDUALS NOT REQUIRED TO EN11 ROLL IN MEDICARE PART B.—In carrying out subsection 

12 (a), the Secretary of Defense shall coordinate with the 

13 Secretary of Health and Human Services and the Commis14 sioner of Social Security to— 

15 ‘‘(1) identify persons described in subparagraph 

16 (B) of section 1086(d)(6) of this title; and 

17 ‘‘(2) provide information and counseling pursu18 ant to subparagraph (C) of such section.’’. 

19 (2) NON-APPLICATION OF MEDICARE PART B

20 LATE ENROLLMENT PENALTY.—Section 1839(b) of 

21 the Social Security Act (42 U.S.C. 1395r(b)) is 

22 amended, in the second sentence, by inserting ‘‘or 

23 months for which the individual can demonstrate 

24 that the individual is an individual described in 

25 paragraph (6)(B) of section 1086(d) of title 10, 


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1 United States Code, who is enrolled in the 

2 TRICARE program pursuant to such section’’ after 

3 ‘‘an individual described in section 1837(k)(3)’’. 

4 (3) REPORT.—Not later than October 1, 2024, 

5 the Secretary of Defense, the Secretary of Health 

6 and Human Services, and the Commissioner of So7 cial Security shall jointly submit to the Committees 

8 on Armed Services of the House of Representatives 

9 and the Senate, the Committee on Ways and Means 

10 and the Committee on Energy and Commerce of the 

11 House of Representatives, and the Committee on Fi12 nance of the Senate a report on the implementation 

13 of section 1086(d)(6) of title 10, United States 

14 Code, as added by paragraph (1). Such report shall 

15 include, with respect to the period covered by the re16 port— 

17 (A) the number of individuals enrolled in 

18 TRICARE for Life who are not enrolled in the 

19 supplementary medical insurance program 

20 under part B of title XVIII of the Social Secu21 rity Act (42 U.S.C. 1395j et seq.) by reason of 

22 such section 1086(d)(6); and 

23 (B) the number of individuals who— 


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1 (i) are retired from the Armed Forces 

2 under chapter 61 of title 10, United States 

3 Code; 

4 (ii) are entitled to hospital insurance 

5 benefits under part A of title XVIII of the 

6 Social Security Act pursuant to receiving 

7 benefits for 24 months as described in sub8 paragraph (A) or (C) of section 226(b)(2) 

9 of such Act (42 U.S.C. 426(b)(2)); and 

10 (iii) because of such entitlement, are 

11 no longer enrolled in TRICARE Standard, 

12 TRICARE Prime, TRICARE Extra, or 

13 TRICARE Select under chapter 55 of title 

14 10, United States Code. 

15 (4) DEPOSIT OF SAVINGS INTO MEDICARE IM16 PROVEMENT FUND.—Section 1898(b)(1) of the So17 cial Security Act (42 U.S.C. 1395iii(b)(1)) is amend18 ed by striking ‘‘during and after fiscal year 2021, 

19 $0’’ and inserting ‘‘during and after fiscal year 

20 2024, $5,000,000’’. 

21 (5) APPLICATION.—The amendments made by 

22 paragraphs (1) and (2) shall apply with respect to 

23 a person who, on or after October 1, 2023, is a per24 son described in section 1086(d)(6)(B) of title 10, 

25 United States Code, as added by paragraph (1). 


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1 (b) COVERAGE OF CERTAIN DNA SPECIMEN PROVE2 NANCE ASSAY TESTS UNDER MEDICARE.— 

3 (1) BENEFIT.— 

4 (A) COVERAGE.—Section 1861 of the So5 cial Security Act (42 U.S.C. 1395x) is amend6 ed— 

7 (i) in subsection (s)(2)— 

8 (I) in subparagraph (GG), by 

9 striking ‘‘and’’ at the end; 

10 (II) in subparagraph (HH), by 

11 striking the period and inserting ‘‘; 

12 and’’; and 

13 (III) by adding at the end the 

14 following new subparagraph: 

15 ‘‘(II) a prostate cancer DNA Specimen Prove16 nance Assay test (DSPA test) (as defined in sub17 section (kkk));’’; and 

18 (ii) by adding at the end the following 

19 new subsection: 

20 ‘‘(kkk) PROSTATE CANCER DNA SPECIMEN PROVE21 NANCE ASSAY TEST.—The term ‘prostate cancer DNA 

22 Specimen Provenance Assay Test’ (DSPA test) means a 

23 test that, after a determination of cancer in one or more 

24 prostate biopsy specimens obtained from an individual, as25 sesses the identity of the DNA in such specimens by comVerDate Sep 11 2014 03:36 Jun 27, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3416.IH H3416

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1 paring such DNA with the DNA that was separately taken 

2 from such individual at the time of the biopsy.’’. 

3 (B) EXCLUSION FROM COVERAGE.—Sec4 tion 1862(a)(1) of the Social Security Act (42 

5 U.S.C. 1395y(a)(1)) is amended— 

6 (i) in subparagraph (O), by striking 

7 ‘‘and’’ at the end; 

8 (ii) in subparagraph (P), by striking 

9 the semicolon at the end and inserting ‘‘, 

10 and’’; and 

11 (iii) by adding at the end the fol12 lowing new subparagraph: 

13 ‘‘(Q) in the case of a prostate cancer DNA 

14 Specimen Provenance Assay test (DSPA test) (as 

15 defined in section 1861(kkk)), unless such test is 

16 furnished on or after January 1, 2020, and before 

17 January 1, 2025, and such test is ordered by the 

18 physician who furnished the prostate cancer biopsy 

19 that obtained the specimen tested;’’. 

20 (2) PAYMENT AMOUNT AND RELATED REQUIRE21 MENTS.—Section 1834 of the Social Security Act 

22 (42 U.S.C. 1395m) is amended by adding at the end 

23 the following new subsection: 

24 ‘‘(x) PROSTATE CANCER DNA SPECIMEN PROVE25 NANCE ASSAY TESTS.— 


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1 ‘‘(1) PAYMENT FOR COVERED TESTS.— 

2 ‘‘(A) IN GENERAL.—Subject to subpara3 graph (B), the payment amount for a prostate 

4 cancer DNA Specimen Provenance Assay test 

5 (DSPA test) (as defined in section 1861(kkk)) 

6 shall be $200. Such payment shall be payment 

7 for all of the specimens obtained from the bi8 opsy furnished to an individual that are tested. 

9 ‘‘(B) LIMITATION.—Payment for a DSPA 

10 test under subparagraph (A) may only be made 

11 on an assignment-related basis. 

12 ‘‘(C) PROHIBITION ON SEPARATE PAY13 MENT.—No separate payment shall be made for 

14 obtaining DNA that was separately taken from 

15 an individual at the time of a biopsy described 

16 in subparagraph (A). 

17 ‘‘(2) HCPCS CODE AND MODIFIER ASSIGN18 MENT.— 

19 ‘‘(A) IN GENERAL.—The Secretary shall 

20 assign one or more HCPCS codes to a prostate 

21 cancer DNA Specimen Provenance Assay test 

22 and may use a modifier to facilitate making 

23 payment under this section for such test. 

24 ‘‘(B) IDENTIFICATION OF DNA MATCH ON

25 CLAIM.—The Secretary shall require an indicaVerDate Sep 11 2014 03:36 Jun 27, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3416.IH H3416

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1 tion on a claim for a prostate cancer DNA 

2 Specimen Provenance Assay test of whether the 

3 DNA of the prostate biopsy specimens match 

4 the DNA of the individual diagnosed with pros5 tate cancer. Such indication may be made 

6 through use of a HCPCS code, a modifier, or 

7 other means, as determined appropriate by the 

8 Secretary. 

9 ‘‘(3) DNA MATCH REVIEW.— 

10 ‘‘(A) IN GENERAL.—The Secretary shall 

11 review at least three years of claims under part 

12 B for prostate cancer DNA Specimen Prove13 nance Assay tests to identify whether the DNA 

14 of the prostate biopsy specimens match the 

15 DNA of the individuals diagnosed with prostate 

16 cancer. 

17 ‘‘(B) POSTING ON INTERNET WEBSITE.— 

18 Not later than July 1, 2023, the Secretary shall 

19 post on the internet website of the Centers for 

20 Medicare & Medicaid Services the findings of 

21 the review conducted under subparagraph 

22 (A).’’. 

23 (3) COST-SHARING.—Section 1833(a)(1) of the 

24 Social Security Act (42 U.S.C. 1395l(a)(1)) is 

25 amended— 


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1 (A) by striking ‘‘and (CC)’’ and inserting 

2 ‘‘(CC)’’; and 

3 (B) by inserting before the semicolon at 

4 the end the following: ‘‘, and (DD) with respect 

5 to a prostate cancer DNA Specimen Provenance 

6 Assay test (DSPA test) (as defined in section 

7 1861(kkk)), the amount paid shall be an 

8 amount equal to 80 percent of the lesser of the 

9 actual charge for the test or the amount speci10 fied under section 1834(x)’’. 

11 SEC. 3. AMBULATORY SURGICAL CENTER PAYMENT TRANS12 PARENCY. 

13 (a) ADVISORY PANEL ON HOSPITAL OUTPATIENT

14 PAYMENT REPRESENTATION.— 

15 (1) ASC REPRESENTATIVE.—The second sen16 tence of section 1833(t)(9)(A) of the Social Security 

17 Act (42 U.S.C. 1395l(t)(9)(A)) is amended by in18 serting ‘‘and at least one ambulatory surgical center 

19 representative’’ after ‘‘an appropriate selection of 

20 representatives of providers’’. 

21 (2) EFFECTIVE DATE.—The amendment made 

22 by paragraph (1) shall apply with respect to advisory 

23 panels consulted on or after the date that is 1 year 

24 after the date of the enactment of this Act. 


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1 (b) REASONS FOR EXCLUDING ADDITIONAL PROCE2 DURES FROM ASC APPROVED LIST.—Section 1833(i)(1) 

3 of the Social Security Act (42 U.S.C. 1395l(i)(1)) is 

4 amended by adding at the end the following: ‘‘In updating 

5 such lists for application in years beginning with the sec6 ond year beginning after the date of the enactment of this 

7 sentence, for each procedure that was not proposed to be 

8 included in such lists in the proposed rule with respect 

9 to such lists and that was subsequently requested to be 

10 included in such lists during the public comment period 

11 with respect to such proposed rule and that is not included 

12 in the final rule updating such lists, the Secretary shall 

13 cite in such final rule the specific criteria in paragraph 

14 (b) or (c) of section 416.166 of title 42, Code of Federal 

15 Regulations (or any successor regulation), based on which 

16 the procedure was excluded. If paragraph (b) of such sec17 tion is cited for exclusion of a procedure, the Secretary 

18 shall identify the peer-reviewed research, if any, or the evi19 dence upon which such determination is based.’’. 


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1 SEC. 4. EXCLUSION OF COMPLEX REHABILITATIVE MAN2 UAL WHEELCHAIRS FROM MEDICARE COM3 PETITIVE ACQUISITION PROGRAM; NON-AP4 PLICATION OF MEDICARE FEE SCHEDULE 

5 ADJUSTMENTS FOR CERTAIN WHEELCHAIR 

6 ACCESSORIES AND CUSHIONS. 

7 (a) EXCLUSION OF COMPLEX REHABILITATIVE MAN8 UAL WHEELCHAIRS FROM COMPETITIVE ACQUISITION

9 PROGRAM.—Section 1847(a)(2)(A) of the Social Security 

10 Act (42 U.S.C. 1395w–3(a)(2)(A)) is amended— 

11 (1) by inserting ‘‘, complex rehabilitative man12 ual wheelchairs (as determined by the Secretary), 

13 and certain manual wheelchairs (identified, as of Oc14 tober 1, 2018, by HCPCS codes E1235, E1236, 

15 E1237, E1238, and K0008 or any successor to such 

16 codes)’’ after ‘‘group 3 or higher’’; and 

17 (2) by striking ‘‘such wheelchairs’’ and insert18 ing ‘‘such complex rehabilitative power wheelchairs, 

19 complex rehabilitative manual wheelchairs, and cer20 tain manual wheelchairs’’. 

21 (b) NON-APPLICATION OF MEDICARE FEE SCHED22 ULE ADJUSTMENTS FOR WHEELCHAIR ACCESSORIES AND

23 SEAT AND BACK CUSHIONS WHEN FURNISHED IN CON24 NECTION WITH COMPLEX REHABILITATIVE MANUAL

25 WHEELCHAIRS.— 


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1 (1) IN GENERAL.—Notwithstanding any other 

2 provision of law, the Secretary of Health and 

3 Human Services shall not, during the period begin4 ning on July 1, 2019, and ending on December 31, 

5 2020, use information on the payment determined 

6 under the competitive acquisition programs under 

7 section 1847 of the Social Security Act (42 U.S.C. 

8 1395w–3) to adjust the payment amount that would 

9 otherwise be recognized under section 

10 1834(a)(1)(B)(ii) of such Act (42 U.S.C. 

11 1395m(a)(1)(B)(ii)) for wheelchair accessories (in12 cluding seating systems) and seat and back cushions 

13 when furnished in connection with complex rehabili14 tative manual wheelchairs (as determined by the 

15 Secretary), and certain manual wheelchairs (identi16 fied, as of October 1, 2018, by HCPCS codes 

17 E1235, E1236, E1237, E1238, and K0008 or any 

18 successor to such codes). 

19 (2) IMPLEMENTATION.—Notwithstanding any 

20 other provision of law, the Secretary may implement 

21 this subsection by program instruction or otherwise. 


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1 SEC. 5. EXTENSION OF ENFORCEMENT INSTRUCTION ON 

2 SUPERVISION REQUIREMENTS FOR OUT3 PATIENT THERAPEUTIC SERVICES IN CRIT4 ICAL ACCESS AND SMALL RURAL HOSPITALS 

5 THROUGH 2021. 

6 Section 1 of Public Law 113–198, as amended by sec7 tion 1 of Public Law 114–112, section 16004 of Public 

8 Law 114–255, and section 51007 of Public Law 115–123, 

9 is amended— 

10 (1) in the section heading, by striking ‘‘2017’’ 

11 and inserting ‘‘2021’’; and 

12 (2) by striking ‘‘and 2017’’ and inserting ‘‘, 

13 2017, 2020, and 2021’’. 

Æ 


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