I 

115TH CONGRESS 

2D SESSION H. R. 5715 

To amend title XVIII of the Social Security Act to provide for certain 

program integrity transparency measures under Medicare parts C and D. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 9, 2018 

Mr. RENACCI (for himself, Ms. SEWELL of Alabama, Mr. GUTHRIE, and Mr. 

PETERS) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy 

and Commerce, 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 title XVIII of the Social Security Act to provide 

for certain program integrity transparency measures 

under Medicare parts C and D. 

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. 

4 This Act may be cited as the ‘‘Strengthening Part5 nerships to Prevent Opioid Abuse Act’’. 


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1 SEC. 2. PROGRAM INTEGRITY TRANSPARENCY MEASURES 

2 UNDER MEDICARE PARTS C AND D. 

3 (a) IN GENERAL.—Section 1859 of the Social Secu4 rity Act (42 U.S.C. 1395w–28) is amended by adding at 

5 the end the following new subsection: 

6 ‘‘(i) PROGRAM INTEGRITY TRANSPARENCY MEAS7 URES.— 

8 ‘‘(1) PROGRAM INTEGRITY PORTAL.— 

9 ‘‘(A) IN GENERAL.—Not later than two 

10 years after the date of the enactment of this 

11 subsection, the Secretary shall, after consulta12 tion with stakeholders, establish a secure Inter13 net website portal (or other successor tech14 nology) that would allow a secure path for com15 munication between the Secretary, MA plans 

16 under this part, prescription drug plans under 

17 part D, and an eligible entity with a contract 

18 under section 1893 (such as a Medicare drug 

19 integrity contractor or an entity responsible for 

20 carrying out program integrity activities under 

21 this part and part D) for the purpose of ena22 bling through such portal (or other successor 

23 technology)— 

24 ‘‘(i) the referral by such plans of sub25 stantiated fraud, waste, and abuse for iniVerDate Sep 11 2014 01:25 May 16, 2018 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5715.IH H5715

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1 tiating or assisting investigations con2 ducted by the eligible entity; and 

3 ‘‘(ii) data sharing among such MA 

4 plans, prescription drug plans, and the 

5 Secretary. 

6 ‘‘(B) REQUIRED USES OF PORTAL.—The 

7 Secretary shall disseminate the following infor8 mation to MA plans under this part and pre9 scription drug plans under part D through the 

10 secure Internet website portal (or other suc11 cessor technology) established under subpara12 graph (A): 

13 ‘‘(i) Providers of services and sup14 pliers that have been referred pursuant to 

15 subparagraph (A)(i) during the previous 

16 12-month period. 

17 ‘‘(ii) Providers of services and sup18 pliers who are the subject of an active ex19 clusion under section 1128 or who are sub20 ject to a suspension of payment under this 

21 title pursuant to section 1862(o) or other22 wise. 

23 ‘‘(iii) Providers of services and sup24 pliers who are the subject of an active rev25 ocation of participation under this title, inVerDate Sep 11 2014 01:25 May 16, 2018 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5715.IH H5715

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1 cluding for not satisfying conditions of par2 ticipation. 

3 ‘‘(iv) In the case of such a plan that 

4 makes a referral under subparagraph 

5 (A)(i) through the portal (or other suc6 cessor technology) with respect to activities 

7 of substantiated fraud, waste, or abuse of 

8 a provider of services or supplier, if such 

9 provider or supplier has been the subject of 

10 an administrative action under this title or 

11 title XI with respect to similar activities, a 

12 notification to such plan of such action so 

13 taken. 

14 ‘‘(C) RULEMAKING.—For purposes of this 

15 paragraph, the Secretary shall, through rule16 making, specify what constitutes substantiated 

17 fraud, waste, and abuse, using guidance such as 

18 what is provided in the Medicare Program In19 tegrity Manual 4.7.1. 

20 ‘‘(D) HIPAA COMPLIANT INFORMATION

21 ONLY.—For purposes of this subsection, com22 munications may only occur if the communica23 tions are permitted under the Federal regula24 tions (concerning the privacy of individually 

25 identifiable health information) promulgated 


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1 under section 264(c) of the Health Insurance 

2 Portability and Accountability Act of 1996. 

3 ‘‘(2) QUARTERLY REPORTS.—Beginning two 

4 years after the date of enactment of this subsection, 

5 the Secretary shall make available to MA plans 

6 under this part and prescription drug plans under 

7 part D in a timely manner (but no less frequently 

8 than quarterly) and using information submitted to 

9 an entity described in paragraph (1) through the 

10 portal (or other successor technology) described in 

11 such paragraph or pursuant to section 1893, infor12 mation on fraud, waste, and abuse schemes and 

13 trends in identifying suspicious activity. Information 

14 included in each such report shall— 

15 ‘‘(A) include administrative actions, perti16 nent information related to opioid overpre17 scribing, and other data determined appropriate 

18 by the Secretary in consultation with stake19 holders; and 

20 ‘‘(B) be anonymized information submitted 

21 by plans without identifying the source of such 

22 information. 

23 ‘‘(3) CLARIFICATION.—Nothing in this sub24 section shall be construed as precluding or otherwise 

25 affecting referrals described in subparagraph (A) 


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1 that may otherwise be made to law enforcement en2 tities or to the Secretary.’’. 

3 (b) CONTRACT REQUIREMENT TO COMMUNICATE

4 PLAN CORRECTIVE ACTIONS AGAINST OPIOIDS OVER5 PRESCRIBERS.—Section 1857(e)(4)(C) of the Social Secu6 rity Act (42 U.S.C. 1395w–27(e)(4)(C)) is amended by 

7 adding at the end the following new paragraph: 

8 ‘‘(5) COMMUNICATING PLAN CORRECTIVE AC9 TIONS AGAINST OPIOIDS OVER-PRESCRIBERS.— 

10 ‘‘(A) IN GENERAL.—Beginning with plan 

11 years beginning on or after January 1, 2021, a 

12 contract under this section with an MA organi13 zation shall require the organization to submit 

14 to the Secretary, through the process estab15 lished under subparagraph (B), information on 

16 the investigations and other actions taken by 

17 such plans related to providers of services who 

18 prescribe a high volume of opioids. 

19 ‘‘(B) PROCESS.—Not later than January 

20 1, 2021, the Secretary shall, in consultation 

21 with stakeholders, establish a process under 

22 which MA plans and prescription drug plans 

23 shall submit to the Secretary information de24 scribed in subparagraph (A). 


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1 ‘‘(C) REGULATIONS.—For purposes of this 

2 paragraph, including as applied under section 

3 1860D–12(b)(3)(D), the Secretary shall, pursu4 ant to rulemaking— 

5 ‘‘(i) specify a definition for the term 

6 ‘high volume of opioids’ and a method for 

7 determining if a provider of services pre8 scribes such a high volume; and 

9 ‘‘(ii) establish the process described in 

10 subparagraph (B) and the types of infor11 mation that shall be submitted through 

12 such process.’’. 

13 (c) REFERENCE UNDER PART D TO PROGRAM IN14 TEGRITY TRANSPARENCY MEASURES.—Section 1860D–4 

15 of the Social Security Act (42 U.S.C. 1395w–104) is 

16 amended by adding at the end the following new sub17 section: 

18 ‘‘(m) PROGRAM INTEGRITY TRANSPARENCY MEAS19 URES.—For program integrity transparency measures ap20 plied with respect to prescription drug plan and MA plans, 

21 see section 1859(i).’’. 

Æ 


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