```

[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 861 Reported in Senate (RS)]

                                                       Calendar No. 183
114th CONGRESS
  1st Session
                                 S. 861

                          [Report No. 114-104]

To amend titles XVIII and XIX of the Social Security Act to curb waste, 
        fraud, and abuse in the Medicare and Medicaid programs.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             March 25, 2015

  Mr. Carper (for himself, Mr. Enzi, Mr. Whitehouse, Mr. Johnson, Mr. 
  Coons, Mr. Portman, Ms. Klobuchar, Mr. Cotton, Mrs. McCaskill, Mr. 
Barrasso, Mr. Manchin, Ms. Ayotte, Mr. Thune, Mrs. Shaheen, Mr. Warner, 
Mr. Tester, and Mr. Burr) introduced the following bill; which was read 
             twice and referred to the Committee on Finance

                             July 30, 2015

                Reported by Mr. Hatch, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL

 
To amend titles XVIII and XIX of the Social Security Act to curb waste, 
        fraud, and abuse in the Medicare and Medicaid programs.

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

<DELETED>SECTION 1. SHORT TITLE; TABLE OF CONTENTS.</DELETED>

<DELETED>    (a) Short Title.--This Act may be cited as the 
``Preventing and Reducing Improper Medicare and Medicaid Expenditures 
Act of 2015'' or the ``PRIME Act of 2015''.</DELETED>
<DELETED>    (b) Table of Contents.--The table of contents of this Act 
is as follows:</DELETED>

<DELETED>Sec. 1. Short title; table of contents.
              <DELETED>TITLE I--CURBING IMPROPER PAYMENTS

<DELETED>Sec. 101. Requiring valid prescriber National Provider 
                            Identifiers on pharmacy claims.
<DELETED>Sec. 102. Reforming how CMS tracks and corrects the 
                            vulnerabilities identified by Recovery 
                            Audit Contractors.
<DELETED>Sec. 103. Improving Senior Medicare Patrol and fraud reporting 
                            rewards.
<DELETED>Sec. 104. Strengthening Medicaid Program integrity through 
                            flexibility.
<DELETED>Sec. 105. Establishing Medicare administrative contractor 
                            error reduction incentives.
<DELETED>Sec. 106. Strengthening penalties for the illegal distribution 
                            of a Medicare, Medicaid, or CHIP 
                            beneficiary identification or billing 
                            privileges.
               <DELETED>TITLE II--IMPROVING DATA SHARING

<DELETED>Sec. 201. Access to the National Directory of New Hires.
<DELETED>Sec. 202. Improving the sharing of data between the Federal 
                            Government and State Medicaid programs.
<DELETED>Sec. 203. Improving claims processing and detection of fraud 
                            within the Medicaid and CHIP programs.
              <DELETED>TITLE III--REPORT ON IMPLEMENTATION

<DELETED>Sec. 301. Report on implementation.

         <DELETED>TITLE I--CURBING IMPROPER PAYMENTS</DELETED>

<DELETED>SEC. 101. REQUIRING VALID PRESCRIBER NATIONAL PROVIDER 
              IDENTIFIERS ON PHARMACY CLAIMS.</DELETED>

<DELETED>    Section 1860D-4(c) of the Social Security Act (42 U.S.C. 
1395w-104(c)) is amended by adding at the end the following new 
paragraph:</DELETED>
        <DELETED>    ``(4) Requiring valid prescriber national provider 
        identifiers on pharmacy claims.--</DELETED>
                <DELETED>    ``(A) In general.--For plan year 2016 and 
                subsequent plan years, subject to subparagraph (B), the 
                Secretary shall prohibit PDP sponsors of prescription 
                drug plans from paying claims for prescription drugs 
                under this part that do not include a valid prescriber 
                National Provider Identifier.</DELETED>
                <DELETED>    ``(B) Procedures.--The Secretary shall 
                establish--</DELETED>
                        <DELETED>    ``(i) procedures for determining 
                        the validity of prescriber National Provider 
                        Identifiers under subparagraph (A); 
                        and</DELETED>
                        <DELETED>    ``(ii) procedures for transferring 
                        to the Inspector General of the Department of 
                        Health and Human Services and appropriate law 
                        enforcement agencies and other oversight 
                        entities information on those National Provider 
                        Identifiers and pharmacy claims, including 
                        records related to such claims, that the 
                        Secretary determines are invalid under clause 
                        (i).</DELETED>
                <DELETED>    ``(C) Report.--Not later than January 1, 
                2018, the Inspector General of the Department of Health 
                and Human Services shall submit to Congress a report on 
                the effectiveness of the procedures established under 
                subparagraph (B).''.</DELETED>

<DELETED>SEC. 102. REFORMING HOW CMS TRACKS AND CORRECTS THE 
              VULNERABILITIES IDENTIFIED BY RECOVERY AUDIT 
              CONTRACTORS.</DELETED>

<DELETED>    (a) In General.--Section 1893(h) of the Social Security 
Act (42 U.S.C. 1395ddd(h)) is amended--</DELETED>
        <DELETED>    (1) in paragraph (8)--</DELETED>
                <DELETED>    (A) by striking ``report.--The Secretary'' 
                and inserting ``report.--</DELETED>
                <DELETED>    ``(A) In general.--Subject to subparagraph 
                (C), the Secretary''; and</DELETED>
                <DELETED>    (B) by adding after subparagraph (A), as 
                inserted by subparagraph (A), the following new 
                subparagraphs:</DELETED>
                <DELETED>    ``(B) Inclusion of improper payment 
                vulnerabilities identified.--Each report submitted 
                under subparagraph (A) shall, subject to subparagraph 
                (C), include--</DELETED>
                        <DELETED>    ``(i) a description of--</DELETED>
                                <DELETED>    ``(I) the types and 
                                financial cost to the program under 
                                this title of improper payment 
                                vulnerabilities identified by recovery 
                                audit contractors under this 
                                subsection; and</DELETED>
                                <DELETED>    ``(II) how the Secretary 
                                is addressing such improper payment 
                                vulnerabilities; and</DELETED>
                        <DELETED>    ``(ii) an assessment of the 
                        effectiveness of changes made to payment 
                        policies and procedures under this title in 
                        order to address the vulnerabilities so 
                        identified.</DELETED>
                <DELETED>    ``(C) Limitation.--The Secretary shall 
                ensure that each report submitted under subparagraph 
                (A) does not include information that the Secretary 
                determines would be sensitive or would otherwise 
                negatively impact program integrity.''; and</DELETED>
        <DELETED>    (2) by adding at the end the following new 
        paragraph:</DELETED>
        <DELETED>    ``(10) Addressing improper payment 
        vulnerabilities.--The Secretary shall address improper payment 
        vulnerabilities identified by recovery audit contractors under 
        this subsection in a timely manner, prioritized based on the 
        risk to the program under this title.''.</DELETED>
<DELETED>    (b) Use of Medicare and Medicaid Recovery Audit Contractor 
Recoveries for Provider Education and To Prevent Improper Payments and 
Fraud.--</DELETED>
        <DELETED>    (1) Medicare rac program.--Section 1893(h)(1)(C) 
        of the Social Security Act (42 U.S.C. 1395ddd(h)(1)(C)) is 
        amended--</DELETED>
                <DELETED>    (A) by striking ``the Secretary shall 
                retain'' and inserting ``the Secretary--</DELETED>
                        <DELETED>    ``(i) shall retain'';</DELETED>
                <DELETED>    (B) in clause (i), as added by 
                subparagraph (A)--</DELETED>
                        <DELETED>    (i) by inserting ``, in addition 
                        to any other funds that may be available,'' 
                        after ``available'';</DELETED>
                        <DELETED>    (ii) by inserting ``until 
                        expended'' after ``Services''; and</DELETED>
                        <DELETED>    (iii) by striking the period at 
                        the end and inserting a semicolon; 
                        and</DELETED>
                <DELETED>    (C) by adding at the end the following new 
                clauses:</DELETED>
                        <DELETED>    ``(ii) may retain an additional 
                        portion of the amounts recovered (not to exceed 
                        25 percent of such amounts recovered) which 
                        shall be available, in addition to any other 
                        funds that may be available, to such program 
                        management account until expended for purposes 
                        of activities to address problems that 
                        contribute to improper payments and fraud under 
                        this title; and</DELETED>
                        <DELETED>    ``(iii) shall retain an additional 
                        5 percent of such amounts recovered to be made 
                        available, in addition to any other funds that 
                        may be available, to the Inspector General of 
                        the Department of Health and Human Services 
                        until expended for the Inspector General to 
                        carry out activities of the Inspector General 
                        relating to investigating improper payments or 
                        auditing internal controls associated with 
                        payments under this title.''.</DELETED>
        <DELETED>    (2) Medicaid rac program.--Section 1936 of the 
        Social Security Act (42 U.S.C. 1396u-6) is amended by adding at 
        the end the following new subsection:</DELETED>
<DELETED>    ``(f) Amounts Recovered Through Recovery Audit 
Contractors.--Notwithstanding any other provision of law, the 
Secretary--</DELETED>
        <DELETED>    ``(1) may retain a portion of the amounts 
        recovered pursuant to the program established under section 
        1902(a)(42)(B) (not to exceed 25 percent of the Federal share 
        of such amounts recovered) which shall be available, in 
        addition to any other funds that may be available, to the 
        program management account of the Centers for Medicare & 
        Medicaid Services for purposes of activities to address 
        problems that contribute to improper payments and fraud under 
        this title; and</DELETED>
        <DELETED>    ``(2) shall retain an additional 5 percent of the 
        Federal share of such amounts recovered to be made available, 
        in addition to any other funds that may be available, to the 
        Inspector General of the Department of Health and Human 
        Services until expended for the Inspector General to carry out 
        activities of the Inspector General relating to investigating 
        improper payments or auditing internal controls associated with 
        payments under this title.''.</DELETED>
        <DELETED>    (3) Effective date.--The amendments made by this 
        section shall take effect on the date that is 1 year after the 
        date of enactment of this Act.</DELETED>

<DELETED>SEC. 103. IMPROVING SENIOR MEDICARE PATROL AND FRAUD REPORTING 
              REWARDS.</DELETED>

<DELETED>    (a) In General.--The Secretary of Health and Human 
Services (in this section referred to as the ``Secretary'') shall 
develop a plan to revise the incentive program under section 203(b) of 
the Health Insurance Portability and Accountability Act of 1996 (42 
U.S.C. 1395b-5(b)) to encourage greater participation by individuals to 
report fraud and abuse in the Medicare program. Such plan shall include 
recommendations for--</DELETED>
        <DELETED>    (1) ways to enhance rewards for individuals 
        reporting under the incentive program, including rewards based 
        on information that leads to an administrative action; 
        and</DELETED>
        <DELETED>    (2) extending the incentive program to the 
        Medicaid program.</DELETED>
<DELETED>    (b) Public Awareness and Education Campaign.--The plan 
developed under subsection (a) shall also include recommendations for 
the use of the Senior Medicare Patrols authorized under section 411 of 
the Older Americans Act of 1965 (42 U.S.C. 3032) to conduct a public 
awareness and education campaign to encourage participation in the 
revised incentive program under subsection (a).</DELETED>
<DELETED>    (c) Submission of Plan.--Not later than 180 days after the 
date of enactment of this Act, the Secretary shall submit to Congress 
the plan developed under subsection (a).</DELETED>

<DELETED>SEC. 104. STRENGTHENING MEDICAID PROGRAM INTEGRITY THROUGH 
              FLEXIBILITY.</DELETED>

<DELETED>    Section 1936 of the Social Security Act (42 U.S.C. 1396u-
6) is amended--</DELETED>
        <DELETED>    (1) in subsection (a), by inserting ``, or 
        otherwise,'' after ``entities''; and</DELETED>
        <DELETED>    (2) in subsection (e)--</DELETED>
                <DELETED>    (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</DELETED>
                <DELETED>    (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,''.</DELETED>

<DELETED>SEC. 105. ESTABLISHING MEDICARE ADMINISTRATIVE CONTRACTOR 
              ERROR REDUCTION INCENTIVES.</DELETED>

<DELETED>    (a) In General.--Section 1874A(b)(1)(D) of the Social 
Security Act (42 U.S.C. 1395kk-1(b)(1)(D)) is amended--</DELETED>
        <DELETED>    (1) by striking ``quality.--The Secretary'' and 
        inserting ``quality.--</DELETED>
                        <DELETED>    ``(i) In general.--Subject to 
                        clauses (ii) and (iii), the Secretary''; 
                        and</DELETED>
        <DELETED>    (2) by inserting after clause (i), as added by 
        paragraph (1), the following new clauses:</DELETED>
                        <DELETED>    ``(ii) Improper payment error rate 
                        reduction incentives.--The Secretary shall 
                        provide incentives for medicare administrative 
                        contractors to reduce the improper payment 
                        error rates in their jurisdictions.</DELETED>
                        <DELETED>    ``(iii) Incentives.--The 
                        incentives provided for under clause (ii)--
                        </DELETED>
                                <DELETED>    ``(I) may include a 
                                sliding scale of bonus payments and 
                                additional incentives to medicare 
                                administrative contractors that reduce 
                                the improper payment error rates in 
                                their jurisdictions to certain 
                                benchmark levels, as determined by the 
                                Secretary; and</DELETED>
                                <DELETED>    ``(II) shall include 
                                substantial reductions in award fee 
                                payments under award fee contracts, for 
                                any medicare administrative contractor 
                                that reaches an upper end error 
                                threshold or other threshold as 
                                determined by the 
                                Secretary.''.</DELETED>
<DELETED>    (b) Effective Date.--</DELETED>
        <DELETED>    (1) In general.--The amendments made by subsection 
        (a) shall apply to contracts entered into or renewed on or 
        after the date that is 12 months after the date of enactment of 
        this Act.</DELETED>
        <DELETED>    (2) Contracts entered into or renewed prior to 
        effective date.--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.</DELETED>

<DELETED>SEC. 106. STRENGTHENING PENALTIES FOR THE ILLEGAL DISTRIBUTION 
              OF A MEDICARE, MEDICAID, OR CHIP BENEFICIARY 
              IDENTIFICATION OR BILLING PRIVILEGES.</DELETED>

<DELETED>    Section 1128B(b) of the Social Security Act (42 U.S.C. 
1320a-7b(b)) is amended by adding at the end the following:</DELETED>
        <DELETED>    ``(4) Whoever knowingly, intentionally, and with 
        the intent to defraud purchases, sells or distributes, or 
        arranges for the purchase, sale, or distribution of a Medicare, 
        Medicaid, or CHIP beneficiary identification number or billing 
        privileges 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.''.</DELETED>

          <DELETED>TITLE II--IMPROVING DATA SHARING</DELETED>

<DELETED>SEC. 201. ACCESS TO THE NATIONAL DIRECTORY OF NEW 
              HIRES.</DELETED>

<DELETED>    Section 453(j) of the Social Security Act (42 U.S.C. 
653(j)) is amended by adding at the end of the following new 
paragraph:</DELETED>
        <DELETED>    ``(12) Information comparisons and disclosures to 
        assist in administration of the medicare program and state 
        health subsidy programs.--</DELETED>
                <DELETED>    ``(A) Disclosure to the administrator of 
                the centers for medicare & medicaid services.--The 
                Administrator of the Centers for Medicare & Medicaid 
                Services shall have access to the information in the 
                National Directory of New Hires for purposes of 
                determining the eligibility of an applicant for, or 
                enrollee in, the Medicare program under title XVIII or 
                an applicable State health subsidy program (as defined 
                in section 1413(e) of the Patient Protection and 
                Affordable Care Act (42 U.S.C. 18083(e))).</DELETED>
                <DELETED>    ``(B) Disclosure to the inspector general 
                of the department of health and human services.--
                </DELETED>
                        <DELETED>    ``(i) In general.--If the 
                        Inspector General of the Department of Health 
                        and Human Services transmits to the Secretary 
                        the names and social security account numbers 
                        of individuals, the Secretary shall disclose to 
                        the Inspector General information on such 
                        individuals and their employers maintained in 
                        the National Directory of New Hires.</DELETED>
                        <DELETED>    ``(ii) Use of information.--The 
                        Inspector General of the Department of Health 
                        and Human Services may use information provided 
                        under clause (i) only for purposes of--
                        </DELETED>
                                <DELETED>    ``(I) determining the 
                                eligibility of an applicant for, or 
                                enrollee in, the Medicare program under 
                                title XVIII or an applicable State 
                                health subsidy program (as defined in 
                                section 1413(e) of the Patient 
                                Protection and Affordable Care Act (42 
                                U.S.C. 18083(e))); or</DELETED>
                                <DELETED>    ``(II) evaluating the 
                                integrity of the Medicare program or an 
                                applicable State health subsidy program 
                                (as so defined).</DELETED>
                <DELETED>    ``(C) Disclosure to state agencies.--
                </DELETED>
                        <DELETED>    ``(i) In general.--If, for 
                        purposes of administering an applicable State 
                        health subsidy program (as defined in section 
                        1413(e) of the Patient Protection and 
                        Affordable Care Act (42 U.S.C. 18083(e))), a 
                        State agency responsible for administering such 
                        program transmits to the Secretary the names 
                        and social security account numbers of 
                        individuals, the Secretary shall disclose to 
                        such State agency information on such 
                        individuals and their employers maintained in 
                        the National Directory of New Hires, subject to 
                        this subparagraph.</DELETED>
                        <DELETED>    ``(ii) Condition on disclosure by 
                        the secretary.--The Secretary shall make a 
                        disclosure under clause (i) only to the extent 
                        that the Secretary determines that the 
                        disclosure would not interfere with the 
                        effective operation of the program under this 
                        part.</DELETED>
                        <DELETED>    ``(iii) Use and disclosure of 
                        information by state agencies.--</DELETED>
                                <DELETED>    ``(I) In general.--A State 
                                agency may not use or disclose 
                                information provided under clause (i) 
                                except for purposes of administering a 
                                program referred to in clause 
                                (i).</DELETED>
                                <DELETED>    ``(II) Information 
                                security.--The State agency shall have 
                                in effect data security and control 
                                policies that the Secretary finds 
                                adequate to ensure the security of 
                                information obtained under clause (i) 
                                and to ensure that access to such 
                                information is restricted to authorized 
                                persons for purposes of authorized uses 
                                and disclosures.</DELETED>
                                <DELETED>    ``(III) Penalty for misuse 
                                of information.--An officer or employee 
                                of the State agency who fails to comply 
                                with this clause shall be subject to 
                                the sanctions under subsection (l)(2) 
                                to the same extent as if such officer 
                                or employee were an officer or employee 
                                of the United States.</DELETED>
                        <DELETED>    ``(iv) Procedural requirements.--
                        State agencies requesting information under 
                        clause (i) shall adhere to uniform procedures 
                        established by the Secretary governing 
                        information requests and data matching under 
                        this paragraph.</DELETED>
                        <DELETED>    ``(v) Reimbursement of costs.--The 
                        State agency shall reimburse the Secretary, in 
                        accordance with subsection (k)(3), for the 
                        costs incurred by the Secretary in furnishing 
                        the information requested under this 
                        subparagraph.''.</DELETED>

<DELETED>SEC. 202. IMPROVING THE SHARING OF DATA BETWEEN THE FEDERAL 
              GOVERNMENT AND STATE MEDICAID PROGRAMS.</DELETED>

<DELETED>    (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)).</DELETED>
<DELETED>    (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--</DELETED>
        <DELETED>    (1) in the matter preceding clause (i), by 
        inserting ``or otherwise'' after ``eligible 
        entities'';</DELETED>
        <DELETED>    (2) in clause (i)--</DELETED>
                <DELETED>    (A) by inserting ``to review claims data'' 
                after ``algorithms''; and</DELETED>
                <DELETED>    (B) by striking ``service, time, or 
                patient'' and inserting ``provider, service, time, or 
                patient'';</DELETED>
        <DELETED>    (3) in clause (ii)--</DELETED>
                <DELETED>    (A) by inserting ``to investigate and 
                recover amounts with respect to suspect claims'' after 
                ``appropriate actions''; and</DELETED>
                <DELETED>    (B) by striking ``; and'' and inserting a 
                semicolon;</DELETED>
        <DELETED>    (4) in clause (iii), by striking the period and 
        inserting ``; and''; and</DELETED>
        <DELETED>    (5) by adding at the end the following new 
        clause:</DELETED>
                        <DELETED>    ``(iv) furthering the Secretary's 
                        design, development, installation, or 
                        enhancement of an automated data system 
                        architecture--</DELETED>
                                <DELETED>    ``(I) to collect, 
                                integrate, and assess data for purposes 
                                of program integrity, program 
                                oversight, and administration, 
                                including the Medi-Medi Program; 
                                and</DELETED>
                                <DELETED>    ``(II) that improves the 
                                coordination of requests for data from 
                                States.''.</DELETED>
<DELETED>    (c) Providing States With Data on Improper Payments Made 
for Items or Services Provided to Dual Eligible Individuals.--
</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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 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.</DELETED>

<DELETED>SEC. 203. IMPROVING CLAIMS PROCESSING AND DETECTION OF FRAUD 
              WITHIN THE MEDICAID AND CHIP PROGRAMS.</DELETED>

<DELETED>    (a) Medicaid.--Section 1903(i) of the Social Security Act 
(42 U.S.C. 1396b(i)) is amended (after the application of the 
amendments made by subsection (c) of this section)--</DELETED>
        <DELETED>    (1) in paragraph (25), by striking ``or'' at the 
        end;</DELETED>
        <DELETED>    (2) in paragraph (26), by striking the period and 
        inserting ``; or''; and</DELETED>
        <DELETED>    (3) by inserting after paragraph (26), the 
        following new paragraph:</DELETED>
        <DELETED>    ``(27) with respect to amounts expended for an 
        item or service for which medical assistance is provided under 
        the State plan or under a waiver of such plan unless the claim 
        for payment for such item or service contains a valid 
        beneficiary identification number that, for purposes of the 
        individual who received such item or service, has been 
        determined by the State agency to correspond to an individual 
        who is eligible to receive benefits under the State plan or 
        waiver.''.</DELETED>
<DELETED>    (b) CHIP.--Section 2107(e)(1)(I) of the Social Security 
Act (42 U.S.C. 1397gg(e)(1)(I)) is amended by striking ``and (17)'' and 
inserting ``(17), and (27)''.</DELETED>
<DELETED>    (c) Technical Corrections.--Effective as if included in 
the enactment of Public Law 111-148, the following sections of such Act 
are amended as follows:</DELETED>
        <DELETED>    (1) Section 6402(c)(3) is amended by striking ``by 
        adding at the end'' and inserting ``by inserting after 
        paragraph (24)''.</DELETED>
        <DELETED>    (2) Section 2001(a)(2)(B)(iii) is amended by 
        striking ``by adding at the end'' and inserting ``by inserting 
        after paragraph (25)''.</DELETED>

         <DELETED>TITLE III--REPORT ON IMPLEMENTATION</DELETED>

<DELETED>SEC. 301. REPORT ON IMPLEMENTATION.</DELETED>

<DELETED>    Not later than 270 days after the date of the enactment of 
this Act, the Secretary of Health and Human Services shall submit to 
Congress a report on the implementation of the provisions of, and the 
amendments made by, this Act.</DELETED>

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Preventing and Reducing Improper 
Medicare and Medicaid Expenditures Act of 2015'' or the ``PRIME Act of 
2015''.

SEC. 2. 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
                    (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. 3. 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 
                        incentives.--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. 4. 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 
        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. 5. 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 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.

SEC. 6. REPORT ON IMPLEMENTATION.

    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 implementation of the provisions of, and the 
amendments made by--
            (1) this Act; and
            (2) sections 506 and 507 of the Medicare Access and CHIP 
        Reauthorization Act of 2015 (Public Law 114-10).
                                                       Calendar No. 183

114th CONGRESS

  1st Session

                                 S. 861

                          [Report No. 114-104]

_______________________________________________________________________

                                 A BILL

To amend titles XVIII and XIX of the Social Security Act to curb waste, 
        fraud, and abuse in the Medicare and Medicaid programs.

_______________________________________________________________________

                             July 30, 2015

                       Reported with an amendment
```