I 

111TH CONGRESS 

1ST SESSION H. R. 27 

To amend title XVIII of the Social Security Act to establish additional 

provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 6, 2009 

Mrs. BIGGERT introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committees on Energy 

and Commerce and the Judiciary, 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 establish 

additional provisions to combat waste, fraud, and abuse 

within 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 ‘‘Medicare Fraud Prevention and Enforcement Act of 

6 2009’’. 

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

8 this Act is as follows: 


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Sec. 1. Short title; table of contents. 

Sec. 2. Site inspections and background checks. 

Sec. 3. Registration of billing agencies. 

Sec. 4. Expanded access to the health integrity protection database (HIPDB). 

Sec. 5. Liability of medicare carriers and fiscal intermediaries for claims submitted by excluded providers. 

Sec. 6. Community mental health centers. 

Sec. 7. Limiting the use of discharge in bankruptcy proceedings for provider liability for health care fraud. 

Sec. 8. Illegal distribution of a medicare or medicaid beneficiary identification 

or provider number. 

Sec. 9. Treatment of certain Social Security Act crimes as Federal health care 

offenses. 

Sec. 10. Authority of Office of Inspector General of the Department of Health 

and Human Services. 

Sec. 11. Universal product numbers on claims forms for reimbursement under 

the medicare program. 

1 SEC. 2. SITE INSPECTIONS AND BACKGROUND CHECKS. 

2 (a) SITE INSPECTIONS FOR DME SUPPLIERS, COM3 MUNITY MENTAL HEALTH CENTERS, AND OTHER PRO4 VIDER GROUPS.—Title XVIII of the Social Security Act 

5 (42 U.S.C. 1395 et seq.) is amended by adding at the end 

6 the following: 

7 ‘‘SITE INSPECTIONS FOR DME SUPPLIERS, COMMUNITY

8 MENTAL HEALTH CENTERS, AND OTHER PROVIDER

9 GROUPS

10 ‘‘SEC. 1899. (a) SITE INSPECTIONS.— 

11 ‘‘(1) IN GENERAL.—The Secretary shall con12 duct a site inspection for each applicable provider 

13 (as defined in paragraph (2)) that applies for a pro14 vider number in order to provide items or services 

15 under this title. Such site inspection shall be in addi16 tion to any other site inspection that the Secretary 


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1 would otherwise conduct with regard to an applica2 ble provider. 

3 ‘‘(2) APPLICABLE PROVIDER DEFINED.— 

4 ‘‘(A) IN GENERAL.—Except as provided in 

5 subparagraph (B), in this section the term ‘ap6 plicable provider’ means— 

7 ‘‘(i) a supplier of durable medical 

8 equipment (including items described in 

9 section 1834(a)(13)); 

10 ‘‘(ii) a supplier of prosthetics, 

11 orthotics, or supplies (including items de12 scribed in paragraphs (8) and (9) of sec13 tion 1861(s)); 

14 ‘‘(iii) a community mental health cen15 ter; or 

16 ‘‘(iv) any other provider group, as de17 termined by the Secretary. 

18 ‘‘(B) EXCEPTION.—In this section, the 

19 term ‘applicable provider’ does not include— 

20 ‘‘(i) a physician that provides durable 

21 medical equipment (as described in sub22 paragraph (A)(i)) or prosthetics, orthotics, 

23 or supplies (as described in subparagraph 

24 (A)(ii)) to an individual as incident to an 

25 office visit by such individual; or 


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1 ‘‘(ii) a hospital that provides durable 

2 medical equipment (as described in sub3 paragraph (A)(i)) or prosthetics, orthotics, 

4 or supplies (as described in subparagraph 

5 (A)(ii)) to an individual as incident to an 

6 emergency room visit by such individual. 

7 ‘‘(b) STANDARDS AND REQUIREMENTS.—In con8 ducting the site inspection pursuant to subsection (a), the 

9 Secretary shall ensure that the site being inspected is in 

10 full compliance with all the conditions and standards of 

11 participation and requirements for obtaining medicare bill12 ing privileges under this title. 

13 ‘‘(c) TIME.—The Secretary shall conduct the site in14 spection for an applicable provider prior to the issuance 

15 of a provider number to such provider. 

16 ‘‘(d) TIMELY REVIEW.—The Secretary shall provide 

17 for procedures to ensure that the site inspection required 

18 under this section does not unreasonably delay the 

19 issuance of a provider number to an applicable provider.’’. 

20 (b) BACKGROUND CHECKS.—Title XVIII of the So21 cial Security Act (42 U.S.C. 1395 et seq.) (as amended 

22 by subsection (a)) is amended by adding at the end the 

23 following: 

24 ‘‘BACKGROUND CHECKS

25 ‘‘SEC. 1899A. (a) BACKGROUND CHECK RE26 QUIRED.—Except as provided in subsection (b), the SecVerDate Nov 24 2008 03:11 Jan 08, 2009 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H27.IH H27

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1 retary shall conduct a background check on any individual 

2 or entity that applies to the Secretary for a provider num3 ber for the purpose of furnishing any item or service under 

4 this title. In performing the background check, the Sec5 retary shall— 

6 ‘‘(1) conduct the background check before 

7 issuing a provider number to an individual or entity; 

8 ‘‘(2) include a search of criminal records in the 

9 background check; and 

10 ‘‘(3) provide for procedures that ensure the 

11 background check does not unreasonably delay the 

12 issuance of a provider number to an eligible indi13 vidual or entity. 

14 ‘‘(b) USE OF STATE LICENSING PROCEDURE.—The 

15 Secretary may use the results of a State licensing proce16 dure as a background check under subsection (a) if the 

17 State licensing procedure meets the requirements of sub18 section (a). 

19 ‘‘(c) ATTORNEY GENERAL REQUIRED TO PROVIDE

20 INFORMATION.— 

21 ‘‘(1) IN GENERAL.—Upon request of the Sec22 retary, the Attorney General shall provide the crimi23 nal background check information referred to in sub24 section (a)(2) to the Secretary. 


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1 ‘‘(2) RESTRICTION ON USE OF DISCLOSED IN2 FORMATION.—The Secretary may only use the infor3 mation disclosed under subsection (a) for the pur4 pose of carrying out the Secretary’s responsibilities 

5 under this title. 

6 ‘‘(d) REFUSAL TO ISSUE PROVIDER NUMBER.— 

7 ‘‘(1) AUTHORITY.—In addition to any other 

8 remedy available to the Secretary, the Secretary may 

9 refuse to issue a provider number to an individual 

10 or entity if the Secretary determines, after a back11 ground check conducted under this section, that 

12 such individual or entity has a history of acts that 

13 indicate issuance of a provider number to such indi14 vidual or entity would be detrimental to the best in15 terests of the program or program beneficiaries. 

16 Such acts may include— 

17 ‘‘(A) any bankruptcy; 

18 ‘‘(B) any act resulting in a civil judgment 

19 against such individual or entity; or 

20 ‘‘(C) any felony conviction under Federal 

21 or State law. 

22 ‘‘(2) REPORTING OF REFUSAL TO ISSUE PRO23 VIDER NUMBER TO THE HEALTH INTEGRITY PRO24 TECTION DATABASE (HIPDB).—A determination to 

25 refuse to issue a provider number to an individual 


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1 or entity as a result of a background check con2 ducted under this section shall be reported to the 

3 health integrity protection database established 

4 under section 1128E in accordance with the proce5 dures for reporting final adverse actions taken 

6 against a health care provider, supplier, or practi7 tioner under that section.’’. 

8 (c) REGULATIONS; EFFECTIVE DATE.— 

9 (1) REGULATIONS.—Not later than one year 

10 after the date of the enactment of this Act, the Sec11 retary of Health and Human Services shall promul12 gate such regulations as are necessary to implement 

13 the amendments made by subsections (a) and (b). 

14 (2) EFFECTIVE DATE.—The amendments made 

15 by subsections (a) and (b) shall apply to applications 

16 for a provider number received by the Secretary of 

17 Health and Human Services on or after the first day 

18 of the first year beginning after the date of the en19 actment of this Act. 

20 (d) USE OF MEDICARE INTEGRITY PROGRAM

21 FUNDS.—The Secretary of Health and Human Services 

22 may use funds appropriated or transferred for purposes 

23 of carrying out the medicare integrity program established 

24 under section 1893 of the Social Security Act (42 U.S.C. 


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1 1395ddd) to carry out the provisions of sections 1899 and 

2 1899A of that Act (as added by subsections (a) and (b)). 

3 SEC. 3. REGISTRATION OF BILLING AGENCIES. 

4 (a) REGISTRATION OF BILLING AGENCIES AND INDI5 VIDUALS.—Title XVIII of the Social Security Act (42 

6 U.S.C. 1395 et seq.) (as amended by section 2(b)) is 

7 amended by adding at the end the following: 

8 ‘‘REGISTRATION OF BILLING AGENCIES AND INDIVIDUALS

9 ‘‘SEC. 1899B. (a) REGISTRATION.—The Secretary 

10 shall establish procedures for the registration of all appli11 cable persons. 

12 ‘‘(b) REQUIRED APPLICATION.—Each applicable per13 son shall submit a registration application to the Secretary 

14 at such time, in such manner, and accompanied by such 

15 information as the Secretary may require. 

16 ‘‘(c) IDENTIFICATION NUMBER.—If the Secretary ap17 proves an application submitted under subsection (b), the 

18 Secretary shall assign a unique identification number to 

19 the applicable person. 

20 ‘‘(d) REQUIREMENT.—Every claim for reimburse21 ment under this title that is compiled and submitted by 

22 an applicable person shall contain the identification num23 ber that is assigned to the applicable person pursuant to 

24 subsection (c). 

25 ‘‘(e) TIMELY REVIEW.—The Secretary shall provide 

26 for procedures that ensure the timely consideration and 


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1 determination regarding approval of applications under 

2 this section. 

3 ‘‘(f) DEFINITION OF APPLICABLE PERSON.—In this 

4 section, the term ‘applicable person’ means an individual 

5 or an entity that compiles and submits claims for reim6 bursement under this title to the Secretary on behalf of 

7 any individual or entity.’’. 

8 (b) PERMISSIVE EXCLUSION.—Section 1128(b) of 

9 the Social Security Act (42 U.S.C. 1320a–7(b)) is amend10 ed by adding at the end the following: 

11 ‘‘(16) FRAUD BY APPLICABLE PERSON.—An ap12 plicable person (as defined in section 1899B(f)) that 

13 the Secretary determines knowingly submitted or 

14 caused to be submitted a claim for reimbursement 

15 under title XVIII that the applicable person knows 

16 or should know is false or fraudulent.’’. 

17 (c) REGULATIONS; EFFECTIVE DATE.— 

18 (1) REGULATIONS.—Not later than one year 

19 after the date of the enactment of this Act, the Sec20 retary of Health and Human Services shall promul21 gate such regulations as are necessary to implement 

22 the amendments made by subsections (a) and (b). 

23 (2) EFFECTIVE DATE.—The amendments made 

24 by subsections (a) and (b) shall take effect on the 


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1 first day of the first year beginning after the date 

2 of the enactment of this Act. 

3 SEC. 4. EXPANDED ACCESS TO THE HEALTH INTEGRITY 

4 PROTECTION DATABASE (HIPDB). 

5 (a) IN GENERAL.—Section 1128E(d)(1) of the Social 

6 Security Act (42 U.S.C. 1320a–7e(d)(1)) is amended to 

7 read as follows: 

8 ‘‘(1) AVAILABILITY.—The information in the 

9 database maintained under this section shall be 

10 available to— 

11 ‘‘(A) Federal and State government agen12 cies and health plans, and any health care pro13 vider, supplier, or practitioner entering an em14 ployment or contractual relationship with an in15 dividual or entity who could potentially be the 

16 subject of a final adverse action, where the con17 tract involves the furnishing of items or services 

18 reimbursed by one or more Federal health care 

19 programs (regardless of whether the individual 

20 or entity is paid by the programs directly, or 

21 whether the items or services are reimbursed di22 rectly or indirectly through the claims of a di23 rect provider); and 

24 ‘‘(B) utilization and quality control peer 

25 review organizations and accreditation entities 


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1 as defined by the Secretary, including but not 

2 limited to organizations described in part B of 

3 this title and in section 1154(a)(4)(C).’’. 

4 (b) CRIMINAL PENALTY FOR MISUSE OF INFORMA5 TION.—Section 1128B(b) of the Social Security Act (42 

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

7 following: 

8 ‘‘(4) Whoever knowingly uses information maintained 

9 in the health integrity protection database maintained in 

10 accordance with section 1128E for a purpose other than 

11 a purpose authorized under that section shall be impris12 oned for not more than three years or fined under title 

13 18, United States Code, or both.’’. 

14 (c) EFFECTIVE DATE.—The amendments made by 

15 this section shall take effect on the date of the enactment 

16 of this Act. 

17 SEC. 5. LIABILITY OF MEDICARE ADMINISTRATIVE CON18 TRACTORS FOR CLAIMS SUBMITTED BY EX19 CLUDED PROVIDERS. 

20 (a) REIMBURSEMENT TO THE SECRETARY FOR

21 AMOUNTS PAID TO EXCLUDED PROVIDERS.—Section 

22 1874A(b) of the Social Security Act (42 U.S.C. 

23 1395kk(b)) is amended by adding at the end the following 

24 new paragraph: 


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1 ‘‘(6) REIMBURSEMENTS TO SECRETARY FOR

2 AMOUNTS PAID TO EXCLUDED PROVIDERS.—The 

3 Secretary shall not enter into a contract with a 

4 medicare administrative contractor under this sec5 tion unless the contractor agrees to reimburse the 

6 Secretary for any amounts paid by the contractor 

7 for a service under this title which is furnished by 

8 an individual or entity during any period for which 

9 the individual or entity is excluded, pursuant to sec10 tion 1128, 1128A, or 1156, from participation in the 

11 health care program under this title if the amounts 

12 are paid after the 60-day period beginning on the 

13 date the Secretary provides notice of the exclusion to 

14 the contractor, unless the payment was made as a 

15 result of incorrect information provided by the Sec16 retary or the individual or entity excluded from par17 ticipation has concealed or altered their identity.’’. 

18 (b) CONFORMING REPEAL OF MANDATORY PAYMENT

19 RULE.—Section 1862(e) of the Social Security Act (42 

20 U.S.C. 1395y(e)) is amended— 

21 (1) in paragraph (1)(B), by striking ‘‘and when 

22 the person’’ and all that follows through ‘‘person)’’; 

23 and 

24 (2) by amending paragraph (2) to read as fol25 lows: 


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1 ‘‘(2) No individual or entity may bill (or collect any 

2 amount from) any individual for any item or service for 

3 which payment is denied under paragraph (1). No indi4 vidual is liable for payment of any amounts billed for such 

5 an item or service in violation of the preceding sentence.’’. 

6 (c) EFFECTIVE DATE.— 

7 (1) IN GENERAL.—The amendments made by 

8 this section shall apply to claims for payment sub9 mitted on or after the date of enactment of this Act. 

10 (2) CONTRACT MODIFICATION.—The Secretary 

11 of Health and Human Services shall take such steps 

12 as may be necessary to modify contracts entered 

13 into, renewed, or extended prior to the date of enact14 ment of this Act to conform such contracts to the 

15 provisions of this section. 

16 SEC. 6. COMMUNITY MENTAL HEALTH CENTERS. 

17 (a) IN GENERAL.—Section 1861(ff)(3)(B) of the So18 cial Security Act (42 U.S.C. 1395x(ff)(3)(B)) is amended 

19 by striking ‘‘entity that—’’ and all that follows and insert20 ing the following: ‘‘entity that— 

21 ‘‘(i) provides the community mental health serv22 ices specified in paragraph (1) of section 1913(c) of 

23 the Public Health Service Act; 


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1 ‘‘(ii) meets applicable certification or licensing 

2 requirements for community mental health centers 

3 in the State in which it is located; 

4 ‘‘(iii) provides a significant share of its services 

5 to individuals who are not eligible for benefits under 

6 this title; and 

7 ‘‘(iv) meets such additional standards or re8 quirements for obtaining medicare billing privileges 

9 as the Secretary may specify to ensure— 

10 ‘‘(I) the health and safety of beneficiaries 

11 receiving such services; or 

12 ‘‘(II) the furnishing of such services in an 

13 effective and efficient manner.’’. 

14 (b) RESTRICTION.—Section 1861(ff)(3)(A) of such 

15 Act (42 U.S.C. 1395x(ff)(3)(A)) is amended by inserting 

16 ‘‘other than in an individual’s home or in an inpatient or 

17 residential setting’’ before the period. 

18 (c) EFFECTIVE DATE.—The amendments made by 

19 this section shall apply to items and services furnished on 

20 or after the first day of the sixth month that begins after 

21 the date of the enactment of this Act. 


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1 SEC. 7. LIMITING THE DISCHARGE OF DEBTS IN BANK2 RUPTCY PROCEEDINGS IN CASES WHERE A 

3 HEALTH CARE PROVIDER OR A SUPPLIER EN4 GAGES IN FRAUDULENT ACTIVITY. 

5 (a) IN GENERAL.— 

6 (1) CIVIL MONETARY PENALTIES.—Section 

7 1128A(a) of the Social Security Act (42 U.S.C. 

8 1320a–7a(a)) is amended by adding at the end the 

9 following: ‘‘Notwithstanding any other provision of 

10 law, amounts made payable under this section are 

11 not dischargeable under section 727, 944, 1141, 

12 1228, or 1328 of title 11, United States Code, or 

13 any other provision of such title.’’. 

14 (2) RECOVERY OF OVERPAYMENT TO PRO15 VIDERS OF SERVICES UNDER PART A OF MEDI16 CARE.—Section 1815(d) of the Social Security Act 

17 (42 U.S.C. 1395g(d)) is amended— 

18 (A) by inserting ‘‘(1)’’ after ‘‘(d)’’; and 

19 (B) by adding at the end the following: 

20 ‘‘(2) Notwithstanding any other provision of law, 

21 amounts due to the Secretary under this section are not 

22 dischargeable under section 727, 944, 1141, 1228, or 

23 1328 of title 11, United States Code, or any other provi24 sion of such title if the overpayment was the result of 

25 fraudulent activity, as may be defined by the Secretary.’’. 


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1 (3) RECOVERY OF OVERPAYMENT OF BENEFITS

2 UNDER PART b OF MEDICARE.—Section 1833(j) of 

3 the Social Security Act (42 U.S.C. 1395l(j)) is 

4 amended— 

5 (A) by inserting ‘‘(1)’’ after ‘‘(j)’’; and 

6 (B) by adding at the end the following: 

7 ‘‘(2) Notwithstanding any other provision of law, 

8 amounts due to the Secretary under this section are not 

9 dischargeable under section 727, 944, 1141, 1228, or 

10 1328 of title 11, United States Code, or any other provi11 sion of such title if the overpayment was the result of 

12 fraudulent activity, as may be defined by the Secretary.’’. 

13 (4) COLLECTION OF PAST-DUE OBLIGATIONS

14 ARISING FROM BREACH OF SCHOLARSHIP AND LOAN

15 CONTRACT.—Section 1892(a) of the Social Security 

16 Act (42 U.S.C. 1395ccc(a)) is amended by adding at 

17 the end the following: 

18 ‘‘(5) Notwithstanding any other provision of 

19 law, amounts due to the Secretary under this section 

20 are not dischargeable under section 727, 944, 1141, 

21 1228, or 1328 of title 11, United States Code, or 

22 any other provision of such title.’’. 

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

24 subsection (a) shall apply to bankruptcy petitions filed 

25 after the date of the enactment of this Act. 


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1 SEC. 8. ILLEGAL DISTRIBUTION OF A MEDICARE OR MED2 ICAID BENEFICIARY IDENTIFICATION OR 

3 PROVIDER NUMBER. 

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

5 U.S.C. 1320a–7b(b)), as amended by section 4(b), is 

6 amended by adding at the end the following: 

7 ‘‘(5) Whoever knowingly, intentionally, and with the 

8 intent to defraud purchases, sells or distributes, or ar9 ranges for the purchase, sale, or distribution of two or 

10 more medicare or medicaid beneficiary identification num11 bers or provider numbers shall be imprisoned for not more 

12 than three years or fined under title 18, United States 

13 Code (or, if greater, an amount equal to the monetary loss 

14 to the Federal and any State government as a result of 

15 such acts), or both.’’. 

16 SEC. 9. TREATMENT OF CERTAIN SOCIAL SECURITY ACT 

17 CRIMES AS FEDERAL HEALTH CARE OF18 FENSES. 

19 (a) IN GENERAL.—Section 24(a) of title 18, United 

20 States Code, is amended— 

21 (1) by striking the period at the end of para22 graph (2) and inserting ‘‘; or’’; and 

23 (2) by adding at the end the following: 

24 ‘‘(3) section 1128B of the Social Security Act 

25 (42 U.S.C. 1320a–7b).’’. 


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

2 subsection (a) shall take effect on the date of the enact3 ment of this Act and apply to acts committed on or after 

4 the date of the enactment of this Act. 

5 SEC. 10. AUTHORITY OF OFFICE OF INSPECTOR GENERAL 

6 OF THE DEPARTMENT OF HEALTH AND 

7 HUMAN SERVICES. 

8 (a) AUTHORITY.—Notwithstanding any other provi9 sion of law, upon designation by the Inspector General of 

10 the Department of Health and Human Services, any 

11 criminal investigator of the Office of Inspector General of 

12 such department may, in accordance with guidelines 

13 issued by the Secretary of Health and Human Services 

14 and approved by the Attorney General, while engaged in 

15 activities within the lawful jurisdiction of such Inspector 

16 General— 

17 (1) obtain and execute any warrant or other 

18 process issued under the authority of the United 

19 States; 

20 (2) make an arrest without a warrant for— 

21 (A) any offense against the United States 

22 committed in the presence of such investigator; 

23 or 

24 (B) any felony offense against the United 

25 States, if such investigator has reasonable cause 


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1 to believe that the person to be arrested has 

2 committed or is committing that felony offense; 

3 and 

4 (3) exercise any other authority necessary to 

5 carry out the authority described in paragraphs (1) 

6 and (2). 

7 (b) FUNDS.—The Office of Inspector General of the 

8 Department of Health and Human Services may receive 

9 and expend funds that represent the equitable share from 

10 the forfeiture of property in investigations in which the 

11 Office of Inspector General participated, and that are 

12 transferred to the Office of Inspector General by the De13 partment of Justice, the Department of the Treasury, or 

14 the United States Postal Service. Such equitable sharing 

15 funds shall be deposited in a separate account and shall 

16 remain available until expended. 

17 SEC. 11. UNIVERSAL PRODUCT NUMBERS ON CLAIMS 

18 FORMS FOR REIMBURSEMENT UNDER THE 

19 MEDICARE PROGRAM. 

20 (a) UPNS ON CLAIMS FORMS FOR REIMBURSEMENT

21 UNDER THE MEDICARE PROGRAM.— 

22 (1) ACCOMMODATION OF UPNS ON MEDICARE

23 CLAIMS FORMS.—Not later than July 1, 2010, all 

24 claims forms developed or used by the Secretary of 

25 Health and Human Services for reimbursement 


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1 under the medicare program under title XVIII of the 

2 Social Security Act (42 U.S.C. 1395 et seq.) shall 

3 accommodate the use of universal product numbers 

4 for a UPN covered item. 

5 (2) REQUIREMENT FOR PAYMENT OF CLAIMS.— 

6 Title XVIII of the Social Security Act (42 U.S.C. 

7 1395 et seq.), as amended by sections 2(b) and 3(a), 

8 is amended by adding at the end the following: 

9 ‘‘USE OF UNIVERSAL PRODUCT NUMBERS

10 ‘‘SEC. 1899C. (a) IN GENERAL.—No payment shall 

11 be made under this title for any claim for reimbursement 

12 for any UPN covered item unless the claim contains the 

13 universal product number of the UPN covered item. 

14 ‘‘(b) DEFINITIONS.—In this section: 

15 ‘‘(1) UPN COVERED ITEM.— 

16 ‘‘(A) IN GENERAL.—Except as provided in 

17 subparagraph (B), the term ‘UPN covered 

18 item’ means— 

19 ‘‘(i) a covered item as that term is de20 fined in section 1834(a)(13); 

21 ‘‘(ii) an item described in paragraph 

22 (8) or (9) of section 1861(s); 

23 ‘‘(iii) an item described in paragraph 

24 (5) of section 1861(s); and 


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1 ‘‘(iv) any other item for which pay2 ment is made under this title that the Sec3 retary determines to be appropriate. 

4 ‘‘(B) EXCLUSION.—The term ‘UPN cov5 ered item’ does not include a customized item 

6 for which payment is made under this title. 

7 ‘‘(2) UNIVERSAL PRODUCT NUMBER.—The 

8 term ‘universal product number’ means a number 

9 that is— 

10 ‘‘(A) affixed by the manufacturer to each 

11 individual UPN covered item that uniquely 

12 identifies the item at each packaging level; and 

13 ‘‘(B) based on commercially acceptable 

14 identification standards such as, but not limited 

15 to, standards established by the Uniform Code 

16 Council-International Article Numbering Sys17 tem or the Health Industry Business Commu18 nication Council.’’. 

19 (3) DEVELOPMENT AND IMPLEMENTATION OF

20 PROCEDURES.— 

21 (A) INFORMATION INCLUDED IN UPN.— 

22 The Secretary of Health and Human Services, 

23 in consultation with manufacturers and entities 

24 with appropriate expertise, shall determine the 

25 relevant descriptive information appropriate for 


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1 inclusion in a universal product number for a 

2 UPN covered item. 

3 (B) REVIEW OF PROCEDURE.—From the 

4 information obtained by the use of universal 

5 product numbers on claims for reimbursement 

6 under the medicare program, the Secretary of 

7 Health and Human Services, in consultation 

8 with interested parties, shall periodically review 

9 the UPN covered items billed under the Health 

10 Care Financing Administration Common Proce11 dure Coding System and adjust such coding 

12 system to ensure that functionally equivalent 

13 UPN covered items are billed and reimbursed 

14 under the same codes. 

15 (4) EFFECTIVE DATE.—The amendment made 

16 by paragraph (2) shall apply to claims for reim17 bursement submitted on and after July 1, 2010. 

18 (b) STUDY AND REPORTS TO CONGRESS.— 

19 (1) STUDY.—The Secretary of Health and 

20 Human Services shall conduct a study on the results 

21 of the implementation of the provisions in paragraph 

22 (1) and (3) of subsection (a) and the amendment to 

23 the Social Security Act in paragraph (2) of that sub24 section. 

25 (2) REPORTS.— 


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1 (A) PROGRESS REPORT.—Not later than 

2 six months after the date of the enactment of 

3 this Act, the Secretary of Health and Human 

4 Services shall submit to Congress a report that 

5 contains a detailed description of the progress 

6 of the matters studied pursuant to paragraph 

7 (1). 

8 (B) IMPLEMENTATION.—Not later than 18 

9 months after the date of the enactment of this 

10 Act, and annually thereafter for three years, the 

11 Secretary of Health and Human Services shall 

12 submit to Congress a report that contains a de13 tailed description of the results of the study 

14 conducted pursuant to paragraph (1), together 

15 with the Secretary’s recommendations regard16 ing the use of universal product numbers and 

17 the use of data obtained from the use of such 

18 numbers. 

19 (c) DEFINITIONS.—In this section: 

20 (1) UPN COVERED ITEM.—The term ‘‘UPN 

21 covered item’’ has the meaning given such term in 

22 section 1899C(b)(1) of the Social Security Act (as 

23 added by subsection (a)(2)). 

24 (2) UNIVERSAL PRODUCT NUMBER.—The term 

25 ‘‘universal product number’’ has the meaning given 


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24 

•HR 27 IH

1 such term in section 1899C(b)(2) of the Social Secu2 rity Act (as added by subsection (a)(2)). 

3 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated such sums as may be 

5 necessary for the purpose of carrying out the provisions 

6 in paragraphs (1) and (3) of subsection (a), subsection 

7 (b), and section 1899C of the Social Security Act (as 

8 added by subsection (a)(2)). 

Æ 


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