Medicaid Physician Self-Referral Act of 2015

To amend titles XVIII and XIX of the Social Security Act to apply the Medicare restriction on self-referral to State plan requirements under Medicaid, and for other purposes. 1. Short title This Act may be cited as the Medicaid Physician Self-Referral Act of 2015 2. Adjustments to restriction on self-referral under Medicaid (a) Repeal of restriction on receipt of Federal funds in the case of self-Referral Subsection (s) of section 1903 of the Social Security Act ( 42 U.S.C. 1396b (b) Requirement of restriction on self-Referral in State plan requirements Section 1902 of such Act ( 42 U.S.C. 1396a (1) in subsection (a)— (A) in paragraph (80) by striking and (B) in paragraph (81) by striking the period at the end and inserting ; and (C) by inserting after paragraph (81) the following: (82) provide that no payment may be made under the State plan for a Medicaid designated health service furnished to an individual on the basis of a referral by a physician if the physician (or an immediate family member of the physician) has an ownership or investment interest or a compensation arrangement (as defined in section 1877) with the entity furnishing the Medicaid designated health service that would not comply with section 1877 if the referral were for an item or service otherwise payable under title XVIII. ; and (D) by inserting after the matter immediately following paragraph (82) the following: For purposes of paragraph (82), subsections (f) and (g) of section 1877 shall apply to a provider of a Medicaid designated health service in a similar manner as such subsections apply to a provider of an item or service for which payment may be made under title XVIII. ; and (2) by adding at the end the following new subsection: (ll) Definition of Medicaid designated health service For purposes of subsection (a) the term Medicaid designated health service . (c) Application of False Claims Act to violations of self-Referral Section 1877(g) of such Act ( 42 U.S.C. 1395nn(g) (7) False Claims Act A claim that includes an item or service resulting from a violation of this section constitutes a false or fraudulent claim for purposes of sections 3729–3733 of title 31, United States Code. . (d) Exceptions for violations of self-Referral limited to Medicaid Section 1877(h) of such Act ( 42 U.S.C. 1395nn(h) (8) Medicaid self-Referral limitations Any authority of the Secretary to issue regulations under this section shall include the authority to issue regulations limited to the application of self-referral limitations to State plan requirements, as described under section 1902(a)(82) of this Act ( 42 U.S.C. 1396a(a)(82) . (e) Medicaid self-Referral disclosure protocol The Secretary of Health and Human Services shall establish a protocol consistent with the requirements of the Medicare self-referral disclosure protocol required under section 6409 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 1395nn 42 U.S.C. 1395nn 42 U.S.C. 1396a(a)(82) 3. Effective date (1) In general Subject to paragraph (2), the amendments made by this Act shall apply to items and services furnished after the first day of the first calendar year that begins after the date of the enactment of this Act. (2) Exception for State legislation In the case of a State plan under title XIX of the Social Security Act that the Secretary of Health and Human Services determines requires State legislation in order for the respective plan to meet any requirement imposed by amendments made by this Act, the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be considered to be a separate regular session of the State legislature.

Summary: Medicaid Physician Self-Referral Act of 2015 Amends title XIX (Medicaid) of the Social Security Act (SSAct) with respect to physician self-referral limitations to repeal the prohibition against payment of federal funds to a state for medical assistance expenditures for a designated health service furnished to an individual on the basis of a referral (self-referral) that would result in denial of payment under SSAct title XVIII (Medicare). Requires a state plan for medical assistance to prohibit payment for a Medicaid designated health service furnished to an individual on the basis of a physician's referral if the physician (or an immediate family member) has an ownership or investment interest or a compensation arrangement with the entity furnishing the service that would not comply with Medicare requirements. Requires application of certain reporting requirements and sanctions to a provider of a Medicaid designated health service the same way they apply under Medicare. Amends SSAct title XVIII to: (1) apply the False Claims Act to violations of the self-referral prohibition, and (2) declare the authority of the Secretary of Health and Human Services to issue regulations under Medicaid limited to the application of self-referral limitations to state plan requirements. Directs the Secretary to establish a protocol consistent with the Medicare self-referral disclosure protocol required under the Patient Protection and Affordable Care Act that enables health care providers to disclose an actual or potential violation of Medicare self-referral limitations as applied to Medicaid.