(i) are retired from the Armed Forces 
under chapter 61 of title 10, United States 
Code; 
(ii) are entitled to hospital insurance 
benefits under part A of title XVIII of the 
Social Security Act pursuant to receiving 
benefits for 24 months as described in sub-
paragraph (A) or (C) of section 226(b)(2) 
of such Act (42 U.S.C. 426(b)(2)); and 
(iii) because of such entitlement, are 
no longer enrolled in TRICARE Standard, 
TRICARE Prime, TRICARE Extra, or 
TRICARE Select under chapter 55 of title 
10, United States Code. 
(4) DEPOSIT OF SAVINGS INTO MEDICARE IM-
PROVEMENT FUND.—Section 1898(b)(1) of the So-
cial Security Act (42 U.S.C. 1395iii(b)(1)) is amend-
ed by striking ‘‘during and after fiscal year 2021, 
$0’’ and inserting ‘‘during and after fiscal year 
2024, $5,000,000’’. 
(5) APPLICATION.—The amendments made by 
paragraphs (1) and (2) shall apply with respect to 
a person who, on or after October 1, 2023, is a per-
son described in section 1086(d)(6)(B) of title 10, 
United States Code, as added by paragraph (1). 
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(b) COVERAGE OF CERTAIN DNA SPECIMEN PROVE-
NANCE ASSAY TESTS UNDER MEDICARE.— 
(1) BENEFIT.— 
(A) COVERAGE.—Section 1861 of the So-
cial Security Act (42 U.S.C. 1395x) is amend-
ed— 
(i) in subsection (s)(2)— 
(I) in subparagraph (GG), by 
striking ‘‘and’’ at the end; 
(II) in subparagraph (HH), by 
striking the period and inserting ‘‘; 
and’’; and 
(III) by adding at the end the 
following new subparagraph: 
‘‘(II) a prostate cancer DNA Specimen Prove-
nance Assay test (DSPA test) (as defined in sub-
section (kkk));’’; and 
(ii) by adding at the end the following 
new subsection: 
‘‘(kkk) PROSTATE CANCER DNA SPECIMEN PROVE-
NANCE ASSAY TEST.—The term ‘prostate cancer DNA 
Specimen Provenance Assay Test’ (DSPA test) means a 
test that, after a determination of cancer in one or more 
prostate biopsy specimens obtained from an individual, as-
sesses the identity of the DNA in such specimens by com-
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paring such DNA with the DNA that was separately taken 
from such individual at the time of the biopsy.’’. 
(B) EXCLUSION
FROM
COVERAGE.—Sec-
tion 1862(a)(1) of the Social Security Act (42 
U.S.C. 1395y(a)(1)) is amended— 
(i) in subparagraph (O), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (P), by striking 
the semicolon at the end and inserting ‘‘, 
and’’; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(Q) in the case of a prostate cancer DNA 
Specimen Provenance Assay test (DSPA test) (as 
defined in section 1861(kkk)), unless such test is 
furnished on or after January 1, 2020, and before 
January 1, 2025, and such test is ordered by the 
physician who furnished the prostate cancer biopsy 
that obtained the specimen tested;’’. 
(2) PAYMENT AMOUNT AND RELATED REQUIRE-
MENTS.—Section 1834 of the Social Security Act 
(42 U.S.C. 1395m) is amended by adding at the end 
the following new subsection: 
‘‘(x) PROSTATE CANCER DNA SPECIMEN PROVE-
NANCE ASSAY TESTS.— 
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‘‘(1) PAYMENT FOR COVERED TESTS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the payment amount for a prostate 
cancer DNA Specimen Provenance Assay test 
(DSPA test) (as defined in section 1861(kkk)) 
shall be $200. Such payment shall be payment 
for all of the specimens obtained from the bi-
opsy furnished to an individual that are tested. 
‘‘(B) LIMITATION.—Payment for a DSPA 
test under subparagraph (A) may only be made 
on an assignment-related basis. 
‘‘(C) PROHIBITION
ON
SEPARATE
PAY-
MENT.—No separate payment shall be made for 
obtaining DNA that was separately taken from 
an individual at the time of a biopsy described 
in subparagraph (A). 
‘‘(2) HCPCS CODE
AND
MODIFIER
ASSIGN-
MENT.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
assign one or more HCPCS codes to a prostate 
cancer DNA Specimen Provenance Assay test 
and may use a modifier to facilitate making 
payment under this section for such test. 
‘‘(B) IDENTIFICATION OF DNA MATCH ON 
CLAIM.—The Secretary shall require an indica-
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tion on a claim for a prostate cancer DNA 
Specimen Provenance Assay test of whether the 
DNA of the prostate biopsy specimens match 
the DNA of the individual diagnosed with pros-
tate cancer. Such indication may be made 
through use of a HCPCS code, a modifier, or 
other means, as determined appropriate by the 
Secretary. 
‘‘(3) DNA MATCH REVIEW.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
review at least three years of claims under part 
B for prostate cancer DNA Specimen Prove-
nance Assay tests to identify whether the DNA 
of the prostate biopsy specimens match the 
DNA of the individuals diagnosed with prostate 
cancer. 
‘‘(B) POSTING ON INTERNET WEBSITE.— 
Not later than July 1, 2023, the Secretary shall 
post on the internet website of the Centers for 
Medicare & Medicaid Services the findings of 
the review conducted under subparagraph 
(A).’’. 
(3) COST-SHARING.—Section 1833(a)(1) of the 
Social Security Act (42 U.S.C. 1395l(a)(1)) is 
amended— 
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(A) by striking ‘‘and (CC)’’ and inserting 
‘‘(CC)’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘, and (DD) with respect 
to a prostate cancer DNA Specimen Provenance 
Assay test (DSPA test) (as defined in section 
1861(kkk)), the amount paid shall be an 
amount equal to 80 percent of the lesser of the 
actual charge for the test or the amount speci-
fied under section 1834(x)’’. 
SEC. 3. AMBULATORY SURGICAL CENTER PAYMENT TRANS-
PARENCY. 
(a) ADVISORY PANEL ON HOSPITAL OUTPATIENT 
PAYMENT REPRESENTATION.— 
(1) ASC REPRESENTATIVE.—The second sen-
tence of section 1833(t)(9)(A) of the Social Security 
Act (42 U.S.C. 1395l(t)(9)(A)) is amended by in-
serting ‘‘and at least one ambulatory surgical center 
representative’’ after ‘‘an appropriate selection of 
representatives of providers’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply with respect to advisory 
panels consulted on or after the date that is 1 year 
after the date of the enactment of this Act. 
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(b) REASONS FOR EXCLUDING ADDITIONAL PROCE-
DURES FROM ASC APPROVED LIST.—Section 1833(i)(1) 
of the Social Security Act (42 U.S.C. 1395l(i)(1)) is 
amended by adding at the end the following: ‘‘In updating 
such lists for application in years beginning with the sec-
ond year beginning after the date of the enactment of this 
sentence, for each procedure that was not proposed to be 
included in such lists in the proposed rule with respect 
to such lists and that was subsequently requested to be 
included in such lists during the public comment period 
with respect to such proposed rule and that is not included 
in the final rule updating such lists, the Secretary shall 
cite in such final rule the specific criteria in paragraph 
(b) or (c) of section 416.166 of title 42, Code of Federal 
Regulations (or any successor regulation), based on which 
the procedure was excluded. If paragraph (b) of such sec-
tion is cited for exclusion of a procedure, the Secretary 
shall identify the peer-reviewed research, if any, or the evi-
dence upon which such determination is based.’’. 
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SEC. 4. EXCLUSION OF COMPLEX REHABILITATIVE MAN-
UAL WHEELCHAIRS FROM MEDICARE COM-
PETITIVE ACQUISITION PROGRAM; NON-AP-
PLICATION OF MEDICARE FEE SCHEDULE 
ADJUSTMENTS FOR CERTAIN WHEELCHAIR 
ACCESSORIES AND CUSHIONS. 
(a) EXCLUSION OF COMPLEX REHABILITATIVE MAN-
UAL WHEELCHAIRS FROM COMPETITIVE ACQUISITION 
PROGRAM.—Section 1847(a)(2)(A) of the Social Security 
Act (42 U.S.C. 1395w–3(a)(2)(A)) is amended— 
(1) by inserting ‘‘, complex rehabilitative man-
ual wheelchairs (as determined by the Secretary), 
and certain manual wheelchairs (identified, as of Oc-
tober 1, 2018, by HCPCS codes E1235, E1236, 
E1237, E1238, and K0008 or any successor to such 
codes)’’ after ‘‘group 3 or higher’’; and 
(2) by striking ‘‘such wheelchairs’’ and insert-
ing ‘‘such complex rehabilitative power wheelchairs, 
complex rehabilitative manual wheelchairs, and cer-
tain manual wheelchairs’’. 
(b) NON-APPLICATION OF MEDICARE FEE SCHED-
ULE ADJUSTMENTS FOR WHEELCHAIR ACCESSORIES AND 
SEAT AND BACK CUSHIONS WHEN FURNISHED IN CON-
NECTION
WITH
COMPLEX
REHABILITATIVE
MANUAL 
WHEELCHAIRS.— 
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(1) IN GENERAL.—Notwithstanding any other 
provision of law, the Secretary of Health and 
Human Services shall not, during the period begin-
ning on July 1, 2019, and ending on December 31, 
2020, use information on the payment determined 
under the competitive acquisition programs under 
section 1847 of the Social Security Act (42 U.S.C. 
1395w–3) to adjust the payment amount that would 
otherwise 
be 
recognized 
under 
section 
1834(a)(1)(B)(ii) 
of 
such 
Act 
(42 
U.S.C. 
1395m(a)(1)(B)(ii)) for wheelchair accessories (in-
cluding seating systems) and seat and back cushions 
when furnished in connection with complex rehabili-
tative manual wheelchairs (as determined by the 
Secretary), and certain manual wheelchairs (identi-
fied, as of October 1, 2018, by HCPCS codes 
E1235, E1236, E1237, E1238, and K0008 or any 
successor to such codes). 
(2) IMPLEMENTATION.—Notwithstanding any 
other provision of law, the Secretary may implement 
this subsection by program instruction or otherwise. 
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SEC. 5. EXTENSION OF ENFORCEMENT INSTRUCTION ON 
SUPERVISION 
REQUIREMENTS 
FOR 
OUT-
PATIENT THERAPEUTIC SERVICES IN CRIT-
ICAL ACCESS AND SMALL RURAL HOSPITALS 
THROUGH 2021. 
Section 1 of Public Law 113–198, as amended by sec-
tion 1 of Public Law 114–112, section 16004 of Public 
Law 114–255, and section 51007 of Public Law 115–123, 
is amended— 
(1) in the section heading, by striking ‘‘2017’’ 
and inserting ‘‘2021’’; and 
(2) by striking ‘‘and 2017’’ and inserting ‘‘, 
2017, 2020, and 2021’’. 
Æ 
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