SEC. 15. MODIFICATION OF MEDICARE HOME HEALTH SUR-
ETY BOND CONDITION OF PARTICIPATION 
REQUIREMENT. 
Section 1861(o)(7) of the Social Security Act (42 
U.S.C. 1395x(o)(7)) is amended to read as follows: 
‘‘(7) provides the Secretary with a surety bond— 
‘‘(A) in a form specified by the Secretary 
and in an amount that is not less than the min-
imum of $50,000; and 
‘‘(B) that the Secretary determines is com-
mensurate with the volume of payments to the 
home health agency; and’’. 
SEC. 16. OVERSIGHT OF MEDICARE COVERAGE OF MANUAL 
MANIPULATION OF THE SPINE TO CORRECT 
SUBLUXATION. 
(a) IN GENERAL.—Section 1833 of the Social Security 
Act (42 U.S.C. 1395l) is amended by adding at the end 
the following new subsection: 
‘‘(z) MEDICAL REVIEW
OF SPINAL SUBLUXATION 
SERVICES.— 
‘‘(1) IN GENERAL.—The Secretary shall imple-
ment a process for the medical review (as described in 
paragraph (2)) of treatment by a chiropractor de-
scribed in section 1861(r)(5) by means of manual ma-
nipulation of the spine to correct a subluxation (as 
described in such section) of an individual who is en-
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rolled under this part and apply such process to such 
services furnished on or after January 1, 2017, focus-
ing on services such as— 
‘‘(A) services furnished by a such a chiro-
practor whose pattern of billing is aberrant com-
pared to peers; and 
‘‘(B) services furnished by such a chiro-
practor who, in a prior period, has a services de-
nial percentage in the 85th percentile or greater, 
taking into consideration the extent that service 
denials are overturned on appeal. 
‘‘(2) MEDICAL REVIEW.— 
‘‘(A) PRIOR AUTHORIZATION MEDICAL RE-
VIEW.— 
‘‘(i) IN
GENERAL.—Subject to clause 
(ii), the Secretary shall use prior authoriza-
tion medical review for services described in 
paragraph (1) that are furnished to an in-
dividual by a chiropractor described in sec-
tion 1861(r)(5) that are part of an episode 
of treatment that includes more than 12 
services. For purposes of the preceding sen-
tence, an episode of treatment shall be deter-
mined by the underlying cause that justifies 
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the need for services, such as a diagnosis 
code. 
‘‘(ii) ENDING APPLICATION OF PRIOR 
AUTHORIZATION
MEDICAL
REVIEW.—The 
Secretary shall end the application of prior 
authorization medical review under clause 
(i) to services described in paragraph (1) by 
such a chiropractor if the Secretary deter-
mines that the chiropractor has a low de-
nial rate under such prior authorization 
medical review. The Secretary may subse-
quently reapply prior authorization medical 
review to such chiropractor if the Secretary 
determines it to be appropriate and the chi-
ropractor has, in the time period subsequent 
to the determination by the Secretary of a 
low denial rate with respect to the chiro-
practor, furnished such services described in 
paragraph (1). 
‘‘(iii) EARLY REQUEST FOR PRIOR AU-
THORIZATION
REVIEW
PERMITTED.—Noth-
ing in this subsection shall be construed to 
prevent such a chiropractor from requesting 
prior authorization for services described in 
paragraph (1) that are to be furnished to 
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an individual before the chiropractor fur-
nishes the twelfth such service to such indi-
vidual for an episode of treatment. 
‘‘(B) TYPE
OF
REVIEW.—The Secretary 
may use pre-payment review or post-payment 
review of services described in section 1861(r)(5) 
that are not subject to prior authorization med-
ical review under subparagraph (A). 
‘‘(C) RELATIONSHIP TO LAW ENFORCEMENT 
ACTIVITIES.—The Secretary may determine that 
medical review under this subsection does not 
apply in the case where potential fraud may be 
involved. 
‘‘(3) NO PAYMENT WITHOUT PRIOR AUTHORIZA-
TION.—With respect to a service described in para-
graph (1) for which prior authorization medical re-
view under this subsection applies, the following shall 
apply: 
‘‘(A) PRIOR
AUTHORIZATION
DETERMINA-
TION.—The Secretary shall make a determina-
tion, prior to the service being furnished, of 
whether the service would or would not meet the 
applicable requirements of section 1862(a)(1)(A). 
‘‘(B) DENIAL
OF
PAYMENT.—Subject to 
paragraph (5), no payment may be made under 
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this part for the service unless the Secretary de-
termines pursuant to subparagraph (A) that the 
service would meet the applicable requirements of 
such section 1862(a)(1)(A). 
‘‘(4) SUBMISSION
OF
INFORMATION.—A chiro-
practor described in section 1861(r)(5) may submit 
the information necessary for medical review by fax, 
by mail, or by electronic means. The Secretary shall 
make available the electronic means described in the 
preceding sentence as soon as practicable. 
‘‘(5) TIMELINESS.—If the Secretary does not 
make a prior authorization determination under 
paragraph (3)(A) within 14 business days of the date 
of the receipt of medical documentation needed to 
make such determination, paragraph (3)(B) shall not 
apply. 
‘‘(6) APPLICATION
OF
LIMITATION
ON
BENE-
FICIARY
LIABILITY.—Where payment may not be 
made as a result of the application of paragraph 
(2)(B), section 1879 shall apply in the same manner 
as such section applies to a denial that is made by 
reason of section 1862(a)(1). 
‘‘(7) REVIEW
BY
CONTRACTORS.—The medical 
review described in paragraph (2) may be conducted 
by medicare administrative contractors pursuant to 
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