I 
114TH CONGRESS 
1ST SESSION H. R. 4273 
To amend titles XVIII and XIX of the Social Security Act to improve 
payments for hospital outpatient department services and complex reha-
bilitation technology and to improve program integrity, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 16, 2015 
Mr. GENE GREEN of Texas (for himself and Mr. MCDERMOTT) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
to improve payments for hospital outpatient department 
services and complex rehabilitation technology and to 
improve program integrity, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Medicare and Medicaid Improvements and Adjustments 
Act of 2015’’. 
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(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—CORRECTIONS TO OUTPATIENT PROVISION 
Sec. 101. Continuing Medicare payment under HOPD prospective payment sys-
tem for services furnished by off-campus outpatient depart-
ments of providers under development. 
Sec. 102. Maintaining cancer hospital adjustment under Medicare off-campus 
outpatient departments of a provider payment policy. 
TITLE II—PROVISIONS PROTECTING PEOPLE WITH DISABILITIES 
AND CHRONIC CARE NEEDS 
Sec. 201. Non-application of Medicare fee schedule adjustments for wheelchair 
accessories and seat and back cushions when furnished in con-
nection with complex rehabilitative power wheelchairs. 
Sec. 202. Treatment of infusion drugs furnished through durable medical 
equipment. 
Sec. 203. Transitional payment rules for certain radiation therapy services 
under the Medicare physician fee schedule. 
Sec. 204. Fairness in Medicaid supplemental needs trusts. 
TITLE III—PROGRAM INTEGRITY, PAYMENT EFFICIENCY, AND 
ADDITIONAL MEDICARE POLICIES 
Sec. 301. Strengthening penalties for the illegal distribution of a Medicare, 
Medicaid, or CHIP beneficiary identification or billing privi-
leges. 
Sec. 302. Civil monetary penalties for violations related to grants, contracts, 
and other agreements. 
Sec. 303. Authorizing a blanket meaningful use significant hardship exception. 
Sec. 304. Limiting Federal Medicaid reimbursement to States for durable med-
ical equipment (DME) to Medicare payment rates. 
Sec. 305. Treatment of patient encounters in ambulatory surgical centers in de-
termining meaningful EHR use. 
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TITLE I—CORRECTIONS TO 
OUTPATIENT PROVISION 
SEC. 101. CONTINUING MEDICARE PAYMENT UNDER HOPD 
PROSPECTIVE PAYMENT SYSTEM FOR SERV-
ICES 
FURNISHED 
BY 
OFF-CAMPUS 
OUT-
PATIENT 
DEPARTMENTS 
OF 
PROVIDERS 
UNDER DEVELOPMENT. 
Section 1833(t) of the Social Security Act (42 U.S.C. 
1395l(t)) is amended— 
(1) in paragraph (1)(B)(v), by inserting ‘‘, sub-
ject to subparagraph (E) of such paragraph,’’ after 
‘‘2017, by’’; and 
(2) in paragraph (21)— 
(A) in subparagraph (C) by striking ‘‘that 
are described in paragraph (1)(B)(v) shall be 
made’’ and inserting ‘‘to which paragraph 
(1)(B)(v) applies shall be the amount deter-
mined’’; 
(B) by redesignating subparagraph (E) as 
subparagraph (F); and 
(C) by inserting after subparagraph (D) 
the following new subparagraph: 
‘‘(E) NON-APPLICATION WITH RESPECT TO 
DEPARTMENTS UNDER DEVELOPMENT.— 
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‘‘(i) 
IN
GENERAL.—Paragraph 
(1)(B)(v) shall not apply to an off-campus 
outpatient department of a provider that is 
determined by the Secretary to be under 
development as of the date of the enact-
ment of the Bipartisan Budget Act of 
2015. 
‘‘(ii) APPLICATION.—For purposes of 
paragraph (1)(B)(v) and this paragraph, 
in determining whether an off-campus out-
patient department of a provider was 
under development, the Secretary shall re-
quire that as of the date of the enactment 
of such Act the department met— 
‘‘(I) at least one of the require-
ments described in clause (iii); and 
‘‘(II) any additional requirements 
the Secretary determines would indi-
cate whether such off-campus out-
patient department of a provider was 
under development as of such date. 
‘‘(iii) REQUIREMENTS
DESCRIBED.— 
The following requirements are described 
in this clause: 
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‘‘(I) Architectural plans were 
completed. 
‘‘(II) Zoning requirements were 
met or a request for approval of meet-
ing such zoning requirements was 
submitted to appropriate agencies. 
‘‘(III) Necessary approvals from 
appropriate State agencies were ap-
plied for or received.’’. 
SEC. 102. MAINTAINING CANCER HOSPITAL ADJUSTMENT 
UNDER MEDICARE OFF-CAMPUS OUTPATIENT 
DEPARTMENTS OF A PROVIDER PAYMENT 
POLICY. 
Section 1833(t) of the Social Security Act (42 U.S.C. 
1395l(t)) is amended— 
(1) in paragraph (1)(B)(v), as amended by sec-
tion 101(1), by striking ‘‘subparagraph (E)’’ and in-
serting ‘‘subparagraph (F)’’; and 
(2) in paragraph (21), as added by section 603 
of the Bipartisan Budget Act of 2015 and as 
amended by section 101(2)— 
(A) by redesignating subparagraphs (D), 
(E), and (F) as subparagraphs (E), (F), and 
(G), respectively; 
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(B) by inserting after subparagraph (C) 
the following new subparagraph: 
‘‘(D) APPLICATION OF CANCER HOSPITAL 
ADJUSTMENT.—The Secretary shall apply the 
adjustment under paragraph (18) to applicable 
items and services furnished on or after Janu-
ary 1, 2017, by an off-campus outpatient de-
partment of a provider (as defined in subpara-
graph (B)) of a hospital described in section 
1886(d)(1)(B)(v)— 
‘‘(i) as if this paragraph (other than 
this 
subparagraph) 
and 
paragraph 
(1)(B)(v) were not applicable to such ap-
plicable items and services and such appli-
cable items and services were covered OPD 
services and paid under this subsection; 
and 
‘‘(ii) without application of para-
graphs (2)(E) and (9)(B).’’; and 
(C) in subparagraph (G)(iii), as redesig-
nated by subparagraph (A) of this paragraph, 
by striking ‘‘subparagraph (D)’’ and inserting 
‘‘subparagraph (E)’’. 
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TITLE 
II—PROVISIONS 
PRO-
TECTING PEOPLE WITH DIS-
ABILITIES 
AND 
CHRONIC 
CARE NEEDS 
SEC. 201. NON-APPLICATION OF MEDICARE FEE SCHEDULE 
ADJUSTMENTS 
FOR 
WHEELCHAIR 
ACCES-
SORIES AND SEAT AND BACK CUSHIONS 
WHEN FURNISHED IN CONNECTION WITH 
COMPLEX REHABILITATIVE POWER WHEEL-
CHAIRS. 
(a) NON-APPLICATION.— 
(1) IN GENERAL.—Notwithstanding any other 
provision of law, the Secretary of Health and 
Human Services shall not, prior to January 1, 2017, 
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 other-
wise be recognized under section 1834(a)(1)(B)(ii) 
of such Act (42 U.S.C. 1395m(a)(1)(B)(ii)) for 
wheelchair accessories (including seating systems) 
and seat and back cushions when furnished in con-
nection with Group 3 complex rehabilitative power 
wheelchairs. 
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(2) IMPLEMENTATION.—Notwithstanding any 
other provision of law, the Secretary may implement 
this subsection by program instruction or otherwise. 
(b) GAO STUDY AND REPORT.— 
(1) STUDY.— 
(A) IN GENERAL.—The Comptroller Gen-
eral of the United States shall conduct a study 
on wheelchair accessories (including seating sys-
tems) and seat and back cushions furnished in 
connection with Group 3 complex rehabilitative 
power wheelchairs. Such study shall include an 
analysis of the following with respect to such 
wheelchair accessories and seat and back cush-
ions in each of the groups described in clauses 
(i) through (iii) of subparagraph (B): 
(i) The item descriptions and associ-
ated HCPCS codes for such wheelchair ac-
cessories and seat and back cushions. 
(ii) A breakdown of utilization and ex-
penditures for such wheelchair accessories 
and seat and back cushions under title 
XVIII of the Social Security Act. 
(iii) A comparison of the payment 
amount under the competitive acquisition 
program under section 1847 of such Act 
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(42 U.S.C. 1395w–3) with the payment 
amount that would otherwise be recognized 
under section 1834 of such Act (42 U.S.C. 
1395m), including beneficiary cost sharing, 
for such wheelchair accessories and seat 
and back cushions. 
(iv) The aggregate distribution of 
such wheelchair accessories and seat and 
back cushions furnished under such title 
XVIII within each of the groups described 
in subparagraph (B). 
(v) Other areas determined appro-
priate by the Comptroller General. 
(B) GROUPS
DESCRIBED.—The following 
groups are described in this subparagraph: 
(i) Wheelchair accessories and seat 
and back cushions furnished predominantly 
with Group 3 complex rehabilitative power 
wheelchairs. 
(ii) Wheelchair accessories and seat 
and back cushions furnished predominantly 
with power wheelchairs that are not de-
scribed in clause (i). 
(iii) Other wheelchair accessories and 
seat and back cushions furnished with ei-
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ther power wheelchairs described in clause 
(i) or (ii). 
(2) REPORT.—Not later than June 1, 2016, the 
Comptroller General of the United States shall sub-
mit to Congress a report containing the results of 
the study conducted under paragraph (1), together 
with recommendations for such legislation and ad-
ministrative as the Comptroller General determines 
to be appropriate. 
SEC. 202. TREATMENT OF INFUSION DRUGS FURNISHED 
THROUGH DURABLE MEDICAL EQUIPMENT. 
Section 1842(o)(1) of the Social Security Act (42 
U.S.C. 1395u(o)(1)) is amended— 
(1) in subparagraph (C), by inserting ‘‘(and in-
cluding a drug or biological described in subpara-
graph (D)(i) furnished during the 6-year period be-
ginning on January 1, 2017)’’ after ‘‘2005’’; and 
(2) in subparagraph (D)— 
(A) by striking ‘‘infusion drugs’’ and in-
serting ‘‘infusion drugs or biologicals’’ each 
place it appears; and 
(B) in clause (i)— 
(i) by striking ‘‘2004’’ and inserting 
‘‘2004 (other than during the 6-year pe-
riod beginning on January 1, 2017)’’; and 
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(ii) by striking ‘‘for such drug’’. 
SEC. 203. TRANSITIONAL PAYMENT RULES FOR CERTAIN 
RADIATION THERAPY SERVICES UNDER THE 
MEDICARE PHYSICIAN FEE SCHEDULE. 
(a) IN GENERAL.—Section 1848 of the Social Secu-
rity Act (42 U.S.C. 1395w–4) is amended— 
(1) in subsection (b), as amended by section 
502 of division O of the Consolidated Appropriations 
Act, 2016, by adding at the end the following new 
paragraph: 
‘‘(11) SPECIAL RULE FOR CERTAIN RADIATION 
THERAPY SERVICES.—The code definitions, the work 
relative value units under subsection (c)(2)(C)(i), 
and the direct inputs for the practice expense rel-
ative value units under subsection (c)(2)(C)(ii) for 
radiation treatment delivery and related imaging 
services (identified in 2016 by HCPCS G-codes 
G6001 through G6015) for the fee schedule estab-
lished under this subsection for services furnished in 
2017 and 2018 shall be the same as such defini-
tions, units, and inputs for such services for the fee 
schedule established for services furnished in 2016.’’; 
and 
(2) in subsection (c)(2)(K), by adding at the 
end the following new clause: 
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‘‘(iv) TREATMENT OF CERTAIN RADI-
ATION
THERAPY
SERVICES.—Radiation 
treatment delivery and related imaging 
services identified under subsection (b)(11) 
shall not be considered as potentially 
misvalued services for purposes of this sub-
paragraph and subparagraph (O) for 2017 
and 2018.’’. 
(b) REPORT TO CONGRESS ON ALTERNATIVE PAY-
MENT MODEL.—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 
development of an episodic alternative payment model for 
payment under the Medicare program under title XVIII 
of the Social Security Act for radiation therapy services 
furnished in nonfacility settings. 
SEC. 204. FAIRNESS IN MEDICAID SUPPLEMENTAL NEEDS 
TRUSTS. 
(a) IN GENERAL.—Section 1917(d)(4)(A) of the So-
cial Security Act (42 U.S.C. 1396p(d)(4)(A)) is amended 
by inserting ‘‘the individual,’’ after ‘‘for the benefit of such 
individual by’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to trusts established on or after 
the date of the enactment of this Act. 
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TITLE 
III—PROGRAM 
INTEG-
RITY, PAYMENT EFFICIENCY, 
AND ADDITIONAL MEDICARE 
POLICIES 
SEC. 301. 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 know-
ingly 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.’’. 
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SEC. 302. CIVIL MONETARY PENALTIES FOR VIOLATIONS 
RELATED 
TO 
GRANTS, 
CONTRACTS, 
AND 
OTHER AGREEMENTS. 
(a) IN GENERAL.—Section 1128A of the Social Secu-
rity Act (42 U.S.C. 1320a–7a) is amended by adding at 
the end the following new subsection: 
‘‘(o) Any person (including an organization, agency, 
or other entity, but excluding a program beneficiary, as 
defined in subsection (r)(4)) that, with respect to a grant, 
contract, or other agreement for which the Secretary of 
Health and Human Services provides funding— 
‘‘(1) knowingly presents or causes to be pre-
sented a specified claim (as defined in subsection 
(r)(6)) under such grant, contract, or other agree-
ment that the person knows or should know is false 
or fraudulent; 
‘‘(2) knowingly makes, uses, or causes to be 
made or used any false statement, omission, or mis-
representation of a material fact in any application, 
proposal, bid, progress report, or other document 
that is required to be submitted in order to directly 
or indirectly receive or retain funds provided in 
whole or in part by such Secretary pursuant to such 
grant, contract, or other agreement; 
‘‘(3) knowingly makes, uses, or causes to be 
made or used, a false record or statement material 
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to a false or fraudulent specified claim under such 
grant, contract, or other agreement; 
‘‘(4) knowingly makes, uses, or causes to be 
made or used, a false record or statement material 
to an obligation to pay or transmit funds or property 
to such Secretary with respect to such grant, con-
tract, or other agreement, or knowingly conceals or 
knowingly and improperly avoids or decreases an ob-
ligation to pay or transmit funds or property to such 
Secretary with respect to such grant, contract, or 
other agreement; or 
‘‘(5) fails to grant timely access, upon reason-
able request (as defined by such Secretary in regula-
tions), to the Inspector General of the Department, 
for the purpose of audits, investigations, evaluations, 
or other statutory functions of such Inspector Gen-
eral in matters involving such grants, contracts, or 
other agreements; 
shall be subject, in addition to any other penalties that 
may be prescribed by law, to a civil money penalty in cases 
under paragraph (1), of not more than $10,000 for each 
specified claim; in cases under paragraph (2), not more 
than $50,000 for each false statement, omission, or mis-
representation of a material fact; in cases under para-
graph (3), not more than $50,000 for each false record 
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or statement; in cases under paragraph (4), not more than 
$50,000 for each false record or statement or $10,000 for 
each day that the person knowingly conceals or knowingly 
and improperly avoids or decreases an obligation to pay; 
or in cases under paragraph (5), not more than $15,000 
for each day of the failure described in such paragraph. 
In addition, in cases under paragraphs (1) and (3), such 
a person shall be subject to an assessment of not more 
than 3 times the amount claimed in the specified claim 
described in such paragraph in lieu of damages sustained 
by the United States or a specified State agency because 
of such specified claim, and in cases under paragraphs (2) 
and (4), such a person shall be subject to an assessment 
of not more than 3 times the total amount of the funds 
described in paragraph (2) or (4), respectively (or, in the 
case of an obligation to transmit property to the Secretary 
Health and Human Services described in paragraph (4), 
of the value of the property described in such paragraph) 
in lieu of damages sustained by the United States or a 
specified State agency because of such case. In addition, 
the Secretary of Health and Human Services may make 
a determination in the same proceeding to exclude the per-
son from participation in the Federal health care pro-
grams (as defined in section 1128B(f)(1)) and to direct 
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the appropriate State agency to exclude the person from 
participation in any State health care program. 
‘‘(p) The provisions of subsections (c), (d), and (g) 
shall apply to a civil money penalty or assessment under 
subsection (o) in the same manner as such provisions 
apply to a penalty, assessment, or proceeding under sub-
section (a). 
‘‘(q) With respect to a penalty or assessment under 
subsection (o), the Inspector General of the Department 
is authorized to receive, and to retain for current use, such 
amounts of such penalty or assessment as are necessary 
to provide reimbursement for the costs of conducting in-
vestigations and audits with respect to such subsection 
and for monitoring compliance plans with respect to such 
subsection when such penalty or assessment is ordered by 
a court, voluntarily agreed to by the payor, or otherwise. 
Funds received by such Inspector General as reimburse-
ment under the preceding sentence shall be deposited to 
the credit of the appropriations from which initially paid, 
or to appropriations for similar purposes currently avail-
able at the time of deposit, and shall remain available for 
obligation for 1 year from the date of the deposit of such 
funds. 
‘‘(r) For purposes of this subsection and subsections 
(o), (p), and (q): 
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‘‘(1) The term ‘Department’ means the Depart-
ment of Health and Human Services. 
‘‘(2) The term ‘material’ means having a nat-
ural tendency to influence, or be capable of influ-
encing, the payment or receipt of money or property. 
‘‘(3) The term ‘other agreement’ includes a co-
operative agreement, scholarship, fellowship, loan, 
subsidy, payment for a specified use, donation agree-
ment, award, or sub-award (regardless of whether 
one or more of the persons entering into the agree-
ment is a contractor or sub-contractor). 
‘‘(4) The term ‘program beneficiary’ means, in 
the case of a grant, contract, or other agreement de-
signed to accomplish the objective of awarding or 
otherwise furnishing benefits or assistance to indi-
viduals and for which the Secretary of Health and 
Human Services provides funding, an individual who 
applies for, or who receives, such benefits or assist-
ance from such grant, contract, or other agreement. 
Such term does not include, with respect to such 
grant, contract, or other agreement, an officer, em-
ployee, or agent of a person or entity that receives 
such grant or that enters into such contract or other 
agreement. 
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‘‘(5) The term ‘recipient’ includes a sub-recipi-
ent or subcontractor. 
‘‘(6) The term ‘specified claim’ means any ap-
plication, request, or demand under a grant, con-
tract, or other agreement for money or property, 
whether or not the United States or a specified 
State agency has title to the money or property, that 
is not a claim (as defined in subsection (i)(2)) and 
that— 
‘‘(A) is presented or caused to be pre-
sented to an officer, employee, or agent of the 
Department or agency thereof, or of any speci-
fied State agency; or 
‘‘(B) is made to a contractor, grantee, or 
any other recipient if the money or property is 
to be spent or used on the Department’s behalf 
or to advance a Department program or inter-
est, and if the Department— 
‘‘(i) provides or has provided any por-
tion of the money or property requested or 
demanded; or 
‘‘(ii) will reimburse such contractor, 
grantee or other recipient for any portion 
of the money or property which is re-
quested or demanded. 
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