H. R. 2015—138
of durable medical equipment with respect to such equipment
furnished on or after January 1, 1998.
(2) HOME HEALTH AGENCIES.—The amendments made by
subsection (b) shall apply to home health agencies with respect
to services furnished on or after January 1, 1998. The Secretary
of Health and Human Services shall modify participation agree-
ments under section 1866(a)(1) of the Social Security Act (42
U.S.C. 1395cc(a)(1)) with respect to home health agencies to
provide for implementation of such amendments on a timely
basis.
(3) OTHER AMENDMENTS.—The amendments made by sub-
sections (c) through (e) shall take effect on the date of the
enactment of this Act and may be applied with respect to
items and services furnished on or after January 1, 1998.
SEC. 4313. PROVISION OF CERTAIN IDENTIFICATION NUMBERS.
(a) REQUIREMENTS TO DISCLOSE EMPLOYER IDENTIFICATION
NUMBERS
(EINS) 
AND
SOCIAL
SECURITY
ACCOUNT
NUMBERS
(SSNS).—Section 1124(a)(1) (42 U.S.C. 1320a–3(a)(1)) is amended
by inserting before the period at the end the following: ‘‘and supply
the Secretary with the both the employer identification number
(assigned pursuant to section 6109 of the Internal Revenue Code
of 1986) and social security account number (assigned under section
205(c)(2)(B)) of the disclosing entity, each person with an ownership
or control interest (as defined in subsection (a)(3)), and any sub-
contractor in which the entity directly or indirectly has a 5 percent
or more ownership interest.
(b) OTHER MEDICARE PROVIDERS.—Section 1124A (42 U.S.C.
1320a–3a) is amended—
(1) in subsection (a)—
(A) in paragraph (1), by striking ‘‘and’’ at the end;
(B) in paragraph (2), by striking the period at the
end and inserting ‘‘; and’’; and
(C) by adding at the end the following new paragraph:
‘‘(3) including the employer identification number (assigned
pursuant to section 6109 of the Internal Revenue Code of
1986) and social security account number (assigned under sec-
tion 205(c)(2)(B)) of the disclosing part B provider and any
person, managing employee, or other entity identified or
described under paragraph (1) or (2).’’; and
(2) in subsection (c)(1), by inserting ‘‘(or, for purposes of
subsection (a)(3), any entity receiving payment)’’ after ‘‘on an
assignment-related basis’’.
(c) VERIFICATION BY SOCIAL SECURITY ADMINISTRATION (SSA).—
Section 1124A (42 U.S.C. 1320a–3a), as amended by subsection
(b), is amended—
(1) by redesignating subsection (c) as subsection (d); and
(2) by inserting after subsection (b) the following new sub-
section:
‘‘(c) VERIFICATION.—
‘‘(1) TRANSMITTAL BY HHS.—The Secretary shall transmit—
‘‘(A) to the Commissioner of Social Security information
concerning each social security account number (assigned
under section 205(c)(2)(B)), and
‘‘(B) to the Secretary of the Treasury information
concerning each employer identification number (assigned
H. R. 2015—139
pursuant to section 6109 of the Internal Revenue Code
of 1986),
supplied to the Secretary pursuant to subsection (a)(3) or sec-
tion 1124(c) to the extent necessary for verification of such
information in accordance with paragraph (2).
‘‘(2) VERIFICATION.—The Commissioner of Social Security
and the Secretary of the Treasury shall verify the accuracy
of, or correct, the information supplied by the Secretary to
such official pursuant to paragraph (1), and shall report such
verifications or corrections to the Secretary.
‘‘(3) 
FEES
FOR
VERIFICATION.—The 
Secretary 
shall
reimburse the Commissioner and Secretary of the Treasury,
at a rate negotiated between the Secretary and such official,
for the costs incurred by such official in performing the verifica-
tion and correction services described in this subsection.’’.
(d) REPORT.—Before the amendments made by this section may
become effective, the Secretary of Health and Human Services
shall submit to Congress a report on steps the Secretary has taken
to assure the confidentiality of social security account numbers
that will be provided to the Secretary under such amendments.
(e) EFFECTIVE DATES.—
(1) DISCLOSURE REQUIREMENTS.—The amendment made by
subsection (a) shall apply to the application of conditions of
participation, and entering into and renewal of contracts and
agreements, occurring more than 90 days after the date of
submission of the report under subsection (d).
(2) OTHER
PROVIDERS.—The amendments made by sub-
section (b) shall apply to payment for items and services fur-
nished more than 90 days after the date of submission of
such report.
SEC. 4314. ADVISORY OPINIONS REGARDING CERTAIN PHYSICIAN
SELF-REFERRAL PROVISIONS.
Section 1877(g) (42 U.S.C. 1395nn(g)) is amended by adding
at the end the following new paragraph:
‘‘(6) ADVISORY OPINIONS.—
‘‘(A) IN GENERAL.—The Secretary shall issue written
advisory opinions concerning whether a referral relating
to designated health services (other than clinical laboratory
services) is prohibited under this section. Each advisory
opinion issued by the Secretary shall be binding as to
the Secretary and the party or parties requesting the opin-
ion.
‘‘(B) APPLICATION OF CERTAIN RULES.—The Secretary
shall, to the extent practicable, apply the rules under sub-
sections (b)(3) and (b)(4) and take into account the regula-
tions promulgated under subsection (b)(5) of section 1128D
in the issuance of advisory opinions under this paragraph.
‘‘(C) REGULATIONS.—In order to implement this para-
graph in a timely manner, the Secretary may promulgate
regulations that take effect on an interim basis, after notice
and pending opportunity for public comment.
‘‘(D) APPLICABILITY.—This paragraph shall apply to
requests for advisory opinions made after the date which
is 90 days after the date of the enactment of this paragraph
and before the close of the period described in section
1128D(b)(6).’’.
H. R. 2015—140
SEC. 4315. REPLACEMENT OF REASONABLE CHARGE METHODOLOGY
BY FEE SCHEDULES.
(a) APPLICATION OF FEE SCHEDULE.—Section 1842 (42 U.S.C.
1395u) is amended by adding at the end the following new sub-
section:
‘‘(s)(1) The Secretary may implement a statewide or other
areawide fee schedule to be used for payment of any item or
service described in paragraph (2) which is paid on a reasonable
charge basis. Any fee schedule established under this paragraph
for such item or service shall be updated each year by the percent-
age increase in the consumer price index for all urban consumers
(United States city average) for the 12-month period ending with
June of the preceding year, except that in no event shall a fee
schedule for an item described in paragraph (2)(D) be updated
before 2003.
‘‘(2) The items and services described in this paragraph are
as follows:
‘‘(A) Medical supplies.
‘‘(B) Home dialysis supplies and equipment (as defined
in section 1881(b)(8)).
‘‘(C) Therapeutic shoes.
‘‘(D) Parenteral and enteral nutrients, equipment, and sup-
plies.
‘‘(E) Electromyogram devices
‘‘(F) Salivation devices.
‘‘(G) Blood products.
‘‘(H) Transfusion medicine.’’.
(b) CONFORMING AMENDMENT.—Section 1833(a)(1) (42 U.S.C.
1395l(a)(1)) is amended—
(A) by striking ‘‘and (P)’’ and inserting ‘‘(P)’’; and
(B) by striking the semicolon at the end and inserting
the following: ‘‘, and (Q) with respect to items or services
for which fee schedules are established pursuant to section
1842(s), the amounts paid shall be 80 percent of the lesser
of the actual charge or the fee schedule established in
such section;’’.
(c) EFFECTIVE DATES.—The amendments made by this section
to the extent such amendments substitute fee schedules for reason-
able charges, shall apply to particular services as of the date speci-
fied by the Secretary of Health and Human Services.
(d) INITIAL BUDGET NEUTRALITY.—The Secretary, in developing
a fee schedule for particular services (under the amendments made
by this section), shall set amounts for the first year period to
which the fee schedule applies at a level so that the total payments
under title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) for those services for that year period shall be approximately
equal to the estimated total payments if such fee schedule had
not been implemented.
SEC. 4316. APPLICATION OF INHERENT REASONABLENESS TO ALL
PART B SERVICES OTHER THAN PHYSICIANS’ SERVICES.
(a) IN GENERAL.—Paragraphs (8) and (9) of section 1842(b)
(42 U.S.C. 1395u(b)) are amended to read as follows:
‘‘(8)(A)(i) The Secretary shall by regulation—
‘‘(I) describe the factors to be used in determining the
cases (of particular items or services) in which the application
of this part (other than to physicians’ services paid under
H. R. 2015—141
section 1848) results in the determination of an amount that,
because of its being grossly excessive or grossly deficient, is
not inherently reasonable, and
‘‘(II) provide in those cases for the factors to be considered
in determining an amount that is realistic and equitable.
‘‘(ii) Notwithstanding the determination made in clause (i),
the Secretary may not apply factors that would increase or decrease
the payment under this part during any year for any particular
item or service by more than 15 percent from such payment during
the preceding year except as provided in subparagraph (B).
‘‘(B) The Secretary may make a determination under this
subparagraph that would result in an increase or decrease under
subparagraph (A) of more than 15 percent of the payment amount
for a year, but only if—
‘‘(i) the Secretary’s determination takes into account the
factors described in subparagraph (C) and any additional factors
the Secretary determines appropriate,
‘‘(ii) the Secretary’s determination takes into account the
potential impacts described in subparagraph (D), and
‘‘(iii) the Secretary complies with the procedural require-
ments of paragraph (9).
‘‘(C) The factors described in this subparagraph are as follows:
‘‘(i) The programs established under this title and title
XIX are the sole or primary sources of payment for an item
or service.
‘‘(ii) The payment amount does not reflect changing tech-
nology, increased facility with that technology, or reductions
in acquisition or production costs.
‘‘(iii) The payment amount for an item or service under
this part is substantially higher or lower than the payment
made for the item or service by other purchasers.
‘‘(D) The potential impacts of a determination under subpara-
graph (B) on quality, access, and beneficiary liability, including
the likely effects on assignment rates and participation rates.
‘‘(9)(A) The Secretary shall consult with representatives of
suppliers or other individuals who furnish an item or service before
making a determination under paragraph (8)(B) with regard to
that item or service.
‘‘(B) The Secretary shall publish notice of a proposed determina-
tion under paragraph (8)(B) in the Federal Register—
‘‘(i) specifying the payment amount proposed to be estab-
lished with respect to an item or service,
‘‘(ii) explaining the factors and data that the Secretary
took into account in determining the payment amount so speci-
fied, and
‘‘(iii) explaining the potential impacts described in para-
graph (8)(D).
‘‘(C) After publication of the notice required by subparagraph
(B), the Secretary shall allow not less than 60 days for public
comment on the proposed determination.
‘‘(D)(i) Taking into consideration the comments made by the
public, the Secretary shall publish in the Federal Register a final
determination under paragraph (8)(B) with respect to the payment
amount to be established with respect to the item or service.
‘‘(ii) A final determination published pursuant to clause (i)
shall explain the factors and data that the Secretary took into
consideration in making the final determination.’’.