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that are complaints regarding the lack of access by the 
individual to prescription drugs due to a drug manage-
ment program for at-risk beneficiaries.’’. 
(e) SENSE OF CONGRESS REGARDING USE OF TECH-
NOLOGY TOOLS TO COMBAT FRAUD.—It is the sense of 
Congress that MA organizations and PDP sponsors 
should consider using e-prescribing and other health infor-
mation technology tools to support combating fraud under 
MA–PD plans and prescription drug plans under parts C 
and D of the Medicare Program. 
(f) EFFECTIVE DATE.— 
(1) IN GENERAL.—The amendments made by 
this section shall apply to prescription drug plans 
(and MA–PD plans) for plan years beginning more 
than 1 year after the date of the enactment of this 
Act. 
(2) STAKEHOLDER MEETINGS PRIOR TO EFFEC-
TIVE DATE.— 
(A) IN GENERAL.—Not later than January 
1, 2016, the Secretary of Health and Human 
Services shall convene stakeholders, including 
individuals entitled to benefits under part A of 
title XVIII of the Social Security Act or en-
rolled under part B of such title of such Act, 
advocacy groups representing such individuals, 
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physicians, pharmacists, and other clinicians, 
retail pharmacies, plan sponsors, entities dele-
gated by plan sponsors, and biopharmaceutical 
manufacturers for input regarding the topics 
described in subparagraph (B). 
(B) TOPICS DESCRIBED.—The topics de-
scribed in this subparagraph are the topics of— 
(i) the anticipated impact of drug 
management programs for at-risk bene-
ficiaries under paragraph (5) of section 
1860D–4(c) of the Social Security Act (42 
U.S.C. 1395w–104(c)) on cost-sharing and 
ensuring accessibility to prescription drugs 
for enrollees in prescription drug plans of 
PDP sponsors, and enrollees in MA–PD 
plans, who are at-risk beneficiaries for pre-
scription drug abuse (as defined in sub-
paragraph (C) of such paragraph); 
(ii) the use of an expedited appeals 
process under which such an enrollee may 
appeal an identification of such enrollee as 
an at-risk beneficiary for prescription drug 
abuse under such paragraph (similar to the 
processes established under the Medicare 
Advantage program under part C of title 
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XVIII of the Social Security Act that allow 
an automatic escalation to external review 
of claims submitted under such part); 
(iii) the types of enrollees that should 
be treated as exempted individuals, as de-
scribed in subparagraph (C)(ii) of such 
paragraph; 
(iv) the manner in which terms and 
definitions in such paragraph should be ap-
plied, such as the use of clinical appro-
priateness in determining whether an en-
rollee is an at-risk beneficiary for prescrip-
tion drug abuse as defined in subpara-
graph (C) of such paragraph; 
(v) the information to be included in 
the notices described in subparagraph (B) 
of such paragraph and the standardization 
of such notices; and 
(vi) with respect to a PDP sponsor 
(or Medicare Advantage organization) that 
establishes a drug management program 
for at-risk beneficiaries under such para-
graph, the responsibilities of such PDP 
sponsor (or organization) with respect to 
the implementation of such program. 
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(g) RULEMAKING.—The Secretary of Health and 
Human Services shall promulgate regulations based on the 
input gathered pursuant to subsection (f)(2)(A). 
TITLE 
IV—MEDICAID, 
MEDI-
CARE, AND OTHER REFORMS 
Subtitle A—Medicaid and Medicare 
Reforms 
SEC. 4001. LIMITING FEDERAL MEDICAID REIMBURSEMENT 
TO STATES FOR DURABLE MEDICAL EQUIP-
MENT (DME) TO MEDICARE PAYMENT RATES. 
(a) MEDICAID REIMBURSEMENT.— 
(1) IN GENERAL.—Section 1903(i) of the Social 
Security Act (42 U.S.C. 1396b(i)) is amended— 
(A) in paragraph (25), by striking ‘‘or’’ at 
the end; 
(B) in paragraph (26), by striking the pe-
riod at the end and inserting ‘‘; or’’; and 
(C) by inserting after paragraph (26) the 
following new paragraph: 
‘‘(27) with respect to any amounts expended by 
the State on the basis of a fee schedule for items de-
scribed in section 1861(n), as determined in the ag-
gregate with respect to each class of such items as 
defined by the Secretary, in excess of the aggregate 
amount, if any, that would be paid for such items 
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within such class on a fee-for-service basis under the 
program under part B of title XVIII, including, as 
applicable, under a competitive acquisition program 
under section 1847 in an area of the State.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall be effective with respect to 
payments for items furnished on or after January 1, 
2020. 
(b) MEDICARE OMBUDSMAN.—Section 1808(c) of the 
Social Security Act (42 U.S.C. 1395b(c)), as amended by 
section 3101, is further amended by adding at the end 
the following new paragraph: 
‘‘(5) 
MONITORING
DME
REIMBURSEMENT 
UNDER MEDICAID.—The ombudsmen under each of 
paragraphs (1) and (4) shall evaluate the impact of 
the competitive acquisition program under section 
1847, 
including 
as 
applied 
under 
section 
1903(i)(27), on beneficiary health status and health 
outcomes.’’. 
SEC. 4002. EXCLUDING AUTHORIZED GENERICS FROM CAL-
CULATION 
OF 
AVERAGE 
MANUFACTURER 
PRICE. 
(a) IN GENERAL.—Subparagraph (C) of section 
1927(k)(1) of the Social Security Act (42 U.S.C. 1396r– 
8(k)(1)) is amended— 
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(1) in the subparagraph heading, by striking 
‘‘INCLUSION’’ and inserting ‘‘EXCLUSION’’; 
(2) by striking ‘‘a new drug application’’ and 
inserting ‘‘the manufacturer’s new drug applica-
tion’’; and 
(3) by striking ‘‘inclusive’’ and inserting ‘‘exclu-
sive’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section take effect on October 1, 2015. 
SEC. 4003. MEDICARE PAYMENT INCENTIVE FOR THE TRAN-
SITION FROM TRADITIONAL X-RAY IMAGING 
TO 
DIGITAL 
RADIOGRAPHY 
AND 
OTHER 
MEDICARE IMAGING PAYMENT PROVISION. 
(a) PHYSICIAN FEE SCHEDULE.— 
(1) PAYMENT INCENTIVE FOR TRANSITION.— 
(A) IN GENERAL.—Section 1848(b) of the 
Social Security Act (42 U.S.C. 1395w–4(b)) is 
amended by adding at the end the following 
new paragraph: 
‘‘(9) SPECIAL RULE TO INCENTIVIZE TRANSI-
TION FROM TRADITIONAL X-RAY IMAGING TO DIG-
ITAL RADIOGRAPHY.— 
‘‘(A) LIMITATION ON PAYMENT FOR FILM 
X-RAY IMAGING SERVICES.—In the case of an 
imaging service (including the imaging portion 
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of a service) that is an X-ray taken using film 
and that is furnished during 2017 or a subse-
quent year, the payment amount for the tech-
nical component (including the technical compo-
nent portion of a global service) of such service 
that would otherwise be determined under this 
section (without application of this paragraph 
and before application of any other adjustment 
under this section) for such year shall be re-
duced by 20 percent. 
‘‘(B) PHASED-IN LIMITATION ON PAYMENT 
FOR COMPUTED RADIOGRAPHY IMAGING SERV-
ICES.—In the case of an imaging service (in-
cluding the imaging portion of a service) that is 
an X-ray taken using computed radiography 
technology— 
‘‘(i) in the case of such a service fur-
nished during 2018, 2019, 2020, 2021, or 
2022, the payment amount for the tech-
nical component (including the technical 
component portion of a global service) of 
such service that would otherwise be deter-
mined under this section (without applica-
tion of this paragraph and before applica-
tion of any other adjustment under this 
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section) for such year shall be reduced by 
7 percent; and 
‘‘(ii) in the case of such a service fur-
nished during 2023 or a subsequent year, 
the payment amount for the technical com-
ponent (including the technical component 
portion of a global service) of such service 
that would otherwise be determined under 
this section (without application of this 
paragraph and before application of any 
other adjustment under this section) for 
such year shall be reduced by 10 percent. 
‘‘(C) COMPUTED
RADIOGRAPHY
TECH-
NOLOGY DEFINED.—For purposes of this para-
graph, the term ‘computed radiography tech-
nology’ means cassette-based imaging which 
utilizes an imaging plate to create the image in-
volved. 
‘‘(D) IMPLEMENTATION.—In order to im-
plement this paragraph, the Secretary shall 
adopt appropriate mechanisms which may in-
clude use of modifiers.’’. 
(B) EXEMPTION
FROM
BUDGET
NEU-
TRALITY.—Section 1848(c)(2)(B)(v) of the So-
cial 
Security 
Act 
(42 
U.S.C. 
1395w– 
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4(c)(2)(B)(v)) is amended by adding at the end 
the following new subclause: 
‘‘(X) REDUCED
EXPENDITURES 
ATTRIBUTABLE
TO
INCENTIVES
TO 
TRANSITION
TO
DIGITAL
RADIOG-
RAPHY.—Effective for fee schedules 
established beginning with 2017, re-
duced expenditures attributable to 
subparagraph (A) of subsection (b)(9) 
and effective for fee schedules estab-
lished beginning with 2018, reduced 
expenditures attributable to subpara-
graph (B) of such subsection.’’. 
(2) ELIMINATION
OF
APPLICATION
OF
MUL-
TIPLE PROCEDURE PAYMENT REDUCTION.— 
(A) IN GENERAL.—Section 1848(b)(4) of 
the Social Security Act (42 U.S.C. 1395w– 
4(b)(4)) is amended by adding at the end the 
following new subparagraph: 
‘‘(E) ELIMINATION
OF
APPLICATION
OF 
MULTIPLE
PROCEDURE
PAYMENT
REDUC-
TION.— 
‘‘(i) IN GENERAL.—For services fur-
nished on or after January 1, 2017, the 
Secretary shall not apply a multiple proce-
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dure payment reduction to the professional 
component of imaging services unless the 
Secretary has published as part of a Medi-
care Physician Fee Schedule Proposed 
Rule the empirical analysis described in 
clause (ii) with tables made available on 
the website of the Centers for Medicare & 
Medicaid Services. 
‘‘(ii) 
EMPIRICAL
ANALYSIS
DE-
SCRIBED.—The 
empirical 
analysis 
de-
scribed in this clause is an analysis of the 
Resource-Based Relative Value Scale Data 
Manager information or other information 
that is used to determine what, if any, effi-
ciencies exist within the professional com-
ponent of imaging services when two or 
more studies are furnished to the same in-
dividual on the same day. Such empirical 
analysis shall include— 
‘‘(I) information detailing which 
physician work activities overlap and 
the reductions applicable to such over-
lap; 
‘‘(II) a discussion of the clinical 
aspects that informed the assignment 
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of the reduction percentages described 
in subclause (I); 
‘‘(III) to the extent that such re-
ductions are used for proposed pay-
ment reductions, an explanation of 
how the percentage reductions for pre- 
service, intra-service, and post-service 
work were determined and calculated; 
‘‘(IV) other data used to deter-
mine a reduction; and 
‘‘(V) a demonstration that the 
Secretary has consulted with prac-
ticing radiologists to gain knowledge 
of how radiologists interpret studies of 
multiple body parts on the same indi-
vidual on the same day.’’. 
(B) CONFORMING
AMENDMENT.—Section 
220(i) of the Protecting Access to Medicare Act 
of 2014 (42 U.S.C. 1395w–4 note) is repealed. 
(b) PAYMENT INCENTIVE FOR TRANSITION UNDER 
HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT SYS-
TEM.—Section 1833(t)(16) of the Social Security Act (42 
U.S.C. 1395(t)(16)) is amended by adding at the end the 
following new subparagraph: 
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‘‘(F) PAYMENT INCENTIVE FOR THE TRAN-
SITION FROM TRADITIONAL X-RAY IMAGING TO 
DIGITAL
RADIOGRAPHY.—Notwithstanding the 
previous provisions of this subsection: 
‘‘(i) LIMITATION
ON
PAYMENT
FOR 
FILM
X-RAY
IMAGING
SERVICES.—In the 
case of an imaging service that is an X-ray 
taken using film and that is furnished dur-
ing 2017 or a subsequent year, the pay-
ment amount for such service (including 
the X-ray component of a packaged serv-
ice) that would otherwise be determined 
under this section (without application of 
this paragraph and before application of 
any other adjustment under this sub-
section) for such year shall be reduced by 
20 percent. 
‘‘(ii) PHASED-IN LIMITATION ON PAY-
MENT FOR COMPUTED RADIOGRAPHY IM-
AGING SERVICES.—In the case of an imag-
ing service that is an X-ray taken using 
computed radiography technology (as de-
fined in section 1848(b)(9)(C))— 
‘‘(I) in the case of such a service 
furnished during 2018, 2019, 2020, 
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2021, or 2022, the payment amount 
for such service (including the X-ray 
component of a packaged service) that 
would otherwise be determined under 
this section (without application of 
this paragraph and before application 
of any other adjustment under this 
subsection) for such year shall be re-
duced by 7 percent; and 
‘‘(II) in the case of such a service 
furnished during 2023 or a subse-
quent year, the payment amount for 
such service (including the X-ray com-
ponent of a packaged service) that 
would otherwise be determined under 
this section (without application of 
this paragraph and before application 
of any other adjustment under this 
subsection) for such year shall be re-
duced by 10 percent. 
‘‘(iii) APPLICATION WITHOUT REGARD 
TO BUDGET NEUTRALITY.—The reductions 
made under this paragraph— 
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‘‘(I) shall not be considered an 
adjustment under paragraph (2)(E); 
and 
‘‘(II) shall not be implemented in 
a budget neutral manner. 
‘‘(iv) IMPLEMENTATION.—In order to 
implement this subparagraph, the Sec-
retary shall adopt appropriate mechanisms 
which may include use of modifiers.’’. 
SEC. 4004. 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 on or after 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, and before January 1, 2017’’; and 
(ii) by striking ‘‘for such drug’’. 
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SEC. 4005. EXTENSION AND EXPANSION OF PRIOR AUTHOR-
IZATION FOR POWER MOBILITY DEVICES 
(PMDS) AND ACCESSORIES AND PRIOR AU-
THORIZATION AUDIT LIMITATIONS. 
Section 1834(a) of the Social Security Act (42 U.S.C. 
1395m(a)) is amended— 
(1) in paragraph (15), by adding at the end the 
following new subparagraph: 
‘‘(D) LIMITATION ON AUDITS AFTER AD-
VANCE DETERMINATION.—A claim for an item 
that has received a provisional affirmation 
under an advance determination under this 
paragraph or a prior authorization under para-
graph (23) shall not be subject to review under 
section 1893(h) but may be subject to audits 
for potential fraud, inappropriate utilization, 
changes in billing patterns, or information that 
could not have been considered during the ad-
vance determination (such as proof of item de-
livery).’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(23) PRIOR AUTHORIZATION FOR POWER MO-
BILITY
DEVICES
(PMDS)
AND
ACCESSORIES.—Not 
later than 90 days after the date of the enactment 
of this paragraph, the Secretary shall, using funds 
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provided under paragraph (2) of section 402(a) of 
the Social Security Amendments of 1967 and other 
funds available to the Secretary— 
‘‘(A) extend at least through August 31, 
2018, the PMD Prior Authorization Dem-
onstration (being conducted under paragraph 
(1)(J) of such section); 
‘‘(B) begin to expand, as appropriate, such 
demonstration to include additional power mo-
bility devices and accessories as part of initial 
claims for payment under this part for such de-
vices; and 
‘‘(C) begin to expand such demonstration 
to such additional States or geographic areas as 
may be appropriate.’’. 
SEC. 4006. 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, 
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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 
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 
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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 
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 
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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): 
‘‘(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 
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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. 
‘‘(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— 
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‘‘(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. 
‘‘(7) The term ‘specified State agency’ means 
an agency of a State government established or des-
ignated to administer or supervise the administra-
tion of a grant, contract, or other agreement funded 
in whole or in part by the Secretary of Health and 
Human Services. 
‘‘(s) For purposes of subsection (o), the term ‘obliga-
tion’ means an established duty, whether or not fixed, aris-
ing from an express or implied contractual, grantor-grant-
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ee, or licensor-licensee relationship, for a fee-based or 
similar relationship, from statute or regulation, or from 
the retention of any overpayment.’’. 
(b) CONFORMING AMENDMENTS.—Section 1128A of 
the Social Security Act (42 U.S.C. 1320a–7a) is amend-
ed— 
(1) in subsection (d)— 
(A) in paragraph (1), by inserting ‘‘or 
specified claims’’ after ‘‘claims’’; and 
(B) in paragraph (2), by inserting ‘‘or 
specified claims’’ after ‘‘claims’’; 
(2) in subsection (e), by inserting ‘‘or specified 
claim’’ after ‘‘claim’’; and 
(3) in subsection (f)— 
(A) by inserting ‘‘or specified claim (as de-
fined in subsection (r)(6))’’ after ‘‘district 
where the claim’’; 
(B) by inserting ‘‘(or, with respect to a 
person described in subsection (o), the person)’’ 
after ‘‘claimant’’; 
(C) by inserting ‘‘that are not received by 
the Inspector General of the Department of 
Health and Human Services under subsection 
(q) as reimbursement’’ after ‘‘amounts recov-
ered’’; and 
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(D) by inserting ‘‘(or, in the case of a pen-
alty or assessment under subsection (o), by a 
specified State agency (as defined in subsection 
(r)(7))’’ after ‘‘or a State agency’’. 
Subtitle B—Other Reforms 
SEC. 4041. SPR DRAWDOWN. 
(a) DRAWDOWN AND SALE.—Notwithstanding sec-
tion 161 of the Energy Policy and Conservation Act (42 
U.S.C. 6241), except as provided in subsection (b) the 
Secretary of Energy shall draw down and sell— 
(1) 4 million barrels of crude oil from the Stra-
tegic Petroleum Reserve during fiscal year 2018; 
(2) 5 million barrels of crude oil from the Stra-
tegic Petroleum Reserve during fiscal year 2019; 
(3) 8 million barrels of crude oil from the Stra-
tegic Petroleum Reserve during fiscal year 2020; 
(4) 8 million barrels of crude oil from the Stra-
tegic Petroleum Reserve during fiscal year 2021; 
(5) 10 million barrels of crude oil from the 
Strategic Petroleum Reserve during fiscal year 
2022; 
(6) 15 million barrels of crude oil from the 
Strategic Petroleum Reserve during fiscal year 
2023; 
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