H. R. 3103—72
(b) AGREEMENTS WITH PEER REVIEW ORGANIZATIONS.—Section
1876(i)(7)(A) (42 U.S.C. 1395mm(i)(7)(A)) is amended by striking
‘‘an agreement’’ and inserting ‘‘a written agreement’’.
(c) EFFECTIVE DATE.—The amendments made by this section
shall apply with respect to contract years beginning on or after
January 1, 1997.
SEC. 216. ADDITIONAL EXCEPTION TO ANTI-KICKBACK PENALTIES
FOR RISK-SHARING ARRANGEMENTS.
(a) IN
GENERAL.—Section 1128B(b)(3) (42 U.S.C. 1320a–
7b(b)(3)) is amended—
(1) by striking ‘‘and’’ at the end of subparagraph (D);
(2) by striking the period at the end of subparagraph (E)
and inserting ‘‘; and’’; and
(3) by adding at the end the following new subparagraph:
‘‘(F) any remuneration between an organization and an
individual or entity providing items or services, or a combina-
tion thereof, pursuant to a written agreement between the
organization and the individual or entity if the organization
is an eligible organization under section 1876 or if the written
agreement, through a risk-sharing arrangement, places the
individual or entity at substantial financial risk for the cost
or utilization of the items or services, or a combination thereof,
which the individual or entity is obligated to provide.’’.
(b) NEGOTIATED RULEMAKING FOR RISK-SHARING EXCEPTION.—
(1) ESTABLISHMENT.—
(A) IN GENERAL.—The Secretary of Health and Human
Services (in this subsection referred to as the ‘‘Secretary’’)
shall establish, on an expedited basis and using a nego-
tiated rulemaking process under subchapter 3 of chapter
5 of title 5, United States Code, standards relating to
the exception for risk-sharing arrangements to the anti-
kickback penalties described in section 1128B(b)(3)(F) of
the Social Security Act, as added by subsection (a).
(B) FACTORS TO CONSIDER.—In establishing standards
relating to the exception for risk-sharing arrangements
to the anti-kickback penalties under subparagraph (A), the
Secretary—
(i) shall consult with the Attorney General and
representatives of the hospital, physician, other health
practitioner, and health plan communities, and other
interested parties; and
(ii) shall take into account—
(I) the level of risk appropriate to the size
and type of arrangement;
(II) the frequency of assessment and distribu-
tion of incentives;
(III) the level of capital contribution; and
(IV) the extent to which the risk-sharing
arrangement provides incentives to control the cost
and quality of health care services.
(2) PUBLICATION
OF
NOTICE.—In carrying out the rule-
making process under this subsection, the Secretary shall pub-
lish the notice provided for under section 564(a) of title 5,
United States Code, by not later than 45 days after the date
of the enactment of this Act.
H. R. 3103—73
(3) TARGET DATE FOR PUBLICATION OF RULE.—As part of
the notice under paragraph (2), and for purposes of this sub-
section, the ‘‘target date for publication’’ (referred to in section
564(a)(5) of such title) shall be January 1, 1997.
(4) ABBREVIATED PERIOD FOR SUBMISSION OF COMMENTS.—
In applying section 564(c) of such title under this subsection,
‘‘15 days’’ shall be substituted for ‘‘30 days’’.
(5) APPOINTMENT OF NEGOTIATED RULEMAKING COMMITTEE
AND FACILITATOR.—The Secretary shall provide for—
(A) the appointment of a negotiated rulemaking
committee under section 565(a) of such title by not later
than 30 days after the end of the comment period provided
for under section 564(c) of such title (as shortened under
paragraph (4)), and
(B) the nomination of a facilitator under section 566(c)
of such title by not later than 10 days after the date
of appointment of the committee.
(6) PRELIMINARY COMMITTEE REPORT.—The negotiated rule-
making committee appointed under paragraph (5) shall report
to the Secretary, by not later than October 1, 1996, regarding
the committee’s progress on achieving a consensus with regard
to the rulemaking proceeding and whether such consensus is
likely to occur before one month before the target date for
publication of the rule. If the committee reports that the
committee has failed to make significant progress toward such
consensus or is unlikely to reach such consensus by the target
date, the Secretary may terminate such process and provide
for the publication of a rule under this subsection through
such other methods as the Secretary may provide.
(7) FINAL
COMMITTEE
REPORT.—If the committee is not
terminated under paragraph (6), the rulemaking committee
shall submit a report containing a proposed rule by not later
than one month before the target publication date.
(8) INTERIM, FINAL EFFECT.—The Secretary shall publish
a rule under this subsection in the Federal Register by not
later than the target publication date. Such rule shall be effec-
tive and final immediately on an interim basis, but is subject
to change and revision after public notice and opportunity
for a period (of not less than 60 days) for public comment.
In connection with such rule, the Secretary shall specify the
process for the timely review and approval of applications of
entities to be certified as provider-sponsored organizations
pursuant to such rules and consistent with this subsection.
(9) PUBLICATION OF RULE AFTER PUBLIC COMMENT.—The
Secretary shall provide for consideration of such comments
and republication of such rule by not later than 1 year after
the target publication date.
(c) EFFECTIVE DATE.—The amendments made by subsection
(a) shall apply to written agreements entered into on or after
January 1, 1997, without regard to whether regulations have been
issued to implement such amendments.
SEC. 217. CRIMINAL PENALTY FOR FRAUDULENT DISPOSITION OF
ASSETS IN ORDER TO OBTAIN MEDICAID BENEFITS.
Section 1128B(a) (42 U.S.C. 1320a–7b(a)) is amended—
(1) by striking ‘‘or’’ at the end of paragraph (4);
(2) by adding ‘‘or’’ at the end of paragraph (5); and
H. R. 3103—74
(3) by inserting after paragraph (5) the following new para-
graph:
‘‘(6) knowingly and willfully disposes of assets (including
by any transfer in trust) in order for an individual to become
eligible for medical assistance under a State plan under title
XIX, if disposing of the assets results in the imposition of
a period of ineligibility for such assistance under section
1917(c),’’.
SEC. 218. EFFECTIVE DATE.
Except as otherwise provided, the amendments made by this
subtitle shall take effect January 1, 1997.
Subtitle C—Data Collection
SEC. 221. ESTABLISHMENT OF THE HEALTH CARE FRAUD AND ABUSE
DATA COLLECTION PROGRAM.
(a) IN GENERAL.—Title XI (42 U.S.C. 1301 et seq.), as amended
by sections 201 and 205, is amended by inserting after section
1128D the following new section:
‘‘HEALTH CARE FRAUD AND ABUSE DATA COLLECTION PROGRAM
‘‘SEC. 1128E. (a) GENERAL PURPOSE.—Not later than January
1, 1997, the Secretary shall establish a national health care fraud
and abuse data collection program for the reporting of final adverse
actions (not including settlements in which no findings of liability
have been made) against health care providers, suppliers, or
practitioners as required by subsection (b), with access as set forth
in subsection (c), and shall maintain a database of the information
collected under this section.
‘‘(b) REPORTING OF INFORMATION.—
‘‘(1) IN GENERAL.—Each Government agency and health
plan shall report any final adverse action (not including settle-
ments in which no findings of liability have been made) taken
against a health care provider, supplier, or practitioner.
‘‘(2) INFORMATION TO BE REPORTED.—The information to
be reported under paragraph (1) includes:
‘‘(A) The name and TIN (as defined in section
7701(a)(41) of the Internal Revenue Code of 1986) of any
health care provider, supplier, or practitioner who is the
subject of a final adverse action.
‘‘(B) The name (if known) of any health care entity
with which a health care provider, supplier, or practitioner,
who is the subject of a final adverse action, is affiliated
or associated.
‘‘(C) The nature of the final adverse action and whether
such action is on appeal.
‘‘(D) A description of the acts or omissions and injuries
upon which the final adverse action was based, and such
other information as the Secretary determines by regula-
tion is required for appropriate interpretation of informa-
tion reported under this section.
‘‘(3) CONFIDENTIALITY.—In determining what information
is required, the Secretary shall include procedures to assure
that the privacy of individuals receiving health care services
is appropriately protected.
H. R. 3103—75
‘‘(4) TIMING
AND
FORM
OF
REPORTING.—The information
required to be reported under this subsection shall be reported
regularly (but not less often than monthly) and in such form
and manner as the Secretary prescribes. Such information shall
first be required to be reported on a date specified by the
Secretary.
‘‘(5) TO WHOM REPORTED.—The information required to be
reported under this subsection shall be reported to the Sec-
retary.
‘‘(c) DISCLOSURE AND CORRECTION OF INFORMATION.—
‘‘(1) DISCLOSURE.—With respect to the information about
final adverse actions (not including settlements in which no
findings of liability have been made) reported to the Secretary
under this section with respect to a health care provider, sup-
plier, or practitioner, the Secretary shall, by regulation, provide
for—
‘‘(A) disclosure of the information, upon request, to
the health care provider, supplier, or licensed practitioner,
and
‘‘(B) procedures in the case of disputed accuracy of
the information.
‘‘(2) CORRECTIONS.—Each Government agency and health
plan shall report corrections of information already reported
about any final adverse action taken against a health care
provider, supplier, or practitioner, in such form and manner
that the Secretary prescribes by regulation.
‘‘(d) ACCESS TO REPORTED INFORMATION.—
‘‘(1) AVAILABILITY.—The information in the database main-
tained under this section shall be available to Federal and
State government agencies and health plans pursuant to proce-
dures that the Secretary shall provide by regulation.
‘‘(2) FEES FOR DISCLOSURE.—The Secretary may establish
or approve reasonable fees for the disclosure of information
in such database (other than with respect to requests by Federal
agencies). The amount of such a fee shall be sufficient to
recover the full costs of operating the database. Such fees
shall be available to the Secretary or, in the Secretary’s discre-
tion to the agency designated under this section to cover such
costs.
‘‘(e) PROTECTION FROM LIABILITY FOR REPORTING.—No person
or entity, including the agency designated by the Secretary in
subsection (b)(5) shall be held liable in any civil action with respect
to any report made as required by this section, without knowledge
of the falsity of the information contained in the report.
‘‘(f) COORDINATION
WITH
NATIONAL
PRACTITIONER
DATA
BANK.—The Secretary shall implement this section in such a man-
ner as to avoid duplication with the reporting requirements estab-
lished for the National Practitioner Data Bank under the Health
Care Quality Improvement Act of 1986 (42 U.S.C. 11101 et seq.).
‘‘(g) DEFINITIONS AND SPECIAL RULES.—For purposes of this
section:
‘‘(1) FINAL ADVERSE ACTION.—
‘‘(A) IN
GENERAL.—The term ‘final adverse action’
includes:
‘‘(i) Civil judgments against a health care provider,
supplier, or practitioner in Federal or State court
related to the delivery of a health care item or service.