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such program to a newly eligible Medicare bene-
ficiary on or after January 1, 2020. 
‘‘(4) TREATMENT OF REFERENCES TO CERTAIN 
POLICIES.—In the case of a newly eligible Medicare 
beneficiary, except as the Secretary may otherwise 
provide, any reference in this section to a medicare 
supplemental policy which has a benefit package 
classified as ‘C’ or ‘F’ shall be deemed, as of Janu-
ary 1, 2020, to be a reference to a medicare supple-
mental policy which has a benefit package classified 
as ‘D’ or ‘G’, respectively. 
‘‘(5) ENFORCEMENT.—The penalties described 
in clause (ii) of subsection (d)(3)(A) shall apply with 
respect to a violation of paragraph (1) in the same 
manner as it applies to a violation of clause (i) of 
such subsection.’’. 
SEC. 402. INCOME-RELATED PREMIUM ADJUSTMENT FOR 
PARTS B AND D. 
(a) IN GENERAL.—Section 1839(i)(3)(C)(i) of the 
Social Security Act (42 U.S.C. 1395r(i)(3)(C)(i)) is 
amended— 
(1) by inserting after ‘‘IN GENERAL.—’’ the fol-
lowing: 
‘‘(I) Subject to paragraphs (5) 
and (6), for years before 2018:’’; and 
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(2) by adding at the end the following: 
‘‘(II) Subject to paragraph (5), 
for years beginning with 2018: 
‘‘If the modified adjusted gross income is: 
The applicable 
percentage is:
More than $85,000 but not more than $107,000 ......
35 percent
More than $107,000 but not more than $133,500 ....
50 percent
More than $133,500 but not more than $160,000 ....
65 percent
More than $160,000 ...................................................
80 percent.’’. 
(b) CONFORMING AMENDMENTS.—Section 1839(i) of 
the Social Security Act (42 U.S.C. 1395r(i)) is amended— 
(1) in paragraph (2)(A), by inserting ‘‘(or, be-
ginning with 2018, $85,000)’’ after ‘‘$80,000’’; 
(2) in paragraph (3)(A)(i), by inserting ‘‘appli-
cable’’ before ‘‘table’’; 
(3) in paragraph (5)(A)— 
(A) in the matter before clause (i), by in-
serting ‘‘(other than 2018 and 2019)’’ after 
‘‘2007’’; and 
(B) in clause (ii), by inserting ‘‘(or, in the 
case of a calendar year beginning with 2020, 
August 2018)’’ after ‘‘August 2006’’; and 
(4) in paragraph (6), in the matter before sub-
paragraph (A), by striking ‘‘2019’’ and inserting 
‘‘2017’’. 
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Subtitle B—Other Offsets 
SEC. 411. MEDICARE PAYMENT UPDATES FOR POST-ACUTE 
PROVIDERS. 
(a) SNFS.—Section 1888(e) of the Social Security 
Act (42 U.S.C. 1395yy(e))— 
(1) in paragraph (5)(B)— 
(A) in clause (i), by striking ‘‘clause (ii)’’ 
and inserting ‘‘clauses (ii) and (iii)’’; 
(B) in clause (ii), by inserting ‘‘subject to 
clause (iii),’’ after ‘‘each subsequent fiscal 
year,’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(iii) SPECIAL
RULE
FOR
FISCAL 
YEAR 2018.—For fiscal year 2018 (or other 
similar annual period specified in clause 
(i)), the skilled nursing facility market bas-
ket percentage, after application of clause 
(ii), is equal to 1 percent.’’; and 
(2) in paragraph (6)(A), by striking ‘‘paragraph 
(5)(B)(ii)’’ and inserting ‘‘clauses (ii) and (iii) of 
paragraph (5)(B)’’ each place it appears. 
(b) IRFS.—Section 1886(j) of the Social Security Act 
(42 U.S.C. 1395ww(j)) is amended— 
(1) in paragraph (3)(C)— 
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(A) in clause (i), by striking ‘‘clause (ii)’’ 
and inserting ‘‘clauses (ii) and (iii)’’; 
(B) in clause (ii), by striking ‘‘After’’ and 
inserting ‘‘Subject to clause (iii), after’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(iii) SPECIAL
RULE
FOR
FISCAL 
YEAR 2018.—The increase factor to be ap-
plied under this subparagraph for fiscal 
year 2018, after the application of clause 
(ii), shall be 1 percent.’’; and 
(2) in paragraph (7)(A)(i), by striking ‘‘para-
graph (3)(D)’’ and inserting ‘‘subparagraphs (C)(iii) 
and (D) of paragraph (3)’’. 
(c) HHAS.—Section 1895(b)(3)(B) of the Social Se-
curity Act (42 U.S.C. 1395fff(b)(3)(B)) is amended— 
(1) in clause (iii), by adding at the end the fol-
lowing: ‘‘Notwithstanding the previous sentence, the 
home health market basket percentage increase for 
2018 shall be 1 percent.’’; and 
(2) in clause (vi)(I), by inserting ‘‘(except 
2018)’’ after ‘‘each subsequent year’’. 
(d) HOSPICE.—Section 1814(i) of the Social Security 
Act (42 U.S.C. 1395f(i)) is amended— 
(1) in paragraph (1)(C)— 
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(A) in clause (ii)(VII), by striking ‘‘clause 
(iv),,’’ and inserting ‘‘clauses (iv) and (vi),’’; 
(B) in clause (iii), by striking ‘‘clause 
(iv),’’ and inserting ‘‘clauses (iv) and (vi),’’; 
(C) in clause (iv), by striking ‘‘After deter-
mining’’ and inserting ‘‘Subject to clause (vi), 
after determining’’; and 
(D) by adding at the end the following new 
clause: 
‘‘(vi) For fiscal year 2018, the market basket per-
centage increase under clause (ii)(VII) or (iii), as applica-
ble, after application of clause (iv), shall be 1 percent.’’; 
and 
(2) in paragraph (5)(A)(i), by striking ‘‘para-
graph (1)(C)(iv)’’ and inserting ‘‘clauses (iv) and 
(vi) of paragraph (1)(C)’’. 
(e) LTCHS.—Section 1886(m)(3) of the Social Secu-
rity Act (42 U.S.C. 1395ww(m)(3)) is amended— 
(1) in subparagraph (A), in the matter pre-
ceding clause (i), by striking ‘‘In implementing’’ and 
inserting ‘‘Subject to subparagraph (C), in imple-
menting’’; and 
(2) by adding at the end the following new sub-
paragraph: 
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‘‘(C) ADDITIONAL
SPECIAL
RULE.—For 
fiscal year 2018, the annual update under sub-
paragraph (A) for the fiscal year, after applica-
tion of clauses (i) and (ii) of subparagraph (A), 
shall be 1 percent.’’. 
SEC. 412. DELAY OF REDUCTION TO MEDICAID DSH ALLOT-
MENTS. 
Section 1923(f) of the Social Security Act (42 U.S.C. 
1396r–4(f)) is amended— 
(1) in paragraph (7)(A)— 
(A) in clause (i), by striking ‘‘2017 
through 2024’’ and inserting ‘‘2018 through 
2025’’; 
(B) by striking clause (ii) and inserting the 
following new clause: 
‘‘(ii) AGGREGATE REDUCTIONS.—The 
aggregate reductions in DSH allotments 
for all States under clause (i)(I) shall be 
equal to— 
‘‘(I) $2,000,000,000 for fiscal 
year 2018; 
‘‘(II) $3,000,000,000 for fiscal 
year 2019; 
‘‘(III) $4,000,000,000 for fiscal 
year 2020; 
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‘‘(IV) $5,000,000,000 for fiscal 
year 2021; 
‘‘(V) $6,000,000,000 for fiscal 
year 2022; 
‘‘(VI) $7,000,000,000 for fiscal 
year 2023; 
‘‘(VII) $8,000,000,000 for fiscal 
year 2024; and 
‘‘(VIII) $8,000,000,000 for fiscal 
year 2025.’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(v) DISTRIBUTION
OF
AGGREGATE 
REDUCTIONS.—The Secretary shall dis-
tribute the aggregate reductions under 
clause (ii) among States in accordance 
with subparagraph (B).’’; and 
(2) in paragraph (8), by striking ‘‘2024’’ and 
inserting ‘‘2025’’. 
SEC. 413. LEVY ON DELINQUENT PROVIDERS. 
(a) IN GENERAL.—Paragraph (3) of section 6331(h) 
of the Internal Revenue Code of 1986 is amended by strik-
ing ‘‘30 percent’’ and inserting ‘‘100 percent’’. 
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(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to payments made after 180 days 
after the date of the enactment of this Act. 
SEC. 414. ADJUSTMENTS TO INPATIENT HOSPITAL PAY-
MENT RATES. 
Section 7(b) of the TMA, Abstinence Education, and 
QI Programs Extension Act of 2007 (Public Law 110– 
90), as amended by section 631(b) of the American Tax-
payer Relief Act of 2012 (Public Law 112–240), is amend-
ed— 
(1) in paragraph (1)— 
(A) in the matter preceding subparagraph 
(A), by striking ‘‘, 2009, or 2010’’ and insert-
ing ‘‘or 2009’’; and 
(B) in subparagraph (B)— 
(i) in clause (i), by striking ‘‘and’’ at 
the end; 
(ii) in clause (ii), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(iii) by adding at the end the fol-
lowing new clause: 
‘‘(iii) make an additional adjustment to the 
standardized 
amounts 
under 
such 
section 
1886(d) of an increase of 0.5 percentage points 
for discharges occurring during each of fiscal 
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years 2018 through 2023 and not make the ad-
justment (estimated to be an increase of 3.2 
percent) that would otherwise apply for dis-
charges occurring during fiscal year 2018 by 
reason of the completion of the adjustments re-
quired under clause (ii).’’; 
(2) in paragraph (3)— 
(A) by striking ‘‘shall be construed’’ and 
all that follows through ‘‘providing authority’’ 
and inserting ‘‘shall be construed as providing 
authority’’; and 
(B) by inserting ‘‘and each succeeding fis-
cal year through fiscal year 2023’’ after 
‘‘2017’’; 
(3) by redesignating paragraphs (3) and (4) as 
paragraphs (4) and (5), respectively; and 
(4) by inserting after paragraph (2) the fol-
lowing new paragraph: 
‘‘(3) PROHIBITION.—The Secretary shall not 
make an additional prospective adjustment (esti-
mated to be a decrease of 0.55 percent) to the 
standardized amounts under such section 1886(d) to 
offset the amount of the increase in aggregate pay-
ments related to documentation and coding changes 
for discharges occurring during fiscal year 2010.’’. 
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TITLE V—MISCELLANEOUS 
Subtitle A—Protecting the 
Integrity of Medicare 
SEC. 501. PROHIBITION OF INCLUSION OF SOCIAL SECU-
RITY ACCOUNT NUMBERS ON MEDICARE 
CARDS. 
(a) IN GENERAL.—Section 205(c)(2)(C) of the Social 
Security Act (42 U.S.C. 405(c)(2)(C)) is amended— 
(1) by moving clause (x), as added by section 
1414(a)(2) of the Patient Protection and Affordable 
Care Act, 6 ems to the left; 
(2) by redesignating clause (x), as added by 
section 2(a)(1) of the Social Security Number Pro-
tection Act of 2010, and clause (xi) as clauses (xi) 
and (xii), respectively; and 
(3) by adding at the end the following new 
clause: 
‘‘(xiii) The Secretary of Health and Human Services, 
in consultation with the Commissioner of Social Security, 
shall establish cost-effective procedures to ensure that a 
Social Security account number (or derivative thereof) is 
not displayed, coded, or embedded on the Medicare card 
issued to an individual who is entitled to benefits under 
part A of title XVIII or enrolled under part B of title 
XVIII and that any other identifier displayed on such card 
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is not identifiable as a Social Security account number (or 
derivative thereof).’’. 
(b) IMPLEMENTATION.—In implementing clause (xiii) 
of section 205(c)(2)(C) of the Social Security Act (42 
U.S.C. 405(c)(2)(C)), as added by subsection (a)(3), the 
Secretary of Health and Human Services shall do the fol-
lowing: 
(1) IN
GENERAL.—Establish a cost-effective 
process that involves the least amount of disruption 
to, as well as necessary assistance for, Medicare 
beneficiaries and health care providers, such as a 
process that provides such beneficiaries with access 
to assistance through a toll-free telephone number 
and provides outreach to providers. 
(2) CONSIDERATION
OF
MEDICARE
BENE-
FICIARY
IDENTIFIED.—Consider implementing a 
process, similar to the process involving Railroad Re-
tirement Board beneficiaries, under which a Medi-
care beneficiary identifier which is not a Social Secu-
rity account number (or derivative thereof) is used 
external to the Department of Health and Human 
Services and is convertible over to a Social Security 
account number (or derivative thereof) for use inter-
nal to such Department and the Social Security Ad-
ministration. 
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(c) FUNDING FOR IMPLEMENTATION.—For purposes 
of implementing the provisions of and the amendments 
made by this section, the Secretary of Health and Human 
Services shall provide for the following transfers from the 
Federal Hospital Insurance Trust Fund under section 
1817 of the Social Security Act (42 U.S.C. 1395i) and 
from the Federal Supplementary Medical Insurance Trust 
Fund established under section 1841 of such Act (42 
U.S.C. 1395t), in such proportions as the Secretary deter-
mines appropriate: 
(1) To the Centers for Medicare & Medicaid 
Program Management Account, transfers of the fol-
lowing amounts: 
(A) For fiscal year 2015, $65,000,000, to 
be made available through fiscal year 2018. 
(B) For each of fiscal years 2016 and 
2017, $53,000,000, to be made available 
through fiscal year 2018. 
(C) For fiscal year 2018, $48,000,000, to 
be made available until expended. 
(2) To the Social Security Administration Limi-
tation on Administration Account, transfers of the 
following amounts: 
(A) For fiscal year 2015, $27,000,000, to 
be made available through fiscal year 2018. 
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(B) For each of fiscal years 2016 and 
2017, $22,000,000, to be made available 
through fiscal year 2018. 
(C) For fiscal year 2018, $27,000,000, to 
be made available until expended. 
(3) To the Railroad Retirement Board Limita-
tion on Administration Account, the following 
amount: 
(A) For fiscal year 2015, $3,000,000, to 
be made available until expended. 
(d) EFFECTIVE DATE.— 
(1) IN
GENERAL.—Clause (xiii) of section 
205(c)(2)(C) of the Social Security Act (42 U.S.C. 
405(c)(2)(C)), as added by subsection (a)(3), shall 
apply with respect to Medicare cards issued on and 
after an effective date specified by the Secretary of 
Health and Human Services, but in no case shall 
such effective date be later than the date that is four 
years after the date of the enactment of this Act. 
(2) REISSUANCE.—The Secretary shall provide 
for the reissuance of Medicare cards that comply 
with the requirements of such clause not later than 
four years after the effective date specified by the 
Secretary under paragraph (1). 
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SEC. 502. PREVENTING WRONGFUL MEDICARE PAYMENTS 
FOR ITEMS AND SERVICES FURNISHED TO IN-
CARCERATED 
INDIVIDUALS, 
INDIVIDUALS 
NOT LAWFULLY PRESENT, AND DECEASED IN-
DIVIDUALS. 
(a) REQUIREMENT FOR THE SECRETARY TO ESTAB-
LISH POLICIES AND CLAIMS EDITS RELATING TO INCAR-
CERATED INDIVIDUALS, INDIVIDUALS NOT LAWFULLY 
PRESENT, AND DECEASED INDIVIDUALS.—Section 1874 
of the Social Security Act (42 U.S.C. 1395kk) is amended 
by adding at the end the following new subsection: 
‘‘(f) REQUIREMENT FOR THE SECRETARY TO ESTAB-
LISH POLICIES AND CLAIMS EDITS RELATING TO INCAR-
CERATED INDIVIDUALS, INDIVIDUALS NOT LAWFULLY 
PRESENT, AND DECEASED INDIVIDUALS.—The Secretary 
shall establish and maintain procedures, including proce-
dures for using claims processing edits, updating eligibility 
information to improve provider accessibility, and con-
ducting recoupment activities such as through recovery 
audit contractors, in order to ensure that payment is not 
made under this title for items and services furnished to 
an individual who is one of the following: 
‘‘(1) An individual who is incarcerated. 
‘‘(2) An individual who is not lawfully present 
in the United States and who is not eligible for cov-
erage under this title. 
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‘‘(3) A deceased individual.’’. 
(b) REPORT.—Not later than 18 months after the 
date of the enactment of this section, and periodically 
thereafter as determined necessary by the Office of Inspec-
tor General of the Department of Health and Human 
Services, such Office shall submit to Congress a report 
on the activities described in subsection (f) of section 1874 
of the Social Security Act (42 U.S.C. 1395kk), as added 
by subsection (a), that have been conducted since such 
date of enactment. 
SEC. 503. CONSIDERATION OF MEASURES REGARDING 
MEDICARE BENEFICIARY SMART CARDS. 
To the extent the Secretary of Health and Human 
Services determines that it is cost effective and techno-
logically viable to use electronic Medicare beneficiary and 
provider cards (such as cards that use smart card tech-
nology, including an embedded and secure integrated cir-
cuit chip), as presented in the Government Accountability 
Office report required by the conference report accom-
panying the Consolidated Appropriations Act, 2014 (Pub-
lic Law 113–76), the Secretary shall consider such meas-
ures as determined appropriate by the Secretary to imple-
ment such use of such cards for beneficiary and provider 
use under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.). In the case that the Secretary con-
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siders measures under the preceding sentence, the Sec-
retary shall submit to the Committees on Ways and Means 
and Energy and Commerce of the House of Representa-
tives, and to the Committee on Finance of the Senate, a 
report outlining the considerations undertaken by the Sec-
retary under such sentence. 
SEC. 
504. 
MODIFYING 
MEDICARE 
DURABLE 
MEDICAL 
EQUIPMENT 
FACE-TO-FACE 
ENCOUNTER 
DOCUMENTATION REQUIREMENT. 
(a) IN GENERAL.—Section 1834(a)(11)(B)(ii) of the 
Social Security Act (42 U.S.C. 1395m(a)(11)(B)(ii)) is 
amended— 
(1) by striking ‘‘the physician documenting 
that’’; and 
(2) by striking ‘‘has had a face-to-face encoun-
ter’’ and inserting ‘‘documenting such physician, 
physician assistant, practitioner, or specialist has 
had a face-to-face encounter’’. 
(b) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human 
Services may implement the amendments made by sub-
section (a) by program instruction or otherwise. 
SEC. 505. REDUCING IMPROPER MEDICARE PAYMENTS. 
(a) MEDICARE ADMINISTRATIVE CONTRACTOR IM-
PROPER PAYMENT OUTREACH
AND EDUCATION PRO-
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GRAM.—Section 1874A of the Social Security Act (42 
U.S.C. 1395kk–1) is amended— 
(1) in subsection (a)(4)— 
(A) by redesignating subparagraph (G) as 
subparagraph (H); and 
(B) by inserting after subparagraph (F) 
the following new subparagraph: 
‘‘(G) IMPROPER PAYMENT OUTREACH AND 
EDUCATION PROGRAM.—Having in place an im-
proper payment outreach and education pro-
gram described in subsection (h).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(h) IMPROPER PAYMENT OUTREACH
AND EDU-
CATION PROGRAM.— 
‘‘(1) IN
GENERAL.—In order to reduce im-
proper payments under this title, each medicare ad-
ministrative contractor shall establish and have in 
place an improper payment outreach and education 
program under which the contractor, through out-
reach, education, training, and technical assistance 
or other activities, shall provide providers of services 
and suppliers located in the region covered by the 
contract under this section with the information de-
scribed in paragraph (2). The activities described in 
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the preceding sentence shall be conducted on a reg-
ular basis. 
‘‘(2) INFORMATION TO BE PROVIDED THROUGH 
ACTIVITIES.—The information to be provided under 
such payment outreach and education program shall 
include information the Secretary determines to be 
appropriate, which may include the following infor-
mation: 
‘‘(A) A list of the providers’ or suppliers’ 
most frequent and expensive payment errors 
over the last quarter. 
‘‘(B) Specific instructions regarding how to 
correct or avoid such errors in the future. 
‘‘(C) A notice of new topics that have been 
approved by the Secretary for audits conducted 
by recovery audit contractors under section 
1893(h). 
‘‘(D) Specific instructions to prevent fu-
ture issues related to such new audits. 
‘‘(E) Other information determined appro-
priate by the Secretary. 
‘‘(3) PRIORITY.—A medicare administrative 
contractor shall give priority to activities under such 
program that will reduce improper payments that 
are one or more of the following: 
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‘‘(A) Are for items and services that have 
the highest rate of improper payment. 
‘‘(B) Are for items and service that have 
the greatest total dollar amount of improper 
payments. 
‘‘(C) Are due to clear misapplication or 
misinterpretation of Medicare policies. 
‘‘(D) Are clearly due to common and inad-
vertent clerical or administrative errors. 
‘‘(E) Are due to other types of errors that 
the Secretary determines could be prevented 
through activities under the program. 
‘‘(4) INFORMATION
ON
IMPROPER
PAYMENTS 
FROM RECOVERY AUDIT CONTRACTORS.— 
‘‘(A) IN
GENERAL.—In order to assist 
medicare administrative contractors in carrying 
out improper payment outreach and education 
programs, the Secretary shall provide each con-
tractor with a complete list of the types of im-
proper payments identified by recovery audit 
contractors under section 1893(h) with respect 
to providers of services and suppliers located in 
the region covered by the contract under this 
section. Such information shall be provided on 
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a time frame the Secretary determines appro-
priate which may be on a quarterly basis. 
‘‘(B) INFORMATION.—The information de-
scribed in subparagraph (A) shall include infor-
mation such as the following: 
‘‘(i) Providers of services and sup-
pliers that have the highest rate of im-
proper payments. 
‘‘(ii) Providers of services and sup-
pliers that have the greatest total dollar 
amounts of improper payments. 
‘‘(iii) Items and services furnished in 
the region that have the highest rates of 
improper payments. 
‘‘(iv) Items and services furnished in 
the region that are responsible for the 
greatest total dollar amount of improper 
payments. 
‘‘(v) Other information the Secretary 
determines would assist the contractor in 
carrying out the program. 
‘‘(5) COMMUNICATIONS.—Communications with 
providers of services and suppliers under an im-
proper payment outreach and education program are 
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subject to the standards and requirements of sub-
section (g).’’. 
(b) USE
OF
CERTAIN
FUNDS
RECOVERED
BY 
RACS.—Section 1893(h) of the Social Security Act (42 
U.S.C. 1395ddd(h)) is amended— 
(1) in paragraph (2), by inserting ‘‘or para-
graph (10)’’ after ‘‘paragraph (1)(C)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(10) USE OF CERTAIN RECOVERED FUNDS.— 
‘‘(A) IN
GENERAL.—After application of 
paragraph (1)(C), the Secretary shall retain a 
portion of the amounts recovered by recovery 
audit contractors for each year under this sec-
tion which shall be available to the program 
management account of the Centers for Medi-
care & Medicaid Services for purposes of, sub-
ject to subparagraph (B), carrying out sections 
1833(z), 1834(l)(16), and 1874A(a)(4)(G), car-
rying out section 514(b) of the Medicare Access 
and CHIP Reauthorization Act of 2015, and 
implementing strategies (such as claims proc-
essing edits) to help reduce the error rate of 
payments under this title. The amounts re-
tained under the preceding sentence shall not 
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exceed an amount equal to 15 percent of the 
amounts recovered under this subsection, and 
shall remain available until expended. 
‘‘(B) LIMITATION.—Except for uses that 
support claims processing (including edits) or 
system 
functionality 
for 
detecting 
fraud, 
amounts retained under subparagraph (A) may 
not be used for technological-related infrastruc-
ture, capital investments, or information sys-
tems. 
‘‘(C) NO REDUCTION IN PAYMENTS TO RE-
COVERY
AUDIT
CONTRACTORS.—Nothing in 
subparagraph (A) shall reduce amounts avail-
able for payments to recovery audit contractors 
under this subsection.’’. 
SEC. 506. IMPROVING SENIOR MEDICARE PATROL AND 
FRAUD REPORTING REWARDS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall develop a plan to revise the incentive pro-
gram under section 203(b) of the Health Insurance Port-
ability and Accountability Act of 1996 (42 U.S.C. 1395b– 
5(b)) to encourage greater participation by individuals to 
report fraud and abuse in the Medicare program. Such 
plan shall include recommendations for— 
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(1) ways to enhance rewards for individuals re-
porting under the incentive program, including re-
wards based on information that leads to an admin-
istrative action; and 
(2) extending the incentive program to the 
Medicaid program. 
(b) PUBLIC AWARENESS
AND EDUCATION CAM-
PAIGN.—The plan developed under subsection (a) shall 
also include recommendations for the use of the Senior 
Medicare Patrols authorized under section 411 of the 
Older Americans Act of 1965 (42 U.S.C. 3032) to conduct 
a public awareness and education campaign to encourage 
participation in the revised incentive program under sub-
section (a). 
(c) SUBMISSION OF PLAN.—Not later than 180 days 
after the date of enactment of this Act, the Secretary shall 
submit to Congress the plan developed under subsection 
(a). 
SEC. 507. REQUIRING VALID PRESCRIBER NATIONAL PRO-
VIDER IDENTIFIERS ON PHARMACY CLAIMS. 
Section 1860D–4(c) of the Social Security Act (42 
U.S.C. 1395w–104(c)) is amended by adding at the end 
the following new paragraph: 
‘‘(4) REQUIRING VALID PRESCRIBER NATIONAL 
PROVIDER IDENTIFIERS ON PHARMACY CLAIMS.— 
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‘‘(A) IN GENERAL.—For plan year 2016 
and subsequent plan years, the Secretary shall 
require a claim for a covered part D drug for 
a part D eligible individual enrolled in a pre-
scription drug plan under this part or an MA– 
PD plan under part C to include a prescriber 
National Provider Identifier that is determined 
to be valid under the procedures established 
under subparagraph (B)(i). 
‘‘(B) PROCEDURES.— 
‘‘(i) VALIDITY
OF
PRESCRIBER
NA-
TIONAL
PROVIDER
IDENTIFIERS.—The 
Secretary, in consultation with appropriate 
stakeholders, shall establish procedures for 
determining the validity of prescriber Na-
tional Provider Identifiers under subpara-
graph (A). 
‘‘(ii) INFORMING
BENEFICIARIES
OF 
REASON FOR DENIAL.—The Secretary shall 
establish procedures to ensure that, in the 
case that a claim for a covered part D 
drug of an individual described in subpara-
graph (A) is denied because the claim does 
not meet the requirements of this para-
graph, the individual is properly informed 
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at the point of service of the reason for the 
denial. 
‘‘(C) REPORT.—Not later than January 1, 
2018, the Inspector General of the Department 
of Health and Human Services shall submit to 
Congress a report on the effectiveness of the 
procedures established under subparagraph 
(B)(i).’’. 
SEC. 508. OPTION TO RECEIVE MEDICARE SUMMARY NO-
TICE ELECTRONICALLY. 
(a) IN GENERAL.—Section 1806 of the Social Secu-
rity Act (42 U.S.C. 1395b–7) is amended by adding at 
the end the following new subsection: 
‘‘(c) FORMAT OF STATEMENTS FROM SECRETARY.— 
‘‘(1) 
ELECTRONIC
OPTION
BEGINNING
IN 
2016.—Subject to paragraph (2), for statements de-
scribed in subsection (a) that are furnished for a pe-
riod in 2016 or a subsequent year, in the case that 
an individual described in subsection (a) elects, in 
accordance with such form, manner, and time speci-
fied by the Secretary, to receive such statement in 
an electronic format, such statement shall be fur-
nished to such individual for each period subsequent 
to such election in such a format and shall not be 
mailed to the individual. 
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‘‘(2) LIMITATION ON REVOCATION OPTION.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the Secretary may determine a max-
imum number of elections described in para-
graph (1) by an individual that may be revoked 
by the individual. 
‘‘(B) MINIMUM OF ONE REVOCATION OP-
TION.—In no case may the Secretary determine 
a maximum number under subparagraph (A) 
that is less than one. 
‘‘(3) NOTIFICATION.—The Secretary shall en-
sure that, in the most cost effective manner and be-
ginning January 1, 2017, a clear notification of the 
option to elect to receive statements described in 
subsection (a) in an electronic format is made avail-
able, such as through the notices distributed under 
section 1804, to individuals described in subsection 
(a).’’. 
(b) ENCOURAGED
EXPANSION
OF
ELECTRONIC 
STATEMENTS.—To the extent to which the Secretary of 
Health and Human Services determines appropriate, the 
Secretary shall— 
(1) apply an option similar to the option de-
scribed in subsection (c)(1) of section 1806 of the 
Social Security Act (42 U.S.C. 1395b–7) (relating to 
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the provision of the Medicare Summary Notice in an 
electronic format), as added by subsection (a), to 
other statements and notifications under title XVIII 
of such Act (42 U.S.C. 1395 et seq.); and 
(2) provide such Medicare Summary Notice and 
any such other statements and notifications on a 
more frequent basis than is otherwise required under 
such title. 
SEC. 509. RENEWAL OF MAC CONTRACTS. 
(a) IN GENERAL.—Section 1874A(b)(1)(B) of the 
Social Security Act (42 U.S.C. 1395kk–1(b)(1)(B)) is 
amended by striking ‘‘5 years’’ and inserting ‘‘10 years’’. 
(b) APPLICATION.—The amendments made by sub-
section (a) shall apply to contracts entered into on or 
after, and to contracts in effect as of, the date of the en-
actment of this Act. 
(c) CONTRACTOR PERFORMANCE TRANSPARENCY.— 
Section 1874A(b)(3)(A) of the Social Security Act (42 
U.S.C. 1395kk–1(b)(3)(A)) is amended by adding at the 
end the following new clause: 
‘‘(iv) 
CONTRACTOR
PERFORMANCE 
TRANSPARENCY.—To the extent possible 
without compromising the process for en-
tering into and renewing contracts with 
medicare administrative contractors under 
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this section, the Secretary shall make 
available to the public the performance of 
each medicare administrative contractor 
with respect to such performance require-
ments and measurement standards.’’. 
SEC. 510. STUDY ON PATHWAY FOR INCENTIVES TO STATES 
FOR STATE PARTICIPATION IN MEDICAID 
DATA MATCH PROGRAM. 
Section 1893(g) of the Social Security Act (42 U.S.C. 
1395ddd(g)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(3) INCENTIVES FOR STATES.—The Secretary 
shall study and, as appropriate, may specify incen-
tives for States to work with the Secretary for the 
purposes described in paragraph (1)(A)(ii). The ap-
plication of the previous sentence may include use of 
the waiver authority described in paragraph (2).’’. 
SEC. 511. GUIDANCE ON APPLICATION OF COMMON RULE 
TO CLINICAL DATA REGISTRIES. 
Not later than one year after the date of the enact-
ment of this section, the Secretary of Health and Human 
Services shall issue a clarification or modification with re-
spect to the application of subpart A of part 46 of title 
45, Code of Federal Regulations, governing the protection 
of human subjects in research (and commonly known as 
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the ‘‘Common Rule’’), to activities, including quality im-
provement activities, involving clinical data registries, in-
cluding entities that are qualified clinical data registries 
pursuant to section 1848(m)(3)(E) of the Social Security 
Act (42 U.S.C. 1395w–4(m)(3)(E)). 
SEC. 512. ELIMINATING CERTAIN CIVIL MONEY PENALTIES; 
GAINSHARING STUDY AND REPORT. 
(a) ELIMINATING CIVIL MONEY PENALTIES FOR IN-
DUCEMENTS TO PHYSICIANS TO LIMIT SERVICES THAT 
ARE NOT MEDICALLY NECESSARY.— 
(1) IN GENERAL.—Section 1128A(b)(1) of the 
Social Security Act (42 U.S.C. 1320a–7a(b)(1)) is 
amended by inserting ‘‘medically necessary’’ after 
‘‘reduce or limit’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply to payments made on 
or after the date of the enactment of this Act. 
(b) GAINSHARING STUDY AND REPORT.—Not later 
than 12 months after the date of the enactment of this 
Act, the Secretary of Health and Human Services, in con-
sultation with the Inspector General of the Department 
of Health and Human Services, shall submit to Congress 
a report with options for amending existing fraud and 
abuse laws in, and regulations related to, titles XI and 
XVIII of the Social Security Act (42 U.S.C. 301 et seq.), 
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through exceptions, safe harbors, or other narrowly tar-
geted provisions, to permit gainsharing arrangements that 
otherwise would be subject to the civil money penalties de-
scribed in paragraphs (1) and (2) of section 1128A(b) of 
such Act (42 U.S.C. 1320a–7a(b)), or similar arrange-
ments between physicians and hospitals, and that improve 
care while reducing waste and increasing efficiency. The 
report shall— 
(1) consider whether such provisions should 
apply to ownership interests, compensation arrange-
ments, or other relationships; 
(2) describe how the recommendations address 
accountability, transparency, and quality, including 
how best to limit inducements to stint on care, dis-
charge patients prematurely, or otherwise reduce or 
limit medically necessary care; and 
(3) consider whether a portion of any savings 
generated by such arrangements (as compared to an 
historical benchmark or other metric specified by the 
Secretary to determine the impact of delivery and 
payment system changes under such title XVIII on 
expenditures made under such title) should accrue to 
the Medicare program under title XVIII of the So-
cial Security Act. 
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SEC. 513. MODIFICATION OF MEDICARE HOME HEALTH 
SURETY BOND CONDITION OF PARTICIPA-
TION 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. 514. OVERSIGHT OF MEDICARE COVERAGE OF MAN-
UAL MANIPULATION OF THE SPINE TO COR-
RECT SUBLUXATION. 
(a) IN GENERAL.—Section 1833 of the Social Secu-
rity 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 
manipulation of the spine to correct a subluxation 
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(as described in such section) of an individual who 
is enrolled under this part and apply such process to 
such services furnished on or after January 1, 2017, 
focusing on services such as— 
‘‘(A) services furnished by a such a chiro-
practor whose pattern of billing is aberrant 
compared to peers; and 
‘‘(B) services furnished by such a chiro-
practor who, in a prior period, has a services 
denial 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 author-
ization medical review for services de-
scribed in paragraph (1) that are furnished 
to an individual by a chiropractor de-
scribed in section 1861(r)(5) that are part 
of an episode of treatment that includes 
more than 12 services. For purposes of the 
preceding sentence, an episode of treat-
ment shall be determined by the underlying 
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cause that justifies 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 de-
termines that the chiropractor has a low 
denial 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 
chiropractor has, in the time period subse-
quent to the determination by the Sec-
retary of a low denial rate with respect to 
the chiropractor, 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 request-
ing prior authorization for services de-
scribed in paragraph (1) that are to be 
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furnished to an individual before the chiro-
practor furnishes the twelfth such service 
to such individual for an episode of treat-
ment. 
‘‘(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 author-
ization medical review under subparagraph (A). 
‘‘(C) RELATIONSHIP
TO
LAW
ENFORCE-
MENT ACTIVITIES.—The Secretary may deter-
mine 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). 
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‘‘(B) DENIAL
OF
PAYMENT.—Subject to 
paragraph (5), no payment may be made under 
this part for the service unless the Secretary 
determines pursuant to subparagraph (A) that 
the service would meet the applicable require-
ments 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). 
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‘‘(7) REVIEW BY CONTRACTORS.—The medical 
review described in paragraph (2) may be conducted 
by medicare administrative contractors pursuant to 
section 1874A(a)(4)(G) or by any other contractor 
determined appropriate by the Secretary that is not 
a recovery audit contractor. 
‘‘(8) MULTIPLE
SERVICES.—The Secretary 
shall, where practicable, apply the medical review 
under this subsection in a manner so as to allow an 
individual described in paragraph (1) to obtain, at a 
single time rather than on a service-by-service basis, 
an authorization in accordance with paragraph 
(3)(A) for multiple services. 
‘‘(9) CONSTRUCTION.—With respect to a serv-
ice described in paragraph (1) that has been af-
firmed by medical review under this subsection, 
nothing in this subsection shall be construed to pre-
clude the subsequent denial of a claim for such serv-
ice that does not meet other applicable requirements 
under this Act. 
‘‘(10) IMPLEMENTATION.— 
‘‘(A) AUTHORITY.—The Secretary may im-
plement the provisions of this subsection by in-
terim final rule with comment period. 
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‘‘(B) ADMINISTRATION.—Chapter 35 of 
title 44, United States Code, shall not apply to 
medical review under this subsection.’’. 
(b) IMPROVING DOCUMENTATION OF SERVICES.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall, in consultation with stake-
holders (including the American Chiropractic Asso-
ciation) and representatives of medicare administra-
tive 
contractors 
(as 
defined 
in 
section 
1874A(a)(3)(A) of the Social Security Act (42 
U.S.C. 1395kk–1(a)(3)(A))), develop educational 
and training programs to improve the ability of 
chiropractors to provide documentation to the Sec-
retary of services described in section 1861(r)(5) in 
a manner that demonstrates that such services are, 
in accordance with section 1862(a)(1) of such Act 
(42 U.S.C. 1395y(a)(1)), reasonable and necessary 
for the diagnosis or treatment of illness or injury or 
to improve the functioning of a malformed body 
member. 
(2) TIMING.—The Secretary shall make the 
educational and training programs described in 
paragraph (1) publicly available not later than Janu-
ary 1, 2016. 
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(3) FUNDING.—The Secretary shall use funds 
made available under paragraph (10) of section 
1893(h) of the Social Security Act (42 U.S.C. 
1395ddd(h)), as added by section 505, to carry out 
this subsection. 
(c) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study on the effective-
ness of the process for medical review of services 
furnished as part of a treatment by means of man-
ual manipulation of the spine to correct a sub-
luxation implemented under subsection (z) of section 
1833 of the Social Security Act (42 U.S.C. 1395l), 
as added by subsection (a). Such study shall include 
an analysis of— 
(A) aggregate data on— 
(i) the number of individuals, chiro-
practors, and claims for services subject to 
such review; and 
(ii) the number of reviews conducted 
under such section; and 
(B) the outcomes of such reviews. 
(2) REPORT.—Not later than four years after 
the date of enactment of this Act, the Comptroller 
General shall submit to Congress a report containing 
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the results of the study conducted under paragraph 
(1), including recommendations for such legislation 
and administrative action with respect to the process 
for medical review implemented under subsection (z) 
of section 1833 of the Social Security Act (42 
U.S.C. 1395l) as the Comptroller General deter-
mines appropriate. 
SEC. 515. NATIONAL EXPANSION OF PRIOR AUTHORIZA-
TION MODEL FOR REPETITIVE SCHEDULED 
NON-EMERGENT AMBULANCE TRANSPORT. 
(a) INITIAL EXPANSION.— 
(1) IN GENERAL.—In implementing the model 
described in paragraph (2) proposed to be tested 
under subsection (b) of section 1115A of the Social 
Security Act (42 U.S.C. 1315a), the Secretary of 
Health and Human Services shall revise the testing 
under subsection (b) of such section to cover, effec-
tive not later than January 1, 2016, States located 
in medicare administrative contractor (MAC) regions 
L and 11 (consisting of Delaware, the District of 
Columbia, Maryland, New Jersey, Pennsylvania, 
North Carolina, South Carolina, West Virginia, and 
Virginia). 
(2) MODEL DESCRIBED.—The model described 
in this paragraph is the testing of a model of prior 
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authorization for repetitive scheduled non-emergent 
ambulance transport proposed to be carried out in 
New Jersey, Pennsylvania, and South Carolina. 
(3) FUNDING.—The Secretary shall allocate 
funds made available under section 1115A(f)(1)(B) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1315a(f)(1)(B)) to carry out this subsection. 
(b) NATIONAL EXPANSION.—Section 1834(l) of the 
Social Security Act (42 U.S.C. 1395m(l)) is amended by 
adding at the end the following new paragraph: 
‘‘(16) PRIOR AUTHORIZATION FOR REPETITIVE 
SCHEDULED
NON-EMERGENT
AMBULANCE
TRANS-
PORTS.— 
‘‘(A) IN GENERAL.—Beginning January 1, 
2017, if the expansion to all States of the 
model of prior authorization described in para-
graph (2) of section 515(a) of the Medicare Ac-
cess and CHIP Reauthorization Act of 2015 
meets the requirements described in paragraphs 
(1) through (3) of section 1115A(c), then the 
Secretary shall expand such model to all States. 
‘‘(B) FUNDING.—The Secretary shall use 
funds made available under section 1893(h)(10) 
to carry out this paragraph. 
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‘‘(C) CLARIFICATION REGARDING BUDGET 
NEUTRALITY.—Nothing in this paragraph may 
be construed to limit or modify the application 
of section 1115A(b)(3)(B) to models described 
in such section, including with respect to the 
model described in subparagraph (A) and ex-
panded beginning on January 1, 2017, under 
such subparagraph.’’. 
SEC. 
516. 
REPEALING 
DUPLICATIVE 
MEDICARE 
SEC-
ONDARY PAYOR PROVISION. 
(a) IN GENERAL.—Section 1862(b)(5) of the Social 
Security Act (42 U.S.C. 1395y(b)(5)) is amended by in-
serting at the end the following new subparagraph: 
‘‘(E) END DATE.—The provisions of this 
paragraph shall not apply to information re-
quired to be provided on or after July 1, 
2016.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect on the date of the enact-
ment of this Act and shall apply to information required 
to be provided on or after January 1, 2016. 
SEC. 517. PLAN FOR EXPANDING DATA IN ANNUAL CERT 
REPORT. 
Not later than June 30, 2015, the Secretary of 
Health and Human Services shall submit to the Com-
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mittee on Finance of the Senate, and to the Committees 
on Energy and Commerce and Ways and Means of the 
House of Representatives— 
(1) a plan for including, in the annual report of 
the Comprehensive Error Rate Testing (CERT) pro-
gram, data on services (or groupings of services) 
(other than medical visits) paid under the physician 
fee schedule under section 1848 of the Social Secu-
rity Act (42 U.S.C. 1395w–4) where the fee sched-
ule amount is in excess of $250 and where the error 
rate is in excess of 20 percent; and 
(2) to the extent practicable by such date, spe-
cific examples of services described in paragraph (1). 
SEC. 518. REMOVING FUNDS FOR MEDICARE IMPROVE-
MENT FUND ADDED BY IMPACT ACT OF 2014. 
Section 1898(b)(1) of the Social Security Act (42 
U.S.C. 1395iii(b)(1)), as amended by section 3(e)(3) of 
the IMPACT Act of 2014 (Public Law 113–185), is 
amended by striking ‘‘$195,000,000’’ and inserting ‘‘$0’’. 
SEC. 519. RULE OF CONSTRUCTION. 
Except as explicitly provided in this subtitle, nothing 
in this subtitle, including the amendments made by this 
subtitle, shall be construed as preventing the use of notice 
and comment rulemaking in the implementation of the 
provisions of, and the amendments made by, this subtitle. 
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Subtitle B—Other Provisions 
SEC. 521. EXTENSION OF TWO-MIDNIGHT PAMA RULES ON 
CERTAIN MEDICAL REVIEW ACTIVITIES. 
Section 111 of the Protecting Access to Medicare Act 
of 2014 (Public Law 113–93; 42 U.S.C. 1395ddd note) 
is amended— 
(1) in subsection (a), by striking ‘‘the first 6 
months of fiscal year 2015’’ and inserting ‘‘through 
the end of fiscal year 2015’’; 
(2) in subsection (b), by striking ‘‘March 31, 
2015’’ and inserting ‘‘September 30, 2015’’; and 
(3) by adding at the end the following new sub-
section: 
‘‘(c) CONSTRUCTION.—Except as provided in sub-
sections (a) and (b), nothing in this section shall be con-
strued as limiting the Secretary’s authority to pursue 
fraud and abuse activities under such section 1893(h) or 
otherwise.’’. 
SEC. 522. REQUIRING BID SURETY BONDS AND STATE LI-
CENSURE FOR ENTITIES SUBMITTING BIDS 
UNDER THE MEDICARE DMEPOS COMPETI-
TIVE ACQUISITION PROGRAM. 
(a) BID SURETY BONDS.—Section 1847(a)(1) of the 
Social Security Act (42 U.S.C. 1395w–3(a)(1)) is amend-
ed by adding at the end the following new subparagraphs: 
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‘‘(G) REQUIRING BID BONDS FOR BIDDING 
ENTITIES.—With respect to rounds of competi-
tions beginning under this subsection for con-
tracts beginning not earlier than January 1, 
2017, and not later than January 1, 2019, an 
entity may not submit a bid for a competitive 
acquisition area unless, as of the deadline for 
bid submission, the entity has obtained (and 
provided the Secretary with proof of having ob-
tained) a bid surety bond (in this paragraph re-
ferred to as a ‘bid bond’) in a form specified by 
the Secretary consistent with subparagraph (H) 
and in an amount that is not less than $50,000 
and not more than $100,000 for each competi-
tive acquisition area in which the entity submits 
the bid. 
‘‘(H) TREATMENT
OF
BID
BONDS
SUB-
MITTED.— 
‘‘(i) FOR BIDDERS THAT SUBMIT BIDS 
AT OR BELOW THE MEDIAN AND ARE OF-
FERED
BUT
DO
NOT
ACCEPT
THE
CON-
TRACT.—In the case of a bidding entity 
that is offered a contract for any product 
category for a competitive acquisition area, 
if— 
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‘‘(I) the entity’s composite bid 
for such product category and area 
was at or below the median composite 
bid rate for all bidding entities in-
cluded in the calculation of the single 
payment amounts for such product 
category and area; and 
‘‘(II) the entity does not accept 
the contract offered for such product 
category and area, 
the bid bond submitted by such entity for 
such area shall be forfeited by the entity 
and the Secretary shall collect on it. 
‘‘(ii) TREATMENT
OF
OTHER
BID-
DERS.—In the case of a bidding entity for 
any product category for a competitive ac-
quisition area, if the entity does not meet 
the bid forfeiture conditions in subclauses 
(I) and (II) of clause (i) for any product 
category for such area, the bid bond sub-
mitted by such entity for such area shall 
be returned within 90 days of the public 
announcement of the contract suppliers for 
such area.’’. 
(b) STATE LICENSURE.— 
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(1) IN GENERAL.—Section 1847(b)(2)(A) of the 
Social Security Act (42 U.S.C. 1395w–3(b)(2)(A)) is 
amended by adding at the end the following new 
clause: 
‘‘(v) The entity meets applicable State 
licensure requirements.’’. 
(2) CONSTRUCTION.—Nothing in the amend-
ment made by paragraph (1) shall be construed as 
affecting the authority of the Secretary of Health 
and Human Services to require State licensure of an 
entity under the Medicare competitive acquisition 
program under section 1847 of the Social Security 
Act (42 U.S.C. 1395w–3) before the date of the en-
actment of this Act. 
(c) GAO REPORT ON BID BOND IMPACT ON SMALL 
SUPPLIERS.— 
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study that evaluates 
the effect of the bid surety bond requirement under 
the amendment made by subsection (a) on the par-
ticipation of small suppliers in the Medicare 
DMEPOS competitive acquisition program under 
section 1847 of the Social Security Act (42 U.S.C. 
1395w–3). 
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(2) REPORT.—Not later than 6 months after 
the date contracts are first awarded subject to such 
bid surety bond requirement, the Comptroller Gen-
eral shall submit to Congress a report on the study 
conducted under paragraph (1). Such report shall 
include recommendations for changes in such re-
quirement in order to ensure robust participation by 
legitimate small suppliers in the Medicare DMEPOS 
competition acquisition program. 
SEC. 523. PAYMENT FOR GLOBAL SURGICAL PACKAGES. 
(a) IN GENERAL.—Section 1848(c) of the Social Se-
curity Act (42 U.S.C. 1395w–4(c)) is amended by adding 
at the end the following new paragraph: 
‘‘(8) GLOBAL SURGICAL PACKAGES.— 
‘‘(A) PROHIBITION
OF
IMPLEMENTATION 
OF RULE REGARDING GLOBAL SURGICAL PACK-
AGES.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall not implement the policy established 
in the final rule published on November 
13, 2014 (79 Fed. Reg. 67548 et seq.), 
that requires the transition of all 10-day 
and 90-day global surgery packages to 0- 
day global periods. 
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‘‘(ii) 
CONSTRUCTION.—Nothing 
in 
clause (i) shall be construed to prevent the 
Secretary from revaluing misvalued codes 
for specific surgical services or assigning 
values to new or revised codes for surgical 
services. 
‘‘(B) COLLECTION OF DATA ON SERVICES 
INCLUDED IN GLOBAL SURGICAL PACKAGES.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), the Secretary shall through rule-
making develop and implement a process 
to gather, from a representative sample of 
physicians, beginning not later than Janu-
ary 1, 2017, information needed to value 
surgical services. Such information shall 
include the number and level of medical 
visits furnished during the global period 
and other items and services related to the 
surgery and furnished during the global 
period, as appropriate. Such information 
shall be reported on claims at the end of 
the global period or in another manner 
specified by the Secretary. For purposes of 
carrying out this paragraph (other than 
clause (iii)), the Secretary shall transfer 
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from the Federal Supplemental Medical In-
surance Trust Fund under section 1841 
$2,000,000 to the Center for Medicare & 
Medicaid Services Program Management 
Account for fiscal year 2015. Amounts 
transferred under the previous sentence 
shall remain available until expended. 
‘‘(ii) REASSESSMENT AND POTENTIAL 
SUNSET.—Every 4 years, the Secretary 
shall reassess the value of the information 
collected pursuant to clause (i). Based on 
such a reassessment and by regulation, the 
Secretary may discontinue the requirement 
for collection of information under such 
clause if the Secretary determines that the 
Secretary has adequate information from 
other sources, such as qualified clinical 
data registries, surgical logs, billing sys-
tems or other practice or facility records, 
and electronic health records, in order to 
accurately value global surgical services 
under this section. 
‘‘(iii) INSPECTOR GENERAL AUDIT.— 
The Inspector General of the Department 
of Health and Human Services shall audit 
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a sample of the information reported under 
clause (i) to verify the accuracy of the in-
formation so reported. 
‘‘(C) IMPROVING
ACCURACY
OF
PRICING 
FOR SURGICAL SERVICES.—For years beginning 
with 2019, the Secretary shall use the informa-
tion reported under subparagraph (B)(i) as ap-
propriate and other available data for the pur-
pose of improving the accuracy of valuation of 
surgical services under the physician fee sched-
ule under this section.’’. 
(b) INCENTIVE FOR REPORTING INFORMATION ON 
GLOBAL SURGICAL SERVICES.—Section 1848(a) of the 
Social Security Act (42 U.S.C. 1395w–4(a)) is amended 
by adding at the end the following new paragraph: 
‘‘(9) INFORMATION
REPORTING
ON
SERVICES 
INCLUDED IN GLOBAL SURGICAL PACKAGES.—With 
respect to services for which a physician is required 
to report information in accordance with subsection 
(c)(8)(B)(i), the Secretary may through rulemaking 
delay payment of 5 percent of the amount that 
would otherwise be payable under the physician fee 
schedule under this section for such services until 
the information so required is reported.’’. 
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SEC. 524. EXTENSION OF SECURE RURAL SCHOOLS AND 
COMMUNITY SELF-DETERMINATION ACT OF 
2000. 
(a) PAYMENTS
FOR
FISCAL
YEARS
2014 AND 
2015.— 
(1) PAYMENTS REQUIRED.—Section 101 of the 
Secure Rural Schools and Community Self-Deter-
mination Act of 2000 (16 U.S.C. 7111) is amended 
by striking ‘‘2013’’ both places it appears and in-
serting ‘‘2015’’. 
(2) PROMPT
PAYMENT.—Payments for fiscal 
year 2014 under title I of the Secure Rural Schools 
and Community Self-Determination Act of 2000 (16 
U.S.C. 7111 et seq.), as amended by this section, 
shall be made not later than 45 days after the date 
of the enactment of this Act. 
(3) REDUCTION
IN
FISCAL
YEAR
2014
PAY-
MENTS ON ACCOUNT OF PREVIOUS 25- AND 50-PER-
CENT PAYMENTS.—Section 101 of the Secure Rural 
Schools and Community Self-Determination Act of 
2000 (16 U.S.C. 7111) is amended by adding at the 
end the following new subsection: 
‘‘(c) SPECIAL RULE FOR FISCAL YEAR 2014 PAY-
MENTS.— 
‘‘(1) STATE PAYMENT.—If an eligible county in 
a State that will receive a share of the State pay-
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ment for fiscal year 2014 has already received, or 
will receive, a share of the 25-percent payment for 
fiscal year 2014 distributed to the State before the 
date of the enactment of this subsection, the amount 
of the State payment shall be reduced by the 
amount of that eligible county’s share of the 25-per-
cent payment. 
‘‘(2) COUNTY PAYMENT.—If an eligible county 
that will receive a county payment for fiscal year 
2014 has already received a 50-percent payment for 
that fiscal year, the amount of the county payment 
shall be reduced by the amount of the 50-percent 
payment.’’. 
(4) SHARES
OF
CALIFORNIA
STATE
PAY-
MENT.—Section 103(d)(2) of the Secure Rural 
Schools and Community Self-Determination Act of 
2000 (16 U.S.C. 7113(d)(2)) is amended by striking 
‘‘2013’’ and inserting ‘‘2015’’. 
(b) USE OF FISCAL YEAR 2013 ELECTIONS AND 
RESERVATIONS FOR FISCAL YEARS 2014 AND 2015.— 
Section 102 of the Secure Rural Schools and Community 
Self-Determination Act of 2000 (16 U.S.C. 7112) is 
amended— 
(1) in subsection (b)(1), by adding at the end 
the following new subparagraph: 
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‘‘(C) EFFECT OF LATE PAYMENT FOR FIS-
CAL YEARS 2014 AND 2015.—The election other-
wise required by subparagraph (A) shall not 
apply for fiscal year 2014 or 2015.’’; 
(2) in subsection (b)(2)— 
(A) in subparagraph (A), by adding at the 
end the following new sentence: ‘‘If such two- 
fiscal year period included fiscal year 2013, the 
county election to receive a share of the 25-per-
cent payment or 50-percent payment, as appli-
cable, also shall be effective for fiscal years 
2014 and 2015.’’; and 
(B) in subparagraph (B), by striking 
‘‘2013’’ the second place it appears and insert-
ing ‘‘2015’’; and 
(3) in subsection (d)— 
(A) by adding at the end of paragraph (1) 
the following new subparagraph: 
‘‘(E) EFFECT OF LATE PAYMENT FOR FIS-
CAL YEAR 2014.—The election made by an eligi-
ble county under subparagraph (B), (C), or (D) 
for fiscal year 2013, or deemed to be made by 
the county under paragraph (3)(B) for that fis-
cal year, shall be effective for fiscal years 2014 
and 2015.’’; and 
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(B) by adding at the end of paragraph (3) 
the following new subparagraph: 
‘‘(C) EFFECT OF LATE PAYMENT FOR FIS-
CAL YEAR 2014.—This paragraph does not apply 
for fiscal years 2014 and 2015.’’. 
(c) SPECIAL PROJECTS ON FEDERAL LAND.—Title 
II of the Secure Rural Schools and Community Self-Deter-
mination Act of 2000 (16 U.S.C. 7121 et seq.) is amend-
ed— 
(1) 
in 
section 
203(a)(1) 
(16 
U.S.C. 
7123(a)(1)), by striking ‘‘September 30 for fiscal 
year 2008 (or as soon thereafter as the Secretary 
concerned determines is practicable), and each Sep-
tember 30 thereafter for each succeeding fiscal year 
through fiscal year 2013’’ and inserting ‘‘September 
30 of each fiscal year (or a later date specified by 
the Secretary concerned for the fiscal year)’’; 
(2) in section 204(e)(3)(B)(iii) (16 U.S.C. 
7124(e)(3)(B)(iii)), by striking ‘‘each of fiscal years 
2010 through 2013’’ and inserting ‘‘fiscal year 2010 
and fiscal years thereafter’’; 
(3) in section 207(a) (16 U.S.C. 7127(a)), by 
striking ‘‘September 30, 2008 (or as soon thereafter 
as the Secretary concerned determines is prac-
ticable), and each September 30 thereafter for each 
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succeeding fiscal year through fiscal year 2013’’ and 
inserting ‘‘September 30 of each fiscal year (or a 
later date specified by the Secretary concerned for 
the fiscal year)’’; and 
(4) in section 208 (16 U.S.C. 7128)— 
(A) in subsection (a), by striking ‘‘2013’’ 
and inserting ‘‘2017’’; and 
(B) in subsection (b), by striking ‘‘2014’’ 
and inserting ‘‘2018’’. 
(d) COUNTY FUNDS.—Section 304 of the Secure 
Rural Schools and Community Self-Determination Act of 
2000 (16 U.S.C. 7144) is amended— 
(1) in subsection (a), by striking ‘‘2013’’ and 
inserting ‘‘2017’’; and 
(2) in subsection (b), by striking ‘‘2014’’ and 
inserting ‘‘2018’’. 
(e) AUTHORIZATION OF APPROPRIATIONS.—Section 
402 of the Secure Rural Schools and Community Self-De-
termination Act of 2000 (16 U.S.C. 7152) is amended by 
striking ‘‘for each of fiscal years 2008 through 2013’’. 
SEC. 525. EXCLUSION FROM PAYGO SCORECARDS. 
(a) STATUTORY PAY-AS-YOU-GO SCORECARDS.—The 
budgetary effects of this Act shall not be entered on either 
PAYGO scorecard maintained pursuant to section 4(d) of 
the Statutory Pay-As-You-Go Act of 2010. 
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(b) SENATE PAYGO SCORECARDS.—The budgetary 
effects of this Act shall not be entered on any PAYGO 
scorecard maintained for purposes of section 201 of S. 
Con. Res. 21 (110th Congress). 
Passed the House of Representatives March 26, 
2015. 
Attest: 
KAREN L. HAAS, 
Clerk. 
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