282 
Subtitle E—Local Coverage 
Decision Reforms 
SEC. 3081. IMPROVEMENTS IN THE MEDICARE LOCAL COV-
ERAGE DETERMINATION (LCD) PROCESS. 
(a) IN GENERAL.—Section 1862(l)(5) of the Social 
Security Act (42 U.S.C. 1395y(l)(5)) is amended by add-
ing at the end the following new subparagraph: 
‘‘(D) 
LOCAL
COVERAGE
DETERMINA-
TIONS.—The Secretary shall require each medi-
care administrative contractor that develops a 
local coverage determination to make available 
on the website of such contractor and in the 
coverage database on the Medicare website, at 
least 45 days before the effective date of such 
determination, the following information: 
‘‘(i) Such determination in its en-
tirety. 
‘‘(ii) Where and when the proposed 
determination was first made public. 
‘‘(iii) Links to the proposed deter-
mination and a response to comments sub-
mitted to the contractor with respect to 
such proposed determination. 
‘‘(iv) A summary of evidence that was 
considered by the contractor during the de-
VerDate Sep 11 2014 
01:31 May 20, 2015
Jkt 049200
PO 00000
Frm 00282
Fmt 6652
Sfmt 6201
E:\BILLS\H6.IH
H6
SSpencer on DSK4SPTVN1PROD with BILLS
283 
velopment of such determination and a list 
of the sources of such evidence. 
‘‘(v) An explanation of the rationale 
that supports such determination.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply with respect to local coverage 
determinations that are proposed or revised on or after 
the date that is 180 days after the date of the enactment 
of this Act. 
Subtitle 
F—Medicare 
Pharma-
ceutical and Technology Om-
budsman 
SEC. 
3101. 
MEDICARE 
PHARMACEUTICAL 
AND 
TECH-
NOLOGY OMBUDSMAN. 
Section 1808(c) of the Social Security Act (42 U.S.C. 
1395b–9(c)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(4) PHARMACEUTICAL AND TECHNOLOGY OM-
BUDSMAN.—Not later than 12 months after the date 
of the enactment of this paragraph, the Secretary 
shall provide for a pharmaceutical and technology 
ombudsman within the Centers for Medicare & Med-
icaid Services who shall receive and respond to com-
plaints, grievances, and requests that— 
VerDate Sep 11 2014 
01:31 May 20, 2015
Jkt 049200
PO 00000
Frm 00283
Fmt 6652
Sfmt 6201
E:\BILLS\H6.IH
H6
SSpencer on DSK4SPTVN1PROD with BILLS
284 
‘‘(A) are from entities that manufacture 
pharmaceutical, biotechnology, medical device, 
or diagnostic products that are covered or for 
which coverage is being sought under this title; 
and 
‘‘(B) regard coverage, coding, or payment 
under this title for such products.’’. 
Subtitle G—Medicare Site-of- 
Service Price Transparency 
SEC. 3121. MEDICARE SITE-OF-SERVICE PRICE TRANS-
PARENCY. 
Section 1834 of the Social Security Act (42 U.S.C. 
1395m) is amended by adding at the end the following 
new subsection: 
‘‘(r) SITE-OF-SERVICE PRICE TRANSPARENCY.— 
‘‘(1) IN GENERAL.—In order to facilitate price 
transparency with respect to items and services for 
which payment may be made either to a hospital 
outpatient department or to an ambulatory surgery 
center under this title, the Secretary shall, for 2017 
and each year thereafter, make available to the pub-
lic via a searchable website, with respect to an ap-
propriate number of such items and services— 
‘‘(A) the estimated payment amount for 
such items and services under the outpatient 
VerDate Sep 11 2014 
01:31 May 20, 2015
Jkt 049200
PO 00000
Frm 00284
Fmt 6652
Sfmt 6201
E:\BILLS\H6.IH
H6
SSpencer on DSK4SPTVN1PROD with BILLS
285 
department fee schedule under subsection (t) of 
section 1833 and the ambulatory surgical cen-
ter payment system under subsection (i) of such 
section; and 
‘‘(B) the estimated amount of beneficiary 
liability applicable to such an item or service. 
‘‘(2) CALCULATION
OF
ESTIMATED
BENE-
FICIARY
LIABILITY.—For purposes of paragraph 
(1)(B), the estimated amount of beneficiary liability, 
with respect to an item or service, is the amount for 
such item or service for which an individual who 
does not have coverage under a medicare supple-
mental policy certified under section 1882 or any 
other supplemental insurance coverage is respon-
sible. 
‘‘(3) IMPLEMENTATION.—In carrying out this 
subsection, the Secretary— 
‘‘(A) shall include in the notice described 
in section 1804(a) a notification of the avail-
ability of the estimated amounts made available 
under paragraph (1); and 
‘‘(B) may utilize existing mechanisms, such 
as the portion of the website of the Centers for 
Medicare & Medicaid Services on which infor-
mation comparing physician performance is 
VerDate Sep 11 2014 
01:31 May 20, 2015
Jkt 049200
PO 00000
Frm 00285
Fmt 6652
Sfmt 6201
E:\BILLS\H6.IH
H6
SSpencer on DSK4SPTVN1PROD with BILLS
286 
posted (commonly referred to as the Physician 
Compare website), to make available such esti-
mated amounts under such paragraph. 
‘‘(4) FUNDING.—For purposes of implementing 
this subsection, the Secretary shall provide for the 
transfer, from the Supplemental Medical Insurance 
Trust Fund under section 1841 to the Centers for 
Medicare & Medicaid Services Program Management 
Account, of $6,000,000 for fiscal year 2015, to re-
main available until expended.’’. 
Subtitle H—Medicare Part D Pa-
tient Safety and Drug Abuse 
Prevention 
SEC. 3141. PROGRAMS TO PREVENT PRESCRIPTION DRUG 
ABUSE UNDER MEDICARE PARTS C AND D. 
(a) DRUG MANAGEMENT PROGRAM
FOR AT-RISK 
BENEFICIARIES.— 
(1) IN GENERAL.—Section 1860D–4(c) of the 
Social Security Act (42 U.S.C. 1395w–10(c)) is 
amended by adding at the end the following: 
‘‘(5) DRUG MANAGEMENT PROGRAM FOR AT- 
RISK BENEFICIARIES.— 
‘‘(A) AUTHORITY TO ESTABLISH.—A PDP 
sponsor may establish a drug management pro-
gram for at-risk beneficiaries under which, sub-
VerDate Sep 11 2014 
01:31 May 20, 2015
Jkt 049200
PO 00000
Frm 00286
Fmt 6652
Sfmt 6201
E:\BILLS\H6.IH
H6
SSpencer on DSK4SPTVN1PROD with BILLS
287 
ject to subparagraph (B), the PDP sponsor 
may, in the case of an at-risk beneficiary for 
prescription drug abuse who is an enrollee in a 
prescription drug plan of such PDP sponsor, 
limit such beneficiary’s access to coverage for 
frequently abused drugs under such plan to fre-
quently abused drugs that are prescribed for 
such beneficiary by one or more prescribers se-
lected under subparagraph (D), and dispensed 
for such beneficiary by one or more pharmacies 
selected under such subparagraph. 
‘‘(B) REQUIREMENT FOR NOTICES.— 
‘‘(i) IN
GENERAL.—A PDP sponsor 
may not limit the access of an at-risk ben-
eficiary for prescription drug abuse to cov-
erage for frequently abused drugs under a 
prescription drug plan until such spon-
sor— 
‘‘(I) provides to the beneficiary 
an initial notice described in clause 
(ii) and a second notice described in 
clause (iii); and 
‘‘(II) verifies with the providers 
of the beneficiary that the beneficiary 
VerDate Sep 11 2014 
01:31 May 20, 2015
Jkt 049200
PO 00000
Frm 00287
Fmt 6652
Sfmt 6201
E:\BILLS\H6.IH
H6
SSpencer on DSK4SPTVN1PROD with BILLS