SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Medicare Part B Improvement Act of 2017’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—IMPROVEMENTS IN PROVISION OF HOME INFUSION 
THERAPY 
Sec. 101. Home infusion therapy services temporary transitional payment. 
Sec. 102. Extension of Medicare Patient IVIG Access Demonstration Project. 
Sec. 103. Orthotist’s and prosthetist’s clinical notes as part of the patient’s 
medical record. 
TITLE II—IMPROVEMENTS IN DIALYSIS SERVICES 
Sec. 201. Independent accreditation for dialysis facilities and assurance of high 
quality surveys. 
Sec. 202. Expanding access to home dialysis therapy. 
TITLE III—IMPROVEMENTS IN APPLICATION OF STARK RULE 
Sec. 301. Modernizing the application of the Stark rule under Medicare. 
Sec. 302. Funds from the Medicare Improvement Fund. 
TITLE 
I—IMPROVEMENTS 
IN 
PROVISION OF HOME INFU-
SION THERAPY 
SEC. 101. HOME INFUSION THERAPY SERVICES TEM-
PORARY TRANSITIONAL PAYMENT. 
(a) IN GENERAL.—Section 1834(u) of the Social Se-
curity Act (42 U.S.C. 1395m(u)) is amended, by adding 
at the end the following new paragraph: 
‘‘(7) HOME INFUSION THERAPY SERVICES TEM-
PORARY TRANSITIONAL PAYMENT.— 
‘‘(A) TEMPORARY
TRANSITIONAL
PAY-
MENT.—
‘‘(i) IN
GENERAL.—The Secretary 
shall, in accordance with the payment 
methodology described in subparagraph 
(B) and subject to the provisions of this 
paragraph, provide a home infusion ther-
apy services temporary transitional pay-
ment under this part to an eligible home 
infusion supplier (as defined in subpara-
graph (F)) for items and services described 
in subparagraphs (A) and (B) of section 
1861(iii)(2)) furnished during the period 
specified in clause (ii) by such supplier in 
coordination with the furnishing of transi-
tional home infusion drugs (as defined in 
clause (iii)). 
‘‘(ii) PERIOD
SPECIFIED.—For pur-
poses of clause (i), the period specified in 
this clause is the period beginning on Jan-
uary 1, 2019, and ending on the day be-
fore the date of the implementation of the 
payment system under paragraph (1)(A). 
‘‘(iii) TRANSITIONAL HOME INFUSION 
DRUG
DEFINED.—For purposes of this 
paragraph, the term ‘transitional home in-
fusion drug’ has the meaning given to the
term ‘home infusion drug’ under section 
1861(iii)(3)(C)), except that clause (ii) of 
such section shall not apply if a drug de-
scribed in such clause is identified in 
clauses (i), (ii), (iii) or (iv) of subpara-
graph (C) as of the date of the enactment 
of this paragraph. 
‘‘(B) PAYMENT METHODOLOGY.—For pur-
poses of this paragraph, the Secretary shall es-
tablish a payment methodology, with respect to 
items and services described in subparagraph 
(A)(i). Under such payment methodology the 
Secretary shall— 
‘‘(i) create the three payment cat-
egories described in clauses (i), (ii), and 
(iii) of subparagraph (C); 
‘‘(ii) assign drugs to such categories, 
in accordance with such clauses; 
‘‘(iii) assign appropriate Healthcare 
Common 
Procedure 
Coding 
System 
(HCPCS) codes to each payment category; 
and 
‘‘(iv) establish a single payment 
amount for each such payment category, in 
accordance with subparagraph (D), for
each infusion drug administration calendar 
day in the individual’s home for drugs as-
signed to such category. 
‘‘(C) PAYMENT CATEGORIES.— 
‘‘(i) PAYMENT
CATEGORY
1.—The 
Secretary shall create a payment category 
1 and assign to such category drugs which 
are covered under the Local Coverage De-
termination on External Infusion Pumps 
(LCD number L33794) and billed with the 
following HCPCS codes (as identified as of 
July 1, 2017, and as subsequently modi-
fied by the Secretary): J0133, J0285, 
J0287, J0288, J0289, J0895, J1170, 
J1250, J1265, J1325, J1455, J1457, 
J1570, J2175, J2260, J2270, J2274, 
J2278, J3010, or J3285. 
‘‘(ii) PAYMENT
CATEGORY
2.—The 
Secretary shall create a payment category 
2 and assign to such category drugs which 
are covered under such local coverage de-
termination and billed with the following 
HCPCS codes (as identified as of July 1, 
2017, and as subsequently modified by the
Secretary): J1559 JB, J1561 JB, J1562 
JB, J1569 JB, or J1575 JB. 
‘‘(iii) PAYMENT
CATEGORY
3.—The 
Secretary shall create a payment category 
3 and assign to such category drugs which 
are covered under such local coverage de-
termination and billed with the following 
HCPCS codes (as identified as of July 1, 
2017, and as subsequently modified by the 
Secretary): J9000, J9039, J9040, J9065, 
J9100, J9190, J9200, J9360, or J9370. 
‘‘(iv) INFUSION DRUGS NOT OTHER-
WISE INCLUDED.—With respect to drugs 
that are not included in payment category 
1, 2, or 3 under clause (i), (ii), or (iii), re-
spectively, the Secretary shall assign to the 
most appropriate of such categories, as de-
termined by the Secretary, drugs which 
are— 
‘‘(I) covered under such local cov-
erage determination and billed under 
HCPCS codes J7799 or J7999 (as 
identified as of July 1, 2017, and as 
subsequently modified by the Sec-
retary); or
‘‘(ii) PAYMENT
AMOUNT
FOR
CAT-
EGORY 1.—For purposes of clause (i), the 
codes and units described in this clause, 
with respect to drugs included in payment 
category 1 described in subparagraph 
(C)(i), are one unit of HCPCS code 96365 
plus four units of HCPCS code 96366 (as 
identified as of July 1, 2017, and as subse-
quently modified by the Secretary). 
‘‘(iii) PAYMENT
AMOUNT
FOR
CAT-
EGORY 2.—For purposes of clause (i), the 
codes and units described in this clause, 
with respect to drugs included in payment 
category 2 described in subparagraph 
(C)(i), are one unit of HCPCS code 96369 
plus four units of HCPCS code 96370 (as 
identified as of July 1, 2017, and as subse-
quently modified by the Secretary). 
‘‘(iv) PAYMENT
AMOUNT
FOR
CAT-
EGORY 3.—For purposes of clause (i), the 
codes and units described in this clause, 
with respect to drugs included in payment 
category 3 described in subparagraph 
(C)(i), are one unit of HCPCS code 96413 
plus four units of HCPCS code 96415 (as
identified as of July 1, 2017, and as subse-
quently modified by the Secretary). 
‘‘(E) CLARIFICATIONS.— 
‘‘(i) INFUSION DRUG ADMINISTRATION 
DAY.—For purposes of this subsection, a 
reference, with respect to the furnishing of 
transitional home infusion drugs or home 
infusion drugs to an individual by an eligi-
ble home infusion supplier, to payment to 
such supplier for an infusion drug adminis-
tration calendar day in the individual’s 
home shall refer to payment only for the 
date on which professional services (as de-
scribed in section 1861(iii)(2)(A)) were 
furnished to administer such drugs to such 
individual. For purposes of the previous 
sentence, an infusion drug administration 
calendar day shall include all such drugs 
administered to such individual on such 
day. 
‘‘(ii) 
TREATMENT
OF
MULTIPLE 
DRUGS ADMINISTERED ON SAME INFUSION 
DRUG ADMINISTRATION DAY.—In the case 
that an eligible home infusion supplier, 
with respect to an infusion drug adminis-
tration calendar day in an individual’s 
home, furnishes to such individual transi-
tional home infusion drugs which are not 
all assigned to the same payment category 
under subparagraph (C), payment to such 
supplier for such infusion drug administra-
tion calendar day in the individual’s home 
shall be a single payment equal to the 
amount of payment under this paragraph 
for the drug, among all such drugs so fur-
nished to such individual during such cal-
endar day, for which the highest payment 
would be made under this paragraph. 
‘‘(F) ELIGIBLE
HOME
INFUSION
SUP-
PLIERS.—In this paragraph, the term ‘eligible 
home infusion supplier’ means a supplier that is 
enrolled under this part as a pharmacy that 
provides external infusion pumps and external 
infusion pump supplies and that maintains all 
pharmacy licensure requirements in the State in 
which the applicable infusion drugs are admin-
istered. 
‘‘(G) IMPLEMENTATION.—Notwithstanding 
any other provision of law, the Secretary may
implement this paragraph by program instruc-
tion or otherwise.’’. 
(b) 
CONFORMING
AMENDMENT.—Section 
1842(b)(6)(I) of the Social Security Act (42 U.S.C. 
1395u(b)(6)(I)) is amended by inserting ‘‘or, in the case 
of items and services described in clause (i) of section 
1834(u)(7)(A) furnished to an individual during the pe-
riod described in clause (ii) of such section, payment shall 
be made to the eligible home infusion therapy supplier’’ 
after ‘‘payment shall be made to the qualified home infu-
sion therapy supplier’’. 
SEC. 102. EXTENSION OF MEDICARE PATIENT IVIG ACCESS 
DEMONSTRATION PROJECT. 
Section 101(b) of the Medicare IVIG Access and 
Strengthening Medicare and Repaying Taxpayers Act of 
2012 (42 U.S.C. 1395l note) is amended— 
(1) in paragraph (1), by inserting after ‘‘for a 
period of 3 years’’ the following: ‘‘and, subject to the 
availability of funds under subsection (g)— 
‘‘(A) if the date of enactment of the Medi-
care Part B Improvement Act of 2017 is on or 
before September 30, 2017, for the period be-
ginning on October 1, 2017, and ending on De-
cember 31, 2020; and
‘‘(B) if the date of enactment of such Act 
is after September 30, 2017, for the period be-
ginning on the date of enactment of such Act 
and ending on December 31, 2020’ ’’’; and 
(2) in paragraph (2), by adding at the end the 
following new sentences: ‘‘Subject to the preceding 
sentence, a Medicare beneficiary enrolled in the dem-
onstration project on September 30, 2017, shall be 
automatically enrolled during the period beginning 
on the date of the enactment of the Medicare Part 
B Improvement Act of 2017 and ending on Decem-
ber 31, 2020, without submission of another applica-
tion. Chapter 35 of title 44, United States Code, 
shall not apply to any application form used for a 
Medicare beneficiary who enrolls in the demonstra-
tion project on or after such date of enactment.’’. 
SEC. 103. ORTHOTIST’S AND PROSTHETIST’S CLINICAL 
NOTES AS PART OF THE PATIENT’S MEDICAL 
RECORD. 
Section 1834(h) of the Social Security Act (42 U.S.C. 
1395m(h)) is amended by adding at the end the following 
new paragraph: 
‘‘(5) 
DOCUMENTATION
CREATED
BY 
ORTHOTISTS AND PROSTHETISTS.—For purposes of 
determining the reasonableness and medical neces-
sity of orthotics and prosthetics, documentation cre-
ated by an orthotist or prosthetist shall be consid-
ered part of the individual’s medical record to sup-
port documentation created by eligible professionals 
described in section 1848(k)(3)(B).’’. 
TITLE II—IMPROVEMENTS IN 
DIALYSIS SERVICES 
SEC. 201. INDEPENDENT ACCREDITATION FOR DIALYSIS 
FACILITIES AND ASSURANCE OF HIGH QUAL-
ITY SURVEYS. 
(a) ACCREDITATION AND SURVEYS.— 
(1) IN GENERAL.—Section 1865 of the Social 
Security Act (42 U.S.C. 1395bb) is amended— 
(A) in subsection (a)— 
(i) in paragraph (1), in the matter 
preceding subparagraph (A), by striking 
‘‘or the conditions and requirements under 
section 1881(b)’’; and 
(ii) in paragraph (4), by inserting 
‘‘(including a renal dialysis facility)’’ after 
‘‘facility’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(e) With respect to an accreditation body that has 
received approval from the Secretary under subsection
(a)(3)(A) for accreditation of provider entities that are re-
quired to meet the conditions and requirements under sec-
tion 1881(b), in addition to review and oversight authori-
ties otherwise applicable under this title, the Secretary 
shall (as the Secretary determines appropriate) conduct, 
with respect to such accreditation body and provider enti-
ties, any or all of the following as frequently as is other-
wise required to be conducted under this title with respect 
to other accreditation bodies or other provider entities: 
‘‘(1) Validation surveys referred to in sub-
section (d). 
‘‘(2) Accreditation program reviews (as defined 
in section 488.8(c) of title 42 of the Code of Federal 
Regulations, or a successor regulation). 
‘‘(3) Performance reviews (as defined in section 
488.8(a) of title 42 of the Code of Federal Regula-
tions, or a successor regulation).’’. 
(2) TIMING
FOR
ACCEPTANCE
OF
REQUESTS 
FROM ACCREDITATION ORGANIZATIONS.—Not later 
than 90 days after the date of enactment of this 
Act, the Secretary of Health and Human Services 
shall begin accepting requests from national accredi-
tation bodies for a finding described in section 
1865(a)(3)(A) of the Social Security Act (42 U.S.C. 
1395bb(a)(3)(A)) for purposes of accrediting pro-
vider entities that are required to meet the condi-
tions and requirements under section 1881(b) of 
such Act (42 U.S.C. 1395rr(b)). 
(b) REQUIREMENT
FOR TIMING
OF SURVEYS
OF 
NEW DIALYSIS FACILITIES.—Section 1881(b)(1) of the 
Social Security Act (42 U.S.C. 1395rr(b)(1)) is amended 
by adding at the end the following new sentence: ‘‘Begin-
ning 180 days after the date of the enactment of this sen-
tence, an initial survey of a provider of services or a renal 
dialysis facility to determine if the conditions and require-
ments under this paragraph are met shall be initiated not 
later than 90 days after such date on which both the pro-
vider enrollment form (without regard to whether such 
form is submitted prior to or after such date of enactment) 
has been determined by the Secretary to be complete and 
the provider’s enrollment status indicates approval is 
pending the results of such survey.’’. 
SEC. 202. EXPANDING ACCESS TO HOME DIALYSIS THER-
APY. 
(a) ALLOWING USE OF TELEHEALTH FOR MONTHLY 
END STAGE RENAL DISEASE-RELATED VISITS.— 
(1) IN
GENERAL.—Paragraph (3) of section 
1881(b) of the Social Security Act (42 U.S.C. 
1395rr(b)) is amended—
(A) by redesignating subparagraphs (A) 
and (B) as clauses (i) and (ii), respectively; 
(B) in clause (i), as redesignated by sub-
paragraph (A), by striking ‘‘under this subpara-
graph’’ and inserting ‘‘under this clause’’; 
(C) in clause (ii), as redesignated by sub-
paragraph (A), by inserting ‘‘subject to sub-
paragraph (B),’’ before ‘‘on a comprehensive’’; 
(D) by striking ‘‘With respect to’’ and in-
serting ‘‘(A) With respect to’’; and 
(E) by adding at the end the following new 
subparagraph: 
‘‘(B)(i) Subject to clause (ii), an individual who is 
determined to have end stage renal disease and who is re-
ceiving home dialysis may choose to receive monthly end 
stage renal disease-related visits, furnished on or after 
January 1, 2019, via telehealth. 
‘‘(ii) Clause (i) shall apply to an individual only if 
the individual receives a face-to-face visit, without the use 
of telehealth— 
‘‘(I) in the case of the initial 3 months of home 
dialysis of such individual, at least monthly; and 
‘‘(II) after such initial 3 months, at least once 
every 3 consecutive months.’’.
(2) CONFORMING AMENDMENT.—Paragraph (1) 
of such section is amended by striking ‘‘paragraph 
(3)(A)’’ and inserting ‘‘paragraph (3)(A)(i)’’. 
(b) EXPANDING ORIGINATING SITES
FOR TELE-
HEALTH TO INCLUDE RENAL DIALYSIS FACILITIES AND 
THE HOME FOR PURPOSES OF MONTHLY END STAGE 
RENAL DISEASE-RELATED VISITS.— 
(1) IN GENERAL.—Section 1834(m) of the So-
cial Security Act (42 U.S.C. 1395m(m)) is amend-
ed— 
(A) in paragraph (4)(C)(ii), by adding at 
the end the following new subclauses: 
‘‘(IX) A renal dialysis facility, 
but only for purposes of section 
1881(b)(3)(B). 
‘‘(X) The home of an individual, 
but only for purposes of section 
1881(b)(3)(B).’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(5) TREATMENT OF HOME DIALYSIS MONTHLY 
ESRD-RELATED
VISIT.—The geographic require-
ments described in paragraph (4)(C)(i) shall not 
apply with respect to telehealth services furnished on 
or after January 1, 2019, for purposes of section
1881(b)(3)(B), at an originating site described in 
subclause 
(VI), 
(IX), 
or 
(X) 
of 
paragraph 
(4)(C)(ii)), subject to applicable State law require-
ments, including State licensure requirements.’’. 
(2) NO
FACILITY
FEE
IF
ORIGINATING
SITE 
FOR HOME DIALYSIS THERAPY IS THE HOME.—Sec-
tion 1834(m)(2)(B) of the Social Security (42 
U.S.C. 1395m(m)(2)(B)) is amended— 
(A) by redesignating clauses (i) and (ii) as 
subclauses (I) and (II), respectively, and by in-
denting each of such subclauses 2 ems to the 
right; 
(B) in subclause (II), as redesignated by 
subparagraph (A), by striking ‘‘clause (i) or 
this clause’’ and inserting ‘‘subclause (I) or this 
subclause’’; 
(C) by striking ‘‘SITE.—With respect to’’ 
and inserting ‘‘SITE.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), with respect to’’; and 
(D) by adding at the end the following new 
clause: 
‘‘(ii) NO
FACILITY
FEE
IF
ORIGI-
NATING SITE FOR HOME DIALYSIS THER-
APY IS THE HOME.—No facility fee shall
be paid under this subparagraph to an 
originating site described in subclause (X) 
of paragraph (4)(C)(ii).’’. 
(c) CLARIFICATION REGARDING TELEHEALTH PRO-
VIDED TO BENEFICIARIES.—Section 1128A(i)(6) of the 
Social Security Act (42 U.S.C. 1320a–7a(i)(6)) is amend-
ed— 
(1) in subparagraph (H), by striking ‘‘; or’’ and 
inserting a semicolon; 
(2) in subparagraph (I), by striking the period 
at the end and inserting ‘‘; or’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(J) the provision of telehealth tech-
nologies on or after January 1, 2019, to indi-
viduals with end stage renal disease under title 
XVIII by a health care provider for the purpose 
of furnishing of telehealth.’’. 
(d) STUDY
AND REPORT
ON FURTHER EXPAN-
SION.— 
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study to examine the 
feasibility, benefits, and drawbacks of expanding the 
use of telehealth and store-and-forward technologies 
under the Medicare program under title XVIII of
the Social Security Act for items and services in-
cluded in renal dialysis services, as such term is de-
fined in section 1881(b)(14)(B) of such Act (42 
U.S.C. 1395rr(b)(14)(B)). 
(2) REPORT.—Not later than 2 years after the 
date of the enactment of this Act, the Comptroller 
General shall submit to Congress a report on the re-
sults of the study conducted under paragraph (1). 
TITLE III—IMPROVEMENTS IN 
APPLICATION OF STARK RULE 
SEC. 301. MODERNIZING THE APPLICATION OF THE STARK 
RULE UNDER MEDICARE. 
(a) CLARIFICATION OF THE WRITING REQUIREMENT 
AND SIGNATURE REQUIREMENT
FOR ARRANGEMENTS 
PURSUANT TO THE STARK RULE.— 
(1) 
WRITING
REQUIREMENT.—Section 
1877(h)(1) of the Social Security Act (42 U.S.C. 
1395nn(h)(1)) is amended by adding at the end the 
following new subparagraph: 
‘‘(D) WRITTEN REQUIREMENT CLARIFIED.—In 
the case of any requirement pursuant to this section 
for a compensation arrangement to be in writing, 
such requirement shall be satisfied by such means as 
determined by the Secretary, including by a collec-
tion of documents, including contemporaneous docu-
ments evidencing the course of conduct between the 
parties involved.’’. 
(2) 
SIGNATURE
REQUIREMENT.—Section 
1877(h)(1) of the Social Security Act (42 U.S.C. 
1395nn(h)(1)), as amended by paragraph (1), is fur-
ther amended by adding at the end the following 
new subparagraph: 
‘‘(E) SPECIAL RULE FOR SIGNATURE RE-
QUIREMENTS.—In the case of any requirement 
pursuant to this section for a compensation ar-
rangement to be in writing and signed by the 
parties, such signature requirement shall be 
met if— 
‘‘(i) not later than 90 consecutive cal-
endar days immediately following the date 
on which the compensation arrangement 
became noncompliant, the parties obtain 
the required signatures; and 
‘‘(ii) the compensation arrangement 
otherwise complies with all criteria of the 
applicable exception.’’. 
(b) INDEFINITE HOLDOVER FOR LEASE ARRANGE-
MENTS AND PERSONAL SERVICES ARRANGEMENTS PUR-
SUANT TO THE STARK RULE.—Section 1877(e) of the So-
cial Security Act (42 U.S.C. 1395nn(e)) is amended—
(1) in paragraph (1), by adding at the end the 
following new subparagraph: 
‘‘(C) 
HOLDOVER
LEASE
ARRANGE-
MENTS.—In the case of a holdover lease ar-
rangement for the lease of office space or equip-
ment, which immediately follows a lease ar-
rangement described in subparagraph (A) for 
the use of such office space or subparagraph 
(B) for the use of such equipment and that ex-
pired after a term of at least 1 year, payments 
made by the lessee to the lessor pursuant to 
such holdover lease arrangement, if— 
‘‘(i) the lease arrangement met the 
conditions of subparagraph (A) for the 
lease of office space or subparagraph (B) 
for the use of equipment when the ar-
rangement expired; 
‘‘(ii) the holdover lease arrangement is 
on the same terms and conditions as the 
immediately preceding arrangement; and 
‘‘(iii) the holdover arrangement con-
tinues to satisfy the conditions of subpara-
graph (A) for the lease of office space or 
subparagraph (B) for the use of equip-
ment.’’; and
(2) in paragraph (3), by adding at the end the 
following new subparagraph: 
‘‘(C) HOLDOVER PERSONAL SERVICE AR-
RANGEMENT.—In the case of a holdover per-
sonal service arrangement, which immediately 
follows an arrangement described in subpara-
graph (A) that expired after a term of at least 
1 year, remuneration from an entity pursuant 
to such holdover personal service arrangement, 
if— 
‘‘(i) the personal service arrangement 
met the conditions of subparagraph (A) 
when the arrangement expired; 
‘‘(ii) the holdover personal service ar-
rangement is on the same terms and condi-
tions as the immediately preceding ar-
rangement; and 
‘‘(iii) the holdover arrangement con-
tinues to satisfy the conditions of subpara-
graph (A).’’. 
SEC. 302. FUNDS FROM THE MEDICARE IMPROVEMENT 
FUND. 
Section 1898(b)(1) of the Social Security Act (42 
U.S.C. 1395iii(b)(1)) is amended by striking ‘‘during and
after fiscal year 2021, $270,000,000’’ and inserting ‘‘dur-
ing and after fiscal year 2021, $245,000,000’’. 
Passed the House of Representatives July 25, 2017. 
Attest: 
Clerk.