I 
114TH CONGRESS 
1ST SESSION H. R. 1021 
To amend title XVIII of the Social Security Act to improve the integrity 
of the Medicare program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 24, 2015 
Mr. BRADY of Texas (for himself, Mr. MCDERMOTT, Mr. LEVIN, Mr. RANGEL, 
Mr. LEWIS, Mr. NEAL, Mr. SAM JOHNSON of Texas, Mr. DOGGETT, Mr. 
BLUMENAUER, Mr. DANNY K. DAVIS of Illinois, Mr. PASCRELL, Mr. 
TIBERI, Mr. NUNES, Ms. LINDA T. SA´NCHEZ of California, Mr. BOU-
STANY, Mr. REICHERT, Mr. BUCHANAN, Mr. ROSKAM, Mr. SMITH of Ne-
braska, Mr. REED, Mrs. BLACK, Mr. KELLY of Pennsylvania, Mr. 
RENACCI, Mr. MEEHAN, Mr. YOUNG of Indiana, Mr. HOLDING, and Mr. 
CARNEY) introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committee on Energy 
and Commerce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to improve 
the integrity of the Medicare program, and for other 
purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Protecting the Integrity of Medicare Act of 2015’’. 
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(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Prohibition of inclusion of Social Security account numbers on Medicare 
cards. 
Sec. 3. Preventing wrongful Medicare payments for items and services fur-
nished to incarcerated individuals, individuals not lawfully 
present, and deceased individuals. 
Sec. 4. Consideration of measures regarding Medicare beneficiary smart cards. 
Sec. 5. Modifying medicare durable medical equipment face-to-face encounter 
documentation requirement. 
Sec. 6. Reducing improper Medicare payments. 
Sec. 7. Improving senior Medicare patrol and fraud reporting rewards. 
Sec. 8. Requiring valid prescriber National Provider Identifiers on pharmacy 
claims. 
Sec. 9. Option to receive Medicare Summary Notice electronically. 
Sec. 10. Renewal of MAC contracts. 
Sec. 11. Study on pathway for incentives to States for State participation in 
medicaid data match program. 
Sec. 12. Programs to prevent prescription drug abuse under Medicare part D. 
Sec. 13. Guidance on application of Common Rule to clinical data registries. 
Sec. 14. Eliminating certain civil money penalties; gainsharing study and re-
port. 
Sec. 15. Modification of Medicare home health surety bond condition of partici-
pation requirement. 
Sec. 16. Oversight of Medicare coverage of manual manipulation of the spine 
to correct subluxation. 
Sec. 17. National expansion of prior authorization model for repetitive sched-
uled non-emergent ambulance transport. 
Sec. 18. Repealing duplicative Medicare secondary payor provision. 
Sec. 19. Plan for expanding data in annual CERT report. 
Sec. 20. Removing funds for Medicare Improvement Fund added by IMPACT 
Act of 2014. 
Sec. 21. Rule of construction. 
SEC. 2. PROHIBITION OF INCLUSION OF SOCIAL SECURITY 
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; 
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(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 
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 
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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. 
(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: 
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(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. 
(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. 
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(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). 
SEC. 3. 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: 
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‘‘(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. 
‘‘(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 subparagraph (a), that have been conducted since such 
date of enactment. 
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SEC. 4. CONSIDERATION OF MEASURES REGARDING MEDI-
CARE 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-
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. 
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SEC. 5. MODIFYING MEDICARE DURABLE MEDICAL EQUIP-
MENT 
FACE-TO-FACE 
ENCOUNTER 
DOCU-
MENTATION 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. 6. REDUCING IMPROPER MEDICARE PAYMENTS. 
(a) MEDICARE ADMINISTRATIVE CONTRACTOR IM-
PROPER PAYMENT OUTREACH
AND EDUCATION PRO-
GRAM.— 
(1) IN GENERAL.—Section 1874A of the Social 
Security Act (42 U.S.C. 1395kk–1) is amended— 
(A) in subsection (a)(4)— 
(i) by redesignating subparagraph (G) 
as subparagraph (H); and 
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(ii) 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 
(B) by adding at the end the following new 
subsection: 
‘‘(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 
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 
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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: 
‘‘(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. 
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‘‘(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 
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: 
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‘‘(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 
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— 
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(1) in paragraph (2), by inserting ‘‘or section 
1874(h)(6)’’ 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 16(b) of the Protecting the In-
tegrity of Medicare Act of 2015, and imple-
menting strategies (such as claims processing 
edits) to help reduce the error rate of payments 
under this title. The amounts retained under 
the preceding sentence shall not exceed an 
amount equal to 15 percent of the amounts re-
covered under this subsection, and shall remain 
available until expended. 
‘‘(B) LIMITATION.—Except for uses that 
support claims processing (including edits) or 
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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. 7. 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— 
(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 
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(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. 8. 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.— 
‘‘(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-
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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 
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 
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of Health and Human Services shall submit to 
Congress a report on the effectiveness of the 
procedures established under subparagraph 
(B)(i).’’. 
SEC. 9. OPTION TO RECEIVE MEDICARE SUMMARY NOTICE 
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. 
‘‘(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-
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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 
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 
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(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. 10. 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 
this section, the Secretary shall make 
available to the public the performance of 
each medicare administrative contractor 
VerDate Sep 11 2014 
06:24 Feb 28, 2015
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H1021
SSpencer on DSK4SPTVN1PROD with BILLS