(1) ESTABLISHMENT.—The Secretary shall es-
tablish a pilot program utilizing smart card tech-
nology to evaluate— 
(A) the applicability of smart card tech-
nology to the Medicare program under title 
XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.), including the applicability of such 
technology to Medicare beneficiaries or Medi-
care providers; and 
(B) whether such cards would be effective 
in preventing fraud under the Medicare pro-
gram. 
(2) IMPLEMENTATION.— 
(A) INITIAL IMPLEMENTATION.—The Sec-
retary shall implement the pilot program under 
this subsection not later than 1 year after the 
date of enactment of this Act. 
(B) SCOPE
AND
DURATION.—The Sec-
retary shall conduct the pilot program— 
(i) in not less than 2 States; and 
(ii) for a period of not less than 180 
days or more than 2 years. 
(3) REPORT.—Not later than 12 months after 
the completion of the pilot program under this sub-
section, the Secretary shall submit to the appro-
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priate committees of Congress and make available to 
the public a report that includes the following: 
(A) A summary of the pilot program and 
findings, including— 
(i) the costs or savings to the Medi-
care program as a result of the implemen-
tation of the pilot program; 
(ii) whether the use of smart card 
technology resulted in improvements in the 
quality of care provided to Medicare bene-
ficiaries under the pilot program; and 
(iii) whether such technology was use-
ful in preventing or detecting fraud, waste, 
and abuse in the Medicare program. 
(B) Recommendations regarding whether 
the use of smart card technology should be ex-
panded under the Medicare program. 
(4) DEFINITIONS.—In this subsection: 
(A) MEDICARE
BENEFICIARY.—The term 
‘‘Medicare beneficiary’’ means an individual en-
titled to, or enrolled for, benefits under part A 
of title XVIII of the Social Security Act (42 
U.S.C. 1395c et seq.) or enrolled for benefits 
under part B of such title (42 U.S.C. 1395j et 
seq.). 
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(B) 
MEDICARE
PROVIDER.—The 
term 
‘‘Medicare provider’’ includes a provider of serv-
ices (as defined in section 1861(u) of the Social 
Security Act (42 U.S.C. 1395x(u))) and a sup-
plier (as defined in section 1861(d) of such Act 
(42 U.S.C. 1395x(d))). 
(C) SECRETARY.—The term ‘‘Secretary’’ 
means the Secretary of Health and Human 
Services. 
(D) SMART
CARD.—The term ‘‘smart 
card’’ means identification used by a Medicare 
beneficiary or a Medicare provider that includes 
anti-fraud attributes. Such a card— 
(i) may rely on existing commercial 
data transfer networks or on a network of 
proprietary card readers or databases; and 
(ii) may include— 
(I) cards using technology adapt-
ed from the financial services indus-
try; 
(II) cards containing individual 
biometric identification, provided that 
such identification is encrypted and 
not contained in any central database; 
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(III) cards adapting technology 
and 
processes 
utilized 
in 
the 
TRICARE program under chapter 55 
of title 10, United States Code, or by 
the Veterans Administration; or 
(IV) such other technology as the 
Secretary determines appropriate. 
SEC. 204. REQUIRING PRIOR AUTHORIZATION OF INITIAL 
CLAIMS 
FOR 
STANDARD 
POWER 
WHEEL-
CHAIRS. 
Section 1834(a) of the Social Security Act (42 U.S.C. 
1395m(a)) is amended by adding at the end the following 
new paragraph: 
‘‘(22) PRIOR AUTHORIZATION FOR STANDARD 
POWER WHEELCHAIRS.— 
‘‘(A) IN
GENERAL.—Not later than 270 
days after the date of the enactment of this 
paragraph, the Secretary shall establish policies 
and procedures for a process to require prior 
authorization for initial claims for reimburse-
ment under this title for standard power wheel-
chairs. Such process shall include and be con-
sistent with the following: 
‘‘(i) The process shall include develop-
ment, formatting, and approval of docu-
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ments, including a comprehensive medical 
necessity evaluation form for physicians. 
‘‘(ii) The process shall provide 7 days 
for the Secretary, acting through the Cen-
ters for Medicare & Medicaid Services, to 
review and determine whether the informa-
tion provided meets coverage requirements. 
‘‘(iii) The Secretary shall include 
stakeholders in the development of the 
process, including representatives from the 
Centers for Medicare & Medicaid Services, 
clinicians, consumer groups, and national 
trade associations representing suppliers of 
durable medical equipment. 
‘‘(iv) Not later than 9 months after 
the date of the enactment of this para-
graph, the Secretary shall have developed 
and approved an online process for prior 
authorization of standard power wheel-
chairs. 
‘‘(v) For standard power wheelchairs 
furnished not later than 12 months after 
the date of approval of such online process, 
the Secretary shall implement the require-
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ment for prior authorization under this 
paragraph. 
‘‘(vi) No later than 12 months after 
enactment of this paragraph, the Sec-
retary, working with stakeholders, shall 
make recommendations to Congress for an 
electronic review process for other durable 
medical equipment items deemed at high 
risk. 
‘‘(B) PRIOR AUTHORIZATION DEFINED.— 
In this paragraph, the term ‘prior authoriza-
tion’ means an electronic process to evaluate 
medical documentation in order to determine 
whether medical necessity and coverage require-
ments have been met for a claim for a standard 
power wheelchair.’’. 
SEC. 205. STRENGTHENING MEDICAID PROGRAM INTEG-
RITY THROUGH FLEXIBILITY. 
Section 1936 of the Social Security Act (42 U.S.C. 
1396u–6) is amended— 
(1) in subsection (a), by inserting ‘‘, or other-
wise,’’ after ‘‘entities’’; and 
(2) in subsection (e)— 
(A) in paragraph (1), in the matter pre-
ceding subparagraph (A), by inserting ‘‘(includ-
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ing the costs of equipment, salaries and bene-
fits, and travel and training)’’ after ‘‘Program 
under this section’’; and 
(B) in paragraph (3), by striking ‘‘by 100’’ 
and inserting ‘‘by 100, or such number as de-
termined necessary by the Secretary to carry 
out the Program,’’. 
TITLE 
III—IMPROVING 
DATA 
SHARING ACROSS AGENCIES 
AND PROGRAMS 
SEC. 301. IMPROVING DATA SHARING ACROSS AGENCIES 
AND PROGRAMS. 
(a) IN GENERAL.—In order to ensure that the Sec-
retary, Medicare program safeguard contractors and other 
oversight contractors (as defined in subsection (g)(4)), the 
Inspector General of the Department of Health and 
Human Services, the Attorney General, and State and 
local law enforcement are able to operate with greater co-
ordination to curb fraud and improper payments, the Sec-
retary, the Inspector General of the Department of Health 
and Human Services, and the Attorney General shall pro-
vide for increased coordination and data sharing as de-
scribed in the succeeding subsections. 
(b) IMPROVING DATA SHARING INTERNALLY AND 
WITH CMS CONTRACTORS.— 
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(1) IN GENERAL.—The Secretary shall establish 
policies and procedures to ensure that claims and 
other data, including the data described in para-
graph (3), is accessible to Medicare program safe-
guard contractors and other oversight contractors 
not less frequently than on a daily basis. 
(2) ANALYSIS OF DATA.—The Secretary shall 
require Medicare program safeguard contractors and 
other oversight contractors to analyze the data 
accessed under paragraph (1) on an ongoing basis 
for purposes of conducting pre- and post-payment 
reviews under the Medicare program. 
(3) DATA DESCRIBED.—The following data is 
described in this paragraph: 
(A) Claims payment, claims denial, and 
other claims data under the Medicare program 
from the common working file and the Medicare 
national claims history database. 
(B) Data on providers of services and sup-
pliers under the Medicare program, including 
data from the Medicare Provider Enrollment, 
Chain, and Ownership System (PECOS) of the 
Centers for Medicare & Medicaid Services. 
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(C) Medicare beneficiary data, including 
data from the Enrollment DataBase of the Cen-
ters for Medicare & Medicaid Services. 
(c) 
PROVIDER
DATABASE
REVIEWS
AND 
VERIFICATION.— 
(1) IN GENERAL.— 
(A) REVIEW AND UPDATE OF MEDICARE 
PROVIDER
DATABASES.—The Secretary shall 
establish policies and procedures, which may in-
clude contractors, to review and update on a 
daily basis Medicare provider databases, includ-
ing the review and update of the Medicare Pro-
vider Enrollment, Chain, and Ownership Sys-
tem (PECOS) of the Centers for Medicare & 
Medicaid Services against death data of the So-
cial Security Administration, for accuracy and 
completeness. Such policies and procedures 
shall also include data matches on a daily basis, 
as determined appropriate by the Secretary, 
against other databases as determined appro-
priate by the Secretary, including the database 
of the Drug Enforcement Agency of persons 
registered to manufacture, distribute, or dis-
pense a controlled substance under part C of 
title II of the Controlled Substances Act (21 
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U.S.C. 821 et seq.), State medical licensing 
data, databases of suspended or debarred Fed-
eral contractors, including the Excluded Parties 
List System of the General Services Adminis-
tration, the Debt Check program of the Depart-
ment of the Treasury, a list of incarcerated in-
dividuals from the Department of Justice and 
each State’s Department of Corrections, and 
the List of Excluded Individuals/Entities of the 
Office of Inspector General of the Department 
of Health and Human Services. 
(B) CONSULTATION.—The policies and 
procedures under subparagraph (A) shall re-
quire the Secretary to periodically consult with 
external organizations, including the Federation 
of State Medical Boards, to determine data 
sources and screening tools best suited to detect 
fraudulent applications for enrollment under 
section 1866(j) of the Social Security Act (42 
U.S.C. 1395cc(j)) submitted by providers of 
medical or other items or services and suppliers 
under the Medicare program. 
(C) DATA MATCHING.— 
(i) IN
GENERAL.—The policies and 
procedures under subparagraph (A) may 
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include entering into agreements with the 
Commissioner of Social Security pursuant 
to section 205(r) of the Social Security Act 
(42 U.S.C. 405(r)) to match data against 
the death information maintained by the 
Commissioner, and matching against the 
database of the Drug Enforcement Agency 
of persons registered to manufacture, dis-
tribute, or dispense a controlled substance 
under part C of title II of the Controlled 
Substances Act (21 U.S.C. 821 et seq.), 
and other Federal databases, as deter-
mined appropriate by the Secretary. 
(ii) CONFIDENTIALITY OF DATA OB-
TAINED.—The Secretary shall take any ac-
tions required by an agreement described 
in clause (i) or any other agreement with 
the Commissioner of Social Security to ob-
tain data from the Commissioner for pur-
poses of this section to maintain the con-
fidentiality of data obtained from the Com-
missioner and to assure that the data is 
used solely for the purposes of this section. 
(D) ONGOING
ANALYSIS.—The Secretary 
shall use analytic software for the conduct of 
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ongoing analysis of Medicare provider databases 
described in subparagraph (A) to verify and up-
date data. The Secretary may use commercial 
database sources for purposes of verifying such 
data. 
(2) ACCESS TO NATIONAL DIRECTORY OF NEW 
HIRES.—Section 453(j) of the Social Security Act 
(42 U.S.C. 653(j)) is amended by adding at the end 
the following new paragraph: 
‘‘(12) PROVISION OF NEW HIRE INFORMATION 
TO THE CENTERS FOR MEDICARE & MEDICAID SERV-
ICES, THE INSPECTOR GENERAL OF THE DEPART-
MENT OF HEALTH AND HUMAN SERVICES, AND AP-
PLICABLE
STATE
HEALTH
SUBSIDY
PROGRAMS.— 
The National Directory of New Hires shall provide 
the Administrator of the Centers for Medicare & 
Medicaid Services and the Inspector General of the 
Department of Health and Human Services and, for 
purposes of carrying out section 1413(c)(3)(A)(ii) of 
Public Law 111–148, each applicable State health 
subsidy program (as defined in section 1413(e) of 
such Public Law) with all information in the Na-
tional Directory. With respect to the Inspector Gen-
eral, such authority is in addition to any authority 
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conferred under the Inspector General Act (5 U.S.C. 
App. 3).’’ 
(3) ACCESS TO LIST OF CONVICTED INDIVID-
UALS.—The Attorney General shall provide the Sec-
retary of Health and Human Services access to a 
list of convicted individuals for use in preventing 
waste, fraud, and abuse under the Medicare and 
Medicaid programs. 
(d) 
BENEFICIARY
DATABASE
REVIEW
AND 
VERIFICATION.— 
(1) IN GENERAL.—The Secretary shall establish 
policies and procedures, which may include contrac-
tors, to review and update on a daily basis Medicare 
beneficiary databases, including the Enrollment 
DataBase of the Centers for Medicare & Medicaid 
Services, for accuracy and completeness. Such poli-
cies and procedures shall include data matches 
against death data of the Social Security Adminis-
tration and also on a daily basis, as determined ap-
propriate by the Secretary, other Federal databases 
as determined appropriate by the Secretary, includ-
ing a list of incarcerated individuals from the De-
partment of Justice and each State’s Department of 
Corrections. 
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(2) ONGOING ANALYSIS.—The Secretary shall 
use analytic software for the conduct of ongoing 
analysis of Medicare beneficiary databases described 
in paragraph (1) to verify and update data supplied 
by providers of services and suppliers under the 
Medicare program. The Secretary may use commer-
cial database sources for purposes of verifying such 
data. 
(e) CONTINUED EFFORTS
ON INTEGRATED DATA 
REPOSITORY AND ONE PI PROJECT; EXPANDED ACCESS 
BY AGENCIES.— 
(1) CONTINUED
EFFORTS
ON
INTEGRATED 
DATA REPOSITORY AND ONE PI PROJECT.— 
(A) IN GENERAL.—The Secretary shall— 
(i) continue to incorporate Medicare 
claims and payment, provider, and bene-
ficiary data into the Integrated Data Re-
pository under section 1128J(a)(1) of the 
Social Security Act, as added by section 
6402(a) of the Patient Protection and Af-
fordable Care Act; and 
(ii) fully implement the waste, fraud, 
and abuse detection solution of the Centers 
for Medicare & Medicaid Services, called 
the ‘‘One PI project’’. 
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(B) UPDATING OF IDR ON DAILY BASIS.— 
The Secretary shall establish policies and proce-
dures to ensure that the Integrated Data Re-
pository is updated with Medicare claims pay-
ment data and data from the Medicare provider 
databases described in subsection (c)(1) and 
Medicare beneficiary databases described in 
subsection (d)(1), including the common work-
ing file, on a daily basis. 
(C) ACCESS TO IDR.—The Secretary shall 
ensure that Medicare program safeguard con-
tractors and other oversight contractors have 
access to the full range of data contained in the 
Integrated Data Repository and related analytic 
tools by not later than September 30, 2012. 
Such access shall include both real-time portal 
access and other means in accordance with pro-
tocols established by the Secretary. 
(D) LAW
ENFORCEMENT
ACCESS.—The 
Secretary shall ensure that Federal and other 
appropriate law enforcement agencies, including 
the Inspector General of the Department of 
Health and Human Services and the Attorney 
General, have access to the full range of data 
contained in the Integrated Data Repository 
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and related analytic tools by not later than Sep-
tember 30, 2012. Such access shall include both 
real-time portal access and other means in ac-
cordance with protocols established by the Sec-
retary. 
(E) DATE
CERTAIN
FOR
INCLUSION
OF 
PREPAYMENT
CLAIMS
DATA.—The Secretary 
shall ensure that the Integrated Data Reposi-
tory includes access to prepayment claims data 
by not later than September 30, 2012. 
(F) DATE
CERTAIN
FOR
INCLUSION
OF 
MEDICAID
PROGRAM
DATA.—The Secretary 
shall ensure that the Integrated Data Reposi-
tory includes access to or incorporates Medicaid 
program data by not later than September 30, 
2014 (or, if States are unable to provide certain 
data to the Secretary by such date, a substan-
tial amount of the Medicaid program data that 
is available as of such date). 
(2) EXPANDED DATABASE ACCESS TO APPRO-
PRIATE STATE ENTITIES.— 
(A) ACCESS TO INTEGRATED DATA REPOS-
ITORY.—For purposes of enhancing data shar-
ing in order to identify programmatic weak-
nesses and improving the timeliness of analysis 
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and actions to prevent waste, fraud, and abuse, 
relevant State agencies, including the State 
Medicaid plans under title XIX of the Social 
Security Act, State child health plans under 
title XXI of such Act, and State Medicaid fraud 
control units (as described in section 1903(q) of 
the Social Security Act (42 U.S.C. 1396b(q))), 
shall have access to the full range of data con-
tained in the Integrated Data Repository, in-
cluding the One PI system established under 
the One PI project, as directed by the Sec-
retary, by not later than September 30, 2013. 
The Secretary may, in consultation with the In-
spector General of the Department of Health 
and Human Services, give such access to State 
attorneys general and State law enforcement 
agencies. 
(B) CONFORMING AMENDMENTS.—Section 
1128J(a)(2) of the Social Security Act, as 
added by section 6402(a) of the Patient Protec-
tion and Affordable Care Act (Public Law 111– 
148) is amended— 
(i) by striking ‘‘DATABASES.—’’ 
and inserting ‘‘DATABASES.—’’ 
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