section 1874A(a)(4)(G) or by any other contractor de-
termined 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 indi-
vidual described in paragraph (1) to obtain, at a sin-
gle 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 service 
described in paragraph (1) that has been affirmed by 
medical review under this subsection, nothing in this 
subsection shall be construed to preclude the subse-
quent denial of a claim for such service 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. 
‘‘(B) ADMINISTRATION.—Chapter 35 of title 
44, United States Code, shall not apply to med-
ical review under this subsection.’’. 
(b) IMPROVING DOCUMENTATION OF SERVICES.— 
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(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 pro-
grams to improve the ability of chiropractors to pro-
vide documentation to the Secretary of services de-
scribed in section 1861(r)(5) in a manner that dem-
onstrates 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 diag-
nosis or treatment of illness or injury or to improve 
the functioning of a malformed body member. 
(2) TIMING.—The Secretary shall make the edu-
cational and training programs described in para-
graph (1) publicly available not later than January 
1, 2016. 
(3) FUNDING.—The Secretary shall use funds 
made available under section 1893(h)(10) of the So-
cial Security Act (42 U.S.C. 1395ddd(h)(10)), as 
added by section 6, to carry out this subsection. 
(c) GAO STUDY AND REPORT.— 
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(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 fur-
nished as part of a treatment by means of manual 
manipulation of the spine to correct a subluxation 
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 anal-
ysis 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 the re-
sults of the study conducted under paragraph (1), in-
cluding recommendations for such legislation and ad-
ministrative 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. 
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1395l) as the Comptroller General determines appro-
priate. 
SEC. 17. NATIONAL EXPANSION OF PRIOR AUTHORIZATION 
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, effective 
not later than January 1, 2016, States located in 
medicare administrative contractor (MAC) regions L 
and 11 (consisting of Delaware, the District of Co-
lumbia, Maryland, New Jersey, Pennsylvania, North 
Carolina, South Carolina, West Virginia, and Vir-
ginia). 
(2) MODEL DESCRIBED.—The model described in 
this paragraph is the testing of a model of prior au-
thorization for repetitive scheduled non-emergent am-
bulance 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 
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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 So-
cial Security Act (42 U.S.C. 1395m(l)) is amended by add-
ing 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 paragraph 
(2) of section 18(a) of the Protecting the Integ-
rity of Medicare Act of 2015 meets the require-
ments 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. 
‘‘(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 expanded be-
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