Patient Access and Medicare Protection Act

SECTION 1. SHORT TITLE.
    This Act may be cited as the ``Patient Access and Medicare 
Protection Act''.
SEC. 2. NON-APPLICATION OF MEDICARE FEE SCHEDULE ADJUSTMENTS FOR 
WHEELCHAIR ACCESSORIES AND SEAT AND BACK CUSHIONS WHEN FURNISHED IN 
CONNECTION WITH COMPLEX REHABILITATIVE POWER WHEELCHAIRS.
    (a) Non-application.--
        (1) In general.--Notwithstanding any other provision of law, 
    the Secretary of Health and Human Services shall not, prior to 
    January 1, 2017, use information on the payment determined under 
    the competitive acquisition programs under section 1847 of the 
    Social Security Act (42 U.S.C. 1395w-3) to adjust the payment 
    amount that would otherwise be recognized under section 
    1834(a)(1)(B)(ii) of such Act (42 U.S.C. 1395m(a)(1)(B)(ii)) for 
    wheelchair accessories (including seating systems) and seat and 
    back cushions when furnished in connection with Group 3 complex 
    rehabilitative power wheelchairs.
        (2) Implementation.--Notwithstanding any other provision of 
    law, the Secretary may implement this subsection by program 
    instruction or otherwise.
    (b) GAO Study and Report.--
        (1) Study.--
            (A) In general.--The Comptroller General of the United 
        States shall conduct a study on wheelchair accessories 
        (including seating systems) and seat and back cushions 
        furnished in connection with Group 3 complex rehabilitative 
        power wheelchairs. Such study shall include an analysis of the 
        following with respect to such wheelchair accessories and seat 
        and back cushions in each of the groups described in clauses 
        (i) through (iii) of subparagraph (B):
                (i) The item descriptions and associated HCPCS codes 
            for such wheelchair accessories and seat and back cushions.
                (ii) A breakdown of utilization and expenditures for 
            such wheelchair accessories and seat and back cushions 
            under title XVIII of the Social Security Act.
                (iii) A comparison of the payment amount under the 
            competitive acquisition program under section 1847 of such 
            Act (42 U.S.C. 1395w-3) with the payment amount that would 
            otherwise be recognized under section 1834 of such Act (42 
            U.S.C. 1395m), including beneficiary cost sharing, for such 
            wheelchair accessories and seat and back cushions.
                (iv) The aggregate distribution of such wheelchair 
            accessories and seat and back cushions furnished under such 
            title XVIII within each of the groups described in 
            subparagraph (B).
                (v) Other areas determined appropriate by the 
            Comptroller General.
            (B) Groups described.--The following groups are described 
        in this subparagraph:
                (i) Wheelchair accessories and seat and back cushions 
            furnished predominantly with Group 3 complex rehabilitative 
            power wheelchairs.
                (ii) Wheelchair accessories and seat and back cushions 
            furnished predominantly with power wheelchairs that are not 
            described in clause (i).
                (iii) Other wheelchair accessories and seat and back 
            cushions furnished with either power wheelchairs described 
            in clause (i) or (ii).
        (2) Report.--Not later than June 1, 2016, the Comptroller 
    General of the United States shall submit to Congress a report 
    containing the results of the study conducted under paragraph (1), 
    together with recommendations for such legislation and 
    administrative as the Comptroller General determines to be 
    appropriate.
SEC. 3. TRANSITIONAL PAYMENT RULES FOR CERTAIN RADIATION THERAPY 
SERVICES UNDER THE MEDICARE PHYSICIAN FEE SCHEDULE.
    (a) In General.--Section 1848 of the Social Security Act (42 U.S.C. 
1395w-4) is amended--
        (1) in subsection (b), by adding at the end the following new 
    paragraph:
        ``(11) Special rule for certain radiation therapy services.--
    The code definitions, the work relative value units under 
    subsection (c)(2)(C)(i), and the direct inputs for the practice 
    expense relative value units under subsection (c)(2)(C)(ii) for 
    radiation treatment delivery and related imaging services 
    (identified in 2016 by HCPCS G-codes G6001 through G6015) for the 
    fee schedule established under this subsection for services 
    furnished in 2017 and 2018 shall be the same as such definitions, 
    units, and inputs for such services for the fee schedule 
    established for services furnished in 2016.''; and
        (2) in subsection (c)(2)(K), by adding at the end the following 
    new clause:
                ``(iv) Treatment of certain radiation therapy 
            services.--Radiation treatment delivery and related imaging 
            services identified under subsection (b)(11) shall not be 
            considered as potentially misvalued services for purposes 
            of this subparagraph and subparagraph (O) for 2017 and 
            2018.''.
    (b) Report to Congress on Alternative Payment Model.--Not later 
than 18 months after the date of the enactment of this Act, the 
Secretary of Health and Human Services shall submit to Congress a 
report on the development of an episodic alternative payment model for 
payment under the Medicare program under title XVIII of the Social 
Security Act for radiation therapy services furnished in nonfacility 
settings.
SEC. 4. ENSURING FLEXIBILITY IN APPLYING HARDSHIP EXCEPTION FOR 
MEANINGFUL USE FOR 2015 EHR REPORTING PERIOD FOR 2017 PAYMENT 
ADJUSTMENTS.
    (a) Eligible Professionals.--Section 1848(a)(7)(B) of the Social 
Security Act (42 U.S.C. 1395w-4(a)(7)(B)) is amended, in the first 
sentence, by inserting ``(and, with respect to the payment adjustment 
under subparagraph (A) for 2017, for categories of eligible 
professionals, as established by the Secretary and posted on the 
Internet website of the Centers for Medicare & Medicaid Services prior 
to December 15, 2015, an application for which must be submitted to the 
Secretary by not later than March 15, 2016)'' after ``case-by-case 
basis''.
    (b) Eligible Hospitals.--Section 1886(b)(3)(B)(ix) of the Social 
Security Act (42 U.S.C. 1395ww(b)(3)(B)(ix)) is amended--
        (1) in the first sentence of subclause (I), by striking 
    ``(n)(6)(A)'' and inserting ``(n)(6)''; and
        (2) in subclause (II), in the first sentence, by inserting 
    ``(and, with respect to the application of subclause (I) for fiscal 
    year 2017, for categories of subsection (d) hospitals, as 
    established by the Secretary and posted on the Internet website of 
    the Centers for Medicare & Medicaid Services prior to December 15, 
    2015, an application for which must be submitted to the Secretary 
    by not later than April 1, 2016)'' after ``case-by-case basis''.
    (c) Implementation.--Notwithstanding any other provision of law, 
the Secretary of Health and Human Services shall implement the 
provisions of, and the amendments made by, subsections (a) and (b) by 
program instruction, such as through information on the Internet 
website of the Centers for Medicare & Medicaid Services.
SEC. 5. MEDICARE IMPROVEMENT FUND.
    Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
1395iii(b)(1)) is amended by striking ``$5,000,000'' and inserting 
``$0''.
SEC. 6. STRENGTHENING MEDICAID PROGRAM INTEGRITY THROUGH FLEXIBILITY.
    Section 1936 of the Social Security Act (42 U.S.C. 1396u-6) is 
amended--
        (1) in subsection (a), by inserting ``, or otherwise,'' after 
    ``entities''; and
        (2) in subsection (e)--
            (A) in paragraph (1), in the matter preceding subparagraph 
        (A), by inserting ``(including the costs of equipment, salaries 
        and benefits, 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 determined necessary by the 
        Secretary to carry out the Program,''.
SEC. 7. ESTABLISHING MEDICARE ADMINISTRATIVE CONTRACTOR ERROR REDUCTION 
INCENTIVES.
    (a) In General.--Section 1874A(b)(1)(D) of the Social Security Act 
(42 U.S.C. 1395kk-1(b)(1)(D)) is amended--
        (1) by striking ``quality.--The Secretary'' and inserting 
    ``quality.--
                ``(i) In general.--Subject to clauses (ii) and (iii), 
            the Secretary''; and
        (2) by inserting after clause (i), as added by paragraph (1), 
    the following new clauses:
                ``(ii) Improper payment rate reduction incentives.--The 
            Secretary shall provide incentives for medicare 
            administrative contractors to reduce the improper payment 
            error rates in their jurisdictions.
                ``(iii) Incentives.--The incentives provided for under 
            clause (ii)--

                    ``(I) may include a sliding scale of award fee 
                payments and additional incentives to medicare 
                administrative contractors that either reduce the 
                improper payment rates in their jurisdictions to 
                certain thresholds, as determined by the Secretary, or 
                accomplish tasks, as determined by the Secretary, that 
                further improve payment accuracy; and
                    ``(II) may include substantial reductions in award 
                fee payments under cost-plus-award-fee contracts, for 
                medicare administrative contractors that reach an upper 
                end improper payment rate threshold or other threshold 
                as determined by the Secretary, or fail to accomplish 
                tasks, as determined by the Secretary, that further 
                improve payment accuracy.''.

    (b) Effective Date.--
        (1) In general.--The amendments made by subsection (a) shall 
    apply to contracts entered into or renewed on or after the date 
    that is 3 years after the date of enactment of this Act.
        (2) Application to existing contracts.--In the case of 
    contracts in existence on or after the date of the enactment of 
    this Act and that are not subject to the effective date under 
    paragraph (1), the Secretary of Health and Human Services shall, 
    when appropriate and practicable, seek to apply the incentives 
    provided for in the amendments made by subsection (a) through 
    contract modifications.
SEC. 8. STRENGTHENING PENALTIES FOR THE ILLEGAL DISTRIBUTION OF A 
MEDICARE, MEDICAID, OR CHIP BENEFICIARY IDENTIFICATION OR BILLING 
PRIVILEGES.
    Section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)) 
is amended by adding at the end the following:
        ``(4) Whoever without lawful authority knowingly and willfully 
    purchases, sells or distributes, or arranges for the purchase, 
    sale, or distribution of a beneficiary identification number or 
    unique health identifier for a health care provider under title 
    XVIII, title XIX, or title XXI shall be imprisoned for not more 
    than 10 years or fined not more than $500,000 ($1,000,000 in the 
    case of a corporation), or both.''.
SEC. 9. IMPROVING THE SHARING OF DATA BETWEEN THE FEDERAL GOVERNMENT 
AND STATE MEDICAID PROGRAMS.
    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall establish a plan 
to encourage and facilitate the participation of States in the 
Medicare-Medicaid Data Match Program (commonly referred to as the 
``Medi-Medi Program'') under section 1893(g) of the Social Security Act 
(42 U.S.C. 1395ddd(g)).
    (b) Program Revisions To Improve Medi-Medi Data Match Program 
Participation by States.--Section 1893(g)(1)(A) of the Social Security 
Act (42 U.S.C. 1395ddd(g)(1)(A)) is amended--
        (1) in the matter preceding clause (i), by inserting ``or 
    otherwise'' after ``eligible entities'';
        (2) in clause (i)--
            (A) by inserting ``to review claims data'' after 
        ``algorithms''; and
            (B) by striking ``service, time, or patient'' and inserting 
        ``provider, service, time, or patient'';
        (3) in clause (ii)--
            (A) by inserting ``to investigate and recover amounts with 
        respect to suspect claims'' after ``appropriate actions''; and
            (B) by striking ``; and'' and inserting a semicolon;
        (4) in clause (iii), by striking the period and inserting`` ; 
    and''; and
        (5) by adding at the end the following new clause:
                ``(iv) furthering the Secretary's design, development, 
            installation, or enhancement of an automated data system 
            architecture--

                    ``(I) to collect, integrate, and assess data for 
                purposes of program integrity, program oversight, and 
                administration, including the Medi-Medi Program; and
                    ``(II) that improves the coordination of requests 
                for data from States.''.

    (c) Providing States With Data on Improper Payments Made for Items 
or Services Provided to Dual Eligible Individuals.--
        (1) In general.--The Secretary shall develop and implement a 
    plan that allows each State agency responsible for administering a 
    State plan for medical assistance under title XIX of the Social 
    Security Act access to relevant data on improper or fraudulent 
    payments made under the Medicare program under title XVIII of the 
    Social Security Act (42 U.S.C. 1395 et seq.) for health care items 
    or services provided to dual eligible individuals.
        (2) Dual eligible individual defined.--In this section, the 
    term ``dual eligible individual'' means an individual who is 
    entitled 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 title XVIII of such Act (42 U.S.C. 
    1395j et seq.), and is eligible for medical assistance under a 
    State plan under title XIX of such Act (42 U.S.C. 1396 et seq.) or 
    under a waiver of such plan.

                               Speaker of the House of Representatives.

                            Vice President of the United States and    
                                               President of the Senate.

Summary: .   Patient Access and Medicare Protection Act (Sec. 2) This bill temporarily exempts from certain Medicare payment adjustments wheelchair accessories and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs. (Group 3 power wheelchairs are those that meet the highest performance requirements with regard to speed, range, and climbing capability.) The Government Accountability Office must study wheelchair accessories and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs. (Sec. 3) The bill amends title XVIII (Medicare) of the Social Security Act (SSAct) to prohibit specified adjustments to the Medicare fee schedule for certain radiation therapy services in 2017 or 2018. Under current law, the Centers for Medicare &amp; Medicaid Services (CMS) must periodically identify, review, and make adjustments to potentially misvalued services under Medicare. The bill specifies that certain radiation therapy services shall not be considered as potentially misvalued services for these purposes in 2017 or 2018. (Sec. 4) For 2017, CMS may exempt categories of eligible professionals from requirements for meaningful use of electronic health records (EHR) technology. Under current law, CMS may, on a case-by-case basis, exempt an eligible professional from certain negative payment adjustments that would otherwise apply due to the professional's failure to comply with those requirements. (Sec. 5) The bill eliminates funding for the Medicare Improvement Fund. (The fund was established to make improvements under the original Medicare fee-for-service program.) (Sec. 6) The bill amends title XIX (Medicaid) of the SSAct to make changes related to the Medicaid Integrity Program (MIP). The bill: (1) specifies that program appropriations&nbsp;may cover the costs of equipment, travel, training, and salaries and benefits; and (2) allows CMS flexibility in determining the number of additional staff necessary to carry out the program. (MIP is a federal program aimed at preventing and reducing provider fraud, waste, and abuse in the Medicaid program.) (Sec. 7) Under current law, CMS may contract with Medicare administrative contractors (MACs), which are&nbsp;private&nbsp;insurers that process Medicare claims within&nbsp;specified geographic jurisdictions. The bill&nbsp;requires CMS to provide specified incentives for MACs to reduce improper payment error rates within their jurisdictions. (Sec. 8) The bill establishes criminal penalties of up to 10 years imprisonment and up to $500,000 ($1,000,000 for corporations) in fines for illegally purchasing or distributing Medicare, Medicaid, or Children's Health Insurance Program (CHIP) beneficiary identification or billing privileges. (Sec. 9) The bill increases the scope of the Medicare-Medicaid Data Match Program (Medi-Medi Program), an existing program through which contractors and participating&nbsp;governmental agencies collaboratively analyze&nbsp;Medicare and Medicaid billing trends. CMS must establish a plan to encourage states to participate in the Medi-Medi Program.  CMS shall implement a plan to allow states to access relevant data on improper or fraudulent payments made under the Medicare program on behalf of individuals dually eligible for both Medicare and Medicaid.