Title: Fighting Fraud to Protect Care for Seniors Act of 2018
Policy area: Health

Summary:
Fighting Fraud to Protect Care for Seniors Act of 2018
This bill requires the Centers for Medicare & Medicaid Services (CMS) to establish a pilot program that evaluates the feasibility of using smart card technology to address Medicare fraud. Under the program, smart card technology must be issued free-of-charge to selected Medicare beneficiaries, suppliers, and providers; such technology must support the secure, electronic authentication of beneficiary identity at points of service. In selecting program participants, the CMS must consider the risk of fraud, waste, or abuse among categories of suppliers and providers.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6690 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 6690

  To establish a smart card pilot program to combat fraud, waste, and 
 abuse and to protect beneficiary identity under the Medicare program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            August 28, 2018

 Mr. Roskam (for himself and Mr. Blumenauer) introduced the following 
  bill; which was referred to the Committee on Ways and Means, and in 
 addition to the Committee on Energy and Commerce, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL


 
  To establish a smart card pilot program to combat fraud, waste, and 
 abuse and to protect beneficiary identity under the Medicare program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Fighting Fraud to Protect Care for 
Seniors Act of 2018''.

SEC. 2. MEDICARE SMART CARD PILOT PROGRAM.

    Part E of title XVIII of the Social Security Act is amended by 
inserting after section 1866E the following new section:

``SEC. 1866F. SMART CARD PILOT PROGRAM.

    ``(a) Implementation.--
            ``(1) In general.--Not later than 36 months after the date 
        of the enactment of this section, the Secretary shall establish 
        a pilot program (in this section referred to as the `pilot 
        program') to evaluate the feasibility of using smart card 
        technology under this title.
            ``(2) Smart card technology defined.--In this section, the 
        term `smart card technology' means the following:
                    ``(A) Beneficiary smart card.--A machine readable, 
                tamper-resistant card (in this section referred to as a 
                `smart card') that includes an embedded integrated 
                circuit chip with a secure micro-controller (as defined 
                by the National Institute on Standards and Technology) 
                that enables the verification and secure, electronic 
                authentication of the identity of a Medicare 
                beneficiary at the point of service through a 
                combination of the smart card and a personal 
                identification number known by or associated with such 
                beneficiary.
                    ``(B) Card reader technology.--Information 
                technology that enables a supplier and provider to 
                authenticate the identity of a Medicare beneficiary 
                through presentation of such a smart card and such 
                components, with such authentication to be reflected 
                through the use of a modifier or in another appropriate 
                manner, as determined by the Secretary, in the claims 
                adjudication process.
            ``(3) Program design elements.--The pilot program shall be 
        conducted for a period of 3 years consistent with the 
        following:
                    ``(A) Selection of area.--In consultation with the 
                Inspector General of the Department of Health and Human 
                Services, the Secretary shall select at least 3 
                geographic areas in which the pilot program will 
                operate.
                    ``(B) Selection of supplier and provider types.--In 
                consultation with the Inspector General of the 
                Department of Health and Human Services, the Secretary 
                shall select supplier and provider types that will be 
                required to participate in the pilot program (referred 
                to in this section as `participating suppliers and 
                providers'). In selecting such supplier and provider 
                types, the Secretary shall--
                            ``(i) take into account the risk of fraud, 
                        waste, and abuse (as described in section 
                        1866(j)(2)(B)) with respect to the category of 
                        provider or supplier) and other factors as 
                        determined appropriate by the Secretary; and
                            ``(ii) limit the pilot program to no more 
                        than 2,000 suppliers and providers.
                    ``(C) Supplier and provider hardship exemptions.--
                The Secretary shall exempt from participation in the 
                pilot program a supplier or provider that either--
                            ``(i) does not have access to card reader 
                        technology (as described in paragraph (2)(B));
                            ``(ii) does not have sufficient internet 
                        access; or
                            ``(iii) has a low volume (as determined by 
                        the Secretary) of Medicare claims for which 
                        payment is made under this title.
                    ``(D) Smart card and smart card reader issuance.--
                            ``(i) Beneficiary smart card issuance.--The 
                        Secretary shall provide for, at no cost, the 
                        issuance (and, if necessary, replacement) of 
                        beneficiary smart cards described in paragraph 
                        (2)(A) to all Medicare beneficiaries residing 
                        in a geographic area in which the pilot program 
                        is conducted under subparagraph (A). 
                        Information that appears on Medicare cards used 
                        outside the pilot program may appear on the 
                        face of the beneficiary smart card.
                            ``(ii) Supplier and provider smart card 
                        reader issuance.--At the request of a 
                        participating supplier or provider, the 
                        Secretary shall provide for, at no cost, the 
                        issuance to such supplier or provider of smart 
                        card hardware and software necessary to 
                        participate in the pilot program.
                    ``(E) Information on operation of pilot program.--
                The Secretary shall provide participating suppliers and 
                providers and Medicare beneficiaries who are furnished 
                items and services by such suppliers and providers, 
                with information on the operation of the pilot program, 
                including privacy protections described in subparagraph 
                (I).
                    ``(F) Access to services outside the pilot 
                program.--
                            ``(i) Beneficiaries.--Medicare 
                        beneficiaries who receive beneficiary smart 
                        cards may receive items and services from 
                        suppliers and providers not participating in 
                        the pilot program.
                            ``(ii) Suppliers and provider claims.--
                                    ``(I) Suppliers and providers not 
                                participating in pilot.--Suppliers and 
                                providers not participating in the 
                                pilot program may submit claims under 
                                this title for items and services 
                                furnished without use of smart card 
                                technology to Medicare beneficiaries 
                                who receive beneficiary smart cards.
                                    ``(II) Participating suppliers and 
                                providers furnishing services to non-
                                participating beneficiaries.--Supplier 
                                and providers participating in the 
                                pilot program may submit claims under 
                                this title for items and services 
                                furnished to Medicare beneficiaries who 
                                do not receive beneficiary smart cards.
                    ``(G) Clarification on access to services without 
                smart cards.--In the case of a Medicare beneficiary who 
                receives a beneficiary smart card and does not present 
                such card at the time of receipt of items or services 
                from a participating supplier or provider, the 
                participating supplier or provider--
                            ``(i) shall furnish such items or services 
                        to such Medicare beneficiary as if such 
                        beneficiary does present such card;
                            ``(ii) may submit claims under this title 
                        for such items or services; and
                            ``(iii) shall provide, in accordance with 
                        such manner, process, and timing as specified 
                        by the Secretary, information to the Secretary 
                        (through the contractor described in 
                        subparagraph (H)) that such beneficiary 
                        received such a smart card but did not have the 
                        smart card at the time the items or services 
                        were furnished.
                    ``(H) Private sector implementation.--The Secretary 
                shall select, by using a competitive procurement 
                process in accordance with the provisions of chapter 1 
                of title 48, Code of Federal Regulations (or any 
                successor regulations), a private sector contractor to 
                implement and operate the pilot program.
                    ``(I) Privacy protections.--The Secretary shall 
                ensure that the pilot program complies with applicable 
                Federal laws and regulations concerning individually 
                identifiable health information, including the Privacy 
                Act of 1974 and regulations promulgated under section 
                264(c) of the Health Insurance Portability and 
                Accountability Act of 1996 and such individually 
                identifiable information shall be exempt from 
                disclosure under section 552(b)(3) of title 5, United 
                States Code.
                    ``(J) Mandatory participation.--Subject to 
                subparagraph (C), in the case of items or services 
                furnished by a provider or supplier included in a 
                supplier or provider type selected under subparagraph 
                (B) in a geographic area selected under subparagraph 
                (A), payment may only be made under this title for such 
                items or services during the period of the pilot 
                program if the provider or supplier is participating in 
                the pilot program.
                    ``(K) Prohibition of smart card fees.--No 
                transaction, utilization, or other fees may be imposed 
                on Medicare beneficiaries or participating suppliers 
                and providers with respect to the use of smart cards 
                under the pilot program.
            ``(4) Stakeholder input.--
                    ``(A) In general.--Not later than 6 months after 
                the date of the enactment of this section, the 
                Secretary shall convene a panel consisting of 
                stakeholders (including representatives of providers, 
                suppliers, Medicare beneficiaries, and claims 
                processing contractors) selected by the Secretary for 
                purposes of providing input to the Secretary on the 
                implementation of the pilot program (including on the 
                selection of areas and participants under subparagraphs 
                (A) and (B) of paragraph (3) and the development of 
                exemptions and requirements described in such 
                paragraph).
                    ``(B) Nonapplicability of faca.--The Federal 
                Advisory Committee Act shall not apply to the panel 
                convened pursuant to subparagraph (A).
            ``(5) Definitions.--In this section:
                    ``(A) The terms `supplier' and `provider' have the 
                meanings given the terms `supplier' and `provider of 
                services' in subsections (d) and (u), respectively, of 
                section 1861.
                    ``(B) The term `Medicare beneficiary' means an 
                individual who is enrolled in the original Medicare 
                fee-for-service program under parts A and B and is not 
                enrolled in an MA plan under part C, an eligible 
                organization under section 1876, or a PACE program 
                under section 1894.
    ``(b) Reports to Congress.--The Secretary shall submit to Congress 
the following reports:
            ``(1) Interim performance report.--Not later than 2 years 
        after the date the pilot program is implemented, an interim 
        report on the performance of such program.
            ``(2) Final performance report.--Not later than 18 months 
        after the date of the completion of the pilot program, a final 
        evaluation on the effectiveness of the pilot program. The 
        report shall include the following:
                    ``(A) An evaluation of the extent to which health 
                care fraud schemes were affected by the use of smart 
                card technology.
                    ``(B) A description of any barriers to 
                implementation of the pilot program.
                    ``(C) Participant feedback on the pilot program.
                    ``(D) Recommendations regarding the future use of 
                smart cards to address fraud under this title.
                    ``(E) Data on the information provided under 
                subsection (a)(3)(G)(iii).''.
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