Title: Medicare Accelerated and Advance Payments Improvement Act
Policy area: Health

Summary:
Medicare Accelerated and Advance Payments Improvement Act
This bill establishes and otherwise modifies requirements for the Medicare Accelerated and Advance Payment Program during the public health emergency relating to COVID-19 (i.e., coronavirus disease 2019). The program provides Medicare payments in advance to eligible providers experiencing claims or cash flow disruptions, such as during national emergencies; the program was specifically expanded in response to COVID-19 to encompass more types of providers, subject to certain recoupment and repayment provisions.
Under the current program, recoupment of advance payments (through claims offsets) begins up to four months after the payment is made. Additionally, certain hospitals have one year to repay the full amount; other types of providers have seven months. Repayments made after this period are subject to the prevailing interest rate set by the Department of the Treasury (generally around 10% in FY2020).
The bill delays recoupment for one year and caps the recoupment at 25% of a claim. The bill also gives all providers up to two years for full repayment and caps the interest rate at 1%. Additionally, the Centers for Medicare & Medicaid Services (CMS) may waive repayment entirely upon a demonstration of extreme hardship, among other factors.
The bill also requires the CMS to continue to make the program available to providers of Medicare medical services for the duration of the public health emergency. (The CMS suspended the program for such providers on April 26, 2020.)

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3750 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  2d Session
                                S. 3750

     To amend title XVIII of the Social Security Act to modify the 
  accelerated and advance payment programs under parts A and B of the 
            Medicare program during the COVID-19 emergency.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 14, 2020

Mrs. Shaheen (for herself, Mr. Bennet, Ms. Smith, Ms. Cortez Masto, Ms. 
Hassan, Mr. Jones, Mr. Reed, Mr. Blumenthal, Mr. Heinrich, Mr. Manchin, 
   Mr. Durbin, Ms. Klobuchar, Ms. Warren, Ms. Rosen, and Mr. Markey) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 A BILL


 
     To amend title XVIII of the Social Security Act to modify the 
  accelerated and advance payment programs under parts A and B of the 
            Medicare program during the COVID-19 emergency.

    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 ``Medicare Accelerated and Advance 
Payments Improvement Act''.

SEC. 2. MODIFYING THE ACCELERATED AND ADVANCE PAYMENT PROGRAMS UNDER 
              PARTS A AND B OF THE MEDICARE PROGRAM DURING THE COVID-19 
              EMERGENCY.

    (a) Special Repayment Rules.--
            (1) Part a.--Section 1815(f)(2)(C) of the Social Security 
        Act (42 U.S.C. 1395g(f)(2)(C)) is amended to read as follows:
            ``(C) In the case of an accelerated payment made under such 
        program on or after the date of the enactment of the CARES Act 
        and so made during the emergency period described in section 
        1135(g)(1)(B)--
                    ``(i) such payment shall be treated as if such 
                payment were made from the General Fund of the 
                Treasury;
                    ``(ii) upon request of the hospital, the Secretary 
                shall--
                            ``(I) provide 1 year before claims are 
                        offset to recoup such payment;
                            ``(II) provide that any such offset of a 
                        claim to recoup such payment shall not exceed 
                        25 percent of the amount of such claim; and
                            ``(III) allow not less than 2 years from 
                        the date of the first accelerated payment 
                        before requiring that the outstanding balance 
                        be paid in full; and
                    ``(iii) the Secretary may waive the requirement 
                that such payment be repaid (or recouped) if, not 
                earlier than 2 years from the date of the first 
                accelerated payment, the hospital submits to the 
                Secretary a request for such waiver containing such 
                information that demonstrates that--
                            ``(I) requiring repayment of such payment 
                        (or recouping such payment) would constitute an 
                        extreme hardship for the hospital;
                            ``(II) the hospital made efforts to 
                        maintain a comparable number of employees at a 
                        comparable level of pay during the such 
                        emergency period compared to the number of, and 
                        level of pay for, such employees as of the day 
                        before the beginning of such period; and
                            ``(III) the hospital did not increase 
                        executive compensation or undertake any stock 
                        buyback, if applicable, during such emergency 
                        period.''.
            (2) Part b.--
                    (A) Continuing conduct of advance payment 
                program.--Notwithstanding any other provision of law, 
                the Secretary of Health and Human Services shall carry 
                out the program described in section 421.214 of title 
                42, Code of Federal Regulations (or a successor 
                regulation) for the duration of the emergency period 
                described in section 1135(g)(1)(B) of the Social 
                Security Act (42 U.S.C. 1320b-5(g)(1)(B)).
                    (B) Repayment rules.--In carrying out such program, 
                in the case of a payment made under such program on or 
                after the date of the enactment of the CARES Act 
                (Public Law 116-136) and so made during the emergency 
                period described in section 1135(g)(1)(B) of the Social 
                Security Act (42 U.S.C. 1320b-5(g)(1)(B)), the 
                Secretary of Health and Human Services--
                            (i) shall treat such payment as if such 
                        payment were made from the General Fund of the 
                        Treasury;
                            (ii) upon request of the entity receiving 
                        such payment, shall--
                                    (I) provide 1 year before claims 
                                are offset to recoup the payment;
                                    (II) provide that any such offset 
                                of a claim to recoup such payment shall 
                                not exceed 25 percent of the amount of 
                                such claim; and
                                    (III) allow not less than 2 years 
                                from the date of the first advance 
                                payment before requiring that the 
                                outstanding balance be paid in full; 
                                and
                            (iii) may waive the requirement that such 
                        payment be repaid (or recouped) if, not earlier 
                        than 2 years from the date of the first advance 
                        payment, the entity submits to the Secretary a 
                        request for such waiver containing such 
                        information that demonstrates that--
                                    (I) requiring repayment of such 
                                payment (or recouping such payment) 
                                would constitute an extreme hardship 
                                for the entity;
                                    (II) the entity made efforts to 
                                maintain a comparable number of 
                                employees at a comparable level of pay 
                                during the such emergency period 
                                compared to the number of, and level of 
                                pay for, such employees as of the day 
                                before the beginning of such period; 
                                and
                                    (III) the entity did not increase 
                                executive compensation or undertake any 
                                stock buyback, if applicable, during 
                                such emergency period.
    (b) Interest Rates.--
            (1) Part a.--Section 1815(d) of the Social Security Act (42 
        U.S.C. 1395g(d)) is amended by inserting before the period at 
        the end the following: ``(or, in the case of such a 
        determination made with respect to a payment made on or after 
        the date of the enactment of the CARES Act and during the 
        emergency period described in section 1135(g)(1)(B) under the 
        program under subsection (e)(3), at a rate of 1 percent)''.
            (2) Part b.--Section 1833(j) of the Social Security Act (42 
        U.S.C. 1395l(j)) is amended by inserting before the period at 
        the end the following: ``(or, in the case of such a 
        determination made with respect to a payment made on or after 
        the date of the enactment of the CARES Act and during the 
        emergency period described in section 1135(g)(1)(B) under the 
        program described in section 421.214 of title 42, Code of 
        Federal Regulations (or a successor regulation), at a rate of 1 
        percent)''.
    (c) Report.--
            (1) Reports during covid-19 emergency.--Not later than 2 
        weeks after the date of the enactment of this section, and 
        every 2 weeks thereafter during the emergency period described 
        in section 1135(g)(1)(B) of the Social Security Act (42 U.S.C. 
        1320b-5(g)(1)(B)), the Secretary of Health and Human Services 
        shall submit to the Committee on Ways and Means and the 
        Committee on Energy and Commerce of the House of 
        Representatives, and the Committee on Finance of the Senate, a 
        report that includes the following:
                    (A) The total amount of payments made under section 
                1815(e)(3) of the Social Security Act (42 U.S.C. 
                1395g(e)(3)) and under the program described in section 
                421.214 of title 42, Code of Federal Regulations (or a 
                successor regulation) during the 2-week period 
                preceding the date of the submission of such report.
                    (B) The number of entities receiving such payments 
                during such period.
                    (C) A specification of each such entity.
            (2) Reports after covid-19 emergency.--
                    (A) In general.--Not later than 6 months after the 
                termination of the emergency period described in 
                paragraph (1), and every 6 months thereafter until all 
                specified payments (as defined in subparagraph (B)) 
                have been recouped or repaid, the Secretary of Health 
                and Human Services shall submit to the Committee on 
                Ways and Means and the Committee on Energy and Commerce 
                of the House of Representatives, and the Committee on 
                Finance of the Senate, a report that includes the 
                following:
                            (i) The total amount of all specified 
                        payments that have been recouped or repaid.
                            (ii) The total amount of all specified 
                        payments that have been recouped or repaid.
                            (iii) The amount of interest that has 
                        accrued with respect to all specified payments.
                    (B) Specified payments.--For purposes of 
                subparagraph (A), the term ``specified payments'' means 
                all payments made under section 1815(e)(3) of the 
                Social Security Act (42 U.S.C. 1395g(e)(3)) or under 
                the program described in section 421.214 of title 42, 
                Code of Federal Regulations (or a successor regulation) 
                made on or after the date of the enactment of the CARES 
                Act (Public Law 116-136) during the emergency period 
                described in such subparagraph.
                                 <all>