Title: Fairness for Medical Providers Act of 2019
Policy area: Health

Summary:
Fairness for Medical Providers Act of 2019
This bill allows administrative or judicial review of certain decisions by the Centers for Medicare & Medicaid Services (CMS) relating to the Medicare Primary Care Incentive Payment Program. (The program authorized additional payments to certain primary-care practitioners who provided primary-care services on or after January 1, 2011, and before January 1, 2016.)
Current law prohibits administrative or judicial review of CMS decisions regarding the eligibility of primary-care practitioners to receive incentive payments under the program. The bill authorizes review of such decisions in cases where the practitioner failed to meet eligibility criteria due to a coding error for provided items and services.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 373 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 373

To amend title XVIII of the Social Security Act to provide for certain 
  administrative or judicial review respecting the identification of 
    primary care practitioners under part B of the Medicare program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 9, 2019

  Ms. Brownley of California introduced the following bill; which was 
 referred to the Committee on Energy and Commerce, and in addition to 
   the Committee on Ways and Means, 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 amend title XVIII of the Social Security Act to provide for certain 
  administrative or judicial review respecting the identification of 
    primary care practitioners under part B of 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 ``Fairness for Medical Providers Act 
of 2019''.

SEC. 2. PROVIDING FOR CERTAIN ADMINISTRATIVE OR JUDICIAL REVIEW 
              RESPECTING THE IDENTIFICATION OF PRIMARY CARE 
              PRACTITIONERS UNDER PART B OF THE MEDICARE PROGRAM.

    (a) In General.--Section 1833(x)(4) of the Social Security Act (42 
U.S.C. 1395l(x)(4)) is amended to read as follows:
            ``(4) Limitation on review.--
                    ``(A) In general.--Subject to subparagraph (B), 
                there shall be no administrative or judicial review 
                under section 1869, 1878, or otherwise, respecting the 
                identification of primary care practitioners under this 
                subsection.
                    ``(B) Exception.--Subparagraph (A) shall not apply 
                in the case of administrative or judicial review under 
                section 1869, 1878, or otherwise, of the issue of 
                whether the Secretary (or an entity contracting with 
                the Secretary) failed to identify an individual 
                described in clause (i) of paragraph (2)(A) as a 
                primary care practitioner by reason of coding error 
                with respect to items and services furnished by such 
                individual during an applicable prior period (as 
                described in clause (ii) of such paragraph).''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply as if included in the enactment of the Patient Protection and 
Affordable Care Act (Public Law 111-148).
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