Title: HEARTS and Rural Relief Act
Policy area: Health

Summary:
HEARTS and Rural Relief Act
This bill makes a series of changes relating to Medicare coverage and requirements, particularly with respect to military retirees. Specifically, the bill (1) exempts certain military retirees who are under 65 years of age, and who no longer receive Social Security Disability Insurance benefits, from the requirement to enroll in Medicare medical services in order to be eligible for TRICARE; (2) increases funding for the Medicare Improvement Fund; and (3) temporarily provides for Medicare coverage of certain prostate cancer DNA Specimen Provenance Assay tests.
The bill also makes other changes to Medicare payment systems for certain items and services. Among other things, the bill (1) requires the Centers for Medicare & Medicaid Services (CMS) to specify the criteria used to exclude certain procedures from the list of covered surgical procedures that may be performed in an ambulatory surgical center under Medicare, and (2) extends the instruction from the CMS for contractors not to enforce the requirements for direct physician supervision of outpatient therapeutic services in critical access and small rural hospitals through 2021.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3416 Introduced in House (IH)]

<DOC>






116th CONGRESS
  1st Session
                                H. R. 3416

   To provide for health equity and access for returning troops and 
servicemembers, to provide for ambulatory surgical payment transparency 
          under the Medicare program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 21, 2019

     Ms. Sewell of Alabama (for herself and Mr. Smith of Nebraska) 
 introduced the following bill; which was referred to the Committee on 
  Energy and Commerce, and in addition to the Committees on Ways and 
 Means, and Armed Services, 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 provide for health equity and access for returning troops and 
servicemembers, to provide for ambulatory surgical payment transparency 
          under the Medicare program, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``HEARTS and Rural 
Relief Act''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Health Equity and Access for Returning Troops and 
                            Servicemembers and Rural Relief Act of 
                            2019.
Sec. 3. Ambulatory surgical center payment transparency.
Sec. 4. Exclusion of complex rehabilitative manual wheelchairs from 
                            Medicare competitive acquisition program; 
                            non-application of Medicare fee schedule 
                            adjustments for certain wheelchair 
                            accessories and cushions.
Sec. 5. Extension of enforcement instruction on supervision 
                            requirements for outpatient therapeutic 
                            services in critical access and small rural 
                            hospitals through 2021.

SEC. 2. HEALTH EQUITY AND ACCESS FOR RETURNING TROOPS AND 
              SERVICEMEMBERS AND RURAL RELIEF ACT OF 2019.

    (a) Modification of Requirement for Certain Former Members of the 
Armed Forces To Enroll in Medicare Part B To Be Eligible for TRICARE 
for Life.--
            (1) TRICARE eligibility.--
                    (A) In general.--Subsection (d) of section 1086 of 
                title 10, United States Code, is amended by adding at 
                the end the following new paragraph:
            ``(6)(A) The requirement in paragraph (2)(A) to enroll in 
        the supplementary medical insurance program under part B of 
        title XVIII of the Social Security Act (42 U.S.C. 1395j et 
        seq.) shall not apply to a person described in subparagraph (B) 
        during any month in which such person is not entitled to a 
        benefit described in subparagraph (A) of section 226(b)(2) of 
        the Social Security Act (42 U.S.C. 426(b)(2)) if such person 
        has received the counseling and information under subparagraph 
        (C).
            ``(B) A person described in this subparagraph is a person--
                    ``(i) who is under 65 years of age;
                    ``(ii) who is entitled to hospital insurance 
                benefits under part A of title XVIII of the Social 
                Security Act pursuant to subparagraph (A) or (C) of 
                section 226(b)(2) of such Act (42 U.S.C. 426(b)(2));
                    ``(iii) whose entitlement to a benefit described in 
                subparagraph (A) of such section has terminated due to 
                performance of substantial gainful activity; and
                    ``(iv) who is retired under chapter 61 of this 
                title.
            ``(C) The Secretary of Defense shall coordinate with the 
        Secretary of Health and Human Services and the Commissioner of 
        Social Security to notify persons described in subparagraph (B) 
        of, and provide information and counseling regarding, the 
        effects of not enrolling in the supplementary medical insurance 
        program under part B of title XVIII of the Social Security Act 
        (42 U.S.C. 1395j et seq.), as described in subparagraph (A).''.
                    (B) Conforming amendment.--Paragraph (2)(A) of such 
                subsection is amended by striking ``is enrolled'' and 
                inserting ``except as provided by paragraph (6), is 
                enrolled''.
                    (C) Identification of persons.--Section 1110a of 
                such title is amended by adding at the end the 
                following new subsection:
    ``(c) Certain Individuals Not Required To Enroll in Medicare Part 
B.--In carrying out subsection (a), the Secretary of Defense shall 
coordinate with the Secretary of Health and Human Services and the 
Commissioner of Social Security to--
            ``(1) identify persons described in subparagraph (B) of 
        section 1086(d)(6) of this title; and
            ``(2) provide information and counseling pursuant to 
        subparagraph (C) of such section.''.
            (2) Non-application of medicare part b late enrollment 
        penalty.--Section 1839(b) of the Social Security Act (42 U.S.C. 
        1395r(b)) is amended, in the second sentence, by inserting ``or 
        months for which the individual can demonstrate that the 
        individual is an individual described in paragraph (6)(B) of 
        section 1086(d) of title 10, United States Code, who is 
        enrolled in the TRICARE program pursuant to such section'' 
        after ``an individual described in section 1837(k)(3)''.
            (3) Report.--Not later than October 1, 2024, the Secretary 
        of Defense, the Secretary of Health and Human Services, and the 
        Commissioner of Social Security shall jointly submit to the 
        Committees on Armed Services of the House of Representatives 
        and the Senate, 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 on the implementation of section 1086(d)(6) of title 10, 
        United States Code, as added by paragraph (1). Such report 
        shall include, with respect to the period covered by the 
        report--
                    (A) the number of individuals enrolled in TRICARE 
                for Life who are not enrolled in the supplementary 
                medical insurance program under part B of title XVIII 
                of the Social Security Act (42 U.S.C. 1395j et seq.) by 
                reason of such section 1086(d)(6); and
                    (B) the number of individuals who--
                            (i) are retired from the Armed Forces under 
                        chapter 61 of title 10, United States Code;
                            (ii) are entitled to hospital insurance 
                        benefits under part A of title XVIII of the 
                        Social Security Act pursuant to receiving 
                        benefits for 24 months as described in 
                        subparagraph (A) or (C) of section 226(b)(2) of 
                        such Act (42 U.S.C. 426(b)(2)); and
                            (iii) because of such entitlement, are no 
                        longer enrolled in TRICARE Standard, TRICARE 
                        Prime, TRICARE Extra, or TRICARE Select under 
                        chapter 55 of title 10, United States Code.
            (4) Deposit of savings into medicare improvement fund.--
        Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
        1395iii(b)(1)) is amended by striking ``during and after fiscal 
        year 2021, $0'' and inserting ``during and after fiscal year 
        2024, $5,000,000''.
            (5) Application.--The amendments made by paragraphs (1) and 
        (2) shall apply with respect to a person who, on or after 
        October 1, 2023, is a person described in section 1086(d)(6)(B) 
        of title 10, United States Code, as added by paragraph (1).
    (b) Coverage of Certain DNA Specimen Provenance Assay Tests Under 
Medicare.--
            (1) Benefit.--
                    (A) Coverage.--Section 1861 of the Social Security 
                Act (42 U.S.C. 1395x) is amended--
                            (i) in subsection (s)(2)--
                                    (I) in subparagraph (GG), by 
                                striking ``and'' at the end;
                                    (II) in subparagraph (HH), by 
                                striking the period and inserting ``; 
                                and''; and
                                    (III) by adding at the end the 
                                following new subparagraph:
            ``(II) a prostate cancer DNA Specimen Provenance Assay test 
        (DSPA test) (as defined in subsection (kkk));''; and
                            (ii) by adding at the end the following new 
                        subsection:
    ``(kkk) Prostate Cancer DNA Specimen Provenance Assay Test.--The 
term `prostate cancer DNA Specimen Provenance Assay Test' (DSPA test) 
means a test that, after a determination of cancer in one or more 
prostate biopsy specimens obtained from an individual, assesses the 
identity of the DNA in such specimens by comparing such DNA with the 
DNA that was separately taken from such individual at the time of the 
biopsy.''.
                    (B) Exclusion from coverage.--Section 1862(a)(1) of 
                the Social Security Act (42 U.S.C. 1395y(a)(1)) is 
                amended--
                            (i) in subparagraph (O), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (P), by striking the 
                        semicolon at the end and inserting ``, and''; 
                        and
                            (iii) by adding at the end the following 
                        new subparagraph:
            ``(Q) in the case of a prostate cancer DNA Specimen 
        Provenance Assay test (DSPA test) (as defined in section 
        1861(kkk)), unless such test is furnished on or after January 
        1, 2020, and before January 1, 2025, and such test is ordered 
        by the physician who furnished the prostate cancer biopsy that 
        obtained the specimen tested;''.
            (2) Payment amount and related requirements.--Section 1834 
        of the Social Security Act (42 U.S.C. 1395m) is amended by 
        adding at the end the following new subsection:
    ``(x) Prostate Cancer DNA Specimen Provenance Assay Tests.--
            ``(1) Payment for covered tests.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                payment amount for a prostate cancer DNA Specimen 
                Provenance Assay test (DSPA test) (as defined in 
                section 1861(kkk)) shall be $200. Such payment shall be 
                payment for all of the specimens obtained from the 
                biopsy furnished to an individual that are tested.
                    ``(B) Limitation.--Payment for a DSPA test under 
                subparagraph (A) may only be made on an assignment-
                related basis.
                    ``(C) Prohibition on separate payment.--No separate 
                payment shall be made for obtaining DNA that was 
                separately taken from an individual at the time of a 
                biopsy described in subparagraph (A).
            ``(2) HCPCS code and modifier assignment.--
                    ``(A) In general.--The Secretary shall assign one 
                or more HCPCS codes to a prostate cancer DNA Specimen 
                Provenance Assay test and may use a modifier to 
                facilitate making payment under this section for such 
                test.
                    ``(B) Identification of dna match on claim.--The 
                Secretary shall require an indication on a claim for a 
                prostate cancer DNA Specimen Provenance Assay test of 
                whether the DNA of the prostate biopsy specimens match 
                the DNA of the individual diagnosed with prostate 
                cancer. Such indication may be made through use of a 
                HCPCS code, a modifier, or other means, as determined 
                appropriate by the Secretary.
            ``(3) DNA match review.--
                    ``(A) In general.--The Secretary shall review at 
                least three years of claims under part B for prostate 
                cancer DNA Specimen Provenance Assay tests to identify 
                whether the DNA of the prostate biopsy specimens match 
                the DNA of the individuals diagnosed with prostate 
                cancer.
                    ``(B) Posting on internet website.--Not later than 
                July 1, 2023, the Secretary shall post on the internet 
                website of the Centers for Medicare & Medicaid Services 
                the findings of the review conducted under subparagraph 
                (A).''.
            (3) Cost-sharing.--Section 1833(a)(1) of the Social 
        Security Act (42 U.S.C. 1395l(a)(1)) is amended--
                    (A) by striking ``and (CC)'' and inserting 
                ``(CC)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (DD) with respect to a prostate 
                cancer DNA Specimen Provenance Assay test (DSPA test) 
                (as defined in section 1861(kkk)), the amount paid 
                shall be an amount equal to 80 percent of the lesser of 
                the actual charge for the test or the amount specified 
                under section 1834(x)''.

SEC. 3. AMBULATORY SURGICAL CENTER PAYMENT TRANSPARENCY.

    (a) Advisory Panel on Hospital Outpatient Payment Representation.--
            (1) ASC representative.--The second sentence of section 
        1833(t)(9)(A) of the Social Security Act (42 U.S.C. 
        1395l(t)(9)(A)) is amended by inserting ``and at least one 
        ambulatory surgical center representative'' after ``an 
        appropriate selection of representatives of providers''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply with respect to advisory panels consulted on or 
        after the date that is 1 year after the date of the enactment 
        of this Act.
    (b) Reasons for Excluding Additional Procedures From ASC Approved 
List.--Section 1833(i)(1) of the Social Security Act (42 U.S.C. 
1395l(i)(1)) is amended by adding at the end the following: ``In 
updating such lists for application in years beginning with the second 
year beginning after the date of the enactment of this sentence, for 
each procedure that was not proposed to be included in such lists in 
the proposed rule with respect to such lists and that was subsequently 
requested to be included in such lists during the public comment period 
with respect to such proposed rule and that is not included in the 
final rule updating such lists, the Secretary shall cite in such final 
rule the specific criteria in paragraph (b) or (c) of section 416.166 
of title 42, Code of Federal Regulations (or any successor regulation), 
based on which the procedure was excluded. If paragraph (b) of such 
section is cited for exclusion of a procedure, the Secretary shall 
identify the peer-reviewed research, if any, or the evidence upon which 
such determination is based.''.

SEC. 4. EXCLUSION OF COMPLEX REHABILITATIVE MANUAL WHEELCHAIRS FROM 
              MEDICARE COMPETITIVE ACQUISITION PROGRAM; NON-APPLICATION 
              OF MEDICARE FEE SCHEDULE ADJUSTMENTS FOR CERTAIN 
              WHEELCHAIR ACCESSORIES AND CUSHIONS.

    (a) Exclusion of Complex Rehabilitative Manual Wheelchairs From 
Competitive Acquisition Program.--Section 1847(a)(2)(A) of the Social 
Security Act (42 U.S.C. 1395w-3(a)(2)(A)) is amended--
            (1) by inserting ``, complex rehabilitative manual 
        wheelchairs (as determined by the Secretary), and certain 
        manual wheelchairs (identified, as of October 1, 2018, by HCPCS 
        codes E1235, E1236, E1237, E1238, and K0008 or any successor to 
        such codes)'' after ``group 3 or higher''; and
            (2) by striking ``such wheelchairs'' and inserting ``such 
        complex rehabilitative power wheelchairs, complex 
        rehabilitative manual wheelchairs, and certain manual 
        wheelchairs''.
    (b) Non-Application of Medicare Fee Schedule Adjustments for 
Wheelchair Accessories and Seat and Back Cushions When Furnished in 
Connection With Complex Rehabilitative Manual Wheelchairs.--
            (1) In general.--Notwithstanding any other provision of 
        law, the Secretary of Health and Human Services shall not, 
        during the period beginning on July 1, 2019, and ending on 
        December 31, 2020, 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 complex 
        rehabilitative manual wheelchairs (as determined by the 
        Secretary), and certain manual wheelchairs (identified, as of 
        October 1, 2018, by HCPCS codes E1235, E1236, E1237, E1238, and 
        K0008 or any successor to such codes).
            (2) Implementation.--Notwithstanding any other provision of 
        law, the Secretary may implement this subsection by program 
        instruction or otherwise.

SEC. 5. EXTENSION OF ENFORCEMENT INSTRUCTION ON SUPERVISION 
              REQUIREMENTS FOR OUTPATIENT THERAPEUTIC SERVICES IN 
              CRITICAL ACCESS AND SMALL RURAL HOSPITALS THROUGH 2021.

    Section 1 of Public Law 113-198, as amended by section 1 of Public 
Law 114-112, section 16004 of Public Law 114-255, and section 51007 of 
Public Law 115-123, is amended--
            (1) in the section heading, by striking ``2017'' and 
        inserting ``2021''; and
            (2) by striking ``and 2017'' and inserting ``, 2017, 2020, 
        and 2021''.
                                 <all>