jiayi-li23/proxann_data huggingface dataset:
Topic: Health — Insurance Providers
Subject: Health
Date: 2015-11-18 00:00:00

Medicare Established Provider Act of 2015

This bill amends title XVIII (Medicare) of the Social Security Act to direct the Department of Health and Human Services (HHS) to develop a system for designating providers that represent a low risk of submitting fraudulent Medicare claims as "established providers" for purposes of applying for special treatment in the claim review process.

To qualify as an established provider, a provider must demonstrate that, within a specified timeframe: (1) at least 90% of Medicare claims submitted by the provider were determined to be eligible for full or partial payment, and (2) the provider appealed at least 90% of all Medicare claims that were not initially determined to be eligible for payment.

HHS may withhold payment for a Medicare claim made by an established provider only if a final determination has been made that the claim is ineligible for payment. If such a final determination is made, the provider shall repay such payment electronically and within a specified timeframe.
Topic: Health — Insurance Providers
Subject: Armed forces and national security
Date: 2015-11-19 00:00:00

Critical Access Hospitals for Veterans Act or the CAHV Act

This bill directs the Department of Veterans Affairs (VA) to provide eligible requesting veterans who are enrolled in the VA health care system with hospital care and medical services at critical access hospitals pursuant to an agreement between the VA and the Department of Health and Human Services.
Topic: Health — Insurance Providers
Subject: Health
Date: 2016-01-13 00:00:00

Behavioral Health Care Integration Act of 2016

This bill amends the Public Health Service Act to replace a Substance Abuse and Mental Health Services Administration (SAMHSA) program to support demonstration projects for providing integrated health care to certain patient populations with a program to support integration of primary and behavioral health care.

The program must be designed to lead to full collaboration between primary care and behavioral health providers in the same facility to ensure support for individuals with mental illness and a physical condition or substance use disorder.

Under the program, grants and cooperative agreements may be awarded to state departments of health, state mental health or addiction agencies, state Medicaid agencies, and health care providers and institutions. Recipients must report to SAMHSA on progress in reducing barriers to integrated care and outcomes for certain patient populations.
Topic: Health — Insurance Providers
Subject: Health
Date: 2016-02-25 00:00:00

Medicare Access to Radiology Care Act of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to revise physician supervision requirements under the Medicare program for radiology services performed by advanced level radiographers. Specifically, with respect to a state that has established such requirements for those services, the bill aligns Medicare's requirements with state requirements.

An "advanced level radiographer" is a radiographer who has obtained specified certification from either the American Registry of Radiologic Technologists or the Certification Board for Radiology Practitioner Assistants.
Topic: Health — Insurance Providers
Subject: Health
Date: 2016-03-23 00:00:00

Healthy Inpatient Procedures Act of 2016 or the HIP Act

This bill delays and suspends implementation of Medicare's Comprehensive Care for Joint Replacement Model, which tests episode-based payment and quality measurement for care associated with hip and knee replacements.

The bill also reduces and rescinds specified FY2017 and FY2018 funding that was appropriated for the Prevention and Public Health Trust Fund.
Topic: Health — Insurance Providers
Subject: Health
Date: 2016-03-23 00:00:00

Better Care, Lower Cost Act

This bill amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to establish an integrated chronic care delivery program through which qualified "Better Care Programs" (BCPs) shall: (1)  promote accountability and better care management for chronically ill patient populations, (2) coordinate items and services under Medicare, and (3) encourage investment in infrastructure and redesigned care processes. A health plan (including a Medicare Advantage plan) or group of providers may participate as a BCP if certified to do so by the Department of Health and Human Services (HHS).

The program shall focus on containing long-term costs and improving the overall health of the Medicare population by implementing, through qualified BCPs, strategies that prevent, delay, or minimize the progression of illness or disability associated with chronic conditions.

With respect to a BCP enrollee who is dually eligible for both Medicare and Medicaid, Medicare shall be the primary payor.

A Medigap policy (supplemental insurance that covers health care costs not covered by Medicare) may not provide for coverage of cost-sharing for Medicare services furnished to a BCP enrollee by a provider that is not a qualified BCP professional.

HHS, acting through the Agency for Healthcare Research and Quality, shall designate and provide core funding for at least three Chronic Care Innovation Centers. To be eligible for such designation and funding, an eligible entity must partner with other specified entities to develop new, evidence-based curricula that addresses the need for chronic care management.
Topic: Health — Insurance Providers
Subject: Health
Date: 2016-04-18 00:00:00

Cranial Prosthetic Medicaid Coverage Enhancement Act

This bill amends title XIX (Medicaid) of the Social Security Act to alter coverage requirements under a state plan for medical assistance. Specifically, a state plan that provides medical assistance for an individual's inpatient hospital services shall also provide biennial medical assistance to the individual for one cranial prosthesis, as specified by the bill. (A cranial prosthesis is a custom-made wig designed for a patient who has suffered hair loss as a result of a medical condition or treatment.)
Topic: Health — Insurance Providers
Subject: Armed forces and national security
Date: 2016-04-19 00:00:00

Veterans Pensions Protection Act of 2016

This bill exempts the following payments from annual income determinations with respect to pensions for veterans and surviving spouses and children of veterans: (1) reimbursements, including insurance settlement payments, for medical expenses related to an accident, theft, loss, or casualty, up to the costs of medical care provided to the victim of such event; and (2) payments for pain and suffering, including insurance settlement payments and general damages awarded by a court related to an accident, theft, loss, or casualty loss up to an amount determined by the Department of Veterans Affairs on a case-by-case basis.
Topic: Health — Insurance Providers
Subject: Health
Date: 2016-04-20 00:00:00

Flexibility in Electronic Health Record Reporting Act 

This bill requires the Department of Health and Human Services, with respect to electronic health record (EHR) meaningful use incentive programs under Medicare and Medicaid, to continue through 2016 to allow the use of quarterly reporting without regard to the payment year or the stage of meaningful use criteria involved.
Topic: Health — Insurance Providers
Subject: Health
Date: 2016-04-20 00:00:00

Ensuring Patient Access to Critical Breakthrough Products Act of 2016

This bill amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to modify provisions related to coverage and payment for certain breakthrough medical devices under the Medicare and Medicaid programs. Specifically, with respect to such devices, the bill: (1) provides for transitional coverage; (2) establishes accelerated processes for determining regular coverage and payment; and (3) modifies provisions related to specified payment adjustments, cost thresholds, and classification.
Topic: Health — Insurance Providers
Subject: Health
Date: 2016-04-25 00:00:00

Preserving Access to Modern Prosthetic Limbs Act of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to postpone implementation and enforcement of a local coverage determination (LCD) proposed by a Medicare Administrative Contractor (MAC) on lower limb prostheses. (An LCD is a decision by a MAC, which is a private insurer that processes Medicare claims within a specified geographic jurisdiction, as to whether to cover a service on a MAC-wide basis.) The Centers for Medicare & Medicaid shall provide guidance and oversight related to LCDs, as specified by the bill.
Topic: Health — Insurance Providers
Subject: Health
Date: 2016-05-11 00:00:00

Breast Cancer Patient Protect Act of 2016

This bill amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act, and the Internal Revenue Code to require a group or individual health plan that provides medical and surgical benefits to ensure that inpatient (and in the case of a lumpectomy, outpatient) coverage and radiation therapy are provided for breast cancer treatment. Such a plan may not: (1) restrict benefits for any medically necessary hospital stay to less than 48 hours for a mastectomy or breast conserving surgery or less than 24 hours for a lymph node dissection, or (2) require that a provider obtain authorization from the plan for prescribing any such hospital stay.

Such a plan must: (1) provide notice to each participant and beneficiary regarding the coverage required under this bill, and (2) ensure that coverage is provided for secondary consultations.

Health plans are prohibited from taking specified actions to avoid the requirements of this bill.

Health insurers that provide individual health insurance coverage may discontinue an individual's coverage based on the intentional concealment of material facts regarding a health condition related to a condition for which coverage is being claimed.
Topic: Health — Insurance Providers
Subject: Health
Date: 2016-05-12 00:00:00

Patient Access to Durable Medical Equipment Act of 2016 or the PADME Act

(Sec. 2) This bill amends titles XIX (Medicaid) and XXI (Children's Health Insurance Program [CHIP]) of the Social Security Act to prohibit federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated.

Under current law, a state must exclude from Medicaid participation any provider that has been terminated under any state's Medicaid program or under Medicare. The bill maintains those requirements and further requires a state to exclude from Medicaid participation any provider that has been terminated under CHIP. Furthermore, a state must exclude from CHIP participation any provider that has been terminated under Medicaid or Medicare.

The bill also revises a state's reporting requirements with respect to terminating a provider under a state plan. A state shall require each Medicaid or CHIP provider, whether the provider participates on a fee-for-service (FFS) basis or within the network of a managed care organization (MCO), to enroll with the state by providing specified identifying information. When notifying the Department of Health and Human Services (HHS) that a provider has been terminated under a state plan, the state must submit this information as well as information regarding the termination date and reason. HHS shall review such termination notifications and, if appropriate, include them in a database or similar system, as specified by the bill.

The bill prohibits federal payment under a state's Medicaid or CHIP program for services provided by an MCO unless: (1) the state has a system for notifying MCOs when a provider is terminated under Medicaid, Medicare, or CHIP; and (2) any contract between the state plan and an MCO provides that such providers be excluded from participation in the MCO provider network.

HHS shall report to Congress on this bill's implementation.

(Sec. 3) A state must publish and annually update a public directory of FFS providers participating under the state plan.

(Sec. 4) HHS shall: (1) delay by three months the full implementation of new Medicare payment rates for durable medical equipment (DME), and (2) study and report on the impact of applicable payment adjustments on the availability of DME to Medicare beneficiaries.

(Sec. 5) For purposes of eligibility determinations for federal public benefits, the bill excludes payments made under a state eugenics compensation program from classification as income or resources. A "state eugenics compensation program" is a state program intended to compensate individuals who were sterilized under the state's authority.

(Sec. 6) The bill makes available $3 million to the Medicare Improvement Fund for services furnished during and after FY2020.
Topic: Health — Insurance Providers
Subject: Armed forces and national security
Date: 2016-05-26 00:00:00

Veteran Prescription Continuity Act

This bill amends the National Defense Authorization Act for Fiscal Year 2016 to direct the Department of Veterans Affairs (VA) to furnish an individual who is transitioning from Department of Defense (DOD)- to VA-furnished medical treatment any pharmaceutical agent not included in the joint uniform formulary if a DOD health care provider determines that the pharmaceutical agent is critical for the transition.

The VA shall furnish an individual with such pharmaceutical agent: (1) beginning when the individual enrolls in the VA health care system, and (2) ending when a DOD health care provider determines that the individual does not require the pharmaceutical agent.
Topic: Health — Insurance Providers
Subject: Health
Date: 2016-06-07 00:00:00

Medicare Dental, Vision, and Hearing Benefit Act of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to provide for Medicare coverage of dental, vision, and hearing care. With respect to such care, the bill establishes special payment rules, limitations, and coinsurance requirements.
Topic: Health — Insurance Providers
Subject: Health
Date: 2016-06-16 00:00:00

Hospital Price Transparency and Disclosure Act of 2016

This bill amends the Public Health Service Act to require hospitals and ambulatory surgical centers to report to the Department of Health and Human Services (HHS): (1) the frequency of certain treatment episodes for the most frequently treated conditions in each setting, (2) the total number of such treatment episodes, and (3) the average charge for the insured and uninsured for such a treatment episode. 

HHS must publish on its website: (1) such information in a manner that promotes charge comparisons among hospitals and among ambulatory surgical centers, and (2) a link to other consumer quality information maintained on an HHS or Centers for Medicare and Medicaid Services website. Hospitals and ambulatory surgical centers must post prominently at each admission site a notice of the availability of such data.

Civil penalties are authorized for violations of this bill.
Topic: Health — Insurance Providers
Subject: Health
Date: 2016-06-16 00:00:00

Dialysis PATIENT Demonstration Act of 2016 or the Patient Access to Integrated-care, Empowerment, Nephrologists and Treatment Demonstration Act of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to establish a demonstration program for the provision of integrated care to Medicare beneficiaries with end-stage renal disease (ESRD).

Under the voluntary program, eligible participating providers may form organizations to offer ESRD integrated care models and serve as medical homes for program-eligible beneficiaries. Such a model: (1) shall cover medical and hospital services, other than hospice care, under Medicare; (2) must include benefits for transition into palliative care; and (3) may cover prescription drug benefits. An organization must offer at least one open network model but may also offer one or more preferred network models.

An organization shall return savings achieved under the models to program-eligible beneficiaries.

A beneficiary shall have the opportunity to: (1) opt out of the program, (2) make an assignment change into an open network model offered by a different organization, or (3) elect a preferred network model.

The bill establishes requirements regarding: (1) benefits for program-eligible beneficiaries who are also eligible for Medicaid benefits, (2) program quality and reporting, (2) ESRD integrated care strategy, (3) program operation and scope, (4) beneficiary notification, and (5) payment.
Topic: Health — Insurance Providers
Subject: Armed forces and national security
Date: 2016-06-28 00:00:00

No Hero Left Untreated Act

(Sec. 3) This bill requires the Department of Veterans Affairs (VA) to carry out a one-year pilot program to provide access to magnetic EEG/EKG-guided resonance therapy to treat larger populations of veterans suffering from post-traumatic stress disorder, traumatic brain injury, military sexual trauma, chronic pain, or opiate addiction.

The VA shall carry out the program at up to two VA facilities and may provide access to such therapy to up to 50 veterans.
Topic: Health — Insurance Providers
Subject: Health
Date: 2016-07-07 00:00:00

(This measure has not been amended since it was reported to the House on September 19, 2016. The summary of that version is repeated here.)

Expanding Seniors Receiving Dialysis Choice Act of 2016 or the ESRD Choice Act of 2016

(Sec. 2) This bill amends title XVIII (Medicare) of the Social Security Act to allow individuals with end-stage renal disease (ESRD) to be eligible for Medicare Advantage (MA). Under current law, only individuals who develop ESRD while already enrolled in an MA plan may be considered eligible.

With respect to payment, the bill: (1) shifts responsibility for the cost of kidney acquisitions from MA plans to Medicare's fee-for-service program, and (2) excludes such costs from the calculation of certain benchmarks that form the basis for payment under MA plans.
Topic: Health — Insurance Providers
Subject: Health
Date: 2016-07-07 00:00:00

Rural ACO Provider Equity Act of 2016 

This bill amends title XVIII (Medicare) of the Social Security Act to establish additional requirements for assigning Medicare fee-for-service beneficiaries to accountable care organizations (ACOs) under the Medicare shared savings program. (The program enables ACOs to receive payments for savings stemming from care coordination and management.)

Specifically, the bill requires the basis for assignment to reflect beneficiaries' utilization of not only primary care services provided by ACO physicians, but also those furnished in federally qualified health centers or rural health clinics.
Topic: Health — Insurance Providers
Subject: Health
Date: 2016-07-11 00:00:00

Local Coverage Determination Clarification Act of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to revise the process by which Medicare administrative contractors (MACs) issue and reconsider local coverage determinations (LCDs) that: (1) are new, (2) restrict or substantively revise existing LCDs, or (3) are otherwise specified in regulation. (MACs are private insurers that process Medicare claims within specified geographic areas.)

Before such an LCD may take effect, the MAC issuing the determination must, with respect to each geographic area to which the determination applies:

 publish online a proposed version of the determination and other specified, related information; convene one or more public meetings to review the draft determination, receive comments, and secure the advice of an expert panel; post online a record of the minutes from each such meeting; provide a period for submission of written public comments; and post online specified information related to the rationale for the final determination. Upon the filing of an applicable request by an interested party with regard to the reconsideration of a specified LCD, the MAC that issued the determination shall:

 provide specified information related to whether the determination failed to correctly apply qualifying relevant evidence, exceeds the scope of its intended purpose, fails to apply as intended, or is otherwise erroneous; preserve the determination, modify the determination, or rescind the determination in part; and make publicly available a written description of such action. An interested party may appeal a reconsideration decision to the Centers for Medicare & Medicaid Services (CMS).

CMS shall appoint a Medicare Reviews and Appeals Ombudsman to carry out specified duties with regard to LCDs.
Topic: Health — Insurance Providers
Subject: Armed forces and national security
Date: 2016-07-13 00:00:00

Department of Veterans Affairs Dental Insurance Reauthorization Act of 2016

This bill directs the Department of Veterans Affairs (VA) to establish and administer a dental insurance plan for veterans enrolled in the system of annual patient enrollment under federal veterans' benefits provisions and for veterans' survivors and dependents who are eligible for medical care under such provisions.

The VA shall contract with a dental insurer to administer the plan. Benefits shall include diagnostic services, preventative services, endodontics and other restorative services, surgical services, and emergency services.

Enrollment shall be voluntary. The VA shall: (1) prescribe the minimum enrollment period, and (2) prescribe and annually adjust the premiums necessary to cover costs associated with carrying out the plan. Each individual covered by the plan shall pay the entire premium and the full cost of any copayments.

The VA shall permit voluntary disenrollment within 30 days after initial enrollment and under other specified circumstances the VA shall prescribe to the extent that such disenrollment does not jeopardize the fiscal integrity of the plan.

This bill's provisions terminate on December 31, 2021.
Topic: Health — Insurance Providers
Subject: Health
Date: 2016-07-14 00:00:00

This bill amends title XVIII (Medicare) of the Social Security Act to establish a five-year, population-based payment demonstration project through which provider networks are prospectively paid monthly capitated payments for coordinated care furnished to Medicare beneficiaries.

To be eligible to participate in the project, a provider network must:

 be an integrated care system that provides Medicare services directly; include physicians in group practice arrangements, a federally qualified health center, and at least one hospital; enter into, and be responsible for making payments to providers under, appropriate contractual arrangements; be accountable for the quality, cost, and overall care of the network's participating beneficiaries; enter into a participation agreement with the Centers for Medicare & Medicaid Services (CMS); and meet other specified requirements. CMS shall establish a process for prospectively assigning Medicare fee-for-service beneficiaries to a participating provider network. This process must allow beneficiaries to opt out of such assignment.

The bill limits Medicare payment for out-of-network services furnished to a participating beneficiary.

To calculate payments to participating networks, CMS shall: (1) determine a base annual prospective population health budget, (2) adjust such budget to account for the number and characteristics of participating beneficiaries with respect to each network, and (3) annually update the budget to account for population changes and Medicare program growth.

The bill establishes certain limits on total program expenditures for the program's initial three years.

CMS may expand the project's duration and scope under specified circumstances.