Patient Access and Medicare Protection Act
PL 114-115 (S.2425), enacted 12/28/2015

129 STAT. 3131 
PUBLIC LAW 114–115—DEC. 28, 2015 
Public Law 114–115 
114th Congress 
An Act 
To amend titles XVIII and XIX of the Social Security Act to improve payments 
for complex rehabilitation technology and certain radiation therapy services, to 
ensure flexibility in applying the hardship exception for meaningful use for the 
2015 EHR reporting period for 2017 payment adjustments, 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. 
This Act may be cited as the ‘‘Patient Access and Medicare 
Protection Act’’. 
SEC. 2. NON-APPLICATION OF MEDICARE FEE SCHEDULE ADJUST-
MENTS FOR WHEELCHAIR ACCESSORIES AND SEAT AND 
BACK CUSHIONS WHEN FURNISHED IN CONNECTION WITH 
COMPLEX REHABILITATIVE POWER WHEELCHAIRS. 
(a) NON-APPLICATION.— 
(1) IN GENERAL.—Notwithstanding any other provision of 
law, the Secretary of Health and Human Services shall not, 
prior to January 1, 2017, 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 connec-
tion with Group 3 complex rehabilitative power wheelchairs. 
(2) IMPLEMENTATION.—Notwithstanding any other provi-
sion of law, the Secretary may implement this subsection by 
program instruction or otherwise. 
(b) GAO STUDY AND REPORT.— 
(1) STUDY.— 
(A) IN
GENERAL.—The Comptroller General of the 
United States shall conduct a study on wheelchair acces-
sories (including seating systems) and seat and back cush-
ions furnished in connection with Group 3 complex rehabili-
tative power wheelchairs. Such study shall include an anal-
ysis of the following with respect to such wheelchair acces-
sories and seat and back cushions in each of the groups 
described in clauses (i) through (iii) of subparagraph (B): 
(i) The item descriptions and associated HCPCS 
codes for such wheelchair accessories and seat and 
back cushions. 
42 USC 1305 
note. 
Patient Access 
and Medicare 
Protection Act. 
Dec. 28, 2015 
[S. 2425] 
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129 STAT. 3132 
PUBLIC LAW 114–115—DEC. 28, 2015 
(ii) A breakdown of utilization and expenditures 
for such wheelchair accessories and seat and back cush-
ions under title XVIII of the Social Security Act. 
(iii) A comparison of the payment amount under 
the competitive acquisition program under section 1847 
of such Act (42 U.S.C. 1395w–3) with the payment 
amount that would otherwise be recognized under sec-
tion 1834 of such Act (42 U.S.C. 1395m), including 
beneficiary cost sharing, for such wheelchair acces-
sories and seat and back cushions. 
(iv) The aggregate distribution of such wheelchair 
accessories and seat and back cushions furnished under 
such title XVIII within each of the groups described 
in subparagraph (B). 
(v) Other areas determined appropriate by the 
Comptroller General. 
(B) GROUPS
DESCRIBED.—The following groups are 
described in this subparagraph: 
(i) Wheelchair accessories and seat and back cush-
ions furnished predominantly with Group 3 complex 
rehabilitative power wheelchairs. 
(ii) Wheelchair accessories and seat and back cush-
ions furnished predominantly with power wheelchairs 
that are not described in clause (i). 
(iii) Other wheelchair accessories and seat and 
back cushions furnished with either power wheelchairs 
described in clause (i) or (ii). 
(2) REPORT.—Not later than June 1, 2016, the Comptroller 
General of the United States shall submit to Congress a report 
containing the results of the study conducted under paragraph 
(1), together with recommendations for such legislation and 
administrative as the Comptroller General determines to be 
appropriate. 
SEC. 3. TRANSITIONAL PAYMENT RULES FOR CERTAIN RADIATION 
THERAPY SERVICES UNDER THE MEDICARE PHYSICIAN FEE 
SCHEDULE. 
(a) IN GENERAL.—Section 1848 of the Social Security Act (42 
U.S.C. 1395w–4) is amended— 
(1) in subsection (b), by adding at the end the following 
new paragraph: 
‘‘(11) SPECIAL RULE FOR CERTAIN RADIATION THERAPY SERV-
ICES.—The code definitions, the work relative value units under 
subsection (c)(2)(C)(i), and the direct inputs for the practice 
expense relative value units under subsection (c)(2)(C)(ii) for 
radiation treatment delivery and related imaging services 
(identified in 2016 by HCPCS G-codes G6001 through G6015) 
for the fee schedule established under this subsection for serv-
ices furnished in 2017 and 2018 shall be the same as such 
definitions, units, and inputs for such services for the fee 
schedule established for services furnished in 2016.’’; and 
(2) in subsection (c)(2)(K), by adding at the end the fol-
lowing new clause: 
‘‘(iv) TREATMENT OF CERTAIN RADIATION THERAPY 
SERVICES.—Radiation treatment delivery and related 
imaging services identified under subsection (b)(11) 
Recommenda- 
tions. 
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129 STAT. 3133 
PUBLIC LAW 114–115—DEC. 28, 2015 
shall not be considered as potentially misvalued serv-
ices for purposes of this subparagraph and subpara-
graph (O) for 2017 and 2018.’’. 
(b) REPORT TO CONGRESS ON ALTERNATIVE PAYMENT MODEL.— 
Not later than 18 months after the date of the enactment of this 
Act, the Secretary of Health and Human Services shall submit 
to Congress a report on the development of an episodic alternative 
payment model for payment under the Medicare program under 
title XVIII of the Social Security Act for radiation therapy services 
furnished in nonfacility settings. 
SEC. 4. ENSURING FLEXIBILITY IN APPLYING HARDSHIP EXCEPTION 
FOR MEANINGFUL USE FOR 2015 EHR REPORTING PERIOD 
FOR 2017 PAYMENT ADJUSTMENTS. 
(a) ELIGIBLE
PROFESSIONALS.—Section 1848(a)(7)(B) of the 
Social Security Act (42 U.S.C. 1395w–4(a)(7)(B)) is amended, in 
the first sentence, by inserting ‘‘(and, with respect to the payment 
adjustment under subparagraph (A) for 2017, for categories of 
eligible professionals, as established by the Secretary and posted 
on the Internet website of the Centers for Medicare & Medicaid 
Services prior to December 15, 2015, an application for which must 
be submitted to the Secretary by not later than March 15, 2016)’’ 
after ‘‘case-by-case basis’’. 
(b) ELIGIBLE HOSPITALS.—Section 1886(b)(3)(B)(ix) of the Social 
Security Act (42 U.S.C. 1395ww(b)(3)(B)(ix)) is amended— 
(1) in the first sentence of subclause (I), by striking 
‘‘(n)(6)(A)’’ and inserting ‘‘(n)(6)’’; and 
(2) in subclause (II), in the first sentence, by inserting 
‘‘(and, with respect to the application of subclause (I) for fiscal 
year 2017, for categories of subsection (d) hospitals, as estab-
lished by the Secretary and posted on the Internet website 
of the Centers for Medicare & Medicaid Services prior to 
December 15, 2015, an application for which must be submitted 
to the Secretary by not later than April 1, 2016)’’ after ‘‘case- 
by-case basis’’. 
(c) IMPLEMENTATION.—Notwithstanding any other provision of 
law, the Secretary of Health and Human Services shall implement 
the provisions of, and the amendments made by, subsections (a) 
and (b) by program instruction, such as through information on 
the Internet website of the Centers for Medicare & Medicaid Serv-
ices. 
SEC. 5. MEDICARE IMPROVEMENT FUND. 
Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
1395iii(b)(1)) is amended by striking ‘‘$5,000,000’’ and inserting 
‘‘$0’’. 
SEC. 6. STRENGTHENING MEDICAID PROGRAM INTEGRITY THROUGH 
FLEXIBILITY. 
Section 1936 of the Social Security Act (42 U.S.C. 1396u– 
6) is amended— 
(1) in subsection (a), by inserting ‘‘, or otherwise,’’ after 
‘‘entities’’; and 
(2) in subsection (e)— 
(A) in paragraph (1), in the matter preceding subpara-
graph (A), by inserting ‘‘(including the costs of equipment, 
salaries and benefits, and travel and training)’’ after ‘‘Pro-
gram under this section’’; and 
42 USC 1395w–4 
note. 
Deadline. 
Deadline. 
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129 STAT. 3134 
PUBLIC LAW 114–115—DEC. 28, 2015 
(B) in paragraph (3), by striking ‘‘by 100’’ and inserting 
‘‘by 100, or such number as determined necessary by the 
Secretary to carry out the Program,’’. 
SEC. 7. ESTABLISHING MEDICARE ADMINISTRATIVE CONTRACTOR 
ERROR REDUCTION INCENTIVES. 
(a) IN GENERAL.—Section 1874A(b)(1)(D) of the Social Security 
Act (42 U.S.C. 1395kk–1(b)(1)(D)) is amended— 
(1) by striking ‘‘QUALITY.—The Secretary’’ and inserting 
‘‘QUALITY.— 
‘‘(i) IN GENERAL.—Subject to clauses (ii) and (iii), 
the Secretary’’; and 
(2) by inserting after clause (i), as added by paragraph 
(1), the following new clauses: 
‘‘(ii) IMPROPER PAYMENT RATE REDUCTION INCEN-
TIVES.—The Secretary shall provide incentives for 
medicare administrative contractors to reduce the 
improper payment error rates in their jurisdictions. 
‘‘(iii) INCENTIVES.—The incentives provided for 
under clause (ii)— 
‘‘(I) may include a sliding scale of award fee 
payments and additional incentives to medicare 
administrative contractors that either reduce the 
improper payment rates in their jurisdictions to 
certain thresholds, as determined by the Secretary, 
or accomplish tasks, as determined by the Sec-
retary, that further improve payment accuracy; 
and 
‘‘(II) may include substantial reductions in 
award fee payments under cost-plus-award-fee con-
tracts, for medicare administrative contractors 
that reach an upper end improper payment rate 
threshold or other threshold as determined by the 
Secretary, or fail to accomplish tasks, as deter-
mined by the Secretary, that further improve pay-
ment accuracy.’’. 
(b) EFFECTIVE DATE.— 
(1) IN
GENERAL.—The amendments made by subsection 
(a) shall apply to contracts entered into or renewed on or 
after the date that is 3 years after the date of enactment 
of this Act. 
(2) APPLICATION TO EXISTING CONTRACTS.—In the case of 
contracts in existence on or after the date of the enactment 
of this Act and that are not subject to the effective date under 
paragraph (1), the Secretary of Health and Human Services 
shall, when appropriate and practicable, seek to apply the 
incentives provided for in the amendments made by subsection 
(a) through contract modifications. 
SEC. 8. STRENGTHENING PENALTIES FOR THE ILLEGAL DISTRIBUTION 
OF A MEDICARE, MEDICAID, OR CHIP BENEFICIARY IDENTI-
FICATION OR BILLING PRIVILEGES. 
Section 1128B(b) of the Social Security Act (42 U.S.C. 1320a– 
7b(b)) is amended by adding at the end the following: 
‘‘(4) Whoever without lawful authority knowingly and will-
fully purchases, sells or distributes, or arranges for the pur-
chase, sale, or distribution of a beneficiary identification 
number or unique health identifier for a health care provider 
Applicability. 
42 USC 
1395kk–1 note. 
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129 STAT. 3135 
PUBLIC LAW 114–115—DEC. 28, 2015 
under title XVIII, title XIX, or title XXI shall be imprisoned 
for not more than 10 years or fined not more than $500,000 
($1,000,000 in the case of a corporation), or both.’’. 
SEC. 9. IMPROVING THE SHARING OF DATA BETWEEN THE FEDERAL 
GOVERNMENT AND STATE MEDICAID PROGRAMS. 
(a) IN GENERAL.—The Secretary of Health and Human Services 
(in this section referred to as the ‘‘Secretary’’) shall establish a 
plan to encourage and facilitate the participation of States in the 
Medicare-Medicaid Data Match Program (commonly referred to as 
the ‘‘Medi-Medi Program’’) under section 1893(g) of the Social Secu-
rity Act (42 U.S.C. 1395ddd(g)). 
(b) PROGRAM REVISIONS TO IMPROVE MEDI-MEDI DATA MATCH 
PROGRAM PARTICIPATION BY STATES.—Section 1893(g)(1)(A) of the 
Social Security Act (42 U.S.C. 1395ddd(g)(1)(A)) is amended— 
(1) in the matter preceding clause (i), by inserting ‘‘or 
otherwise’’ after ‘‘eligible entities’’; 
(2) in clause (i)— 
(A) by inserting ‘‘to review claims data’’ after ‘‘algo-
rithms’’; and 
(B) by striking ‘‘service, time, or patient’’ and inserting 
‘‘provider, service, time, or patient’’; 
(3) in clause (ii)— 
(A) by inserting ‘‘to investigate and recover amounts 
with respect to suspect claims’’ after ‘‘appropriate actions’’; 
and 
(B) by striking ‘‘; and’’ and inserting a semicolon; 
(4) in clause (iii), by striking the period and inserting‘‘ 
; and’’; and 
(5) by adding at the end the following new clause: 
‘‘(iv) furthering the Secretary’s design, develop-
ment, installation, or enhancement of an automated 
data system architecture— 
‘‘(I) to collect, integrate, and assess data for 
purposes of program integrity, program oversight, 
and administration, including the Medi-Medi Pro-
gram; and 
‘‘(II) that improves the coordination of requests 
for data from States.’’. 
(c) PROVIDING STATES WITH DATA
ON IMPROPER PAYMENTS 
MADE FOR ITEMS OR SERVICES PROVIDED TO DUAL ELIGIBLE INDIVID-
UALS.— 
(1) IN GENERAL.—The Secretary shall develop and imple-
ment a plan that allows each State agency responsible for 
administering a State plan for medical assistance under title 
XIX of the Social Security Act access to relevant data on 
improper or fraudulent payments made under the Medicare 
program under title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) for health care items or services provided to 
dual eligible individuals. 
(2) DUAL ELIGIBLE INDIVIDUAL DEFINED.—In this section, 
the term ‘‘dual eligible individual’’ means an individual who 
is entitled to, or enrolled for, benefits under part A of title 
XVIII of the Social Security Act (42 U.S.C. 1395c et seq.), 
or enrolled for benefits under part B of title XVIII of such 
Plan. 
42 USC 1305ddd 
note. 
Plan. 
42 USC 1395ddd 
note. 
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129 STAT. 3136 
PUBLIC LAW 114–115—DEC. 28, 2015 
LEGISLATIVE HISTORY—S. 2425: 
CONGRESSIONAL RECORD, Vol. 161 (2015): 
Dec. 18, considered and passed Senate and House. 
Act (42 U.S.C. 1395j et seq.), and is eligible for medical assist-
ance under a State plan under title XIX of such Act (42 U.S.C. 
1396 et seq.) or under a waiver of such plan. 
Approved December 28, 2015. 
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