115 HR 7253 IH: Remove Extraneous Measures that Obstruct Value and Efficiency Act
U.S. House of Representatives
2018-12-11
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I115th CONGRESS2d SessionH. R. 7253IN THE HOUSE OF REPRESENTATIVESDecember 11, 2018Mr. Smith of Missouri introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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 concernedA BILLTo amend title XVIII of the Social Security Act to minimize costs and burdens under the Medicare
			 program by providing for consideration of the removal of certain measures
			 applicable to inpatient hospitals and post-acute care inpatient providers
			 and providing for meaningful measures.

 1.Short titleThis Act may be cited as the Remove Extraneous Measures that Obstruct Value and Efficiency Act or the REMOVE Act. 2.Removal of certain quality measures applicable to inpatient hospitals and post-acute care providers inpatient providers; providing for meaningful measures (a)Removal for inpatient hospitals (1)In generalSection 1886(b)(3)(B)(viii) of the Social Security Act (42 U.S.C. 1395ww(b)(3)(B)(viii)) is amended by adding at the end the following new subclause:

 (XII)For purposes of this clause, in considering the removal of a quality measure, the Secretary shall base such consideration on factors such as the following:
 (aa)Measure performance is so high and unvarying that meaningful distinctions in improvements in performance can no longer be made.
 (bb)Performance or improvement on such measure does not result in better patient outcomes. (cc)Such measure does not align with clinical guidelines or practice.
 (dd)Another measure is available that, with respect to a particular topic, is more broadly applicable (across settings, populations, or conditions) than the measure that is being considered for removal for the particular topic.
 (ee)Another measure is available that, with respect to a particular topic, is more proximal in time to desired patient outcomes than the measure that is being considered for removal for the particular topic.
 (ff)Another measure is available that, with respect to a particular topic, is more strongly associated with desired patient outcomes than the measure that is being considered for removal for the particular topic.
 (gg)Collection or public reporting of the measure leads to negative unintended consequences. (hh)The costs (including costs associated with administrative burden to providers of services and suppliers) associated with the measure outweigh the benefit of the continued use of the measure.
 (ii)Such other factors determined appropriate by the Secretary.. (2)Value-based purchasing programSection 1886(o)(2)(D) of the Social Security Act (42 U.S.C. 1395ww(o)(2)(D)) is amended—
 (A)in the heading, by inserting and removal of after Replacing; (B)by striking Subclause (VI) and inserting Subclauses (VI) and (XII); and
 (C)by striking such subclause applies and inserting such subclauses apply. (b)Removal for post-Acute care providersSection 1899B(h) of the Social Security Act (42 U.S.C. 1395lll(h)) is amended by adding at the end the following new paragraph:

					(3)Measure removal factors
 (A)In generalIn carrying out paragraph (1) and the provisions specified in subparagraph (B), for purposes of evaluating quality measures described in such paragraph or such subparagraph, respectively, the Secretary shall consider removal of such a measure based on factors such as those described in section 1886(b)(3)(B)(viii)(XII).
 (B)Reporting provisions and measures describedFor purposes of subparagraph (A), the provisions and measures described in this subparagraph are the following:
 (i)In the case of inpatient rehabilitation facilities, section 1886(j)(7) and the measures described in such section.
 (ii)In the case of long-term care hospitals, section 1886(m)(5) and the measures described in such section.
 (iii)In the case of skilled nursing facilities, section 1888(e)(6) and the measures described in such section.
 (iv)In the case of home health agencies, section 1895(b)(3)(B)(v) and the measures described in such section.
							.
 (c)Providing for meaningful measuresSection 1890A(a) of the Social Security Act (42 U.S.C. 1395aaa–1(a)) is amended by adding at the end the following new paragraph:

 (7)Meaningful measuresIn selecting and updating quality measures for use under this title, the Secretary shall, as practicable, consider the extent to which such measures satisfy the following factors:
 (A)The measures are patient-centered and meaningful to patients, clinicians, and providers. (B)The measures address high-impact measure areas that safeguard public health.
 (C)The measures are outcome-based where possible. (D)The measures minimize the level of burden for providers.
 (E)The measures create significant opportunity for improvement; (F)The measures align across programs and with other payors.
 (G)The measures satisfy any other factor specified by the Secretary..


115 HR 5533 IH: Special Counsel Transparency Act of 2018
U.S. House of Representatives
2018-04-17
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I
115th CONGRESS2d Session
H. R. 5533
IN THE HOUSE OF REPRESENTATIVES

April 17, 2018
Mr. Doggett (for himself, Mr. Raskin, Mr. Ted Lieu of California, Mr. Cicilline, Mr. Nadler, Mr. Gallego, Mr. Pocan, Ms. Jayapal, Mr. Johnson of Georgia, Ms. Norton, and Mr. Cohen) introduced the following bill; which was referred to the Committee on the Judiciary

A BILL
To require a report of any Special Counsel who is removed from office, and for other purposes.

1.Short titleThis Act may be cited as the Special Counsel Transparency Act of 2018. 2.Report of a Special Counsel who is removed from office (a)Periodic report of a Special Counsel to CongressA person serving as a Special Counsel appointed in accordance with part 600 of title 28 of the Code of Federal Regulations shall submit a report on the status of the investigation that person was appointed to undertake, at such times and to the extent the Special Counsel determines appropriate, but no later than at the conclusion of the investigation, to—
(1)the Committee on the Judiciary of the House of Representatives; (2)the Committee on the Judiciary of the Senate;
(3)the Speaker of the House of Representatives; (4)the minority leader of the House of Representatives;
(5)the majority leader of the Senate; and (6)the minority leader of the Senate.
(b)Report of a Special Counsel who is removed from officeIf a person serving as a Special Counsel appointed in accordance with part 600 of title 28 of the Code of Federal Regulations is removed from such office, that person shall, not later than 2 weeks after the date of such removal, submit a report detailing the status, as of the date of dismissal, of the investigation that the person was appointed to undertake to— (1)the Committee on the Judiciary of the House of Representatives;
(2)the Committee on the Judiciary of the Senate; (3)the Speaker of the House of Representatives;
(4)the minority leader of the House of Representatives;  (5)the majority leader of the Senate; and
(6)the minority leader of the Senate. (c)Report of the Attorney GeneralIf a person is removed from service as a Special Counsel appointed in accordance with part 600 of title 28 of the Code of Federal Regulations, the Attorney General or, if the Attorney General is recused, the next most senior official in the Department of Justice who is not also recused, shall, not later than 2 weeks after the date of such removal, submit a report detailing the status, as of the date of dismissal, of the investigation that the person was appointed to undertake to—
(1)the Committee on the Judiciary of the House of Representatives; (2)the Committee on the Judiciary of the Senate;
(3)the Speaker of the House of Representatives; (4)the minority leader of the House of Representatives;
(5)the majority leader of the Senate; and (6)the minority leader of the Senate.
(d)Material To be includedEach report under this section shall include but not be limited to— (1)any evidence of criminal activity that implicates the President, any person within the Executive Office of the President at the time of the report or at any time prior, or any person appointed as an officer of the United States by the President (regardless of whether or not that person remained in office as of the date of this report), including, notwithstanding Rule 6 of the Federal Rules of Criminal Procedure, grand jury information (as such term is defined in section 3322(d) of title 18, United States Code); and
(2)such other facts or matters as the Special Counsel determines appropriate, that the Special Counsel has become aware of in the course of the investigation. (e)ExemptionNo information to be included in the reports under subsections (a) and (b) may be withheld from Congress on the grounds that such information is classified or otherwise protected by a statutory, regulatory, or Congressional confidentiality provision. Disclosure of any information to Congress made pursuant to this bill, including classified information, does not constitute a violation of Federal law.


117 HR 2631 IH: Amputation Reduction and Compassion Act of 2021
U.S. House of Representatives
2021-04-16
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I
117th CONGRESS1st Session
H. R. 2631
IN THE HOUSE OF REPRESENTATIVES

April 16, 2021
Mr. Payne (for himself, Mr. Gallego, Mr. Rush, Mr. Takano, Mr. Grijalva, Ms. Porter, Mr. Soto, Mr. Butterfield, Mr. Van Drew, Ms. Pressley, and Mr. Sires) 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 titles XVIII and XIX of the Social Security Act to provide for coverage of peripheral artery disease screening tests furnished to at-risk beneficiaries under the Medicare and Medicaid programs without the imposition of cost-sharing requirements, to amend title XXVII of the Public Health Service Act to require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage for such screening tests furnished to at-risk enrollees of group health plans and group or individual health insurance coverage without the imposition of cost sharing requirements, and for other purposes.

1.Short title; findings
(a)Short titleThis Act may be cited as the Amputation Reduction and Compassion Act of 2021 or the ARC Act of 2021. (b)FindingsCongress makes the following findings:
(1)Atherosclerosis occurs when blood flow is reduced because arteries become narrowed or blocked with fatty deposits. (2)Atherosclerosis is responsible for more deaths in the United States than any other condition, and heart attacks, resulting from clogged coronary arteries, are the leading cause of death in America.
(3)Atherosclerosis also occurs in the legs and is known as peripheral artery disease (in this subsection referred to as PAD) and having PAD significantly increases the risk for heart attack, stroke, amputation, and death. (4)While most Americans are aware of atherosclerosis in the heart, many Americans have never heard of PAD and Americans with PAD are often unaware of the serious risks of the disease.
(5)An estimated 21 million Americans have PAD, and about 200,000 of them—disproportionately minorities—suffer avoidable amputations every year as a result of such disease. (6)According to the Dartmouth Atlas, amputation risks for African Americans living with diabetes are as much as four times higher than the national average.
(7)Data analyses have similarly found that Native Americans are more than twice as likely to be subjected to amputation and Hispanics are up to 75 percent more likely to have an amputation. (8)Fifty-two percent of patients with an above-the-knee amputation and 33 percent of patients with a below-the-knee amputation will die within two years of their amputation.
(9)Screening and arterial testing for PAD is cost-effective and should be part of routine medical care. (10)Once PAD is detected, amputations and deaths can be reduced through the use of national, evidence-based PAD care guidelines.
(11)Americans with a PAD diagnosis are associated with a 67 percent increase in the risk of cardiac death compared to people without a PAD diagnosis. Consequently, screening for PAD enables health care professionals to identify cardiac risk factors earlier and take proactive measures to reduce the risk of cardiac death. 2.Peripheral artery disease education program Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.) is amended by adding at the end the following new section:

399V–7.Peripheral artery disease education program
(a)EstablishmentThe Secretary, acting through the Director of the Centers for Disease Control and Prevention, in collaboration with the Administrator of the Centers for Medicare & Medicaid Services and the Administrator of the Health Resources and Services Administration, shall establish and coordinate a peripheral artery disease education program to support, develop, and implement educational initiatives and outreach strategies that inform health care professionals and the public about the existence of peripheral artery disease and methods to reduce amputations related to such disease, particularly with respect to at-risk populations. (b)Authorization of appropriationsThere is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2022 through 2026..
3.Medicare coverage of peripheral artery disease screening tests furnished to at-risk beneficiaries without imposition of cost sharing requirements
(a)In generalSection 1861 of the Social Security Act (42 U.S.C. 1395x) is amended— (1)in subsection (s)(2)—
(A)in subparagraph (GG), by striking and at the end; (B)in subparagraph (HH), by striking the period at the end and inserting ; and; and
(C)by adding at the end the following new subparagraph:  (II)peripheral artery disease screening tests furnished to at-risk beneficiaries (as such terms are defined in subsection (lll)).; and
(2)by adding at the end the following new subsection:  (lll)Peripheral artery disease screening test; At-Risk beneficiary (1)The term peripheral artery disease screening test means—
(A)noninvasive physiologic studies of extremity arteries (commonly referred to as ankle-brachial index testing); (B)arterial duplex scans of lower extremity arteries vascular; and
(C)such other items and services as the Secretary determines, in consultation with relevant stakeholders, to be appropriate for screening for peripheral artery disease for at-risk beneficiaries. (2)The term at-risk beneficiary means an individual entitled to, or enrolled for, benefits under part A and enrolled for benefits under part B—
(A)who is 65 years of age or older; (B)who is at least 50 years of age but not older than 64 years of age with risk factors for atherosclerosis (such as diabetes mellitus, a history of smoking, hyperlipidemia, and hypertension) or a family history of peripheral artery disease;
(C)who is younger than 50 years of age with diabetes mellitus and one additional risk factor for atherosclerosis; or (D)with a known atherosclerotic disease in another vascular bed such as coronary, carotid, subclavian, renal, or mesenteric artery stenosis, or abdominal aortic aneurysm.
(3)The Secretary shall, in consultation with appropriate organizations, establish standards regarding the frequency for peripheral artery disease screening tests described in subsection (s)(2)(II) for purposes of coverage under this title.. (b)Inclusion of peripheral artery disease screening tests in initial preventive physical examinationSection 1861(ww)(2) of the Social Security Act (42 U.S.C. 1395x(ww)(2)) is amended—
(1)in subparagraph (N), by moving the margins of such subparagraph 2 ems to the left; (2)by redesignating subparagraph (O) as subparagraph (P); and
(3)by inserting after subparagraph (N) the following new subparagraph:  (O)Peripheral artery disease screening tests furnished to at risk-beneficiaries (as such terms are defined in subsection (lll))..
(c)Payment
(1)In generalSection 1833(a) of the Social Security Act (42 U.S.C. 1395l(a)) is amended— (A)in paragraph (1)—
(i)in subparagraph (N), by inserting and other than peripheral artery disease screening tests furnished to at-risk beneficiaries (as such terms are defined in section 1861(lll)) after other than personalized prevention plan services (as defined in section 1861(hhh)(1)); (ii)by striking and before (DD); and
(iii)by striking such service,; at the end and inserting the following: , and (EE) with respect to peripheral artery disease screening tests furnished to at-risk beneficiaries (as such terms are defined in section 1861(lll)), the amount paid shall be 100 percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848; and (B)in paragraph (2)—
(i)in subparagraph (G), by striking and at the end; (ii)in subparagraph (H), by striking the comma at the end and inserting ; and; and
(iii)by inserting after subparagraph (H) the following new subparagraph:  (I)with respect to peripheral artery disease screening tests (as defined in paragraph (1) of section 1861(lll)) furnished by an outpatient department of a hospital to at-risk beneficiaries (as defined in paragraph (2) of such section), the amount determined under paragraph (1)(EE),.
(2)No deductibleSection 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) is amended, in the first sentence— (A)by striking and before (12); and
(B)by inserting , and (13) such deductible shall not apply with respect to peripheral artery disease screening tests furnished to at-risk beneficiaries (as such terms are defined in section 1861(lll)) before the period at the end. (3)Exclusion from prospective payment system for hospital outpatient department servicesSection 1833(t)(1)(B)(iv) of the Social Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)) is amended—
(A)by striking , or personalized and inserting , personalized; and  (B)by inserting , or peripheral artery disease screening tests furnished to at-risk beneficiaries (as such terms are defined in section 1861(lll)) after personalized prevention plan services (as defined in section 1861(hhh)(1)).
(4)Conforming amendmentSection 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w–4(j)(3)) is amended by striking (2)(FF) (including administration of the health risk assessment) , and inserting (2)(FF) (including administration of the health risk assessment), (2)(II). (d)Exclusion from coverage and Medicare as secondary payer for tests performed more frequently than allowedSection 1862(a)(1) of the Social Security Act (42 U.S.C. 1395y(a)(1)) is amended—
(1)in subparagraph (O), by striking and at the end; (2)in subparagraph (P), by striking the semicolon at the end and inserting , and; and
(3)by adding at the end the following new subparagraph:  (Q)in the case of peripheral artery disease screening tests furnished to at-risk beneficiaries (as such terms are defined in section 1861(lll)), which are performed more frequently than is covered under such section;.
(e)Authority To modify or eliminate coverage of certain preventive servicesSection 1834(n) of the Social Security Act (42 U.S.C. 1395m(n)) is amended— (1)by redesignating subparagraphs (A) and (B) of paragraph (1) as clauses (i) and (ii), respectively, and moving the margins of such clauses, as so redesignated, 2 ems to the right;
(2)by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B), respectively, and moving the margins of such subparagraphs, as so redesignated, 2 ems to the right; (3)by striking Certain Preventive Services and all that follows through any other provision of this title and inserting:
Certain Preventive Services.— (1)In generalNotwithstanding any other provision of this title; and
(4)by adding at the end the following new paragraph:  (2)InapplicabilityThe Secretarial authority described in paragraph (1) shall not apply with respect to preventive services described in section 1861(ww)(2)(O)..
(f)Effective dateThe amendments made by this section shall apply with respect to items and services furnished on or after January 1, 2022. 4.Medicaid coverage of peripheral artery disease screening tests furnished to at-risk beneficiaries without imposition of cost sharing requirements (a)In generalSection 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—
(1)in subsection (a)— (A)in paragraph (30), by striking and at the end;
(B)by redesignating paragraph (31) as paragraph (32); and (C)by inserting after paragraph (30) the following new paragraph:

(31)peripheral artery disease screening tests furnished to at-risk beneficiaries (as such terms are defined in subsection (hh)); and; and (2)by adding at the end the following new subsection:

(hh)Peripheral artery disease screening test; At-Risk beneficiary
(1)Peripheral artery disease screening testThe term peripheral artery disease screening test means— (A)noninvasive physiologic studies of extremity arteries (commonly referred to as ankle-brachial index testing);
(B)arterial duplex scans of lower extremity arteries vascular; and (C)such other items and services as the Secretary determines, in consultation with relevant stakeholders, to be appropriate for screening for peripheral artery disease for at-risk beneficiaries.
(2)At-risk beneficiaryThe term at-risk beneficiary means an individual enrolled under a State plan (or a waiver of such plan)— (A)who is 65 years of age or older;
(B)who is at least 50 years of age but not older than 64 years of age with risk factors for atherosclerosis (such as diabetes mellitus, a history of smoking, hyperlipidemia, and hypertension) or a family history of peripheral artery disease; (C)who is younger than 50 years of age with diabetes mellitus and one additional risk factor for atherosclerosis; or
(D)with a known atherosclerotic disease in another vascular bed such as coronary, carotid, subclavian, renal, or mesenteric artery stenosis, or abdominal aortic aneurysm. (3)FrequencyThe Secretary shall, in consultation with appropriate organizations, establish standards regarding the frequency for peripheral artery disease screening tests described in subsection (a)(31) for purposes of coverage under a State plan under this title..
(b)No cost sharing
(1)In generalSubsections (a)(2) and (b)(2) of section 1916 of the Social Security Act (42 U.S.C. 1396o) are each amended— (A)in subparagraph (F), by striking or at the end;
(B)in subparagraph (G), by striking ; and and inserting , or; and (C)by adding at the end the following new subparagraph:

(H)peripheral artery disease screening tests furnished to at-risk beneficiaries (as such terms are defined in section 1905(hh)); and. (2)Application to alternative cost sharingSection 1916A(b)(3)(B) of the Social Security Act (42 U.S.C. 1396o–1(b)(3)(B)) is amended by adding at the end the following new clause:

(xii)Peripheral artery disease screening tests furnished to at-risk beneficiaries (as such terms are defined in section 1905(hh)).. (c)Mandatory coverageSection 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by striking and (30) and inserting (30), and (31).
(d)Conforming amendments
(1)Section 1902(nn)(3) of the Social Security Act (42 U.S.C. 1396a(nn)(3)) is amended by striking following paragraph (30) and inserting following paragraph (32). (2)Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended by striking following paragraph (30) and inserting following paragraph (32).
5.Requirement for group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage for peripheral artery disease screening tests furnished to at-risk enrollees without imposition of cost sharing requirements
(a)In generalSubsection (a) of section 2713 of the Public Health Service Act (42 U.S.C. 300gg–13) is amended to read as follows:  (a)Coverage of preventive health services (1)In generalA group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum, provide coverage for and shall not impose any cost sharing requirements for—
(A)evidence-based items or services that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force; (B)immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved;
(C)with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration; (D)with respect to women, such additional preventive care and screenings not described in subparagraph (A) as provided for in comprehensive guidelines supported by the Health Resources and Services Administration for purposes of this subparagraph; and
(E)with respect to at-risk enrollees, peripheral artery disease screening tests. (2)Peripheral artery disease screening test; At-risk enrolleeFor purposes of paragraph (1)(E):
(A)Peripheral artery disease screening testThe term peripheral artery disease screening test means— (i)noninvasive physiologic studies of extremity arteries (commonly referred to as ankle-brachial index testing);
(ii)arterial duplex scans of lower extremity arteries vascular; and (iii)such other items and services as the Secretary determines, in consultation with relevant stakeholders, to be appropriate for screening for peripheral artery disease for at-risk enrollees.
(B)At-risk enrolleeThe term at-risk enrollee means an individual enrolled in a group health plan or group or individual health insurance coverage— (i)who is 65 years of age or older;
(ii)who is at least 50 years of age but not older than 64 years of age with risk factors for atherosclerosis (such as diabetes mellitus, a history of smoking, hyperlipidemia, and hypertension) or a family history of peripheral artery disease; (iii)who is younger than 50 years of age with diabetes mellitus and one additional risk factor for atherosclerosis; or
(iv)with a known atherosclerotic disease in another vascular bed such as coronary, carotid, subclavian, renal, or mesenteric artery stenosis, or abdominal aortic aneurysm. (C)FrequencyThe Secretary shall, in consultation with appropriate organizations, establish standards regarding the frequency for peripheral artery disease screening tests described in paragraph (1)(E) for purposes of coverage under this section.
(3)Clarification regarding breast cancer screening, mammography, and prevention recommendationsFor the purposes of this Act, and for the purposes of any other provision of law, the current recommendations of the United States Preventive Service Task Force regarding breast cancer screening, mammography, and prevention shall be considered the most current other than those issued in or around November 2009. (4)Rule of constructionNothing in this subsection shall be construed to prohibit a plan or issuer from providing coverage for services in addition to those recommended by the United States Preventive Services Task Force or to deny coverage for services that are not recommended by such Task Force..
(b)Effective dateThe amendment made by subsection (a) shall apply with respect to plan years beginning on or after January 1, 2022. 6.Disallowance of payment for nontraumatic amputation services furnished without anatomical testing servicesSection 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection:

(z)Disallowance of payment for nontraumatic amputation services furnished without anatomical testing services
(1)In generalIn the case of nontraumatic amputation services furnished by a supplier on or after January 1, 2022, to an individual entitled to, or enrolled for, benefits under part A and enrolled for benefits under this part, for which payment is made under this part, payment may only be made under this part if— (A)such supplier furnishes anatomical testing services to such individual during the 3-month period preceding the date on which such nontraumatic amputation services is furnished; or
(B)such individual has a pre-existing dysfunctional or unsalvageable limb, life-threatening sepsis, intractable infection, extensive gangrene or necrotic tissue loss beyond salvage, a poor functional status, severe dementia, or a short life expectancy after shared decision-making with a health care team and patient, family, or caregiver. (2)DefinitionsIn this subsection:
(A)Anatomical testing servicesThe term anatomical testing services means arterial duplex scanning, computed tomography angiography, and magnetic resonance angiography. (B)Nontraumatic amputation servicesThe term nontraumatic amputation services means amputations as a result of atherosclerotic vascular disease or a related comorbidity of such disease (including diabetes)..
7.Development and implementation of quality measures
(a)DevelopmentThe Secretary of Health and Human Services (referred to in this section as the Secretary) shall, in consultation with relevant stakeholders, develop quality measures for nontraumatic, lower-limb, major amputation that utilize appropriate diagnostic screening (including peripheral artery disease screening) in order to encourage alternative treatments (including revascularization) in lieu of such an amputation. (b)ImplementationAfter appropriate testing and validation of the measures developed under subsection (a), the Secretary shall incorporate such measures in quality reporting programs for appropriate providers of services and suppliers under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), including for purposes of—
(1)the merit-based incentive payment system under section 1848(q) of such Act (42 U.S.C. 1395w–4(q)); (2)incentive payments for participation in eligible alternative payment models under section 1833(z) of such Act (42 U.S.C. 1395l(z));
(3)the shared savings program under section 1899 of such Act (42 U.S.C. 1395jjj); (4)models under section 1115A of such Act (42 U.S.C. 1315a); and
(5)such other payment systems or models as the Secretary may specify.


116 HRES 1081 IH: Recognizing the role of democracies in responding to the COVID–19 pandemic, democracy’s resiliency, the dangers of authoritarianism, and reaffirming the commitment of the United States to democratic principles.
U.S. House of Representatives
2020-08-11
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

IV116th CONGRESS2d SessionH. RES. 1081IN THE HOUSE OF REPRESENTATIVESAugust 11, 2020Mr. Loudermilk submitted the following resolution; which was referred to the Committee on Foreign AffairsRESOLUTIONRecognizing the role of democracies in responding to the COVID–19 pandemic, democracy’s resiliency, the dangers of authoritarianism, and reaffirming the commitment of the United States to democratic principles.Whereas the COVID–19 pandemic is a significant event in world history and will continue to challenge governments around the world;Whereas current research shows the novel COVID–19 strain was first transmitted in China in late 2019 and the World Health Organization declared COVID–19 a global pandemic on March 11, 2020;Whereas democracies have responded to the pandemic by sharing scientific information and medical resources internationally and remaining committed to the human rights and freedoms of their people;Whereas authoritarian regimes have taken advantage of the pandemic as an opportunity to centralize power, spread disinformation, expand their corrupt practices, or otherwise deny basic human rights to their people;Whereas democracies contribute to the construction of a vast network of international partnerships, authoritarian regimes see these partnerships as instruments to be exploited for unilateral benefit and for realizing their long-held vision of having these institutions under their direction;Whereas democracies share information transparently and ensure that journalists operate freely, authoritarian regimes manipulate the content journalists can share and organize disinformation through their state-controlled media systems;Whereas democracies have shown resilience during this global crisis by encouraging constructive debate, authoritarian regimes suppress internal criticisms, tightening their grip, giving their people yet more reason to resist;Whereas democracies have taken steps to ensure the health and safety of their people, authoritarian regimes have removed fundamental protections with no intention of returning basic, indispensable rights;Whereas Taiwan’s democratic government was among the first to recognize this new strain of the coronavirus and they chose to build an extensive and coordinated domestic response while seeking to share evidence of human-to-human transmission with the world, authoritarian regimes declined to share early evidence of the virus to mislead the world;Whereas the Republic of South Korea has taken its place on the world stage as one of the most vibrant democracies, they built a concentrated domestic testing program and were the first to share test kits, authoritarian regimes concealed the truth through an elaborate disinformation campaign and blamed democracies as the origin of COVID–19;Whereas the United States remains committed to a system of checks and balances and protecting access to government officials, authoritarian regimes detain or imprison those who dare to criticize their leaders;Whereas Denmark was an early adopter of recommended social distancing practices and its citizens rallied behind their leaders in hopes of having an early return to normalcy, authoritarian regimes mislead and disenfranchised their people;Whereas Australia established a working group of Federal, State, and local leaders to share information and increase resource utilization, authoritarian regimes centralized power to ensure only the dissemination of information favorable to the state and prevent citizen oversight of corrupt practices;Whereas Iceland built their response on a robust testing program, authoritarian regimes’ censorship actions delayed the implementation of public health strategies, exposing a deep mistrust of the government;Whereas Canada trusted their medical experts to lead public health initiatives, authoritarian regimes rejected the findings of medical experts, such as Dr. Li Wenliang;Whereas Germany pursued meticulous contact tracing to slow the spread of the virus, authoritarian regimes have taken extreme measures forcing their people into isolation, including welding closed the doors of their homes;Whereas Japan treasured the health of Olympic visitors ahead of economic prosperity, authoritarian regimes placed regime security over global public health; andWhereas New Zealand rallied its people to face COVID–19 and eliminate the virus from its borders, authoritarian regimes waited several critical days before sharing valuable information on the virus with their people: Now, therefore, be itThat it is the sense of the House of Representatives that the United States—(1)recognizes the commitment of democracies to democratic values and institutions in their dynamic response to the global COVID–19 pandemic and condemns the actions of those that seek to use the pandemic as an instrument to consolidate undemocratic power and violate human rights;(2)remembers its commitment to fundamental democratic principles and to opposing the influence of authoritarian regimes that threaten the international order;(3)rejects the hollow appeal of authoritarianism and urges the leaders of these countries to reconsider their pursuit of censorship, exploitation, and suppression of human rights;(4)encourages authoritarian governments to end their influence operations and disinformation campaigns and discontinue behavior that divides nations and undermines the legitimacy of international institutions; and(5)calls on democracies and international institutions to remember their promise of transparency, accountability, integrity, and the free flow of information.


115 S3252 IS: Reservation of Transportation Funds Improvement Act of 2018
U.S. Senate
2018-07-19
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

		II
		115th CONGRESS2d Session
		S. 3252
		IN THE SENATE OF THE UNITED STATES

			July 19, 2018
			Mr. Hatch introduced the following bill; which was read twice and referred to the Committee on Environment and Public Works

		A BILL
		To amend title 23, United States Code, to modify requirements relating to reservation of funds for
			 failure to enact or enforce open container laws and repeat intoxicated
			 driver laws, and for other purposes.

 1.Short titleThis Act may be cited as the Reservation of Transportation Funds Improvement Act of 2018. 2.Reservation of certain funds (a)Open container requirementsSection 154(c)(2) of title 23, United States Code, is amended—
 (1)in the paragraph heading, by striking 2012 and inserting 2019; (2)by striking subparagraph (A) and inserting the following:

						(A)Reservation of funds
 (i)In generalOn October 1, 2018, and each October 1 thereafter, in the case of a State described in clause (ii), the Secretary shall reserve an amount equal to 2.5 percent of the funds to be apportioned to the State on that date under each of paragraphs (1) and (2) of section 104(b) until the State certifies to the Secretary the means by which the State will use those reserved funds in accordance with subparagraphs (A) and (B) of paragraph (1), and paragraph (3).
 (ii)States describedA State referred to in clause (i) is a State— (I)that has not enacted or is not enforcing an open container law described in subsection (b); and
 (II)for which the Secretary determined for the prior fiscal year that the State had not enacted or was not enforcing an open container law described in subsection (b).; and
 (3)in subparagraph (B), in the matter preceding clause (i), by striking subparagraph (A) and inserting subparagraph (A)(i). (b)Repeat intoxicated driver lawsSection 164(b)(2) of title 23, United States Code, is amended—
 (1)in the paragraph heading, by striking 2012 and inserting 2019; (2)by striking subparagraph (A) and inserting the following:

						(A)Reservation of funds
 (i)In generalOn October 1, 2018, and each October 1 thereafter, in the case of a State described in clause (ii), the Secretary shall reserve an amount equal to 2.5 percent of the funds to be apportioned to the State on that date under each of paragraphs (1) and (2) of section 104(b) until the State certifies to the Secretary the means by which the State will use those reserved funds in accordance with subparagraphs (A) and (B) of paragraph (1), and paragraph (3).
 (ii)States describedA State referred to in clause (i) is a State— (I)that has not enacted or is not enforcing a repeat intoxicated driver law; and
 (II)for which the Secretary determined for the prior fiscal year that the State had not enacted or was not enforcing a repeat intoxicated driver law.; and
 (3)in subparagraph (B), in the matter preceding clause (i), by striking subparagraph (A) and inserting subparagraph (A)(i). (c)Effective dateThe amendments made by this Act take effect on October 1, 2018.


115 HR 4852 IH: Pay Our Protectors Not Our Politicians Act of 2018
U.S. House of Representatives
2018-01-19
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I115th CONGRESS2d SessionH. R. 4852IN THE HOUSE OF REPRESENTATIVESJanuary 19, 2018Ms. McSally (for herself, Mr. Poliquin, Mr. Pittenger, Mr. Bilirakis, Mr. Gallagher, Mr. Faso, Mr. Yoder, Mr. Mullin, Mr. Thompson of Pennsylvania, Mr. Smucker, Mr. Zeldin, Mr. Cole, and Mr. Gottheimer) introduced the following bill; which was referred to the Committee on Appropriations, and in addition to the Committees on House Administration, and Oversight and Government Reform, 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 concernedA BILLTo make continuing appropriations for military pay in the event of a shutdown of the Federal Government, to reduce the pay of Members of Congress during periods in which such a shutdown is in effect, and for other purposes.
1.Short titleThis Act may be cited as the Pay Our Protectors Not Our Politicians Act of 2018. 2.Continuing appropriations for members of the Armed Forces and employees of the Department of Homeland Security (a)In generalThere are hereby appropriated for fiscal year 2018, out of any money in the Treasury not otherwise appropriated, for any period during which interim or full-year appropriations for fiscal year 2018 are not in effect—
(1)such sums as are necessary to provide pay and allowances to members of the Armed Forces (as defined in section 101(a)(4) of title 10, United States Code), including reserve components thereof, who perform active service during such period, including Active Guard and Reserve duty under section 328 of title 32, United States Code; (2)such sums as are necessary to provide pay and allowances to members of the reserve components of the Armed Forces (as named in section 10101 of title 10, United States Code) who perform inactive-duty training (as defined in section 101(d)(7) of such title) during such period;
(3)such sums as are necessary to provide pay and allowances to the civilian personnel of the Department of Defense (and the Department of Homeland Security in the case of the Coast Guard) whom the Secretary concerned determines are providing support to members of the Armed Forces described in paragraph (1);  (4)such sums as are necessary to provide pay and allowances to contractors of the Department of Defense (and the Department of Homeland Security in the case of the Coast Guard) whom the Secretary concerned determines are providing support to members of the Armed Forces described in paragraph (1);
(5)such sums as are necessary to provide pay and allowances to employees of the Department of Homeland Security whom the Secretary concerned determines are performing national security activities; (6)such sums as are necessary to provide death gratuities under sections 1475–1477 and 1489 of title 10, United States Code;
(7) such sums as are necessary to provide payment or reimbursement for funeral and burial expenses authorized under sections 1481 and 1482 of title 10, United States Code; (8)such sums as are necessary to provide payment or reimbursement of authorized funeral travel and travel related to the dignified transfer of remains and unit memorial services under section 481f of title 37, United States Code; and
(9)such sums as are necessary to provide the temporary continuation of a basic allowance of housing for dependents of members dying on active duty, as authorized by section 403(l) of title 37, United States Code. (b)TerminationAppropriations and funds made available and authority granted pursuant to this section shall be available until whichever of the following first occurs: (1) the enactment into law of an appropriation (including a continuing appropriation) for any purpose for which amounts are made available in section 2; (2) the enactment into law of the applicable regular or continuing appropriations resolution or other Act without any appropriation for such purpose; or (3) January 1, 2019.
(c)Secretary concerned definedIn this section, the term Secretary concerned means— (1)the Secretary of Defense with respect to matters concerning the Department of Defense; and
(2)the Secretary of Homeland Security with respect to matters concerning the Department of Homeland Security or the Coast Guard. 3.Requiring reduction of pay of Members of Congress if Government shutdown occurs (a)Reduction of pay for each day of Government shutdownIf on any day during a year a Government shutdown is in effect, the annual rate of pay applicable under section 601(a) of the Legislative Reorganization Act of 1946 (2 U.S.C. 4501) with respect to each Member of Congress for the year shall be reduced by an amount equal to the product of—
(1)an amount equal to one day’s worth of pay under such annual rate; and (2)the number of 24-hour periods during which the Government shutdown is in effect.
(b)Effective dateSubsection (a) shall apply only with respect to days occurring during the One Hundred Sixteenth Congress and each succeeding Congress. (c)Special rule for One Hundred Fifteenth Congress (1)Holding salaries in escrowIf on any day during the One Hundred Fifteenth Congress a Government shutdown is in effect, the payroll administrator of that House of Congress shall—
(A)withhold from the payments otherwise required to be made with respect to a pay period for the compensation of each Member of Congress who serves in that House of Congress an amount equal to the product of— (i)an amount equal to one day’s worth of pay under the annual rate of pay applicable to the Member under section 601(a) of the Legislative Reorganization Act of 1946 (2 U.S.C. 4501); and
(ii)the number of 24-hour periods during which the Government shutdown is in effect which occur during the pay period; and (B)deposit in an escrow account all amounts withheld under paragraph (1).
(2)Release of amounts at end of the CongressIn order to ensure that this section is carried out in a manner that shall not vary the compensation of Senators or Representatives in violation of the twenty-seventh article of amendment to the Constitution of the United States, the payroll administrator of a House of Congress shall release for payments to Members of that House of Congress any amounts remaining in any escrow account under this section on the last day of the One Hundred Fifteenth Congress. (3)Role of Secretary of the TreasuryThe Secretary of the Treasury shall provide the payroll administrators of the Houses of Congress with such assistance as may be necessary to enable the payroll administrators to carry out this section.
(4)Exception for days occurring after general electionThis section does not apply with respect to any day during the One Hundred Fifteenth Congress which occurs after the date of the regularly scheduled general election for Federal office held in November 2018. (d)Determination of Government shutdownFor purposes of this section, a Government shutdown shall be considered to be in effect if there is a lapse in appropriations for any Federal agency or department as a result of a failure to enact a regular appropriations bill or continuing resolution.
(e)DefinitionsIn this section: (1)The term Member of Congress means an individual serving in a position under subparagraph (A), (B), or (C) of section 601(a) of the Legislative Reorganization Act of 1946 (2 U.S.C. 4501).
(2)The term payroll administrator of a House of Congress means— (A)in the case of the House of Representatives, the Chief Administrative Officer of the House of Representatives, or an employee of the Office of the Chief Administrative Officer who is designated by the Chief Administrative Officer to carry out this section; and
(B)in the case of the Senate, the Secretary of the Senate, or an employee of the Office of the Secretary of the Senate who is designated by the Secretary to carry out this section.