zli12321/Bills huggingface dataset:
Prevent Interruptions in Physical Therapy Act of 2015

 Amends part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act to require physical therapists furnishing outpatient physical therapy services to use specified locum tenens arrangements for payment purposes in the same manner as such arrangements are used to apply to physicians furnishing substitute physicians services for other physicians.

(Locum tenens [place holder], or substitute, physicians usually assume professional practices in the absence of a regular physician for reasons such as illness, pregnancy, vacation, or continuing medical education.)

Date: 2015-01-27
Topic: Health (Insurance Providers)
Subject: Health
Patient Access to Higher Quality Health Care Act of 2015

Amends the Patient Protection and Affordable Care Act (PPACA) to repeal the prohibition against Medicare participation by physician-owned hospitals that do not have a provider agreement by August 1, 2010, which nonetheless allows their Medicare participation under a rural provider and hospital exception to a specified ownership or investment prohibition if they meet certain requirements.

Amends the Health Care and Education Reconciliation Act of 2010 (HCERA) to repeal provisions: (1) postponing from August 1, 2010, to December 31, 2010, the date by which physician-owned hospitals must have a provider agreement in order to participate in Medicare under a rural provider and hospital exception to the physician-ownership or -investment prohibition if they also meet certain requirements addressing conflicts of interest, bona fide investments, patient safety issues, and expansion limitations; and (2) modifying the expansion limitation imposed on such a rural hospital 

Restores related previous law amended or repealed by PPACA and HCERA as if PPACA or HCERA had not been enacted.

Date: 2015-02-13
Topic: Health (Insurance Providers)
Subject: Health
Medicare Patient Access to Hospice Act of 2015 

 Amends title XVIII (Medicare) of the Social Security Act to recognize attending physician assistants as attending physicians to serve hospice patients.

Date: 2015-03-02
Topic: Health (Insurance Providers)
Subject: Health
Doctors Helping Heroes Act of 2015 

 Amends the Immigration and Nationality Technical Corrections Act of 1994 to make permanent the J-1 visa waiver program (Conrad state 30/medical services in underserved areas).

Excludes from numerical immigration limitations alien physicians who have completed national interest waiver requirements by working in a health care shortage area (including alien physicians who completed such service before enactment of this Act and any of their spouses or children).

Sets forth specified employment protections and contract requirements for alien physicians working in underserved areas.

Increases the number of alien physicians that a state may be allocated from 30 to 35 per fiscal year in specified circumstances. Provides for additional increases or decreases based upon demand.

Provides up to three visa waivers per fiscal year per state for physicians in academic medical centers.

Permits dual intent for an alien coming to the United States to receive graduate medical education or training, or to take examinations required for graduate medical education or training.

Exempts from specified entry limitations H-1B nonimmigrant aliens seeking to enter the United States to pursue graduate medical education or training.

Amends the Immigration and Nationality Act to authorize waiver of the two-year foreign residency requirement for an alien who has received graduate medical eduction or training in the United States and seeks to apply for an immigrant visa or permanent resident status if:

 the Secretary of Veterans Affairs (VA) determines that VA facilities are not capable of furnishing covered health services to eligible veterans because they lack the required personnel or cannot provide timely and reasonable access; and the head of the appropriate state agency determines that the alien will practice medicine in a Veterans Health Administration facility, the alien physician's work is in the public interest, and such waiver would not cause the number of waivers allotted for that state for that fiscal year to exceed five.

Date: 2015-03-04
Topic: Health (Insurance Providers)
Subject: Immigration
Health IT Modernization for Underserved Communities Act of 2015

 Amends title XIX (Medicaid) of the Social Security Act to extend to physician assistants eligibility for Medicaid electronic health record incentive payments, regardless of whether or not such physician assistants practice at a rural health center that is led by a physician assistant or in a federally qualified health center.

Date: 2015-03-10
Topic: Health (Insurance Providers)
Subject: Health
Providers Consolidation and Medicare Payments Examined through Evaluation Act of 2015 or the Providers COMPETE Act of 2015

This bill directs the Secretary of Health and Human Services, as part of any annual notice and comment rulemaking process to implement changes to payment systems under title XVIII (Medicare) of the Social Security Act (including those for inpatient and outpatient hospital services, physicians' services, and services furnished by other providers and suppliers), to seek public comment on and evaluate the extent to which, and how, such a change is projected to affect provider consolidation.

Date: 2015-03-16
Topic: Health (Insurance Providers)
Subject: Health
SGR Repeal and Medicare Provider Payment Modernization Act of 2015

Amends title XVIII (Medicare) of the Social Security Act (SSAct) to: (1) remove sustainable growth rate (SGR) methodology from the determination of annual conversion factors in the formula for payment for physicians' services, and (2) revise the update in rates for 2015 and subsequent years.

Directs the Secretary of Health and Human Services to establish a Merit-based Incentive Payment (MIP) system under which eligible professionals (including physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists) shall receive annual payment increases or decreases based on their performance.

Requires specified incentive payments to eligible participants in an alternative payment model.

Requires the Secretary to: (1) draft a plan for development of quality measures to assess professionals, including non-patient-facing professionals; and (2) make payments for chronic care management services.

Expands the kinds of uses of Medicare data available to qualified entities. Directs the Secretary to provide Medicare data to qualified clinical data registries to facilitate quality improvement or patient safety.

Declares it a national objective to achieve widespread exchange of health information through interoperable certified electronic health records technology nationwide by December 31, 2018.

Date: 2015-03-19
Topic: Health (Insurance Providers)
Subject: Health
Medicaid Parity Act of 2015

 Amends title XIX (Medicaid) of the Social Security Act to extend through 2019: (1) Medicaid payment parity with Medicare for primary care services furnished under the Medicaid program, and (2) the increased (to 100%) federal medical assistance percentage (FMAP, or federal matching rate) for additional payments for primary care services.

Date: 2015-03-19
Topic: Health (Insurance Providers)
Subject: Health
Veterans' Credit Protection Act

 Directs the Department of Veterans Affairs (VA) to: (1) conduct outreach to inform veterans of how to resolve credit issues caused by a delayed payment of a claim for emergency hospital care, medical services, or other emergency health care furnished through a non-VA provider; and (2) establish a toll-free telephone number for veterans to report such issues to the Chief Business Office of the VA.

Requires the VA to report annually on the effectiveness of such Office in providing timely payment of proper invoices for emergency hospital care, medical services, or other emergency health care furnished through non-VA providers by the required payment date during both the preceding five-year period and the preceding one-year period. Requires the report, for any part of the period covered by such a report that occurred before October 1, 2014, to evaluate the provision of such payments by the Veterans Integrated Service Networks.

 Requires such report to include:

 the number of veterans who contacted the VA regarding delayed payments that could negatively affect their credit; the total amount of interest penalties paid by the VA by reason of delayed payments; the number of proper invoices submitted, the amount owed for and the payment status of such invoices, and the periods that elapsed before such invoices were paid; any comments regarding delayed payments made by medical providers; and a description of the best practices to provide timely payment of a proper invoice, including a plan to improve such timely payments. Directs: (1) the Office to submit to Congress quarterly reports on the number of pending claims for reimbursement for emergency hospital care, medical services, and other emergency health care furnished through non-VA providers; and (2) the Comptroller General to conduct a study that evaluates the effectiveness of the Office in providing timely payment of a proper invoice for such care by the required payment date.

Date: 2015-04-16
Topic: Health (Insurance Providers)
Subject: Armed forces and national security
Cutting Costly Codes Act of 2015

This bill prohibits the Department of Health and Human Services from implementing, administering, or enforcing regulations that would replace ICD-9 (International Classification of Diseases) with ICD-10 as a code set for financial and administrative transactions involving the electronic exchange of health information. ICD is a system of diagnostic codes for classifying diseases.

The Government Accountability Office must recommend steps to mitigate the disruption to health care providers that would result from replacement of ICD-9.

Date: 2015-04-30
Topic: Health (Insurance Providers)
Subject: Health
Medicare Access to Rural Anesthesiology Act of 2015

 Amends title XVIII (Medicare) of the Social Security Act to provide payment under Medicare part A (Hospital Insurance) on a reasonable cost basis for anesthesia services furnished by a physician who is an anesthesiologist in certain rural hospitals in the same manner as payment is made for anesthesia services furnished by a certified registered nurse anesthetist in such hospitals.

Date: 2015-04-30
Topic: Health (Insurance Providers)
Subject: Health
Disabled Veterans' Access to Medical Exams Improvement Act

Amends the Veterans Benefits Act of 2003 to extend until December 31, 2017, the authority of the Department of Veterans Affairs (VA) to provide for persons other than VA employees (i.e., contract physicians) to conduct medical disability examinations of applicants for benefits under laws administered by the Secretary of Veterans Affairs.

Permits licensed, VA-contracted physicians to conduct such examinations at any location in any state, the District of Columbia, or a Commonwealth, territory, or possession of the United States, so long as the examination is authorized under the contract and the physician is not barred from conducting such an examination in the location in which it occurs.

Amends the Veterans' Benefits Improvement Act of 1996 to provide similar authorities with respect to permissible examination locations to licensed physicians under the pilot program authorizing the VA to use contract physicians to perform medical disability examinations of applicants for benefits under laws carried out through the Under Secretary for Benefits. Expands from 10 to 15 the maximum number of VA regional offices through which the Secretary is authorized to carry out such pilot program.

Directs the Secretary to conduct an annual data analysis (including an analysis of backlogged claims, pending workloads, and the timeliness of completed cases) to determine the regional offices requiring support.

Date: 2015-05-01
Topic: Health (Insurance Providers)
Subject: Armed forces and national security
Increasing Clarity for Doctors by Transitioning Effectively Now Act or the ICD-TEN Act

This bill directs the Department of Health and Human Services (HHS) to implement, administer, and enforce regulations that provide for the replacement of International Classification of Diseases (ICD) ICD-9 with ICD-10 as a standard for code sets.

HHS shall conduct, and make available to all participating service providers and suppliers, a comprehensive, end-to-end testing process to assess whether the Medicare fee-for-service claims processing system based on the ICD-10 standard is fully functioning.

HHS must subsequently certify to Congress whether or not the Medicare fee-for-service claims processing system based on the ICD-10 standard is fully functioning, including additional steps a not-fully-functioning system will take to achieve certification as well as the anticipated time frame for achieving it.

Date: 2015-05-12
Topic: Health (Insurance Providers)
Subject: Health
Ensuring Access to Primary Care for Women & Children Act

Amends title XIX (Medicaid) of the Social Security Act (SSAct) to require that the primary care services furnished in the two years after enactment of this Act by a physician with a primary specialty designation of family medicine, general internal medicine, or pediatric medicine be paid at a rate that is not less than 100% of the payment rate that applies under Medicare part B (Supplementary Medical Insurance), but only if the physician self-attests as being Board certified in those areas.

Extends this 100% of Medicare payment floor, subject to certain conditions, to the following providers: (1) physicians with a primary specialty designation of obstetrics and gynecology, and self-attesting they are Board certified; (2) advanced practice clinicians; (3) rural health clinics, federally-qualified health centers, or other specified health clinics; and (4) nurse practitioners, physician assistants, or certified nurse-midwives.

Excludes from coverage of primary care services any such services provided in an emergency department of a hospital.

Prescribes additional requirements for any contract between a state and a Medicaid managed care organization.

Directs the Government Accountability Office to examine the use of alternative payment models in state Medicaid programs and identify opportunities for disseminating successful payment models among them.

Amends SSAct title XI to: (1) extend funding for development of adult health quality measures; and (2) direct the Administrator for the Centers for Medicaid and Medicaid Services and the Director of the Agency for Healthcare Research and Quality to develop such measures specific to adult individuals with disabilities and include them in the Medicaid Quality Measurement Program.

Date: 2015-05-12
Topic: Health (Insurance Providers)
Subject: Health
Prioritizing American Road and Jobs Act of 2015

This bill amends title XIX (Medicaid) of the Social Security Act to eliminate enhanced federal funding after 2016 for individuals who are newly eligible for Medicaid under the Patient Protection and Affordable Care Act. Under current law, a state is entitled to an increased federal medical assistance percentage (FMAP) to cover such individuals; this enhanced FMAP is equivalent to 100% through 2016, 95% in 2017, 94% in 2018, 93% in 2019, and 90% thereafter. The bill eliminates these enhanced funding levels so that, beginning in 2017, federal funding for expenses related to newly eligible individuals instead reverts to a state's regular FMAP (which, under current law, may range from 50% to 83%).

The Department of Health and Human Services (HHS) must estimate, for each calendar quarter beginning on or after January 1, 2017, the net quarterly reductions in federal expenditures resulting from this Act and adjust for a calendar quarter any initial estimate determined inaccurate. The adjusted estimate shall apply so as to adjust the amount appropriated to the Highway Trust Fund for the calendar quarter, subject to a specified limitation.

The amount equivalent to the HHS estimate reduction in federal Medicaid expenditures for a calendar quarter, but no more than a total of $15 billion in any year, is appropriated and transferred to the Highway Trust Fund from any funds in the Treasury not otherwise appropriated for that quarter.

Date: 2015-05-21
Topic: Health (Insurance Providers)
Subject: Health
Protecting Patients and Physicians Against Coding Act of 2015 

The Department of Health and Human Services (HHS), in carrying out regulations providing for the replacement of ICD-9 (International Classification of Diseases-9) with ICD-10 as a standard code set, shall provide for a two-year grace period during which physicians and other health care providers submitting claims and other documents using ICD-10 are not penalized for errors, mistakes, and malfunctions relating to the transition to such code set. HHS shall also give these practitioners assistance during the grace period.

The Government Accountability Office shall study this transition for Congress.

Date: 2015-06-04
Topic: Health (Insurance Providers)
Subject: Health
This bill requires that health care claims submitted with ICD-9 codes (the code set currently used in health care transactions to identify diagnoses and procedures) continue to be paid during the transition from the ICD-9 code set to the ICD-10 code set.

Date: 2015-07-10
Topic: Health (Insurance Providers)
Subject: Health
Medical Practice Freedom Act of 2015

This bill prohibits the Department of Health and Human Services or any state from requiring a health care provider, as a condition of the provider's licensure, to participate in a health plan or comply with requirements for meaningful use of electronic health records.

Date: 2015-07-16
Topic: Health (Insurance Providers)
Subject: Health
Construction Reform Act of 2016

(Sec. 2) This bill requires the Department of Veterans Affairs (VA) to use industry standards, standard designs, and best practices in carrying out medical facility construction.

A super construction project is one for the construction, alteration, or acquisition of a medical facility involving a total expenditure of more than $100 million (but does not include an acquisition by exchange).

 The VA shall provide, on a non-reimbursable basis, a non-VA federal entity with: (1) design, planning, and construction assistance; (2) project documents; and (3) other assistance upon request.

With respect to a proposed change to a contract entered into by a non-VA federal entity with which the VA has entered into an agreement that is estimated at a value of less than $250,000, the entity shall issue a final decision regarding such change within 30 days.

 With respect to a proposed contract change estimated at a value of $250,000 or more:

 the VA may make recommendations to the entity; the VA may issue the final decision regarding the change within 30 days after the entity proposes it; and if the VA does not issue a final decision within 60 days after the entity proposes the contract change, the entity shall issue a final decision regarding the change no later than 90 days after it proposes the change. The VA shall ensure that each VA employee with responsibilities relating to the construction or alteration of medical facilities undergoes ongoing professional training and development.

 The VA is prohibited from:

 obligating or expending funds for advance planning or design for any super construction project until 60 days after congressional notification, obligating funds for a major medical facility project or a super construction project by more than 10% of the amount approved by law unless certain congressional committees approve the obligation, or using bid savings amounts or funds for other than their original purpose before 30 days after notifying those committees unless each committee approves the obligation. The VA shall enter into a contract with an appropriate non-department federal entity to conduct an external forensic audit of: (1) the medical center construction project in Aurora, Colorado; and (2) the expenditures relating to any major medical facility or super construction project when such expenditures exceed the amount approved by law by more than 25%.

The VA must complete a 10-year master plan for: (1) each existing VA medical facility by December 31, 2016, and (2) each new VA medical facility by not later than the earlier of the date on which activation is completed or the date of the facility's formal dedication.

(Sec. 3) There is established in the Office of Inspector General an Assistant Inspector General for Construction who shall be responsible for conducting, supervising, and coordinating audits, evaluations, and investigations of the planning, design, contracting, and construction of VA facilities and infrastructure, including major and minor construction projects and leases.

Date: 2015-07-16
Topic: Health (Insurance Providers)
Subject: Armed forces and national security
VA Medical Center Recovery Act

(Sec. 2) This bill directs the Department of Veterans Affairs (VA) to publish in the Federal Register and on a publicly available VA Internet website a compilation of key health metrics for each VA medical center.

The VA shall: (1) determine on a semiannual basis whether each medical center is satisfactory or underperforming; and (2) upon a determination of underperformance, send a rapid deployment team to the center to ensure that it achieves satisfactory performance as quickly as practicable.

A rapid deployment team shall:

 identify the areas of the medical center that require improvement and whether the center follows directives and best practices; establish a performance remediation plan; review the status of any disciplinary actions taken at the center, any recommendations made by the VA Inspector General, and any Government Accountability Office findings; and provide appropriate training to the director and staff. The Inspector General of the VA shall prioritize investigations regarding underperforming medical centers.

The Office of Accountability Review shall prioritize investigations of whistleblower retaliation regarding underperforming medical centers.

(Sec. 3) The VA shall seek to enter into partnerships with recognized schools of nursing to provide undergraduate nursing students enrolled in such schools with standardized training with respect to:

 the culture of the military and veterans; post-traumatic stress disorder; traumatic brain injury; amputation and assistive devices; environmental, chemical, and toxic exposure; substance use disorders; military sexual trauma; suicide; homelessness; serious illness at the end of life; and federal benefits, services, and resources for veterans.

Date: 2015-07-28
Topic: Health (Insurance Providers)
Subject: Armed forces and national security
Medicare Post-Acute Care Value-Based Purchasing Act of 2015

This bill amends title XVIII (Medicare) of the Social Security Act to: (1) modify market basket percentages for post-acute care (PAC) providers, and (2) establish a PAC value-based purchasing program under which PAC providers receive value-based incentive payments. PAC providers are skilled nursing facilities, inpatient rehabilitation facilities, home health agencies, and long-term care hospitals.

A market basket is an index that reflects inflation and is used to update payments and cost limits. Under current law, market basket percentage increases for PAC providers are generally based on the application of a formula based on costs from the preceding fiscal year, but for FY2018 these increases are fixed at 1%. The bill repeals these fixed increases, leaving FY2018 increases to instead be determined according to the existing formula.

With respect to the PAC value-based purchasing program, the bill: (1) requires the Centers for Medicare & Medicaid (CMS) to establish performance standards and scores by which to rank PAC providers; (2) specifies how CMS must calculate value-based incentive payments for each type of PAC provider in accordance with such ranking; (3) requires CMS to make specified annual adjustments to how incentive payments are calculated; and (4) establishes limits on administrative and judicial review.

Under current law, a value-based purchasing program for skilled nursing facilities has been established to begin in FY2019. The bill maintains this program but specifies that it must terminate in FY2025.

Date: 2015-07-29
Topic: Health (Insurance Providers)
Subject: Health
VA Vendor Verification Act

This bill directs the Department of Veterans Affairs to establish uniform credentialing standards for medical vendors based on the standards prescribed in the "Joint Recommendation for Healthcare Industry Representative (HCIR) Credentialing Best Practices" by the Coalition for Best Practices in HCIR Requirements.

Date: 2015-07-29
Topic: Health (Insurance Providers)
Subject: Armed forces and national security
(This measure has not been amended since it was introduced. The summary has been expanded because action occurred on the measure.)

Women's Public Health and Safety Act

 

(Sec. 2) This bill amends title XIX (Medicaid) of the Social Security Act to modify requirements regarding a state plan for medical assistance.  Under current law, a state plan for medical assistance must provide that any individual eligible for medical assistance may obtain required services from any institution, agency, or person qualified to perform them.  The bill specifies that a state may not be required to provide medical assistance for services furnished by any individual or entity based on the individual's or entity's involvement in abortions.

Date: 2015-09-11
Topic: Health (Insurance Providers)
Subject: Health
Medicaid Qualified Providers Clarification Act

This bill amends title XIX (Medicaid) of the Social Security Act to modify requirements regarding a state plan for medical assistance. Under current law, a state plan for medical assistance must provide that any individual eligible for medical assistance may obtain required services from any institution, agency, or person qualified to perform them. The bill specifies that a state may determine whether a provider is qualified to perform such services. To do so, a state may establish qualification criteria, which may include criteria designed to evaluate: (1) the provider's ability to perform the needed medical services in a professionally competent, safe, and legal manner; and (2) any other qualification deemed necessary by the state.

Date: 2015-09-24
Topic: Health (Insurance Providers)
Subject: Health
Enhanced Veteran Healthcare Act of 2015

This bill directs the Department of Veterans Affairs (VA) to seek to enter into covered agreements and contracts for the mutually beneficial coordination, use, or exchange of covered VA health-care resources with eligible academic affiliates in order to improve access to, and quality of, VA hospital care and medical services.

Date: 2015-11-03
Topic: Health (Insurance Providers)
Subject: Armed forces and national security
This bill amends the Public Health Service Act to revise the priorities the Department of Health and Human Services (HHS) uses in assigning National Health Service Corps (NHSC) members to health professional shortage areas and awarding contracts under the NHSC Loan Repayment Program. Specifically, HHS must prioritize: (1) assignment of members to areas with a high number of veterans with ailments resulting from traumatic brain injuries, and (2) awarding contracts to health professionals receiving training or trained in addressing post-traumatic stress disorder.

Date: 2015-11-17
Topic: Health (Insurance Providers)
Subject: Health
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.

Date: 2015-11-18
Topic: Health (Insurance Providers)
Subject: Health
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.

Date: 2015-11-19
Topic: Health (Insurance Providers)
Subject: Armed forces and national security
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.

Date: 2016-01-13
Topic: Health (Insurance Providers)
Subject: Health
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.

Date: 2016-02-25
Topic: Health (Insurance Providers)
Subject: Health
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.

Date: 2016-03-23
Topic: Health (Insurance Providers)
Subject: Health
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.

Date: 2016-03-23
Topic: Health (Insurance Providers)
Subject: Health
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.)

Date: 2016-04-18
Topic: Health (Insurance Providers)
Subject: Health
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.

Date: 2016-04-19
Topic: Health (Insurance Providers)
Subject: Armed forces and national security
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.

Date: 2016-04-20
Topic: Health (Insurance Providers)
Subject: Health
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.

Date: 2016-04-20
Topic: Health (Insurance Providers)
Subject: Health
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.

Date: 2016-04-25
Topic: Health (Insurance Providers)
Subject: Health
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.

Date: 2016-05-11
Topic: Health (Insurance Providers)
Subject: Health
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.

Date: 2016-05-12
Topic: Health (Insurance Providers)
Subject: Health
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.

Date: 2016-05-26
Topic: Health (Insurance Providers)
Subject: Armed forces and national security
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.

Date: 2016-06-07
Topic: Health (Insurance Providers)
Subject: Health
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.

Date: 2016-06-16
Topic: Health (Insurance Providers)
Subject: Health
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.

Date: 2016-06-16
Topic: Health (Insurance Providers)
Subject: Health
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.

Date: 2016-06-28
Topic: Health (Insurance Providers)
Subject: Armed forces and national security
(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.

Date: 2016-07-07
Topic: Health (Insurance Providers)
Subject: Health
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.

Date: 2016-07-07
Topic: Health (Insurance Providers)
Subject: Health
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.

Date: 2016-07-11
Topic: Health (Insurance Providers)
Subject: Health