zli12321/Bills huggingface dataset:
Generic Drug Pricing Fairness Act - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act to require each contract entered into with a prescription drug plan (PDP) sponsor with respect to a PDP the sponsor offers to prohibit the PDP from entering into a contract with any pharmacy benefits manager (PBM) to manage the prescription drug coverage provided under such plan, or to control the costs of the prescription drug coverage under it, unless the PBM adheres to specified criteria when handling personally identifiable utilization and claims data or other sensitive patient data.

Revises requirements for contracts with PDP sponsors to require that the PDP sponsor disclose to applicable pharmacies the sources used for making any update of the prescription drug pricing standard, and if the source for such a standard is not publicly available, disclose to such pharmacies all individual drug prices to be so updated in advance of their use for the reimbursement of claims. Requires the PDP sponsor, as well, to establish a process to appeal, investigate, and resolve disputes regarding individual drug prices that are less than the pharmacy acquisition price for a drug.

Directs the Secretary of Defense (DOD), with respect to the TRICARE retail pharmacy program, to ensure that a contract entered into with a TRICARE managed care support contractor includes requirements to ensure the provision of information regarding the pricing standard for prescription drugs.

Establishes criteria to which a carrier and a PBM must adhere under a contract or an approved plan under which the carrier has an agreement with the PBM to manage prescription drug coverage or to control the costs of such coverage.

Prohibits a PBM under such criteria from: (1) transmitting to a pharmacy owned by the PBM any personally identifiable utilization or claims data relating to an enrolled individual who has not voluntarily elected in writing or via secure electronic means to fill that particular prescription at such a pharmacy; or (2) requiring any enrolled individual to use a retail pharmacy, mail order pharmacy, specialty pharmacy, or other pharmacy entity in which the PBM has an ownership interest, or that has an ownership interest in the PBM, or give an incentive to encourage an enrollee to use the pharmacy if the incentive applies only to those pharmacies.

Requires any contract or approved plan providing for a reimbursement standard with respect to a PDP to require the carrier to: (1) update the standard at least once every seven days to reflect the market price of a drug accurately; (2) disclose to pharmacies the sources used for making any such update; (3) make advance disclosure to those pharmacies of all individual drug prices to be updated if the source for a standard is not publicly available; and (4) establish a process to appeal, investigate, and resolve disputes regarding individual drug prices less than the pharmacy acquisition price.

Date: 2014-12-09
Topic: Health (Medical Liability)
Subject: Health
Local Medicaid Enforcement Incentives Act of 2014 - Directs the Secretary of Health and Human Services (HHS) to establish a grant program to provide states with funds to: (1) detect and prevent Medicaid fraud, waste, and abuse; (2) recover overpayments to individuals or entities receiving Medicaid funds that result from such fraud, waste, or abuse; and (3) share with localities within the state that assist in such detection and prevention, or the recovery of such overpayments, at least 50% of the state's share of the total overpayments recovered during a period, minus administrative costs.

Date: 2014-12-10
Topic: Health (Medical Liability)
Subject: Health
Medical Care Access Protection Act of 2013 or MCAP Act - Prescribes requirements for lawsuits for health care liability claims related to the provision of health care services.

Sets a statute of limitations of three years after the date of manifestation of injury or one year after the claimant discovers the injury, with certain exceptions.

Requires a court to impose sanctions for the filing of frivolous lawsuits.

Limits noneconomic damages to $250,000 from the provider or health care institution, but no more than $500,000 from multiple health care institutions. Makes each party liable only for the amount of damages directly proportional to its percentage of responsibility.

Allows the court to restrict the payment of attorney contingency fees. Limits the fees to a decreasing percentage based on the increasing value of the amount awarded.

Prescribes qualifications for expert witnesses.

Requires the court to reduce damages received by the amount of collateral source benefits to which a claimant is entitled, unless the payor of such benefits has the right to reimbursement or subrogation under federal or state law.

Authorizes the award of punitive damages only where: (1) it is proven by clear and convincing evidence that a person acted with malicious intent to injure the claimant or deliberately failed to avoid unnecessary injury the claimant was substantially certain to suffer, and (2) compensatory damages are awarded. Limits punitive damages to the greater of two times the amount of economic damages or $250,000.

Prohibits a health care provider from being named as a party in a product liability or class action lawsuit for prescribing or dispensing a Food and Drug Administration (FDA)-approved prescription drug, biological product, or medical device for an approved indication.

Provides for periodic payments of future damage awards.

Date: 2013-01-22
Topic: Health (Medical Liability)
Subject: Law
Family Health Care Accessibility Act of 2013 - Amends the Public Health Service Act to deem a health professional volunteer providing primary health care to an individual at a community health center to be an employee of the Public Health Service for purposes of any civil action that may arise from providing services to patients. Sets forth conditions for such liability protection, including: (1) the service is provided to the individual at a community health center or through offsite programs or events carried out by such center; and (2) the health care practitioner does not receive any compensation for providing the service, except repayment for reasonable expenses.

Considers an entity as sponsoring the health care practitioner if the entity submits an application to the Secretary of Health and Human Services (HHS), and the Secretary determines that the health care practitioner is deemed to be an employee of the Public Health Service.

Requires the Attorney General to submit to Congress an estimate of the amount of claims (together with related fees and expenses of witnesses) that, by reason of the actions or omissions of health professional volunteers, will be paid pursuant to this Act annually. Requires the Secretary to transfer such estimated amount from the claims fund to the appropriate accounts in the Treasury, subject to the extent of amounts in the fund.

Makes this Act effective on October 1, 2013.

Date: 2013-05-15
Topic: Health (Medical Liability)
Subject: Health
Medicare Audit Improvement Act of 2013 - Directs the Secretary of Health and Human Services (HHS) to establish a process which subjects to a single, combined maximum annual limit, applied incrementally, the number of additional documentation requests made to a hospital by Medicare administrative contractors, recovery audit contractors, or Comprehensive Error Rate Testing (CERT) program contractors pursuant to prepayment and postpayment audits requiring a hospital to submit a medical record for audit purposes.

Directs the Secretary also to establish a distinct additional documentation request limit, computed according to a specified formula, for each hospital claim type for each hospital for a 45-day period in a year.

Amends title XVIII (Medicare) of the Social Security Act with respect to the Medicare Integrity Program and use of recovery audit contractors.

Requires the Secretary to ensure that recovery audit contracts include certain mandatory terms and conditions pertaining to: (1) penalties for certain compliance failures, (2) penalties for overturned appeals, (3) postpayment and prepayment audits, and (4) guidelines for prepayment review.

Directs the Secretary to publish on the Internet website of the Centers for Medicare & Medicaid Services information on recovery audit contractor performance regarding: (1) audit rates, denials, and appeals outcomes; and (2) independent performance evaluations.

Deems to be an original claim for Medicare part B (Supplementary Medical Insurance) payment a resubmitted hospital claim for Medicare part A payment for inpatient hospital services which a recovery audit contractor determines: (1) were not medically necessary and reasonable based on the site of service, but (2) would be medically necessary and reasonable in an outpatient setting of the hospital. Requires payment to be made for such a resubmitted claim for all furnished items and services for which payment may be made under Medicare part B.

Deems to be a reopened claim, for purposes of a hospital's ability to resubmit a claim for Medicare payment in timely fashion, any claim that is the subject of an audit by a recovery audit contractor or a Medicare administrative contractor.

Requires contracts for a recovery audit contractor to require that a physician review each denial of a claim for medical necessity made by an employee of the contractor who is not a physician.

Subjects to administrative and judicial review the Secretary's compliance with guidelines for reopening and revising benefit determinations.

Date: 2013-05-22
Topic: Health (Medical Liability)
Subject: Health
Medicare Data Access for Transparency and Accountability Act - Amends title XI of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS) to make available to the public HHS claims and payment data related to SSA title XVIII (Medicare), including data on payments made to any service provider or supplier.

Date: 2013-06-18
Topic: Health (Medical Liability)
Subject: Health
No Obamacare Kickbacks Act of 2013 - Amends title XI of the Social Security Act, with respect to criminal penalties for acts involving federal health care programs, to include any plan or program established or funded under subtitles D (Available Coverage Choices for All Americans) or E (Affordable Coverage Choices for All Americans) of title I of the Patient Protection and Affordable Care Act.

Directs the Inspector General of the Department of Health and Human Services (HHS) and the Comptroller General (GAO) to jointly study, and report to Congress on, the effect of applying the anti-kickback laws and other prohibitions involving federal health care programs to qualified health plans, federally-facilitated marketplaces, state health care exchanges, and any other plan or program established or funded under the provisions described above.

Date: 2013-11-19
Topic: Health (Medical Liability)
Subject: Health
Quality Data, Quality Healthcare Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act (SSA) with respect to the use of certain data by qualified public or private entities to evaluate the performance of service providers and suppliers under Medicare insurance programs.

 Authorizes a qualified entity to: (1) use Medicare data, and information derived from service provider and supplier performance evaluations, for additional non-public analyses; or (2) provide or sell such data and analyses to specified health care-related entities for non-public use (including for purposes of assisting service providers and suppliers to develop and participate in quality and patient care improvement activities, particularly development of new models of care).

Conditions such authorization upon a data use agreement between a qualified entity and a specified health care-related entity under which the latter: (1) may not re-sell such data or analyses; and (2) shall comply with the qualified entity's privacy and security policies in using such data or analyses.

Prescribes a civil money penalty for unauthorized use of data and analyses.

Requires the Secretary of Health and Human Services (HHS) to provide Medicare claims data to qualified clinical data registries for purposes of linking it with clinical outcomes data and performing and disseminating risk-adjusted, scientifically valid research to support quality improvement.

Prohibits a qualified clinical data registry from reporting publicly any claims data thus made available that individually identifies a service provider or supplier without prior consent.

Date: 2013-11-21
Topic: Health (Medical Liability)
Subject: Health
Standard of Care Protection Act - Provides that the development, recognition, or implementation of any guideline or other standard under any provision of the Patient Protection and Affordable Care Act, the health care-related parts of the Health Care and Education Reconciliation Act of 2010, or titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act shall not be construed to establish the standard or duty of care owed by a health care provider to a patient in any medical malpractice or medical product liability action or claim.

Prohibits such health care provisions from being construed to preempt any state or common law governing medical malpractice or medical product liability actions or claims.

Date: 2013-11-21
Topic: Health (Medical Liability)
Subject: Health
Steps Toward Access and Reform Act of 2013 or STAR Act of 2013 - Limits the commencement of a health care lawsuit, except in certain cases including fraud or intentional concealment, to three years after the date of manifestation of injury or one year after the claimant discovers, or through the use of reasonable diligence should have discovered, the injury, whichever occurs first.

Limits to $250,000 the amount of noneconomic damages in such a lawsuit, but allows a claim for the full amount of any economic damages.

Requires the court, in any health care lawsuit, to supervise the arrangements for payment of damages to protect against conflicts of interest that may have the effect of reducing the amount of damages awarded that are actually paid to claimants.

Allows any party in any health care lawsuit involving injury or wrongful death to introduce evidence of collateral source benefits.

Specifies criteria for the award of punitive damages, limited to the greater of $250,000 or double the amount of economic damages.

Preempts state law with respect to health care lawsuits, but subjects to otherwise applicable state or federal law any issue not governed by this Act or any law (including state standards of negligence) established by or under it.

Declares the sense of Congress that a health insurer should be liable for damages for harm caused when it makes a decision as to what care is medically necessary and appropriate.

Directs the Secretary of Health and Human Services (HHS) to contract with eligible health professionals to serve for a period of at least four years as a primary care provider in a medically underserved community, in consideration for which the Secretary shall pay up to $100,000 on the principal and interest on the individual's graduate medical, osteopathic, or other health professional educational loans.

Amends the Internal Revenue Code to allow a bad debt deduction from gross income for worthless qualified medical care debt of at least 75% of a tax-paying medical care provider's charge for such care.

Prohibits the Food and Drug Administration (FDA) from taking action to prevent an individual not in the business of importing a prescription drug from importing one from Canada that complies with the Federal Food, Drug, and Cosmetic Act. Amends the Public Health Service Act to declare that the laws of the state designated by a health insurance issuer (primary state) shall apply to individual health insurance coverage offered by that issuer in the primary state and in any other state (secondary state), but only if the coverage and issuer comply with conditions of this Act.

Prohibits a health insurance issuer from offering, selling, or issuing individual health insurance coverage in a secondary state if its insurance commissioner does not use a risk-based capital formula for determining capital and surplus requirements for all health insurance issuers.

Date: 2013-12-19
Topic: Health (Medical Liability)
Subject: Health
Protecting Seniors from Health Care Fraud Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS), acting through the HHS Office of Inspector General, and the Attorney General to report annually to Congress and the public on health care fraud schemes targeted to seniors and steps being taken to combat such schemes and to educate seniors about them.

Directs the Secretary to: (1) disseminate such reports through mechanisms that reach the most Medicare beneficiaries, and (2) mail to each Medicare beneficiary a list of the top 10 most prevalent health care fraud schemes.

Date: 2014-01-16
Topic: Health (Medical Liability)
Subject: Health
Preventing Unnecessary Medicare Payments (PUMP) Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act to: (1) apply Medicare competitive bidding to vacuum erection systems, and (2) require the Secretary of Health and Human Services (HHS) to phase-in a national mail order program for such devices.

Date: 2014-03-13
Topic: Health (Medical Liability)
Subject: Health
Stop Schemes and Crimes Against Medicare and Seniors (Stop SCAMS) Act - Amends title XI of the Social Security Act with respect to standards for financial and administrative transactions and their data elements to enable the electronic exchange of health information.

Requires the Secretary of Health and Human Services (HHS) to adopt standards that: (1) ensure that any entity producing and transmitting valid transactions that include code sets for appropriate data elements is subject to a consistent, industry-wide framework that supports a seamless transition to new and modified code sets; and (2) establish an end-to-end testing procedure for new and modified code sets that shall require the participation of any entity producing and transmitting valid transactions that use the new or modified code set.

Prohibits the Secretary from adopting a new or modified code set unless the Secretary: (1) assesses its impact on fraud prevention and pre-payment review, determines that anti-fraud edits work as intended, and confirms that a plan is in place to ensure continuing effective detection of fraud following the adoption of the code set; (2) ensures that the end-to-end testing procedure established has been completed; and (3) completes end-to-end testing with any federal government entity that produces and transmits valid transactions that include the code set with private sector tracking partners. Exempts routine, regularly scheduled updates to existing code sets from such prohibition.

Directs the Secretary, with respect to information supplied to it by a disclosing entity about those with an ownership or control interest in the entity, to verify such information in a specified manner and confirm the accuracy of any Social Security account number or employer identification number.

Holds immune from civil liability (in a safe harbor) any non-governmental entity participating in a Healthcare Fraud Prevention Partnership, including private insurers, for sharing information about potentially fraudulent providers with each other, HHS, the Department of Justice (DOJ), any other federal or state law enforcement agency, any federal or state agency contractor, and another Partnership participant.

Directs the Medicare Payment Advisory Commission (MEDPAC) to study administrative efforts to strengthen program integrity in the Medicare program.

Amends the Small Business Jobs Act of 2010, with respect to the use of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse in the Medicare fee-for-service program, to require predictive analytics technologies to capture outcome information on civil recoveries, administrative actions, and criminal convictions for fraud.

Date: 2014-05-20
Topic: Health (Medical Liability)
Subject: Health
VA Accountability Act of 2014 - Prohibits any officer, employee, or agent of the Department of Veterans Affairs (VA) from:

 knowingly falsifying an individual's VA health records; knowingly destroying or excluding information from such records with the intent to defraud the individual, a federal officer or employee, or a Member of Congress; directing another individual to engage in such prohibited conduct; or knowing of such prohibited conduct by an individual under his or her supervision and failing to stop, if possible, or report to a superior the commission of such conduct. Allows an individual aggrieved by such conduct to bring a civil action against the officer, employee, or agent in an appropriate U.S. district court for damages or other legal or equitable relief.

Authorizes the VA Secretary to terminate, without prior notice or cause, the employment and benefits of a VA officer, employee, or agent found by such court to have violated this Act.

Provides that this Act shall apply to conduct committed before, on, or after its enactment.

Date: 2014-06-03
Topic: Health (Medical Liability)
Subject: Armed forces and national security
Health Insurance Industry Antitrust Enforcement Act of 2015

Prohibits the McCarran-Ferguson Act from being construed to permit health insurance or medical malpractice insurance issuers to engage in price fixing, bid rigging, or market allocations in connection with providing health insurance or medical malpractice coverage.

Amends the McCarran-Ferguson Act to provide that nothing in it modifies, impairs, or supersedes the operation of antitrust laws with respect to the business of health insurance.

Applies prohibitions of unfair methods of competition to the business of health insurance without regard to whether the business is for profit.

Date: 2015-01-06
Topic: Health (Medical Liability)
Subject: Health
MAC Transparency Act 

Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act to require each contract entered into with a prescription drug plan (PDP) sponsor with respect to a PDP the sponsor offers to prohibit the PDP from entering into a contract with any pharmacy benefits manager (PBM) to manage the prescription drug coverage provided under such plan, or to control the costs of the prescription drug coverage under it, unless the PBM adheres to specified criteria when handling personally identifiable utilization and claims data or other sensitive patient data.

Revises requirements for contracts with PDP sponsors to require that the PDP sponsor disclose to applicable pharmacies the sources used for making any update of the prescription drug pricing standard, and if the source for such a standard is not publicly available, disclose to such pharmacies all individual drug prices to be so updated in advance of their use for the reimbursement of claims. Requires the PDP sponsor, as well, to establish a process to appeal, investigate, and resolve disputes regarding individual drug prices that are less than the pharmacy acquisition price for a drug.

Directs the Secretary of Defense (DOD), with respect to the TRICARE retail pharmacy program, to ensure that a contract entered into with a TRICARE managed care support contractor includes requirements to ensure the provision of information regarding the pricing standard for prescription drugs.

Establishes criteria to which a carrier and a PBM must adhere under a contract or an approved plan under which the carrier has an agreement with the PBM to manage prescription drug coverage or to control the costs of such coverage.

Prohibits a PBM under such criteria from: (1) transmitting to a pharmacy owned by the PBM any personally identifiable utilization or claims data relating to an enrolled individual who has not voluntarily elected in writing or via secure electronic means to fill that particular prescription at such a pharmacy; or (2) requiring any enrolled individual to use a retail pharmacy, mail order pharmacy, specialty pharmacy, or other pharmacy entity in which the PBM has an ownership interest, or that has an ownership interest in the PBM, or give an incentive to encourage an enrollee to use the pharmacy if the incentive applies only to those pharmacies.

Requires any contract or approved plan providing for a reimbursement standard with respect to a PDP to require the carrier to: (1) update the standard at least once every seven days to reflect the market price of a drug accurately; (2) disclose to pharmacies the sources used for making any such update; (3) make advance disclosure to those pharmacies of all individual drug prices to be updated if the source for a standard is not publicly available; and (4) establish a process to appeal, investigate, and resolve disputes regarding individual drug prices less than the pharmacy acquisition price.

Date: 2015-01-09
Topic: Health (Medical Liability)
Subject: Health
Good Samaritan Health Professionals Act of 2015

Amends the Public Health Service Act to shield a health care professional from liability under federal or state law for harm caused by any act or omission if: (1) the professional is serving as a volunteer in response to a disaster; and (2) the act or omission occurs during the period of the disaster, in the professional's capacity as a volunteer, and in a good faith belief that the individual being treated is in need of health care services.

Makes exceptions where: (1) the harm was caused by an act or omission constituting willful or criminal misconduct, gross negligence, reckless misconduct, or a conscious flagrant indifference to the rights or safety of the individual harmed; or (2) the professional rendered the health care services under the influence of alcohol or an intoxicating drug.

Date: 2015-02-11
Topic: Health (Medical Liability)
Subject: Health
Sports Medicine Licensure Clarity Act of 2016

(Sec. 2) This bill extends the liability insurance coverage of a state-licensed medical professional to another state when the professional provides medical services to an athlete, athletic team, or team staff member pursuant to a written agreement. Prior to providing such services, the medical professional must disclose the nature and extent of the services to the insurer. This extension of coverage does not apply at a health care facility or while a medical professional licensed in the state is transporting the injured individual to a health care facility.

Date: 2015-02-12
Topic: Health (Medical Liability)
Subject: Health
Truth in Healthcare Marketing Act of 2015

This bill prohibits any person from making any statement or engaging in any act that misrepresents: (1) whether the person holds a state health care license; or (2) the person's education, training, degree, license, or clinical expertise.

A person's advertisement for the person's health care services must disclose the license under which the person is authorized to provide those services.

A violation of this Act is an unfair or deceptive act or practice under the Federal Trade Commission Act.

 The Federal Trade Commission must study and report to Congress on health care professionals' misrepresentations under this Act.

Date: 2015-04-13
Topic: Health (Medical Liability)
Subject: Health
This bill amends title XIX (Medicaid) of the Social Security Act to revise the conditions for state use of an independent enrollment broker in marketing Medicaid managed care organizations and other managed care entities to eligible individuals.

The Secretary of Health and Human Services must find that the broker has also established and maintains policies and procedures to ensure the independence of its enrollment activities from the interests of any managed care entity or provider.

Date: 2015-04-29
Topic: Health (Medical Liability)
Subject: Health
Medicare Audit Improvement Act of 2015

This bill amends title XVIII (Medicare) of the Social Security Act (SSAct) with respect to the practices of recovery audit contractors (RACs) under the Medicare program fin identifying underpayments and overpayments and recouping overpayments.

Incentive payments to a RAC for recovery activities are prohibited for FY2015 and subsequent fiscal years.

Payments for recovery activities shall be reduced, according to a sliding scale established by the Secretary of Health and Human Services, to any RAC with a complex audit denial rate at the end of a fiscal year, determined pursuant to a specified formula, that is .1% or greater.

The one-year timely filing limit for certain rebilled SSAct title XVIII part B (Supplementary Medical Insurance) claims is eliminated, extending the deadline for the rebill to 180 days after final denial of the claim.

A determination of whether inpatient hospital services or inpatient critical access hospital services furnished to an individual are reasonable and necessary shall now be based solely on information available to the admitting physician at the time of the inpatient admission of the individual for such services, as documented in the medical record.

Date: 2015-04-30
Topic: Health (Medical Liability)
Subject: Health
This bill amends the Federal Food, Drug, and Cosmetic Act to require the Food and Drug Administration (FDA) to establish a third-party quality system assessment program to accredit persons to assess whether a medical device manufacturer's quality system can ensure the safety and effectiveness of an approved medical device after certain changes, including changes in manufacturing or changes to enhance device safety.

Device manufacturers are allowed to make changes to a device without submitting to the FDA the 30-day notice required for manufacturing changes or a premarket approval supplement if their quality system has been certified by an accredited person.

An accredited person who assesses a device manufacturer's quality system must submit a summary of their assessment and, as appropriate, a certification to the FDA within 30 days of the assessment. An assessment summary and certification is deemed accepted by the FDA 30 days after submission unless the FDA determines that additional information is needed to support certification, the assessment or certification is unwarranted, or an action other than acceptance of the certification is otherwise justified.

Periodic reports by device manufacturers must describe any changes made to a device without submission of the 30-day notice or the premarket approval supplement.

Certifications accepted by the FDA remain in effect for two years.

The FDA must report on this quality system assessment program no later than January 31, 2022. The program is terminated at the end of FY2022.

Date: 2015-05-19
Topic: Health (Medical Liability)
Subject: Health
Saving Lives, Saving Costs Act

Establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines.

Requires the Department of Health and Human Services (HHS) to publish clinical practice guidelines provided and maintained by national or state medical societies or medical specialty societies designated by HHS. Sets forth standards for the development of guidelines, including standards related to transparency, the composition of the panel, and the review of existing evidence. Prohibits holding a professional organization or a participant in guideline development liable for injury allegedly caused by adherence to a guideline to which they contributed.

Declares that this Act does not preempt: (1) any state or federal law that imposes greater procedural or substantive protections for health care providers and health care organizations from liability, loss, or damages than those provided under this Act; (2) any state or federal law that creates a cause of action; or (3) any defenses otherwise available.

Gives jurisdiction of health care liability actions against health care professionsals, providers, or organizations to district courts. Allows a defendant to remove any health care liability action brought in a state court to a district court.

Requires an independent medical review in health care liability actions that have been removed to a district court if the eligible professionals allege that they adhered to applicable clinical practice guidelines. Sets forth procedures for the use of the panel's findings at trial.

Date: 2015-06-02
Topic: Health (Medical Liability)
Subject: Health
Protecting Infants Born Alive 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 not be required to provide medical assistance for such services by any individual or entity whose services or actions are suspected by the state of causing the termination of a human fetus classified as an infant born alive. Furthermore, a provider of such an abortion may neither receive payment under the Medicaid program nor participate in any federal or state health care program.

Date: 2015-09-11
Topic: Health (Medical Liability)
Subject: Health
(This measure has not been amended since it was introduced. The summary has been expanded because action occurred on the measure.)

Born-Alive Abortion Survivors Protection Act

(Sec. 3) This bill amends the federal criminal code to require any health care practitioner who is present when a child is born alive following an abortion or attempted abortion to: (1) exercise the same degree of care as reasonably provided to any other child born alive at the same gestational age, and (2) ensure that such child is immediately admitted to a hospital. The term "born alive" means the complete expulsion or extraction from his or her mother, at any stage of development, who after such expulsion or extraction breathes or has a beating heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, regardless of whether the umbilical cord has been cut.

Also, a health care practitioner or other employee who has knowledge of a failure to comply with these requirements must immediately report such failure to an appropriate law enforcement agency.

An individual who violates the provisions of this Act is subject to a criminal fine, up to five years in prison, or both.

An individual who commits an overt act that kills a child born alive is subject to criminal prosecution for murder.

The legislation bars the criminal prosecution of a mother of a child born alive for conspiracy to violate the provisions of this Act, for being an accessory after the fact, or for concealment of felony.

A woman who undergoes an abortion or attempted abortion may file a civil action for damages against an individual who violates this Act.

Date: 2015-09-15
Topic: Health (Medical Liability)
Subject: Crime and law enforcement
Ensuring Access to Quality Medicaid Providers 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.

Date: 2015-10-08
Topic: Health (Medical Liability)
Subject: Health
Preventing and Reducing Improper Medicare and Medicaid Expenditures to Restore Integrity to Benefits Act of 2015

This bill amends title XIX (Medicaid) of the Social Security Act to make several changes related to the prevention of Medicaid fraud.

With respect to the Medicaid Integrity Program (MIP), the bill: (1) specifies that program appropriations may cover costs of equipment, travel, training, and salaries and benefits; and (2) allows the Department of Health and Human Services (HHS) flexibility in determining the number of additional staff necessary to carry out the program. (MIP is a federal program aimed at preventing and reducing provider fraud, waste, and abuse in the Medicaid program.)

Under current law, HHS may contract with Medicare administrative contractors (MACs), which are private insurers that process Medicare claims within specified geographic jurisdictions. The bill requires HHS to provide specified incentives for MACs to reduce improper payment error rates within their jurisdictions.

The bill establishes criminal penalties of up to 10 years imprisonment and up to $500,000 in fines for illegally purchasing or distributing Medicare, Medicaid, or Children's Health Insurance Program (CHIP) beneficiary identification or billing privileges.

The bill increases the scope of the Medicare-Medicaid Data Match Program (Medi-Medi Program), an existing program through which contractors and participating governmental agencies collaboratively analyze Medicare and Medicaid billing trends. HHS must establish a plan to encourage states to participate in the Medi-Medi Program.

HHS shall develop and implement a plan to allow states to access relevant data on improper or fraudulent payments made under the Medicare program on behalf of individuals dually eligible for both Medicare and Medicaid.

Date: 2015-10-08
Topic: Health (Medical Liability)
Subject: Health
End Surprise Billing Act of 2015

This bill amends title XVIII (Medicare) of the Social Security Act to require a critical access hospital or other hospital to comply, as a condition of participation in Medicare, with certain requirements related to billing for out-of-network services.

With respect to an individual who has health benefits coverage and is seeking services, a hospital must provide notice as to: (1) whether the hospital, or any of the providers furnishing services to the individual at the hospital, is not within the health care provider network or otherwise a participating provider with respect to the individual's health care coverage; and (2) if so, the estimated out-of-pocket costs of the services to the individual. At least 24 hours prior to providing those services, the hospital must document that the individual: (1) has been provided with the required notice, and (2) consents to be furnished with the services and charged an amount approximate to the estimate provided. Otherwise, the hospital may not charge the individual more than the individual would have been required to pay if the services had been furnished by an in-network or participating provider.

With respect to such an individual who is seeking same-day emergency services, a hospital may not charge more than the individual would be required to pay for such services furnished by an in-network or participating provider.

Date: 2015-10-20
Topic: Health (Medical Liability)
Subject: Health
Medical Loss Ratio Accountability Act of 2016

This bill amends the Public Health Service Act to require the Department of Health and Human Services (HHS) to audit a statistically significant and representative selection of health insurers to verify that insurer reports on medical loss ratio are accurate.

This bill amends the Social Security Act to base determinations of the medical loss ratio of a Medicare Advantage plan on information from the HHS audit of the plan, if the plan was audited.

Date: 2016-03-17
Topic: Health (Medical Liability)
Subject: Health
Medicaid Program Integrity Enhancement Act of 2016

This bill amends title XIX (Medicaid) of the Social Security Act to require a state Medicaid agency to establish a process by which a provider may appeal a decision by the agency to suspend payment to the provider on the basis of credible fraud allegations.

The Centers for Medicare & Medicaid Services (CMS) must revise specified regulations related to such suspensions in order to comply with due process requirements established by the bill.

Specifically, a state Medicaid agency may not suspend payment until the agency: (1) consults with the state's Medicaid fraud control unit or, if the state has no such unit, with the state's attorney general; (2) certifies that it has considered whether the suspension will jeopardize beneficiary access and whether there is good cause not to suspend payment; and (3) furnishes the provider with the agency's reasons for finding no such good cause.

Furthermore, the agency must periodically evaluate whether there is good cause to discontinue a suspension for which an investigation is pending. With specified exceptions, such good cause shall be deemed to exist if the investigation remains unresolved after a suspension has been in effect for 18 months.

CMS must also revise specified regulations to provide that an allegation of fraud shall be considered credible only if the allegation has indications of reliability and the state Medicaid agency: (1) has reviewed all allegations, facts, and evidence carefully; (2) acts judiciously on a case-by-case basis; and (3) has considered the potential impact a payment suspension may have on beneficiary access to care.

Date: 2016-03-17
Topic: Health (Medical Liability)
Subject: Health
Promoting Integrity in Medicare Act of 2016 or PIMA of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to: (1) expand Medicare's prohibition on physician self-referrals to include, with specified exceptions, certain advanced imaging, anatomic pathology, radiation therapy, and physical therapy services; and (2) establish increased civil monetary penalties for violations of the self-referral prohibition with respect to those services.

The Centers for Medicare & Medicaid Services shall conduct a compliance review with respect to such referrals.

Date: 2016-04-28
Topic: Health (Medical Liability)
Subject: Health
Protecting Seniors from Health Care Fraud Act of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to direct the Department of Health and Human Services (HHS) to report annually to Congress and the public on: (1) the ten most prevalent health care fraud schemes targeted to seniors, (2) steps being taken to combat such schemes, and (3) policy suggestions to improve protections for seniors.

HHS may omit certain information from an annual report if public disclosure would compromise an ongoing investigation or educate criminals rather than seniors.

HHS shall disseminate reports to Medicare beneficiaries as specified by the bill.

Date: 2016-05-13
Topic: Health (Medical Liability)
Subject: Health
(This measure has not been amended since it was introduced. The expanded summary of the House reported version is repeated here.)

Ethical Patient Care for Veterans Act of 2016

(Sec. 2) This bill directs the Department of Veterans Affairs (VA) to ensure that each VA physician is informed of the duty to report any covered activity committed by another physician that the physician witnesses or otherwise directly discovers to the applicable state licensing authority within five days.

 Disciplinary Appeals Boards shall have exclusive jurisdiction to review any case of professional conduct or competence arising from a VA physician's failure to properly report such activity.

"Covered activity" means any activity occurring in a VA medical facility that consists of or causes the provision of impaired, incompetent, or unethical health care that requires direct reporting under the Code of Medical Ethics of the American Medical Association.

Date: 2016-06-07
Topic: Health (Medical Liability)
Subject: Armed forces and national security
Health Care Price Transparency Promotion Act of 2016

This bill amends title XIX (Medicaid) of the Social Security Act to require state Medicaid plans to provide that the state will establish and maintain laws to: (1) require disclosure of information on hospital charges, (2) make such information available to the public, and (3) provide individuals with information about estimated out-of-pocket costs for health care services.

Date: 2016-06-21
Topic: Health (Medical Liability)
Subject: Health
Local Medicaid Enforcement Incentives Act of 2016

This bill requires the Centers for Medicare & Medicaid Services to award grants to states for the purpose of establishing or expanding programs that: (1) detect and prevent Medicaid fraud, waste, and abuse; (2) identify and recover overpayments resulting from such fraud, waste, or abuse; and (3) share recovered overpayments with localities that assist in detection, prevention, or recovery.

Date: 2016-09-15
Topic: Health (Medical Liability)
Subject: Health
No Obamacare Kickbacks Act of 2015

Applies prohibitions against, and criminal penalties for, false statements and kickbacks in part A (General Provisions) of title XI of the Social Security Act to plans and programs established or funded under the Patient Protection and Affordable Care Act, including qualified health plans, catastrophic plans, health benefit exchanges, reinsurance programs, the risk corridor program, patient navigators, and contracts with individuals or entities to facilitate enrollment in exchanges.

Directs the Inspector General of the Department of Health and Human Services and the Government Accountability Office to jointly study and report to Congress on the effect of this Act.

Date: 2015-01-07
Topic: Health (Medical Liability)
Subject: Health