text: SECTION 1. SHORT TITLE.
      This Act may be cited as the ``Patient Access and Medicare 
  Protection Act''.
  SEC. 2. NON-APPLICATION OF MEDICARE FEE SCHEDULE ADJUSTMENTS FOR 
  WHEELCHAIR ACCESSORIES AND SEAT AND BACK CUSHIONS WHEN FURNISHED IN 
  CONNECTION WITH COMPLEX REHABILITATIVE POWER WHEELCHAIRS.
      (a) Non-application.--
          (1) In general.--Notwithstanding any other provision of law, 
      the Secretary of Health and Human Services shall not, prior to 
      January 1, 2017, use information on the payment determined under 
      the competitive acquisition programs under section 1847 of the 
      Social Security Act (42 U.S.C. 1395w-3) to adjust the payment 
      amount that would otherwise be recognized under section 
      1834(a)(1)(B)(ii) of such Act (42 U.S.C. 1395m(a)(1)(B)(ii)) for 
      wheelchair accessories (including seating systems) and seat and 
      back cushions when furnished in connection with Group 3 complex 
      rehabilitative power wheelchairs.
          (2) Implementation.--Notwithstanding any other provision of 
      law, the Secretary may implement this subsection by program 
      instruction or otherwise.
      (b) GAO Study and Report.--
          (1) Study.--
              (A) In general.--The Comptroller General of the United 
          States shall conduct a study on wheelchair accessories 
          (including seating systems) and seat and back cushions 
          furnished in connection with Group 3 complex rehabilitative 
          power wheelchairs. Such study shall include an analysis of the 
          following with respect to such wheelchair accessories and seat 
          and back cushions in each of the groups described in clauses 
          (i) through (iii) of subparagraph (B):
                  (i) The item descriptions and associated HCPCS codes 
              for such wheelchair accessories and seat and back cushions.
                  (ii) A breakdown of utilization and expenditures for 
              such wheelchair accessories and seat and back cushions 
              under title XVIII of the Social Security Act.
                  (iii) A comparison of the payment amount under the 
              competitive acquisition program under section 1847 of such 
              Act (42 U.S.C. 1395w-3) with the payment amount that would 
              otherwise be recognized under section 1834 of such Act (42 
              U.S.C. 1395m), including beneficiary cost sharing, for such 
              wheelchair accessories and seat and back cushions.
                  (iv) The aggregate distribution of such wheelchair 
              accessories and seat and back cushions furnished under such 
              title XVIII within each of the groups described in 
              subparagraph (B).
                  (v) Other areas determined appropriate by the 
              Comptroller General.
              (B) Groups described.--The following groups are described 
          in this subparagraph:
                  (i) Wheelchair accessories and seat and back cushions 
              furnished predominantly with Group 3 complex rehabilitative 
              power wheelchairs.
                  (ii) Wheelchair accessories and seat and back cushions 
              furnished predominantly with power wheelchairs that are not 
              described in clause (i).
                  (iii) Other wheelchair accessories and seat and back 
              cushions furnished with either power wheelchairs described 
              in clause (i) or (ii).
          (2) Report.--Not later than June 1, 2016, the Comptroller 
      General of the United States shall submit to Congress a report 
      containing the results of the study conducted under paragraph (1), 
      together with recommendations for such legislation and 
      administrative as the Comptroller General determines to be 
      appropriate.
  SEC. 3. TRANSITIONAL PAYMENT RULES FOR CERTAIN RADIATION THERAPY 
  SERVICES UNDER THE MEDICARE PHYSICIAN FEE SCHEDULE.
      (a) In General.--Section 1848 of the Social Security Act (42 U.S.C. 
  1395w-4) is amended--
          (1) in subsection (b), by adding at the end the following new 
      paragraph:
          ``(11) Special rule for certain radiation therapy services.--
      The code definitions, the work relative value units under 
      subsection (c)(2)(C)(i), and the direct inputs for the practice 
      expense relative value units under subsection (c)(2)(C)(ii) for 
      radiation treatment delivery and related imaging services 
      (identified in 2016 by HCPCS G-codes G6001 through G6015) for the 
      fee schedule established under this subsection for services 
      furnished in 2017 and 2018 shall be the same as such definitions, 
      units, and inputs for such services for the fee schedule 
      established for services furnished in 2016.''; and
          (2) in subsection (c)(2)(K), by adding at the end the following 
      new clause:
                  ``(iv) Treatment of certain radiation therapy 
              services.--Radiation treatment delivery and related imaging 
              services identified under subsection (b)(11) shall not be 
              considered as potentially misvalued services for purposes 
              of this subparagraph and subparagraph (O) for 2017 and 
              2018.''.
      (b) Report to Congress on Alternative Payment Model.--Not later 
  than 18 months after the date of the enactment of this Act, the 
  Secretary of Health and Human Services shall submit to Congress a 
  report on the development of an episodic alternative payment model for 
  payment under the Medicare program under title XVIII of the Social 
  Security Act for radiation therapy services furnished in nonfacility 
  settings.
  SEC. 4. ENSURING FLEXIBILITY IN APPLYING HARDSHIP EXCEPTION FOR 
  MEANINGFUL USE FOR 2015 EHR REPORTING PERIOD FOR 2017 PAYMENT 
  ADJUSTMENTS.
      (a) Eligible Professionals.--Section 1848(a)(7)(B) of the Social 
  Security Act (42 U.S.C. 1395w-4(a)(7)(B)) is amended, in the first 
  sentence, by inserting ``(and, with respect to the payment adjustment 
  under subparagraph (A) for 2017, for categories of eligible 
  professionals, as established by the Secretary and posted on the 
  Internet website of the Centers for Medicare & Medicaid Services prior 
  to December 15, 2015, an application for which must be submitted to the 
  Secretary by not later than March 15, 2016)'' after ``case-by-case 
  basis''.
      (b) Eligible Hospitals.--Section 1886(b)(3)(B)(ix) of the Social 
  Security Act (42 U.S.C. 1395ww(b)(3)(B)(ix)) is amended--
          (1) in the first sentence of subclause (I), by striking 
      ``(n)(6)(A)'' and inserting ``(n)(6)''; and
          (2) in subclause (II), in the first sentence, by inserting 
      ``(and, with respect to the application of subclause (I) for fiscal 
      year 2017, for categories of subsection (d) hospitals, as 
      established by the Secretary and posted on the Internet website of 
      the Centers for Medicare & Medicaid Services prior to December 15, 
      2015, an application for which must be submitted to the Secretary 
      by not later than April 1, 2016)'' after ``case-by-case basis''.
      (c) Implementation.--Notwithstanding any other provision of law, 
  the Secretary of Health and Human Services shall implement the 
  provisions of, and the amendments made by, subsections (a) and (b) by 
  program instruction, such as through information on the Internet 
  website of the Centers for Medicare & Medicaid Services.
  SEC. 5. MEDICARE IMPROVEMENT FUND.
      Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
  1395iii(b)(1)) is amended by striking ``$5,000,000'' and inserting 
  ``$0''.
  SEC. 6. STRENGTHENING MEDICAID PROGRAM INTEGRITY THROUGH FLEXIBILITY.
      Section 1936 of the Social Security Act (42 U.S.C. 1396u-6) is 
  amended--
          (1) in subsection (a), by inserting ``, or otherwise,'' after 
      ``entities''; and
          (2) in subsection (e)--
              (A) in paragraph (1), in the matter preceding subparagraph 
          (A), by inserting ``(including the costs of equipment, salaries 
          and benefits, and travel and training)'' after ``Program under 
          this section''; and
              (B) in paragraph (3), by striking ``by 100'' and inserting 
          ``by 100, or such number as determined necessary by the 
          Secretary to carry out the Program,''.
  SEC. 7. ESTABLISHING MEDICARE ADMINISTRATIVE CONTRACTOR ERROR REDUCTION 
  INCENTIVES.
      (a) In General.--Section 1874A(b)(1)(D) of the Social Security Act 
  (42 U.S.C. 1395kk-1(b)(1)(D)) is amended--
          (1) by striking ``quality.--The Secretary'' and inserting 
      ``quality.--
                  ``(i) In general.--Subject to clauses (ii) and (iii), 
              the Secretary''; and
          (2) by inserting after clause (i), as added by paragraph (1), 
      the following new clauses:
                  ``(ii) Improper payment rate reduction incentives.--The 
              Secretary shall provide incentives for medicare 
              administrative contractors to reduce the improper payment 
              error rates in their jurisdictions.
                  ``(iii) Incentives.--The incentives provided for under 
              clause (ii)--
  
                      ``(I) may include a sliding scale of award fee 
                  payments and additional incentives to medicare 
                  administrative contractors that either reduce the 
                  improper payment rates in their jurisdictions to 
                  certain thresholds, as determined by the Secretary, or 
                  accomplish tasks, as determined by the Secretary, that 
                  further improve payment accuracy; and
                      ``(II) may include substantial reductions in award 
                  fee payments under cost-plus-award-fee contracts, for 
                  medicare administrative contractors that reach an upper 
                  end improper payment rate threshold or other threshold 
                  as determined by the Secretary, or fail to accomplish 
                  tasks, as determined by the Secretary, that further 
                  improve payment accuracy.''.
  
      (b) Effective Date.--
          (1) In general.--The amendments made by subsection (a) shall 
      apply to contracts entered into or renewed on or after the date 
      that is 3 years after the date of enactment of this Act.
          (2) Application to existing contracts.--In the case of 
      contracts in existence on or after the date of the enactment of 
      this Act and that are not subject to the effective date under 
      paragraph (1), the Secretary of Health and Human Services shall, 
      when appropriate and practicable, seek to apply the incentives 
      provided for in the amendments made by subsection (a) through 
      contract modifications.
  SEC. 8. STRENGTHENING PENALTIES FOR THE ILLEGAL DISTRIBUTION OF A 
  MEDICARE, MEDICAID, OR CHIP BENEFICIARY IDENTIFICATION OR BILLING 
  PRIVILEGES.
      Section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)) 
  is amended by adding at the end the following:
          ``(4) Whoever without lawful authority knowingly and willfully 
      purchases, sells or distributes, or arranges for the purchase, 
      sale, or distribution of a beneficiary identification number or 
      unique health identifier for a health care provider under title 
      XVIII, title XIX, or title XXI shall be imprisoned for not more 
      than 10 years or fined not more than $500,000 ($1,000,000 in the 
      case of a corporation), or both.''.
  SEC. 9. IMPROVING THE SHARING OF DATA BETWEEN THE FEDERAL GOVERNMENT 
  AND STATE MEDICAID PROGRAMS.
      (a) In General.--The Secretary of Health and Human Services (in 
  this section referred to as the ``Secretary'') shall establish a plan 
  to encourage and facilitate the participation of States in the 
  Medicare-Medicaid Data Match Program (commonly referred to as the 
  ``Medi-Medi Program'') under section 1893(g) of the Social Security Act 
  (42 U.S.C. 1395ddd(g)).
      (b) Program Revisions To Improve Medi-Medi Data Match Program 
  Participation by States.--Section 1893(g)(1)(A) of the Social Security 
  Act (42 U.S.C. 1395ddd(g)(1)(A)) is amended--
          (1) in the matter preceding clause (i), by inserting ``or 
      otherwise'' after ``eligible entities'';
          (2) in clause (i)--
              (A) by inserting ``to review claims data'' after 
          ``algorithms''; and
              (B) by striking ``service, time, or patient'' and inserting 
          ``provider, service, time, or patient'';
          (3) in clause (ii)--
              (A) by inserting ``to investigate and recover amounts with 
          respect to suspect claims'' after ``appropriate actions''; and
              (B) by striking ``; and'' and inserting a semicolon;
          (4) in clause (iii), by striking the period and inserting`` ; 
      and''; and
          (5) by adding at the end the following new clause:
                  ``(iv) furthering the Secretary's design, development, 
              installation, or enhancement of an automated data system 
              architecture--
  
                      ``(I) to collect, integrate, and assess data for 
                  purposes of program integrity, program oversight, and 
                  administration, including the Medi-Medi Program; and
                      ``(II) that improves the coordination of requests 
                  for data from States.''.
  
      (c) Providing States With Data on Improper Payments Made for Items 
  or Services Provided to Dual Eligible Individuals.--
          (1) In general.--The Secretary shall develop and implement a 
      plan that allows each State agency responsible for administering a 
      State plan for medical assistance under title XIX of the Social 
      Security Act access to relevant data on improper or fraudulent 
      payments made under the Medicare program under title XVIII of the 
      Social Security Act (42 U.S.C. 1395 et seq.) for health care items 
      or services provided to dual eligible individuals.
          (2) Dual eligible individual defined.--In this section, the 
      term ``dual eligible individual'' means an individual who is 
      entitled to, or enrolled for, benefits under part A of title XVIII 
      of the Social Security Act (42 U.S.C. 1395c et seq.), or enrolled 
      for benefits under part B of title XVIII of such Act (42 U.S.C. 
      1395j et seq.), and is eligible for medical assistance under a 
      State plan under title XIX of such Act (42 U.S.C. 1396 et seq.) or 
      under a waiver of such plan.
  
                                 Speaker of the House of Representatives.
  
                              Vice President of the United States and    
                                                 President of the Senate.
target: .   Patient Access and Medicare Protection Act (Sec. 2) This bill temporarily exempts from certain Medicare payment adjustments wheelchair accessories and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs. (Group 3 power wheelchairs are those that meet the highest performance requirements with regard to speed, range, and climbing capability.) The Government Accountability Office must study wheelchair accessories and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs. (Sec. 3) The bill amends title XVIII (Medicare) of the Social Security Act (SSAct) to prohibit specified adjustments to the Medicare fee schedule for certain radiation therapy services in 2017 or 2018. Under current law, the Centers for Medicare &amp; Medicaid Services (CMS) must periodically identify, review, and make adjustments to potentially misvalued services under Medicare. The bill specifies that certain radiation therapy services shall not be considered as potentially misvalued services for these purposes in 2017 or 2018. (Sec. 4) For 2017, CMS may exempt categories of eligible professionals from requirements for meaningful use of electronic health records (EHR) technology. Under current law, CMS may, on a case-by-case basis, exempt an eligible professional from certain negative payment adjustments that would otherwise apply due to the professional's failure to comply with those requirements. (Sec. 5) The bill eliminates funding for the Medicare Improvement Fund. (The fund was established to make improvements under the original Medicare fee-for-service program.) (Sec. 6) The bill amends title XIX (Medicaid) of the SSAct to make changes related to the Medicaid Integrity Program (MIP). The bill: (1) specifies that program appropriations&nbsp;may cover the costs of equipment, travel, training, and salaries and benefits; and (2) allows CMS 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.) (Sec. 7) Under current law, CMS may contract with Medicare administrative contractors (MACs), which are&nbsp;private&nbsp;insurers that process Medicare claims within&nbsp;specified geographic jurisdictions. The bill&nbsp;requires CMS to provide specified incentives for MACs to reduce improper payment error rates within their jurisdictions. (Sec. 8) The bill establishes criminal penalties of up to 10 years imprisonment and up to $500,000 ($1,000,000 for corporations) in fines for illegally purchasing or distributing Medicare, Medicaid, or Children's Health Insurance Program (CHIP) beneficiary identification or billing privileges. (Sec. 9) The bill increases the scope of the Medicare-Medicaid Data Match Program (Medi-Medi Program), an existing program through which contractors and participating&nbsp;governmental agencies collaboratively analyze&nbsp;Medicare and Medicaid billing trends. CMS must establish a plan to encourage states to participate in the Medi-Medi Program.  CMS shall 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.
feat_title: Patient Access and Medicare Protection Act