Protecting the Integrity of Medicare Act of 2015

referredUnited States· United States Congress· EN

Introduced

24 February 2015

Last action

19 March 2015 · Referred

Status

Referred to the Subcommittee on Health.

Summary

Protecting the Integrity of Medicare Act of 2015 Amends title II (Old Age, Survivors and Disability Insurance) of the Social Security Act (SSAct) to direct the Secretary of Health and Human Services to establish cost-effective procedures to ensure that: (1) a Social Security account number (or any derivative) is not displayed, coded, or embedded on the Medicare card issued to an individual entitled to benefits under part A (Hospital Insurance) of SSAct title XVIII (Medicare) or enrolled under Medicare part B (Supplementary Medical Insurance); and (2) any other identifier displayed on such card is not identifiable as a Social Security account number (or any derivative). Directs the Secretary to establish procedures to ensure that Medicare payment is not made for items and services furnished to an individual incarcerated, deceased, or otherwise ineligible and not lawfully present in the United States. Directs the Secretary, if cost-effective and technologically viable, to consider appropriate measures to implement use of electronic Medicare beneficiary and provider cards. Extends the Medicare durable medical equipment face-to-face encounter documentation requirement to include physician assistants, practitioners, or specialists as well as physicians (as under current law). Requires each Medicare administrative contractor to establish an improper payment outreach and education program for service providers and suppliers in order to reduce improper Medicare payments. Requires the Secretary to develop a plan to revise the incentive program under the Health Insurance Portability and Accountability Act of 1996 to encourage greater participation by individuals to report fraud and abuse in the Medicare program. Directs the Secretary to require a claim for a covered Medicare part D (Voluntary Prescription Drug Benefit Program) drug for an individual enrolled in a prescription drug plan or in a Medicare Advantage Prescription Drug plan (PDP) to include a valid prescriber National Provider Identifier. Gives Medicare beneficiaries the option to receive the Medicare Summary Notice (explanation of benefits) electronically. Directs the Secretary to: (1) apply competitive procedures to selection of a Medicare administrative contractor at least once every 10 years (currently once every 5 years); and (3) study and, as appropriate, specify incentives for states to work with the Secretary under the Medicare-Medicaid Data Match Program to protect the federal and state share of expenditures. Authorizes a PDP sponsor to establish a drug management program for at-risk beneficiaries. Directs the Secretary to authorize Medicare drug integrity contractors (MEDICs) to accept directly an individual's prescription and necessary medical records from pharmacies, prescription drug plans, and physicians in order for MEDICs to provide information relevant to determining whether the individual is an at-risk beneficiary. Directs the Secretary to issue a clarification or modification with respect to the application of the Common Rule (governing the protection of human subjects in research) to activities involving clinical data registries. Amends SSA title XI to eliminate civil monetary penalties for inducements to physicians to limit services that are not medically necessary. Directs the Secretary to report to Congress on options for amending existing Medicare fraud and abuse laws and regulations to permit gainsharing or similar arrangements between physicians and hospitals that would otherwise be subject to penalties. Modifies the Medicare home health surety bond condition of participation requirement. Directs the Secretary to: (1) implement a process for medical review of spinal subluxation services by a chiropractor, and (2) develop educational and training programs to improve the ability of chiropractors to document services in a manner that demonstrates they are reasonable and necessary. Requires the Secretary to: (1) revise the testing in New Jersey, Pennsylvania, and South Carolina of a model of prior authorization for repetitive scheduled non-emergent ambulance transport to cover specified additional states; and (2) apply the prior authorization program to all states under certain conditions. Directs the Secretary to submit a plan to Congress for including in the annual report of the Comprehensive Error Rate Testing programs data on services (other than medical visits) paid under the physician fee schedule where the fee schedule amount exceeds $250 and where the error rate exceeds 20%. Removes funds for the Medicare Improvement Fund that were added by the Impact Act of 2014.

This text is taken from the official record. PoliticalRepo does not editorialize.

Timeline

24 February 2015
Introduced
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Source: IntroReferral
24 February 2015
Introduced
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Source: IntroReferral
24 February 2015
Introduced
Introduced in House
Source: IntroReferral
24 February 2015
Introduced
Introduced in House
Source: IntroReferral
26 February 2015
Reported
Ordered to be Reported (Amended) by Voice Vote.
Source: Committee
26 February 2015
Committee
Committee Consideration and Mark-up Session Held.
Source: Committee
27 February 2015
Referred
Referred to the Subcommittee on Health.
Source: Committee
18 March 2015
Calendars
Placed on the Union Calendar, Calendar No. 29.
Source: Calendars
18 March 2015
Discharge
Committee on Energy and Commerce discharged.
Source: Discharge
18 March 2015
Committee
Committee on Energy and Commerce discharged.
Source: Committee
18 March 2015
Reported
Reported (Amended) by the Committee on Ways and Means. H. Rept. 114-46, Part I.
Source: Committee
18 March 2015
Reported
Reported (Amended) by the Committee on Ways and Means. H. Rept. 114-46, Part I.
Source: Committee
19 March 2015
Referred
Referred to the Subcommittee on Health.
Source: Committee

Votes

No vote records are attached yet.

Versions

Reported in House · 18 March 2015 · Download file
Introduced in House · 24 February 2015 · Download file

Documents

6 official files

Reported in House (text)

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Reported in House (text)
Reported in House · EN · 18 March 2015
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Reported in House (PDF)
Reported in House · EN · 18 March 2015
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Reported to House amended, Part I
summary · EN · 18 March 2015
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Introduced in House (text)
Introduced in House · EN · 24 February 2015
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Introduced in House (PDF)
Introduced in House · EN · 24 February 2015
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Introduced in House
summary · EN · 24 February 2015
Open at official source
Leesvertaling
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Related records

related to → Better Efficiency and Administrative Simplification Act of 2015
related to → Medicare Identity Theft Prevention Act of 2015
related to → Medicare Access and CHIP Reauthorization Act of 2015
related to → Medicare Employer Relief Act of 2015
related to ← Better Efficiency and Administrative Simplification Act of 2015
related to ← Medicare Patient Safety and Drug Abuse Prevention Act
related to ← Stopping Medication Abuse and Protecting Seniors Act of 2015
related to ← To amend title II of the Social Security Act to prohibit inclusion of Social Security account numbers on Medicare cards, and for other purposes.

Sources

PoliticalRepo is an index and interpretation layer, not the authoritative legal source.

Official source: https://www.congress.gov/bill/114th-congress/house-bill/1021
Open data entity: https://api.congress.gov/v3/bill/114/hr/1021
us · 114-hr-1021 · source updated 7 April 2025