Medicare and Medicaid Patient and Program Protection Act of 1986

Summary

Medicare and Medicaid Patient and Program Protection Act of 1985 - Amends part A (General Provisions) of title XI of the Social Security Act to direct the Secretary of Health and Human Services to exclude from participation in programs under title XVIII (Medicare) of the Social Security Act any individual or entity: (1) convicted of a criminal offense related to the delivery of an item or service under title XVIII or under titles XIX (Medicaid), V (Maternal and Child Health Block Grant), or XX (Block Grants to states for Social Services) of such Act; or (2) convicted of a criminal offense related to neglect or abuse of patients in connection with the delivery of a health care item or service. Authorizes the Secretary to exclude from Medicare participation any individual or entity: (1) convicted of fraud with respect to any Federal, State, or locally financed health care program; (2) convicted of interferring with the investigation of health care fraud; (3) convicted of manufacturing, distributing, or dispensing a controlled substance; (4) whose health care license has been suspended or revoked; (5) suspended or excluded from participation in a Federal health care program; (6) claiming excessive charges or providing unnecessary services; (7) committing certain acts prohibited under title XI; (8) owned or controlled by an individual convicted of health care related crimes, fined for health care abuses, or excluded from Medicare or a State health care program; and (9) failing to supply certain information. Authorizes the Secretary to exclude any hospital failing to comply with corrective action required under title XVIII. Sets forth provisions relating to notice requirements, judicial review, and period of exclusion. Directs the Secretary to promptly notify each appropriate State agency administering or supervising the administration of a State health care program of each exclusion and the period of exclusion. Permits an excluded individual or entity to apply, following a period exclusion, to the Secretary for reinstatement. Sets forth provisions providing for civil and criminal penalties for acts involving Medicare or State health care programs abuse, including penalties for physician misrepresentations. Requires a State, as a condition of Medicaid plan approval, to provide for the following: (1) a system of reporting any type of adverse action concluded against any health care practitioner or entity by the State or a local licensing authority; and (2) such access to documents as may be necessary by the Secretary. Requires the Secretary to provide suitable safeguards for the confidentiality of such information. Requires any health care provider providing health care services for which payment may be made under the Act to assure that services or items furnished: (1) will be provided economically and only when, and to the extent, medically necessary; (2) will be quality services which meet professionally recognized standards of health care; and (3) will be supported by evidence of medical necessity and quality in such form and fashion and at such time as may reasonably be required by a reviewing peer review organization in the exercise of its duties and responsibilities. Permits a State to exclude from Medicaid participation any individual or entity excluded under Medicare pursuant to the patient and program protection provisions. Requires a State in order to receive Federal payments with respect to a health maintenance organization (HMO) to exclude any HMO that: (1) could be excluded because of the conviction of the owners or managers of certain crimes; or (2) contracts with any individual or entity convicted of such crimes. Prohibits Federal payments with respect to any amount expended for items or services furnished with respect to any individual or entity excluded from Medicaid participation because of the patient and program protection provisions. Prohibits a State under title V from making payments to any individual or entity excluded from participation pursuant to the patient and program protection provisions. Prohibits Federal payments with respect to any amount expended for items or services furnished with respect to any individual or entity excluded from Medicare because of the patient and program protection provisions of part A of title XI. Prohibits using a grant under title XX for payment for any item or service furnished by a person excluded from title XX participation because of the patient and program protection provisions of title XI. Revises disclosure requirements under part A of title XI. Revises Medicare provisions concerning agreements with providers. Modifies the Medicaid moratorium provisions of the Deficit Reduction Act of 1984 to consider a State's Medicaid plan to include any plan change submitted to the Secretary either before or after the enactment of that Act and whether or not approved or disapproved by the Secretary. Sets forth effective date provisions.

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

Timeline

1. 2 April 1985

   Introduced

   Referred to House Committee on Energy and Commerce.

   Source: IntroReferral

2. 2 April 1985

   Introduced

   Introduced in House

   Source: IntroReferral

3. 2 April 1985

   Introduced

   Introduced in House

   Source: IntroReferral

4. 3 April 1985

   Referred

   Referred to Subcommittee on Health.

   Source: Committee

5. 4 April 1985

   Committee

   Forwarded by Subcommittee to Full Committee.

   Source: Committee

6. 4 April 1985

   Committee

   Subcommittee Consideration and Mark-up Session Held.

   Source: Committee

7. 4 April 1985

   Referred

   Referred to Subcommittee on Health and the Environment.

   Source: Committee

8. 23 April 1985

   Committee

   Forwarded by Subcommittee to Full Committee.

   Source: Committee

9. 23 April 1985

   Committee

   Subcommittee Consideration and Mark-up Session Held.

   Source: Committee

10. 2 May 1985

    Reported

    Ordered to be Reported (Amended).

    Source: Committee

11. 2 May 1985

    Committee

    Committee Consideration and Mark-up Session Held.

    Source: Committee

12. 9 May 1985

    Reported

    Ordered to be Reported (Amended).

    Source: Committee

13. 9 May 1985

    Committee

    Committee Consideration and Mark-up Session Held.

    Source: Committee

14. 10 May 1985

    Reported

    Reported to House (Amended) by House Committee on Ways and Means. Report No: 99-80 (Part I).

    Source: Committee

15. 10 May 1985

    Reported

    Reported to House (Amended) by House Committee on Ways and Means. Report No: 99-80 (Part I).

    Source: Committee

16. 23 May 1985

    Reported

    Reported to House (Amended) by House Committee on Energy and Commerce. Report No: 99-80 (Part II).

    Source: Committee

17. 23 May 1985

    Calendars

    Placed on Union Calendar No: 92.

    Source: Calendars

18. 23 May 1985

    Reported

    Reported to House (Amended) by House Committee on Energy and Commerce. Report No: 99-80 (Part II).

    Source: Committee

19. 4 June 1985

    Passed

    Passed House (Amended) by Voice Vote.

    Source: Floor

20. 4 June 1985

    Passed

    Passed/agreed to in House: Passed House (Amended) by Voice Vote.

    Source: Floor

21. 4 June 1985

    Floor

    Called up by House Under Suspension of Rules.

    Source: Floor

22. 6 June 1985

    Introduced

    Received in the Senate and read twice and referred to the Committee on Finance.

    Source: IntroReferral

23. 10 June 1985

    Committee

    Committee on Finance requested executive comment from OMB, Treasury Department, Health and Human Services Department.

    Source: Committee

24. 12 July 1985

    Committee

    Subcommittee on Health (Finance). Hearings held.

    Source: Committee

25. 10 September 1986

    Reported

    Committee on Finance. Ordered to be reported without amendment favorably.

    Source: Committee

26. 2 October 1986

    Calendars

    Placed on Senate Legislative Calendar under General Orders. Calendar No. 1066.

    Source: Calendars

27. 2 October 1986

    Reported

    Committee on Finance. Reported to Senate by Senator Packwood with an amendment in the nature of a substitute and an amendment to the title. With written report No. 99-520.

    Source: Committee

28. 2 October 1986

    Reported

    Committee on Finance. Reported to Senate by Senator Packwood with an amendment in the nature of a substitute and an amendment to the title. With written report No. 99-520.

    Source: Committee

Votes

No vote records are attached yet.

Versions

No version snapshots stored. Document URLs remain at the source.

Documents

5 official files

• Reported to Senate with amendment(s)

  summary · EN · 2 October 1986

  Open at official source

• Passed House amended

  summary · EN · 4 June 1985

  Open at official source

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  Vertaal document

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• Reported to House amended, Part II

  summary · EN · 23 May 1985

  Open at official source

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  Vertaal document

  Documentvertaling op verzoek met downloadbare PDF (logo + link naar de officiële bron). Het bronbestand blijft leidend.

• Reported to House amended, Part I

  summary · EN · 10 May 1985

  Open at official source

  Leesvertaling

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  Vertaal naarNL · DutchDE · GermanFR · FrenchES · SpanishIT · ItalianPL · PolishPT · PortugueseSV · SwedishDA · DanishFI · FinnishEL · GreekCS · CzechHU · HungarianRO · RomanianBG · BulgarianHR · CroatianSK · SlovakSL · SlovenianLT · LithuanianLV · LatvianET · EstonianGA · IrishMT · Maltese

  Vertaal document

  Documentvertaling op verzoek met downloadbare PDF (logo + link naar de officiële bron). Het bronbestand blijft leidend.

• Introduced in House

  summary · EN · 2 April 1985

  Open at official source

  Leesvertaling

  Vertaal dit document naar jouw taal. PoliticalRepo bewaart geen aparte kopie per EU-taal.

  Vertaal naarNL · DutchDE · GermanFR · FrenchES · SpanishIT · ItalianPL · PolishPT · PortugueseSV · SwedishDA · DanishFI · FinnishEL · GreekCS · CzechHU · HungarianRO · RomanianBG · BulgarianHR · CroatianSK · SlovakSL · SlovenianLT · LithuanianLV · LatvianET · EstonianGA · IrishMT · Maltese

  Vertaal document

  Documentvertaling op verzoek met downloadbare PDF (logo + link naar de officiële bron). Het bronbestand blijft leidend.

Sponsors

• Rep. Moore, W. Henson [R-LA-6] · R · Sponsor
• Rep. Waxman, Henry A. [D-CA-33] · D · Sponsor
• Rep. Stark, Fortney Pete [D-CA-13] · D · Sponsor
• Rep. Gradison, Willis D., Jr. [R-OH-2] · R · Sponsor
• Rep. Rangel, Charles B. [D-NY-15] · D · Sponsor
• Rep. Pepper, Claude [D-FL-18] · D · Sponsor
• Rep. Gephardt, Richard A. [D-MO-3] · D · Sponsor
• Sen. Wyden, Ron [D-OR] · D · Sponsor
• Rep. Madigan, Edward R. [R-IL-15] · R · Sponsor
• Rep. McGrath, Raymond J. [R-NY-5] · R · Sponsor
• Rep. Daub, Hal [R-NE-2] · R · Sponsor
• Rep. Downey, Thomas J. [D-NY-2] · D · Sponsor
• Rep. Kaptur, Marcy [D-OH-9] · D · Sponsor
• Rep. Sabo, Martin Olav [D-MN-5] · D · Sponsor
• Rep. Conyers, John, Jr. [D-MI-13] · D · Sponsor
• Rep. Bilirakis, Michael [R-FL-9] · R · Sponsor
• Rep. Mrazek, Robert J. [D-NY-3] · D · Sponsor
• Rep. Miller, George [D-CA-11] · D · Sponsor
• Rep. Penny, Timothy J. [D-MN-1] · D · Cosponsor
• Rep. Beilenson, Anthony C. [D-CA-24] · D · Cosponsor
• Rep. Smith, Lawrence [D-FL-16] · D · Cosponsor
• Rep. Hyde, Henry J. [R-IL-6] · R · Cosponsor
• Rep. Bedell, Berkley W. [D-IA-6] · D · Cosponsor
• Rep. Johnson, Nancy L. [R-CT-5] · R · Cosponsor
• Rep. Hughes, William J. [D-NJ-2] · D · Cosponsor
• Rep. Garcia, Robert [D-NY-18] · D · Cosponsor
• Rep. Vento, Bruce F. [D-MN-4] · D · Cosponsor
• Rep. Green, S. William [R-NY-15] · R · Cosponsor
• Rep. Glickman, Dan [D-KS-4] · D · Cosponsor
• Rep. Bonior, David E. [D-MI-10] · D · Cosponsor
• Rep. Collins, Cardiss [D-IL-7] · D · Cosponsor
• Rep. Berman, Howard L. [D-CA-28] · D · Cosponsor
• Rep. Fazio, Vic [D-CA-3] · D · Cosponsor
• Rep. Rose, Charlie [D-NC-7] · D · Cosponsor
• Rep. Spratt, John M., Jr. [D-SC-5] · D · Cosponsor
• Rep. Scheuer, James H. [D-NY-8] · D · Cosponsor
• Rep. Pickle, J. J. [D-TX-10] · D · Cosponsor
• Rep. Boehlert, Sherwood [R-NY-24] · R · Cosponsor
• Rep. Solarz, Stephen J. [D-NY-13] · D · Cosponsor
• Rep. Levine, Mel [D-CA-27] · D · Cosponsor
• Rep. Panetta, Leon [D-CA-16] · D · Cosponsor
• Rep. Biaggi, Mario [D-NY-19] · D · Cosponsor
• Rep. Wortley, George C. [R-NY-27] · R · Cosponsor
• Rep. Lehman, William [D-FL-17] · D · Cosponsor
• Rep. Kolter, Joseph P. [D-PA-4] · D · Cosponsor
• Rep. Bentley, Helen Delich [R-MD-2] · R · Cosponsor
• Rep. Dannemeyer, William E. [R-CA-39] · R · Cosponsor
• Rep. Miller, John R. [R-WA-1] · R · Cosponsor

Showing 48 of 65 sponsors and actors.

Related records

• related to → A bill to amend titles XI, XVIII, and XIX of the Social Security Act to provide for civil monetary and criminal penalties for an individual who has made a material misrepresentation in order to be licensed as a physician and for whose services payments are made under the medicare or medicaid programs.
• related to → A bill to amend the Controlled Substances Act and title XI of the Social Security Act to deny, revoke, or suspend the registration to manufacture, distribute or dispense a controlled substance for entities excluded from the medicare program.