Medicaid Physician Self-Referral Act of 2014 - Amends title XIX (Medicaid) of the Social Security Act (SSA) with respect to physician self-referral limitations to repeal the prohibition against payment of federal funds to a state for medical assistance expenditures for a designated health service furnished to an individual on the basis of a referral (self-referral) that would result in denial of payment under SSA title XVIII (Medicare).
Requires a state plan for medical assistance to prohibit payment for a Medicaid designated health service furnished to an individual on the basis of a physician's referral if the physician (or an immediate family member) has an ownership or investment interest or a compensation arrangement with the entity furnishing the service that would not comply with Medicare requirements.
Requires application of certain reporting requirements and sanctions to a provider of a Medicaid designated health service the same way they apply under Medicare.
Amends SSA title XVIII to: (1) apply the False Claims Act to violations of the self-referral prohibition, and (2) declare the authority of the Secretary of Health and Human Services (HHS) to issue regulations under Medicaid limited to the application of self-referral limitations to state plan requirements.
Directs the Secretary to establish a protocol consistent with the Medicare self-referral disclosure protocol required under the Patient Protection and Affordable Care Act that enables health care providers to disclose an actual or potential violation of Medicare self-referral limitations as applied to Medicaid.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4676 Introduced in House (IH)]
113th CONGRESS
2d Session
H. R. 4676
To amend titles XVIII and XIX of the Social Security Act to apply the
Medicare restriction on self-referral to State plan requirements under
Medicaid, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 19, 2014
Mr. McDermott introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committee on
Ways and Means, 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
_______________________________________________________________________
A BILL
To amend titles XVIII and XIX of the Social Security Act to apply the
Medicare restriction on self-referral to State plan requirements under
Medicaid, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicaid Physician Self-Referral Act
of 2014''.
SEC. 2. ADJUSTMENTS TO RESTRICTION ON SELF-REFERRAL UNDER MEDICAID.
(a) Repeal of Restriction on Receipt of Federal Funds in the Case
of Self-Referral.--Subsection (s) of section 1903 of the Social
Security Act (42 U.S.C. 1396b(s)) is repealed.
(b) Requirement of Restriction on Self-Referral in State Plan
Requirements.--Section 1902 of such Act (42 U.S.C. 1396a) is amended--
(1) in subsection (a)--
(A) in paragraph (80) by striking ``and'' at the
end;
(B) in paragraph (81) by striking the period at the
end and inserting ``; and'';
(C) by inserting after paragraph (81) the
following:
``(82) provide that no payment may be made under the State
plan for a Medicaid designated health service furnished to an
individual on the basis of a referral by a physician if the
physician (or an immediate family member of the physician) has
an ownership or investment interest or a compensation
arrangement (as defined in section 1877) with the entity
furnishing the Medicaid designated health service that would
not comply with section 1877 if the referral were for an item
or service otherwise payable under title XVIII.''; and
(D) by inserting after the matter immediately
following paragraph (82) the following:
``For purposes of paragraph (82), subsections (f) and (g) of section
1877 shall apply to a provider of a Medicaid designated health service
in a similar manner as such subsections apply to a provider of an item
or service for which payment may be made under title XVIII.''; and
(2) by adding at the end the following new subsection:
``(ll) Definition of Medicaid Designated Health Service.--For
purposes of subsection (a) the term `Medicaid designated health
service' means an item or service listed in subsection (h)(6) of
section 1877 as covered by a State plan and any other service a State
may choose to add for purposes of subsection (a)(82).''.
(c) Application of False Claims Act to Violations of Self-
Referral.--Section 1877(g) of such Act (42 U.S.C. 1395nn(g)) is amended
by adding at the end the following:
``(7) False claims act.--A claim that includes an item or
service resulting from a violation of this section constitutes
a false or fraudulent claim for purposes of sections 3729-3733
of title 31, United States Code.''.
(d) Exceptions for Violations of Self-Referral Limited to
Medicaid.--Section 1877(h) of such Act (42 U.S.C. 1395nn(h)) is amended
by adding at the end the following:
``(8) Medicaid self-referral limitations.--Any authority of
the Secretary to issue regulations under this section shall
include the authority to issue regulations limited to the
application of self-referral limitations to State plan
requirements, as described under section 1902(a)(82) of this
Act (42 U.S.C. 1396a(a)(82)).''.
(e) Medicaid Self-Referral Disclosure Protocol.--The Secretary of
Health and Human Services shall establish a protocol consistent with
the requirements of the Medicare self-referral disclosure protocol
required under section 6409 of the Patient Protection and Affordable
Care Act (42 U.S.C. 1395nn note) that enables health care providers to
disclose an actual or potential violation of section 1877 of the Social
Security Act (42 U.S.C. 1395nn) as applied to title XIX of such Act,
pursuant to section 1902(a)(82) of such Act (42 U.S.C. 1396a(a)(82)).
SEC. 3. EFFECTIVE DATE.
(1) In general.--Subject to paragraph (2), the amendments
made by this Act shall apply to items and services furnished
after the first day of the first calendar year that begins
after date of enactment of this Act.
(2) Exception for state legislation.--In the case of a
State plan under title XIX of the Social Security Act that the
Secretary of Health and Human Services determines requires
State legislation in order for the respective plan to meet any
requirement imposed by amendments made by this Act, the
respective plan shall not be regarded as failing to comply with
the requirements of such title solely on the basis of its
failure to meet such an additional requirement before the first
day of the first calendar quarter beginning after the close of
the first regular session of the State legislature that begins
after the date of enactment of this Act. For purposes of the
previous sentence, in the case of a State that has a 2-year
legislative session, each year of the session shall be
considered to be a separate regular session of the State
legislature.
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Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR E761)
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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.
Referred to the Subcommittee on Health.
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