Medicaid Physician Self-Referral Act of 2015

Medicaid Physician Self-Referral Act of 2015

Amends title XIX (Medicaid) of the Social Security Act (SSAct) 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 SSAct 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 SSAct 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 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 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1083 Introduced in House (IH)]

114th CONGRESS
  1st Session
                                H. R. 1083

 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

                           February 25, 2015

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 2015''.

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) 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 the date of the 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 the 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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