Patient Access to Durable Medical Equipment Act of 2016 or the PADME Act
(Sec. 2) This bill amends titles XIX (Medicaid) and XXI (Children's Health Insurance Program [CHIP]) of the Social Security Act to prohibit federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated.
Under current law, a state must exclude from Medicaid participation any provider that has been terminated under any state's Medicaid program or under Medicare. The bill maintains those requirements and further requires a state to exclude from Medicaid participation any provider that has been terminated under CHIP. Furthermore, a state must exclude from CHIP participation any provider that has been terminated under Medicaid or Medicare.
The bill also revises a state's reporting requirements with respect to terminating a provider under a state plan. A state shall require each Medicaid or CHIP provider, whether the provider participates on a fee-for-service (FFS) basis or within the network of a managed care organization (MCO), to enroll with the state by providing specified identifying information. When notifying the Department of Health and Human Services (HHS) that a provider has been terminated under a state plan, the state must submit this information as well as information regarding the termination date and reason. HHS shall review such termination notifications and, if appropriate, include them in a database or similar system, as specified by the bill.
The bill prohibits federal payment under a state's Medicaid or CHIP program for services provided by an MCO unless: (1) the state has a system for notifying MCOs when a provider is terminated under Medicaid, Medicare, or CHIP; and (2) any contract between the state plan and an MCO provides that such providers be excluded from participation in the MCO provider network.
HHS shall report to Congress on this bill's implementation.
(Sec. 3) A state must publish and annually update a public directory of FFS providers participating under the state plan.
(Sec. 4) HHS shall: (1) delay by three months the full implementation of new Medicare payment rates for durable medical equipment (DME), and (2) study and report on the impact of applicable payment adjustments on the availability of DME to Medicare beneficiaries.
(Sec. 5) For purposes of eligibility determinations for federal public benefits, the bill excludes payments made under a state eugenics compensation program from classification as income or resources. A "state eugenics compensation program" is a state program intended to compensate individuals who were sterilized under the state's authority.
(Sec. 6) The bill makes available $3 million to the Medicare Improvement Fund for services furnished during and after FY2020.
[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5210 Introduced in House (IH)]
<DOC>
114th CONGRESS
2d Session
H. R. 5210
To improve access to durable medical equipment for Medicare
beneficiaries under the Medicare program, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 12, 2016
Mr. Tom Price of Georgia (for himself, Mr. Loebsack, Mrs. McMorris
Rodgers, Mr. Welch, Mr. Collins of New York, Mr. Cramer, Mr. Flores,
Mr. Harper, Mr. Luetkemeyer, Mr. Roe of Tennessee, Mr. Thompson of
Pennsylvania, Mr. Tipton, Ms. Duckworth, Mr. Duncan of Tennessee, Mr.
Joyce, Mr. Zinke, Mr. Kelly of Pennsylvania, Mr. Blum, Mrs. Ellmers of
North Carolina, Mr. Gohmert, Mr. Long, Mr. Harris, Mr. Renacci, Mr.
Tiberi, Mr. Peterson, Mr. Murphy of Pennsylvania, Mrs. Noem, Mr. Gibbs,
Mr. Austin Scott of Georgia, Mr. Guthrie, Mr. DesJarlais, Ms. Jenkins
of Kansas, Mr. David Scott of Georgia, Mrs. Black, Mrs. Blackburn, Mr.
Smith of Missouri, Mr. Mullin, Mr. Pompeo, Mr. Byrne, Mrs. Wagner, and
Mr. Boustany) 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 improve access to durable medical equipment for Medicare
beneficiaries under the Medicare program, 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 ``Patient Access to Durable Medical
Equipment Act of 2016'' or the ``PADME Act''.
SEC. 2. EXTENSION OF THE TRANSITION TO NEW PAYMENT RATES FOR DURABLE
MEDICAL EQUIPMENT UNDER THE MEDICARE PROGRAM.
The Secretary of Health and Human Services shall extend the
transition period described in clause (i) of section 414.210(g)(9) of
title 42, Code of Federal Regulations, from June 30, 2016, to September
30, 2017 (with the full implementation described in clause (ii) of such
section applying to items and services furnished with dates of service
on or after October 1, 2017).
SEC. 3. BID CEILING FOR COMPETITIVE ACQUISITION FOR DURABLE MEDICAL
EQUIPMENT UNDER THE MEDICARE PROGRAM.
Section 1847(b)(5) of the Social Security Act (42 U.S.C. 1395w-
3(b)(5)) is amended--
(1) in subparagraph (A)--
(A) by inserting ``, subject to subparagraph (E),''
after ``subsection (a)(2)''; and
(B) by inserting ``, subject to subparagraph (E),''
after ``Based on such bids''; and
(2) by adding at the end the following new subparagraph:
``(E) Bid ceiling for durable medical equipment.--
``(i) In general.--The ceiling for a bid
submitted for applicable covered items may not
be less than the fee schedule amount that would
otherwise be determined for such items under
section 1834(a), section 1834(h), or section
1842(s)(1) on January 1, 2015, updated by the
covered item update for such items under
section 1834(a)(14)(L), section 1834(h), or
section 1842(s)(1), respectively, as
appropriate for the year with respect to which
the bid ceiling is established for such
applicable covered item.
``(ii) Application to new covered items.--
The Secretary shall establish a process for
purposes of applying clause (i) with respect to
applicable covered items for which no fee
schedule amount would otherwise be paid under
section 1834(a), section 1834(h), or section
1842(s), as appropriate, on January 1, 2015.
``(iii) Applicable covered items defined.--
For purposes of this subparagraph, the term
`applicable covered items' means competitively
priced items and services described in
subsection (a)(2) that are furnished with
respect to rounds of competition that begin on
or after January 1, 2017.''.
SEC. 4. REQUIREMENTS IN DETERMINING ADJUSTMENTS USING INFORMATION FROM
COMPETITIVE BIDDING PROGRAMS.
Section 1834(a)(1)(G) of the Social Security Act (42 U.S.C.
1395m(a)(1)(G)) is amended by adding at the end the following new
sentence: ``In the case of items and services furnished on or after
January 1, 2019, in making any adjustments under clause (ii) or (iii)
of subparagraph (F), the Secretary shall--
``(i) solicit and take into account
stakeholder input; and
``(ii) take into account the highest amount
bid by a winning supplier in a competitive
acquisition area and a comparison of each of
the following with respect non-competitive
acquisition areas and competitive acquisition
areas:
``(I) The average travel distance
and cost associated with furnishing
items and services in the area.
``(II) Any barriers to access for
items and services in the area.
``(III) The average delivery time
in furnishing items and services in the
area.
``(IV) The average volume of items
and services furnished by suppliers in
the area.
``(V) The number of suppliers in
the area.''.
SEC. 5. MONTHLY REPORT ON THE RESULTS OF THE MONITORING OF ACCESS OF
MEDICARE BENEFICIARIES TO DURABLE MEDICAL EQUIPMENT AND
OF HEALTH OUTCOMES.
Not later than the first of each month (beginning with May 1, 2016,
and ending with September 1, 2017), the Secretary of Health and Human
Services shall publish on the Internet website of the Centers for
Medicare & Medicaid Services the results of the monitoring of access of
Medicare beneficiaries to durable medical equipment and of health
outcomes, as described on page 66228 in the final rule published by the
Center for Medicare & Medicaid Services on November 6, 2014, and
entitled ``Medicare Program; End-Stage Renal Disease Prospective
Payment System, Quality Incentive Program, and Durable Medical
Equipment, Prosthetics, Orthotics, and Supplies'' (79 Fed. Reg. 66120-
66265).
SEC. 6. REQUIRING REDUCTION IN FEDERAL EXPENDITURES TO FULLY OFFSET
INCREASED EXPENDITURES FROM THIS ACT.
It is the sense of Congress that this Act should not be enacted
unless the increase in Federal expenditures under this Act is fully
offset through a decrease in other Federal expenditures.
<all>
Introduced in House
Introduced in House
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 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.
Referred to the Subcommittee on Health.
Mr. Pitts moved to suspend the rules and pass the bill, as amended.
Considered under suspension of the rules. (consideration: CR H4230-4235)
DEBATE - The House proceeded with forty minutes of debate on H.R. 5210.
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Passed/agreed to in House: On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote.(text: CR H4230-4232)
On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote. (text: CR H4230-4232)
Motion to reconsider laid on the table Agreed to without objection.
Received in the Senate and Read twice and referred to the Committee on Finance.