Protecting Seniors Access to Proper Care Act of 2017

Protecting Seniors Access to Proper Care Act of 2017

This bill allows an authorized physician or practitioner who is not enrolled as a Medicare provider to, under certain circumstances, prescribe covered drugs under the Medicare prescription drug benefit. Specifically, the bill applies to a physician or practitioner, other than a doctor of medicine or osteopathy, who: (1) is not otherwise barred or excluded from participating in Medicare, and (2) prescribes a low-volume of billings for such drugs.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4169 Introduced in House (IH)]

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115th CONGRESS
  1st Session
                                H. R. 4169

     To amend title XVIII of the Social Security Act to remove the 
    enrollment restriction on certain physicians and practitioners 
 prescribing covered outpatient drugs under the Medicare prescription 
                             drug program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 31, 2017

Mr. Marchant (for himself, Mr. Smith of Missouri, Mr. Simpson, and Mr. 
  Ferguson) 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 title XVIII of the Social Security Act to remove the 
    enrollment restriction on certain physicians and practitioners 
 prescribing covered outpatient drugs under the Medicare prescription 
                             drug program.

    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 ``Protecting Seniors Access to Proper 
Care Act of 2017''.

SEC. 2. PERMITTING CERTAIN NON-ENROLLED PHYSICIANS OR PRACTITIONERS TO 
              PRESCRIBE COVERED OUTPATIENT DRUGS UNDER MEDICARE PART D.

    (a) In General.--Section 1860D-4 of the Social Security Act (42 
U.S.C. 1395w-103) is amended by adding at the end the following new 
subsection:
    ``(m) Removal of Enrollment Restriction.--
            ``(1) In general.--Nothing in this title or section 6405(c) 
        of the Patient Protection and Affordable Care Act shall be 
        construed as authorizing the Secretary to require, as a 
        condition of payment by a PDP sponsor for a covered part D drug 
        that is prescribed by an applicable physician or practitioner 
        who is authorized under State law to prescribe such drug, that 
        such applicable physician or practitioner be enrolled under 
        section 1866(j).
            ``(2) Applicable physician or practitioner defined.--For 
        purposes of paragraph (1), the term `applicable physician or 
        practitioner' means an eligible professional described in 
        section 1848(k)(3)(B) (other than a physician described in 
        section 1861(r)(1))--
                    ``(A) who--
                            ``(i) is not excluded under this title or 
                        title XI;
                            ``(ii) is not barred from participating in 
                        the program under this title for a period of 
                        time following a revocation under section 
                        424.535(c) of title 42, Code of Federal 
                        Regulations (or any successor regulation); or
                            ``(iii) meets other criteria similar to 
                        clauses (i) and (ii) that may be specified by 
                        the Secretary; and
                    ``(B) who prescribes a low volume (as determined by 
                the Secretary) of such drugs to individuals enrolled in 
                plans under this part.
        In determining low volume under subparagraph (B), the Secretary 
        may determine low volume differently based on the specialty of 
        the applicable physician or practitioner.''.
    (b) Effective Date and Enforcement Delay.--
            (1) Effective date.--The amendment made by subsection (a) 
        shall apply to covered part D drugs prescribed on or after 
        January 1, 2019.
            (2) Delay in enforcement of enrollment requirement until 
        low volume exemption is implemented.--The Secretary shall 
        continue not to enforce the enrollment requirement under 
        clauses (ii) through (v) of section 423.120(c)(6) of title 42, 
        Code of Federal Regulations, until section 1860D-4(m), as added 
        by subsection (a), takes effect.
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