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112-HR-2205 | Ending Defensive Medicine and Encouraging Innovative Reforms Act of 2011 - Sets conditions for lawsuits arising from health care liability claims regarding health care goods or services or any medical product affecting interstate commerce. Provides for periodic payment of future damages. Makes each party liable only for the amount of damages directly proportional to such party's percentage of responsibility. Requires the dismissal of any lawsuit for which a qualified specialist does not submit an affidavit to the court as to whether there is a reasonable and meritorious cause for filing the action. Requires the claimant to pay the defendant's reasonable costs and attorney fees, under certain circumstances. Absolves health care providers from liability if such providers acted consistent with accepted clinical practice guidelines. Amends the Public Health Service Act to extend liability protections for employees of the Public Health Service to certain emergency medical personnel and health center volunteer practitioners. Protects disaster relief volunteers, nonprofit organizations, and other entities from civil liability for injuries related to disaster relief services or donated goods, except for injuries caused by willful, wanton, or reckless misconduct. Makes a state that has enacted and is implementing an alternative medical liability law eligible to receive an incentive payment from the Secretary of Health and Human Services (HHS). Subjects health care lawsuits in a state receiving an incentive payment to liability limits and other provisions governing health care liability claims if the state's alternative medical liability laws have not brought about a reduction in the number of health care lawsuits in the state, a reduction in the amount of time required to resolve lawsuits in the state, and a reduction in the cost of malpractice insurance in the state. | Health | Medical Liability | Health | 2011-06-16 | reforms act sets conditions lawsuits arising health care liability claims health care goods services medical product affecting interstate commerce provides periodic payment future damages makes party liable damages directly proportional party percentage responsibility requires dismissal lawsuit qualified specialist submit affidavit court reasonable meritorious cause filing action requires claimant pay defendant reasonable costs attorney fees certain circumstances absolves health care providers liability providers acted consistent accepted clinical practice guidelines amends public_health_service_act extend liability protections employees public_health_service certain emergency medical personnel health center volunteer practitioners protects disaster relief volunteers nonprofit organizations entities civil liability injuries related disaster relief services donated goods injuries caused willful wanton reckless misconduct makes state enacted implementing alternative medical liability law eligible receive incentive payment secretary health_and_human_services hhs subjects health care lawsuits state receiving incentive payment liability limits provisions governing health care liability claims state alternative medical liability laws brought reduction number health care lawsuits state reduction time required resolve lawsuits state reduction cost malpractice insurance state |
112-HR-2925 | Medicare Common Access Card Act of 2011 - Establishes a pilot program under title XVIII (Medicare) of the Social Security Act in order to utilize smart card technology for Medicare beneficiary and provider identification cards. | Health | Medical Liability | Health | 2011-09-14 | medicare common access card act establishes pilot program title xviii medicare social security act order utilize smart card technology medicare beneficiary provider identification cards |
112-HR-2965 | Requires any employee of the Veterans Health Administration who, while working in a Department of Veterans Affairs (VA) medical facility, intentionally fails to follow infection control practices to be fined in accordance with the federal criminal code or imprisoned for up to one year, or both. Directs the Secretary of Veterans Affairs to establish infection control practices. | Health | Medical Liability | Armed forces and national security | 2011-09-19 | requires employee veterans_health_administration working department_of_veterans_affairs medical facility intentionally fails follow infection control practices fined accordance federal criminal code imprisoned year directs secretary veterans_affairs establish infection control practices |
112-HR-3399 | Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act or Medicare and Medicaid FAST Act - Amends part D (Prescription Drug Benefits) of title XVIII (Medicare) of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS) to prohibit sponsors of prescription drug plans (PDPs) from paying claims for prescription drugs that do not include the valid National Provider Identifier for the drug's prescriber. Directs the Secretary of HHS to establish procedures and rules to restrict access to the National Provider Identifier Registry in order to deter fraudulent use of it. Amends SSA title XIX (Medicaid), for any state that has established a State Prescription Drug Monitoring Program meeting certain requirements, to decrease by 10% the federal medical assistance percentage (FMAP) with respect to any amounts recovered by or paid to the state related to an overpayment due to fraud, waste, or abuse. Allows the state to use such amounts to support its State Prescription Drug Monitoring Program. Directs the Secretary of HHS and the Attorney General jointly to establish a Commission to examine interoperability and other issues related to State Prescription Drug Monitoring Programs. Directs the Attorney General to: (1) update daily the Drug Enforcement Agency (DEA) database of persons registered to manufacture, distribute, or dispense a controlled substance under the Controlled Substances Act to reflect any changes in the information in the Death Master File of the Social Security Administration; (2) agree with the Commissioner of Social Security to obtain death information in order to update such database; (3) establish procedures and rules to restrict access to the database to deter its fraudulent use; and (4) establish procedures and rules to review and investigate pharmacy claims under Medicare part D that contain a registration number not assigned to a practitioner by the Attorney General under the Controlled Substances Act. Amends SSA title XVIII to require certain annual reports to describe the types and financial costs to the Medicare program of improper payment vulnerabilities identified by Recovery Audit Contractors (RACs). Requires the Secretary of HHS to develop a plan to revise the beneficiary incentive program under the Health Instance Portability and Accountability Act of 1996 (HIPAA) to encourage greater participation by individuals in reporting fraud and abuse in the Medicare program. Requires the Secretary of HHS to: (1) establish and implement procedures to eliminate the unnecessary collection, use, and display of Social Security account numbers of Medicare beneficiaries; and (2) ensure that each newly issued Medicare identification card meets specified requirements. Directs the Secretary of HHS to establish a pilot program utilizing smart card technology to evaluate its applicability to the Medicare program and whether such cards would be effective in preventing Medicare fraud. Directs the Secretary of HHS to establish policies and procedures for a process to require prior authorization for initial claims for reimbursement for standard power wheelchairs. Requires the Secretary of HHS, the HHS Inspector General, and the Attorney General to increase coordination and data sharing. Directs the Secretary of HHS to establish: (1) automated prepayment review of all Medicare claims, (2) a plan to facilitate the inclusion of states in the Medicare-Medicaid Data Match Program, and (3) a plan that allows each state Medicaid agency access to relevant data on improper or erroneous Medicare payments for items or services for dual eligible individuals. Prohibits Medicaid payments as well as payments under SSA title XXI (State Children's Health Insurance Program) (CHIP) unless a claim contains a valid beneficiary identification number and a valid National Provider Identifier. Directs the Secretary to establish Medicare administrative contractor error reduction incentives. Requires the provider enrollment process and provider screening to be separate from any contract to serve as a Medicare administrative contractor. Directs the Secretary of HHS to report to Congress on measurable metrics for improving Medicare contractor performance. Amends SSA title XI to establish penalties for the illegal distribution of a Medicare, Medicaid, or CHIP beneficiary identification number or billing privileges. | Health | Medical Liability | Health | 2011-11-10 | medicare medicare medicaid fast act_-_amends prescription drug benefits title xviii medicare social security act ssa direct secretary health_and_human_services hhs prohibit sponsors prescription drug plans pdps paying claims prescription drugs include valid national provider identifier drug prescriber directs secretary hhs establish procedures rules restrict access order deter fraudulent use amends ssa title xix medicaid state established meeting certain requirements decrease federal medical assistance percentage fmap respect amounts recovered paid state related overpayment fraud waste abuse allows state use amounts support state prescription drug monitoring program directs secretary hhs attorney general jointly establish commission examine interoperability issues related state prescription drug monitoring programs directs attorney general update daily dea database persons registered manufacture distribute dispense controlled substance controlled substances act reflect changes information death master file social_security_administration agree commissioner_of_social_security obtain death information order update database establish procedures rules restrict access database deter fraudulent use establish procedures rules review investigate pharmacy claims medicare contain registration number assigned practitioner attorney general controlled substances act amends ssa title xviii require certain annual reports describe types financial costs medicare program improper payment vulnerabilities identified requires secretary hhs develop plan revise beneficiary incentive program hipaa encourage greater participation individuals reporting fraud abuse medicare program requires secretary hhs establish implement procedures eliminate unnecessary collection use display social_security account numbers medicare beneficiaries ensure newly issued medicare identification card meets specified requirements directs secretary hhs establish pilot program utilizing smart card technology evaluate applicability medicare program cards effective preventing medicare fraud directs secretary hhs establish policies procedures process require prior authorization initial claims reimbursement standard power wheelchairs requires secretary hhs attorney general increase coordination data sharing directs secretary hhs establish automated prepayment review medicare claims plan facilitate inclusion states medicare-medicaid data_match_program plan allows state medicaid agency access relevant data improper erroneous medicare payments items services dual eligible individuals prohibits medicaid payments payments ssa title chip claim contains valid beneficiary identification number valid national provider identifier directs secretary establish medicare administrative contractor error reduction incentives requires provider enrollment process provider screening separate contract serve medicare administrative contractor directs secretary hhs report congress measurable metrics improving medicare contractor performance amends ssa title establish penalties illegal distribution medicare medicaid chip beneficiary identification number billing privileges |
112-HR-3474 | Promoting Responsibility in Medical Expenditures Act of 2011 - Amends title XI of the Social Security Act (SSA) to increase civil money penalties, criminal fines, and prison sentences for fraud and abuse under the SSA title XVIII (Medicare) program. Directs the Secretary of Health and Human Services to submit to Congress annual fraud reports with respect to Medicare, SSA title XIX (Medicaid), and SSA title XXI (Children's Health Insurance) (CHIP). Amends the Small Business Jobs Act to exempt from disclosure under the Freedom of Information Act the algorithms used in predictive modeling and other analytics technology to identify and prevent waste, fraud, and abuse in the Medicare fee-for-service program. Requires valid National Provider Identifiers for prescribers on pharmacy claims for covered Medicare part D prescription drugs. Requires a prescription drug plan (PDP) sponsor identifying a claim for reimbursement for a drug prescribed by an individual without a valid National Provider Identifier to report to the HHS Inspector General any relevant information on such a prescriber, including any invalid national provider identifiers being used to submit such claims and related records. Requires the Inspector General of HHS to provide such information to appropriate law enforcement agencies. Directs the Secretary of HHS to establish procedures and rules to restrict access to the National Provider Identifier Registry in order to deter the fraudulent use of National Provider Identifiers. Decreases by 10% per quarter the federal medical assistance percentage (FMAP) for a state if: (1) it is receiving a grant for a state controlled substance monitoring program through which it identifies fraud, waste, or abuse in connection with the provision of prescription drug coverage under the state Medicaid plan; and (2) the state or a political subdivision is reimbursed by a third party for expenditures related to such fraud, waste, or abuse, or for a recovered amount. Directs the Secretary of HHS to establish procedures to eliminate the unnecessary collection, use, and display of Social Security account numbers of Medicare beneficiaries. Requires the Secretary of HHS to ensure that each newly issued Medicare identification card does not display or electronically store, in an unencrypted format, a Medicare beneficiary's Social Security account number, unless the beneficiary's health insurance claim number is the beneficiary's or spouse's Social Security number, and the risk of fraudulent use of such numbers is not unacceptably high. Requires the Secretary of HHS to prohibit the display of a Medicare beneficiary's Social Security account number in any written or electronic communication to the beneficiary unless its inclusion is essential for the operation of the Medicare program. Directs the Secretary of HHS to establish a pilot program to evaluate the applicability of smart card technology to the Medicare program, and whether such cards would be effective in preventing Medicare fraud. Prohibits payment for an item or service under Medicaid or CHIP unless the claim contains: (1) a valid beneficiary identification number corresponding to an individual enrolled under the state plan or an applicable waiver; and (2) a valid provider identifier corresponding to a provider eligible to receive payment for furnishing such item or service. Directs the Comptroller General to recommend methods to make Medicare claims data available to the public to improve Medicare transparency while protecting the privacy of individual Medicare beneficiaries, service providers, and suppliers. | Health | Medical Liability | Health | 2011-11-18 | promoting responsibility medical expenditures act amends title social security act ssa increase civil money penalties criminal fines prison sentences fraud abuse ssa title xviii medicare program directs secretary health_and_human_services submit congress annual fraud reports respect medicare ssa title xix medicaid ssa title chip amends small_business_jobs_act exempt disclosure freedom information act predictive modeling analytics technology identify prevent waste fraud abuse medicare fee service program requires valid national provider identifiers prescribers pharmacy claims covered medicare prescription drugs requires prescription drug plan pdp sponsor identifying claim reimbursement drug prescribed individual valid national provider identifier report hhs_inspector general relevant information prescriber including invalid national provider identifiers submit claims related records requires inspector general hhs provide information appropriate law enforcement agencies directs secretary hhs establish procedures rules restrict access order deter fraudulent use decreases quarter federal medical assistance percentage fmap state receiving grant state controlled substance monitoring program identifies fraud waste abuse connection provision prescription drug coverage state medicaid plan state political subdivision reimbursed party expenditures related fraud waste abuse recovered directs secretary hhs establish procedures eliminate unnecessary collection use display social_security account numbers medicare beneficiaries requires secretary hhs ensure newly issued medicare identification card display electronically store unencrypted format medicare beneficiary social_security account number beneficiary health insurance claim number beneficiary spouse social_security number risk fraudulent use numbers high requires secretary hhs prohibit display medicare beneficiary social_security account number written electronic communication beneficiary inclusion essential operation medicare program directs secretary hhs establish pilot program evaluate applicability smart card technology medicare program cards effective preventing medicare fraud prohibits payment item service medicaid chip claim contains valid beneficiary identification number corresponding individual enrolled state plan applicable waiver valid provider identifier corresponding provider eligible receive payment furnishing item service directs comptroller general recommend methods medicare claims data available public improve medicare transparency protecting privacy individual medicare beneficiaries service providers suppliers |
112-HR-3511 | Cardiac Arrest Survival Act of 2011 - Amends the Public Health Service Act to expand immunity from civil liability related to automated external defibrillator devices (AEDs), including by giving immunity to: (1) a person who owns, occupies, or manages the premises from which an AED is taken or at which an AED is used or attempted to be used on a victim of a perceived medical emergency; and (2) the owner-acquirer of an AED for any harm resulting from the use or attempted use of such device, unless the harm was proximately caused by the failure of the owner-acquirer to properly maintain the device according to the guidelines of the device manufacturer. Applies immunity regardless of whether: (1) the AED is marked with cautionary signage or registered with any government; or (2) the person who used or attempted to use the AED complied with such signage, had received training on such use, or was assisted or supervised by any other person, including a licensed physician. | Health | Medical Liability | Health | 2011-11-29 | cardiac arrest survival act amends public_health_service_act expand immunity civil liability related automated external devices aeds including giving immunity person owns occupies manages premises aed taken aed attempted victim perceived medical emergency owner aed harm resulting use attempted use device harm proximately caused failure owner properly maintain device according guidelines device manufacturer applies immunity regardless aed marked cautionary signage registered government person attempted use aed complied signage received training use assisted supervised person including licensed physician |
112-HR-3586 | Good Samaritan Health Professionals Act of 2011 - Amends the Public Health Service Act to provide that a health care professional shall not be liable under federal or state law for harm caused by any act or omission if: (1) the professional is serving as a volunteer for purposes of responding to a disaster; and (2) the act or omission occurs during the period of the disaster, in the professional's capacity as such a volunteer, and in a good faith belief that the individual being treated is in need of health care services. Makes exceptions where: (1) the harm was caused by an act or omission constituting willful or criminal misconduct, gross negligence, reckless misconduct, or a conscious flagrant indifference to the rights or safety of the individual harmed; or (2) the professional rendered the health care services under the influence of intoxicating alcohol or an intoxicating drug. | Health | Medical Liability | Health | 2011-12-07 | good samaritan health professionals act amends public_health_service_act provide health care professional shall liable federal state law harm caused act omission professional serving volunteer purposes responding disaster act omission occurs period disaster professional capacity volunteer good faith belief individual treated need health care services makes exceptions harm caused act omission constituting willful criminal misconduct gross negligence reckless misconduct conscious flagrant indifference rights safety individual harmed professional rendered health care services influence intoxicating alcohol intoxicating drug |
112-HR-3735 | Medicare Fraud Enforcement and Prevention Act of 2011 - Amends title XI of the Social Security Act (SSA) to increase criminal penalties for both felony and misdemeanor fraud under SSA titles XVIII (Medicare) and XIX (Medicaid). Adds a new offense of distribution of two or more Medicare or Medicaid beneficiary identification numbers or billing privileges with the intent to defraud. Applies civil monetary penalties to: (1) conspiracy to make false statements or commit other specified offenses with respect to Medicare or Medicaid claims; and (2) knowing creation or use of false records or statements with respect to the transmission of money or property to a federal health care program. Extends the statute of limitations from six to 10 years after presentation of a claim. Amends SSA title XVIII (Medicare), as amended by the Patient Protection and Affordable Care Act (PPACA), to revise screening requirements. Amends SSA title XI, as amended by PPACA, to require the access to claims and payment data granted to Inspector General of the Department of Health and Human Services (HHS) and the Attorney General to include access to real time claims and payment data. Requires the HHS Inspector General to implement mechanisms for the sharing of information about suspected fraud relating to the federal health care programs under Medicare, Medicaid, and SSA title XXI (Children's Health Insurance Program) (CHIP) with other appropriate law enforcement officials. Directs the HHS Secretary to carry out a five-year pilot program that implements biometric technology to ensure that individuals entitled to benefits under Medicare part A or enrolled under Medicare part B are physically present at the time and place of receipt of certain items and services for which payment may be made. | Health | Medical Liability | Health | 2011-12-19 | amends title social security act ssa increase criminal penalties felony misdemeanor fraud ssa titles xviii medicare xix medicaid adds new offense distribution medicare medicaid beneficiary identification numbers billing privileges intent defraud applies civil monetary penalties conspiracy false statements commit specified offenses respect medicare medicaid claims knowing creation use false records statements respect transmission money property federal health care program extends statute limitations years presentation claim amends ssa title xviii medicare amended patient_protection affordable care act ppaca revise screening requirements amends ssa title amended ppaca require access claims payment data granted inspector general department_of_health_and_human_services hhs attorney general include access real time claims payment data requires hhs inspector general implement mechanisms sharing information suspected fraud relating federal health care programs medicare medicaid ssa title chip appropriate law enforcement officials directs hhs secretary carry year pilot program implements biometric technology ensure individuals entitled benefits medicare enrolled medicare physically present time place receipt certain items services payment |
112-HR-4223 | Strengthening and Focusing Enforcement to Deter Organized Stealing and Enhance Safety Act of 2012 or the SAFE DOSES Act - Amends the federal criminal code to prohibit, in or using any means or facility of interstate or foreign commerce: (1) embezzling, stealing, obtaining by fraud or deception, or knowingly and unlawfully taking, carrying away, or concealing a medical product that has not yet been made available for retail purchase by a consumer (pre-retail medical product); (2) knowingly and falsely making, altering, forging, or counterfeiting the labeling or documentation of such a product; (3) knowingly possessing, transporting, or trafficking in a product involved in such a violation; (4) buying or otherwise obtaining, or selling or distributing, with intent to defraud, such a product that has expired or been stolen; or (5) attempting or conspiring to commit such a violation. Makes such a violation an aggravated offense if: (1) the defendant is employed by, or is an agent of, an organization in the supply chain for the product; or (2) the violation involves the use of violence, force, a threat of violence or force, or the use of a deadly weapon, results in serious bodily injury or death, or is subsequent to a prior conviction for an offense under this Act. Prescribes criminal and civil penalties for violations, including a civil penalty of up to the greater of 3 times the economic loss attributable to the violation or $1 million. Provides for civil forfeiture for any property which constitutes or is derived from proceeds traceable to such a violation. Requires the penalties under this Act to apply for the following offenses involving a pre-retail medical product: (1) interstate and foreign travel or transportation in aid of racketeering enterprises; (2) engaging in monetary transactions in property derived from specified unlawful activity; (3) breaking into or entering carrier facilities with intent to commit larceny; and (4) the transportation, sale, or receipt of stolen property. Directs the Attorney General to give increased priority to efforts to investigate and prosecute offenses involving pre-retail medical products. Extends provisions authorizing wiretapping and requiring victim restitution to offenses relating to theft of a pre-retail medical product. Directs the U.S. Sentencing Commission to review and, if appropriate, amend the sentencing guidelines and policy statements applicable to offenses related to pre-retail medical product theft or robberies and burglaries involving controlled substances to reflect congressional intent that penalties are sufficient to deter and punish such offenses and to appropriately account for actual harm to the public. | Health | Medical Liability | Crime and law enforcement | 2012-03-20 | strengthening focusing enforcement deter organized stealing enhance safety act safe doses act amends federal criminal code prohibit means facility interstate foreign commerce stealing obtaining fraud deception knowingly unlawfully taking carrying away concealing medical product available retail purchase consumer pre retail medical product knowingly falsely making altering counterfeiting labeling documentation product knowingly possessing transporting trafficking product involved violation buying obtaining selling distributing intent defraud product expired stolen attempting conspiring commit violation makes violation aggravated offense defendant employed agent organization supply chain product violation involves use violence force threat violence force use deadly weapon results bodily injury death subsequent prior conviction offense act prescribes criminal civil penalties violations including civil penalty greater times economic loss attributable violation million provides civil forfeiture property constitutes derived proceeds traceable violation requires penalties act apply following offenses involving pre retail medical product interstate foreign travel transportation aid racketeering enterprises engaging monetary transactions property derived specified unlawful activity breaking entering carrier facilities intent commit transportation sale receipt stolen property directs attorney general increased priority efforts investigate prosecute offenses involving pre retail medical products extends provisions authorizing requiring victim restitution offenses relating theft pre retail medical product directs review appropriate amend sentencing guidelines policy statements applicable offenses related pre retail medical product theft involving controlled substances reflect congressional intent penalties sufficient deter punish offenses appropriately account actual harm public |
112-HR-6103 | Stop Medicare Fraud Act of 2012 - Amends title XI of the Social Security Act (SSA) to increase the civil and criminal penalty levels for fraud under SSA title XVIII (Medicare). | Health | Medical Liability | Health | 2012-07-11 | stop medicare fraud act amends title social security act ssa increase civil criminal penalty levels fraud ssa title xviii medicare |
112-HR-6332 | Local Medicaid Enforcement Incentives Act of 2012 - Directs the Secretary of Health and Human Services (HHS) to establish a grant program to provide states with funds to: (1) detect and prevent Medicaid fraud, waste, and abuse; (2) recover overpayments to individuals or entities receiving Medicaid funds that result from such fraud, waste, or abuse; and (3) share with localities within the state that assist in such detection and prevention, or the recovery of such overpayments, at least 50% of the state's share of the total overpayments recovered during a period, minus administrative costs. | Health | Medical Liability | Health | 2012-08-02 | local directs secretary health_and_human_services hhs establish grant program provide states funds detect prevent medicaid fraud waste abuse recover overpayments individuals entities receiving medicaid funds result fraud waste abuse share localities state assist detection prevention recovery overpayments state share total overpayments recovered period minus administrative costs |
112-S-197 | Medical Care Access Protection Act of 2011 or the MCAP Act - Sets forth provisions regulating lawsuits for health care liability claims related to the provision of health care services. Sets a statute of limitations of three years after the date of manifestation of injury or one year after the claimant discovers the injury, with certain exceptions. Requires a court to impose sanctions for the filing of frivolous lawsuits. Limits noneconomic damages to $250,000 from the provider or health care institution, but no more than $500,000 from multiple health care institutions. Makes each party liable only for the amount of damages directly proportional to such party's percentage of responsibility. Allows the court to restrict the payment of attorney contingency fees. Limits the fees to a decreasing percentage based on the increasing value of the amount awarded. Prescribes qualifications for expert witnesses. Requires the court to reduce damages received by the amount of collateral source benefits to which a claimant is entitled, unless the payor of such benefits has the right to reimbursement or subrogation under federal or state law. Authorizes the award of punitive damages only where: (1) it is proven by clear and convincing evidence that a person acted with malicious intent to injure the claimant or deliberately failed to avoid unnecessary injury the claimant was substantially certain to suffer, and (2) compensatory damages are awarded. Limits punitive damages to the greater of two times the amount of economic damages or $250,000. Prohibits a health care provider from being named as a party in a product liability or class action lawsuit for prescribing or dispensing a Food and Drug Administration (FDA)-approved prescription drug, biological product, or medical device for an approved indication. Provides for periodic payments of future damage awards. | Health | Medical Liability | Law | 2011-01-26 | act sets forth provisions regulating lawsuits health care liability claims related provision health care services sets statute limitations years date manifestation injury year claimant discovers injury certain exceptions requires court impose sanctions filing frivolous lawsuits limits noneconomic damages provider health care institution multiple health care institutions makes party liable damages directly proportional party percentage responsibility allows court restrict payment attorney contingency fees limits fees decreasing percentage based increasing value awarded prescribes qualifications expert witnesses requires court reduce damages received collateral source benefits claimant entitled payor benefits right reimbursement subrogation federal state law authorizes award punitive damages proven clear convincing evidence person acted malicious intent injure claimant deliberately failed avoid unnecessary injury claimant substantially certain suffer compensatory damages awarded limits punitive damages greater times economic damages prohibits health care provider named party product liability class action lawsuit prescribing dispensing food_and_drug_administration prescription drug biological product medical device approved indication provides periodic payments future damage awards |
112-S-218 | Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 - Sets conditions for lawsuits arising from health care liability claims regarding health care goods or services or any medical product affecting interstate commerce. Sets a statute of limitations of three years after the date of manifestation of injury or one year after the claimant discovers the injury, with certain exceptions. Limits noneconomic damages to $250,000. Makes each party liable only for the amount of damages directly proportional to such party's percentage of responsibility. Allows the court to restrict the payment of attorney contingency fees. Limits the fees to a decreasing percentage based on the increasing value of the amount awarded. Allows the introduction of collateral source benefits and the amount paid to secure such benefits as evidence. Prohibits a provider of such benefits from recovering any amount from an award in a health care lawsuit involving injury or wrongful death. Authorizes the award of punitive damages only where: (1) it is proven by clear and convincing evidence that a person acted with malicious intent to injure the claimant or deliberately failed to avoid unnecessary injury the claimant was substantially certain to suffer; and (2) compensatory damages are awarded. Limits punitive damages to the greater of two times the amount of economic damages or $250,000. Denies punitive damages in the case of products approved, cleared, or licensed by the Food and Drug Administration (FDA), or otherwise considered in compliance with FDA standards. Provides for periodic payments of future damages. | Health | Medical Liability | Health | 2011-01-27 | help efficient accessible low cost timely healthcare health act sets conditions lawsuits arising health care liability claims health care goods services medical product affecting interstate commerce sets statute limitations years date manifestation injury year claimant discovers injury certain exceptions limits noneconomic damages makes party liable damages directly proportional party percentage responsibility allows court restrict payment attorney contingency fees limits fees decreasing percentage based increasing value awarded allows introduction collateral source benefits paid secure benefits evidence prohibits provider benefits recovering award health care lawsuit involving injury wrongful death authorizes award punitive damages proven clear convincing evidence person acted malicious intent injure claimant deliberately failed avoid unnecessary injury claimant substantially certain suffer compensatory damages awarded limits punitive damages greater times economic damages denies punitive damages case products approved cleared licensed food_and_drug_administration fda considered compliance fda standards provides periodic payments future damages |
112-S-454 | Strengthening Program Integrity and Accountability in Health Care Act of 2011 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to: (1) change from discretionary to mandatory the authority of the Secretary of Health and Human Services (HHS) to suspend Medicare and Medicaid payments pending investigation of credible allegations of fraud; and (2) require the Secretary to extend to up to 365 calendar days for particular categories of service providers or suppliers in which fraud, waste, or abuse is likely the number of days in which Medicare claims are required to be paid in order to ensure that they are clean claims. Requires the Inspector General of HHS to notify the relevant congressional committees within 30 days after transmitting to another HHS agency a management implication report (which details investigative findings about the possible implication of agency management in prohibited or otherwise inappropriate transactions). Directs the Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services, to establish an information sharing program regarding beneficiary medical ID theft under the programs under SSA titles XVIII (Medicare), XIX (Medicaid), and XXI (State Children's Health Insurance) (CHIP). Amends SSA title XI to authorize the Secretary to exclude from federal health care programs entities affiliated with a sanctioned entity, as well as any officer or managing employee of an affiliated entity (currently, only individuals with an ownership or control interest in a sanctioned entity), if the affiliated entity was so affiliated at the time of any of the conduct forming the basis for the conviction or exclusion of the sanctioned entity. Directs the Secretary to make available to the public Medicare claims and payment data. Amends SSA title XIX to require a state Medicaid agency to exclude from program participation with respect to a particular period any individual or entity which owns, controls, or manages an entity that: (1) has delinquent unpaid overpayments during such period; (2) is suspended or excluded from Medicaid participation or whose participation is terminated; or (3) is affiliated with an individual or entity that has been suspended or excluded from Medicaid participation or whose participation is terminated. Amends the Federal Food, Drug, and Cosmetic Act to require the Secretary to list on the Food and Drug Administration (FDA) Internet website certain new drugs (for human consumption) or new animal drugs that have not been approved by the FDA, together with the name of the person who listed such drug and the authority under such Act that does not require such drug to be subject to FDA approval. Amends SSA title XIX to prohibit a state from making a Medicaid payment for a covered outpatient drug which has not been FDA-approved. Amends SSA title XI to require individuals or entities that participate in or conduct activities under federal health care programs to comply with certain congressional requests for documents, information, or interviews. | Health | Medical Liability | Health | 2011-03-02 | amends title xviii medicare social security act ssa change discretionary mandatory authority secretary health_and_human_services hhs suspend medicare medicaid payments pending investigation credible allegations fraud require secretary extend calendar days particular categories service providers suppliers fraud waste abuse likely number days medicare claims required paid order ensure clean claims requires inspector general hhs notify relevant congressional committees days transmitting hhs agency management report details investigative findings possible agency management prohibited inappropriate transactions directs secretary acting administrator centers establish information sharing program beneficiary medical theft programs ssa titles xviii medicare xix medicaid chip amends ssa title authorize secretary exclude federal health care programs entities affiliated sanctioned entity officer managing employee affiliated entity currently individuals ownership control interest sanctioned entity affiliated entity affiliated time conduct forming basis conviction exclusion sanctioned entity directs secretary available public medicare claims payment data amends ssa title xix require state medicaid agency exclude program participation respect particular period individual entity owns controls manages entity delinquent unpaid overpayments period suspended excluded medicaid participation participation terminated affiliated individual entity suspended excluded medicaid participation participation terminated amends cosmetic act require secretary list food_and_drug_administration fda internet website certain new drugs human consumption new animal drugs approved fda person listed drug authority act require drug subject fda approval amends ssa title xix prohibit state making medicaid payment covered outpatient drug fda approved amends ssa title require individuals entities participate conduct activities federal health care programs comply certain congressional requests documents information interviews |
112-S-856 | Medicare Spending Transparency Act of 2011 - Amends title XI of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS), consistent with applicable information, privacy, security, and disclosure laws, to make public on the Internet website of the Centers for Medicare and Medicaid Services the following data with respect to SSA title XVIII (Medicare): (1) a complete list of service providers and suppliers participating in the Medicare program, including their business addresses; and (2) certain aggregate information about each provider and supplier. Entitles a qualified individual or group, for health research and fraud detection purposes, to access to Medicare claims and payment data of both HHS and its contractors. Directs the Secretary to establish procedures for the storage and use of data provided to such an individual or group. | Health | Medical Liability | Health | 2011-04-14 | medicare spending transparency act amends title social security act ssa direct secretary health_and_human_services hhs consistent applicable information privacy security disclosure laws public internet website centers medicare medicaid_services following data respect ssa title xviii medicare complete list service providers suppliers participating medicare program including business addresses certain aggregate information provider supplier entitles qualified individual group health research fraud detection purposes access medicare claims payment data hhs contractors directs secretary establish procedures storage use data provided individual group |
112-S-1059 | Family Health Care Accessibility Act of 2011 - Amends the Public Health Service Act to deem a health professional volunteer providing primary health care to an individual at a community health center to be an employee of the Public Health Service for purposes of any civil action that may arise from providing services to patients. Sets forth conditions for such liability protection, including: (1) the service is provided to the individual at a community health center or through offsite programs or events carried out by such center; and (2) the health care practitioner does not receive any compensation for providing the service, except repayment for reasonable expenses. Considers an entity as sponsoring the health care practitioner if the entity submits an application to the Secretary of Health and Human Services (HHS), and the Secretary determines that the health care practitioner is deemed to be an employee of the Public Health Service. Requires the Attorney General to submit to Congress an estimate of the amount of claims (together with related fees and expenses of witnesses) that, by reason of the actions or omissions of health professional volunteers, will be paid pursuant to this Act annually. Requires the Secretary to transfer such estimated amount from the claims fund to the appropriate accounts in the Treasury, subject to the extent of amounts in the fund. Makes this Act effective on October 1, 2012. | Health | Medical Liability | Health | 2011-05-25 | family health care accessibility act amends public_health_service_act deem health professional volunteer providing primary health care individual community health center employee public_health_service purposes civil action arise providing services patients sets forth conditions liability protection including service provided individual community health center offsite programs events carried center health care practitioner receive compensation providing service repayment reasonable expenses considers entity sponsoring health care practitioner entity submits application secretary health_and_human_services hhs secretary determines health care practitioner deemed employee public_health_service requires attorney general submit congress estimate claims related fees expenses witnesses reason actions omissions health professional volunteers paid pursuant act annually requires secretary transfer estimated claims fund appropriate accounts treasury subject extent amounts fund makes act effective october |
112-S-1251 | Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act or Medicare and Medicaid FAST Act - Amends part D (Prescription Drug Benefits) of title XVIII (Medicare) of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS) to prohibit sponsors of prescription drug plans (PDPs) from paying claims for prescription drugs that do not include the valid National Provider Identifier for the drug's prescriber. Directs the Secretary of HHS to establish procedures and rules to restrict access to the National Provider Identifier Registry in order to deter fraudulent use of it. Amends SSA title XIX (Medicaid), for any state that has established a State Prescription Drug Monitoring Program meeting certain requirements, to decrease by 10% the federal medical assistance percentage (FMAP) with respect to any amounts recovered by or paid to the state related to an overpayment due to fraud, waste, or abuse. Allows the state to use such amounts to support its State Prescription Drug Monitoring Program. Directs the Secretary of HHS and the Attorney General jointly to establish a Commission to examine interoperability and other issues related to State Prescription Drug Monitoring Programs. Directs the Attorney General to: (1) update daily the Drug Enforcement Agency (DEA) database of persons registered to manufacture, distribute, or dispense a controlled substance under the Controlled Substances Act to reflect any changes in the information in the Death Master File of the Social Security Administration; (2) agree with the Commissioner of Social Security to obtain death information in order to update such database; (3) establish procedures and rules to restrict access to the database to deter its fraudulent use; and (4) establish procedures and rules to review and investigate pharmacy claims under Medicare part D that contain a registration number not assigned to a practitioner by the Attorney General under the Controlled Substances Act. Amends SSA title XVIII to require certain annual reports to describe the types and financial costs to the Medicare program of improper payment vulnerabilities identified by Recovery Audit Contractors (RACs). Requires the Secretary of HHS to develop a plan to revise the beneficiary incentive program under the Health Instance Portability and Accountability Act of 1996 (HIPAA) to encourage greater participation by individuals in reporting fraud and abuse in the Medicare program. Requires the Secretary of HHS to: (1) establish and implement procedures to eliminate the unnecessary collection, use, and display of Social Security account numbers of Medicare beneficiaries; and (2) ensure that each newly issued Medicare identification card meets specified requirements. Directs the Secretary of HHS to establish a pilot program utilizing smart card technology to evaluate its applicability to the Medicare program and whether such cards would be effective in preventing Medicare fraud. Directs the Secretary of HHS to establish policies and procedures for prepayment review, which may include pre-certification, for all claims for reimbursement for durable medical equipment (DME) at high risk of waste, fraud, and abuse, including power wheelchairs. Requires the Secretary of HHS, the HHS Inspector General, and the Attorney General to increase coordination and data sharing. Directs the Secretary of HHS to establish: (1) automated prepayment review of all Medicare claims, (2) a plan to facilitate the inclusion of states in the Medicare-Medicaid Data Match Program, and (3) a plan that allows each state Medicaid agency access to relevant data on improper or erroneous Medicare payments for items or services for dual eligible individuals. Prohibits Medicaid payments as well as payments under SSA title XXI (State Children's Health Insurance Program) (CHIP) unless a claim contains a valid beneficiary identification number and a valid National Provider Identifier. Directs the Secretary to establish Medicare administrative contractor error reduction incentives. Requires the provider enrollment process and provider screening to be separate from any contract to serve as a Medicare administrative contractor. Directs the Secretary of HHS to report to Congress on measurable metrics for improving Medicare contractor performance. Amends SSA title XI to establish penalties for the illegal distribution of a Medicare, Medicaid, or CHIP beneficiary identification number or billing privileges. | Health | Medical Liability | Health | 2011-06-22 | medicare medicare medicaid fast act_-_amends prescription drug benefits title xviii medicare social security act ssa direct secretary health_and_human_services hhs prohibit sponsors prescription drug plans pdps paying claims prescription drugs include valid national provider identifier drug prescriber directs secretary hhs establish procedures rules restrict access order deter fraudulent use amends ssa title xix medicaid state established meeting certain requirements decrease federal medical assistance percentage fmap respect amounts recovered paid state related overpayment fraud waste abuse allows state use amounts support state prescription drug monitoring program directs secretary hhs attorney general jointly establish commission examine interoperability issues related state prescription drug monitoring programs directs attorney general update daily dea database persons registered manufacture distribute dispense controlled substance controlled substances act reflect changes information death master file social_security_administration agree commissioner_of_social_security obtain death information order update database establish procedures rules restrict access database deter fraudulent use establish procedures rules review investigate pharmacy claims medicare contain registration number assigned practitioner attorney general controlled substances act amends ssa title xviii require certain annual reports describe types financial costs medicare program improper payment vulnerabilities identified requires secretary hhs develop plan revise beneficiary incentive program hipaa encourage greater participation individuals reporting fraud abuse medicare program requires secretary hhs establish implement procedures eliminate unnecessary collection use display social_security account numbers medicare beneficiaries ensure newly issued medicare identification card meets specified requirements directs secretary hhs establish pilot program utilizing smart card technology evaluate applicability medicare program cards effective preventing medicare fraud directs secretary hhs establish policies procedures prepayment review include pre certification claims reimbursement durable medical equipment dme high risk waste fraud abuse including power wheelchairs requires secretary hhs attorney general increase coordination data sharing directs secretary hhs establish automated prepayment review medicare claims plan facilitate inclusion states medicare-medicaid data_match_program plan allows state medicaid agency access relevant data improper erroneous medicare payments items services dual eligible individuals prohibits medicaid payments payments ssa title chip claim contains valid beneficiary identification number valid national provider identifier directs secretary establish medicare administrative contractor error reduction incentives requires provider enrollment process provider screening separate contract serve medicare administrative contractor directs secretary hhs report congress measurable metrics improving medicare contractor performance amends ssa title establish penalties illegal distribution medicare medicaid chip beneficiary identification number billing privileges |
113-HR-418 | Medicare Fraud Enforcement and Prevention Act of 2013 - Amends title XI of the Social Security Act (SSA) to increase criminal penalties for both felony and misdemeanor fraud under SSA titles XVIII (Medicare) and XIX (Medicaid).
Adds a new offense of distribution of two or more Medicare or Medicaid beneficiary identification numbers or billing privileges.
Applies civil monetary penalties to: (1) conspiracy to make false statements or commit other specified offenses with respect to Medicare or Medicaid claims; and (2) knowing creation or use of false records or statements with respect to the transmission of money or property to a federal health care program. Extends the statute of limitations from six to 10 years after presentation of a claim.
Amends SSA title XVIII (Medicare), as amended by the Patient Protection and Affordable Care Act (PPACA), to revise screening requirements.
Amends SSA title XI, as amended by PPACA, to require the access to claims and payment data granted to Inspector General of the Department of Health and Human Services (HHS) and the Attorney General to include access to real time claims and payment data.
Requires the HHS Inspector General to implement mechanisms for the sharing of information about suspected fraud relating to the federal health care programs under Medicare, Medicaid, and SSA title XXI (Children's Health Insurance Program) (CHIP) with other appropriate law enforcement officials.
Directs the HHS Secretary to provide for a study that analyzes the feasibility and benefits in reducing waste, fraud, and abuse of carrying out a program that implements biometric technology to ensure that individuals entitled to benefits under Medicare part A or enrolled under Medicare part B are physically present at the time and place of receipt of certain items and services for which payment may be made. | Health | Medical Liability | Health | 2013-01-25 | amends title social security act ssa increase criminal penalties felony misdemeanor fraud ssa titles xviii medicare xix medicaid adds new offense distribution medicare medicaid beneficiary identification numbers billing privileges applies civil monetary penalties conspiracy false statements commit specified offenses respect medicare medicaid claims knowing creation use false records statements respect transmission money property federal health care program extends statute limitations years presentation claim amends ssa title xviii medicare amended patient_protection affordable care act ppaca revise screening requirements amends ssa title amended ppaca require access claims payment data granted inspector general department_of_health_and_human_services hhs attorney general include access real time claims payment data requires hhs inspector general implement mechanisms sharing information suspected fraud relating federal health care programs medicare medicaid ssa title chip appropriate law enforcement officials directs hhs secretary provide study analyzes feasibility benefits reducing waste fraud abuse carrying program implements biometric technology ensure individuals entitled benefits medicare enrolled medicare physically present time place receipt certain items services payment |
113-HR-1250 | Medicare Audit Improvement Act of 2013 - Directs the Secretary of Health and Human Services (HHS) to establish a process which subjects to a single, combined maximum annual limit, applied incrementally, the number of additional documentation requests made to a hospital by Medicare administrative contractors, recovery audit contractors, or Comprehensive Error Rate Testing (CERT) program contractors pursuant to prepayment and postpayment audits requiring a hospital to submit a medical record for audit purposes.
Directs the Secretary also to establish a distinct additional documentation request limit, computed according to a specified formula, for each hospital claim type for each hospital for a 45-day period in a year.
Amends title XVIII (Medicare) of the Social Security Act with respect to the Medicare Integrity Program and use of recovery audit contractors.
Requires the Secretary to ensure that recovery audit contracts include certain mandatory terms and conditions pertaining to: (1) penalties for certain compliance failures, (2) penalties for overturned appeals, (3) postpayment and prepayment audits, and (4) guidelines for prepayment review.
Directs the Secretary to publish on the Internet website of the Centers for Medicare & Medicaid Services information on recovery audit contractor performance regarding: (1) audit rates, denials, and appeals outcomes; and (2) independent performance evaluations.
Deems to be an original claim for Medicare part B (Supplementary Medical Insurance) payment a resubmitted hospital claim for Medicare part A payment for inpatient hospital services which a recovery audit contractor determines: (1) were not medically necessary and reasonable based on the site of service, but (2) would be medically necessary and reasonable in an outpatient setting of the hospital. Requires payment to be made for such a resubmitted claim for all furnished items and services for which payment may be made under Medicare part B.
Deems to be a reopened claim, for purposes of a hospital's ability to resubmit a claim for Medicare payment in timely fashion, any claim that is the subject of an audit by a recovery audit contractor or a Medicare administrative contractor.
Requires contracts for a recovery audit contractor to require that a physician review each denial of a claim for medical necessity made by an employee of the contractor who is not a physician.
Subjects to administrative and judicial review the Secretary's compliance with guidelines for reopening and revising benefit determinations. | Health | Medical Liability | Health | 2013-03-19 | medicare audit improvement act directs secretary health_and_human_services hhs establish process subjects single combined maximum annual limit applied incrementally number additional documentation requests hospital medicare administrative contractors recovery audit contractors comprehensive error rate testing program contractors pursuant prepayment audits requiring hospital submit medical record audit purposes directs secretary establish distinct additional documentation request limit computed according specified formula hospital claim type hospital day period year amends title xviii medicare social security act respect medicare_integrity_program use recovery audit contractors requires secretary ensure recovery audit contracts include certain mandatory terms conditions pertaining penalties certain compliance failures penalties overturned appeals prepayment audits guidelines prepayment review directs secretary publish internet website centers information recovery audit contractor performance audit rates denials appeals outcomes independent performance evaluations deems original claim medicare supplementary_medical_insurance payment resubmitted hospital claim medicare payment inpatient hospital services recovery audit contractor determines medically necessary reasonable based site service medically necessary reasonable outpatient setting hospital requires payment resubmitted claim furnished items services payment medicare deems reopened claim purposes hospital ability resubmit claim medicare payment timely fashion claim subject audit recovery audit contractor medicare administrative contractor requires contracts recovery audit contractor require physician review denial claim medical necessity employee contractor physician subjects administrative judicial review secretary compliance guidelines reopening revising benefit determinations |
113-HR-1473 | Standard of Care Protection Act of 2013 - Declares that the development, recognition, or implementation of any guideline or other standard under any provision of the Patient Protection and Affordable Care Act (PPACA) or titles XVIII (Medicare) or XIX (Medicaid) of the Social Security Act shall not be construed to establish the standard of care or duty of care owed by a health care provider to a patient in any medical malpractice case.
Declares also that no provision of PPACA or amendments made by it shall be construed to preempt any state law governing medical professional liability cases. | Health | Medical Liability | Health | 2013-04-10 | declares development recognition implementation guideline standard provision patient_protection affordable care act ppaca titles xviii medicare xix medicaid social security act shall construed establish standard care duty care owed health care provider patient medical malpractice case declares provision ppaca amendments shall construed preempt state law governing medical professional liability cases |
113-HR-1487 | Improved Health Care at Lower Cost Act of 2013 - Amends title XVIII (Medicare) and XI of the Social Security Act with respect to the prohibition against certain (potential financial conflict-of-interest) physician referrals.
Excepts from the physician self-referral prohibition any monetary incentive payments made by hospitals to physicians under certain incentive payment programs designed to align incentives among hospitals and physicians (through techniques such as product standardization, the substitution of lower cost products, and care coordination initiatives that encourage medically appropriate decreases in length of stay) to improve efficiency and decrease costs while maintaining or improving quality.
Exempts such monetary incentive payments (creates a safe harbor for them) from federal criminal antikickback and other sanctions. | Health | Medical Liability | Health | 2013-04-11 | amends title xviii medicare social security act respect prohibition certain potential financial conflict interest physician referrals excepts physician self referral prohibition monetary incentive payments hospitals physicians certain incentive payment programs designed align incentives hospitals physicians techniques product standardization substitution lower cost products care coordination initiatives encourage medically appropriate decreases length stay improve efficiency decrease costs maintaining improving quality exempts monetary incentive payments creates safe harbor federal criminal antikickback sanctions |
113-HR-1733 | Good Samaritan Health Professionals Act of 2013 - Amends the Public Health Service Act to shield a health care professional from liability under federal or state law for harm caused by any act or omission if: (1) the professional is serving as a volunteer in response to a disaster; and (2) the act or omission occurs during the period of the disaster, in the professional's capacity as such a volunteer, and in a good faith belief that the individual being treated is in need of health care services.
Makes exceptions where: (1) the harm was caused by an act or omission constituting willful or criminal misconduct, gross negligence, reckless misconduct, or a conscious flagrant indifference to the rights or safety of the individual harmed; or (2) the professional rendered the health care services under the influence of intoxicating alcohol or an intoxicating drug. | Health | Medical Liability | Health | 2013-04-25 | good samaritan health professionals act amends public_health_service_act shield health care professional liability federal state law harm caused act omission professional serving volunteer response disaster act omission occurs period disaster professional capacity volunteer good faith belief individual treated need health care services makes exceptions harm caused act omission constituting willful criminal misconduct gross negligence reckless misconduct conscious flagrant indifference rights safety individual harmed professional rendered health care services influence intoxicating alcohol intoxicating drug |
113-HR-1841 | State Leadership in Health Care Act - Amends the Patient Protection and Affordable Care Act (PPACA) to allow states to apply for a waiver of specified requirements under PPACA with respect to health insurance coverage within that state due to implementation of a state plan that provides comparable coverage for plan years beginning in 2015 (currently, 2017). Permits the Secretary of Health and Human Services (HHS) or the Secretary of the Treasury to deny waivers only if: (1) the state plan does not meet requirements for granting a waiver, (2) the Secretary of HHS or the Treasury notifies the state in writing of the requirements that the state plan did not meet and provides the state with information used in making such a determination, and (3) the state is given an opportunity to appeal.
Requires the Secretary of HHS or the Treasury to reconsider the determination in the event of an appeal and issue a written decision within 60 days. | Health | Medical Liability | Health | 2013-05-06 | state leadership health care act amends patient protection affordable care act ppaca allow states apply waiver specified requirements ppaca respect health insurance coverage state implementation state plan provides comparable coverage plan years beginning currently permits secretary health_and_human_services hhs secretary treasury deny waivers state plan meet requirements granting waiver secretary hhs treasury notifies state writing requirements state plan meet provides state information making determination state given opportunity appeal requires secretary hhs treasury reconsider determination event appeal issue written decision days |
113-HR-2305 | Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2013 or PRIME Act of 2013 - Amends part D (Prescription Drug Benefits) of title XVIII (Medicare) of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS) to prohibit sponsors of prescription drug plans (PDPs) from paying claims for prescription drugs that do not include the valid National Provider Identifier for the drug's prescriber.
Requires the Secretary's annual report to Congress on the use of recovery audit contractors under the Medicare Integrity Program to: (1) describe the types and financial cost of improper payment vulnerabilities identified by recovery audit contractors and how the Secretary is addressing them, and (2) assess the effectiveness of changes made to Medicare payment policies and procedures in order to address those vulnerabilities.
Requires the Secretary to address improper payment vulnerabilities in a timely manner, prioritized based on the risk to the Medicare program.
Authorizes the Secretary, under recovery audit contracts under both Medicare and Medicaid (SSA title XIX), to retain a certain portion of the recovered amounts for a program management account for activities addressing problems that contribute to improper payments and fraud.
Requires the Secretary, under such contracts, to retain an additional 5% of the recovered amounts to be made available to the HHS Inspector General to investigate improper payments or audit internal controls associated with Medicare or Medicaid payments.
Directs the Secretary to develop a plan to revise the incentive program under the Health Insurance Portability and Accountability Act of 1996 for the reporting of fraud and abuse to encourage greater participation by individuals reporting Medicare fraud and abuse. Requires the plan to include certain recommendations for: (1) ways to enhance rewards for individuals reporting, and (2) extention of the incentive program to the Medicaid program.
Amends SSA title XIX to cover the costs of equipment, salaries and benefits, and travel and training in appropriations for the Medicaid Integrity Program. Allows the Secretary to increase Centers for Medicare and Medicaid Services (CMS) staff whose duties consist solely of protecting the integrity of the Medicare program by a number determined necessary to carry out the Program (currently, by 100).
Directs the Secretary to provide incentives for Medicare administrative contractors to reduce the improper payment error rates in their jurisdictions.
Requires imprisonment for up to 10 years or a fine of up to $500,000 ($1 million in the case of a corporation), or both, for knowingly, intentionally, and with the intent to defraud purchasing, selling, distributing, or arranging for the purchase, sale, or distribution of a Medicare, Medicaid, or CHIP beneficiary identification number or billing privileges under SSA titles XVIII, title XIX, or title XXI (Children's Health Insurance Program).
Amends SSA title IV part D (Child Support and Establishment of Paternity) with respect to the Federal Parent Locator Service to give the CMS Administrator access to information in the National Directory of New Hires to determine the eligibility of an applicant for, or enrollee in, the Medicare program or an applicable state health subsidy program under the Patient Protection and Affordable Care Act (PPACA).
Requires the Secretary to disclose to the HHS Inspector General information on individuals and their employers in the National Directory of New Hires if the HHS Inspector General gives the Secretary their names and Social Security account numbers. Restricts the use of such information to: (1) determining the eligibility of an applicant for, or enrollee in, the Medicare program or an applicable state health subsidy program; or (2) evaluating the integrity of such programs. Sets forth rules for the use and disclosure of such information by state agencies.
Directs the Secretary to establish a plan to encourage and facilitate the participation of states in the Medicare-Medicaid Data Match Program (Medi-Medi Program). Revises Medi-Medi Data Match Program purposes.
Amends SSA title XIX, as amended by PPACA, and XXI with respect to claims processing and detection of fraud within the Medicaid and CHIP programs. | Health | Medical Liability | Health | 2013-06-10 | preventing reducing improper medicare medicaid expenditures act prime act amends prescription drug benefits title xviii medicare social security act ssa direct secretary health_and_human_services hhs prohibit sponsors prescription drug plans pdps paying claims prescription drugs include valid national provider identifier drug prescriber requires secretary annual report congress use recovery audit contractors medicare_integrity_program describe types financial cost improper payment vulnerabilities identified recovery audit contractors secretary addressing assess effectiveness changes medicare payment policies procedures order address vulnerabilities requires secretary address improper payment vulnerabilities timely manner prioritized based risk medicare program authorizes secretary recovery audit contracts medicare medicaid ssa title xix retain certain portion recovered amounts program management account activities addressing problems contribute improper payments fraud requires secretary contracts retain additional recovered amounts available investigate improper payments audit internal controls associated medicare medicaid payments directs secretary develop plan revise incentive program health_insurance_portability_and_accountability_act reporting fraud abuse encourage greater participation individuals reporting medicare fraud abuse requires plan include certain recommendations ways enhance rewards individuals reporting incentive program medicaid program amends ssa title xix cover costs equipment salaries benefits travel training appropriations medicaid_integrity_program allows secretary increase centers medicare medicaid_services cms staff duties consist solely protecting integrity medicare program number determined necessary carry program currently directs secretary provide incentives medicare administrative contractors reduce improper payment error rates jurisdictions requires imprisonment years fine million case corporation knowingly intentionally intent defraud purchasing selling distributing arranging purchase sale distribution medicare medicaid chip beneficiary identification number billing privileges ssa titles xviii title xix title amends ssa title child support establishment paternity respect federal_parent_locator_service access information national_directory_of_new_hires determine eligibility applicant enrollee medicare program applicable state health subsidy program patient_protection affordable care act ppaca requires secretary disclose hhs_inspector general information individuals employers national_directory_of_new_hires hhs_inspector general gives secretary names social_security account numbers restricts use information determining eligibility applicant enrollee medicare program applicable state health subsidy program evaluating integrity programs sets forth rules use disclosure information state agencies directs secretary establish plan encourage facilitate participation states medicare-medicaid data_match_program medi-medi_program data match program purposes amends ssa title xix amended ppaca xxi respect claims processing detection fraud medicaid chip programs |
113-HR-2703 | Family Health Care Accessibility Act of 2013 - Amends the Public Health Service Act to deem a health professional volunteer providing primary health care to an individual at a community health center to be an employee of the Public Health Service for purposes of any civil action that may arise from providing services to patients. Sets forth conditions for such liability protection, including: (1) the service is provided to the individual at a community health center or through offsite programs or events carried out by such center; and (2) the health care practitioner does not receive any compensation for providing the service, except repayment for reasonable expenses.
Considers an entity as sponsoring the health care practitioner if the entity submits an application to the Secretary of Health and Human Services (HHS), and the Secretary determines that the health care practitioner is deemed to be an employee of the Public Health Service.
Requires the Attorney General to submit to Congress an estimate of the amount of claims (together with related fees and expenses of witnesses) that, by reason of the actions or omissions of health professional volunteers, will be paid pursuant to this Act annually. Requires the Secretary to transfer such estimated amount from the claims fund to the appropriate accounts in the Treasury, subject to the extent of amounts in the fund.
Makes this Act effective on October 1, 2014. | Health | Medical Liability | Health | 2013-07-17 | family health care accessibility act amends public_health_service_act deem health professional volunteer providing primary health care individual community health center employee public_health_service purposes civil action arise providing services patients sets forth conditions liability protection including service provided individual community health center offsite programs events carried center health care practitioner receive compensation providing service repayment reasonable expenses considers entity sponsoring health care practitioner entity submits application secretary health_and_human_services hhs secretary determines health care practitioner deemed employee public_health_service requires attorney general submit congress estimate claims related fees expenses witnesses reason actions omissions health professional volunteers paid pursuant act annually requires secretary transfer estimated claims fund appropriate accounts treasury subject extent amounts fund makes act effective october |
113-HR-2828 | Medicare Abuse Prevention Act of 2013 or MAP Act of 2013 - Amends title XI of the Social Security Act (SSA) to increase civil money penalties, criminal fines, and prison sentences for fraud and abuse under the SSA title XVIII (Medicare) program.
Directs the Secretary of Health and Human Services to submit to Congress annual fraud reports with respect to Medicare, SSA title XIX (Medicaid), and SSA title XXI (Children's Health Insurance) (CHIP).
Amends the Small Business Jobs Act to exempt from disclosure under the Freedom of Information Act the algorithms used in predictive modeling and other analytics technology to identify and prevent waste, fraud, and abuse in the Medicare fee-for-service program.
Requires valid National Provider Identifiers for prescribers on pharmacy claims for covered Medicare part D prescription drugs.
Requires a prescription drug plan (PDP) sponsor identifying a claim for reimbursement for a drug prescribed by an individual without a valid National Provider Identifier to report to the HHS Inspector General any relevant information on such a prescriber, including any invalid national provider identifiers being used to submit such claims and related records. Requires the Inspector General of HHS to provide such information to appropriate law enforcement agencies.
Directs the Secretary of HHS to establish procedures and rules to restrict access to the National Provider Identifier Registry in order to deter the fraudulent use of National Provider Identifiers.
Decreases by 10% per quarter the federal medical assistance percentage (FMAP) for a state if: (1) it is receiving a grant for a state controlled substance monitoring program through which it identifies fraud, waste, or abuse in connection with the provision of prescription drug coverage under the state Medicaid plan; and (2) the state or a political subdivision is reimbursed by a third party for expenditures related to such fraud, waste, or abuse, or for a recovered amount.
Directs the Secretary of HHS to establish procedures to eliminate the unnecessary collection, use, and display of Social Security account numbers of Medicare beneficiaries.
Requires the Secretary of HHS to ensure that each newly issued Medicare identification card does not display or electronically store, in an unencrypted format, a Medicare beneficiary's Social Security account number, unless the beneficiary's health insurance claim number is the beneficiary's or spouse's Social Security number, and the risk of fraudulent use of such numbers is not unacceptably high.
Requires the Secretary of HHS to prohibit the display of a Medicare beneficiary's Social Security account number in any written or electronic communication to the beneficiary unless its inclusion is essential for the operation of the Medicare program.
Directs the Secretary of HHS to establish a pilot program to evaluate the applicability of smart card technology to the Medicare program, and whether such cards would be effective in preventing Medicare fraud.
Prohibits payment for an item or service under Medicaid or CHIP unless the claim contains: (1) a valid beneficiary identification number corresponding to an individual enrolled under the state plan or an applicable waiver; and (2) a valid provider identifier corresponding to a provider eligible to receive payment for furnishing such item or service. | Health | Medical Liability | Health | 2013-07-25 | medicare abuse prevention act map act amends title social security act ssa increase civil money penalties criminal fines prison sentences fraud abuse ssa title xviii medicare program directs secretary health_and_human_services submit congress annual fraud reports respect medicare ssa title xix medicaid ssa title chip amends small_business_jobs_act exempt disclosure freedom information act predictive modeling analytics technology identify prevent waste fraud abuse medicare fee service program requires valid national provider identifiers prescribers pharmacy claims covered medicare prescription drugs requires prescription drug plan pdp sponsor identifying claim reimbursement drug prescribed individual valid national provider identifier report hhs_inspector general relevant information prescriber including invalid national provider identifiers submit claims related records requires inspector general hhs provide information appropriate law enforcement agencies directs secretary hhs establish procedures rules restrict access order deter fraudulent use decreases quarter federal medical assistance percentage fmap state receiving grant state controlled substance monitoring program identifies fraud waste abuse connection provision prescription drug coverage state medicaid plan state political subdivision reimbursed party expenditures related fraud waste abuse recovered directs secretary hhs establish procedures eliminate unnecessary collection use display social_security account numbers medicare beneficiaries requires secretary hhs ensure newly issued medicare identification card display electronically store unencrypted format medicare beneficiary social_security account number beneficiary health insurance claim number beneficiary spouse social_security number risk fraudulent use numbers high requires secretary hhs prohibit display medicare beneficiary social_security account number written electronic communication beneficiary inclusion essential operation medicare program directs secretary hhs establish pilot program evaluate applicability smart card technology medicare program cards effective preventing medicare fraud prohibits payment item service medicaid chip claim contains valid beneficiary identification number corresponding individual enrolled state plan applicable waiver valid provider identifier corresponding provider eligible receive payment furnishing item service |
113-HR-2843 | Medicare Data Access for Transparency and Accountability Act - Amends title XI of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS) to make available to the public HHS claims and payment data related to SSA title XVIII (Medicare), including data on payments made to any service provider or supplier. | Health | Medical Liability | Health | 2013-07-25 | title social security act ssa direct secretary health_and_human_services hhs available public hhs claims payment data related ssa title xviii medicare including data payments service provider supplier |
113-HR-2931 | Fairness in Health Care Claims, Guidance, and Investigations Act - Amends the False Claims Act to set forth special rules for the investigation and prosecution of false claims submitted with respect to a federal health care program (i.e., a health care program funded by the federal government, a state health care program defined by the Social Security Act, or a health plan offered under the Patient Protection and Affordable Care Act).
Requires the Attorney General to certify in writing, prior to requesting any information from a physician, hospital, or other provider or supplier of health care services in connection with an investigation reasonably expected to concern 10 or more claims submitted to a federal health care program by or on behalf of a single entity, that: (1) each agency responsible for promulgating relevant regulations, guidelines, and billing instructions relevant to any allegations of fraud has examined such regulations, guidelines, and instructions, all communications between the alleged perpetrator of the fraud and the agency, and each of the allegedly false claims; (2) the allegations under investigation are viewed as viable based on unambiguous regulations, guidelines, and billing instructions issued during the relevant time period; and (3) if proven to be true, the allegations will be pursued under the False Claims Act.
Prohibits an action against a health care provider or supplier under the False Claims Act: (1) unless the amount of damages alleged to have been sustained by the government is a material amount, (2) if a claim is submitted in good faith reliance on erroneous information or written statements of federal policy provided by a federal agency or in good faith reliance on an audit or review by an agency of the entity submitting the claim or retaining an overpayment, or (3) if a claim is submitted in substantial compliance with a model compliance plan issued by the Secretary of Health and Human Services (HHS).
Establishes the standard of proof necessary for a civil prosecution of a claim submitted with respect to a federal health care program as clear and convincing evidence (currently, a preponderance of the evidence is required for all other claims). | Health | Medical Liability | Health | 2013-08-01 | fairness health care claims guidance investigations act amends false claims act set forth special rules investigation prosecution false claims submitted respect federal health care program health care program funded federal government state health care program defined social_security_act health plan offered patient_protection affordable care act requires attorney general certify writing prior requesting information physician hospital provider supplier health care services connection investigation reasonably expected concern claims submitted federal health care program behalf single entity agency responsible promulgating relevant regulations guidelines billing instructions relevant allegations fraud examined regulations guidelines instructions communications alleged perpetrator fraud agency allegedly false claims allegations investigation viewed viable based unambiguous regulations guidelines billing instructions issued relevant time period proven true allegations pursued false claims act prohibits action health care provider supplier false claims act damages alleged sustained government material claim submitted good faith reliance erroneous information written statements federal policy provided federal agency good faith reliance audit review agency entity submitting claim retaining overpayment claim submitted substantial compliance model compliance plan issued secretary health_and_human_services hhs establishes standard proof necessary civil prosecution claim submitted respect federal health care program clear convincing evidence currently preponderance evidence required claims |
113-HR-2960 | Medicare Prescription Drug Integrity Act of 2013 - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act (SSA) to require a prescription drug plan (PDP) sponsor to have in place procedures designed to prevent fraud and abuse in PDPs.
Authorizes the Secretary of Health and Human Services (HHS), with respect to establishing special enrollment periods for full-benefit dual eligible individuals, to set coverage limits for individuals who have obtained coverage for a covered Medicare part D drug at a frequency or amount not medically necessary.
Amends SSA title IX to allow the Secretary to exclude from participation in any federal health care program any individual or entity that has engaged in the inappropriate prescribing or dispensing of a covered Medicare part D drug.
Amends SSA title XVIII part D to allow a PDP or a MedicareAdvantage-PD (MA-PD) plan to exclude from qualified prescription drug coverage, and deny payment for, any covered part D drug: (1) prescribed or dispensed inappropriately to an individual under a PDP or a MA-PD plan that could not have been prescribed or dispensed to the individual on the date of such prescribing or dispensing; or (2) any drug at a frequency or amount that represents a practice or pattern of abusive prescribing or dispensing, or presents a risk to enrollee health or safety.
Amends the Controlled Substances Act to direct the Attorney General to: (1) compile a list of the unique health identifiers of prescribers and dispensers that are members of a group practice registered and authorized to prescribe or dispense controlled substances in schedules II and III, and (2) make the list available to all PDP sponsors.
Amends SSA title XVIII with respect to the use of recovery audit contractors under the Medicare Integrity Program to identify underpayments and overpayments and recoup the latter. Authorizes the Secretary to retain an additional portion of up to 25% of the amounts recovered for purposes of carrying out this Act. | Health | Medical Liability | Health | 2013-08-01 | amends voluntary prescription drug benefit program title xviii medicare social security act ssa require prescription drug plan pdp sponsor place procedures designed prevent fraud abuse pdps authorizes secretary health_and_human_services hhs respect establishing special enrollment periods benefit dual eligible individuals set coverage limits individuals obtained coverage covered medicare drug frequency medically necessary amends ssa title allow secretary exclude participation federal health care program individual entity engaged inappropriate prescribing dispensing covered medicare drug amends ssa title xviii allow pdp medicareadvantage ma-pd plan exclude qualified prescription drug coverage deny payment covered drug prescribed dispensed inappropriately individual pdp plan prescribed dispensed individual date prescribing dispensing drug frequency represents practice pattern abusive prescribing dispensing presents risk enrollee health safety amends controlled substances act direct attorney general compile list unique health identifiers prescribers dispensers members group practice registered authorized prescribe dispense controlled substances schedules iii list available pdp sponsors amends ssa title xviii respect use recovery audit contractors medicare_integrity_program identify underpayments overpayments recoup authorizes secretary retain additional portion amounts recovered purposes carrying act |
113-HR-3168 | Medicare Established Provider Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services (HHS) to develop a system to designate service providers and suppliers who meet specified criteria representing a low risk for submitting fraudulent Medicare claims as established providers afforded certain special treatment in the claim review process. | Health | Medical Liability | Health | 2013-09-20 | medicare established provider act amends title xviii medicare social security act direct secretary health_and_human_services hhs develop system designate service providers suppliers meet specified criteria representing low risk submitting fraudulent medicare claims established providers afforded certain special treatment claim review process |
113-HR-3392 | Medicare Part D Patient Safety and Drug Abuse Prevention Act of 2013 - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act (SSA) to establish a safe pharmacy access program under which a prescription drug plan (PDP) sponsor (or a Medicare Advantage (MA) organization offering an MA-PD plan) shall have in place procedures designed to prevent fraud and abuse in the dispensing of certain controlled substances under Medicare part D.
Allows a PDP sponsor to suspend payments and clean claim notifications to a pharmacy pending an investigation of a credible allegation of fraud against the pharmacy, unless the Secretary determines there is a good cause not to suspend payments.
Directs the Secretary of Health and Human Services (HHS), under contracts entered into under the Medicare integrity program with Medicare drug integrity contractors (MEDICs), to authorize such MEDICs to obtain prescription and medical records directly from entities such as pharmacies, PDPs, and physicians. Requires a MEDIC to acknowledge receipt of a PDP sponsor referral of information for investigation, report back to the sponsor the investigation results within 45 days, and share them with appropriate agencies.
Requires electronic transmission (e-prescribing) of prescriptions for certain covered Medicare part D controlled substances. | Health | Medical Liability | Health | 2013-10-30 | medicare patient safety drug abuse prevention act amends voluntary prescription drug benefit program title xviii medicare social security act ssa establish safe pharmacy access program prescription drug plan pdp sponsor medicare advantage organization offering ma-pd plan shall place procedures designed prevent fraud abuse dispensing certain controlled substances medicare allows pdp sponsor suspend payments clean claim notifications pharmacy pending investigation credible allegation fraud pharmacy secretary determines good cause suspend payments directs secretary health_and_human_services hhs contracts entered medicare integrity program medicare drug integrity contractors medics authorize medics obtain prescription medical records directly entities pharmacies pdps physicians requires medic acknowledge receipt pdp sponsor referral information investigation report sponsor investigation results days share appropriate agencies requires electronic transmission prescribing prescriptions certain covered medicare controlled substances |
113-HR-3616 | Protecting Seniors from Health Care Fraud Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS), acting through the HHS Office of Inspector General, and the Attorney General to report annually to Congress and the public on health care fraud schemes targeted to seniors and steps being taken to combat such schemes and to educate seniors about them.
Directs the Secretary to: (1) disseminate such reports through mechanisms that reach the most Medicare beneficiaries, and (2) mail to each Medicare beneficiary a list of the top 10 most prevalent health care fraud schemes. | Health | Medical Liability | Health | 2013-11-21 | health care fraud act amends title xviii medicare social security act ssa direct secretary health_and_human_services hhs acting attorney general report annually congress public health care fraud schemes targeted seniors steps taken combat schemes educate seniors directs secretary disseminate reports mechanisms reach medicare beneficiaries mail medicare beneficiary list prevalent health care fraud schemes |
113-HR-4106 | Saving Lives, Saving Costs Act - Establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services.
Requires the Secretary of Health and Human Services (HHS) to publish clinical practice guidelines that have been provided and maintained by national or state medical societies or medical specialty societies designated by the Secretary. Sets forth standards for the development of guidelines, including related to transparency, the composition of the panel, and the review of existing evidence.
Declares that this Act does not preempt or supersede any state or federal law that imposes greater procedural or substantive protections for health care providers and health care organizations from liability, loss, or damages than those provided under this Act nor does it create a cause of action or preempt any defenses otherwise available.
Allows a defendant to remove any health care liability action brought in a state court to a district court.
Requires an independent medical review in health care liability actions if the eligible professionals allege that they adhered to applicable clinical practice guideline. Sets forth procedures for the use of the panel's findings at trial. Enables defendants to recover costs and attorneys' fees from plaintiffs if the defendants prevail subsequent to preliminary findings in their favor. | Health | Medical Liability | Health | 2014-02-27 | saving lives saving costs act establishes framework health care liability lawsuits undergo review independent medical review panels health care professionals practicing physicians agents employees allege adherence applicable clinical practice guidelines provision health care goods services requires secretary health_and_human_services hhs publish clinical practice guidelines provided maintained national state medical societies medical specialty societies designated secretary sets forth standards development guidelines including related transparency composition panel review existing evidence declares act preempt supersede state federal law imposes greater procedural substantive protections health care providers health care organizations liability loss damages provided act create cause action preempt defenses available allows defendant remove health care liability action brought state court district court requires independent medical review health care liability actions eligible professionals allege applicable clinical practice guideline sets forth procedures use panel findings trial enables defendants recover costs attorneys fees plaintiffs defendants prevail subsequent preliminary findings favor |
113-HR-4437 | Generic Drug Pricing Fairness Act - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act to require each contract entered into with a prescription drug plan (PDP) sponsor with respect to a PDP the sponsor offers to prohibit the PDP from entering into a contract with any pharmacy benefits manager (PBM) to manage the prescription drug coverage provided under such plan, or to control the costs of the prescription drug coverage under it, unless the PBM adheres to specified criteria when handling personally identifiable utilization and claims data or other sensitive patient data.
Revises requirements for contracts with PDP sponsors to require that the PDP sponsor disclose to applicable pharmacies the sources used for making any update of the prescription drug pricing standard, and if the source for such a standard is not publicly available, disclose to such pharmacies all individual drug prices to be so updated in advance of their use for the reimbursement of claims. Requires the PDP sponsor, as well, to establish a process to appeal, investigate, and resolve disputes regarding individual drug prices that are less than the pharmacy acquisition price for a drug. | Health | Medical Liability | Health | 2014-04-09 | fairness act amends voluntary prescription drug benefit program title xviii medicare social security act require contract entered prescription drug plan pdp sponsor respect pdp sponsor offers prohibit pdp entering contract pharmacy benefits manager pbm manage prescription drug coverage provided plan control costs prescription drug coverage pbm adheres specified criteria handling personally identifiable utilization claims data sensitive patient data revises requirements contracts pdp sponsors require pdp sponsor disclose applicable pharmacies sources making update prescription drug pricing standard source standard publicly available disclose pharmacies individual drug prices updated advance use reimbursement claims requires pdp sponsor establish process appeal investigate resolve disputes individual drug prices pharmacy acquisition price drug |
113-HR-5083 | Medicare DMEPOS Audit Improvement and Reform (AIR) Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to establish a Medicare Administrative Contractor Payment Outreach and Education Program for DMEPOS (durable medical equipment, prosthetics, orthotics, and supplies) suppliers.
Requires each Medicare administrative contractor responsible for DMEPOS payments, in order to reduce improper payments to DMEPOS suppliers under Medicare part B (Supplementary Medical Insurance), to provide suppliers, physicians and practitioners who prescribe DMEPOS, and discharge planners and case managers who coordinate DMEPOS for individuals in the contractor's area with error rate reduction training as well as:
a list of suppliers' most frequent payment errors and the most expensive payment errors over the last quarter, specific instructions regarding how to correct or avoid such errors in the future as well as to prevent future issues related to new audits, and a notice of all new topics that have been approved by the Secretary of Health and Human Services (HHS) for audits. Sets forth the structure for audits of DMEPOS suppliers, requiring a contractor to give priority to activities under the DMEPOS payment outreach and education program that will reduce improper Medicare payments based on technical errors, medical necessity, and fraud.
Requires annual reports to Congress on the use of recovery audit contractors under the Medicare Integrity Program to include certain information on the results of audit appeals related to DMEPOS.
Requires the Secretary to: (1) increase the maximum record requests made by Medicare DMEPOS contractors in auditing claims of suppliers with a relatively high audited claims error rate for DMEPOS payments, and (2) decrease the maximum record requests for suppliers with a relatively low error rate.
Directs the Secretary to limit the audit documentation review period for Medicare administrative contractors to three years. | Health | Medical Liability | Health | 2014-07-11 | act amends title xviii medicare social security act ssa establish education program dmepos durable medical equipment prosthetics orthotics supplies suppliers requires medicare administrative contractor responsible dmepos payments order reduce improper payments dmepos suppliers medicare supplementary_medical_insurance provide suppliers physicians practitioners prescribe dmepos discharge planners case managers coordinate dmepos individuals contractor area error rate reduction training list suppliers frequent payment errors expensive payment errors quarter specific instructions correct avoid errors future prevent future issues related new audits notice new topics approved secretary health_and_human_services hhs audits sets forth structure audits dmepos suppliers requiring contractor priority activities dmepos payment outreach education program reduce improper medicare payments based technical errors medical necessity fraud requires annual reports congress use recovery audit contractors medicare_integrity_program include certain information results audit appeals related dmepos requires secretary increase maximum record requests contractors auditing claims suppliers relatively high audited claims error rate dmepos payments decrease maximum record requests suppliers relatively low error rate directs secretary limit audit documentation review period medicare administrative contractors years |
113-HR-5340 | Fighting Medicare Fraud Act of 2014 - Amends title XI of the Social Security Act (SSA) with respect to the authority of the Secretary of Health and Human Services (HHS) to exclude from federal health programs certain individuals, including officers or managing employees, with an ownership or control interest in entities sanctioned for a criminal conviction relating to fraud, obstruction of an investigation or audit, or a misdemeanor related to a controlled substance.
Extends the permissive exclusion from federal health programs to persons, including officers or managing employees, with an ownership or control interest in entities affiliated with a sanctioned entity. Includes individuals with such connections at the time of the conduct that formed a basis for the conviction or exclusion of the sanctioned entity or the affiliated entity.
Establishes criminal penalties for anyone who knowingly and with intent to defraud purchases, sells, or distributes, or arranges for the purchase, sale, or distribution of two or more beneficiary identification or provider numbers under SSA titles XVIII (Medicare), XIX (Medicaid), or XXI (Children's Health Insurance Program [CHIP]).
Amends SSA title XVIII part C (Medicare+Choice) to require a contract with a Medicare Advantage (MA) organization offering an MA plan to require that the MA organization report to the Secretary any instances of probable fraud or abuse related to the payment or delivery of health benefits within 60 days after the organization identifies that instance. | Health | Medical Liability | Health | 2014-07-31 | fighting medicare amends title social security act ssa respect authority secretary health_and_human_services hhs exclude federal health programs certain individuals including officers managing employees ownership control interest entities sanctioned criminal conviction relating fraud obstruction investigation audit misdemeanor related controlled substance extends exclusion federal health programs persons including officers managing employees ownership control interest entities affiliated sanctioned entity includes individuals connections time conduct formed basis conviction exclusion sanctioned entity affiliated entity establishes criminal penalties knowingly intent defraud purchases sells distributes arranges purchase sale distribution beneficiary identification provider numbers ssa titles xviii medicare xix medicaid amends ssa title xviii require contract organization offering plan require organization report secretary instances probable fraud abuse related payment delivery health benefits days organization identifies instance |
113-HR-5732 | Stop Schemes and Crimes Against Medicare and Seniors (Stop SCAMS) Act - Amends title XI of the Social Security Act with respect to standards for financial and administrative transactions and their data elements to enable the electronic exchange of health information.
Requires the Secretary of Health and Human Services (HHS) to adopt standards that: (1) ensure that any entity producing and transmitting valid transactions that include code sets for appropriate data elements is subject to a consistent, industry-wide framework that supports a seamless transition to new and modified code sets; and (2) establish an end-to-end testing procedure for new and modified code sets that shall require the participation of any entity producing and transmitting valid transactions that use the new or modified code set.
Prohibits the Secretary from adopting a new or modified code set unless the Secretary: (1) assesses its impact on fraud prevention and pre-payment review, determines that anti-fraud edits work as intended, and confirms that a plan is in place to ensure continuing effective detection of fraud following the adoption of the code set; (2) ensures that the end-to-end testing procedure established has been completed; and (3) completes end-to-end testing with any federal government entity that produces and transmits valid transactions that include the code set with private sector tracking partners. Exempts routine, regularly scheduled updates to existing code sets from such prohibition.
Directs the Secretary, with respect to information supplied to it by a disclosing entity about those with an ownership or control interest in the entity, to verify such information in a specified manner and confirm the accuracy of any Social Security account number or employer identification number.
Holds immune from civil liability (in a safe harbor) any non-governmental entity participating in a Healthcare Fraud Prevention Partnership, including private insurers, for sharing information about potentially fraudulent providers with each other, HHS, the Department of Justice (DOJ), any other federal or state law enforcement agency, any federal or state agency contractor, and another Partnership participant.
Directs the Medicare Payment Advisory Commission (MEDPAC) to study administrative efforts to strengthen program integrity in the Medicare program.
Amends the Small Business Jobs Act of 2010, with respect to the use of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse in the Medicare fee-for-service program, to require predictive analytics technologies to capture outcome information on civil recoveries, administrative actions, and criminal convictions for fraud. | Health | Medical Liability | Health | 2014-11-18 | act_-_amends title social security act respect standards financial administrative transactions data elements enable electronic exchange health information requires secretary health_and_human_services hhs adopt standards ensure entity producing transmitting valid transactions include code sets appropriate data elements subject consistent industry wide framework supports seamless transition new modified code sets establish end end testing procedure new modified code sets shall require participation entity producing transmitting valid transactions use new modified code set prohibits secretary adopting new modified code set secretary assesses impact fraud prevention pre payment review determines anti fraud work intended confirms plan place ensure continuing effective detection fraud following adoption code set ensures end end testing procedure established completed completes end end testing federal government entity produces transmits valid transactions include code set private sector tracking partners exempts routine regularly scheduled updates existing code sets prohibition directs secretary respect information supplied disclosing entity ownership control interest entity verify information specified manner confirm accuracy social_security account number employer identification number holds immune civil liability safe harbor non governmental entity participating including private insurers sharing information potentially fraudulent providers hhs department_of_justice doj federal state law enforcement agency federal state agency contractor partnership participant directs medicare_payment_advisory_commission medpac study administrative efforts strengthen program integrity medicare program amends small_business_jobs_act respect use predictive modeling analytics technologies identify prevent waste fraud abuse medicare fee service program require predictive analytics technologies capture outcome information civil recoveries administrative actions criminal convictions fraud |
113-HR-5780 | Protecting the Integrity of Medicare Act of 2014 - Amends title II (Old Age, Survivors and Disability Insurance) (OASDI) of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS) to establish cost-effective procedures to ensure that: (1) a Social Security account number (or any derivative) is not displayed, coded, or embedded on the Medicare card issued to an individual entitled to benefits under part A (Hospital Insurance) of SSA title XVIII (Medicare) or enrolled under Medicare part B (Supplementary Medical Insurance); and (2) any other identifier displayed on such card is not identifiable as a Social Security account number (or any derivative).
Directs the Secretary to establish procedures to ensure that Medicare payment is not made for items and services furnished to an individual incarcerated, deceased, or otherwise ineligible and not lawfully present in the United States.
Directs the Secretary, if cost-effective and technologically viable, to consider appropriate measures to implement use of electronic Medicare beneficiary and provider cards.
Extends the Medicare durable medical equipment (DME) face-to-face encounter documentation requirement to include physician assistants, practitioners, or specialists as well as physicians (as under current law).
Requires each Medicare administrative contractor to establish an improper payment outreach and education program for service providers and suppliers in order to reduce improper Medicare payments.
Requires the Secretary to develop a plan to revise the incentive program under the Health Insurance Portability and Accountability Act of 1996 to encourage greater participation by individuals to report fraud and abuse in the Medicare program.
Directs the Secretary to require a claim for a covered Medicare part D (Voluntary Prescription Drug Benefit Program) drug for an individual enrolled in a prescription drug plan (PDP) or in a Medicare Advantage Prescription Drug (MA-PD) plan to include a valid prescriber National Provider Identifier.
Gives Medicare beneficiaries the option to receive the Medicare Summary Notice (explanation of benefits) electronically.
Directs the Secretary to: (1) apply competitive procedures to selection of a Medicare administrative contractor at least once every 10 years (currently once every 5 years); and (3) study and, as appropriate, specify incentives for states to work with the Secretary under the Medicare-Medicaid Data Match Program to protect the federal and state share of expenditures.
Authorizes a PDP sponsor to establish a drug management program for at-risk beneficiaries.
Directs the Secretary to authorize Medicare drug integrity contractors (MEDICs) to accept directly an individual's prescription and necessary medical records from pharmacies, prescription drug plans, and physicians in order for MEDICs to provide information relevant to determining whether the individual is an at-risk beneficiary.
Directs the Secretary to issue a clarification or modification with respect to the application of the Common Rule (governing the protection of human subjects in research) to activities involving clinical data registries.
Amends SSA title XI to eliminate civil monetary penalties for inducements to physicians to limit services that are not medically necessary.
Directs the Secretary to report to Congress on options for amending existing Medicare fraud and abuse laws and regulations to permit gainsharing or similar arrangements between physicians and hospitals that would otherwise be subject to penalties.
Modifies the Medicare home health surety bond condition of participation requirement.
Directs the Secretary to: (1) implement a process for medical review of spinal subluxation services by a chiropractor, and (2) develop educational and training programs to improve the ability of chiropractors to document services in a manner that demonstrates they are reasonable and necessary.
Applies Medicare competitive bidding to vacuum erection systems, and requires the Secretary to phase-in a national mail order program for such devices.
Requires the Secretary to: (1) revise the testing in New Jersey, Pennsylvania, and South Carolina of a model of prior authorization for repetitive scheduled non-emergent ambulance transport to cover specified additional states; and (2) apply the prior authorization program to all states.
Directs the Secretary to submit a plan to Congress for including in the annual report of the Comprehensive Error Rate Testing (CERT) programs data on services (other than medical visits) paid under the physician fee schedule where the fee schedule amount exceeds $250 and where the error rate exceeds 20%. | Health | Medical Liability | Health | 2014-12-02 | protecting integrity medicare act amends title old age survivors disability insurance oasdi social security act ssa direct secretary health_and_human_services hhs establish cost effective procedures ensure social_security account number derivative displayed coded embedded medicare card issued individual entitled benefits ssa title xviii medicare enrolled medicare supplementary_medical_insurance identifier displayed card identifiable social_security account number derivative directs secretary establish procedures ensure medicare payment items services furnished individual incarcerated deceased ineligible lawfully present united_states directs secretary cost effective technologically viable consider appropriate measures implement use electronic medicare beneficiary provider cards extends medicare durable medical equipment dme face face encounter documentation requirement include physician assistants practitioners specialists physicians current law requires medicare administrative contractor establish improper payment outreach education program service providers suppliers order reduce improper medicare payments requires secretary develop plan revise incentive program health_insurance_portability_and_accountability_act encourage greater participation individuals report fraud abuse medicare program directs secretary require claim covered medicare voluntary prescription drug benefit program drug individual enrolled prescription drug plan pdp medicare advantage prescription drug ma-pd plan include valid prescriber national provider identifier gives medicare beneficiaries option receive medicare summary notice explanation benefits electronically directs secretary apply competitive procedures selection medicare administrative contractor years currently years study appropriate specify incentives states work secretary medicare-medicaid data_match_program protect federal state share expenditures authorizes pdp sponsor establish drug management program risk beneficiaries directs secretary authorize medicare drug integrity contractors medics accept directly individual prescription necessary medical records pharmacies prescription drug plans physicians order medics provide information relevant determining individual risk beneficiary directs secretary issue clarification modification respect application common rule governing protection human subjects research activities involving clinical data registries amends ssa title eliminate civil monetary penalties inducements physicians limit services medically necessary directs secretary report congress options amending existing medicare fraud abuse laws regulations permit gainsharing similar arrangements physicians hospitals subject penalties modifies medicare home health surety bond condition participation requirement directs secretary implement process medical review spinal services chiropractor develop educational training programs improve ability chiropractors document services manner demonstrates reasonable necessary applies medicare competitive bidding vacuum systems requires secretary phase national mail order program devices requires secretary revise testing new_jersey pennsylvania south_carolina model prior authorization repetitive scheduled non emergent ambulance transport cover specified additional states apply prior authorization program states directs secretary submit plan congress including annual report programs data services medical visits paid physician fee schedule fee schedule exceeds error rate exceeds |
113-HR-5815 | Generic Drug Pricing Fairness Act - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act to require each contract entered into with a prescription drug plan (PDP) sponsor with respect to a PDP the sponsor offers to prohibit the PDP from entering into a contract with any pharmacy benefits manager (PBM) to manage the prescription drug coverage provided under such plan, or to control the costs of the prescription drug coverage under it, unless the PBM adheres to specified criteria when handling personally identifiable utilization and claims data or other sensitive patient data.
Revises requirements for contracts with PDP sponsors to require that the PDP sponsor disclose to applicable pharmacies the sources used for making any update of the prescription drug pricing standard, and if the source for such a standard is not publicly available, disclose to such pharmacies all individual drug prices to be so updated in advance of their use for the reimbursement of claims. Requires the PDP sponsor, as well, to establish a process to appeal, investigate, and resolve disputes regarding individual drug prices that are less than the pharmacy acquisition price for a drug.
Directs the Secretary of Defense (DOD), with respect to the TRICARE retail pharmacy program, to ensure that a contract entered into with a TRICARE managed care support contractor includes requirements to ensure the provision of information regarding the pricing standard for prescription drugs.
Establishes criteria to which a carrier and a PBM must adhere under a contract or an approved plan under which the carrier has an agreement with the PBM to manage prescription drug coverage or to control the costs of such coverage.
Prohibits a PBM under such criteria from: (1) transmitting to a pharmacy owned by the PBM any personally identifiable utilization or claims data relating to an enrolled individual who has not voluntarily elected in writing or via secure electronic means to fill that particular prescription at such a pharmacy; or (2) requiring any enrolled individual to use a retail pharmacy, mail order pharmacy, specialty pharmacy, or other pharmacy entity in which the PBM has an ownership interest, or that has an ownership interest in the PBM, or give an incentive to encourage an enrollee to use the pharmacy if the incentive applies only to those pharmacies.
Requires any contract or approved plan providing for a reimbursement standard with respect to a PDP to require the carrier to: (1) update the standard at least once every seven days to reflect the market price of a drug accurately; (2) disclose to pharmacies the sources used for making any such update; (3) make advance disclosure to those pharmacies of all individual drug prices to be updated if the source for a standard is not publicly available; and (4) establish a process to appeal, investigate, and resolve disputes regarding individual drug prices less than the pharmacy acquisition price. | Health | Medical Liability | Health | 2014-12-09 | fairness act amends voluntary prescription drug benefit program title xviii medicare social security act require contract entered prescription drug plan pdp sponsor respect pdp sponsor offers prohibit pdp entering contract pharmacy benefits manager pbm manage prescription drug coverage provided plan control costs prescription drug coverage pbm adheres specified criteria handling personally identifiable utilization claims data sensitive patient data revises requirements contracts pdp sponsors require pdp sponsor disclose applicable pharmacies sources making update prescription drug pricing standard source standard publicly available disclose pharmacies individual drug prices updated advance use reimbursement claims requires pdp sponsor establish process appeal investigate resolve disputes individual drug prices pharmacy acquisition price drug directs secretary defense dod respect tricare retail pharmacy program ensure contract entered tricare managed care support contractor includes requirements ensure provision information pricing standard prescription drugs establishes criteria carrier pbm adhere contract approved plan carrier agreement pbm manage prescription drug coverage control costs coverage prohibits pbm criteria transmitting pharmacy owned pbm personally identifiable utilization claims data relating enrolled individual voluntarily elected writing secure electronic means fill particular prescription pharmacy requiring enrolled individual use retail pharmacy mail order pharmacy specialty pharmacy pharmacy entity pbm ownership interest ownership interest pbm incentive encourage enrollee use pharmacy incentive applies pharmacies requires contract approved plan providing reimbursement standard respect pdp require carrier update standard seven days reflect market price drug accurately disclose pharmacies sources making update advance disclosure pharmacies individual drug prices updated source standard publicly available establish process appeal investigate resolve disputes individual drug prices pharmacy acquisition price |
113-HR-5841 | Local Medicaid Enforcement Incentives Act of 2014 - Directs the Secretary of Health and Human Services (HHS) to establish a grant program to provide states with funds to: (1) detect and prevent Medicaid fraud, waste, and abuse; (2) recover overpayments to individuals or entities receiving Medicaid funds that result from such fraud, waste, or abuse; and (3) share with localities within the state that assist in such detection and prevention, or the recovery of such overpayments, at least 50% of the state's share of the total overpayments recovered during a period, minus administrative costs. | Health | Medical Liability | Health | 2014-12-10 | local directs secretary health_and_human_services hhs establish grant program provide states funds detect prevent medicaid fraud waste abuse recover overpayments individuals entities receiving medicaid funds result fraud waste abuse share localities state assist detection prevention recovery overpayments state share total overpayments recovered period minus administrative costs |
113-S-44 | Medical Care Access Protection Act of 2013 or MCAP Act - Prescribes requirements for lawsuits for health care liability claims related to the provision of health care services.
Sets a statute of limitations of three years after the date of manifestation of injury or one year after the claimant discovers the injury, with certain exceptions.
Requires a court to impose sanctions for the filing of frivolous lawsuits.
Limits noneconomic damages to $250,000 from the provider or health care institution, but no more than $500,000 from multiple health care institutions. Makes each party liable only for the amount of damages directly proportional to its percentage of responsibility.
Allows the court to restrict the payment of attorney contingency fees. Limits the fees to a decreasing percentage based on the increasing value of the amount awarded.
Prescribes qualifications for expert witnesses.
Requires the court to reduce damages received by the amount of collateral source benefits to which a claimant is entitled, unless the payor of such benefits has the right to reimbursement or subrogation under federal or state law.
Authorizes the award of punitive damages only where: (1) it is proven by clear and convincing evidence that a person acted with malicious intent to injure the claimant or deliberately failed to avoid unnecessary injury the claimant was substantially certain to suffer, and (2) compensatory damages are awarded. Limits punitive damages to the greater of two times the amount of economic damages or $250,000.
Prohibits a health care provider from being named as a party in a product liability or class action lawsuit for prescribing or dispensing a Food and Drug Administration (FDA)-approved prescription drug, biological product, or medical device for an approved indication.
Provides for periodic payments of future damage awards. | Health | Medical Liability | Law | 2013-01-22 | requirements lawsuits health care liability claims related provision health care services sets statute limitations years date manifestation injury year claimant discovers injury certain exceptions requires court impose sanctions filing frivolous lawsuits limits noneconomic damages provider health care institution multiple health care institutions makes party liable damages directly proportional percentage responsibility allows court restrict payment attorney contingency fees limits fees decreasing percentage based increasing value awarded prescribes qualifications expert witnesses requires court reduce damages received collateral source benefits claimant entitled payor benefits right reimbursement subrogation federal state law authorizes award punitive damages proven clear convincing evidence person acted malicious intent injure claimant deliberately failed avoid unnecessary injury claimant substantially certain suffer compensatory damages awarded limits punitive damages greater times economic damages prohibits health care provider named party product liability class action lawsuit prescribing dispensing food_and_drug_administration prescription drug biological product medical device approved indication provides periodic payments future damage awards |
113-S-858 | State Leadership in Health Care Act - Amends the Patient Protection and Affordable Care Act (PPACA) to allow states to apply for a waiver of specified requirements under PPACA with respect to health insurance coverage within that state due to implementation of a state plan that provides comparable coverage for plan years beginning in 2015 (currently, 2017). Permits the Secretary of Health and Human Services (HHS) or the Secretary of the Treasury to deny waivers only if: (1) the state plan does not meet requirements for granting a waiver, (2) the Secretary of HHS or the Treasury notifies the state in writing of the requirements that the state plan did not meet and provides the state with information used in making such a determination, and (3) the state is given an opportunity to appeal.
Requires the Secretary of HHS or the Treasury to reconsider the determination in the event of an appeal and issue a written decision within 60 days. | Health | Medical Liability | Health | 2013-05-06 | state leadership health care act amends patient protection affordable care act ppaca allow states apply waiver specified requirements ppaca respect health insurance coverage state implementation state plan provides comparable coverage plan years beginning currently permits secretary health_and_human_services hhs secretary treasury deny waivers state plan meet requirements granting waiver secretary hhs treasury notifies state writing requirements state plan meet provides state information making determination state given opportunity appeal requires secretary hhs treasury reconsider determination event appeal issue written decision days |
113-S-955 | Family Health Care Accessibility Act of 2013 - Amends the Public Health Service Act to deem a health professional volunteer providing primary health care to an individual at a community health center to be an employee of the Public Health Service for purposes of any civil action that may arise from providing services to patients. Sets forth conditions for such liability protection, including: (1) the service is provided to the individual at a community health center or through offsite programs or events carried out by such center; and (2) the health care practitioner does not receive any compensation for providing the service, except repayment for reasonable expenses.
Considers an entity as sponsoring the health care practitioner if the entity submits an application to the Secretary of Health and Human Services (HHS), and the Secretary determines that the health care practitioner is deemed to be an employee of the Public Health Service.
Requires the Attorney General to submit to Congress an estimate of the amount of claims (together with related fees and expenses of witnesses) that, by reason of the actions or omissions of health professional volunteers, will be paid pursuant to this Act annually. Requires the Secretary to transfer such estimated amount from the claims fund to the appropriate accounts in the Treasury, subject to the extent of amounts in the fund.
Makes this Act effective on October 1, 2013. | Health | Medical Liability | Health | 2013-05-15 | family health care accessibility act amends public_health_service_act deem health professional volunteer providing primary health care individual community health center employee public_health_service purposes civil action arise providing services patients sets forth conditions liability protection including service provided individual community health center offsite programs events carried center health care practitioner receive compensation providing service repayment reasonable expenses considers entity sponsoring health care practitioner entity submits application secretary health_and_human_services hhs secretary determines health care practitioner deemed employee public_health_service requires attorney general submit congress estimate claims related fees expenses witnesses reason actions omissions health professional volunteers paid pursuant act annually requires secretary transfer estimated claims fund appropriate accounts treasury subject extent amounts fund makes act effective october |
113-S-1012 | Medicare Audit Improvement Act of 2013 - Directs the Secretary of Health and Human Services (HHS) to establish a process which subjects to a single, combined maximum annual limit, applied incrementally, the number of additional documentation requests made to a hospital by Medicare administrative contractors, recovery audit contractors, or Comprehensive Error Rate Testing (CERT) program contractors pursuant to prepayment and postpayment audits requiring a hospital to submit a medical record for audit purposes.
Directs the Secretary also to establish a distinct additional documentation request limit, computed according to a specified formula, for each hospital claim type for each hospital for a 45-day period in a year.
Amends title XVIII (Medicare) of the Social Security Act with respect to the Medicare Integrity Program and use of recovery audit contractors.
Requires the Secretary to ensure that recovery audit contracts include certain mandatory terms and conditions pertaining to: (1) penalties for certain compliance failures, (2) penalties for overturned appeals, (3) postpayment and prepayment audits, and (4) guidelines for prepayment review.
Directs the Secretary to publish on the Internet website of the Centers for Medicare & Medicaid Services information on recovery audit contractor performance regarding: (1) audit rates, denials, and appeals outcomes; and (2) independent performance evaluations.
Deems to be an original claim for Medicare part B (Supplementary Medical Insurance) payment a resubmitted hospital claim for Medicare part A payment for inpatient hospital services which a recovery audit contractor determines: (1) were not medically necessary and reasonable based on the site of service, but (2) would be medically necessary and reasonable in an outpatient setting of the hospital. Requires payment to be made for such a resubmitted claim for all furnished items and services for which payment may be made under Medicare part B.
Deems to be a reopened claim, for purposes of a hospital's ability to resubmit a claim for Medicare payment in timely fashion, any claim that is the subject of an audit by a recovery audit contractor or a Medicare administrative contractor.
Requires contracts for a recovery audit contractor to require that a physician review each denial of a claim for medical necessity made by an employee of the contractor who is not a physician.
Subjects to administrative and judicial review the Secretary's compliance with guidelines for reopening and revising benefit determinations. | Health | Medical Liability | Health | 2013-05-22 | medicare audit improvement act directs secretary health_and_human_services hhs establish process subjects single combined maximum annual limit applied incrementally number additional documentation requests hospital medicare administrative contractors recovery audit contractors comprehensive error rate testing program contractors pursuant prepayment audits requiring hospital submit medical record audit purposes directs secretary establish distinct additional documentation request limit computed according specified formula hospital claim type hospital day period year amends title xviii medicare social security act respect medicare_integrity_program use recovery audit contractors requires secretary ensure recovery audit contracts include certain mandatory terms conditions pertaining penalties certain compliance failures penalties overturned appeals prepayment audits guidelines prepayment review directs secretary publish internet website centers information recovery audit contractor performance audit rates denials appeals outcomes independent performance evaluations deems original claim medicare supplementary_medical_insurance payment resubmitted hospital claim medicare payment inpatient hospital services recovery audit contractor determines medically necessary reasonable based site service medically necessary reasonable outpatient setting hospital requires payment resubmitted claim furnished items services payment medicare deems reopened claim purposes hospital ability resubmit claim medicare payment timely fashion claim subject audit recovery audit contractor medicare administrative contractor requires contracts recovery audit contractor require physician review denial claim medical necessity employee contractor physician subjects administrative judicial review secretary compliance guidelines reopening revising benefit determinations |
113-S-1123 | Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2013 or PRIME Act of 2013 - Amends part D (Prescription Drug Benefits) of title XVIII (Medicare) of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS) to prohibit sponsors of prescription drug plans (PDPs) from paying claims for prescription drugs that do not include the valid National Provider Identifier for the drug's prescriber.
Requires the Secretary's annual report to Congress on the use of recovery audit contractors under the Medicare Integrity Program to: (1) describe the types and financial cost of improper payment vulnerabilities identified by recovery audit contractors and how the Secretary is addressing them, and (2) assess the effectiveness of changes made to Medicare payment policies and procedures in order to address those vulnerabilities.
Requires the Secretary to address improper payment vulnerabilities in a timely manner, prioritized based on the risk to the Medicare program.
Authorizes the Secretary, under recovery audit contracts under both Medicare and Medicaid (SSA title XIX), to retain a certain portion of the recovered amounts for a program management account for activities addressing problems that contribute to improper payments and fraud.
Requires the Secretary, under such contracts, to retain an additional 5% of the recovered amounts to be made available to the HHS Inspector General to investigate improper payments or audit internal controls associated with Medicare or Medicaid payments.
Directs the Secretary to develop a plan to revise the incentive program under the Health Insurance Portability and Accountability Act of 1996 for the reporting of fraud and abuse to encourage greater participation by individuals reporting Medicare fraud and abuse. Requires the plan to include certain recommendations for: (1) ways to enhance rewards for individuals reporting, and (2) extention of the incentive program to the Medicaid program.
Amends SSA title XIX to cover the costs of equipment, salaries and benefits, and travel and training in appropriations for the Medicaid Integrity Program. Allows the Secretary to increase Centers for Medicare and Medicaid Services (CMS) staff whose duties consist solely of protecting the integrity of the Medicare program by a number determined necessary to carry out the Program (currently, by 100).
Directs the Secretary to provide incentives for Medicare administrative contractors to reduce the improper payment error rates in their jurisdictions.
Requires imprisonment for up to 10 years or a fine of up to $500,000 ($1 million in the case of a corporation), or both, for knowingly, intentionally, and with the intent to defraud purchasing, selling, distributing, or arranging for the purchase, sale, or distribution of a Medicare, Medicaid, or CHIP beneficiary identification number or billing privileges under SSA titles XVIII, title XIX, or title XXI (Children's Health Insurance Program).
Amends SSA title IV part D (Child Support and Establishment of Paternity) with respect to the Federal Parent Locator Service to give the CMS Administrator access to information in the National Directory of New Hires to determine the eligibility of an applicant for, or enrollee in, the Medicare program or an applicable state health subsidy program under the Patient Protection and Affordable Care Act (PPACA).
Requires the Secretary to disclose to the HHS Inspector General information on individuals and their employers in the National Directory of New Hires if the HHS Inspector General gives the Secretary their names and Social Security account numbers. Restricts the use of such information to: (1) determining the eligibility of an applicant for, or enrollee in, the Medicare program or an applicable state health subsidy program; or (2) evaluating the integrity of such programs. Sets forth rules for the use and disclosure of such information by state agencies.
Directs the Secretary to establish a plan to encourage and facilitate the participation of states in the Medicare-Medicaid Data Match Program (Medi-Medi Program). Revises Medi-Medi Data Match Program purposes.
Amends SSA title XIX, as amended by PPACA, and XXI with respect to claims processing and detection of fraud within the Medicaid and CHIP programs. | Health | Medical Liability | Health | 2013-06-10 | preventing reducing improper medicare medicaid expenditures act prime act amends prescription drug benefits title xviii medicare social security act ssa direct secretary health_and_human_services hhs prohibit sponsors prescription drug plans pdps paying claims prescription drugs include valid national provider identifier drug prescriber requires secretary annual report congress use recovery audit contractors medicare_integrity_program describe types financial cost improper payment vulnerabilities identified recovery audit contractors secretary addressing assess effectiveness changes medicare payment policies procedures order address vulnerabilities requires secretary address improper payment vulnerabilities timely manner prioritized based risk medicare program authorizes secretary recovery audit contracts medicare medicaid ssa title xix retain certain portion recovered amounts program management account activities addressing problems contribute improper payments fraud requires secretary contracts retain additional recovered amounts available investigate improper payments audit internal controls associated medicare medicaid payments directs secretary develop plan revise incentive program health_insurance_portability_and_accountability_act reporting fraud abuse encourage greater participation individuals reporting medicare fraud abuse requires plan include certain recommendations ways enhance rewards individuals reporting incentive program medicaid program amends ssa title xix cover costs equipment salaries benefits travel training appropriations medicaid_integrity_program allows secretary increase centers medicare medicaid_services cms staff duties consist solely protecting integrity medicare program number determined necessary carry program currently directs secretary provide incentives medicare administrative contractors reduce improper payment error rates jurisdictions requires imprisonment years fine million case corporation knowingly intentionally intent defraud purchasing selling distributing arranging purchase sale distribution medicare medicaid chip beneficiary identification number billing privileges ssa titles xviii title xix title amends ssa title child support establishment paternity respect federal_parent_locator_service access information national_directory_of_new_hires determine eligibility applicant enrollee medicare program applicable state health subsidy program patient_protection affordable care act ppaca requires secretary disclose hhs_inspector general information individuals employers national_directory_of_new_hires hhs_inspector general gives secretary names social_security account numbers restricts use information determining eligibility applicant enrollee medicare program applicable state health subsidy program evaluating integrity programs sets forth rules use disclosure information state agencies directs secretary establish plan encourage facilitate participation states medicare-medicaid data_match_program medi-medi_program data match program purposes amends ssa title xix amended ppaca xxi respect claims processing detection fraud medicaid chip programs |
113-S-1180 | Medicare Data Access for Transparency and Accountability Act - Amends title XI of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS) to make available to the public HHS claims and payment data related to SSA title XVIII (Medicare), including data on payments made to any service provider or supplier. | Health | Medical Liability | Health | 2013-06-18 | title social security act ssa direct secretary health_and_human_services hhs available public hhs claims payment data related ssa title xviii medicare including data payments service provider supplier |
113-S-1723 | No Obamacare Kickbacks Act of 2013 - Amends title XI of the Social Security Act, with respect to criminal penalties for acts involving federal health care programs, to include any plan or program established or funded under subtitles D (Available Coverage Choices for All Americans) or E (Affordable Coverage Choices for All Americans) of title I of the Patient Protection and Affordable Care Act.
Directs the Inspector General of the Department of Health and Human Services (HHS) and the Comptroller General (GAO) to jointly study, and report to Congress on, the effect of applying the anti-kickback laws and other prohibitions involving federal health care programs to qualified health plans, federally-facilitated marketplaces, state health care exchanges, and any other plan or program established or funded under the provisions described above. | Health | Medical Liability | Health | 2013-11-19 | obamacare kickbacks act amends title social security act respect criminal penalties acts involving federal health care programs include plan program established funded subtitles available coverage choices americans affordable coverage choices americans title patient_protection affordable care act directs inspector general department_of_health_and_human_services hhs comptroller_general gao jointly study report congress effect applying anti laws prohibitions involving federal health care programs qualified health plans federally facilitated state health care exchanges plan program established funded provisions described |
113-S-1758 | Quality Data, Quality Healthcare Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act (SSA) with respect to the use of certain data by qualified public or private entities to evaluate the performance of service providers and suppliers under Medicare insurance programs.
Authorizes a qualified entity to: (1) use Medicare data, and information derived from service provider and supplier performance evaluations, for additional non-public analyses; or (2) provide or sell such data and analyses to specified health care-related entities for non-public use (including for purposes of assisting service providers and suppliers to develop and participate in quality and patient care improvement activities, particularly development of new models of care).
Conditions such authorization upon a data use agreement between a qualified entity and a specified health care-related entity under which the latter: (1) may not re-sell such data or analyses; and (2) shall comply with the qualified entity's privacy and security policies in using such data or analyses.
Prescribes a civil money penalty for unauthorized use of data and analyses.
Requires the Secretary of Health and Human Services (HHS) to provide Medicare claims data to qualified clinical data registries for purposes of linking it with clinical outcomes data and performing and disseminating risk-adjusted, scientifically valid research to support quality improvement.
Prohibits a qualified clinical data registry from reporting publicly any claims data thus made available that individually identifies a service provider or supplier without prior consent. | Health | Medical Liability | Health | 2013-11-21 | quality healthcare act amends title xviii medicare social security act ssa respect use certain data qualified public private entities evaluate performance service providers suppliers medicare insurance programs authorizes qualified entity use medicare data information derived service provider supplier performance evaluations additional non public analyses provide sell data analyses specified health care related entities non public use including purposes assisting service providers suppliers develop participate quality patient care improvement activities particularly development new models care conditions authorization data use agreement qualified entity specified health care related entity sell data analyses shall comply qualified entity privacy security policies data analyses prescribes civil money penalty unauthorized use data analyses requires secretary health_and_human_services hhs provide medicare claims data qualified clinical data registries purposes linking clinical outcomes data performing disseminating risk adjusted scientifically valid research support quality improvement prohibits qualified clinical data registry reporting publicly claims data available individually identifies service provider supplier prior consent |
113-S-1769 | Standard of Care Protection Act - Provides that the development, recognition, or implementation of any guideline or other standard under any provision of the Patient Protection and Affordable Care Act, the health care-related parts of the Health Care and Education Reconciliation Act of 2010, or titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act shall not be construed to establish the standard or duty of care owed by a health care provider to a patient in any medical malpractice or medical product liability action or claim.
Prohibits such health care provisions from being construed to preempt any state or common law governing medical malpractice or medical product liability actions or claims. | Health | Medical Liability | Health | 2013-11-21 | development recognition implementation guideline standard provision patient_protection affordable care act health care related parts health_care_and_education reconciliation act titles xviii medicare xix medicaid social security act shall construed establish standard duty care owed health care provider patient medical malpractice medical product liability action claim prohibits health care provisions construed preempt state common law governing medical malpractice medical product liability actions claims |
113-S-1860 | Steps Toward Access and Reform Act of 2013 or STAR Act of 2013 - Limits the commencement of a health care lawsuit, except in certain cases including fraud or intentional concealment, to three years after the date of manifestation of injury or one year after the claimant discovers, or through the use of reasonable diligence should have discovered, the injury, whichever occurs first.
Limits to $250,000 the amount of noneconomic damages in such a lawsuit, but allows a claim for the full amount of any economic damages.
Requires the court, in any health care lawsuit, to supervise the arrangements for payment of damages to protect against conflicts of interest that may have the effect of reducing the amount of damages awarded that are actually paid to claimants.
Allows any party in any health care lawsuit involving injury or wrongful death to introduce evidence of collateral source benefits.
Specifies criteria for the award of punitive damages, limited to the greater of $250,000 or double the amount of economic damages.
Preempts state law with respect to health care lawsuits, but subjects to otherwise applicable state or federal law any issue not governed by this Act or any law (including state standards of negligence) established by or under it.
Declares the sense of Congress that a health insurer should be liable for damages for harm caused when it makes a decision as to what care is medically necessary and appropriate.
Directs the Secretary of Health and Human Services (HHS) to contract with eligible health professionals to serve for a period of at least four years as a primary care provider in a medically underserved community, in consideration for which the Secretary shall pay up to $100,000 on the principal and interest on the individual's graduate medical, osteopathic, or other health professional educational loans.
Amends the Internal Revenue Code to allow a bad debt deduction from gross income for worthless qualified medical care debt of at least 75% of a tax-paying medical care provider's charge for such care.
Prohibits the Food and Drug Administration (FDA) from taking action to prevent an individual not in the business of importing a prescription drug from importing one from Canada that complies with the Federal Food, Drug, and Cosmetic Act. Amends the Public Health Service Act to declare that the laws of the state designated by a health insurance issuer (primary state) shall apply to individual health insurance coverage offered by that issuer in the primary state and in any other state (secondary state), but only if the coverage and issuer comply with conditions of this Act.
Prohibits a health insurance issuer from offering, selling, or issuing individual health insurance coverage in a secondary state if its insurance commissioner does not use a risk-based capital formula for determining capital and surplus requirements for all health insurance issuers. | Health | Medical Liability | Health | 2013-12-19 | steps access reform_act star act limits commencement health care lawsuit certain cases including fraud intentional concealment years date manifestation injury year claimant discovers use reasonable diligence discovered injury whichever occurs limits noneconomic damages lawsuit allows claim economic damages requires court health care lawsuit supervise arrangements payment damages protect conflicts interest effect reducing damages awarded actually paid claimants allows party health care lawsuit involving injury wrongful death introduce evidence collateral source benefits specifies criteria award punitive damages limited greater double economic damages preempts state law respect health care lawsuits subjects applicable state federal law issue governed act law including state standards negligence established declares sense congress health insurer liable damages harm caused makes decision care medically necessary appropriate directs secretary health_and_human_services hhs contract eligible health professionals serve period years primary care provider medically underserved community consideration secretary shall pay principal interest individual graduate medical osteopathic health professional educational loans amends internal revenue code allow bad debt deduction gross income worthless qualified medical care debt tax paying medical care provider charge care fda taking action prevent individual business importing prescription drug importing canada complies cosmetic act amends public_health_service_act declare laws state designated health insurance issuer primary state shall apply individual health insurance coverage offered issuer primary state state secondary state coverage issuer comply conditions act prohibits health insurance issuer offering selling issuing individual health insurance coverage secondary state insurance commissioner use risk based capital formula determining capital surplus requirements health insurance issuers |
113-S-1944 | Protecting Seniors from Health Care Fraud Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS), acting through the HHS Office of Inspector General, and the Attorney General to report annually to Congress and the public on health care fraud schemes targeted to seniors and steps being taken to combat such schemes and to educate seniors about them.
Directs the Secretary to: (1) disseminate such reports through mechanisms that reach the most Medicare beneficiaries, and (2) mail to each Medicare beneficiary a list of the top 10 most prevalent health care fraud schemes. | Health | Medical Liability | Health | 2014-01-16 | health care fraud act amends title xviii medicare social security act ssa direct secretary health_and_human_services hhs acting attorney general report annually congress public health care fraud schemes targeted seniors steps taken combat schemes educate seniors directs secretary disseminate reports mechanisms reach medicare beneficiaries mail medicare beneficiary list prevalent health care fraud schemes |
113-S-2144 | Preventing Unnecessary Medicare Payments (PUMP) Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act to: (1) apply Medicare competitive bidding to vacuum erection systems, and (2) require the Secretary of Health and Human Services (HHS) to phase-in a national mail order program for such devices. | Health | Medical Liability | Health | 2014-03-13 | preventing unnecessary medicare payments pump act amends title xviii medicare social security act apply medicare competitive bidding vacuum systems require secretary health_and_human_services hhs phase national mail order program devices |
113-S-2361 | Stop Schemes and Crimes Against Medicare and Seniors (Stop SCAMS) Act - Amends title XI of the Social Security Act with respect to standards for financial and administrative transactions and their data elements to enable the electronic exchange of health information.
Requires the Secretary of Health and Human Services (HHS) to adopt standards that: (1) ensure that any entity producing and transmitting valid transactions that include code sets for appropriate data elements is subject to a consistent, industry-wide framework that supports a seamless transition to new and modified code sets; and (2) establish an end-to-end testing procedure for new and modified code sets that shall require the participation of any entity producing and transmitting valid transactions that use the new or modified code set.
Prohibits the Secretary from adopting a new or modified code set unless the Secretary: (1) assesses its impact on fraud prevention and pre-payment review, determines that anti-fraud edits work as intended, and confirms that a plan is in place to ensure continuing effective detection of fraud following the adoption of the code set; (2) ensures that the end-to-end testing procedure established has been completed; and (3) completes end-to-end testing with any federal government entity that produces and transmits valid transactions that include the code set with private sector tracking partners. Exempts routine, regularly scheduled updates to existing code sets from such prohibition.
Directs the Secretary, with respect to information supplied to it by a disclosing entity about those with an ownership or control interest in the entity, to verify such information in a specified manner and confirm the accuracy of any Social Security account number or employer identification number.
Holds immune from civil liability (in a safe harbor) any non-governmental entity participating in a Healthcare Fraud Prevention Partnership, including private insurers, for sharing information about potentially fraudulent providers with each other, HHS, the Department of Justice (DOJ), any other federal or state law enforcement agency, any federal or state agency contractor, and another Partnership participant.
Directs the Medicare Payment Advisory Commission (MEDPAC) to study administrative efforts to strengthen program integrity in the Medicare program.
Amends the Small Business Jobs Act of 2010, with respect to the use of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse in the Medicare fee-for-service program, to require predictive analytics technologies to capture outcome information on civil recoveries, administrative actions, and criminal convictions for fraud. | Health | Medical Liability | Health | 2014-05-20 | act_-_amends title social security act respect standards financial administrative transactions data elements enable electronic exchange health information requires secretary health_and_human_services hhs adopt standards ensure entity producing transmitting valid transactions include code sets appropriate data elements subject consistent industry wide framework supports seamless transition new modified code sets establish end end testing procedure new modified code sets shall require participation entity producing transmitting valid transactions use new modified code set prohibits secretary adopting new modified code set secretary assesses impact fraud prevention pre payment review determines anti fraud work intended confirms plan place ensure continuing effective detection fraud following adoption code set ensures end end testing procedure established completed completes end end testing federal government entity produces transmits valid transactions include code set private sector tracking partners exempts routine regularly scheduled updates existing code sets prohibition directs secretary respect information supplied disclosing entity ownership control interest entity verify information specified manner confirm accuracy social_security account number employer identification number holds immune civil liability safe harbor non governmental entity participating including private insurers sharing information potentially fraudulent providers hhs department_of_justice doj federal state law enforcement agency federal state agency contractor partnership participant directs medicare_payment_advisory_commission medpac study administrative efforts strengthen program integrity medicare program amends small_business_jobs_act respect use predictive modeling analytics technologies identify prevent waste fraud abuse medicare fee service program require predictive analytics technologies capture outcome information civil recoveries administrative actions criminal convictions fraud |
113-S-2419 | VA Accountability Act of 2014 - Prohibits any officer, employee, or agent of the Department of Veterans Affairs (VA) from:
knowingly falsifying an individual's VA health records; knowingly destroying or excluding information from such records with the intent to defraud the individual, a federal officer or employee, or a Member of Congress; directing another individual to engage in such prohibited conduct; or knowing of such prohibited conduct by an individual under his or her supervision and failing to stop, if possible, or report to a superior the commission of such conduct. Allows an individual aggrieved by such conduct to bring a civil action against the officer, employee, or agent in an appropriate U.S. district court for damages or other legal or equitable relief.
Authorizes the VA Secretary to terminate, without prior notice or cause, the employment and benefits of a VA officer, employee, or agent found by such court to have violated this Act.
Provides that this Act shall apply to conduct committed before, on, or after its enactment. | Health | Medical Liability | Armed forces and national security | 2014-06-03 | accountability act prohibits officer employee agent department_of_veterans_affairs knowingly falsifying individual health records knowingly destroying excluding information records intent defraud individual federal officer employee member congress directing individual engage prohibited conduct knowing prohibited conduct individual supervision failing stop possible report superior commission conduct allows individual aggrieved conduct bring civil action officer employee agent appropriate district court damages legal equitable relief authorizes secretary terminate prior notice cause employment benefits officer employee agent found court violated act provides act shall apply conduct committed enactment |
114-HR-99 | Health Insurance Industry Antitrust Enforcement Act of 2015
Prohibits the McCarran-Ferguson Act from being construed to permit health insurance or medical malpractice insurance issuers to engage in price fixing, bid rigging, or market allocations in connection with providing health insurance or medical malpractice coverage.
Amends the McCarran-Ferguson Act to provide that nothing in it modifies, impairs, or supersedes the operation of antitrust laws with respect to the business of health insurance.
Applies prohibitions of unfair methods of competition to the business of health insurance without regard to whether the business is for profit. | Health | Medical Liability | Health | 2015-01-06 | prohibits mccarran ferguson act construed permit health insurance medical malpractice insurance issuers engage price fixing bid rigging market allocations connection providing health insurance medical malpractice coverage amends mccarran ferguson act provide modifies supersedes operation antitrust laws respect business health insurance applies prohibitions unfair methods competition business health insurance regard business profit |
114-HR-244 | MAC Transparency Act
Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act to require each contract entered into with a prescription drug plan (PDP) sponsor with respect to a PDP the sponsor offers to prohibit the PDP from entering into a contract with any pharmacy benefits manager (PBM) to manage the prescription drug coverage provided under such plan, or to control the costs of the prescription drug coverage under it, unless the PBM adheres to specified criteria when handling personally identifiable utilization and claims data or other sensitive patient data.
Revises requirements for contracts with PDP sponsors to require that the PDP sponsor disclose to applicable pharmacies the sources used for making any update of the prescription drug pricing standard, and if the source for such a standard is not publicly available, disclose to such pharmacies all individual drug prices to be so updated in advance of their use for the reimbursement of claims. Requires the PDP sponsor, as well, to establish a process to appeal, investigate, and resolve disputes regarding individual drug prices that are less than the pharmacy acquisition price for a drug.
Directs the Secretary of Defense (DOD), with respect to the TRICARE retail pharmacy program, to ensure that a contract entered into with a TRICARE managed care support contractor includes requirements to ensure the provision of information regarding the pricing standard for prescription drugs.
Establishes criteria to which a carrier and a PBM must adhere under a contract or an approved plan under which the carrier has an agreement with the PBM to manage prescription drug coverage or to control the costs of such coverage.
Prohibits a PBM under such criteria from: (1) transmitting to a pharmacy owned by the PBM any personally identifiable utilization or claims data relating to an enrolled individual who has not voluntarily elected in writing or via secure electronic means to fill that particular prescription at such a pharmacy; or (2) requiring any enrolled individual to use a retail pharmacy, mail order pharmacy, specialty pharmacy, or other pharmacy entity in which the PBM has an ownership interest, or that has an ownership interest in the PBM, or give an incentive to encourage an enrollee to use the pharmacy if the incentive applies only to those pharmacies.
Requires any contract or approved plan providing for a reimbursement standard with respect to a PDP to require the carrier to: (1) update the standard at least once every seven days to reflect the market price of a drug accurately; (2) disclose to pharmacies the sources used for making any such update; (3) make advance disclosure to those pharmacies of all individual drug prices to be updated if the source for a standard is not publicly available; and (4) establish a process to appeal, investigate, and resolve disputes regarding individual drug prices less than the pharmacy acquisition price. | Health | Medical Liability | Health | 2015-01-09 | mac transparency act amends voluntary prescription drug benefit program title xviii medicare social security act require contract entered prescription drug plan pdp sponsor respect pdp sponsor offers prohibit pdp entering contract pharmacy benefits manager pbm manage prescription drug coverage provided plan control costs prescription drug coverage pbm adheres specified criteria handling personally identifiable utilization claims data sensitive patient data revises requirements contracts pdp sponsors require pdp sponsor disclose applicable pharmacies sources making update prescription drug pricing standard source standard publicly available disclose pharmacies individual drug prices updated advance use reimbursement claims requires pdp sponsor establish process appeal investigate resolve disputes individual drug prices pharmacy acquisition price drug directs secretary defense dod respect tricare retail pharmacy program ensure contract entered tricare managed care support contractor includes requirements ensure provision information pricing standard prescription drugs establishes criteria carrier pbm adhere contract approved plan carrier agreement pbm manage prescription drug coverage control costs coverage prohibits pbm criteria transmitting pharmacy owned pbm personally identifiable utilization claims data relating enrolled individual voluntarily elected writing secure electronic means fill particular prescription pharmacy requiring enrolled individual use retail pharmacy mail order pharmacy specialty pharmacy pharmacy entity pbm ownership interest ownership interest pbm incentive encourage enrollee use pharmacy incentive applies pharmacies requires contract approved plan providing reimbursement standard respect pdp require carrier update standard seven days reflect market price drug accurately disclose pharmacies sources making update advance disclosure pharmacies individual drug prices updated source standard publicly available establish process appeal investigate resolve disputes individual drug prices pharmacy acquisition price |
114-HR-818 | Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015
Amends part D (Prescription Drug Benefits) of title XVIII (Medicare) of the Social Security Act (SSAct) to direct the Secretary of Health and Human Services (HHS) to prohibit sponsors of prescription drug plans from paying claims for prescription drugs that do not include the valid National Provider Identifier for the drug's prescriber.
Requires the Secretary's annual report to Congress on the use of recovery audit contractors under the Medicare Integrity Program to: (1) describe the types and financial cost of improper payment vulnerabilities identified by recovery audit contractors and how the Secretary is addressing them, and (2) assess the effectiveness of changes made to Medicare payment policies and procedures in order to address those vulnerabilities.
Requires the Secretary to address improper payment vulnerabilities in a timely manner, prioritized based on the risk to the Medicare program.
Authorizes the Secretary, under recovery audit contracts under both Medicare and Medicaid (SSAct title XIX), to retain a certain portion of the recovered amounts for a program management account for activities addressing problems that contribute to improper payments and fraud.
Requires the Secretary, under such contracts, to retain an additional 5% of the recovered amounts to be made available to the HHS Inspector General to investigate improper payments or audit internal controls associated with Medicare or Medicaid payments.
Directs the Secretary to develop a plan to revise the incentive program under the Health Insurance Portability and Accountability Act of 1996 for the reporting of fraud and abuse to encourage greater participation by individuals reporting Medicare fraud and abuse. Requires the plan to include certain recommendations for: (1) ways to enhance rewards for individuals reporting, and (2) extension of the incentive program to the Medicaid program.
Amends SSAct title XIX to cover the costs of equipment, salaries and benefits, and travel and training in appropriations for the Medicaid Integrity Program. Allows the Secretary to increase Centers for Medicare and Medicaid Services (CMS) staff whose duties consist solely of protecting the integrity of the Medicare program by a number determined necessary to carry out the Program (currently, by 100).
Directs the Secretary to provide incentives for Medicare administrative contractors to reduce the improper payment error rates in their jurisdictions.
Requires imprisonment for up to 10 years or a fine of up to $500,000 ($1 million in the case of a corporation), or both, for knowingly, intentionally, and with the intent to defraud purchasing, selling, distributing, or arranging for the purchase, sale, or distribution of a Medicare, Medicaid, or CHIP beneficiary identification number or billing privileges under SSAct titles XVIII, title XIX, or title XXI (Children's Health Insurance Program) (CHIP).
Amends SSAct title IV part D (Child Support and Establishment of Paternity) with respect to the Federal Parent Locator Service to give the CMS Administrator access to information in the National Directory of New Hires to determine the eligibility of an applicant for, or enrollee in, the Medicare program or an applicable state health subsidy program under the Patient Protection and Affordable Care Act (PPACA).
Requires the Secretary to disclose to the HHS Inspector General information on individuals and their employers in the National Directory of New Hires if the HHS Inspector General gives the Secretary their names and Social Security account numbers. Restricts the use of such information to: (1) determining the eligibility of an applicant for, or enrollee in, the Medicare program or an applicable state health subsidy program; or (2) evaluating the integrity of such programs. Sets forth rules for the use and disclosure of such information by state agencies.
Directs the Secretary to establish a plan to encourage and facilitate the participation of states in the Medicare-Medicaid Data Match Program (Medi-Medi Program). Revises Medi-Medi Data Match Program purposes.
Amends SSAct title XIX, as amended by PPACA, and SSAct XXI with respect to claims processing and detection of fraud within the Medicaid and CHIP programs. | Health | Medical Liability | Health | 2015-02-09 | preventing reducing improper medicare medicaid expenditures act prime act amends prescription drug benefits title xviii medicare social security act ssact direct secretary health_and_human_services hhs prohibit sponsors prescription drug plans paying claims prescription drugs include valid national provider identifier drug prescriber requires secretary annual report congress use recovery audit contractors medicare_integrity_program describe types financial cost improper payment vulnerabilities identified recovery audit contractors secretary addressing assess effectiveness changes medicare payment policies procedures order address vulnerabilities requires secretary address improper payment vulnerabilities timely manner prioritized based risk medicare program authorizes secretary recovery audit contracts medicare medicaid ssact title xix retain certain portion recovered amounts program management account activities addressing problems contribute improper payments fraud requires secretary contracts retain additional recovered amounts available investigate improper payments audit internal controls associated medicare medicaid payments directs secretary develop plan revise incentive program health_insurance_portability_and_accountability_act reporting fraud abuse encourage greater participation individuals reporting medicare fraud abuse requires plan include certain recommendations ways enhance rewards individuals reporting extension incentive program medicaid program amends ssact title xix cover costs equipment salaries benefits travel training appropriations medicaid_integrity_program allows secretary increase centers medicare medicaid_services cms staff duties consist solely protecting integrity medicare program number determined necessary carry program currently directs secretary provide incentives medicare administrative contractors reduce improper payment error rates jurisdictions requires imprisonment years fine million case corporation knowingly intentionally intent defraud purchasing selling distributing arranging purchase sale distribution medicare medicaid chip beneficiary identification number billing privileges ssact titles xviii title xix title chip amends ssact title child support establishment paternity respect federal_parent_locator_service access information national_directory_of_new_hires determine eligibility applicant enrollee medicare program applicable state health subsidy program patient_protection affordable care act ppaca requires secretary disclose hhs_inspector general information individuals employers national_directory_of_new_hires hhs_inspector general gives secretary names social_security account numbers restricts use information determining eligibility applicant enrollee medicare program applicable state health subsidy program evaluating integrity programs sets forth rules use disclosure information state agencies directs secretary establish plan encourage facilitate participation states medicare-medicaid data_match_program medi-medi_program data match program purposes amends ssact title xix amended ppaca ssact xxi respect claims processing detection fraud medicaid chip programs |
114-HR-865 | Good Samaritan Health Professionals Act of 2015
Amends the Public Health Service Act to shield a health care professional from liability under federal or state law for harm caused by any act or omission if: (1) the professional is serving as a volunteer in response to a disaster; and (2) the act or omission occurs during the period of the disaster, in the professional's capacity as a volunteer, and in a good faith belief that the individual being treated is in need of health care services.
Makes exceptions where: (1) the harm was caused by an act or omission constituting willful or criminal misconduct, gross negligence, reckless misconduct, or a conscious flagrant indifference to the rights or safety of the individual harmed; or (2) the professional rendered the health care services under the influence of alcohol or an intoxicating drug. | Health | Medical Liability | Health | 2015-02-11 | good samaritan health professionals act amends public_health_service_act shield health care professional liability federal state law harm caused act omission professional serving volunteer response disaster act omission occurs period disaster professional capacity volunteer good faith belief individual treated need health care services makes exceptions harm caused act omission constituting willful criminal misconduct gross negligence reckless misconduct conscious flagrant indifference rights safety individual harmed professional rendered health care services influence alcohol intoxicating drug |
114-HR-921 | Sports Medicine Licensure Clarity Act of 2016
(Sec. 2) This bill extends the liability insurance coverage of a state-licensed medical professional to another state when the professional provides medical services to an athlete, athletic team, or team staff member pursuant to a written agreement. Prior to providing such services, the medical professional must disclose the nature and extent of the services to the insurer. This extension of coverage does not apply at a health care facility or while a medical professional licensed in the state is transporting the injured individual to a health care facility. | Health | Medical Liability | Health | 2015-02-12 | sec bill extends liability insurance coverage state licensed medical professional state professional provides medical services athlete athletic team team staff member pursuant written agreement prior providing services medical professional disclose nature extent services insurer extension coverage apply health care facility medical professional licensed state transporting injured individual health care facility |
114-HR-1021 | Protecting the Integrity of Medicare Act of 2015
(Sec. 2) Amends title II (Old Age, Survivors and Disability Insurance) of the Social Security Act (SSAct) to direct the Secretary of Health and Human Services to establish cost-effective procedures to ensure that: (1) a Social Security account number (or any derivative) is not displayed, coded, or embedded on the Medicare card issued to an individual entitled to benefits under part A (Hospital Insurance) of SSAct title XVIII (Medicare) or enrolled under Medicare part B (Supplementary Medical Insurance); and (2) any other identifier displayed on such card is not identifiable as a Social Security account number (or any derivative).
Directs the Secretary to make specified transfers during FY2015-FY2018 from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund to: (1) the Centers for Medicare and Medicaid Program Management Account, (2) the Social Security Administration Limitation on Administration Account, and (3) the Railroad Retirement Board Limitation on Administration Account.
(Sec. 3) Directs the Secretary to establish procedures to ensure that Medicare payment is not made for items and services furnished to an individual incarcerated, deceased, or otherwise ineligible and not lawfully present in the United States.
(Sec. 4) Directs the Secretary, if cost-effective and technologically viable, to consider appropriate measures to implement use of electronic Medicare beneficiary and provider smart cards.
(Sec. 5) Extends the Medicare durable medical equipment face-to-face encounter documentation requirement to include physician assistants, practitioners, or specialists as well as physicians (as under current law).
(Sec. 6) Requires each Medicare administrative contractor to establish an improper payment outreach and education program for service providers and suppliers in order to reduce improper Medicare payments.
Requires the Secretary to retain a portion of the amounts recovered by recovery audit contractors to improve the ability of chiropractors to provide documentation of services to the Secretary to ensure that they are reasonable and necessary.
(Sec.7) Requires the Secretary to develop a plan to revise the incentive program under the Health Insurance Portability and Accountability Act of 1996 to encourage greater participation by individuals to report fraud and abuse in the Medicare program.
(Sec. 8) Directs the Secretary to require a claim for a covered Medicare part D (Voluntary Prescription Drug Benefit Program) drug for an individual enrolled in a prescription drug plan or in a Medicare Advantage Prescription Drug plan (PDP) to include a valid prescriber National Provider Identifier.
(Sec. 9) Gives Medicare beneficiaries the option to receive the Medicare Summary Notice (explanation of benefits) electronically.
(Sec.10) Directs the Secretary to: (1) apply competitive procedures to selection of a Medicare administrative contractor at least once every 10 years (currently once every 5 years); and (3) study and, as appropriate, specify incentives for states to work with the Secretary under the Medicare-Medicaid Data Match Program to protect the federal and state share of expenditures.
(Sec. 12) Authorizes a PDP sponsor to establish a drug management program for at-risk beneficiaries.
Requires a PDP sponsor, with respect to covered part D drugs, to have in place, directly or through appropriate arrangements, a utilization management tool designed to prevent: (1) the abuse of frequently abused drugs by individuals, and (2) the diversion of such drugs at pharmacies.
Directs the Secretary to authorize Medicare drug integrity contractors (MEDICs) to accept directly an individual's prescription and necessary medical records from pharmacies, prescription drug plans, and physicians in order for MEDICs to provide information relevant to determining whether the individual is an at-risk beneficiary.
Requires the Government Accountability Office to study: (1) the implementation of these amendments; and (2) the effectiveness of the at-risk beneficiaries for prescription drug abuse drug management program.
(Sec. 13) Directs the Secretary to issue a clarification or modification with respect to the application of the Common Rule (governing the protection of human subjects in research) to activities involving clinical data registries.
(Sec. 14) Amends SSA title XI to eliminate civil monetary penalties for inducements to physicians to limit services that are not medically necessary. Retains such penalties for inducements to limit medically necessary services.
Directs the Secretary to report to Congress on options for amending existing Medicare fraud and abuse laws and regulations to permit gainsharing or similar arrangements between physicians and hospitals that would otherwise be subject to penalties.
(Sec. 15) Modifies the Medicare home health surety bond condition of participation requirement.
(Sec. 16) Directs the Secretary to: (1) implement a process for medical review of spinal subluxation services by a chiropractor, and (2) develop educational and training programs to improve the ability of chiropractors to document services in a manner that demonstrates they are reasonable and necessary.
(Sec. 17) Requires the Secretary to: (1) revise the testing in New Jersey, Pennsylvania, and South Carolina of a model of prior authorization for repetitive scheduled non-emergent ambulance transport to cover specified additional states; and (2) apply the prior authorization program to all states under certain conditions.
(Sec. 19) Directs the Secretary to submit a plan to Congress for including in the annual report of the Comprehensive Error Rate Testing programs data on services (other than medical visits) paid under the physician fee schedule where the fee schedule amount exceeds $250 and where the error rate exceeds 20%.
(Sec. 20) Removes funds for the Medicare Improvement Fund that were added by the Impact Act of 2014. | Health | Medical Liability | Health | 2015-02-24 | protecting integrity medicare act sec amends title old age survivors disability insurance social security act ssact direct secretary health_and_human_services establish cost effective procedures ensure social_security account number derivative displayed coded embedded medicare card issued individual entitled benefits ssact title xviii medicare enrolled medicare supplementary_medical_insurance identifier displayed card identifiable social_security account number derivative directs secretary specified transfers fy2015 fy2018 federal_hospital_insurance_trust_fund federal_supplementary_medical_insurance_trust_fund centers medicare sec directs secretary establish procedures ensure medicare payment items services furnished individual incarcerated deceased ineligible lawfully present united_states sec directs secretary cost effective technologically viable consider appropriate measures implement use electronic medicare beneficiary provider smart cards sec extends medicare durable medical equipment face face encounter documentation requirement include physician assistants practitioners specialists physicians current law sec requires medicare administrative contractor establish improper payment outreach education program service providers suppliers order reduce improper medicare payments requires secretary retain portion amounts recovered recovery audit contractors improve ability chiropractors provide documentation services secretary ensure reasonable necessary requires secretary develop plan revise incentive program health_insurance_portability_and_accountability_act encourage greater participation individuals report fraud abuse medicare program sec directs secretary require claim covered medicare voluntary prescription drug benefit program drug individual enrolled prescription drug plan medicare advantage prescription drug plan pdp include valid prescriber national provider identifier sec gives medicare beneficiaries option receive medicare summary notice explanation benefits electronically directs secretary apply competitive procedures selection medicare administrative contractor years currently years study appropriate specify incentives states work secretary medicare-medicaid data_match_program protect federal state share expenditures sec authorizes pdp sponsor establish drug management program risk beneficiaries requires pdp sponsor respect covered drugs place directly appropriate arrangements utilization management tool designed prevent abuse frequently abused drugs individuals diversion drugs pharmacies directs secretary authorize medicare drug integrity contractors medics accept directly individual prescription necessary medical records pharmacies prescription drug plans physicians order medics provide information relevant determining individual risk beneficiary requires government accountability office study implementation amendments effectiveness risk beneficiaries prescription drug abuse drug management program sec directs secretary issue clarification modification respect application common rule governing protection human subjects research activities involving clinical data registries sec amends ssa title eliminate civil monetary penalties inducements physicians limit services medically necessary retains penalties inducements limit medically necessary services directs secretary report congress options amending existing medicare fraud abuse laws regulations permit gainsharing similar arrangements physicians hospitals subject penalties sec modifies medicare home health surety bond condition participation requirement sec directs secretary implement process medical review spinal services chiropractor develop educational training programs improve ability chiropractors document services manner demonstrates reasonable necessary sec requires secretary revise testing new_jersey pennsylvania south_carolina model prior authorization repetitive scheduled non emergent ambulance transport cover specified additional states apply prior authorization program states certain conditions sec directs secretary submit plan congress including annual report programs data services medical visits paid physician fee schedule fee schedule exceeds error rate exceeds sec removes funds medicare_improvement_fund added impact act |
114-HR-1741 | Truth in Healthcare Marketing Act of 2015
This bill prohibits any person from making any statement or engaging in any act that misrepresents: (1) whether the person holds a state health care license; or (2) the person's education, training, degree, license, or clinical expertise.
A person's advertisement for the person's health care services must disclose the license under which the person is authorized to provide those services.
A violation of this Act is an unfair or deceptive act or practice under the Federal Trade Commission Act.
The Federal Trade Commission must study and report to Congress on health care professionals' misrepresentations under this Act. | Health | Medical Liability | Health | 2015-04-13 | truth bill prohibits person making statement engaging act misrepresents person holds state health care license person education training degree license clinical expertise person advertisement person health care services disclose license person authorized provide services violation act unfair deceptive act practice federal_trade_commission_act federal_trade_commission study report congress health care professionals misrepresentations act |
114-HR-2107 | This bill amends title XIX (Medicaid) of the Social Security Act to revise the conditions for state use of an independent enrollment broker in marketing Medicaid managed care organizations and other managed care entities to eligible individuals.
The Secretary of Health and Human Services must find that the broker has also established and maintains policies and procedures to ensure the independence of its enrollment activities from the interests of any managed care entity or provider. | Health | Medical Liability | Health | 2015-04-29 | bill amends title xix medicaid social security act revise conditions state use independent enrollment broker marketing medicaid managed care organizations managed care entities eligible individuals secretary health_and_human_services find broker established maintains policies procedures ensure independence enrollment activities interests managed care entity provider |
114-HR-2156 | Medicare Audit Improvement Act of 2015
This bill amends title XVIII (Medicare) of the Social Security Act (SSAct) with respect to the practices of recovery audit contractors (RACs) under the Medicare program fin identifying underpayments and overpayments and recouping overpayments.
Incentive payments to a RAC for recovery activities are prohibited for FY2015 and subsequent fiscal years.
Payments for recovery activities shall be reduced, according to a sliding scale established by the Secretary of Health and Human Services, to any RAC with a complex audit denial rate at the end of a fiscal year, determined pursuant to a specified formula, that is .1% or greater.
The one-year timely filing limit for certain rebilled SSAct title XVIII part B (Supplementary Medical Insurance) claims is eliminated, extending the deadline for the rebill to 180 days after final denial of the claim.
A determination of whether inpatient hospital services or inpatient critical access hospital services furnished to an individual are reasonable and necessary shall now be based solely on information available to the admitting physician at the time of the inpatient admission of the individual for such services, as documented in the medical record. | Health | Medical Liability | Health | 2015-04-30 | medicare audit improvement act bill amends title xviii medicare social security act ssact respect practices recovery audit contractors medicare program fin identifying underpayments overpayments overpayments incentive payments recovery activities prohibited fy2015 subsequent fiscal years payments recovery activities shall reduced according sliding scale established secretary health_and_human_services complex audit denial rate end fiscal year determined pursuant specified formula greater year timely filing limit certain ssact title xviii supplementary_medical_insurance claims eliminated extending deadline days final denial claim determination inpatient hospital services inpatient critical access hospital services furnished individual reasonable necessary shall based solely information available admitting physician time inpatient admission individual services documented medical record |
114-HR-2422 | This bill amends the Federal Food, Drug, and Cosmetic Act to require the Food and Drug Administration (FDA) to establish a third-party quality system assessment program to accredit persons to assess whether a medical device manufacturer's quality system can ensure the safety and effectiveness of an approved medical device after certain changes, including changes in manufacturing or changes to enhance device safety.
Device manufacturers are allowed to make changes to a device without submitting to the FDA the 30-day notice required for manufacturing changes or a premarket approval supplement if their quality system has been certified by an accredited person.
An accredited person who assesses a device manufacturer's quality system must submit a summary of their assessment and, as appropriate, a certification to the FDA within 30 days of the assessment. An assessment summary and certification is deemed accepted by the FDA 30 days after submission unless the FDA determines that additional information is needed to support certification, the assessment or certification is unwarranted, or an action other than acceptance of the certification is otherwise justified.
Periodic reports by device manufacturers must describe any changes made to a device without submission of the 30-day notice or the premarket approval supplement.
Certifications accepted by the FDA remain in effect for two years.
The FDA must report on this quality system assessment program no later than January 31, 2022. The program is terminated at the end of FY2022. | Health | Medical Liability | Health | 2015-05-19 | bill amends cosmetic act require food_and_drug_administration fda establish party quality system assessment program accredit persons assess medical device manufacturer quality system ensure safety effectiveness approved medical device certain changes including changes manufacturing changes enhance device safety device manufacturers allowed changes device submitting fda day notice required manufacturing changes premarket approval supplement quality system certified accredited person accredited person assesses device manufacturer quality system submit summary assessment appropriate certification fda days assessment assessment summary certification deemed accepted fda days submission fda determines additional information needed support certification assessment certification unwarranted action acceptance certification justified periodic reports device manufacturers describe changes device submission day notice premarket approval supplement certifications accepted fda remain effect years fda report quality system assessment program later january program terminated end fy2022 |
114-HR-2603 | Saving Lives, Saving Costs Act
Establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines.
Requires the Department of Health and Human Services (HHS) to publish clinical practice guidelines provided and maintained by national or state medical societies or medical specialty societies designated by HHS. Sets forth standards for the development of guidelines, including standards related to transparency, the composition of the panel, and the review of existing evidence. Prohibits holding a professional organization or a participant in guideline development liable for injury allegedly caused by adherence to a guideline to which they contributed.
Declares that this Act does not preempt: (1) any state or federal law that imposes greater procedural or substantive protections for health care providers and health care organizations from liability, loss, or damages than those provided under this Act; (2) any state or federal law that creates a cause of action; or (3) any defenses otherwise available.
Gives jurisdiction of health care liability actions against health care professionsals, providers, or organizations to district courts. Allows a defendant to remove any health care liability action brought in a state court to a district court.
Requires an independent medical review in health care liability actions that have been removed to a district court if the eligible professionals allege that they adhered to applicable clinical practice guidelines. Sets forth procedures for the use of the panel's findings at trial. | Health | Medical Liability | Health | 2015-06-02 | saving lives saving costs act establishes framework health care liability lawsuits undergo review independent medical review panels health care professionals practicing physicians agents employees allege adherence applicable clinical practice guidelines requires department_of_health_and_human_services hhs publish clinical practice guidelines provided maintained national state medical societies medical specialty societies designated hhs sets forth standards development guidelines including standards related transparency composition panel review existing evidence prohibits holding professional organization participant guideline development liable injury allegedly caused adherence guideline contributed declares act preempt state federal law imposes greater procedural substantive protections health care providers health care organizations liability loss damages provided act state federal law creates cause action defenses available gives jurisdiction health care liability actions health care providers organizations district courts allows defendant remove health care liability action brought state court district court requires independent medical review health care liability actions removed district court eligible professionals allege applicable clinical practice guidelines sets forth procedures use panel findings trial |
114-HR-3494 | Protecting Infants Born Alive Act
This bill amends title XIX (Medicaid) of the Social Security Act to modify requirements regarding a state plan for medical assistance. Under current law, a state plan for medical assistance must provide that any individual eligible for medical assistance may obtain required services from any institution, agency, or person qualified to perform them. The bill specifies that a state may not be required to provide medical assistance for such services by any individual or entity whose services or actions are suspected by the state of causing the termination of a human fetus classified as an infant born alive. Furthermore, a provider of such an abortion may neither receive payment under the Medicaid program nor participate in any federal or state health care program. | Health | Medical Liability | Health | 2015-09-11 | protecting infants born alive act bill amends title xix medicaid social security act modify requirements state plan medical assistance current law state plan medical assistance provide individual eligible medical assistance obtain required services institution agency person qualified perform bill specifies state required provide medical assistance services individual entity services actions suspected state causing termination human fetus classified infant born alive furthermore provider abortion receive payment medicaid program participate federal state health care program |
114-HR-3504 | (This measure has not been amended since it was introduced. The summary has been expanded because action occurred on the measure.)
Born-Alive Abortion Survivors Protection Act
(Sec. 3) This bill amends the federal criminal code to require any health care practitioner who is present when a child is born alive following an abortion or attempted abortion to: (1) exercise the same degree of care as reasonably provided to any other child born alive at the same gestational age, and (2) ensure that such child is immediately admitted to a hospital. The term "born alive" means the complete expulsion or extraction from his or her mother, at any stage of development, who after such expulsion or extraction breathes or has a beating heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, regardless of whether the umbilical cord has been cut.
Also, a health care practitioner or other employee who has knowledge of a failure to comply with these requirements must immediately report such failure to an appropriate law enforcement agency.
An individual who violates the provisions of this Act is subject to a criminal fine, up to five years in prison, or both.
An individual who commits an overt act that kills a child born alive is subject to criminal prosecution for murder.
The legislation bars the criminal prosecution of a mother of a child born alive for conspiracy to violate the provisions of this Act, for being an accessory after the fact, or for concealment of felony.
A woman who undergoes an abortion or attempted abortion may file a civil action for damages against an individual who violates this Act. | Health | Medical Liability | Crime and law enforcement | 2015-09-15 | measure amended introduced summary expanded action occurred measure born alive abortion survivors protection act sec bill amends federal criminal code require health care practitioner present child born alive following abortion attempted abortion exercise degree care reasonably provided child born alive gestational age ensure child immediately admitted hospital term born alive means complete expulsion extraction mother stage development expulsion extraction heart umbilical cord definite movement voluntary regardless umbilical cord cut health care practitioner employee knowledge failure comply requirements immediately report failure appropriate law enforcement agency individual violates provisions act subject criminal fine years prison individual commits act kills child born alive subject criminal prosecution murder legislation bars criminal prosecution mother child born alive conspiracy violate provisions act accessory fact concealment felony woman undergoes abortion attempted abortion file civil action damages individual violates act |
114-HR-3716 | Ensuring Access to Quality Medicaid Providers 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. | Health | Medical Liability | Health | 2015-10-08 | ensuring access quality medicaid providers act sec bill amends titles xix medicaid social security act prohibit federal payment medicaid nonemergency services furnished providers participation medicaid medicare chip terminated current law state exclude medicaid participation provider terminated state medicaid program medicare bill maintains requirements requires state exclude medicaid participation provider terminated chip furthermore state exclude chip participation provider terminated medicaid medicare bill revises state reporting requirements respect terminating provider state plan state shall require medicaid chip provider provider participates fee service ffs basis network managed care organization enroll state providing specified identifying information notifying department_of_health_and_human_services hhs provider terminated state plan state submit information information termination date reason hhs shall review termination notifications appropriate include database similar system specified bill bill prohibits federal payment state medicaid chip program services provided state system notifying provider terminated medicaid medicare chip contract state plan provides providers excluded participation provider network hhs shall report congress bill implementation sec state publish annually update public directory ffs providers participating state plan |
114-HR-3718 | Preventing and Reducing Improper Medicare and Medicaid Expenditures to Restore Integrity to Benefits Act of 2015
This bill amends title XIX (Medicaid) of the Social Security Act to make several changes related to the prevention of Medicaid fraud.
With respect to the Medicaid Integrity Program (MIP), the bill: (1) specifies that program appropriations may cover costs of equipment, travel, training, and salaries and benefits; and (2) allows the Department of Health and Human Services (HHS) flexibility in determining the number of additional staff necessary to carry out the program. (MIP is a federal program aimed at preventing and reducing provider fraud, waste, and abuse in the Medicaid program.)
Under current law, HHS may contract with Medicare administrative contractors (MACs), which are private insurers that process Medicare claims within specified geographic jurisdictions. The bill requires HHS to provide specified incentives for MACs to reduce improper payment error rates within their jurisdictions.
The bill establishes criminal penalties of up to 10 years imprisonment and up to $500,000 in fines for illegally purchasing or distributing Medicare, Medicaid, or Children's Health Insurance Program (CHIP) beneficiary identification or billing privileges.
The bill increases the scope of the Medicare-Medicaid Data Match Program (Medi-Medi Program), an existing program through which contractors and participating governmental agencies collaboratively analyze Medicare and Medicaid billing trends. HHS must establish a plan to encourage states to participate in the Medi-Medi Program.
HHS shall develop and implement a plan to allow states to access relevant data on improper or fraudulent payments made under the Medicare program on behalf of individuals dually eligible for both Medicare and Medicaid. | Health | Medical Liability | Health | 2015-10-08 | preventing reducing improper medicare benefits act bill amends title xix medicaid social security act changes related prevention medicaid fraud respect medicaid_integrity_program mip bill specifies program appropriations cover costs equipment travel training salaries benefits allows department_of_health_and_human_services hhs flexibility determining number additional staff necessary carry program mip federal program aimed preventing reducing provider fraud waste abuse medicaid program current law hhs contract medicare administrative contractors macs private insurers process medicare claims specified geographic jurisdictions bill requires hhs provide specified incentives macs reduce improper payment error rates jurisdictions bill establishes criminal penalties years imprisonment fines illegally purchasing distributing medicare medicaid beneficiary identification billing privileges bill increases scope medicare-medicaid data_match_program medi-medi_program existing program contractors participating governmental agencies collaboratively analyze medicare medicaid billing trends hhs establish plan encourage states participate program hhs shall develop implement plan allow states access relevant data improper fraudulent payments medicare program behalf individuals dually eligible medicare medicaid |
114-HR-3770 | End Surprise Billing Act of 2015
This bill amends title XVIII (Medicare) of the Social Security Act to require a critical access hospital or other hospital to comply, as a condition of participation in Medicare, with certain requirements related to billing for out-of-network services.
With respect to an individual who has health benefits coverage and is seeking services, a hospital must provide notice as to: (1) whether the hospital, or any of the providers furnishing services to the individual at the hospital, is not within the health care provider network or otherwise a participating provider with respect to the individual's health care coverage; and (2) if so, the estimated out-of-pocket costs of the services to the individual. At least 24 hours prior to providing those services, the hospital must document that the individual: (1) has been provided with the required notice, and (2) consents to be furnished with the services and charged an amount approximate to the estimate provided. Otherwise, the hospital may not charge the individual more than the individual would have been required to pay if the services had been furnished by an in-network or participating provider.
With respect to such an individual who is seeking same-day emergency services, a hospital may not charge more than the individual would be required to pay for such services furnished by an in-network or participating provider. | Health | Medical Liability | Health | 2015-10-20 | end billing act bill amends title xviii medicare social security act require critical access hospital hospital comply condition participation medicare certain requirements related billing network services respect individual health benefits coverage seeking services hospital provide notice hospital providers furnishing services individual hospital health care provider network participating provider respect individual health care coverage estimated pocket costs services individual hours prior providing services hospital document individual provided required notice consents furnished services charged approximate estimate provided hospital charge individual individual required pay services furnished network participating provider respect individual seeking day emergency services hospital charge individual required pay services furnished network participating provider |
114-HR-4801 | Medical Loss Ratio Accountability Act of 2016
This bill amends the Public Health Service Act to require the Department of Health and Human Services (HHS) to audit a statistically significant and representative selection of health insurers to verify that insurer reports on medical loss ratio are accurate.
This bill amends the Social Security Act to base determinations of the medical loss ratio of a Medicare Advantage plan on information from the HHS audit of the plan, if the plan was audited. | Health | Medical Liability | Health | 2016-03-17 | medical loss ratio accountability act bill amends public_health_service_act require department_of_health_and_human_services hhs audit statistically significant representative selection health insurers verify insurer reports medical loss ratio accurate bill amends social security act base determinations medical loss ratio medicare_advantage plan information hhs audit plan plan audited |
114-HR-4802 | Medicaid Program Integrity Enhancement Act of 2016
This bill amends title XIX (Medicaid) of the Social Security Act to require a state Medicaid agency to establish a process by which a provider may appeal a decision by the agency to suspend payment to the provider on the basis of credible fraud allegations.
The Centers for Medicare & Medicaid Services (CMS) must revise specified regulations related to such suspensions in order to comply with due process requirements established by the bill.
Specifically, a state Medicaid agency may not suspend payment until the agency: (1) consults with the state's Medicaid fraud control unit or, if the state has no such unit, with the state's attorney general; (2) certifies that it has considered whether the suspension will jeopardize beneficiary access and whether there is good cause not to suspend payment; and (3) furnishes the provider with the agency's reasons for finding no such good cause.
Furthermore, the agency must periodically evaluate whether there is good cause to discontinue a suspension for which an investigation is pending. With specified exceptions, such good cause shall be deemed to exist if the investigation remains unresolved after a suspension has been in effect for 18 months.
CMS must also revise specified regulations to provide that an allegation of fraud shall be considered credible only if the allegation has indications of reliability and the state Medicaid agency: (1) has reviewed all allegations, facts, and evidence carefully; (2) acts judiciously on a case-by-case basis; and (3) has considered the potential impact a payment suspension may have on beneficiary access to care. | Health | Medical Liability | Health | 2016-03-17 | bill amends title xix medicaid social security act require state medicaid agency establish process provider appeal decision agency suspend payment provider basis credible fraud allegations centers cms revise specified regulations related suspensions order comply process requirements established bill specifically state medicaid agency suspend payment agency consults state medicaid fraud control unit state unit state attorney general certifies considered suspension jeopardize beneficiary access good cause suspend payment furnishes provider agency reasons finding good cause furthermore agency periodically evaluate good cause discontinue suspension investigation pending specified exceptions good cause shall deemed exist investigation remains unresolved suspension effect months cms revise specified regulations provide allegation fraud shall considered credible allegation indications reliability state medicaid agency reviewed allegations facts evidence carefully acts case case basis considered potential impact payment suspension beneficiary access care |
114-HR-5088 | Promoting Integrity in Medicare Act of 2016 or PIMA of 2016
This bill amends title XVIII (Medicare) of the Social Security Act to: (1) expand Medicare's prohibition on physician self-referrals to include, with specified exceptions, certain advanced imaging, anatomic pathology, radiation therapy, and physical therapy services; and (2) establish increased civil monetary penalties for violations of the self-referral prohibition with respect to those services.
The Centers for Medicare & Medicaid Services shall conduct a compliance review with respect to such referrals. | Health | Medical Liability | Health | 2016-04-28 | promoting integrity medicare_act pima bill amends title xviii medicare social security act expand medicare prohibition physician self referrals include specified exceptions certain advanced imaging pathology radiation therapy physical therapy services establish increased civil monetary penalties violations self referral prohibition respect services centers shall conduct compliance review respect referrals |
114-HR-5241 | Protecting Seniors from Health Care Fraud Act of 2016
This bill amends title XVIII (Medicare) of the Social Security Act to direct the Department of Health and Human Services (HHS) to report annually to Congress and the public on: (1) the ten most prevalent health care fraud schemes targeted to seniors, (2) steps being taken to combat such schemes, and (3) policy suggestions to improve protections for seniors.
HHS may omit certain information from an annual report if public disclosure would compromise an ongoing investigation or educate criminals rather than seniors.
HHS shall disseminate reports to Medicare beneficiaries as specified by the bill. | Health | Medical Liability | Health | 2016-05-13 | health care fraud act bill amends title xviii medicare social security act direct department_of_health_and_human_services hhs report annually congress public prevalent health care fraud schemes targeted seniors steps taken combat schemes policy suggestions improve protections seniors hhs omit certain information annual report public disclosure compromise ongoing investigation educate criminals seniors hhs shall disseminate reports medicare beneficiaries specified bill |
114-HR-5399 | (This measure has not been amended since it was introduced. The expanded summary of the House reported version is repeated here.)
Ethical Patient Care for Veterans Act of 2016
(Sec. 2) This bill directs the Department of Veterans Affairs (VA) to ensure that each VA physician is informed of the duty to report any covered activity committed by another physician that the physician witnesses or otherwise directly discovers to the applicable state licensing authority within five days.
Disciplinary Appeals Boards shall have exclusive jurisdiction to review any case of professional conduct or competence arising from a VA physician's failure to properly report such activity.
"Covered activity" means any activity occurring in a VA medical facility that consists of or causes the provision of impaired, incompetent, or unethical health care that requires direct reporting under the Code of Medical Ethics of the American Medical Association. | Health | Medical Liability | Armed forces and national security | 2016-06-07 | measure amended introduced expanded summary house reported version repeated ethical patient care veterans act sec bill directs department_of_veterans_affairs ensure physician informed duty report covered activity committed physician physician witnesses directly discovers applicable state licensing authority days disciplinary appeals boards shall exclusive jurisdiction review case professional conduct competence arising physician failure properly report activity covered activity means activity occurring medical facility consists causes provision impaired incompetent unethical health care requires direct reporting code medical ethics |
114-HR-5547 | Health Care Price Transparency Promotion Act of 2016
This bill amends title XIX (Medicaid) of the Social Security Act to require state Medicaid plans to provide that the state will establish and maintain laws to: (1) require disclosure of information on hospital charges, (2) make such information available to the public, and (3) provide individuals with information about estimated out-of-pocket costs for health care services. | Health | Medical Liability | Health | 2016-06-21 | health care price transparency promotion act bill amends title xix medicaid social security act require state medicaid plans provide state establish maintain laws require disclosure information hospital charges information available public provide individuals information estimated pocket costs health care services |
114-HR-6051 | Local Medicaid Enforcement Incentives Act of 2016
This bill requires the Centers for Medicare & Medicaid Services to award grants to states for the purpose of establishing or expanding programs that: (1) detect and prevent Medicaid fraud, waste, and abuse; (2) identify and recover overpayments resulting from such fraud, waste, or abuse; and (3) share recovered overpayments with localities that assist in detection, prevention, or recovery. | Health | Medical Liability | Health | 2016-09-15 | local bill requires centers award grants states purpose establishing expanding programs detect prevent medicaid fraud waste abuse identify recover overpayments resulting fraud waste abuse share recovered overpayments localities assist detection prevention recovery |
114-S-97 | No Obamacare Kickbacks Act of 2015
Applies prohibitions against, and criminal penalties for, false statements and kickbacks in part A (General Provisions) of title XI of the Social Security Act to plans and programs established or funded under the Patient Protection and Affordable Care Act, including qualified health plans, catastrophic plans, health benefit exchanges, reinsurance programs, the risk corridor program, patient navigators, and contracts with individuals or entities to facilitate enrollment in exchanges.
Directs the Inspector General of the Department of Health and Human Services and the Government Accountability Office to jointly study and report to Congress on the effect of this Act. | Health | Medical Liability | Health | 2015-01-07 | obamacare kickbacks act applies prohibitions criminal penalties false statements kickbacks general provisions title social security act plans programs established funded patient_protection affordable care act including qualified health plans catastrophic plans health benefit exchanges reinsurance programs risk corridor program patient navigators contracts individuals entities facilitate enrollment exchanges directs inspector general department_of_health_and_human_services government_accountability_office jointly study report congress effect act |
114-S-679 | Quality Data, Quality Healthcare Act of 2015
Amends title XVIII (Medicare) of the Social Security Act with respect to the use of certain data by qualified public or private entities to evaluate the performance of service providers and suppliers under Medicare insurance programs.
Authorizes a qualified entity to: (1) use Medicare data, and information derived from service provider and supplier performance evaluations, for additional non-public analyses; or (2) provide or sell such data and analyses to specified health care-related entities for non-public use (including for purposes of assisting service providers and suppliers to develop and participate in quality and patient care improvement activities, particularly development of new models of care).
Conditions such authorization upon a data use agreement between a qualified entity and a specified health care-related entity under which the latter: (1) may not re-sell such data or analyses, and (2) shall comply with the qualified entity's privacy and security policies in using such data or analyses.
Prescribes a civil money penalty for unauthorized use of data and analyses.
Requires the Secretary of Health and Human Services to provide Medicare claims data to qualified clinical data registries for purposes of linking it with clinical outcomes data and performing and disseminating risk-adjusted, scientifically valid research to support quality improvement.
Prohibits a qualified clinical data registry from reporting publicly any claims data thus made available that individually identifies a service provider or supplier without prior consent. | Health | Medical Liability | Health | 2015-03-09 | quality healthcare act amends title xviii medicare social security act respect use certain data qualified public private entities evaluate performance service providers suppliers medicare insurance programs authorizes qualified entity use medicare data information derived service provider supplier performance evaluations additional non public analyses provide sell data analyses specified health care related entities non public use including purposes assisting service providers suppliers develop participate quality patient care improvement activities particularly development new models care conditions authorization data use agreement qualified entity specified health care related entity sell data analyses shall comply qualified entity privacy security policies data analyses prescribes civil money penalty unauthorized use data analyses requires secretary health_and_human_services provide medicare claims data qualified clinical data registries purposes linking clinical outcomes data performing disseminating risk adjusted scientifically valid research support quality improvement prohibits qualified clinical data registry reporting publicly claims data available individually identifies service provider supplier prior consent |
114-S-861 | Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015
(Sec. 2) Amends title XIX (Medicaid) of the Social Security Act (SSAct) to cover the costs of equipment, salaries and benefits, and travel and training in appropriations for the Medicaid Integrity Program. Allows the Department of Health and Human Services (HHS) to increase Centers for Medicare and Medicaid Services staff whose duties consist solely of protecting the integrity of the Medicare program under SSAct title XVIII by a number determined necessary to carry out the Program (currently, by 100).
(Sec. 3) Directs HHS to provide incentives for Medicare administrative contractors (MACs) to reduce the improper payment error rates in their jurisdictions.
Authorizes among such incentives:
a sliding scale of award fee payments and additional incentives to MACs that either reduce the improper payment rates in their jurisdictions to certain HHS-determined thresholds or accomplish tasks that further improve payment accuracy; and substantial reductions in award fee payments under cost-plus-award-fee contracts for MACs that reach an upper end improper payment rate threshold or fail to accomplish tasks that further improve payment accuracy. (Sec. 4) Requires imprisonment for up to 10 years or a fine of up to $500,000 ($1 million in the case of a corporation), or both, for without lawful authority knowingly and willfully purchasing, selling, distributing, or arranging for the purchase, sale, or distribution of a beneficiary identification number or unique health identifier for a health care provider under SSAct titles XVIII, XIX, or XXI (Children's Health Insurance Program) (CHIP).
(Sec. 5) Directs HHS to establish a plan to encourage and facilitate the participation of states in the Medicare-Medicaid Data Match Program (Medi-Medi Program). Revises Medi-Medi Data Match Program purposes.
Directs HHS to develop and implement a plan that allows state agencies responsible for administering a state Medicaid plan access to relevant data on improper or fraudulent payments made under the Medicare program for health care items or services provided to dual eligible individuals (eligible for both Medicare and Medicaid). | Health | Medical Liability | Health | 2015-03-25 | preventing reducing improper medicare medicaid expenditures act prime act sec amends title xix medicaid social security act ssact cover costs equipment salaries benefits travel training appropriations medicaid_integrity_program allows department_of_health_and_human_services hhs increase centers medicare medicaid_services staff duties consist solely protecting integrity medicare program ssact title xviii number determined necessary carry program currently sec directs hhs provide incentives medicare administrative contractors macs reduce improper payment error rates jurisdictions authorizes incentives sliding scale award fee payments additional incentives macs reduce improper payment rates jurisdictions certain hhs determined thresholds accomplish tasks improve payment accuracy substantial reductions award fee payments cost plus award fee contracts macs reach upper end improper payment rate threshold fail accomplish tasks improve payment accuracy sec requires imprisonment years fine million case corporation lawful authority knowingly willfully purchasing selling distributing arranging purchase sale distribution beneficiary identification number unique health identifier health care provider ssact titles xviii xix chip sec directs hhs establish plan encourage facilitate participation states medicare-medicaid data_match_program medi-medi_program data match program purposes directs hhs develop implement plan allows state agencies responsible administering state medicaid plan access relevant data improper fraudulent payments medicare program health care items services provided dual eligible individuals eligible medicare medicaid |
114-S-1475 | Saving Lives, Saving Costs Act
Establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines.
Requires the Department of Health and Human Services (HHS) to publish clinical practice guidelines provided and maintained by national or state medical societies or medical specialty societies designated by HHS. Sets forth standards for the development of guidelines, including standards related to transparency, the composition of the panel, and the review of existing evidence. Prohibits holding a professional organization or a participant in guideline development liable for injury allegedly caused by adherence to a guideline to which they contributed.
Declares that this Act does not preempt: (1) any state or federal law that imposes greater procedural or substantive protections for health care providers and health care organizations from liability, loss, or damages than those provided under this Act; (2) any state or federal law that creates a cause of action; or (3) any defenses otherwise available.
Gives jurisdiction of health care liability actions against health care professionsals, providers, or organizations to district courts. Allows a defendant to remove any health care liability action brought in a state court to a district court.
Requires an independent medical review in health care liability actions that have been removed to a district court if the eligible professionals allege that they adhered to applicable clinical practice guidelines. Sets forth procedures for the use of the panel's findings at trial. | Health | Medical Liability | Health | 2015-06-02 | saving lives saving costs act establishes framework health care liability lawsuits undergo review independent medical review panels health care professionals practicing physicians agents employees allege adherence applicable clinical practice guidelines requires department_of_health_and_human_services hhs publish clinical practice guidelines provided maintained national state medical societies medical specialty societies designated hhs sets forth standards development guidelines including standards related transparency composition panel review existing evidence prohibits holding professional organization participant guideline development liable injury allegedly caused adherence guideline contributed declares act preempt state federal law imposes greater procedural substantive protections health care providers health care organizations liability loss damages provided act state federal law creates cause action defenses available gives jurisdiction health care liability actions health care providers organizations district courts allows defendant remove health care liability action brought state court district court requires independent medical review health care liability actions removed district court eligible professionals allege applicable clinical practice guidelines sets forth procedures use panel findings trial |
110-HR-2406 | Healthcare Information Technology Enterprise Integration Act - (Sec. 3) Requires the Director of the National Institute of Standards and Technology (NIST) to establish an initiative for advancing health care information enterprise integration within the United States. Authorizes the Director to focus on: (1) information technology standards and interoperability analysis; (2) supporting the establishment of conformance testing infrastructure; (3) security; (4) medical device communication; (5) supporting the provisioning of technical architecture products for management and retrieval; and (6) information management.Allows the Director to assist health care representatives and organizations and federal agencies in the development of technical roadmaps that identify the remaining steps needed to ensure that standards will be in place. Requires such roadmaps to rely upon voluntary consensus standards, where possible, consistent with federal technology transfer laws.(Sec. 4) Requires the Director to report on the development or adoption of technology-neutral information technology infrastructure guidelines and standards to enable federal agencies to effectively select and utilize health care information technologies in a manner that is: (1) sufficiently secure; (2) interoperable; and (3) inclusive of ongoing federal efforts that provide technical expertise to harmonize existing standards and assist in the development of interoperability specifications. Requires such guidelines and standards to: (1) promote the use by federal agencies of commercially available products; (2) develop uniform testing procedures suitable for determining product conformance; (3) support and promote the testing of electronic health care information technologies utilized by federal agencies; (4) provide protection and security profiles; (5) establish a core set of interoperability specifications in federal agency transactions; and (6) include validation criteria to enable federal agencies to select appropriate health care information technologies. Requires the Director to report on: (1) the level of interoperability and security of technologies for sharing health care information among federal agencies; and (2) federal agency problems and progress in ensuring interoperable and secure health care information systems and electronic health care records.(Sec. 5) Requires the Director to establish a program of assistance to institutions of higher education to establish multidisciplinary Centers for Healthcare Information Enterprise Integration in order to: (1) generate innovative approaches to health care information enterprise integration; and (2) develop and use information technologies and other complementary fields.Directs the National High-Performance Computing Program to coordinate federal research and development programs related to the development and deployment of health information technology.Requires the Director to establish a task force to develop a strategic plan, including recommendations for: (1) the development, adoption, and maintenance of terminologies and classifications; (2) gaining commitment of terminology and classification stakeholders to principles and guidelines for an open and transparent process to enable cost-effective interoperability and complete and accurate information; (3) the design of a centralized authority or governance model; and (4) U.S. participation in the International Health Terminology Standards Development Organization.(Sec. 6) Authorizes Appropriations for FY2009-FY2010. | Technology | Science Transfer | Health | 2007-05-21 | sec requires director national_institute_of_standards_and_technology nist establish initiative advancing health care information enterprise integration united_states authorizes director focus information technology standards interoperability analysis supporting establishment conformance testing infrastructure security medical device communication supporting technical architecture products management retrieval information management allows director assist health care representatives organizations federal agencies development technical roadmaps identify remaining steps needed ensure standards place requires roadmaps rely voluntary consensus standards possible consistent federal technology transfer requires director report development adoption technology neutral information technology infrastructure guidelines standards enable federal agencies effectively select utilize health care information technologies manner sufficiently secure interoperable inclusive ongoing federal efforts provide technical expertise harmonize existing standards assist development interoperability specifications requires guidelines standards promote use federal agencies commercially available products develop uniform testing procedures suitable determining product conformance support promote testing electronic health care information technologies utilized federal agencies provide protection security profiles establish core set interoperability specifications federal agency transactions include validation criteria enable federal agencies select appropriate health care information technologies requires director report level interoperability security technologies sharing health care information federal agencies federal agency problems progress ensuring interoperable secure health care information systems electronic health care requires director establish program assistance institutions higher education establish multidisciplinary order generate innovative approaches health care information enterprise integration develop use information technologies complementary fields directs national high performance computing program coordinate federal research development programs related development deployment health information technology requires director establish task force develop strategic plan including recommendations development adoption maintenance classifications gaining commitment terminology classification stakeholders principles guidelines open transparent process enable cost effective interoperability complete accurate information design centralized authority governance model participation authorizes appropriations fy2009 fy2010 |
110-HR-3466 | Blue Collar Computing and Business Assistance Act of 2007 - Directs the Under Secretary of Technology of the Department of Commerce to award grants to eligible entities (any nonprofit, consortium of nonprofits, or partnership between a for-profit and a nonprofit) to establish up to five Advanced Multidisciplinary Computing Software Centers throughout the United States. Requires each Center to conduct: (1) general outreach to small businesses and manufacturers in all industry sectors within the geographic region assigned to the Center by the Under Secretary; and (2) technology transfer, development, and utilization programs for businesses throughout the United States in the specific industry sector assigned to the Center by the Under Secretary. | Technology | Science Transfer | Science, technology, communications | 2007-08-04 | business assistance act directs secretary award grants eligible entities nonprofit consortium nonprofits partnership profit nonprofit establish advanced multidisciplinary computing software centers united_states requires center conduct general outreach small businesses manufacturers industry sectors geographic region assigned center secretary technology transfer development utilization programs businesses united_states specific industry sector assigned center secretary |
110-S-124 | Satellite and Cable Access Act of 2007 - Amends federal copyright law and the Communications Act of 1934 to allow certain counties and areas to receive broadcast transmissions of network television stations located in the capital of the state in which such counties and areas are located. | Technology | Science Transfer | Science, technology, communications | 2007-01-04 | satellite cable access act amends federal copyright law communications act allow certain counties areas receive broadcast transmissions network television stations located capital state counties areas located |
110-S-760 | Four Corners Television Access Act of 2007 - Amends federal copyright law and the Communications Act of 1934 to allow certain counties and areas to receive broadcast transmissions of network television stations located in the capital of the state in which such counties and areas are located. Allows, notwithstanding any other provision of law, a satellite carrier, cable system, or translator station that elects to provide secondary transmission only to subscribers in the state who otherwise would not receive the primary transmission because the subscribers are in a designated market area outside of that state if: (1) the Federal Communications Commission (FCC) determines that it is in the best interest of the public welfare; and (2) the satellite carrier, cable system, or translator station agrees to also provide the secondary transmission in the assigned designated market area. | Technology | Science Transfer | Science, technology, communications | 2007-03-05 | corners television access act amends federal copyright law communications act allow certain counties areas receive broadcast transmissions network television stations located capital state counties areas located allows notwithstanding provision law satellite carrier cable system translator station elects provide secondary transmission subscribers state receive primary transmission subscribers designated market area outside state federal_communications_commission fcc determines best interest public welfare satellite carrier cable system translator station agrees provide secondary transmission assigned designated market area |
110-S-3630 | AmericaView Authorization Act - Directs the Secretary of the Interior, acting through the Director of the United States Geological Survey (USGS), to: (1) establish and maintain a nationwide AmericaView Program to advance the availability, distribution, and use of remote sensing data (information acquired from above the surface of the Earth by satellite or airplane) and technology in each state; (2) maintain AmericaView (the national nonprofit collaboration of StateView participants cooperating with the EROS Data Center to achieve the purposes of the AmericaView Program) in each state to develop publicly accessible remote sensing data archive and distribution infrastructure and expand remote sensing education, research, and knowledge; (3) award annual grants to sustain and develop StateView programs (the AmericaView programs of an individual states, comprised of educational institutions and state and local governments); and (4) maintain an advisory committee to advise the USGS Director about the AmericaView Program. | Technology | Science Transfer | Public lands and natural resources | 2008-09-26 | authorization act directs secretary interior acting director united_states_geological_survey usgs establish maintain nationwide advance availability distribution use remote sensing data information acquired surface earth satellite airplane technology state maintain national nonprofit collaboration participants cooperating achieve purposes state develop publicly accessible remote sensing data archive distribution infrastructure expand remote sensing education research knowledge award annual grants sustain develop programs programs individual states comprised educational institutions state local governments maintain advisory committee advise usgs director |
111-HR-1736 | International Science and Technology Cooperation Act of 2009 - Requires the Director of the Office of Science and Technology Policy (OSTP) to establish a committee under the National Science and Technology Council that has the responsibility of identifying and coordinating international science and technology cooperation that can strengthen U.S. science and technology enterprise, improve economic and national security, and support U.S. foreign policy goals. Requires the committee to be co-chaired by senior level officials from OSTP and the Department of State. Requires the committee to: (1) plan and coordinate interagency international science and technology cooperative research and training activities and partnerships supported or managed by federal agencies; (2) establish federal priorities and policies for aligning such international science and technology cooperative research and training activities and partnerships with the foreign policy goals of the United States; (3) identify opportunities for new international science and technology cooperative research and training partnerships that advance science and technology and U.S. foreign policy priorities; (4) solicit recommendations from non-federal science and technology stakeholders; (5) work with international science and technology counterparts to establish and maintain partnerships; and (6) address broad issues that influence the ability of U.S. scientists and engineers to collaborate with foreign counterparts. Requires the Director of OSTP to report annually to Congress on: (1) the priorities and policies established under this Act; (2) the ongoing and new partnerships identified in the previous year; and (3) how stakeholder input was received. | Technology | Science Transfer | Science, technology, communications | 2009-03-26 | requires director office_of_science_and_technology_policy ostp establish committee national_science_and_technology_council responsibility identifying coordinating international science technology cooperation strengthen science technology enterprise improve economic national security support foreign policy goals requires committee chaired senior level officials ostp department_of_state requires committee plan coordinate interagency international science technology cooperative research training activities partnerships supported managed federal agencies establish federal priorities policies aligning international science technology cooperative research training activities partnerships foreign policy goals united_states identify opportunities new international science technology cooperative research training partnerships advance science technology foreign policy priorities solicit recommendations non federal science technology stakeholders work international science technology counterparts establish maintain partnerships address broad issues influence ability scientists engineers collaborate foreign counterparts requires director ostp report annually congress priorities policies established act ongoing new partnerships identified previous year stakeholder input received |
111-HR-1860 | Four Corners Television Access Act of 2009 - Amends federal copyright law and the Communications Act of 1934 to allow satellite or cable retransmission of signals of broadcast television stations located in the capital of a state to counties in that state if the counties meet specified criteria. | Technology | Science Transfer | Science, technology, communications | 2009-04-01 | corners television access act amends federal copyright law communications act allow satellite cable retransmission signals broadcast television stations located capital state counties state counties meet specified criteria |
111-S-695 | Amends the National Institute of Standards and Technology Act to authorize the Secretary of Commerce to reduce the matching funds requirement for participants in the Hollings Manufacturing Partnership Program from not less than 50% of the costs incurred for the first three years and an increasing share for each of the last three years to 50% of the costs incurred or such lesser percentage as determined by the Secretary, by rule, and authorized by law. | Technology | Science Transfer | Commerce | 2009-03-25 | amends national_institute_of_standards_and_technology_act authorize secretary commerce reduce matching funds requirement participants costs incurred years increasing share years costs incurred lesser percentage determined secretary rule authorized law |
111-S-3155 | International Cybercrime Reporting and Cooperation Act - Directs the President to report annually to Congress regarding: (1) foreign countries use of information and communications technologies (ICT) in critical infrastructure, cybercrime based in each country, the adequacy of each countrys legal and law enforcement systems addressing cybercrime, and online protection of consumers and commerce; (2) multilateral efforts to prevent and investigate cybercrime, including U.S. actions to promote such multilateral efforts; and (3) countries for which action plans have been developed. Directs the President to give priority for assistance to improve legal, judicial, and enforcement capabilities with respect to cybercrime to countries with low ICT levels of development or utilization in their critical infrastructure, telecommunications systems, and financial industries. Directs the President to develop an action plan (with legislative, institutional, or enforcement benchmarks) and annual compliance assessment for each country determined to be a country of cyber concern: (1) from which there is a pattern of cybercrime incidents against the U.S. government, private U.S. entities, or other U.S. persons; and (2) whose government is uncooperative with efforts to combat cybercrime. Urges the President to take restrictive actions against a country that has not complied with the appropriate benchmarks with respect to: (1) the Overseas Private Investment Corporation (OPIC); (2) the Export-Import Bank of the United States; (3) multilateral development financing; (4) the Trade and Development Agency; (5) preferential trade programs; and (6) foreign assistance. Authorizes the President to waive the requirements to develop an action plan or make a determination of cyber concern if in U.S. national interest. Directs the Secretary of State to: (1) designate a high-level Department of State employee to coordinate anti-cybercrime activities; and (2) assign an employee to have primary responsibility for cybercrime policy in each country or region significant to U.S. anti-cybercrime efforts. | Technology | Science Transfer | International affairs | 2010-03-23 | international cybercrime reporting cooperation act directs president report annually congress foreign use information communications technologies critical infrastructure cybercrime based country adequacy legal law enforcement systems addressing cybercrime online protection consumers commerce multilateral efforts prevent investigate cybercrime including actions promote multilateral efforts countries action plans developed directs president priority assistance improve legal judicial enforcement capabilities respect cybercrime countries low levels development utilization critical infrastructure telecommunications systems financial industries directs president develop action plan legislative institutional enforcement benchmarks annual compliance assessment country determined country cyber concern pattern cybercrime incidents government private entities persons government efforts combat cybercrime urges president restrictive actions country complied appropriate benchmarks respect overseas_private_investment_corporation opic export-import_bank united_states multilateral development financing trade_and_development_agency preferential trade programs foreign assistance authorizes president waive requirements develop action plan determination cyber concern national interest directs secretary state designate high level department_of_state employee coordinate anti cybercrime activities assign employee primary responsibility cybercrime policy country region significant anti cybercrime efforts |
112-HR-134 | Amends the Internal Revenue Code to make the tax credit for increasing research activities permanent. | Technology | Science Transfer | Taxation | 2011-01-05 | amends internal revenue code tax credit increasing research activities permanent |
112-HR-1329 | Amends the Internal Revenue Code to: (1) make permanent the tax credit for increasing research activities, and (2) increase the amount of such credit for taxpayers who earn more than 50% of their gross receipts from domestic production activities. | Technology | Science Transfer | Taxation | 2011-04-01 | amends internal revenue code permanent tax credit increasing research activities increase credit taxpayers earn gross receipts domestic production activities |
112-S-2063 | Prohibits a U.S. commercial entity from transferring any proprietary technology or intellectual property researched, developed, or commercialized with federal financial assistance to an entity: (1) owned or controlled by the government of a country which requires any U.S. commercial entity to transfer proprietary technology or intellectual property as a condition of doing business, or (2) in which the citizens of such a country hold 5% interests of the capital structure of that entity. Authorizes the Secretary of Commerce to waive such prohibition if the transfer would not compromise U.S. economic interests or competitiveness. | Technology | Science Transfer | Science, technology, communications | 2012-02-02 | prohibits commercial entity transferring proprietary technology intellectual property developed federal financial assistance entity owned controlled government country requires commercial entity transfer proprietary technology intellectual property condition business citizens country hold interests capital structure entity authorizes secretary commerce waive prohibition transfer compromise economic interests competitiveness |
113-HR-4472 | US-Israel Global Neuroscience Partnership Act of 2014 - Directs the Secretary of Health and Human Services (HHS) to award grants to eligible entities for U.S.-Israel cooperative neuroscience research.
Establishes in the National Institutes of Health (NIH) an International Neuroscience-Related Research Advisory Board.
Terminates the grant program and the Advisory Board seven years after the date of enactment of this Act. | Technology | Science Transfer | Health | 2014-04-10 | israel global neuroscience partnership act directs secretary health_and_human_services hhs award grants eligible entities cooperative neuroscience research establishes national_institutes_of_health nih international neuroscience related research advisory board terminates grant program advisory_board seven years date enactment act |
113-HR-5029 | (This measure has not been amended since it was introduced. The summary has been expanded because action occurred on the measure.)
International Science and Technology Cooperation Act of 2014 - Requires the Director of the Office of Science and Technology Policy (OSTP) to establish a body under the National Science and Technology Council that has the responsibility of identifying and coordinating international science and technology cooperation that can strengthen U.S. science and technology enterprise, improve economic and national security, and support U.S. foreign policy goals.
Requires the body to be co-chaired by senior level officials from OSTP and the Department of State.
Requires the body to: (1) coordinate interagency international science and technology cooperative research and training activities and partnerships supported or managed by federal agencies, (2) establish federal priorities and policies for aligning such international science and technology cooperative research and training activities and partnerships with the foreign policy goals of the United States, (3) identify opportunities for new international science and technology cooperative research and training partnerships that advance science and technology and U.S. foreign policy priorities, (4) solicit recommendations from non-federal science and technology stakeholders, and (5) identify broad issues that influence the ability of U.S. scientists and engineers to collaborate with foreign counterparts.
Requires the Director to report annually on the body's activities. | Technology | Science Transfer | Science, technology, communications | 2014-07-08 | measure amended introduced summary expanded action occurred measure requires director office_of_science_and_technology_policy ostp establish body national_science_and_technology_council responsibility identifying coordinating international science technology cooperation strengthen science technology enterprise improve economic national security support foreign policy goals requires body chaired senior level officials ostp department_of_state requires body coordinate interagency international science technology cooperative research training activities partnerships supported managed federal agencies establish federal priorities policies aligning international science technology cooperative research training activities partnerships foreign policy goals united_states identify opportunities new international science technology cooperative research training partnerships advance science technology foreign policy priorities solicit recommendations non federal science technology stakeholders identify broad issues influence ability scientists engineers collaborate foreign counterparts requires director report annually body activities |
113-HR-5666 | Authorizes the U.S.-Israel Science and Technology Foundation, created pursuant to the 1994 Memorandum of Understanding between the U.S. Department of Commerce and the Israeli Ministry of Industry and Trade (now the Ministry of Economy), to facilitate research and development and technology partnerships among U.S. and Israeli researchers, and business and industrial entities for purposes of advancing technologies, leading to commercialization and domestic manufacturing, and creating benefits for both nations.
Instructs the Department of Commerce, through the Deputy Secretary's office and in conjunction with Israel's Ministry of Economy's Chief Scientist, to ensure that the U.S.-Israel Science and Technology Foundation maintains its role as the facilitator of the reauthorized 1994 Memorandum of Understanding to create and execute joint research and development agreements between Israel and U.S. entities, including U.S. federal agencies, states, cities, businesses, academic institutions, and scientific foundations. | Technology | Science Transfer | Science, technology, communications | 2014-09-18 | authorizes created pursuant memorandum understanding facilitate research development technology partnerships israeli researchers business industrial entities purposes advancing technologies leading commercialization domestic manufacturing creating benefits nations instructs department_of_commerce deputy secretary office conjunction israel chief scientist ensure maintains role facilitator reauthorized memorandum understanding create execute joint research development agreements israel entities including federal agencies states cities businesses academic institutions scientific foundations |
114-HR-1156 | International Science and Technology Cooperation Act of 2015
Directs the Office of Science and Technology Policy (OSTP) to establish or designate a working group under the National Science and Technology Council that has the responsibility of identifying and coordinating international science and technology cooperation that can strengthen U.S. science and technology enterprise, improve economic and national security, and support U.S. foreign policy goals.
Requires the working group to be co-chaired by officials from OSTP and the Department of State.
Requires the working group to: (1) coordinate interagency international science and technology cooperative research and training activities and partnerships supported or managed by federal agencies; (2) establish federal priorities and policies for aligning such international research, training, and partnerships with U.S. foreign policy goals; (3) identify opportunities for new international research and training partnerships that advance science and technology and U.S. foreign policy priorities; (4) solicit recommendations from non-federal science and technology stakeholders; and (5) identify broad issues that influence the ability of U.S. scientists and engineers to collaborate with foreign counterparts.
Requires the Director to report every two years on the working group's activities. | Technology | Science Transfer | Science, technology, communications | 2015-02-27 | directs office_of_science_and_technology_policy ostp establish designate working group national_science_and_technology_council responsibility identifying coordinating international science technology cooperation strengthen science technology enterprise improve economic national security support foreign policy goals requires working group chaired officials ostp department_of_state requires working group coordinate interagency international science technology cooperative research training activities partnerships supported managed federal agencies establish federal priorities policies aligning international research training partnerships foreign policy goals identify opportunities new international research training partnerships advance science technology foreign policy priorities solicit recommendations non federal science technology stakeholders identify broad issues influence ability scientists engineers collaborate foreign counterparts requires director report years working group activities |
114-HR-3717 | U.S.-Israel Global Neuroscience Partnership Act
This bill directs the Department of Health and Human Services to award grants to eligible entities for U.S.-Israel cooperative neuroscience research and related technological innovation.
The programs shall be carried out through the Small Business Innovation Research and Small Business Technology Transfer programs of the National Institutes of Health (NIH).
The bill establishes in NIH a U.S.-Israel Neuroscience Advisory Committee.
The grant program and the Committee are terminated seven years after enactment of this Act. | Technology | Science Transfer | Health | 2015-10-08 | global neuroscience partnership act bill directs department_of_health_and_human_services award grants eligible entities cooperative neuroscience research related technological innovation programs shall carried programs national_institutes_of_health nih bill establishes nih grant program committee terminated seven years enactment act |
110-HR-2430 | Amends the Department of Education Organization Act to redesignate the Office of Vocational and Adult Education of the Department of Education as the Office of Career, Technical, and Adult Education. Amends the Carl D. Perkins Career and Technical Education Act of 2006 to make conforming amendments. | Education | Vocational | Labor and employment | 2007-05-22 | amends department_of_education_organization_act redesignate adult_education department_of_education technical adult_education amends carl perkins career technical education act conforming amendments |
110-HR-3418 | Employee Educational Assistance Act of 2007 - Renders the general terminating date (i.e., December 31, 2010) of the Economic Growth and Tax Relief Reconciliation Act of 2001 inapplicable to provisions of that Act that extended the exclusion of employer-provided educational assistance from the gross income of employees (thus making such tax exclusion permanent). | Education | Vocational | Taxation | 2007-08-03 | employee educational assistance act renders general terminating date december economic_growth_and_tax_relief_reconciliation_act inapplicable provisions act extended exclusion employer provided educational assistance gross income employees making tax exclusion permanent |
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