Summary:
SGR Repeal and Medicare Beneficiary Access Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to: (1) end and remove sustainable growth rate (SGR) methodology from the determination of annual conversion factors in the formula for payment for physicians' services, (2) freeze the update to the single conversion factor at 0.5% for 2014 through 2018 and at 0.00% for 2019 through 2023, and (3) establish an update of 1% for health professionals participating in alternative payment models (APMs) and an update of 0.5% for all other health professionals after 2023.

Directs the Medicare Payment Advisory Commission (MEDPAC) to report to Congress on the relationship between: (1) physician and other health professional utilization and expenditures (and their rate of increase) of items and services for which Medicare payment is made; and (2) total utilization and expenditures (and their rate of increase) under Medicare parts A (Hospital Insurance), B (Supplementary Medical Insurance), and D (Voluntary Prescription Drug Benefit Program). Requires a separate report on the 2014-2018 update to physicians' services under Medicare

Revises and consolidates components of the three specified existing performance incentive programs into a merit-based incentive payment (MIP) system the Secretary of Health and Human Services (HHS) is directed to establish, under which MIP-eligible professionals (excluding most APM participants) receive annual payment increases or decreases based on their performance.

Requires specified incentive payments to eligible APM participants.

Directs the Secretary to make available on the Physician Compare website certain information, including information regarding the performance of MIP-eligible professionals.

Requires the Comptroller General (GAO) to evaluate the VBP program.

Requires the Secretary to study the application of federal fraud prevention laws related to APMs.

Directs the Secretary to draft a plan for development of quality measures to assess professionals, including non-patient-facing professionals.

Requires the Secretary to establish new Healthcare Common Procedure Coding System (HCPCS) codes for chronic care management services.

Directs the Secretary to conduct an education and outreach campaign to inform professionals who furnish items and services under Medicare part B and part B enrollees of the benefits of chronic care management services.

Authorizes the Secretary to: (1) collect and use information on the resources directly or indirectly related to physicians' services in the determination of relative values under the fee schedule; and (2) establish or adjust practice expense relative values using cost, charge, or other data from suppliers or service providers.

Revises and expands factors for identification of potentially misvalued codes. Sets an annual target for relative value adjustments for misvalued services. Phases-in significant relative value unit (RVU) reductions.

Directs the Secretary to establish a program to promote the use of appropriate use evidence-based criteria for applicable imaging services furnished in an applicable setting by ordering professionals and furnishing professionals.

Expands the kinds of uses of Medicare data available to qualified entities for quality improvement activities.

Directs the Secretary to provide Medicare data to qualified clinical data registries to facilitate quality improvement or patient safety.

Allows continuing renewals of any two-year period for which a physician or practitioner opts out of the Medicare claims process under a private contract with a beneficiary.

Declares it a national objective to achieve widespread exchange of health information through interoperable certified electronic health records (EHR) technology nationwide by December 31, 2017. Directs the Secretary to establish related metrics.

Requires meaningful EHR professionals and hospitals to demonstrate that they have not knowingly and willfully taken any action to limit or restrict the compatibility or interoperability of the certified EHR technology.

Directs GAO to study specified telehealth and remote patient monitoring services.

Modifies extensions and other requirements pertaining to the work geographic adjustment as well as Medicare payment for therapy services and ambulance services.

Revises requirements for: (1) the Medicare-dependent hospital (MDH) program, (2) the Medicare inpatient hospital payment adjustment for low-volume hospitals, as well as (3) specialized Medicare Advantage (MA) plans for special needs individuals.

Amends SSA title XIX (Medicaid) to extend the qualifying individual (QI) program, the transitional medical assistance (TMA) program, and express lane program eligibility.

Amends SSA title XI with respect to continue funding for pediatric quality measures.

Amends the Public Health Service Act to extend certain special diabetes programs.

Extends the abstinence education grant program, the personal responsibility education program, and family-to-family health information centers.

Extends the health workforce demonstration project for low-income individuals under SSA title XX.

Requires each Medicare administrative contractor to establish an improper payment outreach and education program to give service providers and suppliers information on payment errors with a view to reducing improper Medicare payments.

Revises requirements for a Medicaid fraud control unit's authority to investigate and prosecute complaints of abuse and neglect of patients in home and community-based settings.

Authorizes the HHS Inspector General to receive and retain 3% of all amounts collected pursuant to civil debt collection and administrative enforcement actions related to false claims or frauds involving the Medicare or Medicaid program.

Requires valid prescriber National Provider Identifiers on pharmacy claims against prescription drug plans (PDPs).

Directs the Secretary to establish a Commission on Improving Patient Directed Health Care.

Expands the definition of inpatient hospital services for certain cancer hospitals.

Directs the Secretary to provide for the development of one or more quality measures under Medicare to accurately communicate the existence and provide for the transfer of patient health information and patient care preferences when an individual transitions from a hospital to return home or move to other post-acute care settings.

Specifies that the minimum level of supervision with respect to outpatient therapeutic critical access hospital services shall be general supervision.

Requires state licensure of bidding entities under the competitive acquisition program for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).

Recognizes attending physician assistants as attending physicians to serve hospice patients under Medicare.

Directs the Secretary to conduct remote patient monitoring pilot projects.

Requires the Secretary to establish a Community-Based Institutional Special Needs Plan demonstration project to prevent and delay institutionalization under Medicaid among targeted low-income Medicare beneficiaries.

Directs the Secretary to implement a strategic plan to increase the usefulness of data about Medicaid programs reported by states to the Centers for Medicare and Medicaid Services.

Includes podiatrists as physicians under the Medicaid program.

Modifies Medicare requirements for inclusion of diabetic shoes under medical and other health services.

Directs the Secretary to: (1) publish criteria for a clinic to be certified by a state as a certified community behavioral health clinic, (2) award states planning grants to develop proposals to participate in time-limited related demonstration programs, and (3) select states to participate in such programs.

Requires the Secretary to report annually to Congress on payment adjustments to disproportionate share hospitals (DSHs) in order to provide Congress with information relevant to determining an appropriate level of overall funding for such adjustments during and after a certain period in which aggregate reductions in DSH allotments to states are required.

Amends the Patient Protection and Affordable Care Act and the Internal Revenue Code (IRC) to repeal the requirement that individuals maintain minimal essential health care coverage beginning in 2014, subject to a specified tax penalty for failing to do so (individual mandate). Requires the IRC to be applied and administered as if such requirement had never been enacted.

sgr_repeal medicare beneficiary access act amends title xviii medicare social_security_act ssa end remove sustainable growth rate sgr methodology determination annual conversion factors formula payment physicians services freeze update single conversion factor establish update health professionals participating alternative payment models apms update health professionals directs medicare_payment_advisory_commission medpac report congress relationship physician health professional utilization expenditures rate increase items services medicare payment total utilization expenditures rate increase medicare parts hospital insurance supplementary_medical_insurance voluntary prescription drug benefit program requires separate report update physicians services medicare revises consolidates components specified existing performance incentive programs merit based incentive payment mip system secretary health_and_human_services hhs directed establish mip eligible professionals excluding apm participants receive annual payment increases decreases based performance requires specified incentive payments eligible apm participants directs secretary available physician compare website certain information including information performance mip eligible professionals requires comptroller_general gao evaluate program requires secretary study application federal fraud prevention laws related apms directs secretary draft plan development quality measures assess professionals including non patient facing professionals requires secretary establish new healthcare common procedure coding system hcpcs codes chronic care management services directs secretary conduct education outreach campaign inform professionals furnish items services medicare enrollees benefits chronic care management services authorizes secretary collect use information resources directly indirectly related physicians services determination relative values fee schedule establish adjust practice expense relative values cost charge data suppliers service providers revises expands factors identification potentially misvalued codes sets annual target relative value adjustments misvalued services phases significant relative value unit reductions directs secretary establish program promote use appropriate use evidence based criteria applicable imaging services furnished applicable setting ordering professionals furnishing professionals expands kinds uses medicare data available qualified entities quality improvement activities directs secretary provide medicare data qualified clinical data registries facilitate quality improvement patient safety allows continuing renewals year period physician practitioner medicare claims process private contract beneficiary declares national objective achieve widespread exchange health information interoperable certified electronic health records ehr technology nationwide december directs secretary establish related metrics requires meaningful ehr professionals hospitals demonstrate knowingly willfully taken action limit restrict compatibility interoperability certified ehr technology directs gao study specified telehealth remote patient monitoring services modifies extensions requirements pertaining work geographic adjustment medicare payment therapy services ambulance services revises requirements medicare dependent hospital program medicare inpatient hospital payment adjustment low volume hospitals specialized medicare_advantage plans special needs individuals amends ssa title xix medicaid extend qualifying individual program transitional medical assistance tma program express lane program eligibility amends ssa title respect continue funding pediatric quality measures amends public_health_service_act extend certain special diabetes programs extends abstinence education grant program personal responsibility education program family family health information centers extends health workforce demonstration project low income individuals ssa title requires medicare administrative contractor establish improper payment outreach education program service providers suppliers information payment errors view reducing improper medicare payments revises requirements medicaid fraud control unit authority investigate prosecute complaints abuse neglect patients home community based settings authorizes hhs_inspector general receive retain amounts collected pursuant civil debt collection administrative enforcement actions related false claims involving medicare medicaid program requires valid prescriber national provider identifiers pharmacy claims prescription drug plans pdps directs secretary establish commission improving patient directed health_care expands definition inpatient hospital services certain cancer hospitals directs secretary provide development quality measures medicare accurately communicate existence provide transfer patient health information patient care preferences individual transitions hospital return home post acute care settings specifies minimum level supervision respect outpatient therapeutic critical access hospital services shall general supervision requires state licensure bidding entities competitive acquisition program certain durable medical equipment prosthetics orthotics supplies dmepos recognizes attending physician assistants attending physicians serve hospice patients medicare directs secretary conduct remote patient monitoring pilot projects requires secretary establish community based institutional special needs plan demonstration project prevent delay institutionalization medicaid targeted low income medicare beneficiaries directs secretary implement strategic plan increase usefulness data medicaid programs reported states centers medicare medicaid_services includes podiatrists physicians medicaid program modifies medicare requirements inclusion diabetic shoes medical health services directs secretary publish criteria clinic certified state certified community behavioral health clinic award states planning grants develop proposals participate time limited related demonstration programs select states participate programs requires secretary report annually congress payment adjustments disproportionate share hospitals order provide congress information relevant determining appropriate level overall funding adjustments certain period aggregate reductions dsh allotments states required amends patient_protection affordable care act internal_revenue_code irc repeal requirement individuals maintain minimal essential health_care coverage beginning subject specified tax penalty failing individual mandate requires irc applied administered requirement enacted


Summary:
Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to: (1) end and remove sustainable growth rate (SGR) methodology from the determination of annual conversion factors in the formula for payment for physicians' services; (2) freeze the update to the single conversion factor at 0.5% for 2014 through 2018 and at 0.00% for 2019 through 2023, and (3) establish an update of 1% for health professionals participating in alternative payment models (APMs) and an update of 0.5% for all other health professionals after 2023.

Directs the Medicare Payment Advisory Commission (MEDPAC) to report to Congress on the relationship between: (1) physician and other health professional utilization and expenditures (and their rate of increase) of items and services for which Medicare payment is made, and (2) total utilization and expenditures (and their rate of increase) under Medicare parts A (Hospital Insurance), B (Supplementary Medical Insurance), and D (Voluntary Prescription Drug Benefit Program). Requires a separate report on the 2014-2018 update to physicians' services under Medicare

Revises and consolidates components of the three specified existing performance incentive programs into a merit-based incentive payment (MIP) system the Secretary of Health and Human Services (HHS) is directed to establish, under which MIP-eligible professionals (excluding most APM participants) receive annual payment increases or decreases based on their performance.

Requires specified incentive payments to eligible APM participants.

Directs the Secretary to make available on the Physician Compare website certain information, including information regarding the performance of MIP-eligible professionals.

Requires the Comptroller General (GAO) to evaluate the VBP program.

Requires the Secretary to study the application of federal fraud prevention laws related to APMs.

Directs the Secretary to draft a plan for development of quality measures to assess professionals, including non-patient-facing professionals.

Requires the Secretary to establish new Healthcare Common Procedure Coding System (HCPCS) codes for chronic care management services.

Directs the Secretary to conduct an education and outreach campaign to inform professionals who furnish items and services under Medicare part B and part B enrollees of the benefits of chronic care management services.

Authorizes the Secretary to: (1) collect and use information on the resources directly or indirectly related to physicians' services in the determination of relative values under the fee schedule; and (2) establish or adjust practice expense relative values using cost, charge, or other data from suppliers or service providers.

Revises and expands factors for identification of potentially misvalued codes. Sets an annual target for relative value adjustments for misvalued services. Phases-in significant relative value unit (RVU) reductions.

Directs the Secretary to establish a program to promote the use of appropriate use evidence-based criteria for applicable imaging services furnished in an applicable setting by ordering professionals and furnishing professionals.

Expands the kinds of uses of Medicare data available to qualified entities for quality improvement activities.

Directs the Secretary to provide Medicare data to qualified clinical data registries to facilitate quality improvement or patient safety.

Allows continuing renewals of any two-year period for which a physician or practitioner opts out of the Medicare claims process under a private contract with a beneficiary.

Declares it a national objective to achieve widespread exchange of health information through interoperable certified electronic health records (EHR) technology nationwide by December 31, 2017. Directs the Secretary to establish related metrics.

Requires meaningful EHR professionals and hospitals to demonstrate that they have not knowingly and willfully taken any action to limit or restrict the compatibility or interoperability of the certified EHR technology.

Directs GAO to study specified telehealth and remote patient monitoring services.

Modifies extensions and other requirements pertaining to the work geographic adjustment as well as Medicare payment for therapy services and ambulance services.

Revises requirements for: (1) the Medicare-dependent hospital (MDH) program, (2) the Medicare inpatient hospital payment adjustment for low-volume hospitals, as well as (3) specialized Medicare Advantage (MA) plans for special needs individuals.

Amends SSA title XIX (Medicaid) to extend the qualifying individual (QI) program, the transitional medical assistance (TMA) program, and express lane program eligibility.

Amends SSA title XI with respect to continue funding for pediatric quality measures.

Amends the Public Health Service Act to extend certain special diabetes programs.

Extends the abstinence education grant program, the personal responsibility education program, and family-to-family health information centers.

Extends the health workforce demonstration project for low-income individuals under SSA title XX.

Requires each Medicare administrative contractor to establish an improper payment outreach and education program to give service providers and suppliers information on payment errors with a view to reducing improper Medicare payments.

Revises requirements for a Medicaid fraud control unit's authority to investigate and prosecute complaints of abuse and neglect of patients in home and community-based settings.

Authorizes the HHS Inspector General to receive and retain 3% of all amounts collected pursuant to civil debt collection and administrative enforcement actions related to false claims or frauds involving the Medicare or Medicaid program.

Requires valid prescriber National Provider Identifiers on pharmacy claims against prescription drug plans (PDPs).

Directs the Secretary to establish a Commission on Improving Patient Directed Health Care.

Expands the definition of inpatient hospital services for certain cancer hospitals.

Directs the Secretary to provide for the development of one or more quality measures under Medicare to accurately communicate the existence and provide for the transfer of patient health information and patient care preferences when an individual transitions from a hospital to return home or move to other post-acute care settings.

Specifies that the minimum level of supervision with respect to outpatient therapeutic critical access hospital services shall be general supervision unless the Secretary specifies otherwise for a particular service.

Requires state licensure of bidding entities under the competitive acquisition program for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).

Recognizes attending physician assistants as attending physicians to serve hospice patients under Medicare.

Directs the Secretary to conduct remote patient monitoring pilot projects.

Requires the Secretary to establish a Community-Based Institutional Special Needs Plan demonstration project to prevent and delay institutionalization under Medicaid among targeted low-income Medicare beneficiaries.

Directs the Secretary to implement a strategic plan to increase the usefulness of data about Medicaid programs reported by states to the Centers for Medicare and Medicaid Services.

Includes podiatrists as physicians under the Medicaid program.

Modifies Medicare requirements for inclusion of diabetic shoes under medical and other health services.

Directs the Secretary to: (1) publish criteria for a clinic to be certified by a state as a certified community behavioral health clinic, (2) award states planning grants to develop proposals to participate in time-limited related demonstration programs, and (3) select states to participate in such programs.

Requires the Secretary to report annually to Congress on payment adjustments to disproportionate share hospitals (DSHs) in order to provide Congress with information relevant to determining an appropriate level of overall funding for such adjustments during and after a certain period in which aggregate reductions in DSH allotments to states are required.

Amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) with respect to enforcing discretionary spending limits under a sequestration to specify diminishing maximum levels of budget authority designated for any of FY2016-2021 as emergency requirements for Overseas Contingency Operations (OCO)/Global War on Terrorism.

Expresses the sense of Congress that: (1) the annual adjustments to the statutory limits on discretionary spending should be reserved for programs and activities in budget functions 050 (National Defense) and 150 (International Affairs) necessary to meet OCO needs, and (2) the requirements for designating OCO funding provided for under that Act should remain fully in effect.

Expresses the sense of the Congress that savings from any reductions in annual adjustments to discretionary spending should be reserved for deficit reduction only.

Declares that nothing in this Act shall be construed to modify or eliminate any point of order that would otherwise be available against legislation that establishes or modifies any limit or adjustment to a limit on discretionary spending.

commonsense medicare sgr_repeal beneficiary access improvement act amends title xviii medicare social_security_act ssa end remove sustainable growth rate sgr methodology determination annual conversion factors formula payment physicians services freeze update single conversion factor establish update health professionals participating alternative payment models apms update health professionals directs medicare_payment_advisory_commission medpac report congress relationship physician health professional utilization expenditures rate increase items services medicare payment total utilization expenditures rate increase medicare parts hospital insurance supplementary_medical_insurance voluntary prescription drug benefit program requires separate report update physicians services medicare revises consolidates components specified existing performance incentive programs merit based incentive payment mip system secretary health_and_human_services hhs directed establish mip eligible professionals excluding apm participants receive annual payment increases decreases based performance requires specified incentive payments eligible apm participants directs secretary available physician compare website certain information including information performance mip eligible professionals requires comptroller_general gao evaluate program requires secretary study application federal fraud prevention laws related apms directs secretary draft plan development quality measures assess professionals including non patient facing professionals requires secretary establish new healthcare common procedure coding system hcpcs codes chronic care management services directs secretary conduct education outreach campaign inform professionals furnish items services medicare enrollees benefits chronic care management services authorizes secretary collect use information resources directly indirectly related physicians services determination relative values fee schedule establish adjust practice expense relative values cost charge data suppliers service providers revises expands factors identification potentially misvalued codes sets annual target relative value adjustments misvalued services phases significant relative value unit reductions directs secretary establish program promote use appropriate use evidence based criteria applicable imaging services furnished applicable setting ordering professionals furnishing professionals expands kinds uses medicare data available qualified entities quality improvement activities directs secretary provide medicare data qualified clinical data registries facilitate quality improvement patient safety allows continuing renewals year period physician practitioner medicare claims process private contract beneficiary declares national objective achieve widespread exchange health information interoperable certified electronic health records ehr technology nationwide december directs secretary establish related metrics requires meaningful ehr professionals hospitals demonstrate knowingly willfully taken action limit restrict compatibility interoperability certified ehr technology directs gao study specified telehealth remote patient monitoring services modifies extensions requirements pertaining work geographic adjustment medicare payment therapy services ambulance services revises requirements medicare dependent hospital program medicare inpatient hospital payment adjustment low volume hospitals specialized medicare_advantage plans special needs individuals amends ssa title xix medicaid extend qualifying individual program transitional medical assistance tma program express lane program eligibility amends ssa title respect continue funding pediatric quality measures amends public_health_service_act extend certain special diabetes programs extends abstinence education grant program personal responsibility education program family family health information centers extends health workforce demonstration project low income individuals ssa title requires medicare administrative contractor establish improper payment outreach education program service providers suppliers information payment errors view reducing improper medicare payments revises requirements medicaid fraud control unit authority investigate prosecute complaints abuse neglect patients home community based settings authorizes hhs_inspector general receive retain amounts collected pursuant civil debt collection administrative enforcement actions related false claims involving medicare medicaid program requires valid prescriber national provider identifiers pharmacy claims prescription drug plans pdps directs secretary establish commission improving patient directed health_care expands definition inpatient hospital services certain cancer hospitals directs secretary provide development quality measures medicare accurately communicate existence provide transfer patient health information patient care preferences individual transitions hospital return home post acute care settings specifies minimum level supervision respect outpatient therapeutic critical access hospital services shall general supervision secretary specifies particular service requires state licensure bidding entities competitive acquisition program certain durable medical equipment prosthetics orthotics supplies dmepos recognizes attending physician assistants attending physicians serve hospice patients medicare directs secretary conduct remote patient monitoring pilot projects requires secretary establish community based institutional special needs plan demonstration project prevent delay institutionalization medicaid targeted low income medicare beneficiaries directs secretary implement strategic plan increase usefulness data medicaid programs reported states centers medicare medicaid_services includes podiatrists physicians medicaid program modifies medicare requirements inclusion diabetic shoes medical health services directs secretary publish criteria clinic certified state certified community behavioral health clinic award states planning grants develop proposals participate time limited related demonstration programs select states participate programs requires secretary report annually congress payment adjustments disproportionate share hospitals order provide congress information relevant determining appropriate level overall funding adjustments certain period aggregate reductions dsh allotments states required amends balanced_budget emergency deficit control act gramm rudman hollings act respect enforcing discretionary spending limits sequestration specify diminishing maximum levels budget authority designated fy2016 emergency requirements overseas contingency operations war terrorism expresses sense congress annual adjustments statutory limits discretionary spending reserved programs activities budget functions national defense international affairs necessary meet needs requirements designating funding provided act remain fully effect expresses sense congress savings reductions annual adjustments discretionary spending reserved deficit reduction declares act shall construed modify eliminate point order available legislation establishes modifies limit adjustment limit discretionary spending


Summary:
Enhancing Access for Agents and Brokers Act - Directs the Secretary of Health and Human Services (HHS) to establish a toll-free customer service support help line to enable certified health insurance agents and brokers to seek assistance regarding qualified health plans offered in the federal health insurance marketplace.

Amends the Patient Protection and Affordable Care Act to require the Secretary to establish procedures to permit a broker name and National Producer Number to be added to an application for enrollment in a health plan offered through a health care exchange at any time during the application process and for any enrollment period.

 Requires such procedures to ensure that the National Producer Number is designed to assist consumers in obtaining needed assistance to complete enrollment, ensure that brokers are adequately compensated, and provide consumer protections by identifying each agent or broker that has worked on an enrollment case.

Directs the Secretary to:

 make available on the federal government website for health insurance coverage a list of all certified agents and brokers; contract with the National Insurance Producers Registry to regularly verify the licensure status of all such agents and brokers and develop a mechanism to enable submission of changes to contact and licensure information; and provide trained navigators, agents, and brokers, no later than five business days after promulgation or issuance of any new cost- or enrollment-related policies, with a clear description of such policy changes.

enhancing access agents brokers act_-_directs secretary health_and_human_services hhs establish toll free customer service support help line enable certified health insurance agents brokers seek assistance qualified health plans offered federal health insurance marketplace amends patient_protection affordable care act require secretary establish procedures permit broker national producer number added application enrollment health plan offered health_care exchange time application process enrollment period requires procedures ensure national producer number designed assist consumers obtaining needed assistance complete enrollment ensure brokers adequately compensated provide consumer protections identifying agent broker worked enrollment case directs secretary available federal_government website health insurance coverage list certified agents brokers contract national insurance producers registry regularly verify licensure status agents brokers develop mechanism enable submission changes contact licensure information provide trained navigators agents brokers later business days promulgation issuance new enrollment related policies clear description policy changes


Summary:
Increasing Medical Oversight in the Department of Veterans Affairs Act of 2014 - Establishes the Office of the Medical Inspector of the Department of Veterans Affairs (VA) within the Office of the Under Secretary for Health. Includes among the functions of the Office to:

 review the quality of health care provided to veterans by the VA generally and by the VA through contracts with non-VA health care providers; review offices of the Veterans Health Administration (VHA) that have an impact on the quality of health care provided to veterans by the VA and the performance of the VA in providing such care; review VHA offices and facilities to ensure that VA and VHA policies and procedures are applied consistently; investigate any systemic issues that arise within VHA, including improper issuance of credentials and privileges to health care providers, impediments to access to VA health care, wait times for appointments at VA medical facilities in excess of VA goals, and intentional falsification by VA employees of information regarding wait times; establish temporary investigative teams to carry out reviews in response to specific incidents or inquiries, including veterans' complaints and potential systemic issues within VHA that may require the conduct of surveys, the collection of data, and the analysis of VA databases; recommend policies to promote economy and efficiency in the administration of, and to prevent and detect criminal activity, waste, abuse, and mismanagement in, VHA programs and operations; and report on problems or deficiencies encountered in VHA programs and operations and recommend corrective actions.

increasing medical oversight department_of_veterans_affairs act establishes office medical inspector department_of_veterans_affairs office secretary health includes functions office review quality health_care provided veterans generally contracts non-va health_care providers review offices veterans_health_administration vha impact quality health_care provided veterans performance providing care review vha offices facilities ensure vha policies procedures applied consistently investigate systemic issues arise vha including improper issuance credentials privileges health_care providers impediments access health_care wait times appointments medical facilities excess goals intentional falsification employees information wait times establish temporary investigative teams carry reviews response specific incidents inquiries including veterans complaints potential systemic issues vha require conduct surveys collection data analysis databases recommend policies promote economy efficiency administration prevent detect criminal activity waste abuse mismanagement vha programs operations report problems deficiencies encountered vha programs operations recommend corrective actions


Summary:
(This measure has not been amended since it was introduced. The summary of that version is repeated here.)

Trauma Systems and Regionalization of Emergency Care Reauthorization Act - Amends the Public Health Service Act to authorize appropriations for trauma care programs through FY2019. Requires that not more than 50% of amounts remaining for a fiscal year after FY2014 (after allocation for administrative purposes or for improvement of emergency medical services in rural areas) be allocated for competitive grants to support pilot projects for emergency care and trauma systems.

Requires the inclusion of standards and requirements of the American Burn Association in trauma care modifications of a state plan for providing emergency medical services.

measure amended introduced summary version repeated trauma systems emergency care reauthorization act_-_amends public_health_service_act authorize appropriations trauma care programs fy2019 requires amounts remaining fiscal year fy2014 allocation administrative purposes improvement emergency medical services rural areas allocated competitive grants support pilot projects emergency care trauma systems requires inclusion standards requirements american burn association trauma care modifications state plan providing emergency medical services


Summary:
(This measure has not been amended since it was introduced. The summary of that version is repeated here.)

Improving Trauma Care Act of 2014 - Amends the Public Health Service Act, with respect to trauma care and research programs, to include in the definition of "trauma" an injury resulting from extrinsic agents other than mechanical force, including those that are thermal, electrical, chemical, or radioactive.

measure amended introduced summary version repeated improving trauma care act amends public_health_service_act respect trauma care research programs include definition trauma injury resulting agents mechanical force including thermal electrical chemical radioactive


Summary:
Veterans Access to Care Accountability Act - Directs the Comptroller General (GAO) to conduct random, periodic audits of the medical facilities of the Department of Veterans Affairs (VA) and the Veterans Integrated Service Networks to determine if they are in compliance with legal and administrative standards requiring that veterans be provided timely access to health care from the VA.

Requires the VA Secretary, upon the receipt of a specified report finding that a veteran has been subjected to a wait time of more than 30 days for health care from the VA, to: (1) notify the veteran, within 48 hours of receiving such report, of the status of the veteran's appointment; and (2) make every possible effort to schedule the veteran's appointment at a VA facility or through a non-VA health care provider on a date not later than 7 days after receiving such report.

Requires the VA Inspector General to provide the Secretary with a list of the names of each director or other VA official responsible for activities at a VA medical facility who is found to have purposefully misrepresented patient records or other data in order to: (1) conceal a failure of the facility to comply with VA patient access or care standards, or (2) qualify for a performance award or any other compensation that is in addition to basic pay. Prohibits the Secretary from paying a bonus or award to any director or official on such list until the Secretary determines that all issues relating to the reasons why such director or official was included on such list have been resolved.

Directs the Secretary to ensure that any performance review or consideration for promotion of a director or other VA official responsible for activities at a VA medical facility where such misrepresentation has occurred includes an evaluation of whether the director or other official knew or should have known about such misrepresentation.

Prohibits the Inspector General from making the names of the individuals on the list public.

veterans access care accountability act_-_directs comptroller_general gao conduct random periodic audits medical facilities department_of_veterans_affairs veterans_integrated_service_networks determine compliance legal administrative standards requiring veterans provided timely access health_care requires secretary receipt specified report finding veteran subjected wait time days health_care notify veteran hours receiving report status veteran appointment possible effort schedule veteran appointment facility non-va health_care provider date later days receiving report requires inspector_general provide secretary list names director official responsible activities medical facility found purposefully misrepresented patient records data order conceal failure facility comply patient access care standards qualify performance award compensation addition basic pay prohibits secretary paying bonus award director official list secretary determines issues relating reasons director official included list resolved directs secretary ensure performance review consideration promotion director official responsible activities medical facility misrepresentation occurred includes evaluation director official knew known misrepresentation prohibits inspector_general making names individuals list public


Summary:
Special Inspector General for Monitoring the ACA Act of 2014 or the SIGMA Act of 2014 - Establishes the Office of the Special Inspector General for Monitoring the Affordable Care Act to conduct, supervise, and coordinate audits and investigations of the implementation and administration of programs and activities established under, and payment system changes made by, the Affordable Care Act (the Patient Protection and Affordable Care Act and the health care provisions of the Health Care and Education Reconciliation Act of 2010). Requires the Special Inspector General to be appointed by the President, with the advice and consent of the Senate.

Requires the Special Inspector General to appoint an Assistant Inspector General for Auditing and an Assistant Inspector General for Investigations.

Places the Special Inspector General under the supervision of the Secretary of Health and Human Services (HHS), but prohibits federal agencies involved in implementing or administering the Affordable Care Act from preventing or prohibiting the Special Inspector General from initiating, carrying out, or completing any audit or investigation.

special inspector_general monitoring act act establishes office special inspector_general monitoring affordable care act conduct supervise coordinate audits investigations implementation administration programs activities established payment system changes affordable care act patient_protection affordable care act health_care provisions health_care_and_education reconciliation act requires special inspector_general appointed president advice consent senate requires special inspector_general appoint assistant inspector_general auditing assistant inspector_general investigations places special inspector_general supervision secretary health_and_human_services hhs prohibits federal agencies involved implementing administering affordable care act preventing prohibiting special inspector_general initiating carrying completing audit investigation


Summary: Continuing Care for Veterans Act of 2014 - Prohibits the Secretary of Veterans Affairs (VA) from altering the health care available to a veteran who is enrolled in the VA health care system or the amount of time that veteran has to wait for an appointment for such care based solely on the length of time since he or she last received health care from the VA.

continuing care veterans act prohibits secretary veterans_affairs altering health_care available veteran enrolled health_care system time veteran wait appointment care based solely length time received health_care


Summary:
Medicare Common Access Card Act of 2014 - Establishes a pilot program under title XVIII (Medicare) of the Social Security Act (SSA) in order to utilize smart card technology for Medicare beneficiary and provider identification cards.

Amends SSA title XI to extend through FY2029 funding for the Center for Medicare and Medicaid Innovation.

medicare common access card act establishes pilot program title xviii medicare social_security_act ssa order utilize smart card technology medicare beneficiary provider identification cards amends ssa title extend funding center medicare medicaid_innovation


Summary:
Stopping Illegal Obamacare Subsidies Act - Prohibits American Health Benefit Exchanges from providing for automatic enrollment in health plans until the Inspector General (IG) of the Department of Health and Human Services (HHS) verifies that each state exchange and the federal exchange established under the Patient Protection and Affordable Care Act (PPACA) have resolved the inconsistencies outlined in the June 14 IG report.

Directs the Secretary of HHS to make public the steps that the Centers for Medicare and Medicaid Services (CMS) and the federal exchange will take to clear any inconsistencies that arose on or before the enactment of this Act and to ensure that the systems used by the CMS to determine or assess eligibility for premium tax credits, cost-sharing reductions, Medicaid, and the State Children's Health Insurance Program (CHIP) under title XXI of the Social Security Act can resolve such inconsistencies within 30 days after enactment of this Act.

Directs the Secretary to make public the methods that the CMS use to monitor, track, and measure the progress of the federal and state exchanges in resolving inconsistencies.

Suspends for plan year 2015 the availability of premium assistance tax credits and the reduced cost-sharing program under PPACA; and allows them to resume only after the Commissioner of the Social Security Administration declares affirmatively that all inconsistencies related to invalid Social Security numbers have been resolved, and the IG determines that this is so.

Directs the Secretary to request additional information from any applicant for a qualified health plan on a state or federal exchange whose information contains inconsistencies. Requires the applicant to: (1) be withdrawn from the premium assistance credit and reduced cost-sharing programs if the additional information is not provided within 90 days, and (2) re-enroll in a qualified health plan with appropriate and accurate information during the next open enrollment period.

stopping illegal obamacare subsidies act prohibits american health benefit exchanges providing automatic enrollment health plans inspector_general department_of_health_and_human_services hhs verifies state exchange federal exchange established patient_protection affordable care act ppaca resolved inconsistencies outlined june report directs secretary hhs public steps centers medicare medicaid_services cms federal exchange clear inconsistencies arose enactment act ensure systems cms determine assess eligibility premium tax credits cost sharing reductions medicaid state children health insurance program chip title xxi social_security_act resolve inconsistencies days enactment act directs secretary public methods cms use monitor track measure progress federal state exchanges resolving inconsistencies suspends plan year availability premium assistance tax credits reduced cost sharing program ppaca allows resume commissioner social_security_administration declares affirmatively inconsistencies related invalid social_security numbers resolved determines directs secretary request additional information applicant qualified health plan state federal exchange information contains inconsistencies requires applicant withdrawn premium assistance credit reduced cost sharing programs additional information provided days enroll qualified health plan appropriate accurate information open enrollment period


Summary: Amends title XVIII (Medicare) of the Social Security Act to: (1) create an exception to Medicare secondary payer requirements for certain workers' compensation settlement agreements, and (2) provide for the satisfaction of such requirements through use of qualified Medicare set-asides under such agreements.

amends title xviii medicare social_security_act create exception medicare_secondary_payer requirements certain workers compensation settlement agreements provide satisfaction requirements use qualified medicare set asides agreements


Summary:
Better Efficiency and Administrative Simplification Act of 2015

 Amends title XVIII (Medicare) of the Social Security Act to allow individuals the option to receive the Medicare Summary Notice (explanation of benefits) electronically.

Requires the Secretary of Health and Human Services to: (1) apply a similar option to other Medicare statements and notifications, and (2) provide such Medicare Summary Notice and any other such statements and notifications on a more frequent basis than is otherwise required under Medicare.

Extends from at least once every 5 years to at least once every 10 years the application of competitive procedures when the contract of a Medicare administrative contractor comes up for renewal.

Directs the Secretary, to the extent possible without compromising the process for entering into and renewing contracts with Medicare administrative contractors (MACs), to make available to the public the performance of each MAC with respect to requirements and measurement standards.

better efficiency administrative simplification act amends title xviii medicare social_security_act allow individuals option receive medicare summary notice explanation benefits electronically requires secretary health_and_human_services apply similar option medicare statements notifications provide medicare summary notice statements notifications frequent basis required medicare extends years years application competitive procedures contract medicare administrative contractor comes renewal directs secretary extent possible compromising process entering renewing contracts medicare administrative contractors macs available public performance mac respect requirements measurement standards


Summary:
Health and Human Services Hiree Clarification Act

Amends the Public Health Service Act to state that provisions authorizing the appointment of special consultants or authorizing individual scientists to receive fellowships do not authorize the designation, appointment, or employment of any special consultant, fellow, or other employee by an agency outside of the Department of Health and Human Services.

health_and_human_services clarification act amends public_health_service_act state provisions authorizing appointment special consultants authorizing individual scientists receive fellowships authorize designation appointment employment special consultant fellow employee agency outside department_of_health_and_human_services


Summary:
Medicaid Requiring Expenditures for Public Objectives to be Reflective of Total Spending Act or the Medicaid REPORTS Act

 This bill amends title XIX (Medicaid) of the Social Security Act to direct the Secretary of Health and Human Services to require each state to report each source of funds, each entity providing such funds, and the amount of funds from each source, used by the state to finance the non-federal share of expenditures under Medicaid.

The Secretary must make the information reported publicly available through publication on the Internet site of the Centers for Medicaid & Medicaid Services.

medicaid requiring expenditures public objectives reflective total spending act medicaid reports act bill amends title xix medicaid social_security_act direct secretary health_and_human_services require state report source funds entity providing funds funds source state finance non federal share expenditures medicaid secretary information reported publicly available publication internet site centers medicaid medicaid_services


Summary:
Medicaid Tax Fairness Act of 2015

This bill amends title XIX (Medicaid) of the Social Security Act, with respect to payments to states for medical assistance programs, to reduce from 6% to 5.5% on a graduated basis for 2016-2020 and each subsequent year the indirect guarantee thresholds applied for determining permissible broad-based state or local health care-related provider taxes where a requirement is in effect to hold taxpayers harmless for any portion of the costs of the tax.

(Currently the state [or other unit of government] imposing a broad-based health care-related tax or tax on each health care class provides for a direct or indirect non-Medicaid payment to those providers or others paying the tax, which may include an offset or waiver that directly or indirectly guarantees to hold taxpayers harmless for all or any portion of the tax amount. Such taxes are permissible if they are applied at a rate that produces revenues less than or equal to 6% of the revenues received by the taxpayer.)

medicaid tax fairness act bill amends title xix medicaid social_security_act respect payments states medical assistance programs reduce graduated basis subsequent year indirect guarantee thresholds applied determining permissible broad based state local health_care related provider taxes requirement effect hold taxpayers harmless portion costs tax currently state unit government imposing broad based health_care related tax tax health_care class provides direct indirect non medicaid payment providers paying tax include offset waiver directly indirectly guarantees hold taxpayers harmless portion tax taxes permissible applied rate produces revenues equal revenues received taxpayer


Summary:
Department of Veterans Affairs Medical Facility Earthquake Protection and Improvement Act

This bill authorizes the Department of Veterans Affairs (VA) to carry out the major medical facility projects of the VA specified in the explanatory statement accompanying the Consolidated and Further Continuing Appropriations Act, 2015, including by obligating and expending the amounts specified in such statement. (Those projects include seismic corrections to the West Los Angeles Medical Center, replacement of a community living center and mental health facilities in Long Beach, and replacement of an existing spinal cord injury clinic in San Diego, California, all of which are at high risk of sustaining damage during an earthquake, and renovations to address substantial safety and compliance issues and construction of a new clinic and community living center at the VA medical center in Canandaigua, New York.)

department_of_veterans_affairs medical facility earthquake protection improvement act bill authorizes department_of_veterans_affairs carry major medical facility projects specified explanatory statement accompanying consolidated continuing appropriations act including obligating expending amounts specified statement projects include seismic corrections west los_angeles medical center replacement community living center mental health facilities long_beach replacement existing spinal cord injury clinic san_diego california high risk sustaining damage earthquake renovations address substantial safety compliance issues construction new clinic community living center medical center new_york


Summary:
Equalizing Transparency for Veterans Act

Directs the Secretary of Veterans Affairs (VA) to biennially publish information on the VA's provision of health care on a VA Internet database that is publicly available.

Includes among that information for each VA medical facility:

 quality measures regarding inpatient and outpatient care that the Secretary of Health and Human Services (HHS) is required to make publicly available under the Medicare program; the average length of stay, opioid prescription rate, and suicide rate for patients discharged from the facility; and the average number of days a patient waited for an appointment or procedure at such facility. Includes in such information for each VA nursing home any quality measures the Secretary of HHS makes publicly available regarding Medicare nursing homes.

Directs the Secretary to establish a process to validate the published information.

Requires the Secretary to annually submit a plan to Congress to improve each VA medical facility that ranks within the bottom quartile on each quality measure used by the Secretary to rank such facilities.

Directs the Secretary to establish a toll-free telephone number for individuals to use to notify the Secretary of low-quality care being provided at a VA medical facility.

equalizing transparency veterans act directs secretary veterans_affairs biennially publish information provision health_care internet database publicly available includes information medical facility quality measures inpatient outpatient care secretary health_and_human_services hhs required publicly available medicare program average length stay opioid prescription rate suicide rate patients discharged facility average number days patient appointment procedure facility includes information nursing home quality measures secretary hhs makes publicly available medicare nursing homes directs secretary establish process validate published information requires secretary annually submit plan congress improve medical facility ranks quartile quality measure secretary rank facilities directs secretary establish toll free telephone number individuals use notify secretary low quality care provided medical facility


Summary: This bill amends title XVIII (Medicare) of the Social Security Act, in order to facilitate price transparency with respect to items and services for which payment may be made to a hospital outpatient department or to an ambulatory surgery center, to require the Secretary of Health and Human Services to make available to the public via a searchable website: (1) the estimated payment amount for an appropriate number of items and services under the outpatient department fee schedule and the ambulatory surgical center payment system, and (2) the estimated amount of beneficiary liability applicable to such an item or service.

bill amends title xviii medicare social_security_act order facilitate price transparency respect items services payment hospital outpatient department ambulatory surgery center require secretary health_and_human_services available public searchable website estimated payment appropriate number items services outpatient department fee schedule ambulatory surgical center payment system estimated beneficiary liability applicable item service


Summary:
Sensible Oversight for Technology which Advances Regulatory Efficiency Act or the SOFTWARE Act

This bill amends the Federal Food, Drug, and Cosmetic Act to define health software as software that does not acquire, process, or analyze data from an in vitro diagnostic device or signal acquisition system, is not an accessory or part of a medical device, is not used to prevent disease in the transfusion of blood and blood components, and is for:

 administrative or operational support or the processing and maintenance of financial records; use in clinical, laboratory, or administrative workflow and recordkeeping; managing data but not for active patient monitoring or controlling the functions of a connected medical device; organizing and presenting information for health or wellness education or maintaining a healthy lifestyle; or analyzing information to provide general health information or patient-specific recommendations. The FDA must classify an accessory of a medical device independently from the medical device with which it is used.

Health software is exempted from regulation by the FDA (including as a medical device), except for software that provides patient-specific recommendations and poses a significant risk to patient safety.

The FDA must review existing regulations and guidance regarding the regulation of health software.

sensible oversight technology advances regulatory efficiency_act software act bill amends federal food drug cosmetic act define health software software acquire process analyze data vitro diagnostic device signal acquisition system accessory medical device prevent disease blood blood components administrative operational support processing maintenance financial records use clinical laboratory administrative recordkeeping managing data active patient monitoring controlling functions connected medical device organizing presenting information health wellness education maintaining healthy lifestyle analyzing information provide general health information patient specific recommendations fda classify accessory medical device independently medical device health software exempted regulation fda including medical device software provides patient specific recommendations poses significant risk patient safety fda review existing regulations guidance regulation health software


Summary:
This bill amends the Federal Food, Drug, and Cosmetic Act to allow a person to request that the Food and Drug Administration (FDA) recognize all or part of a performance standard established by a nationally or internationally recognized standard organization as a standard to which a medical device may conform in order to meet an FDA requirement. When a request to recognize a standard is received, the FDA must determine whether to recognize all, part, or none of the standard and publish the rationale for that determination. (Currently, the FDA recognizes certain performance standards, but it is not required to respond to requests or publish rationales for recognizing standards.)

The FDA must: (1) publish the rationale for recognizing only part of a standard, (2) periodically train employees who review premarket submissions for medical devices on the concept and use of recognized standards for purposes of meeting requirements, and (3) publish its principles for recognizing standards.

bill amends federal food drug cosmetic act allow person request food_and_drug_administration fda recognize performance standard established nationally internationally recognized standard organization standard medical device conform order meet fda requirement request recognize standard received fda determine recognize standard publish rationale determination currently fda recognizes certain performance standards required respond requests publish recognizing standards fda publish rationale recognizing standard periodically train employees review premarket submissions medical devices concept use recognized standards purposes meeting requirements publish principles recognizing standards


Summary:
This bill amends the Federal Food, Drug, and Cosmetic Act to revise the requirements for health care economic information that is provided to entities selecting drugs for coverage or reimbursement, such as formularies. The information must include a conspicuous and prominent statement describing the differences between the information and the labeling approved for the drug.

"Health care economic information" is an analysis that describes the economic consequences of the use of a drug. Such an analysis is no longer required to compare the use of the drug to another intervention or no intervention. An analysis that relates only to an indication for which the drug is not approved is not health care economic information.

bill amends federal food drug cosmetic act revise requirements health_care economic information provided entities selecting drugs coverage reimbursement formularies information include conspicuous prominent statement describing differences information labeling approved drug health_care economic information analysis describes economic consequences use drug analysis longer required compare use drug intervention intervention analysis relates indication drug approved health_care economic information


Summary:
Fair Medical Audits Act of 2015

This bill amends title XVIII (Medicare) of the Social Security Act to modify requirements related to the identification and recovery of overpayments under Medicare.

A contract between the the Centers for Medicare & Medicaid Services (CMS) and a recovery audit contractor must require the contractor to provide a health care provider with: (1) specified identifying, legal, and logistical information; (2) an identification of any errors or underpayments discovered in the audit; and (3) a description of how any requested overpayment amount was calculated. Standards for extrapolation when used to determine overpayment amounts are established. CMS must require a contractor to give a provider at least 90 days' notice of identified code over-utilization and to reimburse a provider for the cost of producing certain documentation. The retrospective audit period is limited to two (rather than four) years.

Recovery audit contractors must have staff with knowledge and experience related to clinical licensure and medical records, claims, and codes. A contractor that has excessive overturned determinations shall be subject to administrative penalty and, under specified circumstances, liable for attorneys' fees.

In the case of a provider seeking reconsideration of an overpayment determination, CMS may not recoup the overpayment until a decision has been rendered at the third level of appeal by an Administrative Law Judge. A recoupment based on a decision that is reversed on appeal must be returned to the provider within 30 days.

fair medical audits act bill amends title xviii medicare social_security_act modify requirements related identification recovery overpayments medicare contract centers medicare medicaid_services cms recovery audit contractor require contractor provide health_care provider specified identifying legal logistical information identification errors underpayments discovered audit description requested overpayment calculated standards determine overpayment amounts established cms require contractor provider days notice identified code utilization reimburse provider cost producing certain documentation retrospective audit period limited years recovery audit contractors staff knowledge experience related clinical licensure medical records claims codes contractor excessive overturned determinations shall subject administrative penalty specified circumstances liable attorneys fees case provider seeking reconsideration overpayment determination cms recoup overpayment decision rendered level appeal administrative law judge recoupment based decision appeal returned provider days


Summary:
Securing Care for Seniors Act of 2015

(Sec. 2) This bill amends part C (Medicare+Choice) of title XVIII (Medicare) of the Social Security Act (SSAct) to direct the Department of Health and Human Services (HHS) (in effect, the Centers for Medicare & Medicaid Services [CMS]) to revise for 2017, and periodically afterwards, the system for risk adjustments to payments to Medicare+Choice organizations so that an individual's risk score takes into account the number of chronic conditions with which the individual has been diagnosed.

HHS must, including an actuarial opinion of the CMS Chief Actuary, evaluate the impacts of:

 including two years of data to compare the models used to determine the risk scores for 2013 and 2014, removing the diagnosis codes related to chronic kidney disease in the 2014 risk adjustment model, and including 10% of encounter data in computing payment for 2016 and CMS readiness to incorporate encounter data in risk scores. HHS shall also analyze the best practices of MedicareAdvantage (MA) plans to slow disease progression related to chronic kidney disease.

HHS shall then, if appropriate, make revisions to the risk adjustment system, based on such an evaluation or analysis, to better reflect and appropriately weight for the population served.

(Sec. 3) Congress declares that the MA star rating system lacks proper accounting for the socioeconomic status of plan enrollees and the extent to which those plans serve individuals also eligible for medical assistance under SSAct title XIX (Medicaid).

securing care seniors act sec bill amends title xviii medicare social_security_act ssact direct department_of_health_and_human_services hhs effect centers medicare medicaid_services cms revise periodically system risk adjustments payments organizations individual risk score takes account number chronic conditions individual diagnosed hhs including actuarial opinion cms chief actuary evaluate impacts including years data compare models determine risk scores removing diagnosis codes related chronic kidney disease risk adjustment model including encounter data computing payment cms readiness incorporate encounter data risk scores hhs shall analyze best practices medicareadvantage plans slow disease progression related chronic kidney disease hhs shall appropriate revisions risk adjustment system based evaluation analysis better reflect appropriately weight population served sec congress declares star rating system lacks proper accounting socioeconomic status plan enrollees extent plans serve individuals eligible medical assistance ssact title xix medicaid


Summary:
Accuracy in Medicare Physician Payment Act of 2015

 Amends title XVIII (Medicare) of the Social Security Act to direct the Department of Health and Human Services to establish and appoint an expert outside advisory panel for purposes of providing oversight to the processes relating to valuation of physicians' services.

accuracy medicare physician payment act amends title xviii medicare social_security_act direct department_of_health_and_human_services establish appoint expert outside advisory_panel purposes providing oversight processes relating valuation physicians services


Summary:
Medicare Telehealth Parity Act of 2015

Amends title XVIII (Medicare) of the Social Security Act to expand telehealth coverage in three phases.

Extends the term "originating site," for telehealth service payment purposes, to additional sites, including any federally qualified health center and any rural health clinic, at which the eligible telehealth individual is located at the time the service is furnished via a telecommunications system.

Prohibits application of the originating site facility fee to the additional sites.

Authorizes additional telehealth providers, including a certified diabetes educator or licensed respiratory therapist, audiologist, occupational therapist, physical therapist, or speech language pathologist.

Authorizes the Department of Health and Human Services (HHS) to develop payment methods to apply in the case of anyone who would be an eligible telehealth individual except that the telehealth services are furnished at a site other than an originating site.

Extends Medicare coverage to remote patient management services for certain chronic health conditions.

Authorizes home telehealth sites as additional originating sites.

 Requires the monthly fee or other basis of payment for physicians' services to individuals with end stage renal disease (ESRD) to allow for a patient-specific waiver process to permit a physician, clinical nurse specialist, nurse practitioner, or physician's assistant to request a waiver of face-to-face visit requirements for home dialysis of ESRD patients.

Requires all ESRD patients receiving home dialysis to receive a face-to-face examination at least once every three consecutive months and, in the intervening months, to receive a monthly clinical assessment which may be furnished, if the patient so chooses, via remote monitoring by a physician, clinical nurse specialist, nurse practitioner, or physician's assistant.

Directs HHS, in determining the component of a physician's fee corresponding to practice expense relative value units for diagnostic tests provided remotely, to include in direct costs of supplies and equipment the costs of the diagnostic device, clinical systems (including hardware and software), information transmission, and device delivery and installation. Directs the Government Accountability Office to study the effectiveness of using specified telehealth services between therapy providers and patients, any associated savings, and the potential for greater use of telehealth services for other forms of therapy.

medicare telehealth parity act amends title xviii medicare social_security_act expand telehealth coverage phases extends term originating site telehealth service payment purposes additional sites including federally qualified health center rural health clinic eligible telehealth individual located time service furnished telecommunications system prohibits application originating site facility fee additional sites authorizes additional telehealth providers including certified diabetes educator licensed respiratory therapist audiologist occupational therapist physical therapist speech language authorizes department_of_health_and_human_services hhs develop payment methods apply case eligible telehealth individual telehealth services furnished site originating site extends medicare coverage remote patient management services certain chronic health conditions authorizes home telehealth sites additional originating sites requires monthly fee basis payment physicians services individuals end stage renal disease esrd allow patient specific waiver process permit physician clinical nurse specialist nurse practitioner physician assistant request waiver face face visit requirements home dialysis esrd patients requires esrd patients receiving home dialysis receive face face examination consecutive months intervening months receive monthly clinical assessment furnished patient chooses remote monitoring physician clinical nurse specialist nurse practitioner physician assistant directs hhs determining component physician fee corresponding practice expense relative value units diagnostic tests provided remotely include direct costs supplies equipment costs diagnostic device clinical systems including hardware software information transmission device delivery installation directs government_accountability_office study effectiveness specified telehealth services therapy providers patients associated savings potential greater use telehealth services forms therapy


Summary:
TELEmedicine for MEDicare Act of 2015 or the TELE-MED Act of 2015

This bill amends title XVIII (Medicare) of the Social Security Act to allow a Medicare provider to provide telemedicine services to a Medicare beneficiary who is in a different state from the one in which the provider is licensed or authorized to provide health care services. The licensing or authorizing state has jurisdiction to enforce its licensure or other legal authorization requirements with regard to such a provision of service.

telemedicine medicare_act tele act bill amends title xviii medicare social_security_act allow medicare provider provide telemedicine services medicare beneficiary different state provider licensed authorized provide health_care services licensing authorizing state jurisdiction enforce licensure legal authorization requirements regard provision service


Summary: This bill amends title XVIII (Medicare) of the Social Security Act to exclude from Medicare coverage advanced planning services, with the exception of certain hospice-related services that may include advising on end-of-life or advanced care planning.

bill amends title xviii medicare social_security_act exclude medicare coverage advanced planning services exception certain hospice related services include advising end life advanced care planning


Summary:
Further Flexibility in HIT Reporting and Advancing Interoperability Act or the Flex-IT 2 Act

This bill amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to modify Medicare and Medicaid program requirements related to electronic health record (EHR) meaningful use programs, which establish incentives to promote EHR meaningful use and the adoption of health information technology (HIT).

Specifically, the bill requires the Centers for Medicare & Medicaid to establish and apply a linear scale to determine meaningful or "partial meaningful" EHR use. In accordance with this linear scale, eligible professionals and hospitals that are partial meaningful EHR users shall: (1) receive certain incentive payments currently available only to meaningful EHR users, and (2) be partially exempt from certain negative payment adjustments.

In addition, the bill: (1) establishes three-month reporting periods for the Medicare and Medicaid EHR incentive payment programs; (2) modifies provisions regarding quality reporting on meaningful EHR use; (3) expands the hardship exception to Medicare EHR payment adjustments; and (4) limits, with respect to timing and frequency, the adoption of more stringent measures of EHR meaningful use under Medicaid and Medicare.

The bill also amends the Public Health Service Act to: (1) require the Department of Health and Human Services (HHS) to pause rulemaking related to EHR meaningful use, unless and until specified conditions are met; and (2) prohibit HHS from proposing the adoption of certain untested standards regarding HIT.

flexibility hit reporting advancing interoperability act flex act bill amends titles xviii medicare xix medicaid social_security_act modify medicare medicaid program requirements related electronic health record ehr meaningful use programs establish incentives promote ehr meaningful use adoption health information technology hit specifically bill requires centers medicare medicaid establish apply scale determine meaningful partial meaningful ehr use accordance scale eligible professionals hospitals partial meaningful ehr users shall receive certain incentive payments currently available meaningful ehr users partially exempt certain negative payment adjustments addition bill establishes month reporting periods medicare medicaid ehr incentive payment programs modifies provisions quality reporting meaningful ehr use expands hardship exception medicare ehr payment adjustments limits respect timing frequency adoption stringent measures ehr meaningful use medicaid medicare bill amends public_health_service_act require department_of_health_and_human_services hhs rulemaking related ehr meaningful use specified conditions met prohibit hhs proposing adoption certain standards hit


Summary:
Veteran's Choice Accountability Act

This bill directs the Department of Veterans Affairs (VA) to:

 evaluate VA programs that furnish hospital care, medical services, and nursing home care to ensure that the most intensively used specialized care programs are maintained as centers of excellence; and submit to Congress an evaluation of the VA's implementation of the VA Budget and Choice Improvement Act.

veteran choice accountability_act bill directs department_of_veterans_affairs evaluate programs furnish hospital care medical services nursing home care ensure specialized care programs maintained centers_of_excellence submit congress evaluation implementation budget choice improvement act


Summary:
Ensuring Fair Access to Veterans Healthcare Act

This bill establishes in the Veterans Health Administration an Office of the Ombudsman, which shall:

 investigate and resolve complaints made by or on behalf of patients receiving medical care or hospital services at a Department of Veterans Affairs (VA) medical facility (covered patients) that relate to action, inaction, or decisions made by VA employees that may adversely affect such patients; assist covered patients in finding patient advocates, veterans service organizations, or other similar entities to advocate for their health, safety, welfare, and rights; ensure that covered patients have regular and timely access to Office services; administer the reporting system provided for by this Act; and provide training to local ombudsmen and volunteers. The Office shall establish a reporting system to collect and analyze complaint data in order to determine how to resolve significant VA medical facility problems.

Each VA medical facility shall have a local ombudsman responsible for carrying out the duties of the Office at such location.

ensuring fair access veterans healthcare act bill establishes veterans_health_administration office_of_the_ombudsman shall investigate resolve complaints behalf patients receiving medical care hospital services department_of_veterans_affairs medical facility covered patients relate action inaction decisions employees adversely affect patients assist covered patients finding patient advocates veterans service organizations similar entities advocate health safety welfare rights ensure covered patients regular timely access office services administer reporting system provided act provide training local volunteers office shall establish reporting system collect analyze complaint data order determine resolve significant medical facility problems medical facility shall local ombudsman responsible carrying duties office location


Summary:
Medicare Choices Empowerment and Protection Act

This bill amends title XVIII (Medicare) of the Social Security Act to establish an Advance Directive Certification Program. Under the program, the Centers for Medicare & Medicaid Services (CMS) shall grant accreditation to advance directive vendors that meet specified accreditation criteria.

CMS shall establish procedures for an eligible beneficiary to register the adoption of a certified advance directive under the program. Beneficiary registration in the program shall be optional, but each eligible beneficiary who adopts and registers a certified advance directive shall receive a one-time incentive payment.

CMS shall provide for related education and outreach.

medicare choices empowerment protection act bill amends title xviii medicare social_security_act establish advance directive certification program program centers medicare medicaid_services cms shall grant accreditation advance directive vendors meet specified accreditation criteria cms shall establish procedures eligible beneficiary register adoption certified advance directive program beneficiary registration program shall optional eligible beneficiary adopts registers certified advance directive shall receive time incentive payment cms shall provide related education outreach


Summary:
Promoting Responsible Opioid Management and Incorporating Scientific Expertise Act or the Jason Simcakoski PROMISE Act

(Sec. 2) This bill directs the Department Veterans Affairs (VA) to expand its Opioid Safety Initiative to include all VA medical facilities.

The VA shall establish guidance that each VA health care provider, before initiating opioid therapy, use the VA Opioid Therapy Risk Report tool, which shall include: (1) information from state prescription drug monitoring programs; and (2) a patient's most recent information in order to assess the risk for adverse outcomes of opioid therapy, including the concurrent use of controlled substances such as benzodiazepines.

The VA shall establish enhanced standards for the use of routine and random urine drug tests before and during opioid therapy to help prevent substance abuse, dependence, and diversion, including that: (1) tests occur at least once each year; and (2) health care providers use the test results to tailor pain therapy, safeguards, and risk management strategies for each patient.

The VA shall use the Interdisciplinary Chronic Pain Management Training Team Program to provide education and training on pain management and safe opioid prescribing practices for managing patients with chronic pain.

In carrying out the VA Opioid Safety Initiative, each VA medical facility shall designate a pain management team of health care professionals to coordinate pain management therapy for patients experiencing acute and chronic pain that is non-cancer related.

The VA shall establish standard protocols for the designation of pain management teams at each VA medical facility. Each protocol shall ensure that any health care provider without expertise in prescribing analgesics, or who has not completed the required education and training, does not prescribe opioids unless such health care provider:

 consults with a provider who has pain management expertise or who is on the pain management team; and refers the patient to the pain management team for subsequent prescriptions and therapy. In carrying out the Opioid Safety Initiative and the Opioid Therapy Risk Report tool, the VA shall:

 ensure access by VA health care providers to information on controlled substances, including opioids and benzodiazepines, prescribed to veterans who receive care outside the VA through a state prescription drug monitoring program; include such information in the Opioid Therapy Risk Report; and require VA health care providers to provide to a state's prescription drug monitoring program information on prescriptions of controlled substances received by veterans in that state. The VA shall report to Congress with respect to improving the VA Opioid Therapy Risk Report tool to allow for improved real-time tracking and access to data on: (1) key clinical indicators regarding the totality of veterans' opioid use, (2) concurrent prescribing by VA health care providers of opioids in different health care settings, and (3) mail-order prescriptions of opioids prescribed to veterans under VA-administered laws.

The VA shall:

 maximize the availability to veterans of Food and Drug Administration (FDA)-approved opioid receptor antagonists, including naloxone; equip each VA pharmacy with such antagonists for outpatient use; and expand the Overdose Education and Naloxone Distribution program to ensure that all veterans in receipt of VA health care who are at risk of opioid overdose may access such antagonists and training on the proper administration of such antagonists. The VA shall include in the Opioid Therapy Risk Report tool:

 information on the most recent time the tool was accessed by a VA health care provider with respect to a veteran and the results of such veteran's most recent urine drug test; and the ability of VA health care providers to determine whether a health care provider prescribed opioids to a veteran without checking tool information. The VA shall modify its computerized patient record system to ensure that any health care provider that accesses a veteran's record will be immediately notified about whether the veteran: (1) is receiving opioid therapy and has a history of substance use disorder or prior instances of overdose, (2) has a history of opioid abuse, or (3) is at risk of becoming an opioid abuser.

(Sec. 3) The VA and the Department of Defense (DOD) shall ensure that the VA/DOD Pain Management Working Group includes a focus on:

 opioid prescribing practices; management of acute and chronic pain, including related training for health care providers; complementary and integrative health and complementary alternative medicines; concurrent use of opioids and prescription drugs to treat mental health disorders, including benzodiazepines; prescribing opioids to treat mental health disorders; coordination in coverage of and consistent access to medications prescribed for patients transitioning from DOD to VA health care; and identification and treatment of substance use disorders. The VA and DOD shall ensure that such working group: (1) coordinates with other relevant working groups, (2) consults with other relevant federal agencies, and (3) and consults with VA and DOD regarding any proposed updates to the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain.

The VA and DOD shall update the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain. Matters to be included in such update are prescribed.

(Sec. 4) The Government Accountability Office shall, within two years, report to Congress on: (1) the VA Opioid Safety Initiative, and (2) opioid prescribing practices of VA health care providers. Such report shall include:

 improvements to the Opioid Safety Initiative; information regarding VA-prescribed opioid-related deaths, overall opioid prescription rates for non-cancer, non-palliative, and non-hospice care patients, concomitant opioid and benzodiazepine prescription rates, the prescription of opioids to patients without any pain (including non-opioid mental health disorders); the effectiveness of opioid therapy; and evaluations of the VA's oversight processes regarding veterans' opioid use and of its implementation of the VA/DOD Guideline for Management of Opioid Therapy. The VA shall: (1) report to Congress for five years regarding the prescription of opioids at each VA facility to treat non-cancer, non-palliative, and non-hospice care patients; and (2) notify Congress and conduct an investigation through the Office of the Medical Inspector if the VA determines that a prescription rate is inconsistent with safe care standards.

(Sec. 5) VA disclosure of certain information to a state controlled substance monitoring program in order to prevent misuse of prescription medicines by a veteran or dependent is made mandatory.

(Sec. 6) The Veterans Access, Choice, and Accountability Act of 2014 is amended to reduce the aggregate amount of awards and bonuses that may be paid by the VA in each of FY2017-FY2021 to $230 million.

promoting responsible opioid management incorporating scientific expertise act promise act sec bill directs department veterans_affairs expand opioid safety initiative include medical facilities shall establish guidance health_care provider initiating opioid therapy use opioid therapy risk report tool shall include information state prescription drug monitoring programs patient recent information order assess risk adverse outcomes opioid therapy including concurrent use controlled substances benzodiazepines shall establish enhanced standards use routine random drug tests opioid therapy help prevent substance abuse dependence diversion including tests occur year health_care providers use test results tailor pain therapy safeguards risk management strategies patient shall use interdisciplinary chronic pain management training team program provide education training pain management safe opioid prescribing practices managing patients chronic pain carrying opioid safety initiative medical facility shall designate pain management team health_care professionals coordinate pain management therapy patients experiencing acute chronic pain non cancer related shall establish standard protocols designation pain management teams medical facility protocol shall ensure health_care provider expertise prescribing completed required education training prescribe opioids health_care provider consults provider pain management expertise pain management team refers patient pain management team subsequent prescriptions therapy carrying opioid safety initiative opioid therapy risk report tool shall ensure access health_care providers information controlled substances including opioids benzodiazepines prescribed veterans receive care outside state prescription drug monitoring program include information opioid therapy risk report require health_care providers provide state prescription drug monitoring program information prescriptions controlled substances received veterans state shall report congress respect improving opioid therapy risk report tool allow improved real time tracking access data key clinical indicators totality veterans opioid use concurrent prescribing health_care providers opioids different health_care settings mail order prescriptions opioids prescribed veterans administered laws shall maximize availability veterans food_and_drug_administration opioid including naloxone equip pharmacy outpatient use expand overdose education naloxone distribution program ensure veterans receipt health_care risk opioid overdose access training proper administration shall include opioid therapy risk report tool information recent time tool accessed health_care provider respect veteran results veteran recent drug test ability health_care providers determine health_care provider prescribed opioids veteran checking tool information shall modify computerized patient record system ensure health_care provider accesses veteran record immediately notified veteran receiving opioid therapy history substance use disorder prior instances overdose history opioid abuse risk opioid sec department_of_defense dod shall ensure dod pain management working_group includes focus opioid prescribing practices management acute chronic pain including related training health_care providers complementary integrative health complementary alternative medicines concurrent use opioids prescription drugs treat mental health disorders including benzodiazepines prescribing opioids treat mental health disorders coordination coverage consistent access medications prescribed patients transitioning dod health_care identification treatment substance use disorders dod shall ensure working_group coordinates relevant working groups consults relevant federal agencies consults dod proposed updates dod clinical practice guideline management opioid therapy chronic pain dod shall update dod clinical practice guideline management opioid therapy chronic pain matters included update prescribed sec government_accountability_office shall years report congress opioid safety initiative opioid prescribing practices health_care providers report shall include improvements opioid safety initiative information prescribed opioid related deaths overall opioid prescription rates non cancer non palliative non hospice care patients opioid prescription rates prescription opioids patients pain including non opioid mental health disorders effectiveness opioid therapy evaluations oversight processes veterans opioid use implementation dod guideline management opioid therapy shall report congress years prescription opioids facility treat non cancer non palliative non hospice care patients notify congress conduct investigation office medical inspector determines prescription rate inconsistent safe care standards sec disclosure certain information state controlled substance monitoring program order prevent misuse prescription medicines veteran dependent mandatory sec veterans access choice accountability_act amended reduce aggregate awards bonuses paid fy2017-fy2021 million


Summary:
(This measure has not been amended since it was introduced. The expanded summary of the House passed version is repeated here.)

(Sec. 1) This bill amends the Veterans Access, Choice, and Accountability Act of 2014 to extend the deadline for the Commission on Care's final report to June 30, 2016. (The Commission is charged with examining veterans' access to Department of Veterans Affairs health care and to examine how best to organize the Veterans Health Administration, locate health resources, and deliver health care to veterans during the next 20 years.)

measure amended introduced expanded summary house passed version repeated sec bill amends veterans access choice accountability_act extend deadline commission care final report june commission charged examining veterans access department_of_veterans_affairs health_care examine best organize veterans_health_administration locate health resources deliver health_care veterans years


Summary:
Opioid and Heroin Epidemic Emergency Supplemental Appropriations Act

This bill provides FY2016 supplemental appropriations for the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) to address heroin and opioid drug abuse. The funds are designated as an emergency requirement, which exempts the funds from discretionary spending limits and other budget enforcement rules.

For DOJ, the bill provides funds for State and Local Law Enforcement Assistance and Community Oriented Policing Services (COPS) programs.

For HHS, the bill provides funds for:

 the Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and Prevention, the National Institutes of Health, and the Public Health and Social Services Emergency Fund.

opioid heroin epidemic emergency supplemental appropriations act bill provides fy2016 supplemental appropriations department_of_justice doj department_of_health_and_human_services hhs address heroin opioid drug abuse funds designated emergency requirement exempts funds discretionary spending limits budget enforcement rules doj bill provides funds state local law enforcement assistance community oriented policing services cops programs hhs bill provides funds substance_abuse_and_mental_health_services_administration centers_for_disease_control_and_prevention national_institutes_of_health public health social_services emergency fund