[Pages H8118-H8120]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

FIGHTING FRAUD TO PROTECT CARE FOR SENIORS ACT OF 2018

Mr. ROSKAM. Mr. Speaker, I move to suspend the rules and pass the
bill (H.R. 6690) to establish a smart card pilot program to combat
fraud, waste, and abuse and to protect beneficiary identity under the
Medicare program, as amended.
The Clerk read the title of the bill.
The text of the bill is as follows:

H.R. 6690

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Fighting Fraud to Protect
Care for Seniors Act of 2018''.

SEC. 2. MEDICARE SMART CARD PILOT PROGRAM.

Part E of title XVIII of the Social Security Act is amended
by inserting after section 1866E the following new section:

``SEC. 1866F. SMART CARD PILOT PROGRAM.

``(a) Implementation.--
``(1) In general.--Not later than 36 months after the date
of the enactment of this section, the Secretary shall
establish a pilot program (in this section referred to as the
`pilot program') to evaluate the feasibility of using smart
card technology under this title.
``(2) Smart card technology defined.--In this section, the
term `smart card technology' means the following:
``(A) Beneficiary smart card.--A machine readable, tamper-
resistant card (in this section referred to as a `smart
card') that includes an embedded integrated circuit chip with
a secure micro-controller (as defined by the National
Institute on Standards and Technology) that enables the
verification and secure, electronic authentication of the
identity of a Medicare beneficiary at the point of service
through a combination of the smart card and a personal
identification number known by or associated with such
beneficiary.
``(B) Card reader technology.--Information technology that
enables a supplier and provider to authenticate the identity
of a Medicare beneficiary through presentation of such a
smart card and such components, with such authentication to
be reflected through the use of a modifier or in another
appropriate manner, as determined by the Secretary, in the
claims adjudication process.
``(3) Program design elements.--The pilot program shall be
conducted for a period of 3 years consistent with the
following:
``(A) Selection of area.--In consultation with the
Inspector General of the Department of Health and Human
Services, the Secretary shall select at least 3 geographic
areas in which the pilot program will operate.
``(B) Selection of supplier and provider types.--In
consultation with the Inspector General of the Department of
Health and Human Services, the Secretary shall select
supplier and provider types that will be required to
participate in the pilot program (referred to in this section
as `participating suppliers and providers'). In selecting
such supplier and provider types, the Secretary shall--
``(i) take into account the risk of fraud, waste, and abuse
(as described in section 1866(j)(2)(B)) with respect to the
category of provider or supplier) and other factors as
determined appropriate by the Secretary; and
``(ii) limit the pilot program to no more than 2,000
suppliers and providers.
``(C) Supplier and provider hardship exemptions.--The
Secretary shall exempt from participation in the pilot
program a supplier or provider that either--
``(i) does not have access to card reader technology (as
described in paragraph (2)(B));
``(ii) does not have sufficient internet access; or
``(iii) has a low volume (as determined by the Secretary)
of Medicare claims for which payment is made under this
title.
``(D) Smart card and smart card reader issuance.--
``(i) Beneficiary smart card issuance.--The Secretary shall
provide for, at no cost, the issuance (and, if necessary,
replacement) of beneficiary smart cards described in
paragraph (2)(A) to all Medicare beneficiaries residing in a
geographic area in which the pilot program is conducted under
subparagraph (A). Information that appears on Medicare cards
used outside the pilot program may appear on the face of the
beneficiary smart card.
``(ii) Supplier and provider smart card reader issuance.--
At the request of a participating supplier or provider, the
Secretary shall provide for, at no cost, the issuance to such
supplier or provider of smart card hardware and

[[Page H8119]]

software necessary to participate in the pilot program.
``(E) Information on operation of pilot program.--The
Secretary shall provide participating suppliers and providers
and Medicare beneficiaries who are furnished items and
services by such suppliers and providers, with information on
the operation of the pilot program, including privacy
protections described in subparagraph (I).
``(F) Access to services outside the pilot program.--
``(i) Beneficiaries.--Medicare beneficiaries who receive
beneficiary smart cards may receive items and services from
suppliers and providers not participating in the pilot
program.
``(ii) Suppliers and provider claims.--

``(I) Suppliers and providers not participating in pilot.--
Suppliers and providers not participating in the pilot
program may submit claims under this title for items and
services furnished without use of smart card technology to
Medicare beneficiaries who receive beneficiary smart cards.
``(II) Participating suppliers and providers furnishing
services to non-participating beneficiaries.--Supplier and
providers participating in the pilot program may submit
claims under this title for items and services furnished to
Medicare beneficiaries who do not receive beneficiary smart
cards.

``(G) Clarification on access to services without smart
cards.--In the case of a Medicare beneficiary who receives a
beneficiary smart card and does not present such card at the
time of receipt of items or services from a participating
supplier or provider, the participating supplier or
provider--
``(i) shall furnish such items or services to such Medicare
beneficiary as if such beneficiary does present such card;
``(ii) may submit claims under this title for such items or
services; and
``(iii) shall provide, in accordance with such manner,
process, and timing as specified by the Secretary,
information to the Secretary (through the contractor
described in subparagraph (H)) that such beneficiary received
such a smart card but did not have the smart card at the time
the items or services were furnished.
``(H) Private sector implementation.--The Secretary shall
select, by using a competitive procurement process in
accordance with the provisions of chapter 1 of title 48, Code
of Federal Regulations (or any successor regulations), a
private sector contractor to implement and operate the pilot
program.
``(I) Privacy protections.--The Secretary shall ensure that
the pilot program complies with applicable Federal laws and
regulations concerning individually identifiable health
information, including the Privacy Act of 1974 and
regulations promulgated under section 264(c) of the Health
Insurance Portability and Accountability Act of 1996 and such
individually identifiable information shall be exempt from
disclosure under section 552(b)(3) of title 5, United States
Code.
``(J) Mandatory participation.--Subject to subparagraph
(C), in the case of items or services furnished by a provider
or supplier included in a supplier or provider type selected
under subparagraph (B) in a geographic area selected under
subparagraph (A), payment may only be made under this title
for such items or services during the period of the pilot
program if the provider or supplier is participating in the
pilot program.
``(K) Prohibition of smart card fees.--No transaction,
utilization, or other fees may be imposed on Medicare
beneficiaries or participating suppliers and providers with
respect to the use of smart cards under the pilot program.
``(4) Stakeholder input.--
``(A) In general.--Not later than 6 months after the date
of the enactment of this section, the Secretary shall convene
a panel consisting of stakeholders (including representatives
of providers, suppliers, technology vendors, Medicare
beneficiaries, and claims processing contractors) selected by
the Secretary for purposes of providing input to the
Secretary on the implementation of the pilot program
(including on the selection of areas and participants under
subparagraphs (A) and (B) of paragraph (3) and the
development of exemptions and requirements described in such
paragraph).
``(B) Nonapplicability of faca.--The Federal Advisory
Committee Act shall not apply to the panel convened pursuant
to subparagraph (A).
``(5) Definitions.--In this section:
``(A) The terms `supplier' and `provider' have the meanings
given the terms `supplier' and `provider of services' in
subsections (d) and (u), respectively, of section 1861.
``(B) The term `Medicare beneficiary' means an individual
who is enrolled in the original Medicare fee-for-service
program under parts A and B and is not enrolled in an MA plan
under part C, an eligible organization under section 1876, or
a PACE program under section 1894.
``(b) Reports to Congress.--The Secretary shall submit to
Congress the following reports:
``(1) Interim performance report.--Not later than 2 years
after the date the pilot program is implemented, an interim
report on the performance of such program.
``(2) Final performance report.--Not later than 18 months
after the date of the completion of the pilot program, a
final evaluation on the effectiveness of the pilot program.
The report shall include the following:
``(A) An evaluation of the effect of the pilot program on
potential fraud under the insurance programs established
under this title.
``(B) A description of any barriers to implementation of
the pilot program.
``(C) Participant feedback on the pilot program.
``(D) Recommendations regarding the future use of smart
cards to address fraud under this title.
``(E) Data on the information provided under subsection
(a)(3)(G)(iii).''.

The SPEAKER pro tempore (Mr. Abraham). Pursuant to the rule, the
gentleman from Illinois (Mr. Roskam) and the gentleman from Michigan
(Mr. Levin) each will control 20 minutes.
The Chair recognizes the gentleman from Illinois.

General Leave

Mr. ROSKAM. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days in which to revise and extend their remarks and
include extraneous material on H.R. 6690, currently under
consideration.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Illinois?
There was no objection.
Mr. ROSKAM. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, we have an opportunity to do something together on a
bipartisan basis that can bring a level of confidence to a program that
all of us cherish and all of us want to defend, and that is Medicare.
Medicare is an incredibly popular program. It is a necessary program,
and it is a program that needs all of us to defend it, particularly on
the integrity side.
If Medicare were to ask CMS today what their fraudulent or erroneous
payment rate is, those two numbers together, they would come back and
they would tell them it is about 10 percent. So, in other words, about
$40 billion a year, Mr. Speaker, is going out the door not to benefit
seniors, but it is going out the door either fraudulently or
erroneously.
I thank Mr. Blumenauer from Oregon because, together, we have been
working on this concept which would apply the same type of technology
that we see in so many other parts of the economy right now, and that
is smart card technology, and use it in a Medicare setting. The
proposal is this: Let's try it. Let's see how it works. Let's have a
pilot program.
Toward that end, what we are hoping and the expectation is that the
same types of savings that we have seen in the private sector we will
see in this sector to make sure that seniors are protected, not only
the funds that seniors have come to rely on, but their identities and
so forth.
This is a concept, again, that Mr. Blumenauer and I have worked on.
I thank Chairman Brady for his work on this bill and the attention
that this has gotten on a bipartisan basis.

{time} 1500

I think it is particularly interesting to note that AARP has weighed
in very strongly in favor of it. Let me just read one quick snapshot
from a letter that they sent to Mr. Blumenauer and me at the end of
August, and I will just give you a couple of sentences.
``While the new cards are more secure than before, `smart cards'
could provide even greater security, and have the potential to contain
useful health information and facilitate care. If enacted, this pilot
program would also help Medicare learn more about the beneficiary
engagement and education. This technology deserves to be tested and
evaluated.''
Mr. Speaker, in a nutshell, this is a proposal to create a pilot
program. I urge its passage, and I reserve the balance of my time.

Committee on Ways and Means,

House of Representatives,

Washington, DC, September 7, 2018.
Hon. Greg Walden,
Chairman, Committee on Energy and Commerce,
Washington, DC.
Dear Chairman Walden: I write to you regarding several
health bills the Committee on Ways and Means ordered
favorably reported to the House. The following bills were
also referred to the Committee on Energy and Commerce.
I ask that the Committee on Energy and Commerce waive
formal consideration of the following bills so that they may
proceed expeditiously to the House Floor:
H.R. 6662, Empowering Seniors' Enrollment Decision Act of
2018;
H.R. 6690, Fighting Fraud to Protect Care for Seniors Act
of 2018;
H.R. 6561, Comprehensive Care for Seniors Act of 2018; and
H.R. 3635, Local Coverage Determination Clarification Act
of 2018.
I acknowledge that by waiving formal consideration of the
bills, the Committee on Energy and Commerce is in no way
waiving its jurisdiction over the subject matter contained in
those provisions of the bills that fall within your Rule X
jurisdiction. I would support your effort to seek appointment
of

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an appropriate number of conferees on any House-Senate
conference involving this legislation.
I will include a copy of our letters in the Congressional
Record during consideration of this legislation on the House
floor.
Sincerely,
Kevin Brady,
Chairman.
____

House of Representatives,

Committee on Energy and Commerce,

Washington, DC, September 7, 2018.
Hon. Kevin Brady,
Chairman, Committee on Ways and Means,
Washington, DC.
Dear Chairman Brady: Thank you for your letter regarding
H.R. 3635, Local Coverage Determination Clarification Act of
2018; H.R. 6561, Comprehensive Care for Seniors Act of 2018;
H.R. 6662, Empowering Seniors' Enrollment Decision Act of
2018; and H.R. 6690, Fighting Fraud to Protect Care for
Seniors Act of 2018.
The Committee on Energy and Commerce will forgo
consideration of both bills so that they may proceed
expeditiously to the House Floor.
I appreciate your assurance that by forgoing action on
these bills, the Committee is in no way waiving its
jurisdiction over the subject matter contained in the bills.
I also appreciate your offer of support for the appointment
of conferees from the Committee to any House-Senate
conference involving this legislation.
Sincerely,
Greg Walden,
Chairman.

Mr. LEVIN. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, this is the first of four bills that came out of the
Ways and Means Committee. They came out without much controversy. The
only one that really had any is this first bill. I am not sure we will
have any speakers on our side. I will say a few words about this bill
in a few minutes.
I first want to talk a bit about bipartisanship. These four bills do
have some bipartisanship. Unfortunately, what isn't bipartisan is the
basic dispute about healthcare and about the continuation of the reform
that we on the Democratic side started some years ago with our
President.
It has turned out to be an important piece of legislation--I think
historic--and the more people look at it and the more they are covered
by it, the greater the support for it.
Unfortunately, unlike the bipartisanship in these four bills, ACA
continues to be hit by the worst kind of partisanship and continued
efforts to undermine and destroy it.
In October 2017, the administration ended cost-sharing reduction
subsidies. That has led to premium increases of 20 to 25 percent across
the Nation. In June of this year, the Trump administration expanded the
reach of junk insurance policies that have weakened the risk pool, and
these policies are not subject to consumer protections.
In July, we saw the impact of this firsthand in Michigan. The
administration announced another cut in so-called navigator
organizations. They slashed the funding from $63 million just 2 years
ago to $10 million. It had an impact throughout this country, and I saw
firsthand what it meant in the State of Michigan.
Essentially, the administration said we are going to cut and
essentially eliminate help for outreach to people in terms of their
knowing about the ACA and how, as millions of others have, they can
obtain coverage.
I think maybe most disturbing, last week, the Federal court heard
arguments in Texas v. the United States. It is a lawsuit launched by
Republicans that could jeopardize healthcare for 130 million patients
living with preexisting conditions. The Republicans like to point to
language that says that won't happen. But essentially, I think they
have their heads in the sand on this if the court were to rule in favor
of the suit. I think, to the disgrace of the administration, they
decided not to defend the government's position.
So we are here today with bipartisan bills, and it is really sad--
indeed, worse than that. We haven't had a single hearing on any of the
issues I mentioned. And the Republicans, while they come here and talk
about bipartisanship, which has been so essential until recent years
when it comes to healthcare, they now essentially are engaging in very
partisan efforts to undermine healthcare for millions and millions of
people.
So let me just say, Mr. Speaker, a brief word about this. Mr. Roskam
has been working on this for a long time, working with Mr. Blumenauer,
and I think the gentleman's efforts to strive for some bipartisanship
have been a positive.
As I said at the beginning, of all four bills, this one had the most
discussion in our committee and had some disagreement. The smart card
idea has been examined by a number of entities, including the
Government Accountability Office. According to their 2016 report--and I
have copies of their report of 2016, and there is also another report
that relates to this--according to that, their estimate was that smart
cards would help in only a minority of cases. In fact, of the 739
healthcare fraud cases that the GAO examined, only 18 would have been
fully addressed had Medicare used these cards. That is only about 2
percent of the cases.
Also, transition to smart cards is going to be significant, and the
estimate is that it is going to cost about $40 million. As we discussed
in the committee, some thought there might be a better use of this
money.
Be that as it may, this has been worked on, and Mr. Roskam and Mr.
Blumenauer have combined forces to undertake this 3-year pilot program.
So under those circumstances, wishing we had more bipartisanship on
healthcare issues that run more deeply and affect the needs of people
even more broadly, with that caveat, I do not suggest anything but
support for this bill.
Mr. Speaker, I have no further conversation, and I yield back the
balance of my time.
Mr. ROSKAM. Mr. Speaker, I want to thank Mr. Levin for his
observations about this bill, that it is created in a spirit of
bipartisanship, and I appreciate his support for it.
I think it is interesting, just a little bit of a point of
clarification, because we were able to discuss in the committee the GAO
report. There are two facets of it. There are two numbers, and those
people who are tracking this closely will care about it. There is one 2
percent representation and then a 22 percent representation.
Here is the story. The GAO said only 2 percent of cases that they
evaluated would have been completely changed by this. I think if we
were talking about any other thing in Medicare as it relates to 2
percent, we would be chasing it. Be that as it may, 2 percent would be
completely changed. Twenty-two percent of the cases they evaluated,
however, would be impacted in some way.
So the bottom line here is that we have an opportunity to adopt
technology at a cost of about $40 million, we are told, to pursue $40
billion in fraud and error. That is good math any day of the week. Both
sides of the aisle recognize it.
Mr. Speaker, I urge its passage, and I yield back the balance of my
time.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from Illinois (Mr. Roskam) that the House suspend the rules
and pass the bill, H.R. 6690, as amended.
The question was taken; and (two-thirds being in the affirmative) the
rules were suspended and the bill, as amended, was passed.
A motion to reconsider was laid on the table.

____________________