[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3429 Introduced in House (IH)]
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116th CONGRESS
1st Session
H. R. 3429
To provide for health equity and access for returning troops and
servicemembers, to provide for ambulatory surgical payment transparency
under the Medicare program, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 24, 2019
Ms. Sewell of Alabama (for herself and Mr. Nunes) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committees on Ways and Means, and
Armed Services, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To provide for health equity and access for returning troops and
servicemembers, to provide for ambulatory surgical payment transparency
under the Medicare program, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``HEARTS and Rural
Relief Act''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Health Equity and Access for Returning Troops and
Servicemembers and Rural Relief Act of
2019.
Sec. 3. Ambulatory surgical center payment transparency.
Sec. 4. Exclusion of complex rehabilitative manual wheelchairs from
Medicare competitive acquisition program;
non-application of Medicare fee schedule
adjustments for certain wheelchair
accessories and cushions.
Sec. 5. Extension of enforcement instruction on supervision
requirements for outpatient therapeutic
services in critical access and small rural
hospitals through 2021.
SEC. 2. HEALTH EQUITY AND ACCESS FOR RETURNING TROOPS AND
SERVICEMEMBERS AND RURAL RELIEF ACT OF 2019.
(a) Modification of Requirement for Certain Former Members of the
Armed Forces To Enroll in Medicare Part B To Be Eligible for TRICARE
for Life.--
(1) TRICARE eligibility.--
(A) In general.--Subsection (d) of section 1086 of
title 10, United States Code, is amended by adding at
the end the following new paragraph:
``(6)(A) The requirement in paragraph (2)(A) to enroll in
the supplementary medical insurance program under part B of
title XVIII of the Social Security Act (42 U.S.C. 1395j et
seq.) shall not apply to a person described in subparagraph (B)
during any month in which such person is not entitled to a
benefit described in subparagraph (A) of section 226(b)(2) of
the Social Security Act (42 U.S.C. 426(b)(2)) if such person
has received the counseling and information under subparagraph
(C).
``(B) A person described in this subparagraph is a person--
``(i) who is under 65 years of age;
``(ii) who is entitled to hospital insurance
benefits under part A of title XVIII of the Social
Security Act pursuant to subparagraph (A) or (C) of
section 226(b)(2) of such Act (42 U.S.C. 426(b)(2));
``(iii) whose entitlement to a benefit described in
subparagraph (A) of such section has terminated due to
performance of substantial gainful activity; and
``(iv) who is retired under chapter 61 of this
title.
``(C) The Secretary of Defense shall coordinate with the
Secretary of Health and Human Services and the Commissioner of
Social Security to notify persons described in subparagraph (B)
of, and provide information and counseling regarding, the
effects of not enrolling in the supplementary medical insurance
program under part B of title XVIII of the Social Security Act
(42 U.S.C. 1395j et seq.), as described in subparagraph (A).''.
(B) Conforming amendment.--Paragraph (2)(A) of such
subsection is amended by striking ``is enrolled'' and
inserting ``except as provided by paragraph (6), is
enrolled''.
(C) Identification of persons.--Section 1110a of
such title is amended by adding at the end the
following new subsection:
``(c) Certain Individuals Not Required To Enroll in Medicare Part
B.--In carrying out subsection (a), the Secretary of Defense shall
coordinate with the Secretary of Health and Human Services and the
Commissioner of Social Security to--
``(1) identify persons described in subparagraph (B) of
section 1086(d)(6) of this title; and
``(2) provide information and counseling pursuant to
subparagraph (C) of such section.''.
(2) Non-application of medicare part b late enrollment
penalty.--Section 1839(b) of the Social Security Act (42 U.S.C.
1395r(b)) is amended, in the second sentence, by inserting ``or
months for which the individual can demonstrate that the
individual is an individual described in paragraph (6)(B) of
section 1086(d) of title 10, United States Code, who is
enrolled in the TRICARE program pursuant to such section''
after ``an individual described in section 1837(k)(3)''.
(3) Report.--Not later than October 1, 2024, the Secretary
of Defense, the Secretary of Health and Human Services, and the
Commissioner of Social Security shall jointly submit to the
Committees on Armed Services of the House of Representatives
and the Senate, the Committee on Ways and Means and the
Committee on Energy and Commerce of the House of
Representatives, and the Committee on Finance of the Senate a
report on the implementation of section 1086(d)(6) of title 10,
United States Code, as added by paragraph (1). Such report
shall include, with respect to the period covered by the
report--
(A) the number of individuals enrolled in TRICARE
for Life who are not enrolled in the supplementary
medical insurance program under part B of title XVIII
of the Social Security Act (42 U.S.C. 1395j et seq.) by
reason of such section 1086(d)(6); and
(B) the number of individuals who--
(i) are retired from the Armed Forces under
chapter 61 of title 10, United States Code;
(ii) are entitled to hospital insurance
benefits under part A of title XVIII of the
Social Security Act pursuant to receiving
benefits for 24 months as described in
subparagraph (A) or (C) of section 226(b)(2) of
such Act (42 U.S.C. 426(b)(2)); and
(iii) because of such entitlement, are no
longer enrolled in TRICARE Standard, TRICARE
Prime, TRICARE Extra, or TRICARE Select under
chapter 55 of title 10, United States Code.
(4) Deposit of savings into medicare improvement fund.--
Section 1898(b)(1) of the Social Security Act (42 U.S.C.
1395iii(b)(1)) is amended by striking ``during and after fiscal
year 2021, $0'' and inserting ``during and after fiscal year
2024, $5,000,000''.
(5) Application.--The amendments made by paragraphs (1) and
(2) shall apply with respect to a person who, on or after
October 1, 2023, is a person described in section 1086(d)(6)(B)
of title 10, United States Code, as added by paragraph (1).
(b) Coverage of Certain DNA Specimen Provenance Assay Tests Under
Medicare.--
(1) Benefit.--
(A) Coverage.--Section 1861 of the Social Security
Act (42 U.S.C. 1395x) is amended--
(i) in subsection (s)(2)--
(I) in subparagraph (GG), by
striking ``and'' at the end;
(II) in subparagraph (HH), by
striking the period and inserting ``;
and''; and
(III) by adding at the end the
following new subparagraph:
``(II) a prostate cancer DNA Specimen Provenance Assay test
(DSPA test) (as defined in subsection (kkk));''; and
(ii) by adding at the end the following new
subsection:
``(kkk) Prostate Cancer DNA Specimen Provenance Assay Test.--The
term `prostate cancer DNA Specimen Provenance Assay Test' (DSPA test)
means a test that, after a determination of cancer in one or more
prostate biopsy specimens obtained from an individual, assesses the
identity of the DNA in such specimens by comparing such DNA with the
DNA that was separately taken from such individual at the time of the
biopsy.''.
(B) Exclusion from coverage.--Section 1862(a)(1) of
the Social Security Act (42 U.S.C. 1395y(a)(1)) is
amended--
(i) in subparagraph (O), by striking
``and'' at the end;
(ii) in subparagraph (P), by striking the
semicolon at the end and inserting ``, and'';
and
(iii) by adding at the end the following
new subparagraph:
``(Q) in the case of a prostate cancer DNA Specimen
Provenance Assay test (DSPA test) (as defined in section
1861(kkk)), unless such test is furnished on or after January
1, 2020, and before January 1, 2025, and such test is ordered
by the physician who furnished the prostate cancer biopsy that
obtained the specimen tested;''.
(2) Payment amount and related requirements.--Section 1834
of the Social Security Act (42 U.S.C. 1395m) is amended by
adding at the end the following new subsection:
``(x) Prostate Cancer DNA Specimen Provenance Assay Tests.--
``(1) Payment for covered tests.--
``(A) In general.--Subject to subparagraph (B), the
payment amount for a prostate cancer DNA Specimen
Provenance Assay test (DSPA test) (as defined in
section 1861(kkk)) shall be $200. Such payment shall be
payment for all of the specimens obtained from the
biopsy furnished to an individual that are tested.
``(B) Limitation.--Payment for a DSPA test under
subparagraph (A) may only be made on an assignment-
related basis.
``(C) Prohibition on separate payment.--No separate
payment shall be made for obtaining DNA that was
separately taken from an individual at the time of a
biopsy described in subparagraph (A).
``(2) HCPCS code and modifier assignment.--
``(A) In general.--The Secretary shall assign one
or more HCPCS codes to a prostate cancer DNA Specimen
Provenance Assay test and may use a modifier to
facilitate making payment under this section for such
test.
``(B) Identification of dna match on claim.--The
Secretary shall require an indication on a claim for a
prostate cancer DNA Specimen Provenance Assay test of
whether the DNA of the prostate biopsy specimens match
the DNA of the individual diagnosed with prostate
cancer. Such indication may be made through use of a
HCPCS code, a modifier, or other means, as determined
appropriate by the Secretary.
``(3) DNA match review.--
``(A) In general.--The Secretary shall review at
least three years of claims under part B for prostate
cancer DNA Specimen Provenance Assay tests to identify
whether the DNA of the prostate biopsy specimens match
the DNA of the individuals diagnosed with prostate
cancer.
``(B) Posting on internet website.--Not later than
July 1, 2023, the Secretary shall post on the internet
website of the Centers for Medicare & Medicaid Services
the findings of the review conducted under subparagraph
(A).''.
(3) Cost-sharing.--Section 1833(a)(1) of the Social
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(A) by striking ``and (CC)'' and inserting
``(CC)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (DD) with respect to a prostate
cancer DNA Specimen Provenance Assay test (DSPA test)
(as defined in section 1861(kkk)), the amount paid
shall be an amount equal to 80 percent of the lesser of
the actual charge for the test or the amount specified
under section 1834(x)''.
SEC. 3. AMBULATORY SURGICAL CENTER PAYMENT TRANSPARENCY.
(a) Advisory Panel on Hospital Outpatient Payment Representation.--
(1) ASC representative.--The second sentence of section
1833(t)(9)(A) of the Social Security Act (42 U.S.C.
1395l(t)(9)(A)) is amended by inserting ``and at least one
ambulatory surgical center representative'' after ``an
appropriate selection of representatives of providers''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply with respect to advisory panels consulted on or
after the date that is 1 year after the date of the enactment
of this Act.
(b) Reasons for Excluding Additional Procedures From ASC Approved
List.--Section 1833(i)(1) of the Social Security Act (42 U.S.C.
1395l(i)(1)) is amended by adding at the end the following: ``In
updating such lists for application in years beginning with the second
year beginning after the date of the enactment of this sentence, for
each procedure that was not proposed to be included in such lists in
the proposed rule with respect to such lists and that was subsequently
requested to be included in such lists during the public comment period
with respect to such proposed rule and that is not included in the
final rule updating such lists, the Secretary shall cite in such final
rule the specific criteria in paragraph (b) or (c) of section 416.166
of title 42, Code of Federal Regulations (or any successor regulation),
based on which the procedure was excluded. If paragraph (b) of such
section is cited for exclusion of a procedure, the Secretary shall
identify the peer-reviewed research, if any, or the evidence upon which
such determination is based.''.
SEC. 4. EXCLUSION OF COMPLEX REHABILITATIVE MANUAL WHEELCHAIRS FROM
MEDICARE COMPETITIVE ACQUISITION PROGRAM; NON-APPLICATION
OF MEDICARE FEE SCHEDULE ADJUSTMENTS FOR CERTAIN
WHEELCHAIR ACCESSORIES AND CUSHIONS.
(a) Exclusion of Complex Rehabilitative Manual Wheelchairs From
Competitive Acquisition Program.--Section 1847(a)(2)(A) of the Social
Security Act (42 U.S.C. 1395w-3(a)(2)(A)) is amended--
(1) by inserting ``, complex rehabilitative manual
wheelchairs (as determined by the Secretary), and certain
manual wheelchairs (identified, as of October 1, 2018, by HCPCS
codes E1235, E1236, E1237, E1238, and K0008 or any successor to
such codes)'' after ``group 3 or higher''; and
(2) by striking ``such wheelchairs'' and inserting ``such
complex rehabilitative power wheelchairs, complex
rehabilitative manual wheelchairs, and certain manual
wheelchairs''.
(b) Non-Application of Medicare Fee Schedule Adjustments for
Wheelchair Accessories and Seat and Back Cushions When Furnished in
Connection With Complex Rehabilitative Manual Wheelchairs.--
(1) In general.--Notwithstanding any other provision of
law, the Secretary of Health and Human Services shall not,
during the period beginning on July 1, 2019, and ending on
December 31, 2020, use information on the payment determined
under the competitive acquisition programs under section 1847
of the Social Security Act (42 U.S.C. 1395w-3) to adjust the
payment amount that would otherwise be recognized under section
1834(a)(1)(B)(ii) of such Act (42 U.S.C. 1395m(a)(1)(B)(ii))
for wheelchair accessories (including seating systems) and seat
and back cushions when furnished in connection with complex
rehabilitative manual wheelchairs (as determined by the
Secretary), and certain manual wheelchairs (identified, as of
October 1, 2018, by HCPCS codes E1235, E1236, E1237, E1238, and
K0008 or any successor to such codes).
(2) Implementation.--Notwithstanding any other provision of
law, the Secretary may implement this subsection by program
instruction or otherwise.
SEC. 5. EXTENSION OF ENFORCEMENT INSTRUCTION ON SUPERVISION
REQUIREMENTS FOR OUTPATIENT THERAPEUTIC SERVICES IN
CRITICAL ACCESS AND SMALL RURAL HOSPITALS THROUGH 2021.
Section 1 of Public Law 113-198, as amended by section 1 of Public
Law 114-112, section 16004 of Public Law 114-255, and section 51007 of
Public Law 115-123, is amended--
(1) in the section heading, by striking ``2017'' and
inserting ``2021''; and
(2) by striking ``and 2017'' and inserting ``, 2017, 2020,
and 2021''.
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