Bill summaries are authored by CRS.

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Passed House amended (06/17/2015)

Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act of 2015

(Sec. 2) This bill amends title XVIII (Medicare) of the Social Security Act (SSAct) with respect to criteria for qualifying as a meaningful user of electronic health records (meaningful EHR user). For any payment year after 2015 any patient encounter of an eligible professional occurring at an eligible ambulatory surgical center shall not be treated as one in determining whether an eligible professional qualifies as a meaningful EHR user.

(Sec. 3) HHS shall establish a three-year demonstration program to test the use of value-based insurance design methodologies under the eligible Medicare Advantage (MA) plans offered by MA organizations under Medicare part C.

"Value-based insurance design methodology" is one for identifying specific prescription medications, and clinical services payable under Medicare, for which copayments, coinsurance, or both would improve the management of specific chronic clinical conditions because of the high value and effectiveness of such medications and services for such specific chronic clinical conditions, as approved by HHS.

HHS may expand the duration and scope of the demonstration program to an appropriate extent if specified requirements are met.

(Sec. 4) Payment amounts are prescribed for infusion drugs and biologicals furnished through durable medical equipment (DME) on or after January 1, 2017.

(Sec. 5) It is the sense of Congress that HHS:

  • has incorrectly interpreted the determination of blended benchmark amounts as prohibiting the provision of any Medicare quality incentive payments with respect to MA plans that exceed the payment benchmark cap for the area served by those plans; and
  • should immediately apply quality incentive payments with respect to such MA plans without regard to limits.

(Sec. 6) $220 million shall be available to the Medicare Improvement Fund during and after FY2020.

(Sec. 7) DME competitive acquisition programs shall not cover infusion drugs and biologicals.