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[From the U.S. Government Publishing Office]


114th Congress     }                                {   Rept. 114-39
                        HOUSE OF REPRESENTATIVES
 1st Session       }                                {    Part 1
======================================================================
 
                              NOTICE ACT

                                _______
                                

 March 13, 2015.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mr. Ryan of Wisconsin, from the Committee on Ways and Means, submitted 
                             the following

                              R E P O R T

                        [To accompany H.R. 876]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Ways and Means, to whom was referred the 
bill (H.R. 876) to amend title XVIII of the Social Security Act 
to require hospitals to provide certain notifications to 
individuals classified by such hospitals under observation 
status rather than admitted as inpatients of such hospitals, 
having considered the same, report favorably thereon with an 
amendment and recommend that the bill as amended do pass.

                                CONTENTS

                                                                   Page
 I. SUMMARY AND BACKGROUND............................................2
        A. Purpose and Summary...................................     2
        B. Background and Need for Legislation...................     3
        C. Legislative History...................................     3
II. EXPLANATION OF THE BILL...........................................3
III.VOTES OF THE COMMITTEE............................................4

IV. BUDGET EFFECTS OF THE BILL........................................4
        A. Committee Estimate of Budgetary Effects...............     4
        B. Statement Regarding New Budget Authority and Tax 
            Expenditures Budget Authority........................     4
        C. Cost Estimate Prepared by the Congressional Budget 
            Office...............................................     5
 V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE........5
        A. Committee Oversight Findings and Recommendations......     5
        B. Statement of General Performance Goals and Objectives.     6
        C. Duplication of Federal Programs Information Relating 
            to Unfunded Mandates.................................     6
        D. Disclosure of Directed Rule Makings...................     6
        E. Information Relating to Unfunded Mandates.............     6
        F. Congressional Earmarks, Limited Tax Benefits, and 
            Limited Tariff Benefits..............................     6
VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED.............7

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Notice of Observation Treatment and 
Implication for Care Eligibility Act'' or the ``NOTICE Act''.

SEC. 2. MEDICARE REQUIREMENT FOR HOSPITAL NOTIFICATIONS OF OBSERVATION 
                    STATUS.

  Section 1866(a)(1) of the Social Security Act (42 U.S.C. 
1395cc(a)(1)) is amended--
          (1) in subparagraph (V), by striking at the end ``and'';
          (2) in the first subparagraph (W), by striking at the end the 
        period and inserting a comma;
          (3) in the second subparagraph (W)--
                  (A) by redesignating such subparagraph as 
                subparagraph (X); and
                  (B) by striking at the end the period and inserting 
                ``, and''; and
          (4) by inserting after such subparagraph (X) the following 
        new subparagraph:
          ``(Y) beginning 12 months after the date of the enactment of 
        this subparagraph, in the case of a hospital or critical access 
        hospital, with respect to each individual who receives 
        observation services as an outpatient at such hospital or 
        critical access hospital for more than 24 hours, to provide to 
        such individual not later than 36 hours after the time such 
        individual begins receiving such services (or, if sooner, upon 
        release)--
                  ``(i) such oral explanation of the written 
                notification described in clause (ii), and such 
                documentation of the provision of such explanation, as 
                the Secretary determines to be appropriate;
                  ``(ii) a written notification (as specified by the 
                Secretary pursuant to rulemaking and containing such 
                language as the Secretary prescribes consistent with 
                this paragraph) which--
                          ``(I) explains the status of the individual 
                        as an outpatient receiving observation services 
                        and not as an inpatient of the hospital or 
                        critical access hospital and the reasons for 
                        such status of such individual;
                          ``(II) explains the implications of such 
                        status on services furnished by the hospital or 
                        critical access hospital (including services 
                        furnished on an inpatient basis), such as 
                        implications for cost-sharing requirements 
                        under this title and for subsequent eligibility 
                        for coverage under this title for services 
                        furnished by a skilled nursing facility;
                          ``(III) includes such additional information 
                        as the Secretary determines appropriate;
                          ``(IV) either--
                                  ``(aa) is signed by such individual 
                                or a person acting on such individual's 
                                behalf to acknowledge receipt of such 
                                notification; or
                                  ``(bb) if such individual or person 
                                refuses to provide the signature 
                                described in item (aa), is signed by 
                                the staff member of the hospital or 
                                critical access hospital who presented 
                                the written notification and includes 
                                the name and title of such staff 
                                member, a certification that the 
                                notification was presented, and the 
                                date and time the notification was 
                                presented; and
                          ``(V) is written and formatted using plain 
                        language and is made available in appropriate 
                        languages as determined by the Secretary.''.

                       I. SUMMARY AND BACKGROUND


                         A. Purpose and Summary

    The bill, H.R. 876, as ordered reported by the Committee on 
Ways and Means on February 26, 2015, is legislation to provide 
certainty to beneficiaries regarding their status as an 
outpatient under observation (or any similar status) and not as 
an inpatient. The Notice of Observation Treatment and 
Implication for Care Eligibility Act (NOTICE Act) contains 
bipartisan policies, promoted by Ways and Means Committee 
members, that include the:
           Explanation for the reason for beneficiary's 
        classification as outpatient or inpatient
           Clarification on the implications of that 
        outpatient status for beneficiaries on eligibility for 
        Medicare coverage of items and services as well as 
        cost-sharing requirements
           Name and title of the hospital staff who 
        gave an oral notification and its date and time
           Requirement that the clarification be signed 
        by the patient, if the notification is written, to 
        acknowledge receipt, or if patient refuses to sign, the 
        written notification is signed by the staff of the 
        hospital who presented it

               B. Background and the Need for Legislation

    On February 11, 2015, Representative Lloyd Doggett (D-TX), 
and Representative Todd Young (R-IN), introduced H.R. 876, 
which requires hospitals to provide certain notification to 
individuals classified by such hospitals under observation 
status rather than admitted as inpatients of such hospitals.
    The NOTICE Act provides certainty to beneficiaries with 
regard to their classification as an inpatient or outpatient. 
Without the NOTICE Act, beneficiaries could be subject to costs 
they did not foresee due to their classification as either an 
outpatient under observation or an inpatient. By clarifying a 
beneficiary's status as either an outpatient under observation 
(or any similar status) or as an inpatient, the NOTICE Act will 
provide beneficiaries with accurate, real-time information with 
respect to their classification, the services and benefits 
available to them, and the respective cost-sharing requirements 
they are subject to.

                         C. Legislative History


Background

    H.R. 876 was introduced on February 11, 2015, and was 
referred to the Committee on Ways and Means, in addition to the 
Committee on Energy and Commerce. The bill was subsequently 
referred to the Subcommittee on Health.

Committee Action

    The Committee on Ways and Means marked up the bill on 
February 26, 2015, and with a quorum present, ordered the bill 
favorably reported.

Committee Markups

    On February 26, 2015, the Committee on Ways and Means held 
a markup of H.R. 876, ``NOTICE Act'', which was favorably 
reported to the House of Representatives by voice vote.

                      II. EXPLANATION OF THE BILL


                              PRESENT LAW

    Current statute does not include requirements for 
beneficiary notification regarding their patient status.

                           REASONS FOR CHANGE

    The Committee believes it is necessary to provide notice to 
beneficiaries regarding their status as either outpatient (or 
any similar status) or inpatient. In order to ensure the 
transparency, it is necessary for hospitals to notify patients 
of their status in order to prevent unanticipated cost sharing 
for services rendered.
    The Committee believes that proper prior notification to 
patients will allow for the transmission of appropriate 
information to increase awareness of cost sharing requirements 
for services rendered. Ultimately, prior notification will 
allow patients to better anticipate their costs, create 
heightened clarity in the Medicare program, and reduce 
uncertainty to hospitals.

                        EXPLANATION OF PROVISION

    The provision would require documentation, as the Secretary 
determines to be appropriate, to be provided to patients 
explaining the status of the patient as an outpatient receiving 
observation services and not as an inpatient of the hospital or 
critical access hospital (CAHs). Further, hospitals and CAHs 
must provide the reasons for such determination in order to 
increase the transparency to patients regarding his/her status 
within the Medicare program.

                             EFFECTIVE DATE

    The provision becomes effective 12 months after the date of 
enactment.

                      III. VOTES OF THE COMMITTEE

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, the following statements are made 
concerning the votes of the Committee on Ways and Means in its 
consideration of the bill, H.R. 876.
    The bill, H.R. 876, to amend title XVII of the Social 
Security Act to require hospitals to provide certain 
notifications to individuals classified by such hospitals under 
observation status rather than admitted as inpatients of such 
hospitals was ordered favorably reported with an amendment in 
the nature of a substitute to the House of Representatives by 
voice vote (with a quorum present).

                          VOTES ON AMENDMENTS

    The amendment in the nature of a substitute was agreed to 
favorably by voice vote.

                     IV. BUDGET EFFECTS OF THE BILL


               A. Committee Estimate of Budgetary Effects

    In compliance with clause 3(d) of rule XIII of the Rules of 
the House of Representatives, the following statement is made 
concerning the effects on the budget of the revenue provisions 
of the bill, H.R. 876 as reported: The Committee agrees with 
the estimates prepared by the Congressional Budget Office 
(CBO), which are included below.

B. Statement Regarding New Budget Authority and Tax Expenditures Budget 
                               Authority

    The bill as reported is in compliance with clause 3(c)(2) 
of rule XIII of the Rules of the House of Representatives. 
Further, the bill involves no new or increased tax expenditures 
and no new budget authority.

      C. Cost Estimate Prepared by the Congressional Budget Office

    In compliance with clause 3(c)(3) of rule XIII of the Rules 
of the House of Representatives, requiring a cost estimate 
prepared by the CBO, the following statement by CBO is 
provided.

                                     U.S. Congress,
                               Congressional Budget Office,
                                    Washington, DC, March 11, 2015.
Hon. Paul Ryan,
Chairman, Committee on Ways and Means,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 876, the Notice of 
Observation Treatment and Implication for Care Eligibility Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Erica Socker.
            Sincerely,
                                              Douglas W. Elmendorf.
    Enclosure.

H.R. 876--Notice of Observation Treatment and Implication for Care 
        Eligibility Act

    H.R. 876 would require hospitals to notify Medicare 
beneficiaries receiving observation services for more than 24 
hours of their status as an outpatient under observation. The 
written notification must explain that, because the beneficiary 
is receiving outpatient--rather than inpatient--services:
           The beneficiary will be subject to cost-
        sharing requirements that apply to outpatient services, 
        and
           The beneficiary's outpatient stay will not 
        count toward the three-day inpatient stay required for 
        a beneficiary to be eligible for Medicare coverage of 
        subsequent skilled nursing facility services.
    Enacting H.R. 876 could affect direct spending; therefore, 
pay-as-you-go procedures apply. However, CBO estimates that the 
bill would not have significant budgetary effects over the 
2015-2025 period.
    H.R. 876 contains no intergovernmental mandates as defined 
in the Unfunded Mandates Reform Act and would not affect the 
budgets of state, local, or tribal governments.
    The CBO staff contact for this estimate is Erica Socker. 
The estimate was approved by Holly Harvey, Deputy Assistant 
Director for Budget Analysis.

   V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE OF 
                            REPRESENTATIVES


          A. Committee Oversight Findings and Recommendations

    With respect to clause 3(c)(1) of rule XIII of the Rules of 
the House of Representatives (relating to oversight findings), 
the Committee concluded that it was appropriate and timely to 
enact the sections included in the bill, as reported.
    On May 20, 2014, the Subcommittee on Health held a hearing 
on current hospital issues in the Medicare program. During this 
hearing, the Subcommittee heard testimony from experts on the 
classification of patients as inpatient or outpatient and the 
resulting implication of patient cost sharing.
    The Committee believes this legislation is necessary to 
ensure that patients are made aware of their status as 
outpatients (or any similar status) or as inpatients. This 
legislation is needed to ensure that patients are aware of 
their status in order to properly inform his/her cost-sharing 
status with regard to such classification.

        B. Statement of General Performance Goals and Objectives

    With respect to clause 3(c)(4) of rule XIII of the Rules of 
the House of Representatives, the Committee advises that the 
bill contains no measure that authorizes new or additional 
funding compared with the current law baseline, so no statement 
of general performance goals and objectives for which any 
measure authorizes funding is required.

               C. Duplication of Federal Programs

    In compliance with Sec. 3(g)(2) of H. Res. 5 (114th 
Congress), the Committee states that no provision of the bill 
establishes or reauthorizes: (1) a program of the Federal 
Government known to be duplicative of another Federal program, 
(2) a program included in any report from the Government 
Accountability Office to Congress pursuant to section 21 of 
Public Law 111-139, or (3) a program related to a program 
identified in the most recent Catalog of Federal Domestic 
Assistance, published pursuant to the Federal Program 
Information Act (Public Law 95-220, as amended by Public Law 
98-169).

                 D. Disclosure of Directed Rule Makings

    In compliance with Sec. 3(i) of H. Res. 5 (114th Congress), 
the Committee estimates that H.R. 876 specifically directs the 
Secretary to complete rule-making on the change requiring 
changes in CMS policy regarding the notice to patients.

              E. Information Relating to Unfunded Mandates

    This information is provided in accordance with section 423 
of the Unfunded Mandates Act of 1995 (Pub. L. No. 104-4).
    The bill does not impose a Federal mandate on the private 
sector. H.R. 876 does not impose a Federal intergovernmental 
mandate on State, local, or tribal governments.

  F. Congressional Earmarks, Limited Tax Benefits, and Limited Tariff 
                                Benefits

    With respect to clause 9 of rule XXI of the Rules of the 
House of Representatives, the Committee has carefully reviewed 
the provisions of the bill, and states that the provisions of 
the bill do not contain any congressional earmarks, limited tax 
benefits, or limited tariff benefits within the meaning of the 
rule.

       VI. Changes in Existing Law Made by the Bill, as Reported

    With respect to clause 3(e) of rule XIII of the rules of 
the House of Representatives, H.R. 876 makes the following 
changes to current law.

       Changes in Existing Law Proposed by the Bill, as Reported

  In compliance with clause 3(e)(1)(B) of rule XIII of the 
Rules of the House of Representatives, changes in existing law 
proposed by the bill, as reported, are shown as follows (new 
matter is printed in italic and existing law in which no change 
is proposed is shown in roman):

                          SOCIAL SECURITY ACT




           *       *       *       *       *       *       *
TITLE XVIII--HEALTH INSURANCE FOR THE AGED AND DISABLED

           *       *       *       *       *       *       *



Part E--Miscellaneous Provisions

           *       *       *       *       *       *       *



      agreements with providers of services; enrollment processes

  Sec. 1866. (a)(1) Any provider of services (except a fund 
designated for purposes of section 1814(g) and section 1835(e)) 
shall be qualified to participate under this title and shall be 
eligible for payments under this title if it files with the 
Secretary an agreement--
          (A)(i) not to charge, except as provided in paragraph 
        (2), any individual or any other person for items or 
        services for which such individual is entitled to have 
        payment made under this title (or for which he would be 
        so entitled if such provider of services had complied 
        with the procedural and other requirements under or 
        pursuant to this title or for which such provider is 
        paid pursuant to the provisions of section 1814(e)), 
        and (ii) not to impose any charge that is prohibited 
        under section 1902(n)(3),
          (B) not to charge any individual or any other person 
        for items or services for which such individual is not 
        entitled to have payment made under this title because 
        payment for expenses incurred for such items or 
        services may not be made by reason of the provisions of 
        paragraph (1) or (9) of section 1862(a), but only if 
        (i) such individual was without fault in incurring such 
        expenses and (ii) the Secretary's determination that 
        such payment may not be made for such items and 
        services was made after the third year following the 
        year in which notice of such payment was sent to such 
        individual; except that the Secretary may reduce such 
        three-year period to not less than one year if he finds 
        such reduction is consistent with the objectives of 
        this title,
          (C) to make adequate provision for return (or other 
        disposition, in accordance with regulations) of any 
        moneys incorrectly collected from such individual or 
        other person,
          (D) to promptly notify the Secretary of its 
        employment of an individual who, at any time during the 
        year preceding such employment, was employed in a 
        managerial, accounting, auditing, or similar capacity 
        (as determined by the Secretary by regulation) by an 
        agency or organization which serves as a fiscal 
        intermediary or carrier (for purposes of part A or part 
        B, or both, of this title) with respect to the 
        provider,
          (E) to release data with respect to patients of such 
        provider upon request to an organization having a 
        contract with the Secretary under part B of title XI as 
        may be necessary (i) to allow such organization to 
        carry out its functions under such contract, or (ii) to 
        allow such organization to carry out similar review 
        functions under any contract the organization may have 
        with a private or public agency paying for health care 
        in the same area with respect to patients who authorize 
        release of such data for such purposes,
          (F)(i) in the case of hospitals which provide 
        inpatient hospital services for which payment may be 
        made under subsection (b), (c), or (d) of section 1886, 
        to maintain an agreement with a professional standards 
        review organization (if there is such an organization 
        in existence in the area in which the hospital is 
        located) or with a quality improvement organization 
        which has a contract with the Secretary under part B of 
        title XI for the area in which the hospital is located, 
        under which the organization will perform functions 
        under that part with respect to the review of the 
        validity of diagnostic information provided by such 
        hospital, the completeness, adequacy, and quality of 
        care provided, the appropriateness of admissions and 
        discharges, and the appropriateness of care provided 
        for which additional payments are sought under section 
        1886(d)(5), with respect to inpatient hospital services 
        for which payment may be made under part A of this 
        title (and for purposes of payment under this title, 
        the cost of such agreement to the hospital shall be 
        considered a cost incurred by such hospital in 
        providing inpatient services under part A, and (I) 
        shall be paid directly by the Secretary to such 
        organization on behalf of such hospital in accordance 
        with a rate per review established by the Secretary, 
        (II) shall be transferred from the Federal Hospital 
        Insurance Trust Fund, without regard to amounts 
        appropriated in advance in appropriation Acts, in the 
        same manner as transfers are made for payment for 
        services provided directly to beneficiaries, and (III) 
        shall not be less in the aggregate for a fiscal year 
        than the aggregate amount expended in fiscal year 1988 
        for direct and administrative costs (adjusted for 
        inflation and for any direct or administrative costs 
        incurred as a result of review functions added with 
        respect to a subsequent fiscal year) of such reviews),
          (ii) in the case of hospitals, critical access 
        hospitals, skilled nursing facilities, and home health 
        agencies, to maintain an agreement with a quality 
        improvement organization (which has a contract with the 
        Secretary under part B of title XI for the area in 
        which the hospital, facility, or agency is located) to 
        perform the functions described in paragraph (3)(A),
          (G) in the case of hospitals which provide inpatient 
        hospital services for which payment may be made under 
        subsection (b) or (d) of section 1886, not to charge 
        any individual or any other person for inpatient 
        hospital services for which such individual would be 
        entitled to have payment made under part A but for a 
        denial or reduction of payments under section 
        1886(f)(2),
          (H)(i) in the case of hospitals which provide 
        services for which payment may be made under this title 
        and in the case of critical access hospitals which 
        provide critical access hospital services, to have all 
        items and services (other than physicians' services as 
        defined in regulations for purposes of section 
        1862(a)(14), and other than services described by 
        section 1861(s)(2)(K), certified nurse-midwife 
        services, qualified psychologist services, and services 
        of a certified registered nurse anesthetist) (I) that 
        are furnished to an individual who is a patient of the 
        hospital, and (II) for which the individual is entitled 
        to have payment made under this title, furnished by the 
        hospital or otherwise under arrangements (as defined in 
        section 1861(w)(1)) made by the hospital,
          (ii) in the case of skilled nursing facilities which 
        provide covered skilled nursing facility services--
                  (I) that are furnished to an individual who 
                is a resident of the skilled nursing facility 
                during a period in which the resident is 
                provided covered post-hospital extended care 
                services (or, for services described in section 
                1861(s)(2)(D), that are furnished to such an 
                individual without regard to such period), and
                  (II) for which the individual is entitled to 
                have payment made under this title,
        to have items and services (other than services 
        described in section 1888(e)(2)(A)(ii)) furnished by 
        the skilled nursing facility or otherwise under 
        arrangements (as defined in section 1861(w)(1)) made by 
        the skilled nursing facility,
          (I) in the case of a hospital or critical access 
        hospital--
                  (i) to adopt and enforce a policy to ensure 
                compliance with the requirements of section 
                1867 and to meet the requirements of such 
                section,
                  (ii) to maintain medical and other records 
                related to individuals transferred to or from 
                the hospital for a period of five years from 
                the date of the transfer, and
                  (iii) to maintain a list of physicians who 
                are on call for duty after the initial 
                examination to provide treatment necessary to 
                stabilize an individual with an emergency 
                medical condition,
          (J) in the case of hospitals which provide inpatient 
        hospital services for which payment may be made under 
        this title, to be a participating provider of medical 
        care under any health plan contracted for under section 
        1079 or 1086 of title 10, or under section 613 of title 
        38, United States Code, in accordance with admission 
        practices, payment methodology, and amounts as 
        prescribed under joint regulations issued by the 
        Secretary and by the Secretaries of Defense and 
        Transportation, in implementation of sections 1079 and 
        1086 of title 10, United States Code,
          (K) not to charge any individual or any other person 
        for items or services for which payment under this 
        title is denied under section 1154(a)(2) by reason of a 
        determination under section 1154(a)(1)(B),
          (L) in the case of hospitals which provide inpatient 
        hospital services for which payment may be made under 
        this title, to be a participating provider of medical 
        care under section 603 of title 38, United States Code, 
        in accordance with such admission practices, and such 
        payment methodology and amounts, as are prescribed 
        under joint regulations issued by the Secretary and by 
        the Secretary of Veterans Affairs in implementation of 
        such section,
          (M) in the case of hospitals, to provide to each 
        individual who is entitled to benefits under part A (or 
        to a person acting on the individual's behalf), at or 
        about the time of the individual's admission as an 
        inpatient to the hospital, a written statement 
        (containing such language as the Secretary prescribes 
        consistent with this paragraph) which explains--
                  (i) the individual's rights to benefits for 
                inpatient hospital services and for post-
                hospital services under this title,
                  (ii) the circumstances under which such an 
                individual will and will not be liable for 
                charges for continued stay in the hospital,
                  (iii) the individual's right to appeal 
                denials of benefits for continued inpatient 
                hospital services, including the practical 
                steps to initiate such an appeal, and
                  (iv) the individual's liability for payment 
                for services if such a denial of benefits is 
                upheld on appeal,--and which provides such 
                additional information as the Secretary may 
                specify,
          (N) in the case of hospitals and critical access 
        hospitals--
                  (i) to make available to its patients the 
                directory or directories of participating 
                physicians (published under section 1842(h)(4)) 
                for the area served by the hospital or critical 
                access hospital,
                  (ii) if hospital personnel (including staff 
                of any emergency or outpatient department) 
                refer a patient to a nonparticipating physician 
                for further medical care on an outpatient 
                basis, the personnel must inform the patient 
                that the physician is a nonparticipating 
                physician and, whenever practicable, must 
                identify at least one qualified participating 
                physician who is listed in such a directory and 
                from whom the patient may receive the necessary 
                services,
                  (iii) to post conspicuously in any emergency 
                department a sign (in a form specified by the 
                Secretary) specifying rights of individuals 
                under section 1867 with respect to examination 
                and treatment for emergency medical conditions 
                and women in labor, and
                  (iv) to post conspicuously (in a form 
                specified by the Secretary) information 
                indicating whether or not the hospital 
                participates in the medicaid program under a 
                State plan approved under title XIX,
          (O) to accept as payment in full for services that 
        are covered under this title and are furnished to any 
        individual enrolled with a Medicare+Choice organization 
        under part C, with a PACE provider under section 1894 
        or 1934, or with an eligible organization with a risk-
        sharing contract under section 1876, under section 
        1876(i)(2)(A) (as in effect before February 1, 1985), 
        under section 402(a) of the Social Security Amendments 
        of 1967, or under section 222(a) of the Social Security 
        Amendments of 1972, which does not have a contract (or, 
        in the case of a PACE provider, contract or other 
        agreement) establishing payment amounts for services 
        furnished to members of the organization or PACE 
        program eligible individuals enrolled with the PACE 
        provider, the amounts that would be made as a payment 
        in full under this title (less any payments under 
        sections 1886(d)(11) and 1886(h)(3)(D)) if the 
        individuals were not so enrolled,
          (P) in the case of home health agencies which provide 
        home health services to individuals entitled to 
        benefits under this title who require catheters, 
        catheter supplies, ostomy bags, and supplies related to 
        ostomy car (described in section 1861(m)(5)), to offer 
        to furnish such supplies to such an individual as part 
        of their furnishing of home health services,
          (Q) in the case of hospitals, skilled nursing 
        facilities, home health agencies, and hospice programs, 
        to comply with the requirement of subsection (f) 
        (relating to maintaining written policies and 
        procedures respecting advance directives),
          (R) to contract only with a health care clearinghouse 
        (as defined in section 1171) that meets each standard 
        and implementation specification adopted or established 
        under part C of title XI on or after the date on which 
        the health care clearinghouse is required to comply 
        with the standard or specification,
          (S) in the case of a hospital that has a financial 
        interest (as specified by the Secretary in regulations) 
        in an entity to which individuals are referred as 
        described in section 1861(ee)(2)(H)(ii), or in which 
        such an entity has such a financial interest, or in 
        which another entity has such a financial interest 
        (directly or indirectly) with such hospital and such an 
        entity, to maintain and disclose to the Secretary (in a 
        form and manner specified by the Secretary) information 
        on--
                  (i) the nature of such financial interest,
                  (ii) the number of individuals who were 
                discharged from the hospital and who were 
                identified as requiring home health services, 
                and
                  (iii) the percentage of such individuals who 
                received such services from such provider (or 
                another such provider),
          (T) in the case of hospitals and critical access 
        hospitals, to furnish to the Secretary such data as the 
        Secretary determines appropriate pursuant to 
        subparagraph (E) of section 1886(d)(12) to carry out 
        such section,
          (U) in the case of hospitals which furnish inpatient 
        hospital services for which payment may be made under 
        this title, to be a participating provider of medical 
        care both--
                  (i) under the contract health services 
                program funded by the Indian Health Service and 
                operated by the Indian Health Service, an 
                Indian tribe, or tribal organization (as those 
                terms are defined in section 4 of the Indian 
                Health Care Improvement Act), with respect to 
                items and services that are covered under such 
                program and furnished to an individual eligible 
                for such items and services under such program; 
                and
                  (ii) under any program funded by the Indian 
                Health Service and operated by an urban Indian 
                organization with respect to the purchase of 
                items and services for an eligible urban Indian 
                (as those terms are defined in such section 4),
        in accordance with regulations promulgated by the 
        Secretary regarding admission practices, payment 
        methodology, and rates of payment (including the 
        acceptance of no more than such payment rate as payment 
        in full for such items and services,
          (V) in the case of hospitals that are not otherwise 
        subject to the Occupational Safety and Health Act of 
        1970 (or a State occupational safety and health plan 
        that is approved under 18(b) of such Act), to comply 
        with the Bloodborne Pathogens standard under section 
        1910.1030 of title 29 of the Code of Federal 
        Regulations (or as subsequently redesignated), [and]
                  (W) in the case of a hospital described in 
                section 1886(d)(1)(B)(v), to report quality 
                data to the Secretary in accordance with 
                subsection (k)[.],
                  [(W)] (X) maintain and, upon request of the 
                Secretary, provide access to documentation 
                relating to written orders or requests for 
                payment for durable medical equipment, 
                certifications for home health services, or 
                referrals for other items or services written 
                or ordered by the provider under this title, as 
                specified by the Secretary[.], and
          (Y) beginning 12 months after the date of the 
        enactment of this subparagraph, in the case of a 
        hospital or critical access hospital, with respect to 
        each individual who receives observation services as an 
        outpatient at such hospital or critical access hospital 
        for more than 24 hours, to provide to such individual 
        not later than 36 hours after the time such individual 
        begins receiving such services (or, if sooner, upon 
        release)--
                  (i) such oral explanation of the written 
                notification described in clause (ii), and such 
                documentation of the provision of such 
                explanation, as the Secretary determines to be 
                appropriate;
                  (ii) a written notification (as specified by 
                the Secretary pursuant to rulemaking and 
                containing such language as the Secretary 
                prescribes consistent with this paragraph) 
                which--
                          (I) explains the status of the 
                        individual as an outpatient receiving 
                        observation services and not as an 
                        inpatient of the hospital or critical 
                        access hospital and the reasons for 
                        such status of such individual;
                          (II) explains the implications of 
                        such status on services furnished by 
                        the hospital or critical access 
                        hospital (including services furnished 
                        on an inpatient basis), such as 
                        implications for cost-sharing 
                        requirements under this title and for 
                        subsequent eligibility for coverage 
                        under this title for services furnished 
                        by a skilled nursing facility;
                          (III) includes such additional 
                        information as the Secretary determines 
                        appropriate;
                          (IV) either--
                                  (aa) is signed by such 
                                individual or a person acting 
                                on such individual's behalf to 
                                acknowledge receipt of such 
                                notification; or
                                  (bb) if such individual or 
                                person refuses to provide the 
                                signature described in item 
                                (aa), is signed by the staff 
                                member of the hospital or 
                                critical access hospital who 
                                presented the written 
                                notification and includes the 
                                name and title of such staff 
                                member, a certification that 
                                the notification was presented, 
                                and the date and time the 
                                notification was presented; and
                          (V) is written and formatted using 
                        plain language and is made available in 
                        appropriate languages as determined by 
                        the Secretary.
In the case of a hospital which has an agreement in effect with 
an organization described in subparagraph (F), which 
organization's contract with the Secretary under part B of 
title XI is terminated on or after October 1, 1984, the 
hospital shall not be determined to be out of compliance with 
the requirement of such subparagraph during the six month 
period beginning on the date of the termination of that 
contract.
  (2)(A) A provider of services may charge such individual or 
other person (i) the amount of any deduction or coinsurance 
amount imposed pursuant to section 1813(a)(1), (a)(3), or 
(a)(4), section 1833(b), or section 1861(y)(3) with respect to 
such items and services (not in excess of the amount 
customarily charged for such items and services by such 
provider), and (ii) an amount equal to 20 per centum of the 
reasonable charges for such items and services (not in excess 
of 20 per centum of the amount customarily charged for such 
items and services by such provider) for which payment is made 
under part B or which are durable medical equipment furnished 
as home health services (but in the case of items and services 
furnished to individuals with end-stage renal disease, an 
amount equal to 20 percent of the estimated amounts for such 
items and services calculated on the basis established by the 
Secretary). In the case of items and services described in 
section 1833(c), clause (ii) of the preceding sentence shall be 
applied by substituting for 20 percent the proportion which is 
appropriate under such section. A provider of services may not 
impose a charge under clause (ii) of the first sentence of this 
subparagraph with respect to items and services described in 
section 1861(s)(10)(A) and with respect to clinical diagnostic 
laboratory tests for which payment is made under part B. 
Notwithstanding the first sentence of this subparagraph, a home 
health agency may charge such an individual or person, with 
respect to covered items subject to payment under section 
1834(a), the amount of any deduction imposed under section 
1833(b) and 20 percent of the payment basis described in 
section 1834(a)(1)(B). In the case of items and services for 
which payment is made under part B under the prospective 
payment system established under section 1833(t), clause (ii) 
of the first sentence shall be applied by substituting for 20 
percent of the reasonable charge, the applicable copayment 
amount established under section 1833(t)(5). In the case of 
services described in section 1833(a)(8) or section 1833(a)(9) 
for which payment is made under part B under section 1834(k), 
clause (ii) of the first sentence shall be applied by 
substituting for 20 percent of the reasonable charge for such 
services 20 percent of the lesser of the actual charge or the 
applicable fee schedule amount (as defined in such section) for 
such services.
  (B) Where a provider of services has furnished, at the 
request of such individual, items or services which are in 
excess of or more expensive than the items or services with 
respect to which payment may be made under this title, such 
provider of services may also charge such individual or other 
person for such more expensive items or services to the extent 
that the amount customarily charged by it for the items or 
services furnished at such request exceeds the amount 
customarily charged by it for the items or services with 
respect to which payment may be made under this title.
  (C) A provider of services may in accordance with its 
customary practice also appropriately charge any such 
individual for any whole blood (or equivalent quantities of 
packed red blood cells, as defined under regulations) furnished 
him with respect to which a deductible is imposed under section 
1813(a)(2), except that (i) any excess of such charge over the 
cost to such provider for the blood (or equivalent quantities 
of packed red blood cells, as so defined) shall be deducted 
from any payment to such provider under this title, (ii) no 
such charge may be imposed for the cost of administration of 
such blood (or equivalent quantities of packed red blood cells, 
as so defined), and (iii) such charge may not be made to the 
extent such blood (or equivalent quantities of packed red blood 
cells, as so defined) has been replaced on behalf of such 
individual or arrangements have been made for its replacement 
on his behalf. For purposes of subparagraph (C), whole blood 
(or equivalent quantities of packed red blood cells, as so 
defined) furnished an individual shall be deemed replaced when 
the provider of services is given one pint of blood for each 
pint of blood (or equivalent quantities of packed red blood 
cells, as so defined) furnished such individual with respect to 
which a deduction is imposed under section 1813(a)(2).
  (D) Where a provider of services customarily furnishes items 
or services which are in excess of or more expensive than the 
items or services with respect to which payment may be made 
under this title, such provider, notwithstanding the preceding 
provisions of this paragraph, may not, under the authority of 
section 1866(a)(2)(B)(ii), charge any individual or other 
person any amount for such items or services in excess of the 
amount of the payment which may otherwise be made for such 
items or services under this title if the admitting physician 
has a direct or indirect financial interest in such provider.
  (3)(A) Under the agreement required under paragraph 
(1)(F)(ii), the quality improvement organization must perform 
functions (other than those covered under an agreement under 
paragraph (1)(F)(i)) under the third sentence of section 
1154(a)(4)(A) and under section 1154(a)(14) with respect to 
services, furnished by the hospital, critical access hospital, 
facility, or agency involved, for which payment may be made 
under this title.
  (B) For purposes of payment under this title, the cost of 
such an agreement to the hospital, critical access hospital, 
facility, or agency shall be considered a cost incurred by such 
hospital, critical access hospital, facility, or agency in 
providing covered services under this title and shall be paid 
directly by the Secretary to the quality improvement 
organization on behalf of such hospital, critical access 
hospital, facility, or agency in accordance with a schedule 
established by the Secretary.
  (C) Such payments--
          (i) shall be transferred in appropriate proportions 
        from the Federal Hospital Insurance Trust Fund and from 
        the Federal Supplementary Medical Insurance Trust Fund, 
        without regard to amounts appropriated in advance in 
        appropriation Acts, in the same manner as transfers are 
        made for payment for services provided directly to 
        beneficiaries, and
          (ii) shall not be less in the aggregate for a fiscal 
        year--
                  (I) in the case of hospitals, than the amount 
                specified in paragraph (1)(F)(i)(III), and
                  (II) in the case of facilities, critical 
                access hospitals, and agencies, than the 
                amounts the Secretary determines to be 
                sufficient to cover the costs of such 
                organizations' conducting the activities 
                described in subparagraph (A) with respect to 
                such facilities, critical access hospitals, or 
                agencies under part B of title XI.
  (b)(1) A provider of services may terminate an agreement with 
the Secretary under this section at such time and upon such 
notice to the Secretary and the public as may be provided in 
regulations, except that notice of more than six months shall 
not be required.
  (2) The Secretary may refuse to enter into an agreement under 
this section or, upon such reasonable notice to the provider 
and the public as may be specified in regulations, may refuse 
to renew or may terminate such an agreement after the 
Secretary--
          (A) has determined that the provider fails to comply 
        substantially with the provisions of the agreement, 
        with the provisions of this title and regulations 
        thereunder, or with a corrective action required under 
        section 1886(f)(2)(B),
          (B) has determined that the provider fails 
        substantially to meet the applicable provisions of 
        section 1861,
          (C) has excluded the provider from participation in a 
        program under this title pursuant to section 1128 or 
        section 1128A, or
          (D) has ascertained that the provider has been 
        convicted of a felony under Federal or State law for an 
        offense which the Secretary determines is detrimental 
        to the best interests of the program or program 
        beneficiaries.
  (3) A termination of an agreement or a refusal to renew an 
agreement under this subsection shall become effective on the 
same date and in the same manner as an exclusion from 
participation under the programs under this title becomes 
effective under section 1128(c).
  (4)(A) A hospital that fails to comply with the requirement 
of subsection (a)(1)(V) (relating to the Bloodborne Pathogens 
standard) is subject to a civil money penalty in an amount 
described in subparagraph (B), but is not subject to 
termination of an agreement under this section.
  (B) The amount referred to in subparagraph (A) is an amount 
that is similar to the amount of civil penalties that may be 
imposed under section 17 of the Occupational Safety and Health 
Act of 1970 for a violation of the Bloodborne Pathogens 
standard referred to in subsection (a)(1)(U) by a hospital that 
is subject to the provisions of such Act.
  (C) A civil money penalty under this paragraph shall be 
imposed and collected in the same manner as civil money 
penalties under subsection (a) of section 1128A are imposed and 
collected under that section.
  (c)(1) Where the Secretary has terminated or has refused to 
renew an agreement under this title with a provider of 
services, such provider may not file another agreement under 
this title unless the Secretary finds that the reason for the 
termination or nonrenewal has been removed and that there is 
reasonable assurance that it will not recur.
  (2) Where the Secretary has terminated or has refused to 
renew an agreement under this title with a provider of 
services, the Secretary shall promptly notify each State agency 
which administers or supervises the administration of a State 
plan approved under title XIX of such termination or 
nonrenewal.
  (d) If the Secretary finds that there is a substantial 
failure to make timely review in accordance with section 
1861(k) of long-stay cases in a hospital, he may, in lieu of 
terminating his agreement with such hospital, decide that, with 
respect to any individual admitted to such hospital after a 
subsequent date specified by him, no payment shall be made 
under this title for inpatient hospital services (including 
inpatient psychiatric hospital services) after the 20th day of 
a continuous period of such services. Such decision may be made 
effective only after such notice to the hospital and to the 
public, as may be prescribed by regulations, and its 
effectiveness shall terminate when the Secretary finds that the 
reason therefor has been removed and that there is reasonable 
assurance that it will not recur. The Secretary shall not make 
any such decision except after reasonable notice and 
opportunity for hearing to the institution or agency affected 
thereby.
  (e) For purposes of this section, the term ``provider of 
services'' shall include--
          (1) a clinic, rehabilitation agency, or public health 
        agency if, in the case of a clinic or rehabilitation 
        agency, such clinic or agency meets the requirements of 
        section 1861(p)(4)(A) (or meets the requirements of 
        such section through the operation of subsection (g) or 
        (ll)(2) of section 1861), or if, in the case of a 
        public health agency, such agency meets the 
        requirements of section 1861(p)(4)(B) (or meets the 
        requirements of such section through the operation of 
        subsection (g) or (ll)(2) of section 1861), but only 
        with respect to the furnishing of outpatient physical 
        therapy services (as therein defined), (through the 
        operation of section 1861(g)) with respect to the 
        furnishing of outpatient occupational therapy services, 
        or (through the operation of section 1861(ll)(2)) with 
        respect to the furnishing of outpatient speech-language 
        pathology; and
          (2) a community mental health center (as defined in 
        section 1861(ff)(3)(B)), but only with respect to the 
        furnishing of partial hospitalization services (as 
        described in section 1861(ff)(1)).
  (f)(1) For purposes of subsection (a)(1)(Q) and sections 
1819(c)(2)(E), 1833(s), 1855(i), 1876(c)(8), and 1891(a)(6), 
the requirement of this subsection is that a provider of 
services, Medicare+Choice organization, or prepaid or eligible 
organization (as the case may be) maintain written policies and 
procedures with respect to all adult individuals receiving 
medical care by or through the provider or organization--
          (A) to provide written information to each such 
        individual concerning--
                  (i) an individual's rights under State law 
                (whether statutory or as recognized by the 
                courts of the State) to make decisions 
                concerning such medical care, including the 
                right to accept or refuse medical or surgical 
                treatment and the right to formulate advance 
                directives (as defined in paragraph (3)), and
                  (ii) the written policies of the provider or 
                organization respecting the implementation of 
                such rights;
          (B) to document in a prominent part of the 
        individual's current medical record whether or not the 
        individual has executed an advance directive;
          (C) not to condition the provision of care or 
        otherwise discriminate against an individual based on 
        whether or not the individual has executed an advance 
        directive;
          (D) to ensure compliance with requirements of State 
        law (whether statutory or as recognized by the courts 
        of the State) respecting advance directives at 
        facilities of the provider or organization; and
          (E) to provide (individually or with others) for 
        education for staff and the community on issues 
        concerning advance directives.
Subparagraph (C) shall not be construed as requiring the 
provision of care which conflicts with an advance directive.
  (2) The written information described in paragraph (1)(A) 
shall be provided to an adult individual--
          (A) in the case of a hospital, at the time of the 
        individual's admission as an inpatient,
          (B) in the case of a skilled nursing facility, at the 
        time of the individual's admission as a resident,
          (C) in the case of a home health agency, in advance 
        of the individual coming under the care of the agency,
          (D) in the case of a hospice program, at the time of 
        initial receipt of hospice care by the individual from 
        the program, and
          (E) in the case of an eligible organization (as 
        defined in section 1876(b)) or an organization provided 
        payments under section 1833(a)(1)(A) or a 
        Medicare+Choice organization, at the time of enrollment 
        of the individual with the organization.
  (3) In this subsection, the term ``advance directive'' means 
a written instruction, such as a living will or durable power 
of attorney for health care, recognized under State law 
(whether statutory or as recognized by the courts of the State) 
and relating to the provision of such care when the individual 
is incapacitated.
  (4) For construction relating to this subsection, see section 
7 of the Assisted Suicide Funding Restriction Act of 1997 
(relating to clarification respecting assisted suicide, 
euthanasia, and mercy killing).
  (g) Except as permitted under subsection (a)(2), any person 
who knowingly and willfully presents, or causes to be 
presented, a bill or request for payment inconsistent with an 
arrangement under subsection (a)(1)(H) or in violation of the 
requirement for such an arrangement, is subject to a civil 
money penalty of not to exceed $2,000. The provisions of 
section 1128A (other than subsections (a) and (b)) shall apply 
to a civil money penalty under the previous sentence in the 
same manner as such provisions apply to a penalty or proceeding 
under section 1128A(a).
  (h)(1)(A) Except as provided in paragraph (2), an institution 
or agency dissatisfied with a determination by the Secretary 
that it is not a provider of services or with a determination 
described in subsection (b)(2) shall be entitled to a hearing 
thereon by the Secretary (after reasonable notice) to the same 
extent as is provided in section 205(b), and to judicial review 
of the Secretary's final decision after such hearing as is 
provided in section 205(g), except that, in so applying such 
sections and in applying section 205(l) thereto, any reference 
therein to the Commissioner of Social Security or the Social 
Security Administration shall be considered a reference to the 
Secretary or the Department of Health and Human Services, 
respectively.
  (B) An institution or agency described in subparagraph (A) 
that has filed for a hearing under subparagraph (A) shall have 
expedited access to judicial review under this subparagraph in 
the same manner as providers of services, suppliers, and 
individuals entitled to benefits under part A or enrolled under 
part B, or both, may obtain expedited access to judicial review 
under the process established under section 1869(b)(2). Nothing 
in this subparagraph shall be construed to affect the 
application of any remedy imposed under section 1819 during the 
pendency of an appeal under this subparagraph.
  (C)(i) The Secretary shall develop and implement a process to 
expedite proceedings under this subsection in which--
          (I) the remedy of termination of participation has 
        been imposed;
          (II) a remedy described in clause (i) or (iii) of 
        section 1819(h)(2)(B) has been imposed, but only if 
        such remedy has been imposed on an immediate basis; or
          (III) a determination has been made as to a finding 
        of substandard quality of care that results in the loss 
        of approval of a skilled nursing facility's nurse aide 
        training program.
  (ii) Under such process under clause (i), priority shall be 
provided in cases of termination described in clause (i)(I).
  (iii) Nothing in this subparagraph shall be construed to 
affect the application of any remedy imposed under section 1819 
during the pendency of an appeal under this subparagraph.
  (2) An institution or agency is not entitled to separate 
notice and opportunity for a hearing under both section 1128 
and this section with respect to a determination or 
determinations based on the same underlying facts and issues.
  (i)(1) If the Secretary determines that a psychiatric 
hospital which has an agreement in effect under this section no 
longer meets the requirements for a psychiatric hospital under 
this title and further finds that the hospital's deficiencies--
          (A) immediately jeopardize the health and safety of 
        its patients, the Secretary shall terminate such 
        agreement; or
          (B) do not immediately jeopardize the health and 
        safety of its patients, the Secretary may terminate 
        such agreement, or provide that no payment will be made 
        under this title with respect to any individual 
        admitted to such hospital after the effective date of 
        the finding, or both.
  (2) If a psychiatric hospital, found to have deficiencies 
described in paragraph (1)(B), has not complied with the 
requirements of this title--
          (A) within 3 months after the date the hospital is 
        found to be out of compliance with such requirements, 
        the Secretary shall provide that no payment will be 
        made under this title with respect to any individual 
        admitted to such hospital after the end of such 3-month 
        period, or
          (B) within 6 months after the date the hospital is 
        found to be out of compliance with such requirements, 
        no payment may be made under this title with respect to 
        any individual in the hospital until the Secretary 
        finds that the hospital is in compliance with the 
        requirements of this title.
  (j) Enrollment Process for Providers of Services and 
Suppliers.--
          (1) Enrollment process.--
                  (A) In general.--The Secretary shall 
                establish by regulation a process for the 
                enrollment of providers of services and 
                suppliers under this title. Such process shall 
                include screening of providers and suppliers in 
                accordance with paragraph (2), a provisional 
                period of enhanced oversight in accordance with 
                paragraph (3), disclosure requirements in 
                accordance with paragraph (4), the imposition 
                of temporary enrollment moratoria in accordance 
                with paragraph (5), and the establishment of 
                compliance programs in accordance with 
                paragraph (6).
                  (B) Deadlines.--The Secretary shall establish 
                by regulation procedures under which there are 
                deadlines for actions on applications for 
                enrollment (and, if applicable, renewal of 
                enrollment). The Secretary shall monitor the 
                performance of medicare administrative 
                contractors in meeting the deadlines 
                established under this subparagraph.
                  (C) Consultation before changing provider 
                enrollment forms.--The Secretary shall consult 
                with providers of services and suppliers before 
                making changes in the provider enrollment forms 
                required of such providers and suppliers to be 
                eligible to submit claims for which payment may 
                be made under this title.
          (2) Provider screening.--
                  (A) Procedures.--Not later than 180 days 
                after the date of enactment of this paragraph, 
                the Secretary, in consultation with the 
                Inspector General of the Department of Health 
                and Human Services, shall establish procedures 
                under which screening is conducted with respect 
                to providers of medical or other items or 
                services and suppliers under the program under 
                this title, the Medicaid program under title 
                XIX, and the CHIP program under title XXI.
                  (B) Level of screening.--The Secretary shall 
                determine the level of screening conducted 
                under this paragraph according to the risk of 
                fraud, waste, and abuse, as determined by the 
                Secretary, with respect to the category of 
                provider of medical or other items or services 
                or supplier. Such screening--
                          (i) shall include a licensure check, 
                        which may include such checks across 
                        States; and
                          (ii) may, as the Secretary determines 
                        appropriate based on the risk of fraud, 
                        waste, and abuse described in the 
                        preceding sentence, include--
                                  (I) a criminal background 
                                check;
                                  (II) fingerprinting;
                                  (III) unscheduled and 
                                unannounced site visits, 
                                including preenrollment site 
                                visits;
                                  (IV) database checks 
                                (including such checks across 
                                States); and
                                  (V) such other screening as 
                                the Secretary determines 
                                appropriate.
                  (C) Application fees.--
                          (i) Institutional providers.--Except 
                        as provided in clause (ii), the 
                        Secretary shall impose a fee on each 
                        institutional provider of medical or 
                        other items or services or supplier 
                        (such as a hospital or skilled nursing 
                        facility) with respect to which 
                        screening is conducted under this 
                        paragraph in an amount equal to--
                                  (I) for 2010, $500; and
                                  (II) for 2011 and each 
                                subsequent year, the amount 
                                determined under this clause 
                                for the preceding year, 
                                adjusted by the percentage 
                                change in the consumer price 
                                index for all urban consumers 
                                (all items; United States city 
                                average) for the 12-month 
                                period ending with June of the 
                                previous year.
                          (ii) Hardship exception; waiver for 
                        certain medicaid providers.--The 
                        Secretary may, on a case-by-case basis, 
                        exempt a provider of medical or other 
                        items or services or supplier from the 
                        imposition of an application fee under 
                        this subparagraph if the Secretary 
                        determines that the imposition of the 
                        application fee would result in a 
                        hardship. The Secretary may waive the 
                        application fee under this subparagraph 
                        for providers enrolled in a State 
                        Medicaid program for whom the State 
                        demonstrates that imposition of the fee 
                        would impede beneficiary access to 
                        care.
                          (iii) Use of funds.--Amounts 
                        collected as a result of the imposition 
                        of a fee under this subparagraph shall 
                        be used by the Secretary for program 
                        integrity efforts, including to cover 
                        the costs of conducting screening under 
                        this paragraph and to carry out this 
                        subsection and section 1128J.
                  (D) Application and enforcement.--
                          (i) New providers of services and 
                        suppliers.--The screening under this 
                        paragraph shall apply, in the case of a 
                        provider of medical or other items or 
                        services or supplier who is not 
                        enrolled in the program under this 
                        title, title XIX, or title XXI as of 
                        the date of enactment of this 
                        paragraph, on or after the date that is 
                        1 year after such date of enactment.
                          (ii) Current providers of services 
                        and suppliers.--The screening under 
                        this paragraph shall apply, in the case 
                        of a provider of medical or other items 
                        or services or supplier who is enrolled 
                        in the program under this title, title 
                        XIX, or title XXI as of such date of 
                        enactment, on or after the date that is 
                        2 years after such date of enactment.
                          (iii) Revalidation of enrollment.--
                        Effective beginning on the date that is 
                        180 days after such date of enactment, 
                        the screening under this paragraph 
                        shall apply with respect to the 
                        revalidation of enrollment of a 
                        provider of medical or other items or 
                        services or supplier in the program 
                        under this title, title XIX, or title 
                        XXI.
                          (iv) Limitation on enrollment and 
                        revalidation of enrollment.--In no case 
                        may a provider of medical or other 
                        items or services or supplier who has 
                        not been screened under this paragraph 
                        be initially enrolled or reenrolled in 
                        the program under this title, title 
                        XIX, or title XXI on or after the date 
                        that is 3 years after such date of 
                        enactment.
                  (E) Use of information from the department of 
                treasury concerning tax debts.--In reviewing 
                the application of a provider of services or 
                supplier to enroll or reenroll under the 
                program under this title, the Secretary shall 
                take into account the information supplied by 
                the Secretary of the Treasury pursuant to 
                section 6103(l)(22) of the Internal Revenue 
                Code of 1986, in determining whether to deny 
                such application or to apply enhanced oversight 
                to such provider of services or supplier 
                pursuant to paragraph (3) if the Secretary 
                determines such provider of services or 
                supplier owes such a debt.
                  (F) Expedited rulemaking.--The Secretary may 
                promulgate an interim final rule to carry out 
                this paragraph.
          (3) Provisional period of enhanced oversight for new 
        providers of services and suppliers.--
                  (A) In general.--The Secretary shall 
                establish procedures to provide for a 
                provisional period of not less than 30 days and 
                not more than 1 year during which new providers 
                of medical or other items or services and 
                suppliers, as the Secretary determines 
                appropriate, including categories of providers 
                or suppliers, would be subject to enhanced 
                oversight, such as prepayment review and 
                payment caps, under the program under this 
                title, the Medicaid program under title XIX. 
                and the CHIP program under title XXI.
                  (B) Implementation.--The Secretary may 
                establish by program instruction or otherwise 
                the procedures under this paragraph.
          (4) 90-day period of enhanced oversight for initial 
        claims of dme suppliers.--For periods beginning after 
        January 1, 2011, if the Secretary determines that there 
        is a significant risk of fraudulent activity among 
        suppliers of durable medical equipment, in the case of 
        a supplier of durable medical equipment who is within a 
        category or geographic area under title XVIII 
        identified pursuant to such determination and who is 
        initially enrolling under such title, the Secretary 
        shall, notwithstanding sections 1816(c), 1842(c), and 
        1869(a)(2), withhold payment under such title with 
        respect to durable medical equipment furnished by such 
        supplier during the 90-day period beginning on the date 
        of the first submission of a claim under such title for 
        durable medical equipment furnished by such supplier.
          (5) Increased disclosure requirements.--
                  (A) Disclosure.--A provider of medical or 
                other items or services or supplier who submits 
                an application for enrollment or revalidation 
                of enrollment in the program under this title, 
                title XIX, or title XXI on or after the date 
                that is 1 year after the date of enactment of 
                this paragraph shall disclose (in a form and 
                manner and at such time as determined by the 
                Secretary) any current or previous affiliation 
                (directly or indirectly) with a provider of 
                medical or other items or services or supplier 
                that has uncollected debt, has been or is 
                subject to a payment suspension under a Federal 
                health care program (as defined in section 
                1128B(f)), has been excluded from participation 
                under the program under this title, the 
                Medicaid program under title XIX, or the CHIP 
                program under title XXI, or has had its billing 
                privileges denied or revoked.
                  (B) Authority to deny enrollment.--If the 
                Secretary determines that such previous 
                affiliation poses an undue risk of fraud, 
                waste, or abuse, the Secretary may deny such 
                application. Such a denial shall be subject to 
                appeal in accordance with paragraph (7).
          (6) Authority to adjust payments of providers of 
        services and suppliers with the same tax identification 
        number for medicare obligations.--
                  (A) In general.--Notwithstanding any other 
                provision of this title, in the case of an 
                applicable provider of services or supplier, 
                the Secretary may make any necessary 
                adjustments to payments to the applicable 
                provider of services or supplier under the 
                program under this title in order to satisfy 
                any amount described in subparagraph (B)(ii) 
                due from such obligated provider of services or 
                supplier.
                  (B) Definitions.--In this paragraph:
                          (i) In general.--The term 
                        ``applicable provider of services or 
                        supplier'' means a provider of services 
                        or supplier that has the same taxpayer 
                        identification number assigned under 
                        section 6109 of the Internal Revenue 
                        Code of 1986 as is assigned to the 
                        obligated provider of services or 
                        supplier under such section, regardless 
                        of whether the applicable provider of 
                        services or supplier is assigned a 
                        different billing number or national 
                        provider identification number under 
                        the program under this title than is 
                        assigned to the obligated provider of 
                        services or supplier.
                          (ii) Obligated provider of services 
                        or supplier.--The term ``obligated 
                        provider of services or supplier'' 
                        means a provider of services or 
                        supplier that owes an amount that is 
                        more than the amount required to be 
                        paid under the program under this title 
                        (as determined by the Secretary).
          (7) Temporary moratorium on enrollment of new 
        providers.--
                  (A) In general.--The Secretary may impose a 
                temporary moratorium on the enrollment of new 
                providers of services and suppliers, including 
                categories of providers of services and 
                suppliers, in the program under this title, 
                under the Medicaid program under title XIX, or 
                under the CHIP program under title XXI if the 
                Secretary determines such moratorium is 
                necessary to prevent or combat fraud, waste, or 
                abuse under either such program.
                  (B) Limitation on review.--There shall be no 
                judicial review under section 1869, section 
                1878, or otherwise, of a temporary moratorium 
                imposed under subparagraph (A).
          (8) Compliance programs.--
                  (A) In general.--On or after the date of 
                implementation determined by the Secretary 
                under subparagraph (C), a provider of medical 
                or other items or services or supplier within a 
                particular industry sector or category shall, 
                as a condition of enrollment in the program 
                under this title, title XIX, or title XXI, 
                establish a compliance program that contains 
                the core elements established under 
                subparagraph (B) with respect to that provider 
                or supplier and industry or category.
                  (B) Establishment of core elements.--The 
                Secretary, in consultation with the Inspector 
                General of the Department of Health and Human 
                Services, shall establish core elements for a 
                compliance program under subparagraph (A) for 
                providers or suppliers within a particular 
                industry or category.
                  (C) Timeline for implementation.--The 
                Secretary shall determine the timeline for the 
                establishment of the core elements under 
                subparagraph (B) and the date of the 
                implementation of subparagraph (A) for 
                providers or suppliers within a particular 
                industry or category. The Secretary shall, in 
                determining such date of implementation, 
                consider the extent to which the adoption of 
                compliance programs by a provider of medical or 
                other items or services or supplier is 
                widespread in a particular industry sector or 
                with respect to a particular provider or 
                supplier category.
          (8) Hearing rights in cases of denial or non-
        renewal.--A provider of services or supplier whose 
        application to enroll (or, if applicable, to renew 
        enrollment) under this title is denied may have a 
        hearing and judicial review of such denial under the 
        procedures that apply under subsection (h)(1)(A) to a 
        provider of services that is dissatisfied with a 
        determination by the Secretary.
  (k) Quality Reporting by Cancer Hospitals.--
          (1) In general.--For purposes of fiscal year 2014 and 
        each subsequent fiscal year, a hospital described in 
        section 1886(d)(1)(B)(v) shall submit data to the 
        Secretary in accordance with paragraph (2) with respect 
        to such a fiscal year.
          (2) Submission of quality data.--For fiscal year 2014 
        and each subsequent fiscal year, each hospital 
        described in such section shall submit to the Secretary 
        data on quality measures specified under paragraph (3). 
        Such data shall be submitted in a form and manner, and 
        at a time, specified by the Secretary for purposes of 
        this subparagraph.
          (3) Quality measures.--
                  (A) In general.--Subject to subparagraph (B), 
                any measure specified by the Secretary under 
                this paragraph must have been endorsed by the 
                entity with a contract under section 1890(a).
                  (B) Exception.--In the case of a specified 
                area or medical topic determined appropriate by 
                the Secretary for which a feasible and 
                practical measure has not been endorsed by the 
                entity with a contract under section 1890(a), 
                the Secretary may specify a measure that is not 
                so endorsed as long as due consideration is 
                given to measures that have been endorsed or 
                adopted by a consensus organization identified 
                by the Secretary.
                  (C) Time frame.--Not later than October 1, 
                2012, the Secretary shall publish the measures 
                selected under this paragraph that will be 
                applicable with respect to fiscal year 2014.
          (4) Public availability of data submitted.--The 
        Secretary shall establish procedures for making data 
        submitted under paragraph (4) available to the public. 
        Such procedures shall ensure that a hospital described 
        in section 1886(d)(1)(B)(v) has the opportunity to 
        review the data that is to be made public with respect 
        to the hospital prior to such data being made public. 
        The Secretary shall report quality measures of process, 
        structure, outcome, patients' perspective on care, 
        efficiency, and costs of care that relate to services 
        furnished in such hospitals on the Internet website of 
        the Centers for Medicare & Medicaid Services.

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   Text of Existing Law Amended or Repealed by the Bill, as Reported

  In compliance with clause 3(e)(1)(A) of rule XIII of the 
Rules of the House of Representatives, the text of each section 
proposed to be amended or repealed by the bill, as reported, is 
shown below:

                          SOCIAL SECURITY ACT



           *       *       *       *       *       *       *
TITLE XVIII--HEALTH INSURANCE FOR THE AGED AND DISABLED

           *       *       *       *       *       *       *


Part E--Miscellaneous Provisions

           *       *       *       *       *       *       *


      agreements with providers of services; enrollment processes

  Sec. 1866. (a)(1) Any provider of services (except a fund 
designated for purposes of section 1814(g) and section 1835(e)) 
shall be qualified to participate under this title and shall be 
eligible for payments under this title if it files with the 
Secretary an agreement--
          (A)(i) not to charge, except as provided in paragraph 
        (2), any individual or any other person for items or 
        services for which such individual is entitled to have 
        payment made under this title (or for which he would be 
        so entitled if such provider of services had complied 
        with the procedural and other requirements under or 
        pursuant to this title or for which such provider is 
        paid pursuant to the provisions of section 1814(e)), 
        and (ii) not to impose any charge that is prohibited 
        under section 1902(n)(3),
          (B) not to charge any individual or any other person 
        for items or services for which such individual is not 
        entitled to have payment made under this title because 
        payment for expenses incurred for such items or 
        services may not be made by reason of the provisions of 
        paragraph (1) or (9) of section 1862(a), but only if 
        (i) such individual was without fault in incurring such 
        expenses and (ii) the Secretary's determination that 
        such payment may not be made for such items and 
        services was made after the third year following the 
        year in which notice of such payment was sent to such 
        individual; except that the Secretary may reduce such 
        three-year period to not less than one year if he finds 
        such reduction is consistent with the objectives of 
        this title,
          (C) to make adequate provision for return (or other 
        disposition, in accordance with regulations) of any 
        moneys incorrectly collected from such individual or 
        other person,
          (D) to promptly notify the Secretary of its 
        employment of an individual who, at any time during the 
        year preceding such employment, was employed in a 
        managerial, accounting, auditing, or similar capacity 
        (as determined by the Secretary by regulation) by an 
        agency or organization which serves as a fiscal 
        intermediary or carrier (for purposes of part A or part 
        B, or both, of this title) with respect to the 
        provider,
          (E) to release data with respect to patients of such 
        provider upon request to an organization having a 
        contract with the Secretary under part B of title XI as 
        may be necessary (i) to allow such organization to 
        carry out its functions under such contract, or (ii) to 
        allow such organization to carry out similar review 
        functions under any contract the organization may have 
        with a private or public agency paying for health care 
        in the same area with respect to patients who authorize 
        release of such data for such purposes,
          (F)(i) in the case of hospitals which provide 
        inpatient hospital services for which payment may be 
        made under subsection (b), (c), or (d) of section 1886, 
        to maintain an agreement with a professional standards 
        review organization (if there is such an organization 
        in existence in the area in which the hospital is 
        located) or with a quality improvement organization 
        which has a contract with the Secretary under part B of 
        title XI for the area in which the hospital is located, 
        under which the organization will perform functions 
        under that part with respect to the review of the 
        validity of diagnostic information provided by such 
        hospital, the completeness, adequacy, and quality of 
        care provided, the appropriateness of admissions and 
        discharges, and the appropriateness of care provided 
        for which additional payments are sought under section 
        1886(d)(5), with respect to inpatient hospital services 
        for which payment may be made under part A of this 
        title (and for purposes of payment under this title, 
        the cost of such agreement to the hospital shall be 
        considered a cost incurred by such hospital in 
        providing inpatient services under part A, and (I) 
        shall be paid directly by the Secretary to such 
        organization on behalf of such hospital in accordance 
        with a rate per review established by the Secretary, 
        (II) shall be transferred from the Federal Hospital 
        Insurance Trust Fund, without regard to amounts 
        appropriated in advance in appropriation Acts, in the 
        same manner as transfers are made for payment for 
        services provided directly to beneficiaries, and (III) 
        shall not be less in the aggregate for a fiscal year 
        than the aggregate amount expended in fiscal year 1988 
        for direct and administrative costs (adjusted for 
        inflation and for any direct or administrative costs 
        incurred as a result of review functions added with 
        respect to a subsequent fiscal year) of such reviews),
          (ii) in the case of hospitals, critical access 
        hospitals, skilled nursing facilities, and home health 
        agencies, to maintain an agreement with a quality 
        improvement organization (which has a contract with the 
        Secretary under part B of title XI for the area in 
        which the hospital, facility, or agency is located) to 
        perform the functions described in paragraph (3)(A),
          (G) in the case of hospitals which provide inpatient 
        hospital services for which payment may be made under 
        subsection (b) or (d) of section 1886, not to charge 
        any individual or any other person for inpatient 
        hospital services for which such individual would be 
        entitled to have payment made under part A but for a 
        denial or reduction of payments under section 
        1886(f)(2),
          (H)(i) in the case of hospitals which provide 
        services for which payment may be made under this title 
        and in the case of critical access hospitals which 
        provide critical access hospital services, to have all 
        items and services (other than physicians' services as 
        defined in regulations for purposes of section 
        1862(a)(14), and other than services described by 
        section 1861(s)(2)(K), certified nurse-midwife 
        services, qualified psychologist services, and services 
        of a certified registered nurse anesthetist) (I) that 
        are furnished to an individual who is a patient of the 
        hospital, and (II) for which the individual is entitled 
        to have payment made under this title, furnished by the 
        hospital or otherwise under arrangements (as defined in 
        section 1861(w)(1)) made by the hospital,
          (ii) in the case of skilled nursing facilities which 
        provide covered skilled nursing facility services--
                  (I) that are furnished to an individual who 
                is a resident of the skilled nursing facility 
                during a period in which the resident is 
                provided covered post-hospital extended care 
                services (or, for services described in section 
                1861(s)(2)(D), that are furnished to such an 
                individual without regard to such period), and
                  (II) for which the individual is entitled to 
                have payment made under this title,
        to have items and services (other than services 
        described in section 1888(e)(2)(A)(ii)) furnished by 
        the skilled nursing facility or otherwise under 
        arrangements (as defined in section 1861(w)(1)) made by 
        the skilled nursing facility,
          (I) in the case of a hospital or critical access 
        hospital--
                  (i) to adopt and enforce a policy to ensure 
                compliance with the requirements of section 
                1867 and to meet the requirements of such 
                section,
                  (ii) to maintain medical and other records 
                related to individuals transferred to or from 
                the hospital for a period of five years from 
                the date of the transfer, and
                  (iii) to maintain a list of physicians who 
                are on call for duty after the initial 
                examination to provide treatment necessary to 
                stabilize an individual with an emergency 
                medical condition,
          (J) in the case of hospitals which provide inpatient 
        hospital services for which payment may be made under 
        this title, to be a participating provider of medical 
        care under any health plan contracted for under section 
        1079 or 1086 of title 10, or under section 613 of title 
        38, United States Code, in accordance with admission 
        practices, payment methodology, and amounts as 
        prescribed under joint regulations issued by the 
        Secretary and by the Secretaries of Defense and 
        Transportation, in implementation of sections 1079 and 
        1086 of title 10, United States Code,
          (K) not to charge any individual or any other person 
        for items or services for which payment under this 
        title is denied under section 1154(a)(2) by reason of a 
        determination under section 1154(a)(1)(B),
          (L) in the case of hospitals which provide inpatient 
        hospital services for which payment may be made under 
        this title, to be a participating provider of medical 
        care under section 603 of title 38, United States Code, 
        in accordance with such admission practices, and such 
        payment methodology and amounts, as are prescribed 
        under joint regulations issued by the Secretary and by 
        the Secretary of Veterans Affairs in implementation of 
        such section,
          (M) in the case of hospitals, to provide to each 
        individual who is entitled to benefits under part A (or 
        to a person acting on the individual's behalf), at or 
        about the time of the individual's admission as an 
        inpatient to the hospital, a written statement 
        (containing such language as the Secretary prescribes 
        consistent with this paragraph) which explains--
                  (i) the individual's rights to benefits for 
                inpatient hospital services and for post-
                hospital services under this title,
                  (ii) the circumstances under which such an 
                individual will and will not be liable for 
                charges for continued stay in the hospital,
                  (iii) the individual's right to appeal 
                denials of benefits for continued inpatient 
                hospital services, including the practical 
                steps to initiate such an appeal, and
                  (iv) the individual's liability for payment 
                for services if such a denial of benefits is 
                upheld on appeal,--and which provides such 
                additional information as the Secretary may 
                specify,
          (N) in the case of hospitals and critical access 
        hospitals--
                  (i) to make available to its patients the 
                directory or directories of participating 
                physicians (published under section 1842(h)(4)) 
                for the area served by the hospital or critical 
                access hospital,
                  (ii) if hospital personnel (including staff 
                of any emergency or outpatient department) 
                refer a patient to a nonparticipating physician 
                for further medical care on an outpatient 
                basis, the personnel must inform the patient 
                that the physician is a nonparticipating 
                physician and, whenever practicable, must 
                identify at least one qualified participating 
                physician who is listed in such a directory and 
                from whom the patient may receive the necessary 
                services,
                  (iii) to post conspicuously in any emergency 
                department a sign (in a form specified by the 
                Secretary) specifying rights of individuals 
                under section 1867 with respect to examination 
                and treatment for emergency medical conditions 
                and women in labor, and
                  (iv) to post conspicuously (in a form 
                specified by the Secretary) information 
                indicating whether or not the hospital 
                participates in the medicaid program under a 
                State plan approved under title XIX,
          (O) to accept as payment in full for services that 
        are covered under this title and are furnished to any 
        individual enrolled with a Medicare+Choice organization 
        under part C, with a PACE provider under section 1894 
        or 1934, or with an eligible organization with a risk-
        sharing contract under section 1876, under section 
        1876(i)(2)(A) (as in effect before February 1, 1985), 
        under section 402(a) of the Social Security Amendments 
        of 1967, or under section 222(a) of the Social Security 
        Amendments of 1972, which does not have a contract (or, 
        in the case of a PACE provider, contract or other 
        agreement) establishing payment amounts for services 
        furnished to members of the organization or PACE 
        program eligible individuals enrolled with the PACE 
        provider, the amounts that would be made as a payment 
        in full under this title (less any payments under 
        sections 1886(d)(11) and 1886(h)(3)(D)) if the 
        individuals were not so enrolled,
          (P) in the case of home health agencies which provide 
        home health services to individuals entitled to 
        benefits under this title who require catheters, 
        catheter supplies, ostomy bags, and supplies related to 
        ostomy car (described in section 1861(m)(5)), to offer 
        to furnish such supplies to such an individual as part 
        of their furnishing of home health services,
          (Q) in the case of hospitals, skilled nursing 
        facilities, home health agencies, and hospice programs, 
        to comply with the requirement of subsection (f) 
        (relating to maintaining written policies and 
        procedures respecting advance directives),
          (R) to contract only with a health care clearinghouse 
        (as defined in section 1171) that meets each standard 
        and implementation specification adopted or established 
        under part C of title XI on or after the date on which 
        the health care clearinghouse is required to comply 
        with the standard or specification,
          (S) in the case of a hospital that has a financial 
        interest (as specified by the Secretary in regulations) 
        in an entity to which individuals are referred as 
        described in section 1861(ee)(2)(H)(ii), or in which 
        such an entity has such a financial interest, or in 
        which another entity has such a financial interest 
        (directly or indirectly) with such hospital and such an 
        entity, to maintain and disclose to the Secretary (in a 
        form and manner specified by the Secretary) information 
        on--
                  (i) the nature of such financial interest,
                  (ii) the number of individuals who were 
                discharged from the hospital and who were 
                identified as requiring home health services, 
                and
                  (iii) the percentage of such individuals who 
                received such services from such provider (or 
                another such provider),
          (T) in the case of hospitals and critical access 
        hospitals, to furnish to the Secretary such data as the 
        Secretary determines appropriate pursuant to 
        subparagraph (E) of section 1886(d)(12) to carry out 
        such section,
          (U) in the case of hospitals which furnish inpatient 
        hospital services for which payment may be made under 
        this title, to be a participating provider of medical 
        care both--
                  (i) under the contract health services 
                program funded by the Indian Health Service and 
                operated by the Indian Health Service, an 
                Indian tribe, or tribal organization (as those 
                terms are defined in section 4 of the Indian 
                Health Care Improvement Act), with respect to 
                items and services that are covered under such 
                program and furnished to an individual eligible 
                for such items and services under such program; 
                and
                  (ii) under any program funded by the Indian 
                Health Service and operated by an urban Indian 
                organization with respect to the purchase of 
                items and services for an eligible urban Indian 
                (as those terms are defined in such section 4),
        in accordance with regulations promulgated by the 
        Secretary regarding admission practices, payment 
        methodology, and rates of payment (including the 
        acceptance of no more than such payment rate as payment 
        in full for such items and services,
          (V) in the case of hospitals that are not otherwise 
        subject to the Occupational Safety and Health Act of 
        1970 (or a State occupational safety and health plan 
        that is approved under 18(b) of such Act), to comply 
        with the Bloodborne Pathogens standard under section 
        1910.1030 of title 29 of the Code of Federal 
        Regulations (or as subsequently redesignated), and
                  (W) in the case of a hospital described in 
                section 1886(d)(1)(B)(v), to report quality 
                data to the Secretary in accordance with 
                subsection (k).
                  (W) maintain and, upon request of the 
                Secretary, provide access to documentation 
                relating to written orders or requests for 
                payment for durable medical equipment, 
                certifications for home health services, or 
                referrals for other items or services written 
                or ordered by the provider under this title, as 
                specified by the Secretary.
In the case of a hospital which has an agreement in effect with 
an organization described in subparagraph (F), which 
organization's contract with the Secretary under part B of 
title XI is terminated on or after October 1, 1984, the 
hospital shall not be determined to be out of compliance with 
the requirement of such subparagraph during the six month 
period beginning on the date of the termination of that 
contract.
  (2)(A) A provider of services may charge such individual or 
other person (i) the amount of any deduction or coinsurance 
amount imposed pursuant to section 1813(a)(1), (a)(3), or 
(a)(4), section 1833(b), or section 1861(y)(3) with respect to 
such items and services (not in excess of the amount 
customarily charged for such items and services by such 
provider), and (ii) an amount equal to 20 per centum of the 
reasonable charges for such items and services (not in excess 
of 20 per centum of the amount customarily charged for such 
items and services by such provider) for which payment is made 
under part B or which are durable medical equipment furnished 
as home health services (but in the case of items and services 
furnished to individuals with end-stage renal disease, an 
amount equal to 20 percent of the estimated amounts for such 
items and services calculated on the basis established by the 
Secretary). In the case of items and services described in 
section 1833(c), clause (ii) of the preceding sentence shall be 
applied by substituting for 20 percent the proportion which is 
appropriate under such section. A provider of services may not 
impose a charge under clause (ii) of the first sentence of this 
subparagraph with respect to items and services described in 
section 1861(s)(10)(A) and with respect to clinical diagnostic 
laboratory tests for which payment is made under part B. 
Notwithstanding the first sentence of this subparagraph, a home 
health agency may charge such an individual or person, with 
respect to covered items subject to payment under section 
1834(a), the amount of any deduction imposed under section 
1833(b) and 20 percent of the payment basis described in 
section 1834(a)(1)(B). In the case of items and services for 
which payment is made under part B under the prospective 
payment system established under section 1833(t), clause (ii) 
of the first sentence shall be applied by substituting for 20 
percent of the reasonable charge, the applicable copayment 
amount established under section 1833(t)(5). In the case of 
services described in section 1833(a)(8) or section 1833(a)(9) 
for which payment is made under part B under section 1834(k), 
clause (ii) of the first sentence shall be applied by 
substituting for 20 percent of the reasonable charge for such 
services 20 percent of the lesser of the actual charge or the 
applicable fee schedule amount (as defined in such section) for 
such services.
  (B) Where a provider of services has furnished, at the 
request of such individual, items or services which are in 
excess of or more expensive than the items or services with 
respect to which payment may be made under this title, such 
provider of services may also charge such individual or other 
person for such more expensive items or services to the extent 
that the amount customarily charged by it for the items or 
services furnished at such request exceeds the amount 
customarily charged by it for the items or services with 
respect to which payment may be made under this title.
  (C) A provider of services may in accordance with its 
customary practice also appropriately charge any such 
individual for any whole blood (or equivalent quantities of 
packed red blood cells, as defined under regulations) furnished 
him with respect to which a deductible is imposed under section 
1813(a)(2), except that (i) any excess of such charge over the 
cost to such provider for the blood (or equivalent quantities 
of packed red blood cells, as so defined) shall be deducted 
from any payment to such provider under this title, (ii) no 
such charge may be imposed for the cost of administration of 
such blood (or equivalent quantities of packed red blood cells, 
as so defined), and (iii) such charge may not be made to the 
extent such blood (or equivalent quantities of packed red blood 
cells, as so defined) has been replaced on behalf of such 
individual or arrangements have been made for its replacement 
on his behalf. For purposes of subparagraph (C), whole blood 
(or equivalent quantities of packed red blood cells, as so 
defined) furnished an individual shall be deemed replaced when 
the provider of services is given one pint of blood for each 
pint of blood (or equivalent quantities of packed red blood 
cells, as so defined) furnished such individual with respect to 
which a deduction is imposed under section 1813(a)(2).
  (D) Where a provider of services customarily furnishes items 
or services which are in excess of or more expensive than the 
items or services with respect to which payment may be made 
under this title, such provider, notwithstanding the preceding 
provisions of this paragraph, may not, under the authority of 
section 1866(a)(2)(B)(ii), charge any individual or other 
person any amount for such items or services in excess of the 
amount of the payment which may otherwise be made for such 
items or services under this title if the admitting physician 
has a direct or indirect financial interest in such provider.
  (3)(A) Under the agreement required under paragraph 
(1)(F)(ii), the quality improvement organization must perform 
functions (other than those covered under an agreement under 
paragraph (1)(F)(i)) under the third sentence of section 
1154(a)(4)(A) and under section 1154(a)(14) with respect to 
services, furnished by the hospital, critical access hospital, 
facility, or agency involved, for which payment may be made 
under this title.
  (B) For purposes of payment under this title, the cost of 
such an agreement to the hospital, critical access hospital, 
facility, or agency shall be considered a cost incurred by such 
hospital, critical access hospital, facility, or agency in 
providing covered services under this title and shall be paid 
directly by the Secretary to the quality improvement 
organization on behalf of such hospital, critical access 
hospital, facility, or agency in accordance with a schedule 
established by the Secretary.
  (C) Such payments--
          (i) shall be transferred in appropriate proportions 
        from the Federal Hospital Insurance Trust Fund and from 
        the Federal Supplementary Medical Insurance Trust Fund, 
        without regard to amounts appropriated in advance in 
        appropriation Acts, in the same manner as transfers are 
        made for payment for services provided directly to 
        beneficiaries, and
          (ii) shall not be less in the aggregate for a fiscal 
        year--
                  (I) in the case of hospitals, than the amount 
                specified in paragraph (1)(F)(i)(III), and
                  (II) in the case of facilities, critical 
                access hospitals, and agencies, than the 
                amounts the Secretary determines to be 
                sufficient to cover the costs of such 
                organizations' conducting the activities 
                described in subparagraph (A) with respect to 
                such facilities, critical access hospitals, or 
                agencies under part B of title XI.
  (b)(1) A provider of services may terminate an agreement with 
the Secretary under this section at such time and upon such 
notice to the Secretary and the public as may be provided in 
regulations, except that notice of more than six months shall 
not be required.
  (2) The Secretary may refuse to enter into an agreement under 
this section or, upon such reasonable notice to the provider 
and the public as may be specified in regulations, may refuse 
to renew or may terminate such an agreement after the 
Secretary--
          (A) has determined that the provider fails to comply 
        substantially with the provisions of the agreement, 
        with the provisions of this title and regulations 
        thereunder, or with a corrective action required under 
        section 1886(f)(2)(B),
          (B) has determined that the provider fails 
        substantially to meet the applicable provisions of 
        section 1861,
          (C) has excluded the provider from participation in a 
        program under this title pursuant to section 1128 or 
        section 1128A, or
          (D) has ascertained that the provider has been 
        convicted of a felony under Federal or State law for an 
        offense which the Secretary determines is detrimental 
        to the best interests of the program or program 
        beneficiaries.
  (3) A termination of an agreement or a refusal to renew an 
agreement under this subsection shall become effective on the 
same date and in the same manner as an exclusion from 
participation under the programs under this title becomes 
effective under section 1128(c).
  (4)(A) A hospital that fails to comply with the requirement 
of subsection (a)(1)(V) (relating to the Bloodborne Pathogens 
standard) is subject to a civil money penalty in an amount 
described in subparagraph (B), but is not subject to 
termination of an agreement under this section.
  (B) The amount referred to in subparagraph (A) is an amount 
that is similar to the amount of civil penalties that may be 
imposed under section 17 of the Occupational Safety and Health 
Act of 1970 for a violation of the Bloodborne Pathogens 
standard referred to in subsection (a)(1)(U) by a hospital that 
is subject to the provisions of such Act.
  (C) A civil money penalty under this paragraph shall be 
imposed and collected in the same manner as civil money 
penalties under subsection (a) of section 1128A are imposed and 
collected under that section.
  (c)(1) Where the Secretary has terminated or has refused to 
renew an agreement under this title with a provider of 
services, such provider may not file another agreement under 
this title unless the Secretary finds that the reason for the 
termination or nonrenewal has been removed and that there is 
reasonable assurance that it will not recur.
  (2) Where the Secretary has terminated or has refused to 
renew an agreement under this title with a provider of 
services, the Secretary shall promptly notify each State agency 
which administers or supervises the administration of a State 
plan approved under title XIX of such termination or 
nonrenewal.
  (d) If the Secretary finds that there is a substantial 
failure to make timely review in accordance with section 
1861(k) of long-stay cases in a hospital, he may, in lieu of 
terminating his agreement with such hospital, decide that, with 
respect to any individual admitted to such hospital after a 
subsequent date specified by him, no payment shall be made 
under this title for inpatient hospital services (including 
inpatient psychiatric hospital services) after the 20th day of 
a continuous period of such services. Such decision may be made 
effective only after such notice to the hospital and to the 
public, as may be prescribed by regulations, and its 
effectiveness shall terminate when the Secretary finds that the 
reason therefor has been removed and that there is reasonable 
assurance that it will not recur. The Secretary shall not make 
any such decision except after reasonable notice and 
opportunity for hearing to the institution or agency affected 
thereby.
  (e) For purposes of this section, the term ``provider of 
services'' shall include--
          (1) a clinic, rehabilitation agency, or public health 
        agency if, in the case of a clinic or rehabilitation 
        agency, such clinic or agency meets the requirements of 
        section 1861(p)(4)(A) (or meets the requirements of 
        such section through the operation of subsection (g) or 
        (ll)(2) of section 1861), or if, in the case of a 
        public health agency, such agency meets the 
        requirements of section 1861(p)(4)(B) (or meets the 
        requirements of such section through the operation of 
        subsection (g) or (ll)(2) of section 1861), but only 
        with respect to the furnishing of outpatient physical 
        therapy services (as therein defined), (through the 
        operation of section 1861(g)) with respect to the 
        furnishing of outpatient occupational therapy services, 
        or (through the operation of section 1861(ll)(2)) with 
        respect to the furnishing of outpatient speech-language 
        pathology; and
          (2) a community mental health center (as defined in 
        section 1861(ff)(3)(B)), but only with respect to the 
        furnishing of partial hospitalization services (as 
        described in section 1861(ff)(1)).
  (f)(1) For purposes of subsection (a)(1)(Q) and sections 
1819(c)(2)(E), 1833(s), 1855(i), 1876(c)(8), and 1891(a)(6), 
the requirement of this subsection is that a provider of 
services, Medicare+Choice organization, or prepaid or eligible 
organization (as the case may be) maintain written policies and 
procedures with respect to all adult individuals receiving 
medical care by or through the provider or organization--
          (A) to provide written information to each such 
        individual concerning--
                  (i) an individual's rights under State law 
                (whether statutory or as recognized by the 
                courts of the State) to make decisions 
                concerning such medical care, including the 
                right to accept or refuse medical or surgical 
                treatment and the right to formulate advance 
                directives (as defined in paragraph (3)), and
                  (ii) the written policies of the provider or 
                organization respecting the implementation of 
                such rights;
          (B) to document in a prominent part of the 
        individual's current medical record whether or not the 
        individual has executed an advance directive;
          (C) not to condition the provision of care or 
        otherwise discriminate against an individual based on 
        whether or not the individual has executed an advance 
        directive;
          (D) to ensure compliance with requirements of State 
        law (whether statutory or as recognized by the courts 
        of the State) respecting advance directives at 
        facilities of the provider or organization; and
          (E) to provide (individually or with others) for 
        education for staff and the community on issues 
        concerning advance directives.
Subparagraph (C) shall not be construed as requiring the 
provision of care which conflicts with an advance directive.
  (2) The written information described in paragraph (1)(A) 
shall be provided to an adult individual--
          (A) in the case of a hospital, at the time of the 
        individual's admission as an inpatient,
          (B) in the case of a skilled nursing facility, at the 
        time of the individual's admission as a resident,
          (C) in the case of a home health agency, in advance 
        of the individual coming under the care of the agency,
          (D) in the case of a hospice program, at the time of 
        initial receipt of hospice care by the individual from 
        the program, and
          (E) in the case of an eligible organization (as 
        defined in section 1876(b)) or an organization provided 
        payments under section 1833(a)(1)(A) or a 
        Medicare+Choice organization, at the time of enrollment 
        of the individual with the organization.
  (3) In this subsection, the term ``advance directive'' means 
a written instruction, such as a living will or durable power 
of attorney for health care, recognized under State law 
(whether statutory or as recognized by the courts of the State) 
and relating to the provision of such care when the individual 
is incapacitated.
  (4) For construction relating to this subsection, see section 
7 of the Assisted Suicide Funding Restriction Act of 1997 
(relating to clarification respecting assisted suicide, 
euthanasia, and mercy killing).
  (g) Except as permitted under subsection (a)(2), any person 
who knowingly and willfully presents, or causes to be 
presented, a bill or request for payment inconsistent with an 
arrangement under subsection (a)(1)(H) or in violation of the 
requirement for such an arrangement, is subject to a civil 
money penalty of not to exceed $2,000. The provisions of 
section 1128A (other than subsections (a) and (b)) shall apply 
to a civil money penalty under the previous sentence in the 
same manner as such provisions apply to a penalty or proceeding 
under section 1128A(a).
  (h)(1)(A) Except as provided in paragraph (2), an institution 
or agency dissatisfied with a determination by the Secretary 
that it is not a provider of services or with a determination 
described in subsection (b)(2) shall be entitled to a hearing 
thereon by the Secretary (after reasonable notice) to the same 
extent as is provided in section 205(b), and to judicial review 
of the Secretary's final decision after such hearing as is 
provided in section 205(g), except that, in so applying such 
sections and in applying section 205(l) thereto, any reference 
therein to the Commissioner of Social Security or the Social 
Security Administration shall be considered a reference to the 
Secretary or the Department of Health and Human Services, 
respectively.
  (B) An institution or agency described in subparagraph (A) 
that has filed for a hearing under subparagraph (A) shall have 
expedited access to judicial review under this subparagraph in 
the same manner as providers of services, suppliers, and 
individuals entitled to benefits under part A or enrolled under 
part B, or both, may obtain expedited access to judicial review 
under the process established under section 1869(b)(2). Nothing 
in this subparagraph shall be construed to affect the 
application of any remedy imposed under section 1819 during the 
pendency of an appeal under this subparagraph.
  (C)(i) The Secretary shall develop and implement a process to 
expedite proceedings under this subsection in which--
          (I) the remedy of termination of participation has 
        been imposed;
          (II) a remedy described in clause (i) or (iii) of 
        section 1819(h)(2)(B) has been imposed, but only if 
        such remedy has been imposed on an immediate basis; or
          (III) a determination has been made as to a finding 
        of substandard quality of care that results in the loss 
        of approval of a skilled nursing facility's nurse aide 
        training program.
  (ii) Under such process under clause (i), priority shall be 
provided in cases of termination described in clause (i)(I).
  (iii) Nothing in this subparagraph shall be construed to 
affect the application of any remedy imposed under section 1819 
during the pendency of an appeal under this subparagraph.
  (2) An institution or agency is not entitled to separate 
notice and opportunity for a hearing under both section 1128 
and this section with respect to a determination or 
determinations based on the same underlying facts and issues.
  (i)(1) If the Secretary determines that a psychiatric 
hospital which has an agreement in effect under this section no 
longer meets the requirements for a psychiatric hospital under 
this title and further finds that the hospital's deficiencies--
          (A) immediately jeopardize the health and safety of 
        its patients, the Secretary shall terminate such 
        agreement; or
          (B) do not immediately jeopardize the health and 
        safety of its patients, the Secretary may terminate 
        such agreement, or provide that no payment will be made 
        under this title with respect to any individual 
        admitted to such hospital after the effective date of 
        the finding, or both.
  (2) If a psychiatric hospital, found to have deficiencies 
described in paragraph (1)(B), has not complied with the 
requirements of this title--
          (A) within 3 months after the date the hospital is 
        found to be out of compliance with such requirements, 
        the Secretary shall provide that no payment will be 
        made under this title with respect to any individual 
        admitted to such hospital after the end of such 3-month 
        period, or
          (B) within 6 months after the date the hospital is 
        found to be out of compliance with such requirements, 
        no payment may be made under this title with respect to 
        any individual in the hospital until the Secretary 
        finds that the hospital is in compliance with the 
        requirements of this title.
  (j) Enrollment Process for Providers of Services and 
Suppliers.--
          (1) Enrollment process.--
                  (A) In general.--The Secretary shall 
                establish by regulation a process for the 
                enrollment of providers of services and 
                suppliers under this title. Such process shall 
                include screening of providers and suppliers in 
                accordance with paragraph (2), a provisional 
                period of enhanced oversight in accordance with 
                paragraph (3), disclosure requirements in 
                accordance with paragraph (4), the imposition 
                of temporary enrollment moratoria in accordance 
                with paragraph (5), and the establishment of 
                compliance programs in accordance with 
                paragraph (6).
                  (B) Deadlines.--The Secretary shall establish 
                by regulation procedures under which there are 
                deadlines for actions on applications for 
                enrollment (and, if applicable, renewal of 
                enrollment). The Secretary shall monitor the 
                performance of medicare administrative 
                contractors in meeting the deadlines 
                established under this subparagraph.
                  (C) Consultation before changing provider 
                enrollment forms.--The Secretary shall consult 
                with providers of services and suppliers before 
                making changes in the provider enrollment forms 
                required of such providers and suppliers to be 
                eligible to submit claims for which payment may 
                be made under this title.
          (2) Provider screening.--
                  (A) Procedures.--Not later than 180 days 
                after the date of enactment of this paragraph, 
                the Secretary, in consultation with the 
                Inspector General of the Department of Health 
                and Human Services, shall establish procedures 
                under which screening is conducted with respect 
                to providers of medical or other items or 
                services and suppliers under the program under 
                this title, the Medicaid program under title 
                XIX, and the CHIP program under title XXI.
                  (B) Level of screening.--The Secretary shall 
                determine the level of screening conducted 
                under this paragraph according to the risk of 
                fraud, waste, and abuse, as determined by the 
                Secretary, with respect to the category of 
                provider of medical or other items or services 
                or supplier. Such screening--
                          (i) shall include a licensure check, 
                        which may include such checks across 
                        States; and
                          (ii) may, as the Secretary determines 
                        appropriate based on the risk of fraud, 
                        waste, and abuse described in the 
                        preceding sentence, include--
                                  (I) a criminal background 
                                check;
                                  (II) fingerprinting;
                                  (III) unscheduled and 
                                unannounced site visits, 
                                including preenrollment site 
                                visits;
                                  (IV) database checks 
                                (including such checks across 
                                States); and
                                  (V) such other screening as 
                                the Secretary determines 
                                appropriate.
                  (C) Application fees.--
                          (i) Institutional providers.--Except 
                        as provided in clause (ii), the 
                        Secretary shall impose a fee on each 
                        institutional provider of medical or 
                        other items or services or supplier 
                        (such as a hospital or skilled nursing 
                        facility) with respect to which 
                        screening is conducted under this 
                        paragraph in an amount equal to--
                                  (I) for 2010, $500; and
                                  (II) for 2011 and each 
                                subsequent year, the amount 
                                determined under this clause 
                                for the preceding year, 
                                adjusted by the percentage 
                                change in the consumer price 
                                index for all urban consumers 
                                (all items; United States city 
                                average) for the 12-month 
                                period ending with June of the 
                                previous year.
                          (ii) Hardship exception; waiver for 
                        certain medicaid providers.--The 
                        Secretary may, on a case-by-case basis, 
                        exempt a provider of medical or other 
                        items or services or supplier from the 
                        imposition of an application fee under 
                        this subparagraph if the Secretary 
                        determines that the imposition of the 
                        application fee would result in a 
                        hardship. The Secretary may waive the 
                        application fee under this subparagraph 
                        for providers enrolled in a State 
                        Medicaid program for whom the State 
                        demonstrates that imposition of the fee 
                        would impede beneficiary access to 
                        care.
                          (iii) Use of funds.--Amounts 
                        collected as a result of the imposition 
                        of a fee under this subparagraph shall 
                        be used by the Secretary for program 
                        integrity efforts, including to cover 
                        the costs of conducting screening under 
                        this paragraph and to carry out this 
                        subsection and section 1128J.
                  (D) Application and enforcement.--
                          (i) New providers of services and 
                        suppliers.--The screening under this 
                        paragraph shall apply, in the case of a 
                        provider of medical or other items or 
                        services or supplier who is not 
                        enrolled in the program under this 
                        title, title XIX, or title XXI as of 
                        the date of enactment of this 
                        paragraph, on or after the date that is 
                        1 year after such date of enactment.
                          (ii) Current providers of services 
                        and suppliers.--The screening under 
                        this paragraph shall apply, in the case 
                        of a provider of medical or other items 
                        or services or supplier who is enrolled 
                        in the program under this title, title 
                        XIX, or title XXI as of such date of 
                        enactment, on or after the date that is 
                        2 years after such date of enactment.
                          (iii) Revalidation of enrollment.--
                        Effective beginning on the date that is 
                        180 days after such date of enactment, 
                        the screening under this paragraph 
                        shall apply with respect to the 
                        revalidation of enrollment of a 
                        provider of medical or other items or 
                        services or supplier in the program 
                        under this title, title XIX, or title 
                        XXI.
                          (iv) Limitation on enrollment and 
                        revalidation of enrollment.--In no case 
                        may a provider of medical or other 
                        items or services or supplier who has 
                        not been screened under this paragraph 
                        be initially enrolled or reenrolled in 
                        the program under this title, title 
                        XIX, or title XXI on or after the date 
                        that is 3 years after such date of 
                        enactment.
                  (E) Use of information from the department of 
                treasury concerning tax debts.--In reviewing 
                the application of a provider of services or 
                supplier to enroll or reenroll under the 
                program under this title, the Secretary shall 
                take into account the information supplied by 
                the Secretary of the Treasury pursuant to 
                section 6103(l)(22) of the Internal Revenue 
                Code of 1986, in determining whether to deny 
                such application or to apply enhanced oversight 
                to such provider of services or supplier 
                pursuant to paragraph (3) if the Secretary 
                determines such provider of services or 
                supplier owes such a debt.
                  (F) Expedited rulemaking.--The Secretary may 
                promulgate an interim final rule to carry out 
                this paragraph.
          (3) Provisional period of enhanced oversight for new 
        providers of services and suppliers.--
                  (A) In general.--The Secretary shall 
                establish procedures to provide for a 
                provisional period of not less than 30 days and 
                not more than 1 year during which new providers 
                of medical or other items or services and 
                suppliers, as the Secretary determines 
                appropriate, including categories of providers 
                or suppliers, would be subject to enhanced 
                oversight, such as prepayment review and 
                payment caps, under the program under this 
                title, the Medicaid program under title XIX. 
                and the CHIP program under title XXI.
                  (B) Implementation.--The Secretary may 
                establish by program instruction or otherwise 
                the procedures under this paragraph.
          (4) 90-day period of enhanced oversight for initial 
        claims of dme suppliers.--For periods beginning after 
        January 1, 2011, if the Secretary determines that there 
        is a significant risk of fraudulent activity among 
        suppliers of durable medical equipment, in the case of 
        a supplier of durable medical equipment who is within a 
        category or geographic area under title XVIII 
        identified pursuant to such determination and who is 
        initially enrolling under such title, the Secretary 
        shall, notwithstanding sections 1816(c), 1842(c), and 
        1869(a)(2), withhold payment under such title with 
        respect to durable medical equipment furnished by such 
        supplier during the 90-day period beginning on the date 
        of the first submission of a claim under such title for 
        durable medical equipment furnished by such supplier.
          (5) Increased disclosure requirements.--
                  (A) Disclosure.--A provider of medical or 
                other items or services or supplier who submits 
                an application for enrollment or revalidation 
                of enrollment in the program under this title, 
                title XIX, or title XXI on or after the date 
                that is 1 year after the date of enactment of 
                this paragraph shall disclose (in a form and 
                manner and at such time as determined by the 
                Secretary) any current or previous affiliation 
                (directly or indirectly) with a provider of 
                medical or other items or services or supplier 
                that has uncollected debt, has been or is 
                subject to a payment suspension under a Federal 
                health care program (as defined in section 
                1128B(f)), has been excluded from participation 
                under the program under this title, the 
                Medicaid program under title XIX, or the CHIP 
                program under title XXI, or has had its billing 
                privileges denied or revoked.
                  (B) Authority to deny enrollment.--If the 
                Secretary determines that such previous 
                affiliation poses an undue risk of fraud, 
                waste, or abuse, the Secretary may deny such 
                application. Such a denial shall be subject to 
                appeal in accordance with paragraph (7).
          (6) Authority to adjust payments of providers of 
        services and suppliers with the same tax identification 
        number for medicare obligations.--
                  (A) In general.--Notwithstanding any other 
                provision of this title, in the case of an 
                applicable provider of services or supplier, 
                the Secretary may make any necessary 
                adjustments to payments to the applicable 
                provider of services or supplier under the 
                program under this title in order to satisfy 
                any amount described in subparagraph (B)(ii) 
                due from such obligated provider of services or 
                supplier.
                  (B) Definitions.--In this paragraph:
                          (i) In general.--The term 
                        ``applicable provider of services or 
                        supplier'' means a provider of services 
                        or supplier that has the same taxpayer 
                        identification number assigned under 
                        section 6109 of the Internal Revenue 
                        Code of 1986 as is assigned to the 
                        obligated provider of services or 
                        supplier under such section, regardless 
                        of whether the applicable provider of 
                        services or supplier is assigned a 
                        different billing number or national 
                        provider identification number under 
                        the program under this title than is 
                        assigned to the obligated provider of 
                        services or supplier.
                          (ii) Obligated provider of services 
                        or supplier.--The term ``obligated 
                        provider of services or supplier'' 
                        means a provider of services or 
                        supplier that owes an amount that is 
                        more than the amount required to be 
                        paid under the program under this title 
                        (as determined by the Secretary).
          (7) Temporary moratorium on enrollment of new 
        providers.--
                  (A) In general.--The Secretary may impose a 
                temporary moratorium on the enrollment of new 
                providers of services and suppliers, including 
                categories of providers of services and 
                suppliers, in the program under this title, 
                under the Medicaid program under title XIX, or 
                under the CHIP program under title XXI if the 
                Secretary determines such moratorium is 
                necessary to prevent or combat fraud, waste, or 
                abuse under either such program.
                  (B) Limitation on review.--There shall be no 
                judicial review under section 1869, section 
                1878, or otherwise, of a temporary moratorium 
                imposed under subparagraph (A).
          (8) Compliance programs.--
                  (A) In general.--On or after the date of 
                implementation determined by the Secretary 
                under subparagraph (C), a provider of medical 
                or other items or services or supplier within a 
                particular industry sector or category shall, 
                as a condition of enrollment in the program 
                under this title, title XIX, or title XXI, 
                establish a compliance program that contains 
                the core elements established under 
                subparagraph (B) with respect to that provider 
                or supplier and industry or category.
                  (B) Establishment of core elements.--The 
                Secretary, in consultation with the Inspector 
                General of the Department of Health and Human 
                Services, shall establish core elements for a 
                compliance program under subparagraph (A) for 
                providers or suppliers within a particular 
                industry or category.
                  (C) Timeline for implementation.--The 
                Secretary shall determine the timeline for the 
                establishment of the core elements under 
                subparagraph (B) and the date of the 
                implementation of subparagraph (A) for 
                providers or suppliers within a particular 
                industry or category. The Secretary shall, in 
                determining such date of implementation, 
                consider the extent to which the adoption of 
                compliance programs by a provider of medical or 
                other items or services or supplier is 
                widespread in a particular industry sector or 
                with respect to a particular provider or 
                supplier category.
          (8) Hearing rights in cases of denial or non-
        renewal.--A provider of services or supplier whose 
        application to enroll (or, if applicable, to renew 
        enrollment) under this title is denied may have a 
        hearing and judicial review of such denial under the 
        procedures that apply under subsection (h)(1)(A) to a 
        provider of services that is dissatisfied with a 
        determination by the Secretary.
  (k) Quality Reporting by Cancer Hospitals.--
          (1) In general.--For purposes of fiscal year 2014 and 
        each subsequent fiscal year, a hospital described in 
        section 1886(d)(1)(B)(v) shall submit data to the 
        Secretary in accordance with paragraph (2) with respect 
        to such a fiscal year.
          (2) Submission of quality data.--For fiscal year 2014 
        and each subsequent fiscal year, each hospital 
        described in such section shall submit to the Secretary 
        data on quality measures specified under paragraph (3). 
        Such data shall be submitted in a form and manner, and 
        at a time, specified by the Secretary for purposes of 
        this subparagraph.
          (3) Quality measures.--
                  (A) In general.--Subject to subparagraph (B), 
                any measure specified by the Secretary under 
                this paragraph must have been endorsed by the 
                entity with a contract under section 1890(a).
                  (B) Exception.--In the case of a specified 
                area or medical topic determined appropriate by 
                the Secretary for which a feasible and 
                practical measure has not been endorsed by the 
                entity with a contract under section 1890(a), 
                the Secretary may specify a measure that is not 
                so endorsed as long as due consideration is 
                given to measures that have been endorsed or 
                adopted by a consensus organization identified 
                by the Secretary.
                  (C) Time frame.--Not later than October 1, 
                2012, the Secretary shall publish the measures 
                selected under this paragraph that will be 
                applicable with respect to fiscal year 2014.
          (4) Public availability of data submitted.--The 
        Secretary shall establish procedures for making data 
        submitted under paragraph (4) available to the public. 
        Such procedures shall ensure that a hospital described 
        in section 1886(d)(1)(B)(v) has the opportunity to 
        review the data that is to be made public with respect 
        to the hospital prior to such data being made public. 
        The Secretary shall report quality measures of process, 
        structure, outcome, patients' perspective on care, 
        efficiency, and costs of care that relate to services 
        furnished in such hospitals on the Internet website of 
        the Centers for Medicare & Medicaid Services.

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