[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5715 Introduced in House (IH)]
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115th CONGRESS
2d Session
H. R. 5715
To amend title XVIII of the Social Security Act to provide for certain
program integrity transparency measures under Medicare parts C and D.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 9, 2018
Mr. Renacci (for himself, Ms. Sewell of Alabama, Mr. Guthrie, and Mr.
Peters) introduced the following bill; which was referred to the
Committee on Ways and Means, and in addition to the Committee on Energy
and Commerce, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for certain
program integrity transparency measures under Medicare parts C and D.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Strengthening Partnerships to
Prevent Opioid Abuse Act''.
SEC. 2. PROGRAM INTEGRITY TRANSPARENCY MEASURES UNDER MEDICARE PARTS C
AND D.
(a) In General.--Section 1859 of the Social Security Act (42 U.S.C.
1395w-28) is amended by adding at the end the following new subsection:
``(i) Program Integrity Transparency Measures.--
``(1) Program integrity portal.--
``(A) In general.--Not later than two years after
the date of the enactment of this subsection, the
Secretary shall, after consultation with stakeholders,
establish a secure Internet website portal (or other
successor technology) that would allow a secure path
for communication between the Secretary, MA plans under
this part, prescription drug plans under part D, and an
eligible entity with a contract under section 1893
(such as a Medicare drug integrity contractor or an
entity responsible for carrying out program integrity
activities under this part and part D) for the purpose
of enabling through such portal (or other successor
technology)--
``(i) the referral by such plans of
substantiated fraud, waste, and abuse for
initiating or assisting investigations
conducted by the eligible entity; and
``(ii) data sharing among such MA plans,
prescription drug plans, and the Secretary.
``(B) Required uses of portal.--The Secretary shall
disseminate the following information to MA plans under
this part and prescription drug plans under part D
through the secure Internet website portal (or other
successor technology) established under subparagraph
(A):
``(i) Providers of services and suppliers
that have been referred pursuant to
subparagraph (A)(i) during the previous 12-
month period.
``(ii) Providers of services and suppliers
who are the subject of an active exclusion
under section 1128 or who are subject to a
suspension of payment under this title pursuant
to section 1862(o) or otherwise.
``(iii) Providers of services and suppliers
who are the subject of an active revocation of
participation under this title, including for
not satisfying conditions of participation.
``(iv) In the case of such a plan that
makes a referral under subparagraph (A)(i)
through the portal (or other successor
technology) with respect to activities of
substantiated fraud, waste, or abuse of a
provider of services or supplier, if such
provider or supplier has been the subject of an
administrative action under this title or title
XI with respect to similar activities, a
notification to such plan of such action so
taken.
``(C) Rulemaking.--For purposes of this paragraph,
the Secretary shall, through rulemaking, specify what
constitutes substantiated fraud, waste, and abuse,
using guidance such as what is provided in the Medicare
Program Integrity Manual 4.7.1.
``(D) HIPAA compliant information only.--For
purposes of this subsection, communications may only
occur if the communications are permitted under the
Federal regulations (concerning the privacy of
individually identifiable health information)
promulgated under section 264(c) of the Health
Insurance Portability and Accountability Act of 1996.
``(2) Quarterly reports.--Beginning two years after the
date of enactment of this subsection, the Secretary shall make
available to MA plans under this part and prescription drug
plans under part D in a timely manner (but no less frequently
than quarterly) and using information submitted to an entity
described in paragraph (1) through the portal (or other
successor technology) described in such paragraph or pursuant
to section 1893, information on fraud, waste, and abuse schemes
and trends in identifying suspicious activity. Information
included in each such report shall--
``(A) include administrative actions, pertinent
information related to opioid overprescribing, and
other data determined appropriate by the Secretary in
consultation with stakeholders; and
``(B) be anonymized information submitted by plans
without identifying the source of such information.
``(3) Clarification.--Nothing in this subsection shall be
construed as precluding or otherwise affecting referrals
described in subparagraph (A) that may otherwise be made to law
enforcement entities or to the Secretary.''.
(b) Contract Requirement To Communicate Plan Corrective Actions
Against Opioids Over-prescribers.--Section 1857(e)(4)(C) of the Social
Security Act (42 U.S.C. 1395w-27(e)(4)(C)) is amended by adding at the
end the following new paragraph:
``(5) Communicating plan corrective actions against opioids
over-prescribers.--
``(A) In general.--Beginning with plan years
beginning on or after January 1, 2021, a contract under
this section with an MA organization shall require the
organization to submit to the Secretary, through the
process established under subparagraph (B), information
on the investigations and other actions taken by such
plans related to providers of services who prescribe a
high volume of opioids.
``(B) Process.--Not later than January 1, 2021, the
Secretary shall, in consultation with stakeholders,
establish a process under which MA plans and
prescription drug plans shall submit to the Secretary
information described in subparagraph (A).
``(C) Regulations.--For purposes of this paragraph,
including as applied under section 1860D-12(b)(3)(D),
the Secretary shall, pursuant to rulemaking--
``(i) specify a definition for the term
`high volume of opioids' and a method for
determining if a provider of services
prescribes such a high volume; and
``(ii) establish the process described in
subparagraph (B) and the types of information
that shall be submitted through such
process.''.
(c) Reference Under Part D to Program Integrity Transparency
Measures.--Section 1860D-4 of the Social Security Act (42 U.S.C. 1395w-
104) is amended by adding at the end the following new subsection:
``(m) Program Integrity Transparency Measures.--For program
integrity transparency measures applied with respect to prescription
drug plan and MA plans, see section 1859(i).''.
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