HR 27 IHCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes.CommentsClose CommentsPermalink

January 6, 2009CommentsClose CommentsPermalink

Mrs. BIGGERT introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce and the Judiciary, 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 concernedCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes.CommentsClose CommentsPermalink

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title- This Act may be cited as the ‘Medicare Fraud Prevention and Enforcement Act of 2009’.CommentsClose CommentsPermalink





(b) Table of Contents- The table of contents for this Act is as follows:CommentsClose CommentsPermalink





Sec. 1. Short title; table of contents.CommentsClose CommentsPermalink





Sec. 2. Site inspections and background checks.CommentsClose CommentsPermalink





Sec. 3. Registration of billing agencies.CommentsClose CommentsPermalink





Sec. 4. Expanded access to the health integrity protection database (HIPDB).CommentsClose CommentsPermalink





Sec. 5. Liability of medicare carriers and fiscal intermediaries for claims submitted by excluded providers.CommentsClose CommentsPermalink





Sec. 6. Community mental health centers.CommentsClose CommentsPermalink





Sec. 7. Limiting the use of discharge in bankruptcy proceedings for provider liability for health care fraud.CommentsClose CommentsPermalink





Sec. 8. Illegal distribution of a medicare or medicaid beneficiary identification or provider number.CommentsClose CommentsPermalink





Sec. 9. Treatment of certain Social Security Act crimes as Federal health care offenses.CommentsClose CommentsPermalink





Sec. 10. Authority of Office of Inspector General of the Department of Health and Human Services.CommentsClose CommentsPermalink





Sec. 11. Universal product numbers on claims forms for reimbursement under the medicare program.CommentsClose CommentsPermalink

SEC. 2. SITE INSPECTIONS AND BACKGROUND CHECKS.

(a) Site Inspections for DME Suppliers, Community Mental Health Centers, and Other Provider Groups- Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by adding at the end the following:CommentsClose CommentsPermalink

‘SITE INSPECTIONS FOR DME SUPPLIERS, COMMUNITY MENTAL HEALTH CENTERS, AND OTHER PROVIDER GROUPS

‘Sec. 1899. (a) Site Inspections-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Secretary shall conduct a site inspection for each applicable provider (as defined in paragraph (2)) that applies for a provider number in order to provide items or services under this title. Such site inspection shall be in addition to any other site inspection that the Secretary would otherwise conduct with regard to an applicable provider.CommentsClose CommentsPermalink





‘(2) APPLICABLE PROVIDER DEFINED-CommentsClose CommentsPermalink





‘(A) IN GENERAL- Except as provided in subparagraph (B), in this section the term ‘applicable provider’ means--CommentsClose CommentsPermalink





‘(i) a supplier of durable medical equipment (including items described in section 1834(a)(13));CommentsClose CommentsPermalink





‘(ii) a supplier of prosthetics, orthotics, or supplies (including items described in paragraphs (8) and (9) of section 1861(s));CommentsClose CommentsPermalink





‘(iii) a community mental health center; orCommentsClose CommentsPermalink





‘(iv) any other provider group, as determined by the Secretary.CommentsClose CommentsPermalink





‘(B) EXCEPTION- In this section, the term ‘applicable provider’ does not include--CommentsClose CommentsPermalink





‘(i) a physician that provides durable medical equipment (as described in subparagraph (A)(i)) or prosthetics, orthotics, or supplies (as described in subparagraph (A)(ii)) to an individual as incident to an office visit by such individual; orCommentsClose CommentsPermalink





‘(ii) a hospital that provides durable medical equipment (as described in subparagraph (A)(i)) or prosthetics, orthotics, or supplies (as described in subparagraph (A)(ii)) to an individual as incident to an emergency room visit by such individual.CommentsClose CommentsPermalink





‘(b) Standards and Requirements- In conducting the site inspection pursuant to subsection (a), the Secretary shall ensure that the site being inspected is in full compliance with all the conditions and standards of participation and requirements for obtaining medicare billing privileges under this title.CommentsClose CommentsPermalink





‘(c) Time- The Secretary shall conduct the site inspection for an applicable provider prior to the issuance of a provider number to such provider.CommentsClose CommentsPermalink





‘(d) Timely Review- The Secretary shall provide for procedures to ensure that the site inspection required under this section does not unreasonably delay the issuance of a provider number to an applicable provider.’.CommentsClose CommentsPermalink





(b) Background Checks- Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) (as amended by subsection (a)) is amended by adding at the end the following:CommentsClose CommentsPermalink

‘BACKGROUND CHECKS

‘Sec. 1899A. (a) Background Check Required- Except as provided in subsection (b), the Secretary shall conduct a background check on any individual or entity that applies to the Secretary for a provider number for the purpose of furnishing any item or service under this title. In performing the background check, the Secretary shall--CommentsClose CommentsPermalink





‘(1) conduct the background check before issuing a provider number to an individual or entity;CommentsClose CommentsPermalink





‘(2) include a search of criminal records in the background check; andCommentsClose CommentsPermalink





‘(3) provide for procedures that ensure the background check does not unreasonably delay the issuance of a provider number to an eligible individual or entity.CommentsClose CommentsPermalink





‘(b) Use of State Licensing Procedure- The Secretary may use the results of a State licensing procedure as a background check under subsection (a) if the State licensing procedure meets the requirements of subsection (a).CommentsClose CommentsPermalink





‘(c) Attorney General Required To Provide Information-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Upon request of the Secretary, the Attorney General shall provide the criminal background check information referred to in subsection (a)(2) to the Secretary.CommentsClose CommentsPermalink





‘(2) RESTRICTION ON USE OF DISCLOSED INFORMATION- The Secretary may only use the information disclosed under subsection (a) for the purpose of carrying out the Secretary’s responsibilities under this title.CommentsClose CommentsPermalink





‘(d) Refusal To Issue Provider Number-CommentsClose CommentsPermalink





‘(1) AUTHORITY- In addition to any other remedy available to the Secretary, the Secretary may refuse to issue a provider number to an individual or entity if the Secretary determines, after a background check conducted under this section, that such individual or entity has a history of acts that indicate issuance of a provider number to such individual or entity would be detrimental to the best interests of the program or program beneficiaries. Such acts may include--CommentsClose CommentsPermalink





‘(A) any bankruptcy;CommentsClose CommentsPermalink





‘(B) any act resulting in a civil judgment against such individual or entity; orCommentsClose CommentsPermalink





‘(C) any felony conviction under Federal or State law.CommentsClose CommentsPermalink





‘(2) REPORTING OF REFUSAL TO ISSUE PROVIDER NUMBER TO THE HEALTH INTEGRITY PROTECTION DATABASE (HIPDB)- A determination to refuse to issue a provider number to an individual or entity as a result of a background check conducted under this section shall be reported to the health integrity protection database established under section 1128E in accordance with the procedures for reporting final adverse actions taken against a health care provider, supplier, or practitioner under that section.’.CommentsClose CommentsPermalink





(c) Regulations; Effective Date-CommentsClose CommentsPermalink





(1) REGULATIONS- Not later than one year after the date of the enactment of this Act, the Secretary of Health and Human Services shall promulgate such regulations as are necessary to implement the amendments made by subsections (a) and (b).CommentsClose CommentsPermalink





(2) EFFECTIVE DATE- The amendments made by subsections (a) and (b) shall apply to applications for a provider number received by the Secretary of Health and Human Services on or after the first day of the first year beginning after the date of the enactment of this Act.CommentsClose CommentsPermalink





(d) Use of Medicare Integrity Program Funds- The Secretary of Health and Human Services may use funds appropriated or transferred for purposes of carrying out the medicare integrity program established under section 1893 of the Social Security Act (42 U.S.C. 1395ddd) to carry out the provisions of sections 1899 and 1899A of that Act (as added by subsections (a) and (b)).CommentsClose CommentsPermalink

SEC. 3. REGISTRATION OF BILLING AGENCIES.

(a) Registration of Billing Agencies and Individuals- Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) (as amended by section 2(b)) is amended by adding at the end the following:CommentsClose CommentsPermalink

‘REGISTRATION OF BILLING AGENCIES AND INDIVIDUALS

‘Sec. 1899B. (a) Registration- The Secretary shall establish procedures for the registration of all applicable persons.CommentsClose CommentsPermalink





‘(b) Required Application- Each applicable person shall submit a registration application to the Secretary at such time, in such manner, and accompanied by such information as the Secretary may require.CommentsClose CommentsPermalink





‘(c) Identification Number- If the Secretary approves an application submitted under subsection (b), the Secretary shall assign a unique identification number to the applicable person.CommentsClose CommentsPermalink





‘(d) Requirement- Every claim for reimbursement under this title that is compiled and submitted by an applicable person shall contain the identification number that is assigned to the applicable person pursuant to subsection (c).CommentsClose CommentsPermalink





‘(e) Timely Review- The Secretary shall provide for procedures that ensure the timely consideration and determination regarding approval of applications under this section.CommentsClose CommentsPermalink





‘(f) Definition of Applicable Person- In this section, the term ‘applicable person’ means an individual or an entity that compiles and submits claims for reimbursement under this title to the Secretary on behalf of any individual or entity.’.CommentsClose CommentsPermalink





(b) Permissive Exclusion- Section 1128(b) of the Social Security Act (42 U.S.C. 1320a-7(b)) is amended by adding at the end the following:CommentsClose CommentsPermalink





‘(16) FRAUD BY APPLICABLE PERSON- An applicable person (as defined in section 1899B(f)) that the Secretary determines knowingly submitted or caused to be submitted a claim for reimbursement under title XVIII that the applicable person knows or should know is false or fraudulent.’.CommentsClose CommentsPermalink





(c) Regulations; Effective Date-CommentsClose CommentsPermalink





(1) REGULATIONS- Not later than one year after the date of the enactment of this Act, the Secretary of Health and Human Services shall promulgate such regulations as are necessary to implement the amendments made by subsections (a) and (b).CommentsClose CommentsPermalink





(2) EFFECTIVE DATE- The amendments made by subsections (a) and (b) shall take effect on the first day of the first year beginning after the date of the enactment of this Act.CommentsClose CommentsPermalink

SEC. 4. EXPANDED ACCESS TO THE HEALTH INTEGRITY PROTECTION DATABASE (HIPDB).

(a) In General- Section 1128E(d)(1) of the Social Security Act (42 U.S.C. 1320a-7e(d)(1)) is amended to read as follows:CommentsClose CommentsPermalink





‘(1) AVAILABILITY- The information in the database maintained under this section shall be available to--CommentsClose CommentsPermalink





‘(A) Federal and State government agencies and health plans, and any health care provider, supplier, or practitioner entering an employment or contractual relationship with an individual or entity who could potentially be the subject of a final adverse action, where the contract involves the furnishing of items or services reimbursed by one or more Federal health care programs (regardless of whether the individual or entity is paid by the programs directly, or whether the items or services are reimbursed directly or indirectly through the claims of a direct provider); andCommentsClose CommentsPermalink





‘(B) utilization and quality control peer review organizations and accreditation entities as defined by the Secretary, including but not limited to organizations described in part B of this title and in section 1154(a)(4)(C).’.CommentsClose CommentsPermalink





(b) Criminal Penalty for Misuse of Information- Section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)) is amended by adding at the end the following:CommentsClose CommentsPermalink





‘(4) Whoever knowingly uses information maintained in the health integrity protection database maintained in accordance with section 1128E for a purpose other than a purpose authorized under that section shall be imprisoned for not more than three years or fined under title 18, United States Code, or both.’.CommentsClose CommentsPermalink





(c) Effective Date- The amendments made by this section shall take effect on the date of the enactment of this Act.CommentsClose CommentsPermalink

SEC. 5. LIABILITY OF MEDICARE ADMINISTRATIVE CONTRACTORS FOR CLAIMS SUBMITTED BY EXCLUDED PROVIDERS.

(a) Reimbursement to the Secretary for Amounts Paid to Excluded Providers- Section 1874A(b) of the Social Security Act (42 U.S.C. 1395kk(b)) is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(6) REIMBURSEMENTS TO SECRETARY FOR AMOUNTS PAID TO EXCLUDED PROVIDERS- The Secretary shall not enter into a contract with a medicare administrative contractor under this section unless the contractor agrees to reimburse the Secretary for any amounts paid by the contractor for a service under this title which is furnished by an individual or entity during any period for which the individual or entity is excluded, pursuant to section 1128, 1128A, or 1156, from participation in the health care program under this title if the amounts are paid after the 60-day period beginning on the date the Secretary provides notice of the exclusion to the contractor, unless the payment was made as a result of incorrect information provided by the Secretary or the individual or entity excluded from participation has concealed or altered their identity.’.CommentsClose CommentsPermalink





(b) Conforming Repeal of Mandatory Payment Rule- Section 1862(e) of the Social Security Act (42 U.S.C. 1395y(e)) is amended--CommentsClose CommentsPermalink





(1) in paragraph (1)(B), by striking ‘and when the person’ and all that follows through ‘person)’; andCommentsClose CommentsPermalink





(2) by amending paragraph (2) to read as follows:CommentsClose CommentsPermalink





‘(2) No individual or entity may bill (or collect any amount from) any individual for any item or service for which payment is denied under paragraph (1). No individual is liable for payment of any amounts billed for such an item or service in violation of the preceding sentence.’.CommentsClose CommentsPermalink





(c) Effective Date-CommentsClose CommentsPermalink





(1) IN GENERAL- The amendments made by this section shall apply to claims for payment submitted on or after the date of enactment of this Act.CommentsClose CommentsPermalink





(2) CONTRACT MODIFICATION- The Secretary of Health and Human Services shall take such steps as may be necessary to modify contracts entered into, renewed, or extended prior to the date of enactment of this Act to conform such contracts to the provisions of this section.CommentsClose CommentsPermalink

SEC. 6. COMMUNITY MENTAL HEALTH CENTERS.

(a) In General- Section 1861(ff)(3)(B) of the Social Security Act (42 U.S.C. 1395x(ff)(3)(B)) is amended by striking ‘entity that--’ and all that follows and inserting the following: ‘entity that--CommentsClose CommentsPermalink





‘(i) provides the community mental health services specified in paragraph (1) of section 1913(c) of the Public Health Service Act;CommentsClose CommentsPermalink





‘(ii) meets applicable certification or licensing requirements for community mental health centers in the State in which it is located;CommentsClose CommentsPermalink





‘(iii) provides a significant share of its services to individuals who are not eligible for benefits under this title; andCommentsClose CommentsPermalink





‘(iv) meets such additional standards or requirements for obtaining medicare billing privileges as the Secretary may specify to ensure--CommentsClose CommentsPermalink





‘(I) the health and safety of beneficiaries receiving such services; orCommentsClose CommentsPermalink





‘(II) the furnishing of such services in an effective and efficient manner.’.CommentsClose CommentsPermalink





(b) Restriction- Section 1861(ff)(3)(A) of such Act (42 U.S.C. 1395x(ff)(3)(A)) is amended by inserting ‘other than in an individual’s home or in an inpatient or residential setting’ before the period.CommentsClose CommentsPermalink





(c) Effective Date- The amendments made by this section shall apply to items and services furnished on or after the first day of the sixth month that begins after the date of the enactment of this Act.CommentsClose CommentsPermalink

SEC. 7. LIMITING THE DISCHARGE OF DEBTS IN BANKRUPTCY PROCEEDINGS IN CASES WHERE A HEALTH CARE PROVIDER OR A SUPPLIER ENGAGES IN FRAUDULENT ACTIVITY.

(a) In General-CommentsClose CommentsPermalink





(1) CIVIL MONETARY PENALTIES- Section 1128A(a) of the Social Security Act (42 U.S.C. 1320a-7a(a)) is amended by adding at the end the following: ‘Notwithstanding any other provision of law, amounts made payable under this section are not dischargeable under section 727, 944, 1141, 1228, or 1328 of title 11, United States Code, or any other provision of such title.’.CommentsClose CommentsPermalink





(2) RECOVERY OF OVERPAYMENT TO PROVIDERS OF SERVICES UNDER PART A OF MEDICARE- Section 1815(d) of the Social Security Act (42 U.S.C. 1395g(d)) is amended--CommentsClose CommentsPermalink





(A) by inserting ‘(1)’ after ‘(d)’; andCommentsClose CommentsPermalink





(B) by adding at the end the following:CommentsClose CommentsPermalink





‘(2) Notwithstanding any other provision of law, amounts due to the Secretary under this section are not dischargeable under section 727, 944, 1141, 1228, or 1328 of title 11, United States Code, or any other provision of such title if the overpayment was the result of fraudulent activity, as may be defined by the Secretary.’.CommentsClose CommentsPermalink





(3) RECOVERY OF OVERPAYMENT OF BENEFITS UNDER PART b OF MEDICARE- Section 1833(j) of the Social Security Act (42 U.S.C. 1395l(j)) is amended--CommentsClose CommentsPermalink





(A) by inserting ‘(1)’ after ‘(j)’; andCommentsClose CommentsPermalink





(B) by adding at the end the following:CommentsClose CommentsPermalink





‘(2) Notwithstanding any other provision of law, amounts due to the Secretary under this section are not dischargeable under section 727, 944, 1141, 1228, or 1328 of title 11, United States Code, or any other provision of such title if the overpayment was the result of fraudulent activity, as may be defined by the Secretary.’.CommentsClose CommentsPermalink





(4) COLLECTION OF PAST-DUE OBLIGATIONS ARISING FROM BREACH OF SCHOLARSHIP AND LOAN CONTRACT- Section 1892(a) of the Social Security Act (42 U.S.C. 1395ccc(a)) is amended by adding at the end the following:CommentsClose CommentsPermalink





‘(5) Notwithstanding any other provision of law, amounts due to the Secretary under this section are not dischargeable under section 727, 944, 1141, 1228, or 1328 of title 11, United States Code, or any other provision of such title.’.CommentsClose CommentsPermalink





(b) Effective Date- The amendments made by subsection (a) shall apply to bankruptcy petitions filed after the date of the enactment of this Act.CommentsClose CommentsPermalink

SEC. 8. ILLEGAL DISTRIBUTION OF A MEDICARE OR MEDICAID BENEFICIARY IDENTIFICATION OR PROVIDER NUMBER.

Section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)), as amended by section 4(b), is amended by adding at the end the following:CommentsClose CommentsPermalink





‘(5) Whoever knowingly, intentionally, and with the intent to defraud purchases, sells or distributes, or arranges for the purchase, sale, or distribution of two or more medicare or medicaid beneficiary identification numbers or provider numbers shall be imprisoned for not more than three years or fined under title 18, United States Code (or, if greater, an amount equal to the monetary loss to the Federal and any State government as a result of such acts), or both.’.CommentsClose CommentsPermalink

SEC. 9. TREATMENT OF CERTAIN SOCIAL SECURITY ACT CRIMES AS FEDERAL HEALTH CARE OFFENSES.

(a) In General- Section 24(a) of title 18, United States Code, is amended--CommentsClose CommentsPermalink





(1) by striking the period at the end of paragraph (2) and inserting ‘; or’; andCommentsClose CommentsPermalink





(2) by adding at the end the following:CommentsClose CommentsPermalink





‘(3) section 1128B of the Social Security Act (42 U.S.C. 1320a-7b).’.CommentsClose CommentsPermalink





(b) Effective Date- The amendment made by subsection (a) shall take effect on the date of the enactment of this Act and apply to acts committed on or after the date of the enactment of this Act.CommentsClose CommentsPermalink

SEC. 10. AUTHORITY OF OFFICE OF INSPECTOR GENERAL OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES.

(a) Authority- Notwithstanding any other provision of law, upon designation by the Inspector General of the Department of Health and Human Services, any criminal investigator of the Office of Inspector General of such department may, in accordance with guidelines issued by the Secretary of Health and Human Services and approved by the Attorney General, while engaged in activities within the lawful jurisdiction of such Inspector General--CommentsClose CommentsPermalink





(1) obtain and execute any warrant or other process issued under the authority of the United States;CommentsClose CommentsPermalink





(2) make an arrest without a warrant for--CommentsClose CommentsPermalink





(A) any offense against the United States committed in the presence of such investigator; orCommentsClose CommentsPermalink





(B) any felony offense against the United States, if such investigator has reasonable cause to believe that the person to be arrested has committed or is committing that felony offense; andCommentsClose CommentsPermalink





(3) exercise any other authority necessary to carry out the authority described in paragraphs (1) and (2).CommentsClose CommentsPermalink





(b) Funds- The Office of Inspector General of the Department of Health and Human Services may receive and expend funds that represent the equitable share from the forfeiture of property in investigations in which the Office of Inspector General participated, and that are transferred to the Office of Inspector General by the Department of Justice, the Department of the Treasury, or the United States Postal Service. Such equitable sharing funds shall be deposited in a separate account and shall remain available until expended.CommentsClose CommentsPermalink

SEC. 11. UNIVERSAL PRODUCT NUMBERS ON CLAIMS FORMS FOR REIMBURSEMENT UNDER THE MEDICARE PROGRAM.

(a) UPNs on Claims Forms for Reimbursement Under the Medicare Program-CommentsClose CommentsPermalink





(1) ACCOMMODATION OF UPNS ON MEDICARE CLAIMS FORMS- Not later than July 1, 2010, all claims forms developed or used by the Secretary of Health and Human Services for reimbursement under the medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) shall accommodate the use of universal product numbers for a UPN covered item.CommentsClose CommentsPermalink





(2) REQUIREMENT FOR PAYMENT OF CLAIMS- Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), as amended by sections 2(b) and 3(a), is amended by adding at the end the following:CommentsClose CommentsPermalink

‘USE OF UNIVERSAL PRODUCT NUMBERS

‘Sec. 1899C. (a) In General- No payment shall be made under this title for any claim for reimbursement for any UPN covered item unless the claim contains the universal product number of the UPN covered item.CommentsClose CommentsPermalink





‘(b) Definitions- In this section:CommentsClose CommentsPermalink





‘(1) UPN COVERED ITEM-CommentsClose CommentsPermalink





‘(A) IN GENERAL- Except as provided in subparagraph (B), the term ‘UPN covered item’ means--CommentsClose CommentsPermalink





‘(i) a covered item as that term is defined in section 1834(a)(13);CommentsClose CommentsPermalink





‘(ii) an item described in paragraph (8) or (9) of section 1861(s);CommentsClose CommentsPermalink





‘(iii) an item described in paragraph (5) of section 1861(s); andCommentsClose CommentsPermalink





‘(iv) any other item for which payment is made under this title that the Secretary determines to be appropriate.CommentsClose CommentsPermalink





‘(B) EXCLUSION- The term ‘UPN covered item’ does not include a customized item for which payment is made under this title.CommentsClose CommentsPermalink





‘(2) UNIVERSAL PRODUCT NUMBER- The term ‘universal product number’ means a number that is--CommentsClose CommentsPermalink





‘(A) affixed by the manufacturer to each individual UPN covered item that uniquely identifies the item at each packaging level; andCommentsClose CommentsPermalink





‘(B) based on commercially acceptable identification standards such as, but not limited to, standards established by the Uniform Code Council-International Article Numbering System or the Health Industry Business Communication Council.’.CommentsClose CommentsPermalink





(3) DEVELOPMENT AND IMPLEMENTATION OF PROCEDURES-CommentsClose CommentsPermalink





(A) INFORMATION INCLUDED IN UPN- The Secretary of Health and Human Services, in consultation with manufacturers and entities with appropriate expertise, shall determine the relevant descriptive information appropriate for inclusion in a universal product number for a UPN covered item.CommentsClose CommentsPermalink





(B) REVIEW OF PROCEDURE- From the information obtained by the use of universal product numbers on claims for reimbursement under the medicare program, the Secretary of Health and Human Services, in consultation with interested parties, shall periodically review the UPN covered items billed under the Health Care Financing Administration Common Procedure Coding System and adjust such coding system to ensure that functionally equivalent UPN covered items are billed and reimbursed under the same codes.CommentsClose CommentsPermalink





(4) EFFECTIVE DATE- The amendment made by paragraph (2) shall apply to claims for reimbursement submitted on and after July 1, 2010.CommentsClose CommentsPermalink





(b) Study and Reports to Congress-CommentsClose CommentsPermalink





(1) STUDY- The Secretary of Health and Human Services shall conduct a study on the results of the implementation of the provisions in paragraph (1) and (3) of subsection (a) and the amendment to the Social Security Act in paragraph (2) of that subsection.CommentsClose CommentsPermalink





(2) REPORTS-CommentsClose CommentsPermalink





(A) PROGRESS REPORT- Not later than six months after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report that contains a detailed description of the progress of the matters studied pursuant to paragraph (1).CommentsClose CommentsPermalink





(B) IMPLEMENTATION- Not later than 18 months after the date of the enactment of this Act, and annually thereafter for three years, the Secretary of Health and Human Services shall submit to Congress a report that contains a detailed description of the results of the study conducted pursuant to paragraph (1), together with the Secretary’s recommendations regarding the use of universal product numbers and the use of data obtained from the use of such numbers.CommentsClose CommentsPermalink





(c) Definitions- In this section:CommentsClose CommentsPermalink





(1) UPN COVERED ITEM- The term ‘UPN covered item’ has the meaning given such term in section 1899C(b)(1) of the Social Security Act (as added by subsection (a)(2)).CommentsClose CommentsPermalink





(2) UNIVERSAL PRODUCT NUMBER- The term ‘universal product number’ has the meaning given such term in section 1899C(b)(2) of the Social Security Act (as added by subsection (a)(2)).CommentsClose CommentsPermalink





(d) Authorization of Appropriations- There are authorized to be appropriated such sums as may be necessary for the purpose of carrying out the provisions in paragraphs (1) and (3) of subsection (a), subsection (b), and section 1899C of the Social Security Act (as added by subsection (a)(2)).CommentsClose CommentsPermalink