SEC. 4301. PERMANENT EXCLUSION FOR THOSE CONVICTED OF 3 HEALTH CARE RELATED CRIMES.
Section 1128(c)(3) (42 U.S.C. 1320a-7(c)(3)) is amended-- (1) in subparagraph (A), by inserting "or in the case described in subparagraph (G)" after "subsection (b)(12)"; (2) in subparagraphs (B) and (D), by striking "In the case" and inserting "Subject to subparagraph (G), in the case"; and (3) by adding at the end the following new subparagraph: (G) In the case of an exclusion of an individual under subsection (a) based on a conviction occurring on or after the date of the enactment of this subparagraph, if the individual has (before, on, or after such date) been convicted-- (i) on one previous occasion of one or more offenses for which an exclusion may be effected under such subsection, the period of the exclusion shall be not less than 10 years, or (ii) on 2 or more previous occasions of one or more offenses for which an exclusion may be effected under such subsection, the period of the exclusion shall be permanent.".
(a) Medicare Part A.--Section 1866(b)(2) (42 U.S.C. 1395cc(b)(2)) is amended-- (1) in subparagraph (B), by striking "or" at the end; (2) in subparagraph (C), by striking the period at the end and inserting ", or"; and (3) by adding at the end the following new subparagraph: (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.".
(b) Medicare Part B.--Section 1842(h) (42 U.S.C. 1395u(h)) is amended by adding at the end the following new paragraph: (8) The Secretary may refuse to enter into an agreement with a physician or supplier under this subsection, or may terminate or refuse to renew such agreement, in the event that such physician or supplier 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.".
(c) Effective Date.--The amendments made by this section shall take effect on the date of the enactment of this Act and apply to the entry and renewal of contracts on or after such date.
(a) In General.--Section 1128 (42 U.S.C. 1320a-7) is amended-- (1) in subsection (b)(8)(A)-- (A) in clause (i), by striking "or" at the end; (B) in clause (ii), by striking the dash at the end and inserting "; or"; and (C) by inserting after clause (ii) the following: (iii) who was described in clause (i) but is no longer so described because of a transfer of ownership or control interest, in anticipation of (or following) a conviction, assessment, or exclusion described in subparagraph (B) against the person, to an immediate family member (as defined in subsection (j)(1)) or a member of the household of the person (as defined in subsection (j)(2)) who continues to maintain an interest described in such clause--"; and (2) by adding at the end the following new subsection: (j) Definition of Immediate Family Member and Member of Household.--For purposes of subsection (b)(8)(A)(iii): (1) The term `immediate family member' means, with respect to a person-- (A) the husband or wife of the person; (B) the natural or adoptive parent, child, or sibling of the person; (C) the stepparent, stepchild, stepbrother, or stepsister of the person; (D) the father-, mother-, daughter-, son-, brother-, or sister-in-law of the person; (E) the grandparent or grandchild of the person; and (F) the spouse of a grandparent or grandchild of the person.
(2) The term `member of the household' means, with respect to any person, any individual sharing a common abode as part of a single family unit with the person, including domestic employees and others who live together as a family unit, but not including a roomer or boarder.".
(b) Effective Date.--The amendments made by this section shall take effect on the date that is 45 days after the date of the enactment of this Act.
(a) Civil Money Penalties for Persons That Contract With Excluded Individuals.--Section 1128A(a) (42 U.S.C. 1320a-7a(a)) is amended-- (1) in paragraph (4), by striking "or" at the end; (2) in paragraph (5), by adding or" at the end; and (3) by inserting after paragraph (5) the following new paragraph: (6) arranges or contracts (by employment or otherwise) with an individual or entity that the person knows or should know is excluded from participation in a Federal health care program (as defined in section 1128B(f)), for the provision of items or services for which payment may be made under such a program;".
(b) Civil Money Penalties for Kickbacks.-- (1) Permitting secretary to impose civil money penalty.-- Section 1128A(a) (42 U.S.C. 1320a-7a(a)), as amended by subsection (a), is amended-- (A) in paragraph (5), by striking "or" at the end; (B) in paragraph (6), by adding or" at the end; and (C) by adding after paragraph (6) the following new paragraph: (7) commits an act described in paragraph (1) or (2) of section 1128B(b);".
(2) Description of civil money penalty applicable.--Section 1128A(a) (42 U.S.C. 1320a-7a(a)), as amended by paragraph (1), is amended in the matter following paragraph (7)-- (A) by striking "occurs)." and inserting "occurs; or in cases under paragraph (7), $50,000 for each such act)."; and (B) by inserting "after of such claim" the following: (or, in cases under paragraph (7), damages of not more than 3 times the total amount of remuneration offered, paid, solicited, or received, without regard to whether a portion of such remuneration was offered, paid, solicited, or received for a lawful purpose)".
(c) Effective Dates.-- (1) Contracts with excluded persons.--The amendments made by subsection (a) shall apply to arrangements and contracts entered into after the date of the enactment of this Act.
(2) Kickbacks.--The amendments made by subsection (b) shall apply to acts committed after the date of the enactment of this Act.
SEC. 4311. IMPROVING INFORMATION TO MEDICARE BENEFICIARIES.
(a) Inclusion of Information Regarding Medicare Waste, Fraud, and Abuse in Annual Notice.-- (1) In General.--Section 1804 (42 U.S.C. 1395b-2) is amended by adding at the end the following new subsection: (c) The notice provided under subsection (a) shall include-- (1) a statement which indicates that because errors do occur and because medicare fraud, waste, and abuse is a significant problem, beneficiaries should carefully check any explanation of benefits or itemized statement furnished pursuant to section 1806 for accuracy and report any errors or questionable charges by calling the toll-free phone number described in paragraph (4); (2) a statement of the beneficiary's right to request an itemized statement for medicare items and services (as provided in section 1806(b)); (3) a description of the program to collect information on medicare fraud and abuse established under section 203(b) of the Health Insurance Portability and Accountability Act of 1996; and (4) a toll-free telephone number maintained by the Inspector General in the Department of Health and Human Services for the receipt of complaints and information about waste, fraud, and abuse in the provision or billing of services under this title.".
(2) Effective date.--The amendment made by this subsection shall apply to notices provided on or after January 1, 1998.
(b) Clarification of Requirement To Provide Explanation of Medicare Benefits.-- (1) In general.--Title XVIII is amended by inserting after section 1805 (as added by section 4022) the following new section:
Sec. 1806. (a) In General.--The Secretary shall furnish to each individual for whom payment has been made under this title (or would be made without regard to any deductible) a statement which-- (1) lists the item or service for which payment has been made and the amount of such payment for each item or service; and (2) includes a notice of the individual's right to request an itemized statement (as provided in subsection (b)).
(b) Request for Itemized Statement for Medicare Items and Services.-- (1) In general.--An individual may submit a written request to any physician, provider, supplier, or any other person (including an organization, agency, or other entity) for an itemized statement for any item or service provided to such individual by such person with respect to which payment has been made under this title.
(2) 30-day period to furnish statement.-- (A) In general.--Not later than 30 days after the date on which a request under paragraph (1) has been made, a person described in such paragraph shall furnish an itemized statement describing each item or service provided to the individual requesting the itemized statement.
(B) Penalty.--Whoever knowingly fails to furnish an itemized statement in accordance with subparagraph (A) shall be subject to a civil money penalty of not more than $100 for each such failure. Such penalty 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.
(3) Review of itemized statement.-- (A) In general.--Not later than 90 days after the receipt of an itemized statement furnished under paragraph (1), an individual may submit a written request for a review of the itemized statement to the Secretary.
(B) Specific allegations.--A request for a review of the itemized statement shall identify-- (i) specific items or services that the individual believes were not provided as claimed, or (ii) any other billing irregularity (including duplicate billing).
(4) Findings of secretary.--The Secretary shall, with respect to each written request submitted under paragraph (3), determine whether the itemized statement identifies specific items or services that were not provided as claimed or any other billing irregularity (including duplicate billing) that has resulted in unnecessary payments under this title.
(5) Recovery of amounts.--The Secretary shall take all appropriate measures to recover amounts unnecessarily paid under this title with respect to a statement described in paragraph (4).".
(2) Conforming amendment.--Subsection (a) of section 203 of the Health Insurance Portability and Accountability Act of 1996 is repealed.
(3) Effective dates.-- (A) Statement by secretary.--Paragraph (1) of section 1806(a) of the Social Security Act, as added by paragraph (1), and the repeal made by paragraph (2) shall take effect on the date of the enactment of this Act.
(B) Itemized statement.--Paragraph (2) of section 1806(a) and section 1806(b) of the Social Security Act, as so added, shall take effect not later than January 1, 1999.
(a) Disclosure of Information and Surety Bond Requirement for Suppliers of Durable Medical Equipment.--Section 1834(a) (42 U.S.C. 1395m(a)) is amended by inserting after paragraph (15) the following new paragraph: (16) Disclosure of information and surety bond.--The Secretary shall not provide for the issuance (or renewal) of a provider number for a supplier of durable medical equipment, for purposes of payment under this part for durable medical equipment furnished by the supplier, unless the supplier provides the Secretary on a continuing basis-- (A) with-- (i) full and complete information as to the identity of each person with an ownership or control interest (as defined in section 1124(a)(3)) in the supplier or in any subcontractor (as defined by the Secretary in regulations) in which the supplier directly or indirectly has a 5 percent or more ownership interest; and (ii) to the extent determined to be feasible under regulations of the Secretary, the name of any disclosing entity (as defined in section 1124(a)(2)) with respect to which a person with such an ownership or control interest in the supplier is a person with such an ownership or control interest in the disclosing entity; and (B) with a surety bond in a form specified by the Secretary and in an amount that is not less than $50,000.
The Secretary may waive the requirement of a bond under subparagraph (B) in the case of a supplier that provides a comparable surety bond under State law.".
(b) Surety Bond Requirement for Home Health Agencies.-- (1) In general.--Section 1861(o) (42 U.S.C. 1395x(o)) is amended-- (A) in paragraph (6), by striking "and" at the end; (B) by redesignating paragraph (7) as paragraph (8); (C) by inserting after paragraph (6) the following new paragraph: (7) provides the Secretary on a continuing basis with a surety bond in a form specified by the Secretary and in an amount that is not less than $50,000; and"; and (D) by adding at the end the following: The Secretary may waive the requirement of a surety bond under paragraph (7) in the case of an agency or organization that provides a comparable surety bond under State law.".
(2) Conforming amendments.--Section 1861(v)(1)(H) (42 U.S.C. 1395x(v)(1)(H)) is amended-- (A) in clause (i), by striking "the financial security requirement described in subsection (o)(7)" and inserting "the surety bond requirement described in subsection (o)(7) and the financial security requirement described in subsection (o)(8)"; and (B) in clause (ii), by striking "the financial security requirement described in subsection (o)(7) applies" and inserting "the surety bond requirement described in subsection (o)(7) and the financial security requirement described in subsection (o)(8) apply".
(3) Reference to current disclosure requirement.--For additional provisions requiring home health agencies to disclose information on ownership and control interests, see section 1124 of the Social Security Act (42 U.S.C. 1320a-3).
(c) Authorizing Application of Disclosure and Surety Bond Requirements to Other Health Care Providers.--Section 1834(a)(16) (42 U.S.C. 1395m(a)(16)), as added by subsection (a), is amended by adding at the end the following: The Secretary, at the Secretary's discretion, may impose the requirements of the first sentence with respect to some or all providers of items or services under part A or some or all suppliers or other persons (other than physicians or other practitioners, as defined in section 1842(b)(18)(C)) who furnish items or services under this part.".
(d) Application to Comprehensive Outpatient Rehabilitation Facilities (CORFs).--Section 1861(cc)(2) (42 U.S.C. 1395x(cc)(2)) is amended-- (1) in subparagraph (H), by striking "and" at the end; (2) by redesignating subparagraph (I) as subparagraph (J); (3) by inserting after subparagraph (H) the following new subparagraph: (I) provides the Secretary on a continuing basis with a surety bond in a form specified by the Secretary and in an amount that is not less than $50,000; and"; and (4) by adding at the end the following flush sentence: The Secretary may waive the requirement of a surety bond under subparagraph (I) in the case of a facility that provides a comparable surety bond under State law.".
(e) Application to Rehabilitation Agencies.--Section 1861(p) (42 U.S.C. 1395x(p)) is amended-- (1) in paragraph (4)(A)(v), by inserting after "as the Secretary may find necessary," the following: and provides the Secretary on a continuing basis with a surety bond in a form specified by the Secretary and in an amount that is not less than $50,000,", and (2) by adding at the end the following: The Secretary may waive the requirement of a surety bond under paragraph (4)(A)(v) in the case of a clinic or agency that provides a comparable surety bond under State law.".
(f) Effective Dates.-- (1) Suppliers of durable medical equipment.--The amendment made by subsection (a) shall apply to suppliers of durable medical equipment with respect to such equipment furnished on or after January 1, 1998.
(2) Home health agencies.--The amendments made by subsection (b) shall apply to home health agencies with respect to services furnished on or after January 1, 1998. The Secretary of Health and Human Services shall modify participation agreements under section 1866(a)(1) of the Social Security Act (42 U.S.C. 1395cc(a)(1)) with respect to home health agencies to provide for implementation of such amendments on a timely basis.
(3) Other amendments.--The amendments made by subsections (c) through (e) shall take effect on the date of the enactment of this Act and may be applied with respect to items and services furnished on or after January 1, 1998.
(a) Requirements To Disclose Employer Identification Numbers (EINS) and Social Security Account Numbers (SSNs).--Section 1124(a)(1) (42 U.S.C. 1320a-3(a)(1)) is amended by inserting before the period at the end the following: and supply the Secretary with the both the employer identification number (assigned pursuant to section 6109 of the Internal Revenue Code of 1986) and social security account number (assigned under section 205(c)(2)(B)) of the disclosing entity, each person with an ownership or control interest (as defined in subsection (a)(3)), and any subcontractor in which the entity directly or indirectly has a 5 percent or more ownership interest.
(b) Other Medicare Providers.--Section 1124A (42 U.S.C. 1320a-3a) is amended-- (1) in subsection (a)-- (A) in paragraph (1), by striking "and" at the end; (B) in paragraph (2), by striking the period at the end and inserting "; and"; and (C) by adding at the end the following new paragraph: (3) including the employer identification number (assigned pursuant to section 6109 of the Internal Revenue Code of 1986) and social security account number (assigned under section 205(c)(2)(B)) of the disclosing part B provider and any person, managing employee, or other entity identified or described under paragraph (1) or (2)."; and (2) in subsection (c)(1), by inserting "(or, for purposes of subsection (a)(3), any entity receiving payment)" after on an assignment-related basis".
(c) Verification by Social Security Administration (SSA).--Section 1124A (42 U.S.C. 1320a-3a), as amended by subsection (b), is amended-- (1) by redesignating subsection (c) as subsection (d); and (2) by inserting after subsection (b) the following new subsection: (c) Verification.-- (1) Transmittal by hhs.--The Secretary shall transmit-- (A) to the Commissioner of Social Security information concerning each social security account number (assigned under section 205(c)(2)(B)), and (B) to the Secretary of the Treasury information concerning each employer identification number (assigned pursuant to section 6109 of the Internal Revenue Code of 1986), supplied to the Secretary pursuant to subsection (a)(3) or section 1124(c) to the extent necessary for verification of such information in accordance with paragraph (2).
(2) Verification.--The Commissioner of Social Security and the Secretary of the Treasury shall verify the accuracy of, or correct, the information supplied by the Secretary to such official pursuant to paragraph (1), and shall report such verifications or corrections to the Secretary.
(3) Fees for verification.--The Secretary shall reimburse the Commissioner and Secretary of the Treasury, at a rate negotiated between the Secretary and such official, for the costs incurred by such official in performing the verification and correction services described in this subsection.".
(d) Report.--Before the amendments made by this section may become effective, the Secretary of Health and Human Services shall submit to Congress a report on steps the Secretary has taken to assure the confidentiality of social security account numbers that will be provided to the Secretary under such amendments.
(e) Effective Dates.-- (1) Disclosure requirements.--The amendment made by subsection (a) shall apply to the application of conditions of participation, and entering into and renewal of contracts and agreements, occurring more than 90 days after the date of submission of the report under subsection (d).
(2) Other providers.--The amendments made by subsection (b) shall apply to payment for items and services furnished more than 90 days after the date of submission of such report.
Section 1877(g) (42 U.S.C. 1395nn(g)) is amended by adding at the end the following new paragraph: (6) Advisory opinions.-- (A) In general.--The Secretary shall issue written advisory opinions concerning whether a referral relating to designated health services (other than clinical laboratory services) is prohibited under this section. Each advisory opinion issued by the Secretary shall be binding as to the Secretary and the party or parties requesting the opinion.
(B) Application of certain rules.--The Secretary shall, to the extent practicable, apply the rules under subsections (b)(3) and (b)(4) and take into account the regulations promulgated under subsection (b)(5) of section 1128D in the issuance of advisory opinions under this paragraph.
(C) Regulations.--In order to implement this paragraph in a timely manner, the Secretary may promulgate regulations that take effect on an interim basis, after notice and pending opportunity for public comment.
(D) Applicability.--This paragraph shall apply to requests for advisory opinions made after the date which is 90 days after the date of the enactment of this paragraph and before the close of the period described in section 1128D(b)(6).".
(a) Application of Fee Schedule.--Section 1842 (42 U.S.C. 1395u) is amended by adding at the end the following new subsection: (s)(1) The Secretary may implement a statewide or other areawide fee schedule to be used for payment of any item or service described in paragraph (2) which is paid on a reasonable charge basis. Any fee schedule established under this paragraph for such item or service shall be updated each year by the percentage increase in the consumer price index for all urban consumers (United States city average) for the 12-month period ending with June of the preceding year, except that in no event shall a fee schedule for an item described in paragraph (2)(D) be updated before 2003.
(2) The items and services described in this paragraph are as follows: (A) Medical supplies.
(B) Home dialysis supplies and equipment (as defined in section 1881(b)(8)).
(C) Therapeutic shoes.
(D) Parenteral and enteral nutrients, equipment, and supplies.
(E) Electromyogram devices (F) Salivation devices.
(G) Blood products.
(H) Transfusion medicine.".
(b) Conforming Amendment.--Section 1833(a)(1) (42 U.S.C. 1395l(a)(1)) is amended-- (A) by striking "and (P)" and inserting "(P)"; and (B) by striking the semicolon at the end and inserting the following: ", and (Q) with respect to items or services for which fee schedules are established pursuant to section 1842(s), the amounts paid shall be 80 percent of the lesser of the actual charge or the fee schedule established in such section;".
(c) Effective Dates.--The amendments made by this section to the extent such amendments substitute fee schedules for reasonable charges, shall apply to particular services as of the date specified by the Secretary of Health and Human Services.
(d) Initial Budget Neutrality.--The Secretary, in developing a fee schedule for particular services (under the amendments made by this section), shall set amounts for the first year period to which the fee schedule applies at a level so that the total payments under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) for those services for that year period shall be approximately equal to the estimated total payments if such fee schedule had not been implemented.
(a) In General.--Paragraphs (8) and (9) of section 1842(b) (42 U.S.C. 1395u(b)) are amended to read as follows: (8)(A)(i) The Secretary shall by regulation-- (I) describe the factors to be used in determining the cases (of particular items or services) in which the application of this part (other than to physicians' services paid under section 1848) results in the determination of an amount that, because of its being grossly excessive or grossly deficient, is not inherently reasonable, and (II) provide in those cases for the factors to be considered in determining an amount that is realistic and equitable.
(ii) Notwithstanding the determination made in clause (i), the Secretary may not apply factors that would increase or decrease the payment under this part during any year for any particular item or service by more than 15 percent from such payment during the preceding year except as provided in subparagraph (B).
(B) The Secretary may make a determination under this subparagraph that would result in an increase or decrease under subparagraph (A) of more than 15 percent of the payment amount for a year, but only if-- (i) the Secretary's determination takes into account the factors described in subparagraph (C) and any additional factors the Secretary determines appropriate, (ii) the Secretary's determination takes into account the potential impacts described in subparagraph (D), and (iii) the Secretary complies with the procedural requirements of paragraph (9).
(C) The factors described in this subparagraph are as follows: (i) The programs established under this title and title XIX are the sole or primary sources of payment for an item or service.
(ii) The payment amount does not reflect changing technology, increased facility with that technology, or reductions in acquisition or production costs.
(iii) The payment amount for an item or service under this part is substantially higher or lower than the payment made for the item or service by other purchasers.
(D) The potential impacts of a determination under subparagraph (B) on quality, access, and beneficiary liability, including the likely effects on assignment rates and participation rates.
(9)(A) The Secretary shall consult with representatives of suppliers or other individuals who furnish an item or service before making a determination under paragraph (8)(B) with regard to that item or service.
(B) The Secretary shall publish notice of a proposed determination under paragraph (8)(B) in the Federal Register-- (i) specifying the payment amount proposed to be established with respect to an item or service, (ii) explaining the factors and data that the Secretary took into account in determining the payment amount so specified, and (iii) explaining the potential impacts described in paragraph (8)(D).
(C) After publication of the notice required by subparagraph (B), the Secretary shall allow not less than 60 days for public comment on the proposed determination.
(D)(i) Taking into consideration the comments made by the public, the Secretary shall publish in the Federal Register a final determination under paragraph (8)(B) with respect to the payment amount to be established with respect to the item or service.
(ii) A final determination published pursuant to clause (i) shall explain the factors and data that the Secretary took into consideration in making the final determination.".
(b) Conforming Amendment.--Section 1834(a)(10)(B) (42 U.S.C.
1395m(a)(10)(B)) is amended-- (1) by striking "For covered items furnished on or after January 1, 1991, the" and inserting "The"; (2) by striking "(other than subparagraph (D))"; and (3) by striking "all that follows payments under this subsection" and inserting a period.
(c) Effective Date.--The amendments made by this section shall take effect on the date of the enactment of this Act.
(a) Inclusion of Non-Physician Practitioners in Requirement To Provide Diagnostic Codes for Physician Services.--Paragraphs (1) and (2) of section 1842(p) (42 U.S.C. 1395u(p)) are each amended by inserting "or practitioner specified in subsection (b)(18)(C)" after by a physician".
(b) Requirement To Provide Diagnostic Information When Ordering Certain Items or Services Furnished by Another Entity.--Section 1842(p) (42 U.S.C. 1395u(p)), is amended by adding at the end the following new paragraph: (4) In the case of an item or service defined in paragraph (3), (6), (8), or (9) of subsection 1861(s) ordered by a physician or a practitioner specified in subsection (b)(18)(C), but furnished by another entity, if the Secretary (or fiscal agent of the Secretary) requires the entity furnishing the item or service to provide diagnostic or other medical information in order for payment to be made to the entity, the physician or practitioner shall provide that information to the entity at the time that the item or service is ordered by the physician or practitioner.".
(c) Effective Date.--The amendments made by this section shall apply to items and services furnished on or after January 1, 1998.
Section 1817(k)(6) (42 U.S.C. 1395i(k)(6)) is amended by inserting "June 1, 1998, and" after "Not later than".
(a) General Rule.--Part B of title XVIII (42 U.S.C. 1395j et seq.) is amended by inserting after section 1846 the following new section:
SEC. 1847. DEMONSTRATION PROJECTS FOR COMPETITIVE ACQUISITION OF ITEMS AND SERVICES.
(a) Establishment of Demonstration Project Bidding Areas.-- (1) In general.--The Secretary shall implement not more than 5 demonstration projects under which competitive acquisition areas are established for contract award purposes for the furnishing under this part of the items and services described in subsection (d).
(2) Project requirements.--Each demonstration project under paragraph (1)-- (A) shall include such group of items and services as the Secretary may prescribe, (B) shall be conducted in not more than 3 competitive acquisition areas, and (C) shall be operated over a 3-year period.
(3) Criteria for establishment of competitive acquisition areas.--Each competitive acquisition area established under a demonstration project implemented under paragraph (1)-- (A) shall be, or shall be within, a metropolitan statistical area (as defined by the Secretary of Commerce), and (B) shall be chosen based on the availability and accessibility of entities able to furnish items and services, and the probable savings to be realized by the use of competitive bidding in the furnishing of items and services in such area.
(b) Awarding of Contracts in Areas.-- (1) In general.--The Secretary shall conduct a competition among individuals and entities supplying items and services described in subsection (c) for each competitive acquisition area established under a demonstration project implemented under subsection (a).
(2) Conditions for awarding contract.--The Secretary may not award a contract to any entity under the competition conducted pursuant to paragraph (1) to furnish an item or service unless the Secretary finds that the entity meets quality standards specified by the Secretary that the total amounts to be paid under the contract are expected to be less than the total amounts that would otherwise be paid.
(3) Contents of contract.--A contract entered into with an entity under the competition conducted pursuant to paragraph (1) is subject to terms and conditions that the Secretary may specify.
(4) Limit on number of contractors.--The Secretary may limit the number of contractors in a competitive acquisition area to the number needed to meet projected demand for items and services covered under the contracts.
(c) Expansion of Projects.-- (1) Evaluations.--The Secretary shall evaluate the impact of the implementation of the demonstration projects on medicare program payments, access, diversity of product selection, and quality. The Secretary shall make annual reports to the Committees on Ways and Means and Commerce of the House of Representatives and the Committee on Finance of the Senate on the results of the evaluation described in the preceding sentence and a final report not later than 6 months after the termination date specified in subsection (e).
(2) Expansion.--If the Secretary determines from the evaluations under paragraph (1) that there is clear evidence that any demonstration project-- (A) results in a decrease in Federal expenditures under this title, and (B) does not reduce program access, diversity of product selection, and quality under this title, the Secretary may expand the project to additional competitive acquisition areas.
(d) Services described.--The items and services to which this section applies are all items and services covered under this part (except for physicians' services as defined in section 1861(s)(1)) that the Secretary may specify. At least one demonstration project shall include oxygen and oxygen equipment.
(e) Termination.--Notwithstanding any other provision of this section, all projects under this section shall terminate not later than December 31, 2002.".
(b) Items and Services To Be Furnished Only Through Competitive Acquisition.--Section 1862(a) (42 U.S.C. 1395y(a)) is amended-- (1) by striking "or" at the end of paragraph (15), (2) by striking the period at the end of paragraph (16) and inserting "; or", and (3) by inserting after paragraph (16) the following new paragraph: (17) where the expenses are for an item or service furnished in a competitive acquisition area (as established by the Secretary under section 1847(a)) by an entity other than an entity with which the Secretary has entered into a contract under section 1847(b) for the furnishing of such an item or service in that area, unless the Secretary finds that the expenses were incurred in a case of urgent need, or in other circumstances specified by the Secretary.".
(c) Study by GAO.--The Comptroller of the United States shall study the effectiveness of the establishment of competitive acquisition areas under section 1847(a) of the Social Security Act, as added by this section.
Section 1861(v) (42 U.S.C. 1395x(v)) is amended by adding at the end the following new paragraph: (8) Items unrelated to patient care.--Reasonable costs do not include costs for the following-- (i) entertainment, including tickets to sporting and other entertainment events; (ii) gifts or donations; (iii) personal use of motor vehicles; (iv) costs for fines and penalties resulting from violations of Federal, State, or local laws; and (v) education expenses for spouses or other dependents of providers of services, their employees or contractors.".
(a) Notification of Availability of Home Health Agencies and Other Entities As Part of Discharge Planning Process.--Section 1861(ee)(2) (42 U.S.C. 1395x(ee)(2)) is amended-- (1) in subparagraph (D), by inserting before the period the following: , including the availability of home health services through individuals and entities that participate in the program under this title and that serve the area in which the patient resides and that request to be listed by the hospital as available"; and (2) by adding at the end the following new subparagraph: (H) Consistent with section 1802, the discharge plan shall-- (i) not specify or otherwise limit the qualified provider which may provide post-hospital home health services, and (ii) identify (in a form and manner specified by the Secretary) any entity to whom the individual is referred in which the hospital has a disclosable financial interest (as specified by the Secretary consistent with section 1866(a)(1)(S)) or which has such an interest in the hospital.".
(b) Maintenance and Disclosure of Information on Post-Hospital Home Health Agencies and Other Entities.--Section 1866(a)(1) (42 U.S.C. 1395cc(a)(1)) is amended-- (1) by striking "and" at the end of subparagraph (Q), (2) by striking the period at the end of subparagraph (R), and (3) by adding at the end the following new subparagraph: (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).".
(c) Disclosure of Information to the Public.--Title XI is amended by inserting after section 1145 the following new section:
Sec. 1146. The Secretary shall make available to the public, in a form and manner specified by the Secretary, information disclosed to the Secretary pursuant to section 1866(a)(1)(S).".
(d) Effective Dates.-- (1) The amendments made by subsection (a) shall apply to discharges occurring on or after the date which is 90 days after the date of the enactment of this Act.
(2) The Secretary of Health and Human Services shall issue regulations by not later than the date which is 1 year after the date of the enactment of this Act to carry out the amendments made by subsections (b) and (c) and such amendments shall take effect as of such date (on or after the issuance of such regulations) as the Secretary specifies in such regulations.
SEC. 4331. OTHER FRAUD AND ABUSE RELATED PROVISIONS.
(a) Reference Correction.--(1) Section 1128D(b)(2)(D) (42 U.S.C.
1320a-7d(b)(2)(D)), as added by section 205 of the Health Insurance Portability and Accountability Act of 1996, is amended by striking "1128B(b)" and inserting "1128A(b)".
(2) Section 1128E(g)(3)(C) (42 U.S.C. 1320a-7e(g)(3)(C)) is amended by striking "Veterans' Administration" and inserting "Department of Veterans Affairs".
(b) Language in Definition of Conviction.--Section 1128E(g)(5) (42 U.S.C. 1320a-7e(g)(5)), as inserted by section 221(a) of the Health Insurance Portability and Accountability Act of 1996, is amended by striking "paragraph (4)" and inserting "paragraphs (1) through (4)".
(c) Implementation of Exclusions.--Section 1128 (42 U.S.C. 1320a-7) is amended-- (1) in subsection (a), by striking "any program under title XVIII and shall direct that the following individuals and entities be excluded from participation in any State health care program (as defined in subsection (h))" and inserting "any Federal health care program (as defined in section 1128B(f))"; and (2) in subsection (b), by striking "any program under title XVIII and may direct that the following individuals and entities be excluded from participation in any State health care program" and inserting "any Federal health care program (as defined in section 1128B(f))".
(d) Sanctions for Failure to Report.--Section 1128E(b) (42 U.S.C. 1320a-7e(b)), as inserted by section 221(a) of the Health Insurance Portability and Accountability Act of 1996, is amended by adding at the end the following: (6) Sanctions for failure to report.-- (A) Health plans.--Any health plan that fails to report information on an adverse action required to be reported under this subsection shall be subject to a civil money penalty of not more than $25,000 for each such adverse action not reported. Such penalty 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.
(B) Governmental agencies.--The Secretary shall provide for a publication of a public report that identifies those Government agencies that have failed to report information on adverse actions as required to be reported under this subsection.".
(e) Clarification of Treatment of Certain Waivers and Payments of Premiums.--Section 1128A(i)(6) (42 U.S.C. 1320a-7a(i)(6)) is amended-- (1) in subparagraph (A)(iii)-- (A) in subclause (I), by adding or" at the end; (B) in subclause (II), by striking "or" at the end; and (C) by striking subclause (III); (2) by redesignating subparagraphs (B) and (C) as subparagraphs (C) and (D); and (3) by inserting after subparagraph (A) the following: (B) any permissible waiver as specified in section 1128B(b)(3) or in regulations issued by the Secretary;".
(f) Effective Dates.-- (1) In general.--Except as provided in this subsection, the amendments made by this section shall be effective as if included in the enactment of the Health Insurance Portability and Accountability Act of 1996.
(2) Federal health program.--The amendments made by subsection (c) shall take effect on the date of the enactment of this Act.
(3) Sanction for failure to report.--The amendment made by subsection (d) shall apply to failures occurring on or after the date of the enactment of this Act.