Summary:
SGR Repeal and Medicare Provider Payment Modernization Act of 2015

Amends title XVIII (Medicare) of the Social Security Act (SSAct) to: (1) remove sustainable growth rate (SGR) methodology from the determination of annual conversion factors in the formula for payment for physicians' services, and (2) revise the update in rates for 2015 and subsequent years.

Directs the Secretary of Health and Human Services to establish a Merit-based Incentive Payment (MIP) system under which eligible professionals (including physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists) shall receive annual payment increases or decreases based on their performance.

Requires specified incentive payments to eligible participants in an alternative payment model.

Requires the Secretary to: (1) draft a plan for development of quality measures to assess professionals, including non-patient-facing professionals; and (2) make payments for chronic care management services.

Expands the kinds of uses of Medicare data available to qualified entities. Directs the Secretary to provide Medicare data to qualified clinical data registries to facilitate quality improvement or patient safety.

Declares it a national objective to achieve widespread exchange of health information through interoperable certified electronic health records technology nationwide by December 31, 2018.

sgr_repeal medicare provider payment modernization act amends title xviii medicare social security act ssact remove sustainable growth rate sgr methodology determination annual conversion factors formula payment physicians services revise update rates subsequent years directs secretary health_and_human_services establish merit based mip system eligible professionals including physicians physician assistants nurse practitioners clinical nurse specialists certified registered nurse anesthetists shall receive annual payment increases decreases based performance requires specified incentive payments eligible participants alternative payment model requires secretary draft plan development quality measures assess professionals including non patient facing professionals payments chronic care management services expands kinds uses medicare data available qualified entities directs secretary provide medicare data qualified clinical data registries facilitate quality improvement patient safety declares national objective achieve widespread exchange health information interoperable certified electronic health records technology nationwide december


Summary:
Medicaid Parity Act of 2015

 Amends title XIX (Medicaid) of the Social Security Act to extend through 2019: (1) Medicaid payment parity with Medicare for primary care services furnished under the Medicaid program, and (2) the increased (to 100%) federal medical assistance percentage (FMAP, or federal matching rate) for additional payments for primary care services.

medicaid parity act amends title xix medicaid social security act extend medicaid payment parity medicare primary care services furnished medicaid program increased federal medical assistance percentage fmap federal matching rate additional payments primary care services


Summary:
Veterans' Credit Protection Act

 Directs the Department of Veterans Affairs (VA) to: (1) conduct outreach to inform veterans of how to resolve credit issues caused by a delayed payment of a claim for emergency hospital care, medical services, or other emergency health care furnished through a non-VA provider; and (2) establish a toll-free telephone number for veterans to report such issues to the Chief Business Office of the VA.

Requires the VA to report annually on the effectiveness of such Office in providing timely payment of proper invoices for emergency hospital care, medical services, or other emergency health care furnished through non-VA providers by the required payment date during both the preceding five-year period and the preceding one-year period. Requires the report, for any part of the period covered by such a report that occurred before October 1, 2014, to evaluate the provision of such payments by the Veterans Integrated Service Networks.

 Requires such report to include:

 the number of veterans who contacted the VA regarding delayed payments that could negatively affect their credit; the total amount of interest penalties paid by the VA by reason of delayed payments; the number of proper invoices submitted, the amount owed for and the payment status of such invoices, and the periods that elapsed before such invoices were paid; any comments regarding delayed payments made by medical providers; and a description of the best practices to provide timely payment of a proper invoice, including a plan to improve such timely payments. Directs: (1) the Office to submit to Congress quarterly reports on the number of pending claims for reimbursement for emergency hospital care, medical services, and other emergency health care furnished through non-VA providers; and (2) the Comptroller General to conduct a study that evaluates the effectiveness of the Office in providing timely payment of a proper invoice for such care by the required payment date.

directs department_of_veterans_affairs conduct outreach inform veterans resolve credit issues caused delayed payment claim emergency hospital care medical services emergency health care furnished non-va provider establish toll free telephone number veterans report issues requires report annually effectiveness office providing timely payment proper emergency hospital care medical services emergency health care furnished non providers required payment date preceding year period preceding year period requires report period covered report occurred october evaluate provision payments veterans_integrated_service_networks requires report include number veterans contacted delayed payments negatively affect credit total interest penalties paid reason delayed payments number proper submitted owed payment status periods elapsed paid comments delayed payments medical providers description best practices provide timely payment proper invoice including plan improve timely payments directs office submit congress quarterly reports number pending claims reimbursement emergency hospital care medical services emergency health care furnished non providers comptroller general conduct study evaluates effectiveness office providing timely payment proper invoice care required payment date


Summary:
Cutting Costly Codes Act of 2015

This bill prohibits the Department of Health and Human Services from implementing, administering, or enforcing regulations that would replace ICD-9 (International Classification of Diseases) with ICD-10 as a code set for financial and administrative transactions involving the electronic exchange of health information. ICD is a system of diagnostic codes for classifying diseases.

The Government Accountability Office must recommend steps to mitigate the disruption to health care providers that would result from replacement of ICD-9.

cutting costly codes act bill prohibits department_of_health_and_human_services implementing administering enforcing regulations replace icd-10 code set financial administrative transactions involving electronic exchange health information system diagnostic codes classifying diseases government_accountability_office recommend steps mitigate disruption health care providers result replacement


Summary:
Medicare Access to Rural Anesthesiology Act of 2015

 Amends title XVIII (Medicare) of the Social Security Act to provide payment under Medicare part A (Hospital Insurance) on a reasonable cost basis for anesthesia services furnished by a physician who is an anesthesiologist in certain rural hospitals in the same manner as payment is made for anesthesia services furnished by a certified registered nurse anesthetist in such hospitals.

medicare access rural act amends title xviii medicare social security act provide payment medicare reasonable cost basis anesthesia services furnished physician anesthesiologist certain rural hospitals manner payment anesthesia services furnished certified registered nurse anesthetist hospitals


Summary:
Disabled Veterans' Access to Medical Exams Improvement Act

Amends the Veterans Benefits Act of 2003 to extend until December 31, 2017, the authority of the Department of Veterans Affairs (VA) to provide for persons other than VA employees (i.e., contract physicians) to conduct medical disability examinations of applicants for benefits under laws administered by the Secretary of Veterans Affairs.

Permits licensed, VA-contracted physicians to conduct such examinations at any location in any state, the District of Columbia, or a Commonwealth, territory, or possession of the United States, so long as the examination is authorized under the contract and the physician is not barred from conducting such an examination in the location in which it occurs.

Amends the Veterans' Benefits Improvement Act of 1996 to provide similar authorities with respect to permissible examination locations to licensed physicians under the pilot program authorizing the VA to use contract physicians to perform medical disability examinations of applicants for benefits under laws carried out through the Under Secretary for Benefits. Expands from 10 to 15 the maximum number of VA regional offices through which the Secretary is authorized to carry out such pilot program.

Directs the Secretary to conduct an annual data analysis (including an analysis of backlogged claims, pending workloads, and the timeliness of completed cases) to determine the regional offices requiring support.

disabled veterans access medical exams improvement act amends veterans benefits act extend december authority department_of_veterans_affairs provide persons employees contract physicians conduct medical disability examinations applicants benefits laws administered secretary veterans_affairs permits licensed contracted physicians conduct examinations location state district_of_columbia commonwealth territory possession united_states long examination authorized contract physician barred conducting examination location occurs amends veterans benefits improvement act provide similar authorities respect permissible examination locations licensed physicians pilot program authorizing use contract physicians perform medical disability examinations applicants benefits laws carried secretary benefits expands maximum number regional offices secretary authorized carry pilot program directs secretary conduct annual data analysis including analysis claims pending workloads timeliness completed cases determine regional offices requiring support


Summary:
Increasing Clarity for Doctors by Transitioning Effectively Now Act or the ICD-TEN Act

This bill directs the Department of Health and Human Services (HHS) to implement, administer, and enforce regulations that provide for the replacement of International Classification of Diseases (ICD) ICD-9 with ICD-10 as a standard for code sets.

HHS shall conduct, and make available to all participating service providers and suppliers, a comprehensive, end-to-end testing process to assess whether the Medicare fee-for-service claims processing system based on the ICD-10 standard is fully functioning.

HHS must subsequently certify to Congress whether or not the Medicare fee-for-service claims processing system based on the ICD-10 standard is fully functioning, including additional steps a not-fully-functioning system will take to achieve certification as well as the anticipated time frame for achieving it.

increasing clarity doctors transitioning effectively act act bill directs department_of_health_and_human_services hhs implement administer enforce regulations provide replacement icd-10 standard code sets hhs shall conduct available participating service providers suppliers comprehensive end end testing process assess medicare fee service claims processing system based icd-10 standard fully functioning hhs subsequently certify congress medicare fee service claims processing system based icd-10 standard fully functioning including additional steps fully functioning system achieve certification anticipated time frame achieving


Summary:
Ensuring Access to Primary Care for Women & Children Act

Amends title XIX (Medicaid) of the Social Security Act (SSAct) to require that the primary care services furnished in the two years after enactment of this Act by a physician with a primary specialty designation of family medicine, general internal medicine, or pediatric medicine be paid at a rate that is not less than 100% of the payment rate that applies under Medicare part B (Supplementary Medical Insurance), but only if the physician self-attests as being Board certified in those areas.

Extends this 100% of Medicare payment floor, subject to certain conditions, to the following providers: (1) physicians with a primary specialty designation of obstetrics and gynecology, and self-attesting they are Board certified; (2) advanced practice clinicians; (3) rural health clinics, federally-qualified health centers, or other specified health clinics; and (4) nurse practitioners, physician assistants, or certified nurse-midwives.

Excludes from coverage of primary care services any such services provided in an emergency department of a hospital.

Prescribes additional requirements for any contract between a state and a Medicaid managed care organization.

Directs the Government Accountability Office to examine the use of alternative payment models in state Medicaid programs and identify opportunities for disseminating successful payment models among them.

Amends SSAct title XI to: (1) extend funding for development of adult health quality measures; and (2) direct the Administrator for the Centers for Medicaid and Medicaid Services and the Director of the Agency for Healthcare Research and Quality to develop such measures specific to adult individuals with disabilities and include them in the Medicaid Quality Measurement Program.

ensuring access primary care women children act amends title xix medicaid social security act ssact require primary care services furnished years enactment act physician primary specialty designation family medicine general internal medicine pediatric medicine paid rate payment rate applies medicare supplementary_medical_insurance physician self attests board certified areas extends medicare payment floor subject certain conditions following providers physicians primary specialty designation obstetrics gynecology self attesting board certified advanced practice clinicians rural health clinics federally qualified health centers specified health clinics nurse practitioners physician assistants certified nurse midwives excludes coverage primary care services services provided emergency department hospital prescribes additional requirements contract state medicaid managed care organization directs government_accountability_office examine use alternative payment models state medicaid programs identify opportunities disseminating successful payment models amends ssact title extend funding development adult health quality measures direct administrator centers medicaid medicaid_services director agency healthcare_research quality develop measures specific adult individuals disabilities include medicaid quality measurement program


Summary:
Prioritizing American Road and Jobs Act of 2015

This bill amends title XIX (Medicaid) of the Social Security Act to eliminate enhanced federal funding after 2016 for individuals who are newly eligible for Medicaid under the Patient Protection and Affordable Care Act. Under current law, a state is entitled to an increased federal medical assistance percentage (FMAP) to cover such individuals; this enhanced FMAP is equivalent to 100% through 2016, 95% in 2017, 94% in 2018, 93% in 2019, and 90% thereafter. The bill eliminates these enhanced funding levels so that, beginning in 2017, federal funding for expenses related to newly eligible individuals instead reverts to a state's regular FMAP (which, under current law, may range from 50% to 83%).

The Department of Health and Human Services (HHS) must estimate, for each calendar quarter beginning on or after January 1, 2017, the net quarterly reductions in federal expenditures resulting from this Act and adjust for a calendar quarter any initial estimate determined inaccurate. The adjusted estimate shall apply so as to adjust the amount appropriated to the Highway Trust Fund for the calendar quarter, subject to a specified limitation.

The amount equivalent to the HHS estimate reduction in federal Medicaid expenditures for a calendar quarter, but no more than a total of $15 billion in any year, is appropriated and transferred to the Highway Trust Fund from any funds in the Treasury not otherwise appropriated for that quarter.

prioritizing american road jobs act bill amends title xix medicaid social security act eliminate enhanced federal funding individuals newly eligible medicaid patient_protection affordable care act current law state entitled increased federal medical assistance percentage fmap cover individuals enhanced fmap equivalent bill eliminates enhanced funding levels beginning federal funding expenses related newly eligible individuals instead reverts state regular fmap current law range department_of_health_and_human_services hhs estimate calendar quarter beginning january net quarterly reductions federal expenditures resulting act adjust calendar quarter initial estimate determined inaccurate adjusted estimate shall apply adjust appropriated highway_trust_fund calendar quarter subject specified limitation equivalent hhs estimate reduction federal medicaid expenditures calendar quarter total billion year appropriated transferred highway_trust_fund funds treasury appropriated quarter


Summary:
Protecting Patients and Physicians Against Coding Act of 2015

The Department of Health and Human Services (HHS), in carrying out regulations providing for the replacement of ICD-9 (International Classification of Diseases-9) with ICD-10 as a standard code set, shall provide for a two-year grace period during which physicians and other health care providers submitting claims and other documents using ICD-10 are not penalized for errors, mistakes, and malfunctions relating to the transition to such code set. HHS shall also give these practitioners assistance during the grace period.

The Government Accountability Office shall study this transition for Congress.

protecting patients physicians coding act department_of_health_and_human_services hhs carrying regulations providing replacement icd-10 standard code set shall provide year grace period physicians health care providers submitting claims documents icd-10 penalized errors malfunctions relating transition code set hhs shall practitioners assistance grace period government_accountability_office shall study transition congress


Summary: This bill requires that health care claims submitted with ICD-9 codes (the code set currently used in health care transactions to identify diagnoses and procedures) continue to be paid during the transition from the ICD-9 code set to the ICD-10 code set.

bill requires health care claims submitted codes code set currently health care transactions identify diagnoses procedures continue paid transition code set icd-10 code set


Summary:
Medical Practice Freedom Act of 2015

This bill prohibits the Department of Health and Human Services or any state from requiring a health care provider, as a condition of the provider's licensure, to participate in a health plan or comply with requirements for meaningful use of electronic health records.

medical practice freedom act bill prohibits department_of_health_and_human_services state requiring health care provider condition provider licensure participate health plan comply requirements meaningful use electronic health records


Summary:
Construction Reform Act of 2016

(Sec. 2) This bill requires the Department of Veterans Affairs (VA) to use industry standards, standard designs, and best practices in carrying out medical facility construction.

A super construction project is one for the construction, alteration, or acquisition of a medical facility involving a total expenditure of more than $100 million (but does not include an acquisition by exchange).

 The VA shall provide, on a non-reimbursable basis, a non-VA federal entity with: (1) design, planning, and construction assistance; (2) project documents; and (3) other assistance upon request.

With respect to a proposed change to a contract entered into by a non-VA federal entity with which the VA has entered into an agreement that is estimated at a value of less than $250,000, the entity shall issue a final decision regarding such change within 30 days.

 With respect to a proposed contract change estimated at a value of $250,000 or more:

 the VA may make recommendations to the entity; the VA may issue the final decision regarding the change within 30 days after the entity proposes it; and if the VA does not issue a final decision within 60 days after the entity proposes the contract change, the entity shall issue a final decision regarding the change no later than 90 days after it proposes the change. The VA shall ensure that each VA employee with responsibilities relating to the construction or alteration of medical facilities undergoes ongoing professional training and development.

 The VA is prohibited from:

 obligating or expending funds for advance planning or design for any super construction project until 60 days after congressional notification, obligating funds for a major medical facility project or a super construction project by more than 10% of the amount approved by law unless certain congressional committees approve the obligation, or using bid savings amounts or funds for other than their original purpose before 30 days after notifying those committees unless each committee approves the obligation. The VA shall enter into a contract with an appropriate non-department federal entity to conduct an external forensic audit of: (1) the medical center construction project in Aurora, Colorado; and (2) the expenditures relating to any major medical facility or super construction project when such expenditures exceed the amount approved by law by more than 25%.

The VA must complete a 10-year master plan for: (1) each existing VA medical facility by December 31, 2016, and (2) each new VA medical facility by not later than the earlier of the date on which activation is completed or the date of the facility's formal dedication.

(Sec. 3) There is established in the Office of Inspector General an Assistant Inspector General for Construction who shall be responsible for conducting, supervising, and coordinating audits, evaluations, and investigations of the planning, design, contracting, and construction of VA facilities and infrastructure, including major and minor construction projects and leases.

construction reform act sec bill requires department_of_veterans_affairs use industry standards standard designs best practices carrying medical facility construction super construction project construction alteration acquisition medical facility involving total expenditure million include acquisition exchange shall provide non reimbursable basis non federal entity design planning construction assistance project documents assistance request respect proposed change contract entered non-va federal entity entered agreement estimated value entity shall issue final decision change days respect proposed contract change estimated value recommendations entity issue final decision change days entity proposes issue final decision days entity proposes contract change entity shall issue final decision change later days proposes change shall ensure employee responsibilities relating construction alteration medical facilities undergoes ongoing professional training development prohibited obligating expending funds advance planning design super construction project days congressional notification obligating funds major medical facility project super construction project approved law certain congressional committees approve obligation bid savings amounts funds original purpose days notifying committees committee approves obligation shall enter contract appropriate non department federal entity conduct external forensic audit medical center construction project aurora colorado expenditures relating major medical facility super construction project expenditures exceed approved law complete year master plan existing medical facility december new medical facility later earlier date activation completed date facility formal dedication sec established office_of_inspector_general assistant inspector general construction shall responsible conducting supervising coordinating audits evaluations investigations planning design contracting construction facilities infrastructure including major minor construction projects leases


Summary:
VA Medical Center Recovery Act

(Sec. 2) This bill directs the Department of Veterans Affairs (VA) to publish in the Federal Register and on a publicly available VA Internet website a compilation of key health metrics for each VA medical center.

The VA shall: (1) determine on a semiannual basis whether each medical center is satisfactory or underperforming; and (2) upon a determination of underperformance, send a rapid deployment team to the center to ensure that it achieves satisfactory performance as quickly as practicable.

A rapid deployment team shall:

 identify the areas of the medical center that require improvement and whether the center follows directives and best practices; establish a performance remediation plan; review the status of any disciplinary actions taken at the center, any recommendations made by the VA Inspector General, and any Government Accountability Office findings; and provide appropriate training to the director and staff. The Inspector General of the VA shall prioritize investigations regarding underperforming medical centers.

The Office of Accountability Review shall prioritize investigations of whistleblower retaliation regarding underperforming medical centers.

(Sec. 3) The VA shall seek to enter into partnerships with recognized schools of nursing to provide undergraduate nursing students enrolled in such schools with standardized training with respect to:

 the culture of the military and veterans; post-traumatic stress disorder; traumatic brain injury; amputation and assistive devices; environmental, chemical, and toxic exposure; substance use disorders; military sexual trauma; suicide; homelessness; serious illness at the end of life; and federal benefits, services, and resources for veterans.

sec bill directs department_of_veterans_affairs publish federal_register publicly available internet website compilation key health metrics medical center shall determine semiannual basis medical center satisfactory underperforming determination underperformance send rapid deployment team center ensure achieves satisfactory performance quickly practicable rapid deployment team shall identify areas medical center require improvement center follows directives best practices establish performance remediation plan review status disciplinary actions taken center recommendations inspector general government_accountability_office findings provide appropriate training director staff inspector general shall prioritize investigations underperforming medical centers shall prioritize investigations whistleblower retaliation underperforming medical centers sec shall seek enter partnerships recognized schools nursing provide undergraduate nursing students enrolled schools standardized training respect culture military veterans post traumatic stress disorder traumatic brain injury assistive devices environmental chemical toxic exposure substance use disorders military sexual trauma suicide homelessness illness end life federal benefits services resources veterans


Summary:
Medicare Post-Acute Care Value-Based Purchasing Act of 2015

This bill amends title XVIII (Medicare) of the Social Security Act to: (1) modify market basket percentages for post-acute care (PAC) providers, and (2) establish a PAC value-based purchasing program under which PAC providers receive value-based incentive payments. PAC providers are skilled nursing facilities, inpatient rehabilitation facilities, home health agencies, and long-term care hospitals.

A market basket is an index that reflects inflation and is used to update payments and cost limits. Under current law, market basket percentage increases for PAC providers are generally based on the application of a formula based on costs from the preceding fiscal year, but for FY2018 these increases are fixed at 1%. The bill repeals these fixed increases, leaving FY2018 increases to instead be determined according to the existing formula.

With respect to the PAC value-based purchasing program, the bill: (1) requires the Centers for Medicare & Medicaid (CMS) to establish performance standards and scores by which to rank PAC providers; (2) specifies how CMS must calculate value-based incentive payments for each type of PAC provider in accordance with such ranking; (3) requires CMS to make specified annual adjustments to how incentive payments are calculated; and (4) establishes limits on administrative and judicial review.

Under current law, a value-based purchasing program for skilled nursing facilities has been established to begin in FY2019. The bill maintains this program but specifies that it must terminate in FY2025.

bill amends title xviii medicare social security act modify market basket percentages post acute care pac providers establish pac value based purchasing program pac providers receive value based incentive payments pac providers skilled nursing facilities inpatient rehabilitation facilities home health agencies long term care hospitals market basket index reflects inflation update payments cost limits current law market basket percentage increases pac providers generally based application formula based costs preceding fiscal year fy2018 increases fixed bill repeals fixed increases leaving fy2018 increases instead determined according existing formula respect pac value based purchasing program bill requires centers cms establish performance standards scores rank pac providers specifies cms calculate value based incentive payments type pac provider accordance ranking requires cms specified annual adjustments incentive payments calculated establishes limits administrative judicial review current law value based purchasing program skilled nursing facilities established begin fy2019 bill maintains program specifies terminate fy2025


Summary:
VA Vendor Verification Act

This bill directs the Department of Veterans Affairs to establish uniform credentialing standards for medical vendors based on the standards prescribed in the "Joint Recommendation for Healthcare Industry Representative (HCIR) Credentialing Best Practices" by the Coalition for Best Practices in HCIR Requirements.

vendor verification act bill directs department_of_veterans_affairs establish uniform credentialing standards medical vendors based standards prescribed joint recommendation healthcare industry representative credentialing best practices


Summary:
(This measure has not been amended since it was introduced. The summary has been expanded because action occurred on the measure.)

Women's Public Health and Safety Act

(Sec. 2) This bill amends title XIX (Medicaid) of the Social Security Act to modify requirements regarding a state plan for medical assistance.  Under current law, a state plan for medical assistance must provide that any individual eligible for medical assistance may obtain required services from any institution, agency, or person qualified to perform them.  The bill specifies that a state may not be required to provide medical assistance for services furnished by any individual or entity based on the individual's or entity's involvement in abortions.

measure amended introduced summary expanded action occurred measure women public health safety act sec bill amends title xix medicaid social security act modify requirements state plan medical assistance current law state plan medical assistance provide individual eligible medical assistance obtain required services institution agency person qualified perform bill specifies state required provide medical assistance services furnished individual entity based individual entity involvement abortions


Summary:
Medicaid Qualified Providers Clarification Act

This bill amends title XIX (Medicaid) of the Social Security Act to modify requirements regarding a state plan for medical assistance. Under current law, a state plan for medical assistance must provide that any individual eligible for medical assistance may obtain required services from any institution, agency, or person qualified to perform them. The bill specifies that a state may determine whether a provider is qualified to perform such services. To do so, a state may establish qualification criteria, which may include criteria designed to evaluate: (1) the provider's ability to perform the needed medical services in a professionally competent, safe, and legal manner; and (2) any other qualification deemed necessary by the state.

bill amends title xix medicaid social security act modify requirements state plan medical assistance current law state plan medical assistance provide individual eligible medical assistance obtain required services institution agency person qualified perform bill specifies state determine provider qualified perform services state establish qualification criteria include criteria designed evaluate provider ability perform needed medical services professionally competent safe legal manner qualification deemed necessary state


Summary:
Enhanced Veteran Healthcare Act of 2015

This bill directs the Department of Veterans Affairs (VA) to seek to enter into covered agreements and contracts for the mutually beneficial coordination, use, or exchange of covered VA health-care resources with eligible academic affiliates in order to improve access to, and quality of, VA hospital care and medical services.

enhanced veteran healthcare act bill directs department_of_veterans_affairs seek enter covered agreements contracts mutually beneficial coordination use exchange covered health care resources eligible academic affiliates order improve access quality hospital care medical services


Summary: This bill amends the Public Health Service Act to revise the priorities the Department of Health and Human Services (HHS) uses in assigning National Health Service Corps (NHSC) members to health professional shortage areas and awarding contracts under the NHSC Loan Repayment Program. Specifically, HHS must prioritize: (1) assignment of members to areas with a high number of veterans with ailments resulting from traumatic brain injuries, and (2) awarding contracts to health professionals receiving training or trained in addressing post-traumatic stress disorder.

bill amends public_health_service_act revise priorities department_of_health_and_human_services hhs uses assigning national_health_service_corps members health professional shortage areas awarding contracts specifically hhs prioritize assignment members areas high number veterans resulting traumatic brain injuries awarding contracts health professionals receiving training trained addressing post traumatic stress disorder


Summary:
Medicare Established Provider Act of 2015

This bill amends title XVIII (Medicare) of the Social Security Act to direct the Department of Health and Human Services (HHS) to develop a system for designating providers that represent a low risk of submitting fraudulent Medicare claims as "established providers" for purposes of applying for special treatment in the claim review process.

To qualify as an established provider, a provider must demonstrate that, within a specified timeframe: (1) at least 90% of Medicare claims submitted by the provider were determined to be eligible for full or partial payment, and (2) the provider appealed at least 90% of all Medicare claims that were not initially determined to be eligible for payment.

HHS may withhold payment for a Medicare claim made by an established provider only if a final determination has been made that the claim is ineligible for payment. If such a final determination is made, the provider shall repay such payment electronically and within a specified timeframe.

medicare established provider act bill amends title xviii medicare social security act direct department_of_health_and_human_services hhs develop system designating providers represent low risk submitting fraudulent medicare claims established providers purposes applying special treatment claim review process qualify established provider provider demonstrate specified timeframe medicare claims submitted provider determined eligible partial payment provider appealed medicare claims initially determined eligible payment hhs withhold payment medicare claim established provider final determination claim ineligible payment final determination provider shall repay payment electronically specified timeframe


Summary:
Critical Access Hospitals for Veterans Act or the CAHV Act

This bill directs the Department of Veterans Affairs (VA) to provide eligible requesting veterans who are enrolled in the VA health care system with hospital care and medical services at critical access hospitals pursuant to an agreement between the VA and the Department of Health and Human Services.

veterans act act bill directs department_of_veterans_affairs provide eligible requesting veterans enrolled health care system hospital care medical services critical access hospitals pursuant agreement department_of_health_and_human_services


Summary:
Behavioral Health Care Integration Act of 2016

This bill amends the Public Health Service Act to replace a Substance Abuse and Mental Health Services Administration (SAMHSA) program to support demonstration projects for providing integrated health care to certain patient populations with a program to support integration of primary and behavioral health care.

The program must be designed to lead to full collaboration between primary care and behavioral health providers in the same facility to ensure support for individuals with mental illness and a physical condition or substance use disorder.

Under the program, grants and cooperative agreements may be awarded to state departments of health, state mental health or addiction agencies, state Medicaid agencies, and health care providers and institutions. Recipients must report to SAMHSA on progress in reducing barriers to integrated care and outcomes for certain patient populations.

behavioral health care integration act bill amends public_health_service_act replace substance_abuse_and_mental_health_services_administration samhsa program support demonstration projects providing integrated health care certain patient populations program support integration primary behavioral health care program designed lead collaboration primary care behavioral health providers facility ensure support individuals mental illness physical condition substance use disorder program grants cooperative agreements awarded state departments health state mental health addiction agencies state medicaid agencies health care providers institutions recipients report samhsa progress reducing barriers integrated care outcomes certain patient populations


Summary:
Medicare Access to Radiology Care Act of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to revise physician supervision requirements under the Medicare program for radiology services performed by advanced level radiographers. Specifically, with respect to a state that has established such requirements for those services, the bill aligns Medicare's requirements with state requirements.

An "advanced level radiographer" is a radiographer who has obtained specified certification from either the American Registry of Radiologic Technologists or the Certification Board for Radiology Practitioner Assistants.

bill amends title xviii medicare social security act revise physician supervision requirements medicare program services performed advanced level specifically respect state established requirements services bill medicare requirements state requirements advanced level obtained specified certification assistants


Summary:
Healthy Inpatient Procedures Act of 2016 or the HIP Act

This bill delays and suspends implementation of Medicare's Comprehensive Care for Joint Replacement Model, which tests episode-based payment and quality measurement for care associated with hip and knee replacements.

The bill also reduces and rescinds specified FY2017 and FY2018 funding that was appropriated for the Prevention and Public Health Trust Fund.

act bill delays suspends implementation medicare comprehensive care joint replacement model tests episode based payment quality measurement care associated replacements bill reduces rescinds specified fy2017 fy2018 funding appropriated


Summary:
Better Care, Lower Cost Act

This bill amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to establish an integrated chronic care delivery program through which qualified "Better Care Programs" (BCPs) shall: (1)  promote accountability and better care management for chronically ill patient populations, (2) coordinate items and services under Medicare, and (3) encourage investment in infrastructure and redesigned care processes. A health plan (including a Medicare Advantage plan) or group of providers may participate as a BCP if certified to do so by the Department of Health and Human Services (HHS).

The program shall focus on containing long-term costs and improving the overall health of the Medicare population by implementing, through qualified BCPs, strategies that prevent, delay, or minimize the progression of illness or disability associated with chronic conditions.

With respect to a BCP enrollee who is dually eligible for both Medicare and Medicaid, Medicare shall be the primary payor.

A Medigap policy (supplemental insurance that covers health care costs not covered by Medicare) may not provide for coverage of cost-sharing for Medicare services furnished to a BCP enrollee by a provider that is not a qualified BCP professional.

HHS, acting through the Agency for Healthcare Research and Quality, shall designate and provide core funding for at least three Chronic Care Innovation Centers. To be eligible for such designation and funding, an eligible entity must partner with other specified entities to develop new, evidence-based curricula that addresses the need for chronic care management.

bill amends titles xviii medicare xix medicaid social security act establish integrated chronic care delivery program qualified better care programs shall promote accountability better care management chronically ill patient populations coordinate items services medicare encourage investment infrastructure care processes health plan including medicare_advantage plan group providers participate certified department_of_health_and_human_services hhs program shall focus containing long term costs improving overall health medicare population implementing qualified strategies prevent delay minimize progression illness disability associated chronic conditions respect enrollee dually eligible medicare medicaid medicare shall primary payor medigap policy supplemental insurance covers health care costs covered medicare provide coverage cost sharing medicare services furnished enrollee provider qualified professional hhs acting agency healthcare_research quality shall designate provide core funding chronic care innovation centers eligible designation funding eligible entity partner specified entities develop new evidence based curricula addresses need chronic care management


Summary:
Cranial Prosthetic Medicaid Coverage Enhancement Act

This bill amends title XIX (Medicaid) of the Social Security Act to alter coverage requirements under a state plan for medical assistance. Specifically, a state plan that provides medical assistance for an individual's inpatient hospital services shall also provide biennial medical assistance to the individual for one cranial prosthesis, as specified by the bill. (A cranial prosthesis is a custom-made wig designed for a patient who has suffered hair loss as a result of a medical condition or treatment.)

enhancement act bill amends title xix medicaid social security act alter coverage requirements state plan medical assistance specifically state plan provides medical assistance individual inpatient hospital services shall provide biennial medical assistance individual specified bill custom designed patient suffered hair loss result medical condition treatment


Summary:
Veterans Pensions Protection Act of 2016

This bill exempts the following payments from annual income determinations with respect to pensions for veterans and surviving spouses and children of veterans: (1) reimbursements, including insurance settlement payments, for medical expenses related to an accident, theft, loss, or casualty, up to the costs of medical care provided to the victim of such event; and (2) payments for pain and suffering, including insurance settlement payments and general damages awarded by a court related to an accident, theft, loss, or casualty loss up to an amount determined by the Department of Veterans Affairs on a case-by-case basis.

bill exempts following payments annual income determinations respect pensions veterans surviving spouses children veterans reimbursements including insurance settlement payments medical expenses related accident theft loss casualty costs medical care provided victim event payments pain suffering including insurance settlement payments general damages awarded court related accident theft loss casualty loss determined department_of_veterans_affairs case case basis


Summary:
Flexibility in Electronic Health Record Reporting Act

This bill requires the Department of Health and Human Services, with respect to electronic health record (EHR) meaningful use incentive programs under Medicare and Medicaid, to continue through 2016 to allow the use of quarterly reporting without regard to the payment year or the stage of meaningful use criteria involved.

flexibility electronic health record reporting act bill requires respect electronic health record ehr meaningful use incentive programs medicare medicaid continue allow use quarterly reporting regard payment year stage meaningful use criteria involved


Summary:
Ensuring Patient Access to Critical Breakthrough Products Act of 2016

This bill amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to modify provisions related to coverage and payment for certain breakthrough medical devices under the Medicare and Medicaid programs. Specifically, with respect to such devices, the bill: (1) provides for transitional coverage; (2) establishes accelerated processes for determining regular coverage and payment; and (3) modifies provisions related to specified payment adjustments, cost thresholds, and classification.

ensuring patient access critical breakthrough products act bill amends titles xviii medicare xix medicaid social security act modify provisions related coverage payment certain breakthrough medical devices medicare medicaid programs specifically respect devices bill provides transitional coverage establishes accelerated processes determining regular coverage payment modifies provisions related specified payment adjustments cost thresholds classification


Summary:
Preserving Access to Modern Prosthetic Limbs Act of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to postpone implementation and enforcement of a local coverage determination (LCD) proposed by a Medicare Administrative Contractor (MAC) on lower limb prostheses. (An LCD is a decision by a MAC, which is a private insurer that processes Medicare claims within a specified geographic jurisdiction, as to whether to cover a service on a MAC-wide basis.) The Centers for Medicare & Medicaid shall provide guidance and oversight related to LCDs, as specified by the bill.

preserving access modern prosthetic act bill amends title xviii medicare social security act postpone implementation enforcement local coverage determination lcd proposed mac lower limb prostheses lcd decision mac private insurer processes medicare claims specified geographic jurisdiction cover service mac wide basis shall provide guidance oversight related specified bill


Summary:
Breast Cancer Patient Protect Act of 2016

This bill amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act, and the Internal Revenue Code to require a group or individual health plan that provides medical and surgical benefits to ensure that inpatient (and in the case of a lumpectomy, outpatient) coverage and radiation therapy are provided for breast cancer treatment. Such a plan may not: (1) restrict benefits for any medically necessary hospital stay to less than 48 hours for a mastectomy or breast conserving surgery or less than 24 hours for a lymph node dissection, or (2) require that a provider obtain authorization from the plan for prescribing any such hospital stay.

Such a plan must: (1) provide notice to each participant and beneficiary regarding the coverage required under this bill, and (2) ensure that coverage is provided for secondary consultations.

Health plans are prohibited from taking specified actions to avoid the requirements of this bill.

Health insurers that provide individual health insurance coverage may discontinue an individual's coverage based on the intentional concealment of material facts regarding a health condition related to a condition for which coverage is being claimed.

breast cancer patient protect act bill amends employee retirement income security act erisa public_health_service_act internal revenue code require group individual health plan provides medical surgical benefits ensure inpatient case lumpectomy outpatient coverage radiation therapy provided breast cancer treatment plan restrict benefits medically necessary hospital stay hours mastectomy breast conserving surgery hours lymph node dissection require provider obtain authorization plan prescribing hospital stay plan provide notice participant beneficiary coverage required bill ensure coverage provided secondary consultations health plans prohibited taking specified actions avoid requirements bill health insurers provide individual health insurance coverage discontinue individual coverage based intentional concealment material facts health condition related condition coverage claimed


Summary:
Patient Access to Durable Medical Equipment Act of 2016 or the PADME Act

(Sec. 2) This bill amends titles XIX (Medicaid) and XXI (Children's Health Insurance Program [CHIP]) of the Social Security Act to prohibit federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated.

Under current law, a state must exclude from Medicaid participation any provider that has been terminated under any state's Medicaid program or under Medicare. The bill maintains those requirements and further requires a state to exclude from Medicaid participation any provider that has been terminated under CHIP. Furthermore, a state must exclude from CHIP participation any provider that has been terminated under Medicaid or Medicare.

The bill also revises a state's reporting requirements with respect to terminating a provider under a state plan. A state shall require each Medicaid or CHIP provider, whether the provider participates on a fee-for-service (FFS) basis or within the network of a managed care organization (MCO), to enroll with the state by providing specified identifying information. When notifying the Department of Health and Human Services (HHS) that a provider has been terminated under a state plan, the state must submit this information as well as information regarding the termination date and reason. HHS shall review such termination notifications and, if appropriate, include them in a database or similar system, as specified by the bill.

The bill prohibits federal payment under a state's Medicaid or CHIP program for services provided by an MCO unless: (1) the state has a system for notifying MCOs when a provider is terminated under Medicaid, Medicare, or CHIP; and (2) any contract between the state plan and an MCO provides that such providers be excluded from participation in the MCO provider network.

HHS shall report to Congress on this bill's implementation.

(Sec. 3) A state must publish and annually update a public directory of FFS providers participating under the state plan.

(Sec. 4) HHS shall: (1) delay by three months the full implementation of new Medicare payment rates for durable medical equipment (DME), and (2) study and report on the impact of applicable payment adjustments on the availability of DME to Medicare beneficiaries.

(Sec. 5) For purposes of eligibility determinations for federal public benefits, the bill excludes payments made under a state eugenics compensation program from classification as income or resources. A "state eugenics compensation program" is a state program intended to compensate individuals who were sterilized under the state's authority.

(Sec. 6) The bill makes available $3 million to the Medicare Improvement Fund for services furnished during and after FY2020.

patient access durable medical equipment act act sec bill amends titles xix medicaid social security act prohibit federal payment medicaid nonemergency services furnished providers participation medicaid medicare chip terminated current law state exclude medicaid participation provider terminated state medicaid program medicare bill maintains requirements requires state exclude medicaid participation provider terminated chip furthermore state exclude chip participation provider terminated medicaid medicare bill revises state reporting requirements respect terminating provider state plan state shall require medicaid chip provider provider participates fee service ffs basis network managed care organization enroll state providing specified identifying information notifying department_of_health_and_human_services hhs provider terminated state plan state submit information information termination date reason hhs shall review termination notifications appropriate include database similar system specified bill bill prohibits federal payment state medicaid chip program services provided state system notifying provider terminated medicaid medicare chip contract state plan provides providers excluded participation provider network hhs shall report congress bill implementation sec state publish annually update public directory ffs providers participating state plan sec hhs shall delay months implementation new medicare payment rates durable medical equipment dme study report impact applicable payment adjustments availability dme medicare beneficiaries sec purposes eligibility determinations federal public benefits bill excludes payments state compensation program classification income resources state compensation program state program intended compensate individuals state authority sec bill makes available million medicare_improvement_fund services furnished fy2020


Summary:
Veteran Prescription Continuity Act

This bill amends the National Defense Authorization Act for Fiscal Year 2016 to direct the Department of Veterans Affairs (VA) to furnish an individual who is transitioning from Department of Defense (DOD)- to VA-furnished medical treatment any pharmaceutical agent not included in the joint uniform formulary if a DOD health care provider determines that the pharmaceutical agent is critical for the transition.

The VA shall furnish an individual with such pharmaceutical agent: (1) beginning when the individual enrolls in the VA health care system, and (2) ending when a DOD health care provider determines that the individual does not require the pharmaceutical agent.

veteran prescription continuity act bill amends national_defense_authorization_act fiscal year direct department_of_veterans_affairs furnish individual transitioning furnished medical treatment pharmaceutical agent included joint uniform formulary dod health care provider determines pharmaceutical agent critical transition shall furnish individual pharmaceutical agent beginning individual enrolls health care system ending dod health care provider determines individual require pharmaceutical agent


Summary:
Medicare Dental, Vision, and Hearing Benefit Act of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to provide for Medicare coverage of dental, vision, and hearing care. With respect to such care, the bill establishes special payment rules, limitations, and coinsurance requirements.

vision hearing benefit act bill amends title xviii medicare social security act provide medicare coverage dental vision hearing care respect care bill establishes special payment rules limitations coinsurance requirements


Summary:
Hospital Price Transparency and Disclosure Act of 2016

This bill amends the Public Health Service Act to require hospitals and ambulatory surgical centers to report to the Department of Health and Human Services (HHS): (1) the frequency of certain treatment episodes for the most frequently treated conditions in each setting, (2) the total number of such treatment episodes, and (3) the average charge for the insured and uninsured for such a treatment episode.

HHS must publish on its website: (1) such information in a manner that promotes charge comparisons among hospitals and among ambulatory surgical centers, and (2) a link to other consumer quality information maintained on an HHS or Centers for Medicare and Medicaid Services website. Hospitals and ambulatory surgical centers must post prominently at each admission site a notice of the availability of such data.

Civil penalties are authorized for violations of this bill.

hospital price transparency disclosure act bill amends public_health_service_act require hospitals ambulatory surgical centers report department_of_health_and_human_services hhs frequency certain treatment frequently treated conditions setting total number treatment average charge insured uninsured treatment episode hhs publish website information manner promotes charge comparisons hospitals ambulatory surgical centers link consumer quality information maintained hhs medicaid_services website hospitals ambulatory surgical centers post prominently admission site notice availability data civil penalties authorized violations bill


Summary:
Dialysis PATIENT Demonstration Act of 2016 or the Patient Access to Integrated-care, Empowerment, Nephrologists and Treatment Demonstration Act of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to establish a demonstration program for the provision of integrated care to Medicare beneficiaries with end-stage renal disease (ESRD).

Under the voluntary program, eligible participating providers may form organizations to offer ESRD integrated care models and serve as medical homes for program-eligible beneficiaries. Such a model: (1) shall cover medical and hospital services, other than hospice care, under Medicare; (2) must include benefits for transition into palliative care; and (3) may cover prescription drug benefits. An organization must offer at least one open network model but may also offer one or more preferred network models.

An organization shall return savings achieved under the models to program-eligible beneficiaries.

A beneficiary shall have the opportunity to: (1) opt out of the program, (2) make an assignment change into an open network model offered by a different organization, or (3) elect a preferred network model.

The bill establishes requirements regarding: (1) benefits for program-eligible beneficiaries who are also eligible for Medicaid benefits, (2) program quality and reporting, (2) ESRD integrated care strategy, (3) program operation and scope, (4) beneficiary notification, and (5) payment.

dialysis patient demonstration act patient access integrated care empowerment treatment demonstration act bill amends title xviii medicare social security act establish demonstration program provision integrated care medicare beneficiaries end stage renal disease esrd voluntary program eligible participating providers form organizations offer esrd integrated care models serve medical homes program eligible beneficiaries model shall cover medical hospital services hospice care medicare include benefits transition palliative care cover prescription drug benefits organization offer open network model offer preferred network models organization shall return savings achieved models program eligible beneficiaries beneficiary shall opportunity opt program assignment change open network model offered different organization elect preferred network model bill establishes requirements benefits program eligible beneficiaries eligible medicaid benefits program quality reporting esrd integrated care strategy program operation scope beneficiary notification payment


Summary:
No Hero Left Untreated Act

(Sec. 3) This bill requires the Department of Veterans Affairs (VA) to carry out a one-year pilot program to provide access to magnetic EEG/EKG-guided resonance therapy to treat larger populations of veterans suffering from post-traumatic stress disorder, traumatic brain injury, military sexual trauma, chronic pain, or opiate addiction.

The VA shall carry out the program at up to two VA facilities and may provide access to such therapy to up to 50 veterans.

hero left untreated act sec bill requires department_of_veterans_affairs carry year pilot program provide access magnetic guided resonance therapy treat larger populations veterans suffering post traumatic stress disorder traumatic brain injury military sexual trauma chronic pain opiate addiction shall carry program facilities provide access therapy veterans


Summary:
(This measure has not been amended since it was reported to the House on September 19, 2016. The summary of that version is repeated here.)

Expanding Seniors Receiving Dialysis Choice Act of 2016 or the ESRD Choice Act of 2016

(Sec. 2) This bill amends title XVIII (Medicare) of the Social Security Act to allow individuals with end-stage renal disease (ESRD) to be eligible for Medicare Advantage (MA). Under current law, only individuals who develop ESRD while already enrolled in an MA plan may be considered eligible.

With respect to payment, the bill: (1) shifts responsibility for the cost of kidney acquisitions from MA plans to Medicare's fee-for-service program, and (2) excludes such costs from the calculation of certain benchmarks that form the basis for payment under MA plans.

measure amended reported house september summary version repeated expanding seniors receiving dialysis choice act esrd choice act sec bill amends title xviii medicare social security act allow individuals end stage renal disease esrd eligible current law individuals develop esrd enrolled plan considered eligible respect payment bill shifts responsibility cost kidney acquisitions plans medicare fee service program excludes costs calculation certain benchmarks form basis payment plans


Summary:
Rural ACO Provider Equity Act of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to establish additional requirements for assigning Medicare fee-for-service beneficiaries to accountable care organizations (ACOs) under the Medicare shared savings program. (The program enables ACOs to receive payments for savings stemming from care coordination and management.)

Specifically, the bill requires the basis for assignment to reflect beneficiaries' utilization of not only primary care services provided by ACO physicians, but also those furnished in federally qualified health centers or rural health clinics.

rural aco provider equity act bill amends title xviii medicare social security act establish additional requirements assigning medicare fee service beneficiaries accountable care organizations medicare shared savings program program enables receive payments savings stemming care coordination management specifically bill requires basis assignment reflect beneficiaries utilization primary care services provided aco physicians furnished federally qualified health centers rural health clinics


Summary:
Local Coverage Determination Clarification Act of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to revise the process by which Medicare administrative contractors (MACs) issue and reconsider local coverage determinations (LCDs) that: (1) are new, (2) restrict or substantively revise existing LCDs, or (3) are otherwise specified in regulation. (MACs are private insurers that process Medicare claims within specified geographic areas.)

Before such an LCD may take effect, the MAC issuing the determination must, with respect to each geographic area to which the determination applies:

 publish online a proposed version of the determination and other specified, related information; convene one or more public meetings to review the draft determination, receive comments, and secure the advice of an expert panel; post online a record of the minutes from each such meeting; provide a period for submission of written public comments; and post online specified information related to the rationale for the final determination. Upon the filing of an applicable request by an interested party with regard to the reconsideration of a specified LCD, the MAC that issued the determination shall:

 provide specified information related to whether the determination failed to correctly apply qualifying relevant evidence, exceeds the scope of its intended purpose, fails to apply as intended, or is otherwise erroneous; preserve the determination, modify the determination, or rescind the determination in part; and make publicly available a written description of such action. An interested party may appeal a reconsideration decision to the Centers for Medicare & Medicaid Services (CMS).

CMS shall appoint a Medicare Reviews and Appeals Ombudsman to carry out specified duties with regard to LCDs.

local coverage determination clarification act bill amends title xviii medicare social security act revise process medicare administrative contractors macs issue reconsider local coverage determinations new restrict revise existing specified regulation macs private insurers process medicare claims specified geographic areas lcd effect mac issuing determination respect geographic area determination applies publish online proposed version determination specified related information convene public meetings review draft determination receive comments secure advice expert panel post online record minutes meeting provide period submission written public comments post online specified information related rationale final determination filing applicable request interested party regard reconsideration specified lcd mac issued determination shall provide specified information related determination failed correctly apply qualifying relevant evidence exceeds scope intended purpose fails apply intended erroneous preserve determination modify determination rescind determination publicly available written description action interested party appeal reconsideration decision cms cms shall appoint carry specified duties regard


Summary:
Department of Veterans Affairs Dental Insurance Reauthorization Act of 2016

This bill directs the Department of Veterans Affairs (VA) to establish and administer a dental insurance plan for veterans enrolled in the system of annual patient enrollment under federal veterans' benefits provisions and for veterans' survivors and dependents who are eligible for medical care under such provisions.

The VA shall contract with a dental insurer to administer the plan. Benefits shall include diagnostic services, preventative services, endodontics and other restorative services, surgical services, and emergency services.

Enrollment shall be voluntary. The VA shall: (1) prescribe the minimum enrollment period, and (2) prescribe and annually adjust the premiums necessary to cover costs associated with carrying out the plan. Each individual covered by the plan shall pay the entire premium and the full cost of any copayments.

The VA shall permit voluntary disenrollment within 30 days after initial enrollment and under other specified circumstances the VA shall prescribe to the extent that such disenrollment does not jeopardize the fiscal integrity of the plan.

This bill's provisions terminate on December 31, 2021.

bill directs department_of_veterans_affairs establish administer dental insurance plan veterans enrolled system annual patient enrollment federal veterans benefits provisions veterans survivors dependents eligible medical care provisions shall contract dental insurer administer plan benefits shall include diagnostic services preventative services restorative services surgical services emergency services enrollment shall voluntary shall prescribe minimum enrollment period prescribe annually adjust premiums necessary cover costs associated carrying plan individual covered plan shall pay entire premium cost copayments shall permit voluntary disenrollment days initial enrollment specified circumstances shall prescribe extent disenrollment jeopardize fiscal integrity plan bill provisions terminate december


Summary:
This bill amends title XVIII (Medicare) of the Social Security Act to establish a five-year, population-based payment demonstration project through which provider networks are prospectively paid monthly capitated payments for coordinated care furnished to Medicare beneficiaries.

To be eligible to participate in the project, a provider network must:

 be an integrated care system that provides Medicare services directly; include physicians in group practice arrangements, a federally qualified health center, and at least one hospital; enter into, and be responsible for making payments to providers under, appropriate contractual arrangements; be accountable for the quality, cost, and overall care of the network's participating beneficiaries; enter into a participation agreement with the Centers for Medicare & Medicaid Services (CMS); and meet other specified requirements. CMS shall establish a process for prospectively assigning Medicare fee-for-service beneficiaries to a participating provider network. This process must allow beneficiaries to opt out of such assignment.

The bill limits Medicare payment for out-of-network services furnished to a participating beneficiary.

To calculate payments to participating networks, CMS shall: (1) determine a base annual prospective population health budget, (2) adjust such budget to account for the number and characteristics of participating beneficiaries with respect to each network, and (3) annually update the budget to account for population changes and Medicare program growth.

The bill establishes certain limits on total program expenditures for the program's initial three years.

CMS may expand the project's duration and scope under specified circumstances.

bill amends title xviii medicare social security act establish year population based payment demonstration project provider networks paid monthly capitated payments coordinated care furnished medicare beneficiaries eligible participate project provider network integrated care system provides medicare services directly include physicians group practice arrangements federally qualified health center hospital enter responsible making payments providers appropriate contractual arrangements accountable quality cost overall care network participating beneficiaries enter participation agreement cms meet specified requirements cms shall establish process assigning medicare fee service beneficiaries participating provider network process allow beneficiaries opt assignment bill limits medicare payment network services furnished participating beneficiary calculate payments participating networks cms shall determine base annual prospective population health budget adjust budget account number characteristics participating beneficiaries respect network annually update budget account population changes medicare program growth bill establishes certain limits total program expenditures program initial years cms expand project duration scope specified circumstances


Summary:
Dialysis PATIENTS Demonstration Act of 2016 or the Dialysis Patient Access to Integrated-care, Empowerment, Nephrologists, Treatment, and Services Demonstration Act of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to establish a demonstration program for the provision of integrated care to Medicare beneficiaries with end-stage renal disease (ESRD).

Under the voluntary program, eligible participating providers may form organizations to offer ESRD integrated care models and serve as medical homes for program-eligible beneficiaries. Such a model: (1) shall cover medical and hospital services, other than hospice care, under Medicare; (2) must include benefits for transition into palliative care; and (3) may cover prescription drug benefits. An organization must offer at least one open network model but may also offer one or more preferred network models.

An organization shall return savings achieved under the models to program-eligible beneficiaries.

A beneficiary shall have the opportunity to: (1) opt out of the program, (2) make an assignment change into an open network model offered by a different organization, or (3) elect a preferred network model.

The bill establishes requirements regarding: (1) benefits for program-eligible beneficiaries who are also eligible for Medicaid benefits, (2) program quality and reporting, (2) ESRD integrated care strategy, (3) program operation and scope, (4) beneficiary notification, and (5) payment.

dialysis patients demonstration act dialysis patient access integrated care empowerment treatment services demonstration act bill amends title xviii medicare social security act establish demonstration program provision integrated care medicare beneficiaries end stage renal disease esrd voluntary program eligible participating providers form organizations offer esrd integrated care models serve medical homes program eligible beneficiaries model shall cover medical hospital services hospice care medicare include benefits transition palliative care cover prescription drug benefits organization offer open network model offer preferred network models organization shall return savings achieved models program eligible beneficiaries beneficiary shall opportunity opt program assignment change open network model offered different organization elect preferred network model bill establishes requirements benefits program eligible beneficiaries eligible medicaid benefits program quality reporting esrd integrated care strategy program operation scope beneficiary notification payment


Summary:
The Consumer Healthcare Insurance Transparency Act of 2016

This bill amends the Public Health Service Act to require the Department of Health and Human Services to publish information on changes in group health plan and health insurance premiums for the next year for small employers and individuals. The information must be published by November 1 of each year.

transparency act bill amends public_health_service_act require department_of_health_and_human_services publish information changes group health plan health insurance premiums year small employers individuals information published november year


Summary:
Beneficiary Respiratory Equipment Access and Transparency to Home Ventilator Care Act of 2016 or the BREATH Act of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to require the Centers for Medicare & Medicaid Services to establish policies and standards for determining the appropriate use of certain ventilators under the Medicare program.

Subject to budget neutrality requirements, the bill: (1) increases the Medicare payment rate for such ventilators for 2017; and (2) for subsequent years, establishes a new base payment rate based on the percentage change, between 2015 and 2017, in the total number of beneficiaries receiving such ventilators under Medicare.

beneficiary respiratory equipment access transparency home care act act bill amends title xviii medicare social security act require centers establish policies standards determining appropriate use certain medicare program subject budget neutrality requirements bill increases medicare payment rate subsequent years establishes new base payment rate based percentage change total number beneficiaries receiving medicare


Summary:
Primary Care Enhancement Act of 2016

This bill amends the Internal Revenue Code to: (1) permit an individual to pay primary care service arrangement costs from a health savings account; and (2) allow an eligible taxpayer enrolled in a high-deductible health plan to take a tax deduction for cash paid into a health savings account, even if the taxpayer is simultaneously enrolled in a primary care service arrangement.

Under a "primary care service arrangement," an individual is provided coverage restricted to primary care services in exchange for a fixed periodic fee or payment for such services.

For the purposes of certain tax-deductible expenses for medical care, the bill expands the definition of "medical care" to include periodic provider fees, including: (1) periodic fees paid to a primary care physician for a defined set of medical services or the right to receive medical services on an as-needed basis; and (2) pre-paid primary care services designed to screen for, diagnose, cure, mitigate, treat, or prevent disease and promote wellness.

primary care enhancement act bill amends internal_revenue_code permit individual pay primary care service arrangement costs health savings account allow eligible taxpayer enrolled high deductible health plan tax deduction cash paid health savings account taxpayer simultaneously enrolled primary care service arrangement primary care service arrangement individual provided coverage restricted primary care services exchange fixed periodic fee payment services purposes certain tax deductible expenses medical care bill expands definition medical care include periodic provider fees including periodic fees paid primary care physician defined set medical services right receive medical services needed basis pre paid primary care services designed screen diagnose cure mitigate treat prevent disease promote wellness


Summary:
Adding Middle East Respiratory Syndrome to the FDA Priority Review Voucher Program Act

This bill amends the Federal Food, Drug, and Cosmetic Act to add Middle East respiratory syndrome to the list of tropical diseases under the priority review voucher program, which awards a voucher to the sponsor of a new drug or biological product that is approved to prevent or treat a tropical disease. (A voucher entitles the holder to have a future new drug or biological product application acted upon by the Food and Drug Administration within six months.)

adding middle east respiratory syndrome bill amends cosmetic act add middle_east respiratory syndrome list tropical diseases priority review voucher program awards voucher sponsor new drug biological product approved prevent treat tropical disease voucher entitles holder future new drug biological product application acted food_and_drug_administration months


Summary:
Patient Navigation Assistance Act of 2016

This bill amends title XIX (Medicaid) of the Social Security Act to require state Medicaid programs to provide medical assistance for patient navigator services. ("Patient navigators" are individuals who are trained to facilitate the care of other individuals and who have direct knowledge of the communities they serve.)

patient navigation assistance act bill amends title xix medicaid social security act require state medicaid programs provide medical assistance patient navigator services patient navigators individuals trained facilitate care individuals direct knowledge communities serve


Summary:
Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2016

This bill amends titles II (Old Age, Survivors, and Disability Insurance) and XVIII (Medicare) of the Social Security Act to indefinitely extend Medicare coverage of immunosuppressive drugs for kidney transplant recipients. Under current law, such coverage is limited to 36 months following a transplant.

comprehensive immunosuppressive drug coverage kidney transplant patients act bill amends titles old age survivors disability_insurance xviii medicare social security act indefinitely extend medicare coverage immunosuppressive drugs kidney transplant recipients current law coverage limited months following transplant


Summary:
ACO Assignment Improvement Act of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to establish additional requirements for assigning Medicare fee-for-service beneficiaries to accountable care organizations (ACOs) under the Medicare shared savings program. (The program enables ACOs to receive payments for savings stemming from care coordination and management.)

Specifically, the bill requires the basis for assignment to reflect beneficiaries' utilization of not only primary care services provided by ACO physicians, but also those provided by other ACO practitioners. Other ACO practitioners include physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, certified nurse-midwives, clinical social workers, clinical psychologists, and registered dieticians or nutrition professionals.

aco assignment improvement act bill amends title xviii medicare social security act establish additional requirements assigning medicare fee service beneficiaries accountable care organizations medicare shared savings program program enables receive payments savings stemming care coordination management specifically bill requires basis assignment reflect beneficiaries utilization primary care services provided aco physicians provided aco practitioners aco practitioners include physician assistants nurse practitioners clinical nurse specialists certified registered nurse anesthetists certified nurse midwives clinical social workers clinical psychologists registered nutrition professionals


Summary:
VA Provider Pay Modernization Act of 2016

This bill provides that market pay (one of the three salary components of Veterans Health Administration [VHA] physicians and dentists) shall be the same for each physician or dentist with the same specialty or assignment in the same Integrated Service Network (VISN).

The market pay of a physician or dentist may exceed the market pay generally available to a physician or dentist with the same specialty or assignment in the same VISN by up to 5%.

Such amount shall take into account the pay in the relevant health service area, as designated by the Department of Health and Human Services.

Market pay in a health professional shortage area for a physician's or dentist's specialty may exceed by up to 25% the market pay for a physician or dentist in a health service area with a specialty or assignment not relevant to the health professional shortage area.

The VA shall: (1) evaluate the market pay of a physician or dentist every 12 months; and (2) in implementing a promotion system, create parity between the grades and annual rates of basic pay for VHA employees performing similar duties in the same facility, regardless of service time.

provider pay modernization act bill provides market pay salary components veterans_health_administration vha physicians dentists shall physician dentist specialty assignment visn market pay physician dentist exceed market pay generally available physician dentist specialty assignment visn shall account pay relevant health service area designated department_of_health_and_human_services market pay health professional shortage area physician dentist specialty exceed market pay physician dentist health service area specialty assignment relevant health professional shortage area shall evaluate market pay physician dentist months implementing promotion system create parity grades annual rates basic pay vha employees performing similar duties facility regardless service time


Summary:
Medicare DMEPOS Competitive Bidding Improvement Act of 2015

 Amends title XVIII (Medicare) of the Social Security Act with respect to the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive acquisition program.

Prohibits the Secretary of Health and Human Services from accepting a bid from an entity for an area unless it: (1) meets state licensure requirements for the area for all items in the submitted bid for a product category, and (2) has obtained a bid surety bond of between $50,000 and $100,000 for each such area.

Prescribes requirements for the treatment of losing bidders and successful bidders that do not accept a contract.

medicare dmepos competitive bidding improvement act amends title xviii medicare social security act respect medicare durable medical equipment prosthetics orthotics supplies dmepos competitive acquisition program prohibits secretary health_and_human_services accepting bid entity area meets state licensure requirements area items submitted bid product category obtained bid surety bond area prescribes requirements treatment losing bidders successful bidders accept contract


Summary:
Prevent Interruptions in Physical Therapy Act of 2015

 (Sec. 2) This bill amends part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act to require physical therapists furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area to use specified locum tenens arrangements for payment purposes in the same manner as such arrangements are used to apply to physicians furnishing substitute physicians services for other physicians.

(Locum tenens [place holder], or substitute, physicians usually assume professional practices in the absence of a regular physician for reasons such as illness, pregnancy, vacation, or continuing medical education.)

prevent interruptions physical therapy act sec bill amends title xviii medicare social security act require physical therapists furnishing outpatient physical therapy services health professional shortage area medically underserved area rural area use specified locum tenens arrangements payment purposes manner arrangements apply physicians furnishing substitute physicians services physicians locum tenens place holder substitute physicians usually assume professional practices absence regular physician reasons illness pregnancy vacation continuing medical education


Summary:
Pharmacy and Medically Underserved Areas Enhancement Act

Amends title XVIII (Medicare) of the Social Security Act to cover pharmacist services.

pharmacy medically underserved areas enhancement act amends title xviii medicare social security act cover pharmacist services


Summary: Amends title XVIII (Medicare) of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs.

amends title xviii medicare social security act allow physician assistants nurse practitioners clinical nurse specialists supervise cardiac intensive cardiac pulmonary rehabilitation programs


Summary:
Veterans Hearing Aid Access and Assistance Act

Authorizes the Secretary of Veterans Affairs (VA) to appoint licensed hearing aid specialists in the Veterans Health Administration.

Requires the Secretary to submit an annual report on: (1) the timely access of veterans to VA hearing health services, and (2) VA contracting policies regarding the provision of hearing health services to veterans in non-VA facilities.

veterans hearing aid access assistance act authorizes secretary veterans_affairs appoint licensed hearing aid specialists veterans_health_administration requires secretary submit annual report timely access veterans hearing health services contracting policies provision hearing health services veterans non-va facilities


Summary:
Frontline Mental Health Provider Training Act

Requires the Department of Defense (DOD) and the Department of Veterans Affairs (VA) to jointly commence a pilot program to assess the feasibility and advisability of expanding use of physician assistants specializing in psychiatric medicine at DOD and VA medical facilities in order to meet the increasing demand for mental health care providers at such facilities through the completion of two 18-month psychiatry fellowship programs for physician assistants.

Directs DOD to carry out the pilot program at not less than one military medical treatment facility under the jurisdiction of the Department of the Army, one under the jurisdiction of the Department of the Navy, and one under the jurisdiction of the Department of the Air Force. Requires the VA to carry out the program at not less than three VA medical centers. Requires each Department to select at least 12 physician assistants to participate in each fellowship program. Sets forth qualifications for eligible physician assistants.

Requires each fellowship program to: (1) meet the training model for acuity, mixture, and volume established for psychiatric residency programs; and (2) provide to the selected individuals training equivalent to that received during a psychiatric residency, education leading to a clinical doctorate of science in psychiatry, and education that addresses the particular needs of rural and other under served populations of members of the Armed Forces and veterans.

act requires department_of_defense dod department_of_veterans_affairs jointly commence pilot program assess feasibility advisability expanding use physician assistants specializing psychiatric medicine dod medical facilities order meet increasing demand mental health care providers facilities completion month psychiatry fellowship programs physician assistants directs dod carry pilot program military medical treatment facility jurisdiction department_of_the_army jurisdiction department_of_the_navy jurisdiction requires carry program medical centers requires department select physician assistants participate fellowship program sets forth qualifications eligible physician assistants requires fellowship program meet training model acuity mixture volume established psychiatric residency programs provide selected individuals training equivalent received psychiatric residency education leading clinical doctorate science psychiatry education addresses particular needs rural served populations members armed_forces veterans


Summary:
Community Provider Readiness Recognition Act of 2015

Directs the Departments of Defense and Veterans Affairs to jointly develop a system by which a non-Department mental health care provider who provides health care to members of the Armed Forces or veterans shall receive a mental health provider readiness designation if such provider meets eligibility criteria relating to: (1) knowledge, comfort, and understanding with respect to the culture of members of the Armed Forces, veterans, and family members and caregivers of such members and veterans; and (2) knowledge regarding evidence-based treatments that have been approved by such Departments for the treatment of mental health issues among such members and veterans.

Requires such Departments to: (1) jointly establish and update a registry, which shall be available to the public, of all non-Department mental health care providers that are currently so designated, and (2) update all lists maintained by such Departments of such non-Department providers by indicating the providers that are currently so designated.

community provider readiness recognition act directs departments defense veterans_affairs jointly develop system mental health care provider provides health care members armed_forces veterans shall receive mental health provider readiness designation provider meets eligibility criteria relating knowledge comfort understanding respect culture members armed_forces veterans family members caregivers members veterans knowledge evidence based treatments approved departments treatment mental health issues members veterans requires departments jointly establish update registry shall available public mental health care providers currently designated update lists maintained departments non department providers indicating providers currently designated


Summary:
Ensuring Access to Primary Care for Women & Children Act

Amends title XIX (Medicaid) of the Social Security Act (SSAct) to require that the primary care services furnished in the two years after enactment of this Act by a physician with a primary specialty designation of family medicine, general internal medicine, or pediatric medicine be paid at a rate that is not less than 100% of the payment rate that applies under Medicare part B (Supplementary Medical Insurance), but only if the physician self-attests as being Board certified in those areas.

Extends this 100% of Medicare payment floor, subject to certain conditions, to the following providers: (1) physicians with a primary specialty designation of obstetrics and gynecology, and self-attesting they are Board certified; (2) advanced practice clinicians; (3) rural health clinics, federally-qualified health centers, or other specified health clinics; and (4) nurse practitioners, physician assistants, or certified nurse-midwives.

Excludes from coverage of primary care services any such services provided in an emergency department of a hospital.

Prescribes additional requirements for any contract between a state and a Medicaid managed care organization.

Directs the Government Accountability Office to examine the use of alternative payment models in state Medicaid programs and identify opportunities for disseminating successful payment models among them.

Amends SSAct title XI to: (1) extend funding for development of adult health quality measures; and (2) direct the Administrator for the Centers for Medicaid and Medicaid Services and the Director of the Agency for Healthcare Research and Quality to develop such measures specific to adult individuals with disabilities and include them in the Medicaid Quality Measurement Program.

ensuring access primary care women children act amends title xix medicaid social security act ssact require primary care services furnished years enactment act physician primary specialty designation family medicine general internal medicine pediatric medicine paid rate payment rate applies medicare supplementary_medical_insurance physician self attests board certified areas extends medicare payment floor subject certain conditions following providers physicians primary specialty designation obstetrics gynecology self attesting board certified advanced practice clinicians rural health clinics federally qualified health centers specified health clinics nurse practitioners physician assistants certified nurse midwives excludes coverage primary care services services provided emergency department hospital prescribes additional requirements contract state medicaid managed care organization directs government_accountability_office examine use alternative payment models state medicaid programs identify opportunities disseminating successful payment models amends ssact title extend funding development adult health quality measures direct administrator centers medicaid medicaid_services director agency healthcare_research quality develop measures specific adult individuals disabilities include medicaid quality measurement program


Summary:
SGR Repeal and Medicare Provider Payment Modernization Act of 2015

Amends title XVIII (Medicare) of the Social Security Act (SSAct) to: (1) remove sustainable growth rate (SGR) methodology from the determination of annual conversion factors in the formula for payment for physicians' services, and (2) revise the update in rates for 2015 and subsequent years.

Directs the Secretary of Health and Human Services to establish a Merit-based Incentive Payment (MIP) system under which eligible professionals (including physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists) shall receive annual payment increases or decreases based on their performance.

Requires specified incentive payments to eligible participants in an alternative payment model.

Requires the Secretary to: (1) draft a plan for development of quality measures to assess professionals, including non-patient-facing professionals; and (2) make payments for chronic care management services.

Expands the kinds of uses of Medicare data available to qualified entities. Directs the Secretary to provide Medicare data to qualified clinical data registries to facilitate quality improvement or patient safety.

Declares it a national objective to achieve widespread exchange of health information through interoperable certified electronic health records technology nationwide by December 31, 2018.

sgr_repeal medicare provider payment modernization act amends title xviii medicare social security act ssact remove sustainable growth rate sgr methodology determination annual conversion factors formula payment physicians services revise update rates subsequent years directs secretary health_and_human_services establish merit based mip system eligible professionals including physicians physician assistants nurse practitioners clinical nurse specialists certified registered nurse anesthetists shall receive annual payment increases decreases based performance requires specified incentive payments eligible participants alternative payment model requires secretary draft plan development quality measures assess professionals including non patient facing professionals payments chronic care management services expands kinds uses medicare data available qualified entities directs secretary provide medicare data qualified clinical data registries facilitate quality improvement patient safety declares national objective achieve widespread exchange health information interoperable certified electronic health records technology nationwide december