I 116TH CONGRESS 1ST SESSION H. R. 3429 To provide for health equity and access for returning troops and servicemembers, to provide for ambulatory surgical payment transparency under the Medicare program, and for other purposes. IN THE HOUSE OF REPRESENTATIVES JUNE 24, 2019 Ms. SEWELL of Alabama (for herself and Mr. NUNES) introduced the fol- lowing bill; which was referred to the Committee on Energy and Com- merce, and in addition to the Committees on Ways and Means, and Armed Services, for a period to be subsequently determined by the Speak- er, in each case for consideration of such provisions as fall within the ju- risdiction of the committee concerned A BILL To provide for health equity and access for returning troops and servicemembers, to provide for ambulatory surgical payment transparency under the Medicare program, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘HEARTS and Rural Relief Act’’. 5 VerDate Sep 11 2014 01:41 Jun 29, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3429.IH H3429 kjohnson on DSK79L0C42 with BILLS 2 •HR 3429 IH (b) TABLE OF CONTENTS.—The table of contents for 1 this Act is as follows: 2 Sec. 1. Short title; table of contents. Sec. 2. Health Equity and Access for Returning Troops and Servicemembers and Rural Relief Act of 2019. Sec. 3. Ambulatory surgical center payment transparency. Sec. 4. Exclusion of complex rehabilitative manual wheelchairs from Medicare competitive acquisition program; non-application of Medicare fee schedule adjustments for certain wheelchair accessories and cushions. Sec. 5. Extension of enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2021. SEC. 2. HEALTH EQUITY AND ACCESS FOR RETURNING 3 TROOPS AND SERVICEMEMBERS AND RURAL 4 RELIEF ACT OF 2019. 5 (a) MODIFICATION OF REQUIREMENT FOR CERTAIN 6 FORMER MEMBERS OF THE ARMED FORCES TO ENROLL 7 IN MEDICARE PART B TO BE ELIGIBLE FOR TRICARE 8 FOR LIFE.— 9 (1) TRICARE ELIGIBILITY.— 10 (A) IN GENERAL.—Subsection (d) of sec- 11 tion 1086 of title 10, United States Code, is 12 amended by adding at the end the following 13 new paragraph: 14 ‘‘(6)(A) The requirement in paragraph (2)(A) 15 to enroll in the supplementary medical insurance 16 program under part B of title XVIII of the Social 17 Security Act (42 U.S.C. 1395j et seq.) shall not 18 apply to a person described in subparagraph (B) 19 during any month in which such person is not enti- 20 VerDate Sep 11 2014 23:03 Jul 08, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3429.IH H3429 kjohnson on DSK79L0C42 with BILLS 3 •HR 3429 IH tled to a benefit described in subparagraph (A) of 1 section 226(b)(2) of the Social Security Act (42 2 U.S.C. 426(b)(2)) if such person has received the 3 counseling and information under subparagraph (C). 4 ‘‘(B) A person described in this subparagraph 5 is a person— 6 ‘‘(i) who is under 65 years of age; 7 ‘‘(ii) who is entitled to hospital insurance 8 benefits under part A of title XVIII of the So- 9 cial Security Act pursuant to subparagraph (A) 10 or (C) of section 226(b)(2) of such Act (42 11 U.S.C. 426(b)(2)); 12 ‘‘(iii) whose entitlement to a benefit de- 13 scribed in subparagraph (A) of such section has 14 terminated due to performance of substantial 15 gainful activity; and 16 ‘‘(iv) who is retired under chapter 61 of 17 this title. 18 ‘‘(C) The Secretary of Defense shall coordinate 19 with the Secretary of Health and Human Services 20 and the Commissioner of Social Security to notify 21 persons described in subparagraph (B) of, and pro- 22 vide information and counseling regarding, the ef- 23 fects of not enrolling in the supplementary medical 24 insurance program under part B of title XVIII of 25 VerDate Sep 11 2014 23:03 Jul 08, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3429.IH H3429 kjohnson on DSK79L0C42 with BILLS 4 •HR 3429 IH the Social Security Act (42 U.S.C. 1395j et seq.), as 1 described in subparagraph (A).’’. 2 (B) CONFORMING AMENDMENT.—Para- 3 graph (2)(A) of such subsection is amended by 4 striking ‘‘is enrolled’’ and inserting ‘‘except as 5 provided by paragraph (6), is enrolled’’. 6 (C) IDENTIFICATION OF PERSONS.—Sec- 7 tion 1110a of such title is amended by adding 8 at the end the following new subsection: 9 ‘‘(c) CERTAIN INDIVIDUALS NOT REQUIRED TO EN- 10 ROLL IN MEDICARE PART B.—In carrying out subsection 11 (a), the Secretary of Defense shall coordinate with the 12 Secretary of Health and Human Services and the Commis- 13 sioner of Social Security to— 14 ‘‘(1) identify persons described in subparagraph 15 (B) of section 1086(d)(6) of this title; and 16 ‘‘(2) provide information and counseling pursu- 17 ant to subparagraph (C) of such section.’’. 18 (2) NON-APPLICATION OF MEDICARE PART B 19 LATE ENROLLMENT PENALTY.—Section 1839(b) of 20 the Social Security Act (42 U.S.C. 1395r(b)) is 21 amended, in the second sentence, by inserting ‘‘or 22 months for which the individual can demonstrate 23 that the individual is an individual described in 24 paragraph (6)(B) of section 1086(d) of title 10, 25 VerDate Sep 11 2014 01:41 Jun 29, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3429.IH H3429 kjohnson on DSK79L0C42 with BILLS 5 •HR 3429 IH United States Code, who is enrolled in the 1 TRICARE program pursuant to such section’’ after 2 ‘‘an individual described in section 1837(k)(3)’’. 3 (3) REPORT.—Not later than October 1, 2024, 4 the Secretary of Defense, the Secretary of Health 5 and Human Services, and the Commissioner of So- 6 cial Security shall jointly submit to the Committees 7 on Armed Services of the House of Representatives 8 and the Senate, the Committee on Ways and Means 9 and the Committee on Energy and Commerce of the 10 House of Representatives, and the Committee on Fi- 11 nance of the Senate a report on the implementation 12 of section 1086(d)(6) of title 10, United States 13 Code, as added by paragraph (1). Such report shall 14 include, with respect to the period covered by the re- 15 port— 16 (A) the number of individuals enrolled in 17 TRICARE for Life who are not enrolled in the 18 supplementary medical insurance program 19 under part B of title XVIII of the Social Secu- 20 rity Act (42 U.S.C. 1395j et seq.) by reason of 21 such section 1086(d)(6); and 22 (B) the number of individuals who— 23 VerDate Sep 11 2014 01:41 Jun 29, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3429.IH H3429 kjohnson on DSK79L0C42 with BILLS 6 •HR 3429 IH (i) are retired from the Armed Forces 1 under chapter 61 of title 10, United States 2 Code; 3 (ii) are entitled to hospital insurance 4 benefits under part A of title XVIII of the 5 Social Security Act pursuant to receiving 6 benefits for 24 months as described in sub- 7 paragraph (A) or (C) of section 226(b)(2) 8 of such Act (42 U.S.C. 426(b)(2)); and 9 (iii) because of such entitlement, are 10 no longer enrolled in TRICARE Standard, 11 TRICARE Prime, TRICARE Extra, or 12 TRICARE Select under chapter 55 of title 13 10, United States Code. 14 (4) DEPOSIT OF SAVINGS INTO MEDICARE IM- 15 PROVEMENT FUND.—Section 1898(b)(1) of the So- 16 cial Security Act (42 U.S.C. 1395iii(b)(1)) is amend- 17 ed by striking ‘‘during and after fiscal year 2021, 18 $0’’ and inserting ‘‘during and after fiscal year 19 2024, $5,000,000’’. 20 (5) APPLICATION.—The amendments made by 21 paragraphs (1) and (2) shall apply with respect to 22 a person who, on or after October 1, 2023, is a per- 23 son described in section 1086(d)(6)(B) of title 10, 24 United States Code, as added by paragraph (1). 25 VerDate Sep 11 2014 01:41 Jun 29, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3429.IH H3429 kjohnson on DSK79L0C42 with BILLS 7 •HR 3429 IH (b) COVERAGE OF CERTAIN DNA SPECIMEN PROVE- 1 NANCE ASSAY TESTS UNDER MEDICARE.— 2 (1) BENEFIT.— 3 (A) COVERAGE.—Section 1861 of the So- 4 cial Security Act (42 U.S.C. 1395x) is amend- 5 ed— 6 (i) in subsection (s)(2)— 7 (I) in subparagraph (GG), by 8 striking ‘‘and’’ at the end; 9 (II) in subparagraph (HH), by 10 striking the period and inserting ‘‘; 11 and’’; and 12 (III) by adding at the end the 13 following new subparagraph: 14 ‘‘(II) a prostate cancer DNA Specimen Prove- 15 nance Assay test (DSPA test) (as defined in sub- 16 section (kkk));’’; and 17 (ii) by adding at the end the following 18 new subsection: 19 ‘‘(kkk) PROSTATE CANCER DNA SPECIMEN PROVE- 20 NANCE ASSAY TEST.—The term ‘prostate cancer DNA 21 Specimen Provenance Assay Test’ (DSPA test) means a 22 test that, after a determination of cancer in one or more 23 prostate biopsy specimens obtained from an individual, as- 24 sesses the identity of the DNA in such specimens by com- 25 VerDate Sep 11 2014 01:41 Jun 29, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3429.IH H3429 kjohnson on DSK79L0C42 with BILLS 8 •HR 3429 IH paring such DNA with the DNA that was separately taken 1 from such individual at the time of the biopsy.’’. 2 (B) EXCLUSION FROM COVERAGE.—Sec- 3 tion 1862(a)(1) of the Social Security Act (42 4 U.S.C. 1395y(a)(1)) is amended— 5 (i) in subparagraph (O), by striking 6 ‘‘and’’ at the end; 7 (ii) in subparagraph (P), by striking 8 the semicolon at the end and inserting ‘‘, 9 and’’; and 10 (iii) by adding at the end the fol- 11 lowing new subparagraph: 12 ‘‘(Q) in the case of a prostate cancer DNA 13 Specimen Provenance Assay test (DSPA test) (as 14 defined in section 1861(kkk)), unless such test is 15 furnished on or after January 1, 2020, and before 16 January 1, 2025, and such test is ordered by the 17 physician who furnished the prostate cancer biopsy 18 that obtained the specimen tested;’’. 19 (2) PAYMENT AMOUNT AND RELATED REQUIRE- 20 MENTS.—Section 1834 of the Social Security Act 21 (42 U.S.C. 1395m) is amended by adding at the end 22 the following new subsection: 23 ‘‘(x) PROSTATE CANCER DNA SPECIMEN PROVE- 24 NANCE ASSAY TESTS.— 25 VerDate Sep 11 2014 01:41 Jun 29, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3429.IH H3429 kjohnson on DSK79L0C42 with BILLS 9 •HR 3429 IH ‘‘(1) PAYMENT FOR COVERED TESTS.— 1 ‘‘(A) IN GENERAL.—Subject to subpara- 2 graph (B), the payment amount for a prostate 3 cancer DNA Specimen Provenance Assay test 4 (DSPA test) (as defined in section 1861(kkk)) 5 shall be $200. Such payment shall be payment 6 for all of the specimens obtained from the bi- 7 opsy furnished to an individual that are tested. 8 ‘‘(B) LIMITATION.—Payment for a DSPA 9 test under subparagraph (A) may only be made 10 on an assignment-related basis. 11 ‘‘(C) PROHIBITION ON SEPARATE PAY- 12 MENT.—No separate payment shall be made for 13 obtaining DNA that was separately taken from 14 an individual at the time of a biopsy described 15 in subparagraph (A). 16 ‘‘(2) HCPCS CODE AND MODIFIER ASSIGN- 17 MENT.— 18 ‘‘(A) IN GENERAL.—The Secretary shall 19 assign one or more HCPCS codes to a prostate 20 cancer DNA Specimen Provenance Assay test 21 and may use a modifier to facilitate making 22 payment under this section for such test. 23 ‘‘(B) IDENTIFICATION OF DNA MATCH ON 24 CLAIM.—The Secretary shall require an indica- 25 VerDate Sep 11 2014 01:41 Jun 29, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3429.IH H3429 kjohnson on DSK79L0C42 with BILLS 10 •HR 3429 IH tion on a claim for a prostate cancer DNA 1 Specimen Provenance Assay test of whether the 2 DNA of the prostate biopsy specimens match 3 the DNA of the individual diagnosed with pros- 4 tate cancer. Such indication may be made 5 through use of a HCPCS code, a modifier, or 6 other means, as determined appropriate by the 7 Secretary. 8 ‘‘(3) DNA MATCH REVIEW.— 9 ‘‘(A) IN GENERAL.—The Secretary shall 10 review at least three years of claims under part 11 B for prostate cancer DNA Specimen Prove- 12 nance Assay tests to identify whether the DNA 13 of the prostate biopsy specimens match the 14 DNA of the individuals diagnosed with prostate 15 cancer. 16 ‘‘(B) POSTING ON INTERNET WEBSITE.— 17 Not later than July 1, 2023, the Secretary shall 18 post on the internet website of the Centers for 19 Medicare & Medicaid Services the findings of 20 the review conducted under subparagraph 21 (A).’’. 22 (3) COST-SHARING.—Section 1833(a)(1) of the 23 Social Security Act (42 U.S.C. 1395l(a)(1)) is 24 amended— 25 VerDate Sep 11 2014 01:41 Jun 29, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3429.IH H3429 kjohnson on DSK79L0C42 with BILLS 11 •HR 3429 IH (A) by striking ‘‘and (CC)’’ and inserting 1 ‘‘(CC)’’; and 2 (B) by inserting before the semicolon at 3 the end the following: ‘‘, and (DD) with respect 4 to a prostate cancer DNA Specimen Provenance 5 Assay test (DSPA test) (as defined in section 6 1861(kkk)), the amount paid shall be an 7 amount equal to 80 percent of the lesser of the 8 actual charge for the test or the amount speci- 9 fied under section 1834(x)’’. 10 SEC. 3. AMBULATORY SURGICAL CENTER PAYMENT TRANS- 11 PARENCY. 12 (a) ADVISORY PANEL ON HOSPITAL OUTPATIENT 13 PAYMENT REPRESENTATION.— 14 (1) ASC REPRESENTATIVE.—The second sen- 15 tence of section 1833(t)(9)(A) of the Social Security 16 Act (42 U.S.C. 1395l(t)(9)(A)) is amended by in- 17 serting ‘‘and at least one ambulatory surgical center 18 representative’’ after ‘‘an appropriate selection of 19 representatives of providers’’. 20 (2) EFFECTIVE DATE.—The amendment made 21 by paragraph (1) shall apply with respect to advisory 22 panels consulted on or after the date that is 1 year 23 after the date of the enactment of this Act. 24 VerDate Sep 11 2014 01:41 Jun 29, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3429.IH H3429 kjohnson on DSK79L0C42 with BILLS 12 •HR 3429 IH (b) REASONS FOR EXCLUDING ADDITIONAL PROCE- 1 DURES FROM ASC APPROVED LIST.—Section 1833(i)(1) 2 of the Social Security Act (42 U.S.C. 1395l(i)(1)) is 3 amended by adding at the end the following: ‘‘In updating 4 such lists for application in years beginning with the sec- 5 ond year beginning after the date of the enactment of this 6 sentence, for each procedure that was not proposed to be 7 included in such lists in the proposed rule with respect 8 to such lists and that was subsequently requested to be 9 included in such lists during the public comment period 10 with respect to such proposed rule and that is not included 11 in the final rule updating such lists, the Secretary shall 12 cite in such final rule the specific criteria in paragraph 13 (b) or (c) of section 416.166 of ti [Text truncated for display. 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