Electrodiagnostic Medicine Patient Protection and Fraud Elimination Act of 2023

I 118TH CONGRESS 1ST SESSION H. R. 2639 To amend title XVIII of the Social Security Act to provide for additional requirements with respect to electrodiagnostic services under the Medi- care program. IN THE HOUSE OF REPRESENTATIVES APRIL 17, 2023 Mr. SESSIONS introduced the following bill; which was referred to the Com- mittee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title XVIII of the Social Security Act to provide for additional requirements with respect to electrodiagnostic services under the Medicare program. 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. 3 This Act may be cited as the ‘‘Electrodiagnostic Med- 4 icine Patient Protection and Fraud Elimination Act of 5 2023’’. 6 VerDate Sep 11 2014 03:14 Apr 21, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2639.IH H2639 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 2639 IH SEC. 2. ADDITIONAL REQUIREMENTS FOR 1 ELECTRODIAGNOSTIC SERVICES. 2 Section 1834 of the Social Security Act (42 U.S.C. 3 1395m) is amended by adding at the end the following 4 new subsection: 5 ‘‘(z) PAYMENT FOR ELECTRODIAGNOSTIC SERV- 6 ICES.— 7 ‘‘(1) IN GENERAL.—No payment may be made 8 under this part for electrodiagnostic services de- 9 scribed in paragraph (2) furnished on or after a date 10 determined appropriate by the Secretary that is not 11 earlier than 3 years after the date of the enactment 12 of this subsection and not later than 4 years after 13 such date of enactment that are not furnished at a 14 qualified facility. 15 ‘‘(2) ELECTRODIAGNOSTIC SERVICES.—The 16 services described in this paragraph are the fol- 17 lowing: 18 ‘‘(A) Nerve conduction studies. 19 ‘‘(B) Needle electromyography tests. 20 ‘‘(3) QUALIFIED FACILITY.—In this subsection, 21 the term ‘qualified facility’ means a facility accred- 22 ited by an organization specified by the Secretary 23 pursuant to paragraph (4). 24 ‘‘(4) ACCREDITATION ORGANIZATIONS.— 25 VerDate Sep 11 2014 03:14 Apr 21, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2639.IH H2639 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 2639 IH ‘‘(A) IN GENERAL.—Not later than 2 years 1 after the date of the enactment of this sub- 2 section, the Secretary shall specify accrediting 3 organizations, in consultation with the advisory 4 committee described in paragraph (5), for pur- 5 poses determining whether a facility is a quali- 6 fied facility. The Secretary may specify an orga- 7 nization pursuant to the preceding sentence 8 only if such organization requires, as a condi- 9 tion of accreditation of a facility by such orga- 10 nization, that such facility meet the require- 11 ments described in subparagraph (B). In mak- 12 ing such specification, the Secretary shall— 13 ‘‘(i) ensure that the number of accred- 14 iting organizations so specified is adequate 15 to facilitate the accreditation of facilities; 16 and 17 ‘‘(ii) prioritize such specification of 18 accrediting organizations that are widely 19 recognized by both public and private enti- 20 ties as having experience in the accredita- 21 tion of such facilities. 22 ‘‘(B) FACILITY REQUIREMENTS.—The re- 23 quirements described in this subparagraph are, 24 VerDate Sep 11 2014 03:14 Apr 21, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2639.IH H2639 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 2639 IH with respect to a facility and electrodiagnostic 1 services furnished at such facility, the following: 2 ‘‘(i) The facility establishes and main- 3 tains a quality assurance and control pro- 4 gram to ensure the reliability, safety, and 5 accuracy of such service. 6 ‘‘(ii) The facility ensures that such 7 service is conducted using a device capable 8 of performing both nerve conduction stud- 9 ies that record amplitude and latency and 10 needle electromyography tests capable of 11 real-time waveform display and analysis. 12 ‘‘(iii) In the case that such service is 13 a needle electromyography test, the facility 14 ensures that the individual furnishing such 15 test has completed not less than 3 months 16 of training in performing and interpreting 17 electrodiagnostic studies during a residency 18 or fellowship program accredited by the 19 Accreditation Council for Graduate Med- 20 ical Education or the Royal College of 21 Physicians and Surgeons of Canada, or by 22 an individual described in section 23 410.32(b)(2)(iv) of title 42, Code of Fed- 24 VerDate Sep 11 2014 03:14 Apr 21, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2639.IH H2639 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 2639 IH eral Regulations (or a successor regula- 1 tion). 2 ‘‘(iv) The facility ensures that the re- 3 sults are interpreted on-site and at the 4 time of the procedure— 5 ‘‘(I) in the case of a needle 6 electromyography test, by the indi- 7 vidual who performed such test; and 8 ‘‘(II) in the case of a nerve con- 9 duction study, by the individual who 10 performed or supervised such study. 11 ‘‘(v) Any other requirement deter- 12 mined appropriate by the Secretary. 13 ‘‘(C) REGULATIONS.—Not later than 1 14 year after the date of the enactment of this 15 subsection, the Secretary shall finalize regula- 16 tions that outline— 17 ‘‘(i) the process by which an accred- 18 iting organization may be specified under 19 subparagraph (A); 20 ‘‘(ii) the duration and the minimum 21 time period between reviews for reaccredi- 22 tation an organization so specified must 23 provide for with respect to an accreditation 24 of a facility made by such organization; 25 VerDate Sep 11 2014 03:14 Apr 21, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2639.IH H2639 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 2639 IH ‘‘(iii) the process by which the Sec- 1 retary may withdraw approval of an ac- 2 crediting organization so specified if the 3 Secretary determines that such organiza- 4 tion no longer requires, as a condition of 5 accreditation of a facility by such organiza- 6 tion, that such facility meet the require- 7 ments described in subparagraph (B); and 8 ‘‘(iv) the effect such a withdrawal will 9 have on facilities accredited by such orga- 10 nization as of the date of such withdrawal. 11 ‘‘(5) ADVISORY COMMITTEE.— 12 ‘‘(A) IN GENERAL.—Not later than 2 years 13 after the date of the enactment of this sub- 14 section, the Secretary shall establish an advi- 15 sory committee to be known as the ‘National 16 Electrodiagnostic Services Advisory Committee’ 17 (in this subsection referred to as the ‘com- 18 mittee’) for purposes of carrying out the duties 19 specified in subparagraph (B). 20 ‘‘(B) DUTIES.—The duties of the com- 21 mittee are the following: 22 ‘‘(i) To provide to the Secretary rec- 23 ommendations with respect to require- 24 ments that may be determined appropriate 25 VerDate Sep 11 2014 03:14 Apr 21, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2639.IH H2639 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 2639 IH by the Secretary pursuant to paragraph 1 (4)(B)(v), including any proposed additions 2 to such requirements or modifications of 3 such requirements. In developing such rec- 4 ommendations, the committee shall 5 prioritize— 6 ‘‘(I) reducing unnecessary treat- 7 ments and surgeries; 8 ‘‘(II) decreasing the need for re- 9 testing of individuals; 10 ‘‘(III) enhancing the reliability of 11 diagnoses and promoting positive 12 health outcomes for individuals; 13 ‘‘(IV) addressing emerging waste, 14 fraud, and abuse schemes; and 15 ‘‘(V) otherwise improving the 16 quality of care for individuals. 17 ‘‘(ii) To provide to the Secretary rec- 18 ommendations regarding the regulations 19 described in paragraph (4)(C). 20 ‘‘(iii) To provide to the Secretary rec- 21 ommendations with respect to whether ac- 22 crediting organizations seeking to be speci- 23 fied pursuant to paragraph (4)(A) should 24 be so specified. 25 VerDate Sep 11 2014 03:14 Apr 21, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2639.IH H2639 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 2639 IH ‘‘(C) COMPOSITION.—The committee shall 1 be composed of not fewer than 9 and not more 2 than 11 individuals selected by the Secretary. 3 Such individuals shall not be officers or employ- 4 ees of the Federal Government and shall in- 5 clude— 6 ‘‘(i) at least one physician with experi- 7 ence in furnishing electrodiagnostic serv- 8 ices described in paragraph (2) in a lab ac- 9 credited by an organization determined ap- 10 propriate by the Secretary; 11 ‘‘(ii) at least one physical therapist 12 that is certified in clinical electrophysiology 13 by an organization determined appropriate 14 by the Secretary; 15 ‘‘(iii) other health care practitioners; 16 ‘‘(iv) at least one patient representing 17 an affected community; and 18 ‘‘(v) other individuals determined ap- 19 propriate by the Secretary. 20 ‘‘(D) MEETINGS.—The committee shall 21 convene not less than twice each year.’’. 22 Æ VerDate Sep 11 2014 03:14 Apr 21, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6301 E:\BILLS\H2639.IH H2639 pbinns on DSKJLVW7X2PROD with $$_JOB