Fighting Fraud to Protect Care for Seniors Act of 2018
(Sec. 2) This bill requires the Centers for Medicare & Medicaid Services (CMS) to establish a pilot program that evaluates the feasibility of using smart card technology to address Medicare fraud. Under the program, smart card technology must be issued free-of-charge to selected Medicare beneficiaries, suppliers, and providers; such technology must support the secure, electronic authentication of beneficiary identity at points of service. In selecting program participants, the CMS must consider the risk of fraud, waste, or abuse among categories of suppliers and providers.
[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6690 Introduced in House (IH)]
<DOC>
115th CONGRESS
2d Session
H. R. 6690
To establish a smart card pilot program to combat fraud, waste, and
abuse and to protect beneficiary identity under the Medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
August 28, 2018
Mr. Roskam (for himself and Mr. Blumenauer) introduced the following
bill; which was referred to the Committee on Ways and Means, and in
addition to the Committee on Energy and Commerce, 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 establish a smart card pilot program to combat fraud, waste, and
abuse and to protect beneficiary identity under the Medicare program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Fighting Fraud to Protect Care for
Seniors Act of 2018''.
SEC. 2. MEDICARE SMART CARD PILOT PROGRAM.
Part E of title XVIII of the Social Security Act is amended by
inserting after section 1866E the following new section:
``SEC. 1866F. SMART CARD PILOT PROGRAM.
``(a) Implementation.--
``(1) In general.--Not later than 36 months after the date
of the enactment of this section, the Secretary shall establish
a pilot program (in this section referred to as the `pilot
program') to evaluate the feasibility of using smart card
technology under this title.
``(2) Smart card technology defined.--In this section, the
term `smart card technology' means the following:
``(A) Beneficiary smart card.--A machine readable,
tamper-resistant card (in this section referred to as a
`smart card') that includes an embedded integrated
circuit chip with a secure micro-controller (as defined
by the National Institute on Standards and Technology)
that enables the verification and secure, electronic
authentication of the identity of a Medicare
beneficiary at the point of service through a
combination of the smart card and a personal
identification number known by or associated with such
beneficiary.
``(B) Card reader technology.--Information
technology that enables a supplier and provider to
authenticate the identity of a Medicare beneficiary
through presentation of such a smart card and such
components, with such authentication to be reflected
through the use of a modifier or in another appropriate
manner, as determined by the Secretary, in the claims
adjudication process.
``(3) Program design elements.--The pilot program shall be
conducted for a period of 3 years consistent with the
following:
``(A) Selection of area.--In consultation with the
Inspector General of the Department of Health and Human
Services, the Secretary shall select at least 3
geographic areas in which the pilot program will
operate.
``(B) Selection of supplier and provider types.--In
consultation with the Inspector General of the
Department of Health and Human Services, the Secretary
shall select supplier and provider types that will be
required to participate in the pilot program (referred
to in this section as `participating suppliers and
providers'). In selecting such supplier and provider
types, the Secretary shall--
``(i) take into account the risk of fraud,
waste, and abuse (as described in section
1866(j)(2)(B)) with respect to the category of
provider or supplier) and other factors as
determined appropriate by the Secretary; and
``(ii) limit the pilot program to no more
than 2,000 suppliers and providers.
``(C) Supplier and provider hardship exemptions.--
The Secretary shall exempt from participation in the
pilot program a supplier or provider that either--
``(i) does not have access to card reader
technology (as described in paragraph (2)(B));
``(ii) does not have sufficient internet
access; or
``(iii) has a low volume (as determined by
the Secretary) of Medicare claims for which
payment is made under this title.
``(D) Smart card and smart card reader issuance.--
``(i) Beneficiary smart card issuance.--The
Secretary shall provide for, at no cost, the
issuance (and, if necessary, replacement) of
beneficiary smart cards described in paragraph
(2)(A) to all Medicare beneficiaries residing
in a geographic area in which the pilot program
is conducted under subparagraph (A).
Information that appears on Medicare cards used
outside the pilot program may appear on the
face of the beneficiary smart card.
``(ii) Supplier and provider smart card
reader issuance.--At the request of a
participating supplier or provider, the
Secretary shall provide for, at no cost, the
issuance to such supplier or provider of smart
card hardware and software necessary to
participate in the pilot program.
``(E) Information on operation of pilot program.--
The Secretary shall provide participating suppliers and
providers and Medicare beneficiaries who are furnished
items and services by such suppliers and providers,
with information on the operation of the pilot program,
including privacy protections described in subparagraph
(I).
``(F) Access to services outside the pilot
program.--
``(i) Beneficiaries.--Medicare
beneficiaries who receive beneficiary smart
cards may receive items and services from
suppliers and providers not participating in
the pilot program.
``(ii) Suppliers and provider claims.--
``(I) Suppliers and providers not
participating in pilot.--Suppliers and
providers not participating in the
pilot program may submit claims under
this title for items and services
furnished without use of smart card
technology to Medicare beneficiaries
who receive beneficiary smart cards.
``(II) Participating suppliers and
providers furnishing services to non-
participating beneficiaries.--Supplier
and providers participating in the
pilot program may submit claims under
this title for items and services
furnished to Medicare beneficiaries who
do not receive beneficiary smart cards.
``(G) Clarification on access to services without
smart cards.--In the case of a Medicare beneficiary who
receives a beneficiary smart card and does not present
such card at the time of receipt of items or services
from a participating supplier or provider, the
participating supplier or provider--
``(i) shall furnish such items or services
to such Medicare beneficiary as if such
beneficiary does present such card;
``(ii) may submit claims under this title
for such items or services; and
``(iii) shall provide, in accordance with
such manner, process, and timing as specified
by the Secretary, information to the Secretary
(through the contractor described in
subparagraph (H)) that such beneficiary
received such a smart card but did not have the
smart card at the time the items or services
were furnished.
``(H) Private sector implementation.--The Secretary
shall select, by using a competitive procurement
process in accordance with the provisions of chapter 1
of title 48, Code of Federal Regulations (or any
successor regulations), a private sector contractor to
implement and operate the pilot program.
``(I) Privacy protections.--The Secretary shall
ensure that the pilot program complies with applicable
Federal laws and regulations concerning individually
identifiable health information, including the Privacy
Act of 1974 and regulations promulgated under section
264(c) of the Health Insurance Portability and
Accountability Act of 1996 and such individually
identifiable information shall be exempt from
disclosure under section 552(b)(3) of title 5, United
States Code.
``(J) Mandatory participation.--Subject to
subparagraph (C), in the case of items or services
furnished by a provider or supplier included in a
supplier or provider type selected under subparagraph
(B) in a geographic area selected under subparagraph
(A), payment may only be made under this title for such
items or services during the period of the pilot
program if the provider or supplier is participating in
the pilot program.
``(K) Prohibition of smart card fees.--No
transaction, utilization, or other fees may be imposed
on Medicare beneficiaries or participating suppliers
and providers with respect to the use of smart cards
under the pilot program.
``(4) Stakeholder input.--
``(A) In general.--Not later than 6 months after
the date of the enactment of this section, the
Secretary shall convene a panel consisting of
stakeholders (including representatives of providers,
suppliers, Medicare beneficiaries, and claims
processing contractors) selected by the Secretary for
purposes of providing input to the Secretary on the
implementation of the pilot program (including on the
selection of areas and participants under subparagraphs
(A) and (B) of paragraph (3) and the development of
exemptions and requirements described in such
paragraph).
``(B) Nonapplicability of faca.--The Federal
Advisory Committee Act shall not apply to the panel
convened pursuant to subparagraph (A).
``(5) Definitions.--In this section:
``(A) The terms `supplier' and `provider' have the
meanings given the terms `supplier' and `provider of
services' in subsections (d) and (u), respectively, of
section 1861.
``(B) The term `Medicare beneficiary' means an
individual who is enrolled in the original Medicare
fee-for-service program under parts A and B and is not
enrolled in an MA plan under part C, an eligible
organization under section 1876, or a PACE program
under section 1894.
``(b) Reports to Congress.--The Secretary shall submit to Congress
the following reports:
``(1) Interim performance report.--Not later than 2 years
after the date the pilot program is implemented, an interim
report on the performance of such program.
``(2) Final performance report.--Not later than 18 months
after the date of the completion of the pilot program, a final
evaluation on the effectiveness of the pilot program. The
report shall include the following:
``(A) An evaluation of the extent to which health
care fraud schemes were affected by the use of smart
card technology.
``(B) A description of any barriers to
implementation of the pilot program.
``(C) Participant feedback on the pilot program.
``(D) Recommendations regarding the future use of
smart cards to address fraud under this title.
``(E) Data on the information provided under
subsection (a)(3)(G)(iii).''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Committee Consideration and Mark-up Session Held.
Ordered to be Reported in the Nature of a Substitute by Voice Vote.
Reported (Amended) by the Committee on Ways and Means. H. Rept. 115-936, Part I.
Reported (Amended) by the Committee on Ways and Means. H. Rept. 115-936, Part I.
Committee on Energy and Commerce discharged.
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Committee on Energy and Commerce discharged.
Placed on the Union Calendar, Calendar No. 727.
Mr. Roskam moved to suspend the rules and pass the bill, as amended.
Considered under suspension of the rules. (consideration: CR H8118-8120)
DEBATE - The House proceeded with forty minutes of debate on H.R. 6690.
Passed/agreed to in House: On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote.(text: CR H8118-8119)
On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote. (text: CR H8118-8119)
Motion to reconsider laid on the table Agreed to without objection.
Received in the Senate and Read twice and referred to the Committee on Finance.