Medicare and Medicaid Patient Protection Act of 1984 - Amends part A (General Provisions) of title XI of the Social Security Act to direct the Secretary of Health and Human Services to exclude from participation in programs under title XVIII (Medicare) of the Act, and to direct State agencies to exclude from participation in programs under title XIX (Medicaid) of the Act, title V (Maternal and Child Health Block Grant) of the Act, and title XX (Block Grants to States for Social Services) of the Act, for a period of not less than five years, any individual or entity that has been convicted of a criminal offense related to such individual's or entity's participation in the delivery of items or services under title XVIII or any such State health care program. Authorizes the Secretary to exclude from participation in Medicare and to direct State agencies to exclude from participation in such State health care programs: (1) any individual or entity convicted of any financial abuse or abuse of patients in connection with the delivery of health care items or services in any publicly operated or financed program; (2) any individual or entity convicted of unlawful manufacture or distribution of a controlled substance; (3) any individual who has had his or her health care license revoked or suspended; (4) any individual suspended or sanctioned under any Federal program involving the provision of health care; (5) any individual or entity that the Secretary determines has knowingly made any false statement in an application for payment under Medicare or a State health care program; (6) any entity whenever the Secretary determines that any person with an ownership or controlling interest in that entity or a managing employee of that entity is a person who has been convicted of specified health care related crimes, fined for specified health care abuses, or denied payment pursuant to this Act; or (7) any individual or entity which fails to supply certain information. Entitles any individual or entity excluded from participation to a hearing.
Directs the Secretary to promptly notify each appropriate State agency administering or supervising the administration of a State health care program of the fact and circumstances of each exclusion and of the period for which the State agency shall exclude the individual or entity from health care program participation. Permits the Secretary to waive the requirement to exclude an individual or entity from participation if a waiver request is received from the State. Directs the Secretary to notify the appropriate State or local licensing authority of the fact of an individual's or entity's exclusion. Permits reinstatement of an individual or entity if there is no basis for continuing the exclusion.
Requires a State, under title XIX of the Act, to supply the Secretary information with respect to any health care practitioner or entity against whom a formal proceeding is undertaken by a State licensing authority.
Requires each State having a plan approved under title XIX of the Act to have in effect a system of reporting under which the State agency administering Medicaid reports in a timely manner to the Secretary any proceeding commenced against a health care practitioner or entity and any results of such proceedings. Directs the Secretary to maintain a central information system on all such proceedings. Authorizes the Secretary to release information from the system to a State if such information may be useful to the State in determining the fitness of an individual to provide health care services.
Establishes as the criminal penalties for violations of this Act the penalties set forth under title XIX of the Act. Sets forth civil penalties.
Requires any health care provider providing health care services for which payment may be made under the Act to assure that services or items furnished: (1) will be provided economically and only when, and to the extent, medically necessary; (2) will be quality services which meet professionally recognized standards of health care; and (3) will be supported by evidence of medical necessity and quality in such form and fashion and at such time as may reasonably be required by a reviewing peer review organization in the exercise of its duties and responsibilities.
Amends the Controlled Substances Act to permit the Attorney General to suspend or revoke a registration to manufacture, distribute, or dispense a controlled substance upon a finding that the registrant has been excluded from participation in the Medicare program pursuant to the provisions of this Act.
Authorizes the Secretary to give an individual or entity six months to correct any deficiencies in meeting the requirements of this Act in any case in which an individual or entity must obtain certification for participation in the programs covered by this Act and such deficiencies do not immediately jeopardize the health and safety of patients.
Introduced in Senate
Read twice and referred to the Committee on Finance.
Committee on Finance requested executive comment from OMB, Treasury Department, Health and Human Services Department.
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