PlainBillCongress, translated.Legislation. Context. Public interest.
H.R.1021 / 114th Congress

Protecting the Integrity of Medicare Act of 2015

Referred to the Subcommittee on Health.

Official summary

Version 18 · Reported to House amended, Part I · Mar 18, 2015

Protecting the Integrity of Medicare Act of 2015

(Sec. 2) Amends title II (Old Age, Survivors and Disability Insurance) of the Social Security Act (SSAct) to direct the Secretary of Health and Human Services to establish cost-effective procedures to ensure that: (1) a Social Security account number (or any derivative) is not displayed, coded, or embedded on the Medicare card issued to an individual entitled to benefits under part A (Hospital Insurance) of SSAct title XVIII (Medicare) or enrolled under Medicare part B (Supplementary Medical Insurance); and (2) any other identifier displayed on such card is not identifiable as a Social Security account number (or any derivative).

Directs the Secretary to make specified transfers during FY2015-FY2018 from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund to: (1) the Centers for Medicare and Medicaid Program Management Account, (2) the Social Security Administration Limitation on Administration Account, and (3) the Railroad Retirement Board Limitation on Administration Account.

Showing the opening paragraphs of the official summary.

Read full official summaryShow less

(Sec. 3) Directs the Secretary to establish procedures to ensure that Medicare payment is not made for items and services furnished to an individual incarcerated, deceased, or otherwise ineligible and not lawfully present in the United States.

(Sec. 4) Directs the Secretary, if cost-effective and technologically viable, to consider appropriate measures to implement use of electronic Medicare beneficiary and provider smart cards.

(Sec. 5) Extends the Medicare durable medical equipment face-to-face encounter documentation requirement to include physician assistants, practitioners, or specialists as well as physicians (as under current law).

(Sec. 6) Requires each Medicare administrative contractor to establish an improper payment outreach and education program for service providers and suppliers in order to reduce improper Medicare payments.

Requires the Secretary to retain a portion of the amounts recovered by recovery audit contractors to improve the ability of chiropractors to provide documentation of services to the Secretary to ensure that they are reasonable and necessary.

(Sec.7) Requires the Secretary to develop a plan to revise the incentive program under the Health Insurance Portability and Accountability Act of 1996 to encourage greater participation by individuals to report fraud and abuse in the Medicare program.

(Sec. 8) Directs the Secretary to require a claim for a covered Medicare part D (Voluntary Prescription Drug Benefit Program) drug for an individual enrolled in a prescription drug plan or in a Medicare Advantage Prescription Drug plan (PDP) to include a valid prescriber National Provider Identifier.

(Sec. 9) Gives Medicare beneficiaries the option to receive the Medicare Summary Notice (explanation of benefits) electronically.

(Sec.10) Directs the Secretary to: (1) apply competitive procedures to selection of a Medicare administrative contractor at least once every 10 years (currently once every 5 years); and (3) study and, as appropriate, specify incentives for states to work with the Secretary under the Medicare-Medicaid Data Match Program to protect the federal and state share of expenditures.

(Sec. 12) Authorizes a PDP sponsor to establish a drug management program for at-risk beneficiaries.

Requires a PDP sponsor, with respect to covered part D drugs, to have in place, directly or through appropriate arrangements, a utilization management tool designed to prevent: (1) the abuse of frequently abused drugs by individuals, and (2) the diversion of such drugs at pharmacies.

Directs the Secretary to authorize Medicare drug integrity contractors (MEDICs) to accept directly an individual's prescription and necessary medical records from pharmacies, prescription drug plans, and physicians in order for MEDICs to provide information relevant to determining whether the individual is an at-risk beneficiary.

Requires the Government Accountability Office to study: (1) the implementation of these amendments; and (2) the effectiveness of the at-risk beneficiaries for prescription drug abuse drug management program.

(Sec. 13) Directs the Secretary to issue a clarification or modification with respect to the application of the Common Rule (governing the protection of human subjects in research) to activities involving clinical data registries.

(Sec. 14) Amends SSA title XI to eliminate civil monetary penalties for inducements to physicians to limit services that are not medically necessary. Retains such penalties for inducements to limit medically necessary services.

Directs the Secretary to report to Congress on options for amending existing Medicare fraud and abuse laws and regulations to permit gainsharing or similar arrangements between physicians and hospitals that would otherwise be subject to penalties.

(Sec. 15) Modifies the Medicare home health surety bond condition of participation requirement.

(Sec. 16) Directs the Secretary to: (1) implement a process for medical review of spinal subluxation services by a chiropractor, and (2) develop educational and training programs to improve the ability of chiropractors to document services in a manner that demonstrates they are reasonable and necessary.

(Sec. 17) Requires the Secretary to: (1) revise the testing in New Jersey, Pennsylvania, and South Carolina of a model of prior authorization for repetitive scheduled non-emergent ambulance transport to cover specified additional states; and (2) apply the prior authorization program to all states under certain conditions.

(Sec. 19) Directs the Secretary to submit a plan to Congress for including in the annual report of the Comprehensive Error Rate Testing programs data on services (other than medical visits) paid under the physician fee schedule where the fee schedule amount exceeds $250 and where the error rate exceeds 20%.

(Sec. 20) Removes funds for the Medicare Improvement Fund that were added by the Impact Act of 2014.

Read the summary on Congress.gov
PlainBill analysis is coming later. This page presents official source data. We have not yet published a PlainBill explanation for this bill.

Who introduced it

Rep. Brady, Kevin [R-TX-8] · R–TX

Committees

  • Ways and Means Committee
  • Energy and Commerce Committee
31 cosponsorship records, including any withdrawals

Actions

A procedural vote is different from passage. Passage in one chamber does not establish enactment. Explore the glossary.

  1. Referred to the Subcommittee on Health.

  2. Placed on the Union Calendar, Calendar No. 29.

  3. Committee on Energy and Commerce discharged.

  4. Committee on Energy and Commerce discharged.

  5. Reported (Amended) by the Committee on Ways and Means. H. Rept. 114-46, Part I.

  6. Reported (Amended) by the Committee on Ways and Means. H. Rept. 114-46, Part I.

  7. Referred to the Subcommittee on Health.

  8. Ordered to be Reported (Amended) by Voice Vote.

  9. Committee Consideration and Mark-up Session Held.

  10. 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.

  11. 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.

  12. 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.

  13. Introduced in House

  14. Introduced in House

Bill text & related measures

Text links open the official source. We currently store references to these documents.

Related bills identified by Congress.gov

Source last updated: Apr 7, 2025. Consult Congress.gov for the current record.

Explore the bill from different angles

Choose a perspective, copy a prompt, and paste it into your preferred AI. Each prompt includes the bill version and available official source links, and asks for counterarguments as well as supporting evidence.

Neutral evidence review

Objective

Analyze H.R.1021 as objectively as possible. Explain its main provisions, who would be affected, possible benefits and harms, implementation, exceptions, and uncertainties. Present the strongest arguments for and against it, and identify evidence needed to assess its public impact.

View full prompt & sources
Fairness and public impact

Progressive lens

Examine H.R.1021 through a progressive lens, focusing on fairness, access, economic inequality, and effects on vulnerable communities. Explain potential benefits, costs, and unintended consequences. Consider the strongest counterarguments and distinguish stated goals from demonstrated outcomes.

View full prompt & sources
Institutions and government scope

Conservative lens

Examine H.R.1021 through a conservative lens, focusing on fiscal responsibility, institutional stability, federalism, and the scope of government. Explain potential benefits, costs, and unintended consequences. Consider the strongest counterarguments and any provisions that challenge this perspective.

View full prompt & sources
Individual rights and government power

Liberty lens

Examine H.R.1021 through a civil-liberties and limited-government lens. Consider individual rights, privacy, voluntary choice, accountability, and government power. Explain tradeoffs, possible safeguards, and the strongest counterarguments without assuming the proposal is beneficial or harmful.

View full prompt & sources