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Republican Alternative to Pelosicare

Republican Alternative to Pelosicare

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10/21/2011

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LINES.

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(a) GREATERCOORDINATION.—The Secretary of

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Health and Human Services shall provide for increased

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coordination between the Administrator of the Centers for

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Medicare & Medicaid Services (in this section referred to

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as ‘‘CMS’’) and its regional offices to ensure that pro-

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viders of services and suppliers that have operated in one

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State and are excluded from participation in the Medicare

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program are unable to begin operation and participation

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in the Medicare program in another State.

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(b) IMPROVEDINFORMATIONSYSTEMS.—

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(1) INGENERAL.—The Secretary shall improve

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information systems to allow greater integration be-

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tween databases under the Medicare program so

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that—

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(A) medicare administrative contractors,

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fiscal intermediaries, and carriers have imme-

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diate access to information identifying providers

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and suppliers excluded from participation in the

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Medicare and Medicaid program and other Fed-

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eral health care programs; and

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(B) such information can be shared across

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Federal health care programs and agencies, in-

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cluding between the Departments of Health and

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Human Services, the Social Security Adminis-

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tration, the Department of Veterans Affairs,

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the Department of Defense, the Department of

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Justice, and the Office of Personnel Manage-

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ment.

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(c) MEDICARE/MEDICAID‘‘ONEPI’’ DATABASE.—

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The Secretary shall implement a database that includes

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claims and payment data for all components of the Medi-

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care program and the Medicaid program.

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(d) AUTHORIZINGEXPANDEDDATAMATCHING.—

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Notwithstanding any provision of the Computer Matching

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and Privacy Protection Act of 1988 to the contrary—

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(1) the Secretary and the Inspector General in

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the Department of Health and Human Services may

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perform data matching of data from the Medicare

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program with data from the Medicaid program; and

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(2) the Commissioner of Social Security and the

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Secretary may perform data matching of data of the

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Social Security Administration with data from the

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Medicare and Medicaid programs.

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(e) CONSOLIDATIONOFDATABASES.—The Sec-

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retary shall consolidate and expand into a centralized data

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base for individuals and entities that have been excluded

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from Federal health care programs the Healthcare Integ-

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rity and Protection Data Bank, the National Practitioner

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Data Bank, the List of Excluded Individuals/Entities, and

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a national patient abuse/neglect registry.

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(f) COMPREHENSIVEPROVIDERDATABASE.—

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(1) ESTABLISHMENT.—The Secretary shall es-

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tablish a comprehensive database that includes infor-

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mation on providers of services, suppliers, and re-

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lated entities participating in the Medicare program,

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the Medicaid program, or both. Such database shall

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include, information on ownership and business rela-

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tionships, history of adverse actions, results of site

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visits or other monitoring by any program.

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(2) USE.—Prior to issuing a provider or sup-

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plier number for an entity under the Medicare pro-

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gram, the Secretary shall obtain information on the

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entity from such database to assure the entity quali-

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fies for the issuance of such a number.

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(g) COMPREHENSIVESANCTIONSDATABASE.—The

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Secretary shall establish a comprehensive sanctions data-

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base on sanctions imposed on providers of services, sup-

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pliers, and related entities. Such database shall be over-

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seen by the Inspector General of the Department of

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Health and Human Services and shall be linked to related

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databases maintained by State licensure boards and by

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Federal or State law enforcement agencies.

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(h) ACCESSTOCLAIMSANDPAYMENTDATA-

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BASES.—The Secretary shall ensure that the Inspector

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General of the Department of Health and Human Services

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and Federal law enforcement agencies have direct access

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to all claims and payment databases of the Secretary

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under the Medicare or Medicaid programs.

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(i) CIVILMONEYPENALTIESFORSUBMISSIONOF

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ERRONEOUSINFORMATION.—In the case of a provider of

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services, supplier, or other entity that submits erroneous

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information that serves as a basis for payment of any enti-

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ty under the Medicare or Medicaid program, the Secretary

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may impose a civil money penalty of not to exceed $50,000

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for each such erroneous submission. A civil money penalty

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under this subsection shall be imposed and collected in the

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same manner as a civil money penalty under subsection

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(a) of section 1128A of the Social Security Act is imposed

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and collected under that section.

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DIVISION G—PATHWAY FOR BIO-

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SIMILAR BIOLOGICAL PROD-

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UCTS

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