HR 3417 — BETTER Act of 2019

3417 IntroducedReported in House (IH)](RH)] <DOC> 116thUnion CONGRESSCalendar 1stNo. Session H.

574 116th CONGRESS 2d Session H.

3417 To[Report amendNo. title XVIII of the Social Security Act to provide for patient improvements and rural and quality improvements under the Medicare program.

116-691, Part I] To amend title XVIII of the Social Security Act to provide for patient improvements and rural and quality improvements under the Medicare program.

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 _______________________________________________________________________December A24, BILL2020 ToReported amendfrom titlethe XVIIICommittee ofon theWays Socialand SecurityMeans Actwith toan provideamendment for[Strike patientout improvementsall andafter ruralthe andenacting qualityclause improvementsand underinsert the Medicarepart program.printed in italic] December 24, 2020 Committee on Energy and Commerce discharged;

committed to the Committee of the Whole House on the State of the Union and ordered to be printed [For text of introduced bill, see copy of bill as introduced on June 21, 2019] _______________________________________________________________________ A BILL To amend title XVIII of the Social Security Act to provide for patient improvements and rural and quality improvements under the Medicare program.

``(iv) the need for coordination of benefits (including primary and secondary coverage scenarios) pursuant to section 1862,1862(b), in particular for benefits under part B of such title;

and ``(v) information for populations, such as residents of Puerto Rico and veterans, for whom there are special considerations with respect to enrollmentenrollment, eligibility, and coordination of benefits under title XVIII.

``(E) Posting of notice on websites.--The Commissioner of Social Security and the Secretary shall ensurepost that the notice beingrequired used under subparagraph (A) is posted in a prominent location on the public Internet website of the Social Security Administration and on the public Internet website of the Centers for Medicare & Medicaid Services, respectively.

Such agreement shall-- ``(I) provide funds to the Commissioner for the full cost of the Social Security Administration's work related to the implementation of this paragraph, including any initial costs incurred prior to the finalization of such agreement;

``(ii) Limitation.--In no case shall funds from the Social Security Administration's Limitation on Administrative Expenses be used to carry out activities related to the implementation of this paragraph.paragraph, except as the Commissioner determines is necessary in developing the agreement under clause (i).

``medicare enrollment notification and eligibility notices for individuals in medicare waiting period ``Notices ``Sec.

(a) Notices.-- ``(1) In General.--Thegeneral.--The Commissioner of Social Security shall distribute the notice to be provided pursuant to section 1143(a)(4), as may be modified under paragraph (2), to individuals in the 24-month waiting period under section 226(b).

``(2) Authority Toto Modifymodify Notice.--Thenotice.--The Secretary, in coordination with the Commissioner of Social Security, may modify the notice to be distributed under paragraph (1) as necessary to take into account the individuals described in such paragraph.

``(3) Posting of Noticenotice on Websites.--Thewebsites.--The Commissioner of Social Security and the Secretary shall ensurepost that the notice beingrequired usedto be distributed under paragraph (1) is posted in a prominent location on the public Internet website of the Social Security Administration and on the public Internet website of the Centers for Medicare & Medicaid Services, respectively.

``Timing ``(b) BeginningTiming.--Beginning not later than 2 years after the date of the enactment of this section, a notice required under subsection (a)(1) shall be mailed to an individual no less than two times in accordance with the following:

``Reimbursement``(c) Reimbursement of CostsCosts.-- ``(c) ``(1) In General.--Effectivegeneral.--Effective for fiscal years beginning in the year in which the date of enactment of this section occurs, the Commissioner of Social Security and the Secretary shall enter into an agreement which shall provide funding to cover the administrative costs of the Commissioner's activities under this section.

Such agreement shall-- ``(A) provide funds to the Commissioner for the full cost of the Social Security Administration's work related to the implementation of this section, including any initial costs incurred prior to the finalization of such agreement;

``(2) Limitation.--In no case shall funds from the Social Security Administration's Limitation on Administrative Expenses be used to carry out activities related to the implementation of this section.''.section, except as the Commissioner determines is necessary in developing the agreement under paragraph (1).''.

(3) in paragraph (4)(F)(i), by inserting ``services identified by CPT codes 9083490832, 90834, and 90837 (and as subsequently modified by the Secretary),'' before ``and any additional service'';

``(8) Treatment of mental health telehealth services.-- ``(A) Non-application of originating site requirements.--The requirements described in paragraph (4)(C)(i) shall not apply with respect to telehealth services furnished on or after January 1, 2020,2021, that are mental health telehealth services.

``(E) Mental health telehealth services defined.-- For purposes of this paragraph, the term `mental health telehealth service' means services identified by CPT codes 9083490832, 90834, and 90837 (and as subsequently modified by the Secretary).

``(F) Real-time benefit information.-- ``(i) In general.--Not later than January 1, 2021, the program shall provideimplement for the real-time electronicbenefit transmissiontools tothat prescribingare health care professionals, using technology capable of integrating with sucha professionals'prescribing health care professional's electronic prescribing andor electronic health record systems,system offor individual-specificthe transmission of formulary and benefit information underin areal prescriptiontime drug plan with respect to anprescribing individualhealth enrolledcare inprofessionals. such plan.

SuchWith informationrespect shallto include,a withcovered respectpart toD thedrug, prescribingsuch oftools ashall coveredbe partcapable Dof drugtransmitting such information specific to suchan individual,individual theenrolled following:in a prescription drug plan.

``(I)Such Ainformation descriptionshall ofinclude any clinically-appropriate alternatives to such drug included in the formularyfollowing: of such plan.

``(II)``(I) InformationA relatinglist toof applicableany cost-sharingclinically- requirementsappropriate foralternatives to such drug andincluded such alternatives, including a description of any variance in such requirements based on the pharmacyformulary dispensingof such drugplan. or such alternatives.

``(III)``(II) InformationCost-sharing relatinginformation tofor anysuch priordrug authorizationand orsuch otheralternatives, utilizationincluding managementa requirementsdescription applicableof toany suchvariance drugin andcost suchsharing alternativesbased withinon the formularypharmacy ofdispensing such plan.drug or such alternatives.

``(ii)``(III) SpecialInformation rulerelating forto 2021.--Thewhether programsuch shalldrug beis deemedincluded to be in compliance with clause (i) for 2021 if the programformulary compliesof withsuch theplan provisionsand ofany sectionprior 423.160(b)(7)authorization ofor titleother 42,utilization Codemanagement ofrequirements Federalapplicable Regulationsto (orsuch adrug successorand regulation),such foralternatives suchso year.''.included.

``(ii) Electronic transmission.--The provisions of subclauses (I) and (II) of clause (ii) of subparagraph (E) shall apply to an electronic transmission described in clause (i) in the same manner as such provisions apply with respect to an electronic transmission described in clause (i) of such subparagraph.

``(iii) Special rule for 2021.--The program shall be deemed to be in compliance with clause (i) for 2021 if the program complies with the provisions of section 423.160(b)(7) of title 42, Code of Federal Regulations (or a successor regulation), for such year.''.

availability of information on changes in formulary through the Internet).internet).

``(ii) In applying this subparagraph in the case of a hospital that,that ontrains or after the date of the enactment of this clause, begins to train residents and has not entered into a GME affiliation agreement (as defined by the Secretary for purposes of paragraph (4)(H)(ii)), on or after the date of the enactment of this clause, the Secretary shall not establish an FTE resident amount until such time as the Secretary determines that the hospital has trained at least 1.0 full-time-full-time-equivalent equivalent resident in an approved medical residency training program in a cost reporting period.

``(iii) In applying this subparagraph for cost reporting periods beginning on or after the date of enactment of this clause, in the case of a hospital that, as of such date of enactment, has an approved FTE resident amount based on the training in an approved medical residency program or programs of-- ``(I) less than 1.0 full-time-equivalent resident in any cost reporting period beginning before October 1, 1997, as determined by the Secretary;

``(iv) For purposes of carrying out this subparagraph for cost reporting periods beginning on or after the date of the enactment of this clause, a hospital shall report full-time-equivalent residents on its cost report for a cost reporting period if the hospital trains at least 1.0 full-time-equivalent residentresidents in an approved medical residency training program or programs in such period.

``(II) In applying this clause in the case of a hospital that, on or after the date of the enactment of this subclause, begins totraining train residents in a new approved medical residency training program or programs (as defined by the Secretary), the Secretary shall not determine a limitation applicable to the hospital under subparagraph (F) until such time as the Secretary determines that the hospital has trained at least 1.0 full-time-equivalent resident in such new approved medical residency training program or programs in a cost reporting period.

``(III) In applying this clause in the case of a hospital that, as of the date of the enactment of this subclause, has a limitation under subparagraph (F), based on a cost reporting period beginning before October 1, 1997, of less than 1.0 full-time-equivalent resident, the Secretary shall adjust the limitation in the manner applicable to a new approved medical residency training program if the Secretary determines the hospital trainsbegins training at least 1.0 full-time-equivalent residentresidents in a program year beginning on or after such date of enactment and before the date that is 5 years after such date of enactment.

``(9) Prioritization of measure endorsement.--The Secretary--entity-- ``(A) during the period beginning on the date of the enactment of this paragraph and ending on December 31, 2023, shall prioritize the endorsement of measures relating to maternal morbidity and mortality by the entity with a contract under subsection (a) in connection with endorsement of measures described in paragraph (2);

<all>Union Calendar No.

574 116th CONGRESS 2d Session H.

R.