H.R. 5780: Protecting the Integrity of Medicare Act of 2014
On December 2, Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) and Ranking Member Jim McDermott (D-WA) introduced the Protecting the Integrity of Medicare Act (PIMA) of 2014. The legislation reforms Medicare’s anti-fraud programs and emphasizes preventing fraud, waste, and abuse before it happens.
The legislation is a combination of bipartisan Ways and Means policy proposals, including proposals that would:
- Remove social security numbers from Medicare beneficiary cards and is based on legislation introduced by Rep. Sam Johnson and Rep. Lloyd Doggett in each of the last three Congresses. (H.R. 781)
- Require consideration of use of smart cards in Medicare, a provision spearheaded by Rep. Jim Gerlach and Rep. Earl Blumenauer. (H.R. 3024)
- Expand who can document the face-to-face encounter required for Medicare durable medical equipment prescriptions to include nurse practitioners and physician assistants, as allowed by state law, based on legislation introduced by Rep. Jim McDermott. (H.R. 3833)
- Increase outreach and education for providers by Medicare contractors and other program integrity efforts in the PRIME Act, legislation sponsored by Rep. Peter Roskam and Rep. Earl Blumenauer. (H.R.2305)
- Provide existing beneficiaries the option to receive a Medicare summary notice (MSN) electronically beginning in 2015 and Medicare Administrative Contractor efficiency measures in accordance with a bill introduced by Rep. Jim Renacci and co-sponsored by Rep. Bill Pascrell. (H.R. 4853)
- Require that the HHS Secretary issue guidance on the application of the “Common Rule,” which provides protection for individuals involved in research by incorporating a policy advocated by Rep. Bill Pascrell.
- Require the HHS Secretary to issue a report describing how a permanent physician-hospital gainsharing program can best be established based on policy advocated by Rep. Charles Boustany.
- Require changes to gainsharing restrictions to apply only to medically necessary services, allowing for the elimination of wasteful activity as introduced by Rep. Jim McDermott. (H.R. 4658)
- Require the HHS Secretary to require each home health agency to obtain a surety bond in the amount of no less than $50,000 as a condition of participation in the Medicare program based on a bill introduced by Rep. Jim McDermott. (H.R. 3832)
- Repeal a duplicative provision in statute causing unnecessary paperwork and burdens on employers based on a bill introduced by Rep. John Lewis. (H.R. 5102)
Below are the supporting materials for the bill: