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S. 861 (114th): PRIME Act of 2015

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The summary below was written by the Congressional Research Service, which is a nonpartisan division of the Library of Congress, and was published on Jul 30, 2015.


Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015

(Sec. 2) Amends title XIX (Medicaid) of the Social Security Act (SSAct) to cover the costs of equipment, salaries and benefits, and travel and training in appropriations for the Medicaid Integrity Program. Allows the Department of Health and Human Services (HHS) to increase Centers for Medicare and Medicaid Services staff whose duties consist solely of protecting the integrity of the Medicare program under SSAct title XVIII by a number determined necessary to carry out the Program (currently, by 100).

(Sec. 3) Directs HHS to provide incentives for Medicare administrative contractors (MACs) to reduce the improper payment error rates in their jurisdictions.

Authorizes among such incentives:

a sliding scale of award fee payments and additional incentives to MACs that either reduce the improper payment rates in their jurisdictions to certain HHS-determined thresholds or accomplish tasks that further improve payment accuracy; and substantial reductions in award fee payments under cost-plus-award-fee contracts for MACs that reach an upper end improper payment rate threshold or fail to accomplish tasks that further improve payment accuracy. (Sec. 4) Requires imprisonment for up to 10 years or a fine of up to $500,000 ($1 million in the case of a corporation), or both, for without lawful authority knowingly and willfully purchasing, selling, distributing, or arranging for the purchase, sale, or distribution of a beneficiary identification number or unique health identifier for a health care provider under SSAct titles XVIII, XIX, or XXI (Children's Health Insurance Program) (CHIP).

(Sec. 5) Directs HHS to establish a plan to encourage and facilitate the participation of states in the Medicare-Medicaid Data Match Program (Medi-Medi Program). Revises Medi-Medi Data Match Program purposes.

Directs HHS to develop and implement a plan that allows state agencies responsible for administering a state Medicaid plan access to relevant data on improper or fraudulent payments made under the Medicare program for health care items or services provided to dual eligible individuals (eligible for both Medicare and Medicaid).