42 U.S.C. § 1395zz | Provider education and technical assistance

(a)

Coordination of education funding

section 1395ddd of this titleThe Secretary shall coordinate the educational activities provided through medicare contractors (as defined in subsection (g), including under ) in order to maximize the effectiveness of Federal education efforts for providers of services and suppliers.

(b)

Enhanced education and training

(1)

Additional resources

There are authorized to be appropriated to the Secretary (in appropriate part from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund) such sums as may be necessary for fiscal years beginning with fiscal year 2005.

(2)

Use

The funds made available under paragraph (1) shall be used to increase the conduct by medicare contractors of education and training of providers of services and suppliers regarding billing, coding, and other appropriate items and may also be used to improve the accuracy, consistency, and timeliness of contractor responses.

(c)

Tailoring education and training activities for small providers or suppliers

(1)

In general

Insofar as a medicare contractor conducts education and training activities, it shall tailor such activities to meet the special needs of small providers of services or suppliers (as defined in paragraph (2)). Such education and training activities for small providers of services and suppliers may include the provision of technical assistance (such as review of billing systems and internal controls to determine program compliance and to suggest more efficient and effective means of achieving such compliance).

(2)

Small provider of services or supplier

In this subsection, the term “small provider of services or supplier” means—

(A)

a provider of services with fewer than 25 full-time-equivalent employees; or

(B)

a supplier with fewer than 10 full-time-equivalent employees.

(d)

Internet websites; FAQs

The Secretary, and each medicare contractor insofar as it provides services (including claims processing) for providers of services or suppliers, shall maintain an Internet website which—

(1)

provides answers in an easily accessible format to frequently asked questions, and

(2)

includes other published materials of the contractor,

that relate to providers of services and suppliers under the programs under this subchapter (and subchapter XI insofar as it relates to such programs).

(e)

Encouragement of participation in education program activities

A medicare contractor may not use a record of attendance at (or failure to attend) educational activities or other information gathered during an educational program conducted under this section or otherwise by the Secretary to select or track providers of services or suppliers for the purpose of conducting any type of audit or prepayment review.

(f)

Construction

section 1395ddd(g) of this titleNothing in this section or shall be construed as providing for disclosure by a medicare contractor—

(1)

of the screens used for identifying claims that will be subject to medical review; or

(2)

of information that would compromise pending law enforcement activities or reveal findings of law enforcement-related audits.

(g)

Definitions

For purposes of this section, the term “medicare contractor” includes the following:

(1)

section 1395kk–1 of this title section 1395h of this title section 1395u of this title A medicare administrative contractor with a contract under , including a fiscal intermediary with a contract under and a carrier with a contract under .

(2)

section 1395ddd of this title An eligible entity with a contract under .

Such term does not include, with respect to activities of a specific provider of services or supplier an entity that has no authority under this subchapter or subchapter IX with respect to such activities and such provider of services or supplier.

Aug. 14, 1935, ch. 531 Pub. L. 108–173, title IX, § 921(a)(1)Dec. 8, 2003117 Stat. 2388(, title XVIII, § 1889, as added and amended , (d)(1), (e)(1), (f)(1), , , 2391.)

Editorial Notes

Prior Provisions

act Aug. 14, 1935, ch. 531, title XVIII, § 1889Nov. 5, 1990Pub. L. 101–508, title IV, § 4361(a)104 Stat. 1388–141 Pub. L. 103–432, title I, § 171(j)(3)lOct. 31, 1994108 Stat. 4451 Pub. L. 101–508A prior section 1395zz, , as added , , , related to medicare and medigap information by telephone, prior to repeal by , (), , , effective as if included in the enactment of .

act Aug. 14, 1935, ch. 531, title XVIII, § 1889Jan. 2, 1968Pub. L. 90–248, title I, § 132(b)81 Stat. 850Oct. 30, 1972Pub. L. 92–603, title II, § 245(d)86 Stat. 1424Oct. 25, 1977Pub. L. 95–142, § 16(a)91 Stat. 1200July 18, 1984Pub. L. 98–369, div. B, title III, § 2321(d)98 Stat. 1084 Pub. L. 100–203, title IV, § 4062(d)(5)Dec. 22, 1987101 Stat. 1330–109Jan. 1, 1989June 1, 1989Another prior section 1395zz, , formerly § 1833(f), as added , , , and amended , , ; , , ; renumbered § 1889 and amended , , , provided for purchase of durable medical equipment, covering (a) lease-purchase basis or rental and determination by Secretary, (b) waiver of coinsurance amount in purchase of used equipment, (c) reimbursement procedures, and (d) encouragement of lease-purchase basis, prior to repeal by , (e), , , applicable to covered items (other than oxygen and oxygen equipment) furnished on or after , and to oxygen and oxygen equipment furnished on or after .

Amendments

Pub. L. 108–173, § 921(d)(1)2003—Subsecs. (b), (c). , added subsecs. (b) and (c).

Pub. L. 108–173, § 921(e)(1)Subsec. (d). , added subsec. (d).

Pub. L. 108–173, § 921(f)(1)Subsecs. (e) to (g). , added subsecs. (e) to (g).

Statutory Notes and Related Subsidiaries

Effective Date of 2003 Amendment

Pub. L. 108–173, title IX, § 921(d)(2)Dec. 8, 2003117 Stat. 2391

October 1, 2004“The amendment made by paragraph (1) [amending this section] shall take effect on .”

, , , provided that:

Pub. L. 108–173, title IX, § 921(e)(2)Dec. 8, 2003117 Stat. 2391

October 1, 2004“The amendment made by paragraph (1) [amending this section] shall take effect on .”

, , , provided that:

Pub. L. 108–173, title IX, § 921(f)(2)Dec. 8, 2003117 Stat. 2392

Dec. 8, 2003“The amendment made by paragraph (1) [amending this section] shall take effect on the date of the enactment of this Act [].”

, , , provided that:

Effective Date

Pub. L. 108–173, title IX, § 921(a)(2)Dec. 8, 2003117 Stat. 2388

Dec. 8, 2003“The amendment made by paragraph (1) [enacting this section] shall take effect on the date of the enactment of this Act [].”

, , , provided that:

Small Provider Technical Assistance Demonstration Program

Pub. L. 108–173, title IX, § 922Dec. 8, 2003117 Stat. 2392

“(a)

Establishment.—

“(1)

In general .—

42 U.S.C. 1395 42 U.S.C. 1301The Secretary [of Health and Human Services] shall establish a demonstration program (in this section referred to as the ‘demonstration program’) under which technical assistance described in paragraph (2) is made available, upon request and on a voluntary basis, to small providers of services or suppliers in order to improve compliance with the applicable requirements of the programs under medicare program under title XVIII of the Social Security Act [ et seq.] (including provisions of title XI of such Act [ et seq.] insofar as they relate to such title and are not administered by the Office of the Inspector General of the Department of Health and Human Services).

“(2)

Forms of technical assistance .—

The technical assistance described in this paragraph is—

“(A)

evaluation and recommendations regarding billing and related systems; and

“(B)

information and assistance regarding policies and procedures under the medicare program, including coding and reimbursement.

“(3)

Small providers of services or suppliers .—

In this section, the term ‘small providers of services or suppliers’ means—

“(A)

a provider of services with fewer than 25 full-time-equivalent employees; or

“(B)

a supplier with fewer than 10 full-time-equivalent employees.

“(b)

Qualification of Contractors .—

42 U.S.C. 1395zz(g)(2)In conducting the demonstration program, the Secretary shall enter into contracts with qualified organizations (such as peer review [now “quality improvement”] organizations or entities described in section 1889(g)(2) of the Social Security Act [], as inserted by section 921(f)(1)) with appropriate expertise with billing systems of the full range of providers of services and suppliers to provide the technical assistance. In awarding such contracts, the Secretary shall consider any prior investigations of the entity’s work by the Inspector General of Department of Health and Human Services or the Comptroller General of the United States.

“(c)

Description of Technical Assistance .—

The technical assistance provided under the demonstration program shall include a direct and in-person examination of billing systems and internal controls of small providers of services or suppliers to determine program compliance and to suggest more efficient or effective means of achieving such compliance.

“(d)

Evaluation GAO .—

Not later than 2 years after the date the demonstration program is first implemented, the Comptroller General, in consultation with the Inspector General of the Department of Health and Human Services, shall conduct an evaluation of the demonstration program. The evaluation shall include a determination of whether claims error rates are reduced for small providers of services or suppliers who participated in the program and the extent of improper payments made as a result of the demonstration program. The Comptroller General shall submit a report to the Secretary and the Congress on such evaluation and shall include in such report recommendations regarding the continuation or extension of the demonstration program.

“(e)

Financial Participation by Providers .—

The provision of technical assistance to a small provider of services or supplier under the demonstration program is conditioned upon the small provider of services or supplier paying an amount estimated (and disclosed in advance of a provider’s or supplier’s participation in the program) to be equal to 25 percent of the cost of the technical assistance.

“(f)

Authorization of Appropriations .—

There are authorized to be appropriated, from amounts not otherwise appropriated in the Treasury, such sums as may be necessary to carry out this section.”

, , , provided that: