Revision to civil monetary penalties regarding radiation oncology case rate patient transportation services

Section 1128A of the Social Security Act (42 U.S.C. 1320a–7a) is amended— (1) in subsection (i)(6)— (A) in subparagraph (I), by striking or at the end; (B) in subparagraph (J)(iii), by striking the period at the end and inserting; or; and (C) by adding at the end the following new subparagraph: (K) the provision of transportation services by an eligible entity, as defined in subsection (t), if— (i) the availability of the transportation services— (I) is set forth in a policy that the eligible entity, as defined in subsection (t), applies uniformly and consistently; and (II) is not determined in a manner related to the past or anticipated volume or value of Federal health care program business; (ii) the eligible entity does not publicly market or advertise the transportation services; (iii) the driver who provides the transportation services does not market health care items or services during the course of the transportation or at any time; (iv) the driver or individual arranging for the transportation services is not paid on a per-beneficiary-transported basis; (v) the eligible entity makes the transportation services available only to an individual who— (I) is an established patient, as defined in subsection (t), of the eligible entity that is providing or facilitating free or discounted transportation; (II) resides— (aa) within a 75-mile radius of the radiation therapy provider or radiation therapy supplier to or from which the patient would be transported; or (bb) in a rural area, as defined in subsection (t); and (III) is receiving radiation therapy services for the purpose of obtaining medically necessary items and services; and (vi) the eligible entity that makes the transportation services available bears the costs of the transportation services and does not shift the burden of those costs onto any Federal health care program, other payers, or individuals.; and (2) by adding at the end the following new subsection: (t) For purposes of subsection (i)(6)(K), the following definitions apply: (1) The term eligible entity means any individual or entity, or any individual or entity acting on behalf of such individual or entity that does not supply health care items as the primary occupation of the individual or entity. (2) The term established patient means an individual who— (A) has selected and scheduled an appointment with a radiation therapy provider or radiation therapy supplier; or (B) has attended an appointment with such provider or supplier. (3) The terms radiation therapy provider, radiation therapy services, and radiation therapy supplier have the meaning given such terms in section 1866G(j). (4) The term rural area means an area that is not an urban area. (5) The term transportation services — (A) means the provision of free or discounted transportation made available to Federal health care program beneficiaries receiving radiation therapy services; (B) includes car services, ride shares, and public transportation; and (C) does not include air, luxury, or ambulance-level transportation. (6) The term urban area means— (A) a Metropolitan Statistical Area or New England County Metropolitan Area, as defined by the Office of Management and Budget; (B) Litchfield County, Connecticut; (C) York County, Maine; (D) Sagadahoc County, Maine; (E) Merrimack County, New Hampshire; and (F) Newport County, Rhode Island..