[114th Congress Public Law 10]
[From the U.S. Government Publishing Office]
[[Page 129 STAT. 87]]
Public Law 114-10
114th Congress
An Act
To amend title XVIII of the Social Security Act to repeal the Medicare
sustainable growth rate and strengthen Medicare access by improving
physician payments and making other improvements, to reauthorize the
Children's Health Insurance Program, and for other
purposes. <<NOTE: Apr. 16, 2015 - [H.R. 2]>>
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled, <<NOTE: Medicare Access
and CHIP Reauthorization Act of 2015. 42 USC 1305 note.>>
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Medicare Access and
CHIP Reauthorization Act of 2015''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--SGR REPEAL AND MEDICARE PROVIDER PAYMENT MODERNIZATION
Sec. 101. Repealing the sustainable growth rate (SGR) and improving
Medicare payment for physicians' services.
Sec. 102. Priorities and funding for measure development.
Sec. 103. Encouraging care management for individuals with chronic care
needs.
Sec. 104. Empowering beneficiary choices through continued access to
information on physicians' services.
Sec. 105. Expanding availability of Medicare data.
Sec. 106. Reducing administrative burden and other provisions.
TITLE II--MEDICARE AND OTHER HEALTH EXTENDERS
Subtitle A--Medicare Extenders
Sec. 201. Extension of work GPCI floor.
Sec. 202. Extension of therapy cap exceptions process.
Sec. 203. Extension of ambulance add-ons.
Sec. 204. Extension of increased inpatient hospital payment adjustment
for certain low-volume hospitals.
Sec. 205. Extension of the Medicare-dependent hospital (MDH) program.
Sec. 206. Extension for specialized Medicare Advantage plans for special
needs individuals.
Sec. 207. Extension of funding for quality measure endorsement, input,
and selection.
Sec. 208. Extension of funding outreach and assistance for low-income
programs.
Sec. 209. Extension and transition of reasonable cost reimbursement
contracts.
Sec. 210. Extension of home health rural add-on.
Subtitle B--Other Health Extenders
Sec. 211. Permanent extension of the qualifying individual (QI) program.
Sec. 212. Permanent extension of transitional medical assistance (TMA).
Sec. 213. Extension of special diabetes program for type I diabetes and
for Indians.
Sec. 214. Extension of abstinence education.
Sec. 215. Extension of personal responsibility education program (PREP).
Sec. 216. Extension of funding for family-to-family health information
centers.
Sec. 217. Extension of health workforce demonstration project for low-
income individuals.
[[Page 129 STAT. 88]]
Sec. 218. Extension of maternal, infant, and early childhood home
visiting programs.
Sec. 219. Tennessee DSH allotment for fiscal years 2015 through 2025.
Sec. 220. Delay in effective date for Medicaid amendments relating to
beneficiary liability settlements.
Sec. 221. Extension of funding for community health centers, the
National Health Service Corps, and teaching health centers.
TITLE III--CHIP
Sec. 301. 2-year extension of the Children's Health Insurance Program.
Sec. 302. Extension of express lane eligibility.
Sec. 303. Extension of outreach and enrollment program.
Sec. 304. Extension of certain programs and demonstration projects.
Sec. 305. Report of Inspector General of HHS on use of express lane
option under Medicaid and CHIP.
TITLE IV--OFFSETS
Subtitle A--Medicare Beneficiary Reforms
Sec. 401. Limitation on certain medigap policies for newly eligible
Medicare beneficiaries.
Sec. 402. Income-related premium adjustment for parts B and D.
Subtitle B--Other Offsets
Sec. 411. Medicare payment updates for post-acute providers.
Sec. 412. Delay of reduction to Medicaid DSH allotments.
Sec. 413. Levy on delinquent providers.
Sec. 414. Adjustments to inpatient hospital payment rates.
TITLE V--MISCELLANEOUS
Subtitle A--Protecting the Integrity of Medicare
Sec. 501. Prohibition of inclusion of Social Security account numbers on
Medicare cards.
Sec. 502. Preventing wrongful Medicare payments for items and services
furnished to incarcerated individuals, individuals not
lawfully present, and deceased individuals.
Sec. 503. Consideration of measures regarding Medicare beneficiary smart
cards.
Sec. 504. Modifying Medicare durable medical equipment face-to-face
encounter documentation requirement.
Sec. 505. Reducing improper Medicare payments.
Sec. 506. Improving senior Medicare patrol and fraud reporting rewards.
Sec. 507. Requiring valid prescriber National Provider Identifiers on
pharmacy claims.
Sec. 508. Option to receive Medicare Summary Notice electronically.
Sec. 509. Renewal of MAC contracts.
Sec. 510. Study on pathway for incentives to States for State
participation in medicaid data match program.
Sec. 511. Guidance on application of Common Rule to clinical data
registries.
Sec. 512. Eliminating certain civil money penalties; gainsharing study
and report.
Sec. 513. Modification of Medicare home health surety bond condition of
participation requirement.
Sec. 514. Oversight of Medicare coverage of manual manipulation of the
spine to correct subluxation.
Sec. 515. National expansion of prior authorization model for repetitive
scheduled non-emergent ambulance transport.
Sec. 516. Repealing duplicative Medicare secondary payor provision.
Sec. 517. Plan for expanding data in annual CERT report.
Sec. 518. Removing funds for Medicare Improvement Fund added by IMPACT
Act of 2014.
Sec. 519. Rule of construction.
Subtitle B--Other Provisions
Sec. 521. Extension of two-midnight PAMA rules on certain medical review
activities.
Sec. 522. Requiring bid surety bonds and State licensure for entities
submitting bids under the Medicare DMEPOS competitive
acquisition program.
Sec. 523. Payment for global surgical packages.
Sec. 524. Extension of Secure Rural Schools and Community Self-
Determination Act of 2000.
Sec. 525. Exclusion from PAYGO scorecards.
[[Page 129 STAT. 89]]
TITLE I--SGR REPEAL AND MEDICARE PROVIDER PAYMENT MODERNIZATION
SEC. 101. REPEALING THE SUSTAINABLE GROWTH RATE (SGR) AND
IMPROVING MEDICARE PAYMENT FOR PHYSICIANS'
SERVICES.
(a) Stabilizing Fee Updates.--
(1) Repeal of sgr payment methodology.--Section 1848 of the
Social Security Act (42 U.S.C. 1395w-4) is amended--
(A) in subsection (d)--
(i) in paragraph (1)(A)--
(I) by inserting ``and ending with
2025'' after ``beginning with 2001'';
and
(II) by inserting ``or a subsequent
paragraph'' after ``paragraph (4)''; and
(ii) in paragraph (4)--
(I) in the heading, by inserting
``and ending with 2014'' after ``years
beginning with 2001''; and
(II) in subparagraph (A), by
inserting ``and ending with 2014'' after
``a year beginning with 2001''; and
(B) in subsection (f)--
(i) in paragraph (1)(B), by inserting
``through 2014'' after ``of each succeeding
year''; and
(ii) in paragraph (2), in the matter preceding
subparagraph (A), by inserting ``and ending with
2014'' after ``beginning with 2000''.
(2) Update of rates for 2015 and subsequent years.--
Subsection (d) of section 1848 of the Social Security Act (42
U.S.C. 1395w-4) is amended--
(A) <<NOTE: Effective date.>> in paragraph (1)(A),
by adding at the end the following: ``There shall be two
separate conversion factors for each year beginning with
2026, one for items and services furnished by a
qualifying APM participant (as defined in section
1833(z)(2)) (referred to in this subsection as the
`qualifying APM conversion factor') and the other for
other items and services (referred to in this subsection
as the `nonqualifying APM conversion factor'), equal to
the respective conversion factor for the previous year
(or, in the case of 2026, equal to the single conversion
factor for 2025) multiplied by the update established
under paragraph (20) for such respective conversion
factor for such year.'';
(B) in paragraph (1)(D), by inserting ``(or,
beginning with 2026, applicable conversion factor)''
after ``single conversion factor''; and
(C) by striking paragraph (16) and inserting the
following new paragraphs:
``(16) Update for january through june of 2015.--Subject to
paragraphs (7)(B), (8)(B), (9)(B), (10)(B), (11)(B), (12)(B),
(13)(B), (14)(B), and (15)(B), in lieu of the update to the
single conversion factor established in paragraph (1)(C) that
would otherwise apply for 2015 for the period beginning on
January 1, 2015, and ending on June 30, 2015, the update to the
single conversion factor shall be 0.0 percent.
[[Page 129 STAT. 90]]
``(17) Update for july through december of 2015.--The update
to the single conversion factor established in paragraph (1)(C)
for the period beginning on July 1, 2015, and ending on December
31, 2015, shall be 0.5 percent.
``(18) Update for 2016 through 2019.--The update to the
single conversion factor established in paragraph (1)(C) for
2016 and each subsequent year through 2019 shall be 0.5 percent.
``(19) Update for 2020 through 2025.--The update to the
single conversion factor established in paragraph (1)(C) for
2020 and each subsequent year through 2025 shall be 0.0 percent.
``(20) Update for 2026 and subsequent years.--For 2026 and
each subsequent year, the update to the qualifying APM
conversion factor established under paragraph (1)(A) is 0.75
percent, and the update to the nonqualifying APM conversion
factor established under such paragraph is 0.25 percent.''.
(3) MedPAC reports.--
(A) Initial report.--Not later than July 1, 2017,
the Medicare Payment Advisory Commission shall submit to
Congress a report on the relationship between--
(i) physician and other health professional
utilization and expenditures (and the rate of
increase of such utilization and expenditures) of
items and services for which payment is made under
section 1848 of the Social Security Act (42 U.S.C.
1395w-4); and
(ii) total utilization and expenditures (and
the rate of increase of such utilization and
expenditures) under parts A, B, and D of title
XVIII of such Act.
Such report shall include a methodology to describe such
relationship and the impact of changes in such physician
and other health professional practice and service
ordering patterns on total utilization and expenditures
under parts A, B, and D of such title.
(B) Final report.--Not later than July 1, 2021, the
Medicare Payment Advisory Commission shall submit to
Congress a report on the relationship described in
subparagraph (A), including the results determined from
applying the methodology included in the report
submitted under such subparagraph.
(C) Report on update to physicians' services under
medicare.--Not later than July 1, 2019, the Medicare
Payment Advisory Commission shall submit to Congress a
report on--
(i) the payment update for professional
services applied under the Medicare program under
title XVIII of the Social Security Act for the
period of years 2015 through 2019;
(ii) the effect of such update on the
efficiency, economy, and quality of care provided
under such program;
(iii) the effect of such update on ensuring a
sufficient number of providers to maintain access
to care by Medicare beneficiaries; and
(iv) recommendations for any future payment
updates for professional services under such
program
[[Page 129 STAT. 91]]
to ensure adequate access to care is maintained
for Medicare beneficiaries.
(b) Consolidation of Certain Current Law Performance Programs With
New Merit-Based Incentive Payment System.--
(1) EHR meaningful use incentive program.--
(A) Sunsetting separate meaningful use payment
adjustments.--Section 1848(a)(7)(A) of the Social
Security Act (42 U.S.C. 1395w-4(a)(7)(A)) is amended--
(i) in clause (i), by striking ``2015 or any
subsequent payment year'' and inserting ``each of
2015 through 2018'';
(ii) in clause (ii)(III), by striking ``each
subsequent year'' and inserting ``2018''; and
(iii) in clause (iii)--
(I) in the heading, by striking
``and subsequent years'';
(II) by striking ``and each
subsequent year''; and
(III) by striking ``, but in no case
shall the applicable percent be less
than 95 percent''.
(B) Continuation of meaningful use determinations
for mips.--Section 1848(o)(2) of the Social Security Act
(42 U.S.C. 1395w-4(o)(2)) is amended--
(i) in subparagraph (A), in the matter
preceding clause (i)--
(I) by striking ``For purposes of
paragraph (1), an'' and inserting
``An''; and
(II) by inserting ``, or pursuant to
subparagraph (D) for purposes of
subsection (q), for a performance period
under such subsection for a year'' after
``under such subsection for a year'';
and
(ii) by adding at the end the following new
subparagraph:
``(D) Continued application for purposes of mips.--
With respect to 2019 and each subsequent payment year,
the Secretary shall, for purposes of subsection (q) and
in accordance with paragraph (1)(F) of such subsection,
determine whether an eligible professional who is a MIPS
eligible professional (as defined in subsection
(q)(1)(C)) for such year is a meaningful EHR user under
this paragraph for the performance period under
subsection (q) for such year.''.
(2) Quality reporting.--
(A) Sunsetting separate quality reporting
incentives.--Section 1848(a)(8)(A) of the Social
Security Act (42 U.S.C. 1395w-4(a)(8)(A)) is amended--
(i) in clause (i), by striking ``2015 or any
subsequent year'' and inserting ``each of 2015
through 2018''; and
(ii) in clause (ii)(II), by striking ``and
each subsequent year'' and inserting ``, 2017, and
2018''.
(B) Continuation of quality measures and processes
for mips.--Section 1848 of the Social Security Act (42
U.S.C. 1395w-4) is amended--
(i) in subsection (k), by adding at the end
the following new paragraph:
[[Page 129 STAT. 92]]
``(9) Continued application for purposes of mips and for
certain professionals volunteering to report.--The Secretary
shall, in accordance with subsection (q)(1)(F), carry out the
provisions of this subsection--
``(A) for purposes of subsection (q); and
``(B) for eligible professionals who are not MIPS
eligible professionals (as defined in subsection
(q)(1)(C)) for the year involved.''; and
(ii) in subsection (m)--
(I) by redesignating paragraph (7)
added by section 10327(a) of Public Law
111-148 as paragraph (8); and
(II) by adding at the end the
following new paragraph:
``(9) Continued application for purposes of mips and for
certain professionals volunteering to report.--The Secretary
shall, in accordance with subsection (q)(1)(F), carry out the
processes under this subsection--
``(A) for purposes of subsection (q); and
``(B) for eligible professionals who are not MIPS
eligible professionals (as defined in subsection
(q)(1)(C)) for the year involved.''.
(3) Value-based payments.--
(A) Sunsetting separate value-based payments.--
Clause (iii) of section 1848(p)(4)(B) of the Social
Security Act (42 U.S.C. 1395w-4(p)(4)(B)) is amended to
read as follows:
``(iii) Application.--The Secretary shall
apply the payment modifier established under this
subsection for items and services furnished on or
after January 1, 2015, with respect to specific
physicians and groups of physicians the Secretary
determines appropriate, and for services furnished
on or after January 1, 2017, with respect to all
physicians and groups of physicians. Such payment
modifier shall not be applied for items and
services furnished on or after January 1, 2019.''.
(B) Continuation of value-based payment modifier
measures for mips.--Section 1848(p) of the Social
Security Act (42 U.S.C. 1395w-4(p)) is amended--
(i) in paragraph (2), by adding at the end the
following new subparagraph:
``(C) Continued application for purposes of mips.--
The Secretary shall, in accordance with subsection
(q)(1)(F), carry out subparagraph (B) for purposes of
subsection (q).''; and
(ii) in paragraph (3), by adding at the end
the following: ``With respect to 2019 and each
subsequent year, the Secretary shall, in
accordance with subsection (q)(1)(F), carry out
this paragraph for purposes of subsection (q).''.
(c) Merit-Based Incentive Payment System.--
(1) In general.--Section 1848 of the Social Security Act (42
U.S.C. 1395w-4) is amended by adding at the end the following
new subsection:
``(q) Merit-Based Incentive Payment System.--
``(1) Establishment.--
[[Page 129 STAT. 93]]
``(A) In general.--Subject to the succeeding
provisions of this subsection, the Secretary shall
establish an eligible professional Merit-based Incentive
Payment System (in this subsection referred to as the
`MIPS') under which the Secretary shall--
``(i) develop a methodology for assessing the
total performance of each MIPS eligible
professional according to performance standards
under paragraph (3) for a performance period (as
established under paragraph (4)) for a year;
``(ii) using such methodology, provide for a
composite performance score in accordance with
paragraph (5) for each such professional for each
performance period; and
``(iii) use such composite performance score
of the MIPS eligible professional for a
performance period for a year to determine and
apply a MIPS adjustment factor (and, as
applicable, an additional MIPS adjustment factor)
under paragraph (6) to the professional for the
year.
Notwithstanding subparagraph (C)(ii), under the MIPS,
the Secretary shall permit any eligible professional (as
defined in subsection (k)(3)(B)) to report on applicable
measures and activities described in paragraph (2)(B).
``(B) <<NOTE: Applicability. Effective date.>>
Program implementation.--The MIPS shall apply to
payments for items and services furnished on or after
January 1, 2019.
``(C) MIPS eligible professional defined.--
``(i) In general.--For purposes of this
subsection, subject to clauses (ii) and (iv), the
term `MIPS eligible professional' means--
``(I) for the first and second years
for which the MIPS applies to payments
(and for the performance period for such
first and second year), a physician (as
defined in section 1861(r)), a physician
assistant, nurse practitioner, and
clinical nurse specialist (as such terms
are defined in section 1861(aa)(5)), a
certified registered nurse anesthetist
(as defined in section 1861(bb)(2)), and
a group that includes such
professionals; and
``(II) for the third year for which
the MIPS applies to payments (and for
the performance period for such third
year) and for each succeeding year (and
for the performance period for each such
year), the professionals described in
subclause (I), such other eligible
professionals (as defined in subsection
(k)(3)(B)) as specified by the
Secretary, and a group that includes
such professionals.
``(ii) Exclusions.--For purposes of clause
(i), the term `MIPS eligible professional' does
not include, with respect to a year, an eligible
professional (as defined in subsection (k)(3)(B))
who--
``(I) is a qualifying APM
participant (as defined in section
1833(z)(2));
``(II) subject to clause (vii), is a
partial qualifying APM participant (as
defined in clause (iii))
[[Page 129 STAT. 94]]
for the most recent period for which
data are available and who, for the
performance period with respect to such
year, does not report on applicable
measures and activities described in
paragraph (2)(B) that are required to be
reported by such a professional under
the MIPS; or
``(III) for the performance period
with respect to such year, does not
exceed the low-volume threshold
measurement selected under clause (iv).
``(iii) <<NOTE: Definition.>> Partial
qualifying apm participant.--For purposes of this
subparagraph, the term `partial qualifying APM
participant' means, with respect to a year, an
eligible professional for whom the Secretary
determines the minimum payment percentage (or
percentages), as applicable, described in
paragraph (2) of section 1833(z) for such year
have not been satisfied, but who would be
considered a qualifying APM participant (as
defined in such paragraph) for such year if--
``(I) with respect to 2019 and 2020,
the reference in subparagraph (A) of
such paragraph to 25 percent was instead
a reference to 20 percent;
``(II) with respect to 2021 and
2022--
``(aa) the reference in
subparagraph (B)(i) of such
paragraph to 50 percent was
instead a reference to 40
percent; and
``(bb) the references in
subparagraph (B)(ii) of such
paragraph to 50 percent and 25
percent of such paragraph were
instead references to 40 percent
and 20 percent, respectively;
and
``(III) with respect to 2023 and
subsequent years--
``(aa) the reference in
subparagraph (C)(i) of such
paragraph to 75 percent was
instead a reference to 50
percent; and
``(bb) the references in
subparagraph (C)(ii) of such
paragraph to 75 percent and 25
percent of such paragraph were
instead references to 50 percent
and 20 percent, respectively.
``(iv) Selection of low-volume threshold
measurement.--The Secretary shall select a low-
volume threshold to apply for purposes of clause
(ii)(III), which may include one or more or a
combination of the following:
``(I) The minimum number (as
determined by the Secretary) of
individuals enrolled under this part who
are treated by the eligible professional
for the performance period involved.
``(II) The minimum number (as
determined by the Secretary) of items
and services furnished to individuals
enrolled under this part by such
professional for such performance
period.
``(III) The minimum amount (as
determined by the Secretary) of allowed
charges billed by such
[[Page 129 STAT. 95]]
professional under this part for such
performance period.
``(v) Treatment of new medicare enrolled
eligible professionals.--In the case of a
professional who first becomes a Medicare enrolled
eligible professional during the performance
period for a year (and had not previously
submitted claims under this title such as a
person, an entity, or a part of a physician group
or under a different billing number or tax
identifier), such professional shall not be
treated under this subsection as a MIPS eligible
professional until the subsequent year and
performance period for such subsequent year.
``(vi) Clarification.--In the case of items
and services furnished during a year by an
individual who is not a MIPS eligible professional
(including pursuant to clauses (ii) and (v)) with
respect to a year, in no case shall a MIPS
adjustment factor (or additional MIPS adjustment
factor) under paragraph (6) apply to such
individual for such year.
``(vii) Partial qualifying apm participant
clarifications.--
``(I) Treatment as mips eligible
professional.--In the case of an
eligible professional who is a partial
qualifying APM participant, with respect
to a year, and who, for the performance
period for such year, reports on
applicable measures and activities
described in paragraph (2)(B) that are
required to be reported by such a
professional under the MIPS, such
eligible professional is considered to
be a MIPS eligible professional with
respect to such year.
``(II) Not eligible for qualifying
apm participant payments.--In no case
shall an eligible professional who is a
partial qualifying APM participant, with
respect to a year, be considered a
qualifying APM participant (as defined
in paragraph (2) of section 1833(z)) for
such year or be eligible for the
additional payment under paragraph (1)
of such section for such year.
``(D) Application to group practices.--
``(i) In general.--Under the MIPS:
``(I) Quality performance
category.--The Secretary shall establish
and apply a process that includes
features of the provisions of subsection
(m)(3)(C) for MIPS eligible
professionals in a group practice with
respect to assessing performance of such
group with respect to the performance
category described in clause (i) of
paragraph (2)(A).
``(II) Other performance
categories.--The Secretary may establish
and apply a process that includes
features of the provisions of subsection
(m)(3)(C) for MIPS eligible
professionals in a group practice with
respect to assessing the performance of
such group with respect to the
performance categories described in
clauses (ii) through (iv) of such
paragraph.
[[Page 129 STAT. 96]]
``(ii) Ensuring comprehensiveness of group
practice assessment.--The process established
under clause (i) shall to the extent practicable
reflect the range of items and services furnished
by the MIPS eligible professionals in the group
practice involved.
``(E) Use of registries.--Under the MIPS, the
Secretary shall encourage the use of qualified clinical
data registries pursuant to subsection (m)(3)(E) in
carrying out this subsection.
``(F) Application of certain provisions.--In
applying a provision of subsection (k), (m), (o), or (p)
for purposes of this subsection, the Secretary shall--
``(i) adjust the application of such provision
to ensure the provision is consistent with the
provisions of this subsection; and
``(ii) not apply such provision to the extent
that the provision is duplicative with a provision
of this subsection.
``(G) Accounting for risk factors.--
``(i) Risk factors.--Taking into account the
relevant studies conducted and recommendations
made in reports under section 2(d) of the
Improving Medicare Post-Acute Care Transformation
Act of 2014, and, as appropriate, other
information, including information collected
before completion of such studies and
recommendations, the Secretary, on an ongoing
basis, shall, as the Secretary determines
appropriate and based on an individual's health
status and other risk factors--
``(I) assess appropriate adjustments
to quality measures, resource use
measures, and other measures used under
the MIPS; and
``(II) assess and implement
appropriate adjustments to payment
adjustments, composite performance
scores, scores for performance
categories, or scores for measures or
activities under the MIPS.
``(2) Measures and activities under performance
categories.--
``(A) Performance categories.--Under the MIPS, the
Secretary shall use the following performance categories
(each of which is referred to in this subsection as a
performance category) in determining the composite
performance score under paragraph (5):
``(i) Quality.
``(ii) Resource use.
``(iii) Clinical practice improvement
activities.
``(iv) Meaningful use of certified EHR
technology.
``(B) Measures and activities specified for each
category.--For purposes of paragraph (3)(A) and subject
to subparagraph (C), measures and activities specified
for a performance period (as established under paragraph
(4)) for a year are as follows:
``(i) Quality.--For the performance category
described in subparagraph (A)(i), the quality
measures included in the final measures list
published under subparagraph (D)(i) for such year
and the list of quality measures described in
subparagraph (D)(vi) used by
[[Page 129 STAT. 97]]
qualified clinical data registries under
subsection (m)(3)(E).
``(ii) Resource use.--For the performance
category described in subparagraph (A)(ii), the
measurement of resource use for such period under
subsection (p)(3), using the methodology under
subsection (r) as appropriate, and, as feasible
and applicable, accounting for the cost of drugs
under part D.
``(iii) Clinical practice improvement
activities.--For the performance category
described in subparagraph (A)(iii), clinical
practice improvement activities (as defined in
subparagraph (C)(v)(III)) under subcategories
specified by the Secretary for such period, which
shall include at least the following:
``(I) The subcategory of expanded
practice access, such as same day
appointments for urgent needs and after
hours access to clinician advice.
``(II) The subcategory of population
management, such as monitoring health
conditions of individuals to provide
timely health care interventions or
participation in a qualified clinical
data registry.
``(III) The subcategory of care
coordination, such as timely
communication of test results, timely
exchange of clinical information to
patients and other providers, and use of
remote monitoring or telehealth.
``(IV) The subcategory of
beneficiary engagement, such as the
establishment of care plans for
individuals with complex care needs,
beneficiary self-management assessment
and training, and using shared decision-
making mechanisms.
``(V) The subcategory of patient
safety and practice assessment, such as
through use of clinical or surgical
checklists and practice assessments
related to maintaining certification.
``(VI) The subcategory of
participation in an alternative payment
model (as defined in section
1833(z)(3)(C)).
In establishing activities under this clause, the
Secretary shall give consideration to the
circumstances of small practices (consisting of 15
or fewer professionals) and practices located in
rural areas and in health professional shortage
areas (as designated under section 332(a)(1)(A) of
the Public Health Service Act).
``(iv) Meaningful ehr use.--For the
performance category described in subparagraph
(A)(iv), the requirements established for such
period under subsection (o)(2) for determining
whether an eligible professional is a meaningful
EHR user.
``(C) Additional provisions.--
``(i) Emphasizing outcome measures under the
quality performance category.--
In <<NOTE: Applicability.>> applying subparagraph
(B)(i), the Secretary shall, as feasible,
emphasize the application of outcome measures.
[[Page 129 STAT. 98]]
``(ii) Application of additional system
measures.--The Secretary may use measures used for
a payment system other than for physicians, such
as measures for inpatient hospitals, for purposes
of the performance categories described in clauses
(i) and (ii) of subparagraph (A). For purposes of
the previous sentence, the Secretary may not use
measures for hospital outpatient departments,
except in the case of items and services furnished
by emergency physicians, radiologists, and
anesthesiologists.
``(iii) Global and population-based
measures.--The Secretary may use global measures,
such as global outcome measures, and population-
based measures for purposes of the performance
category described in subparagraph (A)(i).
``(iv) Application of measures and activities
to non-patient-facing professionals.--In carrying
out this paragraph, with respect to measures and
activities specified in subparagraph (B) for
performance categories described in subparagraph
(A), the Secretary--
``(I) shall give consideration to
the circumstances of professional types
(or subcategories of those types
determined by practice characteristics)
who typically furnish services that do
not involve face-to-face interaction
with a patient; and
``(II) may, to the extent feasible
and appropriate, take into account such
circumstances and apply under this
subsection with respect to MIPS eligible
professionals of such professional types
or subcategories, alternative measures
or activities that fulfill the goals of
the applicable performance category.
In <<NOTE: Consultation.>> carrying out the
previous sentence, the Secretary shall consult
with professionals of such professional types or
subcategories.
``(v) Clinical practice improvement
activities.--
``(I) Request for information.--In
initially applying subparagraph
(B)(iii), the Secretary shall use a
request for information to solicit
recommendations from stakeholders to
identify activities described in such
subparagraph and specifying criteria for
such activities.
``(II) Contract authority for
clinical practice improvement activities
performance category.--
In <<NOTE: Applicability.>> applying
subparagraph (B)(iii), the Secretary may
contract with entities to assist the
Secretary in--
``(aa) identifying
activities described in
subparagraph (B)(iii);
``(bb) specifying criteria
for such activities; and
``(cc) determining whether a
MIPS eligible professional meets
such criteria.
``(III) Clinical practice
improvement activities defined.--For
purposes of this subsection, the term
`clinical practice improvement activity'
[[Page 129 STAT. 99]]
means an activity that relevant eligible
professional organizations and other
relevant stakeholders identify as
improving clinical practice or care
delivery and that the Secretary
determines, when effectively executed,
is likely to result in improved
outcomes.
``(D) Annual list of quality measures available for
mips assessment.--
``(i) <<NOTE: Notice. Regulations. Deadlines.>>
In general.--Under the MIPS, the Secretary,
through notice and comment rulemaking and subject
to the succeeding clauses of this subparagraph,
shall, with respect to the performance period for
a year, establish an annual final list of quality
measures from which MIPS eligible professionals
may choose for purposes of assessment under this
subsection for such performance period. Pursuant
to the previous sentence, the Secretary shall--
``(I) not later than November 1 of
the year prior to the first day of the
first performance period under the MIPS,
establish and publish in the Federal
Register a final list of quality
measures; and
``(II) not later than November 1 of
the year prior to the first day of each
subsequent performance period, update
the final list of quality measures from
the previous year (and publish such
updated final list in the Federal
Register), by--
``(aa) removing from such
list, as appropriate, quality
measures, which may include the
removal of measures that are no
longer meaningful (such as
measures that are topped out);
``(bb) adding to such list,
as appropriate, new quality
measures; and
``(cc) determining whether
or not quality measures on such
list that have undergone
substantive changes should be
included in the updated list.
``(ii) Call for quality measures.--
``(I) In general.--Eligible
professional organizations and other
relevant stakeholders shall be requested
to identify and submit quality measures
to be considered for selection under
this subparagraph in the annual list of
quality measures published under clause
(i) and to identify and submit updates
to the measures on such list. For
purposes of the previous sentence,
measures may be submitted regardless of
whether such measures were previously
published in a proposed rule or endorsed
by an entity with a contract under
section 1890(a).
``(II) Eligible professional
organization defined.--In this
subparagraph, the term `eligible
professional organization' means a
professional organization as defined by
nationally recognized specialty boards
of certification or equivalent
certification boards.
[[Page 129 STAT. 100]]
``(iii) Requirements.--In selecting quality
measures for inclusion in the annual final list
under clause (i), the Secretary shall--
``(I) provide that, to the extent
practicable, all quality domains (as
defined in subsection (s)(1)(B)) are
addressed by such measures; and
``(II) ensure that such selection is
consistent with the process for
selection of measures under subsections
(k), (m), and (p)(2).
``(iv) <<NOTE: Publication.>> Peer review.--
Before including a new measure in the final list
of measures published under clause (i) for a year,
the Secretary shall submit for publication in
applicable specialty-appropriate, peer-reviewed
journals such measure and the method for
developing and selecting such measure, including
clinical and other data supporting such measure.
``(v) Measures for inclusion.--The final list
of quality measures published under clause (i)
shall include, as applicable, measures under
subsections (k), (m), and (p)(2), including
quality measures from among--
``(I) measures endorsed by a
consensus-based entity;
``(II) measures developed under
subsection (s); and
``(III) measures submitted under
clause (ii)(I).
Any measure selected for inclusion in such list
that is not endorsed by a consensus-based entity
shall have a focus that is evidence-based.
``(vi) Exception for qualified clinical data
registry measures.--Measures used by a qualified
clinical data registry under subsection (m)(3)(E)
shall not be subject to the requirements under
clauses (i), (iv), and (v). <<NOTE: Web
posting.>> The Secretary shall publish the list
of measures used by such qualified clinical data
registries on the Internet website of the Centers
for Medicare & Medicaid Services.
``(vii) Exception for existing quality
measures.--Any quality measure specified by the
Secretary under subsection (k) or (m), including
under subsection (m)(3)(E), and any measure of
quality of care established under subsection
(p)(2) for the reporting period or performance
period under the respective subsection beginning
before the first performance period under the
MIPS--
``(I) shall not be subject to the
requirements under clause (i) (except
under items (aa) and (cc) of subclause
(II) of such clause) or to the
requirement under clause (iv); and
``(II) shall be included in the
final list of quality measures published
under clause (i) unless removed under
clause (i)(II)(aa).
``(viii) Consultation with relevant eligible
professional organizations and other relevant
stakeholders.--Relevant eligible professional
organizations and other relevant stakeholders,
[[Page 129 STAT. 101]]
including State and national medical societies,
shall be consulted in carrying out this
subparagraph.
``(ix) Optional application.--The process
under section 1890A is not required to apply to
the selection of measures under this subparagraph.
``(3) Performance standards.--
``(A) Establishment.--Under the MIPS, the Secretary
shall establish performance standards with respect to
measures and activities specified under paragraph (2)(B)
for a performance period (as established under paragraph
(4)) for a year.
``(B) Considerations in establishing standards.--In
establishing such performance standards with respect to
measures and activities specified under paragraph
(2)(B), the Secretary shall consider the following:
``(i) Historical performance standards.
``(ii) Improvement.
``(iii) The opportunity for continued
improvement.
``(4) Performance period.--The Secretary shall establish a
performance period (or periods) for a year (beginning with
2019). Such performance period (or periods) shall begin and end
prior to the beginning of such year and be as close as possible
to such year. In this subsection, such performance period (or
periods) for a year shall be referred to as the performance
period for the year.
``(5) Composite performance score.--
``(A) In general.--Subject to the succeeding
provisions of this paragraph and taking into account, as
available and applicable, paragraph (1)(G), the
Secretary shall develop a methodology for assessing the
total performance of each MIPS eligible professional
according to performance standards under paragraph (3)
with respect to applicable measures and activities
specified in paragraph (2)(B) with respect to each
performance category applicable to such professional for
a performance period (as established under paragraph
(4)) for a year. Using such methodology, the Secretary
shall provide for a composite assessment (using a
scoring scale of 0 to 100) for each such professional
for the performance period for such year. In this
subsection such a composite assessment for such a
professional with respect to a performance period shall
be referred to as the `composite performance score' for
such professional for such performance period.
``(B) Incentive to report; encouraging use of
certified ehr technology for reporting quality
measures.--
``(i) Incentive to report.--Under the
methodology established under subparagraph (A),
the Secretary shall provide that in the case of a
MIPS eligible professional who fails to report on
an applicable measure or activity that is required
to be reported by the professional, the
professional shall be treated as achieving the
lowest potential score applicable to such measure
or activity.
``(ii) Encouraging use of certified ehr
technology and qualified clinical data registries
for
[[Page 129 STAT. 102]]
reporting quality measures.--Under the methodology
established under subparagraph (A), the Secretary
shall--
``(I) encourage MIPS eligible
professionals to report on applicable
measures with respect to the performance
category described in paragraph
(2)(A)(i) through the use of certified
EHR technology and qualified clinical
data registries; and
``(II) with respect to a performance
period, with respect to a year, for
which a MIPS eligible professional
reports such measures through the use of
such EHR technology, treat such
professional as satisfying the clinical
quality measures reporting requirement
described in subsection (o)(2)(A)(iii)
for such year.
``(C) Clinical practice improvement activities
performance score.--
``(i) Rule for certification.--A MIPS eligible
professional who is in a practice that is
certified as a patient-centered medical home or
comparable specialty practice, as determined by
the Secretary, with respect to a performance
period shall be given the highest potential score
for the performance category described in
paragraph (2)(A)(iii) for such period.
``(ii) APM participation.--Participation by a
MIPS eligible professional in an alternative
payment model (as defined in section
1833(z)(3)(C)) with respect to a performance
period shall earn such eligible professional a
minimum score of one-half of the highest potential
score for the performance category described in
paragraph (2)(A)(iii) for such performance period.
``(iii) Subcategories.--A MIPS eligible
professional shall not be required to perform
activities in each subcategory under paragraph
(2)(B)(iii) or participate in an alternative
payment model in order to achieve the highest
potential score for the performance category
described in paragraph (2)(A)(iii).
``(D) Achievement and improvement.--
``(i) Taking into account improvement.--
Beginning with the second year to which the MIPS
applies, in addition to the achievement of a MIPS
eligible professional, if data sufficient to
measure improvement is available, the methodology
developed under subparagraph (A)--
``(I) in the case of the performance
score for the performance category
described in clauses (i) and (ii) of
paragraph (2)(A), shall take into
account the improvement of the
professional; and
``(II) in the case of performance
scores for other performance categories,
may take into account the improvement of
the professional.
``(ii) Assigning higher weight for
achievement.--Subject to clause (i), under the
methodology developed under subparagraph (A), the
Secretary may assign a higher scoring weight under
subparagraph (F) with respect to the achievement
of a MIPS eligible professional than with respect
to any improvement
[[Page 129 STAT. 103]]
of such professional applied under clause (i) with
respect to a measure, activity, or category
described in paragraph (2).
``(E) Weights for the performance categories.--
``(i) In general.--Under the methodology
developed under subparagraph (A), subject to
subparagraph (F)(i) and clause (ii), the composite
performance score shall be determined as follows:
``(I) Quality.--
``(aa) In general.--Subject
to item (bb), thirty percent of
such score shall be based on
performance with respect to the
category described in clause (i)
of paragraph (2)(A). In applying
the previous sentence, the
Secretary shall, as feasible,
encourage the application of
outcome measures within such
category.
``(bb) First 2 years.--For
the first and second years for
which the MIPS applies to
payments, the percentage
applicable under item (aa) shall
be increased in a manner such
that the total percentage points
of the increase under this item
for the respective year equals
the total number of percentage
points by which the percentage
applied under subclause (II)(bb)
for the respective year is less
than 30 percent.
``(II) Resource use.--
``(aa) In general.--Subject
to item (bb), thirty percent of
such score shall be based on
performance with respect to the
category described in clause
(ii) of paragraph (2)(A).
``(bb) First 2 years.--For
the first year for which the
MIPS applies to payments, not
more than 10 percent of such
score shall be based on
performance with respect to the
category described in clause
(ii) of paragraph (2)(A). For
the second year for which the
MIPS applies to payments, not
more than 15 percent of such
score shall be based on
performance with respect to the
category described in clause
(ii) of paragraph (2)(A).
``(III) Clinical practice
improvement activities.--Fifteen percent
of such score shall be based on
performance with respect to the category
described in clause (iii) of paragraph
(2)(A).
``(IV) Meaningful use of certified
ehr technology.--Twenty-five percent of
such score shall be based on performance
with respect to the category described
in clause (iv) of paragraph (2)(A).
``(ii) Authority to adjust percentages in case
of high ehr meaningful use adoption.--In any year
in which the Secretary estimates that the
proportion of eligible professionals (as defined
in subsection (o)(5)) who are meaningful EHR users
(as determined under subsection (o)(2)) is 75
percent or greater, the Secretary may reduce the
percent applicable under clause (i)(IV),
[[Page 129 STAT. 104]]
but not below 15 percent. If the Secretary makes
such reduction for a year, subject to subclauses
(I)(bb) and (II)(bb) of clause (i), the
percentages applicable under one or more of
subclauses (I), (II), and (III) of clause (i) for
such year shall be increased in a manner such that
the total percentage points of the increase under
this clause for such year equals the total number
of percentage points reduced under the preceding
sentence for such year.
``(F) Certain flexibility for weighting performance
categories, measures, and activities.--Under the
methodology under subparagraph (A), if there are not
sufficient measures and activities (described in
paragraph (2)(B)) applicable and available to each type
of eligible professional involved, the Secretary shall
assign different scoring weights (including a weight of
0)--
``(i) which may vary from the scoring weights
specified in subparagraph (E), for each
performance category based on the extent to which
the category is applicable to the type of eligible
professional involved; and
``(ii) for each measure and activity specified
under paragraph (2)(B) with respect to each such
category based on the extent to which the measure
or activity is applicable and available to the
type of eligible professional involved.
``(G) Resource use.--Analysis of the performance
category described in paragraph (2)(A)(ii) shall include
results from the methodology described in subsection
(r)(5), as appropriate.
``(H) Inclusion of quality measure data from other
payers.--In applying subsections (k), (m), and (p) with
respect to measures described in paragraph (2)(B)(i),
analysis of the performance category described in
paragraph (2)(A)(i) may include data submitted by MIPS
eligible professionals with respect to items and
services furnished to individuals who are not
individuals entitled to benefits under part A or
enrolled under part B.
``(I) Use of voluntary virtual groups for certain
assessment purposes.--
``(i) In general.--In the case of MIPS
eligible professionals electing to be a virtual
group under clause (ii) with respect to a
performance period for a year, for purposes of
applying the methodology under subparagraph (A)
with respect to the performance categories
described in clauses (i) and (ii) of paragraph
(2)(A)--
``(I) the assessment of performance
provided under such methodology with
respect to such performance categories
that is to be applied to each such
professional in such group for such
performance period shall be with respect
to the combined performance of all such
professionals in such group for such
period; and
``(II) with respect to the composite
performance score provided under this
paragraph for such performance period
for each such MIPS eligible professional
in such virtual group, the components
[[Page 129 STAT. 105]]
of the composite performance score that
assess performance with respect to such
performance categories shall be based on
the assessment of the combined
performance under subclause (I) for such
performance categories and performance
period.
``(ii) Election of practices to be a virtual
group.--The Secretary shall, in accordance with
the requirements under clause (iii), establish and
have in place a process to allow an individual
MIPS eligible professional or a group practice
consisting of not more than 10 MIPS eligible
professionals to elect, with respect to a
performance period for a year to be a virtual
group under this subparagraph with at least one
other such individual MIPS eligible professional
or group practice. Such a virtual group may be
based on appropriate classifications of providers,
such as by geographic areas or by provider
specialties defined by nationally recognized
specialty boards of certification or equivalent
certification boards.
``(iii) Requirements.--The requirements for
the process under clause (ii) shall--
``(I) provide that an election under
such clause, with respect to a
performance period, shall be made before
the beginning of such performance period
and may not be changed during such
performance period;
``(II) provide that an individual
MIPS eligible professional and a group
practice described in clause (ii) may
elect to be in no more than one virtual
group for a performance period and that,
in the case of such a group practice
that elects to be in such virtual group
for such performance period, such
election applies to all MIPS eligible
professionals in such group practice;
``(III) provide that a virtual group
be a combination of tax identification
numbers;
``(IV) provide for formal written
agreements among MIPS eligible
professionals electing to be a virtual
group under this subparagraph; and
``(V) include such other
requirements as the Secretary determines
appropriate.
``(6) MIPS payments.--
``(A) MIPS adjustment factor.--Taking into account
paragraph (1)(G), the Secretary shall specify a MIPS
adjustment factor for each MIPS eligible professional
for a year. Such MIPS adjustment factor for a MIPS
eligible professional for a year shall be in the form of
a percent and shall be determined--
``(i) by comparing the composite performance
score of the eligible professional for such year
to the performance threshold established under
subparagraph (D)(i) for such year;
``(ii) in a manner such that the adjustment
factors specified under this subparagraph for a
year result in differential payments under this
paragraph reflecting that--
[[Page 129 STAT. 106]]
``(I) MIPS eligible professionals
with composite performance scores for
such year at or above such performance
threshold for such year receive zero or
positive payment adjustment factors for
such year in accordance with clause
(iii), with such professionals having
higher composite performance scores
receiving higher adjustment factors; and
``(II) MIPS eligible professionals
with composite performance scores for
such year below such performance
threshold for such year receive negative
payment adjustment factors for such year
in accordance with clause (iv), with
such professionals having lower
composite performance scores receiving
lower adjustment factors;
``(iii) in a manner such that MIPS eligible
professionals with composite scores described in
clause (ii)(I) for such year, subject to clauses
(i) and (ii) of subparagraph (F), receive a zero
or positive adjustment factor on a linear sliding
scale such that an adjustment factor of 0 percent
is assigned for a score at the performance
threshold and an adjustment factor of the
applicable percent specified in subparagraph (B)
is assigned for a score of 100; and
``(iv) in a manner such that--
``(I) subject to subclause (II),
MIPS eligible professionals with
composite performance scores described
in clause (ii)(II) for such year receive
a negative payment adjustment factor on
a linear sliding scale such that an
adjustment factor of 0 percent is
assigned for a score at the performance
threshold and an adjustment factor of
the negative of the applicable percent
specified in subparagraph (B) is
assigned for a score of 0; and
``(II) MIPS eligible professionals
with composite performance scores that
are equal to or greater than 0, but not
greater than \1/4\ of the performance
threshold specified under subparagraph
(D)(i) for such year, receive a negative
payment adjustment factor that is equal
to the negative of the applicable
percent specified in subparagraph (B)
for such year.
``(B) Applicable percent defined.--For purposes of
this paragraph, the term `applicable percent' means--
``(i) for 2019, 4 percent;
``(ii) for 2020, 5 percent;
``(iii) for 2021, 7 percent; and
``(iv) for 2022 and subsequent years, 9
percent.
``(C) Additional mips adjustment factors for
exceptional performance.--For 2019 and each subsequent
year through 2024, in the case of a MIPS eligible
professional with a composite performance score for a
year at or above the additional performance threshold
under subparagraph (D)(ii) for such year, in addition to
the MIPS adjustment factor under subparagraph (A) for
the eligible professional for such year, subject to
subparagraph (F)(iv), the Secretary shall specify an
additional positive MIPS adjustment factor for such
professional and year. Such additional MIPS
[[Page 129 STAT. 107]]
adjustment factors shall be in the form of a percent and
determined by the Secretary in a manner such that
professionals having higher composite performance scores
above the additional performance threshold receive
higher additional MIPS adjustment factors.
``(D) Establishment of performance thresholds.--
``(i) Performance threshold.--For each year of
the MIPS, the Secretary shall compute a
performance threshold with respect to which the
composite performance score of MIPS eligible
professionals shall be compared for purposes of
determining adjustment factors under subparagraph
(A) that are positive, negative, and zero. Such
performance threshold for a year shall be the mean
or median (as selected by the Secretary) of the
composite performance scores for all MIPS eligible
professionals with respect to a prior period
specified by the Secretary. The Secretary may
reassess the selection of the mean or median under
the previous sentence every 3 years.
``(ii) Additional performance threshold for
exceptional performance.--In addition to the
performance threshold under clause (i), for each
year of the MIPS, the Secretary shall compute an
additional performance threshold for purposes of
determining the additional MIPS adjustment factors
under subparagraph (C). For each such year, the
Secretary shall apply either of the following
methods for computing such additional performance
threshold for such a year:
``(I) The threshold shall be the
score that is equal to the 25th
percentile of the range of possible
composite performance scores above the
performance threshold determined under
clause (i).
``(II) The threshold shall be the
score that is equal to the 25th
percentile of the actual composite
performance scores for MIPS eligible
professionals with composite performance
scores at or above the performance
threshold with respect to the prior
period described in clause (i).
``(iii) Special rule for initial 2 years.--
With respect to each of the first two years to
which the MIPS applies, the Secretary shall, prior
to the performance period for such years,
establish a performance threshold for purposes of
determining MIPS adjustment factors under
subparagraph (A) and a threshold for purposes of
determining additional MIPS adjustment factors
under subparagraph (C). Each such performance
threshold shall--
``(I) be based on a period prior to
such performance periods; and
``(II) take into account--
``(aa) data available with
respect to performance on
measures and activities that may
be used under the performance
categories under subparagraph
(2)(B); and
``(bb) other factors
determined appropriate by the
Secretary.
[[Page 129 STAT. 108]]
``(E) Application of mips adjustment factors.--In
the case of items and services furnished by a MIPS
eligible professional during a year (beginning with
2019), the amount otherwise paid under this part with
respect to such items and services and MIPS eligible
professional for such year, shall be multiplied by--
``(i) 1, plus
``(ii) the sum of--
``(I) the MIPS adjustment factor
determined under subparagraph (A)
divided by 100, and
``(II) as applicable, the additional
MIPS adjustment factor determined under
subparagraph (C) divided by 100.
``(F) Aggregate application of mips adjustment
factors.--
``(i) Application of scaling factor.--
``(I) In general.--With respect to
positive MIPS adjustment factors under
subparagraph (A)(ii)(I) for eligible
professionals whose composite
performance score is above the
performance threshold under subparagraph
(D)(i) for such year, subject to
subclause (II), the Secretary shall
increase or decrease such adjustment
factors by a scaling factor in order to
ensure that the budget neutrality
requirement of clause (ii) is met.
``(II) Scaling factor limit.--In no
case may the scaling factor applied
under this clause exceed 3.0.
``(ii) Budget neutrality requirement.--
``(I) In general.--Subject to clause
(iii), the Secretary shall ensure that
the estimated amount described in
subclause (II) for a year is equal to
the estimated amount described in
subclause (III) for such year.
``(II) Aggregate increases.--The
amount described in this subclause is
the estimated increase in the aggregate
allowed charges resulting from the
application of positive MIPS adjustment
factors under subparagraph (A) (after
application of the scaling factor
described in clause (i)) to MIPS
eligible professionals whose composite
performance score for a year is above
the performance threshold under
subparagraph (D)(i) for such year.
``(III) Aggregate decreases.--The
amount described in this subclause is
the estimated decrease in the aggregate
allowed charges resulting from the
application of negative MIPS adjustment
factors under subparagraph (A) to MIPS
eligible professionals whose composite
performance score for a year is below
the performance threshold under
subparagraph (D)(i) for such year.
``(iii) Exceptions.--
``(I) <<NOTE: Applicability.>> In
the case that all MIPS eligible
professionals receive composite
performance scores for a year that are
below the performance threshold
[[Page 129 STAT. 109]]
under subparagraph (D)(i) for such year,
the negative MIPS adjustment factors
under subparagraph (A) shall apply with
respect to such MIPS eligible
professionals and the budget neutrality
requirement of clause (ii) and the
additional adjustment factors under
clause (iv) shall not apply for such
year.
``(II) In the case that, with
respect to a year, the application of
clause (i) results in a scaling factor
equal to the maximum scaling factor
specified in clause (i)(II), such
scaling factor shall apply and the
budget neutrality requirement of clause
(ii) shall not apply for such year.
``(iv) Additional incentive payment
adjustments.--
``(I) <<NOTE: Time period.>> In
general.--Subject to subclause (II), in
specifying the MIPS additional
adjustment factors under subparagraph
(C) for each applicable MIPS eligible
professional for a year, the Secretary
shall ensure that the estimated
aggregate increase in payments under
this part resulting from the application
of such additional adjustment factors
for MIPS eligible professionals in a
year shall be equal (as estimated by the
Secretary) to $500,000,000 for each year
beginning with 2019 and ending with
2024.
``(II) Limitation on additional
incentive payment adjustments.--The MIPS
additional adjustment factor under
subparagraph (C) for a year for an
applicable MIPS eligible professional
whose composite performance score is
above the additional performance
threshold under subparagraph (D)(ii) for
such year shall not exceed 10 percent.
The application of the previous sentence
may result in an aggregate amount of
additional incentive payments that are
less than the amount specified in
subclause (I).
``(7) <<NOTE: Deadline.>> Announcement of result of
adjustments.--Under the MIPS, the Secretary shall, not later
than 30 days prior to January 1 of the year involved, make
available to MIPS eligible professionals the MIPS adjustment
factor (and, as applicable, the additional MIPS adjustment
factor) under paragraph (6) applicable to the eligible
professional for items and services furnished by the
professional for such year. The Secretary may include such
information in the confidential feedback under paragraph (12).
``(8) No effect in subsequent years.--The MIPS adjustment
factors and additional MIPS adjustment factors under paragraph
(6) shall apply only with respect to the year involved, and the
Secretary shall not take into account such adjustment factors in
making payments to a MIPS eligible professional under this part
in a subsequent year.
``(9) Public reporting.--
``(A) <<NOTE: Web posting.>> In general.--The
Secretary shall, in an easily understandable format,
make available on the Physician Compare Internet website
of the Centers for Medicare & Medicaid Services the
following:
[[Page 129 STAT. 110]]
``(i) Information regarding the performance of
MIPS eligible professionals under the MIPS,
which--
``(I) shall include the composite
score for each such MIPS eligible
professional and the performance of each
such MIPS eligible professional with
respect to each performance category;
and
``(II) may include the performance
of each such MIPS eligible professional
with respect to each measure or activity
specified in paragraph (2)(B).
``(ii) The names of eligible professionals in
eligible alternative payment models (as defined in
section 1833(z)(3)(D)) and, to the extent
feasible, the names of such eligible alternative
payment models and performance of such models.
``(B) Disclosure.--The information made available
under this paragraph shall indicate, where appropriate,
that publicized information may not be representative of
the eligible professional's entire patient population,
the variety of services furnished by the eligible
professional, or the health conditions of individuals
treated.
``(C) Opportunity to review and submit
corrections.--The Secretary shall provide for an
opportunity for a professional described in subparagraph
(A) to review, and submit corrections for, the
information to be made public with respect to the
professional under such subparagraph prior to such
information being made public.
``(D) <<NOTE: Web posting.>> Aggregate
information.--The Secretary shall periodically post on
the Physician Compare Internet website aggregate
information on the MIPS, including the range of
composite scores for all MIPS eligible professionals and
the range of the performance of all MIPS eligible
professionals with respect to each performance category.
``(10) Consultation.--The Secretary shall consult with
stakeholders in carrying out the MIPS, including for the
identification of measures and activities under paragraph (2)(B)
and the methodologies developed under paragraphs (5)(A) and (6)
and regarding the use of qualified clinical data registries.
Such consultation shall include the use of a request for
information or other mechanisms determined appropriate.
``(11) Technical assistance to small practices and practices
in health professional shortage areas.--
``(A) <<NOTE: Contracts.>> In general.--The
Secretary shall enter into contracts or agreements with
appropriate entities (such as quality improvement
organizations, regional extension centers (as described
in section 3012(c) of the Public Health Service Act), or
regional health collaboratives) to offer guidance and
assistance to MIPS eligible professionals in practices
of 15 or fewer professionals (with priority given to
such practices located in rural areas, health
professional shortage areas (as designated under in
section 332(a)(1)(A) of such Act), and medically
underserved areas, and practices with low composite
scores) with respect to--
``(i) the performance categories described in
clauses (i) through (iv) of paragraph (2)(A); or
``(ii) how to transition to the implementation
of and participation in an alternative payment
model as described in section 1833(z)(3)(C).
[[Page 129 STAT. 111]]
``(B) Funding for technical assistance.--For
purposes of implementing subparagraph (A), the Secretary
shall provide for the transfer from the Federal
Supplementary Medical Insurance Trust Fund established
under section 1841 to the Centers for Medicare &
Medicaid Services Program Management Account of
$20,000,000 for each of fiscal years 2016 through 2020.
Amounts transferred under this subparagraph for a fiscal
year shall be available until expended.
``(12) Feedback and information to improve performance.--
``(A) Performance feedback.--
``(i) <<NOTE: Effective date.>> In general.--
Beginning July 1, 2017, the Secretary--
``(I) shall make available timely
(such as quarterly) confidential
feedback to MIPS eligible professionals
on the performance of such professionals
with respect to the performance
categories under clauses (i) and (ii) of
paragraph (2)(A); and
``(II) may make available
confidential feedback to such
professionals on the performance of such
professionals with respect to the
performance categories under clauses
(iii) and (iv) of such paragraph.
``(ii) Mechanisms.--The Secretary may use one
or more mechanisms to make feedback available
under clause (i), which may include use of a web-
based portal or other mechanisms determined
appropriate by the Secretary. With respect to the
performance category described in paragraph
(2)(A)(i), feedback under this subparagraph shall,
to the extent an eligible professional chooses to
participate in a data registry for purposes of
this subsection (including registries under
subsections (k) and (m)), be provided based on
performance on quality measures reported through
the use of such registries. With respect to any
other performance category described in paragraph
(2)(A), the Secretary shall encourage provision of
feedback through qualified clinical data
registries as described in subsection (m)(3)(E)).
``(iii) Use of data.--For purposes of clause
(i), the Secretary may use data, with respect to a
MIPS eligible professional, from periods prior to
the current performance period and may use rolling
periods in order to make illustrative calculations
about the performance of such professional.
``(iv) Disclosure exemption.--Feedback made
available under this subparagraph shall be exempt
from disclosure under section 552 of title 5,
United States Code.
``(v) Receipt of information.--The Secretary
may use the mechanisms established under clause
(ii) to receive information from professionals,
such as information with respect to this
subsection.
``(B) Additional information.--
[[Page 129 STAT. 112]]
``(i) <<NOTE: Effective date.>> In general.--
Beginning July 1, 2018, the Secretary shall make
available to MIPS eligible professionals
information, with respect to individuals who are
patients of such MIPS eligible professionals,
about items and services for which payment is made
under this title that are furnished to such
individuals by other suppliers and providers of
services, which may include information described
in clause (ii). Such information may be made
available under the previous sentence to such MIPS
eligible professionals by mechanisms determined
appropriate by the Secretary, which may include
use of a web-based portal. Such information may be
made available in accordance with the same or
similar terms as data are made available to
accountable care organizations participating in
the shared savings program under section 1899.
``(ii) Type of information.--For purposes of
clause (i), the information described in this
clause, is the following:
``(I) With respect to selected items
and services (as determined appropriate
by the Secretary) for which payment is
made under this title and that are
furnished to individuals, who are
patients of a MIPS eligible
professional, by another supplier or
provider of services during the most
recent period for which data are
available (such as the most recent
three-month period), such as the name of
such providers furnishing such items and
services to such patients during such
period, the types of such items and
services so furnished, and the dates
such items and services were so
furnished.
``(II) Historical data, such as
averages and other measures of the
distribution if appropriate, of the
total, and components of, allowed
charges (and other figures as determined
appropriate by the Secretary).
``(13) Review.--
``(A) Targeted review.--The Secretary shall
establish a process under which a MIPS eligible
professional may seek an informal review of the
calculation of the MIPS adjustment factor (or factors)
applicable to such eligible professional under this
subsection for a year. The results of a review conducted
pursuant to the previous sentence shall not be taken
into account for purposes of paragraph (6) with respect
to a year (other than with respect to the calculation of
such eligible professional's MIPS adjustment factor for
such year or additional MIPS adjustment factor for such
year) after the factors determined in subparagraph (A)
and subparagraph (C) of such paragraph have been
determined for such year.
``(B) Limitation.--Except as provided for in
subparagraph (A), there shall be no administrative or
judicial review under section 1869, section 1878, or
otherwise of the following:
``(i) The methodology used to determine the
amount of the MIPS adjustment factor under
paragraph (6)(A) and the amount of the additional
MIPS adjustment
[[Page 129 STAT. 113]]
factor under paragraph (6)(C) and the
determination of such amounts.
``(ii) The establishment of the performance
standards under paragraph (3) and the performance
period under paragraph (4).
``(iii) The identification of measures and
activities specified under paragraph (2)(B) and
information made public or posted on the Physician
Compare Internet website of the Centers for
Medicare & Medicaid Services under paragraph (9).
``(iv) The methodology developed under
paragraph (5) that is used to calculate
performance scores and the calculation of such
scores, including the weighting of measures and
activities under such methodology.''.
(2) GAO reports.--
(A) Evaluation of eligible professional mips.--Not
later than October 1, 2021, the Comptroller General of
the United States shall submit to Congress a report
evaluating the eligible professional Merit-based
Incentive Payment System under subsection (q) of section
1848 of the Social Security Act (42 U.S.C. 1395w-4), as
added by paragraph (1). Such report shall--
(i) examine the distribution of the composite
performance scores and MIPS adjustment factors
(and additional MIPS adjustment factors) for MIPS
eligible professionals (as defined in subsection
(q)(1)(c) of such section) under such program, and
patterns relating to such scores and adjustment
factors, including based on type of provider,
practice size, geographic location, and patient
mix;
(ii) provide recommendations for improving
such program;
(iii) evaluate the impact of technical
assistance funding under section 1848(q)(11) of
the Social Security Act, as added by paragraph
(1), on the ability of professionals to improve
within such program or successfully transition to
an alternative payment model (as defined in
section 1833(z)(3) of the Social Security Act, as
added by subsection (e)), with priority for such
evaluation given to practices located in rural
areas, health professional shortage areas (as
designated in section 332(a)(1)(A) of the Public
Health Service Act), and medically underserved
areas; and
(iv) provide recommendations for optimizing
the use of such technical assistance funds.
(B) Study to examine alignment of quality measures
used in public and private programs.--
(i) In general.--Not later than 18 months
after the date of the enactment of this Act, the
Comptroller General of the United States shall
submit to Congress a report that--
(I) compares the similarities and
differences in the use of quality
measures under the original Medicare
fee-for-service program under parts A
and B of title XVIII of the Social
Security Act, the Medicare Advantage
program under part C of such title,
selected State Medicaid programs
[[Page 129 STAT. 114]]
under title XIX of such Act, and private
payer arrangements; and
(II) makes recommendations on how to
reduce the administrative burden
involved in applying such quality
measures.
(ii) Requirements.--The report under clause
(i) shall--
(I) consider those measures
applicable to individuals entitled to,
or enrolled for, benefits under such
part A, or enrolled under such part B
and individuals under the age of 65; and
(II) focus on those measures that
comprise the most significant component
of the quality performance category of
the eligible professional MIPS incentive
program under subsection (q) of section
1848 of the Social Security Act (42
U.S.C. 1395w-4), as added by paragraph
(1).
(C) Study on role of independent risk managers.--Not
later than January 1, 2017, the Comptroller General of
the United States shall submit to Congress a report
examining whether entities that pool financial risk for
physician practices, such as independent risk managers,
can play a role in supporting physician practices,
particularly small physician practices, in assuming
financial risk for the treatment of patients. Such
report shall examine barriers that small physician
practices currently face in assuming financial risk for
treating patients, the types of risk management entities
that could assist physician practices in participating
in two-sided risk payment models, and how such entities
could assist with risk management and with quality
improvement activities. Such report shall also include
an analysis of any existing legal barriers to such
arrangements.
(D) Study to examine rural and health professional
shortage area alternative payment models.--Not later
than October 1, 2021, the Comptroller General of the
United States shall submit to Congress a report that
examines the transition of professionals in rural areas,
health professional shortage areas (as designated in
section 332(a)(1)(A) of the Public Health Service Act),
or medically underserved areas to an alternative payment
model (as defined in section 1833(z)(3) of the Social
Security Act, as added by subsection (e)). Such report
shall make recommendations for removing administrative
barriers to practices, including small practices
consisting of 15 or fewer professionals, in rural areas,
health professional shortage areas, and medically
underserved areas to participation in such models.
(3) Funding for implementation.--For purposes of
implementing the provisions of and the amendments made by this
section, the Secretary of Health and Human Services shall
provide for the transfer of $80,000,000 from the Supplementary
Medical Insurance Trust Fund established under section 1841 of
the Social Security Act (42 U.S.C. 1395t) to the Centers for
Medicare & Medicaid Program Management Account for each of the
fiscal years 2015 through 2019. Amounts transferred under this
paragraph shall be available until expended.
[[Page 129 STAT. 115]]
(d) Improving Quality Reporting for Composite Scores.--
(1) Changes for group reporting option.--
(A) In general.--Section 1848(m)(3)(C)(ii) of the
Social Security Act (42 U.S.C. 1395w-4(m)(3)(C)(ii)) is
amended by inserting ``and, for 2016 and subsequent
years, may provide'' after ``shall provide''.
(B) Clarification of qualified clinical data
registry reporting to group practices.--Section
1848(m)(3)(D) of the Social Security Act (42 U.S.C.
1395w-4(m)(3)(D)) is amended by inserting ``and, for
2016 and subsequent years, subparagraph (A) or (C)''
after ``subparagraph (A)''.
(2) Changes for multiple reporting periods and alternative
criteria for satisfactory reporting.--Section 1848(m)(5)(F) of
the Social Security Act (42 U.S.C. 1395w-4(m)(5)(F)) is
amended--
(A) by striking ``and subsequent years'' and
inserting ``through reporting periods occurring in
2015''; and
(B) by inserting ``and, for reporting periods
occurring in 2016 and subsequent years, the Secretary
may establish'' after ``shall establish''.
(3) Physician feedback program reports succeeded by reports
under mips.--Section 1848(n) of the Social Security Act (42
U.S.C. 1395w-4(n)) is amended by adding at the end the following
new paragraph:
``(11) Reports ending with 2017.--Reports under the Program
shall not be provided after December 31, 2017. See subsection
(q)(12) for reports under the eligible professionals Merit-based
Incentive Payment System.''.
(4) Coordination with satisfying meaningful ehr use clinical
quality measure reporting requirement.--Section
1848(o)(2)(A)(iii) of the Social Security Act (42 U.S.C. 1395w-
4(o)(2)(A)(iii)) is amended by inserting ``and subsection
(q)(5)(B)(ii)(II)'' after ``Subject to subparagraph (B)(ii)''.
(e) Promoting Alternative Payment Models.--
(1) Increasing transparency of physician-focused payment
models.--Section 1868 of the Social Security Act (42 U.S.C.
1395ee) is amended by adding at the end the following new
subsection:
``(c) Physician-Focused Payment Models.--
``(1) Technical advisory committee.--
``(A) Establishment.--There is established an ad hoc
committee to be known as the `Physician-Focused Payment
Model Technical Advisory Committee' (referred to in this
subsection as the `Committee').
``(B) Membership.--
``(i) Number and appointment.--The Committee
shall be composed of 11 members appointed by the
Comptroller General of the United States.
``(ii) Qualifications.--The membership of the
Committee shall include individuals with national
recognition for their expertise in physician-
focused payment models and related delivery of
care. No more than 5 members of the Committee
shall be providers of services or suppliers, or
representatives of providers of services or
suppliers.
[[Page 129 STAT. 116]]
``(iii) Prohibition on federal employment.--A
member of the Committee shall not be an employee
of the Federal Government.
``(iv) Ethics disclosure.--The Comptroller
General shall establish a system for public
disclosure by members of the Committee of
financial and other potential conflicts of
interest relating to such members. Members of the
Committee shall be treated as employees of
Congress for purposes of applying title I of the
Ethics in Government Act of 1978 (Public Law 95-
521).
``(v) <<NOTE: Deadline.>> Date of initial
appointments.--The initial appointments of members
of the Committee shall be made by not later than
180 days after the date of enactment of this
subsection.
``(C) Term; vacancies.--
``(i) Term.--The terms of members of the
Committee shall be for 3 years except that the
Comptroller General shall designate staggered
terms for the members first appointed.
``(ii) Vacancies.--Any member appointed to
fill a vacancy occurring before the expiration of
the term for which the member's predecessor was
appointed shall be appointed only for the
remainder of that term. A member may serve after
the expiration of that member's term until a
successor has taken office. A vacancy in the
Committee shall be filled in the manner in which
the original appointment was made.
``(D) Duties.--The Committee shall meet, as needed,
to provide comments and recommendations to the
Secretary, as described in paragraph (2)(C), on
physician-focused payment models.
``(E) Compensation of members.--
``(i) In general.--Except as provided in
clause (ii), a member of the Committee shall serve
without compensation.
``(ii) Travel expenses.--A member of the
Committee shall be allowed travel expenses,
including per diem in lieu of subsistence, at
rates authorized for an employee of an agency
under subchapter I of chapter 57 of title 5,
United States Code, while away from the home or
regular place of business of the member in the
performance of the duties of the Committee.
``(F) Operational and technical support.--
``(i) In general.--The Assistant Secretary for
Planning and Evaluation shall provide technical
and operational support for the Committee, which
may be by use of a contractor. The Office of the
Actuary of the Centers for Medicare & Medicaid
Services shall provide to the Committee actuarial
assistance as needed.
``(ii) Funding.--The Secretary shall provide
for the transfer, from the Federal Supplementary
Medical Insurance Trust Fund under section 1841,
such amounts as are necessary to carry out this
paragraph (not to exceed $5,000,000) for fiscal
year 2015 and each subsequent fiscal year. Any
amounts transferred
[[Page 129 STAT. 117]]
under the preceding sentence for a fiscal year
shall remain available until expended.
``(G) Application.--Section 14 of the Federal
Advisory Committee Act (5 U.S.C. App.) shall not apply
to the Committee.
``(2) Criteria and process for submission and review of
physician-focused payment models.--
``(A) Criteria for assessing physician-focused
payment models.--
``(i) <<NOTE: Deadline.>> Rulemaking.--Not
later than November 1, 2016, the Secretary shall,
through notice and comment rulemaking, following a
request for information, establish criteria for
physician-focused payment models, including models
for specialist physicians, that could be used by
the Committee for making comments and
recommendations pursuant to paragraph (1)(D).
``(ii) MedPAC submission of comments.--During
the comment period for the proposed rule described
in clause (i), the Medicare Payment Advisory
Commission may submit comments to the Secretary on
the proposed criteria under such clause.
``(iii) Updating.--The Secretary may update
the criteria established under this subparagraph
through rulemaking.
``(B) Stakeholder submission of physician-focused
payment models.--On an ongoing basis, individuals and
stakeholder entities may submit to the Committee
proposals for physician-focused payment models that such
individuals and entities believe meet the criteria
described in subparagraph (A).
``(C) Committee review of models submitted.--The
Committee shall, on a periodic basis, review models
submitted under subparagraph (B), prepare comments and
recommendations regarding whether such models meet the
criteria described in subparagraph (A), and submit such
comments and recommendations to the Secretary.
``(D) Secretary review and response.--The Secretary
shall review the comments and recommendations submitted
by the Committee under subparagraph (C) and post a
detailed response to such comments and recommendations
on the Internet website of the Centers for Medicare &
Medicaid Services.
``(3) Rule of construction.--Nothing in this subsection
shall be construed to impact the development or testing of
models under this title or titles XI, XIX, or XXI.''.
(2) Incentive payments for participation in eligible
alternative payment models.--Section 1833 of the Social Security
Act (42 U.S.C. 1395l) is amended by adding at the end the
following new subsection:
``(z) Incentive Payments for Participation in Eligible Alternative
Payment Models.--
``(1) Payment incentive.--
``(A) <<NOTE: Time period.>> In general.--In the
case of covered professional services furnished by an
eligible professional during a year that is in the
period beginning with 2019 and ending with 2024 and for
which the professional is a qualifying APM participant
with respect to such year, in addition to the
[[Page 129 STAT. 118]]
amount of payment that would otherwise be made for such
covered professional services under this part for such
year, there also shall be paid to such professional an
amount equal to 5 percent of the estimated aggregate
payment amounts for such covered professional services
under this part for the preceding year. For purposes of
the previous sentence, the payment amount for the
preceding year may be an estimation for the full
preceding year based on a period of such preceding year
that is less than the full year.
The <<NOTE: Policies.>> Secretary shall establish
policies to implement this subparagraph in cases in
which payment for covered professional services
furnished by a qualifying APM participant in an
alternative payment model--
``(i) is made to an eligible alternative
payment entity rather than directly to the
qualifying APM participant; or
``(ii) is made on a basis other than a fee-
for-service basis (such as payment on a capitated
basis).
``(B) Form of payment.--Payments under this
subsection shall be made in a lump sum, on an annual
basis, as soon as practicable.
``(C) Treatment of payment incentive.--Payments
under this subsection shall not be taken into account
for purposes of determining actual expenditures under an
alternative payment model and for purposes of
determining or rebasing any benchmarks used under the
alternative payment model.
``(D) Coordination.--The amount of the additional
payment under this subsection or subsection (m) shall be
determined without regard to any additional payment
under subsection (m) and this subsection, respectively.
The amount of the additional payment under this
subsection or subsection (x) shall be determined without
regard to any additional payment under subsection (x)
and this subsection, respectively. The amount of the
additional payment under this subsection or subsection
(y) shall be determined without regard to any additional
payment under subsection (y) and this subsection,
respectively.
``(2) <<NOTE: Definition.>> Qualifying apm participant.--
For purposes of this subsection, the term `qualifying APM
participant' means the following:
``(A) 2019 and 2020.--With respect to 2019 and 2020,
an eligible professional for whom the Secretary
determines that at least 25 percent of payments under
this part for covered professional services furnished by
such professional during the most recent period for
which data are available (which may be less than a year)
were attributable to such services furnished under this
part through an eligible alternative payment entity.
``(B) 2021 and 2022.--With respect to 2021 and 2022,
an eligible professional described in either of the
following clauses:
``(i) Medicare payment threshold option.--An
eligible professional for whom the Secretary
determines that at least 50 percent of payments
under this part for covered professional services
furnished by such professional during the most
recent period for which
[[Page 129 STAT. 119]]
data are available (which may be less than a year)
were attributable to such services furnished under
this part through an eligible alternative payment
entity.
``(ii) Combination all-payer and medicare
payment threshold option.--An eligible
professional--
``(I) for whom the Secretary
determines, with respect to items and
services furnished by such professional
during the most recent period for which
data are available (which may be less
than a year), that at least 50 percent
of the sum of--
``(aa) payments described in
clause (i); and
``(bb) all other payments,
regardless of payer (other than
payments made by the Secretary
of Defense or the Secretary of
Veterans Affairs and other than
payments made under title XIX in
a State in which no medical home
or alternative payment model is
available under the State
program under that title),
meet the requirement described in clause
(iii)(I) with respect to payments
described in item (aa) and meet the
requirement described in clause
(iii)(II) with respect to payments
described in item (bb);
``(II) for whom the Secretary
determines at least 25 percent of
payments under this part for covered
professional services furnished by such
professional during the most recent
period for which data are available
(which may be less than a year) were
attributable to such services furnished
under this part through an eligible
alternative payment entity; and
``(III) who provides to the
Secretary such information as is
necessary for the Secretary to make a
determination under subclause (I), with
respect to such professional.
``(iii) Requirement.--For purposes of clause
(ii)(I)--
``(I) the requirement described in
this subclause, with respect to payments
described in item (aa) of such clause,
is that such payments are made to an
eligible alternative payment entity; and
``(II) the requirement described in
this subclause, with respect to payments
described in item (bb) of such clause,
is that such payments are made under
arrangements in which--
``(aa) quality measures
comparable to measures under the
performance category described
in section 1848(q)(2)(B)(i)
apply;
``(bb) certified EHR
technology is used; and
``(cc) the eligible
professional participates in an
entity that--
``(AA) bears more than
nominal financial risk if
actual aggregate
expenditures exceeds
expected aggregate
expenditures; or
[[Page 129 STAT. 120]]
``(BB) with respect to
beneficiaries under title
XIX, is a medical home that
meets criteria comparable to
medical homes expanded under
section 1115A(c).
``(C) <<NOTE: Effective date.>> Beginning in
2023.--With respect to 2023 and each subsequent year, an
eligible professional described in either of the
following clauses:
``(i) Medicare payment threshold option.--An
eligible professional for whom the Secretary
determines that at least 75 percent of payments
under this part for covered professional services
furnished by such professional during the most
recent period for which data are available (which
may be less than a year) were attributable to such
services furnished under this part through an
eligible alternative payment entity.
``(ii) Combination all-payer and medicare
payment threshold option.--An eligible
professional--
``(I) for whom the Secretary
determines, with respect to items and
services furnished by such professional
during the most recent period for which
data are available (which may be less
than a year), that at least 75 percent
of the sum of--
``(aa) payments described in
clause (i); and
``(bb) all other payments,
regardless of payer (other than
payments made by the Secretary
of Defense or the Secretary of
Veterans Affairs and other than
payments made under title XIX in
a State in which no medical home
or alternative payment model is
available under the State
program under that title),
meet the requirement described in clause
(iii)(I) with respect to payments
described in item (aa) and meet the
requirement described in clause
(iii)(II) with respect to payments
described in item (bb);
``(II) for whom the Secretary
determines at least 25 percent of
payments under this part for covered
professional services furnished by such
professional during the most recent
period for which data are available
(which may be less than a year) were
attributable to such services furnished
under this part through an eligible
alternative payment entity; and
``(III) who provides to the
Secretary such information as is
necessary for the Secretary to make a
determination under subclause (I), with
respect to such professional.
``(iii) Requirement.--For purposes of clause
(ii)(I)--
``(I) the requirement described in
this subclause, with respect to payments
described in item (aa) of such clause,
is that such payments are made to an
eligible alternative payment entity; and
``(II) the requirement described in
this subclause, with respect to payments
described in item
[[Page 129 STAT. 121]]
(bb) of such clause, is that such
payments are made under arrangements in
which--
``(aa) <<NOTE: Applicability.>>
quality measures comparable to
measures under the performance
category described in section
1848(q)(2)(B)(i) apply;
``(bb) certified EHR
technology is used; and
``(cc) the eligible
professional participates in an
entity that--
``(AA) bears more than
nominal financial risk if
actual aggregate
expenditures exceeds
expected aggregate
expenditures; or
``(BB) with respect to
beneficiaries under title
XIX, is a medical home that
meets criteria comparable to
medical homes expanded under
section 1115A(c).
``(D) Use of patient approach.--The Secretary may
base the determination of whether an eligible
professional is a qualifying APM participant under this
subsection and the determination of whether an eligible
professional is a partial qualifying APM participant
under section 1848(q)(1)(C)(iii) by using counts of
patients in lieu of using payments and using the same or
similar percentage criteria (as specified in this
subsection and such section, respectively), as the
Secretary determines appropriate.
``(3) Additional definitions.--In this subsection:
``(A) Covered professional services.--The term
`covered professional services' has the meaning given
that term in section 1848(k)(3)(A).
``(B) Eligible professional.--The term `eligible
professional' has the meaning given that term in section
1848(k)(3)(B) and includes a group that includes such
professionals.
``(C) Alternative payment model (apm).--The term
`alternative payment model' means, other than for
purposes of subparagraphs (B)(ii)(I)(bb) and
(C)(ii)(I)(bb) of paragraph (2), any of the following:
``(i) A model under section 1115A (other than
a health care innovation award).
``(ii) The shared savings program under
section 1899.
``(iii) A demonstration under section 1866C.
``(iv) A demonstration required by Federal
law.
``(D) Eligible alternative payment entity.--The term
`eligible alternative payment entity' means, with
respect to a year, an entity that--
``(i) participates in an alternative payment
model that--
``(I) requires participants in such
model to use certified EHR technology
(as defined in subsection (o)(4)); and
``(II) provides for payment for
covered professional services based on
quality measures comparable to measures
under the performance category described
in section 1848(q)(2)(B)(i); and
[[Page 129 STAT. 122]]
``(ii)(I) bears financial risk for monetary
losses under such alternative payment model that
are in excess of a nominal amount; or
``(II) is a medical home expanded under
section 1115A(c).
``(4) Limitation.--There shall be no administrative or
judicial review under section 1869, 1878, or otherwise, of the
following:
``(A) The determination that an eligible
professional is a qualifying APM participant under
paragraph (2) and the determination that an entity is an
eligible alternative payment entity under paragraph
(3)(D).
``(B) The determination of the amount of the 5
percent payment incentive under paragraph (1)(A),
including any estimation as part of such
determination.''.
(3) Coordination conforming amendments.--Section 1833 of the
Social Security Act (42 U.S.C. 1395l) is further amended--
(A) in subsection (x)(3), by adding at the end the
following new sentence: ``The amount of the additional
payment for a service under this subsection and
subsection (z) shall be determined without regard to any
additional payment for the service under subsection (z)
and this subsection, respectively.''; and
(B) in subsection (y)(3), by adding at the end the
following new sentence: ``The amount of the additional
payment for a service under this subsection and
subsection (z) shall be determined without regard to any
additional payment for the service under subsection (z)
and this subsection, respectively.''.
(4) Encouraging development and testing of certain models.--
Section 1115A(b)(2) of the Social Security Act (42 U.S.C.
1315a(b)(2)) is amended--
(A) in subparagraph (B), by adding at the end the
following new clauses:
``(xxi) Focusing primarily on physicians'
services (as defined in section 1848(j)(3))
furnished by physicians who are not primary care
practitioners.
``(xxii) Focusing on practices of 15 or fewer
professionals.
``(xxiii) Focusing on risk-based models for
small physician practices which may involve two-
sided risk and prospective patient assignment, and
which examine risk-adjusted decreases in mortality
rates, hospital readmissions rates, and other
relevant and appropriate clinical measures.
``(xxiv) Focusing primarily on title XIX,
working in conjunction with the Center for
Medicaid and CHIP Services.''; and
(B) in subparagraph (C)(viii), by striking ``other
public sector or private sector payers'' and inserting
``other public sector payers, private sector payers, or
statewide payment models''.
(5) <<NOTE: 42 USC 1315a note.>> Construction regarding
telehealth services.--Nothing in the provisions of, or
amendments made by, this title shall be construed as precluding
an alternative payment model or a qualifying APM participant (as
those terms are
[[Page 129 STAT. 123]]
defined in section 1833(z) of the Social Security Act, as added
by paragraph (1)) from furnishing a telehealth service for which
payment is not made under section 1834(m) of the Social Security
Act (42 U.S.C. 1395m(m)).
(6) <<NOTE: Deadline. Study.>> Integrating medicare
advantage alternative payment models.--Not later than July 1,
2016, the Secretary of Health and Human Services shall submit to
Congress a study that examines the feasibility of integrating
alternative payment models in the Medicare Advantage payment
system. The study shall include the feasibility of including a
value-based modifier and whether such modifier should be budget
neutral.
(7) Study and report on fraud related to alternative payment
models under the medicare program.--
(A) <<NOTE: Consultation.>> Study.--The Secretary
of Health and Human Services, in consultation with the
Inspector General of the Department of Health and Human
Services, shall conduct a study that--
(i) examines the applicability of the Federal
fraud prevention laws to items and services
furnished under title XVIII of the Social Security
Act for which payment is made under an alternative
payment model (as defined in section 1833(z)(3)(C)
of such Act (42 U.S.C. 1395l(z)(3)(C)));
(ii) identifies aspects of such alternative
payment models that are vulnerable to fraudulent
activity; and
(iii) examines the implications of waivers to
such laws granted in support of such alternative
payment models, including under any potential
expansion of such models.
(B) Report.--Not later than 2 years after the date
of the enactment of this Act, the Secretary shall submit
to Congress a report containing the results of the study
conducted under subparagraph (A). <<NOTE: Recommenda-
tions.>> Such report shall include recommendations for
actions to be taken to reduce the vulnerability of such
alternative payment models to fraudulent activity. Such
report also shall include, as appropriate,
recommendations of the Inspector General for changes in
Federal fraud prevention laws to reduce such
vulnerability.
(f) Collaborating With the Physician, Practitioner, and Other
Stakeholder Communities To Improve Resource Use Measurement.--Section
1848 of the Social Security Act (42 U.S.C. 1395w-4), as amended by
subsection (c), is further amended by adding at the end the following
new subsection:
``(r) Collaborating With the Physician, Practitioner, and Other
Stakeholder Communities To Improve Resource Use Measurement.--
``(1) In general.--In order to involve the physician,
practitioner, and other stakeholder communities in enhancing the
infrastructure for resource use measurement, including for
purposes of the Merit-based Incentive Payment System under
subsection (q) and alternative payment models under section
1833(z), the Secretary shall undertake the steps described in
the succeeding provisions of this subsection.
``(2) Development of care episode and patient condition
groups and classification codes.--
[[Page 129 STAT. 124]]
``(A) In general.--In order to classify similar
patients into care episode groups and patient condition
groups, the Secretary shall undertake the steps
described in the succeeding provisions of this
paragraph.
``(B) Public availability of existing efforts to
design an episode grouper.--Not <<NOTE: Deadline. Web
posting.>> later than 180 days after the date of the
enactment of this subsection, the Secretary shall post
on the Internet website of the Centers for Medicare &
Medicaid Services a list of the episode groups developed
pursuant to subsection (n)(9)(A) and related descriptive
information.
``(C) <<NOTE: Comment period.>> Stakeholder
input.--The Secretary shall accept, through the date
that is 120 days after the day the Secretary posts the
list pursuant to subparagraph (B), suggestions from
physician specialty societies, applicable practitioner
organizations, and other stakeholders for episode groups
in addition to those posted pursuant to such
subparagraph, and specific clinical criteria and patient
characteristics to classify patients into--
``(i) care episode groups; and
``(ii) patient condition groups.
``(D) Development of proposed classification
codes.--
``(i) In general.--Taking into account the
information described in subparagraph (B) and the
information received under subparagraph (C), the
Secretary shall--
``(I) establish care episode groups
and patient condition groups, which
account for a target of an estimated \1/
2\ of expenditures under parts A and B
(with such target increasing over time
as appropriate); and
``(II) assign codes to such groups.
``(ii) Care episode groups.--In establishing
the care episode groups under clause (i), the
Secretary shall take into account--
``(I) the patient's clinical
problems at the time items and services
are furnished during an episode of care,
such as the clinical conditions or
diagnoses, whether or not inpatient
hospitalization occurs, and the
principal procedures or services
furnished; and
``(II) other factors determined
appropriate by the Secretary.
``(iii) Patient condition groups.--In
establishing the patient condition groups under
clause (i), the Secretary shall take into
account--
``(I) the patient's clinical history
at the time of a medical visit, such as
the patient's combination of chronic
conditions, current health status, and
recent significant history (such as
hospitalization and major surgery during
a previous period, such as 3 months);
and
``(II) other factors determined
appropriate by the Secretary, such as
eligibility status under this title
(including eligibility under section
226(a), 226(b), or 226A, and dual
eligibility under this title and title
XIX).
[[Page 129 STAT. 125]]
``(E) Draft care episode and patient condition
groups and classification codes.--
Not <<NOTE: Deadline. Web posting.>> later than 270 days
after the end of the comment period described in
subparagraph (C), the Secretary shall post on the
Internet website of the Centers for Medicare & Medicaid
Services a draft list of the care episode and patient
condition codes established under subparagraph (D) (and
the criteria and characteristics assigned to such code).
``(F) <<NOTE: Comment period.>> Solicitation of
input.--The Secretary shall seek, through the date that
is 120 days after the Secretary posts the list pursuant
to subparagraph (E), comments from physician specialty
societies, applicable practitioner organizations, and
other stakeholders, including representatives of
individuals entitled to benefits under part A or
enrolled under this part, regarding the care episode and
patient condition groups (and codes) posted under
subparagraph (E). In seeking such comments, the
Secretary shall use one or more mechanisms (other than
notice and comment rulemaking) that may include use of
open door forums, town hall meetings, or other
appropriate mechanisms.
``(G) Operational list of care episode and patient
condition groups and codes.--Not <<NOTE: Deadline. Web
posting.>> later than 270 days after the end of the
comment period described in subparagraph (F), taking
into account the comments received under such
subparagraph, the Secretary shall post on the Internet
website of the Centers for Medicare & Medicaid Services
an operational list of care episode and patient
condition codes (and the criteria and characteristics
assigned to such code).
``(H) <<NOTE: Deadline. Effective
date. Regulations.>> Subsequent revisions.--Not later
than November 1 of each year (beginning with 2018), the
Secretary shall, through rulemaking, make revisions to
the operational lists of care episode and patient
condition codes as the Secretary determines may be
appropriate. Such revisions may be based on experience,
new information developed pursuant to subsection
(n)(9)(A), and input from the physician specialty
societies, applicable practitioner organizations, and
other stakeholders, including representatives of
individuals entitled to benefits under part A or
enrolled under this part.
``(3) Attribution of patients to physicians or
practitioners.--
``(A) In general.--In order to facilitate the
attribution of patients and episodes (in whole or in
part) to one or more physicians or applicable
practitioners furnishing items and services, the
Secretary shall undertake the steps described in the
succeeding provisions of this paragraph.
``(B) Development of patient relationship categories
and codes.--The Secretary shall develop patient
relationship categories and codes that define and
distinguish the relationship and responsibility of a
physician or applicable practitioner with a patient at
the time of furnishing an item or service. Such patient
relationship categories shall include different
relationships of the physician or applicable
practitioner to the patient (and the codes
[[Page 129 STAT. 126]]
may reflect combinations of such categories), such as a
physician or applicable practitioner who--
``(i) considers themself to have the primary
responsibility for the general and ongoing care
for the patient over extended periods of time;
``(ii) considers themself to be the lead
physician or practitioner and who furnishes items
and services and coordinates care furnished by
other physicians or practitioners for the patient
during an acute episode;
``(iii) furnishes items and services to the
patient on a continuing basis during an acute
episode of care, but in a supportive rather than a
lead role;
``(iv) furnishes items and services to the
patient on an occasional basis, usually at the
request of another physician or practitioner; or
``(v) furnishes items and services only as
ordered by another physician or practitioner.
``(C) <<NOTE: Deadline. Web posting.>> Draft list
of patient relationship categories and codes.--Not later
than one year after the date of the enactment of this
subsection, the Secretary shall post on the Internet
website of the Centers for Medicare & Medicaid Services
a draft list of the patient relationship categories and
codes developed under subparagraph (B).
``(D) <<NOTE: Comment period.>> Stakeholder
input.--The Secretary shall seek, through the date that
is 120 days after the Secretary posts the list pursuant
to subparagraph (C), comments from physician specialty
societies, applicable practitioner organizations, and
other stakeholders, including representatives of
individuals entitled to benefits under part A or
enrolled under this part, regarding the patient
relationship categories and codes posted under
subparagraph (C). In seeking such comments, the
Secretary shall use one or more mechanisms (other than
notice and comment rulemaking) that may include open
door forums, town hall meetings, web-based forums, or
other appropriate mechanisms.
``(E) Operational list of patient relationship
categories and codes.--Not <<NOTE: Deadline. Web
posting.>> later than 240 days after the end of the
comment period described in subparagraph (D), taking
into account the comments received under such
subparagraph, the Secretary shall post on the Internet
website of the Centers for Medicare & Medicaid Services
an operational list of patient relationship categories
and codes.
``(F) <<NOTE: Deadline. Effective
date. Regulations.>> Subsequent revisions.--Not later
than November 1 of each year (beginning with 2018), the
Secretary shall, through rulemaking, make revisions to
the operational list of patient relationship categories
and codes as the Secretary determines appropriate. Such
revisions may be based on experience, new information
developed pursuant to subsection (n)(9)(A), and input
from the physician specialty societies, applicable
practitioner organizations, and other stakeholders,
including representatives of individuals entitled to
benefits under part A or enrolled under this part.
[[Page 129 STAT. 127]]
``(4) Reporting of information for resource use
measurement.--Claims <<NOTE: Claims. Effective date.>> submitted
for items and services furnished by a physician or applicable
practitioner on or after January 1, 2018, shall, as determined
appropriate by the Secretary, include--
``(A) applicable codes established under paragraphs
(2) and (3); and
``(B) the national provider identifier of the
ordering physician or applicable practitioner (if
different from the billing physician or applicable
practitioner).
``(5) Methodology for resource use analysis.--
``(A) In general.--In order to evaluate the
resources used to treat patients (with respect to care
episode and patient condition groups), the Secretary
shall, as the Secretary determines appropriate--
``(i) use the patient relationship codes
reported on claims pursuant to paragraph (4) to
attribute patients (in whole or in part) to one or
more physicians and applicable practitioners;
``(ii) use the care episode and patient
condition codes reported on claims pursuant to
paragraph (4) as a basis to compare similar
patients and care episodes and patient condition
groups; and
``(iii) conduct an analysis of resource use
(with respect to care episodes and patient
condition groups of such patients).
``(B) Analysis of patients of physicians and
practitioners.--In conducting the analysis described in
subparagraph (A)(iii) with respect to patients
attributed to physicians and applicable practitioners,
the Secretary shall, as feasible--
``(i) <<NOTE: Time period.>> use the claims
data experience of such patients by patient
condition codes during a common period, such as 12
months; and
``(ii) use the claims data experience of such
patients by care episode codes--
``(I) in the case of episodes
without a hospitalization, during
periods of time (such as the number of
days) determined appropriate by the
Secretary; and
``(II) in the case of episodes with
a hospitalization, during periods of
time (such as the number of days)
before, during, and after the
hospitalization.
``(C) Measurement of resource use.--In measuring
such resource use, the Secretary--
``(i) shall use per patient total allowed
charges for all services under part A and this
part (and, if the Secretary determines
appropriate, part D) for the analysis of patient
resource use, by care episode codes and by patient
condition codes; and
``(ii) may, as determined appropriate, use
other measures of allowed charges (such as
subtotals for categories of items and services)
and measures of utilization of items and services
(such as frequency of specific items and services
and the ratio of specific items and services among
attributed patients or episodes).
[[Page 129 STAT. 128]]
``(D) Stakeholder input.--The Secretary shall seek
comments from the physician specialty societies,
applicable practitioner organizations, and other
stakeholders, including representatives of individuals
entitled to benefits under part A or enrolled under this
part, regarding the resource use methodology established
pursuant to this paragraph. In seeking comments the
Secretary shall use one or more mechanisms (other than
notice and comment rulemaking) that may include open
door forums, town hall meetings, web-based forums, or
other appropriate mechanisms.
``(6) <<NOTE: Contracts.>> Implementation.--To the extent
that the Secretary contracts with an entity to carry out any
part of the provisions of this subsection, the Secretary may not
contract with an entity or an entity with a subcontract if the
entity or subcontracting entity currently makes recommendations
to the Secretary on relative values for services under the fee
schedule for physicians' services under this section.
``(7) Limitation.--There shall be no administrative or
judicial review under section 1869, section 1878, or otherwise
of--
``(A) care episode and patient condition groups and
codes established under paragraph (2);
``(B) patient relationship categories and codes
established under paragraph (3); and
``(C) measurement of, and analyses of resource use
with respect to, care episode and patient condition
codes and patient relationship codes pursuant to
paragraph (5).
``(8) Administration.--Chapter 35 of title 44, United States
Code, shall not apply to this section.
``(9) Definitions.--In this subsection:
``(A) Physician.--The term `physician' has the
meaning given such term in section 1861(r)(1).
``(B) Applicable practitioner.--The term `applicable
practitioner' means--
``(i) a physician assistant, nurse
practitioner, and clinical nurse specialist (as
such terms are defined in section 1861(aa)(5)),
and a certified registered nurse anesthetist (as
defined in section 1861(bb)(2)); and
``(ii) <<NOTE: Effective date.>> beginning
January 1, 2019, such other eligible professionals
(as defined in subsection (k)(3)(B)) as specified
by the Secretary.
``(10) Clarification.--The provisions of sections 1890(b)(7)
and 1890A shall not apply to this subsection.''.
SEC. 102. PRIORITIES AND FUNDING FOR MEASURE DEVELOPMENT.
Section 1848 of the Social Security Act (42 U.S.C. 1395w-4), as
amended by subsections (c) and (f) of section 101, is further amended by
inserting at the end the following new subsection:
``(s) Priorities and Funding for Measure Development.--
``(1) Plan identifying measure development priorities and
timelines.--
``(A) <<NOTE: Deadline. Plans.>> Draft measure
development plan.--Not later than January 1, 2016, the
Secretary shall develop, and post on the Internet
website of the Centers for Medicare & Medicaid Services,
a draft plan for the development of quality measures for
application under the applicable
[[Page 129 STAT. 129]]
provisions (as defined in paragraph (5)). Under such
plan the Secretary shall--
``(i) address how measures used by private
payers and integrated delivery systems could be
incorporated under title XVIII;
``(ii) describe how coordination, to the
extent possible, will occur across organizations
developing such measures; and
``(iii) take into account how clinical best
practices and clinical practice guidelines should
be used in the development of quality measures.
``(B) <<NOTE: Definitions.>> Quality domains.--For
purposes of this subsection, the term `quality domains'
means at least the following domains:
``(i) Clinical care.
``(ii) Safety.
``(iii) Care coordination.
``(iv) Patient and caregiver experience.
``(v) Population health and prevention.
``(C) <<NOTE: Plans.>> Consideration.--In
developing the draft plan under this paragraph, the
Secretary shall consider--
``(i) gap analyses conducted by the entity
with a contract under section 1890(a) or other
contractors or entities;
``(ii) whether measures are applicable across
health care settings;
``(iii) clinical practice improvement
activities submitted under subsection
(q)(2)(C)(iv) for identifying possible areas for
future measure development and identifying
existing gaps with respect to such measures; and
``(iv) the quality domains applied under this
subsection.
``(D) <<NOTE: Plans.>> Priorities.--In developing
the draft plan under this paragraph, the Secretary shall
give priority to the following types of measures:
``(i) Outcome measures, including patient
reported outcome and functional status measures.
``(ii) Patient experience measures.
``(iii) Care coordination measures.
``(iv) Measures of appropriate use of
services, including measures of over use.
``(E) <<NOTE: Deadline. Comment period.>>
Stakeholder input.--The Secretary shall accept through
March 1, 2016, comments on the draft plan posted under
paragraph (1)(A) from the public, including health care
providers, payers, consumers, and other stakeholders.
``(F) <<NOTE: Deadline. Web posting.>> Final
measure development plan.--Not later than May 1, 2016,
taking into account the comments received under this
subparagraph, the Secretary shall finalize the plan and
post on the Internet website of the Centers for Medicare
& Medicaid Services an operational plan for the
development of quality measures for use under the
applicable provisions. Such plan shall be updated as
appropriate.
``(2) Contracts and other arrangements for quality measure
development.--
[[Page 129 STAT. 130]]
``(A) In general.--The Secretary shall enter into
contracts or other arrangements with entities for the
purpose of developing, improving, updating, or expanding
in accordance with the plan under paragraph (1) quality
measures for application under the applicable
provisions. Such entities shall include organizations
with quality measure development expertise.
``(B) Prioritization.--
``(i) In general.--In entering into contracts
or other arrangements under subparagraph (A), the
Secretary shall give priority to the development
of the types of measures described in paragraph
(1)(D).
``(ii) Consideration.--In selecting measures
for development under this subsection, the
Secretary shall consider--
``(I) whether such measures would be
electronically specified; and
``(II) clinical practice guidelines
to the extent that such guidelines
exist.
``(3) Annual report by the secretary.--
``(A) <<NOTE: Web posting.>> In general.--Not later
than May 1, 2017, and annually thereafter, the Secretary
shall post on the Internet website of the Centers for
Medicare & Medicaid Services a report on the progress
made in developing quality measures for application
under the applicable provisions.
``(B) Requirements.--Each report submitted pursuant
to subparagraph (A) shall include the following:
``(i) A description of the Secretary's efforts
to implement this paragraph.
``(ii) With respect to the measures developed
during the previous year--
``(I) a description of the total
number of quality measures developed and
the types of such measures, such as an
outcome or patient experience measure;
``(II) the name of each measure
developed;
``(III) the name of the developer
and steward of each measure;
``(IV) with respect to each type of
measure, an estimate of the total amount
expended under this title to develop all
measures of such type; and
``(V) whether the measure would be
electronically specified.
``(iii) With respect to measures in
development at the time of the report--
``(I) the information described in
clause (ii), if available; and
``(II) a timeline for completion of
the development of such measures.
``(iv) A description of any updates to the
plan under paragraph (1) (including newly
identified gaps and the status of previously
identified gaps) and the inventory of measures
applicable under the applicable provisions.
``(v) Other information the Secretary
determines to be appropriate.
[[Page 129 STAT. 131]]
``(4) Stakeholder input.--With respect to paragraph (1), the
Secretary shall seek stakeholder input with respect to--
``(A) the identification of gaps where no quality
measures exist, particularly with respect to the types
of measures described in paragraph (1)(D);
``(B) prioritizing quality measure development to
address such gaps; and
``(C) other areas related to quality measure
development determined appropriate by the Secretary.
``(5) Definition of applicable provisions.--In this
subsection, the term `applicable provisions' means the following
provisions:
``(A) Subsection (q)(2)(B)(i).
``(B) Section 1833(z)(2)(C).
``(6) Funding.--For purposes of carrying out this
subsection, the Secretary shall provide for the transfer, from
the Federal Supplementary Medical Insurance Trust Fund under
section 1841, of $15,000,000 to the Centers for Medicare &
Medicaid Services Program Management Account for each of fiscal
years 2015 through 2019. Amounts transferred under this
paragraph shall remain available through the end of fiscal year
2022.
``(7) Administration.--Chapter 35 of title 44, United States
Code, shall not apply to the collection of information for the
development of quality measures.''.
SEC. 103. ENCOURAGING CARE MANAGEMENT FOR INDIVIDUALS WITH CHRONIC
CARE NEEDS.
(a) In General.--Section 1848(b) of the Social Security Act (42
U.S.C. 1395w-4(b)) is amended by adding at the end the following new
paragraph:
``(8) Encouraging care management for individuals with
chronic care needs.--
``(A) <<NOTE: Effective date.>> In general.--In
order to encourage the management of care for
individuals with chronic care needs the Secretary shall,
subject to subparagraph (B), make payment (as the
Secretary determines to be appropriate) under this
section for chronic care management services furnished
on or after January 1, 2015, by a physician (as defined
in section 1861(r)(1)), physician assistant or nurse
practitioner (as defined in section 1861(aa)(5)(A)),
clinical nurse specialist (as defined in section
1861(aa)(5)(B)), or certified nurse midwife (as defined
in section 1861(gg)(2)).
``(B) Policies relating to payment.--In carrying out
this paragraph, with respect to chronic care management
services, the Secretary shall--
``(i) make payment to only one applicable
provider for such services furnished to an
individual during a period;
``(ii) not make payment under subparagraph (A)
if such payment would be duplicative of payment
that is otherwise made under this title for such
services; and
``(iii) not require that an annual wellness
visit (as defined in section 1861(hhh)) or an
initial preventive physical examination (as
defined in section
[[Page 129 STAT. 132]]
1861(ww)) be furnished as a condition of payment
for such management services.''.
(b) Education and Outreach.--
(1) <<NOTE: 42 USC 1395w-4 note.>> Campaign.--
(A) In general.--The Secretary of Health and Human
Services (in this subsection referred to as the
``Secretary'') shall conduct an education and outreach
campaign to inform professionals who furnish items and
services under part B of title XVIII of the Social
Security Act and individuals enrolled under such part of
the benefits of chronic care management services
described in section 1848(b)(8) of the Social Security
Act, as added by subsection (a), and encourage such
individuals with chronic care needs to receive such
services.
(B) Requirements.--Such campaign shall--
(i) be directed by the Office of Rural Health
Policy of the Department of Health and Human
Services and the Office of Minority Health of the
Centers for Medicare & Medicaid Services; and
(ii) focus on encouraging participation by
underserved rural populations and racial and
ethnic minority populations.
(2) Report.--Not later than December 31, 2017, the Secretary
shall submit to Congress a report on the use of chronic care
management services described in such section 1848(b)(8) by
individuals living in rural areas and by racial and ethnic
minority populations. Such report shall--
(A) identify barriers to receiving chronic care
management services; and
(B) <<NOTE: Recommenda- tions.>> make
recommendations for increasing the appropriate use of
chronic care management services.
SEC. 104. <<NOTE: 42 USC 1395w-6.>> EMPOWERING BENEFICIARY
CHOICES THROUGH CONTINUED ACCESS TO
INFORMATION ON PHYSICIANS' SERVICES.
(a) <<NOTE: Deadlines. Effective date. Public information.>> In
General.--On an annual basis (beginning with 2015), the Secretary shall
make publicly available, in an easily understandable format, information
with respect to physicians and, as appropriate, other eligible
professionals on items and services furnished to Medicare beneficiaries
under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
(b) Type and Manner of Information.--The information made available
under this section shall be similar to the type of information in the
Medicare Provider Utilization and Payment Data: Physician and Other
Supplier Public Use File released by the Secretary with respect to 2012
and shall be made available in a manner similar to the manner in which
the information in such file is made available.
(c) Requirements.--The information made available under this section
shall include, at a minimum, the following:
(1) Information on the number of services furnished by the
physician or other eligible professional under part B of title
XVIII of the Social Security Act (42 U.S.C. 1395j et seq.),
which may include information on the most frequent services
furnished or groupings of services.
(2) Information on submitted charges and payments for
services under such part.
[[Page 129 STAT. 133]]
(3) A unique identifier for the physician or other eligible
professional that is available to the public, such as a national
provider identifier.
(d) Searchability.--The information made available under this
section shall be searchable by at least the following:
(1) The specialty or type of the physician or other eligible
professional.
(2) Characteristics of the services furnished, such as
volume or groupings of services.
(3) The location of the physician or other eligible
professional.
(e) <<NOTE: Effective date.>> Integration on Physician Compare.--
Beginning with 2016, the Secretary shall integrate the information made
available under this section on Physician Compare.
(f) Definitions.--In this section:
(1) Eligible professional; physician; secretary.--The terms
``eligible professional'', ``physician'', and ``Secretary'' have
the meaning given such terms in section 10331(i) of Public Law
111-148.
(2) Physician compare.--The term ``Physician Compare'' means
the Physician Compare Internet website of the Centers for
Medicare & Medicaid Services (or a successor website).
SEC. 105. <<NOTE: 42 USC 1395kk-2.>> EXPANDING AVAILABILITY OF
MEDICARE DATA.
(a) Expanding Uses of Medicare Data by Qualified Entities.--
(1) Additional analyses.--
(A) <<NOTE: Effective date.>> In general.--Subject
to subparagraph (B), to the extent consistent with
applicable information, privacy, security, and
disclosure laws (including paragraph (3)),
notwithstanding paragraph (4)(B) of section 1874(e) of
the Social Security Act (42 U.S.C. 1395kk(e)) and the
second sentence of paragraph (4)(D) of such section,
beginning July 1, 2016, a qualified entity may use the
combined data described in paragraph (4)(B)(iii) of such
section received by such entity under such section, and
information derived from the evaluation described in
such paragraph (4)(D), to conduct additional non-public
analyses (as determined appropriate by the Secretary)
and provide or sell such analyses to authorized users
for non-public use (including for the purposes of
assisting providers of services and suppliers to develop
and participate in quality and patient care improvement
activities, including developing new models of care).
(B) Limitations with respect to analyses.--
(i) Employers.--Any analyses provided or sold
under subparagraph (A) to an employer described in
paragraph (9)(A)(iii) may only be used by such
employer for purposes of providing health
insurance to employees and retirees of the
employer.
(ii) Health insurance issuers.--A qualified
entity may not provide or sell an analysis to a
health insurance issuer described in paragraph
(9)(A)(iv) unless the issuer is providing the
qualified entity with data under section
1874(e)(4)(B)(iii) of the Social Security Act (42
U.S.C. 1395kk(e)(4)(B)(iii)).
(2) Access to certain data.--
[[Page 129 STAT. 134]]
(A) <<NOTE: Effective date.>> Access.--To the
extent consistent with applicable information, privacy,
security, and disclosure laws (including paragraph (3)),
notwithstanding paragraph (4)(B) of section 1874(e) of
the Social Security Act (42 U.S.C. 1395kk(e)) and the
second sentence of paragraph (4)(D) of such section,
beginning July 1, 2016, a qualified entity may--
(i) provide or sell the combined data
described in paragraph (4)(B)(iii) of such section
to authorized users described in clauses (i),
(ii), and (v) of paragraph (9)(A) for non-public
use, including for the purposes described in
subparagraph (B); or
(ii) subject to subparagraph (C), provide
Medicare claims data to authorized users described
in clauses (i), (ii), and (v), of paragraph (9)(A)
for non-public use, including for the purposes
described in subparagraph (B).
(B) Purposes described.--The purposes described in
this subparagraph are assisting providers of services
and suppliers in developing and participating in quality
and patient care improvement activities, including
developing new models of care.
(C) Medicare claims data must be provided at no
cost.--A qualified entity may not charge a fee for
providing the data under subparagraph (A)(ii).
(3) Protection of information.--
(A) In general.--Except as provided in subparagraph
(B), an analysis or data that is provided or sold under
paragraph (1) or (2) shall not contain information that
individually identifies a patient.
(B) Information on patients of the provider of
services or supplier.--To the extent consistent with
applicable information, privacy, security, and
disclosure laws, an analysis or data that is provided or
sold to a provider of services or supplier under
paragraph (1) or (2) may contain information that
individually identifies a patient of such provider or
supplier, including with respect to items and services
furnished to the patient by other providers of services
or suppliers.
(C) Prohibition on using analyses or data for
marketing purposes.--An authorized user shall not use an
analysis or data provided or sold under paragraph (1) or
(2) for marketing purposes.
(4) Data use agreement.--A qualified entity and an
authorized user described in clauses (i), (ii), and (v) of
paragraph (9)(A) shall enter into an agreement regarding the use
of any data that the qualified entity is providing or selling to
the authorized user under paragraph (2). Such agreement shall
describe the requirements for privacy and security of the data
and, as determined appropriate by the Secretary, any
prohibitions on using such data to link to other individually
identifiable sources of information. If the authorized user is
not a covered entity under the rules promulgated pursuant to the
Health Insurance Portability and Accountability Act of 1996, the
agreement shall identify the relevant regulations, as determined
by the Secretary, that the user shall comply
[[Page 129 STAT. 135]]
with as if it were acting in the capacity of such a covered
entity.
(5) No redisclosure of analyses or data.--
(A) In general.--Except as provided in subparagraph
(B), an authorized user that is provided or sold an
analysis or data under paragraph (1) or (2) shall not
redisclose or make public such analysis or data or any
analysis using such data.
(B) Permitted redisclosure.--A provider of services
or supplier that is provided or sold an analysis or data
under paragraph (1) or (2) may, as determined by the
Secretary, redisclose such analysis or data for the
purposes of performance improvement and care
coordination activities but shall not make public such
analysis or data or any analysis using such data.
(6) Opportunity for providers of services and suppliers to
review.--Prior to a qualified entity providing or selling an
analysis to an authorized user under paragraph (1), to the
extent that such analysis would individually identify a provider
of services or supplier who is not being provided or sold such
analysis, such qualified entity shall provide such provider or
supplier with the opportunity to appeal and correct errors in
the manner described in section 1874(e)(4)(C)(ii) of the Social
Security Act (42 U.S.C. 1395kk(e)(4)(C)(ii)).
(7) Assessment for a breach.--
(A) In general.--In the case of a breach of a data
use agreement under this section or section 1874(e) of
the Social Security Act (42 U.S.C. 1395kk(e)), the
Secretary shall impose an assessment on the qualified
entity both in the case of--
(i) an agreement between the Secretary and a
qualified entity; and
(ii) an agreement between a qualified entity
and an authorized user.
(B) Assessment.--The assessment under subparagraph
(A) shall be an amount up to $100 for each individual
entitled to, or enrolled for, benefits under part A of
title XVIII of the Social Security Act or enrolled for
benefits under part B of such title--
(i) in the case of an agreement described in
subparagraph (A)(i), for whom the Secretary
provided data on to the qualified entity under
paragraph (2); and
(ii) in the case of an agreement described in
subparagraph (A)(ii), for whom the qualified
entity provided data on to the authorized user
under paragraph (2).
(C) Deposit of amounts collected.--Any amounts
collected pursuant to this paragraph shall be deposited
in Federal Supplementary Medical Insurance Trust Fund
under section 1841 of the Social Security Act (42 U.S.C.
1395t).
(8) Annual reports.--Any qualified entity that provides or
sells an analysis or data under paragraph (1) or (2) shall
annually submit to the Secretary a report that includes--
(A) a summary of the analyses provided or sold,
including the number of such analyses, the number of
[[Page 129 STAT. 136]]
purchasers of such analyses, and the total amount of
fees received for such analyses;
(B) a description of the topics and purposes of such
analyses;
(C) information on the entities who received the
data under paragraph (2), the uses of the data, and the
total amount of fees received for providing, selling, or
sharing the data; and
(D) other information determined appropriate by the
Secretary.
(9) Definitions.--In this subsection and subsection (b):
(A) Authorized user.--The term ``authorized user''
means the following:
(i) A provider of services.
(ii) A supplier.
(iii) An employer (as defined in section 3(5)
of the Employee Retirement Insurance Security Act
of 1974).
(iv) A health insurance issuer (as defined in
section 2791 of the Public Health Service Act).
(v) A medical society or hospital association.
(vi) Any entity not described in clauses (i)
through (v) that is approved by the Secretary
(other than an employer or health insurance issuer
not described in clauses (iii) and (iv),
respectively, as determined by the Secretary).
(B) Provider of services.--The term ``provider of
services'' has the meaning given such term in section
1861(u) of the Social Security Act (42 U.S.C. 1395x(u)).
(C) Qualified entity.--The term ``qualified entity''
has the meaning given such term in section 1874(e)(2) of
the Social Security Act (42 U.S.C. 1395kk(e)).
(D) Secretary.--The term ``Secretary'' means the
Secretary of Health and Human Services.
(E) Supplier.--The term ``supplier'' has the meaning
given such term in section 1861(d) of the Social
Security Act (42 U.S.C. 1395x(d)).
(b) Access to Medicare Data by Qualified Clinical Data Registries To
Facilitate Quality Improvement.--
(1) Access.--
(A) <<NOTE: Effective date.>> In general.--To the
extent consistent with applicable information, privacy,
security, and disclosure laws, beginning July 1, 2016,
the Secretary shall, at the request of a qualified
clinical data registry under section 1848(m)(3)(E) of
the Social Security Act (42 U.S.C. 1395w-4(m)(3)(E)),
provide the data described in subparagraph (B) (in a
form and manner determined to be appropriate) to such
qualified clinical data registry for purposes of linking
such data with clinical outcomes data and performing
risk-adjusted, scientifically valid analyses and
research to support quality improvement or patient
safety, provided that any public reporting of such
analyses or research that identifies a provider of
services or supplier shall only be conducted with the
opportunity of such provider or supplier to appeal and
correct errors in the manner described in subsection
(a)(6).
[[Page 129 STAT. 137]]
(B) Data described.--The data described in this
subparagraph is--
(i) claims data under the Medicare program
under title XVIII of the Social Security Act; and
(ii) if the Secretary determines appropriate,
claims data under the Medicaid program under title
XIX of such Act and the State Children's Health
Insurance Program under title XXI of such Act.
(2) Fee.--Data described in paragraph (1)(B) shall be
provided to a qualified clinical data registry under paragraph
(1) at a fee equal to the cost of providing such data. Any fee
collected pursuant to the preceding sentence shall be deposited
in the Centers for Medicare & Medicaid Services Program
Management Account.
(c) Expansion of Data Available to Qualified Entities.--Section
1874(e) of the Social Security Act (42 U.S.C. 1395kk(e)) is amended--
(1) in the subsection heading, by striking ``Medicare''; and
(2) in paragraph (3)--
(A) <<NOTE: Effective date.>> by inserting after
the first sentence the following new sentence:
``Beginning July 1, 2016, if the Secretary determines
appropriate, the data described in this paragraph may
also include standardized extracts (as determined by the
Secretary) of claims data under titles XIX and XXI for
assistance provided under such titles for one or more
specified geographic areas and time periods requested by
a qualified entity.''; and
(B) in the last sentence, by inserting ``or under
titles XIX or XXI'' before the period at the end.
(d) Revision of Placement of Fees.--Section 1874(e)(4)(A) of the
Social Security Act (42 U.S.C. 1395kk(e)(4)(A)) is amended, in the
second sentence--
(1) by inserting ``, for periods prior to July 1, 2016,''
after ``deposited''; and
(2) by inserting the following before the period at the end:
``, and, beginning July 1, 2016, into the Centers for Medicare &
Medicaid Services Program Management Account''.
SEC. 106. REDUCING ADMINISTRATIVE BURDEN AND OTHER PROVISIONS.
(a) Medicare Physician and Practitioner Opt-Out to Private
Contract.--
(1) Indefinite, continuing automatic extension of opt out
election.--
(A) <<NOTE: Time periods.>> In general.--Section
1802(b)(3) of the Social Security Act (42 U.S.C.
1395a(b)(3)) is amended--
(i) in subparagraph (B)(ii), by striking
``during the 2-year period beginning on the date
the affidavit is signed'' and inserting ``during
the applicable 2-year period (as defined in
subparagraph (D))'';
(ii) in subparagraph (C), by striking ``during
the 2-year period described in subparagraph
(B)(ii)'' and inserting ``during the applicable 2-
year period''; and
(iii) by adding at the end the following new
subparagraph:
``(D) Applicable 2-year periods for effectiveness of
affidavits.--In <<NOTE: Definition.>> this subsection,
the term `applicable
[[Page 129 STAT. 138]]
2-year period' means, with respect to an affidavit of a
physician or practitioner under subparagraph (B), the 2-
year period beginning on the date the affidavit is
signed and includes each subsequent 2-year period unless
the physician or practitioner involved provides notice
to the Secretary (in a form and manner specified by the
Secretary), not later than 30 days before the end of the
previous 2-year period, that the physician or
practitioner does not want to extend the application of
the affidavit for such subsequent 2-year period.''.
(B) <<NOTE: Applicability. 42 USC 1395a note.>>
Effective date.--The amendments made by subparagraph (A)
shall apply to affidavits entered into on or after the
date that is 60 days after the date of the enactment of
this Act.
(2) Public availability of information on opt-out physicians
and practitioners.--Section 1802(b) of the Social Security Act
(42 U.S.C. 1395a(b)) is amended--
(A) in paragraph (5), by adding at the end the
following new subparagraph:
``(D) <<NOTE: Definition.>> Opt-out physician or
practitioner.--The term `opt-out physician or practitioner'
means a physician or practitioner who has in effect an affidavit
under paragraph (3)(B).'';
(B) by redesignating paragraph (5) as paragraph (6);
and
(C) by inserting after paragraph (4) the following
new paragraph:
``(5) Posting of information on opt-out physicians and
practitioners.--
``(A) <<NOTE: Effective date. Public information.>>
In general.--Beginning not later than February 1, 2016,
the Secretary shall make publicly available through an
appropriate publicly accessible website of the
Department of Health and Human Services information on
the number and characteristics of opt-out physicians and
practitioners and shall update such information on such
website not less often than annually.
``(B) Information to be included.--The information
to be made available under subparagraph (A) shall
include at least the following with respect to opt-out
physicians and practitioners:
``(i) Their number.
``(ii) Their physician or professional
specialty or other designation.
``(iii) Their geographic distribution.
``(iv) <<NOTE: Time period.>> The timing of
their becoming opt-out physicians and
practitioners, relative, to the extent feasible,
to when they first enrolled in the program under
this title and with respect to applicable 2-year
periods.
``(v) The proportion of such physicians and
practitioners who billed for emergency or urgent
care services.''.
(b) Promoting Interoperability of Electronic Health Record
Systems.--
(1) Recommendations for achieving widespread ehr
interoperability.--
(A) <<NOTE: Deadline.>> Objective.--As a
consequence of a significant Federal investment in the
implementation of health information technology through
the Medicare and Medicaid EHR
[[Page 129 STAT. 139]]
incentive programs, Congress declares it a national
objective to achieve widespread exchange of health
information through interoperable certified EHR
technology nationwide by December 31, 2018.
(B) Definitions.--In this paragraph:
(i) Widespread interoperability.--The term
``widespread interoperability'' means
interoperability between certified EHR technology
systems employed by meaningful EHR users under the
Medicare and Medicaid EHR incentive programs and
other clinicians and health care providers on a
nationwide basis.
(ii) Interoperability.--The term
``interoperability'' means the ability of two or
more health information systems or components to
exchange clinical and other information and to use
the information that has been exchanged using
common standards as to provide access to
longitudinal information for health care providers
in order to facilitate coordinated care and
improved patient outcomes.
(C) <<NOTE: Deadline. Consultation.>> Establishment
of metrics.--Not later than July 1, 2016, and in
consultation with stakeholders, the Secretary shall
establish metrics to be used to determine if and to the
extent that the objective described in subparagraph (A)
has been achieved.
(D) <<NOTE: Determination. Deadlines. Reports.>>
Recommendations if objective not achieved.--If the
Secretary of Health and Human Services determines that
the objective described in subparagraph (A) has not been
achieved by December 31, 2018, then the Secretary shall
submit to Congress a report, by not later than December
31, 2019, that identifies barriers to such objective and
recommends actions that the Federal Government can take
to achieve such objective. Such recommended actions may
include recommendations--
(i) to adjust payments for not being
meaningful EHR users under the Medicare EHR
incentive programs; and
(ii) for criteria for decertifying certified
EHR technology products.
(2) Preventing blocking the sharing of information.--
(A) For meaningful use ehr professionals.--Section
1848(o)(2)(A)(ii) of the Social Security Act (42 U.S.C.
1395w-4(o)(2)(A)(ii)) is amended by inserting before the
period at the end the following: ``, and the
professional demonstrates (through a process specified
by the Secretary, such as the use of an attestation)
that the professional has not knowingly and willfully
taken action (such as to disable functionality) to limit
or restrict the compatibility or interoperability of the
certified EHR technology''.
(B) For meaningful use ehr hospitals.--Section
1886(n)(3)(A)(ii) of the Social Security Act (42 U.S.C.
1395ww(n)(3)(A)(ii)) is amended by inserting before the
period at the end the following: ``, and the hospital
demonstrates (through a process specified by the
Secretary, such as the use of an attestation) that the
hospital has not knowingly and willfully taken action
(such as to disable functionality) to limit or restrict
the compatibility or interoperability of the certified
EHR technology''.
[[Page 129 STAT. 140]]
(C) <<NOTE: Applicability. 42 USC 1395w-4 note.>>
Effective date.--The amendments made by this subsection
shall apply to meaningful EHR users as of the date that
is one year after the date of the enactment of this Act.
(3) Study and report on the feasibility of establishing a
mechanism to compare certified ehr technology products.--
(A) Study.--The Secretary shall conduct a study to
examine the feasibility of establishing one or more
mechanisms to assist providers in comparing and
selecting certified EHR technology products. Such
mechanisms may include--
(i) a website with aggregated results of
surveys of meaningful EHR users on the
functionality of certified EHR technology products
to enable such users to directly compare the
functionality and other features of such products;
and
(ii) information from vendors of certified
products that is made publicly available in a
standardized format.
The aggregated results of the surveys described in
clause (i) may be made available through contracts with
physicians, hospitals, or other organizations that
maintain such comparative information described in such
clause.
(B) Report.--Not later than 1 year after the date of
the enactment of this Act, the Secretary shall submit to
Congress a report on mechanisms that would assist
providers in comparing and selecting certified EHR
technology products. The report shall include
information on the benefits of, and resources needed to
develop and maintain, such mechanisms.
(4) Definitions.--In this subsection:
(A) The term ``certified EHR technology'' has the
meaning given such term in section 1848(o)(4) of the
Social Security Act (42 U.S.C. 1395w-4(o)(4)).
(B) The term ``meaningful EHR user'' has the meaning
given such term under the Medicare EHR incentive
programs.
(C) The term ``Medicare and Medicaid EHR incentive
programs'' means--
(i) in the case of the Medicare program under
title XVIII of the Social Security Act, the
incentive programs under section 1814(l)(3),
section 1848(o), subsections (l) and (m) of
section 1853, and section 1886(n) of the Social
Security Act (42 U.S.C. 1395f(l)(3), 1395w-4(o),
1395w-23, 1395ww(n)); and
(ii) in the case of the Medicaid program under
title XIX of such Act, the incentive program under
subsections (a)(3)(F) and (t) of section 1903 of
such Act (42 U.S.C. 1396b).
(D) The term ``Secretary'' means the Secretary of
Health and Human Services.
(c) GAO Studies and Reports on the Use of Telehealth Under Federal
Programs and on Remote Patient Monitoring Services.--
[[Page 129 STAT. 141]]
(1) Study on telehealth services.--The Comptroller General
of the United States shall conduct a study on the following:
(A) How the definition of telehealth across various
Federal programs and Federal efforts can inform the use
of telehealth in the Medicare program under title XVIII
of the Social Security Act (42 U.S.C. 1395 et seq.).
(B) Issues that can facilitate or inhibit the use of
telehealth under the Medicare program under such title,
including oversight and professional licensure, changing
technology, privacy and security, infrastructure
requirements, and varying needs across urban and rural
areas.
(C) Potential implications of greater use of
telehealth with respect to payment and delivery system
transformations under the Medicare program under such
title XVIII and the Medicaid program under title XIX of
such Act (42 U.S.C. 1396 et seq.).
(D) How the Centers for Medicare & Medicaid Services
monitors payments made under the Medicare program under
such title XVIII to providers for telehealth services.
(2) Study on remote patient monitoring services.--
(A) In general.--The Comptroller General of the
United States shall conduct a study--
(i) of the dissemination of remote patient
monitoring technology in the private health
insurance market;
(ii) of the financial incentives in the
private health insurance market relating to
adoption of such technology;
(iii) of the barriers to adoption of such
services under the Medicare program under title
XVIII of the Social Security Act;
(iv) that evaluates the patients, conditions,
and clinical circumstances that could most benefit
from remote patient monitoring services; and
(v) that evaluates the challenges related to
establishing appropriate valuation for remote
patient monitoring services under the Medicare
physician fee schedule under section 1848 of the
Social Security Act (42 U.S.C. 1395w-4) in order
to accurately reflect the resources involved in
furnishing such services.
(B) Definitions.--For purposes of this paragraph:
(i) Remote patient monitoring services.--The
term ``remote patient monitoring services'' means
services furnished through remote patient
monitoring technology.
(ii) Remote patient monitoring technology.--
The term ``remote patient monitoring technology''
means a coordinated system that uses one or more
home-based or mobile monitoring devices that
automatically transmit vital sign data or
information on activities of daily living and may
include responses to assessment questions
collected on the devices wirelessly or through a
telecommunications connection to a server that
complies with the Federal regulations (concerning
the privacy of individually identifiable health
information) promulgated under section 264(c)
[[Page 129 STAT. 142]]
of the Health Insurance Portability and
Accountability Act of 1996, as part of an
established plan of care for that patient that
includes the review and interpretation of that
data by a health care professional.
(3) Reports.--Not later than 24 months after the date of the
enactment of this Act, the Comptroller General shall submit to
Congress--
(A) a report containing the results of the study
conducted under paragraph (1); and
(B) a report containing the results of the study
conducted under paragraph (2).
A report <<NOTE: Recommenda- tions.>> required under this
paragraph shall be submitted together with recommendations for
such legislation and administrative action as the Comptroller
General determines appropriate. The Comptroller General may
submit one report containing the results described in
subparagraphs (A) and (B) and the recommendations described in
the previous sentence.
(d) <<NOTE: 42 USC 18122 note.>> Rule of Construction Regarding
Health Care Providers.--
(1) In general.--Subject to paragraph (3), the development,
recognition, or implementation of any guideline or other
standard under any Federal health care provision shall not be
construed to establish the standard of care or duty of care owed
by a health care provider to a patient in any medical
malpractice or medical product liability action or claim.
(2) Definitions.--For purposes of this subsection:
(A) Federal health care provision.--The term
``Federal health care provision'' means any provision of
the Patient Protection and Affordable Care Act (Public
Law 111-148), title I or subtitle B of title II of the
Health Care and Education Reconciliation Act of 2010
(Public Law 111-152), or title XVIII or XIX of the
Social Security Act (42 U.S.C. 1395 et seq., 42 U.S.C.
1396 et seq.).
(B) Health care provider.--The term ``health care
provider'' means any individual, group practice,
corporation of health care professionals, or hospital--
(i) licensed, registered, or certified under
Federal or State laws or regulations to provide
health care services; or
(ii) required to be so licensed, registered,
or certified but that is exempted by other statute
or regulation.
(C) Medical malpractice or medical product liability
action or claim.--The term ``medical malpractice or
medical product liability action or claim'' means a
medical malpractice action or claim (as defined in
section 431(7) of the Health Care Quality Improvement
Act of 1986 (42 U.S.C. 11151(7))) and includes a
liability action or claim relating to a health care
provider's prescription or provision of a drug, device,
or biological product (as such terms are defined in
section 201 of the Federal Food, Drug, and Cosmetic Act
(21 U.S.C. 321) or section 351 of the Public Health
Service Act (42 U.S.C. 262)).
(D) State.--The term ``State'' includes the District
of Columbia, Puerto Rico, and any other commonwealth,
possession, or territory of the United States.
[[Page 129 STAT. 143]]
(3) <<NOTE: 42 USC 18122 note.>> No preemption.--Nothing in
paragraph (1) or any provision of the Patient Protection and
Affordable Care Act (Public Law 111-148), title I or subtitle B
of title II of the Health Care and Education Reconciliation Act
of 2010 (Public Law 111-152), or title XVIII or XIX of the
Social Security Act (42 U.S.C. 1395 et seq., 42 U.S.C. 1396 et
seq.) shall be construed to preempt any State or common law
governing medical professional or medical product liability
actions or claims.
TITLE II--MEDICARE AND OTHER HEALTH EXTENDERS
Subtitle A--Medicare Extenders
SEC. 201. EXTENSION OF WORK GPCI FLOOR.
Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)(E)) is amended by striking ``April 1, 2015'' and inserting
``January 1, 2018''.
SEC. 202. EXTENSION OF THERAPY CAP EXCEPTIONS PROCESS.
(a) In General.--Section 1833(g) of the Social Security Act (42
U.S.C. 1395l(g)) is amended--
(1) in paragraph (5)(A), in the first sentence, by striking
``March 31, 2015'' and inserting ``December 31, 2017''; and
(2) in paragraph (6)(A)--
(A) by striking ``March 31, 2015'' and inserting
``December 31, 2017''; and
(B) by striking ``2012, 2013, 2014, or the first
three months of 2015'' and inserting ``2012 through
2017''.
(b) Targeted Reviews Under Manual Medical Review Process for
Outpatient Therapy Services.--
(1) In general.--Section 1833(g)(5) of the Social Security
Act (42 U.S.C. 1395l(g)(5)) is amended--
(A) in subparagraph (C)(i), by inserting ``, subject
to subparagraph (E),'' after ``manual medical review
process that''; and
(B) by adding at the end the following new
subparagraph:
``(E)(i) In place of the manual medical review process under
subparagraph (C)(i), the Secretary shall implement a process for medical
review under this subparagraph under which the Secretary shall identify
and conduct medical review for services described in subparagraph (C)(i)
furnished by a provider of services or supplier (in this subparagraph
referred to as a `therapy provider') using such factors as the Secretary
determines to be appropriate.
``(ii) Such factors may include the following:
``(I) The therapy provider has had a high claims denial
percentage for therapy services under this part or is less
compliant with applicable requirements under this title.
``(II) The therapy provider has a pattern of billing for
therapy services under this part that is aberrant compared to
peers or otherwise has questionable billing practices for such
services, such as billing medically unlikely units of services
in a day.
[[Page 129 STAT. 144]]
``(III) The therapy provider is newly enrolled under this
title or has not previously furnished therapy services under
this part.
``(IV) The services are furnished to treat a type of medical
condition.
``(V) The therapy provider is part of group that includes
another therapy provider identified using the factors determined
under this subparagraph.
``(iii) For purposes of carrying out this subparagraph, the
Secretary shall provide for the transfer, from the Federal Supplementary
Medical Insurance Trust Fund under section 1841, of $5,000,000 to the
Centers for Medicare & Medicaid Services Program Management Account for
fiscal years 2015 and 2016, to remain available until expended. Such
funds may not be used by a contractor under section 1893(h) for medical
reviews under this subparagraph.
``(iv) The targeted review process under this subparagraph shall not
apply to services for which expenses are incurred beyond the period for
which the exceptions process under subparagraph (A) is implemented.''.
(2) <<NOTE: Applicability. Deadline. 42 USC 1395l note.>>
Effective date.--The amendments made by this subsection shall
apply with respect to requests described in section
1833(g)(5)(C)(i) of the Social Security Act (42 U.S.C.
1395l(g)(5)(C)(i)) with respect to which the Secretary of Health
and Human Services has not conducted medical review under such
section by a date (not later than 90 days after the date of the
enactment of this Act) specified by the Secretary.
SEC. 203. EXTENSION OF AMBULANCE ADD-ONS.
(a) Ground Ambulance.--Section 1834(l)(13)(A) of the Social Security
Act (42 U.S.C. 1395m(l)(13)(A)) is amended by striking ``April 1, 2015''
and inserting ``January 1, 2018'' each place it appears.
(b) Super Rural Ground Ambulance.--Section 1834(l)(12)(A) of the
Social Security Act (42 U.S.C. 1395m(l)(12)(A)) is amended, in the first
sentence, by striking ``April 1, 2015'' and inserting ``January 1,
2018''.
SEC. 204. EXTENSION OF INCREASED INPATIENT HOSPITAL PAYMENT
ADJUSTMENT FOR CERTAIN LOW-VOLUME
HOSPITALS.
Section 1886(d)(12) of the Social Security Act (42 U.S.C.
1395ww(d)(12)) is amended--
(1) in subparagraph (B), in the matter preceding clause (i),
by striking ``in fiscal year 2015 (beginning on April 1, 2015),
fiscal year 2016, and subsequent fiscal years'' and inserting
``in fiscal year 2018 and subsequent fiscal years'';
(2) in subparagraph (C)(i), by striking ``fiscal years 2011
through 2014 and fiscal year 2015 (before April 1, 2015),'' and
inserting ``fiscal years 2011 through 2017,'' each place it
appears; and
(3) in subparagraph (D), by striking ``fiscal years 2011
through 2014 and fiscal year 2015 (before April 1, 2015),'' and
inserting ``fiscal years 2011 through 2017,''.
SEC. 205. EXTENSION OF THE MEDICARE-DEPENDENT HOSPITAL (MDH)
PROGRAM.
(a) In General.--Section 1886(d)(5)(G) of the Social Security Act
(42 U.S.C. 1395ww(d)(5)(G)) is amended--
[[Page 129 STAT. 145]]
(1) in clause (i), by striking ``April 1, 2015'' and
inserting ``October 1, 2017''; and
(2) in clause (ii)(II), by striking ``April 1, 2015'' and
inserting ``October 1, 2017''.
(b) Conforming Amendments.--
(1) Extension of target amount.--Section 1886(b)(3)(D) of
the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is amended--
(A) in the matter preceding clause (i), by striking
``April 1, 2015'' and inserting ``October 1, 2017''; and
(B) in clause (iv), by striking ``through fiscal
year 2014 and the portion of fiscal year 2015 before
April 1, 2015'' and inserting ``through fiscal year
2017''.
(2) Permitting hospitals to decline reclassification.--
Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of
1993 (42 U.S.C. 1395ww note) is amended by striking ``through
the first 2 quarters of fiscal year 2015'' and inserting
``through fiscal year 2017''.
SEC. 206. EXTENSION FOR SPECIALIZED MEDICARE ADVANTAGE PLANS FOR
SPECIAL NEEDS INDIVIDUALS.
Section 1859(f)(1) of the Social Security Act (42 U.S.C. 1395w-
28(f)(1)) is amended by striking ``2017'' and inserting ``2019''.
SEC. 207. EXTENSION OF FUNDING FOR QUALITY MEASURE ENDORSEMENT,
INPUT, AND SELECTION.
Section 1890(d)(2) of the Social Security Act (42 U.S.C.
1395aaa(d)(2)) is amended by striking ``and $15,000,000 for the first 6
months of fiscal year 2015'' and inserting ``and $30,000,000 for each of
fiscal years 2015 through 2017''.
SEC. 208. EXTENSION OF FUNDING OUTREACH AND ASSISTANCE FOR LOW-
INCOME PROGRAMS.
(a) Additional Funding for State Health Insurance Programs.--
Subsection (a)(1)(B) of section 119 of the Medicare Improvements for
Patients and Providers Act of 2008 (42 U.S.C. 1395b-3 note), as amended
by section 3306 of the Patient Protection and Affordable Care Act
(Public Law 111-148), section 610 of the American Taxpayer Relief Act of
2012 (Public Law 112-240), section 1110 of the Pathway for SGR Reform
Act of 2013 (Public Law 113-67), and section 110 of the Protecting
Access to Medicare Act of 2014 (Public Law 113-93), is amended--
(1) in clause (iv), by striking ``and'' at the end;
(2) by striking clause (v); and
(3) by adding at the end the following new clauses:
``(v) for fiscal year 2015, of $7,500,000;
``(vi) for fiscal year 2016, of $13,000,000;
and
``(vii) for fiscal year 2017, of
$13,000,000.''.
(b) Additional Funding for Area Agencies on Aging.--Subsection
(b)(1)(B) of such section 119, as so amended, is amended--
(1) in clause (iv), by striking ``and'' at the end;
(2) by striking clause (v); and
(3) by inserting after clause (iv) the following new
clauses:
``(v) for fiscal year 2015, of $7,500,000;
``(vi) for fiscal year 2016, of $7,500,000;
and
``(vii) for fiscal year 2017, of
$7,500,000.''.
[[Page 129 STAT. 146]]
(c) Additional Funding for Aging and Disability Resource Centers.--
Subsection (c)(1)(B) of such section 119, as so amended, is amended--
(1) in clause (iv), by striking ``and'' at the end;
(2) by striking clause (v); and
(3) by inserting after clause (iv) the following new
clauses:
``(v) for fiscal year 2015, of $5,000,000;
``(vi) for fiscal year 2016, of $5,000,000;
and
``(vii) for fiscal year 2017, of
$5,000,000.''.
(d) Additional Funding for Contract With the National Center for
Benefits and Outreach Enrollment.--Subsection (d)(2) of such section
119, as so amended, is amended--
(1) in clause (iv), by striking ``and'' at the end;
(2) by striking clause (v); and
(3) by inserting after clause (iv) the following new
clauses:
``(v) for fiscal year 2015, of $5,000,000;
``(vi) for fiscal year 2016, of $12,000,000;
and
``(vii) for fiscal year 2017, of
$12,000,000.''.
SEC. 209. EXTENSION AND TRANSITION OF REASONABLE COST
REIMBURSEMENT CONTRACTS.
(a) One-Year Transition and Notice Regarding Transition.--Section
1876(h)(5)(C) of the Social Security Act (42 U.S.C. 1395mm(h)(5)(C)) is
amended--
(1) in clause (ii), in the matter preceding subclause (I),
by striking ``For any'' and inserting ``Subject to clause (iv),
for any'';
(2) in clause (iii)(I), by inserting ``cost plan service''
after ``With respect to any portion of the'';
(3) in clause (iii)(II), by inserting ``cost plan service''
after ``With respect to any other portion of such''; and
(4) by adding at the end the following new clauses:
``(iv) <<NOTE: Deadline. Applicability.>> In the case of an
eligible organization that is offering a reasonable cost reimbursement
contract that may no longer be extended or renewed because of the
application of clause (ii), or where such contract has been extended or
renewed but the eligible organization has informed the Secretary in
writing not later than a date determined appropriate by the Secretary
that such organization voluntarily plans not to seek renewal of the
reasonable cost reimbursement contract, the following shall apply:
``(I) Notwithstanding such clause, such contract may be
extended or renewed for the two years subsequent to 2016. The
final year in which such contract is extended or renewed is
referred to in this subsection as the `last reasonable cost
reimbursement contract year for the contract'.
``(II) The organization may not enroll a new enrollee under
such contract during the last reasonable cost reimbursement
contract year for the contract (but may continue to enroll new
enrollees through the end of the year immediately preceding such
year) unless such enrollee is any of the following:
``(aa) An individual who chooses enrollment in the
reasonable cost contract during the annual election
period with respect to such last year.
``(bb) An individual whose spouse, at the time of
the individual's enrollment is an enrollee under the
reasonable cost reimbursement contract.
[[Page 129 STAT. 147]]
``(cc) An individual who is covered under an
employer group health plan that offers coverage through
the reasonable cost reimbursement contract.
``(dd) An individual who becomes entitled to
benefits under part A, or enrolled under part B, and was
enrolled in a plan offered by the eligible organization
immediately prior to the individual's enrollment under
the reasonable cost reimbursement contract.
``(III) <<NOTE: Deadline. Notification.>> Not later than a
date determined appropriate by the Secretary prior to the
beginning of the last reasonable cost reimbursement contract
year for the contract, the organization shall provide notice to
the Secretary as to whether the organization will apply to have
the contract converted over, in whole or in part, and offered as
a Medicare Advantage plan under part C for the year following
the last reasonable cost reimbursement contract year for the
contract.
``(IV) <<NOTE: Deadline.>> If the organization provides the
notice described in subclause (III) that the contract will be
converted, in whole or in part, the organization shall, not
later than a date determined appropriate by the Secretary,
provide the Secretary with such information as the Secretary
determines appropriate in order to carry out section 1851(c)(4)
and to carry out section 1854(a)(5), including subparagraph
(C)(ii) of such section.
``(V) <<NOTE: Notification.>> In the case that the
organization enrolls a new enrollee under such contract during
the last reasonable cost reimbursement contract year for the
contract, the organization shall provide the individual with a
notification that such year is the last year for such contract.
``(v) <<NOTE: Applicability.>> If an eligible organization that is
offering a reasonable cost reimbursement contract that is extended or
renewed pursuant to clause (iv) provides the notice described in clause
(iv)(III) that the contract will be converted, in whole or in part, the
following shall apply:
``(I) The deemed enrollment under section 1851(c)(4).
``(II) The special rule for quality increase under section
1853(o)(4)(C).
``(III) During the last reasonable cost reimbursement
contract year for the contract and the year immediately
preceding such year, the eligible organization, or the corporate
parent organization of the eligible organization, shall be
permitted to offer an MA plan in the area that such contract is
being offered and enroll Medicare Advantage eligible individuals
in such MA plan and such cost plan.''.
(b) Deemed Enrollment From Reasonable Cost Reimbursement Contracts
Converted to Medicare Advantage Plans.--
(1) In general.--Section 1851(c) of the Social Security Act
(42 U.S.C. 1395w-21(c)) is amended--
(A) in paragraph (1), by striking ``Such elections''
and inserting ``Subject to paragraph (4), such
elections''; and
(B) by adding at the end the following:
``(4) Deemed enrollment relating to converted reasonable
cost reimbursement contracts.--
``(A) <<NOTE: Effective date.>> In general.--On the
first day of the annual, coordinated election period
under subsection (e)(3) for plan years beginning on or
after January 1, 2017, an MA eligible individual
described in clause (i) or (ii) of subparagraph (B) is
deemed, unless the individual elects otherwise, to
[[Page 129 STAT. 148]]
have elected to receive benefits under this title
through an applicable MA plan (and shall be enrolled in
such plan) beginning with such plan year, if--
``(i) the individual is enrolled in a
reasonable cost reimbursement contract under
section 1876(h) in the previous plan year;
``(ii) such reasonable cost reimbursement
contract was extended or renewed for the last
reasonable cost reimbursement contract year of the
contract (as described in subclause (I) of section
1876(h)(5)(C)(iv)) pursuant to such section;
``(iii) the eligible organization that is
offering such reasonable cost reimbursement
contract provided the notice described in
subclause (III) of such section that the contract
was to be converted;
``(iv) the applicable MA plan--
``(I) is the plan that was converted
from the reasonable cost reimbursement
contract described in clause (iii);
``(II) is offered by the same entity
(or an organization affiliated with such
entity that has a common ownership
interest of control) that entered into
such contract; and
``(III) is offered in the service
area where the individual resides;
``(v) in the case of reasonable cost
reimbursement contracts that provide coverage
under parts A and B (and, to the extent the
Secretary determines it to be feasible, contracts
that provide only part B coverage), the difference
between the estimated individual costs (as
determined applicable by the Secretary) for the
applicable MA plan and such costs for the
predecessor cost plan does not exceed a threshold
established by the Secretary; and
``(vi) the applicable MA plan--
``(I) <<NOTE: Time period.>>
provides coverage for enrollees
transitioning from the converted
reasonable cost reimbursement contract
to such plan to maintain current
providers of services and suppliers and
course of treatment at the time of
enrollment for a period of at least 90
days after enrollment; and
``(II) during such period, pays such
providers of services and suppliers for
items and services furnished to the
enrollee an amount that is not less than
the amount of payment applicable for
such items and services under the
original Medicare fee-for-service
program under parts A and B.
``(B) MA eligible individuals described.--
``(i) Without prescription drug coverage.--An
MA eligible individual described in this clause,
with respect to a plan year, is an MA eligible
individual who is enrolled in a reasonable cost
reimbursement contract under section 1876(h) in
the previous plan year and who is not, for such
previous plan year, enrolled in a prescription
drug plan under part D, including coverage under
section 1860D-22.
[[Page 129 STAT. 149]]
``(ii) With prescription drug coverage.--An MA
eligible individual described in this clause, with
respect to a plan year, is an MA eligible
individual who is enrolled in a reasonable cost
reimbursement contract under section 1876(h) in
the previous plan year and who, for such previous
plan year, is enrolled in a prescription drug plan
under part D--
``(I) through such contract; or
``(II) through a prescription drug
plan, if the sponsor of such plan is the
same entity (or an organization
affiliated with such entity) that
entered into such contract.
``(C) Applicable ma plan defined.--In this
paragraph, the term `applicable MA plan' means, in the
case of an individual described in--
``(i) subparagraph (B)(i), an MA plan that is
not an MA-PD plan; and
``(ii) subparagraph (B)(ii), an MA-PD plan.
``(D) Identification and notification of deemed
individuals.--Not <<NOTE: Deadline. Effective
date.>> later than 45 days before the first day of the
annual, coordinated election period under subsection
(e)(3) for plan years beginning on or after January 1,
2017, the Secretary shall identify and notify the
individuals who will be subject to deemed elections
under subparagraph (A) on the first day of such
period.''.
(2) Beneficiary option to discontinue or change ma plan or
ma-pd plan after deemed enrollment.--
(A) In general.--Section 1851(e)(2) of the Social
Security Act (42 U.S.C. 1395w-21(e)(4)) is amended by
adding at the end the following:
``(F) Special period for certain deemed elections.--
``(i) In general.--At any time during the
period beginning after the last day of the annual,
coordinated election period under paragraph (3) in
which an individual is deemed to have elected to
enroll in an MA plan or MA-PD plan under
subsection (c)(4) and ending on the last day of
February of the first plan year for which the
individual is enrolled in such plan, such
individual may change the election under
subsection (a)(1) (including changing the MA plan
or MA-PD plan in which the individual is
enrolled).
``(ii) Limitation of one change.--An
individual may exercise the right under clause (i)
only once during the applicable period described
in such clause. The limitation under this clause
shall not apply to changes in elections effected
during an annual, coordinated election period
under paragraph (3) or during a special enrollment
period under paragraph (4).''.
(B) Conforming amendments.--
(i) Plan requirement for open enrollment.--
Section 1851(e)(6)(A) of the Social Security Act
(42 U.S.C. 1395w-21(e)(6)(A)) is amended by
striking ``paragraph (1),'' and inserting
``paragraph (1), during the period described in
paragraph (2)(F),''.
(ii) Part d.--Section 1860D-1(b)(1)(B) of such
Act (42 U.S.C. 1395w-101(b)(1)(B)) is amended--
[[Page 129 STAT. 150]]
(I) in clause (ii), by adding ``and
paragraph (4)'' after ``paragraph
(3)(A)''; and
(II) in clause (iii) by striking
``and (E)'' and inserting ``(E), and
(F)''.
(3) <<NOTE: Applicability.>> Treatment of esrd for deemed
enrollment.--Section 1851(a)(3)(B) of the Social Security Act
(42 U.S.C. 1395w-21(a)(3)(B)) is amended by adding at the end
the following flush sentence: ``An individual who develops end-
stage renal disease while enrolled in a reasonable cost
reimbursement contract under section 1876(h) shall be treated as
an MA eligible individual for purposes of applying the deemed
enrollment under subsection (c)(4).''.
(c) Information Requirements.--Section 1851(d)(2)(B) of the Social
Security Act (42 U.S.C. 1395w-21(d)(2)(B)) is amended--
(1) in the heading, by striking ``Notification to newly
eligible medicare advantage eligible individuals'' and inserting
the following: ``Notifications required.--
``(i) Notification to newly eligible medicare
advantage eligible individuals.--''; and
(2) by adding at the end the following new clause:
``(ii) Notification related to certain deemed
elections.--The <<NOTE: Deadline.>> Secretary
shall require a Medicare Advantage organization
that is offering a Medicare Advantage plan that
has been converted from a reasonable cost
reimbursement contract pursuant to section
1876(h)(5)(C)(iv) to mail, not later than 30 days
prior to the first day of the annual, coordinated
election period under subsection (e)(3) of a year,
to any individual enrolled under such contract and
identified by the Secretary under subsection
(c)(4)(D) for such year--
``(I) a notification that such
individual will, on such day, be deemed
to have made an election with respect to
such plan to receive benefits under this
title through an MA plan or MA-PD plan
(and shall be enrolled in such plan) for
the next plan year under subsection
(c)(4)(A), but that the individual may
make a different election during the
annual, coordinated election period for
such year;
``(II) the information described in
subparagraph (A);
``(III) a description of the
differences between such MA plan or MA-
PD plan and the reasonable cost
reimbursement contract in which the
individual was most recently enrolled
with respect to benefits covered under
such plans, including cost-sharing,
premiums, drug coverage, and provider
networks;
``(IV) information about the special
period for elections under subsection
(e)(2)(F); and
``(V) other information the
Secretary may specify.''.
(d) Treatment of Transition Plan for Quality Rating for Payment
Purposes.--Section 1853(o)(4) of the Social Security Act (42 U.S.C.
1395w-23(o)(4)) is amended by adding at the end the following new
subparagraph:
[[Page 129 STAT. 151]]
``(C) Special rule for first 3 plan years for plans
that were converted from a reasonable cost reimbursement
contract.--For <<NOTE: Applicability.>> purposes of
applying paragraph (1) and section 1854(b)(1)(C) for the
first 3 plan years under this part in the case of an MA
plan to which deemed enrollment applies under section
1851(c)(4)--
``(i) such plan shall not be treated as a new
MA plan (as defined in paragraph (3)(A)(iii)(II));
and
``(ii) in determining the star rating of the
plan under subparagraph (A), to the extent that
Medicare Advantage data for such plan is not
available for a measure used to determine such
star rating, the Secretary shall use data from the
period in which such plan was a reasonable cost
reimbursement contract.''.
SEC. 210. EXTENSION OF HOME HEALTH RURAL ADD-ON.
Section 421(a) of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2283; 42 U.S.C.
1395fff note), as amended by section 5201(b) of the Deficit Reduction
Act of 2005 (Public Law 109-171; 120 Stat. 46) and by section 3131(c) of
the Patient Protection and Affordable Care Act (Public Law 111-148; 124
Stat. 428), is amended by striking ``January 1, 2016'' and inserting
``January 1, 2018'' each place it appears.
Subtitle B--Other Health Extenders
SEC. 211. PERMANENT EXTENSION OF THE QUALIFYING INDIVIDUAL (QI)
PROGRAM.
(a) Permanent Extension.--Section 1902(a)(10)(E)(iv) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is amended by striking
``(but only for premiums payable with respect to months during the
period beginning with January 1998, and ending with March 2015)''.
(b) Allocations.--Section 1933(g) of the Social Security Act (42
U.S.C. 1396u-3(g)) is amended--
(1) in paragraph (2)--
(A) by striking subparagraphs (A) through (H);
(B) in subparagraph (V), by striking ``and'' at the
end;
(C) in subparagraph (W), by striking the period at
the end and inserting a semicolon;
(D) by redesignating subparagraphs (I) through (W)
as subparagraphs (A) through (O), respectively; and
(E) by adding at the end the following new
subparagraphs:
``(P) <<NOTE: Time period.>> for the period that
begins on April 1, 2015, and ends on December 31, 2015,
the total allocation amount is $535,000,000; and
``(Q) for 2016 and, subject to paragraph (4), for
each subsequent year, the total allocation amount is
$980,000,000.'';
(2) in paragraph (3), by striking ``(P), (R), (T), or (V)''
and inserting ``or (P)''; and
(3) by adding at the end the following new paragraph:
``(4) Adjustment to allocations.--The Secretary may increase
the allocation amount under paragraph (2)(Q) for a
[[Page 129 STAT. 152]]
year (beginning with 2017) up to an amount that does not exceed
the product of the following:
``(A) Maximum allocation amount for previous year.--
In the case of 2017, the allocation amount for 2016, or
in the case of a subsequent year, the maximum allocation
amount allowed under this paragraph for the previous
year.
``(B) Increase in part b premium.--The monthly
premium rate determined under section 1839 for the year
divided by the monthly premium rate determined under
such section for the previous year.
``(C) Increase in part b enrollment.--The average
number of individuals (as estimated by the Chief Actuary
of the Centers for Medicare & Medicaid Services in
September of the previous year) to be enrolled under
part B of title XVIII for months in the year divided by
the average number of such individuals (as so estimated)
under this subparagraph with respect to enrollments in
months in the previous year.''.
SEC. 212. PERMANENT EXTENSION OF TRANSITIONAL MEDICAL ASSISTANCE
(TMA).
(a) In General.--Section 1925 of the Social Security Act (42 U.S.C.
1396r-6) is amended--
(1) by striking subsection (f); and
(2) by redesignating subsection (g) as subsection (f).
(b) Conforming Amendment.--Section 1902(e)(1) of the Social Security
Act (42 U.S.C. 1396a(e)(1)) is amended to read as follows:
``(1) <<NOTE: Effective date.>> Beginning April 1, 1990, for
provisions relating to the extension of eligibility for medical
assistance for certain families who have received aid pursuant to a
State plan approved under part A of title IV and have earned income, see
section 1925.''.
SEC. 213. EXTENSION OF SPECIAL DIABETES PROGRAM FOR TYPE I
DIABETES AND FOR INDIANS.
(a) Special Diabetes Programs for Type I Diabetes.--Section
330B(b)(2)(C) of the Public Health Service Act (42 U.S.C. 254c-
2(b)(2)(C)) is amended by striking ``2015'' and inserting ``2017''.
(b) Special Diabetes Programs for Indians.--Section 330C(c)(2)(C) of
the Public Health Service Act (42 U.S.C. 254c-3(c)(2)(C)) is amended by
striking ``2015'' and inserting ``2017''.
SEC. 214. EXTENSION OF ABSTINENCE EDUCATION.
(a) In General.--Section 510 of the Social Security Act (42 U.S.C.
710) is amended--
(1) in subsection (a), striking ``2015'' and inserting
``2017''; and
(2) in subsection (d), by inserting ``and an additional
$75,000,000 for each of fiscal years 2016 and 2017'' after
``2015''.
(b) Budget Scoring.--Notwithstanding section 257(b)(2) of the
Balanced Budget and Emergency Deficit Control Act of 1985, the baseline
shall be calculated assuming that no grant shall be made under section
510 of the Social Security Act (42 U.S.C. 710) after fiscal year 2017.
(c) Reallocation of Unused Funding.--The remaining unobligated
balances of the amount appropriated for fiscal years 2016 and 2017 by
section 510(d) of the Social Security Act (42 U.S.C. 710(d)) for which
no application has been received by the
[[Page 129 STAT. 153]]
Funding Opportunity Announcement deadline, shall be made available to
States that require the implementation of each element described in
subparagraphs (A) through (H) of the definition of abstinence education
in section 510(b)(2). The remaining unobligated balances shall be
reallocated to such States that submit a valid application consistent
with the original formula for this funding.
SEC. 215. EXTENSION OF PERSONAL RESPONSIBILITY EDUCATION PROGRAM
(PREP).
Section 513 of the Social Security Act (42 U.S.C. 713) is amended--
(1) in paragraphs (1)(A) and (4)(A) of subsection (a), by
striking ``2015'' and inserting ``2017'' each place it appears;
(2) in subsection (a)(4)(B)(i), by striking ``, 2013, 2014,
and 2015'' and inserting ``through 2017''; and
(3) in subsection (f), by striking ``2015'' and inserting
``2017''.
SEC. 216. EXTENSION OF FUNDING FOR FAMILY-TO-FAMILY HEALTH
INFORMATION CENTERS.
Section 501(c)(1)(A) of the Social Security Act (42 U.S.C.
701(c)(1)(A)) is amended--
(1) by striking clause (vi); and
(2) by adding after clause (v) the following new clause:
``(vi) $5,000,000 for each of fiscal years 2015 through
2017.''.
SEC. 217. EXTENSION OF HEALTH WORKFORCE DEMONSTRATION PROJECT FOR
LOW-INCOME INDIVIDUALS.
Section 2008(c)(1) of the Social Security Act (42 U.S.C.
1397g(c)(1)) is amended by striking ``2015'' and inserting ``2017''.
SEC. 218. EXTENSION OF MATERNAL, INFANT, AND EARLY CHILDHOOD HOME
VISITING PROGRAMS.
Section 511(j)(1) of the Social Security Act (42 U.S.C. 711(j)) is
amended--
(1) by striking ``and'' at the end of subparagraph (E);
(2) in subparagraph (F)--
(A) by striking ``for the period beginning on
October 1, 2014, and ending on March 31, 2015'' and
inserting ``for fiscal year 2015'';
(B) by striking ``an amount equal to the amount
provided in subparagraph (E)'' and inserting
``$400,000,000''; and
(C) by striking the period at the end and inserting
a semicolon; and
(3) by adding at the end the following new subparagraphs:
``(G) for fiscal year 2016, $400,000,000; and
``(H) for fiscal year 2017, $400,000,000.''.
SEC. 219. TENNESSEE DSH ALLOTMENT FOR FISCAL YEARS 2015 THROUGH
2025.
Section 1923(f)(6)(A) of the Social Security Act (42 U.S.C. 1396r-
4(f)(6)(A)) is amended by adding at the end the following:
``(vi) Allotment for fiscal years 2015 through
2025.--Notwithstanding any other provision of this
subsection, any other provision of law, or the
terms of the TennCare Demonstration Project in
effect for the State, the DSH allotment for
Tennessee for fiscal year
[[Page 129 STAT. 154]]
2015, and for each fiscal year thereafter through
fiscal year 2025, shall be $53,100,000 for each
such fiscal year.''.
SEC. 220. DELAY IN EFFECTIVE DATE FOR MEDICAID AMENDMENTS RELATING
TO BENEFICIARY LIABILITY SETTLEMENTS.
Section 202(c) of the Bipartisan Budget Act of 2013 (division A of
Public Law 113-67; 42 U.S.C. 1396a note), as amended by section 211 of
the Protecting Access to Medicare Act of 2014 (Public Law 113-93; 128
Stat. 1047) is amended by striking ``October 1, 2016'' and inserting
``October 1, 2017''.
SEC. 221. EXTENSION OF FUNDING FOR COMMUNITY HEALTH CENTERS, THE
NATIONAL HEALTH SERVICE CORPS, AND
TEACHING HEALTH CENTERS.
(a) Funding for Community Health Centers and the National Health
Service Corps.--
(1) Community health centers.--Section 10503(b)(1)(E) of the
Patient Protection and Affordable Care Act (42 U.S.C. 254b-
2(b)(1)(E)) is amended by striking ``for fiscal year 2015'' and
inserting ``for each of fiscal years 2015 through 2017''.
(2) National health service corps.--Section 10503(b)(2)(E)
of the Patient Protection and Affordable Care Act (42 U.S.C.
254b-2(b)(2)(E)) is amended by striking ``for fiscal year 2015''
and inserting ``for each of fiscal years 2015 through 2017''.
(b) Extension of Teaching Health Centers Program.--Section 340H(g)
of the Public Health Service Act (42 U.S.C. 256h(g)) is amended by
inserting ``and $60,000,000 for each of fiscal years 2016 and 2017''
before the period at the end.
(c) Application.--Amounts appropriated pursuant to this section for
fiscal year 2016 and fiscal year 2017 are subject to the requirements
contained in Public Law 113-235 for funds for programs authorized under
sections 330 through 340 of the Public Health Service Act (42 U.S.C.
254b-256).
TITLE III--CHIP
SEC. 301. 2-YEAR EXTENSION OF THE CHILDREN'S HEALTH INSURANCE
PROGRAM.
(a) Funding.--Section 2104(a) of the Social Security Act (42 U.S.C.
1397dd(a)) is amended--
(1) in paragraph (17), by striking ``and'' at the end;
(2) in paragraph (18)(B), by striking the period at the end
and inserting a semicolon; and
(3) by adding at the end the following new paragraphs:
``(19) for fiscal year 2016, $19,300,000,000; and
``(20) <<NOTE: Time periods.>> for fiscal year 2017, for
purposes of making 2 semi-annual allotments--
``(A) $2,850,000,000 for the period beginning on
October 1, 2016, and ending on March 31, 2017; and
``(B) $2,850,000,000 for the period beginning on
April 1, 2017, and ending on September 30, 2017.''.
(b) Allotments.--
(1) In general.--Section 2104(m) of the Social Security Act
(42 U.S.C. 1397dd(m)) is amended--
[[Page 129 STAT. 155]]
(A) in the subsection heading, by striking ``Through
2015'' and inserting ``and Thereafter'';
(B) in paragraph (2)--
(i) in the paragraph heading, by striking
``2014'' and inserting ``2016''; and
(ii) by striking subparagraph (B) and
inserting the following new subparagraph:
``(B) Fiscal year 2013 and each succeeding fiscal
year.--Subject to paragraphs (5) and (7), from the
amount made available under paragraphs (16) through (19)
of subsection (a) for fiscal year 2013 and each
succeeding fiscal year, respectively, the Secretary
shall compute a State allotment for each State
(including the District of Columbia and each
commonwealth and territory) for each such fiscal year as
follows:
``(i) Rebasing in fiscal year 2013 and each
succeeding odd-numbered fiscal year.--For fiscal
year 2013 and each succeeding odd-numbered fiscal
year (other than fiscal years 2015 and 2017), the
allotment of the State is equal to the Federal
payments to the State that are attributable to
(and countable toward) the total amount of
allotments available under this section to the
State in the preceding fiscal year (including
payments made to the State under subsection (n)
for such preceding fiscal year as well as amounts
redistributed to the State in such preceding
fiscal year), multiplied by the allotment increase
factor under paragraph (6) for such odd-numbered
fiscal year.
``(ii) Growth factor update for fiscal year
2014 and each succeeding even-numbered fiscal
year.--Except as provided in clauses (iii) and
(iv), for fiscal year 2014 and each succeeding
even-numbered fiscal year, the allotment of the
State is equal to the sum of--
``(I) the amount of the State
allotment under clause (i) for the
preceding fiscal year; and
``(II) the amount of any payments
made to the State under subsection (n)
for such preceding fiscal year,
multiplied by the allotment increase factor under
paragraph (6) for such even-numbered fiscal year.
``(iii) Special rule for 2016.--For fiscal
year 2016, the allotment of the State is equal to
the Federal payments to the State that are
attributable to (and countable toward) the total
amount of allotments available under this section
to the State in the preceding fiscal year
(including payments made to the State under
subsection (n) for such preceding fiscal year as
well as amounts redistributed to the State in such
preceding fiscal year), but determined as if the
last two sentences of section 2105(b) were in
effect in such preceding fiscal year and then
multiplying the result by the allotment increase
factor under paragraph (6) for fiscal year 2016.
``(iv) Reduction in 2018.--For fiscal year
2018, with respect to the allotment of the State
for fiscal year 2017, any amounts of such
allotment that remain
[[Page 129 STAT. 156]]
available for expenditure by the State in fiscal
year 2018 shall be reduced by one-third.'';
(C) in paragraph (4), by inserting ``or 2017'' after
``2015'';
(D) in paragraph (6)--
(i) in subparagraph (A), by striking ``2015''
and inserting ``2017''; and
(ii) in the second sentence, by striking ``or
fiscal year 2014'' and inserting ``fiscal year
2014, or fiscal year 2016'';
(E) in paragraph (8)--
(i) in the paragraph heading, by striking
``fiscal year 2015'' and inserting ``fiscal years
2015 and 2017''; and
(ii) by inserting ``or fiscal year 2017''
after ``2015'';
(F) by redesignating paragraphs (4) through (8) as
paragraphs (5) through (9), respectively; and
(G) by inserting after paragraph (3) the following
new paragraph:
``(4) For fiscal year 2017.--
``(A) First half.--Subject to paragraphs (5) and
(7), from the amount made available under subparagraph
(A) of paragraph (20) of subsection (a) for the semi-
annual period described in such paragraph, increased by
the amount of the appropriation for such period under
section 301(b)(3) of the Medicare Access and CHIP
Reauthorization Act of 2015, the Secretary shall compute
a State allotment for each State (including the District
of Columbia and each commonwealth and territory) for
such semi-annual period in an amount equal to the first
half ratio (described in subparagraph (D)) of the amount
described in subparagraph (C).
``(B) Second half.--Subject to paragraphs (5) and
(7), from the amount made available under subparagraph
(B) of paragraph (20) of subsection (a) for the semi-
annual period described in such paragraph, the Secretary
shall compute a State allotment for each State
(including the District of Columbia and each
commonwealth and territory) for such semi-annual period
in an amount equal to the amount made available under
such subparagraph, multiplied by the ratio of--
``(i) the amount of the allotment to such
State under subparagraph (A); to
``(ii) the total of the amount of all of the
allotments made available under such subparagraph.
``(C) Full year amount based on rebased amount.--The
amount described in this subparagraph for a State is
equal to the Federal payments to the State that are
attributable to (and countable towards) the total amount
of allotments available under this section to the State
in fiscal year 2016 (including payments made to the
State under subsection (n) for fiscal year 2016 as well
as amounts redistributed to the State in fiscal year
2016), multiplied by the allotment increase factor under
paragraph (6) for fiscal year 2017.
``(D) First half ratio.--The first half ratio
described in this subparagraph is the ratio of--
[[Page 129 STAT. 157]]
``(i) the sum of--
``(I) the amount made available
under subsection (a)(20)(A); and
``(II) the amount of the
appropriation for such period under
section 301(b)(3) of the Medicare Access
and CHIP Reauthorization Act of 2015; to
``(ii) the sum of the--
``(I) amount described in clause
(i); and
``(II) the amount made available
under subsection (a)(20)(B).''.
(2) Conforming amendments.--
(A) Section 2104(c)(1) of the Social Security Act
(42 U.S.C. 1397dd(c)(1)) is amended by striking
``(m)(4)'' and inserting ``(m)(5)''.
(B) Section 2104(m) of such Act (42 U.S.C.
1397dd(m)), as amended by paragraph (1), is further
amended--
(i) in paragraph (1)--
(I) by striking ``paragraph (4)''
each place it appears in subparagraphs
(A) and (B) and inserting ``paragraph
(5)''; and
(II) by striking ``the allotment
increase factor determined under
paragraph (5)'' each place it appears
and inserting ``the allotment increase
factor determined under paragraph (6)'';
(ii) in paragraph (2)(A), by striking ``the
allotment increase factor under paragraph (5)''
and inserting ``the allotment increase factor
under paragraph (6)'';
(iii) in paragraph (3)--
(I) by striking ``paragraphs (4) and
(6)'' and inserting ``paragraphs (5) and
(7)'' each place it appears; and
(II) by striking ``the allotment
increase factor under paragraph (5)''
and inserting ``the allotment increase
factor under paragraph (6)'';
(iv) in paragraph (5) (as redesignated by
paragraph (1)(F)), by striking ``paragraph (1),
(2), or (3)'' and inserting ``paragraph (1), (2),
(3), or (4)'';
(v) in paragraph (7) (as redesignated by
paragraph (1)(F)), by striking ``subject to
paragraph (4)'' and inserting ``subject to
paragraph (5)''; and
(vi) in paragraph (9), (as redesignated by
paragraph (1)(F)), by striking ``paragraph (3)''
and inserting ``paragraph (3) or (4)''.
(C) Section 2104(n)(3)(B)(ii) of such Act (42 U.S.C.
1397dd(n)(3)(B)(ii)) is amended by striking ``subsection
(m)(5)(B)'' and inserting ``subsection (m)(6)(B)''.
(D) Section 2111(b)(2)(B)(i) of such Act (42 U.S.C.
1397kk(b)(2)(B)(i)) is amended by striking ``section
2104(m)(4)'' and inserting ``section 2104(m)(5)''.
(3) One-time appropriation for fiscal year 2017.--There is
appropriated to the Secretary of Health and Human Services, out
of any money in the Treasury not otherwise appropriated,
$14,700,000,000 to accompany the allotment made for the period
beginning on October 1, 2016, and ending on March 31, 2017,
under paragraph (20)(A) of section 2104(a) of the Social
Security Act (42 U.S.C. 1397dd(a)) (as added by subsection
(a)(1)), to remain available until expended. Such amount
[[Page 129 STAT. 158]]
shall be used to provide allotments to States under paragraph
(4) of section 2104(m) of such Act (42 U.S.C. 1397dd(m)) (as
amended by paragraph(1)(G)) for the first 6 months of fiscal
year 2017 in the same manner as allotments are provided under
subsection (a)(20)(A) of such section 2104 and subject to the
same terms and conditions as apply to the allotments provided
from such subsection (a)(20)(A).
(c) Extension of Qualifying States Option.--Section 2105(g)(4) of
the Social Security Act (42 U.S.C. 1397ee(g)(4)) is amended--
(1) in the paragraph heading, by striking ``2015'' and
inserting ``2017''; and
(2) in subparagraph (A), by striking ``2015'' and inserting
``2017''.
(d) Extension of the Child Enrollment Contingency Fund.--
(1) In general.--Section 2104(n) of the Social Security Act
(42 U.S.C. 1397dd(n)) is amended--
(A) in paragraph (2)--
(i) in subparagraph (A)(ii)--
(I) by striking ``2010 through
2014'' and inserting ``2010, 2011, 2012,
2013, 2014, and 2016''; and
(II) by inserting ``and fiscal year
2017'' after ``2015''; and
(ii) in subparagraph (B)--
(I) by striking ``2010 through
2014'' and inserting ``2010, 2011, 2012,
2013, 2014, and 2016''; and
(II) by inserting ``and fiscal year
2017'' after ``2015''; and
(B) in paragraph (3)(A), in the matter preceding
clause (i), by striking ``fiscal year 2009, fiscal year
2010, fiscal year 2011, fiscal year 2012, fiscal year
2013, fiscal year 2014, or a semi-annual allotment
period for fiscal year 2015'' and inserting ``any of
fiscal years 2009 through 2014, fiscal year 2016, or a
semi-annual allotment period for fiscal year 2015 or
2017''.
SEC. 302. EXTENSION OF EXPRESS LANE ELIGIBILITY.
Section 1902(e)(13)(I) of the Social Security Act (42 U.S.C.
1396a(e)(13)(I)) is amended by striking ``2015'' and inserting ``2017''.
SEC. 303. EXTENSION OF OUTREACH AND ENROLLMENT PROGRAM.
Section 2113 of the Social Security Act (42 U.S.C. 1397mm) is
amended--
(1) in subsection (a)(1), by striking ``2015'' and inserting
``2017''; and
(2) in subsection (g), by inserting ``and $40,000,000 for
the period of fiscal years 2016 and 2017'' after ``2015''.
SEC. 304. EXTENSION OF CERTAIN PROGRAMS AND DEMONSTRATION
PROJECTS.
(a) Childhood Obesity Demonstration Project.--Section 1139A(e)(8) of
the Social Security Act (42 U.S.C. 1320b-9a(e)(8)) is amended by
inserting ``, and $10,000,000 for the period of fiscal years 2016 and
2017'' after ``2014''.
[[Page 129 STAT. 159]]
(b) Pediatric Quality Measures Program.--Section 1139A(i) of the
Social Security Act (42 U.S.C. 1320b-9a(i)) is amended in the first
sentence by inserting before the period at the end the following: ``,
and there is appropriated for the period of fiscal years 2016 and 2017,
$20,000,000 for the purpose of carrying out this section (other than
subsections (e), (f), and (g))''.
SEC. 305. REPORT OF INSPECTOR GENERAL OF HHS ON USE OF EXPRESS
LANE OPTION UNDER MEDICAID AND CHIP.
Not later than 18 months after the date of the enactment of this
Act, the Inspector General of the Department of Health and Human
Services shall submit to the Committee on Energy and Commerce of the
House of Representatives and the Committee on Finance of the Senate a
report that--
(1) provides data on the number of individuals enrolled in
the Medicaid program under title XIX of the Social Security Act
(referred to in this section as ``Medicaid'') and the Children's
Health Insurance Program under title XXI of such Act (referred
to in this section as ``CHIP'') through the use of the Express
Lane option under section 1902(e)(13) of the Social Security Act
(42 U.S.C. 1396a(e)(13));
(2) assesses the extent to which individuals so enrolled
meet the eligibility requirements under Medicaid or CHIP (as
applicable); and
(3) provides data on Federal and State expenditures under
Medicaid and CHIP for individuals so enrolled and disaggregates
such data between expenditures made for individuals who meet the
eligibility requirements under Medicaid or CHIP (as applicable)
and expenditures made for individuals who do not meet such
requirements.
TITLE IV--OFFSETS
Subtitle A--Medicare Beneficiary Reforms
SEC. 401. LIMITATION ON CERTAIN MEDIGAP POLICIES FOR NEWLY
ELIGIBLE MEDICARE BENEFICIARIES.
Section 1882 of the Social Security Act (42 U.S.C. 1395ss) is
amended by adding at the end the following new subsection:
``(z) Limitation on Certain Medigap Policies for Newly Eligible
Medicare Beneficiaries.--
``(1) <<NOTE: Effective date.>> In general.--
Notwithstanding any other provision of this section, on or after
January 1, 2020, a medicare supplemental policy that provides
coverage of the part B deductible, including any such policy (or
rider to such a policy) issued under a waiver granted under
subsection (p)(6), may not be sold or issued to a newly eligible
Medicare beneficiary.
``(2) Newly eligible medicare beneficiary defined.--In this
subsection, the term `newly eligible Medicare beneficiary' means
an individual who is neither of the following:
``(A) An individual who has attained age 65 before
January 1, 2020.
``(B) An individual who was entitled to benefits
under part A pursuant to section 226(b) or 226A, or
deemed to be eligible for benefits under section 226(a),
before January 1, 2020.
[[Page 129 STAT. 160]]
``(3) Treatment of waivered states.--In the case of a State
described in subsection (p)(6), nothing in this section shall be
construed as preventing the State from modifying its alternative
simplification program under such subsection so as to eliminate
the coverage of the part B deductible for any medical
supplemental policy sold or issued under such program to a newly
eligible Medicare beneficiary on or after January 1, 2020.
``(4) Treatment of references to certain policies.--In the
case of a newly eligible Medicare beneficiary, except as the
Secretary may otherwise provide, any reference in this section
to a medicare supplemental policy which has a benefit package
classified as `C' or `F' shall be deemed, as of January 1, 2020,
to be a reference to a medicare supplemental policy which has a
benefit package classified as `D' or `G', respectively.
``(5) <<NOTE: Applicability.>> Enforcement.--The penalties
described in clause (ii) of subsection (d)(3)(A) shall apply
with respect to a violation of paragraph (1) in the same manner
as it applies to a violation of clause (i) of such
subsection.''.
SEC. 402. INCOME-RELATED PREMIUM ADJUSTMENT FOR PARTS B AND D.
(a) In General.--Section 1839(i)(3)(C)(i) of the Social Security Act
(42 U.S.C. 1395r(i)(3)(C)(i)) is amended--
(1) by inserting after ``In general.--'' the following:
``(I) Subject to paragraphs (5) and
(6), for years before 2018:''; and
(2) by adding at the end the following:
``(II) Subject to paragraph (5), for
years beginning with 2018:
``If the modified adjusted gross income is: The applicable
percentage is:
More than $85,000 but not more than $107,000..... 35 percent
More than $107,000 but not more than $133,500.... 50 percent
More than $133,500 but not more than $160,000.... 65 percent
More than $160,000............................... 80 percent.''.
(b) Conforming Amendments.--Section 1839(i) of the Social Security
Act (42 U.S.C. 1395r(i)) is amended--
(1) in paragraph (2)(A), by inserting ``(or, beginning with
2018, $85,000)'' after ``$80,000'';
(2) in paragraph (3)(A)(i), by inserting ``applicable''
before ``table'';
(3) in paragraph (5)(A)--
(A) in the matter before clause (i), by inserting
``(other than 2018 and 2019)'' after ``2007''; and
(B) in clause (ii), by inserting ``(or, in the case
of a calendar year beginning with 2020, August 2018)''
after ``August 2006''; and
(4) in paragraph (6), in the matter before subparagraph (A),
by striking ``2019'' and inserting ``2017''.
[[Page 129 STAT. 161]]
Subtitle B--Other Offsets
SEC. 411. MEDICARE PAYMENT UPDATES FOR POST-ACUTE PROVIDERS.
(a) SNFs.--Section 1888(e) of the Social Security Act (42 U.S.C.
1395yy(e))--
(1) in paragraph (5)(B)--
(A) in clause (i), by striking ``clause (ii)'' and
inserting ``clauses (ii) and (iii)'';
(B) in clause (ii), by inserting ``subject to clause
(iii),'' after ``each subsequent fiscal year,''; and
(C) by adding at the end the following new clause:
``(iii) Special rule for fiscal year 2018.--
For fiscal year 2018 (or other similar annual
period specified in clause (i)), the skilled
nursing facility market basket percentage, after
application of clause (ii), is equal to 1
percent.''; and
(2) in paragraph (6)(A), by striking ``paragraph
(5)(B)(ii)'' and inserting ``clauses (ii) and (iii) of paragraph
(5)(B)'' each place it appears.
(b) IRFs.--Section 1886(j) of the Social Security Act (42 U.S.C.
1395ww(j)) is amended--
(1) in paragraph (3)(C)--
(A) in clause (i), by striking ``clause (ii)'' and
inserting ``clauses (ii) and (iii)'';
(B) in clause (ii), by striking ``After'' and
inserting ``Subject to clause (iii), after''; and
(C) by adding at the end the following new clause:
``(iii) <<NOTE: Applicability.>> Special rule
for fiscal year 2018.--The increase factor to be
applied under this subparagraph for fiscal year
2018, after the application of clause (ii), shall
be 1 percent.''; and
(2) in paragraph (7)(A)(i), by striking ``paragraph (3)(D)''
and inserting ``subparagraphs (C)(iii) and (D) of paragraph
(3)''.
(c) HHAs.--Section 1895(b)(3)(B) of the Social Security Act (42
U.S.C. 1395fff(b)(3)(B)) is amended--
(1) in clause (iii), by adding at the end the following:
``Notwithstanding the previous sentence, the home health market
basket percentage increase for 2018 shall be 1 percent.''; and
(2) in clause (vi)(I), by inserting ``(except 2018)'' after
``each subsequent year''.
(d) Hospice.--Section 1814(i) of the Social Security Act (42 U.S.C.
1395f(i)) is amended--
(1) in paragraph (1)(C)--
(A) in clause (ii)(VII), by striking ``clause
(iv),,'' and inserting ``clauses (iv) and (vi),'';
(B) in clause (iii), by striking ``clause (iv),''
and inserting ``clauses (iv) and (vi),'';
(C) in clause (iv), by striking ``After
determining'' and inserting ``Subject to clause (vi),
after determining''; and
(D) by adding at the end the following new clause:
``(vi) For fiscal year 2018, the market basket percentage increase
under clause (ii)(VII) or (iii), as applicable, after application of
clause (iv), shall be 1 percent.''; and
[[Page 129 STAT. 162]]
(2) in paragraph (5)(A)(i), by striking ``paragraph
(1)(C)(iv)'' and inserting ``clauses (iv) and (vi) of paragraph
(1)(C)''.
(e) LTCHs.--Section 1886(m)(3) of the Social Security Act (42 U.S.C.
1395ww(m)(3)) is amended--
(1) in subparagraph (A), in the matter preceding clause (i),
by striking ``In implementing'' and inserting ``Subject to
subparagraph (C), in implementing''; and
(2) by adding at the end the following new subparagraph:
``(C) Additional special rule.--For fiscal year
2018, the annual update under subparagraph (A) for the
fiscal year, after application of clauses (i) and (ii)
of subparagraph (A), shall be 1 percent.''.
SEC. 412. DELAY OF REDUCTION TO MEDICAID DSH ALLOTMENTS.
Section 1923(f) of the Social Security Act (42 U.S.C. 1396r-4(f)) is
amended--
(1) in paragraph (7)(A)--
(A) in clause (i), by striking ``2017 through 2024''
and inserting ``2018 through 2025'';
(B) by striking clause (ii) and inserting the
following new clause:
``(ii) Aggregate reductions.--The aggregate
reductions in DSH allotments for all States under
clause (i)(I) shall be equal to--
``(I) $2,000,000,000 for fiscal year
2018;
``(II) $3,000,000,000 for fiscal
year 2019;
``(III) $4,000,000,000 for fiscal
year 2020;
``(IV) $5,000,000,000 for fiscal
year 2021;
``(V) $6,000,000,000 for fiscal year
2022;
``(VI) $7,000,000,000 for fiscal
year 2023;
``(VII) $8,000,000,000 for fiscal
year 2024; and
``(VIII) $8,000,000,000 for fiscal
year 2025.''; and
(C) by adding at the end the following new clause:
``(v) Distribution of aggregate reductions.--
The Secretary shall distribute the aggregate
reductions under clause (ii) among States in
accordance with subparagraph (B).''; and
(2) in paragraph (8), by striking ``2024'' and inserting
``2025''.
SEC. 413. LEVY ON DELINQUENT PROVIDERS.
(a) In General.--Paragraph (3) of section 6331(h) of the Internal
Revenue Code of 1986 <<NOTE: 26 USC 6331.>> is amended by striking ``30
percent'' and inserting ``100 percent''.
(b) <<NOTE: Applicability. 26 USC 6331 note.>> Effective Date.--The
amendment made by this section shall apply to payments made after 180
days after the date of the enactment of this Act.
SEC. 414. ADJUSTMENTS TO INPATIENT HOSPITAL PAYMENT RATES.
Section 7(b) of the TMA, Abstinence Education, and QI Programs
Extension Act of 2007 (Public Law 110-90), as amended by section 631(b)
of the American Taxpayer Relief Act of 2012 (Public Law 112-
240), <<NOTE: 121 Stat. 986.>> is amended--
(1) in paragraph (1)--
(A) in the matter preceding subparagraph (A), by
striking ``, 2009, or 2010'' and inserting ``or 2009'';
and
(B) in subparagraph (B)--
[[Page 129 STAT. 163]]
(i) in clause (i), by striking ``and'' at the
end;
(ii) in clause (ii), by striking the period at
the end and inserting ``; and''; and
(iii) by adding at the end the following new
clause:
``(iii) make an additional adjustment to the
standardized amounts under such section 1886(d) of an
increase of 0.5 percentage points for discharges
occurring during each of fiscal years 2018 through 2023
and not make the adjustment (estimated to be an increase
of 3.2 percent) that would otherwise apply for
discharges occurring during fiscal year 2018 by reason
of the completion of the adjustments required under
clause (ii).'';
(2) in paragraph (3)--
(A) by striking ``shall be construed'' and all that
follows through ``providing authority'' and inserting
``shall be construed as providing authority''; and
(B) by inserting ``and each succeeding fiscal year
through fiscal year 2023'' after ``2017'';
(3) by redesignating paragraphs (3) and (4) as paragraphs
(4) and (5), respectively; and
(4) by inserting after paragraph (2) the following new
paragraph:
``(3) Prohibition.--The Secretary shall not make an
additional prospective adjustment (estimated to be a decrease of
0.55 percent) to the standardized amounts under such section
1886(d) to offset the amount of the increase in aggregate
payments related to documentation and coding changes for
discharges occurring during fiscal year 2010.''.
TITLE V--MISCELLANEOUS
Subtitle A--Protecting the Integrity of Medicare
SEC. 501. PROHIBITION OF INCLUSION OF SOCIAL SECURITY ACCOUNT
NUMBERS ON MEDICARE CARDS.
(a) In General.--Section 205(c)(2)(C) of the Social Security Act (42
U.S.C. 405(c)(2)(C)) is amended--
(1) by moving clause (x), as added by section 1414(a)(2) of
the Patient Protection and Affordable Care Act, 6 ems to the
left;
(2) by redesignating clause (x), as added by section 2(a)(1)
of the Social Security Number Protection Act of 2010, and clause
(xi) as clauses (xi) and (xii), respectively; and
(3) by adding at the end the following new clause:
``(xiii) <<NOTE: Consultation. Procedures.>> The Secretary of
Health and Human Services, in consultation with the Commissioner of
Social Security, shall establish cost-effective procedures to ensure
that a Social Security account number (or derivative thereof) is not
displayed, coded, or embedded on the Medicare card issued to an
individual who is entitled to benefits under part A of title XVIII or
enrolled under part B of title XVIII and that any other identifier
displayed on such card is not identifiable as a Social Security account
number (or derivative thereof).''.
(b) <<NOTE: 42 USC 405 note.>> Implementation.--In implementing
clause (xiii) of section 205(c)(2)(C) of the Social Security Act (42
U.S.C. 405(c)(2)(C)), as
[[Page 129 STAT. 164]]
added by subsection (a)(3), the Secretary of Health and Human Services
shall do the following:
(1) In general.--Establish a cost-effective process that
involves the least amount of disruption to, as well as necessary
assistance for, Medicare beneficiaries and health care
providers, such as a process that provides such beneficiaries
with access to assistance through a toll-free telephone number
and provides outreach to providers.
(2) Consideration of medicare beneficiary identified.--
Consider implementing a process, similar to the process
involving Railroad Retirement Board beneficiaries, under which a
Medicare beneficiary identifier which is not a Social Security
account number (or derivative thereof) is used external to the
Department of Health and Human Services and is convertible over
to a Social Security account number (or derivative thereof) for
use internal to such Department and the Social Security
Administration.
(c) Funding for Implementation.--For purposes of implementing the
provisions of and the amendments made by this section, the Secretary of
Health and Human Services shall provide for the following transfers from
the Federal Hospital Insurance Trust Fund under section 1817 of the
Social Security Act (42 U.S.C. 1395i) and from the Federal Supplementary
Medical Insurance Trust Fund established under section 1841 of such Act
(42 U.S.C. 1395t), in such proportions as the Secretary determines
appropriate:
(1) To the Centers for Medicare & Medicaid Program
Management Account, transfers of the following amounts:
(A) For fiscal year 2015, $65,000,000, to be made
available through fiscal year 2018.
(B) For each of fiscal years 2016 and 2017,
$53,000,000, to be made available through fiscal year
2018.
(C) For fiscal year 2018, $48,000,000, to be made
available until expended.
(2) To the Social Security Administration Limitation on
Administration Account, transfers of the following amounts:
(A) For fiscal year 2015, $27,000,000, to be made
available through fiscal year 2018.
(B) For each of fiscal years 2016 and 2017,
$22,000,000, to be made available through fiscal year
2018.
(C) For fiscal year 2018, $27,000,000, to be made
available until expended.
(3) To the Railroad Retirement Board Limitation on
Administration Account, the following amount:
(A) For fiscal year 2015, $3,000,000, to be made
available until expended.
(d) <<NOTE: Deadlines.>> Effective Date.--
(1) In general.--Clause (xiii) of section 205(c)(2)(C) of
the Social Security Act (42 U.S.C. 405(c)(2)(C)), as added by
subsection (a)(3), shall apply with respect to Medicare cards
issued on and after an effective date specified by the Secretary
of Health and Human Services, but in no case shall such
effective date be later than the date that is four years after
the date of the enactment of this Act.
(2) Reissuance.--The Secretary shall provide for the
reissuance of Medicare cards that comply with the requirements
of such clause not later than four years after the effective
date specified by the Secretary under paragraph (1).
[[Page 129 STAT. 165]]
SEC. 502. PREVENTING WRONGFUL MEDICARE PAYMENTS FOR ITEMS AND
SERVICES FURNISHED TO INCARCERATED
INDIVIDUALS, INDIVIDUALS NOT LAWFULLY
PRESENT, AND DECEASED INDIVIDUALS.
(a) Requirement for the Secretary To Establish Policies and Claims
Edits Relating to Incarcerated Individuals, Individuals Not Lawfully
Present, and Deceased Individuals.--Section 1874 of the Social Security
Act (42 U.S.C. 1395kk) is amended by adding at the end the following new
subsection:
``(f) Requirement for the Secretary To Establish Policies and Claims
Edits Relating to Incarcerated Individuals, Individuals Not Lawfully
Present, and Deceased Individuals.--
The <<NOTE: Procedures. Audits.>> Secretary shall establish and maintain
procedures, including procedures for using claims processing edits,
updating eligibility information to improve provider accessibility, and
conducting recoupment activities such as through recovery audit
contractors, in order to ensure that payment is not made under this
title for items and services furnished to an individual who is one of
the following:
``(1) An individual who is incarcerated.
``(2) An individual who is not lawfully present in the
United States and who is not eligible for coverage under this
title.
``(3) A deceased individual.''.
(b) <<NOTE: 42 USC 1395kk note.>> Report.--Not later than 18 months
after the date of the enactment of this section, and periodically
thereafter as determined necessary by the Office of Inspector General of
the Department of Health and Human Services, such Office shall submit to
Congress a report on the activities described in subsection (f) of
section 1874 of the Social Security Act (42 U.S.C. 1395kk), as added by
subsection (a), that have been conducted since such date of enactment.
SEC. 503. CONSIDERATION OF MEASURES REGARDING MEDICARE BENEFICIARY
SMART CARDS.
To the extent the Secretary of Health and Human Services determines
that it is cost effective and technologically viable to use electronic
Medicare beneficiary and provider cards (such as cards that use smart
card technology, including an embedded and secure integrated circuit
chip), as presented in the Government Accountability Office report
required by the conference report accompanying the Consolidated
Appropriations Act, 2014 (Public Law 113-76), the Secretary shall
consider such measures as determined appropriate by the Secretary to
implement such use of such cards for beneficiary and provider use under
title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.). <<NOTE: Reports.>> In the case that the Secretary considers
measures under the preceding sentence, the Secretary shall submit to the
Committees on Ways and Means and Energy and Commerce of the House of
Representatives, and to the Committee on Finance of the Senate, a report
outlining the considerations undertaken by the Secretary under such
sentence.
SEC. 504. MODIFYING MEDICARE DURABLE MEDICAL EQUIPMENT FACE-TO-
FACE ENCOUNTER DOCUMENTATION REQUIREMENT.
(a) In General.--Section 1834(a)(11)(B)(ii) of the Social Security
Act (42 U.S.C. 1395m(a)(11)(B)(ii)) is amended--
[[Page 129 STAT. 166]]
(1) by striking ``the physician documenting that''; and
(2) by striking ``has had a face-to-face encounter'' and
inserting ``documenting such physician, physician assistant,
practitioner, or specialist has had a face-to-face encounter''.
(b) Implementation.--Notwithstanding any other provision of law, the
Secretary of Health and Human Services may implement the amendments made
by subsection (a) by program instruction or otherwise.
SEC. 505. REDUCING IMPROPER MEDICARE PAYMENTS.
(a) Medicare Administrative Contractor Improper Payment Outreach and
Education Program.--Section 1874A of the Social Security Act (42 U.S.C.
1395kk-1) is amended--
(1) in subsection (a)(4)--
(A) by redesignating subparagraph (G) as
subparagraph (H); and
(B) by inserting after subparagraph (F) the
following new subparagraph:
``(G) Improper payment outreach and education
program.--Having in place an improper payment outreach
and education program described in subsection (h).'';
and
(2) by adding at the end the following new subsection:
``(h) Improper Payment Outreach and Education Program.--
``(1) In general.--In order to reduce improper payments
under this title, each medicare administrative contractor shall
establish and have in place an improper payment outreach and
education program under which the contractor, through outreach,
education, training, and technical assistance or other
activities, shall provide providers of services and suppliers
located in the region covered by the contract under this section
with the information described in paragraph (2). The activities
described in the preceding sentence shall be conducted on a
regular basis.
``(2) Information to be provided through activities.--The
information to be provided under such payment outreach and
education program shall include information the Secretary
determines to be appropriate, which may include the following
information:
``(A) A list of the providers' or suppliers' most
frequent and expensive payment errors over the last
quarter.
``(B) Specific instructions regarding how to correct
or avoid such errors in the future.
``(C) A notice of new topics that have been approved
by the Secretary for audits conducted by recovery audit
contractors under section 1893(h).
``(D) Specific instructions to prevent future issues
related to such new audits.
``(E) Other information determined appropriate by
the Secretary.
``(3) Priority.--A medicare administrative contractor shall
give priority to activities under such program that will reduce
improper payments that are one or more of the following:
``(A) Are for items and services that have the
highest rate of improper payment.
``(B) Are for items and service that have the
greatest total dollar amount of improper payments.
[[Page 129 STAT. 167]]
``(C) Are due to clear misapplication or
misinterpretation of Medicare policies.
``(D) Are clearly due to common and inadvertent
clerical or administrative errors.
``(E) Are due to other types of errors that the
Secretary determines could be prevented through
activities under the program.
``(4) Information on improper payments from recovery audit
contractors.--
``(A) In general.--In order to assist medicare
administrative contractors in carrying out improper
payment outreach and education programs, the Secretary
shall provide each contractor with a complete list of
the types of improper payments identified by recovery
audit contractors under section 1893(h) with respect to
providers of services and suppliers located in the
region covered by the contract under this section. Such
information shall be provided on a time frame the
Secretary determines appropriate which may be on a
quarterly basis.
``(B) Information.--The information described in
subparagraph (A) shall include information such as the
following:
``(i) Providers of services and suppliers that
have the highest rate of improper payments.
``(ii) Providers of services and suppliers
that have the greatest total dollar amounts of
improper payments.
``(iii) Items and services furnished in the
region that have the highest rates of improper
payments.
``(iv) Items and services furnished in the
region that are responsible for the greatest total
dollar amount of improper payments.
``(v) Other information the Secretary
determines would assist the contractor in carrying
out the program.
``(5) Communications.--Communications with providers of
services and suppliers under an improper payment outreach and
education program are subject to the standards and requirements
of subsection (g).''.
(b) Use of Certain Funds Recovered by RACs.--Section 1893(h) of the
Social Security Act (42 U.S.C. 1395ddd(h)) is amended--
(1) in paragraph (2), by inserting ``or paragraph (10)''
after ``paragraph (1)(C)''; and
(2) by adding at the end the following new paragraph:
``(10) Use of certain recovered funds.--
``(A) In general.--After application of paragraph
(1)(C), the Secretary shall retain a portion of the
amounts recovered by recovery audit contractors for each
year under this section which shall be available to the
program management account of the Centers for Medicare &
Medicaid Services for purposes of, subject to
subparagraph (B), carrying out sections 1833(z),
1834(l)(16), and 1874A(a)(4)(G), carrying out section
514(b) of the Medicare Access and CHIP Reauthorization
Act of 2015, and implementing strategies (such as claims
processing edits) to help reduce the error rate of
payments under this title.
[[Page 129 STAT. 168]]
The amounts retained under the preceding sentence shall
not exceed an amount equal to 15 percent of the amounts
recovered under this subsection, and shall remain
available until expended.
``(B) Limitation.--Except for uses that support
claims processing (including edits) or system
functionality for detecting fraud, amounts retained
under subparagraph (A) may not be used for
technological-related infrastructure, capital
investments, or information systems.
``(C) No reduction in payments to recovery audit
contractors.--Nothing in subparagraph (A) shall reduce
amounts available for payments to recovery audit
contractors under this subsection.''.
SEC. 506. IMPROVING SENIOR MEDICARE PATROL AND FRAUD REPORTING
REWARDS.
(a) <<NOTE: Plans. Recommenda- tions.>> In General.--The Secretary
of Health and Human Services (in this section referred to as the
``Secretary'') shall develop a plan to revise the incentive program
under section 203(b) of the Health Insurance Portability and
Accountability Act of 1996 (42 U.S.C. 1395b-5(b)) to encourage greater
participation by individuals to report fraud and abuse in the Medicare
program. Such plan shall include recommendations for--
(1) ways to enhance rewards for individuals reporting under
the incentive program, including rewards based on information
that leads to an administrative action; and
(2) extending the incentive program to the Medicaid program.
(b) Public Awareness and Education Campaign.--The plan developed
under subsection (a) shall also include recommendations for the use of
the Senior Medicare Patrols authorized under section 411 of the Older
Americans Act of 1965 (42 U.S.C. 3032) to conduct a public awareness and
education campaign to encourage participation in the revised incentive
program under subsection (a).
(c) <<NOTE: Deadline.>> Submission of Plan.--Not later than 180
days after the date of enactment of this Act, the Secretary shall submit
to Congress the plan developed under subsection (a).
SEC. 507. REQUIRING VALID PRESCRIBER NATIONAL PROVIDER IDENTIFIERS
ON PHARMACY CLAIMS.
Section 1860D-4(c) of the Social Security Act (42 U.S.C. 1395w-
104(c)) is amended by adding at the end the following new paragraph:
``(4) Requiring valid prescriber national provider
identifiers on pharmacy claims.--
``(A) In general.--For plan year 2016 and subsequent
plan years, the Secretary shall require a claim for a
covered part D drug for a part D eligible individual
enrolled in a prescription drug plan under this part or
an MA-PD plan under part C to include a prescriber
National Provider Identifier that is determined to be
valid under the procedures established under
subparagraph (B)(i).
``(B) Procedures.--
``(i) Validity of prescriber national provider
identifiers.--
The <<NOTE: Consultation.>> Secretary, in
consultation with appropriate stakeholders, shall
establish procedures for determining the validity
of prescriber National Provider Identifiers under
subparagraph (A).
[[Page 129 STAT. 169]]
``(ii) Informing beneficiaries of reason for
denial.--The Secretary shall establish procedures
to ensure that, in the case that a claim for a
covered part D drug of an individual described in
subparagraph (A) is denied because the claim does
not meet the requirements of this paragraph, the
individual is properly informed at the point of
service of the reason for the denial.
``(C) Report.--Not later than January 1, 2018, the
Inspector General of the Department of Health and Human
Services shall submit to Congress a report on the
effectiveness of the procedures established under
subparagraph (B)(i).''.
SEC. 508. OPTION TO RECEIVE MEDICARE SUMMARY NOTICE
ELECTRONICALLY.
(a) In General.--Section 1806 of the Social Security Act (42 U.S.C.
1395b-7) is amended by adding at the end the following new subsection:
``(c) Format of Statements From Secretary.--
``(1) Electronic option beginning in 2016.--Subject to
paragraph (2), for statements described in subsection (a) that
are furnished for a period in 2016 or a subsequent year, in the
case that an individual described in subsection (a) elects, in
accordance with such form, manner, and time specified by the
Secretary, to receive such statement in an electronic format,
such statement shall be furnished to such individual for each
period subsequent to such election in such a format and shall
not be mailed to the individual.
``(2) Limitation on revocation option.--
``(A) In general.--Subject to subparagraph (B), the
Secretary may determine a maximum number of elections
described in paragraph (1) by an individual that may be
revoked by the individual.
``(B) Minimum of one revocation option.--In no case
may the Secretary determine a maximum number under
subparagraph (A) that is less than one.
``(3) <<NOTE: Effective date.>> Notification.--The
Secretary shall ensure that, in the most cost effective manner
and beginning January 1, 2017, a clear notification of the
option to elect to receive statements described in subsection
(a) in an electronic format is made available, such as through
the notices distributed under section 1804, to individuals
described in subsection (a).''.
(b) <<NOTE: 7 USC 1395b-7 note.>> Encouraged Expansion of
Electronic Statements.--To the extent to which the Secretary of Health
and Human Services determines appropriate, the Secretary shall--
(1) <<NOTE: Applicability.>> apply an option similar to the
option described in subsection (c)(1) of section 1806 of the
Social Security Act (42 U.S.C. 1395b-7) (relating to the
provision of the Medicare Summary Notice in an electronic
format), as added by subsection (a), to other statements and
notifications under title XVIII of such Act (42 U.S.C. 1395 et
seq.); and
(2) provide such Medicare Summary Notice and any such other
statements and notifications on a more frequent basis than is
otherwise required under such title.
[[Page 129 STAT. 170]]
SEC. 509. RENEWAL OF MAC CONTRACTS.
(a) In General.--Section 1874A(b)(1)(B) of the Social Security Act
(42 U.S.C. 1395kk-1(b)(1)(B)) is amended by striking ``5 years'' and
inserting ``10 years''.
(b) <<NOTE: 42 USC 1395kk-1 note.>> Application.--The amendments
made by subsection (a) shall apply to contracts entered into on or
after, and to contracts in effect as of, the date of the enactment of
this Act.
(c) Contractor Performance Transparency.--Section 1874A(b)(3)(A) of
the Social Security Act (42 U.S.C. 1395kk-1(b)(3)(A)) is amended by
adding at the end the following new clause:
``(iv) <<NOTE: Public information.>>
Contractor performance transparency.--To the
extent possible without compromising the process
for entering into and renewing contracts with
medicare administrative contractors under this
section, the Secretary shall make available to the
public the performance of each medicare
administrative contractor with respect to such
performance requirements and measurement
standards.''.
SEC. 510. STUDY ON PATHWAY FOR INCENTIVES TO STATES FOR STATE
PARTICIPATION IN MEDICAID DATA MATCH
PROGRAM.
Section 1893(g) of the Social Security Act (42 U.S.C. 1395ddd(g)) is
amended by adding at the end the following new paragraph:
``(3) Incentives for states.--The Secretary shall study and,
as appropriate, may specify incentives for States to work with
the Secretary for the purposes described in paragraph
(1)(A)(ii). The application of the previous sentence may include
use of the waiver authority described in paragraph (2).''.
SEC. 511. GUIDANCE ON APPLICATION OF COMMON RULE TO CLINICAL DATA
REGISTRIES.
Not <<NOTE: Deadline.>> later than one year after the date of the
enactment of this section, the Secretary of Health and Human Services
shall issue a clarification or modification with respect to the
application of subpart A of part 46 of title 45, Code of Federal
Regulations, governing the protection of human subjects in research (and
commonly known as the ``Common Rule''), to activities, including quality
improvement activities, involving clinical data registries, including
entities that are qualified clinical data registries pursuant to section
1848(m)(3)(E) of the Social Security Act (42 U.S.C. 1395w-4(m)(3)(E)).
SEC. 512. ELIMINATING CERTAIN CIVIL MONEY PENALTIES; GAINSHARING
STUDY AND REPORT.
(a) Eliminating Civil Money Penalties for Inducements to Physicians
To Limit Services That Are Not Medically Necessary.--
(1) In general.--Section 1128A(b)(1) of the Social Security
Act (42 U.S.C. 1320a-7a(b)(1)) is amended by inserting
``medically necessary'' after ``reduce or limit''.
(2) <<NOTE: Applicability. 42 USC 1320a-7a note.>>
Effective date.--The amendment made by paragraph (1) shall apply
to payments made on or after the date of the enactment of this
Act.
(b) <<NOTE: Consultation.>> Gainsharing Study and Report.--Not
later than 12 months after the date of the enactment of this Act, the
Secretary of Health and Human Services, in consultation with the
Inspector General of the Department of Health and Human Services, shall
[[Page 129 STAT. 171]]
submit to Congress a report with options for amending existing fraud and
abuse laws in, and regulations related to, titles XI and XVIII of the
Social Security Act (42 U.S.C. 301 et seq.), through exceptions, safe
harbors, or other narrowly targeted provisions, to permit gainsharing
arrangements that otherwise would be subject to the civil money
penalties described in paragraphs (1) and (2) of section 1128A(b) of
such Act (42 U.S.C. 1320a-7a(b)), or similar arrangements between
physicians and hospitals, and that improve care while reducing waste and
increasing efficiency. The report shall--
(1) consider whether such provisions should apply to
ownership interests, compensation arrangements, or other
relationships;
(2) describe how the recommendations address accountability,
transparency, and quality, including how best to limit
inducements to stint on care, discharge patients prematurely, or
otherwise reduce or limit medically necessary care; and
(3) consider whether a portion of any savings generated by
such arrangements (as compared to an historical benchmark or
other metric specified by the Secretary to determine the impact
of delivery and payment system changes under such title XVIII on
expenditures made under such title) should accrue to the
Medicare program under title XVIII of the Social Security Act.
SEC. 513. MODIFICATION OF MEDICARE HOME HEALTH SURETY BOND
CONDITION OF PARTICIPATION REQUIREMENT.
Section 1861(o)(7) of the Social Security Act (42 U.S.C.
1395x(o)(7)) is amended to read as follows:
``(7) provides the Secretary with a surety bond--
``(A) in a form specified by the Secretary and in an
amount that is not less than the minimum of $50,000; and
``(B) that the Secretary determines is commensurate
with the volume of payments to the home health agency;
and''.
SEC. 514. OVERSIGHT OF MEDICARE COVERAGE OF MANUAL MANIPULATION OF
THE SPINE TO CORRECT SUBLUXATION.
(a) In General.--Section 1833 of the Social Security Act (42 U.S.C.
1395l) is amended by adding at the end the following new subsection:
``(z) Medical Review of Spinal Subluxation Services.--
``(1) <<NOTE: Applicability. Effective date.>> In
general.--The Secretary shall implement a process for the
medical review (as described in paragraph (2)) of treatment by a
chiropractor described in section 1861(r)(5) by means of manual
manipulation of the spine to correct a subluxation (as described
in such section) of an individual who is enrolled under this
part and apply such process to such services furnished on or
after January 1, 2017, focusing on services such as--
``(A) services furnished by a such a chiropractor
whose pattern of billing is aberrant compared to peers;
and
``(B) services furnished by such a chiropractor who,
in a prior period, has a services denial percentage in
the 85th percentile or greater, taking into
consideration the extent that service denials are
overturned on appeal.
``(2) Medical review.--
[[Page 129 STAT. 172]]
``(A) Prior authorization medical review.--
``(i) In general.--Subject to clause (ii), the
Secretary shall use prior authorization medical
review for services described in paragraph (1)
that are furnished to an individual by a
chiropractor described in section 1861(r)(5) that
are part of an episode of treatment that includes
more than 12 services. For purposes of the
preceding sentence, an episode of treatment shall
be determined by the underlying cause that
justifies the need for services, such as a
diagnosis code.
``(ii) Ending application of prior
authorization medical review.--
The <<NOTE: Determination.>> Secretary shall end
the application of prior authorization medical
review under clause (i) to services described in
paragraph (1) by such a chiropractor if the
Secretary determines that the chiropractor has a
low denial rate under such prior authorization
medical review. The Secretary may subsequently
reapply prior authorization medical review to such
chiropractor if the Secretary determines it to be
appropriate and the chiropractor has, in the time
period subsequent to the determination by the
Secretary of a low denial rate with respect to the
chiropractor, furnished such services described in
paragraph (1).
``(iii) Early request for prior authorization
review permitted.--Nothing in this subsection
shall be construed to prevent such a chiropractor
from requesting prior authorization for services
described in paragraph (1) that are to be
furnished to an individual before the chiropractor
furnishes the twelfth such service to such
individual for an episode of treatment.
``(B) Type of review.--The Secretary may use pre-
payment review or post-payment review of services
described in section 1861(r)(5) that are not subject to
prior authorization medical review under subparagraph
(A).
``(C) Relationship to law enforcement activities.--
The Secretary may determine that medical review under
this subsection does not apply in the case where
potential fraud may be involved.
``(3) <<NOTE: Applicability.>> No payment without prior
authorization.--With respect to a service described in paragraph
(1) for which prior authorization medical review under this
subsection applies, the following shall apply:
``(A) Prior authorization determination.--The
Secretary shall make a determination, prior to the
service being furnished, of whether the service would or
would not meet the applicable requirements of section
1862(a)(1)(A).
``(B) Denial of payment.--Subject to paragraph (5),
no payment may be made under this part for the service
unless the Secretary determines pursuant to subparagraph
(A) that the service would meet the applicable
requirements of such section 1862(a)(1)(A).
``(4) Submission of information.--A chiropractor described
in section 1861(r)(5) may submit the information
[[Page 129 STAT. 173]]
necessary for medical review by fax, by mail, or by electronic
means. The Secretary shall make available the electronic means
described in the preceding sentence as soon as practicable.
``(5) <<NOTE: Deadline.>> Timeliness.--If the Secretary
does not make a prior authorization determination under
paragraph (3)(A) within 14 business days of the date of the
receipt of medical documentation needed to make such
determination, paragraph (3)(B) shall not apply.
``(6) Application of limitation on beneficiary liability.--
Where payment may not be made as a result of the application of
paragraph (2)(B), section 1879 shall apply in the same manner as
such section applies to a denial that is made by reason of
section 1862(a)(1).
``(7) Review by contractors.--The medical review described
in paragraph (2) may be conducted by medicare administrative
contractors pursuant to section 1874A(a)(4)(G) or by any other
contractor determined appropriate by the Secretary that is not a
recovery audit contractor.
``(8) <<NOTE: Applicability.>> Multiple services.--The
Secretary shall, where practicable, apply the medical review
under this subsection in a manner so as to allow an individual
described in paragraph (1) to obtain, at a single time rather
than on a service-by-service basis, an authorization in
accordance with paragraph (3)(A) for multiple services.
``(9) Construction.--With respect to a service described in
paragraph (1) that has been affirmed by medical review under
this subsection, nothing in this subsection shall be construed
to preclude the subsequent denial of a claim for such service
that does not meet other applicable requirements under this Act.
``(10) Implementation.--
``(A) <<NOTE: Regulations. Comment period.>>
Authority.--The Secretary may implement the provisions
of this subsection by interim final rule with comment
period.
``(B) Administration.--Chapter 35 of title 44,
United States Code, shall not apply to medical review
under this subsection.''.
(b) <<NOTE: 42 USC 1395l note. Consultation.>> Improving
Documentation of Services.--
(1) In general.--The Secretary of Health and Human Services
shall, in consultation with stakeholders (including the American
Chiropractic Association) and representatives of medicare
administrative contractors (as defined in section 1874A(a)(3)(A)
of the Social Security Act (42 U.S.C. 1395kk-1(a)(3)(A))),
develop educational and training programs to improve the ability
of chiropractors to provide documentation to the Secretary of
services described in section 1861(r)(5) in a manner that
demonstrates that such services are, in accordance with section
1862(a)(1) of such Act (42 U.S.C. 1395y(a)(1)), reasonable and
necessary for the diagnosis or treatment of illness or injury or
to improve the functioning of a malformed body member.
(2) <<NOTE: Public information. Deadline.>> Timing.--The
Secretary shall make the educational and training programs
described in paragraph (1) publicly available not later than
January 1, 2016.
(3) Funding.--The Secretary shall use funds made available
under paragraph (10) of section 1893(h) of the Social
[[Page 129 STAT. 174]]
Security Act (42 U.S.C. 1395ddd(h)), as added by section 505, to
carry out this subsection.
(c) GAO Study and Report.--
(1) Study.--The Comptroller General of the United States
shall conduct a study on the effectiveness of the process for
medical review of services furnished as part of a treatment by
means of manual manipulation of the spine to correct a
subluxation implemented under subsection (z) of section 1833 of
the Social Security Act (42 U.S.C. 1395l), as added by
subsection (a). Such study shall include an analysis of--
(A) aggregate data on--
(i) the number of individuals, chiropractors,
and claims for services subject to such review;
and
(ii) the number of reviews conducted under
such section; and
(B) the outcomes of such reviews.
(2) <<NOTE: Recommenda- tions.>> Report.--Not later than
four years after the date of enactment of this Act, the
Comptroller General shall submit to Congress a report containing
the results of the study conducted under paragraph (1),
including recommendations for such legislation and
administrative action with respect to the process for medical
review implemented under subsection (z) of section 1833 of the
Social Security Act (42 U.S.C. 1395l) as the Comptroller General
determines appropriate.
SEC. 515. NATIONAL EXPANSION OF PRIOR AUTHORIZATION MODEL FOR
REPETITIVE SCHEDULED NON-EMERGENT
AMBULANCE TRANSPORT.
(a) <<NOTE: State listing.>> Initial Expansion.--
(1) <<NOTE: Effective date.>> In general.--In implementing
the model described in paragraph (2) proposed to be tested under
subsection (b) of section 1115A of the Social Security Act (42
U.S.C. 1315a), the Secretary of Health and Human Services shall
revise the testing under subsection (b) of such section to
cover, effective not later than January 1, 2016, States located
in medicare administrative contractor (MAC) regions L and 11
(consisting of Delaware, the District of Columbia, Maryland, New
Jersey, Pennsylvania, North Carolina, South Carolina, West
Virginia, and Virginia).
(2) Model described.--The model described in this paragraph
is the testing of a model of prior authorization for repetitive
scheduled non-emergent ambulance transport proposed to be
carried out in New Jersey, Pennsylvania, and South Carolina.
(3) Funding.--The Secretary shall allocate funds made
available under section 1115A(f)(1)(B) of the Social Security
Act (42 U.S.C. 1315a(f)(1)(B)) to carry out this subsection.
(b) National Expansion.--Section 1834(l) of the Social Security Act
(42 U.S.C. 1395m(l)) is amended by adding at the end the following new
paragraph:
``(16) Prior authorization for repetitive scheduled non-
emergent ambulance transports.--
``(A) <<NOTE: Effective date.>> In general.--
Beginning January 1, 2017, if the expansion to all
States of the model of prior authorization described in
paragraph (2) of section 515(a) of the Medicare Access
and CHIP Reauthorization Act of 2015 meets the
requirements described in paragraphs (1) through (3) of
[[Page 129 STAT. 175]]
section 1115A(c), then the Secretary shall expand such
model to all States.
``(B) Funding.--The Secretary shall use funds made
available under section 1893(h)(10) to carry out this
paragraph.
``(C) Clarification regarding budget neutrality.--
Nothing in this paragraph may be construed to limit or
modify the application of section 1115A(b)(3)(B) to
models described in such section, including with respect
to the model described in subparagraph (A) and expanded
beginning on January 1, 2017, under such
subparagraph.''.
SEC. 516. REPEALING DUPLICATIVE MEDICARE SECONDARY PAYOR
PROVISION.
(a) In General.--Section 1862(b)(5) of the Social Security Act (42
U.S.C. 1395y(b)(5)) is amended by inserting at the end the following new
subparagraph:
``(E) End date.--The provisions of this paragraph
shall not apply to information required to be provided
on or after July 1, 2016.''.
(b) <<NOTE: Applicability. 42 USC 1395y note.>> Effective Date.--
The amendment made by subsection (a) shall take effect on the date of
the enactment of this Act and shall apply to information required to be
provided on or after January 1, 2016.
SEC. 517. PLAN FOR EXPANDING DATA IN ANNUAL CERT REPORT.
Not later than June 30, 2015, the Secretary of Health and Human
Services shall submit to the Committee on Finance of the Senate, and to
the Committees on Energy and Commerce and Ways and Means of the House of
Representatives--
(1) a plan for including, in the annual report of the
Comprehensive Error Rate Testing (CERT) program, data on
services (or groupings of services) (other than medical visits)
paid under the physician fee schedule under section 1848 of the
Social Security Act (42 U.S.C. 1395w-4) where the fee schedule
amount is in excess of $250 and where the error rate is in
excess of 20 percent; and
(2) to the extent practicable by such date, specific
examples of services described in paragraph (1).
SEC. 518. REMOVING FUNDS FOR MEDICARE IMPROVEMENT FUND ADDED BY
IMPACT ACT OF 2014.
Section 1898(b)(1) of the Social Security Act (42 U.S.C.
1395iii(b)(1)), as amended by section 3(e)(3) of the IMPACT Act of 2014
(Public Law 113-185), is amended by striking ``$195,000,000'' and
inserting ``$0''.
SEC. 519. <<NOTE: 42 USC 405 note.>> RULE OF CONSTRUCTION.
Except as explicitly provided in this subtitle, nothing in this
subtitle, including the amendments made by this subtitle, shall be
construed as preventing the use of notice and comment rulemaking in the
implementation of the provisions of, and the amendments made by, this
subtitle.
[[Page 129 STAT. 176]]
Subtitle B--Other Provisions
SEC. 521. EXTENSION OF TWO-MIDNIGHT PAMA RULES ON CERTAIN MEDICAL
REVIEW ACTIVITIES.
Section 111 of the Protecting Access to Medicare Act of 2014 (Public
Law 113-93; 42 U.S.C. 1395ddd note) is amended--
(1) in subsection (a), by striking ``the first 6 months of
fiscal year 2015'' and inserting ``through the end of fiscal
year 2015'';
(2) in subsection (b), by striking ``March 31, 2015'' and
inserting ``September 30, 2015''; and
(3) by adding at the end the following new subsection:
``(c) Construction.--Except as provided in subsections (a) and (b),
nothing in this section shall be construed as limiting the Secretary's
authority to pursue fraud and abuse activities under such section
1893(h) or otherwise.''.
SEC. 522. REQUIRING BID SURETY BONDS AND STATE LICENSURE FOR
ENTITIES SUBMITTING BIDS UNDER THE
MEDICARE DMEPOS COMPETITIVE ACQUISITION
PROGRAM.
(a) Bid Surety Bonds.--Section 1847(a)(1) of the Social Security Act
(42 U.S.C. 1395w-3(a)(1)) is amended by adding at the end the following
new subparagraphs:
``(G) <<NOTE: Time period.>> Requiring bid bonds
for bidding entities.--With respect to rounds of
competitions beginning under this subsection for
contracts beginning not earlier than January 1, 2017,
and not later than January 1, 2019, an entity may not
submit a bid for a competitive acquisition area unless,
as of the deadline for bid submission, the entity has
obtained (and provided the Secretary with proof of
having obtained) a bid surety bond (in this paragraph
referred to as a `bid bond') in a form specified by the
Secretary consistent with subparagraph (H) and in an
amount that is not less than $50,000 and not more than
$100,000 for each competitive acquisition area in which
the entity submits the bid.
``(H) Treatment of bid bonds submitted.--
``(i) For bidders that submit bids at or below
the median and are offered but do not accept the
contract.--In the case of a bidding entity that is
offered a contract for any product category for a
competitive acquisition area, if--
``(I) the entity's composite bid for
such product category and area was at or
below the median composite bid rate for
all bidding entities included in the
calculation of the single payment
amounts for such product category and
area; and
``(II) the entity does not accept
the contract offered for such product
category and area,
the bid bond submitted by such entity for such
area shall be forfeited by the entity and the
Secretary shall collect on it.
``(ii) <<NOTE: Deadline. Public
information.>> Treatment of other bidders.--In
the case of a bidding entity for any product
category for a competitive acquisition area, if
the entity does not meet the bid forfeiture
conditions in subclauses (I)
[[Page 129 STAT. 177]]
and (II) of clause (i) for any product category
for such area, the bid bond submitted by such
entity for such area shall be returned within 90
days of the public announcement of the contract
suppliers for such area.''.
(b) State Licensure.--
(1) In general.--Section 1847(b)(2)(A) of the Social
Security Act (42 U.S.C. 1395w-3(b)(2)(A)) is amended by adding
at the end the following new clause:
``(v) The entity meets applicable State
licensure requirements.''.
(2) <<NOTE: 42 USC 1395w-3 note.>> Construction.--Nothing
in the amendment made by paragraph (1) shall be construed as
affecting the authority of the Secretary of Health and Human
Services to require State licensure of an entity under the
Medicare competitive acquisition program under section 1847 of
the Social Security Act (42 U.S.C. 1395w-3) before the date of
the enactment of this Act.
(c) GAO Report on Bid Bond Impact on Small Suppliers.--
(1) Study.--The Comptroller General of the United States
shall conduct a study that evaluates the effect of the bid
surety bond requirement under the amendment made by subsection
(a) on the participation of small suppliers in the Medicare
DMEPOS competitive acquisition program under section 1847 of the
Social Security Act (42 U.S.C. 1395w-3).
(2) Report.--Not later than 6 months after the date
contracts are first awarded subject to such bid surety bond
requirement, the Comptroller General shall submit to Congress a
report on the study conducted under paragraph
(1). <<NOTE: Recommenda- tions.>> Such report shall include
recommendations for changes in such requirement in order to
ensure robust participation by legitimate small suppliers in the
Medicare DMEPOS competition acquisition program.
SEC. 523. PAYMENT FOR GLOBAL SURGICAL PACKAGES.
(a) In General.--Section 1848(c) of the Social Security Act (42
U.S.C. 1395w-4(c)) is amended by adding at the end the following new
paragraph:
``(8) Global surgical packages.--
``(A) Prohibition of implementation of rule
regarding global surgical packages.--
``(i) In general.--The Secretary shall not
implement the policy established in the final rule
published on November 13, 2014 (79 Fed. Reg. 67548
et seq.), that requires the transition of all 10-
day and 90-day global surgery packages to 0-day
global periods.
``(ii) Construction.--Nothing in clause (i)
shall be construed to prevent the Secretary from
revaluing misvalued codes for specific surgical
services or assigning values to new or revised
codes for surgical services.
``(B) Collection of data on services included in
global surgical packages.--
``(i) <<NOTE: Regulations. Deadline.>> In
general.--Subject to clause (ii), the Secretary
shall through rulemaking develop and implement a
process to gather, from a representative sample of
physicians, beginning not later than January 1,
2017, information needed to value surgical
services.
[[Page 129 STAT. 178]]
Such information shall include the number and
level of medical visits furnished during the
global period and other items and services related
to the surgery and furnished during the global
period, as appropriate. Such information shall be
reported on claims at the end of the global period
or in another manner specified by the Secretary.
For purposes of carrying out this paragraph (other
than clause (iii)), the Secretary shall transfer
from the Federal Supplemental Medical Insurance
Trust Fund under section 1841 $2,000,000 to the
Center for Medicare & Medicaid Services Program
Management Account for fiscal year 2015. Amounts
transferred under the previous sentence shall
remain available until expended.
``(ii) Reassessment and potential sunset.--
Every
4 <<NOTE: Deadline. Regulation. Determination.>> ye
ars, the Secretary shall reassess the value of the
information collected pursuant to clause (i).
Based on such a reassessment and by regulation,
the Secretary may discontinue the requirement for
collection of information under such clause if the
Secretary determines that the Secretary has
adequate information from other sources, such as
qualified clinical data registries, surgical logs,
billing systems or other practice or facility
records, and electronic health records, in order
to accurately value global surgical services under
this section.
``(iii) Inspector general audit.--The
Inspector General of the Department of Health and
Human Services shall audit a sample of the
information reported under clause (i) to verify
the accuracy of the information so reported.
``(C) Improving accuracy of pricing for surgical
services.--For <<NOTE: Effective date.>> years beginning
with 2019, the Secretary shall use the information
reported under subparagraph (B)(i) as appropriate and
other available data for the purpose of improving the
accuracy of valuation of surgical services under the
physician fee schedule under this section.''.
(b) Incentive for Reporting Information on Global Surgical
Services.--Section 1848(a) of the Social Security Act (42 U.S.C. 1395w-
4(a)) is amended by adding at the end the following new paragraph:
``(9) Information reporting on services included in global
surgical packages.--With <<NOTE: Regulations.>> respect to
services for which a physician is required to report information
in accordance with subsection (c)(8)(B)(i), the Secretary may
through rulemaking delay payment of 5 percent of the amount that
would otherwise be payable under the physician fee schedule
under this section for such services until the information so
required is reported.''.
SEC. 524. EXTENSION OF SECURE RURAL SCHOOLS AND COMMUNITY SELF-
DETERMINATION ACT OF 2000.
(a) Payments for Fiscal Years 2014 and 2015.--
(1) Payments required.--Section 101 of the Secure Rural
Schools and Community Self-Determination Act of 2000 (16
[[Page 129 STAT. 179]]
U.S.C. 7111) is amended by striking ``2013'' both places it
appears and inserting ``2015''.
(2) <<NOTE: Deadline.>> Prompt payment.--Payments for
fiscal year 2014 under title I of the Secure Rural Schools and
Community Self-Determination Act of 2000 (16 U.S.C. 7111 et
seq.), as amended by this section, shall be made not later than
45 days after the date of the enactment of this Act.
(3) Reduction in fiscal year 2014 payments on account of
previous 25- and 50-percent payments.--Section 101 of the Secure
Rural Schools and Community Self-Determination Act of 2000 (16
U.S.C. 7111) is amended by adding at the end the following new
subsection:
``(c) Special Rule for Fiscal Year 2014 Payments.--
``(1) State payment.--If an eligible county in a State that
will receive a share of the State payment for fiscal year 2014
has already received, or will receive, a share of the 25-percent
payment for fiscal year 2014 distributed to the State before the
date of the enactment of this subsection, the amount of the
State payment shall be reduced by the amount of that eligible
county's share of the 25-percent payment.
``(2) County payment.--If an eligible county that will
receive a county payment for fiscal year 2014 has already
received a 50-percent payment for that fiscal year, the amount
of the county payment shall be reduced by the amount of the 50-
percent payment.''.
(4) Shares of california state payment.--Section 103(d)(2)
of the Secure Rural Schools and Community Self-Determination Act
of 2000 (16 U.S.C. 7113(d)(2)) is amended by striking ``2013''
and inserting ``2015''.
(b) Use of Fiscal Year 2013 Elections and Reservations for Fiscal
Years 2014 and 2015.--Section 102 of the Secure Rural Schools and
Community Self-Determination Act of 2000 (16 U.S.C. 7112) is amended--
(1) in subsection (b)(1), by adding at the end the following
new subparagraph:
``(C) Effect of late payment for fiscal years 2014
and 2015.--The election otherwise required by
subparagraph (A) shall not apply for fiscal year 2014 or
2015.'';
(2) in subsection (b)(2)--
(A) <<NOTE: Effective date.>> in subparagraph (A),
by adding at the end the following new sentence: ``If
such two-fiscal year period included fiscal year 2013,
the county election to receive a share of the 25-percent
payment or 50-percent payment, as applicable, also shall
be effective for fiscal years 2014 and 2015.''; and
(B) in subparagraph (B), by striking ``2013'' the
second place it appears and inserting ``2015''; and
(3) in subsection (d)--
(A) by adding at the end of paragraph (1) the
following new subparagraph:
``(E) Effect of late payment for fiscal year 2014.--
The <<NOTE: Effective date.>> election made by an
eligible county under subparagraph (B), (C), or (D) for
fiscal year 2013, or deemed to be made by the county
under paragraph (3)(B) for that fiscal year, shall be
effective for fiscal years 2014 and 2015.''; and
[[Page 129 STAT. 180]]
(B) by adding at the end of paragraph (3) the
following new subparagraph:
``(C) Effect of late payment for fiscal year 2014.--
This paragraph does not apply for fiscal years 2014 and
2015.''.
(c) Special Projects on Federal Land.--Title II of the Secure Rural
Schools and Community Self-Determination Act of 2000 (16 U.S.C. 7121 et
seq.) is amended--
(1) in section 203(a)(1) (16 U.S.C. 7123(a)(1)), by striking
``September 30 for fiscal year 2008 (or as soon thereafter as
the Secretary concerned determines is practicable), and each
September 30 thereafter for each succeeding fiscal year through
fiscal year 2013'' and inserting ``September 30 of each fiscal
year (or a later date specified by the Secretary concerned for
the fiscal year)'';
(2) in section 204(e)(3)(B)(iii) (16 U.S.C.
7124(e)(3)(B)(iii)), by striking ``each of fiscal years 2010
through 2013'' and inserting ``fiscal year 2010 and fiscal years
thereafter'';
(3) in section 207(a) (16 U.S.C. 7127(a)), by striking
``September 30, 2008 (or as soon thereafter as the Secretary
concerned determines is practicable), and each September 30
thereafter for each succeeding fiscal year through fiscal year
2013'' and inserting ``September 30 of each fiscal year (or a
later date specified by the Secretary concerned for the fiscal
year)''; and
(4) in section 208 (16 U.S.C. 7128)--
(A) in subsection (a), by striking ``2013'' and
inserting ``2017''; and
(B) in subsection (b), by striking ``2014'' and
inserting ``2018''.
(d) County Funds.--Section 304 of the Secure Rural Schools and
Community Self-Determination Act of 2000 (16 U.S.C. 7144) is amended--
(1) in subsection (a), by striking ``2013'' and inserting
``2017''; and
(2) in subsection (b), by striking ``2014'' and inserting
``2018''.
(e) Authorization of Appropriations.--Section 402 of the Secure
Rural Schools and Community Self-Determination Act of 2000 (16 U.S.C.
7152) is amended by striking ``for each of fiscal years 2008 through
2013''.
SEC. 525. EXCLUSION FROM PAYGO SCORECARDS.
(a) Statutory Pay-As-You-Go Scorecards.--The budgetary effects of
this Act shall not be entered on either PAYGO scorecard maintained
pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010.
[[Page 129 STAT. 181]]
(b) Senate PAYGO Scorecards.--The budgetary effects of this Act
shall not be entered on any PAYGO scorecard maintained for purposes of
section 201 of S. Con. Res. 21 (110th Congress).
Approved April 16, 2015.
LEGISLATIVE HISTORY--H.R. 2:
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CONGRESSIONAL RECORD, Vol. 161 (2015):
Mar. 26, considered and passed House.
Apr. 14, considered and passed Senate.
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