[113th Congress Public Law 185]
[From the U.S. Government Publishing Office]
[[Page 1951]]
IMPROVING MEDICARE POST-ACUTE CARE TRANSFORMATION ACT OF 2014
[[Page 128 STAT. 1952]]
Public Law 113-185
113th Congress
An Act
To amend title XVIII of the Social Security Act to provide for
standardized post-acute care assessment data for quality, payment, and
discharge planning, and for other purposes. <<NOTE: Oct. 6,
2014 - [H.R. 4994]>>
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled, <<NOTE: Improving
Medicare Post-Acute Care Transformation Act of 2014.>>
SECTION 1. <<NOTE: 42 USC 1305 note.>> SHORT TITLE.
This Act may be cited as the ``Improving Medicare Post-Acute Care
Transformation Act of 2014'' or the ``IMPACT Act of 2014''.
SEC. 2. STANDARDIZATION OF POST-ACUTE CARE DATA.
(a) In General.--Title XVIII of the Social Security Act is amended
by adding at the end the following new section:
``SEC. 1899B. <<NOTE: 42 USC 1395lll.>> STANDARDIZED POST-ACUTE
CARE (PAC) ASSESSMENT DATA FOR
QUALITY, PAYMENT, AND DISCHARGE
PLANNING.
``(a) Requirement for Standardized Assessment Data.--
``(1) In general.--The Secretary shall--
``(A) require under the applicable reporting
provisions post-acute care providers (as defined in
paragraph (2)(A)) to report--
``(i) standardized patient assessment data in
accordance with subsection (b);
``(ii) data on quality measures under
subsection (c)(1); and
``(iii) data on resource use and other
measures under subsection (d)(1);
``(B) require data described in subparagraph (A) to
be standardized and interoperable so as to allow for the
exchange of such data among such post-acute care
providers and other providers and the use by such
providers of such data that has been so exchanged,
including by using common standards and definitions, in
order to provide access to longitudinal information for
such providers to facilitate coordinated care and
improved Medicare beneficiary outcomes; and
``(C) in accordance with subsections (b)(1) and
(c)(2), modify PAC assessment instruments (as defined in
paragraph (2)(B)) applicable to post-acute care
providers to--
``(i) provide for the submission of
standardized patient assessment data under this
title with respect to such providers; and
[[Page 128 STAT. 1953]]
``(ii) enable comparison of such assessment
data across all such providers to whom such data
are applicable.
``(2) Definitions.--For purposes of this section:
``(A) Post-acute care (pac) provider.--The terms
`post-acute care provider' and `PAC provider' mean--
``(i) a home health agency;
``(ii) a skilled nursing facility;
``(iii) an inpatient rehabilitation facility;
and
``(iv) a long-term care hospital (other than a
hospital classified under section
1886(d)(1)(B)(iv)(II)).
``(B) PAC assessment instrument.--The term `PAC
assessment instrument' means--
``(i) in the case of home health agencies, the
instrument used for purposes of reporting and
assessment with respect to the Outcome and
Assessment Information Set (OASIS), as described
in sections 484.55 and 484.250 of title 42, the
Code of Federal Regulations, or any successor
regulation, or any other instrument used with
respect to home health agencies for such purposes;
``(ii) in the case of skilled nursing
facilities, the resident's assessment under
section 1819(b)(3);
``(iii) in the case of inpatient
rehabilitation facilities, any Medicare
beneficiary assessment instrument established by
the Secretary for purposes of section 1886(j); and
``(iv) in the case of long-term care
hospitals, the Medicare beneficiary assessment
instrument used with respect to such hospitals for
the collection of data elements necessary to
calculate quality measures as described in the
August 18, 2011, Federal Register (76 Fed. Reg.
51754-51755), including for purposes of section
1886(m)(5)(C), or any other instrument used with
respect to such hospitals for assessment purposes.
``(C) Applicable reporting provision.--The term
`applicable reporting provision' means--
``(i) for home health agencies, section
1895(b)(3)(B)(v);
``(ii) for skilled nursing facilities, section
1888(e)(6);
``(iii) for inpatient rehabilitation
facilities, section 1886(j)(7); and
``(iv) for long-term care hospitals, section
1886(m)(5).
``(D) PAC payment system.--The term `PAC payment
system' means--
``(i) with respect to a home health agency,
the prospective payment system under section 1895;
``(ii) with respect to a skilled nursing
facility, the prospective payment system under
section 1888(e);
``(iii) with respect to an inpatient
rehabilitation facility, the prospective payment
system under section 1886(j); and
``(iv) with respect to a long-term care
hospital, the prospective payment system under
section 1886(m).
``(E) Specified application date.--The term
`specified application date' means the following:
[[Page 128 STAT. 1954]]
``(i) Quality measures.--In the case of
quality measures under subsection (c)(1)--
``(I) with respect to the domain
described in subsection (c)(1)(A)
(relating to functional status,
cognitive function, and changes in
function and cognitive function)--
``(aa) for PAC providers
described in clauses (ii) and
(iii) of paragraph (2)(A),
October 1, 2016;
``(bb) for PAC providers
described in clause (iv) of such
paragraph, October 1, 2018; and
``(cc) for PAC providers
described in clause (i) of such
paragraph, January 1, 2019;
``(II) with respect to the domain
described in subsection (c)(1)(B)
(relating to skin integrity and changes
in skin integrity)--
``(aa) for PAC providers
described in clauses (ii),
(iii), and (iv) of paragraph
(2)(A), October 1, 2016; and
``(bb) for PAC providers
described in clause (i) of such
paragraph, January 1, 2017;
``(III) with respect to the domain
described in subsection (c)(1)(C)
(relating to medication
reconciliation)--
``(aa) for PAC providers
described in clause (i) of such
paragraph, January 1, 2017; and
``(bb) for PAC providers
described in clauses (ii),
(iii), and (iv) of such
paragraph, October 1, 2018;
``(IV) with respect to the domain
described in subsection (c)(1)(D)
(relating to incidence of major falls)--
``(aa) for PAC providers
described in clauses (ii),
(iii), and (iv) of paragraph
(2)(A), October 1, 2016; and
``(bb) for PAC providers
described in clause (i) of such
paragraph, January 1, 2019; and
``(V) with respect to the domain
described in subsection (c)(1)(E)
(relating to accurately communicating
the existence of and providing for the
transfer of health information and care
preferences)--
``(aa) for PAC providers
described in clauses (ii),
(iii), and (iv) of paragraph
(2)(A), October 1, 2018; and
``(bb) for PAC providers
described in clause (i) of such
paragraph, January 1, 2019.
``(ii) Resource use and other measures.--In
the case of resource use and other measures under
subsection (d)(1)--
``(I) for PAC providers described in
clauses (ii), (iii), and (iv) of
paragraph (2)(A), October 1, 2016; and
``(II) for PAC providers described
in clause (i) of such paragraph, January
1, 2017.
``(F) Medicare beneficiary.--The term `Medicare
beneficiary' means an individual entitled to benefits
under
[[Page 128 STAT. 1955]]
part A or, as appropriate, enrolled for benefits under
part B.
``(b) Standardized Patient Assessment Data.--
``(1) Requirement for reporting assessment data.--
``(A) <<NOTE: Deadlines.>> In general.--Beginning
not later than October 1, 2018, for PAC providers
described in clauses (ii), (iii), and (iv) of subsection
(a)(2)(A) and January 1, 2019, for PAC providers
described in clause (i) of such subsection, the
Secretary shall require PAC providers to submit to the
Secretary, under the applicable reporting provisions and
through the use of PAC assessment instruments, the
standardized patient assessment data described in
subparagraph (B). The Secretary shall require such data
be submitted with respect to admission and discharge of
an individual (and may be submitted more frequently as
the Secretary deems appropriate).
``(B) Standardized patient assessment data
described.--For purposes of subparagraph (A), the
standardized patient assessment data described in this
subparagraph is data required for at least the quality
measures described in subsection (c)(1) and that is with
respect to the following categories:
``(i) Functional status, such as mobility and
self care at admission to a PAC provider and
before discharge from a PAC provider.
``(ii) Cognitive function, such as ability to
express ideas and to understand, and mental
status, such as depression and dementia.
``(iii) Special services, treatments, and
interventions, such as need for ventilator use,
dialysis, chemotherapy, central line placement,
and total parenteral nutrition.
``(iv) Medical conditions and co-morbidities,
such as diabetes, congestive heart failure, and
pressure ulcers.
``(v) Impairments, such as incontinence and an
impaired ability to hear, see, or swallow.
``(vi) Other categories deemed necessary and
appropriate by the Secretary.
``(2) Alignment of claims data with standardized patient
assessment data. <<NOTE: Deadlines.>> --To the extent
practicable, not later than October 1, 2018, for PAC providers
described in clauses (ii), (iii), and (iv) of subsection
(a)(2)(A), and January 1, 2019, for PAC providers described in
clause (i) of such subsection, the Secretary shall match claims
data with assessment data pursuant to this section for purposes
of assessing prior service use and concurrent service use, such
as antecedent hospital or PAC provider use, and may use such
matched data for such other uses as the Secretary determines
appropriate.
``(3) Replacement of certain existing data.--In the case of
patient assessment data being used with respect to a PAC
assessment instrument that duplicates or overlaps with
standardized patient assessment data within a category described
in paragraph (1), the Secretary shall, as soon as practicable,
revise or replace such existing data with the standardized data.
[[Page 128 STAT. 1956]]
``(4) Clarification.--Standardized patient assessment data
submitted pursuant to this subsection shall not be used to
require individuals to be provided post-acute care by a specific
type of PAC provider in order for such care to be eligible for
payment under this title.
``(c) Quality Measures.--
``(1) <<NOTE: Deadline. Applicability.>> Requirement for
reporting quality measures.--Not later than the specified
application date, as applicable to measures and PAC providers,
the Secretary shall specify quality measures on which PAC
providers are required under the applicable reporting provisions
to submit standardized patient assessment data described in
subsection (b)(1) and other necessary data specified by the
Secretary. Such measures shall be with respect to at least the
following domains:
``(A) Functional status, cognitive function, and
changes in function and cognitive function.
``(B) Skin integrity and changes in skin integrity.
``(C) Medication reconciliation.
``(D) Incidence of major falls.
``(E) Accurately communicating the existence of and
providing for the transfer of health information and
care preferences of an individual to the individual,
family caregiver of the individual, and providers of
services furnishing items and services to the
individual, when the individual transitions--
``(i) from a hospital or critical access
hospital to another applicable setting, including
a PAC provider or the home of the individual; or
``(ii) from a PAC provider to another
applicable setting, including a different PAC
provider, a hospital, a critical access hospital,
or the home of the individual.
``(2) Reporting through pac assessment instruments.--
``(A) In general. <<NOTE: Modification.>> --To the
extent possible, the Secretary shall require such
reporting by a PAC provider of quality measures under
paragraph (1) through the use of a PAC assessment
instrument and shall modify such PAC assessment
instrument as necessary to enable the use of such
instrument with respect to such quality measures.
``(B) <<NOTE: Federal Register, publication.>>
Limitation.--The Secretary may not make significant
modifications to a PAC assessment instrument more than
once per calendar year or fiscal year, as applicable,
unless the Secretary publishes in the Federal Register a
justification for such significant modification.
``(3) Adjustments.--
``(A) In general.--The Secretary shall consider
applying adjustments to the quality measures under this
subsection taking into consideration the studies under
section 2(d) of the IMPACT Act of 2014.
``(B) Risk adjustment.--Such quality measures shall
be risk adjusted, as determined appropriate by the
Secretary.
``(d) Resource Use and Other Measures.--
``(1) Requirement for resource use and other
measures. <<NOTE: Deadline. Applicability.>> --Not later than
the specified application date, as applicable to measures and
PAC providers, the Secretary shall specify resource use and
other measures on which PAC providers are required under the
applicable reporting provisions
[[Page 128 STAT. 1957]]
to submit any necessary data specified by the Secretary, which
may include standardized assessment data in addition to claims
data. Such measures shall be with respect to at least the
following domains:
``(A) Resource use measures, including total
estimated Medicare spending per beneficiary.
``(B) Discharge to community.
``(C) Measures to reflect all-condition risk-
adjusted potentially preventable hospital readmission
rates.
``(2) Aligning methodology adjustments for resource use
measures.--
``(A) Period of time.--With respect to the period of
time used for calculating measures under paragraph
(1)(A), the Secretary shall, to the extent the Secretary
determines appropriate, align resource use with the
methodology used for purposes of section
1886(o)(2)(B)(ii).
``(B) Geographic and other adjustments.--The
Secretary shall standardize measures with respect to the
domain described in paragraph (1)(A) for geographic
payment rate differences and payment differentials (and
other adjustments, as applicable) consistent with the
methodology published in the Federal Register on August
18, 2011 (76 Fed. Reg. 51624 through 51626), or any
subsequent modifications made to the methodology.
``(C) Medicare spending per beneficiary.--The
Secretary shall adjust, as appropriate, measures with
respect to the domain described in paragraph (1)(A) for
the factors applied under section 1886(o)(2)(B)(ii).
``(3) Adjustments.--
``(A) In general.--The Secretary shall consider
applying adjustments to the resource use and other
measures specified under this subsection with respect to
the domain described in paragraph (1)(A), taking into
consideration the studies under section 2(d) of the
IMPACT Act of 2014.
``(B) Risk adjustment.--Such resource use and other
measures shall be risk adjusted, as determined
appropriate by the Secretary.
``(e) Measurement Implementation Phases; Selection of Quality
Measures and Resource Use and Other Measures.--
``(1) Measurement implementation phases.--In the case of
quality measures specified under subsection (c)(1) and resource
use and other measures specified under subsection (d)(1), the
provisions of this section shall be implemented in accordance
with the following phases:
``(A) Initial implementation phase.--The initial
implementation phase, with respect to such a measure,
shall, in accordance with subsections (c) and (d), as
applicable, consist of--
``(i) <<NOTE: Public information.>> measure
specification, including informing the public of
the measure's numerator, denominator, exclusions,
and any other aspects the Secretary determines
necessary;
``(ii) <<NOTE: Reports.>> data collection,
including, in the case of quality measures,
requiring PAC providers to report data elements
needed to calculate such a measure; and
[[Page 128 STAT. 1958]]
``(iii) data analysis, including, in the case
of resource use and other measures, the use of
claims data to calculate such a measure.
``(B) <<NOTE: Reports.>> Second implementation
phase.--The second implementation phase, with respect to
such a measure, shall consist of the provision of
feedback reports to PAC providers, in accordance with
subsection (f).
``(C) <<NOTE: Public information.>> Third
implementation phase.--The third implementation phase,
with respect to such a measure, shall consist of public
reporting of PAC providers' performance on such measure
in accordance with subsection (g).
``(2) Consensus-based entity.--
``(A) <<NOTE: Contracts.>> In general.--Subject to
subparagraph (B), each measure specified by the
Secretary under this section shall be endorsed by the
entity with a contract under section 1890(a).
``(B) Exception.--In the case of a specified area or
medical topic determined appropriate by the Secretary
for which a feasible and practical measure has not been
endorsed by the entity with a contract under section
1890(a), the Secretary may specify a measure that is not
so endorsed as long as due consideration is given to
measures that have been endorsed or adopted by a
consensus organization identified by the Secretary.
``(3) Treatment of application of pre-rulemaking process
(measure applications partnership process).--
``(A) In general.--Subject to subparagraph (B), the
provisions of section 1890A shall apply in the case of a
quality measure specified under subsection (c) or a
resource use or other measure specified under subsection
(d).
``(B) Exceptions.--
``(i) Expedited procedures.--For purposes of
satisfying subparagraph (A), the Secretary may use
expedited procedures, such as ad-hoc reviews, as
necessary, in the case of a quality measure
specified under subsection (c) or a resource use
or other measure specified in subsection (d)
required with respect to data submissions under
the applicable reporting provisions during the 1-
year period before the specified application date
applicable to such a measure and provider
involved.
``(ii) Option to waive provisions.--The
Secretary may waive the application of the
provisions of section 1890A in the case of a
quality measure or resource use or other measure
described in clause (i), if the application of
such provisions (including through the use of an
expedited procedure described in such clause)
would result in the inability of the Secretary to
satisfy any deadline specified in this section
with respect to such measure.
``(f) Feedback Reports to PAC Providers.--
``(1) <<NOTE: Effective date.>> In general.--Beginning one
year after the specified application date, as applicable to PAC
providers and quality measures and resource use and other
measures under this section, the Secretary shall provide
confidential feedback reports to such PAC providers on the
performance of such
[[Page 128 STAT. 1959]]
providers with respect to such measures required under the
applicable provisions.
``(2) Frequency.--To the extent feasible, the Secretary
shall provide feedback reports described in paragraph (1) not
less frequently than on a quarterly basis. Notwithstanding the
previous sentence, with respect to measures described in such
paragraph that are reported on an annual basis, the Secretary
may provide such feedback reports on an annual basis.
``(g) Public Reporting of PAC Provider Performance.--
``(1) <<NOTE: Procedures.>> In general.--Subject to the
succeeding paragraphs of this subsection, the Secretary shall
provide for public reporting of PAC provider performance on
quality measures under subsection (c)(1) and the resource use
and other measures under subsection (d)(1), including by
establishing procedures for making available to the public
information regarding the performance of individual PAC
providers with respect to such measures.
``(2) Opportunity to review.--The procedures under paragraph
(1) shall ensure, including through a process consistent with
the process applied under section 1886(b)(3)(B)(viii)(VII) for
similar purposes, that a PAC provider has the opportunity to
review and submit corrections to the data and information that
is to be made public with respect to the provider prior to such
data being made public.
``(3) Timing.--Such procedures shall provide that the data
and information described in paragraph (1), with respect to a
measure and PAC provider, is made publicly available beginning
not later than two years after the specified application date
applicable to such a measure and provider.
``(4) Coordination with existing programs.--Such procedures
shall provide that data and information described in paragraph
(1) with respect to quality measures and resource use and other
measures under subsections (c)(1) and (d)(1) shall be made
publicly available consistent with the following provisions:
``(A) In the case of home health agencies, section
1895(b)(3)(B)(v)(III).
``(B) In the case of skilled nursing facilities,
sections 1819(i) and 1919(i).
``(C) In the case of inpatient rehabilitation
facilities, section 1886(j)(7)(E).
``(D) In the case of long-term care hospitals,
section 1886(m)(5)(E).
``(h) <<NOTE: Federal Register, publication.>> Removing,
Suspending, or Adding Measures.--
``(1) In general.--The Secretary may remove, suspend, or add
a quality measure or resource use or other measure described in
subsection (c)(1) or (d)(1), so long as, subject to paragraph
(2), the Secretary publishes in the Federal Register (with a
notice and comment period) a justification for such removal,
suspension, or addition.
``(2) Exception.--In the case of such a quality measure or
resource use or other measure for which there is a reason to
believe that the continued collection of such measure raises
potential safety concerns or would cause other unintended
consequences, the Secretary may promptly suspend or remove such
measure and satisfy paragraph (1) by publishing in the
[[Page 128 STAT. 1960]]
Federal Register a justification for such suspension or removal
in the next rulemaking cycle following such suspension or
removal.
``(i) Use of Standardized Assessment Data, Quality Measures, and
Resource Use and Other Measures To Inform Discharge Planning and
Incorporate Patient Preference.--
``(1) <<NOTE: Deadlines. Regulations.>> In general.--Not
later than January 1, 2016, and periodically thereafter (but not
less frequently than once every 5 years), the Secretary shall
promulgate regulations to modify conditions of participation and
subsequent interpretive guidance applicable to PAC providers,
hospitals, and critical access hospitals. Such regulations and
interpretive guidance shall require such providers to take into
account quality, resource use, and other measures under the
applicable reporting provisions (which, as available, shall
include measures specified under subsections (c) and (d), and
other relevant measures) in the discharge planning process.
Specifically, such regulations and interpretive guidance shall
address the settings to which a patient may be discharged in
order to assist subsection (d) hospitals, critical access
hospitals, hospitals described in section 1886(d)(1)(B)(v), PAC
providers, patients, and families of such patients with
discharge planning from inpatient settings, including such
hospitals, and from PAC provider
settings. <<NOTE: Procedures.>> In addition, such regulations
and interpretive guidance shall include procedures to address--
``(A) treatment preferences of patients; and
``(B) goals of care of patients.
``(2) Discharge planning.--All requirements applied pursuant
to paragraph (1) shall be used to help inform and mandate the
discharge planning process.
``(3) Clarification.--Such regulations shall not require an
individual to be provided post-acute care by a specific type of
PAC provider in order for such care to be eligible for payment
under this title.
``(j) Stakeholder Input.--Before the initial rulemaking process to
implement this section, the Secretary shall allow for stakeholder input,
such as through town halls, open door forums, and mail-box submissions.
``(k) Funding.--For purposes of carrying out this section, the
Secretary shall provide for the transfer to the Centers for Medicare &
Medicaid Services Program Management Account, from the Federal Hospital
Insurance Trust Fund under section 1817 and the Federal Supplementary
Medical Insurance Trust Fund under section 1841, in such proportion as
the Secretary determines appropriate, of $130,000,000. Fifty percent of
such amount shall be available on the date of the enactment of this
section and fifty percent of such amount shall be equally proportioned
for each of fiscal years 2015 through 2019. Such sums shall remain
available until expended.
``(l) Limitation.--There shall be no administrative or judicial
review under sections 1869 and 1878 or otherwise of the specification of
standardized patient assessment data required, the determination of
measures, and the systems to report such standardized data under this
section.
``(m) Non-Application of Paperwork Reduction Act.--Chapter 35 of
title 44, United States Code (commonly referred to as the `Paperwork
Reduction Act of 1995') shall not apply to
[[Page 128 STAT. 1961]]
this section and the sections referenced in subsection (a)(2)(B) that
require modification in order to achieve the standardization of patient
assessment data.''.
(b) Studies of Alternative PAC Payment Models.--
(1) <<NOTE: Deadline. Reports.>> MedPAC.--Using data from
the Post-Acute Payment Reform Demonstration authorized under
section 5008 of the Deficit Reduction Act of 2005 (Public Law
109-171) or other data, as available, not later than June 30,
2016, the Medicare Payment Advisory Commission shall submit to
Congress a report that evaluates and recommends features of PAC
payment systems (as defined in section 1899B(a)(2)(D) of the
Social Security Act, as added by subsection (a)) that establish,
or a unified post-acute care payment system under title XVIII of
the Social Security Act that establishes, payment rates
according to characteristics of individuals (such as cognitive
ability, functional status, and impairments) instead of
according to the post-acute care setting where the Medicare
beneficiary involved is treated. To the extent feasible, such
report shall consider the impacts of moving from PAC payment
systems (as defined in subsection (a)(2)(D) of such section
1899B) in existence as of the date of the enactment of this Act
to new post-acute care payment systems under title XVIII of the
Social Security Act.
(2) Recommendations for pac prospective payment.--
(A) <<NOTE: Consultation.>> Report by secretary.--
Not later than 2 years after the date by which the
Secretary of Health and Human Services has collected 2
years of data on quality measures under subsection (c)
of section 1899B, as added by subsection (a), the
Secretary shall, in consultation with the Medicare
Payment Advisory Commission and appropriate
stakeholders, submit to Congress a report, including--
(i) recommendations and a technical prototype,
on a post-acute care prospective payment system
under title XVIII of the Social Security Act that
would--
(I) in lieu of the rates that would
otherwise apply under PAC payment
systems (as defined in subsection
(a)(2)(D) of such section 1899B), base
payments under such title, with respect
to items and services furnished to an
individual by a PAC provider (as defined
in subsection (a)(2)(A) of such
section), according to individual
characteristics (such as cognitive
ability, functional status, and
impairments) of such individual instead
of the post-acute care setting in which
the individual is furnished such items
and services;
(II) account for the clinical
appropriateness of items and services so
furnished and Medicare beneficiary
outcomes;
(III) be designed to incorporate (or
otherwise account for) standardized
patient assessment data under section
1899B; and
(IV) further clinical integration,
such as by motivating greater
coordination around a single condition
or procedure to integrate hospital
systems with PAC providers (as so
defined).
[[Page 128 STAT. 1962]]
(ii) recommendations on which Medicare fee-
for-service regulations for post-acute care
payment systems under title XVIII of the Social
Security Act should be altered (such as the
skilled nursing facility 3-day stay and inpatient
rehabilitation facility 60 percent rule);
(iii) an analysis of the impact of the
recommended payment system described in clause (i)
on Medicare beneficiary cost-sharing, access to
care, and choice of setting;
(iv) a projection of any potential reduction
in expenditures under title XVIII of the Social
Security Act that may be attributable to the
application of the recommended payment system
described in clause (i); and
(v) a review of the value of subsection (d)
hospitals (as defined in section 1886(d)(1)(B) of
the Social Security Act (42 U.S.C.
1395ww(d)(1)(B)), hospitals described in section
1886(d)(1)(B)(v) of such Act (42 U.S.C.
1395ww(d)(1)(B)(v)), and critical access hospitals
described in section 1820(c)(2)(B) of such Act (42
U.S.C. 1395i-4(c)(2)(B)) collecting and reporting
to the Secretary standardized patient assessment
data with respect to inpatient hospital services
furnished by such a hospital or critical access
hospital to individuals who are entitled to
benefits under part A of title XVIII of such Act
or, as appropriate, enrolled for benefits under
part B of such title.
(B) <<NOTE: Recommenda- tions.>> Report by
medpac.--Not later than the first June 30th following
the date on which the report is required under
subparagraph (A), the Medicare Payment Advisory
Commission shall submit to Congress a report, including
recommendations and a technical prototype, on a post-
acute care prospective payment system under title XVIII
of the Social Security Act that would satisfy the
criteria described in subparagraph (A).
(3) Medicare beneficiary defined.--For purposes of this
subsection, the term ``Medicare beneficiary'' has the meaning
given such term in section 1899B(a)(2) of the Social Security
Act, as added by subsection (a).
(c) Payment Consequences Under the Applicable Reporting
Provisions.--
(1) Home health agencies.--Section 1895(b)(3)(B)(v) of the
Social Security Act (42 U.S.C. 1395fff(b)(3)(B)(v)) is amended--
(A) in subclause (I), by striking ``subclause (II)''
and inserting ``subclauses (II) and (IV)'';
(B) in subclause (II), by striking ``For 2007'' and
inserting ``Subject to subclause (V), for 2007'';
(C) in subclause (III), by inserting ``and subclause
(IV)(aa)'' after ``subclause (II)''; and
(D) by adding at the end the following new
subclauses:
``(IV) Submission of additional
data.--
``(aa) In general.--For the
year beginning on the specified
application date (as defined in
subsection (a)(2)(E) of section
1899B), as
[[Page 128 STAT. 1963]]
applicable with respect to home
health agencies and quality
measures under subsection (c)(1)
of such section and measures
under subsection (d)(1) of such
section, and each subsequent
year, in addition to the data
described in subclause (II),
each home health agency shall
submit to the Secretary data on
such quality measures and any
necessary data specified by the
Secretary under such subsection
(d)(1).
``(bb) Standardized patient
assessment data.--For 2019 and
each subsequent year, in
addition to such data described
in item (aa), each home health
agency shall submit to the
Secretary standardized patient
assessment data required under
subsection (b)(1) of section
1899B.
``(cc) Submission.--Data
shall be submitted under items
(aa) and (bb) in the form and
manner, and at the time,
specified by the Secretary for
purposes of this clause.
``(V) Non-duplication.--To the
extent data submitted under subclause
(IV) duplicates other data required to
be submitted under subclause (II), the
submission of such data under subclause
(IV) shall be in lieu of the submission
of such data under subclause (II). The
previous sentence shall not apply
insofar as the Secretary determines it
is necessary to avoid a delay in the
implementation of section 1899B, taking
into account the different specified
application dates under subsection
(a)(2)(E) of such section.''.
(2) Inpatient rehabilitation facilities.--Section 1886(j)(7)
of the Social Security Act (42 U.S.C. 1395ww(j)(7)) is amended--
(A) in subparagraph (A)(i), by striking
``subparagraph (C)'' and inserting ``subparagraphs (C)
and (F)'';
(B) in subparagraph (C), by striking ``For fiscal
year 2014 and each subsequent rate year'' and inserting
``Subject to subparagraph (G), for fiscal year 2014 and
each subsequent fiscal year'';
(C) in subparagraph (E), by inserting ``and
subparagraph (F)(i)'' after ``subparagraph (C)''; and
(D) by adding at the end the following new
subparagraphs:
``(F) Submission of additional data.--
``(i) <<NOTE: Effective date.>> In general.--
For the fiscal year beginning on the specified
application date (as defined in subsection
(a)(2)(E) of section 1899B), as applicable with
respect to inpatient rehabilitation facilities and
quality measures under subsection (c)(1) of such
section and measures under subsection (d)(1) of
such section, and each subsequent fiscal year, in
addition to such data on the quality measures
described in subparagraph (C), each rehabilitation
facility shall submit to the Secretary data on the
quality measures under such
[[Page 128 STAT. 1964]]
subsection (c)(1) and any necessary data specified
by the Secretary under such subsection (d)(1).
``(ii) Standardized patient assessment data.--
For fiscal year 2019 and each subsequent fiscal
year, in addition to such data described in clause
(i), each rehabilitation facility shall submit to
the Secretary standardized patient assessment data
required under subsection (b)(1) of section 1899B.
``(iii) Submission.--Such data shall be
submitted in the form and manner, and at the time,
specified by the Secretary for purposes of this
subparagraph.
``(G) Non-duplication.--To the extent data submitted
under subparagraph (F) duplicates other data required to
be submitted under subparagraph (C), the submission of
such data under subparagraph (F) shall be in lieu of the
submission of such data under subparagraph (C). The
previous sentence shall not apply insofar as the
Secretary determines it is necessary to avoid a delay in
the implementation of section 1899B, taking into account
the different specified application dates under
subsection (a)(2)(E) of such section.''.
(3) Long-term care hospitals.--Section 1886(m)(5) of the
Social Security Act (42 U.S.C. 1395ww(m)(5)) is amended--
(A) in subparagraph (A)(i), by striking
``subparagraph (C)'' and inserting ``subparagraphs (C)
and (F)'';
(B) in subparagraph (C), by striking ``For rate
year'' and inserting ``Subject to subparagraph (G), for
rate year'';
(C) in subparagraph (E), by inserting ``and
subparagraph (F)(i)'' after ``subparagraph (C)''; and
(D) by adding at the end the following new
subparagraphs:
``(F) Submission of additional data.--
``(i) <<NOTE: Effective date.>> In general.--
For the rate year beginning on the specified
application date (as defined in subsection
(a)(2)(E) of section 1899B), as applicable with
respect to long-term care hospitals and quality
measures under subsection (c)(1) of such section
and measures under subsection (d)(1) of such
section, and each subsequent rate year, in
addition to the data on the quality measures
described in subparagraph (C), each long-term care
hospital (other than a hospital classified under
subsection (d)(1)(B)(iv)(II)) shall submit to the
Secretary data on the quality measures under such
subsection (c)(1) and any necessary data specified
by the Secretary under such subsection (d)(1).
``(ii) Standardized patient assessment data.--
For rate year 2019 and each subsequent rate year,
in addition to such data described in clause (i),
each long-term care hospital (other than a
hospital classified under subsection
(d)(1)(B)(iv)(II)) shall submit to the Secretary
standardized patient assessment data required
under subsection (b)(1) of section 1899B.
``(iii) Submission.--Such data shall be
submitted in the form and manner, and at the time,
specified by the Secretary for purposes of this
subparagraph.
``(G) Non-duplication.--To the extent data submitted
under subparagraph (F) duplicates other data required to
[[Page 128 STAT. 1965]]
be submitted under subparagraph (C), the submission of
such data under subparagraph (F) shall be in lieu of the
submission of such data under subparagraph (C). The
previous sentence shall not apply insofar as the
Secretary determines it is necessary to avoid a delay in
the implementation of section 1899B, taking into account
the different specified application dates under
subsection (a)(2)(E) of such section.''.
(4) Skilled nursing facilities.--
(A) In general.--Paragraph (6) of section 1888(e) of
the Social Security Act (42 U.S.C. 1395yy(e)) is amended
to read as follows:
``(6) Reporting of assessment and quality data.--
``(A) Reduction in update for failure to report.--
``(i) <<NOTE: Effective date.>> In general.--
For fiscal years beginning with fiscal year 2018,
in the case of a skilled nursing facility that
does not submit data, as applicable, in accordance
with subclauses (II) and (III) of subparagraph
(B)(i) with respect to such a fiscal year, after
determining the percentage described in paragraph
(5)(B)(i), and after application of paragraph
(5)(B)(ii), the Secretary shall reduce such
percentage for payment rates during such fiscal
year by 2 percentage points.
``(ii) Special rule.--The application of this
subparagraph may result in the percentage
described in paragraph (5)(B)(i), after
application of paragraph (5)(B)(ii), being less
than 0.0 for a fiscal year, and may result in
payment rates under this subsection for a fiscal
year being less than such payment rates for the
preceding fiscal year.
``(iii) Noncumulative application.--Any
reduction under clause (i) shall apply only with
respect to the fiscal year involved and the
Secretary shall not take into account such
reduction in computing the payment amount under
this subsection for a subsequent fiscal year.
``(B) Assessment and measure data.--
``(i) In general.--A skilled nursing facility,
or a facility (other than a critical access
hospital) described in paragraph (7)(B), shall
submit to the Secretary, in a manner and within
the timeframes prescribed by the Secretary--
``(I) subject to clause (iii), the
resident assessment data necessary to
develop and implement the rates under
this subsection;
``(II) for fiscal years beginning on
or after the specified application date
(as defined in subsection (a)(2)(E) of
section 1899B), as applicable with
respect to skilled nursing facilities
and quality measures under subsection
(c)(1) of such section and measures
under subsection (d)(1) of such section,
data on such quality measures under such
subsection (c)(1) and any necessary data
specified by the Secretary under such
subsection (d)(1); and
``(III) <<NOTE: Effective date.>>
for fiscal years beginning on or after
October 1, 2018, standardized patient
assessment
[[Page 128 STAT. 1966]]
data required under subsection (b)(1) of
section 1899B.
``(ii) Use of standard instrument.--For
purposes of meeting the requirement under clause
(i), a skilled nursing facility, or a facility
(other than a critical access hospital) described
in paragraph (7)(B), may submit the resident
assessment data required under section 1819(b)(3),
using the standard instrument designated by the
State under section 1819(e)(5).
``(iii) Non-duplication.--To the extent data
submitted under subclause (II) or (III) of clause
(i) duplicates other data required to be submitted
under clause (i)(I), the submission of such data
under such a subclause shall be in lieu of the
submission of such data under clause (i)(I). The
previous sentence shall not apply insofar as the
Secretary determines it is necessary to avoid a
delay in the implementation of section 1899B,
taking into account the different specified
application dates under subsection (a)(2)(E) of
such section.''.
(B) Funding for nursing home compare website.--
Section 1819(i) of the Social Security Act (42 U.S.C.
1395i-3(i)) is amended by adding at the end the
following new paragraph:
``(3) Funding.--The Secretary shall transfer to the Centers
for Medicare & Medicaid Services Program Management Account,
from the Federal Hospital Insurance Trust Fund under section
1817 a one-time allocation of $11,000,000. <<NOTE: Availability
date.>> The amount shall be available on the date of the
enactment of this paragraph. Such sums shall remain available
until expended. Such sums shall be used to implement section
1128I(g).''.
(d) <<NOTE: 42 USC 1395lll note.>> Improving Payment Accuracy Under
the PAC Payment Systems and Other Medicare Payment Systems.--
(1) Studies and reports of effect of certain information on
quality and resource use.--
(A) Study using existing medicare data.--
(i) Study.--The Secretary of Health and Human
Services (in this subsection referred to as the
``Secretary'') shall conduct a study that examines
the effect of individuals' socioeconomic status on
quality measures and resource use and other
measures for individuals under the Medicare
program under title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.) (such as to recognize
that less healthy individuals may require more
intensive interventions). The study shall use
information collected on such individuals in
carrying out such program, such as urban and rural
location, eligibility for Medicaid under title XIX
of such Act (42 U.S.C. 1396 et seq.) (recognizing
and accounting for varying Medicaid eligibility
across States), and eligibility for benefits under
the supplemental security income (SSI) program.
The Secretary shall carry out this paragraph
acting through the Assistant Secretary for
Planning and Evaluation.
(ii) Report.--Not later than 2 years after the
date of the enactment of this Act, the Secretary
shall submit
[[Page 128 STAT. 1967]]
to Congress a report on the study conducted under
clause (i).
(B) Study using other data.--
(i) Study.--The Secretary shall conduct a
study that examines the impact of risk factors,
such as those described in section 1848(p)(3) of
the Social Security Act (42 U.S.C. 1395w-4(p)(3)),
race, health literacy, limited English proficiency
(LEP), and Medicare beneficiary activation, on
quality measures and resource use and other
measures under the Medicare program (such as to
recognize that less healthy individuals may
require more intensive interventions). In
conducting such study the Secretary may use
existing Federal data and collect such additional
data as may be necessary to complete the study.
(ii) Report.--Not later than 5 years after the
date of the enactment of this Act, the Secretary
shall submit to Congress a report on the study
conducted under clause (i).
(C) Examination of data in conducting studies.--In
conducting the studies under subparagraphs (A) and (B),
the Secretary shall examine what non-Medicare data sets,
such as data from the American Community Survey (ACS),
can be useful in conducting the types of studies under
such paragraphs and how such data sets that are
identified as useful can be coordinated with Medicare
administrative data in order to improve the overall data
set available to do such studies and for the
administration of the Medicare program.
(D) Recommendations to account for information in
payment adjustment mechanisms.--If the studies conducted
under subparagraphs (A) and (B) find a relationship
between the factors examined in the studies and quality
measures and resource use and other measures, then the
Secretary shall also provide recommendations for how the
Centers for Medicare & Medicaid Services should--
(i) obtain access to the necessary data (if
such data is not already being collected) on such
factors, including recommendations on how to
address barriers to the Centers in accessing such
data; and
(ii) account for such factors--
(I) in quality measures, resource
use measures, and other measures under
title XVIII of the Social Security Act
(including such measures specified under
subsections (c) and (d) of section 1899B
of such Act, as added by subsection
(a)); and
(II) in determining payment
adjustments based on such measures in
other applicable provisions of such
title.
(E) Funding.--There are hereby appropriated to the
Secretary from the Federal Hospital Insurance Trust Fund
under section 1817 of the Social Security Act (42 U.S.C.
1395i) and the Federal Supplementary Medical Insurance
Trust Fund under section 1841 of such Act (42 U.S.C.
1395t) (in proportions determined appropriate by the
Secretary) to carry out this paragraph $6,000,000, to
remain available until expended.
[[Page 128 STAT. 1968]]
(2) CMS activities.--
(A) In general.--Taking into account the relevant
studies conducted and recommendations made in reports
under paragraph (1) 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 factors--
(i) assess appropriate adjustments to quality
measures, resource use measures, and other
measures under title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.) (including measures
specified in subsections (c) and (d) of section
1899B of such Act, as added by subsection (a));
and
(ii) assess and implement appropriate
adjustments to payments under such title based on
measures described in clause (i).
(B) Accessing data.--The Secretary shall collect or
otherwise obtain access to the data necessary to carry
out this paragraph through existing and new data
sources.
(C) Periodic analyses.--The Secretary shall carry
out periodic analyses, at least every 3 years, based on
the factors referred to in subparagraph (A) so as to
monitor changes in possible relationships.
(D) Funding.--There are hereby appropriated to the
Secretary from the Federal Hospital Insurance Trust Fund
under section 1817 of the Social Security Act (42 U.S.C.
1395i) and the Federal Supplementary Medical Insurance
Trust Fund under section 1841 of such Act (42 U.S.C.
1395t) (in proportions determined appropriate by the
Secretary) to carry out this paragraph $10,000,000, to
remain available until expended.
(3) Strategic plan for accessing race and ethnicity
data. <<NOTE: Deadline.>> --Not later than 18 months after the
date of the enactment of this Act, the Secretary shall develop
and report to Congress on a strategic plan for collecting or
otherwise accessing data on race and ethnicity for purposes of
specifying quality measures and resource use and other measures
under subsections (c) and (d) of section 1899B of the Social
Security Act, as added by subsection (a), and, as the Secretary
determines appropriate, other similar provisions of, including
payment adjustments under, title XVIII of such Act (42 U.S.C.
1395 et seq.).
SEC. 3. HOSPICE CARE.
(a) Hospice Survey Requirement.--
(1) In general.--Section 1861(dd)(4) of the Social Security
Act (42 U.S.C. 1395x(dd)(4)) is amended by adding at the end the
following new subparagraph:
``(C) <<NOTE: Effective date. Time period.>> Any entity that is
certified as a hospice program shall be subject to a standard survey by
an appropriate State or local survey agency, or an approved
accreditation agency, as determined by the Secretary, not less
frequently than once every 36 months beginning 6 months after the date
of the enactment of this subparagraph and ending September 30, 2025.''.
(2) Funding.--For purposes of carrying out subparagraph (C)
of section 1861(dd)(4) of the Social Security Act (42 U.S.C.
[[Page 128 STAT. 1969]]
1395x(dd)(4)), as added by paragraph (1), there shall be
transferred from the Federal Hospital Insurance Trust Fund under
section 1817 of such Act (42 U.S.C. 1395i) to the Centers for
Medicare & Medicaid Services Program Management Account--
(A) $25,000,000 for fiscal years 2015 through 2017,
to be made available for such purposes in equal parts
for each such fiscal year; and
(B) $45,000,000 for fiscal years 2018 through 2025,
to be made available for such purposes in equal parts
for each such fiscal year.
(b) Hospice Program Eligibility Recertification Technical Correction
to Apply Limitation on Liability of Beneficiary Rules.--Section 1879 of
the Social Security Act (42 U.S.C. 1395pp) is amended by adding at the
end the following new subsection:
``(i) The provisions of this section shall apply with respect to a
denial of a payment under this title by reason of section 1814(a)(7)(E)
in the same manner as such provisions apply with respect to a denial of
a payment under this title by reason of section 1862(a)(1).''.
(c) Revision to Requirement for Medical Review of Certain Hospice
Care.--Section 1814(a)(7) of the Social Security Act (42 U.S.C.
1395f(a)(7)) is amended--
(1) in subparagraph (C), by striking ``and'' at the end;
(2) in subparagraph (D), in the matter preceding clause (i),
by inserting ``(and, in the case of clause (ii), before the date
of enactment of subparagraph (E))'' after ``2011''; and
(3) by adding at the end the following new subparagraph:
``(E) on and after the date of enactment of this
subparagraph, in the case of hospice care provided an
individual for more than 180 days by a hospice program
for which the number of such cases for such program
comprises more than a percent (specified by the
Secretary) of the total number of all cases of
individuals provided hospice care by the program under
this title, the hospice care provided to such individual
is medically reviewed (in accordance with procedures
established by the Secretary); and''.
(d) Update of Hospice Aggregate Payment Cap.--Section 1814(i)(2)(B)
of the Social Security Act (42 U.S.C. 1395f(i)(2)(B)) is amended--
(1) by striking ``(B) For purposes'' and inserting ``(B)(i)
Except as provided in clause (ii), for purposes''; and
(2) by adding at the end the following:
``(ii) <<NOTE: Time period.>> For purposes of subparagraph (A) for
accounting years that end after September 30, 2016, and before October
1, 2025, the `cap amount' is the cap amount under this subparagraph for
the preceding accounting year updated by the percentage update to
payment rates for hospice care under paragraph (1)(C) for services
furnished during the fiscal year beginning on the October 1 preceding
the beginning of the accounting year (including the application of any
productivity or other adjustment under clause (iv) of that paragraph).
``(iii) For accounting years that end after September 30, 2025, the
cap amount shall be computed under clause (i) as if clause (ii) had
never applied.''.
(e) Medicare Improvement Fund.--Section 1898 of the Social Security
Act (42 U.S.C. 1395iii) is amended--
[[Page 128 STAT. 1970]]
(1) by amending the heading to read as follows: ``medicare
improvement fund'';
(2) by amending subsection (a) to read as follows:
``(a) Establishment.--The Secretary shall establish under this title
a Medicare Improvement Fund (in this section referred to as the `Fund')
which shall be available to the Secretary to make improvements under the
original Medicare fee-for-service program under parts A and B for
individuals entitled to, or enrolled for, benefits under part or
enrolled under part B including adjustments to payments for items and
services furnished by providers of services and suppliers under such
original Medicare fee-for-service program.'';
(3) in subsection (b)(1), by striking ``during'' and all
that follows and inserting ``during and after fiscal year 2020,
$195,000,000.''; and
(4) in subsection (b)(2), by striking ``from the Federal''
and all that follows and inserting ``from the Federal Hospital
Insurance Trust Fund and the Federal Supplementary Medical
Insurance Trust Fund in such proportion as the Secretary
determines appropriate.''.
Approved October 6, 2014.
LEGISLATIVE HISTORY--H.R. 4994:
---------------------------------------------------------------------------
CONGRESSIONAL RECORD, Vol. 160 (2014):
Sept. 16, considered and passed House.
Sept. 18, considered and passed Senate.
<all>