I 

115TH CONGRESS 

2D SESSION H. R. 4987 

To amend title XVIII of the Social Security Act to provide for technical 

amendments to the Merit-based Incentive Payment System under Medicare. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 8, 2018 

Mr. BURGESS (for himself, Mr. GENE GREEN of Texas, Mr. ROSKAM, and Mr. 

LEVIN) introduced the following bill; which was referred to the Committee 

on Energy and Commerce, and in addition to the Committee on Ways 

and Means, for a period to be subsequently determined by the Speaker, 

in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for technical amendments to the Merit-based Incentive 

Payment System under Medicare. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. TECHNICAL AMENDMENTS TO PUBLIC LAW 114– 

4 10. 

5 (a) MIPS TRANSITION.—Section 1848 of the Social 

6 Security Act (42 U.S.C. 1395w–4) is amended— 

7 (1) in subsection (q)— 

8 (A) in paragraph (1)— 


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1 (i) in subparagraph (B), by striking 

2 ‘‘items and services’’ and inserting ‘‘cov3 ered professional services (as defined in 

4 subsection (k)(3)(A))’’; and 

5 (ii) in subparagraph (C)(iv)— 

6 (I) by amending subclause (I) to 

7 read as follows: 

8 ‘‘(I) The minimum number (as 

9 determined by the Secretary) of— 

10 ‘‘(aa) for performance peri11 ods beginning before January 1, 

12 2018, individuals enrolled under 

13 this part who are treated by the 

14 eligible professional for the per15 formance period involved; and 

16 ‘‘(bb) for performance peri17 ods beginning on or after Janu18 ary 1, 2018, individuals enrolled 

19 under this part who are fur20 nished covered professional serv21 ices (as defined in subsection 

22 (k)(3)(A)) by the eligible profes23 sional for the performance period 

24 involved.’’; 


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1 (II) in subclause (II), by striking 

2 ‘‘items and services’’ and inserting 

3 ‘‘covered professional services (as de4 fined in subsection (k)(3)(A))’’; and 

5 (III) by amending subclause (III) 

6 to read as follows: 

7 ‘‘(III) The minimum amount (as 

8 determined by the Secretary) of— 

9 ‘‘(aa) for performance peri10 ods beginning before January 1, 

11 2018, allowed charges billed by 

12 such professional under this part 

13 for such performance period; and 

14 ‘‘(bb) for performance peri15 ods beginning on or after Janu16 ary 1, 2018, allowed charges for 

17 covered professional services (as 

18 defined in subsection (k)(3)(A)) 

19 billed by such professional for 

20 such performance period.’’; 

21 (B) in paragraph (5)(D)— 

22 (i) in clause (i)(I), by inserting ‘‘sub23 ject to clause (iii),’’ after ‘‘clauses (i) and 

24 (ii) of paragraph (2)(A),’’; and 


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1 (ii) by adding at the end the following 

2 new clause: 

3 ‘‘(iii) TRANSITION YEARS.—For each 

4 of the second, third, fourth, and fifth years 

5 for which the MIPS applies to payments, 

6 the performance score for the performance 

7 category described in paragraph (2)(A)(ii) 

8 shall not take into account the improve9 ment of the professional involved.’’; 

10 (C) in paragraph (5)(E)— 

11 (i) in clause (i)(I)(bb)— 

12 (I) in the heading by striking 

13 ‘‘FIRST 2 YEARS’’ and inserting 

14 ‘‘FIRST 5 YEARS’’; and 

15 (II) by striking ‘‘the first and 

16 second years’’ and inserting ‘‘each of 

17 the first through fifth years’’; and 

18 (ii) in clause (i)(II)(bb)— 

19 (I) in the heading, by striking ‘‘2

20 YEARS’’ and inserting ‘‘5 YEARS’’; and 

21 (II) by striking the second sen22 tence and inserting the following new 

23 sentences: ‘‘For each of the second, 

24 third, fourth, and fifth years for 

25 which the MIPS applies to payments, 


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1 not less than 10 percent and not more 

2 than 30 percent of such score shall be 

3 based on performance with respect to 

4 the category described in clause (ii) of 

5 paragraph (2)(A). Nothing in the pre6 vious sentence shall be construed, with 

7 respect to a performance period for a 

8 year described in the previous sen9 tence, as preventing the Secretary 

10 from basing 30 percent of such score 

11 for such year with respect to the cat12 egory described in such clause (ii), if 

13 the Secretary determines, based on in14 formation posted under subsection 

15 (r)(2)(I) that sufficient resource use 

16 measures are ready for adoption for 

17 use under the performance category 

18 under paragraph (2)(A)(ii) for such 

19 performance period.’’; 

20 (D) in paragraph (6)(D)— 

21 (i) in clause (i), in the second sen22 tence, by striking ‘‘Such performance 

23 threshold’’ and inserting ‘‘Subject to 

24 clauses (iii) and (iv), such performance 

25 threshold’’; 


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1 (ii) in clause (ii)— 

2 (I) in the first sentence, by in3 serting ‘‘(beginning with 2019 and 

4 ending with 2024)’’ after ‘‘for each 

5 year of the MIPS’’; and 

6 (II) in the second sentence, by 

7 inserting ‘‘subject to clause (iii),’’ 

8 after ‘‘For each such year,’’; 

9 (iii) in clause (iii)— 

10 (I) in the heading, by striking 

11 ‘‘2’’ and inserting ‘‘5’’; and 

12 (II) in the first sentence, by 

13 striking ‘‘two years’’ and inserting 

14 ‘‘five years’’; and 

15 (iv) by adding at the end the following 

16 new clause: 

17 ‘‘(iv) ADDITIONAL SPECIAL RULE FOR

18 THIRD, FOURTH AND FIFTH YEARS OF

19 MIPS.—For purposes of determining MIPS 

20 adjustment factors under subparagraph 

21 (A), in addition to the requirements speci22 fied in clause (iii), the Secretary shall in23 crease the performance threshold with re24 spect to each of the third, fourth, and fifth 

25 years to which the MIPS applies to ensure 


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1 a gradual and incremental transition to the 

2 performance threshold described in clause 

3 (i) (as estimated by the Secretary) with re4 spect to the sixth year to which the MIPS 

5 applies.’’; 

6 (E) in paragraph (6)(E)— 

7 (i) by striking ‘‘In the case of items 

8 and services’’ and inserting ‘‘In the case of 

9 covered professional services (as defined in 

10 subsection (k)(3)(A))’’; and 

11 (ii) by striking ‘‘under this part with 

12 respect to such items and services’’ and in13 serting ‘‘under this part with respect to 

14 such covered professional services’’; and 

15 (F) in paragraph (7), in the first sentence, 

16 by striking ‘‘items and services’’ and inserting 

17 ‘‘covered professional services (as defined in 

18 subsection (k)(3)(A))’’; 

19 (2) in subsection (r)(2), by adding at the end 

20 the following new subparagraph: 

21 ‘‘(I) INFORMATION.—The Secretary shall, 

22 not later than December 31st of each year (be23 ginning with 2018), post on the Internet 

24 website of the Centers for Medicare & Medicaid 

25 Services information on resource use measures 


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1 in use under subsection (q), resource use meas2 ures under development and the time-frame for 

3 such development, potential future resource use 

4 measure topics, a description of stakeholder en5 gagement, and the percent of expenditures 

6 under part A and this part that are covered by 

7 resource use measures.’’; and 

8 (3) in subsection (s)(5)(B), by striking ‘‘section 

9 1833(z)(2)(C)’’ and inserting ‘‘section 

10 1833(z)(3)(D)’’. 

11 (b) PHYSICIAN-FOCUSED PAYMENT MODEL TECH12 NICAL ADVISORY COMMITTEE PROVISION OF INITIAL

13 PROPOSAL FEEDBACK.—Section 1868(c)(2)(C) of the So14 cial Security Act (42 U.S.C. 1395ee(c)(2)(C)) is amended 

15 to read as follows: 

16 ‘‘(C) COMMITTEE REVIEW OF MODELS

17 SUBMITTED.—The Committee, on a periodic 

18 basis— 

19 ‘‘(i) shall review models submitted 

20 under subparagraph (B); 

21 ‘‘(ii) may provide individuals and 

22 stakeholder entities who submitted such 

23 models with— 

24 ‘‘(I) initial feedback on such 

25 models regarding the extent to which 


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1 such models meet the criteria de2 scribed in subparagraph (A); and 

3 ‘‘(II) an explanation of the basis 

4 for the feedback provided under sub5 clause (I); and 

6 ‘‘(iii) shall prepare comments and rec7 ommendations regarding whether such 

8 models meet the criteria described in sub9 paragraph (A) and submit such comments 

10 and recommendations to the Secretary.’’. 

Æ 


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