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[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2810 Introduced in House (IH)]

113th CONGRESS
  1st Session
                                H. R. 2810

     To amend title XVIII of the Social Security Act to reform the 
sustainable growth rate and Medicare payment for physicians' services, 
                        and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             July 24, 2013

   Mr. Burgess (for himself, Mr. Pallone, Mr. Upton, Mr. Waxman, Mr. 
   Pitts, and Mr. Dingell) introduced the following bill; which was 
 referred to the Committee on Energy and Commerce, and in addition to 
the Committees on Ways and Means and the Judiciary, 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 reform the 
sustainable growth rate and Medicare payment for physicians' services, 
                        and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare Patient 
Access and Quality Improvement Act of 2013''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Reform of sustainable growth rate (SGR) and Medicare payment 
                            for physicians' services.
Sec. 3. Expanding availability of Medicare data.
Sec. 4. Encouraging care coordination and medical homes.
Sec. 5. Miscellaneous.

SEC. 2. REFORM OF SUSTAINABLE GROWTH RATE (SGR) AND MEDICARE PAYMENT 
              FOR PHYSICIANS' SERVICES.

    (a) Stabilizing Fee Updates (Phase I).--
            (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), by inserting ``or 
                        a subsequent paragraph or section 1848A'' after 
                        ``paragraph (4)''; and
                            (ii) in paragraph (4)--
                                    (I) in the heading, by striking 
                                ``years beginning with 2001'' and 
                                inserting ``2001, 2002, and 2003''; and
                                    (II) in subparagraph (A), by 
                                striking ``a year beginning with 2001'' 
                                and inserting ``2001, 2002, and 2003''; 
                                and
                    (B) in subsection (f)--
                            (i) in paragraph (1)(B), by inserting 
                        ``through 2013'' after ``of such succeeding 
                        year''; and
                            (ii) in paragraph (2), by inserting ``and 
                        ending with 2013'' after ``beginning with 
                        2000''.
            (2) Update of rates for 2014 through 2018.--Subsection (d) 
        of section 1848 of the Social Security Act (42 U.S.C. 1395w-4) 
        is amended by adding at the end the following new paragraph:
            ``(15) Update for 2014 through 2018.--The update to the 
        single conversion factor established in paragraph (1)(C) for 
        each of 2014 through 2018 shall be 0.5 percent.''.
    (b) Quality Update Incentive Program (Phase II).--
            (1) In general.--Section 1848 of the Social Security Act 
        (42 U.S.C. 1395w-4), as amended by subsection (a), is further 
        amended--
                    (A) in subsection (d), by adding at the end the 
                following new paragraph:
            ``(16) Update beginning with 2019.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                update to the single conversion factor established in 
                paragraph (1)(C) for each year beginning with 2019 
                shall be 0.5 percent.
                    ``(B) Adjustment.--In the case of an eligible 
                professional (as defined in subsection (k)(3)) who does 
                not have a payment arrangement described in section 
                1848A(a) in effect, the update under subparagraph (A) 
                for a year beginning with 2019 shall be adjusted by the 
                applicable quality adjustment determined under 
                subsection (q)(3) for the year involved.''; and
                    (B) in subsection (i)(1)--
                            (i) by striking ``and'' at the end of 
                        subparagraph (D);
                            (ii) by striking the period at the end of 
                        subparagraph (E) and inserting ``, and''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(F) the implementation of subsection (q).''.
            (2) Enhancing physician quality reporting system to support 
        quality update incentive program.--Section 1848 of the Social 
        Security Act (42 U.S.C. 1395w-4) is amended--
                    (A) in subsection (k)(1), in the first sentence, by 
                inserting ``and, if applicable, clinical practice 
                improvement activities,'' after ``quality measures'';
                    (B) in subsection (k)(2)--
                            (i) in subparagraph (C)--
                                    (I) in the subparagraph heading, by 
                                striking ``and subsequent years'' and 
                                inserting ``through 2018''; and
                                    (II) in clause (i), by inserting 
                                ``(before 2019)'' after ``subsequent 
                                year'';
                            (ii) by redesignating subparagraph (D) as 
                        subparagraph (E);
                            (iii) by inserting after subparagraph (C) 
                        the following new subparagraph:
                    ``(D) For 2019 and subsequent years.--For purposes 
                of reporting data on quality measures and, as 
                applicable clinical practice improvement activities, 
                for covered professional services furnished during the 
                performance period (as defined in subsection (q)(2)(B)) 
                with respect to 2019 and the performance period with 
                respect to each subsequent year, subject to subsection 
                (q)(1)(D), the quality measures and clinical practice 
                improvement activities specified under this paragraph 
                shall be, with respect to an eligible professional, the 
                quality measures and, as applicable, clinical practice 
                improvement activities within the final core measure 
                set under paragraph (9)(F) applicable to the peer 
                cohort of such provider and year involved.''; and
                            (iv) in subparagraph (E), as redesignated 
                        by subparagraph (B)(ii) of this paragraph, by 
                        striking ``and subsequent years'';
                    (C) in subsection (k)(3)--
                            (i) in the paragraph heading, by striking 
                        ``Covered professional services and eligible 
                        professionals defined'' and inserting 
                        ``Definitions''; and
                            (ii) by adding at the end the following new 
                        subparagraphs:
                    ``(C) Clinical practice improvement activities.--
                The term `clinical practice improvement activity' 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) Eligible professional organization.--The term 
                `eligible professional organization' means a 
                professional organization that is recognized by the 
                American Board of Medical Specialties, American 
                Osteopathic Association, American Board of Physician 
                Specialties, or an equivalent certification board.
                    ``(E) Peer cohort.--The term `peer cohort' means a 
                peer cohort identified on the list under paragraph 
                (9)(B), as updated under clause (ii) of such 
                paragraph.'';
                    (D) in subsection (k)(7), by striking `` and the 
                application of paragraphs (4) and (5)'' and inserting 
                ``, the application of paragraphs (4) and (5), and the 
                implementation of paragraph (9)'';
                    (E) by adding at the end of subsection (k) the 
                following new paragraph:
            ``(9) Establishment of final core measure sets.--
                    ``(A) In general.--Under the system under this 
                subsection--
                            ``(i) for each peer cohort identified under 
                        subparagraph (B) and in accordance with this 
                        paragraph, there shall be published a final 
                        core measure set under subparagraph (F), which 
                        shall consist of quality measures and may also 
                        consist of clinical practice improvement 
                        activities, with respect to which eligible 
                        professionals shall, subject to subsection 
                        (m)(3)(C), be assessed for purposes of 
                        determining, for years beginning with 2019, the 
                        quality adjustment under subsection (q)(3) 
                        applicable to such professionals; and
                            ``(ii) each eligible professional shall 
                        self-identify, in accordance with subparagraph 
                        (B), within such a peer cohort for purposes of 
                        such assessments.
                    ``(B) Peer cohorts.--The Secretary shall identify 
                (and publish a list of) peer cohorts by which eligible 
                professionals shall self-identify for purposes of this 
                subsection and subsection (q) with respect to a 
                performance period (as defined in subsection (q)(2)(B)) 
                for a year beginning with 2019. For purposes of this 
                subsection and subsection (q), the Secretary shall 
                develop one or more peer cohorts for multispecialty 
                groups, each of which shall be included as a peer 
                cohort under this subparagraph. Such self-
                identification will be made through such a process and 
                at such time as specified under the system under this 
                subsection. Such list--
                            ``(i) shall include, as peer cohorts, 
                        provider specialties defined by the American 
                        Board of Medical Specialties or equivalent 
                        certification boards and such other cohorts as 
                        established under this section in order to 
                        capture classifications of providers across 
                        eligible professional organizations and other 
                        practice areas, groupings, or categories; and
                            ``(ii) shall be updated from time to time.
                    ``(C) Quality measures for core measure sets.--
                            ``(i) Development.--Under the system under 
                        this subsection there shall be established a 
                        process for the development of quality measures 
                        under this subparagraph for purposes of 
                        potential inclusion of such measures in core 
                        measure sets under this paragraph. Under such 
                        process--
                                    ``(I) there shall be coordination, 
                                to the extent possible, across 
                                organizations developing such measures;
                                    ``(II) eligible professional 
                                organizations and other relevant 
                                stakeholders may submit best practices 
                                and clinical practice guidelines for 
                                the development of quality measures 
                                that address quality domains (as 
                                defined under clause (ii)) for 
                                potential inclusion in such core 
                                measure sets;
                                    ``(III) there is encouraged to be 
                                developed, as appropriate, meaningful 
                                outcome measures (or quality of life 
                                measures in cases for which outcomes 
                                may not be a valid measurement), 
                                functional status measures, and patient 
                                experience measures; and
                                    ``(IV) measures developed under 
                                this clause shall be developed, to the 
                                extent possible, in accordance with 
                                best practices and clinical practice 
                                guidelines.
                            ``(ii) Quality domains.--For purposes of 
                        this paragraph, 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.
                    ``(D) Process for establishing core measure sets.--
                            ``(i) In general.--Under the system under 
                        this subsection, for purposes of subparagraph 
                        (A), there shall be established a process to 
                        approve final core measure sets under this 
                        paragraph for peer cohorts. Each such final 
                        core measure set shall be composed of quality 
                        measures (and, as applicable, clinical practice 
                        improvement activities) with respect to which 
                        eligible professionals within such peer cohort 
                        shall report under this subsection and be 
                        assessed under subsection (q). Such process 
                        shall provide--
                                    ``(I) for the establishment of 
                                criteria, which shall be made publicly 
                                available before the request is made 
                                under clause (ii), for selecting such 
                                measures and activities for potential 
                                inclusion in such a final core measure 
                                set; and
                                    ``(II) that all peer cohorts, and 
                                to the extent practicable all quality 
                                domains, are addressed by measures and, 
                                as applicable, clinical practice 
                                improvement activities selected to be 
                                included in a core measure set under 
                                this paragraph, which may include 
                                through the use of such a measure or 
                                clinical practice improvement activity 
                                that addresses more than one such 
                                domain or cohort.
                            ``(ii) Solicitation of public input on 
                        quality measures and clinical practice 
                        improvement activities.--Under the process 
                        established under clause (i), relevant eligible 
                        professional organizations and other relevant 
                        stakeholders shall be requested to identify and 
                        submit quality measures and clinical practice 
                        improvement activities (as defined in paragraph 
                        (3)(C)) for selection under this paragraph. For 
                        purposes of the previous sentence, measures and 
                        activities 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).
                    ``(E) Core measure sets.--
                            ``(i) In general.--Under the process 
                        established under subparagraph (D)(i), the 
                        Secretary--
                                    ``(I) shall select, from quality 
                                measures described in clause (ii) 
                                applicable to a peer cohort, quality 
                                measures to be included in a core 
                                measure set for such cohort;
                                    ``(II) shall, to the extent there 
                                are insufficient quality measures 
                                applicable to a peer cohort to address 
                                one or more applicable quality domains, 
                                select to be included in a core measure 
                                set for such cohort such clinical 
                                practice improvement activities 
                                described in clause (ii)(IV) as are 
                                needed and available to sufficiently 
                                address such an applicable domain with 
                                respect to such peer cohort; and
                                    ``(III) may select, to the extent 
                                determined appropriate, any additional 
                                clinical practice improvement 
                                activities described in clause (ii)(IV) 
                                applicable to a peer cohort to be 
                                included in a core measure set for such 
                                cohort.
                        Activities selected under this paragraph shall 
                        be selected with consideration of best 
                        practices and clinical practice guidelines 
                        identified under subparagraph (C)(i)(II).
                            ``(ii) Sources of quality measures and 
                        clinical practice improvement activities.--A 
                        quality measure or clinical practice 
                        improvement activity selected for inclusion in 
                        a core measure set under the process under 
                        subparagraph (D)(i) shall be--
                                    ``(I) a measure endorsed by a 
                                consensus-based entity;
                                    ``(II) a measure developed under 
                                paragraph (2)(C) or a measure otherwise 
                                applied or developed for a similar 
                                purpose under this section;
                                    ``(III) a measure developed under 
                                subparagraph (C); or
                                    ``(IV) a measure or activity 
                                submitted under subparagraph (D)(ii).
                        A measure or activity may be selected under 
                        this subparagraph, regardless of whether such 
                        measure or activity was previously published in 
                        a proposed rule. A measure so selected shall be 
                        evidence-based but (other than a measure 
                        described in subclause (I)) shall not be 
                        required to be consensus-based.
                            ``(iii) Transparency.--Before publishing in 
                        a final regulation a core measure set under 
                        clause (i) as a final core measure set under 
                        subparagraph (F), the Secretary shall--
                                    ``(I) submit for publication in 
                                applicable specialty-appropriate peer-
                                reviewed journals such core measure set 
                                under clause (i) and the method for 
                                developing and selecting measures 
                                within such set, including clinical and 
                                other data supporting such measures, 
                                and, as applicable, the method for 
                                selecting clinical practice improvement 
                                activities included within such set; 
                                and
                                    ``(II) regardless of whether or not 
                                the core measure set or method is 
                                published in such a journal under 
                                subclause (I), provide for notice of 
                                the proposed regulation in the Federal 
                                Register, including with respect to the 
                                applicable methods and data described 
                                in subclause (I), and a period for 
                                public comment thereon.
                    ``(F) Final core measure sets.--Not later than 
                November 15 of the year prior to the first day of a 
                performance period, the Secretary shall publish a final 
                regulation in the Federal Register that includes a 
                final core measure set (and the applicable methods and 
                data described in subparagraph (E)(iii)(I)) for each 
                peer cohort to be applied for such performance period.
                    ``(G) Periodic review and updates.--
                            ``(i) In general.--In carrying out this 
                        paragraph, under the system under this 
                        subsection, there shall periodically be 
                        reviewed--
                                    ``(I) the quality measures and 
                                clinical practice improvement 
                                activities selected for inclusion in 
                                final core measure sets under this 
                                paragraph for each year such measures 
                                and activities are to be applied under 
                                this subsection or subsection (q) to 
                                ensure that such measures and 
                                activities continue to meet the 
                                conditions applicable to such measures 
                                and activities for such selection; and
                                    ``(II) the final core measure sets 
                                published under subparagraph (F) for 
                                each year such sets are to be applied 
                                to peer cohorts of eligible 
                                professionals to ensure that each 
                                applicable set continues to meet the 
                                conditions applicable to such sets 
                                before being so published.
                            ``(ii) Collaboration with stakeholders.--In 
                        carrying out clause (i), relevant eligible 
                        professional organizations and other relevant 
                        stakeholders may identify and submit updates to 
                        quality measures and clinical practice 
                        improvement activities selected under this 
                        paragraph for inclusion in final core measure 
                        sets as well as any additional quality measures 
                        and clinical practice improvement activities. 
                        Not later than November 15 of the year prior to 
                        the first day of a performance period, 
                        submissions under this clause shall be 
                        reviewed.
                            ``(iii) Additional, and updates to, 
                        measures and activities.--Based on the review 
                        conducted under this subparagraph for a period, 
                        as needed, there shall be--
                                    ``(I) selected additional, and 
                                updates to, quality measures and 
                                clinical practice improvement 
                                activities selected under this 
                                paragraph for potential inclusion in 
                                final core measure sets in the same 
                                manner such quality measures and 
                                clinical practice improvement 
                                activities are selected under this 
                                paragraph for such potential inclusion;
                                    ``(II) removed, from final core 
                                measure sets, quality measures and 
                                clinical practice improvement 
                                activities that are no longer 
                                meaningful; and
                                    ``(III) updated final core measure 
                                sets published under subparagraph (F) 
                                in the same manner as such sets are 
                                approved under such subparagraph.
                        For purposes of this subsection and subsection 
                        (q), a final core measure set, as updated under 
                        this subparagraph, shall be treated in the same 
                        manner as a final core measure set published 
                        under subparagraph (F).
                            ``(iv) Transparency.--
                                    ``(I) Notification required for 
                                certain updates.--In the case of an 
                                update under subclause (II) or (III) of 
                                clause (iii) that adds, materially 
                                changes, or removes a measure or 
                                activity from a measure set, such 
                                update shall not apply under this 
                                subsection or subsection (q) unless 
                                notification of such update is made 
                                available to applicable eligible 
                                professionals.
                                    ``(II) Public availability of 
                                updated final core measure sets.--
                                Subparagraph (E)(iii) shall apply with 
                                respect to measure sets updated under 
                                subclause (II) or (III) of clause (iii) 
                                in the same manner as such subparagraph 
                                applies to applicable core measure sets 
                                under subparagraph (E).
                    ``(H) Coordination with existing programs.--The 
                development and selection of quality measures and 
                clinical practice improvement activities under this 
                paragraph shall, as appropriate, be coordinated with 
                the development and selection of existing measures and 
                requirements, such as the development of the Physician 
                Compare Website under subsection (m)(5)(G) and the 
                application of resource use management under subsection 
                (n). To the extent feasible, such measures and 
                activities shall align with measures used by other 
                payers and with measures and activities in use under 
                other programs in order to streamline the process of 
                such development and selection under this paragraph. 
                The Secretary shall develop a plan to integrate 
                reporting on quality measures under this subsection 
                with reporting requirements under subsection (o) 
                relating to the meaningful use of certified EHR 
                technology.
                    ``(I) Consultation with relevant eligible 
                professional organizations and other relevant 
                stakeholders.--Relevant eligible professional 
                organizations (as defined in paragraph (3)(D)) and 
                other relevant stakeholders, including State and 
                national medical societies, shall be consulted in 
                carrying out this paragraph.
                    ``(J) Optional application.--The process under 
                section 1890A is not required to apply to the 
                development or selection of measures under this 
                paragraph.''; and
                    (F) in subsection (m)(3)(C)(i), by adding at the 
                end the following new sentence: ``Such process shall, 
                beginning for 2019, treat eligible professionals in 
                such a group practice as reporting on measures for 
                purposes of application of subsections (q) and 
                (a)(8)(A)(iii) if, in lieu of reporting measures under 
                subsection (k)(2)(D), the group practice reports 
                measures determined appropriate by the Secretary.''.
            (3) Establishment of quality update incentive program.--
                    (A) 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) Quality Update Incentive Program.--
            ``(1) Establishment.--
                    ``(A) In general.--The Secretary shall establish an 
                eligible professional quality update incentive program 
                (in this section referred to as the `quality update 
                incentive program') under which--
                            ``(i) there is developed and applied, in 
                        accordance with paragraph (2), appropriate 
                        methodologies for assessing the performance of 
                        eligible professionals with respect to quality 
                        measures and clinical practice improvement 
                        activities included within the final core 
                        measure sets published under subsection 
                        (k)(9)(F) applicable to the peer cohorts of 
                        such providers;
                            ``(ii) there is applied, consistent with 
                        the system under subsection (k), methods for 
                        collecting information needed for such 
                        assessments (which shall involve the minimum 
                        amount of administrative burden required to 
                        ensure reliable results); and
                            ``(iii) the applicable update adjustments 
                        under paragraph (3) are determined by such 
                        assessments.
                    ``(B) Definitions.--
                            ``(i) Eligible professional.--In this 
                        subsection, the term `eligible professional' 
                        has the meaning given such term in subsection 
                        (k)(3), except that such term shall not include 
                        a professional who has a payment arrangement 
                        described in section 1848A(a)(1) in effect.
                            ``(ii)  Peer cohorts; clinical practice 
                        improvement activities; eligible professional 
                        organizations.--In this subsection, the terms 
                        `peer cohort', `clinical practice improvement 
                        activity', and `eligible professional 
                        organization' have the meanings given such 
                        terms in subsection (k)(3).
                    ``(C) Consultation with eligible professional 
                organizations and other relevant stakeholders.--
                Eligible professional organizations and other relevant 
                stakeholders, including State and national medical 
                societies, shall be consulted in carrying out this 
                subsection.
                    ``(D) Application at group practice level.--The 
                Secretary shall establish a process, consistent with 
                subsection (m)(3)(C), under which the provisions of 
                this subsection are applied to eligible professionals 
                in a group practice if the group practice reports 
                measures determined appropriate by the Secretary under 
                such subsection.
                    ``(E) Coordination with existing programs.--The 
                application of measures and clinical practice 
                improvement activities and assessment of performance 
                under this subsection shall, as appropriate, be 
                coordinated with the application of measures and 
                assessment of performance under other provisions of 
                this section.
            ``(2) Assessing performance with respect to final core 
        measure sets for applicable peer cohorts.--
                    ``(A) Establishment of methods for assessment.--
                            ``(i) In general.--Under the quality update 
                        incentive program, the Secretary shall--
                                    ``(I) establish one or more 
                                methods, applicable with respect to a 
                                performance period, to assess (using a 
                                scoring scale of 0 to 100) the 
                                performance of an eligible professional 
                                with respect to, subject to paragraph 
                                (1)(D), quality measures and clinical 
                                practice improvement activities 
                                included within the final core measure 
                                set published under subsection 
                                (k)(9)(F) applicable for the period to 
                                the peer cohort in which the provider 
                                self-identified under subsection 
                                (k)(9)(B) for such period; and
                                    ``(II) subject to paragraph (1)(D), 
                                compute a composite score for such 
                                provider for such performance period 
                                with respect to the measures and 
                                activities included within such final 
                                core measure set.
                            ``(ii) Methods.--Such methods shall, with 
                        respect to an eligible professional, provide 
                        that the performance of such professional 
                        shall, subject to paragraph (1)(D), be assessed 
                        for a performance period with respect to the 
                        quality measures and clinical practice 
                        improvement activities within the final core 
                        measure set for such period for the peer cohort 
                        of such professional and on which information 
                        is collected from such professional.
                            ``(iii) Weighting of measures.--Such a 
                        method may provide for the assignment of 
                        different scoring weights or, as appropriate, 
                        other factors--
                                    ``(I) for quality measures and 
                                clinical practice improvement 
                                activities;
                                    ``(II) based on the type or 
                                category of measure or activity; and
                                    ``(III) based on the extent to 
                                which a quality measure or clinical 
                                practice improvement activity 
                                meaningfully assesses quality.
                            ``(iv) Risk adjustment.--Such a method 
                        shall provide for appropriate risk adjustments.
                            ``(v) Incorporation of other methods of 
                        measuring physician quality.--In establishing 
                        such methods, there shall be, as appropriate, 
                        incorporated comparable methods of measurement 
                        from physician quality incentive programs under 
                        this subsection.
                    ``(B) Performance period.--There shall be 
                established a period (in this subsection referred to as 
                a `performance period'), with respect to a year 
                (beginning with 2019) for which the quality adjustment 
                is applied under paragraph (3), to assess performance 
                on quality measures and clinical practice improvement 
                activities. Each such performance period shall be a 
                period of 12 consecutive months and shall end as close 
                as possible to the beginning of the year for which such 
                adjustment is applied.
            ``(3) Quality adjustment taking into account quality 
        assessments.--
                    ``(A) Quality adjustment.--For purposes of 
                subsection (d)(16), if the composite score computed 
                under paragraph (2)(A) for an eligible professional for 
                a year (beginning with 2019) is--
                            ``(i) a score of 67 or higher, the quality 
                        adjustment under this paragraph for the 
                        eligible professional and year is 1 percentage 
                        point;
                            ``(ii) a score of at least 34, but below 
                        67, the quality adjustment under this paragraph 
                        for the eligible professional and year is zero; 
                        or
                            ``(iii) a score below 34, the quality 
                        adjustment under this paragraph for the 
                        eligible professional and year is -1 percentage 
                        point.
                    ``(B) No effect on subsequent years' quality 
                adjustments.--Each such quality adjustment shall be 
                made each year without regard to the update adjustment 
                for a previous year under this paragraph.
            ``(4) Transition for new eligible professionals.--In the 
        case of a physician, practitioner, or other supplier that 
        during a performance period, with respect to a year for which a 
        quality adjustment is applied under paragraph (3), first 
        becomes an eligible professional (and had not previously 
        submitted claims under this title as a person, as an entity, or 
        as part of a physician group or under a different billing 
        number or tax identifier), the quality adjustment under this 
        subsection applicable to such physician, practitioner, or 
        supplier--
                    ``(A) for such year, with respect to such first 
                performance period, shall be zero; and
                    ``(B) for a year, with respect to a subsequent 
                performance period, shall be the quality adjustment 
                that would otherwise be applied under this subsection.
            ``(5) Feedback.--
                    ``(A) Feedback.--
                            ``(i) Ongoing feedback.--Under the process 
                        under subsection (m)(5)(H), there shall be 
                        provided, as real time as possible, but at 
                        least quarterly, to each eligible professional 
                        feedback--
                                    ``(I) on the performance of such 
                                provider with respect to quality 
                                measures and clinical practice 
                                improvement activities within the final 
                                core measure set published under 
                                subsection (k)(9)(F) for the applicable 
                                performance period and the peer cohort 
                                of such professional; and
                                    ``(II) to assess the progress of 
                                such professional under the quality 
                                update incentive program with respect 
                                to a performance period for a year.
                            ``(ii) Use of registries and other 
                        mechanisms.--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 and based on performance received 
                        through the use of such registry, and to the 
                        extent that an eligible professional chooses 
                        not to participate in such a registry for such 
                        purposes, be provided through other similar 
                        mechanisms that allow for the provision of such 
                        feedback and receipt of such performance 
                        information.
                    ``(B) Data mechanism.--Under the quality update 
                incentive program, there shall be developed an 
                electronic interactive eligible professional mechanism 
                through which such a professional may receive 
                performance data, including data with respect to 
                performance on the measures and activities developed 
                and selected under this section. Such mechanism shall 
                be developed in consultation with private payers and 
                health insurance issuers (as defined in section 
                2791(b)(2) of the Public Health Service Act) as 
                appropriate.
                    ``(C) Transfer of funds.--The Secretary shall 
                provide for the transfer of $100,000,000 from the 
                Federal Supplementary Medical Insurance Trust Fund 
                established in section 1841 to the Center for Medicare 
                & Medicaid Services Program Management Account to 
                support such efforts to develop the infrastructure as 
                necessary to carry out subsection (k)(9) and this 
                subsection and for purposes of section 1889(h). Such 
                funds shall be so transferred on the date of the 
                enactment of this subsection and shall remain available 
                until expended.''.
                    (B) Incentive to report under quality update 
                incentive program.--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 ``With 
                        respect to'' and inserting ``Subject to clause 
                        (iii), with respect to''; and
                            (ii) by adding at the end the following new 
                        clause:
                            ``(iii) Application to eligible 
                        professionals not reporting.--With respect to 
                        covered professional services (as defined in 
                        subsection (k)(3)) furnished by an eligible 
                        professional during 2019 or any subsequent 
                        year, if the eligible professional does not 
                        submit data for the performance period (as 
                        defined in subsection (q)(2)(B)) with respect 
                        to such year on, subject to subsection 
                        (q)(1)(D), the quality measures and, as 
                        applicable, clinical practice improvement 
                        activities within the final core measure set 
                        under subsection (k)(9)(F) applicable to the 
                        peer cohort of such provider, the fee schedule 
                        amount for such services furnished by such 
                        professional during the year (including the fee 
                        schedule amount for purposes of determining a 
                        payment based on such amount) shall be equal to 
                        95 percent (in lieu of the applicable percent) 
                        of the fee schedule amount that would otherwise 
                        apply to such services under this subsection 
                        (determined after application of paragraphs 
                        (3), (5), and (7), but without regard to this 
                        paragraph). The Secretary shall develop a 
                        minimum per year caseload threshold, with 
                        respect to eligible professionals, and the 
                        previous sentence shall not apply to eligible 
                        professionals with a caseload for a year below 
                        such threshold for such year.''.
                    (C) Education on quality update incentive 
                program.--Section 1889 of the Social Security Act (42 
                U.S.C. 1395zz) is amended by adding at the end the 
                following new subsection:
    ``(h) Quality Update Incentive Program.--Under this section, 
information shall be disseminated to educate and assist eligible 
professionals (as defined in section 1848(k)(3)) about the quality 
update incentive program under section 1848(q) and quality measures 
under section 1848(k)(9) through multiple approaches, including a 
national dissemination strategy and outreach by medicare 
contractors.''.
            (4) Conforming amendments.--
                    (A) Treatment of satisfactorily reporting pqrs 
                measures through participation in a qualified clinical 
                data registry.--Section 1848(m)(3)(D) of the Social 
                Security Act (42 U.S.C. 1395w-4(m)(3)(D)) is amended by 
                striking ``For 2014 and subsequent years'' and 
                inserting ``For each of 2014 through 2018''.
                    (B) Coordinating enhanced pqrs reporting with 
                ehr.--Section 1848(o)(2)(B)(iii) of the Social Security 
                Act (42 U.S.C. 1395w-4(o)(2)(B)(iii)) is amended by 
                striking ``subsection (k)(2)(C)'' and inserting 
                ``subparagraph (C) or (D) of subsection (k)(2)''.
                    (C) Coordinating pqrs reporting period with quality 
                update incentive program performance period.--Section 
                1848(m)(6)(C) of the Social Security Act (42 U.S.C. 
                1395w-4(m)(6)(C)) is amended--
                            (i) in clause (i), by striking ``and 
                        (iii)'' and inserting ``, (iii), and (iv)''; 
                        and
                            (ii) by adding at the end the following new 
                        clause:
                            ``(iv) Coordination with quality update 
                        incentive program.--For 2019 and each 
                        subsequent year the reporting period shall be 
                        coordinated with the performance period under 
                        subsection (q)(2)(B).''.
                    (D) Coordinating ehr reporting with quality update 
                incentive program performance period.--Section 
                1848(o)(5)(B) of the Social Security Act (42 U.S.C. 
                1395w-4(o)(5)(B)) is amended by adding at the end the 
                following: ``Beginning for 2019, the EHR reporting 
                period shall be coordinated with the performance period 
                under subsection (q)(2)(B).''.
    (c) Advancing Alternative Payment Models.--
            (1) In general.--Part B of title XVIII of the Social 
        Security Act (42 U.S.C. 1395w-4 et seq.) is amended by adding 
        at the end the following new section:

``SEC. 1848A. ADVANCING ALTERNATIVE PAYMENT MODELS.

    ``(a) Payment Model Choice Program.--Payment for covered 
professional services (as defined in section 1848(k)) that are 
furnished by an eligible professional (as defined in such section) 
under an Alternative Payment Model specified on the list under 
subsection (h) (in this section referred to as an `eligible APM') shall 
be made under this title in accordance with the payment arrangement 
under such model. In applying the previous sentence, such a 
professional with such a payment arrangement in effect, shall be deemed 
for purposes of section 1848(a)(8) to be satisfactorily submitting data 
on quality measures for such covered professional services.
    ``(b) Process for Implementing Eligible APMs.--
            ``(1) In general.--For purposes of subsection (a) and in 
        accordance with this section, the Secretary shall establish a 
        process under which--
                    ``(A) a contract is entered into, in accordance 
                with paragraph (2);
                    ``(B) proposals for potential Alternative Payment 
                Models are submitted in accordance with subsection (c);
                    ``(C) Alternative Payment Models so proposed are 
                recommended, in accordance with subsection (d), for 
                evaluation, including through the demonstration program 
                under subsection (e), and approval under subsection 
                (f);
                    ``(D) applicable Alternative Payment Models are 
                evaluated under such demonstration program;
                    ``(E) models are implemented as eligible APMs in 
                accordance with subsection (f); and
                    ``(F) a comprehensive list of all eligible APMs is 
                made publicly available, in accordance with subsection 
                (h), for application under subsection (a).
            ``(2) Contract with apm contracting entity.--
                    ``(A) In general.--For purposes of paragraph 
                (1)(A), the Secretary shall identify and have in effect 
                a contract with an independent entity that has 
                appropriate expertise to carry out the functions 
                applicable to such entity under this section. Such 
                entity shall be referred to in this section as the `APM 
                contracting entity'.
                    ``(B) Timing for first contract.--As soon as 
                practicable, but not later than one year after the date 
                of the enactment of this section, the Secretary shall 
                enter into the first contract under subparagraph (A).
                    ``(C) Competitive procedures.--Competitive 
                procedures (as defined in section 4(5) of the Office of 
                Federal Procurement Policy Act (41 U.S.C. 403(5))) 
                shall be used to enter into a contract under 
                subparagraph (A).
    ``(c) Submission of Proposed Alternative Payment Models.--Beginning 
not later than 90 days after the date the Secretary enters into a 
contract under subsection (b)(2) with the APM contracting entity, 
physicians, eligible professional organizations, health care provider 
organizations, and other entities may submit to the APM contracting 
entity proposals for Alternative Payment Models for application under 
this section. Such a proposal of a model shall include suggestions for 
measures to be used under subsection (e)(1)(B) for purposes of 
evaluating such model. In reviewing submissions under this subsection 
for purposes of making recommendations under subsection (d)(1), the 
contracting entity shall focus on submissions for such models that are 
intended to improve care coordination and quality for patients through 
modifying the manner in which physicians and other providers are paid 
under this title.
    ``(d) Recommendation by APM Contracting Entity of Proposed 
Models.--
            ``(1) Recommendation.--
                    ``(A) In general.--Under the process under 
                subsection (b), the APM contracting entity shall at 
                least annually recommend to the Secretary--
                            ``(i) based on the criteria described in 
                        subparagraph (B), Alternative Payment Models 
                        submitted under subsection (c) to be evaluated 
                        through a demonstration program under 
                        subsection (e); and
                            ``(ii) based on the criteria described in 
                        subparagraph (C), Alternative Payment Models 
                        submitted under subsection (c) for purposes of 
                        implementation under subsection (f), without 
                        evaluation through such a demonstration 
                        program.
                Such a recommendation may be made with respect to a 
                model for which a waiver would be required under 
                paragraph (2).
                    ``(B) Criteria for recommending models for 
                demonstration.--The APM contracting entity shall make a 
                recommendation under subparagraph (A)(i), with respect 
                to an Alternative Payment Model, only if the entity 
                determines that the model satisfies each of the 
                following criteria:
                            ``(i) The model has been supported by 
                        meaningful clinical and non-clinical data, with 
                        respect to a sufficient population sample, that 
                        indicates the model would be successful at 
                        addressing each of the abilities described in 
                        clause (v).
                            ``(ii)(I) In the case of a model that has 
                        already been evaluated and supported by data 
                        with respect to a population of individuals 
                        enrolled under this part, if the model were 
                        evaluated under the demonstration under 
                        subsection (e) such a population would 
                        represent a sufficient number of individuals 
                        enrolled under this part to ensure meaningful 
                        evaluation.
                            ``(II) In the case of a model that has not 
                        been so evaluated and supported by data with 
                        respect to such a population, the population 
                        that would be furnished services under such 
                        model if the model were evaluated under the 
                        demonstration under subsection (e) would 
                        represent a sufficient number of individuals 
                        enrolled under this part to ensure meaningful 
                        evaluation.
                            ``(iii) Such model, including if evaluated 
                        under the demonstration under subsection (e), 
                        would not deny or limit the coverage or 
                        provision of benefits under this title for 
                        applicable individuals.
                            ``(iv) The implementation of such model as 
                        an eligible APM under this section is 
                        expected--
                                    ``(I) to reduce spending under this 
                                title without reducing the quality of 
                                care; or
                                    ``(II) improve the quality of 
                                patient care without increasing 
                                spending.
                            ``(v) The proposal for such model 
                        demonstrates--
                                    ``(I) the potential to successfully 
                                manage the cost of furnishing items and 
                                services under this title so as to not 
                                result in expenditures under this title 
                                for individuals participating under 
                                such APM being greater than 
                                expenditures under this title for such 
                                individuals if the APM were not 
                                implemented;
                                    ``(II) the ability to maintain or 
                                improve the overall patient care; and
                                    ``(III) the ability to maintain or 
                                improve the quality of care provided to 
                                individuals enrolled under this part 
                                who participate under such mode.
                            ``(vi) The model provides for a payment 
                        arrangement--
                                    ``(I) covering at least items and 
                                services furnished under this part by 
                                eligible professionals participating in 
                                the model;
                                    ``(II) in the case such payment 
                                arrangement does not provide for 
                                payment under the fee schedule under 
                                section 1848 for such items and 
                                services furnished by such eligible 
                                professionals, that provides for a 
                                payment adjustment based on meaningful 
                                EHR use comparable to such adjustment 
                                that would otherwise apply under 
                                section 1848; and
                                    ``(III) that provides for a payment 
                                adjustment based on quality measures 
                                comparable to such adjustment that 
                                would otherwise apply under section 
                                1848.
                    ``(C) Criteria for recommending models for approval 
                without evaluation under demonstration.--The APM 
                contracting entity may make a recommendation under 
                subparagraph (A)(ii), with respect to an Alternative 
                Payment Model, only if the entity determines that the 
                model has already been evaluated for a sufficient 
                enough period and through such evaluation the model was 
                shown--
                            ``(i) to have satisfied the criteria 
                        described in each of clauses (i), (ii), (iii), 
                        and (vi) of subparagraph (B);
                            ``(ii) to demonstrate each of the abilities 
                        described in clause (v) of such subparagraph; 
                        and
                            ``(iii)(I) to reduce spending under this 
                        title without reducing the quality of care; or
                            ``(II) improve the quality of patient care 
                        without increasing spending.
                    ``(D) Transparency and disclosures.--
                            ``(i) Disclosures.--Not later than 90 days 
                        after receipt of a submission of a model under 
                        subsection (c) by an entity, the APM 
                        contracting entity shall submit to the 
                        Secretary and such entity and make publicly 
                        available a notification on whether or not, and 
                        if so how, the model meets criteria for 
                        recommending such model under subparagraph (A), 
                        including whether or not such model requires a 
                        waiver under paragraph (2). In the case that 
                        the APM contracting entity determines not to 
                        recommend such model under this paragraph, such 
                        notification shall include an explanation of 
                        the reasons for not making such a 
                        recommendation. Any information made publicly 
                        available pursuant to the previous sentence 
                        shall not include proprietary data.
                            ``(ii) Submission of recommended models.--
                        The APM contracting entity shall at least 
                        quarterly submit to the Secretary, the Medicare 
                        Payment Advisory Commission, and the Chief 
                        Actuary of the Centers for Medicare & Medicaid 
                        Services the following:
                                    ``(I) The models recommended under 
                                subparagraph (A)(i), including any such 
                                models that require a waiver under 
                                paragraph (2), and the data and 
                                analyses on such recommended models 
                                that support the criteria described in 
                                subparagraph (B).
                                    ``(II) The models recommended under 
                                subparagraph (A)(ii), including any 
                                such models that require a waiver under 
                                paragraph (2), and the data and 
                                analyses on such recommended models 
                                that support the criteria described in 
                                subparagraph (C).
                        For any year beginning with 2015 that the APM 
                        contracting does not recommend any models under 
                        subparagraph (A), the entity shall instead 
                        satisfy this clause by submitting to the 
                        Secretary and making publicly available an 
                        explanation for not having any such 
                        recommendations.
            ``(2) Models requiring waiver approval.--
                    ``(A) In general.--In the case that an Alternative 
                Payment Model recommended under paragraph (1)(A)(i) 
                would require a waiver from any requirement under this 
                title, in determining approval of such model, the 
                Secretary may make such a waiver in order for such 
                model to be evaluated under the demonstration program 
                (if described in clause (i) of such paragraph).
                    ``(B) Approval.--Not later than 90 days after the 
                date of the receipt of such submission for a model, the 
                Secretary shall notify the APM contracting entity and 
                the entity submitting such model under subsection (c) 
                whether or not such a waiver for such model is provided 
                and the reason for any denial of such a waiver.
    ``(e) Demonstration.--
            ``(1) In general.--Subject to paragraphs (5), (6), and (7), 
        the Secretary may conduct a demonstration program, with respect 
        to an Alternative Payment Model approved under paragraph (2), 
        under which participating entities shall be paid under this 
        title in accordance with the payment arrangement under such 
        model and such model shall be evaluated by the independent 
        evaluation entity under paragraph (3). The duration of a 
        demonstration program under this subsection, with respect to 
        such a model, shall be 3 years (or a shorter period, taking 
        into account the applicable recommendation under subsection 
        (d)(1)(A)(i)).
            ``(2) Approval by secretary of models for demonstration.--
        Not later than 90 days after the date of receipt of a 
        recommendation under subsection (d)(1)(A)(i), with respect to 
        an Alternative Payment Model, the Secretary shall approve such 
        model for a demonstration program under this subsection only if 
        the Secretary determines the model satisfies the criteria 
        described in subsection (d)(1)(B). The Secretary shall 
        periodically make a available a list of such models so 
        approved.
            ``(3) Participating entities.--To participate under a 
        demonstration program under this subsection, with respect to an 
        Alternative Payment Model, a physician, practitioner, or other 
        supplier shall enter into a contract with the Administrator of 
        the Centers for Medicare & Medicaid Services under this 
        subsection. For purposes of this section, such a physician, 
        practitioner, or supplier who so participates under such an 
        Alternative Payment Model shall be referred to as a 
        `participating APM provider'.
            ``(4) Reporting and evaluation.--
                    ``(A) Independent evaluation entity.--Under this 
                subsection, the Secretary shall enter into a contract 
                with an independent entity to evaluate Alternative 
                Payment Models under demonstration programs under this 
                subsection based on appropriate measures specified 
                under subparagraph (B). In this section, such entity 
                shall be referred to as the `independent evaluation 
                entity'. Such contract shall be entered into in a 
                timely manner so as to ensure evaluation of an 
                Alternative Payment Model under a demonstration program 
                under this subsection may begin as soon as possible 
                after the model is approved under paragraph (2).
                    ``(B) Performance measures.--For purposes of this 
                subsection, the Secretary shall specify--
                            ``(i) measures to evaluate Alternative 
                        Payment Models under demonstration programs 
                        under this subsection, which may include 
                        measures suggested under subsection (c) and 
                        shall be sufficient to allow for a 
                        comprehensive assessment of such a model; and
                            ``(ii) quality measures on which 
                        participating entities shall report, which 
                        shall be similar to measures applicable under 
                        section 1848(k).
                    ``(C) Reporting requirements.--A contract entered 
                into with a participating APM provider under paragraph 
                (3) shall require such provider to report on 
                appropriate measures specified under subparagraph (B).
                    ``(D) Periodic review.--The independent evaluation 
                entity shall periodically review and analyze and submit 
                such analysis to the Secretary and the participating 
                entities involved data reported under subparagraph (C) 
                and such other data as deemed necessary to evaluate the 
                model.
                    ``(E) Final evaluation.--Not later than 6 months 
                after the date of completion of a demonstration 
                program, the independent evaluation entity shall submit 
                to the Secretary, the Medicare Payment Advisory 
                Commission, and the Chief Actuary of the Centers for 
                Medicare & Medicaid Services (and make publicly 
                available) a report on each model evaluated under such 
                program. Such report shall include--
                            ``(i) outcomes on the clinical and claims 
                        data received through such program with respect 
                        to such model;
                            ``(ii) recommendations on--
                                    ``(I) whether or not such model 
                                should be implemented as an eligible 
                                APM under this section; or
                                    ``(II) whether or not the 
                                evaluation of such model under the 
                                demonstration program should be 
                                extended or expanded;
                            ``(iii) the justification for each such 
                        recommendation described in clause (ii); and
                            ``(iv) in the case of a recommendation to 
                        implement such model as an eligible APM, 
                        recommendations on standardized rules for 
                        purposes of such implementation.
            ``(5) Approval of extending evaluation under 
        demonstration.--Not later than 90 days after the date of 
        receipt of a submission under paragraph (4)(E), the Secretary 
        shall, including based on a recommendation submitted under such 
        paragraph, determine whether an Alternative Payment Model may 
        be extended or expanded under the demonstration program.
            ``(6) Termination.--The Secretary shall terminate a 
        demonstration program for a model under this subsection unless 
        the Secretary determines (and the Chief Actuary of the Centers 
        for Medicare & Medicaid Services, with respect to program 
        spending under this title, certifies), after testing has begun, 
        that the model is expected to--
                    ``(A) improve the quality of care (as determined by 
                the Administrator of the Centers for Medicare & 
                Medicaid Services) without increasing spending under 
                this title;
                    ``(B) reduce spending under this title without 
                reducing the quality of care; or
                    ``(C) improve the quality of care and reduce 
                spending.
        Such termination may occur at any time after such testing has 
        begun and before completion of the testing.
            ``(7) Funding.--
                    ``(A) In general.--There are appropriated, from 
                amounts in the Federal Supplementary Medical Insurance 
                Trust Fund under section 1841 not otherwise 
                appropriated, $2,000,000,000 for the purposes described 
                in subparagraph (B), of which no more than 2.5 percent 
                may be used for the purpose described in clause (iii) 
                of such subparagraph. Amounts transferred under this 
                subparagraph shall be available until expended.
                    ``(B) Purposes.--Amounts appropriated under 
                subparagraph (A) shall be used for--
                            ``(i) payments for items and services 
                        furnished by participating entities under an 
                        Alternative Payment Model under a demonstration 
                        program under this subsection that--
                                    ``(I) would not otherwise be 
                                eligible for payment under this title; 
                                or
                                    ``(II) exceed the amount of payment 
                                that would otherwise be made for such 
                                items and services under this title if 
                                such items and services were not 
                                furnished under such demonstration 
                                program;
                            ``(ii) the evaluations provided for under 
                        this section of models under such a 
                        demonstration program;
                            ``(iii) payment to the contracting entity 
                        for carrying out its duties under this section; 
                        and
                            ``(iv) for otherwise carrying out this 
                        subsection.
                    ``(C) Limitation.--The amounts appropriated under 
                subparagraph (A) are the only amounts authorized or 
                appropriated to carry out the purposes described in 
                subparagraph (B).
    ``(f) Implementation of Recommended Models as Eligible APMs.--
            ``(1) In general.--Not later than the applicable date under 
        paragraph (2), the Secretary shall, implement an Alternative 
        Payment Model recommended under subsection (d)(1)(A)(ii) or 
        (e)(4)(E)(ii)(I) as an eligible APM only if--
                    ``(A) the Secretary determines that such model is 
                expected to--
                            ``(i) reduce spending under this title 
                        without reducing the quality of care; or
                            ``(ii) improve the quality of patient care 
                        without increasing spending;
                    ``(B) the Chief Actuary of the Centers for Medicare 
                & Medicaid Services certifies that such model would 
                reduce (or would not result in any increase in) program 
                spending under this title; and
                    ``(C) the Secretary determines that such model 
                would not deny or limit the coverage or provision of 
                benefits under this title for applicable individuals.
        Not later than 90 days after the date of issuance of a proposed 
        rule, with respect to an Alternative Payment Model, the 
        Medicare Payment Advisory Commission shall submit comments to 
        Congress and the Secretary evaluating the reports from the 
        contracting entity and independent evaluation entity on such 
        model regarding the model's impact on expenditures and quality 
        of care under this title.
            ``(2) Applicable date.--For purposes of paragraph (1), the 
        applicable date under this paragraph--
                    ``(A) for an Alternative Payment Model recommended 
                under subsection (d)(1)(A)(ii) is 90 days after the 
                date of submission of such recommendation; and
                    ``(B) for an Alternative Payment Model recommended 
                under subsection (e)(4)(E)(ii)(I) is 90 days after the 
                date of submission of such recommendation
            ``(3) Justification for disapprovals.--In the case that an 
        Alternative Payment Model recommended under subsection 
        (d)(1)(A)(ii) or (e)(4)(E)(ii)(I) is not implemented as an 
        eligible APM under this subsection, the Secretary shall make 
        publicly available the rational, in detail, for such decision.
    ``(g) Periodic Review and Termination.--
            ``(1) Periodic review.--In the case of an Alternative 
        Payment Model that has been implemented, the Secretary and the 
        Chief Actuary of the Centers for Medicare & Medicaid Services 
        shall review such model every 3 years to determine (and 
        certify, in the case of the Chief Actuary and spending under 
        this title), for the previous 3 years, whether the model has--
                    ``(A) reduced the quality of care, or
                    ``(B) increased spending under this title,
        compared to the quality of care or spending that would have 
        resulted if the model had not been implemented.
            ``(2) Termination.--
                    ``(A) Quality of care reduction termination.--If 
                based upon such review the Secretary determines under 
                paragraph (1)(A) that the model has reduced the quality 
                of care, the Secretary may terminate such model.
                    ``(B) Spending increase termination.--Unless such 
                Chief Actuary certifies under paragraph (1)(B) that the 
                expenditures under this title under the model do not 
                exceed the expenditures that would otherwise have been 
                made if the model had not been implemented for the 
                period involved, the Secretary shall terminate such 
                model.
    ``(h) Dissemination of Eligible APMs.--Under this section there 
shall be established a process for specifying, and making publicly 
available a list of, all eligible APMs, which shall include at least 
those implemented under subsection (f) and demonstrations carried out 
with respect to payments under section 1848 through authority in 
existence as of the day before the date of the enactment of this 
section. Under such process such list shall be periodically updated 
and, beginning with January 1, 2015, and annually thereafter, such list 
shall be published in the Federal Register.''.
            (2) Conforming amendment.--Section 1848(a)(1) of the Social 
        Security Act (42 U.S.C. 1395w-4(a)(1)) is amended by striking 
        ``shall instead'' and inserting ``shall, subject to section 
        1848A, instead''.

SEC. 3. EXPANDING AVAILABILITY OF MEDICARE DATA.

    (a) Expanding Uses of Medicare Data by Qualified Entities.--
            (1) In general.--To the extent consistent with applicable 
        information, privacy, security, and disclosure laws, beginning 
        with 2014, notwithstanding the second sentence of paragraph 
        (4)(D) of section 1874(e) of the Social Security Act (42 U.S.C. 
        1395kk(e)), a qualified entity may use data received by such 
        entity under such section, and information derived from the 
        evaluation described in such paragraph (4)(D), for additional 
        analyses (as determined appropriate by the Secretary of Health 
        and Human Services) that such entity may provide or sell to 
        providers of services and suppliers (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).
            (2) Definitions.--In this section:
                    (A) 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)).
                    (B) The terms ``supplier'' and ``provider of 
                services'' have the meanings given such terms in 
                subsections (d) and (u), respectively, of section 1861 
                of the Social Security Act (42 U.S.C. 1395x).
    (b) Access to Medicare Data to Providers of Services and Suppliers 
To Facilitate Development of Alternative Payment Models and to 
Qualified Clinical Data Registries To Facilitate Quality Improvement.--
Consistent with applicable laws and regulations with respect to privacy 
and other relevant matters, the Secretary shall provide Medicare claims 
data for non-public use (in a form and manner determined to be 
appropriate) to--
            (1) qualified entities, that may share with providers of 
        services and suppliers that are registered or authorized users 
        or subscribers, in order to facilitate the development of new 
        models of care (including development of Alternate Payment 
        Models under section 1848A of the Social Security Act, models 
        for small group specialty practices, and care coordination 
        models); and
            (2) qualified clinical data registries under section 
        1848(m)(3)(E) of the Social Security Act (42 U.S.C. 1395w-
        4(m)(3)(E)) for purposes of linking such data with clinical 
        outcomes data and performing analysis and research to support 
        quality improvement.

SEC. 4. ENCOURAGING CARE COORDINATION AND MEDICAL HOMES.

    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 coordination and medical homes.--
                    ``(A) In general.--In order to promote the 
                coordination of care by an applicable physician (as 
                defined in subparagraph (B)) for individuals with 
                complex chronic care needs who are furnished items and 
                services by multiple physicians and other suppliers and 
                providers of services, the Secretary shall--
                            ``(i) develop one or more HCPCS codes for 
                        complex chronic care management services for 
                        individuals with complex chronic care needs; 
                        and
                            ``(ii) for such services furnished on or 
                        after January 1, 2015, by an applicable 
                        physician, make payment (as the Secretary 
                        determines to be appropriate) under the fee 
                        schedule under this section using such HCPCS 
                        codes.
                    ``(B) Applicable physician defined.--For purposes 
                of this paragraph, the term `applicable physician' 
                means a physician (as defined in section 1861(r)(1)) 
                who--
                            ``(i) is certified as a medical home (by 
                        achieving an accreditation status of level 3 by 
                        the National Committee for Quality Assurance);
                            ``(ii) is recognized as a patient-centered 
                        specialty practice by the National Committee 
                        for Quality Assurance;
                            ``(iii) has received equivalent 
                        certification (as determined by the Secretary); 
                        or
                            ``(iv) meets such other comparable 
                        qualifications as the Secretary determines to 
                        be appropriate.
                    ``(C) Budget neutrality.--The budget neutrality 
                provision under subsection (c)(2)(B)(ii)(II) shall 
                apply in establishing the payment under subparagraph 
                (A)(ii).
                    ``(D) Single applicable physician payment.--In 
                carrying out this paragraph, the Secretary shall only 
                make payment to a single applicable physician for 
                complex chronic care management services furnished to 
                an individual.''.

SEC. 5. MISCELLANEOUS.

    (a) Solicitations, Recommendations, and Reports.--
            (1) Solicitation for recommendations on episodes of care 
        definition.--The Administrator of the Centers for Medicare & 
        Medicaid Services shall request eligible professional 
        organizations (as defined in section 1848(k)(3) of the Social 
        Security Act (42 U.S.C. 1395w-4(k)(3))) and other relevant 
        stakeholders to submit recommendations for defining non-acute 
        related episodes of care for purposes of applying such 
        definition under subsections (k) and (q) of section 1848 of the 
        Social Security Act (42 U.S.C. 1395w-4) and section 1848A of 
        such Act, as added by subsections (b) and (c) of section 2.
            (2) Solicitation for recommendations on provider fee 
        schedule payment bundles.--
                    (A) In general.--The Administrator of the Centers 
                for Medicare & Medicaid Services shall solicit from 
                eligible professional organizations (as defined in 
                section 1848(k)(3) of the Social Security Act (42 
                U.S.C. 1395w-4(k)(3))) recommendations for payment 
                bundles for chronic conditions and expensive, high-
                volume services for which payment is made under title 
                XVIII of such Act.
                    (B) Report to congress.--Not later than 24 months 
                after the date of the enactment of this Act, the 
                Administrator shall submit to Congress a report 
                proposals for such payment bundles.
            (3) Reports on modified pfs system and payment system 
        alternatives.--
                    (A) Biannual progress reports.--Not later than 
                January 15, 2016, and annually thereafter, the 
                Secretary of Health and Human Services shall submit to 
                Congress and post on the public Internet website of the 
                Centers for Medicare & Medicaid Services a biannual 
                progress report--
                            (i) on the implementation of paragraph (9) 
                        of section 1848(k) of the Social Security Act 
                        (42 U.S.C. 1395w-4(k)), as added by section 
                        2(b)(2), and the quality update incentive 
                        program under subsection (q) of section 1848 of 
                        the Social Security Act (42 U.S.C. 1395w-4), as 
                        added by section 2(b)(3);
                            (ii) that includes an evaluation of such 
                        paragraph and such quality update incentive 
                        program and recommendations with respect to 
                        such program and appropriate update mechanisms; 
                        and
                            (iii) on the actions taken to promote and 
                        fulfill the identification of eligible APMs 
                        under section 1848A of the Social Security Act, 
                        as added by section 2(c), for application under 
                        such section 1848A.
                    (B) GAO and medpac reports.--
                            (i) GAO report on initial stages of 
                        program.--The Comptroller General of the United 
                        States shall submit to Congress a report 
                        analyzing the extent to which the system under 
                        section 1848(k)(9) of the Social Security Act 
                        (42 U.S.C. 1395w-4(k)(9)) and such quality 
                        update incentive program under section 1848(q) 
                        of the Social Security Act, as added by section 
                        2(b), as of such date, is successfully 
                        satisfying performance objectives, including 
                        with respect to--
                                    (I) the process for developing and 
                                selecting measures and activities under 
                                subsection (k)(9) of section 1848 of 
                                such Act (42 U.S.C. 1395w-4);
                                    (II) the process for assessing 
                                performance against such measures and 
                                activities under subsection (q) of such 
                                section; and
                                    (III) the adequacy of the measures 
                                and activities so selected.
                            (ii) Evaluation by gao and medpac on 
                        implementation of quality update incentive 
                        program.--
                                    (I) GAO.--The Comptroller General 
                                of the United States shall evaluate the 
                                initial phase of the quality update 
                                incentive program under subsection (q) 
                                of section 1848 of the Social Security 
                                Act (42 U.S.C. 1395w-4) and shall 
                                submit to Congress, not later than 
                                2019, a report with recommendations for 
                                improving such quality update incentive 
                                program.
                                    (II) MedPAC.--In the course of its 
                                March Report to Congress on Medicare 
                                payment policy, MedPAC shall analyze 
                                the initial phase of such quality 
                                update incentive program and make 
                                recommendations, as appropriate, for 
                                improving such quality update incentive 
                                program.
                            (iii) MedPAC report on payment system 
                        alternatives.--
                                    (I) In general.--Not later than 
                                June 15, 2016, the Medicare Payment 
                                Advisory Commission shall submit to 
                                Congress a report that analyzes 
                                multiple options for alternative 
                                payment models in lieu of section 1848 
                                of the Social Security Act (42 U.S.C. 
                                1395w-4). In analyzing such models, the 
                                Medicare Payment Advisory Commission 
                                shall examine at least the following 
                                models:
                                            (aa) Accountable care 
                                        organization payment models.
                                            (bb) Primary care medical 
                                        home payment models.
                                            (cc) Bundled or episodic 
                                        payments for certain conditions 
                                        and services.
                                            (dd) Gainsharing 
                                        arrangements
                                    (II) Items to be included.--Such 
                                report shall include information on how 
                                each recommended new payment model will 
                                achieve maximum flexibility to reward 
                                high-quality, efficient care.
                    (C) Tracking expenditure growth and access.--
                Beginning in 2015, the Chief Actuary of the Centers for 
                Medicare & Medicaid Services shall track expenditure 
                growth and beneficiary access to physicians' services 
                under section 1848 of the Social Security Act (42 
                U.S.C. 1395w-4) and shall post on the public Internet 
                website of the Centers for Medicare & Medicaid Services 
                annual reports on such topics.
    (b) Relative Values Under the Medicare Physician Fee Schedule.--
            (1) Eligible physicians reporting system to improve 
        accuracy of relative values.--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) Physician reporting system to improve accuracy of 
        relative values.--
                    ``(A) In general.--The Secretary shall implement a 
                system for the periodic reporting by physicians of data 
                on the accuracy of relative values under this 
                subsection, such as data relating to service volume and 
                time. Such data shall be submitted in a form and manner 
                specified by the Secretary and shall, as appropriate, 
                incorporate data from existing sources of data, patient 
                scheduling systems, cost accounting systems, and other 
                similar systems.
                    ``(B) Identification of reporting cohort.--Not 
                later than January 1, 2015, the Secretary shall 
                establish a mechanism for physicians to participate 
                under the reporting system under this paragraph, all of 
                whom shall collectively be referred to under this 
                paragraph as the `reporting group'. The reporting group 
                shall include physicians across settings that 
                collectively represent a range of specialties and 
                practitioner types, furnish a range of physicians' 
                services, and serve a range of patient populations.
                    ``(C) Incentive to report.--Under the system under 
                this paragraph, the Secretary may provide for such 
                payments under this part to physicians included in the 
                reporting group as the Secretary determines appropriate 
                to compensate such physicians for reporting data under 
                the system. Such payments shall be provided in such 
                form and manner as specified by the Secretary. In 
                carrying out this subparagraph, reporting by such a 
                physician under this paragraph shall not be treated as 
                the furnishing of physicians' services for purposes of 
                applying this section.
                    ``(D) Funding.--To carry out this paragraph (other 
                than with respect to payments made under subparagraph 
                (C)), in addition to funds otherwise appropriated, the 
                Secretary shall provide for the transfer from the 
                Federal Supplementary Medical Insurance Trust Fund 
                under section 1841 of $1,000,000 to the Centers for 
                Medicare & Medicaid Services Program Management Account 
                for each fiscal year beginning with fiscal year 2014. 
                Amounts transferred under this subparagraph for a 
                fiscal year shall be available until expended.''.
            (2) Relative value adjustments for misvalued physicians' 
        services.--
                    (A) In general.--Section 1848(c)(2) of the Social 
                Security Act (42 U.S.C. 1395w-4(c)(2)) is amended by 
                adding at the end the following new subparagraph:
                    ``(M) Adjustments for misvalued physicians' 
                services.--With respect to fee schedules established 
                for 2016, 2017, and 2018, the Secretary shall--
                            ``(i) identify, based on the data reported 
                        under paragraph (8) and other relevant data, 
                        misvalued services for which adjustments to the 
                        relative values established under this 
                        paragraph would result in a net reduction in 
                        expenditures under the fee schedule under this 
                        section, with respect to such year, of not more 
                        than 1 percent of the projected amount of 
                        expenditures under such fee schedule for such 
                        year; and
                            ``(ii) make such adjustments for each such 
                        year so as to result in such a net reduction 
                        for such year.''.
                    (B) Budget neutrality.--Section 1848(c)(2)(B)(v) of 
                the Social Security Act (42 U.S.C. 1395w-4(c)(2)(B)(v)) 
                is amended by adding at the end the following new 
                subclause:
                                    ``(VIII) Reductions for misvalued 
                                physicians' services.--Reduced 
                                expenditures attributable to 
                                subparagraph (M).''.
    (c) Rule of Construction Regarding Health Care Provider Standards 
of Care.--
            (1) In general.--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) The term ``Federal health care provision'' 
                means any provision of the Patient Protection and 
                Affordable Care Act (Public Law 111-148), title I and 
                subtitle B of title III of the Health Care and 
                Education Reconciliation Act of 2010 (Public Law 111-
                152), and titles XVIII and XIX of the Social Security 
                Act.
                    (B) The term ``health care provider'' means any 
                individual or entity--
                            (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) The term ``medical malpractice or medical 
                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 or section 351 of the 
                Public Health Service Act).
                    (D) The term ``State'' includes the District of 
                Columbia, Puerto Rico, and any other commonwealth, 
                possession, or territory of the United States.
            (3) No preemption.--No provision of the Patient Protection 
        and Affordable Care Act (Public Law 111-148), title I or 
        subtitle B of title III of the Health Care and Education 
        Reconciliation Act of 2010 (Public Law 111-152), or title XVIII 
        or XIX of the Social Security Act shall be construed to preempt 
        any State or common law governing medical professional or 
        medical product liability actions or claims.
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